Procedure Code Type Code NDC Procedure Description IP/OP Charge Cash Discount (74%) Payor Rate Min Payor Rate Max GHS AETNA HMO [12] GHS AETNA PPO [12] GHS COVENTRY HMO [12] GHS COVENTRY PPO [12] GHS MEDICARE ADVANTAGE AETNA[60] GHS MEDICARE ADVANTAGE COVENTRY [60] GHS AMBETTER [56] GHS AMERIGROUP [20] GHS MEDICARE ADVANTAGE BCBS [52] GHS BLUE CROSS HMO [39] GHS BLUE CROSS POS [39] GHS BLUE CROSS PPO [37] GHS ANTHEM MARKETPLACE [67] GHS CARESOURCE CMO [62] GHS MARKETPLACE CARESOURCE [48] GHS CIGNA CONNECT [105] GHS CIGNA [15] GHS CIGNA HEALTHSPRING [54] GHS MEDICARE ADVANTAGE CIGNA [65] CLEAR SPRING HEALTH (FORMERLY EON) [35] GHS MEDICARE ADVANTAGE CLOVER HEALTH [74] FIRST HEALTH [% OF CHG] GHS MEDICARE ADVANTAGE HUMANA [63] GHS MEDICARE ADVANTAGE HUMANA GOLD DUAL [42] GHS MEDICARE ADVANTAGE HUMANA GOLD PLUS [66] GHS HUMANA HMO [21] GHS MARKETPLACE - HUMANA HUMX [51] GHS KAISER [13] GHS MEDICARE ADVANTAGE KAISER [59] MULTIPLAN [61] GHS OSCAR HEALTH [102] GHS PEACHSTATE [30] GHS MEDICARE ADVANTAGE ALLWELL [35] PHCS [% OF CHG] GHS SONDER HEALTH [73] GHS NAPHCARE [43] GHS VETERANS CCN [101] GHS WELLCARE [19] GHS MEDICARE ADVANTAGE - WELLCARE [72] PB GRADY CIGNA PHYSICIAN AGREEMENT CONTRACT [96] PB SONDER HOSPITAL AGREEMENT REIMBURSEMENT CONTRACT [100] MS003 DRG MS-DRG V39 (FY2022) 003 "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES" INPATIENT ONLY "$1,158,110.50" "$857,002.00" "$171,934.68" "$957,489.37" "$570,676.43" "$570,676.43" "$570,676.43" "$570,676.43" "$171,934.68" "$171,934.68" "$570,676.43" "$207,283.45" "$171,934.68" "$957,489.37" "$957,489.37" "$957,489.37" "$957,489.37" "$207,283.45" "$570,676.43" "$570,676.43" "$570,676.43" "$171,934.68" "$171,934.68" "$171,934.68" "$171,934.68" "$868,582.88" "$171,934.68" "$171,934.68" "$171,934.68" "$570,676.43" "$570,676.43" "$570,676.43" "$171,934.68" "$279,448.19" "$570,676.43" "$207,283.45" "$171,934.68" "$671,704.09" "$171,934.68" "$570,676.43" "$570,676.43" "$207,283.45" "$171,934.68" N/A N/A MS004 DRG MS-DRG V39 (FY2022) 004 "TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES" INPATIENT ONLY "$870,206.50" "$643,953.00" "$115,321.14" "$1,936,635.43" "$222,209.11" "$222,209.11" "$222,209.11" "$222,209.11" "$115,321.14" "$115,321.14" "$222,209.11" N/A "$115,321.14" "$1,936,635.43" "$1,936,635.43" "$1,936,635.43" "$1,936,635.43" N/A "$222,209.11" "$222,209.11" "$222,209.11" "$115,321.14" "$115,321.14" "$115,321.14" "$115,321.14" "$652,654.88" "$115,321.14" "$115,321.14" "$115,321.14" "$222,209.11" "$222,209.11" "$222,209.11" "$115,321.14" N/A "$222,209.11" N/A "$115,321.14" "$504,719.77" "$115,321.14" "$222,209.11" "$222,209.11" N/A "$115,321.14" N/A N/A MS011 DRG MS-DRG V39 (FY2022) 011 "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC" INPATIENT ONLY "$641,076.50" "$474,397.00" "$64,111.92" "$512,861.19" N/A N/A N/A N/A N/A N/A N/A N/A N/A "$394,257.10" "$394,257.10" N/A "$282,062.34" N/A N/A N/A N/A "$64,111.92" N/A N/A N/A "$480,807.38" N/A N/A N/A N/A N/A "$507,732.61" "$64,111.92" "$512,861.19" N/A N/A "$64,111.92" "$371,824.37" "$67,317.52" N/A N/A N/A N/A N/A N/A MS012 DRG MS-DRG V39 (FY2022) 012 "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC" INPATIENT ONLY "$201,061.00" "$148,785.50" "$32,832.33" "$160,848.47" "$129,012.99" "$129,012.99" "$129,012.99" "$129,012.99" "$37,505.53" "$37,505.53" "$32,832.33" "$39,825.41" "$37,505.53" "$73,717.45" "$73,717.45" "$77,544.31" "$48,401.20" "$39,825.41" "$60,008.85" "$96,086.04" "$130,689.38" "$37,505.53" "$39,587.16" "$93,295.24" "$39,380.81" "$150,795.75" "$37,505.53" "$33,829.99" "$37,505.53" "$130,689.38" "$130,689.38" "$159,239.99" "$37,505.53" "$160,848.47" "$116,615.14" "$37,928.94" "$37,505.53" "$116,615.38" "$39,380.81" "$38,421.15" "$44,150.68" "$39,825.41" "$37,505.53" N/A N/A MS013 DRG MS-DRG V39 (FY2022) 013 "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC" INPATIENT ONLY "$237,876.50" "$176,029.00" "$29,851.77" "$178,407.38" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$178,407.38" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$29,851.77" "$137,968.37" N/A N/A N/A N/A N/A N/A N/A MS020 DRG MS-DRG V39 (FY2022) 020 INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC INPATIENT ONLY "$615,828.00" "$455,713.00" "$78,114.05" "$523,949.43" "$523,949.43" "$523,949.43" "$523,949.43" "$523,949.43" "$78,114.05" "$78,114.05" "$523,949.43" "$95,593.83" "$78,114.05" "$518,820.96" "$518,820.96" "$518,820.96" "$518,820.96" "$95,593.83" "$523,949.43" "$523,949.43" "$523,949.43" "$78,114.05" "$78,114.05" "$78,114.05" "$78,114.05" "$461,871.00" "$78,114.05" "$78,114.05" "$78,114.05" "$523,949.43" "$523,949.43" "$487,735.59" "$78,114.05" "$492,662.22" "$523,949.43" "$95,593.83" "$78,114.05" "$357,180.24" "$78,114.05" "$523,949.43" "$523,949.43" "$95,593.83" "$78,114.05" N/A N/A MS021 DRG MS-DRG V39 (FY2022) 021 INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC INPATIENT ONLY "$314,082.50" "$232,421.50" "$58,676.13" "$263,722.49" "$263,722.49" "$263,722.49" "$263,722.49" "$263,722.49" "$60,156.31" "$60,156.31" "$263,722.49" "$58,676.13" "$60,156.31" "$153,312.37" "$153,312.37" "$161,271.21" "$106,422.85" N/A "$263,722.49" "$263,722.49" "$204,153.63" "$63,114.92" "$60,156.31" "$60,156.31" "$66,270.67" "$235,561.88" "$60,156.31" "$60,156.31" "$60,156.31" "$204,153.63" "$263,722.49" "$248,753.37" "$63,114.92" "$251,266.01" "$263,722.49" N/A "$63,114.92" "$182,167.85" "$66,270.67" "$263,722.49" "$76,193.54" N/A "$60,156.31" N/A N/A MS022 DRG MS-DRG V39 (FY2022) 022 INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC INPATIENT ONLY "$315,865.50" "$233,740.50" "$38,357.83" "$252,692.25" "$197,509.64" "$197,509.64" "$197,509.64" "$197,509.64" "$44,476.05" "$44,476.05" "$62,387.57" "$40,275.74" "$44,476.05" "$162,871.54" "$162,871.54" "$171,208.29" "$115,077.52" "$40,275.74" N/A "$154,062.66" "$205,312.46" "$44,476.05" "$42,794.28" "$44,476.05" "$46,699.85" "$236,899.13" "$44,476.05" "$40,117.40" "$44,476.05" "$205,312.46" "$205,312.46" "$250,165.32" "$44,476.05" "$252,692.25" N/A "$38,357.83" "$44,476.05" "$183,201.99" "$46,699.85" "$48,545.70" "$52,872.30" "$40,275.74" "$44,476.05" N/A N/A MS023 DRG MS-DRG V39 (FY2022) 023 CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR INPATIENT ONLY "$274,892.50" "$203,420.50" "$45,278.64" "$219,913.66" "$176,480.71" "$176,480.71" "$176,480.71" "$176,480.71" "$50,198.05" "$50,198.05" "$55,941.24" "$55,493.50" "$50,198.05" "$125,544.67" "$125,544.67" "$132,062.01" "$86,181.26" "$55,493.50" "$188,057.47" "$140,999.65" "$178,679.85" "$50,198.05" "$52,600.65" "$52,600.65" "$52,707.95" "$206,169.38" "$50,198.05" "$45,278.64" "$50,198.05" "$178,679.85" "$178,679.85" "$217,714.52" "$50,198.05" "$219,913.66" "$159,346.87" "$52,850.93" "$50,198.05" "$159,437.65" "$52,707.95" "$56,856.85" "$60,031.77" "$55,493.50" "$50,198.05" N/A N/A MS024 DRG MS-DRG V39 (FY2022) 024 CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC INPATIENT ONLY "$169,338.50" "$125,310.50" "$28,965.48" "$136,636.93" "$108,715.05" "$108,715.05" "$108,715.05" "$108,715.05" "$38,238.47" "$38,238.47" "$33,436.68" "$30,413.76" "$38,238.47" "$49,917.50" "$49,917.50" "$52,508.85" "$31,051.95" "$30,413.76" "$61,181.55" "$78,775.71" "$110,069.74" "$38,238.47" "$39,867.88" "$38,238.47" "$40,150.39" "$127,003.88" "$38,238.47" "$34,491.10" "$38,238.47" "$110,069.74" "$110,069.74" "$134,115.75" "$38,238.47" "$135,470.45" "$98,216.07" "$28,965.48" "$38,238.47" "$98,216.33" "$40,150.39" "$39,485.73" "$45,067.75" "$30,413.76" "$38,238.47" N/A N/A MS025 DRG MS-DRG V39 (FY2022) 025 CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC INPATIENT ONLY "$334,724.00" "$247,696.00" "$38,865.71" "$267,779.00" "$238,601.36" "$238,601.36" "$238,601.36" "$238,601.36" "$46,615.44" "$46,615.44" "$238,601.36" "$38,865.71" "$46,615.44" "$166,723.74" "$166,723.74" "$175,357.47" "$116,156.25" "$38,865.71" "$238,601.36" "$238,601.36" "$238,601.36" "$42,092.27" "$46,615.44" "$46,615.44" "$44,196.88" "$251,043.00" "$46,615.44" "$46,615.44" "$46,615.44" "$238,601.36" "$238,601.36" "$265,101.21" "$46,615.44" "$267,779.00" "$238,601.36" "$38,865.71" "$44,453.35" "$194,139.92" "$46,615.44" "$238,601.36" "$238,601.36" "$38,865.71" "$46,615.44" N/A N/A MS026 DRG MS-DRG V39 (FY2022) 026 CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC INPATIENT ONLY "$249,179.00" "$184,392.50" "$26,787.01" "$199,343.16" "$157,166.50" "$157,166.50" "$157,166.50" "$157,166.50" "$32,185.85" "$32,185.85" "$42,466.89" "$32,285.12" "$32,185.85" "$106,245.21" "$106,245.21" "$111,657.15" "$71,903.96" "$32,285.12" "$51,497.36" "$122,855.55" "$161,966.32" "$32,185.85" "$33,258.63" "$32,185.85" "$33,795.14" "$186,884.25" "$32,185.85" "$29,031.64" "$32,185.85" "$161,966.32" "$161,966.32" "$197,349.73" "$32,185.85" "$199,343.16" "$144,523.79" "$30,747.72" "$32,185.85" "$144,523.82" "$33,795.14" "$30,694.42" "$37,494.63" "$32,285.12" "$32,185.85" N/A N/A MS027 DRG MS-DRG V39 (FY2022) 027 CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$234,871.00" "$173,805.00" "$23,958.44" "$187,896.78" "$147,094.32" "$147,094.32" "$147,094.32" "$147,094.32" "$28,405.90" "$28,405.90" "$36,848.48" "$31,186.08" "$28,405.90" "$95,815.58" "$95,815.58" "$100,640.34" "$64,208.90" "$31,186.08" "$45,449.44" "$102,862.92" "$152,666.14" "$28,405.90" "$29,486.51" "$28,405.90" "$29,826.20" "$176,153.25" "$28,405.90" "$25,622.12" "$28,405.90" "$152,666.14" "$152,666.14" "$186,017.81" "$28,405.90" "$187,896.78" "$136,225.17" "$23,958.44" "$28,405.90" "$136,225.18" "$29,826.20" "$25,204.10" "$32,765.10" "$31,186.08" "$28,405.90" N/A N/A MS028 DRG MS-DRG V39 (FY2022) 028 SPINAL PROCEDURES WITH MCC INPATIENT ONLY "$490,380.00" "$362,881.50" "$53,644.21" "$382,066.62" "$361,394.07" "$361,394.07" "$361,394.07" "$361,394.07" "$53,644.21" "$53,644.21" "$361,394.07" N/A "$53,644.21" N/A N/A N/A N/A N/A "$361,394.07" "$361,394.07" "$361,394.07" "$53,644.21" "$53,644.21" "$53,644.21" "$53,644.21" "$367,785.00" "$53,644.21" "$53,644.21" "$53,644.21" "$361,394.07" "$361,394.07" "$361,394.07" "$53,644.21" "$382,066.62" "$361,394.07" N/A "$53,644.21" "$284,420.40" "$53,644.21" "$361,394.07" "$361,394.07" N/A "$53,644.21" N/A N/A MS029 DRG MS-DRG V39 (FY2022) 029 SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS INPATIENT ONLY "$355,919.50" "$263,380.50" "$33,806.33" "$320,932.09" "$320,932.09" "$320,932.09" "$320,932.09" "$320,932.09" "$36,073.61" "$36,073.61" "$320,932.09" "$59,034.60" "$36,073.61" "$191,156.79" "$191,156.79" "$200,825.99" "$135,422.37" "$59,034.60" "$320,932.09" "$320,932.09" "$231,347.62" "$33,806.33" "$36,073.61" "$36,073.61" "$35,496.65" "$266,939.63" "$36,073.61" "$36,073.61" "$36,073.61" "$320,932.09" "$320,932.09" "$281,888.20" "$33,806.33" "$284,735.54" "$320,932.09" "$59,034.60" "$33,806.33" "$206,433.31" "$35,496.65" "$320,932.09" "$39,522.20" "$59,034.60" "$33,806.33" N/A N/A MS030 DRG MS-DRG V39 (FY2022) 030 SPINAL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$310,830.50" "$230,015.00" "$27,318.91" "$248,664.40" "$197,685.39" "$197,685.39" "$197,685.39" "$197,685.39" "$28,385.09" "$28,385.09" N/A "$44,430.41" "$27,318.91" "$150,334.09" "$150,334.09" "$158,096.52" "$104,167.52" "$44,430.41" N/A "$152,095.66" "$202,039.83" "$27,318.91" "$28,385.09" "$28,385.09" "$28,684.86" "$233,122.88" "$27,318.91" "$28,385.09" "$28,385.09" "$202,039.83" "$202,039.83" "$246,177.77" "$27,318.91" "$248,664.40" "$180,281.69" "$32,898.94" "$27,318.91" "$180,281.69" "$28,684.86" N/A "$31,405.04" "$44,430.41" "$27,318.91" N/A N/A MS031 DRG MS-DRG V39 (FY2022) 031 VENTRICULAR SHUNT PROCEDURES WITH MCC INPATIENT ONLY "$214,639.50" "$158,833.50" "$22,721.32" "$171,711.40" "$135,387.45" "$135,387.45" "$135,387.45" "$135,387.45" "$41,224.75" "$41,224.75" "$65,756.59" "$23,857.40" "$41,224.75" "$80,959.28" "$80,959.28" "$85,078.75" "$53,512.19" "$23,857.40" "$65,959.60" "$104,470.56" "$139,515.52" "$41,224.75" "$41,097.87" "$41,224.75" "$43,285.99" "$160,979.63" "$41,224.75" "$37,184.72" "$41,224.75" "$139,515.52" "$139,515.52" "$169,994.28" "$41,224.75" "$171,711.40" "$124,490.77" "$22,721.32" "$46,715.02" "$124,490.91" "$43,285.99" "$43,823.24" "$48,804.23" "$23,857.40" "$41,224.75" N/A N/A MS032 DRG MS-DRG V39 (FY2022) 032 VENTRICULAR SHUNT PROCEDURES WITH CC INPATIENT ONLY "$108,613.00" "$80,374.00" "$2,365.26" "$86,890.38" "$6,653.63" "$6,653.63" "$6,653.63" "$6,653.63" "$26,350.65" "$26,350.65" "$18,141.55" "$15,280.20" "$26,350.65" "$3,481.97" "$3,481.97" "$3,645.08" "$2,978.91" "$15,280.20" "$42,161.04" "$27,651.52" "$70,598.44" "$26,350.65" "$26,337.24" N/A "$27,668.18" "$81,459.75" "$26,350.65" "$23,768.29" "$26,350.65" "$70,598.44" "$70,598.44" "$86,021.47" "$26,350.65" "$86,890.38" "$2,365.26" "$14,552.57" "$26,350.65" "$62,995.54" "$27,668.18" "$22,218.87" "$30,193.53" "$15,280.20" "$26,350.65" N/A N/A MS033 DRG MS-DRG V39 (FY2022) 033 VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$128,940.00" "$95,416.00" "$8,034.00" "$103,151.77" "$17,114.93" "$17,114.93" "$17,114.93" "$17,114.93" "$22,939.23" "$22,939.23" "$13,925.92" "$12,572.51" "$22,939.23" "$18,571.66" "$18,571.66" "$19,452.42" "$8,034.00" "$12,572.51" "$36,702.77" "$22,860.11" "$83,810.82" "$22,939.23" "$23,794.41" "$22,939.23" "$24,086.19" "$96,705.00" "$22,939.23" "$20,691.19" "$22,939.23" "$83,810.82" "$83,810.82" "$102,120.26" "$22,939.23" "$103,151.77" "$15,775.27" "$11,973.81" "$22,939.23" "$74,785.20" "$24,086.19" "$17,263.85" "$25,925.11" "$12,572.51" "$22,939.23" N/A N/A MS034 DRG MS-DRG V39 (FY2022) 034 CAROTID ARTERY STENT PROCEDURES WITH MCC INPATIENT ONLY "$291,023.50" "$215,357.50" "$34,734.50" "$232,818.44" "$185,097.10" "$185,097.10" "$185,097.10" "$185,097.10" "$38,508.31" "$38,508.31" "$54,168.25" "$54,268.51" "$38,508.31" "$135,651.51" "$135,651.51" "$142,660.70" "$93,482.59" "$54,268.51" "$61,613.30" "$141,513.65" "$189,164.98" "$38,508.31" "$40,229.31" "$38,508.31" "$40,433.73" "$218,267.63" "$38,508.31" "$34,734.50" "$38,508.31" "$189,164.98" "$189,164.98" "$230,490.27" "$38,508.31" "$232,818.44" "$168,793.37" "$42,380.01" "$38,508.31" "$168,793.63" "$40,433.73" "$39,877.69" "$45,405.38" "$54,268.51" "$38,508.31" N/A N/A MS035 DRG MS-DRG V39 (FY2022) 035 CAROTID ARTERY STENT PROCEDURES WITH CC INPATIENT ONLY "$212,932.50" "$157,570.50" "$18,232.38" "$170,345.96" "$135,026.34" "$135,026.34" "$135,026.34" "$135,026.34" "$27,200.91" "$27,200.91" "$31,709.84" "$19,144.01" "$27,200.91" "$79,003.08" "$79,003.08" "$83,067.89" "$52,180.73" "$19,144.01" "$43,521.46" "$97,506.78" "$138,406.09" "$27,200.91" "$27,975.10" "$27,200.91" "$28,560.96" "$159,699.38" "$27,200.91" "$24,535.22" "$27,200.91" "$138,406.09" "$138,406.09" "$168,642.49" "$27,200.91" "$170,345.96" "$123,500.82" "$18,232.38" "$27,200.91" "$123,500.85" "$28,560.96" "$23,453.86" "$31,257.39" "$19,144.01" "$27,200.91" N/A N/A MS036 DRG MS-DRG V39 (FY2022) 036 CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$49,900.00" "$36,926.00" "$3,150.00" "$39,919.88" "$8,946.83" "$8,946.83" "$8,946.83" "$8,946.83" "$23,837.10" "$23,837.10" "$15,453.12" "$10,825.09" "$23,837.10" "$6,155.56" "$6,155.56" "$6,392.54" "$4,320.97" "$10,825.09" "$38,139.36" "$25,312.34" "$27,784.50" "$23,837.10" "$25,095.82" N/A "$25,028.96" "$37,425.00" "$23,837.10" "$21,501.06" "$23,837.10" "$27,784.50" "$24,096.95" "$39,520.68" "$23,837.10" "$39,919.88" "$3,150.00" "$10,309.61" "$23,837.10" "$28,942.00" "$25,028.96" "$18,568.02" "$27,048.54" "$10,825.09" "$23,837.10" N/A N/A MS037 DRG MS-DRG V39 (FY2022) 037 EXTRACRANIAL PROCEDURES WITH MCC INPATIENT ONLY "$307,127.50" "$227,274.50" "$30,373.79" "$245,701.97" "$196,748.88" "$196,748.88" "$196,748.88" "$196,748.88" "$35,755.04" "$35,755.04" N/A N/A "$35,755.04" "$149,989.53" "$149,989.53" "$157,775.87" "$104,000.63" N/A N/A N/A N/A "$33,673.82" "$35,755.04" "$35,755.04" "$35,357.51" "$230,345.63" "$35,755.04" "$30,373.79" "$33,673.82" "$199,632.85" N/A "$243,244.94" "$33,673.82" "$245,701.97" N/A N/A "$33,673.82" "$178,133.95" "$35,357.51" N/A "$39,356.39" N/A "$35,755.04" N/A N/A MS038 DRG MS-DRG V39 (FY2022) 038 EXTRACRANIAL PROCEDURES WITH CC INPATIENT ONLY "$246,585.50" "$182,473.50" "$20,296.51" "$197,268.20" "$158,077.64" "$158,077.64" "$158,077.64" "$158,077.64" "$22,501.67" "$22,501.67" "$37,117.74" "$40,796.89" "$22,501.67" "$106,423.10" "$106,423.10" "$111,947.80" "$72,242.37" "$40,796.89" "$36,002.67" "$120,652.12" "$160,280.42" "$22,501.67" "$23,344.41" "$22,501.67" "$23,626.75" "$184,939.13" "$22,501.67" "$20,296.51" "$22,501.67" "$160,280.42" "$160,280.42" "$195,295.53" "$22,501.67" "$197,268.20" "$143,019.45" "$31,572.96" "$22,501.67" "$143,019.59" "$23,626.75" "$24,422.94" "$25,377.63" "$40,796.89" "$22,501.67" N/A N/A MS039 DRG MS-DRG V39 (FY2022) 039 EXTRACRANIAL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$267,170.50" "$197,706.50" "$6,843.37" "$213,736.14" "$170,750.55" "$170,750.55" "$170,750.55" "$170,750.55" "$18,914.96" "$18,914.96" "$39,929.20" "$42,002.57" "$18,914.96" "$119,422.61" "$119,422.61" "$125,622.14" "$81,718.51" "$42,002.57" "$30,263.94" "$130,887.67" "$173,660.62" "$18,914.96" "$19,895.87" "$18,914.96" "$19,860.71" "$200,377.88" "$18,914.96" "$17,061.29" "$18,914.96" "$173,660.62" "$173,660.62" "$211,598.80" "$18,914.96" "$213,736.14" "$154,958.71" "$32,385.70" "$18,914.96" "$154,958.89" "$19,860.71" "$28,194.59" "$20,889.89" "$42,002.57" "$18,914.96" N/A N/A MS040 DRG MS-DRG V39 (FY2022) 040 "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC" INPATIENT ONLY "$192,389.50" "$142,368.50" "$28,046.66" "$153,911.57" "$122,982.82" "$122,982.82" "$122,982.82" "$122,982.82" "$38,722.16" "$38,722.16" "$73,595.57" "$28,046.66" "$38,722.16" "$115,904.14" "$115,904.14" "$129,280.91" "$79,755.20" N/A "$73,595.57" "$91,279.13" "$73,595.57" "$42,580.06" "$38,722.16" "$38,722.16" "$44,709.06" "$144,292.13" "$38,722.16" "$38,722.16" "$38,722.16" "$73,595.57" "$73,595.57" "$152,372.46" "$42,580.06" "$153,911.57" "$73,595.57" N/A "$38,722.16" "$111,585.91" "$44,709.06" "$73,595.57" "$50,620.82" N/A "$38,722.16" N/A N/A MS041 DRG MS-DRG V39 (FY2022) 041 "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR" INPATIENT ONLY "$153,391.00" "$113,509.50" "$18,982.35" "$122,712.49" "$85,811.47" "$85,811.47" "$85,811.47" "$85,811.47" "$27,269.91" "$27,269.91" "$18,982.35" "$27,327.64" "$27,269.91" "$46,252.22" "$46,252.22" "$48,553.59" "$30,104.05" "$27,327.64" "$43,631.86" "$76,009.96" "$99,703.89" "$27,269.91" "$28,362.96" "$27,269.91" "$28,633.41" "$115,043.25" "$27,269.91" "$24,597.46" "$27,269.91" "$99,703.89" "$99,703.89" "$121,485.36" "$27,269.91" "$122,712.49" "$104,356.10" "$26,026.31" "$27,269.91" "$88,966.78" "$28,633.41" "$23,554.11" "$31,343.73" "$27,327.64" "$27,269.91" N/A N/A MS042 DRG MS-DRG V39 (FY2022) 042 "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$106,322.50" "$78,679.00" "$1,961.50" "$85,057.79" "$4,386.82" "$4,386.82" "$4,386.82" "$4,386.82" "$24,174.58" "$24,174.58" "$16,589.36" "$13,678.48" "$24,174.58" "$3,822.98" "$3,822.98" "$4,021.44" "$1,961.50" "$13,678.48" "$38,679.33" "$24,895.11" "$69,109.46" "$24,174.58" "$24,874.40" "$24,174.58" "$25,383.31" "$79,741.88" "$24,174.58" "$21,805.47" "$24,174.58" "$29,122.77" "$69,109.46" "$84,207.22" "$24,174.58" "$85,057.79" "$3,500.00" "$13,027.12" "$24,174.58" "$61,667.05" "$25,383.31" "$19,058.20" "$27,470.81" "$13,678.48" "$24,174.58" N/A N/A MS052 DRG MS-DRG V39 (FY2022) 052 SPINAL DISORDERS AND INJURIES WITH CC/MCC INPATIENT ONLY "$132,547.00" "$98,085.00" "$14,114.26" "$106,037.58" "$85,313.53" "$85,313.53" "$85,313.53" "$85,313.53" "$23,845.39" "$23,845.39" "$14,114.26" "$74,152.17" "$24,378.69" "$30,001.02" "$30,001.02" "$31,458.75" "$18,257.55" "$79,343.54" N/A "$23,961.06" "$86,155.53" "$23,845.39" "$24,378.69" "$23,845.39" "$25,037.66" "$99,410.25" "$23,845.39" "$21,508.54" "$23,845.39" "$86,155.53" "$86,155.53" "$104,977.19" "$23,845.39" "$106,037.58" N/A "$70,621.09" "$23,845.39" "$76,877.26" "$25,037.66" N/A "$27,058.91" "$74,152.17" "$23,845.39" N/A N/A MS053 DRG MS-DRG V39 (FY2022) 053 SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC INPATIENT ONLY "$165,252.00" "$122,286.50" "$9,549.07" "$132,201.44" "$93,291.96" "$93,291.96" "$93,291.96" "$93,291.96" "$18,896.33" "$18,896.33" "$16,743.00" "$15,544.88" "$18,896.33" "$54,422.29" "$54,422.29" "$57,147.78" "$36,059.72" "$15,544.88" "$30,234.13" "$78,664.02" "$107,413.66" "$18,896.33" N/A "$18,896.33" "$19,841.15" "$123,939.00" "$18,896.33" "$17,044.49" "$18,896.33" "$107,413.66" "$107,413.66" "$130,879.40" "$18,896.33" "$132,201.44" "$111,235.59" "$9,549.07" "$18,896.33" "$95,846.16" "$19,841.15" "$11,391.62" "$20,866.58" "$15,544.88" "$18,896.33" N/A N/A MS054 DRG MS-DRG V39 (FY2022) 054 NERVOUS SYSTEM NEOPLASMS WITH MCC INPATIENT ONLY "$69,838.50" "$51,680.50" "$11,646.29" "$55,870.59" "$30,698.58" "$30,698.58" "$30,698.58" "$30,698.58" "$20,496.79" "$20,496.79" "$11,646.29" "$16,128.84" "$20,496.79" "$31,518.52" "$31,518.52" "$32,346.11" "$22,126.78" "$16,128.84" "$32,794.86" "$18,667.63" "$20,524.50" "$20,496.79" "$21,569.42" "$20,496.79" "$21,521.63" "$52,378.88" "$20,496.79" "$18,488.10" "$20,496.79" "$36,381.10" "$33,302.42" "$55,311.89" "$20,496.79" "$55,870.59" "$11,646.29" "$15,360.79" "$20,496.79" "$40,506.33" "$21,521.63" "$13,716.25" "$22,869.10" "$16,128.84" "$20,496.79" N/A N/A MS055 DRG MS-DRG V39 (FY2022) 055 NERVOUS SYSTEM NEOPLASMS WITHOUT MCC INPATIENT ONLY "$72,168.00" "$53,404.50" "$3,500.00" "$57,734.37" "$8,582.11" "$8,582.11" "$8,582.11" "$8,582.11" "$18,262.77" "$18,262.77" "$9,096.21" "$12,854.44" "$18,262.77" "$5,717.74" "$5,717.74" "$6,255.35" "$4,013.91" "$12,854.44" "$29,220.43" "$13,570.71" "$15,669.00" "$18,262.77" "$18,864.43" "$18,262.77" "$19,175.91" "$54,126.00" "$18,262.77" "$16,473.02" "$18,262.77" "$16,381.68" "$14,031.33" "$57,157.01" "$18,262.77" "$57,734.37" "$3,500.00" "$12,242.32" "$18,262.77" "$41,857.44" "$19,175.91" "$10,471.39" "$20,073.85" "$12,854.44" "$18,262.77" N/A N/A MS056 DRG MS-DRG V39 (FY2022) 056 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC INPATIENT ONLY "$97,205.50" "$71,932.50" "$13,770.00" "$77,764.23" "$71,128.82" "$71,128.82" "$71,128.82" "$71,128.82" "$28,961.33" "$28,961.33" "$13,770.00" "$27,637.01" "$28,961.33" "$50,300.28" "$50,300.28" "$60,271.38" "$35,307.00" "$27,637.01" "$46,338.13" "$30,024.34" "$32,929.50" "$28,961.33" "$30,511.70" "$28,961.33" "$30,409.40" "$72,904.13" "$28,961.33" "$26,123.12" "$28,961.33" "$34,240.73" "$29,301.30" "$76,986.59" "$28,961.33" "$77,764.23" "$63,000.00" "$26,320.95" "$26,204.32" "$56,379.19" "$30,409.40" "$22,006.36" "$33,528.68" "$27,637.01" "$28,961.33" N/A N/A MS057 DRG MS-DRG V39 (FY2022) 057 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC INPATIENT ONLY "$54,170.00" "$40,086.00" "$2,295.00" "$43,335.98" "$12,920.07" "$12,920.07" "$12,920.07" "$12,920.07" "$19,801.12" "$19,801.12" "$2,295.00" "$15,112.75" "$19,801.12" "$8,769.84" "$8,769.84" "$8,720.82" "$6,157.23" "$15,112.75" "$31,681.79" "$17,516.89" "$19,012.50" "$19,801.12" "$20,958.70" "$20,958.70" "$20,791.18" "$40,627.50" "$19,801.12" "$17,860.61" "$19,801.12" "$19,744.69" "$16,892.82" "$42,902.61" "$19,801.12" "$43,335.98" "$3,825.00" "$14,393.09" "$19,801.12" "$31,418.60" "$20,791.18" "$12,705.80" "$21,998.66" "$15,112.75" "$19,801.12" N/A N/A MS058 DRG MS-DRG V39 (FY2022) 058 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC INPATIENT ONLY "$78,503.00" "$58,092.50" "$5,884.50" "$62,802.36" "$12,028.35" "$12,028.35" "$12,028.35" "$12,028.35" "$23,046.89" "$23,046.89" "$14,581.07" "$12,396.54" "$23,046.89" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$12,396.54" "$36,875.02" "$23,220.81" "$30,327.00" "$23,046.89" "$23,985.83" "$23,046.89" "$24,199.23" "$58,877.25" "$23,046.89" "$20,788.29" "$23,046.89" "$26,067.00" "$22,156.95" "$62,174.34" "$23,046.89" "$62,802.36" "$10,500.00" "$11,806.22" "$23,046.89" "$45,531.74" "$24,199.23" "$17,420.23" "$26,059.82" "$12,396.54" "$23,046.89" N/A N/A MS059 DRG MS-DRG V39 (FY2022) 059 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC INPATIENT ONLY "$150,895.50" "$111,663.00" "$11,780.09" "$120,716.39" "$92,540.54" "$92,540.54" "$92,540.54" "$92,540.54" "$19,830.13" "$19,830.13" N/A "$16,934.69" "$18,833.52" "$44,309.64" "$44,309.64" "$46,510.16" "$28,687.98" "$16,934.69" N/A "$71,595.83" "$98,082.07" "$18,833.52" "$19,830.13" "$19,830.13" "$19,775.20" "$113,171.63" "$19,830.13" "$16,987.84" "$19,830.13" "$98,082.07" "$98,082.07" "$119,509.21" "$18,833.52" "$120,716.39" N/A "$11,780.09" "$18,833.52" "$87,519.39" "$19,775.20" N/A "$20,787.99" "$16,934.69" "$18,833.52" N/A N/A MS060 DRG MS-DRG V39 (FY2022) 060 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC INPATIENT ONLY "$39,774.50" "$29,433.50" "$1,961.50" "$31,819.22" "$3,892.00" "$3,892.00" "$3,892.00" "$3,892.00" "$17,386.96" "$17,386.96" "$7,021.87" "$8,036.98" "$17,386.96" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$8,036.98" "$27,819.14" "$12,197.89" "$18,025.50" "$17,386.96" "$18,135.87" N/A "$18,256.31" "$29,830.88" "$17,386.96" "$15,683.04" "$17,386.96" "$13,765.50" "$11,700.68" "$31,501.02" "$17,386.96" "$31,819.22" "$3,500.00" "$7,654.27" "$17,386.96" "$23,069.21" "$18,256.31" "$9,199.31" "$18,978.03" "$8,036.98" "$17,386.96" N/A N/A MS061 DRG MS-DRG V39 (FY2022) 061 "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC" INPATIENT ONLY "$172,441.50" "$127,607.00" "$20,858.89" "$137,952.82" "$106,590.48" "$106,590.48" "$106,590.48" "$106,590.48" "$31,007.07" "$31,007.07" "$24,609.13" "$21,901.84" "$31,007.07" "$50,953.91" "$50,953.91" "$53,417.00" "$31,440.36" "$21,901.84" "$49,611.31" "$79,322.44" "$112,086.66" "$31,007.07" "$32,609.35" "$31,007.07" "$32,557.42" "$129,331.13" "$32,609.35" "$27,968.38" "$31,007.07" "$112,086.66" "$112,086.66" "$136,573.27" "$31,007.07" "$137,952.82" "$100,015.79" "$20,858.89" "$31,007.07" "$100,016.07" "$32,557.42" "$28,982.27" "$36,019.71" "$21,901.84" "$31,007.07" N/A N/A MS062 DRG MS-DRG V39 (FY2022) 062 "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC" INPATIENT ONLY "$96,420.50" "$71,351.50" "$15,233.75" "$77,136.36" "$21,304.46" "$21,304.46" "$21,304.46" "$21,304.46" "$24,775.73" "$24,775.73" "$16,561.69" "$15,995.44" "$24,775.73" "$21,737.17" "$21,737.17" "$23,338.52" "$15,259.51" "$15,995.44" "$39,641.17" "$25,803.59" "$29,824.50" "$24,775.73" "$25,356.54" "$24,775.73" "$26,014.52" "$72,315.38" "$24,775.73" "$22,347.71" "$24,775.73" "$41,329.84" "$36,856.17" "$76,364.98" "$24,775.73" "$77,136.36" "$55,923.86" "$15,233.75" "$24,775.73" "$55,923.89" "$26,014.52" "$19,931.33" "$28,222.97" "$15,995.44" "$24,775.73" N/A N/A MS063 DRG MS-DRG V39 (FY2022) 063 "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC" INPATIENT ONLY "$97,142.00" "$71,885.50" "$8,339.09" "$77,713.35" "$10,992.65" "$10,992.65" "$10,992.65" "$10,992.65" "$22,852.96" "$22,852.96" "$13,476.07" "$14,092.87" "$22,852.96" "$11,878.50" "$11,878.50" "$12,207.36" "$8,339.09" "$14,092.87" "$36,564.74" "$21,278.68" "$29,905.50" "$22,852.96" "$22,955.13" "$22,852.96" "$23,995.61" "$72,856.50" "$22,852.96" "$20,613.37" "$22,852.96" "$34,061.29" "$30,214.47" "$76,936.23" "$22,852.96" "$77,713.35" "$56,342.18" "$13,421.77" "$22,852.96" "$56,342.36" "$23,995.61" "$17,138.55" "$25,817.17" "$14,092.87" "$22,852.96" N/A N/A MS064 DRG MS-DRG V39 (FY2022) 064 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC INPATIENT ONLY "$134,420.50" "$99,471.50" "$15,513.81" "$107,536.04" "$66,387.28" "$66,387.28" "$66,387.28" "$66,387.28" "$25,747.96" "$25,747.96" "$15,513.81" "$25,409.92" "$26,706.64" "$30,097.65" "$30,097.65" "$31,536.43" "$18,279.68" "$25,409.92" "$29,428.85" "$26,541.15" "$29,428.85" "$26,706.64" "$28,324.94" "$25,747.96" "$28,041.97" "$100,815.38" "$25,747.96" "$24,089.39" "$26,706.64" "$87,373.04" "$29,428.85" "$106,460.67" "$26,706.64" "$107,536.04" "$60,726.35" "$24,199.92" "$24,296.75" "$77,963.89" "$28,041.97" "$19,235.63" "$30,698.93" "$25,409.92" "$26,706.64" N/A N/A MS065 DRG MS-DRG V39 (FY2022) 065 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS INPATIENT ONLY "$81,151.50" "$60,052.50" "$7,000.00" "$64,921.18" "$20,357.40" "$20,357.40" "$20,357.40" "$20,357.40" "$18,093.01" "$18,093.01" "$9,499.65" "$25,409.92" "$18,093.01" "$14,358.76" "$14,358.76" "$15,417.64" "$10,080.23" "$25,409.92" "$28,948.82" "$13,679.73" "$15,300.00" "$18,093.01" "$18,922.29" "$18,093.01" "$18,997.66" "$60,863.63" "$18,093.01" "$16,319.90" "$18,093.01" "$15,300.00" "$13,005.00" "$64,271.97" "$18,093.01" "$64,921.18" "$7,000.00" "$24,199.92" "$18,093.01" "$47,067.87" "$18,997.66" "$10,224.78" "$19,861.45" "$25,409.92" "$18,093.01" N/A N/A MS066 DRG MS-DRG V39 (FY2022) 066 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC INPATIENT ONLY "$63,992.00" "$47,354.50" "$6,721.07" "$51,193.37" "$17,969.22" "$17,969.22" "$17,969.22" "$17,969.22" "$15,964.58" "$15,964.58" "$6,721.07" "$7,759.78" "$15,964.58" "$12,280.11" "$12,280.11" "$12,366.10" "$8,621.17" "$7,759.78" "$25,543.33" "$9,401.11" "$10,674.00" "$15,964.58" "$16,651.58" "$15,964.58" "$16,762.81" "$47,994.00" "$15,964.58" "$14,400.05" "$15,964.58" "$10,674.00" "$9,072.90" "$50,681.42" "$15,964.58" "$51,193.37" N/A "$7,390.26" "$15,964.58" "$37,115.36" "$16,762.81" "$7,133.30" "$17,198.33" "$7,759.78" "$15,964.58" N/A N/A MS067 DRG MS-DRG V39 (FY2022) 067 NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC INPATIENT ONLY "$242,681.50" "$179,584.50" "$20,893.62" "$194,145.17" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$182,011.13" N/A N/A N/A N/A N/A "$192,203.71" N/A "$194,145.17" N/A N/A "$20,893.62" "$140,755.27" N/A N/A N/A N/A N/A N/A N/A MS068 DRG MS-DRG V39 (FY2022) 068 NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC INPATIENT ONLY "$46,303.50" "$34,265.00" "$3,500.00" "$37,042.76" "$8,098.56" "$8,098.56" "$8,098.56" "$8,098.56" "$17,188.20" "$17,188.20" "$7,493.15" "$7,491.09" "$17,188.20" "$5,717.74" "$5,717.74" "$6,255.35" "$4,013.91" "$7,491.09" "$27,501.12" "$12,162.90" "$13,333.50" "$17,188.20" "$18,117.30" "$17,188.20" "$18,047.61" "$34,727.63" "$17,188.20" "$15,503.76" "$17,188.20" "$13,333.50" "$11,333.48" "$36,672.34" "$17,188.20" "$37,042.76" "$3,500.00" "$7,134.37" "$17,188.20" "$26,856.03" "$18,047.61" "$8,910.60" "$18,729.34" "$7,491.09" "$17,188.20" N/A N/A MS069 DRG MS-DRG V39 (FY2022) 069 TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC INPATIENT ONLY "$63,205.50" "$46,772.50" "$1,961.50" "$50,564.33" "$4,316.64" "$4,316.64" "$4,316.64" "$4,316.64" "$16,485.64" "$16,485.64" "$6,234.62" "$7,189.29" "$16,485.64" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$7,189.29" "$26,377.02" "$10,738.94" "$11,806.50" "$16,485.64" "$17,361.59" "$16,485.64" "$17,309.92" "$47,404.13" "$16,485.64" "$14,870.05" "$16,485.64" "$11,806.50" "$10,554.53" "$50,058.68" "$16,485.64" "$50,564.33" "$3,500.00" "$6,846.94" "$16,485.64" "$36,659.19" "$17,309.92" "$7,890.14" "$17,850.28" "$7,189.29" "$16,485.64" N/A N/A MS070 DRG MS-DRG V39 (FY2022) 070 NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC INPATIENT ONLY "$80,620.50" "$59,659.50" "$10,500.00" "$64,496.13" "$22,891.26" "$22,891.26" "$22,891.26" "$22,891.26" "$24,754.58" "$24,754.58" "$14,672.11" "$17,920.72" "$24,754.58" "$15,403.92" "$15,403.92" "$17,335.79" "$10,812.38" "$17,920.72" "$39,607.33" "$23,206.01" "$25,194.00" "$24,754.58" "$26,231.14" "$24,754.58" "$25,992.31" "$60,465.38" "$24,754.58" "$22,328.63" "$24,754.58" "$25,194.00" "$21,912.67" "$63,851.16" "$24,754.58" "$64,496.13" "$10,500.00" "$17,067.35" "$22,645.22" "$46,759.89" "$25,992.31" "$16,836.81" "$28,249.02" "$17,920.72" "$24,754.58" N/A N/A MS071 DRG MS-DRG V39 (FY2022) 071 NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC INPATIENT ONLY "$58,789.00" "$43,504.00" "$8,700.80" "$47,030.95" "$35,400.70" "$35,400.70" "$35,400.70" "$35,400.70" "$18,036.40" "$18,036.40" "$8,700.80" "$11,411.67" "$18,036.40" "$25,150.14" "$25,150.14" "$30,135.69" "$17,653.50" "$11,411.67" "$28,858.24" "$13,617.82" "$19,437.00" "$18,036.40" "$18,036.40" "$18,036.40" "$18,938.22" "$44,091.75" "$18,036.40" "$16,268.83" "$18,036.40" "$15,177.00" "$12,900.45" "$46,560.65" "$18,036.40" "$47,030.95" "$31,500.00" "$10,868.25" "$18,036.40" "$34,097.62" "$18,938.22" "$10,142.59" "$19,790.62" "$11,411.67" "$18,036.40" N/A N/A MS072 DRG MS-DRG V39 (FY2022) 072 NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$39,689.00" "$29,370.00" "$1,961.50" "$31,750.82" "$4,210.93" "$4,210.93" "$4,210.93" "$4,210.93" "$15,684.86" "$15,684.86" "$2,695.96" "$6,438.10" "$15,684.86" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,438.10" "$25,095.78" "$10,390.35" "$11,575.50" "$15,684.86" "$16,457.53" "$15,684.86" "$16,469.10" "$29,766.75" "$15,684.86" "$14,147.74" "$15,684.86" "$11,575.50" "$9,839.18" "$31,433.29" "$15,684.86" "$31,750.82" "$3,500.00" "$6,131.52" "$15,684.86" "$23,019.62" "$16,469.10" "$6,727.01" "$16,848.33" "$6,438.10" "$15,684.86" N/A N/A MS073 DRG MS-DRG V39 (FY2022) 073 CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC INPATIENT ONLY "$51,357.00" "$38,004.50" "$7,000.00" "$105,235.80" "$20,792.38" "$20,792.38" "$20,792.38" "$20,792.38" "$21,080.64" "$21,080.64" "$11,862.30" "$14,136.39" "$21,080.64" "$14,358.76" "$14,358.76" "$15,417.64" "$10,080.23" "$14,136.39" "$33,729.02" "$20,179.08" "$21,793.50" "$21,080.64" "$22,371.56" "$21,080.64" "$22,134.67" "$38,517.75" "$21,080.64" "$19,014.74" "$21,080.64" "$22,633.64" "$19,364.61" "$40,674.39" "$21,080.64" "$41,085.26" "$7,000.00" "$13,463.22" "$21,080.64" "$29,787.06" "$22,134.67" "$14,564.31" "$23,599.62" "$14,136.39" "$21,080.64" N/A N/A MS074 DRG MS-DRG V39 (FY2022) 074 CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC INPATIENT ONLY "$42,780.00" "$31,657.50" "$5,884.50" "$34,223.78" "$12,054.76" "$12,054.76" "$12,054.76" "$12,054.76" "$18,086.09" "$18,086.09" "$7,896.59" "$8,974.55" "$18,086.09" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$8,974.55" "$28,937.74" "$13,776.63" "$15,285.00" "$18,086.09" "$18,973.72" "$18,086.09" "$18,990.39" "$32,085.00" "$18,086.09" "$16,313.65" "$18,086.09" "$15,285.00" "$12,992.25" "$33,881.52" "$18,086.09" "$34,223.78" "$10,500.00" "$8,547.19" "$18,086.09" "$24,812.40" "$18,990.39" "$10,214.78" "$19,852.80" "$8,974.55" "$18,086.09" N/A N/A MS075 DRG MS-DRG V39 (FY2022) 075 VIRAL MENINGITIS WITH CC/MCC INPATIENT ONLY "$87,747.00" "$64,933.00" "$22,282.20" "$70,197.51" N/A N/A N/A N/A N/A N/A N/A N/A N/A "$35,670.65" "$35,670.65" "$41,507.33" "$26,962.49" N/A N/A N/A N/A "$22,282.20" N/A N/A "$23,396.31" "$65,810.25" N/A N/A N/A N/A N/A "$69,495.53" "$22,282.20" "$70,197.51" N/A N/A "$22,282.20" "$50,893.26" "$23,396.31" N/A "$25,103.02" N/A N/A N/A N/A MS076 DRG MS-DRG V39 (FY2022) 076 VIRAL MENINGITIS WITHOUT CC/MCC INPATIENT ONLY "$48,851.50" "$36,150.50" "$4,980.90" "$39,081.12" "$12,176.14" "$12,176.14" "$12,176.14" "$12,176.14" "$17,850.74" "$17,850.74" "$7,702.01" "$5,229.95" "$17,850.74" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$5,229.95" "$28,561.18" "$13,288.07" "$19,033.50" "$17,850.74" "$18,714.43" "$17,850.74" "$18,743.28" "$36,638.63" "$17,850.74" "$16,101.37" "$17,850.74" "$15,384.79" "$13,168.76" "$38,690.32" "$17,850.74" "$39,081.12" "$10,500.00" "$4,980.90" "$17,850.74" "$28,333.87" "$18,743.28" "$9,872.93" "$19,558.32" "$5,229.95" "$17,850.74" N/A N/A MS077 DRG MS-DRG V39 (FY2022) 077 HYPERTENSIVE ENCEPHALOPATHY WITH MCC INPATIENT ONLY "$762,945.00" "$564,579.50" "$22,835.13" "$572,208.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$572,208.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,835.13" "$442,508.10" N/A N/A N/A N/A N/A N/A N/A MS078 DRG MS-DRG V39 (FY2022) 078 HYPERTENSIVE ENCEPHALOPATHY WITH CC INPATIENT ONLY "$50,344.00" "$37,255.00" "$2,052.41" "$40,274.87" "$4,343.43" "$4,343.43" "$4,343.43" "$4,343.43" "$17,609.19" "$17,609.19" "$8,355.38" "$9,403.13" "$17,609.19" "$2,923.28" "$2,923.28" "$2,906.94" "$2,052.41" "$9,403.13" "$28,174.70" "$13,362.10" "$14,248.50" "$17,609.19" "$18,753.73" "$17,609.19" "$18,489.65" "$37,758.00" "$17,609.19" "$15,883.49" "$17,609.19" "$14,248.50" "$12,111.23" "$39,872.14" "$17,609.19" "$40,274.87" "$20,606.87" "$8,955.36" "$17,609.19" "$29,199.52" "$18,489.65" "$9,522.08" "$19,256.08" "$9,403.13" "$17,609.19" N/A N/A MS080 DRG MS-DRG V39 (FY2022) 080 NONTRAUMATIC STUPOR AND COMA WITH MCC INPATIENT ONLY "$124,237.50" "$91,936.00" "$6,551.38" "$99,389.83" "$36,553.82" "$36,553.82" "$36,553.82" "$36,553.82" "$26,232.26" "$26,232.26" N/A "$7,446.63" "$25,514.87" "$16,307.27" "$16,307.27" "$17,153.82" "$6,551.38" N/A N/A "$27,453.67" N/A "$25,514.87" "$26,232.26" "$26,232.26" "$26,790.61" "$93,178.13" "$26,232.26" "$26,232.26" "$25,514.87" "$32,508.77" "$80,754.23" "$98,395.93" "$25,514.87" "$99,389.83" N/A "$7,092.02" "$25,514.87" "$72,057.75" "$26,790.61" "$21,004.92" "$29,147.80" "$7,446.63" "$25,514.87" N/A N/A MS081 DRG MS-DRG V39 (FY2022) 081 NONTRAUMATIC STUPOR AND COMA WITHOUT MCC INPATIENT ONLY "$24,792.00" "$18,346.50" $765.00 "$24,791.86" "$3,987.34" "$3,987.34" "$3,987.34" "$3,987.34" "$16,389.70" "$16,389.70" $765.00 "$5,679.17" "$16,389.70" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$7,446.63" "$24,791.86" "$12,092.91" "$11,598.00" "$16,389.70" "$18,080.16" "$16,389.70" "$17,209.19" "$18,594.00" "$16,389.70" "$14,783.51" "$16,389.70" "$11,598.00" "$9,858.30" "$19,635.14" "$16,389.70" "$19,833.49" "$3,500.00" "$7,092.02" "$16,389.70" "$14,379.36" "$17,209.19" "$7,750.80" "$17,730.24" "$5,679.17" "$16,389.70" N/A N/A MS082 DRG MS-DRG V39 (FY2022) 082 TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC INPATIENT ONLY "$159,218.50" "$117,822.00" "$16,126.67" "$127,374.64" "$86,859.52" "$86,859.52" "$86,859.52" "$86,859.52" "$26,677.77" "$26,677.77" "$18,718.14" "$16,933.01" "$26,677.77" "$48,488.25" "$48,488.25" "$50,795.59" "$31,512.02" "$16,933.01" "$42,684.43" "$77,470.73" "$103,491.90" "$26,677.77" "$27,842.95" "$26,677.77" "$28,011.66" "$119,413.88" "$26,677.77" "$24,063.35" "$26,677.77" "$63,927.86" "$103,491.90" "$126,100.91" "$26,677.77" "$127,374.64" "$107,736.16" "$16,126.67" "$29,520.92" "$92,346.73" "$28,011.66" "$22,694.02" "$30,602.83" "$16,933.01" "$26,677.77" N/A N/A MS083 DRG MS-DRG V39 (FY2022) 083 TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC INPATIENT ONLY "$98,629.00" "$72,985.50" "$10,733.99" "$78,902.91" "$26,043.79" "$26,043.79" "$26,043.79" "$26,043.79" "$20,329.09" "$20,329.09" "$11,068.80" "$11,270.70" "$20,329.09" "$30,242.51" "$30,242.51" "$31,405.68" "$23,152.30" "$11,270.70" "$32,526.54" "$18,145.42" "$20,160.00" "$20,329.09" "$21,292.27" "$20,329.09" "$21,345.54" "$73,971.75" "$20,329.09" "$18,336.84" "$20,329.09" "$64,108.62" "$64,108.62" "$78,113.88" "$20,329.09" "$78,902.91" "$18,889.55" "$10,733.99" "$20,329.09" "$57,204.82" "$21,345.54" "$13,472.66" "$22,659.26" "$11,270.70" "$20,329.09" N/A N/A MS084 DRG MS-DRG V39 (FY2022) 084 TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC INPATIENT ONLY "$63,919.50" "$47,300.50" "$7,668.99" "$51,135.46" "$9,668.49" "$9,668.49" "$9,668.49" "$9,668.49" "$17,303.46" "$17,303.46" "$7,668.99" "$8,314.19" "$17,303.46" "$13,119.92" "$13,119.92" "$13,624.53" "$11,133.55" "$8,314.19" "$27,685.54" "$12,335.17" "$13,584.00" "$17,303.46" "$18,208.72" "$18,208.72" "$18,168.63" "$47,939.63" "$17,303.46" "$15,607.72" "$17,303.46" "$41,547.56" "$41,547.56" "$50,624.09" "$17,303.46" "$51,135.46" "$8,226.35" "$7,918.27" "$17,303.46" "$37,073.31" "$18,168.63" "$9,078.01" "$18,873.55" "$8,314.19" "$17,303.46" N/A N/A MS085 DRG MS-DRG V39 (FY2022) 085 TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC INPATIENT ONLY "$141,883.50" "$104,994.00" "$13,987.62" "$113,506.58" "$78,098.95" "$78,098.95" "$78,098.95" "$78,098.95" "$27,007.67" "$27,007.67" "$17,646.17" "$14,687.01" "$27,007.67" "$36,590.55" "$36,590.55" "$38,390.36" "$23,061.07" "$14,687.01" "$43,212.27" "$31,436.19" "$92,224.10" "$27,007.67" "$28,345.81" "$27,007.67" "$28,358.05" "$106,412.63" "$27,007.67" "$24,360.92" "$27,007.67" "$92,224.10" "$92,224.10" "$112,371.53" "$27,007.67" "$113,506.58" "$25,889.55" "$13,987.62" "$27,007.67" "$82,292.43" "$28,358.05" "$23,173.19" "$31,015.60" "$14,687.01" "$27,007.67" N/A N/A MS086 DRG MS-DRG V39 (FY2022) 086 TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC INPATIENT ONLY "$95,269.50" "$70,499.50" "$7,804.74" "$76,215.56" "$25,980.10" "$25,980.10" "$25,980.10" "$25,980.10" "$19,849.42" "$19,849.42" "$9,979.86" "$8,194.98" "$19,849.42" "$35,950.04" "$35,950.04" "$37,332.73" "$27,158.55" "$8,194.98" "$31,759.07" "$17,492.66" "$19,117.50" "$19,849.42" "$20,945.85" "$19,849.42" "$20,841.89" "$71,452.13" "$19,849.42" "$17,904.18" "$19,849.42" "$61,925.14" "$61,925.14" "$75,453.40" "$19,849.42" "$76,215.56" "$15,226.35" "$7,804.74" "$19,849.42" "$55,256.31" "$20,841.89" "$12,775.97" "$22,059.10" "$8,194.98" "$19,849.42" N/A N/A MS087 DRG MS-DRG V39 (FY2022) 087 TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC INPATIENT ONLY "$61,917.50" "$45,819.00" "$6,036.01" "$49,533.81" "$21,696.39" "$21,696.39" "$21,696.39" "$21,696.39" "$17,013.59" "$17,013.59" "$6,658.59" "$6,337.82" "$17,013.59" "$24,534.98" "$24,534.98" "$25,478.63" "$19,146.05" "$6,337.82" "$27,221.74" "$11,741.63" "$12,954.00" "$17,013.59" "$17,893.72" "$17,013.59" "$17,864.27" "$46,438.13" "$17,013.59" "$15,346.26" "$17,013.59" "$40,246.23" "$40,246.23" "$49,038.47" "$17,013.59" "$49,533.81" "$8,226.35" "$6,036.01" "$17,013.59" "$35,912.15" "$17,864.27" "$8,656.98" "$18,510.86" "$6,337.82" "$17,013.59" N/A N/A MS088 DRG MS-DRG V39 (FY2022) 088 CONCUSSION WITH MCC INPATIENT ONLY "$66,396.00" "$49,133.50" "$10,500.00" "$53,116.78" "$12,080.52" "$12,080.52" "$12,080.52" "$12,080.52" "$21,096.54" "$21,096.54" "$14,020.54" "$12,687.93" "$21,096.54" "$17,122.59" "$17,122.59" "$17,781.15" "$12,018.75" "$12,687.93" "$33,754.46" "$21,215.42" "$21,828.00" "$21,096.54" "$22,921.54" "$21,096.54" "$22,151.37" "$49,797.00" "$21,096.54" "$19,029.08" "$21,096.54" "$43,157.39" "$43,157.39" "$52,585.62" "$21,096.54" "$53,116.78" "$10,500.00" "$12,083.74" "$21,096.54" "$38,509.68" "$22,151.37" "$14,587.36" "$23,619.51" "$12,687.93" "$21,096.54" N/A N/A MS089 DRG MS-DRG V39 (FY2022) 089 CONCUSSION WITH CC INPATIENT ONLY "$55,771.00" "$41,271.00" "$8,557.99" "$44,616.51" "$9,341.89" "$9,341.89" "$9,341.89" "$9,341.89" "$18,393.22" "$18,393.22" "$8,557.99" "$10,166.62" "$18,393.22" "$13,119.92" "$13,119.92" "$13,624.53" "$11,133.55" "$10,166.62" "$29,429.15" "$15,716.07" "$15,952.50" "$18,393.22" "$20,003.00" "$18,393.22" "$19,312.88" "$41,828.25" "$18,393.22" "$16,590.68" "$18,393.22" "$36,250.91" "$36,250.91" "$44,170.35" "$18,393.22" "$44,616.51" "$11,726.35" "$9,682.49" "$18,393.22" "$32,347.18" "$19,312.88" "$10,660.85" "$20,237.08" "$10,166.62" "$18,393.22" N/A N/A MS090 DRG MS-DRG V39 (FY2022) 090 CONCUSSION WITHOUT CC/MCC INPATIENT ONLY "$47,291.00" "$34,995.50" "$5,769.31" "$37,832.52" "$19,593.25" "$19,593.25" "$19,593.25" "$19,593.25" "$16,951.49" "$16,951.49" "$6,563.09" "$6,057.78" "$16,951.49" "$28,537.65" "$28,537.65" "$29,635.25" "$20,031.25" "$6,057.78" "$27,122.38" "$11,078.10" "$12,819.00" "$16,951.49" "$17,541.58" "$16,951.49" "$17,799.06" "$35,468.25" "$16,951.49" "$15,290.24" "$16,951.49" "$30,738.92" "$30,738.92" "$37,454.17" "$16,951.49" "$37,832.52" "$17,500.00" "$5,769.31" "$16,951.49" "$27,428.78" "$17,799.06" "$8,566.78" "$18,433.17" "$6,057.78" "$16,951.49" N/A N/A MS091 DRG MS-DRG V39 (FY2022) 091 OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC INPATIENT ONLY "$131,241.50" "$97,119.00" "$10,969.74" "$104,993.00" "$84,125.72" "$84,125.72" "$84,125.72" "$84,125.72" "$22,446.47" "$22,446.47" "$14,261.53" "$21,807.24" "$22,446.47" "$22,368.45" "$22,368.45" "$23,529.65" "$10,969.74" N/A "$14,261.53" "$23,249.08" "$14,261.53" "$22,446.47" "$24,000.83" "$24,000.83" "$23,568.79" "$98,431.13" "$24,000.83" "$24,000.83" "$24,000.83" "$14,261.53" "$85,306.81" "$103,943.09" "$22,446.47" "$104,993.00" "$14,261.53" "$20,768.79" "$22,446.47" "$76,120.07" "$23,568.79" "$16,548.12" "$25,308.56" "$21,807.24" "$22,446.47" N/A N/A MS092 DRG MS-DRG V39 (FY2022) 092 OTHER DISORDERS OF NERVOUS SYSTEM WITH CC INPATIENT ONLY "$46,742.00" "$34,589.50" "$3,923.00" "$37,393.54" "$8,430.47" "$8,430.47" "$8,430.47" "$8,430.47" "$17,878.35" "$17,878.35" "$8,023.34" "$10,853.48" "$17,878.35" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$10,853.48" "$28,605.36" "$13,382.28" "$19,093.50" "$17,878.35" "$18,764.44" "$17,878.35" "$18,772.27" "$35,056.50" "$17,878.35" "$16,126.27" "$17,878.35" "$15,623.63" "$13,398.61" "$37,019.61" "$17,878.35" "$37,393.54" "$7,000.00" "$10,336.64" "$17,878.35" "$27,110.36" "$18,772.27" "$9,913.04" "$19,592.86" "$10,853.48" "$17,878.35" N/A N/A MS093 DRG MS-DRG V39 (FY2022) 093 OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC INPATIENT ONLY "$51,570.00" "$38,162.00" "$6,054.32" "$41,255.67" "$16,508.97" "$16,508.97" "$16,508.97" "$16,508.97" "$16,451.82" "$16,451.82" "$6,054.32" "$7,940.48" "$17,125.15" "$11,435.48" "$11,435.48" "$12,510.70" "$8,027.82" "$7,940.48" "$26,322.91" "$10,293.44" "$11,733.00" "$16,451.82" "$17,125.15" "$16,451.82" "$17,274.41" "$38,677.50" "$16,451.82" "$14,839.54" "$16,451.82" "$12,357.51" "$10,597.56" "$40,843.14" "$16,451.82" "$41,255.67" "$7,000.00" "$7,562.36" "$16,451.82" "$29,910.60" "$17,274.41" "$7,841.00" "$17,807.97" "$7,940.48" "$16,451.82" N/A N/A MS094 DRG MS-DRG V39 (FY2022) 094 BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC INPATIENT ONLY "$182,847.00" "$135,307.00" "$32,616.71" "$137,135.25" "$43,857.38" "$43,857.38" "$43,857.38" "$43,857.38" "$37,187.17" "$37,187.17" "$43,857.38" N/A "$37,187.17" N/A N/A N/A N/A N/A "$43,857.38" "$43,857.38" "$43,857.38" "$37,187.17" "$37,187.17" "$37,187.17" "$37,187.17" "$137,135.25" "$37,187.17" "$32,616.71" "$36,160.43" "$43,857.38" "$43,857.38" "$43,857.38" "$37,187.17" N/A "$43,857.38" N/A "$37,187.17" "$106,051.26" "$37,187.17" "$43,857.38" "$43,857.38" N/A "$37,187.17" N/A N/A MS095 DRG MS-DRG V39 (FY2022) 095 BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC INPATIENT ONLY "$158,150.50" "$117,031.50" "$25,133.93" "$126,520.02" "$62,202.35" "$62,202.35" "$62,202.35" "$62,202.35" "$28,357.59" "$28,357.59" N/A "$34,842.38" "$28,357.59" "$75,934.36" "$75,934.36" "$81,985.05" "$53,305.17" "$34,842.38" "$45,372.14" "$74,286.01" "$102,797.52" "$28,357.59" "$29,925.07" "$29,925.07" "$29,775.47" "$118,612.88" "$28,357.59" "$25,578.55" "$28,357.59" "$102,797.52" "$102,797.52" "$125,254.82" "$28,357.59" "$126,520.02" "$91,727.02" "$33,183.21" "$28,357.59" "$91,727.29" "$29,775.47" "$25,133.93" "$32,704.65" "$34,842.38" "$28,357.59" N/A N/A MS097 DRG MS-DRG V39 (FY2022) 097 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC INPATIENT ONLY "$99,238.50" "$73,436.50" "$18,896.30" "$79,390.54" "$30,258.94" "$30,258.94" "$30,258.94" "$30,258.94" "$37,005.85" "$37,005.85" "$28,227.62" "$33,115.78" "$37,005.85" "$24,179.15" "$24,179.15" "$27,787.94" "$18,896.30" "$33,115.78" "$59,209.36" "$52,331.28" "$56,406.00" "$37,005.85" "$39,435.02" "$37,005.85" "$38,856.14" "$74,428.88" "$37,005.85" "$33,379.28" "$37,005.85" "$58,294.26" "$49,833.36" "$78,596.63" "$37,005.85" "$79,390.54" "$29,226.35" "$31,538.82" "$53,399.49" "$57,558.33" "$38,856.14" "$37,695.40" "$43,525.49" "$33,115.78" "$37,005.85" N/A N/A MS098 DRG MS-DRG V39 (FY2022) 098 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC INPATIENT ONLY "$62,780.50" "$46,458.00" "$15,342.44" "$50,224.04" "$31,842.95" "$31,842.95" "$31,842.95" "$31,842.95" "$25,632.89" "$25,632.89" "$15,342.44" "$19,150.63" "$25,632.89" "$22,355.68" "$22,355.68" "$26,787.28" "$15,692.00" "$19,150.63" "$41,012.62" "$28,051.25" "$31,687.50" "$25,632.89" "$26,549.40" "$25,632.89" "$26,914.53" "$47,085.38" "$25,632.89" "$23,120.87" "$25,632.89" "$32,551.55" "$27,798.43" "$49,721.81" "$25,632.89" "$50,224.04" "$28,000.00" "$18,238.69" "$25,632.89" "$36,412.69" "$26,914.53" "$21,176.34" "$29,295.46" "$19,150.63" "$25,632.89" N/A N/A MS099 DRG MS-DRG V39 (FY2022) 099 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC INPATIENT ONLY "$78,461.00" "$58,061.50" "$8,876.97" "$62,768.78" "$23,955.38" "$23,955.38" "$23,955.38" "$23,955.38" "$20,728.67" "$20,728.67" "$10,361.88" "$9,320.82" "$20,728.67" "$16,766.76" "$16,766.76" "$20,090.46" "$11,769.00" "$9,320.82" "$33,165.87" "$18,822.41" "$21,028.50" "$20,728.67" "$21,651.56" "$20,728.67" "$21,765.10" "$58,845.75" "$20,728.67" "$18,697.26" "$20,728.67" "$21,765.96" "$18,611.69" "$62,141.08" "$20,728.67" "$62,768.78" "$21,000.00" "$8,876.97" "$20,728.67" "$45,507.38" "$21,765.10" "$14,053.08" "$23,159.23" "$9,320.82" "$20,728.67" N/A N/A MS100 DRG MS-DRG V39 (FY2022) 100 SEIZURES WITH MCC INPATIENT ONLY "$112,202.00" "$83,029.50" "$6,453.81" "$105,859.69" "$42,082.86" "$42,082.86" "$42,082.86" "$42,082.86" "$25,383.68" "$25,383.68" "$13,659.94" "$16,066.40" "$24,003.43" "$6,453.81" "$6,453.81" "$6,753.19" "$21,487.28" "$105,859.69" "$25,854.74" "$25,854.74" "$72,931.16" "$24,003.43" "$25,383.68" "$24,003.43" "$25,203.60" "$84,151.50" "$24,003.43" "$25,383.68" "$24,003.43" "$32,011.72" "$72,931.16" "$88,863.81" "$24,003.43" "$89,761.43" "$35,000.00" "$15,301.33" "$24,003.43" "$65,077.16" "$25,203.60" "$18,809.60" "$27,256.66" "$16,066.40" "$24,003.43" N/A N/A MS101 DRG MS-DRG V39 (FY2022) 101 SEIZURES WITHOUT MCC INPATIENT ONLY "$41,048.00" "$30,376.00" "$5,884.50" "$32,838.13" "$11,873.30" "$11,873.30" "$11,873.30" "$11,873.30" "$17,184.76" "$17,184.76" "$6,754.10" "$7,244.17" "$17,184.76" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$7,244.17" "$27,495.62" "$12,133.29" "$13,326.00" "$17,184.76" "$18,101.59" "$17,184.76" "$18,044.00" "$30,786.00" "$17,184.76" "$15,500.65" "$17,184.76" "$13,326.00" "$11,327.10" "$32,509.73" "$17,184.76" "$32,838.13" "$10,500.00" "$6,899.20" "$17,184.76" "$23,807.84" "$18,044.00" "$8,905.59" "$18,725.03" "$7,244.17" "$17,184.76" N/A N/A MS102 DRG MS-DRG V39 (FY2022) 102 HEADACHES WITH MCC INPATIENT ONLY "$105,677.00" "$78,201.00" "$8,248.05" "$84,541.23" "$25,729.32" "$25,729.32" "$25,729.32" "$25,729.32" "$19,011.58" "$19,011.58" "$8,990.89" "$8,660.45" "$19,011.58" "$10,091.71" "$10,091.71" "$10,515.90" "$16,934.80" "$8,660.45" "$30,418.53" "$15,476.50" "$68,689.75" "$19,011.58" "$19,875.85" "$19,011.58" "$19,962.16" "$79,257.75" "$19,011.58" "$17,148.45" "$19,011.58" "$18,405.44" "$15,810.97" "$83,695.81" "$19,011.58" "$84,541.23" "$32,889.55" "$8,248.05" "$19,011.58" "$61,292.66" "$19,962.16" "$11,559.02" "$21,010.78" "$8,660.45" "$19,011.58" N/A N/A MS103 DRG MS-DRG V39 (FY2022) 103 HEADACHES WITHOUT MCC INPATIENT ONLY "$31,007.00" "$22,945.50" "$3,923.00" "$26,845.18" "$7,784.00" "$7,784.00" "$7,784.00" "$7,784.00" "$16,778.24" "$16,778.24" "$6,172.14" "$6,670.84" "$16,778.24" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$6,670.84" "$26,845.18" "$11,204.62" "$12,442.50" "$16,778.24" "$17,608.74" "$16,778.24" "$17,617.15" "$23,255.25" "$16,778.24" "$15,133.97" "$16,778.24" "$12,442.50" "$10,576.13" "$24,557.54" "$16,778.24" "$24,805.60" "$7,000.00" "$6,353.18" "$16,778.24" "$17,984.06" "$17,617.15" "$8,315.16" "$18,216.40" "$6,670.84" "$16,778.24" N/A N/A MS113 DRG MS-DRG V39 (FY2022) 113 ORBITAL PROCEDURES WITH CC/MCC INPATIENT ONLY "$184,856.50" "$136,794.00" "$16,328.50" "$147,885.01" "$118,452.61" "$118,452.61" "$118,452.61" "$118,452.61" "$27,700.08" "$27,700.08" "$24,262.31" "$17,144.93" "$26,198.12" "$61,256.51" "$61,256.51" "$64,436.50" "$39,317.65" "$17,144.93" "$41,916.99" "$90,550.67" "$120,156.58" "$26,198.12" "$27,700.08" "$27,700.08" "$27,508.03" "$138,642.38" "$27,700.08" "$27,700.08" "$26,198.12" "$120,156.58" "$120,156.58" "$146,406.17" "$26,198.12" "$147,885.01" N/A "$16,328.50" "$28,954.00" "$107,216.77" "$27,508.03" N/A "$30,002.68" "$17,144.93" "$26,198.12" N/A N/A MS114 DRG MS-DRG V39 (FY2022) 114 ORBITAL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$88,557.00" "$65,532.50" "$3,923.00" "$70,845.47" "$8,081.47" "$8,081.47" "$8,081.47" "$8,081.47" "$21,044.07" "$21,044.07" "$10,325.28" "$11,034.18" "$21,044.07" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$11,034.18" "$33,670.51" "$17,534.39" "$21,714.00" "$21,044.07" "$20,967.99" "$20,967.99" "$22,096.27" "$66,417.75" "$21,044.07" "$18,981.75" "$21,044.07" "$21,714.00" "$18,456.90" "$70,137.01" "$21,044.07" "$70,845.47" "$7,000.00" "$10,508.74" "$21,044.07" "$51,363.06" "$22,096.27" "$14,511.18" "$23,553.86" "$11,034.18" "$21,044.07" N/A N/A MS115 DRG MS-DRG V39 (FY2022) 115 EXTRAOCULAR PROCEDURES EXCEPT ORBIT INPATIENT ONLY "$173,573.50" "$128,444.50" "$12,745.14" "$138,858.51" "$111,017.14" "$111,017.14" "$111,017.14" "$111,017.14" "$21,106.20" "$21,106.20" "$19,776.55" "$19,224.64" "$21,106.20" "$52,266.38" "$52,266.38" "$54,979.66" "$32,764.19" "$19,224.64" "$33,769.92" "$84,112.74" "$112,822.53" "$21,106.20" "$22,512.99" "$21,106.20" "$22,161.51" "$130,180.13" "$21,106.20" "$19,037.79" "$21,106.20" "$112,822.53" "$112,822.53" "$137,469.94" "$21,106.20" "$138,858.51" "$100,672.42" "$12,745.14" "$21,106.20" "$100,672.63" "$22,161.51" "$14,601.40" "$23,631.59" "$19,224.64" "$21,106.20" N/A N/A MS116 DRG MS-DRG V39 (FY2022) 116 INTRAOCULAR PROCEDURES WITH CC/MCC INPATIENT ONLY "$99,121.00" "$73,350.00" "$11,574.66" "$79,296.44" "$21,265.65" "$21,265.65" "$21,265.65" "$21,265.65" "$24,046.91" "$24,046.91" "$12,500.48" "$12,153.40" "$24,046.91" "$18,590.23" "$18,590.23" "$21,091.12" "$14,973.30" "$12,153.40" "$38,475.06" "$25,390.40" "$28,240.50" "$24,046.91" "$25,137.25" "$24,046.91" "$25,249.26" "$74,340.75" "$24,046.91" "$21,690.31" "$24,046.91" "$28,240.50" "$24,004.43" "$78,503.50" "$24,046.91" "$79,296.44" "$29,389.55" "$11,574.66" "$24,046.91" "$57,490.18" "$25,249.26" "$18,872.76" "$27,311.06" "$12,153.40" "$24,046.91" N/A N/A MS117 DRG MS-DRG V39 (FY2022) 117 INTRAOCULAR PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$106,384.50" "$78,725.00" "$3,804.92" "$85,107.49" "$12,209.87" "$12,209.87" "$12,209.87" "$12,209.87" "$18,239.31" "$18,239.31" "$7,353.91" "$8,905.49" "$18,239.31" "$3,804.92" "$3,804.92" "$4,002.44" "$5,884.50" "$8,905.49" "$29,182.90" "$13,362.10" "$69,149.83" "$18,239.31" "$18,753.73" "$18,239.31" "$19,151.28" "$79,788.38" "$18,239.31" "$16,451.86" "$18,239.31" "$16,270.51" "$69,149.83" "$84,256.41" "$18,239.31" "$85,107.49" "$10,500.00" "$8,481.41" "$18,239.31" "$61,703.01" "$19,151.28" "$10,437.31" "$20,044.51" "$8,905.49" "$18,239.31" N/A N/A MS121 DRG MS-DRG V39 (FY2022) 121 ACUTE MAJOR EYE INFECTIONS WITH CC/MCC INPATIENT ONLY "$46,329.00" "$34,283.50" "$5,645.87" "$37,063.06" "$16,707.91" "$16,707.91" "$16,707.91" "$16,707.91" "$19,270.39" "$19,270.39" "$9,492.51" "$5,928.16" "$19,270.39" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$5,928.16" "$30,832.62" "$16,491.31" "$17,859.00" "$19,270.39" "$20,414.43" "$19,270.39" "$20,233.91" "$34,746.75" "$19,270.39" "$17,381.89" "$19,270.39" "$19,252.23" "$16,573.38" "$36,692.44" "$19,270.39" "$37,063.06" "$14,000.00" "$5,645.87" "$19,270.39" "$26,870.82" "$20,233.91" "$11,934.94" "$21,334.61" "$5,928.16" "$19,270.39" N/A N/A MS122 DRG MS-DRG V39 (FY2022) 122 ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC INPATIENT ONLY "$36,749.00" "$27,194.50" "$4,813.31" "$29,398.90" "$20,162.27" "$20,162.27" "$20,162.27" "$20,162.27" "$15,508.38" "$15,508.38" "$5,669.62" "$5,053.98" "$15,508.38" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$5,053.98" "$24,813.41" "$9,297.48" "$9,682.50" "$15,508.38" "$16,596.60" "$15,508.38" "$16,283.80" "$27,561.75" "$15,508.38" "$13,988.56" "$15,508.38" "$10,540.83" "$9,088.46" "$29,104.92" "$15,508.38" "$29,398.90" "$17,500.00" "$4,813.31" "$15,508.38" "$21,314.42" "$16,283.80" "$6,470.69" "$16,627.53" "$5,053.98" "$15,508.38" N/A N/A MS123 DRG MS-DRG V39 (FY2022) 123 NEUROLOGICAL EYE DISORDERS INPATIENT ONLY "$52,054.50" "$38,520.50" "$2,052.41" "$41,643.32" "$4,328.26" "$4,328.26" "$4,328.26" "$4,328.26" "$16,345.53" "$16,345.53" "$6,008.80" "$7,845.87" "$16,345.53" "$2,923.28" "$2,923.28" "$2,906.94" "$2,052.41" "$7,845.87" "$26,152.85" "$10,683.75" "$15,762.00" "$16,345.53" "$17,332.30" "$16,345.53" "$17,162.81" "$39,040.88" "$16,345.53" "$14,743.67" "$16,345.53" "$11,502.00" "$9,776.70" "$41,226.86" "$16,345.53" "$41,643.32" "$10,683.75" "$7,472.26" "$16,345.53" "$30,191.61" "$17,162.81" "$7,686.64" "$17,674.98" "$7,845.87" "$16,345.53" N/A N/A MS124 DRG MS-DRG V39 (FY2022) 124 OTHER DISORDERS OF THE EYE WITH MCC INPATIENT ONLY "$45,845.00" "$33,925.50" "$7,800.23" "$36,675.76" "$19,580.56" "$19,580.56" "$19,580.56" "$19,580.56" "$20,729.36" "$20,729.36" "$10,203.89" "$8,190.25" "$20,729.36" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$8,190.25" "$33,166.98" "$18,852.02" "$21,030.00" "$20,729.36" "$21,667.28" N/A "$21,765.83" "$34,383.75" "$20,729.36" "$18,697.88" "$20,729.36" "$21,030.00" "$17,875.50" "$36,309.00" "$20,729.36" "$36,675.76" "$17,500.00" "$7,800.23" "$20,729.36" "$26,590.10" "$21,765.83" "$14,054.08" "$23,160.09" "$8,190.25" "$20,729.36" N/A N/A MS125 DRG MS-DRG V39 (FY2022) 125 OTHER DISORDERS OF THE EYE WITHOUT MCC INPATIENT ONLY "$42,671.50" "$31,577.00" "$4,863.77" "$34,137.15" "$24,342.12" "$24,342.12" "$24,342.12" "$24,342.12" "$16,830.03" "$16,830.03" "$6,115.91" "$5,106.96" "$16,830.03" "$16,766.76" "$16,766.76" "$20,090.46" "$11,769.00" "$5,106.96" "$26,928.05" "$11,603.00" "$12,555.00" "$16,830.03" "$17,820.17" "$17,820.17" "$17,671.53" "$32,003.63" "$16,830.03" "$15,180.69" "$16,830.03" "$13,765.14" "$11,881.89" "$33,795.78" "$16,830.03" "$34,137.15" "$21,000.00" "$4,863.77" "$16,830.03" "$24,749.47" "$17,671.53" "$8,390.34" "$18,281.19" "$5,106.96" "$16,830.03" N/A N/A MS135 DRG MS-DRG V39 (FY2022) 135 SINUS AND MASTOID PROCEDURES WITH CC/MCC INPATIENT ONLY "$210,718.50" "$155,932.00" "$18,312.57" "$168,574.42" "$133,894.16" "$133,894.16" "$133,894.16" "$133,894.16" N/A N/A N/A "$19,228.21" "$25,846.83" "$78,573.16" "$78,573.16" "$82,614.47" "$51,864.97" N/A "$41,354.93" "$102,208.32" "$136,966.72" "$25,846.83" N/A N/A "$27,139.17" "$158,038.88" N/A N/A N/A "$136,966.72" "$136,966.72" "$166,888.68" "$25,846.83" "$168,574.42" N/A "$18,312.57" "$25,846.83" "$122,216.73" "$27,139.17" N/A "$29,563.14" "$19,228.21" N/A N/A N/A MS137 DRG MS-DRG V39 (FY2022) 137 MOUTH PROCEDURES WITH CC/MCC INPATIENT ONLY "$76,877.00" "$56,889.00" "$8,339.05" "$61,501.35" "$9,808.82" "$9,808.82" "$9,808.82" "$9,808.82" "$21,472.66" "$21,472.66" "$12,259.49" "$8,756.01" "$21,472.66" "$10,206.85" "$10,206.85" "$11,045.89" "$9,088.80" "$8,756.01" "$34,356.26" "$20,183.12" "$26,905.50" "$21,472.66" "$22,373.69" N/A "$22,546.29" "$57,657.75" "$21,472.66" "$19,368.34" "$21,472.66" "$23,323.61" "$19,926.79" "$60,886.33" "$21,472.66" "$61,501.35" "$11,726.35" "$8,339.05" "$21,472.66" "$44,588.66" "$22,546.29" "$15,133.68" "$24,090.13" "$8,756.01" "$21,472.66" N/A N/A MS138 DRG MS-DRG V39 (FY2022) 138 MOUTH PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$22,744.50" "$16,831.00" "$1,961.50" "$22,744.50" "$4,420.83" "$4,420.83" "$4,420.83" "$4,420.83" "$16,964.60" "$16,964.60" "$7,040.62" "$5,210.17" "$16,964.60" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,473.11" "$22,744.50" "$11,901.79" "$12,847.50" "$16,964.60" "$17,978.72" "$16,964.60" "$17,812.83" "$17,058.38" "$16,964.60" "$15,302.07" "$16,964.60" "$13,493.85" "$11,566.72" "$18,013.64" "$16,964.60" "$18,195.60" "$3,500.00" "$6,164.86" "$16,964.60" "$13,191.81" "$17,812.83" "$8,585.81" "$18,449.57" "$5,210.17" "$16,964.60" N/A N/A MS139 DRG MS-DRG V39 (FY2022) 139 SALIVARY GLAND PROCEDURES INPATIENT ONLY "$126,860.00" "$93,876.50" "$3,500.00" "$101,487.77" "$4,164.21" "$4,164.21" "$4,164.21" "$4,164.21" "$19,570.62" "$19,570.62" "$8,797.20" "$9,736.15" "$19,570.62" "$22,012.97" "$22,012.97" "$23,564.60" "$10,635.06" "$9,736.15" "$31,312.99" "$16,924.69" "$82,458.81" "$19,570.62" "$20,644.42" "$19,570.62" "$20,549.15" "$95,145.00" "$19,570.62" "$17,652.70" "$19,570.62" "$82,458.81" "$82,458.81" "$100,472.88" "$19,570.62" "$101,487.77" "$3,500.00" "$9,272.52" "$19,570.62" "$73,578.80" "$20,549.15" "$12,370.99" "$21,710.25" "$9,736.15" "$19,570.62" N/A N/A MS140 DRG MS-DRG V39 (FY2022) 140 MAJOR HEAD AND NECK PROCEDURES WITH MCC INPATIENT ONLY "$337,027.00" "$249,400.00" "$29,990.56" "$358,306.92" "$358,306.92" "$358,306.92" "$358,306.92" "$358,306.92" "$41,350.01" "$41,350.01" "$358,306.92" "$29,990.56" "$41,350.01" "$133,800.66" "$133,800.66" "$133,800.66" "$133,800.66" "$29,990.56" "$358,306.92" "$358,306.92" "$358,306.92" "$41,350.01" "$41,350.01" "$41,350.01" "$41,350.01" "$252,770.25" "$41,350.01" "$41,350.01" "$41,350.01" "$358,306.92" "$358,306.92" "$358,306.92" "$41,350.01" N/A "$358,306.92" "$29,990.56" "$43,502.66" "$195,475.66" "$41,350.01" "$358,306.92" "$358,306.92" "$29,990.56" "$41,350.01" N/A N/A MS141 DRG MS-DRG V39 (FY2022) 141 MAJOR HEAD AND NECK PROCEDURES WITH CC INPATIENT ONLY "$181,007.50" "$133,946.00" "$18,146.78" "$149,295.48" "$114,754.80" "$114,754.80" "$114,754.80" "$114,754.80" "$26,278.86" "$26,278.86" "$24,571.50" "$19,054.13" "$26,278.86" "$54,878.24" "$54,878.24" "$57,712.20" "$34,638.07" "$19,054.13" "$42,046.18" "$88,753.58" "$117,654.57" "$26,278.86" "$27,609.37" "$26,278.86" "$27,592.80" "$135,755.63" "$26,278.86" "$23,703.53" "$26,278.86" "$117,654.57" "$117,654.57" "$143,357.59" "$26,278.86" "$144,805.62" "$104,984.08" "$18,146.78" "$26,278.86" "$104,984.35" "$27,592.80" "$22,114.62" "$30,103.70" "$19,054.13" "$26,278.86" N/A N/A MS142 DRG MS-DRG V39 (FY2022) 142 MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$158,467.00" "$117,266.00" "$15,777.98" "$126,773.52" "$86,890.31" "$86,890.31" "$86,890.31" "$86,890.31" "$22,131.06" "$22,131.06" "$17,520.21" "$21,920.20" "$22,131.06" "$45,502.48" "$45,502.48" "$47,713.51" "$29,453.87" "$21,920.20" "$35,409.70" "$78,445.10" "$103,003.49" "$22,131.06" "$23,817.25" "$22,131.06" "$23,237.61" "$118,850.25" "$22,131.06" "$19,962.22" "$22,131.06" "$103,003.49" "$103,003.49" "$125,505.79" "$22,131.06" "$126,773.52" "$107,300.35" "$15,777.98" "$22,131.06" "$91,910.86" "$23,237.61" "$16,090.01" "$24,913.92" "$21,920.20" "$22,131.06" N/A N/A MS143 DRG MS-DRG V39 (FY2022) 143 "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC" INPATIENT ONLY "$299,739.00" "$221,807.00" "$157,578.05" "$224,804.25" "$157,578.05" "$157,578.05" "$157,578.05" "$157,578.05" N/A N/A "$157,578.05" N/A N/A N/A N/A N/A N/A N/A "$157,578.05" "$157,578.05" "$157,578.05" N/A N/A N/A N/A "$224,804.25" N/A N/A N/A "$157,578.05" "$157,578.05" "$157,578.05" N/A N/A "$157,578.05" N/A N/A "$173,848.62" N/A "$157,578.05" "$157,578.05" N/A N/A N/A N/A MS144 DRG MS-DRG V39 (FY2022) 144 "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC" INPATIENT ONLY "$73,074.50" "$54,075.50" "$3,923.00" "$58,459.29" "$8,901.26" "$8,901.26" "$8,901.26" "$8,901.26" "$23,210.46" "$23,210.46" "$15,624.56" "$14,213.97" "$23,210.46" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$14,213.97" "$37,136.74" "$24,351.37" "$26,422.50" "$23,210.46" "$24,585.83" "$23,210.46" "$24,370.98" "$54,805.88" "$23,210.46" "$20,935.83" "$23,210.46" "$27,788.03" "$23,824.66" "$57,874.69" "$23,210.46" "$58,459.29" "$7,000.00" "$13,537.10" "$23,210.46" "$42,383.21" "$24,370.98" "$17,657.81" "$26,264.48" "$14,213.97" "$23,210.46" N/A N/A MS145 DRG MS-DRG V39 (FY2022) 145 "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$125,090.00" "$92,567.00" "$3,500.00" "$100,071.87" "$4,162.81" "$4,162.81" "$4,162.81" "$4,162.81" "$19,505.03" "$19,505.03" "$10,831.43" "$6,455.13" "$19,505.03" "$17,925.22" "$17,925.22" "$18,855.77" "$7,730.80" "$6,455.13" "$31,208.05" "$16,255.78" "$81,308.38" "$19,505.03" "$20,289.43" "$19,505.03" "$20,480.28" "$93,817.50" "$19,505.03" "$17,593.54" "$19,505.03" "$81,308.38" "$81,308.38" "$99,071.13" "$19,505.03" "$100,071.87" "$3,500.00" "$6,147.74" "$19,505.03" "$72,552.20" "$20,480.28" "$12,275.77" "$21,628.19" "$6,455.13" "$19,505.03" N/A N/A MS146 DRG MS-DRG V39 (FY2022) 146 "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC" INPATIENT ONLY "$254,114.00" "$188,044.50" "$28,678.89" "$203,291.06" N/A N/A N/A N/A N/A N/A N/A N/A N/A "$108,888.55" "$108,888.55" N/A "$73,765.41" N/A N/A N/A N/A N/A N/A N/A N/A "$190,585.50" N/A N/A N/A N/A N/A "$201,258.15" N/A "$203,291.06" N/A N/A N/A "$147,386.12" N/A N/A "$28,678.89" N/A N/A N/A N/A MS147 DRG MS-DRG V39 (FY2022) 147 "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC" INPATIENT ONLY "$53,133.00" "$39,318.50" "$7,846.00" "$42,506.33" "$15,946.40" "$15,946.40" "$15,946.40" "$15,946.40" "$20,033.00" "$20,033.00" "$11,486.52" "$12,751.32" "$20,033.00" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$12,751.32" "$32,052.80" "$16,300.19" "$19,516.50" "$20,033.00" "$20,312.99" "$20,033.00" "$21,034.65" "$39,849.75" "$20,033.00" "$18,069.77" "$20,033.00" "$19,516.50" "$16,589.03" "$42,081.26" "$20,033.00" "$42,506.33" "$14,000.00" "$12,144.11" "$20,033.00" "$30,817.14" "$21,034.65" "$13,042.63" "$22,288.79" "$12,751.32" "$20,033.00" N/A N/A MS148 DRG MS-DRG V39 (FY2022) 148 "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC" INPATIENT ONLY "$42,498.50" "$31,449.00" "$3,923.00" "$33,998.64" "$8,243.80" "$8,243.80" "$8,243.80" "$8,243.80" "$16,484.95" "$16,484.95" "$7,323.56" "$7,209.16" "$16,484.95" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$7,209.16" "$26,375.92" "$11,004.08" "$11,805.00" "$16,484.95" "$17,502.31" "$16,484.95" "$17,309.20" "$31,873.88" "$16,484.95" "$14,869.42" "$16,484.95" "$12,366.97" "$10,596.22" "$33,658.64" "$16,484.95" "$33,998.64" "$7,000.00" "$6,865.86" "$16,484.95" "$24,649.13" "$17,309.20" "$7,889.12" "$17,849.41" "$7,209.16" "$16,484.95" N/A N/A MS149 DRG MS-DRG V39 (FY2022) 149 DYSEQUILIBRIUM INPATIENT ONLY "$53,314.50" "$39,453.00" "$1,961.50" "$42,651.37" "$4,071.93" "$4,071.93" "$4,071.93" "$4,071.93" "$16,139.87" "$16,139.87" "$5,660.70" "$6,355.79" "$16,139.87" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,355.79" "$25,823.79" "$10,161.55" "$15,315.00" "$16,139.87" "$17,055.16" "$16,139.87" "$16,946.86" "$39,985.88" "$16,139.87" "$14,558.16" "$16,139.87" "$11,055.00" "$9,396.75" "$42,224.85" "$16,139.87" "$42,651.37" "$3,500.00" "$6,053.13" "$16,139.87" "$30,922.41" "$16,946.86" "$7,387.92" "$17,417.65" "$6,355.79" "$16,139.87" N/A N/A MS151 DRG MS-DRG V39 (FY2022) 151 EPISTAXIS WITHOUT MCC INPATIENT ONLY "$22,233.00" "$16,452.50" "$3,923.00" "$22,232.90" "$7,927.89" "$7,927.89" "$7,927.89" "$7,927.89" "$16,149.53" "$16,149.53" "$5,971.31" "$4,827.87" "$16,149.53" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$4,827.87" "$22,232.90" "$10,376.89" "$11,076.00" "$16,149.53" "$17,169.45" "$16,149.53" "$16,957.01" "$16,674.75" "$16,149.53" "$14,566.88" "$16,149.53" "$11,076.00" "$9,414.60" "$17,608.45" "$16,149.53" "$17,786.32" "$7,000.00" "$4,597.97" "$16,149.53" "$12,895.14" "$16,957.01" "$7,401.94" "$17,429.74" "$4,827.87" "$16,149.53" N/A N/A MS152 DRG MS-DRG V39 (FY2022) 152 OTITIS MEDIA AND URI WITH MCC INPATIENT ONLY "$29,965.00" "$22,174.50" "$5,884.50" "$29,616.83" "$12,273.24" "$12,273.24" "$12,273.24" "$12,273.24" "$18,510.52" "$18,510.52" "$8,003.23" "$7,145.77" "$18,510.52" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$7,145.77" "$29,616.83" "$16,119.84" "$16,207.50" "$18,510.52" "$20,217.29" "$18,510.52" "$19,436.05" "$22,473.75" "$18,510.52" "$16,696.49" "$18,510.52" "$16,937.46" "$14,506.34" "$23,732.28" "$18,510.52" "$23,972.00" "$10,500.00" "$6,805.49" "$18,510.52" "$17,379.70" "$19,436.05" "$10,831.27" "$20,383.85" "$7,145.77" "$18,510.52" N/A N/A MS153 DRG MS-DRG V39 (FY2022) 153 OTITIS MEDIA AND URI WITHOUT MCC INPATIENT ONLY "$31,778.00" "$23,516.00" "$5,802.65" "$25,560.99" "$9,898.95" "$9,898.95" "$9,898.95" "$9,898.95" "$15,975.62" "$15,975.62" "$6,144.47" "$6,092.78" "$15,975.62" "$10,206.85" "$10,206.85" "$11,045.89" "$9,088.80" "$6,092.78" "$25,560.99" "$9,293.44" "$10,698.00" "$15,975.62" "$16,594.46" "$15,975.62" "$16,774.40" "$23,833.50" "$15,975.62" "$14,410.01" "$15,975.62" "$11,486.28" "$9,881.58" "$25,167.95" "$15,975.62" "$25,422.19" "$7,628.85" "$5,802.65" "$15,975.62" "$18,431.24" "$16,774.40" "$7,149.33" "$17,212.14" "$6,092.78" "$15,975.62" N/A N/A MS154 DRG MS-DRG V39 (FY2022) 154 "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC" INPATIENT ONLY "$56,022.50" "$41,457.00" "$5,884.50" "$44,817.64" "$11,970.39" "$11,970.39" "$11,970.39" "$11,970.39" "$21,728.69" "$21,728.69" "$12,230.93" "$10,185.54" "$21,728.69" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$10,185.54" "$34,765.90" "$20,227.53" "$23,202.00" "$21,728.69" "$22,397.27" "$21,728.69" "$22,815.12" "$42,016.88" "$21,728.69" "$19,599.28" "$21,728.69" "$23,202.00" "$19,721.70" "$44,369.46" "$21,728.69" "$44,817.64" "$10,500.00" "$9,700.51" "$21,728.69" "$32,493.05" "$22,815.12" "$15,505.59" "$24,410.47" "$10,185.54" "$21,728.69" N/A N/A MS155 DRG MS-DRG V39 (FY2022) 155 "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC" INPATIENT ONLY "$47,444.00" "$35,109.00" "$6,136.03" "$47,555.13" "$18,212.88" "$18,212.88" "$18,212.88" "$18,212.88" "$17,330.38" "$17,330.38" "$7,897.49" "$6,442.83" "$17,330.38" "$16,053.41" "$16,053.41" "$16,859.77" "$13,193.62" "$6,442.83" "$27,728.61" "$12,372.86" "$17,902.50" "$17,330.38" "$18,228.72" "$17,330.38" "$18,196.90" "$35,583.00" "$17,330.38" "$15,632.00" "$17,330.38" "$14,552.90" "$12,506.53" "$37,575.29" "$17,330.38" "$37,954.85" "$7,628.85" "$6,136.03" "$17,330.38" "$27,517.52" "$18,196.90" "$9,117.10" "$18,907.23" "$6,442.83" "$17,330.38" N/A N/A MS156 DRG MS-DRG V39 (FY2022) 156 "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC" INPATIENT ONLY "$62,026.00" "$45,899.50" "$4,865.57" "$49,620.70" "$20,945.85" "$20,945.85" "$20,945.85" "$20,945.85" "$15,597.40" "$15,597.40" "$5,816.01" "$5,108.85" "$15,597.40" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$5,108.85" "$24,955.84" "$9,175.00" "$9,876.00" "$15,597.40" "$16,531.60" "$15,597.40" "$16,377.27" "$46,519.50" "$15,597.40" "$14,068.85" "$15,597.40" "$11,692.03" "$10,210.63" "$49,124.48" "$15,597.40" "$49,620.70" "$17,500.00" "$4,865.57" "$15,597.40" "$35,975.08" "$16,377.27" "$6,600.00" "$16,738.91" "$5,108.85" "$15,597.40" N/A N/A MS157 DRG MS-DRG V39 (FY2022) 157 DENTAL AND ORAL DISEASES WITH MCC INPATIENT ONLY "$156,790.00" "$116,025.00" "$9,415.78" "$160,670.35" "$87,339.68" "$87,339.68" "$87,339.68" "$87,339.68" "$21,931.61" "$21,931.61" "$17,053.42" "$9,886.58" "$21,931.61" "$46,412.27" "$46,412.27" "$48,719.73" "$30,216.25" "$9,886.58" "$35,090.58" "$77,129.43" "$101,913.47" "$21,931.61" "$23,603.69" "$21,931.61" "$23,028.19" "$117,592.50" "$21,931.61" "$19,782.31" "$21,931.61" "$101,913.47" "$101,913.47" "$124,177.66" "$21,931.61" "$125,431.96" "$106,327.73" "$9,415.78" "$21,931.61" "$90,938.20" "$23,028.19" "$15,800.31" "$24,664.36" "$9,886.58" "$21,931.61" N/A N/A MS158 DRG MS-DRG V39 (FY2022) 158 DENTAL AND ORAL DISEASES WITH CC INPATIENT ONLY "$70,898.00" "$52,465.00" "$7,603.83" "$56,718.20" "$13,282.12" "$13,282.12" "$13,282.12" "$13,282.12" "$17,266.18" "$17,266.18" "$7,603.83" "$8,751.28" "$17,266.18" "$13,001.31" "$13,001.31" "$14,394.30" "$11,050.30" "$8,751.28" "$27,625.89" "$12,504.76" "$13,503.00" "$17,266.18" "$18,298.72" "$17,266.18" "$18,129.49" "$53,173.50" "$17,266.18" "$15,574.09" "$17,266.18" "$13,503.00" "$11,477.55" "$56,151.01" "$17,266.18" "$56,718.20" "$15,226.35" "$8,334.55" "$17,266.18" "$41,120.84" "$18,129.49" "$9,023.87" "$18,826.92" "$8,751.28" "$17,266.18" N/A N/A MS159 DRG MS-DRG V39 (FY2022) 159 DENTAL AND ORAL DISEASES WITHOUT CC/MCC INPATIENT ONLY "$67,391.50" "$49,870.00" "$3,923.00" "$53,913.11" "$8,052.73" "$8,052.73" "$8,052.73" "$8,052.73" "$15,629.86" "$15,629.86" "$5,297.42" "$6,833.56" "$15,629.86" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$6,833.56" "$25,007.78" "$10,092.90" "$9,946.50" "$15,629.86" "$17,018.73" "$15,629.86" "$16,411.35" "$50,543.63" "$15,629.86" "$14,098.13" "$15,629.86" "$9,946.50" "$8,454.53" "$53,373.98" "$15,629.86" "$53,913.11" "$7,000.00" "$6,508.15" "$15,629.86" "$39,087.07" "$16,411.35" "$6,647.12" "$16,779.52" "$6,833.56" "$15,629.86" N/A N/A MS163 DRG MS-DRG V39 (FY2022) 163 MAJOR CHEST PROCEDURES WITH MCC INPATIENT ONLY "$272,180.50" "$201,414.00" "$41,138.31" "$217,744.24" "$161,853.74" "$161,853.74" "$161,853.74" "$161,853.74" "$45,607.88" "$45,607.88" "$54,456.49" "$53,850.16" "$45,607.88" "$132,364.86" "$132,364.86" "$139,136.55" "$92,876.87" "$53,850.16" "$72,972.61" "$133,711.34" "$176,917.20" "$45,607.88" "$46,259.96" "$45,607.88" "$47,888.27" "$204,135.38" "$45,607.88" "$41,138.31" "$45,607.88" "$176,917.20" "$176,917.20" "$215,566.79" "$45,607.88" "$217,744.24" "$173,254.12" "$51,285.84" "$45,607.88" "$157,864.69" "$47,888.27" "$50,189.69" "$54,288.47" "$53,850.16" "$45,607.88" N/A N/A MS164 DRG MS-DRG V39 (FY2022) 164 MAJOR CHEST PROCEDURES WITH CC INPATIENT ONLY "$224,363.00" "$166,029.00" "$23,786.34" "$179,490.22" "$143,418.81" "$143,418.81" "$143,418.81" "$143,418.81" "$29,381.09" "$29,381.09" "$35,577.42" "$24,975.67" "$29,381.09" "$88,661.90" "$88,661.90" "$93,264.56" "$59,295.13" "$24,975.67" "$47,009.74" "$87,287.48" "$145,835.80" "$29,381.09" "$30,110.08" "$29,381.09" "$30,850.14" "$168,272.25" "$29,381.09" "$26,501.74" "$29,381.09" "$145,835.80" "$145,835.80" "$177,695.31" "$29,381.09" "$179,490.22" "$130,130.41" "$23,786.34" "$29,381.09" "$130,130.54" "$30,850.14" "$26,620.54" "$33,985.26" "$24,975.67" "$29,381.09" N/A N/A MS165 DRG MS-DRG V39 (FY2022) 165 MAJOR CHEST PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$174,281.50" "$128,968.50" "$19,212.58" "$139,425.09" "$111,779.48" "$111,779.48" "$111,779.48" "$111,779.48" "$24,280.88" "$24,280.88" "$21,769.73" "$26,954.06" "$24,280.88" "$53,957.75" "$53,957.75" "$56,758.84" "$33,997.14" "$26,954.06" "$38,849.41" "$84,129.43" "$113,282.88" "$24,280.88" "$25,425.81" "$24,280.88" "$25,494.92" "$130,711.13" "$24,280.88" "$21,901.35" "$24,280.88" "$113,282.88" "$113,282.88" "$138,030.85" "$24,280.88" "$139,425.09" "$101,083.18" "$20,205.76" "$24,280.88" "$101,083.27" "$25,494.92" "$19,212.58" "$27,603.80" "$26,954.06" "$24,280.88" N/A N/A MS166 DRG MS-DRG V39 (FY2022) 166 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC INPATIENT ONLY "$174,824.50" "$129,370.50" "$32,677.10" "$139,859.44" "$32,677.10" "$32,677.10" "$32,677.10" "$32,677.10" "$37,846.46" "$37,846.46" "$32,677.10" "$40,290.32" "$37,846.46" "$52,536.00" "$52,536.00" "$55,263.28" "$32,960.73" "$40,290.32" "$32,677.10" "$32,677.10" "$32,677.10" "$36,751.19" "$37,846.46" "$37,846.46" "$38,588.75" "$131,118.38" "$37,846.46" "$37,846.46" "$37,846.46" "$32,677.10" "$32,677.10" "$138,460.85" "$36,751.19" "$139,859.44" "$32,677.10" "$40,290.32" "$36,751.19" "$101,398.21" "$38,588.75" "$32,677.10" "$32,677.10" "$40,290.32" "$37,846.46" N/A N/A MS167 DRG MS-DRG V39 (FY2022) 167 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC INPATIENT ONLY "$103,721.50" "$76,754.00" "$1,950.28" "$355,946.91" "$27,514.18" "$27,514.18" "$27,514.18" "$27,514.18" "$23,605.22" "$23,605.22" "$355,946.91" "$39,536.85" "$1,950.28" "$2,284.37" "$2,284.37" "$2,402.96" "$13,730.50" "$18,598.72" "$37,768.35" "$25,586.90" "$355,946.91" "$23,605.22" "$1,950.28" "$23,605.22" "$24,785.48" "$77,791.13" "$1,950.28" "$1,950.28" "$1,950.28" "$355,946.91" "$23,188.43" "$82,147.16" "$23,605.22" "$82,976.90" "$355,946.91" "$37,654.13" "$23,605.22" "$60,158.47" "$24,785.48" "$355,946.91" "$26,758.41" "$39,536.85" "$23,605.22" N/A N/A MS168 DRG MS-DRG V39 (FY2022) 168 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$156,025.00" "$115,458.50" "$12,448.72" "$124,819.98" "$99,956.87" "$99,956.87" "$99,956.87" "$99,956.87" "$20,400.85" "$20,400.85" "$16,031.58" "$18,365.07" "$20,400.85" "$40,205.29" "$40,205.29" "$42,292.45" "$23,972.12" "$18,365.07" "$32,641.36" "$75,326.46" "$101,416.23" "$20,400.85" "$21,787.99" "$20,400.85" "$21,420.89" "$117,018.75" "$20,400.85" "$18,401.57" "$20,400.85" "$101,416.23" "$101,416.23" "$123,571.77" "$20,400.85" "$124,819.98" "$90,494.48" "$12,448.72" "$20,400.85" "$90,494.50" "$21,420.89" "$13,576.91" "$22,749.05" "$18,365.07" "$20,400.85" N/A N/A MS175 DRG MS-DRG V39 (FY2022) 175 PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE INPATIENT ONLY "$65,307.00" "$48,327.50" "$7,000.00" "$52,245.23" "$19,762.97" "$19,762.97" "$19,762.97" "$19,762.97" "$21,723.17" "$21,723.17" "$13,630.48" "$14,985.97" "$21,723.17" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$14,985.97" "$34,757.07" "$18,799.53" "$23,190.00" "$21,723.17" "$21,639.42" "$21,723.17" "$22,809.33" "$48,980.25" "$21,723.17" "$19,594.30" "$21,723.17" "$23,190.00" "$19,711.50" "$51,722.76" "$21,723.17" "$52,245.23" "$17,500.00" "$14,272.35" "$21,723.17" "$37,878.06" "$22,809.33" "$15,497.58" "$24,403.57" "$14,985.97" "$21,723.17" N/A N/A MS176 DRG MS-DRG V39 (FY2022) 176 PULMONARY EMBOLISM WITHOUT MCC INPATIENT ONLY "$50,954.00" "$37,706.00" "$3,500.00" "$40,762.87" "$14,888.91" "$14,888.91" "$14,888.91" "$14,888.91" "$17,180.62" "$17,180.62" "$8,631.18" "$9,159.04" "$17,180.62" "$9,815.00" "$9,815.00" "$10,638.97" "$6,889.38" "$9,159.04" "$27,488.99" "$11,004.08" "$13,317.00" "$17,180.62" "$17,502.31" "$17,180.62" "$18,039.65" "$38,215.50" "$17,180.62" "$15,496.92" "$17,180.62" "$13,317.00" "$11,319.45" "$40,355.22" "$17,180.62" "$40,762.87" "$3,500.00" "$8,722.89" "$17,180.62" "$29,553.32" "$18,039.65" "$8,899.57" "$18,719.85" "$9,159.04" "$17,180.62" N/A N/A MS177 DRG MS-DRG V39 (FY2022) 177 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC INPATIENT ONLY "$62,529.00" "$46,271.50" "$7,526.51" "$50,023.09" "$14,644.67" "$14,644.67" "$14,644.67" "$14,644.67" "$26,137.26" "$26,137.26" "$17,398.03" "$18,110.89" "$26,137.26" "$10,722.38" "$10,722.38" "$12,474.40" "$7,526.51" "$18,110.89" "$41,819.62" "$23,955.67" "$27,736.50" "$26,137.26" "$26,701.78" "$26,137.26" "$27,444.12" "$46,896.75" "$26,137.26" "$23,575.81" "$26,137.26" "$31,364.87" "$27,204.40" "$49,522.85" "$26,137.26" "$50,023.09" "$10,500.00" "$17,248.46" "$26,137.26" "$36,266.82" "$27,444.12" "$18,535.95" "$29,984.33" "$18,110.89" "$26,137.26" N/A N/A MS178 DRG MS-DRG V39 (FY2022) 178 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC INPATIENT ONLY "$46,587.50" "$34,475.00" "$5,884.50" "$37,269.77" "$11,934.86" "$11,934.86" "$11,934.86" "$11,934.86" "$19,389.09" "$19,389.09" "$12,414.80" "$13,949.06" "$19,389.09" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$13,949.06" "$31,022.54" "$14,629.93" "$18,117.00" "$19,389.09" "$19,426.58" "$19,389.09" "$20,358.54" "$34,940.63" "$19,389.09" "$17,488.96" "$19,389.09" "$18,117.00" "$15,399.45" "$36,897.06" "$19,389.09" "$37,269.77" "$10,500.00" "$13,284.82" "$19,389.09" "$27,020.75" "$20,358.54" "$12,107.36" "$21,483.13" "$13,949.06" "$19,389.09" N/A N/A MS179 DRG MS-DRG V39 (FY2022) 179 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC INPATIENT ONLY "$38,337.50" "$28,370.00" "$1,961.50" "$30,669.98" "$4,129.67" "$4,129.67" "$4,129.67" "$4,129.67" "$17,076.41" "$17,076.41" "$8,651.71" "$6,880.87" "$17,076.41" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,880.87" "$27,322.26" "$10,570.70" "$13,090.50" "$17,076.41" "$17,272.31" "$17,076.41" "$17,930.23" "$28,753.13" "$17,076.41" "$15,402.92" "$17,076.41" "$13,090.50" "$11,126.93" "$30,363.28" "$17,076.41" "$30,669.98" "$3,500.00" "$6,553.21" "$17,076.41" "$22,235.75" "$17,930.23" "$8,748.21" "$18,589.47" "$6,880.87" "$17,076.41" N/A N/A MS180 DRG MS-DRG V39 (FY2022) 180 RESPIRATORY NEOPLASMS WITH MCC INPATIENT ONLY "$80,965.50" "$59,914.50" "$7,846.00" "$64,772.22" "$15,961.97" "$15,961.97" "$15,961.97" "$15,961.97" "$23,061.38" "$23,061.38" "$15,056.81" "$16,863.95" "$23,061.38" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$16,863.95" "$36,898.21" "$22,798.20" "$26,098.50" "$23,061.38" "$23,761.55" "$23,061.38" "$24,214.45" "$60,724.13" "$23,061.38" "$20,801.36" "$23,061.38" "$26,098.50" "$22,665.24" "$64,124.49" "$23,061.38" "$64,772.22" "$14,000.00" "$16,060.90" "$23,061.38" "$46,959.99" "$24,214.45" "$17,441.28" "$26,077.95" "$16,863.95" "$23,061.38" N/A N/A MS181 DRG MS-DRG V39 (FY2022) 181 RESPIRATORY NEOPLASMS WITH CC INPATIENT ONLY "$50,799.50" "$37,592.00" "$8,348.44" "$40,639.36" "$17,438.11" "$17,438.11" "$17,438.11" "$17,438.11" "$18,783.83" "$18,783.83" "$10,337.78" "$12,564.94" "$18,783.83" "$11,893.65" "$11,893.65" "$13,690.51" "$8,348.44" "$12,564.94" "$30,054.13" "$15,258.47" "$16,801.50" "$18,783.83" "$19,760.15" "$19,760.15" "$19,723.02" "$38,099.63" "$18,783.83" "$16,943.01" "$18,783.83" "$16,801.50" "$14,281.28" "$40,232.95" "$18,783.83" "$40,639.36" "$10,500.00" "$11,966.61" "$18,783.83" "$29,463.71" "$19,723.02" "$11,228.22" "$20,725.82" "$12,564.94" "$18,783.83" N/A N/A MS182 DRG MS-DRG V39 (FY2022) 182 RESPIRATORY NEOPLASMS WITHOUT CC/MCC INPATIENT ONLY "$44,939.50" "$33,255.50" "$3,923.00" "$35,951.39" "$8,871.27" "$8,871.27" "$8,871.27" "$8,871.27" "$16,519.46" "$16,519.46" "$7,219.13" "$7,167.53" "$16,519.46" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$7,167.53" "$26,431.14" "$11,944.86" "$11,880.00" "$16,519.46" "$18,001.57" N/A "$17,345.43" "$33,704.63" "$16,519.46" "$14,900.55" "$16,519.46" "$13,208.89" "$11,426.89" "$35,591.87" "$16,519.46" "$35,951.39" "$7,000.00" "$6,826.22" "$16,519.46" "$26,064.91" "$17,345.43" "$7,939.26" "$17,892.60" "$7,167.53" "$16,519.46" N/A N/A MS183 DRG MS-DRG V39 (FY2022) 183 MAJOR CHEST TRAUMA WITH MCC INPATIENT ONLY "$93,054.00" "$68,860.00" "$11,726.35" "$74,443.07" "$23,200.87" "$23,200.87" "$23,200.87" "$23,200.87" "$21,812.21" "$21,812.21" "$13,478.74" "$12,420.19" "$21,812.21" "$30,242.51" "$30,242.51" "$31,405.68" "$23,152.30" "$12,420.19" "$34,899.54" "$20,218.11" "$23,383.50" "$21,812.21" "$22,392.28" "$21,812.21" "$22,902.82" "$69,790.50" "$21,812.21" "$19,674.61" "$21,812.21" "$60,484.99" "$60,484.99" "$73,698.62" "$21,812.21" "$74,443.07" "$11,726.35" "$11,828.75" "$21,812.21" "$53,971.32" "$22,902.82" "$15,626.89" "$24,514.97" "$12,420.19" "$21,812.21" N/A N/A MS184 DRG MS-DRG V39 (FY2022) 184 MAJOR CHEST TRAUMA WITH CC INPATIENT ONLY "$69,760.50" "$51,623.00" "$7,515.51" "$55,808.13" "$10,950.28" "$10,950.28" "$10,950.28" "$10,950.28" "$18,237.24" "$18,237.24" "$8,826.65" "$7,891.29" "$18,237.24" "$13,119.92" "$13,119.92" "$13,624.53" "$11,133.55" "$7,891.29" "$29,179.58" "$14,067.35" "$15,613.50" "$18,237.24" "$19,128.01" "$18,237.24" "$19,149.10" "$52,320.38" "$18,237.24" "$16,449.99" "$18,237.24" "$45,344.10" "$45,344.10" "$55,250.06" "$18,237.24" "$55,808.13" "$8,226.35" "$7,515.51" "$18,237.24" "$40,461.09" "$19,149.10" "$10,434.30" "$20,041.91" "$7,891.29" "$18,237.24" N/A N/A MS185 DRG MS-DRG V39 (FY2022) 185 MAJOR CHEST TRAUMA WITHOUT CC/MCC INPATIENT ONLY "$64,153.00" "$47,473.50" "$4,646.62" "$51,322.22" "$11,008.51" "$11,008.51" "$11,008.51" "$11,008.51" "$16,401.44" "$16,401.44" "$5,915.97" "$4,878.96" "$16,401.44" "$13,119.92" "$13,119.92" "$13,624.53" "$11,133.55" "$4,878.96" "$26,242.30" "$10,161.55" "$11,623.50" "$16,401.44" "$17,055.16" "$16,401.44" "$17,221.51" "$48,114.75" "$16,401.44" "$14,794.10" "$16,401.44" "$41,699.31" "$41,699.31" "$50,808.99" "$16,401.44" "$51,322.22" "$8,226.35" "$4,646.62" "$16,401.44" "$37,208.74" "$17,221.51" "$7,767.84" "$17,744.93" "$4,878.96" "$16,401.44" N/A N/A MS186 DRG MS-DRG V39 (FY2022) 186 PLEURAL EFFUSION WITH MCC INPATIENT ONLY "$92,236.00" "$68,255.00" "$13,730.50" "$73,788.40" "$27,578.45" "$27,578.45" "$27,578.45" "$27,578.45" "$21,708.01" "$21,708.01" "$13,792.04" "$15,411.71" "$21,708.01" "$19,561.22" "$19,561.22" "$23,438.87" "$13,730.50" "$15,411.71" "$34,732.82" "$20,549.20" "$23,157.00" "$21,708.01" "$22,567.98" "$21,708.01" "$22,793.41" "$69,177.00" "$21,708.01" "$19,580.63" "$21,708.01" "$23,157.00" "$19,683.45" "$73,050.53" "$21,708.01" "$73,788.40" "$24,500.00" "$14,677.81" "$21,708.01" "$53,496.88" "$22,793.41" "$15,475.53" "$24,384.59" "$15,411.71" "$21,708.01" N/A N/A MS187 DRG MS-DRG V39 (FY2022) 187 PLEURAL EFFUSION WITH CC INPATIENT ONLY "$22,452.50" "$16,615.00" "$1,961.50" "$22,452.13" "$3,901.90" "$3,901.90" "$3,901.90" "$3,901.90" "$18,182.03" "$18,182.03" "$9,542.50" "$5,143.20" "$18,182.03" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$10,980.25" "$22,452.13" "$14,076.77" "$15,493.50" "$18,182.03" "$19,133.00" "$18,182.03" "$19,091.13" "$16,839.38" "$18,182.03" "$16,400.19" "$18,182.03" "$15,493.50" "$13,169.48" "$17,782.08" "$18,182.03" "$17,961.70" "$3,500.00" "$10,457.38" "$18,182.03" "$13,022.45" "$19,091.13" "$10,354.10" "$19,972.83" "$5,143.20" "$18,182.03" N/A N/A MS188 DRG MS-DRG V39 (FY2022) 188 PLEURAL EFFUSION WITHOUT CC/MCC INPATIENT ONLY "$19,629.00" "$14,525.50" "$1,961.50" "$19,628.85" "$4,033.04" "$4,033.04" "$4,033.04" "$4,033.04" "$16,088.11" "$16,088.11" "$6,791.59" "$4,496.46" "$16,088.11" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,126.84" "$19,628.85" "$9,744.32" "$10,942.50" "$16,088.11" "$16,833.74" "$16,088.11" "$16,892.52" "$14,721.75" "$16,088.11" "$14,511.48" "$16,088.11" "$10,942.50" "$9,301.13" "$15,546.06" "$16,088.11" "$15,703.08" "$3,500.00" "$5,835.08" "$16,088.11" "$11,384.82" "$16,892.52" "$7,312.74" "$17,352.89" "$4,496.46" "$16,088.11" N/A N/A MS189 DRG MS-DRG V39 (FY2022) 189 PULMONARY EDEMA AND RESPIRATORY FAILURE INPATIENT ONLY "$46,900.50" "$34,706.50" "$7,000.00" "$37,520.09" "$16,129.94" "$16,129.94" "$16,129.94" "$16,129.94" "$19,515.39" "$19,515.39" "$10,832.27" "$13,272.61" "$19,515.39" "$11,435.48" "$11,435.48" "$12,510.70" "$8,027.82" "$13,272.61" "$31,224.62" "$16,245.01" "$18,391.50" "$19,515.39" "$20,283.71" "$19,515.39" "$20,491.16" "$35,175.38" "$19,515.39" "$17,602.88" "$19,515.39" "$18,391.50" "$15,632.78" "$37,144.87" "$19,515.39" "$37,520.09" "$7,000.00" "$12,640.58" "$19,515.39" "$27,202.29" "$20,491.16" "$12,290.81" "$21,641.16" "$13,272.61" "$19,515.39" N/A N/A MS190 DRG MS-DRG V39 (FY2022) 190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC INPATIENT ONLY "$44,439.50" "$32,885.50" "$3,923.00" "$35,551.51" "$8,152.43" "$8,152.43" "$8,152.43" "$8,152.43" "$18,818.34" "$18,818.34" "$10,481.48" "$10,597.09" "$18,818.34" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$10,597.09" "$30,109.34" "$14,609.74" "$16,876.50" "$18,818.34" "$19,415.86" "$19,415.86" "$19,759.26" "$33,329.63" "$18,818.34" "$16,974.14" "$18,818.34" "$16,876.50" "$14,345.03" "$35,195.98" "$18,818.34" "$35,551.51" "$7,000.00" "$10,092.46" "$18,818.34" "$25,774.91" "$19,759.26" "$11,278.34" "$20,768.99" "$10,597.09" "$18,818.34" N/A N/A MS191 DRG MS-DRG V39 (FY2022) 191 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC INPATIENT ONLY "$42,239.00" "$31,257.00" "$6,157.23" "$33,791.11" "$12,411.17" "$12,411.17" "$12,411.17" "$12,411.17" "$17,156.46" "$17,156.46" "$8,363.41" "$8,483.54" "$17,156.46" "$8,769.84" "$8,769.84" "$8,720.82" "$6,157.23" "$8,483.54" "$27,450.34" "$11,631.27" "$13,264.50" "$17,156.46" "$17,835.16" "$17,835.16" "$18,014.28" "$31,679.25" "$17,156.46" "$15,475.13" "$17,156.46" "$13,264.50" "$11,274.83" "$33,453.19" "$17,156.46" "$33,791.11" "$8,363.41" "$8,079.55" "$17,156.46" "$24,498.62" "$18,014.28" "$8,864.50" "$18,689.63" "$8,483.54" "$17,156.46" N/A N/A MS192 DRG MS-DRG V39 (FY2022) 192 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC INPATIENT ONLY "$22,724.00" "$16,816.00" "$3,923.00" "$22,723.63" "$7,911.56" "$7,911.56" "$7,911.56" "$7,911.56" "$15,854.15" "$15,854.15" "$6,417.60" "$6,654.75" "$15,854.15" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$6,654.75" "$22,723.63" "$8,776.61" "$10,434.00" "$15,854.15" "$16,320.17" "$15,854.15" "$16,646.86" "$17,043.00" "$15,854.15" "$14,300.44" "$15,854.15" "$10,434.00" "$8,868.90" "$17,997.11" "$15,854.15" "$18,178.91" "$7,000.00" "$6,337.86" "$15,854.15" "$13,179.92" "$16,646.86" "$6,972.91" "$17,060.16" "$6,654.75" "$15,854.15" N/A N/A MS193 DRG MS-DRG V39 (FY2022) 193 SIMPLE PNEUMONIA AND PLEURISY WITH MCC INPATIENT ONLY "$58,342.00" "$43,173.50" "$10,500.00" "$46,673.39" "$24,282.84" "$24,282.84" "$24,282.84" "$24,282.84" "$20,108.24" "$20,108.24" "$12,934.28" "$12,713.48" "$20,108.24" "$17,153.22" "$17,153.22" "$18,766.05" "$12,041.73" "$12,713.48" "$32,173.18" "$17,479.20" "$19,680.00" "$20,108.24" "$20,938.71" "$20,108.24" "$21,113.65" "$43,756.50" "$20,108.24" "$18,137.63" "$20,108.24" "$19,680.00" "$16,728.00" "$46,206.65" "$20,108.24" "$46,673.39" "$10,500.00" "$12,108.07" "$20,108.24" "$33,838.36" "$21,113.65" "$13,151.89" "$22,382.93" "$12,713.48" "$20,108.24" N/A N/A MS194 DRG MS-DRG V39 (FY2022) 194 SIMPLE PNEUMONIA AND PLEURISY WITH CC INPATIENT ONLY "$32,735.50" "$24,224.50" "$3,923.00" "$27,225.07" "$8,050.01" "$8,050.01" "$8,050.01" "$8,050.01" "$17,015.67" "$17,015.67" "$8,647.25" "$8,799.53" "$17,015.67" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$8,799.53" "$27,225.07" "$11,308.25" "$17,218.50" "$17,015.67" "$17,663.73" "$17,015.67" "$17,866.45" "$24,551.63" "$17,015.67" "$15,348.13" "$17,015.67" "$12,958.50" "$11,014.73" "$25,926.30" "$17,015.67" "$26,188.20" "$7,000.00" "$8,380.50" "$17,015.67" "$18,986.59" "$17,866.45" "$8,660.00" "$18,513.47" "$8,799.53" "$17,015.67" N/A N/A MS195 DRG MS-DRG V39 (FY2022) 195 SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC INPATIENT ONLY "$22,324.00" "$16,520.00" "$1,961.50" "$22,323.82" "$4,165.52" "$4,165.52" "$4,165.52" "$4,165.52" "$15,648.49" "$15,648.49" "$6,287.28" "$5,113.81" "$15,648.49" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,633.94" "$22,323.82" "$8,637.99" "$9,987.00" "$15,648.49" "$16,246.60" "$15,648.49" "$16,430.91" "$16,743.00" "$15,648.49" "$14,114.94" "$15,648.49" "$9,987.00" "$8,488.95" "$17,680.46" "$15,648.49" "$17,859.06" "$3,500.00" "$6,318.04" "$15,648.49" "$12,947.92" "$16,430.91" "$6,674.19" "$16,802.83" "$5,113.81" "$15,648.49" N/A N/A MS196 DRG MS-DRG V39 (FY2022) 196 INTERSTITIAL LUNG DISEASE WITH MCC INPATIENT ONLY "$54,057.00" "$40,002.50" "$10,262.05" "$43,245.34" "$21,162.51" "$21,162.51" "$21,162.51" "$21,162.51" "$23,052.43" "$23,052.43" "$14,847.95" "$12,297.20" "$23,052.43" "$14,616.40" "$14,616.40" "$14,534.70" "$10,262.05" "$12,297.20" "$36,883.89" "$23,387.70" "$26,079.00" "$23,052.43" "$24,074.40" "$27,317.95" "$24,205.05" "$40,542.75" "$23,052.43" "$20,793.29" "$23,052.43" "$26,845.96" "$22,934.11" "$42,812.88" "$23,052.43" "$43,245.34" N/A "$11,711.61" "$23,052.43" "$31,353.06" "$24,205.05" "$17,428.26" "$26,066.74" "$12,297.20" "$23,052.43" N/A N/A MS197 DRG MS-DRG V39 (FY2022) 197 INTERSTITIAL LUNG DISEASE WITH CC INPATIENT ONLY "$38,308.00" "$28,348.00" "$7,846.00" "$30,646.27" "$15,708.36" "$15,708.36" "$15,708.36" "$15,708.36" "$18,003.28" "$18,003.28" "$9,474.66" "$9,669.92" "$18,003.28" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$9,669.92" "$28,805.25" "$13,238.27" "$15,105.00" "$18,003.28" "$18,688.00" "$18,003.28" "$18,903.44" "$28,731.00" "$18,003.28" "$16,238.96" "$18,003.28" "$15,105.00" "$12,839.25" "$30,339.80" "$18,003.28" "$30,646.27" "$14,000.00" "$9,209.45" "$18,003.28" "$22,218.64" "$18,903.44" "$10,094.47" "$19,749.17" "$9,669.92" "$18,003.28" N/A N/A MS198 DRG MS-DRG V39 (FY2022) 198 INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC INPATIENT ONLY "$65,526.50" "$48,490.00" "$5,884.50" "$52,421.17" "$12,151.96" "$12,151.96" "$12,151.96" "$12,151.96" "$16,184.03" "$16,184.03" "$7,188.78" "$6,417.29" "$16,184.03" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$6,417.29" "$25,894.45" "$9,568.00" "$11,151.00" "$16,184.03" "$16,740.16" "$16,184.03" "$16,993.23" "$49,144.88" "$16,184.03" "$14,598.00" "$16,184.03" "$11,732.73" "$10,060.08" "$51,896.95" "$16,184.03" "$52,421.17" "$10,500.00" "$6,111.70" "$16,184.03" "$38,005.37" "$16,993.23" "$7,452.06" "$17,472.92" "$6,417.29" "$16,184.03" N/A N/A MS199 DRG MS-DRG V39 (FY2022) 199 PNEUMOTHORAX WITH MCC INPATIENT ONLY "$92,383.00" "$68,363.50" "$8,226.35" "$73,906.26" "$22,279.95" "$22,279.95" "$22,279.95" "$22,279.95" "$23,407.13" "$23,407.13" "$16,374.25" "$14,325.60" "$23,407.13" "$19,105.51" "$19,105.51" "$19,325.24" "$15,336.94" "$14,325.60" "$37,451.41" "$23,669.00" "$26,850.00" "$23,407.13" "$24,223.67" "$23,407.13" "$24,577.49" "$69,287.25" "$23,407.13" "$21,113.23" "$23,407.13" "$27,448.82" "$23,421.32" "$73,167.19" "$23,407.13" "$73,906.26" "$8,226.35" "$13,643.43" "$23,407.13" "$53,582.14" "$24,577.49" "$17,943.50" "$26,510.57" "$14,325.60" "$23,407.13" N/A N/A MS200 DRG MS-DRG V39 (FY2022) 200 PNEUMOTHORAX WITH CC INPATIENT ONLY "$65,947.50" "$48,801.50" "$6,868.57" "$52,757.72" "$16,541.46" "$16,541.46" "$16,541.46" "$16,541.46" "$18,482.92" "$18,482.92" "$9,000.71" "$7,212.00" "$18,482.92" "$10,530.81" "$10,530.81" "$10,935.84" "$7,391.82" "$7,212.00" "$29,572.67" "$14,428.05" "$16,147.50" "$18,482.92" "$19,319.43" "$18,482.92" "$19,407.07" "$49,460.63" "$18,482.92" "$16,671.59" "$18,482.92" "$16,147.50" "$13,725.38" "$52,230.13" "$18,482.92" "$52,757.72" "$13,375.34" "$6,868.57" "$18,482.92" "$38,249.55" "$19,407.07" "$10,791.16" "$20,349.32" "$7,212.00" "$18,482.92" N/A N/A MS201 DRG MS-DRG V39 (FY2022) 201 PNEUMOTHORAX WITHOUT CC/MCC INPATIENT ONLY "$56,772.00" "$42,011.50" "$5,554.86" "$45,417.55" "$21,519.05" "$21,519.05" "$21,519.05" "$21,519.05" "$15,950.78" "$15,950.78" "$6,333.70" "$5,832.61" "$15,950.78" "$18,590.23" "$18,590.23" "$21,091.12" "$14,973.30" "$5,832.61" "$25,521.25" "$9,796.81" "$10,644.00" "$15,950.78" "$16,861.59" "$15,950.78" "$16,748.32" "$42,579.00" "$15,950.78" "$14,387.60" "$15,950.78" "$11,363.95" "$9,767.35" "$44,963.36" "$15,950.78" "$45,417.55" "$18,128.85" "$5,554.86" "$15,950.78" "$32,927.76" "$16,748.32" "$7,113.25" "$17,181.05" "$5,832.61" "$15,950.78" N/A N/A MS202 DRG MS-DRG V39 (FY2022) 202 BRONCHITIS AND ASTHMA WITH CC/MCC INPATIENT ONLY "$43,546.00" "$32,224.50" "$3,500.00" "$34,836.62" "$8,343.52" "$8,343.52" "$8,343.52" "$8,343.52" "$17,727.21" "$17,727.21" "$7,832.33" "$8,183.63" "$17,727.21" "$6,304.73" "$6,304.73" "$6,993.69" "$4,425.44" "$8,183.63" "$28,363.54" "$12,460.34" "$14,505.00" "$17,727.21" "$18,275.15" "$17,727.21" "$18,613.57" "$32,659.50" "$17,727.21" "$15,989.94" "$17,727.21" "$14,505.00" "$12,329.25" "$34,488.23" "$17,727.21" "$34,836.62" "$3,500.00" "$7,793.93" "$17,727.21" "$25,256.68" "$18,613.57" "$9,693.50" "$19,403.75" "$8,183.63" "$17,727.21" N/A N/A MS203 DRG MS-DRG V39 (FY2022) 203 BRONCHITIS AND ASTHMA WITHOUT CC/MCC INPATIENT ONLY "$18,454.50" "$13,656.50" "$1,961.50" "$18,454.26" "$4,032.86" "$4,032.86" "$4,032.86" "$4,032.86" "$15,932.82" "$15,932.82" "$5,832.96" "$4,227.39" "$15,932.82" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$5,866.67" "$18,454.26" "$8,978.50" "$10,605.00" "$15,932.82" "$16,427.31" "$15,932.82" "$16,729.46" "$13,840.88" "$15,932.82" "$14,371.40" "$15,932.82" "$10,605.00" "$9,014.25" "$14,615.78" "$15,932.82" "$14,763.41" "$3,500.00" "$5,587.30" "$15,932.82" "$10,703.61" "$16,729.46" "$7,087.18" "$17,158.59" "$4,227.39" "$15,932.82" N/A N/A MS204 DRG MS-DRG V39 (FY2022) 204 RESPIRATORY SIGNS AND SYMPTOMS INPATIENT ONLY "$53,976.50" "$39,943.00" "$6,284.61" "$43,180.96" "$9,395.04" "$9,395.04" "$9,395.04" "$9,395.04" "$16,530.50" "$16,530.50" "$6,284.61" "$7,541.24" "$16,530.50" "$10,206.85" "$10,206.85" "$11,045.89" "$9,088.80" "$7,541.24" "$26,448.80" "$10,893.71" "$11,904.00" "$16,530.50" "$17,443.73" "$16,530.50" "$17,357.03" "$40,482.38" "$16,530.50" "$14,910.51" "$16,530.50" "$11,904.00" "$10,118.40" "$42,749.16" "$16,530.50" "$43,180.96" "$11,726.35" "$7,182.13" "$16,530.50" "$31,306.37" "$17,357.03" "$7,955.30" "$17,906.41" "$7,541.24" "$16,530.50" N/A N/A MS205 DRG MS-DRG V39 (FY2022) 205 OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC INPATIENT ONLY "$80,470.00" "$59,548.00" "$10,552.89" "$64,375.65" "$23,950.40" "$23,950.40" "$23,950.40" "$23,950.40" "$22,681.11" "$22,681.11" "$12,495.13" "$11,080.54" "$22,681.11" "$16,895.58" "$16,895.58" "$19,648.99" "$11,859.91" "$11,080.54" "$36,289.78" "$23,970.48" "$25,272.00" "$22,681.11" "$24,383.69" "$22,681.11" "$23,815.17" "$60,352.50" "$22,681.11" "$20,458.36" "$22,681.11" "$25,272.00" "$21,949.80" "$63,731.89" "$22,681.11" "$64,375.65" "$17,500.00" "$10,552.89" "$22,681.11" "$46,672.60" "$23,815.17" "$16,888.95" "$25,602.14" "$11,080.54" "$22,681.11" N/A N/A MS206 DRG MS-DRG V39 (FY2022) 206 OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC INPATIENT ONLY "$43,834.50" "$32,438.00" "$2,052.41" "$35,067.35" "$4,376.73" "$4,376.73" "$4,376.73" "$4,376.73" "$17,168.19" "$17,168.19" "$7,088.81" "$6,502.44" "$17,168.19" "$2,923.28" "$2,923.28" "$2,906.94" "$2,052.41" "$6,502.44" "$27,469.10" "$12,024.27" "$13,290.00" "$17,168.19" "$18,043.72" "$17,168.19" "$18,026.60" "$32,875.88" "$17,168.19" "$15,485.71" "$17,168.19" "$13,290.00" "$11,296.50" "$34,716.65" "$17,168.19" "$35,067.35" "$7,088.81" "$6,192.79" "$17,168.19" "$25,424.01" "$18,026.60" "$8,881.54" "$18,704.31" "$6,502.44" "$17,168.19" N/A N/A MS207 DRG MS-DRG V39 (FY2022) 207 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS INPATIENT ONLY "$306,703.00" "$226,960.50" "$50,641.13" "$281,124.88" "$196,185.83" "$196,185.83" "$196,185.83" "$196,185.83" "$58,814.57" "$58,814.57" "$281,124.88" "$66,097.21" "$58,814.57" "$148,735.91" "$148,735.91" "$156,454.98" "$103,082.37" N/A "$281,124.88" "$281,124.88" "$281,124.88" "$50,641.13" "$58,814.57" "$58,814.57" "$53,173.19" "$230,027.25" "$58,814.57" "$58,814.57" "$58,814.57" "$281,124.88" "$281,124.88" "$242,908.50" "$50,641.13" "$245,362.13" "$281,124.88" N/A "$58,561.31" "$177,887.74" "$53,173.19" "$281,124.88" "$60,586.16" N/A "$58,814.57" N/A N/A MS208 DRG MS-DRG V39 (FY2022) 208 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS INPATIENT ONLY "$136,376.50" "$100,919.00" "$13,528.89" "$109,100.85" "$87,357.19" "$87,357.19" "$87,357.19" "$87,357.19" "$30,234.36" "$30,234.36" "$20,501.51" "$20,116.58" "$28,616.41" "$25,879.13" "$25,879.13" "$27,222.58" "$13,528.89" "$20,499.96" "$45,786.26" "$34,994.75" "$47,812.15" "$28,616.41" "$30,234.36" "$30,234.36" "$30,047.23" "$102,282.38" "$30,234.36" "$30,234.36" "$28,616.41" "$88,644.44" "$88,644.44" "$108,009.83" "$28,616.41" "$109,100.85" "$47,812.15" "$19,158.64" "$28,616.41" "$79,098.37" "$30,047.23" "$47,812.15" "$33,028.48" "$20,116.58" "$28,616.41" N/A N/A MS215 DRG MS-DRG V39 (FY2022) 215 OTHER HEART ASSIST SYSTEM IMPLANT INPATIENT ONLY "$278,907.50" "$206,392.00" "$83,922.24" "$223,125.74" "$177,689.39" "$177,689.39" "$177,689.39" "$177,689.39" "$88,118.35" "$88,118.35" "$177,689.39" N/A "$88,118.35" "$155,554.25" "$155,554.25" "$164,572.82" "$107,260.96" N/A "$177,689.39" "$177,689.39" "$177,689.39" "$83,922.24" "$88,118.35" "$88,118.35" "$88,118.35" "$209,180.63" "$88,118.35" "$88,118.35" "$88,118.35" "$181,289.66" "$177,689.39" "$220,894.46" "$83,922.24" "$223,125.74" "$177,689.39" N/A "$83,922.24" "$161,766.35" "$88,118.35" "$177,689.39" "$177,689.39" N/A "$88,118.35" N/A N/A MS216 DRG MS-DRG V39 (FY2022) 216 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC INPATIENT ONLY "$430,623.00" "$318,661.50" "$72,466.37" "$344,498.01" "$272,703.16" "$272,703.16" "$272,703.16" "$272,703.16" N/A N/A "$104,974.35" "$121,411.91" "$80,339.66" "$238,113.73" "$238,113.73" "$250,335.57" "$167,959.00" "$121,411.91" "$261,360.89" "$193,003.88" "$279,904.63" "$80,339.66" N/A "$80,339.66" "$84,356.64" "$322,967.25" N/A "$72,466.37" "$80,339.66" "$279,904.63" "$279,904.63" "$341,053.01" "$80,339.66" "$344,498.01" "$249,761.06" "$115,630.34" "$80,339.66" "$249,761.34" "$84,356.64" "$100,637.00" "$97,745.39" "$121,411.91" "$80,339.66" N/A N/A MS217 DRG MS-DRG V39 (FY2022) 217 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC INPATIENT ONLY "$443,780.00" "$328,397.50" "$50,331.00" "$355,023.78" "$277,515.77" "$277,515.77" "$277,515.77" "$277,515.77" "$55,799.33" "$55,799.33" "$97,134.85" "$121,411.91" "$55,799.33" "$248,158.21" "$248,158.21" "$260,710.77" "$174,896.50" "$121,411.91" "$89,278.93" "$199,138.51" "$288,456.82" "$55,799.33" "$57,010.63" "$55,799.33" "$58,589.30" "$332,835.00" "$55,799.33" "$50,331.00" N/A "$288,456.82" "$288,456.82" "$351,473.55" "$55,799.33" "$355,023.78" "$257,392.24" "$115,630.34" "$55,799.33" "$257,392.40" "$58,589.30" "$80,207.75" "$67,040.17" "$121,411.91" "$55,799.33" N/A N/A MS219 DRG MS-DRG V39 (FY2022) 219 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC INPATIENT ONLY "$448,086.50" "$331,584.50" "$66,662.96" "$358,469.17" N/A N/A N/A N/A "$69,721.25" "$69,721.25" N/A N/A "$69,721.25" "$250,046.76" "$250,046.76" N/A "$176,646.60" N/A N/A N/A N/A "$69,721.25" "$69,721.25" "$69,721.25" "$69,721.25" "$336,064.88" "$69,721.25" "$69,721.25" "$69,721.25" N/A N/A "$354,884.49" "$66,662.96" "$358,469.17" N/A N/A "$66,662.96" "$259,890.17" "$69,996.11" N/A N/A N/A "$69,721.25" N/A N/A MS220 DRG MS-DRG V39 (FY2022) 220 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC INPATIENT ONLY "$357,898.50" "$264,845.00" "$48,358.12" "$286,318.77" N/A N/A N/A N/A N/A N/A N/A N/A N/A "$150,282.61" "$150,282.61" "$150,282.61" "$150,282.61" N/A N/A N/A N/A N/A N/A N/A "$50,776.03" "$268,423.88" N/A N/A N/A N/A N/A "$283,455.59" N/A "$286,318.77" N/A N/A "$48,358.12" "$207,581.13" N/A N/A N/A N/A N/A N/A N/A MS222 DRG MS-DRG V39 (FY2022) 222 "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITH MCC" INPATIENT ONLY "$411,884.50" "$304,795.00" "$238,893.01" "$308,913.38" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$308,913.38" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$238,893.01" N/A N/A N/A N/A N/A N/A N/A MS223 DRG MS-DRG V39 (FY2022) 223 "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITHOUT MCC" INPATIENT ONLY "$290,043.00" "$214,632.00" "$51,072.49" "$232,034.17" "$169,759.84" "$169,759.84" "$169,759.84" "$169,759.84" N/A N/A N/A N/A N/A "$136,167.63" "$136,167.63" "$142,437.70" "$92,314.46" N/A N/A N/A "$188,527.77" "$51,072.49" N/A N/A "$53,626.11" "$217,532.25" N/A N/A N/A N/A "$188,527.77" "$229,713.83" "$51,072.49" "$232,034.17" N/A N/A "$51,072.49" "$168,224.94" "$53,626.11" N/A N/A N/A N/A N/A N/A MS224 DRG MS-DRG V39 (FY2022) 224 "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITH MCC" INPATIENT ONLY "$164,283.00" "$121,569.50" "$25,208.87" "$131,426.12" "$100,953.96" "$100,953.96" "$100,953.96" "$100,953.96" "$62,946.52" "$62,946.52" "$68,489.80" "$50,616.44" "$62,299.14" "$42,364.93" "$42,364.93" "$44,396.80" "$25,208.87" "$50,616.44" "$100,714.43" "$87,528.52" "$106,783.71" "$62,946.52" "$62,299.14" "$62,946.52" "$66,093.85" "$123,212.25" "$62,946.52" "$56,777.76" "$62,946.52" "$106,783.71" "$106,783.71" "$130,111.83" "$62,946.52" "$131,426.12" "$95,283.93" "$48,206.11" "$62,946.52" "$95,284.14" "$66,093.85" "$75,373.75" "$75,982.84" "$50,616.44" "$62,946.52" N/A N/A MS226 DRG MS-DRG V39 (FY2022) 226 CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC INPATIENT ONLY "$130,438.50" "$96,524.50" "$26,537.58" "$104,350.71" "$33,262.39" "$33,262.39" "$33,262.39" "$33,262.39" "$56,361.78" "$56,361.78" "$62,098.98" "$49,259.76" "$56,361.78" "$37,803.53" "$37,803.53" "$41,045.68" "$26,537.58" "$49,259.76" "$90,178.85" "$72,752.89" "$84,784.95" "$56,361.78" "$57,382.74" "$57,382.74" "$59,179.87" "$97,828.88" "$56,361.78" "$50,838.33" "$56,361.78" "$84,784.95" "$84,784.95" "$103,307.18" "$56,361.78" "$104,350.71" "$31,347.05" "$46,914.03" "$56,361.78" "$75,654.33" "$59,179.87" "$65,809.55" "$67,743.92" "$49,259.76" "$56,361.78" N/A N/A MS227 DRG MS-DRG V39 (FY2022) 227 CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC INPATIENT ONLY "$189,601.00" "$140,305.00" "$40,508.25" "$151,680.79" "$114,316.25" "$114,316.25" "$114,316.25" "$114,316.25" "$47,024.76" "$47,024.76" "$48,638.98" "$43,432.66" "$47,024.76" "$63,870.36" "$63,870.36" "$66,831.53" "$40,508.25" "$46,867.11" "$75,239.62" "$87,984.15" "$123,240.64" "$47,024.76" "$47,524.25" "$47,024.76" "$49,376.00" "$142,200.75" "$47,024.76" "$42,416.33" "$47,024.76" "$123,240.64" "$123,240.64" "$150,163.98" "$47,024.76" "$151,680.79" "$109,968.57" "$44,635.32" "$47,024.76" "$109,968.58" "$49,376.00" "$52,247.68" "$56,061.29" "$43,432.66" "$47,024.76" N/A N/A MS228 DRG MS-DRG V39 (FY2022) 228 OTHER CARDIOTHORACIC PROCEDURES WITH MCC INPATIENT ONLY "$78,177.00" "$57,851.00" "$17,653.50" "$78,176.66" "$76,976.92" "$76,976.92" "$76,976.92" "$76,976.92" "$47,840.51" "$47,840.51" "$65,258.69" "$53,996.80" "$47,840.51" "$25,150.14" "$25,150.14" "$30,135.69" "$17,653.50" "$53,996.80" "$76,544.82" "$66,329.99" "$78,176.66" "$47,840.51" "$46,864.26" "$47,840.51" "$50,232.54" "$58,632.75" "$47,840.51" "$43,152.14" "$47,840.51" "$78,176.66" "$69,161.06" "$61,915.91" "$47,840.51" "$62,541.33" "$31,500.00" "$51,425.50" "$47,840.51" "$45,342.66" "$50,232.54" "$53,432.55" "$57,081.97" "$53,996.80" "$47,840.51" N/A N/A MS229 DRG MS-DRG V39 (FY2022) 229 OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC INPATIENT ONLY "$27,843.00" "$20,604.00" "$5,884.50" "$40,769.12" "$27,806.65" "$27,806.65" "$27,806.65" "$27,806.65" "$34,802.91" "$34,802.91" "$27,842.95" "$34,549.10" "$34,802.91" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$34,549.10" "$27,842.95" "$28,322.95" "$27,842.95" "$34,802.91" "$35,240.03" "$34,802.91" "$36,543.06" "$20,882.25" "$34,802.91" "$31,392.22" "$34,802.91" "$27,842.95" "$27,842.95" "$22,051.60" "$34,802.91" "$22,274.36" "$10,500.00" "$32,903.89" "$34,802.91" "$16,148.94" "$36,543.06" "$27,842.95" "$40,769.12" "$34,549.10" "$27,842.95" N/A N/A MS231 DRG MS-DRG V39 (FY2022) 231 CORONARY BYPASS WITH PTCA WITH MCC INPATIENT ONLY "$446,845.50" "$330,666.00" "$71,206.24" "$357,476.05" "$285,071.29" "$285,071.29" "$285,071.29" "$285,071.29" N/A N/A N/A N/A N/A "$248,803.68" "$248,803.68" "$261,695.82" "$175,984.18" N/A N/A N/A "$290,449.29" "$71,206.24" N/A N/A "$74,766.55" "$335,134.13" N/A N/A N/A "$290,449.29" N/A "$353,901.29" "$71,206.24" "$357,476.05" N/A N/A "$71,206.24" "$259,170.39" "$74,766.55" N/A N/A N/A N/A N/A N/A MS232 DRG MS-DRG V39 (FY2022) 232 CORONARY BYPASS WITH PTCA WITHOUT MCC INPATIENT ONLY "$521,866.50" "$386,181.50" "$52,143.59" "$391,399.88" N/A N/A N/A N/A "$53,503.49" "$53,503.49" N/A N/A "$53,503.49" N/A N/A N/A N/A N/A N/A N/A N/A "$53,503.49" "$53,503.49" "$53,503.49" "$53,503.49" "$391,399.88" "$53,503.49" "$53,503.49" "$53,503.49" N/A N/A N/A "$53,503.49" N/A N/A N/A "$53,503.49" "$302,682.57" "$53,503.49" N/A N/A N/A "$52,143.59" N/A N/A MS233 DRG MS-DRG V39 (FY2022) 233 CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC INPATIENT ONLY "$545,770.00" "$403,870.00" "$66,982.69" "$409,327.50" N/A N/A N/A N/A "$66,982.69" "$66,982.69" N/A N/A "$66,982.69" N/A N/A N/A N/A N/A N/A N/A N/A "$66,982.69" "$66,982.69" "$66,982.69" "$66,982.69" "$409,327.50" "$66,982.69" "$66,982.69" "$66,982.69" N/A N/A N/A "$66,982.69" N/A N/A N/A "$66,982.69" "$316,546.60" "$66,982.69" N/A N/A N/A "$66,982.69" N/A N/A MS234 DRG MS-DRG V39 (FY2022) 234 CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC INPATIENT ONLY "$450,670.00" "$333,496.00" "$47,879.86" "$360,535.81" "$271,224.19" "$271,224.19" "$271,224.19" "$271,224.19" "$63,828.92" "$63,828.92" "$271,224.19" N/A "$63,828.92" N/A N/A N/A N/A N/A "$271,224.19" "$271,224.19" "$271,224.19" "$63,828.92" "$63,828.92" "$63,828.92" "$63,828.92" "$338,002.50" "$63,828.92" "$63,828.92" "$63,828.92" "$271,224.19" "$271,224.19" "$356,930.46" "$63,828.92" "$360,535.81" "$261,260.37" N/A "$47,879.86" "$261,388.60" "$63,828.92" "$271,224.19" "$271,224.19" N/A "$63,828.92" N/A N/A MS235 DRG MS-DRG V39 (FY2022) 235 CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC INPATIENT ONLY "$434,088.50" "$321,225.50" "$53,180.90" "$347,270.45" N/A N/A N/A N/A N/A N/A N/A N/A N/A "$259,045.52" "$259,045.52" "$272,098.25" "$182,963.39" N/A N/A N/A N/A "$53,180.90" N/A N/A "$55,839.95" "$325,566.38" N/A N/A N/A N/A N/A "$343,797.73" "$53,180.90" "$347,270.45" N/A N/A "$53,180.90" "$251,771.33" "$55,839.95" N/A N/A N/A N/A N/A N/A MS236 DRG MS-DRG V39 (FY2022) 236 CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC INPATIENT ONLY "$395,796.50" "$292,889.50" "$39,328.90" "$420,491.23" N/A N/A N/A N/A "$420,491.23" "$420,491.23" N/A N/A "$420,491.23" "$213,948.38" "$213,948.38" "$225,054.30" "$150,622.80" N/A N/A N/A "$257,267.67" "$39,328.90" "$420,491.23" "$420,491.23" "$41,295.35" "$296,847.38" "$420,491.23" "$393,875.70" "$393,875.70" N/A N/A "$313,470.76" "$39,328.90" "$316,637.13" N/A N/A "$39,328.90" "$229,561.97" "$41,295.35" N/A N/A N/A "$420,491.23" N/A N/A MS239 DRG MS-DRG V39 (FY2022) 239 AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC INPATIENT ONLY "$337,776.00" "$249,954.50" "$52,711.33" "$270,220.80" N/A N/A N/A N/A "$52,711.33" "$52,711.33" N/A N/A "$52,711.33" "$171,651.10" "$171,651.10" N/A N/A N/A N/A N/A N/A "$52,711.33" "$52,711.33" "$52,711.33" "$52,711.33" "$253,332.00" "$52,711.33" "$52,711.33" "$52,711.33" N/A N/A "$267,518.59" "$52,711.33" "$270,220.80" N/A N/A "$52,711.33" "$195,910.08" "$52,711.33" N/A N/A N/A "$52,711.33" N/A N/A MS240 DRG MS-DRG V39 (FY2022) 240 AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC INPATIENT ONLY "$215,354.00" "$159,362.00" "$30,300.37" "$172,283.13" "$100,009.25" "$100,009.25" "$100,009.25" "$100,009.25" "$36,115.63" "$36,115.63" "$100,009.25" N/A "$36,115.63" "$83,682.98" "$83,682.98" N/A "$55,665.69" N/A "$100,009.25" "$100,009.25" "$100,009.25" "$30,300.37" "$36,115.63" "$36,115.63" "$31,815.39" "$161,515.50" "$36,115.63" "$36,115.63" "$36,115.63" "$100,009.25" "$100,009.25" "$170,560.30" "$30,300.37" "$172,283.13" "$100,009.25" N/A "$30,300.37" "$124,905.32" "$31,815.39" "$100,009.25" "$100,009.25" N/A "$36,115.63" N/A N/A MS241 DRG MS-DRG V39 (FY2022) 241 AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC INPATIENT ONLY "$103,671.50" "$76,717.00" "$1,869.09" "$82,937.20" "$31,639.15" "$31,639.15" "$31,639.15" "$31,639.15" "$22,043.40" "$22,043.40" N/A "$10,703.05" "$22,043.40" "$1,869.09" "$1,869.09" "$1,966.12" "$15,692.00" "$10,703.05" "$35,269.44" "$20,846.65" "$67,386.48" "$22,043.40" "$22,725.85" "$22,043.40" "$23,145.57" "$77,753.63" "$22,043.40" "$19,883.15" "$22,043.40" "$24,500.96" "$20,918.06" "$82,107.82" "$22,043.40" "$82,937.20" N/A "$10,193.38" "$22,043.40" "$60,129.47" "$23,145.57" "$15,962.71" "$24,804.24" "$10,703.05" "$22,043.40" N/A N/A MS242 DRG MS-DRG V39 (FY2022) 242 PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC INPATIENT ONLY "$176,879.50" "$130,891.00" "$24,682.66" "$141,503.49" "$111,405.69" "$111,405.69" "$111,405.69" "$111,405.69" "$36,472.88" "$36,472.88" "$24,682.66" N/A "$36,472.88" "$52,488.00" "$52,488.00" "$55,153.83" "$32,806.84" N/A "$24,682.66" "$24,682.66" "$24,682.66" "$36,779.50" "$36,472.88" "$36,472.88" "$38,618.48" "$132,659.63" "$36,472.88" "$36,472.88" "$36,472.88" "$114,971.58" "$114,971.58" "$140,088.47" "$36,779.50" "$141,503.49" "$24,682.66" N/A "$36,779.50" "$102,590.11" "$38,618.48" "$24,682.66" "$43,242.27" "$40,245.47" "$36,472.88" N/A N/A MS243 DRG MS-DRG V39 (FY2022) 243 PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC INPATIENT ONLY "$235,498.50" "$174,269.00" "$28,434.89" "$186,514.75" N/A N/A N/A N/A "$32,780.34" "$32,780.34" N/A N/A "$32,780.34" N/A N/A N/A N/A N/A N/A N/A N/A "$32,780.34" "$32,780.34" "$32,780.34" "$32,780.34" "$176,623.88" "$32,780.34" "$32,780.34" "$32,780.34" N/A N/A "$186,514.75" "$32,780.34" N/A N/A N/A "$28,434.89" "$136,589.13" "$32,780.34" N/A N/A N/A "$32,780.34" N/A N/A MS244 DRG MS-DRG V39 (FY2022) 244 PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC INPATIENT ONLY "$85,677.50" "$63,401.50" "$3,500.00" "$68,541.60" "$43,362.75" "$43,362.75" "$43,362.75" "$43,362.75" "$25,293.32" "$25,293.32" "$19,239.41" "$20,019.14" "$25,293.32" "$18,584.84" "$18,584.84" "$19,359.79" "$13,046.61" "$20,019.14" "$40,469.31" "$25,586.90" "$30,949.50" "$25,293.32" "$25,241.55" "$25,293.32" "$26,557.99" "$64,258.13" "$25,293.32" "$22,814.57" "$25,293.32" "$55,690.06" "$55,690.06" "$67,856.19" "$25,293.32" "$68,541.60" "$3,500.00" "$19,065.84" "$25,293.32" "$49,692.95" "$26,557.99" "$20,683.15" "$28,870.59" "$20,019.14" "$25,293.32" N/A N/A MS245 DRG MS-DRG V39 (FY2022) 245 AICD GENERATOR PROCEDURES INPATIENT ONLY "$152,644.50" "$112,957.00" "$23,930.77" "$122,115.58" "$25,238.81" "$25,238.81" "$25,238.81" "$25,238.81" "$48,444.39" "$48,444.39" "$41,491.26" "$34,966.88" "$48,444.39" "$36,850.11" "$36,850.11" "$38,354.40" "$23,930.77" "$46,867.11" "$77,511.02" "$71,866.43" "$99,218.91" "$48,444.39" "$46,490.68" "$48,444.39" "$50,866.61" "$114,483.38" "$48,444.39" "$43,696.84" "$48,444.39" "$99,218.91" "$99,218.91" "$120,894.43" "$48,444.39" "$122,115.58" "$88,533.80" "$44,635.32" "$48,444.39" "$88,533.81" "$50,866.61" "$54,309.67" "$57,837.56" "$34,966.88" "$48,444.39" N/A N/A MS246 DRG MS-DRG V39 (FY2022) 246 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS INPATIENT ONLY "$140,798.00" "$104,191.00" "$1,405.35" "$112,638.20" "$89,549.89" "$89,549.89" "$89,549.89" "$89,549.89" "$32,615.82" "$32,615.82" "$28,890.80" "$28,866.92" "$32,615.82" "$26,652.90" "$26,652.90" "$28,036.52" "$14,092.94" "$28,866.92" "$52,185.31" "$40,315.09" "$91,518.54" "$32,615.82" "$33,057.91" "$32,615.82" "$34,246.61" "$105,598.50" "$32,615.82" "$29,419.47" "$32,615.82" "$91,518.54" "$91,518.54" "$111,511.81" "$32,615.82" "$112,638.20" "$1,405.35" "$27,492.29" "$32,615.82" "$81,662.84" "$34,246.61" "$31,318.93" "$38,032.60" "$28,866.92" "$32,615.82" N/A N/A MS247 DRG MS-DRG V39 (FY2022) 247 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC INPATIENT ONLY "$111,447.50" "$82,471.50" "$3,590.88" "$89,063.43" "$17,590.67" "$17,590.67" "$17,590.67" "$17,590.67" "$24,671.50" "$24,671.50" "$18,374.51" "$21,040.91" "$24,671.50" "$3,590.88" "$3,590.88" "$3,777.29" "$6,889.38" "$21,040.91" "$39,474.40" "$25,699.96" "$72,364.04" "$24,671.50" "$25,301.54" "$25,301.54" "$25,905.08" "$83,585.63" "$24,671.50" "$22,253.69" "$24,671.50" "$31,481.05" "$72,364.04" "$88,172.79" "$24,671.50" "$89,063.43" "$4,850.00" "$20,038.95" "$24,671.50" "$64,639.55" "$25,905.08" "$19,779.96" "$28,092.56" "$21,040.91" "$24,671.50" N/A N/A MS248 DRG MS-DRG V39 (FY2022) 248 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS INPATIENT ONLY "$179,934.50" "$133,152.00" "$26,769.66" "$143,947.46" "$112,822.86" "$112,822.86" "$112,822.86" "$112,822.86" "$36,848.69" "$36,848.69" "$27,144.04" "$28,108.16" "$36,848.69" "$53,555.52" "$53,555.52" "$56,264.65" "$33,560.62" "$28,108.16" "$58,957.90" "$74,760.06" "$116,957.31" "$36,848.69" "$37,093.94" "$36,848.69" "$38,691.12" "$134,950.88" "$36,848.69" "$33,237.52" "$36,848.69" "$116,957.31" "$116,957.31" "$142,507.97" "$36,848.69" "$143,947.46" "$104,361.91" "$26,769.66" "$36,848.69" "$104,362.01" "$38,691.12" "$31,698.86" "$43,427.69" "$28,108.16" "$36,848.69" N/A N/A MS249 DRG MS-DRG V39 (FY2022) 249 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC INPATIENT ONLY "$123,757.50" "$91,581.00" "$6,255.35" "$99,005.80" "$7,210.99" "$7,210.99" "$7,210.99" "$7,210.99" "$23,984.81" "$23,984.81" "$16,787.51" "$19,427.83" "$23,984.81" "$16,764.57" "$16,764.57" "$18,017.30" "$6,755.85" "$19,427.83" "$38,375.70" "$24,450.97" "$84,702.22" "$23,984.81" "$24,638.69" "$23,984.81" "$25,184.05" "$92,818.13" "$23,984.81" "$21,634.30" "$23,984.81" "$28,794.39" "$80,442.22" "$98,015.76" "$23,984.81" "$99,005.80" "$6,255.35" "$18,502.69" "$23,984.81" "$71,779.35" "$25,184.05" "$18,782.53" "$27,233.36" "$19,427.83" "$23,984.81" N/A N/A MS250 DRG MS-DRG V39 (FY2022) 250 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC INPATIENT ONLY "$86,808.00" "$64,238.00" "$7,846.00" "$69,446.27" "$16,475.71" "$16,475.71" "$16,475.71" "$16,475.71" "$28,457.67" "$28,457.67" "$26,674.54" "$23,069.31" "$28,457.67" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$23,069.31" "$45,532.27" "$32,566.74" "$37,827.00" "$28,457.67" "$28,945.80" "$28,457.67" "$29,880.55" "$65,106.00" "$28,457.67" "$25,668.82" "$28,457.67" "$38,936.42" "$33,262.37" "$68,751.81" "$28,457.67" "$69,446.27" "$14,000.00" "$21,970.76" "$28,457.67" "$50,348.64" "$29,880.55" "$25,279.29" "$32,829.87" "$23,069.31" "$28,457.67" N/A N/A MS251 DRG MS-DRG V39 (FY2022) 251 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC INPATIENT ONLY "$137,664.50" "$101,872.00" "$12,022.34" "$110,131.45" "$20,461.75" "$20,461.75" "$20,461.75" "$20,461.75" "$22,498.90" "$22,498.90" "$18,207.60" "$15,651.98" "$22,498.90" "$24,122.36" "$24,122.36" "$25,262.56" "$12,022.34" "$15,651.98" "$35,998.24" "$21,874.91" "$89,481.81" "$22,498.90" "$23,271.53" "$22,498.90" "$23,623.85" "$103,248.38" "$22,498.90" "$20,294.01" "$22,498.90" "$89,481.81" "$89,481.81" "$109,030.13" "$22,498.90" "$110,131.45" "$13,547.50" "$13,442.50" "$22,498.90" "$79,845.41" "$23,623.85" "$16,624.30" "$25,374.17" "$15,651.98" "$22,498.90" N/A N/A MS252 DRG MS-DRG V39 (FY2022) 252 OTHER VASCULAR PROCEDURES WITH MCC INPATIENT ONLY "$154,321.00" "$114,198.00" "$29,138.94" "$123,456.44" "$86,432.47" "$86,432.47" "$86,432.47" "$86,432.47" "$34,005.79" "$34,005.79" "$29,138.94" "$32,163.07" "$34,005.79" "$47,024.32" "$47,024.32" "$49,365.77" "$30,666.88" "$32,163.07" "$54,409.26" "$75,349.78" "$104,568.35" "$34,005.79" "$33,865.49" "$34,005.79" "$35,706.08" "$115,740.75" "$34,005.79" "$30,673.22" "$34,005.79" "$100,308.35" "$100,308.35" "$122,221.89" "$34,005.79" "$123,456.44" "$104,895.46" "$30,631.48" "$34,005.79" "$89,506.18" "$35,706.08" "$33,337.83" "$39,771.76" "$32,163.07" "$34,005.79" N/A N/A MS253 DRG MS-DRG V39 (FY2022) 253 OTHER VASCULAR PROCEDURES WITH CC INPATIENT ONLY "$258,956.50" "$191,628.00" "$25,922.69" "$207,165.05" "$166,007.37" "$166,007.37" "$166,007.37" "$166,007.37" "$29,367.29" "$29,367.29" "$43,138.66" "$35,893.57" "$29,367.29" "$115,431.12" "$115,431.12" "$121,423.45" "$78,808.87" "$35,893.57" "$46,987.66" "$129,771.65" "$168,321.61" "$29,367.29" "$30,762.22" "$29,367.29" "$30,835.65" "$194,217.38" "$29,367.29" "$26,489.30" "$29,367.29" "$168,321.61" "$168,321.61" "$205,093.43" "$29,367.29" "$207,165.05" "$150,194.67" "$25,922.69" "$29,367.29" "$150,194.77" "$30,835.65" "$29,310.22" "$33,968.00" "$35,893.57" "$29,367.29" N/A N/A MS254 DRG MS-DRG V39 (FY2022) 254 OTHER VASCULAR PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$115,476.00" "$85,452.50" "$3,032.55" "$92,380.40" "$13,310.94" "$13,310.94" "$13,310.94" "$13,310.94" "$23,585.90" "$23,585.90" "$15,445.08" "$17,895.18" "$23,585.90" "$7,593.76" "$7,593.76" "$7,955.26" "$6,234.11" "$17,895.18" "$37,737.44" "$24,609.78" "$75,059.08" "$23,585.90" "$24,722.98" "$23,585.90" "$24,765.20" "$86,607.00" "$23,585.90" "$21,274.48" "$23,585.90" "$28,176.42" "$75,059.08" "$91,456.62" "$23,585.90" "$92,380.40" "$3,032.55" "$17,043.02" "$23,585.90" "$66,976.08" "$24,765.20" "$18,203.13" "$26,734.24" "$17,895.18" "$23,585.90" N/A N/A MS255 DRG MS-DRG V39 (FY2022) 255 UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC INPATIENT ONLY "$148,959.00" "$110,230.00" "$13,611.89" "$119,167.20" "$94,634.59" "$94,634.59" "$94,634.59" "$94,634.59" "$28,550.84" "$28,550.84" "$23,252.42" "$18,414.87" "$28,550.84" "$33,308.51" "$33,308.51" "$35,020.64" "$18,910.36" "$18,414.87" "$45,681.34" "$73,035.31" "$96,823.35" "$28,550.84" "$29,987.93" "$29,987.93" "$29,978.38" "$111,719.25" "$28,550.84" "$25,752.86" "$28,550.84" "$96,823.35" "$96,823.35" "$117,975.53" "$28,550.84" "$119,167.20" "$24,500.00" "$13,611.89" "$28,550.84" "$86,396.22" "$29,978.38" "$25,414.62" "$32,946.44" "$18,414.87" "$28,550.84" N/A N/A MS256 DRG MS-DRG V39 (FY2022) 256 UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC INPATIENT ONLY "$94,242.00" "$69,739.50" "$13,301.03" "$75,393.45" "$39,768.40" "$39,768.40" "$39,768.40" "$39,768.40" N/A N/A N/A "$13,966.09" "$22,400.91" "$27,944.60" "$27,944.60" "$33,484.10" "$19,615.00" N/A N/A N/A "$24,663.00" "$22,400.91" N/A N/A "$23,520.96" "$70,681.50" N/A N/A N/A "$25,699.94" N/A "$74,639.53" "$22,400.91" "$75,393.45" N/A "$13,301.03" "$22,400.91" "$54,660.36" "$23,520.96" N/A "$25,251.55" "$13,966.09" "$22,400.91" N/A N/A MS258 DRG MS-DRG V39 (FY2022) 258 CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC INPATIENT ONLY "$247,400.00" "$183,076.00" "$143,492.00" "$185,550.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$185,550.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$143,492.00" N/A N/A N/A N/A N/A N/A N/A MS259 DRG MS-DRG V39 (FY2022) 259 CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC INPATIENT ONLY "$38,019.50" "$28,134.50" $62.10 "$38,019.19" "$20,585.20" "$20,585.20" "$20,585.20" "$20,585.20" "$25,472.08" "$25,472.08" "$17,783.62" "$8,709.21" "$25,472.08" N/A N/A N/A N/A "$14,100.44" "$38,019.19" "$26,838.59" "$31,338.00" "$25,472.08" "$25,905.80" "$25,472.08" "$26,745.68" "$28,514.63" "$25,472.08" "$22,975.82" "$25,472.08" "$31,338.00" "$26,637.30" "$30,111.22" "$25,472.08" "$30,415.36" $62.10 "$13,428.98" "$25,472.08" "$22,051.31" "$26,745.68" "$20,942.78" "$29,094.25" "$8,709.21" "$25,472.08" N/A N/A MS260 DRG MS-DRG V39 (FY2022) 260 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC INPATIENT ONLY "$164,312.50" "$121,591.50" "$25,674.91" "$131,449.78" "$98,289.16" "$98,289.16" "$98,289.16" "$98,289.16" "$35,673.17" "$35,673.17" "$33,432.21" "$26,958.66" "$35,673.17" "$51,223.57" "$51,223.57" "$53,675.88" "$33,511.97" "$26,958.66" "$57,077.07" "$86,825.30" "$106,802.94" "$35,673.17" "$36,652.18" "$35,673.17" "$37,456.83" "$123,234.38" "$35,673.17" "$32,177.20" "$35,673.17" "$106,802.94" "$106,802.94" "$130,135.28" "$35,673.17" "$131,449.78" "$103,527.44" "$25,674.91" "$35,673.17" "$95,301.25" "$37,456.83" "$35,759.70" "$41,858.02" "$26,958.66" "$35,673.17" N/A N/A MS261 DRG MS-DRG V39 (FY2022) 261 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC INPATIENT ONLY "$89,477.50" "$66,213.50" "$12,314.46" "$71,581.75" "$25,046.29" "$25,046.29" "$25,046.29" "$25,046.29" "$24,814.37" "$24,814.37" "$16,559.01" "$14,009.61" "$24,814.37" "$17,539.68" "$17,539.68" "$17,441.64" "$12,314.46" "$14,009.61" "$39,702.99" "$25,717.46" "$29,908.50" "$24,814.37" "$25,310.82" "$24,814.37" "$26,055.09" "$67,108.13" "$24,814.37" "$22,382.56" "$24,814.37" "$29,908.50" "$25,916.36" "$70,865.94" "$24,814.37" "$71,581.75" N/A "$13,342.48" "$24,814.37" "$51,896.95" "$26,055.09" "$19,987.46" "$28,271.31" "$14,009.61" "$24,814.37" N/A N/A MS262 DRG MS-DRG V39 (FY2022) 262 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC INPATIENT ONLY "$12,914.00" "$9,556.50" "$2,958.18" "$25,786.95" "$7,012.10" "$7,012.10" "$7,012.10" "$7,012.10" "$22,828.81" "$22,828.81" "$12,476.39" "$2,958.18" "$22,828.81" N/A N/A N/A N/A "$12,759.83" "$12,913.63" "$22,568.05" "$12,913.63" "$22,828.81" "$23,639.41" "$22,828.81" "$23,970.25" "$9,685.50" "$22,828.81" "$20,591.59" "$22,828.81" "$12,913.63" "$12,913.63" "$10,227.60" "$22,828.81" "$10,330.90" N/A "$12,152.22" "$22,828.81" "$7,490.12" "$23,970.25" "$12,913.63" "$25,786.95" "$2,958.18" "$12,913.63" N/A N/A MS263 DRG MS-DRG V39 (FY2022) 263 VEIN LIGATION AND STRIPPING INPATIENT ONLY "$231,226.50" "$171,108.00" "$27,018.01" "$173,419.88" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$173,419.88" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,018.01" "$134,111.37" N/A N/A N/A N/A N/A N/A N/A MS264 DRG MS-DRG V39 (FY2022) 264 OTHER CIRCULATORY SYSTEM O.R. PROCEDURES INPATIENT ONLY "$269,844.50" "$199,685.00" "$33,508.18" "$202,383.38" N/A N/A N/A N/A "$35,302.88" "$35,302.88" N/A N/A "$35,302.88" N/A N/A N/A N/A N/A N/A N/A N/A "$35,302.88" "$35,302.88" "$35,302.88" "$35,302.88" "$202,383.38" "$33,508.18" "$35,302.88" "$35,302.88" N/A N/A N/A "$35,302.88" N/A N/A N/A "$35,302.88" "$156,509.81" "$35,302.88" N/A N/A N/A "$35,302.88" N/A N/A MS265 DRG MS-DRG V39 (FY2022) 265 AICD LEAD PROCEDURES INPATIENT ONLY "$49,618.50" "$36,718.00" "$13,342.48" "$49,618.13" "$27,669.75" "$27,669.75" "$27,669.75" "$27,669.75" "$34,280.46" "$34,280.46" "$25,564.18" "$14,009.61" "$34,280.46" "$19,561.22" "$19,561.22" "$23,438.87" "$13,730.50" "$14,009.61" "$49,618.13" "$45,519.68" "$49,618.13" "$34,280.46" "$35,820.04" "$34,280.46" "$35,994.48" "$37,213.88" "$34,280.46" "$30,920.97" "$34,280.46" "$49,618.13" "$43,430.49" "$39,297.55" "$34,280.46" "$39,694.51" "$24,500.00" "$13,342.48" "$34,280.46" "$28,778.73" "$35,994.48" "$33,736.80" "$40,115.43" "$14,009.61" "$34,280.46" N/A N/A MS269 DRG MS-DRG V39 (FY2022) 269 AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC INPATIENT ONLY "$206,127.00" "$152,534.00" "$32,234.42" "$164,901.54" "$122,595.12" "$122,595.12" "$122,595.12" "$122,595.12" "$40,834.12" "$40,834.12" N/A "$33,846.16" "$40,834.12" "$75,456.57" "$75,456.57" "$78,907.27" "$48,728.46" "$33,846.16" "$65,334.59" "$100,440.34" "$133,982.50" "$40,834.12" "$42,207.14" "$40,834.12" "$42,875.83" "$154,595.25" "$40,834.12" "$36,832.38" "$40,834.12" "$133,982.50" "$133,982.50" "$163,252.53" "$40,834.12" "$164,901.54" "$119,553.62" "$32,234.42" "$40,834.12" "$119,553.66" "$42,875.83" "$43,255.87" "$48,315.47" "$33,846.16" "$40,834.12" N/A N/A MS270 DRG MS-DRG V39 (FY2022) 270 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC INPATIENT ONLY "$344,072.50" "$254,614.00" "$46,851.53" "$275,257.98" "$218,524.36" "$218,524.36" "$218,524.36" "$218,524.36" "$48,180.68" "$48,180.68" N/A N/A "$48,180.68" "$173,657.13" "$173,657.13" "$182,618.22" "$121,144.73" N/A N/A N/A N/A "$46,851.53" "$48,180.68" "$48,180.68" "$48,180.68" "$258,054.38" "$48,180.68" "$48,180.68" "$48,180.68" N/A N/A "$272,505.41" "$46,851.53" "$275,257.98" N/A N/A "$46,851.53" "$199,562.05" "$48,180.68" N/A N/A N/A "$48,180.68" N/A N/A MS271 DRG MS-DRG V39 (FY2022) 271 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC INPATIENT ONLY "$283,039.50" "$209,449.50" "$32,133.50" "$226,431.24" "$180,210.24" "$180,210.24" "$180,210.24" "$180,210.24" "$35,660.07" "$35,660.07" N/A "$36,255.18" "$35,660.07" "$131,528.84" "$131,528.84" "$138,313.19" "$90,455.47" "$36,255.18" "$57,056.11" "$111,959.41" "$183,975.39" "$35,660.07" "$36,546.46" "$35,660.07" "$37,443.07" "$212,279.63" "$35,660.07" "$32,165.38" "$35,660.07" "$183,975.39" "$183,975.39" "$224,166.95" "$35,660.07" "$226,431.24" "$164,162.65" "$32,133.50" "$35,660.07" "$164,162.91" "$37,443.07" "$36,769.77" "$41,841.62" "$36,255.18" "$35,660.07" N/A N/A MS272 DRG MS-DRG V39 (FY2022) 272 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$215,281.00" "$159,308.00" "$20,130.17" "$172,224.55" "$133,593.28" "$133,593.28" "$133,593.28" "$133,593.28" "$29,606.76" "$29,606.76" "$20,130.17" "$30,287.63" "$29,606.76" "$81,762.82" "$81,762.82" "$85,807.13" "$53,862.29" "$30,287.63" "$47,370.82" "$77,603.21" "$139,932.45" "$29,606.76" "$30,207.93" "$29,606.76" "$31,087.10" "$161,460.75" "$29,606.76" "$26,705.30" "$29,606.76" "$139,932.45" "$139,932.45" "$170,502.32" "$29,606.76" "$172,224.55" "$124,862.80" "$21,941.54" "$29,606.76" "$124,862.98" "$31,087.10" "$26,948.34" "$34,267.63" "$30,287.63" "$29,606.76" N/A N/A MS273 DRG MS-DRG V39 (FY2022) 273 PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC INPATIENT ONLY "$294,884.00" "$218,214.50" "$33,792.01" "$235,906.98" "$188,804.67" "$188,804.67" "$188,804.67" "$188,804.67" "$37,463.43" "$37,463.43" N/A "$41,488.11" "$37,463.43" "$140,707.85" "$140,707.85" "$148,012.36" "$97,234.64" "$41,488.11" N/A "$144,948.42" N/A "$37,463.43" "$40,326.45" "$47,817.02" "$39,336.60" "$221,163.00" "$47,817.02" "$33,792.01" "$47,817.02" "$191,674.42" "$191,674.42" "$233,547.94" "$37,463.43" "$235,906.98" N/A "$35,097.00" "$37,463.43" "$171,032.72" "$39,336.60" N/A "$44,098.02" "$41,488.11" "$37,463.43" N/A N/A MS274 DRG MS-DRG V39 (FY2022) 274 PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC INPATIENT ONLY "$36,430.50" "$26,959.00" "$3,500.00" "$39,434.11" "$9,490.76" "$9,490.76" "$9,490.76" "$9,490.76" "$33,735.93" "$33,735.93" N/A "$19,582.99" "$33,735.93" "$6,304.73" "$6,304.73" "$6,993.69" "$4,425.44" "$19,582.99" "$36,430.31" "$36,425.31" "$36,430.31" "$33,735.93" "$35,658.61" "$33,735.93" "$35,422.73" "$27,322.88" "$33,735.93" "$30,429.81" "$33,735.93" "$36,430.31" "$36,430.31" "$28,852.82" "$33,735.93" "$29,144.25" "$3,500.00" "$18,650.46" "$33,735.93" "$21,129.69" "$35,422.73" "$32,945.87" "$39,434.11" "$19,582.99" "$33,735.93" N/A N/A MS280 DRG MS-DRG V39 (FY2022) 280 "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC" INPATIENT ONLY "$66,309.50" "$49,069.50" "$8,348.44" "$98,535.72" "$33,450.69" "$33,450.69" "$33,450.69" "$33,450.69" "$22,143.49" "$22,143.49" "$15,431.69" "$15,741.89" "$22,143.49" "$11,893.65" "$11,893.65" "$13,690.51" "$8,348.44" "$15,741.89" "$35,429.58" "$21,620.54" "$24,103.50" "$22,143.49" "$23,136.55" "$22,143.49" "$23,250.66" "$49,732.13" "$22,143.49" "$19,973.43" "$22,143.49" "$24,103.50" "$20,487.98" "$52,516.87" "$22,143.49" "$53,047.34" "$10,500.00" "$14,992.27" "$22,143.49" "$38,459.51" "$23,250.66" "$16,108.06" "$24,929.47" "$15,741.89" "$22,143.49" N/A N/A MS281 DRG MS-DRG V39 (FY2022) 281 "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC" INPATIENT ONLY "$51,556.50" "$38,152.00" "$3,923.00" "$41,244.94" "$8,022.71" "$8,022.71" "$8,022.71" "$8,022.71" "$17,475.99" "$17,475.99" "$9,146.20" "$9,314.20" "$17,475.99" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$9,314.20" "$27,961.58" "$12,363.44" "$13,959.00" "$17,475.99" "$18,223.73" "$17,475.99" "$18,349.79" "$38,667.38" "$17,475.99" "$15,763.34" "$17,475.99" "$13,959.00" "$11,865.15" "$40,832.50" "$17,475.99" "$41,244.94" "$7,000.00" "$8,870.66" "$17,475.99" "$29,902.77" "$18,349.79" "$9,328.63" "$19,089.43" "$9,314.20" "$17,475.99" N/A N/A MS282 DRG MS-DRG V39 (FY2022) 282 "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC" INPATIENT ONLY "$56,667.50" "$41,934.00" "$3,500.00" "$45,333.94" "$15,385.21" "$15,385.21" "$15,385.21" "$15,385.21" "$16,064.63" "$16,064.63" "$6,749.64" "$9,314.20" "$16,064.63" "$6,304.73" "$6,304.73" "$6,993.69" "$4,425.44" "$9,314.20" "$25,703.41" "$9,646.07" "$10,891.50" "$16,064.63" "$16,781.61" "$16,064.63" "$16,867.86" "$42,500.63" "$16,064.63" "$14,490.30" "$16,064.63" "$10,891.50" "$9,257.78" "$44,880.62" "$16,064.63" "$45,333.94" "$3,500.00" "$8,870.66" "$16,064.63" "$32,867.15" "$16,867.86" "$7,278.64" "$17,323.51" "$9,314.20" "$16,064.63" N/A N/A MS283 DRG MS-DRG V39 (FY2022) 283 "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC" INPATIENT ONLY "$149,901.50" "$110,927.50" "$23,922.70" "$119,920.88" N/A N/A N/A N/A "$27,873.73" "$27,873.73" N/A N/A "$27,873.73" "$34,655.50" "$34,655.50" N/A N/A N/A N/A N/A N/A "$27,873.73" "$27,873.73" "$27,873.73" "$27,873.73" "$112,426.13" "$23,922.70" "$27,873.73" "$27,873.73" N/A N/A "$118,721.68" "$23,922.70" "$119,920.88" N/A N/A "$25,366.53" "$86,942.87" "$27,873.73" N/A N/A N/A "$27,873.73" N/A N/A MS286 DRG MS-DRG V39 (FY2022) 286 "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC" INPATIENT ONLY "$114,129.50" "$84,456.00" "$7,533.20" "$91,303.42" "$21,757.31" "$21,757.31" "$21,757.31" "$21,757.31" "$26,812.25" "$26,812.25" "$28,546.54" "$24,380.58" "$26,812.25" "$7,838.59" "$7,838.59" "$8,219.31" "$7,533.20" "$24,380.58" "$28,546.54" "$28,546.54" "$28,546.54" "$25,797.14" "$26,812.25" "$26,812.25" "$27,087.00" "$85,597.13" "$26,812.25" "$26,812.25" "$26,812.25" "$35,398.66" "$74,184.03" "$90,390.39" "$25,797.14" "$91,303.42" "$28,546.54" "$23,219.59" "$25,797.14" "$66,195.11" "$27,087.00" "$28,546.54" "$29,500.97" "$24,380.58" "$26,812.25" N/A N/A MS287 DRG MS-DRG V39 (FY2022) 287 "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC" INPATIENT ONLY "$59,617.50" "$44,117.00" "$3,923.00" "$47,693.87" "$15,616.98" "$15,616.98" "$15,616.98" "$15,616.98" "$18,749.32" "$18,749.32" "$10,077.15" "$12,609.41" "$18,749.32" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$12,609.41" "$29,998.91" "$14,807.59" "$20,986.50" "$18,749.32" "$19,520.86" "$18,749.32" "$19,686.79" "$44,713.13" "$18,749.32" "$16,911.89" "$18,749.32" "$17,360.80" "$14,851.83" "$47,216.92" "$18,749.32" "$47,693.87" "$7,000.00" "$12,008.95" "$18,749.32" "$34,578.15" "$19,686.79" "$11,178.11" "$20,682.63" "$12,609.41" "$18,749.32" N/A N/A MS288 DRG MS-DRG V39 (FY2022) 288 ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC INPATIENT ONLY "$371,134.50" "$274,640.00" "$215,258.01" "$278,350.88" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$278,350.88" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$215,258.01" N/A N/A N/A N/A N/A N/A N/A MS289 DRG MS-DRG V39 (FY2022) 289 ACUTE AND SUBACUTE ENDOCARDITIS WITH CC INPATIENT ONLY "$33,093.50" "$24,489.50" "$7,846.00" "$33,093.27" "$15,973.29" "$15,973.29" "$15,973.29" "$15,973.29" "$22,396.77" "$22,396.77" "$15,165.71" "$12,692.66" "$22,396.77" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$12,692.66" "$33,093.27" "$21,629.96" "$24,654.00" "$22,396.77" "$23,141.55" "$22,396.77" "$23,516.61" "$24,820.13" "$22,396.77" "$20,201.89" "$22,396.77" "$24,654.00" "$21,451.26" "$26,209.87" "$22,396.77" "$26,474.61" "$14,000.00" "$12,088.25" "$22,396.77" "$19,194.23" "$23,516.61" "$16,475.95" "$25,246.38" "$12,692.66" "$22,396.77" N/A N/A MS291 DRG MS-DRG V39 (FY2022) 291 HEART FAILURE AND SHOCK WITH MCC INPATIENT ONLY "$46,939.50" "$34,735.50" "$12,460.37" "$37,551.27" "$23,030.77" "$23,030.77" "$23,030.77" "$23,030.77" "$19,806.64" "$19,806.64" "$13,475.17" "$13,083.40" "$19,806.64" "$22,830.12" "$22,830.12" "$23,708.20" "$16,025.00" "$13,083.40" "$31,690.62" "$17,224.83" "$19,024.50" "$19,806.64" "$20,803.71" "$19,806.64" "$20,796.97" "$35,204.63" "$19,806.64" "$17,865.59" "$19,806.64" "$19,024.50" "$16,170.83" "$37,175.76" "$19,806.64" "$37,551.27" "$14,000.00" "$12,460.37" "$19,806.64" "$27,224.91" "$20,796.97" "$12,713.83" "$22,005.57" "$13,083.40" "$19,806.64" N/A N/A MS292 DRG MS-DRG V39 (FY2022) 292 HEART FAILURE AND SHOCK WITH CC INPATIENT ONLY "$34,773.00" "$25,732.50" "$8,039.01" "$29,635.25" "$27,018.89" "$27,018.89" "$27,018.89" "$27,018.89" "$17,012.91" "$17,012.91" "$8,768.64" "$8,440.96" "$17,012.91" "$28,537.65" "$28,537.65" "$29,635.25" "$20,031.25" "$8,440.96" "$27,220.66" "$11,612.43" "$12,952.50" "$17,012.91" "$17,825.15" "$17,012.91" "$17,863.56" "$26,079.75" "$17,012.91" "$15,345.64" "$17,012.91" "$12,952.50" "$11,009.63" "$27,540.05" "$17,012.91" "$27,818.23" "$17,500.00" "$8,039.01" "$17,012.91" "$20,168.34" "$17,863.56" "$8,655.98" "$18,510.01" "$8,440.96" "$17,012.91" N/A N/A MS293 DRG MS-DRG V39 (FY2022) 293 HEART FAILURE AND SHOCK WITHOUT CC/MCC INPATIENT ONLY "$36,103.00" "$26,716.50" "$5,580.09" "$28,882.33" "$23,007.91" "$23,007.91" "$23,007.91" "$23,007.91" "$15,124.67" "$15,124.67" "$6,035.58" "$5,859.10" "$15,124.67" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$5,859.10" "$24,199.47" "$7,541.08" "$8,848.50" "$15,124.67" "$15,664.46" "$15,124.67" "$15,880.90" "$27,077.25" "$15,124.67" "$13,642.45" "$15,124.67" "$8,848.50" "$7,521.23" "$28,593.51" "$15,124.67" "$28,882.33" "$14,000.00" "$5,580.09" "$15,124.67" "$20,939.74" "$15,880.90" "$5,913.34" "$16,147.41" "$5,859.10" "$15,124.67" N/A N/A MS296 DRG MS-DRG V39 (FY2022) 296 "CARDIAC ARREST, UNEXPLAINED WITH MCC" INPATIENT ONLY "$128,649.50" "$95,201.00" "$11,020.60" "$102,919.58" "$12,510.11" "$12,510.11" "$12,510.11" "$12,510.11" "$24,066.11" "$24,066.11" "$11,020.60" "$16,265.08" "$24,066.11" "$25,817.31" "$25,817.31" "$27,054.23" "$15,200.49" "$16,265.08" "$38,505.78" "$22,049.88" "$83,622.16" "$24,066.11" "$25,505.31" "$24,066.11" "$25,269.42" "$96,487.13" "$24,066.11" "$21,707.63" "$24,066.11" "$83,622.16" "$83,622.16" "$101,890.36" "$24,066.11" "$102,919.58" "$15,389.55" "$15,490.54" "$24,066.11" "$74,616.71" "$25,269.42" "$15,990.77" "$27,384.94" "$16,265.08" "$24,066.11" N/A N/A MS299 DRG MS-DRG V39 (FY2022) 299 PERIPHERAL VASCULAR DISORDERS WITH MCC INPATIENT ONLY "$65,225.00" "$48,266.50" "$11,297.14" "$52,179.70" "$27,492.53" "$27,492.53" "$27,492.53" "$27,492.53" "$22,647.98" "$22,647.98" "$20,699.94" "$11,862.00" "$21,630.71" "$19,561.22" "$19,561.22" "$23,438.87" "$13,730.50" N/A "$20,699.94" "$20,699.94" "$22,989.00" "$21,630.71" "$22,647.98" "$22,647.98" "$22,712.25" "$48,918.75" "$22,647.98" "$19,510.90" "$22,647.98" "$22,989.00" "$19,540.65" "$51,657.92" "$21,630.71" "$52,179.70" "$20,699.94" "$11,297.14" "$21,630.71" "$37,830.50" "$22,712.25" "$20,699.94" "$24,287.87" "$11,862.00" "$21,630.71" N/A N/A MS300 DRG MS-DRG V39 (FY2022) 300 PERIPHERAL VASCULAR DISORDERS WITH CC INPATIENT ONLY "$47,370.00" "$35,054.00" "$8,720.44" "$37,895.80" "$24,139.01" "$24,139.01" "$24,139.01" "$24,139.01" "$18,257.24" "$18,257.24" "$8,720.44" "$9,773.05" "$18,257.24" "$16,766.76" "$16,766.76" "$24,500.00" "$11,769.00" "$9,773.05" "$29,211.58" "$13,877.57" "$15,657.00" "$18,257.24" "$19,027.30" "$19,027.30" "$19,170.10" "$35,527.50" "$18,257.24" "$19,027.30" "$18,257.24" "$16,618.90" "$14,270.35" "$37,516.83" "$18,257.24" "$37,895.80" "$21,000.00" "$9,307.66" "$18,257.24" "$27,474.60" "$19,170.10" "$8,720.44" "$20,066.94" "$9,773.05" "$18,257.24" N/A N/A MS301 DRG MS-DRG V39 (FY2022) 301 PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$21,458.00" "$15,879.00" "$1,961.50" "$21,457.59" "$4,179.71" "$4,179.71" "$4,179.71" "$4,179.71" "$16,181.99" "$16,181.99" "$6,048.07" "$4,915.38" "$16,181.99" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$5,615.95" "$21,457.59" "$9,639.34" "$11,146.50" "$16,181.99" "$16,778.02" "$16,181.99" "$16,991.09" "$16,093.50" "$16,181.99" "$14,596.15" "$16,181.99" "$11,146.50" "$9,474.53" "$16,994.42" "$16,181.99" "$17,166.08" "$3,500.00" "$5,348.53" "$16,181.99" "$12,445.64" "$16,991.09" "$7,449.06" "$17,470.34" "$4,915.38" "$16,181.99" N/A N/A MS302 DRG MS-DRG V39 (FY2022) 302 ATHEROSCLEROSIS WITH MCC INPATIENT ONLY "$50,749.00" "$37,554.50" "$6,690.16" "$40,598.82" "$16,643.20" "$16,643.20" "$16,643.20" "$16,643.20" "$18,609.23" "$18,609.23" "$9,203.32" "$7,024.67" "$18,609.23" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$7,024.67" "$29,774.77" "$16,228.86" "$16,422.00" "$18,609.23" "$20,275.13" "$18,609.23" "$19,539.69" "$38,061.75" "$18,609.23" "$16,785.53" "$18,609.23" "$17,736.13" "$15,272.83" "$40,192.84" "$18,609.23" "$40,598.82" "$14,000.00" "$6,690.16" "$18,609.23" "$29,434.42" "$19,539.69" "$10,974.61" "$20,507.35" "$7,024.67" "$18,609.23" N/A N/A MS303 DRG MS-DRG V39 (FY2022) 303 ATHEROSCLEROSIS WITHOUT MCC INPATIENT ONLY "$29,241.00" "$21,638.50" "$3,923.00" "$25,167.86" "$7,803.80" "$7,803.80" "$7,803.80" "$7,803.80" "$15,729.91" "$15,729.91" "$5,445.59" "$6,745.58" "$15,729.91" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$6,745.58" "$25,167.86" "$9,099.63" "$10,164.00" "$15,729.91" "$16,491.60" "$15,729.91" "$16,516.41" "$21,930.75" "$15,729.91" "$14,188.38" "$15,729.91" "$10,164.00" "$8,639.40" "$23,158.56" "$15,729.91" "$23,392.48" "$7,000.00" "$6,424.36" "$15,729.91" "$16,959.78" "$16,516.41" "$6,792.46" "$16,904.71" "$6,745.58" "$15,729.91" N/A N/A MS304 DRG MS-DRG V39 (FY2022) 304 HYPERTENSION WITH MCC INPATIENT ONLY "$48,685.50" "$36,027.50" "$5,884.50" "$38,948.40" "$11,997.67" "$11,997.67" "$11,997.67" "$11,997.67" "$18,624.42" "$18,624.42" "$8,940.01" "$8,359.60" "$18,624.42" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$8,359.60" "$29,799.07" "$14,786.06" "$16,455.00" "$18,624.42" "$19,509.43" "$18,624.42" "$19,555.64" "$36,514.13" "$18,624.42" "$16,799.23" "$18,624.42" "$16,455.00" "$13,986.75" "$38,558.92" "$18,624.42" "$38,948.40" "$10,500.00" "$7,961.52" "$18,624.42" "$28,237.59" "$19,555.64" "$10,996.66" "$20,526.36" "$8,359.60" "$18,624.42" N/A N/A MS305 DRG MS-DRG V39 (FY2022) 305 HYPERTENSION WITHOUT MCC INPATIENT ONLY "$37,491.50" "$27,744.00" "$1,540.69" "$29,993.07" "$4,202.05" "$4,202.05" "$4,202.05" "$4,202.05" "$16,159.88" "$16,159.88" "$5,598.22" "$6,841.13" "$16,159.88" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,841.13" "$25,855.81" "$10,035.03" "$11,098.50" "$16,159.88" "$16,988.01" "$16,159.88" "$16,967.87" "$28,118.63" "$16,159.88" "$1,575.06" "$1,540.69" "$11,098.50" "$9,433.73" "$29,693.15" "$16,159.88" "$29,993.07" "$3,500.00" "$6,515.36" "$16,159.88" "$21,745.07" "$16,967.87" "$7,416.98" "$17,442.69" "$6,841.13" "$16,159.88" N/A N/A MS306 DRG MS-DRG V39 (FY2022) 306 CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC INPATIENT ONLY "$22,002.50" "$16,282.00" "$1,961.50" "$24,070.26" "$3,931.60" "$3,931.60" "$3,931.60" "$3,931.60" "$21,456.78" "$21,456.78" "$12,216.65" "$5,040.09" "$21,456.78" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$8,495.83" "$22,002.03" "$19,862.79" "$22,002.03" "$21,456.78" "$22,203.71" "$21,456.78" "$22,529.62" "$16,501.88" "$21,456.78" "$19,354.02" "$21,456.78" "$22,002.03" "$19,219.35" "$17,425.61" "$21,456.78" "$17,601.62" "$3,500.00" "$8,091.27" "$21,456.78" "$12,761.45" "$22,529.62" "$15,110.63" "$24,070.26" "$5,040.09" "$21,456.78" N/A N/A MS307 DRG MS-DRG V39 (FY2022) 307 CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC INPATIENT ONLY "$9,876.50" "$7,309.00" "$2,262.41" "$18,569.60" "$5,358.76" "$5,358.76" "$5,358.76" "$5,358.76" "$17,060.53" "$17,060.53" "$6,871.03" "$2,262.41" "$17,060.53" N/A N/A N/A N/A "$6,598.94" "$9,876.34" "$11,181.34" "$9,876.34" "$17,060.53" "$18,172.31" "$17,060.53" "$17,913.56" "$7,407.38" "$17,060.53" "$15,388.60" "$17,060.53" "$9,876.34" "$9,876.34" "$7,822.07" "$17,060.53" "$7,901.07" N/A "$6,284.70" "$17,060.53" "$5,728.37" "$17,913.56" "$8,725.16" "$18,569.60" "$2,262.41" "$9,876.34" N/A N/A MS308 DRG MS-DRG V39 (FY2022) 308 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC INPATIENT ONLY "$56,557.50" "$41,853.00" "$8,209.64" "$45,245.78" "$16,520.02" "$16,520.02" "$16,520.02" "$16,520.02" "$19,341.47" "$19,341.47" "$10,806.38" "$12,743.75" "$19,341.47" "$11,693.12" "$11,693.12" "$11,627.76" "$8,209.64" "$12,743.75" "$30,946.35" "$15,782.02" "$18,013.50" "$19,341.47" "$20,038.00" "$19,341.47" "$20,308.54" "$42,418.13" "$19,341.47" "$17,446.01" "$19,341.47" "$18,013.50" "$15,311.48" "$44,793.34" "$19,341.47" "$45,245.78" "$10,806.38" "$12,136.90" "$19,341.47" "$32,803.35" "$20,308.54" "$12,038.19" "$21,423.54" "$12,743.75" "$19,341.47" N/A N/A MS309 DRG MS-DRG V39 (FY2022) 309 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC INPATIENT ONLY "$44,152.50" "$32,673.00" "$1,961.50" "$35,321.85" "$4,129.43" "$4,129.43" "$4,129.43" "$4,129.43" "$16,233.04" "$16,233.04" "$7,020.09" "$8,155.24" "$16,233.04" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$8,155.24" "$25,972.86" "$9,927.36" "$11,257.50" "$16,233.04" "$16,930.88" "$16,930.88" "$17,044.69" "$33,114.38" "$16,233.04" "$14,642.20" "$16,233.04" "$11,257.50" "$9,568.88" "$34,968.64" "$16,233.04" "$35,321.85" "$3,500.00" "$7,766.90" "$16,233.04" "$25,608.45" "$17,044.69" "$7,523.25" "$17,534.23" "$8,155.24" "$16,233.04" N/A N/A MS310 DRG MS-DRG V39 (FY2022) 310 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$29,525.00" "$21,848.50" "$3,923.00" "$23,860.46" "$7,936.45" "$7,936.45" "$7,936.45" "$7,936.45" "$14,912.79" "$14,912.79" "$4,902.90" "$5,516.62" "$14,912.79" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$5,516.62" "$23,860.46" "$7,418.60" "$8,388.00" "$14,912.79" "$15,599.45" "$14,912.79" "$15,658.43" "$22,143.75" "$14,912.79" "$13,451.34" "$14,912.79" "$8,388.00" "$7,129.80" "$23,383.67" "$14,912.79" "$23,619.88" "$7,000.00" "$5,253.92" "$14,912.79" "$17,124.50" "$15,658.43" "$5,605.59" "$15,882.30" "$5,516.62" "$14,912.79" N/A N/A MS311 DRG MS-DRG V39 (FY2022) 311 ANGINA PECTORIS INPATIENT ONLY "$30,375.50" "$22,478.00" "$1,961.50" "$25,398.64" "$3,892.00" "$3,892.00" "$3,892.00" "$3,892.00" "$15,874.15" "$15,874.15" "$5,053.75" "$6,914.93" "$15,874.15" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,914.93" "$25,398.64" "$8,991.96" "$10,477.50" "$15,874.15" "$16,434.46" "$15,874.15" "$16,667.86" "$22,781.63" "$15,874.15" "$14,318.48" "$15,874.15" "$10,477.50" "$8,905.88" "$24,057.01" "$15,874.15" "$24,300.01" "$3,500.00" "$6,585.64" "$15,874.15" "$17,617.79" "$16,667.86" "$7,001.97" "$17,085.18" "$6,914.93" "$15,874.15" N/A N/A MS312 DRG MS-DRG V39 (FY2022) 312 SYNCOPE AND COLLAPSE INPATIENT ONLY "$57,427.00" "$42,496.00" "$6,625.57" "$45,941.33" "$21,054.18" "$21,054.18" "$21,054.18" "$21,054.18" "$16,841.76" "$16,841.76" "$6,625.57" "$7,220.51" "$16,841.76" "$18,590.23" "$18,590.23" "$21,091.12" "$14,973.30" "$7,220.51" "$26,946.82" "$11,476.49" "$12,580.50" "$16,841.76" "$17,753.02" "$16,841.76" "$17,683.85" "$43,070.25" "$16,841.76" "$15,191.27" "$16,841.76" "$12,580.50" "$10,693.43" "$45,481.90" "$16,841.76" "$45,941.33" "$18,128.85" "$6,876.68" "$16,841.76" "$33,307.66" "$17,683.85" "$8,407.38" "$18,295.86" "$7,220.51" "$16,841.76" N/A N/A MS313 DRG MS-DRG V39 (FY2022) 313 CHEST PAIN INPATIENT ONLY "$35,237.00" "$26,075.50" "$1,961.50" "$28,189.49" "$4,193.89" "$4,193.89" "$4,193.89" "$4,193.89" "$16,032.21" "$16,032.21" "$5,478.61" "$7,073.87" "$16,032.21" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$7,073.87" "$25,651.54" "$9,736.24" "$10,821.00" "$16,032.21" "$16,829.46" "$16,032.21" "$16,833.82" "$26,427.75" "$16,032.21" "$14,461.05" "$16,032.21" "$10,821.00" "$9,197.85" "$27,907.59" "$16,032.21" "$28,189.49" "$3,500.00" "$6,737.02" "$16,032.21" "$20,437.46" "$16,833.82" "$7,231.54" "$17,282.94" "$7,073.87" "$16,032.21" N/A N/A MS314 DRG MS-DRG V39 (FY2022) 314 OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC INPATIENT ONLY "$84,571.50" "$62,583.00" "$9,807.50" "$67,656.93" "$19,832.24" "$19,832.24" "$19,832.24" "$19,832.24" "$25,441.03" "$25,441.03" "$17,132.94" "$22,062.68" "$25,441.03" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$22,062.68" "$40,705.65" "$28,029.71" "$31,270.50" "$25,441.03" "$26,537.96" "$25,441.03" "$26,713.08" "$63,428.63" "$25,441.03" "$22,947.81" "$25,441.03" "$31,270.50" "$26,579.93" "$66,980.35" "$25,441.03" "$67,656.93" "$17,500.00" "$21,012.07" "$25,441.03" "$49,051.47" "$26,713.08" "$20,897.67" "$29,055.40" "$22,062.68" "$25,441.03" N/A N/A MS315 DRG MS-DRG V39 (FY2022) 315 OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC INPATIENT ONLY "$37,701.50" "$27,899.50" "$3,923.00" "$30,161.02" "$7,813.82" "$7,813.82" "$7,813.82" "$7,813.82" "$17,771.38" "$17,771.38" "$8,580.30" "$10,849.69" "$17,771.38" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$10,849.69" "$28,434.21" "$13,035.04" "$18,861.00" "$17,771.38" "$18,580.16" "$17,771.38" "$18,659.95" "$28,276.13" "$17,771.38" "$16,029.78" "$17,771.38" "$14,601.00" "$12,410.85" "$29,859.40" "$17,771.38" "$30,161.02" "$7,000.00" "$10,333.03" "$17,771.38" "$21,866.87" "$18,659.95" "$9,757.66" "$19,459.02" "$10,849.69" "$17,771.38" N/A N/A MS316 DRG MS-DRG V39 (FY2022) 316 OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC INPATIENT ONLY "$43,879.50" "$32,471.00" "$2,463.94" "$35,103.44" "$4,400.09" "$4,400.09" "$4,400.09" "$4,400.09" "$16,046.01" "$16,046.01" "$5,542.88" "$8,312.29" "$16,046.01" "$3,510.27" "$3,510.27" "$3,645.28" "$2,463.94" "$8,312.29" "$25,673.62" "$9,179.04" "$10,851.00" "$16,046.01" "$16,533.73" "$16,046.01" "$16,848.31" "$32,909.63" "$16,046.01" "$14,473.50" "$16,046.01" "$10,851.00" "$9,223.35" "$34,752.41" "$16,046.01" "$35,103.44" N/A "$7,916.47" "$16,046.01" "$25,450.11" "$16,848.31" "$7,251.57" "$17,300.21" "$8,312.29" "$16,046.01" N/A N/A MS326 DRG MS-DRG V39 (FY2022) 326 "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC" INPATIENT ONLY "$212,436.00" "$157,203.00" "$37,839.33" "$169,948.61" "$135,867.70" "$135,867.70" "$135,867.70" "$135,867.70" "$41,950.48" "$41,950.48" "$91,670.68" "$44,237.94" "$41,950.48" "$80,335.45" "$80,335.45" "$84,505.87" "$53,225.47" "$44,237.94" "$67,120.77" "$102,854.06" "$138,083.25" "$41,950.48" "$42,780.78" "$41,950.48" "$44,048.00" "$159,327.00" "$41,950.48" "$37,839.33" "$41,950.48" "$138,083.25" "$138,083.25" "$168,249.14" "$41,950.48" "$169,948.61" "$91,670.68" "$42,131.36" "$47,743.90" "$123,212.88" "$44,048.00" "$44,877.37" "$49,712.28" "$44,237.94" "$41,950.48" N/A N/A MS327 DRG MS-DRG V39 (FY2022) 327 "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC" INPATIENT ONLY "$185,576.50" "$137,327.00" "$21,075.14" "$148,461.09" "$119,061.79" "$119,061.79" "$119,061.79" "$119,061.79" "$28,753.75" "$28,753.75" "$27,095.03" "$22,128.90" "$28,753.75" "$62,343.65" "$62,343.65" "$65,580.07" "$40,110.14" "$22,128.90" "$46,006.00" "$91,870.09" "$120,624.63" "$28,753.75" "$29,957.22" "$28,753.75" "$30,191.44" "$139,182.38" "$28,753.75" "$25,935.88" "$28,753.75" "$120,624.63" "$120,624.63" "$146,976.47" "$28,753.75" "$148,461.09" "$107,634.29" "$21,075.14" "$28,753.75" "$107,634.37" "$30,191.44" "$25,709.34" "$33,200.32" "$22,128.90" "$28,753.75" N/A N/A MS328 DRG MS-DRG V39 (FY2022) 328 "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$240,164.00" "$177,721.50" "$20,346.94" "$192,130.94" "$153,763.25" "$153,763.25" "$153,763.25" "$153,763.25" "$22,557.58" "$22,557.58" "$35,373.53" "$38,451.68" "$22,557.58" "$100,991.62" "$100,991.62" "$106,234.36" "$68,283.03" "$38,451.68" "$36,092.13" "$118,971.51" "$156,106.39" "$22,557.58" "$23,502.97" "$22,557.58" "$23,685.46" "$180,123.00" "$22,557.58" "$20,346.94" "$22,557.58" "$156,106.39" "$156,106.39" "$190,209.62" "$22,557.58" "$192,130.94" "$139,294.93" "$29,629.56" "$22,557.58" "$139,295.12" "$23,685.46" "$22,937.56" "$25,447.58" "$38,451.68" "$22,557.58" N/A N/A MS329 DRG MS-DRG V39 (FY2022) 329 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC INPATIENT ONLY "$321,070.50" "$237,592.50" "$40,387.56" "$256,856.27" "$193,147.81" "$193,147.81" "$193,147.81" "$193,147.81" "$44,775.57" "$44,775.57" "$65,520.20" "$46,129.16" "$44,775.57" "$167,796.57" "$167,796.57" "$176,407.61" "$118,705.23" "$46,129.16" "$71,640.91" "$156,507.35" "$208,695.71" "$44,775.57" "$44,685.70" "$44,775.57" "$47,014.35" "$240,802.88" "$44,775.57" "$40,387.56" "$44,775.57" "$208,695.71" "$208,695.71" "$254,287.68" "$44,775.57" "$256,856.27" "$201,610.34" "$43,932.52" "$44,685.70" "$186,220.89" "$47,014.35" "$48,980.75" "$53,247.07" "$46,129.16" "$44,775.57" N/A N/A MS330 DRG MS-DRG V39 (FY2022) 330 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC INPATIENT ONLY "$207,916.00" "$153,858.00" "$22,765.47" "$166,332.75" "$132,883.68" "$132,883.68" "$132,883.68" "$132,883.68" "$28,647.46" "$28,647.46" "$31,730.84" "$26,009.28" "$28,647.46" "$76,713.25" "$76,713.25" "$80,695.63" "$50,585.02" "$26,009.28" "$45,835.94" "$101,851.47" "$135,145.37" "$28,647.46" "$29,200.80" "$28,647.46" "$30,079.83" "$155,937.00" "$28,647.46" "$25,840.01" "$28,647.46" "$135,145.37" "$135,145.37" "$164,669.43" "$28,647.46" "$166,332.75" "$120,591.25" "$22,765.47" "$28,647.46" "$120,591.28" "$30,079.83" "$25,554.96" "$33,067.34" "$26,009.28" "$28,647.46" N/A N/A MS331 DRG MS-DRG V39 (FY2022) 331 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$171,867.00" "$127,182.00" "$17,146.58" "$137,493.45" "$110,245.63" "$110,245.63" "$110,245.63" "$110,245.63" "$22,858.48" "$22,858.48" "$20,677.49" "$25,315.34" "$22,858.48" "$52,252.43" "$52,252.43" "$54,964.99" "$32,754.02" "$25,315.34" "$36,573.57" "$85,081.61" "$111,713.42" "$22,858.48" "$23,867.98" "$22,858.48" "$24,001.40" "$128,900.25" "$22,858.48" "$20,618.35" "$22,858.48" "$111,713.42" "$111,713.42" "$136,118.51" "$22,858.48" "$137,493.45" "$99,682.74" "$18,701.01" "$22,858.48" "$99,682.86" "$24,001.40" "$17,146.58" "$25,824.07" "$25,315.34" "$22,858.48" N/A N/A MS332 DRG MS-DRG V39 (FY2022) 332 RECTAL RESECTION WITH MCC INPATIENT ONLY "$168,891.50" "$124,980.00" "$30,198.26" "$135,113.10" "$107,987.05" "$107,987.05" "$107,987.05" "$107,987.05" "$39,774.05" "$39,774.05" "$41,993.77" "$33,849.94" "$39,774.05" "$48,746.40" "$48,746.40" "$51,276.95" "$30,198.26" "$33,849.94" "$63,638.48" "$83,554.11" "$109,779.38" "$39,774.05" "$40,664.31" "$39,774.05" "$41,762.75" "$126,668.63" "$39,774.05" "$35,876.19" "$39,774.05" "$109,779.38" "$109,779.38" "$133,761.95" "$39,774.05" "$135,113.10" "$97,956.99" "$32,238.02" "$39,774.05" "$97,957.07" "$41,762.75" "$41,716.15" "$46,989.09" "$33,849.94" "$39,774.05" N/A N/A MS333 DRG MS-DRG V39 (FY2022) 333 RECTAL RESECTION WITH CC INPATIENT ONLY "$375,461.50" "$277,842.00" "$27,602.11" "$300,368.91" "$240,771.09" "$240,771.09" "$240,771.09" "$240,771.09" N/A N/A "$233,897.49" "$51,961.10" N/A "$200,589.31" "$200,589.31" "$211,002.41" "$140,885.93" "$51,961.10" "$233,897.49" "$185,909.84" "$244,049.74" "$27,602.11" N/A N/A "$28,982.22" "$281,596.13" N/A N/A N/A "$244,049.74" "$244,049.74" "$297,365.22" "$27,602.11" "$300,368.91" "$217,765.37" "$38,283.60" "$27,602.11" "$217,767.67" "$28,982.22" "$233,897.49" "$29,544.14" "$51,961.10" "$27,602.11" N/A N/A MS334 DRG MS-DRG V39 (FY2022) 334 RECTAL RESECTION WITHOUT CC/MCC INPATIENT ONLY "$244,164.00" "$180,681.50" "$19,984.01" "$195,331.09" "$156,574.26" "$156,574.26" "$156,574.26" "$156,574.26" "$22,155.22" "$22,155.22" "$36,631.84" "$33,390.64" "$22,155.22" "$104,845.70" "$104,845.70" "$110,288.51" "$71,092.50" "$33,390.64" "$35,448.35" "$120,805.44" "$158,706.50" "$22,155.22" "$23,908.69" "$22,155.22" "$23,262.98" "$183,123.00" "$22,155.22" "$19,984.01" "$22,155.22" "$158,706.50" "$158,706.50" "$193,377.78" "$22,155.22" "$195,331.09" "$141,615.03" "$24,385.93" "$22,155.22" "$141,615.12" "$23,262.98" "$23,756.07" "$24,944.15" "$33,390.64" "$22,155.22" N/A N/A MS335 DRG MS-DRG V39 (FY2022) 335 PERITONEAL ADHESIOLYSIS WITH MCC INPATIENT ONLY "$392,939.00" "$290,775.00" "$38,062.48" "$294,704.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$294,704.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$38,062.48" "$227,904.62" N/A N/A N/A N/A N/A N/A N/A MS336 DRG MS-DRG V39 (FY2022) 336 PERITONEAL ADHESIOLYSIS WITH CC INPATIENT ONLY "$162,655.50" "$120,365.50" "$21,010.28" "$130,124.06" "$103,934.83" "$103,934.83" "$103,934.83" "$103,934.83" "$26,866.86" "$26,866.86" "$21,010.28" "$41,541.04" "$26,866.86" "$43,996.46" "$43,996.46" "$46,280.43" "$26,735.73" "$41,541.04" "$42,986.98" "$80,101.55" "$105,725.80" "$26,866.86" "$26,855.10" "$26,866.86" "$28,210.20" "$121,991.63" "$26,866.86" "$24,233.91" "$26,866.86" "$105,725.80" "$105,725.80" "$128,822.82" "$26,866.86" "$130,124.06" "$94,339.95" "$41,541.04" "$26,866.86" "$94,340.19" "$28,210.20" "$22,968.69" "$30,839.42" "$41,541.04" "$26,866.86" N/A N/A MS337 DRG MS-DRG V39 (FY2022) 337 PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC INPATIENT ONLY "$189,822.00" "$140,468.50" "$16,412.79" "$151,857.48" "$121,584.45" "$121,584.45" "$121,584.45" "$121,584.45" "$22,353.30" "$22,353.30" "$24,353.74" "$27,725.56" "$22,353.30" "$64,677.62" "$64,677.62" "$68,035.21" "$41,811.51" "$27,725.56" "$35,765.28" "$93,988.61" "$123,384.20" "$22,353.30" "$22,915.83" "$22,353.30" "$23,470.97" "$142,366.50" "$22,353.30" "$20,162.68" "$22,353.30" "$123,384.20" "$123,384.20" "$150,338.90" "$22,353.30" "$151,857.48" "$110,096.67" "$20,580.49" "$22,353.30" "$110,096.76" "$23,470.97" "$16,412.79" "$25,191.99" "$27,725.56" "$22,353.30" N/A N/A MS338 DRG MS-DRG V39 (FY2022) 338 APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC INPATIENT ONLY "$215,692.50" "$159,612.50" "$30,359.02" "$172,553.75" N/A N/A N/A N/A "$30,637.22" "$30,637.22" N/A N/A "$30,359.02" "$82,509.43" "$82,509.43" N/A N/A N/A N/A N/A N/A "$30,637.22" "$30,637.22" "$30,637.22" "$30,637.22" "$161,769.38" "$30,637.22" "$30,637.22" "$30,637.22" N/A N/A "$170,828.21" "$30,359.02" "$172,553.75" N/A N/A "$30,359.02" "$125,101.65" "$30,637.22" N/A N/A N/A "$30,637.22" N/A N/A MS339 DRG MS-DRG V39 (FY2022) 339 APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC INPATIENT ONLY "$173,685.50" "$128,527.50" "$17,015.25" "$138,948.15" "$111,033.59" "$111,033.59" "$111,033.59" "$111,033.59" "$22,768.07" "$22,768.07" "$21,339.77" "$25,772.20" "$22,768.07" "$52,136.88" "$52,136.88" "$54,843.43" "$32,669.79" "$25,772.20" "$36,428.91" "$84,420.25" "$112,895.37" "$22,768.07" "$23,293.69" "$22,768.07" "$23,906.47" "$130,264.13" "$22,768.07" "$20,536.80" "$22,768.07" "$112,895.37" "$112,895.37" "$137,558.68" "$22,768.07" "$138,948.15" "$100,737.41" "$19,093.99" "$22,768.07" "$100,737.59" "$23,906.47" "$17,015.25" "$25,710.95" "$25,772.20" "$22,768.07" N/A N/A MS340 DRG MS-DRG V39 (FY2022) 340 APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC INPATIENT ONLY "$102,641.00" "$75,954.50" $548.51 "$82,112.48" "$12,527.07" "$12,527.07" "$12,527.07" "$12,527.07" "$19,530.56" "$19,530.56" "$10,833.16" "$12,523.31" "$19,530.56" $548.51 $548.51 $576.98 "$5,884.50" "$12,523.31" "$31,248.90" "$16,149.45" "$66,716.38" "$19,530.56" "$20,232.99" "$19,530.56" "$20,507.09" "$76,980.75" "$19,530.56" "$17,616.57" "$19,530.56" "$19,464.69" "$16,701.02" "$81,291.38" "$19,530.56" "$82,112.48" "$10,500.00" "$11,926.96" "$19,530.56" "$59,531.78" "$20,507.09" "$12,312.86" "$21,660.14" "$12,523.31" "$19,530.56" N/A N/A MS341 DRG MS-DRG V39 (FY2022) 341 APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC INPATIENT ONLY "$146,967.50" "$108,756.00" "$10,500.00" "$117,573.96" "$94,199.76" "$94,199.76" "$94,199.76" "$94,199.76" "$27,081.51" "$27,081.51" "$20,406.00" "$22,477.56" "$27,081.51" "$33,795.58" "$33,795.58" "$35,549.99" "$19,299.68" "$22,477.56" "$43,330.42" "$71,678.79" "$95,528.84" "$27,081.51" "$27,797.95" "$27,081.51" "$28,435.59" "$110,225.63" "$27,081.51" "$24,427.52" "$27,081.51" "$95,528.84" "$95,528.84" "$116,398.21" "$27,081.51" "$117,573.96" "$10,500.00" "$17,915.22" "$27,081.51" "$85,241.15" "$28,435.59" "$23,280.44" "$31,108.00" "$22,477.56" "$27,081.51" N/A N/A MS342 DRG MS-DRG V39 (FY2022) 342 APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC INPATIENT ONLY "$212,717.50" "$157,411.00" "$16,050.32" "$170,173.74" "$136,116.13" "$136,116.13" "$136,116.13" "$136,116.13" "$20,942.62" "$20,942.62" N/A "$37,525.76" N/A "$80,799.89" "$80,799.89" N/A "$53,564.03" N/A N/A "$103,840.79" "$138,266.16" "$20,942.62" N/A N/A "$21,989.75" "$159,538.13" N/A N/A "$20,942.62" "$138,266.16" "$138,266.16" "$168,472.00" "$20,942.62" "$170,173.74" N/A "$29,383.59" "$20,942.62" "$123,376.15" "$21,989.75" "$16,050.32" "$23,426.92" "$37,525.76" "$20,942.62" N/A N/A MS343 DRG MS-DRG V39 (FY2022) 343 APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC INPATIENT ONLY "$99,750.00" "$73,815.00" "$1,961.50" "$79,799.84" "$4,465.62" "$4,465.62" "$4,465.62" "$4,465.62" "$18,704.47" "$18,704.47" "$8,393.76" "$8,365.27" "$18,704.47" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$8,365.27" "$29,927.15" "$14,706.65" "$16,629.00" "$18,704.47" "$19,467.30" "$18,704.47" "$19,639.69" "$74,812.50" "$18,704.47" "$16,871.43" "$18,704.47" "$17,330.09" "$14,835.74" "$79,001.86" "$18,704.47" "$79,799.84" "$3,500.00" "$7,966.92" "$18,704.47" "$57,855.00" "$19,639.69" "$11,112.95" "$20,626.51" "$8,365.27" "$18,704.47" N/A N/A MS344 DRG MS-DRG V39 (FY2022) 344 MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC INPATIENT ONLY "$679,920.00" "$503,141.00" "$394,353.60" "$509,940.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$509,940.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$394,353.60" N/A N/A N/A N/A N/A N/A N/A MS345 DRG MS-DRG V39 (FY2022) 345 MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC INPATIENT ONLY "$99,542.50" "$73,661.50" "$7,846.00" "$79,633.85" "$16,749.67" "$16,749.67" "$16,749.67" "$16,749.67" "$21,949.56" "$21,949.56" "$15,269.25" "$12,833.63" "$21,949.56" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$12,833.63" "$35,119.30" "$20,881.64" "$27,942.00" "$21,949.56" "$22,744.42" "$21,949.56" "$23,047.04" "$74,656.88" "$21,949.56" "$19,798.50" "$21,949.56" "$25,126.26" "$21,573.96" "$78,837.53" "$21,949.56" "$79,633.85" "$14,000.00" "$12,222.50" "$21,949.56" "$57,734.65" "$23,047.04" "$15,826.38" "$24,686.82" "$12,833.63" "$21,949.56" N/A N/A MS346 DRG MS-DRG V39 (FY2022) 346 MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$60,888.00" "$45,057.50" "$1,961.50" "$48,710.26" "$4,209.75" "$4,209.75" "$4,209.75" "$4,209.75" "$19,855.62" "$19,855.62" "$10,702.84" "$9,145.79" "$19,855.62" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$9,145.79" "$31,768.99" "$16,833.17" "$19,131.00" "$19,855.62" "$20,595.85" "$19,855.62" "$20,848.40" "$45,666.00" "$19,855.62" "$17,909.77" "$19,855.62" "$19,131.00" "$16,261.35" "$48,223.17" "$19,855.62" "$48,710.26" "$3,500.00" "$8,710.28" "$19,855.62" "$35,315.04" "$20,848.40" "$12,785.00" "$22,066.85" "$9,145.79" "$19,855.62" N/A N/A MS347 DRG MS-DRG V39 (FY2022) 347 ANAL AND STOMAL PROCEDURES WITH MCC INPATIENT ONLY "$90,922.50" "$67,283.00" "$9,807.50" "$72,737.70" "$19,849.33" "$19,849.33" "$19,849.33" "$19,849.33" "$28,063.60" "$28,063.60" "$23,408.62" "$11,318.95" "$28,063.60" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$11,318.95" "$44,901.76" "$34,161.63" "$36,970.50" "$28,063.60" "$29,792.23" "$28,063.60" "$29,466.78" "$68,191.88" "$28,063.60" "$25,313.37" "$28,063.60" "$36,970.50" "$31,900.77" "$72,010.33" "$28,063.60" "$72,737.70" "$17,500.00" "$10,779.95" "$28,063.60" "$52,735.05" "$29,466.78" "$24,706.90" "$32,336.80" "$11,318.95" "$28,063.60" N/A N/A MS348 DRG MS-DRG V39 (FY2022) 348 ANAL AND STOMAL PROCEDURES WITH CC INPATIENT ONLY "$100,696.00" "$74,515.50" "$5,884.50" "$80,556.77" "$12,349.23" "$12,349.23" "$12,349.23" "$12,349.23" "$20,357.38" "$20,357.38" "$12,339.82" "$10,680.34" "$20,357.38" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$10,680.34" "$32,571.81" "$18,586.88" "$65,452.37" "$20,357.38" "$21,526.56" "$20,357.38" "$21,375.25" "$75,522.00" "$20,357.38" "$18,362.36" "$20,357.38" "$21,044.33" "$18,011.11" "$79,751.20" "$20,357.38" "$80,556.77" "$10,500.00" "$10,171.75" "$20,357.38" "$58,403.68" "$21,375.25" "$13,513.77" "$22,694.66" "$10,680.34" "$20,357.38" N/A N/A MS349 DRG MS-DRG V39 (FY2022) 349 ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$70,312.00" "$52,031.00" "$6,987.50" "$56,249.24" "$17,028.79" "$17,028.79" "$17,028.79" "$17,028.79" "$17,812.12" "$17,812.12" "$8,102.78" "$7,336.88" "$17,812.12" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$7,336.88" "$28,499.39" "$13,421.31" "$14,689.50" "$17,812.12" "$18,785.15" "$17,812.12" "$18,702.73" "$52,734.00" "$17,812.12" "$16,066.53" "$17,812.12" "$16,474.92" "$14,271.49" "$55,686.76" "$17,812.12" "$56,249.24" "$14,000.00" "$6,987.50" "$17,812.12" "$40,780.96" "$18,702.73" "$9,816.80" "$19,509.99" "$7,336.88" "$17,812.12" N/A N/A MS350 DRG MS-DRG V39 (FY2022) 350 INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC INPATIENT ONLY "$244,276.00" "$180,764.50" "$18,181.02" "$195,420.64" "$156,562.77" "$156,562.77" "$156,562.77" "$156,562.77" "$27,995.27" "$27,995.27" "$39,568.98" "$19,090.08" "$27,995.27" "$116,503.56" "$116,503.56" "$123,730.99" "$79,269.06" "$19,090.08" "$44,792.43" "$119,860.37" "$158,779.28" "$27,995.27" "$28,497.95" "$27,995.27" "$29,395.03" "$183,207.00" "$27,995.27" "$25,251.73" "$27,995.27" "$158,779.28" "$158,779.28" "$193,466.42" "$27,995.27" "$195,420.64" "$141,679.98" "$18,181.02" "$27,995.27" "$141,680.08" "$29,395.03" "$25,478.76" "$32,251.30" "$19,090.08" "$27,995.27" N/A N/A MS351 DRG MS-DRG V39 (FY2022) 351 INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC INPATIENT ONLY "$146,177.00" "$108,171.00" "$14,080.40" "$116,941.55" "$93,363.85" "$93,363.85" "$93,363.85" "$93,363.85" "$21,355.32" "$21,355.32" "$14,080.40" "$19,090.08" "$21,355.32" "$31,964.87" "$31,964.87" "$33,624.25" "$17,965.17" "$19,090.08" "$34,168.51" "$71,539.80" "$95,015.01" "$21,355.32" "$22,163.70" N/A "$22,423.09" "$109,632.75" "$21,355.32" "$19,262.50" "$21,355.32" "$95,015.01" "$95,015.01" "$115,772.13" "$21,355.32" "$116,941.55" "$14,764.33" "$18,181.02" "$21,355.32" "$84,782.66" "$22,423.09" "$14,963.28" "$23,943.31" "$19,090.08" "$21,355.32" N/A N/A MS352 DRG MS-DRG V39 (FY2022) 352 INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$141,494.50" "$104,706.00" "$7,177.62" "$113,195.40" "$90,648.35" "$90,648.35" "$90,648.35" "$90,648.35" "$18,675.48" "$18,675.48" "$11,437.48" "$9,950.42" "$18,675.48" "$29,645.79" "$29,645.79" "$31,184.78" "$16,274.65" "$9,950.42" "$29,880.77" "$69,364.48" "$91,971.26" "$18,675.48" "$19,534.43" "$18,675.48" "$19,609.25" "$106,120.88" "$18,675.48" "$16,845.28" "$18,675.48" "$91,971.26" "$91,971.26" "$112,063.44" "$18,675.48" "$113,195.40" "$24,567.05" "$7,177.62" "$18,675.48" "$82,066.81" "$19,609.25" "$11,070.84" "$20,590.25" "$9,950.42" "$18,675.48" N/A N/A MS353 DRG MS-DRG V39 (FY2022) 353 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC INPATIENT ONLY "$206,499.00" "$152,809.50" "$28,800.69" "$165,199.08" "$132,262.01" "$132,262.01" "$132,262.01" "$132,262.01" "$31,929.81" "$31,929.81" "$32,624.14" "$37,863.87" "$31,929.81" "$76,774.37" "$76,774.37" "$80,759.93" "$50,629.58" "$37,863.87" "$51,087.70" "$100,363.78" "$134,224.25" "$31,929.81" "$32,146.49" "$31,929.81" "$33,526.30" "$154,874.25" "$31,929.81" "$28,800.69" "$31,929.81" "$134,224.25" "$134,224.25" "$163,547.09" "$31,929.81" "$165,199.08" "$119,769.33" "$29,823.70" "$31,929.81" "$119,769.42" "$33,526.30" "$30,322.52" "$37,174.26" "$37,863.87" "$31,929.81" N/A N/A MS354 DRG MS-DRG V39 (FY2022) 354 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC INPATIENT ONLY "$190,922.50" "$141,283.00" "$17,891.39" "$152,737.97" "$121,977.90" "$121,977.90" "$121,977.90" "$121,977.90" "$23,371.27" "$23,371.27" "$25,044.37" "$28,854.48" "$23,371.27" "$64,289.45" "$64,289.45" "$67,626.88" "$41,528.55" "$28,854.48" "$37,394.03" "$92,860.36" "$124,099.59" "$23,371.27" "$24,176.54" "$24,176.54" "$24,539.83" "$143,191.88" "$23,371.27" "$21,080.89" "$24,176.54" "$124,099.59" "$124,099.59" "$151,210.56" "$23,371.27" "$152,737.97" N/A "$21,630.15" "$23,371.27" "$110,735.05" "$24,539.83" "$17,891.39" "$26,465.68" "$28,854.48" "$23,371.27" N/A N/A MS355 DRG MS-DRG V39 (FY2022) 355 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC INPATIENT ONLY "$105,356.00" "$77,963.50" "$1,542.92" "$84,284.71" "$5,353.64" "$5,353.64" "$5,353.64" "$5,353.64" "$20,440.90" "$20,440.90" "$11,175.91" "$10,688.86" "$20,440.90" "$1,542.92" "$1,542.92" "$1,623.02" "$1,961.50" "$10,688.86" "$32,705.44" "$18,469.79" "$68,481.33" "$20,440.90" "$21,464.42" "$20,440.90" "$21,462.95" "$79,017.00" "$20,440.90" "$18,437.69" "$20,440.90" "$20,403.00" "$17,342.55" "$83,441.86" "$20,440.90" "$84,284.71" "$4,582.48" "$10,179.86" "$20,440.90" "$61,106.48" "$21,462.95" "$13,635.06" "$22,799.16" "$10,688.86" "$20,440.90" N/A N/A MS356 DRG MS-DRG V39 (FY2022) 356 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC INPATIENT ONLY "$156,613.50" "$115,894.00" "$23,492.68" "$157,300.78" "$100,049.15" "$100,049.15" "$100,049.15" "$100,049.15" "$40,783.74" "$40,783.74" "$34,429.22" "$33,547.19" "$40,783.74" "$39,547.59" "$39,547.59" "$41,600.61" "$23,492.68" "$33,547.19" "$65,253.98" "$84,425.40" "$101,798.68" "$40,783.74" "$41,822.85" "$40,783.74" "$42,822.93" "$117,460.13" "$40,783.74" "$36,786.93" "$40,783.74" "$101,798.68" "$101,798.68" "$124,037.79" "$40,783.74" "$125,290.69" "$90,835.75" "$31,949.69" "$40,783.74" "$90,835.83" "$42,822.93" "$43,182.70" "$48,252.43" "$33,547.19" "$40,783.74" N/A N/A MS357 DRG MS-DRG V39 (FY2022) 357 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC INPATIENT ONLY "$163,907.50" "$121,292.00" "$16,728.78" "$131,125.85" "$100,626.40" "$100,626.40" "$100,626.40" "$100,626.40" "$26,709.52" "$26,709.52" "$20,415.93" "$23,050.87" "$26,709.52" "$52,813.54" "$52,813.54" "$55,455.52" "$34,887.00" "$23,050.87" "$42,735.23" "$79,015.08" "$106,539.75" "$26,709.52" "$27,706.52" "$26,709.52" "$28,045.00" "$122,930.63" "$26,709.52" "$24,091.99" "$26,709.52" "$106,539.75" "$106,539.75" "$129,814.59" "$26,709.52" "$131,125.85" "$103,292.58" "$16,728.78" "$26,709.52" "$95,066.35" "$28,045.00" "$22,740.13" "$30,642.55" "$23,050.87" "$26,709.52" N/A N/A MS358 DRG MS-DRG V39 (FY2022) 358 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$127,388.00" "$94,267.50" "$12,261.28" "$116,679.70" "$13,608.72" "$13,608.72" "$13,608.72" "$13,608.72" "$20,364.28" "$20,364.28" "$12,261.28" "$14,178.01" "$20,364.28" "$26,707.39" "$26,707.39" "$27,994.13" "$15,856.62" "$14,178.01" "$32,582.85" "$18,670.32" "$82,801.91" "$20,364.28" "$21,570.84" "$20,364.28" "$21,382.49" "$95,541.00" "$20,364.28" "$18,368.58" "$20,364.28" "$82,801.91" "$82,801.91" "$100,890.94" "$20,364.28" "$101,910.06" "$22,389.55" "$13,502.87" "$20,364.28" "$73,885.04" "$21,382.49" "$13,523.80" "$22,703.29" "$14,178.01" "$20,364.28" N/A N/A MS368 DRG MS-DRG V39 (FY2022) 368 MAJOR ESOPHAGEAL DISORDERS WITH MCC INPATIENT ONLY "$51,115.50" "$37,825.50" "$6,157.23" "$40,892.23" "$12,415.18" "$12,415.18" "$12,415.18" "$12,415.18" "$24,505.17" "$24,505.17" "$16,638.45" "$10,446.66" "$24,505.17" "$8,769.84" "$8,769.84" "$8,720.82" "$6,157.23" "$10,446.66" "$39,208.27" "$23,609.78" "$29,236.50" "$24,505.17" "$24,192.26" "$24,505.17" "$25,730.43" "$38,336.63" "$24,505.17" "$22,103.66" "$24,505.17" "$29,236.50" "$24,851.03" "$40,483.29" "$24,505.17" "$40,892.23" N/A "$9,949.20" "$24,505.17" "$29,646.99" "$25,730.43" "$19,538.37" "$27,884.45" "$10,446.66" "$24,505.17" N/A N/A MS369 DRG MS-DRG V39 (FY2022) 369 MAJOR ESOPHAGEAL DISORDERS WITH CC INPATIENT ONLY "$31,976.00" "$23,662.50" $296.77 "$29,580.40" "$8,265.26" "$8,265.26" "$8,265.26" "$8,265.26" "$18,487.75" "$18,487.75" "$9,553.21" "$7,045.49" "$18,487.75" "$5,846.56" "$5,846.56" "$5,813.88" "$4,104.82" "$7,045.49" "$29,580.40" "$13,756.44" "$16,158.00" "$18,487.75" "$18,963.01" "$18,487.75" "$19,412.14" "$23,982.00" "$18,487.75" $296.77 $298.80 "$16,158.00" "$13,734.30" "$25,324.74" "$18,487.75" "$25,580.55" "$9,553.21" "$6,709.99" "$18,487.75" "$18,546.08" "$19,412.14" "$10,798.17" "$20,355.36" "$7,045.49" "$18,487.75" N/A N/A MS370 DRG MS-DRG V39 (FY2022) 370 MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$12,744.00" "$9,431.00" "$1,961.50" "$16,555.86" "$3,901.90" "$3,901.90" "$3,901.90" "$3,901.90" "$15,451.11" "$15,451.11" "$6,048.07" "$2,919.28" "$15,451.11" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$7,503.39" "$12,743.85" "$8,530.31" "$9,558.00" "$15,451.11" "$16,189.45" "$15,451.11" "$16,223.67" "$9,558.00" "$15,451.11" "$13,936.90" "$15,451.11" "$9,558.00" "$8,124.30" "$10,093.13" "$15,451.11" "$10,195.08" "$3,500.00" "$7,146.08" "$16,216.47" "$7,391.52" "$16,223.67" "$6,387.50" "$16,555.86" "$2,919.28" "$12,743.85" N/A N/A MS371 DRG MS-DRG V39 (FY2022) 371 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC INPATIENT ONLY "$58,013.00" "$42,930.00" "$13,730.50" "$46,410.38" "$28,394.47" "$28,394.47" "$28,394.47" "$28,394.47" "$25,175.50" "$25,175.50" "$16,631.31" "$16,239.53" "$25,175.50" "$19,561.22" "$19,561.22" "$23,438.87" "$13,730.50" "$16,239.53" "$40,280.80" "$22,769.94" "$25,968.00" "$25,175.50" "$25,957.36" "$25,175.50" "$26,434.28" "$43,509.75" "$25,175.50" "$22,708.30" "$25,175.50" "$27,374.12" "$23,478.92" "$45,946.26" "$25,175.50" "$46,410.38" "$24,500.00" "$15,466.21" "$25,175.50" "$33,647.54" "$26,434.28" "$17,354.07" "$28,777.28" "$16,239.53" "$25,175.50" N/A N/A MS372 DRG MS-DRG V39 (FY2022) 372 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC INPATIENT ONLY "$58,315.50" "$43,153.50" "$9,068.89" "$46,652.26" "$35,992.01" "$35,992.01" "$35,992.01" "$35,992.01" "$18,157.17" "$18,157.17" "$10,124.46" "$9,522.34" "$18,157.17" "$25,150.14" "$25,150.14" "$30,135.69" "$17,653.50" "$9,522.34" "$29,051.47" "$13,701.26" "$15,439.50" "$18,157.17" "$18,933.72" "$18,157.17" "$19,065.03" "$43,736.63" "$18,157.17" "$16,377.77" "$18,933.72" "$16,617.74" "$14,301.81" "$46,185.73" "$18,157.17" "$46,652.26" "$31,500.00" "$9,068.89" "$18,157.17" "$33,822.99" "$19,065.03" "$10,318.02" "$19,941.74" "$9,522.34" "$18,157.17" N/A N/A MS373 DRG MS-DRG V39 (FY2022) 373 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC INPATIENT ONLY "$40,722.50" "$30,135.00" "$3,923.00" "$32,577.80" "$8,503.66" "$8,503.66" "$8,503.66" "$8,503.66" "$16,192.32" "$16,192.32" "$7,152.19" "$7,471.23" "$16,192.32" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$7,471.23" "$25,907.71" "$9,771.23" "$11,169.00" "$16,192.32" "$16,848.03" "$16,192.32" "$17,001.94" "$30,541.88" "$16,192.32" "$14,605.47" "$16,192.32" "$12,048.59" "$10,373.24" "$32,252.01" "$16,192.32" "$32,577.80" "$7,000.00" "$7,115.45" "$16,192.32" "$23,619.05" "$17,001.94" "$7,464.10" "$17,483.28" "$7,471.23" "$16,192.32" N/A N/A MS374 DRG MS-DRG V39 (FY2022) 374 DIGESTIVE MALIGNANCY WITH MCC INPATIENT ONLY "$64,743.50" "$47,910.50" "$12,314.46" "$51,794.60" "$25,169.96" "$25,169.96" "$25,169.96" "$25,169.96" "$25,365.10" "$25,365.10" "$18,013.91" "$15,900.83" "$25,365.10" "$17,539.68" "$17,539.68" "$17,441.64" "$12,314.46" "$15,900.83" "$40,584.16" "$26,827.82" "$31,105.50" "$25,365.10" "$25,900.10" "$25,900.10" "$26,633.36" "$48,557.63" "$25,365.10" "$22,879.32" "$25,365.10" "$31,750.79" "$27,084.96" "$51,276.66" "$25,365.10" "$51,794.60" N/A "$15,143.64" "$25,365.10" "$37,551.23" "$26,633.36" "$20,787.40" "$28,960.39" "$15,900.83" "$25,365.10" N/A N/A MS375 DRG MS-DRG V39 (FY2022) 375 DIGESTIVE MALIGNANCY WITH CC INPATIENT ONLY "$60,677.00" "$44,901.00" "$7,846.00" "$48,541.38" "$16,428.64" "$16,428.64" "$16,428.64" "$16,428.64" "$19,387.71" "$19,387.71" "$11,093.79" "$12,244.22" "$19,387.71" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$12,244.22" "$31,020.34" "$16,212.71" "$18,114.00" "$19,387.71" "$20,266.57" "$16,578.79" "$20,357.10" "$45,507.75" "$19,387.71" "$17,487.71" "$19,387.71" "$18,114.00" "$15,396.90" "$48,055.97" "$19,387.71" "$48,541.38" "$14,725.85" "$11,661.16" "$19,387.71" "$35,192.66" "$20,357.10" "$12,105.35" "$21,481.41" "$12,244.22" "$19,387.71" N/A N/A MS376 DRG MS-DRG V39 (FY2022) 376 DIGESTIVE MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$57,590.00" "$42,617.00" "$7,260.52" "$46,071.93" "$31,288.71" "$31,288.71" "$31,288.71" "$31,288.71" "$17,257.23" "$17,257.23" "$8,051.90" "$7,623.54" "$17,257.23" "$22,355.68" "$22,355.68" "$26,787.28" "$15,692.00" "$7,623.54" "$27,611.57" "$11,814.31" "$13,483.50" "$17,257.23" "$17,932.30" "$17,257.23" "$18,120.09" "$43,192.50" "$17,257.23" "$15,566.02" "$17,257.23" "$13,483.50" "$11,460.98" "$45,611.20" "$17,257.23" "$46,071.93" "$28,000.00" "$7,260.52" "$17,257.23" "$33,402.20" "$18,120.09" "$9,010.85" "$18,815.71" "$7,623.54" "$17,257.23" N/A N/A MS377 DRG MS-DRG V39 (FY2022) 377 GASTROINTESTINAL HEMORRHAGE WITH MCC INPATIENT ONLY "$98,969.50" "$73,237.50" "$2,463.94" "$79,175.39" "$6,183.13" "$6,183.13" "$6,183.13" "$6,183.13" "$23,484.44" "$23,484.44" "$15,865.49" "$15,384.27" "$23,484.44" "$3,510.27" "$3,510.27" "$3,645.28" "$2,463.94" "$15,384.27" "$37,575.10" "$23,930.10" "$27,018.00" "$23,484.44" "$24,362.26" "$23,484.44" "$24,658.66" "$74,227.13" "$23,484.44" "$21,182.96" "$23,484.44" "$27,970.26" "$23,917.56" "$78,383.62" "$23,484.44" "$79,175.39" N/A "$14,651.68" "$23,484.44" "$57,402.31" "$24,658.66" "$18,055.78" "$26,607.29" "$15,384.27" "$23,484.44" N/A N/A MS378 DRG MS-DRG V39 (FY2022) 378 GASTROINTESTINAL HEMORRHAGE WITH CC INPATIENT ONLY "$59,525.00" "$44,048.50" "$7,846.00" "$47,620.01" "$15,718.11" "$15,718.11" "$15,718.11" "$15,718.11" "$17,910.11" "$17,910.11" "$8,944.47" "$9,332.17" "$17,910.11" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$9,332.17" "$28,656.18" "$13,257.12" "$14,902.50" "$17,910.11" "$18,698.00" "$18,698.00" "$18,805.62" "$44,643.75" "$17,910.11" "$16,154.92" "$17,910.11" "$14,902.50" "$12,667.13" "$47,143.80" "$17,910.11" "$47,620.01" "$14,000.00" "$8,887.78" "$17,910.11" "$34,524.50" "$18,805.62" "$9,959.14" "$19,632.60" "$9,332.17" "$17,910.11" N/A N/A MS379 DRG MS-DRG V39 (FY2022) 379 GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC INPATIENT ONLY "$30,763.50" "$22,765.00" "$3,500.00" "$24,721.78" "$7,850.85" "$7,850.85" "$7,850.85" "$7,850.85" "$15,451.11" "$15,451.11" "$6,048.07" "$7,503.39" "$15,451.11" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$7,503.39" "$24,721.78" "$8,530.31" "$13,818.00" "$15,451.11" "$16,189.45" "$15,451.11" "$16,223.67" "$23,072.63" "$15,451.11" "$13,936.90" "$15,451.11" "$9,558.00" "$8,124.30" "$24,364.38" "$15,451.11" "$24,610.48" "$7,000.00" "$7,146.08" "$15,451.11" "$17,842.83" "$16,223.67" "$6,387.50" "$16,555.86" "$7,503.39" "$15,451.11" N/A N/A MS380 DRG MS-DRG V39 (FY2022) 380 COMPLICATED PEPTIC ULCER WITH MCC INPATIENT ONLY "$51,197.50" "$37,886.50" "$8,348.44" "$40,957.64" "$17,658.78" "$17,658.78" "$17,658.78" "$17,658.78" "$24,073.83" "$24,073.83" "$17,195.42" "$9,192.15" "$24,073.83" "$11,893.65" "$11,893.65" "$13,690.51" "$8,348.44" "$9,192.15" "$38,518.13" "$25,627.28" "$28,299.00" "$24,073.83" "$25,262.98" "$24,073.83" "$25,277.52" "$38,398.13" "$24,073.83" "$21,714.59" "$24,073.83" "$29,006.40" "$24,761.55" "$40,548.05" "$24,073.83" "$40,957.64" "$10,500.00" "$8,754.43" "$24,073.83" "$29,694.55" "$25,277.52" "$18,911.85" "$27,344.74" "$9,192.15" "$24,073.83" N/A N/A MS381 DRG MS-DRG V39 (FY2022) 381 COMPLICATED PEPTIC ULCER WITH CC INPATIENT ONLY "$48,971.00" "$36,239.00" "$7,846.00" "$39,176.49" "$16,524.65" "$16,524.65" "$16,524.65" "$16,524.65" "$18,364.22" "$18,364.22" "$9,706.73" "$12,031.35" "$18,364.22" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$12,031.35" "$29,382.75" "$14,205.97" "$15,889.50" "$18,364.22" "$19,201.57" "$18,364.22" "$19,282.43" "$36,728.25" "$18,364.22" "$16,564.53" "$18,364.22" "$17,058.74" "$14,675.31" "$38,784.71" "$18,364.22" "$39,176.49" "$14,000.00" "$11,458.42" "$18,364.22" "$28,403.18" "$19,282.43" "$10,618.74" "$20,200.79" "$12,031.35" "$18,364.22" N/A N/A MS382 DRG MS-DRG V39 (FY2022) 382 COMPLICATED PEPTIC ULCER WITHOUT CC/MCC INPATIENT ONLY "$37,237.50" "$27,556.00" "$6,564.02" "$29,789.72" "$16,001.91" "$16,001.91" "$16,001.91" "$16,001.91" "$16,357.97" "$16,357.97" "$6,775.52" "$6,892.22" "$16,357.97" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$6,892.22" "$26,172.75" "$10,360.74" "$11,529.00" "$16,357.97" "$17,160.87" N/A "$17,175.87" "$27,928.13" "$16,357.97" "$14,754.89" "$16,357.97" "$11,529.00" "$10,329.99" "$29,491.83" "$16,357.97" "$29,789.72" "$14,000.00" "$6,564.02" "$16,357.97" "$21,597.75" "$17,175.87" "$7,704.68" "$17,690.54" "$6,892.22" "$16,357.97" N/A N/A MS383 DRG MS-DRG V39 (FY2022) 383 UNCOMPLICATED PEPTIC ULCER WITH MCC INPATIENT ONLY "$36,130.50" "$26,737.00" "$3,923.00" "$32,179.79" "$8,141.78" "$8,141.78" "$8,141.78" "$8,141.78" "$20,112.37" "$20,112.37" "$11,795.35" "$10,533.70" "$20,112.37" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$10,533.70" "$32,179.79" "$18,304.24" "$19,689.00" "$20,112.37" "$21,376.56" "$20,112.37" "$21,117.99" "$27,097.88" "$20,112.37" "$18,141.36" "$20,112.37" "$19,689.00" "$16,735.65" "$28,615.21" "$20,112.37" "$28,904.25" "$7,000.00" "$10,032.09" "$20,112.37" "$20,955.69" "$21,117.99" "$13,157.90" "$22,388.11" "$10,533.70" "$20,112.37" N/A N/A MS384 DRG MS-DRG V39 (FY2022) 384 UNCOMPLICATED PEPTIC ULCER WITHOUT MCC INPATIENT ONLY "$34,851.00" "$25,790.00" "$5,884.50" "$27,880.48" "$11,856.63" "$11,856.63" "$11,856.63" "$11,856.63" "$17,215.12" "$17,215.12" "$7,595.80" "$7,556.37" "$17,215.12" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$7,556.37" "$27,544.19" "$12,134.63" "$13,392.00" "$17,215.12" "$18,102.29" "$17,215.12" "$18,075.88" "$26,138.25" "$17,215.12" "$15,528.04" "$17,215.12" "$13,392.00" "$11,383.20" "$27,601.68" "$17,215.12" "$27,880.48" "$10,500.00" "$7,196.54" "$17,215.12" "$20,213.58" "$18,075.88" "$8,949.71" "$18,763.02" "$7,556.37" "$17,215.12" N/A N/A MS385 DRG MS-DRG V39 (FY2022) 385 INFLAMMATORY BOWEL DISEASE WITH MCC INPATIENT ONLY "$44,409.00" "$32,863.00" "$9,807.50" "$35,599.62" "$19,817.80" "$19,817.80" "$19,817.80" "$19,817.80" "$22,249.76" "$22,249.76" "$15,753.02" "$10,617.90" "$22,249.76" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$10,617.90" "$35,599.62" "$21,920.67" "$24,334.50" "$22,249.76" "$23,295.84" "$25,424.19" "$23,362.25" "$33,306.75" "$22,249.76" "$20,069.28" "$22,249.76" "$24,334.50" "$20,684.33" "$35,171.69" "$22,249.76" "$35,526.97" "$17,500.00" "$10,112.28" "$22,249.76" "$25,757.22" "$23,362.25" "$16,262.43" "$25,062.44" "$10,617.90" "$22,249.76" N/A N/A MS386 DRG MS-DRG V39 (FY2022) 386 INFLAMMATORY BOWEL DISEASE WITH CC INPATIENT ONLY "$44,262.50" "$32,754.50" "$1,961.50" "$35,409.66" "$4,452.81" "$4,452.81" "$4,452.81" "$4,452.81" "$17,921.16" "$17,921.16" "$8,961.43" "$9,935.77" "$17,921.16" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$9,935.77" "$28,673.86" "$13,321.72" "$14,926.50" "$17,921.16" "$18,732.30" "$17,921.16" "$18,817.22" "$33,196.88" "$17,921.16" "$16,164.89" "$17,921.16" "$15,611.94" "$13,372.96" "$35,055.55" "$17,921.16" "$35,409.66" "$3,500.00" "$9,462.64" "$17,921.16" "$25,672.25" "$18,817.22" "$9,975.18" "$19,646.42" "$9,935.77" "$17,921.16" N/A N/A MS387 DRG MS-DRG V39 (FY2022) 387 INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC INPATIENT ONLY "$34,162.00" "$25,280.00" "$1,961.50" "$27,329.55" "$4,143.88" "$4,143.88" "$4,143.88" "$4,143.88" "$15,985.97" "$15,985.97" "$6,648.78" "$7,825.61" "$15,985.97" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$8,015.22" "$25,577.55" "$9,308.24" "$10,720.50" "$15,985.97" "$16,602.29" "$15,985.97" "$16,785.27" "$25,621.50" "$15,985.97" "$14,419.34" "$15,985.97" "$10,720.50" "$9,112.43" "$27,056.24" "$15,985.97" "$27,329.55" "$3,500.00" "$7,633.54" "$15,985.97" "$19,813.96" "$16,785.27" "$7,164.37" "$17,225.08" "$7,825.61" "$15,985.97" N/A N/A MS388 DRG MS-DRG V39 (FY2022) 388 GASTROINTESTINAL OBSTRUCTION WITH MCC INPATIENT ONLY "$92,397.50" "$68,374.50" "$11,115.13" "$73,917.81" "$26,698.39" "$26,698.39" "$26,698.39" "$26,698.39" "$21,506.47" "$21,506.47" N/A N/A "$24,061.27" "$17,671.32" "$17,671.32" "$20,008.10" "$12,404.42" N/A N/A "$19,749.74" N/A "$21,506.47" "$24,061.27" "$24,061.27" "$22,581.79" "$69,298.13" "$24,061.27" "$24,061.27" "$24,061.27" N/A "$21,290.41" "$73,178.62" "$21,506.47" "$73,917.81" N/A "$11,115.13" "$21,506.47" "$53,590.55" "$22,581.79" N/A "$24,132.43" "$11,670.89" "$24,061.27" N/A N/A MS389 DRG MS-DRG V39 (FY2022) 389 GASTROINTESTINAL OBSTRUCTION WITH CC INPATIENT ONLY "$51,808.50" "$38,338.50" "$7,565.97" "$41,446.42" "$15,939.20" "$15,939.20" "$15,939.20" "$15,939.20" "$16,734.77" "$16,734.77" "$7,780.56" "$7,944.27" "$16,734.77" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$7,944.27" "$26,775.63" "$10,862.76" "$12,348.00" "$16,734.77" "$17,427.30" "$16,734.77" "$17,571.51" "$38,856.38" "$16,734.77" "$15,094.76" "$16,734.77" "$12,348.00" "$10,495.80" "$41,031.95" "$16,734.77" "$41,446.42" "$14,000.00" "$7,565.97" "$16,734.77" "$30,048.93" "$17,571.51" "$8,252.00" "$18,162.01" "$7,944.27" "$16,734.77" N/A N/A MS390 DRG MS-DRG V39 (FY2022) 390 GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC INPATIENT ONLY "$36,915.00" "$27,317.50" "$3,923.00" "$29,531.77" "$8,232.38" "$8,232.38" "$8,232.38" "$8,232.38" "$15,077.74" "$15,077.74" "$5,385.79" "$5,565.81" "$15,077.74" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$5,565.81" "$24,124.38" "$7,611.06" "$8,746.50" "$15,077.74" "$15,701.60" "$15,077.74" "$15,831.63" "$27,686.25" "$15,077.74" "$13,600.12" "$15,077.74" "$8,746.50" "$7,982.54" "$29,236.43" "$15,077.74" "$29,531.77" "$7,000.00" "$5,300.77" "$15,077.74" "$21,410.70" "$15,831.63" "$5,845.17" "$16,088.70" "$5,565.81" "$15,077.74" N/A N/A MS391 DRG MS-DRG V39 (FY2022) 391 "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC" INPATIENT ONLY "$63,799.50" "$47,212.00" "$9,949.20" "$51,039.41" "$31,511.46" "$31,511.46" "$31,511.46" "$31,511.46" "$19,674.82" "$19,674.82" "$10,689.45" "$10,446.66" "$19,674.82" "$22,355.68" "$22,355.68" "$26,787.28" "$15,692.00" "$10,446.66" "$31,479.71" "$17,281.36" "$18,738.00" "$19,674.82" "$20,833.71" "$19,674.82" "$20,658.56" "$47,849.63" "$19,674.82" "$17,746.69" "$19,674.82" "$18,738.00" "$15,927.30" "$50,529.00" "$19,674.82" "$51,039.41" "$28,000.00" "$9,949.20" "$19,674.82" "$37,003.71" "$20,658.56" "$12,522.35" "$21,840.64" "$10,446.66" "$19,674.82" N/A N/A MS392 DRG MS-DRG V39 (FY2022) 392 "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC" INPATIENT ONLY "$36,761.50" "$27,204.00" "$3,923.00" "$29,409.07" "$8,013.32" "$8,013.32" "$8,013.32" "$8,013.32" "$16,338.64" "$16,338.64" "$6,594.33" "$7,045.49" "$16,338.64" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$7,045.49" "$26,141.82" "$10,600.31" "$11,487.00" "$16,338.64" "$17,288.02" "$16,338.64" "$17,155.57" "$27,571.13" "$16,338.64" "$14,737.45" "$16,338.64" "$11,487.00" "$9,763.95" "$29,114.96" "$16,338.64" "$29,409.07" "$7,000.00" "$6,709.99" "$16,338.64" "$21,321.67" "$17,155.57" "$7,676.61" "$17,666.35" "$7,045.49" "$16,338.64" N/A N/A MS393 DRG MS-DRG V39 (FY2022) 393 OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC INPATIENT ONLY "$62,278.50" "$46,086.50" "$11,302.55" "$144,927.35" "$43,527.39" "$43,527.39" "$43,527.39" "$43,527.39" "$24,604.48" "$24,604.48" "$15,078.24" "$11,867.68" "$24,604.48" "$30,739.06" "$30,739.06" "$36,832.51" "$21,576.50" "$11,867.68" "$39,367.17" "$21,686.49" "$24,918.00" "$24,604.48" "$25,277.18" "$23,171.56" "$25,834.70" "$46,708.88" "$24,604.48" "$22,193.24" "$24,604.48" "$25,792.36" "$22,054.66" "$49,324.46" "$24,604.48" "$49,822.69" "$38,500.00" "$11,302.55" "$22,518.23" "$36,121.53" "$25,834.70" "$16,652.37" "$28,060.63" "$11,867.68" "$24,604.48" N/A N/A MS394 DRG MS-DRG V39 (FY2022) 394 OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC INPATIENT ONLY "$40,515.00" "$29,981.50" "$1,961.50" "$32,411.82" "$4,377.19" "$4,377.19" "$4,377.19" "$4,377.19" "$17,547.08" "$17,547.08" "$8,433.03" "$9,280.88" "$17,547.08" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$9,390.83" "$28,075.33" "$12,691.84" "$14,113.50" "$17,547.08" "$18,398.00" "$17,547.08" "$18,424.43" "$30,386.25" "$17,547.08" "$15,827.47" "$17,547.08" "$14,706.51" "$12,589.49" "$32,087.69" "$17,547.08" "$32,411.82" "$3,500.00" "$8,943.64" "$17,547.08" "$23,498.70" "$18,424.43" "$9,431.87" "$19,178.37" "$9,280.88" "$17,547.08" N/A N/A MS395 DRG MS-DRG V39 (FY2022) 395 OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC INPATIENT ONLY "$28,805.00" "$21,316.00" "$1,961.50" "$24,879.66" "$4,226.27" "$4,226.27" "$4,226.27" "$4,226.27" "$15,549.79" "$15,549.79" "$5,867.77" "$6,354.85" "$15,549.79" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,354.85" "$24,879.66" "$8,679.71" "$9,772.50" "$15,549.79" "$16,268.74" "$15,549.79" "$16,327.28" "$21,603.75" "$15,549.79" "$14,025.91" "$15,549.79" "$9,772.50" "$8,306.63" "$22,813.41" "$15,549.79" "$23,043.86" "$3,500.00" "$6,052.23" "$15,549.79" "$16,706.90" "$16,327.28" "$6,530.83" "$16,679.33" "$6,354.85" "$15,549.79" N/A N/A MS405 DRG MS-DRG V39 (FY2022) 405 "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC" INPATIENT ONLY "$189,181.50" "$139,994.50" "$35,128.53" "$151,344.99" "$108,583.82" "$108,583.82" "$108,583.82" "$108,583.82" "$50,651.50" "$50,651.50" "$49,436.94" "$36,884.98" "$50,651.50" "$71,668.49" "$71,668.49" "$75,289.28" "$48,631.54" "$36,884.98" "$81,042.40" "$92,826.61" "$122,967.80" "$50,651.50" "$51,247.08" "$50,651.50" "$53,184.08" "$141,886.13" "$50,651.50" "$45,687.65" "$50,651.50" "$122,967.80" "$122,967.80" "$149,831.54" "$50,651.50" "$151,344.99" "$125,114.66" "$35,128.53" "$50,651.50" "$109,725.27" "$53,184.08" "$57,515.45" "$60,599.12" "$36,884.98" "$50,651.50" N/A N/A MS406 DRG MS-DRG V39 (FY2022) 406 "PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC" INPATIENT ONLY "$412,217.00" "$305,041.00" "$30,936.00" "$329,773.60" "$264,014.37" "$264,014.37" "$264,014.37" "$264,014.37" "$33,116.51" "$33,116.51" "$254,971.48" "$85,383.45" "$33,116.51" "$226,145.16" "$226,145.16" "$237,884.93" "$159,515.17" "$85,383.45" "$254,971.48" "$202,658.37" "$267,941.05" "$33,116.51" "$32,588.63" "$33,116.51" "$34,772.34" "$309,162.75" "$32,588.63" "$32,588.63" "$32,588.63" "$254,971.48" "$267,941.05" "$326,475.83" "$33,116.51" "$329,773.60" "$239,085.86" "$70,079.72" "$30,936.00" "$239,085.86" "$34,772.34" "$254,971.48" "$35,930.78" "$85,383.45" "$32,588.63" N/A N/A MS407 DRG MS-DRG V39 (FY2022) 407 "PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$153,246.50" "$113,402.50" "$17,496.24" "$122,596.85" "$98,174.60" "$98,174.60" "$98,174.60" "$98,174.60" "$25,670.85" "$25,670.85" "$17,496.24" "$24,588.16" "$25,670.85" "$38,177.84" "$38,177.84" "$40,159.75" "$22,494.19" "$24,588.16" "$41,073.36" "$75,869.56" "$99,609.94" "$25,670.85" "$27,560.10" N/A "$26,954.39" "$114,934.88" "$25,670.85" "$23,155.11" "$25,670.85" "$99,609.94" "$99,609.94" "$121,370.89" "$25,670.85" "$122,596.85" "$88,882.71" "$18,556.75" "$25,670.85" "$88,882.97" "$26,954.39" "$21,231.47" "$29,342.96" "$24,588.16" "$25,670.85" N/A N/A MS408 DRG MS-DRG V39 (FY2022) 408 BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC INPATIENT ONLY "$20,911.50" "$15,475.00" "$2,029.90" "$43,460.73" "$5,660.58" "$5,660.58" "$5,660.58" "$5,660.58" "$36,954.11" "$36,954.11" "$20,911.18" "$4,790.21" "$36,954.11" "$2,891.90" "$2,891.90" "$3,449.60" "$2,029.90" "$29,198.99" "$20,911.18" "$21,095.18" "$20,911.18" "$36,954.11" "$37,872.87" "$36,954.11" "$38,801.82" "$15,683.63" "$36,954.11" "$33,332.61" "$36,954.11" "$20,911.18" "$20,911.18" "$16,561.66" "$36,954.11" "$16,728.94" "$5,141.60" "$27,808.55" "$36,954.11" "$12,128.67" "$38,801.82" "$20,911.18" "$43,460.73" "$4,790.21" "$20,911.18" N/A N/A MS414 DRG MS-DRG V39 (FY2022) 414 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC INPATIENT ONLY "$264,734.50" "$195,904.00" "$32,848.02" "$211,787.52" "$169,663.63" "$169,663.63" "$169,663.63" "$169,663.63" "$40,650.84" "$40,650.84" "$47,806.19" "$40,375.95" "$40,650.84" "$119,457.63" "$119,457.63" "$125,658.98" "$81,744.04" "$40,375.95" "$65,041.34" "$130,351.16" "$172,077.35" "$40,650.84" "$41,529.13" "$40,650.84" "$42,683.38" "$198,550.88" "$40,650.84" "$36,667.06" "$40,650.84" "$172,077.35" "$172,077.35" "$209,669.64" "$40,650.84" "$211,787.52" "$153,545.95" "$32,848.02" "$40,650.84" "$153,546.01" "$42,683.38" "$36,371.19" "$48,199.56" "$40,375.95" "$40,650.84" N/A N/A MS415 DRG MS-DRG V39 (FY2022) 415 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC INPATIENT ONLY "$225,867.00" "$167,142.00" "$25,075.23" "$180,693.24" "$143,490.07" "$143,490.07" "$143,490.07" "$143,490.07" "$25,075.23" "$25,075.23" N/A "$38,407.52" "$25,075.23" "$89,680.81" "$89,680.81" "$94,291.90" "$59,948.21" N/A "$40,120.37" "$110,343.83" "$146,813.25" "$25,075.23" "$29,681.10" "$29,681.10" "$26,328.99" "$169,400.25" "$29,681.10" "$29,681.10" "$29,681.10" "$146,813.25" "$146,813.25" "$178,886.31" "$25,075.23" "$180,693.24" N/A "$29,918.73" "$25,075.23" "$131,002.86" "$26,328.99" N/A "$28,597.71" "$38,407.52" "$25,075.23" N/A N/A MS416 DRG MS-DRG V39 (FY2022) 416 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC INPATIENT ONLY "$164,945.00" "$122,059.50" "$10,619.20" "$131,955.99" "$105,607.05" "$105,607.05" "$105,607.05" "$105,607.05" "$20,869.47" "$20,869.47" "$18,081.55" "$16,661.05" "$20,869.47" "$46,443.17" "$46,443.17" "$48,854.16" "$28,519.30" "$16,661.05" "$33,391.15" "$80,379.49" "$107,214.24" "$20,869.47" "$21,493.70" "$20,869.47" "$21,912.94" "$123,708.75" "$20,869.47" "$18,824.26" "$20,869.47" "$107,214.24" "$107,214.24" "$130,636.42" "$20,869.47" "$131,955.99" "$95,668.09" "$10,619.20" "$20,869.47" "$95,668.10" "$21,912.94" "$14,257.56" "$23,335.40" "$16,661.05" "$20,869.47" N/A N/A MS417 DRG MS-DRG V39 (FY2022) 417 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC INPATIENT ONLY "$244,351.50" "$180,820.50" "$20,092.11" "$195,480.95" "$156,223.16" "$156,223.16" "$156,223.16" "$156,223.16" "$27,784.78" "$27,784.78" "$39,480.57" "$21,096.73" "$27,784.78" "$103,185.90" "$103,185.90" "$108,542.54" "$69,882.57" "$21,096.73" "$44,455.65" "$119,240.04" "$158,828.27" "$27,784.78" "$28,645.79" "$27,784.78" "$29,174.02" "$183,263.63" "$27,784.78" "$25,061.87" "$27,784.78" "$158,828.27" "$158,828.27" "$193,526.12" "$27,784.78" "$195,480.95" "$141,723.69" "$20,092.11" "$27,784.78" "$141,723.87" "$29,174.02" "$25,435.24" "$31,987.93" "$21,096.73" "$27,784.78" N/A N/A MS418 DRG MS-DRG V39 (FY2022) 418 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC INPATIENT ONLY "$175,095.50" "$129,571.00" "$16,931.05" "$140,076.14" "$112,084.63" "$112,084.63" "$112,084.63" "$112,084.63" "$22,710.10" "$22,710.10" "$21,404.93" "$24,415.60" "$22,710.10" "$53,724.99" "$53,724.99" "$56,514.00" "$33,827.47" "$24,415.60" "$36,336.16" "$86,067.40" "$113,811.86" "$22,710.10" "$23,526.55" "$22,710.10" "$23,845.61" "$131,321.63" "$22,710.10" "$20,484.51" "$22,710.10" "$113,811.86" "$113,811.86" "$138,675.37" "$22,710.10" "$140,076.14" "$101,555.20" "$17,769.33" "$22,710.10" "$101,555.39" "$23,845.61" "$16,931.05" "$25,638.42" "$24,415.60" "$22,710.10" N/A N/A MS419 DRG MS-DRG V39 (FY2022) 419 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC INPATIENT ONLY "$128,424.00" "$95,034.00" "$9,336.72" "$102,738.90" "$31,552.71" "$31,552.71" "$31,552.71" "$31,552.71" "$20,131.01" "$20,131.01" "$10,992.93" "$11,244.21" "$20,131.01" "$20,128.24" "$20,128.24" "$21,173.15" "$9,336.72" "$11,244.21" "$32,209.62" "$17,564.00" "$83,475.36" "$20,131.01" "$20,983.72" "$20,983.72" "$21,137.56" "$96,318.00" "$20,131.01" "$18,158.17" "$20,131.01" "$83,475.36" "$83,475.36" "$101,711.53" "$20,131.01" "$102,738.90" "$28,000.00" "$10,708.77" "$20,131.01" "$74,485.92" "$21,137.56" "$13,184.97" "$22,411.42" "$11,244.21" "$20,131.01" N/A N/A MS420 DRG MS-DRG V39 (FY2022) 420 HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC INPATIENT ONLY "$161,498.00" "$119,509.00" "$30,766.64" "$129,198.39" "$90,915.35" "$90,915.35" "$90,915.35" "$90,915.35" "$35,322.59" "$35,322.59" "$30,901.77" "$32,304.98" "$35,322.59" "$51,801.54" "$51,801.54" "$54,390.98" "$34,149.29" "$32,304.98" "$56,516.14" "$79,514.20" "$104,973.69" "$35,322.59" "$34,956.47" "$35,322.59" "$37,088.72" "$121,123.50" "$35,322.59" "$31,860.98" "$35,322.59" "$104,973.69" "$104,973.69" "$127,906.40" "$35,322.59" "$129,198.39" "$109,058.38" "$30,766.64" "$35,322.59" "$93,668.84" "$37,088.72" "$35,250.47" "$41,419.35" "$32,304.98" "$35,322.59" N/A N/A MS421 DRG MS-DRG V39 (FY2022) 421 HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC INPATIENT ONLY "$80,962.50" "$59,912.50" "$12,270.25" "$64,769.66" "$32,269.88" "$32,269.88" "$32,269.88" "$32,269.88" "$24,218.07" "$24,218.07" "$15,797.65" "$12,883.77" "$24,218.07" "$22,355.68" "$22,355.68" "$26,787.28" "$15,692.00" "$12,883.77" "$38,748.91" "$24,382.32" "$28,612.50" "$24,218.07" "$24,602.25" "$24,218.07" "$25,428.97" "$60,721.88" "$24,218.07" "$21,844.70" "$24,218.07" "$29,998.36" "$25,706.48" "$64,121.96" "$24,218.07" "$64,769.66" "$28,000.00" "$12,270.25" "$24,218.07" "$46,958.25" "$25,428.97" "$19,121.36" "$27,525.22" "$12,883.77" "$24,218.07" N/A N/A MS422 DRG MS-DRG V39 (FY2022) 422 HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$297,161.00" "$219,899.50" "$19,019.12" "$237,728.41" "$190,492.74" "$190,492.74" "$190,492.74" "$190,492.74" "$21,085.50" "$21,085.50" "$47,221.13" "$49,465.36" "$21,085.50" "$143,237.49" "$143,237.49" "$150,673.32" "$99,078.65" "$49,465.36" "$33,736.80" "$147,355.66" "$193,154.34" "$21,085.50" "$21,559.42" "$21,085.50" "$22,139.78" "$222,870.75" "$21,085.50" "$19,019.12" "$21,085.50" "$193,154.34" "$193,154.34" "$235,351.14" "$21,085.50" "$237,728.41" "$172,353.10" "$38,798.32" "$21,085.50" "$172,353.38" "$22,139.78" "$35,838.05" "$23,605.69" "$49,465.36" "$21,085.50" N/A N/A MS425 DRG MS-DRG V39 (FY2022) 425 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$127,458.50" "$94,319.50" "$8,777.85" "$101,966.79" "$27,533.17" "$27,533.17" "$27,533.17" "$27,533.17" "$21,700.40" "$21,700.40" "$12,311.26" "$9,216.75" "$21,700.40" "$26,960.27" "$26,960.27" "$28,260.15" "$16,040.96" "$9,216.75" "$34,720.64" "$19,254.45" "$82,848.01" "$21,700.40" "$21,880.84" N/A "$22,785.42" "$95,593.88" "$21,700.40" "$19,573.76" "$21,700.40" "$82,848.01" "$82,848.01" "$100,947.11" "$21,700.40" "$101,966.79" "$15,451.65" "$8,777.85" "$21,700.40" "$73,925.93" "$22,785.42" "$15,464.50" "$24,375.08" "$9,216.75" "$21,700.40" N/A N/A MS432 DRG MS-DRG V39 (FY2022) 432 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC INPATIENT ONLY "$70,079.00" "$51,858.50" "$7,000.00" "$56,063.14" "$19,235.59" "$19,235.59" "$19,235.59" "$19,235.59" "$24,033.80" "$24,033.80" "$14,914.89" "$17,726.78" "$24,033.80" "$12,609.46" "$12,609.46" "$13,987.38" "$8,850.88" "$17,726.78" "$38,454.08" "$25,413.28" "$28,212.00" "$24,033.80" "$25,149.39" "$24,033.80" "$25,235.49" "$52,559.25" "$24,033.80" "$21,678.49" "$24,033.80" "$28,998.60" "$24,766.80" "$55,502.53" "$24,033.80" "$56,063.14" "$7,000.00" "$16,882.64" "$24,033.80" "$40,645.82" "$25,235.49" "$18,853.72" "$27,294.66" "$17,726.78" "$24,033.80" N/A N/A MS433 DRG MS-DRG V39 (FY2022) 433 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC INPATIENT ONLY "$41,129.00" "$30,435.50" "$1,966.88" "$32,902.98" "$5,480.46" "$5,480.46" "$5,480.46" "$5,480.46" "$18,161.31" "$18,161.31" "$8,187.57" "$8,920.63" "$18,161.31" "$2,802.13" "$2,802.13" "$3,356.38" "$1,966.88" "$8,920.63" "$29,058.10" "$13,994.67" "$19,708.50" "$18,161.31" "$19,089.44" "$18,161.31" "$19,069.38" "$30,846.75" "$18,161.31" "$16,381.50" "$18,161.31" "$17,389.95" "$15,072.67" "$32,573.94" "$18,161.31" "$32,902.98" "$3,500.00" "$8,495.83" "$18,161.31" "$23,854.82" "$19,069.38" "$10,324.04" "$19,946.92" "$8,920.63" "$18,161.31" N/A N/A MS434 DRG MS-DRG V39 (FY2022) 434 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC INPATIENT ONLY "$18,117.00" "$13,407.00" "$3,923.00" "$18,116.68" "$7,812.00" "$7,812.00" "$7,812.00" "$7,812.00" "$15,337.22" "$15,337.22" "$5,559.84" "$6,206.31" "$15,337.22" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$6,206.31" "$18,116.68" "$8,448.21" "$9,310.50" "$15,337.22" "$16,145.87" "$15,337.22" "$16,104.08" "$13,587.75" "$15,337.22" "$13,834.17" "$15,337.22" "$9,310.50" "$7,913.93" "$14,348.40" "$15,337.22" "$14,493.35" "$7,000.00" "$5,910.77" "$15,337.22" "$10,507.86" "$16,104.08" "$6,222.09" "$16,413.37" "$6,206.31" "$15,337.22" N/A N/A MS435 DRG MS-DRG V39 (FY2022) 435 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC INPATIENT ONLY "$141,291.50" "$104,556.00" "$14,818.91" "$113,033.10" "$89,681.38" "$89,681.38" "$89,681.38" "$89,681.38" "$24,149.40" "$24,149.40" N/A N/A "$23,154.55" "$27,700.29" "$27,700.29" "$29,119.66" "$14,818.91" N/A N/A N/A N/A "$23,154.55" "$24,149.40" "$24,149.40" "$24,312.28" "$105,968.63" "$24,149.40" "$24,149.40" "$24,149.40" N/A N/A "$111,902.77" "$23,154.55" "$113,033.10" N/A N/A "$23,154.55" "$81,949.07" "$24,312.28" N/A "$26,194.52" N/A "$24,149.40" N/A N/A MS436 DRG MS-DRG V39 (FY2022) 436 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC INPATIENT ONLY "$56,747.00" "$41,993.00" "$9,490.57" "$45,397.47" "$36,906.12" "$36,906.12" "$36,906.12" "$36,906.12" "$18,793.50" "$18,793.50" N/A "$9,965.10" "$18,793.50" "$25,865.95" "$25,865.95" "$30,432.56" "$18,155.94" "$9,965.10" "$30,069.60" "$14,810.28" "$16,822.50" "$18,793.50" "$19,522.29" "$18,793.50" "$19,733.18" "$42,560.25" "$19,522.29" "$16,951.74" "$18,793.50" "$16,822.50" "$14,299.13" "$44,943.48" "$18,793.50" "$45,397.47" "$28,000.00" "$9,490.57" "$18,793.50" "$32,913.26" "$19,733.18" "$11,242.27" "$20,737.91" "$9,965.10" "$18,793.50" N/A N/A MS437 DRG MS-DRG V39 (FY2022) 437 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC INPATIENT ONLY "$31,044.50" "$22,973.00" "$1,961.50" "$27,578.43" "$4,082.53" "$4,082.53" "$4,082.53" "$4,082.53" "$17,236.52" "$17,236.52" "$8,007.27" "$7,111.47" "$17,236.52" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$7,826.95" "$27,578.43" "$11,384.97" "$13,438.50" "$17,236.52" "$17,704.46" "$17,236.52" "$18,098.35" "$23,283.38" "$17,236.52" "$15,547.34" "$17,236.52" "$13,438.50" "$11,422.73" "$24,587.18" "$17,236.52" "$24,835.53" "$3,500.00" "$7,454.24" "$17,236.52" "$18,005.81" "$18,098.35" "$8,980.77" "$18,789.80" "$7,111.47" "$17,236.52" N/A N/A MS438 DRG MS-DRG V39 (FY2022) 438 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC INPATIENT ONLY "$71,541.50" "$52,941.00" "$3,500.00" "$57,233.18" "$25,212.73" "$25,212.73" "$25,212.73" "$25,212.73" "$22,080.67" "$22,080.67" "$15,194.27" "$16,741.90" "$22,080.67" "$17,410.86" "$17,410.86" "$17,883.11" "$12,223.55" N/A "$35,329.07" "$22,306.95" "$15,194.27" "$22,080.67" "$23,500.84" "$22,080.67" "$23,184.70" "$53,656.13" "$23,500.84" "$23,500.84" "$23,500.84" "$24,927.33" "$21,332.28" "$56,660.85" "$22,080.67" "$57,233.18" "$3,500.00" "$15,944.66" "$24,087.31" "$41,494.07" "$23,184.70" "$16,016.84" "$24,850.87" "$16,741.90" "$22,080.67" N/A N/A MS439 DRG MS-DRG V39 (FY2022) 439 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC INPATIENT ONLY "$38,329.00" "$28,363.50" "$5,884.50" "$30,663.00" "$12,099.66" "$12,099.66" "$12,099.66" "$12,099.66" "$16,886.61" "$16,886.61" "$8,096.53" "$8,501.51" "$16,886.61" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$8,501.51" "$27,018.58" "$11,706.64" "$12,678.00" "$16,886.61" "$17,875.15" "$16,886.61" "$17,730.94" "$28,746.75" "$16,886.61" "$15,231.72" "$16,886.61" "$12,678.00" "$11,294.11" "$30,356.35" "$16,886.61" "$30,663.00" "$10,500.00" "$8,096.67" "$16,886.61" "$22,230.82" "$17,730.94" "$8,472.54" "$18,351.99" "$8,501.51" "$16,886.61" N/A N/A MS440 DRG MS-DRG V39 (FY2022) 440 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$28,717.00" "$21,251.00" "$5,733.00" "$24,380.54" "$11,966.58" "$11,966.58" "$11,966.58" "$11,966.58" "$15,237.84" "$15,237.84" "$5,733.00" "$6,225.23" "$15,237.84" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$6,225.23" "$24,380.54" "$8,161.54" "$9,094.50" "$15,237.84" "$15,993.76" "$15,237.84" "$15,999.73" "$21,537.75" "$15,237.84" "$13,744.53" "$15,237.84" "$9,094.50" "$7,730.33" "$22,743.82" "$15,237.84" "$22,973.55" "$10,500.00" "$5,928.79" "$15,237.84" "$16,655.86" "$15,999.73" "$6,077.73" "$16,289.02" "$6,225.23" "$15,237.84" N/A N/A MS441 DRG MS-DRG V39 (FY2022) 441 "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC" INPATIENT ONLY "$64,431.00" "$47,679.00" "$7,000.00" "$51,544.42" "$17,950.30" "$17,950.30" "$17,950.30" "$17,950.30" "$24,024.82" "$24,024.82" "$16,811.61" "$17,197.91" "$24,024.82" "$12,057.73" "$12,057.73" "$13,156.93" "$8,464.65" "$17,197.91" "$38,439.71" "$25,502.11" "$28,192.50" "$24,024.82" "$25,196.55" "$24,024.82" "$25,226.06" "$48,323.25" "$24,024.82" "$21,670.39" "$24,024.82" "$30,578.65" "$26,349.77" "$51,028.93" "$24,024.82" "$51,544.42" "$7,000.00" "$16,378.96" "$24,024.82" "$37,369.98" "$25,226.06" "$18,840.68" "$27,283.43" "$17,197.91" "$24,024.82" N/A N/A MS442 DRG MS-DRG V39 (FY2022) 442 "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC" INPATIENT ONLY "$51,664.00" "$38,231.50" "$8,270.58" "$41,331.08" "$23,752.74" "$23,752.74" "$23,752.74" "$23,752.74" "$17,471.86" "$17,471.86" "$8,270.58" "$10,361.51" "$17,471.86" "$16,766.76" "$16,766.76" "$20,090.46" "$11,769.00" "$10,361.51" "$27,954.98" "$12,732.21" "$13,950.00" "$17,471.86" "$18,419.44" "$20,185.22" "$18,345.45" "$38,748.00" "$17,471.86" "$15,759.62" "$17,471.86" "$13,950.00" "$12,347.29" "$40,917.78" "$17,471.86" "$41,331.08" "$21,000.00" "$9,868.10" "$17,471.86" "$29,965.12" "$18,345.45" "$9,322.59" "$19,084.25" "$10,361.51" "$17,471.86" N/A N/A MS443 DRG MS-DRG V39 (FY2022) 443 "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC" INPATIENT ONLY "$27,744.50" "$20,531.00" "$5,812.44" "$26,110.00" "$9,284.90" "$9,284.90" "$9,284.90" "$9,284.90" "$15,630.55" "$15,630.55" "$5,812.44" "$6,355.46" "$15,630.55" "$10,206.85" "$10,206.85" "$11,045.89" "$9,088.80" "$6,445.67" "$25,008.88" "$8,773.92" "$9,948.00" "$15,630.55" "$16,318.75" "$15,630.55" "$16,412.08" "$20,808.38" "$15,630.55" "$14,098.76" "$15,630.55" "$9,948.00" "$8,455.80" "$21,973.34" "$15,630.55" "$22,195.30" "$11,726.35" "$6,138.73" "$15,630.55" "$16,091.81" "$16,412.08" "$6,648.12" "$16,780.37" "$6,355.46" "$15,630.55" N/A N/A MS444 DRG MS-DRG V39 (FY2022) 444 DISORDERS OF THE BILIARY TRACT WITH MCC INPATIENT ONLY "$58,456.00" "$43,257.50" "$3,923.00" "$46,764.49" "$8,386.89" "$8,386.89" "$8,386.89" "$8,386.89" "$22,590.02" "$22,590.02" "$14,470.39" "$14,457.11" "$22,590.02" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$14,457.11" "$36,144.03" "$22,405.20" "$25,074.00" "$22,590.02" "$23,552.98" "$23,552.98" "$23,719.52" "$43,842.00" "$22,590.02" "$20,376.20" "$22,590.02" "$25,810.86" "$22,049.76" "$46,296.86" "$22,590.02" "$46,764.49" "$7,000.00" "$13,768.67" "$22,590.02" "$33,904.48" "$23,719.52" "$16,756.63" "$25,488.17" "$14,457.11" "$22,590.02" N/A N/A MS445 DRG MS-DRG V39 (FY2022) 445 DISORDERS OF THE BILIARY TRACT WITH CC INPATIENT ONLY "$54,755.00" "$40,519.00" "$7,846.00" "$43,803.74" "$15,917.23" "$15,917.23" "$15,917.23" "$15,917.23" "$18,489.83" "$18,489.83" "$9,509.47" "$10,502.48" "$18,489.83" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$10,502.48" "$29,583.73" "$14,799.52" "$16,162.50" "$18,489.83" "$19,516.58" "$18,489.83" "$19,414.32" "$41,066.25" "$18,489.83" "$16,677.83" "$18,489.83" "$16,162.50" "$13,738.13" "$43,365.70" "$18,489.83" "$43,803.74" "$14,000.00" "$10,002.36" "$18,489.83" "$31,757.90" "$19,414.32" "$10,801.19" "$20,357.96" "$10,502.48" "$18,489.83" N/A N/A MS446 DRG MS-DRG V39 (FY2022) 446 DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC INPATIENT ONLY "$62,386.50" "$46,166.50" "$6,347.77" "$49,908.90" "$16,099.49" "$16,099.49" "$16,099.49" "$16,099.49" "$16,689.23" "$16,689.23" "$6,755.89" "$6,665.16" "$16,689.23" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$6,665.16" "$26,702.77" "$10,924.67" "$12,249.00" "$16,689.23" "$17,460.16" "$16,689.23" "$17,523.69" "$46,789.88" "$16,689.23" "$15,053.69" "$16,689.23" "$12,898.60" "$11,061.25" "$49,409.82" "$16,689.23" "$49,908.90" "$14,000.00" "$6,347.77" "$16,689.23" "$36,184.17" "$17,523.69" "$8,185.84" "$18,105.02" "$6,665.16" "$16,689.23" N/A N/A MS453 DRG MS-DRG V39 (FY2022) 453 COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC INPATIENT ONLY "$697,421.50" "$516,092.00" "$77,629.06" "$557,936.84" N/A N/A N/A N/A "$79,117.42" "$79,117.42" N/A N/A "$79,117.42" "$441,469.95" "$441,469.95" N/A "$317,229.00" N/A N/A N/A N/A "$79,117.42" "$79,117.42" "$79,117.42" "$81,523.43" "$523,066.13" "$77,629.06" "$79,117.42" "$79,117.42" N/A N/A "$552,357.47" "$77,641.36" "$557,936.84" N/A N/A "$77,641.36" "$404,504.47" "$79,117.42" N/A N/A N/A "$79,117.42" N/A N/A MS454 DRG MS-DRG V39 (FY2022) 454 COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC INPATIENT ONLY "$283,605.00" "$209,868.00" "$48,052.94" "$226,883.93" "$172,615.44" "$172,615.44" "$172,615.44" "$172,615.44" "$55,168.47" "$55,168.47" N/A N/A "$55,168.47" "$132,035.84" "$132,035.84" "$138,439.77" "$90,004.92" N/A N/A N/A N/A "$53,105.00" "$55,168.47" "$55,168.47" "$55,760.25" "$212,703.75" "$55,168.47" "$55,168.47" "$55,168.47" "$184,343.19" N/A "$224,615.11" "$53,105.00" "$226,883.93" N/A "$48,052.94" "$53,105.00" "$164,490.90" "$55,760.25" N/A N/A "$50,455.61" "$53,105.00" N/A N/A MS455 DRG MS-DRG V39 (FY2022) 455 COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC INPATIENT ONLY "$745,155.50" "$551,415.50" "$432,190.19" "$558,866.63" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$558,866.63" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$432,190.19" N/A N/A N/A N/A N/A N/A N/A MS456 DRG MS-DRG V39 (FY2022) 456 "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC" INPATIENT ONLY "$512,618.50" "$379,338.00" "$80,487.24" "$410,094.55" N/A N/A N/A N/A "$80,487.24" "$80,487.24" N/A N/A "$80,487.24" "$298,173.90" "$298,173.90" N/A N/A N/A N/A N/A N/A "$80,487.24" "$80,487.24" "$80,487.24" "$80,487.24" "$384,463.88" "$80,487.24" "$80,487.24" "$80,487.24" N/A N/A "$405,993.66" "$80,487.24" "$410,094.55" N/A N/A "$80,487.24" "$297,318.73" "$80,487.24" N/A N/A N/A "$80,487.24" N/A N/A MS457 DRG MS-DRG V39 (FY2022) 457 "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC" INPATIENT ONLY "$635,704.00" "$470,421.00" "$65,516.80" "$503,477.24" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$476,778.00" N/A N/A N/A N/A N/A "$503,477.24" N/A N/A N/A N/A "$65,516.80" "$368,708.32" N/A N/A N/A N/A N/A N/A N/A MS459 DRG MS-DRG V39 (FY2022) 459 SPINAL FUSION EXCEPT CERVICAL WITH MCC INPATIENT ONLY "$480,262.50" "$355,394.50" "$68,325.07" "$360,196.88" N/A N/A N/A N/A "$68,325.07" "$68,325.07" N/A N/A "$68,325.07" N/A N/A N/A N/A N/A N/A N/A N/A "$68,325.07" "$68,325.07" "$68,325.07" "$68,325.07" "$360,196.88" "$68,325.07" "$68,325.07" "$68,325.07" N/A N/A N/A "$68,325.07" N/A N/A N/A "$68,325.07" "$278,552.25" "$68,325.07" N/A N/A N/A "$68,325.07" N/A N/A MS460 DRG MS-DRG V39 (FY2022) 460 SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC INPATIENT ONLY "$310,617.00" "$229,857.00" "$34,439.42" "$248,493.35" "$190,338.39" "$190,338.39" "$190,338.39" "$190,338.39" "$38,181.18" "$38,181.18" "$57,029.91" "$39,203.72" "$38,181.18" "$158,488.75" "$158,488.75" "$166,411.50" "$111,506.62" "$39,203.72" "$61,089.89" "$151,484.91" "$201,900.84" "$38,181.18" "$38,562.16" "$38,562.16" "$40,090.24" "$232,962.75" "$38,562.16" "$34,439.42" "$38,181.18" "$201,900.84" "$201,900.84" "$246,008.41" "$38,181.18" "$248,493.35" "$57,029.91" "$36,209.77" "$38,181.18" "$180,157.86" "$40,090.24" "$43,950.88" "$44,996.07" "$39,203.72" "$38,181.18" N/A N/A MS463 DRG MS-DRG V39 (FY2022) 463 WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC INPATIENT ONLY "$551,502.50" "$408,112.00" "$53,694.91" "$441,201.96" "$296,236.60" "$296,236.60" "$296,236.60" "$296,236.60" "$142,391.57" "$142,391.57" "$296,236.60" N/A "$142,391.57" "$325,577.74" "$325,577.74" "$342,395.83" N/A N/A "$296,236.60" "$296,236.60" "$296,236.60" "$142,391.57" "$142,391.57" "$142,391.57" "$56,379.66" "$413,626.88" "$142,391.57" "$142,391.57" "$142,391.57" "$296,236.60" "$296,236.60" "$436,789.93" "$53,694.91" "$441,201.96" "$296,236.60" N/A "$53,694.91" "$319,871.45" "$56,379.66" "$296,236.60" "$57,427.39" N/A "$142,391.57" N/A N/A MS464 DRG MS-DRG V39 (FY2022) 464 WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC INPATIENT ONLY "$381,439.50" "$282,265.50" "$32,999.33" "$302,099.85" "$38,575.17" "$38,575.17" "$38,575.17" "$38,575.17" "$38,575.17" "$38,575.17" "$38,575.17" "$127,985.01" "$38,575.17" "$194,101.92" "$194,101.92" "$194,101.92" "$194,101.92" "$127,985.01" "$38,575.17" "$38,575.17" "$38,575.17" "$38,575.17" "$38,575.17" "$38,575.17" "$38,575.17" "$286,079.63" "$38,575.17" "$38,575.17" "$38,575.17" "$38,575.17" "$38,575.17" "$302,099.85" "$38,575.17" N/A "$38,575.17" "$127,985.01" "$32,999.33" "$221,234.91" "$38,575.17" "$38,575.17" "$38,575.17" "$127,985.01" "$38,575.17" N/A N/A MS465 DRG MS-DRG V39 (FY2022) 465 WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$224,138.00" "$165,862.50" "$19,545.36" "$179,310.34" "$138,369.51" "$138,369.51" "$138,369.51" "$138,369.51" "$23,780.51" "$23,780.51" "$33,318.73" "$35,211.49" "$23,780.51" "$93,722.30" "$93,722.30" "$98,483.32" "$64,698.59" "$35,211.49" "$38,048.82" "$110,135.17" "$145,689.65" "$23,780.51" "$25,895.82" "$23,780.51" "$24,969.54" "$168,103.50" "$23,780.51" "$21,450.02" "$23,780.51" "$145,689.65" "$145,689.65" "$177,517.21" "$23,780.51" "$179,310.34" "$138,226.35" "$26,914.93" "$23,780.51" "$130,000.04" "$24,969.54" "$19,545.36" "$26,977.74" "$35,211.49" "$23,780.51" N/A N/A MS466 DRG MS-DRG V39 (FY2022) 466 REVISION OF HIP OR KNEE REPLACEMENT WITH MCC INPATIENT ONLY "$409,119.50" "$302,748.50" "$47,946.80" "$306,839.63" N/A N/A N/A N/A "$49,127.10" "$49,127.10" N/A N/A "$49,127.10" N/A N/A N/A N/A N/A N/A N/A N/A "$49,127.10" "$49,127.10" "$49,127.10" "$49,127.10" "$306,839.63" "$49,127.10" "$49,127.10" "$49,127.10" N/A N/A N/A "$49,127.10" N/A N/A N/A "$49,127.10" "$237,289.31" "$49,127.10" N/A N/A N/A "$47,946.80" N/A N/A MS467 DRG MS-DRG V39 (FY2022) 467 REVISION OF HIP OR KNEE REPLACEMENT WITH CC INPATIENT ONLY "$165,214.00" "$122,258.50" "$21,292.29" "$132,171.14" "$105,322.72" "$105,322.72" "$105,322.72" "$105,322.72" "$35,743.58" "$35,743.58" "$30,553.67" "$22,356.91" "$35,743.58" "$44,897.65" "$44,897.65" "$47,228.40" "$27,392.67" "$22,356.91" "$57,189.73" "$81,301.47" "$107,389.06" "$35,743.58" "$37,561.46" "$35,743.58" "$37,530.76" "$123,910.50" "$35,743.58" "$32,240.71" "$35,743.58" "$107,389.06" "$107,389.06" "$130,849.44" "$35,743.58" "$132,171.14" "$95,824.09" "$21,292.29" "$35,743.58" "$95,824.12" "$37,530.76" "$35,861.95" "$41,946.11" "$22,356.91" "$35,743.58" N/A N/A MS468 DRG MS-DRG V39 (FY2022) 468 REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC INPATIENT ONLY "$197,403.50" "$146,079.00" "$21,292.29" "$157,922.71" "$122,727.42" "$122,727.42" "$122,727.42" "$122,727.42" "$30,394.23" "$30,394.23" "$30,113.07" "$28,732.60" "$30,394.23" "$68,582.32" "$68,582.32" "$71,974.82" "$44,319.57" "$28,732.60" "$48,630.77" "$96,670.96" "$128,312.20" "$30,394.23" "$31,585.79" "$30,394.23" "$31,913.94" "$148,052.63" "$30,394.23" "$27,415.60" "$30,394.23" "$128,312.20" "$128,312.20" "$156,343.52" "$30,394.23" "$157,922.71" "$114,493.97" "$21,292.29" "$30,394.23" "$114,494.03" "$31,913.94" "$28,092.10" "$35,252.92" "$28,732.60" "$30,394.23" N/A N/A MS469 DRG MS-DRG V39 (FY2022) 469 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT INPATIENT ONLY "$190,117.50" "$140,687.00" "$25,949.72" "$152,093.98" "$120,029.96" "$120,029.96" "$120,029.96" "$120,029.96" "$32,350.79" "$32,350.79" "$30,595.91" "$27,247.22" "$32,350.79" "$63,049.71" "$63,049.71" "$66,258.54" "$40,495.31" "$27,247.22" "$51,761.26" "$93,906.38" "$123,576.36" "$32,350.79" "$34,743.62" "$32,350.79" "$33,968.33" "$142,588.13" "$32,350.79" "$29,180.41" "$32,350.79" "$123,576.36" "$123,576.36" "$150,573.04" "$32,350.79" "$152,093.98" "$110,268.13" "$25,949.72" "$32,350.79" "$110,268.15" "$33,968.33" "$30,934.00" "$37,701.00" "$27,247.22" "$32,350.79" N/A N/A MS470 DRG MS-DRG V39 (FY2022) 470 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC INPATIENT ONLY "$158,566.00" "$117,339.00" "$19,049.19" "$126,852.60" "$99,606.80" "$99,606.80" "$99,606.80" "$99,606.80" "$24,168.39" "$24,168.39" "$19,245.45" "$20,974.43" "$24,168.39" "$39,763.95" "$39,763.95" "$41,758.00" "$23,508.86" "$20,974.43" "$38,669.42" "$79,027.74" "$103,067.74" "$24,168.39" "$25,318.67" "$24,168.39" "$25,376.81" "$118,924.50" "$24,168.39" "$21,799.89" "$24,168.39" "$103,067.74" "$103,067.74" "$125,584.08" "$24,168.39" "$126,852.60" "$91,968.14" "$19,535.27" "$24,168.39" "$91,968.28" "$25,376.81" "$19,049.19" "$27,463.06" "$20,974.43" "$24,168.39" N/A N/A MS471 DRG MS-DRG V39 (FY2022) 471 CERVICAL SPINAL FUSION WITH MCC INPATIENT ONLY "$363,248.00" "$268,804.00" "$31,987.10" "$290,598.20" "$218,736.46" "$218,736.46" "$218,736.46" "$218,736.46" "$47,640.68" "$47,640.68" "$164,289.46" "$31,987.10" "$45,696.91" "$195,774.22" "$195,774.22" "$205,800.48" "$139,024.91" "$32,596.69" "$164,289.46" "$177,432.79" "$236,111.03" "$45,696.91" "$47,640.68" "$47,640.68" "$47,981.76" "$272,436.00" "$47,640.68" "$47,640.68" "$47,640.68" "$236,111.03" "$236,111.03" "$287,692.22" "$45,696.91" "$290,598.20" "$164,289.46" "$32,596.69" "$45,696.91" "$210,683.84" "$47,981.76" "$58,441.43" "$54,399.87" "$31,987.10" "$45,696.91" N/A N/A MS472 DRG MS-DRG V39 (FY2022) 472 CERVICAL SPINAL FUSION WITH CC INPATIENT ONLY "$225,154.00" "$166,614.00" "$24,038.59" "$180,122.88" "$138,433.45" "$138,433.45" "$138,433.45" "$138,433.45" "$32,128.57" "$32,128.57" "$36,818.57" "$32,885.32" "$32,128.57" "$95,399.91" "$95,399.91" "$100,205.58" "$65,835.91" "$32,885.32" "$51,405.71" "$109,792.96" "$146,349.84" "$32,128.57" "$33,597.91" "$32,128.57" "$33,735.00" "$168,865.50" "$32,128.57" "$28,979.97" "$32,128.57" "$146,349.84" "$146,349.84" "$178,321.67" "$32,128.57" "$180,122.88" "$138,815.44" "$24,038.59" "$32,128.57" "$130,589.32" "$33,735.00" "$30,611.21" "$37,422.95" "$32,885.32" "$32,128.57" N/A N/A MS473 DRG MS-DRG V39 (FY2022) 473 CERVICAL SPINAL FUSION WITHOUT CC/MCC INPATIENT ONLY "$241,878.00" "$178,990.00" "$25,451.71" "$384,723.52" "$151,375.98" "$151,375.98" "$151,375.98" "$151,375.98" "$28,576.36" "$28,576.36" "$38,355.62" "$44,122.13" "$28,576.36" "$100,716.11" "$100,716.11" "$105,787.28" "$67,765.10" "$44,122.13" "$45,722.18" "$117,063.40" "$161,480.46" "$28,576.36" "$29,770.09" "$28,576.36" "$30,005.18" "$181,408.50" "$28,576.36" "$25,775.88" "$28,576.36" "$157,220.46" "$157,220.46" "$191,567.08" "$28,576.36" "$193,502.11" "$140,289.03" "$34,969.91" "$28,576.36" "$140,289.24" "$30,005.18" "$25,451.71" "$32,978.38" "$44,122.13" "$28,576.36" N/A N/A MS474 DRG MS-DRG V39 (FY2022) 474 AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC INPATIENT ONLY "$103,190.00" "$76,361.00" "$1,738.93" "$82,551.93" "$15,934.44" "$15,934.44" "$15,934.44" "$15,934.44" "$39,184.68" "$39,184.68" "$32,081.75" "$33,064.69" "$39,184.68" "$1,738.93" "$1,738.93" "$1,829.20" "$7,846.00" "$33,064.69" "$62,695.49" "$55,140.18" "$67,073.44" "$39,184.68" "$40,925.72" "$39,184.68" "$41,143.91" "$77,392.50" "$39,184.68" "$35,344.58" "$39,184.68" "$61,141.50" "$51,970.28" "$81,726.40" "$39,184.68" "$82,551.93" "$14,000.00" "$31,490.17" "$39,184.68" "$59,850.20" "$41,143.91" "$40,860.06" "$46,251.65" "$33,064.69" "$39,184.68" N/A N/A MS475 DRG MS-DRG V39 (FY2022) 475 AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC INPATIENT ONLY "$172,094.50" "$127,350.00" "$26,211.23" "$222,499.21" "$109,947.06" "$109,947.06" "$109,947.06" "$109,947.06" "$27,527.95" "$27,527.95" "$222,499.21" N/A "$26,211.23" "$50,724.11" "$50,724.11" "$53,357.33" "$31,639.93" N/A "$222,499.21" "$83,681.72" "$111,861.20" "$26,211.23" "$27,527.95" "$27,527.95" "$27,521.79" "$129,070.88" "$27,527.95" "$27,527.95" "$27,527.95" "$111,861.20" "$222,499.21" "$136,298.57" "$26,211.23" "$137,675.32" "$222,499.21" N/A "$26,211.23" "$99,814.81" "$27,521.79" "$222,499.21" "$30,019.09" "$33,064.69" "$27,527.95" N/A N/A MS476 DRG MS-DRG V39 (FY2022) 476 AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$108,234.50" "$80,094.00" "$7,391.82" "$86,587.37" "$17,308.80" "$17,308.80" "$17,308.80" "$17,308.80" "$19,061.27" "$19,061.27" "$9,985.21" "$9,074.84" "$19,061.27" "$14,774.13" "$14,774.13" "$15,399.44" "$7,391.82" "$9,074.84" "$30,498.03" "$16,520.92" "$70,352.24" "$19,061.27" "$20,430.14" "$19,061.27" "$20,014.33" "$81,175.88" "$19,061.27" "$17,193.27" "$19,061.27" "$18,745.04" "$70,352.24" "$85,721.49" "$19,061.27" "$86,587.37" N/A "$8,642.70" "$19,061.27" "$62,776.01" "$20,014.33" "$11,631.21" "$21,072.95" "$9,074.84" "$19,061.27" N/A N/A MS477 DRG MS-DRG V39 (FY2022) 477 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC INPATIENT ONLY "$155,216.00" "$114,860.00" "$23,079.35" "$124,172.47" "$99,271.41" "$99,271.41" "$99,271.41" "$99,271.41" "$34,234.90" "$34,234.90" "$28,239.22" "$26,617.13" "$34,234.90" "$38,980.57" "$38,980.57" "$41,004.16" "$23,079.35" "$26,617.13" "$54,775.84" "$75,493.63" "$100,890.13" "$34,234.90" "$35,967.89" "$34,234.90" "$35,946.65" "$116,412.00" "$34,234.90" "$30,879.88" "$34,234.90" "$100,890.13" "$100,890.13" "$122,930.74" "$34,234.90" "$124,172.47" "$90,025.04" "$25,349.63" "$34,234.90" "$90,025.28" "$35,946.65" "$33,670.63" "$40,058.43" "$26,617.13" "$34,234.90" N/A N/A MS478 DRG MS-DRG V39 (FY2022) 478 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC INPATIENT ONLY "$92,183.00" "$68,215.50" "$20,030.23" "$73,746.33" "$62,539.95" "$62,539.95" "$62,539.95" "$62,539.95" "$27,329.97" "$27,329.97" "$20,030.23" "$26,617.13" "$27,329.97" "$44,711.36" "$44,711.36" "$53,574.56" "$31,384.00" "$26,617.13" "$43,727.95" "$31,613.85" "$35,376.00" "$27,329.97" N/A "$27,329.97" "$28,696.47" "$69,137.25" N/A "$24,651.63" N/A "$35,376.00" "$30,069.60" "$73,008.87" "$27,329.97" "$73,746.33" "$56,000.00" "$25,349.63" "$27,329.97" "$53,466.14" "$28,696.47" N/A "$31,418.87" "$26,617.13" N/A N/A N/A MS479 DRG MS-DRG V39 (FY2022) 479 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC INPATIENT ONLY "$56,655.00" "$41,925.00" "$11,769.00" "$45,323.82" "$23,511.48" "$23,511.48" "$23,511.48" "$23,511.48" "$23,541.72" "$23,541.72" "$15,452.22" "$16,005.85" "$23,541.72" "$16,766.76" "$16,766.76" "$20,090.46" "$11,769.00" "$16,005.85" "$37,666.75" "$23,800.90" "$27,142.50" "$23,541.72" "$24,293.69" "$23,541.72" "$24,718.81" "$42,491.25" "$23,541.72" "$21,234.63" "$23,541.72" "$27,142.50" "$23,071.13" "$44,870.58" "$23,541.72" "$45,323.82" "$21,000.00" "$15,243.66" "$23,541.72" "$32,859.90" "$24,718.81" "$18,138.97" "$26,678.97" "$16,005.85" "$23,541.72" N/A N/A MS480 DRG MS-DRG V39 (FY2022) 480 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC INPATIENT ONLY "$268,473.50" "$198,670.50" "$31,936.01" "$275,515.33" "$170,306.18" "$170,306.18" "$170,306.18" "$170,306.18" "$32,847.92" "$32,847.92" "$46,787.87" "$36,402.47" "$31,936.01" "$118,470.57" "$118,470.57" "$124,580.89" "$80,944.27" "$36,402.47" "$275,515.33" "$131,685.17" "$275,515.33" "$31,936.01" "$32,847.92" "$32,847.92" "$33,532.81" "$201,355.13" "$31,936.01" "$32,847.92" "$32,847.92" "$174,507.53" "$275,515.33" "$212,630.75" "$31,936.01" "$214,778.51" "$275,515.33" "$86,763.14" "$31,936.01" "$155,714.63" "$33,532.81" "$275,515.33" "$37,182.02" "$36,402.47" "$31,936.01" N/A N/A MS481 DRG MS-DRG V39 (FY2022) 481 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC INPATIENT ONLY "$198,158.00" "$146,637.00" "$21,011.95" "$158,526.33" "$121,543.21" "$121,543.21" "$121,543.21" "$121,543.21" "$25,519.71" "$25,519.71" "$27,624.69" "$30,442.50" "$25,519.71" "$89,324.13" "$89,324.13" "$95,309.86" "$61,082.65" "$30,442.50" "$40,831.54" "$97,719.05" "$128,802.64" "$25,519.71" "$26,750.81" "$25,519.71" "$26,795.70" "$148,618.50" "$25,519.71" "$23,018.78" "$25,519.71" "$128,802.64" "$128,802.64" "$156,941.06" "$25,519.71" "$158,526.33" "$115,270.52" "$22,891.19" "$25,519.71" "$114,931.64" "$26,795.70" "$21,011.95" "$29,153.84" "$30,442.50" "$25,519.71" N/A N/A MS482 DRG MS-DRG V39 (FY2022) 482 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC INPATIENT ONLY "$175,226.50" "$129,668.00" "$16,498.00" "$140,180.96" "$112,078.47" "$112,078.47" "$112,078.47" "$112,078.47" "$22,411.96" "$22,411.96" "$20,538.39" "$25,823.09" "$22,411.96" "$58,820.85" "$58,820.85" "$61,774.68" "$39,266.10" "$25,823.09" "$35,859.14" "$85,526.66" "$113,897.03" "$22,411.96" "$23,420.12" "$22,411.96" "$23,532.56" "$131,419.88" "$22,411.96" "$20,215.59" "$22,411.96" "$113,897.03" "$113,897.03" "$138,779.14" "$22,411.96" "$140,180.96" "$105,760.05" "$19,106.75" "$22,411.96" "$101,631.37" "$23,532.56" "$16,498.00" "$25,265.38" "$25,823.09" "$22,411.96" N/A N/A MS483 DRG MS-DRG V39 (FY2022) 483 MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES INPATIENT ONLY "$241,372.50" "$178,616.00" "$24,661.26" "$193,097.78" "$151,530.49" "$151,530.49" "$151,530.49" "$151,530.49" "$27,518.38" "$27,518.38" "$38,765.66" "$47,121.00" "$27,518.38" "$100,936.42" "$100,936.42" "$106,035.55" "$67,958.99" "$47,121.00" "$44,029.41" "$119,119.28" "$156,891.95" "$27,518.38" "$28,502.23" N/A "$28,894.30" "$181,029.38" "$27,518.38" "$24,821.58" "$27,518.38" "$156,891.95" "$156,891.95" "$191,166.83" "$27,518.38" "$193,097.78" "$139,995.89" "$37,858.05" "$27,518.38" "$139,996.05" "$28,894.30" "$24,661.26" "$31,654.61" "$47,121.00" "$27,518.38" N/A N/A MS485 DRG MS-DRG V39 (FY2022) 485 KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC INPATIENT ONLY "$132,512.50" "$98,059.50" "$10,323.26" "$106,009.72" "$63,696.57" "$63,696.57" "$63,696.57" "$63,696.57" N/A N/A N/A N/A N/A "$21,481.59" "$21,481.59" "$22,596.76" "$10,323.26" N/A N/A N/A "$86,132.90" "$34,584.81" N/A N/A "$36,314.05" "$99,384.38" N/A N/A N/A N/A N/A "$104,949.63" "$34,584.81" "$106,009.72" N/A N/A "$34,584.81" "$76,857.25" "$36,314.05" N/A "$40,496.24" N/A N/A N/A N/A MS486 DRG MS-DRG V39 (FY2022) 486 KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC INPATIENT ONLY "$119,837.50" "$88,680.00" "$4,119.14" "$95,869.95" "$32,089.06" "$32,089.06" "$32,089.06" "$32,089.06" "$25,887.54" "$25,887.54" "$18,436.99" "$17,852.61" "$25,887.54" "$12,970.70" "$12,970.70" "$13,644.04" "$4,119.14" "$17,852.61" "$41,420.06" "$28,075.47" "$77,894.34" "$25,887.54" "$26,562.24" "$25,887.54" "$27,181.92" "$89,878.13" "$25,887.54" "$23,350.56" N/A "$33,405.85" "$77,894.34" "$94,911.25" "$25,887.54" "$95,869.95" "$28,000.00" "$17,002.47" "$25,887.54" "$69,505.75" "$27,181.92" "$21,546.25" "$29,614.09" "$17,852.61" "$25,887.54" N/A N/A MS487 DRG MS-DRG V39 (FY2022) 487 KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC INPATIENT ONLY "$112,469.50" "$83,227.50" $340.74 "$89,975.48" "$31,959.85" "$31,959.85" "$31,959.85" "$31,959.85" "$22,373.31" "$22,373.31" "$13,950.92" "$12,771.19" "$22,373.31" "$7,787.43" "$7,787.43" "$8,191.70" $340.74 "$12,771.19" "$35,797.30" "$21,588.24" "$73,073.00" "$22,373.31" "$23,119.40" "$22,373.31" "$23,491.98" "$84,352.13" "$22,373.31" "$20,180.73" "$22,373.31" "$25,609.93" "$73,105.08" "$89,075.74" "$22,373.31" "$89,975.48" "$28,000.00" "$12,163.03" "$22,373.31" "$65,232.31" "$23,491.98" "$16,441.86" "$25,217.02" "$12,771.19" "$22,373.31" N/A N/A MS488 DRG MS-DRG V39 (FY2022) 488 KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC INPATIENT ONLY "$243,292.00" "$180,036.50" "$13,629.44" "$213,898.46" "$150,344.33" "$150,344.33" "$150,344.33" "$150,344.33" "$24,688.76" "$24,688.76" "$36,839.61" "$22,598.27" "$24,688.76" "$108,902.13" "$108,902.13" "$114,419.28" "$75,699.78" "$22,598.27" "$39,502.02" "$119,215.01" "$158,139.72" "$24,688.76" "$27,870.81" "$24,688.76" "$25,923.20" "$182,469.00" "$24,688.76" "$22,269.26" "$24,688.76" "$158,139.72" "$158,139.72" "$192,687.16" "$24,688.76" "$194,633.51" "$149,335.64" "$13,629.44" "$24,688.76" "$141,109.36" "$25,923.20" "$24,288.15" "$28,114.15" "$22,598.27" "$24,688.76" N/A N/A MS489 DRG MS-DRG V39 (FY2022) 489 KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC INPATIENT ONLY "$130,454.50" "$96,536.50" "$8,403.74" "$121,181.25" "$13,747.87" "$13,747.87" "$13,747.87" "$13,747.87" "$20,012.99" "$20,012.99" "$11,769.47" "$12,771.19" "$20,012.99" "$19,088.56" "$19,088.56" "$19,992.66" "$8,403.74" "$12,771.19" "$32,020.78" "$17,893.74" "$84,795.42" "$20,012.99" "$21,158.70" "$20,012.99" "$21,013.64" "$97,840.88" "$20,012.99" "$18,051.72" "$20,012.99" "$84,795.42" "$84,795.42" "$103,319.98" "$20,012.99" "$104,363.59" "$12,430.38" "$12,163.03" "$20,012.99" "$75,663.61" "$21,013.64" "$13,013.55" "$22,263.75" "$12,771.19" "$20,012.99" N/A N/A MS492 DRG MS-DRG V39 (FY2022) 492 "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC" INPATIENT ONLY "$263,108.00" "$194,700.00" "$32,163.40" "$197,331.00" "$176,277.24" "$176,277.24" "$176,277.24" "$176,277.24" "$36,561.46" "$36,561.46" "$176,277.24" "$32,163.40" "$35,001.66" "$144,309.78" "$144,309.78" "$144,309.78" "$144,309.78" "$32,163.40" "$176,277.24" "$176,277.24" "$176,277.24" "$36,561.46" "$36,561.46" "$36,561.46" "$36,561.46" "$197,331.00" "$36,561.46" "$36,561.46" "$36,561.46" "$176,277.24" "$176,277.24" "$176,277.24" "$36,561.46" "$175,961.06" "$176,277.24" "$32,163.40" "$36,561.46" "$152,602.64" "$36,561.46" "$176,277.24" "$176,277.24" "$32,163.40" "$36,561.46" N/A N/A MS493 DRG MS-DRG V39 (FY2022) 493 "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC" INPATIENT ONLY "$192,048.50" "$142,116.00" "$19,954.63" "$153,638.59" "$117,151.85" "$117,151.85" "$117,151.85" "$117,151.85" "$27,104.97" "$27,104.97" "$26,455.75" "$27,461.26" "$27,104.97" "$70,874.71" "$70,874.71" "$74,409.69" "$47,962.98" "$27,461.26" "$43,367.95" "$91,058.21" "$124,831.36" "$27,104.97" "$28,632.22" "$27,104.97" "$28,460.22" "$144,036.38" "$27,104.97" "$24,448.68" "$27,104.97" "$124,831.36" "$124,831.36" "$152,102.19" "$27,104.97" "$153,638.59" "$119,614.33" "$19,954.63" "$27,104.97" "$111,388.13" "$28,460.22" "$23,314.53" "$31,137.35" "$27,461.26" "$27,104.97" N/A N/A MS494 DRG MS-DRG V39 (FY2022) 494 "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC" INPATIENT ONLY "$155,104.00" "$114,777.00" "$14,362.37" "$124,083.09" "$98,464.09" "$98,464.09" "$98,464.09" "$98,464.09" "$23,832.96" "$23,832.96" "$16,536.35" "$20,352.00" "$23,832.96" "$37,538.66" "$37,538.66" "$39,468.09" "$21,989.32" "$20,352.00" "$38,132.74" "$76,360.43" "$100,817.50" "$23,832.96" "$25,153.68" "$23,832.96" "$25,024.61" "$116,328.00" "$23,832.96" "$21,497.33" "$23,832.96" "$100,817.50" "$100,817.50" "$122,842.25" "$23,832.96" "$124,083.09" "$89,960.23" "$14,362.37" "$23,832.96" "$89,960.32" "$25,024.61" "$18,562.01" "$27,043.36" "$20,352.00" "$23,832.96" N/A N/A MS495 DRG MS-DRG V39 (FY2022) 495 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC INPATIENT ONLY "$243,269.00" "$180,019.50" "$141,096.02" "$194,615.06" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$182,451.75" N/A N/A N/A N/A N/A "$192,668.91" N/A "$194,615.06" N/A N/A N/A "$141,096.02" N/A N/A N/A N/A N/A N/A N/A MS496 DRG MS-DRG V39 (FY2022) 496 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC INPATIENT ONLY "$150,481.50" "$111,356.50" "$12,960.44" "$120,385.15" "$95,919.46" "$95,919.46" "$95,919.46" "$95,919.46" "$26,660.10" "$26,660.10" "$28,259.86" N/A "$26,660.10" "$34,377.93" "$34,377.93" "$36,161.85" "$19,722.73" N/A "$28,259.86" "$73,604.38" "$97,812.94" "$24,762.61" "$26,660.10" "$26,660.10" "$26,000.74" "$112,861.13" "$26,660.10" "$22,335.87" "$24,762.61" "$28,259.86" "$97,812.94" "$119,181.31" "$24,762.61" "$120,385.15" "$28,259.86" "$12,960.44" "$24,762.61" "$87,279.27" "$26,000.74" "$28,259.86" "$28,206.56" N/A "$24,762.61" N/A N/A MS497 DRG MS-DRG V39 (FY2022) 497 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC INPATIENT ONLY "$101,794.00" "$75,328.00" "$4,029.25" "$139,253.21" "$9,655.82" "$9,655.82" "$9,655.82" "$9,655.82" "$21,070.99" "$21,070.99" "$10,916.17" "$10,834.55" "$21,070.99" "$5,740.27" "$5,740.27" "$6,854.01" "$4,029.25" "$10,834.55" "$33,713.58" "$20,480.56" "$66,166.00" "$21,070.99" "$22,531.56" "$21,070.99" "$22,124.54" "$76,345.50" "$21,070.99" "$19,006.03" "$21,070.99" "$21,772.50" "$18,506.63" "$80,620.72" "$21,070.99" "$81,435.07" "$8,673.52" "$10,318.62" "$21,070.99" "$59,040.52" "$22,124.54" "$14,550.29" "$23,587.54" "$10,834.55" "$21,070.99" N/A N/A MS498 DRG MS-DRG V39 (FY2022) 498 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC INPATIENT ONLY "$100,357.50" "$74,265.00" "$5,884.50" "$80,285.82" "$12,041.45" "$12,041.45" "$12,041.45" "$12,041.45" "$28,884.86" "$28,884.86" "$19,115.34" "$17,598.11" "$28,884.86" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$17,598.11" "$46,215.78" "$34,496.76" "$65,232.23" "$28,884.86" "$29,970.06" N/A "$30,329.10" "$75,268.13" "$28,884.86" "$26,054.14" "$28,884.86" "$38,755.50" "$32,942.18" "$79,482.98" "$28,884.86" "$80,285.82" "$10,500.00" "$16,760.10" "$28,884.86" "$58,207.35" "$30,329.10" "$25,899.80" "$33,364.38" "$17,598.11" "$28,884.86" N/A N/A MS499 DRG MS-DRG V39 (FY2022) 499 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC INPATIENT ONLY "$81,354.50" "$60,202.50" "$7,628.85" "$65,083.53" "$9,679.66" "$9,679.66" "$9,679.66" "$9,679.66" "$19,328.34" "$19,328.34" "$9,597.84" "$9,442.86" "$19,328.34" "$10,206.85" "$10,206.85" "$11,045.89" "$9,088.80" "$9,442.86" "$30,925.34" "$17,748.38" "$17,985.00" "$19,328.34" "$21,081.55" "$19,328.34" "$20,294.76" "$61,015.88" "$19,328.34" "$17,434.16" "$19,328.34" "$17,985.00" "$15,807.50" "$64,432.67" "$19,328.34" "$65,083.53" "$7,628.85" "$8,993.20" "$19,328.34" "$47,185.61" "$20,294.76" "$12,019.14" "$21,407.13" "$9,442.86" "$19,328.34" N/A N/A MS500 DRG MS-DRG V39 (FY2022) 500 SOFT TISSUE PROCEDURES WITH MCC INPATIENT ONLY "$164,378.50" "$121,640.50" "$20,901.24" "$131,502.78" "$80,140.73" "$80,140.73" "$80,140.73" "$80,140.73" "$33,065.79" "$33,065.79" "$28,937.22" "$21,946.31" "$33,065.79" "$53,825.85" "$53,825.85" "$56,520.38" "$35,624.93" "$21,946.31" "$52,905.26" "$81,446.47" "$106,846.01" "$33,065.79" "$34,551.47" "$33,065.79" "$34,719.08" "$123,283.88" "$33,065.79" "$29,825.34" "$33,065.79" "$106,846.01" "$106,846.01" "$130,187.74" "$33,065.79" "$131,502.78" "$126,118.61" "$20,901.24" "$33,065.79" "$95,339.53" "$34,719.08" "$31,972.51" "$38,595.63" "$21,946.31" "$33,065.79" N/A N/A MS501 DRG MS-DRG V39 (FY2022) 501 SOFT TISSUE PROCEDURES WITH CC INPATIENT ONLY "$189,103.00" "$139,936.50" "$14,704.25" "$151,282.28" "$119,906.51" "$119,906.51" "$119,906.51" "$119,906.51" "$23,159.39" "$23,159.39" "$24,230.26" "$28,792.94" "$23,159.39" "$62,767.05" "$62,767.05" "$65,981.98" "$40,331.11" "$42,527.84" "$14,704.25" "$93,121.01" "$122,916.86" "$23,159.39" "$24,217.98" "$24,217.98" "$24,317.36" "$141,827.25" "$24,217.98" "$24,217.98" "$24,217.98" "$122,916.86" "$122,916.86" "$149,769.49" "$23,159.39" "$151,282.28" "$14,704.25" "$21,551.35" "$23,159.39" "$109,679.74" "$24,317.36" "$14,704.25" "$26,200.58" "$28,792.94" "$23,159.39" N/A N/A MS502 DRG MS-DRG V39 (FY2022) 502 SOFT TISSUE PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$146,970.50" "$108,758.50" "$11,888.22" "$117,576.12" "$81,664.33" "$81,664.33" "$81,664.33" "$81,664.33" "$20,251.78" "$20,251.78" "$13,438.79" "$16,149.83" "$20,251.78" "$41,456.33" "$41,456.33" "$43,508.73" "$26,608.03" "$16,149.83" "$32,402.85" "$72,907.22" "$95,530.60" "$20,251.78" "$21,480.12" "$20,251.78" "$21,264.37" "$110,227.88" "$20,251.78" "$18,267.11" "$20,251.78" "$95,530.60" "$95,530.60" "$116,400.38" "$20,251.78" "$117,576.12" "$15,389.55" "$11,888.22" "$20,251.78" "$85,242.89" "$21,264.37" "$13,360.39" "$22,562.54" "$16,149.83" "$20,251.78" N/A N/A MS503 DRG MS-DRG V39 (FY2022) 503 FOOT PROCEDURES WITH MCC INPATIENT ONLY "$258,699.50" "$191,438.00" "$16,287.78" "$206,959.33" "$152,807.67" "$152,807.67" "$152,807.67" "$152,807.67" "$29,277.56" "$29,277.56" N/A N/A "$29,277.56" "$136,538.05" "$136,538.05" "$144,081.62" "$95,499.48" N/A N/A N/A N/A "$29,277.56" "$30,741.44" "$30,741.44" "$30,741.44" "$194,024.63" "$30,741.44" "$30,741.44" "$30,741.44" N/A "$168,154.45" "$204,889.73" "$29,277.56" "$206,959.33" N/A N/A "$29,277.56" "$150,045.71" "$30,741.44" N/A "$33,855.72" "$16,287.78" "$30,741.44" N/A N/A MS504 DRG MS-DRG V39 (FY2022) 504 FOOT PROCEDURES WITH CC INPATIENT ONLY "$173,744.00" "$128,571.00" "$16,275.85" "$138,995.05" "$106,996.65" "$106,996.65" "$106,996.65" "$106,996.65" "$23,303.62" "$23,303.62" "$20,796.61" "$22,870.37" "$23,303.62" "$60,224.39" "$60,224.39" "$63,251.09" "$40,289.23" "$22,870.37" "$37,285.79" "$82,228.49" "$112,933.48" "$23,303.62" "$24,339.39" "$23,303.62" "$24,468.80" "$130,308.00" "$23,303.62" "$21,019.87" "$23,303.62" "$112,933.48" "$112,933.48" "$137,605.09" "$23,303.62" "$138,995.05" "$108,997.77" "$16,275.85" "$23,303.62" "$100,771.52" "$24,468.80" "$17,793.13" "$26,381.04" "$22,870.37" "$23,303.62" N/A N/A MS505 DRG MS-DRG V39 (FY2022) 505 FOOT PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$111,502.50" "$82,512.00" "$4,773.04" "$89,201.79" "$10,360.95" "$10,360.95" "$10,360.95" "$10,360.95" "$23,303.62" "$23,303.62" "$11,133.96" "$13,687.00" "$23,303.62" "$5,438.67" "$5,438.67" "$5,704.83" "$4,773.04" "$13,687.00" "$37,285.79" "$23,779.36" "$72,476.46" "$23,303.62" "$24,282.25" "$23,303.62" "$24,468.80" "$83,626.88" "$23,303.62" "$21,019.87" "$23,303.62" "$26,625.00" "$72,476.46" "$88,309.78" "$23,303.62" "$89,201.79" "$9,300.78" "$13,035.23" "$23,303.62" "$64,671.45" "$24,468.80" "$17,793.13" "$26,381.04" "$13,687.00" "$23,303.62" N/A N/A MS506 DRG MS-DRG V39 (FY2022) 506 MAJOR THUMB OR JOINT PROCEDURES INPATIENT ONLY "$155,561.50" "$115,116.00" "$9,497.78" "$124,448.87" "$99,660.79" "$99,660.79" "$99,660.79" "$99,660.79" "$21,292.53" "$21,292.53" N/A "$11,127.54" "$21,292.53" "$39,872.30" "$39,872.30" "$41,942.17" "$23,729.38" N/A "$34,068.05" "$75,097.86" "$101,114.71" "$21,292.53" N/A N/A "$22,357.16" "$116,671.13" N/A "$19,205.86" N/A "$101,114.71" "$101,114.71" "$123,204.39" "$21,292.53" "$124,448.87" "$90,225.43" "$9,497.78" "$21,292.53" "$90,225.67" "$22,357.16" N/A "$23,864.74" "$11,127.54" "$21,292.53" N/A N/A MS507 DRG MS-DRG V39 (FY2022) 507 MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC INPATIENT ONLY "$282,450.00" "$209,013.00" "$163,821.00" "$211,837.50" "$187,745.42" "$187,745.42" "$187,745.42" "$187,745.42" N/A N/A "$187,745.42" N/A N/A N/A N/A N/A N/A N/A "$187,745.42" "$187,745.42" "$187,745.42" N/A N/A N/A N/A "$211,837.50" N/A N/A N/A "$187,745.42" "$187,745.42" "$187,745.42" N/A N/A "$187,745.42" N/A N/A "$163,821.00" N/A "$187,745.42" "$187,745.42" N/A N/A N/A N/A MS509 DRG MS-DRG V39 (FY2022) 509 ARTHROSCOPY INPATIENT ONLY "$66,915.50" "$49,517.50" "$13,011.80" "$53,532.15" "$17,206.92" "$17,206.92" "$17,206.92" "$17,206.92" "$22,692.85" "$22,692.85" "$13,829.53" "$19,501.63" "$22,692.85" "$15,795.77" "$15,795.77" "$17,742.71" "$13,011.80" "$19,501.63" "$36,308.56" "$20,429.42" "$25,297.50" "$22,692.85" "$22,504.41" "$22,692.85" "$23,827.49" "$50,186.63" "$22,692.85" "$20,468.95" "$22,692.85" "$25,297.50" "$21,502.88" "$52,996.82" "$22,692.85" "$53,532.15" "$18,726.35" "$18,572.97" "$22,692.85" "$38,810.99" "$23,827.49" "$16,905.98" "$25,616.83" "$19,501.63" "$22,692.85" N/A N/A MS510 DRG MS-DRG V39 (FY2022) 510 "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC" INPATIENT ONLY "$149,121.00" "$110,350.00" "$19,241.54" "$119,296.57" "$82,957.32" "$82,957.32" "$82,957.32" "$82,957.32" "$29,989.10" "$29,989.10" "$20,401.54" "$20,203.62" "$29,989.10" "$42,696.21" "$42,696.21" "$44,812.97" "$27,511.86" "$20,203.62" "$47,982.56" "$73,265.68" "$96,928.47" "$29,989.10" "$32,291.49" N/A "$31,488.56" "$111,840.75" "$29,989.10" "$27,050.17" "$29,989.10" "$96,928.47" "$96,928.47" "$118,103.62" "$29,989.10" "$119,296.57" "$22,389.55" "$19,241.54" "$29,989.10" "$86,490.18" "$31,488.56" "$27,503.69" "$34,746.02" "$20,203.62" "$29,989.10" N/A N/A MS511 DRG MS-DRG V39 (FY2022) 511 "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC" INPATIENT ONLY "$179,401.00" "$132,757.00" "$19,109.99" "$143,520.76" "$114,458.03" "$114,458.03" "$114,458.03" "$114,458.03" "$24,631.47" "$24,631.47" "$22,335.42" "$25,928.04" "$24,631.47" "$55,386.43" "$55,386.43" "$58,261.68" "$35,038.59" "$25,928.04" "$39,410.35" "$87,433.70" "$116,610.62" "$24,631.47" "$25,797.97" "$24,631.47" "$25,863.04" "$134,550.75" "$24,631.47" "$22,217.59" "$24,631.47" "$116,610.62" "$116,610.62" "$142,085.57" "$24,631.47" "$143,520.76" "$104,052.55" "$19,109.99" "$24,631.47" "$104,052.58" "$25,863.04" "$19,721.81" "$28,042.46" "$25,928.04" "$24,631.47" N/A N/A MS512 DRG MS-DRG V39 (FY2022) 512 "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$145,495.00" "$107,666.50" "$9,310.36" "$116,396.00" "$92,938.60" "$92,938.60" "$92,938.60" "$92,938.60" "$21,781.85" "$21,781.85" "$13,570.26" "$13,105.46" "$21,781.85" "$31,513.49" "$31,513.49" "$33,149.44" "$17,636.13" "$13,105.46" "$34,850.96" "$69,825.83" "$94,571.75" "$21,781.85" "$23,137.26" "$21,781.85" "$22,870.94" "$109,121.25" "$21,781.85" "$19,647.23" "$21,781.85" "$94,571.75" "$94,571.75" "$115,232.06" "$21,781.85" "$116,396.00" "$14,393.66" "$9,310.36" "$21,781.85" "$84,387.10" "$22,870.94" "$15,582.79" "$24,476.98" "$13,105.46" "$21,781.85" N/A N/A MS513 DRG MS-DRG V39 (FY2022) 513 "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC" INPATIENT ONLY "$73,171.00" "$54,147.00" "$7,628.85" "$58,536.74" "$9,443.38" "$9,443.38" "$9,443.38" "$9,443.38" "$21,902.63" "$21,902.63" "$12,908.39" "$12,534.67" "$21,902.63" "$10,206.85" "$10,206.85" "$11,045.89" "$9,088.80" "$12,534.67" "$35,044.21" "$21,453.65" "$23,580.00" "$21,902.63" "$23,047.98" N/A "$22,997.76" "$54,878.25" "$21,902.63" "$19,756.17" "$21,902.63" "$23,580.00" "$20,043.00" "$57,951.37" "$21,902.63" "$58,536.74" "$7,628.85" "$11,937.77" "$21,902.63" "$42,439.18" "$22,997.76" "$15,758.21" "$24,628.10" "$12,534.67" "$21,902.63" N/A N/A MS514 DRG MS-DRG V39 (FY2022) 514 "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$78,607.50" "$58,170.00" "$1,961.50" "$62,885.61" "$4,087.62" "$4,087.62" "$4,087.62" "$4,087.62" "$17,948.75" "$17,948.75" "$8,029.59" "$10,299.07" "$17,948.75" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$10,299.07" "$28,718.00" "$13,899.11" "$14,986.50" "$17,948.75" "$19,038.72" "$17,948.75" "$18,846.19" "$58,955.63" "$17,948.75" "$16,189.77" "$17,948.75" "$14,986.50" "$12,738.53" "$62,256.76" "$17,948.75" "$62,885.61" "$3,500.00" "$9,808.63" "$17,948.75" "$45,592.35" "$18,846.19" "$10,015.29" "$19,680.95" "$10,299.07" "$17,948.75" N/A N/A MS515 DRG MS-DRG V39 (FY2022) 515 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC INPATIENT ONLY "$219,025.00" "$162,078.50" "$32,728.31" "$175,219.88" "$139,902.55" "$139,902.55" "$139,902.55" "$139,902.55" "$33,932.19" "$33,932.19" N/A "$34,463.00" "$33,932.19" "$84,554.90" "$84,554.90" "$88,942.48" "$56,297.49" "$36,875.74" N/A N/A N/A "$32,728.31" "$33,932.19" "$33,932.19" "$34,364.73" "$164,268.75" "$33,932.19" "$33,932.19" "$33,932.19" N/A "$142,366.15" "$173,467.71" "$32,728.31" "$175,219.88" N/A "$36,875.74" "$32,728.31" "$127,034.50" "$34,364.73" N/A "$38,173.36" "$34,463.00" "$33,932.19" N/A N/A MS516 DRG MS-DRG V39 (FY2022) 516 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC INPATIENT ONLY "$184,094.50" "$136,230.00" "$19,675.71" "$147,275.44" "$113,515.47" "$113,515.47" "$113,515.47" "$113,515.47" "$24,599.75" "$24,599.75" "$24,707.16" "$27,597.06" "$24,599.75" "$67,319.80" "$67,319.80" "$70,714.84" "$45,461.51" "$27,597.06" "$39,359.60" "$89,255.27" "$119,661.30" "$24,599.75" "$26,189.38" "$24,599.75" "$25,829.74" "$138,070.88" "$24,599.75" "$22,188.97" "$24,599.75" "$119,661.30" "$119,661.30" "$145,802.69" "$24,599.75" "$147,275.44" "$115,001.05" "$20,345.39" "$24,599.75" "$106,774.81" "$25,829.74" "$19,675.71" "$28,002.77" "$27,597.06" "$24,599.75" N/A N/A MS517 DRG MS-DRG V39 (FY2022) 517 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$181,899.00" "$134,605.50" "$14,015.99" "$145,518.91" "$114,142.10" "$114,142.10" "$114,142.10" "$114,142.10" "$20,703.15" "$20,703.15" "$23,143.28" "$25,664.98" "$20,703.15" "$54,984.91" "$54,984.91" "$57,771.31" "$34,608.78" "$25,664.98" "$33,125.04" "$89,297.84" "$118,234.12" "$20,703.15" "$22,447.27" "$20,703.15" "$21,738.31" "$136,424.25" "$20,703.15" "$18,674.24" "$20,703.15" "$118,234.12" "$118,234.12" "$144,063.74" "$20,703.15" "$145,518.91" "$105,384.93" "$18,563.80" "$20,703.15" "$105,501.42" "$21,738.31" "$14,015.99" "$23,127.29" "$25,664.98" "$20,703.15" N/A N/A MS518 DRG MS-DRG V39 (FY2022) 518 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR INPATIENT ONLY "$270,974.00" "$200,521.00" "$21,269.76" "$216,778.81" "$164,177.53" "$164,177.53" "$164,177.53" "$164,177.53" "$35,808.45" "$35,808.45" "$47,540.34" "$22,333.26" "$35,808.45" "$129,724.03" "$129,724.03" "$136,113.96" "$90,458.46" "$22,333.26" "$57,293.52" "$134,079.78" "$176,132.78" "$35,808.45" "$38,288.60" "$38,288.60" "$37,598.87" "$203,230.50" "$35,808.45" "$32,299.22" "$35,808.45" "$176,132.78" "$176,132.78" "$214,611.00" "$35,808.45" "$216,778.81" "$165,390.99" "$21,269.76" "$35,808.45" "$157,164.92" "$37,598.87" "$35,956.17" "$42,027.27" "$22,333.26" "$35,808.45" N/A N/A MS519 DRG MS-DRG V39 (FY2022) 519 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC INPATIENT ONLY "$206,438.50" "$152,764.50" "$19,647.63" "$165,150.41" "$132,206.98" "$132,206.98" "$132,206.98" "$132,206.98" "$24,580.40" "$24,580.40" "$28,357.20" "$29,158.39" "$24,580.40" "$76,668.94" "$76,668.94" "$80,649.02" "$50,552.73" "$29,158.39" "$39,328.64" "$100,663.97" "$134,184.71" "$24,580.40" "$25,942.97" "$24,580.40" "$25,809.42" "$154,828.88" "$24,580.40" "$22,171.52" "$24,580.40" "$134,184.71" "$134,184.71" "$163,498.91" "$24,580.40" "$165,150.41" "$119,734.05" "$21,223.81" "$24,580.40" "$119,734.33" "$25,809.42" "$19,647.63" "$27,978.58" "$29,158.39" "$24,580.40" N/A N/A MS520 DRG MS-DRG V39 (FY2022) 520 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC INPATIENT ONLY "$266,130.50" "$196,937.00" "$18,799.36" "$212,904.18" "$161,970.56" "$161,970.56" "$161,970.56" "$161,970.56" N/A N/A "$83,997.98" "$41,249.89" "$20,841.86" "$119,657.43" "$119,657.43" "$125,442.49" "$81,029.37" "$41,249.89" "$33,346.98" "$129,107.30" "$172,984.64" "$20,841.86" N/A N/A "$21,883.95" "$199,597.88" N/A "$18,799.36" "$20,841.86" "$172,984.64" "$172,984.64" "$210,775.14" "$20,841.86" "$212,904.18" "$154,355.53" "$31,692.94" "$20,841.86" "$154,355.69" "$21,883.95" "$28,511.16" "$23,300.85" "$41,249.89" "$20,841.86" N/A N/A MS521 DRG MS-DRG V39 (FY2022) 521 HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC INPATIENT ONLY "$294,129.50" "$217,656.00" "$32,214.84" "$235,303.48" N/A N/A N/A N/A "$33,227.93" "$33,227.93" N/A N/A "$33,227.93" "$145,048.45" "$145,048.45" "$152,402.82" "$101,969.97" N/A N/A N/A N/A "$32,214.84" "$33,227.93" "$33,227.93" "$33,227.93" "$220,597.13" "$33,227.93" "$33,227.93" "$33,227.93" N/A N/A "$232,950.46" "$32,214.84" "$235,303.48" N/A N/A "$32,214.84" "$170,595.11" "$33,825.58" N/A N/A N/A "$33,227.93" N/A N/A MS522 DRG MS-DRG V39 (FY2022) 522 HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC INPATIENT ONLY "$187,144.00" "$138,487.00" "$20,163.10" "$149,715.00" "$119,148.58" "$119,148.58" "$119,148.58" "$119,148.58" "$27,182.96" "$27,182.96" "$31,238.84" "$27,515.10" "$27,182.96" "$67,858.44" "$67,858.44" "$71,247.64" "$45,786.01" "$36,914.50" "$31,238.84" "$91,356.71" "$121,643.42" "$26,163.61" "$27,182.96" "$27,182.96" "$27,471.79" "$140,358.00" "$27,182.96" "$27,182.96" "$27,182.96" "$121,643.42" "$121,643.42" "$148,217.85" "$26,163.61" "$149,715.00" "$31,238.84" "$20,163.10" "$26,163.61" "$108,543.52" "$27,471.79" "$31,238.84" "$29,959.51" "$27,515.10" "$26,163.61" N/A N/A MS533 DRG MS-DRG V39 (FY2022) 533 FRACTURES OF FEMUR WITH MCC INPATIENT ONLY "$47,115.50" "$34,865.50" "$8,195.79" "$37,692.16" "$11,864.91" "$11,864.91" "$11,864.91" "$11,864.91" "$20,827.37" "$20,827.37" "$9,466.72" "$8,605.58" "$20,827.37" "$17,122.59" "$17,122.59" "$17,781.15" "$12,018.75" "$8,605.58" "$33,323.79" "$19,196.57" "$21,243.00" "$20,827.37" "$21,601.55" "$20,827.37" "$21,868.74" "$35,336.63" "$20,827.37" "$18,786.29" "$20,827.37" "$30,624.88" "$30,624.88" "$37,315.23" "$20,827.37" "$37,692.16" "$10,500.00" "$8,195.79" "$20,827.37" "$27,326.99" "$21,868.74" "$14,196.42" "$23,282.72" "$8,605.58" "$20,827.37" N/A N/A MS534 DRG MS-DRG V39 (FY2022) 534 FRACTURES OF FEMUR WITHOUT MCC INPATIENT ONLY "$58,265.50" "$43,116.50" "$4,320.45" "$46,612.06" "$13,543.55" "$13,543.55" "$13,543.55" "$13,543.55" "$16,507.02" "$16,507.02" "$6,778.20" "$4,536.47" "$16,507.02" "$18,827.45" "$18,827.45" "$19,551.58" "$15,139.80" "$4,536.47" "$26,411.23" "$10,712.02" "$11,853.00" "$16,507.02" "$17,347.31" "$17,347.31" "$17,332.37" "$43,699.13" "$16,507.02" "$14,889.33" "$16,507.02" "$37,872.30" "$37,872.30" "$46,145.92" "$16,507.02" "$46,612.06" "$22,514.65" "$4,320.45" "$16,507.02" "$33,793.99" "$17,332.37" "$7,921.20" "$17,877.04" "$4,536.47" "$16,507.02" N/A N/A MS535 DRG MS-DRG V39 (FY2022) 535 FRACTURES OF HIP AND PELVIS WITH MCC INPATIENT ONLY "$149,354.00" "$110,522.00" "$7,688.51" "$119,482.99" "$91,416.20" "$91,416.20" "$91,416.20" "$91,416.20" "$25,446.44" "$25,446.44" N/A "$11,496.10" "$19,561.65" "$42,668.23" "$42,668.23" "$44,783.54" "$27,491.46" "$11,496.10" N/A "$71,455.80" "$97,079.93" "$19,561.65" "$25,446.44" "$25,446.44" "$20,539.73" "$112,015.50" "$25,446.44" "$25,446.44" "$19,561.65" "$97,079.93" "$97,079.93" "$118,288.15" "$19,561.65" "$119,482.99" "$39,726.35" "$7,688.51" "$19,561.65" "$86,625.32" "$20,539.73" "$12,357.96" "$21,699.03" "$11,496.10" "$19,561.65" N/A N/A MS536 DRG MS-DRG V39 (FY2022) 536 FRACTURES OF HIP AND PELVIS WITHOUT MCC INPATIENT ONLY "$62,473.00" "$46,230.50" "$6,427.42" "$49,978.18" "$13,509.83" "$13,509.83" "$13,509.83" "$13,509.83" "$16,379.34" "$16,379.34" "$6,427.42" "$6,888.44" "$16,379.34" "$18,827.45" "$18,827.45" "$19,551.58" "$15,139.80" "$6,888.44" "$26,206.94" "$10,458.99" "$11,575.50" "$16,379.34" "$17,213.02" "$16,379.34" "$17,198.31" "$46,854.75" "$16,379.34" "$14,774.16" "$16,379.34" "$40,607.27" "$40,607.27" "$49,478.39" "$16,379.34" "$49,978.18" "$22,389.55" "$6,560.41" "$16,379.34" "$36,234.34" "$17,198.31" "$7,735.76" "$17,717.29" "$6,888.44" "$16,379.34" N/A N/A MS539 DRG MS-DRG V39 (FY2022) 539 OSTEOMYELITIS WITH MCC INPATIENT ONLY "$70,336.00" "$52,049.00" "$16,205.06" "$56,268.75" "$54,908.91" "$54,908.91" "$54,908.91" "$54,908.91" "$24,495.51" "$24,495.51" "$16,312.66" "$17,015.32" "$24,495.51" "$39,122.44" "$39,122.44" "$46,877.74" "$27,461.00" "$17,015.32" "$16,312.66" "$26,862.82" "$29,215.50" "$24,495.51" "$32,997.50" "$32,997.50" "$25,720.29" "$52,752.00" "$32,997.50" "$32,997.50" "$32,997.50" "$29,215.50" "$25,347.62" "$55,706.06" "$24,495.51" "$56,268.75" "$16,312.66" "$16,205.06" "$24,495.51" "$40,794.88" "$25,720.29" "$19,524.35" "$27,872.35" "$17,015.32" "$24,495.51" N/A N/A MS540 DRG MS-DRG V39 (FY2022) 540 OSTEOMYELITIS WITH CC INPATIENT ONLY "$46,408.00" "$34,342.00" "$11,573.99" "$37,126.29" "$24,032.04" "$24,032.04" "$24,032.04" "$24,032.04" "$20,036.46" "$20,036.46" "$11,573.99" "$12,280.17" "$20,036.46" "$16,766.76" "$16,766.76" "$20,090.46" "$11,769.00" "$12,280.17" "$32,058.34" "$18,123.89" "$19,524.00" "$20,036.46" "$21,280.85" "$20,036.46" "$21,038.28" "$34,806.00" "$20,036.46" "$18,072.89" "$20,036.46" "$20,355.16" "$17,426.56" "$36,755.03" "$20,036.46" "$37,126.29" "$21,000.00" "$11,695.40" "$20,036.46" "$26,916.64" "$21,038.28" "$13,047.64" "$22,293.13" "$12,280.17" "$20,036.46" N/A N/A MS541 DRG MS-DRG V39 (FY2022) 541 OSTEOMYELITIS WITHOUT CC/MCC INPATIENT ONLY "$24,607.50" "$18,210.00" "$1,961.50" "$24,607.14" "$4,144.06" "$4,144.06" "$4,144.06" "$4,144.06" "$16,872.82" "$16,872.82" "$8,227.74" "$5,636.86" "$16,872.82" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,878.98" "$24,607.14" "$11,009.46" "$12,648.00" "$16,872.82" "$17,505.15" "$16,872.82" "$17,716.46" "$18,455.63" "$16,872.82" "$15,219.28" "$16,872.82" "$12,648.00" "$10,750.80" "$19,488.86" "$16,872.82" "$19,685.71" "$3,500.00" "$6,551.40" "$16,872.82" "$14,272.35" "$17,716.46" "$8,452.50" "$18,334.72" "$5,636.86" "$16,872.82" N/A N/A MS542 DRG MS-DRG V39 (FY2022) 542 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC INPATIENT ONLY "$102,631.00" "$75,947.00" "$1,209.22" "$82,104.80" "$27,684.58" "$27,684.58" "$27,684.58" "$27,684.58" "$23,539.66" "$23,539.66" "$17,380.18" "$13,910.27" "$23,539.66" "$1,209.22" "$1,209.22" "$1,271.99" "$13,730.50" "$13,910.27" "$37,663.46" "$24,603.05" "$66,710.15" "$23,539.66" "$24,719.42" "$23,539.66" "$24,716.64" "$76,973.25" "$23,539.66" "$21,232.77" "$23,539.66" "$27,138.00" "$23,605.78" "$81,283.74" "$23,539.66" "$82,104.80" "$24,500.00" "$13,247.87" "$23,539.66" "$59,525.98" "$24,716.64" "$18,135.98" "$26,676.37" "$13,910.27" "$23,539.66" N/A N/A MS543 DRG MS-DRG V39 (FY2022) 543 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC INPATIENT ONLY "$66,844.50" "$49,465.00" "$5,884.50" "$53,475.42" "$12,599.45" "$12,599.45" "$12,599.45" "$12,599.45" "$18,266.92" "$18,266.92" "$10,020.92" "$13,565.90" "$18,266.92" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$13,565.90" "$29,227.07" "$14,656.85" "$15,678.00" "$18,266.92" "$19,440.86" "$21,473.56" "$19,180.27" "$50,133.38" "$18,266.92" "$16,476.76" "$18,266.92" "$16,806.67" "$14,454.97" "$52,940.67" "$18,266.92" "$53,475.42" "$10,500.00" "$12,919.90" "$18,266.92" "$38,769.81" "$19,180.27" "$10,477.40" "$20,079.04" "$13,565.90" "$18,266.92" N/A N/A MS544 DRG MS-DRG V39 (FY2022) 544 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$35,283.00" "$26,109.50" "$5,685.51" "$28,226.06" "$12,060.95" "$12,060.95" "$12,060.95" "$12,060.95" "$16,420.75" "$16,420.75" "$7,083.46" "$5,969.79" "$16,420.75" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$5,969.79" "$26,273.20" "$10,472.45" "$11,665.50" "$16,420.75" "$17,220.16" N/A "$17,241.79" "$26,462.25" "$16,420.75" "$14,811.52" "$16,420.75" "$11,665.50" "$10,386.17" "$27,943.81" "$16,420.75" "$28,226.06" "$10,500.00" "$5,685.51" "$16,420.75" "$20,464.14" "$17,241.79" "$7,795.90" "$17,769.09" "$5,969.79" "$16,420.75" N/A N/A MS545 DRG MS-DRG V39 (FY2022) 545 CONNECTIVE TISSUE DISORDERS WITH MCC INPATIENT ONLY "$74,899.00" "$55,425.50" "$12,271.44" "$59,918.89" "$25,940.76" "$25,940.76" "$25,940.76" "$25,940.76" "$28,328.61" "$28,328.61" "$22,618.69" "$21,485.57" "$28,328.61" "$17,482.57" "$17,482.57" "$20,387.33" "$12,271.44" "$21,485.57" "$45,325.78" "$33,763.25" "$37,546.50" "$28,328.61" "$29,580.80" "$28,328.61" "$29,745.04" "$56,174.25" "$28,328.61" "$25,552.41" "$28,328.61" "$38,862.53" "$33,230.56" "$59,319.67" "$28,328.61" "$59,918.89" "$17,500.00" "$20,462.44" "$28,328.61" "$43,441.42" "$29,745.04" "$25,091.83" "$32,668.39" "$21,485.57" "$28,328.61" N/A N/A MS546 DRG MS-DRG V39 (FY2022) 546 CONNECTIVE TISSUE DISORDERS WITH CC INPATIENT ONLY "$51,120.00" "$37,829.00" "$10,452.92" "$40,895.92" "$23,629.27" "$23,629.27" "$23,629.27" "$23,629.27" "$19,390.49" "$19,390.49" "$10,452.92" "$11,246.10" "$19,390.49" "$16,766.76" "$16,766.76" "$20,090.46" "$11,769.00" N/A "$31,024.78" "$16,226.17" "$18,120.00" "$19,390.49" "$20,273.72" "$22,524.06" "$20,360.01" "$38,340.00" "$22,524.06" "$17,490.22" "$22,524.06" "$18,120.00" "$15,402.00" "$40,486.95" "$19,390.49" "$40,895.92" "$21,000.00" "$10,710.57" "$19,390.49" "$29,649.60" "$20,360.01" "$12,109.36" "$21,484.87" "$11,246.10" "$19,390.49" N/A N/A MS547 DRG MS-DRG V39 (FY2022) 547 CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$53,360.50" "$39,487.00" "$3,923.00" "$42,688.32" "$8,021.68" "$8,021.68" "$8,021.68" "$8,021.68" "$16,806.56" "$16,806.56" "$7,127.20" "$7,589.49" "$16,806.56" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$7,589.49" "$26,890.50" "$12,312.29" "$12,504.00" "$16,806.56" "$18,196.59" "$16,806.56" "$17,646.89" "$40,020.38" "$16,806.56" "$15,159.52" "$16,806.56" "$12,504.00" "$10,628.40" "$42,261.43" "$16,806.56" "$42,688.32" "$7,000.00" "$7,228.08" "$16,806.56" "$30,949.09" "$17,646.89" "$8,356.27" "$18,251.82" "$7,589.49" "$16,806.56" N/A N/A MS549 DRG MS-DRG V39 (FY2022) 549 SEPTIC ARTHRITIS WITH CC INPATIENT ONLY "$40,342.00" "$29,853.50" "$7,846.00" "$32,273.22" "$16,161.28" "$16,161.28" "$16,161.28" "$16,161.28" "$19,679.67" "$19,679.67" "$10,277.09" "$12,682.26" "$19,679.67" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$12,682.26" "$31,487.47" "$16,308.27" "$18,748.50" "$19,679.67" "$20,317.28" "$19,679.67" "$20,663.65" "$30,256.50" "$19,679.67" "$17,751.06" "$19,679.67" "$19,362.52" "$16,550.25" "$31,950.49" "$19,679.67" "$32,273.22" "$14,090.90" "$12,078.33" "$19,679.67" "$23,398.36" "$20,663.65" "$12,529.38" "$21,846.70" "$12,682.26" "$19,679.67" N/A N/A MS550 DRG MS-DRG V39 (FY2022) 550 SEPTIC ARTHRITIS WITHOUT CC/MCC INPATIENT ONLY "$22,923.00" "$16,963.50" "$1,961.50" "$22,922.71" "$3,979.62" "$3,979.62" "$3,979.62" "$3,979.62" "$17,119.20" "$17,119.20" "$7,488.69" "$5,251.00" "$17,119.20" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$7,157.13" "$22,922.71" "$14,109.07" "$13,183.50" "$17,119.20" "$19,150.14" "$17,119.20" "$17,975.16" "$17,192.25" "$17,119.20" "$15,441.52" "$17,119.20" "$13,183.50" "$11,205.98" "$18,154.77" "$17,119.20" "$18,338.17" "$3,500.00" "$6,816.31" "$17,119.20" "$13,295.34" "$17,975.16" "$8,810.37" "$18,643.00" "$5,251.00" "$17,119.20" N/A N/A MS551 DRG MS-DRG V39 (FY2022) 551 MEDICAL BACK PROBLEMS WITH MCC INPATIENT ONLY "$105,021.50" "$77,716.00" "$3,301.13" "$84,017.17" "$11,906.28" "$11,906.28" "$11,906.28" "$11,906.28" "$24,328.76" "$24,328.76" "$13,884.87" "$10,493.02" "$24,328.76" "$3,301.13" "$3,301.13" "$3,472.50" "$5,884.50" "$10,493.02" "$38,926.02" "$22,522.29" "$68,263.96" "$24,328.76" "$25,801.89" "$24,328.76" "$25,545.20" "$78,766.13" "$24,328.76" "$21,944.54" "$24,328.76" "$24,411.00" "$20,749.35" "$83,177.03" "$24,328.76" "$84,017.17" "$10,500.00" "$9,993.35" "$24,328.76" "$60,912.47" "$25,545.20" "$16,313.56" "$27,714.59" "$10,493.02" "$24,328.76" N/A N/A MS552 DRG MS-DRG V39 (FY2022) 552 MEDICAL BACK PROBLEMS WITHOUT MCC INPATIENT ONLY "$72,519.00" "$53,664.50" "$7,763.60" "$58,015.06" "$28,820.85" "$28,820.85" "$28,820.85" "$28,820.85" "$17,564.33" "$17,564.33" "$7,763.60" "$8,531.79" "$17,564.33" "$24,179.15" "$24,179.15" "$27,787.94" "$18,896.30" "$8,531.79" "$28,102.93" "$12,927.37" "$18,411.00" "$17,564.33" "$18,523.01" "$18,523.01" "$18,442.55" "$54,389.25" "$17,564.33" "$15,843.03" "$18,523.01" "$14,151.00" "$12,028.35" "$57,434.90" "$17,564.33" "$58,015.06" "$29,226.35" "$8,125.51" "$17,564.33" "$42,061.02" "$18,442.55" "$9,456.92" "$19,199.96" "$8,531.79" "$17,564.33" N/A N/A MS553 DRG MS-DRG V39 (FY2022) 553 BONE DISEASES AND ARTHROPATHIES WITH MCC INPATIENT ONLY "$61,116.00" "$45,226.00" "$7,668.68" "$48,892.64" "$15,918.76" "$15,918.76" "$15,918.76" "$15,918.76" "$19,828.73" "$19,828.73" "$10,877.79" "$8,052.12" "$19,828.73" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$8,052.12" "$31,725.97" "$17,845.29" "$19,072.50" "$19,828.73" "$21,132.98" "$19,828.73" "$20,820.17" "$45,837.00" "$19,828.73" "$17,885.51" "$19,828.73" "$19,072.50" "$16,211.63" "$48,403.72" "$19,828.73" "$48,892.64" "$14,000.00" "$7,668.68" "$19,828.73" "$35,447.28" "$20,820.17" "$12,745.91" "$22,033.20" "$8,052.12" "$19,828.73" N/A N/A MS554 DRG MS-DRG V39 (FY2022) 554 BONE DISEASES AND ARTHROPATHIES WITHOUT MCC INPATIENT ONLY "$35,334.00" "$26,147.50" "$5,884.50" "$28,267.11" "$11,878.84" "$11,878.84" "$11,878.84" "$11,878.84" "$16,522.90" "$16,522.90" "$6,492.58" "$7,538.40" "$16,522.90" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$7,538.40" "$26,436.64" "$11,039.07" "$11,887.50" "$16,522.90" "$17,520.87" "$17,520.87" "$17,349.05" "$26,500.50" "$16,522.90" "$14,903.66" "$16,522.90" "$11,887.50" "$10,104.38" "$27,984.44" "$16,522.90" "$28,267.11" "$10,500.00" "$7,179.42" "$16,522.90" "$20,493.72" "$17,349.05" "$7,944.27" "$17,896.90" "$7,538.40" "$16,522.90" N/A N/A MS555 DRG MS-DRG V39 (FY2022) 555 SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC INPATIENT ONLY "$119,378.00" "$88,340.00" "$10,298.80" "$95,502.14" "$44,690.59" "$44,690.59" "$44,690.59" "$44,690.59" N/A N/A N/A "$10,813.74" "$20,498.16" "$20,932.21" "$20,932.21" "$21,919.15" "$11,646.73" "$10,813.74" N/A "$17,916.62" "$77,595.49" "$20,498.16" "$21,170.85" N/A "$21,523.07" "$89,533.50" N/A N/A "$20,498.16" "$20,527.50" N/A "$94,547.13" "$20,498.16" "$95,502.14" N/A "$10,298.80" "$20,498.16" "$69,239.24" "$21,523.07" N/A "$22,870.81" "$10,813.74" N/A N/A N/A MS556 DRG MS-DRG V39 (FY2022) 556 SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC INPATIENT ONLY "$33,555.00" "$24,831.00" "$6,411.35" "$26,843.85" "$19,544.56" "$19,544.56" "$19,544.56" "$19,544.56" "$16,634.69" "$16,634.69" "$6,411.35" "$7,158.07" "$16,634.69" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$7,158.07" "$26,615.50" "$10,874.87" "$12,130.50" "$16,634.69" "$17,433.73" "$16,634.69" "$17,466.42" "$25,166.25" "$16,634.69" "$15,004.49" "$16,634.69" "$12,130.50" "$10,310.93" "$26,575.42" "$16,634.69" "$26,843.85" "$17,500.00" "$6,817.21" "$16,634.69" "$19,461.90" "$17,466.42" "$8,106.66" "$18,036.78" "$7,158.07" "$16,634.69" N/A N/A MS557 DRG MS-DRG V39 (FY2022) 557 "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC" INPATIENT ONLY "$61,034.50" "$45,166.00" "$8,937.34" "$48,827.38" "$21,441.45" "$21,441.45" "$21,441.45" "$21,441.45" "$20,709.35" "$20,709.35" "$12,736.12" "$9,384.21" "$20,709.35" "$14,688.11" "$14,688.11" "$17,038.92" "$10,309.94" "$9,384.21" "$33,134.96" "$19,271.94" "$20,986.50" "$20,709.35" "$21,890.12" "$20,709.35" "$21,744.82" "$45,775.88" "$20,709.35" "$18,679.83" "$20,709.35" "$21,560.28" "$18,412.30" "$48,339.10" "$20,709.35" "$48,827.38" "$14,000.00" "$8,937.34" "$20,709.35" "$35,400.01" "$21,744.82" "$14,025.00" "$23,135.06" "$9,384.21" "$20,709.35" N/A N/A MS558 DRG MS-DRG V39 (FY2022) 558 "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC" INPATIENT ONLY "$40,453.50" "$29,936.00" "$7,022.64" "$32,362.78" "$9,322.17" "$9,322.17" "$9,322.17" "$9,322.17" "$16,998.42" "$16,998.42" "$7,606.51" "$7,373.78" "$16,998.42" "$10,206.85" "$10,206.85" "$11,045.89" "$9,088.80" "$7,373.78" "$27,197.47" "$11,695.87" "$12,921.00" "$16,998.42" "$17,869.45" "$16,998.42" "$17,848.34" "$30,340.13" "$16,998.42" "$15,332.57" "$16,998.42" "$12,921.00" "$10,982.85" "$32,039.15" "$16,998.42" "$32,362.78" "$11,726.35" "$7,022.64" "$16,998.42" "$23,463.03" "$17,848.34" "$8,634.93" "$18,491.88" "$7,373.78" "$16,998.42" N/A N/A MS559 DRG MS-DRG V39 (FY2022) 559 "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC" INPATIENT ONLY "$60,914.00" "$45,076.50" "$16,561.69" "$48,730.83" "$24,895.49" "$24,895.49" "$24,895.49" "$24,895.49" "$26,269.40" "$26,269.40" "$16,561.69" "$27,401.43" "$26,269.40" "$21,384.69" "$21,384.69" "$24,439.53" "$16,934.80" "$27,401.43" "$42,031.04" "$24,024.32" "$27,979.50" "$26,269.40" "$26,744.87" "$26,269.40" "$27,582.87" "$45,685.50" "$17,324.46" "$23,695.00" "$26,269.40" "$27,979.50" "$23,782.58" "$48,243.52" "$26,269.40" "$48,730.83" "$25,726.35" "$26,096.59" "$21,561.98" "$35,330.12" "$27,582.87" "$18,698.34" "$30,150.18" "$27,401.43" "$26,269.40" N/A N/A MS560 DRG MS-DRG V39 (FY2022) 560 "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC" INPATIENT ONLY "$32,926.00" "$24,365.50" "$9,600.52" "$83,815.83" "$31,302.79" "$31,302.79" "$31,302.79" "$31,302.79" "$18,479.48" "$18,479.48" "$9,600.52" "$19,176.18" "$18,479.48" "$22,355.68" "$22,355.68" "$26,787.28" "$15,692.00" "$19,176.18" "$29,567.17" "$14,745.68" "$16,140.00" "$18,479.48" "$19,487.99" "$18,479.48" "$19,403.45" "$24,694.50" "$18,479.48" "$16,668.49" "$18,479.48" "$16,140.00" "$13,719.00" "$26,077.29" "$18,479.48" "$26,340.69" "$28,000.00" "$18,263.02" "$18,479.48" "$19,097.08" "$19,403.45" "$10,786.15" "$20,345.00" "$19,176.18" "$18,479.48" N/A N/A MS561 DRG MS-DRG V39 (FY2022) 561 "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC" INPATIENT ONLY "$62,175.50" "$46,010.00" "$5,969.53" "$49,740.16" "$19,878.41" "$19,878.41" "$19,878.41" "$19,878.41" "$18,781.56" "$18,781.56" "$5,969.53" "$14,180.85" "$16,522.21" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$14,180.85" "$26,435.54" "$10,635.30" "$16,146.00" "$16,522.21" "$17,306.59" "$16,522.21" "$17,348.32" "$46,631.63" "$16,522.21" "$14,903.03" "$16,522.21" "$11,886.00" "$10,614.49" "$49,242.76" "$16,522.21" "$49,740.16" N/A "$13,505.57" "$16,522.21" "$36,061.79" "$17,348.32" "$7,943.25" "$17,896.04" "$14,180.85" "$16,522.21" N/A N/A MS562 DRG MS-DRG V39 (FY2022) 562 "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC" INPATIENT ONLY "$71,284.50" "$52,751.00" "$8,721.09" "$57,027.59" "$17,314.22" "$17,314.22" "$17,314.22" "$17,314.22" "$20,797.00" "$20,797.00" "$12,233.61" "$9,157.15" "$20,797.00" "$15,795.77" "$15,795.77" "$17,742.71" "$13,011.80" "$9,157.15" "$33,275.20" "$19,687.83" "$21,177.00" "$20,797.00" "$22,110.85" "$20,797.00" "$21,836.85" "$53,463.38" "$20,797.00" "$18,758.89" "$20,797.00" "$46,334.91" "$46,334.91" "$56,457.33" "$20,797.00" "$57,027.59" "$18,726.35" "$8,721.09" "$22,570.04" "$41,345.01" "$21,836.85" "$14,152.32" "$23,244.72" "$9,157.15" "$20,797.00" N/A N/A MS563 DRG MS-DRG V39 (FY2022) 563 "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC" INPATIENT ONLY "$61,543.00" "$45,542.00" "$1,961.50" "$49,234.16" "$4,252.66" "$4,252.66" "$4,252.66" "$4,252.66" "$17,072.96" "$17,072.96" "$6,922.80" "$8,103.21" "$17,072.96" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$8,103.21" "$27,316.74" "$11,590.89" "$13,083.00" "$17,072.96" "$17,813.72" "$17,072.96" "$17,926.61" "$46,157.25" "$17,072.96" "$15,399.81" "$17,072.96" "$40,002.75" "$40,002.75" "$48,741.80" "$17,072.96" "$49,234.16" "$3,500.00" "$7,717.34" "$17,072.96" "$35,694.94" "$17,926.61" "$8,743.19" "$18,585.14" "$8,103.21" "$17,072.96" N/A N/A MS564 DRG MS-DRG V39 (FY2022) 564 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC INPATIENT ONLY "$97,333.00" "$72,026.50" "$3,500.00" "$77,866.30" "$23,484.41" "$23,484.41" "$23,484.41" "$23,484.41" "$21,568.60" "$21,568.60" "$13,420.73" "$12,420.19" "$21,568.60" "$15,661.56" "$15,661.56" "$16,452.85" "$10,994.20" "$12,420.19" "$34,509.76" "$20,905.86" "$22,854.00" "$21,568.60" "$22,757.27" "$21,568.60" "$22,647.03" "$72,999.75" "$21,568.60" "$19,454.88" "$21,568.60" "$63,266.36" "$63,266.36" "$77,087.64" "$21,568.60" "$77,866.30" "$3,500.00" "$11,828.75" "$21,568.60" "$56,453.14" "$22,647.03" "$15,273.03" "$24,210.15" "$12,420.19" "$21,568.60" N/A N/A MS565 DRG MS-DRG V39 (FY2022) 565 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC INPATIENT ONLY "$68,165.50" "$50,442.50" "$8,388.40" "$54,532.36" "$25,163.72" "$25,163.72" "$25,163.72" "$25,163.72" "$18,019.16" "$18,019.16" "$8,388.40" "$10,729.54" "$18,019.16" "$21,384.69" "$21,384.69" "$24,439.53" "$16,934.80" "$10,729.54" "$28,830.66" "$13,289.42" "$15,139.50" "$18,019.16" "$18,715.16" "$18,019.16" "$18,920.12" "$51,124.13" "$18,019.16" "$16,253.28" "$18,019.16" "$44,307.54" "$44,307.54" "$53,987.05" "$18,019.16" "$54,532.36" "$21,628.85" "$10,218.60" "$18,019.16" "$39,535.99" "$18,920.12" "$10,117.54" "$19,769.04" "$10,729.54" "$18,019.16" N/A N/A MS566 DRG MS-DRG V39 (FY2022) 566 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC INPATIENT ONLY "$62,811.50" "$46,481.00" "$5,231.39" "$50,248.88" "$13,563.20" "$13,563.20" "$13,563.20" "$13,563.20" "$16,242.71" "$16,242.71" "$6,132.87" "$5,492.96" "$16,242.71" "$13,001.31" "$13,001.31" "$14,394.30" "$11,050.30" "$5,492.96" "$25,988.34" "$9,996.00" "$11,278.50" "$16,242.71" "$16,967.30" N/A "$17,054.85" "$47,108.63" "$16,242.71" "$14,650.92" "$16,242.71" "$40,827.22" "$40,827.22" "$49,746.37" "$16,242.71" "$50,248.88" "$22,389.55" "$5,231.39" "$16,242.71" "$36,430.67" "$17,054.85" "$7,537.27" "$17,546.32" "$5,492.96" "$16,242.71" N/A N/A MS570 DRG MS-DRG V39 (FY2022) 570 SKIN DEBRIDEMENT WITH MCC INPATIENT ONLY "$128,081.50" "$94,780.50" "$14,774.22" "$102,464.99" "$17,657.22" "$17,657.22" "$17,657.22" "$17,657.22" "$30,665.46" "$30,665.46" "$21,378.91" "$15,512.94" "$30,665.46" "$26,960.59" "$26,960.59" "$28,260.48" "$16,041.19" "$15,512.94" "$49,064.74" "$39,261.25" "$87,512.80" "$30,665.46" "$32,498.64" "$30,665.46" "$32,198.73" "$96,061.13" "$30,665.46" "$27,660.24" "$30,665.46" "$83,252.80" "$83,252.80" "$101,440.33" "$30,665.46" "$102,464.99" "$18,726.35" "$14,774.22" "$30,665.46" "$74,287.27" "$32,198.73" "$28,486.06" "$35,592.28" "$15,512.94" "$30,665.46" N/A N/A MS571 DRG MS-DRG V39 (FY2022) 571 SKIN DEBRIDEMENT WITH CC INPATIENT ONLY "$109,220.00" "$80,823.00" "$6,322.31" "$87,375.64" "$43,074.13" "$43,074.13" "$43,074.13" "$43,074.13" "$22,340.18" "$22,340.18" "$13,088.69" "$15,512.94" "$22,340.18" "$6,322.31" "$6,322.31" "$6,650.51" "$21,576.50" "$15,512.94" "$35,744.29" "$22,188.51" "$70,992.71" "$22,340.18" "$23,437.98" "$22,340.18" "$23,457.19" "$81,915.00" "$22,340.18" "$20,150.84" "$22,340.18" "$24,531.00" "$70,992.71" "$86,501.86" "$22,340.18" "$87,375.64" "$38,500.00" "$14,774.22" "$22,340.18" "$63,347.60" "$23,457.19" "$16,393.76" "$25,175.57" "$15,512.94" "$22,340.18" N/A N/A MS572 DRG MS-DRG V39 (FY2022) 572 SKIN DEBRIDEMENT WITHOUT CC/MCC INPATIENT ONLY "$329,617.50" "$243,917.00" "$18,553.41" "$263,693.76" "$206,714.22" "$206,714.22" "$206,714.22" "$206,714.22" "$20,569.19" "$20,569.19" N/A "$54,065.91" N/A "$166,121.53" "$166,121.53" "$174,521.82" "$115,309.57" "$54,065.91" "$32,910.70" "$161,562.62" "$214,251.19" "$20,569.19" "$20,259.43" "$20,569.19" "$21,597.65" "$247,213.13" "$20,569.19" "$18,553.41" "$20,569.19" "$214,251.19" "$214,251.19" "$261,056.83" "$20,569.19" "$263,693.76" "$191,177.98" "$42,427.86" "$20,569.19" "$191,178.15" "$21,597.65" "$42,727.64" "$21,025.59" "$54,065.91" "$20,569.19" N/A N/A MS573 DRG MS-DRG V39 (FY2022) 573 SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC INPATIENT ONLY "$296,130.50" "$219,137.00" "$49,281.55" "$236,904.28" "$186,429.01" "$186,429.01" "$186,429.01" "$186,429.01" N/A N/A N/A N/A N/A "$225,088.65" "$225,088.65" "$233,765.29" "$216,441.66" N/A N/A N/A N/A "$49,281.55" N/A N/A "$51,745.63" "$222,097.88" N/A N/A N/A N/A N/A "$234,535.21" "$49,281.55" "$236,904.28" N/A N/A "$49,281.55" "$171,755.69" "$51,745.63" N/A N/A N/A N/A N/A N/A MS574 DRG MS-DRG V39 (FY2022) 574 SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC INPATIENT ONLY "$130,463.50" "$96,543.00" "$23,472.88" "$233,170.81" "$28,837.76" "$28,837.76" "$28,837.76" "$28,837.76" N/A N/A "$23,472.88" "$26,227.34" N/A "$99,165.05" "$99,165.05" "$102,987.61" "$95,355.51" "$26,227.34" "$53,534.70" "$48,514.31" "$89,061.05" "$33,459.19" "$37,409.30" N/A "$35,132.15" "$97,847.63" "$33,459.19" "$30,180.19" "$33,459.19" "$84,801.05" "$84,801.05" "$103,326.82" "$33,459.19" "$104,370.53" "$75,668.63" "$24,978.41" "$33,459.19" "$75,668.83" "$35,132.15" "$233,170.81" "$39,087.84" "$26,227.34" "$33,459.19" N/A N/A MS575 DRG MS-DRG V39 (FY2022) 575 SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC INPATIENT ONLY "$165,296.00" "$122,319.50" "$23,222.19" "$132,236.58" N/A N/A N/A N/A N/A N/A N/A N/A N/A "$125,641.28" "$125,641.28" "$130,484.45" N/A N/A N/A N/A N/A "$23,222.19" N/A N/A N/A "$123,972.00" N/A N/A N/A N/A N/A "$130,914.20" "$23,222.19" "$132,236.58" N/A N/A "$23,222.19" "$95,871.68" "$24,383.30" N/A N/A N/A N/A N/A N/A MS576 DRG MS-DRG V39 (FY2022) 576 SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC INPATIENT ONLY "$529,931.50" "$392,149.50" "$187,666.77" "$397,448.63" N/A N/A N/A N/A "$187,666.77" "$187,666.77" N/A N/A "$187,666.77" N/A N/A N/A N/A N/A N/A N/A N/A "$187,666.77" "$187,666.77" "$187,666.77" "$187,666.77" "$397,448.63" "$187,666.77" "$187,666.77" "$187,666.77" N/A N/A N/A "$187,666.77" N/A N/A N/A "$187,666.77" "$307,360.27" "$187,666.77" N/A N/A N/A "$187,666.77" N/A N/A MS577 DRG MS-DRG V39 (FY2022) 577 SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC INPATIENT ONLY "$341,351.00" "$252,600.00" "$28,649.54" "$334,816.85" "$334,816.85" "$334,816.85" "$334,816.85" "$334,816.85" N/A N/A "$334,816.85" N/A N/A N/A N/A N/A N/A N/A "$334,816.85" "$334,816.85" "$334,816.85" N/A N/A N/A N/A "$256,013.25" N/A N/A N/A "$334,816.85" "$334,816.85" "$270,349.81" N/A "$273,080.61" "$334,816.85" N/A "$28,649.54" "$197,983.58" N/A "$334,816.85" "$334,816.85" N/A N/A N/A N/A MS578 DRG MS-DRG V39 (FY2022) 578 SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC INPATIENT ONLY "$106,127.00" "$78,534.00" "$4,053.96" "$84,901.37" "$4,053.96" "$4,053.96" "$4,053.96" "$4,053.96" "$22,062.74" "$22,062.74" "$11,748.05" "$14,184.64" "$22,062.74" "$80,666.91" "$80,666.91" "$83,776.41" "$77,568.01" "$14,184.64" "$35,300.38" "$23,048.54" "$68,982.36" "$22,062.74" "$23,894.40" N/A "$23,165.88" "$79,595.25" "$22,062.74" "$19,900.59" "$22,062.74" "$23,928.00" "$20,338.80" "$84,052.36" "$22,062.74" "$84,901.37" "$61,553.48" "$13,509.17" "$22,062.74" "$61,553.66" "$23,165.88" "$15,990.77" "$24,828.44" "$14,184.64" "$22,062.74" N/A N/A MS579 DRG MS-DRG V39 (FY2022) 579 "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC" INPATIENT ONLY "$153,497.00" "$113,588.00" "$21,331.60" "$122,797.25" "$97,724.70" "$97,724.70" "$97,724.70" "$97,724.70" "$32,757.98" "$32,757.98" "$24,334.22" "$28,999.37" "$32,757.98" "$36,604.11" "$36,604.11" "$38,496.69" "$21,331.60" "$28,999.37" "$52,412.77" "$74,752.80" "$99,772.77" "$32,757.98" "$34,174.34" "$32,757.98" "$34,395.88" "$115,122.75" "$32,757.98" "$29,547.70" "$32,757.98" "$99,772.77" "$99,772.77" "$121,569.28" "$32,757.98" "$122,797.25" "$89,028.01" "$27,618.43" "$32,757.98" "$89,028.26" "$34,395.88" "$31,525.44" "$38,210.49" "$28,999.37" "$32,757.98" N/A N/A MS580 DRG MS-DRG V39 (FY2022) 580 "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC" INPATIENT ONLY "$113,094.50" "$83,690.00" "$10,451.18" "$90,475.35" "$13,571.44" "$13,571.44" "$13,571.44" "$13,571.44" "$22,984.77" "$22,984.77" "$14,037.50" "$13,046.50" "$22,984.77" "$85,962.88" "$85,962.88" "$89,276.55" "$82,660.55" "$13,046.50" "$36,775.63" "$23,367.52" "$73,511.22" "$22,984.77" "$24,063.68" "$22,984.77" "$24,134.01" "$84,820.88" "$22,984.77" "$20,732.26" "$22,984.77" "$25,932.00" "$73,511.22" "$89,570.60" "$22,984.77" "$90,475.35" "$64,755.20" "$12,425.23" "$22,984.77" "$65,594.81" "$24,134.01" "$17,330.02" "$25,982.09" "$13,046.50" "$22,984.77" N/A N/A MS581 DRG MS-DRG V39 (FY2022) 581 "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$111,697.00" "$82,656.00" "$8,323.39" "$89,357.21" "$8,323.39" "$8,323.39" "$8,323.39" "$8,323.39" "$20,555.45" "$20,555.45" "$10,119.99" "$9,304.74" "$20,555.45" "$84,900.51" "$84,900.51" "$88,173.20" "$81,638.98" "$9,304.74" "$32,888.72" "$18,997.38" "$72,602.73" "$20,555.45" "$21,744.43" "$20,555.45" "$21,583.22" "$83,772.75" "$20,555.45" "$18,541.02" "$20,555.45" "$21,311.26" "$72,602.73" "$88,463.63" "$20,555.45" "$89,357.21" "$64,783.98" "$8,861.65" "$20,555.45" "$64,784.26" "$21,583.22" "$13,801.46" "$22,942.49" "$9,304.74" "$20,555.45" N/A N/A MS582 DRG MS-DRG V39 (FY2022) 582 MASTECTOMY FOR MALIGNANCY WITH CC/MCC INPATIENT ONLY "$122,510.00" "$90,657.50" "$7,000.00" "$98,007.79" "$7,911.80" "$7,911.80" "$7,911.80" "$7,911.80" "$22,393.32" "$22,393.32" "$11,606.13" "$14,540.36" "$22,393.32" "$21,858.16" "$21,858.16" "$23,810.64" "$10,446.65" "$14,540.36" "$35,829.31" "$26,040.47" "$79,631.33" "$22,393.32" "$25,482.24" "$22,393.32" "$23,512.99" "$91,882.50" "$22,393.32" "$20,198.77" "$22,393.32" "$24,646.50" "$79,631.33" "$97,027.72" "$22,393.32" "$98,007.79" "$7,000.00" "$13,847.96" "$22,393.32" "$71,055.80" "$23,512.99" "$16,470.94" "$25,242.07" "$14,540.36" "$22,393.32" N/A N/A MS583 DRG MS-DRG V39 (FY2022) 583 MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$83,918.00" "$62,099.50" "$5,884.50" "$67,134.13" "$11,916.19" "$11,916.19" "$11,916.19" "$11,916.19" "$21,692.12" "$21,692.12" "$9,757.61" "$13,636.85" "$21,692.12" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$13,636.85" "$34,707.39" "$20,333.86" "$23,122.50" "$21,692.12" "$22,453.69" "$21,692.12" "$22,776.73" "$62,938.50" "$21,692.12" "$19,566.29" "$21,692.12" "$23,122.50" "$19,654.13" "$66,462.77" "$21,692.12" "$67,134.13" "$10,500.00" "$12,987.48" "$21,692.12" "$48,672.44" "$22,776.73" "$15,452.46" "$24,364.71" "$13,636.85" "$21,692.12" N/A N/A MS584 DRG MS-DRG V39 (FY2022) 584 "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC" INPATIENT ONLY "$267,892.00" "$198,240.50" "$23,729.46" "$214,313.47" "$167,454.91" "$167,454.91" "$167,454.91" "$167,454.91" "$26,917.95" "$26,917.95" N/A "$37,941.58" "$23,729.46" "$129,198.88" "$129,198.88" "$135,806.21" "$90,568.99" N/A N/A "$129,694.43" N/A "$23,729.46" "$26,917.95" "$26,917.95" "$24,915.93" "$200,919.00" "$26,917.95" "$26,917.95" "$26,917.95" "$174,129.69" N/A "$212,170.32" "$23,729.46" "$214,313.47" N/A "$28,501.37" "$23,729.46" "$155,377.36" "$24,915.93" N/A "$26,913.85" "$37,941.58" "$23,729.46" N/A N/A MS585 DRG MS-DRG V39 (FY2022) 585 "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$644,711.00" "$477,086.50" "$23,059.31" "$515,768.74" "$413,497.94" "$413,497.94" "$413,497.94" "$413,497.94" "$60,110.87" "$60,110.87" "$125,278.70" "$132,105.12" "$60,110.87" "$397,178.78" "$397,178.78" "$417,797.35" "$284,192.14" "$132,105.12" "$96,177.39" "$319,856.52" "$419,062.10" "$60,110.87" "$62,781.89" N/A "$63,116.41" "$483,533.25" N/A "$54,220.00" "$60,110.87" "$419,062.10" "$419,062.10" "$510,611.04" "$60,110.87" "$515,768.74" "$373,932.34" "$109,451.05" "$23,059.31" "$373,932.38" "$63,116.41" "$117,682.64" "$60,714.08" "$132,105.12" "$60,110.87" N/A N/A MS592 DRG MS-DRG V39 (FY2022) 592 SKIN ULCERS WITH MCC INPATIENT ONLY "$49,755.00" "$36,819.00" "$12,718.27" "$39,803.81" "$24,101.94" "$24,101.94" "$24,101.94" "$24,101.94" "$22,746.68" "$22,746.68" "$12,718.27" "$13,651.99" "$22,746.68" "$37,818.61" "$37,818.61" "$39,276.42" "$36,365.78" "$13,651.99" "$36,394.69" "$24,010.86" "$25,414.50" "$22,746.68" "$24,405.12" "$22,746.68" "$23,884.01" "$37,316.25" "$22,746.68" "$20,517.51" "$22,746.68" "$26,331.09" "$22,518.92" "$39,405.77" "$22,746.68" "$39,803.81" "$28,857.77" "$13,001.89" "$22,746.68" "$28,857.90" "$23,884.01" "$16,984.18" "$25,684.18" "$13,651.99" "$22,746.68" N/A N/A MS593 DRG MS-DRG V39 (FY2022) 593 SKIN ULCERS WITH CC INPATIENT ONLY "$37,960.00" "$28,090.50" "$9,100.67" "$30,367.65" "$16,513.07" "$16,513.07" "$16,513.07" "$16,513.07" "$18,925.32" "$18,925.32" "$9,100.67" "$13,651.99" "$18,925.32" "$28,853.06" "$28,853.06" "$29,965.27" "$27,744.67" "$13,651.99" "$30,280.51" "$15,503.42" "$17,109.00" "$18,925.32" "$19,890.14" "$18,925.32" "$19,871.59" "$28,470.00" "$18,925.32" "$17,070.64" "$18,925.32" "$18,264.08" "$15,697.73" "$30,063.96" "$18,925.32" "$30,367.65" "$22,016.55" "$13,001.89" "$18,925.32" "$22,016.80" "$19,871.59" "$11,433.72" "$20,902.84" "$13,651.99" "$18,925.32" N/A N/A MS594 DRG MS-DRG V39 (FY2022) 594 SKIN ULCERS WITHOUT CC/MCC INPATIENT ONLY "$17,531.00" "$12,973.00" "$3,935.70" "$18,099.83" "$3,935.70" "$3,935.70" "$3,935.70" "$3,935.70" "$16,685.08" "$16,685.08" "$6,358.69" "$4,015.89" "$16,685.08" "$13,325.30" "$13,325.30" "$13,838.97" "$12,813.39" "$4,758.80" "$17,530.98" "$10,415.92" "$12,240.00" "$16,685.08" "$17,190.15" "$16,685.08" "$17,519.33" "$13,148.25" "$16,685.08" "$15,049.94" "$16,685.08" "$12,240.00" "$10,404.00" "$13,884.54" "$16,685.08" "$14,024.79" "$10,167.97" "$4,532.19" "$16,685.08" "$10,167.98" "$17,519.33" "$8,179.83" "$18,099.83" "$4,015.89" "$16,685.08" N/A N/A MS595 DRG MS-DRG V39 (FY2022) 595 MAJOR SKIN DISORDERS WITH MCC INPATIENT ONLY "$88,233.50" "$65,293.00" "$13,408.26" "$70,586.67" "$38,942.55" "$38,942.55" "$38,942.55" "$38,942.55" "$27,502.79" "$27,502.79" "$17,520.32" "$14,078.68" "$27,502.79" "$67,066.15" "$67,066.15" "$69,651.38" "$64,489.74" "$14,078.68" "$44,004.46" "$28,821.10" "$30,247.50" "$27,502.79" "$29,756.31" "$27,502.79" "$28,877.93" "$66,175.13" "$27,502.79" "$24,807.52" "$27,502.79" "$57,351.67" "$57,351.67" "$69,880.80" "$27,502.79" "$70,586.67" "$51,175.34" "$13,408.26" "$27,502.79" "$51,175.43" "$28,877.93" "$20,214.01" "$31,698.15" "$14,078.68" "$27,502.79" N/A N/A MS596 DRG MS-DRG V39 (FY2022) 596 MAJOR SKIN DISORDERS WITHOUT MCC INPATIENT ONLY "$28,965.50" "$21,434.50" "$8,503.54" "$28,669.42" "$23,436.00" "$23,436.00" "$23,436.00" "$23,436.00" "$17,918.39" "$17,918.39" "$8,503.54" "$14,078.68" "$17,918.39" "$22,016.68" "$22,016.68" "$22,865.38" "$21,170.88" "$14,078.68" "$28,669.42" "$14,694.54" "$14,920.50" "$17,918.39" "$19,460.87" "$17,918.39" "$18,814.31" "$21,724.13" "$17,918.39" "$16,162.39" "$17,918.39" "$14,920.50" "$12,682.43" "$22,940.67" "$17,918.39" "$23,172.40" "$16,799.99" "$13,408.26" "$17,918.39" "$16,799.99" "$18,814.31" "$9,971.17" "$19,642.96" "$14,078.68" "$17,918.39" N/A N/A MS597 DRG MS-DRG V39 (FY2022) 597 MALIGNANT BREAST DISORDERS WITH MCC INPATIENT ONLY "$155,863.50" "$115,339.00" "$12,054.28" "$116,897.63" N/A N/A N/A N/A "$23,690.84" "$23,690.84" N/A N/A "$23,690.84" "$12,054.28" "$12,054.28" "$12,054.28" "$12,054.28" N/A N/A N/A N/A "$23,690.84" "$23,690.84" "$23,690.84" "$23,690.84" "$116,897.63" "$23,690.84" "$23,690.84" "$23,690.84" N/A N/A N/A "$23,690.84" N/A N/A N/A "$23,690.84" "$90,400.83" "$23,690.84" N/A N/A N/A "$23,690.84" N/A N/A MS598 DRG MS-DRG V39 (FY2022) 598 MALIGNANT BREAST DISORDERS WITH CC INPATIENT ONLY "$46,629.00" "$34,505.50" "$8,374.19" "$37,303.09" "$20,012.23" "$20,012.23" "$20,012.23" "$20,012.23" "$18,734.15" "$18,734.15" "$10,028.06" "$8,792.90" "$18,734.15" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$8,792.90" "$29,974.64" "$14,375.56" "$16,693.50" "$18,734.15" "$19,291.57" "$18,734.15" "$19,670.86" "$34,971.75" "$18,734.15" "$16,898.20" "$18,734.15" "$17,368.45" "$14,864.42" "$36,930.06" "$18,734.15" "$37,303.09" "$17,500.00" "$8,374.19" "$18,734.15" "$27,044.82" "$19,670.86" "$11,156.06" "$20,663.65" "$8,792.90" "$18,734.15" N/A N/A MS600 DRG MS-DRG V39 (FY2022) 600 NON-MALIGNANT BREAST DISORDERS WITH CC/MCC INPATIENT ONLY "$84,260.00" "$62,352.50" "$8,286.79" "$67,407.94" "$20,688.66" "$20,688.66" "$20,688.66" "$20,688.66" "$17,933.57" "$17,933.57" "$8,749.89" "$8,701.13" "$17,933.57" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$8,701.13" "$28,693.71" "$14,012.16" "$14,953.50" "$17,933.57" "$19,098.72" "$17,933.57" "$18,830.25" "$63,195.00" "$17,933.57" "$16,176.08" "$17,933.57" "$16,455.19" "$14,212.17" "$66,733.86" "$17,933.57" "$67,407.94" "$17,500.00" "$8,286.79" "$17,933.57" "$48,870.80" "$18,830.25" "$9,993.24" "$19,661.95" "$8,701.13" "$17,933.57" N/A N/A MS601 DRG MS-DRG V39 (FY2022) 601 NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$13,359.50" "$9,886.50" "$1,961.50" "$16,984.16" "$3,983.64" "$3,983.64" "$3,983.64" "$3,983.64" "$15,793.42" "$15,793.42" "$5,635.71" "$3,060.28" "$15,793.42" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,505.27" "$13,359.37" "$9,473.79" "$10,302.00" "$15,793.42" "$16,690.15" "$15,793.42" "$16,583.09" "$10,019.63" "$15,793.42" "$14,245.66" "$15,793.42" "$10,302.00" "$8,756.70" "$10,580.62" "$15,793.42" "$10,687.50" "$3,500.00" "$6,195.50" "$15,793.42" "$7,748.51" "$16,583.09" "$6,884.70" "$16,984.16" "$3,060.28" "$13,359.37" N/A N/A MS602 DRG MS-DRG V39 (FY2022) 602 CELLULITIS WITH MCC INPATIENT ONLY "$79,903.00" "$59,128.50" "$12,993.19" "$63,922.14" "$39,706.98" "$39,706.98" "$39,706.98" "$39,706.98" "$21,060.64" "$21,060.64" "$12,993.19" "$28,999.37" "$21,060.64" "$27,944.60" "$27,944.60" "$33,484.10" "$19,615.00" "$28,999.37" "$33,697.02" "$19,397.11" "$21,750.00" "$21,060.64" "$21,956.55" "$21,060.64" "$22,113.67" "$59,927.25" "$21,060.64" "$18,996.70" "$21,060.64" "$22,711.87" "$19,449.37" "$63,282.93" "$21,060.64" "$63,922.14" "$35,000.00" "$27,618.43" "$22,881.64" "$46,343.74" "$22,113.67" "$14,535.25" "$23,574.59" "$28,999.37" "$21,060.64" N/A N/A MS603 DRG MS-DRG V39 (FY2022) 603 CELLULITIS WITHOUT MCC INPATIENT ONLY "$35,850.50" "$26,529.50" "$5,884.50" "$28,680.17" "$12,466.58" "$12,466.58" "$12,466.58" "$12,466.58" "$16,944.59" "$16,944.59" "$7,539.56" "$8,358.65" "$16,944.59" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$8,358.65" "$27,111.34" "$11,868.15" "$12,804.00" "$16,944.59" "$17,960.88" "$16,944.59" "$17,791.82" "$26,887.88" "$16,944.59" "$15,284.02" "$16,944.59" "$13,617.37" "$11,696.77" "$28,393.36" "$16,944.59" "$28,680.17" "$10,625.10" "$7,960.62" "$16,944.59" "$20,793.29" "$17,791.82" "$8,556.75" "$18,424.53" "$8,358.65" "$16,944.59" N/A N/A MS604 DRG MS-DRG V39 (FY2022) 604 "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC" INPATIENT ONLY "$105,741.50" "$78,249.00" "$3,682.19" "$84,592.96" "$11,127.90" "$11,127.90" "$11,127.90" "$11,127.90" "$21,253.19" "$21,253.19" "$11,267.84" "$9,197.83" "$21,253.19" "$3,682.19" "$3,682.19" "$3,873.35" "$8,012.50" "$9,197.83" "$34,005.10" "$20,312.32" "$68,731.78" "$21,253.19" "$22,442.26" "$21,253.19" "$22,315.85" "$79,306.13" "$21,253.19" "$19,170.38" "$21,253.19" "$68,731.78" "$68,731.78" "$83,747.04" "$21,253.19" "$84,592.96" N/A "$8,759.83" "$21,253.19" "$61,330.07" "$22,315.85" "$14,814.91" "$23,815.52" "$9,197.83" "$21,253.19" N/A N/A MS605 DRG MS-DRG V39 (FY2022) 605 "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC" INPATIENT ONLY "$59,117.50" "$43,747.00" "$3,500.00" "$47,293.71" "$4,262.26" "$4,262.26" "$4,262.26" "$4,262.26" "$17,291.74" "$17,291.74" "$6,840.68" "$6,598.94" "$17,291.74" "$5,707.53" "$5,707.53" "$5,927.05" "$4,006.25" "$6,598.94" "$27,666.78" "$12,253.07" "$13,558.50" "$17,291.74" "$18,165.15" "$17,291.74" "$18,156.33" "$44,338.13" "$17,291.74" "$15,597.15" "$17,291.74" "$38,426.13" "$38,426.13" "$46,820.78" "$17,291.74" "$47,293.71" "$3,500.00" "$6,284.70" "$17,291.74" "$34,288.15" "$18,156.33" "$9,060.97" "$18,858.89" "$6,598.94" "$17,291.74" N/A N/A MS606 DRG MS-DRG V39 (FY2022) 606 MINOR SKIN DISORDERS WITH MCC INPATIENT ONLY "$47,260.00" "$34,972.50" "$5,884.50" "$37,807.90" "$12,217.82" "$12,217.82" "$12,217.82" "$12,217.82" "$21,489.23" "$21,489.23" "$11,087.38" "$8,651.94" "$21,489.23" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$8,651.94" "$34,382.77" "$20,658.22" "$22,681.50" "$21,489.23" "$22,625.84" "$22,625.84" "$22,563.69" "$35,445.00" "$21,489.23" "$19,383.29" "$21,489.23" "$30,718.92" "$30,718.92" "$37,429.81" "$21,489.23" "$37,807.90" "$10,500.00" "$8,239.94" "$21,489.23" "$27,410.80" "$22,563.69" "$15,157.75" "$24,110.85" "$8,651.94" "$21,489.23" N/A N/A MS607 DRG MS-DRG V39 (FY2022) 607 MINOR SKIN DISORDERS WITHOUT MCC INPATIENT ONLY "$35,692.00" "$26,412.50" "$3,923.00" "$28,553.51" "$8,311.34" "$8,311.34" "$8,311.34" "$8,311.34" "$16,769.28" "$16,769.28" "$6,512.21" "$6,557.31" "$16,769.28" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$6,557.31" "$26,830.85" "$11,415.92" "$16,683.00" "$16,769.28" "$17,720.87" "$17,720.87" "$17,607.74" "$26,769.00" "$16,769.28" "$15,125.89" "$16,769.28" "$13,067.52" "$11,204.07" "$28,267.99" "$16,769.28" "$28,553.51" "$7,000.00" "$6,245.05" "$16,769.28" "$20,701.36" "$17,607.74" "$8,302.13" "$18,205.18" "$6,557.31" "$16,769.28" N/A N/A MS614 DRG MS-DRG V39 (FY2022) 614 ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC INPATIENT ONLY "$305,767.50" "$226,268.00" "$27,545.97" "$244,613.93" "$195,201.14" "$195,201.14" "$195,201.14" "$195,201.14" N/A N/A "$149,300.62" "$54,105.83" N/A "$147,267.65" "$147,267.65" "$154,901.39" "$101,993.69" N/A "$149,300.62" "$149,300.62" "$198,728.74" "$27,545.97" N/A N/A "$28,923.27" "$229,325.63" N/A N/A N/A "$149,300.62" "$149,300.62" "$242,167.81" "$27,545.97" "$244,613.93" "$149,300.62" N/A "$27,545.97" "$177,345.15" "$28,923.27" "$149,300.62" "$31,689.14" N/A N/A N/A N/A MS615 DRG MS-DRG V39 (FY2022) 615 ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$167,471.00" "$123,929.00" "$14,206.30" "$133,976.73" "$107,412.77" "$107,412.77" "$107,412.77" "$107,412.77" "$21,923.33" "$21,923.33" "$18,907.84" "$20,488.96" "$21,923.33" "$54,582.81" "$54,582.81" "$58,234.11" "$34,301.68" "$20,488.96" "$35,077.33" "$82,979.96" "$108,856.09" "$21,923.33" "$22,203.71" "$21,923.33" "$23,019.50" "$125,603.25" "$21,923.33" "$19,774.84" "$21,923.33" "$108,856.09" "$108,856.09" "$132,636.96" "$21,923.33" "$133,976.73" "$97,133.13" "$14,206.30" "$21,923.33" "$97,133.18" "$23,019.50" "$15,788.29" "$24,654.00" "$20,488.96" "$21,923.33" N/A N/A MS616 DRG MS-DRG V39 (FY2022) 616 "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC" INPATIENT ONLY "$266,464.50" "$197,184.00" "$38,426.20" "$199,848.38" N/A N/A N/A N/A "$50,525.61" "$50,525.61" N/A "$49,128.14" "$38,426.20" N/A N/A N/A N/A "$49,128.14" N/A N/A N/A "$50,525.61" "$50,525.61" "$50,525.61" "$50,525.61" "$199,848.38" "$50,525.61" "$50,525.61" "$50,525.61" N/A N/A N/A "$50,525.61" N/A N/A "$49,128.14" "$38,551.44" "$154,549.41" "$50,525.61" N/A N/A "$49,128.14" "$50,525.61" N/A N/A MS617 DRG MS-DRG V39 (FY2022) 617 "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC" INPATIENT ONLY "$105,312.50" "$77,931.50" "$2,151.03" "$84,249.87" "$17,812.19" "$17,812.19" "$17,812.19" "$17,812.19" "$25,547.96" "$25,547.96" "$17,812.19" "$17,752.32" "$25,547.96" "$2,151.03" "$2,151.03" "$2,262.70" "$23,538.00" N/A "$17,812.19" "$17,812.19" "$17,812.19" "$25,062.13" "$25,547.96" "$25,547.96" "$26,315.24" "$78,984.38" "$25,547.96" "$25,547.96" "$25,547.96" "$17,812.19" "$17,812.19" "$83,407.38" "$25,062.13" "$84,249.87" "$17,812.19" N/A "$25,062.13" "$61,081.25" "$26,315.24" "$17,812.19" "$28,581.31" N/A "$25,547.96" N/A N/A MS622 DRG MS-DRG V39 (FY2022) 622 "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC" INPATIENT ONLY "$176,984.50" "$130,969.00" "$36,001.69" "$141,587.39" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$132,738.38" N/A N/A N/A N/A N/A "$140,171.49" N/A "$141,587.39" N/A N/A "$36,001.69" "$102,651.01" N/A N/A N/A N/A N/A N/A N/A MS623 DRG MS-DRG V39 (FY2022) 623 "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC" INPATIENT ONLY "$333,894.50" "$247,082.00" "$23,969.62" "$267,115.30" "$213,262.21" "$213,262.21" "$213,262.21" "$213,262.21" "$23,969.62" "$23,969.62" N/A N/A N/A "$168,695.76" "$168,695.76" "$177,430.86" "$117,591.74" N/A N/A N/A N/A "$23,969.62" N/A N/A "$25,168.10" "$250,420.88" N/A N/A N/A N/A N/A "$264,444.14" "$23,969.62" "$267,115.30" N/A "$50,784.10" "$23,969.62" "$193,658.81" "$25,168.10" N/A "$27,214.36" "$62,973.18" N/A N/A N/A MS625 DRG MS-DRG V39 (FY2022) 625 "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC" INPATIENT ONLY "$310,947.00" "$230,101.00" "$30,655.10" "$248,757.41" N/A N/A N/A N/A N/A N/A N/A N/A N/A "$152,582.65" "$152,582.65" N/A "$105,890.91" N/A N/A N/A N/A "$30,655.10" N/A N/A N/A "$233,210.25" N/A N/A N/A N/A N/A "$246,269.80" "$30,655.10" "$248,757.41" N/A N/A "$30,655.10" "$180,349.26" N/A N/A "$35,579.33" N/A N/A N/A N/A MS626 DRG MS-DRG V39 (FY2022) 626 "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC" INPATIENT ONLY "$153,624.00" "$113,682.00" "$14,338.12" "$122,899.05" "$98,508.31" "$98,508.31" "$98,508.31" "$98,508.31" "$22,460.96" "$22,460.96" "$15,424.37" "$20,245.05" "$22,460.96" "$38,802.03" "$38,802.03" "$40,816.34" "$22,949.20" "$20,245.05" "$35,937.54" "$75,933.53" "$99,855.48" "$22,460.96" "$23,227.98" "$22,460.96" "$23,584.01" "$115,218.00" "$22,460.96" "$20,259.79" "$22,460.96" "$99,855.48" "$99,855.48" "$121,670.06" "$22,460.96" "$122,899.05" "$89,101.81" "$14,338.12" "$22,460.96" "$89,101.92" "$23,584.01" "$16,569.17" "$25,326.69" "$20,245.05" "$22,460.96" N/A N/A MS627 DRG MS-DRG V39 (FY2022) 627 "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$167,723.00" "$124,115.50" "$11,856.74" "$134,178.03" "$107,587.36" "$107,587.36" "$107,587.36" "$107,587.36" "$19,216.56" "$19,216.56" "$17,081.72" "$19,381.92" "$19,216.56" "$49,227.82" "$49,227.82" "$51,783.36" "$30,549.20" "$19,381.92" "$30,746.50" "$83,319.54" "$109,019.64" "$19,216.56" "$20,775.86" "$19,216.56" "$20,177.39" "$125,792.25" "$19,216.56" "$17,333.34" "$19,216.56" "$109,019.64" "$109,019.64" "$132,836.26" "$19,216.56" "$134,178.03" "$97,279.07" "$13,146.15" "$19,216.56" "$97,279.34" "$20,177.39" "$11,856.74" "$21,267.26" "$19,381.92" "$19,216.56" N/A N/A MS628 DRG MS-DRG V39 (FY2022) 628 "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC" INPATIENT ONLY "$231,653.50" "$171,424.00" "$97,538.42" "$173,740.13" N/A N/A N/A N/A N/A N/A N/A N/A N/A "$97,538.42" "$97,538.42" "$97,538.42" "$97,538.42" N/A N/A N/A N/A N/A N/A N/A N/A "$173,740.13" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$134,359.03" N/A N/A N/A N/A N/A N/A N/A MS629 DRG MS-DRG V39 (FY2022) 629 "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC" INPATIENT ONLY "$96,721.50" "$71,574.00" "$17,653.50" "$77,377.13" "$35,780.72" "$35,780.72" "$35,780.72" "$35,780.72" N/A N/A "$30,199.30" "$22,871.58" "$27,239.54" "$25,150.14" "$25,150.14" "$30,135.69" "$17,653.50" N/A "$30,199.30" "$30,199.30" "$30,199.30" "$27,239.54" N/A N/A "$28,601.52" "$72,541.13" N/A N/A N/A "$30,199.30" "$30,822.56" "$76,603.34" "$27,239.54" "$77,377.13" "$30,199.30" "$21,782.45" "$27,239.54" "$56,098.47" "$28,601.52" "$30,199.30" "$31,305.73" "$22,871.58" "$27,239.54" N/A N/A MS630 DRG MS-DRG V39 (FY2022) 630 "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC" INPATIENT ONLY "$192,153.00" "$142,193.50" "$14,127.25" "$153,722.04" "$123,277.99" "$123,277.99" "$123,277.99" "$123,277.99" "$20,779.75" "$20,779.75" "$24,438.54" "$21,697.82" "$20,779.75" "$67,135.57" "$67,135.57" "$70,620.75" "$43,603.26" "$21,697.82" "$33,247.60" "$95,375.62" "$124,899.16" "$20,779.75" "$21,692.28" "$20,779.75" "$21,818.74" "$144,114.75" "$20,779.75" "$18,743.33" "$20,779.75" "$124,899.16" "$124,899.16" "$152,184.83" "$20,779.75" "$153,722.04" "$111,448.48" "$14,612.07" "$20,779.75" "$111,448.74" "$21,818.74" "$14,127.25" "$23,223.14" "$21,697.82" "$20,779.75" N/A N/A MS637 DRG MS-DRG V39 (FY2022) 637 DIABETES WITH MCC INPATIENT ONLY "$56,556.50" "$41,852.00" "$6,848.76" "$45,245.02" "$15,438.05" "$15,438.05" "$15,438.05" "$15,438.05" "$20,554.07" "$20,554.07" "$12,446.04" "$12,778.76" "$20,554.07" "$9,755.68" "$9,755.68" "$9,873.39" "$6,848.76" "$12,778.76" "$32,886.51" "$18,784.73" "$20,649.00" "$20,554.07" "$21,631.57" "$20,554.07" "$21,581.77" "$42,417.38" "$20,554.07" "$18,539.77" "$20,554.07" "$22,873.50" "$19,776.15" "$44,792.54" "$20,554.07" "$45,245.02" "$19,375.08" "$12,170.24" "$20,554.07" "$32,802.77" "$21,581.77" "$13,799.46" "$22,940.77" "$12,778.76" "$20,554.07" N/A N/A MS638 DRG MS-DRG V39 (FY2022) 638 DIABETES WITH CC INPATIENT ONLY "$33,749.50" "$24,975.00" "$7,102.84" "$27,396.22" "$15,679.27" "$15,679.27" "$15,679.27" "$15,679.27" "$17,122.64" "$17,122.64" "$7,373.55" "$7,457.98" "$17,122.64" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$7,457.98" "$27,396.22" "$11,790.08" "$13,191.00" "$17,122.64" "$17,919.45" "$17,122.64" "$17,978.77" "$25,312.13" "$17,122.64" "$15,444.62" "$17,122.64" "$13,191.00" "$11,212.35" "$26,729.21" "$17,122.64" "$26,999.22" "$14,000.00" "$7,102.84" "$17,122.64" "$19,574.71" "$17,978.77" "$8,815.38" "$18,647.31" "$7,457.98" "$17,122.64" N/A N/A MS639 DRG MS-DRG V39 (FY2022) 639 DIABETES WITHOUT CC/MCC INPATIENT ONLY "$25,235.50" "$18,674.50" "$4,104.82" "$24,417.01" "$8,334.30" "$8,334.30" "$8,334.30" "$8,334.30" "$15,260.63" "$15,260.63" "$5,416.13" "$5,194.00" "$15,260.63" "$5,846.56" "$5,846.56" "$5,813.88" "$4,104.82" "$5,194.00" "$24,417.01" "$8,086.17" "$9,144.00" "$15,260.63" "$15,953.75" "$15,260.63" "$16,023.66" "$18,926.63" "$15,260.63" "$13,765.09" "$15,260.63" "$9,144.00" "$7,772.40" "$19,986.53" "$15,260.63" "$20,188.39" "$8,086.17" "$4,946.67" "$15,260.63" "$14,636.59" "$16,023.66" "$6,110.81" "$16,317.54" "$5,194.00" "$15,260.63" N/A N/A MS640 DRG MS-DRG V39 (FY2022) 640 "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC" INPATIENT ONLY "$49,673.50" "$36,758.50" "$8,739.11" "$39,738.42" "$24,032.94" "$24,032.94" "$24,032.94" "$24,032.94" "$19,547.83" "$19,547.83" "$9,857.58" "$9,176.07" "$19,547.83" "$16,766.76" "$16,766.76" "$20,090.46" "$11,769.00" "$9,176.07" "$17,029.67" "$17,029.67" "$18,462.00" "$19,547.83" "$20,700.14" "$20,700.14" "$20,525.22" "$37,255.13" "$20,700.14" "$20,700.14" "$20,700.14" "$19,294.26" "$16,524.96" "$39,341.05" "$19,547.83" "$39,738.42" "$17,029.67" "$8,739.11" "$19,547.83" "$28,810.63" "$20,525.22" "$17,029.67" "$21,681.74" "$9,176.07" "$19,547.83" N/A N/A MS641 DRG MS-DRG V39 (FY2022) 641 "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC" INPATIENT ONLY "$36,984.00" "$27,368.50" "$3,923.00" "$29,586.93" "$7,889.16" "$7,889.16" "$7,889.16" "$7,889.16" "$16,258.58" "$16,258.58" "$6,293.53" "$7,027.51" "$16,258.58" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$7,027.51" "$26,013.73" "$10,366.12" "$11,313.00" "$16,258.58" "$17,163.74" "$17,163.74" "$17,071.51" "$27,738.00" "$16,258.58" "$14,665.24" "$16,258.58" "$11,313.00" "$9,616.05" "$29,291.07" "$16,258.58" "$29,586.93" "$7,000.00" "$6,692.87" "$16,258.58" "$21,450.72" "$17,071.51" "$7,560.34" "$17,566.18" "$7,027.51" "$16,258.58" N/A N/A MS642 DRG MS-DRG V39 (FY2022) 642 INBORN AND OTHER DISORDERS OF METABOLISM INPATIENT ONLY "$143,984.00" "$106,548.50" "$8,697.35" "$115,187.14" "$79,694.57" "$79,694.57" "$79,694.57" "$79,694.57" "$21,685.85" "$21,685.85" N/A "$8,697.35" "$21,685.85" "$39,069.87" "$39,069.87" "$40,998.39" "$24,868.40" N/A N/A N/A N/A "$19,955.02" "$21,685.85" "$21,685.85" "$20,952.77" "$107,988.00" "$21,685.85" "$21,685.85" "$21,685.85" N/A N/A "$114,035.26" "$19,955.02" "$115,187.14" N/A N/A "$19,955.02" "$83,510.72" "$20,952.77" N/A "$22,191.23" "$8,697.35" "$19,955.02" N/A N/A MS643 DRG MS-DRG V39 (FY2022) 643 ENDOCRINE DISORDERS WITH MCC INPATIENT ONLY "$61,407.00" "$45,441.50" "$13,730.50" "$49,125.43" "$27,896.26" "$27,896.26" "$27,896.26" "$27,896.26" "$22,563.09" "$22,563.09" "$14,691.75" "$16,125.06" "$22,563.09" "$19,561.22" "$19,561.22" "$23,438.87" "$13,730.50" "$16,125.06" "$36,100.94" "$22,122.56" "$25,015.50" "$22,563.09" "$23,402.98" "$22,563.09" "$23,691.24" "$46,055.25" "$22,563.09" "$20,351.91" "$22,563.09" "$25,812.71" "$22,060.38" "$48,634.17" "$22,563.09" "$49,125.43" "$24,500.00" "$15,357.19" "$22,563.09" "$35,616.06" "$23,691.24" "$16,717.53" "$25,454.48" "$16,125.06" "$22,563.09" N/A N/A MS644 DRG MS-DRG V39 (FY2022) 644 ENDOCRINE DISORDERS WITH CC INPATIENT ONLY "$41,931.50" "$31,029.50" "$5,884.50" "$33,544.85" "$12,016.38" "$12,016.38" "$12,016.38" "$12,016.38" "$18,091.62" "$18,091.62" "$9,103.35" "$8,553.55" "$18,091.62" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$8,553.55" "$28,946.59" "$13,716.07" "$15,297.00" "$18,091.62" "$18,941.57" "$18,941.57" "$18,996.20" "$31,448.63" "$18,091.62" "$16,318.64" "$18,091.62" "$15,297.00" "$13,002.45" "$33,209.39" "$18,091.62" "$33,544.85" "$10,500.00" "$8,146.23" "$18,091.62" "$24,320.27" "$18,996.20" "$10,222.79" "$19,859.71" "$8,553.55" "$18,091.62" N/A N/A MS645 DRG MS-DRG V39 (FY2022) 645 ENDOCRINE DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$35,762.00" "$26,464.00" "$6,263.07" "$28,609.49" "$15,629.92" "$15,629.92" "$15,629.92" "$15,629.92" "$16,357.97" "$16,357.97" "$6,408.67" "$6,576.23" "$16,357.97" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$6,576.23" "$26,172.75" "$9,994.65" "$11,529.00" "$16,357.97" "$16,966.59" "$16,357.97" "$17,175.87" "$26,821.50" "$16,357.97" "$14,754.89" "$16,357.97" "$11,529.00" "$9,799.65" "$28,323.39" "$16,357.97" "$28,609.49" "$14,000.00" "$6,263.07" "$16,357.97" "$20,741.96" "$17,175.87" "$7,704.68" "$17,690.54" "$6,576.23" "$16,357.97" N/A N/A MS653 DRG MS-DRG V39 (FY2022) 653 MAJOR BLADDER PROCEDURES WITH MCC INPATIENT ONLY "$165,014.00" "$122,110.50" "$28,875.22" "$132,010.89" "$105,766.03" "$105,766.03" "$105,766.03" "$105,766.03" "$48,730.13" "$48,730.13" "$51,731.75" "$45,216.19" "$48,730.13" "$46,931.43" "$46,931.43" "$49,367.76" "$28,875.22" "$45,216.19" "$77,968.21" "$80,293.12" "$107,258.85" "$48,730.13" "$51,352.79" N/A "$51,166.64" "$123,760.50" "$48,730.13" "$43,954.58" "$48,730.13" "$107,258.85" "$107,258.85" "$130,690.80" "$48,730.13" "$132,010.89" "$95,707.90" "$43,063.02" "$48,730.13" "$95,708.12" "$51,166.64" "$54,724.68" "$58,195.07" "$45,216.19" "$48,730.13" N/A N/A MS654 DRG MS-DRG V39 (FY2022) 654 MAJOR BLADDER PROCEDURES WITH CC INPATIENT ONLY "$248,246.50" "$183,702.50" "$28,040.61" "$198,596.83" "$158,982.71" "$158,982.71" "$158,982.71" "$158,982.71" "$31,087.15" "$31,087.15" "$42,583.13" "$45,216.19" "$31,087.15" "$107,024.49" "$107,024.49" "$112,580.41" "$72,680.76" "$45,216.19" "$49,739.44" "$122,011.04" "$161,359.92" "$31,087.15" "$31,965.79" N/A "$32,641.51" "$186,184.88" "$31,087.15" "$28,040.61" "$31,087.15" "$161,359.92" "$161,359.92" "$196,610.86" "$31,087.15" "$198,596.83" "$143,982.70" "$43,063.02" "$31,087.15" "$143,982.97" "$32,641.51" "$29,098.56" "$36,119.91" "$45,216.19" "$31,087.15" N/A N/A MS655 DRG MS-DRG V39 (FY2022) 655 MAJOR BLADDER PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$155,422.00" "$115,012.50" "$16,257.32" "$124,337.33" "$99,400.33" "$99,400.33" "$99,400.33" "$99,400.33" "$25,410.66" "$25,410.66" "$20,163.22" "$17,070.19" "$25,410.66" "$39,118.48" "$39,118.48" "$41,149.22" "$23,179.87" "$17,070.19" "$40,657.06" "$76,214.21" "$101,024.09" "$25,410.66" "$27,081.52" N/A "$26,681.19" "$116,566.50" "$25,410.66" "$22,920.42" "$25,410.66" "$101,024.09" "$101,024.09" "$123,093.95" "$25,410.66" "$124,337.33" "$90,144.57" "$16,257.32" "$25,410.66" "$90,144.76" "$26,681.19" "$20,853.55" "$29,017.39" "$17,070.19" "$25,410.66" N/A N/A MS656 DRG MS-DRG V39 (FY2022) 656 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC INPATIENT ONLY "$647,426.50" "$479,096.00" "$62,515.58" "$485,569.88" N/A N/A N/A N/A "$63,970.49" "$63,970.49" N/A N/A "$62,515.58" N/A N/A N/A N/A N/A N/A N/A N/A "$63,970.49" "$63,970.49" "$63,970.49" "$63,970.49" "$485,569.88" "$63,970.49" "$63,970.49" "$63,970.49" N/A N/A N/A "$63,970.49" N/A N/A N/A "$63,970.49" "$375,507.37" "$63,970.49" N/A N/A N/A "$63,970.49" N/A N/A MS657 DRG MS-DRG V39 (FY2022) 657 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC INPATIENT ONLY "$89,017.50" "$65,873.00" "$7,280.34" "$71,213.66" "$20,430.52" "$20,430.52" "$20,430.52" "$20,430.52" "$24,405.79" "$24,405.79" "$17,950.54" "$7,644.36" "$24,405.79" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$7,644.36" "$39,049.26" "$25,276.00" "$29,020.50" "$24,405.79" "$25,076.54" "$24,405.79" "$25,626.08" "$66,763.13" "$24,405.79" "$22,014.02" "$24,405.79" "$30,206.70" "$25,853.62" "$70,501.51" "$24,405.79" "$71,213.66" "$17,500.00" "$7,280.34" "$24,405.79" "$51,630.15" "$25,626.08" "$19,394.03" "$27,760.09" "$7,644.36" "$24,405.79" N/A N/A MS658 DRG MS-DRG V39 (FY2022) 658 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC INPATIENT ONLY "$244,397.00" "$180,854.00" "$19,792.90" "$195,517.49" "$156,582.28" "$156,582.28" "$156,582.28" "$156,582.28" "$21,943.35" "$21,943.35" "$36,436.58" "$42,785.76" "$21,943.35" "$113,246.48" "$113,246.48" "$118,621.11" "$76,980.70" "$42,785.76" "$35,109.36" "$120,692.50" "$158,857.96" "$21,943.35" "$22,940.85" "$21,943.35" "$23,040.52" "$183,297.75" "$21,943.35" "$19,792.90" "$21,943.35" "$158,857.96" "$158,857.96" "$193,562.31" "$21,943.35" "$195,517.49" "$141,750.19" "$33,659.18" "$21,943.35" "$141,750.26" "$23,040.52" "$23,749.01" "$24,679.05" "$42,785.76" "$21,943.35" N/A N/A MS659 DRG MS-DRG V39 (FY2022) 659 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC INPATIENT ONLY "$116,171.50" "$85,967.00" "$1,532.41" "$92,936.83" "$40,619.65" "$40,619.65" "$40,619.65" "$40,619.65" "$32,804.26" "$32,804.26" N/A "$10,425.85" "$32,804.26" "$9,422.19" "$9,422.19" "$9,911.32" "$1,532.41" "$10,425.85" "$52,486.82" "$34,682.50" N/A "$32,804.26" "$33,436.12" "$33,436.12" "$34,444.47" "$87,128.63" "$33,436.12" "$33,436.12" "$33,436.12" "$41,707.44" "$75,511.18" "$92,007.46" "$32,804.26" "$92,936.83" N/A "$9,929.37" "$33,436.12" "$67,379.47" "$34,444.47" N/A "$38,351.74" "$10,425.85" "$33,436.12" N/A N/A MS660 DRG MS-DRG V39 (FY2022) 660 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC INPATIENT ONLY "$185,804.50" "$137,495.50" "$14,466.08" "$148,643.56" "$118,878.89" "$118,878.89" "$118,878.89" "$118,878.89" "$21,013.02" "$21,013.02" "$24,567.41" "$25,548.75" "$21,013.02" "$61,254.95" "$61,254.95" "$64,434.85" "$39,316.51" "$25,548.75" N/A "$90,925.55" N/A "$21,013.02" "$21,742.28" "$21,742.28" "$22,063.67" "$139,353.38" "$21,742.28" "$21,742.28" "$21,742.28" "$120,772.90" "$120,772.90" "$147,157.14" "$21,013.02" "$148,643.56" N/A "$18,600.41" "$21,742.28" "$107,766.61" "$22,063.67" "$14,466.08" "$23,515.00" "$25,548.75" "$21,013.02" N/A N/A MS661 DRG MS-DRG V39 (FY2022) 661 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC INPATIENT ONLY "$86,091.00" "$63,707.50" "$4,789.50" "$68,872.67" "$12,065.87" "$12,065.87" "$12,065.87" "$12,065.87" "$18,394.60" "$18,394.60" "$12,044.38" "$7,386.08" "$18,394.60" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$7,386.08" "$29,431.36" "$14,507.46" "$15,955.50" "$18,394.60" "$19,361.57" "$18,394.60" "$19,314.33" "$64,568.25" "$18,394.60" "$16,591.93" "$18,394.60" "$15,955.50" "$14,038.68" "$68,183.93" "$18,394.60" "$68,872.67" "$10,500.00" "$7,034.36" "$18,394.60" "$49,932.78" "$19,314.33" "$10,662.85" "$20,238.80" "$7,386.08" "$18,394.60" N/A N/A MS662 DRG MS-DRG V39 (FY2022) 662 MINOR BLADDER PROCEDURES WITH MCC INPATIENT ONLY "$168,313.50" "$124,552.00" "$29,444.40" "$134,650.77" "$107,850.65" "$107,850.65" "$107,850.65" "$107,850.65" "$31,325.23" "$31,325.23" N/A "$32,437.44" "$31,325.23" "$49,217.77" "$49,217.77" "$51,772.79" "$30,541.87" "$32,437.44" N/A "$82,749.72" "$109,403.76" "$31,325.23" "$33,367.20" N/A "$32,891.49" "$126,235.13" N/A N/A "$31,325.23" "$109,403.76" "$109,403.76" "$133,304.29" "$31,325.23" "$134,650.77" N/A "$30,892.78" "$35,014.09" "$97,621.83" "$32,891.49" "$29,444.40" "$36,417.80" "$32,437.44" "$31,325.23" N/A N/A MS663 DRG MS-DRG V39 (FY2022) 663 MINOR BLADDER PROCEDURES WITH CC INPATIENT ONLY "$93,464.00" "$69,163.50" "$7,846.00" "$74,770.99" "$15,719.65" "$15,719.65" "$15,719.65" "$15,719.65" "$22,092.41" "$22,092.41" "$13,642.98" "$12,520.48" "$22,092.41" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$12,520.48" "$35,347.86" "$20,524.98" "$23,992.50" "$22,092.41" "$22,555.12" "$22,092.41" "$23,197.03" "$70,098.00" "$22,092.41" "$19,927.35" "$22,092.41" "$23,992.50" "$20,393.63" "$74,023.30" "$22,092.41" "$74,770.99" "$14,000.00" "$11,924.26" "$22,092.41" "$54,209.12" "$23,197.03" "$16,033.88" "$24,865.56" "$12,520.48" "$22,092.41" N/A N/A MS664 DRG MS-DRG V39 (FY2022) 664 MINOR BLADDER PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$151,487.50" "$112,101.00" "$9,171.60" "$121,189.62" "$97,141.25" "$97,141.25" "$97,141.25" "$97,141.25" "$19,223.47" "$19,223.47" "$14,720.01" "$14,331.16" "$19,223.47" "$37,256.05" "$37,256.05" "$39,190.10" "$21,822.23" "$14,331.16" "$30,757.55" "$75,429.76" "$98,466.57" "$19,223.47" "$19,710.14" "$19,223.47" "$20,184.64" "$113,615.63" "$19,223.47" "$17,339.57" "$19,223.47" "$98,466.57" "$98,466.57" "$119,977.74" "$19,223.47" "$121,189.62" "$87,862.48" "$9,171.60" "$19,223.47" "$87,862.75" "$20,184.64" "$11,866.77" "$21,275.90" "$14,331.16" "$19,223.47" N/A N/A MS668 DRG MS-DRG V39 (FY2022) 668 TRANSURETHRAL PROCEDURES WITH MCC INPATIENT ONLY "$126,993.00" "$93,975.00" "$8,647.83" "$101,594.28" "$23,705.83" "$23,705.83" "$23,705.83" "$23,705.83" "$30,421.13" "$30,421.13" "$22,304.51" "$23,561.28" "$30,421.13" "$19,183.21" "$19,183.21" "$20,179.06" "$8,647.83" "$23,561.28" "$48,673.81" "$37,993.41" "$82,545.36" "$30,421.13" "$31,825.78" "$30,421.13" "$31,942.19" "$95,244.75" "$30,421.13" "$27,439.86" N/A "$82,545.36" "$82,545.36" "$100,578.36" "$30,421.13" "$101,594.28" "$21,000.00" "$22,439.30" "$30,421.13" "$73,655.94" "$31,942.19" "$28,131.21" "$35,286.58" "$23,561.28" "$30,421.13" N/A N/A MS669 DRG MS-DRG V39 (FY2022) 669 TRANSURETHRAL PROCEDURES WITH CC INPATIENT ONLY "$133,238.00" "$98,596.50" "$11,685.10" "$106,590.29" "$85,281.58" "$85,281.58" "$85,281.58" "$85,281.58" "$21,843.94" "$21,843.94" N/A "$23,561.28" "$22,906.55" "$23,349.79" "$23,349.79" "$24,561.94" "$11,685.10" N/A N/A N/A N/A "$21,843.94" "$22,906.55" "$21,843.94" "$22,936.14" "$99,928.50" "$22,906.55" "$22,906.55" "$22,906.55" "$86,604.61" N/A "$105,524.41" "$21,843.94" "$106,590.29" N/A "$22,439.30" "$21,843.94" "$77,278.04" "$22,936.14" N/A "$24,554.68" "$23,561.28" "$22,906.55" N/A N/A MS670 DRG MS-DRG V39 (FY2022) 670 TRANSURETHRAL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$63,130.00" "$46,716.50" "$3,923.00" "$50,503.77" "$8,268.66" "$8,268.66" "$8,268.66" "$8,268.66" "$17,806.61" "$17,806.61" "$7,994.78" "$7,297.15" "$17,806.61" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$7,297.15" "$28,490.58" "$13,290.76" "$14,677.50" "$17,806.61" "$18,715.87" "$17,806.61" "$18,696.94" "$47,347.50" "$17,806.61" "$16,061.56" "$17,806.61" "$15,269.87" "$13,068.24" "$49,998.73" "$17,806.61" "$50,503.77" "$7,000.00" "$6,949.66" "$17,806.61" "$36,615.40" "$18,696.94" "$9,808.77" "$19,503.09" "$7,297.15" "$17,806.61" N/A N/A MS671 DRG MS-DRG V39 (FY2022) 671 URETHRAL PROCEDURES WITH CC/MCC INPATIENT ONLY "$232,886.50" "$172,336.50" "$16,425.74" "$186,308.86" "$149,399.02" "$149,399.02" "$149,399.02" "$149,399.02" "$23,347.11" "$23,347.11" "$34,160.79" "$24,978.77" "$23,347.11" "$96,838.53" "$96,838.53" "$101,865.67" "$65,255.59" "$24,978.77" "$37,355.38" "$115,826.75" "$151,375.95" "$23,347.11" "$24,744.40" "$23,347.11" "$24,514.47" "$174,664.88" "$23,347.11" "$21,059.09" "$23,347.11" "$151,375.95" "$151,375.95" "$184,445.79" "$23,347.11" "$186,308.86" "$135,073.93" "$16,425.74" "$23,347.11" "$135,074.17" "$24,514.47" "$21,465.11" "$26,435.46" "$24,978.77" "$23,347.11" N/A N/A MS672 DRG MS-DRG V39 (FY2022) 672 URETHRAL PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$143,627.50" "$106,284.50" "$3,500.00" "$114,901.70" "$92,138.77" "$92,138.77" "$92,138.77" "$92,138.77" "$18,992.95" "$18,992.95" "$11,646.44" "$11,336.92" "$18,992.95" "$31,668.68" "$31,668.68" "$33,312.69" "$17,749.26" "$11,336.92" "$30,388.72" "$71,189.06" "$93,357.63" "$18,992.95" "$19,103.01" "$18,992.95" "$19,942.60" "$107,720.63" "$18,992.95" "$17,131.64" "$18,992.95" "$93,357.63" "$93,357.63" "$113,752.69" "$18,992.95" "$114,901.70" "$3,500.00" "$10,797.07" "$18,992.95" "$83,303.95" "$19,942.60" "$11,531.96" "$20,987.47" "$11,336.92" "$18,992.95" N/A N/A MS673 DRG MS-DRG V39 (FY2022) 673 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC INPATIENT ONLY "$163,961.50" "$121,332.00" "$23,934.11" "$131,168.96" "$104,910.58" "$104,910.58" "$104,910.58" "$104,910.58" "$36,619.31" "$36,619.31" "$67,898.05" "$25,130.83" "$36,619.31" "$73,420.19" "$73,420.19" "$81,320.44" "$47,428.96" "$25,130.83" "$67,898.05" "$67,898.05" "$67,898.05" "$34,989.93" "$36,619.31" "$36,619.31" "$36,739.43" "$122,971.13" "$36,619.31" "$36,619.31" "$36,619.31" "$67,898.05" "$106,574.78" "$129,857.28" "$34,989.93" "$131,168.96" "$67,898.05" "$23,934.11" "$34,989.93" "$95,097.67" "$36,739.43" "$67,898.05" "$41,003.13" "$25,130.83" "$36,619.31" N/A N/A MS674 DRG MS-DRG V39 (FY2022) 674 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC INPATIENT ONLY "$112,113.00" "$82,964.00" "$18,181.04" "$89,690.15" "$30,861.22" "$30,861.22" "$30,861.22" "$30,861.22" "$27,501.12" "$27,501.12" "$20,172.15" "$24,214.07" "$27,501.12" "$25,899.87" "$25,899.87" "$29,000.37" "$18,181.04" "$24,214.07" "$44,001.79" "$31,904.56" "$72,873.25" "$27,501.12" "$28,594.36" "$27,501.12" "$28,876.18" "$84,084.75" "$27,501.12" "$24,806.01" "$27,501.12" "$35,748.00" "$72,873.25" "$88,793.25" "$27,501.12" "$89,690.15" "$24,414.70" "$23,061.01" "$27,501.12" "$65,025.54" "$28,876.18" "$23,889.92" "$31,633.01" "$24,214.07" "$27,501.12" N/A N/A MS675 DRG MS-DRG V39 (FY2022) 675 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$275,172.00" "$203,627.50" "$23,163.52" "$220,137.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A "$127,101.96" "$127,101.96" N/A "$87,316.47" N/A N/A N/A N/A "$23,163.52" N/A N/A "$24,321.70" "$206,379.00" N/A N/A N/A "$178,861.51" N/A "$217,935.86" "$23,163.52" "$220,137.25" N/A "$30,294.72" "$23,163.52" "$159,599.76" "$24,321.70" N/A N/A N/A N/A N/A N/A MS682 DRG MS-DRG V39 (FY2022) 682 RENAL FAILURE WITH MCC INPATIENT ONLY "$44,833.50" "$33,177.00" "$3,500.00" "$35,866.53" "$14,930.70" "$14,930.70" "$14,930.70" "$14,930.70" "$20,507.88" "$20,507.88" "$12,615.59" "$12,535.61" "$20,507.88" "$9,815.00" "$9,815.00" "$10,638.97" "$6,889.38" "$12,535.61" "$32,812.61" "$20,008.15" "$22,090.50" "$20,507.88" "$21,539.67" "$20,507.88" "$21,533.27" "$33,625.13" "$22,280.84" "$18,498.11" "$20,507.88" "$22,090.50" "$18,776.93" "$35,507.86" "$20,507.88" "$35,866.53" "$3,500.00" "$11,938.67" "$21,217.30" "$26,003.43" "$21,533.27" "$13,732.35" "$22,882.97" "$12,535.61" "$20,507.88" N/A N/A MS683 DRG MS-DRG V39 (FY2022) 683 RENAL FAILURE WITH CC INPATIENT ONLY "$38,239.50" "$28,297.50" "$8,419.24" "$30,591.23" "$19,060.97" "$19,060.97" "$19,060.97" "$19,060.97" "$17,121.96" "$17,121.96" "$8,490.15" "$8,840.21" "$17,121.96" "$14,402.44" "$14,402.44" "$16,742.54" "$10,109.71" "$8,840.21" "$27,395.14" "$12,044.46" "$13,189.50" "$17,121.96" "$18,054.43" "$17,121.96" "$17,978.06" "$28,679.63" "$17,121.96" "$15,444.01" "$17,121.96" "$17,458.68" "$15,480.26" "$30,285.31" "$17,121.96" "$30,591.23" "$14,000.00" "$8,419.24" "$17,121.96" "$22,178.91" "$17,978.06" "$8,814.36" "$18,646.45" "$8,840.21" "$17,121.96" N/A N/A MS684 DRG MS-DRG V39 (FY2022) 684 RENAL FAILURE WITHOUT CC/MCC INPATIENT ONLY "$22,537.00" "$16,677.50" "$3,500.00" "$22,536.77" "$7,832.24" "$7,832.24" "$7,832.24" "$7,832.24" "$15,248.89" "$15,248.89" "$5,431.31" "$5,480.66" "$15,248.89" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$5,480.66" "$22,536.77" "$8,140.00" "$9,118.50" "$15,248.89" "$15,982.33" "$15,248.89" "$16,011.33" "$16,902.75" "$15,248.89" "$13,754.50" "$15,248.89" "$9,118.50" "$7,750.73" "$17,849.11" "$15,248.89" "$18,029.41" "$7,000.00" "$5,219.68" "$15,248.89" "$13,071.46" "$16,011.33" "$6,093.77" "$16,302.84" "$5,480.66" "$15,248.89" N/A N/A MS686 DRG MS-DRG V39 (FY2022) 686 KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC INPATIENT ONLY "$49,467.00" "$36,606.00" "$9,359.92" "$39,573.27" "$24,960.06" "$24,960.06" "$24,960.06" "$24,960.06" "$23,995.84" "$23,995.84" "$15,742.31" "$9,827.92" "$23,995.84" "$17,539.68" "$17,539.68" "$17,441.64" "$12,314.46" "$9,827.92" "$38,393.34" "$22,850.69" "$28,129.50" "$23,995.84" "$23,789.40" "$23,995.84" "$25,195.63" "$37,100.25" "$23,995.84" "$21,644.25" "$23,995.84" "$28,129.50" "$23,910.08" "$39,177.52" "$23,995.84" "$39,573.27" N/A "$9,359.92" "$26,350.97" "$28,690.86" "$25,195.63" "$18,798.57" "$27,247.16" "$9,827.92" "$23,995.84" N/A N/A MS687 DRG MS-DRG V39 (FY2022) 687 KIDNEY AND URINARY TRACT NEOPLASMS WITH CC INPATIENT ONLY "$95,743.00" "$70,850.00" "$7,280.34" "$76,594.33" "$27,974.17" "$27,974.17" "$27,974.17" "$27,974.17" "$18,300.73" "$18,300.73" "$8,973.93" "$7,644.36" "$18,300.73" "$19,561.22" "$19,561.22" "$23,438.87" "$13,730.50" "$7,644.36" "$29,281.17" "$13,994.67" "$15,751.50" "$18,300.73" "$19,089.44" "$18,300.73" "$19,215.77" "$71,807.25" "$18,300.73" "$16,507.26" "$18,300.73" "$16,643.93" "$14,281.21" "$75,828.38" "$18,300.73" "$76,594.33" "$24,500.00" "$7,280.34" "$18,300.73" "$55,530.94" "$19,215.77" "$10,526.52" "$20,121.35" "$7,644.36" "$18,300.73" N/A N/A MS688 DRG MS-DRG V39 (FY2022) 688 KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC INPATIENT ONLY "$23,076.50" "$17,077.00" "$1,961.50" "$23,076.23" "$4,099.99" "$4,099.99" "$4,099.99" "$4,099.99" "$15,786.51" "$15,786.51" "$6,168.57" "$4,974.51" "$15,786.51" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$4,974.51" "$23,076.23" "$11,660.88" "$10,287.00" "$15,786.51" "$17,850.87" "$15,786.51" "$16,575.84" "$17,307.38" "$15,786.51" "$14,239.43" "$15,786.51" "$10,287.00" "$8,743.95" "$18,276.37" "$15,786.51" "$18,460.99" "$3,500.00" "$4,737.63" "$15,786.51" "$13,384.37" "$16,575.84" "$6,874.67" "$16,975.52" "$4,974.51" "$15,786.51" N/A N/A MS689 DRG MS-DRG V39 (FY2022) 689 KIDNEY AND URINARY TRACT INFECTIONS WITH MCC INPATIENT ONLY "$48,385.00" "$35,805.00" "$5,884.50" "$38,707.62" "$12,062.42" "$12,062.42" "$12,062.42" "$12,062.42" "$18,743.11" "$18,743.11" "$9,971.83" "$10,425.85" "$18,743.11" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$10,425.85" "$29,988.98" "$15,438.82" "$16,713.00" "$18,743.11" "$19,855.87" "$18,743.11" "$19,680.27" "$36,288.75" "$18,743.11" "$16,906.29" "$18,743.11" "$16,713.00" "$14,678.35" "$38,320.55" "$18,743.11" "$38,707.62" "$10,500.00" "$9,929.37" "$18,743.11" "$28,063.30" "$19,680.27" "$11,169.08" "$20,674.86" "$10,425.85" "$18,743.11" N/A N/A MS690 DRG MS-DRG V39 (FY2022) 690 KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC INPATIENT ONLY "$39,348.00" "$29,118.00" "$3,923.00" "$31,478.16" "$8,099.27" "$8,099.27" "$8,099.27" "$8,099.27" "$16,533.26" "$16,533.26" "$6,956.71" "$7,386.08" "$16,533.26" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$7,386.08" "$26,453.22" "$10,707.98" "$11,910.00" "$16,533.26" "$17,345.16" "$16,533.26" "$17,359.92" "$29,511.00" "$16,533.26" "$14,913.00" "$16,533.26" "$11,910.00" "$10,123.50" "$31,163.38" "$16,533.26" "$31,478.16" "$7,000.00" "$7,034.36" "$16,533.26" "$22,821.84" "$17,359.92" "$7,959.29" "$17,909.86" "$7,386.08" "$16,533.26" N/A N/A MS693 DRG MS-DRG V39 (FY2022) 693 URINARY STONES WITH MCC INPATIENT ONLY "$86,094.50" "$63,710.00" "$8,614.77" "$85,040.47" "$85,040.47" "$85,040.47" "$85,040.47" "$85,040.47" "$20,270.42" "$20,270.42" N/A N/A "$20,270.42" "$64,272.58" "$64,272.58" N/A "$45,114.50" N/A N/A "$19,257.14" N/A "$20,270.42" "$21,882.27" "$21,882.27" "$21,283.94" "$64,570.88" "$21,882.27" "$21,882.27" "$21,882.27" "$21,086.32" "$18,081.44" "$68,186.67" "$20,270.42" "$68,875.43" N/A "$8,614.77" "$20,270.42" "$49,934.81" "$21,283.94" N/A N/A N/A "$21,882.27" N/A N/A MS694 DRG MS-DRG V39 (FY2022) 694 URINARY STONES WITHOUT MCC INPATIENT ONLY "$47,158.50" "$34,897.50" "$6,122.16" "$37,726.51" "$19,978.18" "$19,978.18" "$19,978.18" "$19,978.18" "$16,375.91" "$16,375.91" "$6,122.16" "$6,940.47" "$16,375.91" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$6,940.47" "$26,201.46" "$10,728.17" "$11,568.00" "$16,375.91" "$17,355.88" "$16,375.91" "$17,194.71" "$35,368.88" "$16,375.91" "$14,771.07" "$16,375.91" "$12,201.33" "$10,466.13" "$37,349.25" "$16,375.91" "$37,726.51" "$17,500.00" "$6,609.97" "$16,375.91" "$27,351.93" "$17,194.71" "$7,730.74" "$17,712.98" "$6,940.47" "$16,375.91" N/A N/A MS696 DRG MS-DRG V39 (FY2022) 696 KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC INPATIENT ONLY "$15,555.00" "$11,511.00" "$4,682.66" "$17,028.21" "$11,794.56" "$11,794.56" "$11,794.56" "$11,794.56" "$15,828.61" "$15,828.61" "$5,907.94" "$4,916.80" "$15,828.61" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$4,916.80" "$15,554.80" "$9,327.09" "$10,378.50" "$15,828.61" "$16,612.31" "$15,828.61" "$16,620.04" "$11,666.25" "$15,828.61" "$14,277.41" "$15,828.61" "$10,378.50" "$8,821.73" "$12,319.41" "$15,828.61" "$12,443.84" "$10,500.00" "$4,682.66" "$15,828.61" "$9,021.90" "$16,620.04" "$6,935.82" "$17,028.21" "$4,916.80" "$15,554.80" N/A N/A MS697 DRG MS-DRG V39 (FY2022) 697 URETHRAL STRICTURE INPATIENT ONLY "$109,947.50" "$81,361.50" "$17,950.14" "$93,978.59" "$93,978.59" "$93,978.59" "$93,978.59" "$93,978.59" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,950.14" N/A N/A N/A "$82,460.63" N/A N/A N/A N/A N/A "$87,078.19" "$17,950.14" "$87,957.76" N/A N/A "$17,950.14" "$63,769.55" "$18,847.65" N/A N/A N/A N/A N/A N/A MS698 DRG MS-DRG V39 (FY2022) 698 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC INPATIENT ONLY "$83,807.00" "$62,017.50" "$3,923.00" "$67,045.27" "$21,568.05" "$21,568.05" "$21,568.05" "$21,568.05" "$23,108.71" "$23,108.71" "$21,568.05" "$14,005.43" "$23,108.71" "$3,923.00" "$3,923.00" "$3,923.00" "$3,923.00" "$14,005.43" "$21,568.05" "$21,568.05" "$21,568.05" "$23,108.71" "$23,108.71" "$23,108.71" "$23,108.71" "$62,855.25" "$23,108.71" "$23,108.71" "$23,108.71" "$21,568.05" "$21,568.05" "$66,374.81" "$22,169.02" "$67,045.27" "$21,568.05" "$14,005.43" "$22,169.02" "$48,608.06" "$23,108.71" "$21,568.05" "$21,568.05" "$14,005.43" "$23,108.71" N/A N/A MS699 DRG MS-DRG V39 (FY2022) 699 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC INPATIENT ONLY "$38,990.50" "$28,853.00" "$7,846.00" "$31,192.09" "$16,157.41" "$16,157.41" "$16,157.41" "$16,157.41" "$18,141.30" "$18,141.30" "$9,077.47" "$9,310.41" "$18,141.30" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$9,310.41" "$29,026.08" "$13,621.85" "$15,405.00" "$18,141.30" "$18,891.58" "$18,891.58" "$19,048.37" "$29,242.88" "$18,141.30" "$16,363.45" "$18,141.30" "$16,125.38" "$13,814.63" "$30,880.16" "$18,141.30" "$31,192.09" "$14,000.00" "$8,867.06" "$18,141.30" "$22,614.49" "$19,048.37" "$10,294.95" "$19,921.88" "$9,310.41" "$18,141.30" N/A N/A MS700 DRG MS-DRG V39 (FY2022) 700 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC INPATIENT ONLY "$26,867.00" "$19,882.00" "$1,961.50" "$25,928.69" "$4,124.56" "$4,124.56" "$4,124.56" "$4,124.56" "$16,205.43" "$16,205.43" "$6,346.19" "$6,154.51" "$16,205.43" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,586.64" "$25,928.69" "$9,970.43" "$11,197.50" "$16,205.43" "$16,953.74" "$16,205.43" "$17,015.70" "$20,150.25" "$16,205.43" "$14,617.30" "$16,205.43" "$11,197.50" "$9,517.88" "$21,278.57" "$16,205.43" "$21,493.51" "$3,500.00" "$6,272.98" "$16,205.43" "$15,582.86" "$17,015.70" "$7,483.14" "$17,499.69" "$6,154.51" "$16,205.43" N/A N/A MS707 DRG MS-DRG V39 (FY2022) 707 MAJOR MALE PELVIC PROCEDURES WITH CC/MCC INPATIENT ONLY "$250,589.00" "$185,436.00" "$21,936.22" "$200,470.97" "$160,780.96" "$160,780.96" "$160,780.96" "$160,780.96" "$24,319.53" "$24,319.53" "$38,782.23" "$45,348.60" "$24,319.53" "$109,861.11" "$109,861.11" "$115,564.29" "$74,748.55" "$45,348.60" "$38,911.25" "$124,645.05" "$162,882.67" "$24,319.53" "$25,914.39" N/A "$25,535.51" "$187,941.75" "$24,319.53" "$21,936.22" "$24,319.53" "$162,882.67" "$162,882.67" "$198,466.27" "$24,319.53" "$200,470.97" "$145,341.46" "$35,956.53" "$24,319.53" "$145,341.62" "$25,535.51" "$25,887.18" "$27,652.17" "$45,348.60" "$24,319.53" N/A N/A MS708 DRG MS-DRG V39 (FY2022) 708 MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$241,226.50" "$178,508.00" "$19,253.18" "$192,981.07" "$154,639.15" "$154,639.15" "$154,639.15" "$154,639.15" "$21,344.99" "$21,344.99" "$35,041.68" "$36,144.25" "$21,344.99" "$102,507.85" "$102,507.85" "$107,829.29" "$69,388.30" "$36,144.25" "$34,151.98" "$119,483.05" "$156,797.11" "$21,344.99" "$22,267.28" "$21,344.99" "$22,412.24" "$180,919.88" "$21,344.99" "$19,253.18" "$21,344.99" "$156,797.11" "$156,797.11" "$191,051.25" "$21,344.99" "$192,981.07" "$139,911.27" "$27,407.39" "$21,344.99" "$139,911.37" "$22,412.24" "$22,833.79" "$23,930.38" "$36,144.25" "$21,344.99" N/A N/A MS709 DRG MS-DRG V39 (FY2022) 709 PENIS PROCEDURES WITH CC/MCC INPATIENT ONLY "$50,016.50" "$37,012.50" "$1,961.50" "$43,258.62" "$3,935.13" "$3,935.13" "$3,935.13" "$3,935.13" "$27,036.64" "$27,036.64" "$19,048.40" "$11,457.37" "$27,036.64" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$14,275.46" "$43,258.62" "$32,463.11" "$34,738.50" "$27,036.64" "$28,890.80" "$27,036.64" "$28,388.47" "$37,512.38" "$27,036.64" "$24,387.05" "$27,036.64" "$34,738.50" "$29,527.73" "$39,612.71" "$27,036.64" "$40,012.83" "$3,500.00" "$13,595.67" "$27,036.64" "$29,009.57" "$28,388.47" "$23,215.28" "$31,051.85" "$11,457.37" "$27,036.64" N/A N/A MS710 DRG MS-DRG V39 (FY2022) 710 PENIS PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$181,988.50" "$134,671.50" "$14,154.68" "$145,590.72" "$103,914.04" "$103,914.04" "$103,914.04" "$103,914.04" "$22,106.91" "$22,106.91" "$21,712.14" "$20,787.91" "$22,106.91" "$66,205.14" "$66,205.14" "$69,542.32" "$44,648.97" "$20,787.91" "$35,371.06" "$89,037.72" "$118,292.46" "$22,106.91" "$21,957.98" N/A "$23,212.26" "$136,491.38" "$22,106.91" "$19,940.43" "$22,106.91" "$118,292.46" "$118,292.46" "$144,134.83" "$22,106.91" "$145,590.72" "$120,942.82" "$14,154.68" "$22,106.91" "$105,553.33" "$23,212.26" "$16,054.93" "$24,883.70" "$20,787.91" "$22,106.91" N/A N/A MS711 DRG MS-DRG V39 (FY2022) 711 TESTES PROCEDURES WITH CC/MCC INPATIENT ONLY "$604,818.50" "$447,566.00" "$25,764.70" "$453,613.88" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$453,613.88" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,764.70" "$350,794.73" N/A N/A N/A N/A N/A N/A N/A MS712 DRG MS-DRG V39 (FY2022) 712 TESTES PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$76,810.50" "$56,840.00" "$7,846.00" "$61,448.24" "$15,767.12" "$15,767.12" "$15,767.12" "$15,767.12" "$18,369.06" "$18,369.06" "$9,489.84" "$10,247.98" "$18,369.06" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$10,247.98" "$29,390.50" "$16,710.69" "$15,900.00" "$18,369.06" "$20,530.85" "$18,369.06" "$19,287.51" "$57,607.88" "$18,369.06" "$16,568.89" "$18,369.06" "$15,900.00" "$13,515.00" "$60,833.77" "$18,369.06" "$61,448.24" "$14,000.00" "$9,759.98" "$18,369.06" "$44,550.09" "$19,287.51" "$10,625.77" "$20,206.85" "$10,247.98" "$18,369.06" N/A N/A MS713 DRG MS-DRG V39 (FY2022) 713 TRANSURETHRAL PROSTATECTOMY WITH CC/MCC INPATIENT ONLY "$109,312.50" "$80,891.50" "$3,923.00" "$87,449.96" "$8,171.96" "$8,171.96" "$8,171.96" "$8,171.96" "$21,360.16" "$21,360.16" "$13,235.07" "$12,758.89" "$21,360.16" "$6,185.63" "$6,185.63" "$6,506.75" "$3,923.00" "$12,758.89" "$34,176.26" "$19,944.89" "$71,053.09" "$21,360.16" "$22,247.27" "$21,360.16" "$22,428.17" "$81,984.38" "$21,360.16" "$19,266.86" "$21,360.16" "$22,401.00" "$71,053.09" "$86,575.46" "$21,360.16" "$87,449.96" "$7,000.00" "$12,151.32" "$21,360.16" "$63,401.25" "$22,428.17" "$14,970.29" "$23,949.36" "$12,758.89" "$21,360.16" N/A N/A MS714 DRG MS-DRG V39 (FY2022) 714 TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC INPATIENT ONLY "$106,990.00" "$79,173.00" "$4,104.82" "$85,591.72" "$8,352.36" "$8,352.36" "$8,352.36" "$8,352.36" "$17,463.58" "$17,463.58" "$7,080.78" "$7,465.55" "$17,463.58" "$4,891.36" "$4,891.36" "$5,145.28" "$4,104.82" "$7,465.55" "$27,941.73" "$12,896.41" "$69,543.27" "$17,463.58" "$18,506.58" "$17,463.58" "$18,336.76" "$80,242.50" "$17,463.58" "$15,752.15" "$17,463.58" "$13,932.00" "$69,543.27" "$84,735.81" "$17,463.58" "$85,591.72" "$12,896.41" "$7,110.04" "$17,463.58" "$62,054.20" "$18,336.76" "$9,310.57" "$19,073.89" "$7,465.55" "$17,463.58" N/A N/A MS715 DRG MS-DRG V39 (FY2022) 715 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC INPATIENT ONLY "$64,810.00" "$47,959.50" "$11,769.00" "$51,847.69" "$23,623.20" "$23,623.20" "$23,623.20" "$23,623.20" "$25,005.54" "$25,005.54" "$17,896.98" "$23,166.76" "$25,005.54" "$16,766.76" "$16,766.76" "$20,090.46" "$11,769.00" "$23,166.76" "$40,008.86" "$30,056.64" "$30,324.00" "$25,005.54" "$27,613.66" "$25,005.54" "$26,255.82" "$48,607.50" "$25,005.54" "$22,555.00" "$25,005.54" "$30,324.00" "$25,775.40" "$51,329.20" "$25,005.54" "$51,847.69" "$21,000.00" "$22,063.57" "$25,005.54" "$37,589.80" "$26,255.82" "$20,265.14" "$28,510.51" "$23,166.76" "$25,005.54" N/A N/A MS717 DRG MS-DRG V39 (FY2022) 717 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC INPATIENT ONLY "$145,981.50" "$108,026.50" "$13,647.03" "$116,784.84" "$92,856.55" "$92,856.55" "$92,856.55" "$92,856.55" "$23,480.31" "$23,480.31" "$15,813.72" "$14,329.39" "$23,480.31" "$31,109.06" "$31,109.06" "$32,714.10" "$17,321.32" "$14,329.39" "$37,568.50" "$70,233.37" "$94,887.68" "$23,480.31" "$24,307.25" "$23,480.31" "$24,654.33" "$109,486.13" "$23,480.31" "$21,179.24" "$23,480.31" "$94,887.68" "$94,887.68" "$115,616.98" "$23,480.31" "$116,784.84" "$35,000.00" "$13,647.03" "$23,480.31" "$84,669.27" "$24,654.33" "$18,049.77" "$26,602.11" "$14,329.39" "$23,480.31" N/A N/A MS718 DRG MS-DRG V39 (FY2022) 718 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$70,224.00" "$51,966.00" "$9,014.09" "$56,178.84" "$24,000.52" "$24,000.52" "$24,000.52" "$24,000.52" "$19,574.05" "$19,574.05" "$9,014.09" "$13,272.61" "$19,574.05" "$16,766.76" "$16,766.76" "$20,090.46" "$11,769.00" "$13,272.61" "$31,318.48" "$17,079.47" "$18,519.00" "$19,574.05" "$20,726.56" "$19,574.05" "$20,552.75" "$52,668.00" "$19,574.05" "$17,655.79" "$19,574.05" "$19,311.64" "$16,533.79" "$55,617.06" "$19,574.05" "$56,178.84" "$21,000.00" "$12,640.58" "$19,574.05" "$40,729.92" "$20,552.75" "$12,376.00" "$21,714.55" "$13,272.61" "$19,574.05" N/A N/A MS722 DRG MS-DRG V39 (FY2022) 722 "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC" INPATIENT ONLY "$333,244.50" "$246,601.00" "$22,872.98" "$249,933.38" N/A N/A N/A N/A "$23,788.68" "$23,788.68" N/A N/A "$23,788.68" N/A N/A N/A N/A N/A N/A N/A N/A "$23,788.68" "$23,788.68" "$23,788.68" "$23,788.68" "$249,933.38" "$23,788.68" "$23,788.68" "$23,788.68" N/A N/A N/A "$23,788.68" N/A N/A N/A "$23,788.68" "$193,281.81" "$23,788.68" N/A N/A N/A "$22,872.98" N/A N/A MS723 DRG MS-DRG V39 (FY2022) 723 "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC" INPATIENT ONLY "$52,933.50" "$39,171.00" "$7,359.63" "$42,346.48" "$19,710.19" "$19,710.19" "$19,710.19" "$19,710.19" "$18,589.21" "$18,589.21" "$9,492.51" "$7,727.61" "$18,589.21" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$7,727.61" "$29,742.74" "$15,510.15" "$16,378.50" "$18,589.21" "$19,893.71" N/A "$19,518.67" "$39,700.13" "$18,589.21" "$16,767.47" "$18,589.21" "$16,378.50" "$13,921.73" "$41,923.02" "$18,589.21" "$42,346.48" "$17,500.00" "$7,359.63" "$18,589.21" "$30,701.43" "$19,518.67" "$10,945.54" "$20,482.30" "$7,727.61" "$18,589.21" N/A N/A MS725 DRG MS-DRG V39 (FY2022) 725 BENIGN PROSTATIC HYPERTROPHY WITH MCC INPATIENT ONLY "$36,646.00" "$27,118.50" "$7,161.40" "$31,880.54" "$15,618.72" "$15,618.72" "$15,618.72" "$15,618.72" "$19,925.34" "$19,925.34" "$10,523.44" "$7,519.48" "$19,925.34" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$7,519.48" "$31,880.54" "$16,814.33" "$19,282.50" "$19,925.34" "$20,585.85" "$19,925.34" "$20,921.61" "$27,484.50" "$19,925.34" "$17,972.66" "$19,925.34" "$19,282.50" "$16,390.13" "$29,023.48" "$19,925.34" "$29,316.66" "$14,000.00" "$7,161.40" "$19,925.34" "$21,254.68" "$20,921.61" "$12,886.25" "$22,154.09" "$7,519.48" "$19,925.34" N/A N/A MS726 DRG MS-DRG V39 (FY2022) 726 BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC INPATIENT ONLY "$39,590.50" "$29,297.00" "$5,139.49" "$38,237.70" "$22,537.66" "$22,537.66" "$22,537.66" "$22,537.66" "$16,193.01" "$16,193.01" "$6,273.90" "$5,396.46" "$38,237.70" "$15,403.92" "$15,403.92" "$17,335.79" "$10,812.38" "$5,396.46" "$25,908.82" "$10,384.96" "$11,170.50" "$16,193.01" "$17,173.74" "$16,193.01" "$17,002.66" "$29,692.88" "$16,193.01" "$14,606.10" "$16,193.01" "$11,170.50" "$9,494.93" "$31,355.33" "$16,193.01" "$31,672.05" "$10,500.00" "$5,139.49" "$16,193.01" "$22,962.49" "$17,002.66" "$7,465.10" "$17,484.14" "$5,396.46" "$16,193.01" N/A N/A MS727 DRG MS-DRG V39 (FY2022) 727 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC INPATIENT ONLY "$19,642.00" "$14,535.50" "$3,923.00" "$25,601.49" "$8,026.79" "$8,026.79" "$8,026.79" "$8,026.79" "$22,645.08" "$22,645.08" "$12,670.07" "$8,759.79" "$22,645.08" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$8,759.79" "$19,641.60" "$19,337.89" "$19,641.60" "$22,645.08" "$23,802.72" "$22,645.08" "$23,777.33" "$14,731.50" "$22,645.08" "$20,425.86" "$22,645.08" "$19,641.60" "$18,117.75" "$15,556.14" "$22,645.08" "$15,713.28" "$7,000.00" "$8,342.66" "$22,645.08" "$11,392.36" "$23,777.33" "$14,244.54" "$25,601.49" "$8,759.79" "$19,641.60" N/A N/A MS728 DRG MS-DRG V39 (FY2022) 728 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC INPATIENT ONLY "$34,755.00" "$25,719.00" "$1,961.50" "$27,803.61" "$4,279.74" "$4,279.74" "$4,279.74" "$4,279.74" "$16,614.00" "$16,614.00" "$7,145.94" "$7,873.31" "$16,614.00" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$7,873.31" "$26,582.40" "$11,059.26" "$12,085.50" "$16,614.00" "$17,531.59" "$16,614.00" "$17,444.70" "$26,066.25" "$16,614.00" "$14,985.83" "$16,614.00" "$12,085.50" "$10,746.58" "$27,525.54" "$16,614.00" "$27,803.61" "$3,500.00" "$7,498.39" "$16,614.00" "$20,157.90" "$17,444.70" "$8,076.58" "$18,010.89" "$7,873.31" "$16,614.00" N/A N/A MS729 DRG MS-DRG V39 (FY2022) 729 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC INPATIENT ONLY "$31,031.00" "$22,963.00" "$1,961.50" "$28,810.75" "$3,952.62" "$3,952.62" "$3,952.62" "$3,952.62" "$18,006.72" "$18,006.72" "$9,273.83" "$7,108.33" "$18,006.72" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$8,180.79" "$28,810.75" "$14,506.11" "$15,112.50" "$18,006.72" "$19,360.86" "$18,006.72" "$18,907.06" "$23,273.25" "$18,006.72" "$16,242.06" "$18,006.72" "$15,112.50" "$12,845.63" "$24,576.32" "$18,006.72" "$24,824.58" "$3,500.00" "$7,791.22" "$18,006.72" "$17,997.98" "$18,907.06" "$10,099.48" "$19,753.49" "$7,108.33" "$18,006.72" N/A N/A MS730 DRG MS-DRG V39 (FY2022) 730 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC INPATIENT ONLY "$20,832.00" "$15,416.00" "$3,923.00" "$20,831.92" "$8,324.09" "$8,324.09" "$8,324.09" "$8,324.09" "$14,979.73" "$14,979.73" "$5,944.54" "$5,123.04" "$14,979.73" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$5,123.04" "$20,831.92" "$8,826.41" "$8,533.50" "$14,979.73" "$16,346.61" "$14,979.73" "$15,728.72" "$15,624.00" "$14,979.73" "$13,511.72" "$14,979.73" "$9,193.60" "$7,913.58" "$16,498.87" "$14,979.73" "$16,665.53" "$7,000.00" "$4,879.09" "$14,979.73" "$12,082.56" "$15,728.72" "$5,702.83" "$15,966.07" "$5,123.04" "$14,979.73" N/A N/A MS734 DRG MS-DRG V39 (FY2022) 734 "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC" INPATIENT ONLY "$244,435.00" "$180,882.00" "$17,162.86" "$195,547.81" "$156,500.73" "$156,500.73" "$156,500.73" "$156,500.73" "$26,404.48" "$26,404.48" "$39,954.96" "$18,021.01" "$26,404.48" "$118,072.90" "$118,072.90" "$126,246.78" "$80,356.86" "$18,021.01" "$42,247.17" "$120,286.78" "$158,882.60" "$26,404.48" "$27,270.81" "$26,404.48" "$27,724.70" "$183,326.25" "$26,404.48" "$23,816.84" "$26,404.48" "$158,882.60" "$158,882.60" "$193,592.34" "$26,404.48" "$195,547.81" "$141,772.16" "$17,162.86" "$26,404.48" "$141,772.30" "$27,724.70" "$25,053.81" "$30,260.88" "$18,021.01" "$26,404.48" N/A N/A MS736 DRG MS-DRG V39 (FY2022) 736 UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC INPATIENT ONLY "$342,582.50" "$253,511.50" "$27,707.55" "$274,065.92" "$219,502.76" "$219,502.76" "$219,502.76" "$219,502.76" N/A N/A N/A "$40,661.55" N/A "$191,315.22" "$191,315.22" N/A "$133,708.99" N/A N/A "$167,463.05" N/A "$40,458.70" N/A N/A "$42,481.64" "$256,936.88" N/A N/A N/A "$222,678.57" "$222,678.57" "$271,325.27" "$40,458.70" "$274,065.92" N/A "$27,707.55" "$40,458.70" "$198,697.85" "$42,481.64" N/A N/A "$40,661.55" "$40,458.70" N/A N/A MS737 DRG MS-DRG V39 (FY2022) 737 UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC INPATIENT ONLY "$307,945.50" "$227,880.00" "$22,782.21" "$246,356.39" "$197,038.09" "$197,038.09" "$197,038.09" "$197,038.09" "$25,257.44" "$25,257.44" "$52,275.41" "$45,514.84" "$25,257.44" "$149,688.69" "$149,688.69" "$157,459.41" "$103,781.33" "$45,514.84" "$40,411.90" "$152,128.38" "$200,164.57" "$25,257.44" "$26,115.83" "$25,257.44" "$26,520.31" "$230,959.13" "$25,257.44" "$22,782.21" "$25,257.44" "$200,164.57" "$200,164.57" "$243,892.84" "$25,257.44" "$246,356.39" "$178,608.38" "$34,305.19" "$25,257.44" "$178,608.39" "$26,520.31" "$39,571.94" "$28,825.69" "$45,514.84" "$25,257.44" N/A N/A MS738 DRG MS-DRG V39 (FY2022) 738 UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$264,778.00" "$195,936.00" "$19,157.92" "$211,822.24" "$169,672.32" "$169,672.32" "$169,672.32" "$169,672.32" "$21,239.38" "$21,239.38" "$40,125.11" "$41,999.02" "$21,239.38" "$119,416.26" "$119,416.26" "$125,615.47" "$81,713.89" "$41,999.02" "$33,983.01" "$131,351.71" "$172,105.56" "$21,239.38" "$21,689.41" "$21,239.38" "$22,301.35" "$198,583.50" "$21,239.38" "$19,157.92" "$21,239.38" "$172,105.56" "$172,105.56" "$209,704.02" "$21,239.38" "$211,822.24" "$153,540.09" "$32,437.74" "$21,239.38" "$153,571.24" "$22,301.35" "$28,310.38" "$23,798.23" "$41,999.02" "$21,239.38" N/A N/A MS740 DRG MS-DRG V39 (FY2022) 740 UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC INPATIENT ONLY "$261,018.00" "$193,153.50" "$21,185.45" "$208,814.33" "$166,784.56" "$166,784.56" "$166,784.56" "$166,784.56" "$23,487.20" "$23,487.20" "$40,406.70" "$45,518.90" "$23,487.20" "$115,305.16" "$115,305.16" "$121,284.96" "$78,704.98" "$45,518.90" "$37,579.52" "$129,162.93" "$169,661.64" "$23,487.20" "$24,536.54" "$23,487.20" "$24,661.56" "$195,763.50" "$23,487.20" "$21,185.45" "$23,487.20" "$169,661.64" "$169,661.64" "$206,726.18" "$23,487.20" "$208,814.33" "$151,390.38" "$35,818.28" "$23,487.20" "$151,390.44" "$24,661.56" "$28,084.17" "$26,610.73" "$45,518.90" "$23,487.20" N/A N/A MS741 DRG MS-DRG V39 (FY2022) 741 UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$273,480.00" "$202,375.50" "$17,937.79" "$218,783.61" "$175,475.26" "$175,475.26" "$175,475.26" "$175,475.26" "$19,886.68" "$19,886.68" "$41,764.06" "$41,838.25" "$19,886.68" "$126,611.10" "$126,611.10" "$133,183.81" "$86,958.65" "$41,838.25" "$31,818.69" "$132,529.44" "$173,435.28" "$19,886.68" "$21,040.14" "$19,886.68" "$20,881.01" "$205,110.00" "$19,886.68" "$17,937.79" "$19,886.68" "$177,761.68" "$177,761.68" "$216,595.79" "$19,886.68" "$218,783.61" "$158,618.12" "$32,083.03" "$19,886.68" "$158,618.40" "$20,881.01" "$29,952.24" "$22,105.72" "$41,838.25" "$19,886.68" N/A N/A MS742 DRG MS-DRG V39 (FY2022) 742 UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC INPATIENT ONLY "$183,161.50" "$135,540.00" "$16,293.31" "$146,528.84" "$117,451.51" "$117,451.51" "$117,451.51" "$117,451.51" "$22,910.93" "$22,910.93" "$22,812.85" "$23,061.99" "$22,910.93" "$60,348.09" "$60,348.09" "$63,480.92" "$38,655.45" "$23,061.99" "$36,657.49" "$90,871.42" "$119,054.68" "$22,910.93" "$24,534.41" "$22,910.93" "$24,056.48" "$137,371.13" "$22,910.93" "$20,665.66" "$22,910.93" "$119,054.68" "$119,054.68" "$145,063.57" "$22,910.93" "$146,528.84" "$106,233.41" "$16,293.31" "$22,910.93" "$106,233.67" "$24,056.48" "$17,222.76" "$25,889.70" "$23,061.99" "$22,910.93" N/A N/A MS743 DRG MS-DRG V39 (FY2022) 743 UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC INPATIENT ONLY "$189,784.50" "$140,441.00" "$11,355.54" "$151,827.48" "$121,552.31" "$121,552.31" "$121,552.31" "$121,552.31" "$18,871.49" "$18,871.49" "$22,442.16" "$21,856.93" "$18,871.49" "$64,619.33" "$64,619.33" "$67,973.88" "$41,769.02" "$21,856.93" "$30,194.38" "$94,223.95" "$123,359.82" "$18,871.49" "$20,023.72" "$18,871.49" "$19,815.06" "$142,338.38" "$18,871.49" "$17,022.08" "$18,871.49" "$123,359.82" "$123,359.82" "$150,309.22" "$18,871.49" "$151,827.48" "$110,074.92" "$14,992.19" "$18,871.49" "$110,075.01" "$19,815.06" "$11,355.54" "$20,835.49" "$21,856.93" "$18,871.49" N/A N/A MS744 DRG MS-DRG V39 (FY2022) 744 "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC" INPATIENT ONLY "$107,012.00" "$79,189.00" "$2,561.97" "$85,609.36" "$25,030.60" "$25,030.60" "$25,030.60" "$25,030.60" "$23,444.42" "$23,444.42" "$15,605.75" "$11,284.89" "$23,444.42" "$2,561.97" "$2,561.97" "$2,692.84" "$11,881.27" "$11,284.89" "$37,511.07" "$25,549.22" "$69,557.61" "$23,444.42" "$25,221.54" "$23,444.42" "$24,616.64" "$80,259.00" "$23,444.42" "$21,146.87" "$23,444.42" "$28,982.62" "$69,557.61" "$84,753.29" "$23,444.42" "$85,609.36" "$21,000.00" "$10,747.51" "$23,444.42" "$62,066.96" "$24,616.64" "$17,997.63" "$26,557.22" "$11,284.89" "$23,444.42" N/A N/A MS745 DRG MS-DRG V39 (FY2022) 745 "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC" INPATIENT ONLY "$23,299.00" "$17,241.50" "$1,961.50" "$23,298.92" "$3,923.46" "$3,923.46" "$3,923.46" "$3,923.46" "$19,128.23" "$19,128.23" "$8,526.75" "$5,337.18" "$19,128.23" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$7,240.38" "$23,298.92" "$15,488.62" "$17,550.00" "$19,128.23" "$19,882.29" "$19,128.23" "$20,084.64" "$17,474.25" "$19,128.23" "$17,253.66" "$19,128.23" "$17,550.00" "$14,917.50" "$18,452.76" "$19,128.23" "$18,639.14" "$3,500.00" "$6,895.60" "$19,128.23" "$13,513.42" "$20,084.64" "$11,728.45" "$21,156.73" "$5,337.18" "$19,128.23" N/A N/A MS746 DRG MS-DRG V39 (FY2022) 746 "VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC" INPATIENT ONLY "$138,304.00" "$102,345.00" "$10,287.98" "$110,642.85" "$87,898.65" "$87,898.65" "$87,898.65" "$87,898.65" N/A N/A N/A "$10,802.39" N/A "$25,493.39" "$25,493.39" N/A "$13,224.61" N/A N/A N/A N/A "$22,175.24" N/A N/A "$23,284.00" "$103,728.00" N/A N/A N/A "$89,897.32" "$89,897.32" "$109,536.44" "$22,175.24" "$110,642.85" N/A "$10,287.98" "$22,175.24" "$80,216.32" "$23,284.00" N/A N/A N/A "$22,175.24" N/A N/A MS749 DRG MS-DRG V39 (FY2022) 749 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC INPATIENT ONLY "$105,915.50" "$78,377.50" "$15,704.95" "$84,732.16" "$33,828.83" "$33,828.83" "$33,828.83" "$33,828.83" "$29,782.75" "$29,782.75" N/A "$18,800.58" "$29,782.75" "$22,374.12" "$22,374.12" "$39,200.00" "$15,704.95" "$18,800.58" "$47,652.40" "$34,000.13" "$68,844.88" "$29,782.75" N/A N/A "$31,271.89" "$79,436.63" N/A "$26,864.04" N/A "$42,656.24" "$36,550.19" "$83,884.84" "$29,782.75" "$84,732.16" "$29,098.00" "$17,905.31" "$29,782.75" "$61,430.99" "$31,271.89" "$27,203.95" "$34,487.83" "$18,800.58" "$29,782.75" N/A N/A MS754 DRG MS-DRG V39 (FY2022) 754 "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC" INPATIENT ONLY "$284,299.00" "$210,381.50" "$23,656.98" "$213,224.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$213,224.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,656.98" "$164,893.42" N/A N/A N/A N/A N/A N/A N/A MS755 DRG MS-DRG V39 (FY2022) 755 "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC" INPATIENT ONLY "$42,734.00" "$31,623.50" "$1,961.50" "$34,186.90" "$4,270.00" "$4,270.00" "$4,270.00" "$4,270.00" "$18,847.32" "$18,847.32" "$9,877.21" "$9,789.16" "$18,847.32" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$10,971.74" "$30,155.71" "$14,550.52" "$16,939.50" "$18,847.32" "$19,384.43" "$18,847.32" "$19,789.69" "$32,050.50" "$18,847.32" "$17,000.28" "$18,847.32" "$16,939.50" "$14,398.58" "$33,845.03" "$18,847.32" "$34,186.90" "$3,500.00" "$10,449.27" "$18,847.32" "$24,785.72" "$19,789.69" "$11,320.45" "$20,805.26" "$9,789.16" "$18,847.32" N/A N/A MS756 DRG MS-DRG V39 (FY2022) 756 "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC" INPATIENT ONLY "$13,131.00" "$9,717.00" "$1,961.50" "$18,984.09" "$3,965.92" "$3,965.92" "$3,965.92" "$3,965.92" "$17,391.81" "$17,391.81" "$5,937.40" "$3,007.88" "$17,391.81" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,764.50" "$13,130.59" "$13,010.59" "$13,130.59" "$17,391.81" "$18,782.30" "$17,391.81" "$18,261.40" "$9,848.25" "$17,391.81" "$15,687.41" "$17,391.81" "$13,130.59" "$11,709.60" "$10,399.42" "$17,391.81" "$10,504.47" "$3,500.00" "$6,442.38" "$17,391.81" "$7,615.98" "$18,261.40" "$9,206.32" "$18,984.09" "$3,007.88" "$13,130.59" N/A N/A MS757 DRG MS-DRG V39 (FY2022) 757 "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC" INPATIENT ONLY "$68,073.00" "$50,374.50" "$8,991.40" "$54,458.25" "$28,407.80" "$28,407.80" "$28,407.80" "$28,407.80" "$23,491.01" "$23,491.01" "$13,742.95" "$9,440.97" "$23,491.01" "$19,561.22" "$19,561.22" "$23,438.87" "$13,730.50" "$9,440.97" "$37,585.62" "$18,468.44" "$22,870.50" "$23,491.01" "$23,256.88" "$23,491.01" "$24,665.56" "$51,054.75" "$23,491.01" "$21,188.89" "$23,491.01" "$24,292.92" "$20,862.35" "$53,913.67" "$23,491.01" "$54,458.25" "$24,500.00" "$8,991.40" "$23,491.01" "$39,482.34" "$24,665.56" "$15,284.05" "$26,663.17" "$9,440.97" "$23,491.01" N/A N/A MS758 DRG MS-DRG V39 (FY2022) 758 "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC" INPATIENT ONLY "$22,600.50" "$16,724.50" "$7,265.92" "$22,600.29" "$16,212.00" "$16,212.00" "$16,212.00" "$16,212.00" "$17,745.84" "$17,745.84" "$9,388.08" "$7,629.22" "$17,745.84" "$10,530.81" "$10,530.81" "$10,935.84" "$7,391.82" "$7,629.22" "$22,600.29" "$12,860.07" "$14,545.50" "$17,745.84" "$18,487.29" N/A "$18,633.13" "$16,950.38" "$17,745.84" "$16,006.75" "$17,745.84" "$14,545.50" "$12,363.68" "$17,899.43" "$17,745.84" "$18,080.23" N/A "$7,265.92" "$17,745.84" "$13,108.29" "$18,633.13" "$9,720.57" "$19,427.07" "$7,629.22" "$17,745.84" N/A N/A MS759 DRG MS-DRG V39 (FY2022) 759 "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC" INPATIENT ONLY "$40,393.00" "$29,891.00" "$3,923.00" "$32,314.29" "$8,087.34" "$8,087.34" "$8,087.34" "$8,087.34" "$15,769.95" "$15,769.95" "$6,186.42" "$5,805.17" "$15,769.95" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$5,805.17" "$25,231.92" "$8,349.96" "$10,251.00" "$15,769.95" "$16,093.74" N/A "$16,558.45" "$30,294.75" "$15,769.95" "$14,224.49" "$15,769.95" "$10,251.00" "$8,713.35" "$31,991.13" "$15,769.95" "$32,314.29" "$7,000.00" "$5,528.73" "$15,769.95" "$23,427.94" "$16,558.45" "$6,850.61" "$16,954.80" "$5,805.17" "$15,769.95" N/A N/A MS760 DRG MS-DRG V39 (FY2022) 760 MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC INPATIENT ONLY "$39,644.00" "$29,337.00" "$6,633.40" "$31,715.20" "$15,858.23" "$15,858.23" "$15,858.23" "$15,858.23" "$17,403.54" "$17,403.54" "$7,496.72" "$6,965.07" "$17,403.54" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$6,965.07" "$27,845.66" "$13,009.47" "$13,801.50" "$17,403.54" "$18,566.59" N/A "$18,273.72" "$29,733.00" "$17,403.54" "$15,697.99" "$17,403.54" "$13,801.50" "$11,731.28" "$31,398.04" "$17,403.54" "$31,715.20" "$14,000.00" "$6,633.40" "$17,403.54" "$22,993.52" "$18,273.72" "$9,223.36" "$18,998.77" "$6,965.07" "$17,403.54" N/A N/A MS761 DRG MS-DRG V39 (FY2022) 761 MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$22,727.50" "$16,818.50" "$1,961.50" "$22,727.18" "$4,173.07" "$4,173.07" "$4,173.07" "$4,173.07" "$15,130.86" "$15,130.86" "$4,452.15" "$5,206.21" "$15,130.86" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$5,424.85" "$22,727.18" "$7,613.76" "$8,862.00" "$15,130.86" "$15,703.03" "$15,130.86" "$15,887.40" "$17,045.63" "$15,130.86" "$13,648.04" "$15,130.86" "$8,862.00" "$7,532.70" "$17,999.91" "$15,130.86" "$18,181.74" "$3,500.00" "$5,166.52" "$15,130.86" "$13,181.95" "$15,887.40" "$5,922.37" "$16,155.17" "$5,206.21" "$15,130.86" N/A N/A MS768 DRG MS-DRG V39 (FY2022) 768 VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C INPATIENT ONLY "$27,414.50" "$20,287.00" "$3,861.00" "$26,748.62" "$13,144.44" "$13,144.44" "$13,144.44" "$13,144.44" "$19,125.46" "$19,125.46" "$3,861.00" "$8,137.96" "$19,125.46" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$8,137.96" "$26,748.62" "$15,434.78" "$17,544.00" "$19,125.46" "$19,853.71" N/A "$20,081.73" "$20,560.88" "$19,125.46" "$17,251.16" "$19,125.46" "$19,338.76" "$16,707.16" "$21,184.90" "$19,125.46" "$21,398.90" "$10,500.00" "$7,808.09" "$19,125.46" "$15,900.41" "$20,081.73" "$11,724.43" "$21,153.27" "$8,137.96" "$19,125.46" N/A N/A MS769 DRG MS-DRG V39 (FY2022) 769 POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES INPATIENT ONLY "$31,709.50" "$23,465.50" "$9,807.50" "$31,709.20" "$19,566.20" "$19,566.20" "$19,566.20" "$19,566.20" "$22,217.33" "$22,217.33" "$16,896.41" "$12,300.04" "$22,217.33" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$12,300.04" "$31,709.20" "$22,359.44" "$24,264.00" "$22,217.33" "$23,528.70" N/A "$23,328.20" "$23,782.13" "$22,217.33" "$20,040.03" "$22,217.33" "$24,264.00" "$20,624.40" "$25,113.68" "$22,217.33" "$25,367.36" "$17,500.00" "$11,714.32" "$22,217.33" "$18,391.51" "$23,328.20" "$16,215.32" "$25,021.86" "$12,300.04" "$22,217.33" N/A N/A MS770 DRG MS-DRG V39 (FY2022) 770 "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY" INPATIENT ONLY "$35,082.00" "$25,961.00" "$1,961.50" "$28,065.54" "$4,024.65" "$4,024.65" "$4,024.65" "$4,024.65" "$17,194.44" "$17,194.44" "$7,166.47" "$6,129.68" "$17,194.44" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,129.68" "$27,511.10" "$11,652.80" "$13,347.00" "$17,194.44" "$17,846.58" N/A "$18,054.16" "$26,311.50" "$17,194.44" "$15,509.38" "$17,194.44" "$13,347.00" "$11,344.95" "$27,784.90" "$17,194.44" "$28,065.54" "$3,500.00" "$5,837.79" "$17,194.44" "$20,347.56" "$18,054.16" "$8,919.63" "$18,737.14" "$6,129.68" "$17,194.44" N/A N/A MS776 DRG MS-DRG V39 (FY2022) 776 POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES INPATIENT ONLY "$15,588.00" "$11,535.50" "$3,923.00" "$17,741.47" "$7,784.00" "$7,784.00" "$7,784.00" "$7,784.00" "$16,398.68" "$16,398.68" "$7,245.02" "$6,136.30" "$16,398.68" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$6,136.30" "$15,588.00" "$9,382.27" "$11,617.50" "$16,398.68" "$16,641.60" N/A "$17,218.61" "$11,691.00" "$16,398.68" "$14,791.61" "$16,398.68" "$11,617.50" "$9,874.88" "$12,345.69" "$16,398.68" "$12,470.40" "$7,000.00" "$5,844.09" "$16,398.68" "$9,041.04" "$17,218.61" "$7,763.82" "$17,741.47" "$6,136.30" "$15,588.00" N/A N/A MS779 DRG MS-DRG V39 (FY2022) 779 ABORTION WITHOUT D&C INPATIENT ONLY "$14,532.00" "$10,754.00" "$1,961.50" "$20,198.21" "$3,903.66" "$3,903.66" "$3,903.66" "$3,903.66" "$18,362.15" "$18,362.15" "$5,702.65" "$3,328.82" "$18,362.15" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$5,080.47" "$14,531.64" "$13,709.34" "$14,531.64" "$18,362.15" "$18,938.01" "$18,362.15" "$19,280.26" "$10,899.00" "$18,362.15" "$16,562.66" "$18,362.15" "$14,531.64" "$13,502.25" "$11,509.07" "$18,362.15" "$11,625.32" "$3,500.00" "$4,838.54" "$18,362.15" "$8,428.56" "$19,280.26" "$10,615.74" "$20,198.21" "$3,328.82" "$14,531.64" N/A N/A MS783 DRG MS-DRG V39 (FY2022) 783 CESAREAN SECTION WITH STERILIZATION WITH MCC INPATIENT ONLY "$78,051.00" "$57,758.00" "$9,042.76" "$122,056.26" "$27,968.55" "$27,968.55" "$27,968.55" "$27,968.55" "$23,993.08" "$23,993.08" "$122,056.26" "$9,494.90" "$23,993.08" "$19,561.22" "$19,561.22" "$23,438.87" "$13,730.50" "$9,494.90" "$38,388.93" "$25,971.83" "$28,123.50" "$23,993.08" "$25,445.81" N/A "$25,192.73" "$58,538.25" "$23,993.08" N/A "$23,993.08" "$29,009.06" "$24,790.53" "$61,816.27" "$23,993.08" "$62,440.67" "$24,500.00" "$9,042.76" "$23,993.08" "$45,269.58" "$25,192.73" "$18,794.58" "$27,243.70" "$9,494.90" "$23,993.08" N/A N/A MS784 DRG MS-DRG V39 (FY2022) 784 CESAREAN SECTION WITH STERILIZATION WITH CC INPATIENT ONLY "$60,562.50" "$44,816.50" "$5,424.00" "$48,449.81" "$11,896.09" "$11,896.09" "$11,896.09" "$11,896.09" "$18,616.81" "$18,616.81" "$5,424.00" "$9,494.90" "$18,616.81" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$9,494.90" "$29,786.90" "$14,051.20" "$16,438.50" "$18,616.81" "$19,119.44" "$18,616.81" "$19,547.65" "$45,421.88" "$18,616.81" "$16,792.36" "$18,616.81" "$16,438.50" "$13,972.73" "$47,965.31" "$18,616.81" "$48,449.81" "$10,500.00" "$9,042.76" "$18,616.81" "$35,126.25" "$19,547.65" "$10,985.63" "$20,516.84" "$9,494.90" "$18,616.81" N/A N/A MS785 DRG MS-DRG V39 (FY2022) 785 CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC INPATIENT ONLY "$57,714.50" "$42,709.00" "$3,923.00" "$46,171.22" "$8,003.12" "$8,003.12" "$8,003.12" "$8,003.12" "$17,380.78" "$17,380.78" N/A "$7,737.07" "$17,380.78" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$7,737.07" "$27,809.25" "$12,275.95" "$13,752.00" "$17,380.78" "$18,177.30" "$17,380.78" "$18,249.82" "$43,285.88" "$17,380.78" "$15,677.46" "$17,380.78" "$13,752.00" "$11,689.20" "$45,709.55" "$17,380.78" "$46,171.22" "$7,000.00" "$7,368.64" "$17,380.78" "$33,474.41" "$18,249.82" "$9,190.28" "$18,970.29" "$7,737.07" "$17,380.78" N/A N/A MS786 DRG MS-DRG V39 (FY2022) 786 CESAREAN SECTION WITHOUT STERILIZATION WITH MCC INPATIENT ONLY "$72,309.00" "$53,509.00" "$7,050.47" "$57,846.99" "$17,812.09" "$17,812.09" "$17,812.09" "$17,812.09" "$22,057.21" "$22,057.21" "$7,050.47" "$9,494.90" "$22,057.21" "$12,292.95" "$12,292.95" "$14,551.74" "$8,628.82" "$9,494.90" "$35,291.54" "$21,736.29" "$23,916.00" "$22,057.21" "$23,197.98" N/A "$23,160.07" "$54,231.75" "$22,057.21" "$19,895.60" "$22,057.21" "$26,658.78" "$23,071.38" "$57,268.51" "$22,057.21" "$57,846.99" "$14,000.00" "$9,042.76" "$22,057.21" "$41,939.22" "$23,160.07" "$15,982.74" "$24,821.52" "$9,494.90" "$22,057.21" N/A N/A MS787 DRG MS-DRG V39 (FY2022) 787 CESAREAN SECTION WITHOUT STERILIZATION WITH CC INPATIENT ONLY "$60,017.50" "$44,413.00" "$5,884.50" "$48,013.92" "$12,989.23" "$12,989.23" "$12,989.23" "$12,989.23" "$18,399.43" "$18,399.43" "$9,500.59" "$9,494.90" "$18,399.43" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$9,494.90" "$29,439.09" "$14,337.87" "$15,966.00" "$18,399.43" "$19,271.57" "$18,399.43" "$19,319.40" "$45,013.13" "$18,399.43" "$16,596.29" "$18,399.43" "$17,571.05" "$15,176.15" "$47,533.79" "$18,399.43" "$48,013.92" "$10,500.00" "$9,042.76" "$18,399.43" "$34,810.15" "$19,319.40" "$10,669.88" "$20,244.84" "$9,494.90" "$18,399.43" N/A N/A MS788 DRG MS-DRG V39 (FY2022) 788 CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC INPATIENT ONLY "$53,270.50" "$39,420.50" "$3,923.00" "$42,616.17" "$8,248.11" "$8,248.11" "$8,248.11" "$8,248.11" "$17,177.86" "$17,177.86" "$7,920.73" "$7,737.07" "$17,177.86" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$7,737.07" "$27,484.58" "$11,741.63" "$13,311.00" "$17,177.86" "$17,893.72" N/A "$18,036.75" "$39,952.88" "$17,177.86" "$15,494.43" "$17,177.86" "$13,878.24" "$11,881.59" "$42,190.03" "$17,177.86" "$42,616.17" "$7,000.00" "$7,368.64" "$17,177.86" "$30,896.89" "$18,036.75" "$8,895.58" "$18,716.40" "$7,737.07" "$17,177.86" N/A N/A MS789 DRG MS-DRG V39 (FY2022) 789 "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY" INPATIENT ONLY "$78,344.00" "$57,975.00" "$6,348.00" "$62,674.87" "$16,612.18" "$16,612.18" "$16,612.18" "$16,612.18" "$22,924.05" "$22,924.05" "$6,348.00" "$18,997.58" "$22,924.05" "$14,041.08" "$14,041.08" "$14,581.12" "$9,855.76" "$18,997.58" "$36,678.48" "$24,573.44" "$25,800.00" "$22,924.05" "$24,703.67" "$22,924.05" "$24,070.25" "$58,758.00" "$22,924.05" "$20,677.49" "$22,924.05" "$25,800.00" "$21,930.00" "$62,048.10" "$22,924.05" "$62,674.87" "$14,400.00" "$18,096.45" N/A "$45,439.52" "$24,070.25" "$17,241.80" "$25,906.12" "$18,997.58" "$22,924.05" N/A N/A MS790 DRG MS-DRG V39 (FY2022) 790 "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE" INPATIENT ONLY "$238,944.50" "$176,819.00" "$22,610.90" "$193,895.98" "$122,527.58" "$122,527.58" "$122,527.58" "$122,527.58" N/A N/A "$122,527.58" "$62,512.83" N/A "$159,646.35" "$159,646.35" "$193,895.98" "$127,538.80" "$105,986.26" "$122,527.58" "$122,527.58" "$122,527.58" N/A N/A N/A "$52,709.42" "$179,208.38" N/A N/A N/A "$122,527.58" "$122,527.58" "$189,244.03" "$50,199.45" "$191,155.58" "$122,527.58" "$22,610.90" "$50,199.45" "$138,587.81" "$52,709.42" "$122,527.58" "$122,527.58" "$62,512.83" N/A N/A N/A MS791 DRG MS-DRG V39 (FY2022) 791 PREMATURITY WITH MAJOR PROBLEMS INPATIENT ONLY "$86,765.00" "$64,206.50" "$2,624.83" "$69,311.54" "$54,818.08" "$54,818.08" "$54,818.08" "$54,818.08" "$37,788.49" "$37,788.49" "$22,062.00" "$2,752.37" "$37,788.49" "$45,045.36" "$45,045.36" "$46,777.89" "$31,618.38" "$2,752.37" "$60,461.58" "$55,344.75" "$58,107.00" "$37,788.49" "$41,034.28" "$37,788.49" "$39,677.91" "$65,073.75" "$37,788.49" "$34,085.22" "$37,788.49" "$58,107.00" "$49,390.95" "$68,618.42" "$37,788.49" "$69,311.54" "$49,650.00" "$2,624.83" "$37,788.49" "$50,323.70" "$39,677.91" "$38,832.15" "$44,504.73" "$2,752.37" "$37,788.49" N/A N/A MS792 DRG MS-DRG V39 (FY2022) 792 PREMATURITY WITHOUT MAJOR PROBLEMS INPATIENT ONLY "$8,673.50" "$6,418.50" "$1,367.40" "$31,237.53" "$3,525.08" "$3,525.08" "$3,525.08" "$3,525.08" "$27,185.03" "$27,185.03" "$2,012.00" "$5,601.98" "$27,185.03" "$1,948.08" "$1,948.08" "$2,023.02" "$1,367.40" "$5,601.98" "$8,548.20" "$9,484.20" "$8,548.20" "$27,185.03" "$29,385.08" "$27,185.03" "$28,544.28" "$6,505.13" "$27,185.03" "$24,520.90" "$27,185.03" "$8,548.20" "$8,548.20" "$6,770.17" "$27,185.03" "$6,838.56" "$4,300.00" "$5,338.74" "$27,185.03" "$5,030.63" "$28,544.28" "$8,548.20" "$31,237.53" "$5,601.98" "$8,548.20" N/A N/A MS793 DRG MS-DRG V39 (FY2022) 793 FULL TERM NEONATE WITH MAJOR PROBLEMS INPATIENT ONLY "$21,432.00" "$15,860.00" "$2,624.83" "$45,414.89" "$19,624.00" "$19,624.00" "$19,624.00" "$19,624.00" "$38,515.91" "$38,515.91" "$11,066.00" "$2,752.37" "$38,515.91" "$10,714.44" "$10,714.44" "$11,126.61" "$7,520.70" "$2,752.37" "$21,431.58" "$24,702.58" "$21,431.58" "$38,515.91" "$41,833.57" N/A "$40,441.71" "$16,074.00" "$38,515.91" "$34,741.35" "$38,515.91" "$21,431.58" "$21,431.58" "$16,973.80" "$38,515.91" "$17,145.26" "$21,431.58" "$2,624.83" "$38,515.91" "$12,430.56" "$40,441.71" "$21,431.58" "$45,414.89" "$2,752.37" "$21,431.58" N/A N/A MS794 DRG MS-DRG V39 (FY2022) 794 NEONATE WITH OTHER SIGNIFICANT PROBLEMS INPATIENT ONLY "$7,163.00" "$5,301.00" "$2,051.10" "$23,215.35" "$5,282.08" "$5,282.08" "$5,282.08" "$5,282.08" "$20,773.53" "$20,773.53" "$3,018.00" "$2,752.37" "$20,773.53" "$2,922.12" "$2,922.12" "$3,034.53" "$2,051.10" "$2,752.37" "$7,037.27" "$7,446.27" "$7,037.27" "$20,773.53" "$22,341.56" N/A "$21,812.21" "$5,372.25" "$20,773.53" "$18,737.72" "$20,773.53" "$7,037.27" "$7,037.27" "$5,573.52" "$20,773.53" "$5,629.81" "$6,450.00" "$2,624.83" "$20,773.53" "$4,154.54" "$21,812.21" "$7,037.27" "$23,215.35" "$2,752.37" "$7,037.27" N/A N/A MS795 DRG MS-DRG V39 (FY2022) 795 NORMAL NEWBORN INPATIENT ONLY "$5,415.00" "$4,007.50" "$1,518.00" "$13,108.04" "$5,275.72" "$5,275.72" "$5,275.72" "$5,275.72" "$12,369.58" "$12,369.58" "$1,518.00" "$2,139.31" "$12,369.58" "$2,922.12" "$2,922.12" "$3,034.53" "$2,051.10" "$2,139.31" "$5,289.27" "$2,724.10" "$2,860.50" "$12,369.58" "$13,108.04" "$6,676.64" "$12,988.06" "$4,061.25" "$12,369.58" "$11,157.36" "$12,369.58" "$2,860.50" "$2,431.43" "$4,189.10" "$12,369.58" "$4,231.41" "$5,289.27" "$2,040.96" "$12,369.58" "$3,140.70" "$12,988.06" "$1,911.64" "$12,700.21" "$2,139.31" "$5,289.27" N/A N/A MS796 DRG MS-DRG V39 (FY2022) 796 VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC INPATIENT ONLY "$90,450.50" "$66,933.50" "$7,846.00" "$72,360.37" "$15,992.18" "$15,992.18" "$15,992.18" "$15,992.18" "$18,443.58" "$18,443.58" N/A "$8,324.59" "$18,443.58" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$8,324.59" "$29,509.73" "$17,671.67" "$16,062.00" "$18,443.58" "$21,040.86" N/A "$19,365.76" "$67,837.88" "$18,443.58" "$16,636.11" "$18,443.58" "$16,062.00" "$14,171.15" "$71,636.75" "$18,443.58" "$72,360.37" "$14,000.00" "$7,928.18" "$18,443.58" "$52,461.29" "$19,365.76" "$10,734.03" "$20,300.09" "$8,324.59" "$18,443.58" N/A N/A MS797 DRG MS-DRG V39 (FY2022) 797 VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC INPATIENT ONLY "$44,740.50" "$33,108.00" "$3,923.00" "$35,792.28" "$8,009.68" "$8,009.68" "$8,009.68" "$8,009.68" "$17,398.70" "$17,398.70" N/A "$8,324.59" "$17,398.70" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$8,324.59" "$27,837.92" "$12,488.61" "$13,791.00" "$17,398.70" "$18,290.16" N/A "$18,268.64" "$33,555.38" "$17,398.70" "$15,693.63" "$17,398.70" "$13,791.00" "$11,722.35" "$35,434.35" "$17,398.70" "$35,792.28" "$7,000.00" "$7,928.18" "$17,398.70" "$25,949.49" "$18,268.64" "$9,216.35" "$18,992.71" "$8,324.59" "$17,398.70" N/A N/A MS798 DRG MS-DRG V39 (FY2022) 798 VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC INPATIENT ONLY "$41,689.50" "$30,850.50" "$3,923.00" "$33,351.35" "$7,987.50" "$7,987.50" "$7,987.50" "$7,987.50" "$16,764.47" "$16,764.47" N/A "$8,324.59" "$16,764.47" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$8,324.59" "$26,823.15" "$12,488.61" "$12,412.50" "$16,764.47" "$18,290.16" N/A "$17,602.69" "$31,267.13" "$16,764.47" "$15,121.55" "$16,764.47" "$12,412.50" "$10,550.63" "$33,017.84" "$16,764.47" "$33,351.35" "$7,000.00" "$7,928.18" "$16,764.47" "$24,179.91" "$17,602.69" "$8,295.10" "$18,199.16" "$8,324.59" "$16,764.47" N/A N/A MS799 DRG MS-DRG V39 (FY2022) 799 SPLENECTOMY WITH MCC INPATIENT ONLY "$202,050.00" "$149,517.00" "$21,424.38" "$161,640.00" "$116,883.80" "$116,883.80" "$116,883.80" "$116,883.80" "$46,578.24" "$46,578.24" "$44,745.58" "$29,072.43" "$46,578.24" "$81,234.15" "$81,234.15" "$85,351.52" "$55,604.54" "$29,072.43" "$74,525.18" "$98,791.38" "$131,332.50" "$46,578.24" "$48,859.96" N/A "$48,907.15" "$151,537.50" "$46,578.24" "$42,013.57" "$46,578.24" "$131,332.50" "$131,332.50" "$160,023.61" "$46,578.24" "$161,640.00" "$132,578.55" "$21,424.38" "$46,578.24" "$117,189.00" "$48,907.15" "$51,599.11" "$55,502.60" "$29,072.43" "$46,578.24" N/A N/A MS800 DRG MS-DRG V39 (FY2022) 800 SPLENECTOMY WITH CC INPATIENT ONLY "$319,729.00" "$236,599.50" "$30,651.50" "$255,782.90" N/A N/A N/A N/A "$30,651.50" "$30,651.50" N/A N/A "$30,651.50" N/A N/A N/A N/A N/A N/A N/A N/A "$30,651.50" "$30,651.50" "$30,651.50" "$30,651.50" "$239,796.75" "$30,651.50" "$30,651.50" "$30,651.50" N/A N/A "$253,225.06" "$30,651.50" "$255,782.90" N/A N/A "$31,439.80" "$185,442.82" "$30,651.50" N/A N/A N/A "$31,439.80" N/A N/A MS801 DRG MS-DRG V39 (FY2022) 801 SPLENECTOMY WITHOUT CC/MCC INPATIENT ONLY "$172,933.00" "$127,970.50" "$12,661.30" "$138,346.09" "$110,876.71" "$110,876.71" "$110,876.71" "$110,876.71" "$22,675.58" "$22,675.58" "$20,543.33" "$17,095.72" "$22,675.58" "$61,213.33" "$61,213.33" "$65,617.72" "$39,059.51" "$17,095.72" "$36,280.93" "$85,017.90" "$112,406.20" "$22,675.58" "$24,490.82" "$22,675.58" "$23,809.36" "$129,699.75" "$22,675.58" "$20,453.37" "$22,675.58" "$112,406.20" "$112,406.20" "$136,962.63" "$22,675.58" "$138,346.09" "$100,300.91" "$12,661.30" "$22,675.58" "$100,301.14" "$23,809.36" "$16,880.94" "$25,595.23" "$17,095.72" "$22,675.58" N/A N/A MS802 DRG MS-DRG V39 (FY2022) 802 OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC INPATIENT ONLY "$481,608.00" "$356,390.00" "$42,637.58" "$361,206.00" N/A N/A N/A N/A "$42,637.58" "$42,637.58" N/A N/A "$42,637.58" N/A N/A N/A N/A N/A N/A N/A N/A "$42,637.58" "$42,637.58" "$42,637.58" "$42,637.58" "$361,206.00" "$42,733.58" "$42,637.58" "$42,637.58" N/A N/A N/A "$42,637.58" N/A N/A N/A "$42,637.58" "$279,332.64" "$42,637.58" N/A N/A N/A "$42,637.58" N/A N/A MS804 DRG MS-DRG V39 (FY2022) 804 OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC INPATIENT ONLY "$121,082.50" "$89,601.50" "$3,500.00" "$96,865.87" "$4,153.20" "$4,153.20" "$4,153.20" "$4,153.20" "$20,480.23" "$20,480.23" "$10,947.41" "$27,712.22" "$20,480.23" "$15,007.38" "$15,007.38" "$15,786.46" "$5,603.81" "$27,712.22" "$32,768.37" "$18,383.65" "$82,963.51" "$20,480.23" "$20,480.23" "$20,480.23" "$21,504.24" "$90,811.88" "$20,480.23" "$18,473.17" "$20,480.23" "$20,488.50" "$78,703.51" "$95,897.18" "$20,480.23" "$96,865.87" "$3,500.00" "$23,587.44" "$20,480.23" "$70,227.85" "$21,504.24" "$13,692.20" "$22,848.37" "$27,712.22" "$20,480.23" N/A N/A MS805 DRG MS-DRG V39 (FY2022) 805 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC INPATIENT ONLY "$33,105.00" "$24,498.00" "$6,597.36" "$29,058.10" "$16,525.85" "$16,525.85" "$16,525.85" "$16,525.85" "$18,161.31" "$18,161.31" "$12,546.87" "$6,927.23" "$18,161.31" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$6,927.23" "$29,058.10" "$13,534.37" "$15,448.50" "$18,161.31" "$18,845.16" "$18,161.31" "$19,069.38" "$24,828.75" "$18,161.31" "$16,381.50" "$18,161.31" "$16,619.21" "$14,301.93" "$26,218.81" "$18,161.31" "$26,483.65" "$14,000.00" "$6,597.36" "$18,161.31" "$19,200.90" "$19,069.38" "$10,324.04" "$19,946.92" "$6,927.23" "$18,161.31" N/A N/A MS806 DRG MS-DRG V39 (FY2022) 806 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC INPATIENT ONLY "$27,247.00" "$20,163.00" "$5,773.81" "$25,797.28" "$11,793.86" "$11,793.86" "$11,793.86" "$11,793.86" "$16,123.30" "$16,123.30" "$6,550.61" "$6,062.51" "$16,123.30" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$6,062.51" "$25,797.28" "$9,391.69" "$11,019.00" "$16,123.30" "$16,646.59" "$16,123.30" "$16,929.47" "$20,435.25" "$16,123.30" "$14,543.22" "$16,123.30" "$11,019.00" "$9,366.15" "$21,579.56" "$16,123.30" "$21,797.54" "$10,500.00" "$5,773.81" "$16,123.30" "$15,803.26" "$16,929.47" "$7,363.85" "$17,396.92" "$6,062.51" "$16,123.30" N/A N/A MS807 DRG MS-DRG V39 (FY2022) 807 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC INPATIENT ONLY "$24,319.00" "$17,996.50" "$5,733.00" "$24,318.57" "$12,302.29" "$12,302.29" "$12,302.29" "$12,302.29" "$15,486.29" "$15,486.29" "$5,733.00" "$6,062.51" "$15,486.29" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$6,062.51" "$24,318.57" "$8,498.01" "$9,634.50" "$15,486.29" "$16,172.31" "$15,486.29" "$16,260.60" "$18,239.25" "$15,486.29" "$13,968.63" "$15,486.29" "$10,399.96" "$8,954.79" "$19,260.32" "$15,486.29" "$19,454.86" "$10,500.00" "$5,773.81" "$15,486.29" "$14,105.02" "$16,260.60" "$6,438.61" "$16,599.88" "$6,062.51" "$15,486.29" N/A N/A MS808 DRG MS-DRG V39 (FY2022) 808 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC INPATIENT ONLY "$71,534.50" "$52,936.00" "$9,807.50" "$57,227.29" "$20,388.47" "$20,388.47" "$20,388.47" "$20,388.47" "$26,138.77" "$26,138.77" "$19,868.67" "$27,144.10" "$26,138.77" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$27,144.10" "$41,822.03" "$28,815.72" "$32,787.00" "$26,138.77" "$26,955.09" "$26,138.77" "$27,445.71" "$53,650.88" "$26,138.77" "$23,577.17" "$26,138.77" "$33,921.80" "$29,003.75" "$56,655.01" "$26,138.77" "$57,227.29" "$17,500.00" "$25,851.51" "$26,138.77" "$41,490.01" "$27,445.71" "$21,911.12" "$29,928.42" "$27,144.10" "$26,138.77" N/A N/A MS809 DRG MS-DRG V39 (FY2022) 809 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC INPATIENT ONLY "$56,635.00" "$41,910.00" "$5,884.50" "$45,307.75" "$12,333.50" "$12,333.50" "$12,333.50" "$12,333.50" "$19,496.75" "$19,496.75" "$10,743.90" "$12,843.09" "$19,496.75" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$12,843.09" "$31,194.80" "$16,362.11" "$18,351.00" "$19,496.75" "$20,345.85" "$19,496.75" "$20,471.59" "$42,476.25" "$19,496.75" "$17,586.07" "$19,496.75" "$19,154.61" "$16,401.96" "$44,854.65" "$19,496.75" "$45,307.75" "$10,500.00" "$12,231.51" "$19,496.75" "$32,848.30" "$20,471.59" "$12,263.74" "$21,617.84" "$12,843.09" "$19,496.75" N/A N/A MS810 DRG MS-DRG V39 (FY2022) 810 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$25,295.00" "$18,718.50" "$1,961.50" "$25,294.93" "$3,921.70" "$3,921.70" "$3,921.70" "$3,921.70" "$17,690.64" "$17,690.64" "$7,505.65" "$5,794.41" "$17,690.64" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,539.33" "$25,294.93" "$12,635.31" "$14,425.50" "$17,690.64" "$18,368.02" "$17,690.64" "$18,575.17" "$18,971.25" "$17,690.64" "$15,956.96" "$17,690.64" "$14,425.50" "$12,261.68" "$20,033.58" "$17,690.64" "$20,235.94" "$3,500.00" "$6,227.93" "$17,690.64" "$14,671.10" "$18,575.17" "$9,640.37" "$19,357.99" "$5,794.41" "$17,690.64" N/A N/A MS811 DRG MS-DRG V39 (FY2022) 811 RED BLOOD CELL DISORDERS WITH MCC INPATIENT ONLY "$55,810.00" "$41,299.50" "$7,846.00" "$44,647.69" "$16,329.90" "$16,329.90" "$16,329.90" "$16,329.90" "$20,572.70" "$20,572.70" "$11,450.82" "$14,177.07" "$20,572.70" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$14,177.07" "$32,916.32" "$18,712.05" "$20,689.50" "$20,572.70" "$21,592.99" "$20,572.70" "$21,601.34" "$41,857.50" "$20,572.70" "$18,556.58" "$20,572.70" "$21,620.71" "$18,517.29" "$44,201.19" "$20,572.70" "$44,647.69" "$14,000.00" "$13,501.96" "$22,304.93" "$32,369.80" "$21,601.34" "$13,826.53" "$22,964.08" "$14,177.07" "$20,572.70" N/A N/A MS812 DRG MS-DRG V39 (FY2022) 812 RED BLOOD CELL DISORDERS WITHOUT MCC INPATIENT ONLY "$35,132.50" "$25,998.50" "$7,285.18" "$28,105.68" "$15,999.06" "$15,999.06" "$15,999.06" "$15,999.06" "$17,128.85" "$17,128.85" "$7,285.18" "$8,031.31" "$17,128.85" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$8,031.31" "$27,406.16" "$12,086.18" "$13,204.50" "$17,128.85" "$18,076.59" "$17,128.85" "$17,985.29" "$26,349.38" "$17,128.85" "$15,450.22" "$17,128.85" "$13,204.50" "$11,750.67" "$27,824.64" "$17,128.85" "$28,105.68" "$14,000.00" "$7,648.86" "$17,128.85" "$20,376.85" "$17,985.29" "$8,824.39" "$18,655.08" "$8,031.31" "$17,128.85" N/A N/A MS813 DRG MS-DRG V39 (FY2022) 813 COAGULATION DISORDERS INPATIENT ONLY "$66,277.00" "$49,045.00" "$10,999.80" "$53,021.26" "$23,878.68" "$23,878.68" "$23,878.68" "$23,878.68" "$21,716.98" "$21,716.98" "$14,757.80" "$11,549.79" "$21,716.98" "$16,895.58" "$16,895.58" "$19,648.99" "$11,859.91" "$11,549.79" "$34,747.17" "$21,064.68" "$23,176.50" "$21,716.98" "$22,841.55" "$21,716.98" "$22,802.83" "$49,707.75" "$21,716.98" "$19,588.72" "$21,716.98" "$23,176.50" "$19,700.03" "$52,491.03" "$21,716.98" "$53,021.26" "$17,500.00" "$10,999.80" "$21,716.98" "$38,440.66" "$22,802.83" "$15,488.55" "$24,395.81" "$11,549.79" "$21,716.98" N/A N/A MS814 DRG MS-DRG V39 (FY2022) 814 RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC INPATIENT ONLY "$48,703.00" "$36,040.50" "$8,226.35" "$38,962.13" "$9,670.20" "$9,670.20" "$9,670.20" "$9,670.20" "$24,109.04" "$24,109.04" "$15,216.58" "$10,639.66" "$24,109.04" "$10,335.67" "$10,335.67" "$10,604.42" "$9,179.71" "$10,639.66" "$38,574.46" "$25,290.81" "$28,375.50" "$24,109.04" "$25,084.40" "$24,109.04" "$25,314.49" "$36,527.25" "$24,109.04" "$21,746.35" "$24,109.04" "$28,375.50" "$24,119.18" "$38,572.50" "$24,109.04" "$38,962.13" "$8,226.35" "$10,133.01" "$24,109.04" "$28,247.74" "$25,314.49" "$18,962.98" "$27,388.80" "$10,639.66" "$24,109.04" N/A N/A MS815 DRG MS-DRG V39 (FY2022) 815 RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC INPATIENT ONLY "$70,790.00" "$52,385.00" "$7,947.10" "$56,631.87" "$9,940.69" "$9,940.69" "$9,940.69" "$9,940.69" "$17,909.42" "$17,909.42" "$8,879.32" "$8,344.46" "$17,909.42" "$10,335.67" "$10,335.67" "$10,604.42" "$9,179.71" "$8,344.46" "$28,655.07" "$13,877.57" "$14,901.00" "$17,909.42" "$19,027.30" "$17,909.42" "$18,804.89" "$53,092.50" "$17,909.42" "$16,154.30" "$17,909.42" "$15,477.50" "$13,242.35" "$56,065.53" "$17,909.42" "$56,631.87" "$8,226.35" "$7,947.10" "$17,909.42" "$41,058.20" "$18,804.89" "$9,958.14" "$19,631.73" "$8,344.46" "$17,909.42" N/A N/A MS816 DRG MS-DRG V39 (FY2022) 816 RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC INPATIENT ONLY "$30,360.50" "$22,467.00" "$1,961.50" "$24,985.68" "$3,892.00" "$3,892.00" "$3,892.00" "$3,892.00" "$15,616.05" "$15,616.05" "$6,142.69" "$5,485.40" "$15,616.05" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$5,485.40" "$24,985.68" "$9,811.61" "$9,916.50" "$15,616.05" "$16,869.45" "$15,616.05" "$16,396.85" "$22,770.38" "$15,616.05" "$14,085.68" "$15,616.05" "$9,916.50" "$8,429.03" "$24,045.49" "$15,616.05" "$24,288.37" "$3,500.00" "$5,224.18" "$15,616.05" "$17,609.09" "$16,396.85" "$6,627.07" "$16,762.24" "$5,485.40" "$15,616.05" N/A N/A MS817 DRG MS-DRG V39 (FY2022) 817 OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC INPATIENT ONLY "$102,565.50" "$75,898.50" "$1,538.12" "$82,052.25" "$4,100.83" "$4,100.83" "$4,100.83" "$4,100.83" "$26,973.86" "$26,973.86" "$20,589.95" "$8,306.62" "$26,973.86" "$1,538.12" "$1,538.12" "$1,617.96" "$1,961.50" "$8,306.62" "$43,158.18" "$42,123.98" "$66,667.45" "$26,973.86" "$34,017.91" N/A "$28,322.55" "$76,924.13" "$26,973.86" "$24,330.42" "$26,973.86" "$34,602.00" "$29,411.70" "$81,231.75" "$26,973.86" "$82,052.25" "$3,500.00" "$7,911.06" "$26,973.86" "$59,487.99" "$28,322.55" "$23,124.06" "$30,973.30" "$8,306.62" "$26,973.86" N/A N/A MS818 DRG MS-DRG V39 (FY2022) 818 OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC INPATIENT ONLY "$181,772.50" "$134,512.00" "$12,542.98" "$145,417.80" "$116,019.65" "$116,019.65" "$116,019.65" "$116,019.65" "$20,438.13" "$20,438.13" N/A "$19,090.36" "$20,438.13" "$57,281.13" "$57,281.13" "$60,254.62" "$36,419.51" "$19,090.36" "$32,701.01" "$89,715.79" "$122,411.97" "$20,438.13" "$23,020.12" N/A "$21,460.04" "$136,329.38" "$20,438.13" "$18,435.19" "$20,438.13" "$118,151.97" "$118,151.97" "$143,963.63" "$20,438.13" "$145,417.80" "$105,427.91" "$12,542.98" "$20,438.13" "$105,428.05" "$21,460.04" "$13,631.04" "$22,795.70" "$19,090.36" "$20,438.13" N/A N/A MS819 DRG MS-DRG V39 (FY2022) 819 OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$70,403.50" "$52,099.00" "$1,961.50" "$56,322.43" "$4,043.25" "$4,043.25" "$4,043.25" "$4,043.25" "$17,866.63" "$17,866.63" "$20,232.37" "$8,306.62" "$17,866.63" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$8,306.62" "$28,586.61" "$11,958.32" "$14,808.00" "$17,866.63" "$18,008.73" "$17,866.63" "$18,759.96" "$52,802.63" "$17,866.63" "$16,115.70" "$17,866.63" "$14,808.00" "$12,586.80" "$55,759.20" "$17,866.63" "$56,322.43" "$3,500.00" "$7,911.06" "$17,866.63" "$40,834.03" "$18,759.96" "$9,896.00" "$19,578.20" "$8,306.62" "$17,866.63" N/A N/A MS820 DRG MS-DRG V39 (FY2022) 820 LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC INPATIENT ONLY "$758,105.50" "$560,998.50" "$439,701.19" "$600,419.23" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$568,579.13" N/A N/A N/A N/A N/A "$600,419.23" N/A N/A N/A N/A N/A "$439,701.19" N/A N/A N/A N/A N/A N/A N/A MS822 DRG MS-DRG V39 (FY2022) 822 LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$43,702.50" "$32,340.00" "$1,961.50" "$34,961.73" "$4,458.37" "$4,458.37" "$4,458.37" "$4,458.37" "$19,690.70" "$19,690.70" "$11,429.40" "$10,011.03" "$19,690.70" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$10,764.54" "$31,505.12" "$16,218.10" "$18,772.50" "$19,690.70" "$20,269.42" "$19,690.70" "$20,675.24" "$32,776.88" "$19,690.70" "$17,761.01" "$19,690.70" "$19,464.72" "$16,648.85" "$34,612.10" "$19,690.70" "$34,961.73" "$3,500.00" "$10,251.94" "$19,690.70" "$25,347.45" "$20,675.24" "$12,545.42" "$21,860.51" "$10,011.03" "$19,690.70" N/A N/A MS824 DRG MS-DRG V39 (FY2022) 824 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC INPATIENT ONLY "$55,616.50" "$41,156.50" "$3,923.00" "$44,493.06" "$8,377.80" "$8,377.80" "$8,377.80" "$8,377.80" "$27,371.36" "$27,371.36" "$20,485.44" "$18,992.64" "$27,371.36" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$18,992.64" "$43,794.18" "$30,825.15" "$35,466.00" "$27,371.36" "$28,021.52" "$27,371.36" "$28,739.93" "$41,712.38" "$27,371.36" "$24,688.97" "$27,371.36" "$36,191.76" "$30,871.86" "$44,048.14" "$27,371.36" "$44,493.06" "$7,000.00" "$18,088.22" "$27,371.36" "$32,257.57" "$28,739.93" "$23,701.46" "$31,470.66" "$18,992.64" "$27,371.36" N/A N/A MS827 DRG MS-DRG V39 (FY2022) 827 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC INPATIENT ONLY "$142,831.00" "$105,695.00" "$10,500.00" "$114,264.72" "$91,536.61" "$91,536.61" "$91,536.61" "$91,536.61" "$28,311.35" "$28,311.35" "$20,720.19" "$16,603.77" "$28,311.35" "$30,739.08" "$30,739.08" "$32,334.83" "$17,071.61" "$16,603.77" "$45,298.16" "$32,768.63" "$92,840.08" "$28,311.35" "$29,052.94" "$28,311.35" "$29,726.92" "$107,123.25" "$28,311.35" "$25,536.84" "$28,311.35" "$92,840.08" "$92,840.08" "$113,122.08" "$28,311.35" "$114,264.72" "$10,500.00" "$15,813.11" "$28,311.35" "$82,841.98" "$29,726.92" "$25,066.78" "$32,646.78" "$16,603.77" "$28,311.35" N/A N/A MS828 DRG MS-DRG V39 (FY2022) 828 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$247,065.50" "$182,828.50" "$20,391.14" "$197,652.40" "$158,399.18" "$158,399.18" "$158,399.18" "$158,399.18" "$22,606.58" "$22,606.58" "$37,039.74" "$38,542.17" "$22,606.58" "$115,208.49" "$115,208.49" "$122,415.90" "$78,419.92" "$38,542.17" "$36,170.53" "$122,121.90" "$160,592.58" "$22,606.58" "$24,084.40" "$22,606.58" "$23,736.91" "$185,299.13" "$22,606.58" "$20,391.14" "$22,606.58" "$160,592.58" "$160,592.58" "$195,675.89" "$22,606.58" "$197,652.40" "$143,297.99" "$29,555.85" "$22,606.58" "$143,297.99" "$23,736.91" "$24,565.71" "$25,508.89" "$38,542.17" "$22,606.58" N/A N/A MS829 DRG MS-DRG V39 (FY2022) 829 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC INPATIENT ONLY "$201,746.00" "$149,292.50" "$20,761.58" "$161,396.66" "$129,226.81" "$129,226.81" "$129,226.81" "$129,226.81" "$33,196.24" "$33,196.24" "$33,301.70" "$21,799.67" "$33,196.24" "$73,356.98" "$73,356.98" "$77,165.13" "$48,138.43" "$21,799.67" "$53,113.98" "$95,825.69" "$131,134.79" "$33,196.24" "$34,267.18" "$33,196.24" "$34,856.05" "$151,309.50" "$33,196.24" "$29,943.01" "$33,196.24" "$131,134.79" "$131,134.79" "$159,782.71" "$33,196.24" "$161,396.66" "$117,012.58" "$20,761.58" "$33,196.24" "$117,012.68" "$34,856.05" "$32,161.97" "$38,758.84" "$21,799.67" "$33,196.24" N/A N/A MS831 DRG MS-DRG V39 (FY2022) 831 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC INPATIENT ONLY "$26,994.00" "$19,976.00" "$3,923.00" "$26,993.75" "$8,089.28" "$8,089.28" "$8,089.28" "$8,089.28" "$18,795.57" "$18,795.57" "$10,012.94" "$7,457.98" "$18,795.57" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$7,457.98" "$26,993.75" "$16,080.81" "$16,827.00" "$18,795.57" "$20,196.57" N/A "$19,735.35" "$20,245.50" "$18,795.57" "$16,953.60" "$18,795.57" "$16,827.00" "$14,302.95" "$21,379.05" "$18,795.57" "$21,595.00" "$7,000.00" "$7,102.84" "$18,795.57" "$15,656.52" "$19,735.35" "$11,245.26" "$20,740.50" "$7,457.98" "$18,795.57" N/A N/A MS832 DRG MS-DRG V39 (FY2022) 832 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC INPATIENT ONLY "$21,348.00" "$15,798.00" "$1,961.50" "$21,347.92" "$3,903.66" "$3,903.66" "$3,903.66" "$3,903.66" "$16,424.90" "$16,424.90" "$6,946.92" "$4,890.25" "$16,424.90" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$7,457.98" "$21,347.92" "$9,428.03" "$15,934.50" "$16,424.90" "$16,665.88" "$16,424.90" "$17,246.15" "$16,011.00" "$16,424.90" "$14,815.26" "$16,424.90" "$11,674.50" "$9,923.33" "$16,907.54" "$16,424.90" "$17,078.34" "$3,500.00" "$7,102.84" "$16,424.90" "$12,381.84" "$17,246.15" "$7,801.91" "$17,774.29" "$4,890.25" "$16,424.90" N/A N/A MS833 DRG MS-DRG V39 (FY2022) 833 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$12,397.00" "$9,174.00" "$4,302.66" "$15,690.60" "$11,676.00" "$11,676.00" "$11,676.00" "$11,676.00" "$14,759.57" "$14,759.57" "$4,302.66" "$7,457.98" "$14,759.57" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$7,457.98" "$12,397.00" "$6,783.34" "$8,055.00" "$14,759.57" "$15,262.30" N/A "$15,497.55" "$9,297.75" "$14,759.57" "$13,313.13" "$14,759.57" "$8,055.00" "$6,846.75" "$9,818.43" "$14,759.57" "$9,917.60" "$10,500.00" "$7,102.84" "$14,759.57" "$7,190.26" "$15,497.55" "$5,383.06" "$15,690.60" "$7,457.98" "$12,397.00" N/A N/A MS834 DRG MS-DRG V39 (FY2022) 834 ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC INPATIENT ONLY "$570,786.50" "$422,382.50" "$331,056.17" "$428,089.88" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$428,089.88" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$331,056.17" N/A N/A N/A N/A N/A N/A N/A MS835 DRG MS-DRG V39 (FY2022) 835 ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC INPATIENT ONLY "$21,740.00" "$16,088.00" "$1,961.50" "$29,305.82" "$3,892.00" "$3,892.00" "$3,892.00" "$3,892.00" "$25,641.17" "$25,641.17" "$18,781.52" "$4,980.01" "$25,641.17" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$22,382.46" "$21,739.73" "$21,782.73" "$21,739.73" "$25,641.17" "$26,641.53" "$25,641.17" "$26,923.23" "$16,305.00" "$25,641.17" "$23,128.34" "$25,641.17" "$21,739.73" "$21,739.73" "$17,217.85" "$25,641.17" "$17,391.78" "$3,500.00" "$21,316.62" "$25,641.17" "$12,609.20" "$26,923.23" "$21,188.36" "$29,305.82" "$4,980.01" "$21,739.73" N/A N/A MS836 DRG MS-DRG V39 (FY2022) 836 ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$92,463.00" "$68,423.00" "$8,630.08" "$73,970.23" "$36,348.10" "$36,348.10" "$36,348.10" "$36,348.10" "$19,152.37" "$19,152.37" "$10,436.86" "$9,061.59" "$19,152.37" "$28,484.09" "$28,484.09" N/A "$19,994.22" N/A N/A "$21,114.48" "$17,602.50" "$19,152.37" N/A N/A "$20,109.99" "$69,347.25" N/A "$17,275.44" "$19,152.37" "$23,972.84" "$21,332.47" "$73,230.51" "$19,152.37" "$73,970.23" "$28,000.00" "$8,630.08" "$19,152.37" "$53,628.54" "$20,109.99" "$11,763.52" "$21,186.94" "$9,061.59" "$19,152.37" N/A N/A MS837 DRG MS-DRG V39 (FY2022) 837 CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC INPATIENT ONLY "$437,588.50" "$323,815.50" "$253,801.33" "$328,191.38" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$328,191.38" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$253,801.33" N/A N/A N/A N/A N/A N/A N/A MS838 DRG MS-DRG V39 (FY2022) 838 CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT INPATIENT ONLY "$35,685.50" "$26,407.50" "$9,807.50" "$44,251.19" "$20,234.56" "$20,234.56" "$20,234.56" "$20,234.56" "$26,652.23" "$26,652.23" "$24,923.32" "$44,251.19" "$26,652.23" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$44,251.19" "$35,685.46" "$29,934.16" "$33,903.00" "$26,652.23" "$27,548.66" "$26,652.23" "$27,984.84" "$26,764.13" "$26,652.23" "$24,040.31" "$26,652.23" "$34,849.69" "$29,764.24" "$28,262.89" "$26,652.23" "$28,548.37" "$17,500.00" "$42,143.97" "$26,652.23" "$20,697.59" "$27,984.84" "$22,656.93" "$30,570.87" "$44,251.19" "$26,652.23" N/A N/A MS839 DRG MS-DRG V39 (FY2022) 839 CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC INPATIENT ONLY "$29,723.00" "$21,995.50" "$9,049.97" "$29,722.91" "$18,984.26" "$18,984.26" "$18,984.26" "$18,984.26" "$21,317.38" "$21,317.38" "$11,179.48" "$9,502.47" "$21,317.38" "$14,272.87" "$14,272.87" "$16,607.97" "$10,018.75" "$9,502.47" "$29,722.91" "$18,502.09" "$22,308.00" "$21,317.38" "$21,481.56" "$21,317.38" "$22,383.25" "$22,292.25" "$21,317.38" "$19,228.28" "$21,317.38" "$26,483.42" "$23,137.22" "$23,540.54" "$21,317.38" "$23,778.32" "$14,000.00" "$9,049.97" "$21,317.38" "$17,239.34" "$22,383.25" "$14,908.15" "$23,895.83" "$9,502.47" "$21,317.38" N/A N/A MS840 DRG MS-DRG V39 (FY2022) 840 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC INPATIENT ONLY "$200,264.50" "$148,196.00" "$33,279.73" "$150,198.38" N/A N/A N/A N/A "$33,855.05" "$33,855.05" N/A "$42,114.50" "$33,855.05" N/A N/A N/A N/A "$42,114.50" N/A N/A N/A "$33,855.05" "$33,855.05" "$33,855.05" "$33,855.05" "$150,198.38" "$33,855.05" "$33,855.05" "$33,855.05" N/A N/A N/A "$33,855.05" N/A N/A "$42,114.50" "$33,279.73" "$116,153.41" "$33,855.05" N/A N/A "$42,114.50" "$33,855.05" N/A N/A MS841 DRG MS-DRG V39 (FY2022) 841 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC INPATIENT ONLY "$59,903.50" "$44,329.00" "$11,769.00" "$47,922.77" "$23,521.17" "$23,521.17" "$23,521.17" "$23,521.17" "$22,244.93" "$22,244.93" "$14,482.89" "$13,446.69" "$22,244.93" "$16,766.76" "$16,766.76" "$20,090.46" "$11,769.00" "$13,446.69" "$35,591.89" "$21,464.41" "$24,324.00" "$22,244.93" "$23,053.69" "$22,244.93" "$23,357.18" "$44,927.63" "$22,244.93" "$20,064.93" "$22,244.93" "$24,324.00" "$20,675.40" "$47,443.55" "$22,244.93" "$47,922.77" "$21,000.00" "$12,806.37" "$22,244.93" "$34,744.03" "$23,357.18" "$16,255.41" "$25,056.40" "$13,446.69" "$22,244.93" N/A N/A MS842 DRG MS-DRG V39 (FY2022) 842 LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC INPATIENT ONLY "$109,259.00" "$80,852.00" "$4,220.92" "$87,406.85" "$40,826.68" "$40,826.68" "$40,826.68" "$40,826.68" "$20,725.92" "$20,725.92" N/A "$12,446.68" "$20,725.92" "$4,220.92" "$4,220.92" "$4,432.76" "$19,997.73" "$12,446.68" N/A "$17,720.12" "$71,018.06" "$20,725.92" "$21,066.55" N/A "$21,762.22" "$81,944.25" N/A "$18,694.78" "$20,725.92" "$23,352.89" "$71,018.06" "$86,532.78" "$20,725.92" "$87,406.85" N/A "$11,853.98" "$20,725.92" "$63,370.22" "$21,762.22" "$14,049.07" "$23,155.78" "$12,446.68" "$20,725.92" N/A N/A MS843 DRG MS-DRG V39 (FY2022) 843 OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC INPATIENT ONLY "$98,974.00" "$73,241.00" "$11,425.99" "$79,179.08" "$28,259.34" "$28,259.34" "$28,259.34" "$28,259.34" "$24,218.76" "$24,218.76" "$15,978.84" "$11,997.29" "$24,218.76" "$19,561.22" "$19,561.22" "$23,438.87" "$13,730.50" "$11,997.29" "$38,750.02" "$26,075.47" "$28,614.00" "$24,218.76" "$25,500.81" "$25,500.81" "$25,429.70" "$74,230.50" "$24,218.76" "$21,845.32" "$24,218.76" "$29,854.97" "$25,562.87" "$78,387.30" "$24,218.76" "$79,179.08" "$24,500.00" "$11,425.99" "$24,218.76" "$57,404.92" "$25,429.70" "$19,122.36" "$27,526.08" "$11,997.29" "$24,218.76" N/A N/A MS844 DRG MS-DRG V39 (FY2022) 844 OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC INPATIENT ONLY "$54,357.50" "$40,225.00" "$5,975.41" "$43,485.93" "$12,752.58" "$12,752.58" "$12,752.58" "$12,752.58" "$19,226.22" "$19,226.22" "$10,762.65" "$8,111.72" "$19,226.22" "$8,512.20" "$8,512.20" "$9,603.76" "$5,975.41" "$8,111.72" "$30,761.95" "$15,351.34" "$17,763.00" "$19,226.22" "$19,809.42" "$19,226.22" "$20,187.53" "$40,768.13" "$19,226.22" "$17,342.05" "$19,226.22" "$18,816.04" "$16,151.59" "$43,051.05" "$19,226.22" "$43,485.93" "$7,000.00" "$7,725.45" "$19,226.22" "$31,527.35" "$20,187.53" "$11,870.78" "$21,279.34" "$8,111.72" "$19,226.22" N/A N/A MS846 DRG MS-DRG V39 (FY2022) 846 CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC INPATIENT ONLY "$46,122.50" "$34,131.00" "$11,769.00" "$46,122.13" "$24,656.74" "$24,656.74" "$24,656.74" "$24,656.74" "$29,500.50" "$29,500.50" "$20,764.82" "$20,758.98" "$29,500.50" "$16,766.76" "$16,766.76" "$20,090.46" "$11,769.00" "$20,758.98" "$46,122.13" "$32,422.73" "$40,093.50" "$29,500.50" "$28,869.37" "$29,500.50" "$30,975.53" "$34,591.88" "$29,500.50" "$26,609.45" "$29,500.50" "$41,688.18" "$35,674.16" "$36,528.74" "$29,500.50" "$36,897.70" "$21,000.00" "$19,770.44" "$29,500.50" "$26,751.05" "$30,975.53" "$26,793.96" "$34,134.67" "$20,758.98" "$29,500.50" N/A N/A MS847 DRG MS-DRG V39 (FY2022) 847 CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC INPATIENT ONLY "$51,035.50" "$37,766.50" "$10,326.18" "$40,828.01" "$24,864.80" "$24,864.80" "$24,864.80" "$24,864.80" "$20,274.55" "$20,274.55" "$10,326.18" "$20,758.98" "$20,274.55" "$24,205.76" "$24,205.76" "$26,923.76" "$16,991.77" "$20,758.98" "$32,439.28" "$16,394.41" "$20,041.50" "$20,274.55" "$20,362.99" "$20,274.55" "$21,288.28" "$38,276.63" "$20,274.55" "$18,287.64" "$20,274.55" "$31,404.26" "$28,398.03" "$40,419.72" "$20,274.55" "$40,828.01" "$14,000.00" "$19,770.44" "$20,274.55" "$29,600.59" "$21,288.28" "$13,393.48" "$22,591.03" "$20,758.98" "$20,274.55" N/A N/A MS848 DRG MS-DRG V39 (FY2022) 848 CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC INPATIENT ONLY "$37,016.00" "$27,392.00" "$5,552.16" "$29,612.43" "$25,821.04" "$25,821.04" "$25,821.04" "$25,821.04" "$18,177.88" "$18,177.88" "$7,545.81" "$5,829.77" "$18,177.88" "$18,261.84" "$18,261.84" "$21,643.17" "$12,818.56" "$5,829.77" "$29,084.61" "$12,504.76" "$15,484.50" "$18,177.88" "$18,298.72" N/A "$19,086.77" "$27,762.00" "$18,177.88" "$16,396.45" "$18,177.88" "$18,502.22" "$16,179.54" "$29,316.30" "$18,177.88" "$29,612.43" "$21,000.00" "$5,552.16" "$18,177.88" "$21,469.28" "$19,086.77" "$10,348.09" "$19,967.64" "$5,829.77" "$18,177.88" N/A N/A MS853 DRG MS-DRG V39 (FY2022) 853 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC INPATIENT ONLY "$341,261.00" "$252,533.50" "$46,669.25" "$255,945.75" "$152,597.00" "$152,597.00" "$152,597.00" "$152,597.00" "$52,329.63" "$52,329.63" "$152,597.00" "$111,855.49" "$52,329.63" N/A N/A N/A N/A "$111,855.49" "$152,597.00" "$152,597.00" "$152,597.00" "$52,329.63" "$52,329.63" "$52,329.63" "$52,329.63" "$255,945.75" "$52,329.63" "$52,329.63" "$52,329.63" "$152,597.00" "$152,597.00" "$152,597.00" "$52,329.63" N/A "$152,597.00" "$111,855.49" "$53,073.82" "$197,931.38" "$52,329.63" "$152,597.00" "$152,597.00" "$111,855.49" "$46,669.25" N/A N/A MS854 DRG MS-DRG V39 (FY2022) 854 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC INPATIENT ONLY "$179,700.50" "$132,978.50" "$20,870.60" "$143,760.06" "$102,201.46" "$102,201.46" "$102,201.46" "$102,201.46" "$25,699.83" "$25,699.83" "$24,887.64" "$21,914.14" "$25,699.83" "$63,601.88" "$63,601.88" "$66,803.91" "$42,751.29" "$21,914.14" "$41,119.73" "$86,808.64" "$116,805.05" "$25,699.83" "$26,345.09" "$25,699.83" "$26,984.82" "$134,775.38" "$25,699.83" "$26,345.09" "$25,699.83" "$116,805.05" "$116,805.05" "$142,322.47" "$25,699.83" "$143,760.06" "$119,615.59" "$20,870.60" "$25,699.83" "$104,226.29" "$26,984.82" "$21,273.58" "$29,379.21" "$21,914.14" "$25,699.83" N/A N/A MS856 DRG MS-DRG V39 (FY2022) 856 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC INPATIENT ONLY "$251,654.50" "$186,224.50" "$36,148.50" "$201,323.26" "$159,567.18" "$159,567.18" "$159,567.18" "$159,567.18" N/A N/A N/A "$37,955.94" N/A "$107,851.38" "$107,851.38" "$113,390.81" "$73,163.73" N/A N/A "$123,132.21" "$163,575.15" "$49,098.59" N/A N/A "$51,553.52" "$188,740.88" N/A N/A N/A "$163,575.15" "$163,575.15" "$199,310.03" "$49,098.59" "$201,323.26" N/A "$36,148.50" "$43,241.35" "$145,959.61" "$51,553.52" N/A "$58,801.89" "$37,955.94" N/A N/A N/A MS857 DRG MS-DRG V39 (FY2022) 857 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC INPATIENT ONLY "$123,703.50" "$91,541.00" "$5,433.78" "$98,962.45" "$30,066.54" "$30,066.54" "$30,066.54" "$30,066.54" "$25,563.20" "$25,563.20" "$18,297.75" "$16,889.49" "$25,563.20" "$14,851.48" "$14,851.48" "$15,594.50" "$5,433.78" "$16,889.49" "$40,901.12" "$28,385.03" "$80,406.99" "$25,563.20" "$26,726.53" "$25,563.20" "$26,841.36" "$92,777.63" "$25,563.20" "$23,058.01" "$25,563.20" "$34,985.78" "$80,406.99" "$97,972.83" "$25,563.20" "$98,962.45" "$24,500.00" "$16,085.22" "$25,563.20" "$71,748.03" "$26,841.36" "$21,075.09" "$29,208.26" "$16,889.49" "$25,563.20" N/A N/A MS858 DRG MS-DRG V39 (FY2022) 858 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC INPATIENT ONLY "$88,882.00" "$65,773.00" "$1,961.50" "$71,105.27" "$4,776.33" "$4,776.33" "$4,776.33" "$4,776.33" "$20,436.76" "$20,436.76" "$11,951.55" "$14,797.70" "$20,436.76" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$14,797.70" "$32,698.82" "$19,039.10" "$20,394.00" "$20,436.76" "$21,766.56" "$20,436.76" "$21,458.60" "$66,661.50" "$20,436.76" "$18,433.96" "$20,436.76" "$21,474.85" "$18,415.75" "$70,394.24" "$20,436.76" "$71,105.27" "$3,500.00" "$14,093.04" "$20,436.76" "$51,551.56" "$21,458.60" "$13,629.04" "$22,793.98" "$14,797.70" "$20,436.76" N/A N/A MS862 DRG MS-DRG V39 (FY2022) 862 POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC INPATIENT ONLY "$57,623.50" "$42,641.50" "$9,807.50" "$46,098.43" "$20,574.21" "$20,574.21" "$20,574.21" "$20,574.21" "$24,143.55" "$24,143.55" "$16,517.96" "$14,859.20" "$24,143.55" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$14,859.20" "$38,629.68" "$24,617.86" "$28,450.50" "$24,143.55" "$24,727.26" "$24,143.55" "$25,350.73" "$43,217.63" "$24,143.55" "$21,777.48" "$24,143.55" "$29,812.32" "$25,544.74" "$45,637.45" "$24,143.55" "$46,098.43" "$17,500.00" "$14,151.61" "$24,143.55" "$33,421.63" "$25,350.73" "$19,013.10" "$27,431.97" "$14,859.20" "$24,143.55" N/A N/A MS863 DRG MS-DRG V39 (FY2022) 863 POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC INPATIENT ONLY "$38,383.50" "$28,404.00" "$7,764.19" "$30,706.54" "$16,461.54" "$16,461.54" "$16,461.54" "$16,461.54" "$18,033.63" "$18,033.63" "$8,779.35" "$8,152.41" "$18,033.63" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$8,152.41" "$28,853.81" "$13,538.41" "$15,171.00" "$18,033.63" "$18,847.28" "$18,033.63" "$18,935.31" "$28,787.63" "$18,033.63" "$16,266.33" "$18,033.63" "$16,263.11" "$13,987.46" "$30,399.47" "$18,033.63" "$30,706.54" "$14,000.00" "$7,764.19" "$18,033.63" "$22,262.43" "$18,935.31" "$10,138.57" "$19,787.16" "$8,152.41" "$18,033.63" N/A N/A MS864 DRG MS-DRG V39 (FY2022) 864 FEVER AND INFLAMMATORY CONDITIONS INPATIENT ONLY "$37,193.50" "$27,523.50" "$3,923.00" "$29,754.69" "$8,392.58" "$8,392.58" "$8,392.58" "$8,392.58" "$17,102.64" "$17,102.64" "$7,514.57" "$7,641.52" "$17,102.64" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$7,641.52" "$27,364.22" "$11,415.92" "$13,147.50" "$17,102.64" "$17,720.87" "$17,102.64" "$17,957.77" "$27,895.13" "$17,102.64" "$15,426.58" "$17,102.64" "$13,891.31" "$11,919.19" "$29,457.14" "$17,102.64" "$29,754.69" "$7,000.00" "$7,277.64" "$17,102.64" "$21,572.23" "$17,957.77" "$8,786.30" "$18,622.28" "$7,641.52" "$17,102.64" N/A N/A MS865 DRG MS-DRG V39 (FY2022) 865 VIRAL ILLNESS WITH MCC INPATIENT ONLY "$75,130.50" "$55,597.00" "$7,069.50" "$60,104.17" "$23,661.44" "$23,661.44" "$23,661.44" "$23,661.44" "$21,252.51" "$21,252.51" "$13,505.52" "$7,422.98" "$21,252.51" "$16,766.76" "$16,766.76" "$20,090.46" "$11,769.00" "$7,422.98" "$34,004.02" "$22,514.22" "$22,167.00" "$21,252.51" "$23,610.83" "$21,252.51" "$22,315.14" "$56,347.88" "$21,252.51" "$19,169.76" "$21,252.51" "$22,167.00" "$18,841.95" "$59,503.12" "$21,252.51" "$60,104.17" "$21,000.00" "$7,069.50" "$21,252.51" "$43,575.69" "$22,315.14" "$14,813.91" "$23,814.66" "$7,422.98" "$21,252.51" N/A N/A MS866 DRG MS-DRG V39 (FY2022) 866 VIRAL ILLNESS WITHOUT MCC INPATIENT ONLY "$44,449.50" "$32,893.00" "$6,627.35" "$35,559.21" "$24,596.88" "$24,596.88" "$24,596.88" "$24,596.88" "$16,843.82" "$16,843.82" "$6,627.35" "$7,422.98" "$16,843.82" "$16,766.76" "$16,766.76" "$20,090.46" "$11,769.00" "$7,422.98" "$26,950.11" "$12,109.06" "$12,585.00" "$16,843.82" "$18,088.74" "$16,843.82" "$17,686.01" "$33,337.13" "$16,843.82" "$15,193.13" "$16,843.82" "$14,106.52" "$12,218.77" "$35,203.61" "$16,843.82" "$35,559.21" "$21,000.00" "$7,069.50" "$16,843.82" "$25,780.71" "$17,686.01" "$8,410.40" "$18,298.45" "$7,422.98" "$16,843.82" N/A N/A MS867 DRG MS-DRG V39 (FY2022) 867 OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC INPATIENT ONLY "$86,429.50" "$63,958.00" "$15,692.00" "$69,143.51" "$32,008.10" "$32,008.10" "$32,008.10" "$32,008.10" "$26,492.82" "$26,492.82" "$24,318.15" "$16,751.36" "$26,492.82" "$22,355.68" "$22,355.68" "$26,787.28" "$15,692.00" "$16,751.36" "$42,388.51" "$28,444.25" "$33,556.50" "$26,492.82" "$26,757.96" "$26,492.82" "$27,817.46" "$64,822.13" N/A "$23,896.52" N/A "$34,622.41" "$29,588.93" "$68,452.06" "$26,492.82" "$69,143.51" "$28,000.00" "$15,953.67" "$26,492.82" "$50,129.11" "$27,817.46" "$22,425.37" "$30,371.41" "$16,751.36" "$26,492.82" N/A N/A MS868 DRG MS-DRG V39 (FY2022) 868 OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC INPATIENT ONLY "$48,272.00" "$35,721.50" "$6,990.21" "$38,617.38" "$20,737.84" "$20,737.84" "$20,737.84" "$20,737.84" "$18,410.47" "$18,410.47" "$9,726.37" "$7,339.72" "$18,410.47" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$7,339.72" "$29,456.75" "$14,208.67" "$15,990.00" "$18,410.47" "$19,203.01" "$18,410.47" "$19,330.99" "$36,204.00" "$18,410.47" "$16,606.24" "$18,410.47" "$17,551.80" "$15,153.30" "$38,231.18" "$18,410.47" "$38,617.38" "$17,500.00" "$6,990.21" "$18,410.47" "$27,997.76" "$19,330.99" "$10,685.91" "$20,258.66" "$7,339.72" "$18,410.47" N/A N/A MS869 DRG MS-DRG V39 (FY2022) 869 OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC INPATIENT ONLY "$10,203.00" "$7,550.50" "$1,961.50" "$17,344.25" "$3,892.00" "$3,892.00" "$3,892.00" "$3,892.00" "$16,081.20" "$16,081.20" "$6,138.22" "$2,337.24" "$16,081.20" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$7,339.72" "$10,203.00" "$9,970.43" "$10,203.00" "$16,081.20" "$16,953.74" N/A "$16,885.26" "$7,652.25" "$16,081.20" "$14,505.24" "$16,081.20" "$10,203.00" "$9,288.38" "$8,080.78" "$16,081.20" "$8,162.40" "$3,500.00" "$6,990.21" "$16,081.20" "$5,917.74" "$16,885.26" "$7,302.71" "$17,344.25" "$2,337.24" "$10,203.00" N/A N/A MS870 DRG MS-DRG V39 (FY2022) 870 SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS INPATIENT ONLY "$383,926.00" "$284,105.50" "$55,492.21" "$287,944.50" "$72,844.18" "$72,844.18" "$72,844.18" "$72,844.18" "$60,168.45" "$60,168.45" "$72,844.18" N/A "$55,492.21" "$232,133.36" "$232,133.36" "$232,133.36" "$232,133.36" N/A "$72,844.18" "$72,844.18" "$72,844.18" "$60,168.45" "$60,168.45" "$60,168.45" "$60,168.45" "$287,944.50" "$60,168.45" "$60,168.45" "$60,168.45" "$72,844.18" "$72,844.18" "$72,844.18" "$60,168.45" N/A "$72,844.18" N/A "$60,168.45" "$222,677.08" "$60,168.45" "$72,844.18" "$72,844.18" N/A "$60,168.45" N/A N/A MS871 DRG MS-DRG V39 (FY2022) 871 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC INPATIENT ONLY "$102,873.00" "$76,126.50" $162.43 "$82,298.23" "$32,758.90" "$32,758.90" "$32,758.90" "$32,758.90" "$23,974.45" "$23,974.45" "$16,130.58" "$17,521.48" "$23,974.45" $162.43 $162.43 $170.86 "$15,873.82" "$17,521.48" "$38,359.12" "$26,341.95" "$66,867.31" "$23,974.45" "$25,642.26" "$23,974.45" "$25,173.17" "$77,154.75" "$23,974.45" "$21,624.95" "$23,974.45" "$29,540.99" "$25,328.54" "$81,475.23" "$23,974.45" "$82,298.23" "$28,000.00" "$16,687.11" "$23,974.45" "$59,666.34" "$25,173.17" "$18,767.51" "$27,220.40" "$17,521.48" "$23,974.45" N/A N/A MS872 DRG MS-DRG V39 (FY2022) 872 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC INPATIENT ONLY "$43,586.00" "$32,254.00" "$7,846.00" "$34,868.70" "$15,925.32" "$15,925.32" "$15,925.32" "$15,925.32" "$18,136.48" "$18,136.48" "$9,397.01" "$9,417.32" "$18,136.48" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$9,417.32" "$29,018.37" "$13,835.85" "$15,394.50" "$18,136.48" "$19,005.15" "$18,136.48" "$19,043.30" "$32,689.50" "$18,136.48" "$16,359.10" "$18,136.48" "$15,394.50" "$13,085.33" "$34,520.01" "$18,136.48" "$34,868.70" "$14,000.00" "$8,968.87" "$18,136.48" "$25,279.88" "$19,043.30" "$10,287.94" "$19,915.84" "$9,417.32" "$18,136.48" N/A N/A MS876 DRG MS-DRG V39 (FY2022) 876 O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS INPATIENT ONLY "$15,865.00" "$11,740.50" "$3,060.00" "$34,492.91" "$8,785.00" "$8,785.00" "$8,785.00" "$8,785.00" "$7,034.26" "$7,034.26" "$3,060.00" "$18,532.84" "$7,034.26" "$4,870.20" "$4,870.20" "$4,682.90" "$3,418.50" "$18,532.84" "$10,718.88" "$11,125.87" "$15,865.00" "$7,034.26" "$7,301.35" "$7,034.26" "$8,324.33" "$11,898.75" "$7,034.26" "$6,042.77" "$7,034.26" "$15,865.00" "$15,865.00" "$12,565.09" "$7,034.26" "$12,692.00" N/A "$17,650.32" "$34,492.91" "$9,201.70" "$8,324.33" "$7,500.00" "$7,034.26" "$18,532.84" "$7,034.26" N/A N/A MS880 DRG MS-DRG V39 (FY2022) 880 ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION INPATIENT ONLY "$48,691.00" "$36,031.50" "$2,295.00" "$38,952.75" "$11,975.16" "$11,975.16" "$11,975.16" "$11,975.16" "$17,019.80" "$17,019.80" "$2,295.00" "$5,854.37" "$17,019.80" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$5,854.37" "$27,231.68" "$12,196.55" "$12,967.50" "$17,019.80" "$18,135.16" "$17,019.80" "$17,870.79" "$36,518.25" "$17,019.80" "$15,351.86" "$17,019.80" "$12,967.50" "$11,022.38" "$38,563.23" "$17,019.80" "$38,952.75" "$10,500.00" "$5,575.59" "$17,019.80" "$28,240.78" "$17,870.79" "$8,666.01" "$18,518.64" "$5,854.37" "$17,019.80" N/A N/A MS881 DRG MS-DRG V39 (FY2022) 881 DEPRESSIVE NEUROSES INPATIENT ONLY "$23,998.50" "$17,759.00" "$1,530.00" "$23,998.31" "$7,821.90" "$7,821.90" "$7,821.90" "$7,821.90" "$16,588.48" "$16,588.48" "$1,530.00" "$5,050.20" "$16,588.48" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$5,050.20" "$23,998.31" "$11,514.17" "$12,030.00" "$16,588.48" "$17,773.02" "$16,588.48" "$17,417.90" "$17,998.88" "$16,588.48" "$14,962.81" "$16,588.48" "$12,030.00" "$10,225.50" "$19,006.64" "$16,588.48" "$19,198.66" "$7,000.00" "$4,809.71" "$16,588.48" "$13,919.13" "$17,417.90" "$8,039.49" "$17,978.95" "$5,050.20" "$16,588.48" N/A N/A MS882 DRG MS-DRG V39 (FY2022) 882 NEUROSES EXCEPT DEPRESSIVE INPATIENT ONLY "$18,373.00" "$13,596.50" $765.00 "$18,796.67" "$3,915.90" "$3,915.90" "$3,915.90" "$3,915.90" "$16,737.53" "$16,737.53" $765.00 "$4,208.78" "$16,737.53" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$5,202.52" "$18,373.00" "$11,756.44" "$12,354.00" "$16,737.53" "$17,901.59" "$18,796.67" "$17,574.41" "$13,779.75" "$16,737.53" "$15,097.25" "$16,737.53" "$12,354.00" "$10,500.90" "$14,551.41" "$16,737.53" "$14,698.40" "$3,500.00" "$4,954.77" "$16,737.53" "$10,656.34" "$17,574.41" "$8,256.01" "$18,165.46" "$4,208.78" "$16,737.53" N/A N/A MS883 DRG MS-DRG V39 (FY2022) 883 DISORDERS OF PERSONALITY AND IMPULSE CONTROL INPATIENT ONLY "$12,855.50" "$9,513.50" "$2,295.00" "$24,712.72" "$7,939.25" "$7,939.25" "$7,939.25" "$7,939.25" "$21,970.26" "$21,970.26" "$2,295.00" "$4,580.51" "$21,970.26" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$7,459.87" "$12,855.28" "$13,169.28" "$12,855.28" "$21,970.26" "$23,194.41" "$21,970.26" "$23,068.77" "$9,641.63" "$21,970.26" "$19,817.17" "$21,970.26" "$12,855.28" "$12,855.28" "$10,181.40" "$21,970.26" "$10,284.23" "$7,000.00" "$7,104.64" "$21,970.26" "$7,456.19" "$23,068.77" "$12,855.28" "$24,712.72" "$4,580.51" "$12,855.28" N/A N/A MS884 DRG MS-DRG V39 (FY2022) 884 ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY INPATIENT ONLY "$41,303.00" "$30,564.50" "$10,098.77" "$38,929.90" "$38,929.90" "$38,929.90" "$38,929.90" "$38,929.90" "$21,042.01" "$21,042.01" N/A "$10,603.71" "$21,042.01" "$27,944.60" "$27,944.60" "$33,484.10" "$19,615.00" "$10,603.71" "$33,667.22" "$21,130.63" "$21,709.50" "$21,042.01" "$22,876.54" "$21,042.01" "$22,094.11" "$30,977.25" "$21,042.01" "$18,979.89" "$21,042.01" "$21,709.50" "$18,453.08" "$32,711.78" "$21,042.01" "$33,042.20" "$35,000.00" "$10,098.77" "$21,042.01" "$23,955.74" "$22,094.11" "$14,508.18" "$23,551.29" "$10,603.71" "$21,042.01" N/A N/A MS885 DRG MS-DRG V39 (FY2022) 885 PSYCHOSES INPATIENT ONLY "$23,432.50" "$17,340.50" "$1,530.00" "$23,432.06" "$3,985.18" "$3,985.18" "$3,985.18" "$3,985.18" "$19,607.18" "$19,607.18" "$1,530.00" "$5,367.68" "$19,607.18" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$6,833.56" "$23,432.06" "$17,436.13" "$18,591.00" "$19,607.18" "$20,915.85" "$19,607.18" "$20,587.54" "$17,574.38" "$19,607.18" "$17,685.68" "$19,607.18" "$18,591.00" "$15,802.35" "$18,558.20" "$19,607.18" "$18,745.65" "$3,500.00" "$6,508.15" "$7,855.89" "$13,590.85" "$20,587.54" "$12,424.12" "$21,756.00" "$5,367.68" "$19,607.18" N/A N/A MS886 DRG MS-DRG V39 (FY2022) 886 BEHAVIORAL AND DEVELOPMENTAL DISORDERS INPATIENT ONLY "$7,909.00" "$5,853.00" $765.00 "$21,620.43" "$3,892.00" "$3,892.00" "$3,892.00" "$3,892.00" "$19,498.83" "$19,498.83" $765.00 "$1,811.65" "$19,498.83" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$5,408.76" "$7,908.60" "$8,038.60" "$7,908.60" "$19,498.83" "$21,412.26" "$19,498.83" "$20,473.77" "$5,931.75" "$19,498.83" "$17,587.94" "$19,498.83" "$7,908.60" "$7,908.60" "$6,263.62" "$19,498.83" "$6,326.88" "$3,500.00" "$5,151.20" "$19,498.83" "$4,587.22" "$20,473.77" "$7,908.60" "$21,620.43" "$1,811.65" "$7,908.60" N/A N/A MS887 DRG MS-DRG V39 (FY2022) 887 OTHER MENTAL DISORDER DIAGNOSES INPATIENT ONLY "$36,502.00" "$27,011.50" "$5,362.04" "$29,609.12" "$27,429.22" "$27,429.22" "$27,429.22" "$27,429.22" "$18,505.70" "$18,505.70" "$6,120.00" "$5,630.15" "$18,505.70" "$19,561.22" "$19,561.22" "$23,438.87" "$13,730.50" "$5,630.15" "$29,609.12" "$17,449.59" "$16,197.00" "$18,505.70" "$20,922.99" "$18,505.70" "$19,430.99" "$27,376.50" "$18,505.70" "$16,692.14" "$18,505.70" "$16,197.00" "$13,767.45" "$28,909.28" "$18,505.70" "$29,201.29" "$24,500.00" "$5,362.04" "$18,505.70" "$21,171.16" "$19,430.99" "$10,824.24" "$20,377.81" "$5,630.15" "$18,505.70" N/A N/A MS894 DRG MS-DRG V39 (FY2022) 894 "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA" INPATIENT ONLY "$28,320.00" "$20,957.00" $765.00 "$23,747.84" "$4,467.72" "$4,467.72" "$4,467.72" "$4,467.72" "$14,842.40" "$14,842.40" $765.00 "$5,464.58" "$14,842.40" "$2,923.28" "$2,923.28" "$2,906.94" "$2,052.41" "$5,464.58" "$23,747.84" "$7,695.86" "$8,235.00" "$14,842.40" "$15,746.60" "$14,842.40" "$15,584.52" "$21,240.00" "$14,842.40" "$13,387.84" "$14,842.40" "$8,235.00" "$6,999.75" "$22,429.24" "$14,842.40" "$22,655.79" $765.00 "$5,204.36" "$14,842.40" "$16,425.60" "$15,584.52" "$5,503.34" "$15,794.23" "$5,464.58" "$14,842.40" N/A N/A MS896 DRG MS-DRG V39 (FY2022) 896 "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC" INPATIENT ONLY "$62,105.00" "$45,958.00" "$3,825.00" "$49,683.97" "$20,951.03" "$20,951.03" "$20,951.03" "$20,951.03" "$23,340.19" "$23,340.19" "$3,825.00" "$13,225.31" "$23,340.19" "$14,616.40" "$14,616.40" "$14,534.70" "$10,262.05" "$13,225.31" "$37,344.30" "$23,628.62" "$26,704.50" "$23,340.19" "$24,202.25" "$23,340.19" "$24,507.20" "$46,578.75" "$23,340.19" "$21,052.85" "$23,340.19" "$26,704.50" "$23,207.31" "$49,187.13" "$23,340.19" "$49,683.97" "$23,628.62" "$12,595.53" "$23,340.19" "$36,020.90" "$24,507.20" "$17,846.27" "$26,426.80" "$13,225.31" "$23,340.19" N/A N/A MS897 DRG MS-DRG V39 (FY2022) 897 "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC" INPATIENT ONLY "$32,666.00" "$24,173.00" "$2,295.00" "$26,817.60" "$11,758.60" "$11,758.60" "$11,758.60" "$11,758.60" "$16,761.00" "$16,761.00" "$2,295.00" "$6,787.21" "$16,761.00" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$6,787.21" "$26,817.60" "$11,457.65" "$12,405.00" "$16,761.00" "$17,743.02" "$16,761.00" "$17,599.05" "$24,499.50" "$16,761.00" "$15,118.42" "$16,761.00" "$12,405.00" "$10,544.25" "$25,871.16" "$16,761.00" "$26,132.49" "$10,500.00" "$6,464.00" "$16,761.00" "$18,946.28" "$17,599.05" "$8,290.11" "$18,194.81" "$6,787.21" "$16,761.00" N/A N/A MS901 DRG MS-DRG V39 (FY2022) 901 WOUND DEBRIDEMENTS FOR INJURIES WITH MCC INPATIENT ONLY "$368,189.00" "$272,460.00" "$40,513.89" "$294,550.85" "$235,753.93" "$235,753.93" "$235,753.93" "$235,753.93" N/A N/A N/A N/A N/A N/A N/A "$290,648.01" "$269,109.01" N/A N/A N/A N/A "$40,513.89" N/A N/A "$42,539.58" "$276,141.75" N/A N/A N/A N/A N/A "$291,605.34" "$40,513.89" "$294,550.85" N/A N/A "$40,513.89" "$213,549.62" "$42,539.58" N/A "$47,914.79" N/A N/A N/A N/A MS902 DRG MS-DRG V39 (FY2022) 902 WOUND DEBRIDEMENTS FOR INJURIES WITH CC INPATIENT ONLY "$272,841.50" "$201,903.00" "$13,411.11" "$218,272.91" "$174,605.11" "$174,605.11" "$174,605.11" "$174,605.11" "$24,610.09" "$24,610.09" "$43,506.20" "$23,327.10" "$24,610.09" "$207,386.56" "$207,386.56" "$215,380.81" "$199,419.59" "$23,327.10" "$39,376.14" "$134,497.28" "$177,346.75" "$24,610.09" "$25,817.97" N/A "$25,840.59" "$204,631.13" N/A N/A "$24,610.09" "$177,346.75" "$177,346.75" "$216,090.19" "$24,610.09" "$218,272.91" "$158,247.87" "$13,411.11" "$24,610.09" "$158,248.07" "$25,840.59" "$31,175.09" "$28,015.72" "$23,327.10" "$24,610.09" N/A N/A MS903 DRG MS-DRG V39 (FY2022) 903 WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC INPATIENT ONLY "$115,376.50" "$85,379.00" "$9,018.43" "$92,301.14" "$16,040.78" "$16,040.78" "$16,040.78" "$16,040.78" "$18,888.74" "$18,888.74" "$10,068.22" "$9,469.35" "$18,888.74" "$87,697.62" "$87,697.62" "$91,078.15" "$84,328.64" "$9,469.35" "$30,221.98" "$16,360.76" "$74,994.69" "$18,888.74" "$20,345.15" "$18,888.74" "$19,833.18" "$86,532.38" "$18,888.74" "$17,037.64" "$18,888.74" "$17,029.50" "$74,994.69" "$91,378.14" "$18,888.74" "$92,301.14" "$66,918.33" "$9,018.43" "$18,888.74" "$66,918.37" "$19,833.18" "$11,380.59" "$20,857.08" "$9,469.35" "$18,888.74" N/A N/A MS904 DRG MS-DRG V39 (FY2022) 904 SKIN GRAFTS FOR INJURIES WITH CC/MCC INPATIENT ONLY "$368,061.50" "$272,366.00" "$23,729.58" "$294,449.15" "$235,247.31" "$235,247.31" "$235,247.31" "$235,247.31" "$36,775.35" "$36,775.35" N/A "$24,916.07" "$36,775.35" "$279,763.49" "$279,763.49" "$290,547.71" "$269,016.12" "$24,916.07" "$58,840.56" "$178,642.77" "$239,239.94" "$36,775.35" "$37,032.88" "$36,775.35" "$38,614.12" "$276,046.13" "$36,775.35" "$33,171.37" "$36,775.35" "$239,239.94" "$239,239.94" "$291,504.65" "$36,775.35" "$294,449.15" "$213,475.64" "$23,729.58" "$43,662.77" "$213,475.67" "$38,614.12" N/A "$43,237.07" "$24,916.07" "$36,775.35" N/A N/A MS905 DRG MS-DRG V39 (FY2022) 905 SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC INPATIENT ONLY "$401,592.50" "$297,178.50" "$22,440.93" "$301,194.38" "$196,667.39" "$196,667.39" "$196,667.39" "$196,667.39" N/A N/A "$196,667.39" N/A N/A N/A N/A N/A N/A N/A "$196,667.39" "$196,667.39" "$260,986.96" N/A N/A N/A N/A "$301,194.38" N/A N/A N/A "$196,667.39" "$196,667.39" "$196,667.39" N/A N/A "$196,667.39" N/A "$22,440.93" "$232,923.65" N/A "$196,667.39" "$196,667.39" N/A N/A N/A N/A MS906 DRG MS-DRG V39 (FY2022) 906 HAND PROCEDURES FOR INJURIES INPATIENT ONLY "$190,655.50" "$141,085.50" "$9,807.41" "$152,524.19" "$122,197.74" "$122,197.74" "$122,197.74" "$122,197.74" "$23,502.39" "$23,502.39" "$23,255.59" "$16,776.33" "$23,502.39" "$65,585.98" "$65,585.98" "$68,990.71" "$42,473.67" "$16,776.33" "$37,603.82" "$94,279.22" "$123,925.91" "$23,502.39" "$24,432.26" "$23,502.39" "$24,677.51" "$142,991.63" "$23,502.39" "$21,199.16" "$23,502.39" "$123,925.91" "$123,925.91" "$150,998.95" "$23,502.39" "$152,524.19" "$110,580.04" "$9,807.41" "$23,502.39" "$110,580.19" "$24,677.51" "$18,081.84" "$26,629.75" "$16,776.33" "$23,502.39" N/A N/A MS907 DRG MS-DRG V39 (FY2022) 907 OTHER O.R. PROCEDURES FOR INJURIES WITH MCC INPATIENT ONLY "$276,719.50" "$204,772.50" "$34,548.37" "$221,375.57" "$162,772.09" "$162,772.09" "$162,772.09" "$162,772.09" "$38,301.96" "$38,301.96" "$51,266.98" "$41,160.33" "$38,301.96" "$132,661.38" "$132,661.38" "$139,387.22" "$92,969.53" "$41,160.33" "$61,283.14" "$136,595.90" "$179,867.65" "$38,301.96" "$39,274.30" "$38,301.96" "$40,217.06" "$207,539.63" "$38,301.96" "$34,548.37" "$38,301.96" "$179,867.65" "$179,867.65" "$219,161.80" "$38,301.96" "$221,375.57" "$175,886.84" "$39,200.30" "$38,301.96" "$160,497.31" "$40,217.06" "$39,577.96" "$45,147.20" "$41,160.33" "$38,301.96" N/A N/A MS908 DRG MS-DRG V39 (FY2022) 908 OTHER O.R. PROCEDURES FOR INJURIES WITH CC INPATIENT ONLY "$173,657.50" "$128,507.00" "$15,782.48" "$138,925.84" "$98,623.75" "$98,623.75" "$98,623.75" "$98,623.75" "$25,204.31" "$25,204.31" "$22,087.50" "$21,333.70" "$25,204.31" "$60,329.00" "$60,329.00" "$63,361.13" "$40,365.48" "$21,333.70" "$40,326.90" "$86,761.26" "$112,877.25" "$25,204.31" "$26,351.53" "$25,204.31" "$26,464.53" "$130,243.13" "$25,204.31" "$22,734.29" "$25,204.31" "$112,877.25" "$112,877.25" "$137,536.59" "$25,204.31" "$138,925.84" "$116,110.78" "$15,782.48" "$25,204.31" "$100,721.35" "$26,464.53" "$20,553.83" "$28,759.21" "$21,333.70" "$25,204.31" N/A N/A MS909 DRG MS-DRG V39 (FY2022) 909 OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC INPATIENT ONLY "$124,246.50" "$91,942.50" "$11,048.45" "$99,396.99" "$17,444.21" "$17,444.21" "$17,444.21" "$17,444.21" "$20,515.41" "$20,515.41" "$11,207.15" "$11,600.88" "$20,515.41" "$24,499.88" "$24,499.88" "$25,672.02" "$14,247.42" "$11,600.88" "$32,824.66" "$18,367.50" "$80,760.06" "$20,515.41" "$21,410.13" "$21,410.13" "$21,541.18" "$93,184.88" "$20,515.41" "$18,504.90" "$20,515.41" "$80,760.06" "$80,760.06" "$98,403.00" "$20,515.41" "$99,396.99" "$25,889.55" "$11,048.45" "$20,515.41" "$72,062.97" "$21,541.18" "$13,743.32" "$22,892.40" "$11,600.88" "$20,515.41" N/A N/A MS913 DRG MS-DRG V39 (FY2022) 913 TRAUMATIC INJURY WITH MCC INPATIENT ONLY "$19,816.50" "$14,664.50" "$3,500.00" "$25,203.20" "$12,722.13" "$12,722.13" "$12,722.13" "$12,722.13" "$22,362.26" "$22,362.26" "$10,184.26" "$4,539.42" "$22,362.26" "$5,707.53" "$5,707.53" "$5,927.05" "$4,006.25" "$10,731.43" "$19,816.40" "$20,378.27" "$19,816.40" "$22,362.26" "$22,477.27" "$22,362.26" "$23,480.37" "$14,862.38" "$22,362.26" "$20,170.76" "$22,362.26" "$12,880.66" "$12,880.66" "$15,694.59" "$22,362.26" "$15,853.12" "$3,500.00" "$10,220.41" "$22,362.26" "$11,493.57" "$23,480.37" "$16,425.82" "$25,203.20" "$4,539.42" "$19,816.40" N/A N/A MS914 DRG MS-DRG V39 (FY2022) 914 TRAUMATIC INJURY WITHOUT MCC INPATIENT ONLY "$58,492.00" "$43,284.50" "$6,222.53" "$46,793.43" "$37,551.72" "$37,551.72" "$37,551.72" "$37,551.72" "$17,174.42" "$17,174.42" "$6,256.04" "$6,533.66" "$17,174.42" "$13,119.92" "$13,119.92" "$13,624.53" "$11,133.55" "$6,533.66" "$27,479.07" "$11,966.40" "$13,303.50" "$17,174.42" "$18,013.01" "$17,174.42" "$18,033.14" "$43,869.00" "$17,174.42" "$15,491.33" "$17,174.42" "$38,019.66" "$38,019.66" "$46,325.49" "$17,174.42" "$46,793.43" "$18,889.55" "$6,222.53" "$17,174.42" "$33,925.36" "$18,033.14" "$8,890.56" "$18,712.09" "$6,533.66" "$17,174.42" N/A N/A MS915 DRG MS-DRG V39 (FY2022) 915 ALLERGIC REACTIONS WITH MCC INPATIENT ONLY "$72,144.00" "$53,387.00" "$10,500.00" "$57,715.01" "$23,356.44" "$23,356.44" "$23,356.44" "$23,356.44" "$22,782.56" "$22,782.56" "$13,728.67" "$15,137.34" "$22,782.56" "$15,403.92" "$15,403.92" "$17,335.79" "$10,812.38" "$15,137.34" "$36,452.10" "$24,496.73" "$25,492.50" "$22,782.56" "$24,662.97" "$22,782.56" "$23,921.69" "$54,108.00" "$22,782.56" "$20,549.87" "$22,782.56" "$26,558.82" "$22,734.94" "$57,137.89" "$22,782.56" "$57,715.01" "$10,500.00" "$14,416.51" "$22,782.56" "$41,843.52" "$23,921.69" "$17,036.30" "$25,729.09" "$15,137.34" "$22,782.56" N/A N/A MS916 DRG MS-DRG V39 (FY2022) 916 ALLERGIC REACTIONS WITHOUT MCC INPATIENT ONLY "$33,631.00" "$24,887.00" "$1,961.50" "$26,904.78" "$4,608.45" "$4,608.45" "$4,608.45" "$4,608.45" "$15,597.40" "$15,597.40" "$4,585.15" "$5,853.42" "$15,597.40" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$5,853.42" "$24,955.84" "$8,939.47" "$14,136.00" "$15,597.40" "$16,406.60" "$15,597.40" "$16,377.27" "$25,223.25" "$15,597.40" "$14,068.85" "$15,597.40" "$10,751.66" "$9,270.26" "$26,635.72" "$15,597.40" "$26,904.78" "$3,500.00" "$5,574.68" "$15,597.40" "$19,505.98" "$16,377.27" "$6,600.00" "$16,738.91" "$5,853.42" "$15,597.40" N/A N/A MS917 DRG MS-DRG V39 (FY2022) 917 POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC INPATIENT ONLY "$41,684.50" "$30,847.00" "$1,961.50" "$34,011.73" "$4,304.33" "$4,304.33" "$4,304.33" "$4,304.33" "$21,257.33" "$21,257.33" "$12,541.54" "$9,548.73" "$21,257.33" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$11,939.58" "$34,011.73" "$20,491.33" "$22,177.50" "$21,257.33" "$22,537.26" "$21,257.33" "$22,320.20" "$31,263.38" "$21,257.33" "$19,174.11" "$21,257.33" "$22,177.50" "$19,354.83" "$33,013.74" "$21,257.33" "$33,347.21" "$3,500.00" "$11,371.02" "$21,257.33" "$24,177.01" "$22,320.20" "$14,820.94" "$23,820.70" "$9,548.73" "$21,257.33" N/A N/A MS918 DRG MS-DRG V39 (FY2022) 918 POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC INPATIENT ONLY "$27,630.00" "$20,446.50" "$5,723.18" "$26,426.69" "$15,769.86" "$15,769.86" "$15,769.86" "$15,769.86" "$16,516.68" "$16,516.68" "$5,723.18" "$6,225.23" "$16,516.68" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$6,225.23" "$26,426.69" "$11,005.42" "$11,874.00" "$16,516.68" "$17,503.02" "$17,503.02" "$17,342.51" "$20,722.50" "$16,516.68" "$14,898.05" "$16,516.68" "$11,874.00" "$10,092.90" "$21,882.62" "$16,516.68" "$22,103.66" "$14,000.00" "$5,928.79" "$16,516.68" "$16,025.40" "$17,342.51" "$7,935.24" "$17,889.13" "$6,225.23" "$16,516.68" N/A N/A MS919 DRG MS-DRG V39 (FY2022) 919 COMPLICATIONS OF TREATMENT WITH MCC INPATIENT ONLY "$83,959.00" "$62,130.00" "$10,721.38" "$67,167.11" "$59,773.60" "$59,773.60" "$59,773.60" "$59,773.60" "$23,780.51" "$23,780.51" N/A "$11,257.45" "$23,780.51" "$42,045.72" "$42,045.72" "$49,784.68" "$29,513.41" "$11,257.45" "$38,048.82" "$24,140.06" "$27,661.50" "$23,780.51" N/A N/A "$24,969.54" "$62,969.25" N/A "$21,450.02" N/A "$29,102.01" "$24,952.78" "$66,495.45" "$23,780.51" "$67,167.11" "$49,000.00" "$10,721.38" "$23,780.51" "$48,696.22" "$24,969.54" N/A "$26,977.74" "$11,257.45" "$23,780.51" N/A N/A MS920 DRG MS-DRG V39 (FY2022) 920 COMPLICATIONS OF TREATMENT WITH CC INPATIENT ONLY "$30,040.00" "$22,230.00" "$8,791.84" "$28,999.58" "$19,550.99" "$19,550.99" "$19,550.99" "$19,550.99" "$18,124.74" "$18,124.74" "$8,791.84" "$10,389.89" "$18,124.74" "$13,972.30" "$13,972.30" "$16,742.05" "$9,807.50" "$10,389.89" "$28,999.58" "$13,752.41" "$15,369.00" "$18,124.74" "$18,960.88" "$18,124.74" "$19,030.98" "$22,530.00" "$18,124.74" "$16,348.52" "$18,124.74" "$15,369.00" "$13,063.65" "$23,791.31" "$18,124.74" "$24,031.63" "$17,500.00" "$9,895.13" "$18,124.74" "$17,423.20" "$19,030.98" "$10,270.90" "$19,901.15" "$10,389.89" "$18,124.74" N/A N/A MS921 DRG MS-DRG V39 (FY2022) 921 COMPLICATIONS OF TREATMENT WITHOUT CC/MCC INPATIENT ONLY "$25,366.00" "$18,771.00" "$5,810.68" "$25,365.96" "$9,550.08" "$9,550.08" "$9,550.08" "$9,550.08" "$15,870.02" "$15,870.02" "$5,892.77" "$5,810.68" "$15,870.02" "$10,206.85" "$10,206.85" "$11,045.89" "$9,088.80" "$7,165.64" "$25,365.96" "$9,796.81" "$10,468.50" "$15,870.02" "$16,861.59" "$15,870.02" "$16,663.52" "$19,024.50" "$15,870.02" "$14,314.76" "$15,870.02" "$10,468.50" "$8,898.23" "$20,089.83" "$15,870.02" "$20,292.77" "$7,628.85" "$6,824.42" "$15,870.02" "$14,712.28" "$16,663.52" "$6,995.96" "$17,080.00" "$5,810.68" "$15,870.02" N/A N/A MS922 DRG MS-DRG V39 (FY2022) 922 "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC" INPATIENT ONLY "$69,006.50" "$51,065.00" "$11,050.30" "$87,320.82" "$13,270.45" "$13,270.45" "$13,270.45" "$13,270.45" "$22,014.43" "$22,014.43" "$13,346.64" "$12,678.47" "$22,014.43" "$13,001.31" "$13,001.31" "$14,394.30" "$11,050.30" "$12,678.47" "$35,223.09" "$20,939.51" "$23,823.00" "$22,014.43" "$22,775.13" "$22,014.43" "$23,115.15" "$51,754.88" "$22,014.43" "$19,857.02" "$22,014.43" "$23,823.00" "$20,249.55" "$54,652.88" "$22,014.43" "$55,204.93" "$22,389.55" "$12,074.73" "$22,014.43" "$40,023.77" "$23,115.15" "$15,920.60" "$24,767.99" "$12,678.47" "$22,014.43" N/A N/A MS923 DRG MS-DRG V39 (FY2022) 923 "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC" INPATIENT ONLY "$57,091.00" "$42,247.50" "$6,558.63" "$45,672.58" "$28,863.21" "$28,863.21" "$28,863.21" "$28,863.21" "$17,539.50" "$17,539.50" "$6,558.63" "$12,678.47" "$17,539.50" "$20,277.03" "$20,277.03" "$23,735.74" "$14,232.94" "$12,678.47" "$28,063.20" "$12,694.53" "$14,097.00" "$17,539.50" "$18,399.44" "$17,539.50" "$18,416.48" "$42,818.25" "$17,539.50" "$15,820.63" "$17,539.50" "$14,097.00" "$11,982.45" "$45,215.87" "$17,539.50" "$45,672.58" "$21,000.00" "$12,074.73" "$17,539.50" "$33,112.78" "$18,416.48" "$9,420.85" "$19,168.89" "$12,678.47" "$17,539.50" N/A N/A MS927 DRG MS-DRG V39 (FY2022) 927 EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT INPATIENT ONLY "$891,990.00" "$660,073.00" "$137,268.43" "$668,992.50" "$343,998.77" "$343,998.77" "$343,998.77" "$343,998.77" "$160,393.19" "$160,393.19" "$343,998.77" "$137,268.43" "$160,393.19" N/A N/A N/A N/A "$137,268.43" "$343,998.77" "$343,998.77" "$343,998.77" "$160,393.19" "$160,393.19" "$160,393.19" "$160,393.19" "$668,992.50" "$160,393.19" "$160,393.19" "$160,393.19" "$343,998.77" "$343,998.77" "$343,998.77" "$160,393.19" "$274,047.95" "$343,998.77" "$137,268.43" "$160,393.19" "$517,354.20" "$160,393.19" "$343,998.77" "$343,998.77" "$137,268.43" "$160,393.19" N/A N/A MS928 DRG MS-DRG V39 (FY2022) 928 FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC INPATIENT ONLY "$221,516.50" "$163,922.50" "$22,642.54" "$407,965.43" "$115,575.85" "$115,575.85" "$115,575.85" "$115,575.85" "$55,885.63" "$55,885.63" "$48,038.28" "$22,642.54" "$55,885.63" "$407,965.43" "$407,965.43" "$407,965.43" "$407,965.43" "$22,642.54" "$115,575.85" "$115,575.85" "$115,575.85" "$55,885.63" "$55,885.63" "$55,885.63" "$55,885.63" "$166,137.38" "$55,885.63" "$55,885.63" "$55,885.63" "$115,575.85" "$115,575.85" "$115,575.85" "$55,885.63" N/A "$115,575.85" "$22,642.54" "$56,131.28" "$128,479.57" "$55,885.63" "$115,575.85" "$67,455.50" "$22,642.54" "$55,885.63" N/A N/A MS929 DRG MS-DRG V39 (FY2022) 929 FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC INPATIENT ONLY "$152,790.50" "$113,065.00" "$9,637.44" "$122,232.12" "$98,091.29" "$98,091.29" "$98,091.29" "$98,091.29" "$31,853.89" "$31,853.89" "$20,836.22" "$13,982.21" "$31,853.89" "$116,135.79" "$116,135.79" "$120,612.55" "$111,674.31" "$13,982.21" "$50,966.22" "$74,515.19" "$99,313.60" "$31,853.89" "$32,653.62" "$32,653.62" "$33,446.58" "$114,592.88" "$31,853.89" "$28,732.21" "$31,853.89" "$99,313.60" "$99,313.60" "$121,009.82" "$31,853.89" "$122,232.12" "$88,618.30" "$9,637.44" "$31,853.89" "$88,618.49" "$33,446.58" "$30,212.26" "$37,079.27" "$13,982.21" "$31,853.89" N/A N/A MS933 DRG MS-DRG V39 (FY2022) 933 EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT INPATIENT ONLY "$503,917.00" "$372,899.00" "$26,670.86" "$403,133.37" "$46,236.35" "$46,236.35" "$46,236.35" "$46,236.35" N/A N/A "$46,236.35" N/A N/A N/A N/A N/A N/A N/A "$46,236.35" "$46,236.35" "$46,236.35" N/A N/A N/A N/A "$377,937.75" N/A N/A N/A "$46,236.35" "$46,236.35" "$399,102.02" N/A "$403,133.37" "$46,236.35" N/A "$26,670.86" "$292,271.86" N/A "$46,236.35" "$46,036.58" N/A N/A N/A N/A MS934 DRG MS-DRG V39 (FY2022) 934 FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY INPATIENT ONLY "$107,880.00" "$79,831.50" "$8,663.42" "$86,303.88" "$69,258.87" "$69,258.87" "$69,258.87" "$69,258.87" "$24,448.59" "$24,448.59" "$14,056.24" "$9,096.60" "$24,448.59" "$81,999.47" "$81,999.47" "$85,160.35" "$78,849.38" "$9,096.60" "$39,117.74" "$25,249.08" "$70,121.90" "$24,448.59" "$25,062.25" "$24,448.59" "$25,671.02" "$80,910.00" "$24,448.59" "$22,052.63" "$24,448.59" "$70,121.90" "$70,121.90" "$85,440.84" "$24,448.59" "$86,303.88" "$62,121.60" "$8,663.42" "$24,448.59" "$62,570.40" "$25,671.02" "$19,456.17" "$27,813.65" "$9,096.60" "$24,448.59" N/A N/A MS935 DRG MS-DRG V39 (FY2022) 935 NON-EXTENSIVE BURNS INPATIENT ONLY "$83,154.50" "$61,534.50" "$7,789.42" "$66,523.39" "$53,385.02" "$53,385.02" "$53,385.02" "$53,385.02" "$24,393.38" "$24,393.38" "$13,136.00" "$8,178.90" "$24,393.38" "$63,205.55" "$63,205.55" "$65,641.96" "$60,777.45" "$8,178.90" "$39,029.41" "$27,242.36" "$54,050.26" "$24,393.38" "$26,120.10" "$24,393.38" "$25,613.05" "$62,365.88" "$24,393.38" "$22,002.83" "$24,393.38" "$54,050.26" "$54,050.26" "$65,858.17" "$24,393.38" "$66,523.39" "$48,229.47" "$7,789.42" "$24,393.38" "$48,229.61" "$25,613.05" "$19,375.98" "$27,744.57" "$8,178.90" "$24,393.38" N/A N/A MS939 DRG MS-DRG V39 (FY2022) 939 O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC INPATIENT ONLY "$196,180.50" "$145,174.00" "$23,935.01" "$156,944.37" "$113,026.86" "$113,026.86" "$113,026.86" "$113,026.86" "$34,343.26" "$34,343.26" "$29,838.35" "$25,131.78" "$34,343.26" "$76,599.53" "$76,599.53" "$80,476.30" "$52,226.08" "$25,131.78" "$54,949.22" "$96,587.09" "$127,517.30" "$34,343.26" "$33,784.33" "$34,343.26" "$36,060.42" "$147,135.38" N/A "$30,977.62" "$34,343.26" "$127,517.30" "$127,517.30" "$155,374.93" "$34,343.26" "$156,944.37" "$129,174.22" "$23,935.01" "$34,343.26" "$113,784.69" "$36,060.42" "$33,828.03" "$40,194.01" "$25,131.78" "$34,343.26" N/A N/A MS940 DRG MS-DRG V39 (FY2022) 940 O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC INPATIENT ONLY "$111,856.50" "$82,774.00" "$15,810.41" "$89,484.94" "$25,238.94" "$25,238.94" "$25,238.94" "$25,238.94" "$26,381.01" "$26,381.01" "$16,310.88" "$16,600.94" "$26,381.01" "$24,445.53" "$24,445.53" "$27,172.77" "$17,160.09" "$16,600.94" "$42,209.62" "$29,654.21" "$72,706.51" "$26,381.01" "$27,400.09" "$26,381.01" "$27,700.06" "$83,892.38" "$26,381.01" "$23,795.67" "$26,381.01" "$33,313.50" "$72,706.51" "$88,590.10" "$26,381.01" "$89,484.94" "$23,438.75" "$15,810.41" "$26,381.01" "$64,876.77" "$27,700.06" "$22,262.97" "$30,231.51" "$16,600.94" "$26,381.01" N/A N/A MS941 DRG MS-DRG V39 (FY2022) 941 O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC INPATIENT ONLY "$76,714.50" "$56,769.00" "$11,958.50" "$61,371.35" "$26,118.38" "$26,118.38" "$26,118.38" "$26,118.38" "$24,325.75" "$24,325.75" "$12,077.41" "$12,556.43" "$24,325.75" "$21,862.28" "$21,862.28" "$24,936.17" "$15,346.37" "$12,556.43" "$38,921.20" "$25,402.52" "$28,846.50" "$24,325.75" "$25,143.68" "$24,325.75" "$25,542.04" "$57,535.88" "$24,325.75" "$21,941.83" "$24,325.75" "$28,846.50" "$25,012.54" "$60,757.63" "$24,325.75" "$61,371.35" "$23,755.00" "$11,958.50" "$24,325.75" "$44,494.41" "$25,542.04" "$19,277.74" "$27,659.94" "$12,556.43" "$24,325.75" N/A N/A MS947 DRG MS-DRG V39 (FY2022) 947 SIGNS AND SYMPTOMS WITH MCC INPATIENT ONLY "$88,954.50" "$65,826.50" "$10,146.77" "$66,715.88" "$10,146.77" "$10,146.77" "$10,146.77" "$10,146.77" "$20,345.15" "$20,345.15" "$10,146.77" N/A "$20,345.15" N/A N/A N/A N/A N/A "$10,146.77" "$10,146.77" "$10,146.77" "$20,345.15" "$20,345.15" "$20,345.15" "$20,345.15" "$66,715.88" "$20,345.15" "$20,345.15" "$20,345.15" "$10,146.77" "$10,146.77" "$10,146.77" "$20,345.15" N/A "$10,146.77" N/A "$20,345.15" "$51,593.61" "$20,345.15" "$10,146.77" "$10,146.77" N/A "$19,293.84" N/A N/A MS948 DRG MS-DRG V39 (FY2022) 948 SIGNS AND SYMPTOMS WITHOUT MCC INPATIENT ONLY "$40,747.50" "$30,153.50" "$6,364.94" "$32,597.92" "$15,975.12" "$15,975.12" "$15,975.12" "$15,975.12" "$16,485.64" "$16,485.64" "$6,364.94" "$7,783.43" "$16,485.64" "$11,177.84" "$11,177.84" "$13,393.64" "$7,846.00" "$7,783.43" "$26,377.02" "$10,465.72" "$11,806.50" "$16,485.64" "$17,216.59" "$16,485.64" "$17,309.92" "$30,560.63" "$16,485.64" "$14,870.05" "$16,485.64" "$11,806.50" "$10,533.11" "$32,271.92" "$16,485.64" "$32,597.92" "$14,000.00" "$7,412.79" "$16,485.64" "$23,633.55" "$17,309.92" "$7,890.14" "$17,850.28" "$7,783.43" "$16,485.64" N/A N/A MS949 DRG MS-DRG V39 (FY2022) 949 AFTERCARE WITH CC/MCC INPATIENT ONLY "$149,081.50" "$110,320.50" "$11,125.97" "$119,265.16" "$95,585.39" "$95,585.39" "$95,585.39" "$95,585.39" "$18,713.45" "$18,713.45" "$13,548.49" "$20,831.82" "$18,713.45" "$35,451.45" "$35,451.45" "$37,291.82" "$20,506.75" "$20,831.82" "$29,941.52" "$70,848.07" "$96,902.94" "$18,713.45" "$20,176.57" "$18,713.45" "$19,649.12" "$111,811.13" "$18,713.45" "$16,879.53" "$18,713.45" "$96,902.94" "$96,902.94" "$118,072.50" "$18,713.45" "$119,265.16" N/A "$19,839.82" "$18,713.45" "$86,467.27" "$19,649.12" "$11,125.97" "$20,637.75" "$20,831.82" "$18,713.45" N/A N/A MS950 DRG MS-DRG V39 (FY2022) 950 AFTERCARE WITHOUT CC/MCC INPATIENT ONLY "$11,680.50" "$8,644.00" "$1,961.50" "$17,445.28" "$4,022.46" "$4,022.46" "$4,022.46" "$4,022.46" "$16,161.96" "$16,161.96" "$4,916.29" "$2,675.65" "$16,161.96" "$2,794.46" "$2,794.46" "$3,348.41" "$1,961.50" "$7,275.39" "$11,680.28" "$9,549.16" "$11,103.00" "$16,161.96" "$16,730.15" "$16,161.96" "$16,970.06" "$8,760.38" "$16,161.96" "$14,578.09" "$16,161.96" "$11,103.00" "$9,437.55" "$9,250.78" "$16,161.96" "$9,344.23" "$3,500.00" "$6,928.94" "$16,161.96" "$6,774.69" "$16,970.06" "$7,420.00" "$17,445.28" "$2,675.65" "$11,680.28" N/A N/A MS951 DRG MS-DRG V39 (FY2022) 951 OTHER FACTORS INFLUENCING HEALTH STATUS INPATIENT ONLY "$91,930.50" "$68,029.00" "$6,284.70" "$88,905.75" "$58,927.41" "$58,927.41" "$58,927.41" "$58,927.41" "$18,165.15" "$18,165.15" N/A "$6,598.94" "$17,291.74" "$85,612.95" "$85,612.95" "$88,905.75" "$60,093.75" "$6,598.94" N/A N/A N/A "$17,291.74" "$18,165.15" "$18,165.15" "$18,156.33" "$68,947.88" "$18,165.15" "$15,597.15" "$17,291.74" "$59,754.71" N/A "$72,808.80" "$17,291.74" "$73,544.27" N/A "$6,284.70" "$17,291.74" "$53,319.69" "$18,156.33" N/A "$18,858.89" "$6,598.94" "$18,165.15" N/A N/A MS955 DRG MS-DRG V39 (FY2022) 955 CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA INPATIENT ONLY "$593,939.00" "$439,515.00" "$70,316.44" "$445,454.25" N/A N/A N/A N/A "$70,316.44" "$70,316.44" N/A N/A "$70,316.44" "$103,087.19" "$103,087.19" "$103,087.19" "$103,087.19" N/A N/A N/A N/A "$70,316.44" "$70,316.44" "$70,316.44" "$70,316.44" "$445,454.25" "$70,316.44" "$70,316.44" "$70,316.44" N/A N/A N/A "$70,316.44" "$233,288.56" N/A N/A "$70,316.44" "$344,484.62" "$70,316.44" N/A N/A N/A "$70,316.44" N/A N/A MS956 DRG MS-DRG V39 (FY2022) 956 "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA" INPATIENT ONLY "$370,986.00" "$274,530.00" "$37,624.23" "$296,788.47" "$238,172.75" "$238,172.75" "$238,172.75" "$238,172.75" "$45,935.84" "$45,935.84" "$98,708.66" "$52,852.04" "$45,935.84" "$202,674.47" "$202,674.47" "$213,075.76" "$144,088.84" "$56,552.19" "$98,708.66" "$98,708.66" "$98,708.66" "$37,624.23" "$45,935.84" "$45,935.84" "$39,505.44" "$278,239.50" "$45,935.84" "$45,935.84" "$45,935.84" "$98,708.66" "$98,708.66" "$293,820.59" "$37,624.23" "$296,788.47" "$98,708.66" "$50,335.25" "$37,624.23" "$215,171.88" "$39,505.44" "$98,708.66" "$44,299.20" "$52,852.04" "$45,935.84" N/A N/A MS957 DRG MS-DRG V39 (FY2022) 957 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC INPATIENT ONLY "$402,898.00" "$298,145.00" "$62,268.78" "$599,516.12" "$250,847.49" "$250,847.49" "$250,847.49" "$250,847.49" "$64,594.14" "$64,594.14" "$240,190.29" "$85,748.48" "$64,594.14" "$599,516.12" "$599,516.12" "$237,068.40" "$160,564.11" "$81,665.28" "$240,190.29" "$240,190.29" "$240,190.29" "$62,268.78" "$64,594.14" "$64,594.14" "$65,382.22" "$302,173.50" "$64,594.14" "$64,594.14" "$64,594.14" "$240,190.29" "$240,190.29" "$319,095.03" "$62,268.78" "$322,318.21" "$240,190.29" "$81,665.28" "$64,594.14" "$233,680.84" "$65,382.22" "$240,190.29" "$240,190.29" "$81,665.28" "$64,594.14" N/A N/A MS958 DRG MS-DRG V39 (FY2022) 958 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC INPATIENT ONLY "$336,295.50" "$248,859.00" "$33,648.54" "$269,036.37" "$145,414.01" "$145,414.01" "$145,414.01" "$145,414.01" "$41,451.44" "$41,451.44" "$145,414.01" "$35,330.95" "$41,451.44" "$186,986.36" "$186,986.36" "$236,899.16" "$124,384.09" "$35,330.95" "$145,414.01" "$145,414.01" "$145,414.01" "$41,451.44" "$41,451.44" "$41,451.44" "$41,451.44" "$252,221.63" "$41,451.44" "$41,451.44" "$41,451.44" "$145,414.01" "$145,414.01" "$266,346.01" "$41,451.44" "$269,036.37" "$145,414.01" "$33,648.54" "$40,079.09" "$195,051.39" "$41,451.44" "$145,414.01" "$145,414.01" "$35,330.95" "$41,451.44" N/A N/A MS959 DRG MS-DRG V39 (FY2022) 959 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC INPATIENT ONLY "$247,275.00" "$182,983.50" "$27,002.87" "$197,819.98" "$145,883.81" "$145,883.81" "$145,883.81" "$145,883.81" "$29,936.66" "$29,936.66" "$40,502.29" "$43,889.98" "$29,936.66" "$114,207.68" "$114,207.68" "$120,036.79" "$79,640.98" "$43,889.98" "$47,898.66" "$122,477.08" "$160,728.73" "$29,936.66" "$30,010.07" N/A "$31,433.49" "$185,456.25" "$29,936.66" "$27,002.87" "$29,936.66" "$160,728.73" "$160,728.73" "$195,841.78" "$29,936.66" "$197,819.98" "$158,809.03" "$34,497.85" "$29,936.66" "$143,419.50" "$31,433.49" "$27,427.51" "$34,680.40" "$43,889.98" "$29,936.66" N/A N/A MS963 DRG MS-DRG V39 (FY2022) 963 OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC INPATIENT ONLY "$171,213.00" "$126,698.00" "$26,964.27" "$136,970.36" "$96,948.30" "$96,948.30" "$96,948.30" "$96,948.30" "$29,893.87" "$29,893.87" "$37,324.50" "$30,750.57" "$29,893.87" "$58,134.81" "$58,134.81" "$61,053.04" "$38,766.01" "$30,750.57" "$37,324.50" "$80,938.21" "$111,288.42" "$29,893.87" "$35,094.77" "$35,094.77" "$31,388.56" "$128,409.75" "$29,893.87" "$26,964.27" "$29,893.87" "$111,288.42" "$111,288.42" "$135,600.70" "$29,893.87" "$136,970.36" "$37,324.50" "$29,286.24" "$29,893.87" "$99,303.54" "$31,388.56" "$37,324.50" "$34,626.86" "$30,750.57" "$29,893.87" N/A N/A MS964 DRG MS-DRG V39 (FY2022) 964 OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC INPATIENT ONLY "$95,651.50" "$70,782.50" "$13,182.41" "$76,520.91" "$25,796.38" "$25,796.38" "$25,796.38" "$25,796.38" "$21,349.12" "$21,349.12" "$13,182.41" "$17,222.51" "$21,349.12" "$35,950.04" "$35,950.04" "$37,332.73" "$27,158.55" "$17,222.51" "$34,158.59" "$19,710.71" "$22,377.00" "$21,349.12" "$22,122.98" "$22,122.98" "$22,416.58" "$71,738.63" "$21,349.12" "$19,256.91" "$21,349.12" "$62,173.24" "$62,173.24" "$75,755.71" "$21,349.12" "$76,520.91" "$25,980.45" "$16,402.39" "$21,349.12" "$55,477.87" "$22,416.58" "$14,954.25" "$23,935.55" "$17,222.51" "$21,349.12" N/A N/A MS965 DRG MS-DRG V39 (FY2022) 965 OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC INPATIENT ONLY "$77,597.00" "$57,422.00" "$8,145.33" "$62,077.27" "$17,409.30" "$17,409.30" "$17,409.30" "$17,409.30" "$17,351.09" "$17,351.09" "$8,406.25" "$8,552.60" "$17,351.09" "$24,534.98" "$24,534.98" "$25,478.63" "$19,146.05" "$8,552.60" "$27,761.74" "$12,246.34" "$13,687.50" "$17,351.09" "$18,161.58" "$17,351.09" "$18,218.64" "$58,197.75" "$17,351.09" "$15,650.68" "$17,351.09" "$50,437.78" "$50,437.78" "$61,456.51" "$17,351.09" "$62,077.27" "$18,726.35" "$8,145.33" "$17,351.09" "$45,006.26" "$18,218.64" "$9,147.18" "$18,933.15" "$8,552.60" "$17,351.09" N/A N/A MS969 DRG MS-DRG V39 (FY2022) 969 HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC INPATIENT ONLY "$400,724.00" "$296,536.00" "$89,135.47" "$300,543.00" "$101,029.87" "$101,029.87" "$101,029.87" "$101,029.87" N/A N/A "$101,029.87" N/A N/A N/A N/A N/A N/A N/A "$101,029.87" "$101,029.87" "$101,029.87" N/A N/A N/A N/A "$300,543.00" N/A N/A N/A "$101,029.87" "$101,029.87" "$101,029.87" N/A N/A "$101,029.87" N/A "$89,135.47" "$232,419.92" N/A "$101,029.87" "$101,029.87" N/A N/A N/A N/A MS970 DRG MS-DRG V39 (FY2022) 970 HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC INPATIENT ONLY "$298,778.50" "$221,096.50" "$173,291.53" "$224,083.88" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$224,083.88" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$173,291.53" N/A N/A N/A N/A N/A N/A N/A MS974 DRG MS-DRG V39 (FY2022) 974 HIV WITH MAJOR RELATED CONDITION WITH MCC INPATIENT ONLY "$111,043.00" "$82,172.00" "$3,500.00" "$88,834.10" "$25,293.30" "$25,293.30" "$25,293.30" "$25,293.30" "$29,621.95" "$29,621.95" "$23,964.69" "$26,680.51" "$29,621.95" "$24,084.88" "$24,084.88" "$24,903.59" "$12,223.55" "$26,680.51" "$47,395.12" "$38,667.71" "$72,177.70" "$29,621.95" "$32,183.63" "$32,183.63" "$31,103.05" "$83,282.25" "$29,621.95" "$26,719.00" "$29,621.95" "$41,416.31" "$72,177.70" "$87,945.76" "$29,621.95" "$88,834.10" "$3,500.00" "$25,410.00" "$29,621.95" "$64,404.94" "$31,103.05" "$26,970.39" "$34,286.63" "$26,680.51" "$29,621.95" N/A N/A MS975 DRG MS-DRG V39 (FY2022) 975 HIV WITH MAJOR RELATED CONDITION WITH CC INPATIENT ONLY "$53,575.50" "$39,646.00" "$10,733.99" "$42,860.04" "$40,264.87" "$40,264.87" "$40,264.87" "$40,264.87" "$19,901.89" "$19,901.89" "$18,515.55" "$11,270.70" "$19,901.89" "$27,944.60" "$27,944.60" "$33,484.10" "$19,615.00" "$11,270.70" "$18,515.55" "$18,515.55" "$19,231.50" "$19,901.89" "$21,488.71" "$21,488.71" "$20,896.98" "$40,181.63" "$21,488.71" "$21,488.71" "$19,901.89" "$18,515.55" "$18,515.55" "$42,431.45" "$19,901.89" "$42,860.04" "$18,515.55" "$10,733.99" "$19,901.89" "$31,073.79" "$20,896.98" "$12,852.15" "$22,124.75" "$11,270.70" "$19,901.89" N/A N/A MS976 DRG MS-DRG V39 (FY2022) 976 HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC INPATIENT ONLY "$42,378.00" "$31,360.00" "$4,102.20" "$33,902.23" "$10,553.66" "$10,553.66" "$10,553.66" "$10,553.66" "$17,607.14" "$17,607.14" "$7,831.44" "$8,291.48" "$17,607.14" "$5,844.24" "$5,844.24" "$5,619.48" "$4,102.20" "$8,291.48" "$28,171.42" "$12,419.97" "$14,244.00" "$17,607.14" "$18,253.73" "$17,607.14" "$18,487.50" "$31,783.50" "$17,607.14" "$15,881.64" "$17,607.14" "$14,244.00" "$12,107.40" "$33,563.20" "$17,607.14" "$33,902.23" "$20,358.05" "$7,896.64" "$17,607.14" "$24,579.24" "$18,487.50" "$9,000.00" "$19,253.52" "$8,291.48" "$17,607.14" N/A N/A MS977 DRG MS-DRG V39 (FY2022) 977 HIV WITH OR WITHOUT OTHER RELATED CONDITION INPATIENT ONLY "$47,174.50" "$34,909.50" "$5,884.50" "$37,739.24" "$12,567.51" "$12,567.51" "$12,567.51" "$12,567.51" "$20,193.12" "$20,193.12" "$10,090.54" "$11,479.78" "$20,193.12" "$8,383.38" "$8,383.38" "$10,045.23" "$5,884.50" "$11,479.78" "$32,308.99" "$17,495.35" "$24,124.50" "$20,193.12" "$20,947.28" "$20,947.28" "$21,202.78" "$35,380.88" "$20,193.12" "$18,214.19" "$20,193.12" "$20,954.12" "$17,974.45" "$37,361.83" "$20,193.12" "$37,739.24" "$10,500.00" "$10,933.12" "$20,193.12" "$27,361.21" "$21,202.78" "$13,275.19" "$22,489.14" "$11,479.78" "$20,193.12" N/A N/A MS981 DRG MS-DRG V39 (FY2022) 981 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC INPATIENT ONLY "$256,535.00" "$189,836.00" "$42,900.43" "$192,401.25" "$130,096.51" "$130,096.51" "$130,096.51" "$130,096.51" "$50,364.87" "$50,364.87" "$130,096.51" "$48,912.40" "$50,364.87" N/A N/A N/A N/A "$48,912.40" "$130,096.51" "$130,096.51" "$130,096.51" "$50,364.87" "$50,364.87" "$50,364.87" "$50,364.87" "$192,401.25" "$50,364.87" "$50,364.87" "$50,364.87" "$130,096.51" "$130,096.51" "$130,096.51" "$50,364.87" N/A "$130,096.51" "$48,912.40" "$42,900.43" "$148,790.30" "$50,364.87" "$130,096.51" "$130,096.51" "$48,912.40" "$42,900.43" N/A N/A MS982 DRG MS-DRG V39 (FY2022) 982 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC INPATIENT ONLY "$166,292.50" "$123,056.50" "$20,712.02" "$133,033.93" "$105,522.77" "$105,522.77" "$105,522.77" "$105,522.77" "$28,559.81" "$28,559.81" "$25,125.93" "$21,747.63" "$28,559.81" "$45,706.71" "$45,706.71" "$48,054.12" "$27,931.33" "$21,747.63" "$45,695.70" "$82,147.62" "$108,090.07" "$28,559.81" "$29,577.94" "$29,577.94" "$29,987.80" "$124,719.38" "$28,559.81" "$25,760.95" "$28,559.81" "$108,090.07" "$108,090.07" "$131,703.60" "$28,559.81" "$133,033.93" "$96,449.60" "$20,712.02" "$28,559.81" "$96,449.65" "$29,987.80" "$25,427.66" "$32,957.66" "$21,747.63" "$28,559.81" N/A N/A MS983 DRG MS-DRG V39 (FY2022) 983 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC INPATIENT ONLY "$166,718.00" "$123,371.50" "$12,564.89" "$133,374.13" "$105,494.15" "$105,494.15" "$105,494.15" "$105,494.15" "$22,456.80" "$22,456.80" "$20,020.19" "$16,031.30" "$22,456.80" "$46,239.96" "$46,239.96" "$48,596.72" "$28,283.08" "$16,031.30" "$35,930.88" "$82,304.94" "$108,366.48" "$22,456.80" "$23,592.26" "$22,456.80" "$23,579.64" "$125,038.50" "$22,456.80" "$20,256.03" "$22,456.80" "$108,366.48" "$108,366.48" "$132,040.40" "$22,456.80" "$133,374.13" "$96,696.24" "$12,564.89" "$22,456.80" "$96,696.44" "$23,579.64" "$16,563.16" "$25,321.50" "$16,031.30" "$22,456.80" N/A N/A MS987 DRG MS-DRG V39 (FY2022) 987 NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC INPATIENT ONLY "$214,052.50" "$158,399.00" "$33,662.08" "$171,241.83" N/A N/A N/A N/A "$35,365.05" "$35,365.05" N/A N/A "$35,365.05" N/A N/A N/A N/A N/A N/A N/A N/A "$35,365.05" "$35,365.05" "$35,365.05" "$35,365.05" "$160,539.38" "$35,365.05" "$35,365.05" "$35,365.05" N/A N/A "$169,529.40" "$35,365.05" "$171,241.83" N/A N/A "$33,662.08" "$124,150.45" "$35,365.05" N/A N/A N/A "$35,365.05" N/A N/A MS988 DRG MS-DRG V39 (FY2022) 988 NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC INPATIENT ONLY "$102,497.00" "$75,848.00" "$8,701.04" "$81,997.54" "$29,045.41" "$29,045.41" "$29,045.41" "$29,045.41" "$22,830.18" "$22,830.18" "$15,747.67" "$16,461.86" "$22,830.18" "$8,701.04" "$8,701.04" "$9,053.03" "$18,896.30" "$16,461.86" "$36,528.29" "$22,831.85" "$66,623.00" "$22,830.18" "$23,779.40" "$22,830.18" "$23,971.69" "$76,872.75" "$22,830.18" "$20,592.82" "$22,830.18" "$25,596.00" "$21,756.60" "$81,177.54" "$22,830.18" "$81,997.54" "$36,389.55" "$15,677.96" "$22,830.18" "$59,448.26" "$23,971.69" "$17,105.47" "$25,788.67" "$16,461.86" "$22,830.18" N/A N/A MS989 DRG MS-DRG V39 (FY2022) 989 NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC INPATIENT ONLY "$103,344.50" "$76,475.00" "$4,835.35" "$115,165.61" "$12,604.20" "$12,604.20" "$12,604.20" "$12,604.20" "$18,807.98" "$18,807.98" "$9,330.96" "$9,216.75" "$18,807.98" "$6,888.63" "$6,888.63" "$7,600.10" "$4,835.35" "$9,216.75" "$30,092.77" "$14,837.20" "$67,173.68" "$18,807.98" "$19,536.58" N/A "$19,748.38" "$77,508.38" "$18,807.98" "$16,964.80" "$18,807.98" "$18,538.96" "$16,010.86" "$81,848.56" "$18,807.98" "$82,675.30" "$5,429.60" "$8,777.85" "$18,807.98" "$59,939.81" "$19,748.38" "$11,263.30" "$20,756.03" "$9,216.75" "$18,807.98" N/A N/A MS998 DRG MS-DRG V39 (FY2022) 998 PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS INPATIENT ONLY "$19,582.50" "$14,491.50" "$3,421.10" "$19,582.26" "$7,671.68" "$7,671.68" "$7,671.68" "$7,671.68" "$15,486.29" "$15,486.29" "$5,733.00" "$6,062.51" "$15,486.29" "$4,873.90" "$4,873.90" "$5,061.36" "$3,421.10" "$6,062.51" "$19,582.26" "$8,498.01" "$9,634.50" "$15,486.29" "$16,172.31" "$15,486.29" "$16,260.60" "$14,686.88" "$15,486.29" "$13,968.63" "$15,486.29" "$9,634.50" "$8,189.33" "$15,509.15" "$15,486.29" "$15,665.80" "$6,160.00" "$5,773.81" "$15,486.29" "$11,357.85" "$16,260.60" "$6,438.61" "$16,599.88" "$6,062.51" "$15,486.29" N/A N/A MS999 DRG MS-DRG V39 (FY2022) 999 UNGROUPABLE INPATIENT ONLY "$45,201.00" "$33,449.00" "$3,923.00" "$36,160.72" "$8,128.12" "$8,128.12" "$8,128.12" "$8,128.12" "$20,797.00" "$20,797.00" "$12,233.61" "$9,157.15" "$20,797.00" "$5,588.92" "$5,588.92" "$6,696.82" "$3,923.00" "$9,157.15" "$33,275.20" "$19,687.83" "$21,177.00" "$20,797.00" "$22,110.85" "$20,797.00" "$21,836.85" "$33,900.75" "$20,797.00" "$18,758.89" "$20,797.00" "$29,380.59" "$29,380.59" "$35,799.12" "$20,797.00" "$36,160.72" "$7,000.00" "$8,721.09" "$20,797.00" "$26,216.58" "$21,836.85" "$14,152.32" "$23,244.72" "$9,157.15" "$20,797.00" N/A N/A 10060 EAP CPT® 10060 PR INTEGUMENTARY SYSTEM SERVICES BOTH IP/OP $352.00 $260.50 $69.86 $352.00 $352.00 $352.00 $352.00 $352.00 $176.64 $176.64 $175.86 $73.37 $176.64 $352.00 $352.00 $352.00 $352.00 $73.36 $282.63 $260.52 $113.00 $176.64 $106.35 $176.64 $185.48 $264.00 $176.64 $176.64 $176.64 $352.00 $176.00 $278.78 $176.64 $281.60 $352.00 $69.86 $176.64 $204.16 $185.48 $255.56 $176.64 $73.36 $176.64 222.32 111.37 11976 EAP CPT® 11976 PR INTEGUMENTARY SYSTEM SERVICES BOTH IP/OP $408.00 $302.00 $93.64 $979.40 $408.00 $408.00 $408.00 $408.00 $612.13 $612.13 $609.42 $408.00 $612.13 $408.00 $408.00 $408.00 $408.00 $408.00 $979.40 $936.25 $408.00 $612.13 $93.64 $612.13 $642.73 $306.00 $612.13 $612.13 $612.13 $408.00 $408.00 $408.00 $612.13 $408.00 $408.00 $106.11 $612.13 $236.64 $642.73 $408.00 $612.13 $408.00 $612.13 216.03 98.53 11982 EAP CPT® 11982 PR INTEGUMENTARY SYSTEM SERVICES BOTH IP/OP $321.00 $238.00 #N/A #N/A $321.00 $321.00 $321.00 $321.00 $266.97 $266.97 $265.79 $66.90 $266.97 $321.00 $321.00 $321.00 $321.00 $66.90 $427.15 $544.70 $113.00 #N/A $74.65 $266.97 #N/A $240.75 $266.97 $266.97 $266.97 $321.00 $160.50 #N/A #N/A #N/A $321.00 $63.71 $266.97 $186.18 #N/A $321.00 $266.97 $66.90 $266.97 230.91 78.67 11983 EAP CPT® 11983 PR INTEGUMENTARY SYSTEM SERVICES BOTH IP/OP $402.00 $297.50 $79.79 $544.70 $402.00 $402.00 $402.00 $402.00 $266.97 $266.97 $265.79 $83.79 $266.97 $402.00 $402.00 $402.00 $402.00 $83.78 $427.15 $544.70 $113.00 $266.97 $104.50 $266.97 $280.32 $301.50 $266.97 $266.97 $266.97 $402.00 $201.00 $318.38 $266.97 $321.60 $402.00 $79.79 $266.97 $233.16 $280.32 $386.24 $266.97 $83.78 $266.97 400.47 109.62 17250 EAP CPT® 17250 PR INTEGUMENTARY SYSTEM SERVICES BOTH IP/OP $256.00 $189.50 $37.62 $282.63 $256.00 $256.00 $256.00 $256.00 $176.64 $176.64 $175.86 $53.36 $176.64 $256.00 $256.00 $256.00 $256.00 $53.35 $282.63 $260.52 $113.00 $176.64 $37.62 $176.64 $185.48 $192.00 $176.64 $176.64 $176.64 $256.00 $128.00 $202.75 $176.64 $204.80 $256.00 $50.81 $176.64 $148.48 $185.48 $255.56 $176.64 $53.35 $176.64 85.28 39.62 20526 EAP CPT® 20526 INJECT CARPAL TUNNEL BOTH IP/OP $232.00 $172.00 $46.05 $411.20 $232.00 $232.00 $232.00 $232.00 $257.00 $257.00 $255.86 $48.35 $257.00 $232.00 $232.00 $232.00 $232.00 $48.35 $411.20 $392.25 $232.00 $257.00 $57.67 $257.00 $269.85 $174.00 $257.00 $257.00 $257.00 $232.00 $116.00 $183.74 $257.00 $185.60 $232.00 $46.05 $257.00 $134.56 $269.85 $232.00 $257.00 $48.35 $257.00 132.41 60.74 20550 EAP CPT® 20550 INJECT TENDON SHEATH/LIGAMENT BOTH IP/OP $162.00 $120.00 $32.15 $411.20 $162.00 $162.00 $162.00 $162.00 $257.00 $257.00 $255.86 $33.76 $257.00 $162.00 $162.00 $162.00 $162.00 $33.76 $411.20 $392.25 $162.00 $257.00 $39.34 $257.00 $269.85 $121.50 $257.00 $257.00 $257.00 $162.00 $81.00 $128.30 $257.00 $129.60 $162.00 $32.15 $257.00 $93.96 $269.85 $162.00 $257.00 $33.76 $257.00 96.41 41.41 20553 EAP CPT® 20553 "INJECT TRIGGER POINTS, > 3" BOTH IP/OP $175.00 $129.50 $34.73 $411.20 $175.00 $175.00 $175.00 $175.00 $257.00 $257.00 $255.86 $36.47 $257.00 $175.00 $175.00 $175.00 $175.00 $36.47 $411.20 $392.25 $175.00 $257.00 $42.72 $257.00 $269.85 $131.25 $257.00 $257.00 $257.00 $175.00 $87.50 $138.60 $257.00 $140.00 $175.00 $34.73 $257.00 $101.50 $269.85 $175.00 $257.00 $36.47 $257.00 99.69 45.4 20600 EAP CPT® 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US BOTH IP/OP $150.00 $111.00 $29.77 $411.20 $150.00 $150.00 $150.00 $150.00 $257.00 $257.00 $255.86 $31.26 $257.00 $150.00 $150.00 $150.00 $150.00 $31.26 $411.20 $392.25 $150.00 $257.00 $35.60 $257.00 $269.85 $112.50 $257.00 $257.00 $257.00 $150.00 $75.00 $118.80 $257.00 $120.00 $150.00 $29.77 $257.00 $87.00 $269.85 $150.00 $257.00 $31.26 $257.00 81.96 37.82 20604 EAP CPT® 20604 ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT BOTH IP/OP $232.00 $172.00 #N/A #N/A $232.00 $232.00 $232.00 $232.00 $257.00 $257.00 $255.86 $48.35 $257.00 $232.00 $232.00 $232.00 $232.00 $48.35 $411.20 $392.25 $113.00 $257.00 $46.12 $257.00 $269.85 $174.00 $257.00 $257.00 $257.00 $232.00 $116.00 $183.74 $257.00 $185.60 $232.00 $46.05 #N/A $134.56 $269.85 $232.00 $257.00 $48.35 $257.00 106.02 48.68 20610 EAP CPT® 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US BOTH IP/OP $183.00 $135.50 $36.32 $411.20 $183.00 $183.00 $183.00 $183.00 $257.00 $257.00 $255.86 $38.14 $257.00 $183.00 $183.00 $183.00 $183.00 $38.14 $411.20 $392.25 $183.00 $257.00 $45.44 $257.00 $269.85 $137.25 $257.00 $257.00 $257.00 $183.00 $91.50 $144.94 $257.00 $146.40 $183.00 $36.32 $257.00 $106.14 $269.85 $183.00 $257.00 $38.14 $257.00 105.96 47.88 20611 EAP CPT® 20611 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US BOTH IP/OP $281.00 $208.00 $55.77 $411.20 $281.00 $281.00 $281.00 $281.00 $257.00 $257.00 $255.86 $58.57 $257.00 $281.00 $281.00 $281.00 $281.00 $58.56 $411.20 $392.25 $113.00 $257.00 $60.38 $257.00 $269.85 $210.75 $257.00 $257.00 $257.00 $281.00 $140.50 $222.55 $257.00 $224.80 $281.00 $55.77 $257.00 $162.98 $269.85 $281.00 $257.00 $58.56 $257.00 142.07 62.71 20612 EAP CPT® 20612 ASPIRAT/INJECTION GANGLION CYST(S) BOTH IP/OP $181.00 $134.00 $35.92 $411.20 $181.00 $181.00 $181.00 $181.00 $257.00 $257.00 $255.86 $37.72 $257.00 $181.00 $181.00 $181.00 $181.00 $37.72 $411.20 $392.25 $181.00 $257.00 $41.37 $257.00 $269.85 $135.75 $257.00 $257.00 $257.00 $181.00 $90.50 $143.35 $257.00 $144.80 $181.00 $35.92 $257.00 $104.98 $269.85 $181.00 $257.00 $37.72 $257.00 96.42 43.59 25000 EAP CPT® 25000 "INCIS TENDON SHEATH,RADIAL STYLOID" BOTH IP/OP $980.00 $725.50 $273.36 "$2,192.17" $980.00 $980.00 $980.00 $980.00 "$1,370.10" "$1,370.10" "$1,364.04" $980.00 "$1,370.10" $980.00 $980.00 $980.00 $980.00 $980.00 "$2,192.17" "$2,069.52" $980.00 "$1,370.10" $356.76 "$1,370.10" "$1,438.61" $735.00 "$1,370.10" "$1,370.10" "$1,370.10" $980.00 $980.00 $980.00 "$1,370.10" $980.00 $980.00 $273.36 "$1,370.10" $568.40 "$1,438.61" $980.00 "$1,370.10" $980.00 "$1,370.10" 774.03 371.52 26055 EAP CPT® 26055 INCISE FINGER TENDON SHEATH BOTH IP/OP "$1,711.00" "$1,266.50" $246.90 "$2,192.17" "$1,711.00" "$1,711.00" "$1,711.00" "$1,711.00" "$1,370.10" "$1,370.10" "$1,364.04" "$1,711.00" "$1,370.10" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,711.00" "$2,192.17" "$2,069.52" "$1,711.00" "$1,370.10" $300.20 "$1,370.10" "$1,438.61" "$1,283.25" "$1,370.10" "$1,370.10" "$1,370.10" "$1,711.00" "$1,711.00" "$1,711.00" "$1,370.10" "$1,711.00" "$1,711.00" $246.90 "$1,370.10" $992.38 "$1,438.61" "$1,711.00" "$1,370.10" "$1,711.00" "$1,370.10" 712.32 313.31 28510 EAP CPT® 28510 CLOSED RX TOE FX BOTH IP/OP $340.00 $252.00 $82.46 $340.00 $340.00 $340.00 $340.00 $340.00 $202.75 $202.75 $201.85 $340.00 $202.75 $340.00 $340.00 $340.00 $340.00 $340.00 $324.39 $298.65 $113.00 $202.75 $123.61 $202.75 $212.88 $255.00 $202.75 $202.75 $202.75 $340.00 $340.00 $340.00 $202.75 $340.00 $340.00 $82.46 $202.75 $197.20 $212.88 $293.32 $202.75 $340.00 $202.75 278.96 127.32 36415 EAP CPT® 36415 "PHLEB, VENIPUNCTURE" BOTH IP/OP $11.00 $8.50 $1.35 $11.00 $5.97 $5.97 $5.97 $5.97 $3.00 $3.00 $1.50 $1.35 $3.00 $3.12 $3.12 $3.24 $2.28 $2.29 $4.80 $4.80 $6.51 $3.00 $3.00 $3.00 $11.00 $8.25 $3.00 $3.00 $3.00 $5.50 $5.50 $8.71 $3.00 $8.80 $7.15 $2.18 $3.00 $6.38 $11.00 $4.35 $3.00 $2.29 $3.00 4.32 N/A 57500 EAP CPT® 57500 PR FEMALE GENITAL SYSTEM SERVICES BOTH IP/OP $448.00 $332.00 $75.61 "$1,014.87" $448.00 $448.00 $448.00 $448.00 $623.62 $623.62 $620.86 $93.37 $623.62 $448.00 $448.00 $448.00 $448.00 $93.37 $997.79 "$1,014.87" $448.00 $623.62 $75.61 $623.62 $654.80 $336.00 $623.62 $623.62 $623.62 $448.00 $224.00 $354.82 $623.62 $358.40 $448.00 $88.92 $623.62 $259.84 $654.80 $448.00 $623.62 $93.36 $623.62 173.64 79.55 58100 EAP CPT® 58100 PR FEMALE GENITAL SYSTEM SERVICES BOTH IP/OP $292.00 $216.50 $57.95 $292.00 $292.00 $292.00 $292.00 $292.00 $167.58 $167.58 $166.84 $60.86 $167.58 $292.00 $292.00 $292.00 $292.00 $60.86 $268.13 $256.98 $113.00 $167.58 $63.78 $167.58 $175.96 $219.00 $167.58 $167.58 $167.58 $292.00 $146.00 $231.26 $167.58 $233.60 $292.00 $57.95 $167.58 $169.36 $175.96 $242.45 $167.58 $60.85 $167.58 200.03 67.58 58300 EAP CPT® 58300 PR FEMALE GENITAL SYSTEM SERVICES BOTH IP/OP $265.00 $196.50 $51.66 $265.00 $265.00 $265.00 $265.00 $265.00 $265.00 $265.00 $51.66 $55.23 $265.00 $265.00 $265.00 $265.00 $265.00 $55.23 $265.00 $106.00 $113.00 $265.00 $265.00 $265.00 $265.00 $198.75 $265.00 $265.00 $265.00 $265.00 $132.50 $209.88 $265.00 $212.00 $265.00 $52.60 $265.00 $153.70 $265.00 $159.00 $265.00 $55.23 $265.00 123.57 N/A 64450 EAP CPT® 64450 INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH BOTH IP/OP $216.00 $160.00 $42.04 $999.41 $216.00 $216.00 $216.00 $216.00 $624.63 $624.63 $621.87 $45.02 $624.63 $216.00 $216.00 $216.00 $216.00 $45.02 $999.41 $929.56 $216.00 $624.63 $42.04 $624.63 $655.86 $162.00 $624.63 $624.63 $624.63 $216.00 $108.00 $171.07 $624.63 $172.80 $216.00 $42.87 $624.63 $125.28 $655.86 $216.00 $624.63 $45.01 $624.63 105.41 44.72 69200 EAP CPT® 69200 PR AUDITORY SYSTEM SERVICES BOTH IP/OP $227.00 $168.00 $47.31 $227.00 $227.00 $227.00 $227.00 $227.00 $47.70 $47.70 $47.40 $227.00 $47.70 $227.00 $227.00 $227.00 $227.00 $47.31 $76.32 $76.48 $227.00 $47.70 $47.80 $47.70 $227.00 $170.25 $47.70 $47.70 $47.70 $227.00 $113.50 $179.78 $47.70 $181.60 $227.00 $227.00 $47.70 $131.66 $227.00 $48.67 $47.70 $227.00 $47.70 109.31 50.09 69210 EAP CPT® 69210 PR AUDITORY SYSTEM SERVICES BOTH IP/OP $134.00 $99.50 $26.60 $134.00 $134.00 $134.00 $134.00 $134.00 $54.76 $54.76 $54.51 $27.93 $54.76 $134.00 $134.00 $134.00 $134.00 $27.93 $87.61 $82.92 $113.00 $54.76 $32.89 $54.76 $57.49 $100.50 $54.76 $54.76 $54.76 $134.00 $67.00 $106.13 $54.76 $107.20 $134.00 $26.60 $54.76 $77.72 $57.49 $79.22 $54.76 $27.93 $54.76 75.51 34.91 70360 EAP CPT® 70360 PR IMAGING BOTH IP/OP $90.00 $67.00 $17.86 $131.28 $60.57 $60.57 $60.57 $60.57 $79.57 $79.57 $79.21 $18.76 $79.57 $45.06 $45.06 $46.80 $32.90 $18.76 $127.31 $125.33 $53.24 $79.57 $23.34 $79.57 $83.54 $67.50 $79.57 $79.57 $79.57 $43.20 $43.20 $71.28 $79.57 $72.00 $131.28 $17.86 $79.57 $52.20 $83.54 $90.00 $79.57 $18.76 $79.57 32 32 70450 EAP CPT® 70450 PR IMAGING BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $313.00 $313.00 $313.00 $313.00 $107.09 $107.09 $106.62 $65.24 $107.09 $313.00 $313.00 $313.00 $313.00 $65.23 $171.35 $154.19 $313.00 $107.09 $70.69 $107.09 $112.45 $234.75 $107.09 $107.09 $107.09 $313.00 $313.00 $247.90 $107.09 $250.40 $313.00 $62.12 $107.09 $181.54 $112.45 $154.94 $107.09 $65.23 $107.09 142 118.47 70470 EAP CPT® 70470 PR IMAGING BOTH IP/OP $517.00 $383.00 $102.61 $517.00 $517.00 $517.00 $517.00 $517.00 $175.71 $175.71 $174.93 $107.76 $175.71 $517.00 $517.00 $517.00 $517.00 $107.75 $281.13 $260.16 $517.00 $175.71 $121.76 $175.71 $184.49 $387.75 $175.71 $175.71 $175.71 $517.00 $517.00 $409.46 $175.71 $413.60 $517.00 $102.61 $175.71 $299.86 $184.49 $254.21 $175.71 $107.74 $175.71 211 196 70486 EAP CPT® 70486 PR IMAGING BOTH IP/OP $379.00 $280.50 $75.22 $379.00 $379.00 $379.00 $379.00 $379.00 $107.09 $107.09 $106.62 $78.99 $107.09 $379.00 $379.00 $379.00 $379.00 $78.99 $171.35 $154.19 $379.00 $107.09 $93.69 $107.09 $112.45 $284.25 $107.09 $107.09 $107.09 $379.00 $379.00 $300.17 $107.09 $303.20 $379.00 $75.22 $107.09 $219.82 $112.45 $154.94 $107.09 $78.98 $107.09 187.12 143.49 70487 EAP CPT® 70487 PR IMAGING BOTH IP/OP $451.00 $334.00 #N/A #N/A $451.00 $451.00 $451.00 $451.00 $175.71 $175.71 $174.93 $94.00 $175.71 $451.00 $451.00 $451.00 $451.00 $93.99 $281.13 $260.16 $451.00 $175.71 $105.52 $175.71 $184.49 $338.25 $175.71 $175.71 $175.71 $451.00 $451.00 $357.19 $175.71 $360.80 $451.00 $89.51 #N/A $261.58 $184.49 $254.21 $175.71 $93.99 $175.71 212 171.05 70490 EAP CPT® 70490 PR IMAGING BOTH IP/OP $445.00 $329.50 $88.32 $445.00 $445.00 $445.00 $445.00 $445.00 $107.09 $107.09 $106.62 $92.75 $107.09 $445.00 $445.00 $445.00 $445.00 $92.74 $171.35 $154.19 $445.00 $107.09 $96.05 $107.09 $112.45 $333.75 $107.09 $107.09 $107.09 $445.00 $445.00 $352.44 $107.09 $356.00 $445.00 $88.32 $107.09 $258.10 $112.45 $154.94 $107.09 $92.74 $107.09 220 168.81 70491 EAP CPT® 70491 PR IMAGING BOTH IP/OP $550.00 $407.00 $109.16 $550.00 $550.00 $550.00 $550.00 $550.00 $175.71 $175.71 $174.93 $114.63 $175.71 $550.00 $550.00 $550.00 $550.00 $114.63 $281.13 $260.16 $550.00 $175.71 $127.85 $175.71 $184.49 $412.50 $175.71 $175.71 $175.71 $550.00 $550.00 $435.60 $175.71 $440.00 $540.00 $109.16 $175.71 $319.00 $184.49 $254.21 $175.71 $114.62 $175.71 224 208.34 71045 EAP CPT® 71045 PR IMAGING BOTH IP/OP $74.00 $55.00 $14.69 $131.28 $43.07 $43.07 $43.07 $43.07 $79.57 $79.57 $79.21 $15.42 $79.57 $26.80 $26.80 $27.83 $19.56 $15.42 $127.31 $125.33 $43.77 $79.57 $17.59 $79.57 $83.54 $55.50 $79.57 $79.57 $79.57 $35.52 $35.52 $58.61 $79.57 $59.20 $131.28 $14.69 $79.57 $42.92 $83.54 $74.00 $79.57 $15.42 $79.57 26.55 27.87 71046 EAP CPT® 71046 PR IMAGING BOTH IP/OP $96.00 $71.50 $19.05 $131.28 $66.04 $66.04 $66.04 $66.04 $79.57 $79.57 $79.21 $20.01 $79.57 $49.06 $49.06 $50.94 $35.81 $20.01 $127.31 $125.33 $56.78 $79.57 $23.68 $79.57 $83.54 $72.00 $79.57 $79.57 $79.57 $46.08 $46.08 $76.03 $79.57 $76.80 $131.28 $19.05 $79.57 $55.68 $83.54 $96.00 $79.57 $20.01 $79.57 34 34 71110 EAP CPT® 71110 PR IMAGING BOTH IP/OP $126.00 $93.50 $25.01 $176.70 $81.25 $81.25 $81.25 $81.25 $107.09 $107.09 $106.62 $26.26 $107.09 $67.28 $67.28 $69.87 $49.11 $26.26 $171.35 $154.19 $74.53 $107.09 $30.78 $107.09 $112.45 $94.50 $107.09 $107.09 $107.09 $60.48 $60.48 $99.79 $107.09 $100.80 $176.70 $25.01 $107.09 $73.08 $112.45 $126.00 $107.09 $26.26 $107.09 47 47 71111 EAP CPT® 71111 PR IMAGING BOTH IP/OP $150.00 $111.00 $29.77 $176.70 $104.24 $104.24 $104.24 $104.24 $107.09 $107.09 $106.62 $31.26 $107.09 $88.90 $88.90 $92.32 $64.90 $31.26 $171.35 $154.19 $88.73 $107.09 $37.88 $107.09 $112.45 $112.50 $107.09 $107.09 $107.09 $72.00 $72.00 $118.80 $107.09 $120.00 $176.70 $29.77 $107.09 $87.00 $112.45 $150.00 $107.09 $31.26 $107.09 54 54 71250 EAP CPT® 71250 PR IMAGING BOTH IP/OP $393.00 $291.00 $78.00 $393.00 $393.00 $393.00 $393.00 $393.00 $107.09 $107.09 $106.62 $81.91 $107.09 $393.00 $393.00 $393.00 $393.00 $81.91 $171.35 $154.19 $393.00 $107.09 $87.94 $107.09 $112.45 $294.75 $107.09 $107.09 $107.09 $188.64 $188.64 $311.26 $107.09 $314.40 $393.00 $78.00 $107.09 $227.94 $112.45 $154.94 $107.09 $81.90 $107.09 192 148.92 71260 EAP CPT® 71260 PR IMAGING BOTH IP/OP $494.00 $366.00 $98.05 $494.00 $494.00 $494.00 $494.00 $494.00 $175.71 $175.71 $174.93 $102.96 $175.71 $494.00 $494.00 $494.00 $494.00 $102.96 $281.13 $260.16 $494.00 $175.71 $119.39 $175.71 $184.49 $370.50 $175.71 $175.71 $175.71 $237.12 $237.12 $391.25 $175.71 $395.20 $494.00 $98.05 $175.71 $286.52 $184.49 $254.21 $175.71 $102.95 $175.71 202 187.36 71271 EAP CPT® 71271 PR IMAGING BOTH IP/OP $406.00 $300.50 $80.58 $406.00 $406.00 $406.00 $406.00 $406.00 $107.09 $107.09 $106.62 $84.62 $107.09 $301.33 $301.33 $312.94 $211.53 $84.61 $171.35 $154.19 $240.15 $107.09 $92.67 $107.09 $112.45 $304.50 $107.09 $107.09 $107.09 $194.88 $194.88 $321.55 $107.09 $324.80 $176.70 $80.58 $107.09 $235.48 $112.45 $154.94 $107.09 $84.61 $107.09 N/A 153.99 71275 EAP CPT® 71275 PR IMAGING BOTH IP/OP $763.00 $565.00 $151.44 $763.00 $763.00 $763.00 $763.00 $763.00 $175.71 $175.71 $174.93 $159.03 $175.71 $763.00 $763.00 $763.00 $573.58 $159.02 $281.13 $260.16 $763.00 $175.71 $209.03 $175.71 $184.49 $572.25 $175.71 $175.71 $175.71 $366.24 $366.24 $604.30 $175.71 $610.40 $540.00 $151.44 $175.71 $442.54 $184.49 $254.21 $175.71 $159.01 $175.71 279 N/A 72040 EAP CPT® 72040 PR IMAGING BOTH IP/OP $113.00 $84.00 $22.43 $131.28 $71.28 $71.28 $71.28 $71.28 $79.57 $79.57 $79.21 $23.55 $79.57 $62.89 $62.89 $65.31 $45.91 $23.55 $127.31 $125.33 $66.84 $79.57 $29.43 $79.57 $83.54 $84.75 $79.57 $79.57 $79.57 $54.24 $54.24 $89.50 $79.57 $90.40 $131.28 $22.43 $79.57 $65.54 $83.54 $113.00 $79.57 $23.55 $79.57 36 36 72070 EAP CPT® 72070 PR IMAGING BOTH IP/OP $94.00 $70.00 $18.66 $176.70 $73.59 $73.59 $73.59 $73.59 $107.09 $107.09 $106.62 $19.59 $107.09 $55.63 $55.63 $57.77 $40.61 $19.59 $171.35 $154.19 $55.60 $107.09 $23.68 $107.09 $112.45 $70.50 $107.09 $107.09 $107.09 $45.12 $45.12 $74.45 $107.09 $75.20 $176.70 $18.66 $107.09 $54.52 $112.45 $94.00 $107.09 $19.59 $107.09 34 34 72100 EAP CPT® 72100 PR IMAGING BOTH IP/OP $114.00 $84.50 $22.63 $176.70 $75.88 $75.88 $75.88 $75.88 $107.09 $107.09 $106.62 $23.76 $107.09 $67.44 $67.44 $70.04 $49.23 $23.76 $171.35 $154.19 $67.43 $107.09 $29.77 $107.09 $112.45 $85.50 $107.09 $107.09 $107.09 $54.72 $54.72 $90.29 $107.09 $91.20 $176.70 $22.63 $107.09 $66.12 $112.45 $114.00 $107.09 $23.76 $107.09 35 35 72110 EAP CPT® 72110 PR IMAGING BOTH IP/OP $147.00 $109.00 $29.18 $176.70 $105.77 $105.77 $105.77 $105.77 $107.09 $107.09 $106.62 $30.64 $107.09 $94.35 $94.35 $97.98 $68.87 $30.64 $171.35 $154.19 $86.95 $107.09 $39.57 $107.09 $112.45 $110.25 $107.09 $107.09 $107.09 $70.56 $70.56 $116.42 $107.09 $117.60 $176.70 $29.18 $107.09 $85.26 $112.45 $147.00 $107.09 $30.63 $107.09 50 50 72114 EAP CPT® 72114 PR IMAGING BOTH IP/OP $177.00 $131.00 $35.13 $176.70 $134.13 $134.13 $134.13 $134.13 $107.09 $107.09 $106.62 $36.89 $107.09 $127.92 $127.92 $132.84 $93.38 $36.89 $171.35 $154.19 $104.70 $107.09 $48.03 $107.09 $112.45 $132.75 $107.09 $107.09 $107.09 $84.96 $84.96 $140.18 $107.09 $141.60 $176.70 $35.13 $107.09 $102.66 $112.45 $154.94 $107.09 $36.89 $107.09 59 59 72125 EAP CPT® 72125 PR IMAGING BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $385.00 $385.00 $385.00 $385.00 $107.09 $107.09 $106.62 $80.24 $107.09 $385.00 $385.00 $385.00 $385.00 $80.24 $171.35 $154.19 $385.00 $107.09 $88.61 $107.09 $112.45 $288.75 $107.09 $107.09 $107.09 $385.00 $385.00 $304.92 $107.09 $308.00 $385.00 $76.41 $107.09 $223.30 $112.45 $154.94 $107.09 $80.23 $107.09 177 146.01 72170 EAP CPT® 72170 PR IMAGING BOTH IP/OP $80.00 $59.50 $15.88 $176.70 $69.00 $69.00 $69.00 $69.00 $107.09 $107.09 $106.62 $16.67 $107.09 $42.34 $42.34 $43.97 $30.91 $16.67 $171.35 $154.19 $47.32 $107.09 $19.96 $107.09 $112.45 $60.00 $107.09 $107.09 $107.09 $38.40 $38.40 $63.36 $107.09 $64.00 $176.70 $15.88 $107.09 $46.40 $112.45 $80.00 $107.09 $16.67 $107.09 31 30.04 72192 EAP CPT® 72192 PR IMAGING BOTH IP/OP $394.00 $292.00 $78.20 $815.94 $394.00 $394.00 $394.00 $394.00 $107.09 $107.09 $106.62 $82.12 $107.09 $785.72 $785.72 $815.94 $573.57 $82.11 $171.35 $154.19 $233.05 $107.09 $87.60 $107.09 $112.45 $295.50 $107.09 $107.09 $107.09 $394.00 $394.00 $312.05 $107.09 $315.20 $176.70 $78.20 $107.09 $228.52 $112.45 $154.94 $107.09 $82.11 $107.09 167 149.28 72193 EAP CPT® 72193 PR IMAGING BOTH IP/OP $675.00 $499.50 #N/A #N/A $675.00 $675.00 $675.00 $675.00 $175.71 $175.71 $174.93 $140.69 $175.71 $785.72 $785.72 $815.94 $573.57 $140.68 $281.13 $260.16 $399.26 #N/A $187.71 $175.71 #N/A $506.25 $175.71 $175.71 $175.71 $675.00 $675.00 #N/A #N/A #N/A $289.92 $133.97 $175.71 $391.50 #N/A $254.21 $175.71 $140.67 $175.71 177 N/A 72220 EAP CPT® 72220 PR IMAGING BOTH IP/OP $93.00 $69.00 $18.46 $131.28 $60.57 $60.57 $60.57 $60.57 $79.57 $79.57 $79.21 $19.38 $79.57 $51.11 $51.11 $53.07 $37.31 $19.38 $127.31 $125.33 $55.01 $79.57 $24.69 $79.57 $83.54 $69.75 $79.57 $79.57 $79.57 $44.64 $44.64 $73.66 $79.57 $74.40 $131.28 $18.46 $79.57 $53.94 $83.54 $93.00 $79.57 $19.38 $79.57 30 30 73000 EAP CPT® 73000 PR IMAGING BOTH IP/OP $92.00 $68.50 $18.26 $131.28 $59.79 $59.79 $59.79 $59.79 $79.57 $79.57 $79.21 $19.18 $79.57 $46.88 $46.88 $48.69 $34.22 $19.17 $127.31 $125.33 $54.42 $79.57 $24.69 $79.57 $83.54 $69.00 $79.57 $79.57 $79.57 $44.16 $44.16 $72.86 $79.57 $73.60 $131.28 $18.26 $79.57 $53.36 $83.54 $92.00 $79.57 $19.17 $79.57 26 26 73020 EAP CPT® 73020 PR IMAGING BOTH IP/OP $62.00 $46.00 $12.31 $131.28 $49.82 $49.82 $49.82 $49.82 $79.57 $79.57 $79.21 $12.92 $79.57 $38.71 $38.71 $40.20 $28.26 $12.92 $127.31 $125.33 $36.67 $79.57 $14.55 $79.57 $83.54 $46.50 $79.57 $79.57 $79.57 $29.76 $29.76 $49.10 $79.57 $49.60 $131.28 $12.31 $79.57 $35.96 $83.54 $62.00 $79.57 $12.92 $79.57 24 23.15 73030 EAP CPT® 73030 PR IMAGING BOTH IP/OP $99.00 $73.50 $19.65 $131.28 $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $20.63 $79.57 $50.19 $50.19 $52.12 $36.64 $20.63 $127.31 $125.33 $58.56 $79.57 $26.05 $79.57 $83.54 $74.25 $79.57 $79.57 $79.57 $47.52 $47.52 $78.41 $79.57 $79.20 $131.28 $19.65 $79.57 $57.42 $83.54 $99.00 $79.57 $20.63 $79.57 32 32 73060 EAP CPT® 73060 PR IMAGING BOTH IP/OP $91.00 $67.50 $18.06 $131.28 $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $18.97 $79.57 $50.19 $50.19 $52.12 $36.64 $18.97 $127.31 $125.33 $53.83 $79.57 $24.69 $79.57 $83.54 $68.25 $79.57 $79.57 $79.57 $43.68 $43.68 $72.07 $79.57 $72.80 $131.28 $18.06 $79.57 $52.78 $83.54 $91.00 $79.57 $18.96 $79.57 29 29 73070 EAP CPT® 73070 PR IMAGING BOTH IP/OP $83.00 $61.50 $16.47 $131.28 $59.04 $59.04 $59.04 $59.04 $79.57 $79.57 $79.21 $17.30 $79.57 $46.88 $46.88 $48.69 $34.22 $17.30 $127.31 $125.33 $49.09 $79.57 $21.65 $79.57 $83.54 $62.25 $79.57 $79.57 $79.57 $39.84 $39.84 $65.74 $79.57 $66.40 $131.28 $16.47 $79.57 $48.14 $83.54 $83.00 $79.57 $17.30 $79.57 26 26 73080 EAP CPT® 73080 PR IMAGING BOTH IP/OP $93.00 $69.00 $18.46 $131.28 $67.47 $67.47 $67.47 $67.47 $79.57 $79.57 $79.21 $19.38 $79.57 $62.89 $62.89 $65.31 $45.91 $19.38 $127.31 $125.33 $55.01 $79.57 $24.69 $79.57 $83.54 $69.75 $79.57 $79.57 $79.57 $44.64 $44.64 $73.66 $79.57 $74.40 $131.28 $18.46 $79.57 $53.94 $83.54 $93.00 $79.57 $19.38 $79.57 28 28 73090 EAP CPT® 73090 PR IMAGING BOTH IP/OP $83.00 $61.50 $16.47 $131.28 $55.97 $55.97 $55.97 $55.97 $79.57 $79.57 $79.21 $17.30 $79.57 $46.88 $46.88 $48.69 $34.22 $17.30 $127.31 $125.33 $49.09 $79.57 $21.99 $79.57 $83.54 $62.25 $79.57 $79.57 $79.57 $39.84 $39.84 $65.74 $79.57 $66.40 $131.28 $16.47 $79.57 $48.14 $83.54 $83.00 $79.57 $17.30 $79.57 26 26 73100 EAP CPT® 73100 PR IMAGING BOTH IP/OP $97.00 $72.00 $19.25 $131.28 $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $20.22 $79.57 $48.68 $48.68 $50.55 $35.54 $20.22 $127.31 $125.33 $57.38 $79.57 $26.39 $79.57 $83.54 $72.75 $79.57 $79.57 $79.57 $46.56 $46.56 $76.82 $79.57 $77.60 $131.28 $19.25 $79.57 $56.26 $83.54 $97.00 $79.57 $20.21 $79.57 26 26 73110 EAP CPT® 73110 PR IMAGING BOTH IP/OP $117.00 $87.00 $23.22 $131.28 $76.66 $76.66 $76.66 $76.66 $79.57 $79.57 $79.21 $24.39 $79.57 $61.39 $61.39 $63.75 $44.82 $24.38 $127.31 $125.33 $69.21 $79.57 $33.15 $79.57 $83.54 $87.75 $79.57 $79.57 $79.57 $56.16 $56.16 $92.66 $79.57 $93.60 $131.28 $23.22 $79.57 $67.86 $83.54 $115.11 $79.57 $24.38 $79.57 28 28 73120 EAP CPT® 73120 PR IMAGING BOTH IP/OP $89.00 $66.00 $17.66 $176.70 $56.73 $56.73 $56.73 $56.73 $107.09 $107.09 $106.62 $18.55 $107.09 $45.96 $45.96 $47.73 $33.55 $18.55 $171.35 $154.19 $52.64 $107.09 $23.68 $107.09 $112.45 $66.75 $107.09 $107.09 $107.09 $42.72 $42.72 $70.49 $107.09 $71.20 $176.70 $17.66 $107.09 $51.62 $112.45 $89.00 $107.09 $18.55 $107.09 26 26 73130 EAP CPT® 73130 PR IMAGING BOTH IP/OP $105.00 $78.00 $20.84 $131.28 $66.69 $66.69 $66.69 $66.69 $79.57 $79.57 $79.21 $21.88 $79.57 $54.14 $54.14 $56.22 $39.52 $21.88 $127.31 $125.33 $62.11 $79.57 $29.09 $79.57 $83.54 $78.75 $79.57 $79.57 $79.57 $50.40 $50.40 $83.16 $79.57 $84.00 $131.28 $20.84 $79.57 $60.90 $83.54 $105.00 $79.57 $21.88 $79.57 28 28 73140 EAP CPT® 73140 PR IMAGING BOTH IP/OP $107.00 $79.50 $21.24 $131.28 $68.22 $68.22 $68.22 $68.22 $79.57 $79.57 $79.21 $22.30 $79.57 $53.24 $53.24 $55.29 $38.86 $22.30 $127.31 $125.33 $63.29 $79.57 $31.80 $79.57 $83.54 $80.25 $79.57 $79.57 $79.57 $51.36 $51.36 $84.74 $79.57 $85.60 $131.28 $21.24 $79.57 $62.06 $83.54 $107.00 $79.57 $22.30 $79.57 22 22 73501 EAP CPT® 73501 PR IMAGING BOTH IP/OP $93.00 $69.00 #N/A #N/A $64.38 $64.38 $64.38 $64.38 $79.57 $79.57 $79.21 $19.38 $79.57 $50.89 $50.89 $52.84 $37.15 $19.38 $127.31 $125.33 $55.01 #N/A $24.36 $79.57 #N/A $69.75 $79.57 $79.57 $79.57 $44.64 $44.64 #N/A #N/A #N/A $131.28 $18.46 $79.57 $53.94 #N/A $93.00 $79.57 $19.38 $79.57 29 29 73502 EAP CPT® 73502 PR IMAGING BOTH IP/OP $134.00 $99.50 $26.60 $131.28 $89.68 $89.68 $89.68 $89.68 $79.57 $79.57 $79.21 $27.93 $79.57 $75.00 $75.00 $77.89 $54.75 $27.93 $127.31 $125.33 $79.26 $79.57 $36.87 $79.57 $83.54 $100.50 $79.57 $79.57 $79.57 $64.32 $64.32 $106.13 $79.57 $107.20 $131.28 $26.60 $79.57 $77.72 $83.54 $115.11 $79.57 $27.93 $79.57 35 35 73521 EAP CPT® 73521 PR IMAGING BOTH IP/OP $118.00 $87.50 $23.42 $176.70 $85.84 $85.84 $85.84 $85.84 $107.09 $107.09 $106.62 $24.59 $107.09 $70.54 $70.54 $73.26 $51.50 $24.59 $171.35 $154.19 $69.80 $107.09 $31.12 $107.09 $112.45 $88.50 $107.09 $107.09 $107.09 $56.64 $56.64 $93.46 $107.09 $94.40 $176.70 $23.42 $107.09 $68.44 $112.45 $118.00 $107.09 $24.59 $107.09 35 35 73522 EAP CPT® 73522 PR IMAGING BOTH IP/OP $153.00 $113.50 $30.37 $176.70 $105.77 $105.77 $105.77 $105.77 $107.09 $107.09 $106.62 $31.89 $107.09 $83.92 $83.92 $87.15 $61.26 $31.89 $171.35 $154.19 $90.50 $107.09 $40.25 $107.09 $112.45 $114.75 $107.09 $107.09 $107.09 $73.44 $73.44 $121.18 $107.09 $122.40 $176.70 $30.37 $107.09 $88.74 $112.45 $153.00 $107.09 $31.89 $107.09 45 45 73552 EAP CPT® 73552 PR IMAGING BOTH IP/OP $101.00 $75.00 $20.05 $131.28 $70.53 $70.53 $70.53 $70.53 $79.57 $79.57 $79.21 $21.05 $79.57 $57.14 $57.14 $59.34 $41.71 $21.05 $127.31 $125.33 $59.74 $79.57 $27.40 $79.57 $83.54 $75.75 $79.57 $79.57 $79.57 $48.48 $48.48 $79.99 $79.57 $80.80 $131.28 $20.05 $79.57 $58.58 $83.54 $101.00 $79.57 $21.05 $79.57 28 28 73560 EAP CPT® 73560 PR IMAGING BOTH IP/OP $98.00 $73.00 $19.45 $131.28 $66.69 $66.69 $66.69 $66.69 $79.57 $79.57 $79.21 $20.43 $79.57 $47.79 $47.79 $49.63 $34.88 $20.42 $127.31 $125.33 $57.97 $79.57 $26.72 $79.57 $83.54 $73.50 $79.57 $79.57 $79.57 $47.04 $47.04 $77.62 $79.57 $78.40 $131.28 $19.45 $79.57 $56.84 $83.54 $98.00 $79.57 $20.42 $79.57 28 28 73562 EAP CPT® 73562 PR IMAGING BOTH IP/OP $117.00 $87.00 $23.22 $131.28 $77.41 $77.41 $77.41 $77.41 $79.57 $79.57 $79.21 $24.39 $79.57 $60.18 $60.18 $62.50 $43.93 $24.38 $127.31 $125.33 $69.21 $79.57 $32.13 $79.57 $83.54 $87.75 $79.57 $79.57 $79.57 $56.16 $56.16 $92.66 $79.57 $93.60 $131.28 $23.22 $79.57 $67.86 $83.54 $115.11 $79.57 $24.38 $79.57 29 29 73564 EAP CPT® 73564 PR IMAGING BOTH IP/OP $132.00 $98.00 $26.20 $176.70 $85.84 $85.84 $85.84 $85.84 $107.09 $107.09 $106.62 $27.51 $107.09 $69.25 $69.25 $71.92 $50.55 $27.51 $171.35 $154.19 $78.08 $107.09 $36.19 $107.09 $112.45 $99.00 $107.09 $107.09 $107.09 $63.36 $63.36 $104.54 $107.09 $105.60 $176.70 $26.20 $107.09 $76.56 $112.45 $132.00 $107.09 $27.51 $107.09 37 37 73590 EAP CPT® 73590 PR IMAGING BOTH IP/OP $90.00 $67.00 $17.86 $131.28 $62.10 $62.10 $62.10 $62.10 $79.57 $79.57 $79.21 $18.76 $79.57 $45.06 $45.06 $46.80 $32.90 $18.76 $127.31 $125.33 $53.24 $79.57 $24.36 $79.57 $83.54 $67.50 $79.57 $79.57 $79.57 $43.20 $43.20 $71.28 $79.57 $72.00 $131.28 $17.86 $79.57 $52.20 $83.54 $90.00 $79.57 $18.76 $79.57 28 28 73600 EAP CPT® 73600 PR IMAGING BOTH IP/OP $92.00 $68.50 $18.26 $131.28 $64.38 $64.38 $64.38 $64.38 $79.57 $79.57 $79.21 $19.18 $79.57 $45.96 $45.96 $47.73 $33.55 $19.17 $127.31 $125.33 $54.42 $79.57 $25.03 $79.57 $83.54 $69.00 $79.57 $79.57 $79.57 $44.16 $44.16 $72.86 $79.57 $73.60 $131.28 $18.26 $79.57 $53.36 $83.54 $92.00 $79.57 $19.17 $79.57 26 26 73610 EAP CPT® 73610 PR IMAGING BOTH IP/OP $105.00 $78.00 $20.84 $131.28 $68.22 $68.22 $68.22 $68.22 $79.57 $79.57 $79.21 $21.88 $79.57 $54.14 $54.14 $56.22 $39.52 $21.88 $127.31 $125.33 $62.11 $79.57 $29.09 $79.57 $83.54 $78.75 $79.57 $79.57 $79.57 $50.40 $50.40 $83.16 $79.57 $84.00 $131.28 $20.84 $79.57 $60.90 $83.54 $105.00 $79.57 $21.88 $79.57 28 28 73620 EAP CPT® 73620 PR IMAGING BOTH IP/OP $81.00 $60.00 $16.08 $131.28 $55.97 $55.97 $55.97 $55.97 $79.57 $79.57 $79.21 $16.88 $79.57 $44.15 $44.15 $45.85 $32.23 $16.88 $127.31 $125.33 $47.91 $79.57 $21.31 $79.57 $83.54 $60.75 $79.57 $79.57 $79.57 $38.88 $38.88 $64.15 $79.57 $64.80 $131.28 $16.08 $79.57 $46.98 $83.54 $81.00 $79.57 $16.88 $79.57 25 25 73630 EAP CPT® 73630 PR IMAGING BOTH IP/OP $99.00 $73.50 $19.65 $131.28 $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $20.63 $79.57 $53.24 $53.24 $55.29 $38.86 $20.63 $127.31 $125.33 $58.56 $79.57 $26.72 $79.57 $83.54 $74.25 $79.57 $79.57 $79.57 $47.52 $47.52 $78.41 $79.57 $79.20 $131.28 $19.65 $79.57 $57.42 $83.54 $99.00 $79.57 $20.63 $79.57 28 28 73660 EAP CPT® 73660 PR IMAGING BOTH IP/OP $83.00 $61.50 $16.47 $131.28 $60.57 $60.57 $60.57 $60.57 $79.57 $79.57 $79.21 $17.30 $79.57 $50.51 $50.51 $52.46 $36.87 $17.30 $127.31 $125.33 $49.09 $79.57 $23.34 $79.57 $83.54 $62.25 $79.57 $79.57 $79.57 $39.84 $39.84 $65.74 $79.57 $66.40 $131.28 $16.47 $79.57 $48.14 $83.54 $83.00 $79.57 $17.30 $79.57 22 22 74018 EAP CPT® 74018 PR IMAGING BOTH IP/OP $86.00 $64.00 $17.07 $131.28 $59.14 $59.14 $59.14 $59.14 $79.57 $79.57 $79.21 $17.92 $79.57 $45.51 $45.51 $47.26 $33.22 $17.92 $127.31 $125.33 $50.87 $79.57 $21.65 $79.57 $83.54 $64.50 $79.57 $79.57 $79.57 $41.28 $41.28 $68.11 $79.57 $68.80 $131.28 $17.07 $79.57 $49.88 $83.54 $86.00 $79.57 $17.92 $79.57 28 28 74019 EAP CPT® 74019 PR IMAGING BOTH IP/OP $105.00 $78.00 $20.84 $176.70 $72.16 $72.16 $72.16 $72.16 $107.09 $107.09 $106.62 $21.88 $107.09 $54.42 $54.42 $56.52 $39.73 $21.88 $171.35 $154.19 $62.11 $107.09 $26.39 $107.09 $112.45 $78.75 $107.09 $107.09 $107.09 $50.40 $50.40 $83.16 $107.09 $84.00 $176.70 $20.84 $107.09 $60.90 $112.45 $105.00 $107.09 $21.88 $107.09 36 36 74022 EAP CPT® 74022 PR IMAGING BOTH IP/OP $143.00 $106.00 $28.38 $176.70 $96.58 $96.58 $96.58 $96.58 $107.09 $107.09 $106.62 $29.80 $107.09 $79.08 $79.08 $82.12 $57.73 $29.80 $171.35 $154.19 $84.58 $107.09 $35.18 $107.09 $112.45 $107.25 $107.09 $107.09 $107.09 $68.64 $68.64 $113.26 $107.09 $114.40 $176.70 $28.38 $107.09 $82.94 $112.45 $143.00 $107.09 $29.80 $107.09 51 51 74150 EAP CPT® 74150 PR IMAGING BOTH IP/OP $406.00 $300.50 $80.58 $406.00 $406.00 $406.00 $406.00 $406.00 $107.09 $107.09 $106.62 $84.62 $107.09 $406.00 $406.00 $406.00 $406.00 $84.61 $171.35 $154.19 $406.00 $107.09 $86.58 $107.09 $112.45 $304.50 $107.09 $107.09 $107.09 $406.00 $406.00 $321.55 $107.09 $324.80 $406.00 $80.58 $107.09 $235.48 $112.45 $154.94 $107.09 $84.61 $107.09 196 153.93 74174 EAP CPT® 74174 PR IMAGING BOTH IP/OP "$1,140.00" $844.00 $226.26 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $362.23 $362.23 $360.63 $237.60 $362.23 $785.72 $785.72 $815.94 $573.58 $237.59 $579.58 $531.51 "$1,106.00" $362.23 $296.62 $362.23 $380.35 $855.00 $362.23 $362.23 $362.23 $547.20 $547.20 $902.88 $362.23 $912.00 $540.00 $226.26 $362.23 $661.20 $380.35 $524.06 $362.23 $237.58 $362.23 335 335 74176 EAP CPT® 74176 PR IMAGING BOTH IP/OP $242.00 $179.50 $48.03 $815.94 $242.00 $242.00 $242.00 $242.00 $226.34 $226.34 $225.34 $50.44 $226.34 $785.72 $785.72 $815.94 $573.57 $50.44 $362.15 $336.89 $143.14 $226.34 $108.57 $226.34 $237.66 $181.50 $226.34 $226.34 $226.34 $116.16 $116.16 $191.66 $226.34 $193.60 $373.47 $48.03 $226.34 $140.36 $237.66 $242.00 $226.34 $50.43 $226.34 267 205.03 74177 EAP CPT® 74177 PR IMAGING BOTH IP/OP $920.00 $681.00 $533.60 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $690.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $533.60 $920.00 $920.00 $920.00 $920.00 $920.00 280 280 74178 EAP CPT® 74178 PR IMAGING BOTH IP/OP "$1,030.00" $762.50 $597.40 "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" $772.50 "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" $597.40 "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" 307 307 75571 EAP CPT® 75571 PR IMAGING BOTH IP/OP $125.00 $92.50 $24.81 $815.94 $125.00 $125.00 $125.00 $125.00 $79.57 $79.57 $79.21 $26.05 $79.57 $785.72 $785.72 $815.94 $573.57 $26.05 $127.31 $125.33 $73.94 $79.57 $76.44 $79.57 $83.54 $93.75 $79.57 $79.57 $79.57 $60.00 $60.00 $99.00 $79.57 $100.00 $131.28 $24.81 $79.57 $72.50 $83.54 $115.11 $79.57 $26.05 $79.57 89 89 76536 EAP CPT® 76536 PR IMAGING BOTH IP/OP $322.00 $238.50 $63.91 $257.60 $253.71 $253.71 $253.71 $253.71 $107.09 $107.09 $106.62 $67.11 $107.09 $204.76 $204.76 $212.63 $149.47 $67.11 $171.35 $154.19 $190.46 $107.09 $85.91 $107.09 $112.45 $241.50 $107.09 $107.09 $107.09 $154.56 $154.56 $255.02 $107.09 $257.60 $183.00 $63.91 $107.09 $186.76 $112.45 $154.94 $107.09 $67.10 $107.09 90 90 76604 EAP CPT® 76604 PR IMAGING BOTH IP/OP $166.00 $123.00 $29.77 $176.70 $166.00 $166.00 $166.00 $166.00 $107.09 $107.09 $106.62 $34.60 $107.09 $145.00 $145.00 $150.57 $105.85 $34.60 $171.35 $154.19 $98.19 $107.09 $29.77 $107.09 $112.45 $124.50 $107.09 $107.09 $107.09 $79.68 $79.68 $131.47 $107.09 $132.80 $176.70 $32.95 $107.09 $96.28 $112.45 $154.94 $107.09 $34.59 $107.09 118.24 62.97 76700 EAP CPT® 76700 PR IMAGING BOTH IP/OP $338.00 $250.50 $67.08 $270.40 $266.71 $266.71 $266.71 $266.71 $107.09 $107.09 $106.62 $70.45 $107.09 $236.95 $236.95 $246.07 $172.97 $70.44 $171.35 $154.19 $199.93 $107.09 $80.16 $107.09 $112.45 $253.50 $107.09 $107.09 $107.09 $162.24 $162.24 $267.70 $107.09 $270.40 $176.70 $67.08 $107.09 $196.04 $112.45 $154.94 $107.09 $70.44 $107.09 132 127.9 76705 EAP CPT® 76705 PR IMAGING BOTH IP/OP $252.00 $186.50 $50.02 $201.60 $199.27 $199.27 $199.27 $199.27 $107.09 $107.09 $106.62 $52.52 $107.09 $182.05 $182.05 $189.05 $132.90 $52.52 $171.35 $154.19 $149.06 $107.09 $61.22 $107.09 $112.45 $189.00 $107.09 $107.09 $107.09 $120.96 $120.96 $199.58 $107.09 $201.60 $183.00 $50.02 $107.09 $146.16 $112.45 $154.94 $107.09 $52.52 $107.09 122.99 95.61 76706 EAP CPT® 76706 PR IMAGING BOTH IP/OP $307.00 $227.50 $60.93 $245.60 $203.89 $203.89 $203.89 $203.89 $107.09 $107.09 $106.62 $63.99 $107.09 $166.71 $166.71 $173.12 $121.70 $63.98 $171.35 $154.19 $181.59 $107.09 $82.19 $107.09 $112.45 $230.25 $107.09 $107.09 $107.09 $147.36 $147.36 $243.14 $107.09 $245.60 $176.70 $60.93 $107.09 $178.06 $112.45 $154.94 $107.09 $63.98 $107.09 84 84 76770 EAP CPT® 76770 PR IMAGING BOTH IP/OP $313.00 $232.00 $62.12 $250.40 $246.81 $246.81 $246.81 $246.81 $107.09 $107.09 $106.62 $65.24 $107.09 $231.49 $231.49 $240.40 $168.99 $65.23 $171.35 $154.19 $185.14 $107.09 $75.42 $107.09 $112.45 $234.75 $107.09 $107.09 $107.09 $150.24 $150.24 $247.90 $107.09 $250.40 $176.70 $62.12 $107.09 $181.54 $112.45 $154.94 $107.09 $65.23 $107.09 152.43 118.46 76830 EAP CPT® 76830 PR IMAGING BOTH IP/OP $345.00 $255.50 $68.47 $276.00 $266.74 $266.74 $266.74 $266.74 $107.09 $107.09 $106.62 $71.91 $107.09 $211.68 $211.68 $219.82 $154.53 $71.90 $171.35 $154.19 $204.07 $107.09 $88.61 $107.09 $112.45 $258.75 $107.09 $107.09 $107.09 $165.60 $165.60 $273.24 $107.09 $276.00 $176.70 $68.47 $107.09 $200.10 $112.45 $154.94 $107.09 $71.90 $107.09 118 118 76856 EAP CPT® 76856 PR IMAGING BOTH IP/OP $305.00 $226.00 $60.53 $244.00 $240.66 $240.66 $240.66 $240.66 $107.09 $107.09 $106.62 $63.57 $107.09 $212.59 $212.59 $220.76 $155.19 $63.57 $171.35 $154.19 $180.41 $107.09 $74.41 $107.09 $112.45 $228.75 $107.09 $107.09 $107.09 $146.40 $146.40 $241.56 $107.09 $244.00 $176.70 $60.53 $107.09 $176.90 $112.45 $154.94 $107.09 $63.56 $107.09 105 105 76857 EAP CPT® 76857 PR IMAGING BOTH IP/OP $136.00 $101.00 $25.71 $208.22 $105.02 $105.02 $105.02 $105.02 $107.09 $107.09 $106.62 $28.35 $107.09 $200.51 $200.51 $208.22 $146.37 $28.34 $171.35 $154.19 $80.44 $107.09 $25.71 $107.09 $112.45 $102.00 $107.09 $107.09 $107.09 $65.28 $65.28 $107.71 $107.09 $108.80 $176.70 $26.99 $107.09 $78.88 $112.45 $136.00 $107.09 $28.34 $107.09 64.01 51.43 76870 EAP CPT® 76870 PR IMAGING BOTH IP/OP $291.00 $215.50 $57.76 $232.80 $148.69 $148.69 $148.69 $148.69 $107.09 $107.09 $106.62 $60.65 $107.09 $215.32 $215.32 $223.60 $157.18 $60.65 $171.35 $154.19 $172.13 $107.09 $72.04 $107.09 $112.45 $218.25 $107.09 $107.09 $107.09 $139.68 $139.68 $230.47 $107.09 $232.80 $176.70 $57.76 $107.09 $168.78 $112.45 $154.94 $107.09 $60.64 $107.09 90.6 97 76880 EAP CPT® 76880 PR IMAGING BOTH IP/OP $167.00 $124.00 #N/A #N/A $167.00 $167.00 $167.00 $167.00 $167.00 $167.00 $29.73 $167.00 $167.00 $167.00 $167.00 $167.00 $167.00 $167.00 $167.00 $66.80 $167.00 $167.00 $167.00 $167.00 $167.00 $125.25 $167.00 $167.00 $167.00 $80.16 $80.16 $167.00 $167.00 $167.00 $108.55 $167.00 #N/A $96.86 $167.00 $100.20 $167.00 $167.00 $167.00 N/A N/A 76882 EAP CPT® 76882 US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG BOTH IP/OP $160.00 $118.50 #N/A #N/A $78.19 $78.19 $78.19 $78.19 $107.09 $107.09 $106.62 $10.15 $107.09 $160.00 $160.00 $160.00 $160.00 $160.00 $171.35 $154.19 $160.00 $107.09 $9.48 $107.09 $112.45 $120.00 $107.09 $107.09 $107.09 $76.80 $76.80 $160.00 $107.09 $160.00 $104.00 $160.00 #N/A $92.80 $112.45 $154.94 $107.09 $160.00 $107.09 48.31 60.49 76942 EAP CPT® 76942 PR IMAGING BOTH IP/OP $165.00 $122.50 $28.41 $389.47 $131.05 $131.05 $131.05 $131.05 $165.00 $165.00 $165.00 $34.39 $165.00 $375.04 $375.04 $389.47 $273.78 $34.39 $165.00 $165.00 $97.60 $165.00 $28.41 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $79.20 $79.20 $130.68 $165.00 $132.00 $165.00 $32.75 $165.00 $95.70 $165.00 $165.00 $165.00 $34.39 $165.00 81.55 62.25 77063 EAP CPT® 77063 PR IMAGING BOTH IP/OP $149.00 $110.50 $24.18 $149.00 $120.33 $120.33 $120.33 $120.33 $24.18 $24.18 $46.99 $31.06 $24.18 $64.15 $64.15 $66.61 $46.83 $31.05 $38.69 $38.96 $88.13 $24.18 $24.35 $24.18 $149.00 $111.75 $24.18 $24.18 $24.18 $71.52 $71.52 $118.01 $24.18 $119.20 $149.00 $29.57 $24.18 $86.42 $149.00 $25.21 $24.18 $31.05 $24.18 74 56.48 77067 EAP CPT® 77067 PR IMAGING BOTH IP/OP $366.00 $271.00 $72.64 $366.00 $295.08 $295.08 $295.08 $295.08 $95.29 $95.29 $113.86 $76.28 $95.29 $249.62 $249.62 $259.22 $182.22 $76.28 $152.46 $149.90 $216.49 $95.29 $93.69 $95.29 $366.00 $274.50 $95.29 $95.29 $95.29 $175.68 $175.68 $289.87 $95.29 $292.80 $366.00 $72.64 $95.29 $212.28 $366.00 $99.77 $95.29 $76.27 $95.29 118 118 77080 EAP CPT® 77080 PR IMAGING BOTH IP/OP $105.00 $78.00 $20.84 $176.70 $88.90 $88.90 $88.90 $88.90 $107.09 $107.09 $106.62 $21.88 $107.09 $152.48 $152.48 $158.35 $111.31 $21.88 $171.35 $154.19 $62.11 $107.09 $29.09 $107.09 $112.45 $78.75 $107.09 $107.09 $107.09 $50.40 $50.40 $83.16 $107.09 $84.00 $176.70 $20.84 $107.09 $60.90 $112.45 $105.00 $107.09 $21.88 $107.09 41 39.84 77081 EAP CPT® 77081 PR IMAGING BOTH IP/OP $88.00 $65.50 $17.47 $131.28 $60.57 $60.57 $60.57 $60.57 $79.57 $79.57 $79.21 $18.34 $79.57 $48.21 $48.21 $50.07 $35.20 $18.34 $127.31 $125.33 $52.05 $79.57 $21.99 $79.57 $83.54 $66.00 $79.57 $79.57 $79.57 $42.24 $42.24 $69.70 $79.57 $70.40 $131.28 $17.47 $79.57 $51.04 $83.54 $88.00 $79.57 $18.34 $79.57 31 31 80048 EAP CPT® 80048 "CHEM 8, METABOLIC PANEL" BOTH IP/OP $26.00 $19.50 $4.23 $26.00 $16.59 $16.59 $16.59 $16.59 $8.46 $8.46 $4.23 $4.23 $8.46 $12.85 $12.85 $13.35 $9.38 $12.52 $13.54 $13.54 $15.38 $8.46 $8.46 $8.46 $26.00 $19.50 $8.46 $8.46 $8.46 $26.00 $26.00 $20.59 $8.46 $20.80 $13.96 $11.92 $8.46 $15.08 $26.00 $12.27 $8.46 $9.36 $8.46 24 N/A 80053 EAP CPT® 80053 "COMP, METABOLIC PANEL" BOTH IP/OP $32.00 $24.00 $5.28 $32.00 $20.73 $20.73 $20.73 $20.73 $10.56 $10.56 $5.28 $5.28 $10.56 $16.06 $16.06 $16.68 $11.72 $15.61 $16.90 $16.90 $18.93 $10.56 $10.56 $10.56 $32.00 $24.00 $10.56 $10.56 $10.56 $32.00 $32.00 $25.34 $10.56 $25.60 $17.42 $14.87 $10.56 $18.56 $32.00 $15.31 $10.56 $11.68 $10.56 28 N/A 80061 EAP CPT® 80061 "CHEM 3, LIPID PANEL" BOTH IP/OP $41.00 $30.50 $6.70 $41.00 $26.28 $26.28 $26.28 $26.28 $13.39 $13.39 $6.70 $6.70 $13.39 $20.35 $20.35 $21.14 $14.86 $19.79 $21.42 $21.42 $24.25 $13.39 $13.39 $13.39 $41.00 $30.75 $13.39 $13.39 $13.39 $41.00 $41.00 $32.47 $13.39 $32.80 $22.09 $18.85 $13.39 $23.78 $41.00 $19.42 $13.39 $14.81 $13.39 38 N/A 80069 EAP CPT® 80069 RENAL PANEL BOTH IP/OP $27.00 $20.00 $4.34 $27.00 $17.04 $17.04 $17.04 $17.04 $8.68 $8.68 $4.34 $4.34 $8.68 $13.19 $13.19 $13.69 $9.63 $12.83 $13.89 $13.89 $15.97 $8.68 $8.68 $8.68 $27.00 $20.25 $8.68 $8.68 $8.68 $27.00 $27.00 $21.38 $8.68 $21.60 $14.32 $12.22 $8.68 $15.66 $27.00 $12.59 $8.68 $9.60 $8.68 25 N/A 80076 EAP CPT® 80076 HEPATIC PROFILE BOTH IP/OP $25.00 $18.50 $4.09 $25.00 $16.04 $16.04 $16.04 $16.04 $8.17 $8.17 $4.09 $4.09 $8.17 $12.41 $12.41 $12.88 $9.06 $12.08 $13.07 $13.07 $14.79 $8.17 $8.17 $8.17 $25.00 $18.75 $8.17 $8.17 $8.17 $25.00 $25.00 $19.80 $8.17 $20.00 $13.48 $11.50 $8.17 $14.50 $25.00 $11.85 $8.17 $9.03 $8.17 22 N/A 81025 EAP CPT® 81025 PREGNANCY TEST-URINE BOTH IP/OP $26.00 $19.50 $3.87 $26.00 $12.40 $12.40 $12.40 $12.40 $8.61 $8.61 $4.31 $3.87 $8.61 $9.61 $9.61 $9.98 $7.01 $9.36 $13.78 $13.78 $15.38 $8.61 $8.61 $8.61 $26.00 $19.50 $8.61 $8.61 $8.61 $26.00 $26.00 $20.59 $8.61 $20.80 $14.21 $8.91 $8.61 $15.08 $26.00 $12.48 $8.61 $7.00 $8.61 14.5 N/A 82150 EAP CPT® 82150 ASSAY OF AMYLASE BOTH IP/OP $20.00 $15.00 $3.24 $20.00 $12.73 $12.73 $12.73 $12.73 $6.48 $6.48 $3.24 $3.24 $6.48 $9.84 $9.84 $10.22 $7.18 $9.58 $10.37 $10.37 $11.83 $6.48 $6.48 $6.48 $20.00 $15.00 $6.48 $6.48 $6.48 $20.00 $20.00 $15.84 $6.48 $16.00 $10.69 $9.12 $6.48 $11.60 $20.00 $9.40 $6.48 $7.16 $6.48 18 N/A 82465 EAP CPT® 82465 ASSAY BLD/SERUM CHOLESTEROL BOTH IP/OP $14.00 $10.50 $2.18 $14.00 $8.53 $8.53 $8.53 $8.53 $4.35 $4.35 $2.18 $2.18 $4.35 $6.61 $6.61 $6.87 $4.83 $6.43 $6.96 $6.96 $8.28 $4.35 $4.35 $4.35 $14.00 $10.50 $4.35 $4.35 $4.35 $14.00 $14.00 $11.09 $4.35 $11.20 $7.18 $6.12 $4.35 $8.12 $14.00 $6.31 $4.35 $4.81 $4.35 18 N/A 83036 EAP CPT® 83036 HGB GLYCOSYLATED A1C BOTH IP/OP $30.00 $22.50 $4.86 $30.00 $19.05 $19.05 $19.05 $19.05 $9.71 $9.71 $4.86 $4.86 $9.71 $14.74 $14.74 $15.30 $10.76 $14.33 $15.54 $15.54 $17.75 $9.71 $9.71 $9.71 $30.00 $22.50 $9.71 $9.71 $9.71 $30.00 $30.00 $23.76 $9.71 $24.00 $16.02 $13.65 $9.71 $17.40 $30.00 $14.08 $9.71 $10.72 $9.71 35.5 N/A 83540 EAP CPT® 83540 "IRON, LIVER TISSUE" BOTH IP/OP $20.00 $15.00 $3.24 $20.00 $12.70 $12.70 $12.70 $12.70 $6.47 $6.47 $3.24 $3.24 $6.47 $9.84 $9.84 $10.22 $7.18 $9.58 $10.35 $10.35 $11.83 $6.47 $6.47 $6.47 $20.00 $15.00 $6.47 $6.47 $6.47 $20.00 $20.00 $15.84 $6.47 $16.00 $10.68 $9.12 $6.47 $11.60 $20.00 $9.38 $6.47 $7.16 $6.47 14.5 N/A 83615 EAP CPT® 83615 "LDH,CSF" BOTH IP/OP $19.00 $14.50 $3.02 $19.00 $11.85 $11.85 $11.85 $11.85 $6.04 $6.04 $3.02 $3.02 $6.04 $9.16 $9.16 $9.51 $6.69 $7.46 $9.66 $9.66 $11.24 $6.04 $6.04 $6.04 $19.00 $14.25 $6.04 $6.04 $6.04 $19.00 $19.00 $15.05 $6.04 $15.20 $9.97 $7.10 $6.04 $11.02 $19.00 $8.76 $6.04 $5.58 $6.04 14.5 N/A 83690 EAP CPT® 83690 ASSAY OF LIPASE BOTH IP/OP $21.00 $16.00 $3.44 $21.00 $13.53 $13.53 $13.53 $13.53 $6.89 $6.89 $3.45 $3.44 $6.89 $10.46 $10.46 $10.86 $7.64 $10.17 $11.02 $11.02 $12.42 $6.89 $6.89 $6.89 $21.00 $15.75 $6.89 $6.89 $6.89 $21.00 $21.00 $16.63 $6.89 $16.80 $11.37 $9.69 $6.89 $12.18 $21.00 $9.99 $6.89 $7.61 $6.89 29 N/A 83721 EAP CPT® 83721 "CHOL-LDL, DIRECT" BOTH IP/OP $32.00 $24.00 $4.77 $32.00 $18.72 $18.72 $18.72 $18.72 $10.50 $10.50 $5.25 $4.77 $10.50 $14.49 $14.49 $15.04 $10.58 $14.10 $16.80 $16.80 $18.93 $10.50 $10.50 $10.50 $32.00 $24.00 $10.50 $10.50 $10.50 $32.00 $32.00 $25.34 $10.50 $25.60 $17.33 $13.43 $10.50 $18.56 $32.00 $15.23 $10.50 $10.55 $10.50 26 N/A 83735 EAP CPT® 83735 "MAGNESIUM, URINE" BOTH IP/OP $21.00 $16.00 $3.35 $21.00 $13.15 $13.15 $13.15 $13.15 $6.70 $6.70 $3.35 $3.35 $6.70 $10.17 $10.17 $10.56 $7.42 $9.89 $10.72 $10.72 $12.42 $6.70 $6.70 $6.70 $21.00 $15.75 $6.70 $6.70 $6.70 $21.00 $21.00 $16.63 $6.70 $16.80 $11.06 $9.42 $6.70 $12.18 $21.00 $9.72 $6.70 $7.40 $6.70 19 N/A 84100 EAP CPT® 84100 "PHOSPORUS, SERUM" BOTH IP/OP $15.00 $11.50 $2.37 $15.00 $9.31 $9.31 $9.31 $9.31 $4.74 $4.74 $2.37 $2.37 $4.74 $7.21 $7.21 $7.48 $5.26 $7.01 $7.58 $7.58 $8.87 $4.74 $4.74 $4.74 $15.00 $11.25 $4.74 $4.74 $4.74 $15.00 $15.00 $11.88 $4.74 $12.00 $7.82 $6.68 $4.74 $8.70 $15.00 $6.87 $4.74 $5.25 $4.74 12.5 N/A 84132 EAP CPT® 84132 POTASSIUM BOTH IP/OP $15.00 $11.50 $2.30 $15.00 $9.04 $9.04 $9.04 $9.04 $4.76 $4.76 $2.38 $2.30 $4.76 $6.97 $6.97 $7.24 $5.09 $6.79 $7.62 $7.62 $8.87 $4.76 $4.76 $4.76 $15.00 $11.25 $4.76 $4.76 $4.76 $15.00 $15.00 $11.88 $4.76 $12.00 $7.85 $6.47 $4.76 $8.70 $15.00 $6.90 $4.76 $5.08 $4.76 15 N/A 84295 EAP CPT® 84295 SODIUM BOTH IP/OP $15.00 $11.50 $2.41 $15.00 $9.44 $9.44 $9.44 $9.44 $4.81 $4.81 $2.41 $2.41 $4.81 $7.30 $7.30 $7.58 $5.33 $7.11 $7.70 $7.70 $8.87 $4.81 $4.81 $4.81 $15.00 $11.25 $4.81 $4.81 $4.81 $15.00 $15.00 $11.88 $4.81 $12.00 $7.94 $6.77 $4.81 $8.70 $15.00 $6.97 $4.81 $5.32 $4.81 12.5 N/A 84439 EAP CPT® 84439 FREE THYROXINE BOTH IP/OP $28.00 $21.00 $4.51 $28.00 $17.70 $17.70 $17.70 $17.70 $9.02 $9.02 $4.51 $4.51 $9.02 $13.70 $13.70 $14.22 $10.00 $13.32 $14.43 $14.43 $16.56 $9.02 $9.02 $9.02 $28.00 $21.00 $9.02 $9.02 $9.02 $28.00 $28.00 $22.18 $9.02 $22.40 $14.88 $12.69 $9.02 $16.24 $28.00 $13.08 $9.02 $9.97 $9.02 32.5 N/A 84443 EAP CPT® 84443 ASSAY THYROID STIM HORMONE BOTH IP/OP $51.00 $38.00 $8.40 $51.00 $32.98 $32.98 $32.98 $32.98 $16.80 $16.80 $8.40 $8.40 $16.80 $25.51 $25.51 $26.49 $18.62 $24.81 $26.88 $26.88 $30.17 $16.80 $16.80 $16.80 $51.00 $38.25 $16.80 $16.80 $16.80 $51.00 $51.00 $40.39 $16.80 $40.80 $27.72 $23.63 $16.80 $29.58 $51.00 $24.36 $16.80 $18.56 $16.80 46 N/A 84550 EAP CPT® 84550 URIC ACID BOTH IP/OP $14.00 $10.50 $2.26 $14.00 $8.86 $8.86 $8.86 $8.86 $4.52 $4.52 $2.26 $2.26 $4.52 $6.85 $6.85 $7.12 $5.00 $6.67 $7.23 $7.23 $8.28 $4.52 $4.52 $4.52 $14.00 $10.50 $4.52 $4.52 $4.52 $14.00 $14.00 $11.09 $4.52 $11.20 $7.46 $6.35 $4.52 $8.12 $14.00 $6.55 $4.52 $4.99 $4.52 12 N/A 85018 EAP CPT® 85018 "HEMOGLOBIN, MICRO(METER)" BOTH IP/OP $8.00 $6.00 $1.18 $8.00 $4.64 $4.64 $4.64 $4.64 $2.37 $2.37 $1.19 $1.18 $2.37 $3.60 $3.60 $3.74 $2.63 $3.50 $3.79 $3.79 $4.73 $2.37 $2.37 $2.37 $8.00 $6.00 $2.37 $2.37 $2.37 $8.00 $8.00 $6.34 $2.37 $6.40 $3.91 $3.33 $2.37 $4.64 $8.00 $3.44 $2.37 $2.62 $2.37 8.5 N/A 85025 EAP CPT® 85025 "CBC, PLAT & DIFF" BOTH IP/OP $24.00 $18.00 $3.88 $24.00 $15.26 $15.26 $15.26 $15.26 $7.77 $7.77 $3.89 $3.88 $7.77 $9.97 $9.97 $10.36 $7.28 $11.48 $12.43 $12.43 $14.20 $7.77 $7.77 $7.77 $24.00 $18.00 $7.77 $7.77 $7.77 $24.00 $24.00 $19.01 $7.77 $19.20 $12.82 $10.93 $7.77 $13.92 $24.00 $11.27 $7.77 $8.59 $7.77 17.5 N/A 85027 EAP CPT® 85027 CBC & PLAT BOTH IP/OP $20.00 $15.00 $3.23 $20.00 $12.70 $12.70 $12.70 $12.70 $6.47 $6.47 $3.24 $3.23 $6.47 $9.83 $9.83 $10.21 $7.17 $9.57 $10.35 $10.35 $11.83 $6.47 $6.47 $6.47 $20.00 $15.00 $6.47 $6.47 $6.47 $20.00 $20.00 $15.84 $6.47 $16.00 $10.68 $9.11 $6.47 $11.60 $20.00 $9.38 $6.47 $7.16 $6.47 16.5 N/A 85046 EAP CPT® 85046 "RETICULOCYTES, AUTOMATED" BOTH IP/OP $17.00 $13.00 $2.79 $17.00 $10.92 $10.92 $10.92 $10.92 $5.57 $5.57 $2.79 $2.79 $5.57 $8.48 $8.48 $8.80 $6.19 $8.24 $8.91 $8.91 $10.06 $5.57 $5.57 $5.57 $17.00 $12.75 $5.57 $5.57 $5.57 $17.00 $17.00 $13.46 $5.57 $13.60 $9.19 $7.85 $5.57 $9.86 $17.00 $8.08 $5.57 $6.17 $5.57 N/A N/A 86706 EAP CPT® 86706 HBV SURFACE AB BOTH IP/OP $33.00 $24.50 $5.37 $33.00 $21.08 $21.08 $21.08 $21.08 $10.74 $10.74 $5.37 $5.37 $10.74 $16.31 $16.31 $16.93 $11.90 $15.87 $17.18 $17.18 $19.52 $10.74 $10.74 $10.74 $33.00 $24.75 $10.74 $10.74 $10.74 $33.00 $33.00 $26.14 $10.74 $26.40 $17.72 $15.11 $10.74 $19.14 $33.00 $15.57 $10.74 $11.87 $10.74 34 N/A 87210 EAP CPT® 87210 "O & P DIRECT, SMEAR" BOTH IP/OP $18.00 $13.50 $2.62 $18.00 $8.38 $8.38 $8.38 $8.38 $5.82 $5.82 $2.91 $2.62 $5.82 $6.48 $6.48 $6.73 $4.73 $6.30 $9.31 $9.31 $10.65 $5.82 $5.82 $5.82 $18.00 $13.50 $5.82 $5.82 $5.82 $18.00 $18.00 $14.26 $5.82 $14.40 $9.60 $6.00 $5.82 $10.44 $18.00 $8.44 $5.82 $4.71 $5.82 10 N/A 87426 EAP CPT® 87426 IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS BOTH IP/OP $88.00 $65.50 #N/A #N/A $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 #N/A $51.04 $88.00 $88.00 $88.00 $88.00 $88.00 N/A N/A 90460 EAP CPT® 90460 IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX BOTH IP/OP $21.93 $16.50 $8.77 $27.04 $21.93 $21.93 $21.93 $21.93 $16.90 $16.90 $17.04 $21.93 $16.90 $21.93 $21.93 $21.93 $21.93 $21.93 $27.04 $8.77 $21.93 $16.90 $22.69 $16.90 $21.93 $16.45 $16.90 $16.90 $16.90 $21.93 $21.93 $21.93 $16.90 $21.93 $14.25 $21.93 $16.90 $12.72 $21.93 $14.42 $16.90 $21.93 $16.90 32 17.75 90461 EAP CPT® 90461 IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT BOTH IP/OP $21.93 $16.50 $8.77 $21.93 $21.93 $21.93 $21.93 $21.93 $12.76 $12.76 $12.86 $21.93 $12.76 $21.93 $21.93 $21.93 $21.93 $21.93 $20.42 $8.77 $21.93 $12.76 $10.16 $12.76 $21.93 $16.45 $12.76 $12.76 $12.76 $21.93 $21.93 $21.93 $12.76 $21.93 $14.25 $21.93 $12.76 $12.72 $21.93 $12.98 $12.76 $21.93 $12.76 39 26.8 90471 EAP CPT® 90471 PR IMMUNIZATIONS BOTH IP/OP $47.00 $35.00 $9.33 $62.98 $25.52 $25.52 $25.52 $25.52 $39.36 $39.36 $39.19 $9.80 $39.36 $34.88 $34.88 $36.23 $24.49 $9.80 $62.98 $61.13 $27.80 $39.36 $47.00 $39.36 $41.33 $35.25 $39.36 $39.36 $39.36 $23.50 $23.50 $37.22 $39.36 $37.60 $30.55 $9.33 $39.36 $27.26 $41.33 $47.00 $60.99 $9.79 $39.36 32 N/A 90472 EAP CPT® 90472 PR IMMUNIZATIONS BOTH IP/OP $36.00 $27.00 $7.15 $36.00 $19.55 $19.55 $19.55 $19.55 $36.00 $36.00 $36.00 $7.50 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $36.00 $21.29 $36.00 $14.56 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $7.15 $36.00 $20.88 $36.00 $36.00 $36.00 $7.50 $36.00 19.5 13.4 90620 EAP CPT® 90620 MENB RECOMBINANT PROT W/OUT MEMBR VESIC VACC IM BOTH IP/OP $30.00 $22.50 $6.25 $214.53 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $183.95 $6.25 $30.00 $199.42 $199.42 $207.09 $191.75 $30.00 $30.00 $12.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $214.53 $30.00 125 N/A 90621 EAP CPT® 90621 MENB RECOMBINANT LIPOPROTEIN VACCINE IM BOTH IP/OP $30.00 $22.50 #N/A #N/A $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $150.94 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $19.50 $30.00 #N/A $17.40 $30.00 $18.00 $30.00 $175.20 $30.00 N/A N/A 90632 EAP CPT® 90632 HEPA VACCINE ADULT IM BOTH IP/OP $30.00 $22.50 $13.50 $72.43 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $30.00 $56.67 $30.00 $67.33 $67.33 $69.92 $64.74 $30.00 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $30.00 $30.00 $17.40 $30.00 $30.00 $30.00 $72.43 $30.00 63.5 N/A 90633 EAP CPT® 90633 HEPA VACCINE PED/ADOL-2 DOSE BOTH IP/OP $30.00 $22.50 $5.95 $37.64 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $30.00 $9.40 $30.00 $36.24 $36.24 $37.64 $34.85 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $5.95 $30.00 $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 29.5 N/A 90647 EAP CPT® 90647 "HIB VACCINE, PRP-OMP, IM" BOTH IP/OP $30.00 $22.50 $5.95 $30.29 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $30.00 $6.25 $30.00 $29.17 $29.17 $30.29 $28.05 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $5.95 $30.00 $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 21 N/A 90648 EAP CPT® 90648 "HIB VACCINE, PRP-T, IM" BOTH IP/OP $30.00 $22.50 $5.95 $30.00 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $30.00 $6.25 $30.00 $12.03 $12.03 $12.50 $11.57 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $5.95 $30.00 $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 24 N/A 90651 EAP CPT® 90651 HUMAN PAPILLOMA VIRUS NONAVALENT HPV 3 DOSE IM BOTH IP/OP $30.00 $22.50 $6.25 $283.73 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $243.34 $6.25 $30.00 $263.74 $263.74 $273.89 $253.60 $30.00 $30.00 $12.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $283.73 $30.00 200 N/A 90670 EAP CPT® 90670 PNEUMOCOCCAL CONJ VACCINE 13 VALENT IM BOTH IP/OP $30.00 $22.50 $4.26 $270.06 $13.50 $13.50 $13.50 $13.50 $7.80 $7.80 $241.38 $6.25 $7.80 $251.04 $251.04 $260.69 $241.38 $30.00 $30.00 $12.00 $17.75 $7.80 $7.80 $7.80 $30.00 $22.50 $7.80 $4.26 $7.80 $15.00 $15.00 $23.76 $7.80 $24.00 $13.50 $30.00 $7.80 $17.40 $30.00 $4.38 $7.80 $270.06 $7.80 164 N/A 90677 EAP CPT® 90677 PCV20 VACCINE FOR INTRAMUSCULAR USE BOTH IP/OP $872.06 $645.50 $505.79 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $654.05 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $872.06 $505.79 $872.06 $872.06 $872.06 $872.06 $872.06 N/A N/A 90680 EAP CPT® 90680 "ROTOVIRUS VACCINE, ORAL" BOTH IP/OP $30.00 $22.50 $5.95 $97.74 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $30.00 $6.25 $30.00 $94.12 $94.12 $97.74 $90.50 $6.25 $30.00 $12.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $5.95 $30.00 $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 78 N/A 90686 EAP CPT® 90686 IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE BOTH IP/OP $25.00 $18.50 $3.55 $25.00 $11.25 $11.25 $11.25 $11.25 $6.50 $6.50 $20.53 $5.21 $6.50 $21.35 $21.35 $22.17 $20.53 $24.12 $25.00 $10.00 $14.79 $6.50 $6.50 $6.50 $25.00 $18.75 $6.50 $3.55 $6.50 $12.50 $12.50 $19.80 $6.50 $20.00 $11.25 $22.97 $6.50 $14.50 $25.00 $3.65 $6.50 $22.97 $6.50 25 N/A 90694 EAP CPT® 90694 AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE BOTH IP/OP $161.00 $119.50 $93.38 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $93.38 $161.00 $161.00 $161.00 $161.00 $161.00 N/A N/A 90696 EAP CPT® 90696 "DTAP-IPV, IM, AGE 4-6 YEAR" BOTH IP/OP $30.00 $22.50 $5.95 $60.09 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $30.00 $6.25 $30.00 $57.87 $57.87 $60.09 $55.64 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $5.95 $30.00 $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 44 N/A 90697 EAP CPT® 90697 DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR BOTH IP/OP $560.24 $415.00 #N/A #N/A $252.11 $252.11 $252.11 $252.11 $560.24 $560.24 $126.74 $116.77 $560.24 $138.08 $138.08 $143.39 $132.77 $116.76 $560.24 $224.10 $331.38 $560.24 $560.24 $560.24 $560.24 $420.18 $560.24 $560.24 $560.24 $280.12 $280.12 $443.71 $560.24 $448.19 $252.11 $111.19 #N/A $324.94 $560.24 $336.14 $560.24 $116.75 $560.24 N/A N/A 90698 EAP CPT® 90698 "DTAP-HIB-IP VACCINE, IM" BOTH IP/OP $30.00 $22.50 $17.40 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $19.50 $30.00 $30.00 $17.40 $30.00 $30.00 $30.00 $30.00 $30.00 86 N/A 90700 EAP CPT® 90700 "DTAP IMMUNIZATION, IM" BOTH IP/OP $30.00 $22.50 $5.95 $30.00 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $30.00 $6.25 $30.00 $27.36 $27.36 $28.41 $26.31 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $5.95 $30.00 $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 26 N/A 90707 EAP CPT® 90707 "MMR VIRUS IMMUNIZATION, SUBCUT" BOTH IP/OP $30.00 $22.50 $11.75 $97.68 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $30.00 $11.75 $30.00 $90.80 $90.80 $94.29 $87.31 $30.00 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $30.00 $30.00 $17.40 $30.00 $30.00 $30.00 $97.68 $30.00 67 N/A 90710 EAP CPT® 90710 "COMBINED VACCINE,MMR+VARICELLA,SQ" BOTH IP/OP $30.00 $22.50 $5.95 $270.02 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $30.00 $6.25 $30.00 $260.02 $260.02 $270.02 $250.02 $6.25 $30.00 $160.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $5.95 $30.00 $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 183 N/A 90713 EAP CPT® 90713 "POLIOMYELITIS IMMUNIZATN,INACTV,SQ" BOTH IP/OP $30.00 $22.50 $9.40 $41.27 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $30.00 $9.40 $30.00 $38.37 $38.37 $39.84 $36.89 $30.00 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $30.00 $30.00 $17.40 $30.00 $30.00 $30.00 $41.27 $30.00 39.5 N/A 90715 EAP CPT® 90715 TDAP VACCINE >7 IM BOTH IP/OP $30.00 $22.50 $6.25 $40.46 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $30.00 $6.25 $30.00 $37.61 $37.61 $39.05 $36.16 $30.00 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $30.00 $30.00 $17.40 $30.00 $30.00 $30.00 $40.46 $30.00 45 N/A 90716 EAP CPT® 90716 "CHICKEN POX VACCINE,LIVE,SUBCUT" BOTH IP/OP $30.00 $22.50 $9.40 $168.92 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $144.82 $9.40 $30.00 $157.02 $157.02 $163.06 $150.98 $30.00 $30.00 $12.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $168.92 $30.00 116 N/A 90723 EAP CPT® 90723 DTAP-HEPB-IPV VACCINE INTRAMUSCULAR BOTH IP/OP $30.00 $22.50 $5.95 $97.25 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $85.84 $6.25 $30.00 $93.65 $93.65 $97.25 $90.05 $6.25 $30.00 $12.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $5.95 $30.00 $17.40 $30.00 $18.00 $30.00 $6.25 $30.00 75 N/A 90732 EAP CPT® 90732 PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE BOTH IP/OP $30.00 $22.50 $4.26 $149.33 $13.50 $13.50 $13.50 $13.50 $7.80 $7.80 $125.92 $9.40 $7.80 $138.81 $138.81 $144.15 $133.47 $30.00 $30.00 $12.00 $17.75 $7.80 $7.80 $7.80 $30.00 $22.50 $7.80 $4.26 $7.80 $15.00 $15.00 $23.76 $7.80 $24.00 $13.50 $30.00 $7.80 $17.40 $30.00 $4.38 $7.80 $149.33 $7.80 150 N/A 90734 EAP CPT® 90734 MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE BOTH IP/OP $30.00 $22.50 $9.40 $150.78 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $129.26 $9.40 $30.00 $140.16 $140.16 $145.55 $134.77 $30.00 $30.00 $12.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $150.78 $30.00 101 N/A 90744 EAP CPT® 90744 "HEP B VACCINE,PED/ADOL,IM" BOTH IP/OP $30.00 $22.50 $4.26 $31.06 $13.50 $13.50 $13.50 $13.50 $7.80 $7.80 $28.22 $6.25 $7.80 $29.91 $29.91 $31.06 $28.76 $6.25 $30.00 $12.00 $17.75 $7.80 $7.80 $7.80 $30.00 $22.50 $7.80 $4.26 $7.80 $15.00 $15.00 $23.76 $7.80 $24.00 $13.50 $5.95 $7.80 $17.40 $30.00 $18.00 $7.80 $6.25 $7.80 37.5 N/A 90746 EAP CPT® 90746 HEPATITIS B VACCINE ADULT 3 DOSE IM BOTH IP/OP $227.00 $168.00 $32.23 $227.00 $102.15 $102.15 $102.15 $102.15 $59.02 $59.02 $69.65 $70.16 $59.02 $73.20 $73.20 $76.01 $70.38 $82.69 $227.00 $90.80 $134.27 $59.02 $59.02 $59.02 $227.00 $170.25 $59.02 $32.23 $59.02 $113.50 $113.50 $179.78 $59.02 $181.60 $102.15 $78.74 $59.02 $131.66 $227.00 $136.20 $59.02 $78.74 $59.02 87.5 N/A 90791 EAP CPT® 90791 PSYCHIATRIC DIAGNOSTIC EVALUATION BOTH IP/OP $494.00 $366.00 $98.05 $494.00 $268.24 $268.24 $268.24 $268.24 $131.62 $131.62 $131.03 $102.96 $131.62 $366.65 $366.65 $380.78 $257.37 $102.96 $210.59 $210.20 $292.20 $131.62 $150.82 $131.62 $138.20 $370.50 $131.62 $131.62 $131.62 $247.00 $247.00 $391.25 $131.62 $395.20 $321.10 $98.05 $131.62 $286.52 $138.20 $190.41 $131.62 $494.00 $131.62 200.06 161.25 90832 EAP CPT® 90832 PSYCHOTHERAPY W/PATIENT 30 MINUTES BOTH IP/OP $215.00 $159.50 $42.67 $215.00 $116.75 $116.75 $116.75 $116.75 $131.62 $131.62 $131.03 $44.81 $131.62 $159.57 $159.57 $165.72 $112.02 $44.81 $210.59 $210.20 $127.17 $131.62 $66.43 $131.62 $138.20 $161.25 $131.62 $131.62 $131.62 $107.50 $107.50 $170.28 $131.62 $172.00 $139.75 $42.67 $131.62 $124.70 $138.20 $190.41 $131.62 $215.00 $131.62 96 72.05 90834 EAP CPT® 90834 PSYCHOTHERAPY W/PATIENT 45 MINUTES BOTH IP/OP $284.00 $210.50 $56.37 $284.00 $154.21 $154.21 $154.21 $154.21 $131.62 $131.62 $131.03 $59.19 $131.62 $210.78 $210.78 $218.91 $147.96 $59.19 $210.59 $210.20 $167.99 $131.62 $88.12 $131.62 $138.20 $213.00 $131.62 $131.62 $131.62 $142.00 $142.00 $224.93 $131.62 $227.20 $184.60 $56.37 $131.62 $164.72 $138.20 $190.41 $131.62 $284.00 $131.62 127.5 94.87 90837 EAP CPT® 90837 PSYCHOTHERAPY W/PATIENT 60 MINUTES BOTH IP/OP $417.00 $309.00 $82.76 $417.00 $226.43 $226.43 $226.43 $226.43 $131.62 $131.62 $131.03 $86.91 $131.62 $309.50 $309.50 $321.42 $217.26 $86.91 $210.59 $210.20 $246.66 $131.62 $129.46 $131.62 $138.20 $312.75 $131.62 $131.62 $131.62 $208.50 $208.50 $330.26 $131.62 $333.60 $271.05 $82.76 $131.62 $241.86 $138.20 $190.41 $131.62 $417.00 $131.62 191 139.11 91111 EAP CPT® 91111 CHG LABORATORY BOTH IP/OP "$2,479.00" "$1,834.50" $828.40 "$2,479.00" "$2,479.00" "$2,479.00" "$2,479.00" "$2,479.00" $923.49 $923.49 $967.65 "$2,479.00" $923.49 "$2,479.00" "$2,479.00" "$2,479.00" "$2,479.00" "$2,479.00" "$1,477.58" $991.60 "$2,479.00" $923.49 $861.05 $923.49 "$2,479.00" "$1,859.25" $923.49 $923.49 $923.49 "$2,479.00" "$2,479.00" "$2,479.00" $923.49 "$2,479.00" "$2,479.00" "$2,479.00" $923.49 "$1,437.82" "$2,479.00" $828.40 $923.49 "$2,479.00" $923.49 185 N/A 92250 EAP CPT® 92250 FUNDAL PHOTOGRAPHY BOTH IP/OP $105.00 $78.00 $16.58 $177.47 $57.02 $57.02 $57.02 $57.02 $110.92 $110.92 $110.43 $21.88 $110.92 $77.93 $77.93 $80.93 $54.71 $21.88 $177.47 $167.51 $62.11 $110.92 $16.58 $110.92 $116.46 $78.75 $110.92 $110.92 $110.92 $52.50 $52.50 $83.16 $110.92 $84.00 $68.25 $20.84 $110.92 $60.90 $116.46 $105.00 $110.92 $21.88 $110.92 95 39.49 92551 EAP CPT® 92551 "PURE TONE HEARING TEST, AIR" BOTH IP/OP $40.00 $30.00 $7.94 $40.00 $21.72 $21.72 $21.72 $21.72 $40.00 $40.00 $11.81 $8.34 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $23.66 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $40.00 $40.00 $31.68 $40.00 $32.00 $26.00 $7.94 $40.00 $23.20 $40.00 $24.00 $40.00 $8.34 $40.00 19.09 N/A 93000 EAP CPT® 93000 ECC PERFORMABLES BOTH IP/OP $40.00 $30.00 $14.45 $40.00 $35.72 $35.72 $35.72 $35.72 $14.45 $14.45 $14.92 $40.00 $14.45 $40.00 $40.00 $40.00 $40.00 $40.00 $23.12 $16.00 $40.00 $14.45 $14.57 $14.45 $40.00 $30.00 $14.45 $14.45 $14.45 $40.00 $40.00 $40.00 $14.45 $40.00 $26.00 $40.00 $14.45 $23.20 $40.00 $17.30 $14.45 $40.00 $14.45 26.88 15.17 93015 EAP CPT® 93015 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $200.00 $148.00 $71.10 $200.00 $160.72 $160.72 $160.72 $160.72 $72.07 $72.07 $71.62 $200.00 $72.07 $200.00 $200.00 $200.00 $200.00 $200.00 $115.31 $80.00 $200.00 $72.07 $71.10 $72.07 $200.00 $150.00 $72.07 $72.07 $72.07 $200.00 $200.00 $200.00 $72.07 $200.00 $130.00 $200.00 $72.07 $116.00 $200.00 $72.09 $72.07 $200.00 $72.07 120.54 75.67 93017 EAP CPT® 93017 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $106.00 $78.50 $21.04 $416.53 $82.60 $82.60 $82.60 $82.60 $260.33 $260.33 $259.18 $22.09 $260.33 $78.67 $78.67 $81.70 $55.23 $22.09 $416.53 $404.03 $62.70 $260.33 $36.20 $260.33 $273.35 $79.50 $260.33 $260.33 $260.33 $53.00 $53.00 $83.95 $260.33 $84.80 $68.90 $21.04 $260.33 $61.48 $273.35 $106.00 $260.33 $22.09 $260.33 62.38 37.64 93018 EAP CPT® 93018 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $41.00 $30.50 $13.89 $41.00 $31.25 $31.25 $31.25 $31.25 $14.49 $14.49 $14.61 $41.00 $14.49 $41.00 $41.00 $41.00 $41.00 $41.00 $23.18 $16.40 $41.00 $14.49 $13.89 $14.49 $41.00 $30.75 $14.49 $14.49 $14.49 $41.00 $41.00 $41.00 $14.49 $41.00 $26.65 $41.00 $14.49 $23.78 $41.00 $15.15 $14.49 $41.00 $14.49 22.94 15.21 93225 EAP CPT® 93225 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $59.00 $44.00 $11.71 $177.47 $55.82 $55.82 $55.82 $55.82 $110.92 $110.92 $110.43 $12.30 $110.92 $43.79 $43.79 $45.48 $30.74 $12.30 $177.47 $167.51 $34.90 $110.92 $18.61 $110.92 $116.46 $44.25 $110.92 $110.92 $110.92 $29.50 $29.50 $46.73 $110.92 $47.20 $38.35 $11.71 $110.92 $34.22 $116.46 $59.00 $110.92 $12.30 $110.92 42.14 20.63 93227 EAP CPT® 93227 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $56.00 $41.50 $18.30 $56.00 $56.00 $56.00 $56.00 $56.00 $18.64 $18.64 $18.80 $56.00 $18.64 $56.00 $56.00 $56.00 $56.00 $56.00 $29.82 $22.40 $56.00 $18.64 $18.30 $18.64 $56.00 $42.00 $18.64 $18.64 $18.64 $56.00 $56.00 $56.00 $18.64 $56.00 $36.40 $56.00 $18.64 $32.48 $56.00 $27.05 $18.64 $56.00 $18.64 41.95 19.57 93242 EAP CPT® 93242 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $43.00 $32.00 $12.18 $87.61 $31.68 $31.68 $31.68 $31.68 $54.76 $54.76 $54.51 $43.00 $54.76 $43.00 $43.00 $43.00 $43.00 $43.00 $87.61 $48.99 $43.00 $54.76 $12.18 $54.76 $57.49 $32.25 $54.76 $54.76 $54.76 $43.00 $43.00 $43.00 $54.76 $43.00 $27.95 $43.00 $54.76 $24.94 $57.49 $43.00 $54.76 $43.00 $54.76 N/A N/A 93244 EAP CPT® 93244 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $73.00 $54.50 $23.38 $73.00 $51.15 $51.15 $51.15 $51.15 $24.49 $24.49 $24.69 $73.00 $24.49 $73.00 $73.00 $73.00 $73.00 $73.00 $39.18 $29.20 $73.00 $24.49 $23.38 $24.49 $73.00 $54.75 $24.49 $24.49 $24.49 $73.00 $73.00 $73.00 $24.49 $73.00 $47.45 $73.00 $24.49 $42.34 $73.00 $43.80 $24.49 $73.00 $24.49 N/A 25.71 93246 EAP CPT® 93246 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $43.00 $32.00 $12.18 $87.61 $31.68 $31.68 $31.68 $31.68 $54.76 $54.76 $54.51 $43.00 $54.76 $43.00 $43.00 $43.00 $43.00 $43.00 $87.61 $82.92 $43.00 $54.76 $12.18 $54.76 $57.49 $32.25 $54.76 $54.76 $54.76 $43.00 $43.00 $43.00 $54.76 $43.00 $27.95 $43.00 $54.76 $24.94 $57.49 $43.00 $54.76 $43.00 $54.76 N/A N/A 93248 EAP CPT® 93248 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $81.00 $60.00 $25.75 $81.00 $56.20 $56.20 $56.20 $56.20 $26.91 $26.91 $27.13 $81.00 $26.91 $81.00 $81.00 $81.00 $81.00 $81.00 $43.06 $32.40 $81.00 $26.91 $25.75 $26.91 $81.00 $60.75 $26.91 $26.91 $26.91 $81.00 $81.00 $81.00 $26.91 $81.00 $52.65 $81.00 $26.91 $46.98 $81.00 $48.60 $26.91 $81.00 $26.91 N/A 28.26 93306 EAP CPT® 93306 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $566.00 $419.00 $112.34 $760.48 $479.91 $479.91 $479.91 $479.91 $475.30 $475.30 $473.20 $117.97 $475.30 $420.09 $420.09 $436.27 $294.89 $117.96 $760.48 $725.84 $334.79 $475.30 $130.23 $475.30 $499.07 $424.50 $475.30 $475.30 $475.30 $283.00 $283.00 $448.27 $475.30 $452.80 $367.90 $112.34 $475.30 $328.28 $499.07 $566.00 $475.30 $117.95 $475.30 225 214.55 93308 EAP CPT® 93308 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $78.00 $58.00 $15.48 $362.15 $78.00 $78.00 $78.00 $78.00 $226.34 $226.34 $225.34 $16.26 $226.34 $205.76 $205.76 $213.68 $150.21 $16.26 $362.15 $336.89 $46.14 $226.34 $74.75 $226.34 $237.66 $58.50 $226.34 $226.34 $226.34 $39.00 $39.00 $61.78 $226.34 $62.40 $50.70 $15.48 $226.34 $45.24 $237.66 $78.00 $226.34 $16.26 $226.34 197.65 106.55 93350 EAP CPT® 93350 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $537.00 $397.50 $106.58 $760.48 $505.94 $505.94 $505.94 $505.94 $475.30 $475.30 $473.20 $111.92 $475.30 $328.30 $328.30 $340.92 $239.65 $111.92 $760.48 $725.84 $317.64 $475.30 $119.39 $475.30 $499.07 $402.75 $475.30 $475.30 $475.30 $268.50 $268.50 $425.30 $475.30 $429.60 $349.05 $106.58 $475.30 $311.46 $499.07 $537.00 $475.30 $111.91 $475.30 381.68 203.67 93880 EAP CPT® 93880 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $116.00 $86.00 $23.02 $562.53 $116.00 $116.00 $116.00 $116.00 $226.34 $226.34 $225.34 $24.18 $226.34 $541.69 $541.69 $562.53 $395.43 $24.18 $362.15 $336.89 $68.61 $226.34 $155.59 $226.34 $237.66 $87.00 $226.34 $226.34 $226.34 $58.00 $58.00 $91.87 $226.34 $92.80 $75.40 $23.02 $226.34 $67.28 $237.66 $116.00 $226.34 $24.17 $226.34 122 122 93970 EAP CPT® 93970 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $102.00 $75.50 $20.24 $565.47 $102.00 $102.00 $102.00 $102.00 $226.34 $226.34 $225.34 $21.26 $226.34 $544.52 $544.52 $565.47 $397.50 $21.26 $362.15 $336.89 $60.33 $226.34 $157.96 $226.34 $237.66 $76.50 $226.34 $226.34 $226.34 $51.00 $51.00 $80.78 $226.34 $81.60 $66.30 $20.24 $226.34 $59.16 $237.66 $102.00 $226.34 $21.26 $226.34 314.94 205 93971 EAP CPT® 93971 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $343.00 $254.00 $68.08 $374.41 $253.01 $253.01 $253.01 $253.01 $107.09 $107.09 $106.62 $71.49 $107.09 $360.55 $360.55 $374.41 $263.20 $71.48 $171.35 $154.19 $202.88 $107.09 $99.78 $107.09 $112.45 $257.25 $107.09 $107.09 $107.09 $171.50 $171.50 $271.66 $107.09 $274.40 $222.95 $68.08 $107.09 $198.94 $112.45 $154.94 $107.09 $71.48 $107.09 192.55 130.01 93976 EAP CPT® 93976 PR CARDIOVASCULAR SYSTEM SERVICES BOTH IP/OP $423.00 $313.50 $83.95 $405.03 $318.47 $318.47 $318.47 $318.47 $107.09 $107.09 $106.62 $88.16 $107.09 $390.03 $390.03 $405.03 $284.72 $88.16 $171.35 $154.19 $250.20 $107.09 $122.78 $107.09 $112.45 $317.25 $107.09 $107.09 $107.09 $211.50 $211.50 $335.02 $107.09 $338.40 $176.70 $83.95 $107.09 $245.34 $112.45 $154.94 $107.09 $88.15 $107.09 139 N/A 94640 EAP CPT® 94640 "INHAL RX, AIRWAY OBST/DX SPUTUM INDUCT" BOTH IP/OP $32.00 $24.00 $6.35 $295.84 $17.38 $17.38 $17.38 $17.38 $184.90 $184.90 $184.08 $6.67 $184.90 $23.75 $23.75 $24.67 $16.67 $6.67 $295.84 $276.26 $18.93 $184.90 $9.14 $184.90 $194.14 $24.00 $184.90 $184.90 $184.90 $16.00 $16.00 $25.34 $184.90 $25.60 $20.80 $6.35 $184.90 $18.56 $194.14 $32.00 $184.90 $6.67 $184.90 29.2 11.93 94664 EAP CPT® 94664 "DEMO &/OR EVAL,PT USE,AEROSOL DEVICE" BOTH IP/OP $48.00 $36.00 $9.53 $295.84 $26.06 $26.06 $26.06 $26.06 $184.90 $184.90 $184.08 $10.00 $184.90 $35.63 $35.63 $37.00 $25.01 $10.00 $295.84 $276.26 $28.39 $184.90 $17.25 $184.90 $194.14 $36.00 $184.90 $184.90 $184.90 $24.00 $24.00 $38.02 $184.90 $38.40 $31.20 $9.53 $184.90 $27.84 $194.14 $48.00 $184.90 $10.00 $184.90 27.51 18.1 96110 EAP CPT® 96110 PR CNS ASSESSMENTS AND TESTS BOTH IP/OP $35.00 $26.00 $10.07 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $10.07 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 14.03 N/A 96127 EAP CPT® 96127 BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT BOTH IP/OP $14.00 $10.50 $4.74 $53.27 $14.00 $14.00 $14.00 $14.00 $33.30 $33.30 $33.15 $14.00 $33.30 $14.00 $14.00 $14.00 $14.00 $14.00 $53.27 $48.99 $14.00 $33.30 $4.74 $33.30 $34.96 $10.50 $33.30 $33.30 $33.30 $14.00 $14.00 $14.00 $33.30 $14.00 $9.10 $14.00 $33.30 $8.12 $34.96 $14.00 $33.30 $14.00 $33.30 8.4 5.04 96161 EAP CPT® 96161 CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM BOTH IP/OP $8.00 $6.00 $2.71 $42.82 $8.00 $8.00 $8.00 $8.00 $25.85 $25.85 $25.74 $8.00 $25.85 $8.00 $8.00 $8.00 $8.00 $8.00 $41.36 $42.82 $8.00 $25.85 $2.71 $25.85 $27.14 $6.00 $25.85 $25.85 $25.85 $8.00 $8.00 $8.00 $25.85 $8.00 $5.20 $8.00 $25.85 $4.64 $27.14 $8.00 $25.85 $8.00 $25.85 7.31 2.9 96372 EAP CPT® 96372 PR CHEMOTHERAPY SERVICES BOTH IP/OP $41.00 $30.50 $8.14 $97.58 $22.26 $22.26 $22.26 $22.26 $60.99 $60.99 $60.72 $8.55 $60.99 $30.43 $30.43 $31.60 $21.36 $8.54 $97.58 $97.33 $24.25 $60.99 $14.22 $60.99 $64.04 $30.75 $60.99 $60.99 $60.99 $20.50 $20.50 $32.47 $60.99 $32.80 $26.65 $8.14 $60.99 $23.78 $64.04 $41.00 $60.99 $41.00 $60.99 39.84 15.2 97802 EAP CPT® 97802 PR MEDICAL NUTRITION THERAPY BOTH IP/OP $104.00 $77.00 $20.64 $104.00 $56.47 $56.47 $56.47 $56.47 $32.78 $32.78 $33.05 $21.68 $32.78 $77.19 $77.19 $80.16 $54.18 $21.67 $52.45 $52.02 $61.52 $32.78 $32.51 $32.78 $104.00 $78.00 $32.78 $32.78 $32.78 $52.00 $52.00 $82.37 $32.78 $83.20 $67.60 $20.64 $32.78 $60.32 $104.00 $34.61 $32.78 $21.67 $32.78 103.03 68.84 97803 EAP CPT® 97803 PR MEDICAL NUTRITION THERAPY BOTH IP/OP $90.00 $67.00 $17.86 $90.00 $48.87 $48.87 $48.87 $48.87 $27.94 $27.94 $28.17 $18.76 $27.94 $66.80 $66.80 $69.37 $46.89 $18.76 $44.70 $43.89 $53.24 $27.94 $27.43 $27.94 $90.00 $67.50 $27.94 $27.94 $27.94 $45.00 $45.00 $71.28 $27.94 $72.00 $58.50 $17.86 $27.94 $52.20 $90.00 $29.21 $27.94 $18.76 $27.94 43.66 29.34 98967 EAP CPT® 98967 NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN BOTH IP/OP $67.00 $50.00 $22.03 $67.00 $67.00 $67.00 $67.00 $67.00 $22.07 $22.07 $25.32 $67.00 $22.07 $67.00 $67.00 $67.00 $67.00 $67.00 $35.31 $26.80 $67.00 $22.07 $22.03 $22.07 $67.00 $50.25 $22.07 $22.07 $22.07 $67.00 $67.00 $67.00 $22.07 $67.00 $43.55 $67.00 $22.07 $38.86 $67.00 $40.20 $22.07 $67.00 $22.07 40.24 23.17 98968 EAP CPT® 98968 NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN BOTH IP/OP $95.00 $70.50 $31.18 $95.00 $95.00 $95.00 $95.00 $95.00 $32.04 $32.04 $37.85 $95.00 $32.04 $95.00 $95.00 $95.00 $95.00 $95.00 $51.26 $38.00 $95.00 $32.04 $31.18 $32.04 $95.00 $71.25 $32.04 $32.04 $32.04 $95.00 $95.00 $95.00 $32.04 $95.00 $61.75 $95.00 $32.04 $55.10 $95.00 $57.00 $32.04 $95.00 $32.04 60.38 33.64 99173 EAP CPT® 99173 "VISUAL SCREENING TEST, BILAT" BOTH IP/OP $11.00 $8.50 $3.10 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $3.10 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 5.03 N/A 99202 EAP CPT® 99202 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $204.00 $151.00 $42.52 $323.29 $204.00 $204.00 $204.00 $204.00 $49.16 $49.16 $204.00 $67.13 $49.16 $311.31 $311.31 $323.29 $218.52 $42.52 $78.66 $77.02 $120.67 $49.16 $48.14 $49.16 $204.00 $153.00 $49.16 $49.16 $49.16 $102.00 $102.00 $161.57 $49.16 $163.20 $204.00 $108.54 $49.16 $118.32 $204.00 $51.57 $49.16 $99.97 $49.16 87.1 51.62 99203 EAP CPT® 99203 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $314.00 $232.50 $65.44 $323.29 $314.00 $314.00 $314.00 $314.00 $83.83 $83.83 $314.00 $67.13 $83.83 $311.31 $311.31 $323.29 $218.52 $65.44 $134.13 $132.91 $185.73 $83.83 $83.07 $83.83 $314.00 $235.50 $83.83 $83.83 $83.83 $157.00 $157.00 $248.69 $83.83 $251.20 $314.00 $108.54 $83.83 $182.12 $314.00 $77.17 $83.83 $99.97 $83.83 132.99 88.02 99204 EAP CPT® 99204 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $467.00 $346.00 $67.13 $467.00 $467.00 $467.00 $467.00 $467.00 $135.82 $135.82 $467.00 $67.13 $135.82 $311.31 $311.31 $323.29 $218.52 $97.33 $217.31 $213.71 $276.23 $135.82 $133.57 $135.82 $467.00 $350.25 $135.82 $135.82 $135.82 $233.50 $233.50 $369.86 $135.82 $373.60 $467.00 $108.54 $135.82 $270.86 $467.00 $131.98 $135.82 $99.97 $135.82 225.04 142.61 99205 EAP CPT® 99205 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $618.00 $457.50 $67.13 $618.00 $618.00 $618.00 $618.00 $618.00 $184.32 $184.32 $618.00 $67.13 $184.32 $311.31 $311.31 $323.29 $218.52 $128.80 $294.91 $290.18 $365.55 $184.32 $181.36 $184.32 $618.00 $463.50 $184.32 $184.32 $184.32 $309.00 $309.00 $489.46 $184.32 $494.40 $618.00 $108.54 $184.32 $358.44 $618.00 $172.37 $184.32 $99.97 $184.32 292.47 193.54 99211 EAP CPT® 99211 OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP BOTH IP/OP $65.00 $48.50 $8.81 $323.29 $65.00 $65.00 $65.00 $65.00 $8.96 $8.96 $65.00 $67.13 $8.96 $311.31 $311.31 $323.29 $218.52 $13.55 $14.34 $14.10 $38.45 $8.96 $8.81 $8.96 $65.00 $48.75 $8.96 $8.96 $8.96 $32.50 $32.50 $51.48 $8.96 $52.00 $65.00 $65.00 $8.96 $37.70 $65.00 $9.38 $8.96 $99.97 $8.96 15.96 9.41 99212 EAP CPT® 99212 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $159.00 $118.00 $26.32 $323.29 $159.00 $159.00 $159.00 $159.00 $36.43 $36.43 $159.00 $67.13 $36.43 $311.31 $311.31 $323.29 $218.52 $33.14 $58.29 $56.94 $94.05 $36.43 $35.59 $36.43 $159.00 $119.25 $36.43 $36.43 $36.43 $79.50 $79.50 $125.93 $36.43 $127.20 $159.00 $108.54 $36.43 $92.22 $159.00 $26.32 $36.43 $99.97 $36.43 43.54 38.25 99213 EAP CPT® 99213 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $254.00 $188.00 $52.29 $323.29 $254.00 $254.00 $254.00 $254.00 $67.11 $67.11 $254.00 $67.13 $67.11 $311.31 $311.31 $323.29 $218.52 $52.94 $107.38 $105.76 $150.24 $67.11 $66.10 $67.11 $254.00 $190.50 $67.11 $67.11 $67.11 $127.00 $127.00 $201.17 $67.11 $203.20 $254.00 $108.54 $67.11 $147.32 $254.00 $52.29 $67.11 $99.97 $67.11 88.36 70.47 99214 EAP CPT® 99214 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $358.00 $265.00 $67.13 $358.00 $358.00 $358.00 $358.00 $358.00 $98.52 $98.52 $358.00 $67.13 $98.52 $311.31 $311.31 $323.29 $218.52 $74.61 $157.63 $156.19 $211.76 $98.52 $97.62 $98.52 $358.00 $268.50 $98.52 $98.52 $98.52 $179.00 $179.00 $283.54 $98.52 $286.40 $358.00 $108.54 $98.52 $207.64 $358.00 $80.42 $98.52 $99.97 $98.52 135.62 103.45 99215 EAP CPT® 99215 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $505.00 $374.00 $67.13 $505.00 $505.00 $505.00 $505.00 $505.00 $146.29 $146.29 $505.00 $67.13 $146.29 $311.31 $311.31 $323.29 $218.52 $105.25 $234.06 $229.39 $298.71 $146.29 $143.37 $146.29 $505.00 $378.75 $146.29 $146.29 $146.29 $252.50 $252.50 $399.96 $146.29 $404.00 $505.00 $108.54 $146.29 $292.90 $505.00 $113.60 $146.29 $99.97 $146.29 192.06 153.6 99381 EAP CPT® 99381 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $395.00 $292.50 $76.64 $395.00 $395.00 $395.00 $395.00 $395.00 $395.00 $395.00 $76.64 $395.00 $395.00 $395.00 $395.00 $395.00 $395.00 $395.00 $395.00 $158.00 $395.00 $395.00 $395.00 $395.00 $395.00 $296.25 $395.00 $395.00 $395.00 $395.00 $395.00 $395.00 $395.00 $395.00 $256.75 $395.00 $395.00 $229.10 $395.00 $237.00 $395.00 $395.00 $395.00 132.57 N/A 99382 EAP CPT® 99382 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $413.00 $306.00 $81.52 $413.00 $413.00 $413.00 $413.00 $413.00 $413.00 $413.00 $81.52 $413.00 $413.00 $413.00 $413.00 $413.00 $413.00 $413.00 $413.00 $165.20 $413.00 $413.00 $413.00 $413.00 $413.00 $309.75 $413.00 $413.00 $413.00 $413.00 $413.00 $413.00 $413.00 $413.00 $268.45 $413.00 $413.00 $239.54 $413.00 $247.80 $413.00 $413.00 $413.00 141.19 N/A 99383 EAP CPT® 99383 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $429.00 $317.50 $86.72 $429.00 $429.00 $429.00 $429.00 $429.00 $429.00 $429.00 $86.72 $429.00 $429.00 $429.00 $429.00 $429.00 $429.00 $429.00 $429.00 $171.60 $429.00 $429.00 $429.00 $429.00 $429.00 $321.75 $429.00 $429.00 $429.00 $429.00 $429.00 $429.00 $429.00 $429.00 $278.85 $429.00 $429.00 $248.82 $429.00 $257.40 $429.00 $429.00 $429.00 150.39 N/A 99384 EAP CPT® 99384 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $485.00 $359.00 $101.65 $485.00 $485.00 $485.00 $485.00 $485.00 $485.00 $485.00 $101.65 $485.00 $485.00 $485.00 $485.00 $485.00 $485.00 $485.00 $485.00 $194.00 $485.00 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $485.00 $485.00 $485.00 $485.00 $485.00 $315.25 $485.00 $485.00 $281.30 $485.00 $291.00 $485.00 $485.00 $485.00 176.77 N/A 99385 EAP CPT® 99385 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $469.00 $347.50 $97.50 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $97.50 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 169.42 N/A 99386 EAP CPT® 99386 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $545.00 $403.50 $118.64 $545.00 $545.00 $545.00 $545.00 $545.00 $545.00 $545.00 $118.64 $545.00 $545.00 $545.00 $545.00 $545.00 $545.00 $545.00 $545.00 $218.00 $545.00 $545.00 $545.00 $545.00 $545.00 $408.75 $545.00 $545.00 $545.00 $545.00 $545.00 $545.00 $545.00 $545.00 $354.25 $545.00 $545.00 $316.10 $545.00 $327.00 $545.00 $545.00 $545.00 206.23 N/A 99387 EAP CPT® 99387 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $591.00 $437.50 $127.64 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $127.64 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $236.40 $591.00 $591.00 $591.00 $591.00 $591.00 $443.25 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $384.15 $591.00 $591.00 $342.78 $591.00 $354.60 $591.00 $591.00 $591.00 221.59 N/A 99391 EAP CPT® 99391 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $354.00 $262.00 $69.73 $354.00 $354.00 $354.00 $354.00 $354.00 $354.00 $354.00 $69.73 $354.00 $354.00 $354.00 $354.00 $354.00 $354.00 $354.00 $354.00 $141.60 $354.00 $354.00 $354.00 $354.00 $354.00 $265.50 $354.00 $354.00 $354.00 $354.00 $354.00 $354.00 $354.00 $354.00 $230.10 $354.00 $354.00 $205.32 $354.00 $212.40 $354.00 $354.00 $354.00 120.93 N/A 99392 EAP CPT® 99392 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $378.00 $280.00 $76.64 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $76.64 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $151.20 $378.00 $378.00 $378.00 $378.00 $378.00 $283.50 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $245.70 $378.00 $378.00 $219.24 $378.00 $226.80 $378.00 $378.00 $378.00 132.57 N/A 99393 EAP CPT® 99393 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $377.00 $279.00 $76.64 $377.00 $377.00 $377.00 $377.00 $377.00 $377.00 $377.00 $76.64 $377.00 $377.00 $377.00 $377.00 $377.00 $377.00 $377.00 $377.00 $150.80 $377.00 $377.00 $377.00 $377.00 $377.00 $282.75 $377.00 $377.00 $377.00 $377.00 $377.00 $377.00 $377.00 $377.00 $245.05 $377.00 $377.00 $218.66 $377.00 $226.20 $377.00 $377.00 $377.00 132.57 N/A 99394 EAP CPT® 99394 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $414.00 $306.50 $86.72 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $86.72 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $165.60 $414.00 $414.00 $414.00 $414.00 $414.00 $310.50 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $269.10 $414.00 $414.00 $240.12 $414.00 $248.40 $414.00 $414.00 $414.00 150.39 N/A 99395 EAP CPT® 99395 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $423.00 $313.50 $89.16 $423.00 $423.00 $423.00 $423.00 $423.00 $423.00 $423.00 $89.16 $423.00 $423.00 $423.00 $423.00 $423.00 $423.00 $423.00 $423.00 $169.20 $423.00 $423.00 $423.00 $423.00 $423.00 $317.25 $423.00 $423.00 $423.00 $423.00 $423.00 $423.00 $423.00 $423.00 $274.95 $423.00 $423.00 $245.34 $423.00 $253.80 $423.00 $423.00 $423.00 154.7 N/A 99396 EAP CPT® 99396 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $450.00 $333.00 $96.80 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $96.80 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $180.00 $450.00 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $292.50 $450.00 $450.00 $261.00 $450.00 $270.00 $450.00 $450.00 $450.00 168.19 N/A 99397 EAP CPT® 99397 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $486.00 $360.00 $101.65 $486.00 $486.00 $486.00 $486.00 $486.00 $486.00 $486.00 $101.65 $486.00 $486.00 $486.00 $486.00 $486.00 $486.00 $486.00 $486.00 $194.40 $486.00 $486.00 $486.00 $486.00 $486.00 $364.50 $486.00 $486.00 $486.00 $486.00 $486.00 $486.00 $486.00 $486.00 $315.90 $486.00 $486.00 $281.88 $486.00 $291.60 $486.00 $486.00 $486.00 176.77 N/A 99406 EAP CPT® 99406 PR ALCOHOL & DRUG ABUSE TRMT BOTH IP/OP $43.00 $32.00 $11.87 $43.00 $43.00 $43.00 $43.00 $43.00 $25.85 $25.85 $25.74 $43.00 $25.85 $43.00 $43.00 $43.00 $43.00 $43.00 $41.36 $42.82 $43.00 $25.85 $11.87 $25.85 $27.14 $32.25 $25.85 $25.85 $25.85 $43.00 $43.00 $43.00 $25.85 $43.00 $27.95 $43.00 $25.85 $24.94 $27.14 $37.40 $25.85 $43.00 $25.85 21.46 12.64 99441 EAP CPT® 99441 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $157.00 $116.50 $34.91 $157.00 $157.00 $157.00 $157.00 $157.00 $35.80 $35.80 $36.10 $157.00 $35.80 $157.00 $157.00 $157.00 $157.00 $157.00 $57.28 $62.80 $157.00 $35.80 $34.91 $35.80 $157.00 $117.75 $35.80 $35.80 $35.80 $157.00 $157.00 $157.00 $35.80 $157.00 $102.05 $157.00 $35.80 $91.06 $157.00 $94.20 $35.80 $157.00 $35.80 22.11 37.59 99442 EAP CPT® 99442 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $253.00 $187.50 $66.10 $253.00 $253.00 $253.00 $253.00 $253.00 $66.80 $66.80 $67.98 $253.00 $66.80 $253.00 $253.00 $253.00 $253.00 $253.00 $106.88 $101.20 $253.00 $66.80 $66.10 $66.80 $253.00 $189.75 $66.80 $66.80 $66.80 $253.00 $253.00 $253.00 $66.80 $253.00 $164.45 $253.00 $66.80 $146.74 $253.00 $151.80 $66.80 $253.00 $66.80 44.19 70.14 99443 EAP CPT® 99443 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $358.00 $265.00 $96.93 $358.00 $358.00 $358.00 $358.00 $358.00 $98.52 $98.52 $100.28 $358.00 $98.52 $358.00 $358.00 $358.00 $358.00 $358.00 $157.63 $143.20 $358.00 $98.52 $96.93 $98.52 $358.00 $268.50 $98.52 $98.52 $98.52 $358.00 $358.00 $358.00 $98.52 $358.00 $232.70 $358.00 $98.52 $207.64 $358.00 $214.80 $98.52 $358.00 $98.52 66.31 103.45 99495 EAP CPT® 99495 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $576.00 $426.50 $67.13 $576.00 $576.00 $576.00 $576.00 $576.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $120.04 $187.01 $174.36 $340.70 $116.88 $139.97 $116.88 $122.72 $432.00 $116.88 $116.88 $116.88 $288.00 $288.00 $456.19 $116.88 $460.80 $576.00 $114.32 $116.88 $334.08 $122.72 $169.10 $116.88 $120.04 $116.88 190.91 151.14 99496 EAP CPT® 99496 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $777.00 $575.00 $67.13 $777.00 $777.00 $777.00 $777.00 $777.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $161.94 $187.01 $174.36 $459.60 $116.88 $190.81 $116.88 $122.72 $582.75 $116.88 $116.88 $116.88 $388.50 $388.50 $615.38 $116.88 $621.60 $777.00 $154.22 $116.88 $450.66 $122.72 $169.10 $116.88 $161.93 $116.88 276.21 204.71 99497 EAP CPT® 99497 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $236.00 $175.00 $46.84 $323.29 $236.00 $236.00 $236.00 $236.00 $73.60 $73.60 $73.28 $67.13 $73.60 $311.31 $311.31 $323.29 $218.52 $49.18 $117.77 $109.43 $139.59 $73.60 $75.58 $73.60 $77.28 $177.00 $73.60 $73.60 $73.60 $118.00 $118.00 $186.91 $73.60 $188.80 $236.00 $46.84 $73.60 $136.88 $77.28 $106.49 $73.60 $49.18 $73.60 136.24 81.36 99498 EAP CPT® 99498 PR EVALUATION AND MANAGEMENT SERVICES BOTH IP/OP $204.00 $151.00 #N/A #N/A $204.00 $204.00 $204.00 $204.00 $204.00 $204.00 $204.00 $67.13 $204.00 $311.31 $311.31 $323.29 $218.52 $42.52 $204.00 $204.00 $120.67 $204.00 $71.51 $204.00 $204.00 $153.00 $204.00 $204.00 $204.00 $102.00 $102.00 $161.57 $204.00 $163.20 $204.00 $40.49 #N/A $118.32 $204.00 $204.00 $204.00 $42.51 $204.00 127.63 76.67 10104150 EAP RESUSCITATOR MANUAL MEDIUM 10F BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 10933166 EAP HCPCS A4338 CATHETER URETHRAL 12FR 2 WAY 1 BOTH IP/OP $25.00 $18.50 $5.21 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $8.88 $25.00 $25.00 $18.56 $18.56 $19.27 $13.03 $5.21 $25.00 $10.00 $25.00 $25.00 $25.00 $25.00 $25.00 $18.75 $25.00 $25.00 $25.00 $12.50 $12.50 $19.80 $25.00 $20.00 $16.25 $25.00 $25.00 $14.50 $25.00 $15.00 $25.00 $25.00 $25.00 N/A N/A 10945194 EAP HCPCS C1729 SYSTEM DRN 35CM 700ML BLU STRL LF BE2 MNTR TRNDCR ATCH VNTRC BOTH IP/OP $742.00 $549.50 $147.27 $742.00 $402.91 $402.91 $402.91 $402.91 $742.00 $742.00 $742.00 $154.65 $742.00 $550.71 $550.71 $571.93 $386.58 $154.64 $742.00 $742.00 $438.89 $742.00 $742.00 $742.00 $742.00 $556.50 $742.00 $742.00 $742.00 $371.00 $371.00 $587.66 $742.00 $593.60 $482.30 $147.27 $742.00 $430.36 $742.00 $742.00 $742.00 $154.63 $742.00 N/A N/A 10961170 EAP HCPCS C1751 KIT ARTERIAL LINE .018IN 20GA 22GA 1.75IN CATHETER RADIOPQ BOTH IP/OP $38.00 $28.50 $7.54 $38.00 $20.63 $20.63 $20.63 $20.63 $38.00 $38.00 $38.00 $7.92 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $38.00 $22.48 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $7.54 $38.00 $22.04 $38.00 $38.00 $38.00 $7.92 $38.00 N/A N/A 11100001 EAP Custom 11100001 HB MED-SUR-GY/PVT BOTH IP/OP "$3,058.00" "$2,263.00" "$1,773.64" "$2,293.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,293.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,773.64" N/A N/A N/A N/A N/A N/A N/A 11100003 EAP Custom 11100003 TELE PRIVATE MED SURG BOTH IP/OP "$3,378.00" "$2,500.00" "$1,959.24" "$2,533.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,533.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,959.24" N/A N/A N/A N/A N/A N/A N/A 11100021 EAP Custom 11100021 HB PVT GYN BOTH IP/OP "$3,058.00" "$2,263.00" "$1,773.64" "$2,293.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,293.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,773.64" N/A N/A N/A N/A N/A N/A N/A 11100023 EAP Custom 11100023 TELE PRIVATE GYN BOTH IP/OP "$3,378.00" "$2,500.00" "$1,959.24" "$2,533.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,533.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,959.24" N/A N/A N/A N/A N/A N/A N/A 11100501 EAP Custom 11100501 TRAUMA PRIVATE MED SURG BOTH IP/OP "$3,398.00" "$2,515.00" "$1,970.84" "$2,548.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,548.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,970.84" N/A N/A N/A N/A N/A N/A N/A 11100503 EAP Custom 11100503 TRAUMA TELE PRIVATE MED SURG BOTH IP/OP "$3,718.00" "$2,751.50" "$2,156.44" "$2,788.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,788.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,156.44" N/A N/A N/A N/A N/A N/A N/A 11100521 EAP Custom 11100521 TRAUMA PRIVATE GYN BOTH IP/OP "$3,398.00" "$2,515.00" "$1,970.84" "$2,548.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,548.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,970.84" N/A N/A N/A N/A N/A N/A N/A 11100523 EAP Custom 11100523 TRAUMA TELE PRIVATE GYN BOTH IP/OP "$3,718.00" "$2,751.50" "$2,156.44" "$2,788.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,788.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,156.44" N/A N/A N/A N/A N/A N/A N/A 11200001 EAP Custom 11200001 PRIVATE OB BOTH IP/OP "$3,218.00" "$2,381.50" "$1,866.44" "$2,413.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,413.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,866.44" N/A N/A N/A N/A N/A N/A N/A 11200002 EAP Custom 11200002 TELE PRIVATE OB BOTH IP/OP "$3,533.00" "$2,614.50" "$2,049.14" "$2,649.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,649.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,049.14" N/A N/A N/A N/A N/A N/A N/A 11200501 EAP Custom 11200501 TRAUMA PRIVATE OB BOTH IP/OP "$3,559.00" "$2,634.00" "$2,064.22" "$2,669.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,669.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,064.22" N/A N/A N/A N/A N/A N/A N/A 11200502 EAP Custom 11200502 TRAUMA TELE PRIVATE OB BOTH IP/OP "$3,873.00" "$2,866.50" "$2,246.34" "$2,904.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,904.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,246.34" N/A N/A N/A N/A N/A N/A N/A 11400002 EAP Custom 11400002 PRIVATE PSY BOTH IP/OP "$2,837.00" "$2,099.50" "$1,645.46" "$2,127.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,127.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,645.46" N/A N/A N/A N/A N/A N/A N/A 11400502 EAP Custom 11400502 TRAUMA PRIVATE PSY BOTH IP/OP "$3,177.00" "$2,351.00" "$1,842.66" "$2,382.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,382.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,842.66" N/A N/A N/A N/A N/A N/A N/A 11500001 EAP Custom 11500001 INPATIENT HOSPICE BOTH IP/OP "$3,065.00" "$2,268.50" "$1,777.70" "$2,298.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,298.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,777.70" N/A N/A N/A N/A N/A N/A N/A 11500501 EAP Custom 11500501 TRAUMA INPATIENT HOSPICE BOTH IP/OP "$3,176.00" "$2,350.50" "$1,842.08" "$2,382.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,382.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,842.08" N/A N/A N/A N/A N/A N/A N/A 12100001 EAP Custom 12100001 SEMIPRIVATE MEDSURG BOTH IP/OP "$2,166.00" "$1,603.00" "$1,256.28" "$1,624.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,624.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,256.28" N/A N/A N/A N/A N/A N/A N/A 12100003 EAP Custom 12100003 TELE SEMIPRIVATE BOTH IP/OP "$2,550.00" "$1,887.00" "$1,479.00" "$1,912.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,912.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,479.00" N/A N/A N/A N/A N/A N/A N/A 12100021 EAP Custom 12100021 SEMIPRIVATE GYN BOTH IP/OP "$2,166.00" "$1,603.00" "$1,256.28" "$1,624.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,624.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,256.28" N/A N/A N/A N/A N/A N/A N/A 12100023 EAP Custom 12100023 TELE SEMIPRIVATE GYN BOTH IP/OP "$2,550.00" "$1,887.00" "$1,479.00" "$1,912.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,912.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,479.00" N/A N/A N/A N/A N/A N/A N/A 12100501 EAP Custom 12100501 TRAUMA SEMIPRIVATE MEDSURG BOTH IP/OP "$2,507.00" "$1,855.50" "$1,454.06" "$1,880.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,880.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,454.06" N/A N/A N/A N/A N/A N/A N/A 12100503 EAP Custom 12100503 TRAUMA TELE SEMIPRIVATE BOTH IP/OP "$2,890.00" "$2,139.00" "$1,676.20" "$2,167.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,167.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,676.20" N/A N/A N/A N/A N/A N/A N/A 12100521 EAP Custom 12100521 TRAUMA SEMIPRIVATE GYN BOTH IP/OP "$2,507.00" "$1,855.50" "$1,454.06" "$1,880.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,880.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,454.06" N/A N/A N/A N/A N/A N/A N/A 12100523 EAP Custom 12100523 TRAUMA TELE SEMIPRIVATE GYN BOTH IP/OP "$2,890.00" "$2,139.00" "$1,676.20" "$2,167.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,167.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,676.20" N/A N/A N/A N/A N/A N/A N/A 12200001 EAP Custom 12200001 SEMIPRIVATE OB BOTH IP/OP "$2,359.00" "$1,746.00" "$1,368.22" "$1,769.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,769.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,368.22" N/A N/A N/A N/A N/A N/A N/A 12200002 EAP Custom 12200002 TELE SEMIPRIVATE OB BOTH IP/OP "$2,391.00" "$1,769.50" "$1,386.78" "$1,793.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,793.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,386.78" N/A N/A N/A N/A N/A N/A N/A 12200501 EAP Custom 12200501 TRAUMA SEMIPRIVATE OB BOTH IP/OP "$2,700.00" "$1,998.00" "$1,566.00" "$2,025.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,025.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,566.00" N/A N/A N/A N/A N/A N/A N/A 12200502 EAP Custom 12200502 TRAUMA TELE SEMIPRIVATE OB BOTH IP/OP "$2,732.00" "$2,022.00" "$1,584.56" "$2,049.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,049.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,584.56" N/A N/A N/A N/A N/A N/A N/A 12400002 EAP Custom 12400002 SEMIPRIVATE PSYCH BOTH IP/OP "$2,625.00" "$1,942.50" "$1,522.50" "$1,968.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,968.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,522.50" N/A N/A N/A N/A N/A N/A N/A 12400502 EAP Custom 12400502 TRAUMA SEMIPRIVATE PSYCH BOTH IP/OP "$2,966.00" "$2,195.00" "$1,720.28" "$2,224.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,224.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,720.28" N/A N/A N/A N/A N/A N/A N/A 16400001 EAP Custom 16400001 TELE.ISOLATION BOTH IP/OP "$3,488.00" "$2,581.50" "$2,023.04" "$2,616.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,616.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,023.04" N/A N/A N/A N/A N/A N/A N/A 16400002 EAP Custom 16400002 ISOLATION MED SURG BOTH IP/OP "$3,362.00" "$2,488.00" "$1,949.96" "$2,521.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,521.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,949.96" N/A N/A N/A N/A N/A N/A N/A 16400004 EAP Custom 16400004 ISOLATION MED SURG BOTH IP/OP "$3,362.00" "$2,488.00" "$1,949.96" "$2,521.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,521.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,949.96" N/A N/A N/A N/A N/A N/A N/A 16400005 EAP Custom 16400005 ISOLATION OB BOTH IP/OP "$3,563.00" "$2,637.00" "$2,066.54" "$2,672.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,672.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,066.54" N/A N/A N/A N/A N/A N/A N/A 16400006 EAP Custom 16400006 TELE.ISOLATION OB BOTH IP/OP "$3,581.00" "$2,650.00" "$2,076.98" "$2,685.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,685.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,076.98" N/A N/A N/A N/A N/A N/A N/A 16400007 EAP Custom 16400007 ISOLATION HIGH-RISK SCU BOTH IP/OP "$3,953.00" "$2,925.50" "$2,292.74" "$2,964.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,964.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,292.74" N/A N/A N/A N/A N/A N/A N/A 16400022 EAP Custom 16400022 ISOLATION GYN BOTH IP/OP "$3,362.00" "$2,488.00" "$1,949.96" "$2,521.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,521.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,949.96" N/A N/A N/A N/A N/A N/A N/A 16400501 EAP Custom 16400501 TRAUMA TELE.ISOLATION BOTH IP/OP "$3,828.00" "$2,833.00" "$2,220.24" "$2,871.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,871.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,220.24" N/A N/A N/A N/A N/A N/A N/A 16400502 EAP Custom 16400502 TRAUMA ISOLATION MED SURG BOTH IP/OP "$3,702.00" "$2,739.50" "$2,147.16" "$2,776.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,776.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,147.16" N/A N/A N/A N/A N/A N/A N/A 16400504 EAP Custom 16400504 TRAUMA ISOLATION MED SURG BOTH IP/OP "$3,702.00" "$2,739.50" "$2,147.16" "$2,776.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,776.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,147.16" N/A N/A N/A N/A N/A N/A N/A 16400505 EAP Custom 16400505 TRAUMA ISOLATION OB BOTH IP/OP "$3,904.00" "$2,889.00" "$2,264.32" "$2,928.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,928.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,264.32" N/A N/A N/A N/A N/A N/A N/A 16400506 EAP TRAUMA TELE.ISOLATION OB BOTH IP/OP "$3,457.00" "$2,558.50" "$2,005.06" "$2,592.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,592.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,005.06" N/A N/A N/A N/A N/A N/A N/A 16400507 EAP Custom 16400507 TRAUMA ISOLATION HIGH-RISK SCU BOTH IP/OP "$4,293.00" "$3,177.00" "$2,489.94" "$3,219.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,219.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,489.94" N/A N/A N/A N/A N/A N/A N/A 16400522 EAP Custom 16400522 TRAUMA ISOLATION GYN BOTH IP/OP "$3,702.00" "$2,739.50" "$2,147.16" "$2,776.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,776.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,147.16" N/A N/A N/A N/A N/A N/A N/A 17000001 EAP Custom 17000001 GENERAL NURSERY BOTH IP/OP $849.00 $628.50 $492.42 $636.75 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $636.75 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $492.42 N/A N/A N/A N/A N/A N/A N/A 17100001 EAP Custom 17100001 NURSERY/LEVEL I BOTH IP/OP "$1,331.00" $985.00 $771.98 $998.25 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $998.25 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $771.98 N/A N/A N/A N/A N/A N/A N/A 17100002 EAP Custom 17100002 NURSERY LEVEL I BOTH IP/OP "$1,331.00" $985.00 $771.98 $998.25 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $998.25 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $771.98 N/A N/A N/A N/A N/A N/A N/A 17200002 EAP Custom 17200002 NURSERY LEVEL II BOTH IP/OP "$3,458.00" "$2,559.00" "$2,005.64" "$2,593.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,593.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,005.64" N/A N/A N/A N/A N/A N/A N/A 17300001 EAP Custom 17300001 NURSERY LEVEL III BOTH IP/OP "$5,760.00" "$4,262.50" "$3,340.80" "$4,320.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,320.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,340.80" N/A N/A N/A N/A N/A N/A N/A 17400001 EAP Custom 17400001 NURSERY/LEVEL IV BOTH IP/OP "$6,717.00" "$4,971.00" "$3,895.86" "$5,037.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,037.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,895.86" N/A N/A N/A N/A N/A N/A N/A 18000010 EAP Custom 18000010 LEAVE OF ABSENCE BOTH IP/OP $0.01 $0.50 $0.01 $0.01 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $0.01 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $0.01 N/A N/A N/A N/A N/A N/A N/A 19818886 EAP HCPCS A6197 DRESSING HYDROFIBER AQUACEL 0.75IN X 18IN SILVER BOTH IP/OP $30.00 $22.50 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 $30.00 $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A 19818887 EAP HCPCS A6197 DRESSING WOUND SQUARE 6X6IN 2 LAYER ABSORBENT NONWOVEN SOFT BOTH IP/OP $55.00 $41.00 $10.92 $55.00 $29.87 $29.87 $29.87 $29.87 $55.00 $55.00 $55.00 $11.46 $55.00 $40.82 $40.82 $42.39 $28.66 $11.46 $55.00 $55.00 $32.53 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $35.75 $10.92 $55.00 $31.90 $55.00 $55.00 $55.00 $11.46 $55.00 N/A N/A 19862990 EAP TRACHEOSTOMY TRAY BOTH IP/OP $279.00 $206.50 $49.66 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $49.66 $279.00 $279.00 $207.07 $207.07 $215.05 $145.36 $58.15 $279.00 $111.60 $279.00 $279.00 $279.00 $279.00 $279.00 $209.25 $279.00 $279.00 $279.00 $139.50 $139.50 $220.97 $279.00 $223.20 $181.35 $279.00 $279.00 $161.82 $279.00 $167.40 $279.00 $279.00 $279.00 N/A N/A 19935012 EAP HCPCS A6209 KIT DRESSING THK3.3CM LARGE STANDARD 26X15CM 2 ADHESIVE BOTH IP/OP $123.00 $91.50 $24.41 $123.00 $66.79 $66.79 $66.79 $66.79 $123.00 $123.00 $123.00 $25.64 $123.00 $91.29 $91.29 $94.81 $64.08 $25.63 $123.00 $123.00 $72.75 $123.00 $123.00 $123.00 $123.00 $92.25 $123.00 $123.00 $123.00 $61.50 $61.50 $97.42 $123.00 $98.40 $79.95 $24.41 $123.00 $71.34 $123.00 $123.00 $123.00 $25.63 $123.00 N/A N/A 19988898 EAP Custom 19988898 CATHETER PRESSURE 3.5MM 5MM 82CM 2CM SENSOR TIP EXTERNAL BOTH IP/OP $58.00 $43.00 $10.32 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $10.32 $58.00 $58.00 $43.05 $43.05 $44.71 $30.22 $12.09 $58.00 $23.20 $58.00 $58.00 $58.00 $58.00 $58.00 $43.50 $58.00 $58.00 $58.00 $29.00 $29.00 $45.94 $58.00 $46.40 $37.70 $58.00 $58.00 $33.64 $58.00 $34.80 $58.00 $58.00 $58.00 N/A N/A 19993849 EAP HCPCS C1751 KIT ARTERIAL LINE .018IN 20GA 22GA 1.75IN CATHETER RADIOPQ BOTH IP/OP $29.00 $21.50 $5.76 $29.00 $15.75 $15.75 $15.75 $15.75 $29.00 $29.00 $29.00 $6.04 $29.00 $21.52 $21.52 $22.35 $15.11 $6.04 $29.00 $29.00 $17.15 $29.00 $29.00 $29.00 $29.00 $21.75 $29.00 $29.00 $29.00 $14.50 $14.50 $22.97 $29.00 $23.20 $18.85 $5.76 $29.00 $16.82 $29.00 $29.00 $29.00 $6.04 $29.00 N/A N/A 19993898 EAP HCPCS C1729 TRAY CATHETERIZATION 16FR FOLEY ANTIREFLUX EVIDENT SEAL BOTH IP/OP $26.00 $19.50 $5.16 $26.00 $14.12 $14.12 $14.12 $14.12 $26.00 $26.00 $26.00 $5.42 $26.00 $19.30 $19.30 $20.04 $13.55 $5.42 $26.00 $26.00 $15.38 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $16.90 $5.16 $26.00 $15.08 $26.00 $26.00 $26.00 $5.42 $26.00 N/A N/A 19994800 EAP KIT CRNTMY 25GA 5/8IN STRL RZR NDL DRP BOTH IP/OP $701.00 $519.00 $124.78 $701.00 $701.00 $701.00 $701.00 $701.00 $701.00 $701.00 $124.78 $701.00 $701.00 $520.28 $520.28 $540.33 $365.22 $146.10 $701.00 $280.40 $701.00 $701.00 $701.00 $701.00 $701.00 $525.75 $701.00 $701.00 $701.00 $350.50 $350.50 $555.19 $701.00 $560.80 $455.65 $701.00 $701.00 $406.58 $701.00 $420.60 $701.00 $701.00 $701.00 N/A N/A 19996917 EAP HCPCS C1729 KIT THORACENTESIS 8FR 22GA 7.5IN 1.5IN 3 WAY STOPCOCK BOTH IP/OP $134.00 $99.50 $26.60 $134.00 $72.76 $72.76 $72.76 $72.76 $134.00 $134.00 $134.00 $27.93 $134.00 $99.45 $99.45 $103.29 $69.81 $27.93 $134.00 $134.00 $79.26 $134.00 $134.00 $134.00 $134.00 $100.50 $134.00 $134.00 $134.00 $67.00 $67.00 $106.13 $134.00 $107.20 $87.10 $26.60 $134.00 $77.72 $134.00 $134.00 $134.00 $27.93 $134.00 N/A N/A 20000001 EAP Custom 20000001 INTENSIVE CARE ICU OB BOTH IP/OP "$6,502.00" "$4,811.50" "$3,771.16" "$4,876.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,876.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,771.16" N/A N/A N/A N/A N/A N/A N/A 20000501 EAP Custom 20000501 TRAUMA INTENSIVE CARE ICU OB BOTH IP/OP "$6,842.00" "$5,063.50" "$3,968.36" "$5,131.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,131.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,968.36" N/A N/A N/A N/A N/A N/A N/A 20100001 EAP Custom 20100001 INTENSIVE CARE ICU SURGICAL BOTH IP/OP "$6,502.00" "$4,811.50" "$3,771.16" "$4,876.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,876.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,771.16" N/A N/A N/A N/A N/A N/A N/A 20100501 EAP Custom 20100501 TRAUMA INTENSIVE CARE ICU SURGICAL BOTH IP/OP "$6,875.00" "$5,087.50" "$3,987.50" "$5,156.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,156.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,987.50" N/A N/A N/A N/A N/A N/A N/A 20200001 EAP Custom 20200001 INTENSIVE CARE ICU MEDICAL BOTH IP/OP "$6,502.00" "$4,811.50" "$3,771.16" "$4,876.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,876.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,771.16" N/A N/A N/A N/A N/A N/A N/A 20200501 EAP Custom 20200501 TRAUMA INTENSIVE CARE ICU MEDICAL BOTH IP/OP "$6,875.00" "$5,087.50" "$3,987.50" "$5,156.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,156.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,987.50" N/A N/A N/A N/A N/A N/A N/A 20600001 EAP Custom 20600001 INTERMEDIATE CARE BOTH IP/OP "$4,007.00" "$2,965.50" "$2,324.06" "$3,005.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,005.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,324.06" N/A N/A N/A N/A N/A N/A N/A 20600002 EAP Custom 20600002 INTERMEDIATE CARE BURN BOTH IP/OP "$9,266.00" "$6,857.00" "$5,374.28" "$6,949.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,949.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,374.28" N/A N/A N/A N/A N/A N/A N/A 20600005 EAP Custom 20600005 INTERMEDIATE CARE BOTH IP/OP "$4,007.00" "$2,965.50" "$2,324.06" "$3,005.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,005.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,324.06" N/A N/A N/A N/A N/A N/A N/A 20600501 EAP Custom 20600501 TRAUMA INTERMEDIATE CARE BOTH IP/OP "$4,708.00" "$3,484.00" "$2,730.64" "$3,531.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,531.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,730.64" N/A N/A N/A N/A N/A N/A N/A 20600502 EAP Custom 20600502 TRAUMA INTERMEDIATE CARE BURN BOTH IP/OP "$9,580.00" "$7,089.50" "$5,556.40" "$7,185.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,185.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,556.40" N/A N/A N/A N/A N/A N/A N/A 20700001 EAP Custom 20700001 INTENSIVE CARE ICU BURN BOTH IP/OP "$10,118.00" "$7,487.50" "$5,868.44" "$7,588.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,588.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,868.44" N/A N/A N/A N/A N/A N/A N/A 20700501 EAP Custom 20700501 TRAUMA INTENSIVE CARE ICU BURN BOTH IP/OP "$10,421.00" "$7,712.00" "$6,044.18" "$7,815.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,815.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,044.18" N/A N/A N/A N/A N/A N/A N/A 21000001 EAP Custom 21000001 INTENSIVE CARE ICU MEDICAL BOTH IP/OP "$6,502.00" "$4,811.50" "$3,771.16" "$4,876.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,876.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,771.16" N/A N/A N/A N/A N/A N/A N/A 21400005 EAP INTERMEDIATE CORONARY CARE UNIT BOTH IP/OP "$4,793.00" "$3,547.00" "$2,779.94" "$3,594.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,594.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,779.94" N/A N/A N/A N/A N/A N/A N/A 21400505 EAP Custom 21400505 TRAUMA INTERMEDIATE CORONARY CARE UNIT BOTH IP/OP "$5,219.00" "$3,862.50" "$3,027.02" "$3,914.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,914.25" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,027.02" N/A N/A N/A N/A N/A N/A N/A 21900001 EAP Custom 21900001 INTERMEDIATE CARE BOTH IP/OP "$3,741.00" "$2,768.50" "$2,169.78" "$2,805.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,805.75" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,169.78" N/A N/A N/A N/A N/A N/A N/A 22900001 EAP HCPCS T2101 BREAST MILK PROC/STORE/DIST BOTH IP/OP $12.00 $9.00 $2.50 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $2.50 $12.00 $4.80 $12.00 $12.00 $12.00 $12.00 $12.00 $9.00 $12.00 $12.00 $12.00 $6.00 $6.00 $9.50 $12.00 $9.60 $7.80 $12.00 $12.00 $6.96 $12.00 $7.20 $12.00 $12.00 $12.00 N/A N/A 25000141 EAP Custom 25000141 TORADOL 30 MG BOTH IP/OP $37.00 $27.50 $6.59 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $6.59 $37.00 $37.00 $27.46 $27.46 $28.52 $19.28 $7.71 $37.00 $14.80 $37.00 $37.00 $37.00 $37.00 $37.00 $27.75 $37.00 $37.00 $37.00 $18.50 $18.50 $29.30 $37.00 $29.60 $24.05 $37.00 $37.00 $21.46 $37.00 $22.20 $37.00 $37.00 $37.00 N/A N/A 25000153 EAP Custom 25000153 "ROCEPHIN 250MG, IM" BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 25000157 EAP Custom 25000157 DEPOPROVERA 150MG BOTH IP/OP $180.00 $133.50 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 $180.00 $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A 25000169 EAP Custom 25000169 VIT B 12 100MCG BOTH IP/OP $46.00 $34.50 $8.19 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $8.19 $46.00 $46.00 $34.14 $34.14 $35.46 $23.97 $9.59 $46.00 $18.40 $46.00 $46.00 $46.00 $46.00 $46.00 $34.50 $46.00 $46.00 $46.00 $23.00 $23.00 $36.43 $46.00 $36.80 $29.90 $46.00 $46.00 $26.68 $46.00 $27.60 $46.00 $46.00 $46.00 N/A N/A 25000182 EAP Custom 25000182 ROCEPHIN INJECTION BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 25000187 EAP Custom 25000187 ROCEPHIN 250MG BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $15.30 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 25000189 EAP Custom 25000189 BICILLIN INJECTION BOTH IP/OP $44.00 $33.00 $7.83 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $7.83 $44.00 $44.00 $32.66 $32.66 $33.92 $22.92 $9.17 $44.00 $17.60 $44.00 $44.00 $44.00 $44.00 $44.00 $33.00 $44.00 $44.00 $44.00 $22.00 $22.00 $34.85 $44.00 $35.20 $28.60 $44.00 $44.00 $25.52 $44.00 $26.40 $44.00 $44.00 $44.00 N/A N/A 25000224 EAP Custom 25000224 ROCEPHIN 250MG (CEF BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 25000226 EAP Custom 25000226 DEPO PROVERA INJECT BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 $171.00 $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 25000229 EAP Custom 25000229 PLAN B BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 25000327 EAP Custom 25000327 ORAL CONTRACEPTIVES BOTH IP/OP $11.00 $8.50 $1.96 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $1.96 $11.00 $11.00 $8.16 $8.16 $8.48 $5.73 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 25000960 EAP Custom 25000960 HETASTARCH (HESPAN) BOTH IP/OP $435.00 $322.00 $77.43 $435.00 $435.00 $435.00 $435.00 $435.00 $435.00 $435.00 $77.43 $435.00 $435.00 $322.86 $322.86 $335.30 $226.64 $90.66 $435.00 $174.00 $435.00 $435.00 $435.00 $435.00 $435.00 $326.25 $435.00 $435.00 $435.00 $217.50 $217.50 $344.52 $435.00 $348.00 $282.75 $435.00 $435.00 $252.30 $435.00 $261.00 $435.00 $435.00 $435.00 N/A N/A 25000961 EAP Custom 25000961 HETASTARCH BOTH IP/OP $435.00 $322.00 $77.43 $435.00 $435.00 $435.00 $435.00 $435.00 $435.00 $435.00 $77.43 $435.00 $435.00 $322.86 $322.86 $335.30 $226.64 $90.66 $435.00 $174.00 $435.00 $435.00 $435.00 $435.00 $435.00 $326.25 $435.00 $435.00 $435.00 $217.50 $217.50 $344.52 $435.00 $348.00 $282.75 $435.00 $435.00 $252.30 $435.00 $261.00 $435.00 $435.00 $435.00 N/A N/A 25000966 EAP Custom 25000966 "ROCEPHIN 250MG, 1GM" BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 25000990 EAP Custom 25000990 NITRIC OXIDE (PER HR) BOTH IP/OP $789.00 $584.00 $140.44 $789.00 $789.00 $789.00 $789.00 $789.00 $789.00 $789.00 $140.44 $789.00 $789.00 $585.60 $585.60 $608.16 $411.07 $164.44 $789.00 $315.60 $789.00 $789.00 $789.00 $789.00 $789.00 $591.75 $789.00 $789.00 $789.00 $394.50 $394.50 $624.89 $789.00 $631.20 $512.85 $789.00 $789.00 $457.62 $789.00 $473.40 $789.00 $789.00 $789.00 N/A N/A 25002130 EAP Custom 25002130 ZITHROMAX BOTH IP/OP $24.00 $18.00 $4.27 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $4.27 $24.00 $24.00 $17.81 $17.81 $18.50 $12.50 $5.00 $24.00 $9.60 $24.00 $24.00 $24.00 $24.00 $24.00 $18.00 $24.00 $24.00 $24.00 $12.00 $12.00 $19.01 $24.00 $19.20 $15.60 $24.00 $24.00 $13.92 $24.00 $14.40 $24.00 $24.00 $24.00 N/A N/A 25500016 EAP HCPCS Q9965 LOCM 150-199MG/ML I BOTH IP/OP $6.00 $4.50 $0.81 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $0.84 $6.00 $6.00 $6.00 $6.00 $0.87 $0.81 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $2.70 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 25500039 EAP HCPCS Q9965 LOCM 150-199MG/ML I BOTH IP/OP $6.00 $4.50 $0.81 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $0.84 $6.00 $6.00 $6.00 $6.00 $0.87 $0.81 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $2.70 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 25800010 EAP Custom 25800010 SOLUTIONS SODIUM CH BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800013 EAP Custom 25800013 SOLUTION IV D 5% IN BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800016 EAP Custom 25800016 SOLUTION IV LACTATE BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800017 EAP Custom 25800017 SOLUTION IV NACL 0. BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800018 EAP Custom 25800018 SOLUTION IV NACL 0. BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800019 EAP Custom 25800019 SOLUTION IV NACL 0. BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800020 EAP Custom 25800020 SOLUTION IV NACL 0. BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800031 EAP Custom 25800031 SOLUTION IV D 5% IN BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800033 EAP Custom 25800033 SOLUTION IV LACTATE BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800034 EAP Custom 25800034 SOLUTION IV NACL 0. BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800037 EAP Custom 25800037 SOLUTION IV NACL 0. BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800038 EAP Custom 25800038 SOLUTION IV NACL 0. BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800039 EAP Custom 25800039 SOLUTION IV NACL 0. BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800060 EAP Custom 25800060 IV FLUIDS BOTH IP/OP $61.00 $45.50 $10.86 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $10.86 $61.00 $61.00 $45.27 $45.27 $47.02 $31.78 $12.71 $61.00 $24.40 $61.00 $61.00 $61.00 $61.00 $61.00 $45.75 $61.00 $61.00 $61.00 $30.50 $30.50 $48.31 $61.00 $48.80 $39.65 $61.00 $61.00 $35.38 $61.00 $36.60 $61.00 $61.00 $61.00 N/A N/A 25800061 EAP Custom 25800061 IV FLUIDS BOTH IP/OP $61.00 $45.50 $10.86 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $10.86 $61.00 $61.00 $45.27 $45.27 $47.02 $31.78 $12.71 $61.00 $24.40 $61.00 $61.00 $61.00 $61.00 $61.00 $45.75 $61.00 $61.00 $61.00 $30.50 $30.50 $48.31 $61.00 $48.80 $39.65 $61.00 $61.00 $35.38 $61.00 $36.60 $61.00 $61.00 $61.00 N/A N/A 25800062 EAP IV FLUIDS 500ML BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 25800063 EAP Custom 25800063 I.V. FLUID 100ML BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 25800080 EAP Custom 25800080 IV FLUIDS 1000ML BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $28.80 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 25800095 EAP Custom 25800095 SOLUTION IV WATER FOR IRR BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800262 EAP Custom 25800262 SOLUTIONS ADVANTAGE GLOU BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800263 EAP Custom 25800263 SOLUTION IRRIGATION WATER 150 BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800264 EAP Custom 25800264 SOLUTIONS IV WATER FOR INJECT BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800265 EAP Custom 25800265 SOLUTIONS SODIUM CHLORIDE BOTH IP/OP $37.00 $27.50 $6.59 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $6.59 $37.00 $37.00 $27.46 $27.46 $28.52 $19.28 $7.71 $37.00 $14.80 $37.00 $37.00 $37.00 $37.00 $37.00 $27.75 $37.00 $37.00 $37.00 $18.50 $18.50 $29.30 $37.00 $29.60 $24.05 $37.00 $37.00 $21.46 $37.00 $22.20 $37.00 $37.00 $37.00 N/A N/A 25800267 EAP Custom 25800267 "IV FLUIDS, 100CC" BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 25800268 EAP Custom 25800268 "IV FLUIDS, 500CC" BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 25800269 EAP Custom 25800269 "IV FLUIDS, 1000CC" BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 25800274 EAP Custom 25800274 SOLUTION IV NACL 0.9% GLA BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800277 EAP Custom 25800277 SOLUTION IV NACL 0.9% 50M BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 25800278 EAP Custom 25800278 "IV FLUIDS, 50CC" BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 25800401 EAP Custom 25800401 I.V. FLUIDS BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 25800402 EAP Custom 25800402 I.V. FLUIDS 1000CC BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 25800404 EAP Custom 25800404 IV FLUID 1000CC BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 25800405 EAP Custom 25800405 "IV FLUID, # BAGS" BOTH IP/OP $61.00 $45.50 $10.86 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $10.86 $61.00 $61.00 $45.27 $45.27 $47.02 $31.78 $12.71 $61.00 $24.40 $61.00 $61.00 $61.00 $61.00 $61.00 $45.75 $61.00 $61.00 $61.00 $30.50 $30.50 $48.31 $61.00 $48.80 $39.65 $61.00 $61.00 $35.38 $61.00 $36.60 $61.00 $61.00 $61.00 N/A N/A 25800406 EAP Custom 25800406 "IV FLUID, #BAGS" BOTH IP/OP $61.00 $45.50 $10.86 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $10.86 $61.00 $61.00 $45.27 $45.27 $47.02 $31.78 $12.71 $61.00 $24.40 $61.00 $61.00 $61.00 $61.00 $61.00 $45.75 $61.00 $61.00 $61.00 $30.50 $30.50 $48.31 $61.00 $48.80 $39.65 $61.00 $61.00 $35.38 $61.00 $36.60 $61.00 $61.00 $61.00 N/A N/A 25800407 EAP Custom 25800407 IV FLUIDS 1000ML BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 25800408 EAP Custom 25800408 IV FLUIDS 500CC BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 25800409 EAP Custom 25800409 IV FLUIDS 50CC BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 25800410 EAP Custom 25800410 IV FLUIDS-500ML BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 25800411 EAP Custom 25800411 SOLUTION INTRAVENOUS VIAFLEX LATEX FREE PLASMA-LYTE A BOTH IP/OP $29.00 $21.50 $5.16 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $5.16 $29.00 $29.00 $21.52 $21.52 $22.35 $15.11 $6.04 $29.00 $11.60 $29.00 $29.00 $29.00 $29.00 $29.00 $21.75 $29.00 $29.00 $29.00 $14.50 $14.50 $22.97 $29.00 $23.20 $18.85 $29.00 $29.00 $16.82 $29.00 $17.40 $29.00 $29.00 $29.00 N/A N/A 25800412 EAP Custom 25800412 SOLUTION IRR 0.9% NA CHLOR URMTC 3L STRL LF BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 25900227 EAP Custom 25900227 ORAL CONTRACEPTIVES BOTH IP/OP $12.00 $9.00 $2.14 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $2.14 $12.00 $12.00 $8.91 $8.91 $9.25 $6.25 $2.50 $12.00 $4.80 $12.00 $12.00 $12.00 $12.00 $12.00 $9.00 $12.00 $12.00 $12.00 $6.00 $6.00 $9.50 $12.00 $9.60 $7.80 $12.00 $12.00 $6.96 $12.00 $7.20 $12.00 $12.00 $12.00 N/A N/A 25900255 EAP Custom 25900255 INSULIN 5 UNITS BOTH IP/OP $4.00 $3.00 $0.71 $4.00 $4.00 $4.00 $4.00 $4.00 $4.00 $4.00 $0.71 $4.00 $4.00 $2.97 $2.97 $3.08 $2.08 $0.83 $4.00 $1.60 $4.00 $4.00 $4.00 $4.00 $4.00 $3.00 $4.00 $4.00 $4.00 $2.00 $2.00 $3.17 $4.00 $3.20 $2.60 $4.00 $4.00 $2.32 $4.00 $2.40 $4.00 $4.00 $4.00 N/A N/A 26000001 EAP CPT® 96360 IV HYDRA INITIAL (31 MIN TO 1 HR) BOTH IP/OP "$1,030.00" $762.50 $32.82 $824.00 $559.29 $559.29 $559.29 $559.29 $201.23 $201.23 $200.34 $214.68 $201.23 $764.47 $764.47 $793.92 $536.63 $214.66 $321.97 $298.01 $609.25 $201.23 $32.82 $201.23 $211.29 $772.50 $201.23 $201.23 $201.23 $515.00 $515.00 $815.76 $201.23 $824.00 $669.50 $204.43 $201.23 $597.40 $211.29 $291.13 $201.23 $214.65 $201.23 N/A N/A 26000003 EAP CPT® 96361 IV HYDRA ADD'L (31 MIN TO 1 HR) BOTH IP/OP $347.00 $257.00 $12.86 $277.60 $188.42 $188.42 $188.42 $188.42 $39.36 $39.36 $39.19 $72.32 $39.36 $257.54 $257.54 $267.47 $180.79 $72.32 $62.98 $61.13 $205.25 $39.36 $12.86 $39.36 $41.33 $260.25 $39.36 $39.36 $39.36 $173.50 $173.50 $274.82 $39.36 $277.60 $225.55 $68.87 $39.36 $201.26 $41.33 $56.95 $39.36 $72.31 $39.36 N/A N/A 26000005 EAP CPT® 96365 "IV INFUS THER,PROPHYLAX,DX INITIAL (16 MIN TO 1 HR)" BOTH IP/OP "$1,796.00" "$1,329.50" $64.63 "$1,436.80" $975.23 $975.23 $975.23 $975.23 $201.23 $201.23 $200.34 $374.33 $201.23 "$1,332.99" "$1,332.99" "$1,384.36" $935.72 $374.31 $321.97 $298.01 "$1,062.33" $201.23 $64.63 $201.23 $211.29 "$1,347.00" $201.23 $201.23 $201.23 $898.00 $898.00 "$1,422.43" $201.23 "$1,436.80" "$1,167.40" $356.46 $201.23 "$1,041.68" $211.29 $291.13 $201.23 $374.29 $201.23 N/A N/A 26000006 EAP CPT® 96366 "IV INFUS THER,PROPHYLAX,DX ADD'L (31 MIN TO 1 HR)" BOTH IP/OP $347.00 $257.00 $20.65 $277.60 $188.42 $188.42 $188.42 $188.42 $39.36 $39.36 $39.19 $72.32 $39.36 $257.54 $257.54 $267.47 $180.79 $72.32 $62.98 $61.13 $205.25 $39.36 $20.65 $39.36 $41.33 $260.25 $39.36 $39.36 $39.36 $173.50 $173.50 $274.82 $39.36 $277.60 $225.55 $68.87 $39.36 $201.26 $41.33 $56.95 $39.36 $72.31 $39.36 N/A N/A 26000007 EAP CPT® 96367 "IV INFUS THER,PROPHYLAX,DX ADD'L NEW MED (31 MIN TO 1 HR)" BOTH IP/OP $523.00 $387.50 $29.10 $418.40 $283.99 $283.99 $283.99 $283.99 $60.99 $60.99 $60.72 $109.01 $60.99 $388.17 $388.17 $403.13 $272.48 $109.00 $97.58 $97.33 $309.35 $60.99 $29.10 $60.99 $64.04 $392.25 $60.99 $60.99 $60.99 $261.50 $261.50 $414.22 $60.99 $418.40 $339.95 $103.80 $60.99 $303.34 $64.04 $88.23 $60.99 $108.99 $60.99 N/A N/A 26000008 EAP CPT® 96368 "IV INFUS THER,PROPHYLAX,DX ADD'L CONCUR (31 MIN TO 1 HR)" BOTH IP/OP $630.00 $466.50 $19.97 $739.00 $342.09 $342.09 $342.09 $342.09 $630.00 $630.00 $630.00 $131.31 $630.00 $467.59 $467.59 $485.60 $328.23 $131.30 $630.00 $739.00 $372.65 $630.00 $19.97 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $409.50 $125.04 $630.00 $365.40 $630.00 $630.00 $630.00 $131.29 $630.00 N/A N/A 26000111 EAP CPT® 96374 "IV PUSH-THER,PROPHYLAX,DX 1ST MED" BOTH IP/OP $630.00 $466.50 $37.56 $504.00 $342.09 $342.09 $342.09 $342.09 $201.23 $201.23 $200.34 $131.31 $201.23 $467.59 $467.59 $485.60 $328.23 $131.30 $321.97 $298.01 $372.65 $201.23 $37.56 $201.23 $211.29 $472.50 $201.23 $201.23 $201.23 $315.00 $315.00 $498.96 $201.23 $504.00 $409.50 $125.04 $201.23 $365.40 $211.29 $291.13 $201.23 $131.29 $201.23 N/A N/A 26000112 EAP CPT® 96375 "IV PUSH-THER,PROPHYLAX,DX ADD'L MED" BOTH IP/OP $523.00 $387.50 $15.57 $418.40 $283.99 $283.99 $283.99 $283.99 $39.36 $39.36 $39.19 $109.01 $39.36 $388.17 $388.17 $403.13 $272.48 $109.00 $62.98 $61.13 $309.35 $39.36 $15.57 $39.36 $41.33 $392.25 $39.36 $39.36 $39.36 $261.50 $261.50 $414.22 $39.36 $418.40 $339.95 $103.80 $39.36 $303.34 $41.33 $56.95 $39.36 $108.99 $39.36 N/A N/A 26000113 EAP CPT® 96376 "IV PUSH-THER,PROPHYLAX,DX EA PUSH SAME MED" BOTH IP/OP $349.00 $258.50 $69.27 $349.00 $189.51 $189.51 $189.51 $189.51 $349.00 $349.00 $349.00 $72.74 $349.00 $259.03 $259.03 $269.01 $181.83 $72.74 $349.00 $349.00 $206.43 $349.00 $349.00 $349.00 $349.00 $261.75 $349.00 $349.00 $349.00 $174.50 $174.50 $276.41 $349.00 $279.20 $226.85 $69.27 $349.00 $202.42 $349.00 $349.00 $349.00 $72.73 $349.00 N/A N/A 26000114 EAP CPT® 96523 PICC/PORTACATH LINE FLUSH BOTH IP/OP $282.00 $209.00 $25.71 $225.60 $69.45 $69.45 $69.45 $69.45 $54.76 $54.76 $54.51 $58.78 $54.76 $209.30 $209.30 $217.37 $146.92 $58.77 $87.61 $82.92 $166.80 $54.76 $25.71 $54.76 $57.49 $211.50 $54.76 $54.76 $54.76 $141.00 $141.00 $223.34 $54.76 $225.60 $183.30 $55.97 $54.76 $163.56 $57.49 $79.22 $54.76 $58.77 $54.76 N/A N/A 26000140 EAP HCPCS M0239 BAMLANIVIMAB INFUSION BOTH IP/OP $823.00 $609.50 $163.34 $823.00 $446.89 $446.89 $446.89 $446.89 $823.00 $823.00 $823.00 $171.53 $823.00 $610.83 $610.83 $634.37 $428.78 $171.52 $823.00 $329.20 $486.80 $823.00 $823.00 $823.00 $823.00 $617.25 $823.00 $823.00 $823.00 $411.50 $411.50 $651.82 $823.00 $658.40 $534.95 $163.34 $823.00 $477.34 $823.00 $493.80 $823.00 $171.51 $823.00 N/A N/A 26000160 EAP HCPCS M0220 "INJECTION, TIXAGEVIMAB AND CILGAVIMAB W/ POST ADMIN MONITORING" BOTH IP/OP $362.00 $268.00 $71.85 $362.00 $196.57 $196.57 $196.57 $196.57 $144.96 $144.96 $144.31 $75.45 $144.96 $268.68 $268.68 $279.03 $188.60 $75.44 $231.93 $362.00 $214.12 $144.96 $362.00 $144.96 $152.20 $271.50 $144.96 $144.96 $144.96 $181.00 $181.00 $286.70 $144.96 $289.60 $235.30 $71.85 $144.96 $209.96 $152.20 $209.71 $144.96 $75.44 $144.96 N/A N/A 27000010 EAP Custom 27000010 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27000011 EAP Custom 27000011 TUBE SALEM SILICONE SIZE BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27000012 EAP Custom 27000012 TUBES SALEM SUMP 48 LENG BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27000015 EAP Custom 27000015 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27000016 EAP Custom 27000016 SCAPLE SURG W/HANDLE ATTA BOTH IP/OP $152.00 $112.50 $27.06 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $27.06 $152.00 $152.00 $112.81 $112.81 $117.16 $79.19 $31.68 $152.00 $60.80 $152.00 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $98.80 $152.00 $152.00 $88.16 $152.00 $91.20 $152.00 $152.00 $152.00 N/A N/A 27000019 EAP Custom 27000019 KIT L.F. TRACH CARE BOTH IP/OP $511.00 $378.50 $90.96 $511.00 $511.00 $511.00 $511.00 $511.00 $511.00 $511.00 $90.96 $511.00 $511.00 $379.26 $379.26 $393.88 $266.23 $106.50 $511.00 $204.40 $511.00 $511.00 $511.00 $511.00 $511.00 $383.25 $511.00 $511.00 $511.00 $255.50 $255.50 $404.71 $511.00 $408.80 $332.15 $511.00 $511.00 $296.38 $511.00 $306.60 $511.00 $511.00 $511.00 N/A N/A 27000024 EAP Custom 27000024 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27000026 EAP Custom 27000026 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $587.00 $434.50 $104.49 $587.00 $587.00 $587.00 $587.00 $587.00 $587.00 $587.00 $104.49 $587.00 $587.00 $435.67 $435.67 $452.46 $305.83 $122.34 $587.00 $234.80 $587.00 $587.00 $587.00 $587.00 $587.00 $440.25 $587.00 $587.00 $587.00 $293.50 $293.50 $464.90 $587.00 $469.60 $381.55 $587.00 $587.00 $340.46 $587.00 $352.20 $587.00 $587.00 $587.00 N/A N/A 27000027 EAP Custom 27000027 FILTER SET 0.22 MICRON BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27000029 EAP Custom 27000029 SET T-PORT SMALL BORE EXT BOTH IP/OP $14.00 $10.50 $2.49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $2.49 $14.00 $14.00 $10.39 $10.39 $10.79 $7.29 $2.92 $14.00 $5.60 $14.00 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $9.10 $14.00 $14.00 $8.12 $14.00 $8.40 $14.00 $14.00 $14.00 N/A N/A 27000031 EAP Custom 27000031 TRAY DOUCH DISPOSABLE BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27000033 EAP Custom 27000033 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000034 EAP Custom 27000034 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000036 EAP Custom 27000036 CENTRAL LINE DRESSING TRAY WITH BIOPATCH BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27000045 EAP Custom 27000045 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27000046 EAP Custom 27000046 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27000047 EAP Custom 27000047 SLEEVE THIGH REGULAR DVT BOTH IP/OP $553.00 $409.50 $98.43 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $98.43 $553.00 $553.00 $410.44 $410.44 $426.25 $288.11 $115.25 $553.00 $221.20 $553.00 $553.00 $553.00 $553.00 $553.00 $414.75 $553.00 $553.00 $553.00 $276.50 $276.50 $437.98 $553.00 $442.40 $359.45 $553.00 $553.00 $320.74 $553.00 $331.80 $553.00 $553.00 $553.00 N/A N/A 27000048 EAP Custom 27000048 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $663.00 $491.00 $118.01 $663.00 $663.00 $663.00 $663.00 $663.00 $663.00 $663.00 $118.01 $663.00 $663.00 $492.08 $492.08 $511.04 $345.42 $138.18 $663.00 $265.20 $663.00 $663.00 $663.00 $663.00 $663.00 $497.25 $663.00 $663.00 $663.00 $331.50 $331.50 $525.10 $663.00 $530.40 $430.95 $663.00 $663.00 $384.54 $663.00 $397.80 $663.00 $663.00 $663.00 N/A N/A 27000066 EAP Custom 27000066 "TRAY,INSTRUMEN 13-1/2X9/34X5/8" BOTH IP/OP $391.00 $289.50 $69.60 $391.00 $391.00 $391.00 $391.00 $391.00 $391.00 $391.00 $69.60 $391.00 $391.00 $290.20 $290.20 $301.38 $203.71 $81.49 $391.00 $156.40 $391.00 $391.00 $391.00 $391.00 $391.00 $293.25 $391.00 $391.00 $391.00 $195.50 $195.50 $309.67 $391.00 $312.80 $254.15 $391.00 $391.00 $226.78 $391.00 $234.60 $391.00 $391.00 $391.00 N/A N/A 27000076 EAP HCPCS C1729 CATHETER COUDE SIZE 14FR BOTH IP/OP $44.00 $33.00 $8.73 $44.00 $23.89 $23.89 $23.89 $23.89 $44.00 $44.00 $44.00 $9.17 $44.00 $32.66 $32.66 $33.92 $22.92 $9.17 $44.00 $44.00 $26.03 $44.00 $44.00 $44.00 $44.00 $33.00 $44.00 $44.00 $44.00 $22.00 $22.00 $34.85 $44.00 $35.20 $28.60 $8.73 $44.00 $25.52 $44.00 $44.00 $44.00 $9.17 $44.00 N/A N/A 27000078 EAP Custom 27000078 TUBES SALEM SUMP 48 LENG BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27000079 EAP Custom 27000079 KIT TRACHEOTOMY CARE STER BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27000081 EAP Custom 27000081 SCAPEL SURG W/ HANDLE ATTACHED BOTH IP/OP $132.00 $98.00 $23.50 $132.00 $132.00 $132.00 $132.00 $132.00 $132.00 $132.00 $23.50 $132.00 $132.00 $97.97 $97.97 $101.75 $68.77 $27.51 $132.00 $52.80 $132.00 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $85.80 $132.00 $132.00 $76.56 $132.00 $79.20 $132.00 $132.00 $132.00 N/A N/A 27000087 EAP Custom 27000087 KIT THORACOTOMY BOTH IP/OP $203.00 $150.50 $36.13 $203.00 $203.00 $203.00 $203.00 $203.00 $203.00 $203.00 $36.13 $203.00 $203.00 $150.67 $150.67 $156.47 $105.76 $42.31 $203.00 $81.20 $203.00 $203.00 $203.00 $203.00 $203.00 $152.25 $203.00 $203.00 $203.00 $101.50 $101.50 $160.78 $203.00 $162.40 $131.95 $203.00 $203.00 $117.74 $203.00 $121.80 $203.00 $203.00 $203.00 N/A N/A 27000093 EAP Custom 27000093 BAG 1000ML PUMP SET BOTH IP/OP $28.00 $21.00 $4.98 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $4.98 $28.00 $28.00 $20.78 $20.78 $21.58 $14.59 $5.84 $28.00 $11.20 $28.00 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $18.20 $28.00 $28.00 $16.24 $28.00 $16.80 $28.00 $28.00 $28.00 N/A N/A 27000094 EAP Custom 27000094 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $455.00 $337.00 $80.99 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $80.99 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 27000097 EAP Custom 27000097 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $299.00 $221.50 $53.22 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $53.22 $299.00 $299.00 $221.92 $221.92 $230.47 $155.78 $62.31 $299.00 $119.60 $299.00 $299.00 $299.00 $299.00 $299.00 $224.25 $299.00 $299.00 $299.00 $149.50 $149.50 $236.81 $299.00 $239.20 $194.35 $299.00 $299.00 $173.42 $299.00 $179.40 $299.00 $299.00 $299.00 N/A N/A 27000098 EAP Custom 27000098 VEST ECONO COTTON SMALL BOTH IP/OP $94.00 $70.00 $16.73 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $16.73 $94.00 $94.00 $69.77 $69.77 $72.46 $48.97 $19.59 $94.00 $37.60 $94.00 $94.00 $94.00 $94.00 $94.00 $70.50 $94.00 $94.00 $94.00 $47.00 $47.00 $74.45 $94.00 $75.20 $61.10 $94.00 $94.00 $54.52 $94.00 $56.40 $94.00 $94.00 $94.00 N/A N/A 27000101 EAP Custom 27000101 VEST ECONO COTTON X-LARGE BOTH IP/OP $109.00 $81.00 $19.40 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $19.40 $109.00 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $43.60 $109.00 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $109.00 $109.00 $63.22 $109.00 $65.40 $109.00 $109.00 $109.00 N/A N/A 27000103 EAP Custom 27000103 FILTER SET 0.22 MICRON BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 27000107 EAP Custom 27000107 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27000109 EAP Custom 27000109 TRAY THORACENTESIS DISPOS BOTH IP/OP $235.00 $174.00 $41.83 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $41.83 $235.00 $235.00 $174.42 $174.42 $181.14 $122.44 $48.98 $235.00 $94.00 $235.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $152.75 $235.00 $235.00 $136.30 $235.00 $141.00 $235.00 $235.00 $235.00 N/A N/A 27000119 EAP Custom 27000119 3ML POSIFLUSH SALINE SYRINGE BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27000125 EAP Custom 27000125 SLEEVE THIGH REGULAR DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27000127 EAP Custom 27000127 "TRAY,CATHETER INSTRUMENT DULMN" BOTH IP/OP $718.00 $531.50 $127.80 $718.00 $718.00 $718.00 $718.00 $718.00 $718.00 $718.00 $127.80 $718.00 $718.00 $532.90 $532.90 $553.43 $374.08 $149.64 $718.00 $287.20 $718.00 $718.00 $718.00 $718.00 $718.00 $538.50 $718.00 $718.00 $718.00 $359.00 $359.00 $568.66 $718.00 $574.40 $466.70 $718.00 $718.00 $416.44 $718.00 $430.80 $718.00 $718.00 $718.00 N/A N/A 27000150 EAP Custom 27000150 CATHETER URETHRAL TWO-EYE BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27000151 EAP HCPCS C1729 CATHETER COUDE SIZE 14FR BOTH IP/OP $109.00 $81.00 $21.63 $109.00 $59.19 $59.19 $59.19 $59.19 $109.00 $109.00 $109.00 $22.72 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $109.00 $64.47 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $21.63 $109.00 $63.22 $109.00 $109.00 $109.00 $22.72 $109.00 N/A N/A 27000152 EAP HCPCS C1729 CATHETER COUDE 30CC 24FR BOTH IP/OP $87.00 $64.50 $17.27 $87.00 $47.24 $47.24 $47.24 $47.24 $87.00 $87.00 $87.00 $18.13 $87.00 $64.57 $64.57 $67.06 $45.33 $18.13 $87.00 $87.00 $51.46 $87.00 $87.00 $87.00 $87.00 $65.25 $87.00 $87.00 $87.00 $43.50 $43.50 $68.90 $87.00 $69.60 $56.55 $17.27 $87.00 $50.46 $87.00 $87.00 $87.00 $18.13 $87.00 N/A N/A 27000153 EAP Custom 27000153 TUBE SALEM SILICONE SIZE BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000154 EAP Custom 27000154 TUBES SALEM SUMP 48 LENG BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000155 EAP Custom 27000155 KIT TRACHEOTOMY CARE STER BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27000168 EAP Custom 27000168 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27000169 EAP Custom 27000169 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $455.00 $337.00 $80.99 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $80.99 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 27000173 EAP Custom 27000173 TUBE FEEDING NG 8FR 36IN ENTR BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27000174 EAP Custom 27000174 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $299.00 $221.50 $53.22 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $53.22 $299.00 $299.00 $221.92 $221.92 $230.47 $155.78 $62.31 $299.00 $119.60 $299.00 $299.00 $299.00 $299.00 $299.00 $224.25 $299.00 $299.00 $299.00 $149.50 $149.50 $236.81 $299.00 $239.20 $194.35 $299.00 $299.00 $173.42 $299.00 $179.40 $299.00 $299.00 $299.00 N/A N/A 27000179 EAP Custom 27000179 FILTER SET 0.22 MICRON BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 27000181 EAP Custom 27000181 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000182 EAP Custom 27000182 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000184 EAP Custom 27000184 TRAY THORACENTESIS DISPOS BOTH IP/OP $235.00 $174.00 $41.83 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $41.83 $235.00 $235.00 $174.42 $174.42 $181.14 $122.44 $48.98 $235.00 $94.00 $235.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $152.75 $235.00 $235.00 $136.30 $235.00 $141.00 $235.00 $235.00 $235.00 N/A N/A 27000191 EAP Custom 27000191 "SUTURE,SILK, 0" BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27000197 EAP Custom 27000197 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27000198 EAP Custom 27000198 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27000199 EAP Custom 27000199 SLEEVE THIGH REGULAR DVT BOTH IP/OP $553.00 $409.50 $98.43 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $98.43 $553.00 $553.00 $410.44 $410.44 $426.25 $288.11 $115.25 $553.00 $221.20 $553.00 $553.00 $553.00 $553.00 $553.00 $414.75 $553.00 $553.00 $553.00 $276.50 $276.50 $437.98 $553.00 $442.40 $359.45 $553.00 $553.00 $320.74 $553.00 $331.80 $553.00 $553.00 $553.00 N/A N/A 27000200 EAP Custom 27000200 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $663.00 $491.00 $118.01 $663.00 $663.00 $663.00 $663.00 $663.00 $663.00 $663.00 $118.01 $663.00 $663.00 $492.08 $492.08 $511.04 $345.42 $138.18 $663.00 $265.20 $663.00 $663.00 $663.00 $663.00 $663.00 $497.25 $663.00 $663.00 $663.00 $331.50 $331.50 $525.10 $663.00 $530.40 $430.95 $663.00 $663.00 $384.54 $663.00 $397.80 $663.00 $663.00 $663.00 N/A N/A 27000222 EAP Custom 27000222 CATHETER URETHRAL 14FR BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27000223 EAP Custom 27000223 CATHETER URETHRAL TWO-EYE BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27000224 EAP Custom 27000224 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000225 EAP Custom 27000225 TUBES SALEM SUMP 48 LENG BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000226 EAP Custom 27000226 KIT TRACHEOTOMY CARE STER BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27000228 EAP Custom 27000228 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27000232 EAP Custom 27000232 CREAM BAZA 5OZ BOTH IP/OP $56.00 $41.50 $9.97 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $9.97 $56.00 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $22.40 $56.00 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $56.00 $56.00 $32.48 $56.00 $33.60 $56.00 $56.00 $56.00 N/A N/A 27000240 EAP Custom 27000240 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27000241 EAP Custom 27000241 NEEDLE PORT-CATH 20GA X 1 BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27000242 EAP Custom 27000242 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $455.00 $337.00 $80.99 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $80.99 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 27000245 EAP Custom 27000245 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $420.00 $311.00 $74.76 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $74.76 $420.00 $420.00 $311.72 $311.72 $323.74 $218.82 $87.53 $420.00 $168.00 $420.00 $420.00 $420.00 $420.00 $420.00 $315.00 $420.00 $420.00 $420.00 $210.00 $210.00 $332.64 $420.00 $336.00 $273.00 $420.00 $420.00 $243.60 $420.00 $252.00 $420.00 $420.00 $420.00 N/A N/A 27000250 EAP Custom 27000250 TRAY FOLEY PRECONNECTED W BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 27000251 EAP Custom 27000251 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000252 EAP Custom 27000252 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000253 EAP Custom 27000253 TRAY THORACENTESIS/PARACE BOTH IP/OP $67.00 $50.00 $11.93 $67.00 $67.00 $67.00 $67.00 $67.00 $67.00 $67.00 $11.93 $67.00 $67.00 $49.73 $49.73 $51.64 $34.91 $13.96 $67.00 $26.80 $67.00 $67.00 $67.00 $67.00 $67.00 $50.25 $67.00 $67.00 $67.00 $33.50 $33.50 $53.06 $67.00 $53.60 $43.55 $67.00 $67.00 $38.86 $67.00 $40.20 $67.00 $67.00 $67.00 N/A N/A 27000254 EAP Custom 27000254 CENTRAL LINE DRESSING TRAY WITH BIOPATCH BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27000259 EAP Custom 27000259 "SUTURE, SILK, 0" BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27000265 EAP Custom 27000265 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27000266 EAP Custom 27000266 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27000267 EAP Custom 27000267 SLEEVE THIGH REGULAR DVT BOTH IP/OP $553.00 $409.50 $98.43 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $98.43 $553.00 $553.00 $410.44 $410.44 $426.25 $288.11 $115.25 $553.00 $221.20 $553.00 $553.00 $553.00 $553.00 $553.00 $414.75 $553.00 $553.00 $553.00 $276.50 $276.50 $437.98 $553.00 $442.40 $359.45 $553.00 $553.00 $320.74 $553.00 $331.80 $553.00 $553.00 $553.00 N/A N/A 27000268 EAP Custom 27000268 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $284.00 $210.50 $50.55 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $50.55 $284.00 $284.00 $210.78 $210.78 $218.91 $147.96 $59.19 $284.00 $113.60 $284.00 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $184.60 $284.00 $284.00 $164.72 $284.00 $170.40 $284.00 $284.00 $284.00 N/A N/A 27000293 EAP Custom 27000293 CATHETER URETHRAL TWO-EYE BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27000294 EAP HCPCS C1729 CATHETER COUDE SIZE 14FR BOTH IP/OP $109.00 $81.00 $21.63 $109.00 $59.19 $59.19 $59.19 $59.19 $109.00 $109.00 $109.00 $22.72 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $109.00 $64.47 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $21.63 $109.00 $63.22 $109.00 $109.00 $109.00 $22.72 $109.00 N/A N/A 27000295 EAP HCPCS C1729 CATHETER COUDE 30CC 24FR BOTH IP/OP $87.00 $64.50 $17.27 $87.00 $47.24 $47.24 $47.24 $47.24 $87.00 $87.00 $87.00 $18.13 $87.00 $64.57 $64.57 $67.06 $45.33 $18.13 $87.00 $87.00 $51.46 $87.00 $87.00 $87.00 $87.00 $65.25 $87.00 $87.00 $87.00 $43.50 $43.50 $68.90 $87.00 $69.60 $56.55 $17.27 $87.00 $50.46 $87.00 $87.00 $87.00 $18.13 $87.00 N/A N/A 27000296 EAP Custom 27000296 TUBE SALEM SILICONE SIZE BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000297 EAP Custom 27000297 TUBES SALEM SUMP 48 LENG BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000298 EAP Custom 27000298 KIT TRACHEOTOMY CARE STER BOTH IP/OP $61.00 $45.50 $10.86 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $10.86 $61.00 $61.00 $45.27 $45.27 $47.02 $31.78 $12.71 $61.00 $24.40 $61.00 $61.00 $61.00 $61.00 $61.00 $45.75 $61.00 $61.00 $61.00 $30.50 $30.50 $48.31 $61.00 $48.80 $39.65 $61.00 $61.00 $35.38 $61.00 $36.60 $61.00 $61.00 $61.00 N/A N/A 27000300 EAP Custom 27000300 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27000314 EAP Custom 27000314 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27000315 EAP Custom 27000315 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $455.00 $337.00 $80.99 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $80.99 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 27000318 EAP Custom 27000318 TUBE FEEDING NG 8FR 36IN ENTR BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27000319 EAP Custom 27000319 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $697.00 $516.00 $124.07 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $124.07 $697.00 $697.00 $517.31 $517.31 $537.25 $363.14 $145.26 $697.00 $278.80 $697.00 $697.00 $697.00 $697.00 $697.00 $522.75 $697.00 $697.00 $697.00 $348.50 $348.50 $552.02 $697.00 $557.60 $453.05 $697.00 $697.00 $404.26 $697.00 $418.20 $697.00 $697.00 $697.00 N/A N/A 27000323 EAP Custom 27000323 VEST ECONO COTTON X-LARGE BOTH IP/OP $102.00 $75.50 $18.16 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $18.16 $102.00 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $40.80 $102.00 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $102.00 $102.00 $59.16 $102.00 $61.20 $102.00 $102.00 $102.00 N/A N/A 27000324 EAP Custom 27000324 FILTER SET 0.22 MICRON BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 27000326 EAP Custom 27000326 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000327 EAP Custom 27000327 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000330 EAP Custom 27000330 CENTRAL LINE DRESSING TRAY WITH BIOPATCH BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27000335 EAP Custom 27000335 "SUTURE, SILK, 0" BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27000341 EAP Custom 27000341 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27000342 EAP Custom 27000342 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27000343 EAP Custom 27000343 SLEEVE THIGH REGULAR DVT BOTH IP/OP $553.00 $409.50 $98.43 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $98.43 $553.00 $553.00 $410.44 $410.44 $426.25 $288.11 $115.25 $553.00 $221.20 $553.00 $553.00 $553.00 $553.00 $553.00 $414.75 $553.00 $553.00 $553.00 $276.50 $276.50 $437.98 $553.00 $442.40 $359.45 $553.00 $553.00 $320.74 $553.00 $331.80 $553.00 $553.00 $553.00 N/A N/A 27000344 EAP Custom 27000344 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $284.00 $210.50 $50.55 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $50.55 $284.00 $284.00 $210.78 $210.78 $218.91 $147.96 $59.19 $284.00 $113.60 $284.00 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $184.60 $284.00 $284.00 $164.72 $284.00 $170.40 $284.00 $284.00 $284.00 N/A N/A 27000345 EAP Custom 27000345 TUBES EXTENSION PLAIN PLA BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27000360 EAP Custom 27000360 CATHETER THORACIC 36FR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27000361 EAP Custom 27000361 CATHETER VENTRICULAR 20CM BOTH IP/OP $735.00 $544.00 $130.83 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $130.83 $735.00 $735.00 $545.52 $545.52 $566.54 $382.94 $153.18 $735.00 $294.00 $735.00 $735.00 $735.00 $735.00 $735.00 $551.25 $735.00 $735.00 $735.00 $367.50 $367.50 $582.12 $735.00 $588.00 $477.75 $735.00 $735.00 $426.30 $735.00 $441.00 $735.00 $735.00 $735.00 N/A N/A 27000362 EAP Custom 27000362 CATHETER EDM 11 BECKER BOTH IP/OP "$1,339.00" $991.00 $238.34 "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" $238.34 "$1,339.00" "$1,339.00" $993.81 $993.81 "$1,032.10" $697.62 $279.06 "$1,339.00" $535.60 "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" "$1,004.25" "$1,339.00" "$1,339.00" "$1,339.00" $669.50 $669.50 "$1,060.49" "$1,339.00" "$1,071.20" $870.35 "$1,339.00" "$1,339.00" $776.62 "$1,339.00" $803.40 "$1,339.00" "$1,339.00" "$1,339.00" N/A N/A 27000363 EAP Custom 27000363 TUBE FEEDING PLASTIC 8FR BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27000364 EAP Custom 27000364 ARTERY ARTERIAL CATHERIZA BOTH IP/OP $42.00 $31.50 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $7.48 $42.00 $42.00 $31.17 $31.17 $32.37 $21.88 $8.75 $42.00 $16.80 $42.00 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $27.30 $42.00 $42.00 $24.36 $42.00 $25.20 $42.00 $42.00 $42.00 N/A N/A 27000365 EAP Custom 27000365 ARTERY RADIAL CATHERIZATI BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27000366 EAP Custom 27000366 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000367 EAP Custom 27000367 TUBE SALEM SILICONE SIZE BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000368 EAP Custom 27000368 TUBES SALEM SUMP 48 LENG BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27000369 EAP Custom 27000369 KIT TRACHEOTOMY CARE STER BOTH IP/OP $61.00 $45.50 $10.86 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $10.86 $61.00 $61.00 $45.27 $45.27 $47.02 $31.78 $12.71 $61.00 $24.40 $61.00 $61.00 $61.00 $61.00 $61.00 $45.75 $61.00 $61.00 $61.00 $30.50 $30.50 $48.31 $61.00 $48.80 $39.65 $61.00 $61.00 $35.38 $61.00 $36.60 $61.00 $61.00 $61.00 N/A N/A 27000371 EAP Custom 27000371 BAG DRAINAGE BECKER BOTH IP/OP $197.00 $146.00 $35.07 $197.00 $197.00 $197.00 $197.00 $197.00 $197.00 $197.00 $35.07 $197.00 $197.00 $146.21 $146.21 $151.85 $102.64 $41.06 $197.00 $78.80 $197.00 $197.00 $197.00 $197.00 $197.00 $147.75 $197.00 $197.00 $197.00 $98.50 $98.50 $156.02 $197.00 $157.60 $128.05 $197.00 $197.00 $114.26 $197.00 $118.20 $197.00 $197.00 $197.00 N/A N/A 27000372 EAP Custom 27000372 TRAY CATHETER INSRTN DULM BOTH IP/OP $377.00 $279.00 $67.11 $377.00 $377.00 $377.00 $377.00 $377.00 $377.00 $377.00 $67.11 $377.00 $377.00 $279.81 $279.81 $290.59 $196.42 $78.57 $377.00 $150.80 $377.00 $377.00 $377.00 $377.00 $377.00 $282.75 $377.00 $377.00 $377.00 $188.50 $188.50 $298.58 $377.00 $301.60 $245.05 $377.00 $377.00 $218.66 $377.00 $226.20 $377.00 $377.00 $377.00 N/A N/A 27000373 EAP Custom 27000373 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27000374 EAP Custom 27000374 SCAPLE SURG W/HANDLE ATTA BOTH IP/OP $152.00 $112.50 $27.06 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $27.06 $152.00 $152.00 $112.81 $112.81 $117.16 $79.19 $31.68 $152.00 $60.80 $152.00 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $98.80 $152.00 $152.00 $88.16 $152.00 $91.20 $152.00 $152.00 $152.00 N/A N/A 27000376 EAP Custom 27000376 SET BLOOD ADMINISTRATION BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27000378 EAP Custom 27000378 CREAM BAZA 5OZ BOTH IP/OP $26.00 $19.50 $4.63 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $4.63 $26.00 $26.00 $19.30 $19.30 $20.04 $13.55 $5.42 $26.00 $10.40 $26.00 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $16.90 $26.00 $26.00 $15.08 $26.00 $15.60 $26.00 $26.00 $26.00 N/A N/A 27000386 EAP Custom 27000386 POUCH FECAL INCONTINENCE BOTH IP/OP $21.00 $16.00 $3.74 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $3.74 $21.00 $21.00 $15.59 $15.59 $16.19 $10.94 $4.38 $21.00 $8.40 $21.00 $21.00 $21.00 $21.00 $21.00 $15.75 $21.00 $21.00 $21.00 $10.50 $10.50 $16.63 $21.00 $16.80 $13.65 $21.00 $21.00 $12.18 $21.00 $12.60 $21.00 $21.00 $21.00 N/A N/A 27000387 EAP Custom 27000387 KIT PRESSURE MONITORING T BOTH IP/OP $177.00 $131.00 $31.51 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $31.51 $177.00 $177.00 $131.37 $131.37 $136.43 $92.22 $36.89 $177.00 $70.80 $177.00 $177.00 $177.00 $177.00 $177.00 $132.75 $177.00 $177.00 $177.00 $88.50 $88.50 $140.18 $177.00 $141.60 $115.05 $177.00 $177.00 $102.66 $177.00 $106.20 $177.00 $177.00 $177.00 N/A N/A 27000388 EAP Custom 27000388 TRANSDUCER DISP FOR ICP BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27000389 EAP Custom 27000389 BRIDGE KIT BIFURATED RESP BOTH IP/OP $131.00 $97.00 $23.32 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $23.32 $131.00 $131.00 $97.23 $97.23 $100.97 $68.25 $27.30 $131.00 $52.40 $131.00 $131.00 $131.00 $131.00 $131.00 $98.25 $131.00 $131.00 $131.00 $65.50 $65.50 $103.75 $131.00 $104.80 $85.15 $131.00 $131.00 $75.98 $131.00 $78.60 $131.00 $131.00 $131.00 N/A N/A 27000390 EAP Custom 27000390 KIT TRANSDUCER MONITORING BOTH IP/OP $339.00 $251.00 $60.34 $339.00 $339.00 $339.00 $339.00 $339.00 $339.00 $339.00 $60.34 $339.00 $339.00 $251.61 $251.61 $261.30 $176.62 $70.65 $339.00 $135.60 $339.00 $339.00 $339.00 $339.00 $339.00 $254.25 $339.00 $339.00 $339.00 $169.50 $169.50 $268.49 $339.00 $271.20 $220.35 $339.00 $339.00 $196.62 $339.00 $203.40 $339.00 $339.00 $339.00 N/A N/A 27000392 EAP Custom 27000392 KIT PRESSURE MONITORING BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 $250.00 $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 27000394 EAP Custom 27000394 BAG 1000ML PUMP SET BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27000395 EAP Custom 27000395 KIT PECUTANEOUS INTRODUCE BOTH IP/OP $101.00 $75.00 $17.98 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $17.98 $101.00 $101.00 $74.96 $74.96 $77.85 $52.62 $21.05 $101.00 $40.40 $101.00 $101.00 $101.00 $101.00 $101.00 $75.75 $101.00 $101.00 $101.00 $50.50 $50.50 $79.99 $101.00 $80.80 $65.65 $101.00 $101.00 $58.58 $101.00 $60.60 $101.00 $101.00 $101.00 N/A N/A 27000396 EAP Custom 27000396 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $455.00 $337.00 $80.99 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $80.99 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 27000403 EAP Custom 27000403 TUBE FEEDING NG 8FR 36IN ENTR BOTH IP/OP $61.00 $45.50 $10.86 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $10.86 $61.00 $61.00 $45.27 $45.27 $47.02 $31.78 $12.71 $61.00 $24.40 $61.00 $61.00 $61.00 $61.00 $61.00 $45.75 $61.00 $61.00 $61.00 $30.50 $30.50 $48.31 $61.00 $48.80 $39.65 $61.00 $61.00 $35.38 $61.00 $36.60 $61.00 $61.00 $61.00 N/A N/A 27000404 EAP Custom 27000404 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $299.00 $221.50 $53.22 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $53.22 $299.00 $299.00 $221.92 $221.92 $230.47 $155.78 $62.31 $299.00 $119.60 $299.00 $299.00 $299.00 $299.00 $299.00 $224.25 $299.00 $299.00 $299.00 $149.50 $149.50 $236.81 $299.00 $239.20 $194.35 $299.00 $299.00 $173.42 $299.00 $179.40 $299.00 $299.00 $299.00 N/A N/A 27000405 EAP Custom 27000405 CATHETER SWAN GANZ BOTH IP/OP $674.00 $499.00 $119.97 $674.00 $674.00 $674.00 $674.00 $674.00 $674.00 $674.00 $119.97 $674.00 $674.00 $500.24 $500.24 $519.52 $351.15 $140.47 $674.00 $269.60 $674.00 $674.00 $674.00 $674.00 $674.00 $505.50 $674.00 $674.00 $674.00 $337.00 $337.00 $533.81 $674.00 $539.20 $438.10 $674.00 $674.00 $390.92 $674.00 $404.40 $674.00 $674.00 $674.00 N/A N/A 27000406 EAP Custom 27000406 DELIVERY SYSTEM CLOSED IN BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27000407 EAP Custom 27000407 PROBE V-PACING BOTH IP/OP "$1,403.00" "$1,038.50" $249.73 "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" $249.73 "$1,403.00" "$1,403.00" "$1,041.31" "$1,041.31" "$1,081.43" $730.96 $292.40 "$1,403.00" $561.20 "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,052.25" "$1,403.00" "$1,403.00" "$1,403.00" $701.50 $701.50 "$1,111.18" "$1,403.00" "$1,122.40" $911.95 "$1,403.00" "$1,403.00" $813.74 "$1,403.00" $841.80 "$1,403.00" "$1,403.00" "$1,403.00" N/A N/A 27000410 EAP Custom 27000410 FILTER SET 0.22 MICRON BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 27000412 EAP Custom 27000412 KIT VENTRICULOSTOMY BOTH IP/OP "$1,652.00" "$1,222.50" $294.06 "$1,652.00" "$1,652.00" "$1,652.00" "$1,652.00" "$1,652.00" "$1,652.00" "$1,652.00" $294.06 "$1,652.00" "$1,652.00" "$1,226.11" "$1,226.11" "$1,273.36" $860.69 $344.29 "$1,652.00" $660.80 "$1,652.00" "$1,652.00" "$1,652.00" "$1,652.00" "$1,652.00" "$1,239.00" "$1,652.00" "$1,652.00" "$1,652.00" $826.00 $826.00 "$1,308.38" "$1,652.00" "$1,321.60" "$1,073.80" "$1,652.00" "$1,652.00" $958.16 "$1,652.00" $991.20 "$1,652.00" "$1,652.00" "$1,652.00" N/A N/A 27000414 EAP Custom 27000414 "SUTURE, SILK, 0" BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27000455 EAP Custom 27000455 CATHETER THORACIC 32FR BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27000456 EAP Custom 27000456 CATHETER THORACIC 36FR BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27000457 EAP Custom 27000457 CATHETER URETHRAL 14FR BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27000458 EAP Custom 27000458 CATHETER URETHRAL TWO-EYE BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27000459 EAP Custom 27000459 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27000460 EAP Custom 27000460 TUBE SALEM SILICONE SIZE BOTH IP/OP $28.00 $21.00 $4.98 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $4.98 $28.00 $28.00 $20.78 $20.78 $21.58 $14.59 $5.84 $28.00 $11.20 $28.00 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $18.20 $28.00 $28.00 $16.24 $28.00 $16.80 $28.00 $28.00 $28.00 N/A N/A 27000461 EAP Custom 27000461 TUBES SALEM SUMP 48 LENG BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000462 EAP Custom 27000462 KIT TRACHEOTOMY CARE STER BOTH IP/OP $61.00 $45.50 $10.86 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $10.86 $61.00 $61.00 $45.27 $45.27 $47.02 $31.78 $12.71 $61.00 $24.40 $61.00 $61.00 $61.00 $61.00 $61.00 $45.75 $61.00 $61.00 $61.00 $30.50 $30.50 $48.31 $61.00 $48.80 $39.65 $61.00 $61.00 $35.38 $61.00 $36.60 $61.00 $61.00 $61.00 N/A N/A 27000464 EAP Custom 27000464 SCAPLE SURG W/HANDLE ATTA BOTH IP/OP $152.00 $112.50 $27.06 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $27.06 $152.00 $152.00 $112.81 $112.81 $117.16 $79.19 $31.68 $152.00 $60.80 $152.00 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $98.80 $152.00 $152.00 $88.16 $152.00 $91.20 $152.00 $152.00 $152.00 N/A N/A 27000474 EAP Custom 27000474 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27000475 EAP Custom 27000475 NEEDLE PORT-CATH 20GA X 1 BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27000476 EAP Custom 27000476 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $195.00 $144.50 $34.71 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $34.71 $195.00 $195.00 $144.73 $144.73 $150.31 $101.60 $40.64 $195.00 $78.00 $195.00 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $126.75 $195.00 $195.00 $113.10 $195.00 $117.00 $195.00 $195.00 $195.00 N/A N/A 27000481 EAP Custom 27000481 TUBE FEEDING NG 8FR 36IN ENTR BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27000482 EAP Custom 27000482 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $299.00 $221.50 $53.22 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $53.22 $299.00 $299.00 $221.92 $221.92 $230.47 $155.78 $62.31 $299.00 $119.60 $299.00 $299.00 $299.00 $299.00 $299.00 $224.25 $299.00 $299.00 $299.00 $149.50 $149.50 $236.81 $299.00 $239.20 $194.35 $299.00 $299.00 $173.42 $299.00 $179.40 $299.00 $299.00 $299.00 N/A N/A 27000483 EAP Custom 27000483 FILTER SET 0.22 MICRON BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 27000484 EAP Custom 27000484 TRAY CATHETER URETHRAL 14 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27000487 EAP Custom 27000487 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000488 EAP Custom 27000488 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000489 EAP Custom 27000489 TRAY THORACENTESIS DISPOS BOTH IP/OP $235.00 $174.00 $41.83 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $41.83 $235.00 $235.00 $174.42 $174.42 $181.14 $122.44 $48.98 $235.00 $94.00 $235.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $152.75 $235.00 $235.00 $136.30 $235.00 $141.00 $235.00 $235.00 $235.00 N/A N/A 27000491 EAP Custom 27000491 CENTRAL LINE DRESSING TRAY WITH BIOPATCH BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27000495 EAP Custom 27000495 "SUTURE, SILK, 0" BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27000501 EAP Custom 27000501 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27000502 EAP Custom 27000502 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27000503 EAP Custom 27000503 SLEEVE THIGH REGULAR DVT BOTH IP/OP $228.00 $169.00 $40.58 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $40.58 $228.00 $228.00 $169.22 $169.22 $175.74 $118.79 $47.52 $228.00 $91.20 $228.00 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $148.20 $228.00 $228.00 $132.24 $228.00 $136.80 $228.00 $228.00 $228.00 N/A N/A 27000504 EAP Custom 27000504 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $616.00 $456.00 $109.65 $616.00 $616.00 $616.00 $616.00 $616.00 $616.00 $616.00 $109.65 $616.00 $616.00 $457.20 $457.20 $474.81 $320.94 $128.38 $616.00 $246.40 $616.00 $616.00 $616.00 $616.00 $616.00 $462.00 $616.00 $616.00 $616.00 $308.00 $308.00 $487.87 $616.00 $492.80 $400.40 $616.00 $616.00 $357.28 $616.00 $369.60 $616.00 $616.00 $616.00 N/A N/A 27000531 EAP Custom 27000531 CATHETER THORACIC 32FR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27000532 EAP Custom 27000532 CATHETER THORACIC 36FR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27000533 EAP Custom 27000533 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000534 EAP Custom 27000534 TUBES SALEM SUMP 48 LENG BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27000535 EAP Custom 27000535 KIT TRACHEOTOMY CARE STER BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27000538 EAP Custom 27000538 SCAPEL SURG W/ HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27000543 EAP Custom 27000543 KIT THORACOTOMY BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27000549 EAP Custom 27000549 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27000551 EAP Custom 27000551 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27000556 EAP Custom 27000556 TUBE FEEDING NG 8FR 36IN ENTR BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27000557 EAP Custom 27000557 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $299.00 $221.50 $53.22 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $53.22 $299.00 $299.00 $221.92 $221.92 $230.47 $155.78 $62.31 $299.00 $119.60 $299.00 $299.00 $299.00 $299.00 $299.00 $224.25 $299.00 $299.00 $299.00 $149.50 $149.50 $236.81 $299.00 $239.20 $194.35 $299.00 $299.00 $173.42 $299.00 $179.40 $299.00 $299.00 $299.00 N/A N/A 27000558 EAP Custom 27000558 FILTER SET 0.22 MICRON BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 27000559 EAP Custom 27000559 TRAY CATHETER URETHRAL 14 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27000560 EAP Custom 27000560 TRAY DOUCH DISPOSABLE BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27000562 EAP Custom 27000562 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $22.00 $16.50 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 27000563 EAP Custom 27000563 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $22.00 $16.50 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 27000564 EAP Custom 27000564 TRAY THORACENTESIS DISPOS BOTH IP/OP $261.00 $193.50 $46.46 $261.00 $261.00 $261.00 $261.00 $261.00 $261.00 $261.00 $46.46 $261.00 $261.00 $193.71 $193.71 $201.18 $135.98 $54.40 $261.00 $104.40 $261.00 $261.00 $261.00 $261.00 $261.00 $195.75 $261.00 $261.00 $261.00 $130.50 $130.50 $206.71 $261.00 $208.80 $169.65 $261.00 $261.00 $151.38 $261.00 $156.60 $261.00 $261.00 $261.00 N/A N/A 27000570 EAP Custom 27000570 "SUTURE, SILK, 0" BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27000577 EAP Custom 27000577 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27000578 EAP Custom 27000578 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27000579 EAP Custom 27000579 SLEEVE THIGH REGULAR DVT BOTH IP/OP $238.00 $176.50 $42.36 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $42.36 $238.00 $238.00 $176.64 $176.64 $183.45 $124.00 $49.60 $238.00 $95.20 $238.00 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $154.70 $238.00 $238.00 $138.04 $238.00 $142.80 $238.00 $238.00 $238.00 N/A N/A 27000580 EAP Custom 27000580 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $616.00 $456.00 $109.65 $616.00 $616.00 $616.00 $616.00 $616.00 $616.00 $616.00 $109.65 $616.00 $616.00 $457.20 $457.20 $474.81 $320.94 $128.38 $616.00 $246.40 $616.00 $616.00 $616.00 $616.00 $616.00 $462.00 $616.00 $616.00 $616.00 $308.00 $308.00 $487.87 $616.00 $492.80 $400.40 $616.00 $616.00 $357.28 $616.00 $369.60 $616.00 $616.00 $616.00 N/A N/A 27000605 EAP Custom 27000605 CATHETER THORACIC 32FR BOTH IP/OP $18.00 $13.50 $3.20 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $3.20 $18.00 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $7.20 $18.00 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $18.00 $18.00 $10.44 $18.00 $10.80 $18.00 $18.00 $18.00 N/A N/A 27000606 EAP Custom 27000606 CATHETER THORACIC 36FR BOTH IP/OP $18.00 $13.50 $3.20 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $3.20 $18.00 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $7.20 $18.00 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $18.00 $18.00 $10.44 $18.00 $10.80 $18.00 $18.00 $18.00 N/A N/A 27000607 EAP Custom 27000607 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000608 EAP Custom 27000608 TUBES SALEM SUMP 48 LENG BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000612 EAP Custom 27000612 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27000613 EAP Custom 27000613 SCAPLE SURG W/HANDLE ATTA BOTH IP/OP $152.00 $112.50 $27.06 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $27.06 $152.00 $152.00 $112.81 $112.81 $117.16 $79.19 $31.68 $152.00 $60.80 $152.00 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $98.80 $152.00 $152.00 $88.16 $152.00 $91.20 $152.00 $152.00 $152.00 N/A N/A 27000618 EAP Custom 27000618 KIT THORACOTOMY BOTH IP/OP $93.00 $69.00 $16.55 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $16.55 $93.00 $93.00 $69.02 $69.02 $71.68 $48.45 $19.38 $93.00 $37.20 $93.00 $93.00 $93.00 $93.00 $93.00 $69.75 $93.00 $93.00 $93.00 $46.50 $46.50 $73.66 $93.00 $74.40 $60.45 $93.00 $93.00 $53.94 $93.00 $55.80 $93.00 $93.00 $93.00 N/A N/A 27000624 EAP Custom 27000624 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27000625 EAP Custom 27000625 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $332.00 $246.00 $59.10 $332.00 $332.00 $332.00 $332.00 $332.00 $332.00 $332.00 $59.10 $332.00 $332.00 $246.41 $246.41 $255.91 $172.97 $69.19 $332.00 $132.80 $332.00 $332.00 $332.00 $332.00 $332.00 $249.00 $332.00 $332.00 $332.00 $166.00 $166.00 $262.94 $332.00 $265.60 $215.80 $332.00 $332.00 $192.56 $332.00 $199.20 $332.00 $332.00 $332.00 N/A N/A 27000630 EAP Custom 27000630 DRESSING X-LARGE BOTH IP/OP $697.00 $516.00 $124.07 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $124.07 $697.00 $697.00 $517.31 $517.31 $537.25 $363.14 $145.26 $697.00 $278.80 $697.00 $697.00 $697.00 $697.00 $697.00 $522.75 $697.00 $697.00 $697.00 $348.50 $348.50 $552.02 $697.00 $557.60 $453.05 $697.00 $697.00 $404.26 $697.00 $418.20 $697.00 $697.00 $697.00 N/A N/A 27000632 EAP Custom 27000632 TUBE FEEDING NG 8FR 36IN ENTR BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27000633 EAP Custom 27000633 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $299.00 $221.50 $53.22 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $53.22 $299.00 $299.00 $221.92 $221.92 $230.47 $155.78 $62.31 $299.00 $119.60 $299.00 $299.00 $299.00 $299.00 $299.00 $224.25 $299.00 $299.00 $299.00 $149.50 $149.50 $236.81 $299.00 $239.20 $194.35 $299.00 $299.00 $173.42 $299.00 $179.40 $299.00 $299.00 $299.00 N/A N/A 27000637 EAP Custom 27000637 TRAY CATHETER URETHRAL 14 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27000638 EAP Custom 27000638 TRAY DOUCH DISPOSABLE BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27000640 EAP Custom 27000640 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000641 EAP Custom 27000641 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000642 EAP Custom 27000642 TRAY THORACENTESIS DISPOS BOTH IP/OP $235.00 $174.00 $41.83 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $41.83 $235.00 $235.00 $174.42 $174.42 $181.14 $122.44 $48.98 $235.00 $94.00 $235.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $152.75 $235.00 $235.00 $136.30 $235.00 $141.00 $235.00 $235.00 $235.00 N/A N/A 27000648 EAP Custom 27000648 "SUTURE, SILK, 0" BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27000653 EAP Custom 27000653 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27000654 EAP Custom 27000654 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27000655 EAP Custom 27000655 SLEEVE THIGH REGULAR DVT BOTH IP/OP $553.00 $409.50 $98.43 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $98.43 $553.00 $553.00 $410.44 $410.44 $426.25 $288.11 $115.25 $553.00 $221.20 $553.00 $553.00 $553.00 $553.00 $553.00 $414.75 $553.00 $553.00 $553.00 $276.50 $276.50 $437.98 $553.00 $442.40 $359.45 $553.00 $553.00 $320.74 $553.00 $331.80 $553.00 $553.00 $553.00 N/A N/A 27000656 EAP Custom 27000656 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $663.00 $491.00 $118.01 $663.00 $663.00 $663.00 $663.00 $663.00 $663.00 $663.00 $118.01 $663.00 $663.00 $492.08 $492.08 $511.04 $345.42 $138.18 $663.00 $265.20 $663.00 $663.00 $663.00 $663.00 $663.00 $497.25 $663.00 $663.00 $663.00 $331.50 $331.50 $525.10 $663.00 $530.40 $430.95 $663.00 $663.00 $384.54 $663.00 $397.80 $663.00 $663.00 $663.00 N/A N/A 27000666 EAP Custom 27000666 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000667 EAP Custom 27000667 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27000679 EAP Custom 27000679 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $646.00 $478.50 $114.99 $646.00 $646.00 $646.00 $646.00 $646.00 $646.00 $646.00 $114.99 $646.00 $646.00 $479.46 $479.46 $497.94 $336.57 $134.63 $646.00 $258.40 $646.00 $646.00 $646.00 $646.00 $646.00 $484.50 $646.00 $646.00 $646.00 $323.00 $323.00 $511.63 $646.00 $516.80 $419.90 $646.00 $646.00 $374.68 $646.00 $387.60 $646.00 $646.00 $646.00 N/A N/A 27000680 EAP Custom 27000680 FILTER SET 0.22 MICRON BOTH IP/OP $7.00 $5.50 $1.25 $7.00 $7.00 $7.00 $7.00 $7.00 $7.00 $7.00 $1.25 $7.00 $7.00 $5.20 $5.20 $5.40 $3.65 $1.46 $7.00 $2.80 $7.00 $7.00 $7.00 $7.00 $7.00 $5.25 $7.00 $7.00 $7.00 $3.50 $3.50 $5.54 $7.00 $5.60 $4.55 $7.00 $7.00 $4.06 $7.00 $4.20 $7.00 $7.00 $7.00 N/A N/A 27000683 EAP Custom 27000683 TRAY CATHETER URETHRAL 14 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27000686 EAP Custom 27000686 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000687 EAP Custom 27000687 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000689 EAP Custom 27000689 TRAY THORACENTESIS DISPOS BOTH IP/OP $216.00 $160.00 $38.45 $216.00 $216.00 $216.00 $216.00 $216.00 $216.00 $216.00 $38.45 $216.00 $216.00 $160.32 $160.32 $166.49 $112.54 $45.02 $216.00 $86.40 $216.00 $216.00 $216.00 $216.00 $216.00 $162.00 $216.00 $216.00 $216.00 $108.00 $108.00 $171.07 $216.00 $172.80 $140.40 $216.00 $216.00 $125.28 $216.00 $129.60 $216.00 $216.00 $216.00 N/A N/A 27000691 EAP Custom 27000691 BAG DRAINAGE URETERAL BOTH IP/OP $92.00 $68.50 $16.38 $92.00 $92.00 $92.00 $92.00 $92.00 $92.00 $92.00 $16.38 $92.00 $92.00 $68.28 $68.28 $70.91 $47.93 $19.17 $92.00 $36.80 $92.00 $92.00 $92.00 $92.00 $92.00 $69.00 $92.00 $92.00 $92.00 $46.00 $46.00 $72.86 $92.00 $73.60 $59.80 $92.00 $92.00 $53.36 $92.00 $55.20 $92.00 $92.00 $92.00 N/A N/A 27000696 EAP Custom 27000696 "SUTURE, SILK, 0" BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27000697 EAP Custom 27000697 10ML POSIFLUSH SALINE SYRINGE BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27000701 EAP Custom 27000701 SLEEVE KNEE REGULAR DVT BOTH IP/OP $378.00 $280.00 $67.28 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $67.28 $378.00 $378.00 $280.55 $280.55 $291.36 $196.94 $78.78 $378.00 $151.20 $378.00 $378.00 $378.00 $378.00 $378.00 $283.50 $378.00 $378.00 $378.00 $189.00 $189.00 $299.38 $378.00 $302.40 $245.70 $378.00 $378.00 $219.24 $378.00 $226.80 $378.00 $378.00 $378.00 N/A N/A 27000702 EAP Custom 27000702 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27000703 EAP Custom 27000703 SLEEVE THIGH REGULAR DVT BOTH IP/OP $553.00 $409.50 $98.43 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $98.43 $553.00 $553.00 $410.44 $410.44 $426.25 $288.11 $115.25 $553.00 $221.20 $553.00 $553.00 $553.00 $553.00 $553.00 $414.75 $553.00 $553.00 $553.00 $276.50 $276.50 $437.98 $553.00 $442.40 $359.45 $553.00 $553.00 $320.74 $553.00 $331.80 $553.00 $553.00 $553.00 N/A N/A 27000704 EAP Custom 27000704 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $284.00 $210.50 $50.55 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $50.55 $284.00 $284.00 $210.78 $210.78 $218.91 $147.96 $59.19 $284.00 $113.60 $284.00 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $184.60 $284.00 $284.00 $164.72 $284.00 $170.40 $284.00 $284.00 $284.00 N/A N/A 27000705 EAP Custom 27000705 SUCROSE ANALGESIA BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27000709 EAP Custom 27000709 TRAY CIRCUMCISION BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27000712 EAP Custom 27000712 TUBES CAPILLARY HEPARINIZ BOTH IP/OP $160.00 $118.50 $28.48 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $28.48 $160.00 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $64.00 $160.00 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $160.00 $160.00 $92.80 $160.00 $96.00 $160.00 $160.00 $160.00 N/A N/A 27000714 EAP Custom 27000714 TUBE FEEDING PLASTIC 8FR BOTH IP/OP $3.00 $2.50 $0.53 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $0.53 $3.00 $3.00 $2.23 $2.23 $2.31 $1.56 $0.63 $3.00 $1.20 $3.00 $3.00 $3.00 $3.00 $3.00 $2.25 $3.00 $3.00 $3.00 $1.50 $1.50 $2.38 $3.00 $2.40 $1.95 $3.00 $3.00 $1.74 $3.00 $1.80 $3.00 $3.00 $3.00 N/A N/A 27000715 EAP Custom 27000715 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27000721 EAP Custom 27000721 TRAY CATHETER URETHRAL 14 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27000723 EAP Custom 27000723 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000724 EAP Custom 27000724 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000726 EAP Custom 27000726 SLEEVE KNEE REGULAR DVT BOTH IP/OP $166.00 $123.00 $29.55 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $29.55 $166.00 $166.00 $123.21 $123.21 $127.95 $86.49 $34.60 $166.00 $66.40 $166.00 $166.00 $166.00 $166.00 $166.00 $124.50 $166.00 $166.00 $166.00 $83.00 $83.00 $131.47 $166.00 $132.80 $107.90 $166.00 $166.00 $96.28 $166.00 $99.60 $166.00 $166.00 $166.00 N/A N/A 27000727 EAP Custom 27000727 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $201.00 $149.00 $35.78 $201.00 $201.00 $201.00 $201.00 $201.00 $201.00 $201.00 $35.78 $201.00 $201.00 $149.18 $149.18 $154.93 $104.72 $41.89 $201.00 $80.40 $201.00 $201.00 $201.00 $201.00 $201.00 $150.75 $201.00 $201.00 $201.00 $100.50 $100.50 $159.19 $201.00 $160.80 $130.65 $201.00 $201.00 $116.58 $201.00 $120.60 $201.00 $201.00 $201.00 N/A N/A 27000728 EAP Custom 27000728 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $284.00 $210.50 $50.55 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $50.55 $284.00 $284.00 $210.78 $210.78 $218.91 $147.96 $59.19 $284.00 $113.60 $284.00 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $184.60 $284.00 $284.00 $164.72 $284.00 $170.40 $284.00 $284.00 $284.00 N/A N/A 27000742 EAP Custom 27000742 CATHETER THORACIC 32FR BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27000743 EAP Custom 27000743 CATHETER THORACIC 36FR BOTH IP/OP $18.00 $13.50 $3.20 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $3.20 $18.00 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $7.20 $18.00 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $18.00 $18.00 $10.44 $18.00 $10.80 $18.00 $18.00 $18.00 N/A N/A 27000744 EAP Custom 27000744 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000745 EAP Custom 27000745 TUBES SALEM SUMP 48 LENG BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000748 EAP Custom 27000748 SCAPEL SURG W/HANDLE ATT BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27000760 EAP Custom 27000760 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27000762 EAP Custom 27000762 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $420.00 $311.00 $74.76 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $74.76 $420.00 $420.00 $311.72 $311.72 $323.74 $218.82 $87.53 $420.00 $168.00 $420.00 $420.00 $420.00 $420.00 $420.00 $315.00 $420.00 $420.00 $420.00 $210.00 $210.00 $332.64 $420.00 $336.00 $273.00 $420.00 $420.00 $243.60 $420.00 $252.00 $420.00 $420.00 $420.00 N/A N/A 27000765 EAP Custom 27000765 TUBE FEEDING NG 8FR 36IN ENTR BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27000766 EAP Custom 27000766 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $299.00 $221.50 $53.22 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $53.22 $299.00 $299.00 $221.92 $221.92 $230.47 $155.78 $62.31 $299.00 $119.60 $299.00 $299.00 $299.00 $299.00 $299.00 $224.25 $299.00 $299.00 $299.00 $149.50 $149.50 $236.81 $299.00 $239.20 $194.35 $299.00 $299.00 $173.42 $299.00 $179.40 $299.00 $299.00 $299.00 N/A N/A 27000770 EAP Custom 27000770 FILTER SET 0.22 MICRON BOTH IP/OP $7.00 $5.50 $1.25 $7.00 $7.00 $7.00 $7.00 $7.00 $7.00 $7.00 $1.25 $7.00 $7.00 $5.20 $5.20 $5.40 $3.65 $1.46 $7.00 $2.80 $7.00 $7.00 $7.00 $7.00 $7.00 $5.25 $7.00 $7.00 $7.00 $3.50 $3.50 $5.54 $7.00 $5.60 $4.55 $7.00 $7.00 $4.06 $7.00 $4.20 $7.00 $7.00 $7.00 N/A N/A 27000771 EAP Custom 27000771 TRAY CATHETER URETHRAL 14 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27000772 EAP Custom 27000772 TRAY DOUCH DISPOSABLE BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27000773 EAP Custom 27000773 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000774 EAP Custom 27000774 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000775 EAP Custom 27000775 TRAY THORACENTESIS DISPOS BOTH IP/OP $235.00 $174.00 $41.83 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $41.83 $235.00 $235.00 $174.42 $174.42 $181.14 $122.44 $48.98 $235.00 $94.00 $235.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $152.75 $235.00 $235.00 $136.30 $235.00 $141.00 $235.00 $235.00 $235.00 N/A N/A 27000776 EAP Custom 27000776 CENTRAL LINE DRESSING TRAY WITH BIOPATCH BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27000781 EAP Custom 27000781 "SUTURE, SILK, 0" BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27000784 EAP Custom 27000784 3ML POSIFLUSH SALINE SYRINGE BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27000787 EAP Custom 27000787 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27000788 EAP Custom 27000788 SLEEVE KNEE X-RAY DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27000789 EAP Custom 27000789 SLEEVE THIGH REGULAR DVT BOTH IP/OP $553.00 $409.50 $98.43 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $98.43 $553.00 $553.00 $410.44 $410.44 $426.25 $288.11 $115.25 $553.00 $221.20 $553.00 $553.00 $553.00 $553.00 $553.00 $414.75 $553.00 $553.00 $553.00 $276.50 $276.50 $437.98 $553.00 $442.40 $359.45 $553.00 $553.00 $320.74 $553.00 $331.80 $553.00 $553.00 $553.00 N/A N/A 27000790 EAP Custom 27000790 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $284.00 $210.50 $50.55 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $50.55 $284.00 $284.00 $210.78 $210.78 $218.91 $147.96 $59.19 $284.00 $113.60 $284.00 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $184.60 $284.00 $284.00 $164.72 $284.00 $170.40 $284.00 $284.00 $284.00 N/A N/A 27000791 EAP Custom 27000791 FIRST STEP SELECT OVERLAY BOTH IP/OP $131.00 $97.00 $23.32 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $23.32 $131.00 $131.00 $97.23 $97.23 $100.97 $68.25 $27.30 $131.00 $52.40 $131.00 $131.00 $131.00 $131.00 $131.00 $98.25 $131.00 $131.00 $131.00 $65.50 $65.50 $103.75 $131.00 $104.80 $85.15 $131.00 $131.00 $75.98 $131.00 $78.60 $131.00 $131.00 $131.00 N/A N/A 27000792 EAP Custom 27000792 TELEMETRY MED SUPPLIES BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 $150.00 $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A 27000793 EAP Custom 27000793 MED/SURG ISOLATION SUPPLIES BOTH IP/OP $281.00 $208.00 $50.02 $281.00 $281.00 $281.00 $281.00 $281.00 $281.00 $281.00 $50.02 $281.00 $281.00 $208.56 $208.56 $216.59 $146.40 $58.56 $281.00 $112.40 $281.00 $281.00 $281.00 $281.00 $281.00 $210.75 $281.00 $281.00 $281.00 $140.50 $140.50 $222.55 $281.00 $224.80 $182.65 $281.00 $281.00 $162.98 $281.00 $168.60 $281.00 $281.00 $281.00 N/A N/A 27000803 EAP Custom 27000803 DIALYSIS FILTER BOTH IP/OP $699.00 $517.50 $124.42 $699.00 $699.00 $699.00 $699.00 $699.00 $699.00 $699.00 $124.42 $699.00 $699.00 $518.80 $518.80 $538.79 $364.18 $145.68 $699.00 $279.60 $699.00 $699.00 $699.00 $699.00 $699.00 $524.25 $699.00 $699.00 $699.00 $349.50 $349.50 $553.61 $699.00 $559.20 $454.35 $699.00 $699.00 $405.42 $699.00 $419.40 $699.00 $699.00 $699.00 N/A N/A 27000810 EAP Custom 27000810 NEEDLE SPINAL 18GA BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27000811 EAP Custom 27000811 NEEDLE SPINAL STERILE 20G BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27000816 EAP Custom 27000816 CATHETER THORACIC 32FR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27000817 EAP Custom 27000817 CATHETER THORACIC 36FR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27000818 EAP HCPCS C1729 CATHETER FOLEY 30CC 28FR BOTH IP/OP $39.00 $29.00 $7.74 $39.00 $21.18 $21.18 $21.18 $21.18 $39.00 $39.00 $39.00 $8.13 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $39.00 $23.07 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $7.74 $39.00 $22.62 $39.00 $39.00 $39.00 $8.13 $39.00 N/A N/A 27000819 EAP Custom 27000819 ARTERY ARTERIAL CATHERIZA BOTH IP/OP $109.00 $81.00 $19.40 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $19.40 $109.00 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $43.60 $109.00 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $109.00 $109.00 $63.22 $109.00 $65.40 $109.00 $109.00 $109.00 N/A N/A 27000821 EAP Custom 27000821 TUBE SALEM SILICONE SIZE BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000822 EAP Custom 27000822 TUBES SALEM SUMP 48 LENG BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000826 EAP Custom 27000826 TRAY CATHETER INSRTN DULM BOTH IP/OP $434.00 $321.50 $77.25 $434.00 $434.00 $434.00 $434.00 $434.00 $434.00 $434.00 $77.25 $434.00 $434.00 $322.11 $322.11 $334.53 $226.11 $90.45 $434.00 $173.60 $434.00 $434.00 $434.00 $434.00 $434.00 $325.50 $434.00 $434.00 $434.00 $217.00 $217.00 $343.73 $434.00 $347.20 $282.10 $434.00 $434.00 $251.72 $434.00 $260.40 $434.00 $434.00 $434.00 N/A N/A 27000828 EAP Custom 27000828 CATHETER PERITONEAL ADULT BOTH IP/OP $210.00 $155.50 $37.38 $210.00 $210.00 $210.00 $210.00 $210.00 $210.00 $210.00 $37.38 $210.00 $210.00 $155.86 $155.86 $161.87 $109.41 $43.77 $210.00 $84.00 $210.00 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $136.50 $210.00 $210.00 $121.80 $210.00 $126.00 $210.00 $210.00 $210.00 N/A N/A 27000829 EAP Custom 27000829 TRICONNECTOR WITH VALVE BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27000830 EAP Custom 27000830 SET BLOOD ADMINISTRATION BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27000834 EAP Custom 27000834 KIT L.F. TRACH CARE BOTH IP/OP $237.00 $175.50 $42.19 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $42.19 $237.00 $237.00 $175.90 $175.90 $182.68 $123.48 $49.39 $237.00 $94.80 $237.00 $237.00 $237.00 $237.00 $237.00 $177.75 $237.00 $237.00 $237.00 $118.50 $118.50 $187.70 $237.00 $189.60 $154.05 $237.00 $237.00 $137.46 $237.00 $142.20 $237.00 $237.00 $237.00 N/A N/A 27000836 EAP Custom 27000836 KIT THORACOTOMY BOTH IP/OP $217.00 $161.00 $38.63 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $38.63 $217.00 $217.00 $161.06 $161.06 $167.26 $113.06 $45.23 $217.00 $86.80 $217.00 $217.00 $217.00 $217.00 $217.00 $162.75 $217.00 $217.00 $217.00 $108.50 $108.50 $171.86 $217.00 $173.60 $141.05 $217.00 $217.00 $125.86 $217.00 $130.20 $217.00 $217.00 $217.00 N/A N/A 27000841 EAP Custom 27000841 POUCH FECAL INCONTINENCE BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27000842 EAP Custom 27000842 KIT PRESSURE MONITORING T BOTH IP/OP $177.00 $131.00 $31.51 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $31.51 $177.00 $177.00 $131.37 $131.37 $136.43 $92.22 $36.89 $177.00 $70.80 $177.00 $177.00 $177.00 $177.00 $177.00 $132.75 $177.00 $177.00 $177.00 $88.50 $88.50 $140.18 $177.00 $141.60 $115.05 $177.00 $177.00 $102.66 $177.00 $106.20 $177.00 $177.00 $177.00 N/A N/A 27000843 EAP Custom 27000843 KIT TRANSDUCER MONITORING BOTH IP/OP $339.00 $251.00 $60.34 $339.00 $339.00 $339.00 $339.00 $339.00 $339.00 $339.00 $60.34 $339.00 $339.00 $251.61 $251.61 $261.30 $176.62 $70.65 $339.00 $135.60 $339.00 $339.00 $339.00 $339.00 $339.00 $254.25 $339.00 $339.00 $339.00 $169.50 $169.50 $268.49 $339.00 $271.20 $220.35 $339.00 $339.00 $196.62 $339.00 $203.40 $339.00 $339.00 $339.00 N/A N/A 27000844 EAP Custom 27000844 KIT PRESSURE MONITORING BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 $250.00 $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 27000846 EAP Custom 27000846 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27000847 EAP Custom 27000847 KIT PECUTANEOUS INTRODUCE BOTH IP/OP $298.00 $221.00 $53.04 $298.00 $298.00 $298.00 $298.00 $298.00 $298.00 $298.00 $53.04 $298.00 $298.00 $221.18 $221.18 $229.70 $155.26 $62.11 $298.00 $119.20 $298.00 $298.00 $298.00 $298.00 $298.00 $223.50 $298.00 $298.00 $298.00 $149.00 $149.00 $236.02 $298.00 $238.40 $193.70 $298.00 $298.00 $172.84 $298.00 $178.80 $298.00 $298.00 $298.00 N/A N/A 27000848 EAP Custom 27000848 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $420.00 $311.00 $74.76 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $74.76 $420.00 $420.00 $311.72 $311.72 $323.74 $218.82 $87.53 $420.00 $168.00 $420.00 $420.00 $420.00 $420.00 $420.00 $315.00 $420.00 $420.00 $420.00 $210.00 $210.00 $332.64 $420.00 $336.00 $273.00 $420.00 $420.00 $243.60 $420.00 $252.00 $420.00 $420.00 $420.00 N/A N/A 27000849 EAP Custom 27000849 CHEST UNIT DRY SUCTION SY BOTH IP/OP $316.00 $234.00 $56.25 $316.00 $316.00 $316.00 $316.00 $316.00 $316.00 $316.00 $56.25 $316.00 $316.00 $234.54 $234.54 $243.57 $164.64 $65.86 $316.00 $126.40 $316.00 $316.00 $316.00 $316.00 $316.00 $237.00 $316.00 $316.00 $316.00 $158.00 $158.00 $250.27 $316.00 $252.80 $205.40 $316.00 $316.00 $183.28 $316.00 $189.60 $316.00 $316.00 $316.00 N/A N/A 27000854 EAP Custom 27000854 TRAC DRESSING XL BOTH IP/OP $70.00 $52.00 $12.46 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $12.46 $70.00 $70.00 $51.95 $51.95 $53.96 $36.47 $14.59 $70.00 $28.00 $70.00 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $45.50 $70.00 $70.00 $40.60 $70.00 $42.00 $70.00 $70.00 $70.00 N/A N/A 27000857 EAP Custom 27000857 TUBE FEEDING NG 8FR 36IN ENTR BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27000858 EAP Custom 27000858 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $697.00 $516.00 $124.07 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $124.07 $697.00 $697.00 $517.31 $517.31 $537.25 $363.14 $145.26 $697.00 $278.80 $697.00 $697.00 $697.00 $697.00 $697.00 $522.75 $697.00 $697.00 $697.00 $348.50 $348.50 $552.02 $697.00 $557.60 $453.05 $697.00 $697.00 $404.26 $697.00 $418.20 $697.00 $697.00 $697.00 N/A N/A 27000859 EAP Custom 27000859 CATHETER SWAN GANZ BOTH IP/OP $726.00 $537.50 $129.23 $726.00 $726.00 $726.00 $726.00 $726.00 $726.00 $726.00 $129.23 $726.00 $726.00 $538.84 $538.84 $559.60 $378.25 $151.31 $726.00 $290.40 $726.00 $726.00 $726.00 $726.00 $726.00 $544.50 $726.00 $726.00 $726.00 $363.00 $363.00 $574.99 $726.00 $580.80 $471.90 $726.00 $726.00 $421.08 $726.00 $435.60 $726.00 $726.00 $726.00 N/A N/A 27000860 EAP Custom 27000860 DELIVERY SYSTEM CLOSED IN BOTH IP/OP $152.00 $112.50 $27.06 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $27.06 $152.00 $152.00 $112.81 $112.81 $117.16 $79.19 $31.68 $152.00 $60.80 $152.00 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $98.80 $152.00 $152.00 $88.16 $152.00 $91.20 $152.00 $152.00 $152.00 N/A N/A 27000866 EAP Custom 27000866 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000868 EAP Custom 27000868 TRAY URINE METER 18FR BOTH IP/OP $94.00 $70.00 $16.73 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $16.73 $94.00 $94.00 $69.77 $69.77 $72.46 $48.97 $19.59 $94.00 $37.60 $94.00 $94.00 $94.00 $94.00 $94.00 $70.50 $94.00 $94.00 $94.00 $47.00 $47.00 $74.45 $94.00 $75.20 $61.10 $94.00 $94.00 $54.52 $94.00 $56.40 $94.00 $94.00 $94.00 N/A N/A 27000869 EAP Custom 27000869 KIT VENTRICULOSTOMY BOTH IP/OP $763.00 $565.00 $135.81 $763.00 $763.00 $763.00 $763.00 $763.00 $763.00 $763.00 $135.81 $763.00 $763.00 $566.30 $566.30 $588.12 $397.52 $159.02 $763.00 $305.20 $763.00 $763.00 $763.00 $763.00 $763.00 $572.25 $763.00 $763.00 $763.00 $381.50 $381.50 $604.30 $763.00 $610.40 $495.95 $763.00 $763.00 $442.54 $763.00 $457.80 $763.00 $763.00 $763.00 N/A N/A 27000870 EAP Custom 27000870 TRAY THORACENTESIS DISPOS BOTH IP/OP $101.00 $75.00 $17.98 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $17.98 $101.00 $101.00 $74.96 $74.96 $77.85 $52.62 $21.05 $101.00 $40.40 $101.00 $101.00 $101.00 $101.00 $101.00 $75.75 $101.00 $101.00 $101.00 $50.50 $50.50 $79.99 $101.00 $80.80 $65.65 $101.00 $101.00 $58.58 $101.00 $60.60 $101.00 $101.00 $101.00 N/A N/A 27000872 EAP Custom 27000872 CENTRAL LINE DRESSING TRAY WITH BIOPATCH BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27000880 EAP Custom 27000880 FEMORAL ARTERIAL LINE KIT BOTH IP/OP $178.00 $132.00 $31.68 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $31.68 $178.00 $178.00 $132.11 $132.11 $137.20 $92.74 $37.10 $178.00 $71.20 $178.00 $178.00 $178.00 $178.00 $178.00 $133.50 $178.00 $178.00 $178.00 $89.00 $89.00 $140.98 $178.00 $142.40 $115.70 $178.00 $178.00 $103.24 $178.00 $106.80 $178.00 $178.00 $178.00 N/A N/A 27000881 EAP Custom 27000881 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27000882 EAP Custom 27000882 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27000883 EAP Custom 27000883 SLEEVE THIGH REGULAR DVT BOTH IP/OP $553.00 $409.50 $98.43 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $98.43 $553.00 $553.00 $410.44 $410.44 $426.25 $288.11 $115.25 $553.00 $221.20 $553.00 $553.00 $553.00 $553.00 $553.00 $414.75 $553.00 $553.00 $553.00 $276.50 $276.50 $437.98 $553.00 $442.40 $359.45 $553.00 $553.00 $320.74 $553.00 $331.80 $553.00 $553.00 $553.00 N/A N/A 27000884 EAP Custom 27000884 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $284.00 $210.50 $50.55 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $50.55 $284.00 $284.00 $210.78 $210.78 $218.91 $147.96 $59.19 $284.00 $113.60 $284.00 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $184.60 $284.00 $284.00 $164.72 $284.00 $170.40 $284.00 $284.00 $284.00 N/A N/A 27000886 EAP Custom 27000886 MED/SURG ISOLATION SUPPLIES BOTH IP/OP $281.00 $208.00 $50.02 $281.00 $281.00 $281.00 $281.00 $281.00 $281.00 $281.00 $50.02 $281.00 $281.00 $208.56 $208.56 $216.59 $146.40 $58.56 $281.00 $112.40 $281.00 $281.00 $281.00 $281.00 $281.00 $210.75 $281.00 $281.00 $281.00 $140.50 $140.50 $222.55 $281.00 $224.80 $182.65 $281.00 $281.00 $162.98 $281.00 $168.60 $281.00 $281.00 $281.00 N/A N/A 27000887 EAP Custom 27000887 MED/PRI SUPPLIES BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 27000888 EAP Custom 27000888 MED/SURG SEMI-SUPPLIES BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 27000903 EAP Custom 27000903 CATHETER THORACIC 32FR BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27000904 EAP Custom 27000904 CATHETER THORACIC 36FR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27000905 EAP HCPCS C1729 CATHETER FOLEY 16FR BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 27000906 EAP HCPCS C1729 CATHETER COUDE SIZE 14FR BOTH IP/OP $109.00 $81.00 $21.63 $109.00 $59.19 $59.19 $59.19 $59.19 $109.00 $109.00 $109.00 $22.72 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $109.00 $64.47 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $21.63 $109.00 $63.22 $109.00 $109.00 $109.00 $22.72 $109.00 N/A N/A 27000907 EAP HCPCS C1729 CATHETER COUDE SIZE 16FR BOTH IP/OP $109.00 $81.00 $21.63 $109.00 $59.19 $59.19 $59.19 $59.19 $109.00 $109.00 $109.00 $22.72 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $109.00 $64.47 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $21.63 $109.00 $63.22 $109.00 $109.00 $109.00 $22.72 $109.00 N/A N/A 27000908 EAP Custom 27000908 ARTERY ARTERIAL CATHERIZA BOTH IP/OP $109.00 $81.00 $19.40 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $19.40 $109.00 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $43.60 $109.00 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $109.00 $109.00 $63.22 $109.00 $65.40 $109.00 $109.00 $109.00 N/A N/A 27000909 EAP Custom 27000909 ARTERY RADIAL CATHERIZATI BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27000910 EAP Custom 27000910 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000911 EAP Custom 27000911 TUBE SALEM SILICONE SIZE BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000912 EAP Custom 27000912 TUBES SALEM SUMP 48 LENG BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27000915 EAP Custom 27000915 TRAY CATHETER INSRTN DULM BOTH IP/OP $937.00 $693.50 $166.79 $937.00 $937.00 $937.00 $937.00 $937.00 $937.00 $937.00 $166.79 $937.00 $937.00 $695.44 $695.44 $722.24 $488.18 $195.28 $937.00 $374.80 $937.00 $937.00 $937.00 $937.00 $937.00 $702.75 $937.00 $937.00 $937.00 $468.50 $468.50 $742.10 $937.00 $749.60 $609.05 $937.00 $937.00 $543.46 $937.00 $562.20 $937.00 $937.00 $937.00 N/A N/A 27000916 EAP Custom 27000916 SCAPLE SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27000918 EAP Custom 27000918 TRICONNECTOR WITH VALVE BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27000922 EAP Custom 27000922 POUCH ACTIVE LIFE SQUIB DRAIN BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27000926 EAP Custom 27000926 KIT THORACOTOMY BOTH IP/OP $210.00 $155.50 $37.38 $210.00 $210.00 $210.00 $210.00 $210.00 $210.00 $210.00 $37.38 $210.00 $210.00 $155.86 $155.86 $161.87 $109.41 $43.77 $210.00 $84.00 $210.00 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $136.50 $210.00 $210.00 $121.80 $210.00 $126.00 $210.00 $210.00 $210.00 N/A N/A 27000931 EAP Custom 27000931 POUCH FECAL INCONTINENCE BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27000932 EAP Custom 27000932 KIT PRESSURE MONITORING T BOTH IP/OP $177.00 $131.00 $31.51 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $31.51 $177.00 $177.00 $131.37 $131.37 $136.43 $92.22 $36.89 $177.00 $70.80 $177.00 $177.00 $177.00 $177.00 $177.00 $132.75 $177.00 $177.00 $177.00 $88.50 $88.50 $140.18 $177.00 $141.60 $115.05 $177.00 $177.00 $102.66 $177.00 $106.20 $177.00 $177.00 $177.00 N/A N/A 27000933 EAP Custom 27000933 KIT PRESSURE MONITORING BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 $250.00 $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 27000934 EAP Custom 27000934 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27000935 EAP Custom 27000935 NEEDLE PORT-CATH 20GA X 1 BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27000936 EAP Custom 27000936 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $455.00 $337.00 $80.99 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $80.99 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 27000941 EAP Custom 27000941 DRESSING X-LARGE BOTH IP/OP $321.00 $238.00 $57.14 $321.00 $321.00 $321.00 $321.00 $321.00 $321.00 $321.00 $57.14 $321.00 $321.00 $238.25 $238.25 $247.43 $167.24 $66.90 $321.00 $128.40 $321.00 $321.00 $321.00 $321.00 $321.00 $240.75 $321.00 $321.00 $321.00 $160.50 $160.50 $254.23 $321.00 $256.80 $208.65 $321.00 $321.00 $186.18 $321.00 $192.60 $321.00 $321.00 $321.00 N/A N/A 27000942 EAP Custom 27000942 TRAC DRESSING XL BOTH IP/OP $157.00 $116.50 $27.95 $157.00 $157.00 $157.00 $157.00 $157.00 $157.00 $157.00 $27.95 $157.00 $157.00 $116.53 $116.53 $121.02 $81.80 $32.72 $157.00 $62.80 $157.00 $157.00 $157.00 $157.00 $157.00 $117.75 $157.00 $157.00 $157.00 $78.50 $78.50 $124.34 $157.00 $125.60 $102.05 $157.00 $157.00 $91.06 $157.00 $94.20 $157.00 $157.00 $157.00 N/A N/A 27000945 EAP Custom 27000945 TUBE FEEDING NG 8FR 36IN ENTRI BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27000946 EAP Custom 27000946 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $697.00 $516.00 $124.07 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $124.07 $697.00 $697.00 $517.31 $517.31 $537.25 $363.14 $145.26 $697.00 $278.80 $697.00 $697.00 $697.00 $697.00 $697.00 $522.75 $697.00 $697.00 $697.00 $348.50 $348.50 $552.02 $697.00 $557.60 $453.05 $697.00 $697.00 $404.26 $697.00 $418.20 $697.00 $697.00 $697.00 N/A N/A 27000949 EAP Custom 27000949 FILTER SET 0.22 MICRON BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27000951 EAP Custom 27000951 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000952 EAP Custom 27000952 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27000953 EAP Custom 27000953 TRAY THORACENTESIS DISPOS BOTH IP/OP $235.00 $174.00 $41.83 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $41.83 $235.00 $235.00 $174.42 $174.42 $181.14 $122.44 $48.98 $235.00 $94.00 $235.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $152.75 $235.00 $235.00 $136.30 $235.00 $141.00 $235.00 $235.00 $235.00 N/A N/A 27000955 EAP Custom 27000955 CENTRAL LINE DRESSING TRAY WITH BIOPATCH BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27000962 EAP Custom 27000962 SLEEVE KNEE REGULAR DVT BOTH IP/OP $370.00 $274.00 $65.86 $370.00 $370.00 $370.00 $370.00 $370.00 $370.00 $370.00 $65.86 $370.00 $370.00 $274.61 $274.61 $285.20 $192.77 $77.11 $370.00 $148.00 $370.00 $370.00 $370.00 $370.00 $370.00 $277.50 $370.00 $370.00 $370.00 $185.00 $185.00 $293.04 $370.00 $296.00 $240.50 $370.00 $370.00 $214.60 $370.00 $222.00 $370.00 $370.00 $370.00 N/A N/A 27000963 EAP Custom 27000963 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $450.00 $333.00 $80.10 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $80.10 $450.00 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $180.00 $450.00 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $450.00 $450.00 $261.00 $450.00 $270.00 $450.00 $450.00 $450.00 N/A N/A 27000964 EAP Custom 27000964 SLEEVE THIGH REGULAR DVT BOTH IP/OP $529.00 $391.50 $94.16 $529.00 $529.00 $529.00 $529.00 $529.00 $529.00 $529.00 $94.16 $529.00 $529.00 $392.62 $392.62 $407.75 $275.61 $110.25 $529.00 $211.60 $529.00 $529.00 $529.00 $529.00 $529.00 $396.75 $529.00 $529.00 $529.00 $264.50 $264.50 $418.97 $529.00 $423.20 $343.85 $529.00 $529.00 $306.82 $529.00 $317.40 $529.00 $529.00 $529.00 N/A N/A 27000965 EAP Custom 27000965 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $488.00 $361.50 $86.86 $488.00 $488.00 $488.00 $488.00 $488.00 $488.00 $488.00 $86.86 $488.00 $488.00 $362.19 $362.19 $376.15 $254.25 $101.70 $488.00 $195.20 $488.00 $488.00 $488.00 $488.00 $488.00 $366.00 $488.00 $488.00 $488.00 $244.00 $244.00 $386.50 $488.00 $390.40 $317.20 $488.00 $488.00 $283.04 $488.00 $292.80 $488.00 $488.00 $488.00 N/A N/A 27000968 EAP Custom 27000968 DIALYSIS FLUID BAG BOTH IP/OP $166.00 $123.00 $29.55 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $29.55 $166.00 $166.00 $123.21 $123.21 $127.95 $86.49 $34.60 $166.00 $66.40 $166.00 $166.00 $166.00 $166.00 $166.00 $124.50 $166.00 $166.00 $166.00 $83.00 $83.00 $131.47 $166.00 $132.80 $107.90 $166.00 $166.00 $96.28 $166.00 $99.60 $166.00 $166.00 $166.00 N/A N/A 27000969 EAP Custom 27000969 DIALYSIS FILTER BOTH IP/OP $699.00 $517.50 $124.42 $699.00 $699.00 $699.00 $699.00 $699.00 $699.00 $699.00 $124.42 $699.00 $699.00 $518.80 $518.80 $538.79 $364.18 $145.68 $699.00 $279.60 $699.00 $699.00 $699.00 $699.00 $699.00 $524.25 $699.00 $699.00 $699.00 $349.50 $349.50 $553.61 $699.00 $559.20 $454.35 $699.00 $699.00 $405.42 $699.00 $419.40 $699.00 $699.00 $699.00 N/A N/A 27000975 EAP Custom 27000975 IOBAN 2 DRAPE INCISE SMAL BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27000977 EAP Custom 27000977 IOBAN 2 DRAPE INCISE LARG BOTH IP/OP $462.00 $342.00 $82.24 $462.00 $462.00 $462.00 $462.00 $462.00 $462.00 $462.00 $82.24 $462.00 $462.00 $342.90 $342.90 $356.11 $240.70 $96.29 $462.00 $184.80 $462.00 $462.00 $462.00 $462.00 $462.00 $346.50 $462.00 $462.00 $462.00 $231.00 $231.00 $365.90 $462.00 $369.60 $300.30 $462.00 $462.00 $267.96 $462.00 $277.20 $462.00 $462.00 $462.00 N/A N/A 27000978 EAP Custom 27000978 NEEDLE SPINAL 18GA BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27000982 EAP Custom 27000982 CATHETER THORACIC 32FR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27000983 EAP Custom 27000983 CATHETER THORACIC 36FR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27000984 EAP Custom 27000984 CATHETER URETHRAL TWO-EYE BOTH IP/OP $7.00 $5.50 $1.25 $7.00 $7.00 $7.00 $7.00 $7.00 $7.00 $7.00 $1.25 $7.00 $7.00 $5.20 $5.20 $5.40 $3.65 $1.46 $7.00 $2.80 $7.00 $7.00 $7.00 $7.00 $7.00 $5.25 $7.00 $7.00 $7.00 $3.50 $3.50 $5.54 $7.00 $5.60 $4.55 $7.00 $7.00 $4.06 $7.00 $4.20 $7.00 $7.00 $7.00 N/A N/A 27000985 EAP HCPCS C1729 CATHETER FOLEY 5CC 14FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27000986 EAP HCPCS C1729 CATHETER FOLEY 16FR BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 27000987 EAP HCPCS C1729 CATHETER FOLEY 5CC 18FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27000988 EAP HCPCS C1729 CATHETER FOLEY 3-WAY 30CC BOTH IP/OP $37.00 $27.50 $7.34 $37.00 $20.09 $20.09 $20.09 $20.09 $37.00 $37.00 $37.00 $7.71 $37.00 $27.46 $27.46 $28.52 $19.28 $7.71 $37.00 $37.00 $21.89 $37.00 $37.00 $37.00 $37.00 $27.75 $37.00 $37.00 $37.00 $18.50 $18.50 $29.30 $37.00 $29.60 $24.05 $7.34 $37.00 $21.46 $37.00 $37.00 $37.00 $7.71 $37.00 N/A N/A 27000989 EAP Custom 27000989 CATHETER VENTRICULAR 20CM BOTH IP/OP $313.00 $232.00 $55.71 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $55.71 $313.00 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $125.20 $313.00 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $313.00 $313.00 $181.54 $313.00 $187.80 $313.00 $313.00 $313.00 N/A N/A 27000990 EAP Custom 27000990 CATHETER EDM II BECKER BOTH IP/OP $617.00 $457.00 $109.83 $617.00 $617.00 $617.00 $617.00 $617.00 $617.00 $617.00 $109.83 $617.00 $617.00 $457.94 $457.94 $475.58 $321.46 $128.59 $617.00 $246.80 $617.00 $617.00 $617.00 $617.00 $617.00 $462.75 $617.00 $617.00 $617.00 $308.50 $308.50 $488.66 $617.00 $493.60 $401.05 $617.00 $617.00 $357.86 $617.00 $370.20 $617.00 $617.00 $617.00 N/A N/A 27000991 EAP Custom 27000991 ARTERY ARTERIAL CATHERIZA BOTH IP/OP $109.00 $81.00 $19.40 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $19.40 $109.00 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $43.60 $109.00 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $109.00 $109.00 $63.22 $109.00 $65.40 $109.00 $109.00 $109.00 N/A N/A 27000992 EAP Custom 27000992 ARTERY RADIAL CATHERIZATI BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27000993 EAP Custom 27000993 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000994 EAP Custom 27000994 TUBE SALEM SILICONE SIZE BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000995 EAP Custom 27000995 TUBES SALEM SUMP 48 LENG BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27000996 EAP Custom 27000996 KIT PERCUATANE TRACHE 7FR BOTH IP/OP "$1,219.00" $902.50 $216.98 "$1,219.00" "$1,219.00" "$1,219.00" "$1,219.00" "$1,219.00" "$1,219.00" "$1,219.00" $216.98 "$1,219.00" "$1,219.00" $904.74 $904.74 $939.61 $635.10 $254.05 "$1,219.00" $487.60 "$1,219.00" "$1,219.00" "$1,219.00" "$1,219.00" "$1,219.00" $914.25 "$1,219.00" "$1,219.00" "$1,219.00" $609.50 $609.50 $965.45 "$1,219.00" $975.20 $792.35 "$1,219.00" "$1,219.00" $707.02 "$1,219.00" $731.40 "$1,219.00" "$1,219.00" "$1,219.00" N/A N/A 27000997 EAP Custom 27000997 KIT PERCUATANE TRACHE 8FR BOTH IP/OP "$1,424.00" "$1,054.00" $253.47 "$1,424.00" "$1,424.00" "$1,424.00" "$1,424.00" "$1,424.00" "$1,424.00" "$1,424.00" $253.47 "$1,424.00" "$1,424.00" "$1,056.89" "$1,056.89" "$1,097.62" $741.90 $296.78 "$1,424.00" $569.60 "$1,424.00" "$1,424.00" "$1,424.00" "$1,424.00" "$1,424.00" "$1,068.00" "$1,424.00" "$1,424.00" "$1,424.00" $712.00 $712.00 "$1,127.81" "$1,424.00" "$1,139.20" $925.60 "$1,424.00" "$1,424.00" $825.92 "$1,424.00" $854.40 "$1,424.00" "$1,424.00" "$1,424.00" N/A N/A 27000998 EAP Custom 27000998 KIT TRACHEOTOMY CARE STER BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27001001 EAP Custom 27001001 BAG DRAINAGE BECKER BOTH IP/OP $213.00 $158.00 $37.91 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $37.91 $213.00 $213.00 $158.09 $158.09 $164.18 $110.97 $44.39 $213.00 $85.20 $213.00 $213.00 $213.00 $213.00 $213.00 $159.75 $213.00 $213.00 $213.00 $106.50 $106.50 $168.70 $213.00 $170.40 $138.45 $213.00 $213.00 $123.54 $213.00 $127.80 $213.00 $213.00 $213.00 N/A N/A 27001002 EAP Custom 27001002 TRAY CATHETER INSRTN DULM BOTH IP/OP $937.00 $693.50 $166.79 $937.00 $937.00 $937.00 $937.00 $937.00 $937.00 $937.00 $166.79 $937.00 $937.00 $695.44 $695.44 $722.24 $488.18 $195.28 $937.00 $374.80 $937.00 $937.00 $937.00 $937.00 $937.00 $702.75 $937.00 $937.00 $937.00 $468.50 $468.50 $742.10 $937.00 $749.60 $609.05 $937.00 $937.00 $543.46 $937.00 $562.20 $937.00 $937.00 $937.00 N/A N/A 27001006 EAP Custom 27001006 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27001007 EAP Custom 27001007 SCAPLE SURG W/HANDLE ATTA BOTH IP/OP $152.00 $112.50 $27.06 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $27.06 $152.00 $152.00 $112.81 $112.81 $117.16 $79.19 $31.68 $152.00 $60.80 $152.00 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $98.80 $152.00 $152.00 $88.16 $152.00 $91.20 $152.00 $152.00 $152.00 N/A N/A 27001009 EAP Custom 27001009 TRICONNECTOR WITH VALVE BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27001012 EAP Custom 27001012 CREAM BAZA 5OZ BOTH IP/OP $63.00 $47.00 $11.21 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $11.21 $63.00 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $25.20 $63.00 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $31.50 $31.50 $49.90 $63.00 $50.40 $40.95 $63.00 $63.00 $36.54 $63.00 $37.80 $63.00 $63.00 $63.00 N/A N/A 27001016 EAP Custom 27001016 VALVE ANTI-REFLUX SALEM S BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 27001017 EAP Custom 27001017 KIT L.F. TRACH CARE BOTH IP/OP $237.00 $175.50 $42.19 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $42.19 $237.00 $237.00 $175.90 $175.90 $182.68 $123.48 $49.39 $237.00 $94.80 $237.00 $237.00 $237.00 $237.00 $237.00 $177.75 $237.00 $237.00 $237.00 $118.50 $118.50 $187.70 $237.00 $189.60 $154.05 $237.00 $237.00 $137.46 $237.00 $142.20 $237.00 $237.00 $237.00 N/A N/A 27001025 EAP Custom 27001025 POUCH FECAL INCONTINENCE BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27001026 EAP Custom 27001026 KIT PRESSURE MONITORING T BOTH IP/OP $177.00 $131.00 $31.51 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $31.51 $177.00 $177.00 $131.37 $131.37 $136.43 $92.22 $36.89 $177.00 $70.80 $177.00 $177.00 $177.00 $177.00 $177.00 $132.75 $177.00 $177.00 $177.00 $88.50 $88.50 $140.18 $177.00 $141.60 $115.05 $177.00 $177.00 $102.66 $177.00 $106.20 $177.00 $177.00 $177.00 N/A N/A 27001027 EAP Custom 27001027 TRANSDUCER DISP FOR ICP BOTH IP/OP $79.00 $58.50 $14.06 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $14.06 $79.00 $79.00 $58.63 $58.63 $60.89 $41.16 $16.46 $79.00 $31.60 $79.00 $79.00 $79.00 $79.00 $79.00 $59.25 $79.00 $79.00 $79.00 $39.50 $39.50 $62.57 $79.00 $63.20 $51.35 $79.00 $79.00 $45.82 $79.00 $47.40 $79.00 $79.00 $79.00 N/A N/A 27001028 EAP Custom 27001028 KIT TRANSDUCER MONITORING BOTH IP/OP $339.00 $251.00 $60.34 $339.00 $339.00 $339.00 $339.00 $339.00 $339.00 $339.00 $60.34 $339.00 $339.00 $251.61 $251.61 $261.30 $176.62 $70.65 $339.00 $135.60 $339.00 $339.00 $339.00 $339.00 $339.00 $254.25 $339.00 $339.00 $339.00 $169.50 $169.50 $268.49 $339.00 $271.20 $220.35 $339.00 $339.00 $196.62 $339.00 $203.40 $339.00 $339.00 $339.00 N/A N/A 27001029 EAP Custom 27001029 KIT PRESSURE MONITORING BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 $250.00 $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 27001031 EAP Custom 27001031 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27001032 EAP Custom 27001032 KIT PECUTANEOUS INTRODUCE BOTH IP/OP $298.00 $221.00 $53.04 $298.00 $298.00 $298.00 $298.00 $298.00 $298.00 $298.00 $53.04 $298.00 $298.00 $221.18 $221.18 $229.70 $155.26 $62.11 $298.00 $119.20 $298.00 $298.00 $298.00 $298.00 $298.00 $223.50 $298.00 $298.00 $298.00 $149.00 $149.00 $236.02 $298.00 $238.40 $193.70 $298.00 $298.00 $172.84 $298.00 $178.80 $298.00 $298.00 $298.00 N/A N/A 27001033 EAP Custom 27001033 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $455.00 $337.00 $80.99 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $80.99 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 27001034 EAP Custom 27001034 CHEST UNIT DRY SUCTION SY BOTH IP/OP $333.00 $246.50 $59.27 $333.00 $333.00 $333.00 $333.00 $333.00 $333.00 $333.00 $59.27 $333.00 $333.00 $247.15 $247.15 $256.68 $173.49 $69.40 $333.00 $133.20 $333.00 $333.00 $333.00 $333.00 $333.00 $249.75 $333.00 $333.00 $333.00 $166.50 $166.50 $263.74 $333.00 $266.40 $216.45 $333.00 $333.00 $193.14 $333.00 $199.80 $333.00 $333.00 $333.00 N/A N/A 27001035 EAP Custom 27001035 BAG AUTO-TRANSFUSION PLE BOTH IP/OP $245.00 $181.50 $43.61 $245.00 $245.00 $245.00 $245.00 $245.00 $245.00 $245.00 $43.61 $245.00 $245.00 $181.84 $181.84 $188.85 $127.65 $51.06 $245.00 $98.00 $245.00 $245.00 $245.00 $245.00 $245.00 $183.75 $245.00 $245.00 $245.00 $122.50 $122.50 $194.04 $245.00 $196.00 $159.25 $245.00 $245.00 $142.10 $245.00 $147.00 $245.00 $245.00 $245.00 N/A N/A 27001040 EAP Custom 27001040 DRESSING X-LARGE BOTH IP/OP $682.00 $505.00 $121.40 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $121.40 $682.00 $682.00 $506.18 $506.18 $525.69 $355.32 $142.14 $682.00 $272.80 $682.00 $682.00 $682.00 $682.00 $682.00 $511.50 $682.00 $682.00 $682.00 $341.00 $341.00 $540.14 $682.00 $545.60 $443.30 $682.00 $682.00 $395.56 $682.00 $409.20 $682.00 $682.00 $682.00 N/A N/A 27001041 EAP Custom 27001041 TRAC DRESSING XL BOTH IP/OP $170.00 $126.00 $30.26 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $30.26 $170.00 $170.00 $126.17 $126.17 $131.04 $88.57 $35.43 $170.00 $68.00 $170.00 $170.00 $170.00 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $110.50 $170.00 $170.00 $98.60 $170.00 $102.00 $170.00 $170.00 $170.00 N/A N/A 27001044 EAP Custom 27001044 TUBE FEEDING NG 8FR 36IN ENTR BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27001045 EAP Custom 27001045 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $697.00 $516.00 $124.07 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $124.07 $697.00 $697.00 $517.31 $517.31 $537.25 $363.14 $145.26 $697.00 $278.80 $697.00 $697.00 $697.00 $697.00 $697.00 $522.75 $697.00 $697.00 $697.00 $348.50 $348.50 $552.02 $697.00 $557.60 $453.05 $697.00 $697.00 $404.26 $697.00 $418.20 $697.00 $697.00 $697.00 N/A N/A 27001046 EAP Custom 27001046 WIRE GUIDE DUAL PURPOSE BOTH IP/OP $362.00 $268.00 $64.44 $362.00 $362.00 $362.00 $362.00 $362.00 $362.00 $362.00 $64.44 $362.00 $362.00 $268.68 $268.68 $279.03 $188.60 $75.44 $362.00 $144.80 $362.00 $362.00 $362.00 $362.00 $362.00 $271.50 $362.00 $362.00 $362.00 $181.00 $181.00 $286.70 $362.00 $289.60 $235.30 $362.00 $362.00 $209.96 $362.00 $217.20 $362.00 $362.00 $362.00 N/A N/A 27001047 EAP Custom 27001047 KIT MONITORING INTRACRANI BOTH IP/OP $426.00 $315.50 $75.83 $426.00 $426.00 $426.00 $426.00 $426.00 $426.00 $426.00 $75.83 $426.00 $426.00 $316.18 $316.18 $328.36 $221.95 $88.78 $426.00 $170.40 $426.00 $426.00 $426.00 $426.00 $426.00 $319.50 $426.00 $426.00 $426.00 $213.00 $213.00 $337.39 $426.00 $340.80 $276.90 $426.00 $426.00 $247.08 $426.00 $255.60 $426.00 $426.00 $426.00 N/A N/A 27001049 EAP Custom 27001049 CATHETER SWAN GANZ BOTH IP/OP $309.00 $229.00 $55.00 $309.00 $309.00 $309.00 $309.00 $309.00 $309.00 $309.00 $55.00 $309.00 $309.00 $229.34 $229.34 $238.18 $160.99 $64.40 $309.00 $123.60 $309.00 $309.00 $309.00 $309.00 $309.00 $231.75 $309.00 $309.00 $309.00 $154.50 $154.50 $244.73 $309.00 $247.20 $200.85 $309.00 $309.00 $179.22 $309.00 $185.40 $309.00 $309.00 $309.00 N/A N/A 27001050 EAP Custom 27001050 DELIVERY SYSTEM CLOSED IN BOTH IP/OP $152.00 $112.50 $27.06 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $27.06 $152.00 $152.00 $112.81 $112.81 $117.16 $79.19 $31.68 $152.00 $60.80 $152.00 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $98.80 $152.00 $152.00 $88.16 $152.00 $91.20 $152.00 $152.00 $152.00 N/A N/A 27001051 EAP Custom 27001051 PROBE V-PACING BOTH IP/OP "$1,277.00" $945.00 $227.31 "$1,277.00" "$1,277.00" "$1,277.00" "$1,277.00" "$1,277.00" "$1,277.00" "$1,277.00" $227.31 "$1,277.00" "$1,277.00" $947.79 $947.79 $984.31 $665.32 $266.14 "$1,277.00" $510.80 "$1,277.00" "$1,277.00" "$1,277.00" "$1,277.00" "$1,277.00" $957.75 "$1,277.00" "$1,277.00" "$1,277.00" $638.50 $638.50 "$1,011.38" "$1,277.00" "$1,021.60" $830.05 "$1,277.00" "$1,277.00" $740.66 "$1,277.00" $766.20 "$1,277.00" "$1,277.00" "$1,277.00" N/A N/A 27001055 EAP Custom 27001055 FILTER SET 0.22 MICRON BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27001057 EAP Custom 27001057 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27001058 EAP Custom 27001058 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27001060 EAP Custom 27001060 TRAY URINE METER 18FR BOTH IP/OP $94.00 $70.00 $16.73 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $16.73 $94.00 $94.00 $69.77 $69.77 $72.46 $48.97 $19.59 $94.00 $37.60 $94.00 $94.00 $94.00 $94.00 $94.00 $70.50 $94.00 $94.00 $94.00 $47.00 $47.00 $74.45 $94.00 $75.20 $61.10 $94.00 $94.00 $54.52 $94.00 $56.40 $94.00 $94.00 $94.00 N/A N/A 27001061 EAP Custom 27001061 KIT VENTRICULOSTOMY BOTH IP/OP "$1,782.00" "$1,319.00" $317.20 "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" $317.20 "$1,782.00" "$1,782.00" "$1,322.60" "$1,322.60" "$1,373.57" $928.42 $371.39 "$1,782.00" $712.80 "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,336.50" "$1,782.00" "$1,782.00" "$1,782.00" $891.00 $891.00 "$1,411.34" "$1,782.00" "$1,425.60" "$1,158.30" "$1,782.00" "$1,782.00" "$1,033.56" "$1,782.00" "$1,069.20" "$1,782.00" "$1,782.00" "$1,782.00" N/A N/A 27001062 EAP Custom 27001062 TRAY THORACENTESIS DISPOS BOTH IP/OP $101.00 $75.00 $17.98 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $17.98 $101.00 $101.00 $74.96 $74.96 $77.85 $52.62 $21.05 $101.00 $40.40 $101.00 $101.00 $101.00 $101.00 $101.00 $75.75 $101.00 $101.00 $101.00 $50.50 $50.50 $79.99 $101.00 $80.80 $65.65 $101.00 $101.00 $58.58 $101.00 $60.60 $101.00 $101.00 $101.00 N/A N/A 27001063 EAP Custom 27001063 CENTRAL LINE DRESSING TRAY WITH BIOPATCH BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27001064 EAP Custom 27001064 BAG DRAINAGE URETERAL BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27001078 EAP Custom 27001078 FEMORAL ARTERIAL LINE KIT BOTH IP/OP $172.00 $127.50 $30.62 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $30.62 $172.00 $172.00 $127.66 $127.66 $132.58 $89.61 $35.85 $172.00 $68.80 $172.00 $172.00 $172.00 $172.00 $172.00 $129.00 $172.00 $172.00 $172.00 $86.00 $86.00 $136.22 $172.00 $137.60 $111.80 $172.00 $172.00 $99.76 $172.00 $103.20 $172.00 $172.00 $172.00 N/A N/A 27001079 EAP Custom 27001079 KIT PERCUTANE TRACHE 9FR BOTH IP/OP "$3,007.00" "$2,225.50" $535.25 "$3,007.00" "$3,007.00" "$3,007.00" "$3,007.00" "$3,007.00" "$3,007.00" "$3,007.00" $535.25 "$3,007.00" "$3,007.00" "$2,231.80" "$2,231.80" "$2,317.80" "$1,566.65" $626.69 "$3,007.00" "$1,202.80" "$3,007.00" "$3,007.00" "$3,007.00" "$3,007.00" "$3,007.00" "$2,255.25" "$3,007.00" "$3,007.00" "$3,007.00" "$1,503.50" "$1,503.50" "$2,381.54" "$3,007.00" "$2,405.60" "$1,954.55" "$3,007.00" "$3,007.00" "$1,744.06" "$3,007.00" "$1,804.20" "$3,007.00" "$3,007.00" "$3,007.00" N/A N/A 27001082 EAP Custom 27001082 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27001083 EAP Custom 27001083 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27001084 EAP Custom 27001084 SLEEVE THIGH REGULAR DVT BOTH IP/OP $553.00 $409.50 $98.43 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $98.43 $553.00 $553.00 $410.44 $410.44 $426.25 $288.11 $115.25 $553.00 $221.20 $553.00 $553.00 $553.00 $553.00 $553.00 $414.75 $553.00 $553.00 $553.00 $276.50 $276.50 $437.98 $553.00 $442.40 $359.45 $553.00 $553.00 $320.74 $553.00 $331.80 $553.00 $553.00 $553.00 N/A N/A 27001085 EAP Custom 27001085 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $284.00 $210.50 $50.55 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $50.55 $284.00 $284.00 $210.78 $210.78 $218.91 $147.96 $59.19 $284.00 $113.60 $284.00 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $184.60 $284.00 $284.00 $164.72 $284.00 $170.40 $284.00 $284.00 $284.00 N/A N/A 27001086 EAP Custom 27001086 FIRST STEP SELECT OVERLAY BOTH IP/OP $60.00 $44.50 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 $60.00 $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A 27001096 EAP Custom 27001096 DIALYSIS FILTER BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 $300.00 $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 27001107 EAP Custom 27001107 CATHETER THORACIC 32FR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27001108 EAP Custom 27001108 CATHETER THORACIC 36FR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27001109 EAP HCPCS C1729 CATHETER FOLEY 5CC 14FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27001110 EAP HCPCS C1729 CATHETER FOLEY 16FR BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 27001111 EAP HCPCS C1729 CATHETER FOLEY 5CC 18FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27001112 EAP HCPCS C1729 CATHETER FOLEY 30CC 28FR BOTH IP/OP $39.00 $29.00 $7.74 $39.00 $21.18 $21.18 $21.18 $21.18 $39.00 $39.00 $39.00 $8.13 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $39.00 $23.07 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $7.74 $39.00 $22.62 $39.00 $39.00 $39.00 $8.13 $39.00 N/A N/A 27001113 EAP Custom 27001113 CATHETER VENTRICULAR 20CM BOTH IP/OP $735.00 $544.00 $130.83 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $130.83 $735.00 $735.00 $545.52 $545.52 $566.54 $382.94 $153.18 $735.00 $294.00 $735.00 $735.00 $735.00 $735.00 $735.00 $551.25 $735.00 $735.00 $735.00 $367.50 $367.50 $582.12 $735.00 $588.00 $477.75 $735.00 $735.00 $426.30 $735.00 $441.00 $735.00 $735.00 $735.00 N/A N/A 27001114 EAP Custom 27001114 CATHETER EDM II BECKER BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,068.77" "$1,068.77" "$1,109.95" $750.24 $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $936.00 "$1,440.00" "$1,440.00" $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 27001115 EAP Custom 27001115 TUBE FEEDING NG 8FR 43IN EN BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27001116 EAP Custom 27001116 ARTERY ARTERIAL CATHERIZA BOTH IP/OP $109.00 $81.00 $19.40 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $19.40 $109.00 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $43.60 $109.00 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $109.00 $109.00 $63.22 $109.00 $65.40 $109.00 $109.00 $109.00 N/A N/A 27001117 EAP Custom 27001117 ARTERY RADIAL CATHERIZATI BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27001118 EAP Custom 27001118 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27001119 EAP Custom 27001119 TUBE SALEM SILICONE SIZE BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27001120 EAP Custom 27001120 TUBES SALEM SUMP 48 LENG BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27001124 EAP Custom 27001124 BAG DRAINAGE BECKER BOTH IP/OP $213.00 $158.00 $37.91 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $37.91 $213.00 $213.00 $158.09 $158.09 $164.18 $110.97 $44.39 $213.00 $85.20 $213.00 $213.00 $213.00 $213.00 $213.00 $159.75 $213.00 $213.00 $213.00 $106.50 $106.50 $168.70 $213.00 $170.40 $138.45 $213.00 $213.00 $123.54 $213.00 $127.80 $213.00 $213.00 $213.00 N/A N/A 27001125 EAP Custom 27001125 BLADES SURGICAL #10 W/O H BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27001126 EAP Custom 27001126 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27001127 EAP Custom 27001127 TRICONNECTOR WITH VALVE BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27001129 EAP Custom 27001129 SET BLOOD ADMINISTRATION BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27001135 EAP Custom 27001135 VALVE ANTI-REFLUX SALEM S BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 27001137 EAP Custom 27001137 KIT THORACOTOMY BOTH IP/OP $217.00 $161.00 $38.63 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $38.63 $217.00 $217.00 $161.06 $161.06 $167.26 $113.06 $45.23 $217.00 $86.80 $217.00 $217.00 $217.00 $217.00 $217.00 $162.75 $217.00 $217.00 $217.00 $108.50 $108.50 $171.86 $217.00 $173.60 $141.05 $217.00 $217.00 $125.86 $217.00 $130.20 $217.00 $217.00 $217.00 N/A N/A 27001142 EAP Custom 27001142 POUCH FECAL INCONTINENCE BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27001143 EAP Custom 27001143 KIT PRESSURE MONITORING T BOTH IP/OP $177.00 $131.00 $31.51 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $31.51 $177.00 $177.00 $131.37 $131.37 $136.43 $92.22 $36.89 $177.00 $70.80 $177.00 $177.00 $177.00 $177.00 $177.00 $132.75 $177.00 $177.00 $177.00 $88.50 $88.50 $140.18 $177.00 $141.60 $115.05 $177.00 $177.00 $102.66 $177.00 $106.20 $177.00 $177.00 $177.00 N/A N/A 27001144 EAP Custom 27001144 TRANSDUCER DISP FOR ICP BOTH IP/OP $79.00 $58.50 $14.06 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $14.06 $79.00 $79.00 $58.63 $58.63 $60.89 $41.16 $16.46 $79.00 $31.60 $79.00 $79.00 $79.00 $79.00 $79.00 $59.25 $79.00 $79.00 $79.00 $39.50 $39.50 $62.57 $79.00 $63.20 $51.35 $79.00 $79.00 $45.82 $79.00 $47.40 $79.00 $79.00 $79.00 N/A N/A 27001145 EAP Custom 27001145 BRIDGE KIT BIFURATED RESP BOTH IP/OP $120.00 $89.00 $21.36 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $21.36 $120.00 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $48.00 $120.00 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $120.00 $120.00 $69.60 $120.00 $72.00 $120.00 $120.00 $120.00 N/A N/A 27001146 EAP Custom 27001146 KIT TRANSDUCER MONITORING BOTH IP/OP $339.00 $251.00 $60.34 $339.00 $339.00 $339.00 $339.00 $339.00 $339.00 $339.00 $60.34 $339.00 $339.00 $251.61 $251.61 $261.30 $176.62 $70.65 $339.00 $135.60 $339.00 $339.00 $339.00 $339.00 $339.00 $254.25 $339.00 $339.00 $339.00 $169.50 $169.50 $268.49 $339.00 $271.20 $220.35 $339.00 $339.00 $196.62 $339.00 $203.40 $339.00 $339.00 $339.00 N/A N/A 27001147 EAP Custom 27001147 KIT PRESSURE MONITORING BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 $250.00 $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 27001149 EAP Custom 27001149 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27001150 EAP Custom 27001150 KIT PECUTANEOUS INTRODUCE BOTH IP/OP $276.00 $204.50 $49.13 $276.00 $276.00 $276.00 $276.00 $276.00 $276.00 $276.00 $49.13 $276.00 $276.00 $204.85 $204.85 $212.74 $143.80 $57.52 $276.00 $110.40 $276.00 $276.00 $276.00 $276.00 $276.00 $207.00 $276.00 $276.00 $276.00 $138.00 $138.00 $218.59 $276.00 $220.80 $179.40 $276.00 $276.00 $160.08 $276.00 $165.60 $276.00 $276.00 $276.00 N/A N/A 27001151 EAP Custom 27001151 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $401.00 $297.00 $71.38 $401.00 $401.00 $401.00 $401.00 $401.00 $401.00 $401.00 $71.38 $401.00 $401.00 $297.62 $297.62 $309.09 $208.92 $83.57 $401.00 $160.40 $401.00 $401.00 $401.00 $401.00 $401.00 $300.75 $401.00 $401.00 $401.00 $200.50 $200.50 $317.59 $401.00 $320.80 $260.65 $401.00 $401.00 $232.58 $401.00 $240.60 $401.00 $401.00 $401.00 N/A N/A 27001152 EAP Custom 27001152 CHEST UNIT DRY SUCTION SY BOTH IP/OP $316.00 $234.00 $56.25 $316.00 $316.00 $316.00 $316.00 $316.00 $316.00 $316.00 $56.25 $316.00 $316.00 $234.54 $234.54 $243.57 $164.64 $65.86 $316.00 $126.40 $316.00 $316.00 $316.00 $316.00 $316.00 $237.00 $316.00 $316.00 $316.00 $158.00 $158.00 $250.27 $316.00 $252.80 $205.40 $316.00 $316.00 $183.28 $316.00 $189.60 $316.00 $316.00 $316.00 N/A N/A 27001157 EAP Custom 27001157 DRESSING X-LARGE BOTH IP/OP $697.00 $516.00 $124.07 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $124.07 $697.00 $697.00 $517.31 $517.31 $537.25 $363.14 $145.26 $697.00 $278.80 $697.00 $697.00 $697.00 $697.00 $697.00 $522.75 $697.00 $697.00 $697.00 $348.50 $348.50 $552.02 $697.00 $557.60 $453.05 $697.00 $697.00 $404.26 $697.00 $418.20 $697.00 $697.00 $697.00 N/A N/A 27001158 EAP Custom 27001158 TRAC DRESSING XL BOTH IP/OP $157.00 $116.50 $27.95 $157.00 $157.00 $157.00 $157.00 $157.00 $157.00 $157.00 $27.95 $157.00 $157.00 $116.53 $116.53 $121.02 $81.80 $32.72 $157.00 $62.80 $157.00 $157.00 $157.00 $157.00 $157.00 $117.75 $157.00 $157.00 $157.00 $78.50 $78.50 $124.34 $157.00 $125.60 $102.05 $157.00 $157.00 $91.06 $157.00 $94.20 $157.00 $157.00 $157.00 N/A N/A 27001161 EAP Custom 27001161 TUBE FEEDING NG 8FR 36IN ENTR BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27001162 EAP Custom 27001162 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $344.00 $255.00 $61.23 $344.00 $344.00 $344.00 $344.00 $344.00 $344.00 $344.00 $61.23 $344.00 $344.00 $255.32 $255.32 $265.16 $179.22 $71.69 $344.00 $137.60 $344.00 $344.00 $344.00 $344.00 $344.00 $258.00 $344.00 $344.00 $344.00 $172.00 $172.00 $272.45 $344.00 $275.20 $223.60 $344.00 $344.00 $199.52 $344.00 $206.40 $344.00 $344.00 $344.00 N/A N/A 27001163 EAP Custom 27001163 WIRE GUIDE DUAL PURPOSE BOTH IP/OP $392.00 $290.50 $69.78 $392.00 $392.00 $392.00 $392.00 $392.00 $392.00 $392.00 $69.78 $392.00 $392.00 $290.94 $290.94 $302.15 $204.23 $81.70 $392.00 $156.80 $392.00 $392.00 $392.00 $392.00 $392.00 $294.00 $392.00 $392.00 $392.00 $196.00 $196.00 $310.46 $392.00 $313.60 $254.80 $392.00 $392.00 $227.36 $392.00 $235.20 $392.00 $392.00 $392.00 N/A N/A 27001164 EAP Custom 27001164 KIT MONITORING INTRACRANI BOTH IP/OP $460.00 $340.50 $81.88 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $81.88 $460.00 $460.00 $341.41 $341.41 $354.57 $239.66 $95.87 $460.00 $184.00 $460.00 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $299.00 $460.00 $460.00 $266.80 $460.00 $276.00 $460.00 $460.00 $460.00 N/A N/A 27001166 EAP Custom 27001166 CATHETER SWAN GANZ BOTH IP/OP $309.00 $229.00 $55.00 $309.00 $309.00 $309.00 $309.00 $309.00 $309.00 $309.00 $55.00 $309.00 $309.00 $229.34 $229.34 $238.18 $160.99 $64.40 $309.00 $123.60 $309.00 $309.00 $309.00 $309.00 $309.00 $231.75 $309.00 $309.00 $309.00 $154.50 $154.50 $244.73 $309.00 $247.20 $200.85 $309.00 $309.00 $179.22 $309.00 $185.40 $309.00 $309.00 $309.00 N/A N/A 27001167 EAP Custom 27001167 DELIVERY SYSTEM CLOSED IN BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27001173 EAP Custom 27001173 FILTER SET 0.22 MICRON BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27001174 EAP Custom 27001174 TRAY CATHETER URETHRAL 14 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27001176 EAP Custom 27001176 KIT VENTRICULOSTOMY BOTH IP/OP "$1,782.00" "$1,319.00" $317.20 "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" $317.20 "$1,782.00" "$1,782.00" "$1,322.60" "$1,322.60" "$1,373.57" $928.42 $371.39 "$1,782.00" $712.80 "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,336.50" "$1,782.00" "$1,782.00" "$1,782.00" $891.00 $891.00 "$1,411.34" "$1,782.00" "$1,425.60" "$1,158.30" "$1,782.00" "$1,782.00" "$1,033.56" "$1,782.00" "$1,069.20" "$1,782.00" "$1,782.00" "$1,782.00" N/A N/A 27001178 EAP Custom 27001178 CENTRAL LINE DRESSING TRAY WITH BIOPATCH BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27001179 EAP Custom 27001179 KIT LUMBAR DRAINAGE EDM BOTH IP/OP $788.00 $583.50 $140.26 $788.00 $788.00 $788.00 $788.00 $788.00 $788.00 $788.00 $140.26 $788.00 $788.00 $584.85 $584.85 $607.39 $410.55 $164.23 $788.00 $315.20 $788.00 $788.00 $788.00 $788.00 $788.00 $591.00 $788.00 $788.00 $788.00 $394.00 $394.00 $624.10 $788.00 $630.40 $512.20 $788.00 $788.00 $457.04 $788.00 $472.80 $788.00 $788.00 $788.00 N/A N/A 27001190 EAP Custom 27001190 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27001191 EAP Custom 27001191 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27001192 EAP Custom 27001192 SLEEVE THIGH REGULAR DVT BOTH IP/OP $553.00 $409.50 $98.43 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $98.43 $553.00 $553.00 $410.44 $410.44 $426.25 $288.11 $115.25 $553.00 $221.20 $553.00 $553.00 $553.00 $553.00 $553.00 $414.75 $553.00 $553.00 $553.00 $276.50 $276.50 $437.98 $553.00 $442.40 $359.45 $553.00 $553.00 $320.74 $553.00 $331.80 $553.00 $553.00 $553.00 N/A N/A 27001193 EAP Custom 27001193 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $663.00 $491.00 $118.01 $663.00 $663.00 $663.00 $663.00 $663.00 $663.00 $663.00 $118.01 $663.00 $663.00 $492.08 $492.08 $511.04 $345.42 $138.18 $663.00 $265.20 $663.00 $663.00 $663.00 $663.00 $663.00 $497.25 $663.00 $663.00 $663.00 $331.50 $331.50 $525.10 $663.00 $530.40 $430.95 $663.00 $663.00 $384.54 $663.00 $397.80 $663.00 $663.00 $663.00 N/A N/A 27001194 EAP Custom 27001194 FIRST STEP SELECT OVERLAY BOTH IP/OP $131.00 $97.00 $23.32 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $23.32 $131.00 $131.00 $97.23 $97.23 $100.97 $68.25 $27.30 $131.00 $52.40 $131.00 $131.00 $131.00 $131.00 $131.00 $98.25 $131.00 $131.00 $131.00 $65.50 $65.50 $103.75 $131.00 $104.80 $85.15 $131.00 $131.00 $75.98 $131.00 $78.60 $131.00 $131.00 $131.00 N/A N/A 27001205 EAP Custom 27001205 DIALYSIS FILTER BOTH IP/OP $651.00 $482.00 $115.88 $651.00 $651.00 $651.00 $651.00 $651.00 $651.00 $651.00 $115.88 $651.00 $651.00 $483.17 $483.17 $501.79 $339.17 $135.68 $651.00 $260.40 $651.00 $651.00 $651.00 $651.00 $651.00 $488.25 $651.00 $651.00 $651.00 $325.50 $325.50 $515.59 $651.00 $520.80 $423.15 $651.00 $651.00 $377.58 $651.00 $390.60 $651.00 $651.00 $651.00 N/A N/A 27001206 EAP Custom 27001206 TUBES EXTENSION PLAIN PLA BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27001218 EAP Custom 27001218 CATHETER THORACIC 16F BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27001219 EAP Custom 27001219 CATHETER THORACIC 20FR BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27001220 EAP Custom 27001220 CATHETER THORACIC 24FR BOTH IP/OP $18.00 $13.50 $3.20 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $3.20 $18.00 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $7.20 $18.00 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $18.00 $18.00 $10.44 $18.00 $10.80 $18.00 $18.00 $18.00 N/A N/A 27001221 EAP Custom 27001221 CATHETER THORACIC 28FR BOTH IP/OP $18.00 $13.50 $3.20 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $3.20 $18.00 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $7.20 $18.00 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $18.00 $18.00 $10.44 $18.00 $10.80 $18.00 $18.00 $18.00 N/A N/A 27001222 EAP Custom 27001222 CATHETER THORACIC 32FR BOTH IP/OP $18.00 $13.50 $3.20 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $3.20 $18.00 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $7.20 $18.00 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $18.00 $18.00 $10.44 $18.00 $10.80 $18.00 $18.00 $18.00 N/A N/A 27001223 EAP Custom 27001223 CATHETER URETHRAL 8FR BOTH IP/OP $31.00 $23.00 $5.52 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $5.52 $31.00 $31.00 $23.01 $23.01 $23.89 $16.15 $6.46 $31.00 $12.40 $31.00 $31.00 $31.00 $31.00 $31.00 $23.25 $31.00 $31.00 $31.00 $15.50 $15.50 $24.55 $31.00 $24.80 $20.15 $31.00 $31.00 $17.98 $31.00 $18.60 $31.00 $31.00 $31.00 N/A N/A 27001224 EAP Custom 27001224 ENTRIFLEX BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27001225 EAP Custom 27001225 TUBE FEEDING NASOGASTRIC BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27001226 EAP Custom 27001226 ARTERY ARTERIAL CATHERIZA BOTH IP/OP $109.00 $81.00 $19.40 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $19.40 $109.00 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $43.60 $109.00 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $109.00 $109.00 $63.22 $109.00 $65.40 $109.00 $109.00 $109.00 N/A N/A 27001227 EAP Custom 27001227 ARTERY RADIAL CATHERIZATI BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27001228 EAP Custom 27001228 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27001229 EAP Custom 27001229 TUBES SALEM SUMP 48 LENG BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27001231 EAP Custom 27001231 SET URINARY DRAIN W/CONTA BOTH IP/OP $21.00 $16.00 $3.74 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $3.74 $21.00 $21.00 $15.59 $15.59 $16.19 $10.94 $4.38 $21.00 $8.40 $21.00 $21.00 $21.00 $21.00 $21.00 $15.75 $21.00 $21.00 $21.00 $10.50 $10.50 $16.63 $21.00 $16.80 $13.65 $21.00 $21.00 $12.18 $21.00 $12.60 $21.00 $21.00 $21.00 N/A N/A 27001232 EAP Custom 27001232 TRAY CATHETER INSRTN DULM BOTH IP/OP $434.00 $321.50 $77.25 $434.00 $434.00 $434.00 $434.00 $434.00 $434.00 $434.00 $77.25 $434.00 $434.00 $322.11 $322.11 $334.53 $226.11 $90.45 $434.00 $173.60 $434.00 $434.00 $434.00 $434.00 $434.00 $325.50 $434.00 $434.00 $434.00 $217.00 $217.00 $343.73 $434.00 $347.20 $282.10 $434.00 $434.00 $251.72 $434.00 $260.40 $434.00 $434.00 $434.00 N/A N/A 27001234 EAP Custom 27001234 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27001235 EAP Custom 27001235 STAPLER SKIN DISPOSABLE 3 BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27001236 EAP Custom 27001236 TRICONNECTOR WITH VALVE BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27001240 EAP Custom 27001240 AQUACEL AG 4X4 BOTH IP/OP $92.00 $68.50 $16.38 $92.00 $92.00 $92.00 $92.00 $92.00 $92.00 $92.00 $16.38 $92.00 $92.00 $68.28 $68.28 $70.91 $47.93 $19.17 $92.00 $36.80 $92.00 $92.00 $92.00 $92.00 $92.00 $69.00 $92.00 $92.00 $92.00 $46.00 $46.00 $72.86 $92.00 $73.60 $59.80 $92.00 $92.00 $53.36 $92.00 $55.20 $92.00 $92.00 $92.00 N/A N/A 27001243 EAP Custom 27001243 ELECTRODES OPERATIVE BOTH IP/OP $289.00 $214.00 $51.44 $289.00 $289.00 $289.00 $289.00 $289.00 $289.00 $289.00 $51.44 $289.00 $289.00 $214.50 $214.50 $222.76 $150.57 $60.23 $289.00 $115.60 $289.00 $289.00 $289.00 $289.00 $289.00 $216.75 $289.00 $289.00 $289.00 $144.50 $144.50 $228.89 $289.00 $231.20 $187.85 $289.00 $289.00 $167.62 $289.00 $173.40 $289.00 $289.00 $289.00 N/A N/A 27001249 EAP Custom 27001249 KIT PRESSURE MONITORING T BOTH IP/OP $177.00 $131.00 $31.51 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $31.51 $177.00 $177.00 $131.37 $131.37 $136.43 $92.22 $36.89 $177.00 $70.80 $177.00 $177.00 $177.00 $177.00 $177.00 $132.75 $177.00 $177.00 $177.00 $88.50 $88.50 $140.18 $177.00 $141.60 $115.05 $177.00 $177.00 $102.66 $177.00 $106.20 $177.00 $177.00 $177.00 N/A N/A 27001250 EAP Custom 27001250 KIT TRANSDUCER MONITORING BOTH IP/OP $339.00 $251.00 $60.34 $339.00 $339.00 $339.00 $339.00 $339.00 $339.00 $339.00 $60.34 $339.00 $339.00 $251.61 $251.61 $261.30 $176.62 $70.65 $339.00 $135.60 $339.00 $339.00 $339.00 $339.00 $339.00 $254.25 $339.00 $339.00 $339.00 $169.50 $169.50 $268.49 $339.00 $271.20 $220.35 $339.00 $339.00 $196.62 $339.00 $203.40 $339.00 $339.00 $339.00 N/A N/A 27001252 EAP Custom 27001252 KIT PRESSURE MONITORING BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 $250.00 $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 27001254 EAP Custom 27001254 BAG 1000ML PUMP SET BOTH IP/OP $28.00 $21.00 $4.98 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $4.98 $28.00 $28.00 $20.78 $20.78 $21.58 $14.59 $5.84 $28.00 $11.20 $28.00 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $18.20 $28.00 $28.00 $16.24 $28.00 $16.80 $28.00 $28.00 $28.00 N/A N/A 27001255 EAP Custom 27001255 KIT PECUTANEOUS INTRODUCE BOTH IP/OP $276.00 $204.50 $49.13 $276.00 $276.00 $276.00 $276.00 $276.00 $276.00 $276.00 $49.13 $276.00 $276.00 $204.85 $204.85 $212.74 $143.80 $57.52 $276.00 $110.40 $276.00 $276.00 $276.00 $276.00 $276.00 $207.00 $276.00 $276.00 $276.00 $138.00 $138.00 $218.59 $276.00 $220.80 $179.40 $276.00 $276.00 $160.08 $276.00 $165.60 $276.00 $276.00 $276.00 N/A N/A 27001256 EAP Custom 27001256 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $195.00 $144.50 $34.71 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $34.71 $195.00 $195.00 $144.73 $144.73 $150.31 $101.60 $40.64 $195.00 $78.00 $195.00 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $126.75 $195.00 $195.00 $113.10 $195.00 $117.00 $195.00 $195.00 $195.00 N/A N/A 27001257 EAP Custom 27001257 BAG PRESSURE 500CC BOTH IP/OP $82.00 $61.00 $14.60 $82.00 $82.00 $82.00 $82.00 $82.00 $82.00 $82.00 $14.60 $82.00 $82.00 $60.86 $60.86 $63.21 $42.72 $17.09 $82.00 $32.80 $82.00 $82.00 $82.00 $82.00 $82.00 $61.50 $82.00 $82.00 $82.00 $41.00 $41.00 $64.94 $82.00 $65.60 $53.30 $82.00 $82.00 $47.56 $82.00 $49.20 $82.00 $82.00 $82.00 N/A N/A 27001258 EAP Custom 27001258 BAG PRESSURE 1000CC BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27001260 EAP Custom 27001260 TUBE FEEDING NG 8FR 36IN ENTRI BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27001261 EAP Custom 27001261 MULTI LUMEN CVC W/O SILVER SU BOTH IP/OP $751.00 $556.00 $133.68 $751.00 $751.00 $751.00 $751.00 $751.00 $751.00 $751.00 $133.68 $751.00 $751.00 $557.39 $557.39 $578.87 $391.27 $156.52 $751.00 $300.40 $751.00 $751.00 $751.00 $751.00 $751.00 $563.25 $751.00 $751.00 $751.00 $375.50 $375.50 $594.79 $751.00 $600.80 $488.15 $751.00 $751.00 $435.58 $751.00 $450.60 $751.00 $751.00 $751.00 N/A N/A 27001262 EAP Custom 27001262 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $697.00 $516.00 $124.07 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $124.07 $697.00 $697.00 $517.31 $517.31 $537.25 $363.14 $145.26 $697.00 $278.80 $697.00 $697.00 $697.00 $697.00 $697.00 $522.75 $697.00 $697.00 $697.00 $348.50 $348.50 $552.02 $697.00 $557.60 $453.05 $697.00 $697.00 $404.26 $697.00 $418.20 $697.00 $697.00 $697.00 N/A N/A 27001263 EAP Custom 27001263 CATHETER SWAN GANZ BOTH IP/OP $726.00 $537.50 $129.23 $726.00 $726.00 $726.00 $726.00 $726.00 $726.00 $726.00 $129.23 $726.00 $726.00 $538.84 $538.84 $559.60 $378.25 $151.31 $726.00 $290.40 $726.00 $726.00 $726.00 $726.00 $726.00 $544.50 $726.00 $726.00 $726.00 $363.00 $363.00 $574.99 $726.00 $580.80 $471.90 $726.00 $726.00 $421.08 $726.00 $435.60 $726.00 $726.00 $726.00 N/A N/A 27001264 EAP Custom 27001264 DELIVERY SYSTEM CLOSED IN BOTH IP/OP $141.00 $104.50 $25.10 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $25.10 $141.00 $141.00 $104.65 $104.65 $108.68 $73.46 $29.39 $141.00 $56.40 $141.00 $141.00 $141.00 $141.00 $141.00 $105.75 $141.00 $141.00 $141.00 $70.50 $70.50 $111.67 $141.00 $112.80 $91.65 $141.00 $141.00 $81.78 $141.00 $84.60 $141.00 $141.00 $141.00 N/A N/A 27001265 EAP Custom 27001265 SET T-PORT SMALL BORE EXT BOTH IP/OP $14.00 $10.50 $2.49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $2.49 $14.00 $14.00 $10.39 $10.39 $10.79 $7.29 $2.92 $14.00 $5.60 $14.00 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $9.10 $14.00 $14.00 $8.12 $14.00 $8.40 $14.00 $14.00 $14.00 N/A N/A 27001268 EAP Custom 27001268 TRAY CATHETER URETHRAL 14 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27001270 EAP Custom 27001270 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27001271 EAP Custom 27001271 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27001272 EAP Custom 27001272 TRAY THORACENTESIS DISPOS BOTH IP/OP $207.00 $153.50 $36.85 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $36.85 $207.00 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $82.80 $207.00 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $207.00 $207.00 $120.06 $207.00 $124.20 $207.00 $207.00 $207.00 N/A N/A 27001273 EAP Custom 27001273 SPONGES LAPAROTOMY 6522 BOTH IP/OP $119.00 $88.50 $21.18 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $21.18 $119.00 $119.00 $88.32 $88.32 $91.73 $62.00 $24.80 $119.00 $47.60 $119.00 $119.00 $119.00 $119.00 $119.00 $89.25 $119.00 $119.00 $119.00 $59.50 $59.50 $94.25 $119.00 $95.20 $77.35 $119.00 $119.00 $69.02 $119.00 $71.40 $119.00 $119.00 $119.00 N/A N/A 27001274 EAP Custom 27001274 BOVIE PENCIL VALLEYLAB BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27001283 EAP Custom 27001283 DRESSING ACTICOAT 16X16 BOTH IP/OP $678.00 $502.00 $120.68 $678.00 $678.00 $678.00 $678.00 $678.00 $678.00 $678.00 $120.68 $678.00 $678.00 $503.21 $503.21 $522.60 $353.24 $141.30 $678.00 $271.20 $678.00 $678.00 $678.00 $678.00 $678.00 $508.50 $678.00 $678.00 $678.00 $339.00 $339.00 $536.98 $678.00 $542.40 $440.70 $678.00 $678.00 $393.24 $678.00 $406.80 $678.00 $678.00 $678.00 N/A N/A 27001284 EAP Custom 27001284 KIT VASCULAR CONFORM BOTH IP/OP $108.00 $80.00 $19.22 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $19.22 $108.00 $108.00 $80.16 $80.16 $83.25 $56.27 $22.51 $108.00 $43.20 $108.00 $108.00 $108.00 $108.00 $108.00 $81.00 $108.00 $108.00 $108.00 $54.00 $54.00 $85.54 $108.00 $86.40 $70.20 $108.00 $108.00 $62.64 $108.00 $64.80 $108.00 $108.00 $108.00 N/A N/A 27001285 EAP Custom 27001285 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27001286 EAP Custom 27001286 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27001287 EAP Custom 27001287 SLEEVE THIGH REGULAR DVT BOTH IP/OP $553.00 $409.50 $98.43 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $98.43 $553.00 $553.00 $410.44 $410.44 $426.25 $288.11 $115.25 $553.00 $221.20 $553.00 $553.00 $553.00 $553.00 $553.00 $414.75 $553.00 $553.00 $553.00 $276.50 $276.50 $437.98 $553.00 $442.40 $359.45 $553.00 $553.00 $320.74 $553.00 $331.80 $553.00 $553.00 $553.00 N/A N/A 27001288 EAP Custom 27001288 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $284.00 $210.50 $50.55 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $50.55 $284.00 $284.00 $210.78 $210.78 $218.91 $147.96 $59.19 $284.00 $113.60 $284.00 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $184.60 $284.00 $284.00 $164.72 $284.00 $170.40 $284.00 $284.00 $284.00 N/A N/A 27001289 EAP Custom 27001289 1ST FIRST SELECT OVERLAY BOTH IP/OP $131.00 $97.00 $23.32 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $23.32 $131.00 $131.00 $97.23 $97.23 $100.97 $68.25 $27.30 $131.00 $52.40 $131.00 $131.00 $131.00 $131.00 $131.00 $98.25 $131.00 $131.00 $131.00 $65.50 $65.50 $103.75 $131.00 $104.80 $85.15 $131.00 $131.00 $75.98 $131.00 $78.60 $131.00 $131.00 $131.00 N/A N/A 27001298 EAP Custom 27001298 THERAPY FOR CVVH/CVVHD 4 BOTH IP/OP $166.00 $123.00 $29.55 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $29.55 $166.00 $166.00 $123.21 $123.21 $127.95 $86.49 $34.60 $166.00 $66.40 $166.00 $166.00 $166.00 $166.00 $166.00 $124.50 $166.00 $166.00 $166.00 $83.00 $83.00 $131.47 $166.00 $132.80 $107.90 $166.00 $166.00 $96.28 $166.00 $99.60 $166.00 $166.00 $166.00 N/A N/A 27001299 EAP Custom 27001299 DIALYSIS FILTER BOTH IP/OP $699.00 $517.50 $124.42 $699.00 $699.00 $699.00 $699.00 $699.00 $699.00 $699.00 $124.42 $699.00 $699.00 $518.80 $518.80 $538.79 $364.18 $145.68 $699.00 $279.60 $699.00 $699.00 $699.00 $699.00 $699.00 $524.25 $699.00 $699.00 $699.00 $349.50 $349.50 $553.61 $699.00 $559.20 $454.35 $699.00 $699.00 $405.42 $699.00 $419.40 $699.00 $699.00 $699.00 N/A N/A 27001313 EAP Custom 27001313 CATHETER THORACIC 32FR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27001314 EAP Custom 27001314 CATHETER THORACIC 36FR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27001315 EAP HCPCS C1729 CATHETER FOLEY 5CC 14FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27001316 EAP HCPCS C1729 CATHETER FOLEY 16FR BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 27001317 EAP HCPCS C1729 CATHETER FOLEY 5CC 18FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27001318 EAP Custom 27001318 CATHETER VENTRICULAR 20CM BOTH IP/OP $683.00 $505.50 $121.57 $683.00 $683.00 $683.00 $683.00 $683.00 $683.00 $683.00 $121.57 $683.00 $683.00 $506.92 $506.92 $526.46 $355.84 $142.34 $683.00 $273.20 $683.00 $683.00 $683.00 $683.00 $683.00 $512.25 $683.00 $683.00 $683.00 $341.50 $341.50 $540.94 $683.00 $546.40 $443.95 $683.00 $683.00 $396.14 $683.00 $409.80 $683.00 $683.00 $683.00 N/A N/A 27001319 EAP Custom 27001319 CATHETER EDM II BECKER BOTH IP/OP "$1,339.00" $991.00 $238.34 "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" $238.34 "$1,339.00" "$1,339.00" $993.81 $993.81 "$1,032.10" $697.62 $279.06 "$1,339.00" $535.60 "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" "$1,004.25" "$1,339.00" "$1,339.00" "$1,339.00" $669.50 $669.50 "$1,060.49" "$1,339.00" "$1,071.20" $870.35 "$1,339.00" "$1,339.00" $776.62 "$1,339.00" $803.40 "$1,339.00" "$1,339.00" "$1,339.00" N/A N/A 27001320 EAP Custom 27001320 ARTERY ARTERIAL CATHERIZA BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27001321 EAP Custom 27001321 ARTERY RADIAL CATHERIZATI BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27001322 EAP Custom 27001322 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27001323 EAP Custom 27001323 TUBE SALEM SILICONE SIZE BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27001324 EAP Custom 27001324 TUBES SALEM SUMP 48 LENG BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27001328 EAP Custom 27001328 BAG DRAINAGE BECKER BOTH IP/OP $202.00 $149.50 $35.96 $202.00 $202.00 $202.00 $202.00 $202.00 $202.00 $202.00 $35.96 $202.00 $202.00 $149.92 $149.92 $155.70 $105.24 $42.10 $202.00 $80.80 $202.00 $202.00 $202.00 $202.00 $202.00 $151.50 $202.00 $202.00 $202.00 $101.00 $101.00 $159.98 $202.00 $161.60 $131.30 $202.00 $202.00 $117.16 $202.00 $121.20 $202.00 $202.00 $202.00 N/A N/A 27001329 EAP Custom 27001329 TRAY CATHETER INSRTN DULM BOTH IP/OP $937.00 $693.50 $166.79 $937.00 $937.00 $937.00 $937.00 $937.00 $937.00 $937.00 $166.79 $937.00 $937.00 $695.44 $695.44 $722.24 $488.18 $195.28 $937.00 $374.80 $937.00 $937.00 $937.00 $937.00 $937.00 $702.75 $937.00 $937.00 $937.00 $468.50 $468.50 $742.10 $937.00 $749.60 $609.05 $937.00 $937.00 $543.46 $937.00 $562.20 $937.00 $937.00 $937.00 N/A N/A 27001330 EAP Custom 27001330 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27001331 EAP Custom 27001331 TRICONNECTOR WITH VALVE BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27001337 EAP Custom 27001337 CABLE PATIENT 12 PIN #R53 BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 $300.00 $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 27001341 EAP Custom 27001341 KIT THORACOTOMY BOTH IP/OP $217.00 $161.00 $38.63 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $38.63 $217.00 $217.00 $161.06 $161.06 $167.26 $113.06 $45.23 $217.00 $86.80 $217.00 $217.00 $217.00 $217.00 $217.00 $162.75 $217.00 $217.00 $217.00 $108.50 $108.50 $171.86 $217.00 $173.60 $141.05 $217.00 $217.00 $125.86 $217.00 $130.20 $217.00 $217.00 $217.00 N/A N/A 27001347 EAP Custom 27001347 POUCH FECAL INCONTINENCE BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27001348 EAP Custom 27001348 KIT PRESSURE MONITORING T BOTH IP/OP $177.00 $131.00 $31.51 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $31.51 $177.00 $177.00 $131.37 $131.37 $136.43 $92.22 $36.89 $177.00 $70.80 $177.00 $177.00 $177.00 $177.00 $177.00 $132.75 $177.00 $177.00 $177.00 $88.50 $88.50 $140.18 $177.00 $141.60 $115.05 $177.00 $177.00 $102.66 $177.00 $106.20 $177.00 $177.00 $177.00 N/A N/A 27001349 EAP Custom 27001349 TRANSDUCER DISP FOR ICP BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27001350 EAP Custom 27001350 BRIDGE KIT BIFURATED RESP BOTH IP/OP $120.00 $89.00 $21.36 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $21.36 $120.00 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $48.00 $120.00 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $120.00 $120.00 $69.60 $120.00 $72.00 $120.00 $120.00 $120.00 N/A N/A 27001351 EAP Custom 27001351 KIT TRANSDUCER MONITORING BOTH IP/OP $324.00 $240.00 $57.67 $324.00 $324.00 $324.00 $324.00 $324.00 $324.00 $324.00 $57.67 $324.00 $324.00 $240.47 $240.47 $249.74 $168.80 $67.53 $324.00 $129.60 $324.00 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $210.60 $324.00 $324.00 $187.92 $324.00 $194.40 $324.00 $324.00 $324.00 N/A N/A 27001352 EAP Custom 27001352 KIT PRESSURE MONITORING BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 $250.00 $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 27001354 EAP Custom 27001354 BAG FEEDING GAVAGE 500ML BOTH IP/OP $28.00 $21.00 $4.98 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $4.98 $28.00 $28.00 $20.78 $20.78 $21.58 $14.59 $5.84 $28.00 $11.20 $28.00 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $18.20 $28.00 $28.00 $16.24 $28.00 $16.80 $28.00 $28.00 $28.00 N/A N/A 27001355 EAP Custom 27001355 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27001356 EAP Custom 27001356 KIT PECUTANEOUS INTRODUCE BOTH IP/OP $129.00 $95.50 $22.96 $129.00 $129.00 $129.00 $129.00 $129.00 $129.00 $129.00 $22.96 $129.00 $129.00 $95.74 $95.74 $99.43 $67.21 $26.89 $129.00 $51.60 $129.00 $129.00 $129.00 $129.00 $129.00 $96.75 $129.00 $129.00 $129.00 $64.50 $64.50 $102.17 $129.00 $103.20 $83.85 $129.00 $129.00 $74.82 $129.00 $77.40 $129.00 $129.00 $129.00 N/A N/A 27001357 EAP Custom 27001357 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $455.00 $337.00 $80.99 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $80.99 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 27001358 EAP Custom 27001358 CHEST IMOT DRY SUCTION SY BOTH IP/OP $316.00 $234.00 $56.25 $316.00 $316.00 $316.00 $316.00 $316.00 $316.00 $316.00 $56.25 $316.00 $316.00 $234.54 $234.54 $243.57 $164.64 $65.86 $316.00 $126.40 $316.00 $316.00 $316.00 $316.00 $316.00 $237.00 $316.00 $316.00 $316.00 $158.00 $158.00 $250.27 $316.00 $252.80 $205.40 $316.00 $316.00 $183.28 $316.00 $189.60 $316.00 $316.00 $316.00 N/A N/A 27001363 EAP Custom 27001363 TRAC DRESSING XL BOTH IP/OP $157.00 $116.50 $27.95 $157.00 $157.00 $157.00 $157.00 $157.00 $157.00 $157.00 $27.95 $157.00 $157.00 $116.53 $116.53 $121.02 $81.80 $32.72 $157.00 $62.80 $157.00 $157.00 $157.00 $157.00 $157.00 $117.75 $157.00 $157.00 $157.00 $78.50 $78.50 $124.34 $157.00 $125.60 $102.05 $157.00 $157.00 $91.06 $157.00 $94.20 $157.00 $157.00 $157.00 N/A N/A 27001366 EAP Custom 27001366 TUBE FEEDING NG 8FR 36IN ENTR BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27001367 EAP Custom 27001367 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $697.00 $516.00 $124.07 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $124.07 $697.00 $697.00 $517.31 $517.31 $537.25 $363.14 $145.26 $697.00 $278.80 $697.00 $697.00 $697.00 $697.00 $697.00 $522.75 $697.00 $697.00 $697.00 $348.50 $348.50 $552.02 $697.00 $557.60 $453.05 $697.00 $697.00 $404.26 $697.00 $418.20 $697.00 $697.00 $697.00 N/A N/A 27001369 EAP Custom 27001369 KIT MONITORING INTRACRANI BOTH IP/OP $460.00 $340.50 $81.88 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $81.88 $460.00 $460.00 $341.41 $341.41 $354.57 $239.66 $95.87 $460.00 $184.00 $460.00 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $299.00 $460.00 $460.00 $266.80 $460.00 $276.00 $460.00 $460.00 $460.00 N/A N/A 27001370 EAP Custom 27001370 CATHETER SWAN GANZ BOTH IP/OP $674.00 $499.00 $119.97 $674.00 $674.00 $674.00 $674.00 $674.00 $674.00 $674.00 $119.97 $674.00 $674.00 $500.24 $500.24 $519.52 $351.15 $140.47 $674.00 $269.60 $674.00 $674.00 $674.00 $674.00 $674.00 $505.50 $674.00 $674.00 $674.00 $337.00 $337.00 $533.81 $674.00 $539.20 $438.10 $674.00 $674.00 $390.92 $674.00 $404.40 $674.00 $674.00 $674.00 N/A N/A 27001371 EAP Custom 27001371 DELIVERY SYSTEM CLOSED IN BOTH IP/OP $152.00 $112.50 $27.06 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $27.06 $152.00 $152.00 $112.81 $112.81 $117.16 $79.19 $31.68 $152.00 $60.80 $152.00 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $98.80 $152.00 $152.00 $88.16 $152.00 $91.20 $152.00 $152.00 $152.00 N/A N/A 27001372 EAP Custom 27001372 PROBE V-PACING BOTH IP/OP "$1,403.00" "$1,038.50" $249.73 "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" $249.73 "$1,403.00" "$1,403.00" "$1,041.31" "$1,041.31" "$1,081.43" $730.96 $292.40 "$1,403.00" $561.20 "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,052.25" "$1,403.00" "$1,403.00" "$1,403.00" $701.50 $701.50 "$1,111.18" "$1,403.00" "$1,122.40" $911.95 "$1,403.00" "$1,403.00" $813.74 "$1,403.00" $841.80 "$1,403.00" "$1,403.00" "$1,403.00" N/A N/A 27001374 EAP Custom 27001374 FILTER SET 0.22 MICRON BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27001376 EAP Custom 27001376 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27001377 EAP Custom 27001377 KIT VENTRICULOSTOMY BOTH IP/OP "$1,782.00" "$1,319.00" $317.20 "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" $317.20 "$1,782.00" "$1,782.00" "$1,322.60" "$1,322.60" "$1,373.57" $928.42 $371.39 "$1,782.00" $712.80 "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,782.00" "$1,336.50" "$1,782.00" "$1,782.00" "$1,782.00" $891.00 $891.00 "$1,411.34" "$1,782.00" "$1,425.60" "$1,158.30" "$1,782.00" "$1,782.00" "$1,033.56" "$1,782.00" "$1,069.20" "$1,782.00" "$1,782.00" "$1,782.00" N/A N/A 27001379 EAP Custom 27001379 TRAY PERICARDIOCENTESIS BOTH IP/OP "$1,235.00" $914.00 $219.83 "$1,235.00" "$1,235.00" "$1,235.00" "$1,235.00" "$1,235.00" "$1,235.00" "$1,235.00" $219.83 "$1,235.00" "$1,235.00" $916.62 $916.62 $951.94 $643.44 $257.39 "$1,235.00" $494.00 "$1,235.00" "$1,235.00" "$1,235.00" "$1,235.00" "$1,235.00" $926.25 "$1,235.00" "$1,235.00" "$1,235.00" $617.50 $617.50 $978.12 "$1,235.00" $988.00 $802.75 "$1,235.00" "$1,235.00" $716.30 "$1,235.00" $741.00 "$1,235.00" "$1,235.00" "$1,235.00" N/A N/A 27001380 EAP Custom 27001380 CENTRAL LINE DRESSING TRAY WITH BIOPATCH BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27001391 EAP Custom 27001391 .014 NITREX GUIDEWIRE BOTH IP/OP "$2,554.00" "$1,890.00" $454.61 "$2,554.00" "$2,554.00" "$2,554.00" "$2,554.00" "$2,554.00" "$2,554.00" "$2,554.00" $454.61 "$2,554.00" "$2,554.00" "$1,895.58" "$1,895.58" "$1,968.62" "$1,330.63" $532.28 "$2,554.00" "$1,021.60" "$2,554.00" "$2,554.00" "$2,554.00" "$2,554.00" "$2,554.00" "$1,915.50" "$2,554.00" "$2,554.00" "$2,554.00" "$1,277.00" "$1,277.00" "$2,022.77" "$2,554.00" "$2,043.20" "$1,660.10" "$2,554.00" "$2,554.00" "$1,481.32" "$2,554.00" "$1,532.40" "$2,554.00" "$2,554.00" "$2,554.00" N/A N/A 27001392 EAP Custom 27001392 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27001393 EAP Custom 27001393 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27001394 EAP Custom 27001394 SLEEVE THIGH REGULAR DVT BOTH IP/OP $553.00 $409.50 $98.43 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $98.43 $553.00 $553.00 $410.44 $410.44 $426.25 $288.11 $115.25 $553.00 $221.20 $553.00 $553.00 $553.00 $553.00 $553.00 $414.75 $553.00 $553.00 $553.00 $276.50 $276.50 $437.98 $553.00 $442.40 $359.45 $553.00 $553.00 $320.74 $553.00 $331.80 $553.00 $553.00 $553.00 N/A N/A 27001395 EAP Custom 27001395 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $616.00 $456.00 $109.65 $616.00 $616.00 $616.00 $616.00 $616.00 $616.00 $616.00 $109.65 $616.00 $616.00 $457.20 $457.20 $474.81 $320.94 $128.38 $616.00 $246.40 $616.00 $616.00 $616.00 $616.00 $616.00 $462.00 $616.00 $616.00 $616.00 $308.00 $308.00 $487.87 $616.00 $492.80 $400.40 $616.00 $616.00 $357.28 $616.00 $369.60 $616.00 $616.00 $616.00 N/A N/A 27001399 EAP Custom 27001399 TRAY CIRCUMCISION BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27001400 EAP Custom 27001400 NEEDLE NEO-NATAL LUMBAR P BOTH IP/OP $21.00 $16.00 $3.74 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $3.74 $21.00 $21.00 $15.59 $15.59 $16.19 $10.94 $4.38 $21.00 $8.40 $21.00 $21.00 $21.00 $21.00 $21.00 $15.75 $21.00 $21.00 $21.00 $10.50 $10.50 $16.63 $21.00 $16.80 $13.65 $21.00 $21.00 $12.18 $21.00 $12.60 $21.00 $21.00 $21.00 N/A N/A 27001401 EAP Custom 27001401 TUBES CAPILLARY HEPARINIZ BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 $150.00 $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A 27001403 EAP Custom 27001403 TUBE FEEDING PLASTIC 8FR BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27001408 EAP Custom 27001408 BAG FEEDING GAVAGE 500ML BOTH IP/OP $14.00 $10.50 $2.49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $2.49 $14.00 $14.00 $10.39 $10.39 $10.79 $7.29 $2.92 $14.00 $5.60 $14.00 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $9.10 $14.00 $14.00 $8.12 $14.00 $8.40 $14.00 $14.00 $14.00 N/A N/A 27001409 EAP Custom 27001409 SET BREAST PUMP COMPLETE BOTH IP/OP $71.00 $53.00 $12.64 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $12.64 $71.00 $71.00 $52.70 $52.70 $54.73 $36.99 $14.80 $71.00 $28.40 $71.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $46.15 $71.00 $71.00 $41.18 $71.00 $42.60 $71.00 $71.00 $71.00 N/A N/A 27001411 EAP Custom 27001411 CATHETER QUICK IV 22GA BOTH IP/OP $7.00 $5.50 $1.25 $7.00 $7.00 $7.00 $7.00 $7.00 $7.00 $7.00 $1.25 $7.00 $7.00 $5.20 $5.20 $5.40 $3.65 $1.46 $7.00 $2.80 $7.00 $7.00 $7.00 $7.00 $7.00 $5.25 $7.00 $7.00 $7.00 $3.50 $3.50 $5.54 $7.00 $5.60 $4.55 $7.00 $7.00 $4.06 $7.00 $4.20 $7.00 $7.00 $7.00 N/A N/A 27001412 EAP Custom 27001412 FILTER SET 0.22 MICRON BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27001413 EAP Custom 27001413 SET T-PORT SMALL BORE EXT BOTH IP/OP $14.00 $10.50 $2.49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $2.49 $14.00 $14.00 $10.39 $10.39 $10.79 $7.29 $2.92 $14.00 $5.60 $14.00 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $9.10 $14.00 $14.00 $8.12 $14.00 $8.40 $14.00 $14.00 $14.00 N/A N/A 27001415 EAP Custom 27001415 TUBE SUMP GASTRIC 50/CS BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 27001418 EAP Custom 27001418 PRECISION INTROD.26G(1.9F) BOTH IP/OP $149.00 $110.50 $26.52 $149.00 $149.00 $149.00 $149.00 $149.00 $149.00 $149.00 $26.52 $149.00 $149.00 $110.59 $110.59 $114.85 $77.63 $31.05 $149.00 $59.60 $149.00 $149.00 $149.00 $149.00 $149.00 $111.75 $149.00 $149.00 $149.00 $74.50 $74.50 $118.01 $149.00 $119.20 $96.85 $149.00 $149.00 $86.42 $149.00 $89.40 $149.00 $149.00 $149.00 N/A N/A 27001419 EAP Custom 27001419 26G CATHETER(1.9F 1ST PICC BD) BOTH IP/OP $260.00 $192.50 $46.28 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $46.28 $260.00 $260.00 $192.97 $192.97 $200.41 $135.46 $54.19 $260.00 $104.00 $260.00 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $169.00 $260.00 $260.00 $150.80 $260.00 $156.00 $260.00 $260.00 $260.00 N/A N/A 27001420 EAP Custom 27001420 PICC TRAY (BD PROCEDURE TRAY) BOTH IP/OP $219.00 $162.50 $38.98 $219.00 $219.00 $219.00 $219.00 $219.00 $219.00 $219.00 $38.98 $219.00 $219.00 $162.54 $162.54 $168.81 $114.10 $45.64 $219.00 $87.60 $219.00 $219.00 $219.00 $219.00 $219.00 $164.25 $219.00 $219.00 $219.00 $109.50 $109.50 $173.45 $219.00 $175.20 $142.35 $219.00 $219.00 $127.02 $219.00 $131.40 $219.00 $219.00 $219.00 N/A N/A 27001421 EAP Custom 27001421 PRECISION INTRODUCER 22G(2.8F) BOTH IP/OP $183.00 $135.50 $32.57 $183.00 $183.00 $183.00 $183.00 $183.00 $183.00 $183.00 $32.57 $183.00 $183.00 $135.82 $135.82 $141.06 $95.34 $38.14 $183.00 $73.20 $183.00 $183.00 $183.00 $183.00 $183.00 $137.25 $183.00 $183.00 $183.00 $91.50 $91.50 $144.94 $183.00 $146.40 $118.95 $183.00 $183.00 $106.14 $183.00 $109.80 $183.00 $183.00 $183.00 N/A N/A 27001422 EAP Custom 27001422 22G CATHETER(2.8F 1ST PICC BD) BOTH IP/OP $343.00 $254.00 $61.05 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $61.05 $343.00 $343.00 $254.57 $254.57 $264.38 $178.70 $71.48 $343.00 $137.20 $343.00 $343.00 $343.00 $343.00 $343.00 $257.25 $343.00 $343.00 $343.00 $171.50 $171.50 $271.66 $343.00 $274.40 $222.95 $343.00 $343.00 $198.94 $343.00 $205.80 $343.00 $343.00 $343.00 N/A N/A 27001423 EAP Custom 27001423 ARGYLE PICC 1.9FRX39CM DUAL LU BOTH IP/OP $423.00 $313.50 $75.29 $423.00 $423.00 $423.00 $423.00 $423.00 $423.00 $423.00 $75.29 $423.00 $423.00 $313.95 $313.95 $326.05 $220.38 $88.16 $423.00 $169.20 $423.00 $423.00 $423.00 $423.00 $423.00 $317.25 $423.00 $423.00 $423.00 $211.50 $211.50 $335.02 $423.00 $338.40 $274.95 $423.00 $423.00 $245.34 $423.00 $253.80 $423.00 $423.00 $423.00 N/A N/A 27001424 EAP Custom 27001424 20G(3FR)BDL CATH PICC DUAL LUM BOTH IP/OP $154.00 $114.00 $27.41 $154.00 $154.00 $154.00 $154.00 $154.00 $154.00 $154.00 $27.41 $154.00 $154.00 $114.30 $114.30 $118.70 $80.23 $32.10 $154.00 $61.60 $154.00 $154.00 $154.00 $154.00 $154.00 $115.50 $154.00 $154.00 $154.00 $77.00 $77.00 $121.97 $154.00 $123.20 $100.10 $154.00 $154.00 $89.32 $154.00 $92.40 $154.00 $154.00 $154.00 N/A N/A 27001428 EAP Custom 27001428 TRAY CIRCUMCISION BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27001429 EAP Custom 27001429 NEEDLE NEO-NATAL LUMBAR P BOTH IP/OP $21.00 $16.00 $3.74 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $3.74 $21.00 $21.00 $15.59 $15.59 $16.19 $10.94 $4.38 $21.00 $8.40 $21.00 $21.00 $21.00 $21.00 $21.00 $15.75 $21.00 $21.00 $21.00 $10.50 $10.50 $16.63 $21.00 $16.80 $13.65 $21.00 $21.00 $12.18 $21.00 $12.60 $21.00 $21.00 $21.00 N/A N/A 27001431 EAP Custom 27001431 TUBES CAPILLARY HEPARINIZ BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 $150.00 $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A 27001432 EAP Custom 27001432 TUBE NASOGASTRIC FEEDING BOTH IP/OP $91.00 $67.50 $16.20 $91.00 $91.00 $91.00 $91.00 $91.00 $91.00 $91.00 $16.20 $91.00 $91.00 $67.54 $67.54 $70.14 $47.41 $18.97 $91.00 $36.40 $91.00 $91.00 $91.00 $91.00 $91.00 $68.25 $91.00 $91.00 $91.00 $45.50 $45.50 $72.07 $91.00 $72.80 $59.15 $91.00 $91.00 $52.78 $91.00 $54.60 $91.00 $91.00 $91.00 N/A N/A 27001435 EAP Custom 27001435 CATHETER URETHRAL 8FR BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27001436 EAP Custom 27001436 CATHETER UMBILICAL 15 3- BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 27001437 EAP Custom 27001437 CATHETER UMBILICAL 15 5F BOTH IP/OP $63.00 $47.00 $11.21 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $11.21 $63.00 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $25.20 $63.00 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $31.50 $31.50 $49.90 $63.00 $50.40 $40.95 $63.00 $63.00 $36.54 $63.00 $37.80 $63.00 $63.00 $63.00 N/A N/A 27001438 EAP Custom 27001438 TUBE FEEDING PLASTIC 8FR BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27001441 EAP Custom 27001441 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27001443 EAP Custom 27001443 POUCH LITTLE ONES CUT TO BOTH IP/OP $6.00 $4.50 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 27001446 EAP Custom 27001446 TRANSDUCER WITH INTERG 43 BOTH IP/OP $37.00 $27.50 $6.59 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $6.59 $37.00 $37.00 $27.46 $27.46 $28.52 $19.28 $7.71 $37.00 $14.80 $37.00 $37.00 $37.00 $37.00 $37.00 $27.75 $37.00 $37.00 $37.00 $18.50 $18.50 $29.30 $37.00 $29.60 $24.05 $37.00 $37.00 $21.46 $37.00 $22.20 $37.00 $37.00 $37.00 N/A N/A 27001447 EAP Custom 27001447 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27001449 EAP Custom 27001449 CATHETER THORACIC TROCAR 10 F BOTH IP/OP $177.00 $131.00 $31.51 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $31.51 $177.00 $177.00 $131.37 $131.37 $136.43 $92.22 $36.89 $177.00 $70.80 $177.00 $177.00 $177.00 $177.00 $177.00 $132.75 $177.00 $177.00 $177.00 $88.50 $88.50 $140.18 $177.00 $141.60 $115.05 $177.00 $177.00 $102.66 $177.00 $106.20 $177.00 $177.00 $177.00 N/A N/A 27001450 EAP Custom 27001450 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $161.00 $119.50 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $28.66 $161.00 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $64.40 $161.00 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $161.00 $161.00 $93.38 $161.00 $96.60 $161.00 $161.00 $161.00 N/A N/A 27001452 EAP Custom 27001452 CATHETER QUICK IV 22GAX1- BOTH IP/OP $3.00 $2.50 $0.53 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $0.53 $3.00 $3.00 $2.23 $2.23 $2.31 $1.56 $0.63 $3.00 $1.20 $3.00 $3.00 $3.00 $3.00 $3.00 $2.25 $3.00 $3.00 $3.00 $1.50 $1.50 $2.38 $3.00 $2.40 $1.95 $3.00 $3.00 $1.74 $3.00 $1.80 $3.00 $3.00 $3.00 N/A N/A 27001453 EAP Custom 27001453 CATHETER INTRODUCER STERI BOTH IP/OP $3.00 $2.50 $0.53 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $0.53 $3.00 $3.00 $2.23 $2.23 $2.31 $1.56 $0.63 $3.00 $1.20 $3.00 $3.00 $3.00 $3.00 $3.00 $2.25 $3.00 $3.00 $3.00 $1.50 $1.50 $2.38 $3.00 $2.40 $1.95 $3.00 $3.00 $1.74 $3.00 $1.80 $3.00 $3.00 $3.00 N/A N/A 27001454 EAP Custom 27001454 FILTER SET 0.22 MICRON BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27001455 EAP Custom 27001455 SET T-PORT SMALL BORE EXT BOTH IP/OP $14.00 $10.50 $2.49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $2.49 $14.00 $14.00 $10.39 $10.39 $10.79 $7.29 $2.92 $14.00 $5.60 $14.00 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $9.10 $14.00 $14.00 $8.12 $14.00 $8.40 $14.00 $14.00 $14.00 N/A N/A 27001456 EAP Custom 27001456 TRAY TRANSFUSION STERILE BOTH IP/OP $597.00 $442.00 $106.27 $597.00 $597.00 $597.00 $597.00 $597.00 $597.00 $597.00 $106.27 $597.00 $597.00 $443.09 $443.09 $460.17 $311.04 $124.42 $597.00 $238.80 $597.00 $597.00 $597.00 $597.00 $597.00 $447.75 $597.00 $597.00 $597.00 $298.50 $298.50 $472.82 $597.00 $477.60 $388.05 $597.00 $597.00 $346.26 $597.00 $358.20 $597.00 $597.00 $597.00 N/A N/A 27001458 EAP Custom 27001458 TUBE SUMP GASTRIC 50/CS BOTH IP/OP $44.00 $33.00 $7.83 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $7.83 $44.00 $44.00 $32.66 $32.66 $33.92 $22.92 $9.17 $44.00 $17.60 $44.00 $44.00 $44.00 $44.00 $44.00 $33.00 $44.00 $44.00 $44.00 $22.00 $22.00 $34.85 $44.00 $35.20 $28.60 $44.00 $44.00 $25.52 $44.00 $26.40 $44.00 $44.00 $44.00 N/A N/A 27001466 EAP Custom 27001466 CATHETER SUCTION 5FR STER BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27001469 EAP Custom 27001469 CATHETER URETHRAL TWO-EYE BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27001471 EAP Custom 27001471 SET URINARY DRAIN W/CONTA BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27001473 EAP Custom 27001473 SCAPLE SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27001475 EAP Custom 27001475 STAPLER SKIN DISPOSABLE 3 BOTH IP/OP $87.00 $64.50 $15.49 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $15.49 $87.00 $87.00 $64.57 $64.57 $67.06 $45.33 $18.13 $87.00 $34.80 $87.00 $87.00 $87.00 $87.00 $87.00 $65.25 $87.00 $87.00 $87.00 $43.50 $43.50 $68.90 $87.00 $69.60 $56.55 $87.00 $87.00 $50.46 $87.00 $52.20 $87.00 $87.00 $87.00 N/A N/A 27001486 EAP Custom 27001486 SPECULUM PEDIATRIC BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27001487 EAP Custom 27001487 BAG HYPERINFLATION BOTH IP/OP $85.00 $63.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 $85.00 $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 27001490 EAP Custom 27001490 TRAY CATHETER URETHRAL 14 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27001492 EAP Custom 27001492 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $51.00 $38.00 $9.08 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $9.08 $51.00 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $20.40 $51.00 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $51.00 $51.00 $29.58 $51.00 $30.60 $51.00 $51.00 $51.00 N/A N/A 27001494 EAP Custom 27001494 SPONGES LAPAROTOMY 6522 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27001501 EAP Custom 27001501 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27001502 EAP Custom 27001502 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27001503 EAP Custom 27001503 SLEEVE THIGH REGULAR DVT BOTH IP/OP $238.00 $176.50 $42.36 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $42.36 $238.00 $238.00 $176.64 $176.64 $183.45 $124.00 $49.60 $238.00 $95.20 $238.00 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $154.70 $238.00 $238.00 $138.04 $238.00 $142.80 $238.00 $238.00 $238.00 N/A N/A 27001618 EAP Custom 27001618 TRIADYNE II (BED) BOTH IP/OP $737.00 $545.50 $131.19 $737.00 $737.00 $737.00 $737.00 $737.00 $737.00 $737.00 $131.19 $737.00 $737.00 $547.00 $547.00 $568.08 $383.98 $153.60 $737.00 $294.80 $737.00 $737.00 $737.00 $737.00 $737.00 $552.75 $737.00 $737.00 $737.00 $368.50 $368.50 $583.70 $737.00 $589.60 $479.05 $737.00 $737.00 $427.46 $737.00 $442.20 $737.00 $737.00 $737.00 N/A N/A 27001620 EAP Custom 27001620 FLUIDAIR ELITE (BED) BOTH IP/OP $772.00 $571.50 $137.42 $772.00 $772.00 $772.00 $772.00 $772.00 $772.00 $772.00 $137.42 $772.00 $772.00 $572.98 $572.98 $595.06 $402.21 $160.89 $772.00 $308.80 $772.00 $772.00 $772.00 $772.00 $772.00 $579.00 $772.00 $772.00 $772.00 $386.00 $386.00 $611.42 $772.00 $617.60 $501.80 $772.00 $772.00 $447.76 $772.00 $463.20 $772.00 $772.00 $772.00 N/A N/A 27001635 EAP Custom 27001635 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27001636 EAP Custom 27001636 SET URINARY DRAIN W/CONTA BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27001641 EAP Custom 27001641 TRAY DOUCH DISPOSABLE BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27001644 EAP Custom 27001644 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27001645 EAP Custom 27001645 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27001647 EAP Custom 27001647 ARROW SUPER/EXTREME CATH KIT BOTH IP/OP $802.00 $593.50 $142.76 $802.00 $802.00 $802.00 $802.00 $802.00 $802.00 $802.00 $142.76 $802.00 $802.00 $595.24 $595.24 $618.18 $417.84 $167.15 $802.00 $320.80 $802.00 $802.00 $802.00 $802.00 $802.00 $601.50 $802.00 $802.00 $802.00 $401.00 $401.00 $635.18 $802.00 $641.60 $521.30 $802.00 $802.00 $465.16 $802.00 $481.20 $802.00 $802.00 $802.00 N/A N/A 27001649 EAP Custom 27001649 CENTRAL LINE DRESSING TRAY BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27001650 EAP Custom 27001650 CONTINUOUS CARDIAC O/PUT SWANS BOTH IP/OP $604.00 $447.00 $107.51 $604.00 $604.00 $604.00 $604.00 $604.00 $604.00 $604.00 $107.51 $604.00 $604.00 $448.29 $448.29 $465.56 $314.68 $125.88 $604.00 $241.60 $604.00 $604.00 $604.00 $604.00 $604.00 $453.00 $604.00 $604.00 $604.00 $302.00 $302.00 $478.37 $604.00 $483.20 $392.60 $604.00 $604.00 $350.32 $604.00 $362.40 $604.00 $604.00 $604.00 N/A N/A 27001652 EAP Custom 27001652 PRESSURE TRANSCLUCER KITS BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27001653 EAP Custom 27001653 PERCUTANEOUS INTRODUCER KITS BOTH IP/OP "$2,364.00" "$1,749.50" $420.79 "$2,364.00" "$2,364.00" "$2,364.00" "$2,364.00" "$2,364.00" "$2,364.00" "$2,364.00" $420.79 "$2,364.00" "$2,364.00" "$1,754.56" "$1,754.56" "$1,822.17" "$1,231.64" $492.68 "$2,364.00" $945.60 "$2,364.00" "$2,364.00" "$2,364.00" "$2,364.00" "$2,364.00" "$1,773.00" "$2,364.00" "$2,364.00" "$2,364.00" "$1,182.00" "$1,182.00" "$1,872.29" "$2,364.00" "$1,891.20" "$1,536.60" "$2,364.00" "$2,364.00" "$1,371.12" "$2,364.00" "$1,418.40" "$2,364.00" "$2,364.00" "$2,364.00" N/A N/A 27001655 EAP Custom 27001655 SUTURES BOTH IP/OP $211.00 $156.50 $37.56 $211.00 $211.00 $211.00 $211.00 $211.00 $211.00 $211.00 $37.56 $211.00 $211.00 $156.60 $156.60 $162.64 $109.93 $43.97 $211.00 $84.40 $211.00 $211.00 $211.00 $211.00 $211.00 $158.25 $211.00 $211.00 $211.00 $105.50 $105.50 $167.11 $211.00 $168.80 $137.15 $211.00 $211.00 $122.38 $211.00 $126.60 $211.00 $211.00 $211.00 N/A N/A 27001657 EAP Custom 27001657 SWAN GANZ CATHETERS BOTH IP/OP $604.00 $447.00 $107.51 $604.00 $604.00 $604.00 $604.00 $604.00 $604.00 $604.00 $107.51 $604.00 $604.00 $448.29 $448.29 $465.56 $314.68 $125.88 $604.00 $241.60 $604.00 $604.00 $604.00 $604.00 $604.00 $453.00 $604.00 $604.00 $604.00 $302.00 $302.00 $478.37 $604.00 $483.20 $392.60 $604.00 $604.00 $350.32 $604.00 $362.40 $604.00 $604.00 $604.00 N/A N/A 27001658 EAP Custom 27001658 GUIDEWIRE .35X.68CM BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 27001660 EAP Custom 27001660 HUBER NEEDLE BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27001665 EAP Custom 27001665 14FX15CM SCHON XL DBL LMN VASC BOTH IP/OP "$6,497.00" "$4,808.00" "$1,156.47" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$1,156.47" "$6,497.00" "$6,497.00" "$4,181.12" "$4,181.12" "$5,007.89" "$2,060.15" "$1,354.05" "$6,497.00" "$2,598.80" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$4,872.75" "$6,497.00" "$6,497.00" "$6,497.00" "$3,248.50" "$3,248.50" "$5,145.62" "$6,497.00" "$5,197.60" "$4,223.05" "$6,497.00" "$6,497.00" "$3,768.26" "$6,497.00" "$3,898.20" "$6,497.00" "$6,497.00" "$6,497.00" N/A N/A 27001666 EAP Custom 27001666 14FX24CM SCHON XL DBL LMN VASC BOTH IP/OP "$6,497.00" "$4,808.00" "$1,156.47" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$1,156.47" "$6,497.00" "$6,497.00" "$4,181.12" "$4,181.12" "$5,007.89" "$2,060.15" "$1,354.05" "$6,497.00" "$2,598.80" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$4,872.75" "$6,497.00" "$6,497.00" "$6,497.00" "$3,248.50" "$3,248.50" "$5,145.62" "$6,497.00" "$5,197.60" "$4,223.05" "$6,497.00" "$6,497.00" "$3,768.26" "$6,497.00" "$3,898.20" "$6,497.00" "$6,497.00" "$6,497.00" N/A N/A 27001667 EAP Custom 27001667 14FX20CM SCHON XL DBL LMN VASC BOTH IP/OP "$6,497.00" "$4,808.00" "$1,156.47" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$1,156.47" "$6,497.00" "$6,497.00" "$4,181.12" "$4,181.12" "$5,007.89" "$2,060.15" "$1,354.05" "$6,497.00" "$2,598.80" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$6,497.00" "$4,872.75" "$6,497.00" "$6,497.00" "$6,497.00" "$3,248.50" "$3,248.50" "$5,145.62" "$6,497.00" "$5,197.60" "$4,223.05" "$6,497.00" "$6,497.00" "$3,768.26" "$6,497.00" "$3,898.20" "$6,497.00" "$6,497.00" "$6,497.00" N/A N/A 27001670 EAP Custom 27001670 TWIST LOCK CATH GARD CATHETER BOTH IP/OP $80.00 $59.50 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 27001671 EAP Custom 27001671 NEEDLES 18 GA/7CM (COOK) BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27001672 EAP Custom 27001672 COOK TLC TRAY BOTH IP/OP $457.00 $338.50 $81.35 $457.00 $457.00 $457.00 $457.00 $457.00 $457.00 $457.00 $81.35 $457.00 $457.00 $339.19 $339.19 $352.26 $238.10 $95.24 $457.00 $182.80 $457.00 $457.00 $457.00 $457.00 $457.00 $342.75 $457.00 $457.00 $457.00 $228.50 $228.50 $361.94 $457.00 $365.60 $297.05 $457.00 $457.00 $265.06 $457.00 $274.20 $457.00 $457.00 $457.00 N/A N/A 27001675 EAP Custom 27001675 TUBES EXTENSION PLAIN PLA BOTH IP/OP $5.00 $4.00 $0.89 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $0.89 $5.00 $5.00 $3.71 $3.71 $3.85 $2.61 $1.04 $5.00 $2.00 $5.00 $5.00 $5.00 $5.00 $5.00 $3.75 $5.00 $5.00 $5.00 $2.50 $2.50 $3.96 $5.00 $4.00 $3.25 $5.00 $5.00 $2.90 $5.00 $3.00 $5.00 $5.00 $5.00 N/A N/A 27001679 EAP Custom 27001679 METER ASTECH PEAK FLOW BOTH IP/OP $94.00 $70.00 $16.73 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $16.73 $94.00 $94.00 $69.77 $69.77 $72.46 $48.97 $19.59 $94.00 $37.60 $94.00 $94.00 $94.00 $94.00 $94.00 $70.50 $94.00 $94.00 $94.00 $47.00 $47.00 $74.45 $94.00 $75.20 $61.10 $94.00 $94.00 $54.52 $94.00 $56.40 $94.00 $94.00 $94.00 N/A N/A 27001693 EAP Custom 27001693 CATHETER THORACIC 32FR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27001694 EAP Custom 27001694 CATHETER THORACIC 36FR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27001695 EAP HCPCS C1729 CATHETER FOLEY 5CC 14FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27001696 EAP HCPCS C1729 CATHETER COUDE SIZE 14FR BOTH IP/OP $109.00 $81.00 $21.63 $109.00 $59.19 $59.19 $59.19 $59.19 $109.00 $109.00 $109.00 $22.72 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $109.00 $64.47 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $21.63 $109.00 $63.22 $109.00 $109.00 $109.00 $22.72 $109.00 N/A N/A 27001697 EAP HCPCS C1729 CATHETER COUDE SIZE 16FR BOTH IP/OP $109.00 $81.00 $21.63 $109.00 $59.19 $59.19 $59.19 $59.19 $109.00 $109.00 $109.00 $22.72 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $109.00 $64.47 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $21.63 $109.00 $63.22 $109.00 $109.00 $109.00 $22.72 $109.00 N/A N/A 27001698 EAP Custom 27001698 ARTERY ARTERIAL CATHERIZA BOTH IP/OP $102.00 $75.50 $18.16 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $18.16 $102.00 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $40.80 $102.00 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $102.00 $102.00 $59.16 $102.00 $61.20 $102.00 $102.00 $102.00 N/A N/A 27001699 EAP Custom 27001699 ARTERY RADIAL CATHERIZATI BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27001700 EAP Custom 27001700 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27001701 EAP Custom 27001701 TUBE SALEM SILICONE SIZE BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27001702 EAP Custom 27001702 TUBES SALEM SUMP 48 LENG BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27001703 EAP Custom 27001703 KIT TRACHEOTOMY CARE STER BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27001706 EAP Custom 27001706 TRAY CATHETER INSRTN DULM BOTH IP/OP "$1,009.00" $747.00 $179.60 "$1,009.00" "$1,009.00" "$1,009.00" "$1,009.00" "$1,009.00" "$1,009.00" "$1,009.00" $179.60 "$1,009.00" "$1,009.00" $748.88 $748.88 $777.74 $525.69 $210.29 "$1,009.00" $403.60 "$1,009.00" "$1,009.00" "$1,009.00" "$1,009.00" "$1,009.00" $756.75 "$1,009.00" "$1,009.00" "$1,009.00" $504.50 $504.50 $799.13 "$1,009.00" $807.20 $655.85 "$1,009.00" "$1,009.00" $585.22 "$1,009.00" $605.40 "$1,009.00" "$1,009.00" "$1,009.00" N/A N/A 27001707 EAP Custom 27001707 SCAPEL SURG W/HANDLE ATTACHED BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27001709 EAP Custom 27001709 TRICONNECTOR WITH VALVE BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27001713 EAP Custom 27001713 POUCH ACTIVE LIFE SQUIB DRAIN BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27001715 EAP Custom 27001715 CABLE PATIENT 12 PIN #R53 BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 $300.00 $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 27001716 EAP Custom 27001716 ELECTRODES OPERATIVE BOTH IP/OP $122.00 $90.50 $21.72 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $21.72 $122.00 $122.00 $90.55 $90.55 $94.04 $63.56 $25.43 $122.00 $48.80 $122.00 $122.00 $122.00 $122.00 $122.00 $91.50 $122.00 $122.00 $122.00 $61.00 $61.00 $96.62 $122.00 $97.60 $79.30 $122.00 $122.00 $70.76 $122.00 $73.20 $122.00 $122.00 $122.00 N/A N/A 27001721 EAP Custom 27001721 POUCH FECAL INCONTINENCE BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27001722 EAP Custom 27001722 KIT PRESSURE MONITORING T BOTH IP/OP $177.00 $131.00 $31.51 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $31.51 $177.00 $177.00 $131.37 $131.37 $136.43 $92.22 $36.89 $177.00 $70.80 $177.00 $177.00 $177.00 $177.00 $177.00 $132.75 $177.00 $177.00 $177.00 $88.50 $88.50 $140.18 $177.00 $141.60 $115.05 $177.00 $177.00 $102.66 $177.00 $106.20 $177.00 $177.00 $177.00 N/A N/A 27001723 EAP Custom 27001723 KIT PRESSURE MONITORING BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 $250.00 $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 27001725 EAP Custom 27001725 BAG 1000ML PUMP SET BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27001726 EAP Custom 27001726 NEEDLE PORT-CATH 20GA X 1 BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27001727 EAP Custom 27001727 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $455.00 $337.00 $80.99 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $80.99 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 27001732 EAP Custom 27001732 DRESSING X-LARGE BOTH IP/OP $697.00 $516.00 $124.07 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $124.07 $697.00 $697.00 $517.31 $517.31 $537.25 $363.14 $145.26 $697.00 $278.80 $697.00 $697.00 $697.00 $697.00 $697.00 $522.75 $697.00 $697.00 $697.00 $348.50 $348.50 $552.02 $697.00 $557.60 $453.05 $697.00 $697.00 $404.26 $697.00 $418.20 $697.00 $697.00 $697.00 N/A N/A 27001733 EAP Custom 27001733 TRAC DRESSING XL BOTH IP/OP $157.00 $116.50 $27.95 $157.00 $157.00 $157.00 $157.00 $157.00 $157.00 $157.00 $27.95 $157.00 $157.00 $116.53 $116.53 $121.02 $81.80 $32.72 $157.00 $62.80 $157.00 $157.00 $157.00 $157.00 $157.00 $117.75 $157.00 $157.00 $157.00 $78.50 $78.50 $124.34 $157.00 $125.60 $102.05 $157.00 $157.00 $91.06 $157.00 $94.20 $157.00 $157.00 $157.00 N/A N/A 27001735 EAP Custom 27001735 TUBE FEEDING NG 8FR 36IN ENTRI BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27001736 EAP Custom 27001736 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $697.00 $516.00 $124.07 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $697.00 $124.07 $697.00 $697.00 $517.31 $517.31 $537.25 $363.14 $145.26 $697.00 $278.80 $697.00 $697.00 $697.00 $697.00 $697.00 $522.75 $697.00 $697.00 $697.00 $348.50 $348.50 $552.02 $697.00 $557.60 $453.05 $697.00 $697.00 $404.26 $697.00 $418.20 $697.00 $697.00 $697.00 N/A N/A 27001740 EAP Custom 27001740 TUBE TRACH #8 DCT BOTH IP/OP $335.00 $248.00 $59.63 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $59.63 $335.00 $335.00 $248.64 $248.64 $258.22 $174.54 $69.82 $335.00 $134.00 $335.00 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $217.75 $335.00 $335.00 $194.30 $335.00 $201.00 $335.00 $335.00 $335.00 N/A N/A 27001741 EAP Custom 27001741 TUBE TRACH #6 DCT BOTH IP/OP $335.00 $248.00 $59.63 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $59.63 $335.00 $335.00 $248.64 $248.64 $258.22 $174.54 $69.82 $335.00 $134.00 $335.00 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $217.75 $335.00 $335.00 $194.30 $335.00 $201.00 $335.00 $335.00 $335.00 N/A N/A 27001742 EAP Custom 27001742 TUBE TRACH #10 DCT BOTH IP/OP $335.00 $248.00 $59.63 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $59.63 $335.00 $335.00 $248.64 $248.64 $258.22 $174.54 $69.82 $335.00 $134.00 $335.00 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $217.75 $335.00 $335.00 $194.30 $335.00 $201.00 $335.00 $335.00 $335.00 N/A N/A 27001743 EAP Custom 27001743 TUBE TRACHEOSTOMY 4-DCFS BOTH IP/OP $326.00 $241.50 $58.03 $326.00 $326.00 $326.00 $326.00 $326.00 $326.00 $326.00 $58.03 $326.00 $326.00 $241.96 $241.96 $251.28 $169.85 $67.94 $326.00 $130.40 $326.00 $326.00 $326.00 $326.00 $326.00 $244.50 $326.00 $326.00 $326.00 $163.00 $163.00 $258.19 $326.00 $260.80 $211.90 $326.00 $326.00 $189.08 $326.00 $195.60 $326.00 $326.00 $326.00 N/A N/A 27001744 EAP Custom 27001744 FILTER SET 0.22 MICRON BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27001746 EAP Custom 27001746 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27001747 EAP Custom 27001747 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27001748 EAP Custom 27001748 TRAY THORACENTESIS DISPOS BOTH IP/OP $101.00 $75.00 $17.98 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $17.98 $101.00 $101.00 $74.96 $74.96 $77.85 $52.62 $21.05 $101.00 $40.40 $101.00 $101.00 $101.00 $101.00 $101.00 $75.75 $101.00 $101.00 $101.00 $50.50 $50.50 $79.99 $101.00 $80.80 $65.65 $101.00 $101.00 $58.58 $101.00 $60.60 $101.00 $101.00 $101.00 N/A N/A 27001763 EAP Custom 27001763 SLEEVE KNEE REGULAR DVT BOTH IP/OP $388.00 $287.50 $69.06 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $388.00 $69.06 $388.00 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $155.20 $388.00 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $388.00 $388.00 $225.04 $388.00 $232.80 $388.00 $388.00 $388.00 N/A N/A 27001764 EAP Custom 27001764 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27001765 EAP Custom 27001765 SLEEVE THIGH REGULAR DVT BOTH IP/OP $238.00 $176.50 $42.36 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $42.36 $238.00 $238.00 $176.64 $176.64 $183.45 $124.00 $49.60 $238.00 $95.20 $238.00 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $154.70 $238.00 $238.00 $138.04 $238.00 $142.80 $238.00 $238.00 $238.00 N/A N/A 27001766 EAP Custom 27001766 SLEEVE THIGH X-LARGE DVT BOTH IP/OP $284.00 $210.50 $50.55 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $284.00 $50.55 $284.00 $284.00 $210.78 $210.78 $218.91 $147.96 $59.19 $284.00 $113.60 $284.00 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $184.60 $284.00 $284.00 $164.72 $284.00 $170.40 $284.00 $284.00 $284.00 N/A N/A 27001768 EAP HCPCS A4300 TEMPORARY VEN CATH REMOVAL BOTH IP/OP $438.00 $324.50 $91.28 $438.00 $438.00 $438.00 $438.00 $438.00 $438.00 $438.00 $438.00 $438.00 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $175.20 $438.00 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $438.00 $438.00 $254.04 $438.00 $262.80 $438.00 $438.00 $438.00 N/A N/A 27001769 EAP Custom 27001769 TRAY CATHETER INSRTN DULM BOTH IP/OP "$1,048.00" $776.00 $186.54 "$1,048.00" "$1,048.00" "$1,048.00" "$1,048.00" "$1,048.00" "$1,048.00" "$1,048.00" $186.54 "$1,048.00" "$1,048.00" $777.83 $777.83 $807.80 $546.01 $218.41 "$1,048.00" $419.20 "$1,048.00" "$1,048.00" "$1,048.00" "$1,048.00" "$1,048.00" $786.00 "$1,048.00" "$1,048.00" "$1,048.00" $524.00 $524.00 $830.02 "$1,048.00" $838.40 $681.20 "$1,048.00" "$1,048.00" $607.84 "$1,048.00" $628.80 "$1,048.00" "$1,048.00" "$1,048.00" N/A N/A 27001770 EAP Custom 27001770 CENTRAL LINE DRESSING TRAY BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27001771 EAP Custom 27001771 CATHETER REPAIR KIT BOTH IP/OP $803.00 $594.50 $142.93 $803.00 $803.00 $803.00 $803.00 $803.00 $803.00 $803.00 $142.93 $803.00 $803.00 $595.99 $595.99 $618.95 $418.36 $167.35 $803.00 $321.20 $803.00 $803.00 $803.00 $803.00 $803.00 $602.25 $803.00 $803.00 $803.00 $401.50 $401.50 $635.98 $803.00 $642.40 $521.95 $803.00 $803.00 $465.74 $803.00 $481.80 $803.00 $803.00 $803.00 N/A N/A 27001773 EAP Custom 27001773 OCCULT BLOOD SUPPLY BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27001778 EAP Custom 27001778 NEEDLE PORT-CATH 20GA X 1 BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27001779 EAP Custom 27001779 TRAY CATHETER URETHRAL 14 BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27001781 EAP Custom 27001781 ACE WRAP BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27001782 EAP Custom 27001782 SPLINT BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 27001783 EAP Custom 27001783 SPLINT - SUPPLY BOTH IP/OP $266.00 $197.00 $47.35 $266.00 $266.00 $266.00 $266.00 $266.00 $266.00 $266.00 $47.35 $266.00 $266.00 $197.43 $197.43 $205.03 $138.59 $55.44 $266.00 $106.40 $266.00 $266.00 $266.00 $266.00 $266.00 $199.50 $266.00 $266.00 $266.00 $133.00 $133.00 $210.67 $266.00 $212.80 $172.90 $266.00 $266.00 $154.28 $266.00 $159.60 $266.00 $266.00 $266.00 N/A N/A 27001785 EAP Custom 27001785 ACE WRAP BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27001786 EAP Custom 27001786 ACE WRAP SUPPLY BOTH IP/OP $31.00 $23.00 $5.52 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $5.52 $31.00 $31.00 $23.01 $23.01 $23.89 $16.15 $6.46 $31.00 $12.40 $31.00 $31.00 $31.00 $31.00 $31.00 $23.25 $31.00 $31.00 $31.00 $15.50 $15.50 $24.55 $31.00 $24.80 $20.15 $31.00 $31.00 $17.98 $31.00 $18.60 $31.00 $31.00 $31.00 N/A N/A 27001788 EAP Custom 27001788 WRIST BRACE BOTH IP/OP $60.00 $44.50 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 $60.00 $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A 27001789 EAP Custom 27001789 SLING/FIG. 8 BOTH IP/OP $83.00 $61.50 $14.77 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $14.77 $83.00 $83.00 $61.60 $61.60 $63.98 $43.24 $17.30 $83.00 $33.20 $83.00 $83.00 $83.00 $83.00 $83.00 $62.25 $83.00 $83.00 $83.00 $41.50 $41.50 $65.74 $83.00 $66.40 $53.95 $83.00 $83.00 $48.14 $83.00 $49.80 $83.00 $83.00 $83.00 N/A N/A 27002257 EAP Custom 27002257 CAST APPLICATION SUPPLY BOTH IP/OP $567.00 $420.00 $100.93 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $100.93 $567.00 $567.00 $420.83 $420.83 $437.04 $295.41 $118.17 $567.00 $226.80 $567.00 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $368.55 $567.00 $567.00 $328.86 $567.00 $340.20 $567.00 $567.00 $567.00 N/A N/A 27002259 EAP Custom 27002259 SLING BOTH IP/OP $108.00 $80.00 $19.22 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $19.22 $108.00 $108.00 $80.16 $80.16 $83.25 $56.27 $22.51 $108.00 $43.20 $108.00 $108.00 $108.00 $108.00 $108.00 $81.00 $108.00 $108.00 $108.00 $54.00 $54.00 $85.54 $108.00 $86.40 $70.20 $108.00 $108.00 $62.64 $108.00 $64.80 $108.00 $108.00 $108.00 N/A N/A 27002260 EAP Custom 27002260 ACE BANDAGE BOTH IP/OP $14.00 $10.50 $2.49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $2.49 $14.00 $14.00 $10.39 $10.39 $10.79 $7.29 $2.92 $14.00 $5.60 $14.00 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $9.10 $14.00 $14.00 $8.12 $14.00 $8.40 $14.00 $14.00 $14.00 N/A N/A 27002261 EAP Custom 27002261 URINARY DRAINAGE BAG BOTH IP/OP $28.00 $21.00 $4.98 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $4.98 $28.00 $28.00 $20.78 $20.78 $21.58 $14.59 $5.84 $28.00 $11.20 $28.00 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $18.20 $28.00 $28.00 $16.24 $28.00 $16.80 $28.00 $28.00 $28.00 N/A N/A 27002263 EAP Custom 27002263 GASTRIC LAVAGE KIT BOTH IP/OP $234.00 $173.50 $41.65 $234.00 $234.00 $234.00 $234.00 $234.00 $234.00 $234.00 $41.65 $234.00 $234.00 $173.67 $173.67 $180.37 $121.91 $48.77 $234.00 $93.60 $234.00 $234.00 $234.00 $234.00 $234.00 $175.50 $234.00 $234.00 $234.00 $117.00 $117.00 $185.33 $234.00 $187.20 $152.10 $234.00 $234.00 $135.72 $234.00 $140.40 $234.00 $234.00 $234.00 N/A N/A 27002265 EAP Custom 27002265 PELVIC TRAY BOTH IP/OP $138.00 $102.50 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 $138.00 $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 27002266 EAP Custom 27002266 PEAK FLOW METER BOTH IP/OP $343.00 $254.00 $61.05 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $61.05 $343.00 $343.00 $254.57 $254.57 $264.38 $178.70 $71.48 $343.00 $137.20 $343.00 $343.00 $343.00 $343.00 $343.00 $257.25 $343.00 $343.00 $343.00 $171.50 $171.50 $271.66 $343.00 $274.40 $222.95 $343.00 $343.00 $198.94 $343.00 $205.80 $343.00 $343.00 $343.00 N/A N/A 27002267 EAP Custom 27002267 ORTHO TRACTION PINS BOTH IP/OP $408.00 $302.00 $72.62 $408.00 $408.00 $408.00 $408.00 $408.00 $408.00 $408.00 $72.62 $408.00 $408.00 $302.82 $302.82 $314.49 $212.57 $85.03 $408.00 $163.20 $408.00 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $265.20 $408.00 $408.00 $236.64 $408.00 $244.80 $408.00 $408.00 $408.00 N/A N/A 27002268 EAP Custom 27002268 ACE BANDAGE BOTH IP/OP $147.00 $109.00 $26.17 $147.00 $147.00 $147.00 $147.00 $147.00 $147.00 $147.00 $26.17 $147.00 $147.00 $109.10 $109.10 $113.31 $76.59 $30.64 $147.00 $58.80 $147.00 $147.00 $147.00 $147.00 $147.00 $110.25 $147.00 $147.00 $147.00 $73.50 $73.50 $116.42 $147.00 $117.60 $95.55 $147.00 $147.00 $85.26 $147.00 $88.20 $147.00 $147.00 $147.00 N/A N/A 27002473 EAP Custom 27002473 ANGIOCATH IV BB 18GX1.25IN NW BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 27002510 EAP Custom 27002510 NUVA RING BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27002515 EAP Custom 27002515 CLAVICAL STRAPS BOTH IP/OP $28.00 $21.00 $4.98 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $4.98 $28.00 $28.00 $20.78 $20.78 $21.58 $14.59 $5.84 $28.00 $11.20 $28.00 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $18.20 $28.00 $28.00 $16.24 $28.00 $16.80 $28.00 $28.00 $28.00 N/A N/A 27002516 EAP Custom 27002516 FIBERGLASS CASTING BOTH IP/OP $129.00 $95.50 $22.96 $129.00 $129.00 $129.00 $129.00 $129.00 $129.00 $129.00 $22.96 $129.00 $129.00 $95.74 $95.74 $99.43 $67.21 $26.89 $129.00 $51.60 $129.00 $129.00 $129.00 $129.00 $129.00 $96.75 $129.00 $129.00 $129.00 $64.50 $64.50 $102.17 $129.00 $103.20 $83.85 $129.00 $129.00 $74.82 $129.00 $77.40 $129.00 $129.00 $129.00 N/A N/A 27002517 EAP Custom 27002517 ANKLE STIRRUP BOTH IP/OP $149.00 $110.50 $26.52 $149.00 $149.00 $149.00 $149.00 $149.00 $149.00 $149.00 $26.52 $149.00 $149.00 $110.59 $110.59 $114.85 $77.63 $31.05 $149.00 $59.60 $149.00 $149.00 $149.00 $149.00 $149.00 $111.75 $149.00 $149.00 $149.00 $74.50 $74.50 $118.01 $149.00 $119.20 $96.85 $149.00 $149.00 $86.42 $149.00 $89.40 $149.00 $149.00 $149.00 N/A N/A 27002518 EAP Custom 27002518 KNEE IMMOBILIZER BOTH IP/OP $232.00 $172.00 $41.30 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $41.30 $232.00 $232.00 $172.19 $172.19 $178.83 $120.87 $48.35 $232.00 $92.80 $232.00 $232.00 $232.00 $232.00 $232.00 $174.00 $232.00 $232.00 $232.00 $116.00 $116.00 $183.74 $232.00 $185.60 $150.80 $232.00 $232.00 $134.56 $232.00 $139.20 $232.00 $232.00 $232.00 N/A N/A 27002519 EAP Custom 27002519 PHILADEPHIA COLLAR BOTH IP/OP $193.00 $143.00 $34.35 $193.00 $193.00 $193.00 $193.00 $193.00 $193.00 $193.00 $34.35 $193.00 $193.00 $143.24 $143.24 $148.76 $100.55 $40.22 $193.00 $77.20 $193.00 $193.00 $193.00 $193.00 $193.00 $144.75 $193.00 $193.00 $193.00 $96.50 $96.50 $152.86 $193.00 $154.40 $125.45 $193.00 $193.00 $111.94 $193.00 $115.80 $193.00 $193.00 $193.00 N/A N/A 27002520 EAP Custom 27002520 CERVICAL COLLAR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27002521 EAP Custom 27002521 PAVLIK HARNESS BOTH IP/OP $178.00 $132.00 $31.68 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $31.68 $178.00 $178.00 $132.11 $132.11 $137.20 $92.74 $37.10 $178.00 $71.20 $178.00 $178.00 $178.00 $178.00 $178.00 $133.50 $178.00 $178.00 $178.00 $89.00 $89.00 $140.98 $178.00 $142.40 $115.70 $178.00 $178.00 $103.24 $178.00 $106.80 $178.00 $178.00 $178.00 N/A N/A 27002522 EAP Custom 27002522 CAST SHOE BOTH IP/OP $51.00 $38.00 $9.08 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $9.08 $51.00 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $20.40 $51.00 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $51.00 $51.00 $29.58 $51.00 $30.60 $51.00 $51.00 $51.00 N/A N/A 27002523 EAP Custom 27002523 SHOULDER IMMOBILIZER BOTH IP/OP $232.00 $172.00 $41.30 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $41.30 $232.00 $232.00 $172.19 $172.19 $178.83 $120.87 $48.35 $232.00 $92.80 $232.00 $232.00 $232.00 $232.00 $232.00 $174.00 $232.00 $232.00 $232.00 $116.00 $116.00 $183.74 $232.00 $185.60 $150.80 $232.00 $232.00 $134.56 $232.00 $139.20 $232.00 $232.00 $232.00 N/A N/A 27002524 EAP Custom 27002524 POST OP SHOE BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27002525 EAP Custom 27002525 HINGED KNEE BRACE BOTH IP/OP $705.00 $522.00 $125.49 $705.00 $705.00 $705.00 $705.00 $705.00 $705.00 $705.00 $125.49 $705.00 $705.00 $523.25 $523.25 $543.41 $367.31 $146.93 $705.00 $282.00 $705.00 $705.00 $705.00 $705.00 $705.00 $528.75 $705.00 $705.00 $705.00 $352.50 $352.50 $558.36 $705.00 $564.00 $458.25 $705.00 $705.00 $408.90 $705.00 $423.00 $705.00 $705.00 $705.00 N/A N/A 27002526 EAP Custom 27002526 SLING/FIG. 8 BOTH IP/OP $88.00 $65.50 $15.66 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $15.66 $88.00 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $35.20 $88.00 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $88.00 $88.00 $51.04 $88.00 $52.80 $88.00 $88.00 $88.00 N/A N/A 27002527 EAP Custom 27002527 HINGED KNEE SLEEVE BOTH IP/OP $129.00 $95.50 $22.96 $129.00 $129.00 $129.00 $129.00 $129.00 $129.00 $129.00 $22.96 $129.00 $129.00 $95.74 $95.74 $99.43 $67.21 $26.89 $129.00 $51.60 $129.00 $129.00 $129.00 $129.00 $129.00 $96.75 $129.00 $129.00 $129.00 $64.50 $64.50 $102.17 $129.00 $103.20 $83.85 $129.00 $129.00 $74.82 $129.00 $77.40 $129.00 $129.00 $129.00 N/A N/A 27002528 EAP Custom 27002528 UNIVERSAL KNEE BRACE BOTH IP/OP $728.00 $539.00 $129.58 $728.00 $728.00 $728.00 $728.00 $728.00 $728.00 $728.00 $129.58 $728.00 $728.00 $540.32 $540.32 $561.14 $379.29 $151.72 $728.00 $291.20 $728.00 $728.00 $728.00 $728.00 $728.00 $546.00 $728.00 $728.00 $728.00 $364.00 $364.00 $576.58 $728.00 $582.40 $473.20 $728.00 $728.00 $422.24 $728.00 $436.80 $728.00 $728.00 $728.00 N/A N/A 27002529 EAP Custom 27002529 UNIVERSAL KNEE BRACE BOTH IP/OP $371.00 $275.00 $66.04 $371.00 $371.00 $371.00 $371.00 $371.00 $371.00 $371.00 $66.04 $371.00 $371.00 $275.36 $275.36 $285.97 $193.29 $77.32 $371.00 $148.40 $371.00 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $241.15 $371.00 $371.00 $215.18 $371.00 $222.60 $371.00 $371.00 $371.00 N/A N/A 27002530 EAP Custom 27002530 3D WALKING BOOT BOTH IP/OP $197.00 $146.00 $35.07 $197.00 $197.00 $197.00 $197.00 $197.00 $197.00 $197.00 $35.07 $197.00 $197.00 $146.21 $146.21 $151.85 $102.64 $41.06 $197.00 $78.80 $197.00 $197.00 $197.00 $197.00 $197.00 $147.75 $197.00 $197.00 $197.00 $98.50 $98.50 $156.02 $197.00 $157.60 $128.05 $197.00 $197.00 $114.26 $197.00 $118.20 $197.00 $197.00 $197.00 N/A N/A 27002531 EAP Custom 27002531 KNEE IMMOBILIZER BOTH IP/OP $232.00 $172.00 $41.30 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $41.30 $232.00 $232.00 $172.19 $172.19 $178.83 $120.87 $48.35 $232.00 $92.80 $232.00 $232.00 $232.00 $232.00 $232.00 $174.00 $232.00 $232.00 $232.00 $116.00 $116.00 $183.74 $232.00 $185.60 $150.80 $232.00 $232.00 $134.56 $232.00 $139.20 $232.00 $232.00 $232.00 N/A N/A 27002532 EAP Custom 27002532 SHOULDER IMMOBILIZER BOTH IP/OP $232.00 $172.00 $41.30 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $41.30 $232.00 $232.00 $172.19 $172.19 $178.83 $120.87 $48.35 $232.00 $92.80 $232.00 $232.00 $232.00 $232.00 $232.00 $174.00 $232.00 $232.00 $232.00 $116.00 $116.00 $183.74 $232.00 $185.60 $150.80 $232.00 $232.00 $134.56 $232.00 $139.20 $232.00 $232.00 $232.00 N/A N/A 27002533 EAP Custom 27002533 PHILADELPHIA COLLAR BOTH IP/OP $207.00 $153.50 $36.85 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $36.85 $207.00 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $82.80 $207.00 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $207.00 $207.00 $120.06 $207.00 $124.20 $207.00 $207.00 $207.00 N/A N/A 27002534 EAP Custom 27002534 SOFT COLLAR BOTH IP/OP $130.00 $96.50 $23.14 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $23.14 $130.00 $130.00 $96.49 $96.49 $100.20 $67.73 $27.09 $130.00 $52.00 $130.00 $130.00 $130.00 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $65.00 $65.00 $102.96 $130.00 $104.00 $84.50 $130.00 $130.00 $75.40 $130.00 $78.00 $130.00 $130.00 $130.00 N/A N/A 27002535 EAP Custom 27002535 ARM SLING BOTH IP/OP $94.00 $70.00 $16.73 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $16.73 $94.00 $94.00 $69.77 $69.77 $72.46 $48.97 $19.59 $94.00 $37.60 $94.00 $94.00 $94.00 $94.00 $94.00 $70.50 $94.00 $94.00 $94.00 $47.00 $47.00 $74.45 $94.00 $75.20 $61.10 $94.00 $94.00 $54.52 $94.00 $56.40 $94.00 $94.00 $94.00 N/A N/A 27002536 EAP Custom 27002536 ACTIVE ANKLE BRACE BOTH IP/OP $417.00 $309.00 $74.23 $417.00 $417.00 $417.00 $417.00 $417.00 $417.00 $417.00 $74.23 $417.00 $417.00 $309.50 $309.50 $321.42 $217.26 $86.91 $417.00 $166.80 $417.00 $417.00 $417.00 $417.00 $417.00 $312.75 $417.00 $417.00 $417.00 $208.50 $208.50 $330.26 $417.00 $333.60 $271.05 $417.00 $417.00 $241.86 $417.00 $250.20 $417.00 $417.00 $417.00 N/A N/A 27002537 EAP Custom 27002537 BUCK'S TRACTION SPLINT BOTH IP/OP $172.00 $127.50 $30.62 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $30.62 $172.00 $172.00 $127.66 $127.66 $132.58 $89.61 $35.85 $172.00 $68.80 $172.00 $172.00 $172.00 $172.00 $172.00 $129.00 $172.00 $172.00 $172.00 $86.00 $86.00 $136.22 $172.00 $137.60 $111.80 $172.00 $172.00 $99.76 $172.00 $103.20 $172.00 $172.00 $172.00 N/A N/A 27002538 EAP Custom 27002538 KNEE BRACE BOTH IP/OP $762.00 $564.00 $135.64 $762.00 $762.00 $762.00 $762.00 $762.00 $762.00 $762.00 $135.64 $762.00 $762.00 $565.56 $565.56 $587.35 $397.00 $158.81 $762.00 $304.80 $762.00 $762.00 $762.00 $762.00 $762.00 $571.50 $762.00 $762.00 $762.00 $381.00 $381.00 $603.50 $762.00 $609.60 $495.30 $762.00 $762.00 $441.96 $762.00 $457.20 $762.00 $762.00 $762.00 N/A N/A 27002539 EAP Custom 27002539 JACKSONVILLE SLING BOTH IP/OP $88.00 $65.50 $15.66 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $15.66 $88.00 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $35.20 $88.00 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $88.00 $88.00 $51.04 $88.00 $52.80 $88.00 $88.00 $88.00 N/A N/A 27002543 EAP Custom 27002543 SANDBAG BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 27002544 EAP Custom 27002544 ASPEN COLLAR BOTH IP/OP $154.00 $114.00 $27.41 $154.00 $154.00 $154.00 $154.00 $154.00 $154.00 $154.00 $27.41 $154.00 $154.00 $114.30 $114.30 $118.70 $80.23 $32.10 $154.00 $61.60 $154.00 $154.00 $154.00 $154.00 $154.00 $115.50 $154.00 $154.00 $154.00 $77.00 $77.00 $121.97 $154.00 $123.20 $100.10 $154.00 $154.00 $89.32 $154.00 $92.40 $154.00 $154.00 $154.00 N/A N/A 27002545 EAP Custom 27002545 MIAMI J. COLLAR BOTH IP/OP $195.00 $144.50 $34.71 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $34.71 $195.00 $195.00 $144.73 $144.73 $150.31 $101.60 $40.64 $195.00 $78.00 $195.00 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $126.75 $195.00 $195.00 $113.10 $195.00 $117.00 $195.00 $195.00 $195.00 N/A N/A 27002546 EAP Custom 27002546 ATLAS COLLAR BOTH IP/OP $194.00 $144.00 $34.53 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $34.53 $194.00 $194.00 $143.99 $143.99 $149.54 $101.07 $40.43 $194.00 $77.60 $194.00 $194.00 $194.00 $194.00 $194.00 $145.50 $194.00 $194.00 $194.00 $97.00 $97.00 $153.65 $194.00 $155.20 $126.10 $194.00 $194.00 $112.52 $194.00 $116.40 $194.00 $194.00 $194.00 N/A N/A 27002547 EAP Custom 27002547 PEDIATRIC PMT COLLAR BOTH IP/OP $63.00 $47.00 $11.21 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $11.21 $63.00 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $25.20 $63.00 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $31.50 $31.50 $49.90 $63.00 $50.40 $40.95 $63.00 $63.00 $36.54 $63.00 $37.80 $63.00 $63.00 $63.00 N/A N/A 27002548 EAP Custom 27002548 ABDUCTION PILLOW BOTH IP/OP $96.00 $71.50 $17.09 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $96.00 $17.09 $96.00 $96.00 $71.25 $71.25 $74.00 $50.02 $20.01 $96.00 $38.40 $96.00 $96.00 $96.00 $96.00 $96.00 $72.00 $96.00 $96.00 $96.00 $48.00 $48.00 $76.03 $96.00 $76.80 $62.40 $96.00 $96.00 $55.68 $96.00 $57.60 $96.00 $96.00 $96.00 N/A N/A 27002549 EAP Custom 27002549 NEOPRENE KNEE SLEEVE BOTH IP/OP $68.00 $50.50 $12.10 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $12.10 $68.00 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $27.20 $68.00 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $68.00 $68.00 $39.44 $68.00 $40.80 $68.00 $68.00 $68.00 N/A N/A 27002550 EAP Custom 27002550 CUFF AND COLLAR BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27002551 EAP Custom 27002551 POST OP SHOE BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27002552 EAP Custom 27002552 TLSO PRE FAB BOTH IP/OP "$2,419.00" "$1,790.50" $430.58 "$2,419.00" "$2,419.00" "$2,419.00" "$2,419.00" "$2,419.00" "$2,419.00" "$2,419.00" $430.58 "$2,419.00" "$2,419.00" "$1,795.38" "$1,795.38" "$1,864.57" "$1,260.30" $504.15 "$2,419.00" $967.60 "$2,419.00" "$2,419.00" "$2,419.00" "$2,419.00" "$2,419.00" "$1,814.25" "$2,419.00" "$2,419.00" "$2,419.00" "$1,209.50" "$1,209.50" "$1,915.85" "$2,419.00" "$1,935.20" "$1,572.35" "$2,419.00" "$2,419.00" "$1,403.02" "$2,419.00" "$1,451.40" "$2,419.00" "$2,419.00" "$2,419.00" N/A N/A 27002564 EAP CPT® C1751 "CVP KIT, DOUBLE LUMEN" BOTH IP/OP $569.00 $421.50 $112.93 $569.00 $308.97 $308.97 $308.97 $308.97 $569.00 $569.00 $569.00 $118.59 $569.00 $422.31 $422.31 $438.59 $296.45 $118.59 $569.00 $569.00 $336.56 $569.00 $569.00 $569.00 $569.00 $426.75 $569.00 $569.00 $569.00 $284.50 $284.50 $450.65 $569.00 $455.20 $369.85 $112.93 $569.00 $330.02 $569.00 $569.00 $569.00 $118.58 $569.00 N/A N/A 27002565 EAP Custom 27002565 "ETT, DOUBLE-LUMEN" BOTH IP/OP $837.00 $619.50 $148.99 $837.00 $837.00 $837.00 $837.00 $837.00 $837.00 $837.00 $148.99 $837.00 $837.00 $621.22 $621.22 $645.16 $436.08 $174.44 $837.00 $334.80 $837.00 $837.00 $837.00 $837.00 $837.00 $627.75 $837.00 $837.00 $837.00 $418.50 $418.50 $662.90 $837.00 $669.60 $544.05 $837.00 $837.00 $485.46 $837.00 $502.20 $837.00 $837.00 $837.00 N/A N/A 27002572 EAP Custom 27002572 INTRODUCER KIT BOTH IP/OP $261.00 $193.50 $46.46 $261.00 $261.00 $261.00 $261.00 $261.00 $261.00 $261.00 $46.46 $261.00 $261.00 $193.71 $193.71 $201.18 $135.98 $54.40 $261.00 $104.40 $261.00 $261.00 $261.00 $261.00 $261.00 $195.75 $261.00 $261.00 $261.00 $130.50 $130.50 $206.71 $261.00 $208.80 $169.65 $261.00 $261.00 $151.38 $261.00 $156.60 $261.00 $261.00 $261.00 N/A N/A 27002573 EAP Custom 27002573 RADIAL ARTERY SET (ARROW) BOTH IP/OP $92.00 $68.50 $16.38 $92.00 $92.00 $92.00 $92.00 $92.00 $92.00 $92.00 $16.38 $92.00 $92.00 $68.28 $68.28 $70.91 $47.93 $19.17 $92.00 $36.80 $92.00 $92.00 $92.00 $92.00 $92.00 $69.00 $92.00 $92.00 $92.00 $46.00 $46.00 $72.86 $92.00 $73.60 $59.80 $92.00 $92.00 $53.36 $92.00 $55.20 $92.00 $92.00 $92.00 N/A N/A 27002576 EAP Custom 27002576 EPIDURAL TRAY BOTH IP/OP $316.00 $234.00 $56.25 $316.00 $316.00 $316.00 $316.00 $316.00 $316.00 $316.00 $56.25 $316.00 $316.00 $234.54 $234.54 $243.57 $164.64 $65.86 $316.00 $126.40 $316.00 $316.00 $316.00 $316.00 $316.00 $237.00 $316.00 $316.00 $316.00 $158.00 $158.00 $250.27 $316.00 $252.80 $205.40 $316.00 $316.00 $183.28 $316.00 $189.60 $316.00 $316.00 $316.00 N/A N/A 27002579 EAP Custom 27002579 LEVEL ONE INSERTS BOTH IP/OP $101.00 $75.00 $17.98 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $17.98 $101.00 $101.00 $74.96 $74.96 $77.85 $52.62 $21.05 $101.00 $40.40 $101.00 $101.00 $101.00 $101.00 $101.00 $75.75 $101.00 $101.00 $101.00 $50.50 $50.50 $79.99 $101.00 $80.80 $65.65 $101.00 $101.00 $58.58 $101.00 $60.60 $101.00 $101.00 $101.00 N/A N/A 27002587 EAP HCPCS C1751 KIT QUAD LUMEN CATHER BOTH IP/OP $148.00 $110.00 $29.37 $148.00 $80.36 $80.36 $80.36 $80.36 $148.00 $148.00 $148.00 $30.85 $148.00 $109.85 $109.85 $114.08 $77.11 $30.84 $148.00 $148.00 $87.54 $148.00 $148.00 $148.00 $148.00 $111.00 $148.00 $148.00 $148.00 $74.00 $74.00 $117.22 $148.00 $118.40 $96.20 $29.37 $148.00 $85.84 $148.00 $148.00 $148.00 $30.84 $148.00 N/A N/A 27002589 EAP Custom 27002589 AINTREE INTUBATION CHANGER BOTH IP/OP $83.00 $61.50 $14.77 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $14.77 $83.00 $83.00 $61.60 $61.60 $63.98 $43.24 $17.30 $83.00 $33.20 $83.00 $83.00 $83.00 $83.00 $83.00 $62.25 $83.00 $83.00 $83.00 $41.50 $41.50 $65.74 $83.00 $66.40 $53.95 $83.00 $83.00 $48.14 $83.00 $49.80 $83.00 $83.00 $83.00 N/A N/A 27002590 EAP Custom 27002590 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $646.00 $478.50 $114.99 $646.00 $646.00 $646.00 $646.00 $646.00 $646.00 $646.00 $114.99 $646.00 $646.00 $479.46 $479.46 $497.94 $336.57 $134.63 $646.00 $258.40 $646.00 $646.00 $646.00 $646.00 $646.00 $484.50 $646.00 $646.00 $646.00 $323.00 $323.00 $511.63 $646.00 $516.80 $419.90 $646.00 $646.00 $374.68 $646.00 $387.60 $646.00 $646.00 $646.00 N/A N/A 27002593 EAP Custom 27002593 "CVP KIT, DOUBLE LUMEN" BOTH IP/OP $307.00 $227.50 $54.65 $307.00 $307.00 $307.00 $307.00 $307.00 $307.00 $307.00 $54.65 $307.00 $307.00 $227.86 $227.86 $236.64 $159.95 $63.98 $307.00 $122.80 $307.00 $307.00 $307.00 $307.00 $307.00 $230.25 $307.00 $307.00 $307.00 $153.50 $153.50 $243.14 $307.00 $245.60 $199.55 $307.00 $307.00 $178.06 $307.00 $184.20 $307.00 $307.00 $307.00 N/A N/A 27002594 EAP Custom 27002594 "TRANSDUCER AND TUBING, DISP" BOTH IP/OP $60.00 $44.50 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 $60.00 $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A 27002595 EAP Custom 27002595 FIBEROPTIC INTUBATION SCOPE BOTH IP/OP $321.00 $238.00 $57.14 $321.00 $321.00 $321.00 $321.00 $321.00 $321.00 $321.00 $57.14 $321.00 $321.00 $238.25 $238.25 $247.43 $167.24 $66.90 $321.00 $128.40 $321.00 $321.00 $321.00 $321.00 $321.00 $240.75 $321.00 $321.00 $321.00 $160.50 $160.50 $254.23 $321.00 $256.80 $208.65 $321.00 $321.00 $186.18 $321.00 $192.60 $321.00 $321.00 $321.00 N/A N/A 27002598 EAP Custom 27002598 AIR EMBOLISM DETECTOR BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27002599 EAP Custom 27002599 INTRODUCER KIT BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 27002600 EAP Custom 27002600 RADIAL ARTERY SET (ARROW) BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27002602 EAP Custom 27002602 DISP. SAO2 PROBE BOTH IP/OP $61.00 $45.50 $10.86 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $10.86 $61.00 $61.00 $45.27 $45.27 $47.02 $31.78 $12.71 $61.00 $24.40 $61.00 $61.00 $61.00 $61.00 $61.00 $45.75 $61.00 $61.00 $61.00 $30.50 $30.50 $48.31 $61.00 $48.80 $39.65 $61.00 $61.00 $35.38 $61.00 $36.60 $61.00 $61.00 $61.00 N/A N/A 27002604 EAP Custom 27002604 EPIDURAL TRAY BOTH IP/OP $132.00 $98.00 $23.50 $132.00 $132.00 $132.00 $132.00 $132.00 $132.00 $132.00 $23.50 $132.00 $132.00 $97.97 $97.97 $101.75 $68.77 $27.51 $132.00 $52.80 $132.00 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $85.80 $132.00 $132.00 $76.56 $132.00 $79.20 $132.00 $132.00 $132.00 N/A N/A 27002605 EAP Custom 27002605 SPINAL TRAY BOTH IP/OP $190.00 $141.00 $33.82 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $33.82 $190.00 $190.00 $141.02 $141.02 $146.45 $98.99 $39.60 $190.00 $76.00 $190.00 $190.00 $190.00 $190.00 $190.00 $142.50 $190.00 $190.00 $190.00 $95.00 $95.00 $150.48 $190.00 $152.00 $123.50 $190.00 $190.00 $110.20 $190.00 $114.00 $190.00 $190.00 $190.00 N/A N/A 27002609 EAP Custom 27002609 THORACOTOMY TRAY BOTH IP/OP $132.00 $98.00 $23.50 $132.00 $132.00 $132.00 $132.00 $132.00 $132.00 $132.00 $23.50 $132.00 $132.00 $97.97 $97.97 $101.75 $68.77 $27.51 $132.00 $52.80 $132.00 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $85.80 $132.00 $132.00 $76.56 $132.00 $79.20 $132.00 $132.00 $132.00 N/A N/A 27002610 EAP Custom 27002610 TRACHEOTOMY TRAY BOTH IP/OP $394.00 $292.00 $70.13 $394.00 $394.00 $394.00 $394.00 $394.00 $394.00 $394.00 $70.13 $394.00 $394.00 $292.43 $292.43 $303.70 $205.27 $82.11 $394.00 $157.60 $394.00 $394.00 $394.00 $394.00 $394.00 $295.50 $394.00 $394.00 $394.00 $197.00 $197.00 $312.05 $394.00 $315.20 $256.10 $394.00 $394.00 $228.52 $394.00 $236.40 $394.00 $394.00 $394.00 N/A N/A 27002618 EAP Custom 27002618 IOBAN 2 DRAPE INCISE SMAL BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27002620 EAP Custom 27002620 IOBAN 2 DRAPE INCISE LARG BOTH IP/OP $434.00 $321.50 $77.25 $434.00 $434.00 $434.00 $434.00 $434.00 $434.00 $434.00 $77.25 $434.00 $434.00 $322.11 $322.11 $334.53 $226.11 $90.45 $434.00 $173.60 $434.00 $434.00 $434.00 $434.00 $434.00 $325.50 $434.00 $434.00 $434.00 $217.00 $217.00 $343.73 $434.00 $347.20 $282.10 $434.00 $434.00 $251.72 $434.00 $260.40 $434.00 $434.00 $434.00 N/A N/A 27002621 EAP Custom 27002621 NEEDLE SPINAL 18GA BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27002624 EAP Custom 27002624 CATHETER TEXAS LARGE BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27002625 EAP Custom 27002625 CATHETER THORACIC 32FR BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27002626 EAP Custom 27002626 CATHETER THORACIC 36FR BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27002627 EAP Custom 27002627 CATHETER URETHRAL TWO-EYE BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27002628 EAP Custom 27002628 ARTERY ARTERIAL CATHERIZA BOTH IP/OP $102.00 $75.50 $18.16 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $18.16 $102.00 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $40.80 $102.00 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $102.00 $102.00 $59.16 $102.00 $61.20 $102.00 $102.00 $102.00 N/A N/A 27002629 EAP Custom 27002629 ARTERY RADIAL CATHERIZATI BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27002630 EAP Custom 27002630 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27002631 EAP Custom 27002631 TUBE SALEM SILICONE SIZE BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27002632 EAP Custom 27002632 TUBES SALEM SUMP 48 LENG BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27002636 EAP Custom 27002636 BAG DRAINAGE BECKER BOTH IP/OP $197.00 $146.00 $35.07 $197.00 $197.00 $197.00 $197.00 $197.00 $197.00 $197.00 $35.07 $197.00 $197.00 $146.21 $146.21 $151.85 $102.64 $41.06 $197.00 $78.80 $197.00 $197.00 $197.00 $197.00 $197.00 $147.75 $197.00 $197.00 $197.00 $98.50 $98.50 $156.02 $197.00 $157.60 $128.05 $197.00 $197.00 $114.26 $197.00 $118.20 $197.00 $197.00 $197.00 N/A N/A 27002637 EAP Custom 27002637 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27002640 EAP Custom 27002640 SET BLOOD ADMINISTRATION BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27002643 EAP Custom 27002643 CREAM BAZA 5OZ BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27002646 EAP Custom 27002646 ELECTRODES OPERATIVE BOTH IP/OP $266.00 $197.00 $47.35 $266.00 $266.00 $266.00 $266.00 $266.00 $266.00 $266.00 $47.35 $266.00 $266.00 $197.43 $197.43 $205.03 $138.59 $55.44 $266.00 $106.40 $266.00 $266.00 $266.00 $266.00 $266.00 $199.50 $266.00 $266.00 $266.00 $133.00 $133.00 $210.67 $266.00 $212.80 $172.90 $266.00 $266.00 $154.28 $266.00 $159.60 $266.00 $266.00 $266.00 N/A N/A 27002647 EAP Custom 27002647 VALVE ANTI-REFLUX SALEM S BOTH IP/OP $46.00 $34.50 $8.19 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $8.19 $46.00 $46.00 $34.14 $34.14 $35.46 $23.97 $9.59 $46.00 $18.40 $46.00 $46.00 $46.00 $46.00 $46.00 $34.50 $46.00 $46.00 $46.00 $23.00 $23.00 $36.43 $46.00 $36.80 $29.90 $46.00 $46.00 $26.68 $46.00 $27.60 $46.00 $46.00 $46.00 N/A N/A 27002649 EAP Custom 27002649 KIT THORACOTOMY BOTH IP/OP $203.00 $150.50 $36.13 $203.00 $203.00 $203.00 $203.00 $203.00 $203.00 $203.00 $36.13 $203.00 $203.00 $150.67 $150.67 $156.47 $105.76 $42.31 $203.00 $81.20 $203.00 $203.00 $203.00 $203.00 $203.00 $152.25 $203.00 $203.00 $203.00 $101.50 $101.50 $160.78 $203.00 $162.40 $131.95 $203.00 $203.00 $117.74 $203.00 $121.80 $203.00 $203.00 $203.00 N/A N/A 27002653 EAP Custom 27002653 SET PEDIATRIC MEASURED FI BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27002656 EAP Custom 27002656 POUCH FECAL INCONTINENCE BOTH IP/OP $50.00 $37.00 $8.90 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $8.90 $50.00 $50.00 $37.11 $37.11 $38.54 $26.05 $10.42 $50.00 $20.00 $50.00 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $32.50 $50.00 $50.00 $29.00 $50.00 $30.00 $50.00 $50.00 $50.00 N/A N/A 27002657 EAP Custom 27002657 KIT PRESSURE MONITORING T BOTH IP/OP $163.00 $121.00 $29.01 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $29.01 $163.00 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $65.20 $163.00 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $163.00 $163.00 $94.54 $163.00 $97.80 $163.00 $163.00 $163.00 N/A N/A 27002658 EAP Custom 27002658 TRANSDUCER DISP FOR ICP BOTH IP/OP $70.00 $52.00 $12.46 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $12.46 $70.00 $70.00 $51.95 $51.95 $53.96 $36.47 $14.59 $70.00 $28.00 $70.00 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $45.50 $70.00 $70.00 $40.60 $70.00 $42.00 $70.00 $70.00 $70.00 N/A N/A 27002659 EAP Custom 27002659 KIT TRANSDUCER MONITORING BOTH IP/OP $313.00 $232.00 $55.71 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $55.71 $313.00 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $125.20 $313.00 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $313.00 $313.00 $181.54 $313.00 $187.80 $313.00 $313.00 $313.00 N/A N/A 27002660 EAP Custom 27002660 KIT PRESSURE MONITORING BOTH IP/OP $234.00 $173.50 $41.65 $234.00 $234.00 $234.00 $234.00 $234.00 $234.00 $234.00 $41.65 $234.00 $234.00 $173.67 $173.67 $180.37 $121.91 $48.77 $234.00 $93.60 $234.00 $234.00 $234.00 $234.00 $234.00 $175.50 $234.00 $234.00 $234.00 $117.00 $117.00 $185.33 $234.00 $187.20 $152.10 $234.00 $234.00 $135.72 $234.00 $140.40 $234.00 $234.00 $234.00 N/A N/A 27002662 EAP Custom 27002662 BAG 1000ML PUMP SET BOTH IP/OP $37.00 $27.50 $6.59 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $6.59 $37.00 $37.00 $27.46 $27.46 $28.52 $19.28 $7.71 $37.00 $14.80 $37.00 $37.00 $37.00 $37.00 $37.00 $27.75 $37.00 $37.00 $37.00 $18.50 $18.50 $29.30 $37.00 $29.60 $24.05 $37.00 $37.00 $21.46 $37.00 $22.20 $37.00 $37.00 $37.00 N/A N/A 27002663 EAP Custom 27002663 KIT PECUTANEOUS INTRODUCE BOTH IP/OP $276.00 $204.50 $49.13 $276.00 $276.00 $276.00 $276.00 $276.00 $276.00 $276.00 $49.13 $276.00 $276.00 $204.85 $204.85 $212.74 $143.80 $57.52 $276.00 $110.40 $276.00 $276.00 $276.00 $276.00 $276.00 $207.00 $276.00 $276.00 $276.00 $138.00 $138.00 $218.59 $276.00 $220.80 $179.40 $276.00 $276.00 $160.08 $276.00 $165.60 $276.00 $276.00 $276.00 N/A N/A 27002664 EAP Custom 27002664 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $420.00 $311.00 $74.76 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $74.76 $420.00 $420.00 $311.72 $311.72 $323.74 $218.82 $87.53 $420.00 $168.00 $420.00 $420.00 $420.00 $420.00 $420.00 $315.00 $420.00 $420.00 $420.00 $210.00 $210.00 $332.64 $420.00 $336.00 $273.00 $420.00 $420.00 $243.60 $420.00 $252.00 $420.00 $420.00 $420.00 N/A N/A 27002665 EAP Custom 27002665 CHEST UNIT DRY SUCTION SY BOTH IP/OP $309.00 $229.00 $55.00 $309.00 $309.00 $309.00 $309.00 $309.00 $309.00 $309.00 $55.00 $309.00 $309.00 $229.34 $229.34 $238.18 $160.99 $64.40 $309.00 $123.60 $309.00 $309.00 $309.00 $309.00 $309.00 $231.75 $309.00 $309.00 $309.00 $154.50 $154.50 $244.73 $309.00 $247.20 $200.85 $309.00 $309.00 $179.22 $309.00 $185.40 $309.00 $309.00 $309.00 N/A N/A 27002666 EAP Custom 27002666 BAG AUTO-TRANSFUSION PLE BOTH IP/OP $245.00 $181.50 $43.61 $245.00 $245.00 $245.00 $245.00 $245.00 $245.00 $245.00 $43.61 $245.00 $245.00 $181.84 $181.84 $188.85 $127.65 $51.06 $245.00 $98.00 $245.00 $245.00 $245.00 $245.00 $245.00 $183.75 $245.00 $245.00 $245.00 $122.50 $122.50 $194.04 $245.00 $196.00 $159.25 $245.00 $245.00 $142.10 $245.00 $147.00 $245.00 $245.00 $245.00 N/A N/A 27002670 EAP Custom 27002670 TUBE FEEDING NG 8FR 36IN ENTR BOTH IP/OP $61.00 $45.50 $10.86 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $61.00 $10.86 $61.00 $61.00 $45.27 $45.27 $47.02 $31.78 $12.71 $61.00 $24.40 $61.00 $61.00 $61.00 $61.00 $61.00 $45.75 $61.00 $61.00 $61.00 $30.50 $30.50 $48.31 $61.00 $48.80 $39.65 $61.00 $61.00 $35.38 $61.00 $36.60 $61.00 $61.00 $61.00 N/A N/A 27002671 EAP Custom 27002671 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $646.00 $478.50 $114.99 $646.00 $646.00 $646.00 $646.00 $646.00 $646.00 $646.00 $114.99 $646.00 $646.00 $479.46 $479.46 $497.94 $336.57 $134.63 $646.00 $258.40 $646.00 $646.00 $646.00 $646.00 $646.00 $484.50 $646.00 $646.00 $646.00 $323.00 $323.00 $511.63 $646.00 $516.80 $419.90 $646.00 $646.00 $374.68 $646.00 $387.60 $646.00 $646.00 $646.00 N/A N/A 27002672 EAP Custom 27002672 CATHETER SWAN GANZ BOTH IP/OP $674.00 $499.00 $119.97 $674.00 $674.00 $674.00 $674.00 $674.00 $674.00 $674.00 $119.97 $674.00 $674.00 $500.24 $500.24 $519.52 $351.15 $140.47 $674.00 $269.60 $674.00 $674.00 $674.00 $674.00 $674.00 $505.50 $674.00 $674.00 $674.00 $337.00 $337.00 $533.81 $674.00 $539.20 $438.10 $674.00 $674.00 $390.92 $674.00 $404.40 $674.00 $674.00 $674.00 N/A N/A 27002673 EAP Custom 27002673 DELIVERY SYSTEM CLOSED IN BOTH IP/OP $141.00 $104.50 $25.10 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $25.10 $141.00 $141.00 $104.65 $104.65 $108.68 $73.46 $29.39 $141.00 $56.40 $141.00 $141.00 $141.00 $141.00 $141.00 $105.75 $141.00 $141.00 $141.00 $70.50 $70.50 $111.67 $141.00 $112.80 $91.65 $141.00 $141.00 $81.78 $141.00 $84.60 $141.00 $141.00 $141.00 N/A N/A 27002676 EAP Custom 27002676 FILTER SET 0.22 MICRON BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 27002677 EAP Custom 27002677 TRAY CATHETER URETHRAL 14 BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27002678 EAP Custom 27002678 TRAY FOLEY PRECONNECTED W BOTH IP/OP $42.00 $31.50 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $7.48 $42.00 $42.00 $31.17 $31.17 $32.37 $21.88 $8.75 $42.00 $16.80 $42.00 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $27.30 $42.00 $42.00 $24.36 $42.00 $25.20 $42.00 $42.00 $42.00 N/A N/A 27002679 EAP Custom 27002679 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27002681 EAP Custom 27002681 TRAY URINE METER 18FR BOTH IP/OP $85.00 $63.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 $85.00 $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 27002682 EAP Custom 27002682 TRAY THORACENTESIS DISPOS BOTH IP/OP $216.00 $160.00 $38.45 $216.00 $216.00 $216.00 $216.00 $216.00 $216.00 $216.00 $38.45 $216.00 $216.00 $160.32 $160.32 $166.49 $112.54 $45.02 $216.00 $86.40 $216.00 $216.00 $216.00 $216.00 $216.00 $162.00 $216.00 $216.00 $216.00 $108.00 $108.00 $171.07 $216.00 $172.80 $140.40 $216.00 $216.00 $125.28 $216.00 $129.60 $216.00 $216.00 $216.00 N/A N/A 27002684 EAP Custom 27002684 BAG DRAINAGE URETERAL BOTH IP/OP $92.00 $68.50 $16.38 $92.00 $92.00 $92.00 $92.00 $92.00 $92.00 $92.00 $16.38 $92.00 $92.00 $68.28 $68.28 $70.91 $47.93 $19.17 $92.00 $36.80 $92.00 $92.00 $92.00 $92.00 $92.00 $69.00 $92.00 $92.00 $92.00 $46.00 $46.00 $72.86 $92.00 $73.60 $59.80 $92.00 $92.00 $53.36 $92.00 $55.20 $92.00 $92.00 $92.00 N/A N/A 27002687 EAP Custom 27002687 SLEEVE KNEE REGULAR DVT BOTH IP/OP $358.00 $265.00 $63.72 $358.00 $358.00 $358.00 $358.00 $358.00 $358.00 $358.00 $63.72 $358.00 $358.00 $265.71 $265.71 $275.95 $186.52 $74.61 $358.00 $143.20 $358.00 $358.00 $358.00 $358.00 $358.00 $268.50 $358.00 $358.00 $358.00 $179.00 $179.00 $283.54 $358.00 $286.40 $232.70 $358.00 $358.00 $207.64 $358.00 $214.80 $358.00 $358.00 $358.00 N/A N/A 27002688 EAP Custom 27002688 SLEEVE KNEE X-LARGE DVT BOTH IP/OP $439.00 $325.00 $78.14 $439.00 $439.00 $439.00 $439.00 $439.00 $439.00 $439.00 $78.14 $439.00 $439.00 $325.83 $325.83 $338.38 $228.72 $91.49 $439.00 $175.60 $439.00 $439.00 $439.00 $439.00 $439.00 $329.25 $439.00 $439.00 $439.00 $219.50 $219.50 $347.69 $439.00 $351.20 $285.35 $439.00 $439.00 $254.62 $439.00 $263.40 $439.00 $439.00 $439.00 N/A N/A 27002689 EAP Custom 27002689 SLEEVE THIGH REGULAR DVT BOTH IP/OP $512.00 $379.00 $91.14 $512.00 $512.00 $512.00 $512.00 $512.00 $512.00 $512.00 $91.14 $512.00 $512.00 $380.01 $380.01 $394.65 $266.75 $106.71 $512.00 $204.80 $512.00 $512.00 $512.00 $512.00 $512.00 $384.00 $512.00 $512.00 $512.00 $256.00 $256.00 $405.50 $512.00 $409.60 $332.80 $512.00 $512.00 $296.96 $512.00 $307.20 $512.00 $512.00 $512.00 N/A N/A 27002701 EAP Custom 27002701 SET PEDIATRIC MICRO DRIP BOTH IP/OP $28.00 $21.00 $4.98 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $4.98 $28.00 $28.00 $20.78 $20.78 $21.58 $14.59 $5.84 $28.00 $11.20 $28.00 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $18.20 $28.00 $28.00 $16.24 $28.00 $16.80 $28.00 $28.00 $28.00 N/A N/A 27002702 EAP Custom 27002702 SET PEDIATRIC MEASURED FI BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27002703 EAP Custom 27002703 STOCKINGS ANTIEMBOLISM THIGH BOTH IP/OP $22.00 $16.50 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 27002704 EAP Custom 27002704 STOCKINGS ANTIEMBOLISM THIGH BOTH IP/OP $44.00 $33.00 $7.83 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $7.83 $44.00 $44.00 $32.66 $32.66 $33.92 $22.92 $9.17 $44.00 $17.60 $44.00 $44.00 $44.00 $44.00 $44.00 $33.00 $44.00 $44.00 $44.00 $22.00 $22.00 $34.85 $44.00 $35.20 $28.60 $44.00 $44.00 $25.52 $44.00 $26.40 $44.00 $44.00 $44.00 N/A N/A 27002705 EAP Custom 27002705 STOCKINGS ANTIEMBOLISM THIGH BOTH IP/OP $50.00 $37.00 $8.90 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $8.90 $50.00 $50.00 $37.11 $37.11 $38.54 $26.05 $10.42 $50.00 $20.00 $50.00 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $32.50 $50.00 $50.00 $29.00 $50.00 $30.00 $50.00 $50.00 $50.00 N/A N/A 27002706 EAP Custom 27002706 STOCKINGS ANTIEMBOLISH EX BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27002707 EAP Custom 27002707 NEEDLE PORT-CATH 20GA X 1 BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27002708 EAP Custom 27002708 TRAY CATHETER URETHRAL 14 BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27002709 EAP Custom 27002709 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27002710 EAP Custom 27002710 BAG URINE LEG BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27002884 EAP Custom 27002884 ET/CO2 SENSORS BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27002885 EAP Custom 27002885 CPAP CIRCUIT BOTH IP/OP "$1,347.00" $997.00 $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $239.77 "$1,347.00" "$1,347.00" $999.74 $999.74 "$1,038.27" $701.79 $280.73 "$1,347.00" $538.80 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,010.25" "$1,347.00" "$1,347.00" "$1,347.00" $673.50 $673.50 "$1,066.82" "$1,347.00" "$1,077.60" $875.55 "$1,347.00" "$1,347.00" $781.26 "$1,347.00" $808.20 "$1,347.00" "$1,347.00" "$1,347.00" N/A N/A 27002886 EAP Custom 27002886 FLUTTER VALVE BOTH IP/OP $167.00 $124.00 $29.73 $167.00 $167.00 $167.00 $167.00 $167.00 $167.00 $167.00 $29.73 $167.00 $167.00 $123.95 $123.95 $128.72 $87.01 $34.80 $167.00 $66.80 $167.00 $167.00 $167.00 $167.00 $167.00 $125.25 $167.00 $167.00 $167.00 $83.50 $83.50 $132.26 $167.00 $133.60 $108.55 $167.00 $167.00 $96.86 $167.00 $100.20 $167.00 $167.00 $167.00 N/A N/A 27002892 EAP Custom 27002892 FECAL OCCULT BLOOD SUPPLY BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27002893 EAP Custom 27002893 TUBES EXTENSION PLAIN PLA BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27002938 EAP Custom 27002938 INFLATION DEVICE BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 $250.00 $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 27002939 EAP Custom 27002939 "CATHETER, THROMBECTOMY" BOTH IP/OP "$1,076.00" $796.50 $191.53 "$1,076.00" "$1,076.00" "$1,076.00" "$1,076.00" "$1,076.00" "$1,076.00" "$1,076.00" $191.53 "$1,076.00" "$1,076.00" $798.61 $798.61 $829.38 $560.60 $224.25 "$1,076.00" $430.40 "$1,076.00" "$1,076.00" "$1,076.00" "$1,076.00" "$1,076.00" $807.00 "$1,076.00" "$1,076.00" "$1,076.00" $538.00 $538.00 $852.19 "$1,076.00" $860.80 $699.40 "$1,076.00" "$1,076.00" $624.08 "$1,076.00" $645.60 "$1,076.00" "$1,076.00" "$1,076.00" N/A N/A 27002940 EAP HCPCS C1751 CATHETER IV 180GA X 1X1/4 BOTH IP/OP $16.00 $12.00 $3.18 $16.00 $8.69 $8.69 $8.69 $8.69 $16.00 $16.00 $16.00 $3.33 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $16.00 $9.46 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $3.18 $16.00 $9.28 $16.00 $16.00 $16.00 $3.33 $16.00 N/A N/A 27002942 EAP HCPCS C1751 CATHETER IV 22GA X 1 BOTH IP/OP $16.00 $12.00 $3.18 $16.00 $8.69 $8.69 $8.69 $8.69 $16.00 $16.00 $16.00 $3.33 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $16.00 $9.46 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $3.18 $16.00 $9.28 $16.00 $16.00 $16.00 $3.33 $16.00 N/A N/A 27002943 EAP Custom 27002943 IOBAN 2 DRAPE INCISE MEDI BOTH IP/OP $56.00 $41.50 $9.97 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $9.97 $56.00 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $22.40 $56.00 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $56.00 $56.00 $32.48 $56.00 $33.60 $56.00 $56.00 $56.00 N/A N/A 27002944 EAP Custom 27002944 NEEDLE SPINAL 18GA BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27002945 EAP Custom 27002945 LANCET GRADY ORANGE BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27002946 EAP HCPCS C1751 CATHETER IV CUT-DOWN 14G BOTH IP/OP $44.00 $33.00 $8.73 $44.00 $23.89 $23.89 $23.89 $23.89 $44.00 $44.00 $44.00 $9.17 $44.00 $32.66 $32.66 $33.92 $22.92 $9.17 $44.00 $44.00 $26.03 $44.00 $44.00 $44.00 $44.00 $33.00 $44.00 $44.00 $44.00 $22.00 $22.00 $34.85 $44.00 $35.20 $28.60 $8.73 $44.00 $25.52 $44.00 $44.00 $44.00 $9.17 $44.00 N/A N/A 27002947 EAP HCPCS C1751 CATHETER IV CUT-DOWN 8 1 BOTH IP/OP $44.00 $33.00 $8.73 $44.00 $23.89 $23.89 $23.89 $23.89 $44.00 $44.00 $44.00 $9.17 $44.00 $32.66 $32.66 $33.92 $22.92 $9.17 $44.00 $44.00 $26.03 $44.00 $44.00 $44.00 $44.00 $33.00 $44.00 $44.00 $44.00 $22.00 $22.00 $34.85 $44.00 $35.20 $28.60 $8.73 $44.00 $25.52 $44.00 $44.00 $44.00 $9.17 $44.00 N/A N/A 27002951 EAP HCPCS C1729 CATHETER FOLEY 5CC 14FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27002953 EAP HCPCS C1729 CATHETER FOLEY 5CC 18FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27002954 EAP Custom 27002954 TUBE SALEM SILICONE SIZE BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27002955 EAP Custom 27002955 TUBES SALEM SUMP 48 LENG BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27002957 EAP Custom 27002957 SCAPLE SURG W/HANDLE ATTA BOTH IP/OP $152.00 $112.50 $27.06 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $152.00 $27.06 $152.00 $152.00 $112.81 $112.81 $117.16 $79.19 $31.68 $152.00 $60.80 $152.00 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $98.80 $152.00 $152.00 $88.16 $152.00 $91.20 $152.00 $152.00 $152.00 N/A N/A 27002958 EAP Custom 27002958 SCAPLE SURG W/HANDLE ATTACHED BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27002959 EAP Custom 27002959 BORE Y EXTENSION SMALL BOTH IP/OP $26.00 $19.50 $4.63 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $4.63 $26.00 $26.00 $19.30 $19.30 $20.04 $13.55 $5.42 $26.00 $10.40 $26.00 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $16.90 $26.00 $26.00 $15.08 $26.00 $15.60 $26.00 $26.00 $26.00 N/A N/A 27002961 EAP Custom 27002961 PAD DEFI BOTH IP/OP $50.00 $37.00 $8.90 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $8.90 $50.00 $50.00 $37.11 $37.11 $38.54 $26.05 $10.42 $50.00 $20.00 $50.00 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $32.50 $50.00 $50.00 $29.00 $50.00 $30.00 $50.00 $50.00 $50.00 N/A N/A 27002962 EAP Custom 27002962 VALVE REFLUX BOTH IP/OP $3.00 $2.50 $0.53 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $0.53 $3.00 $3.00 $2.23 $2.23 $2.31 $1.56 $0.63 $3.00 $1.20 $3.00 $3.00 $3.00 $3.00 $3.00 $2.25 $3.00 $3.00 $3.00 $1.50 $1.50 $2.38 $3.00 $2.40 $1.95 $3.00 $3.00 $1.74 $3.00 $1.80 $3.00 $3.00 $3.00 N/A N/A 27002963 EAP Custom 27002963 "FILTER,MICRON .22 FLUID A" BOTH IP/OP $14.00 $10.50 $2.49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $2.49 $14.00 $14.00 $10.39 $10.39 $10.79 $7.29 $2.92 $14.00 $5.60 $14.00 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $9.10 $14.00 $14.00 $8.12 $14.00 $8.40 $14.00 $14.00 $14.00 N/A N/A 27002964 EAP Custom 27002964 SET SCALP VEIN INFUSION 21 G BOTH IP/OP $3.00 $2.50 $0.53 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $0.53 $3.00 $3.00 $2.23 $2.23 $2.31 $1.56 $0.63 $3.00 $1.20 $3.00 $3.00 $3.00 $3.00 $3.00 $2.25 $3.00 $3.00 $3.00 $1.50 $1.50 $2.38 $3.00 $2.40 $1.95 $3.00 $3.00 $1.74 $3.00 $1.80 $3.00 $3.00 $3.00 N/A N/A 27002965 EAP Custom 27002965 MASK SUB-MICRON SMALL BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27002966 EAP Custom 27002966 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $646.00 $478.50 $114.99 $646.00 $646.00 $646.00 $646.00 $646.00 $646.00 $646.00 $114.99 $646.00 $646.00 $479.46 $479.46 $497.94 $336.57 $134.63 $646.00 $258.40 $646.00 $646.00 $646.00 $646.00 $646.00 $484.50 $646.00 $646.00 $646.00 $323.00 $323.00 $511.63 $646.00 $516.80 $419.90 $646.00 $646.00 $374.68 $646.00 $387.60 $646.00 $646.00 $646.00 N/A N/A 27002967 EAP Custom 27002967 CATHETER SWAN GANZ BOTH IP/OP $674.00 $499.00 $119.97 $674.00 $674.00 $674.00 $674.00 $674.00 $674.00 $674.00 $119.97 $674.00 $674.00 $500.24 $500.24 $519.52 $351.15 $140.47 $674.00 $269.60 $674.00 $674.00 $674.00 $674.00 $674.00 $505.50 $674.00 $674.00 $674.00 $337.00 $337.00 $533.81 $674.00 $539.20 $438.10 $674.00 $674.00 $390.92 $674.00 $404.40 $674.00 $674.00 $674.00 N/A N/A 27002968 EAP Custom 27002968 PROBE V-PACING BOTH IP/OP "$1,403.00" "$1,038.50" $249.73 "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" $249.73 "$1,403.00" "$1,403.00" "$1,041.31" "$1,041.31" "$1,081.43" $730.96 $292.40 "$1,403.00" $561.20 "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,052.25" "$1,403.00" "$1,403.00" "$1,403.00" $701.50 $701.50 "$1,111.18" "$1,403.00" "$1,122.40" $911.95 "$1,403.00" "$1,403.00" $813.74 "$1,403.00" $841.80 "$1,403.00" "$1,403.00" "$1,403.00" N/A N/A 27002969 EAP Custom 27002969 FILTER SET 0.22 MICRON BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27002970 EAP Custom 27002970 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27002971 EAP Custom 27002971 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $14.00 $10.50 $2.49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $2.49 $14.00 $14.00 $10.39 $10.39 $10.79 $7.29 $2.92 $14.00 $5.60 $14.00 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $9.10 $14.00 $14.00 $8.12 $14.00 $8.40 $14.00 $14.00 $14.00 N/A N/A 27002972 EAP Custom 27002972 BAG URINE LEG BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27002973 EAP Custom 27002973 POUNCHES STERILIZATION 12 BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27002974 EAP Custom 27002974 BAG DRAINAGE URETERAL BOTH IP/OP $103.00 $76.50 $18.33 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $18.33 $103.00 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $41.20 $103.00 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $103.00 $103.00 $59.74 $103.00 $61.80 $103.00 $103.00 $103.00 N/A N/A 27002976 EAP Custom 27002976 DRAPE HALF BOTH IP/OP $6.00 $4.50 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 27002978 EAP Custom 27002978 JCD 5.0-38-20 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27002979 EAP Custom 27002979 JCD 7.0-38-20 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27002982 EAP Custom 27002982 AVANTIPLUS INTRODUCER 6FR 23CM BOTH IP/OP $80.00 $59.50 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 27002984 EAP Custom 27002984 NAIL CLEANER PLASTIC NON-STERI BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27002985 EAP Custom 27002985 SUPER ARROW FLEX INTRODUCER-C BOTH IP/OP $425.00 $314.50 $75.65 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $75.65 $425.00 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $170.00 $425.00 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $425.00 $425.00 $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 27002986 EAP Custom 27002986 6FR-24CM FLEXSHEATH INTRODUCER BOTH IP/OP $185.00 $137.00 $32.93 $185.00 $185.00 $185.00 $185.00 $185.00 $185.00 $185.00 $32.93 $185.00 $185.00 $137.31 $137.31 $142.60 $96.39 $38.56 $185.00 $74.00 $185.00 $185.00 $185.00 $185.00 $185.00 $138.75 $185.00 $185.00 $185.00 $92.50 $92.50 $146.52 $185.00 $148.00 $120.25 $185.00 $185.00 $107.30 $185.00 $111.00 $185.00 $185.00 $185.00 N/A N/A 27002987 EAP Custom 27002987 8FR-35CM FLEXSHEATH INTRODUCER BOTH IP/OP $185.00 $137.00 $32.93 $185.00 $185.00 $185.00 $185.00 $185.00 $185.00 $185.00 $32.93 $185.00 $185.00 $137.31 $137.31 $142.60 $96.39 $38.56 $185.00 $74.00 $185.00 $185.00 $185.00 $185.00 $185.00 $138.75 $185.00 $185.00 $185.00 $92.50 $92.50 $146.52 $185.00 $148.00 $120.25 $185.00 $185.00 $107.30 $185.00 $111.00 $185.00 $185.00 $185.00 N/A N/A 27002990 EAP Custom 27002990 ADAPTER MORSE - Y BOTH IP/OP $80.00 $59.50 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 27002991 EAP Custom 27002991 DRAPE C-ARM 42 X 64 BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27002993 EAP Custom 27002993 KIT CATHETER SUCTION 14FR BOTH IP/OP $810.00 $599.50 $144.18 $810.00 $810.00 $810.00 $810.00 $810.00 $810.00 $810.00 $144.18 $810.00 $810.00 $601.18 $601.18 $624.35 $422.01 $168.81 $810.00 $324.00 $810.00 $810.00 $810.00 $810.00 $810.00 $607.50 $810.00 $810.00 $810.00 $405.00 $405.00 $641.52 $810.00 $648.00 $526.50 $810.00 $810.00 $469.80 $810.00 $486.00 $810.00 $810.00 $810.00 N/A N/A 27002994 EAP Custom 27002994 KIT PERCUTANEOUS INTRODUCER BOTH IP/OP $810.00 $599.50 $144.18 $810.00 $810.00 $810.00 $810.00 $810.00 $810.00 $810.00 $144.18 $810.00 $810.00 $601.18 $601.18 $624.35 $422.01 $168.81 $810.00 $324.00 $810.00 $810.00 $810.00 $810.00 $810.00 $607.50 $810.00 $810.00 $810.00 $405.00 $405.00 $641.52 $810.00 $648.00 $526.50 $810.00 $810.00 $469.80 $810.00 $486.00 $810.00 $810.00 $810.00 N/A N/A 27002995 EAP Custom 27002995 KANGURU WEB BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 27003005 EAP Custom 27003005 FILTER SET 0.22 MICRON BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 27003006 EAP Custom 27003006 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $56.00 $41.50 $9.97 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $9.97 $56.00 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $22.40 $56.00 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $56.00 $56.00 $32.48 $56.00 $33.60 $56.00 $56.00 $56.00 N/A N/A 27003007 EAP Custom 27003007 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27003008 EAP Custom 27003008 CENTRAL LINE DRESSING TRAY BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 27003028 EAP HCPCS L0627 LUMBO-SACRAL SUPPORT BOTH IP/OP $39.00 $29.00 $8.13 $266.40 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $266.40 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27003040 EAP Custom 27003040 "WALKER, FOR PLATFORM ONLY" BOTH IP/OP $243.00 $180.00 $43.25 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $43.25 $243.00 $243.00 $180.35 $180.35 $187.30 $126.60 $50.64 $243.00 $97.20 $243.00 $243.00 $243.00 $243.00 $243.00 $182.25 $243.00 $243.00 $243.00 $121.50 $121.50 $192.46 $243.00 $194.40 $157.95 $243.00 $243.00 $140.94 $243.00 $145.80 $243.00 $243.00 $243.00 N/A N/A 27003045 EAP Custom 27003045 FOOT PLATE-PREFB BOTH IP/OP $577.00 $427.00 $102.71 $577.00 $577.00 $577.00 $577.00 $577.00 $577.00 $577.00 $102.71 $577.00 $577.00 $428.25 $428.25 $444.75 $300.62 $120.25 $577.00 $230.80 $577.00 $577.00 $577.00 $577.00 $577.00 $432.75 $577.00 $577.00 $577.00 $288.50 $288.50 $456.98 $577.00 $461.60 $375.05 $577.00 $577.00 $334.66 $577.00 $346.20 $577.00 $577.00 $577.00 N/A N/A 27003049 EAP Custom 27003049 DRESSING STICK BOTH IP/OP $31.00 $23.00 $5.52 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $5.52 $31.00 $31.00 $23.01 $23.01 $23.89 $16.15 $6.46 $31.00 $12.40 $31.00 $31.00 $31.00 $31.00 $31.00 $23.25 $31.00 $31.00 $31.00 $15.50 $15.50 $24.55 $31.00 $24.80 $20.15 $31.00 $31.00 $17.98 $31.00 $18.60 $31.00 $31.00 $31.00 N/A N/A 27003050 EAP Custom 27003050 LEG LIFTER BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27003051 EAP Custom 27003051 REACHER BOTH IP/OP $117.00 $87.00 $20.83 $117.00 $117.00 $117.00 $117.00 $117.00 $117.00 $117.00 $20.83 $117.00 $117.00 $86.84 $86.84 $90.18 $60.96 $24.38 $117.00 $46.80 $117.00 $117.00 $117.00 $117.00 $117.00 $87.75 $117.00 $117.00 $117.00 $58.50 $58.50 $92.66 $117.00 $93.60 $76.05 $117.00 $117.00 $67.86 $117.00 $70.20 $117.00 $117.00 $117.00 N/A N/A 27003053 EAP Custom 27003053 ABDUCTION PILLOW BOTH IP/OP $404.00 $299.00 $71.91 $404.00 $404.00 $404.00 $404.00 $404.00 $404.00 $404.00 $71.91 $404.00 $404.00 $299.85 $299.85 $311.40 $210.48 $84.20 $404.00 $161.60 $404.00 $404.00 $404.00 $404.00 $404.00 $303.00 $404.00 $404.00 $404.00 $202.00 $202.00 $319.97 $404.00 $323.20 $262.60 $404.00 $404.00 $234.32 $404.00 $242.40 $404.00 $404.00 $404.00 N/A N/A 27003054 EAP Custom 27003054 COMPRESSION GLOVE BOTH IP/OP $87.00 $64.50 $15.49 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $15.49 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $18.13 $87.00 $34.80 $87.00 $87.00 $87.00 $87.00 $87.00 $65.25 $87.00 $87.00 $87.00 $43.50 $43.50 $68.90 $87.00 $69.60 $56.55 $87.00 $87.00 $50.46 $87.00 $52.20 $87.00 $87.00 $87.00 N/A N/A 27003055 EAP Custom 27003055 DOWEL BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 27003063 EAP Custom 27003063 SIMPLE HAND-BASED SPLINT BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27003069 EAP Custom 27003069 COMPRESSION GLOVE BOTH IP/OP $87.00 $64.50 $15.49 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $15.49 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $18.13 $87.00 $34.80 $87.00 $87.00 $87.00 $87.00 $87.00 $65.25 $87.00 $87.00 $87.00 $43.50 $43.50 $68.90 $87.00 $69.60 $56.55 $87.00 $87.00 $50.46 $87.00 $52.20 $87.00 $87.00 $87.00 N/A N/A 27003070 EAP Custom 27003070 DOWEL BOTH IP/OP $46.00 $34.50 $8.19 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $8.19 $46.00 $46.00 $34.14 $34.14 $35.46 $23.97 $9.59 $46.00 $18.40 $46.00 $46.00 $46.00 $46.00 $46.00 $34.50 $46.00 $46.00 $46.00 $23.00 $23.00 $36.43 $46.00 $36.80 $29.90 $46.00 $46.00 $26.68 $46.00 $27.60 $46.00 $46.00 $46.00 N/A N/A 27003073 EAP Custom 27003073 FOOT DROP SPLINT BOTH IP/OP $233.00 $172.50 $41.47 $233.00 $233.00 $233.00 $233.00 $233.00 $233.00 $233.00 $41.47 $233.00 $233.00 $172.93 $172.93 $179.60 $121.39 $48.56 $233.00 $93.20 $233.00 $233.00 $233.00 $233.00 $233.00 $174.75 $233.00 $233.00 $233.00 $116.50 $116.50 $184.54 $233.00 $186.40 $151.45 $233.00 $233.00 $135.14 $233.00 $139.80 $233.00 $233.00 $233.00 N/A N/A 27003080 EAP Custom 27003080 CUSTOM FINGER SPLINT BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27003081 EAP Custom 27003081 SAFE POSITION SPLINT BOTH IP/OP $101.00 $75.00 $17.98 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $17.98 $101.00 $101.00 $74.96 $74.96 $77.85 $52.62 $21.05 $101.00 $40.40 $101.00 $101.00 $101.00 $101.00 $101.00 $75.75 $101.00 $101.00 $101.00 $50.50 $50.50 $79.99 $101.00 $80.80 $65.65 $101.00 $101.00 $58.58 $101.00 $60.60 $101.00 $101.00 $101.00 N/A N/A 27003084 EAP Custom 27003084 COMPRESSION GLOVE BOTH IP/OP $87.00 $64.50 $15.49 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $15.49 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $18.13 $87.00 $34.80 $87.00 $87.00 $87.00 $87.00 $87.00 $65.25 $87.00 $87.00 $87.00 $43.50 $43.50 $68.90 $87.00 $69.60 $56.55 $87.00 $87.00 $50.46 $87.00 $52.20 $87.00 $87.00 $87.00 N/A N/A 27003085 EAP Custom 27003085 DOWEL BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 27003087 EAP Custom 27003087 "TUBIGRIP, PER PIECE" BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27003089 EAP Custom 27003089 HELSPER BUTTON BOTH IP/OP $710.00 $525.50 $126.38 $710.00 $710.00 $710.00 $710.00 $710.00 $710.00 $710.00 $126.38 $710.00 $710.00 $526.96 $526.96 $547.27 $369.91 $147.97 $710.00 $284.00 $710.00 $710.00 $710.00 $710.00 $710.00 $532.50 $710.00 $710.00 $710.00 $355.00 $355.00 $562.32 $710.00 $568.00 $461.50 $710.00 $710.00 $411.80 $710.00 $426.00 $710.00 $710.00 $710.00 N/A N/A 27003090 EAP Custom 27003090 LARYNGECTOMY TUBE BOTH IP/OP $667.00 $494.00 $118.73 $667.00 $667.00 $667.00 $667.00 $667.00 $667.00 $667.00 $118.73 $667.00 $667.00 $495.05 $495.05 $514.12 $347.51 $139.01 $667.00 $266.80 $667.00 $667.00 $667.00 $667.00 $667.00 $500.25 $667.00 $667.00 $667.00 $333.50 $333.50 $528.26 $667.00 $533.60 $433.55 $667.00 $667.00 $386.86 $667.00 $400.20 $667.00 $667.00 $667.00 N/A N/A 27003091 EAP Custom 27003091 INHEALTH ADVAN.INDWELLING PROS BOTH IP/OP $859.00 $636.00 $152.90 $859.00 $859.00 $859.00 $859.00 $859.00 $859.00 $859.00 $152.90 $859.00 $859.00 $637.55 $637.55 $662.12 $447.54 $179.03 $859.00 $343.60 $859.00 $859.00 $859.00 $859.00 $859.00 $644.25 $859.00 $859.00 $859.00 $429.50 $429.50 $680.33 $859.00 $687.20 $558.35 $859.00 $859.00 $498.22 $859.00 $515.40 $859.00 $859.00 $859.00 N/A N/A 27003092 EAP Custom 27003092 INHEALTH INDWELLING PROSTHESIS BOTH IP/OP $878.00 $650.00 $156.28 $878.00 $878.00 $878.00 $878.00 $878.00 $878.00 $878.00 $156.28 $878.00 $878.00 $651.65 $651.65 $676.76 $457.44 $182.98 $878.00 $351.20 $878.00 $878.00 $878.00 $878.00 $878.00 $658.50 $878.00 $878.00 $878.00 $439.00 $439.00 $695.38 $878.00 $702.40 $570.70 $878.00 $878.00 $509.24 $878.00 $526.80 $878.00 $878.00 $878.00 N/A N/A 27003093 EAP Custom 27003093 INHEALTH LOW PRESSURE PROSTHESIS BOTH IP/OP $491.00 $363.50 $87.40 $491.00 $491.00 $491.00 $491.00 $491.00 $491.00 $491.00 $87.40 $491.00 $491.00 $364.42 $364.42 $378.46 $255.81 $102.33 $491.00 $196.40 $491.00 $491.00 $491.00 $491.00 $491.00 $368.25 $491.00 $491.00 $491.00 $245.50 $245.50 $388.87 $491.00 $392.80 $319.15 $491.00 $491.00 $284.78 $491.00 $294.60 $491.00 $491.00 $491.00 N/A N/A 27003094 EAP Custom 27003094 DUCKBILL PROSTHESIS BOTH IP/OP $309.00 $229.00 $55.00 $309.00 $309.00 $309.00 $309.00 $309.00 $309.00 $309.00 $55.00 $309.00 $309.00 $229.34 $229.34 $238.18 $160.99 $64.40 $309.00 $123.60 $309.00 $309.00 $309.00 $309.00 $309.00 $231.75 $309.00 $309.00 $309.00 $154.50 $154.50 $244.73 $309.00 $247.20 $200.85 $309.00 $309.00 $179.22 $309.00 $185.40 $309.00 $309.00 $309.00 N/A N/A 27003095 EAP Custom 27003095 PROVOX/ATOX PROSTHESIS BOTH IP/OP $893.00 $661.00 $158.95 $893.00 $893.00 $893.00 $893.00 $893.00 $893.00 $893.00 $158.95 $893.00 $893.00 $662.78 $662.78 $688.32 $465.25 $186.11 $893.00 $357.20 $893.00 $893.00 $893.00 $893.00 $893.00 $669.75 $893.00 $893.00 $893.00 $446.50 $446.50 $707.26 $893.00 $714.40 $580.45 $893.00 $893.00 $517.94 $893.00 $535.80 $893.00 $893.00 $893.00 N/A N/A 27003096 EAP Custom 27003096 INSUFFLATION TEST KIT BOTH IP/OP $863.00 $639.00 $153.61 $863.00 $863.00 $863.00 $863.00 $863.00 $863.00 $863.00 $153.61 $863.00 $863.00 $640.52 $640.52 $665.20 $449.62 $179.86 $863.00 $345.20 $863.00 $863.00 $863.00 $863.00 $863.00 $647.25 $863.00 $863.00 $863.00 $431.50 $431.50 $683.50 $863.00 $690.40 $560.95 $863.00 $863.00 $500.54 $863.00 $517.80 $863.00 $863.00 $863.00 N/A N/A 27003097 EAP Custom 27003097 PLUG INSERT BOTH IP/OP $339.00 $251.00 $60.34 $339.00 $339.00 $339.00 $339.00 $339.00 $339.00 $339.00 $60.34 $339.00 $339.00 $251.61 $251.61 $261.30 $176.62 $70.65 $339.00 $135.60 $339.00 $339.00 $339.00 $339.00 $339.00 $254.25 $339.00 $339.00 $339.00 $169.50 $169.50 $268.49 $339.00 $271.20 $220.35 $339.00 $339.00 $196.62 $339.00 $203.40 $339.00 $339.00 $339.00 N/A N/A 27003098 EAP Custom 27003098 CATHETERS BOTH IP/OP $6.00 $4.50 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 27003100 EAP Custom 27003100 BARTON-MAYO BUTTON BOTH IP/OP $849.00 $628.50 $151.12 $849.00 $849.00 $849.00 $849.00 $849.00 $849.00 $849.00 $151.12 $849.00 $849.00 $630.13 $630.13 $654.41 $442.33 $176.94 $849.00 $339.60 $849.00 $849.00 $849.00 $849.00 $849.00 $636.75 $849.00 $849.00 $849.00 $424.50 $424.50 $672.41 $849.00 $679.20 $551.85 $849.00 $849.00 $492.42 $849.00 $509.40 $849.00 $849.00 $849.00 N/A N/A 27003101 EAP Custom 27003101 ORAL TUBING BOTH IP/OP $5.00 $4.00 $0.89 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $0.89 $5.00 $5.00 $3.71 $3.71 $3.85 $2.61 $1.04 $5.00 $2.00 $5.00 $5.00 $5.00 $5.00 $5.00 $3.75 $5.00 $5.00 $5.00 $2.50 $2.50 $3.96 $5.00 $4.00 $3.25 $5.00 $5.00 $2.90 $5.00 $3.00 $5.00 $5.00 $5.00 N/A N/A 27003103 EAP Custom 27003103 OCCULT BLOOD SUPPLY BOTH IP/OP $42.00 $31.50 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $7.48 $42.00 $42.00 $31.17 $31.17 $32.37 $21.88 $8.75 $42.00 $16.80 $42.00 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $27.30 $42.00 $42.00 $24.36 $42.00 $25.20 $42.00 $42.00 $42.00 N/A N/A 27003104 EAP Custom 27003104 INTERCEED SUP/ADMIN BOTH IP/OP $424.00 $314.00 $75.47 $424.00 $424.00 $424.00 $424.00 $424.00 $424.00 $424.00 $75.47 $424.00 $424.00 $314.69 $314.69 $326.82 $220.90 $88.37 $424.00 $169.60 $424.00 $424.00 $424.00 $424.00 $424.00 $318.00 $424.00 $424.00 $424.00 $212.00 $212.00 $335.81 $424.00 $339.20 $275.60 $424.00 $424.00 $245.92 $424.00 $254.40 $424.00 $424.00 $424.00 N/A N/A 27003105 EAP Custom 27003105 PUDENDAL KIT BOTH IP/OP $102.00 $75.50 $18.16 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $18.16 $102.00 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $40.80 $102.00 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $102.00 $102.00 $59.16 $102.00 $61.20 $102.00 $102.00 $102.00 N/A N/A 27003108 EAP Custom 27003108 DRESSING HEMOSTASIS BOTH IP/OP $441.00 $326.50 $78.50 $441.00 $441.00 $441.00 $441.00 $441.00 $441.00 $441.00 $78.50 $441.00 $441.00 $327.31 $327.31 $339.92 $229.76 $91.91 $441.00 $176.40 $441.00 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $286.65 $441.00 $441.00 $255.78 $441.00 $264.60 $441.00 $441.00 $441.00 N/A N/A 27003113 EAP Custom 27003113 TEGADERM DRESSING BOTH IP/OP $51.00 $38.00 $9.08 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $9.08 $51.00 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $20.40 $51.00 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $51.00 $51.00 $29.58 $51.00 $30.60 $51.00 $51.00 $51.00 N/A N/A 27003114 EAP Custom 27003114 TEGADERM DRESSING BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27003115 EAP Custom 27003115 "WOUND GEL, CARRINGTON" BOTH IP/OP $103.00 $76.50 $18.33 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $18.33 $103.00 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $41.20 $103.00 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $103.00 $103.00 $59.74 $103.00 $61.80 $103.00 $103.00 $103.00 N/A N/A 27003116 EAP Custom 27003116 "KARA KLENZ, WOUND CLEANSER" BOTH IP/OP $102.00 $75.50 $18.16 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $18.16 $102.00 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $40.80 $102.00 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $102.00 $102.00 $59.16 $102.00 $61.20 $102.00 $102.00 $102.00 N/A N/A 27003117 EAP Custom 27003117 "LITTLE ONES, WHITE COLLAR 4X4" BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27003118 EAP Custom 27003118 "POUCH, CUT TO FIT, LITTLE ONES" BOTH IP/OP $31.00 $23.00 $5.52 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $5.52 $31.00 $31.00 $23.01 $23.01 $23.89 $16.15 $6.46 $31.00 $12.40 $31.00 $31.00 $31.00 $31.00 $31.00 $23.25 $31.00 $31.00 $31.00 $15.50 $15.50 $24.55 $31.00 $24.80 $20.15 $31.00 $31.00 $17.98 $31.00 $18.60 $31.00 $31.00 $31.00 N/A N/A 27003119 EAP Custom 27003119 "POUCH, ACTIVE LIFE" BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27003120 EAP Custom 27003120 "FLANGE, SUR-FIT" BOTH IP/OP $42.00 $31.50 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $7.48 $42.00 $42.00 $31.17 $31.17 $32.37 $21.88 $8.75 $42.00 $16.80 $42.00 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $27.30 $42.00 $42.00 $24.36 $42.00 $25.20 $42.00 $42.00 $42.00 N/A N/A 27003121 EAP Custom 27003121 POUCH DRAINABLE OPAQUE BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27003124 EAP Custom 27003124 BARRIER WITH CONVEXITY BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27003127 EAP Custom 27003127 HIGH FLOW CONTINUOUS BOTH IP/OP $406.00 $300.50 $72.27 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $72.27 $406.00 $406.00 $301.33 $301.33 $312.94 $211.53 $84.61 $406.00 $162.40 $406.00 $406.00 $406.00 $406.00 $406.00 $304.50 $406.00 $406.00 $406.00 $203.00 $203.00 $321.55 $406.00 $324.80 $263.90 $406.00 $406.00 $235.48 $406.00 $243.60 $406.00 $406.00 $406.00 N/A N/A 27003128 EAP Custom 27003128 LOW FLOW CONTINOUS BOTH IP/OP $406.00 $300.50 $72.27 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $72.27 $406.00 $406.00 $301.33 $301.33 $312.94 $211.53 $84.61 $406.00 $162.40 $406.00 $406.00 $406.00 $406.00 $406.00 $304.50 $406.00 $406.00 $406.00 $203.00 $203.00 $321.55 $406.00 $324.80 $263.90 $406.00 $406.00 $235.48 $406.00 $243.60 $406.00 $406.00 $406.00 N/A N/A 27003130 EAP Custom 27003130 MDI SPACER SUPPLY BOTH IP/OP $195.00 $144.50 $34.71 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $34.71 $195.00 $195.00 $144.73 $144.73 $150.31 $101.60 $40.64 $195.00 $78.00 $195.00 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $126.75 $195.00 $195.00 $113.10 $195.00 $117.00 $195.00 $195.00 $195.00 N/A N/A 27003131 EAP Custom 27003131 OCCULT BLOOD SUPPLY BOTH IP/OP $44.00 $33.00 $7.83 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $7.83 $44.00 $44.00 $32.66 $32.66 $33.92 $22.92 $9.17 $44.00 $17.60 $44.00 $44.00 $44.00 $44.00 $44.00 $33.00 $44.00 $44.00 $44.00 $22.00 $22.00 $34.85 $44.00 $35.20 $28.60 $44.00 $44.00 $25.52 $44.00 $26.40 $44.00 $44.00 $44.00 N/A N/A 27003132 EAP Custom 27003132 WRIST BRACE BOTH IP/OP $60.00 $44.50 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 $60.00 $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A 27004266 EAP Custom 27004266 13.5MM/3.2MM WIRE GUIDE BOTH IP/OP "$1,747.00" "$1,293.00" $310.97 "$1,747.00" "$1,747.00" "$1,747.00" "$1,747.00" "$1,747.00" "$1,747.00" "$1,747.00" $310.97 "$1,747.00" "$1,747.00" "$1,296.62" "$1,296.62" "$1,346.59" $910.19 $364.09 "$1,747.00" $698.80 "$1,747.00" "$1,747.00" "$1,747.00" "$1,747.00" "$1,747.00" "$1,310.25" "$1,747.00" "$1,747.00" "$1,747.00" $873.50 $873.50 "$1,383.62" "$1,747.00" "$1,397.60" "$1,135.55" "$1,747.00" "$1,747.00" "$1,013.26" "$1,747.00" "$1,048.20" "$1,747.00" "$1,747.00" "$1,747.00" N/A N/A 27004311 EAP Custom 27004311 LONG FORCEPS 230MM BOTH IP/OP "$2,779.00" "$2,056.50" $494.66 "$2,779.00" "$2,779.00" "$2,779.00" "$2,779.00" "$2,779.00" "$2,779.00" "$2,779.00" $494.66 "$2,779.00" "$2,779.00" "$2,062.57" "$2,062.57" "$2,142.05" "$1,447.86" $579.17 "$2,779.00" "$1,111.60" "$2,779.00" "$2,779.00" "$2,779.00" "$2,779.00" "$2,779.00" "$2,084.25" "$2,779.00" "$2,779.00" "$2,779.00" "$1,389.50" "$1,389.50" "$2,200.97" "$2,779.00" "$2,223.20" "$1,806.35" "$2,779.00" "$2,779.00" "$1,611.82" "$2,779.00" "$1,667.40" "$2,779.00" "$2,779.00" "$2,779.00" N/A N/A 27004327 EAP Custom 27004327 MEDIUM WIRE CUTTER 160MM BOTH IP/OP "$4,148.00" "$3,070.00" $738.34 "$4,148.00" "$4,148.00" "$4,148.00" "$4,148.00" "$4,148.00" "$4,148.00" "$4,148.00" $738.34 "$4,148.00" "$4,148.00" "$3,078.65" "$3,078.65" "$3,197.28" "$2,060.15" $864.49 "$4,148.00" "$1,659.20" "$4,148.00" "$4,148.00" "$4,148.00" "$4,148.00" "$4,148.00" "$3,111.00" "$4,148.00" "$4,148.00" "$4,148.00" "$2,074.00" "$2,074.00" "$3,285.22" "$4,148.00" "$3,318.40" "$2,696.20" "$4,148.00" "$4,148.00" "$2,405.84" "$4,148.00" "$2,488.80" "$4,148.00" "$4,148.00" "$4,148.00" N/A N/A 27004640 EAP Custom 27004640 LARGE ANCHORING HOOK 30MM BOTH IP/OP $509.00 $377.00 $90.60 $509.00 $509.00 $509.00 $509.00 $509.00 $509.00 $509.00 $90.60 $509.00 $509.00 $377.78 $377.78 $392.34 $265.19 $106.08 $509.00 $203.60 $509.00 $509.00 $509.00 $509.00 $509.00 $381.75 $509.00 $509.00 $509.00 $254.50 $254.50 $403.13 $509.00 $407.20 $330.85 $509.00 $509.00 $295.22 $509.00 $305.40 $509.00 $509.00 $509.00 N/A N/A 27007212 EAP Custom 27007212 10.0MM CIRCULAR SAW 28MM BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007213 EAP Custom 27007213 12.0MM CIRCULAR SAW 28MM BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007214 EAP Custom 27007214 15.0MM CIRCULAR SAW 28MM BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007219 EAP Custom 27007219 TIBIAL NAIL DRIVING ADAPTOR BOTH IP/OP "$4,208.00" "$3,114.00" $749.02 "$4,208.00" "$4,208.00" "$4,208.00" "$4,208.00" "$4,208.00" "$4,208.00" "$4,208.00" $749.02 "$4,208.00" "$4,208.00" "$3,123.18" "$3,123.18" "$3,243.53" "$2,060.15" $876.99 "$4,208.00" "$1,683.20" "$4,208.00" "$4,208.00" "$4,208.00" "$4,208.00" "$4,208.00" "$3,156.00" "$4,208.00" "$4,208.00" "$4,208.00" "$2,104.00" "$2,104.00" "$3,332.74" "$4,208.00" "$3,366.40" "$2,735.20" "$4,208.00" "$4,208.00" "$2,440.64" "$4,208.00" "$2,524.80" "$4,208.00" "$4,208.00" "$4,208.00" N/A N/A 27007220 EAP Custom 27007220 SAW BLADE 27MM WIDTH 50MM/0.6M BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 $255.00 $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 27007221 EAP Custom 27007221 SAW BLADE 10MM WIDTH 25MM/0.6M BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 $255.00 $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 27007222 EAP Custom 27007222 SAW BLADE 10MM WIDTH 50MM/0.6M BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 $255.00 $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 27007223 EAP Custom 27007223 SAW BLADE 20MM WIDTH 50MM/0.6M BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 $255.00 $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 27007224 EAP Custom 27007224 SAW BLADE 19MM WIDTH 70MM/1.0M BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 $255.00 $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 27007225 EAP Custom 27007225 SAW BLADE 19MM WIDTH 95MM/0.9M BOTH IP/OP $325.00 $240.50 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 $325.00 $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A 27007226 EAP Custom 27007226 SAW BLADE 25MM WIDTH 95MM/0.9 BOTH IP/OP $325.00 $240.50 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 $325.00 $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A 27007227 EAP Custom 27007227 SAW BLADE 25MM WIDTH 60MM/0.9 BOTH IP/OP $325.00 $240.50 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 $325.00 $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A 27007228 EAP Custom 27007228 SAW BLADE 18MM WIDTH 70MM/1.2 BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 $255.00 $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 27007229 EAP Custom 27007229 SAW BLADE 19MM WIDTH 95MM/1.25 BOTH IP/OP $325.00 $240.50 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 $325.00 $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A 27007230 EAP Custom 27007230 SAW BLADE 25MM WIDTH 95MM/1.25 BOTH IP/OP $325.00 $240.50 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 $325.00 $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A 27007231 EAP Custom 27007231 SAW BLADE 19MM WIDTH 95MM/1.4 BOTH IP/OP $325.00 $240.50 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 $325.00 $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A 27007232 EAP Custom 27007232 SAW BLADE 25MM WIDTH 95MM/1.4 BOTH IP/OP $325.00 $240.50 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 $325.00 $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A 27007233 EAP Custom 27007233 SAW BLADE 12.5MM WDTH 90MM/0.9 BOTH IP/OP $325.00 $240.50 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 $325.00 $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A 27007234 EAP Custom 27007234 SAW BLADE 14MM WIDTH 50MM/0.6 BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 $255.00 $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 27007235 EAP Custom 27007235 SAW BLADE 27MM WIDTH 70MM/0.8 BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 $255.00 $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 27007236 EAP Custom 27007236 SAW BLADE 50MM WIDTH 70MM/0.8 BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 $255.00 $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 27007237 EAP Custom 27007237 SAW BLADE 27MM WIDTH 70MM/1.0 BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 $255.00 $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 27007238 EAP Custom 27007238 SAW BLADE 27MM WIDTH 70MM/1.2 BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 $255.00 $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 27007239 EAP Custom 27007239 SAW BLADE 6MM WIDTH 25MM/0.6M BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 $255.00 $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 27007240 EAP Custom 27007240 SAW BLADE 14MM WIDTH 25MM/0.6M BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 $255.00 $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 27007241 EAP Custom 27007241 SAW BLADE 6MM WIDTH 10MM/0.4MM BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007242 EAP Custom 27007242 SAW BLADE 6MM WIDTH 10MM/0.4MM BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007243 EAP Custom 27007243 SAW BLADE 10MM WIDTH 10MM/0.4M BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007244 EAP Custom 27007244 SAW BLADE 10MM WIDTH 10MM/0.4M BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007245 EAP Custom 27007245 SAW BLADE 16MM WIDTH 10MM/0.4M BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007246 EAP Custom 27007246 SAW BLADE 16MM WIDTH 10MM/0.4M BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007247 EAP Custom 27007247 SAW BLADE 4MM WIDTH 15MM/0.4MM BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007248 EAP Custom 27007248 SAW BLADE 4MM WIDTH 15MM/0.4M BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007249 EAP Custom 27007249 SAW BLADE 8MM WIDTH 20MM/0.4MM BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007250 EAP Custom 27007250 SAW BLADE 8MM WIDTH 20MM/0.4 BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007251 EAP Custom 27007251 SAW BLADE 12MM WIDTH 20MM/0.4 BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007252 EAP Custom 27007252 SAW BLADE 12MM WIDTH 20MM/0.4 BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007253 EAP Custom 27007253 SAW BLADE 6MM WIDTH 30MM/0.4 BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007254 EAP Custom 27007254 SAW BLADE 6MM WIDTH 30MM/0.4 BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007255 EAP Custom 27007255 SAW BLADE 10MM WIDTH 30MM/0.4 BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007256 EAP Custom 27007256 SAW BLADE 10MM WIDTH 30MM/0.4 BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007257 EAP Custom 27007257 SAW BLADE 6MM WIDTH 25MM/0.6 BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007258 EAP Custom 27007258 SAW BLADE 6MM WIDTH 25MM/0.6 BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007259 EAP Custom 27007259 SAW BLADE 10MM WIDTH 25MM/0.6 BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007260 EAP Custom 27007260 SAW BLADE 10MM WIDTH 25MM/0.6 BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007261 EAP Custom 27007261 SAW BLADE 14MM WIDTH 25MM/0.6 BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007262 EAP Custom 27007262 SAW BLADE 14MM WIDTH 25MM/0.6 BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007263 EAP Custom 27007263 SAW BLADE 10MM WIDTH 50MM/0.6 BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007264 EAP Custom 27007264 SAW BLD 10 WDTH 50/0.6CUT THK BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007265 EAP Custom 27007265 SAW BLD 14 WDTH 50/0.6CUT THK BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007266 EAP Custom 27007266 SAW BLD 14 WDTH 50/0.6 CUT THK BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007267 EAP Custom 27007267 SAW BLD 20 WDTH 50/0.6 CUT THK BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007268 EAP Custom 27007268 SAW BLD 20 WDTH 50/0.6 CUT THK BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007269 EAP Custom 27007269 SAW BLD 27 WDTH 50/0.6 CUT THK BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27007270 EAP Custom 27007270 SAW BLD 27 WDTH 50/0.6 CUT THK BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27007451 EAP Custom 27007451 "PEG FULLY THREAD 2.5MM, 24MM" BOTH IP/OP $398.00 $295.00 $70.84 $398.00 $398.00 $398.00 $398.00 $398.00 $398.00 $398.00 $70.84 $398.00 $398.00 $295.40 $295.40 $306.78 $207.36 $82.95 $398.00 $159.20 $398.00 $398.00 $398.00 $398.00 $398.00 $298.50 $398.00 $398.00 $398.00 $199.00 $199.00 $315.22 $398.00 $318.40 $258.70 $398.00 $398.00 $230.84 $398.00 $238.80 $398.00 $398.00 $398.00 N/A N/A 27007489 EAP Custom 27007489 MINI-CLIP STR 3MM BOTH IP/OP "$1,693.00" "$1,253.00" $301.35 "$1,693.00" "$1,693.00" "$1,693.00" "$1,693.00" "$1,693.00" "$1,693.00" "$1,693.00" $301.35 "$1,693.00" "$1,693.00" "$1,256.54" "$1,256.54" "$1,304.96" $882.05 $352.84 "$1,693.00" $677.20 "$1,693.00" "$1,693.00" "$1,693.00" "$1,693.00" "$1,693.00" "$1,269.75" "$1,693.00" "$1,693.00" "$1,693.00" $846.50 $846.50 "$1,340.86" "$1,693.00" "$1,354.40" "$1,100.45" "$1,693.00" "$1,693.00" $981.94 "$1,693.00" "$1,015.80" "$1,693.00" "$1,693.00" "$1,693.00" N/A N/A 27007557 EAP Custom 27007557 SCREWDRIVER BLADE BOTH IP/OP "$1,268.00" $938.50 $225.70 "$1,268.00" "$1,268.00" "$1,268.00" "$1,268.00" "$1,268.00" "$1,268.00" "$1,268.00" $225.70 "$1,268.00" "$1,268.00" $941.11 $941.11 $977.37 $660.63 $264.27 "$1,268.00" $507.20 "$1,268.00" "$1,268.00" "$1,268.00" "$1,268.00" "$1,268.00" $951.00 "$1,268.00" "$1,268.00" "$1,268.00" $634.00 $634.00 "$1,004.26" "$1,268.00" "$1,014.40" $824.20 "$1,268.00" "$1,268.00" $735.44 "$1,268.00" $760.80 "$1,268.00" "$1,268.00" "$1,268.00" N/A N/A 27007632 EAP Custom 27007632 ROTARY MIXER BOTH IP/OP "$8,539.00" "$6,319.00" "$1,519.94" "$8,539.00" "$8,539.00" "$8,539.00" "$8,539.00" "$8,539.00" "$8,539.00" "$8,539.00" "$1,519.94" "$8,539.00" "$8,539.00" "$4,181.12" "$4,181.12" "$6,581.86" "$2,060.15" "$1,779.62" "$8,539.00" "$3,415.60" "$8,539.00" "$8,539.00" "$8,539.00" "$8,539.00" "$8,539.00" "$6,404.25" "$8,539.00" "$8,539.00" "$8,539.00" "$4,269.50" "$4,269.50" "$6,762.89" "$8,539.00" "$6,831.20" "$5,550.35" "$8,539.00" "$8,539.00" "$4,952.62" "$8,539.00" "$5,123.40" "$8,539.00" "$8,539.00" "$8,539.00" N/A N/A 27007633 EAP Custom 27007633 SRS? FAST SET PUTTY 3CC STERIL BOTH IP/OP "$3,760.00" "$2,782.50" $669.28 "$3,760.00" "$3,760.00" "$3,760.00" "$3,760.00" "$3,760.00" "$3,760.00" "$3,760.00" $669.28 "$3,760.00" "$3,760.00" "$2,790.67" "$2,790.67" "$2,898.21" "$1,958.96" $783.63 "$3,760.00" "$1,504.00" "$3,760.00" "$3,760.00" "$3,760.00" "$3,760.00" "$3,760.00" "$2,820.00" "$3,760.00" "$3,760.00" "$3,760.00" "$1,880.00" "$1,880.00" "$2,977.92" "$3,760.00" "$3,008.00" "$2,444.00" "$3,760.00" "$3,760.00" "$2,180.80" "$3,760.00" "$2,256.00" "$3,760.00" "$3,760.00" "$3,760.00" N/A N/A 27007634 EAP Custom 27007634 NOR? SRS? BNE VOID FILL RO 3CC BOTH IP/OP "$3,852.00" "$2,850.50" $685.66 "$3,852.00" "$3,852.00" "$3,852.00" "$3,852.00" "$3,852.00" "$3,852.00" "$3,852.00" $685.66 "$3,852.00" "$3,852.00" "$2,858.95" "$2,858.95" "$2,969.12" "$2,006.89" $802.80 "$3,852.00" "$1,540.80" "$3,852.00" "$3,852.00" "$3,852.00" "$3,852.00" "$3,852.00" "$2,889.00" "$3,852.00" "$3,852.00" "$3,852.00" "$1,926.00" "$1,926.00" "$3,050.78" "$3,852.00" "$3,081.60" "$2,503.80" "$3,852.00" "$3,852.00" "$2,234.16" "$3,852.00" "$2,311.20" "$3,852.00" "$3,852.00" "$3,852.00" N/A N/A 27007635 EAP Custom 27007635 SRS? FAST SET PUTTY 5CC STERIL BOTH IP/OP "$6,218.00" "$4,601.50" "$1,106.80" "$6,218.00" "$6,218.00" "$6,218.00" "$6,218.00" "$6,218.00" "$6,218.00" "$6,218.00" "$1,106.80" "$6,218.00" "$6,218.00" "$4,181.12" "$4,181.12" "$4,792.83" "$2,060.15" "$1,295.90" "$6,218.00" "$2,487.20" "$6,218.00" "$6,218.00" "$6,218.00" "$6,218.00" "$6,218.00" "$4,663.50" "$6,218.00" "$6,218.00" "$6,218.00" "$3,109.00" "$3,109.00" "$4,924.66" "$6,218.00" "$4,974.40" "$4,041.70" "$6,218.00" "$6,218.00" "$3,606.44" "$6,218.00" "$3,730.80" "$6,218.00" "$6,218.00" "$6,218.00" N/A N/A 27007636 EAP Custom 27007636 NOR? SRS? BNE VOID FILL RO 5CC BOTH IP/OP "$6,310.00" "$4,669.50" "$1,123.18" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$1,123.18" "$6,310.00" "$6,310.00" "$4,181.12" "$4,181.12" "$4,863.75" "$2,060.15" "$1,315.07" "$6,310.00" "$2,524.00" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$4,732.50" "$6,310.00" "$6,310.00" "$6,310.00" "$3,155.00" "$3,155.00" "$4,997.52" "$6,310.00" "$5,048.00" "$4,101.50" "$6,310.00" "$6,310.00" "$3,659.80" "$6,310.00" "$3,786.00" "$6,310.00" "$6,310.00" "$6,310.00" N/A N/A 27007637 EAP Custom 27007637 SRS? FAST SET PUTTY 10CC STERI BOTH IP/OP "$12,321.00" "$9,118.00" "$2,060.15" "$12,321.00" "$12,321.00" "$12,321.00" "$12,321.00" "$12,321.00" "$12,321.00" "$12,321.00" "$2,193.14" "$12,321.00" "$12,321.00" "$4,181.12" "$4,181.12" "$9,497.03" "$2,060.15" "$2,567.83" "$12,321.00" "$4,928.40" "$12,321.00" "$12,321.00" "$12,321.00" "$12,321.00" "$12,321.00" "$9,240.75" "$12,321.00" "$12,321.00" "$12,321.00" "$6,160.50" "$6,160.50" "$9,758.23" "$12,321.00" "$9,856.80" "$8,008.65" "$12,321.00" "$12,321.00" "$7,146.18" "$12,321.00" "$7,392.60" "$12,321.00" "$12,321.00" "$12,321.00" N/A N/A 27007638 EAP Custom 27007638 NOR? SRS? BNE VD FILL RO MX 10 BOTH IP/OP "$12,413.00" "$9,186.00" "$2,060.15" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$2,209.51" "$12,413.00" "$12,413.00" "$4,181.12" "$4,181.12" "$9,567.94" "$2,060.15" "$2,587.01" "$12,413.00" "$4,965.20" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$9,309.75" "$12,413.00" "$12,413.00" "$12,413.00" "$6,206.50" "$6,206.50" "$9,831.10" "$12,413.00" "$9,930.40" "$8,068.45" "$12,413.00" "$12,413.00" "$7,199.54" "$12,413.00" "$7,447.80" "$12,413.00" "$12,413.00" "$12,413.00" N/A N/A 27007639 EAP Custom 27007639 SRS? FAST SET PUTTY 15CC STER BOTH IP/OP "$18,167.00" "$13,444.00" "$2,060.15" "$18,167.00" "$18,167.00" "$18,167.00" "$18,167.00" "$18,167.00" "$18,167.00" "$18,167.00" "$3,233.73" "$18,167.00" "$18,167.00" "$4,181.12" "$4,181.12" "$14,003.12" "$2,060.15" "$3,786.20" "$18,167.00" "$7,266.80" "$18,167.00" "$18,167.00" "$18,167.00" "$18,167.00" "$18,167.00" "$13,625.25" "$18,167.00" "$18,167.00" "$18,167.00" "$9,083.50" "$9,083.50" "$14,388.26" "$18,167.00" "$14,533.60" "$11,808.55" "$18,167.00" "$18,167.00" "$10,536.86" "$18,167.00" "$10,900.20" "$18,167.00" "$18,167.00" "$18,167.00" N/A N/A 27007640 EAP Custom 27007640 PRESSURE MEASUREMENT BOTH IP/OP $904.00 $669.00 $160.91 $904.00 $904.00 $904.00 $904.00 $904.00 $904.00 $904.00 $160.91 $904.00 $904.00 $670.95 $670.95 $696.80 $470.98 $188.40 $904.00 $361.60 $904.00 $904.00 $904.00 $904.00 $904.00 $678.00 $904.00 $904.00 $904.00 $452.00 $452.00 $715.97 $904.00 $723.20 $587.60 $904.00 $904.00 $524.32 $904.00 $542.40 $904.00 $904.00 $904.00 N/A N/A 27007719 EAP Custom 27007719 UNIV LOCK TROCH STAB PL 131MM BOTH IP/OP "$2,620.00" "$1,939.00" $466.36 "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" $466.36 "$2,620.00" "$2,620.00" "$1,944.56" "$1,944.56" "$2,019.50" "$1,365.02" $546.04 "$2,620.00" "$1,048.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$1,965.00" "$2,620.00" "$2,620.00" "$2,620.00" "$1,310.00" "$1,310.00" "$2,075.04" "$2,620.00" "$2,096.00" "$1,703.00" "$2,620.00" "$2,620.00" "$1,519.60" "$2,620.00" "$1,572.00" "$2,620.00" "$2,620.00" "$2,620.00" N/A N/A 27007749 EAP Custom 27007749 T15/2.5M HEX CERCLAGE BUT- STE BOTH IP/OP $652.00 $482.50 $116.06 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $116.06 $652.00 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $652.00 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $652.00 $652.00 $378.16 $652.00 $391.20 $652.00 $652.00 $652.00 N/A N/A 27007795 EAP Custom 27007795 SWANS BUR S?2.0M HD LGH 6.3MM BOTH IP/OP $366.00 $271.00 $65.15 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $65.15 $366.00 $366.00 $271.65 $271.65 $282.11 $190.69 $76.28 $366.00 $146.40 $366.00 $366.00 $366.00 $366.00 $366.00 $274.50 $366.00 $366.00 $366.00 $183.00 $183.00 $289.87 $366.00 $292.80 $237.90 $366.00 $366.00 $212.28 $366.00 $219.60 $366.00 $366.00 $366.00 N/A N/A 27007796 EAP Custom 27007796 SWANS BUR M?2.0M HD LGH 6.3MM BOTH IP/OP $366.00 $271.00 $65.15 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $65.15 $366.00 $366.00 $271.65 $271.65 $282.11 $190.69 $76.28 $366.00 $146.40 $366.00 $366.00 $366.00 $366.00 $366.00 $274.50 $366.00 $366.00 $366.00 $183.00 $183.00 $289.87 $366.00 $292.80 $237.90 $366.00 $366.00 $212.28 $366.00 $219.60 $366.00 $366.00 $366.00 N/A N/A 27007797 EAP Custom 27007797 SWANS BUR L?2.0M HD LGH 6.3MM BOTH IP/OP $366.00 $271.00 $65.15 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $65.15 $366.00 $366.00 $271.65 $271.65 $282.11 $190.69 $76.28 $366.00 $146.40 $366.00 $366.00 $366.00 $366.00 $366.00 $274.50 $366.00 $366.00 $366.00 $183.00 $183.00 $289.87 $366.00 $292.80 $237.90 $366.00 $366.00 $212.28 $366.00 $219.60 $366.00 $366.00 $366.00 N/A N/A 27007798 EAP Custom 27007798 SWANS BUR S?3.0M HD LGH 9.7MM BOTH IP/OP $366.00 $271.00 $65.15 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $65.15 $366.00 $366.00 $271.65 $271.65 $282.11 $190.69 $76.28 $366.00 $146.40 $366.00 $366.00 $366.00 $366.00 $366.00 $274.50 $366.00 $366.00 $366.00 $183.00 $183.00 $289.87 $366.00 $292.80 $237.90 $366.00 $366.00 $212.28 $366.00 $219.60 $366.00 $366.00 $366.00 N/A N/A 27007799 EAP Custom 27007799 SWANS BUR M?3.0M HD LGH 9.7MM BOTH IP/OP $366.00 $271.00 $65.15 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $65.15 $366.00 $366.00 $271.65 $271.65 $282.11 $190.69 $76.28 $366.00 $146.40 $366.00 $366.00 $366.00 $366.00 $366.00 $274.50 $366.00 $366.00 $366.00 $183.00 $183.00 $289.87 $366.00 $292.80 $237.90 $366.00 $366.00 $212.28 $366.00 $219.60 $366.00 $366.00 $366.00 N/A N/A 27007800 EAP Custom 27007800 SWANS BUR L?3.0M HD LGH 9.7MM BOTH IP/OP $366.00 $271.00 $65.15 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $65.15 $366.00 $366.00 $271.65 $271.65 $282.11 $190.69 $76.28 $366.00 $146.40 $366.00 $366.00 $366.00 $366.00 $366.00 $274.50 $366.00 $366.00 $366.00 $183.00 $183.00 $289.87 $366.00 $292.80 $237.90 $366.00 $366.00 $212.28 $366.00 $219.60 $366.00 $366.00 $366.00 N/A N/A 27007801 EAP Custom 27007801 SWANS BUR S?4.0M HD LGH 12.7MM BOTH IP/OP $366.00 $271.00 $65.15 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $65.15 $366.00 $366.00 $271.65 $271.65 $282.11 $190.69 $76.28 $366.00 $146.40 $366.00 $366.00 $366.00 $366.00 $366.00 $274.50 $366.00 $366.00 $366.00 $183.00 $183.00 $289.87 $366.00 $292.80 $237.90 $366.00 $366.00 $212.28 $366.00 $219.60 $366.00 $366.00 $366.00 N/A N/A 27007802 EAP Custom 27007802 SWANS BUR M?4.0M HD LGH 12.7MM BOTH IP/OP $148.00 $110.00 $26.34 $148.00 $148.00 $148.00 $148.00 $148.00 $148.00 $148.00 $26.34 $148.00 $148.00 $109.85 $109.85 $114.08 $77.11 $30.84 $148.00 $59.20 $148.00 $148.00 $148.00 $148.00 $148.00 $111.00 $148.00 $148.00 $148.00 $74.00 $74.00 $117.22 $148.00 $118.40 $96.20 $148.00 $148.00 $85.84 $148.00 $88.80 $148.00 $148.00 $148.00 N/A N/A 27007803 EAP Custom 27007803 SWANS BUR L?4.0M HD LGH 12.7MM BOTH IP/OP $366.00 $271.00 $65.15 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $65.15 $366.00 $366.00 $271.65 $271.65 $282.11 $190.69 $76.28 $366.00 $146.40 $366.00 $366.00 $366.00 $366.00 $366.00 $274.50 $366.00 $366.00 $366.00 $183.00 $183.00 $289.87 $366.00 $292.80 $237.90 $366.00 $366.00 $212.28 $366.00 $219.60 $366.00 $366.00 $366.00 N/A N/A 27007810 EAP Custom 27007810 SWANS BUR S?5.0M HD LGH 15.8MM BOTH IP/OP $366.00 $271.00 $65.15 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $65.15 $366.00 $366.00 $271.65 $271.65 $282.11 $190.69 $76.28 $366.00 $146.40 $366.00 $366.00 $366.00 $366.00 $366.00 $274.50 $366.00 $366.00 $366.00 $183.00 $183.00 $289.87 $366.00 $292.80 $237.90 $366.00 $366.00 $212.28 $366.00 $219.60 $366.00 $366.00 $366.00 N/A N/A 27007811 EAP Custom 27007811 SWANS BUR M?5.0M HD LGH 15.8MM BOTH IP/OP $366.00 $271.00 $65.15 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $65.15 $366.00 $366.00 $271.65 $271.65 $282.11 $190.69 $76.28 $366.00 $146.40 $366.00 $366.00 $366.00 $366.00 $366.00 $274.50 $366.00 $366.00 $366.00 $183.00 $183.00 $289.87 $366.00 $292.80 $237.90 $366.00 $366.00 $212.28 $366.00 $219.60 $366.00 $366.00 $366.00 N/A N/A 27007812 EAP Custom 27007812 SWANS BUR L?5.0M HD LGH 15.8MM BOTH IP/OP $366.00 $271.00 $65.15 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $65.15 $366.00 $366.00 $271.65 $271.65 $282.11 $190.69 $76.28 $366.00 $146.40 $366.00 $366.00 $366.00 $366.00 $366.00 $274.50 $366.00 $366.00 $366.00 $183.00 $183.00 $289.87 $366.00 $292.80 $237.90 $366.00 $366.00 $212.28 $366.00 $219.60 $366.00 $366.00 $366.00 N/A N/A 27007840 EAP Custom 27007840 LINDEMAN RMER LGH 45M ?2.3M BOTH IP/OP $325.00 $240.50 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 $325.00 $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A 27007853 EAP Custom 27007853 SAW BLADE F/SAGITTAL SAW BOTH IP/OP $325.00 $240.50 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 $325.00 $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A 27007854 EAP Custom 27007854 SAW BLDE CRESC F/OSCILLAT SAW BOTH IP/OP $366.00 $271.00 $65.15 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $366.00 $65.15 $366.00 $366.00 $271.65 $271.65 $282.11 $190.69 $76.28 $366.00 $146.40 $366.00 $366.00 $366.00 $366.00 $366.00 $274.50 $366.00 $366.00 $366.00 $183.00 $183.00 $289.87 $366.00 $292.80 $237.90 $366.00 $366.00 $212.28 $366.00 $219.60 $366.00 $366.00 $366.00 N/A N/A 27007864 EAP Custom 27007864 TIBIAL NAIL-EX INSERTION HANDL BOTH IP/OP "$5,201.00" "$3,849.00" $925.78 "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" $925.78 "$5,201.00" "$5,201.00" "$3,860.18" "$3,860.18" "$4,008.93" "$2,060.15" "$1,083.95" "$5,201.00" "$2,080.40" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$3,900.75" "$5,201.00" "$5,201.00" "$5,201.00" "$2,600.50" "$2,600.50" "$4,119.19" "$5,201.00" "$4,160.80" "$3,380.65" "$5,201.00" "$5,201.00" "$3,016.58" "$5,201.00" "$3,120.60" "$5,201.00" "$5,201.00" "$5,201.00" N/A N/A 27007865 EAP Custom 27007865 RAD RULER TI CANNUL FEM NAILS BOTH IP/OP "$1,330.00" $984.50 $236.74 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $236.74 "$1,330.00" "$1,330.00" $987.13 $987.13 "$1,025.16" $692.93 $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $864.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27007866 EAP Custom 27007866 RAD RULER TI CANNUL TIB NAILS BOTH IP/OP "$1,330.00" $984.50 $236.74 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $236.74 "$1,330.00" "$1,330.00" $987.13 $987.13 "$1,025.16" $692.93 $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $864.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27007867 EAP Custom 27007867 RAD RULER TI CANNUL HUM NAILS BOTH IP/OP "$1,330.00" $984.50 $236.74 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $236.74 "$1,330.00" "$1,330.00" $987.13 $987.13 "$1,025.16" $692.93 $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $864.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27007868 EAP Custom 27007868 RAD CANAL WDTH ESTIMAT IM NAIL BOTH IP/OP "$1,330.00" $984.50 $236.74 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $236.74 "$1,330.00" "$1,330.00" $987.13 $987.13 "$1,025.16" $692.93 $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $864.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27007869 EAP Custom 27007869 HOLD DEVIC GDE WIRE & REAM ROD BOTH IP/OP "$3,375.00" "$2,497.50" $600.75 "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" $600.75 "$3,375.00" "$3,375.00" "$2,504.93" "$2,504.93" "$2,601.45" "$1,758.38" $703.39 "$3,375.00" "$1,350.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$2,531.25" "$3,375.00" "$3,375.00" "$3,375.00" "$1,687.50" "$1,687.50" "$2,673.00" "$3,375.00" "$2,700.00" "$2,193.75" "$3,375.00" "$3,375.00" "$1,957.50" "$3,375.00" "$2,025.00" "$3,375.00" "$3,375.00" "$3,375.00" N/A N/A 27007871 EAP Custom 27007871 15.0 CANNUL DRL BIT LG QC/280M BOTH IP/OP "$1,969.00" "$1,457.50" $350.48 "$1,969.00" "$1,969.00" "$1,969.00" "$1,969.00" "$1,969.00" "$1,969.00" "$1,969.00" $350.48 "$1,969.00" "$1,969.00" "$1,461.39" "$1,461.39" "$1,517.71" "$1,025.85" $410.36 "$1,969.00" $787.60 "$1,969.00" "$1,969.00" "$1,969.00" "$1,969.00" "$1,969.00" "$1,476.75" "$1,969.00" "$1,969.00" "$1,969.00" $984.50 $984.50 "$1,559.45" "$1,969.00" "$1,575.20" "$1,279.85" "$1,969.00" "$1,969.00" "$1,142.02" "$1,969.00" "$1,181.40" "$1,969.00" "$1,969.00" "$1,969.00" N/A N/A 27007872 EAP Custom 27007872 17.0M CANNUL DRL BIT LG QC/280 BOTH IP/OP "$2,461.00" "$1,821.50" $438.06 "$2,461.00" "$2,461.00" "$2,461.00" "$2,461.00" "$2,461.00" "$2,461.00" "$2,461.00" $438.06 "$2,461.00" "$2,461.00" "$1,826.55" "$1,826.55" "$1,896.94" "$1,282.18" $512.90 "$2,461.00" $984.40 "$2,461.00" "$2,461.00" "$2,461.00" "$2,461.00" "$2,461.00" "$1,845.75" "$2,461.00" "$2,461.00" "$2,461.00" "$1,230.50" "$1,230.50" "$1,949.11" "$2,461.00" "$1,968.80" "$1,599.65" "$2,461.00" "$2,461.00" "$1,427.38" "$2,461.00" "$1,476.60" "$2,461.00" "$2,461.00" "$2,461.00" N/A N/A 27007873 EAP Custom 27007873 13.0MM PROTECTION SLEEVE BOTH IP/OP "$1,490.00" "$1,103.00" $265.22 "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" $265.22 "$1,490.00" "$1,490.00" "$1,105.88" "$1,105.88" "$1,148.49" $776.29 $310.53 "$1,490.00" $596.00 "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,117.50" "$1,490.00" "$1,490.00" "$1,490.00" $745.00 $745.00 "$1,180.08" "$1,490.00" "$1,192.00" $968.50 "$1,490.00" "$1,490.00" $864.20 "$1,490.00" $894.00 "$1,490.00" "$1,490.00" "$1,490.00" N/A N/A 27007874 EAP Custom 27007874 13.0/3.2 WIRE GUDE W/ TROC TIP BOTH IP/OP $591.00 $437.50 $105.20 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $105.20 $591.00 $591.00 $438.64 $438.64 $455.54 $307.91 $123.17 $591.00 $236.40 $591.00 $591.00 $591.00 $591.00 $591.00 $443.25 $591.00 $591.00 $591.00 $295.50 $295.50 $468.07 $591.00 $472.80 $384.15 $591.00 $591.00 $342.78 $591.00 $354.60 $591.00 $591.00 $591.00 N/A N/A 27007875 EAP Custom 27007875 13 FLEX CAN DRL BIT LG QC/465 BOTH IP/OP "$2,762.00" "$2,044.00" $491.64 "$2,762.00" "$2,762.00" "$2,762.00" "$2,762.00" "$2,762.00" "$2,762.00" "$2,762.00" $491.64 "$2,762.00" "$2,762.00" "$2,049.96" "$2,049.96" "$2,128.95" "$1,439.00" $575.63 "$2,762.00" "$1,104.80" "$2,762.00" "$2,762.00" "$2,762.00" "$2,762.00" "$2,762.00" "$2,071.50" "$2,762.00" "$2,762.00" "$2,762.00" "$1,381.00" "$1,381.00" "$2,187.50" "$2,762.00" "$2,209.60" "$1,795.30" "$2,762.00" "$2,762.00" "$1,601.96" "$2,762.00" "$1,657.20" "$2,762.00" "$2,762.00" "$2,762.00" N/A N/A 27007876 EAP Custom 27007876 13 FLEX CAN DRL BIT LG QC/465 BOTH IP/OP "$2,891.00" "$2,139.50" $514.60 "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" $514.60 "$2,891.00" "$2,891.00" "$2,145.70" "$2,145.70" "$2,228.38" "$1,506.21" $602.52 "$2,891.00" "$1,156.40" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,168.25" "$2,891.00" "$2,891.00" "$2,891.00" "$1,445.50" "$1,445.50" "$2,289.67" "$2,891.00" "$2,312.80" "$1,879.15" "$2,891.00" "$2,891.00" "$1,676.78" "$2,891.00" "$1,734.60" "$2,891.00" "$2,891.00" "$2,891.00" N/A N/A 27007877 EAP Custom 27007877 12.0MM PROTECTION SLEEVE BOTH IP/OP "$1,490.00" "$1,103.00" $265.22 "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" $265.22 "$1,490.00" "$1,490.00" "$1,105.88" "$1,105.88" "$1,148.49" $776.29 $310.53 "$1,490.00" $596.00 "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,117.50" "$1,490.00" "$1,490.00" "$1,490.00" $745.00 $745.00 "$1,180.08" "$1,490.00" "$1,192.00" $968.50 "$1,490.00" "$1,490.00" $864.20 "$1,490.00" $894.00 "$1,490.00" "$1,490.00" "$1,490.00" N/A N/A 27007878 EAP Custom 27007878 12.0 CANNUL DRL BIT LG QC/190 BOTH IP/OP "$2,211.00" "$1,636.50" $393.56 "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $393.56 "$2,211.00" "$2,211.00" "$1,641.00" "$1,641.00" "$1,704.24" "$1,151.93" $460.80 "$2,211.00" $884.40 "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,658.25" "$2,211.00" "$2,211.00" "$2,211.00" "$1,105.50" "$1,105.50" "$1,751.11" "$2,211.00" "$1,768.80" "$1,437.15" "$2,211.00" "$2,211.00" "$1,282.38" "$2,211.00" "$1,326.60" "$2,211.00" "$2,211.00" "$2,211.00" N/A N/A 27007879 EAP Custom 27007879 10.0MM PROTECTION SLEEVE BOTH IP/OP "$1,490.00" "$1,103.00" $265.22 "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" $265.22 "$1,490.00" "$1,490.00" "$1,105.88" "$1,105.88" "$1,148.49" $776.29 $310.53 "$1,490.00" $596.00 "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,117.50" "$1,490.00" "$1,490.00" "$1,490.00" $745.00 $745.00 "$1,180.08" "$1,490.00" "$1,192.00" $968.50 "$1,490.00" "$1,490.00" $864.20 "$1,490.00" $894.00 "$1,490.00" "$1,490.00" "$1,490.00" N/A N/A 27007880 EAP Custom 27007880 10.0MM CANNULATED AWL BOTH IP/OP "$1,747.00" "$1,293.00" $310.97 "$1,747.00" "$1,747.00" "$1,747.00" "$1,747.00" "$1,747.00" "$1,747.00" "$1,747.00" $310.97 "$1,747.00" "$1,747.00" "$1,296.62" "$1,296.62" "$1,346.59" $910.19 $364.09 "$1,747.00" $698.80 "$1,747.00" "$1,747.00" "$1,747.00" "$1,747.00" "$1,747.00" "$1,310.25" "$1,747.00" "$1,747.00" "$1,747.00" $873.50 $873.50 "$1,383.62" "$1,747.00" "$1,397.60" "$1,135.55" "$1,747.00" "$1,747.00" "$1,013.26" "$1,747.00" "$1,048.20" "$1,747.00" "$1,747.00" "$1,747.00" N/A N/A 27007881 EAP Custom 27007881 12.0MM CANNULATED AWL BOTH IP/OP "$1,778.00" "$1,316.00" $316.48 "$1,778.00" "$1,778.00" "$1,778.00" "$1,778.00" "$1,778.00" "$1,778.00" "$1,778.00" $316.48 "$1,778.00" "$1,778.00" "$1,319.63" "$1,319.63" "$1,370.48" $926.34 $370.55 "$1,778.00" $711.20 "$1,778.00" "$1,778.00" "$1,778.00" "$1,778.00" "$1,778.00" "$1,333.50" "$1,778.00" "$1,778.00" "$1,778.00" $889.00 $889.00 "$1,408.18" "$1,778.00" "$1,422.40" "$1,155.70" "$1,778.00" "$1,778.00" "$1,031.24" "$1,778.00" "$1,066.80" "$1,778.00" "$1,778.00" "$1,778.00" N/A N/A 27007882 EAP Custom 27007882 14.0MM CANNULATED AWL BOTH IP/OP "$1,855.00" "$1,373.00" $330.19 "$1,855.00" "$1,855.00" "$1,855.00" "$1,855.00" "$1,855.00" "$1,855.00" "$1,855.00" $330.19 "$1,855.00" "$1,855.00" "$1,376.78" "$1,376.78" "$1,429.83" $966.46 $386.60 "$1,855.00" $742.00 "$1,855.00" "$1,855.00" "$1,855.00" "$1,855.00" "$1,855.00" "$1,391.25" "$1,855.00" "$1,855.00" "$1,855.00" $927.50 $927.50 "$1,469.16" "$1,855.00" "$1,484.00" "$1,205.75" "$1,855.00" "$1,855.00" "$1,075.90" "$1,855.00" "$1,113.00" "$1,855.00" "$1,855.00" "$1,855.00" N/A N/A 27007884 EAP Custom 27007884 STANDARD INSERTION HANDLE BOTH IP/OP "$5,201.00" "$3,849.00" $925.78 "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" $925.78 "$5,201.00" "$5,201.00" "$3,860.18" "$3,860.18" "$4,008.93" "$2,060.15" "$1,083.95" "$5,201.00" "$2,080.40" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$3,900.75" "$5,201.00" "$5,201.00" "$5,201.00" "$2,600.50" "$2,600.50" "$4,119.19" "$5,201.00" "$4,160.80" "$3,380.65" "$5,201.00" "$5,201.00" "$3,016.58" "$5,201.00" "$3,120.60" "$5,201.00" "$5,201.00" "$5,201.00" N/A N/A 27007885 EAP Custom 27007885 PERCUTANEOUS INSERTION HANDLE BOTH IP/OP "$5,201.00" "$3,849.00" $925.78 "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" $925.78 "$5,201.00" "$5,201.00" "$3,860.18" "$3,860.18" "$4,008.93" "$2,060.15" "$1,083.95" "$5,201.00" "$2,080.40" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$5,201.00" "$3,900.75" "$5,201.00" "$5,201.00" "$5,201.00" "$2,600.50" "$2,600.50" "$4,119.19" "$5,201.00" "$4,160.80" "$3,380.65" "$5,201.00" "$5,201.00" "$3,016.58" "$5,201.00" "$3,120.60" "$5,201.00" "$5,201.00" "$5,201.00" N/A N/A 27007887 EAP Custom 27007887 REC LOC AIM ARM LAT ENT FEM NL BOTH IP/OP "$4,071.00" "$3,013.00" $724.64 "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" $724.64 "$4,071.00" "$4,071.00" "$3,021.50" "$3,021.50" "$3,137.93" "$2,060.15" $848.44 "$4,071.00" "$1,628.40" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$3,053.25" "$4,071.00" "$4,071.00" "$4,071.00" "$2,035.50" "$2,035.50" "$3,224.23" "$4,071.00" "$3,256.80" "$2,646.15" "$4,071.00" "$4,071.00" "$2,361.18" "$4,071.00" "$2,442.60" "$4,071.00" "$4,071.00" "$4,071.00" N/A N/A 27007893 EAP Custom 27007893 INSERT HDLE TI CANN HUM NLS-EX BOTH IP/OP "$4,522.00" "$3,346.50" $804.92 "$4,522.00" "$4,522.00" "$4,522.00" "$4,522.00" "$4,522.00" "$4,522.00" "$4,522.00" $804.92 "$4,522.00" "$4,522.00" "$3,356.23" "$3,356.23" "$3,485.56" "$2,060.15" $942.43 "$4,522.00" "$1,808.80" "$4,522.00" "$4,522.00" "$4,522.00" "$4,522.00" "$4,522.00" "$3,391.50" "$4,522.00" "$4,522.00" "$4,522.00" "$2,261.00" "$2,261.00" "$3,581.42" "$4,522.00" "$3,617.60" "$2,939.30" "$4,522.00" "$4,522.00" "$2,622.76" "$4,522.00" "$2,713.20" "$4,522.00" "$4,522.00" "$4,522.00" N/A N/A 27007894 EAP Custom 27007894 SPRL BLDE AIM ARM TI CAN HUM N BOTH IP/OP "$4,071.00" "$3,013.00" $724.64 "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" $724.64 "$4,071.00" "$4,071.00" "$3,021.50" "$3,021.50" "$3,137.93" "$2,060.15" $848.44 "$4,071.00" "$1,628.40" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$3,053.25" "$4,071.00" "$4,071.00" "$4,071.00" "$2,035.50" "$2,035.50" "$3,224.23" "$4,071.00" "$3,256.80" "$2,646.15" "$4,071.00" "$4,071.00" "$2,361.18" "$4,071.00" "$2,442.60" "$4,071.00" "$4,071.00" "$4,071.00" N/A N/A 27007900 EAP Custom 27007900 12.0MM/8.0MM PROTECTN SLVE 188 BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $688.76 $688.76 $715.30 $483.49 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $603.20 $928.00 $928.00 $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 27007904 EAP Custom 27007904 11.5/8.5 PROTECTN SLVE REC LCK BOTH IP/OP $635.00 $470.00 $113.03 $635.00 $635.00 $635.00 $635.00 $635.00 $635.00 $635.00 $113.03 $635.00 $635.00 $471.30 $471.30 $489.46 $330.84 $132.34 $635.00 $254.00 $635.00 $635.00 $635.00 $635.00 $635.00 $476.25 $635.00 $635.00 $635.00 $317.50 $317.50 $502.92 $635.00 $508.00 $412.75 $635.00 $635.00 $368.30 $635.00 $381.00 $635.00 $635.00 $635.00 N/A N/A 27007909 EAP Custom 27007909 TAP FOR 6.5MM RECON SCREWS BOTH IP/OP "$1,997.00" "$1,478.00" $355.47 "$1,997.00" "$1,997.00" "$1,997.00" "$1,997.00" "$1,997.00" "$1,997.00" "$1,997.00" $355.47 "$1,997.00" "$1,997.00" "$1,482.17" "$1,482.17" "$1,539.29" "$1,040.44" $416.20 "$1,997.00" $798.80 "$1,997.00" "$1,997.00" "$1,997.00" "$1,997.00" "$1,997.00" "$1,497.75" "$1,997.00" "$1,997.00" "$1,997.00" $998.50 $998.50 "$1,581.62" "$1,997.00" "$1,597.60" "$1,298.05" "$1,997.00" "$1,997.00" "$1,158.26" "$1,997.00" "$1,198.20" "$1,997.00" "$1,997.00" "$1,997.00" N/A N/A 27007910 EAP Custom 27007910 15.0/13.0 PRO SLVE F/SPIR BLD BOTH IP/OP "$1,616.00" "$1,196.00" $287.65 "$1,616.00" "$1,616.00" "$1,616.00" "$1,616.00" "$1,616.00" "$1,616.00" "$1,616.00" $287.65 "$1,616.00" "$1,616.00" "$1,199.40" "$1,199.40" "$1,245.61" $841.94 $336.79 "$1,616.00" $646.40 "$1,616.00" "$1,616.00" "$1,616.00" "$1,616.00" "$1,616.00" "$1,212.00" "$1,616.00" "$1,616.00" "$1,616.00" $808.00 $808.00 "$1,279.87" "$1,616.00" "$1,292.80" "$1,050.40" "$1,616.00" "$1,616.00" $937.28 "$1,616.00" $969.60 "$1,616.00" "$1,616.00" "$1,616.00" N/A N/A 27007911 EAP Custom 27007911 13.0/3.2 WRE GDE SPIR BLDE AIM BOTH IP/OP "$1,222.00" $904.50 $217.52 "$1,222.00" "$1,222.00" "$1,222.00" "$1,222.00" "$1,222.00" "$1,222.00" "$1,222.00" $217.52 "$1,222.00" "$1,222.00" $906.97 $906.97 $941.92 $636.66 $254.68 "$1,222.00" $488.80 "$1,222.00" "$1,222.00" "$1,222.00" "$1,222.00" "$1,222.00" $916.50 "$1,222.00" "$1,222.00" "$1,222.00" $611.00 $611.00 $967.82 "$1,222.00" $977.60 $794.30 "$1,222.00" "$1,222.00" $708.76 "$1,222.00" $733.20 "$1,222.00" "$1,222.00" "$1,222.00" N/A N/A 27007912 EAP Custom 27007912 SPIR BLDE INSERT RETRGRDE FEM BOTH IP/OP "$3,061.00" "$2,265.50" $544.86 "$3,061.00" "$3,061.00" "$3,061.00" "$3,061.00" "$3,061.00" "$3,061.00" "$3,061.00" $544.86 "$3,061.00" "$3,061.00" "$2,271.87" "$2,271.87" "$2,359.42" "$1,594.78" $637.95 "$3,061.00" "$1,224.40" "$3,061.00" "$3,061.00" "$3,061.00" "$3,061.00" "$3,061.00" "$2,295.75" "$3,061.00" "$3,061.00" "$3,061.00" "$1,530.50" "$1,530.50" "$2,424.31" "$3,061.00" "$2,448.80" "$1,989.65" "$3,061.00" "$3,061.00" "$1,775.38" "$3,061.00" "$1,836.60" "$3,061.00" "$3,061.00" "$3,061.00" N/A N/A 27007913 EAP Custom 27007913 SPECLTY LCK MEAS DEV TI FEM NL BOTH IP/OP $616.00 $456.00 $109.65 $616.00 $616.00 $616.00 $616.00 $616.00 $616.00 $616.00 $109.65 $616.00 $616.00 $457.20 $457.20 $474.81 $320.94 $128.38 $616.00 $246.40 $616.00 $616.00 $616.00 $616.00 $616.00 $462.00 $616.00 $616.00 $616.00 $308.00 $308.00 $487.87 $616.00 $492.80 $400.40 $616.00 $616.00 $357.28 $616.00 $369.60 $616.00 $616.00 $616.00 N/A N/A 27007914 EAP Custom 27007914 14.0MM/8.0MM DRILL SLEEVE 130M BOTH IP/OP $679.00 $502.50 $120.86 $679.00 $679.00 $679.00 $679.00 $679.00 $679.00 $679.00 $120.86 $679.00 $679.00 $503.95 $503.95 $523.37 $353.76 $141.51 $679.00 $271.60 $679.00 $679.00 $679.00 $679.00 $679.00 $509.25 $679.00 $679.00 $679.00 $339.50 $339.50 $537.77 $679.00 $543.20 $441.35 $679.00 $679.00 $393.82 $679.00 $407.40 $679.00 $679.00 $679.00 N/A N/A 27007919 EAP Custom 27007919 SPIR BLD MEA DEV TI CAN HUM NL BOTH IP/OP "$2,296.00" "$1,699.50" $408.69 "$2,296.00" "$2,296.00" "$2,296.00" "$2,296.00" "$2,296.00" "$2,296.00" "$2,296.00" $408.69 "$2,296.00" "$2,296.00" "$1,704.09" "$1,704.09" "$1,769.76" "$1,196.22" $478.51 "$2,296.00" $918.40 "$2,296.00" "$2,296.00" "$2,296.00" "$2,296.00" "$2,296.00" "$1,722.00" "$2,296.00" "$2,296.00" "$2,296.00" "$1,148.00" "$1,148.00" "$1,818.43" "$2,296.00" "$1,836.80" "$1,492.40" "$2,296.00" "$2,296.00" "$1,331.68" "$2,296.00" "$1,377.60" "$2,296.00" "$2,296.00" "$2,296.00" N/A N/A 27007920 EAP Custom 27007920 STAN AIM ARM TI CAN HUM NLS-EX BOTH IP/OP "$4,071.00" "$3,013.00" $724.64 "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" $724.64 "$4,071.00" "$4,071.00" "$3,021.50" "$3,021.50" "$3,137.93" "$2,060.15" $848.44 "$4,071.00" "$1,628.40" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$3,053.25" "$4,071.00" "$4,071.00" "$4,071.00" "$2,035.50" "$2,035.50" "$3,224.23" "$4,071.00" "$3,256.80" "$2,646.15" "$4,071.00" "$4,071.00" "$2,361.18" "$4,071.00" "$2,442.60" "$4,071.00" "$4,071.00" "$4,071.00" N/A N/A 27007921 EAP Custom 27007921 REAM ROD PUSH ROD WTH BALL HDL BOTH IP/OP "$1,484.00" "$1,098.50" $264.15 "$1,484.00" "$1,484.00" "$1,484.00" "$1,484.00" "$1,484.00" "$1,484.00" "$1,484.00" $264.15 "$1,484.00" "$1,484.00" "$1,101.42" "$1,101.42" "$1,143.87" $773.16 $309.28 "$1,484.00" $593.60 "$1,484.00" "$1,484.00" "$1,484.00" "$1,484.00" "$1,484.00" "$1,113.00" "$1,484.00" "$1,484.00" "$1,484.00" $742.00 $742.00 "$1,175.33" "$1,484.00" "$1,187.20" $964.60 "$1,484.00" "$1,484.00" $860.72 "$1,484.00" $890.40 "$1,484.00" "$1,484.00" "$1,484.00" N/A N/A 27007932 EAP Custom 27007932 HOLD SLVE W/ LCKING DEVICE BOTH IP/OP "$3,354.00" "$2,482.00" $597.01 "$3,354.00" "$3,354.00" "$3,354.00" "$3,354.00" "$3,354.00" "$3,354.00" "$3,354.00" $597.01 "$3,354.00" "$3,354.00" "$2,489.34" "$2,489.34" "$2,585.26" "$1,747.43" $699.01 "$3,354.00" "$1,341.60" "$3,354.00" "$3,354.00" "$3,354.00" "$3,354.00" "$3,354.00" "$2,515.50" "$3,354.00" "$3,354.00" "$3,354.00" "$1,677.00" "$1,677.00" "$2,656.37" "$3,354.00" "$2,683.20" "$2,180.10" "$3,354.00" "$3,354.00" "$1,945.32" "$3,354.00" "$2,012.40" "$3,354.00" "$3,354.00" "$3,354.00" N/A N/A 27007935 EAP Custom 27007935 LRG HEXA SCWDRVR 3.5 WDTH ACRS BOTH IP/OP "$1,199.00" $887.50 $213.42 "$1,199.00" "$1,199.00" "$1,199.00" "$1,199.00" "$1,199.00" "$1,199.00" "$1,199.00" $213.42 "$1,199.00" "$1,199.00" $889.90 $889.90 $924.19 $624.68 $249.88 "$1,199.00" $479.60 "$1,199.00" "$1,199.00" "$1,199.00" "$1,199.00" "$1,199.00" $899.25 "$1,199.00" "$1,199.00" "$1,199.00" $599.50 $599.50 $949.61 "$1,199.00" $959.20 $779.35 "$1,199.00" "$1,199.00" $695.42 "$1,199.00" $719.40 "$1,199.00" "$1,199.00" "$1,199.00" N/A N/A 27007937 EAP Custom 27007937 SHRT COMPRES DEV TI CAN TIB NL BOTH IP/OP "$1,799.00" "$1,331.50" $320.22 "$1,799.00" "$1,799.00" "$1,799.00" "$1,799.00" "$1,799.00" "$1,799.00" "$1,799.00" $320.22 "$1,799.00" "$1,799.00" "$1,335.22" "$1,335.22" "$1,386.67" $937.28 $374.93 "$1,799.00" $719.60 "$1,799.00" "$1,799.00" "$1,799.00" "$1,799.00" "$1,799.00" "$1,349.25" "$1,799.00" "$1,799.00" "$1,799.00" $899.50 $899.50 "$1,424.81" "$1,799.00" "$1,439.20" "$1,169.35" "$1,799.00" "$1,799.00" "$1,043.42" "$1,799.00" "$1,079.40" "$1,799.00" "$1,799.00" "$1,799.00" N/A N/A 27007938 EAP Custom 27007938 LNG COMPRES DEV TI CAN TIB NL BOTH IP/OP "$1,799.00" "$1,331.50" $320.22 "$1,799.00" "$1,799.00" "$1,799.00" "$1,799.00" "$1,799.00" "$1,799.00" "$1,799.00" $320.22 "$1,799.00" "$1,799.00" "$1,335.22" "$1,335.22" "$1,386.67" $937.28 $374.93 "$1,799.00" $719.60 "$1,799.00" "$1,799.00" "$1,799.00" "$1,799.00" "$1,799.00" "$1,349.25" "$1,799.00" "$1,799.00" "$1,799.00" $899.50 $899.50 "$1,424.81" "$1,799.00" "$1,439.20" "$1,169.35" "$1,799.00" "$1,799.00" "$1,043.42" "$1,799.00" "$1,079.40" "$1,799.00" "$1,799.00" "$1,799.00" N/A N/A 27007941 EAP Custom 27007941 15.0CAN FLEX DL BIT LRG QC/310 BOTH IP/OP "$2,711.00" "$2,006.50" $482.56 "$2,711.00" "$2,711.00" "$2,711.00" "$2,711.00" "$2,711.00" "$2,711.00" "$2,711.00" $482.56 "$2,711.00" "$2,711.00" "$2,012.10" "$2,012.10" "$2,089.64" "$1,412.43" $565.00 "$2,711.00" "$1,084.40" "$2,711.00" "$2,711.00" "$2,711.00" "$2,711.00" "$2,711.00" "$2,033.25" "$2,711.00" "$2,711.00" "$2,711.00" "$1,355.50" "$1,355.50" "$2,147.11" "$2,711.00" "$2,168.80" "$1,762.15" "$2,711.00" "$2,711.00" "$1,572.38" "$2,711.00" "$1,626.60" "$2,711.00" "$2,711.00" "$2,711.00" N/A N/A 27007942 EAP Custom 27007942 17 CAN FLEX DRL BIT LRG QC/310 BOTH IP/OP "$2,711.00" "$2,006.50" $482.56 "$2,711.00" "$2,711.00" "$2,711.00" "$2,711.00" "$2,711.00" "$2,711.00" "$2,711.00" $482.56 "$2,711.00" "$2,711.00" "$2,012.10" "$2,012.10" "$2,089.64" "$1,412.43" $565.00 "$2,711.00" "$1,084.40" "$2,711.00" "$2,711.00" "$2,711.00" "$2,711.00" "$2,711.00" "$2,033.25" "$2,711.00" "$2,711.00" "$2,711.00" "$1,355.50" "$1,355.50" "$2,147.11" "$2,711.00" "$2,168.80" "$1,762.15" "$2,711.00" "$2,711.00" "$1,572.38" "$2,711.00" "$1,626.60" "$2,711.00" "$2,711.00" "$2,711.00" N/A N/A 27007943 EAP Custom 27007943 11/8 PRO SLVE 188MM FOR ASLS BOTH IP/OP $889.00 $658.00 $158.24 $889.00 $889.00 $889.00 $889.00 $889.00 $889.00 $889.00 $158.24 $889.00 $889.00 $659.82 $659.82 $685.24 $463.17 $185.28 $889.00 $355.60 $889.00 $889.00 $889.00 $889.00 $889.00 $666.75 $889.00 $889.00 $889.00 $444.50 $444.50 $704.09 $889.00 $711.20 $577.85 $889.00 $889.00 $515.62 $889.00 $533.40 $889.00 $889.00 $889.00 N/A N/A 27007945 EAP Custom 27007945 INSERT HNDL F/4.5 LCP PROX TIB BOTH IP/OP "$5,623.00" "$4,161.50" "$1,000.89" "$5,623.00" "$5,623.00" "$5,623.00" "$5,623.00" "$5,623.00" "$5,623.00" "$5,623.00" "$1,000.89" "$5,623.00" "$5,623.00" "$4,173.39" "$4,173.39" "$4,334.21" "$2,060.15" "$1,171.90" "$5,623.00" "$2,249.20" "$5,623.00" "$5,623.00" "$5,623.00" "$5,623.00" "$5,623.00" "$4,217.25" "$5,623.00" "$5,623.00" "$5,623.00" "$2,811.50" "$2,811.50" "$4,453.42" "$5,623.00" "$4,498.40" "$3,654.95" "$5,623.00" "$5,623.00" "$3,261.34" "$5,623.00" "$3,373.80" "$5,623.00" "$5,623.00" "$5,623.00" N/A N/A 27007947 EAP Custom 27007947 STRT BALL SPIKE LOW PRO PELVIC BOTH IP/OP "$1,511.00" "$1,118.50" $268.96 "$1,511.00" "$1,511.00" "$1,511.00" "$1,511.00" "$1,511.00" "$1,511.00" "$1,511.00" $268.96 "$1,511.00" "$1,511.00" "$1,121.46" "$1,121.46" "$1,164.68" $787.23 $314.91 "$1,511.00" $604.40 "$1,511.00" "$1,511.00" "$1,511.00" "$1,511.00" "$1,511.00" "$1,133.25" "$1,511.00" "$1,511.00" "$1,511.00" $755.50 $755.50 "$1,196.71" "$1,511.00" "$1,208.80" $982.15 "$1,511.00" "$1,511.00" $876.38 "$1,511.00" $906.60 "$1,511.00" "$1,511.00" "$1,511.00" N/A N/A 27007948 EAP Custom 27007948 STRT BALL SPIKE LOW PRO PELVIC BOTH IP/OP "$1,608.00" "$1,190.00" $286.22 "$1,608.00" "$1,608.00" "$1,608.00" "$1,608.00" "$1,608.00" "$1,608.00" "$1,608.00" $286.22 "$1,608.00" "$1,608.00" "$1,193.46" "$1,193.46" "$1,239.45" $837.77 $335.12 "$1,608.00" $643.20 "$1,608.00" "$1,608.00" "$1,608.00" "$1,608.00" "$1,608.00" "$1,206.00" "$1,608.00" "$1,608.00" "$1,608.00" $804.00 $804.00 "$1,273.54" "$1,608.00" "$1,286.40" "$1,045.20" "$1,608.00" "$1,608.00" $932.64 "$1,608.00" $964.80 "$1,608.00" "$1,608.00" "$1,608.00" N/A N/A 27007949 EAP Custom 27007949 STRT REDUC FORCEPS LOW PRO PEL BOTH IP/OP "$6,337.00" "$4,689.50" "$1,127.99" "$6,337.00" "$6,337.00" "$6,337.00" "$6,337.00" "$6,337.00" "$6,337.00" "$6,337.00" "$1,127.99" "$6,337.00" "$6,337.00" "$4,181.12" "$4,181.12" "$4,884.56" "$2,060.15" "$1,320.70" "$6,337.00" "$2,534.80" "$6,337.00" "$6,337.00" "$6,337.00" "$6,337.00" "$6,337.00" "$4,752.75" "$6,337.00" "$6,337.00" "$6,337.00" "$3,168.50" "$3,168.50" "$5,018.90" "$6,337.00" "$5,069.60" "$4,119.05" "$6,337.00" "$6,337.00" "$3,675.46" "$6,337.00" "$3,802.20" "$6,337.00" "$6,337.00" "$6,337.00" N/A N/A 27007952 EAP Custom 27007952 REDUCT FORCEPS FOR LOW PRO PEL BOTH IP/OP "$8,489.00" "$6,282.00" "$1,511.04" "$8,489.00" "$8,489.00" "$8,489.00" "$8,489.00" "$8,489.00" "$8,489.00" "$8,489.00" "$1,511.04" "$8,489.00" "$8,489.00" "$4,181.12" "$4,181.12" "$6,543.32" "$2,060.15" "$1,769.20" "$8,489.00" "$3,395.60" "$8,489.00" "$8,489.00" "$8,489.00" "$8,489.00" "$8,489.00" "$6,366.75" "$8,489.00" "$8,489.00" "$8,489.00" "$4,244.50" "$4,244.50" "$6,723.29" "$8,489.00" "$6,791.20" "$5,517.85" "$8,489.00" "$8,489.00" "$4,923.62" "$8,489.00" "$5,093.40" "$8,489.00" "$8,489.00" "$8,489.00" N/A N/A 27007954 EAP Custom 27007954 LO PRO PEL SYS RD FRCP 3.5 SCW BOTH IP/OP "$7,620.00" "$5,639.00" "$1,356.36" "$7,620.00" "$7,620.00" "$7,620.00" "$7,620.00" "$7,620.00" "$7,620.00" "$7,620.00" "$1,356.36" "$7,620.00" "$7,620.00" "$4,181.12" "$4,181.12" "$5,873.50" "$2,060.15" "$1,588.09" "$7,620.00" "$3,048.00" "$7,620.00" "$7,620.00" "$7,620.00" "$7,620.00" "$7,620.00" "$5,715.00" "$7,620.00" "$7,620.00" "$7,620.00" "$3,810.00" "$3,810.00" "$6,035.04" "$7,620.00" "$6,096.00" "$4,953.00" "$7,620.00" "$7,620.00" "$4,419.60" "$7,620.00" "$4,572.00" "$7,620.00" "$7,620.00" "$7,620.00" N/A N/A 27007955 EAP Custom 27007955 ROUND DISK BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 27007956 EAP Custom 27007956 RECTANGULAR DISK BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 27007966 EAP Custom 27007966 INSTN HNDL F/4.5 LCP PROX TIB BOTH IP/OP "$5,623.00" "$4,161.50" "$1,000.89" "$5,623.00" "$5,623.00" "$5,623.00" "$5,623.00" "$5,623.00" "$5,623.00" "$5,623.00" "$1,000.89" "$5,623.00" "$5,623.00" "$4,173.39" "$4,173.39" "$4,334.21" "$2,060.15" "$1,171.90" "$5,623.00" "$2,249.20" "$5,623.00" "$5,623.00" "$5,623.00" "$5,623.00" "$5,623.00" "$4,217.25" "$5,623.00" "$5,623.00" "$5,623.00" "$2,811.50" "$2,811.50" "$4,453.42" "$5,623.00" "$4,498.40" "$3,654.95" "$5,623.00" "$5,623.00" "$3,261.34" "$5,623.00" "$3,373.80" "$5,623.00" "$5,623.00" "$5,623.00" N/A N/A 27007967 EAP Custom 27007967 SOLID 4.0 HEX SCWDRVR SHFT 200 BOTH IP/OP "$1,131.00" $837.00 $201.32 "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" $201.32 "$1,131.00" "$1,131.00" $839.43 $839.43 $871.77 $589.25 $235.71 "$1,131.00" $452.40 "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" $848.25 "$1,131.00" "$1,131.00" "$1,131.00" $565.50 $565.50 $895.75 "$1,131.00" $904.80 $735.15 "$1,131.00" "$1,131.00" $655.98 "$1,131.00" $678.60 "$1,131.00" "$1,131.00" "$1,131.00" N/A N/A 27007969 EAP Custom 27007969 SPIKED ROUND DISK BOTH IP/OP "$1,247.00" $923.00 $221.97 "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" $221.97 "$1,247.00" "$1,247.00" $925.52 $925.52 $961.19 $649.69 $259.89 "$1,247.00" $498.80 "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" $935.25 "$1,247.00" "$1,247.00" "$1,247.00" $623.50 $623.50 $987.62 "$1,247.00" $997.60 $810.55 "$1,247.00" "$1,247.00" $723.26 "$1,247.00" $748.20 "$1,247.00" "$1,247.00" "$1,247.00" N/A N/A 27007970 EAP Custom 27007970 SPIKED RECTANGULAR DISK BOTH IP/OP "$1,247.00" $923.00 $221.97 "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" $221.97 "$1,247.00" "$1,247.00" $925.52 $925.52 $961.19 $649.69 $259.89 "$1,247.00" $498.80 "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" $935.25 "$1,247.00" "$1,247.00" "$1,247.00" $623.50 $623.50 $987.62 "$1,247.00" $997.60 $810.55 "$1,247.00" "$1,247.00" $723.26 "$1,247.00" $748.20 "$1,247.00" "$1,247.00" "$1,247.00" N/A N/A 27007974 EAP Custom 27007974 PED LCP HIP PL GDNG BLK 3.5SCW BOTH IP/OP "$1,986.00" "$1,470.00" $353.51 "$1,986.00" "$1,986.00" "$1,986.00" "$1,986.00" "$1,986.00" "$1,986.00" "$1,986.00" $353.51 "$1,986.00" "$1,986.00" "$1,474.01" "$1,474.01" "$1,530.81" "$1,034.71" $413.90 "$1,986.00" $794.40 "$1,986.00" "$1,986.00" "$1,986.00" "$1,986.00" "$1,986.00" "$1,489.50" "$1,986.00" "$1,986.00" "$1,986.00" $993.00 $993.00 "$1,572.91" "$1,986.00" "$1,588.80" "$1,290.90" "$1,986.00" "$1,986.00" "$1,151.88" "$1,986.00" "$1,191.60" "$1,986.00" "$1,986.00" "$1,986.00" N/A N/A 27007975 EAP Custom 27007975 PED LCP HIP PL GDNG BLCK 5SCW BOTH IP/OP "$1,986.00" "$1,470.00" $353.51 "$1,986.00" "$1,986.00" "$1,986.00" "$1,986.00" "$1,986.00" "$1,986.00" "$1,986.00" $353.51 "$1,986.00" "$1,986.00" "$1,474.01" "$1,474.01" "$1,530.81" "$1,034.71" $413.90 "$1,986.00" $794.40 "$1,986.00" "$1,986.00" "$1,986.00" "$1,986.00" "$1,986.00" "$1,489.50" "$1,986.00" "$1,986.00" "$1,986.00" $993.00 $993.00 "$1,572.91" "$1,986.00" "$1,588.80" "$1,290.90" "$1,986.00" "$1,986.00" "$1,151.88" "$1,986.00" "$1,191.60" "$1,986.00" "$1,986.00" "$1,986.00" N/A N/A 27007977 EAP Custom 27007977 REDUCTION SLEEVE 4.3MM/2.8MM BOTH IP/OP $647.00 $479.00 $115.17 $647.00 $647.00 $647.00 $647.00 $647.00 $647.00 $647.00 $115.17 $647.00 $647.00 $480.20 $480.20 $498.71 $337.09 $134.84 $647.00 $258.80 $647.00 $647.00 $647.00 $647.00 $647.00 $485.25 $647.00 $647.00 $647.00 $323.50 $323.50 $512.42 $647.00 $517.60 $420.55 $647.00 $647.00 $375.26 $647.00 $388.20 $647.00 $647.00 $647.00 N/A N/A 27007979 EAP Custom 27007979 POSITIONING DEVICE GDNG BLCK BOTH IP/OP "$1,727.00" "$1,278.00" $307.41 "$1,727.00" "$1,727.00" "$1,727.00" "$1,727.00" "$1,727.00" "$1,727.00" "$1,727.00" $307.41 "$1,727.00" "$1,727.00" "$1,281.78" "$1,281.78" "$1,331.17" $899.77 $359.93 "$1,727.00" $690.80 "$1,727.00" "$1,727.00" "$1,727.00" "$1,727.00" "$1,727.00" "$1,295.25" "$1,727.00" "$1,727.00" "$1,727.00" $863.50 $863.50 "$1,367.78" "$1,727.00" "$1,381.60" "$1,122.55" "$1,727.00" "$1,727.00" "$1,001.66" "$1,727.00" "$1,036.20" "$1,727.00" "$1,727.00" "$1,727.00" N/A N/A 27007980 EAP Custom 27007980 MEDIALIZATION GDE 3.5&5.0 LCP BOTH IP/OP "$1,727.00" "$1,278.00" $307.41 "$1,727.00" "$1,727.00" "$1,727.00" "$1,727.00" "$1,727.00" "$1,727.00" "$1,727.00" $307.41 "$1,727.00" "$1,727.00" "$1,281.78" "$1,281.78" "$1,331.17" $899.77 $359.93 "$1,727.00" $690.80 "$1,727.00" "$1,727.00" "$1,727.00" "$1,727.00" "$1,727.00" "$1,295.25" "$1,727.00" "$1,727.00" "$1,727.00" $863.50 $863.50 "$1,367.78" "$1,727.00" "$1,381.60" "$1,122.55" "$1,727.00" "$1,727.00" "$1,001.66" "$1,727.00" "$1,036.20" "$1,727.00" "$1,727.00" "$1,727.00" N/A N/A 27007981 EAP Custom 27007981 OSTEOTOMY MEASURING DEVICE BOTH IP/OP "$1,061.00" $785.50 $188.86 "$1,061.00" "$1,061.00" "$1,061.00" "$1,061.00" "$1,061.00" "$1,061.00" "$1,061.00" $188.86 "$1,061.00" "$1,061.00" $787.47 $787.47 $817.82 $552.78 $221.12 "$1,061.00" $424.40 "$1,061.00" "$1,061.00" "$1,061.00" "$1,061.00" "$1,061.00" $795.75 "$1,061.00" "$1,061.00" "$1,061.00" $530.50 $530.50 $840.31 "$1,061.00" $848.80 $689.65 "$1,061.00" "$1,061.00" $615.38 "$1,061.00" $636.60 "$1,061.00" "$1,061.00" "$1,061.00" N/A N/A 27007984 EAP Custom 27007984 MEAS DEV 3.0 HDLES COMPRES SCW BOTH IP/OP $722.00 $534.50 $128.52 $722.00 $722.00 $722.00 $722.00 $722.00 $722.00 $722.00 $128.52 $722.00 $722.00 $535.87 $535.87 $556.52 $376.16 $150.47 $722.00 $288.80 $722.00 $722.00 $722.00 $722.00 $722.00 $541.50 $722.00 $722.00 $722.00 $361.00 $361.00 $571.82 $722.00 $577.60 $469.30 $722.00 $722.00 $418.76 $722.00 $433.20 $722.00 $722.00 $722.00 N/A N/A 27007990 EAP Custom 27007990 MEAS DEV F/DRL GDE W/STP 3.0M BOTH IP/OP $642.00 $475.50 $114.28 $642.00 $642.00 $642.00 $642.00 $642.00 $642.00 $642.00 $114.28 $642.00 $642.00 $476.49 $476.49 $494.85 $334.48 $133.80 $642.00 $256.80 $642.00 $642.00 $642.00 $642.00 $642.00 $481.50 $642.00 $642.00 $642.00 $321.00 $321.00 $508.46 $642.00 $513.60 $417.30 $642.00 $642.00 $372.36 $642.00 $385.20 $642.00 $642.00 $642.00 N/A N/A 27007991 EAP Custom 27007991 MEDIUM OPEN COMPRESSOR BOTH IP/OP "$4,431.00" "$3,279.00" $788.72 "$4,431.00" "$4,431.00" "$4,431.00" "$4,431.00" "$4,431.00" "$4,431.00" "$4,431.00" $788.72 "$4,431.00" "$4,431.00" "$3,288.69" "$3,288.69" "$3,415.41" "$2,060.15" $923.47 "$4,431.00" "$1,772.40" "$4,431.00" "$4,431.00" "$4,431.00" "$4,431.00" "$4,431.00" "$3,323.25" "$4,431.00" "$4,431.00" "$4,431.00" "$2,215.50" "$2,215.50" "$3,509.35" "$4,431.00" "$3,544.80" "$2,880.15" "$4,431.00" "$4,431.00" "$2,569.98" "$4,431.00" "$2,658.60" "$4,431.00" "$4,431.00" "$4,431.00" N/A N/A 27007992 EAP Custom 27007992 LO-PRO WRST FXTR/SCHAN SCR/200 BOTH IP/OP "$4,535.00" "$3,356.00" $807.23 "$4,535.00" "$4,535.00" "$4,535.00" "$4,535.00" "$4,535.00" "$4,535.00" "$4,535.00" $807.23 "$4,535.00" "$4,535.00" "$3,365.88" "$3,365.88" "$3,495.58" "$2,060.15" $945.14 "$4,535.00" "$1,814.00" "$4,535.00" "$4,535.00" "$4,535.00" "$4,535.00" "$4,535.00" "$3,401.25" "$4,535.00" "$4,535.00" "$4,535.00" "$2,267.50" "$2,267.50" "$3,591.72" "$4,535.00" "$3,628.00" "$2,947.75" "$4,535.00" "$4,535.00" "$2,630.30" "$4,535.00" "$2,721.00" "$4,535.00" "$4,535.00" "$4,535.00" N/A N/A 27007993 EAP Custom 27007993 LO-PRO WRST FXTR/SCHAN SCR/220 BOTH IP/OP "$4,535.00" "$3,356.00" $807.23 "$4,535.00" "$4,535.00" "$4,535.00" "$4,535.00" "$4,535.00" "$4,535.00" "$4,535.00" $807.23 "$4,535.00" "$4,535.00" "$3,365.88" "$3,365.88" "$3,495.58" "$2,060.15" $945.14 "$4,535.00" "$1,814.00" "$4,535.00" "$4,535.00" "$4,535.00" "$4,535.00" "$4,535.00" "$3,401.25" "$4,535.00" "$4,535.00" "$4,535.00" "$2,267.50" "$2,267.50" "$3,591.72" "$4,535.00" "$3,628.00" "$2,947.75" "$4,535.00" "$4,535.00" "$2,630.30" "$4,535.00" "$2,721.00" "$4,535.00" "$4,535.00" "$4,535.00" N/A N/A 27007994 EAP Custom 27007994 LOW-PRO WRST FXTR/SLF-DRLG/200 BOTH IP/OP "$5,757.00" "$4,260.50" "$1,024.75" "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" "$1,024.75" "$5,757.00" "$5,757.00" "$4,181.12" "$4,181.12" "$4,437.50" "$2,060.15" "$1,199.82" "$5,757.00" "$2,302.80" "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" "$4,317.75" "$5,757.00" "$5,757.00" "$5,757.00" "$2,878.50" "$2,878.50" "$4,559.54" "$5,757.00" "$4,605.60" "$3,742.05" "$5,757.00" "$5,757.00" "$3,339.06" "$5,757.00" "$3,454.20" "$5,757.00" "$5,757.00" "$5,757.00" N/A N/A 27007995 EAP Custom 27007995 LOW-PRO WRST FXTR/SLF-DRLG/220 BOTH IP/OP "$5,757.00" "$4,260.50" "$1,024.75" "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" "$1,024.75" "$5,757.00" "$5,757.00" "$4,181.12" "$4,181.12" "$4,437.50" "$2,060.15" "$1,199.82" "$5,757.00" "$2,302.80" "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" "$4,317.75" "$5,757.00" "$5,757.00" "$5,757.00" "$2,878.50" "$2,878.50" "$4,559.54" "$5,757.00" "$4,605.60" "$3,742.05" "$5,757.00" "$5,757.00" "$3,339.06" "$5,757.00" "$3,454.20" "$5,757.00" "$5,757.00" "$5,757.00" N/A N/A 27007996 EAP Custom 27007996 TENSIONER BOTH IP/OP "$16,191.00" "$11,981.50" "$2,060.15" "$16,191.00" "$16,191.00" "$16,191.00" "$16,191.00" "$16,191.00" "$16,191.00" "$16,191.00" "$2,882.00" "$16,191.00" "$16,191.00" "$4,181.12" "$4,181.12" "$12,480.02" "$2,060.15" "$3,374.38" "$16,191.00" "$6,476.40" "$16,191.00" "$16,191.00" "$16,191.00" "$16,191.00" "$16,191.00" "$12,143.25" "$16,191.00" "$16,191.00" "$16,191.00" "$8,095.50" "$8,095.50" "$12,823.27" "$16,191.00" "$12,952.80" "$10,524.15" "$16,191.00" "$16,191.00" "$9,390.78" "$16,191.00" "$9,714.60" "$16,191.00" "$16,191.00" "$16,191.00" N/A N/A 27007997 EAP Custom 27007997 SLOTTED SOCKET WRENCH 11MM BOTH IP/OP "$2,314.00" "$1,712.50" $411.89 "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" $411.89 "$2,314.00" "$2,314.00" "$1,717.45" "$1,717.45" "$1,783.63" "$1,205.59" $482.26 "$2,314.00" $925.60 "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$1,735.50" "$2,314.00" "$2,314.00" "$2,314.00" "$1,157.00" "$1,157.00" "$1,832.69" "$2,314.00" "$1,851.20" "$1,504.10" "$2,314.00" "$2,314.00" "$1,342.12" "$2,314.00" "$1,388.40" "$2,314.00" "$2,314.00" "$2,314.00" N/A N/A 27007998 EAP Custom 27007998 PATIENT WRENCH 8MM/11MM BOTH IP/OP $604.00 $447.00 $107.51 $604.00 $604.00 $604.00 $604.00 $604.00 $604.00 $604.00 $107.51 $604.00 $604.00 $448.29 $448.29 $465.56 $314.68 $125.88 $604.00 $241.60 $604.00 $604.00 $604.00 $604.00 $604.00 $453.00 $604.00 $604.00 $604.00 $302.00 $302.00 $478.37 $604.00 $483.20 $392.60 $604.00 $604.00 $350.32 $604.00 $362.40 $604.00 $604.00 $604.00 N/A N/A 27007999 EAP Custom 27007999 RATCHET WRENCH 11MM BOTH IP/OP "$2,891.00" "$2,139.50" $514.60 "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" $514.60 "$2,891.00" "$2,891.00" "$2,145.70" "$2,145.70" "$2,228.38" "$1,506.21" $602.52 "$2,891.00" "$1,156.40" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,168.25" "$2,891.00" "$2,891.00" "$2,891.00" "$1,445.50" "$1,445.50" "$2,289.67" "$2,891.00" "$2,312.80" "$1,879.15" "$2,891.00" "$2,891.00" "$1,676.78" "$2,891.00" "$1,734.60" "$2,891.00" "$2,891.00" "$2,891.00" N/A N/A 27008000 EAP Custom 27008000 SPLIT TISSUE PROTECT SLVE 2.5M BOTH IP/OP "$2,314.00" "$1,712.50" $411.89 "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" $411.89 "$2,314.00" "$2,314.00" "$1,717.45" "$1,717.45" "$1,783.63" "$1,205.59" $482.26 "$2,314.00" $925.60 "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$1,735.50" "$2,314.00" "$2,314.00" "$2,314.00" "$1,157.00" "$1,157.00" "$1,832.69" "$2,314.00" "$1,851.20" "$1,504.10" "$2,314.00" "$2,314.00" "$1,342.12" "$2,314.00" "$1,388.40" "$2,314.00" "$2,314.00" "$2,314.00" N/A N/A 27008001 EAP Custom 27008001 SPLIT TISSUE PROTECT SLVE 5MM BOTH IP/OP "$2,314.00" "$1,712.50" $411.89 "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" $411.89 "$2,314.00" "$2,314.00" "$1,717.45" "$1,717.45" "$1,783.63" "$1,205.59" $482.26 "$2,314.00" $925.60 "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$1,735.50" "$2,314.00" "$2,314.00" "$2,314.00" "$1,157.00" "$1,157.00" "$1,832.69" "$2,314.00" "$1,851.20" "$1,504.10" "$2,314.00" "$2,314.00" "$1,342.12" "$2,314.00" "$1,388.40" "$2,314.00" "$2,314.00" "$2,314.00" N/A N/A 27008004 EAP Custom 27008004 SCHANZ SCREW BOLT MR SAFE BOTH IP/OP $906.00 $670.50 $161.27 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $161.27 $906.00 $906.00 $672.43 $672.43 $698.34 $472.03 $188.82 $906.00 $362.40 $906.00 $906.00 $906.00 $906.00 $906.00 $679.50 $906.00 $906.00 $906.00 $453.00 $453.00 $717.55 $906.00 $724.80 $588.90 $906.00 $906.00 $525.48 $906.00 $543.60 $906.00 $906.00 $906.00 N/A N/A 27008005 EAP Custom 27008005 PIVOT SCHANZ SCREW CLAMP MR SA BOTH IP/OP "$1,830.00" "$1,354.50" $325.74 "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" $325.74 "$1,830.00" "$1,830.00" "$1,358.23" "$1,358.23" "$1,410.56" $953.43 $381.39 "$1,830.00" $732.00 "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,372.50" "$1,830.00" "$1,830.00" "$1,830.00" $915.00 $915.00 "$1,449.36" "$1,830.00" "$1,464.00" "$1,189.50" "$1,830.00" "$1,830.00" "$1,061.40" "$1,830.00" "$1,098.00" "$1,830.00" "$1,830.00" "$1,830.00" N/A N/A 27008006 EAP Custom 27008006 LOCKING HINGE MR SAFE BOTH IP/OP $906.00 $670.50 $161.27 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $161.27 $906.00 $906.00 $672.43 $672.43 $698.34 $472.03 $188.82 $906.00 $362.40 $906.00 $906.00 $906.00 $906.00 $906.00 $679.50 $906.00 $906.00 $906.00 $453.00 $453.00 $717.55 $906.00 $724.80 $588.90 $906.00 $906.00 $525.48 $906.00 $543.60 $906.00 $906.00 $906.00 N/A N/A 27008007 EAP Custom 27008007 SCHANZ SCREW BOLT POST MOUNT M BOTH IP/OP "$1,045.00" $773.50 $186.01 "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" $186.01 "$1,045.00" "$1,045.00" $775.60 $775.60 $805.49 $544.45 $217.79 "$1,045.00" $418.00 "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" $783.75 "$1,045.00" "$1,045.00" "$1,045.00" $522.50 $522.50 $827.64 "$1,045.00" $836.00 $679.25 "$1,045.00" "$1,045.00" $606.10 "$1,045.00" $627.00 "$1,045.00" "$1,045.00" "$1,045.00" N/A N/A 27008008 EAP Custom 27008008 SMTH WIRE/1.5MM DIAMETER 400M BOTH IP/OP $308.00 $228.00 $54.82 $308.00 $308.00 $308.00 $308.00 $308.00 $308.00 $308.00 $54.82 $308.00 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $123.20 $308.00 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $308.00 $308.00 $178.64 $308.00 $184.80 $308.00 $308.00 $308.00 N/A N/A 27008009 EAP Custom 27008009 SMTH WIRE/1.8MM DIAMETER 400M BOTH IP/OP $308.00 $228.00 $54.82 $308.00 $308.00 $308.00 $308.00 $308.00 $308.00 $308.00 $54.82 $308.00 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $123.20 $308.00 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $308.00 $308.00 $178.64 $308.00 $184.80 $308.00 $308.00 $308.00 N/A N/A 27008010 EAP Custom 27008010 SMTH WIRE/2.0MM DIAMETER 400M BOTH IP/OP $308.00 $228.00 $54.82 $308.00 $308.00 $308.00 $308.00 $308.00 $308.00 $308.00 $54.82 $308.00 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $123.20 $308.00 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $308.00 $308.00 $178.64 $308.00 $184.80 $308.00 $308.00 $308.00 N/A N/A 27008011 EAP Custom 27008011 SMTH WIRE 1.5M DIA HLF PNT TIP BOTH IP/OP $308.00 $228.00 $54.82 $308.00 $308.00 $308.00 $308.00 $308.00 $308.00 $308.00 $54.82 $308.00 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $123.20 $308.00 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $308.00 $308.00 $178.64 $308.00 $184.80 $308.00 $308.00 $308.00 N/A N/A 27008012 EAP Custom 27008012 SMTH WIRE 1.8M DIA HLF PNT TIP BOTH IP/OP $308.00 $228.00 $54.82 $308.00 $308.00 $308.00 $308.00 $308.00 $308.00 $308.00 $54.82 $308.00 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $123.20 $308.00 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $308.00 $308.00 $178.64 $308.00 $184.80 $308.00 $308.00 $308.00 N/A N/A 27008013 EAP Custom 27008013 SMTH WIRE 2.0M DIA HLF PNT TIP BOTH IP/OP $308.00 $228.00 $54.82 $308.00 $308.00 $308.00 $308.00 $308.00 $308.00 $308.00 $54.82 $308.00 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $123.20 $308.00 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $308.00 $308.00 $178.64 $308.00 $184.80 $308.00 $308.00 $308.00 N/A N/A 27008014 EAP Custom 27008014 REDUCTN WRE/1.5MM DIAM 400M BOTH IP/OP $962.00 $712.00 $171.24 $962.00 $962.00 $962.00 $962.00 $962.00 $962.00 $962.00 $171.24 $962.00 $962.00 $714.00 $714.00 $741.51 $501.20 $200.49 $962.00 $384.80 $962.00 $962.00 $962.00 $962.00 $962.00 $721.50 $962.00 $962.00 $962.00 $481.00 $481.00 $761.90 $962.00 $769.60 $625.30 $962.00 $962.00 $557.96 $962.00 $577.20 $962.00 $962.00 $962.00 N/A N/A 27008015 EAP Custom 27008015 REDUCTN WRE/1.8MM DIAM 400M BOTH IP/OP $962.00 $712.00 $171.24 $962.00 $962.00 $962.00 $962.00 $962.00 $962.00 $962.00 $171.24 $962.00 $962.00 $714.00 $714.00 $741.51 $501.20 $200.49 $962.00 $384.80 $962.00 $962.00 $962.00 $962.00 $962.00 $721.50 $962.00 $962.00 $962.00 $481.00 $481.00 $761.90 $962.00 $769.60 $625.30 $962.00 $962.00 $557.96 $962.00 $577.20 $962.00 $962.00 $962.00 N/A N/A 27008016 EAP Custom 27008016 REDUCTN WIRE/2.0MM DIAM 400M BOTH IP/OP $962.00 $712.00 $171.24 $962.00 $962.00 $962.00 $962.00 $962.00 $962.00 $962.00 $171.24 $962.00 $962.00 $714.00 $714.00 $741.51 $501.20 $200.49 $962.00 $384.80 $962.00 $962.00 $962.00 $962.00 $962.00 $721.50 $962.00 $962.00 $962.00 $481.00 $481.00 $761.90 $962.00 $769.60 $625.30 $962.00 $962.00 $557.96 $962.00 $577.20 $962.00 $962.00 $962.00 N/A N/A 27008017 EAP Custom 27008017 REDUCTN WRE 1.5MM DIA HALF PNT BOTH IP/OP $962.00 $712.00 $171.24 $962.00 $962.00 $962.00 $962.00 $962.00 $962.00 $962.00 $171.24 $962.00 $962.00 $714.00 $714.00 $741.51 $501.20 $200.49 $962.00 $384.80 $962.00 $962.00 $962.00 $962.00 $962.00 $721.50 $962.00 $962.00 $962.00 $481.00 $481.00 $761.90 $962.00 $769.60 $625.30 $962.00 $962.00 $557.96 $962.00 $577.20 $962.00 $962.00 $962.00 N/A N/A 27008018 EAP Custom 27008018 REDUCTN WRE 1.8MM DIA HLF PNT BOTH IP/OP $962.00 $712.00 $171.24 $962.00 $962.00 $962.00 $962.00 $962.00 $962.00 $962.00 $171.24 $962.00 $962.00 $714.00 $714.00 $741.51 $501.20 $200.49 $962.00 $384.80 $962.00 $962.00 $962.00 $962.00 $962.00 $721.50 $962.00 $962.00 $962.00 $481.00 $481.00 $761.90 $962.00 $769.60 $625.30 $962.00 $962.00 $557.96 $962.00 $577.20 $962.00 $962.00 $962.00 N/A N/A 27008019 EAP Custom 27008019 REDUCTN WRE 2.0MM DIA HALF PNT BOTH IP/OP $962.00 $712.00 $171.24 $962.00 $962.00 $962.00 $962.00 $962.00 $962.00 $962.00 $171.24 $962.00 $962.00 $714.00 $714.00 $741.51 $501.20 $200.49 $962.00 $384.80 $962.00 $962.00 $962.00 $962.00 $962.00 $721.50 $962.00 $962.00 $962.00 $481.00 $481.00 $761.90 $962.00 $769.60 $625.30 $962.00 $962.00 $557.96 $962.00 $577.20 $962.00 $962.00 $962.00 N/A N/A 27008020 EAP Custom 27008020 WIRE BOLT/SLOTTED MR SAFE BOTH IP/OP $197.00 $146.00 $35.07 $197.00 $197.00 $197.00 $197.00 $197.00 $197.00 $197.00 $35.07 $197.00 $197.00 $146.21 $146.21 $151.85 $102.64 $41.06 $197.00 $78.80 $197.00 $197.00 $197.00 $197.00 $197.00 $147.75 $197.00 $197.00 $197.00 $98.50 $98.50 $156.02 $197.00 $157.60 $128.05 $197.00 $197.00 $114.26 $197.00 $118.20 $197.00 $197.00 $197.00 N/A N/A 27008021 EAP Custom 27008021 WIRE BOLT/OFFSET MR SAFE BOTH IP/OP $183.00 $135.50 $32.57 $183.00 $183.00 $183.00 $183.00 $183.00 $183.00 $183.00 $32.57 $183.00 $183.00 $135.82 $135.82 $141.06 $95.34 $38.14 $183.00 $73.20 $183.00 $183.00 $183.00 $183.00 $183.00 $137.25 $183.00 $183.00 $183.00 $91.50 $91.50 $144.94 $183.00 $146.40 $118.95 $183.00 $183.00 $106.14 $183.00 $109.80 $183.00 $183.00 $183.00 N/A N/A 27008024 EAP Custom 27008024 SCHANZ SCRW BOLT CAN RNG MNT BOTH IP/OP $906.00 $670.50 $161.27 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $161.27 $906.00 $906.00 $672.43 $672.43 $698.34 $472.03 $188.82 $906.00 $362.40 $906.00 $906.00 $906.00 $906.00 $906.00 $679.50 $906.00 $906.00 $906.00 $453.00 $453.00 $717.55 $906.00 $724.80 $588.90 $906.00 $906.00 $525.48 $906.00 $543.60 $906.00 $906.00 $906.00 N/A N/A 27008025 EAP Custom 27008025 SCHANZ SCRW BOLT CAN POST MNT BOTH IP/OP "$1,045.00" $773.50 $186.01 "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" $186.01 "$1,045.00" "$1,045.00" $775.60 $775.60 $805.49 $544.45 $217.79 "$1,045.00" $418.00 "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" $783.75 "$1,045.00" "$1,045.00" "$1,045.00" $522.50 $522.50 $827.64 "$1,045.00" $836.00 $679.25 "$1,045.00" "$1,045.00" $606.10 "$1,045.00" $627.00 "$1,045.00" "$1,045.00" "$1,045.00" N/A N/A 27008026 EAP Custom 27008026 SQUARE NUT MR SAFE BOTH IP/OP $337.00 $249.50 $59.99 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $59.99 $337.00 $337.00 $250.12 $250.12 $259.76 $175.58 $70.23 $337.00 $134.80 $337.00 $337.00 $337.00 $337.00 $337.00 $252.75 $337.00 $337.00 $337.00 $168.50 $168.50 $266.90 $337.00 $269.60 $219.05 $337.00 $337.00 $195.46 $337.00 $202.20 $337.00 $337.00 $337.00 N/A N/A 27008027 EAP Custom 27008027 NUT MR SAFE BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27008028 EAP Custom 27008028 NUT 10 PACK MR SAFE BOTH IP/OP $154.00 $114.00 $27.41 $154.00 $154.00 $154.00 $154.00 $154.00 $154.00 $154.00 $27.41 $154.00 $154.00 $114.30 $114.30 $118.70 $80.23 $32.10 $154.00 $61.60 $154.00 $154.00 $154.00 $154.00 $154.00 $115.50 $154.00 $154.00 $154.00 $77.00 $77.00 $121.97 $154.00 $123.20 $100.10 $154.00 $154.00 $89.32 $154.00 $92.40 $154.00 $154.00 $154.00 N/A N/A 27008029 EAP Custom 27008029 SPEED NUT MR SAFE BOTH IP/OP $652.00 $482.50 $116.06 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $116.06 $652.00 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $652.00 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $652.00 $652.00 $378.16 $652.00 $391.20 $652.00 $652.00 $652.00 N/A N/A 27008030 EAP Custom 27008030 WIRE POST-SHORT MR SAFE BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 27008031 EAP Custom 27008031 WIRE POST-TALL MR SAFE BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $688.76 $688.76 $715.30 $483.49 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $603.20 $928.00 $928.00 $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 27008032 EAP Custom 27008032 SPACING WASHER 1MM MR SAFE BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27008033 EAP Custom 27008033 SPACING WASHER 2MM MR SAFE BOTH IP/OP $21.00 $16.00 $3.74 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $3.74 $21.00 $21.00 $15.59 $15.59 $16.19 $10.94 $4.38 $21.00 $8.40 $21.00 $21.00 $21.00 $21.00 $21.00 $15.75 $21.00 $21.00 $21.00 $10.50 $10.50 $16.63 $21.00 $16.80 $13.65 $21.00 $21.00 $12.18 $21.00 $12.60 $21.00 $21.00 $21.00 N/A N/A 27008034 EAP Custom 27008034 SPACING WASHER 4MM MR SAFE BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27008035 EAP Custom 27008035 SPHERICAL WASHER COUPLE MR SAF BOTH IP/OP $145.00 $107.50 $25.81 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $25.81 $145.00 $145.00 $107.62 $107.62 $111.77 $75.55 $30.22 $145.00 $58.00 $145.00 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $94.25 $145.00 $145.00 $84.10 $145.00 $87.00 $145.00 $145.00 $145.00 N/A N/A 27008036 EAP Custom 27008036 OBLIQUE SUPPORT MR SAFE BOTH IP/OP "$2,314.00" "$1,712.50" $411.89 "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" $411.89 "$2,314.00" "$2,314.00" "$1,717.45" "$1,717.45" "$1,783.63" "$1,205.59" $482.26 "$2,314.00" $925.60 "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$1,735.50" "$2,314.00" "$2,314.00" "$2,314.00" "$1,157.00" "$1,157.00" "$1,832.69" "$2,314.00" "$1,851.20" "$1,504.10" "$2,314.00" "$2,314.00" "$1,342.12" "$2,314.00" "$1,388.40" "$2,314.00" "$2,314.00" "$2,314.00" N/A N/A 27008038 EAP Custom 27008038 THREAD ROD 80 LNG/SLOT MR SAFE BOTH IP/OP $280.00 $207.50 $49.84 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $49.84 $280.00 $280.00 $207.82 $207.82 $215.82 $145.88 $58.36 $280.00 $112.00 $280.00 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $182.00 $280.00 $280.00 $162.40 $280.00 $168.00 $280.00 $280.00 $280.00 N/A N/A 27008039 EAP Custom 27008039 THREAD ROD 100 LNG/SLOT MR SFE BOTH IP/OP $280.00 $207.50 $49.84 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $49.84 $280.00 $280.00 $207.82 $207.82 $215.82 $145.88 $58.36 $280.00 $112.00 $280.00 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $182.00 $280.00 $280.00 $162.40 $280.00 $168.00 $280.00 $280.00 $280.00 N/A N/A 27008040 EAP Custom 27008040 THREADED ROD 120MM LNG MR SAFE BOTH IP/OP $280.00 $207.50 $49.84 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $49.84 $280.00 $280.00 $207.82 $207.82 $215.82 $145.88 $58.36 $280.00 $112.00 $280.00 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $182.00 $280.00 $280.00 $162.40 $280.00 $168.00 $280.00 $280.00 $280.00 N/A N/A 27008041 EAP Custom 27008041 THREADED ROD 150MM LNG MR SAFE BOTH IP/OP $280.00 $207.50 $49.84 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $49.84 $280.00 $280.00 $207.82 $207.82 $215.82 $145.88 $58.36 $280.00 $112.00 $280.00 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $182.00 $280.00 $280.00 $162.40 $280.00 $168.00 $280.00 $280.00 $280.00 N/A N/A 27008042 EAP Custom 27008042 THREADED ROD 200MM LNG MR SAFE BOTH IP/OP $301.00 $223.00 $53.58 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $53.58 $301.00 $301.00 $223.40 $223.40 $232.01 $156.82 $62.73 $301.00 $120.40 $301.00 $301.00 $301.00 $301.00 $301.00 $225.75 $301.00 $301.00 $301.00 $150.50 $150.50 $238.39 $301.00 $240.80 $195.65 $301.00 $301.00 $174.58 $301.00 $180.60 $301.00 $301.00 $301.00 N/A N/A 27008043 EAP Custom 27008043 THREADED ROD 250MM LNG MR SAFE BOTH IP/OP $301.00 $223.00 $53.58 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $53.58 $301.00 $301.00 $223.40 $223.40 $232.01 $156.82 $62.73 $301.00 $120.40 $301.00 $301.00 $301.00 $301.00 $301.00 $225.75 $301.00 $301.00 $301.00 $150.50 $150.50 $238.39 $301.00 $240.80 $195.65 $301.00 $301.00 $174.58 $301.00 $180.60 $301.00 $301.00 $301.00 N/A N/A 27008044 EAP Custom 27008044 THREADED ROD 300MM LNG MR SAFE BOTH IP/OP $347.00 $257.00 $61.77 $347.00 $347.00 $347.00 $347.00 $347.00 $347.00 $347.00 $61.77 $347.00 $347.00 $257.54 $257.54 $267.47 $180.79 $72.32 $347.00 $138.80 $347.00 $347.00 $347.00 $347.00 $347.00 $260.25 $347.00 $347.00 $347.00 $173.50 $173.50 $274.82 $347.00 $277.60 $225.55 $347.00 $347.00 $201.26 $347.00 $208.20 $347.00 $347.00 $347.00 N/A N/A 27008045 EAP Custom 27008045 THREADED ROD 350MM LNG MR SAFE BOTH IP/OP $347.00 $257.00 $61.77 $347.00 $347.00 $347.00 $347.00 $347.00 $347.00 $347.00 $61.77 $347.00 $347.00 $257.54 $257.54 $267.47 $180.79 $72.32 $347.00 $138.80 $347.00 $347.00 $347.00 $347.00 $347.00 $260.25 $347.00 $347.00 $347.00 $173.50 $173.50 $274.82 $347.00 $277.60 $225.55 $347.00 $347.00 $201.26 $347.00 $208.20 $347.00 $347.00 $347.00 N/A N/A 27008046 EAP Custom 27008046 THREADED ROD 400MM LNG MR SAFE BOTH IP/OP $441.00 $326.50 $78.50 $441.00 $441.00 $441.00 $441.00 $441.00 $441.00 $441.00 $78.50 $441.00 $441.00 $327.31 $327.31 $339.92 $229.76 $91.91 $441.00 $176.40 $441.00 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $286.65 $441.00 $441.00 $255.78 $441.00 $264.60 $441.00 $441.00 $441.00 N/A N/A 27008051 EAP Custom 27008051 STANDOFF 20MM LONG MR SAFE BOTH IP/OP $185.00 $137.00 $32.93 $185.00 $185.00 $185.00 $185.00 $185.00 $185.00 $185.00 $32.93 $185.00 $185.00 $137.31 $137.31 $142.60 $96.39 $38.56 $185.00 $74.00 $185.00 $185.00 $185.00 $185.00 $185.00 $138.75 $185.00 $185.00 $185.00 $92.50 $92.50 $146.52 $185.00 $148.00 $120.25 $185.00 $185.00 $107.30 $185.00 $111.00 $185.00 $185.00 $185.00 N/A N/A 27008052 EAP Custom 27008052 STANDOFF 30MM LONG MR SAFE BOTH IP/OP $208.00 $154.00 $37.02 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $37.02 $208.00 $208.00 $154.38 $154.38 $160.33 $108.37 $43.35 $208.00 $83.20 $208.00 $208.00 $208.00 $208.00 $208.00 $156.00 $208.00 $208.00 $208.00 $104.00 $104.00 $164.74 $208.00 $166.40 $135.20 $208.00 $208.00 $120.64 $208.00 $124.80 $208.00 $208.00 $208.00 N/A N/A 27008053 EAP Custom 27008053 STANDOFF 40MM LONG MR SAFE BOTH IP/OP $234.00 $173.50 $41.65 $234.00 $234.00 $234.00 $234.00 $234.00 $234.00 $234.00 $41.65 $234.00 $234.00 $173.67 $173.67 $180.37 $121.91 $48.77 $234.00 $93.60 $234.00 $234.00 $234.00 $234.00 $234.00 $175.50 $234.00 $234.00 $234.00 $117.00 $117.00 $185.33 $234.00 $187.20 $152.10 $234.00 $234.00 $135.72 $234.00 $140.40 $234.00 $234.00 $234.00 N/A N/A 27008054 EAP Custom 27008054 STANDOFF 50MM LONG MR SAFE BOTH IP/OP $301.00 $223.00 $53.58 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $53.58 $301.00 $301.00 $223.40 $223.40 $232.01 $156.82 $62.73 $301.00 $120.40 $301.00 $301.00 $301.00 $301.00 $301.00 $225.75 $301.00 $301.00 $301.00 $150.50 $150.50 $238.39 $301.00 $240.80 $195.65 $301.00 $301.00 $174.58 $301.00 $180.60 $301.00 $301.00 $301.00 N/A N/A 27008055 EAP Custom 27008055 TI HALF RING/80M DIAM MR SAFE BOTH IP/OP "$1,505.00" "$1,114.00" $267.89 "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" $267.89 "$1,505.00" "$1,505.00" "$1,117.01" "$1,117.01" "$1,160.05" $784.11 $313.66 "$1,505.00" $602.00 "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,128.75" "$1,505.00" "$1,505.00" "$1,505.00" $752.50 $752.50 "$1,191.96" "$1,505.00" "$1,204.00" $978.25 "$1,505.00" "$1,505.00" $872.90 "$1,505.00" $903.00 "$1,505.00" "$1,505.00" "$1,505.00" N/A N/A 27008056 EAP Custom 27008056 TI HALF RING/100M DIAM MR SAFE BOTH IP/OP "$1,624.00" "$1,202.00" $289.07 "$1,624.00" "$1,624.00" "$1,624.00" "$1,624.00" "$1,624.00" "$1,624.00" "$1,624.00" $289.07 "$1,624.00" "$1,624.00" "$1,205.33" "$1,205.33" "$1,251.78" $846.10 $338.46 "$1,624.00" $649.60 "$1,624.00" "$1,624.00" "$1,624.00" "$1,624.00" "$1,624.00" "$1,218.00" "$1,624.00" "$1,624.00" "$1,624.00" $812.00 $812.00 "$1,286.21" "$1,624.00" "$1,299.20" "$1,055.60" "$1,624.00" "$1,624.00" $941.92 "$1,624.00" $974.40 "$1,624.00" "$1,624.00" "$1,624.00" N/A N/A 27008057 EAP Custom 27008057 TI HALF RING/110M DIAM MR SAFE BOTH IP/OP "$1,667.00" "$1,234.00" $296.73 "$1,667.00" "$1,667.00" "$1,667.00" "$1,667.00" "$1,667.00" "$1,667.00" "$1,667.00" $296.73 "$1,667.00" "$1,667.00" "$1,237.25" "$1,237.25" "$1,284.92" $868.51 $347.42 "$1,667.00" $666.80 "$1,667.00" "$1,667.00" "$1,667.00" "$1,667.00" "$1,667.00" "$1,250.25" "$1,667.00" "$1,667.00" "$1,667.00" $833.50 $833.50 "$1,320.26" "$1,667.00" "$1,333.60" "$1,083.55" "$1,667.00" "$1,667.00" $966.86 "$1,667.00" "$1,000.20" "$1,667.00" "$1,667.00" "$1,667.00" N/A N/A 27008058 EAP Custom 27008058 TI HALF RING/120M DIAM MR SAFE BOTH IP/OP "$1,735.00" "$1,284.00" $308.83 "$1,735.00" "$1,735.00" "$1,735.00" "$1,735.00" "$1,735.00" "$1,735.00" "$1,735.00" $308.83 "$1,735.00" "$1,735.00" "$1,287.72" "$1,287.72" "$1,337.34" $903.94 $361.59 "$1,735.00" $694.00 "$1,735.00" "$1,735.00" "$1,735.00" "$1,735.00" "$1,735.00" "$1,301.25" "$1,735.00" "$1,735.00" "$1,735.00" $867.50 $867.50 "$1,374.12" "$1,735.00" "$1,388.00" "$1,127.75" "$1,735.00" "$1,735.00" "$1,006.30" "$1,735.00" "$1,041.00" "$1,735.00" "$1,735.00" "$1,735.00" N/A N/A 27008059 EAP Custom 27008059 TI HALF RING/130M DIAM MR SAFE BOTH IP/OP "$1,783.00" "$1,319.50" $317.37 "$1,783.00" "$1,783.00" "$1,783.00" "$1,783.00" "$1,783.00" "$1,783.00" "$1,783.00" $317.37 "$1,783.00" "$1,783.00" "$1,323.34" "$1,323.34" "$1,374.34" $928.94 $371.60 "$1,783.00" $713.20 "$1,783.00" "$1,783.00" "$1,783.00" "$1,783.00" "$1,783.00" "$1,337.25" "$1,783.00" "$1,783.00" "$1,783.00" $891.50 $891.50 "$1,412.14" "$1,783.00" "$1,426.40" "$1,158.95" "$1,783.00" "$1,783.00" "$1,034.14" "$1,783.00" "$1,069.80" "$1,783.00" "$1,783.00" "$1,783.00" N/A N/A 27008060 EAP Custom 27008060 TI HALF RING/140M DIAM MR SAFE BOTH IP/OP "$1,850.00" "$1,369.00" $329.30 "$1,850.00" "$1,850.00" "$1,850.00" "$1,850.00" "$1,850.00" "$1,850.00" "$1,850.00" $329.30 "$1,850.00" "$1,850.00" "$1,373.07" "$1,373.07" "$1,425.98" $963.85 $385.56 "$1,850.00" $740.00 "$1,850.00" "$1,850.00" "$1,850.00" "$1,850.00" "$1,850.00" "$1,387.50" "$1,850.00" "$1,850.00" "$1,850.00" $925.00 $925.00 "$1,465.20" "$1,850.00" "$1,480.00" "$1,202.50" "$1,850.00" "$1,850.00" "$1,073.00" "$1,850.00" "$1,110.00" "$1,850.00" "$1,850.00" "$1,850.00" N/A N/A 27008061 EAP Custom 27008061 TI HALF RING/150M DIAM MR SAFE BOTH IP/OP "$1,969.00" "$1,457.50" $350.48 "$1,969.00" "$1,969.00" "$1,969.00" "$1,969.00" "$1,969.00" "$1,969.00" "$1,969.00" $350.48 "$1,969.00" "$1,969.00" "$1,461.39" "$1,461.39" "$1,517.71" "$1,025.85" $410.36 "$1,969.00" $787.60 "$1,969.00" "$1,969.00" "$1,969.00" "$1,969.00" "$1,969.00" "$1,476.75" "$1,969.00" "$1,969.00" "$1,969.00" $984.50 $984.50 "$1,559.45" "$1,969.00" "$1,575.20" "$1,279.85" "$1,969.00" "$1,969.00" "$1,142.02" "$1,969.00" "$1,181.40" "$1,969.00" "$1,969.00" "$1,969.00" N/A N/A 27008062 EAP Custom 27008062 TI HALF RING/160M DIAM MR SAFE BOTH IP/OP "$2,153.00" "$1,593.50" $383.23 "$2,153.00" "$2,153.00" "$2,153.00" "$2,153.00" "$2,153.00" "$2,153.00" "$2,153.00" $383.23 "$2,153.00" "$2,153.00" "$1,597.96" "$1,597.96" "$1,659.53" "$1,121.71" $448.71 "$2,153.00" $861.20 "$2,153.00" "$2,153.00" "$2,153.00" "$2,153.00" "$2,153.00" "$1,614.75" "$2,153.00" "$2,153.00" "$2,153.00" "$1,076.50" "$1,076.50" "$1,705.18" "$2,153.00" "$1,722.40" "$1,399.45" "$2,153.00" "$2,153.00" "$1,248.74" "$2,153.00" "$1,291.80" "$2,153.00" "$2,153.00" "$2,153.00" N/A N/A 27008063 EAP Custom 27008063 TI HALF RING/180M DIAM MR SAFE BOTH IP/OP "$2,314.00" "$1,712.50" $411.89 "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" $411.89 "$2,314.00" "$2,314.00" "$1,717.45" "$1,717.45" "$1,783.63" "$1,205.59" $482.26 "$2,314.00" $925.60 "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$2,314.00" "$1,735.50" "$2,314.00" "$2,314.00" "$2,314.00" "$1,157.00" "$1,157.00" "$1,832.69" "$2,314.00" "$1,851.20" "$1,504.10" "$2,314.00" "$2,314.00" "$1,342.12" "$2,314.00" "$1,388.40" "$2,314.00" "$2,314.00" "$2,314.00" N/A N/A 27008064 EAP Custom 27008064 TI HALF RING/200M DIAM MR SAFE BOTH IP/OP "$2,498.00" "$1,849.00" $444.64 "$2,498.00" "$2,498.00" "$2,498.00" "$2,498.00" "$2,498.00" "$2,498.00" "$2,498.00" $444.64 "$2,498.00" "$2,498.00" "$1,854.02" "$1,854.02" "$1,925.46" "$1,301.46" $520.61 "$2,498.00" $999.20 "$2,498.00" "$2,498.00" "$2,498.00" "$2,498.00" "$2,498.00" "$1,873.50" "$2,498.00" "$2,498.00" "$2,498.00" "$1,249.00" "$1,249.00" "$1,978.42" "$2,498.00" "$1,998.40" "$1,623.70" "$2,498.00" "$2,498.00" "$1,448.84" "$2,498.00" "$1,498.80" "$2,498.00" "$2,498.00" "$2,498.00" N/A N/A 27008065 EAP Custom 27008065 TI HALF RING/220M DIAM MR SAFE BOTH IP/OP "$2,663.00" "$1,971.00" $474.01 "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" $474.01 "$2,663.00" "$2,663.00" "$1,976.48" "$1,976.48" "$2,052.64" "$1,387.42" $555.00 "$2,663.00" "$1,065.20" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$1,997.25" "$2,663.00" "$2,663.00" "$2,663.00" "$1,331.50" "$1,331.50" "$2,109.10" "$2,663.00" "$2,130.40" "$1,730.95" "$2,663.00" "$2,663.00" "$1,544.54" "$2,663.00" "$1,597.80" "$2,663.00" "$2,663.00" "$2,663.00" N/A N/A 27008066 EAP Custom 27008066 TI HALF RING/240M DIAM MR SAFE BOTH IP/OP "$2,779.00" "$2,056.50" $494.66 "$2,779.00" "$2,779.00" "$2,779.00" "$2,779.00" "$2,779.00" "$2,779.00" "$2,779.00" $494.66 "$2,779.00" "$2,779.00" "$2,062.57" "$2,062.57" "$2,142.05" "$1,447.86" $579.17 "$2,779.00" "$1,111.60" "$2,779.00" "$2,779.00" "$2,779.00" "$2,779.00" "$2,779.00" "$2,084.25" "$2,779.00" "$2,779.00" "$2,779.00" "$1,389.50" "$1,389.50" "$2,200.97" "$2,779.00" "$2,223.20" "$1,806.35" "$2,779.00" "$2,779.00" "$1,611.82" "$2,779.00" "$1,667.40" "$2,779.00" "$2,779.00" "$2,779.00" N/A N/A 27008067 EAP Custom 27008067 TI FULL RING/140M DIAM MR SAFE BOTH IP/OP "$3,704.00" "$2,741.00" $659.31 "$3,704.00" "$3,704.00" "$3,704.00" "$3,704.00" "$3,704.00" "$3,704.00" "$3,704.00" $659.31 "$3,704.00" "$3,704.00" "$2,749.11" "$2,749.11" "$2,855.04" "$1,929.78" $771.95 "$3,704.00" "$1,481.60" "$3,704.00" "$3,704.00" "$3,704.00" "$3,704.00" "$3,704.00" "$2,778.00" "$3,704.00" "$3,704.00" "$3,704.00" "$1,852.00" "$1,852.00" "$2,933.57" "$3,704.00" "$2,963.20" "$2,407.60" "$3,704.00" "$3,704.00" "$2,148.32" "$3,704.00" "$2,222.40" "$3,704.00" "$3,704.00" "$3,704.00" N/A N/A 27008068 EAP Custom 27008068 TI FULL RING/160M DIAM MR SAFE BOTH IP/OP "$4,303.00" "$3,184.50" $765.93 "$4,303.00" "$4,303.00" "$4,303.00" "$4,303.00" "$4,303.00" "$4,303.00" "$4,303.00" $765.93 "$4,303.00" "$4,303.00" "$3,193.69" "$3,193.69" "$3,316.75" "$2,060.15" $896.79 "$4,303.00" "$1,721.20" "$4,303.00" "$4,303.00" "$4,303.00" "$4,303.00" "$4,303.00" "$3,227.25" "$4,303.00" "$4,303.00" "$4,303.00" "$2,151.50" "$2,151.50" "$3,407.98" "$4,303.00" "$3,442.40" "$2,796.95" "$4,303.00" "$4,303.00" "$2,495.74" "$4,303.00" "$2,581.80" "$4,303.00" "$4,303.00" "$4,303.00" N/A N/A 27008069 EAP Custom 27008069 TI FULL RING/180M DIAM MR SAFE BOTH IP/OP "$4,627.00" "$3,424.00" $823.61 "$4,627.00" "$4,627.00" "$4,627.00" "$4,627.00" "$4,627.00" "$4,627.00" "$4,627.00" $823.61 "$4,627.00" "$4,627.00" "$3,434.16" "$3,434.16" "$3,566.49" "$2,060.15" $964.32 "$4,627.00" "$1,850.80" "$4,627.00" "$4,627.00" "$4,627.00" "$4,627.00" "$4,627.00" "$3,470.25" "$4,627.00" "$4,627.00" "$4,627.00" "$2,313.50" "$2,313.50" "$3,664.58" "$4,627.00" "$3,701.60" "$3,007.55" "$4,627.00" "$4,627.00" "$2,683.66" "$4,627.00" "$2,776.20" "$4,627.00" "$4,627.00" "$4,627.00" N/A N/A 27008070 EAP Custom 27008070 TI FULL RING/200M DIAM MR SAFE BOTH IP/OP "$5,022.00" "$3,716.50" $893.92 "$5,022.00" "$5,022.00" "$5,022.00" "$5,022.00" "$5,022.00" "$5,022.00" "$5,022.00" $893.92 "$5,022.00" "$5,022.00" "$3,727.33" "$3,727.33" "$3,870.96" "$2,060.15" "$1,046.64" "$5,022.00" "$2,008.80" "$5,022.00" "$5,022.00" "$5,022.00" "$5,022.00" "$5,022.00" "$3,766.50" "$5,022.00" "$5,022.00" "$5,022.00" "$2,511.00" "$2,511.00" "$3,977.42" "$5,022.00" "$4,017.60" "$3,264.30" "$5,022.00" "$5,022.00" "$2,912.76" "$5,022.00" "$3,013.20" "$5,022.00" "$5,022.00" "$5,022.00" N/A N/A 27008071 EAP Custom 27008071 TI 5/8 RING/130M DIAM MR SAFE BOTH IP/OP "$2,430.00" "$1,798.50" $432.54 "$2,430.00" "$2,430.00" "$2,430.00" "$2,430.00" "$2,430.00" "$2,430.00" "$2,430.00" $432.54 "$2,430.00" "$2,430.00" "$1,803.55" "$1,803.55" "$1,873.04" "$1,266.03" $506.44 "$2,430.00" $972.00 "$2,430.00" "$2,430.00" "$2,430.00" "$2,430.00" "$2,430.00" "$1,822.50" "$2,430.00" "$2,430.00" "$2,430.00" "$1,215.00" "$1,215.00" "$1,924.56" "$2,430.00" "$1,944.00" "$1,579.50" "$2,430.00" "$2,430.00" "$1,409.40" "$2,430.00" "$1,458.00" "$2,430.00" "$2,430.00" "$2,430.00" N/A N/A 27008072 EAP Custom 27008072 TI 5/8 RING/150MM DIAM MR SAFE BOTH IP/OP "$2,663.00" "$1,971.00" $474.01 "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" $474.01 "$2,663.00" "$2,663.00" "$1,976.48" "$1,976.48" "$2,052.64" "$1,387.42" $555.00 "$2,663.00" "$1,065.20" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$1,997.25" "$2,663.00" "$2,663.00" "$2,663.00" "$1,331.50" "$1,331.50" "$2,109.10" "$2,663.00" "$2,130.40" "$1,730.95" "$2,663.00" "$2,663.00" "$1,544.54" "$2,663.00" "$1,597.80" "$2,663.00" "$2,663.00" "$2,663.00" N/A N/A 27008073 EAP Custom 27008073 TI 5/8 RING/160MM DIAM MR SAFE BOTH IP/OP "$2,891.00" "$2,139.50" $514.60 "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" $514.60 "$2,891.00" "$2,891.00" "$2,145.70" "$2,145.70" "$2,228.38" "$1,506.21" $602.52 "$2,891.00" "$1,156.40" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,168.25" "$2,891.00" "$2,891.00" "$2,891.00" "$1,445.50" "$1,445.50" "$2,289.67" "$2,891.00" "$2,312.80" "$1,879.15" "$2,891.00" "$2,891.00" "$1,676.78" "$2,891.00" "$1,734.60" "$2,891.00" "$2,891.00" "$2,891.00" N/A N/A 27008074 EAP Custom 27008074 TI 5/8 RING/180MM DIAM MR SAFE BOTH IP/OP "$3,358.00" "$2,485.00" $597.72 "$3,358.00" "$3,358.00" "$3,358.00" "$3,358.00" "$3,358.00" "$3,358.00" "$3,358.00" $597.72 "$3,358.00" "$3,358.00" "$2,492.31" "$2,492.31" "$2,588.35" "$1,749.52" $699.84 "$3,358.00" "$1,343.20" "$3,358.00" "$3,358.00" "$3,358.00" "$3,358.00" "$3,358.00" "$2,518.50" "$3,358.00" "$3,358.00" "$3,358.00" "$1,679.00" "$1,679.00" "$2,659.54" "$3,358.00" "$2,686.40" "$2,182.70" "$3,358.00" "$3,358.00" "$1,947.64" "$3,358.00" "$2,014.80" "$3,358.00" "$3,358.00" "$3,358.00" N/A N/A 27008075 EAP Custom 27008075 TI 5/8 RING/200MM DIAM MR SAFE BOTH IP/OP "$3,470.00" "$2,568.00" $617.66 "$3,470.00" "$3,470.00" "$3,470.00" "$3,470.00" "$3,470.00" "$3,470.00" "$3,470.00" $617.66 "$3,470.00" "$3,470.00" "$2,575.43" "$2,575.43" "$2,674.68" "$1,807.87" $723.19 "$3,470.00" "$1,388.00" "$3,470.00" "$3,470.00" "$3,470.00" "$3,470.00" "$3,470.00" "$2,602.50" "$3,470.00" "$3,470.00" "$3,470.00" "$1,735.00" "$1,735.00" "$2,748.24" "$3,470.00" "$2,776.00" "$2,255.50" "$3,470.00" "$3,470.00" "$2,012.60" "$3,470.00" "$2,082.00" "$3,470.00" "$3,470.00" "$3,470.00" N/A N/A 27008076 EAP Custom 27008076 TI FEM ARCH PL 180 DIA/90 DEGR BOTH IP/OP "$4,165.00" "$3,082.50" $741.37 "$4,165.00" "$4,165.00" "$4,165.00" "$4,165.00" "$4,165.00" "$4,165.00" "$4,165.00" $741.37 "$4,165.00" "$4,165.00" "$3,091.26" "$3,091.26" "$3,210.38" "$2,060.15" $868.03 "$4,165.00" "$1,666.00" "$4,165.00" "$4,165.00" "$4,165.00" "$4,165.00" "$4,165.00" "$3,123.75" "$4,165.00" "$4,165.00" "$4,165.00" "$2,082.50" "$2,082.50" "$3,298.68" "$4,165.00" "$3,332.00" "$2,707.25" "$4,165.00" "$4,165.00" "$2,415.70" "$4,165.00" "$2,499.00" "$4,165.00" "$4,165.00" "$4,165.00" N/A N/A 27008077 EAP Custom 27008077 TI FEM ARCH PL 180 DIA/120 DEG BOTH IP/OP "$4,281.00" "$3,168.00" $762.02 "$4,281.00" "$4,281.00" "$4,281.00" "$4,281.00" "$4,281.00" "$4,281.00" "$4,281.00" $762.02 "$4,281.00" "$4,281.00" "$3,177.36" "$3,177.36" "$3,299.79" "$2,060.15" $892.21 "$4,281.00" "$1,712.40" "$4,281.00" "$4,281.00" "$4,281.00" "$4,281.00" "$4,281.00" "$3,210.75" "$4,281.00" "$4,281.00" "$4,281.00" "$2,140.50" "$2,140.50" "$3,390.55" "$4,281.00" "$3,424.80" "$2,782.65" "$4,281.00" "$4,281.00" "$2,482.98" "$4,281.00" "$2,568.60" "$4,281.00" "$4,281.00" "$4,281.00" N/A N/A 27008078 EAP Custom 27008078 TI FEM ARCH PL 240 DIA/90 DEGR BOTH IP/OP "$4,515.00" "$3,341.50" $803.67 "$4,515.00" "$4,515.00" "$4,515.00" "$4,515.00" "$4,515.00" "$4,515.00" "$4,515.00" $803.67 "$4,515.00" "$4,515.00" "$3,351.03" "$3,351.03" "$3,480.16" "$2,060.15" $940.98 "$4,515.00" "$1,806.00" "$4,515.00" "$4,515.00" "$4,515.00" "$4,515.00" "$4,515.00" "$3,386.25" "$4,515.00" "$4,515.00" "$4,515.00" "$2,257.50" "$2,257.50" "$3,575.88" "$4,515.00" "$3,612.00" "$2,934.75" "$4,515.00" "$4,515.00" "$2,618.70" "$4,515.00" "$2,709.00" "$4,515.00" "$4,515.00" "$4,515.00" N/A N/A 27008079 EAP Custom 27008079 TI FEM ARCH PL 240 DIA/120 DEG BOTH IP/OP "$4,627.00" "$3,424.00" $823.61 "$4,627.00" "$4,627.00" "$4,627.00" "$4,627.00" "$4,627.00" "$4,627.00" "$4,627.00" $823.61 "$4,627.00" "$4,627.00" "$3,434.16" "$3,434.16" "$3,566.49" "$2,060.15" $964.32 "$4,627.00" "$1,850.80" "$4,627.00" "$4,627.00" "$4,627.00" "$4,627.00" "$4,627.00" "$3,470.25" "$4,627.00" "$4,627.00" "$4,627.00" "$2,313.50" "$2,313.50" "$3,664.58" "$4,627.00" "$3,701.60" "$3,007.55" "$4,627.00" "$4,627.00" "$2,683.66" "$4,627.00" "$2,776.20" "$4,627.00" "$4,627.00" "$4,627.00" N/A N/A 27008080 EAP Custom 27008080 LINEAR DISTRAC 60 LNG 25MM TR BOTH IP/OP "$2,663.00" "$1,971.00" $474.01 "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" $474.01 "$2,663.00" "$2,663.00" "$1,976.48" "$1,976.48" "$2,052.64" "$1,387.42" $555.00 "$2,663.00" "$1,065.20" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$2,663.00" "$1,997.25" "$2,663.00" "$2,663.00" "$2,663.00" "$1,331.50" "$1,331.50" "$2,109.10" "$2,663.00" "$2,130.40" "$1,730.95" "$2,663.00" "$2,663.00" "$1,544.54" "$2,663.00" "$1,597.80" "$2,663.00" "$2,663.00" "$2,663.00" N/A N/A 27008081 EAP Custom 27008081 LINEAR DISTRAC 120LNG 85MM TRA BOTH IP/OP "$2,891.00" "$2,139.50" $514.60 "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" $514.60 "$2,891.00" "$2,891.00" "$2,145.70" "$2,145.70" "$2,228.38" "$1,506.21" $602.52 "$2,891.00" "$1,156.40" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,168.25" "$2,891.00" "$2,891.00" "$2,891.00" "$1,445.50" "$1,445.50" "$2,289.67" "$2,891.00" "$2,312.80" "$1,879.15" "$2,891.00" "$2,891.00" "$1,676.78" "$2,891.00" "$1,734.60" "$2,891.00" "$2,891.00" "$2,891.00" N/A N/A 27008082 EAP Custom 27008082 LINEAR DISTRAC 180 LNG 145 TRA BOTH IP/OP "$3,241.00" "$2,398.50" $576.90 "$3,241.00" "$3,241.00" "$3,241.00" "$3,241.00" "$3,241.00" "$3,241.00" "$3,241.00" $576.90 "$3,241.00" "$3,241.00" "$2,405.47" "$2,405.47" "$2,498.16" "$1,688.56" $675.46 "$3,241.00" "$1,296.40" "$3,241.00" "$3,241.00" "$3,241.00" "$3,241.00" "$3,241.00" "$2,430.75" "$3,241.00" "$3,241.00" "$3,241.00" "$1,620.50" "$1,620.50" "$2,566.87" "$3,241.00" "$2,592.80" "$2,106.65" "$3,241.00" "$3,241.00" "$1,879.78" "$3,241.00" "$1,944.60" "$3,241.00" "$3,241.00" "$3,241.00" N/A N/A 27008083 EAP Custom 27008083 LINEAR DISTRAC 250 LNG 215 TRA BOTH IP/OP "$3,934.00" "$2,911.50" $700.25 "$3,934.00" "$3,934.00" "$3,934.00" "$3,934.00" "$3,934.00" "$3,934.00" "$3,934.00" $700.25 "$3,934.00" "$3,934.00" "$2,919.81" "$2,919.81" "$3,032.33" "$2,049.61" $819.89 "$3,934.00" "$1,573.60" "$3,934.00" "$3,934.00" "$3,934.00" "$3,934.00" "$3,934.00" "$2,950.50" "$3,934.00" "$3,934.00" "$3,934.00" "$1,967.00" "$1,967.00" "$3,115.73" "$3,934.00" "$3,147.20" "$2,557.10" "$3,934.00" "$3,934.00" "$2,281.72" "$3,934.00" "$2,360.40" "$3,934.00" "$3,934.00" "$3,934.00" N/A N/A 27008118 EAP Custom 27008118 SFT TISSUE SPRDER TROCAR 35MM BOTH IP/OP "$1,247.00" $923.00 $221.97 "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" $221.97 "$1,247.00" "$1,247.00" $925.52 $925.52 $961.19 $649.69 $259.89 "$1,247.00" $498.80 "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" $935.25 "$1,247.00" "$1,247.00" "$1,247.00" $623.50 $623.50 $987.62 "$1,247.00" $997.60 $810.55 "$1,247.00" "$1,247.00" $723.26 "$1,247.00" $748.20 "$1,247.00" "$1,247.00" "$1,247.00" N/A N/A 27008119 EAP Custom 27008119 SFT TISSUE SPRDER TROCAR 75 BOTH IP/OP "$1,247.00" $923.00 $221.97 "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" $221.97 "$1,247.00" "$1,247.00" $925.52 $925.52 $961.19 $649.69 $259.89 "$1,247.00" $498.80 "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" "$1,247.00" $935.25 "$1,247.00" "$1,247.00" "$1,247.00" $623.50 $623.50 $987.62 "$1,247.00" $997.60 $810.55 "$1,247.00" "$1,247.00" $723.26 "$1,247.00" $748.20 "$1,247.00" "$1,247.00" "$1,247.00" N/A N/A 27008122 EAP Custom 27008122 STRAIGHT SHARP HOOK BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $445.32 $445.32 $462.48 $312.60 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $390.00 $600.00 $600.00 $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 27008124 EAP Custom 27008124 SMALL SCREW REMOVAL FORCEPS BOTH IP/OP "$1,770.00" "$1,310.00" $315.06 "$1,770.00" "$1,770.00" "$1,770.00" "$1,770.00" "$1,770.00" "$1,770.00" "$1,770.00" $315.06 "$1,770.00" "$1,770.00" "$1,313.69" "$1,313.69" "$1,364.32" $922.17 $368.89 "$1,770.00" $708.00 "$1,770.00" "$1,770.00" "$1,770.00" "$1,770.00" "$1,770.00" "$1,327.50" "$1,770.00" "$1,770.00" "$1,770.00" $885.00 $885.00 "$1,401.84" "$1,770.00" "$1,416.00" "$1,150.50" "$1,770.00" "$1,770.00" "$1,026.60" "$1,770.00" "$1,062.00" "$1,770.00" "$1,770.00" "$1,770.00" N/A N/A 27008125 EAP Custom 27008125 LARGE SCREW REMOVAL FORCEPS BOTH IP/OP "$2,123.00" "$1,571.50" $377.89 "$2,123.00" "$2,123.00" "$2,123.00" "$2,123.00" "$2,123.00" "$2,123.00" "$2,123.00" $377.89 "$2,123.00" "$2,123.00" "$1,575.69" "$1,575.69" "$1,636.41" "$1,106.08" $442.46 "$2,123.00" $849.20 "$2,123.00" "$2,123.00" "$2,123.00" "$2,123.00" "$2,123.00" "$1,592.25" "$2,123.00" "$2,123.00" "$2,123.00" "$1,061.50" "$1,061.50" "$1,681.42" "$2,123.00" "$1,698.40" "$1,379.95" "$2,123.00" "$2,123.00" "$1,231.34" "$2,123.00" "$1,273.80" "$2,123.00" "$2,123.00" "$2,123.00" N/A N/A 27008126 EAP Custom 27008126 TI END CAP T25 STRDR 0MEXT HU BOTH IP/OP $631.00 $467.00 $112.32 $631.00 $631.00 $631.00 $631.00 $631.00 $631.00 $631.00 $112.32 $631.00 $631.00 $468.33 $468.33 $486.37 $328.75 $131.51 $631.00 $252.40 $631.00 $631.00 $631.00 $631.00 $631.00 $473.25 $631.00 $631.00 $631.00 $315.50 $315.50 $499.75 $631.00 $504.80 $410.15 $631.00 $631.00 $365.98 $631.00 $378.60 $631.00 $631.00 $631.00 N/A N/A 27008127 EAP Custom 27008127 TI END CAP T25 STRDRV 0MM EXT BOTH IP/OP $759.00 $562.00 $135.10 $759.00 $759.00 $759.00 $759.00 $759.00 $759.00 $759.00 $135.10 $759.00 $759.00 $563.33 $563.33 $585.04 $395.44 $158.18 $759.00 $303.60 $759.00 $759.00 $759.00 $759.00 $759.00 $569.25 $759.00 $759.00 $759.00 $379.50 $379.50 $601.13 $759.00 $607.20 $493.35 $759.00 $759.00 $440.22 $759.00 $455.40 $759.00 $759.00 $759.00 N/A N/A 27008128 EAP Custom 27008128 TI END CAP T25 STRDRV 5MM EXT BOTH IP/OP $631.00 $467.00 $112.32 $631.00 $631.00 $631.00 $631.00 $631.00 $631.00 $631.00 $112.32 $631.00 $631.00 $468.33 $468.33 $486.37 $328.75 $131.51 $631.00 $252.40 $631.00 $631.00 $631.00 $631.00 $631.00 $473.25 $631.00 $631.00 $631.00 $315.50 $315.50 $499.75 $631.00 $504.80 $410.15 $631.00 $631.00 $365.98 $631.00 $378.60 $631.00 $631.00 $631.00 N/A N/A 27008129 EAP Custom 27008129 TI END CAP T25 STRDRV 5MM EXT BOTH IP/OP $759.00 $562.00 $135.10 $759.00 $759.00 $759.00 $759.00 $759.00 $759.00 $759.00 $135.10 $759.00 $759.00 $563.33 $563.33 $585.04 $395.44 $158.18 $759.00 $303.60 $759.00 $759.00 $759.00 $759.00 $759.00 $569.25 $759.00 $759.00 $759.00 $379.50 $379.50 $601.13 $759.00 $607.20 $493.35 $759.00 $759.00 $440.22 $759.00 $455.40 $759.00 $759.00 $759.00 N/A N/A 27008130 EAP Custom 27008130 TI END CAP T25 STRDRV 10MM EX BOTH IP/OP $631.00 $467.00 $112.32 $631.00 $631.00 $631.00 $631.00 $631.00 $631.00 $631.00 $112.32 $631.00 $631.00 $468.33 $468.33 $486.37 $328.75 $131.51 $631.00 $252.40 $631.00 $631.00 $631.00 $631.00 $631.00 $473.25 $631.00 $631.00 $631.00 $315.50 $315.50 $499.75 $631.00 $504.80 $410.15 $631.00 $631.00 $365.98 $631.00 $378.60 $631.00 $631.00 $631.00 N/A N/A 27008131 EAP Custom 27008131 TI END CAP T25 STRDRV 10MM EX BOTH IP/OP $759.00 $562.00 $135.10 $759.00 $759.00 $759.00 $759.00 $759.00 $759.00 $759.00 $135.10 $759.00 $759.00 $563.33 $563.33 $585.04 $395.44 $158.18 $759.00 $303.60 $759.00 $759.00 $759.00 $759.00 $759.00 $569.25 $759.00 $759.00 $759.00 $379.50 $379.50 $601.13 $759.00 $607.20 $493.35 $759.00 $759.00 $440.22 $759.00 $455.40 $759.00 $759.00 $759.00 N/A N/A 27008132 EAP Custom 27008132 TI END CAP T25 STRDRV 15MM EXT BOTH IP/OP $631.00 $467.00 $112.32 $631.00 $631.00 $631.00 $631.00 $631.00 $631.00 $631.00 $112.32 $631.00 $631.00 $468.33 $468.33 $486.37 $328.75 $131.51 $631.00 $252.40 $631.00 $631.00 $631.00 $631.00 $631.00 $473.25 $631.00 $631.00 $631.00 $315.50 $315.50 $499.75 $631.00 $504.80 $410.15 $631.00 $631.00 $365.98 $631.00 $378.60 $631.00 $631.00 $631.00 N/A N/A 27008133 EAP Custom 27008133 TI END CAP T25 STRDRV 15MM EX BOTH IP/OP $759.00 $562.00 $135.10 $759.00 $759.00 $759.00 $759.00 $759.00 $759.00 $759.00 $135.10 $759.00 $759.00 $563.33 $563.33 $585.04 $395.44 $158.18 $759.00 $303.60 $759.00 $759.00 $759.00 $759.00 $759.00 $569.25 $759.00 $759.00 $759.00 $379.50 $379.50 $601.13 $759.00 $607.20 $493.35 $759.00 $759.00 $440.22 $759.00 $455.40 $759.00 $759.00 $759.00 N/A N/A 27008138 EAP Custom 27008138 11M TI CAN PROX HUM NL-EX/150M BOTH IP/OP "$7,722.00" "$5,714.50" "$1,374.52" "$7,722.00" "$7,722.00" "$7,722.00" "$7,722.00" "$7,722.00" "$7,722.00" "$7,722.00" "$1,374.52" "$7,722.00" "$7,722.00" "$4,181.12" "$4,181.12" "$5,952.12" "$2,060.15" "$1,609.35" "$7,722.00" "$3,088.80" "$7,722.00" "$7,722.00" "$7,722.00" "$7,722.00" "$7,722.00" "$5,791.50" "$7,722.00" "$7,722.00" "$7,722.00" "$3,861.00" "$3,861.00" "$6,115.82" "$7,722.00" "$6,177.60" "$5,019.30" "$7,722.00" "$7,722.00" "$4,478.76" "$7,722.00" "$4,633.20" "$7,722.00" "$7,722.00" "$7,722.00" N/A N/A 27008139 EAP Custom 27008139 11M TI CAN HUM NAIL-EX/190-320 BOTH IP/OP "$7,722.00" "$5,714.50" "$1,374.52" "$7,722.00" "$7,722.00" "$7,722.00" "$7,722.00" "$7,722.00" "$7,722.00" "$7,722.00" "$1,374.52" "$7,722.00" "$7,722.00" "$4,181.12" "$4,181.12" "$5,952.12" "$2,060.15" "$1,609.35" "$7,722.00" "$3,088.80" "$7,722.00" "$7,722.00" "$7,722.00" "$7,722.00" "$7,722.00" "$5,791.50" "$7,722.00" "$7,722.00" "$7,722.00" "$3,861.00" "$3,861.00" "$6,115.82" "$7,722.00" "$6,177.60" "$5,019.30" "$7,722.00" "$7,722.00" "$4,478.76" "$7,722.00" "$4,633.20" "$7,722.00" "$7,722.00" "$7,722.00" N/A N/A 27008140 EAP Custom 27008140 TI END CAP T40 SDRV 0MEXT FEM BOTH IP/OP $682.00 $505.00 $121.40 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $121.40 $682.00 $682.00 $506.18 $506.18 $525.69 $355.32 $142.14 $682.00 $272.80 $682.00 $682.00 $682.00 $682.00 $682.00 $511.50 $682.00 $682.00 $682.00 $341.00 $341.00 $540.14 $682.00 $545.60 $443.30 $682.00 $682.00 $395.56 $682.00 $409.20 $682.00 $682.00 $682.00 N/A N/A 27008141 EAP Custom 27008141 TI END CAP T40 SDRV 0MEXT STE BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 27008142 EAP Custom 27008142 12 TI END CAP T40 SDRV 5M EXT BOTH IP/OP $682.00 $505.00 $121.40 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $121.40 $682.00 $682.00 $506.18 $506.18 $525.69 $355.32 $142.14 $682.00 $272.80 $682.00 $682.00 $682.00 $682.00 $682.00 $511.50 $682.00 $682.00 $682.00 $341.00 $341.00 $540.14 $682.00 $545.60 $443.30 $682.00 $682.00 $395.56 $682.00 $409.20 $682.00 $682.00 $682.00 N/A N/A 27008143 EAP Custom 27008143 12 TI END CAP T40 SDRV 5M EXT BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 27008144 EAP Custom 27008144 12 TI END CAP T40 SDRV 10MM EX BOTH IP/OP $682.00 $505.00 $121.40 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $121.40 $682.00 $682.00 $506.18 $506.18 $525.69 $355.32 $142.14 $682.00 $272.80 $682.00 $682.00 $682.00 $682.00 $682.00 $511.50 $682.00 $682.00 $682.00 $341.00 $341.00 $540.14 $682.00 $545.60 $443.30 $682.00 $682.00 $395.56 $682.00 $409.20 $682.00 $682.00 $682.00 N/A N/A 27008145 EAP Custom 27008145 12 TI END CAP T40 SDRV 10MM EX BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 27008146 EAP Custom 27008146 12 TI END CAP T40 SDRV 15MM EX BOTH IP/OP $682.00 $505.00 $121.40 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $121.40 $682.00 $682.00 $506.18 $506.18 $525.69 $355.32 $142.14 $682.00 $272.80 $682.00 $682.00 $682.00 $682.00 $682.00 $511.50 $682.00 $682.00 $682.00 $341.00 $341.00 $540.14 $682.00 $545.60 $443.30 $682.00 $682.00 $395.56 $682.00 $409.20 $682.00 $682.00 $682.00 N/A N/A 27008147 EAP Custom 27008147 12 TI END CAP T40 SDRV 15MM EX BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 27008148 EAP Custom 27008148 12 TI END CAP T40 SDRV 20MM EX BOTH IP/OP $682.00 $505.00 $121.40 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $121.40 $682.00 $682.00 $506.18 $506.18 $525.69 $355.32 $142.14 $682.00 $272.80 $682.00 $682.00 $682.00 $682.00 $682.00 $511.50 $682.00 $682.00 $682.00 $341.00 $341.00 $540.14 $682.00 $545.60 $443.30 $682.00 $682.00 $395.56 $682.00 $409.20 $682.00 $682.00 $682.00 N/A N/A 27008149 EAP Custom 27008149 12 TI END CAP T40 SDRV 20MM EX BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 27008150 EAP Custom 27008150 16 TI END CAP T40 SDRV 5M EXT BOTH IP/OP $682.00 $505.00 $121.40 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $121.40 $682.00 $682.00 $506.18 $506.18 $525.69 $355.32 $142.14 $682.00 $272.80 $682.00 $682.00 $682.00 $682.00 $682.00 $511.50 $682.00 $682.00 $682.00 $341.00 $341.00 $540.14 $682.00 $545.60 $443.30 $682.00 $682.00 $395.56 $682.00 $409.20 $682.00 $682.00 $682.00 N/A N/A 27008151 EAP Custom 27008151 16M TI END CAP T40 SDRV 5M EXT BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 27008152 EAP Custom 27008152 16M TI END CAP T40 SDRV 10MM BOTH IP/OP $682.00 $505.00 $121.40 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $121.40 $682.00 $682.00 $506.18 $506.18 $525.69 $355.32 $142.14 $682.00 $272.80 $682.00 $682.00 $682.00 $682.00 $682.00 $511.50 $682.00 $682.00 $682.00 $341.00 $341.00 $540.14 $682.00 $545.60 $443.30 $682.00 $682.00 $395.56 $682.00 $409.20 $682.00 $682.00 $682.00 N/A N/A 27008153 EAP Custom 27008153 16M TI END CAP T40 SDRV 10MM BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 27008154 EAP Custom 27008154 16M TI END CAP T40 SDRV 15MM BOTH IP/OP $682.00 $505.00 $121.40 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $121.40 $682.00 $682.00 $506.18 $506.18 $525.69 $355.32 $142.14 $682.00 $272.80 $682.00 $682.00 $682.00 $682.00 $682.00 $511.50 $682.00 $682.00 $682.00 $341.00 $341.00 $540.14 $682.00 $545.60 $443.30 $682.00 $682.00 $395.56 $682.00 $409.20 $682.00 $682.00 $682.00 N/A N/A 27008155 EAP Custom 27008155 16M TI END CAP T40 SDRV 15MM BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 27008156 EAP Custom 27008156 16 TI END CAP T40 SDRV 20MM EX BOTH IP/OP $682.00 $505.00 $121.40 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $121.40 $682.00 $682.00 $506.18 $506.18 $525.69 $355.32 $142.14 $682.00 $272.80 $682.00 $682.00 $682.00 $682.00 $682.00 $511.50 $682.00 $682.00 $682.00 $341.00 $341.00 $540.14 $682.00 $545.60 $443.30 $682.00 $682.00 $395.56 $682.00 $409.20 $682.00 $682.00 $682.00 N/A N/A 27008157 EAP Custom 27008157 16 TI END CAP T40 SDRV 20MM EX BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 27008185 EAP Custom 27008185 10TI LAT EN FEM NL-EX/300M-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008186 EAP Custom 27008186 11TI LAT EN FEM NL-EX/300M-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008187 EAP Custom 27008187 11TI LAT EN FEM NL-EX/300M-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008188 EAP Custom 27008188 12 TI LAT EN FEM NL-EX/300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008189 EAP Custom 27008189 12 TI LAT EN FEM NL-EX/300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008190 EAP Custom 27008190 13TI LAT ENT FEM NL-EX/300M480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008191 EAP Custom 27008191 13TI LAT ENT FEM NL-EX/300M480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008192 EAP Custom 27008192 14TI LAT ENT FEM NL-EX/300M480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008193 EAP Custom 27008193 14TI LAT ENT FEM NL-EX/300M480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008194 EAP Custom 27008194 15TI LAT ENT FEM NL-EX/300M480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008195 EAP Custom 27008195 15TI LAT ENT FEM NL-EX/300M480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008196 EAP Custom 27008196 16TI LAT ENT FEM NL-EX/300M480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008197 EAP Custom 27008197 16TI LAT ENT FEM NL-EX/300M480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008198 EAP Custom 27008198 TI EN CP W/T40 SDR 0M EXT F/T BOTH IP/OP $682.00 $505.00 $121.40 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $121.40 $682.00 $682.00 $506.18 $506.18 $525.69 $355.32 $142.14 $682.00 $272.80 $682.00 $682.00 $682.00 $682.00 $682.00 $511.50 $682.00 $682.00 $682.00 $341.00 $341.00 $540.14 $682.00 $545.60 $443.30 $682.00 $682.00 $395.56 $682.00 $409.20 $682.00 $682.00 $682.00 N/A N/A 27008199 EAP Custom 27008199 TI EN CAP W/T40 SDR 0M EXT F/T BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 27008200 EAP Custom 27008200 TI EN CAP W/T40 SDR 5M EXT F/T BOTH IP/OP $882.00 $653.00 $157.00 $882.00 $882.00 $882.00 $882.00 $882.00 $882.00 $882.00 $157.00 $882.00 $882.00 $654.62 $654.62 $679.85 $459.52 $183.82 $882.00 $352.80 $882.00 $882.00 $882.00 $882.00 $882.00 $661.50 $882.00 $882.00 $882.00 $441.00 $441.00 $698.54 $882.00 $705.60 $573.30 $882.00 $882.00 $511.56 $882.00 $529.20 $882.00 $882.00 $882.00 N/A N/A 27008201 EAP Custom 27008201 TI EN CAP W/T40 SDR 5M EXT-STE BOTH IP/OP "$1,010.00" $747.50 $179.78 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $179.78 "$1,010.00" "$1,010.00" $749.62 $749.62 $778.51 $526.21 $210.50 "$1,010.00" $404.00 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $757.50 "$1,010.00" "$1,010.00" "$1,010.00" $505.00 $505.00 $799.92 "$1,010.00" $808.00 $656.50 "$1,010.00" "$1,010.00" $585.80 "$1,010.00" $606.00 "$1,010.00" "$1,010.00" "$1,010.00" N/A N/A 27008202 EAP Custom 27008202 TI EN CAP W/ T40 SDR EXT F/TI BOTH IP/OP $882.00 $653.00 $157.00 $882.00 $882.00 $882.00 $882.00 $882.00 $882.00 $882.00 $157.00 $882.00 $882.00 $654.62 $654.62 $679.85 $459.52 $183.82 $882.00 $352.80 $882.00 $882.00 $882.00 $882.00 $882.00 $661.50 $882.00 $882.00 $882.00 $441.00 $441.00 $698.54 $882.00 $705.60 $573.30 $882.00 $882.00 $511.56 $882.00 $529.20 $882.00 $882.00 $882.00 N/A N/A 27008203 EAP Custom 27008203 TI EN CAP W/T40 SDR 10M EXT-ST BOTH IP/OP "$1,010.00" $747.50 $179.78 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $179.78 "$1,010.00" "$1,010.00" $749.62 $749.62 $778.51 $526.21 $210.50 "$1,010.00" $404.00 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $757.50 "$1,010.00" "$1,010.00" "$1,010.00" $505.00 $505.00 $799.92 "$1,010.00" $808.00 $656.50 "$1,010.00" "$1,010.00" $585.80 "$1,010.00" $606.00 "$1,010.00" "$1,010.00" "$1,010.00" N/A N/A 27008204 EAP Custom 27008204 TI EN CAP W/T40 SDR 15M EXT BOTH IP/OP $882.00 $653.00 $157.00 $882.00 $882.00 $882.00 $882.00 $882.00 $882.00 $882.00 $157.00 $882.00 $882.00 $654.62 $654.62 $679.85 $459.52 $183.82 $882.00 $352.80 $882.00 $882.00 $882.00 $882.00 $882.00 $661.50 $882.00 $882.00 $882.00 $441.00 $441.00 $698.54 $882.00 $705.60 $573.30 $882.00 $882.00 $511.56 $882.00 $529.20 $882.00 $882.00 $882.00 N/A N/A 27008205 EAP Custom 27008205 TI EN CAP W/T40 SDR 15M EXT-ST BOTH IP/OP "$1,010.00" $747.50 $179.78 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $179.78 "$1,010.00" "$1,010.00" $749.62 $749.62 $778.51 $526.21 $210.50 "$1,010.00" $404.00 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $757.50 "$1,010.00" "$1,010.00" "$1,010.00" $505.00 $505.00 $799.92 "$1,010.00" $808.00 $656.50 "$1,010.00" "$1,010.00" $585.80 "$1,010.00" $606.00 "$1,010.00" "$1,010.00" "$1,010.00" N/A N/A 27008206 EAP Custom 27008206 TI EN CAP TIB NL-EX T40 SDR 0M BOTH IP/OP $682.00 $505.00 $121.40 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $121.40 $682.00 $682.00 $506.18 $506.18 $525.69 $355.32 $142.14 $682.00 $272.80 $682.00 $682.00 $682.00 $682.00 $682.00 $511.50 $682.00 $682.00 $682.00 $341.00 $341.00 $540.14 $682.00 $545.60 $443.30 $682.00 $682.00 $395.56 $682.00 $409.20 $682.00 $682.00 $682.00 N/A N/A 27008207 EAP Custom 27008207 TI EN CAP TIB NL-EX T40 SDR 0 BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 27008208 EAP Custom 27008208 TI EN CAP TIB NL-EX T40 SDR 5M BOTH IP/OP $882.00 $653.00 $157.00 $882.00 $882.00 $882.00 $882.00 $882.00 $882.00 $882.00 $157.00 $882.00 $882.00 $654.62 $654.62 $679.85 $459.52 $183.82 $882.00 $352.80 $882.00 $882.00 $882.00 $882.00 $882.00 $661.50 $882.00 $882.00 $882.00 $441.00 $441.00 $698.54 $882.00 $705.60 $573.30 $882.00 $882.00 $511.56 $882.00 $529.20 $882.00 $882.00 $882.00 N/A N/A 27008209 EAP Custom 27008209 TI EN CAP TIB NL-EX T40 SDR 5M BOTH IP/OP "$1,010.00" $747.50 $179.78 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $179.78 "$1,010.00" "$1,010.00" $749.62 $749.62 $778.51 $526.21 $210.50 "$1,010.00" $404.00 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $757.50 "$1,010.00" "$1,010.00" "$1,010.00" $505.00 $505.00 $799.92 "$1,010.00" $808.00 $656.50 "$1,010.00" "$1,010.00" $585.80 "$1,010.00" $606.00 "$1,010.00" "$1,010.00" "$1,010.00" N/A N/A 27008210 EAP Custom 27008210 TI EN CAP TIB NL-EX T40 SDR 10 BOTH IP/OP $882.00 $653.00 $157.00 $882.00 $882.00 $882.00 $882.00 $882.00 $882.00 $882.00 $157.00 $882.00 $882.00 $654.62 $654.62 $679.85 $459.52 $183.82 $882.00 $352.80 $882.00 $882.00 $882.00 $882.00 $882.00 $661.50 $882.00 $882.00 $882.00 $441.00 $441.00 $698.54 $882.00 $705.60 $573.30 $882.00 $882.00 $511.56 $882.00 $529.20 $882.00 $882.00 $882.00 N/A N/A 27008211 EAP Custom 27008211 TI EN CAP TIB NL-EX T40 SDR 10 BOTH IP/OP "$1,010.00" $747.50 $179.78 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $179.78 "$1,010.00" "$1,010.00" $749.62 $749.62 $778.51 $526.21 $210.50 "$1,010.00" $404.00 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $757.50 "$1,010.00" "$1,010.00" "$1,010.00" $505.00 $505.00 $799.92 "$1,010.00" $808.00 $656.50 "$1,010.00" "$1,010.00" $585.80 "$1,010.00" $606.00 "$1,010.00" "$1,010.00" "$1,010.00" N/A N/A 27008212 EAP Custom 27008212 TI EN CAP TIB NL-EX T40 SDR 15 BOTH IP/OP $882.00 $653.00 $157.00 $882.00 $882.00 $882.00 $882.00 $882.00 $882.00 $882.00 $157.00 $882.00 $882.00 $654.62 $654.62 $679.85 $459.52 $183.82 $882.00 $352.80 $882.00 $882.00 $882.00 $882.00 $882.00 $661.50 $882.00 $882.00 $882.00 $441.00 $441.00 $698.54 $882.00 $705.60 $573.30 $882.00 $882.00 $511.56 $882.00 $529.20 $882.00 $882.00 $882.00 N/A N/A 27008213 EAP Custom 27008213 TI EN CAP TIB NL-EX T40 SDR 15 BOTH IP/OP "$1,010.00" $747.50 $179.78 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $179.78 "$1,010.00" "$1,010.00" $749.62 $749.62 $778.51 $526.21 $210.50 "$1,010.00" $404.00 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $757.50 "$1,010.00" "$1,010.00" "$1,010.00" $505.00 $505.00 $799.92 "$1,010.00" $808.00 $656.50 "$1,010.00" "$1,010.00" $585.80 "$1,010.00" $606.00 "$1,010.00" "$1,010.00" "$1,010.00" N/A N/A 27008216 EAP Custom 27008216 10M TI CAN TIB NL-EX/255-435MM BOTH IP/OP "$6,110.00" "$4,521.50" "$1,087.58" "$6,110.00" "$6,110.00" "$6,110.00" "$6,110.00" "$6,110.00" "$6,110.00" "$6,110.00" "$1,087.58" "$6,110.00" "$6,110.00" "$4,181.12" "$4,181.12" "$4,709.59" "$2,060.15" "$1,273.39" "$6,110.00" "$2,444.00" "$6,110.00" "$6,110.00" "$6,110.00" "$6,110.00" "$6,110.00" "$4,582.50" "$6,110.00" "$6,110.00" "$6,110.00" "$3,055.00" "$3,055.00" "$4,839.12" "$6,110.00" "$4,888.00" "$3,971.50" "$6,110.00" "$6,110.00" "$3,543.80" "$6,110.00" "$3,666.00" "$6,110.00" "$6,110.00" "$6,110.00" N/A N/A 27008217 EAP Custom 27008217 12M TI CAN TIB NL-EX/255-435MM BOTH IP/OP "$6,110.00" "$4,521.50" "$1,087.58" "$6,110.00" "$6,110.00" "$6,110.00" "$6,110.00" "$6,110.00" "$6,110.00" "$6,110.00" "$1,087.58" "$6,110.00" "$6,110.00" "$4,181.12" "$4,181.12" "$4,709.59" "$2,060.15" "$1,273.39" "$6,110.00" "$2,444.00" "$6,110.00" "$6,110.00" "$6,110.00" "$6,110.00" "$6,110.00" "$4,582.50" "$6,110.00" "$6,110.00" "$6,110.00" "$3,055.00" "$3,055.00" "$4,839.12" "$6,110.00" "$4,888.00" "$3,971.50" "$6,110.00" "$6,110.00" "$3,543.80" "$6,110.00" "$3,666.00" "$6,110.00" "$6,110.00" "$6,110.00" N/A N/A 27008219 EAP Custom 27008219 TI EN CAP T25 SDR HNDFT ART NL BOTH IP/OP $712.00 $527.00 $126.74 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $126.74 $712.00 $712.00 $528.45 $528.45 $548.81 $370.95 $148.39 $712.00 $284.80 $712.00 $712.00 $712.00 $712.00 $712.00 $534.00 $712.00 $712.00 $712.00 $356.00 $356.00 $563.90 $712.00 $569.60 $462.80 $712.00 $712.00 $412.96 $712.00 $427.20 $712.00 $712.00 $712.00 N/A N/A 27008220 EAP Custom 27008220 TI EN CAP T25 SDR HNDFT ART NL BOTH IP/OP $842.00 $623.50 $149.88 $842.00 $842.00 $842.00 $842.00 $842.00 $842.00 $842.00 $149.88 $842.00 $842.00 $624.93 $624.93 $649.01 $438.68 $175.48 $842.00 $336.80 $842.00 $842.00 $842.00 $842.00 $842.00 $631.50 $842.00 $842.00 $842.00 $421.00 $421.00 $666.86 $842.00 $673.60 $547.30 $842.00 $842.00 $488.36 $842.00 $505.20 $842.00 $842.00 $842.00 N/A N/A 27008221 EAP Custom 27008221 TI EN CAP T25 SDR HNDFT ART NL BOTH IP/OP $712.00 $527.00 $126.74 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $712.00 $126.74 $712.00 $712.00 $528.45 $528.45 $548.81 $370.95 $148.39 $712.00 $284.80 $712.00 $712.00 $712.00 $712.00 $712.00 $534.00 $712.00 $712.00 $712.00 $356.00 $356.00 $563.90 $712.00 $569.60 $462.80 $712.00 $712.00 $412.96 $712.00 $427.20 $712.00 $712.00 $712.00 N/A N/A 27008222 EAP Custom 27008222 TI EN CAP T25 SDR HNDFT ART NL BOTH IP/OP $842.00 $623.50 $149.88 $842.00 $842.00 $842.00 $842.00 $842.00 $842.00 $842.00 $149.88 $842.00 $842.00 $624.93 $624.93 $649.01 $438.68 $175.48 $842.00 $336.80 $842.00 $842.00 $842.00 $842.00 $842.00 $631.50 $842.00 $842.00 $842.00 $421.00 $421.00 $666.86 $842.00 $673.60 $547.30 $842.00 $842.00 $488.36 $842.00 $505.20 $842.00 $842.00 $842.00 N/A N/A 27008223 EAP Custom 27008223 10TI HFT ART CAN NL-EX150-240M BOTH IP/OP "$6,453.00" "$4,775.50" "$1,148.63" "$6,453.00" "$6,453.00" "$6,453.00" "$6,453.00" "$6,453.00" "$6,453.00" "$6,453.00" "$1,148.63" "$6,453.00" "$6,453.00" "$4,181.12" "$4,181.12" "$4,973.97" "$2,060.15" "$1,344.88" "$6,453.00" "$2,581.20" "$6,453.00" "$6,453.00" "$6,453.00" "$6,453.00" "$6,453.00" "$4,839.75" "$6,453.00" "$6,453.00" "$6,453.00" "$3,226.50" "$3,226.50" "$5,110.78" "$6,453.00" "$5,162.40" "$4,194.45" "$6,453.00" "$6,453.00" "$3,742.74" "$6,453.00" "$3,871.80" "$6,453.00" "$6,453.00" "$6,453.00" N/A N/A 27008224 EAP Custom 27008224 TI EN CAP T40 SDR 0M EXT RETR BOTH IP/OP $682.00 $505.00 $121.40 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $682.00 $121.40 $682.00 $682.00 $506.18 $506.18 $525.69 $355.32 $142.14 $682.00 $272.80 $682.00 $682.00 $682.00 $682.00 $682.00 $511.50 $682.00 $682.00 $682.00 $341.00 $341.00 $540.14 $682.00 $545.60 $443.30 $682.00 $682.00 $395.56 $682.00 $409.20 $682.00 $682.00 $682.00 N/A N/A 27008225 EAP Custom 27008225 TI SPIR BLD 45M TI RETR FEM NL BOTH IP/OP "$2,318.00" "$1,715.50" $412.60 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" $412.60 "$2,318.00" "$2,318.00" "$1,720.42" "$1,720.42" "$1,786.71" "$1,207.68" $483.10 "$2,318.00" $927.20 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$1,738.50" "$2,318.00" "$2,318.00" "$2,318.00" "$1,159.00" "$1,159.00" "$1,835.86" "$2,318.00" "$1,854.40" "$1,506.70" "$2,318.00" "$2,318.00" "$1,344.44" "$2,318.00" "$1,390.80" "$2,318.00" "$2,318.00" "$2,318.00" N/A N/A 27008226 EAP Custom 27008226 TI SPIR BLD 50M TI RETR FEM NL BOTH IP/OP "$2,318.00" "$1,715.50" $412.60 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" $412.60 "$2,318.00" "$2,318.00" "$1,720.42" "$1,720.42" "$1,786.71" "$1,207.68" $483.10 "$2,318.00" $927.20 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$1,738.50" "$2,318.00" "$2,318.00" "$2,318.00" "$1,159.00" "$1,159.00" "$1,835.86" "$2,318.00" "$1,854.40" "$1,506.70" "$2,318.00" "$2,318.00" "$1,344.44" "$2,318.00" "$1,390.80" "$2,318.00" "$2,318.00" "$2,318.00" N/A N/A 27008227 EAP Custom 27008227 TI SPIR BLD 50M-STER F/TI RETR BOTH IP/OP "$2,447.00" "$1,811.00" $435.57 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" $435.57 "$2,447.00" "$2,447.00" "$1,816.16" "$1,816.16" "$1,886.15" "$1,274.89" $509.98 "$2,447.00" $978.80 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$1,835.25" "$2,447.00" "$2,447.00" "$2,447.00" "$1,223.50" "$1,223.50" "$1,938.02" "$2,447.00" "$1,957.60" "$1,590.55" "$2,447.00" "$2,447.00" "$1,419.26" "$2,447.00" "$1,468.20" "$2,447.00" "$2,447.00" "$2,447.00" N/A N/A 27008228 EAP Custom 27008228 TI SPIR BLD 55M TI RETR FEM BOTH IP/OP "$2,318.00" "$1,715.50" $412.60 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" $412.60 "$2,318.00" "$2,318.00" "$1,720.42" "$1,720.42" "$1,786.71" "$1,207.68" $483.10 "$2,318.00" $927.20 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$1,738.50" "$2,318.00" "$2,318.00" "$2,318.00" "$1,159.00" "$1,159.00" "$1,835.86" "$2,318.00" "$1,854.40" "$1,506.70" "$2,318.00" "$2,318.00" "$1,344.44" "$2,318.00" "$1,390.80" "$2,318.00" "$2,318.00" "$2,318.00" N/A N/A 27008229 EAP Custom 27008229 TI SPIR BLD 55M-STER F/TI RETR BOTH IP/OP "$2,447.00" "$1,811.00" $435.57 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" $435.57 "$2,447.00" "$2,447.00" "$1,816.16" "$1,816.16" "$1,886.15" "$1,274.89" $509.98 "$2,447.00" $978.80 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$1,835.25" "$2,447.00" "$2,447.00" "$2,447.00" "$1,223.50" "$1,223.50" "$1,938.02" "$2,447.00" "$1,957.60" "$1,590.55" "$2,447.00" "$2,447.00" "$1,419.26" "$2,447.00" "$1,468.20" "$2,447.00" "$2,447.00" "$2,447.00" N/A N/A 27008230 EAP Custom 27008230 TI SPIR BLD 65M TI RETR FEM NL BOTH IP/OP "$2,318.00" "$1,715.50" $412.60 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" $412.60 "$2,318.00" "$2,318.00" "$1,720.42" "$1,720.42" "$1,786.71" "$1,207.68" $483.10 "$2,318.00" $927.20 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$1,738.50" "$2,318.00" "$2,318.00" "$2,318.00" "$1,159.00" "$1,159.00" "$1,835.86" "$2,318.00" "$1,854.40" "$1,506.70" "$2,318.00" "$2,318.00" "$1,344.44" "$2,318.00" "$1,390.80" "$2,318.00" "$2,318.00" "$2,318.00" N/A N/A 27008231 EAP Custom 27008231 TI SPIR BLD 65F/TI RET FEM NLS BOTH IP/OP "$2,447.00" "$1,811.00" $435.57 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" $435.57 "$2,447.00" "$2,447.00" "$1,816.16" "$1,816.16" "$1,886.15" "$1,274.89" $509.98 "$2,447.00" $978.80 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$1,835.25" "$2,447.00" "$2,447.00" "$2,447.00" "$1,223.50" "$1,223.50" "$1,938.02" "$2,447.00" "$1,957.60" "$1,590.55" "$2,447.00" "$2,447.00" "$1,419.26" "$2,447.00" "$1,468.20" "$2,447.00" "$2,447.00" "$2,447.00" N/A N/A 27008232 EAP Custom 27008232 TI SPIR BLD 70M TI RETR FEM NL BOTH IP/OP "$2,318.00" "$1,715.50" $412.60 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" $412.60 "$2,318.00" "$2,318.00" "$1,720.42" "$1,720.42" "$1,786.71" "$1,207.68" $483.10 "$2,318.00" $927.20 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$1,738.50" "$2,318.00" "$2,318.00" "$2,318.00" "$1,159.00" "$1,159.00" "$1,835.86" "$2,318.00" "$1,854.40" "$1,506.70" "$2,318.00" "$2,318.00" "$1,344.44" "$2,318.00" "$1,390.80" "$2,318.00" "$2,318.00" "$2,318.00" N/A N/A 27008233 EAP Custom 27008233 TI SPIR BLD 70M F/TI RETR FEM BOTH IP/OP "$2,447.00" "$1,811.00" $435.57 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" $435.57 "$2,447.00" "$2,447.00" "$1,816.16" "$1,816.16" "$1,886.15" "$1,274.89" $509.98 "$2,447.00" $978.80 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$1,835.25" "$2,447.00" "$2,447.00" "$2,447.00" "$1,223.50" "$1,223.50" "$1,938.02" "$2,447.00" "$1,957.60" "$1,590.55" "$2,447.00" "$2,447.00" "$1,419.26" "$2,447.00" "$1,468.20" "$2,447.00" "$2,447.00" "$2,447.00" N/A N/A 27008234 EAP Custom 27008234 TI SPIR BLD 75M TI RETR FEM NL BOTH IP/OP "$2,318.00" "$1,715.50" $412.60 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" $412.60 "$2,318.00" "$2,318.00" "$1,720.42" "$1,720.42" "$1,786.71" "$1,207.68" $483.10 "$2,318.00" $927.20 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$1,738.50" "$2,318.00" "$2,318.00" "$2,318.00" "$1,159.00" "$1,159.00" "$1,835.86" "$2,318.00" "$1,854.40" "$1,506.70" "$2,318.00" "$2,318.00" "$1,344.44" "$2,318.00" "$1,390.80" "$2,318.00" "$2,318.00" "$2,318.00" N/A N/A 27008235 EAP Custom 27008235 TI SPIR BLD 75 F/TI RET FEM NL BOTH IP/OP "$2,447.00" "$1,811.00" $435.57 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" $435.57 "$2,447.00" "$2,447.00" "$1,816.16" "$1,816.16" "$1,886.15" "$1,274.89" $509.98 "$2,447.00" $978.80 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$1,835.25" "$2,447.00" "$2,447.00" "$2,447.00" "$1,223.50" "$1,223.50" "$1,938.02" "$2,447.00" "$1,957.60" "$1,590.55" "$2,447.00" "$2,447.00" "$1,419.26" "$2,447.00" "$1,468.20" "$2,447.00" "$2,447.00" "$2,447.00" N/A N/A 27008236 EAP Custom 27008236 TI SPIR BLD 80M TI RETR FEM NL BOTH IP/OP "$2,318.00" "$1,715.50" $412.60 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" $412.60 "$2,318.00" "$2,318.00" "$1,720.42" "$1,720.42" "$1,786.71" "$1,207.68" $483.10 "$2,318.00" $927.20 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$1,738.50" "$2,318.00" "$2,318.00" "$2,318.00" "$1,159.00" "$1,159.00" "$1,835.86" "$2,318.00" "$1,854.40" "$1,506.70" "$2,318.00" "$2,318.00" "$1,344.44" "$2,318.00" "$1,390.80" "$2,318.00" "$2,318.00" "$2,318.00" N/A N/A 27008237 EAP Custom 27008237 TI SPIR BLD 80 F/TI RET FEM NL BOTH IP/OP "$2,447.00" "$1,811.00" $435.57 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" $435.57 "$2,447.00" "$2,447.00" "$1,816.16" "$1,816.16" "$1,886.15" "$1,274.89" $509.98 "$2,447.00" $978.80 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$1,835.25" "$2,447.00" "$2,447.00" "$2,447.00" "$1,223.50" "$1,223.50" "$1,938.02" "$2,447.00" "$1,957.60" "$1,590.55" "$2,447.00" "$2,447.00" "$1,419.26" "$2,447.00" "$1,468.20" "$2,447.00" "$2,447.00" "$2,447.00" N/A N/A 27008238 EAP Custom 27008238 TI SPIR BLD 85 TI RETR FEM NL BOTH IP/OP "$2,318.00" "$1,715.50" $412.60 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" $412.60 "$2,318.00" "$2,318.00" "$1,720.42" "$1,720.42" "$1,786.71" "$1,207.68" $483.10 "$2,318.00" $927.20 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$1,738.50" "$2,318.00" "$2,318.00" "$2,318.00" "$1,159.00" "$1,159.00" "$1,835.86" "$2,318.00" "$1,854.40" "$1,506.70" "$2,318.00" "$2,318.00" "$1,344.44" "$2,318.00" "$1,390.80" "$2,318.00" "$2,318.00" "$2,318.00" N/A N/A 27008239 EAP Custom 27008239 TI SPIR BLD 85M F/TI RETR FEM BOTH IP/OP "$2,447.00" "$1,811.00" $435.57 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" $435.57 "$2,447.00" "$2,447.00" "$1,816.16" "$1,816.16" "$1,886.15" "$1,274.89" $509.98 "$2,447.00" $978.80 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$1,835.25" "$2,447.00" "$2,447.00" "$2,447.00" "$1,223.50" "$1,223.50" "$1,938.02" "$2,447.00" "$1,957.60" "$1,590.55" "$2,447.00" "$2,447.00" "$1,419.26" "$2,447.00" "$1,468.20" "$2,447.00" "$2,447.00" "$2,447.00" N/A N/A 27008240 EAP Custom 27008240 TI SPIR BLD 90M TI RETR FEM NL BOTH IP/OP "$2,318.00" "$1,715.50" $412.60 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" $412.60 "$2,318.00" "$2,318.00" "$1,720.42" "$1,720.42" "$1,786.71" "$1,207.68" $483.10 "$2,318.00" $927.20 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$1,738.50" "$2,318.00" "$2,318.00" "$2,318.00" "$1,159.00" "$1,159.00" "$1,835.86" "$2,318.00" "$1,854.40" "$1,506.70" "$2,318.00" "$2,318.00" "$1,344.44" "$2,318.00" "$1,390.80" "$2,318.00" "$2,318.00" "$2,318.00" N/A N/A 27008241 EAP Custom 27008241 TI SPIR BLD 90M F/TI RETR FEM BOTH IP/OP "$2,447.00" "$1,811.00" $435.57 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" $435.57 "$2,447.00" "$2,447.00" "$1,816.16" "$1,816.16" "$1,886.15" "$1,274.89" $509.98 "$2,447.00" $978.80 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$1,835.25" "$2,447.00" "$2,447.00" "$2,447.00" "$1,223.50" "$1,223.50" "$1,938.02" "$2,447.00" "$1,957.60" "$1,590.55" "$2,447.00" "$2,447.00" "$1,419.26" "$2,447.00" "$1,468.20" "$2,447.00" "$2,447.00" "$2,447.00" N/A N/A 27008242 EAP Custom 27008242 TI SPIR BLD 95M TI RETR FEM NL BOTH IP/OP "$2,318.00" "$1,715.50" $412.60 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" $412.60 "$2,318.00" "$2,318.00" "$1,720.42" "$1,720.42" "$1,786.71" "$1,207.68" $483.10 "$2,318.00" $927.20 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$1,738.50" "$2,318.00" "$2,318.00" "$2,318.00" "$1,159.00" "$1,159.00" "$1,835.86" "$2,318.00" "$1,854.40" "$1,506.70" "$2,318.00" "$2,318.00" "$1,344.44" "$2,318.00" "$1,390.80" "$2,318.00" "$2,318.00" "$2,318.00" N/A N/A 27008243 EAP Custom 27008243 TI SPIR BLD 100M TI RETR FEM BOTH IP/OP "$2,318.00" "$1,715.50" $412.60 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" $412.60 "$2,318.00" "$2,318.00" "$1,720.42" "$1,720.42" "$1,786.71" "$1,207.68" $483.10 "$2,318.00" $927.20 "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$2,318.00" "$1,738.50" "$2,318.00" "$2,318.00" "$2,318.00" "$1,159.00" "$1,159.00" "$1,835.86" "$2,318.00" "$1,854.40" "$1,506.70" "$2,318.00" "$2,318.00" "$1,344.44" "$2,318.00" "$1,390.80" "$2,318.00" "$2,318.00" "$2,318.00" N/A N/A 27008244 EAP Custom 27008244 TI SPIR BLD 100M-ST F/TI RET BOTH IP/OP "$2,447.00" "$1,811.00" $435.57 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" $435.57 "$2,447.00" "$2,447.00" "$1,816.16" "$1,816.16" "$1,886.15" "$1,274.89" $509.98 "$2,447.00" $978.80 "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$2,447.00" "$1,835.25" "$2,447.00" "$2,447.00" "$2,447.00" "$1,223.50" "$1,223.50" "$1,938.02" "$2,447.00" "$1,957.60" "$1,590.55" "$2,447.00" "$2,447.00" "$1,419.26" "$2,447.00" "$1,468.20" "$2,447.00" "$2,447.00" "$2,447.00" N/A N/A 27008247 EAP Custom 27008247 10TI CAN RET FEM NL-EX/160-280 BOTH IP/OP "$6,897.00" "$5,104.00" "$1,227.67" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$1,227.67" "$6,897.00" "$6,897.00" "$4,181.12" "$4,181.12" "$5,316.21" "$2,060.15" "$1,437.41" "$6,897.00" "$2,758.80" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$5,172.75" "$6,897.00" "$6,897.00" "$6,897.00" "$3,448.50" "$3,448.50" "$5,462.42" "$6,897.00" "$5,517.60" "$4,483.05" "$6,897.00" "$6,897.00" "$4,000.26" "$6,897.00" "$4,138.20" "$6,897.00" "$6,897.00" "$6,897.00" N/A N/A 27008248 EAP Custom 27008248 10TI CAN RET/ANT FEM NL300-480 BOTH IP/OP "$6,897.00" "$5,104.00" "$1,227.67" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$1,227.67" "$6,897.00" "$6,897.00" "$4,181.12" "$4,181.12" "$5,316.21" "$2,060.15" "$1,437.41" "$6,897.00" "$2,758.80" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$5,172.75" "$6,897.00" "$6,897.00" "$6,897.00" "$3,448.50" "$3,448.50" "$5,462.42" "$6,897.00" "$5,517.60" "$4,483.05" "$6,897.00" "$6,897.00" "$4,000.26" "$6,897.00" "$4,138.20" "$6,897.00" "$6,897.00" "$6,897.00" N/A N/A 27008249 EAP Custom 27008249 11TI CAN RET FEM NL-EX/160-280 BOTH IP/OP "$6,897.00" "$5,104.00" "$1,227.67" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$1,227.67" "$6,897.00" "$6,897.00" "$4,181.12" "$4,181.12" "$5,316.21" "$2,060.15" "$1,437.41" "$6,897.00" "$2,758.80" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$5,172.75" "$6,897.00" "$6,897.00" "$6,897.00" "$3,448.50" "$3,448.50" "$5,462.42" "$6,897.00" "$5,517.60" "$4,483.05" "$6,897.00" "$6,897.00" "$4,000.26" "$6,897.00" "$4,138.20" "$6,897.00" "$6,897.00" "$6,897.00" N/A N/A 27008250 EAP Custom 27008250 12MMTI CAN RETR FEM NL 160-280 BOTH IP/OP "$6,897.00" "$5,104.00" "$1,227.67" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$1,227.67" "$6,897.00" "$6,897.00" "$4,181.12" "$4,181.12" "$5,316.21" "$2,060.15" "$1,437.41" "$6,897.00" "$2,758.80" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$5,172.75" "$6,897.00" "$6,897.00" "$6,897.00" "$3,448.50" "$3,448.50" "$5,462.42" "$6,897.00" "$5,517.60" "$4,483.05" "$6,897.00" "$6,897.00" "$4,000.26" "$6,897.00" "$4,138.20" "$6,897.00" "$6,897.00" "$6,897.00" N/A N/A 27008251 EAP Custom 27008251 13TI CAN RETR FEM NL-EX160-280 BOTH IP/OP "$6,897.00" "$5,104.00" "$1,227.67" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$1,227.67" "$6,897.00" "$6,897.00" "$4,181.12" "$4,181.12" "$5,316.21" "$2,060.15" "$1,437.41" "$6,897.00" "$2,758.80" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$5,172.75" "$6,897.00" "$6,897.00" "$6,897.00" "$3,448.50" "$3,448.50" "$5,462.42" "$6,897.00" "$5,517.60" "$4,483.05" "$6,897.00" "$6,897.00" "$4,000.26" "$6,897.00" "$4,138.20" "$6,897.00" "$6,897.00" "$6,897.00" N/A N/A 27008252 EAP Custom 27008252 13TI CAN RET/ANT FEM NL300-480 BOTH IP/OP "$6,897.00" "$5,104.00" "$1,227.67" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$1,227.67" "$6,897.00" "$6,897.00" "$4,181.12" "$4,181.12" "$5,316.21" "$2,060.15" "$1,437.41" "$6,897.00" "$2,758.80" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$5,172.75" "$6,897.00" "$6,897.00" "$6,897.00" "$3,448.50" "$3,448.50" "$5,462.42" "$6,897.00" "$5,517.60" "$4,483.05" "$6,897.00" "$6,897.00" "$4,000.26" "$6,897.00" "$4,138.20" "$6,897.00" "$6,897.00" "$6,897.00" N/A N/A 27008253 EAP Custom 27008253 14TI CAN RETR FEM NL-EX160-280 BOTH IP/OP "$6,897.00" "$5,104.00" "$1,227.67" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$1,227.67" "$6,897.00" "$6,897.00" "$4,181.12" "$4,181.12" "$5,316.21" "$2,060.15" "$1,437.41" "$6,897.00" "$2,758.80" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$5,172.75" "$6,897.00" "$6,897.00" "$6,897.00" "$3,448.50" "$3,448.50" "$5,462.42" "$6,897.00" "$5,517.60" "$4,483.05" "$6,897.00" "$6,897.00" "$4,000.26" "$6,897.00" "$4,138.20" "$6,897.00" "$6,897.00" "$6,897.00" N/A N/A 27008254 EAP Custom 27008254 14TI CAN RET/ANT FEM NL300-480 BOTH IP/OP "$6,897.00" "$5,104.00" "$1,227.67" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$1,227.67" "$6,897.00" "$6,897.00" "$4,181.12" "$4,181.12" "$5,316.21" "$2,060.15" "$1,437.41" "$6,897.00" "$2,758.80" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$5,172.75" "$6,897.00" "$6,897.00" "$6,897.00" "$3,448.50" "$3,448.50" "$5,462.42" "$6,897.00" "$5,517.60" "$4,483.05" "$6,897.00" "$6,897.00" "$4,000.26" "$6,897.00" "$4,138.20" "$6,897.00" "$6,897.00" "$6,897.00" N/A N/A 27008255 EAP Custom 27008255 15TI CAN RETR FEM NL-160-280MM BOTH IP/OP "$6,897.00" "$5,104.00" "$1,227.67" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$1,227.67" "$6,897.00" "$6,897.00" "$4,181.12" "$4,181.12" "$5,316.21" "$2,060.15" "$1,437.41" "$6,897.00" "$2,758.80" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$5,172.75" "$6,897.00" "$6,897.00" "$6,897.00" "$3,448.50" "$3,448.50" "$5,462.42" "$6,897.00" "$5,517.60" "$4,483.05" "$6,897.00" "$6,897.00" "$4,000.26" "$6,897.00" "$4,138.20" "$6,897.00" "$6,897.00" "$6,897.00" N/A N/A 27008256 EAP Custom 27008256 15TI CAN RET/ANT FEM NL300-480 BOTH IP/OP "$6,897.00" "$5,104.00" "$1,227.67" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$1,227.67" "$6,897.00" "$6,897.00" "$4,181.12" "$4,181.12" "$5,316.21" "$2,060.15" "$1,437.41" "$6,897.00" "$2,758.80" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$6,897.00" "$5,172.75" "$6,897.00" "$6,897.00" "$6,897.00" "$3,448.50" "$3,448.50" "$5,462.42" "$6,897.00" "$5,517.60" "$4,483.05" "$6,897.00" "$6,897.00" "$4,000.26" "$6,897.00" "$4,138.20" "$6,897.00" "$6,897.00" "$6,897.00" N/A N/A 27008258 EAP Custom 27008258 10TI CAN LAT ENT FEM NL300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008259 EAP Custom 27008259 10TI CAN LAT ENT FEM NL300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008260 EAP Custom 27008260 11TI CAN LAT ENT FEM NL300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008261 EAP Custom 27008261 12TI CAN LAT ENT FEM NL300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008262 EAP Custom 27008262 12TI CAN LAT ENT FEM NL300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008263 EAP Custom 27008263 13TI CAN LAT ENT FEM NL300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008264 EAP Custom 27008264 13TI CAN LAT ENT FEM NL300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008265 EAP Custom 27008265 14TI CAN LAT ENT FEM NL300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008266 EAP Custom 27008266 14TI CAN LAT ENT FEM NL300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008267 EAP Custom 27008267 15TI CAN LAT ENT FEM NL300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008268 EAP Custom 27008268 15TI CAN LAT ENT FEM NL300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008269 EAP Custom 27008269 16TI CAN LAT ENT FEM NL300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008270 EAP Custom 27008270 16TI CAN LAT ENT FEM NL300-480 BOTH IP/OP "$6,829.00" "$5,053.50" "$1,215.56" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$1,215.56" "$6,829.00" "$6,829.00" "$4,181.12" "$4,181.12" "$5,263.79" "$2,060.15" "$1,423.24" "$6,829.00" "$2,731.60" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$6,829.00" "$5,121.75" "$6,829.00" "$6,829.00" "$6,829.00" "$3,414.50" "$3,414.50" "$5,408.57" "$6,829.00" "$5,463.20" "$4,438.85" "$6,829.00" "$6,829.00" "$3,960.82" "$6,829.00" "$4,097.40" "$6,829.00" "$6,829.00" "$6,829.00" N/A N/A 27008275 EAP Custom 27008275 T15/2.5M HEX TI CERCLAGE BUTTN BOTH IP/OP $652.00 $482.50 $116.06 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $116.06 $652.00 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $652.00 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $652.00 $652.00 $378.16 $652.00 $391.20 $652.00 $652.00 $652.00 N/A N/A 27008276 EAP Custom 27008276 T25/3.5M HEX TI CERCLAGE BUTTN BOTH IP/OP $652.00 $482.50 $116.06 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $116.06 $652.00 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $652.00 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $652.00 $652.00 $378.16 $652.00 $391.20 $652.00 $652.00 $652.00 N/A N/A 27008281 EAP Custom 27008281 SAW BLD 95X19 0.89M CUT THKNES BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008282 EAP Custom 27008282 SAW BLD 95X19 1.19M CUT THKNES BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008283 EAP Custom 27008283 SAW BLD 95X19 1.27M CUT THKNES BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008284 EAP Custom 27008284 SAW BLD 95X19 1.37M CUT THKNES BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008285 EAP Custom 27008285 SAW BLD 95X 19 1.47 CUT THKNES BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008286 EAP Custom 27008286 SAW BLD 80X19 0.89 CUT THKNESS BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008287 EAP Custom 27008287 SAW BLD 95X19 1.00 CUT THKNESS BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008288 EAP Custom 27008288 SAW BLD 95 X 19 1.07CUT THKNES BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008289 EAP Custom 27008289 SAW BLD 95X25 0.89 CUT THKNESS BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008290 EAP Custom 27008290 SAW BLD 95X25 1.19 CUT THCKNES BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008291 EAP Custom 27008291 SAW BLD 95X25 1.27 CUT THCKNES BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008292 EAP Custom 27008292 SAW BLD 95X25 1.37 CUT THCKNES BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008293 EAP Custom 27008293 SAW BLD 95X25 1.47CUT THCKNESS BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008294 EAP Custom 27008294 SAW BLADE 95MM X 25MM 1.00MM BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008295 EAP Custom 27008295 SAW BLADE 95MM X 25MM 1.07MM BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008296 EAP Custom 27008296 SAW BLADE 90MM X 12.5MM 0.89M BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008297 EAP Custom 27008297 SAW BLADE 90MM X 12.5MM 1.19M BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008298 EAP Custom 27008298 SAW BLADE 90MM X 12.5MM 1.27M BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008299 EAP Custom 27008299 SAW BLADE 90MM X 12.5MM 1.37M BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008300 EAP Custom 27008300 SAW BLADE 90MM X 12.5MM 1.47M BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008301 EAP Custom 27008301 SAW BLADE 90M X 19-12.5M 0.89M BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008302 EAP Custom 27008302 SAW BLADE 90M X19-12.5MM 1.19M BOTH IP/OP $328.00 $243.00 $58.38 $328.00 $328.00 $328.00 $328.00 $328.00 $328.00 $328.00 $58.38 $328.00 $328.00 $243.44 $243.44 $252.82 $170.89 $68.36 $328.00 $131.20 $328.00 $328.00 $328.00 $328.00 $328.00 $246.00 $328.00 $328.00 $328.00 $164.00 $164.00 $259.78 $328.00 $262.40 $213.20 $328.00 $328.00 $190.24 $328.00 $196.80 $328.00 $328.00 $328.00 N/A N/A 27008303 EAP Custom 27008303 SAW BLADE 90MX19-12.5MM 1.27M BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008304 EAP Custom 27008304 SAW BLADE 90M X19-12.5M 1.37M BOTH IP/OP $310.00 $229.50 $55.18 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $55.18 $310.00 $310.00 $230.08 $230.08 $238.95 $161.51 $64.61 $310.00 $124.00 $310.00 $310.00 $310.00 $310.00 $310.00 $232.50 $310.00 $310.00 $310.00 $155.00 $155.00 $245.52 $310.00 $248.00 $201.50 $310.00 $310.00 $179.80 $310.00 $186.00 $310.00 $310.00 $310.00 N/A N/A 27008305 EAP Custom 27008305 SAW BLADE 90MX19-12.5MM 1.47M BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008306 EAP Custom 27008306 SAW BLADE 90MX19-12.5MM 1.00M BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008307 EAP Custom 27008307 SAW BLADE 90MM X 12.5MM 1.00M BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008308 EAP Custom 27008308 SAW BLADE 60MM X 25MM 0.89MM BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008309 EAP Custom 27008309 PLAN&REDUCT TECH IN FX SURGERY BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $579.66 $579.66 $601.99 $406.90 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $507.65 $781.00 $781.00 $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A 27008312 EAP Custom 27008312 THE RATIONAL OPERATIVE FX CARE BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $579.66 $579.66 $601.99 $406.90 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $507.65 $781.00 $781.00 $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A 27008316 EAP Custom 27008316 MINIMAX FRACTURE FIXATION BOTH IP/OP $630.00 $466.50 $112.14 $630.00 $630.00 $630.00 $630.00 $630.00 $630.00 $630.00 $112.14 $630.00 $630.00 $467.59 $467.59 $485.60 $328.23 $131.30 $630.00 $252.00 $630.00 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $409.50 $630.00 $630.00 $365.40 $630.00 $378.00 $630.00 $630.00 $630.00 N/A N/A 27008318 EAP Custom 27008318 INTERN FIXATN OSTEOPOROTIC BNE BOTH IP/OP $538.00 $398.50 $95.76 $538.00 $538.00 $538.00 $538.00 $538.00 $538.00 $538.00 $95.76 $538.00 $538.00 $399.30 $399.30 $414.69 $280.30 $112.13 $538.00 $215.20 $538.00 $538.00 $538.00 $538.00 $538.00 $403.50 $538.00 $538.00 $538.00 $269.00 $269.00 $426.10 $538.00 $430.40 $349.70 $538.00 $538.00 $312.04 $538.00 $322.80 $538.00 $538.00 $538.00 N/A N/A 27008321 EAP Custom 27008321 OPER APPROACH ORTH SURG&TRAUMA BOTH IP/OP $635.00 $470.00 $113.03 $635.00 $635.00 $635.00 $635.00 $635.00 $635.00 $635.00 $113.03 $635.00 $635.00 $471.30 $471.30 $489.46 $330.84 $132.34 $635.00 $254.00 $635.00 $635.00 $635.00 $635.00 $635.00 $476.25 $635.00 $635.00 $635.00 $317.50 $317.50 $502.92 $635.00 $508.00 $412.75 $635.00 $635.00 $368.30 $635.00 $381.00 $635.00 $635.00 $635.00 N/A N/A 27008324 EAP Custom 27008324 1.5MM CORTEX SCW 6-20MM BOTH IP/OP $83.00 $61.50 $14.77 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $14.77 $83.00 $83.00 $61.60 $61.60 $63.98 $43.24 $17.30 $83.00 $33.20 $83.00 $83.00 $83.00 $83.00 $83.00 $62.25 $83.00 $83.00 $83.00 $41.50 $41.50 $65.74 $83.00 $66.40 $53.95 $83.00 $83.00 $48.14 $83.00 $49.80 $83.00 $83.00 $83.00 N/A N/A 27008325 EAP Custom 27008325 1.0COR SCW SELF-TAPG 6-14MM BOTH IP/OP $340.00 $252.00 $60.52 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $60.52 $340.00 $340.00 $252.35 $252.35 $262.07 $177.14 $70.86 $340.00 $136.00 $340.00 $340.00 $340.00 $340.00 $340.00 $255.00 $340.00 $340.00 $340.00 $170.00 $170.00 $269.28 $340.00 $272.00 $221.00 $340.00 $340.00 $197.20 $340.00 $204.00 $340.00 $340.00 $340.00 N/A N/A 27008326 EAP Custom 27008326 1.3MM CORT SCW SLF-TAPG 6-18 BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27008327 EAP Custom 27008327 1.5MM CORT SCW SLF-TAPG 6-24 BOTH IP/OP $97.00 $72.00 $17.27 $97.00 $97.00 $97.00 $97.00 $97.00 $97.00 $97.00 $17.27 $97.00 $97.00 $71.99 $71.99 $74.77 $50.54 $20.22 $97.00 $38.80 $97.00 $97.00 $97.00 $97.00 $97.00 $72.75 $97.00 $97.00 $97.00 $48.50 $48.50 $76.82 $97.00 $77.60 $63.05 $97.00 $97.00 $56.26 $97.00 $58.20 $97.00 $97.00 $97.00 N/A N/A 27008335 EAP Custom 27008335 1.8MM BUTTRESS PIN/12-30MM BOTH IP/OP $170.00 $126.00 $30.26 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $30.26 $170.00 $170.00 $126.17 $126.17 $131.04 $88.57 $35.43 $170.00 $68.00 $170.00 $170.00 $170.00 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $110.50 $170.00 $170.00 $98.60 $170.00 $102.00 $170.00 $170.00 $170.00 N/A N/A 27008367 EAP Custom 27008367 SCHUHLI ASSEMBLY - 4.5 COR SCW BOTH IP/OP "$1,039.00" $769.00 $184.94 "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" $184.94 "$1,039.00" "$1,039.00" $771.15 $771.15 $800.86 $541.32 $216.54 "$1,039.00" $415.60 "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" $779.25 "$1,039.00" "$1,039.00" "$1,039.00" $519.50 $519.50 $822.89 "$1,039.00" $831.20 $675.35 "$1,039.00" "$1,039.00" $602.62 "$1,039.00" $623.40 "$1,039.00" "$1,039.00" "$1,039.00" N/A N/A 27008368 EAP Custom 27008368 SCHUHLI ASSEMBLY- 3.5 COR SCW BOTH IP/OP "$1,039.00" $769.00 $184.94 "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" $184.94 "$1,039.00" "$1,039.00" $771.15 $771.15 $800.86 $541.32 $216.54 "$1,039.00" $415.60 "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" $779.25 "$1,039.00" "$1,039.00" "$1,039.00" $519.50 $519.50 $822.89 "$1,039.00" $831.20 $675.35 "$1,039.00" "$1,039.00" $602.62 "$1,039.00" $623.40 "$1,039.00" "$1,039.00" "$1,039.00" N/A N/A 27008369 EAP Custom 27008369 THRDED WASH 3.0 CANNUL SCW BOTH IP/OP $560.00 $414.50 $99.68 $560.00 $560.00 $560.00 $560.00 $560.00 $560.00 $560.00 $99.68 $560.00 $560.00 $415.63 $415.63 $431.65 $291.76 $116.71 $560.00 $224.00 $560.00 $560.00 $560.00 $560.00 $560.00 $420.00 $560.00 $560.00 $560.00 $280.00 $280.00 $443.52 $560.00 $448.00 $364.00 $560.00 $560.00 $324.80 $560.00 $336.00 $560.00 $560.00 $560.00 N/A N/A 27008370 EAP Custom 27008370 SPIKED WASHER 8.0MM/3.2MM BOTH IP/OP $497.00 $368.00 $88.47 $497.00 $497.00 $497.00 $497.00 $497.00 $497.00 $497.00 $88.47 $497.00 $497.00 $368.87 $368.87 $383.09 $258.94 $103.58 $497.00 $198.80 $497.00 $497.00 $497.00 $497.00 $497.00 $372.75 $497.00 $497.00 $497.00 $248.50 $248.50 $393.62 $497.00 $397.60 $323.05 $497.00 $497.00 $288.26 $497.00 $298.20 $497.00 $497.00 $497.00 N/A N/A 27008371 EAP Custom 27008371 SPIKED WASHER 13.5MM/4.0MM BOTH IP/OP $501.00 $371.00 $89.18 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $89.18 $501.00 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $200.40 $501.00 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $501.00 $501.00 $290.58 $501.00 $300.60 $501.00 $501.00 $501.00 N/A N/A 27008372 EAP Custom 27008372 SPIKED WASHER 13.5MM/5.5MM BOTH IP/OP $492.00 $364.50 $87.58 $492.00 $492.00 $492.00 $492.00 $492.00 $492.00 $492.00 $87.58 $492.00 $492.00 $365.16 $365.16 $379.23 $256.33 $102.54 $492.00 $196.80 $492.00 $492.00 $492.00 $492.00 $492.00 $369.00 $492.00 $492.00 $492.00 $246.00 $246.00 $389.66 $492.00 $393.60 $319.80 $492.00 $492.00 $285.36 $492.00 $295.20 $492.00 $492.00 $492.00 N/A N/A 27008373 EAP Custom 27008373 SPHER WASH/SM OVAL 6.5/ 0.3MM BOTH IP/OP $608.00 $450.00 $108.22 $608.00 $608.00 $608.00 $608.00 $608.00 $608.00 $608.00 $108.22 $608.00 $608.00 $451.26 $451.26 $468.65 $316.77 $126.71 $608.00 $243.20 $608.00 $608.00 $608.00 $608.00 $608.00 $456.00 $608.00 $608.00 $608.00 $304.00 $304.00 $481.54 $608.00 $486.40 $395.20 $608.00 $608.00 $352.64 $608.00 $364.80 $608.00 $608.00 $608.00 N/A N/A 27008374 EAP Custom 27008374 SPHER WASHER/LRG RND 6.5/7.3 BOTH IP/OP $608.00 $450.00 $108.22 $608.00 $608.00 $608.00 $608.00 $608.00 $608.00 $608.00 $108.22 $608.00 $608.00 $451.26 $451.26 $468.65 $316.77 $126.71 $608.00 $243.20 $608.00 $608.00 $608.00 $608.00 $608.00 $456.00 $608.00 $608.00 $608.00 $304.00 $304.00 $481.54 $608.00 $486.40 $395.20 $608.00 $608.00 $352.64 $608.00 $364.80 $608.00 $608.00 $608.00 N/A N/A 27008375 EAP Custom 27008375 NUT FOR 4.5MM CORTEX SCREWS BOTH IP/OP $120.00 $89.00 $21.36 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $21.36 $120.00 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $48.00 $120.00 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $120.00 $120.00 $69.60 $120.00 $72.00 $120.00 $120.00 $120.00 N/A N/A 27008376 EAP Custom 27008376 WASHER 6.5MM BOTH IP/OP $109.00 $81.00 $19.40 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $19.40 $109.00 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $43.60 $109.00 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $109.00 $109.00 $63.22 $109.00 $65.40 $109.00 $109.00 $109.00 N/A N/A 27008377 EAP Custom 27008377 1.3MM STRAIGHT PLATE 6 HOLES BOTH IP/OP $789.00 $584.00 $140.44 $789.00 $789.00 $789.00 $789.00 $789.00 $789.00 $789.00 $140.44 $789.00 $789.00 $585.60 $585.60 $608.16 $411.07 $164.44 $789.00 $315.60 $789.00 $789.00 $789.00 $789.00 $789.00 $591.75 $789.00 $789.00 $789.00 $394.50 $394.50 $624.89 $789.00 $631.20 $512.85 $789.00 $789.00 $457.62 $789.00 $473.40 $789.00 $789.00 $789.00 N/A N/A 27008378 EAP Custom 27008378 1.3MM STRAIGHT PLATE 12 HOLES BOTH IP/OP $996.00 $737.50 $177.29 $996.00 $996.00 $996.00 $996.00 $996.00 $996.00 $996.00 $177.29 $996.00 $996.00 $739.23 $739.23 $767.72 $518.92 $207.58 $996.00 $398.40 $996.00 $996.00 $996.00 $996.00 $996.00 $747.00 $996.00 $996.00 $996.00 $498.00 $498.00 $788.83 $996.00 $796.80 $647.40 $996.00 $996.00 $577.68 $996.00 $597.60 $996.00 $996.00 $996.00 N/A N/A 27008379 EAP Custom 27008379 1.3MM EXTENDED H-PLATE/RIGHT BOTH IP/OP $954.00 $706.00 $169.81 $954.00 $954.00 $954.00 $954.00 $954.00 $954.00 $954.00 $169.81 $954.00 $954.00 $708.06 $708.06 $735.34 $497.03 $198.82 $954.00 $381.60 $954.00 $954.00 $954.00 $954.00 $954.00 $715.50 $954.00 $954.00 $954.00 $477.00 $477.00 $755.57 $954.00 $763.20 $620.10 $954.00 $954.00 $553.32 $954.00 $572.40 $954.00 $954.00 $954.00 N/A N/A 27008380 EAP Custom 27008380 1.3MM EXTENDED H-PLATE/LEFT BOTH IP/OP $954.00 $706.00 $169.81 $954.00 $954.00 $954.00 $954.00 $954.00 $954.00 $954.00 $169.81 $954.00 $954.00 $708.06 $708.06 $735.34 $497.03 $198.82 $954.00 $381.60 $954.00 $954.00 $954.00 $954.00 $954.00 $715.50 $954.00 $954.00 $954.00 $477.00 $477.00 $755.57 $954.00 $763.20 $620.10 $954.00 $954.00 $553.32 $954.00 $572.40 $954.00 $954.00 $954.00 N/A N/A 27008381 EAP Custom 27008381 1.3MM T-PLTE 3 HLES HD/ 8HLES BOTH IP/OP $913.00 $676.00 $162.51 $913.00 $913.00 $913.00 $913.00 $913.00 $913.00 $913.00 $162.51 $913.00 $913.00 $677.63 $677.63 $703.74 $475.67 $190.28 $913.00 $365.20 $913.00 $913.00 $913.00 $913.00 $913.00 $684.75 $913.00 $913.00 $913.00 $456.50 $456.50 $723.10 $913.00 $730.40 $593.45 $913.00 $913.00 $529.54 $913.00 $547.80 $913.00 $913.00 $913.00 N/A N/A 27008382 EAP Custom 27008382 1.3MM T-PLTE 4HLES HEAD/8HLES BOTH IP/OP $954.00 $706.00 $169.81 $954.00 $954.00 $954.00 $954.00 $954.00 $954.00 $954.00 $169.81 $954.00 $954.00 $708.06 $708.06 $735.34 $497.03 $198.82 $954.00 $381.60 $954.00 $954.00 $954.00 $954.00 $954.00 $715.50 $954.00 $954.00 $954.00 $477.00 $477.00 $755.57 $954.00 $763.20 $620.10 $954.00 $954.00 $553.32 $954.00 $572.40 $954.00 $954.00 $954.00 N/A N/A 27008383 EAP Custom 27008383 1.3MM Y-PLTE 3 HLES HEAD/8HLE BOTH IP/OP $913.00 $676.00 $162.51 $913.00 $913.00 $913.00 $913.00 $913.00 $913.00 $913.00 $162.51 $913.00 $913.00 $677.63 $677.63 $703.74 $475.67 $190.28 $913.00 $365.20 $913.00 $913.00 $913.00 $913.00 $913.00 $684.75 $913.00 $913.00 $913.00 $456.50 $456.50 $723.10 $913.00 $730.40 $593.45 $913.00 $913.00 $529.54 $913.00 $547.80 $913.00 $913.00 $913.00 N/A N/A 27008384 EAP Custom 27008384 SEMI-TUBUL PLATE 2 HOLES 39M BOTH IP/OP $228.00 $169.00 $40.58 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $40.58 $228.00 $228.00 $169.22 $169.22 $175.74 $118.79 $47.52 $228.00 $91.20 $228.00 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $148.20 $228.00 $228.00 $132.24 $228.00 $136.80 $228.00 $228.00 $228.00 N/A N/A 27008385 EAP Custom 27008385 SEMI-TUBUL PLATE 3 HOLES 55M BOTH IP/OP $235.00 $174.00 $41.83 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $41.83 $235.00 $235.00 $174.42 $174.42 $181.14 $122.44 $48.98 $235.00 $94.00 $235.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $152.75 $235.00 $235.00 $136.30 $235.00 $141.00 $235.00 $235.00 $235.00 N/A N/A 27008386 EAP Custom 27008386 SEMI-TUBUL PLATE 4 HOLES 71M BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 $255.00 $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 27008387 EAP Custom 27008387 SEMI-TUBUL PLATE 5 HOLES 87M BOTH IP/OP $267.00 $198.00 $47.53 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $47.53 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 27008388 EAP Custom 27008388 SEMI-TUBULPLATE 6 HOLES 103M BOTH IP/OP $283.00 $209.50 $50.37 $283.00 $283.00 $283.00 $283.00 $283.00 $283.00 $283.00 $50.37 $283.00 $283.00 $210.04 $210.04 $218.14 $147.44 $58.98 $283.00 $113.20 $283.00 $283.00 $283.00 $283.00 $283.00 $212.25 $283.00 $283.00 $283.00 $141.50 $141.50 $224.14 $283.00 $226.40 $183.95 $283.00 $283.00 $164.14 $283.00 $169.80 $283.00 $283.00 $283.00 N/A N/A 27008389 EAP Custom 27008389 SEMI-TUBUL PLATE 7 HOLES 119M BOTH IP/OP $307.00 $227.50 $54.65 $307.00 $307.00 $307.00 $307.00 $307.00 $307.00 $307.00 $54.65 $307.00 $307.00 $227.86 $227.86 $236.64 $159.95 $63.98 $307.00 $122.80 $307.00 $307.00 $307.00 $307.00 $307.00 $230.25 $307.00 $307.00 $307.00 $153.50 $153.50 $243.14 $307.00 $245.60 $199.55 $307.00 $307.00 $178.06 $307.00 $184.20 $307.00 $307.00 $307.00 N/A N/A 27008390 EAP Custom 27008390 SEMI-TUBUL PLATE 8 HOLES 135M BOTH IP/OP $325.00 $240.50 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 $325.00 $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A 27008391 EAP Custom 27008391 SEMI-TUBUL PLATE 9 HOLES 151M BOTH IP/OP $337.00 $249.50 $59.99 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $59.99 $337.00 $337.00 $250.12 $250.12 $259.76 $175.58 $70.23 $337.00 $134.80 $337.00 $337.00 $337.00 $337.00 $337.00 $252.75 $337.00 $337.00 $337.00 $168.50 $168.50 $266.90 $337.00 $269.60 $219.05 $337.00 $337.00 $195.46 $337.00 $202.20 $337.00 $337.00 $337.00 N/A N/A 27008392 EAP Custom 27008392 SEMI-TUBUL PLATE 10 HOLES 167M BOTH IP/OP $345.00 $255.50 $61.41 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $61.41 $345.00 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $138.00 $345.00 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $345.00 $345.00 $200.10 $345.00 $207.00 $345.00 $345.00 $345.00 N/A N/A 27008393 EAP Custom 27008393 SEMI-TUBUL PLATE 11 HOLES/183M BOTH IP/OP $356.00 $263.50 $63.37 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $356.00 $63.37 $356.00 $356.00 $264.22 $264.22 $274.40 $185.48 $74.19 $356.00 $142.40 $356.00 $356.00 $356.00 $356.00 $356.00 $267.00 $356.00 $356.00 $356.00 $178.00 $178.00 $281.95 $356.00 $284.80 $231.40 $356.00 $356.00 $206.48 $356.00 $213.60 $356.00 $356.00 $356.00 N/A N/A 27008394 EAP Custom 27008394 SEMI-TUBULAR PLATE 12 HLES/199 BOTH IP/OP $375.00 $277.50 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $66.75 $375.00 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $150.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $375.00 $375.00 $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 27008662 EAP Custom 27008662 100DEG ADOLES OSTEO PLT 50/10 BOTH IP/OP "$2,088.00" "$1,545.50" $371.66 "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" $371.66 "$2,088.00" "$2,088.00" "$1,549.71" "$1,549.71" "$1,609.43" "$1,087.85" $435.16 "$2,088.00" $835.20 "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$1,566.00" "$2,088.00" "$2,088.00" "$2,088.00" "$1,044.00" "$1,044.00" "$1,653.70" "$2,088.00" "$1,670.40" "$1,357.20" "$2,088.00" "$2,088.00" "$1,211.04" "$2,088.00" "$1,252.80" "$2,088.00" "$2,088.00" "$2,088.00" N/A N/A 27008663 EAP Custom 27008663 100DEG ADOLES OSTEO PLT 50/10 BOTH IP/OP "$2,219.00" "$1,642.50" $394.98 "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" $394.98 "$2,219.00" "$2,219.00" "$1,646.94" "$1,646.94" "$1,710.41" "$1,156.10" $462.46 "$2,219.00" $887.60 "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$1,664.25" "$2,219.00" "$2,219.00" "$2,219.00" "$1,109.50" "$1,109.50" "$1,757.45" "$2,219.00" "$1,775.20" "$1,442.35" "$2,219.00" "$2,219.00" "$1,287.02" "$2,219.00" "$1,331.40" "$2,219.00" "$2,219.00" "$2,219.00" N/A N/A 27008666 EAP Custom 27008666 100DEG ADOLES OSTEO PLT 40/10 BOTH IP/OP "$2,088.00" "$1,545.50" $371.66 "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" $371.66 "$2,088.00" "$2,088.00" "$1,549.71" "$1,549.71" "$1,609.43" "$1,087.85" $435.16 "$2,088.00" $835.20 "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$1,566.00" "$2,088.00" "$2,088.00" "$2,088.00" "$1,044.00" "$1,044.00" "$1,653.70" "$2,088.00" "$1,670.40" "$1,357.20" "$2,088.00" "$2,088.00" "$1,211.04" "$2,088.00" "$1,252.80" "$2,088.00" "$2,088.00" "$2,088.00" N/A N/A 27008667 EAP Custom 27008667 100DEG ADOLES OSTEO PLT 40/10 BOTH IP/OP "$2,219.00" "$1,642.50" $394.98 "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" $394.98 "$2,219.00" "$2,219.00" "$1,646.94" "$1,646.94" "$1,710.41" "$1,156.10" $462.46 "$2,219.00" $887.60 "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$1,664.25" "$2,219.00" "$2,219.00" "$2,219.00" "$1,109.50" "$1,109.50" "$1,757.45" "$2,219.00" "$1,775.20" "$1,442.35" "$2,219.00" "$2,219.00" "$1,287.02" "$2,219.00" "$1,331.40" "$2,219.00" "$2,219.00" "$2,219.00" N/A N/A 27008670 EAP Custom 27008670 100DEG ADOLES OSTEO PLT 50/15 BOTH IP/OP "$2,088.00" "$1,545.50" $371.66 "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" $371.66 "$2,088.00" "$2,088.00" "$1,549.71" "$1,549.71" "$1,609.43" "$1,087.85" $435.16 "$2,088.00" $835.20 "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$1,566.00" "$2,088.00" "$2,088.00" "$2,088.00" "$1,044.00" "$1,044.00" "$1,653.70" "$2,088.00" "$1,670.40" "$1,357.20" "$2,088.00" "$2,088.00" "$1,211.04" "$2,088.00" "$1,252.80" "$2,088.00" "$2,088.00" "$2,088.00" N/A N/A 27008671 EAP Custom 27008671 100DEG ADOLES OSTEO PLT 50/15 BOTH IP/OP "$2,219.00" "$1,642.50" $394.98 "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" $394.98 "$2,219.00" "$2,219.00" "$1,646.94" "$1,646.94" "$1,710.41" "$1,156.10" $462.46 "$2,219.00" $887.60 "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$1,664.25" "$2,219.00" "$2,219.00" "$2,219.00" "$1,109.50" "$1,109.50" "$1,757.45" "$2,219.00" "$1,775.20" "$1,442.35" "$2,219.00" "$2,219.00" "$1,287.02" "$2,219.00" "$1,331.40" "$2,219.00" "$2,219.00" "$2,219.00" N/A N/A 27008674 EAP Custom 27008674 100DEG ADOLES OSTEO PLT 60/15 BOTH IP/OP "$2,088.00" "$1,545.50" $371.66 "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" $371.66 "$2,088.00" "$2,088.00" "$1,549.71" "$1,549.71" "$1,609.43" "$1,087.85" $435.16 "$2,088.00" $835.20 "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$1,566.00" "$2,088.00" "$2,088.00" "$2,088.00" "$1,044.00" "$1,044.00" "$1,653.70" "$2,088.00" "$1,670.40" "$1,357.20" "$2,088.00" "$2,088.00" "$1,211.04" "$2,088.00" "$1,252.80" "$2,088.00" "$2,088.00" "$2,088.00" N/A N/A 27008675 EAP Custom 27008675 100DEG ADOLES OSTEO PLT 60/15 BOTH IP/OP "$2,219.00" "$1,642.50" $394.98 "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" $394.98 "$2,219.00" "$2,219.00" "$1,646.94" "$1,646.94" "$1,710.41" "$1,156.10" $462.46 "$2,219.00" $887.60 "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$1,664.25" "$2,219.00" "$2,219.00" "$2,219.00" "$1,109.50" "$1,109.50" "$1,757.45" "$2,219.00" "$1,775.20" "$1,442.35" "$2,219.00" "$2,219.00" "$1,287.02" "$2,219.00" "$1,331.40" "$2,219.00" "$2,219.00" "$2,219.00" N/A N/A 27008678 EAP Custom 27008678 100DEG ADOLES OSTEO PLT 40/15 BOTH IP/OP "$2,088.00" "$1,545.50" $371.66 "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" $371.66 "$2,088.00" "$2,088.00" "$1,549.71" "$1,549.71" "$1,609.43" "$1,087.85" $435.16 "$2,088.00" $835.20 "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$2,088.00" "$1,566.00" "$2,088.00" "$2,088.00" "$2,088.00" "$1,044.00" "$1,044.00" "$1,653.70" "$2,088.00" "$1,670.40" "$1,357.20" "$2,088.00" "$2,088.00" "$1,211.04" "$2,088.00" "$1,252.80" "$2,088.00" "$2,088.00" "$2,088.00" N/A N/A 27008679 EAP Custom 27008679 100DEG ADOLES OSTEO PLT 40/15 BOTH IP/OP "$2,219.00" "$1,642.50" $394.98 "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" $394.98 "$2,219.00" "$2,219.00" "$1,646.94" "$1,646.94" "$1,710.41" "$1,156.10" $462.46 "$2,219.00" $887.60 "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$2,219.00" "$1,664.25" "$2,219.00" "$2,219.00" "$2,219.00" "$1,109.50" "$1,109.50" "$1,757.45" "$2,219.00" "$1,775.20" "$1,442.35" "$2,219.00" "$2,219.00" "$1,287.02" "$2,219.00" "$1,331.40" "$2,219.00" "$2,219.00" "$2,219.00" N/A N/A 27008680 EAP Custom 27008680 115 DEG BIFURCATD PLTE 30/5 BOTH IP/OP "$1,187.00" $878.50 $211.29 "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" $211.29 "$1,187.00" "$1,187.00" $880.99 $880.99 $914.94 $618.43 $247.38 "$1,187.00" $474.80 "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" $890.25 "$1,187.00" "$1,187.00" "$1,187.00" $593.50 $593.50 $940.10 "$1,187.00" $949.60 $771.55 "$1,187.00" "$1,187.00" $688.46 "$1,187.00" $712.20 "$1,187.00" "$1,187.00" "$1,187.00" N/A N/A 27008681 EAP Custom 27008681 115 DEG BIFURCATD PLTE 30/5 BOTH IP/OP "$1,318.00" $975.50 $234.60 "$1,318.00" "$1,318.00" "$1,318.00" "$1,318.00" "$1,318.00" "$1,318.00" "$1,318.00" $234.60 "$1,318.00" "$1,318.00" $978.22 $978.22 "$1,015.91" $686.68 $274.69 "$1,318.00" $527.20 "$1,318.00" "$1,318.00" "$1,318.00" "$1,318.00" "$1,318.00" $988.50 "$1,318.00" "$1,318.00" "$1,318.00" $659.00 $659.00 "$1,043.86" "$1,318.00" "$1,054.40" $856.70 "$1,318.00" "$1,318.00" $764.44 "$1,318.00" $790.80 "$1,318.00" "$1,318.00" "$1,318.00" N/A N/A 27008682 EAP Custom 27008682 115 DEG BIFURCATD PLTE 35/5 BOTH IP/OP "$1,187.00" $878.50 $211.29 "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" $211.29 "$1,187.00" "$1,187.00" $880.99 $880.99 $914.94 $618.43 $247.38 "$1,187.00" $474.80 "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" $890.25 "$1,187.00" "$1,187.00" "$1,187.00" $593.50 $593.50 $940.10 "$1,187.00" $949.60 $771.55 "$1,187.00" "$1,187.00" $688.46 "$1,187.00" $712.20 "$1,187.00" "$1,187.00" "$1,187.00" N/A N/A 27008683 EAP Custom 27008683 115 DEG BIFURCATD PLTE 35/5 BOTH IP/OP "$1,318.00" $975.50 $234.60 "$1,318.00" "$1,318.00" "$1,318.00" "$1,318.00" "$1,318.00" "$1,318.00" "$1,318.00" $234.60 "$1,318.00" "$1,318.00" $978.22 $978.22 "$1,015.91" $686.68 $274.69 "$1,318.00" $527.20 "$1,318.00" "$1,318.00" "$1,318.00" "$1,318.00" "$1,318.00" $988.50 "$1,318.00" "$1,318.00" "$1,318.00" $659.00 $659.00 "$1,043.86" "$1,318.00" "$1,054.40" $856.70 "$1,318.00" "$1,318.00" $764.44 "$1,318.00" $790.80 "$1,318.00" "$1,318.00" "$1,318.00" N/A N/A 27010225 EAP Custom 27010225 0.8MM GUIDE WIRE 100MM BOTH IP/OP $611.00 $452.50 $108.76 $611.00 $611.00 $611.00 $611.00 $611.00 $611.00 $611.00 $108.76 $611.00 $611.00 $453.48 $453.48 $470.96 $318.33 $127.34 $611.00 $244.40 $611.00 $611.00 $611.00 $611.00 $611.00 $458.25 $611.00 $611.00 $611.00 $305.50 $305.50 $483.91 $611.00 $488.80 $397.15 $611.00 $611.00 $354.38 $611.00 $366.60 $611.00 $611.00 $611.00 N/A N/A 27010807 EAP Custom 27010807 "BIPOLAR CORD,DISPOSABLE" BOTH IP/OP $683.00 $505.50 $121.57 $683.00 $683.00 $683.00 $683.00 $683.00 $683.00 $683.00 $121.57 $683.00 $683.00 $506.92 $506.92 $526.46 $355.84 $142.34 $683.00 $273.20 $683.00 $683.00 $683.00 $683.00 $683.00 $512.25 $683.00 $683.00 $683.00 $341.50 $341.50 $540.94 $683.00 $546.40 $443.95 $683.00 $683.00 $396.14 $683.00 $409.80 $683.00 $683.00 $683.00 N/A N/A 27010880 EAP Custom 27010880 COLOSTOMY BAG & SUPPLIES BOTH IP/OP $509.00 $377.00 $90.60 $509.00 $509.00 $509.00 $509.00 $509.00 $509.00 $509.00 $90.60 $509.00 $509.00 $377.78 $377.78 $392.34 $265.19 $106.08 $509.00 $203.60 $509.00 $509.00 $509.00 $509.00 $509.00 $381.75 $509.00 $509.00 $509.00 $254.50 $254.50 $403.13 $509.00 $407.20 $330.85 $509.00 $509.00 $295.22 $509.00 $305.40 $509.00 $509.00 $509.00 N/A N/A 27010881 EAP Custom 27010881 GEN-SUPP-GUIDE WIRE BOTH IP/OP $160.00 $118.50 $28.48 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $28.48 $160.00 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $64.00 $160.00 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $160.00 $160.00 $92.80 $160.00 $96.00 $160.00 $160.00 $160.00 N/A N/A 27010943 EAP Custom 27010943 ENDO STITCH* POLYSORB* 3/0 7 V BOTH IP/OP $198.00 $147.00 $35.24 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $35.24 $198.00 $198.00 $146.96 $146.96 $152.62 $103.16 $41.27 $198.00 $79.20 $198.00 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $128.70 $198.00 $198.00 $114.84 $198.00 $118.80 $198.00 $198.00 $198.00 N/A N/A 27010987 EAP Custom 27010987 3.2MM GUIDE WIRE 290MM BOTH IP/OP $501.00 $371.00 $89.18 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $89.18 $501.00 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $200.40 $501.00 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $501.00 $501.00 $290.58 $501.00 $300.60 $501.00 $501.00 $501.00 N/A N/A 27010993 EAP Custom 27010993 HUMERAL FRACTURE BRACE BOTH IP/OP $196.00 $145.50 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $34.89 $196.00 $196.00 $145.47 $145.47 $151.08 $102.12 $40.85 $196.00 $78.40 $196.00 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $127.40 $196.00 $196.00 $113.68 $196.00 $117.60 $196.00 $196.00 $196.00 N/A N/A 27010994 EAP Custom 27010994 WOUND CARE SHOE BOTH IP/OP $309.00 $229.00 $55.00 $309.00 $309.00 $309.00 $309.00 $309.00 $309.00 $309.00 $55.00 $309.00 $309.00 $229.34 $229.34 $238.18 $160.99 $64.40 $309.00 $123.60 $309.00 $309.00 $309.00 $309.00 $309.00 $231.75 $309.00 $309.00 $309.00 $154.50 $154.50 $244.73 $309.00 $247.20 $200.85 $309.00 $309.00 $179.22 $309.00 $185.40 $309.00 $309.00 $309.00 N/A N/A 27010997 EAP Custom 27010997 3MMX20CM TUNNELER BOTH IP/OP $656.00 $485.50 $116.77 $656.00 $656.00 $656.00 $656.00 $656.00 $656.00 $656.00 $116.77 $656.00 $656.00 $486.88 $486.88 $505.64 $341.78 $136.72 $656.00 $262.40 $656.00 $656.00 $656.00 $656.00 $656.00 $492.00 $656.00 $656.00 $656.00 $328.00 $328.00 $519.55 $656.00 $524.80 $426.40 $656.00 $656.00 $380.48 $656.00 $393.60 $656.00 $656.00 $656.00 N/A N/A 27011002 EAP Custom 27011002 4FR CATHETER COBRA 2 BOTH IP/OP $166.00 $123.00 $29.55 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $29.55 $166.00 $166.00 $123.21 $123.21 $127.95 $86.49 $34.60 $166.00 $66.40 $166.00 $166.00 $166.00 $166.00 $166.00 $124.50 $166.00 $166.00 $166.00 $83.00 $83.00 $131.47 $166.00 $132.80 $107.90 $166.00 $166.00 $96.28 $166.00 $99.60 $166.00 $166.00 $166.00 N/A N/A 27011008 EAP Custom 27011008 5FR-100CM SIM 1 CATH BOTH IP/OP $60.00 $44.50 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 $60.00 $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A 27011009 EAP Custom 27011009 5MMX19CMX90CM MONORAIL BILARY BOTH IP/OP "$4,654.00" "$3,444.00" $828.41 "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" $828.41 "$4,654.00" "$4,654.00" "$3,454.20" "$3,454.20" "$3,587.30" "$2,060.15" $969.94 "$4,654.00" "$1,861.60" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$3,490.50" "$4,654.00" "$4,654.00" "$4,654.00" "$2,327.00" "$2,327.00" "$3,685.97" "$4,654.00" "$3,723.20" "$3,025.10" "$4,654.00" "$4,654.00" "$2,699.32" "$4,654.00" "$2,792.40" "$4,654.00" "$4,654.00" "$4,654.00" N/A N/A 27011010 EAP Custom 27011010 5X135X40CM UNIFUSE KIT BOTH IP/OP $550.00 $407.00 $97.90 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $97.90 $550.00 $550.00 $408.21 $408.21 $423.94 $286.55 $114.63 $550.00 $220.00 $550.00 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $357.50 $550.00 $550.00 $319.00 $550.00 $330.00 $550.00 $550.00 $550.00 N/A N/A 27011011 EAP Custom 27011011 5X135X50CM UNIFUSE KIT BOTH IP/OP $550.00 $407.00 $97.90 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $97.90 $550.00 $550.00 $408.21 $408.21 $423.94 $286.55 $114.63 $550.00 $220.00 $550.00 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $357.50 $550.00 $550.00 $319.00 $550.00 $330.00 $550.00 $550.00 $550.00 N/A N/A 27011013 EAP Custom 27011013 6FR AL1 CATHETER BOTH IP/OP $31.00 $23.00 $5.52 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $5.52 $31.00 $31.00 $23.01 $23.01 $23.89 $16.15 $6.46 $31.00 $12.40 $31.00 $31.00 $31.00 $31.00 $31.00 $23.25 $31.00 $31.00 $31.00 $15.50 $15.50 $24.55 $31.00 $24.80 $20.15 $31.00 $31.00 $17.98 $31.00 $18.60 $31.00 $31.00 $31.00 N/A N/A 27011015 EAP Custom 27011015 6FR AR1 CATHETER BOTH IP/OP $31.00 $23.00 $5.52 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $5.52 $31.00 $31.00 $23.01 $23.01 $23.89 $16.15 $6.46 $31.00 $12.40 $31.00 $31.00 $31.00 $31.00 $31.00 $23.25 $31.00 $31.00 $31.00 $15.50 $15.50 $24.55 $31.00 $24.80 $20.15 $31.00 $31.00 $17.98 $31.00 $18.60 $31.00 $31.00 $31.00 N/A N/A 27011028 EAP Custom 27011028 7.1 FR 100CM PIGTAIL CATH BOTH IP/OP $60.00 $44.50 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 $60.00 $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A 27011029 EAP Custom 27011029 8FR X 40CM SKATER BILIARY DRAI BOTH IP/OP $254.00 $188.00 $45.21 $254.00 $254.00 $254.00 $254.00 $254.00 $254.00 $254.00 $45.21 $254.00 $254.00 $188.52 $188.52 $195.78 $132.33 $52.94 $254.00 $101.60 $254.00 $254.00 $254.00 $254.00 $254.00 $190.50 $254.00 $254.00 $254.00 $127.00 $127.00 $201.17 $254.00 $203.20 $165.10 $254.00 $254.00 $147.32 $254.00 $152.40 $254.00 $254.00 $254.00 N/A N/A 27011032 EAP Custom 27011032 AIR GUARD VALVED INTRODUCER BOTH IP/OP $335.00 $248.00 $59.63 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $59.63 $335.00 $335.00 $248.64 $248.64 $258.22 $174.54 $69.82 $335.00 $134.00 $335.00 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $217.75 $335.00 $335.00 $194.30 $335.00 $201.00 $335.00 $335.00 $335.00 N/A N/A 27011033 EAP Custom 27011033 BAG DRAINAGE URETERAL BOTH IP/OP $103.00 $76.50 $18.33 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $18.33 $103.00 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $41.20 $103.00 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $103.00 $103.00 $59.74 $103.00 $61.80 $103.00 $103.00 $103.00 N/A N/A 27011037 EAP Custom 27011037 BALLOON DIAL CATH XXL 12MMX4CM BOTH IP/OP $856.00 $633.50 $152.37 $856.00 $856.00 $856.00 $856.00 $856.00 $856.00 $856.00 $152.37 $856.00 $856.00 $635.32 $635.32 $659.80 $445.98 $178.40 $856.00 $342.40 $856.00 $856.00 $856.00 $856.00 $856.00 $642.00 $856.00 $856.00 $856.00 $428.00 $428.00 $677.95 $856.00 $684.80 $556.40 $856.00 $856.00 $496.48 $856.00 $513.60 $856.00 $856.00 $856.00 N/A N/A 27011039 EAP Custom 27011039 BALLOON POLAR CATH 4X60X120 BOTH IP/OP "$2,002.00" "$1,481.50" $356.36 "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" $356.36 "$2,002.00" "$2,002.00" "$1,485.88" "$1,485.88" "$1,543.14" "$1,043.04" $417.24 "$2,002.00" $800.80 "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$1,501.50" "$2,002.00" "$2,002.00" "$2,002.00" "$1,001.00" "$1,001.00" "$1,585.58" "$2,002.00" "$1,601.60" "$1,301.30" "$2,002.00" "$2,002.00" "$1,161.16" "$2,002.00" "$1,201.20" "$2,002.00" "$2,002.00" "$2,002.00" N/A N/A 27011040 EAP Custom 27011040 BALLOON POLAR CATH 5X40X120 BOTH IP/OP "$2,002.00" "$1,481.50" $356.36 "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" $356.36 "$2,002.00" "$2,002.00" "$1,485.88" "$1,485.88" "$1,543.14" "$1,043.04" $417.24 "$2,002.00" $800.80 "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$1,501.50" "$2,002.00" "$2,002.00" "$2,002.00" "$1,001.00" "$1,001.00" "$1,585.58" "$2,002.00" "$1,601.60" "$1,301.30" "$2,002.00" "$2,002.00" "$1,161.16" "$2,002.00" "$1,201.20" "$2,002.00" "$2,002.00" "$2,002.00" N/A N/A 27011041 EAP Custom 27011041 BALLOON POLAR CATH 5X60X120 BOTH IP/OP "$2,002.00" "$1,481.50" $356.36 "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" $356.36 "$2,002.00" "$2,002.00" "$1,485.88" "$1,485.88" "$1,543.14" "$1,043.04" $417.24 "$2,002.00" $800.80 "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$1,501.50" "$2,002.00" "$2,002.00" "$2,002.00" "$1,001.00" "$1,001.00" "$1,585.58" "$2,002.00" "$1,601.60" "$1,301.30" "$2,002.00" "$2,002.00" "$1,161.16" "$2,002.00" "$1,201.20" "$2,002.00" "$2,002.00" "$2,002.00" N/A N/A 27011051 EAP Custom 27011051 BASKET STONE REMOVAL 8-WIRE BOTH IP/OP $963.00 $713.00 $171.41 $963.00 $963.00 $963.00 $963.00 $963.00 $963.00 $963.00 $171.41 $963.00 $963.00 $714.74 $714.74 $742.28 $501.72 $200.70 $963.00 $385.20 $963.00 $963.00 $963.00 $963.00 $963.00 $722.25 $963.00 $963.00 $963.00 $481.50 $481.50 $762.70 $963.00 $770.40 $625.95 $963.00 $963.00 $558.54 $963.00 $577.80 $963.00 $963.00 $963.00 N/A N/A 27011052 EAP Custom 27011052 BEAD BLOCK 100-300 BOTH IP/OP $667.00 $494.00 $118.73 $667.00 $667.00 $667.00 $667.00 $667.00 $667.00 $667.00 $118.73 $667.00 $667.00 $495.05 $495.05 $514.12 $347.51 $139.01 $667.00 $266.80 $667.00 $667.00 $667.00 $667.00 $667.00 $500.25 $667.00 $667.00 $667.00 $333.50 $333.50 $528.26 $667.00 $533.60 $433.55 $667.00 $667.00 $386.86 $667.00 $400.20 $667.00 $667.00 $667.00 N/A N/A 27011053 EAP Custom 27011053 BEAD BLOCK 300-500 BOTH IP/OP $667.00 $494.00 $118.73 $667.00 $667.00 $667.00 $667.00 $667.00 $667.00 $667.00 $118.73 $667.00 $667.00 $495.05 $495.05 $514.12 $347.51 $139.01 $667.00 $266.80 $667.00 $667.00 $667.00 $667.00 $667.00 $500.25 $667.00 $667.00 $667.00 $333.50 $333.50 $528.26 $667.00 $533.60 $433.55 $667.00 $667.00 $386.86 $667.00 $400.20 $667.00 $667.00 $667.00 N/A N/A 27011054 EAP Custom 27011054 BEAD BLOCK 500-700 BOTH IP/OP $667.00 $494.00 $118.73 $667.00 $667.00 $667.00 $667.00 $667.00 $667.00 $667.00 $118.73 $667.00 $667.00 $495.05 $495.05 $514.12 $347.51 $139.01 $667.00 $266.80 $667.00 $667.00 $667.00 $667.00 $667.00 $500.25 $667.00 $667.00 $667.00 $333.50 $333.50 $528.26 $667.00 $533.60 $433.55 $667.00 $667.00 $386.86 $667.00 $400.20 $667.00 $667.00 $667.00 N/A N/A 27011055 EAP Custom 27011055 BEAD BLOCK 700-900 BOTH IP/OP $667.00 $494.00 $118.73 $667.00 $667.00 $667.00 $667.00 $667.00 $667.00 $667.00 $118.73 $667.00 $667.00 $495.05 $495.05 $514.12 $347.51 $139.01 $667.00 $266.80 $667.00 $667.00 $667.00 $667.00 $667.00 $500.25 $667.00 $667.00 $667.00 $333.50 $333.50 $528.26 $667.00 $533.60 $433.55 $667.00 $667.00 $386.86 $667.00 $400.20 $667.00 $667.00 $667.00 N/A N/A 27011056 EAP Custom 27011056 BEAD BLOCK 900-1200 BOTH IP/OP $667.00 $494.00 $118.73 $667.00 $667.00 $667.00 $667.00 $667.00 $667.00 $667.00 $118.73 $667.00 $667.00 $495.05 $495.05 $514.12 $347.51 $139.01 $667.00 $266.80 $667.00 $667.00 $667.00 $667.00 $667.00 $500.25 $667.00 $667.00 $667.00 $333.50 $333.50 $528.26 $667.00 $533.60 $433.55 $667.00 $667.00 $386.86 $667.00 $400.20 $667.00 $667.00 $667.00 N/A N/A 27011061 EAP Custom 27011061 CATH 5FR 100CM BERENSTEIN BOTH IP/OP $35.00 $26.00 $6.23 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $6.23 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 27011065 EAP Custom 27011065 CATH 5FR 40CM BERENSTEIN BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27011067 EAP Custom 27011067 CATH 5FR 65CM BERENSTEIN BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27011068 EAP Custom 27011068 CATH 5FR 65CM COBRA1 BOTH IP/OP $35.00 $26.00 $6.23 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $6.23 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 27011069 EAP Custom 27011069 CATH 5FR 65CM COBRA2 BOTH IP/OP $35.00 $26.00 $6.23 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $6.23 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 27011070 EAP Custom 27011070 CATH 5FR 65CM NS STRAIGHT BOTH IP/OP $60.00 $44.50 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 $60.00 $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A 27011071 EAP Custom 27011071 CATH 5FR 65CM PIG BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27011073 EAP Custom 27011073 CATH 5FR 80 CM MIKALESSON BOTH IP/OP $35.00 $26.00 $6.23 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $6.23 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 27011074 EAP Custom 27011074 CATH 5FR 80CM SOS1 BOTH IP/OP $166.00 $123.00 $29.55 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $29.55 $166.00 $166.00 $123.21 $123.21 $127.95 $86.49 $34.60 $166.00 $66.40 $166.00 $166.00 $166.00 $166.00 $166.00 $124.50 $166.00 $166.00 $166.00 $83.00 $83.00 $131.47 $166.00 $132.80 $107.90 $166.00 $166.00 $96.28 $166.00 $99.60 $166.00 $166.00 $166.00 N/A N/A 27011075 EAP Custom 27011075 CATH 5FR 80CM SOS2 BOTH IP/OP $35.00 $26.00 $6.23 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $6.23 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 27011084 EAP Custom 27011084 CATHETER REPAIR KIT BOTH IP/OP $349.00 $258.50 $62.12 $349.00 $349.00 $349.00 $349.00 $349.00 $349.00 $349.00 $62.12 $349.00 $349.00 $259.03 $259.03 $269.01 $181.83 $72.74 $349.00 $139.60 $349.00 $349.00 $349.00 $349.00 $349.00 $261.75 $349.00 $349.00 $349.00 $174.50 $174.50 $276.41 $349.00 $279.20 $226.85 $349.00 $349.00 $202.42 $349.00 $209.40 $349.00 $349.00 $349.00 N/A N/A 27011086 EAP Custom 27011086 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $469.00 $347.50 $83.48 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $469.00 $83.48 $469.00 $469.00 $348.09 $348.09 $361.51 $244.35 $97.74 $469.00 $187.60 $469.00 $469.00 $469.00 $469.00 $469.00 $351.75 $469.00 $469.00 $469.00 $234.50 $234.50 $371.45 $469.00 $375.20 $304.85 $469.00 $469.00 $272.02 $469.00 $281.40 $469.00 $469.00 $469.00 N/A N/A 27011088 EAP Custom 27011088 COIL 15-250 MICRON (2VL/BX) BOTH IP/OP $477.00 $353.00 $84.91 $477.00 $477.00 $477.00 $477.00 $477.00 $477.00 $477.00 $84.91 $477.00 $477.00 $354.03 $354.03 $367.67 $248.52 $99.41 $477.00 $190.80 $477.00 $477.00 $477.00 $477.00 $477.00 $357.75 $477.00 $477.00 $477.00 $238.50 $238.50 $377.78 $477.00 $381.60 $310.05 $477.00 $477.00 $276.66 $477.00 $286.20 $477.00 $477.00 $477.00 N/A N/A 27011089 EAP Custom 27011089 COIL 250-355 MICRON (5VL/BX) BOTH IP/OP $463.00 $343.00 $82.41 $463.00 $463.00 $463.00 $463.00 $463.00 $463.00 $463.00 $82.41 $463.00 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $185.20 $463.00 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $463.00 $463.00 $268.54 $463.00 $277.80 $463.00 $463.00 $463.00 N/A N/A 27011090 EAP Custom 27011090 COIL 355-500 MICRON (5VL/BX) BOTH IP/OP $384.00 $284.50 $68.35 $384.00 $384.00 $384.00 $384.00 $384.00 $384.00 $384.00 $68.35 $384.00 $384.00 $285.00 $285.00 $295.99 $200.06 $80.03 $384.00 $153.60 $384.00 $384.00 $384.00 $384.00 $384.00 $288.00 $384.00 $384.00 $384.00 $192.00 $192.00 $304.13 $384.00 $307.20 $249.60 $384.00 $384.00 $222.72 $384.00 $230.40 $384.00 $384.00 $384.00 N/A N/A 27011093 EAP Custom 27011093 COIL PUSHER 16 BOTH IP/OP $544.00 $403.00 $96.83 $544.00 $544.00 $544.00 $544.00 $544.00 $544.00 $544.00 $96.83 $544.00 $544.00 $403.76 $403.76 $419.32 $283.42 $113.38 $544.00 $217.60 $544.00 $544.00 $544.00 $544.00 $544.00 $408.00 $544.00 $544.00 $544.00 $272.00 $272.00 $430.85 $544.00 $435.20 $353.60 $544.00 $544.00 $315.52 $544.00 $326.40 $544.00 $544.00 $544.00 N/A N/A 27011094 EAP Custom 27011094 COIL PUSHER TRUPUSH BOTH IP/OP "$1,228.00" $909.00 $218.58 "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" $218.58 "$1,228.00" "$1,228.00" $911.42 $911.42 $946.54 $639.79 $255.93 "$1,228.00" $491.20 "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" $921.00 "$1,228.00" "$1,228.00" "$1,228.00" $614.00 $614.00 $972.58 "$1,228.00" $982.40 $798.20 "$1,228.00" "$1,228.00" $712.24 "$1,228.00" $736.80 "$1,228.00" "$1,228.00" "$1,228.00" N/A N/A 27011095 EAP Custom 27011095 CONNECTOR URETERAL CATHETER BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27011096 EAP Custom 27011096 CONNECTORY TUOHY BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27011097 EAP Custom 27011097 CONTRA 2 BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27011098 EAP Custom 27011098 CONTRA FLUSH CATHETER BOTH IP/OP $199.00 $147.50 $35.42 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $35.42 $199.00 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $79.60 $199.00 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $199.00 $199.00 $115.42 $199.00 $119.40 $199.00 $199.00 $199.00 N/A N/A 27011099 EAP Custom 27011099 COPE SUTURE ANCHOR SET BOTH IP/OP $199.00 $147.50 $35.42 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $35.42 $199.00 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $79.60 $199.00 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $199.00 $199.00 $115.42 $199.00 $119.40 $199.00 $199.00 $199.00 N/A N/A 27011105 EAP Custom 27011105 EMBOLIZATION 38-4-3 BOTH IP/OP $194.00 $144.00 $34.53 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $34.53 $194.00 $194.00 $143.99 $143.99 $149.54 $101.07 $40.43 $194.00 $77.60 $194.00 $194.00 $194.00 $194.00 $194.00 $145.50 $194.00 $194.00 $194.00 $97.00 $97.00 $153.65 $194.00 $155.20 $126.10 $194.00 $194.00 $112.52 $194.00 $116.40 $194.00 $194.00 $194.00 N/A N/A 27011106 EAP Custom 27011106 EMBOLIZATION 38-8-15 BOTH IP/OP $194.00 $144.00 $34.53 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $34.53 $194.00 $194.00 $143.99 $143.99 $149.54 $101.07 $40.43 $194.00 $77.60 $194.00 $194.00 $194.00 $194.00 $194.00 $145.50 $194.00 $194.00 $194.00 $97.00 $97.00 $153.65 $194.00 $155.20 $126.10 $194.00 $194.00 $112.52 $194.00 $116.40 $194.00 $194.00 $194.00 N/A N/A 27011107 EAP Custom 27011107 EMBOLIZATION COIL 38-5-5 BOTH IP/OP $194.00 $144.00 $34.53 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $34.53 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $40.43 $194.00 $77.60 $194.00 $194.00 $194.00 $194.00 $194.00 $145.50 $194.00 $194.00 $194.00 $97.00 $97.00 $153.65 $194.00 $155.20 $87.30 $194.00 $194.00 $112.52 $194.00 $116.40 $194.00 $194.00 $194.00 N/A N/A 27011108 EAP Custom 27011108 EMBOLIZATION COILS 38-2-3 BOTH IP/OP $194.00 $144.00 $34.53 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $34.53 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $40.43 $194.00 $77.60 $194.00 $194.00 $194.00 $194.00 $194.00 $145.50 $194.00 $194.00 $194.00 $97.00 $97.00 $153.65 $194.00 $155.20 $87.30 $194.00 $194.00 $112.52 $194.00 $116.40 $194.00 $194.00 $194.00 N/A N/A 27011109 EAP Custom 27011109 EMBOLIZATION COILS 38-4-2 BOTH IP/OP $194.00 $144.00 $34.53 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $34.53 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $40.43 $194.00 $77.60 $194.00 $194.00 $194.00 $194.00 $194.00 $145.50 $194.00 $194.00 $194.00 $97.00 $97.00 $153.65 $194.00 $155.20 $87.30 $194.00 $194.00 $112.52 $194.00 $116.40 $194.00 $194.00 $194.00 N/A N/A 27011110 EAP Custom 27011110 EMBOLIZATION COILS 38-5-10 BOTH IP/OP $194.00 $144.00 $34.53 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $34.53 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $40.43 $194.00 $77.60 $194.00 $194.00 $194.00 $194.00 $194.00 $145.50 $194.00 $194.00 $194.00 $97.00 $97.00 $153.65 $194.00 $155.20 $87.30 $194.00 $194.00 $112.52 $194.00 $116.40 $194.00 $194.00 $194.00 N/A N/A 27011111 EAP Custom 27011111 FACE SHIELDS BOTH IP/OP $14.00 $10.50 $2.49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $2.49 $14.00 $14.00 $10.39 $10.39 $10.79 $7.29 $2.92 $14.00 $5.60 $14.00 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $9.10 $14.00 $14.00 $8.12 $14.00 $8.40 $14.00 $14.00 $14.00 N/A N/A 27011112 EAP Custom 27011112 FILLING STATION PLUS (NEURO) BOTH IP/OP $94.00 $70.00 $16.73 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $16.73 $94.00 $94.00 $69.77 $69.77 $72.46 $48.97 $19.59 $94.00 $37.60 $94.00 $94.00 $94.00 $94.00 $94.00 $70.50 $94.00 $94.00 $94.00 $47.00 $47.00 $74.45 $94.00 $75.20 $61.10 $94.00 $94.00 $54.52 $94.00 $56.40 $94.00 $94.00 $94.00 N/A N/A 27011113 EAP Custom 27011113 FILTER JUGULAR G-2 BOTH IP/OP "$4,337.00" "$3,209.50" $771.99 "$4,337.00" "$4,337.00" "$4,337.00" "$4,337.00" "$4,337.00" "$4,337.00" "$4,337.00" $771.99 "$4,337.00" "$4,337.00" "$3,218.92" "$3,218.92" "$3,342.96" "$2,060.15" $903.88 "$4,337.00" "$1,734.80" "$4,337.00" "$4,337.00" "$4,337.00" "$4,337.00" "$4,337.00" "$3,252.75" "$4,337.00" "$4,337.00" "$4,337.00" "$2,168.50" "$2,168.50" "$3,434.90" "$4,337.00" "$3,469.60" "$2,819.05" "$4,337.00" "$4,337.00" "$2,515.46" "$4,337.00" "$2,602.20" "$4,337.00" "$4,337.00" "$4,337.00" N/A N/A 27011114 EAP Custom 27011114 FLO-SWITCH HP BOTH IP/OP $380.00 $281.50 $67.64 $380.00 $380.00 $380.00 $380.00 $380.00 $380.00 $380.00 $67.64 $380.00 $380.00 $282.04 $282.04 $292.90 $197.98 $79.20 $380.00 $152.00 $380.00 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $247.00 $380.00 $380.00 $220.40 $380.00 $228.00 $380.00 $380.00 $380.00 N/A N/A 27011120 EAP Custom 27011120 FOREARM BASED OUTRIGGER BOTH IP/OP $172.00 $127.50 $30.62 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $30.62 $172.00 $172.00 $127.66 $127.66 $132.58 $89.61 $35.85 $172.00 $68.80 $172.00 $172.00 $172.00 $172.00 $172.00 $129.00 $172.00 $172.00 $172.00 $86.00 $86.00 $136.22 $172.00 $137.60 $111.80 $172.00 $172.00 $99.76 $172.00 $103.20 $172.00 $172.00 $172.00 N/A N/A 27011121 EAP Custom 27011121 GTGW.180CM-45DEG ANGLE BOTH IP/OP $501.00 $371.00 $89.18 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $89.18 $501.00 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $200.40 $501.00 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $501.00 $501.00 $290.58 $501.00 $300.60 $501.00 $501.00 $501.00 N/A N/A 27011122 EAP Custom 27011122 HEMOSTASIS V-PAD BOTH IP/OP $160.00 $118.50 $28.48 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $28.48 $160.00 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $64.00 $160.00 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $160.00 $160.00 $92.80 $160.00 $96.00 $160.00 $160.00 $160.00 N/A N/A 27011124 EAP Custom 27011124 IGTCFS-65-FEM CELECT PERM COOK BOTH IP/OP "$4,005.00" "$2,964.00" $712.89 "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" $712.89 "$4,005.00" "$4,005.00" "$2,972.51" "$2,972.51" "$3,087.05" "$2,060.15" $834.69 "$4,005.00" "$1,602.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$3,003.75" "$4,005.00" "$4,005.00" "$4,005.00" "$2,002.50" "$2,002.50" "$3,171.96" "$4,005.00" "$3,204.00" "$2,603.25" "$4,005.00" "$4,005.00" "$2,322.90" "$4,005.00" "$2,403.00" "$4,005.00" "$4,005.00" "$4,005.00" N/A N/A 27011127 EAP Custom 27011127 INTRODUCER MPIS-401 BOTH IP/OP $94.00 $70.00 $16.73 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $16.73 $94.00 $94.00 $69.77 $69.77 $72.46 $48.97 $19.59 $94.00 $37.60 $94.00 $94.00 $94.00 $94.00 $94.00 $70.50 $94.00 $94.00 $94.00 $47.00 $47.00 $74.45 $94.00 $75.20 $61.10 $94.00 $94.00 $54.52 $94.00 $56.40 $94.00 $94.00 $94.00 N/A N/A 27011128 EAP Custom 27011128 INTRODUCER PINNACLE 5FR 10CM BOTH IP/OP $67.00 $50.00 $11.93 $67.00 $67.00 $67.00 $67.00 $67.00 $67.00 $67.00 $11.93 $67.00 $67.00 $49.73 $49.73 $51.64 $34.91 $13.96 $67.00 $26.80 $67.00 $67.00 $67.00 $67.00 $67.00 $50.25 $67.00 $67.00 $67.00 $33.50 $33.50 $53.06 $67.00 $53.60 $43.55 $67.00 $67.00 $38.86 $67.00 $40.20 $67.00 $67.00 $67.00 N/A N/A 27011129 EAP Custom 27011129 JCD 10.0-38-20 BOTH IP/OP $42.00 $31.50 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $7.48 $42.00 $42.00 $31.17 $31.17 $32.37 $21.88 $8.75 $42.00 $16.80 $42.00 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $27.30 $42.00 $42.00 $24.36 $42.00 $25.20 $42.00 $42.00 $42.00 N/A N/A 27011130 EAP Custom 27011130 JCD 12.0-38-20 BOTH IP/OP $44.00 $33.00 $7.83 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $7.83 $44.00 $44.00 $32.66 $32.66 $33.92 $22.92 $9.17 $44.00 $17.60 $44.00 $44.00 $44.00 $44.00 $44.00 $33.00 $44.00 $44.00 $44.00 $22.00 $22.00 $34.85 $44.00 $35.20 $28.60 $44.00 $44.00 $25.52 $44.00 $26.40 $44.00 $44.00 $44.00 N/A N/A 27011131 EAP Custom 27011131 JCD 14.0-38-20 BOTH IP/OP $51.00 $38.00 $9.08 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $9.08 $51.00 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $20.40 $51.00 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $51.00 $51.00 $29.58 $51.00 $30.60 $51.00 $51.00 $51.00 N/A N/A 27011132 EAP Custom 27011132 JCD 16.0-38-20 BOTH IP/OP $51.00 $38.00 $9.08 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $9.08 $51.00 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $20.40 $51.00 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $51.00 $51.00 $29.58 $51.00 $30.60 $51.00 $51.00 $51.00 N/A N/A 27011133 EAP Custom 27011133 JCD 4.0-25-20 BOTH IP/OP $31.00 $23.00 $5.52 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $5.52 $31.00 $31.00 $23.01 $23.01 $23.89 $16.15 $6.46 $31.00 $12.40 $31.00 $31.00 $31.00 $31.00 $31.00 $23.25 $31.00 $31.00 $31.00 $15.50 $15.50 $24.55 $31.00 $24.80 $20.15 $31.00 $31.00 $17.98 $31.00 $18.60 $31.00 $31.00 $31.00 N/A N/A 27011134 EAP Custom 27011134 JCD 5.0-38-20 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27011135 EAP Custom 27011135 JCD 6.0-38-20 BOTH IP/OP $42.00 $31.50 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $7.48 $42.00 $42.00 $31.17 $31.17 $32.37 $21.88 $8.75 $42.00 $16.80 $42.00 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $27.30 $42.00 $42.00 $24.36 $42.00 $25.20 $42.00 $42.00 $42.00 N/A N/A 27011136 EAP Custom 27011136 JCD 7.0-38-20 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27011137 EAP Custom 27011137 JCD 8.0-38-20 BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27011138 EAP Custom 27011138 JCD 9.0-38-20 BOTH IP/OP $42.00 $31.50 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $7.48 $42.00 $42.00 $31.17 $31.17 $32.37 $21.88 $8.75 $42.00 $16.80 $42.00 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $27.30 $42.00 $42.00 $24.36 $42.00 $25.20 $42.00 $42.00 $42.00 N/A N/A 27011139 EAP Custom 27011139 JCD-20.0-38-20 DILATOR BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27011140 EAP Custom 27011140 JCD-22.0-38-20 DILATOR BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 27011141 EAP Custom 27011141 JCD-24.0-38-20 DILATOR BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 27011142 EAP Custom 27011142 JCD-D18.0-38-20 DILATOR BOTH IP/OP $51.00 $38.00 $9.08 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $9.08 $51.00 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $20.40 $51.00 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $51.00 $51.00 $29.58 $51.00 $30.60 $51.00 $51.00 $51.00 N/A N/A 27011143 EAP Custom 27011143 KINAIR III W/O SCALE BOTH IP/OP $192.00 $142.50 $34.18 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $34.18 $192.00 $192.00 $142.50 $142.50 $147.99 $100.03 $40.01 $192.00 $76.80 $192.00 $192.00 $192.00 $192.00 $192.00 $144.00 $192.00 $192.00 $192.00 $96.00 $96.00 $152.06 $192.00 $153.60 $124.80 $192.00 $192.00 $111.36 $192.00 $115.20 $192.00 $192.00 $192.00 N/A N/A 27011148 EAP Custom 27011148 KIT ANGIO SAFTEY WITH J WIRE BOTH IP/OP $178.00 $132.00 $31.68 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $31.68 $178.00 $178.00 $132.11 $132.11 $137.20 $92.74 $37.10 $178.00 $71.20 $178.00 $178.00 $178.00 $178.00 $178.00 $133.50 $178.00 $178.00 $178.00 $89.00 $89.00 $140.98 $178.00 $142.40 $115.70 $178.00 $178.00 $103.24 $178.00 $106.80 $178.00 $178.00 $178.00 N/A N/A 27011149 EAP Custom 27011149 KIT FALLOPIAN TUBE BOTH IP/OP $349.00 $258.50 $62.12 $349.00 $349.00 $349.00 $349.00 $349.00 $349.00 $349.00 $62.12 $349.00 $349.00 $259.03 $259.03 $269.01 $181.83 $72.74 $349.00 $139.60 $349.00 $349.00 $349.00 $349.00 $349.00 $261.75 $349.00 $349.00 $349.00 $174.50 $174.50 $276.41 $349.00 $279.20 $226.85 $349.00 $349.00 $202.42 $349.00 $209.40 $349.00 $349.00 $349.00 N/A N/A 27011150 EAP Custom 27011150 KIT GASTROSTOMY 18FR BOTH IP/OP $541.00 $400.50 $96.30 $541.00 $541.00 $541.00 $541.00 $541.00 $541.00 $541.00 $96.30 $541.00 $541.00 $401.53 $401.53 $417.00 $281.86 $112.75 $541.00 $216.40 $541.00 $541.00 $541.00 $541.00 $541.00 $405.75 $541.00 $541.00 $541.00 $270.50 $270.50 $428.47 $541.00 $432.80 $351.65 $541.00 $541.00 $313.78 $541.00 $324.60 $541.00 $541.00 $541.00 N/A N/A 27011151 EAP Custom 27011151 KIT MAHURKAR 12F TRIPLE LUMEN BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 $300.00 $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 27011152 EAP Custom 27011152 KIT PRESSURE MONITORING T BOTH IP/OP $71.00 $53.00 $12.64 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $12.64 $71.00 $71.00 $52.70 $52.70 $54.73 $36.99 $14.80 $71.00 $28.40 $71.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $46.15 $71.00 $71.00 $41.18 $71.00 $42.60 $71.00 $71.00 $71.00 N/A N/A 27011153 EAP Custom 27011153 KIT PRESSURE MONITORING T BOTH IP/OP $163.00 $121.00 $29.01 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $29.01 $163.00 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $65.20 $163.00 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $163.00 $163.00 $94.54 $163.00 $97.80 $163.00 $163.00 $163.00 N/A N/A 27011154 EAP Custom 27011154 KIT TRIPLE LUMEN CATHETER BOTH IP/OP $726.00 $537.50 $129.23 $726.00 $726.00 $726.00 $726.00 $726.00 $726.00 $726.00 $129.23 $726.00 $726.00 $538.84 $538.84 $559.60 $378.25 $151.31 $726.00 $290.40 $726.00 $726.00 $726.00 $726.00 $726.00 $544.50 $726.00 $726.00 $726.00 $363.00 $363.00 $574.99 $726.00 $580.80 $471.90 $726.00 $726.00 $421.08 $726.00 $435.60 $726.00 $726.00 $726.00 N/A N/A 27011156 EAP Custom 27011156 LANCET GRADY ORANGE BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27011157 EAP Custom 27011157 LINE CONNECTING 36 HP BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27011158 EAP Custom 27011158 LINE CONNECTING 48 HP BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27011160 EAP Custom 27011160 MASK SUB-MICRON SMALL BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27011161 EAP Custom 27011161 MED/SURG SEMI SUPPLIES BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 27011162 EAP Custom 27011162 MICROSPHERE EMBOGOLD 500-700 BOTH IP/OP $734.00 $543.50 $130.65 $734.00 $734.00 $734.00 $734.00 $734.00 $734.00 $734.00 $130.65 $734.00 $734.00 $544.77 $544.77 $565.77 $382.41 $152.97 $734.00 $293.60 $734.00 $734.00 $734.00 $734.00 $734.00 $550.50 $734.00 $734.00 $734.00 $367.00 $367.00 $581.33 $734.00 $587.20 $477.10 $734.00 $734.00 $425.72 $734.00 $440.40 $734.00 $734.00 $734.00 N/A N/A 27011163 EAP Custom 27011163 MICROSPHERE EMBOGOLD 700-900 BOTH IP/OP $734.00 $543.50 $130.65 $734.00 $734.00 $734.00 $734.00 $734.00 $734.00 $734.00 $130.65 $734.00 $734.00 $544.77 $544.77 $565.77 $382.41 $152.97 $734.00 $293.60 $734.00 $734.00 $734.00 $734.00 $734.00 $550.50 $734.00 $734.00 $734.00 $367.00 $367.00 $581.33 $734.00 $587.20 $477.10 $734.00 $734.00 $425.72 $734.00 $440.40 $734.00 $734.00 $734.00 N/A N/A 27011165 EAP Custom 27011165 NEEDLE CHIBA 22GA X 15CM BOTH IP/OP $82.00 $61.00 $14.60 $82.00 $82.00 $82.00 $82.00 $82.00 $82.00 $82.00 $14.60 $82.00 $82.00 $60.86 $60.86 $63.21 $42.72 $17.09 $82.00 $32.80 $82.00 $82.00 $82.00 $82.00 $82.00 $61.50 $82.00 $82.00 $82.00 $41.00 $41.00 $64.94 $82.00 $65.60 $53.30 $82.00 $82.00 $47.56 $82.00 $49.20 $82.00 $82.00 $82.00 N/A N/A 27011168 EAP Custom 27011168 NEEDLE PORT-CATH 20GA X 1 BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27011169 EAP Custom 27011169 NEEDLE PORT-CATH 20GA X 1 BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27011172 EAP Custom 27011172 OLCOTT TORQUE DEVICE BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27011176 EAP Custom 27011176 PERC GASTROSTOMY SET BOTH IP/OP "$1,079.00" $798.50 $192.06 "$1,079.00" "$1,079.00" "$1,079.00" "$1,079.00" "$1,079.00" "$1,079.00" "$1,079.00" $192.06 "$1,079.00" "$1,079.00" $800.83 $800.83 $831.69 $562.16 $224.88 "$1,079.00" $431.60 "$1,079.00" "$1,079.00" "$1,079.00" "$1,079.00" "$1,079.00" $809.25 "$1,079.00" "$1,079.00" "$1,079.00" $539.50 $539.50 $854.57 "$1,079.00" $863.20 $701.35 "$1,079.00" "$1,079.00" $625.82 "$1,079.00" $647.40 "$1,079.00" "$1,079.00" "$1,079.00" N/A N/A 27011177 EAP Custom 27011177 POLAR CATH INFLATION UNIT BOTH IP/OP "$7,912.00" "$5,855.00" "$1,408.34" "$7,912.00" "$7,912.00" "$7,912.00" "$7,912.00" "$7,912.00" "$7,912.00" "$7,912.00" "$1,408.34" "$7,912.00" "$7,912.00" "$4,181.12" "$4,181.12" "$6,098.57" "$2,060.15" "$1,648.95" "$7,912.00" "$3,164.80" "$7,912.00" "$7,912.00" "$7,912.00" "$7,912.00" "$7,912.00" "$5,934.00" "$7,912.00" "$7,912.00" "$7,912.00" "$3,956.00" "$3,956.00" "$6,266.30" "$7,912.00" "$6,329.60" "$5,142.80" "$7,912.00" "$7,912.00" "$4,588.96" "$7,912.00" "$4,747.20" "$7,912.00" "$7,912.00" "$7,912.00" N/A N/A 27011178 EAP Custom 27011178 PORT PERITONEAL/DRAIN/ASCITES BOTH IP/OP "$1,070.00" $792.00 $190.46 "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" $190.46 "$1,070.00" "$1,070.00" $794.15 $794.15 $824.76 $557.47 $223.00 "$1,070.00" $428.00 "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" $802.50 "$1,070.00" "$1,070.00" "$1,070.00" $535.00 $535.00 $847.44 "$1,070.00" $856.00 $695.50 "$1,070.00" "$1,070.00" $620.60 "$1,070.00" $642.00 "$1,070.00" "$1,070.00" "$1,070.00" N/A N/A 27011179 EAP Custom 27011179 PRESSURE TUBING BOTH IP/OP $555.00 $411.00 $98.79 $555.00 $555.00 $555.00 $555.00 $555.00 $555.00 $555.00 $98.79 $555.00 $555.00 $411.92 $411.92 $427.79 $289.16 $115.67 $555.00 $222.00 $555.00 $555.00 $555.00 $555.00 $555.00 $416.25 $555.00 $555.00 $555.00 $277.50 $277.50 $439.56 $555.00 $444.00 $360.75 $555.00 $555.00 $321.90 $555.00 $333.00 $555.00 $555.00 $555.00 N/A N/A 27011182 EAP Custom 27011182 RECOVERY CONE REMOVAL SYSTEM BOTH IP/OP "$1,985.00" "$1,469.00" $353.33 "$1,985.00" "$1,985.00" "$1,985.00" "$1,985.00" "$1,985.00" "$1,985.00" "$1,985.00" $353.33 "$1,985.00" "$1,985.00" "$1,473.27" "$1,473.27" "$1,530.04" "$1,034.19" $413.70 "$1,985.00" $794.00 "$1,985.00" "$1,985.00" "$1,985.00" "$1,985.00" "$1,985.00" "$1,488.75" "$1,985.00" "$1,985.00" "$1,985.00" $992.50 $992.50 "$1,572.12" "$1,985.00" "$1,588.00" "$1,290.25" "$1,985.00" "$1,985.00" "$1,151.30" "$1,985.00" "$1,191.00" "$1,985.00" "$1,985.00" "$1,985.00" N/A N/A 27011183 EAP Custom 27011183 RETENTION DEVICE 10FR BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27011184 EAP Custom 27011184 RETENTION DEVICE 12FR BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27011185 EAP Custom 27011185 RETENTION DEVICE 8FR BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27011190 EAP Custom 27011190 RING TRANSJUGULAR SET BOTH IP/OP "$1,404.00" "$1,039.00" $249.91 "$1,404.00" "$1,404.00" "$1,404.00" "$1,404.00" "$1,404.00" "$1,404.00" "$1,404.00" $249.91 "$1,404.00" "$1,404.00" "$1,042.05" "$1,042.05" "$1,082.20" $731.48 $292.61 "$1,404.00" $561.60 "$1,404.00" "$1,404.00" "$1,404.00" "$1,404.00" "$1,404.00" "$1,053.00" "$1,404.00" "$1,404.00" "$1,404.00" $702.00 $702.00 "$1,111.97" "$1,404.00" "$1,123.20" $912.60 "$1,404.00" "$1,404.00" $814.32 "$1,404.00" $842.40 "$1,404.00" "$1,404.00" "$1,404.00" N/A N/A 27011194 EAP Custom 27011194 SAFETY ANGIO KIT BOTH IP/OP $127.00 $94.00 $22.61 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $22.61 $127.00 $127.00 $94.26 $94.26 $97.89 $66.17 $26.47 $127.00 $50.80 $127.00 $127.00 $127.00 $127.00 $127.00 $95.25 $127.00 $127.00 $127.00 $63.50 $63.50 $100.58 $127.00 $101.60 $82.55 $127.00 $127.00 $73.66 $127.00 $76.20 $127.00 $127.00 $127.00 N/A N/A 27011195 EAP Custom 27011195 SAFETY PEG KIT MONI BOLSTER BOTH IP/OP "$1,497.00" "$1,108.00" $266.47 "$1,497.00" "$1,497.00" "$1,497.00" "$1,497.00" "$1,497.00" "$1,497.00" "$1,497.00" $266.47 "$1,497.00" "$1,497.00" "$1,111.07" "$1,111.07" "$1,153.89" $779.94 $311.99 "$1,497.00" $598.80 "$1,497.00" "$1,497.00" "$1,497.00" "$1,497.00" "$1,497.00" "$1,122.75" "$1,497.00" "$1,497.00" "$1,497.00" $748.50 $748.50 "$1,185.62" "$1,497.00" "$1,197.60" $973.05 "$1,497.00" "$1,497.00" $868.26 "$1,497.00" $898.20 "$1,497.00" "$1,497.00" "$1,497.00" N/A N/A 27011196 EAP Custom 27011196 SCAPLE SURG W/HANDLE ATTACHED BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27011197 EAP Custom 27011197 SET BLOOD ADMINISTRATION BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27011198 EAP Custom 27011198 SET BLOOD ADMINSTRATION BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27011199 EAP Custom 27011199 SET BLOOD ADMINSTRATION BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27011200 EAP Custom 27011200 SET LIVER BIOPSY LABS-100 BOTH IP/OP "$1,409.00" "$1,043.00" $250.80 "$1,409.00" "$1,409.00" "$1,409.00" "$1,409.00" "$1,409.00" "$1,409.00" "$1,409.00" $250.80 "$1,409.00" "$1,409.00" "$1,045.76" "$1,045.76" "$1,086.06" $734.09 $293.65 "$1,409.00" $563.60 "$1,409.00" "$1,409.00" "$1,409.00" "$1,409.00" "$1,409.00" "$1,056.75" "$1,409.00" "$1,409.00" "$1,409.00" $704.50 $704.50 "$1,115.93" "$1,409.00" "$1,127.20" $915.85 "$1,409.00" "$1,409.00" $817.22 "$1,409.00" $845.40 "$1,409.00" "$1,409.00" "$1,409.00" N/A N/A 27011201 EAP Custom 27011201 SET MEDIPORT INFUSION W/I BOTH IP/OP $36.00 $27.00 $6.41 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $6.41 $36.00 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27011202 EAP Custom 27011202 SET NEFF PERC ACCESS BOTH IP/OP $244.00 $181.00 $43.43 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $43.43 $244.00 $244.00 $181.10 $181.10 $188.08 $127.12 $50.85 $244.00 $97.60 $244.00 $244.00 $244.00 $244.00 $244.00 $183.00 $244.00 $244.00 $244.00 $122.00 $122.00 $193.25 $244.00 $195.20 $158.60 $244.00 $244.00 $141.52 $244.00 $146.40 $244.00 $244.00 $244.00 N/A N/A 27011203 EAP Custom 27011203 SET PCA MINI-BORE W/INT A BOTH IP/OP $44.00 $33.00 $7.83 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $7.83 $44.00 $44.00 $32.66 $32.66 $33.92 $22.92 $9.17 $44.00 $17.60 $44.00 $44.00 $44.00 $44.00 $44.00 $33.00 $44.00 $44.00 $44.00 $22.00 $22.00 $34.85 $44.00 $35.20 $28.60 $44.00 $44.00 $25.52 $44.00 $26.40 $44.00 $44.00 $44.00 N/A N/A 27011204 EAP Custom 27011204 SET SCALP VEIN INFUSION 21 G BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27011207 EAP Custom 27011207 SET SCALP VEIN INFUSION 2 BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27011208 EAP Custom 27011208 SET SECONDARY PIGGY BACK BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27011209 EAP Custom 27011209 SET URINARY DRAIN W/CONTA BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27011212 EAP Custom 27011212 SIMON-NITINOL VENA CAVA FILTE BOTH IP/OP "$3,605.00" "$2,668.00" $641.69 "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" $641.69 "$3,605.00" "$3,605.00" "$2,675.63" "$2,675.63" "$2,778.73" "$1,878.21" $751.32 "$3,605.00" "$1,442.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$2,703.75" "$3,605.00" "$3,605.00" "$3,605.00" "$1,802.50" "$1,802.50" "$2,855.16" "$3,605.00" "$2,884.00" "$2,343.25" "$3,605.00" "$3,605.00" "$2,090.90" "$3,605.00" "$2,163.00" "$3,605.00" "$3,605.00" "$3,605.00" N/A N/A 27011213 EAP Custom 27011213 SIMON-NITINOL VENA FILTER AN BOTH IP/OP "$3,085.00" "$2,283.00" $549.13 "$3,085.00" "$3,085.00" "$3,085.00" "$3,085.00" "$3,085.00" "$3,085.00" "$3,085.00" $549.13 "$3,085.00" "$3,085.00" "$2,289.69" "$2,289.69" "$2,377.92" "$1,607.29" $642.95 "$3,085.00" "$1,234.00" "$3,085.00" "$3,085.00" "$3,085.00" "$3,085.00" "$3,085.00" "$2,313.75" "$3,085.00" "$3,085.00" "$3,085.00" "$1,542.50" "$1,542.50" "$2,443.32" "$3,085.00" "$2,468.00" "$2,005.25" "$3,085.00" "$3,085.00" "$1,789.30" "$3,085.00" "$1,851.00" "$3,085.00" "$3,085.00" "$3,085.00" N/A N/A 27011214 EAP Custom 27011214 SKATER INTRODUCER SYSTEM BOTH IP/OP $254.00 $188.00 $45.21 $254.00 $254.00 $254.00 $254.00 $254.00 $254.00 $254.00 $45.21 $254.00 $254.00 $188.52 $188.52 $195.78 $132.33 $52.94 $254.00 $101.60 $254.00 $254.00 $254.00 $254.00 $254.00 $190.50 $254.00 $254.00 $254.00 $127.00 $127.00 $201.17 $254.00 $203.20 $165.10 $254.00 $254.00 $147.32 $254.00 $152.40 $254.00 $254.00 $254.00 N/A N/A 27011215 EAP HCPCS C1729 SKATER NEPHRO CATH 8FR X 35CM BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 27011216 EAP Custom 27011216 SNARE AMPLATZ 10MM BOTH IP/OP $916.00 $678.00 $163.05 $916.00 $916.00 $916.00 $916.00 $916.00 $916.00 $916.00 $163.05 $916.00 $916.00 $679.86 $679.86 $706.05 $477.24 $190.90 $916.00 $366.40 $916.00 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $595.40 $916.00 $916.00 $531.28 $916.00 $549.60 $916.00 $916.00 $916.00 N/A N/A 27011217 EAP Custom 27011217 SNARE AMPLATZ 5MM BOTH IP/OP $916.00 $678.00 $163.05 $916.00 $916.00 $916.00 $916.00 $916.00 $916.00 $916.00 $163.05 $916.00 $916.00 $679.86 $679.86 $706.05 $477.24 $190.90 $916.00 $366.40 $916.00 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $595.40 $916.00 $916.00 $531.28 $916.00 $549.60 $916.00 $916.00 $916.00 N/A N/A 27011226 EAP Custom 27011226 SPONGE GELFOAM GELATIN BOTH IP/OP $85.00 $63.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 $85.00 $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 27011227 EAP HCPCS C1876 STENT VASCULAR COVERA COVERED 10MM X 60MM 80CM DELIVERY BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" "$6,750.00" "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A 27011228 EAP Custom 27011228 STENT LUMINEX 12X60 BOTH IP/OP "$3,986.00" "$2,950.00" $709.51 "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" $709.51 "$3,986.00" "$3,986.00" "$2,958.41" "$2,958.41" "$3,072.41" "$2,060.15" $830.73 "$3,986.00" "$1,594.40" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$2,989.50" "$3,986.00" "$3,986.00" "$3,986.00" "$1,993.00" "$1,993.00" "$3,156.91" "$3,986.00" "$3,188.80" "$2,590.90" "$3,986.00" "$3,986.00" "$2,311.88" "$3,986.00" "$2,391.60" "$3,986.00" "$3,986.00" "$3,986.00" N/A N/A 27011229 EAP Custom 27011229 STENT LUMINEXX 7X30 BOTH IP/OP "$3,986.00" "$2,950.00" $709.51 "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" $709.51 "$3,986.00" "$3,986.00" "$2,958.41" "$2,958.41" "$3,072.41" "$2,060.15" $830.73 "$3,986.00" "$1,594.40" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$2,989.50" "$3,986.00" "$3,986.00" "$3,986.00" "$1,993.00" "$1,993.00" "$3,156.91" "$3,986.00" "$3,188.80" "$2,590.90" "$3,986.00" "$3,986.00" "$2,311.88" "$3,986.00" "$2,391.60" "$3,986.00" "$3,986.00" "$3,986.00" N/A N/A 27011230 EAP Custom 27011230 STENT LUMINEXX 7X40 BOTH IP/OP "$3,986.00" "$2,950.00" $709.51 "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" $709.51 "$3,986.00" "$3,986.00" "$2,958.41" "$2,958.41" "$3,072.41" "$2,060.15" $830.73 "$3,986.00" "$1,594.40" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$2,989.50" "$3,986.00" "$3,986.00" "$3,986.00" "$1,993.00" "$1,993.00" "$3,156.91" "$3,986.00" "$3,188.80" "$2,590.90" "$3,986.00" "$3,986.00" "$2,311.88" "$3,986.00" "$2,391.60" "$3,986.00" "$3,986.00" "$3,986.00" N/A N/A 27011231 EAP Custom 27011231 STENT LUMINEXX 8X40 BOTH IP/OP "$3,986.00" "$2,950.00" $709.51 "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" $709.51 "$3,986.00" "$3,986.00" "$2,958.41" "$2,958.41" "$3,072.41" "$2,060.15" $830.73 "$3,986.00" "$1,594.40" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$2,989.50" "$3,986.00" "$3,986.00" "$3,986.00" "$1,993.00" "$1,993.00" "$3,156.91" "$3,986.00" "$3,188.80" "$2,590.90" "$3,986.00" "$3,986.00" "$2,311.88" "$3,986.00" "$2,391.60" "$3,986.00" "$3,986.00" "$3,986.00" N/A N/A 27011232 EAP Custom 27011232 STENT LUMINEXX STENT 8X30 BOTH IP/OP "$3,986.00" "$2,950.00" $709.51 "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" $709.51 "$3,986.00" "$3,986.00" "$2,958.41" "$2,958.41" "$3,072.41" "$2,060.15" $830.73 "$3,986.00" "$1,594.40" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$2,989.50" "$3,986.00" "$3,986.00" "$3,986.00" "$1,993.00" "$1,993.00" "$3,156.91" "$3,986.00" "$3,188.80" "$2,590.90" "$3,986.00" "$3,986.00" "$2,311.88" "$3,986.00" "$2,391.60" "$3,986.00" "$3,986.00" "$3,986.00" N/A N/A 27011234 EAP Custom 27011234 STOPCOCK 1-WAY HP BOTH IP/OP $14.00 $10.50 $2.49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $2.49 $14.00 $14.00 $10.39 $10.39 $10.79 $7.29 $2.92 $14.00 $5.60 $14.00 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $9.10 $14.00 $14.00 $8.12 $14.00 $8.40 $14.00 $14.00 $14.00 N/A N/A 27011236 EAP Custom 27011236 STOPCOCK 3-WAY HP BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27011237 EAP Custom 27011237 "SUPPLIES, NON-STERILE PENUMBRA" BOTH IP/OP $66.00 $49.00 $11.75 $66.00 $66.00 $66.00 $66.00 $66.00 $66.00 $66.00 $11.75 $66.00 $66.00 $48.99 $48.99 $50.87 $34.39 $13.76 $66.00 $26.40 $66.00 $66.00 $66.00 $66.00 $66.00 $49.50 $66.00 $66.00 $66.00 $33.00 $33.00 $52.27 $66.00 $52.80 $42.90 $66.00 $66.00 $38.28 $66.00 $39.60 $66.00 $66.00 $66.00 N/A N/A 27011241 EAP Custom 27011241 THREAPULSE II BOTH IP/OP $581.00 $430.00 $103.42 $581.00 $581.00 $581.00 $581.00 $581.00 $581.00 $581.00 $103.42 $581.00 $581.00 $431.22 $431.22 $447.83 $302.70 $121.09 $581.00 $232.40 $581.00 $581.00 $581.00 $581.00 $581.00 $435.75 $581.00 $581.00 $581.00 $290.50 $290.50 $460.15 $581.00 $464.80 $377.65 $581.00 $581.00 $336.98 $581.00 $348.60 $581.00 $581.00 $581.00 N/A N/A 27011242 EAP Custom 27011242 TRAY CATHETER URETHRAL 14 BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27011243 EAP Custom 27011243 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27011244 EAP Custom 27011244 TRAY FOLEY PERCONNECTED 1 BOTH IP/OP $60.00 $44.50 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 $60.00 $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A 27011245 EAP Custom 27011245 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27011246 EAP Custom 27011246 TRAY FOLEY PRECONNECTED 1 BOTH IP/OP $60.00 $44.50 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 $60.00 $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A 27011252 EAP Custom 27011252 TRIPLE LUMEN CATHETER SIZE 24 BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 $250.00 $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 27011253 EAP Custom 27011253 TUBE FEEDING NG 8FR 43IN EN BOTH IP/OP $68.00 $50.50 $12.10 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $12.10 $68.00 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $27.20 $68.00 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $68.00 $68.00 $39.44 $68.00 $40.80 $68.00 $68.00 $68.00 N/A N/A 27011254 EAP Custom 27011254 TUBE FEEDING NG 8FR 36IN ENTR BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 27011255 EAP Custom 27011255 TUBE GASTROSTOMY 18FR BOTH IP/OP $80.00 $59.50 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 27011256 EAP Custom 27011256 TUBE GASTROSTOMY 22FR BOTH IP/OP $76.00 $56.50 $13.53 $76.00 $76.00 $76.00 $76.00 $76.00 $76.00 $76.00 $13.53 $76.00 $76.00 $56.41 $56.41 $58.58 $39.60 $15.84 $76.00 $30.40 $76.00 $76.00 $76.00 $76.00 $76.00 $57.00 $76.00 $76.00 $76.00 $38.00 $38.00 $60.19 $76.00 $60.80 $49.40 $76.00 $76.00 $44.08 $76.00 $45.60 $76.00 $76.00 $76.00 N/A N/A 27011257 EAP Custom 27011257 TUBE JEJUNAL FEEDING 18 FR O.D BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 $300.00 $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 27011258 EAP Custom 27011258 TUBE JEJUNOSTOMY FEED 14 FR BOTH IP/OP $501.00 $371.00 $89.18 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $89.18 $501.00 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $200.40 $501.00 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $501.00 $501.00 $290.58 $501.00 $300.60 $501.00 $501.00 $501.00 N/A N/A 27011259 EAP Custom 27011259 TUBE SALEM SILICONE SIZE BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27011260 EAP Custom 27011260 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27011261 EAP Custom 27011261 TUBE TJ FEEDING 18 FR 45CM END BOTH IP/OP $651.00 $482.00 $115.88 $651.00 $651.00 $651.00 $651.00 $651.00 $651.00 $651.00 $115.88 $651.00 $651.00 $483.17 $483.17 $501.79 $339.17 $135.68 $651.00 $260.40 $651.00 $651.00 $651.00 $651.00 $651.00 $488.25 $651.00 $651.00 $651.00 $325.50 $325.50 $515.59 $651.00 $520.80 $423.15 $651.00 $651.00 $377.58 $651.00 $390.60 $651.00 $651.00 $651.00 N/A N/A 27011262 EAP Custom 27011262 TUBE TJ FEEDING 22 FR 45CM END BOTH IP/OP $651.00 $482.00 $115.88 $651.00 $651.00 $651.00 $651.00 $651.00 $651.00 $651.00 $115.88 $651.00 $651.00 $483.17 $483.17 $501.79 $339.17 $135.68 $651.00 $260.40 $651.00 $651.00 $651.00 $651.00 $651.00 $488.25 $651.00 $651.00 $651.00 $325.50 $325.50 $515.59 $651.00 $520.80 $423.15 $651.00 $651.00 $377.58 $651.00 $390.60 $651.00 $651.00 $651.00 N/A N/A 27011263 EAP Custom 27011263 TUBES EXTENSION PLAIN PLA BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27011265 EAP Custom 27011265 TUBES EXTENSION PLAIN PLA BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27011266 EAP Custom 27011266 TUBES SALEM SUMP 48 LENG BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27011267 EAP Custom 27011267 ULTRASOUND PROBE COVERS BOTH IP/OP $46.00 $34.50 $8.19 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $8.19 $46.00 $46.00 $34.14 $34.14 $35.46 $23.97 $9.59 $46.00 $18.40 $46.00 $46.00 $46.00 $46.00 $46.00 $34.50 $46.00 $46.00 $46.00 $23.00 $23.00 $36.43 $46.00 $36.80 $29.90 $46.00 $46.00 $26.68 $46.00 $27.60 $46.00 $46.00 $46.00 N/A N/A 27011268 EAP Custom 27011268 VALVE REFLUX BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27011269 EAP Custom 27011269 VALVE REFLUX BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27011270 EAP Custom 27011270 .014 NITREX GUIDEWIRE BOTH IP/OP "$1,219.00" $902.50 $216.98 "$1,219.00" "$1,219.00" "$1,219.00" "$1,219.00" "$1,219.00" "$1,219.00" "$1,219.00" $216.98 "$1,219.00" "$1,219.00" $904.74 $904.74 $939.61 $635.10 $254.05 "$1,219.00" $487.60 "$1,219.00" "$1,219.00" "$1,219.00" "$1,219.00" "$1,219.00" $914.25 "$1,219.00" "$1,219.00" "$1,219.00" $609.50 $609.50 $965.45 "$1,219.00" $975.20 $792.35 "$1,219.00" "$1,219.00" $707.02 "$1,219.00" $731.40 "$1,219.00" "$1,219.00" "$1,219.00" N/A N/A 27011301 EAP Custom 27011301 DRSG ANTI SFT SIL 8X20 20X50CM BOTH IP/OP $248.00 $184.00 $44.14 $248.00 $248.00 $248.00 $248.00 $248.00 $248.00 $248.00 $44.14 $248.00 $248.00 $184.07 $184.07 $191.16 $129.21 $51.69 $248.00 $99.20 $248.00 $248.00 $248.00 $248.00 $248.00 $186.00 $248.00 $248.00 $248.00 $124.00 $124.00 $196.42 $248.00 $198.40 $161.20 $248.00 $248.00 $143.84 $248.00 $148.80 $248.00 $248.00 $248.00 N/A N/A 27011302 EAP Custom 27011302 DRSG ANTI SFT SIL 8X20 20X50CM BOTH IP/OP $248.00 $184.00 $44.14 $248.00 $248.00 $248.00 $248.00 $248.00 $248.00 $248.00 $44.14 $248.00 $248.00 $184.07 $184.07 $191.16 $129.21 $51.69 $248.00 $99.20 $248.00 $248.00 $248.00 $248.00 $248.00 $186.00 $248.00 $248.00 $248.00 $124.00 $124.00 $196.42 $248.00 $198.40 $161.20 $248.00 $248.00 $143.84 $248.00 $148.80 $248.00 $248.00 $248.00 N/A N/A 27011304 EAP Custom 27011304 BLOOD ADMINISTRATION SET BOTH IP/OP $111.00 $82.50 $19.76 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $19.76 $111.00 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $44.40 $111.00 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $111.00 $111.00 $64.38 $111.00 $66.60 $111.00 $111.00 $111.00 N/A N/A 27011305 EAP Custom 27011305 DRSNG ANTI SFT SIL 6X6 15X15CM BOTH IP/OP $63.00 $47.00 $11.21 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $11.21 $63.00 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $25.20 $63.00 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $31.50 $31.50 $49.90 $63.00 $50.40 $40.95 $63.00 $63.00 $36.54 $63.00 $37.80 $63.00 $63.00 $63.00 N/A N/A 27011306 EAP Custom 27011306 DRSNG ANTI SFT SIL 6X6 15X15CM BOTH IP/OP $63.00 $47.00 $11.21 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $11.21 $63.00 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $25.20 $63.00 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $31.50 $31.50 $49.90 $63.00 $50.40 $40.95 $63.00 $63.00 $36.54 $63.00 $37.80 $63.00 $63.00 $63.00 N/A N/A 27011308 EAP Custom 27011308 DRSNG ANTI SFT SIL 4X4 10X10CM BOTH IP/OP $28.00 $21.00 $4.98 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $4.98 $28.00 $28.00 $20.78 $20.78 $21.58 $14.59 $5.84 $28.00 $11.20 $28.00 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $18.20 $28.00 $28.00 $16.24 $28.00 $16.80 $28.00 $28.00 $28.00 N/A N/A 27011309 EAP Custom 27011309 DRSNG ANTI SFT SIL 4X4 10X10CM BOTH IP/OP $28.00 $21.00 $4.98 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $4.98 $28.00 $28.00 $20.78 $20.78 $21.58 $14.59 $5.84 $28.00 $11.20 $28.00 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $18.20 $28.00 $28.00 $16.24 $28.00 $16.80 $28.00 $28.00 $28.00 N/A N/A 27011310 EAP HCPCS C1769 VOLCANO COMBOWIRE BOTH IP/OP "$3,669.00" "$2,715.50" $728.20 "$3,669.00" "$1,992.27" "$1,992.27" "$1,992.27" "$1,992.27" "$3,669.00" "$3,669.00" "$3,669.00" $764.71 "$3,669.00" "$2,723.13" "$2,723.13" "$2,828.07" "$1,911.55" $764.66 "$3,669.00" "$3,669.00" "$2,170.21" "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" "$2,751.75" "$3,669.00" "$3,669.00" "$3,669.00" "$1,834.50" "$1,834.50" "$2,905.85" "$3,669.00" "$2,935.20" "$2,384.85" $728.20 "$3,669.00" "$2,128.02" "$3,669.00" "$3,669.00" "$3,669.00" $764.62 "$3,669.00" N/A N/A 27011320 EAP Custom 27011320 TUBES SALEM SUMP 48 LENG BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27011323 EAP Custom 27011323 JCD 9.0-38-20 BOTH IP/OP $42.00 $31.50 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $7.48 $42.00 $42.00 $31.17 $31.17 $32.37 $21.88 $8.75 $42.00 $16.80 $42.00 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $27.30 $42.00 $42.00 $24.36 $42.00 $25.20 $42.00 $42.00 $42.00 N/A N/A 27011325 EAP Custom 27011325 TUBE SALEM SUMP 48 LENGT BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27011326 EAP Custom 27011326 TUBES SALEM SUMP 48 LENG BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27011327 EAP Custom 27011327 JCD 9.0-38-20 BOTH IP/OP $42.00 $31.50 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $7.48 $42.00 $42.00 $31.17 $31.17 $32.37 $21.88 $8.75 $42.00 $16.80 $42.00 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $27.30 $42.00 $42.00 $24.36 $42.00 $25.20 $42.00 $42.00 $42.00 N/A N/A 27011328 EAP Custom 27011328 JCD 6.0-38-20 BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27011401 EAP Custom 27011401 SUPER ARROW FLEX INTRODUCER - BOTH IP/OP $251.00 $186.00 $44.68 $251.00 $251.00 $251.00 $251.00 $251.00 $251.00 $251.00 $44.68 $251.00 $251.00 $186.29 $186.29 $193.47 $130.77 $52.31 $251.00 $100.40 $251.00 $251.00 $251.00 $251.00 $251.00 $188.25 $251.00 $251.00 $251.00 $125.50 $125.50 $198.79 $251.00 $200.80 $163.15 $251.00 $251.00 $145.58 $251.00 $150.60 $251.00 $251.00 $251.00 N/A N/A 27011410 EAP Custom 27011410 TUBE TRACH #8 DCT BOTH IP/OP $131.00 $97.00 $23.32 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $23.32 $131.00 $131.00 $97.23 $97.23 $100.97 $68.25 $27.30 $131.00 $52.40 $131.00 $131.00 $131.00 $131.00 $131.00 $98.25 $131.00 $131.00 $131.00 $65.50 $65.50 $103.75 $131.00 $104.80 $85.15 $131.00 $131.00 $75.98 $131.00 $78.60 $131.00 $131.00 $131.00 N/A N/A 27011411 EAP Custom 27011411 TUBE TRACHE 8-DCFS BOTH IP/OP $126.00 $93.50 $22.43 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $22.43 $126.00 $126.00 $93.52 $93.52 $97.12 $65.65 $26.26 $126.00 $50.40 $126.00 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $81.90 $126.00 $126.00 $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 27011413 EAP Custom 27011413 BAG RESUSITATOR ADULT BOTH IP/OP $38.00 $28.50 $6.76 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 27011421 EAP Custom 27011421 BLADE ON TITANIUM LOPRO S3 BOTH IP/OP $95.00 $70.50 $16.91 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $16.91 $95.00 $95.00 $70.51 $70.51 $73.23 $49.50 $19.80 $95.00 $38.00 $95.00 $95.00 $95.00 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $61.75 $95.00 $95.00 $55.10 $95.00 $57.00 $95.00 $95.00 $95.00 N/A N/A 27011422 EAP Custom 27011422 BLADE ON TITANIUM LOPRO S4 BOTH IP/OP $95.00 $70.50 $16.91 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $16.91 $95.00 $95.00 $70.51 $70.51 $73.23 $49.50 $19.80 $95.00 $38.00 $95.00 $95.00 $95.00 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $61.75 $95.00 $95.00 $55.10 $95.00 $57.00 $95.00 $95.00 $95.00 N/A N/A 27011423 EAP Custom 27011423 KIT 135CM 2.7FR 20MM IMG 1 SYR RAPEX TIP RADIOPQ BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 27011425 EAP Custom 27011425 MIC TRANSGASTRIC JEJUNAL FEEDING KIT 18F 45CM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $500.00 $500.00 $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 27011428 EAP TUBE GSTRM 12FR 10CM 5-7ML ENTUIT BLN RTNT BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27011429 EAP TUBE FD STD 14FR 10CM 5ML ENTUIT THRIVE BLN RTNT SM GSTRM BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27011430 EAP TUBE FD STD 16FR 10CM 5ML ENTUIT THRIVE BLN RTNT MED GSTRM BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27011431 EAP TUBE GSTRM STD 18FR 10CM 5ML 60ML ENTUIT THRIVE BLN RTNT BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27011432 EAP TUBE FD STD 20FR 10CM 20ML ENTUIT THRIVE BLN RTNT LG GSTRM BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27011433 EAP TUBE FD STD 22FR 10CM 20ML ENTUIT THRIVE BLN RTNT LG GSTRM BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27011434 EAP TUBE FD STD 24FR 10CM 20ML ENTUIT THRIVE BLN RTNT LG GSTRM BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27011435 EAP KIT TRACHEOSTOMY 12.3MM 9MM COMPLETE SET INNER CANNU BOTH IP/OP "$1,255.00" $929.00 $223.39 "$1,255.00" "$1,255.00" "$1,255.00" "$1,255.00" "$1,255.00" "$1,255.00" "$1,255.00" $223.39 "$1,255.00" "$1,255.00" $931.46 $931.46 $967.35 $653.86 $261.56 "$1,255.00" $502.00 "$1,255.00" "$1,255.00" "$1,255.00" "$1,255.00" "$1,255.00" $941.25 "$1,255.00" "$1,255.00" "$1,255.00" $627.50 $627.50 $993.96 "$1,255.00" "$1,004.00" $815.75 "$1,255.00" "$1,255.00" $727.90 "$1,255.00" $753.00 "$1,255.00" "$1,255.00" "$1,255.00" N/A N/A 27011437 EAP Custom 27011437 BLANKET WRM 84X36IN CLR STRL LF 24X48IN 3M BR HGR FULL ACC BOTH IP/OP $63.00 $47.00 $11.21 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $11.21 $63.00 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $25.20 $63.00 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $31.50 $31.50 $49.90 $63.00 $50.40 $40.95 $63.00 $63.00 $36.54 $63.00 $37.80 $63.00 $63.00 $63.00 N/A N/A 27100021 EAP Custom 27100021 PAD GEL HYPO-HYPERTHERMIA LARGE BOTH IP/OP "$2,481.00" "$1,836.00" $441.62 "$2,481.00" "$2,481.00" "$2,481.00" "$2,481.00" "$2,481.00" "$2,481.00" "$2,481.00" $441.62 "$2,481.00" "$2,481.00" "$1,841.40" "$1,841.40" "$1,912.35" "$1,292.60" $517.07 "$2,481.00" $992.40 "$2,481.00" "$2,481.00" "$2,481.00" "$2,481.00" "$2,481.00" "$1,860.75" "$2,481.00" "$2,481.00" "$2,481.00" "$1,240.50" "$1,240.50" "$1,964.95" "$2,481.00" "$1,984.80" "$1,612.65" "$2,481.00" "$2,481.00" "$1,438.98" "$2,481.00" "$1,488.60" "$2,481.00" "$2,481.00" "$2,481.00" N/A N/A 27100022 EAP HCPCS A4467 POSTERIOR ELBOW SPLINT BOTH IP/OP $112.00 $83.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $83.13 $83.13 $86.33 $58.35 $23.34 $112.00 $44.80 $112.00 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $72.80 $112.00 $112.00 $64.96 $112.00 $67.20 $112.00 $112.00 $112.00 N/A N/A 27100023 EAP Custom 27100023 MÖLNLYCKE Z-FLO FLUIDIZED POSITIONER PAD BOTH IP/OP $122.00 $90.50 $21.72 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $21.72 $122.00 $122.00 $90.55 $90.55 $94.04 $63.56 $25.43 $122.00 $48.80 $122.00 $122.00 $122.00 $122.00 $122.00 $91.50 $122.00 $122.00 $122.00 $61.00 $61.00 $96.62 $122.00 $97.60 $79.30 $122.00 $122.00 $70.76 $122.00 $73.20 $122.00 $122.00 $122.00 N/A N/A 27100040 EAP SUP ORTHO UNIVERSAL ABD BINDER VELCRO CLOSURE BOTH IP/OP $538.00 $398.50 $95.76 $538.00 $538.00 $538.00 $538.00 $538.00 $538.00 $538.00 $95.76 $538.00 $538.00 $399.30 $399.30 $414.69 $280.30 $112.13 $538.00 $215.20 $538.00 $538.00 $538.00 $538.00 $538.00 $403.50 $538.00 $538.00 $538.00 $269.00 $269.00 $426.10 $538.00 $430.40 $349.70 $538.00 $538.00 $312.04 $538.00 $322.80 $538.00 $538.00 $538.00 N/A N/A 27200003 EAP Custom 27200003 CHEST UNIT DRAINAGE PLEUR BOTH IP/OP $76.00 $56.50 $13.53 $76.00 $76.00 $76.00 $76.00 $76.00 $76.00 $76.00 $13.53 $76.00 $76.00 $56.41 $56.41 $58.58 $39.60 $15.84 $76.00 $30.40 $76.00 $76.00 $76.00 $76.00 $76.00 $57.00 $76.00 $76.00 $76.00 $38.00 $38.00 $60.19 $76.00 $60.80 $49.40 $76.00 $76.00 $44.08 $76.00 $45.60 $76.00 $76.00 $76.00 N/A N/A 27200008 EAP HCPCS C1769 .014 NITREX GUIDEWIRE BOTH IP/OP "$1,295.00" $958.50 $257.03 "$1,295.00" $703.19 $703.19 $703.19 $703.19 "$1,295.00" "$1,295.00" "$1,295.00" $269.91 "$1,295.00" $961.15 $961.15 $998.19 $674.70 $269.89 "$1,295.00" "$1,295.00" $765.99 "$1,295.00" "$1,295.00" "$1,295.00" "$1,295.00" $971.25 "$1,295.00" "$1,295.00" "$1,295.00" $647.50 $647.50 "$1,025.64" "$1,295.00" "$1,036.00" $841.75 $257.03 "$1,295.00" $751.10 "$1,295.00" "$1,295.00" "$1,295.00" $269.88 "$1,295.00" N/A N/A 27200011 EAP HCPCS C1729 CATHETER FOLEY 16FR BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 27200019 EAP HCPCS C1729 CATHETER FOLEY 5CC 14FR BOTH IP/OP $6.00 $4.50 $1.19 $6.00 $3.26 $3.26 $3.26 $3.26 $6.00 $6.00 $6.00 $1.25 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $6.00 $3.55 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $1.19 $6.00 $3.48 $6.00 $6.00 $6.00 $1.25 $6.00 N/A N/A 27200021 EAP HCPCS C1729 CATHETER FOLEY 30CC 28FR BOTH IP/OP $36.00 $27.00 $7.15 $36.00 $19.55 $19.55 $19.55 $19.55 $36.00 $36.00 $36.00 $7.50 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $36.00 $21.29 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $7.15 $36.00 $20.88 $36.00 $36.00 $36.00 $7.50 $36.00 N/A N/A 27200024 EAP HCPCS C1729 CATHETER FOLEY 3CC 10 FR BOTH IP/OP $34.00 $25.50 $6.75 $34.00 $18.46 $18.46 $18.46 $18.46 $34.00 $34.00 $34.00 $7.09 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $34.00 $20.11 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $6.75 $34.00 $19.72 $34.00 $34.00 $34.00 $7.09 $34.00 N/A N/A 27200025 EAP HCPCS C1729 CATHETER FOLEY 5CC 12FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27200026 EAP Custom 27200026 DRESS SOFSORB ABSORB BUTTOC SM BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 27200027 EAP Custom 27200027 DRESS SOFSORB ABSORB BUTTO LG BOTH IP/OP $97.00 $72.00 $17.27 $97.00 $97.00 $97.00 $97.00 $97.00 $97.00 $97.00 $17.27 $97.00 $97.00 $71.99 $71.99 $74.77 $50.54 $20.22 $97.00 $38.80 $97.00 $97.00 $97.00 $97.00 $97.00 $72.75 $97.00 $97.00 $97.00 $48.50 $48.50 $76.82 $97.00 $77.60 $63.05 $97.00 $97.00 $56.26 $97.00 $58.20 $97.00 $97.00 $97.00 N/A N/A 27200028 EAP Custom 27200028 DRESS SOFSORB ABSORB CHEST SSM BOTH IP/OP $41.00 $30.50 $7.30 $41.00 $41.00 $41.00 $41.00 $41.00 $41.00 $41.00 $7.30 $41.00 $41.00 $30.43 $30.43 $31.60 $21.36 $8.54 $41.00 $16.40 $41.00 $41.00 $41.00 $41.00 $41.00 $30.75 $41.00 $41.00 $41.00 $20.50 $20.50 $32.47 $41.00 $32.80 $26.65 $41.00 $41.00 $23.78 $41.00 $24.60 $41.00 $41.00 $41.00 N/A N/A 27200029 EAP Custom 27200029 DRESS SOFSORB ABSORS CHEST ILG BOTH IP/OP $41.00 $30.50 $7.30 $41.00 $41.00 $41.00 $41.00 $41.00 $41.00 $41.00 $7.30 $41.00 $41.00 $30.43 $30.43 $31.60 $21.36 $8.54 $41.00 $16.40 $41.00 $41.00 $41.00 $41.00 $41.00 $30.75 $41.00 $41.00 $41.00 $20.50 $20.50 $32.47 $41.00 $32.80 $26.65 $41.00 $41.00 $23.78 $41.00 $24.60 $41.00 $41.00 $41.00 N/A N/A 27200030 EAP Custom 27200030 DRESS SOFSORB ABSORB XL CHEST BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27200031 EAP Custom 27200031 DRESSING LEG/HIP ADULT BOTH IP/OP $87.00 $64.50 $15.49 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $15.49 $87.00 $87.00 $64.57 $64.57 $67.06 $45.33 $18.13 $87.00 $34.80 $87.00 $87.00 $87.00 $87.00 $87.00 $65.25 $87.00 $87.00 $87.00 $43.50 $43.50 $68.90 $87.00 $69.60 $56.55 $87.00 $87.00 $50.46 $87.00 $52.20 $87.00 $87.00 $87.00 N/A N/A 27200032 EAP Custom 27200032 DRESSING BURN GAUZE 17 PLY 36' BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27200033 EAP HCPCS C1751 KIT CATH TRIPLE LUMEN 5.5 PEDI BOTH IP/OP $159.00 $118.00 $31.56 $159.00 $86.34 $86.34 $86.34 $86.34 $159.00 $159.00 $159.00 $33.14 $159.00 $118.01 $118.01 $122.56 $82.84 $33.14 $159.00 $159.00 $94.05 $159.00 $159.00 $159.00 $159.00 $119.25 $159.00 $159.00 $159.00 $79.50 $79.50 $125.93 $159.00 $127.20 $103.35 $31.56 $159.00 $92.22 $159.00 $159.00 $159.00 $33.14 $159.00 N/A N/A 27200035 EAP HCPCS C1751 FEMORAL ARTERIAL LINE CATH KIT BOTH IP/OP $873.00 $646.50 $173.27 $873.00 $474.04 $474.04 $474.04 $474.04 $873.00 $873.00 $873.00 $181.96 $873.00 $647.94 $647.94 $672.91 $454.83 $181.94 $873.00 $873.00 $516.38 $873.00 $873.00 $873.00 $873.00 $654.75 $873.00 $873.00 $873.00 $436.50 $436.50 $691.42 $873.00 $698.40 $567.45 $173.27 $873.00 $506.34 $873.00 $873.00 $873.00 $181.93 $873.00 N/A N/A 27200040 EAP Custom 27200040 KIT TRANSDUCER MONITORING BOTH IP/OP $145.00 $107.50 $25.81 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $25.81 $145.00 $145.00 $107.62 $107.62 $111.77 $75.55 $30.22 $145.00 $58.00 $145.00 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $94.25 $145.00 $145.00 $84.10 $145.00 $87.00 $145.00 $145.00 $145.00 N/A N/A 27200041 EAP Custom 27200041 KIT PRESSURE MONITORING BOTH IP/OP $108.00 $80.00 $19.22 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $19.22 $108.00 $108.00 $80.16 $80.16 $83.25 $56.27 $22.51 $108.00 $43.20 $108.00 $108.00 $108.00 $108.00 $108.00 $81.00 $108.00 $108.00 $108.00 $54.00 $54.00 $85.54 $108.00 $86.40 $70.20 $108.00 $108.00 $62.64 $108.00 $64.80 $108.00 $108.00 $108.00 N/A N/A 27200043 EAP HCPCS C1729 CATHETER FOLEY 16FR BOTH IP/OP $6.00 $4.50 $1.19 $6.00 $3.26 $3.26 $3.26 $3.26 $6.00 $6.00 $6.00 $1.25 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $6.00 $3.55 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $1.19 $6.00 $3.48 $6.00 $6.00 $6.00 $1.25 $6.00 N/A N/A 27200045 EAP Custom 27200045 PARACENTESIS TRAY BOTH IP/OP $214.00 $158.50 $38.09 $214.00 $214.00 $214.00 $214.00 $214.00 $214.00 $214.00 $38.09 $214.00 $214.00 $158.83 $158.83 $164.95 $111.49 $44.60 $214.00 $85.60 $214.00 $214.00 $214.00 $214.00 $214.00 $160.50 $214.00 $214.00 $214.00 $107.00 $107.00 $169.49 $214.00 $171.20 $139.10 $214.00 $214.00 $124.12 $214.00 $128.40 $214.00 $214.00 $214.00 N/A N/A 27200047 EAP Custom 27200047 BILIARY PLASTIC STENTS BOTH IP/OP "$1,091.00" $807.50 $194.20 "$1,091.00" "$1,091.00" "$1,091.00" "$1,091.00" "$1,091.00" "$1,091.00" "$1,091.00" $194.20 "$1,091.00" "$1,091.00" $809.74 $809.74 $840.94 $568.41 $227.38 "$1,091.00" $436.40 "$1,091.00" "$1,091.00" "$1,091.00" "$1,091.00" "$1,091.00" $818.25 "$1,091.00" "$1,091.00" "$1,091.00" $545.50 $545.50 $864.07 "$1,091.00" $872.80 $709.15 "$1,091.00" "$1,091.00" $632.78 "$1,091.00" $654.60 "$1,091.00" "$1,091.00" "$1,091.00" N/A N/A 27200048 EAP HCPCS C1769 HYDRATOMES RX CANNULATING SPHI BOTH IP/OP "$3,556.00" "$2,631.50" $705.78 "$3,556.00" "$1,930.91" "$1,930.91" "$1,930.91" "$1,930.91" "$3,556.00" "$3,556.00" "$3,556.00" $741.16 "$3,556.00" "$2,639.26" "$2,639.26" "$2,740.96" "$1,852.68" $741.11 "$3,556.00" "$3,556.00" "$2,103.37" "$3,556.00" "$3,556.00" "$3,556.00" "$3,556.00" "$2,667.00" "$3,556.00" "$3,556.00" "$3,556.00" "$1,778.00" "$1,778.00" "$2,816.35" "$3,556.00" "$2,844.80" "$2,311.40" $705.78 "$3,556.00" "$2,062.48" "$3,556.00" "$3,556.00" "$3,556.00" $741.07 "$3,556.00" N/A N/A 27200049 EAP HCPCS C1769 JAGTOMES RX CANNULATING SPHINC BOTH IP/OP "$1,255.00" $929.00 $249.09 "$1,255.00" $681.47 $681.47 $681.47 $681.47 "$1,255.00" "$1,255.00" "$1,255.00" $261.57 "$1,255.00" $931.46 $931.46 $967.35 $653.86 $261.56 "$1,255.00" $502.00 $742.33 "$1,255.00" "$1,255.00" "$1,255.00" "$1,255.00" $941.25 "$1,255.00" "$1,255.00" "$1,255.00" $627.50 $627.50 $993.96 "$1,255.00" "$1,004.00" $815.75 $249.09 "$1,255.00" $727.90 "$1,255.00" "$1,255.00" "$1,255.00" $261.54 "$1,255.00" N/A N/A 27200050 EAP Custom 27200050 EXTRACTOR BALLOON BOTH IP/OP "$1,388.00" "$1,027.50" $247.06 "$1,388.00" "$1,388.00" "$1,388.00" "$1,388.00" "$1,388.00" "$1,388.00" "$1,388.00" $247.06 "$1,388.00" "$1,388.00" "$1,030.17" "$1,030.17" "$1,069.87" $723.15 $289.27 "$1,388.00" $555.20 "$1,388.00" "$1,388.00" "$1,388.00" "$1,388.00" "$1,388.00" "$1,041.00" "$1,388.00" "$1,388.00" "$1,388.00" $694.00 $694.00 "$1,099.30" "$1,388.00" "$1,110.40" $902.20 "$1,388.00" "$1,388.00" $805.04 "$1,388.00" $832.80 "$1,388.00" "$1,388.00" "$1,388.00" N/A N/A 27200051 EAP Custom 27200051 TRAPEZOID RETRIEVAL BASKETS BOTH IP/OP "$2,263.00" "$1,675.00" $402.81 "$2,263.00" "$2,263.00" "$2,263.00" "$2,263.00" "$2,263.00" "$2,263.00" "$2,263.00" $402.81 "$2,263.00" "$2,263.00" "$1,679.60" "$1,679.60" "$1,744.32" "$1,179.02" $471.63 "$2,263.00" $905.20 "$2,263.00" "$2,263.00" "$2,263.00" "$2,263.00" "$2,263.00" "$1,697.25" "$2,263.00" "$2,263.00" "$2,263.00" "$1,131.50" "$1,131.50" "$1,792.30" "$2,263.00" "$1,810.40" "$1,470.95" "$2,263.00" "$2,263.00" "$1,312.54" "$2,263.00" "$1,357.80" "$2,263.00" "$2,263.00" "$2,263.00" N/A N/A 27200052 EAP Custom 27200052 ENDOPROSTHESIS METAL STENT BOTH IP/OP "$9,693.00" "$7,173.00" "$1,725.35" "$9,693.00" "$9,693.00" "$9,693.00" "$9,693.00" "$9,693.00" "$9,693.00" "$9,693.00" "$1,725.35" "$9,693.00" "$9,693.00" "$4,181.12" "$4,181.12" "$7,471.36" "$2,060.15" "$2,020.13" "$9,693.00" "$3,877.20" "$9,693.00" "$9,693.00" "$9,693.00" "$9,693.00" "$9,693.00" "$7,269.75" "$9,693.00" "$9,693.00" "$9,693.00" "$4,846.50" "$4,846.50" "$7,676.86" "$9,693.00" "$7,754.40" "$6,300.45" "$9,693.00" "$9,693.00" "$5,621.94" "$9,693.00" "$5,815.80" "$9,693.00" "$9,693.00" "$9,693.00" N/A N/A 27200053 EAP Custom 27200053 ESOPHAGEAL STENT BOTH IP/OP "$11,672.00" "$8,637.50" "$2,060.15" "$11,672.00" "$11,672.00" "$11,672.00" "$11,672.00" "$11,672.00" "$11,672.00" "$11,672.00" "$2,077.62" "$11,672.00" "$11,672.00" "$4,181.12" "$4,181.12" "$8,996.78" "$2,060.15" "$2,432.57" "$11,672.00" "$4,668.80" "$11,672.00" "$11,672.00" "$11,672.00" "$11,672.00" "$11,672.00" "$8,754.00" "$11,672.00" "$11,672.00" "$11,672.00" "$5,836.00" "$5,836.00" "$9,244.22" "$11,672.00" "$9,337.60" "$7,586.80" "$11,672.00" "$11,672.00" "$6,769.76" "$11,672.00" "$7,003.20" "$11,672.00" "$11,672.00" "$11,672.00" N/A N/A 27200054 EAP Custom 27200054 COLONIC AND DUODENAL STENT BOTH IP/OP "$16,179.00" "$11,972.50" "$2,060.15" "$16,179.00" "$16,179.00" "$16,179.00" "$16,179.00" "$16,179.00" "$16,179.00" "$16,179.00" "$2,879.86" "$16,179.00" "$16,179.00" "$4,181.12" "$4,181.12" "$12,470.77" "$2,060.15" "$3,371.88" "$16,179.00" "$6,471.60" "$16,179.00" "$16,179.00" "$16,179.00" "$16,179.00" "$16,179.00" "$12,134.25" "$16,179.00" "$16,179.00" "$16,179.00" "$8,089.50" "$8,089.50" "$12,813.77" "$16,179.00" "$12,943.20" "$10,516.35" "$16,179.00" "$16,179.00" "$9,383.82" "$16,179.00" "$9,707.40" "$16,179.00" "$16,179.00" "$16,179.00" N/A N/A 27200055 EAP HCPCS C1726 CRE BALLOONS BOTH IP/OP "$1,523.00" "$1,127.50" $302.28 "$1,523.00" $826.99 $826.99 $826.99 $826.99 "$1,523.00" "$1,523.00" "$1,523.00" $317.43 "$1,523.00" "$1,130.37" "$1,130.37" "$1,173.93" $793.48 $317.41 "$1,523.00" "$1,523.00" $900.85 "$1,523.00" "$1,523.00" "$1,523.00" "$1,523.00" "$1,142.25" "$1,523.00" "$1,523.00" "$1,523.00" $761.50 $761.50 "$1,206.22" "$1,523.00" "$1,218.40" $989.95 $302.28 "$1,523.00" $883.34 "$1,523.00" "$1,523.00" "$1,523.00" $317.39 "$1,523.00" N/A N/A 27200056 EAP Custom 27200056 ESOPHAGEAL/PYLORIC BALLOON DIL BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" "$1,750.00" "$1,750.00" "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 27200057 EAP Custom 27200057 ESOPHAGEAL/PYLORIC/COLONIC BA BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" "$1,750.00" "$1,750.00" "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 27200058 EAP Custom 27200058 O2 SUPPLY-EACH BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27200060 EAP Custom 27200060 VENOUS PORT - MAINTENANCE BOTH IP/OP $184.00 $136.50 $32.75 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $32.75 $184.00 $184.00 $136.56 $136.56 $141.83 $95.86 $38.35 $184.00 $73.60 $184.00 $184.00 $184.00 $184.00 $184.00 $138.00 $184.00 $184.00 $184.00 $92.00 $92.00 $145.73 $184.00 $147.20 $119.60 $184.00 $184.00 $106.72 $184.00 $110.40 $184.00 $184.00 $184.00 N/A N/A 27200061 EAP Custom 27200061 DRESSING BOTH IP/OP $42.00 $31.50 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $7.48 $42.00 $42.00 $31.17 $31.17 $32.37 $21.88 $8.75 $42.00 $16.80 $42.00 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $27.30 $42.00 $42.00 $24.36 $42.00 $25.20 $42.00 $42.00 $42.00 N/A N/A 27200062 EAP Custom 27200062 "DRESSING, BURN SUPPLIES" BOTH IP/OP $206.00 $152.50 $36.67 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $36.67 $206.00 $206.00 $152.89 $152.89 $158.78 $107.33 $42.93 $206.00 $82.40 $206.00 $206.00 $206.00 $206.00 $206.00 $154.50 $206.00 $206.00 $206.00 $103.00 $103.00 $163.15 $206.00 $164.80 $133.90 $206.00 $206.00 $119.48 $206.00 $123.60 $206.00 $206.00 $206.00 N/A N/A 27200063 EAP Custom 27200063 IV START SUPPLY BOTH IP/OP $228.00 $169.00 $40.58 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $40.58 $228.00 $228.00 $169.22 $169.22 $175.74 $118.79 $47.52 $228.00 $91.20 $228.00 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $148.20 $228.00 $228.00 $132.24 $228.00 $136.80 $228.00 $228.00 $228.00 N/A N/A 27200064 EAP Custom 27200064 "DRESSING, BURN SUPPLIES" BOTH IP/OP $193.00 $143.00 $34.35 $193.00 $193.00 $193.00 $193.00 $193.00 $193.00 $193.00 $34.35 $193.00 $193.00 $143.24 $143.24 $148.76 $100.55 $40.22 $193.00 $77.20 $193.00 $193.00 $193.00 $193.00 $193.00 $144.75 $193.00 $193.00 $193.00 $96.50 $96.50 $152.86 $193.00 $154.40 $125.45 $193.00 $193.00 $111.94 $193.00 $115.80 $193.00 $193.00 $193.00 N/A N/A 27200065 EAP Custom 27200065 SPLINT SUPPLY BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 27200066 EAP Custom 27200066 NEPHROSTOMY BAG BOTH IP/OP $299.00 $221.50 $53.22 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $299.00 $53.22 $299.00 $299.00 $221.92 $221.92 $230.47 $155.78 $62.31 $299.00 $119.60 $299.00 $299.00 $299.00 $299.00 $299.00 $224.25 $299.00 $299.00 $299.00 $149.50 $149.50 $236.81 $299.00 $239.20 $194.35 $299.00 $299.00 $173.42 $299.00 $179.40 $299.00 $299.00 $299.00 N/A N/A 27200067 EAP Custom 27200067 DRESSING CHANGE BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 27200068 EAP HCPCS C1729 CATHETER FOLEY BOTH IP/OP $34.00 $25.50 $6.75 $34.00 $18.46 $18.46 $18.46 $18.46 $34.00 $34.00 $34.00 $7.09 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $34.00 $20.11 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $6.75 $34.00 $19.72 $34.00 $34.00 $34.00 $7.09 $34.00 N/A N/A 27200069 EAP Custom 27200069 LEG BAG BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27200070 EAP Custom 27200070 URINARY DRAINAGE BAG BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27200074 EAP Custom 27200074 ACTICOAT DRESSING BOTH IP/OP $315.00 $233.50 $56.07 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $56.07 $315.00 $315.00 $233.79 $233.79 $242.80 $164.12 $65.65 $315.00 $126.00 $315.00 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $204.75 $315.00 $315.00 $182.70 $315.00 $189.00 $315.00 $315.00 $315.00 N/A N/A 27200075 EAP Custom 27200075 FEEDING/NG TUBE BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 27200076 EAP Custom 27200076 TRIPLE LUMEN CATH BOTH IP/OP $222.00 $164.50 $39.52 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $39.52 $222.00 $222.00 $164.77 $164.77 $171.12 $115.66 $46.27 $222.00 $88.80 $222.00 $222.00 $222.00 $222.00 $222.00 $166.50 $222.00 $222.00 $222.00 $111.00 $111.00 $175.82 $222.00 $177.60 $144.30 $222.00 $222.00 $128.76 $222.00 $133.20 $222.00 $222.00 $222.00 N/A N/A 27200077 EAP Custom 27200077 TRANSVENOUS PACING ELECTRODE BOTH IP/OP $389.00 $288.00 $69.24 $389.00 $389.00 $389.00 $389.00 $389.00 $389.00 $389.00 $69.24 $389.00 $389.00 $288.72 $288.72 $299.84 $202.67 $81.07 $389.00 $155.60 $389.00 $389.00 $389.00 $389.00 $389.00 $291.75 $389.00 $389.00 $389.00 $194.50 $194.50 $308.09 $389.00 $311.20 $252.85 $389.00 $389.00 $225.62 $389.00 $233.40 $389.00 $389.00 $389.00 N/A N/A 27200080 EAP Custom 27200080 "INJECTION, IV, ANTIBIOTIC" BOTH IP/OP $214.00 $158.50 $38.09 $214.00 $214.00 $214.00 $214.00 $214.00 $214.00 $214.00 $38.09 $214.00 $214.00 $158.83 $158.83 $164.95 $111.49 $44.60 $214.00 $85.60 $214.00 $214.00 $214.00 $214.00 $214.00 $160.50 $214.00 $214.00 $214.00 $107.00 $107.00 $169.49 $214.00 $171.20 $139.10 $214.00 $214.00 $124.12 $214.00 $128.40 $214.00 $214.00 $214.00 N/A N/A 27200081 EAP Custom 27200081 "STEROID INJECTION, IV SUPPLY" BOTH IP/OP $192.00 $142.50 $34.18 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $34.18 $192.00 $192.00 $142.50 $142.50 $147.99 $100.03 $40.01 $192.00 $76.80 $192.00 $192.00 $192.00 $192.00 $192.00 $144.00 $192.00 $192.00 $192.00 $96.00 $96.00 $152.06 $192.00 $153.60 $124.80 $192.00 $192.00 $111.36 $192.00 $115.20 $192.00 $192.00 $192.00 N/A N/A 27200085 EAP Custom 27200085 "ETT, LASER" BOTH IP/OP $897.00 $664.00 $159.67 $897.00 $897.00 $897.00 $897.00 $897.00 $897.00 $897.00 $159.67 $897.00 $897.00 $665.75 $665.75 $691.41 $467.34 $186.94 $897.00 $358.80 $897.00 $897.00 $897.00 $897.00 $897.00 $672.75 $897.00 $897.00 $897.00 $448.50 $448.50 $710.42 $897.00 $717.60 $583.05 $897.00 $897.00 $520.26 $897.00 $538.20 $897.00 $897.00 $897.00 N/A N/A 27200086 EAP Custom 27200086 "ETT, RAE" BOTH IP/OP $118.00 $87.50 $21.00 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $21.00 $118.00 $118.00 $87.58 $87.58 $90.95 $61.48 $24.59 $118.00 $47.20 $118.00 $118.00 $118.00 $118.00 $118.00 $88.50 $118.00 $118.00 $118.00 $59.00 $59.00 $93.46 $118.00 $94.40 $76.70 $118.00 $118.00 $68.44 $118.00 $70.80 $118.00 $118.00 $118.00 N/A N/A 27200087 EAP Custom 27200087 "ETT, WIRE REINF" BOTH IP/OP $362.00 $268.00 $64.44 $362.00 $362.00 $362.00 $362.00 $362.00 $362.00 $362.00 $64.44 $362.00 $362.00 $268.68 $268.68 $279.03 $188.60 $75.44 $362.00 $144.80 $362.00 $362.00 $362.00 $362.00 $362.00 $271.50 $362.00 $362.00 $362.00 $181.00 $181.00 $286.70 $362.00 $289.60 $235.30 $362.00 $362.00 $209.96 $362.00 $217.20 $362.00 $362.00 $362.00 N/A N/A 27200088 EAP Custom 27200088 "ETT, ENDOTROL/MLT" BOTH IP/OP $138.00 $102.50 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 $138.00 $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 27200090 EAP Custom 27200090 "CVP KIT, SINGLE LUMEN" BOTH IP/OP $238.00 $176.50 $42.36 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $42.36 $238.00 $238.00 $176.64 $176.64 $183.45 $124.00 $49.60 $238.00 $95.20 $238.00 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $154.70 $238.00 $238.00 $138.04 $238.00 $142.80 $238.00 $238.00 $238.00 N/A N/A 27200091 EAP HCPCS C1756 SWAN PACEPORT CATH BOTH IP/OP $666.00 $493.00 $138.80 $666.00 $666.00 $666.00 $666.00 $666.00 $666.00 $666.00 $666.00 $666.00 $666.00 $494.31 $494.31 $513.35 $346.99 $138.80 $666.00 $266.40 $666.00 $666.00 $666.00 $666.00 $666.00 $499.50 $666.00 $666.00 $666.00 $333.00 $333.00 $527.47 $666.00 $532.80 $432.90 $666.00 $666.00 $386.28 $666.00 $399.60 $666.00 $666.00 $666.00 N/A N/A 27200092 EAP HCPCS C1751 CVP KIT TRIPLE LUMEN BOTH IP/OP $569.00 $421.50 $112.93 $569.00 $308.97 $308.97 $308.97 $308.97 $569.00 $569.00 $569.00 $118.59 $569.00 $422.31 $422.31 $438.59 $296.45 $118.59 $569.00 $569.00 $336.56 $569.00 $569.00 $569.00 $569.00 $426.75 $569.00 $569.00 $569.00 $284.50 $284.50 $450.65 $569.00 $455.20 $369.85 $112.93 $569.00 $330.02 $569.00 $569.00 $569.00 $118.58 $569.00 N/A N/A 27200093 EAP HCPCS C1756 SWAN GANZ CATH-BIPOLAR PACING BOTH IP/OP "$1,225.00" $906.50 $255.30 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $909.20 $909.20 $944.23 $638.23 $255.30 "$1,225.00" $490.00 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $796.25 "$1,225.00" "$1,225.00" $710.50 "$1,225.00" $735.00 "$1,225.00" "$1,225.00" "$1,225.00" N/A N/A 27200094 EAP HCPCS C1756 SWAN PACING TD BOTH IP/OP "$2,409.00" "$1,783.00" $502.06 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,787.96" "$1,787.96" "$1,856.86" "$1,255.09" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,565.85" "$2,409.00" "$2,409.00" "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 27200096 EAP Custom 27200096 ADULT IV SET-UP BOTH IP/OP $26.00 $19.50 $4.63 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $4.63 $26.00 $26.00 $19.30 $19.30 $20.04 $13.55 $5.42 $26.00 $10.40 $26.00 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $16.90 $26.00 $26.00 $15.08 $26.00 $15.60 $26.00 $26.00 $26.00 N/A N/A 27200097 EAP Custom 27200097 "ETT, ENDOTROL/MLT" BOTH IP/OP $60.00 $44.50 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 $60.00 $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A 27200098 EAP Custom 27200098 "CVP KIT, SINGLE LUMEN" BOTH IP/OP $238.00 $176.50 $42.36 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $42.36 $238.00 $238.00 $176.64 $176.64 $183.45 $124.00 $49.60 $238.00 $95.20 $238.00 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $154.70 $238.00 $238.00 $138.04 $238.00 $142.80 $238.00 $238.00 $238.00 N/A N/A 27200099 EAP HCPCS C1756 SWAN PACEPORT CATH BOTH IP/OP $634.00 $469.50 $132.13 $634.00 $634.00 $634.00 $634.00 $634.00 $634.00 $634.00 $634.00 $634.00 $634.00 $470.55 $470.55 $488.69 $330.31 $132.13 $634.00 $253.60 $634.00 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $412.10 $634.00 $634.00 $367.72 $634.00 $380.40 $634.00 $634.00 $634.00 N/A N/A 27200100 EAP Custom 27200100 CVP KIT TRIPLE LUMEN BOTH IP/OP $141.00 $104.50 $25.10 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $25.10 $141.00 $141.00 $104.65 $104.65 $108.68 $73.46 $29.39 $141.00 $56.40 $141.00 $141.00 $141.00 $141.00 $141.00 $105.75 $141.00 $141.00 $141.00 $70.50 $70.50 $111.67 $141.00 $112.80 $91.65 $141.00 $141.00 $81.78 $141.00 $84.60 $141.00 $141.00 $141.00 N/A N/A 27200101 EAP HCPCS C1756 SWAN BIPOLAR BOTH IP/OP "$1,225.00" $906.50 $255.30 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $909.20 $909.20 $944.23 $638.23 $255.30 "$1,225.00" $490.00 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $796.25 "$1,225.00" "$1,225.00" $710.50 "$1,225.00" $735.00 "$1,225.00" "$1,225.00" "$1,225.00" N/A N/A 27200102 EAP HCPCS C1756 SWAN PACING TD BOTH IP/OP "$2,409.00" "$1,783.00" $502.06 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,787.96" "$1,787.96" "$1,856.86" "$1,255.09" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,565.85" "$2,409.00" "$2,409.00" "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 27200104 EAP HCPCS C1729 CATHETER FOLEY 30CC 28FR BOTH IP/OP $37.00 $27.50 $7.34 $37.00 $20.09 $20.09 $20.09 $20.09 $37.00 $37.00 $37.00 $7.71 $37.00 $27.46 $27.46 $28.52 $19.28 $7.71 $37.00 $37.00 $21.89 $37.00 $37.00 $37.00 $37.00 $27.75 $37.00 $37.00 $37.00 $18.50 $18.50 $29.30 $37.00 $29.60 $24.05 $7.34 $37.00 $21.46 $37.00 $37.00 $37.00 $7.71 $37.00 N/A N/A 27200107 EAP HCPCS L8680 IMPLT NEUROSTIM ELCTR EACH BOTH IP/OP "$1,605.00" "$1,188.00" $180.99 "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" $180.99 "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" $334.50 "$1,605.00" $642.00 "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" "$1,203.75" "$1,605.00" "$1,605.00" "$1,605.00" $802.50 $802.50 "$1,271.16" "$1,605.00" "$1,284.00" $722.25 "$1,605.00" "$1,605.00" $930.90 "$1,605.00" $963.00 "$1,605.00" "$1,605.00" "$1,605.00" N/A N/A 27200108 EAP Custom 27200108 REGIONAL NERVE BLOCK TRAY BOTH IP/OP $88.00 $65.50 $15.66 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $15.66 $88.00 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $35.20 $88.00 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $88.00 $88.00 $51.04 $88.00 $52.80 $88.00 $88.00 $88.00 N/A N/A 27200109 EAP Custom 27200109 EPIDURAL TRAY BOTH IP/OP $160.00 $118.50 $28.48 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $28.48 $160.00 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $64.00 $160.00 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $160.00 $160.00 $92.80 $160.00 $96.00 $160.00 $160.00 $160.00 N/A N/A 27200110 EAP Custom 27200110 INSULATED BLOCK NEEDLE BOTH IP/OP $46.00 $34.50 $8.19 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $8.19 $46.00 $46.00 $34.14 $34.14 $35.46 $23.97 $9.59 $46.00 $18.40 $46.00 $46.00 $46.00 $46.00 $46.00 $34.50 $46.00 $46.00 $46.00 $23.00 $23.00 $36.43 $46.00 $36.80 $29.90 $46.00 $46.00 $26.68 $46.00 $27.60 $46.00 $46.00 $46.00 N/A N/A 27200111 EAP Custom 27200111 O2 THERAPY-EA 8 HRS BOTH IP/OP $296.00 $219.50 $52.69 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $52.69 $296.00 $296.00 $219.69 $219.69 $228.16 $154.22 $61.69 $296.00 $118.40 $296.00 $296.00 $296.00 $296.00 $296.00 $222.00 $296.00 $296.00 $296.00 $148.00 $148.00 $234.43 $296.00 $236.80 $192.40 $296.00 $296.00 $171.68 $296.00 $177.60 $296.00 $296.00 $296.00 N/A N/A 27200113 EAP Custom 27200113 PEAK FLOW METER BOTH IP/OP $487.00 $360.50 $86.69 $487.00 $487.00 $487.00 $487.00 $487.00 $487.00 $487.00 $86.69 $487.00 $487.00 $361.45 $361.45 $375.38 $253.73 $101.50 $487.00 $194.80 $487.00 $487.00 $487.00 $487.00 $487.00 $365.25 $487.00 $487.00 $487.00 $243.50 $243.50 $385.70 $487.00 $389.60 $316.55 $487.00 $487.00 $282.46 $487.00 $292.20 $487.00 $487.00 $487.00 N/A N/A 27200114 EAP Custom 27200114 HEART NEBULIZER BOTH IP/OP $440.00 $326.00 $78.32 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $78.32 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 27200115 EAP Custom 27200115 MINI HEART BOTH IP/OP $424.00 $314.00 $75.47 $424.00 $424.00 $424.00 $424.00 $424.00 $424.00 $424.00 $75.47 $424.00 $424.00 $314.69 $314.69 $326.82 $220.90 $88.37 $424.00 $169.60 $424.00 $424.00 $424.00 $424.00 $424.00 $318.00 $424.00 $424.00 $424.00 $212.00 $212.00 $335.81 $424.00 $339.20 $275.60 $424.00 $424.00 $245.92 $424.00 $254.40 $424.00 $424.00 $424.00 N/A N/A 27200116 EAP Custom 27200116 MDI SPACER BOTH IP/OP $192.00 $142.50 $34.18 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $34.18 $192.00 $192.00 $142.50 $142.50 $147.99 $100.03 $40.01 $192.00 $76.80 $192.00 $192.00 $192.00 $192.00 $192.00 $144.00 $192.00 $192.00 $192.00 $96.00 $96.00 $152.06 $192.00 $153.60 $124.80 $192.00 $192.00 $111.36 $192.00 $115.20 $192.00 $192.00 $192.00 N/A N/A 27200117 EAP Custom 27200117 INC SPIR-DISPOSABLE BOTH IP/OP $319.00 $236.50 $56.78 $319.00 $319.00 $319.00 $319.00 $319.00 $319.00 $319.00 $56.78 $319.00 $319.00 $236.76 $236.76 $245.89 $166.20 $66.48 $319.00 $127.60 $319.00 $319.00 $319.00 $319.00 $319.00 $239.25 $319.00 $319.00 $319.00 $159.50 $159.50 $252.65 $319.00 $255.20 $207.35 $319.00 $319.00 $185.02 $319.00 $191.40 $319.00 $319.00 $319.00 N/A N/A 27200118 EAP Custom 27200118 INNER CANNULA BOTH IP/OP $134.00 $99.50 $23.85 $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $23.85 $134.00 $134.00 $99.45 $99.45 $103.29 $69.81 $27.93 $134.00 $53.60 $134.00 $134.00 $134.00 $134.00 $134.00 $100.50 $134.00 $134.00 $134.00 $67.00 $67.00 $106.13 $134.00 $107.20 $87.10 $134.00 $134.00 $77.72 $134.00 $80.40 $134.00 $134.00 $134.00 N/A N/A 27200119 EAP Custom 27200119 NASAL PRONGS BOTH IP/OP $26.00 $19.50 $4.63 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $4.63 $26.00 $26.00 $19.30 $19.30 $20.04 $13.55 $5.42 $26.00 $10.40 $26.00 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $16.90 $26.00 $26.00 $15.08 $26.00 $15.60 $26.00 $26.00 $26.00 N/A N/A 27200120 EAP Custom 27200120 VENT KIT ONLY BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $500.00 $500.00 $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 27200124 EAP Custom 27200124 METER ASTECH PEAK FLOW BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 27200125 EAP Custom 27200125 SLEEP APNEA SUPPLY KIT BOTH IP/OP "$1,443.00" "$1,068.00" $256.85 "$1,443.00" "$1,443.00" "$1,443.00" "$1,443.00" "$1,443.00" "$1,443.00" "$1,443.00" $256.85 "$1,443.00" "$1,443.00" "$1,070.99" "$1,070.99" "$1,112.26" $751.80 $300.74 "$1,443.00" $577.20 "$1,443.00" "$1,443.00" "$1,443.00" "$1,443.00" "$1,443.00" "$1,082.25" "$1,443.00" "$1,443.00" "$1,443.00" $721.50 $721.50 "$1,142.86" "$1,443.00" "$1,154.40" $937.95 "$1,443.00" "$1,443.00" $836.94 "$1,443.00" $865.80 "$1,443.00" "$1,443.00" "$1,443.00" N/A N/A 27200126 EAP Custom 27200126 TRACHEOSTOMY-PIPE CLEANER BOTH IP/OP $84.00 $62.50 $14.95 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $14.95 $84.00 $84.00 $62.34 $62.34 $64.75 $43.76 $17.51 $84.00 $33.60 $84.00 $84.00 $84.00 $84.00 $84.00 $63.00 $84.00 $84.00 $84.00 $42.00 $42.00 $66.53 $84.00 $67.20 $54.60 $84.00 $84.00 $48.72 $84.00 $50.40 $84.00 $84.00 $84.00 N/A N/A 27200128 EAP Custom 27200128 TUBE TRACH #8 DCT BOTH IP/OP $377.00 $279.00 $67.11 $377.00 $377.00 $377.00 $377.00 $377.00 $377.00 $377.00 $67.11 $377.00 $377.00 $279.81 $279.81 $290.59 $196.42 $78.57 $377.00 $150.80 $377.00 $377.00 $377.00 $377.00 $377.00 $282.75 $377.00 $377.00 $377.00 $188.50 $188.50 $298.58 $377.00 $301.60 $245.05 $377.00 $377.00 $218.66 $377.00 $226.20 $377.00 $377.00 $377.00 N/A N/A 27200129 EAP Custom 27200129 TUBE TRACH #6 DCT BOTH IP/OP $377.00 $279.00 $67.11 $377.00 $377.00 $377.00 $377.00 $377.00 $377.00 $377.00 $67.11 $377.00 $377.00 $279.81 $279.81 $290.59 $196.42 $78.57 $377.00 $150.80 $377.00 $377.00 $377.00 $377.00 $377.00 $282.75 $377.00 $377.00 $377.00 $188.50 $188.50 $298.58 $377.00 $301.60 $245.05 $377.00 $377.00 $218.66 $377.00 $226.20 $377.00 $377.00 $377.00 N/A N/A 27200130 EAP Custom 27200130 TUBE TRACH #10 DCT BOTH IP/OP $335.00 $248.00 $59.63 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $59.63 $335.00 $335.00 $248.64 $248.64 $258.22 $174.54 $69.82 $335.00 $134.00 $335.00 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $217.75 $335.00 $335.00 $194.30 $335.00 $201.00 $335.00 $335.00 $335.00 N/A N/A 27200131 EAP Custom 27200131 TUBE TRACHEOSTOMY 4-DCFS BOTH IP/OP $342.00 $253.50 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 $342.00 $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 27200132 EAP Custom 27200132 TUBE TRACHEOSTOMY 8-DCFS BOTH IP/OP $326.00 $241.50 $58.03 $326.00 $326.00 $326.00 $326.00 $326.00 $326.00 $326.00 $58.03 $326.00 $326.00 $241.96 $241.96 $251.28 $169.85 $67.94 $326.00 $130.40 $326.00 $326.00 $326.00 $326.00 $326.00 $244.50 $326.00 $326.00 $326.00 $163.00 $163.00 $258.19 $326.00 $260.80 $211.90 $326.00 $326.00 $189.08 $326.00 $195.60 $326.00 $326.00 $326.00 N/A N/A 27200133 EAP Custom 27200133 MINI BAL-BRONCHO-ALVEOLAR LAVA BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27200134 EAP Custom 27200134 CONT OXY HOOD-PEDIATRICS BOTH IP/OP $866.00 $641.00 $154.15 $866.00 $866.00 $866.00 $866.00 $866.00 $866.00 $866.00 $154.15 $866.00 $866.00 $642.75 $642.75 $667.51 $451.19 $180.48 $866.00 $346.40 $866.00 $866.00 $866.00 $866.00 $866.00 $649.50 $866.00 $866.00 $866.00 $433.00 $433.00 $685.87 $866.00 $692.80 $562.90 $866.00 $866.00 $502.28 $866.00 $519.60 $866.00 $866.00 $866.00 N/A N/A 27200135 EAP Custom 27200135 HE-OX RX AIRWAY OBS + SUPPLY BOTH IP/OP $947.00 $701.00 $168.57 $947.00 $947.00 $947.00 $947.00 $947.00 $947.00 $947.00 $168.57 $947.00 $947.00 $702.86 $702.86 $729.95 $493.39 $197.37 $947.00 $378.80 $947.00 $947.00 $947.00 $947.00 $947.00 $710.25 $947.00 $947.00 $947.00 $473.50 $473.50 $750.02 $947.00 $757.60 $615.55 $947.00 $947.00 $549.26 $947.00 $568.20 $947.00 $947.00 $947.00 N/A N/A 27200136 EAP Custom 27200136 TRACH TUBE/PASSY MUIR BOTH IP/OP $554.00 $410.00 $98.61 $554.00 $554.00 $554.00 $554.00 $554.00 $554.00 $554.00 $98.61 $554.00 $554.00 $411.18 $411.18 $427.02 $288.63 $115.46 $554.00 $221.60 $554.00 $554.00 $554.00 $554.00 $554.00 $415.50 $554.00 $554.00 $554.00 $277.00 $277.00 $438.77 $554.00 $443.20 $360.10 $554.00 $554.00 $321.32 $554.00 $332.40 $554.00 $554.00 $554.00 N/A N/A 27200137 EAP Custom 27200137 INTUBATION SPECIALTY TUBE BOTH IP/OP "$1,545.00" "$1,143.50" $275.01 "$1,545.00" "$1,545.00" "$1,545.00" "$1,545.00" "$1,545.00" "$1,545.00" "$1,545.00" $275.01 "$1,545.00" "$1,545.00" "$1,146.70" "$1,146.70" "$1,190.89" $804.95 $321.99 "$1,545.00" $618.00 "$1,545.00" "$1,545.00" "$1,545.00" "$1,545.00" "$1,545.00" "$1,158.75" "$1,545.00" "$1,545.00" "$1,545.00" $772.50 $772.50 "$1,223.64" "$1,545.00" "$1,236.00" "$1,004.25" "$1,545.00" "$1,545.00" $896.10 "$1,545.00" $927.00 "$1,545.00" "$1,545.00" "$1,545.00" N/A N/A 27200138 EAP Custom 27200138 PULSE OXIMETRY SENSOR BOTH IP/OP $292.00 $216.50 $51.98 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $292.00 $51.98 $292.00 $292.00 $216.72 $216.72 $225.07 $152.13 $60.86 $292.00 $116.80 $292.00 $292.00 $292.00 $292.00 $292.00 $219.00 $292.00 $292.00 $292.00 $146.00 $146.00 $231.26 $292.00 $233.60 $189.80 $292.00 $292.00 $169.36 $292.00 $175.20 $292.00 $292.00 $292.00 N/A N/A 27200139 EAP Custom 27200139 VENT CIRCUIT KIT BOTH IP/OP $423.00 $313.50 $75.29 $423.00 $423.00 $423.00 $423.00 $423.00 $423.00 $423.00 $75.29 $423.00 $423.00 $313.95 $313.95 $326.05 $220.38 $88.16 $423.00 $169.20 $423.00 $423.00 $423.00 $423.00 $423.00 $317.25 $423.00 $423.00 $423.00 $211.50 $211.50 $335.02 $423.00 $338.40 $274.95 $423.00 $423.00 $245.34 $423.00 $253.80 $423.00 $423.00 $423.00 N/A N/A 27200140 EAP Custom 27200140 SPECIALTY VENT CIRCUIT KIT BOTH IP/OP $990.00 $733.00 $176.22 $990.00 $990.00 $990.00 $990.00 $990.00 $990.00 $990.00 $176.22 $990.00 $990.00 $734.78 $734.78 $763.09 $515.79 $206.33 $990.00 $396.00 $990.00 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $643.50 $990.00 $990.00 $574.20 $990.00 $594.00 $990.00 $990.00 $990.00 N/A N/A 27200143 EAP Custom 27200143 BLOOD GAS KIT BOTH IP/OP $112.00 $83.00 $19.94 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $19.94 $112.00 $112.00 $83.13 $83.13 $86.33 $58.35 $23.34 $112.00 $44.80 $112.00 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $72.80 $112.00 $112.00 $64.96 $112.00 $67.20 $112.00 $112.00 $112.00 N/A N/A 27200144 EAP HCPCS C1729 RED RUBBER CATHETER BOTH IP/OP $54.00 $40.00 $10.72 $54.00 $29.32 $29.32 $29.32 $29.32 $54.00 $54.00 $54.00 $11.25 $54.00 $40.08 $40.08 $41.62 $28.13 $11.25 $54.00 $54.00 $31.94 $54.00 $54.00 $54.00 $54.00 $40.50 $54.00 $54.00 $54.00 $27.00 $27.00 $42.77 $54.00 $43.20 $35.10 $10.72 $54.00 $31.32 $54.00 $54.00 $54.00 $11.25 $54.00 N/A N/A 27200145 EAP Custom 27200145 AIR VEST-DISPOSABLE BOTH IP/OP $675.00 $499.50 $120.15 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $120.15 $675.00 $675.00 $500.99 $500.99 $520.29 $351.68 $140.68 $675.00 $270.00 $675.00 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $438.75 $675.00 $675.00 $391.50 $675.00 $405.00 $675.00 $675.00 $675.00 N/A N/A 27200148 EAP Custom 27200148 "IV START, SUPPLY" BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27200149 EAP HCPCS C1769 GUIDEWIRE:PRESSUREWIRE:RADI BOTH IP/OP "$2,511.00" "$1,858.50" $498.37 "$2,511.00" "$1,363.47" "$1,363.47" "$1,363.47" "$1,363.47" "$2,511.00" "$2,511.00" "$2,511.00" $523.36 "$2,511.00" "$1,863.66" "$1,863.66" "$1,935.48" "$1,308.23" $523.32 "$2,511.00" "$1,004.40" "$1,485.26" "$2,511.00" "$2,511.00" "$2,511.00" "$2,511.00" "$1,883.25" "$2,511.00" "$2,511.00" "$2,511.00" "$1,255.50" "$1,255.50" "$1,988.71" "$2,511.00" "$2,008.80" "$1,632.15" $498.37 "$2,511.00" "$1,456.38" "$2,511.00" "$2,511.00" "$2,511.00" $523.29 "$2,511.00" N/A N/A 27200150 EAP Custom 27200150 PERICARDIOCENTESIS KIT BOTH IP/OP $591.00 $437.50 $105.20 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $105.20 $591.00 $591.00 $438.64 $438.64 $455.54 $307.91 $123.17 $591.00 $236.40 $591.00 $591.00 $591.00 $591.00 $591.00 $443.25 $591.00 $591.00 $591.00 $295.50 $295.50 $468.07 $591.00 $472.80 $384.15 $591.00 $591.00 $342.78 $591.00 $354.60 $591.00 $591.00 $591.00 N/A N/A 27200151 EAP HCPCS C1769 CHOICE PT X-SUPPORT GUIDEWIRE BOTH IP/OP $605.00 $448.00 $120.08 $605.00 $328.52 $328.52 $328.52 $328.52 $605.00 $605.00 $605.00 $126.10 $605.00 $449.03 $449.03 $466.33 $315.21 $126.09 $605.00 $242.00 $357.86 $605.00 $605.00 $605.00 $605.00 $453.75 $605.00 $605.00 $605.00 $302.50 $302.50 $479.16 $605.00 $484.00 $393.25 $120.08 $605.00 $350.90 $605.00 $605.00 $605.00 $126.08 $605.00 N/A N/A 27200152 EAP HCPCS C1769 CHOICE PT GUIDEWIRE BOTH IP/OP $605.00 $448.00 $120.08 $605.00 $328.52 $328.52 $328.52 $328.52 $605.00 $605.00 $605.00 $126.10 $605.00 $449.03 $449.03 $466.33 $315.21 $126.09 $605.00 $605.00 $357.86 $605.00 $605.00 $605.00 $605.00 $453.75 $605.00 $605.00 $605.00 $302.50 $302.50 $479.16 $605.00 $484.00 $393.25 $120.08 $605.00 $350.90 $605.00 $605.00 $605.00 $126.08 $605.00 N/A N/A 27200154 EAP HCPCS C1892 CUSTOM LEFT HEART KIT W/TRANSD BOTH IP/OP $69.00 $51.50 $13.69 $69.00 $37.47 $37.47 $37.47 $37.47 $69.00 $69.00 $69.00 $14.38 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $69.00 $40.81 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $13.69 $69.00 $40.02 $69.00 $69.00 $69.00 $14.38 $69.00 N/A N/A 27200155 EAP HCPCS C1892 CUSTOM RIGHT HEART KIT W/TRANS BOTH IP/OP $47.00 $35.00 $9.33 $47.00 $25.52 $25.52 $25.52 $25.52 $47.00 $47.00 $47.00 $9.80 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $47.00 $27.80 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $9.33 $47.00 $27.26 $47.00 $47.00 $47.00 $9.79 $47.00 N/A N/A 27200156 EAP HCPCS C2629 MICROPUNCTURE SET BOTH IP/OP $102.00 $75.50 $20.24 $102.00 $55.39 $55.39 $55.39 $55.39 $102.00 $102.00 $102.00 $21.26 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $102.00 $60.33 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $20.24 $102.00 $59.16 $102.00 $102.00 $102.00 $21.26 $102.00 N/A N/A 27200157 EAP HCPCS C1769 .025 X 260CM 7CM EMERALD GUIDEWIRE BOTH IP/OP $21.00 $16.00 $4.17 $21.00 $11.40 $11.40 $11.40 $11.40 $21.00 $21.00 $21.00 $4.38 $21.00 $15.59 $15.59 $16.19 $10.94 $4.38 $21.00 $21.00 $12.42 $21.00 $21.00 $21.00 $21.00 $15.75 $21.00 $21.00 $21.00 $10.50 $10.50 $16.63 $21.00 $16.80 $13.65 $4.17 $21.00 $12.18 $21.00 $21.00 $21.00 $4.38 $21.00 N/A N/A 27200158 EAP HCPCS C1887 6FR AL 1 ST GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $199.00 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200159 EAP HCPCS C1887 6FR AR 2 GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $199.00 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200160 EAP HCPCS C1894 6FR - 10CM AVANTI + SHEATH IN BOTH IP/OP $34.00 $25.50 $6.75 $34.00 $18.46 $18.46 $18.46 $18.46 $34.00 $34.00 $34.00 $7.09 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $34.00 $20.11 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $6.75 $34.00 $19.72 $34.00 $34.00 $34.00 $7.09 $34.00 N/A N/A 27200161 EAP HCPCS C1887 6FR JL4 ST GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $199.00 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200162 EAP HCPCS C1887 6FR MPA-1 GUIDING CATH BOTH IP/OP $189.00 $140.00 $37.51 $189.00 $102.63 $102.63 $102.63 $102.63 $189.00 $189.00 $189.00 $39.39 $189.00 $140.28 $140.28 $145.68 $98.47 $39.39 $189.00 $189.00 $111.79 $189.00 $189.00 $189.00 $189.00 $141.75 $189.00 $189.00 $189.00 $94.50 $94.50 $149.69 $189.00 $151.20 $122.85 $37.51 $189.00 $109.62 $189.00 $189.00 $189.00 $39.39 $189.00 N/A N/A 27200163 EAP HCPCS C1887 6FT JR 4 ST GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $79.60 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200164 EAP HCPCS C1887 7FR AR 1 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200165 EAP HCPCS C1887 7FR JR 3.5 GUIDING CATH BOTH IP/OP $180.00 $133.50 $35.73 $180.00 $97.74 $97.74 $97.74 $97.74 $180.00 $180.00 $180.00 $37.52 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $35.73 $180.00 $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A 27200166 EAP HCPCS C1887 7FR H-STICK GUIDING CATH BOTH IP/OP $180.00 $133.50 $35.73 $180.00 $97.74 $97.74 $97.74 $97.74 $180.00 $180.00 $180.00 $37.52 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $35.73 $180.00 $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A 27200167 EAP HCPCS C1887 7FR JL5 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200168 EAP HCPCS C1887 7FR JR 4 ST GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $79.60 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200169 EAP HCPCS C1887 7FR JR 5 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200170 EAP HCPCS C1887 7FR MPA-1 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $64.40 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200171 EAP HCPCS C1887 7FR XB 3.5 GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $199.00 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200172 EAP HCPCS C1887 7FR XB 3.0 GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $199.00 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200173 EAP HCPCS C1887 7FR AL 1 ST GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $199.00 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200174 EAP HCPCS C1887 7FR AL 2 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $64.40 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200175 EAP HCPCS C1887 7FR JR 4 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200176 EAP HCPCS C1887 7FR IM GUIDING CATH BOTH IP/OP $180.00 $133.50 $35.73 $180.00 $97.74 $97.74 $97.74 $97.74 $180.00 $180.00 $180.00 $37.52 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $35.73 $180.00 $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A 27200177 EAP HCPCS C1887 6FR AR 1 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200178 EAP HCPCS C1887 6FR JL4 SH GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200179 EAP HCPCS C1887 6FR JR 4 SH GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $64.40 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200180 EAP HCPCS C1769 .035 X 260CM 3CM EMERALD GUIDEWIRE BOTH IP/OP $22.00 $16.50 $4.37 $22.00 $11.95 $11.95 $11.95 $11.95 $22.00 $22.00 $22.00 $4.59 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 27200181 EAP HCPCS C1887 6FR XB 3 SH GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $199.00 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200182 EAP HCPCS C1887 7FR XB 3.5 SH GUILDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $199.00 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200183 EAP HCPCS C1887 6FR XB 3.5 SH GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $199.00 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200184 EAP HCPCS C1769 .035 X 150CM 3CM EMERALD GUIDEWIRE BOTH IP/OP $22.00 $16.50 $4.37 $22.00 $11.95 $11.95 $11.95 $11.95 $22.00 $22.00 $22.00 $4.59 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 27200185 EAP HCPCS C1887 7FR JL4 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $64.40 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200186 EAP HCPCS C1887 7FR JL4 SH GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200187 EAP HCPCS C1887 7FR XB 4.0 GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $199.00 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200188 EAP HCPCS C1887 7FR JR 4 SH GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $64.40 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200189 EAP HCPCS C1887 7FR AR 1 SH GUIDING CATH BOTH IP/OP $180.00 $133.50 $35.73 $180.00 $97.74 $97.74 $97.74 $97.74 $180.00 $180.00 $180.00 $37.52 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $35.73 $180.00 $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A 27200190 EAP HCPCS C1887 6FR AL 1 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200191 EAP HCPCS C1887 6FR XB 4.0 GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $199.00 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200192 EAP HCPCS C1887 7FR AL 1 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200194 EAP HCPCS C1887 6FR JR 4 GUIDING CATH BOTH IP/OP $189.00 $140.00 $37.51 $189.00 $102.63 $102.63 $102.63 $102.63 $189.00 $189.00 $189.00 $39.39 $189.00 $140.28 $140.28 $145.68 $98.47 $39.39 $189.00 $75.60 $111.79 $189.00 $189.00 $189.00 $189.00 $141.75 $189.00 $189.00 $189.00 $94.50 $94.50 $149.69 $189.00 $151.20 $122.85 $37.51 $189.00 $109.62 $189.00 $189.00 $189.00 $39.39 $189.00 N/A N/A 27200195 EAP HCPCS C1887 6FR XB 3 GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $199.00 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200196 EAP HCPCS C1887 6FR XB 3.5 GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $199.00 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200197 EAP HCPCS C1887 6FR H-STICK GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200198 EAP HCPCS C1887 6FR JL3.5 GUIDING CATH BOTH IP/OP $180.00 $133.50 $35.73 $180.00 $97.74 $97.74 $97.74 $97.74 $180.00 $180.00 $180.00 $37.52 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $35.73 $180.00 $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A 27200199 EAP HCPCS C1887 6FR JR 3.5 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $64.40 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200200 EAP HCPCS C1887 6FR AL .75 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200201 EAP HCPCS C1887 7FR AL .75 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $64.40 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200202 EAP HCPCS C1894 7FR - 10CM AVANTI + SHEATH INT BOTH IP/OP $34.00 $25.50 $6.75 $34.00 $18.46 $18.46 $18.46 $18.46 $34.00 $34.00 $34.00 $7.09 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $34.00 $20.11 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $6.75 $34.00 $19.72 $34.00 $34.00 $34.00 $7.09 $34.00 N/A N/A 27200203 EAP HCPCS C1894 8FR - 10CM AVANTI + SHEATH INT BOTH IP/OP $34.00 $25.50 $6.75 $34.00 $18.46 $18.46 $18.46 $18.46 $34.00 $34.00 $34.00 $7.09 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $20.11 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $6.75 $34.00 $19.72 $34.00 $34.00 $34.00 $7.09 $34.00 N/A N/A 27200204 EAP HCPCS C1769 .025 X 150CM EMERALD GUIDEWIRE BOTH IP/OP $21.00 $16.00 $4.17 $21.00 $11.40 $11.40 $11.40 $11.40 $21.00 $21.00 $21.00 $4.38 $21.00 $15.59 $15.59 $16.19 $10.94 $4.38 $21.00 $21.00 $12.42 $21.00 $21.00 $21.00 $21.00 $15.75 $21.00 $21.00 $21.00 $10.50 $10.50 $16.63 $21.00 $16.80 $13.65 $4.17 $21.00 $12.18 $21.00 $21.00 $21.00 $4.38 $21.00 N/A N/A 27200205 EAP HCPCS C1769 300CM BALANCED MIDDLEWEIGHT (B BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 27200206 EAP HCPCS C1769 AMPLATZ GUIDEWIRE SUPER STIFF BOTH IP/OP $87.00 $64.50 $17.27 $87.00 $47.24 $47.24 $47.24 $47.24 $87.00 $87.00 $87.00 $18.13 $87.00 $64.57 $64.57 $67.06 $45.33 $18.13 $87.00 $87.00 $51.46 $87.00 $87.00 $87.00 $87.00 $65.25 $87.00 $87.00 $87.00 $43.50 $43.50 $68.90 $87.00 $69.60 $56.55 $17.27 $87.00 $50.46 $87.00 $87.00 $87.00 $18.13 $87.00 N/A N/A 27200207 EAP HCPCS C1751 7FR-100CM SWAN-GANZ TD CATHETE BOTH IP/OP $189.00 $140.00 $37.51 $189.00 $102.63 $102.63 $102.63 $102.63 $189.00 $189.00 $189.00 $39.39 $189.00 $140.28 $140.28 $145.68 $98.47 $39.39 $189.00 $189.00 $111.79 $189.00 $189.00 $189.00 $189.00 $141.75 $189.00 $189.00 $189.00 $94.50 $94.50 $149.69 $189.00 $151.20 $122.85 $37.51 $189.00 $109.62 $189.00 $113.40 $189.00 $39.39 $189.00 N/A N/A 27200208 EAP HCPCS C1894 5FR - 10CM AVANTI+SHEATH INTRO BOTH IP/OP $34.00 $25.50 $6.75 $34.00 $18.46 $18.46 $18.46 $18.46 $34.00 $34.00 $34.00 $7.09 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $34.00 $20.11 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $6.75 $34.00 $19.72 $34.00 $34.00 $34.00 $7.09 $34.00 N/A N/A 27200209 EAP HCPCS C1887 7FR JL4 ST GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $64.40 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200214 EAP HCPCS C1884 FILTER WIRE EX-300CM BOTH IP/OP "$5,361.00" "$3,967.50" "$1,064.02" "$5,361.00" "$2,911.02" "$2,911.02" "$2,911.02" "$2,911.02" "$5,361.00" "$5,361.00" "$5,361.00" "$1,117.37" "$5,361.00" "$3,978.93" "$3,978.93" "$4,132.26" "$2,060.15" "$1,117.29" "$5,361.00" "$5,361.00" "$3,094.73" "$5,361.00" "$5,361.00" "$5,361.00" "$5,361.00" "$4,020.75" "$5,361.00" "$5,361.00" "$5,361.00" "$2,680.50" "$2,680.50" "$4,245.91" "$5,361.00" "$4,288.80" "$3,484.65" "$1,064.02" "$5,361.00" "$3,109.38" "$5,361.00" "$5,361.00" "$5,361.00" "$1,117.23" "$5,361.00" N/A N/A 27200215 EAP HCPCS C1727 2.50 X 15MM CUTTING BALLOON BOTH IP/OP "$2,869.00" "$2,123.50" $597.93 "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,129.37" "$2,129.37" "$2,211.43" "$1,494.75" $597.93 "$2,869.00" "$1,147.60" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,151.75" "$2,869.00" "$2,869.00" "$2,869.00" "$1,434.50" "$1,434.50" "$2,272.25" "$2,869.00" "$2,295.20" "$1,864.85" "$2,869.00" "$2,869.00" "$1,664.02" "$2,869.00" "$1,721.40" "$2,869.00" "$2,869.00" "$2,869.00" N/A N/A 27200216 EAP HCPCS C1727 2.50 X 10CM CUTTING BALLOON BOTH IP/OP "$2,869.00" "$2,123.50" $597.93 "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,129.37" "$2,129.37" "$2,211.43" "$1,494.75" $597.93 "$2,869.00" "$1,147.60" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,151.75" "$2,869.00" "$2,869.00" "$2,869.00" "$1,434.50" "$1,434.50" "$2,272.25" "$2,869.00" "$2,295.20" "$1,864.85" "$2,869.00" "$2,869.00" "$1,664.02" "$2,869.00" "$1,721.40" "$2,869.00" "$2,869.00" "$2,869.00" N/A N/A 27200218 EAP HCPCS C1757 .014-145CM EXPORT CATHETER BOTH IP/OP "$1,865.00" "$1,380.50" $370.16 "$1,865.00" "$1,012.70" "$1,012.70" "$1,012.70" "$1,012.70" "$1,865.00" "$1,865.00" "$1,865.00" $388.71 "$1,865.00" "$1,384.20" "$1,384.20" "$1,437.54" $971.67 $388.69 "$1,865.00" "$1,865.00" "$1,103.15" "$1,865.00" "$1,865.00" "$1,865.00" "$1,865.00" "$1,398.75" "$1,865.00" "$1,865.00" "$1,865.00" $932.50 $932.50 "$1,477.08" "$1,865.00" "$1,492.00" "$1,212.25" $370.16 "$1,865.00" "$1,081.70" "$1,865.00" "$1,865.00" "$1,865.00" $388.67 "$1,865.00" N/A N/A 27200219 EAP HCPCS C1756 TEMPORARY PACE ELETRODE CATHET BOTH IP/OP $591.00 $437.50 $123.17 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $438.64 $438.64 $455.54 $307.91 $123.17 $591.00 $236.40 $591.00 $591.00 $591.00 $591.00 $591.00 $443.25 $591.00 $591.00 $591.00 $295.50 $295.50 $468.07 $591.00 $472.80 $384.15 $591.00 $591.00 $342.78 $591.00 $354.60 $591.00 $591.00 $591.00 N/A N/A 27200220 EAP HCPCS C1727 "BALLOON CUTTING ULTRA TUBE, 2." BOTH IP/OP "$2,574.00" "$1,905.00" $536.45 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,910.42" "$1,910.42" "$1,984.04" "$1,341.05" $536.45 "$2,574.00" "$1,029.60" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,673.10" "$2,574.00" "$2,574.00" "$1,492.92" "$2,574.00" "$1,544.40" "$2,574.00" "$2,574.00" "$2,574.00" N/A N/A 27200226 EAP HCPCS C1725 4.00 X 15MM VOYAGER RX BALLOON BOTH IP/OP $699.00 $517.50 $138.73 $699.00 $379.56 $379.56 $379.56 $379.56 $699.00 $699.00 $699.00 $145.69 $699.00 $518.80 $518.80 $538.79 $364.18 $145.68 $699.00 $699.00 $413.46 $699.00 $699.00 $699.00 $699.00 $524.25 $699.00 $699.00 $699.00 $349.50 $349.50 $553.61 $699.00 $559.20 $454.35 $138.73 $699.00 $405.42 $699.00 $699.00 $699.00 $145.67 $699.00 N/A N/A 27200227 EAP HCPCS C1769 190CM ALL-STAR GUIDEWIRE BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $115.20 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 27200228 EAP HCPCS C1769 CHOICE X-SUPPORT GUIDEWIRE BOTH IP/OP $605.00 $448.00 $120.08 $605.00 $328.52 $328.52 $328.52 $328.52 $605.00 $605.00 $605.00 $126.10 $605.00 $449.03 $449.03 $466.33 $315.21 $126.09 $605.00 $605.00 $357.86 $605.00 $605.00 $605.00 $605.00 $453.75 $605.00 $605.00 $605.00 $302.50 $302.50 $479.16 $605.00 $484.00 $393.25 $120.08 $605.00 $350.90 $605.00 $605.00 $605.00 $126.08 $605.00 N/A N/A 27200229 EAP HCPCS C1769 CHOICE STANDARD GUIDEWIRE BOTH IP/OP $605.00 $448.00 $120.08 $605.00 $328.52 $328.52 $328.52 $328.52 $605.00 $605.00 $605.00 $126.10 $605.00 $449.03 $449.03 $466.33 $315.21 $126.09 $605.00 $605.00 $357.86 $605.00 $605.00 $605.00 $605.00 $453.75 $605.00 $605.00 $605.00 $302.50 $302.50 $479.16 $605.00 $484.00 $393.25 $120.08 $605.00 $350.90 $605.00 $605.00 $605.00 $126.08 $605.00 N/A N/A 27200230 EAP HCPCS C1887 7FR XB 3.0 SH GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $199.00 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200231 EAP HCPCS C1887 6FR AL 2 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200238 EAP HCPCS C1887 7FR AR 2 GUIDING CATH BOTH IP/OP $180.00 $133.50 $35.73 $180.00 $97.74 $97.74 $97.74 $97.74 $180.00 $180.00 $180.00 $37.52 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $35.73 $180.00 $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A 27200239 EAP HCPCS C1887 7FR JL3.5 GUIDING CATH BOTH IP/OP $180.00 $133.50 $35.73 $180.00 $97.74 $97.74 $97.74 $97.74 $180.00 $180.00 $180.00 $37.52 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $35.73 $180.00 $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A 27200247 EAP HCPCS C1887 7FR LCB GUIDING CATH BOTH IP/OP $199.00 $147.50 $39.50 $199.00 $108.06 $108.06 $108.06 $108.06 $199.00 $199.00 $199.00 $41.48 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $79.60 $117.71 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $39.50 $199.00 $115.42 $199.00 $199.00 $199.00 $41.47 $199.00 N/A N/A 27200248 EAP HCPCS C1887 7FR JR 4 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200249 EAP HCPCS C1887 7FR AR 1 GUIDING CATH BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200250 EAP HCPCS C1769 "GLIDE WIRE,.035 STRAIGHT" BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $60.82 $60.82 $60.82 $60.82 $112.00 $112.00 $112.00 $23.34 $112.00 $83.13 $83.13 $86.33 $58.35 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $72.80 $22.23 $112.00 $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 27200251 EAP HCPCS C1887 6FR MPA- 1 GUIDING CATH BOTH IP/OP $180.00 $133.50 $35.73 $180.00 $97.74 $97.74 $97.74 $97.74 $180.00 $180.00 $180.00 $37.52 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $35.73 $180.00 $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A 27200252 EAP HCPCS C1769 190CM J TIP BMW GUIDEWIRE BOTH IP/OP $348.00 $258.00 $69.07 $348.00 $188.96 $188.96 $188.96 $188.96 $348.00 $348.00 $348.00 $72.53 $348.00 $258.29 $258.29 $268.24 $181.31 $72.53 $348.00 $348.00 $205.84 $348.00 $348.00 $348.00 $348.00 $261.00 $348.00 $348.00 $348.00 $174.00 $174.00 $275.62 $348.00 $278.40 $226.20 $69.07 $348.00 $201.84 $348.00 $348.00 $348.00 $72.52 $348.00 N/A N/A 27200253 EAP HCPCS C1726 12FRX28MMX70CM INOUE BALLOON BOTH IP/OP "$19,725.00" "$14,596.50" "$2,060.15" "$19,725.00" "$10,710.68" "$10,710.68" "$10,710.68" "$10,710.68" "$19,725.00" "$19,725.00" "$19,725.00" "$4,111.18" "$19,725.00" "$4,181.12" "$4,181.12" "$15,204.03" "$2,060.15" "$4,110.91" "$19,725.00" "$19,725.00" "$3,094.73" "$19,725.00" "$19,725.00" "$19,725.00" "$19,725.00" "$14,793.75" "$19,725.00" "$19,725.00" "$19,725.00" "$9,862.50" "$9,862.50" "$15,622.20" "$19,725.00" "$15,780.00" "$12,821.25" "$3,914.92" "$19,725.00" "$11,440.50" "$19,725.00" "$19,725.00" "$19,725.00" "$4,110.69" "$19,725.00" N/A N/A 27200254 EAP HCPCS C1887 6FR H STICK SH GUIDING CATHETE BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $64.40 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200255 EAP HCPCS C1887 6FR AL 1 SH GUIDING CATHETER BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200256 EAP HCPCS C1887 6FR AL 2 SH GUIDING CATHETER BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $64.40 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200257 EAP HCPCS C1725 2.0 X 9MM MAVERICK MONORAIL BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $497.39 $497.39 $497.39 $497.39 $916.00 $916.00 $916.00 $190.92 $916.00 $679.86 $679.86 $706.05 $477.24 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $595.40 $181.80 $916.00 $531.28 $916.00 $916.00 $916.00 $190.89 $916.00 N/A N/A 27200258 EAP HCPCS C1725 2.5 X 9MM MAVERICK MONORAIL BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $497.39 $497.39 $497.39 $497.39 $916.00 $916.00 $916.00 $190.92 $916.00 $679.86 $679.86 $706.05 $477.24 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $595.40 $181.80 $916.00 $531.28 $916.00 $916.00 $916.00 $190.89 $916.00 N/A N/A 27200259 EAP HCPCS C1725 3.0 X 9MM MAVERICK MONORAIL BOTH IP/OP $872.00 $645.50 $173.07 $872.00 $473.50 $473.50 $473.50 $473.50 $872.00 $872.00 $872.00 $181.75 $872.00 $647.20 $647.20 $672.14 $454.31 $181.73 $872.00 $348.80 $515.79 $872.00 $872.00 $872.00 $872.00 $654.00 $872.00 $872.00 $872.00 $436.00 $436.00 $690.62 $872.00 $697.60 $566.80 $173.07 $872.00 $505.76 $872.00 $872.00 $872.00 $181.72 $872.00 N/A N/A 27200283 EAP HCPCS C1769 HI-TORQUE PILOT 50 GUIDE WIRE BOTH IP/OP $302.00 $223.50 $59.94 $302.00 $163.99 $163.99 $163.99 $163.99 $302.00 $302.00 $302.00 $62.94 $302.00 $224.14 $224.14 $232.78 $157.34 $62.94 $302.00 $302.00 $178.63 $302.00 $302.00 $302.00 $302.00 $226.50 $302.00 $302.00 $302.00 $151.00 $151.00 $239.18 $302.00 $241.60 $196.30 $59.94 $302.00 $175.16 $302.00 $302.00 $302.00 $62.94 $302.00 N/A N/A 27200285 EAP HCPCS C1769 DOC GUIDE WIRE EXTENSION BOTH IP/OP $324.00 $240.00 $64.31 $324.00 $175.93 $175.93 $175.93 $175.93 $324.00 $324.00 $324.00 $67.53 $324.00 $240.47 $240.47 $249.74 $168.80 $67.53 $324.00 $324.00 $191.65 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $210.60 $64.31 $324.00 $187.92 $324.00 $324.00 $324.00 $67.52 $324.00 N/A N/A 27200292 EAP HCPCS C1725 1.5 X 6 SPRINTER BALLOON BOTH IP/OP $853.00 $631.50 $169.30 $853.00 $463.18 $463.18 $463.18 $463.18 $853.00 $853.00 $853.00 $177.79 $853.00 $633.10 $633.10 $657.49 $444.41 $177.77 $853.00 $853.00 $504.55 $853.00 $853.00 $853.00 $853.00 $639.75 $853.00 $853.00 $853.00 $426.50 $426.50 $675.58 $853.00 $682.40 $554.45 $169.30 $853.00 $494.74 $853.00 $853.00 $853.00 $177.77 $853.00 N/A N/A 27200294 EAP HCPCS C1751 7FR WEDGE PRESSURE CATH BOTH IP/OP $153.00 $113.50 $30.37 $153.00 $83.08 $83.08 $83.08 $83.08 $153.00 $153.00 $153.00 $31.89 $153.00 $113.56 $113.56 $117.93 $79.71 $31.89 $153.00 $153.00 $90.50 $153.00 $153.00 $153.00 $153.00 $114.75 $153.00 $153.00 $153.00 $76.50 $76.50 $121.18 $153.00 $122.40 $99.45 $30.37 $153.00 $88.74 $153.00 $153.00 $153.00 $31.89 $153.00 N/A N/A 27200295 EAP Custom 27200295 CARDIAC CATH PACK BOTH IP/OP $190.00 $141.00 $33.82 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $33.82 $190.00 $190.00 $141.02 $141.02 $146.45 $98.99 $39.60 $190.00 $76.00 $190.00 $190.00 $190.00 $190.00 $190.00 $142.50 $190.00 $190.00 $190.00 $95.00 $95.00 $150.48 $190.00 $152.00 $123.50 $190.00 $190.00 $110.20 $190.00 $114.00 $190.00 $190.00 $190.00 N/A N/A 27200296 EAP Custom 27200296 CONTRAST INJECT LINE-LOW PRESS BOTH IP/OP $7.00 $5.50 $1.25 $7.00 $7.00 $7.00 $7.00 $7.00 $7.00 $7.00 $1.25 $7.00 $7.00 $5.20 $5.20 $5.40 $3.65 $1.46 $7.00 $2.80 $7.00 $7.00 $7.00 $7.00 $7.00 $5.25 $7.00 $7.00 $7.00 $3.50 $3.50 $5.54 $7.00 $5.60 $4.55 $7.00 $7.00 $4.06 $7.00 $4.20 $7.00 $7.00 $7.00 N/A N/A 27200298 EAP HCPCS C1893 5FR - 10CM PINNACLE INTRODUCER BOTH IP/OP $38.00 $28.50 $7.54 $38.00 $20.63 $20.63 $20.63 $20.63 $38.00 $38.00 $38.00 $7.92 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $38.00 $22.48 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $7.54 $38.00 $22.04 $38.00 $38.00 $38.00 $7.92 $38.00 N/A N/A 27200299 EAP HCPCS C1893 6FR - 10CM PINNACLE INTRODUCER BOTH IP/OP $40.00 $30.00 $7.94 $40.00 $21.72 $21.72 $21.72 $21.72 $40.00 $40.00 $40.00 $8.34 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $40.00 $23.66 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $7.94 $40.00 $23.20 $40.00 $40.00 $40.00 $8.34 $40.00 N/A N/A 27200300 EAP HCPCS C1893 7FR - 10CM PINNACLE INTRODUCER BOTH IP/OP $38.00 $28.50 $7.54 $38.00 $20.63 $20.63 $20.63 $20.63 $38.00 $38.00 $38.00 $7.92 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $38.00 $22.48 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $7.54 $38.00 $22.04 $38.00 $38.00 $38.00 $7.92 $38.00 N/A N/A 27200301 EAP HCPCS C1893 8FR - 10CM PINNACLE INTRODUCER BOTH IP/OP $38.00 $28.50 $7.54 $38.00 $20.63 $20.63 $20.63 $20.63 $38.00 $38.00 $38.00 $7.92 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $38.00 $22.48 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $7.54 $38.00 $22.04 $38.00 $38.00 $38.00 $7.92 $38.00 N/A N/A 27200302 EAP HCPCS C1893 6FR - 25CM PINNACLE INTRODUCER BOTH IP/OP $69.00 $51.50 $13.69 $69.00 $37.47 $37.47 $37.47 $37.47 $69.00 $69.00 $69.00 $14.38 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $69.00 $40.81 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $13.69 $69.00 $40.02 $69.00 $69.00 $69.00 $14.38 $69.00 N/A N/A 27200303 EAP HCPCS C1893 7FR - 25CM PINNACLE INTRODUCER BOTH IP/OP $69.00 $51.50 $13.69 $69.00 $37.47 $37.47 $37.47 $37.47 $69.00 $69.00 $69.00 $14.38 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $69.00 $40.81 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $13.69 $69.00 $40.02 $69.00 $69.00 $69.00 $14.38 $69.00 N/A N/A 27200304 EAP HCPCS C1893 8FR - 25CM PINNACLE INTRODUCER BOTH IP/OP $69.00 $51.50 $13.69 $69.00 $37.47 $37.47 $37.47 $37.47 $69.00 $69.00 $69.00 $14.38 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $69.00 $40.81 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $13.69 $69.00 $40.02 $69.00 $69.00 $69.00 $14.38 $69.00 N/A N/A 27200305 EAP HCPCS C1887 6FR EBU 3.0 GUIDING CATHETER BOTH IP/OP $189.00 $140.00 $37.51 $189.00 $102.63 $102.63 $102.63 $102.63 $189.00 $189.00 $189.00 $39.39 $189.00 $140.28 $140.28 $145.68 $98.47 $39.39 $189.00 $189.00 $111.79 $189.00 $189.00 $189.00 $189.00 $141.75 $189.00 $189.00 $189.00 $94.50 $94.50 $149.69 $189.00 $151.20 $122.85 $37.51 $189.00 $109.62 $189.00 $189.00 $189.00 $39.39 $189.00 N/A N/A 27200306 EAP HCPCS C1887 6FR EBU 3.5 GUIDING CATHETER BOTH IP/OP $169.00 $125.50 $33.54 $169.00 $91.77 $91.77 $91.77 $91.77 $169.00 $169.00 $169.00 $35.22 $169.00 $125.43 $125.43 $130.27 $88.05 $35.22 $169.00 $67.60 $99.96 $169.00 $169.00 $169.00 $169.00 $126.75 $169.00 $169.00 $169.00 $84.50 $84.50 $133.85 $169.00 $135.20 $109.85 $33.54 $169.00 $98.02 $169.00 $169.00 $169.00 $35.22 $169.00 N/A N/A 27200307 EAP HCPCS C1887 6FR EBU 4.0 GUIDING CATHETER BOTH IP/OP $169.00 $125.50 $33.54 $169.00 $91.77 $91.77 $91.77 $91.77 $169.00 $169.00 $169.00 $35.22 $169.00 $125.43 $125.43 $130.27 $88.05 $35.22 $169.00 $169.00 $99.96 $169.00 $169.00 $169.00 $169.00 $126.75 $169.00 $169.00 $169.00 $84.50 $84.50 $133.85 $169.00 $135.20 $109.85 $33.54 $169.00 $98.02 $169.00 $169.00 $169.00 $35.22 $169.00 N/A N/A 27200308 EAP HCPCS C1887 7FR EBU 3.0 GUIDING CATHETER BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $64.40 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200309 EAP HCPCS C1887 7FR EBU 3.5 GUIDING CATHETER BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200310 EAP HCPCS C1887 7FR EBU 4.0 GUIDING CATHETER BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $87.42 $87.42 $87.42 $87.42 $161.00 $161.00 $161.00 $33.56 $161.00 $119.49 $119.49 $124.10 $83.88 $33.55 $161.00 $64.40 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $104.65 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27200311 EAP HCPCS C1887 8FR EBU 3.5 GUIDING CATHETER BOTH IP/OP $180.00 $133.50 $35.73 $180.00 $97.74 $97.74 $97.74 $97.74 $180.00 $180.00 $180.00 $37.52 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $35.73 $180.00 $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A 27200312 EAP HCPCS C1887 8FR EBU 4.0 GUIDING CATHETER BOTH IP/OP $180.00 $133.50 $35.73 $180.00 $97.74 $97.74 $97.74 $97.74 $180.00 $180.00 $180.00 $37.52 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $35.73 $180.00 $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A 27200313 EAP HCPCS C1727 3.0 X 10CM CUTTING BALLOON OTW BOTH IP/OP $986.00 $730.00 $205.49 $986.00 $986.00 $986.00 $986.00 $986.00 $986.00 $986.00 $986.00 $986.00 $986.00 $731.81 $731.81 $760.01 $513.71 $205.49 $986.00 $394.40 $986.00 $986.00 $986.00 $986.00 $986.00 $739.50 $986.00 $986.00 $986.00 $493.00 $493.00 $780.91 $986.00 $788.80 $640.90 $986.00 $986.00 $571.88 $986.00 $591.60 $986.00 $986.00 $986.00 N/A N/A 27200314 EAP HCPCS C1757 7FR EXPORT XT CATHETER BOTH IP/OP "$2,850.00" "$2,109.00" $565.65 "$2,850.00" "$1,547.55" "$1,547.55" "$1,547.55" "$1,547.55" "$2,850.00" "$2,850.00" "$2,850.00" $594.01 "$2,850.00" "$2,115.27" "$2,115.27" "$2,196.78" "$1,484.85" $593.97 "$2,850.00" "$2,850.00" "$1,685.78" "$2,850.00" "$2,850.00" "$2,850.00" "$2,850.00" "$2,137.50" "$2,850.00" "$2,850.00" "$2,850.00" "$1,425.00" "$1,425.00" "$2,257.20" "$2,850.00" "$2,280.00" "$1,852.50" $565.65 "$2,850.00" "$1,653.00" "$2,850.00" "$2,850.00" "$2,850.00" $593.94 "$2,850.00" N/A N/A 27200315 EAP HCPCS C1769 .014 - 300CM ASAHI MIRACLEBROS BOTH IP/OP $691.00 $511.50 $137.15 $691.00 $375.21 $375.21 $375.21 $375.21 $691.00 $691.00 $691.00 $144.02 $691.00 $512.86 $512.86 $532.62 $360.01 $144.01 $691.00 $691.00 $408.73 $691.00 $691.00 $691.00 $691.00 $518.25 $691.00 $691.00 $691.00 $345.50 $345.50 $547.27 $691.00 $552.80 $449.15 $137.15 $691.00 $400.78 $691.00 $691.00 $691.00 $144.00 $691.00 N/A N/A 27200316 EAP HCPCS C1769 .014 - 300CM ASAHI SOFT WIRE BOTH IP/OP $268.00 $198.50 $53.19 $268.00 $145.52 $145.52 $145.52 $145.52 $268.00 $268.00 $268.00 $55.86 $268.00 $198.91 $198.91 $206.57 $139.63 $55.85 $268.00 $268.00 $158.52 $268.00 $268.00 $268.00 $268.00 $201.00 $268.00 $268.00 $268.00 $134.00 $134.00 $212.26 $268.00 $214.40 $174.20 $53.19 $268.00 $155.44 $268.00 $268.00 $268.00 $55.85 $268.00 N/A N/A 27200317 EAP HCPCS C1769 .014 - 300CM WHISPER MS BOTH IP/OP $331.00 $245.00 $65.70 $331.00 $179.73 $179.73 $179.73 $179.73 $331.00 $331.00 $331.00 $68.99 $331.00 $245.67 $245.67 $255.13 $172.45 $68.98 $331.00 $132.40 $195.79 $331.00 $331.00 $331.00 $331.00 $248.25 $331.00 $331.00 $331.00 $165.50 $165.50 $262.15 $331.00 $264.80 $215.15 $65.70 $331.00 $191.98 $331.00 $331.00 $331.00 $68.98 $331.00 N/A N/A 27200318 EAP HCPCS C1769 .014 - 300CM ALL-STAR WIRE BOTH IP/OP $307.00 $227.50 $60.93 $307.00 $166.70 $166.70 $166.70 $166.70 $307.00 $307.00 $307.00 $63.99 $307.00 $227.86 $227.86 $236.64 $159.95 $63.98 $307.00 $122.80 $181.59 $307.00 $307.00 $307.00 $307.00 $230.25 $307.00 $307.00 $307.00 $153.50 $153.50 $243.14 $307.00 $245.60 $199.55 $60.93 $307.00 $178.06 $307.00 $307.00 $307.00 $63.98 $307.00 N/A N/A 27200319 EAP HCPCS C1753 EAGLE EYE CORONARY IMAGING CAT BOTH IP/OP "$2,449.00" "$1,812.50" $486.07 "$2,449.00" "$1,329.81" "$1,329.81" "$1,329.81" "$1,329.81" "$2,449.00" "$2,449.00" "$2,449.00" $510.43 "$2,449.00" "$1,817.65" "$1,817.65" "$1,887.69" "$1,275.93" $510.40 "$2,449.00" "$2,449.00" "$1,448.58" "$2,449.00" "$2,449.00" "$2,449.00" "$2,449.00" "$1,836.75" "$2,449.00" "$2,449.00" "$2,449.00" "$1,224.50" "$1,224.50" "$1,939.61" "$2,449.00" "$1,959.20" "$1,591.85" $486.07 "$2,449.00" "$1,420.42" "$2,449.00" "$2,449.00" "$2,449.00" $510.37 "$2,449.00" N/A N/A 27200320 EAP Custom 27200320 PRIMEWIRE BOTH IP/OP "$2,332.00" "$1,726.00" $415.10 "$2,332.00" "$2,332.00" "$2,332.00" "$2,332.00" "$2,332.00" "$2,332.00" "$2,332.00" $415.10 "$2,332.00" "$2,332.00" "$1,730.81" "$1,730.81" "$1,797.51" "$1,214.97" $486.01 "$2,332.00" $932.80 "$2,332.00" "$2,332.00" "$2,332.00" "$2,332.00" "$2,332.00" "$1,749.00" "$2,332.00" "$2,332.00" "$2,332.00" "$1,166.00" "$1,166.00" "$1,846.94" "$2,332.00" "$1,865.60" "$1,515.80" "$2,332.00" "$2,332.00" "$1,352.56" "$2,332.00" "$1,399.20" "$2,332.00" "$2,332.00" "$2,332.00" N/A N/A 27200321 EAP HCPCS C1893 8FR-35CM SUPER ARROW FLEX INTR BOTH IP/OP $249.00 $184.50 $49.42 $249.00 $135.21 $135.21 $135.21 $135.21 $249.00 $249.00 $249.00 $51.90 $249.00 $184.81 $184.81 $191.93 $129.73 $51.89 $249.00 $249.00 $147.28 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $161.85 $49.42 $249.00 $144.42 $249.00 $249.00 $249.00 $51.89 $249.00 N/A N/A 27200322 EAP Custom 27200322 PLATINUM PLUS ST .018 GUIDEWIR BOTH IP/OP $288.00 $213.50 $51.26 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $51.26 $288.00 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $115.20 $288.00 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $288.00 $288.00 $167.04 $288.00 $172.80 $288.00 $288.00 $288.00 N/A N/A 27200323 EAP Custom 27200323 PLATINUM PLUS ST .014 GUIDEWIR BOTH IP/OP $288.00 $213.50 $51.26 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $51.26 $288.00 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $115.20 $288.00 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $288.00 $288.00 $167.04 $288.00 $172.80 $288.00 $288.00 $288.00 N/A N/A 27200324 EAP Custom 27200324 V-18 CONTROL WIRE BOTH IP/OP $340.00 $252.00 $60.52 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $60.52 $340.00 $340.00 $252.35 $252.35 $262.07 $177.14 $70.86 $340.00 $136.00 $340.00 $340.00 $340.00 $340.00 $340.00 $255.00 $340.00 $340.00 $340.00 $170.00 $170.00 $269.28 $340.00 $272.00 $221.00 $340.00 $340.00 $197.20 $340.00 $204.00 $340.00 $340.00 $340.00 N/A N/A 27200325 EAP Custom 27200325 STEEL CORE 18 GUIDEWIRE BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 27200329 EAP Custom 27200329 14FR SHEATH INTRODUCER BOTH IP/OP $87.00 $64.50 $15.49 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $15.49 $87.00 $87.00 $64.57 $64.57 $67.06 $45.33 $18.13 $87.00 $34.80 $87.00 $87.00 $87.00 $87.00 $87.00 $65.25 $87.00 $87.00 $87.00 $43.50 $43.50 $68.90 $87.00 $69.60 $56.55 $87.00 $87.00 $50.46 $87.00 $52.20 $87.00 $87.00 $87.00 N/A N/A 27200338 EAP HCPCS C1725 VOYAGER NC 2.5 X 15MM BALLOON BOTH IP/OP $634.00 $469.50 $125.83 $634.00 $344.26 $344.26 $344.26 $344.26 $634.00 $634.00 $634.00 $132.14 $634.00 $470.55 $470.55 $488.69 $330.31 $132.13 $634.00 $634.00 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $412.10 $125.83 $634.00 $367.72 $634.00 $634.00 $634.00 $132.13 $634.00 N/A N/A 27200373 EAP HCPCS C1726 CATHETER BALDILAT 12 ATM 1.5MM 142CM 12MM RAPEX BOTH IP/OP $413.00 $306.00 $81.97 $413.00 $224.26 $224.26 $224.26 $224.26 $413.00 $413.00 $413.00 $86.08 $413.00 $306.53 $306.53 $318.34 $215.17 $86.07 $413.00 $413.00 $244.29 $413.00 $413.00 $413.00 $413.00 $309.75 $413.00 $413.00 $413.00 $206.50 $206.50 $327.10 $413.00 $330.40 $268.45 $81.97 $413.00 $239.54 $413.00 $413.00 $413.00 $86.07 $413.00 N/A N/A 27200376 EAP HCPCS C1726 CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 12MM SPNTR LGND BOTH IP/OP $413.00 $306.00 $81.97 $413.00 $224.26 $224.26 $224.26 $224.26 $413.00 $413.00 $413.00 $86.08 $413.00 $306.53 $306.53 $318.34 $215.17 $86.07 $413.00 $413.00 $244.29 $413.00 $413.00 $413.00 $413.00 $309.75 $413.00 $413.00 $413.00 $206.50 $206.50 $327.10 $413.00 $330.40 $268.45 $81.97 $413.00 $239.54 $413.00 $413.00 $413.00 $86.07 $413.00 N/A N/A 27200382 EAP HCPCS C1726 SPRINTER LEGEND BALLOON RX 3.0 BOTH IP/OP $569.00 $421.50 $112.93 $569.00 $308.97 $308.97 $308.97 $308.97 $569.00 $569.00 $569.00 $118.59 $569.00 $422.31 $422.31 $438.59 $296.45 $118.59 $569.00 $569.00 $336.56 $569.00 $569.00 $569.00 $569.00 $426.75 $569.00 $569.00 $569.00 $284.50 $284.50 $450.65 $569.00 $455.20 $369.85 $112.93 $569.00 $330.02 $569.00 $569.00 $569.00 $118.58 $569.00 N/A N/A 27200406 EAP HCPCS C1726 SPRINTER NC BALLOON RX 3.50X06 BOTH IP/OP $627.00 $464.00 $124.44 $627.00 $340.46 $340.46 $340.46 $340.46 $627.00 $627.00 $627.00 $130.68 $627.00 $465.36 $465.36 $483.29 $326.67 $130.67 $627.00 $627.00 $370.87 $627.00 $627.00 $627.00 $627.00 $470.25 $627.00 $627.00 $627.00 $313.50 $313.50 $496.58 $627.00 $501.60 $407.55 $124.44 $627.00 $363.66 $627.00 $627.00 $627.00 $130.67 $627.00 N/A N/A 27200408 EAP HCPCS C1726 SPRINTER NC BALLOON RX 3.50X12 BOTH IP/OP $627.00 $464.00 $124.44 $627.00 $340.46 $340.46 $340.46 $340.46 $627.00 $627.00 $627.00 $130.68 $627.00 $465.36 $465.36 $483.29 $326.67 $130.67 $627.00 $627.00 $370.87 $627.00 $627.00 $627.00 $627.00 $470.25 $627.00 $627.00 $627.00 $313.50 $313.50 $496.58 $627.00 $501.60 $407.55 $124.44 $627.00 $363.66 $627.00 $627.00 $627.00 $130.67 $627.00 N/A N/A 27200417 EAP HCPCS C1726 SPRINTER NC BALLOON RX 4.00X15 BOTH IP/OP $627.00 $464.00 $124.44 $627.00 $340.46 $340.46 $340.46 $340.46 $627.00 $627.00 $627.00 $130.68 $627.00 $465.36 $465.36 $483.29 $326.67 $130.67 $627.00 $627.00 $370.87 $627.00 $627.00 $627.00 $627.00 $470.25 $627.00 $627.00 $627.00 $313.50 $313.50 $496.58 $627.00 $501.60 $407.55 $124.44 $627.00 $363.66 $627.00 $376.20 $627.00 $130.67 $627.00 N/A N/A 27200422 EAP Custom 27200422 SPACER (MDI) BOTH IP/OP $215.00 $159.50 $38.27 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $38.27 $215.00 $215.00 $159.57 $159.57 $165.72 $112.02 $44.81 $215.00 $86.00 $215.00 $215.00 $215.00 $215.00 $215.00 $161.25 $215.00 $215.00 $215.00 $107.50 $107.50 $170.28 $215.00 $172.00 $139.75 $215.00 $215.00 $124.70 $215.00 $129.00 $215.00 $215.00 $215.00 N/A N/A 27200423 EAP Custom 27200423 FOOT DROP SPLINT-CUSTOM BOTH IP/OP $243.00 $180.00 $43.25 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $43.25 $243.00 $243.00 $180.35 $180.35 $187.30 $126.60 $50.64 $243.00 $97.20 $243.00 $243.00 $243.00 $243.00 $243.00 $182.25 $243.00 $243.00 $243.00 $121.50 $121.50 $192.46 $243.00 $194.40 $157.95 $243.00 $243.00 $140.94 $243.00 $145.80 $243.00 $243.00 $243.00 N/A N/A 27200425 EAP Custom 27200425 "CATHETERIZATION KIT, STRAIGHT" BOTH IP/OP $60.00 $44.50 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 $60.00 $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A 27200426 EAP Custom 27200426 BLOOD ADMINISTRATION SET UP BOTH IP/OP $3.00 $2.50 $0.53 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $3.00 $0.53 $3.00 $3.00 $2.23 $2.23 $2.31 $1.56 $0.63 $3.00 $1.20 $3.00 $3.00 $3.00 $3.00 $3.00 $2.25 $3.00 $3.00 $3.00 $1.50 $1.50 $2.38 $3.00 $2.40 $1.95 $3.00 $3.00 $1.74 $3.00 $1.80 $3.00 $3.00 $3.00 N/A N/A 27200427 EAP Custom 27200427 INTRA-UTERINE PRESS CATH BOTH IP/OP $92.00 $68.50 $16.38 $92.00 $92.00 $92.00 $92.00 $92.00 $92.00 $92.00 $16.38 $92.00 $92.00 $68.28 $68.28 $70.91 $47.93 $19.17 $92.00 $36.80 $92.00 $92.00 $92.00 $92.00 $92.00 $69.00 $92.00 $92.00 $92.00 $46.00 $46.00 $72.86 $92.00 $73.60 $59.80 $92.00 $92.00 $53.36 $92.00 $55.20 $92.00 $92.00 $92.00 N/A N/A 27200428 EAP Custom 27200428 "PACK, C-SECTION" BOTH IP/OP $157.00 $116.50 $27.95 $157.00 $157.00 $157.00 $157.00 $157.00 $157.00 $157.00 $27.95 $157.00 $157.00 $116.53 $116.53 $121.02 $81.80 $32.72 $157.00 $62.80 $157.00 $157.00 $157.00 $157.00 $157.00 $117.75 $157.00 $157.00 $157.00 $78.50 $78.50 $124.34 $157.00 $125.60 $102.05 $157.00 $157.00 $91.06 $157.00 $94.20 $157.00 $157.00 $157.00 N/A N/A 27200430 EAP Custom 27200430 "CATHETERIZATION KIT, FOLEY" BOTH IP/OP $64.00 $47.50 $11.39 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $11.39 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 27200431 EAP Custom 27200431 "CATHETERIZATION KIT, STRAIGHT" BOTH IP/OP $180.00 $133.50 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 $180.00 $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A 27200432 EAP Custom 27200432 BLOOD ADMINISTRATION SET UP BOTH IP/OP $18.00 $13.50 $3.20 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $3.20 $18.00 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $7.20 $18.00 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $18.00 $18.00 $10.44 $18.00 $10.80 $18.00 $18.00 $18.00 N/A N/A 27200433 EAP Custom 27200433 KARMEN CANNULA BOTH IP/OP "$1,131.00" $837.00 $201.32 "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" $201.32 "$1,131.00" "$1,131.00" $839.43 $839.43 $871.77 $589.25 $235.71 "$1,131.00" $452.40 "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" $848.25 "$1,131.00" "$1,131.00" "$1,131.00" $565.50 $565.50 $895.75 "$1,131.00" $904.80 $735.15 "$1,131.00" "$1,131.00" $655.98 "$1,131.00" $678.60 "$1,131.00" "$1,131.00" "$1,131.00" N/A N/A 27200434 EAP HCPCS A4405 STOMAHESIVE PASTE 2 OZ TUBE BOTH IP/OP $108.00 $80.00 $1.76 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $1.76 $108.00 $108.00 $80.16 $80.16 $83.25 $56.27 $22.51 $108.00 $43.20 $108.00 $108.00 $108.00 $108.00 $108.00 $81.00 $108.00 $108.00 $108.00 $54.00 $54.00 $85.54 $108.00 $86.40 $70.20 $108.00 $108.00 $62.64 $108.00 $64.80 $108.00 $108.00 $108.00 N/A N/A 27200435 EAP Custom 27200435 "LITTLE ONES, POUCH FLANGE" BOTH IP/OP $18.00 $13.50 $3.20 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $3.20 $18.00 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $7.20 $18.00 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $18.00 $18.00 $10.44 $18.00 $10.80 $18.00 $18.00 $18.00 N/A N/A 27200436 EAP Custom 27200436 "POUCH, UROSTOMY OPAQUE" BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27200437 EAP Custom 27200437 FLEXIBLE FLANGE BOTH IP/OP $42.00 $31.50 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $7.48 $42.00 $42.00 $31.17 $31.17 $32.37 $21.88 $8.75 $42.00 $16.80 $42.00 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $27.30 $42.00 $42.00 $24.36 $42.00 $25.20 $42.00 $42.00 $42.00 N/A N/A 27200438 EAP Custom 27200438 "IRRIGATOR, VISIFLOW W/CONE" BOTH IP/OP $201.00 $149.00 $35.78 $201.00 $201.00 $201.00 $201.00 $201.00 $201.00 $201.00 $35.78 $201.00 $201.00 $149.18 $149.18 $154.93 $104.72 $41.89 $201.00 $80.40 $201.00 $201.00 $201.00 $201.00 $201.00 $150.75 $201.00 $201.00 $201.00 $100.50 $100.50 $159.19 $201.00 $160.80 $130.65 $201.00 $201.00 $116.58 $201.00 $120.60 $201.00 $201.00 $201.00 N/A N/A 27200439 EAP Custom 27200439 IRRIGATION SLEEVE BOTH IP/OP $207.00 $153.50 $36.85 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $36.85 $207.00 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $82.80 $207.00 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $207.00 $207.00 $120.06 $207.00 $124.20 $207.00 $207.00 $207.00 N/A N/A 27200440 EAP HCPCS A4371 STOMAHESIVE POWDER BOTH IP/OP $56.00 $41.50 $4.63 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $4.63 $56.00 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $22.40 $56.00 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $56.00 $56.00 $32.48 $56.00 $33.60 $56.00 $56.00 $56.00 N/A N/A 27200441 EAP Custom 27200441 MINI POUCH BOTH IP/OP $56.00 $41.50 $9.97 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $9.97 $56.00 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $22.40 $56.00 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $56.00 $56.00 $32.48 $56.00 $33.60 $56.00 $56.00 $56.00 N/A N/A 27200442 EAP Custom 27200442 WOUND POUCH MED. BOTH IP/OP $68.00 $50.50 $12.10 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $12.10 $68.00 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $27.20 $68.00 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $68.00 $68.00 $39.44 $68.00 $40.80 $68.00 $68.00 $68.00 N/A N/A 27200443 EAP HCPCS A4364 MEDICAL ADHESIVE BOTH IP/OP $68.00 $50.50 $13.50 $68.00 $36.92 $36.92 $36.92 $36.92 $68.00 $68.00 $68.00 $14.17 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $68.00 $40.22 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $13.50 $68.00 $39.44 $68.00 $68.00 $68.00 $14.17 $68.00 N/A N/A 27200444 EAP Custom 27200444 DRAIN TUBE ATTACHMENT BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27200446 EAP HCPCS A4364 "SKIN BOND CEMENT, 4OZ" BOTH IP/OP $76.00 $56.50 $15.08 $76.00 $41.27 $41.27 $41.27 $41.27 $76.00 $76.00 $76.00 $15.84 $76.00 $56.41 $56.41 $58.58 $39.60 $15.84 $76.00 $76.00 $44.95 $76.00 $76.00 $76.00 $76.00 $57.00 $76.00 $76.00 $76.00 $38.00 $38.00 $60.19 $76.00 $60.80 $49.40 $15.08 $76.00 $44.08 $76.00 $76.00 $76.00 $15.84 $76.00 N/A N/A 27200447 EAP HCPCS A4455 "UNI-SOLVE WIPES,ADHES. REMOVER" BOTH IP/OP $103.00 $76.50 $4.59 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $4.59 $103.00 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $41.20 $103.00 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $103.00 $103.00 $59.74 $103.00 $61.80 $103.00 $103.00 $103.00 N/A N/A 27200448 EAP HCPCS A6197 ALGINATE DRESSING>16<= 48 SQ IN BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27200449 EAP Custom 27200449 ACE WRAP SUPPLY BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27200450 EAP HCPCS C1728 "CATHETER,BRACHYTHERAPY SEED AD" BOTH IP/OP "$10,554.00" "$7,810.00" "$2,060.15" "$10,554.00" "$5,730.82" "$5,730.82" "$5,730.82" "$5,730.82" "$10,554.00" "$10,554.00" "$10,554.00" "$2,199.72" "$10,554.00" "$4,181.12" "$4,181.12" "$8,135.02" "$2,060.15" "$2,199.57" "$10,554.00" "$10,554.00" "$3,094.73" "$10,554.00" "$10,554.00" "$10,554.00" "$10,554.00" "$7,915.50" "$10,554.00" "$10,554.00" "$10,554.00" "$5,277.00" "$5,277.00" "$8,358.77" "$10,554.00" "$8,443.20" "$6,860.10" "$2,094.71" "$10,554.00" "$6,121.32" "$10,554.00" "$10,554.00" "$10,554.00" "$2,199.45" "$10,554.00" N/A N/A 27200456 EAP HCPCS C2629 MIC G-18 INTRODUCER KIT BOTH IP/OP $585.00 $433.00 $116.11 $585.00 $317.66 $317.66 $317.66 $317.66 $585.00 $585.00 $585.00 $121.93 $585.00 $434.19 $434.19 $450.92 $304.79 $121.92 $585.00 $585.00 $346.03 $585.00 $585.00 $585.00 $585.00 $438.75 $585.00 $585.00 $585.00 $292.50 $292.50 $463.32 $585.00 $468.00 $380.25 $116.11 $585.00 $339.30 $585.00 $585.00 $585.00 $121.91 $585.00 N/A N/A 27200457 EAP HCPCS C1751 CATH CEN VEN 4FR 1 LUM TRY 3CG SHRLK STY MAXIMAL BRR PIC BOTH IP/OP $249.00 $184.50 $49.42 $249.00 $135.21 $135.21 $135.21 $135.21 $249.00 $249.00 $249.00 $51.90 $249.00 $184.81 $184.81 $191.93 $129.73 $51.89 $249.00 $249.00 $147.28 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $161.85 $49.42 $249.00 $144.42 $249.00 $249.00 $249.00 $51.89 $249.00 N/A N/A 27200458 EAP HCPCS C1751 CATH 5FR 1LUM TRY 3CG SHRLK STY MAXIMAL BRR PICC P BOTH IP/OP $260.00 $192.50 $51.60 $260.00 $141.18 $141.18 $141.18 $141.18 $260.00 $260.00 $260.00 $54.19 $260.00 $192.97 $192.97 $200.41 $135.46 $54.19 $260.00 $260.00 $153.79 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $169.00 $51.60 $260.00 $150.80 $260.00 $260.00 $260.00 $54.18 $260.00 N/A N/A 27200460 EAP HCPCS C1894 MICRO MICROINTRUDUCER 7CM 5.0FR FLECURA GUIDEWIRE BOTH IP/OP $39.00 $29.00 $7.74 $39.00 $21.18 $21.18 $21.18 $21.18 $39.00 $39.00 $39.00 $8.13 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $39.00 $23.07 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $7.74 $39.00 $22.62 $39.00 $39.00 $39.00 $8.13 $39.00 N/A N/A 27200461 EAP HCPCS C1751 TRAY CATH 5FR 12CM CEN VEN SPCTRM 3 LUM PU .025IN DISP D BOTH IP/OP $320.00 $237.00 $63.51 $320.00 $173.76 $173.76 $173.76 $173.76 $320.00 $320.00 $320.00 $66.70 $320.00 $237.50 $237.50 $246.66 $166.72 $66.69 $320.00 $320.00 $189.28 $320.00 $320.00 $320.00 $320.00 $240.00 $320.00 $320.00 $320.00 $160.00 $160.00 $253.44 $320.00 $256.00 $208.00 $63.51 $320.00 $185.60 $320.00 $320.00 $320.00 $66.69 $320.00 N/A N/A 27200462 EAP HCPCS C1887 SHEATH GUID 65CM 6FR PN DSTN .038IN STR HYDPHI BOTH IP/OP $224.00 $166.00 $44.46 $224.00 $121.63 $121.63 $121.63 $121.63 $224.00 $224.00 $224.00 $46.69 $224.00 $166.25 $166.25 $172.66 $116.70 $46.68 $224.00 $224.00 $132.50 $224.00 $224.00 $224.00 $224.00 $168.00 $224.00 $224.00 $224.00 $112.00 $112.00 $177.41 $224.00 $179.20 $145.60 $44.46 $224.00 $129.92 $224.00 $224.00 $224.00 $46.68 $224.00 N/A N/A 27200470 EAP HCPCS C1884 EMBOSPHERE PRE-FILLED SYRINGE 300-500 MICRONS/2ML BOTH IP/OP $625.00 $462.50 $124.05 $625.00 $339.38 $339.38 $339.38 $339.38 $625.00 $625.00 $625.00 $130.27 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $124.05 $625.00 $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A 27200471 EAP HCPCS C1894 INTRODUCER SHEATH 7FR .1IN 80CM TUOHY BORST SIDEARM RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27200472 EAP HCPCS C1769 GUIDEWIRE VASCULAR 45D .016IN 180CM 2MM ANGLED FLEXIBLE TIP BOTH IP/OP $725.00 $536.50 $143.89 $725.00 $393.68 $393.68 $393.68 $393.68 $725.00 $725.00 $725.00 $151.11 $725.00 $538.10 $538.10 $558.83 $377.73 $151.10 $725.00 $725.00 $428.84 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $471.25 $143.89 $725.00 $420.50 $725.00 $725.00 $725.00 $151.09 $725.00 N/A N/A 27200473 EAP HCPCS C1887 CATHETER GUID MPC CURVE 5FR .056IN 90CM BRAID RADIOPQ SOFT BOTH IP/OP $893.00 $661.00 $177.24 $893.00 $484.90 $484.90 $484.90 $484.90 $893.00 $893.00 $893.00 $186.12 $893.00 $662.78 $662.78 $688.32 $465.25 $186.11 $893.00 $893.00 $528.21 $893.00 $893.00 $893.00 $893.00 $669.75 $893.00 $893.00 $893.00 $446.50 $446.50 $707.26 $893.00 $714.40 $580.45 $177.24 $893.00 $517.94 $893.00 $893.00 $893.00 $186.10 $893.00 N/A N/A 27200474 EAP HCPCS C1725 CATHETER ANGIOGRAPHIC MOTARJEME CURVE 5FR .046IN 100CM BRAID BOTH IP/OP $310.00 $229.50 $61.53 $310.00 $168.33 $168.33 $168.33 $168.33 $310.00 $310.00 $310.00 $64.61 $310.00 $230.08 $230.08 $238.95 $161.51 $64.61 $310.00 $310.00 $183.37 $310.00 $310.00 $310.00 $310.00 $232.50 $310.00 $310.00 $310.00 $155.00 $155.00 $245.52 $310.00 $248.00 $201.50 $61.53 $310.00 $179.80 $310.00 $310.00 $310.00 $64.60 $310.00 N/A N/A 27200475 EAP HCPCS C1725 CATHETER ANGIOGRAPHIC .035IN PIGTAIL 5FR .052IN 90CM ULTRA BOTH IP/OP $305.00 $226.00 $60.53 $305.00 $165.62 $165.62 $165.62 $165.62 $305.00 $305.00 $305.00 $63.57 $305.00 $226.37 $226.37 $235.09 $158.91 $63.57 $305.00 $305.00 $180.41 $305.00 $305.00 $305.00 $305.00 $228.75 $305.00 $305.00 $305.00 $152.50 $152.50 $241.56 $305.00 $244.00 $198.25 $60.53 $305.00 $176.90 $305.00 $305.00 $305.00 $63.56 $305.00 N/A N/A 27200477 EAP HCPCS C1769 GUIDEWIRE VASCULAR .014IN 300CM 20CM EXCHANGE RADIOPQ DISTAL BOTH IP/OP $896.00 $663.50 $177.83 $896.00 $486.53 $486.53 $486.53 $486.53 $896.00 $896.00 $896.00 $186.75 $896.00 $665.01 $665.01 $690.64 $466.82 $186.74 $896.00 $896.00 $529.98 $896.00 $896.00 $896.00 $896.00 $672.00 $896.00 $896.00 $896.00 $448.00 $448.00 $709.63 $896.00 $716.80 $582.40 $177.83 $896.00 $519.68 $896.00 $896.00 $896.00 $186.73 $896.00 N/A N/A 27200478 EAP HCPCS C1887 CATHETER INFUS 45D .014IN MICRO STR 1.9-2.4FR .017IN 155CM BOTH IP/OP "$1,773.00" "$1,312.50" $351.90 "$1,773.00" $962.74 $962.74 $962.74 $962.74 "$1,773.00" "$1,773.00" "$1,773.00" $369.54 "$1,773.00" "$1,315.92" "$1,315.92" "$1,366.63" $923.73 $369.51 "$1,773.00" "$1,773.00" "$1,048.73" "$1,773.00" "$1,773.00" "$1,773.00" "$1,773.00" "$1,329.75" "$1,773.00" "$1,773.00" "$1,773.00" $886.50 $886.50 "$1,404.22" "$1,773.00" "$1,418.40" "$1,152.45" $351.90 "$1,773.00" "$1,028.34" "$1,773.00" "$1,773.00" "$1,773.00" $369.49 "$1,773.00" N/A N/A 27200479 EAP HCPCS C1887 CATHETER INFUS 90D .014IN MICRO STR 1.9-2.4FR .017IN 155CM BOTH IP/OP "$1,688.00" "$1,249.50" $335.03 "$1,688.00" $916.58 $916.58 $916.58 $916.58 "$1,688.00" "$1,688.00" "$1,688.00" $351.82 "$1,688.00" "$1,252.83" "$1,252.83" "$1,301.11" $879.45 $351.80 "$1,688.00" "$1,688.00" $998.45 "$1,688.00" "$1,688.00" "$1,688.00" "$1,688.00" "$1,266.00" "$1,688.00" "$1,688.00" "$1,688.00" $844.00 $844.00 "$1,336.90" "$1,688.00" "$1,350.40" "$1,097.20" $335.03 "$1,688.00" $979.04 "$1,688.00" "$1,688.00" "$1,688.00" $351.78 "$1,688.00" N/A N/A 27200481 EAP Custom 27200481 CATHETER VASCULAR OCCLUSION 1028 FLOCONTROL TN BOTH IP/OP "$6,988.00" "$5,171.50" "$1,243.86" "$6,988.00" "$6,988.00" "$6,988.00" "$6,988.00" "$6,988.00" "$6,988.00" "$6,988.00" "$1,243.86" "$6,988.00" "$6,988.00" "$4,181.12" "$4,181.12" "$5,386.35" "$2,060.15" "$1,456.38" "$6,988.00" "$2,795.20" "$6,988.00" "$6,988.00" "$6,988.00" "$6,988.00" "$6,988.00" "$5,241.00" "$6,988.00" "$6,988.00" "$6,988.00" "$3,494.00" "$3,494.00" "$5,534.50" "$6,988.00" "$5,590.40" "$4,542.20" "$6,988.00" "$6,988.00" "$4,053.04" "$6,988.00" "$4,192.80" "$6,988.00" "$6,988.00" "$6,988.00" N/A N/A 27200482 EAP HCPCS C1757 CATHETER REPERFUSION 4MAX BOTH IP/OP "$3,225.00" "$2,386.50" $640.08 "$3,225.00" "$1,751.18" "$1,751.18" "$1,751.18" "$1,751.18" "$3,225.00" "$3,225.00" "$3,225.00" $672.17 "$3,225.00" "$2,393.60" "$2,393.60" "$2,485.83" "$1,680.23" $672.13 "$3,225.00" "$3,225.00" "$1,907.59" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$2,096.25" $640.08 "$3,225.00" "$1,870.50" "$3,225.00" "$3,225.00" "$3,225.00" $672.09 "$3,225.00" N/A N/A 27200484 EAP Custom 27200484 ADHESIVE OSTOMY MED REMAIN FLEXIBLE SILICONE BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 27200485 EAP HCPCS C1887 CATHETER GUID 9FR BALLOON CELLO BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27200496 EAP HCPCS C1894 INTRODUCER SHEATH .035IN 7FR .1IN 70CM ANL1 CURVE BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27200561 EAP HCPCS C1769 GUIDE WIRE BOTH IP/OP $338.00 $250.50 $67.08 $338.00 $183.53 $183.53 $183.53 $183.53 $338.00 $338.00 $338.00 $70.45 $338.00 $250.86 $250.86 $260.53 $176.10 $70.44 $338.00 $135.20 $199.93 $338.00 $338.00 $338.00 $338.00 $253.50 $338.00 $338.00 $338.00 $169.00 $169.00 $267.70 $338.00 $270.40 $219.70 $67.08 $338.00 $196.04 $338.00 $338.00 $338.00 $70.44 $338.00 N/A N/A 27200714 EAP Custom 27200714 COMPRESSION HOSE LG/XLG KNEE BOTH IP/OP $131.00 $97.00 $23.32 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $23.32 $131.00 $131.00 $97.23 $97.23 $100.97 $68.25 $27.30 $131.00 $52.40 $131.00 $131.00 $131.00 $131.00 $131.00 $98.25 $131.00 $131.00 $131.00 $65.50 $65.50 $103.75 $131.00 $104.80 $85.15 $131.00 $131.00 $75.98 $131.00 $78.60 $131.00 $131.00 $131.00 N/A N/A 27200751 EAP Custom 27200751 "GRASPING FORCEPS, 10MM X 120CM" BOTH IP/OP $744.00 $551.00 $132.43 $744.00 $744.00 $744.00 $744.00 $744.00 $744.00 $744.00 $132.43 $744.00 $744.00 $552.20 $552.20 $573.48 $387.62 $155.06 $744.00 $297.60 $744.00 $744.00 $744.00 $744.00 $744.00 $558.00 $744.00 $744.00 $744.00 $372.00 $372.00 $589.25 $744.00 $595.20 $483.60 $744.00 $744.00 $431.52 $744.00 $446.40 $744.00 $744.00 $744.00 N/A N/A 27200753 EAP Custom 27200753 "GRASPING FORCEPS, 8MM X 120CM" BOTH IP/OP $708.00 $524.00 $126.02 $708.00 $708.00 $708.00 $708.00 $708.00 $708.00 $708.00 $126.02 $708.00 $708.00 $525.48 $525.48 $545.73 $368.87 $147.55 $708.00 $283.20 $708.00 $708.00 $708.00 $708.00 $708.00 $531.00 $708.00 $708.00 $708.00 $354.00 $354.00 $560.74 $708.00 $566.40 $460.20 $708.00 $708.00 $410.64 $708.00 $424.80 $708.00 $708.00 $708.00 N/A N/A 27200755 EAP Custom 27200755 "GRASP FORCEPS, STONE RETRIEVAL" BOTH IP/OP $705.00 $522.00 $125.49 $705.00 $705.00 $705.00 $705.00 $705.00 $705.00 $705.00 $125.49 $705.00 $705.00 $523.25 $523.25 $543.41 $367.31 $146.93 $705.00 $282.00 $705.00 $705.00 $705.00 $705.00 $705.00 $528.75 $705.00 $705.00 $705.00 $352.50 $352.50 $558.36 $705.00 $564.00 $458.25 $705.00 $705.00 $408.90 $705.00 $423.00 $705.00 $705.00 $705.00 N/A N/A 27200766 EAP Custom 27200766 "PROBE, ELECTROHYDRAULIC LITHOT" BOTH IP/OP $428.00 $317.00 $76.18 $428.00 $428.00 $428.00 $428.00 $428.00 $428.00 $428.00 $76.18 $428.00 $428.00 $317.66 $317.66 $329.90 $222.99 $89.20 $428.00 $171.20 $428.00 $428.00 $428.00 $428.00 $428.00 $321.00 $428.00 $428.00 $428.00 $214.00 $214.00 $338.98 $428.00 $342.40 $278.20 $428.00 $428.00 $248.24 $428.00 $256.80 $428.00 $428.00 $428.00 N/A N/A 27200769 EAP Custom 27200769 BIPOLAR FORCEPS BOTH IP/OP $573.00 $424.50 $101.99 $573.00 $573.00 $573.00 $573.00 $573.00 $573.00 $573.00 $101.99 $573.00 $573.00 $425.28 $425.28 $441.67 $298.53 $119.42 $573.00 $229.20 $573.00 $573.00 $573.00 $573.00 $573.00 $429.75 $573.00 $573.00 $573.00 $286.50 $286.50 $453.82 $573.00 $458.40 $372.45 $573.00 $573.00 $332.34 $573.00 $343.80 $573.00 $573.00 $573.00 N/A N/A 27200834 EAP Custom 27200834 WET FIELD CAUTERY BOTH IP/OP $136.00 $101.00 $24.21 $136.00 $136.00 $136.00 $136.00 $136.00 $136.00 $136.00 $24.21 $136.00 $136.00 $100.94 $100.94 $104.83 $70.86 $28.34 $136.00 $54.40 $136.00 $136.00 $136.00 $136.00 $136.00 $102.00 $136.00 $136.00 $136.00 $68.00 $68.00 $107.71 $136.00 $108.80 $88.40 $136.00 $136.00 $78.88 $136.00 $81.60 $136.00 $136.00 $136.00 N/A N/A 27201077 EAP HCPCS C1769 "GUIDE WIRE, 292.653" BOTH IP/OP $183.00 $135.50 $36.32 $183.00 $99.37 $99.37 $99.37 $99.37 $183.00 $183.00 $183.00 $38.14 $183.00 $135.82 $135.82 $141.06 $95.34 $38.14 $183.00 $183.00 $108.24 $183.00 $183.00 $183.00 $183.00 $137.25 $183.00 $183.00 $183.00 $91.50 $91.50 $144.94 $183.00 $146.40 $118.95 $36.32 $183.00 $106.14 $183.00 $183.00 $183.00 $38.14 $183.00 N/A N/A 27201301 EAP Custom 27201301 "DRILL BIT, 357.047" BOTH IP/OP "$1,952.00" "$1,444.50" $347.46 "$1,952.00" "$1,952.00" "$1,952.00" "$1,952.00" "$1,952.00" "$1,952.00" "$1,952.00" $347.46 "$1,952.00" "$1,952.00" "$1,448.77" "$1,448.77" "$1,504.60" "$1,016.99" $406.82 "$1,952.00" $780.80 "$1,952.00" "$1,952.00" "$1,952.00" "$1,952.00" "$1,952.00" "$1,464.00" "$1,952.00" "$1,952.00" "$1,952.00" $976.00 $976.00 "$1,545.98" "$1,952.00" "$1,561.60" "$1,268.80" "$1,952.00" "$1,952.00" "$1,132.16" "$1,952.00" "$1,171.20" "$1,952.00" "$1,952.00" "$1,952.00" N/A N/A 27201369 EAP Custom 27201369 ENDO DISPOSABLE LAP. INSTR. BOTH IP/OP $977.00 $723.00 $173.91 $977.00 $977.00 $977.00 $977.00 $977.00 $977.00 $977.00 $173.91 $977.00 $977.00 $725.13 $725.13 $753.07 $509.02 $203.62 $977.00 $390.80 $977.00 $977.00 $977.00 $977.00 $977.00 $732.75 $977.00 $977.00 $977.00 $488.50 $488.50 $773.78 $977.00 $781.60 $635.05 $977.00 $977.00 $566.66 $977.00 $586.20 $977.00 $977.00 $977.00 N/A N/A 27201377 EAP Custom 27201377 TA PREMIUM DLU STAPLES BOTH IP/OP "$1,093.00" $809.00 $194.55 "$1,093.00" "$1,093.00" "$1,093.00" "$1,093.00" "$1,093.00" "$1,093.00" "$1,093.00" $194.55 "$1,093.00" "$1,093.00" $811.22 $811.22 $842.48 $569.45 $227.79 "$1,093.00" $437.20 "$1,093.00" "$1,093.00" "$1,093.00" "$1,093.00" "$1,093.00" $819.75 "$1,093.00" "$1,093.00" "$1,093.00" $546.50 $546.50 $865.66 "$1,093.00" $874.40 $710.45 "$1,093.00" "$1,093.00" $633.94 "$1,093.00" $655.80 "$1,093.00" "$1,093.00" "$1,093.00" N/A N/A 27201399 EAP Custom 27201399 BIPOLAR BOVIE BOTH IP/OP $14.00 $10.50 $2.49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $2.49 $14.00 $14.00 $10.39 $10.39 $10.79 $7.29 $2.92 $14.00 $5.60 $14.00 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $9.10 $14.00 $14.00 $8.12 $14.00 $8.40 $14.00 $14.00 $14.00 N/A N/A 27201400 EAP Custom 27201400 MICRO CLIPS BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27201403 EAP Custom 27201403 ABD BINDER BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27201407 EAP Custom 27201407 DERMABOND BOTH IP/OP $87.00 $64.50 $15.49 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $15.49 $87.00 $87.00 $64.57 $64.57 $67.06 $45.33 $18.13 $87.00 $34.80 $87.00 $87.00 $87.00 $87.00 $87.00 $65.25 $87.00 $87.00 $87.00 $43.50 $43.50 $68.90 $87.00 $69.60 $56.55 $87.00 $87.00 $50.46 $87.00 $52.20 $87.00 $87.00 $87.00 N/A N/A 27201456 EAP Custom 27201456 "GRASPING FORCEPS, 10MM X 120CM" BOTH IP/OP $744.00 $551.00 $132.43 $744.00 $744.00 $744.00 $744.00 $744.00 $744.00 $744.00 $132.43 $744.00 $744.00 $552.20 $552.20 $573.48 $387.62 $155.06 $744.00 $297.60 $744.00 $744.00 $744.00 $744.00 $744.00 $558.00 $744.00 $744.00 $744.00 $372.00 $372.00 $589.25 $744.00 $595.20 $483.60 $744.00 $744.00 $431.52 $744.00 $446.40 $744.00 $744.00 $744.00 N/A N/A 27201458 EAP Custom 27201458 "GRASPING FORCEPS, STONE RETRIE" BOTH IP/OP $705.00 $522.00 $125.49 $705.00 $705.00 $705.00 $705.00 $705.00 $705.00 $705.00 $125.49 $705.00 $705.00 $523.25 $523.25 $543.41 $367.31 $146.93 $705.00 $282.00 $705.00 $705.00 $705.00 $705.00 $705.00 $528.75 $705.00 $705.00 $705.00 $352.50 $352.50 $558.36 $705.00 $564.00 $458.25 $705.00 $705.00 $408.90 $705.00 $423.00 $705.00 $705.00 $705.00 N/A N/A 27201474 EAP Custom 27201474 "GRASPING FORCEPS, 8MM X 120CM" BOTH IP/OP $707.00 $523.50 $125.85 $707.00 $707.00 $707.00 $707.00 $707.00 $707.00 $707.00 $125.85 $707.00 $707.00 $524.74 $524.74 $544.96 $368.35 $147.35 $707.00 $282.80 $707.00 $707.00 $707.00 $707.00 $707.00 $530.25 $707.00 $707.00 $707.00 $353.50 $353.50 $559.94 $707.00 $565.60 $459.55 $707.00 $707.00 $410.06 $707.00 $424.20 $707.00 $707.00 $707.00 N/A N/A 27201489 EAP Custom 27201489 IRRIGATION CLIP BOTH IP/OP $214.00 $158.50 $38.09 $214.00 $214.00 $214.00 $214.00 $214.00 $214.00 $214.00 $38.09 $214.00 $214.00 $158.83 $158.83 $164.95 $111.49 $44.60 $214.00 $85.60 $214.00 $214.00 $214.00 $214.00 $214.00 $160.50 $214.00 $214.00 $214.00 $107.00 $107.00 $169.49 $214.00 $171.20 $139.10 $214.00 $214.00 $124.12 $214.00 $128.40 $214.00 $214.00 $214.00 N/A N/A 27201492 EAP Custom 27201492 JP DRAIN (HEMADUCT) BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27201536 EAP Custom 27201536 COMPRESSION HOSE REG. KNEE BOTH IP/OP $101.00 $75.00 $17.98 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $17.98 $101.00 $101.00 $74.96 $74.96 $77.85 $52.62 $21.05 $101.00 $40.40 $101.00 $101.00 $101.00 $101.00 $101.00 $75.75 $101.00 $101.00 $101.00 $50.50 $50.50 $79.99 $101.00 $80.80 $65.65 $101.00 $101.00 $58.58 $101.00 $60.60 $101.00 $101.00 $101.00 N/A N/A 27201630 EAP Custom 27201630 "CATH,CHEST TUBE RT. ANGLED" BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 $135.00 $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A 27201681 EAP Custom 27201681 CATHETER ANGIO .038IN KA2 CRV 5FR .046IN 65CM PRFM BOTH IP/OP $153.00 $113.50 $27.23 $153.00 $153.00 $153.00 $153.00 $153.00 $153.00 $153.00 $27.23 $153.00 $153.00 $113.56 $113.56 $117.93 $79.71 $31.89 $153.00 $61.20 $153.00 $153.00 $153.00 $153.00 $153.00 $114.75 $153.00 $153.00 $153.00 $76.50 $76.50 $121.18 $153.00 $122.40 $99.45 $153.00 $153.00 $88.74 $153.00 $91.80 $153.00 $153.00 $153.00 N/A N/A 27201700 EAP Custom 27201700 RBC FILTER UNIT BOTH IP/OP $83.00 $61.50 $14.77 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $14.77 $83.00 $83.00 $61.60 $61.60 $63.98 $43.24 $17.30 $83.00 $33.20 $83.00 $83.00 $83.00 $83.00 $83.00 $62.25 $83.00 $83.00 $83.00 $41.50 $41.50 $65.74 $83.00 $66.40 $53.95 $83.00 $83.00 $48.14 $83.00 $49.80 $83.00 $83.00 $83.00 N/A N/A 27201701 EAP Custom 27201701 PLAT FILTER UNIT BOTH IP/OP $215.00 $159.50 $38.27 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $38.27 $215.00 $215.00 $159.57 $159.57 $165.72 $112.02 $44.81 $215.00 $86.00 $215.00 $215.00 $215.00 $215.00 $215.00 $161.25 $215.00 $215.00 $215.00 $107.50 $107.50 $170.28 $215.00 $172.00 $139.75 $215.00 $215.00 $124.70 $215.00 $129.00 $215.00 $215.00 $215.00 N/A N/A 27201702 EAP Custom 27201702 PLF1 FILTER UNIT BOTH IP/OP $39.00 $29.00 $6.94 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $39.00 $6.94 $39.00 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $15.60 $39.00 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $39.00 $39.00 $22.62 $39.00 $23.40 $39.00 $39.00 $39.00 N/A N/A 27201800 EAP HCPCS C1729 CATHETER FOLEY 16FR BOTH IP/OP $6.00 $4.50 $1.19 $6.00 $3.26 $3.26 $3.26 $3.26 $6.00 $6.00 $6.00 $1.25 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $6.00 $3.55 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $1.19 $6.00 $3.48 $6.00 $6.00 $6.00 $1.25 $6.00 N/A N/A 27201801 EAP HCPCS C1769 GUIDEWIRE .35X150CM BENTSON BOTH IP/OP $76.00 $56.50 $15.08 $76.00 $41.27 $41.27 $41.27 $41.27 $76.00 $76.00 $76.00 $15.84 $76.00 $56.41 $56.41 $58.58 $39.60 $15.84 $76.00 $76.00 $44.95 $76.00 $76.00 $76.00 $76.00 $57.00 $76.00 $76.00 $76.00 $38.00 $38.00 $60.19 $76.00 $60.80 $49.40 $15.08 $76.00 $44.08 $76.00 $76.00 $76.00 $15.84 $76.00 N/A N/A 27201802 EAP HCPCS C1750 24CM DURAFLOW CATHETER BOTH IP/OP "$2,096.00" "$1,551.50" $416.00 "$2,096.00" "$1,138.13" "$1,138.13" "$1,138.13" "$1,138.13" "$2,096.00" "$2,096.00" "$2,096.00" $436.86 "$2,096.00" "$1,555.65" "$1,555.65" "$1,615.60" "$1,092.02" $436.83 "$2,096.00" "$2,096.00" "$1,239.78" "$2,096.00" "$2,096.00" "$2,096.00" "$2,096.00" "$1,572.00" "$2,096.00" "$2,096.00" "$2,096.00" "$1,048.00" "$1,048.00" "$1,660.03" "$2,096.00" "$1,676.80" "$1,362.40" $416.00 "$2,096.00" "$1,215.68" "$2,096.00" "$2,096.00" "$2,096.00" $436.81 "$2,096.00" N/A N/A 27201803 EAP HCPCS C1750 28CM DURAFLOW CATHETER BOTH IP/OP "$1,720.00" "$1,273.00" $341.38 "$1,720.00" $933.96 $933.96 $933.96 $933.96 "$1,720.00" "$1,720.00" "$1,720.00" $358.49 "$1,720.00" "$1,276.58" "$1,276.58" "$1,325.78" $896.12 $358.47 "$1,720.00" "$1,720.00" "$1,017.38" "$1,720.00" "$1,720.00" "$1,720.00" "$1,720.00" "$1,290.00" "$1,720.00" "$1,720.00" "$1,720.00" $860.00 $860.00 "$1,362.24" "$1,720.00" "$1,376.00" "$1,118.00" $341.38 "$1,720.00" $997.60 "$1,720.00" "$1,720.00" "$1,720.00" $358.45 "$1,720.00" N/A N/A 27201804 EAP HCPCS C1752 24CM SCHON XL TEMP CATH BOTH IP/OP $315.00 $233.50 $65.65 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $233.79 $233.79 $242.80 $164.12 $65.65 $315.00 $126.00 $315.00 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $204.75 $315.00 $315.00 $182.70 $315.00 $189.00 $315.00 $315.00 $315.00 N/A N/A 27201805 EAP HCPCS C1751 5X1235X20CM UNIFUSE KIT BOTH IP/OP $550.00 $407.00 $109.16 $550.00 $298.65 $298.65 $298.65 $298.65 $550.00 $550.00 $550.00 $114.63 $550.00 $408.21 $408.21 $423.94 $286.55 $114.63 $550.00 $550.00 $325.33 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $357.50 $109.16 $550.00 $319.00 $550.00 $550.00 $550.00 $114.62 $550.00 N/A N/A 27201806 EAP HCPCS C1751 5X135X10CM UNIFUSE KIT BOTH IP/OP $550.00 $407.00 $109.16 $550.00 $298.65 $298.65 $298.65 $298.65 $550.00 $550.00 $550.00 $114.63 $550.00 $408.21 $408.21 $423.94 $286.55 $114.63 $550.00 $550.00 $325.33 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $357.50 $109.16 $550.00 $319.00 $550.00 $550.00 $550.00 $114.62 $550.00 N/A N/A 27201807 EAP HCPCS C1725 8-4/5/75 WORKHORSE PTA BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 27201808 EAP HCPCS C1752 TEMPORARY DIALYSIS CATH BOTH IP/OP $315.00 $233.50 $65.65 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $233.79 $233.79 $242.80 $164.12 $65.65 $315.00 $126.00 $315.00 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $204.75 $315.00 $315.00 $182.70 $315.00 $189.00 $315.00 $315.00 $315.00 N/A N/A 27201809 EAP HCPCS C1752 TEMPORAY DIALYSIS CATH BOTH IP/OP $740.00 $548.00 $154.22 $740.00 $740.00 $740.00 $740.00 $740.00 $740.00 $740.00 $740.00 $740.00 $740.00 $549.23 $549.23 $570.39 $385.54 $154.22 $740.00 $296.00 $740.00 $740.00 $740.00 $740.00 $740.00 $555.00 $740.00 $740.00 $740.00 $370.00 $370.00 $586.08 $740.00 $592.00 $481.00 $740.00 $740.00 $429.20 $740.00 $444.00 $740.00 $740.00 $740.00 N/A N/A 27201810 EAP HCPCS C1725 WORKHORSE PTA BALLOON BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $175.20 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 27201811 EAP HCPCS C1725 WORKHORSE PTA BALLOON BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 27201812 EAP HCPCS C1725 WRKHORSE BALLOON 5-2/5/75 BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 27201813 EAP HCPCS C1725 WRKHRSE BALLOON 10-4/5/75 BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 27201814 EAP HCPCS C1725 WRKHRSE BALLOON 5-2/5/100 BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $175.20 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 27201815 EAP HCPCS C1725 WRKHRSE BALLOON 6-2/5/75 BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 27201816 EAP HCPCS C1751 5FR DUAL LUMEN PICC LINE BOTH IP/OP $533.00 $394.50 $105.79 $533.00 $289.42 $289.42 $289.42 $289.42 $533.00 $533.00 $533.00 $111.09 $533.00 $395.59 $395.59 $410.84 $277.69 $111.08 $533.00 $533.00 $315.27 $533.00 $533.00 $533.00 $533.00 $399.75 $533.00 $533.00 $533.00 $266.50 $266.50 $422.14 $533.00 $426.40 $346.45 $105.79 $533.00 $309.14 $533.00 $533.00 $533.00 $111.08 $533.00 N/A N/A 27201817 EAP HCPCS C1751 5FR SGLE LUMEN PIC LINE BOTH IP/OP $419.00 $310.50 $83.16 $419.00 $227.52 $227.52 $227.52 $227.52 $419.00 $419.00 $419.00 $87.33 $419.00 $310.98 $310.98 $322.97 $218.30 $87.32 $419.00 $419.00 $247.84 $419.00 $419.00 $419.00 $419.00 $314.25 $419.00 $419.00 $419.00 $209.50 $209.50 $331.85 $419.00 $335.20 $272.35 $83.16 $419.00 $243.02 $419.00 $419.00 $419.00 $87.32 $419.00 N/A N/A 27201818 EAP HCPCS C1757 THROMBEX DEVICE BOTH IP/OP "$5,955.00" "$4,407.00" "$1,181.92" "$5,955.00" "$3,233.57" "$3,233.57" "$3,233.57" "$3,233.57" "$5,955.00" "$5,955.00" "$5,955.00" "$1,241.17" "$5,955.00" "$4,181.12" "$4,181.12" "$4,590.11" "$2,060.15" "$1,241.09" "$5,955.00" "$5,955.00" "$3,094.73" "$5,955.00" "$5,955.00" "$5,955.00" "$5,955.00" "$4,466.25" "$5,955.00" "$5,955.00" "$5,955.00" "$2,977.50" "$2,977.50" "$4,716.36" "$5,955.00" "$4,764.00" "$3,870.75" "$1,181.92" "$5,955.00" "$3,453.90" "$5,955.00" "$5,955.00" "$5,955.00" "$1,241.02" "$5,955.00" N/A N/A 27201819 EAP HCPCS C1769 GUIDEWIRE .035/260M EXCHANGE BOTH IP/OP $149.00 $110.50 $29.57 $149.00 $80.91 $80.91 $80.91 $80.91 $149.00 $149.00 $149.00 $31.06 $149.00 $110.59 $110.59 $114.85 $77.63 $31.05 $149.00 $149.00 $88.13 $149.00 $149.00 $149.00 $149.00 $111.75 $149.00 $149.00 $149.00 $74.50 $74.50 $118.01 $149.00 $119.20 $96.85 $29.57 $149.00 $86.42 $149.00 $149.00 $149.00 $31.05 $149.00 N/A N/A 27201820 EAP HCPCS C1769 GUIDEWIRE .035-150CM ANGLED STIFF BOTH IP/OP $167.00 $124.00 $33.15 $167.00 $90.68 $90.68 $90.68 $90.68 $167.00 $167.00 $167.00 $34.81 $167.00 $123.95 $123.95 $128.72 $87.01 $34.80 $167.00 $66.80 $98.78 $167.00 $167.00 $167.00 $167.00 $125.25 $167.00 $167.00 $167.00 $83.50 $83.50 $132.26 $167.00 $133.60 $108.55 $33.15 $167.00 $96.86 $167.00 $167.00 $167.00 $34.80 $167.00 N/A N/A 27201821 EAP HCPCS C1751 12CM KATZEN INFUSION CATH BOTH IP/OP "$1,506.00" "$1,114.50" $298.90 "$1,506.00" $817.76 $817.76 $817.76 $817.76 "$1,506.00" "$1,506.00" "$1,506.00" $313.89 "$1,506.00" "$1,117.75" "$1,117.75" "$1,160.82" $784.63 $313.87 "$1,506.00" "$1,506.00" $890.80 "$1,506.00" "$1,506.00" "$1,506.00" "$1,506.00" "$1,129.50" "$1,506.00" "$1,506.00" "$1,506.00" $753.00 $753.00 "$1,192.75" "$1,506.00" "$1,204.80" $978.90 $298.90 "$1,506.00" $873.48 "$1,506.00" "$1,506.00" "$1,506.00" $313.85 "$1,506.00" N/A N/A 27201822 EAP HCPCS C1751 150/20 TRACKER-18 INFUSIO BOTH IP/OP "$3,033.00" "$2,244.50" $601.97 "$3,033.00" "$1,646.92" "$1,646.92" "$1,646.92" "$1,646.92" "$3,033.00" "$3,033.00" "$3,033.00" $632.15 "$3,033.00" "$2,251.09" "$2,251.09" "$2,337.84" "$1,580.19" $632.11 "$3,033.00" "$3,033.00" "$1,794.02" "$3,033.00" "$3,033.00" "$3,033.00" "$3,033.00" "$2,274.75" "$3,033.00" "$3,033.00" "$3,033.00" "$1,516.50" "$1,516.50" "$2,402.14" "$3,033.00" "$2,426.40" "$1,971.45" $601.97 "$3,033.00" "$1,759.14" "$3,033.00" "$3,033.00" "$3,033.00" $632.08 "$3,033.00" N/A N/A 27201823 EAP HCPCS C1769 32-150 ANGLED GUIDEWIRE BOTH IP/OP $287.00 $212.50 $56.96 $287.00 $155.84 $155.84 $155.84 $155.84 $287.00 $287.00 $287.00 $59.82 $287.00 $213.01 $213.01 $221.22 $149.53 $59.81 $287.00 $114.80 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $186.55 $56.96 $287.00 $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A 27201824 EAP HCPCS C1894 5FR PINNACLE INTRODUCER BOTH IP/OP $67.00 $50.00 $13.30 $67.00 $36.38 $36.38 $36.38 $36.38 $67.00 $67.00 $67.00 $13.96 $67.00 $49.73 $49.73 $51.64 $34.91 $13.96 $67.00 $67.00 $39.63 $67.00 $67.00 $67.00 $67.00 $50.25 $67.00 $67.00 $67.00 $33.50 $33.50 $53.06 $67.00 $53.60 $43.55 $13.30 $67.00 $38.86 $67.00 $67.00 $67.00 $13.96 $67.00 N/A N/A 27201825 EAP HCPCS C1887 5FR-100CM AT CATHETER BOTH IP/OP $37.00 $27.50 $7.34 $37.00 $20.09 $20.09 $20.09 $20.09 $37.00 $37.00 $37.00 $7.71 $37.00 $27.46 $27.46 $28.52 $19.28 $7.71 $37.00 $37.00 $21.89 $37.00 $37.00 $37.00 $37.00 $27.75 $37.00 $37.00 $37.00 $18.50 $18.50 $29.30 $37.00 $29.60 $24.05 $7.34 $37.00 $21.46 $37.00 $37.00 $37.00 $7.71 $37.00 N/A N/A 27201826 EAP HCPCS C1751 A50/20 FASTRACKER-18 INFU BOTH IP/OP "$1,590.00" "$1,177.00" $315.58 "$1,590.00" $863.37 $863.37 $863.37 $863.37 "$1,590.00" "$1,590.00" "$1,590.00" $331.40 "$1,590.00" "$1,180.10" "$1,180.10" "$1,225.57" $828.39 $331.37 "$1,590.00" "$1,590.00" $940.49 "$1,590.00" "$1,590.00" "$1,590.00" "$1,590.00" "$1,192.50" "$1,590.00" "$1,590.00" "$1,590.00" $795.00 $795.00 "$1,259.28" "$1,590.00" "$1,272.00" "$1,033.50" $315.58 "$1,590.00" $922.20 "$1,590.00" "$1,590.00" "$1,590.00" $331.36 "$1,590.00" N/A N/A 27201827 EAP HCPCS C1769 AMPLATZ GUIDEWIRE 260CM BOTH IP/OP $129.00 $95.50 $25.60 $129.00 $70.05 $70.05 $70.05 $70.05 $129.00 $129.00 $129.00 $26.89 $129.00 $95.74 $95.74 $99.43 $67.21 $26.89 $129.00 $129.00 $76.30 $129.00 $129.00 $129.00 $129.00 $96.75 $129.00 $129.00 $129.00 $64.50 $64.50 $102.17 $129.00 $103.20 $83.85 $25.60 $129.00 $74.82 $129.00 $129.00 $129.00 $26.88 $129.00 N/A N/A 27201829 EAP HCPCS C1887 GLIDECATH C2 HYDEOPHILIC BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 27201830 EAP HCPCS C1769 GLIDEWIRE .035 150CM ANGLED BOTH IP/OP $101.00 $75.00 $20.05 $101.00 $54.84 $54.84 $54.84 $54.84 $101.00 $101.00 $101.00 $21.05 $101.00 $74.96 $74.96 $77.85 $52.62 $21.05 $101.00 $101.00 $59.74 $101.00 $101.00 $101.00 $101.00 $75.75 $101.00 $101.00 $101.00 $50.50 $50.50 $79.99 $101.00 $80.80 $65.65 $20.05 $101.00 $58.58 $101.00 $101.00 $101.00 $21.05 $101.00 N/A N/A 27201831 EAP HCPCS C1769 GUIDEWIRE AMPLATZ SUPER BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 27201832 EAP HCPCS C1769 GUIDEWIRE-LONG TAPER BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 27201833 EAP HCPCS C1769 TRANSCEND STEERABLE BOTH IP/OP $546.00 $404.50 $108.37 $546.00 $296.48 $296.48 $296.48 $296.48 $546.00 $546.00 $546.00 $113.80 $546.00 $405.24 $405.24 $420.86 $284.47 $113.79 $546.00 $546.00 $322.96 $546.00 $546.00 $546.00 $546.00 $409.50 $546.00 $546.00 $546.00 $273.00 $273.00 $432.43 $546.00 $436.80 $354.90 $108.37 $546.00 $316.68 $546.00 $546.00 $546.00 $113.79 $546.00 N/A N/A 27201834 EAP HCPCS C1725 XXL 14-4/5.8/120 BOTH IP/OP $856.00 $633.50 $169.89 $856.00 $464.81 $464.81 $464.81 $464.81 $856.00 $856.00 $856.00 $178.41 $856.00 $635.32 $635.32 $659.80 $445.98 $178.40 $856.00 $856.00 $506.32 $856.00 $856.00 $856.00 $856.00 $642.00 $856.00 $856.00 $856.00 $428.00 $428.00 $677.95 $856.00 $684.80 $556.40 $169.89 $856.00 $496.48 $856.00 $856.00 $856.00 $178.39 $856.00 N/A N/A 27201835 EAP HCPCS C1725 XXL/12-5/5.8/120 BALLOON BOTH IP/OP $856.00 $633.50 $169.89 $856.00 $464.81 $464.81 $464.81 $464.81 $856.00 $856.00 $856.00 $178.41 $856.00 $635.32 $635.32 $659.80 $445.98 $178.40 $856.00 $856.00 $506.32 $856.00 $856.00 $856.00 $856.00 $642.00 $856.00 $856.00 $856.00 $428.00 $428.00 $677.95 $856.00 $684.80 $556.40 $169.89 $856.00 $496.48 $856.00 $856.00 $856.00 $178.39 $856.00 N/A N/A 27201836 EAP HCPCS C1769 GUIDEWIRE .035-260CM BENTSON E BOTH IP/OP $88.00 $65.50 $17.47 $88.00 $47.78 $47.78 $47.78 $47.78 $88.00 $88.00 $88.00 $18.34 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $35.20 $52.05 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $17.47 $88.00 $51.04 $88.00 $88.00 $88.00 $18.34 $88.00 N/A N/A 27201837 EAP HCPCS C1729 10.2FR MP DRAIN CATHETER BOTH IP/OP $296.00 $219.50 $58.75 $296.00 $160.73 $160.73 $160.73 $160.73 $296.00 $296.00 $296.00 $61.69 $296.00 $219.69 $219.69 $228.16 $154.22 $61.69 $296.00 $296.00 $175.08 $296.00 $296.00 $296.00 $296.00 $222.00 $296.00 $296.00 $296.00 $148.00 $148.00 $234.43 $296.00 $236.80 $192.40 $58.75 $296.00 $171.68 $296.00 $296.00 $296.00 $61.69 $296.00 N/A N/A 27201838 EAP HCPCS C1894 11FR-70CM INTRODUCER SET BOTH IP/OP $233.00 $172.50 $46.24 $233.00 $126.52 $126.52 $126.52 $126.52 $233.00 $233.00 $233.00 $48.56 $233.00 $172.93 $172.93 $179.60 $121.39 $48.56 $233.00 $233.00 $137.82 $233.00 $233.00 $233.00 $233.00 $174.75 $233.00 $233.00 $233.00 $116.50 $116.50 $184.54 $233.00 $186.40 $151.45 $46.24 $233.00 $135.14 $233.00 $233.00 $233.00 $48.56 $233.00 N/A N/A 27201839 EAP HCPCS C1729 14.0FR MP DRAIN CATHETER BOTH IP/OP $289.00 $214.00 $57.36 $289.00 $156.93 $156.93 $156.93 $156.93 $289.00 $289.00 $289.00 $60.23 $289.00 $214.50 $214.50 $222.76 $150.57 $60.23 $289.00 $289.00 $170.94 $289.00 $289.00 $289.00 $289.00 $216.75 $289.00 $289.00 $289.00 $144.50 $144.50 $228.89 $289.00 $231.20 $187.85 $57.36 $289.00 $167.62 $289.00 $289.00 $289.00 $60.23 $289.00 N/A N/A 27201840 EAP Custom 27201840 35-3-5 EMBOLIZATION COIL BOTH IP/OP $172.00 $127.50 $30.62 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $30.62 $172.00 $172.00 $172.00 $172.00 $172.00 $172.00 $35.85 $172.00 $68.80 $172.00 $172.00 $172.00 $172.00 $172.00 $129.00 $172.00 $172.00 $172.00 $86.00 $86.00 $136.22 $172.00 $137.60 $77.40 $172.00 $172.00 $99.76 $172.00 $103.20 $172.00 $172.00 $172.00 N/A N/A 27201841 EAP Custom 27201841 35-5-10 EMBOLIZATION COIL BOTH IP/OP $279.00 $206.50 $49.66 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $49.66 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $58.15 $279.00 $111.60 $279.00 $279.00 $279.00 $279.00 $279.00 $209.25 $279.00 $279.00 $279.00 $139.50 $139.50 $220.97 $279.00 $223.20 $125.55 $279.00 $279.00 $161.82 $279.00 $167.40 $279.00 $279.00 $279.00 N/A N/A 27201842 EAP Custom 27201842 35-5-3 EMBOLIZATION COIL BOTH IP/OP $228.00 $169.00 $40.58 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $40.58 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $228.00 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $228.00 $228.00 $132.24 $228.00 $136.80 $228.00 $228.00 $228.00 N/A N/A 27201843 EAP Custom 27201843 35-5-8 EMBOLIZATION COIL BOTH IP/OP $167.00 $124.00 $29.73 $167.00 $167.00 $167.00 $167.00 $167.00 $167.00 $167.00 $29.73 $167.00 $167.00 $167.00 $167.00 $167.00 $167.00 $34.80 $167.00 $66.80 $167.00 $167.00 $167.00 $167.00 $167.00 $125.25 $167.00 $167.00 $167.00 $83.50 $83.50 $132.26 $167.00 $133.60 $75.15 $167.00 $167.00 $96.86 $167.00 $100.20 $167.00 $167.00 $167.00 N/A N/A 27201844 EAP HCPCS C1893 5FR80CM NEFF CATHETER BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 27201845 EAP HCPCS C1894 6FR BALKAN INTRODUCER SET BOTH IP/OP $60.00 $44.50 $11.91 $60.00 $32.58 $32.58 $32.58 $32.58 $60.00 $60.00 $60.00 $12.51 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $60.00 $35.49 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $11.91 $60.00 $34.80 $60.00 $60.00 $60.00 $12.50 $60.00 N/A N/A 27201846 EAP HCPCS C1894 7FR BALKAN INTRODUCER SET BOTH IP/OP $170.00 $126.00 $33.74 $170.00 $92.31 $92.31 $92.31 $92.31 $170.00 $170.00 $170.00 $35.43 $170.00 $126.17 $126.17 $131.04 $88.57 $35.43 $170.00 $68.00 $100.56 $170.00 $170.00 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $110.50 $33.74 $170.00 $98.60 $170.00 $170.00 $170.00 $35.43 $170.00 N/A N/A 27201847 EAP HCPCS C1729 8.5FR MP DRAIN CATHETER BOTH IP/OP $311.00 $230.50 $61.73 $311.00 $168.87 $168.87 $168.87 $168.87 $311.00 $311.00 $311.00 $64.82 $311.00 $230.82 $230.82 $239.72 $162.03 $64.82 $311.00 $311.00 $183.96 $311.00 $311.00 $311.00 $311.00 $233.25 $311.00 $311.00 $311.00 $155.50 $155.50 $246.31 $311.00 $248.80 $202.15 $61.73 $311.00 $180.38 $311.00 $311.00 $311.00 $64.81 $311.00 N/A N/A 27201848 EAP HCPCS C1729 9.5FR BILIARY DRAIN CATH. BOTH IP/OP $296.00 $219.50 $58.75 $296.00 $160.73 $160.73 $160.73 $160.73 $296.00 $296.00 $296.00 $61.69 $296.00 $219.69 $219.69 $228.16 $154.22 $61.69 $296.00 $296.00 $175.08 $296.00 $296.00 $296.00 $296.00 $222.00 $296.00 $296.00 $296.00 $148.00 $148.00 $234.43 $296.00 $236.80 $192.40 $58.75 $296.00 $171.68 $296.00 $296.00 $296.00 $61.69 $296.00 N/A N/A 27201849 EAP HCPCS C1757 COIL EMBOLIZATION 35-4-3 BOTH IP/OP $172.00 $127.50 $34.14 $172.00 $93.40 $93.40 $93.40 $93.40 $172.00 $172.00 $172.00 $35.85 $172.00 $127.66 $127.66 $132.58 $89.61 $35.85 $172.00 $172.00 $101.74 $172.00 $172.00 $172.00 $172.00 $129.00 $172.00 $172.00 $172.00 $86.00 $86.00 $136.22 $172.00 $137.60 $111.80 $34.14 $172.00 $99.76 $172.00 $172.00 $172.00 $35.84 $172.00 N/A N/A 27201850 EAP HCPCS C1769 DTDW35-80-10 DEFLECTING BOTH IP/OP $520.00 $385.00 $103.21 $520.00 $282.36 $282.36 $282.36 $282.36 $520.00 $520.00 $520.00 $108.38 $520.00 $385.94 $385.94 $400.82 $270.92 $108.37 $520.00 $208.00 $307.58 $520.00 $520.00 $520.00 $520.00 $390.00 $520.00 $520.00 $520.00 $260.00 $260.00 $411.84 $520.00 $416.00 $338.00 $103.21 $520.00 $301.60 $520.00 $520.00 $520.00 $108.37 $520.00 N/A N/A 27201851 EAP HCPCS C1773 FILTER RETRIEVAL SET BOTH IP/OP $886.00 $656.00 $175.85 $886.00 $481.10 $481.10 $481.10 $481.10 $886.00 $886.00 $886.00 $184.66 $886.00 $657.59 $657.59 $682.93 $461.61 $184.65 $886.00 $886.00 $524.07 $886.00 $886.00 $886.00 $886.00 $664.50 $886.00 $886.00 $886.00 $443.00 $443.00 $701.71 $886.00 $708.80 $575.90 $175.85 $886.00 $513.88 $886.00 $886.00 $886.00 $184.64 $886.00 N/A N/A 27201852 EAP HCPCS C1769 GUIDEWIRE COPE MANDRIL BOTH IP/OP $116.00 $86.00 $23.02 $116.00 $62.99 $62.99 $62.99 $62.99 $116.00 $116.00 $116.00 $24.18 $116.00 $86.10 $86.10 $89.41 $60.44 $24.18 $116.00 $46.40 $68.61 $116.00 $116.00 $116.00 $116.00 $87.00 $116.00 $116.00 $116.00 $58.00 $58.00 $91.87 $116.00 $92.80 $75.40 $23.02 $116.00 $67.28 $116.00 $116.00 $116.00 $24.17 $116.00 N/A N/A 27201853 EAP HCPCS C1769 LEWIS MICROPUNTURE SET BOTH IP/OP $130.00 $96.50 $25.80 $130.00 $70.59 $70.59 $70.59 $70.59 $130.00 $130.00 $130.00 $27.10 $130.00 $96.49 $96.49 $100.20 $67.73 $27.09 $130.00 $52.00 $76.90 $130.00 $130.00 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $65.00 $65.00 $102.96 $130.00 $104.00 $84.50 $25.80 $130.00 $75.40 $130.00 $130.00 $130.00 $27.09 $130.00 N/A N/A 27201854 EAP HCPCS C2629 MICROPUNCTURE SET BOTH IP/OP $102.00 $75.50 $20.24 $102.00 $55.39 $55.39 $55.39 $55.39 $102.00 $102.00 $102.00 $21.26 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $102.00 $60.33 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $20.24 $102.00 $59.16 $102.00 $102.00 $102.00 $21.26 $102.00 N/A N/A 27201855 EAP HCPCS C1894 8FR-23CMAVANTI-INTRODUCER BOTH IP/OP $10.00 $7.50 $1.98 $10.00 $5.43 $5.43 $5.43 $5.43 $10.00 $10.00 $10.00 $2.08 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $5.92 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $1.98 $10.00 $5.80 $10.00 $10.00 $10.00 $2.08 $10.00 N/A N/A 27201856 EAP HCPCS C1894 9FR-23CM AVANTI INTRODUCE BOTH IP/OP $10.00 $7.50 $1.98 $10.00 $5.43 $5.43 $5.43 $5.43 $10.00 $10.00 $10.00 $2.08 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $10.00 $5.92 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $1.98 $10.00 $5.80 $10.00 $10.00 $10.00 $2.08 $10.00 N/A N/A 27201857 EAP HCPCS C1773 12-20MMX120CM STD SNARE BOTH IP/OP "$1,119.00" $828.50 $222.09 "$1,119.00" $607.62 $607.62 $607.62 $607.62 "$1,119.00" "$1,119.00" "$1,119.00" $233.23 "$1,119.00" $830.52 $830.52 $862.53 $583.00 $233.21 "$1,119.00" "$1,119.00" $661.89 "$1,119.00" "$1,119.00" "$1,119.00" "$1,119.00" $839.25 "$1,119.00" "$1,119.00" "$1,119.00" $559.50 $559.50 $886.25 "$1,119.00" $895.20 $727.35 $222.09 "$1,119.00" $649.02 "$1,119.00" "$1,119.00" "$1,119.00" $233.20 "$1,119.00" N/A N/A 27201858 EAP HCPCS C1773 9-15MMX120CM STD SNARE BOTH IP/OP "$1,119.00" $828.50 $222.09 "$1,119.00" $607.62 $607.62 $607.62 $607.62 "$1,119.00" "$1,119.00" "$1,119.00" $233.23 "$1,119.00" $830.52 $830.52 $862.53 $583.00 $233.21 "$1,119.00" "$1,119.00" $661.89 "$1,119.00" "$1,119.00" "$1,119.00" "$1,119.00" $839.25 "$1,119.00" "$1,119.00" "$1,119.00" $559.50 $559.50 $886.25 "$1,119.00" $895.20 $727.35 $222.09 "$1,119.00" $649.02 "$1,119.00" "$1,119.00" "$1,119.00" $233.20 "$1,119.00" N/A N/A 27201859 EAP HCPCS C1725 WRKHORSE BALLOON 10-4/5/100 BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $175.20 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 27201860 EAP HCPCS C1894 PINNACLE INTRODUCER 5FR 10CM BOTH IP/OP $80.00 $59.50 $15.88 $80.00 $43.44 $43.44 $43.44 $43.44 $80.00 $80.00 $80.00 $16.67 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $80.00 $47.32 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $15.88 $80.00 $46.40 $80.00 $80.00 $80.00 $16.67 $80.00 N/A N/A 27201861 EAP HCPCS C1725 CONQUEST PTA BALLOON DILATATIO BOTH IP/OP $753.00 $557.50 $149.45 $753.00 $408.88 $408.88 $408.88 $408.88 $753.00 $753.00 $753.00 $156.94 $753.00 $558.88 $558.88 $580.41 $392.31 $156.93 $753.00 $753.00 $445.40 $753.00 $753.00 $753.00 $753.00 $564.75 $753.00 $753.00 $753.00 $376.50 $376.50 $596.38 $753.00 $602.40 $489.45 $149.45 $753.00 $436.74 $753.00 $753.00 $753.00 $156.93 $753.00 N/A N/A 27201862 EAP HCPCS C1725 OPTI-PLAST BALLOON DILATATION BOTH IP/OP $501.00 $371.00 $99.44 $501.00 $272.04 $272.04 $272.04 $272.04 $501.00 $501.00 $501.00 $104.42 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $501.00 $296.34 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $99.44 $501.00 $290.58 $501.00 $501.00 $501.00 $104.41 $501.00 N/A N/A 27201863 EAP HCPCS C1725 WORKHORSE PTA WORKHORSE BALLOO BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 27201864 EAP HCPCS C1769 GUIDEWIRE STRAIGHT FIXED CORE BOTH IP/OP $86.00 $64.00 $17.07 $86.00 $46.70 $46.70 $46.70 $46.70 $86.00 $86.00 $86.00 $17.92 $86.00 $63.83 $63.83 $66.29 $44.81 $17.92 $86.00 $34.40 $50.87 $86.00 $86.00 $86.00 $86.00 $64.50 $86.00 $86.00 $86.00 $43.00 $43.00 $68.11 $86.00 $68.80 $55.90 $17.07 $86.00 $49.88 $86.00 $86.00 $86.00 $17.92 $86.00 N/A N/A 27201865 EAP HCPCS C1769 GUIDEWIRE 3MM J FIXED CORE .03 BOTH IP/OP $46.00 $34.50 $9.13 $46.00 $24.98 $24.98 $24.98 $24.98 $46.00 $46.00 $46.00 $9.59 $46.00 $34.14 $34.14 $35.46 $23.97 $9.59 $46.00 $46.00 $27.21 $46.00 $46.00 $46.00 $46.00 $34.50 $46.00 $46.00 $46.00 $23.00 $23.00 $36.43 $46.00 $36.80 $29.90 $9.13 $46.00 $26.68 $46.00 $46.00 $46.00 $9.59 $46.00 N/A N/A 27201866 EAP HCPCS C1894 PINNACLE INTRODUCER 6FR 10CM BOTH IP/OP $76.00 $56.50 $15.08 $76.00 $41.27 $41.27 $41.27 $41.27 $76.00 $76.00 $76.00 $15.84 $76.00 $56.41 $56.41 $58.58 $39.60 $15.84 $76.00 $76.00 $44.95 $76.00 $76.00 $76.00 $76.00 $57.00 $76.00 $76.00 $76.00 $38.00 $38.00 $60.19 $76.00 $60.80 $49.40 $15.08 $76.00 $44.08 $76.00 $76.00 $76.00 $15.84 $76.00 N/A N/A 27201867 EAP HCPCS C1894 8FR 10CM PINNACLE INTRODUCER BOTH IP/OP $72.00 $53.50 $14.29 $72.00 $39.10 $39.10 $39.10 $39.10 $72.00 $72.00 $72.00 $15.01 $72.00 $53.44 $53.44 $55.50 $37.51 $15.01 $72.00 $72.00 $42.59 $72.00 $72.00 $72.00 $72.00 $54.00 $72.00 $72.00 $72.00 $36.00 $36.00 $57.02 $72.00 $57.60 $46.80 $14.29 $72.00 $41.76 $72.00 $72.00 $72.00 $15.00 $72.00 N/A N/A 27201868 EAP HCPCS C1894 PINNACLE INTRODUCER 8FR 10CM BOTH IP/OP $67.00 $50.00 $13.30 $67.00 $36.38 $36.38 $36.38 $36.38 $67.00 $67.00 $67.00 $13.96 $67.00 $49.73 $49.73 $51.64 $34.91 $13.96 $67.00 $26.80 $39.63 $67.00 $67.00 $67.00 $67.00 $50.25 $67.00 $67.00 $67.00 $33.50 $33.50 $53.06 $67.00 $53.60 $43.55 $13.30 $67.00 $38.86 $67.00 $67.00 $67.00 $13.96 $67.00 N/A N/A 27201870 EAP HCPCS C1757 FOGARTY 5.5-40CM BOTH IP/OP $352.00 $260.50 $69.86 $352.00 $191.14 $191.14 $191.14 $191.14 $352.00 $352.00 $352.00 $73.37 $352.00 $261.25 $261.25 $271.32 $183.39 $73.36 $352.00 $352.00 $208.21 $352.00 $352.00 $352.00 $352.00 $264.00 $352.00 $352.00 $352.00 $176.00 $176.00 $278.78 $352.00 $281.60 $228.80 $69.86 $352.00 $204.16 $352.00 $352.00 $352.00 $73.36 $352.00 N/A N/A 27201872 EAP HCPCS C1757 ARROW TREROTOLA THROMOLYTIC DE BOTH IP/OP "$1,805.00" "$1,336.00" $358.25 "$1,805.00" $980.12 $980.12 $980.12 $980.12 "$1,805.00" "$1,805.00" "$1,805.00" $376.21 "$1,805.00" "$1,339.67" "$1,339.67" "$1,391.29" $940.41 $376.18 "$1,805.00" "$1,805.00" "$1,067.66" "$1,805.00" "$1,805.00" "$1,805.00" "$1,805.00" "$1,353.75" "$1,805.00" "$1,805.00" "$1,805.00" $902.50 $902.50 "$1,429.56" "$1,805.00" "$1,444.00" "$1,173.25" $358.25 "$1,805.00" "$1,046.90" "$1,805.00" "$1,805.00" "$1,805.00" $376.16 "$1,805.00" N/A N/A 27201873 EAP HCPCS C1757 COMPLEX FIBER COIL 18 X 3MM X BOTH IP/OP "$1,212.00" $897.00 $240.55 "$1,212.00" $658.12 $658.12 $658.12 $658.12 "$1,212.00" "$1,212.00" "$1,212.00" $252.61 "$1,212.00" $899.55 $899.55 $934.21 $631.45 $252.59 "$1,212.00" "$1,212.00" $716.90 "$1,212.00" "$1,212.00" "$1,212.00" "$1,212.00" $909.00 "$1,212.00" "$1,212.00" "$1,212.00" $606.00 $606.00 $959.90 "$1,212.00" $969.60 $787.80 $240.55 "$1,212.00" $702.96 "$1,212.00" "$1,212.00" "$1,212.00" $252.58 "$1,212.00" N/A N/A 27201874 EAP HCPCS C1729 SKATER 10FR BOTH IP/OP $605.00 $448.00 $120.08 $605.00 $328.52 $328.52 $328.52 $328.52 $605.00 $605.00 $605.00 $126.10 $605.00 $449.03 $449.03 $466.33 $315.21 $126.09 $605.00 $605.00 $357.86 $605.00 $605.00 $605.00 $605.00 $453.75 $605.00 $605.00 $605.00 $302.50 $302.50 $479.16 $605.00 $484.00 $393.25 $120.08 $605.00 $350.90 $605.00 $605.00 $605.00 $126.08 $605.00 N/A N/A 27201875 EAP HCPCS C1887 LIMA GUIDING CATHETER 7FR-55CM BOTH IP/OP $417.00 $309.00 $82.76 $417.00 $226.43 $226.43 $226.43 $226.43 $417.00 $417.00 $417.00 $86.91 $417.00 $309.50 $309.50 $321.42 $217.26 $86.91 $417.00 $417.00 $246.66 $417.00 $417.00 $417.00 $417.00 $312.75 $417.00 $417.00 $417.00 $208.50 $208.50 $330.26 $417.00 $333.60 $271.05 $82.76 $417.00 $241.86 $417.00 $417.00 $417.00 $86.90 $417.00 N/A N/A 27201876 EAP HCPCS C1892 MEDITECH ACCUSTICK II INTRODUC BOTH IP/OP $209.00 $155.00 $41.48 $209.00 $113.49 $113.49 $113.49 $113.49 $209.00 $209.00 $209.00 $43.56 $209.00 $155.12 $155.12 $161.10 $108.89 $43.56 $209.00 $209.00 $123.62 $209.00 $209.00 $209.00 $209.00 $156.75 $209.00 $209.00 $209.00 $104.50 $104.50 $165.53 $209.00 $167.20 $135.85 $41.48 $209.00 $121.22 $209.00 $209.00 $209.00 $43.56 $209.00 N/A N/A 27201878 EAP HCPCS C1769 .038-145 AMPLATZ EXTRA STIFF BOTH IP/OP $76.00 $56.50 $15.08 $76.00 $41.27 $41.27 $41.27 $41.27 $76.00 $76.00 $76.00 $15.84 $76.00 $56.41 $56.41 $58.58 $39.60 $15.84 $76.00 $76.00 $44.95 $76.00 $76.00 $76.00 $76.00 $57.00 $76.00 $76.00 $76.00 $38.00 $38.00 $60.19 $76.00 $60.80 $49.40 $15.08 $76.00 $44.08 $76.00 $76.00 $76.00 $15.84 $76.00 N/A N/A 27201879 EAP HCPCS C1751 9FR SINGLE LUMEN HICKMAN BOTH IP/OP $241.00 $178.50 $47.83 $241.00 $130.86 $130.86 $130.86 $130.86 $241.00 $241.00 $241.00 $50.23 $241.00 $178.87 $178.87 $185.76 $125.56 $50.23 $241.00 $241.00 $142.55 $241.00 $241.00 $241.00 $241.00 $180.75 $241.00 $241.00 $241.00 $120.50 $120.50 $190.87 $241.00 $192.80 $156.65 $47.83 $241.00 $139.78 $241.00 $241.00 $241.00 $50.22 $241.00 N/A N/A 27201880 EAP HCPCS C1751 9FR DUAL LUMEN HICKMAN BOTH IP/OP $528.00 $391.00 $104.79 $528.00 $286.70 $286.70 $286.70 $286.70 $528.00 $528.00 $528.00 $110.05 $528.00 $391.88 $391.88 $406.98 $275.09 $110.04 $528.00 $528.00 $312.31 $528.00 $528.00 $528.00 $528.00 $396.00 $528.00 $528.00 $528.00 $264.00 $264.00 $418.18 $528.00 $422.40 $343.20 $104.79 $528.00 $306.24 $528.00 $528.00 $528.00 $110.04 $528.00 N/A N/A 27201881 EAP HCPCS C1769 .035-150CM 3MM J GUIDEWIRE BOTH IP/OP $68.00 $50.50 $13.50 $68.00 $36.92 $36.92 $36.92 $36.92 $68.00 $68.00 $68.00 $14.17 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $68.00 $40.22 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $13.50 $68.00 $39.44 $68.00 $68.00 $68.00 $14.17 $68.00 N/A N/A 27201883 EAP HCPCS C1752 "12CM NIAGRA, TEMP DIALYSIS CAT" BOTH IP/OP $150.00 $111.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 $150.00 $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A 27201884 EAP HCPCS C1752 "15CM NIAGRA, TEMP DIALYSIS CAT" BOTH IP/OP $64.00 $47.50 $13.34 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $64.00 $47.50 $47.50 $49.33 $33.34 $13.34 $64.00 $25.60 $64.00 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $41.60 $64.00 $64.00 $37.12 $64.00 $38.40 $64.00 $64.00 $64.00 N/A N/A 27201885 EAP HCPCS C1725 8-2/5/100 WORKHORSE BALLOON BOTH IP/OP $427.00 $316.00 $84.75 $427.00 $231.86 $231.86 $231.86 $231.86 $427.00 $427.00 $427.00 $89.00 $427.00 $316.92 $316.92 $329.13 $222.47 $88.99 $427.00 $427.00 $252.57 $427.00 $427.00 $427.00 $427.00 $320.25 $427.00 $427.00 $427.00 $213.50 $213.50 $338.18 $427.00 $341.60 $277.55 $84.75 $427.00 $247.66 $427.00 $427.00 $427.00 $88.99 $427.00 N/A N/A 27201886 EAP HCPCS C1725 4-2/5/75 OPTI-PLAST BALLOON BOTH IP/OP $501.00 $371.00 $99.44 $501.00 $272.04 $272.04 $272.04 $272.04 $501.00 $501.00 $501.00 $104.42 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $501.00 $296.34 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $99.44 $501.00 $290.58 $501.00 $501.00 $501.00 $104.41 $501.00 N/A N/A 27201887 EAP HCPCS C1725 3-WAY HP STOPCOCK BOTH IP/OP $934.00 $691.50 $185.38 $934.00 $507.16 $507.16 $507.16 $507.16 $934.00 $934.00 $934.00 $194.67 $934.00 $693.21 $693.21 $719.93 $486.61 $194.66 $934.00 $934.00 $552.46 $934.00 $934.00 $934.00 $934.00 $700.50 $934.00 $934.00 $934.00 $467.00 $467.00 $739.73 $934.00 $747.20 $607.10 $185.38 $934.00 $541.72 $934.00 $934.00 $934.00 $194.65 $934.00 N/A N/A 27201888 EAP HCPCS C1894 7FR 10CM PINNACLE INTRODUCER BOTH IP/OP $71.00 $53.00 $14.09 $71.00 $38.55 $38.55 $38.55 $38.55 $71.00 $71.00 $71.00 $14.80 $71.00 $52.70 $52.70 $54.73 $36.99 $14.80 $71.00 $28.40 $42.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $46.15 $14.09 $71.00 $41.18 $71.00 $71.00 $71.00 $14.80 $71.00 N/A N/A 27201889 EAP HCPCS C1894 7FR 10CM PINNACLE INTRODUCER BOTH IP/OP $135.00 $100.00 $26.79 $135.00 $73.31 $73.31 $73.31 $73.31 $135.00 $135.00 $135.00 $28.14 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $135.00 $79.85 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $26.79 $135.00 $78.30 $135.00 $135.00 $135.00 $28.13 $135.00 N/A N/A 27201890 EAP HCPCS C1725 12-2/5.8/75 UDT DILATATION BAL BOTH IP/OP $889.00 $658.00 $176.44 $889.00 $482.73 $482.73 $482.73 $482.73 $889.00 $889.00 $889.00 $185.29 $889.00 $659.82 $659.82 $685.24 $463.17 $185.28 $889.00 $889.00 $525.84 $889.00 $889.00 $889.00 $889.00 $666.75 $889.00 $889.00 $889.00 $444.50 $444.50 $704.09 $889.00 $711.20 $577.85 $176.44 $889.00 $515.62 $889.00 $889.00 $889.00 $185.27 $889.00 N/A N/A 27201891 EAP HCPCS C1729 8FR FLEXIMA BILIARY CATHETER BOTH IP/OP $271.00 $201.00 $53.79 $271.00 $147.15 $147.15 $147.15 $147.15 $271.00 $271.00 $271.00 $56.48 $271.00 $201.14 $201.14 $208.89 $141.19 $56.48 $271.00 $271.00 $160.30 $271.00 $271.00 $271.00 $271.00 $203.25 $271.00 $271.00 $271.00 $135.50 $135.50 $214.63 $271.00 $216.80 $176.15 $53.79 $271.00 $157.18 $271.00 $271.00 $271.00 $56.48 $271.00 N/A N/A 27201892 EAP HCPCS C1729 CX 18.0-38-40-P-32S-BCL BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $162.90 $162.90 $162.90 $162.90 $300.00 $300.00 $300.00 $62.53 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $59.54 $300.00 $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 27201893 EAP Custom 27201893 TIBIA FRACTURE BRACE BOTH IP/OP $485.00 $359.00 $86.33 $485.00 $485.00 $485.00 $485.00 $485.00 $485.00 $485.00 $86.33 $485.00 $485.00 $359.97 $359.97 $373.84 $252.69 $101.08 $485.00 $194.00 $485.00 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $315.25 $485.00 $485.00 $281.30 $485.00 $291.00 $485.00 $485.00 $485.00 N/A N/A 27201905 EAP Custom 27201905 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27201906 EAP HCPCS A6250 WOUND PASTE BOTH IP/OP $118.00 $87.50 $24.59 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $87.58 $87.58 $90.95 $61.48 $24.59 $118.00 $47.20 $118.00 $118.00 $118.00 $118.00 $118.00 $88.50 $118.00 $118.00 $118.00 $59.00 $59.00 $93.46 $118.00 $94.40 $76.70 $118.00 $118.00 $68.44 $118.00 $70.80 $118.00 $118.00 $118.00 N/A N/A 27201914 EAP Custom 27201914 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27201930 EAP HCPCS C1729 CATHETER FOLEY 5CC 14FR BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 27201931 EAP HCPCS C1729 CATHETER FOLEY 16FR BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 27201932 EAP HCPCS C1729 CATHETER FOLEY 5CC 18FR BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 27202362 EAP Custom 27202362 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27202368 EAP Custom 27202368 SCAPEL SURG W/HANDLE ATT BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27202375 EAP HCPCS C1729 CATHETER FOLEY 5CC 14FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27202376 EAP HCPCS C1729 CATHETER FOLEY 16FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27202377 EAP HCPCS C1729 CATHETER FOLEY 5CC 18FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27202384 EAP HCPCS C1729 CATHETER FOLEY 30CC 28FR BOTH IP/OP $39.00 $29.00 $7.74 $39.00 $21.18 $21.18 $21.18 $21.18 $39.00 $39.00 $39.00 $8.13 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $39.00 $23.07 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $7.74 $39.00 $22.62 $39.00 $39.00 $39.00 $8.13 $39.00 N/A N/A 27202388 EAP HCPCS C1729 CATHETER FOLEY 16FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27202389 EAP HCPCS C1729 CATHETER COUDE SIZE 14FR BOTH IP/OP $109.00 $81.00 $21.63 $109.00 $59.19 $59.19 $59.19 $59.19 $109.00 $109.00 $109.00 $22.72 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $109.00 $64.47 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $21.63 $109.00 $63.22 $109.00 $109.00 $109.00 $22.72 $109.00 N/A N/A 27202390 EAP HCPCS C1729 CATHETER COUDE SIZE 16FR BOTH IP/OP $109.00 $81.00 $21.63 $109.00 $59.19 $59.19 $59.19 $59.19 $109.00 $109.00 $109.00 $22.72 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $109.00 $64.47 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $21.63 $109.00 $63.22 $109.00 $109.00 $109.00 $22.72 $109.00 N/A N/A 27202395 EAP HCPCS C1729 CATHETER COUDE SIZE 14FR BOTH IP/OP $109.00 $81.00 $21.63 $109.00 $59.19 $59.19 $59.19 $59.19 $109.00 $109.00 $109.00 $22.72 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $109.00 $64.47 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $21.63 $109.00 $63.22 $109.00 $109.00 $109.00 $22.72 $109.00 N/A N/A 27202396 EAP HCPCS C1729 CATHETER COUDE 30CC 24FR BOTH IP/OP $82.00 $61.00 $16.27 $82.00 $44.53 $44.53 $44.53 $44.53 $82.00 $82.00 $82.00 $17.09 $82.00 $60.86 $60.86 $63.21 $42.72 $17.09 $82.00 $82.00 $48.50 $82.00 $82.00 $82.00 $82.00 $61.50 $82.00 $82.00 $82.00 $41.00 $41.00 $64.94 $82.00 $65.60 $53.30 $16.27 $82.00 $47.56 $82.00 $82.00 $82.00 $17.09 $82.00 N/A N/A 27202397 EAP Custom 27202397 SCAPEL SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27202403 EAP Custom 27202403 SCAPLE SURG W/HANDLE ATTA BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27202406 EAP HCPCS C1729 CATHETER COUDE SIZE 14FR BOTH IP/OP $47.00 $35.00 $9.33 $47.00 $25.52 $25.52 $25.52 $25.52 $47.00 $47.00 $47.00 $9.80 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $47.00 $27.80 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $9.33 $47.00 $27.26 $47.00 $47.00 $47.00 $9.79 $47.00 N/A N/A 27202407 EAP HCPCS C1729 CATHETER COUDE 30CC 24FR BOTH IP/OP $87.00 $64.50 $17.27 $87.00 $47.24 $47.24 $47.24 $47.24 $87.00 $87.00 $87.00 $18.13 $87.00 $64.57 $64.57 $67.06 $45.33 $18.13 $87.00 $87.00 $51.46 $87.00 $87.00 $87.00 $87.00 $65.25 $87.00 $87.00 $87.00 $43.50 $43.50 $68.90 $87.00 $69.60 $56.55 $17.27 $87.00 $50.46 $87.00 $87.00 $87.00 $18.13 $87.00 N/A N/A 27202418 EAP HCPCS C1729 CATHETER FOLEY 5CC 14FR BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 27202419 EAP HCPCS C1729 CATHETER FOLEY 16FR BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 27202420 EAP HCPCS C1729 CATHETER FOLEY 5CC 18FR BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 27202421 EAP HCPCS C1729 CATHETER FOLEY 3-WAY 30CC BOTH IP/OP $37.00 $27.50 $7.34 $37.00 $20.09 $20.09 $20.09 $20.09 $37.00 $37.00 $37.00 $7.71 $37.00 $27.46 $27.46 $28.52 $19.28 $7.71 $37.00 $37.00 $21.89 $37.00 $37.00 $37.00 $37.00 $27.75 $37.00 $37.00 $37.00 $18.50 $18.50 $29.30 $37.00 $29.60 $24.05 $7.34 $37.00 $21.46 $37.00 $37.00 $37.00 $7.71 $37.00 N/A N/A 27202432 EAP HCPCS C1729 CATHETER FOLEY 5CC 14FR BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 27202433 EAP HCPCS C1729 CATHETER COUDE SIZE 14FR BOTH IP/OP $109.00 $81.00 $21.63 $109.00 $59.19 $59.19 $59.19 $59.19 $109.00 $109.00 $109.00 $22.72 $109.00 $80.90 $80.90 $84.02 $56.79 $22.72 $109.00 $109.00 $64.47 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $70.85 $21.63 $109.00 $63.22 $109.00 $109.00 $109.00 $22.72 $109.00 N/A N/A 27202434 EAP HCPCS C1729 CATHETER COUDE SIZE 16FR BOTH IP/OP $102.00 $75.50 $20.24 $102.00 $55.39 $55.39 $55.39 $55.39 $102.00 $102.00 $102.00 $21.26 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $102.00 $60.33 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $20.24 $102.00 $59.16 $102.00 $102.00 $102.00 $21.26 $102.00 N/A N/A 27202435 EAP Custom 27202435 SCAPEL SURG W/HANDLE ATTACHED BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27202446 EAP HCPCS C1729 CATHETER FOLEY 5CC 14FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27202447 EAP HCPCS C1729 CATHETER FOLEY 16FR BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 27202448 EAP HCPCS C1729 CATHETER FOLEY 5CC 18FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27202449 EAP HCPCS C1729 CATHETER FOLEY 30CC 28FR BOTH IP/OP $39.00 $29.00 $7.74 $39.00 $21.18 $21.18 $21.18 $21.18 $39.00 $39.00 $39.00 $8.13 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $39.00 $23.07 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $7.74 $39.00 $22.62 $39.00 $39.00 $39.00 $8.13 $39.00 N/A N/A 27202462 EAP HCPCS C1729 CATHETER FOLEY 5CC 14FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27202463 EAP HCPCS C1729 CATHETER FOLEY 5CC 18FR BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 27202470 EAP HCPCS C1751 CRAGG-MCNAMARA 5-65-5 INFUSION BOTH IP/OP $740.00 $548.00 $146.87 $740.00 $401.82 $401.82 $401.82 $401.82 $740.00 $740.00 $740.00 $154.23 $740.00 $549.23 $549.23 $570.39 $385.54 $154.22 $740.00 $740.00 $437.71 $740.00 $740.00 $740.00 $740.00 $555.00 $740.00 $740.00 $740.00 $370.00 $370.00 $586.08 $740.00 $592.00 $481.00 $146.87 $740.00 $429.20 $740.00 $740.00 $740.00 $154.22 $740.00 N/A N/A 27202471 EAP HCPCS C1751 CRAGG-MCNAMARA 5-40-20 INFUSIO BOTH IP/OP $315.00 $233.50 $62.52 $315.00 $171.05 $171.05 $171.05 $171.05 $315.00 $315.00 $315.00 $65.65 $315.00 $233.79 $233.79 $242.80 $164.12 $65.65 $315.00 $315.00 $186.32 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $204.75 $62.52 $315.00 $182.70 $315.00 $315.00 $315.00 $65.65 $315.00 N/A N/A 27202472 EAP HCPCS C1751 CRAGG-MCNAMARA 5-100-10 INFUSI BOTH IP/OP $315.00 $233.50 $62.52 $315.00 $171.05 $171.05 $171.05 $171.05 $315.00 $315.00 $315.00 $65.65 $315.00 $233.79 $233.79 $242.80 $164.12 $65.65 $315.00 $315.00 $186.32 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $204.75 $62.52 $315.00 $182.70 $315.00 $315.00 $315.00 $65.65 $315.00 N/A N/A 27202473 EAP HCPCS C1773 15MM AMPLATZ SNARE BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $497.39 $497.39 $497.39 $497.39 $916.00 $916.00 $916.00 $190.92 $916.00 $679.86 $679.86 $706.05 $477.24 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $595.40 $181.80 $916.00 $531.28 $916.00 $916.00 $916.00 $190.89 $916.00 N/A N/A 27202474 EAP HCPCS C1773 25MM AMPLATZ SNARE BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $497.39 $497.39 $497.39 $497.39 $916.00 $916.00 $916.00 $190.92 $916.00 $679.86 $679.86 $706.05 $477.24 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $595.40 $181.80 $916.00 $531.28 $916.00 $916.00 $916.00 $190.89 $916.00 N/A N/A 27202475 EAP HCPCS C1729 10FR X 35CM SKATER NEPHROSTOMY BOTH IP/OP $254.00 $188.00 $50.41 $254.00 $137.92 $137.92 $137.92 $137.92 $254.00 $254.00 $254.00 $52.94 $254.00 $188.52 $188.52 $195.78 $132.33 $52.94 $254.00 $254.00 $150.24 $254.00 $254.00 $254.00 $254.00 $190.50 $254.00 $254.00 $254.00 $127.00 $127.00 $201.17 $254.00 $203.20 $165.10 $50.41 $254.00 $147.32 $254.00 $254.00 $254.00 $52.93 $254.00 N/A N/A 27202476 EAP HCPCS C1750 CHRON CARBOTHANE CATH 14.5F X 19CM BOTH IP/OP "$1,054.00" $780.00 $209.19 "$1,054.00" $572.32 $572.32 $572.32 $572.32 "$1,054.00" "$1,054.00" "$1,054.00" $219.68 "$1,054.00" $782.28 $782.28 $812.42 $549.13 $219.67 "$1,054.00" "$1,054.00" $623.44 "$1,054.00" "$1,054.00" "$1,054.00" "$1,054.00" $790.50 "$1,054.00" "$1,054.00" "$1,054.00" $527.00 $527.00 $834.77 "$1,054.00" $843.20 $685.10 $209.19 "$1,054.00" $611.32 "$1,054.00" "$1,054.00" "$1,054.00" $219.65 "$1,054.00" N/A N/A 27202477 EAP HCPCS C1750 23CM SPORT PACK PERM DIALYSIS BOTH IP/OP $921.00 $682.00 $182.80 $921.00 $500.10 $500.10 $500.10 $500.10 $921.00 $921.00 $921.00 $191.96 $921.00 $683.57 $683.57 $709.91 $479.84 $191.95 $921.00 $921.00 $544.77 $921.00 $921.00 $921.00 $921.00 $690.75 $921.00 $921.00 $921.00 $460.50 $460.50 $729.43 $921.00 $736.80 $598.65 $182.80 $921.00 $534.18 $921.00 $921.00 $921.00 $191.94 $921.00 N/A N/A 27202478 EAP HCPCS C1750 28CM SPORT PACK PERM DIALYSIS BOTH IP/OP "$2,263.00" "$1,675.00" $449.15 "$2,263.00" "$1,228.81" "$1,228.81" "$1,228.81" "$1,228.81" "$2,263.00" "$2,263.00" "$2,263.00" $471.67 "$2,263.00" "$1,679.60" "$1,679.60" "$1,744.32" "$1,179.02" $471.63 "$2,263.00" "$2,263.00" "$1,338.56" "$2,263.00" "$2,263.00" "$2,263.00" "$2,263.00" "$1,697.25" "$2,263.00" "$2,263.00" "$2,263.00" "$1,131.50" "$1,131.50" "$1,792.30" "$2,263.00" "$1,810.40" "$1,470.95" $449.15 "$2,263.00" "$1,312.54" "$2,263.00" "$2,263.00" "$2,263.00" $471.61 "$2,263.00" N/A N/A 27202479 EAP HCPCS C1752 19CM Q-PLUS TEMP DIALYSIS KIT BOTH IP/OP $254.00 $188.00 $52.94 $254.00 $254.00 $254.00 $254.00 $254.00 $254.00 $254.00 $254.00 $254.00 $254.00 $188.52 $188.52 $195.78 $132.33 $52.94 $254.00 $101.60 $254.00 $254.00 $254.00 $254.00 $254.00 $190.50 $254.00 $254.00 $254.00 $127.00 $127.00 $201.17 $254.00 $203.20 $165.10 $254.00 $254.00 $147.32 $254.00 $152.40 $254.00 $254.00 $254.00 N/A N/A 27202480 EAP HCPCS C1894 SHEATH FLEX 6FR 11CM BOTH IP/OP $138.00 $102.50 $27.39 $138.00 $74.93 $74.93 $74.93 $74.93 $138.00 $138.00 $138.00 $28.76 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $138.00 $81.63 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $27.39 $138.00 $80.04 $138.00 $138.00 $138.00 $28.76 $138.00 N/A N/A 27202481 EAP HCPCS C1751 HICKMAN 10.0 FRENCH TRIPLE LUM BOTH IP/OP "$1,357.00" "$1,004.50" $269.33 "$1,357.00" $736.85 $736.85 $736.85 $736.85 "$1,357.00" "$1,357.00" "$1,357.00" $282.83 "$1,357.00" "$1,007.17" "$1,007.17" "$1,045.98" $707.00 $282.81 "$1,357.00" "$1,357.00" $802.67 "$1,357.00" "$1,357.00" "$1,357.00" "$1,357.00" "$1,017.75" "$1,357.00" "$1,357.00" "$1,357.00" $678.50 $678.50 "$1,074.74" "$1,357.00" "$1,085.60" $882.05 $269.33 "$1,357.00" $787.06 "$1,357.00" "$1,357.00" "$1,357.00" $282.80 "$1,357.00" N/A N/A 27202482 EAP HCPCS C1725 BALLOON UDT 4-2/5/120 BOTH IP/OP $717.00 $531.00 $142.31 $717.00 $389.33 $389.33 $389.33 $389.33 $717.00 $717.00 $717.00 $149.44 $717.00 $532.16 $532.16 $552.66 $373.56 $149.43 $717.00 $717.00 $424.11 $717.00 $717.00 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $358.50 $358.50 $567.86 $717.00 $573.60 $466.05 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 27202484 EAP HCPCS C1725 CONQUEST DIALATION BALLOON 5MM BOTH IP/OP $717.00 $531.00 $142.31 $717.00 $389.33 $389.33 $389.33 $389.33 $717.00 $717.00 $717.00 $149.44 $717.00 $532.16 $532.16 $552.66 $373.56 $149.43 $717.00 $717.00 $424.11 $717.00 $717.00 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $358.50 $358.50 $567.86 $717.00 $573.60 $466.05 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 27202485 EAP HCPCS C1725 CONQUEST DIALATION BALLOON 6MM BOTH IP/OP $717.00 $531.00 $142.31 $717.00 $389.33 $389.33 $389.33 $389.33 $717.00 $717.00 $717.00 $149.44 $717.00 $532.16 $532.16 $552.66 $373.56 $149.43 $717.00 $717.00 $424.11 $717.00 $717.00 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $358.50 $358.50 $567.86 $717.00 $573.60 $466.05 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 27202488 EAP HCPCS C1725 CONQUEST DIALATION BALLOON 7MM BOTH IP/OP $717.00 $531.00 $142.31 $717.00 $389.33 $389.33 $389.33 $389.33 $717.00 $717.00 $717.00 $149.44 $717.00 $532.16 $532.16 $552.66 $373.56 $149.43 $717.00 $717.00 $424.11 $717.00 $717.00 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $358.50 $358.50 $567.86 $717.00 $573.60 $466.05 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 27202489 EAP HCPCS C1725 CONQUEST DIALATION BALLOON 8MM BOTH IP/OP $717.00 $531.00 $142.31 $717.00 $389.33 $389.33 $389.33 $389.33 $717.00 $717.00 $717.00 $149.44 $717.00 $532.16 $532.16 $552.66 $373.56 $149.43 $717.00 $717.00 $424.11 $717.00 $717.00 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $358.50 $358.50 $567.86 $717.00 $573.60 $466.05 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 27202490 EAP HCPCS C1725 CONQUEST DIALATION BALLOON 8MM BOTH IP/OP $717.00 $531.00 $142.31 $717.00 $389.33 $389.33 $389.33 $389.33 $717.00 $717.00 $717.00 $149.44 $717.00 $532.16 $532.16 $552.66 $373.56 $149.43 $717.00 $717.00 $424.11 $717.00 $717.00 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $358.50 $358.50 $567.86 $717.00 $573.60 $466.05 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 27202491 EAP HCPCS C1725 CONQUEST DIALATION BALLOON 10M BOTH IP/OP $717.00 $531.00 $142.31 $717.00 $389.33 $389.33 $389.33 $389.33 $717.00 $717.00 $717.00 $149.44 $717.00 $532.16 $532.16 $552.66 $373.56 $149.43 $717.00 $717.00 $424.11 $717.00 $717.00 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $358.50 $358.50 $567.86 $717.00 $573.60 $466.05 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 27202492 EAP HCPCS C1725 CONQUEST DIALATION BALLOON 10M BOTH IP/OP $717.00 $531.00 $142.31 $717.00 $389.33 $389.33 $389.33 $389.33 $717.00 $717.00 $717.00 $149.44 $717.00 $532.16 $532.16 $552.66 $373.56 $149.43 $717.00 $717.00 $424.11 $717.00 $717.00 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $358.50 $358.50 $567.86 $717.00 $573.60 $466.05 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 27202493 EAP HCPCS C1725 CONQUEST DIALATION BALLOON 12M BOTH IP/OP $717.00 $531.00 $142.31 $717.00 $389.33 $389.33 $389.33 $389.33 $717.00 $717.00 $717.00 $149.44 $717.00 $532.16 $532.16 $552.66 $373.56 $149.43 $717.00 $717.00 $424.11 $717.00 $717.00 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $358.50 $358.50 $567.86 $717.00 $573.60 $466.05 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 27202494 EAP HCPCS C1725 BALLOON DIAL CATH 4MMX10CMX120 BOTH IP/OP $717.00 $531.00 $142.31 $717.00 $389.33 $389.33 $389.33 $389.33 $717.00 $717.00 $717.00 $149.44 $717.00 $532.16 $532.16 $552.66 $373.56 $149.43 $717.00 $717.00 $424.11 $717.00 $717.00 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $358.50 $358.50 $567.86 $717.00 $573.60 $466.05 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 27202495 EAP HCPCS C1751 VAXCEL CENTRAL VENOUS CATH BOTH IP/OP $6.00 $4.50 $1.19 $6.00 $3.26 $3.26 $3.26 $3.26 $6.00 $6.00 $6.00 $1.25 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $6.00 $3.55 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $1.19 $6.00 $3.48 $6.00 $6.00 $6.00 $1.25 $6.00 N/A N/A 27202496 EAP HCPCS C1725 4MMX2CMX90XM MONORAIL BALLOON BOTH IP/OP "$1,407.00" "$1,041.50" $279.25 "$1,407.00" $764.00 $764.00 $764.00 $764.00 "$1,407.00" "$1,407.00" "$1,407.00" $293.25 "$1,407.00" "$1,044.28" "$1,044.28" "$1,084.52" $733.05 $293.23 "$1,407.00" "$1,407.00" $832.24 "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" "$1,055.25" "$1,407.00" "$1,407.00" "$1,407.00" $703.50 $703.50 "$1,114.34" "$1,407.00" "$1,125.60" $914.55 $279.25 "$1,407.00" $816.06 "$1,407.00" "$1,407.00" "$1,407.00" $293.22 "$1,407.00" N/A N/A 27202497 EAP HCPCS C1725 5MMX2CMX90CM MONORAIL BALLOON BOTH IP/OP "$1,407.00" "$1,041.50" $279.25 "$1,407.00" $764.00 $764.00 $764.00 $764.00 "$1,407.00" "$1,407.00" "$1,407.00" $293.25 "$1,407.00" "$1,044.28" "$1,044.28" "$1,084.52" $733.05 $293.23 "$1,407.00" "$1,407.00" $832.24 "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" "$1,055.25" "$1,407.00" "$1,407.00" "$1,407.00" $703.50 $703.50 "$1,114.34" "$1,407.00" "$1,125.60" $914.55 $279.25 "$1,407.00" $816.06 "$1,407.00" "$1,407.00" "$1,407.00" $293.22 "$1,407.00" N/A N/A 27202498 EAP HCPCS C1725 5MMX15CMX90XCM MONORAIL BILIAR BOTH IP/OP "$4,654.00" "$3,444.00" $923.70 "$4,654.00" "$2,527.12" "$2,527.12" "$2,527.12" "$2,527.12" "$4,654.00" "$4,654.00" "$4,654.00" $970.01 "$4,654.00" "$3,454.20" "$3,454.20" "$3,587.30" "$2,060.15" $969.94 "$4,654.00" "$4,654.00" "$2,752.84" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$3,490.50" "$4,654.00" "$4,654.00" "$4,654.00" "$2,327.00" "$2,327.00" "$3,685.97" "$4,654.00" "$3,723.20" "$3,025.10" $923.70 "$4,654.00" "$2,699.32" "$4,654.00" "$4,654.00" "$4,654.00" $969.89 "$4,654.00" N/A N/A 27202499 EAP HCPCS C1725 6MMX14CMX90CM MONORAIL BILIARY BOTH IP/OP "$4,654.00" "$3,444.00" $923.70 "$4,654.00" "$2,527.12" "$2,527.12" "$2,527.12" "$2,527.12" "$4,654.00" "$4,654.00" "$4,654.00" $970.01 "$4,654.00" "$3,454.20" "$3,454.20" "$3,587.30" "$2,060.15" $969.94 "$4,654.00" "$4,654.00" "$2,752.84" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$3,490.50" "$4,654.00" "$4,654.00" "$4,654.00" "$2,327.00" "$2,327.00" "$3,685.97" "$4,654.00" "$3,723.20" "$3,025.10" $923.70 "$4,654.00" "$2,699.32" "$4,654.00" "$4,654.00" "$4,654.00" $969.89 "$4,654.00" N/A N/A 27202500 EAP HCPCS C1725 6MMX18CMX90CM MONORAIL BILARY BOTH IP/OP "$4,654.00" "$3,444.00" $923.70 "$4,654.00" "$2,527.12" "$2,527.12" "$2,527.12" "$2,527.12" "$4,654.00" "$4,654.00" "$4,654.00" $970.01 "$4,654.00" "$3,454.20" "$3,454.20" "$3,587.30" "$2,060.15" $969.94 "$4,654.00" "$4,654.00" "$2,752.84" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$3,490.50" "$4,654.00" "$4,654.00" "$4,654.00" "$2,327.00" "$2,327.00" "$3,685.97" "$4,654.00" "$3,723.20" "$3,025.10" $923.70 "$4,654.00" "$2,699.32" "$4,654.00" "$4,654.00" "$4,654.00" $969.89 "$4,654.00" N/A N/A 27202501 EAP HCPCS C1769 .018X190CM THRUWAY GUIDEWIRE BOTH IP/OP $291.00 $215.50 $57.76 $291.00 $158.01 $158.01 $158.01 $158.01 $291.00 $291.00 $291.00 $60.65 $291.00 $215.98 $215.98 $224.30 $151.61 $60.65 $291.00 $291.00 $172.13 $291.00 $291.00 $291.00 $291.00 $218.25 $291.00 $291.00 $291.00 $145.50 $145.50 $230.47 $291.00 $232.80 $189.15 $57.76 $291.00 $168.78 $291.00 $291.00 $291.00 $60.64 $291.00 N/A N/A 27202502 EAP HCPCS C1893 6FRX45CM RENAL GUIDING SHEATH BOTH IP/OP $260.00 $192.50 $51.60 $260.00 $141.18 $141.18 $141.18 $141.18 $260.00 $260.00 $260.00 $54.19 $260.00 $192.97 $192.97 $200.41 $135.46 $54.19 $260.00 $260.00 $153.79 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $169.00 $51.60 $260.00 $150.80 $260.00 $260.00 $260.00 $54.18 $260.00 N/A N/A 27202503 EAP HCPCS C1725 6X40X80 POLAR CATH BALLOON BOTH IP/OP "$4,496.00" "$3,327.50" $892.34 "$4,496.00" "$2,441.33" "$2,441.33" "$2,441.33" "$2,441.33" "$4,496.00" "$4,496.00" "$4,496.00" $937.08 "$4,496.00" "$3,336.93" "$3,336.93" "$3,465.52" "$2,060.15" $937.02 "$4,496.00" "$4,496.00" "$2,659.38" "$4,496.00" "$4,496.00" "$4,496.00" "$4,496.00" "$3,372.00" "$4,496.00" "$4,496.00" "$4,496.00" "$2,248.00" "$2,248.00" "$3,560.83" "$4,496.00" "$3,596.80" "$2,922.40" $892.34 "$4,496.00" "$2,607.68" "$4,496.00" "$4,496.00" "$4,496.00" $936.97 "$4,496.00" N/A N/A 27202504 EAP HCPCS C1725 7X60X80 POLAR CATH BALLOON BOTH IP/OP "$4,496.00" "$3,327.50" $892.34 "$4,496.00" "$2,441.33" "$2,441.33" "$2,441.33" "$2,441.33" "$4,496.00" "$4,496.00" "$4,496.00" $937.08 "$4,496.00" "$3,336.93" "$3,336.93" "$3,465.52" "$2,060.15" $937.02 "$4,496.00" "$4,496.00" "$2,659.38" "$4,496.00" "$4,496.00" "$4,496.00" "$4,496.00" "$3,372.00" "$4,496.00" "$4,496.00" "$4,496.00" "$2,248.00" "$2,248.00" "$3,560.83" "$4,496.00" "$3,596.80" "$2,922.40" $892.34 "$4,496.00" "$2,607.68" "$4,496.00" "$4,496.00" "$4,496.00" $936.97 "$4,496.00" N/A N/A 27202505 EAP HCPCS C2629 BANANA PEEL SHEATH BOTH IP/OP $151.00 $112.00 $29.97 $151.00 $81.99 $81.99 $81.99 $81.99 $151.00 $151.00 $151.00 $31.47 $151.00 $112.07 $112.07 $116.39 $78.67 $31.47 $151.00 $151.00 $89.32 $151.00 $151.00 $151.00 $151.00 $113.25 $151.00 $151.00 $151.00 $75.50 $75.50 $119.59 $151.00 $120.80 $98.15 $29.97 $151.00 $87.58 $151.00 $151.00 $151.00 $31.47 $151.00 N/A N/A 27202506 EAP HCPCS C1769 GUIDEWITE .014X180 SEGWAY GT BOTH IP/OP $417.00 $309.00 $82.76 $417.00 $226.43 $226.43 $226.43 $226.43 $417.00 $417.00 $417.00 $86.91 $417.00 $309.50 $309.50 $321.42 $217.26 $86.91 $417.00 $417.00 $246.66 $417.00 $417.00 $417.00 $417.00 $312.75 $417.00 $417.00 $417.00 $208.50 $208.50 $330.26 $417.00 $333.60 $271.05 $82.76 $417.00 $241.86 $417.00 $417.00 $417.00 $86.90 $417.00 N/A N/A 27202507 EAP HCPCS C1769 GUIDEWIRE .018X180CM SEGWAY GT BOTH IP/OP $417.00 $309.00 $82.76 $417.00 $226.43 $226.43 $226.43 $226.43 $417.00 $417.00 $417.00 $86.91 $417.00 $309.50 $309.50 $321.42 $217.26 $86.91 $417.00 $417.00 $246.66 $417.00 $417.00 $417.00 $417.00 $312.75 $417.00 $417.00 $417.00 $208.50 $208.50 $330.26 $417.00 $333.60 $271.05 $82.76 $417.00 $241.86 $417.00 $417.00 $417.00 $86.90 $417.00 N/A N/A 27202508 EAP HCPCS C1769 STR GUIDEWIRE .014X180 SEGWAY BOTH IP/OP $417.00 $309.00 $82.76 $417.00 $226.43 $226.43 $226.43 $226.43 $417.00 $417.00 $417.00 $86.91 $417.00 $309.50 $309.50 $321.42 $217.26 $86.91 $417.00 $166.80 $246.66 $417.00 $417.00 $417.00 $417.00 $312.75 $417.00 $417.00 $417.00 $208.50 $208.50 $330.26 $417.00 $333.60 $271.05 $82.76 $417.00 $241.86 $417.00 $417.00 $417.00 $86.90 $417.00 N/A N/A 27202509 EAP HCPCS C1751 INFUSION EMBO CATH SEGWAY BOTH IP/OP $835.00 $618.00 $165.73 $835.00 $453.41 $453.41 $453.41 $453.41 $835.00 $835.00 $835.00 $174.03 $835.00 $619.74 $619.74 $643.62 $435.04 $174.02 $835.00 $835.00 $493.90 $835.00 $835.00 $835.00 $835.00 $626.25 $835.00 $835.00 $835.00 $417.50 $417.50 $661.32 $835.00 $668.00 $542.75 $165.73 $835.00 $484.30 $835.00 $835.00 $835.00 $174.01 $835.00 N/A N/A 27202510 EAP HCPCS C1757 COMPLEX HELICAL COIL BOTH IP/OP $239.00 $177.00 $47.44 $239.00 $129.78 $129.78 $129.78 $129.78 $239.00 $239.00 $239.00 $49.81 $239.00 $177.39 $177.39 $184.22 $124.52 $49.81 $239.00 $239.00 $141.37 $239.00 $239.00 $239.00 $239.00 $179.25 $239.00 $239.00 $239.00 $119.50 $119.50 $189.29 $239.00 $191.20 $155.35 $47.44 $239.00 $138.62 $239.00 $239.00 $239.00 $49.81 $239.00 N/A N/A 27202511 EAP HCPCS C1894 6FR DIAL EASE INTRODUCER SHEAT BOTH IP/OP $43.00 $32.00 $8.53 $43.00 $23.35 $23.35 $23.35 $23.35 $43.00 $43.00 $43.00 $8.96 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $25.43 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $8.53 $43.00 $24.94 $43.00 $43.00 $43.00 $8.96 $43.00 N/A N/A 27202512 EAP HCPCS C1725 7-2/7/75 WORKHORSE BALLOON BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 27202513 EAP HCPCS C1725 7-4/5/75 WORKHORSE BALLOON BOTH IP/OP $427.00 $316.00 $84.75 $427.00 $231.86 $231.86 $231.86 $231.86 $427.00 $427.00 $427.00 $89.00 $427.00 $316.92 $316.92 $329.13 $222.47 $88.99 $427.00 $427.00 $252.57 $427.00 $427.00 $427.00 $427.00 $320.25 $427.00 $427.00 $427.00 $213.50 $213.50 $338.18 $427.00 $341.60 $277.55 $84.75 $427.00 $247.66 $427.00 $427.00 $427.00 $88.99 $427.00 N/A N/A 27202514 EAP HCPCS C1894 10FR 25CM PINNACLE SHEATH INTR BOTH IP/OP $67.00 $50.00 $13.30 $67.00 $36.38 $36.38 $36.38 $36.38 $67.00 $67.00 $67.00 $13.96 $67.00 $49.73 $49.73 $51.64 $34.91 $13.96 $67.00 $67.00 $39.63 $67.00 $67.00 $67.00 $67.00 $50.25 $67.00 $67.00 $67.00 $33.50 $33.50 $53.06 $67.00 $53.60 $43.55 $13.30 $67.00 $38.86 $67.00 $67.00 $67.00 $13.96 $67.00 N/A N/A 27202515 EAP HCPCS C1894 5FR 25CM PINNACLE INTRODUCER S BOTH IP/OP $59.00 $44.00 $11.71 $59.00 $32.04 $32.04 $32.04 $32.04 $59.00 $59.00 $59.00 $12.30 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $59.00 $34.90 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $11.71 $59.00 $34.22 $59.00 $59.00 $59.00 $12.30 $59.00 N/A N/A 27202516 EAP HCPCS C1894 9FR 25CM PINNACLE INTRODUCER S BOTH IP/OP $67.00 $50.00 $13.30 $67.00 $36.38 $36.38 $36.38 $36.38 $67.00 $67.00 $67.00 $13.96 $67.00 $49.73 $49.73 $51.64 $34.91 $13.96 $67.00 $67.00 $39.63 $67.00 $67.00 $67.00 $67.00 $50.25 $67.00 $67.00 $67.00 $33.50 $33.50 $53.06 $67.00 $53.60 $43.55 $13.30 $67.00 $38.86 $67.00 $67.00 $67.00 $13.96 $67.00 N/A N/A 27202517 EAP HCPCS C1894 6FR 25CM PINNACLE INTRODUCER S BOTH IP/OP $67.00 $50.00 $13.30 $67.00 $36.38 $36.38 $36.38 $36.38 $67.00 $67.00 $67.00 $13.96 $67.00 $49.73 $49.73 $51.64 $34.91 $13.96 $67.00 $67.00 $39.63 $67.00 $67.00 $67.00 $67.00 $50.25 $67.00 $67.00 $67.00 $33.50 $33.50 $53.06 $67.00 $53.60 $43.55 $13.30 $67.00 $38.86 $67.00 $67.00 $67.00 $13.96 $67.00 N/A N/A 27202518 EAP HCPCS C1894 7FR 25CM PINNACLE INTRODUCER S BOTH IP/OP $59.00 $44.00 $11.71 $59.00 $32.04 $32.04 $32.04 $32.04 $59.00 $59.00 $59.00 $12.30 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $59.00 $34.90 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $11.71 $59.00 $34.22 $59.00 $59.00 $59.00 $12.30 $59.00 N/A N/A 27202519 EAP HCPCS C1750 23CM HEMOGLIDE PERM CATH BOTH IP/OP "$2,140.00" "$1,584.00" $424.74 "$2,140.00" "$1,162.02" "$1,162.02" "$1,162.02" "$1,162.02" "$2,140.00" "$2,140.00" "$2,140.00" $446.03 "$2,140.00" "$1,588.31" "$1,588.31" "$1,649.51" "$1,114.94" $446.00 "$2,140.00" "$2,140.00" "$1,265.81" "$2,140.00" "$2,140.00" "$2,140.00" "$2,140.00" "$1,605.00" "$2,140.00" "$2,140.00" "$2,140.00" "$1,070.00" "$1,070.00" "$1,694.88" "$2,140.00" "$1,712.00" "$1,391.00" $424.74 "$2,140.00" "$1,241.20" "$2,140.00" "$2,140.00" "$2,140.00" $445.98 "$2,140.00" N/A N/A 27202520 EAP HCPCS C1750 19CM HEMOGLIDE PERM CATH BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $497.39 $497.39 $497.39 $497.39 $916.00 $916.00 $916.00 $190.92 $916.00 $679.86 $679.86 $706.05 $477.24 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $595.40 $181.80 $916.00 $531.28 $916.00 $916.00 $916.00 $190.89 $916.00 N/A N/A 27202521 EAP HCPCS C1769 NITREX GUIDEWIRE BOTH IP/OP $728.00 $539.00 $144.49 $728.00 $395.30 $395.30 $395.30 $395.30 $728.00 $728.00 $728.00 $151.73 $728.00 $540.32 $540.32 $561.14 $379.29 $151.72 $728.00 $728.00 $430.61 $728.00 $728.00 $728.00 $728.00 $546.00 $728.00 $728.00 $728.00 $364.00 $364.00 $576.58 $728.00 $582.40 $473.20 $144.49 $728.00 $422.24 $728.00 $728.00 $728.00 $151.72 $728.00 N/A N/A 27202522 EAP HCPCS C1769 DISPOSABLE TIP DEFLECTING WIRE BOTH IP/OP $567.00 $420.00 $112.54 $567.00 $307.88 $307.88 $307.88 $307.88 $567.00 $567.00 $567.00 $118.18 $567.00 $420.83 $420.83 $437.04 $295.41 $118.17 $567.00 $226.80 $335.38 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $368.55 $112.54 $567.00 $328.86 $567.00 $567.00 $567.00 $118.16 $567.00 N/A N/A 27202523 EAP HCPCS C1894 10FR PINNACLE INTRODUCER BOTH IP/OP $76.00 $56.50 $15.08 $76.00 $41.27 $41.27 $41.27 $41.27 $76.00 $76.00 $76.00 $15.84 $76.00 $56.41 $56.41 $58.58 $39.60 $15.84 $76.00 $76.00 $44.95 $76.00 $76.00 $76.00 $76.00 $57.00 $76.00 $76.00 $76.00 $38.00 $38.00 $60.19 $76.00 $60.80 $49.40 $15.08 $76.00 $44.08 $76.00 $76.00 $76.00 $15.84 $76.00 N/A N/A 27202524 EAP HCPCS C1752 NIAGRA DIALYSIS CATHETER BOTH IP/OP $203.00 $150.50 $42.31 $203.00 $203.00 $203.00 $203.00 $203.00 $203.00 $203.00 $203.00 $203.00 $203.00 $150.67 $150.67 $156.47 $105.76 $42.31 $203.00 $81.20 $203.00 $203.00 $203.00 $203.00 $203.00 $152.25 $203.00 $203.00 $203.00 $101.50 $101.50 $160.78 $203.00 $162.40 $131.95 $203.00 $203.00 $117.74 $203.00 $121.80 $203.00 $203.00 $203.00 N/A N/A 27202525 EAP HCPCS C2629 5FR TEAR-AWAY INTRODUCER BOTH IP/OP $81.00 $60.00 $16.08 $81.00 $43.98 $43.98 $43.98 $43.98 $81.00 $81.00 $81.00 $16.88 $81.00 $60.12 $60.12 $62.43 $42.20 $16.88 $81.00 $81.00 $47.91 $81.00 $81.00 $81.00 $81.00 $60.75 $81.00 $81.00 $81.00 $40.50 $40.50 $64.15 $81.00 $64.80 $52.65 $16.08 $81.00 $46.98 $81.00 $81.00 $81.00 $16.88 $81.00 N/A N/A 27202526 EAP HCPCS C2629 6FR TEAR-AWAY INTRODUCER BOTH IP/OP $856.00 $633.50 $169.89 $856.00 $464.81 $464.81 $464.81 $464.81 $856.00 $856.00 $856.00 $178.41 $856.00 $635.32 $635.32 $659.80 $445.98 $178.40 $856.00 $856.00 $506.32 $856.00 $856.00 $856.00 $856.00 $642.00 $856.00 $856.00 $856.00 $428.00 $428.00 $677.95 $856.00 $684.80 $556.40 $169.89 $856.00 $496.48 $856.00 $856.00 $856.00 $178.39 $856.00 N/A N/A 27202527 EAP HCPCS C2629 8 FR TEAR AWAY INTRODUCER BOTH IP/OP $397.00 $294.00 $78.79 $397.00 $215.57 $215.57 $215.57 $215.57 $397.00 $397.00 $397.00 $82.74 $397.00 $294.65 $294.65 $306.01 $206.84 $82.74 $397.00 $397.00 $234.83 $397.00 $397.00 $397.00 $397.00 $297.75 $397.00 $397.00 $397.00 $198.50 $198.50 $314.42 $397.00 $317.60 $258.05 $78.79 $397.00 $230.26 $397.00 $397.00 $397.00 $82.73 $397.00 N/A N/A 27202528 EAP HCPCS C2629 9FR TEAR-AWAY INTRODUCER BOTH IP/OP $81.00 $60.00 $16.08 $81.00 $43.98 $43.98 $43.98 $43.98 $81.00 $81.00 $81.00 $16.88 $81.00 $60.12 $60.12 $62.43 $42.20 $16.88 $81.00 $81.00 $47.91 $81.00 $81.00 $81.00 $81.00 $60.75 $81.00 $81.00 $81.00 $40.50 $40.50 $64.15 $81.00 $64.80 $52.65 $16.08 $81.00 $46.98 $81.00 $81.00 $81.00 $16.88 $81.00 N/A N/A 27202529 EAP HCPCS C2629 10FR-16CM INTRODUCER BOTH IP/OP $85.00 $63.00 $16.87 $85.00 $46.16 $46.16 $46.16 $46.16 $85.00 $85.00 $85.00 $17.72 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $85.00 $50.28 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $16.87 $85.00 $49.30 $85.00 $85.00 $85.00 $17.71 $85.00 N/A N/A 27202530 EAP Custom 27202530 18 GA NEEDLE STERILE GUIDE BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27202531 EAP HCPCS C1729 12FR FLEXIMA BILIARY CATH BOTH IP/OP $291.00 $215.50 $57.76 $291.00 $158.01 $158.01 $158.01 $158.01 $291.00 $291.00 $291.00 $60.65 $291.00 $215.98 $215.98 $224.30 $151.61 $60.65 $291.00 $291.00 $172.13 $291.00 $291.00 $291.00 $291.00 $218.25 $291.00 $291.00 $291.00 $145.50 $145.50 $230.47 $291.00 $232.80 $189.15 $57.76 $291.00 $168.78 $291.00 $291.00 $291.00 $60.64 $291.00 N/A N/A 27202532 EAP HCPCS C1757 2MMX20MM COMPLEX HELICAL BOTH IP/OP $257.00 $190.50 $51.01 $257.00 $139.55 $139.55 $139.55 $139.55 $257.00 $257.00 $257.00 $53.57 $257.00 $190.75 $190.75 $198.10 $133.90 $53.56 $257.00 $257.00 $152.02 $257.00 $257.00 $257.00 $257.00 $192.75 $257.00 $257.00 $257.00 $128.50 $128.50 $203.54 $257.00 $205.60 $167.05 $51.01 $257.00 $149.06 $257.00 $257.00 $257.00 $53.56 $257.00 N/A N/A 27202533 EAP HCPCS C1725 4-4/5/75 BALLOON CATHETER BOTH IP/OP $681.00 $504.00 $135.16 $681.00 $369.78 $369.78 $369.78 $369.78 $681.00 $681.00 $681.00 $141.94 $681.00 $505.44 $505.44 $524.91 $354.80 $141.93 $681.00 $681.00 $402.81 $681.00 $681.00 $681.00 $681.00 $510.75 $681.00 $681.00 $681.00 $340.50 $340.50 $539.35 $681.00 $544.80 $442.65 $135.16 $681.00 $394.98 $681.00 $681.00 $681.00 $141.92 $681.00 N/A N/A 27202534 EAP HCPCS C1769 46FR-65CM C2 GLIDECATH BOTH IP/OP $167.00 $124.00 $33.15 $167.00 $90.68 $90.68 $90.68 $90.68 $167.00 $167.00 $167.00 $34.81 $167.00 $123.95 $123.95 $128.72 $87.01 $34.80 $167.00 $167.00 $98.78 $167.00 $167.00 $167.00 $167.00 $125.25 $167.00 $167.00 $167.00 $83.50 $83.50 $132.26 $167.00 $133.60 $108.55 $33.15 $167.00 $96.86 $167.00 $167.00 $167.00 $34.80 $167.00 N/A N/A 27202535 EAP HCPCS C1757 4MMX30MM COMPLEX HELICAL BOTH IP/OP $265.00 $196.50 $52.60 $265.00 $143.90 $143.90 $143.90 $143.90 $265.00 $265.00 $265.00 $55.23 $265.00 $196.68 $196.68 $204.26 $138.07 $55.23 $265.00 $265.00 $156.75 $265.00 $265.00 $265.00 $265.00 $198.75 $265.00 $265.00 $265.00 $132.50 $132.50 $209.88 $265.00 $212.00 $172.25 $52.60 $265.00 $153.70 $265.00 $265.00 $265.00 $55.23 $265.00 N/A N/A 27202536 EAP HCPCS C1725 BMX 8-3/5.8/75 BALLOON CA BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $497.39 $497.39 $497.39 $497.39 $916.00 $916.00 $916.00 $190.92 $916.00 $679.86 $679.86 $706.05 $477.24 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $595.40 $181.80 $916.00 $531.28 $916.00 $916.00 $916.00 $190.89 $916.00 N/A N/A 27202537 EAP HCPCS C1725 BMX14-4/7/100 BALLON GATH BOTH IP/OP "$1,008.00" $746.00 $200.06 "$1,008.00" $547.34 $547.34 $547.34 $547.34 "$1,008.00" "$1,008.00" "$1,008.00" $210.09 "$1,008.00" $748.14 $748.14 $776.97 $525.17 $210.08 "$1,008.00" "$1,008.00" $596.23 "$1,008.00" "$1,008.00" "$1,008.00" "$1,008.00" $756.00 "$1,008.00" "$1,008.00" "$1,008.00" $504.00 $504.00 $798.34 "$1,008.00" $806.40 $655.20 $200.06 "$1,008.00" $584.64 "$1,008.00" "$1,008.00" "$1,008.00" $210.07 "$1,008.00" N/A N/A 27202538 EAP HCPCS C1729 CATHETER 10FR FLEXIMA BOTH IP/OP $291.00 $215.50 $57.76 $291.00 $158.01 $158.01 $158.01 $158.01 $291.00 $291.00 $291.00 $60.65 $291.00 $215.98 $215.98 $224.30 $151.61 $60.65 $291.00 $291.00 $172.13 $291.00 $291.00 $291.00 $291.00 $218.25 $291.00 $291.00 $291.00 $145.50 $145.50 $230.47 $291.00 $232.80 $189.15 $57.76 $291.00 $168.78 $291.00 $291.00 $291.00 $60.64 $291.00 N/A N/A 27202543 EAP HCPCS C1887 GLIDECATH: 100CM STRAIGHT BOTH IP/OP $838.00 $620.50 $166.32 $838.00 $455.03 $455.03 $455.03 $455.03 $838.00 $838.00 $838.00 $174.66 $838.00 $621.96 $621.96 $645.93 $436.60 $174.65 $838.00 $838.00 $495.68 $838.00 $838.00 $838.00 $838.00 $628.50 $838.00 $838.00 $838.00 $419.00 $419.00 $663.70 $838.00 $670.40 $544.70 $166.32 $838.00 $486.04 $838.00 $838.00 $838.00 $174.64 $838.00 N/A N/A 27202544 EAP HCPCS C1887 GUIDECATH 5FR-100CM BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 27202545 EAP HCPCS C1769 GUIDEWIRE .035/150CM BOTH IP/OP "$1,424.00" "$1,054.00" $282.63 "$1,424.00" $773.23 $773.23 $773.23 $773.23 "$1,424.00" "$1,424.00" "$1,424.00" $296.80 "$1,424.00" "$1,056.89" "$1,056.89" "$1,097.62" $741.90 $296.78 "$1,424.00" $569.60 $842.30 "$1,424.00" "$1,424.00" "$1,424.00" "$1,424.00" "$1,068.00" "$1,424.00" "$1,424.00" "$1,424.00" $712.00 $712.00 "$1,127.81" "$1,424.00" "$1,139.20" $925.60 $282.63 "$1,424.00" $825.92 "$1,424.00" "$1,424.00" "$1,424.00" $296.76 "$1,424.00" N/A N/A 27202546 EAP HCPCS C1769 TRANSCEND -EX GUIDEWIRE BOTH IP/OP "$1,759.00" "$1,302.00" $349.12 "$1,759.00" $955.14 $955.14 $955.14 $955.14 "$1,759.00" "$1,759.00" "$1,759.00" $366.62 "$1,759.00" "$1,305.53" "$1,305.53" "$1,355.84" $916.44 $366.59 "$1,759.00" "$1,759.00" "$1,040.45" "$1,759.00" "$1,759.00" "$1,759.00" "$1,759.00" "$1,319.25" "$1,759.00" "$1,759.00" "$1,759.00" $879.50 $879.50 "$1,393.13" "$1,759.00" "$1,407.20" "$1,143.35" $349.12 "$1,759.00" "$1,020.22" "$1,759.00" "$1,759.00" "$1,759.00" $366.58 "$1,759.00" N/A N/A 27202547 EAP HCPCS C1725 UDT6-10/5/120 BALLON CATH BOTH IP/OP $717.00 $531.00 $142.31 $717.00 $389.33 $389.33 $389.33 $389.33 $717.00 $717.00 $717.00 $149.44 $717.00 $532.16 $532.16 $552.66 $373.56 $149.43 $717.00 $717.00 $424.11 $717.00 $717.00 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $358.50 $358.50 $567.86 $717.00 $573.60 $466.05 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 27202548 EAP HCPCS C1769 V-18 CONTROL GUIDEWIRES BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $125.20 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 27202549 EAP HCPCS C1725 XXL 18-4/5.8/120E BALL GA BOTH IP/OP $934.00 $691.50 $185.38 $934.00 $507.16 $507.16 $507.16 $507.16 $934.00 $934.00 $934.00 $194.67 $934.00 $693.21 $693.21 $719.93 $486.61 $194.66 $934.00 $934.00 $552.46 $934.00 $934.00 $934.00 $934.00 $700.50 $934.00 $934.00 $934.00 $467.00 $467.00 $739.73 $934.00 $747.20 $607.10 $185.38 $934.00 $541.72 $934.00 $934.00 $934.00 $194.65 $934.00 N/A N/A 27202550 EAP HCPCS C1769 GUIDEWIRE .035-260CM ROSEN BOTH IP/OP $68.00 $50.50 $13.50 $68.00 $36.92 $36.92 $36.92 $36.92 $68.00 $68.00 $68.00 $14.17 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $68.00 $40.22 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $13.50 $68.00 $39.44 $68.00 $68.00 $68.00 $14.17 $68.00 N/A N/A 27202551 EAP HCPCS C1729 10.2FR BILIARY DRAIN CATH BOTH IP/OP $289.00 $214.00 $57.36 $289.00 $156.93 $156.93 $156.93 $156.93 $289.00 $289.00 $289.00 $60.23 $289.00 $214.50 $214.50 $222.76 $150.57 $60.23 $289.00 $289.00 $170.94 $289.00 $289.00 $289.00 $289.00 $216.75 $289.00 $289.00 $289.00 $144.50 $144.50 $228.89 $289.00 $231.20 $187.85 $57.36 $289.00 $167.62 $289.00 $289.00 $289.00 $60.23 $289.00 N/A N/A 27202552 EAP HCPCS C1729 12.0FR BILIARY DRAIN CATH BOTH IP/OP $296.00 $219.50 $58.75 $296.00 $160.73 $160.73 $160.73 $160.73 $296.00 $296.00 $296.00 $61.69 $296.00 $219.69 $219.69 $228.16 $154.22 $61.69 $296.00 $296.00 $175.08 $296.00 $296.00 $296.00 $296.00 $222.00 $296.00 $296.00 $296.00 $148.00 $148.00 $234.43 $296.00 $236.80 $192.40 $58.75 $296.00 $171.68 $296.00 $296.00 $296.00 $61.69 $296.00 N/A N/A 27202553 EAP HCPCS C1729 12.0FR MP DRAIN CATHETER BOTH IP/OP $296.00 $219.50 $58.75 $296.00 $160.73 $160.73 $160.73 $160.73 $296.00 $296.00 $296.00 $61.69 $296.00 $219.69 $219.69 $228.16 $154.22 $61.69 $296.00 $296.00 $175.08 $296.00 $296.00 $296.00 $296.00 $222.00 $296.00 $296.00 $296.00 $148.00 $148.00 $234.43 $296.00 $236.80 $192.40 $58.75 $296.00 $171.68 $296.00 $296.00 $296.00 $61.69 $296.00 N/A N/A 27202554 EAP HCPCS C1729 14.0FR BILIARY DRAIN BOTH IP/OP $296.00 $219.50 $58.75 $296.00 $160.73 $160.73 $160.73 $160.73 $296.00 $296.00 $296.00 $61.69 $296.00 $219.69 $219.69 $228.16 $154.22 $61.69 $296.00 $296.00 $175.08 $296.00 $296.00 $296.00 $296.00 $222.00 $296.00 $296.00 $296.00 $148.00 $148.00 $234.43 $296.00 $236.80 $192.40 $58.75 $296.00 $171.68 $296.00 $296.00 $296.00 $61.69 $296.00 N/A N/A 27202555 EAP HCPCS C1769 35-180 COONS WIRE BOTH IP/OP $192.00 $142.50 $38.11 $192.00 $104.26 $104.26 $104.26 $104.26 $192.00 $192.00 $192.00 $40.02 $192.00 $142.50 $142.50 $147.99 $100.03 $40.01 $192.00 $76.80 $113.57 $192.00 $192.00 $192.00 $192.00 $144.00 $192.00 $192.00 $192.00 $96.00 $96.00 $152.06 $192.00 $153.60 $124.80 $38.11 $192.00 $111.36 $192.00 $192.00 $192.00 $40.01 $192.00 N/A N/A 27202556 EAP HCPCS C1757 35-2-3 EMBOLIZATION COIL BOTH IP/OP $172.00 $127.50 $34.14 $172.00 $93.40 $93.40 $93.40 $93.40 $172.00 $172.00 $172.00 $35.85 $172.00 $127.66 $127.66 $132.58 $89.61 $35.85 $172.00 $172.00 $101.74 $172.00 $172.00 $172.00 $172.00 $129.00 $172.00 $172.00 $172.00 $86.00 $86.00 $136.22 $172.00 $137.60 $111.80 $34.14 $172.00 $99.76 $172.00 $172.00 $172.00 $35.84 $172.00 N/A N/A 27202557 EAP HCPCS C1725 7FR-100CM MONTEF 10RE CAT BOTH IP/OP $54.00 $40.00 $10.72 $54.00 $29.32 $29.32 $29.32 $29.32 $54.00 $54.00 $54.00 $11.25 $54.00 $40.08 $40.08 $41.62 $28.13 $11.25 $54.00 $54.00 $31.94 $54.00 $54.00 $54.00 $54.00 $40.50 $54.00 $54.00 $54.00 $27.00 $27.00 $42.77 $54.00 $43.20 $35.10 $10.72 $54.00 $31.32 $54.00 $54.00 $54.00 $11.25 $54.00 N/A N/A 27202558 EAP HCPCS C1894 8FR BALKANINTRODUCER BOTH IP/OP $170.00 $126.00 $33.74 $170.00 $92.31 $92.31 $92.31 $92.31 $170.00 $170.00 $170.00 $35.43 $170.00 $126.17 $126.17 $131.04 $88.57 $35.43 $170.00 $170.00 $100.56 $170.00 $170.00 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $110.50 $33.74 $170.00 $98.60 $170.00 $170.00 $170.00 $35.43 $170.00 N/A N/A 27202559 EAP HCPCS C1894 9FR FLEXOR INTRODUCER BOTH IP/OP $159.00 $118.00 $31.56 $159.00 $86.34 $86.34 $86.34 $86.34 $159.00 $159.00 $159.00 $33.14 $159.00 $118.01 $118.01 $122.56 $82.84 $33.14 $159.00 $159.00 $94.05 $159.00 $159.00 $159.00 $159.00 $119.25 $159.00 $159.00 $159.00 $79.50 $79.50 $125.93 $159.00 $127.20 $103.35 $31.56 $159.00 $92.22 $159.00 $159.00 $159.00 $33.14 $159.00 N/A N/A 27202560 EAP HCPCS C1757 COIL EMBOLIZATION 35-5-5 BOTH IP/OP $172.00 $127.50 $34.14 $172.00 $93.40 $93.40 $93.40 $93.40 $172.00 $172.00 $172.00 $35.85 $172.00 $127.66 $127.66 $132.58 $89.61 $35.85 $172.00 $172.00 $101.74 $172.00 $172.00 $172.00 $172.00 $129.00 $172.00 $172.00 $172.00 $86.00 $86.00 $136.22 $172.00 $137.60 $111.80 $34.14 $172.00 $99.76 $172.00 $172.00 $172.00 $35.84 $172.00 N/A N/A 27202561 EAP HCPCS C1751 135 CM MASS TRANSIT MAX BOTH IP/OP "$2,960.00" "$2,190.50" $587.49 "$2,960.00" "$1,607.28" "$1,607.28" "$1,607.28" "$1,607.28" "$2,960.00" "$2,960.00" "$2,960.00" $616.94 "$2,960.00" "$2,196.91" "$2,196.91" "$2,281.57" "$1,542.16" $616.90 "$2,960.00" "$2,960.00" "$1,750.84" "$2,960.00" "$2,960.00" "$2,960.00" "$2,960.00" "$2,220.00" "$2,960.00" "$2,960.00" "$2,960.00" "$1,480.00" "$1,480.00" "$2,344.32" "$2,960.00" "$2,368.00" "$1,924.00" $587.49 "$2,960.00" "$1,716.80" "$2,960.00" "$2,960.00" "$2,960.00" $616.86 "$2,960.00" N/A N/A 27202562 EAP HCPCS C1894 INTRODUCER PINNACLE 7FR 10CM BOTH IP/OP $67.00 $50.00 $13.30 $67.00 $36.38 $36.38 $36.38 $36.38 $67.00 $67.00 $67.00 $13.96 $67.00 $49.73 $49.73 $51.64 $34.91 $13.96 $67.00 $26.80 $39.63 $67.00 $67.00 $67.00 $67.00 $50.25 $67.00 $67.00 $67.00 $33.50 $33.50 $53.06 $67.00 $53.60 $43.55 $13.30 $67.00 $38.86 $67.00 $67.00 $67.00 $13.96 $67.00 N/A N/A 27202563 EAP HCPCS C1725 BALLOON UDT 4-4/5/120 BOTH IP/OP $717.00 $531.00 $142.31 $717.00 $389.33 $389.33 $389.33 $389.33 $717.00 $717.00 $717.00 $149.44 $717.00 $532.16 $532.16 $552.66 $373.56 $149.43 $717.00 $717.00 $424.11 $717.00 $717.00 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $358.50 $358.50 $567.86 $717.00 $573.60 $466.05 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 27202564 EAP HCPCS C1887 5FR.100CMHINCK HEADHUNTER BOTH IP/OP $167.00 $124.00 $33.15 $167.00 $90.68 $90.68 $90.68 $90.68 $167.00 $167.00 $167.00 $34.81 $167.00 $123.95 $123.95 $128.72 $87.01 $34.80 $167.00 $167.00 $98.78 $167.00 $167.00 $167.00 $167.00 $125.25 $167.00 $167.00 $167.00 $83.50 $83.50 $132.26 $167.00 $133.60 $108.55 $33.15 $167.00 $96.86 $167.00 $167.00 $167.00 $34.80 $167.00 N/A N/A 27202565 EAP HCPCS C1894 8FR 25CM PINNACLE INTRODUCER S BOTH IP/OP $59.00 $44.00 $11.71 $59.00 $32.04 $32.04 $32.04 $32.04 $59.00 $59.00 $59.00 $12.30 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $59.00 $34.90 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $11.71 $59.00 $34.22 $59.00 $59.00 $59.00 $12.30 $59.00 N/A N/A 27202566 EAP HCPCS C1887 5F-90CM RUC CATHETER BOTH IP/OP $129.00 $95.50 $25.60 $129.00 $70.05 $70.05 $70.05 $70.05 $129.00 $129.00 $129.00 $26.89 $129.00 $95.74 $95.74 $99.43 $67.21 $26.89 $129.00 $129.00 $76.30 $129.00 $129.00 $129.00 $129.00 $96.75 $129.00 $129.00 $129.00 $64.50 $64.50 $102.17 $129.00 $103.20 $83.85 $25.60 $129.00 $74.82 $129.00 $129.00 $129.00 $26.88 $129.00 N/A N/A 27202567 EAP HCPCS C2629 INTRODUCER TEAR AWAY 120FX30CM BOTH IP/OP $142.00 $105.50 $28.18 $142.00 $77.11 $77.11 $77.11 $77.11 $142.00 $142.00 $142.00 $29.60 $142.00 $105.39 $105.39 $109.45 $73.98 $29.59 $142.00 $142.00 $83.99 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $28.18 $142.00 $82.36 $142.00 $142.00 $142.00 $29.59 $142.00 N/A N/A 27202568 EAP HCPCS C2629 INTRODUCER TEAR AWAY 16F X15CM BOTH IP/OP $68.00 $50.50 $13.50 $68.00 $36.92 $36.92 $36.92 $36.92 $68.00 $68.00 $68.00 $14.17 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $68.00 $40.22 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $13.50 $68.00 $39.44 $68.00 $68.00 $68.00 $14.17 $68.00 N/A N/A 27202569 EAP HCPCS C2629 INTRODUCER TEAR AWAY 14F X15CM BOTH IP/OP $68.00 $50.50 $13.50 $68.00 $36.92 $36.92 $36.92 $36.92 $68.00 $68.00 $68.00 $14.17 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $68.00 $40.22 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $13.50 $68.00 $39.44 $68.00 $68.00 $68.00 $14.17 $68.00 N/A N/A 27202570 EAP HCPCS C2629 INTRODUCER TEAR AWAY12.5FX15CM BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 27202571 EAP HCPCS C2629 INTRODUCER TEAR AWAY 6F X 10CM BOTH IP/OP $159.00 $118.00 $31.56 $159.00 $86.34 $86.34 $86.34 $86.34 $159.00 $159.00 $159.00 $33.14 $159.00 $118.01 $118.01 $122.56 $82.84 $33.14 $159.00 $159.00 $94.05 $159.00 $159.00 $159.00 $159.00 $119.25 $159.00 $159.00 $159.00 $79.50 $79.50 $125.93 $159.00 $127.20 $103.35 $31.56 $159.00 $92.22 $159.00 $159.00 $159.00 $33.14 $159.00 N/A N/A 27202572 EAP HCPCS C1769 "AMPLATZ SUP GUIDEWIRE,035/75GW" BOTH IP/OP $331.00 $245.00 $65.70 $331.00 $179.73 $179.73 $179.73 $179.73 $331.00 $331.00 $331.00 $68.99 $331.00 $245.67 $245.67 $255.13 $172.45 $68.98 $331.00 $331.00 $195.79 $331.00 $331.00 $331.00 $331.00 $248.25 $331.00 $331.00 $331.00 $165.50 $165.50 $262.15 $331.00 $264.80 $215.15 $65.70 $331.00 $191.98 $331.00 $331.00 $331.00 $68.98 $331.00 N/A N/A 27202573 EAP HCPCS C1726 MERCI BALLOON GUIDE CATHETER BOTH IP/OP "$2,251.00" "$1,666.00" $446.77 "$2,251.00" "$1,222.29" "$1,222.29" "$1,222.29" "$1,222.29" "$2,251.00" "$2,251.00" "$2,251.00" $469.16 "$2,251.00" "$1,670.69" "$1,670.69" "$1,735.07" "$1,172.77" $469.13 "$2,251.00" "$2,251.00" "$1,331.47" "$2,251.00" "$2,251.00" "$2,251.00" "$2,251.00" "$1,688.25" "$2,251.00" "$2,251.00" "$2,251.00" "$1,125.50" "$1,125.50" "$1,782.79" "$2,251.00" "$1,800.80" "$1,463.15" $446.77 "$2,251.00" "$1,305.58" "$2,251.00" "$1,350.60" "$2,251.00" $469.11 "$2,251.00" N/A N/A 27202574 EAP HCPCS C1751 MERCI MICROCATHETER BOTH IP/OP "$1,641.00" "$1,214.50" $325.70 "$1,641.00" $891.06 $891.06 $891.06 $891.06 "$1,641.00" "$1,641.00" "$1,641.00" $342.03 "$1,641.00" "$1,217.95" "$1,217.95" "$1,264.88" $854.96 $342.00 "$1,641.00" "$1,641.00" $970.65 "$1,641.00" "$1,641.00" "$1,641.00" "$1,641.00" "$1,230.75" "$1,641.00" "$1,641.00" "$1,641.00" $820.50 $820.50 "$1,299.67" "$1,641.00" "$1,312.80" "$1,066.65" $325.70 "$1,641.00" $951.78 "$1,641.00" "$1,641.00" "$1,641.00" $341.98 "$1,641.00" N/A N/A 27202575 EAP HCPCS C1757 MERI V-SERIES RETRIEVAL V2.0 BOTH IP/OP "$10,341.00" "$7,652.50" "$2,052.43" "$10,341.00" "$5,615.16" "$5,615.16" "$5,615.16" "$5,615.16" "$10,341.00" "$10,341.00" "$10,341.00" "$2,155.32" "$10,341.00" "$4,181.12" "$4,181.12" "$7,970.84" "$2,060.15" "$2,155.18" "$10,341.00" "$10,341.00" "$3,094.73" "$10,341.00" "$10,341.00" "$10,341.00" "$10,341.00" "$7,755.75" "$10,341.00" "$10,341.00" "$10,341.00" "$5,170.50" "$5,170.50" "$8,190.07" "$10,341.00" "$8,272.80" "$6,721.65" "$2,052.43" "$10,341.00" "$5,997.78" "$10,341.00" "$10,341.00" "$10,341.00" "$2,155.06" "$10,341.00" N/A N/A 27202576 EAP HCPCS C1757 MERI V-SERIES RETRIEVAL V2.5 BOTH IP/OP "$10,708.00" "$7,924.00" "$2,060.15" "$10,708.00" "$5,814.44" "$5,814.44" "$5,814.44" "$5,814.44" "$10,708.00" "$10,708.00" "$10,708.00" "$2,231.81" "$10,708.00" "$4,181.12" "$4,181.12" "$8,253.73" "$2,060.15" "$2,231.66" "$10,708.00" "$10,708.00" "$3,094.73" "$10,708.00" "$10,708.00" "$10,708.00" "$10,708.00" "$8,031.00" "$10,708.00" "$10,708.00" "$10,708.00" "$5,354.00" "$5,354.00" "$8,480.74" "$10,708.00" "$8,566.40" "$6,960.20" "$2,125.27" "$10,708.00" "$6,210.64" "$10,708.00" "$10,708.00" "$10,708.00" "$2,231.55" "$10,708.00" N/A N/A 27202577 EAP HCPCS C1757 MERI V-SERIES RETRIEVAL V3.0 BOTH IP/OP "$10,708.00" "$7,924.00" "$2,060.15" "$10,708.00" "$5,814.44" "$5,814.44" "$5,814.44" "$5,814.44" "$10,708.00" "$10,708.00" "$10,708.00" "$2,231.81" "$10,708.00" "$4,181.12" "$4,181.12" "$8,253.73" "$2,060.15" "$2,231.66" "$10,708.00" "$10,708.00" "$3,094.73" "$10,708.00" "$10,708.00" "$10,708.00" "$10,708.00" "$8,031.00" "$10,708.00" "$10,708.00" "$10,708.00" "$5,354.00" "$5,354.00" "$8,480.74" "$10,708.00" "$8,566.40" "$6,960.20" "$2,125.27" "$10,708.00" "$6,210.64" "$10,708.00" "$10,708.00" "$10,708.00" "$2,231.55" "$10,708.00" N/A N/A 27202578 EAP HCPCS C1757 MERI V-SERIES RETRIEVAL V2.5 BOTH IP/OP "$10,341.00" "$7,652.50" "$2,052.43" "$10,341.00" "$5,615.16" "$5,615.16" "$5,615.16" "$5,615.16" "$10,341.00" "$10,341.00" "$10,341.00" "$2,155.32" "$10,341.00" "$4,181.12" "$4,181.12" "$7,970.84" "$2,060.15" "$2,155.18" "$10,341.00" "$10,341.00" "$3,094.73" "$10,341.00" "$10,341.00" "$10,341.00" "$10,341.00" "$7,755.75" "$10,341.00" "$10,341.00" "$10,341.00" "$5,170.50" "$5,170.50" "$8,190.07" "$10,341.00" "$8,272.80" "$6,721.65" "$2,052.43" "$10,341.00" "$5,997.78" "$10,341.00" "$10,341.00" "$10,341.00" "$2,155.06" "$10,341.00" N/A N/A 27202579 EAP HCPCS C1751 CATHETER REPERFUSION 026 BOTH IP/OP "$3,767.00" "$2,788.00" $747.66 "$3,767.00" "$2,045.48" "$2,045.48" "$2,045.48" "$2,045.48" "$3,767.00" "$3,767.00" "$3,767.00" $785.14 "$3,767.00" "$2,795.87" "$2,795.87" "$2,903.60" "$1,962.61" $785.08 "$3,767.00" "$3,767.00" "$2,228.18" "$3,767.00" "$3,767.00" "$3,767.00" "$3,767.00" "$2,825.25" "$3,767.00" "$3,767.00" "$3,767.00" "$1,883.50" "$1,883.50" "$2,983.46" "$3,767.00" "$3,013.60" "$2,448.55" $747.66 "$3,767.00" "$2,184.86" "$3,767.00" "$3,767.00" "$3,767.00" $785.04 "$3,767.00" N/A N/A 27202580 EAP HCPCS C1751 CATHETER REPERFUSION 032 BOTH IP/OP "$3,635.00" "$2,690.00" $721.46 "$3,635.00" "$1,973.81" "$1,973.81" "$1,973.81" "$1,973.81" "$3,635.00" "$3,635.00" "$3,635.00" $757.62 "$3,635.00" "$2,697.90" "$2,697.90" "$2,801.86" "$1,893.84" $757.57 "$3,635.00" "$3,635.00" "$2,150.10" "$3,635.00" "$3,635.00" "$3,635.00" "$3,635.00" "$2,726.25" "$3,635.00" "$3,635.00" "$3,635.00" "$1,817.50" "$1,817.50" "$2,878.92" "$3,635.00" "$2,908.00" "$2,362.75" $721.46 "$3,635.00" "$2,108.30" "$3,635.00" "$3,635.00" "$3,635.00" $757.53 "$3,635.00" N/A N/A 27202581 EAP HCPCS C1751 CATHETER REPERFUSION 041 BOTH IP/OP "$3,635.00" "$2,690.00" $721.46 "$3,635.00" "$1,973.81" "$1,973.81" "$1,973.81" "$1,973.81" "$3,635.00" "$3,635.00" "$3,635.00" $757.62 "$3,635.00" "$2,697.90" "$2,697.90" "$2,801.86" "$1,893.84" $757.57 "$3,635.00" "$3,635.00" "$2,150.10" "$3,635.00" "$3,635.00" "$3,635.00" "$3,635.00" "$2,726.25" "$3,635.00" "$3,635.00" "$3,635.00" "$1,817.50" "$1,817.50" "$2,878.92" "$3,635.00" "$2,908.00" "$2,362.75" $721.46 "$3,635.00" "$2,108.30" "$3,635.00" "$3,635.00" "$3,635.00" $757.53 "$3,635.00" N/A N/A 27202582 EAP Custom 27202582 SEPARATOR 026 BOTH IP/OP "$7,910.00" "$5,853.50" "$1,407.98" "$7,910.00" "$7,910.00" "$7,910.00" "$7,910.00" "$7,910.00" "$7,910.00" "$7,910.00" "$1,407.98" "$7,910.00" "$7,910.00" "$4,181.12" "$4,181.12" "$6,097.03" "$2,060.15" "$1,648.53" "$7,910.00" "$3,164.00" "$7,910.00" "$7,910.00" "$7,910.00" "$7,910.00" "$7,910.00" "$5,932.50" "$7,910.00" "$7,910.00" "$7,910.00" "$3,955.00" "$3,955.00" "$6,264.72" "$7,910.00" "$6,328.00" "$5,141.50" "$7,910.00" "$7,910.00" "$4,587.80" "$7,910.00" "$4,746.00" "$7,910.00" "$7,910.00" "$7,910.00" N/A N/A 27202583 EAP Custom 27202583 SEPARATOR 032 BOTH IP/OP "$7,639.00" "$5,653.00" "$1,359.74" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$1,359.74" "$7,639.00" "$7,639.00" "$4,181.12" "$4,181.12" "$5,888.14" "$2,060.15" "$1,592.05" "$7,639.00" "$3,055.60" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$5,729.25" "$7,639.00" "$7,639.00" "$7,639.00" "$3,819.50" "$3,819.50" "$6,050.09" "$7,639.00" "$6,111.20" "$4,965.35" "$7,639.00" "$7,639.00" "$4,430.62" "$7,639.00" "$4,583.40" "$7,639.00" "$7,639.00" "$7,639.00" N/A N/A 27202584 EAP Custom 27202584 SEPARATOR 041 BOTH IP/OP "$7,639.00" "$5,653.00" "$1,359.74" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$1,359.74" "$7,639.00" "$7,639.00" "$4,181.12" "$4,181.12" "$5,888.14" "$2,060.15" "$1,592.05" "$7,639.00" "$3,055.60" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$5,729.25" "$7,639.00" "$7,639.00" "$7,639.00" "$3,819.50" "$3,819.50" "$6,050.09" "$7,639.00" "$6,111.20" "$4,965.35" "$7,639.00" "$7,639.00" "$4,430.62" "$7,639.00" "$4,583.40" "$7,639.00" "$7,639.00" "$7,639.00" N/A N/A 27202585 EAP Custom 27202585 "TUBING, ASPIRATION" BOTH IP/OP "$1,279.00" $946.50 $227.66 "$1,279.00" "$1,279.00" "$1,279.00" "$1,279.00" "$1,279.00" "$1,279.00" "$1,279.00" $227.66 "$1,279.00" "$1,279.00" $949.27 $949.27 $985.85 $666.36 $266.56 "$1,279.00" $511.60 "$1,279.00" "$1,279.00" "$1,279.00" "$1,279.00" "$1,279.00" $959.25 "$1,279.00" "$1,279.00" "$1,279.00" $639.50 $639.50 "$1,012.97" "$1,279.00" "$1,023.20" $831.35 "$1,279.00" "$1,279.00" $741.82 "$1,279.00" $767.40 "$1,279.00" "$1,279.00" "$1,279.00" N/A N/A 27202586 EAP Custom 27202586 "PUMP, PENUMBRA ASPIRATION" BOTH IP/OP "$8,340.00" "$6,172.00" "$1,484.52" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$1,484.52" "$8,340.00" "$8,340.00" "$4,181.12" "$4,181.12" "$6,428.47" "$2,060.15" "$1,738.15" "$8,340.00" "$3,336.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$6,255.00" "$8,340.00" "$8,340.00" "$8,340.00" "$4,170.00" "$4,170.00" "$6,605.28" "$8,340.00" "$6,672.00" "$5,421.00" "$8,340.00" "$8,340.00" "$4,837.20" "$8,340.00" "$5,004.00" "$8,340.00" "$8,340.00" "$8,340.00" N/A N/A 27202587 EAP HCPCS C1751 "MICROCATHETER, MICROVENTION" BOTH IP/OP "$2,353.00" "$1,741.50" $467.01 "$2,353.00" "$1,277.68" "$1,277.68" "$1,277.68" "$1,277.68" "$2,353.00" "$2,353.00" "$2,353.00" $490.42 "$2,353.00" "$1,746.40" "$1,746.40" "$1,813.69" "$1,225.91" $490.39 "$2,353.00" "$2,353.00" "$1,391.80" "$2,353.00" "$2,353.00" "$2,353.00" "$2,353.00" "$1,764.75" "$2,353.00" "$2,353.00" "$2,353.00" "$1,176.50" "$1,176.50" "$1,863.58" "$2,353.00" "$1,882.40" "$1,529.45" $467.01 "$2,353.00" "$1,364.74" "$2,353.00" "$2,353.00" "$2,353.00" $490.37 "$2,353.00" N/A N/A 27202588 EAP Custom 27202588 "CONTROLLER, V-GRIP DETACHMENT" BOTH IP/OP $560.00 $414.50 $99.68 $560.00 $560.00 $560.00 $560.00 $560.00 $560.00 $560.00 $99.68 $560.00 $560.00 $415.63 $415.63 $431.65 $291.76 $116.71 $560.00 $224.00 $560.00 $560.00 $560.00 $560.00 $560.00 $420.00 $560.00 $560.00 $560.00 $280.00 $280.00 $443.52 $560.00 $448.00 $364.00 $560.00 $560.00 $324.80 $560.00 $336.00 $560.00 $560.00 $560.00 N/A N/A 27202589 EAP HCPCS C1751 "CATHETER, ECHELON MICRO" BOTH IP/OP "$2,072.00" "$1,533.50" $411.24 "$2,072.00" "$1,125.10" "$1,125.10" "$1,125.10" "$1,125.10" "$2,072.00" "$2,072.00" "$2,072.00" $431.86 "$2,072.00" "$1,537.84" "$1,537.84" "$1,597.10" "$1,079.51" $431.83 "$2,072.00" "$2,072.00" "$1,225.59" "$2,072.00" "$2,072.00" "$2,072.00" "$2,072.00" "$1,554.00" "$2,072.00" "$2,072.00" "$2,072.00" "$1,036.00" "$1,036.00" "$1,641.02" "$2,072.00" "$1,657.60" "$1,346.80" $411.24 "$2,072.00" "$1,201.76" "$2,072.00" "$2,072.00" "$2,072.00" $431.80 "$2,072.00" N/A N/A 27202590 EAP HCPCS C1726 "BALLOON, HYPERFORM 4MM X 7MM" BOTH IP/OP "$4,005.00" "$2,964.00" $794.89 "$4,005.00" "$2,174.72" "$2,174.72" "$2,174.72" "$2,174.72" "$4,005.00" "$4,005.00" "$4,005.00" $834.74 "$4,005.00" "$2,972.51" "$2,972.51" "$3,087.05" "$2,060.15" $834.69 "$4,005.00" "$4,005.00" "$2,368.96" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$3,003.75" "$4,005.00" "$4,005.00" "$4,005.00" "$2,002.50" "$2,002.50" "$3,171.96" "$4,005.00" "$3,204.00" "$2,603.25" $794.89 "$4,005.00" "$2,322.90" "$4,005.00" "$4,005.00" "$4,005.00" $834.64 "$4,005.00" N/A N/A 27202591 EAP HCPCS C1726 "BALLOON, HYPERFORM 7MM X 7MM" BOTH IP/OP "$4,005.00" "$2,964.00" $794.89 "$4,005.00" "$2,174.72" "$2,174.72" "$2,174.72" "$2,174.72" "$4,005.00" "$4,005.00" "$4,005.00" $834.74 "$4,005.00" "$2,972.51" "$2,972.51" "$3,087.05" "$2,060.15" $834.69 "$4,005.00" "$4,005.00" "$2,368.96" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$3,003.75" "$4,005.00" "$4,005.00" "$4,005.00" "$2,002.50" "$2,002.50" "$3,171.96" "$4,005.00" "$3,204.00" "$2,603.25" $794.89 "$4,005.00" "$2,322.90" "$4,005.00" "$4,005.00" "$4,005.00" $834.64 "$4,005.00" N/A N/A 27202592 EAP HCPCS C1726 "BALLOON, HYPERGLIDE 4MM X 15MM" BOTH IP/OP "$3,336.00" "$2,469.00" $662.11 "$3,336.00" "$1,811.45" "$1,811.45" "$1,811.45" "$1,811.45" "$3,336.00" "$3,336.00" "$3,336.00" $695.31 "$3,336.00" "$2,475.98" "$2,475.98" "$2,571.39" "$1,738.06" $695.26 "$3,336.00" "$3,336.00" "$1,973.24" "$3,336.00" "$3,336.00" "$3,336.00" "$3,336.00" "$2,502.00" "$3,336.00" "$3,336.00" "$3,336.00" "$1,668.00" "$1,668.00" "$2,642.11" "$3,336.00" "$2,668.80" "$2,168.40" $662.11 "$3,336.00" "$1,934.88" "$3,336.00" "$2,001.60" "$3,336.00" $695.22 "$3,336.00" N/A N/A 27202593 EAP HCPCS C1887 "CATHETER, ENVOY 6F GUIDING" BOTH IP/OP $884.00 $654.50 $175.45 $884.00 $480.01 $480.01 $480.01 $480.01 $884.00 $884.00 $884.00 $184.25 $884.00 $656.10 $656.10 $681.39 $460.56 $184.24 $884.00 $884.00 $522.89 $884.00 $884.00 $884.00 $884.00 $663.00 $884.00 $884.00 $884.00 $442.00 $442.00 $700.13 $884.00 $707.20 $574.60 $175.45 $884.00 $512.72 $884.00 $884.00 $884.00 $184.23 $884.00 N/A N/A 27202594 EAP HCPCS C1751 "MICROCATHETER, RAPIDTRANSIT" BOTH IP/OP "$2,002.00" "$1,481.50" $397.35 "$2,002.00" "$1,087.09" "$1,087.09" "$1,087.09" "$1,087.09" "$2,002.00" "$2,002.00" "$2,002.00" $417.27 "$2,002.00" "$1,485.88" "$1,485.88" "$1,543.14" "$1,043.04" $417.24 "$2,002.00" "$2,002.00" "$1,184.18" "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$1,501.50" "$2,002.00" "$2,002.00" "$2,002.00" "$1,001.00" "$1,001.00" "$1,585.58" "$2,002.00" "$1,601.60" "$1,301.30" $397.35 "$2,002.00" "$1,161.16" "$2,002.00" "$2,002.00" "$2,002.00" $417.22 "$2,002.00" N/A N/A 27202595 EAP Custom 27202595 "SYSTEM,TRUFILL N-BCA LIQUID EM" BOTH IP/OP $281.00 $208.00 $50.02 $281.00 $281.00 $281.00 $281.00 $281.00 $281.00 $281.00 $50.02 $281.00 $281.00 $208.56 $208.56 $216.59 $146.40 $58.56 $281.00 $112.40 $281.00 $281.00 $281.00 $281.00 $281.00 $210.75 $281.00 $281.00 $281.00 $140.50 $140.50 $222.55 $281.00 $224.80 $182.65 $281.00 $281.00 $162.98 $281.00 $168.60 $281.00 $281.00 $281.00 N/A N/A 27202596 EAP HCPCS C1887 "CATHETER, ENVOY XB GUIDING" BOTH IP/OP $988.00 $731.50 $196.09 $988.00 $536.48 $536.48 $536.48 $536.48 $988.00 $988.00 $988.00 $205.92 $988.00 $733.29 $733.29 $761.55 $514.75 $205.91 $988.00 $988.00 $584.40 $988.00 $988.00 $988.00 $988.00 $741.00 $988.00 $988.00 $988.00 $494.00 $494.00 $782.50 $988.00 $790.40 $642.20 $196.09 $988.00 $573.04 $988.00 $988.00 $988.00 $205.90 $988.00 N/A N/A 27202597 EAP HCPCS C1751 "MICROCATHETER, PROWLER" BOTH IP/OP "$2,169.00" "$1,605.50" $430.49 "$2,169.00" "$1,177.77" "$1,177.77" "$1,177.77" "$1,177.77" "$2,169.00" "$2,169.00" "$2,169.00" $452.07 "$2,169.00" "$1,609.83" "$1,609.83" "$1,671.87" "$1,130.05" $452.04 "$2,169.00" "$2,169.00" "$1,282.96" "$2,169.00" "$2,169.00" "$2,169.00" "$2,169.00" "$1,626.75" "$2,169.00" "$2,169.00" "$2,169.00" "$1,084.50" "$1,084.50" "$1,717.85" "$2,169.00" "$1,735.20" "$1,409.85" $430.49 "$2,169.00" "$1,258.02" "$2,169.00" "$2,169.00" "$2,169.00" $452.02 "$2,169.00" N/A N/A 27202598 EAP HCPCS C1751 "MICROCATHETER, PROWLER" BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,236.41" "$1,236.41" "$1,236.41" "$1,236.41" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$1,689.99" "$1,689.99" "$1,755.11" "$1,186.32" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,480.05" $451.93 "$2,277.00" "$1,320.66" "$2,277.00" "$2,277.00" "$2,277.00" $474.53 "$2,277.00" N/A N/A 27202599 EAP HCPCS C1769 GUIDEWIRE BENTSON .038 260 EXC BOTH IP/OP $88.00 $65.50 $17.47 $88.00 $47.78 $47.78 $47.78 $47.78 $88.00 $88.00 $88.00 $18.34 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $35.20 $52.05 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $17.47 $88.00 $51.04 $88.00 $88.00 $88.00 $18.34 $88.00 N/A N/A 27202600 EAP HCPCS C1769 GUIDWIRE GLIDE .038 150 ANGLE BOTH IP/OP $154.00 $114.00 $30.57 $154.00 $83.62 $83.62 $83.62 $83.62 $154.00 $154.00 $154.00 $32.10 $154.00 $114.30 $114.30 $118.70 $80.23 $32.10 $154.00 $154.00 $91.09 $154.00 $154.00 $154.00 $154.00 $115.50 $154.00 $154.00 $154.00 $77.00 $77.00 $121.97 $154.00 $123.20 $100.10 $30.57 $154.00 $89.32 $154.00 $154.00 $154.00 $32.09 $154.00 N/A N/A 27202601 EAP HCPCS C1769 GUIDWIRE GLIDE .038 180 ANGLE BOTH IP/OP $37.00 $27.50 $7.34 $37.00 $20.09 $20.09 $20.09 $20.09 $37.00 $37.00 $37.00 $7.71 $37.00 $27.46 $27.46 $28.52 $19.28 $7.71 $37.00 $37.00 $21.89 $37.00 $37.00 $37.00 $37.00 $27.75 $37.00 $37.00 $37.00 $18.50 $18.50 $29.30 $37.00 $29.60 $24.05 $7.34 $37.00 $21.46 $37.00 $37.00 $37.00 $7.71 $37.00 N/A N/A 27202602 EAP HCPCS C1769 GUIDEWIRE TRANSEND EX .014 BOTH IP/OP "$1,036.00" $767.00 $205.62 "$1,036.00" $562.55 $562.55 $562.55 $562.55 "$1,036.00" "$1,036.00" "$1,036.00" $215.93 "$1,036.00" $768.92 $768.92 $798.55 $539.76 $215.91 "$1,036.00" "$1,036.00" $612.79 "$1,036.00" "$1,036.00" "$1,036.00" "$1,036.00" $777.00 "$1,036.00" "$1,036.00" "$1,036.00" $518.00 $518.00 $820.51 "$1,036.00" $828.80 $673.40 $205.62 "$1,036.00" $600.88 "$1,036.00" "$1,036.00" "$1,036.00" $215.90 "$1,036.00" N/A N/A 27202603 EAP HCPCS C1769 GUIDEWIRE TRANSEND EX .014ST BOTH IP/OP "$1,036.00" $767.00 $205.62 "$1,036.00" $562.55 $562.55 $562.55 $562.55 "$1,036.00" "$1,036.00" "$1,036.00" $215.93 "$1,036.00" $768.92 $768.92 $798.55 $539.76 $215.91 "$1,036.00" "$1,036.00" $612.79 "$1,036.00" "$1,036.00" "$1,036.00" "$1,036.00" $777.00 "$1,036.00" "$1,036.00" "$1,036.00" $518.00 $518.00 $820.51 "$1,036.00" $828.80 $673.40 $205.62 "$1,036.00" $600.88 "$1,036.00" "$1,036.00" "$1,036.00" $215.90 "$1,036.00" N/A N/A 27202604 EAP HCPCS C1769 GUIDEWIRE TRANSEND ES 300CM BOTH IP/OP "$1,320.00" $977.00 $261.99 "$1,320.00" $716.76 $716.76 $716.76 $716.76 "$1,320.00" "$1,320.00" "$1,320.00" $275.12 "$1,320.00" $979.70 $979.70 "$1,017.46" $687.72 $275.10 "$1,320.00" "$1,320.00" $780.78 "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" $990.00 "$1,320.00" "$1,320.00" "$1,320.00" $660.00 $660.00 "$1,045.44" "$1,320.00" "$1,056.00" $858.00 $261.99 "$1,320.00" $765.60 "$1,320.00" "$1,320.00" "$1,320.00" $275.09 "$1,320.00" N/A N/A 27202605 EAP HCPCS C1887 "CATHETER, 7FR GUIDER SOFTIP" BOTH IP/OP $667.00 $494.00 $132.38 $667.00 $362.18 $362.18 $362.18 $362.18 $667.00 $667.00 $667.00 $139.02 $667.00 $495.05 $495.05 $514.12 $347.51 $139.01 $667.00 $266.80 $394.53 $667.00 $667.00 $667.00 $667.00 $500.25 $667.00 $667.00 $667.00 $333.50 $333.50 $528.26 $667.00 $533.60 $433.55 $132.38 $667.00 $386.86 $667.00 $667.00 $667.00 $139.00 $667.00 N/A N/A 27202606 EAP HCPCS C1751 "CATHETER, RENEGADE MICRO" BOTH IP/OP "$1,202.00" $889.50 $238.57 "$1,202.00" $652.69 $652.69 $652.69 $652.69 "$1,202.00" "$1,202.00" "$1,202.00" $250.53 "$1,202.00" $892.12 $892.12 $926.50 $626.24 $250.51 "$1,202.00" "$1,202.00" $710.98 "$1,202.00" "$1,202.00" "$1,202.00" "$1,202.00" $901.50 "$1,202.00" "$1,202.00" "$1,202.00" $601.00 $601.00 $951.98 "$1,202.00" $961.60 $781.30 $238.57 "$1,202.00" $697.16 "$1,202.00" "$1,202.00" "$1,202.00" $250.50 "$1,202.00" N/A N/A 27202607 EAP HCPCS C1751 "MICROCATHETER, EXCELSIOR 1018" BOTH IP/OP "$2,169.00" "$1,605.50" $430.49 "$2,169.00" "$1,177.77" "$1,177.77" "$1,177.77" "$1,177.77" "$2,169.00" "$2,169.00" "$2,169.00" $452.07 "$2,169.00" "$1,609.83" "$1,609.83" "$1,671.87" "$1,130.05" $452.04 "$2,169.00" "$2,169.00" "$1,282.96" "$2,169.00" "$2,169.00" "$2,169.00" "$2,169.00" "$1,626.75" "$2,169.00" "$2,169.00" "$2,169.00" "$1,084.50" "$1,084.50" "$1,717.85" "$2,169.00" "$1,735.20" "$1,409.85" $430.49 "$2,169.00" "$1,258.02" "$2,169.00" "$2,169.00" "$2,169.00" $452.02 "$2,169.00" N/A N/A 27202608 EAP HCPCS C1769 "GUIDEWIRE, SYNCHRO2" BOTH IP/OP "$1,251.00" $926.00 $248.29 "$1,251.00" $679.29 $679.29 $679.29 $679.29 "$1,251.00" "$1,251.00" "$1,251.00" $260.74 "$1,251.00" $928.49 $928.49 $964.27 $651.77 $260.72 "$1,251.00" "$1,251.00" $739.97 "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" $938.25 "$1,251.00" "$1,251.00" "$1,251.00" $625.50 $625.50 $990.79 "$1,251.00" "$1,000.80" $813.15 $248.29 "$1,251.00" $725.58 "$1,251.00" "$1,251.00" "$1,251.00" $260.71 "$1,251.00" N/A N/A 27202609 EAP Custom 27202609 26X12X12CM AAA ENDOPROSTHESIS BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202610 EAP Custom 27202610 26X12X14CM AAA ENDOPROSTHESIS BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202611 EAP Custom 27202611 12X12X13.5CM LLIAC LIMB AAA ST BOTH IP/OP "$21,112.00" "$15,623.00" "$2,060.15" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$3,757.94" "$21,112.00" "$21,112.00" "$4,181.12" "$4,181.12" "$16,273.13" "$2,060.15" "$4,399.97" "$21,112.00" "$8,444.80" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$15,834.00" "$21,112.00" "$21,112.00" "$21,112.00" "$10,556.00" "$10,556.00" "$16,720.70" "$21,112.00" "$16,889.60" "$13,722.80" "$21,112.00" "$21,112.00" "$12,244.96" "$21,112.00" "$12,667.20" "$21,112.00" "$21,112.00" "$21,112.00" N/A N/A 27202612 EAP Custom 27202612 18X24X13.5CM ILIAC LIMB AAA ST BOTH IP/OP "$24,857.00" "$18,394.50" "$2,060.15" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$4,424.55" "$24,857.00" "$24,857.00" "$4,181.12" "$4,181.12" "$19,159.78" "$2,060.15" "$5,180.47" "$24,857.00" "$9,942.80" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$18,642.75" "$24,857.00" "$24,857.00" "$24,857.00" "$12,428.50" "$12,428.50" "$19,686.74" "$24,857.00" "$19,885.60" "$16,157.05" "$24,857.00" "$24,857.00" "$14,417.06" "$24,857.00" "$14,914.20" "$24,857.00" "$24,857.00" "$24,857.00" N/A N/A 27202613 EAP HCPCS C1751 CATH 6FR 1LUM TRY 3CG SHRLK MAXIMAL BRR PICC P BOTH IP/OP "$1,010.00" $747.50 $200.46 "$1,010.00" $548.43 $548.43 $548.43 $548.43 "$1,010.00" "$1,010.00" "$1,010.00" $210.51 "$1,010.00" $749.62 $749.62 $778.51 $526.21 $210.50 "$1,010.00" "$1,010.00" $597.42 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $757.50 "$1,010.00" "$1,010.00" "$1,010.00" $505.00 $505.00 $799.92 "$1,010.00" $808.00 $656.50 $200.46 "$1,010.00" $585.80 "$1,010.00" "$1,010.00" "$1,010.00" $210.48 "$1,010.00" N/A N/A 27202615 EAP Custom 27202615 23X12X12CM AAA ENDOPROSTHESIS BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202616 EAP Custom 27202616 23X12X14CM AAA ENDOPROSTHESIS BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202617 EAP Custom 27202617 23X12X16CM AAA ENDOPROSTHESIS BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202618 EAP Custom 27202618 23X12X18CM AAA ENDOPROSTHESIS BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202619 EAP Custom 27202619 23X14.5X12CM AAA ENDOPROSTHESI BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202620 EAP Custom 27202620 23X14.5X14CM AAA ENDOPROSTHESI BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202621 EAP Custom 27202621 23X14.5X16CM AAA ENDOPROSTHESI BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202622 EAP Custom 27202622 23X14.5X18CM AAA ENDOPROSTHESI BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202623 EAP Custom 27202623 26X12X12CM AAA ENDOPROSTHESIS BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202624 EAP Custom 27202624 26X12X14CM AAA ENDOPROSTHESIS BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202625 EAP Custom 27202625 26X12X16CM AAA ENDOPROSTHESIS BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202626 EAP Custom 27202626 26X12X18CM AAA ENDOPROSTHESIS BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202627 EAP Custom 27202627 26X14.5X12CM AAA ENDOPROSTHESI BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202628 EAP Custom 27202628 26X14.5X14CM AAA ENDOPROSTHESI BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202629 EAP Custom 27202629 26X14.5X16CM AAA ENDOPROSTHESI BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202630 EAP Custom 27202630 26X14.4X18CM AAA ENDOPROSTHESI BOTH IP/OP "$25,581.00" "$18,930.00" "$2,060.15" "$25,581.00" "$25,581.00" "$25,581.00" "$25,581.00" "$25,581.00" "$25,581.00" "$25,581.00" "$4,553.42" "$25,581.00" "$25,581.00" "$4,181.12" "$4,181.12" "$19,717.83" "$2,060.15" "$5,331.36" "$25,581.00" "$10,232.40" "$25,581.00" "$25,581.00" "$25,581.00" "$25,581.00" "$25,581.00" "$19,185.75" "$25,581.00" "$25,581.00" "$25,581.00" "$12,790.50" "$12,790.50" "$20,260.15" "$25,581.00" "$20,464.80" "$16,627.65" "$25,581.00" "$25,581.00" "$14,836.98" "$25,581.00" "$15,348.60" "$25,581.00" "$25,581.00" "$25,581.00" N/A N/A 27202631 EAP Custom 27202631 28.5X12X12CM AAA ENDOPROSTHESI BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202632 EAP Custom 27202632 28.5X12X14CM AAA ENDOPROSTHESI BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202633 EAP Custom 27202633 28.5X12X16CM AAA ENDOPROSTHESI BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202634 EAP Custom 27202634 28.5X12X18CM AAA ENDOPROSTHESI BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202635 EAP Custom 27202635 28.5X14.5X12CM AAA ENDOPROSTHE BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202636 EAP Custom 27202636 28.5X14.5X14CM AAA ENDOPROSTHE BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202637 EAP Custom 27202637 28.5X14.5X16CM AAA ENDOPROSTHE BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202638 EAP Custom 27202638 28.5X14.4X18CM AAA ENDOPROSTHE BOTH IP/OP "$23,752.00" "$17,576.50" "$2,060.15" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$4,227.86" "$23,752.00" "$23,752.00" "$4,181.12" "$4,181.12" "$18,308.04" "$2,060.15" "$4,950.18" "$23,752.00" "$9,500.80" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$23,752.00" "$17,814.00" "$23,752.00" "$23,752.00" "$23,752.00" "$11,876.00" "$11,876.00" "$18,811.58" "$23,752.00" "$19,001.60" "$15,438.80" "$23,752.00" "$23,752.00" "$13,776.16" "$23,752.00" "$14,251.20" "$23,752.00" "$23,752.00" "$23,752.00" N/A N/A 27202639 EAP Custom 27202639 12X10CM AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202640 EAP Custom 27202640 12X12CM AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202641 EAP Custom 27202641 12X14CM AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202642 EAP Custom 27202642 14.5X10CM AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202643 EAP Custom 27202643 14.4X12 AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202644 EAP Custom 27202644 14.5X14 AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202645 EAP Custom 27202645 16X9.5CM AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202646 EAP Custom 27202646 16X11.5CM AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202647 EAP Custom 27202647 16X13.5CM AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202648 EAP Custom 27202648 18X9.5CM AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202649 EAP Custom 27202649 18X11.5CM AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202650 EAP Custom 27202650 18X13.5CM AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202651 EAP Custom 27202651 20X9.5CM AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202652 EAP Custom 27202652 20X11.5CM AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202653 EAP Custom 27202653 20X13.5CM AAA ENDOPROSTHESIS BOTH IP/OP "$22,940.00" "$16,976.00" "$2,060.15" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$4,083.32" "$22,940.00" "$22,940.00" "$4,181.12" "$4,181.12" "$17,682.15" "$2,060.15" "$4,780.95" "$22,940.00" "$9,176.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$22,940.00" "$17,205.00" "$22,940.00" "$22,940.00" "$22,940.00" "$11,470.00" "$11,470.00" "$18,168.48" "$22,940.00" "$18,352.00" "$14,911.00" "$22,940.00" "$22,940.00" "$13,305.20" "$22,940.00" "$13,764.00" "$22,940.00" "$22,940.00" "$22,940.00" N/A N/A 27202654 EAP Custom 27202654 12X12X8.5CM ILIAC LIMB AAA STE BOTH IP/OP "$18,214.00" "$13,478.50" "$2,060.15" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$3,242.09" "$18,214.00" "$18,214.00" "$4,181.12" "$4,181.12" "$14,039.35" "$2,060.15" "$3,796.00" "$18,214.00" "$7,285.60" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$13,660.50" "$18,214.00" "$18,214.00" "$18,214.00" "$9,107.00" "$9,107.00" "$14,425.49" "$18,214.00" "$14,571.20" "$11,839.10" "$18,214.00" "$18,214.00" "$10,564.12" "$18,214.00" "$10,928.40" "$18,214.00" "$18,214.00" "$18,214.00" N/A N/A 27202655 EAP Custom 27202655 13X13X8.5CM ILIAC LIMB AAA STE BOTH IP/OP "$18,214.00" "$13,478.50" "$2,060.15" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$3,242.09" "$18,214.00" "$18,214.00" "$4,181.12" "$4,181.12" "$14,039.35" "$2,060.15" "$3,796.00" "$18,214.00" "$7,285.60" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$13,660.50" "$18,214.00" "$18,214.00" "$18,214.00" "$9,107.00" "$9,107.00" "$14,425.49" "$18,214.00" "$14,571.20" "$11,839.10" "$18,214.00" "$18,214.00" "$10,564.12" "$18,214.00" "$10,928.40" "$18,214.00" "$18,214.00" "$18,214.00" N/A N/A 27202656 EAP Custom 27202656 14X14X8.5CM ILIAC LIMB AAA STE BOTH IP/OP "$18,214.00" "$13,478.50" "$2,060.15" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$3,242.09" "$18,214.00" "$18,214.00" "$4,181.12" "$4,181.12" "$14,039.35" "$2,060.15" "$3,796.00" "$18,214.00" "$7,285.60" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$13,660.50" "$18,214.00" "$18,214.00" "$18,214.00" "$9,107.00" "$9,107.00" "$14,425.49" "$18,214.00" "$14,571.20" "$11,839.10" "$18,214.00" "$18,214.00" "$10,564.12" "$18,214.00" "$10,928.40" "$18,214.00" "$18,214.00" "$18,214.00" N/A N/A 27202657 EAP Custom 27202657 15X15X8.5CM ILIAC LIMB AAA STE BOTH IP/OP "$18,214.00" "$13,478.50" "$2,060.15" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$3,242.09" "$18,214.00" "$18,214.00" "$4,181.12" "$4,181.12" "$14,039.35" "$2,060.15" "$3,796.00" "$18,214.00" "$7,285.60" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$13,660.50" "$18,214.00" "$18,214.00" "$18,214.00" "$9,107.00" "$9,107.00" "$14,425.49" "$18,214.00" "$14,571.20" "$11,839.10" "$18,214.00" "$18,214.00" "$10,564.12" "$18,214.00" "$10,928.40" "$18,214.00" "$18,214.00" "$18,214.00" N/A N/A 27202658 EAP Custom 27202658 16X16X8.5CM ILIAC LIMB AAA STE BOTH IP/OP "$18,214.00" "$13,478.50" "$2,060.15" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$3,242.09" "$18,214.00" "$18,214.00" "$4,181.12" "$4,181.12" "$14,039.35" "$2,060.15" "$3,796.00" "$18,214.00" "$7,285.60" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$18,214.00" "$13,660.50" "$18,214.00" "$18,214.00" "$18,214.00" "$9,107.00" "$9,107.00" "$14,425.49" "$18,214.00" "$14,571.20" "$11,839.10" "$18,214.00" "$18,214.00" "$10,564.12" "$18,214.00" "$10,928.40" "$18,214.00" "$18,214.00" "$18,214.00" N/A N/A 27202659 EAP Custom 27202659 18X18X8.5CM ILIAC LIMB AAA STE BOTH IP/OP "$18,898.00" "$13,985.00" "$2,060.15" "$18,898.00" "$18,898.00" "$18,898.00" "$18,898.00" "$18,898.00" "$18,898.00" "$18,898.00" "$3,363.84" "$18,898.00" "$18,898.00" "$4,181.12" "$4,181.12" "$14,566.58" "$2,060.15" "$3,938.55" "$18,898.00" "$7,559.20" "$18,898.00" "$18,898.00" "$18,898.00" "$18,898.00" "$18,898.00" "$14,173.50" "$18,898.00" "$18,898.00" "$18,898.00" "$9,449.00" "$9,449.00" "$14,967.22" "$18,898.00" "$15,118.40" "$12,283.70" "$18,898.00" "$18,898.00" "$10,960.84" "$18,898.00" "$11,338.80" "$18,898.00" "$18,898.00" "$18,898.00" N/A N/A 27202660 EAP Custom 27202660 20X20X8.5CM ILIAC LIMB AAA STE BOTH IP/OP "$18,898.00" "$13,985.00" "$2,060.15" "$18,898.00" "$18,898.00" "$18,898.00" "$18,898.00" "$18,898.00" "$18,898.00" "$18,898.00" "$3,363.84" "$18,898.00" "$18,898.00" "$4,181.12" "$4,181.12" "$14,566.58" "$2,060.15" "$3,938.55" "$18,898.00" "$7,559.20" "$18,898.00" "$18,898.00" "$18,898.00" "$18,898.00" "$18,898.00" "$14,173.50" "$18,898.00" "$18,898.00" "$18,898.00" "$9,449.00" "$9,449.00" "$14,967.22" "$18,898.00" "$15,118.40" "$12,283.70" "$18,898.00" "$18,898.00" "$10,960.84" "$18,898.00" "$11,338.80" "$18,898.00" "$18,898.00" "$18,898.00" N/A N/A 27202661 EAP Custom 27202661 12X12X11.5CM ILIAC LIMB AAA ST BOTH IP/OP "$19,236.00" "$14,235.00" "$2,060.15" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$3,424.01" "$19,236.00" "$19,236.00" "$4,181.12" "$4,181.12" "$14,827.11" "$2,060.15" "$4,008.99" "$19,236.00" "$7,694.40" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$14,427.00" "$19,236.00" "$19,236.00" "$19,236.00" "$9,618.00" "$9,618.00" "$15,234.91" "$19,236.00" "$15,388.80" "$12,503.40" "$19,236.00" "$19,236.00" "$11,156.88" "$19,236.00" "$11,541.60" "$19,236.00" "$19,236.00" "$19,236.00" N/A N/A 27202662 EAP Custom 27202662 13X13X11.5CMM ILIAC LIMB AAA S BOTH IP/OP "$19,236.00" "$14,235.00" "$2,060.15" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$3,424.01" "$19,236.00" "$19,236.00" "$4,181.12" "$4,181.12" "$14,827.11" "$2,060.15" "$4,008.99" "$19,236.00" "$7,694.40" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$14,427.00" "$19,236.00" "$19,236.00" "$19,236.00" "$9,618.00" "$9,618.00" "$15,234.91" "$19,236.00" "$15,388.80" "$12,503.40" "$19,236.00" "$19,236.00" "$11,156.88" "$19,236.00" "$11,541.60" "$19,236.00" "$19,236.00" "$19,236.00" N/A N/A 27202663 EAP Custom 27202663 14X14X11.5CM ILIAC LIMB AAA ST BOTH IP/OP "$19,236.00" "$14,235.00" "$2,060.15" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$3,424.01" "$19,236.00" "$19,236.00" "$4,181.12" "$4,181.12" "$14,827.11" "$2,060.15" "$4,008.99" "$19,236.00" "$7,694.40" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$14,427.00" "$19,236.00" "$19,236.00" "$19,236.00" "$9,618.00" "$9,618.00" "$15,234.91" "$19,236.00" "$15,388.80" "$12,503.40" "$19,236.00" "$19,236.00" "$11,156.88" "$19,236.00" "$11,541.60" "$19,236.00" "$19,236.00" "$19,236.00" N/A N/A 27202664 EAP Custom 27202664 15X15X11.5CM ILIAC LIMB AAA ST BOTH IP/OP "$19,236.00" "$14,235.00" "$2,060.15" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$3,424.01" "$19,236.00" "$19,236.00" "$4,181.12" "$4,181.12" "$14,827.11" "$2,060.15" "$4,008.99" "$19,236.00" "$7,694.40" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$14,427.00" "$19,236.00" "$19,236.00" "$19,236.00" "$9,618.00" "$9,618.00" "$15,234.91" "$19,236.00" "$15,388.80" "$12,503.40" "$19,236.00" "$19,236.00" "$11,156.88" "$19,236.00" "$11,541.60" "$19,236.00" "$19,236.00" "$19,236.00" N/A N/A 27202665 EAP Custom 27202665 16X16X11.5CM ILIAC LIMB AAA ST BOTH IP/OP "$19,236.00" "$14,235.00" "$2,060.15" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$3,424.01" "$19,236.00" "$19,236.00" "$4,181.12" "$4,181.12" "$14,827.11" "$2,060.15" "$4,008.99" "$19,236.00" "$7,694.40" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$19,236.00" "$14,427.00" "$19,236.00" "$19,236.00" "$19,236.00" "$9,618.00" "$9,618.00" "$15,234.91" "$19,236.00" "$15,388.80" "$12,503.40" "$19,236.00" "$19,236.00" "$11,156.88" "$19,236.00" "$11,541.60" "$19,236.00" "$19,236.00" "$19,236.00" N/A N/A 27202666 EAP Custom 27202666 18X18X11.5CM ILIAC LIMB AAA ST BOTH IP/OP "$19,916.00" "$14,738.00" "$2,060.15" "$19,916.00" "$19,916.00" "$19,916.00" "$19,916.00" "$19,916.00" "$19,916.00" "$19,916.00" "$3,545.05" "$19,916.00" "$19,916.00" "$4,181.12" "$4,181.12" "$15,351.25" "$2,060.15" "$4,150.71" "$19,916.00" "$7,966.40" "$19,916.00" "$19,916.00" "$19,916.00" "$19,916.00" "$19,916.00" "$14,937.00" "$19,916.00" "$19,916.00" "$19,916.00" "$9,958.00" "$9,958.00" "$15,773.47" "$19,916.00" "$15,932.80" "$12,945.40" "$19,916.00" "$19,916.00" "$11,551.28" "$19,916.00" "$11,949.60" "$19,916.00" "$19,916.00" "$19,916.00" N/A N/A 27202667 EAP Custom 27202667 20X20X11.5CM ILIAC LIMB AAA ST BOTH IP/OP "$19,916.00" "$14,738.00" "$2,060.15" "$19,916.00" "$19,916.00" "$19,916.00" "$19,916.00" "$19,916.00" "$19,916.00" "$19,916.00" "$3,545.05" "$19,916.00" "$19,916.00" "$4,181.12" "$4,181.12" "$15,351.25" "$2,060.15" "$4,150.71" "$19,916.00" "$7,966.40" "$19,916.00" "$19,916.00" "$19,916.00" "$19,916.00" "$19,916.00" "$14,937.00" "$19,916.00" "$19,916.00" "$19,916.00" "$9,958.00" "$9,958.00" "$15,773.47" "$19,916.00" "$15,932.80" "$12,945.40" "$19,916.00" "$19,916.00" "$11,551.28" "$19,916.00" "$11,949.60" "$19,916.00" "$19,916.00" "$19,916.00" N/A N/A 27202668 EAP Custom 27202668 13X13X13.5CM ILIAC LIMB AAA ST BOTH IP/OP "$21,112.00" "$15,623.00" "$2,060.15" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$3,757.94" "$21,112.00" "$21,112.00" "$4,181.12" "$4,181.12" "$16,273.13" "$2,060.15" "$4,399.97" "$21,112.00" "$8,444.80" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$15,834.00" "$21,112.00" "$21,112.00" "$21,112.00" "$10,556.00" "$10,556.00" "$16,720.70" "$21,112.00" "$16,889.60" "$13,722.80" "$21,112.00" "$21,112.00" "$12,244.96" "$21,112.00" "$12,667.20" "$21,112.00" "$21,112.00" "$21,112.00" N/A N/A 27202669 EAP Custom 27202669 14X14X13.5CM ILIAC LIMB AAA ST BOTH IP/OP "$21,112.00" "$15,623.00" "$2,060.15" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$3,757.94" "$21,112.00" "$21,112.00" "$4,181.12" "$4,181.12" "$16,273.13" "$2,060.15" "$4,399.97" "$21,112.00" "$8,444.80" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$15,834.00" "$21,112.00" "$21,112.00" "$21,112.00" "$10,556.00" "$10,556.00" "$16,720.70" "$21,112.00" "$16,889.60" "$13,722.80" "$21,112.00" "$21,112.00" "$12,244.96" "$21,112.00" "$12,667.20" "$21,112.00" "$21,112.00" "$21,112.00" N/A N/A 27202670 EAP Custom 27202670 15X15X13.5CM ILIAC LIMB AAA ST BOTH IP/OP "$21,112.00" "$15,623.00" "$2,060.15" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$3,757.94" "$21,112.00" "$21,112.00" "$4,181.12" "$4,181.12" "$16,273.13" "$2,060.15" "$4,399.97" "$21,112.00" "$8,444.80" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$15,834.00" "$21,112.00" "$21,112.00" "$21,112.00" "$10,556.00" "$10,556.00" "$16,720.70" "$21,112.00" "$16,889.60" "$13,722.80" "$21,112.00" "$21,112.00" "$12,244.96" "$21,112.00" "$12,667.20" "$21,112.00" "$21,112.00" "$21,112.00" N/A N/A 27202671 EAP Custom 27202671 16X16X13.5CM ILIAC LIMB AAA ST BOTH IP/OP "$21,112.00" "$15,623.00" "$2,060.15" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$3,757.94" "$21,112.00" "$21,112.00" "$4,181.12" "$4,181.12" "$16,273.13" "$2,060.15" "$4,399.97" "$21,112.00" "$8,444.80" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$21,112.00" "$15,834.00" "$21,112.00" "$21,112.00" "$21,112.00" "$10,556.00" "$10,556.00" "$16,720.70" "$21,112.00" "$16,889.60" "$13,722.80" "$21,112.00" "$21,112.00" "$12,244.96" "$21,112.00" "$12,667.20" "$21,112.00" "$21,112.00" "$21,112.00" N/A N/A 27202672 EAP Custom 27202672 18X18X13.5CM ILIAC LIMB AAA ST BOTH IP/OP "$21,790.00" "$16,125.00" "$2,060.15" "$21,790.00" "$21,790.00" "$21,790.00" "$21,790.00" "$21,790.00" "$21,790.00" "$21,790.00" "$3,878.62" "$21,790.00" "$21,790.00" "$4,181.12" "$4,181.12" "$16,795.73" "$2,060.15" "$4,541.28" "$21,790.00" "$8,716.00" "$21,790.00" "$21,790.00" "$21,790.00" "$21,790.00" "$21,790.00" "$16,342.50" "$21,790.00" "$21,790.00" "$21,790.00" "$10,895.00" "$10,895.00" "$17,257.68" "$21,790.00" "$17,432.00" "$14,163.50" "$21,790.00" "$21,790.00" "$12,638.20" "$21,790.00" "$13,074.00" "$21,790.00" "$21,790.00" "$21,790.00" N/A N/A 27202673 EAP Custom 27202673 20X20X13.5CM ILIAC LIMB AAA ST BOTH IP/OP "$21,790.00" "$16,125.00" "$2,060.15" "$21,790.00" "$21,790.00" "$21,790.00" "$21,790.00" "$21,790.00" "$21,790.00" "$21,790.00" "$3,878.62" "$21,790.00" "$21,790.00" "$4,181.12" "$4,181.12" "$16,795.73" "$2,060.15" "$4,541.28" "$21,790.00" "$8,716.00" "$21,790.00" "$21,790.00" "$21,790.00" "$21,790.00" "$21,790.00" "$16,342.50" "$21,790.00" "$21,790.00" "$21,790.00" "$10,895.00" "$10,895.00" "$17,257.68" "$21,790.00" "$17,432.00" "$14,163.50" "$21,790.00" "$21,790.00" "$12,638.20" "$21,790.00" "$13,074.00" "$21,790.00" "$21,790.00" "$21,790.00" N/A N/A 27202674 EAP Custom 27202674 16X20X11.5CM ILIAC LIMB AAA ST BOTH IP/OP "$23,492.00" "$17,384.50" "$2,060.15" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$4,181.58" "$23,492.00" "$23,492.00" "$4,181.12" "$4,181.12" "$18,107.63" "$2,060.15" "$4,895.99" "$23,492.00" "$9,396.80" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$17,619.00" "$23,492.00" "$23,492.00" "$23,492.00" "$11,746.00" "$11,746.00" "$18,605.66" "$23,492.00" "$18,793.60" "$15,269.80" "$23,492.00" "$23,492.00" "$13,625.36" "$23,492.00" "$14,095.20" "$23,492.00" "$23,492.00" "$23,492.00" N/A N/A 27202675 EAP Custom 27202675 18X22X11.5CM ILIAC LIMB AAA ST BOTH IP/OP "$23,492.00" "$17,384.50" "$2,060.15" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$4,181.58" "$23,492.00" "$23,492.00" "$4,181.12" "$4,181.12" "$18,107.63" "$2,060.15" "$4,895.99" "$23,492.00" "$9,396.80" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$17,619.00" "$23,492.00" "$23,492.00" "$23,492.00" "$11,746.00" "$11,746.00" "$18,605.66" "$23,492.00" "$18,793.60" "$15,269.80" "$23,492.00" "$23,492.00" "$13,625.36" "$23,492.00" "$14,095.20" "$23,492.00" "$23,492.00" "$23,492.00" N/A N/A 27202676 EAP Custom 27202676 18X24X11.5CM ILIAC LIMB AAA ST BOTH IP/OP "$23,492.00" "$17,384.50" "$2,060.15" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$4,181.58" "$23,492.00" "$23,492.00" "$4,181.12" "$4,181.12" "$18,107.63" "$2,060.15" "$4,895.99" "$23,492.00" "$9,396.80" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$23,492.00" "$17,619.00" "$23,492.00" "$23,492.00" "$23,492.00" "$11,746.00" "$11,746.00" "$18,605.66" "$23,492.00" "$18,793.60" "$15,269.80" "$23,492.00" "$23,492.00" "$13,625.36" "$23,492.00" "$14,095.20" "$23,492.00" "$23,492.00" "$23,492.00" N/A N/A 27202677 EAP Custom 27202677 16X20X13.5CM ILIAC LIMB AAA ST BOTH IP/OP "$24,857.00" "$18,394.50" "$2,060.15" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$4,424.55" "$24,857.00" "$24,857.00" "$4,181.12" "$4,181.12" "$19,159.78" "$2,060.15" "$5,180.47" "$24,857.00" "$9,942.80" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$18,642.75" "$24,857.00" "$24,857.00" "$24,857.00" "$12,428.50" "$12,428.50" "$19,686.74" "$24,857.00" "$19,885.60" "$16,157.05" "$24,857.00" "$24,857.00" "$14,417.06" "$24,857.00" "$14,914.20" "$24,857.00" "$24,857.00" "$24,857.00" N/A N/A 27202678 EAP Custom 27202678 18X22X13.5CM ILIAC LIMB AAA ST BOTH IP/OP "$24,857.00" "$18,394.50" "$2,060.15" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$4,424.55" "$24,857.00" "$24,857.00" "$4,181.12" "$4,181.12" "$19,159.78" "$2,060.15" "$5,180.47" "$24,857.00" "$9,942.80" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$18,642.75" "$24,857.00" "$24,857.00" "$24,857.00" "$12,428.50" "$12,428.50" "$19,686.74" "$24,857.00" "$19,885.60" "$16,157.05" "$24,857.00" "$24,857.00" "$14,417.06" "$24,857.00" "$14,914.20" "$24,857.00" "$24,857.00" "$24,857.00" N/A N/A 27202679 EAP Custom 27202679 18X24X13.5CM ILIAC LIMB AAA ST BOTH IP/OP "$24,857.00" "$18,394.50" "$2,060.15" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$4,424.55" "$24,857.00" "$24,857.00" "$4,181.12" "$4,181.12" "$19,159.78" "$2,060.15" "$5,180.47" "$24,857.00" "$9,942.80" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$24,857.00" "$18,642.75" "$24,857.00" "$24,857.00" "$24,857.00" "$12,428.50" "$12,428.50" "$19,686.74" "$24,857.00" "$19,885.60" "$16,157.05" "$24,857.00" "$24,857.00" "$14,417.06" "$24,857.00" "$14,914.20" "$24,857.00" "$24,857.00" "$24,857.00" N/A N/A 27202680 EAP Custom 27202680 12X12X5.5CM ILIAC CUFF AAA STE BOTH IP/OP "$15,151.00" "$11,212.00" "$2,060.15" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$2,696.88" "$15,151.00" "$15,151.00" "$4,181.12" "$4,181.12" "$11,678.39" "$2,060.15" "$3,157.64" "$15,151.00" "$6,060.40" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$11,363.25" "$15,151.00" "$15,151.00" "$15,151.00" "$7,575.50" "$7,575.50" "$11,999.59" "$15,151.00" "$12,120.80" "$9,848.15" "$15,151.00" "$15,151.00" "$8,787.58" "$15,151.00" "$9,090.60" "$15,151.00" "$15,151.00" "$15,151.00" N/A N/A 27202681 EAP Custom 27202681 13X13X5.5CM ILAIC CUFF AAA STE BOTH IP/OP "$15,151.00" "$11,212.00" "$2,060.15" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$2,696.88" "$15,151.00" "$15,151.00" "$4,181.12" "$4,181.12" "$11,678.39" "$2,060.15" "$3,157.64" "$15,151.00" "$6,060.40" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$11,363.25" "$15,151.00" "$15,151.00" "$15,151.00" "$7,575.50" "$7,575.50" "$11,999.59" "$15,151.00" "$12,120.80" "$9,848.15" "$15,151.00" "$15,151.00" "$8,787.58" "$15,151.00" "$9,090.60" "$15,151.00" "$15,151.00" "$15,151.00" N/A N/A 27202682 EAP Custom 27202682 14X14X5.5CM ILIAC CUFF AAA STE BOTH IP/OP "$15,151.00" "$11,212.00" "$2,060.15" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$2,696.88" "$15,151.00" "$15,151.00" "$4,181.12" "$4,181.12" "$11,678.39" "$2,060.15" "$3,157.64" "$15,151.00" "$6,060.40" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$11,363.25" "$15,151.00" "$15,151.00" "$15,151.00" "$7,575.50" "$7,575.50" "$11,999.59" "$15,151.00" "$12,120.80" "$9,848.15" "$15,151.00" "$15,151.00" "$8,787.58" "$15,151.00" "$9,090.60" "$15,151.00" "$15,151.00" "$15,151.00" N/A N/A 27202683 EAP Custom 27202683 15X15X5.5CM ILIAC CUFF AAA STE BOTH IP/OP "$15,151.00" "$11,212.00" "$2,060.15" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$2,696.88" "$15,151.00" "$15,151.00" "$4,181.12" "$4,181.12" "$11,678.39" "$2,060.15" "$3,157.64" "$15,151.00" "$6,060.40" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$11,363.25" "$15,151.00" "$15,151.00" "$15,151.00" "$7,575.50" "$7,575.50" "$11,999.59" "$15,151.00" "$12,120.80" "$9,848.15" "$15,151.00" "$15,151.00" "$8,787.58" "$15,151.00" "$9,090.60" "$15,151.00" "$15,151.00" "$15,151.00" N/A N/A 27202684 EAP Custom 27202684 16X15X5.5CM ILIAC CUFF AAA STE BOTH IP/OP "$15,151.00" "$11,212.00" "$2,060.15" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$2,696.88" "$15,151.00" "$15,151.00" "$4,181.12" "$4,181.12" "$11,678.39" "$2,060.15" "$3,157.64" "$15,151.00" "$6,060.40" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$11,363.25" "$15,151.00" "$15,151.00" "$15,151.00" "$7,575.50" "$7,575.50" "$11,999.59" "$15,151.00" "$12,120.80" "$9,848.15" "$15,151.00" "$15,151.00" "$8,787.58" "$15,151.00" "$9,090.60" "$15,151.00" "$15,151.00" "$15,151.00" N/A N/A 27202685 EAP Custom 27202685 18X18X5.5CM ILIAC CUFF AAA STE BOTH IP/OP "$15,832.00" "$11,716.00" "$2,060.15" "$15,832.00" "$15,832.00" "$15,832.00" "$15,832.00" "$15,832.00" "$15,832.00" "$15,832.00" "$2,818.10" "$15,832.00" "$15,832.00" "$4,181.12" "$4,181.12" "$12,203.31" "$2,060.15" "$3,299.56" "$15,832.00" "$6,332.80" "$15,832.00" "$15,832.00" "$15,832.00" "$15,832.00" "$15,832.00" "$11,874.00" "$15,832.00" "$15,832.00" "$15,832.00" "$7,916.00" "$7,916.00" "$12,538.94" "$15,832.00" "$12,665.60" "$10,290.80" "$15,832.00" "$15,832.00" "$9,182.56" "$15,832.00" "$9,499.20" "$15,832.00" "$15,832.00" "$15,832.00" N/A N/A 27202686 EAP Custom 27202686 20X20X5.5CM ILIAC CUFF AAA STE BOTH IP/OP "$15,832.00" "$11,716.00" "$2,060.15" "$15,832.00" "$15,832.00" "$15,832.00" "$15,832.00" "$15,832.00" "$15,832.00" "$15,832.00" "$2,818.10" "$15,832.00" "$15,832.00" "$4,181.12" "$4,181.12" "$12,203.31" "$2,060.15" "$3,299.56" "$15,832.00" "$6,332.80" "$15,832.00" "$15,832.00" "$15,832.00" "$15,832.00" "$15,832.00" "$11,874.00" "$15,832.00" "$15,832.00" "$15,832.00" "$7,916.00" "$7,916.00" "$12,538.94" "$15,832.00" "$12,665.60" "$10,290.80" "$15,832.00" "$15,832.00" "$9,182.56" "$15,832.00" "$9,499.20" "$15,832.00" "$15,832.00" "$15,832.00" N/A N/A 27202687 EAP HCPCS C1769 6MMX5CMX110CM 0.035 GUIDEWIRE BOTH IP/OP "$15,219.00" "$11,262.50" "$2,060.15" "$15,219.00" "$8,263.92" "$8,263.92" "$8,263.92" "$8,263.92" "$15,219.00" "$15,219.00" "$15,219.00" "$3,172.02" "$15,219.00" "$4,181.12" "$4,181.12" "$11,730.81" "$2,060.15" "$3,171.81" "$15,219.00" "$15,219.00" "$3,094.73" "$15,219.00" "$15,219.00" "$15,219.00" "$15,219.00" "$11,414.25" "$15,219.00" "$15,219.00" "$15,219.00" "$7,609.50" "$7,609.50" "$12,053.45" "$15,219.00" "$12,175.20" "$9,892.35" "$3,020.59" "$15,219.00" "$8,827.02" "$15,219.00" "$15,219.00" "$15,219.00" "$3,171.64" "$15,219.00" N/A N/A 27202688 EAP HCPCS C1769 6MMX10CMX110CM 0.035 GUIDEWIRE BOTH IP/OP "$18,251.00" "$13,506.00" "$2,060.15" "$18,251.00" "$9,910.29" "$9,910.29" "$9,910.29" "$9,910.29" "$18,251.00" "$18,251.00" "$18,251.00" "$3,803.96" "$18,251.00" "$4,181.12" "$4,181.12" "$14,067.87" "$2,060.15" "$3,803.71" "$18,251.00" "$18,251.00" "$3,094.73" "$18,251.00" "$18,251.00" "$18,251.00" "$18,251.00" "$13,688.25" "$18,251.00" "$18,251.00" "$18,251.00" "$9,125.50" "$9,125.50" "$14,454.79" "$18,251.00" "$14,600.80" "$11,863.15" "$3,622.37" "$18,251.00" "$10,585.58" "$18,251.00" "$18,251.00" "$18,251.00" "$3,803.51" "$18,251.00" N/A N/A 27202689 EAP HCPCS C1769 6MMX15CMX110CM 0.035 GUIDEWIRE BOTH IP/OP "$21,246.00" "$15,722.50" "$2,060.15" "$21,246.00" "$11,536.58" "$11,536.58" "$11,536.58" "$11,536.58" "$21,246.00" "$21,246.00" "$21,246.00" "$4,428.20" "$21,246.00" "$4,181.12" "$4,181.12" "$16,376.42" "$2,060.15" "$4,427.90" "$21,246.00" "$21,246.00" "$3,094.73" "$21,246.00" "$21,246.00" "$21,246.00" "$21,246.00" "$15,934.50" "$21,246.00" "$21,246.00" "$21,246.00" "$10,623.00" "$10,623.00" "$16,826.83" "$21,246.00" "$16,996.80" "$13,809.90" "$4,216.80" "$21,246.00" "$12,322.68" "$21,246.00" "$21,246.00" "$21,246.00" "$4,427.67" "$21,246.00" N/A N/A 27202690 EAP HCPCS C1769 7MMX5CMX110CM 0.035 GUIDEWIRE BOTH IP/OP "$15,219.00" "$11,262.50" "$2,060.15" "$15,219.00" "$8,263.92" "$8,263.92" "$8,263.92" "$8,263.92" "$15,219.00" "$15,219.00" "$15,219.00" "$3,172.02" "$15,219.00" "$4,181.12" "$4,181.12" "$11,730.81" "$2,060.15" "$3,171.81" "$15,219.00" "$15,219.00" "$3,094.73" "$15,219.00" "$15,219.00" "$15,219.00" "$15,219.00" "$11,414.25" "$15,219.00" "$15,219.00" "$15,219.00" "$7,609.50" "$7,609.50" "$12,053.45" "$15,219.00" "$12,175.20" "$9,892.35" "$3,020.59" "$15,219.00" "$8,827.02" "$15,219.00" "$15,219.00" "$15,219.00" "$3,171.64" "$15,219.00" N/A N/A 27202691 EAP HCPCS C1769 7MMX10CMX110CM 0.035 GUIDEWIRE BOTH IP/OP "$18,251.00" "$13,506.00" "$2,060.15" "$18,251.00" "$9,910.29" "$9,910.29" "$9,910.29" "$9,910.29" "$18,251.00" "$18,251.00" "$18,251.00" "$3,803.96" "$18,251.00" "$4,181.12" "$4,181.12" "$14,067.87" "$2,060.15" "$3,803.71" "$18,251.00" "$18,251.00" "$3,094.73" "$18,251.00" "$18,251.00" "$18,251.00" "$18,251.00" "$13,688.25" "$18,251.00" "$18,251.00" "$18,251.00" "$9,125.50" "$9,125.50" "$14,454.79" "$18,251.00" "$14,600.80" "$11,863.15" "$3,622.37" "$18,251.00" "$10,585.58" "$18,251.00" "$18,251.00" "$18,251.00" "$3,803.51" "$18,251.00" N/A N/A 27202692 EAP HCPCS C1769 7MMX15CMX110CM 0.035 GUIDEWIRE BOTH IP/OP "$21,246.00" "$15,722.50" "$2,060.15" "$21,246.00" "$11,536.58" "$11,536.58" "$11,536.58" "$11,536.58" "$21,246.00" "$21,246.00" "$21,246.00" "$4,428.20" "$21,246.00" "$4,181.12" "$4,181.12" "$16,376.42" "$2,060.15" "$4,427.90" "$21,246.00" "$21,246.00" "$3,094.73" "$21,246.00" "$21,246.00" "$21,246.00" "$21,246.00" "$15,934.50" "$21,246.00" "$21,246.00" "$21,246.00" "$10,623.00" "$10,623.00" "$16,826.83" "$21,246.00" "$16,996.80" "$13,809.90" "$4,216.80" "$21,246.00" "$12,322.68" "$21,246.00" "$21,246.00" "$21,246.00" "$4,427.67" "$21,246.00" N/A N/A 27202693 EAP HCPCS C1769 8MMX5CMX110CM 0.035 GUIDEWIRE BOTH IP/OP "$15,219.00" "$11,262.50" "$2,060.15" "$15,219.00" "$8,263.92" "$8,263.92" "$8,263.92" "$8,263.92" "$15,219.00" "$15,219.00" "$15,219.00" "$3,172.02" "$15,219.00" "$4,181.12" "$4,181.12" "$11,730.81" "$2,060.15" "$3,171.81" "$15,219.00" "$15,219.00" "$3,094.73" "$15,219.00" "$15,219.00" "$15,219.00" "$15,219.00" "$11,414.25" "$15,219.00" "$15,219.00" "$15,219.00" "$7,609.50" "$7,609.50" "$12,053.45" "$15,219.00" "$12,175.20" "$9,892.35" "$3,020.59" "$15,219.00" "$8,827.02" "$15,219.00" "$15,219.00" "$15,219.00" "$3,171.64" "$15,219.00" N/A N/A 27202694 EAP HCPCS C1769 8MMX10CMX110CM 0.035 GUIDEWIRE BOTH IP/OP "$18,251.00" "$13,506.00" "$2,060.15" "$18,251.00" "$9,910.29" "$9,910.29" "$9,910.29" "$9,910.29" "$18,251.00" "$18,251.00" "$18,251.00" "$3,803.96" "$18,251.00" "$4,181.12" "$4,181.12" "$14,067.87" "$2,060.15" "$3,803.71" "$18,251.00" "$18,251.00" "$3,094.73" "$18,251.00" "$18,251.00" "$18,251.00" "$18,251.00" "$13,688.25" "$18,251.00" "$18,251.00" "$18,251.00" "$9,125.50" "$9,125.50" "$14,454.79" "$18,251.00" "$14,600.80" "$11,863.15" "$3,622.37" "$18,251.00" "$10,585.58" "$18,251.00" "$18,251.00" "$18,251.00" "$3,803.51" "$18,251.00" N/A N/A 27202695 EAP HCPCS C1769 8MMX15CMX110CM 0.035 GUIDEWIRE BOTH IP/OP "$21,246.00" "$15,722.50" "$2,060.15" "$21,246.00" "$11,536.58" "$11,536.58" "$11,536.58" "$11,536.58" "$21,246.00" "$21,246.00" "$21,246.00" "$4,428.20" "$21,246.00" "$4,181.12" "$4,181.12" "$16,376.42" "$2,060.15" "$4,427.90" "$21,246.00" "$21,246.00" "$3,094.73" "$21,246.00" "$21,246.00" "$21,246.00" "$21,246.00" "$15,934.50" "$21,246.00" "$21,246.00" "$21,246.00" "$10,623.00" "$10,623.00" "$16,826.83" "$21,246.00" "$16,996.80" "$13,809.90" "$4,216.80" "$21,246.00" "$12,322.68" "$21,246.00" "$21,246.00" "$21,246.00" "$4,427.67" "$21,246.00" N/A N/A 27202696 EAP HCPCS C1769 10MMX5CMX110CM 0.025 GUIDEWIRE BOTH IP/OP "$15,219.00" "$11,262.50" "$2,060.15" "$15,219.00" "$8,263.92" "$8,263.92" "$8,263.92" "$8,263.92" "$15,219.00" "$15,219.00" "$15,219.00" "$3,172.02" "$15,219.00" "$4,181.12" "$4,181.12" "$11,730.81" "$2,060.15" "$3,171.81" "$15,219.00" "$15,219.00" "$3,094.73" "$15,219.00" "$15,219.00" "$15,219.00" "$15,219.00" "$11,414.25" "$15,219.00" "$15,219.00" "$15,219.00" "$7,609.50" "$7,609.50" "$12,053.45" "$15,219.00" "$12,175.20" "$9,892.35" "$3,020.59" "$15,219.00" "$8,827.02" "$15,219.00" "$9,131.40" "$15,219.00" "$3,171.64" "$15,219.00" N/A N/A 27202697 EAP HCPCS C1769 10MMX10CMX110CM 0.025 GUIDEWIR BOTH IP/OP "$18,251.00" "$13,506.00" "$2,060.15" "$18,251.00" "$9,910.29" "$9,910.29" "$9,910.29" "$9,910.29" "$18,251.00" "$18,251.00" "$18,251.00" "$3,803.96" "$18,251.00" "$4,181.12" "$4,181.12" "$14,067.87" "$2,060.15" "$3,803.71" "$18,251.00" "$18,251.00" "$3,094.73" "$18,251.00" "$18,251.00" "$18,251.00" "$18,251.00" "$13,688.25" "$18,251.00" "$18,251.00" "$18,251.00" "$9,125.50" "$9,125.50" "$14,454.79" "$18,251.00" "$14,600.80" "$11,863.15" "$3,622.37" "$18,251.00" "$10,585.58" "$18,251.00" "$18,251.00" "$18,251.00" "$3,803.51" "$18,251.00" N/A N/A 27202698 EAP HCPCS C1769 13MMX5CMX110CM 0.025 GUIDEWIRE BOTH IP/OP "$15,219.00" "$11,262.50" "$2,060.15" "$15,219.00" "$8,263.92" "$8,263.92" "$8,263.92" "$8,263.92" "$15,219.00" "$15,219.00" "$15,219.00" "$3,172.02" "$15,219.00" "$4,181.12" "$4,181.12" "$11,730.81" "$2,060.15" "$3,171.81" "$15,219.00" "$15,219.00" "$3,094.73" "$15,219.00" "$15,219.00" "$15,219.00" "$15,219.00" "$11,414.25" "$15,219.00" "$15,219.00" "$15,219.00" "$7,609.50" "$7,609.50" "$12,053.45" "$15,219.00" "$12,175.20" "$9,892.35" "$3,020.59" "$15,219.00" "$8,827.02" "$15,219.00" "$15,219.00" "$15,219.00" "$3,171.64" "$15,219.00" N/A N/A 27202699 EAP HCPCS C1769 13MMX2.5CMX110CM 0.025 GUIDEWI BOTH IP/OP "$15,219.00" "$11,262.50" "$2,060.15" "$15,219.00" "$8,263.92" "$8,263.92" "$8,263.92" "$8,263.92" "$15,219.00" "$15,219.00" "$15,219.00" "$3,172.02" "$15,219.00" "$4,181.12" "$4,181.12" "$11,730.81" "$2,060.15" "$3,171.81" "$15,219.00" "$15,219.00" "$3,094.73" "$15,219.00" "$15,219.00" "$15,219.00" "$15,219.00" "$11,414.25" "$15,219.00" "$15,219.00" "$15,219.00" "$7,609.50" "$7,609.50" "$12,053.45" "$15,219.00" "$12,175.20" "$9,892.35" "$3,020.59" "$15,219.00" "$8,827.02" "$15,219.00" "$15,219.00" "$15,219.00" "$3,171.64" "$15,219.00" N/A N/A 27202700 EAP Custom 27202700 16MMX20MMX8.5CM AAA STENT GRAF BOTH IP/OP "$22,131.00" "$16,377.00" "$2,060.15" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$3,939.32" "$22,131.00" "$22,131.00" "$4,181.12" "$4,181.12" "$17,058.57" "$2,060.15" "$4,612.34" "$22,131.00" "$8,852.40" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$16,598.25" "$22,131.00" "$22,131.00" "$22,131.00" "$11,065.50" "$11,065.50" "$17,527.75" "$22,131.00" "$17,704.80" "$14,385.15" "$22,131.00" "$22,131.00" "$12,835.98" "$22,131.00" "$13,278.60" "$22,131.00" "$22,131.00" "$22,131.00" N/A N/A 27202701 EAP Custom 27202701 18MMX22MMX8.5CM AAA STENT GRAF BOTH IP/OP "$22,131.00" "$16,377.00" "$2,060.15" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$3,939.32" "$22,131.00" "$22,131.00" "$4,181.12" "$4,181.12" "$17,058.57" "$2,060.15" "$4,612.34" "$22,131.00" "$8,852.40" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$16,598.25" "$22,131.00" "$22,131.00" "$22,131.00" "$11,065.50" "$11,065.50" "$17,527.75" "$22,131.00" "$17,704.80" "$14,385.15" "$22,131.00" "$22,131.00" "$12,835.98" "$22,131.00" "$13,278.60" "$22,131.00" "$22,131.00" "$22,131.00" N/A N/A 27202702 EAP Custom 27202702 18MMX24MMX8.5CM AAA STENT GRAF BOTH IP/OP "$22,131.00" "$16,377.00" "$2,060.15" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$3,939.32" "$22,131.00" "$22,131.00" "$4,181.12" "$4,181.12" "$17,058.57" "$2,060.15" "$4,612.34" "$22,131.00" "$8,852.40" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$22,131.00" "$16,598.25" "$22,131.00" "$22,131.00" "$22,131.00" "$11,065.50" "$11,065.50" "$17,527.75" "$22,131.00" "$17,704.80" "$14,385.15" "$22,131.00" "$22,131.00" "$12,835.98" "$22,131.00" "$13,278.60" "$22,131.00" "$22,131.00" "$22,131.00" N/A N/A 27202703 EAP Custom 27202703 20MMX4.0CM AAA STENT GRAFT BOTH IP/OP "$15,151.00" "$11,212.00" "$2,060.15" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$2,696.88" "$15,151.00" "$15,151.00" "$4,181.12" "$4,181.12" "$11,678.39" "$2,060.15" "$3,157.64" "$15,151.00" "$6,060.40" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$11,363.25" "$15,151.00" "$15,151.00" "$15,151.00" "$7,575.50" "$7,575.50" "$11,999.59" "$15,151.00" "$12,120.80" "$9,848.15" "$15,151.00" "$15,151.00" "$8,787.58" "$15,151.00" "$9,090.60" "$15,151.00" "$15,151.00" "$15,151.00" N/A N/A 27202704 EAP Custom 27202704 22MMX4.0CM AAA STENT GRAFT BOTH IP/OP "$15,151.00" "$11,212.00" "$2,060.15" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$2,696.88" "$15,151.00" "$15,151.00" "$4,181.12" "$4,181.12" "$11,678.39" "$2,060.15" "$3,157.64" "$15,151.00" "$6,060.40" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$11,363.25" "$15,151.00" "$15,151.00" "$15,151.00" "$7,575.50" "$7,575.50" "$11,999.59" "$15,151.00" "$12,120.80" "$9,848.15" "$15,151.00" "$15,151.00" "$8,787.58" "$15,151.00" "$9,090.60" "$15,151.00" "$15,151.00" "$15,151.00" N/A N/A 27202705 EAP Custom 27202705 24MMX4.0CM AAA STENT GRAFT BOTH IP/OP "$15,151.00" "$11,212.00" "$2,060.15" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$2,696.88" "$15,151.00" "$15,151.00" "$4,181.12" "$4,181.12" "$11,678.39" "$2,060.15" "$3,157.64" "$15,151.00" "$6,060.40" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$11,363.25" "$15,151.00" "$15,151.00" "$15,151.00" "$7,575.50" "$7,575.50" "$11,999.59" "$15,151.00" "$12,120.80" "$9,848.15" "$15,151.00" "$15,151.00" "$8,787.58" "$15,151.00" "$9,090.60" "$15,151.00" "$15,151.00" "$15,151.00" N/A N/A 27202706 EAP Custom 27202706 26MMX4.0CM AAA STENT GRAFT BOTH IP/OP "$15,151.00" "$11,212.00" "$2,060.15" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$2,696.88" "$15,151.00" "$15,151.00" "$4,181.12" "$4,181.12" "$11,678.39" "$2,060.15" "$3,157.64" "$15,151.00" "$6,060.40" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$11,363.25" "$15,151.00" "$15,151.00" "$15,151.00" "$7,575.50" "$7,575.50" "$11,999.59" "$15,151.00" "$12,120.80" "$9,848.15" "$15,151.00" "$15,151.00" "$8,787.58" "$15,151.00" "$9,090.60" "$15,151.00" "$15,151.00" "$15,151.00" N/A N/A 27202707 EAP Custom 27202707 28MMX4.0CM AAA STENT GRAFT BOTH IP/OP "$15,151.00" "$11,212.00" "$2,060.15" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$2,696.88" "$15,151.00" "$15,151.00" "$4,181.12" "$4,181.12" "$11,678.39" "$2,060.15" "$3,157.64" "$15,151.00" "$6,060.40" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$15,151.00" "$11,363.25" "$15,151.00" "$15,151.00" "$15,151.00" "$7,575.50" "$7,575.50" "$11,999.59" "$15,151.00" "$12,120.80" "$9,848.15" "$15,151.00" "$15,151.00" "$8,787.58" "$15,151.00" "$9,090.60" "$15,151.00" "$15,151.00" "$15,151.00" N/A N/A 27202708 EAP Custom 27202708 23X3.3CM AAA ENDOPROSTHESIS BOTH IP/OP "$17,322.00" "$12,818.50" "$2,060.15" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$3,083.32" "$17,322.00" "$17,322.00" "$4,181.12" "$4,181.12" "$13,351.80" "$2,060.15" "$3,610.10" "$17,322.00" "$6,928.80" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$12,991.50" "$17,322.00" "$17,322.00" "$17,322.00" "$8,661.00" "$8,661.00" "$13,719.02" "$17,322.00" "$13,857.60" "$11,259.30" "$17,322.00" "$17,322.00" "$10,046.76" "$17,322.00" "$10,393.20" "$17,322.00" "$17,322.00" "$17,322.00" N/A N/A 27202709 EAP Custom 27202709 26X3.3CM AAA ENDPROSTHESIS BOTH IP/OP "$17,322.00" "$12,818.50" "$2,060.15" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$3,083.32" "$17,322.00" "$17,322.00" "$4,181.12" "$4,181.12" "$13,351.80" "$2,060.15" "$3,610.10" "$17,322.00" "$6,928.80" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$12,991.50" "$17,322.00" "$17,322.00" "$17,322.00" "$8,661.00" "$8,661.00" "$13,719.02" "$17,322.00" "$13,857.60" "$11,259.30" "$17,322.00" "$17,322.00" "$10,046.76" "$17,322.00" "$10,393.20" "$17,322.00" "$17,322.00" "$17,322.00" N/A N/A 27202710 EAP Custom 27202710 28.5X3.3CM AAA ENDOPROSTHESIS BOTH IP/OP "$16,083.00" "$11,901.50" "$2,060.15" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$2,862.77" "$16,083.00" "$16,083.00" "$4,181.12" "$4,181.12" "$12,396.78" "$2,060.15" "$3,351.87" "$16,083.00" "$6,433.20" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$12,062.25" "$16,083.00" "$16,083.00" "$16,083.00" "$8,041.50" "$8,041.50" "$12,737.74" "$16,083.00" "$12,866.40" "$10,453.95" "$16,083.00" "$16,083.00" "$9,328.14" "$16,083.00" "$9,649.80" "$16,083.00" "$16,083.00" "$16,083.00" N/A N/A 27202711 EAP Custom 27202711 10X7CM AAA ENDOPROSTHESIS BOTH IP/OP "$16,083.00" "$11,901.50" "$2,060.15" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$2,862.77" "$16,083.00" "$16,083.00" "$4,181.12" "$4,181.12" "$12,396.78" "$2,060.15" "$3,351.87" "$16,083.00" "$6,433.20" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$12,062.25" "$16,083.00" "$16,083.00" "$16,083.00" "$8,041.50" "$8,041.50" "$12,737.74" "$16,083.00" "$12,866.40" "$10,453.95" "$16,083.00" "$16,083.00" "$9,328.14" "$16,083.00" "$9,649.80" "$16,083.00" "$16,083.00" "$16,083.00" N/A N/A 27202712 EAP Custom 27202712 12X7CM AAA ENDOPROSTHESIS BOTH IP/OP "$16,083.00" "$11,901.50" "$2,060.15" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$2,862.77" "$16,083.00" "$16,083.00" "$4,181.12" "$4,181.12" "$12,396.78" "$2,060.15" "$3,351.87" "$16,083.00" "$6,433.20" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$12,062.25" "$16,083.00" "$16,083.00" "$16,083.00" "$8,041.50" "$8,041.50" "$12,737.74" "$16,083.00" "$12,866.40" "$10,453.95" "$16,083.00" "$16,083.00" "$9,328.14" "$16,083.00" "$9,649.80" "$16,083.00" "$16,083.00" "$16,083.00" N/A N/A 27202713 EAP Custom 27202713 14.5X7CM AAA ENDOPROSTHESIS BOTH IP/OP "$16,083.00" "$11,901.50" "$2,060.15" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$2,862.77" "$16,083.00" "$16,083.00" "$4,181.12" "$4,181.12" "$12,396.78" "$2,060.15" "$3,351.87" "$16,083.00" "$6,433.20" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$16,083.00" "$12,062.25" "$16,083.00" "$16,083.00" "$16,083.00" "$8,041.50" "$8,041.50" "$12,737.74" "$16,083.00" "$12,866.40" "$10,453.95" "$16,083.00" "$16,083.00" "$9,328.14" "$16,083.00" "$9,649.80" "$16,083.00" "$16,083.00" "$16,083.00" N/A N/A 27202714 EAP Custom 27202714 12FRX30CM INTRODUCER SHEATH BOTH IP/OP $525.00 $388.50 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 $525.00 $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A 27202715 EAP Custom 27202715 18FRX30CM INTRUDER SHEATH BOTH IP/OP $902.00 $667.50 $160.56 $902.00 $902.00 $902.00 $902.00 $902.00 $902.00 $902.00 $160.56 $902.00 $902.00 $669.46 $669.46 $695.26 $469.94 $187.99 $902.00 $360.80 $902.00 $902.00 $902.00 $902.00 $902.00 $676.50 $902.00 $902.00 $902.00 $451.00 $451.00 $714.38 $902.00 $721.60 $586.30 $902.00 $902.00 $523.16 $902.00 $541.20 $902.00 $902.00 $902.00 N/A N/A 27202716 EAP Custom 27202716 26X10CM THORACIC ENDOPROSTHESI BOTH IP/OP "$23,023.00" "$17,037.50" "$2,060.15" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$4,098.09" "$23,023.00" "$23,023.00" "$4,181.12" "$4,181.12" "$17,746.13" "$2,060.15" "$4,798.25" "$23,023.00" "$9,209.20" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$17,267.25" "$23,023.00" "$23,023.00" "$23,023.00" "$11,511.50" "$11,511.50" "$18,234.22" "$23,023.00" "$18,418.40" "$14,964.95" "$23,023.00" "$23,023.00" "$13,353.34" "$23,023.00" "$13,813.80" "$23,023.00" "$23,023.00" "$23,023.00" N/A N/A 27202717 EAP Custom 27202717 28X10CM THORACIC ENDOPROSTHESI BOTH IP/OP "$23,023.00" "$17,037.50" "$2,060.15" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$4,098.09" "$23,023.00" "$23,023.00" "$4,181.12" "$4,181.12" "$17,746.13" "$2,060.15" "$4,798.25" "$23,023.00" "$9,209.20" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$17,267.25" "$23,023.00" "$23,023.00" "$23,023.00" "$11,511.50" "$11,511.50" "$18,234.22" "$23,023.00" "$18,418.40" "$14,964.95" "$23,023.00" "$23,023.00" "$13,353.34" "$23,023.00" "$13,813.80" "$23,023.00" "$23,023.00" "$23,023.00" N/A N/A 27202718 EAP Custom 27202718 28X15CM THORACIC ENDOPROSTHESI BOTH IP/OP "$23,023.00" "$17,037.50" "$2,060.15" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$4,098.09" "$23,023.00" "$23,023.00" "$4,181.12" "$4,181.12" "$17,746.13" "$2,060.15" "$4,798.25" "$23,023.00" "$9,209.20" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$17,267.25" "$23,023.00" "$23,023.00" "$23,023.00" "$11,511.50" "$11,511.50" "$18,234.22" "$23,023.00" "$18,418.40" "$14,964.95" "$23,023.00" "$23,023.00" "$13,353.34" "$23,023.00" "$13,813.80" "$23,023.00" "$23,023.00" "$23,023.00" N/A N/A 27202719 EAP Custom 27202719 31X10CM THORACIC ENDOPROSTHESI BOTH IP/OP "$23,023.00" "$17,037.50" "$2,060.15" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$4,098.09" "$23,023.00" "$23,023.00" "$4,181.12" "$4,181.12" "$17,746.13" "$2,060.15" "$4,798.25" "$23,023.00" "$9,209.20" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$17,267.25" "$23,023.00" "$23,023.00" "$23,023.00" "$11,511.50" "$11,511.50" "$18,234.22" "$23,023.00" "$18,418.40" "$14,964.95" "$23,023.00" "$23,023.00" "$13,353.34" "$23,023.00" "$13,813.80" "$23,023.00" "$23,023.00" "$23,023.00" N/A N/A 27202720 EAP Custom 27202720 31X15CM THORACIC ENDOPROSTHESI BOTH IP/OP "$23,023.00" "$17,037.50" "$2,060.15" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$4,098.09" "$23,023.00" "$23,023.00" "$4,181.12" "$4,181.12" "$17,746.13" "$2,060.15" "$4,798.25" "$23,023.00" "$9,209.20" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$17,267.25" "$23,023.00" "$23,023.00" "$23,023.00" "$11,511.50" "$11,511.50" "$18,234.22" "$23,023.00" "$18,418.40" "$14,964.95" "$23,023.00" "$23,023.00" "$13,353.34" "$23,023.00" "$13,813.80" "$23,023.00" "$23,023.00" "$23,023.00" N/A N/A 27202721 EAP Custom 27202721 34X10CM THORACIC ENDOPROSTHESI BOTH IP/OP "$23,023.00" "$17,037.50" "$2,060.15" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$4,098.09" "$23,023.00" "$23,023.00" "$4,181.12" "$4,181.12" "$17,746.13" "$2,060.15" "$4,798.25" "$23,023.00" "$9,209.20" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$17,267.25" "$23,023.00" "$23,023.00" "$23,023.00" "$11,511.50" "$11,511.50" "$18,234.22" "$23,023.00" "$18,418.40" "$14,964.95" "$23,023.00" "$23,023.00" "$13,353.34" "$23,023.00" "$13,813.80" "$23,023.00" "$23,023.00" "$23,023.00" N/A N/A 27202722 EAP Custom 27202722 34X15CM THORACIC ENDOPROSTHESI BOTH IP/OP "$23,023.00" "$17,037.50" "$2,060.15" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$4,098.09" "$23,023.00" "$23,023.00" "$4,181.12" "$4,181.12" "$17,746.13" "$2,060.15" "$4,798.25" "$23,023.00" "$9,209.20" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$17,267.25" "$23,023.00" "$23,023.00" "$23,023.00" "$11,511.50" "$11,511.50" "$18,234.22" "$23,023.00" "$18,418.40" "$14,964.95" "$23,023.00" "$23,023.00" "$13,353.34" "$23,023.00" "$13,813.80" "$23,023.00" "$23,023.00" "$23,023.00" N/A N/A 27202723 EAP Custom 27202723 34X20CM THORACIC ENDOPROSTHESI BOTH IP/OP "$23,023.00" "$17,037.50" "$2,060.15" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$4,098.09" "$23,023.00" "$23,023.00" "$4,181.12" "$4,181.12" "$17,746.13" "$2,060.15" "$4,798.25" "$23,023.00" "$9,209.20" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$17,267.25" "$23,023.00" "$23,023.00" "$23,023.00" "$11,511.50" "$11,511.50" "$18,234.22" "$23,023.00" "$18,418.40" "$14,964.95" "$23,023.00" "$23,023.00" "$13,353.34" "$23,023.00" "$13,813.80" "$23,023.00" "$23,023.00" "$23,023.00" N/A N/A 27202724 EAP Custom 27202724 37X10CM THORACIC ENDOPROSTHESI BOTH IP/OP "$23,023.00" "$17,037.50" "$2,060.15" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$4,098.09" "$23,023.00" "$23,023.00" "$4,181.12" "$4,181.12" "$17,746.13" "$2,060.15" "$4,798.25" "$23,023.00" "$9,209.20" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$17,267.25" "$23,023.00" "$23,023.00" "$23,023.00" "$11,511.50" "$11,511.50" "$18,234.22" "$23,023.00" "$18,418.40" "$14,964.95" "$23,023.00" "$23,023.00" "$13,353.34" "$23,023.00" "$13,813.80" "$23,023.00" "$23,023.00" "$23,023.00" N/A N/A 27202725 EAP Custom 27202725 37X15CM THORACIC ENDOPROSTHESI BOTH IP/OP "$23,023.00" "$17,037.50" "$2,060.15" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$4,098.09" "$23,023.00" "$23,023.00" "$4,181.12" "$4,181.12" "$17,746.13" "$2,060.15" "$4,798.25" "$23,023.00" "$9,209.20" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$17,267.25" "$23,023.00" "$23,023.00" "$23,023.00" "$11,511.50" "$11,511.50" "$18,234.22" "$23,023.00" "$18,418.40" "$14,964.95" "$23,023.00" "$23,023.00" "$13,353.34" "$23,023.00" "$13,813.80" "$23,023.00" "$23,023.00" "$23,023.00" N/A N/A 27202726 EAP Custom 27202726 37X20CM THORACIC ENDOPROSTHESI BOTH IP/OP "$23,023.00" "$17,037.50" "$2,060.15" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$4,098.09" "$23,023.00" "$23,023.00" "$4,181.12" "$4,181.12" "$17,746.13" "$2,060.15" "$4,798.25" "$23,023.00" "$9,209.20" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$17,267.25" "$23,023.00" "$23,023.00" "$23,023.00" "$11,511.50" "$11,511.50" "$18,234.22" "$23,023.00" "$18,418.40" "$14,964.95" "$23,023.00" "$23,023.00" "$13,353.34" "$23,023.00" "$13,813.80" "$23,023.00" "$23,023.00" "$23,023.00" N/A N/A 27202727 EAP Custom 27202727 40X10CM THORACIC ENDOPROSTHESI BOTH IP/OP "$23,023.00" "$17,037.50" "$2,060.15" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$4,098.09" "$23,023.00" "$23,023.00" "$4,181.12" "$4,181.12" "$17,746.13" "$2,060.15" "$4,798.25" "$23,023.00" "$9,209.20" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$17,267.25" "$23,023.00" "$23,023.00" "$23,023.00" "$11,511.50" "$11,511.50" "$18,234.22" "$23,023.00" "$18,418.40" "$14,964.95" "$23,023.00" "$23,023.00" "$13,353.34" "$23,023.00" "$13,813.80" "$23,023.00" "$23,023.00" "$23,023.00" N/A N/A 27202728 EAP Custom 27202728 40X15CM THORACIC ENDOPROSTHESI BOTH IP/OP "$23,023.00" "$17,037.50" "$2,060.15" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$4,098.09" "$23,023.00" "$23,023.00" "$4,181.12" "$4,181.12" "$17,746.13" "$2,060.15" "$4,798.25" "$23,023.00" "$9,209.20" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$17,267.25" "$23,023.00" "$23,023.00" "$23,023.00" "$11,511.50" "$11,511.50" "$18,234.22" "$23,023.00" "$18,418.40" "$14,964.95" "$23,023.00" "$23,023.00" "$13,353.34" "$23,023.00" "$13,813.80" "$23,023.00" "$23,023.00" "$23,023.00" N/A N/A 27202729 EAP Custom 27202729 40X20CM THORACIC ENDOPROSTHESI BOTH IP/OP "$23,023.00" "$17,037.50" "$2,060.15" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$4,098.09" "$23,023.00" "$23,023.00" "$4,181.12" "$4,181.12" "$17,746.13" "$2,060.15" "$4,798.25" "$23,023.00" "$9,209.20" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$23,023.00" "$17,267.25" "$23,023.00" "$23,023.00" "$23,023.00" "$11,511.50" "$11,511.50" "$18,234.22" "$23,023.00" "$18,418.40" "$14,964.95" "$23,023.00" "$23,023.00" "$13,353.34" "$23,023.00" "$13,813.80" "$23,023.00" "$23,023.00" "$23,023.00" N/A N/A 27202730 EAP Custom 27202730 20FRX30CM INTRODUCER SHEATH BOTH IP/OP "$2,043.00" "$1,512.00" $363.65 "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" $363.65 "$2,043.00" "$2,043.00" "$1,516.31" "$1,516.31" "$1,574.74" "$1,064.40" $425.78 "$2,043.00" $817.20 "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$1,532.25" "$2,043.00" "$2,043.00" "$2,043.00" "$1,021.50" "$1,021.50" "$1,618.06" "$2,043.00" "$1,634.40" "$1,327.95" "$2,043.00" "$2,043.00" "$1,184.94" "$2,043.00" "$1,225.80" "$2,043.00" "$2,043.00" "$2,043.00" N/A N/A 27202731 EAP Custom 27202731 22FRX30CM INTRODUCER SHEATH BOTH IP/OP "$2,043.00" "$1,512.00" $363.65 "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" $363.65 "$2,043.00" "$2,043.00" "$1,516.31" "$1,516.31" "$1,574.74" "$1,064.40" $425.78 "$2,043.00" $817.20 "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$1,532.25" "$2,043.00" "$2,043.00" "$2,043.00" "$1,021.50" "$1,021.50" "$1,618.06" "$2,043.00" "$1,634.40" "$1,327.95" "$2,043.00" "$2,043.00" "$1,184.94" "$2,043.00" "$1,225.80" "$2,043.00" "$2,043.00" "$2,043.00" N/A N/A 27202732 EAP Custom 27202732 24FRX30CM INTRODUCER SHEATH BOTH IP/OP "$2,043.00" "$1,512.00" $363.65 "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" $363.65 "$2,043.00" "$2,043.00" "$1,516.31" "$1,516.31" "$1,574.74" "$1,064.40" $425.78 "$2,043.00" $817.20 "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$1,532.25" "$2,043.00" "$2,043.00" "$2,043.00" "$1,021.50" "$1,021.50" "$1,618.06" "$2,043.00" "$1,634.40" "$1,327.95" "$2,043.00" "$2,043.00" "$1,184.94" "$2,043.00" "$1,225.80" "$2,043.00" "$2,043.00" "$2,043.00" N/A N/A 27202733 EAP Custom 27202733 GORE TRI-LOBE BALLON CATHETER BOTH IP/OP "$3,391.00" "$2,509.50" $603.60 "$3,391.00" "$3,391.00" "$3,391.00" "$3,391.00" "$3,391.00" "$3,391.00" "$3,391.00" $603.60 "$3,391.00" "$3,391.00" "$2,516.80" "$2,516.80" "$2,613.78" "$1,766.71" $706.72 "$3,391.00" "$1,356.40" "$3,391.00" "$3,391.00" "$3,391.00" "$3,391.00" "$3,391.00" "$2,543.25" "$3,391.00" "$3,391.00" "$3,391.00" "$1,695.50" "$1,695.50" "$2,685.67" "$3,391.00" "$2,712.80" "$2,204.15" "$3,391.00" "$3,391.00" "$1,966.78" "$3,391.00" "$2,034.60" "$3,391.00" "$3,391.00" "$3,391.00" N/A N/A 27202734 EAP Custom 27202734 20X12X135MM AAA STENT GRAFT BOTH IP/OP "$25,471.00" "$18,849.00" "$2,060.15" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$4,533.84" "$25,471.00" "$25,471.00" "$4,181.12" "$4,181.12" "$19,633.05" "$2,060.15" "$5,308.44" "$25,471.00" "$10,188.40" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$19,103.25" "$25,471.00" "$25,471.00" "$25,471.00" "$12,735.50" "$12,735.50" "$20,173.03" "$25,471.00" "$20,376.80" "$16,556.15" "$25,471.00" "$25,471.00" "$14,773.18" "$25,471.00" "$15,282.60" "$25,471.00" "$25,471.00" "$25,471.00" N/A N/A 27202735 EAP Custom 27202735 22X13X135MM AAA STENT GRAFT BOTH IP/OP "$25,471.00" "$18,849.00" "$2,060.15" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$4,533.84" "$25,471.00" "$25,471.00" "$4,181.12" "$4,181.12" "$19,633.05" "$2,060.15" "$5,308.44" "$25,471.00" "$10,188.40" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$19,103.25" "$25,471.00" "$25,471.00" "$25,471.00" "$12,735.50" "$12,735.50" "$20,173.03" "$25,471.00" "$20,376.80" "$16,556.15" "$25,471.00" "$25,471.00" "$14,773.18" "$25,471.00" "$15,282.60" "$25,471.00" "$25,471.00" "$25,471.00" N/A N/A 27202736 EAP Custom 27202736 24X14X135MM AAA STENT GRAFT BOTH IP/OP "$25,471.00" "$18,849.00" "$2,060.15" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$4,533.84" "$25,471.00" "$25,471.00" "$4,181.12" "$4,181.12" "$19,633.05" "$2,060.15" "$5,308.44" "$25,471.00" "$10,188.40" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$19,103.25" "$25,471.00" "$25,471.00" "$25,471.00" "$12,735.50" "$12,735.50" "$20,173.03" "$25,471.00" "$20,376.80" "$16,556.15" "$25,471.00" "$25,471.00" "$14,773.18" "$25,471.00" "$15,282.60" "$25,471.00" "$25,471.00" "$25,471.00" N/A N/A 27202737 EAP Custom 27202737 26X15X135MM AAA STENT GRAFT BOTH IP/OP "$25,471.00" "$18,849.00" "$2,060.15" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$4,533.84" "$25,471.00" "$25,471.00" "$4,181.12" "$4,181.12" "$19,633.05" "$2,060.15" "$5,308.44" "$25,471.00" "$10,188.40" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$19,103.25" "$25,471.00" "$25,471.00" "$25,471.00" "$12,735.50" "$12,735.50" "$20,173.03" "$25,471.00" "$20,376.80" "$16,556.15" "$25,471.00" "$25,471.00" "$14,773.18" "$25,471.00" "$15,282.60" "$25,471.00" "$25,471.00" "$25,471.00" N/A N/A 27202738 EAP Custom 27202738 28X16X135MM AAA STENT GRAFT BOTH IP/OP "$25,471.00" "$18,849.00" "$2,060.15" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$4,533.84" "$25,471.00" "$25,471.00" "$4,181.12" "$4,181.12" "$19,633.05" "$2,060.15" "$5,308.44" "$25,471.00" "$10,188.40" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$25,471.00" "$19,103.25" "$25,471.00" "$25,471.00" "$25,471.00" "$12,735.50" "$12,735.50" "$20,173.03" "$25,471.00" "$20,376.80" "$16,556.15" "$25,471.00" "$25,471.00" "$14,773.18" "$25,471.00" "$15,282.60" "$25,471.00" "$25,471.00" "$25,471.00" N/A N/A 27202739 EAP Custom 27202739 20X12X165MM AAA STENT GRAFT BOTH IP/OP "$1,232.00" $912.00 $219.30 "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" $219.30 "$1,232.00" "$1,232.00" $914.39 $914.39 $949.63 $641.87 $256.76 "$1,232.00" $492.80 "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" $924.00 "$1,232.00" "$1,232.00" "$1,232.00" $616.00 $616.00 $975.74 "$1,232.00" $985.60 $800.80 "$1,232.00" "$1,232.00" $714.56 "$1,232.00" $739.20 "$1,232.00" "$1,232.00" "$1,232.00" N/A N/A 27202740 EAP Custom 27202740 22X13X165MM AAA STENT GRAFT BOTH IP/OP "$1,232.00" $912.00 $219.30 "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" $219.30 "$1,232.00" "$1,232.00" $914.39 $914.39 $949.63 $641.87 $256.76 "$1,232.00" $492.80 "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" $924.00 "$1,232.00" "$1,232.00" "$1,232.00" $616.00 $616.00 $975.74 "$1,232.00" $985.60 $800.80 "$1,232.00" "$1,232.00" $714.56 "$1,232.00" $739.20 "$1,232.00" "$1,232.00" "$1,232.00" N/A N/A 27202741 EAP Custom 27202741 24X14X165MM AAA STENT GRAFT BOTH IP/OP "$1,232.00" $912.00 $219.30 "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" $219.30 "$1,232.00" "$1,232.00" $914.39 $914.39 $949.63 $641.87 $256.76 "$1,232.00" $492.80 "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" $924.00 "$1,232.00" "$1,232.00" "$1,232.00" $616.00 $616.00 $975.74 "$1,232.00" $985.60 $800.80 "$1,232.00" "$1,232.00" $714.56 "$1,232.00" $739.20 "$1,232.00" "$1,232.00" "$1,232.00" N/A N/A 27202742 EAP Custom 27202742 26X15X165MM AAA STENT GRAFT BOTH IP/OP "$1,232.00" $912.00 $219.30 "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" $219.30 "$1,232.00" "$1,232.00" $914.39 $914.39 $949.63 $641.87 $256.76 "$1,232.00" $492.80 "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" $924.00 "$1,232.00" "$1,232.00" "$1,232.00" $616.00 $616.00 $975.74 "$1,232.00" $985.60 $800.80 "$1,232.00" "$1,232.00" $714.56 "$1,232.00" $739.20 "$1,232.00" "$1,232.00" "$1,232.00" N/A N/A 27202743 EAP Custom 27202743 28X16X165MM AAA STENT GRAFT BOTH IP/OP "$1,232.00" $912.00 $219.30 "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" $219.30 "$1,232.00" "$1,232.00" $914.39 $914.39 $949.63 $641.87 $256.76 "$1,232.00" $492.80 "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" $924.00 "$1,232.00" "$1,232.00" "$1,232.00" $616.00 $616.00 $975.74 "$1,232.00" $985.60 $800.80 "$1,232.00" "$1,232.00" $714.56 "$1,232.00" $739.20 "$1,232.00" "$1,232.00" "$1,232.00" N/A N/A 27202745 EAP HCPCS C1729 CATHETER DRAINAGE SPV BOTH IP/OP $333.00 $246.50 $66.09 $333.00 $180.82 $180.82 $180.82 $180.82 $333.00 $333.00 $333.00 $69.41 $333.00 $247.15 $247.15 $256.68 $173.49 $69.40 $333.00 $333.00 $196.97 $333.00 $333.00 $333.00 $333.00 $249.75 $333.00 $333.00 $333.00 $166.50 $166.50 $263.74 $333.00 $266.40 $216.45 $66.09 $333.00 $193.14 $333.00 $333.00 $333.00 $69.40 $333.00 N/A N/A 27202750 EAP Custom 27202750 RETRIEVAL DEVICE SPV BOTH IP/OP $391.00 $289.50 $69.60 $391.00 $391.00 $391.00 $391.00 $391.00 $391.00 $391.00 $69.60 $391.00 $391.00 $290.20 $290.20 $301.38 $203.71 $81.49 $391.00 $156.40 $391.00 $391.00 $391.00 $391.00 $391.00 $293.25 $391.00 $391.00 $391.00 $195.50 $195.50 $309.67 $391.00 $312.80 $254.15 $391.00 $391.00 $226.78 $391.00 $234.60 $391.00 $391.00 $391.00 N/A N/A 27202751 EAP Custom 27202751 "PORT, IMPLANTABLE SPV" BOTH IP/OP "$1,930.00" "$1,428.50" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,432.45" "$1,432.45" "$1,487.64" "$1,005.53" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" "$1,254.50" "$1,930.00" "$1,930.00" "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 27202752 EAP Custom 27202752 "STENT, COVRD, W/DELV SPV" BOTH IP/OP "$7,595.00" "$5,620.50" "$1,351.91" "$7,595.00" "$7,595.00" "$7,595.00" "$7,595.00" "$7,595.00" "$7,595.00" "$7,595.00" "$1,351.91" "$7,595.00" "$7,595.00" "$4,181.12" "$4,181.12" "$5,854.23" "$2,060.15" "$1,582.88" "$7,595.00" "$3,038.00" "$7,595.00" "$7,595.00" "$7,595.00" "$7,595.00" "$7,595.00" "$5,696.25" "$7,595.00" "$7,595.00" "$7,595.00" "$3,797.50" "$3,797.50" "$6,015.24" "$7,595.00" "$6,076.00" "$4,936.75" "$7,595.00" "$7,595.00" "$4,405.10" "$7,595.00" "$4,557.00" "$7,595.00" "$7,595.00" "$7,595.00" N/A N/A 27202753 EAP Custom 27202753 "STENT, NON-COVRD W/DELV SPV" BOTH IP/OP "$5,824.00" "$4,310.00" "$1,036.67" "$5,824.00" "$5,824.00" "$5,824.00" "$5,824.00" "$5,824.00" "$5,824.00" "$5,824.00" "$1,036.67" "$5,824.00" "$5,824.00" "$4,181.12" "$4,181.12" "$4,489.14" "$2,060.15" "$1,213.79" "$5,824.00" "$2,329.60" "$5,824.00" "$5,824.00" "$5,824.00" "$5,824.00" "$5,824.00" "$4,368.00" "$5,824.00" "$5,824.00" "$5,824.00" "$2,912.00" "$2,912.00" "$4,612.61" "$5,824.00" "$4,659.20" "$3,785.60" "$5,824.00" "$5,824.00" "$3,377.92" "$5,824.00" "$3,494.40" "$5,824.00" "$5,824.00" "$5,824.00" N/A N/A 27202754 EAP Custom 27202754 "STENT, NON-COVRD W/O DELV SPV" BOTH IP/OP "$3,412.00" "$2,525.00" $607.34 "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" $607.34 "$3,412.00" "$3,412.00" "$2,532.39" "$2,532.39" "$2,629.97" "$1,777.65" $711.10 "$3,412.00" "$1,364.80" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$2,559.00" "$3,412.00" "$3,412.00" "$3,412.00" "$1,706.00" "$1,706.00" "$2,702.30" "$3,412.00" "$2,729.60" "$2,217.80" "$3,412.00" "$3,412.00" "$1,978.96" "$3,412.00" "$2,047.20" "$3,412.00" "$3,412.00" "$3,412.00" N/A N/A 27202755 EAP HCPCS C1887 "CATHETER, GUIDING SPV" BOTH IP/OP $431.00 $319.00 $85.54 $431.00 $234.03 $234.03 $234.03 $234.03 $431.00 $431.00 $431.00 $89.83 $431.00 $319.89 $319.89 $332.21 $224.55 $89.83 $431.00 $431.00 $254.94 $431.00 $431.00 $431.00 $431.00 $323.25 $431.00 $431.00 $431.00 $215.50 $215.50 $341.35 $431.00 $344.80 $280.15 $85.54 $431.00 $249.98 $431.00 $431.00 $431.00 $89.82 $431.00 N/A N/A 27202756 EAP Custom 27202756 WORKHORSE BALLOON CATHETER BOTH IP/OP "$1,462.00" "$1,082.00" $260.24 "$1,462.00" "$1,462.00" "$1,462.00" "$1,462.00" "$1,462.00" "$1,462.00" "$1,462.00" $260.24 "$1,462.00" "$1,462.00" "$1,085.10" "$1,085.10" "$1,126.91" $761.70 $304.70 "$1,462.00" $584.80 "$1,462.00" "$1,462.00" "$1,462.00" "$1,462.00" "$1,462.00" "$1,096.50" "$1,462.00" "$1,462.00" "$1,462.00" $731.00 $731.00 "$1,157.90" "$1,462.00" "$1,169.60" $950.30 "$1,462.00" "$1,462.00" $847.96 "$1,462.00" $877.20 "$1,462.00" "$1,462.00" "$1,462.00" N/A N/A 27202757 EAP Custom 27202757 OPTA 5 BALLOON CATHETER BOTH IP/OP "$1,462.00" "$1,082.00" $260.24 "$1,462.00" "$1,462.00" "$1,462.00" "$1,462.00" "$1,462.00" "$1,462.00" "$1,462.00" $260.24 "$1,462.00" "$1,462.00" "$1,085.10" "$1,085.10" "$1,126.91" $761.70 $304.70 "$1,462.00" $584.80 "$1,462.00" "$1,462.00" "$1,462.00" "$1,462.00" "$1,462.00" "$1,096.50" "$1,462.00" "$1,462.00" "$1,462.00" $731.00 $731.00 "$1,157.90" "$1,462.00" "$1,169.60" $950.30 "$1,462.00" "$1,462.00" $847.96 "$1,462.00" $877.20 "$1,462.00" "$1,462.00" "$1,462.00" N/A N/A 27202758 EAP Custom 27202758 ARROW-TREROTOLA DEVICE BOTH IP/OP "$3,506.00" "$2,594.50" $624.07 "$3,506.00" "$3,506.00" "$3,506.00" "$3,506.00" "$3,506.00" "$3,506.00" "$3,506.00" $624.07 "$3,506.00" "$3,506.00" "$2,602.15" "$2,602.15" "$2,702.42" "$1,826.63" $730.69 "$3,506.00" "$1,402.40" "$3,506.00" "$3,506.00" "$3,506.00" "$3,506.00" "$3,506.00" "$2,629.50" "$3,506.00" "$3,506.00" "$3,506.00" "$1,753.00" "$1,753.00" "$2,776.75" "$3,506.00" "$2,804.80" "$2,278.90" "$3,506.00" "$3,506.00" "$2,033.48" "$3,506.00" "$2,103.60" "$3,506.00" "$3,506.00" "$3,506.00" N/A N/A 27202759 EAP Custom 27202759 FLEXIMA BILIARY DRAIN CATH W/L BOTH IP/OP $439.00 $325.00 $78.14 $439.00 $439.00 $439.00 $439.00 $439.00 $439.00 $439.00 $78.14 $439.00 $439.00 $325.83 $325.83 $338.38 $228.72 $91.49 $439.00 $175.60 $439.00 $439.00 $439.00 $439.00 $439.00 $329.25 $439.00 $439.00 $439.00 $219.50 $219.50 $347.69 $439.00 $351.20 $285.35 $439.00 $439.00 $254.62 $439.00 $263.40 $439.00 $439.00 $439.00 N/A N/A 27202760 EAP Custom 27202760 "CATHETER, OCCLUSION SPV" BOTH IP/OP "$2,336.00" "$1,729.00" $415.81 "$2,336.00" "$2,336.00" "$2,336.00" "$2,336.00" "$2,336.00" "$2,336.00" "$2,336.00" $415.81 "$2,336.00" "$2,336.00" "$1,733.78" "$1,733.78" "$1,800.59" "$1,217.06" $486.85 "$2,336.00" $934.40 "$2,336.00" "$2,336.00" "$2,336.00" "$2,336.00" "$2,336.00" "$1,752.00" "$2,336.00" "$2,336.00" "$2,336.00" "$1,168.00" "$1,168.00" "$1,850.11" "$2,336.00" "$1,868.80" "$1,518.40" "$2,336.00" "$2,336.00" "$1,354.88" "$2,336.00" "$1,401.60" "$2,336.00" "$2,336.00" "$2,336.00" N/A N/A 27202761 EAP Custom 27202761 "G - FEEDING KIT, 18FR, 2.5L" BOTH IP/OP "$1,090.00" $807.00 $194.02 "$1,090.00" "$1,090.00" "$1,090.00" "$1,090.00" "$1,090.00" "$1,090.00" "$1,090.00" $194.02 "$1,090.00" "$1,090.00" $809.00 $809.00 $840.17 $567.89 $227.17 "$1,090.00" $436.00 "$1,090.00" "$1,090.00" "$1,090.00" "$1,090.00" "$1,090.00" $817.50 "$1,090.00" "$1,090.00" "$1,090.00" $545.00 $545.00 $863.28 "$1,090.00" $872.00 $708.50 "$1,090.00" "$1,090.00" $632.20 "$1,090.00" $654.00 "$1,090.00" "$1,090.00" "$1,090.00" N/A N/A 27202786 EAP HCPCS C1892 8FR-14CM PEEL AWAY SHEATH BOTH IP/OP $101.00 $75.00 $20.05 $101.00 $54.84 $54.84 $54.84 $54.84 $101.00 $101.00 $101.00 $21.05 $101.00 $74.96 $74.96 $77.85 $52.62 $21.05 $101.00 $101.00 $59.74 $101.00 $101.00 $101.00 $101.00 $75.75 $101.00 $101.00 $101.00 $50.50 $50.50 $79.99 $101.00 $80.80 $65.65 $20.05 $101.00 $58.58 $101.00 $60.60 $101.00 $21.05 $101.00 N/A N/A 27202790 EAP Custom 27202790 ALLIGATOR RETRIEVAL BOTH IP/OP "$8,967.00" "$6,636.00" "$1,596.13" "$8,967.00" "$8,967.00" "$8,967.00" "$8,967.00" "$8,967.00" "$8,967.00" "$8,967.00" "$1,596.13" "$8,967.00" "$8,967.00" "$4,181.12" "$4,181.12" "$6,911.76" "$2,060.15" "$1,868.82" "$8,967.00" "$3,586.80" "$8,967.00" "$8,967.00" "$8,967.00" "$8,967.00" "$8,967.00" "$6,725.25" "$8,967.00" "$8,967.00" "$8,967.00" "$4,483.50" "$4,483.50" "$7,101.86" "$8,967.00" "$7,173.60" "$5,828.55" "$8,967.00" "$8,967.00" "$5,200.86" "$8,967.00" "$5,380.20" "$8,967.00" "$8,967.00" "$8,967.00" N/A N/A 27202791 EAP HCPCS C1769 CADENCE PRECISION BOTH IP/OP "$1,703.00" "$1,260.50" $338.00 "$1,703.00" $924.73 $924.73 $924.73 $924.73 "$1,703.00" "$1,703.00" "$1,703.00" $354.95 "$1,703.00" "$1,263.97" "$1,263.97" "$1,312.67" $887.26 $354.92 "$1,703.00" "$1,703.00" "$1,007.32" "$1,703.00" "$1,703.00" "$1,703.00" "$1,703.00" "$1,277.25" "$1,703.00" "$1,703.00" "$1,703.00" $851.50 $851.50 "$1,348.78" "$1,703.00" "$1,362.40" "$1,106.95" $338.00 "$1,703.00" $987.74 "$1,703.00" "$1,703.00" "$1,703.00" $354.91 "$1,703.00" N/A N/A 27202792 EAP HCPCS C1751 CATHETER ECHELON 10 MICRO BOTH IP/OP "$2,423.00" "$1,793.50" $480.90 "$2,423.00" "$1,315.69" "$1,315.69" "$1,315.69" "$1,315.69" "$2,423.00" "$2,423.00" "$2,423.00" $505.01 "$2,423.00" "$1,798.35" "$1,798.35" "$1,867.65" "$1,262.38" $504.98 "$2,423.00" "$2,423.00" "$1,433.20" "$2,423.00" "$2,423.00" "$2,423.00" "$2,423.00" "$1,817.25" "$2,423.00" "$2,423.00" "$2,423.00" "$1,211.50" "$1,211.50" "$1,919.02" "$2,423.00" "$1,938.40" "$1,574.95" $480.90 "$2,423.00" "$1,405.34" "$2,423.00" "$2,423.00" "$2,423.00" $504.95 "$2,423.00" N/A N/A 27202794 EAP Custom 27202794 CATHETER MARATHON BOTH IP/OP "$2,152.00" "$1,592.50" $383.06 "$2,152.00" "$2,152.00" "$2,152.00" "$2,152.00" "$2,152.00" "$2,152.00" "$2,152.00" $383.06 "$2,152.00" "$2,152.00" "$1,597.21" "$1,597.21" "$1,658.76" "$1,121.19" $448.50 "$2,152.00" $860.80 "$2,152.00" "$2,152.00" "$2,152.00" "$2,152.00" "$2,152.00" "$1,614.00" "$2,152.00" "$2,152.00" "$2,152.00" "$1,076.00" "$1,076.00" "$1,704.38" "$2,152.00" "$1,721.60" "$1,398.80" "$2,152.00" "$2,152.00" "$1,248.16" "$2,152.00" "$1,291.20" "$2,152.00" "$2,152.00" "$2,152.00" N/A N/A 27202795 EAP HCPCS C2628 CATHETER MARKSMAN 105CM BOTH IP/OP "$3,587.00" "$2,654.50" $711.93 "$3,587.00" "$1,947.74" "$1,947.74" "$1,947.74" "$1,947.74" "$3,587.00" "$3,587.00" "$3,587.00" $747.62 "$3,587.00" "$2,662.27" "$2,662.27" "$2,764.86" "$1,868.83" $747.57 "$3,587.00" "$3,587.00" "$2,121.71" "$3,587.00" "$3,587.00" "$3,587.00" "$3,587.00" "$2,690.25" "$3,587.00" "$3,587.00" "$3,587.00" "$1,793.50" "$1,793.50" "$2,840.90" "$3,587.00" "$2,869.60" "$2,331.55" $711.93 "$3,587.00" "$2,080.46" "$3,587.00" "$3,587.00" "$3,587.00" $747.53 "$3,587.00" N/A N/A 27202796 EAP HCPCS C2628 CATHETER MARKSMAN 135CM BOTH IP/OP "$3,587.00" "$2,654.50" $711.93 "$3,587.00" "$1,947.74" "$1,947.74" "$1,947.74" "$1,947.74" "$3,587.00" "$3,587.00" "$3,587.00" $747.62 "$3,587.00" "$2,662.27" "$2,662.27" "$2,764.86" "$1,868.83" $747.57 "$3,587.00" "$3,587.00" "$2,121.71" "$3,587.00" "$3,587.00" "$3,587.00" "$3,587.00" "$2,690.25" "$3,587.00" "$3,587.00" "$3,587.00" "$1,793.50" "$1,793.50" "$2,840.90" "$3,587.00" "$2,869.60" "$2,331.55" $711.93 "$3,587.00" "$2,080.46" "$3,587.00" "$3,587.00" "$3,587.00" $747.53 "$3,587.00" N/A N/A 27202797 EAP Custom 27202797 CATHETER MARKSMAN 150CM BOTH IP/OP "$3,587.00" "$2,654.50" $638.49 "$3,587.00" "$3,587.00" "$3,587.00" "$3,587.00" "$3,587.00" "$3,587.00" "$3,587.00" $638.49 "$3,587.00" "$3,587.00" "$2,662.27" "$2,662.27" "$2,764.86" "$1,868.83" $747.57 "$3,587.00" "$1,434.80" "$3,587.00" "$3,587.00" "$3,587.00" "$3,587.00" "$3,587.00" "$2,690.25" "$3,587.00" "$3,587.00" "$3,587.00" "$1,793.50" "$1,793.50" "$2,840.90" "$3,587.00" "$2,869.60" "$2,331.55" "$3,587.00" "$3,587.00" "$2,080.46" "$3,587.00" "$2,152.20" "$3,587.00" "$3,587.00" "$3,587.00" N/A N/A 27202798 EAP HCPCS C1751 CATHETER REBAR-027 130CM MICRO BOTH IP/OP $989.00 $732.00 $196.29 $989.00 $537.03 $537.03 $537.03 $537.03 $989.00 $989.00 $989.00 $206.13 $989.00 $734.04 $734.04 $762.32 $515.27 $206.12 $989.00 $989.00 $584.99 $989.00 $989.00 $989.00 $989.00 $741.75 $989.00 $989.00 $989.00 $494.50 $494.50 $783.29 $989.00 $791.20 $642.85 $196.29 $989.00 $573.62 $989.00 $989.00 $989.00 $206.11 $989.00 N/A N/A 27202799 EAP HCPCS C1751 CATHETER REBAR-027 145CM MICRO BOTH IP/OP $989.00 $732.00 $196.29 $989.00 $537.03 $537.03 $537.03 $537.03 $989.00 $989.00 $989.00 $206.13 $989.00 $734.04 $734.04 $762.32 $515.27 $206.12 $989.00 $989.00 $584.99 $989.00 $989.00 $989.00 $989.00 $741.75 $989.00 $989.00 $989.00 $494.50 $494.50 $783.29 $989.00 $791.20 $642.85 $196.29 $989.00 $573.62 $989.00 $989.00 $989.00 $206.11 $989.00 N/A N/A 27202800 EAP HCPCS C1751 CATHETER REBAR-10 153CM MICRO BOTH IP/OP "$1,777.00" "$1,315.00" $352.69 "$1,777.00" $964.91 $964.91 $964.91 $964.91 "$1,777.00" "$1,777.00" "$1,777.00" $370.37 "$1,777.00" "$1,318.89" "$1,318.89" "$1,369.71" $925.82 $370.35 "$1,777.00" "$1,777.00" "$1,051.10" "$1,777.00" "$1,777.00" "$1,777.00" "$1,777.00" "$1,332.75" "$1,777.00" "$1,777.00" "$1,777.00" $888.50 $888.50 "$1,407.38" "$1,777.00" "$1,421.60" "$1,155.05" $352.69 "$1,777.00" "$1,030.66" "$1,777.00" "$1,777.00" "$1,777.00" $370.33 "$1,777.00" N/A N/A 27202801 EAP HCPCS C1751 CATHETER REBAR-14 153CM MICRO BOTH IP/OP "$1,777.00" "$1,315.00" $352.69 "$1,777.00" $964.91 $964.91 $964.91 $964.91 "$1,777.00" "$1,777.00" "$1,777.00" $370.37 "$1,777.00" "$1,318.89" "$1,318.89" "$1,369.71" $925.82 $370.35 "$1,777.00" "$1,777.00" "$1,051.10" "$1,777.00" "$1,777.00" "$1,777.00" "$1,777.00" "$1,332.75" "$1,777.00" "$1,777.00" "$1,777.00" $888.50 $888.50 "$1,407.38" "$1,777.00" "$1,421.60" "$1,155.05" $352.69 "$1,777.00" "$1,030.66" "$1,777.00" "$1,777.00" "$1,777.00" $370.33 "$1,777.00" N/A N/A 27202802 EAP HCPCS C1751 CATHETER REBAR-18 130CM MICRO BOTH IP/OP "$1,023.00" $757.50 $203.04 "$1,023.00" $555.49 $555.49 $555.49 $555.49 "$1,023.00" "$1,023.00" "$1,023.00" $213.22 "$1,023.00" $759.27 $759.27 $788.53 $532.98 $213.20 "$1,023.00" "$1,023.00" $605.10 "$1,023.00" "$1,023.00" "$1,023.00" "$1,023.00" $767.25 "$1,023.00" "$1,023.00" "$1,023.00" $511.50 $511.50 $810.22 "$1,023.00" $818.40 $664.95 $203.04 "$1,023.00" $593.34 "$1,023.00" "$1,023.00" "$1,023.00" $213.19 "$1,023.00" N/A N/A 27202803 EAP HCPCS C1751 CATHETER REBAR-18 153 MICRO BOTH IP/OP "$1,292.00" $956.50 $256.43 "$1,292.00" $701.56 $701.56 $701.56 $701.56 "$1,292.00" "$1,292.00" "$1,292.00" $269.29 "$1,292.00" $958.92 $958.92 $995.87 $673.13 $269.27 "$1,292.00" "$1,292.00" $764.22 "$1,292.00" "$1,292.00" "$1,292.00" "$1,292.00" $969.00 "$1,292.00" "$1,292.00" "$1,292.00" $646.00 $646.00 "$1,023.26" "$1,292.00" "$1,033.60" $839.80 $256.43 "$1,292.00" $749.36 "$1,292.00" "$1,292.00" "$1,292.00" $269.25 "$1,292.00" N/A N/A 27202804 EAP HCPCS C1751 CATHETER REBAR-18 153CM MICRO BOTH IP/OP "$1,435.00" "$1,062.00" $284.81 "$1,435.00" $779.21 $779.21 $779.21 $779.21 "$1,435.00" "$1,435.00" "$1,435.00" $299.09 "$1,435.00" "$1,065.06" "$1,065.06" "$1,106.10" $747.64 $299.07 "$1,435.00" "$1,435.00" $848.80 "$1,435.00" "$1,435.00" "$1,435.00" "$1,435.00" "$1,076.25" "$1,435.00" "$1,435.00" "$1,435.00" $717.50 $717.50 "$1,136.52" "$1,435.00" "$1,148.00" $932.75 $284.81 "$1,435.00" $832.30 "$1,435.00" "$1,435.00" "$1,435.00" $299.05 "$1,435.00" N/A N/A 27202806 EAP Custom 27202806 DRIBATH ONYX HEATER US BOTH IP/OP "$1,793.00" "$1,327.00" $319.15 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" $319.15 "$1,793.00" "$1,793.00" "$1,330.76" "$1,330.76" "$1,382.04" $934.15 $373.68 "$1,793.00" $717.20 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,344.75" "$1,793.00" "$1,793.00" "$1,793.00" $896.50 $896.50 "$1,420.06" "$1,793.00" "$1,434.40" "$1,165.45" "$1,793.00" "$1,793.00" "$1,039.94" "$1,793.00" "$1,075.80" "$1,793.00" "$1,793.00" "$1,793.00" N/A N/A 27202808 EAP HCPCS C1751 EXTENDED ULTRAFLOW BOTH IP/OP "$1,793.00" "$1,327.00" $355.87 "$1,793.00" $973.60 $973.60 $973.60 $973.60 "$1,793.00" "$1,793.00" "$1,793.00" $373.71 "$1,793.00" "$1,330.76" "$1,330.76" "$1,382.04" $934.15 $373.68 "$1,793.00" "$1,793.00" "$1,060.56" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,344.75" "$1,793.00" "$1,793.00" "$1,793.00" $896.50 $896.50 "$1,420.06" "$1,793.00" "$1,434.40" "$1,165.45" $355.87 "$1,793.00" "$1,039.94" "$1,793.00" "$1,793.00" "$1,793.00" $373.66 "$1,793.00" N/A N/A 27202809 EAP HCPCS C1769 GUIDEWIRE SILVERSPEED .010 BOTH IP/OP $825.00 $610.50 $163.74 $825.00 $447.98 $447.98 $447.98 $447.98 $825.00 $825.00 $825.00 $171.95 $825.00 $612.32 $612.32 $635.91 $429.83 $171.94 $825.00 $825.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $536.25 $163.74 $825.00 $478.50 $825.00 $825.00 $825.00 $171.93 $825.00 N/A N/A 27202810 EAP HCPCS C1769 GUIDEWIRE SILVERSPEED .014 BOTH IP/OP $825.00 $610.50 $163.74 $825.00 $447.98 $447.98 $447.98 $447.98 $825.00 $825.00 $825.00 $171.95 $825.00 $612.32 $612.32 $635.91 $429.83 $171.94 $825.00 $825.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $536.25 $163.74 $825.00 $478.50 $825.00 $825.00 $825.00 $171.93 $825.00 N/A N/A 27202811 EAP HCPCS C1769 GUIDEWIRE SILVERSPEED .016 BOTH IP/OP $735.00 $544.00 $145.88 $735.00 $399.11 $399.11 $399.11 $399.11 $735.00 $735.00 $735.00 $153.19 $735.00 $545.52 $545.52 $566.54 $382.94 $153.18 $735.00 $735.00 $434.75 $735.00 $735.00 $735.00 $735.00 $551.25 $735.00 $735.00 $735.00 $367.50 $367.50 $582.12 $735.00 $588.00 $477.75 $145.88 $735.00 $426.30 $735.00 $735.00 $735.00 $153.17 $735.00 N/A N/A 27202812 EAP HCPCS C1769 GUIDEWIRE X-CELERATOR .010R BOTH IP/OP "$1,185.00" $877.00 $235.19 "$1,185.00" $643.46 $643.46 $643.46 $643.46 "$1,185.00" "$1,185.00" "$1,185.00" $246.98 "$1,185.00" $879.51 $879.51 $913.40 $617.39 $246.97 "$1,185.00" "$1,185.00" $700.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $770.25 $235.19 "$1,185.00" $687.30 "$1,185.00" "$1,185.00" "$1,185.00" $246.95 "$1,185.00" N/A N/A 27202813 EAP HCPCS C1769 GUIDEWIRE X-CELERATOR-14 RE BOTH IP/OP "$1,185.00" $877.00 $235.19 "$1,185.00" $643.46 $643.46 $643.46 $643.46 "$1,185.00" "$1,185.00" "$1,185.00" $246.98 "$1,185.00" $879.51 $879.51 $913.40 $617.39 $246.97 "$1,185.00" "$1,185.00" $700.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $770.25 $235.19 "$1,185.00" $687.30 "$1,185.00" "$1,185.00" "$1,185.00" $246.95 "$1,185.00" N/A N/A 27202814 EAP HCPCS C1769 GUIDEWIRE X-PEDION 14 2 BOTH IP/OP $897.00 $664.00 $178.03 $897.00 $487.07 $487.07 $487.07 $487.07 $897.00 $897.00 $897.00 $186.96 $897.00 $665.75 $665.75 $691.41 $467.34 $186.94 $897.00 $897.00 $530.58 $897.00 $897.00 $897.00 $897.00 $672.75 $897.00 $897.00 $897.00 $448.50 $448.50 $710.42 $897.00 $717.60 $583.05 $178.03 $897.00 $520.26 $897.00 $538.20 $897.00 $186.93 $897.00 N/A N/A 27202815 EAP HCPCS C1769 GUIDEWIRE X-PEDION-10 RE 2 BOTH IP/OP $897.00 $664.00 $178.03 $897.00 $487.07 $487.07 $487.07 $487.07 $897.00 $897.00 $897.00 $186.96 $897.00 $665.75 $665.75 $691.41 $467.34 $186.94 $897.00 $897.00 $530.58 $897.00 $897.00 $897.00 $897.00 $672.75 $897.00 $897.00 $897.00 $448.50 $448.50 $710.42 $897.00 $717.60 $583.05 $178.03 $897.00 $520.26 $897.00 $897.00 $897.00 $186.93 $897.00 N/A N/A 27202816 EAP HCPCS C1726 HYPERGLIDE 3.0 X 10MM BOTH IP/OP "$3,837.00" "$2,839.50" $761.55 "$3,837.00" "$2,083.49" "$2,083.49" "$2,083.49" "$2,083.49" "$3,837.00" "$3,837.00" "$3,837.00" $799.73 "$3,837.00" "$2,847.82" "$2,847.82" "$2,957.56" "$1,999.08" $799.67 "$3,837.00" "$3,837.00" "$2,269.59" "$3,837.00" "$3,837.00" "$3,837.00" "$3,837.00" "$2,877.75" "$3,837.00" "$3,837.00" "$3,837.00" "$1,918.50" "$1,918.50" "$3,038.90" "$3,837.00" "$3,069.60" "$2,494.05" $761.55 "$3,837.00" "$2,225.46" "$3,837.00" "$3,837.00" "$3,837.00" $799.63 "$3,837.00" N/A N/A 27202817 EAP HCPCS C1726 HYPERGLIDE 3.0 X 15MM BOTH IP/OP "$3,837.00" "$2,839.50" $761.55 "$3,837.00" "$2,083.49" "$2,083.49" "$2,083.49" "$2,083.49" "$3,837.00" "$3,837.00" "$3,837.00" $799.73 "$3,837.00" "$2,847.82" "$2,847.82" "$2,957.56" "$1,999.08" $799.67 "$3,837.00" "$3,837.00" "$2,269.59" "$3,837.00" "$3,837.00" "$3,837.00" "$3,837.00" "$2,877.75" "$3,837.00" "$3,837.00" "$3,837.00" "$1,918.50" "$1,918.50" "$3,038.90" "$3,837.00" "$3,069.60" "$2,494.05" $761.55 "$3,837.00" "$2,225.46" "$3,837.00" "$3,837.00" "$3,837.00" $799.63 "$3,837.00" N/A N/A 27202818 EAP HCPCS C1726 HYPERGLIDE 4.0 X 10MM BOTH IP/OP "$3,837.00" "$2,839.50" $761.55 "$3,837.00" "$2,083.49" "$2,083.49" "$2,083.49" "$2,083.49" "$3,837.00" "$3,837.00" "$3,837.00" $799.73 "$3,837.00" "$2,847.82" "$2,847.82" "$2,957.56" "$1,999.08" $799.67 "$3,837.00" "$3,837.00" "$2,269.59" "$3,837.00" "$3,837.00" "$3,837.00" "$3,837.00" "$2,877.75" "$3,837.00" "$3,837.00" "$3,837.00" "$1,918.50" "$1,918.50" "$3,038.90" "$3,837.00" "$3,069.60" "$2,494.05" $761.55 "$3,837.00" "$2,225.46" "$3,837.00" "$3,837.00" "$3,837.00" $799.63 "$3,837.00" N/A N/A 27202819 EAP HCPCS C1726 HYPERGLIDE 4.0 X 20MM BOTH IP/OP "$3,676.00" "$2,720.50" $729.59 "$3,676.00" "$1,996.07" "$1,996.07" "$1,996.07" "$1,996.07" "$3,676.00" "$3,676.00" "$3,676.00" $766.17 "$3,676.00" "$2,728.33" "$2,728.33" "$2,833.46" "$1,915.20" $766.12 "$3,676.00" "$3,676.00" "$2,174.35" "$3,676.00" "$3,676.00" "$3,676.00" "$3,676.00" "$2,757.00" "$3,676.00" "$3,676.00" "$3,676.00" "$1,838.00" "$1,838.00" "$2,911.39" "$3,676.00" "$2,940.80" "$2,389.40" $729.59 "$3,676.00" "$2,132.08" "$3,676.00" "$3,676.00" "$3,676.00" $766.08 "$3,676.00" N/A N/A 27202820 EAP HCPCS C1726 HYPERGLIDE 5.0 X 15MM BOTH IP/OP "$3,837.00" "$2,839.50" $761.55 "$3,837.00" "$2,083.49" "$2,083.49" "$2,083.49" "$2,083.49" "$3,837.00" "$3,837.00" "$3,837.00" $799.73 "$3,837.00" "$2,847.82" "$2,847.82" "$2,957.56" "$1,999.08" $799.67 "$3,837.00" "$3,837.00" "$2,269.59" "$3,837.00" "$3,837.00" "$3,837.00" "$3,837.00" "$2,877.75" "$3,837.00" "$3,837.00" "$3,837.00" "$1,918.50" "$1,918.50" "$3,038.90" "$3,837.00" "$3,069.60" "$2,494.05" $761.55 "$3,837.00" "$2,225.46" "$3,837.00" "$3,837.00" "$3,837.00" $799.63 "$3,837.00" N/A N/A 27202821 EAP HCPCS C1726 HYPERGLIDE 5.0 X 20MM BOTH IP/OP "$1,472.00" "$1,089.50" $292.16 "$1,472.00" $799.30 $799.30 $799.30 $799.30 "$1,472.00" "$1,472.00" "$1,472.00" $306.80 "$1,472.00" "$1,092.52" "$1,092.52" "$1,134.62" $766.91 $306.78 "$1,472.00" "$1,472.00" $870.69 "$1,472.00" "$1,472.00" "$1,472.00" "$1,472.00" "$1,104.00" "$1,472.00" "$1,472.00" "$1,472.00" $736.00 $736.00 "$1,165.82" "$1,472.00" "$1,177.60" $956.80 $292.16 "$1,472.00" $853.76 "$1,472.00" "$1,472.00" "$1,472.00" $306.76 "$1,472.00" N/A N/A 27202822 EAP HCPCS C1751 HYPERGLIDE 5.0 X 30 BOTH IP/OP "$4,627.00" "$3,424.00" $918.34 "$4,627.00" "$2,512.46" "$2,512.46" "$2,512.46" "$2,512.46" "$4,627.00" "$4,627.00" "$4,627.00" $964.38 "$4,627.00" "$3,434.16" "$3,434.16" "$3,566.49" "$2,060.15" $964.32 "$4,627.00" "$4,627.00" "$2,736.87" "$4,627.00" "$4,627.00" "$4,627.00" "$4,627.00" "$3,470.25" "$4,627.00" "$4,627.00" "$4,627.00" "$2,313.50" "$2,313.50" "$3,664.58" "$4,627.00" "$3,701.60" "$3,007.55" $918.34 "$4,627.00" "$2,683.66" "$4,627.00" "$4,627.00" "$4,627.00" $964.27 "$4,627.00" N/A N/A 27202823 EAP HCPCS C1726 HYPERGLIDE SYSTEM - 30MM BOTH IP/OP "$3,676.00" "$2,720.50" $729.59 "$3,676.00" "$1,996.07" "$1,996.07" "$1,996.07" "$1,996.07" "$3,676.00" "$3,676.00" "$3,676.00" $766.17 "$3,676.00" "$2,728.33" "$2,728.33" "$2,833.46" "$1,915.20" $766.12 "$3,676.00" "$3,676.00" "$2,174.35" "$3,676.00" "$3,676.00" "$3,676.00" "$3,676.00" "$2,757.00" "$3,676.00" "$3,676.00" "$3,676.00" "$1,838.00" "$1,838.00" "$2,911.39" "$3,676.00" "$2,940.80" "$2,389.40" $729.59 "$3,676.00" "$2,132.08" "$3,676.00" "$3,676.00" "$3,676.00" $766.08 "$3,676.00" N/A N/A 27202825 EAP HCPCS C1769 MERIDIAN .014 RE BOTH IP/OP "$1,777.00" "$1,315.00" $352.69 "$1,777.00" $964.91 $964.91 $964.91 $964.91 "$1,777.00" "$1,777.00" "$1,777.00" $370.37 "$1,777.00" "$1,318.89" "$1,318.89" "$1,369.71" $925.82 $370.35 "$1,777.00" "$1,777.00" "$1,051.10" "$1,777.00" "$1,777.00" "$1,777.00" "$1,777.00" "$1,332.75" "$1,777.00" "$1,777.00" "$1,777.00" $888.50 $888.50 "$1,407.38" "$1,777.00" "$1,421.60" "$1,155.05" $352.69 "$1,777.00" "$1,030.66" "$1,777.00" "$1,777.00" "$1,777.00" $370.33 "$1,777.00" N/A N/A 27202826 EAP HCPCS C1884 MICROCATHETER NAUTICA BOTH IP/OP "$1,882.00" "$1,393.00" $373.53 "$1,882.00" "$1,021.93" "$1,021.93" "$1,021.93" "$1,021.93" "$1,882.00" "$1,882.00" "$1,882.00" $392.26 "$1,882.00" "$1,396.82" "$1,396.82" "$1,450.65" $980.52 $392.23 "$1,882.00" "$1,882.00" "$1,113.20" "$1,882.00" "$1,882.00" "$1,882.00" "$1,882.00" "$1,411.50" "$1,882.00" "$1,882.00" "$1,882.00" $941.00 $941.00 "$1,490.54" "$1,882.00" "$1,505.60" "$1,223.30" $373.53 "$1,882.00" "$1,091.56" "$1,882.00" "$1,882.00" "$1,882.00" $392.21 "$1,882.00" N/A N/A 27202827 EAP HCPCS C1769 MIRAGE RE .008 BOTH IP/OP "$1,490.00" "$1,103.00" $295.73 "$1,490.00" $809.07 $809.07 $809.07 $809.07 "$1,490.00" "$1,490.00" "$1,490.00" $310.55 "$1,490.00" "$1,105.88" "$1,105.88" "$1,148.49" $776.29 $310.53 "$1,490.00" "$1,490.00" $881.34 "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,117.50" "$1,490.00" "$1,490.00" "$1,490.00" $745.00 $745.00 "$1,180.08" "$1,490.00" "$1,192.00" $968.50 $295.73 "$1,490.00" $864.20 "$1,490.00" "$1,490.00" "$1,490.00" $310.52 "$1,490.00" N/A N/A 27202828 EAP Custom 27202828 MIXER US 15-17 MM VIAL BOTH IP/OP "$1,793.00" "$1,327.00" $319.15 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" $319.15 "$1,793.00" "$1,793.00" "$1,330.76" "$1,330.76" "$1,382.04" $934.15 $373.68 "$1,793.00" $717.20 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,344.75" "$1,793.00" "$1,793.00" "$1,793.00" $896.50 $896.50 "$1,420.06" "$1,793.00" "$1,434.40" "$1,165.45" "$1,793.00" "$1,793.00" "$1,039.94" "$1,793.00" "$1,075.80" "$1,793.00" "$1,793.00" "$1,793.00" N/A N/A 27202829 EAP HCPCS C1884 ONYX 18 KIT AVM US BOTH IP/OP "$8,071.00" "$5,973.00" "$1,601.89" "$8,071.00" "$4,382.55" "$4,382.55" "$4,382.55" "$4,382.55" "$8,071.00" "$8,071.00" "$8,071.00" "$1,682.20" "$8,071.00" "$4,181.12" "$4,181.12" "$6,221.13" "$2,060.15" "$1,682.09" "$8,071.00" "$8,071.00" "$3,094.73" "$8,071.00" "$8,071.00" "$8,071.00" "$8,071.00" "$6,053.25" "$8,071.00" "$8,071.00" "$8,071.00" "$4,035.50" "$4,035.50" "$6,392.23" "$8,071.00" "$6,456.80" "$5,246.15" "$1,601.89" "$8,071.00" "$4,681.18" "$8,071.00" "$8,071.00" "$8,071.00" "$1,682.00" "$8,071.00" N/A N/A 27202830 EAP HCPCS C1884 ONYX 34 KIT AVM US BOTH IP/OP "$3,227.00" "$2,388.00" $640.48 "$3,227.00" "$1,752.26" "$1,752.26" "$1,752.26" "$1,752.26" "$3,227.00" "$3,227.00" "$3,227.00" $672.59 "$3,227.00" "$2,395.08" "$2,395.08" "$2,487.37" "$1,681.27" $672.54 "$3,227.00" "$3,227.00" "$3,227.00" "$3,227.00" "$3,227.00" "$3,227.00" "$3,227.00" "$2,420.25" "$3,227.00" "$3,227.00" "$3,227.00" "$1,613.50" "$1,613.50" "$2,555.78" "$3,227.00" "$2,581.60" "$2,097.55" $640.48 "$3,227.00" "$1,871.66" "$3,227.00" "$3,227.00" "$3,227.00" $672.51 "$3,227.00" N/A N/A 27202831 EAP HCPCS C1751 ONYX HD500 KIT ANEURYS BOTH IP/OP "$9,325.00" "$6,900.50" "$1,850.78" "$9,325.00" "$5,063.48" "$5,063.48" "$5,063.48" "$5,063.48" "$9,325.00" "$9,325.00" "$9,325.00" "$1,943.56" "$9,325.00" "$4,181.12" "$4,181.12" "$7,187.71" "$2,060.15" "$1,943.43" "$9,325.00" "$9,325.00" "$3,094.73" "$9,325.00" "$9,325.00" "$9,325.00" "$9,325.00" "$6,993.75" "$9,325.00" "$9,325.00" "$9,325.00" "$4,662.50" "$4,662.50" "$7,385.40" "$9,325.00" "$7,460.00" "$6,061.25" "$1,850.78" "$9,325.00" "$5,408.50" "$9,325.00" "$9,325.00" "$9,325.00" "$1,943.33" "$9,325.00" N/A N/A 27202833 EAP Custom 27202833 SYRINGE 1ML SINGLE PA BOTH IP/OP $268.00 $198.50 $47.70 $268.00 $268.00 $268.00 $268.00 $268.00 $268.00 $268.00 $47.70 $268.00 $268.00 $198.91 $198.91 $206.57 $139.63 $55.85 $268.00 $107.20 $268.00 $268.00 $268.00 $268.00 $268.00 $201.00 $268.00 $268.00 $268.00 $134.00 $134.00 $212.26 $268.00 $214.40 $174.20 $268.00 $268.00 $155.44 $268.00 $160.80 $268.00 $268.00 $268.00 N/A N/A 27202834 EAP HCPCS C1726 SYRINGE ADAPTER-CARTON BOTH IP/OP "$1,793.00" "$1,327.00" $355.87 "$1,793.00" $973.60 $973.60 $973.60 $973.60 "$1,793.00" "$1,793.00" "$1,793.00" $373.71 "$1,793.00" "$1,330.76" "$1,330.76" "$1,382.04" $934.15 $373.68 "$1,793.00" "$1,793.00" "$1,060.56" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,344.75" "$1,793.00" "$1,793.00" "$1,793.00" $896.50 $896.50 "$1,420.06" "$1,793.00" "$1,434.40" "$1,165.45" $355.87 "$1,793.00" "$1,039.94" "$1,793.00" "$1,793.00" "$1,793.00" $373.66 "$1,793.00" N/A N/A 27202835 EAP Custom 27202835 ULTRAFLOW HPC 1.5F FLOW BOTH IP/OP "$1,793.00" "$1,327.00" $319.15 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" $319.15 "$1,793.00" "$1,793.00" "$1,330.76" "$1,330.76" "$1,382.04" $934.15 $373.68 "$1,793.00" $717.20 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,344.75" "$1,793.00" "$1,793.00" "$1,793.00" $896.50 $896.50 "$1,420.06" "$1,793.00" "$1,434.40" "$1,165.45" "$1,793.00" "$1,793.00" "$1,039.94" "$1,793.00" "$1,075.80" "$1,793.00" "$1,793.00" "$1,793.00" N/A N/A 27202850 EAP Custom 27202850 ADJUSTABLE OUTRIGGER(FLEX/EXT) BOTH IP/OP $365.00 $270.50 $64.97 $365.00 $365.00 $365.00 $365.00 $365.00 $365.00 $365.00 $64.97 $365.00 $365.00 $270.90 $270.90 $281.34 $190.17 $76.07 $365.00 $146.00 $365.00 $365.00 $365.00 $365.00 $365.00 $273.75 $365.00 $365.00 $365.00 $182.50 $182.50 $289.08 $365.00 $292.00 $237.25 $365.00 $365.00 $211.70 $365.00 $219.00 $365.00 $365.00 $365.00 N/A N/A 27202852 EAP Custom 27202852 ADJUSTABLE WRIST HINGE BOTH IP/OP $412.00 $305.00 $73.34 $412.00 $412.00 $412.00 $412.00 $412.00 $412.00 $412.00 $73.34 $412.00 $412.00 $305.79 $305.79 $317.57 $214.65 $85.87 $412.00 $164.80 $412.00 $412.00 $412.00 $412.00 $412.00 $309.00 $412.00 $412.00 $412.00 $206.00 $206.00 $326.30 $412.00 $329.60 $267.80 $412.00 $412.00 $238.96 $412.00 $247.20 $412.00 $412.00 $412.00 N/A N/A 27202853 EAP Custom 27202853 ALUMAFOAM SPLINT BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27202854 EAP Custom 27202854 AQUACEL SILVER 4X4 BOTH IP/OP $51.00 $38.00 $9.08 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $9.08 $51.00 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $20.40 $51.00 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $51.00 $51.00 $29.58 $51.00 $30.60 $51.00 $51.00 $51.00 N/A N/A 27202855 EAP Custom 27202855 AQUACEL SILVER 6X6 BOTH IP/OP $117.00 $87.00 $20.83 $117.00 $117.00 $117.00 $117.00 $117.00 $117.00 $117.00 $20.83 $117.00 $117.00 $86.84 $86.84 $90.18 $60.96 $24.38 $117.00 $46.80 $117.00 $117.00 $117.00 $117.00 $117.00 $87.75 $117.00 $117.00 $117.00 $58.50 $58.50 $92.66 $117.00 $93.60 $76.05 $117.00 $117.00 $67.86 $117.00 $70.20 $117.00 $117.00 $117.00 N/A N/A 27202856 EAP Custom 27202856 AQUACEL SILVER 8X12 BOTH IP/OP $163.00 $121.00 $29.01 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $29.01 $163.00 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $65.20 $163.00 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $163.00 $163.00 $94.54 $163.00 $97.80 $163.00 $163.00 $163.00 N/A N/A 27202857 EAP Custom 27202857 AQUACEL SILVER ROPE BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27202858 EAP Custom 27202858 BIOCONCEPT BRIEF BOTH IP/OP $102.00 $75.50 $18.16 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $18.16 $102.00 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $40.80 $102.00 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $102.00 $102.00 $59.16 $102.00 $61.20 $102.00 $102.00 $102.00 N/A N/A 27202859 EAP Custom 27202859 BIOCONCEPT SLEEVED VEST BOTH IP/OP $145.00 $107.50 $25.81 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $25.81 $145.00 $145.00 $107.62 $107.62 $111.77 $75.55 $30.22 $145.00 $58.00 $145.00 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $94.25 $145.00 $145.00 $84.10 $145.00 $87.00 $145.00 $145.00 $145.00 N/A N/A 27202860 EAP Custom 27202860 BIOCONCEPTS BRIEF BOTH IP/OP $102.00 $75.50 $18.16 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $18.16 $102.00 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $40.80 $102.00 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $102.00 $102.00 $59.16 $102.00 $61.20 $102.00 $102.00 $102.00 N/A N/A 27202861 EAP Custom 27202861 BIOCONCEPTS DIGI - SLEEVE BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27202862 EAP Custom 27202862 "BIOCONCEPTS DIGI SLEEVES 3""" BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27202863 EAP Custom 27202863 BIOCONCEPTS FOREARM SLEEVE BOTH IP/OP $22.00 $16.50 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 27202865 EAP Custom 27202865 BIOCONCEPTS GLOVES BOTH IP/OP $56.00 $41.50 $9.97 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $9.97 $56.00 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $22.40 $56.00 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $56.00 $56.00 $32.48 $56.00 $33.60 $56.00 $56.00 $56.00 N/A N/A 27202867 EAP Custom 27202867 BIOCONCEPTS SLEEVED VEST BOTH IP/OP $145.00 $107.50 $25.81 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $25.81 $145.00 $145.00 $107.62 $107.62 $111.77 $75.55 $30.22 $145.00 $58.00 $145.00 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $94.25 $145.00 $145.00 $84.10 $145.00 $87.00 $145.00 $145.00 $145.00 N/A N/A 27202868 EAP Custom 27202868 BIOCONCEPTS UE SLEEVE BOTH IP/OP $56.00 $41.50 $9.97 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $9.97 $56.00 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $22.40 $56.00 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $56.00 $56.00 $32.48 $56.00 $33.60 $56.00 $56.00 $56.00 N/A N/A 27202869 EAP Custom 27202869 CHIN STRAP BOTH IP/OP $54.00 $40.00 $9.61 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $9.61 $54.00 $54.00 $40.08 $40.08 $41.62 $28.13 $11.25 $54.00 $21.60 $54.00 $54.00 $54.00 $54.00 $54.00 $40.50 $54.00 $54.00 $54.00 $27.00 $27.00 $42.77 $54.00 $43.20 $35.10 $54.00 $54.00 $31.32 $54.00 $32.40 $54.00 $54.00 $54.00 N/A N/A 27202870 EAP Custom 27202870 CLEAR ACRYLIC CONE BOTH IP/OP $67.00 $50.00 $11.93 $67.00 $67.00 $67.00 $67.00 $67.00 $67.00 $67.00 $11.93 $67.00 $67.00 $49.73 $49.73 $51.64 $34.91 $13.96 $67.00 $26.80 $67.00 $67.00 $67.00 $67.00 $67.00 $50.25 $67.00 $67.00 $67.00 $33.50 $33.50 $53.06 $67.00 $53.60 $43.55 $67.00 $67.00 $38.86 $67.00 $40.20 $67.00 $67.00 $67.00 N/A N/A 27202871 EAP Custom 27202871 DESENSITIZATION KITS BOTH IP/OP $26.00 $19.50 $4.63 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $4.63 $26.00 $26.00 $19.30 $19.30 $20.04 $13.55 $5.42 $26.00 $10.40 $26.00 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $16.90 $26.00 $26.00 $15.08 $26.00 $15.60 $26.00 $26.00 $26.00 N/A N/A 27202872 EAP Custom 27202872 DIGI SLEEVE BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27202874 EAP Custom 27202874 DOUBLE FINGER STALL BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27202875 EAP Custom 27202875 DYNAMIC FINGER FLEXION STRAP BOTH IP/OP $18.00 $13.50 $3.20 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $3.20 $18.00 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $7.20 $18.00 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $18.00 $18.00 $10.44 $18.00 $10.80 $18.00 $18.00 $18.00 N/A N/A 27202876 EAP Custom 27202876 DYNAMIC MP FLEXION SPRING BOTH IP/OP $130.00 $96.50 $23.14 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $23.14 $130.00 $130.00 $96.49 $96.49 $100.20 $67.73 $27.09 $130.00 $52.00 $130.00 $130.00 $130.00 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $65.00 $65.00 $102.96 $130.00 $104.00 $84.50 $130.00 $130.00 $75.40 $130.00 $78.00 $130.00 $130.00 $130.00 N/A N/A 27202877 EAP Custom 27202877 ELBOW PAD BOTH IP/OP $22.00 $16.50 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 27202878 EAP Custom 27202878 EXTERNAL FIXATOR SPLINT BOTH IP/OP $287.00 $212.50 $51.09 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $287.00 $51.09 $287.00 $287.00 $213.01 $213.01 $221.22 $149.53 $59.81 $287.00 $114.80 $287.00 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $186.55 $287.00 $287.00 $166.46 $287.00 $172.20 $287.00 $287.00 $287.00 N/A N/A 27202879 EAP Custom 27202879 EZY WRAP TIGGER SPLINT BOTH IP/OP $22.00 $16.50 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 27202881 EAP Custom 27202881 FINGER CYLINDER CAST BOTH IP/OP $6.00 $4.50 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 27202882 EAP Custom 27202882 FINGER KNUCKLE BENDER SPLINT BOTH IP/OP $104.00 $77.00 $18.51 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $18.51 $104.00 $104.00 $77.19 $77.19 $80.16 $54.18 $21.67 $104.00 $41.60 $104.00 $104.00 $104.00 $104.00 $104.00 $78.00 $104.00 $104.00 $104.00 $52.00 $52.00 $82.37 $104.00 $83.20 $67.60 $104.00 $104.00 $60.32 $104.00 $62.40 $104.00 $104.00 $104.00 N/A N/A 27202883 EAP Custom 27202883 GREEN STICK SPLINT BOTH IP/OP $160.00 $118.50 $28.48 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $28.48 $160.00 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $64.00 $160.00 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $160.00 $160.00 $92.80 $160.00 $96.00 $160.00 $160.00 $160.00 N/A N/A 27202884 EAP Custom 27202884 INDIVIDUAL OUTIGGER-EACH DIGIT BOTH IP/OP $71.00 $53.00 $12.64 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $12.64 $71.00 $71.00 $52.70 $52.70 $54.73 $36.99 $14.80 $71.00 $28.40 $71.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $46.15 $71.00 $71.00 $41.18 $71.00 $42.60 $71.00 $71.00 $71.00 N/A N/A 27202885 EAP Custom 27202885 INDIVISUAL OUTRIGGER BOTH IP/OP $71.00 $53.00 $12.64 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $12.64 $71.00 $71.00 $52.70 $52.70 $54.73 $36.99 $14.80 $71.00 $28.40 $71.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $46.15 $71.00 $71.00 $41.18 $71.00 $42.60 $71.00 $71.00 $71.00 N/A N/A 27202886 EAP Custom 27202886 JOINT JACK BOTH IP/OP $176.00 $130.50 $31.33 $176.00 $176.00 $176.00 $176.00 $176.00 $176.00 $176.00 $31.33 $176.00 $176.00 $130.63 $130.63 $135.66 $91.70 $36.68 $176.00 $70.40 $176.00 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $114.40 $176.00 $176.00 $102.08 $176.00 $105.60 $176.00 $176.00 $176.00 N/A N/A 27202887 EAP Custom 27202887 KNEE HYPERCONTROL BRACE BOTH IP/OP $217.00 $161.00 $38.63 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $217.00 $38.63 $217.00 $217.00 $161.06 $161.06 $167.26 $113.06 $45.23 $217.00 $86.80 $217.00 $217.00 $217.00 $217.00 $217.00 $162.75 $217.00 $217.00 $217.00 $108.50 $108.50 $171.86 $217.00 $173.60 $141.05 $217.00 $217.00 $125.86 $217.00 $130.20 $217.00 $217.00 $217.00 N/A N/A 27202888 EAP Custom 27202888 LMB ULNAR DEVIATION SPLINT BOTH IP/OP $176.00 $130.50 $31.33 $176.00 $176.00 $176.00 $176.00 $176.00 $176.00 $176.00 $31.33 $176.00 $176.00 $130.63 $130.63 $135.66 $91.70 $36.68 $176.00 $70.40 $176.00 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $114.40 $176.00 $176.00 $102.08 $176.00 $105.60 $176.00 $176.00 $176.00 N/A N/A 27202889 EAP Custom 27202889 MERIT STATIC PRO COMPONENT BOTH IP/OP $149.00 $110.50 $26.52 $149.00 $149.00 $149.00 $149.00 $149.00 $149.00 $149.00 $26.52 $149.00 $149.00 $110.59 $110.59 $114.85 $77.63 $31.05 $149.00 $59.60 $149.00 $149.00 $149.00 $149.00 $149.00 $111.75 $149.00 $149.00 $149.00 $74.50 $74.50 $118.01 $149.00 $119.20 $96.85 $149.00 $149.00 $86.42 $149.00 $89.40 $149.00 $149.00 $149.00 N/A N/A 27202890 EAP Custom 27202890 MERIT STATIC PROGRESSIVE COMP BOTH IP/OP $149.00 $110.50 $26.52 $149.00 $149.00 $149.00 $149.00 $149.00 $149.00 $149.00 $26.52 $149.00 $149.00 $110.59 $110.59 $114.85 $77.63 $31.05 $149.00 $59.60 $149.00 $149.00 $149.00 $149.00 $149.00 $111.75 $149.00 $149.00 $149.00 $74.50 $74.50 $118.01 $149.00 $119.20 $96.85 $149.00 $149.00 $86.42 $149.00 $89.40 $149.00 $149.00 $149.00 N/A N/A 27202891 EAP Custom 27202891 NEOPRENE TENNIS ELBOW STRAP BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 $135.00 $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A 27202892 EAP Custom 27202892 PREFORMED ELBOW HINGE SPLINT BOTH IP/OP $515.00 $381.50 $91.67 $515.00 $515.00 $515.00 $515.00 $515.00 $515.00 $515.00 $91.67 $515.00 $515.00 $382.23 $382.23 $396.96 $268.32 $107.33 $515.00 $206.00 $515.00 $515.00 $515.00 $515.00 $515.00 $386.25 $515.00 $515.00 $515.00 $257.50 $257.50 $407.88 $515.00 $412.00 $334.75 $515.00 $515.00 $298.70 $515.00 $309.00 $515.00 $515.00 $515.00 N/A N/A 27202893 EAP Custom 27202893 PROFORE BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27202894 EAP Custom 27202894 REDI-FIT BREIFS BOTH IP/OP $102.00 $75.50 $18.16 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $18.16 $102.00 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $40.80 $102.00 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $102.00 $102.00 $59.16 $102.00 $61.20 $102.00 $102.00 $102.00 N/A N/A 27202897 EAP Custom 27202897 REDI-FIT FOREARM SLEEVES BOTH IP/OP $22.00 $16.50 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 27202898 EAP Custom 27202898 REDI-FIT SLEEVED VEST BOTH IP/OP $145.00 $107.50 $25.81 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $25.81 $145.00 $145.00 $107.62 $107.62 $111.77 $75.55 $30.22 $145.00 $58.00 $145.00 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $94.25 $145.00 $145.00 $84.10 $145.00 $87.00 $145.00 $145.00 $145.00 N/A N/A 27202899 EAP Custom 27202899 REDI-FIT UE SLEEVES BOTH IP/OP $56.00 $41.50 $9.97 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $9.97 $56.00 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $22.40 $56.00 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $56.00 $56.00 $32.48 $56.00 $33.60 $56.00 $56.00 $56.00 N/A N/A 27202900 EAP Custom 27202900 REVERSE KNUCKLE BENDER SPLINT BOTH IP/OP $104.00 $77.00 $18.51 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $104.00 $18.51 $104.00 $104.00 $77.19 $77.19 $80.16 $54.18 $21.67 $104.00 $41.60 $104.00 $104.00 $104.00 $104.00 $104.00 $78.00 $104.00 $104.00 $104.00 $52.00 $52.00 $82.37 $104.00 $83.20 $67.60 $104.00 $104.00 $60.32 $104.00 $62.40 $104.00 $104.00 $104.00 N/A N/A 27202901 EAP Custom 27202901 RING SPLINT BOTH IP/OP $157.00 $116.50 $27.95 $157.00 $157.00 $157.00 $157.00 $157.00 $157.00 $157.00 $27.95 $157.00 $157.00 $116.53 $116.53 $121.02 $81.80 $32.72 $157.00 $62.80 $157.00 $157.00 $157.00 $157.00 $157.00 $117.75 $157.00 $157.00 $157.00 $78.50 $78.50 $124.34 $157.00 $125.60 $102.05 $157.00 $157.00 $91.06 $157.00 $94.20 $157.00 $157.00 $157.00 N/A N/A 27202902 EAP Custom 27202902 SOFT ULNAR DEVIATION SUPPORT BOTH IP/OP $69.00 $51.50 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 27202903 EAP Custom 27202903 SUPINATION / PRONATION KIT BOTH IP/OP $276.00 $204.50 $49.13 $276.00 $276.00 $276.00 $276.00 $276.00 $276.00 $276.00 $49.13 $276.00 $276.00 $204.85 $204.85 $212.74 $143.80 $57.52 $276.00 $110.40 $276.00 $276.00 $276.00 $276.00 $276.00 $207.00 $276.00 $276.00 $276.00 $138.00 $138.00 $218.59 $276.00 $220.80 $179.40 $276.00 $276.00 $160.08 $276.00 $165.60 $276.00 $276.00 $276.00 N/A N/A 27202905 EAP Custom 27202905 TAP SPLINT BOTH IP/OP $211.00 $156.50 $37.56 $211.00 $211.00 $211.00 $211.00 $211.00 $211.00 $211.00 $37.56 $211.00 $211.00 $156.60 $156.60 $162.64 $109.93 $43.97 $211.00 $84.40 $211.00 $211.00 $211.00 $211.00 $211.00 $158.25 $211.00 $211.00 $211.00 $105.50 $105.50 $167.11 $211.00 $168.80 $137.15 $211.00 $211.00 $122.38 $211.00 $126.60 $211.00 $211.00 $211.00 N/A N/A 27202906 EAP Custom 27202906 ULNAR DEVIATION SLINT BOTH IP/OP $184.00 $136.50 $32.75 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $32.75 $184.00 $184.00 $136.56 $136.56 $141.83 $95.86 $38.35 $184.00 $73.60 $184.00 $184.00 $184.00 $184.00 $184.00 $138.00 $184.00 $184.00 $184.00 $92.00 $92.00 $145.73 $184.00 $147.20 $119.60 $184.00 $184.00 $106.72 $184.00 $110.40 $184.00 $184.00 $184.00 N/A N/A 27202908 EAP Custom 27202908 WRAP FINGER HOOKS BOTH IP/OP $21.00 $16.00 $3.74 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $3.74 $21.00 $21.00 $15.59 $15.59 $16.19 $10.94 $4.38 $21.00 $8.40 $21.00 $21.00 $21.00 $21.00 $21.00 $15.75 $21.00 $21.00 $21.00 $10.50 $10.50 $16.63 $21.00 $16.80 $13.65 $21.00 $21.00 $12.18 $21.00 $12.60 $21.00 $21.00 $21.00 N/A N/A 27202909 EAP Custom 27202909 WRAP ON FINGER HOOKS(EACH) BOTH IP/OP $21.00 $16.00 $3.74 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $3.74 $21.00 $21.00 $15.59 $15.59 $16.19 $10.94 $4.38 $21.00 $8.40 $21.00 $21.00 $21.00 $21.00 $21.00 $15.75 $21.00 $21.00 $21.00 $10.50 $10.50 $16.63 $21.00 $16.80 $13.65 $21.00 $21.00 $12.18 $21.00 $12.60 $21.00 $21.00 $21.00 N/A N/A 27202910 EAP Custom 27202910 WRIST HINGE W/ DYNAMIC SPRINGS BOTH IP/OP $480.00 $355.50 $85.44 $480.00 $480.00 $480.00 $480.00 $480.00 $480.00 $480.00 $85.44 $480.00 $480.00 $356.26 $356.26 $369.98 $250.08 $100.04 $480.00 $192.00 $480.00 $480.00 $480.00 $480.00 $480.00 $360.00 $480.00 $480.00 $480.00 $240.00 $240.00 $380.16 $480.00 $384.00 $312.00 $480.00 $480.00 $278.40 $480.00 $288.00 $480.00 $480.00 $480.00 N/A N/A 27202911 EAP HCPCS C1769 GWIRE VASC 185CM .014IN PRSS CLIP CONCTR RADIOPQ TIP TRQ DEV BOTH IP/OP "$1,772.00" "$1,311.50" $351.70 "$1,772.00" $962.20 $962.20 $962.20 $962.20 "$1,772.00" "$1,772.00" "$1,772.00" $369.33 "$1,772.00" "$1,315.18" "$1,315.18" "$1,365.86" $923.21 $369.30 "$1,772.00" "$1,772.00" "$1,048.14" "$1,772.00" "$1,772.00" "$1,772.00" "$1,772.00" "$1,329.00" "$1,772.00" "$1,772.00" "$1,772.00" $886.00 $886.00 "$1,403.42" "$1,772.00" "$1,417.60" "$1,151.80" $351.70 "$1,772.00" "$1,027.76" "$1,772.00" "$1,772.00" "$1,772.00" $369.28 "$1,772.00" N/A N/A 27202912 EAP HCPCS C1769 ABBOTT VASCULAR BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 27202913 EAP HCPCS C1725 CATH BALDILAT .035IN 5FR 9MM 75CM 40MM PTA LP NC MUSTANG BOTH IP/OP $525.00 $388.50 $104.20 $525.00 $285.08 $285.08 $285.08 $285.08 $525.00 $525.00 $525.00 $109.42 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $525.00 $310.54 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $104.20 $525.00 $304.50 $525.00 $525.00 $525.00 $109.41 $525.00 N/A N/A 27202914 EAP HCPCS C1725 CATH BALDILAT .035IN 5FR 8MM 75CM 40MM PTA LP NC MUSTANG BOTH IP/OP $525.00 $388.50 $104.20 $525.00 $285.08 $285.08 $285.08 $285.08 $525.00 $525.00 $525.00 $109.42 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $525.00 $310.54 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $104.20 $525.00 $304.50 $525.00 $525.00 $525.00 $109.41 $525.00 N/A N/A 27202915 EAP HCPCS C1726 CATHETER BALDILAT LP 5.3FR 4MM 75CM 40MM HIGH PRESSURE BOTH IP/OP $525.00 $388.50 $104.20 $525.00 $285.08 $285.08 $285.08 $285.08 $525.00 $525.00 $525.00 $109.42 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $525.00 $310.54 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $104.20 $525.00 $304.50 $525.00 $525.00 $525.00 $109.41 $525.00 N/A N/A 27202917 EAP HCPCS C1725 CATHETER BALLOON DILIT COYOTE 2 X 220 150CM OTW BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $488.70 $488.70 $488.70 $488.70 $900.00 $900.00 $900.00 $187.58 $900.00 $667.98 $667.98 $693.72 $468.90 $187.57 $900.00 $900.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $585.00 $178.63 $900.00 $522.00 $900.00 $900.00 $900.00 $187.56 $900.00 N/A N/A 27202918 EAP HCPCS C1725 "BALLOON COYOTE 2.5 X 220, 150CM, OTW" BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $488.70 $488.70 $488.70 $488.70 $900.00 $900.00 $900.00 $187.58 $900.00 $667.98 $667.98 $693.72 $468.90 $187.57 $900.00 $900.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $585.00 $178.63 $900.00 $522.00 $900.00 $900.00 $900.00 $187.56 $900.00 N/A N/A 27202919 EAP HCPCS C1725 CATHETER BALLOON DILIT COYOTE 3 X 100 150CM OTW BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $488.70 $488.70 $488.70 $488.70 $900.00 $900.00 $900.00 $187.58 $900.00 $667.98 $667.98 $693.72 $468.90 $187.57 $900.00 $900.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $585.00 $178.63 $900.00 $522.00 $900.00 $900.00 $900.00 $187.56 $900.00 N/A N/A 27202920 EAP HCPCS C1725 CATH BALDILAT .035IN 5FR 5MM 135CM 200MM PTA LP NC MUSTANG BOTH IP/OP $525.00 $388.50 $104.20 $525.00 $285.08 $285.08 $285.08 $285.08 $525.00 $525.00 $525.00 $109.42 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $525.00 $310.54 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $104.20 $525.00 $304.50 $525.00 $525.00 $525.00 $109.41 $525.00 N/A N/A 27202922 EAP HCPCS C1768 SET INTROD 40CM 4FR MPNCH PSH+ .018IN NTNL TRNSTLS STF CANNU BOTH IP/OP $105.00 $78.00 $20.84 $105.00 $57.02 $57.02 $57.02 $57.02 $105.00 $105.00 $105.00 $21.88 $105.00 $77.93 $77.93 $80.93 $54.71 $21.88 $105.00 $105.00 $62.11 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $68.25 $20.84 $105.00 $60.90 $105.00 $105.00 $105.00 $21.88 $105.00 N/A N/A 27202923 EAP HCPCS C1769 GWIRE VASC 1.5MM RSN CURVE .035IN 180CM 1.5MM CVD CATH EXCH BOTH IP/OP $45.00 $33.50 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $45.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 $45.00 $26.10 $45.00 $45.00 $45.00 $9.38 $45.00 N/A N/A 27202926 EAP HCPCS C1894 SHEATH GUID 45CM 6FR .087IN CHK-FLO FLXR .018/.038IN ANL0 BOTH IP/OP $125.00 $92.50 $24.81 $125.00 $67.88 $67.88 $67.88 $67.88 $125.00 $125.00 $125.00 $26.05 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $24.81 $125.00 $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 27202927 EAP HCPCS C1894 SHEATH GUID 45CM 5FR .074IN CHK-FLO FLXR .018/.038IN ANL0 BOTH IP/OP $119.00 $88.50 $23.62 $119.00 $64.62 $64.62 $64.62 $64.62 $119.00 $119.00 $119.00 $24.80 $119.00 $88.32 $88.32 $91.73 $62.00 $24.80 $119.00 $119.00 $70.39 $119.00 $119.00 $119.00 $119.00 $89.25 $119.00 $119.00 $119.00 $59.50 $59.50 $94.25 $119.00 $95.20 $77.35 $23.62 $119.00 $69.02 $119.00 $119.00 $119.00 $24.80 $119.00 N/A N/A 27202928 EAP HCPCS C1769 GWIRE VASC .035IN 145CM 20CM STR FLEXIBILE TIP FLPY BNTSN LG BOTH IP/OP $51.00 $38.00 $10.12 $51.00 $27.69 $27.69 $27.69 $27.69 $51.00 $51.00 $51.00 $10.63 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $51.00 $30.17 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $10.12 $51.00 $29.58 $51.00 $51.00 $51.00 $10.63 $51.00 N/A N/A 27202929 EAP HCPCS C1894 INTROD SHTH 5FR .074IN 70CM ANL1 CURVE MULTPUR TIP ANSEL BOTH IP/OP $170.00 $126.00 $33.74 $170.00 $92.31 $92.31 $92.31 $92.31 $170.00 $170.00 $170.00 $35.43 $170.00 $126.17 $126.17 $131.04 $88.57 $35.43 $170.00 $170.00 $100.56 $170.00 $170.00 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $110.50 $33.74 $170.00 $98.60 $170.00 $170.00 $170.00 $35.43 $170.00 N/A N/A 27202930 EAP HCPCS C1887 CATH GUID .035IN 5MM SPC 3.1FR 150CM LP TPR TIP SPRT RADIOPQ BOTH IP/OP "$2,257.00" "$1,670.50" $447.96 "$2,257.00" "$1,225.55" "$1,225.55" "$1,225.55" "$1,225.55" "$2,257.00" "$2,257.00" "$2,257.00" $470.42 "$2,257.00" "$1,675.15" "$1,675.15" "$1,739.70" "$1,175.90" $470.38 "$2,257.00" "$2,257.00" "$1,335.02" "$2,257.00" "$2,257.00" "$2,257.00" "$2,257.00" "$1,692.75" "$2,257.00" "$2,257.00" "$2,257.00" "$1,128.50" "$1,128.50" "$1,787.54" "$2,257.00" "$1,805.60" "$1,467.05" $447.96 "$2,257.00" "$1,309.06" "$2,257.00" "$2,257.00" "$2,257.00" $470.36 "$2,257.00" N/A N/A 27202931 EAP HCPCS C1887 CATH GUID .014IN 3-1.9FR 150CM 3 RADIOPQ MRKR LOW CX PRFL BOTH IP/OP "$2,257.00" "$1,670.50" $447.96 "$2,257.00" "$1,225.55" "$1,225.55" "$1,225.55" "$1,225.55" "$2,257.00" "$2,257.00" "$2,257.00" $470.42 "$2,257.00" "$1,675.15" "$1,675.15" "$1,739.70" "$1,175.90" $470.38 "$2,257.00" "$2,257.00" "$1,335.02" "$2,257.00" "$2,257.00" "$2,257.00" "$2,257.00" "$1,692.75" "$2,257.00" "$2,257.00" "$2,257.00" "$1,128.50" "$1,128.50" "$1,787.54" "$2,257.00" "$1,805.60" "$1,467.05" $447.96 "$2,257.00" "$1,309.06" "$2,257.00" "$2,257.00" "$2,257.00" $470.36 "$2,257.00" N/A N/A 27202932 EAP HCPCS C1769 GWIRE VASC STD .035IN 150CM 3CM ANG TIP KINK RST GLDWR BOTH IP/OP $418.00 $309.50 $82.96 $418.00 $226.97 $226.97 $226.97 $226.97 $418.00 $418.00 $418.00 $87.12 $418.00 $310.24 $310.24 $322.19 $217.78 $87.12 $418.00 $418.00 $247.25 $418.00 $418.00 $418.00 $418.00 $313.50 $418.00 $418.00 $418.00 $209.00 $209.00 $331.06 $418.00 $334.40 $271.70 $82.96 $418.00 $242.44 $418.00 $418.00 $418.00 $87.11 $418.00 N/A N/A 27202933 EAP HCPCS C1769 GWIRE VASC STD .035IN 260CM 3CM ANG TIP STF SHFT GLDWR BOTH IP/OP $699.00 $517.50 $138.73 $699.00 $379.56 $379.56 $379.56 $379.56 $699.00 $699.00 $699.00 $145.69 $699.00 $518.80 $518.80 $538.79 $364.18 $145.68 $699.00 $699.00 $413.46 $699.00 $699.00 $699.00 $699.00 $524.25 $699.00 $699.00 $699.00 $349.50 $349.50 $553.61 $699.00 $559.20 $454.35 $138.73 $699.00 $405.42 $699.00 $699.00 $699.00 $145.67 $699.00 N/A N/A 27202935 EAP HCPCS C1769 GWIRE VASC ENDOSCOPIC TERUMO L260 CM OD.035 IN STRAIGHT BOTH IP/OP $623.00 $461.50 $123.65 $623.00 $338.29 $338.29 $338.29 $338.29 $623.00 $623.00 $623.00 $129.85 $623.00 $462.39 $462.39 $480.21 $324.58 $129.84 $623.00 $623.00 $368.50 $623.00 $623.00 $623.00 $623.00 $467.25 $623.00 $623.00 $623.00 $311.50 $311.50 $493.42 $623.00 $498.40 $404.95 $123.65 $623.00 $361.34 $623.00 $623.00 $623.00 $129.83 $623.00 N/A N/A 27202936 EAP Custom 27202936 BURN PAD 36X24IN ABS DRSG SLVR STRL BOTH IP/OP $221.00 $164.00 $39.34 $221.00 $221.00 $221.00 $221.00 $221.00 $221.00 $221.00 $39.34 $221.00 $221.00 $164.03 $164.03 $170.35 $115.14 $46.06 $221.00 $88.40 $221.00 $221.00 $221.00 $221.00 $221.00 $165.75 $221.00 $221.00 $221.00 $110.50 $110.50 $175.03 $221.00 $176.80 $143.65 $221.00 $221.00 $128.18 $221.00 $132.60 $221.00 $221.00 $221.00 N/A N/A 27202940 EAP Custom 27202940 "BIOCONCEPTS DIGI-SLEEVE (PER DIGIT - 3"")." BOTH IP/OP $17.00 $13.00 $3.03 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $17.00 $3.03 $17.00 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $17.00 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $17.00 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 27202941 EAP HCPCS C1769 STDJ-185-4076 BOTH IP/OP $223.00 $165.50 $44.26 $223.00 $121.09 $121.09 $121.09 $121.09 $223.00 $223.00 $223.00 $46.48 $223.00 $165.51 $165.51 $171.89 $116.18 $46.48 $223.00 $223.00 $131.90 $223.00 $223.00 $223.00 $223.00 $167.25 $223.00 $223.00 $223.00 $111.50 $111.50 $176.62 $223.00 $178.40 $144.95 $44.26 $223.00 $129.34 $223.00 $223.00 $223.00 $46.47 $223.00 N/A N/A 27202942 EAP HCPCS C1769 STDJ-300-4076 BOTH IP/OP $223.00 $165.50 $44.26 $223.00 $121.09 $121.09 $121.09 $121.09 $223.00 $223.00 $223.00 $46.48 $223.00 $165.51 $165.51 $171.89 $116.18 $46.48 $223.00 $223.00 $131.90 $223.00 $223.00 $223.00 $223.00 $167.25 $223.00 $223.00 $223.00 $111.50 $111.50 $176.62 $223.00 $178.40 $144.95 $44.26 $223.00 $129.34 $223.00 $223.00 $223.00 $46.47 $223.00 N/A N/A 27202943 EAP HCPCS C1769 STDJ-86-15 40785 BOTH IP/OP $281.00 $208.00 $55.77 $281.00 $152.58 $152.58 $152.58 $152.58 $281.00 $281.00 $281.00 $58.57 $281.00 $208.56 $208.56 $216.59 $146.40 $58.56 $281.00 $281.00 $166.21 $281.00 $281.00 $281.00 $281.00 $210.75 $281.00 $281.00 $281.00 $140.50 $140.50 $222.55 $281.00 $224.80 $182.65 $55.77 $281.00 $162.98 $281.00 $281.00 $281.00 $58.56 $281.00 N/A N/A 27202944 EAP HCPCS C1769 SDJ-86-5 40785 BOTH IP/OP $281.00 $208.00 $55.77 $281.00 $152.58 $152.58 $152.58 $152.58 $281.00 $281.00 $281.00 $58.57 $281.00 $208.56 $208.56 $216.59 $146.40 $58.56 $281.00 $281.00 $166.21 $281.00 $281.00 $281.00 $281.00 $210.75 $281.00 $281.00 $281.00 $140.50 $140.50 $222.55 $281.00 $224.80 $182.65 $55.77 $281.00 $162.98 $281.00 $281.00 $281.00 $58.56 $281.00 N/A N/A 27202945 EAP HCPCS C1725 CORONARY SINUS BALLOON VENOGRAPHY CATHETER BOTH IP/OP $325.00 $240.50 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 $325.00 $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 27202950 EAP Custom 27202950 C-36-152 COIL INTERLOCK DETACH BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27202951 EAP Custom 27202951 C-36-154 COIL INTERLOCK DETACH BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27202952 EAP Custom 27202952 C-36-156 COIL INTERLOCK DETACH BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27202953 EAP Custom 27202953 C-36-157 COIL INTERLOCK DETACH BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27202954 EAP HCPCS C1887 CG510 GLIDE CATHETER SIMMON1 BOTH IP/OP "$1,253.00" $927.50 $248.69 "$1,253.00" $680.38 $680.38 $680.38 $680.38 "$1,253.00" "$1,253.00" "$1,253.00" $261.16 "$1,253.00" $929.98 $929.98 $965.81 $652.81 $261.14 "$1,253.00" "$1,253.00" $741.15 "$1,253.00" "$1,253.00" "$1,253.00" "$1,253.00" $939.75 "$1,253.00" "$1,253.00" "$1,253.00" $626.50 $626.50 $992.38 "$1,253.00" "$1,002.40" $814.45 $248.69 "$1,253.00" $726.74 "$1,253.00" "$1,253.00" "$1,253.00" $261.13 "$1,253.00" N/A N/A 27202955 EAP HCPCS C1725 CG514 BENSON-HANAFEE 1 BOTH IP/OP "$1,193.00" $883.00 $236.78 "$1,193.00" $536.85 $536.85 $536.85 $536.85 "$1,193.00" "$1,193.00" "$1,193.00" $248.65 "$1,193.00" "$1,193.00" "$1,193.00" "$1,193.00" "$1,193.00" $248.63 "$1,193.00" "$1,193.00" $705.66 "$1,193.00" "$1,193.00" "$1,193.00" "$1,193.00" $894.75 "$1,193.00" "$1,193.00" "$1,193.00" $596.50 $596.50 $944.86 "$1,193.00" $954.40 $536.85 $236.78 "$1,193.00" $691.94 "$1,193.00" "$1,193.00" "$1,193.00" $248.62 "$1,193.00" N/A N/A 27202956 EAP HCPCS C1880 OPTION IVC FILTER BOTH IP/OP "$1,429.00" "$1,057.50" $297.82 "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" $297.82 "$1,429.00" $571.60 "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,071.75" "$1,429.00" "$1,429.00" "$1,429.00" $714.50 $714.50 "$1,131.77" "$1,429.00" "$1,143.20" $643.05 "$1,429.00" "$1,429.00" $828.82 "$1,429.00" $857.40 "$1,429.00" "$1,429.00" "$1,429.00" N/A N/A 27202959 EAP HCPCS C1725 CATHETER GLIDE SIMMONS 2 BOTH IP/OP $171.00 $127.00 $33.94 $171.00 $76.95 $76.95 $76.95 $76.95 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $101.15 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $76.95 $33.94 $171.00 $99.18 $171.00 $171.00 $171.00 $35.64 $171.00 N/A N/A 27202960 EAP HCPCS C1725 CATHETER VERTEBRAL 5FR BOTH IP/OP $40.00 $30.00 $7.94 $40.00 $18.00 $18.00 $18.00 $18.00 $40.00 $40.00 $40.00 $8.34 $40.00 $40.00 $40.00 $40.00 $40.00 $8.34 $40.00 $40.00 $23.66 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $18.00 $7.94 $40.00 $23.20 $40.00 $40.00 $40.00 $8.34 $40.00 N/A N/A 27202961 EAP HCPCS C1751 MICROCATHETER STC BOTH IP/OP "$1,264.00" $935.50 $250.87 "$1,264.00" $686.35 $686.35 $686.35 $686.35 "$1,264.00" "$1,264.00" "$1,264.00" $263.45 "$1,264.00" $938.14 $938.14 $974.29 $658.54 $263.43 "$1,264.00" "$1,264.00" $747.66 "$1,264.00" "$1,264.00" "$1,264.00" "$1,264.00" $948.00 "$1,264.00" "$1,264.00" "$1,264.00" $632.00 $632.00 "$1,001.09" "$1,264.00" "$1,011.20" $821.60 $250.87 "$1,264.00" $733.12 "$1,264.00" "$1,264.00" "$1,264.00" $263.42 "$1,264.00" N/A N/A 27202962 EAP HCPCS C1751 SYSTEM DRG DLV L106 CM 30CM EKOSONIC INTLGNT CATH MICROSONIC BOTH IP/OP "$7,074.00" "$5,235.00" "$1,404.01" "$7,074.00" "$3,841.18" "$3,841.18" "$3,841.18" "$3,841.18" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.40" "$7,074.00" "$4,181.12" "$4,181.12" "$5,452.64" "$2,060.15" "$1,474.30" "$7,074.00" "$7,074.00" "$3,094.73" "$7,074.00" "$7,074.00" "$7,074.00" "$7,074.00" "$5,305.50" "$7,074.00" "$7,074.00" "$7,074.00" "$3,537.00" "$3,537.00" "$5,602.61" "$7,074.00" "$5,659.20" "$4,598.10" "$1,404.01" "$7,074.00" "$4,102.92" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.22" "$7,074.00" N/A N/A 27202963 EAP HCPCS C1751 SYSTEM DRG DLV L106 CM 40CM EKOSONIC INTLGNT CATH MICROSONIC BOTH IP/OP "$6,738.00" "$4,986.50" "$1,337.32" "$6,738.00" "$3,658.73" "$3,658.73" "$3,658.73" "$3,658.73" "$6,738.00" "$6,738.00" "$6,738.00" "$1,404.37" "$6,738.00" "$4,181.12" "$4,181.12" "$5,193.65" "$2,060.15" "$1,404.27" "$6,738.00" "$6,738.00" "$3,094.73" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$5,053.50" "$6,738.00" "$6,738.00" "$6,738.00" "$3,369.00" "$3,369.00" "$5,336.50" "$6,738.00" "$5,390.40" "$4,379.70" "$1,337.32" "$6,738.00" "$3,908.04" "$6,738.00" "$6,738.00" "$6,738.00" "$1,404.20" "$6,738.00" N/A N/A 27202964 EAP HCPCS C1751 SYSTEM DRG DLV L106 CM 50CM EKOSONIC MACH 4 INTLGNT CATH BOTH IP/OP "$6,738.00" "$4,986.50" "$1,337.32" "$6,738.00" "$3,658.73" "$3,658.73" "$3,658.73" "$3,658.73" "$6,738.00" "$6,738.00" "$6,738.00" "$1,404.37" "$6,738.00" "$4,181.12" "$4,181.12" "$5,193.65" "$2,060.15" "$1,404.27" "$6,738.00" "$6,738.00" "$3,094.73" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$5,053.50" "$6,738.00" "$6,738.00" "$6,738.00" "$3,369.00" "$3,369.00" "$5,336.50" "$6,738.00" "$5,390.40" "$4,379.70" "$1,337.32" "$6,738.00" "$3,908.04" "$6,738.00" "$6,738.00" "$6,738.00" "$1,404.20" "$6,738.00" N/A N/A 27202965 EAP HCPCS C1751 SYSTEM DRG DLV L135 CM 12CM EKOSONIC MACH 4 INTLGNT CATH BOTH IP/OP "$6,738.00" "$4,986.50" "$1,337.32" "$6,738.00" "$3,658.73" "$3,658.73" "$3,658.73" "$3,658.73" "$6,738.00" "$6,738.00" "$6,738.00" "$1,404.37" "$6,738.00" "$4,181.12" "$4,181.12" "$5,193.65" "$2,060.15" "$1,404.27" "$6,738.00" "$6,738.00" "$3,094.73" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$5,053.50" "$6,738.00" "$6,738.00" "$6,738.00" "$3,369.00" "$3,369.00" "$5,336.50" "$6,738.00" "$5,390.40" "$4,379.70" "$1,337.32" "$6,738.00" "$3,908.04" "$6,738.00" "$6,738.00" "$6,738.00" "$1,404.20" "$6,738.00" N/A N/A 27202966 EAP HCPCS C1751 SYSTEM DRG DLV L135 CM 30CM EKOSONIC INTLGNT CATH MICROSONIC BOTH IP/OP "$7,074.00" "$5,235.00" "$1,404.01" "$7,074.00" "$3,841.18" "$3,841.18" "$3,841.18" "$3,841.18" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.40" "$7,074.00" "$4,181.12" "$4,181.12" "$5,452.64" "$2,060.15" "$1,474.30" "$7,074.00" "$7,074.00" "$3,094.73" "$7,074.00" "$7,074.00" "$7,074.00" "$7,074.00" "$5,305.50" "$7,074.00" "$7,074.00" "$7,074.00" "$3,537.00" "$3,537.00" "$5,602.61" "$7,074.00" "$5,659.20" "$4,598.10" "$1,404.01" "$7,074.00" "$4,102.92" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.22" "$7,074.00" N/A N/A 27202967 EAP HCPCS C1751 SYSTEM DRG DLV L135 CM 40CM EKOSONIC INTLGNT CATH MICROSONIC BOTH IP/OP "$7,074.00" "$5,235.00" "$1,404.01" "$7,074.00" "$3,841.18" "$3,841.18" "$3,841.18" "$3,841.18" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.40" "$7,074.00" "$4,181.12" "$4,181.12" "$5,452.64" "$2,060.15" "$1,474.30" "$7,074.00" "$7,074.00" "$3,094.73" "$7,074.00" "$7,074.00" "$7,074.00" "$7,074.00" "$5,305.50" "$7,074.00" "$7,074.00" "$7,074.00" "$3,537.00" "$3,537.00" "$5,602.61" "$7,074.00" "$5,659.20" "$4,598.10" "$1,404.01" "$7,074.00" "$4,102.92" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.22" "$7,074.00" N/A N/A 27202968 EAP HCPCS C1751 SYSTEM DRG DLV L135 CM 50CM EKOSONIC TX ZN EVAS DEV CATH GWI BOTH IP/OP "$7,074.00" "$5,235.00" "$1,404.01" "$7,074.00" "$3,841.18" "$3,841.18" "$3,841.18" "$3,841.18" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.40" "$7,074.00" "$4,181.12" "$4,181.12" "$5,452.64" "$2,060.15" "$1,474.30" "$7,074.00" "$7,074.00" "$3,094.73" "$7,074.00" "$7,074.00" "$7,074.00" "$7,074.00" "$5,305.50" "$7,074.00" "$7,074.00" "$7,074.00" "$3,537.00" "$3,537.00" "$5,602.61" "$7,074.00" "$5,659.20" "$4,598.10" "$1,404.01" "$7,074.00" "$4,102.92" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.22" "$7,074.00" N/A N/A 27202969 EAP HCPCS C1751 SYSTEM DRG DLV L106 CM 6CM EKOSONIC INTLGNT CATH MICROSONIC BOTH IP/OP "$7,074.00" "$5,235.00" "$1,404.01" "$7,074.00" "$3,841.18" "$3,841.18" "$3,841.18" "$3,841.18" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.40" "$7,074.00" "$4,181.12" "$4,181.12" "$5,452.64" "$2,060.15" "$1,474.30" "$7,074.00" "$7,074.00" "$3,094.73" "$7,074.00" "$7,074.00" "$7,074.00" "$7,074.00" "$5,305.50" "$7,074.00" "$7,074.00" "$7,074.00" "$3,537.00" "$3,537.00" "$5,602.61" "$7,074.00" "$5,659.20" "$4,598.10" "$1,404.01" "$7,074.00" "$4,102.92" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.22" "$7,074.00" N/A N/A 27202970 EAP HCPCS C1751 SYSTEM DRG DLV L106 CM 12CM EKOSONIC CATH US THRMBS 106CM 12 BOTH IP/OP "$7,074.00" "$5,235.00" "$1,404.01" "$7,074.00" "$3,841.18" "$3,841.18" "$3,841.18" "$3,841.18" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.40" "$7,074.00" "$4,181.12" "$4,181.12" "$5,452.64" "$2,060.15" "$1,474.30" "$7,074.00" "$7,074.00" "$3,094.73" "$7,074.00" "$7,074.00" "$7,074.00" "$7,074.00" "$5,305.50" "$7,074.00" "$7,074.00" "$7,074.00" "$3,537.00" "$3,537.00" "$5,602.61" "$7,074.00" "$5,659.20" "$4,598.10" "$1,404.01" "$7,074.00" "$4,102.92" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.22" "$7,074.00" N/A N/A 27202971 EAP HCPCS C1751 SYSTEM DRG DLV L106 CM 18CM EKOSONIC INTLGNT CATH MICROSONIC BOTH IP/OP "$7,074.00" "$5,235.00" "$1,404.01" "$7,074.00" "$3,841.18" "$3,841.18" "$3,841.18" "$3,841.18" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.40" "$7,074.00" "$4,181.12" "$4,181.12" "$5,452.64" "$2,060.15" "$1,474.30" "$7,074.00" "$7,074.00" "$3,094.73" "$7,074.00" "$7,074.00" "$7,074.00" "$7,074.00" "$5,305.50" "$7,074.00" "$7,074.00" "$7,074.00" "$3,537.00" "$3,537.00" "$5,602.61" "$7,074.00" "$5,659.20" "$4,598.10" "$1,404.01" "$7,074.00" "$4,102.92" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.22" "$7,074.00" N/A N/A 27202972 EAP HCPCS C1751 SYSTEM DRG DLV L106 CM 24CM EKOSONIC INTLGNT CATH MICROSONIC BOTH IP/OP "$7,074.00" "$5,235.00" "$1,404.01" "$7,074.00" "$3,841.18" "$3,841.18" "$3,841.18" "$3,841.18" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.40" "$7,074.00" "$4,181.12" "$4,181.12" "$5,452.64" "$2,060.15" "$1,474.30" "$7,074.00" "$7,074.00" "$3,094.73" "$7,074.00" "$7,074.00" "$7,074.00" "$7,074.00" "$5,305.50" "$7,074.00" "$7,074.00" "$7,074.00" "$3,537.00" "$3,537.00" "$5,602.61" "$7,074.00" "$5,659.20" "$4,598.10" "$1,404.01" "$7,074.00" "$4,102.92" "$7,074.00" "$7,074.00" "$7,074.00" "$1,474.22" "$7,074.00" N/A N/A 27202973 EAP HCPCS C1729 KIT CATH PERITONEUM STRT PLEURX 1000ML BOTH IP/OP "$2,226.00" "$1,647.50" $441.81 "$2,226.00" "$1,208.72" "$1,208.72" "$1,208.72" "$1,208.72" "$2,226.00" "$2,226.00" "$2,226.00" $463.95 "$2,226.00" "$1,652.14" "$1,652.14" "$1,715.80" "$1,159.75" $463.92 "$2,226.00" "$2,226.00" "$1,316.68" "$2,226.00" "$2,226.00" "$2,226.00" "$2,226.00" "$1,669.50" "$2,226.00" "$2,226.00" "$2,226.00" "$1,113.00" "$1,113.00" "$1,762.99" "$2,226.00" "$1,780.80" "$1,446.90" $441.81 "$2,226.00" "$1,291.08" "$2,226.00" "$2,226.00" "$2,226.00" $463.90 "$2,226.00" N/A N/A 27202974 EAP Custom 27202974 CABLE PCNG 6FT PC LC TRNVNS SF DEV TEMP CONCTR CLIP ADPR BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 27202976 EAP Custom 27202976 SHLD RAD16X16IN DRP ARMR RDBRRIER L PSTN PRTC STRL BOTH IP/OP $72.00 $53.50 $12.82 $72.00 $72.00 $72.00 $72.00 $72.00 $72.00 $72.00 $12.82 $72.00 $72.00 $53.44 $53.44 $55.50 $37.51 $15.01 $72.00 $28.80 $72.00 $72.00 $72.00 $72.00 $72.00 $54.00 $72.00 $72.00 $72.00 $36.00 $36.00 $57.02 $72.00 $57.60 $46.80 $72.00 $72.00 $41.76 $72.00 $43.20 $72.00 $72.00 $72.00 N/A N/A 27202977 EAP Custom 27202977 TRVO PRVUE 4X20MM RTRVR KIT & TRVO PRO 18 MC BOTH IP/OP "$13,399.00" "$9,915.50" "$2,060.15" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$2,385.02" "$13,399.00" "$13,399.00" "$4,181.12" "$4,181.12" "$10,327.95" "$2,060.15" "$2,792.50" "$13,399.00" "$5,359.60" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$10,049.25" "$13,399.00" "$13,399.00" "$13,399.00" "$6,699.50" "$6,699.50" "$10,612.01" "$13,399.00" "$10,719.20" "$8,709.35" "$13,399.00" "$13,399.00" "$7,771.42" "$13,399.00" "$8,039.40" "$13,399.00" "$13,399.00" "$13,399.00" N/A N/A 27202978 EAP Custom 27202978 TRVO XP PRVUE 4X20MM RTRVR KIT & TRVO PRO 18 MC BOTH IP/OP "$13,399.00" "$9,915.50" "$2,060.15" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$2,385.02" "$13,399.00" "$13,399.00" "$4,181.12" "$4,181.12" "$10,327.95" "$2,060.15" "$2,792.50" "$13,399.00" "$5,359.60" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$10,049.25" "$13,399.00" "$13,399.00" "$13,399.00" "$6,699.50" "$6,699.50" "$10,612.01" "$13,399.00" "$10,719.20" "$8,709.35" "$13,399.00" "$13,399.00" "$7,771.42" "$13,399.00" "$8,039.40" "$13,399.00" "$13,399.00" "$13,399.00" N/A N/A 27202979 EAP Custom 27202979 TRVO XP PRVUE 3X20MM RTRVR KIT & TRVO PRO 14 MC BOTH IP/OP "$13,399.00" "$9,915.50" "$2,060.15" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$2,385.02" "$13,399.00" "$13,399.00" "$4,181.12" "$4,181.12" "$10,327.95" "$2,060.15" "$2,792.50" "$13,399.00" "$5,359.60" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$13,399.00" "$10,049.25" "$13,399.00" "$13,399.00" "$13,399.00" "$6,699.50" "$6,699.50" "$10,612.01" "$13,399.00" "$10,719.20" "$8,709.35" "$13,399.00" "$13,399.00" "$7,771.42" "$13,399.00" "$8,039.40" "$13,399.00" "$13,399.00" "$13,399.00" N/A N/A 27202980 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .035IN STRBL STR HTRQ SCR BOTH IP/OP $197.00 $146.00 $39.10 $197.00 $106.97 $106.97 $106.97 $106.97 $197.00 $197.00 $197.00 $41.06 $197.00 $146.21 $146.21 $151.85 $102.64 $41.06 $197.00 $197.00 $116.53 $197.00 $197.00 $197.00 $197.00 $147.75 $197.00 $197.00 $197.00 $98.50 $98.50 $156.02 $197.00 $157.60 $128.05 $39.10 $197.00 $114.26 $197.00 $197.00 $197.00 $41.05 $197.00 N/A N/A 27202981 EAP HCPCS C1887 "TURNPIKE CATHETER, SMOOTH SHAFT, 135CM" BOTH IP/OP "$1,377.00" "$1,019.00" $273.30 "$1,377.00" $747.71 $747.71 $747.71 $747.71 "$1,377.00" "$1,377.00" "$1,377.00" $287.00 "$1,377.00" "$1,022.01" "$1,022.01" "$1,061.39" $717.42 $286.98 "$1,377.00" "$1,377.00" $814.50 "$1,377.00" "$1,377.00" "$1,377.00" "$1,377.00" "$1,032.75" "$1,377.00" "$1,377.00" "$1,377.00" $688.50 $688.50 "$1,090.58" "$1,377.00" "$1,101.60" $895.05 $273.30 "$1,377.00" $798.66 "$1,377.00" "$1,377.00" "$1,377.00" $286.97 "$1,377.00" N/A N/A 27202982 EAP HCPCS C1887 "TURNPIKE CATHETER, SMOOTH SHAFT, 155CM" BOTH IP/OP "$1,561.00" "$1,155.50" $309.82 "$1,561.00" $847.62 $847.62 $847.62 $847.62 "$1,561.00" "$1,561.00" "$1,561.00" $325.35 "$1,561.00" "$1,158.57" "$1,158.57" "$1,203.22" $813.28 $325.33 "$1,561.00" "$1,561.00" $923.33 "$1,561.00" "$1,561.00" "$1,561.00" "$1,561.00" "$1,170.75" "$1,561.00" "$1,561.00" "$1,561.00" $780.50 $780.50 "$1,236.31" "$1,561.00" "$1,248.80" "$1,014.65" $309.82 "$1,561.00" $905.38 "$1,561.00" "$1,561.00" "$1,561.00" $325.31 "$1,561.00" N/A N/A 27202983 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN HBRD RADIOPQ STR TIP BOTH IP/OP $394.00 $292.00 $78.20 $394.00 $213.94 $213.94 $213.94 $213.94 $394.00 $394.00 $394.00 $82.12 $394.00 $292.43 $292.43 $303.70 $205.27 $82.11 $394.00 $394.00 $233.05 $394.00 $394.00 $394.00 $394.00 $295.50 $394.00 $394.00 $394.00 $197.00 $197.00 $312.05 $394.00 $315.20 $256.10 $78.20 $394.00 $228.52 $394.00 $394.00 $394.00 $82.11 $394.00 N/A N/A 27202984 EAP GDWIRE VASC STRGHT; SPRG L200CM L9 CM OD.008 IN BOTH IP/OP "$1,238.00" $916.50 $220.36 "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" $220.36 "$1,238.00" "$1,238.00" $918.84 $918.84 $954.25 $645.00 $258.01 "$1,238.00" $495.20 "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" $928.50 "$1,238.00" "$1,238.00" "$1,238.00" $619.00 $619.00 $980.50 "$1,238.00" $990.40 $804.70 "$1,238.00" "$1,238.00" $718.04 "$1,238.00" $742.80 "$1,238.00" "$1,238.00" "$1,238.00" N/A N/A 27202985 EAP HCPCS C1769 GDWIRE VASC 25D L150 CM RND CURVE L200 CM L170 BOTH IP/OP "$1,337.00" $989.50 $265.36 "$1,337.00" $725.99 $725.99 $725.99 $725.99 "$1,337.00" "$1,337.00" "$1,337.00" $278.66 "$1,337.00" $992.32 $992.32 "$1,030.56" $696.58 $278.65 "$1,337.00" "$1,337.00" $790.84 "$1,337.00" "$1,337.00" "$1,337.00" "$1,337.00" "$1,002.75" "$1,337.00" "$1,337.00" "$1,337.00" $668.50 $668.50 "$1,058.90" "$1,337.00" "$1,069.60" $869.05 $265.36 "$1,337.00" $775.46 "$1,337.00" "$1,337.00" "$1,337.00" $278.63 "$1,337.00" N/A N/A 27202986 EAP HCPCS C1769 "GDWIRE VASC SLIP COAT STNLSS STL POLYMER 25 D, L" BOTH IP/OP "$1,337.00" $989.50 $265.36 "$1,337.00" $725.99 $725.99 $725.99 $725.99 "$1,337.00" "$1,337.00" "$1,337.00" $278.66 "$1,337.00" $992.32 $992.32 "$1,030.56" $696.58 $278.65 "$1,337.00" "$1,337.00" $790.84 "$1,337.00" "$1,337.00" "$1,337.00" "$1,337.00" "$1,002.75" "$1,337.00" "$1,337.00" "$1,337.00" $668.50 $668.50 "$1,058.90" "$1,337.00" "$1,069.60" $869.05 $265.36 "$1,337.00" $775.46 "$1,337.00" "$1,337.00" "$1,337.00" $278.63 "$1,337.00" N/A N/A 27202987 EAP HCPCS C1769 GDWIRE VASC SLIP-COAT; STNLSS STL; POLYMER 25 D; BOTH IP/OP $919.00 $680.50 $182.40 $919.00 $499.02 $499.02 $499.02 $499.02 $919.00 $919.00 $919.00 $191.54 $919.00 $682.08 $682.08 $708.37 $478.80 $191.53 $919.00 $919.00 $543.59 $919.00 $919.00 $919.00 $919.00 $689.25 $919.00 $919.00 $919.00 $459.50 $459.50 $727.85 $919.00 $735.20 $597.35 $182.40 $919.00 $533.02 $919.00 $919.00 $919.00 $191.52 $919.00 N/A N/A 27202988 EAP HCPCS C1887 ARC CATHETER BOTH IP/OP "$4,712.00" "$3,487.00" $935.21 "$4,712.00" "$2,558.62" "$2,558.62" "$2,558.62" "$2,558.62" "$4,712.00" "$4,712.00" "$4,712.00" $982.10 "$4,712.00" "$3,497.25" "$3,497.25" "$3,632.01" "$2,060.15" $982.03 "$4,712.00" "$4,712.00" "$2,787.15" "$4,712.00" "$4,712.00" "$4,712.00" "$4,712.00" "$3,534.00" "$4,712.00" "$4,712.00" "$4,712.00" "$2,356.00" "$2,356.00" "$3,731.90" "$4,712.00" "$3,769.60" "$3,062.80" $935.21 "$4,712.00" "$2,732.96" "$4,712.00" "$4,712.00" "$4,712.00" $981.98 "$4,712.00" N/A N/A 27202989 EAP HCPCS C1887 ARC MINI CATHETER BOTH IP/OP "$3,625.00" "$2,682.50" $719.47 "$3,625.00" "$1,968.38" "$1,968.38" "$1,968.38" "$1,968.38" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$2,690.48" "$2,690.48" "$2,794.15" "$1,888.63" $755.49 "$3,625.00" "$3,625.00" "$2,144.19" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$2,356.25" $719.47 "$3,625.00" "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 27202990 EAP HCPCS C1887 MARKSMAN CATHETER BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" "$1,086.00" "$1,086.00" "$1,086.00" "$1,086.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$1,484.40" "$1,484.40" "$1,541.60" "$1,042.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" "$1,300.00" $396.95 "$2,000.00" "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 27202991 EAP HCPCS C1769 GUIDEWIRE VASC 200CM .014IN STR 3CM TRAXCESS NTNL BOTH IP/OP $844.00 $625.00 $167.51 $844.00 $458.29 $458.29 $458.29 $458.29 $844.00 $844.00 $844.00 $175.91 $844.00 $626.42 $626.42 $650.56 $439.72 $175.90 $844.00 $844.00 $499.23 $844.00 $844.00 $844.00 $844.00 $633.00 $844.00 $844.00 $844.00 $422.00 $422.00 $668.45 $844.00 $675.20 $548.60 $167.51 $844.00 $489.52 $844.00 $844.00 $844.00 $175.89 $844.00 N/A N/A 27202992 EAP HCPCS C1769 GUIDEWIRE VASC TRAXCESS 3X200 EX BOTH IP/OP $878.00 $650.00 $174.26 $878.00 $476.75 $476.75 $476.75 $476.75 $878.00 $878.00 $878.00 $183.00 $878.00 $651.65 $651.65 $676.76 $457.44 $182.98 $878.00 $878.00 $519.34 $878.00 $878.00 $878.00 $878.00 $658.50 $878.00 $878.00 $878.00 $439.00 $439.00 $695.38 $878.00 $702.40 $570.70 $174.26 $878.00 $509.24 $878.00 $878.00 $878.00 $182.98 $878.00 N/A N/A 27202993 EAP HCPCS C1769 GUIDEWIRE VASC DCK TRAXCESS BOTH IP/OP $338.00 $250.50 $67.08 $338.00 $183.53 $183.53 $183.53 $183.53 $338.00 $338.00 $338.00 $70.45 $338.00 $250.86 $250.86 $260.53 $176.10 $70.44 $338.00 $338.00 $199.93 $338.00 $338.00 $338.00 $338.00 $253.50 $338.00 $338.00 $338.00 $169.00 $169.00 $267.70 $338.00 $270.40 $219.70 $67.08 $338.00 $196.04 $338.00 $338.00 $338.00 $70.44 $338.00 N/A N/A 27202995 EAP HCPCS C1725 CATHETER BALDILAT 3.7FR 2.9FR 135CM CORON SDPRT BOTH IP/OP "$4,738.00" "$3,506.50" $940.37 "$4,738.00" "$2,572.73" "$2,572.73" "$2,572.73" "$2,572.73" "$4,738.00" "$4,738.00" "$4,738.00" $987.52 "$4,738.00" "$3,516.54" "$3,516.54" "$3,652.05" "$2,060.15" $987.45 "$4,738.00" "$1,895.20" "$2,802.53" "$4,738.00" "$4,738.00" "$4,738.00" "$4,738.00" "$3,553.50" "$4,738.00" "$4,738.00" "$4,738.00" "$2,369.00" "$2,369.00" "$3,752.50" "$4,738.00" "$3,790.40" "$3,079.70" $940.37 "$4,738.00" "$2,748.04" "$4,738.00" "$4,738.00" "$4,738.00" $987.40 "$4,738.00" N/A N/A 27202996 EAP HCPCS C1769 GUIDEWIRE VASC 185CM .014IN TRUE LUM SLF ORNT BOTH IP/OP "$1,013.00" $750.00 $201.06 "$1,013.00" $550.06 $550.06 $550.06 $550.06 "$1,013.00" "$1,013.00" "$1,013.00" $211.13 "$1,013.00" $751.85 $751.85 $780.82 $527.77 $211.12 "$1,013.00" $405.20 $599.19 "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" $759.75 "$1,013.00" "$1,013.00" "$1,013.00" $506.50 $506.50 $802.30 "$1,013.00" $810.40 $658.45 $201.06 "$1,013.00" $587.54 "$1,013.00" "$1,013.00" "$1,013.00" $211.11 "$1,013.00" N/A N/A 27202997 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN TRUE LUM SLF ORNT BOTH IP/OP "$1,013.00" $750.00 $201.06 "$1,013.00" $550.06 $550.06 $550.06 $550.06 "$1,013.00" "$1,013.00" "$1,013.00" $211.13 "$1,013.00" $751.85 $751.85 $780.82 $527.77 $211.12 "$1,013.00" "$1,013.00" $599.19 "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" $759.75 "$1,013.00" "$1,013.00" "$1,013.00" $506.50 $506.50 $802.30 "$1,013.00" $810.40 $658.45 $201.06 "$1,013.00" $587.54 "$1,013.00" "$1,013.00" "$1,013.00" $211.11 "$1,013.00" N/A N/A 27202999 EAP HCPCS C1769 CORONARY INTERVENTION WIRE. BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 27203001 EAP Custom 27203001 UNIT THERAPEUTIC INCISION MNGMNT SYS PEEL PLC KT BOTH IP/OP "$1,238.00" $916.50 $220.36 "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" $220.36 "$1,238.00" "$1,238.00" $918.84 $918.84 $954.25 $645.00 $258.01 "$1,238.00" $495.20 "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" $928.50 "$1,238.00" "$1,238.00" "$1,238.00" $619.00 $619.00 $980.50 "$1,238.00" $990.40 $804.70 "$1,238.00" "$1,238.00" $718.04 "$1,238.00" $742.80 "$1,238.00" "$1,238.00" "$1,238.00" N/A N/A 27203002 EAP HCPCS C1725 CATHETER BALDILAT LP 5.3FR 3MM 75CM 60MM HIGH PRESSURE BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $271.50 $271.50 $271.50 $271.50 $500.00 $500.00 $500.00 $104.21 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $99.24 $500.00 $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 27203003 EAP HCPCS C1725 CATHETER BALDILAT .035IN 5MM 75CM 40MM HIGH PRESSURE LP BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $271.50 $271.50 $271.50 $271.50 $500.00 $500.00 $500.00 $104.21 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $99.24 $500.00 $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 27203005 EAP HCPCS C1725 CATHETER BALDILAT LP 5.3FR 6MM 135CM 40MM HIGH PRESSURE BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $271.50 $271.50 $271.50 $271.50 $500.00 $500.00 $500.00 $104.21 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $99.24 $500.00 $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 27203006 EAP HCPCS C1725 CATHETER BALDILAT LP 5.3FR 8MM 75CM 20MM HIGH PRESSURE BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $271.50 $271.50 $271.50 $271.50 $500.00 $500.00 $500.00 $104.21 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $99.24 $500.00 $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 27203051 EAP Custom 27203051 CHIBA NEEDLE 18G X 10CM BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27203052 EAP Custom 27203052 CHIBA NEEDLE 18G X 15CM BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27203053 EAP Custom 27203053 CHIBA NEEDLE 18G X 20CM BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27203054 EAP Custom 27203054 CHIBA NEEDLE 20G X 10CM BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27203055 EAP Custom 27203055 CHIBA NEEDLE 20G X 15CM BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27203056 EAP Custom 27203056 CHIBA NEEDLE 20G X 20CM BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27203057 EAP Custom 27203057 6F DILATOR BOTH IP/OP $10.00 $7.50 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 $10.00 $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A 27203058 EAP Custom 27203058 7F DILATOR BOTH IP/OP $18.00 $13.50 $3.20 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $3.20 $18.00 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $7.20 $18.00 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $18.00 $18.00 $10.44 $18.00 $10.80 $18.00 $18.00 $18.00 N/A N/A 27203059 EAP Custom 27203059 8F DILATOR BOTH IP/OP $18.00 $13.50 $3.20 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $3.20 $18.00 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $7.20 $18.00 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $18.00 $18.00 $10.44 $18.00 $10.80 $18.00 $18.00 $18.00 N/A N/A 27203060 EAP Custom 27203060 10F DILATOR BOTH IP/OP $22.00 $16.50 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 27203061 EAP Custom 27203061 12F DILATOR BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27203062 EAP Custom 27203062 14F DILATOR BOTH IP/OP $37.00 $27.50 $6.59 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $6.59 $37.00 $37.00 $27.46 $27.46 $28.52 $19.28 $7.71 $37.00 $14.80 $37.00 $37.00 $37.00 $37.00 $37.00 $27.75 $37.00 $37.00 $37.00 $18.50 $18.50 $29.30 $37.00 $29.60 $24.05 $37.00 $37.00 $21.46 $37.00 $22.20 $37.00 $37.00 $37.00 N/A N/A 27203063 EAP Custom 27203063 INTRODUCER NEEDLE 17G X 10CM BOTH IP/OP $100.00 $74.00 $17.80 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $17.80 $100.00 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $40.00 $100.00 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $100.00 $100.00 $58.00 $100.00 $60.00 $100.00 $100.00 $100.00 N/A N/A 27203064 EAP Custom 27203064 INTRODUCER NEEDLE 17G X 15CM BOTH IP/OP $115.00 $85.50 $20.47 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $20.47 $115.00 $115.00 $85.35 $85.35 $88.64 $59.92 $23.97 $115.00 $46.00 $115.00 $115.00 $115.00 $115.00 $115.00 $86.25 $115.00 $115.00 $115.00 $57.50 $57.50 $91.08 $115.00 $92.00 $74.75 $115.00 $115.00 $66.70 $115.00 $69.00 $115.00 $115.00 $115.00 N/A N/A 27203065 EAP Custom 27203065 INTRODUCER NEEDLE 19G X 6CM BOTH IP/OP $120.00 $89.00 $21.36 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $21.36 $120.00 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $48.00 $120.00 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $120.00 $120.00 $69.60 $120.00 $72.00 $120.00 $120.00 $120.00 N/A N/A 27203066 EAP Custom 27203066 INTRODUCER NEEDLE 19G X 10CM BOTH IP/OP $130.00 $96.50 $23.14 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $23.14 $130.00 $130.00 $96.49 $96.49 $100.20 $67.73 $27.09 $130.00 $52.00 $130.00 $130.00 $130.00 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $65.00 $65.00 $102.96 $130.00 $104.00 $84.50 $130.00 $130.00 $75.40 $130.00 $78.00 $130.00 $130.00 $130.00 N/A N/A 27203067 EAP Custom 27203067 INTRODUCER NEEDLE 19G X 15CM BOTH IP/OP $136.00 $101.00 $24.21 $136.00 $136.00 $136.00 $136.00 $136.00 $136.00 $136.00 $24.21 $136.00 $136.00 $100.94 $100.94 $104.83 $70.86 $28.34 $136.00 $54.40 $136.00 $136.00 $136.00 $136.00 $136.00 $102.00 $136.00 $136.00 $136.00 $68.00 $68.00 $107.71 $136.00 $108.80 $88.40 $136.00 $136.00 $78.88 $136.00 $81.60 $136.00 $136.00 $136.00 N/A N/A 27203068 EAP Custom 27203068 COAXIAL SETS 19X10X20X15 BOTH IP/OP $79.00 $58.50 $14.06 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $14.06 $79.00 $79.00 $58.63 $58.63 $60.89 $41.16 $16.46 $79.00 $31.60 $79.00 $79.00 $79.00 $79.00 $79.00 $59.25 $79.00 $79.00 $79.00 $39.50 $39.50 $62.57 $79.00 $63.20 $51.35 $79.00 $79.00 $45.82 $79.00 $47.40 $79.00 $79.00 $79.00 N/A N/A 27203069 EAP Custom 27203069 COAXIAL SETS 19X15X20X20 BOTH IP/OP $71.00 $53.00 $12.64 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $12.64 $71.00 $71.00 $52.70 $52.70 $54.73 $36.99 $14.80 $71.00 $28.40 $71.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $46.15 $71.00 $71.00 $41.18 $71.00 $42.60 $71.00 $71.00 $71.00 N/A N/A 27203070 EAP Custom 27203070 ACHIEVE GUN 18G X 9CM BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 $135.00 $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A 27203071 EAP Custom 27203071 ACHIEVE GUN 18G X 11CM BOTH IP/OP $138.00 $102.50 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 $138.00 $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 27203072 EAP Custom 27203072 ACHIEVE GUN 18G X 15CM BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 $150.00 $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A 27203073 EAP Custom 27203073 ACHIEVE GUN 18G X 20CM BOTH IP/OP $214.00 $158.50 $38.09 $214.00 $214.00 $214.00 $214.00 $214.00 $214.00 $214.00 $38.09 $214.00 $214.00 $158.83 $158.83 $164.95 $111.49 $44.60 $214.00 $85.60 $214.00 $214.00 $214.00 $214.00 $214.00 $160.50 $214.00 $214.00 $214.00 $107.00 $107.00 $169.49 $214.00 $171.20 $139.10 $214.00 $214.00 $124.12 $214.00 $128.40 $214.00 $214.00 $214.00 N/A N/A 27203074 EAP Custom 27203074 ACHIEVE GUN 20G X 11CM BOTH IP/OP $230.00 $170.50 $40.94 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $40.94 $230.00 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $92.00 $230.00 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $230.00 $230.00 $133.40 $230.00 $138.00 $230.00 $230.00 $230.00 N/A N/A 27203075 EAP Custom 27203075 ACHIEVE GUN 20G X 15CM BOTH IP/OP $237.00 $175.50 $42.19 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $42.19 $237.00 $237.00 $175.90 $175.90 $182.68 $123.48 $49.39 $237.00 $94.80 $237.00 $237.00 $237.00 $237.00 $237.00 $177.75 $237.00 $237.00 $237.00 $118.50 $118.50 $187.70 $237.00 $189.60 $154.05 $237.00 $237.00 $137.46 $237.00 $142.20 $237.00 $237.00 $237.00 N/A N/A 27203076 EAP Custom 27203076 ACHIEVE GUN 20G X 20CM BOTH IP/OP $245.00 $181.50 $43.61 $245.00 $245.00 $245.00 $245.00 $245.00 $245.00 $245.00 $43.61 $245.00 $245.00 $181.84 $181.84 $188.85 $127.65 $51.06 $245.00 $98.00 $245.00 $245.00 $245.00 $245.00 $245.00 $183.75 $245.00 $245.00 $245.00 $122.50 $122.50 $194.04 $245.00 $196.00 $159.25 $245.00 $245.00 $142.10 $245.00 $147.00 $245.00 $245.00 $245.00 N/A N/A 27203077 EAP Custom 27203077 FRANSEEN LUNG BX NEEDLE BOTH IP/OP $122.00 $90.50 $21.72 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $122.00 $21.72 $122.00 $122.00 $90.55 $90.55 $94.04 $63.56 $25.43 $122.00 $48.80 $122.00 $122.00 $122.00 $122.00 $122.00 $91.50 $122.00 $122.00 $122.00 $61.00 $61.00 $96.62 $122.00 $97.60 $79.30 $122.00 $122.00 $70.76 $122.00 $73.20 $122.00 $122.00 $122.00 N/A N/A 27203078 EAP Custom 27203078 VANSONNENBERG NEEDLE SET BOTH IP/OP $146.00 $108.50 $25.99 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $25.99 $146.00 $146.00 $108.36 $108.36 $112.54 $76.07 $30.43 $146.00 $58.40 $146.00 $146.00 $146.00 $146.00 $146.00 $109.50 $146.00 $146.00 $146.00 $73.00 $73.00 $115.63 $146.00 $116.80 $94.90 $146.00 $146.00 $84.68 $146.00 $87.60 $146.00 $146.00 $146.00 N/A N/A 27203079 EAP Custom 27203079 BONOPTY BX SET BOTH IP/OP "$1,154.00" $854.00 $205.41 "$1,154.00" "$1,154.00" "$1,154.00" "$1,154.00" "$1,154.00" "$1,154.00" "$1,154.00" $205.41 "$1,154.00" "$1,154.00" $856.50 $856.50 $889.50 $601.23 $240.51 "$1,154.00" $461.60 "$1,154.00" "$1,154.00" "$1,154.00" "$1,154.00" "$1,154.00" $865.50 "$1,154.00" "$1,154.00" "$1,154.00" $577.00 $577.00 $913.97 "$1,154.00" $923.20 $750.10 "$1,154.00" "$1,154.00" $669.32 "$1,154.00" $692.40 "$1,154.00" "$1,154.00" "$1,154.00" N/A N/A 27203080 EAP Custom 27203080 BONOPTY BX PENETRATION SET BOTH IP/OP "$1,505.00" "$1,114.00" $267.89 "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" $267.89 "$1,505.00" "$1,505.00" "$1,117.01" "$1,117.01" "$1,160.05" $784.11 $313.66 "$1,505.00" $602.00 "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,128.75" "$1,505.00" "$1,505.00" "$1,505.00" $752.50 $752.50 "$1,191.96" "$1,505.00" "$1,204.00" $978.25 "$1,505.00" "$1,505.00" $872.90 "$1,505.00" $903.00 "$1,505.00" "$1,505.00" "$1,505.00" N/A N/A 27203081 EAP Custom 27203081 SOFT TISSUE BX TRAY BOTH IP/OP $63.00 $47.00 $11.21 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $11.21 $63.00 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $25.20 $63.00 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $31.50 $31.50 $49.90 $63.00 $50.40 $40.95 $63.00 $63.00 $36.54 $63.00 $37.80 $63.00 $63.00 $63.00 N/A N/A 27203082 EAP Custom 27203082 LUMBAR PUNCTURE TRAY BOTH IP/OP $229.00 $169.50 $40.76 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $40.76 $229.00 $229.00 $169.96 $169.96 $176.51 $119.31 $47.73 $229.00 $91.60 $229.00 $229.00 $229.00 $229.00 $229.00 $171.75 $229.00 $229.00 $229.00 $114.50 $114.50 $181.37 $229.00 $183.20 $148.85 $229.00 $229.00 $132.82 $229.00 $137.40 $229.00 $229.00 $229.00 N/A N/A 27203083 EAP Custom 27203083 PARA/THORACENTESIS TRAY BOTH IP/OP $138.00 $102.50 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 $138.00 $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 27203084 EAP Custom 27203084 URESIL DRAINAGE BAG BOTH IP/OP $111.00 $82.50 $19.76 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $19.76 $111.00 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $44.40 $111.00 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $111.00 $111.00 $64.38 $111.00 $66.60 $111.00 $111.00 $111.00 N/A N/A 27203085 EAP Custom 27203085 GELFOAM SPONGE BOTH IP/OP $464.00 $343.50 $82.59 $464.00 $464.00 $464.00 $464.00 $464.00 $464.00 $464.00 $82.59 $464.00 $464.00 $344.38 $344.38 $357.65 $241.74 $96.70 $464.00 $185.60 $464.00 $464.00 $464.00 $464.00 $464.00 $348.00 $464.00 $464.00 $464.00 $232.00 $232.00 $367.49 $464.00 $371.20 $301.60 $464.00 $464.00 $269.12 $464.00 $278.40 $464.00 $464.00 $464.00 N/A N/A 27203087 EAP Custom 27203087 STERI-DRAPE BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27203088 EAP Custom 27203088 DRAINGE CATHETERS BOTH IP/OP $228.00 $169.00 $40.58 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $40.58 $228.00 $228.00 $169.22 $169.22 $175.74 $118.79 $47.52 $228.00 $91.20 $228.00 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $148.20 $228.00 $228.00 $132.24 $228.00 $136.80 $228.00 $228.00 $228.00 N/A N/A 27203090 EAP Custom 27203090 CRE WG 6-8MM DILATION BALLOON BOTH IP/OP $324.00 $240.00 $57.67 $324.00 $324.00 $324.00 $324.00 $324.00 $324.00 $324.00 $57.67 $324.00 $324.00 $240.47 $240.47 $249.74 $168.80 $67.53 $324.00 $129.60 $324.00 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $210.60 $324.00 $324.00 $187.92 $324.00 $194.40 $324.00 $324.00 $324.00 N/A N/A 27203091 EAP Custom 27203091 CRE WG 8-10 DILATION BALLOON BOTH IP/OP $324.00 $240.00 $57.67 $324.00 $324.00 $324.00 $324.00 $324.00 $324.00 $324.00 $57.67 $324.00 $324.00 $240.47 $240.47 $249.74 $168.80 $67.53 $324.00 $129.60 $324.00 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $210.60 $324.00 $324.00 $187.92 $324.00 $194.40 $324.00 $324.00 $324.00 N/A N/A 27203092 EAP Custom 27203092 CRE WG 10-12 DILATION BALLOON BOTH IP/OP $324.00 $240.00 $57.67 $324.00 $324.00 $324.00 $324.00 $324.00 $324.00 $324.00 $57.67 $324.00 $324.00 $240.47 $240.47 $249.74 $168.80 $67.53 $324.00 $129.60 $324.00 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $210.60 $324.00 $324.00 $187.92 $324.00 $194.40 $324.00 $324.00 $324.00 N/A N/A 27203093 EAP Custom 27203093 CRE 12-15MM DILATION BALLOON BOTH IP/OP $324.00 $240.00 $57.67 $324.00 $324.00 $324.00 $324.00 $324.00 $324.00 $324.00 $57.67 $324.00 $324.00 $240.47 $240.47 $249.74 $168.80 $67.53 $324.00 $129.60 $324.00 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $210.60 $324.00 $324.00 $187.92 $324.00 $194.40 $324.00 $324.00 $324.00 N/A N/A 27203094 EAP Custom 27203094 CRE 15-18 MM DILATION BALLOON BOTH IP/OP $324.00 $240.00 $57.67 $324.00 $324.00 $324.00 $324.00 $324.00 $324.00 $324.00 $57.67 $324.00 $324.00 $240.47 $240.47 $249.74 $168.80 $67.53 $324.00 $129.60 $324.00 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $210.60 $324.00 $324.00 $187.92 $324.00 $194.40 $324.00 $324.00 $324.00 N/A N/A 27203095 EAP Custom 27203095 CRE 18-20 MM DILATION BALLOON BOTH IP/OP $324.00 $240.00 $57.67 $324.00 $324.00 $324.00 $324.00 $324.00 $324.00 $324.00 $57.67 $324.00 $324.00 $240.47 $240.47 $249.74 $168.80 $67.53 $324.00 $129.60 $324.00 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $210.60 $324.00 $324.00 $187.92 $324.00 $194.40 $324.00 $324.00 $324.00 N/A N/A 27203096 EAP Custom 27203096 ALLIANCE INFLATION SYRINGE BOTH IP/OP $52.00 $38.50 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 27203097 EAP Custom 27203097 2.3MM INTERJECT INJ NEEDLE23G BOTH IP/OP $732.00 $542.00 $130.30 $732.00 $732.00 $732.00 $732.00 $732.00 $732.00 $732.00 $130.30 $732.00 $732.00 $543.29 $543.29 $564.23 $381.37 $152.56 $732.00 $292.80 $732.00 $732.00 $732.00 $732.00 $732.00 $549.00 $732.00 $732.00 $732.00 $366.00 $366.00 $579.74 $732.00 $585.60 $475.80 $732.00 $732.00 $424.56 $732.00 $439.20 $732.00 $732.00 $732.00 N/A N/A 27203098 EAP Custom 27203098 DREAMWIRE .035 260STR STND BOTH IP/OP $281.00 $208.00 $50.02 $281.00 $281.00 $281.00 $281.00 $281.00 $281.00 $281.00 $50.02 $281.00 $281.00 $208.56 $208.56 $216.59 $146.40 $58.56 $281.00 $112.40 $281.00 $281.00 $281.00 $281.00 $281.00 $210.75 $281.00 $281.00 $281.00 $140.50 $140.50 $222.55 $281.00 $224.80 $182.65 $281.00 $281.00 $162.98 $281.00 $168.60 $281.00 $281.00 $281.00 N/A N/A 27203099 EAP Custom 27203099 EXTRACTOR RX 9-12 MM BOTH IP/OP $240.00 $178.00 $42.72 $240.00 $240.00 $240.00 $240.00 $240.00 $240.00 $240.00 $42.72 $240.00 $240.00 $178.13 $178.13 $184.99 $125.04 $50.02 $240.00 $96.00 $240.00 $240.00 $240.00 $240.00 $240.00 $180.00 $240.00 $240.00 $240.00 $120.00 $120.00 $190.08 $240.00 $192.00 $156.00 $240.00 $240.00 $139.20 $240.00 $144.00 $240.00 $240.00 $240.00 N/A N/A 27203100 EAP Custom 27203100 EXTRACTOR RX 12-15 MM BOTH IP/OP $229.00 $169.50 $40.76 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $40.76 $229.00 $229.00 $169.96 $169.96 $176.51 $119.31 $47.73 $229.00 $91.60 $229.00 $229.00 $229.00 $229.00 $229.00 $171.75 $229.00 $229.00 $229.00 $114.50 $114.50 $181.37 $229.00 $183.20 $148.85 $229.00 $229.00 $132.82 $229.00 $137.40 $229.00 $229.00 $229.00 N/A N/A 27203101 EAP Custom 27203101 EXTRACTOR RX 15-18 MM BOTH IP/OP $229.00 $169.50 $40.76 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $40.76 $229.00 $229.00 $169.96 $169.96 $176.51 $119.31 $47.73 $229.00 $91.60 $229.00 $229.00 $229.00 $229.00 $229.00 $171.75 $229.00 $229.00 $229.00 $114.50 $114.50 $181.37 $229.00 $183.20 $148.85 $229.00 $229.00 $132.82 $229.00 $137.40 $229.00 $229.00 $229.00 N/A N/A 27203102 EAP Custom 27203102 22G BLUE SHEATH (STIFFER) BOTH IP/OP $386.00 $286.00 $68.71 $386.00 $386.00 $386.00 $386.00 $386.00 $386.00 $386.00 $68.71 $386.00 $386.00 $286.49 $286.49 $297.53 $201.11 $80.45 $386.00 $154.40 $386.00 $386.00 $386.00 $386.00 $386.00 $289.50 $386.00 $386.00 $386.00 $193.00 $193.00 $305.71 $386.00 $308.80 $250.90 $386.00 $386.00 $223.88 $386.00 $231.60 $386.00 $386.00 $386.00 N/A N/A 27203103 EAP Custom 27203103 22G GREEN SPRING COIL SHEATH BOTH IP/OP $386.00 $286.00 $68.71 $386.00 $386.00 $386.00 $386.00 $386.00 $386.00 $386.00 $68.71 $386.00 $386.00 $286.49 $286.49 $297.53 $201.11 $80.45 $386.00 $154.40 $386.00 $386.00 $386.00 $386.00 $386.00 $289.50 $386.00 $386.00 $386.00 $193.00 $193.00 $305.71 $386.00 $308.80 $250.90 $386.00 $386.00 $223.88 $386.00 $231.60 $386.00 $386.00 $386.00 N/A N/A 27203104 EAP Custom 27203104 CELIAC PLEXUS NEUROLYSIS NEEDL BOTH IP/OP $392.00 $290.50 $69.78 $392.00 $392.00 $392.00 $392.00 $392.00 $392.00 $392.00 $69.78 $392.00 $392.00 $290.94 $290.94 $302.15 $204.23 $81.70 $392.00 $156.80 $392.00 $392.00 $392.00 $392.00 $392.00 $294.00 $392.00 $392.00 $392.00 $196.00 $196.00 $310.46 $392.00 $313.60 $254.80 $392.00 $392.00 $227.36 $392.00 $235.20 $392.00 $392.00 $392.00 N/A N/A 27203105 EAP Custom 27203105 19G BX NEEDLE BOTH IP/OP $515.00 $381.50 $91.67 $515.00 $515.00 $515.00 $515.00 $515.00 $515.00 $515.00 $91.67 $515.00 $515.00 $382.23 $382.23 $396.96 $268.32 $107.33 $515.00 $206.00 $515.00 $515.00 $515.00 $515.00 $515.00 $386.25 $515.00 $515.00 $515.00 $257.50 $257.50 $407.88 $515.00 $412.00 $334.75 $515.00 $515.00 $298.70 $515.00 $309.00 $515.00 $515.00 $515.00 N/A N/A 27203106 EAP Custom 27203106 CYTOLOGY BRUSH ECHO -19 BOTH IP/OP $244.00 $181.00 $43.43 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $43.43 $244.00 $244.00 $181.10 $181.10 $188.08 $127.12 $50.85 $244.00 $97.60 $244.00 $244.00 $244.00 $244.00 $244.00 $183.00 $244.00 $244.00 $244.00 $122.00 $122.00 $193.25 $244.00 $195.20 $158.60 $244.00 $244.00 $141.52 $244.00 $146.40 $244.00 $244.00 $244.00 N/A N/A 27203108 EAP Custom 27203108 OLYMPUS ENDO JAW(COLD FORCEPS) BOTH IP/OP $15.00 $11.50 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 27203109 EAP Custom 27203109 ROTH NET BOTH IP/OP "$1,278.00" $946.00 $227.48 "$1,278.00" "$1,278.00" "$1,278.00" "$1,278.00" "$1,278.00" "$1,278.00" "$1,278.00" $227.48 "$1,278.00" "$1,278.00" $948.53 $948.53 $985.08 $665.84 $266.35 "$1,278.00" $511.20 "$1,278.00" "$1,278.00" "$1,278.00" "$1,278.00" "$1,278.00" $958.50 "$1,278.00" "$1,278.00" "$1,278.00" $639.00 $639.00 "$1,012.18" "$1,278.00" "$1,022.40" $830.70 "$1,278.00" "$1,278.00" $741.24 "$1,278.00" $766.80 "$1,278.00" "$1,278.00" "$1,278.00" N/A N/A 27203110 EAP Custom 27203110 ERBE PROBE BOTH IP/OP $288.00 $213.50 $51.26 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $51.26 $288.00 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $115.20 $288.00 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $288.00 $288.00 $167.04 $288.00 $172.80 $288.00 $288.00 $288.00 N/A N/A 27203111 EAP Custom 27203111 ERCP FORCEP BOTH IP/OP $691.00 $511.50 $123.00 $691.00 $691.00 $691.00 $691.00 $691.00 $691.00 $691.00 $123.00 $691.00 $691.00 $512.86 $512.86 $532.62 $360.01 $144.01 $691.00 $276.40 $691.00 $691.00 $691.00 $691.00 $691.00 $518.25 $691.00 $691.00 $691.00 $345.50 $345.50 $547.27 $691.00 $552.80 $449.15 $691.00 $691.00 $400.78 $691.00 $414.60 $691.00 $691.00 $691.00 N/A N/A 27203112 EAP Custom 27203112 RX DILATATION BALLOON 4-4/5.8 BOTH IP/OP $414.00 $306.50 $73.69 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $73.69 $414.00 $414.00 $307.27 $307.27 $319.11 $215.69 $86.28 $414.00 $165.60 $414.00 $414.00 $414.00 $414.00 $414.00 $310.50 $414.00 $414.00 $414.00 $207.00 $207.00 $327.89 $414.00 $331.20 $269.10 $414.00 $414.00 $240.12 $414.00 $248.40 $414.00 $414.00 $414.00 N/A N/A 27203113 EAP Custom 27203113 RX DILATATION BALLOON 6-4/5.8 BOTH IP/OP $414.00 $306.50 $73.69 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $73.69 $414.00 $414.00 $307.27 $307.27 $319.11 $215.69 $86.28 $414.00 $165.60 $414.00 $414.00 $414.00 $414.00 $414.00 $310.50 $414.00 $414.00 $414.00 $207.00 $207.00 $327.89 $414.00 $331.20 $269.10 $414.00 $414.00 $240.12 $414.00 $248.40 $414.00 $414.00 $414.00 N/A N/A 27203114 EAP Custom 27203114 RX DILATATION BALLOON 8-4/5.8 BOTH IP/OP $414.00 $306.50 $73.69 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $73.69 $414.00 $414.00 $307.27 $307.27 $319.11 $215.69 $86.28 $414.00 $165.60 $414.00 $414.00 $414.00 $414.00 $414.00 $310.50 $414.00 $414.00 $414.00 $207.00 $207.00 $327.89 $414.00 $331.20 $269.10 $414.00 $414.00 $240.12 $414.00 $248.40 $414.00 $414.00 $414.00 N/A N/A 27203115 EAP Custom 27203115 RX DILATATION BALLOON 10-4/5.8 BOTH IP/OP $414.00 $306.50 $73.69 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $73.69 $414.00 $414.00 $307.27 $307.27 $319.11 $215.69 $86.28 $414.00 $165.60 $414.00 $414.00 $414.00 $414.00 $414.00 $310.50 $414.00 $414.00 $414.00 $207.00 $207.00 $327.89 $414.00 $331.20 $269.10 $414.00 $414.00 $240.12 $414.00 $248.40 $414.00 $414.00 $414.00 N/A N/A 27203116 EAP Custom 27203116 ENCORE 26 SINGLE BOTH IP/OP $35.00 $26.00 $6.23 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $6.23 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 27203117 EAP Custom 27203117 INJECTION PROBE 10FR BOTH IP/OP $431.00 $319.00 $76.72 $431.00 $431.00 $431.00 $431.00 $431.00 $431.00 $431.00 $76.72 $431.00 $431.00 $319.89 $319.89 $332.21 $224.55 $89.83 $431.00 $172.40 $431.00 $431.00 $431.00 $431.00 $431.00 $323.25 $431.00 $431.00 $431.00 $215.50 $215.50 $341.35 $431.00 $344.80 $280.15 $431.00 $431.00 $249.98 $431.00 $258.60 $431.00 $431.00 $431.00 N/A N/A 27203118 EAP Custom 27203118 INJECTION PROBE 7FR BOTH IP/OP $431.00 $319.00 $76.72 $431.00 $431.00 $431.00 $431.00 $431.00 $431.00 $431.00 $76.72 $431.00 $431.00 $319.89 $319.89 $332.21 $224.55 $89.83 $431.00 $172.40 $431.00 $431.00 $431.00 $431.00 $431.00 $323.25 $431.00 $431.00 $431.00 $215.50 $215.50 $341.35 $431.00 $344.80 $280.15 $431.00 $431.00 $249.98 $431.00 $258.60 $431.00 $431.00 $431.00 N/A N/A 27203120 EAP HCPCS C1769 .014 NITREX GUIDEWIRE BOTH IP/OP "$1,295.00" $958.50 $257.03 "$1,295.00" $703.19 $703.19 $703.19 $703.19 "$1,295.00" "$1,295.00" "$1,295.00" $269.91 "$1,295.00" $961.15 $961.15 $998.19 $674.70 $269.89 "$1,295.00" "$1,295.00" $765.99 "$1,295.00" "$1,295.00" "$1,295.00" "$1,295.00" $971.25 "$1,295.00" "$1,295.00" "$1,295.00" $647.50 $647.50 "$1,025.64" "$1,295.00" "$1,036.00" $841.75 $257.03 "$1,295.00" $751.10 "$1,295.00" "$1,295.00" "$1,295.00" $269.88 "$1,295.00" N/A N/A 27203121 EAP Custom 27203121 COIL AXIUM HELICAL QC-1.5-2-HELIX BOTH IP/OP "$3,686.00" "$2,728.00" $656.11 "$3,686.00" "$3,686.00" "$3,686.00" "$3,686.00" "$3,686.00" "$3,686.00" "$3,686.00" $656.11 "$3,686.00" "$3,686.00" "$3,686.00" "$3,686.00" "$3,686.00" "$3,686.00" $768.20 "$3,686.00" "$1,474.40" "$3,686.00" "$3,686.00" "$3,686.00" "$3,686.00" "$3,686.00" "$2,764.50" "$3,686.00" "$3,686.00" "$3,686.00" "$1,843.00" "$1,843.00" "$2,919.31" "$3,686.00" "$2,948.80" "$1,658.70" "$3,686.00" "$3,686.00" "$2,137.88" "$3,686.00" "$2,211.60" "$3,686.00" "$3,686.00" "$3,686.00" N/A N/A 27203122 EAP Custom 27203122 COIL AXIUM HELICAL QC-2-1-HELIX BOTH IP/OP "$3,721.00" "$2,754.00" $662.34 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $662.34 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$1,488.40" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" "$3,721.00" "$3,721.00" "$2,158.18" "$3,721.00" "$2,232.60" "$3,721.00" "$3,721.00" "$3,721.00" N/A N/A 27203123 EAP Custom 27203123 COIL AXIUM HELICAL QC-2-2-HELIX BOTH IP/OP "$3,885.00" "$2,875.00" $691.53 "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" $691.53 "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" $809.68 "$3,885.00" "$1,554.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$2,913.75" "$3,885.00" "$3,885.00" "$3,885.00" "$1,942.50" "$1,942.50" "$3,076.92" "$3,885.00" "$3,108.00" "$1,748.25" "$3,885.00" "$3,885.00" "$2,253.30" "$3,885.00" "$2,331.00" "$3,885.00" "$3,885.00" "$3,885.00" N/A N/A 27203124 EAP Custom 27203124 COIL AXIUM HELICAL QC-2-3-HELIX BOTH IP/OP "$3,770.00" "$2,790.00" $671.06 "$3,770.00" "$3,770.00" "$3,770.00" "$3,770.00" "$3,770.00" "$3,770.00" "$3,770.00" $671.06 "$3,770.00" "$3,770.00" "$3,770.00" "$3,770.00" "$3,770.00" "$3,770.00" $785.71 "$3,770.00" "$1,508.00" "$3,770.00" "$3,770.00" "$3,770.00" "$3,770.00" "$3,770.00" "$2,827.50" "$3,770.00" "$3,770.00" "$3,770.00" "$1,885.00" "$1,885.00" "$2,985.84" "$3,770.00" "$3,016.00" "$1,696.50" "$3,770.00" "$3,770.00" "$2,186.60" "$3,770.00" "$2,262.00" "$3,770.00" "$3,770.00" "$3,770.00" N/A N/A 27203125 EAP Custom 27203125 COIL AXIUM HELICAL QC-2-4-HELIX BOTH IP/OP "$3,885.00" "$2,875.00" $691.53 "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" $691.53 "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" $809.68 "$3,885.00" "$1,554.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$2,913.75" "$3,885.00" "$3,885.00" "$3,885.00" "$1,942.50" "$1,942.50" "$3,076.92" "$3,885.00" "$3,108.00" "$1,748.25" "$3,885.00" "$3,885.00" "$2,253.30" "$3,885.00" "$2,331.00" "$3,885.00" "$3,885.00" "$3,885.00" N/A N/A 27203126 EAP Custom 27203126 COIL AXIUM HELICAL QC-2-6-HELIX BOTH IP/OP "$3,819.00" "$2,826.50" $679.78 "$3,819.00" "$3,819.00" "$3,819.00" "$3,819.00" "$3,819.00" "$3,819.00" "$3,819.00" $679.78 "$3,819.00" "$3,819.00" "$2,834.46" "$2,834.46" "$2,943.69" "$1,989.70" $795.92 "$3,819.00" "$1,527.60" "$3,819.00" "$3,819.00" "$3,819.00" "$3,819.00" "$3,819.00" "$2,864.25" "$3,819.00" "$3,819.00" "$3,819.00" "$1,909.50" "$1,909.50" "$3,024.65" "$3,819.00" "$3,055.20" "$2,482.35" "$3,819.00" "$3,819.00" "$2,215.02" "$3,819.00" "$2,291.40" "$3,819.00" "$3,819.00" "$3,819.00" N/A N/A 27203127 EAP Custom 27203127 COIL AXIUM HELICAL QC-2-8-HELIX BOTH IP/OP "$3,986.00" "$2,950.00" $709.51 "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" $709.51 "$3,986.00" "$3,986.00" "$2,958.41" "$2,958.41" "$3,072.41" "$2,060.15" $830.73 "$3,986.00" "$1,594.40" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$2,989.50" "$3,986.00" "$3,986.00" "$3,986.00" "$1,993.00" "$1,993.00" "$3,156.91" "$3,986.00" "$3,188.80" "$2,590.90" "$3,986.00" "$3,986.00" "$2,311.88" "$3,986.00" "$2,391.60" "$3,986.00" "$3,986.00" "$3,986.00" N/A N/A 27203128 EAP Custom 27203128 COIL AXIUM HELICAL QC-3-4-HELIX BOTH IP/OP "$3,854.00" "$2,852.00" $686.01 "$3,854.00" "$3,854.00" "$3,854.00" "$3,854.00" "$3,854.00" "$3,854.00" "$3,854.00" $686.01 "$3,854.00" "$3,854.00" "$2,860.44" "$2,860.44" "$2,970.66" "$2,007.93" $803.22 "$3,854.00" "$1,541.60" "$3,854.00" "$3,854.00" "$3,854.00" "$3,854.00" "$3,854.00" "$2,890.50" "$3,854.00" "$3,854.00" "$3,854.00" "$1,927.00" "$1,927.00" "$3,052.37" "$3,854.00" "$3,083.20" "$2,505.10" "$3,854.00" "$3,854.00" "$2,235.32" "$3,854.00" "$2,312.40" "$3,854.00" "$3,854.00" "$3,854.00" N/A N/A 27203129 EAP Custom 27203129 COIL AXIUM HELICAL QC-3-6-HELIX BOTH IP/OP "$3,986.00" "$2,950.00" $709.51 "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" $709.51 "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" $830.73 "$3,986.00" "$1,594.40" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$2,989.50" "$3,986.00" "$3,986.00" "$3,986.00" "$1,993.00" "$1,993.00" "$3,156.91" "$3,986.00" "$3,188.80" "$1,793.70" "$3,986.00" "$3,986.00" "$2,311.88" "$3,986.00" "$2,391.60" "$3,986.00" "$3,986.00" "$3,986.00" N/A N/A 27203130 EAP Custom 27203130 COIL AXIUM HELICAL QC-3-8-HELIX BOTH IP/OP "$3,885.00" "$2,875.00" $691.53 "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" $691.53 "$3,885.00" "$3,885.00" "$2,883.45" "$2,883.45" "$2,994.56" "$2,024.09" $809.68 "$3,885.00" "$1,554.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$2,913.75" "$3,885.00" "$3,885.00" "$3,885.00" "$1,942.50" "$1,942.50" "$3,076.92" "$3,885.00" "$3,108.00" "$2,525.25" "$3,885.00" "$3,885.00" "$2,253.30" "$3,885.00" "$2,331.00" "$3,885.00" "$3,885.00" "$3,885.00" N/A N/A 27203131 EAP Custom 27203131 COIL AXIUM HELICAL QC-4-8-HELIX BOTH IP/OP "$4,071.00" "$3,013.00" $724.64 "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" $724.64 "$4,071.00" "$4,071.00" "$3,021.50" "$3,021.50" "$3,137.93" "$2,060.15" $848.44 "$4,071.00" "$1,628.40" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$3,053.25" "$4,071.00" "$4,071.00" "$4,071.00" "$2,035.50" "$2,035.50" "$3,224.23" "$4,071.00" "$3,256.80" "$2,646.15" "$4,071.00" "$4,071.00" "$2,361.18" "$4,071.00" "$2,442.60" "$4,071.00" "$4,071.00" "$4,071.00" N/A N/A 27203132 EAP Custom 27203132 COIL AXIUM HELICAL QC-4-10-HELIX BOTH IP/OP "$3,885.00" "$2,875.00" $691.53 "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" $691.53 "$3,885.00" "$3,885.00" "$2,883.45" "$2,883.45" "$2,994.56" "$2,024.09" $809.68 "$3,885.00" "$1,554.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$2,913.75" "$3,885.00" "$3,885.00" "$3,885.00" "$1,942.50" "$1,942.50" "$3,076.92" "$3,885.00" "$3,108.00" "$2,525.25" "$3,885.00" "$3,885.00" "$2,253.30" "$3,885.00" "$2,331.00" "$3,885.00" "$3,885.00" "$3,885.00" N/A N/A 27203133 EAP Custom 27203133 COIL AXIUM HELICAL QC-4-12-HELIX BOTH IP/OP "$3,920.00" "$2,901.00" $697.76 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $697.76 "$3,920.00" "$3,920.00" "$2,909.42" "$2,909.42" "$3,021.54" "$2,042.32" $816.97 "$3,920.00" "$1,568.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$2,548.00" "$3,920.00" "$3,920.00" "$2,273.60" "$3,920.00" "$2,352.00" "$3,920.00" "$3,920.00" "$3,920.00" N/A N/A 27203134 EAP Custom 27203134 COIL AXIUM HELICAL QC-5-15-HELIX BOTH IP/OP "$3,920.00" "$2,901.00" $697.76 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $697.76 "$3,920.00" "$3,920.00" "$2,909.42" "$2,909.42" "$3,021.54" "$2,042.32" $816.97 "$3,920.00" "$1,568.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$2,548.00" "$3,920.00" "$3,920.00" "$2,273.60" "$3,920.00" "$2,352.00" "$3,920.00" "$3,920.00" "$3,920.00" N/A N/A 27203135 EAP Custom 27203135 COIL AXIUM HELICAL QC-5-20-HELIX BOTH IP/OP "$3,955.00" "$2,927.00" $703.99 "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" $703.99 "$3,955.00" "$3,955.00" "$2,935.40" "$2,935.40" "$3,048.51" "$2,060.15" $824.27 "$3,955.00" "$1,582.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$2,966.25" "$3,955.00" "$3,955.00" "$3,955.00" "$1,977.50" "$1,977.50" "$3,132.36" "$3,955.00" "$3,164.00" "$2,570.75" "$3,955.00" "$3,955.00" "$2,293.90" "$3,955.00" "$2,373.00" "$3,955.00" "$3,955.00" "$3,955.00" N/A N/A 27203136 EAP Custom 27203136 COIL AXIUM HELICAL QC-6-20-HELIX BOTH IP/OP "$4,005.00" "$2,964.00" $712.89 "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" $712.89 "$4,005.00" "$4,005.00" "$2,972.51" "$2,972.51" "$3,087.05" "$2,060.15" $834.69 "$4,005.00" "$1,602.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$3,003.75" "$4,005.00" "$4,005.00" "$4,005.00" "$2,002.50" "$2,002.50" "$3,171.96" "$4,005.00" "$3,204.00" "$2,603.25" "$4,005.00" "$4,005.00" "$2,322.90" "$4,005.00" "$2,403.00" "$4,005.00" "$4,005.00" "$4,005.00" N/A N/A 27203137 EAP Custom 27203137 COIL AXIUM HELICAL QC-7 -30-HELIX BOTH IP/OP "$4,020.00" "$2,975.00" $715.56 "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" $715.56 "$4,020.00" "$4,020.00" "$2,983.64" "$2,983.64" "$3,098.62" "$2,060.15" $837.81 "$4,020.00" "$1,608.00" "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" "$3,015.00" "$4,020.00" "$4,020.00" "$4,020.00" "$2,010.00" "$2,010.00" "$3,183.84" "$4,020.00" "$3,216.00" "$2,613.00" "$4,020.00" "$4,020.00" "$2,331.60" "$4,020.00" "$2,412.00" "$4,020.00" "$4,020.00" "$4,020.00" N/A N/A 27203138 EAP Custom 27203138 COIL AXIUM HELICAL QC-8-30-HELIX BOTH IP/OP "$4,071.00" "$3,013.00" $724.64 "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" $724.64 "$4,071.00" "$4,071.00" "$3,021.50" "$3,021.50" "$3,137.93" "$2,060.15" $848.44 "$4,071.00" "$1,628.40" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$3,053.25" "$4,071.00" "$4,071.00" "$4,071.00" "$2,035.50" "$2,035.50" "$3,224.23" "$4,071.00" "$3,256.80" "$2,646.15" "$4,071.00" "$4,071.00" "$2,361.18" "$4,071.00" "$2,442.60" "$4,071.00" "$4,071.00" "$4,071.00" N/A N/A 27203139 EAP Custom 27203139 COIL AXIUM HELICAL QC-9-30-HELIX BOTH IP/OP "$4,071.00" "$3,013.00" $724.64 "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" $724.64 "$4,071.00" "$4,071.00" "$3,021.50" "$3,021.50" "$3,137.93" "$2,060.15" $848.44 "$4,071.00" "$1,628.40" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$3,053.25" "$4,071.00" "$4,071.00" "$4,071.00" "$2,035.50" "$2,035.50" "$3,224.23" "$4,071.00" "$3,256.80" "$2,646.15" "$4,071.00" "$4,071.00" "$2,361.18" "$4,071.00" "$2,442.60" "$4,071.00" "$4,071.00" "$4,071.00" N/A N/A 27203140 EAP Custom 27203140 COIL AXIUM HELICAL QC-10-30-HELIX BOTH IP/OP "$3,885.00" "$2,875.00" $691.53 "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" $691.53 "$3,885.00" "$3,885.00" "$2,883.45" "$2,883.45" "$2,994.56" "$2,024.09" $809.68 "$3,885.00" "$1,554.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$2,913.75" "$3,885.00" "$3,885.00" "$3,885.00" "$1,942.50" "$1,942.50" "$3,076.92" "$3,885.00" "$3,108.00" "$2,525.25" "$3,885.00" "$3,885.00" "$2,253.30" "$3,885.00" "$2,331.00" "$3,885.00" "$3,885.00" "$3,885.00" N/A N/A 27203141 EAP Custom 27203141 COIL AXIUM HELICAL QC-12-30-HELIX BOTH IP/OP "$3,885.00" "$2,875.00" $691.53 "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" $691.53 "$3,885.00" "$3,885.00" "$2,883.45" "$2,883.45" "$2,994.56" "$2,024.09" $809.68 "$3,885.00" "$1,554.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$2,913.75" "$3,885.00" "$3,885.00" "$3,885.00" "$1,942.50" "$1,942.50" "$3,076.92" "$3,885.00" "$3,108.00" "$2,525.25" "$3,885.00" "$3,885.00" "$2,253.30" "$3,885.00" "$2,331.00" "$3,885.00" "$3,885.00" "$3,885.00" N/A N/A 27203142 EAP Custom 27203142 COIL AXIUM HELICAL QC-14-30-HELIX BOTH IP/OP "$3,903.00" "$2,888.50" $694.73 "$3,903.00" "$3,903.00" "$3,903.00" "$3,903.00" "$3,903.00" "$3,903.00" "$3,903.00" $694.73 "$3,903.00" "$3,903.00" "$2,896.81" "$2,896.81" "$3,008.43" "$2,033.46" $813.43 "$3,903.00" "$1,561.20" "$3,903.00" "$3,903.00" "$3,903.00" "$3,903.00" "$3,903.00" "$2,927.25" "$3,903.00" "$3,903.00" "$3,903.00" "$1,951.50" "$1,951.50" "$3,091.18" "$3,903.00" "$3,122.40" "$2,536.95" "$3,903.00" "$3,903.00" "$2,263.74" "$3,903.00" "$2,341.80" "$3,903.00" "$3,903.00" "$3,903.00" N/A N/A 27203143 EAP Custom 27203143 COIL AXIUM HELICAL QC-16-30-HELIX BOTH IP/OP "$3,920.00" "$2,901.00" $697.76 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $697.76 "$3,920.00" "$3,920.00" "$2,909.42" "$2,909.42" "$3,021.54" "$2,042.32" $816.97 "$3,920.00" "$1,568.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$2,548.00" "$3,920.00" "$3,920.00" "$2,273.60" "$3,920.00" "$2,352.00" "$3,920.00" "$3,920.00" "$3,920.00" N/A N/A 27203144 EAP Custom 27203144 COIL AXIUM HELICAL QC-16-40-HELIX BOTH IP/OP "$3,920.00" "$2,901.00" $697.76 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $697.76 "$3,920.00" "$3,920.00" "$2,909.42" "$2,909.42" "$3,021.54" "$2,042.32" $816.97 "$3,920.00" "$1,568.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$2,548.00" "$3,920.00" "$3,920.00" "$2,273.60" "$3,920.00" "$2,352.00" "$3,920.00" "$3,920.00" "$3,920.00" N/A N/A 27203145 EAP Custom 27203145 COIL AXIUM HELICAL QC-18-40-HELIX BOTH IP/OP "$3,955.00" "$2,927.00" $703.99 "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" $703.99 "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" $824.27 "$3,955.00" "$1,582.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$2,966.25" "$3,955.00" "$3,955.00" "$3,955.00" "$1,977.50" "$1,977.50" "$3,132.36" "$3,955.00" "$3,164.00" "$1,779.75" "$3,955.00" "$3,955.00" "$2,293.90" "$3,955.00" "$2,373.00" "$3,955.00" "$3,955.00" "$3,955.00" N/A N/A 27203146 EAP Custom 27203146 COIL AXIUM HELICAL QC-20-40-HELIX BOTH IP/OP "$3,936.00" "$2,913.00" $700.61 "$3,936.00" "$3,936.00" "$3,936.00" "$3,936.00" "$3,936.00" "$3,936.00" "$3,936.00" $700.61 "$3,936.00" "$3,936.00" "$2,921.30" "$2,921.30" "$3,033.87" "$2,050.66" $820.31 "$3,936.00" "$1,574.40" "$3,936.00" "$3,936.00" "$3,936.00" "$3,936.00" "$3,936.00" "$2,952.00" "$3,936.00" "$3,936.00" "$3,936.00" "$1,968.00" "$1,968.00" "$3,117.31" "$3,936.00" "$3,148.80" "$2,558.40" "$3,936.00" "$3,936.00" "$2,282.88" "$3,936.00" "$2,361.60" "$3,936.00" "$3,936.00" "$3,936.00" N/A N/A 27203147 EAP Custom 27203147 COIL AXIUM HELICAL QC-20-50-HELIX BOTH IP/OP "$4,005.00" "$2,964.00" $712.89 "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" $712.89 "$4,005.00" "$4,005.00" "$2,972.51" "$2,972.51" "$3,087.05" "$2,060.15" $834.69 "$4,005.00" "$1,602.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$3,003.75" "$4,005.00" "$4,005.00" "$4,005.00" "$2,002.50" "$2,002.50" "$3,171.96" "$4,005.00" "$3,204.00" "$2,603.25" "$4,005.00" "$4,005.00" "$2,322.90" "$4,005.00" "$2,403.00" "$4,005.00" "$4,005.00" "$4,005.00" N/A N/A 27203148 EAP Custom 27203148 COIL AXIUM 3D QC-2-2-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203149 EAP Custom 27203149 COIL AXIUM 3D QC-2-4-3D BOTH IP/OP "$4,105.00" "$3,038.00" $730.69 "$4,105.00" "$4,105.00" "$4,105.00" "$4,105.00" "$4,105.00" "$4,105.00" "$4,105.00" $730.69 "$4,105.00" "$4,105.00" "$3,046.73" "$3,046.73" "$3,164.13" "$2,060.15" $855.53 "$4,105.00" "$1,642.00" "$4,105.00" "$4,105.00" "$4,105.00" "$4,105.00" "$4,105.00" "$3,078.75" "$4,105.00" "$4,105.00" "$4,105.00" "$2,052.50" "$2,052.50" "$3,251.16" "$4,105.00" "$3,284.00" "$2,668.25" "$4,105.00" "$4,105.00" "$2,380.90" "$4,105.00" "$2,463.00" "$4,105.00" "$4,105.00" "$4,105.00" N/A N/A 27203150 EAP Custom 27203150 COIL AXIUM 3D QC-2-6-3D BOTH IP/OP "$4,020.00" "$2,975.00" $715.56 "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" $715.56 "$4,020.00" "$4,020.00" "$2,983.64" "$2,983.64" "$3,098.62" "$2,060.15" $837.81 "$4,020.00" "$1,608.00" "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" "$3,015.00" "$4,020.00" "$4,020.00" "$4,020.00" "$2,010.00" "$2,010.00" "$3,183.84" "$4,020.00" "$3,216.00" "$2,613.00" "$4,020.00" "$4,020.00" "$2,331.60" "$4,020.00" "$2,412.00" "$4,020.00" "$4,020.00" "$4,020.00" N/A N/A 27203151 EAP Custom 27203151 COIL AXIUM 3D QC-3-4-3D BOTH IP/OP "$4,170.00" "$3,086.00" $742.26 "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" $742.26 "$4,170.00" "$4,170.00" "$3,094.97" "$3,094.97" "$3,214.24" "$2,060.15" $869.07 "$4,170.00" "$1,668.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$2,710.50" "$4,170.00" "$4,170.00" "$2,418.60" "$4,170.00" "$2,502.00" "$4,170.00" "$4,170.00" "$4,170.00" N/A N/A 27203152 EAP Custom 27203152 COIL AXIUM 3D QC-3-6-3D BOTH IP/OP "$3,245.00" "$2,401.50" $577.61 "$3,245.00" "$3,245.00" "$3,245.00" "$3,245.00" "$3,245.00" "$3,245.00" "$3,245.00" $577.61 "$3,245.00" "$3,245.00" "$2,408.44" "$2,408.44" "$2,501.25" "$1,690.65" $676.29 "$3,245.00" "$1,298.00" "$3,245.00" "$3,245.00" "$3,245.00" "$3,245.00" "$3,245.00" "$2,433.75" "$3,245.00" "$3,245.00" "$3,245.00" "$1,622.50" "$1,622.50" "$2,570.04" "$3,245.00" "$2,596.00" "$2,109.25" "$3,245.00" "$3,245.00" "$1,882.10" "$3,245.00" "$1,947.00" "$3,245.00" "$3,245.00" "$3,245.00" N/A N/A 27203153 EAP Custom 27203153 COIL AXIUM 3D QC-3-8-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203154 EAP Custom 27203154 COIL AXIUM 3D QC-4-8-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203155 EAP Custom 27203155 COIL AXIUM 3D QC-4-12-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203156 EAP Custom 27203156 COIL AXIUM 3D QC-5-10-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203157 EAP Custom 27203157 COIL AXIUM 3D QC-5-15-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203158 EAP Custom 27203158 COIL AXIUM 3D QC-6-15-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203159 EAP Custom 27203159 COIL AXIUM 3D QC-6-20-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203160 EAP Custom 27203160 COIL AXIUM 3D QC-7-20-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203161 EAP Custom 27203161 COIL AXIUM 3D QC-7-30-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203162 EAP Custom 27203162 COIL AXIUM 3D QC-8-20-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203163 EAP Custom 27203163 COIL AXIUM 3D QC-8-30-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203164 EAP Custom 27203164 COIL AXIUM 3D QC-9-20-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203165 EAP Custom 27203165 COIL AXIUM 3D QC-9-30-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203166 EAP Custom 27203166 COIL AXIUM 3D QC-10-20-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203167 EAP Custom 27203167 COIL AXIUM 3D QC-10-30-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203168 EAP Custom 27203168 COIL AXIUM 3D QC-12-40-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203169 EAP Custom 27203169 COIL AXIUM 3D QC-14-40-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203170 EAP Custom 27203170 COIL AXIUM 3D QC-16-40-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203171 EAP Custom 27203171 COIL AXIUM 3D QC-18-40-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203172 EAP Custom 27203172 COIL AXIUM 3D QC-20-50-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203173 EAP Custom 27203173 COIL AXIUM 3D QC-22-50-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203174 EAP Custom 27203174 COIL AXIUM 3D QC-25-50-3D BOTH IP/OP "$1,395.00" "$1,032.50" $248.31 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $248.31 "$1,395.00" "$1,395.00" "$1,035.37" "$1,035.37" "$1,075.27" $726.80 $290.73 "$1,395.00" $558.00 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $906.75 "$1,395.00" "$1,395.00" $809.10 "$1,395.00" $837.00 "$1,395.00" "$1,395.00" "$1,395.00" N/A N/A 27203180 EAP HCPCS C1726 ROTH NET BOTH IP/OP "$1,278.00" $946.00 $253.65 "$1,278.00" $693.95 $693.95 $693.95 $693.95 "$1,278.00" "$1,278.00" "$1,278.00" $266.37 "$1,278.00" $948.53 $948.53 $985.08 $665.84 $266.35 "$1,278.00" "$1,278.00" $755.94 "$1,278.00" "$1,278.00" "$1,278.00" "$1,278.00" $958.50 "$1,278.00" "$1,278.00" "$1,278.00" $639.00 $639.00 "$1,012.18" "$1,278.00" "$1,022.40" $830.70 $253.65 "$1,278.00" $741.24 "$1,278.00" "$1,278.00" "$1,278.00" $266.34 "$1,278.00" N/A N/A 27203181 EAP HCPCS C1726 2.3MM INTERJECT INJ NEEDLE23G BOTH IP/OP $732.00 $542.00 $145.28 $732.00 $397.48 $397.48 $397.48 $397.48 $732.00 $732.00 $732.00 $152.57 $732.00 $543.29 $543.29 $564.23 $381.37 $152.56 $732.00 $732.00 $432.98 $732.00 $732.00 $732.00 $732.00 $549.00 $732.00 $732.00 $732.00 $366.00 $366.00 $579.74 $732.00 $585.60 $475.80 $145.28 $732.00 $424.56 $732.00 $439.20 $732.00 $152.55 $732.00 N/A N/A 27203182 EAP HCPCS C1726 ERCP FORCEP BOTH IP/OP $691.00 $511.50 $137.15 $691.00 $375.21 $375.21 $375.21 $375.21 $691.00 $691.00 $691.00 $144.02 $691.00 $512.86 $512.86 $532.62 $360.01 $144.01 $691.00 $691.00 $408.73 $691.00 $691.00 $691.00 $691.00 $518.25 $691.00 $691.00 $691.00 $345.50 $345.50 $547.27 $691.00 $552.80 $449.15 $137.15 $691.00 $400.78 $691.00 $691.00 $691.00 $144.00 $691.00 N/A N/A 27203183 EAP HCPCS C1726 19G BX NEEDLE BOTH IP/OP $515.00 $381.50 $102.21 $515.00 $279.65 $279.65 $279.65 $279.65 $515.00 $515.00 $515.00 $107.34 $515.00 $382.23 $382.23 $396.96 $268.32 $107.33 $515.00 $515.00 $304.62 $515.00 $515.00 $515.00 $515.00 $386.25 $515.00 $515.00 $515.00 $257.50 $257.50 $407.88 $515.00 $412.00 $334.75 $102.21 $515.00 $298.70 $515.00 $309.00 $515.00 $107.33 $515.00 N/A N/A 27203185 EAP HCPCS C1751 INJECTION PROBE 10FR BOTH IP/OP $431.00 $319.00 $85.54 $431.00 $234.03 $234.03 $234.03 $234.03 $431.00 $431.00 $431.00 $89.83 $431.00 $319.89 $319.89 $332.21 $224.55 $89.83 $431.00 $431.00 $254.94 $431.00 $431.00 $431.00 $431.00 $323.25 $431.00 $431.00 $431.00 $215.50 $215.50 $341.35 $431.00 $344.80 $280.15 $85.54 $431.00 $249.98 $431.00 $431.00 $431.00 $89.82 $431.00 N/A N/A 27203186 EAP HCPCS C1751 INJECTION PROBE 7FR BOTH IP/OP $431.00 $319.00 $85.54 $431.00 $234.03 $234.03 $234.03 $234.03 $431.00 $431.00 $431.00 $89.83 $431.00 $319.89 $319.89 $332.21 $224.55 $89.83 $431.00 $431.00 $254.94 $431.00 $431.00 $431.00 $431.00 $323.25 $431.00 $431.00 $431.00 $215.50 $215.50 $341.35 $431.00 $344.80 $280.15 $85.54 $431.00 $249.98 $431.00 $431.00 $431.00 $89.82 $431.00 N/A N/A 27203187 EAP HCPCS C1726 RX DILATATION BALLOON 4-4/5.8 BOTH IP/OP $414.00 $306.50 $82.17 $414.00 $224.80 $224.80 $224.80 $224.80 $414.00 $414.00 $414.00 $86.29 $414.00 $307.27 $307.27 $319.11 $215.69 $86.28 $414.00 $414.00 $244.88 $414.00 $414.00 $414.00 $414.00 $310.50 $414.00 $414.00 $414.00 $207.00 $207.00 $327.89 $414.00 $331.20 $269.10 $82.17 $414.00 $240.12 $414.00 $414.00 $414.00 $86.28 $414.00 N/A N/A 27203188 EAP HCPCS C1726 RX DILATATION BALLOON 6-4/5.8 BOTH IP/OP $414.00 $306.50 $82.17 $414.00 $224.80 $224.80 $224.80 $224.80 $414.00 $414.00 $414.00 $86.29 $414.00 $307.27 $307.27 $319.11 $215.69 $86.28 $414.00 $414.00 $244.88 $414.00 $414.00 $414.00 $414.00 $310.50 $414.00 $414.00 $414.00 $207.00 $207.00 $327.89 $414.00 $331.20 $269.10 $82.17 $414.00 $240.12 $414.00 $414.00 $414.00 $86.28 $414.00 N/A N/A 27203189 EAP HCPCS C1726 RX DILATATION BALLOON 8-4/5.8 BOTH IP/OP $414.00 $306.50 $82.17 $414.00 $224.80 $224.80 $224.80 $224.80 $414.00 $414.00 $414.00 $86.29 $414.00 $307.27 $307.27 $319.11 $215.69 $86.28 $414.00 $414.00 $244.88 $414.00 $414.00 $414.00 $414.00 $310.50 $414.00 $414.00 $414.00 $207.00 $207.00 $327.89 $414.00 $331.20 $269.10 $82.17 $414.00 $240.12 $414.00 $414.00 $414.00 $86.28 $414.00 N/A N/A 27203190 EAP HCPCS C1726 RX DILATATION BALLOON 10-4/5.8 BOTH IP/OP $414.00 $306.50 $82.17 $414.00 $224.80 $224.80 $224.80 $224.80 $414.00 $414.00 $414.00 $86.29 $414.00 $307.27 $307.27 $319.11 $215.69 $86.28 $414.00 $414.00 $244.88 $414.00 $414.00 $414.00 $414.00 $310.50 $414.00 $414.00 $414.00 $207.00 $207.00 $327.89 $414.00 $331.20 $269.10 $82.17 $414.00 $240.12 $414.00 $248.40 $414.00 $86.28 $414.00 N/A N/A 27203191 EAP HCPCS C1726 CELIAC PLEXUS NEUROLYSIS NEEDL BOTH IP/OP $392.00 $290.50 $77.80 $392.00 $212.86 $212.86 $212.86 $212.86 $392.00 $392.00 $392.00 $81.70 $392.00 $290.94 $290.94 $302.15 $204.23 $81.70 $392.00 $392.00 $231.87 $392.00 $392.00 $392.00 $392.00 $294.00 $392.00 $392.00 $392.00 $196.00 $196.00 $310.46 $392.00 $313.60 $254.80 $77.80 $392.00 $227.36 $392.00 $392.00 $392.00 $81.69 $392.00 N/A N/A 27203192 EAP HCPCS C1726 22G BLUE SHEATH (STIFFER) BOTH IP/OP $386.00 $286.00 $76.61 $386.00 $209.60 $209.60 $209.60 $209.60 $386.00 $386.00 $386.00 $80.45 $386.00 $286.49 $286.49 $297.53 $201.11 $80.45 $386.00 $386.00 $228.32 $386.00 $386.00 $386.00 $386.00 $289.50 $386.00 $386.00 $386.00 $193.00 $193.00 $305.71 $386.00 $308.80 $250.90 $76.61 $386.00 $223.88 $386.00 $386.00 $386.00 $80.44 $386.00 N/A N/A 27203193 EAP HCPCS C1726 22G GREEN SPRING COIL SHEATH BOTH IP/OP $386.00 $286.00 $76.61 $386.00 $209.60 $209.60 $209.60 $209.60 $386.00 $386.00 $386.00 $80.45 $386.00 $286.49 $286.49 $297.53 $201.11 $80.45 $386.00 $386.00 $228.32 $386.00 $386.00 $386.00 $386.00 $289.50 $386.00 $386.00 $386.00 $193.00 $193.00 $305.71 $386.00 $308.80 $250.90 $76.61 $386.00 $223.88 $386.00 $386.00 $386.00 $80.44 $386.00 N/A N/A 27203194 EAP HCPCS C1726 CRE WG 8-10 DILATION BALLOON BOTH IP/OP $324.00 $240.00 $64.31 $324.00 $175.93 $175.93 $175.93 $175.93 $324.00 $324.00 $324.00 $67.53 $324.00 $240.47 $240.47 $249.74 $168.80 $67.53 $324.00 $324.00 $191.65 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $210.60 $64.31 $324.00 $187.92 $324.00 $324.00 $324.00 $67.52 $324.00 N/A N/A 27203195 EAP HCPCS C1726 CRE WG 10-12 DILATION BALLOON BOTH IP/OP $324.00 $240.00 $64.31 $324.00 $175.93 $175.93 $175.93 $175.93 $324.00 $324.00 $324.00 $67.53 $324.00 $240.47 $240.47 $249.74 $168.80 $67.53 $324.00 $324.00 $191.65 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $210.60 $64.31 $324.00 $187.92 $324.00 $194.40 $324.00 $67.52 $324.00 N/A N/A 27203196 EAP HCPCS C1726 CRE 12-15MM DILATION BALLOON BOTH IP/OP $324.00 $240.00 $64.31 $324.00 $175.93 $175.93 $175.93 $175.93 $324.00 $324.00 $324.00 $67.53 $324.00 $240.47 $240.47 $249.74 $168.80 $67.53 $324.00 $324.00 $191.65 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $210.60 $64.31 $324.00 $187.92 $324.00 $324.00 $324.00 $67.52 $324.00 N/A N/A 27203197 EAP HCPCS C1726 CRE 15-18 MM DILATION BALLOON BOTH IP/OP $324.00 $240.00 $64.31 $324.00 $175.93 $175.93 $175.93 $175.93 $324.00 $324.00 $324.00 $67.53 $324.00 $240.47 $240.47 $249.74 $168.80 $67.53 $324.00 $324.00 $191.65 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $210.60 $64.31 $324.00 $187.92 $324.00 $194.40 $324.00 $67.52 $324.00 N/A N/A 27203198 EAP HCPCS C1726 CRE 18-20 MM DILATION BALLOON BOTH IP/OP $324.00 $240.00 $64.31 $324.00 $175.93 $175.93 $175.93 $175.93 $324.00 $324.00 $324.00 $67.53 $324.00 $240.47 $240.47 $249.74 $168.80 $67.53 $324.00 $324.00 $191.65 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $210.60 $64.31 $324.00 $187.92 $324.00 $324.00 $324.00 $67.52 $324.00 N/A N/A 27203199 EAP HCPCS C1726 ERBE PROBE BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $172.80 $288.00 $60.02 $288.00 N/A N/A 27203200 EAP HCPCS C1769 DREAMWIRE .035 260STR STND BOTH IP/OP $281.00 $208.00 $55.77 $281.00 $152.58 $152.58 $152.58 $152.58 $281.00 $281.00 $281.00 $58.57 $281.00 $208.56 $208.56 $216.59 $146.40 $58.56 $281.00 $281.00 $166.21 $281.00 $281.00 $281.00 $281.00 $210.75 $281.00 $281.00 $281.00 $140.50 $140.50 $222.55 $281.00 $224.80 $182.65 $55.77 $281.00 $162.98 $281.00 $281.00 $281.00 $58.56 $281.00 N/A N/A 27203201 EAP HCPCS C1726 CYTOLOGY BRUSH ECHO -19 BOTH IP/OP $232.00 $172.00 $46.05 $232.00 $125.98 $125.98 $125.98 $125.98 $232.00 $232.00 $232.00 $48.35 $232.00 $172.19 $172.19 $178.83 $120.87 $48.35 $232.00 $232.00 $137.23 $232.00 $232.00 $232.00 $232.00 $174.00 $232.00 $232.00 $232.00 $116.00 $116.00 $183.74 $232.00 $185.60 $150.80 $46.05 $232.00 $134.56 $232.00 $232.00 $232.00 $48.35 $232.00 N/A N/A 27203202 EAP HCPCS C1726 EXTRACTOR RX 9-12 MM BOTH IP/OP $229.00 $169.50 $45.45 $229.00 $124.35 $124.35 $124.35 $124.35 $229.00 $229.00 $229.00 $47.73 $229.00 $169.96 $169.96 $176.51 $119.31 $47.73 $229.00 $229.00 $135.45 $229.00 $229.00 $229.00 $229.00 $171.75 $229.00 $229.00 $229.00 $114.50 $114.50 $181.37 $229.00 $183.20 $148.85 $45.45 $229.00 $132.82 $229.00 $137.40 $229.00 $47.72 $229.00 N/A N/A 27203203 EAP HCPCS C1726 EXTRACTOR RX 12-15 MM BOTH IP/OP $229.00 $169.50 $45.45 $229.00 $124.35 $124.35 $124.35 $124.35 $229.00 $229.00 $229.00 $47.73 $229.00 $169.96 $169.96 $176.51 $119.31 $47.73 $229.00 $229.00 $135.45 $229.00 $229.00 $229.00 $229.00 $171.75 $229.00 $229.00 $229.00 $114.50 $114.50 $181.37 $229.00 $183.20 $148.85 $45.45 $229.00 $132.82 $229.00 $229.00 $229.00 $47.72 $229.00 N/A N/A 27203204 EAP HCPCS C1726 EXTRACTOR RX 15-18 MM BOTH IP/OP $229.00 $169.50 $45.45 $229.00 $124.35 $124.35 $124.35 $124.35 $229.00 $229.00 $229.00 $47.73 $229.00 $169.96 $169.96 $176.51 $119.31 $47.73 $229.00 $229.00 $135.45 $229.00 $229.00 $229.00 $229.00 $171.75 $229.00 $229.00 $229.00 $114.50 $114.50 $181.37 $229.00 $183.20 $148.85 $45.45 $229.00 $132.82 $229.00 $229.00 $229.00 $47.72 $229.00 N/A N/A 27203205 EAP HCPCS C1726 ALLIANCE INFLATION SYRINGE BOTH IP/OP $52.00 $38.50 $10.32 $52.00 $28.24 $28.24 $28.24 $28.24 $52.00 $52.00 $52.00 $10.84 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $52.00 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $10.32 $52.00 $30.16 $52.00 $52.00 $52.00 $10.84 $52.00 N/A N/A 27203206 EAP HCPCS C1726 ENCORE 26 SINGLE BOTH IP/OP $35.00 $26.00 $6.95 $35.00 $19.01 $19.01 $19.01 $19.01 $35.00 $35.00 $35.00 $7.29 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $35.00 $20.70 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $6.95 $35.00 $20.30 $35.00 $35.00 $35.00 $7.29 $35.00 N/A N/A 27203207 EAP HCPCS C1726 RX LCKNG DVCE &BX CAP/OLYMPUS BOTH IP/OP $16.00 $12.00 $3.18 $16.00 $8.69 $8.69 $8.69 $8.69 $16.00 $16.00 $16.00 $3.33 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $16.00 $9.46 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $3.18 $16.00 $9.28 $16.00 $16.00 $16.00 $3.33 $16.00 N/A N/A 27203208 EAP HCPCS C1726 OLYMPUS ENDO JAW(COLD FORCEPS) BOTH IP/OP $14.00 $10.50 $2.78 $14.00 $7.60 $7.60 $7.60 $7.60 $14.00 $14.00 $14.00 $2.92 $14.00 $10.39 $10.39 $10.79 $7.29 $2.92 $14.00 $14.00 $8.28 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $9.10 $2.78 $14.00 $8.12 $14.00 $14.00 $14.00 $2.92 $14.00 N/A N/A 27203210 EAP HCPCS C1773 KIT SNR AGN 90D MIC 200CM 2.3-3FR 2MM CATH LOOP BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 27203212 EAP HCPCS C1729 "CATHETER, EVD BACTISEAL 82-1750" BOTH IP/OP "$1,924.00" "$1,424.00" $381.87 "$1,924.00" "$1,044.73" "$1,044.73" "$1,044.73" "$1,044.73" "$1,924.00" "$1,924.00" "$1,924.00" $401.01 "$1,924.00" "$1,427.99" "$1,427.99" "$1,483.02" "$1,002.40" $400.98 "$1,924.00" "$1,924.00" "$1,138.05" "$1,924.00" "$1,924.00" "$1,924.00" "$1,924.00" "$1,443.00" "$1,924.00" "$1,924.00" "$1,924.00" $962.00 $962.00 "$1,523.81" "$1,924.00" "$1,539.20" "$1,250.60" $381.87 "$1,924.00" "$1,115.92" "$1,924.00" "$1,924.00" "$1,924.00" $400.96 "$1,924.00" N/A N/A 27203213 EAP HCPCS C1773 KIT SNR AGN 90D 200CM 2.3-3FR 4MM MCTH LOOP COIL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 27203214 EAP HCPCS C1773 KIT SNR AGN 90D 200CM 2.3-3FR 7MM MCTH LOOP COIL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 27203215 EAP HCPCS C1887 CATHETER GUID SIM2 CURVE 6FR 90CM ENV BOTH IP/OP $901.00 $667.00 $178.83 $901.00 $489.24 $489.24 $489.24 $489.24 $901.00 $901.00 $901.00 $187.79 $901.00 $668.72 $668.72 $694.49 $469.42 $187.78 $901.00 $901.00 $532.94 $901.00 $901.00 $901.00 $901.00 $675.75 $901.00 $901.00 $901.00 $450.50 $450.50 $713.59 $901.00 $720.80 $585.65 $178.83 $901.00 $522.58 $901.00 $901.00 $901.00 $187.77 $901.00 N/A N/A 27203216 EAP HCPCS C1887 CATHETER GUID SIM2 CURVE 6FR 100CM ENV BOTH IP/OP $901.00 $667.00 $178.83 $901.00 $489.24 $489.24 $489.24 $489.24 $901.00 $901.00 $901.00 $187.79 $901.00 $668.72 $668.72 $694.49 $469.42 $187.78 $901.00 $360.40 $532.94 $901.00 $901.00 $901.00 $901.00 $675.75 $901.00 $901.00 $901.00 $450.50 $450.50 $713.59 $901.00 $720.80 $585.65 $178.83 $901.00 $522.58 $901.00 $901.00 $901.00 $187.77 $901.00 N/A N/A 27203217 EAP HCPCS C1769 GUIDEWIRE VASC 175CM RND PRFL AGILE TIP SMTR ROT BOTH IP/OP "$1,575.00" "$1,165.50" $312.60 "$1,575.00" $855.23 $855.23 $855.23 $855.23 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,168.97" "$1,168.97" "$1,214.01" $820.58 $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" "$1,023.75" $312.60 "$1,575.00" $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 27203220 EAP HCPCS C1894 INTRODUCER SHTH LNG 5FR 30CM GRY LF TRAW HI KINK RST ULSMTH BOTH IP/OP $102.00 $75.50 $20.24 $102.00 $55.39 $55.39 $55.39 $55.39 $102.00 $102.00 $102.00 $21.26 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $102.00 $60.33 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $20.24 $102.00 $59.16 $102.00 $102.00 $102.00 $21.26 $102.00 N/A N/A 27203221 EAP HCPCS C1894 INTRODUCER SHTH LNG 6FR 30CM LF TRAW UNQ LCK HI KINK RST BOTH IP/OP $102.00 $75.50 $20.24 $102.00 $55.39 $55.39 $55.39 $55.39 $102.00 $102.00 $102.00 $21.26 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $102.00 $60.33 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $20.24 $102.00 $59.16 $102.00 $102.00 $102.00 $21.26 $102.00 N/A N/A 27203222 EAP HCPCS C1894 SHEATH INTRO LNG 7FR 30CM TRAW FNL ULSMTH DIL TPR PTFE BOTH IP/OP $102.00 $75.50 $20.24 $102.00 $55.39 $55.39 $55.39 $55.39 $102.00 $102.00 $102.00 $21.26 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $102.00 $60.33 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $20.24 $102.00 $59.16 $102.00 $61.20 $102.00 $21.26 $102.00 N/A N/A 27203251 EAP Custom 27203251 COIL AXIUM HELICAL QC-1.5-2-HELIX BOTH IP/OP "$1,034.00" $765.50 $184.05 "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" $184.05 "$1,034.00" "$1,034.00" $767.43 $767.43 $797.01 $538.71 $215.50 "$1,034.00" $413.60 "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" $775.50 "$1,034.00" "$1,034.00" "$1,034.00" $517.00 $517.00 $818.93 "$1,034.00" $827.20 $672.10 "$1,034.00" "$1,034.00" $599.72 "$1,034.00" $620.40 "$1,034.00" "$1,034.00" "$1,034.00" N/A N/A 27203270 EAP Custom 27203270 MPC ENVOY GUIDING CATH BOTH IP/OP $303.00 $224.50 $53.93 $303.00 $303.00 $303.00 $303.00 $303.00 $303.00 $303.00 $53.93 $303.00 $303.00 $224.89 $224.89 $233.55 $157.86 $63.15 $303.00 $121.20 $303.00 $303.00 $303.00 $303.00 $303.00 $227.25 $303.00 $303.00 $303.00 $151.50 $151.50 $239.98 $303.00 $242.40 $196.95 $303.00 $303.00 $175.74 $303.00 $181.80 $303.00 $303.00 $303.00 N/A N/A 27203271 EAP Custom 27203271 CONTROL WIRE .018 V-18 BOTH IP/OP $783.00 $579.50 $139.37 $783.00 $783.00 $783.00 $783.00 $783.00 $783.00 $783.00 $139.37 $783.00 $783.00 $581.14 $581.14 $603.54 $407.94 $163.19 $783.00 $313.20 $783.00 $783.00 $783.00 $783.00 $783.00 $587.25 $783.00 $783.00 $783.00 $391.50 $391.50 $620.14 $783.00 $626.40 $508.95 $783.00 $783.00 $454.14 $783.00 $469.80 $783.00 $783.00 $783.00 N/A N/A 27203290 EAP Custom 27203290 FOOT DROP SPLINT-PREFAB BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27203400 EAP Custom 27203400 INTERLOCK DETACH 36-156 COIL BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27203401 EAP Custom 27203401 DFS100406-20 MICRUS MICROCOIL BOTH IP/OP $483.00 $357.50 $85.97 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $85.97 $483.00 $483.00 $358.48 $358.48 $372.30 $251.64 $100.66 $483.00 $193.20 $483.00 $483.00 $483.00 $483.00 $483.00 $362.25 $483.00 $483.00 $483.00 $241.50 $241.50 $382.54 $483.00 $386.40 $313.95 $483.00 $483.00 $280.14 $483.00 $289.80 $483.00 $483.00 $483.00 N/A N/A 27203402 EAP Custom 27203402 DFS100310-20 MICRUS MICROCOIL BOTH IP/OP "$1,429.00" "$1,057.50" $254.36 "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" $254.36 "$1,429.00" "$1,429.00" "$1,060.60" "$1,060.60" "$1,101.47" $744.51 $297.82 "$1,429.00" $571.60 "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,071.75" "$1,429.00" "$1,429.00" "$1,429.00" $714.50 $714.50 "$1,131.77" "$1,429.00" "$1,143.20" $928.85 "$1,429.00" "$1,429.00" $828.82 "$1,429.00" $857.40 "$1,429.00" "$1,429.00" "$1,429.00" N/A N/A 27203403 EAP Custom 27203403 DPL100151-20 MICRUS MICROCOIL BOTH IP/OP "$1,571.00" "$1,163.00" $279.64 "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" $279.64 "$1,571.00" "$1,571.00" "$1,166.00" "$1,166.00" "$1,210.93" $818.49 $327.41 "$1,571.00" $628.40 "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,178.25" "$1,571.00" "$1,571.00" "$1,571.00" $785.50 $785.50 "$1,244.23" "$1,571.00" "$1,256.80" "$1,021.15" "$1,571.00" "$1,571.00" $911.18 "$1,571.00" $942.60 "$1,571.00" "$1,571.00" "$1,571.00" N/A N/A 27203404 EAP Custom 27203404 HEL180620-2O MICRUS MICROCOIL BOTH IP/OP $834.00 $617.50 $148.45 $834.00 $834.00 $834.00 $834.00 $834.00 $834.00 $834.00 $148.45 $834.00 $834.00 $618.99 $618.99 $642.85 $434.51 $173.81 $834.00 $333.60 $834.00 $834.00 $834.00 $834.00 $834.00 $625.50 $834.00 $834.00 $834.00 $417.00 $417.00 $660.53 $834.00 $667.20 $542.10 $834.00 $834.00 $483.72 $834.00 $500.40 $834.00 $834.00 $834.00 N/A N/A 27203405 EAP Custom 27203405 BRS000609-00 BALLOON ASCNT BOTH IP/OP "$1,900.00" "$1,406.00" $338.20 "$1,900.00" "$1,900.00" "$1,900.00" "$1,900.00" "$1,900.00" "$1,900.00" "$1,900.00" $338.20 "$1,900.00" "$1,900.00" "$1,410.18" "$1,410.18" "$1,464.52" $989.90 $395.98 "$1,900.00" $760.00 "$1,900.00" "$1,900.00" "$1,900.00" "$1,900.00" "$1,900.00" "$1,425.00" "$1,900.00" "$1,900.00" "$1,900.00" $950.00 $950.00 "$1,504.80" "$1,900.00" "$1,520.00" "$1,235.00" "$1,900.00" "$1,900.00" "$1,102.00" "$1,900.00" "$1,140.00" "$1,900.00" "$1,900.00" "$1,900.00" N/A N/A 27203406 EAP Custom 27203406 4.5X20 4.5X20 VIATRAC BALLOON BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" "$1,500.00" $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 27203407 EAP Custom 27203407 5X20 VIATRAC BALLOON BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" "$1,500.00" $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 27203408 EAP Custom 27203408 6X20 VIATRAC BALLOON BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" "$1,500.00" $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 27203409 EAP Custom 27203409 .038 150CM STIFF ANGLED GLIDE BOTH IP/OP $163.00 $121.00 $29.01 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $29.01 $163.00 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $65.20 $163.00 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $163.00 $163.00 $94.54 $163.00 $97.80 $163.00 $163.00 $163.00 N/A N/A 27203410 EAP Custom 27203410 .038 150CM GUIDEWIRE BNTSN BOTH IP/OP $60.00 $44.50 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 $60.00 $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A 27203411 EAP Custom 27203411 9FR-30 TEAR-AWAY INTRODUCER BOTH IP/OP $51.00 $38.00 $9.08 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $9.08 $51.00 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $20.40 $51.00 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $51.00 $51.00 $29.58 $51.00 $30.60 $51.00 $51.00 $51.00 N/A N/A 27203412 EAP Custom 27203412 10FR-30CM TEAR-AWAY INTRODUCER BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 27203413 EAP Custom 27203413 16FR-30CM TEAR-AWAY INTRODUCER BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 27203414 EAP Custom 27203414 2.0 MM X9 MAVERICK BALLOON CATHETER BOTH IP/OP $916.00 $678.00 $163.05 $916.00 $916.00 $916.00 $916.00 $916.00 $916.00 $916.00 $163.05 $916.00 $916.00 $679.86 $679.86 $706.05 $477.24 $190.90 $916.00 $366.40 $916.00 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $595.40 $916.00 $916.00 $531.28 $916.00 $549.60 $916.00 $916.00 $916.00 N/A N/A 27203415 EAP Custom 27203415 2.5 MM X9 MAVERICK BALLOON CATHETER BOTH IP/OP $916.00 $678.00 $163.05 $916.00 $916.00 $916.00 $916.00 $916.00 $916.00 $916.00 $163.05 $916.00 $916.00 $679.86 $679.86 $706.05 $477.24 $190.90 $916.00 $366.40 $916.00 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $595.40 $916.00 $916.00 $531.28 $916.00 $549.60 $916.00 $916.00 $916.00 N/A N/A 27203416 EAP Custom 27203416 STENT MICRODELIVERY SYSTEM NEURFORM2 SYSTEM 3.5 X 30MM BOTH IP/OP "$8,535.00" "$6,316.00" "$1,519.23" "$8,535.00" "$8,535.00" "$8,535.00" "$8,535.00" "$8,535.00" "$8,535.00" "$8,535.00" "$1,519.23" "$8,535.00" "$8,535.00" "$4,181.12" "$4,181.12" "$6,578.78" "$2,060.15" "$1,778.79" "$8,535.00" "$3,414.00" "$8,535.00" "$8,535.00" "$8,535.00" "$8,535.00" "$8,535.00" "$6,401.25" "$8,535.00" "$8,535.00" "$8,535.00" "$4,267.50" "$4,267.50" "$6,759.72" "$8,535.00" "$6,828.00" "$5,547.75" "$8,535.00" "$8,535.00" "$4,950.30" "$8,535.00" "$5,121.00" "$8,535.00" "$8,535.00" "$8,535.00" N/A N/A 27203417 EAP Custom 27203417 3.0 MM X9 MAVERICK BALLOON CATHETER BOTH IP/OP $916.00 $678.00 $163.05 $916.00 $916.00 $916.00 $916.00 $916.00 $916.00 $916.00 $163.05 $916.00 $916.00 $679.86 $679.86 $706.05 $477.24 $190.90 $916.00 $366.40 $916.00 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $595.40 $916.00 $916.00 $531.28 $916.00 $549.60 $916.00 $916.00 $916.00 N/A N/A 27203418 EAP Custom 27203418 STENT STABILIZER CATHETER NEURFORM BOTH IP/OP "$3,836.00" "$2,839.00" $682.81 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $682.81 "$3,836.00" "$3,836.00" "$2,847.08" "$2,847.08" "$2,956.79" "$1,998.56" $799.46 "$3,836.00" "$1,534.40" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$2,493.40" "$3,836.00" "$3,836.00" "$2,224.88" "$3,836.00" "$2,301.60" "$3,836.00" "$3,836.00" "$3,836.00" N/A N/A 27203419 EAP Custom 27203419 MPC ENVOY GUIDING CATH BOTH IP/OP $450.00 $333.00 $80.10 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $80.10 $450.00 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $180.00 $450.00 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $450.00 $450.00 $261.00 $450.00 $270.00 $450.00 $450.00 $450.00 N/A N/A 27203420 EAP Custom 27203420 5.5 ACCUNET DISTAL PROTECTION DEVICE BOTH IP/OP "$5,171.00" "$3,827.00" $920.44 "$5,171.00" "$5,171.00" "$5,171.00" "$5,171.00" "$5,171.00" "$5,171.00" "$5,171.00" $920.44 "$5,171.00" "$5,171.00" "$3,837.92" "$3,837.92" "$3,985.81" "$2,060.15" "$1,077.69" "$5,171.00" "$2,068.40" "$5,171.00" "$5,171.00" "$5,171.00" "$5,171.00" "$5,171.00" "$3,878.25" "$5,171.00" "$5,171.00" "$5,171.00" "$2,585.50" "$2,585.50" "$4,095.43" "$5,171.00" "$4,136.80" "$3,361.15" "$5,171.00" "$5,171.00" "$2,999.18" "$5,171.00" "$3,102.60" "$5,171.00" "$5,171.00" "$5,171.00" N/A N/A 27203421 EAP Custom 27203421 2.25 MINIVISION STENT BOTH IP/OP "$1,256.00" $929.50 $223.57 "$1,256.00" "$1,256.00" "$1,256.00" "$1,256.00" "$1,256.00" "$1,256.00" "$1,256.00" $223.57 "$1,256.00" "$1,256.00" $932.20 $932.20 $968.12 $654.38 $261.76 "$1,256.00" $502.40 "$1,256.00" "$1,256.00" "$1,256.00" "$1,256.00" "$1,256.00" $942.00 "$1,256.00" "$1,256.00" "$1,256.00" $628.00 $628.00 $994.75 "$1,256.00" "$1,004.80" $816.40 "$1,256.00" "$1,256.00" $728.48 "$1,256.00" $753.60 "$1,256.00" "$1,256.00" "$1,256.00" N/A N/A 27203422 EAP Custom 27203422 4.0X20MM VIATRAC BALLOON BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" "$1,500.00" $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 27203423 EAP Custom 27203423 125CM VETEBRAL CATHETER BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27203425 EAP HCPCS C1887 CATHETER INTVN 5FR .056IN .046IN 150CM 25CM RAPEX BOTH IP/OP "$1,023.00" $757.50 $203.04 "$1,023.00" $555.49 $555.49 $555.49 $555.49 "$1,023.00" "$1,023.00" "$1,023.00" $213.22 "$1,023.00" $759.27 $759.27 $788.53 $532.98 $213.20 "$1,023.00" $409.20 $605.10 "$1,023.00" "$1,023.00" "$1,023.00" "$1,023.00" $767.25 "$1,023.00" "$1,023.00" "$1,023.00" $511.50 $511.50 $810.22 "$1,023.00" $818.40 $664.95 $203.04 "$1,023.00" $593.34 "$1,023.00" "$1,023.00" "$1,023.00" $213.19 "$1,023.00" N/A N/A 27203426 EAP HCPCS C1887 CATHETER INTVN 7FR .078IN .062IN 150CM 25CM RAPEX BOTH IP/OP "$1,023.00" $757.50 $203.04 "$1,023.00" $555.49 $555.49 $555.49 $555.49 "$1,023.00" "$1,023.00" "$1,023.00" $213.22 "$1,023.00" $759.27 $759.27 $788.53 $532.98 $213.20 "$1,023.00" $409.20 $605.10 "$1,023.00" "$1,023.00" "$1,023.00" "$1,023.00" $767.25 "$1,023.00" "$1,023.00" "$1,023.00" $511.50 $511.50 $810.22 "$1,023.00" $818.40 $664.95 $203.04 "$1,023.00" $593.34 "$1,023.00" "$1,023.00" "$1,023.00" $213.19 "$1,023.00" N/A N/A 27203427 EAP HCPCS C1887 CATHETER INTVN 8FR .088IN .071IN 150CM 25CM RAPEX BOTH IP/OP "$1,023.00" $757.50 $203.04 "$1,023.00" $555.49 $555.49 $555.49 $555.49 "$1,023.00" "$1,023.00" "$1,023.00" $213.22 "$1,023.00" $759.27 $759.27 $788.53 $532.98 $213.20 "$1,023.00" "$1,023.00" $605.10 "$1,023.00" "$1,023.00" "$1,023.00" "$1,023.00" $767.25 "$1,023.00" "$1,023.00" "$1,023.00" $511.50 $511.50 $810.22 "$1,023.00" $818.40 $664.95 $203.04 "$1,023.00" $593.34 "$1,023.00" "$1,023.00" "$1,023.00" $213.19 "$1,023.00" N/A N/A 27203428 EAP HCPCS C1887 SHEATH GUID 90CM 3 RADIOPQ XCUT VLV PN DSTN 8FR BOTH IP/OP $239.00 $177.00 $47.44 $239.00 $129.78 $129.78 $129.78 $129.78 $239.00 $239.00 $239.00 $49.81 $239.00 $177.39 $177.39 $184.22 $124.52 $49.81 $239.00 $239.00 $141.37 $239.00 $239.00 $239.00 $239.00 $179.25 $239.00 $239.00 $239.00 $119.50 $119.50 $189.29 $239.00 $191.20 $155.35 $47.44 $239.00 $138.62 $239.00 $239.00 $239.00 $49.81 $239.00 N/A N/A 27203429 EAP HCPCS C1887 SHEATH GUID 65CM 8FR PN DSTN .038IN STR HYDPHI BOTH IP/OP $224.00 $166.00 $44.46 $224.00 $121.63 $121.63 $121.63 $121.63 $224.00 $224.00 $224.00 $46.69 $224.00 $166.25 $166.25 $172.66 $116.70 $46.68 $224.00 $224.00 $132.50 $224.00 $224.00 $224.00 $224.00 $168.00 $224.00 $224.00 $224.00 $112.00 $112.00 $177.41 $224.00 $179.20 $145.60 $44.46 $224.00 $129.92 $224.00 $224.00 $224.00 $46.68 $224.00 N/A N/A 27203434 EAP HCPCS C1769 MOO326420 GUIDEWIRE STANDARD P BOTH IP/OP "$1,299.00" $961.50 $257.82 "$1,299.00" $705.36 $705.36 $705.36 $705.36 "$1,299.00" "$1,299.00" "$1,299.00" $270.74 "$1,299.00" $964.12 $964.12 "$1,001.27" $676.78 $270.73 "$1,299.00" "$1,299.00" $768.36 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $974.25 "$1,299.00" "$1,299.00" "$1,299.00" $649.50 $649.50 "$1,028.81" "$1,299.00" "$1,039.20" $844.35 $257.82 "$1,299.00" $753.42 "$1,299.00" "$1,299.00" "$1,299.00" $270.71 "$1,299.00" N/A N/A 27203450 EAP HCPCS C1751 105-5092-150 ECHELON 14 MICRO BOTH IP/OP "$1,751.00" "$1,296.00" $347.53 "$1,751.00" $950.79 $950.79 $950.79 $950.79 "$1,751.00" "$1,751.00" "$1,751.00" $364.95 "$1,751.00" "$1,299.59" "$1,299.59" "$1,349.67" $912.27 $364.93 "$1,751.00" "$1,751.00" "$1,035.72" "$1,751.00" "$1,751.00" "$1,751.00" "$1,751.00" "$1,313.25" "$1,751.00" "$1,751.00" "$1,751.00" $875.50 $875.50 "$1,386.79" "$1,751.00" "$1,400.80" "$1,138.15" $347.53 "$1,751.00" "$1,015.58" "$1,751.00" "$1,751.00" "$1,751.00" $364.91 "$1,751.00" N/A N/A 27203467 EAP HCPCS C1884 SPD2-US-050-320 DEVICE PROTECT BOTH IP/OP "$1,411.00" "$1,044.50" $280.05 "$1,411.00" $766.17 $766.17 $766.17 $766.17 "$1,411.00" "$1,411.00" "$1,411.00" $294.09 "$1,411.00" "$1,047.24" "$1,047.24" "$1,087.60" $735.13 $294.07 "$1,411.00" "$1,411.00" $834.61 "$1,411.00" "$1,411.00" "$1,411.00" "$1,411.00" "$1,058.25" "$1,411.00" "$1,411.00" "$1,411.00" $705.50 $705.50 "$1,117.51" "$1,411.00" "$1,128.80" $917.15 $280.05 "$1,411.00" $818.38 "$1,411.00" "$1,411.00" "$1,411.00" $294.05 "$1,411.00" N/A N/A 27203477 EAP Custom 27203477 36-152 COIL DETACHABLE INTERLO BOTH IP/OP "$1,257.00" $930.50 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" $932.95 $932.95 $968.90 $654.90 $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $817.05 "$1,257.00" "$1,257.00" $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 27203478 EAP Custom 27203478 36-154 COIL DETACHABLE INTERLO BOTH IP/OP "$1,320.00" $977.00 $234.96 "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" $234.96 "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" $275.10 "$1,320.00" $528.00 "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" $990.00 "$1,320.00" "$1,320.00" "$1,320.00" $660.00 $660.00 "$1,045.44" "$1,320.00" "$1,056.00" $594.00 "$1,320.00" "$1,320.00" $765.60 "$1,320.00" $792.00 "$1,320.00" "$1,320.00" "$1,320.00" N/A N/A 27203479 EAP Custom 27203479 36-156 COIL DETACHABLE INTERLO BOTH IP/OP "$1,257.00" $930.50 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" $932.95 $932.95 $968.90 $654.90 $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $817.05 "$1,257.00" "$1,257.00" $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 27203480 EAP Custom 27203480 36-157 COIL DETACHABLE INTERLO BOTH IP/OP "$1,257.00" $930.50 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" $932.95 $932.95 $968.90 $654.90 $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $817.05 "$1,257.00" "$1,257.00" $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 27203481 EAP Custom 27203481 MARKER STRAIGHT 2-TIP 150CM/6C BOTH IP/OP "$1,137.00" $841.50 $202.39 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $202.39 "$1,137.00" "$1,137.00" $843.88 $843.88 $876.40 $592.38 $236.96 "$1,137.00" $454.80 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $739.05 "$1,137.00" "$1,137.00" $659.46 "$1,137.00" $682.20 "$1,137.00" "$1,137.00" "$1,137.00" N/A N/A 27203483 EAP HCPCS C1887 MPC ENVOY GUIDING WIRE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 27203484 EAP Custom 27203484 STARCLOSE SE BOTH IP/OP $700.00 $518.00 $124.60 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $124.60 $700.00 $700.00 $519.54 $519.54 $539.56 $364.70 $145.89 $700.00 $280.00 $700.00 $700.00 $700.00 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $350.00 $350.00 $554.40 $700.00 $560.00 $455.00 $700.00 $700.00 $406.00 $700.00 $420.00 $700.00 $700.00 $700.00 N/A N/A 27203485 EAP Custom 27203485 LC BEAD 300-500 BOTH IP/OP "$1,335.00" $988.00 $237.63 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $237.63 "$1,335.00" "$1,335.00" $990.84 $990.84 "$1,029.02" $695.54 $278.23 "$1,335.00" $534.00 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $867.75 "$1,335.00" "$1,335.00" $774.30 "$1,335.00" $801.00 "$1,335.00" "$1,335.00" "$1,335.00" N/A N/A 27203487 EAP HCPCS C1769 GUIDEWIRE SILVERSPEED .014 BOTH IP/OP $825.00 $610.50 $163.74 $825.00 $447.98 $447.98 $447.98 $447.98 $825.00 $825.00 $825.00 $171.95 $825.00 $612.32 $612.32 $635.91 $429.83 $171.94 $825.00 $825.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $536.25 $163.74 $825.00 $478.50 $825.00 $825.00 $825.00 $171.93 $825.00 N/A N/A 27203488 EAP HCPCS C1769 GUIDEWIRE SILVERSPEED .014 BOTH IP/OP $825.00 $610.50 $163.74 $825.00 $447.98 $447.98 $447.98 $447.98 $825.00 $825.00 $825.00 $171.95 $825.00 $612.32 $612.32 $635.91 $429.83 $171.94 $825.00 $825.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $536.25 $163.74 $825.00 $478.50 $825.00 $825.00 $825.00 $171.93 $825.00 N/A N/A 27203489 EAP HCPCS C1751 CATHETER ECHELON 10 MICRO BOTH IP/OP "$2,423.00" "$1,793.50" $480.90 "$2,423.00" "$1,315.69" "$1,315.69" "$1,315.69" "$1,315.69" "$2,423.00" "$2,423.00" "$2,423.00" $505.01 "$2,423.00" "$1,798.35" "$1,798.35" "$1,867.65" "$1,262.38" $504.98 "$2,423.00" "$2,423.00" "$1,433.20" "$2,423.00" "$2,423.00" "$2,423.00" "$2,423.00" "$1,817.25" "$2,423.00" "$2,423.00" "$2,423.00" "$1,211.50" "$1,211.50" "$1,919.02" "$2,423.00" "$1,938.40" "$1,574.95" $480.90 "$2,423.00" "$1,405.34" "$2,423.00" "$2,423.00" "$2,423.00" $504.95 "$2,423.00" N/A N/A 27203490 EAP HCPCS C1751 CATHETER ECHELON 10 MICRO BOTH IP/OP "$2,423.00" "$1,793.50" $480.90 "$2,423.00" "$1,315.69" "$1,315.69" "$1,315.69" "$1,315.69" "$2,423.00" "$2,423.00" "$2,423.00" $505.01 "$2,423.00" "$1,798.35" "$1,798.35" "$1,867.65" "$1,262.38" $504.98 "$2,423.00" "$2,423.00" "$1,433.20" "$2,423.00" "$2,423.00" "$2,423.00" "$2,423.00" "$1,817.25" "$2,423.00" "$2,423.00" "$2,423.00" "$1,211.50" "$1,211.50" "$1,919.02" "$2,423.00" "$1,938.40" "$1,574.95" $480.90 "$2,423.00" "$1,405.34" "$2,423.00" "$2,423.00" "$2,423.00" $504.95 "$2,423.00" N/A N/A 27203491 EAP HCPCS C1751 CATHETER ECHELON 14 MICRO BOTH IP/OP "$2,423.00" "$1,793.50" $480.90 "$2,423.00" "$1,315.69" "$1,315.69" "$1,315.69" "$1,315.69" "$2,423.00" "$2,423.00" "$2,423.00" $505.01 "$2,423.00" "$1,798.35" "$1,798.35" "$1,867.65" "$1,262.38" $504.98 "$2,423.00" "$2,423.00" "$1,433.20" "$2,423.00" "$2,423.00" "$2,423.00" "$2,423.00" "$1,817.25" "$2,423.00" "$2,423.00" "$2,423.00" "$1,211.50" "$1,211.50" "$1,919.02" "$2,423.00" "$1,938.40" "$1,574.95" $480.90 "$2,423.00" "$1,405.34" "$2,423.00" "$2,423.00" "$2,423.00" $504.95 "$2,423.00" N/A N/A 27203492 EAP HCPCS C1751 CATHETER ECHELON 10MICRO BOTH IP/OP "$2,423.00" "$1,793.50" $480.90 "$2,423.00" "$1,315.69" "$1,315.69" "$1,315.69" "$1,315.69" "$2,423.00" "$2,423.00" "$2,423.00" $505.01 "$2,423.00" "$1,798.35" "$1,798.35" "$1,867.65" "$1,262.38" $504.98 "$2,423.00" "$2,423.00" "$1,433.20" "$2,423.00" "$2,423.00" "$2,423.00" "$2,423.00" "$1,817.25" "$2,423.00" "$2,423.00" "$2,423.00" "$1,211.50" "$1,211.50" "$1,919.02" "$2,423.00" "$1,938.40" "$1,574.95" $480.90 "$2,423.00" "$1,405.34" "$2,423.00" "$2,423.00" "$2,423.00" $504.95 "$2,423.00" N/A N/A 27203493 EAP HCPCS C1751 CATHETER ECHELON 14 MICRO BOTH IP/OP "$2,423.00" "$1,793.50" $480.90 "$2,423.00" "$1,315.69" "$1,315.69" "$1,315.69" "$1,315.69" "$2,423.00" "$2,423.00" "$2,423.00" $505.01 "$2,423.00" "$1,798.35" "$1,798.35" "$1,867.65" "$1,262.38" $504.98 "$2,423.00" "$2,423.00" "$1,433.20" "$2,423.00" "$2,423.00" "$2,423.00" "$2,423.00" "$1,817.25" "$2,423.00" "$2,423.00" "$2,423.00" "$1,211.50" "$1,211.50" "$1,919.02" "$2,423.00" "$1,938.40" "$1,574.95" $480.90 "$2,423.00" "$1,405.34" "$2,423.00" "$2,423.00" "$2,423.00" $504.95 "$2,423.00" N/A N/A 27203494 EAP Custom 27203494 ALLIGATOR RETRIEVAL BOTH IP/OP "$8,340.00" "$6,172.00" "$1,484.52" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$1,484.52" "$8,340.00" "$8,340.00" "$4,181.12" "$4,181.12" "$6,428.47" "$2,060.15" "$1,738.15" "$8,340.00" "$3,336.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$6,255.00" "$8,340.00" "$8,340.00" "$8,340.00" "$4,170.00" "$4,170.00" "$6,605.28" "$8,340.00" "$6,672.00" "$5,421.00" "$8,340.00" "$8,340.00" "$4,837.20" "$8,340.00" "$5,004.00" "$8,340.00" "$8,340.00" "$8,340.00" N/A N/A 27203495 EAP Custom 27203495 ALLIGATOR RETRIEVAL BOTH IP/OP "$8,340.00" "$6,172.00" "$1,484.52" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$1,484.52" "$8,340.00" "$8,340.00" "$4,181.12" "$4,181.12" "$6,428.47" "$2,060.15" "$1,738.15" "$8,340.00" "$3,336.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$6,255.00" "$8,340.00" "$8,340.00" "$8,340.00" "$4,170.00" "$4,170.00" "$6,605.28" "$8,340.00" "$6,672.00" "$5,421.00" "$8,340.00" "$8,340.00" "$4,837.20" "$8,340.00" "$5,004.00" "$8,340.00" "$8,340.00" "$8,340.00" N/A N/A 27203496 EAP Custom 27203496 ALLIGATOR RETRIEVAL BOTH IP/OP "$8,340.00" "$6,172.00" "$1,484.52" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$1,484.52" "$8,340.00" "$8,340.00" "$4,181.12" "$4,181.12" "$6,428.47" "$2,060.15" "$1,738.15" "$8,340.00" "$3,336.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$6,255.00" "$8,340.00" "$8,340.00" "$8,340.00" "$4,170.00" "$4,170.00" "$6,605.28" "$8,340.00" "$6,672.00" "$5,421.00" "$8,340.00" "$8,340.00" "$4,837.20" "$8,340.00" "$5,004.00" "$8,340.00" "$8,340.00" "$8,340.00" N/A N/A 27203497 EAP Custom 27203497 ALLIGATOR RETRIEVAL BOTH IP/OP "$8,340.00" "$6,172.00" "$1,484.52" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$1,484.52" "$8,340.00" "$8,340.00" "$4,181.12" "$4,181.12" "$6,428.47" "$2,060.15" "$1,738.15" "$8,340.00" "$3,336.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$6,255.00" "$8,340.00" "$8,340.00" "$8,340.00" "$4,170.00" "$4,170.00" "$6,605.28" "$8,340.00" "$6,672.00" "$5,421.00" "$8,340.00" "$8,340.00" "$4,837.20" "$8,340.00" "$5,004.00" "$8,340.00" "$8,340.00" "$8,340.00" N/A N/A 27203498 EAP HCPCS C1725 CATHETER BALLOON PTA 3.50 X 15 BOTH IP/OP "$3,387.00" "$2,506.50" $672.23 "$3,387.00" "$1,839.14" "$1,839.14" "$1,839.14" "$1,839.14" "$3,387.00" "$3,387.00" "$3,387.00" $705.94 "$3,387.00" "$2,513.83" "$2,513.83" "$2,610.70" "$1,764.63" $705.89 "$3,387.00" "$3,387.00" "$2,003.41" "$3,387.00" "$3,387.00" "$3,387.00" "$3,387.00" "$2,540.25" "$3,387.00" "$3,387.00" "$3,387.00" "$1,693.50" "$1,693.50" "$2,682.50" "$3,387.00" "$2,709.60" "$2,201.55" $672.23 "$3,387.00" "$1,964.46" "$3,387.00" "$3,387.00" "$3,387.00" $705.85 "$3,387.00" N/A N/A 27203499 EAP HCPCS C1725 CATHETER BALLOON PTA 3.00 X 15 BOTH IP/OP "$3,387.00" "$2,506.50" $672.23 "$3,387.00" "$1,839.14" "$1,839.14" "$1,839.14" "$1,839.14" "$3,387.00" "$3,387.00" "$3,387.00" $705.94 "$3,387.00" "$2,513.83" "$2,513.83" "$2,610.70" "$1,764.63" $705.89 "$3,387.00" "$3,387.00" "$2,003.41" "$3,387.00" "$3,387.00" "$3,387.00" "$3,387.00" "$2,540.25" "$3,387.00" "$3,387.00" "$3,387.00" "$1,693.50" "$1,693.50" "$2,682.50" "$3,387.00" "$2,709.60" "$2,201.55" $672.23 "$3,387.00" "$1,964.46" "$3,387.00" "$3,387.00" "$3,387.00" $705.85 "$3,387.00" N/A N/A 27203500 EAP HCPCS C1725 CATHETER BALLOON PTA 2.50 X 15 BOTH IP/OP "$3,387.00" "$2,506.50" $672.23 "$3,387.00" "$1,839.14" "$1,839.14" "$1,839.14" "$1,839.14" "$3,387.00" "$3,387.00" "$3,387.00" $705.94 "$3,387.00" "$2,513.83" "$2,513.83" "$2,610.70" "$1,764.63" $705.89 "$3,387.00" "$3,387.00" "$2,003.41" "$3,387.00" "$3,387.00" "$3,387.00" "$3,387.00" "$2,540.25" "$3,387.00" "$3,387.00" "$3,387.00" "$1,693.50" "$1,693.50" "$2,682.50" "$3,387.00" "$2,709.60" "$2,201.55" $672.23 "$3,387.00" "$1,964.46" "$3,387.00" "$3,387.00" "$3,387.00" $705.85 "$3,387.00" N/A N/A 27203501 EAP HCPCS C1725 CATHETER BALLOON PTA 3.50 X 9. BOTH IP/OP "$3,387.00" "$2,506.50" $672.23 "$3,387.00" "$1,839.14" "$1,839.14" "$1,839.14" "$1,839.14" "$3,387.00" "$3,387.00" "$3,387.00" $705.94 "$3,387.00" "$2,513.83" "$2,513.83" "$2,610.70" "$1,764.63" $705.89 "$3,387.00" "$3,387.00" "$2,003.41" "$3,387.00" "$3,387.00" "$3,387.00" "$3,387.00" "$2,540.25" "$3,387.00" "$3,387.00" "$3,387.00" "$1,693.50" "$1,693.50" "$2,682.50" "$3,387.00" "$2,709.60" "$2,201.55" $672.23 "$3,387.00" "$1,964.46" "$3,387.00" "$3,387.00" "$3,387.00" $705.85 "$3,387.00" N/A N/A 27203502 EAP HCPCS C1725 CATHETER BALLOON PTA 3.00 X 9. BOTH IP/OP "$3,387.00" "$2,506.50" $672.23 "$3,387.00" "$1,839.14" "$1,839.14" "$1,839.14" "$1,839.14" "$3,387.00" "$3,387.00" "$3,387.00" $705.94 "$3,387.00" "$2,513.83" "$2,513.83" "$2,610.70" "$1,764.63" $705.89 "$3,387.00" "$3,387.00" "$2,003.41" "$3,387.00" "$3,387.00" "$3,387.00" "$3,387.00" "$2,540.25" "$3,387.00" "$3,387.00" "$3,387.00" "$1,693.50" "$1,693.50" "$2,682.50" "$3,387.00" "$2,709.60" "$2,201.55" $672.23 "$3,387.00" "$1,964.46" "$3,387.00" "$3,387.00" "$3,387.00" $705.85 "$3,387.00" N/A N/A 27203503 EAP HCPCS C1725 CATHETER BALLOON 2.50 X 9.0MM BOTH IP/OP "$3,387.00" "$2,506.50" $672.23 "$3,387.00" "$1,839.14" "$1,839.14" "$1,839.14" "$1,839.14" "$3,387.00" "$3,387.00" "$3,387.00" $705.94 "$3,387.00" "$2,513.83" "$2,513.83" "$2,610.70" "$1,764.63" $705.89 "$3,387.00" "$3,387.00" "$2,003.41" "$3,387.00" "$3,387.00" "$3,387.00" "$3,387.00" "$2,540.25" "$3,387.00" "$3,387.00" "$3,387.00" "$1,693.50" "$1,693.50" "$2,682.50" "$3,387.00" "$2,709.60" "$2,201.55" $672.23 "$3,387.00" "$1,964.46" "$3,387.00" "$3,387.00" "$3,387.00" $705.85 "$3,387.00" N/A N/A 27203504 EAP HCPCS C1725 CATHETER BALLOON 2.00 X 9.0MM BOTH IP/OP "$3,387.00" "$2,506.50" $672.23 "$3,387.00" "$1,839.14" "$1,839.14" "$1,839.14" "$1,839.14" "$3,387.00" "$3,387.00" "$3,387.00" $705.94 "$3,387.00" "$2,513.83" "$2,513.83" "$2,610.70" "$1,764.63" $705.89 "$3,387.00" "$3,387.00" "$2,003.41" "$3,387.00" "$3,387.00" "$3,387.00" "$3,387.00" "$2,540.25" "$3,387.00" "$3,387.00" "$3,387.00" "$1,693.50" "$1,693.50" "$2,682.50" "$3,387.00" "$2,709.60" "$2,201.55" $672.23 "$3,387.00" "$1,964.46" "$3,387.00" "$3,387.00" "$3,387.00" $705.85 "$3,387.00" N/A N/A 27203505 EAP HCPCS C1725 CATHETER BALLOON PTA 1.50 X 9. BOTH IP/OP "$3,387.00" "$2,506.50" $672.23 "$3,387.00" "$1,839.14" "$1,839.14" "$1,839.14" "$1,839.14" "$3,387.00" "$3,387.00" "$3,387.00" $705.94 "$3,387.00" "$2,513.83" "$2,513.83" "$2,610.70" "$1,764.63" $705.89 "$3,387.00" "$3,387.00" "$2,003.41" "$3,387.00" "$3,387.00" "$3,387.00" "$3,387.00" "$2,540.25" "$3,387.00" "$3,387.00" "$3,387.00" "$1,693.50" "$1,693.50" "$2,682.50" "$3,387.00" "$2,709.60" "$2,201.55" $672.23 "$3,387.00" "$1,964.46" "$3,387.00" "$3,387.00" "$3,387.00" $705.85 "$3,387.00" N/A N/A 27203506 EAP HCPCS C1751 MICROCATHETER HI-FLO DISTAL FL BOTH IP/OP "$2,270.00" "$1,680.00" $450.54 "$2,270.00" "$1,232.61" "$1,232.61" "$1,232.61" "$1,232.61" "$2,270.00" "$2,270.00" "$2,270.00" $473.12 "$2,270.00" "$1,684.79" "$1,684.79" "$1,749.72" "$1,182.67" $473.09 "$2,270.00" "$2,270.00" "$1,342.71" "$2,270.00" "$2,270.00" "$2,270.00" "$2,270.00" "$1,702.50" "$2,270.00" "$2,270.00" "$2,270.00" "$1,135.00" "$1,135.00" "$1,797.84" "$2,270.00" "$1,816.00" "$1,475.50" $450.54 "$2,270.00" "$1,316.60" "$2,270.00" "$2,270.00" "$2,270.00" $473.07 "$2,270.00" N/A N/A 27203507 EAP HCPCS C1751 MICROCATHTER HI-PRO DISTAL FL BOTH IP/OP "$2,270.00" "$1,680.00" $450.54 "$2,270.00" "$1,232.61" "$1,232.61" "$1,232.61" "$1,232.61" "$2,270.00" "$2,270.00" "$2,270.00" $473.12 "$2,270.00" "$1,684.79" "$1,684.79" "$1,749.72" "$1,182.67" $473.09 "$2,270.00" "$2,270.00" "$1,342.71" "$2,270.00" "$2,270.00" "$2,270.00" "$2,270.00" "$1,702.50" "$2,270.00" "$2,270.00" "$2,270.00" "$1,135.00" "$1,135.00" "$1,797.84" "$2,270.00" "$1,816.00" "$1,475.50" $450.54 "$2,270.00" "$1,316.60" "$2,270.00" "$2,270.00" "$2,270.00" $473.07 "$2,270.00" N/A N/A 27203508 EAP HCPCS C1751 MICROCATHETER PRE-SHAPED 45 2- BOTH IP/OP "$2,837.00" "$2,099.50" $563.07 "$2,837.00" "$1,540.49" "$1,540.49" "$1,540.49" "$1,540.49" "$2,837.00" "$2,837.00" "$2,837.00" $591.30 "$2,837.00" "$2,105.62" "$2,105.62" "$2,186.76" "$1,478.08" $591.26 "$2,837.00" "$2,837.00" "$1,678.09" "$2,837.00" "$2,837.00" "$2,837.00" "$2,837.00" "$2,127.75" "$2,837.00" "$2,837.00" "$2,837.00" "$1,418.50" "$1,418.50" "$2,246.90" "$2,837.00" "$2,269.60" "$1,844.05" $563.07 "$2,837.00" "$1,645.46" "$2,837.00" "$2,837.00" "$2,837.00" $591.23 "$2,837.00" N/A N/A 27203509 EAP HCPCS C1769 GUIDEWIRE STANDARD PRE-SHAP 1 BOTH IP/OP "$2,151.00" "$1,592.00" $426.92 "$2,151.00" "$1,167.99" "$1,167.99" "$1,167.99" "$1,167.99" "$2,151.00" "$2,151.00" "$2,151.00" $448.32 "$2,151.00" "$1,596.47" "$1,596.47" "$1,657.99" "$1,120.67" $448.29 "$2,151.00" "$2,151.00" "$1,272.32" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$1,613.25" "$2,151.00" "$2,151.00" "$2,151.00" "$1,075.50" "$1,075.50" "$1,703.59" "$2,151.00" "$1,720.80" "$1,398.15" $426.92 "$2,151.00" "$1,247.58" "$2,151.00" "$2,151.00" "$2,151.00" $448.27 "$2,151.00" N/A N/A 27203511 EAP HCPCS C1769 GUIDEWIRE SOFT PRE-SHAPED 200C BOTH IP/OP "$1,838.00" "$1,360.50" $364.80 "$1,838.00" $998.03 $998.03 $998.03 $998.03 "$1,838.00" "$1,838.00" "$1,838.00" $383.09 "$1,838.00" "$1,364.16" "$1,364.16" "$1,416.73" $957.60 $383.06 "$1,838.00" "$1,838.00" "$1,087.18" "$1,838.00" "$1,838.00" "$1,838.00" "$1,838.00" "$1,378.50" "$1,838.00" "$1,838.00" "$1,838.00" $919.00 $919.00 "$1,455.70" "$1,838.00" "$1,470.40" "$1,194.70" $364.80 "$1,838.00" "$1,066.04" "$1,838.00" "$1,838.00" "$1,838.00" $383.04 "$1,838.00" N/A N/A 27203512 EAP HCPCS C1887 CATHETER UTK SLIP 5F 125CM BOTH IP/OP $740.00 $548.00 $146.87 $740.00 $401.82 $401.82 $401.82 $401.82 $740.00 $740.00 $740.00 $154.23 $740.00 $549.23 $549.23 $570.39 $385.54 $154.22 $740.00 $740.00 $437.71 $740.00 $740.00 $740.00 $740.00 $555.00 $740.00 $740.00 $740.00 $370.00 $370.00 $586.08 $740.00 $592.00 $481.00 $146.87 $740.00 $429.20 $740.00 $740.00 $740.00 $154.22 $740.00 N/A N/A 27203513 EAP HCPCS C1887 CATHETER DAVIS 5F .038 100CM BOTH IP/OP $328.00 $243.00 $65.10 $328.00 $178.10 $178.10 $178.10 $178.10 $328.00 $328.00 $328.00 $68.36 $328.00 $243.44 $243.44 $252.82 $170.89 $68.36 $328.00 $328.00 $194.01 $328.00 $328.00 $328.00 $328.00 $246.00 $328.00 $328.00 $328.00 $164.00 $164.00 $259.78 $328.00 $262.40 $213.20 $65.10 $328.00 $190.24 $328.00 $328.00 $328.00 $68.36 $328.00 N/A N/A 27203514 EAP HCPCS C1894 SHEATH SHUTTLE 7F 90CM BOTH IP/OP $413.00 $306.00 $81.97 $413.00 $224.26 $224.26 $224.26 $224.26 $413.00 $413.00 $413.00 $86.08 $413.00 $306.53 $306.53 $318.34 $215.17 $86.07 $413.00 $413.00 $244.29 $413.00 $413.00 $413.00 $413.00 $309.75 $413.00 $413.00 $413.00 $206.50 $206.50 $327.10 $413.00 $330.40 $268.45 $81.97 $413.00 $239.54 $413.00 $413.00 $413.00 $86.07 $413.00 N/A N/A 27203515 EAP HCPCS C1894 SHEATH SHUTTLE 6F 90CM BOTH IP/OP $483.00 $357.50 $95.86 $483.00 $262.27 $262.27 $262.27 $262.27 $483.00 $483.00 $483.00 $100.67 $483.00 $358.48 $358.48 $372.30 $251.64 $100.66 $483.00 $483.00 $285.69 $483.00 $483.00 $483.00 $483.00 $362.25 $483.00 $483.00 $483.00 $241.50 $241.50 $382.54 $483.00 $386.40 $313.95 $95.86 $483.00 $280.14 $483.00 $483.00 $483.00 $100.66 $483.00 N/A N/A 27203516 EAP HCPCS C1894 SHEATH SHUTTLE 6FR 80CM. BOTH IP/OP $595.00 $440.50 $118.09 $595.00 $323.09 $323.09 $323.09 $323.09 $595.00 $595.00 $595.00 $124.01 $595.00 $441.61 $441.61 $458.63 $310.00 $124.00 $595.00 $595.00 $351.94 $595.00 $595.00 $595.00 $595.00 $446.25 $595.00 $595.00 $595.00 $297.50 $297.50 $471.24 $595.00 $476.00 $386.75 $118.09 $595.00 $345.10 $595.00 $595.00 $595.00 $124.00 $595.00 N/A N/A 27203517 EAP HCPCS C1884 ROADRUNNERS CONNERS.035X260CM BOTH IP/OP $160.00 $118.50 $31.76 $160.00 $86.88 $86.88 $86.88 $86.88 $160.00 $160.00 $160.00 $33.35 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $160.00 $94.64 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $31.76 $160.00 $92.80 $160.00 $160.00 $160.00 $33.34 $160.00 N/A N/A 27203518 EAP HCPCS C1887 CATHETER ENVOY 6FR X13-MP BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 27203519 EAP HCPCS C1887 CATHETER ENVOY 5FR MIPD 9 BOTH IP/OP "$1,048.00" $776.00 $208.00 "$1,048.00" $569.06 $569.06 $569.06 $569.06 "$1,048.00" "$1,048.00" "$1,048.00" $218.43 "$1,048.00" $777.83 $777.83 $807.80 $546.01 $218.41 "$1,048.00" "$1,048.00" $619.89 "$1,048.00" "$1,048.00" "$1,048.00" "$1,048.00" $786.00 "$1,048.00" "$1,048.00" "$1,048.00" $524.00 $524.00 $830.02 "$1,048.00" $838.40 $681.20 $208.00 "$1,048.00" $607.84 "$1,048.00" "$1,048.00" "$1,048.00" $218.40 "$1,048.00" N/A N/A 27203520 EAP HCPCS C1887 CATHETER ENVOY STRAIGHT 9 BOTH IP/OP "$1,048.00" $776.00 $208.00 "$1,048.00" $569.06 $569.06 $569.06 $569.06 "$1,048.00" "$1,048.00" "$1,048.00" $218.43 "$1,048.00" $777.83 $777.83 $807.80 $546.01 $218.41 "$1,048.00" "$1,048.00" $619.89 "$1,048.00" "$1,048.00" "$1,048.00" "$1,048.00" $786.00 "$1,048.00" "$1,048.00" "$1,048.00" $524.00 $524.00 $830.02 "$1,048.00" $838.40 $681.20 $208.00 "$1,048.00" $607.84 "$1,048.00" "$1,048.00" "$1,048.00" $218.40 "$1,048.00" N/A N/A 27203521 EAP HCPCS C1751 MICROCATHTER PROWLER SELECT L BOTH IP/OP "$2,578.00" "$1,908.00" $511.67 "$2,578.00" "$1,399.85" "$1,399.85" "$1,399.85" "$1,399.85" "$2,578.00" "$2,578.00" "$2,578.00" $537.32 "$2,578.00" "$1,913.39" "$1,913.39" "$1,987.12" "$1,343.14" $537.28 "$2,578.00" "$2,578.00" "$1,524.89" "$2,578.00" "$2,578.00" "$2,578.00" "$2,578.00" "$1,933.50" "$2,578.00" "$2,578.00" "$2,578.00" "$1,289.00" "$1,289.00" "$2,041.78" "$2,578.00" "$2,062.40" "$1,675.70" $511.67 "$2,578.00" "$1,495.24" "$2,578.00" "$2,578.00" "$2,578.00" $537.26 "$2,578.00" N/A N/A 27203522 EAP HCPCS C1751 MICROCATHT.PROWLER SELECT L 2 BOTH IP/OP "$2,578.00" "$1,908.00" $511.67 "$2,578.00" "$1,399.85" "$1,399.85" "$1,399.85" "$1,399.85" "$2,578.00" "$2,578.00" "$2,578.00" $537.32 "$2,578.00" "$1,913.39" "$1,913.39" "$1,987.12" "$1,343.14" $537.28 "$2,578.00" "$2,578.00" "$1,524.89" "$2,578.00" "$2,578.00" "$2,578.00" "$2,578.00" "$1,933.50" "$2,578.00" "$2,578.00" "$2,578.00" "$1,289.00" "$1,289.00" "$2,041.78" "$2,578.00" "$2,062.40" "$1,675.70" $511.67 "$2,578.00" "$1,495.24" "$2,578.00" "$2,578.00" "$2,578.00" $537.26 "$2,578.00" N/A N/A 27203523 EAP HCPCS C1751 MICROCATHT.PROWLER SELECT L 3 BOTH IP/OP "$2,578.00" "$1,908.00" $511.67 "$2,578.00" "$1,399.85" "$1,399.85" "$1,399.85" "$1,399.85" "$2,578.00" "$2,578.00" "$2,578.00" $537.32 "$2,578.00" "$1,913.39" "$1,913.39" "$1,987.12" "$1,343.14" $537.28 "$2,578.00" "$2,578.00" "$1,524.89" "$2,578.00" "$2,578.00" "$2,578.00" "$2,578.00" "$1,933.50" "$2,578.00" "$2,578.00" "$2,578.00" "$1,289.00" "$1,289.00" "$2,041.78" "$2,578.00" "$2,062.40" "$1,675.70" $511.67 "$2,578.00" "$1,495.24" "$2,578.00" "$2,578.00" "$2,578.00" $537.26 "$2,578.00" N/A N/A 27203524 EAP HCPCS C1751 MICROCATHT.PROWLER SELECT L 4 BOTH IP/OP "$2,526.00" "$1,869.50" $501.35 "$2,526.00" "$1,371.62" "$1,371.62" "$1,371.62" "$1,371.62" "$2,526.00" "$2,526.00" "$2,526.00" $526.48 "$2,526.00" "$1,874.80" "$1,874.80" "$1,947.04" "$1,316.05" $526.45 "$2,526.00" "$2,526.00" "$1,494.13" "$2,526.00" "$2,526.00" "$2,526.00" "$2,526.00" "$1,894.50" "$2,526.00" "$2,526.00" "$2,526.00" "$1,263.00" "$1,263.00" "$2,000.59" "$2,526.00" "$2,020.80" "$1,641.90" $501.35 "$2,526.00" "$1,465.08" "$2,526.00" "$2,526.00" "$2,526.00" $526.42 "$2,526.00" N/A N/A 27203525 EAP HCPCS C1751 MICROCATHET.PROWLER SELECT P 1 BOTH IP/OP "$2,454.00" "$1,816.00" $487.06 "$2,454.00" "$1,332.52" "$1,332.52" "$1,332.52" "$1,332.52" "$2,454.00" "$2,454.00" "$2,454.00" $511.47 "$2,454.00" "$1,821.36" "$1,821.36" "$1,891.54" "$1,278.53" $511.44 "$2,454.00" "$2,454.00" "$1,451.54" "$2,454.00" "$2,454.00" "$2,454.00" "$2,454.00" "$1,840.50" "$2,454.00" "$2,454.00" "$2,454.00" "$1,227.00" "$1,227.00" "$1,943.57" "$2,454.00" "$1,963.20" "$1,595.10" $487.06 "$2,454.00" "$1,423.32" "$2,454.00" "$2,454.00" "$2,454.00" $511.41 "$2,454.00" N/A N/A 27203526 EAP HCPCS C1751 MICROCATH.PROWLER SELECT P 2 BOTH IP/OP "$1,055.00" $781.00 $209.39 "$1,055.00" $572.87 $572.87 $572.87 $572.87 "$1,055.00" "$1,055.00" "$1,055.00" $219.89 "$1,055.00" $783.02 $783.02 $813.19 $549.66 $219.87 "$1,055.00" "$1,055.00" $624.03 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $791.25 "$1,055.00" "$1,055.00" "$1,055.00" $527.50 $527.50 $835.56 "$1,055.00" $844.00 $685.75 $209.39 "$1,055.00" $611.90 "$1,055.00" "$1,055.00" "$1,055.00" $219.86 "$1,055.00" N/A N/A 27203527 EAP HCPCS C1751 CATHETER ECHELON 14 MICRO BOTH IP/OP "$2,120.00" "$1,569.00" $420.77 "$2,120.00" "$1,151.16" "$1,151.16" "$1,151.16" "$1,151.16" "$2,120.00" "$2,120.00" "$2,120.00" $441.86 "$2,120.00" "$1,573.46" "$1,573.46" "$1,634.10" "$1,104.52" $441.83 "$2,120.00" "$2,120.00" "$1,253.98" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,590.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,060.00" "$1,060.00" "$1,679.04" "$2,120.00" "$1,696.00" "$1,378.00" $420.77 "$2,120.00" "$1,229.60" "$2,120.00" "$2,120.00" "$2,120.00" $441.81 "$2,120.00" N/A N/A 27203528 EAP HCPCS C1751 MICROCATH.PROWLER SELECT P 3 BOTH IP/OP "$1,055.00" $781.00 $209.39 "$1,055.00" $572.87 $572.87 $572.87 $572.87 "$1,055.00" "$1,055.00" "$1,055.00" $219.89 "$1,055.00" $783.02 $783.02 $813.19 $549.66 $219.87 "$1,055.00" "$1,055.00" $624.03 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $791.25 "$1,055.00" "$1,055.00" "$1,055.00" $527.50 $527.50 $835.56 "$1,055.00" $844.00 $685.75 $209.39 "$1,055.00" $611.90 "$1,055.00" "$1,055.00" "$1,055.00" $219.86 "$1,055.00" N/A N/A 27203529 EAP HCPCS C1751 MICRCATHTERS RAPIDTRANSIT 17 BOTH IP/OP "$2,235.00" "$1,654.00" $443.59 "$2,235.00" "$1,213.61" "$1,213.61" "$1,213.61" "$1,213.61" "$2,235.00" "$2,235.00" "$2,235.00" $465.83 "$2,235.00" "$1,658.82" "$1,658.82" "$1,722.74" "$1,164.44" $465.80 "$2,235.00" "$2,235.00" "$1,322.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$1,676.25" "$2,235.00" "$2,235.00" "$2,235.00" "$1,117.50" "$1,117.50" "$1,770.12" "$2,235.00" "$1,788.00" "$1,452.75" $443.59 "$2,235.00" "$1,296.30" "$2,235.00" "$2,235.00" "$2,235.00" $465.77 "$2,235.00" N/A N/A 27203530 EAP HCPCS C1751 MICRCATHETER RAPIDTRANSIT 150 BOTH IP/OP "$2,235.00" "$1,654.00" $443.59 "$2,235.00" "$1,213.61" "$1,213.61" "$1,213.61" "$1,213.61" "$2,235.00" "$2,235.00" "$2,235.00" $465.83 "$2,235.00" "$1,658.82" "$1,658.82" "$1,722.74" "$1,164.44" $465.80 "$2,235.00" "$2,235.00" "$1,322.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$1,676.25" "$2,235.00" "$2,235.00" "$2,235.00" "$1,117.50" "$1,117.50" "$1,770.12" "$2,235.00" "$1,788.00" "$1,452.75" $443.59 "$2,235.00" "$1,296.30" "$2,235.00" "$2,235.00" "$2,235.00" $465.77 "$2,235.00" N/A N/A 27203532 EAP HCPCS C1769 GUIDEWIRE HYDROPHILIC COAT S 2 BOTH IP/OP $39.00 $29.00 $7.74 $39.00 $21.18 $21.18 $21.18 $21.18 $39.00 $39.00 $39.00 $8.13 $39.00 $28.95 $28.95 $30.06 $20.32 $8.13 $39.00 $39.00 $23.07 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $25.35 $7.74 $39.00 $22.62 $39.00 $39.00 $39.00 $8.13 $39.00 N/A N/A 27203533 EAP HCPCS C1769 GUIDEWIRE HYDROPHILIC COATED T BOTH IP/OP $585.00 $433.00 $116.11 $585.00 $317.66 $317.66 $317.66 $317.66 $585.00 $585.00 $585.00 $121.93 $585.00 $434.19 $434.19 $450.92 $304.79 $121.92 $585.00 $585.00 $346.03 $585.00 $585.00 $585.00 $585.00 $438.75 $585.00 $585.00 $585.00 $292.50 $292.50 $463.32 $585.00 $468.00 $380.25 $116.11 $585.00 $339.30 $585.00 $585.00 $585.00 $121.91 $585.00 N/A N/A 27203536 EAP HCPCS C1769 GUIDEWIRE HYDROPHILIC COAT 3 BOTH IP/OP $29.00 $21.50 $5.76 $29.00 $15.75 $15.75 $15.75 $15.75 $29.00 $29.00 $29.00 $6.04 $29.00 $21.52 $21.52 $22.35 $15.11 $6.04 $29.00 $29.00 $17.15 $29.00 $29.00 $29.00 $29.00 $21.75 $29.00 $29.00 $29.00 $14.50 $14.50 $22.97 $29.00 $23.20 $18.85 $5.76 $29.00 $16.82 $29.00 $17.40 $29.00 $6.04 $29.00 N/A N/A 27203537 EAP Custom 27203537 CATHETER SEPARATOR 054 BOTH IP/OP "$8,337.00" "$6,169.50" "$1,483.99" "$8,337.00" "$8,337.00" "$8,337.00" "$8,337.00" "$8,337.00" "$8,337.00" "$8,337.00" "$1,483.99" "$8,337.00" "$8,337.00" "$4,181.12" "$4,181.12" "$6,426.16" "$2,060.15" "$1,737.52" "$8,337.00" "$3,334.80" "$8,337.00" "$8,337.00" "$8,337.00" "$8,337.00" "$8,337.00" "$6,252.75" "$8,337.00" "$8,337.00" "$8,337.00" "$4,168.50" "$4,168.50" "$6,602.90" "$8,337.00" "$6,669.60" "$5,419.05" "$8,337.00" "$8,337.00" "$4,835.46" "$8,337.00" "$5,002.20" "$8,337.00" "$8,337.00" "$8,337.00" N/A N/A 27203538 EAP HCPCS C1757 CATHETER REPERFILISION 054 BOTH IP/OP "$4,170.00" "$3,086.00" $827.64 "$4,170.00" "$2,264.31" "$2,264.31" "$2,264.31" "$2,264.31" "$4,170.00" "$4,170.00" "$4,170.00" $869.13 "$4,170.00" "$3,094.97" "$3,094.97" "$3,214.24" "$2,060.15" $869.07 "$4,170.00" "$4,170.00" "$2,466.56" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$2,710.50" $827.64 "$4,170.00" "$2,418.60" "$4,170.00" "$4,170.00" "$4,170.00" $869.03 "$4,170.00" N/A N/A 27203539 EAP HCPCS C1887 CATH.LUMEN DELIVERY NEURON 1 BOTH IP/OP "$1,719.00" "$1,272.50" $341.18 "$1,719.00" $933.42 $933.42 $933.42 $933.42 "$1,719.00" "$1,719.00" "$1,719.00" $358.28 "$1,719.00" "$1,275.84" "$1,275.84" "$1,325.01" $895.60 $358.26 "$1,719.00" "$1,719.00" "$1,016.79" "$1,719.00" "$1,719.00" "$1,719.00" "$1,719.00" "$1,289.25" "$1,719.00" "$1,719.00" "$1,719.00" $859.50 $859.50 "$1,361.45" "$1,719.00" "$1,375.20" "$1,117.35" $341.18 "$1,719.00" $997.02 "$1,719.00" "$1,719.00" "$1,719.00" $358.24 "$1,719.00" N/A N/A 27203540 EAP HCPCS C1887 CATHETER DELIVERY NEURON 6F ST BOTH IP/OP "$3,436.00" "$2,543.00" $681.96 "$3,436.00" "$1,865.75" "$1,865.75" "$1,865.75" "$1,865.75" "$3,436.00" "$3,436.00" "$3,436.00" $716.15 "$3,436.00" "$2,550.20" "$2,550.20" "$2,648.47" "$1,790.16" $716.10 "$3,436.00" "$3,436.00" "$2,032.39" "$3,436.00" "$3,436.00" "$3,436.00" "$3,436.00" "$2,577.00" "$3,436.00" "$3,436.00" "$3,436.00" "$1,718.00" "$1,718.00" "$2,721.31" "$3,436.00" "$2,748.80" "$2,233.40" $681.96 "$3,436.00" "$1,992.88" "$3,436.00" "$3,436.00" "$3,436.00" $716.06 "$3,436.00" N/A N/A 27203545 EAP HCPCS C1884 DEVICE PROTECTION SPIDER FX 5. BOTH IP/OP "$4,170.00" "$3,086.00" $827.64 "$4,170.00" "$2,264.31" "$2,264.31" "$2,264.31" "$2,264.31" "$4,170.00" "$4,170.00" "$4,170.00" $869.13 "$4,170.00" "$3,094.97" "$3,094.97" "$3,214.24" "$2,060.15" $869.07 "$4,170.00" "$4,170.00" "$2,466.56" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$2,710.50" $827.64 "$4,170.00" "$2,418.60" "$4,170.00" "$4,170.00" "$4,170.00" $869.03 "$4,170.00" N/A N/A 27203546 EAP HCPCS C1884 DEVICE DISTAL PROTECTION SPIDE BOTH IP/OP "$4,170.00" "$3,086.00" $827.64 "$4,170.00" "$2,264.31" "$2,264.31" "$2,264.31" "$2,264.31" "$4,170.00" "$4,170.00" "$4,170.00" $869.13 "$4,170.00" "$3,094.97" "$3,094.97" "$3,214.24" "$2,060.15" $869.07 "$4,170.00" "$4,170.00" "$2,466.56" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$2,710.50" $827.64 "$4,170.00" "$2,418.60" "$4,170.00" "$4,170.00" "$4,170.00" $869.03 "$4,170.00" N/A N/A 27203548 EAP HCPCS C2628 CATHETER BALLOON GUIDE 9F 80CM BOTH IP/OP "$2,364.00" "$1,749.50" $469.19 "$2,364.00" "$1,283.65" "$1,283.65" "$1,283.65" "$1,283.65" "$2,364.00" "$2,364.00" "$2,364.00" $492.72 "$2,364.00" "$1,754.56" "$1,754.56" "$1,822.17" "$1,231.64" $492.68 "$2,364.00" "$2,364.00" "$1,398.31" "$2,364.00" "$2,364.00" "$2,364.00" "$2,364.00" "$1,773.00" "$2,364.00" "$2,364.00" "$2,364.00" "$1,182.00" "$1,182.00" "$1,872.29" "$2,364.00" "$1,891.20" "$1,536.60" $469.19 "$2,364.00" "$1,371.12" "$2,364.00" "$2,364.00" "$2,364.00" $492.66 "$2,364.00" N/A N/A 27203553 EAP HCPCS C1751 CATHETER DAC 044 - 130CM BOTH IP/OP "$1,429.00" "$1,057.50" $283.62 "$1,429.00" $775.95 $775.95 $775.95 $775.95 "$1,429.00" "$1,429.00" "$1,429.00" $297.84 "$1,429.00" "$1,060.60" "$1,060.60" "$1,101.47" $744.51 $297.82 "$1,429.00" "$1,429.00" $845.25 "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,071.75" "$1,429.00" "$1,429.00" "$1,429.00" $714.50 $714.50 "$1,131.77" "$1,429.00" "$1,143.20" $928.85 $283.62 "$1,429.00" $828.82 "$1,429.00" "$1,429.00" "$1,429.00" $297.80 "$1,429.00" N/A N/A 27203554 EAP HCPCS C1751 CATHETER DAC 038 - 136CM BOTH IP/OP "$3,321.00" "$2,458.00" $659.14 "$3,321.00" "$1,803.30" "$1,803.30" "$1,803.30" "$1,803.30" "$3,321.00" "$3,321.00" "$3,321.00" $692.18 "$3,321.00" "$2,464.85" "$2,464.85" "$2,559.83" "$1,730.24" $692.13 "$3,321.00" "$3,321.00" "$1,964.37" "$3,321.00" "$3,321.00" "$3,321.00" "$3,321.00" "$2,490.75" "$3,321.00" "$3,321.00" "$3,321.00" "$1,660.50" "$1,660.50" "$2,630.23" "$3,321.00" "$2,656.80" "$2,158.65" $659.14 "$3,321.00" "$1,926.18" "$3,321.00" "$3,321.00" "$3,321.00" $692.10 "$3,321.00" N/A N/A 27203555 EAP HCPCS C1884 SPH100200-20 MICROCOIL PLATINO BOTH IP/OP "$3,586.00" "$2,654.00" $711.73 "$3,586.00" "$1,947.20" "$1,947.20" "$1,947.20" "$1,947.20" "$3,586.00" "$3,586.00" "$3,586.00" $747.41 "$3,586.00" "$2,661.53" "$2,661.53" "$2,764.09" "$1,868.31" $747.36 "$3,586.00" "$3,586.00" "$2,121.12" "$3,586.00" "$3,586.00" "$3,586.00" "$3,586.00" "$2,689.50" "$3,586.00" "$3,586.00" "$3,586.00" "$1,793.00" "$1,793.00" "$2,840.11" "$3,586.00" "$2,868.80" "$2,330.90" $711.73 "$3,586.00" "$2,079.88" "$3,586.00" "$3,586.00" "$3,586.00" $747.32 "$3,586.00" N/A N/A 27203556 EAP Custom 27203556 MARKER STRGHT 2-TIP 150CM/6CM BOTH IP/OP "$2,518.00" "$1,863.50" $448.20 "$2,518.00" "$2,518.00" "$2,518.00" "$2,518.00" "$2,518.00" "$2,518.00" "$2,518.00" $448.20 "$2,518.00" "$2,518.00" "$1,868.86" "$1,868.86" "$1,940.87" "$1,311.88" $524.78 "$2,518.00" "$1,007.20" "$2,518.00" "$2,518.00" "$2,518.00" "$2,518.00" "$2,518.00" "$1,888.50" "$2,518.00" "$2,518.00" "$2,518.00" "$1,259.00" "$1,259.00" "$1,994.26" "$2,518.00" "$2,014.40" "$1,636.70" "$2,518.00" "$2,518.00" "$1,460.44" "$2,518.00" "$1,510.80" "$2,518.00" "$2,518.00" "$2,518.00" N/A N/A 27203557 EAP Custom 27203557 AXIUM COIL DETACHER BOTH IP/OP $166.00 $123.00 $29.55 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $29.55 $166.00 $166.00 $123.21 $123.21 $127.95 $86.49 $34.60 $166.00 $66.40 $166.00 $166.00 $166.00 $166.00 $166.00 $124.50 $166.00 $166.00 $166.00 $83.00 $83.00 $131.47 $166.00 $132.80 $107.90 $166.00 $166.00 $96.28 $166.00 $99.60 $166.00 $166.00 $166.00 N/A N/A 27203558 EAP HCPCS C1887 MPC ENVOY GUIDING WIRE BOTH IP/OP "$1,048.00" $776.00 $208.00 "$1,048.00" $569.06 $569.06 $569.06 $569.06 "$1,048.00" "$1,048.00" "$1,048.00" $218.43 "$1,048.00" $777.83 $777.83 $807.80 $546.01 $218.41 "$1,048.00" "$1,048.00" $619.89 "$1,048.00" "$1,048.00" "$1,048.00" "$1,048.00" $786.00 "$1,048.00" "$1,048.00" "$1,048.00" $524.00 $524.00 $830.02 "$1,048.00" $838.40 $681.20 $208.00 "$1,048.00" $607.84 "$1,048.00" "$1,048.00" "$1,048.00" $218.40 "$1,048.00" N/A N/A 27203559 EAP Custom 27203559 STARCLOSE SE BOTH IP/OP $266.00 $197.00 $47.35 $266.00 $266.00 $266.00 $266.00 $266.00 $266.00 $266.00 $47.35 $266.00 $266.00 $197.43 $197.43 $205.03 $138.59 $55.44 $266.00 $106.40 $266.00 $266.00 $266.00 $266.00 $266.00 $199.50 $266.00 $266.00 $266.00 $133.00 $133.00 $210.67 $266.00 $212.80 $172.90 $266.00 $266.00 $154.28 $266.00 $159.60 $266.00 $266.00 $266.00 N/A N/A 27203560 EAP Custom 27203560 WRAP ON FINGER HOOKS(EACH) BOTH IP/OP $21.00 $16.00 $3.74 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $21.00 $3.74 $21.00 $21.00 $15.59 $15.59 $16.19 $10.94 $4.38 $21.00 $8.40 $21.00 $21.00 $21.00 $21.00 $21.00 $15.75 $21.00 $21.00 $21.00 $10.50 $10.50 $16.63 $21.00 $16.80 $13.65 $21.00 $21.00 $12.18 $21.00 $12.60 $21.00 $21.00 $21.00 N/A N/A 27203561 EAP HCPCS C1729 SHUNT PRTNVN DNVR ASCT 25-40ML/MIN AMPLE FLOWRATE BOTH IP/OP "$5,625.00" "$4,162.50" "$1,116.42" "$5,625.00" "$3,054.38" "$3,054.38" "$3,054.38" "$3,054.38" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.39" "$5,625.00" "$4,174.88" "$4,174.88" "$4,335.75" "$2,060.15" "$1,172.31" "$5,625.00" "$5,625.00" "$3,094.73" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$3,656.25" "$1,116.42" "$5,625.00" "$3,262.50" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.25" "$5,625.00" N/A N/A 27203563 EAP HCPCS C1769 TRAY TRACHEOSTOMY 24-26-28FR 2 CANNU TUBE SHILEY C BOTH IP/OP "$1,219.00" $902.50 $241.94 "$1,219.00" $661.92 $661.92 $661.92 $661.92 "$1,219.00" "$1,219.00" "$1,219.00" $254.07 "$1,219.00" $904.74 $904.74 $939.61 $635.10 $254.05 "$1,219.00" "$1,219.00" $721.04 "$1,219.00" "$1,219.00" "$1,219.00" "$1,219.00" $914.25 "$1,219.00" "$1,219.00" "$1,219.00" $609.50 $609.50 $965.45 "$1,219.00" $975.20 $792.35 $241.94 "$1,219.00" $707.02 "$1,219.00" $731.40 "$1,219.00" $254.04 "$1,219.00" N/A N/A 27203564 EAP Custom 27203564 CANNULA PRFSN 22FR VNS 20D DILAT CRCT BBL TRP FNL BOTH IP/OP "$32,500.00" "$24,050.00" "$2,060.15" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$5,785.00" "$32,500.00" "$32,500.00" "$4,181.12" "$4,181.12" "$25,051.00" "$2,060.15" "$6,773.36" "$32,500.00" "$13,000.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$24,375.00" "$32,500.00" "$32,500.00" "$32,500.00" "$16,250.00" "$16,250.00" "$25,740.00" "$32,500.00" "$26,000.00" "$21,125.00" "$32,500.00" "$32,500.00" "$18,850.00" "$32,500.00" "$19,500.00" "$32,500.00" "$32,500.00" "$32,500.00" N/A N/A 27203565 EAP HCPCS C1725 CATHETER ANGIO VTK CURVE 5FR 125CM CEREBRUM TRNB BOTH IP/OP $33.00 $24.50 $6.55 $33.00 $17.92 $17.92 $17.92 $17.92 $33.00 $33.00 $33.00 $6.88 $33.00 $24.49 $24.49 $25.44 $17.19 $6.88 $33.00 $13.20 $19.52 $33.00 $33.00 $33.00 $33.00 $24.75 $33.00 $33.00 $33.00 $16.50 $16.50 $26.14 $33.00 $26.40 $21.45 $6.55 $33.00 $19.14 $33.00 $33.00 $33.00 $6.88 $33.00 N/A N/A 27203580 EAP Custom 27203580 SAFEGUARD 24CM PRESSURE DEVCE BOTH IP/OP $66.00 $49.00 $11.75 $66.00 $66.00 $66.00 $66.00 $66.00 $66.00 $66.00 $11.75 $66.00 $66.00 $48.99 $48.99 $50.87 $34.39 $13.76 $66.00 $26.40 $66.00 $66.00 $66.00 $66.00 $66.00 $49.50 $66.00 $66.00 $66.00 $33.00 $33.00 $52.27 $66.00 $52.80 $42.90 $66.00 $66.00 $38.28 $66.00 $39.60 $66.00 $66.00 $66.00 N/A N/A 27203590 EAP Custom 27203590 NEEDLE 25G BOTH IP/OP $119.00 $88.50 $21.18 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $21.18 $119.00 $119.00 $88.32 $88.32 $91.73 $62.00 $24.80 $119.00 $47.60 $119.00 $119.00 $119.00 $119.00 $119.00 $89.25 $119.00 $119.00 $119.00 $59.50 $59.50 $94.25 $119.00 $95.20 $77.35 $119.00 $119.00 $69.02 $119.00 $71.40 $119.00 $119.00 $119.00 N/A N/A 27203591 EAP Custom 27203591 RESOLUTION235CM BOTH IP/OP $228.00 $169.00 $40.58 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $228.00 $40.58 $228.00 $228.00 $169.22 $169.22 $175.74 $118.79 $47.52 $228.00 $91.20 $228.00 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $148.20 $228.00 $228.00 $132.24 $228.00 $136.80 $228.00 $228.00 $228.00 N/A N/A 27203592 EAP Custom 27203592 RX LITHOTRIPTER BASKET3 BOTH IP/OP $379.00 $280.50 $67.46 $379.00 $379.00 $379.00 $379.00 $379.00 $379.00 $379.00 $67.46 $379.00 $379.00 $281.29 $281.29 $292.13 $197.46 $78.99 $379.00 $151.60 $379.00 $379.00 $379.00 $379.00 $379.00 $284.25 $379.00 $379.00 $379.00 $189.50 $189.50 $300.17 $379.00 $303.20 $246.35 $379.00 $379.00 $219.82 $379.00 $227.40 $379.00 $379.00 $379.00 N/A N/A 27203593 EAP Custom 27203593 RX LITHOTRIPTER BASKET4 BOTH IP/OP $379.00 $280.50 $67.46 $379.00 $379.00 $379.00 $379.00 $379.00 $379.00 $379.00 $67.46 $379.00 $379.00 $281.29 $281.29 $292.13 $197.46 $78.99 $379.00 $151.60 $379.00 $379.00 $379.00 $379.00 $379.00 $284.25 $379.00 $379.00 $379.00 $189.50 $189.50 $300.17 $379.00 $303.20 $246.35 $379.00 $379.00 $219.82 $379.00 $227.40 $379.00 $379.00 $379.00 N/A N/A 27203594 EAP Custom 27203594 RX LITHOTRIPTER BASKET5 BOTH IP/OP $379.00 $280.50 $67.46 $379.00 $379.00 $379.00 $379.00 $379.00 $379.00 $379.00 $67.46 $379.00 $379.00 $281.29 $281.29 $292.13 $197.46 $78.99 $379.00 $151.60 $379.00 $379.00 $379.00 $379.00 $379.00 $284.25 $379.00 $379.00 $379.00 $189.50 $189.50 $300.17 $379.00 $303.20 $246.35 $379.00 $379.00 $219.82 $379.00 $227.40 $379.00 $379.00 $379.00 N/A N/A 27203595 EAP Custom 27203595 RX LITHOTRIPTER BASKET6 BOTH IP/OP $379.00 $280.50 $67.46 $379.00 $379.00 $379.00 $379.00 $379.00 $379.00 $379.00 $67.46 $379.00 $379.00 $281.29 $281.29 $292.13 $197.46 $78.99 $379.00 $151.60 $379.00 $379.00 $379.00 $379.00 $379.00 $284.25 $379.00 $379.00 $379.00 $189.50 $189.50 $300.17 $379.00 $303.20 $246.35 $379.00 $379.00 $219.82 $379.00 $227.40 $379.00 $379.00 $379.00 N/A N/A 27203596 EAP Custom 27203596 AUTOTOME RX 44-20MM BOTH IP/OP $622.00 $460.50 $110.72 $622.00 $622.00 $622.00 $622.00 $622.00 $622.00 $622.00 $110.72 $622.00 $622.00 $461.65 $461.65 $479.44 $324.06 $129.63 $622.00 $248.80 $622.00 $622.00 $622.00 $622.00 $622.00 $466.50 $622.00 $622.00 $622.00 $311.00 $311.00 $492.62 $622.00 $497.60 $404.30 $622.00 $622.00 $360.76 $622.00 $373.20 $622.00 $622.00 $622.00 N/A N/A 27203597 EAP Custom 27203597 AUTOTOME RX 44-20MM BOTH IP/OP $592.00 $438.50 $105.38 $592.00 $592.00 $592.00 $592.00 $592.00 $592.00 $592.00 $105.38 $592.00 $592.00 $439.38 $439.38 $456.31 $308.43 $123.38 $592.00 $236.80 $592.00 $592.00 $592.00 $592.00 $592.00 $444.00 $592.00 $592.00 $592.00 $296.00 $296.00 $468.86 $592.00 $473.60 $384.80 $592.00 $592.00 $343.36 $592.00 $355.20 $592.00 $592.00 $592.00 N/A N/A 27203598 EAP Custom 27203598 HYDRO TOME RX 450CM BOTH IP/OP $592.00 $438.50 $105.38 $592.00 $592.00 $592.00 $592.00 $592.00 $592.00 $592.00 $105.38 $592.00 $592.00 $439.38 $439.38 $456.31 $308.43 $123.38 $592.00 $236.80 $592.00 $592.00 $592.00 $592.00 $592.00 $444.00 $592.00 $592.00 $592.00 $296.00 $296.00 $468.86 $592.00 $473.60 $384.80 $592.00 $592.00 $343.36 $592.00 $355.20 $592.00 $592.00 $592.00 N/A N/A 27203599 EAP Custom 27203599 NEEDLEKNIFE RX BOTH IP/OP $260.00 $192.50 $46.28 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $46.28 $260.00 $260.00 $192.97 $192.97 $200.41 $135.46 $54.19 $260.00 $104.00 $260.00 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $169.00 $260.00 $260.00 $150.80 $260.00 $156.00 $260.00 $260.00 $260.00 N/A N/A 27203621 EAP Custom 27203621 LACERATION TRAY BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27203624 EAP Custom 27203624 STANDARD PEG KIT 20 BOTH IP/OP $517.00 $383.00 $92.03 $517.00 $517.00 $517.00 $517.00 $517.00 $517.00 $517.00 $92.03 $517.00 $517.00 $383.72 $383.72 $398.50 $269.36 $107.75 $517.00 $206.80 $517.00 $517.00 $517.00 $517.00 $517.00 $387.75 $517.00 $517.00 $517.00 $258.50 $258.50 $409.46 $517.00 $413.60 $336.05 $517.00 $517.00 $299.86 $517.00 $310.20 $517.00 $517.00 $517.00 N/A N/A 27203680 EAP HCPCS C1769 HYDRA-JAG/.035/260CM/STR BOTH IP/OP $647.00 $479.00 $128.41 $647.00 $351.32 $351.32 $351.32 $351.32 $647.00 $647.00 $647.00 $134.85 $647.00 $480.20 $480.20 $498.71 $337.09 $134.84 $647.00 $647.00 $382.70 $647.00 $647.00 $647.00 $647.00 $485.25 $647.00 $647.00 $647.00 $323.50 $323.50 $512.42 $647.00 $517.60 $420.55 $128.41 $647.00 $375.26 $647.00 $647.00 $647.00 $134.83 $647.00 N/A N/A 27203681 EAP HCPCS C1769 HYDRA-JAG/.035/450CM/STR BOTH IP/OP $749.00 $554.50 $148.66 $749.00 $406.71 $406.71 $406.71 $406.71 $749.00 $749.00 $749.00 $156.11 $749.00 $555.91 $555.91 $577.33 $390.23 $156.10 $749.00 $749.00 $443.03 $749.00 $749.00 $749.00 $749.00 $561.75 $749.00 $749.00 $749.00 $374.50 $374.50 $593.21 $749.00 $599.20 $486.85 $148.66 $749.00 $434.42 $749.00 $749.00 $749.00 $156.09 $749.00 N/A N/A 27203682 EAP HCPCS C1769 JAG HINI 025/260 ST BX2 BOTH IP/OP $352.00 $260.50 $69.86 $352.00 $191.14 $191.14 $191.14 $191.14 $352.00 $352.00 $352.00 $73.37 $352.00 $261.25 $261.25 $271.32 $183.39 $73.36 $352.00 $352.00 $208.21 $352.00 $352.00 $352.00 $352.00 $264.00 $352.00 $352.00 $352.00 $176.00 $176.00 $278.78 $352.00 $281.60 $228.80 $69.86 $352.00 $204.16 $352.00 $352.00 $352.00 $73.36 $352.00 N/A N/A 27203683 EAP HCPCS C1769 JAGWIRE/025/STRAIGHT 450CM BOTH IP/OP $533.00 $394.50 $105.79 $533.00 $289.42 $289.42 $289.42 $289.42 $533.00 $533.00 $533.00 $111.09 $533.00 $395.59 $395.59 $410.84 $277.69 $111.08 $533.00 $533.00 $315.27 $533.00 $533.00 $533.00 $533.00 $399.75 $533.00 $533.00 $533.00 $266.50 $266.50 $422.14 $533.00 $426.40 $346.45 $105.79 $533.00 $309.14 $533.00 $533.00 $533.00 $111.08 $533.00 N/A N/A 27203684 EAP HCPCS C1769 PATHFINDER 018/450 BOTH IP/OP $544.00 $403.00 $107.97 $544.00 $295.39 $295.39 $295.39 $295.39 $544.00 $544.00 $544.00 $113.38 $544.00 $403.76 $403.76 $419.32 $283.42 $113.38 $544.00 $544.00 $321.78 $544.00 $544.00 $544.00 $544.00 $408.00 $544.00 $544.00 $544.00 $272.00 $272.00 $430.85 $544.00 $435.20 $353.60 $107.97 $544.00 $315.52 $544.00 $544.00 $544.00 $113.37 $544.00 N/A N/A 27203701 EAP Custom 27203701 BARRIER ADH ABS PLVS INTCD 4X3 BOTH IP/OP $745.00 $551.50 $132.61 $745.00 $745.00 $745.00 $745.00 $745.00 $745.00 $745.00 $132.61 $745.00 $745.00 $552.94 $552.94 $574.25 $388.15 $155.27 $745.00 $298.00 $745.00 $745.00 $745.00 $745.00 $745.00 $558.75 $745.00 $745.00 $745.00 $372.50 $372.50 $590.04 $745.00 $596.00 $484.25 $745.00 $745.00 $432.10 $745.00 $447.00 $745.00 $745.00 $745.00 N/A N/A 27203702 EAP HCPCS C1877 CATHETER TR RENEGADE HI FLO 13 BOTH IP/OP "$1,257.00" $930.50 $249.48 "$1,257.00" $682.55 $682.55 $682.55 $682.55 "$1,257.00" "$1,257.00" "$1,257.00" $261.99 "$1,257.00" $932.95 $932.95 $968.90 $654.90 $261.97 "$1,257.00" "$1,257.00" $743.52 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $817.05 $249.48 "$1,257.00" $729.06 "$1,257.00" "$1,257.00" "$1,257.00" $261.96 "$1,257.00" N/A N/A 27203703 EAP Custom 27203703 CATHETER EMBOLIC F-IDC 2D 3MM BOTH IP/OP "$1,321.00" $978.00 $235.14 "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" $235.14 "$1,321.00" "$1,321.00" $980.45 $980.45 "$1,018.23" $688.24 $275.31 "$1,321.00" $528.40 "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" $990.75 "$1,321.00" "$1,321.00" "$1,321.00" $660.50 $660.50 "$1,046.23" "$1,321.00" "$1,056.80" $858.65 "$1,321.00" "$1,321.00" $766.18 "$1,321.00" $792.60 "$1,321.00" "$1,321.00" "$1,321.00" N/A N/A 27203704 EAP Custom 27203704 CATHETER EMBOLIC 2/5MM X 5.8CM BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27203705 EAP Custom 27203705 CM CATHETER EMBOLIC 2/5MM X 5.8 BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27203706 EAP Custom 27203706 COIL AXIUM HELICAL DETACHABLE QC-3-8-HELIX BOTH IP/OP "$2,404.00" "$1,779.00" $427.91 "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" $427.91 "$2,404.00" "$2,404.00" "$1,784.25" "$1,784.25" "$1,853.00" "$1,252.48" $501.02 "$2,404.00" $961.60 "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$1,803.00" "$2,404.00" "$2,404.00" "$2,404.00" "$1,202.00" "$1,202.00" "$1,903.97" "$2,404.00" "$1,923.20" "$1,562.60" "$2,404.00" "$2,404.00" "$1,394.32" "$2,404.00" "$1,442.40" "$2,404.00" "$2,404.00" "$2,404.00" N/A N/A 27203707 EAP Custom 27203707 MICROCOIL PLATINUM DELTAPLUSH 2MMX4CM BOTH IP/OP "$3,217.00" "$2,381.00" $572.63 "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" $572.63 "$3,217.00" "$3,217.00" "$2,387.66" "$2,387.66" "$2,479.66" "$1,676.06" $670.46 "$3,217.00" "$1,286.80" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$2,412.75" "$3,217.00" "$3,217.00" "$3,217.00" "$1,608.50" "$1,608.50" "$2,547.86" "$3,217.00" "$2,573.60" "$2,091.05" "$3,217.00" "$3,217.00" "$1,865.86" "$3,217.00" "$1,930.20" "$3,217.00" "$3,217.00" "$3,217.00" N/A N/A 27203708 EAP Custom 27203708 MICROCOIL PLATINUM DELTAPLUSH 2MMX6CM BOTH IP/OP "$3,217.00" "$2,381.00" $572.63 "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" $572.63 "$3,217.00" "$3,217.00" "$2,387.66" "$2,387.66" "$2,479.66" "$1,676.06" $670.46 "$3,217.00" "$1,286.80" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$2,412.75" "$3,217.00" "$3,217.00" "$3,217.00" "$1,608.50" "$1,608.50" "$2,547.86" "$3,217.00" "$2,573.60" "$2,091.05" "$3,217.00" "$3,217.00" "$1,865.86" "$3,217.00" "$1,930.20" "$3,217.00" "$3,217.00" "$3,217.00" N/A N/A 27203740 EAP HCPCS C1887 CATHETER RENEGADE STC-18 130/2 BOTH IP/OP "$1,664.00" "$1,231.50" $330.26 "$1,664.00" $903.55 $903.55 $903.55 $903.55 "$1,664.00" "$1,664.00" "$1,664.00" $346.82 "$1,664.00" "$1,235.02" "$1,235.02" "$1,282.61" $866.94 $346.80 "$1,664.00" "$1,664.00" $984.26 "$1,664.00" "$1,664.00" "$1,664.00" "$1,664.00" "$1,248.00" "$1,664.00" "$1,664.00" "$1,664.00" $832.00 $832.00 "$1,317.89" "$1,664.00" "$1,331.20" "$1,081.60" $330.26 "$1,664.00" $965.12 "$1,664.00" "$1,664.00" "$1,664.00" $346.78 "$1,664.00" N/A N/A 27203741 EAP Custom 27203741 CATHETER EMBOLIC F-3MM X 12CM BOTH IP/OP "$1,321.00" $978.00 $235.14 "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" $235.14 "$1,321.00" "$1,321.00" $980.45 $980.45 "$1,018.23" $688.24 $275.31 "$1,321.00" $528.40 "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" $990.75 "$1,321.00" "$1,321.00" "$1,321.00" $660.50 $660.50 "$1,046.23" "$1,321.00" "$1,056.80" $858.65 "$1,321.00" "$1,321.00" $766.18 "$1,321.00" $792.60 "$1,321.00" "$1,321.00" "$1,321.00" N/A N/A 27203742 EAP Custom 27203742 CATHETER EMBOLIC F-4MM X 8CM BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27203743 EAP Custom 27203743 4MM X 15CM CATHETER EMBOLIC F- BOTH IP/OP "$1,321.00" $978.00 $235.14 "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" $235.14 "$1,321.00" "$1,321.00" $980.45 $980.45 "$1,018.23" $688.24 $275.31 "$1,321.00" $528.40 "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" $990.75 "$1,321.00" "$1,321.00" "$1,321.00" $660.50 $660.50 "$1,046.23" "$1,321.00" "$1,056.80" $858.65 "$1,321.00" "$1,321.00" $766.18 "$1,321.00" $792.60 "$1,321.00" "$1,321.00" "$1,321.00" N/A N/A 27203744 EAP Custom 27203744 CATHETER EMBOLIC F-5MM X 8CM BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27203745 EAP Custom 27203745 COIL EMBOLIZATION 2D HELIX 5MM 15CM 8 COIL OCCLUSION SYSTEM BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27203746 EAP Custom 27203746 COIL EMBOLIZATION 2D HELIX 6MM 10CM 18 COIL OCCLUSION SYSTEM BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27203747 EAP Custom 27203747 COIL EMBOLIZATION 2D HELIX 6MM 20CM 18 COIL OCCLUSION SYSTEM BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27203748 EAP Custom 27203748 8MM X 20CM CATHETER EMBOLIC F- BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27203749 EAP Custom 27203749 10MM X 20CM CATHETER EMBOLIC F BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27203751 EAP Custom 27203751 CATHETER EMBOLIC F12M X 20CM BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27203753 EAP Custom 27203753 CATHETER EMBOLIC F 14MM X 20CM BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27203755 EAP Custom 27203755 CATHETER EMBOLIC F-IDC VORTX DCM BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27203756 EAP Custom 27203756 CATHETER EMBOLIC F-2/4MM X 4.1CM BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" "$1,258.00" $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A 27203766 EAP Custom 27203766 CATHETER SWAN GANZ BOTH IP/OP $207.00 $153.50 $36.85 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $36.85 $207.00 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $82.80 $207.00 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $207.00 $207.00 $120.06 $207.00 $124.20 $207.00 $207.00 $207.00 N/A N/A 27203769 EAP Custom 27203769 TRAY THORACENTESIS/PARACE BOTH IP/OP $100.00 $74.00 $17.80 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $17.80 $100.00 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $40.00 $100.00 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $100.00 $100.00 $58.00 $100.00 $60.00 $100.00 $100.00 $100.00 N/A N/A 27203770 EAP HCPCS C1769 MIRACLEBROS GUIDING WIRE 14937-01 BOTH IP/OP "$2,251.00" "$1,666.00" $446.77 "$2,251.00" "$1,222.29" "$1,222.29" "$1,222.29" "$1,222.29" "$2,251.00" "$2,251.00" "$2,251.00" $469.16 "$2,251.00" "$1,670.69" "$1,670.69" "$1,735.07" "$1,172.77" $469.13 "$2,251.00" "$2,251.00" "$1,331.47" "$2,251.00" "$2,251.00" "$2,251.00" "$2,251.00" "$1,688.25" "$2,251.00" "$2,251.00" "$2,251.00" "$1,125.50" "$1,125.50" "$1,782.79" "$2,251.00" "$1,800.80" "$1,463.15" $446.77 "$2,251.00" "$1,305.58" "$2,251.00" "$2,251.00" "$2,251.00" $469.11 "$2,251.00" N/A N/A 27203773 EAP Custom 27203773 CATHETER GUID 14FR ACTY PRO 130D CS-IC CURVE INR BOTH IP/OP $613.00 $454.00 $109.11 $613.00 $613.00 $613.00 $613.00 $613.00 $613.00 $613.00 $109.11 $613.00 $613.00 $454.97 $454.97 $472.50 $319.37 $127.76 $613.00 $245.20 $613.00 $613.00 $613.00 $613.00 $613.00 $459.75 $613.00 $613.00 $613.00 $306.50 $306.50 $485.50 $613.00 $490.40 $398.45 $613.00 $613.00 $355.54 $613.00 $367.80 $613.00 $613.00 $613.00 N/A N/A 27203774 EAP Custom 27203774 CATHETER GD 16FR 1.5CM BLN LOPRFL BOTH IP/OP "$1,238.00" $916.50 $220.36 "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" $220.36 "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" $258.01 "$1,238.00" $495.20 "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" $928.50 "$1,238.00" "$1,238.00" "$1,238.00" $619.00 $619.00 $980.50 "$1,238.00" $990.40 $557.10 "$1,238.00" "$1,238.00" $718.04 "$1,238.00" $742.80 "$1,238.00" "$1,238.00" "$1,238.00" N/A N/A 27203775 EAP Custom 27203775 CATHETER GD 16FR 3.5CM BLN LOPRFL BOTH IP/OP "$1,238.00" $916.50 $220.36 "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" $220.36 "$1,238.00" "$1,238.00" $918.84 $918.84 $954.25 $645.00 $258.01 "$1,238.00" $495.20 "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" $928.50 "$1,238.00" "$1,238.00" "$1,238.00" $619.00 $619.00 $980.50 "$1,238.00" $990.40 $804.70 "$1,238.00" "$1,238.00" $718.04 "$1,238.00" $742.80 "$1,238.00" "$1,238.00" "$1,238.00" N/A N/A 27203776 EAP HCPCS C1724 CATHETER ATHRCM 145CM STLTH 360 1.25MM ORBTL CLS BOTH IP/OP "$9,488.00" "$7,021.50" "$1,977.40" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$4,181.12" "$4,181.12" "$7,313.35" "$2,060.15" "$1,977.40" "$9,488.00" "$3,795.20" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$7,116.00" "$9,488.00" "$9,488.00" "$9,488.00" "$4,744.00" "$4,744.00" "$7,514.50" "$9,488.00" "$7,590.40" "$6,167.20" "$9,488.00" "$9,488.00" "$5,503.04" "$9,488.00" "$5,692.80" "$9,488.00" "$9,488.00" "$9,488.00" N/A N/A 27203777 EAP HCPCS C1769 GUIDEWIRE VASC 360 ORBTL BOTH IP/OP $488.00 $361.50 $96.86 $488.00 $264.98 $264.98 $264.98 $264.98 $488.00 $488.00 $488.00 $101.71 $488.00 $362.19 $362.19 $376.15 $254.25 $101.70 $488.00 $488.00 $288.65 $488.00 $488.00 $488.00 $488.00 $366.00 $488.00 $488.00 $488.00 $244.00 $244.00 $386.50 $488.00 $390.40 $317.20 $96.86 $488.00 $283.04 $488.00 $488.00 $488.00 $101.70 $488.00 N/A N/A 27203780 EAP HCPCS C1766 SHEATH FLEX 7FR 10CM BOTH IP/OP $700.00 $518.00 $145.89 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $519.54 $519.54 $539.56 $364.70 $145.89 $700.00 $280.00 $700.00 $700.00 $700.00 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $350.00 $350.00 $554.40 $700.00 $560.00 $455.00 $700.00 $700.00 $406.00 $700.00 $420.00 $700.00 $700.00 $700.00 N/A N/A 27203790 EAP HCPCS C1751 MICROCATHETER MICROVENTION BOTH IP/OP "$2,390.00" "$1,769.00" $474.36 "$2,390.00" "$1,297.77" "$1,297.77" "$1,297.77" "$1,297.77" "$2,390.00" "$2,390.00" "$2,390.00" $498.14 "$2,390.00" "$1,773.86" "$1,773.86" "$1,842.21" "$1,245.19" $498.10 "$2,390.00" "$2,390.00" "$1,413.69" "$2,390.00" "$2,390.00" "$2,390.00" "$2,390.00" "$1,792.50" "$2,390.00" "$2,390.00" "$2,390.00" "$1,195.00" "$1,195.00" "$1,892.88" "$2,390.00" "$1,912.00" "$1,553.50" $474.36 "$2,390.00" "$1,386.20" "$2,390.00" "$2,390.00" "$2,390.00" $498.08 "$2,390.00" N/A N/A 27203795 EAP HCPCS C1751 MICROCATHETER MERCI BOTH IP/OP "$1,585.00" "$1,173.00" $314.58 "$1,585.00" $860.66 $860.66 $860.66 $860.66 "$1,585.00" "$1,585.00" "$1,585.00" $330.35 "$1,585.00" "$1,176.39" "$1,176.39" "$1,221.72" $825.79 $330.33 "$1,585.00" "$1,585.00" $937.53 "$1,585.00" "$1,585.00" "$1,585.00" "$1,585.00" "$1,188.75" "$1,585.00" "$1,585.00" "$1,585.00" $792.50 $792.50 "$1,255.32" "$1,585.00" "$1,268.00" "$1,030.25" $314.58 "$1,585.00" $919.30 "$1,585.00" "$1,585.00" "$1,585.00" $330.31 "$1,585.00" N/A N/A 27203796 EAP HCPCS C1757 2.5 MERI V-SERIES RETRIEVAL SY BOTH IP/OP "$10,341.00" "$7,652.50" "$2,052.43" "$10,341.00" "$5,615.16" "$5,615.16" "$5,615.16" "$5,615.16" "$10,341.00" "$10,341.00" "$10,341.00" "$2,155.32" "$10,341.00" "$4,181.12" "$4,181.12" "$7,970.84" "$2,060.15" "$2,155.18" "$10,341.00" "$10,341.00" "$3,094.73" "$10,341.00" "$10,341.00" "$10,341.00" "$10,341.00" "$7,755.75" "$10,341.00" "$10,341.00" "$10,341.00" "$5,170.50" "$5,170.50" "$8,190.07" "$10,341.00" "$8,272.80" "$6,721.65" "$2,052.43" "$10,341.00" "$5,997.78" "$10,341.00" "$10,341.00" "$10,341.00" "$2,155.06" "$10,341.00" N/A N/A 27203797 EAP HCPCS C1757 3.0 MERI V-SERIES RETRIEVAL SY BOTH IP/OP "$10,341.00" "$7,652.50" "$2,052.43" "$10,341.00" "$5,615.16" "$5,615.16" "$5,615.16" "$5,615.16" "$10,341.00" "$10,341.00" "$10,341.00" "$2,155.32" "$10,341.00" "$4,181.12" "$4,181.12" "$7,970.84" "$2,060.15" "$2,155.18" "$10,341.00" "$10,341.00" "$3,094.73" "$10,341.00" "$10,341.00" "$10,341.00" "$10,341.00" "$7,755.75" "$10,341.00" "$10,341.00" "$10,341.00" "$5,170.50" "$5,170.50" "$8,190.07" "$10,341.00" "$8,272.80" "$6,721.65" "$2,052.43" "$10,341.00" "$5,997.78" "$10,341.00" "$10,341.00" "$10,341.00" "$2,155.06" "$10,341.00" N/A N/A 27203798 EAP HCPCS C1757 MERI V-SERIES RETRIEVAL SYSTEM BOTH IP/OP "$10,341.00" "$7,652.50" "$2,052.43" "$10,341.00" "$5,615.16" "$5,615.16" "$5,615.16" "$5,615.16" "$10,341.00" "$10,341.00" "$10,341.00" "$2,155.32" "$10,341.00" "$4,181.12" "$4,181.12" "$7,970.84" "$2,060.15" "$2,155.18" "$10,341.00" "$10,341.00" "$3,094.73" "$10,341.00" "$10,341.00" "$10,341.00" "$10,341.00" "$7,755.75" "$10,341.00" "$10,341.00" "$10,341.00" "$5,170.50" "$5,170.50" "$8,190.07" "$10,341.00" "$8,272.80" "$6,721.65" "$2,052.43" "$10,341.00" "$5,997.78" "$10,341.00" "$10,341.00" "$10,341.00" "$2,155.06" "$10,341.00" N/A N/A 27203799 EAP HCPCS C1751 026 CATHETER REPERFUSION BOTH IP/OP "$3,635.00" "$2,690.00" $721.46 "$3,635.00" "$1,973.81" "$1,973.81" "$1,973.81" "$1,973.81" "$3,635.00" "$3,635.00" "$3,635.00" $757.62 "$3,635.00" "$2,697.90" "$2,697.90" "$2,801.86" "$1,893.84" $757.57 "$3,635.00" "$3,635.00" "$2,150.10" "$3,635.00" "$3,635.00" "$3,635.00" "$3,635.00" "$2,726.25" "$3,635.00" "$3,635.00" "$3,635.00" "$1,817.50" "$1,817.50" "$2,878.92" "$3,635.00" "$2,908.00" "$2,362.75" $721.46 "$3,635.00" "$2,108.30" "$3,635.00" "$3,635.00" "$3,635.00" $757.53 "$3,635.00" N/A N/A 27203800 EAP HCPCS C1751 032 CATHETER REPERFUSION BOTH IP/OP "$3,817.00" "$2,825.00" $757.58 "$3,817.00" "$2,072.63" "$2,072.63" "$2,072.63" "$2,072.63" "$3,817.00" "$3,817.00" "$3,817.00" $795.56 "$3,817.00" "$2,832.98" "$2,832.98" "$2,942.14" "$1,988.66" $795.50 "$3,817.00" "$3,817.00" "$2,257.76" "$3,817.00" "$3,817.00" "$3,817.00" "$3,817.00" "$2,862.75" "$3,817.00" "$3,817.00" "$3,817.00" "$1,908.50" "$1,908.50" "$3,023.06" "$3,817.00" "$3,053.60" "$2,481.05" $757.58 "$3,817.00" "$2,213.86" "$3,817.00" "$3,817.00" "$3,817.00" $795.46 "$3,817.00" N/A N/A 27203801 EAP HCPCS C1751 041 CATHETER REPERFUSION BOTH IP/OP "$3,635.00" "$2,690.00" $721.46 "$3,635.00" "$1,973.81" "$1,973.81" "$1,973.81" "$1,973.81" "$3,635.00" "$3,635.00" "$3,635.00" $757.62 "$3,635.00" "$2,697.90" "$2,697.90" "$2,801.86" "$1,893.84" $757.57 "$3,635.00" "$3,635.00" "$2,150.10" "$3,635.00" "$3,635.00" "$3,635.00" "$3,635.00" "$2,726.25" "$3,635.00" "$3,635.00" "$3,635.00" "$1,817.50" "$1,817.50" "$2,878.92" "$3,635.00" "$2,908.00" "$2,362.75" $721.46 "$3,635.00" "$2,108.30" "$3,635.00" "$3,635.00" "$3,635.00" $757.53 "$3,635.00" N/A N/A 27203802 EAP Custom 27203802 026 SEPARATOR BOTH IP/OP "$7,639.00" "$5,653.00" "$1,359.74" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$1,359.74" "$7,639.00" "$7,639.00" "$4,181.12" "$4,181.12" "$5,888.14" "$2,060.15" "$1,592.05" "$7,639.00" "$3,055.60" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$5,729.25" "$7,639.00" "$7,639.00" "$7,639.00" "$3,819.50" "$3,819.50" "$6,050.09" "$7,639.00" "$6,111.20" "$4,965.35" "$7,639.00" "$7,639.00" "$4,430.62" "$7,639.00" "$4,583.40" "$7,639.00" "$7,639.00" "$7,639.00" N/A N/A 27203803 EAP Custom 27203803 032 SEPARATOR BOTH IP/OP "$7,639.00" "$5,653.00" "$1,359.74" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$1,359.74" "$7,639.00" "$7,639.00" "$4,181.12" "$4,181.12" "$5,888.14" "$2,060.15" "$1,592.05" "$7,639.00" "$3,055.60" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$7,639.00" "$5,729.25" "$7,639.00" "$7,639.00" "$7,639.00" "$3,819.50" "$3,819.50" "$6,050.09" "$7,639.00" "$6,111.20" "$4,965.35" "$7,639.00" "$7,639.00" "$4,430.62" "$7,639.00" "$4,583.40" "$7,639.00" "$7,639.00" "$7,639.00" N/A N/A 27203804 EAP Custom 27203804 "TUBING, ASPIRATION" BOTH IP/OP "$1,297.00" $960.00 $230.87 "$1,297.00" "$1,297.00" "$1,297.00" "$1,297.00" "$1,297.00" "$1,297.00" "$1,297.00" $230.87 "$1,297.00" "$1,297.00" $962.63 $962.63 $999.73 $675.74 $270.31 "$1,297.00" $518.80 "$1,297.00" "$1,297.00" "$1,297.00" "$1,297.00" "$1,297.00" $972.75 "$1,297.00" "$1,297.00" "$1,297.00" $648.50 $648.50 "$1,027.22" "$1,297.00" "$1,037.60" $843.05 "$1,297.00" "$1,297.00" $752.26 "$1,297.00" $778.20 "$1,297.00" "$1,297.00" "$1,297.00" N/A N/A 27203805 EAP Custom 27203805 "SUPPLIES, NON-STERILE PENUMBRA" BOTH IP/OP $913.00 $676.00 $162.51 $913.00 $913.00 $913.00 $913.00 $913.00 $913.00 $913.00 $162.51 $913.00 $913.00 $677.63 $677.63 $703.74 $475.67 $190.28 $913.00 $365.20 $913.00 $913.00 $913.00 $913.00 $913.00 $684.75 $913.00 $913.00 $913.00 $456.50 $456.50 $723.10 $913.00 $730.40 $593.45 $913.00 $913.00 $529.54 $913.00 $547.80 $913.00 $913.00 $913.00 N/A N/A 27203806 EAP Custom 27203806 "PUMP, PENUMBRA ASPIRATION" BOTH IP/OP "$8,340.00" "$6,172.00" "$1,484.52" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$1,484.52" "$8,340.00" "$8,340.00" "$4,181.12" "$4,181.12" "$6,428.47" "$2,060.15" "$1,738.15" "$8,340.00" "$3,336.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$6,255.00" "$8,340.00" "$8,340.00" "$8,340.00" "$4,170.00" "$4,170.00" "$6,605.28" "$8,340.00" "$6,672.00" "$5,421.00" "$8,340.00" "$8,340.00" "$4,837.20" "$8,340.00" "$5,004.00" "$8,340.00" "$8,340.00" "$8,340.00" N/A N/A 27203807 EAP Custom 27203807 DEVICE ACCUNET DISTAL PROTECTI BOTH IP/OP "$7,006.00" "$5,184.50" "$1,247.07" "$7,006.00" "$7,006.00" "$7,006.00" "$7,006.00" "$7,006.00" "$7,006.00" "$7,006.00" "$1,247.07" "$7,006.00" "$7,006.00" "$4,181.12" "$4,181.12" "$5,400.22" "$2,060.15" "$1,460.13" "$7,006.00" "$2,802.40" "$7,006.00" "$7,006.00" "$7,006.00" "$7,006.00" "$7,006.00" "$5,254.50" "$7,006.00" "$7,006.00" "$7,006.00" "$3,503.00" "$3,503.00" "$5,548.75" "$7,006.00" "$5,604.80" "$4,553.90" "$7,006.00" "$7,006.00" "$4,063.48" "$7,006.00" "$4,203.60" "$7,006.00" "$7,006.00" "$7,006.00" N/A N/A 27203808 EAP Custom 27203808 1008195-20 BALLOON VIATRAC BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" "$1,500.00" $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 27203809 EAP Custom 27203809 QC-2-1 HELIX COIL AXIUM HELICA BOTH IP/OP "$2,404.00" "$1,779.00" $427.91 "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" $427.91 "$2,404.00" "$2,404.00" "$1,784.25" "$1,784.25" "$1,853.00" "$1,252.48" $501.02 "$2,404.00" $961.60 "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$1,803.00" "$2,404.00" "$2,404.00" "$2,404.00" "$1,202.00" "$1,202.00" "$1,903.97" "$2,404.00" "$1,923.20" "$1,562.60" "$2,404.00" "$2,404.00" "$1,394.32" "$2,404.00" "$1,442.40" "$2,404.00" "$2,404.00" "$2,404.00" N/A N/A 27203810 EAP Custom 27203810 QC-3-4-HELIX COIL AXIUM HELICA BOTH IP/OP "$2,404.00" "$1,779.00" $427.91 "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" $427.91 "$2,404.00" "$2,404.00" "$1,784.25" "$1,784.25" "$1,853.00" "$1,252.48" $501.02 "$2,404.00" $961.60 "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$1,803.00" "$2,404.00" "$2,404.00" "$2,404.00" "$1,202.00" "$1,202.00" "$1,903.97" "$2,404.00" "$1,923.20" "$1,562.60" "$2,404.00" "$2,404.00" "$1,394.32" "$2,404.00" "$1,442.40" "$2,404.00" "$2,404.00" "$2,404.00" N/A N/A 27203815 EAP Custom 27203815 BALLON-TREK MINI RX 2.0MM X 12MM BOTH IP/OP $685.00 $507.00 $121.93 $685.00 $685.00 $685.00 $685.00 $685.00 $685.00 $685.00 $121.93 $685.00 $685.00 $508.41 $508.41 $528.00 $356.89 $142.76 $685.00 $274.00 $685.00 $685.00 $685.00 $685.00 $685.00 $513.75 $685.00 $685.00 $685.00 $342.50 $342.50 $542.52 $685.00 $548.00 $445.25 $685.00 $685.00 $397.30 $685.00 $411.00 $685.00 $685.00 $685.00 N/A N/A 27203816 EAP Custom 27203816 BALLON-TREK MINI RX 2.0MM X 15MM BOTH IP/OP $652.00 $482.50 $116.06 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $116.06 $652.00 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $652.00 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $652.00 $652.00 $378.16 $652.00 $391.20 $652.00 $652.00 $652.00 N/A N/A 27203817 EAP Custom 27203817 BALLON-TREK RX 2.50MM X 12MM BOTH IP/OP $685.00 $507.00 $121.93 $685.00 $685.00 $685.00 $685.00 $685.00 $685.00 $685.00 $121.93 $685.00 $685.00 $508.41 $508.41 $528.00 $356.89 $142.76 $685.00 $274.00 $685.00 $685.00 $685.00 $685.00 $685.00 $513.75 $685.00 $685.00 $685.00 $342.50 $342.50 $542.52 $685.00 $548.00 $445.25 $685.00 $685.00 $397.30 $685.00 $411.00 $685.00 $685.00 $685.00 N/A N/A 27203818 EAP Custom 27203818 BALLON-TREK RX 2.50MM X 15MM BOTH IP/OP $652.00 $482.50 $116.06 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $116.06 $652.00 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $652.00 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $652.00 $652.00 $378.16 $652.00 $391.20 $652.00 $652.00 $652.00 N/A N/A 27203819 EAP Custom 27203819 BALLON-TREK RX 3.0MM X 12MM BOTH IP/OP $652.00 $482.50 $116.06 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $116.06 $652.00 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $652.00 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $652.00 $652.00 $378.16 $652.00 $391.20 $652.00 $652.00 $652.00 N/A N/A 27203820 EAP HCPCS C1757 SET THROMBECTOMY DVX BOTH IP/OP "$5,308.00" "$3,928.00" "$1,053.51" "$5,308.00" "$2,882.24" "$2,882.24" "$2,882.24" "$2,882.24" "$5,308.00" "$5,308.00" "$5,308.00" "$1,106.32" "$5,308.00" "$3,939.60" "$3,939.60" "$4,091.41" "$2,060.15" "$1,106.25" "$5,308.00" "$5,308.00" "$3,094.73" "$5,308.00" "$5,308.00" "$5,308.00" "$5,308.00" "$3,981.00" "$5,308.00" "$5,308.00" "$5,308.00" "$2,654.00" "$2,654.00" "$4,203.94" "$5,308.00" "$4,246.40" "$3,450.20" "$1,053.51" "$5,308.00" "$3,078.64" "$5,308.00" "$5,308.00" "$5,308.00" "$1,106.19" "$5,308.00" N/A N/A 27203821 EAP HCPCS C1757 SET THROMBECTOMY AVX BOTH IP/OP "$2,452.00" "$1,814.50" $486.66 "$2,452.00" "$1,331.44" "$1,331.44" "$1,331.44" "$1,331.44" "$2,452.00" "$2,452.00" "$2,452.00" $511.06 "$2,452.00" "$1,819.87" "$1,819.87" "$1,890.00" "$1,277.49" $511.02 "$2,452.00" "$2,452.00" "$1,450.36" "$2,452.00" "$2,452.00" "$2,452.00" "$2,452.00" "$1,839.00" "$2,452.00" "$2,452.00" "$2,452.00" "$1,226.00" "$1,226.00" "$1,941.98" "$2,452.00" "$1,961.60" "$1,593.80" $486.66 "$2,452.00" "$1,422.16" "$2,452.00" "$2,452.00" "$2,452.00" $511.00 "$2,452.00" N/A N/A 27203822 EAP HCPCS C1757 SET THROMBECTOMY SPIROFLEX BOTH IP/OP "$6,464.00" "$4,783.50" "$1,282.94" "$6,464.00" "$3,509.95" "$3,509.95" "$3,509.95" "$3,509.95" "$6,464.00" "$6,464.00" "$6,464.00" "$1,347.26" "$6,464.00" "$4,181.12" "$4,181.12" "$4,982.45" "$2,060.15" "$1,347.17" "$6,464.00" "$6,464.00" "$3,094.73" "$6,464.00" "$6,464.00" "$6,464.00" "$6,464.00" "$4,848.00" "$6,464.00" "$6,464.00" "$6,464.00" "$3,232.00" "$3,232.00" "$5,119.49" "$6,464.00" "$5,171.20" "$4,201.60" "$1,282.94" "$6,464.00" "$3,749.12" "$6,464.00" "$6,464.00" "$6,464.00" "$1,347.10" "$6,464.00" N/A N/A 27203823 EAP HCPCS C1757 SET THROMBECTOMY SPIROFLEX VG BOTH IP/OP "$6,156.00" "$4,555.50" "$1,221.81" "$6,156.00" "$3,342.71" "$3,342.71" "$3,342.71" "$3,342.71" "$6,156.00" "$6,156.00" "$6,156.00" "$1,283.06" "$6,156.00" "$4,181.12" "$4,181.12" "$4,745.04" "$2,060.15" "$1,282.98" "$6,156.00" "$6,156.00" "$3,094.73" "$6,156.00" "$6,156.00" "$6,156.00" "$6,156.00" "$4,617.00" "$6,156.00" "$6,156.00" "$6,156.00" "$3,078.00" "$3,078.00" "$4,875.55" "$6,156.00" "$4,924.80" "$4,001.40" "$1,221.81" "$6,156.00" "$3,570.48" "$6,156.00" "$6,156.00" "$6,156.00" "$1,282.91" "$6,156.00" N/A N/A 27203824 EAP Custom 27203824 BALLON-TREK RX 3.0MM X 15MM BOTH IP/OP $652.00 $482.50 $116.06 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $116.06 $652.00 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $652.00 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $652.00 $652.00 $378.16 $652.00 $391.20 $652.00 $652.00 $652.00 N/A N/A 27203825 EAP HCPCS C1725 BALLOON NC TREK 2.0 X 6MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203826 EAP HCPCS C1725 BALLOON NC TREK 2.5 X 6MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203827 EAP HCPCS C1725 BALLOON NC TREK 2.5 X 8MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203828 EAP HCPCS C1725 BALLOON NC TREK 2.5 X 12MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203829 EAP HCPCS C1725 BALLOON NC TREK 2.5 X 20MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203830 EAP HCPCS C1725 BALLOON NC TREK 2.5 X 25MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203831 EAP HCPCS C1725 BALLOON NC TREK 2.75 X 6MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203832 EAP HCPCS C1725 BALLOON NC TREK 2.75 X 12MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203833 EAP HCPCS C1725 "BALLOON, MINI TREK OTW 1.50 X" BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203834 EAP HCPCS C1725 "BALLOON, MINI TREK OTW 1.50 X" BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203835 EAP HCPCS C1725 "BALLOON, MINI TREK OTW 2.00 X" BOTH IP/OP $685.00 $507.00 $135.96 $685.00 $371.96 $371.96 $371.96 $371.96 $685.00 $685.00 $685.00 $142.77 $685.00 $508.41 $508.41 $528.00 $356.89 $142.76 $685.00 $685.00 $405.18 $685.00 $685.00 $685.00 $685.00 $513.75 $685.00 $685.00 $685.00 $342.50 $342.50 $542.52 $685.00 $548.00 $445.25 $135.96 $685.00 $397.30 $685.00 $685.00 $685.00 $142.75 $685.00 N/A N/A 27203836 EAP HCPCS C1725 "BALLOON, MINI TREK OTW 2.00 X" BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203837 EAP HCPCS C1725 "BALLOON, MINI TREK OTW 2.00 X" BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203838 EAP HCPCS C1725 BALLOON NC TREK 2.75 X 15MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203839 EAP HCPCS C1725 BALLOON NC TREK 2.75 X 20MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203840 EAP HCPCS C1725 BALLOON NC TREK 3.0 X 6MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203841 EAP HCPCS C1725 BALLOON NC TREK 3.0 X 8MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203842 EAP HCPCS C1725 BALLOON NC TREK 3.0 X 12MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203843 EAP HCPCS C1725 BALLOON NC TREK 3.0 X 15MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203844 EAP HCPCS C1725 BALLOON NC TREK 3.0 X 20MM BOTH IP/OP $685.00 $507.00 $135.96 $685.00 $371.96 $371.96 $371.96 $371.96 $685.00 $685.00 $685.00 $142.77 $685.00 $508.41 $508.41 $528.00 $356.89 $142.76 $685.00 $685.00 $405.18 $685.00 $685.00 $685.00 $685.00 $513.75 $685.00 $685.00 $685.00 $342.50 $342.50 $542.52 $685.00 $548.00 $445.25 $135.96 $685.00 $397.30 $685.00 $685.00 $685.00 $142.75 $685.00 N/A N/A 27203845 EAP HCPCS C1725 BALLOON NC TREK 3.0 X 25MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203846 EAP HCPCS C1725 BALLOON NC TREK 3.25 X 12MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203848 EAP HCPCS C1725 BALLOON NC TREK 3.5 X 6MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203849 EAP HCPCS C1725 BALLOON NC TREK 3.5 X 8MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203850 EAP HCPCS C1725 BALLOON NC TREK 3.5 X 12MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203851 EAP HCPCS C1725 BALLOON NC TREK 3.5 X 15MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203852 EAP HCPCS C1725 BALLOON NC TREK 3.5 X 20MM BOTH IP/OP $685.00 $507.00 $135.96 $685.00 $371.96 $371.96 $371.96 $371.96 $685.00 $685.00 $685.00 $142.77 $685.00 $508.41 $508.41 $528.00 $356.89 $142.76 $685.00 $685.00 $405.18 $685.00 $685.00 $685.00 $685.00 $513.75 $685.00 $685.00 $685.00 $342.50 $342.50 $542.52 $685.00 $548.00 $445.25 $135.96 $685.00 $397.30 $685.00 $685.00 $685.00 $142.75 $685.00 N/A N/A 27203853 EAP HCPCS C1725 BALLOON NC TREK 3.5 X 25MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203854 EAP HCPCS C1725 BALLOON NC TREK 3.75 X 12MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203855 EAP HCPCS C1725 BALLOON NC TREK 3.75 X 15MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203856 EAP HCPCS C1725 BALLOON NC TREK 3.75 X 20MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $391.20 $652.00 $135.88 $652.00 N/A N/A 27203857 EAP HCPCS C1725 BALLOON NC TREK 4.0 X 8MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $391.20 $652.00 $135.88 $652.00 N/A N/A 27203858 EAP HCPCS C1725 BALLOON NC TREK 4.0 X 12MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203859 EAP HCPCS C1725 BALLOON NC TREK 4.0 X 15MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203860 EAP HCPCS C1725 BALLOON NC TREK 4.0 X 20MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $652.00 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203861 EAP HCPCS C1725 BALLOON NC TREK 5.0 X 8MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203862 EAP HCPCS C1725 BALLOON NC TREK 5.0 X 12MM BOTH IP/OP $652.00 $482.50 $129.41 $652.00 $354.04 $354.04 $354.04 $354.04 $652.00 $652.00 $652.00 $135.89 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $385.66 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $129.41 $652.00 $378.16 $652.00 $652.00 $652.00 $135.88 $652.00 N/A N/A 27203863 EAP HCPCS C1725 STENT XCIENCE 2.25 X 8MM BOTH IP/OP "$6,940.00" "$5,136.00" "$1,377.42" "$6,940.00" "$3,768.42" "$3,768.42" "$3,768.42" "$3,768.42" "$6,940.00" "$6,940.00" "$6,940.00" "$1,446.47" "$6,940.00" "$4,181.12" "$4,181.12" "$5,349.35" "$2,060.15" "$1,446.37" "$6,940.00" "$6,940.00" "$3,094.73" "$6,940.00" "$6,940.00" "$6,940.00" "$6,940.00" "$5,205.00" "$6,940.00" "$6,940.00" "$6,940.00" "$3,470.00" "$3,470.00" "$5,496.48" "$6,940.00" "$5,552.00" "$4,511.00" "$1,377.42" "$6,940.00" "$4,025.20" "$6,940.00" "$6,940.00" "$6,940.00" "$1,446.30" "$6,940.00" N/A N/A 27203864 EAP HCPCS C1887 CATHETER GUID EBU3.75 CURVE 8FR .09IN 90CM LEFT BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27203865 EAP HCPCS C1887 ATHETER GUID XB3.5 CURVE 8FR 90CM CORON LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27203867 EAP HCPCS C1887 CATHETER GUID JL4 CURVE 8FR 90CM CORON SHR NX BAL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27203868 EAP HCPCS C1887 CATHETER GUID MB1 CURVE 8FR .088IN 90CM CORON SHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27203869 EAP HCPCS C1887 CATHETER ANGIO JACKY RADL 3.5 CURVE 5FR 110CM BOTH IP/OP $88.00 $65.50 $17.47 $88.00 $47.78 $47.78 $47.78 $47.78 $88.00 $88.00 $88.00 $18.34 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $88.00 $52.05 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $17.47 $88.00 $51.04 $88.00 $88.00 $88.00 $18.34 $88.00 N/A N/A 27203870 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 2.0X10 MM 5F BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $407.25 $407.25 $407.25 $407.25 $750.00 $750.00 $750.00 $156.32 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $148.86 $750.00 $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 27203871 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 2.0X15 MM 5F BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $407.25 $407.25 $407.25 $407.25 $750.00 $750.00 $750.00 $156.32 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $148.86 $750.00 $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 27203873 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 2.5X10 MM 5F BOTH IP/OP $788.00 $583.50 $156.40 $788.00 $427.88 $427.88 $427.88 $427.88 $788.00 $788.00 $788.00 $164.24 $788.00 $584.85 $584.85 $607.39 $410.55 $164.23 $788.00 $788.00 $466.10 $788.00 $788.00 $788.00 $788.00 $591.00 $788.00 $788.00 $788.00 $394.00 $394.00 $624.10 $788.00 $630.40 $512.20 $156.40 $788.00 $457.04 $788.00 $788.00 $788.00 $164.22 $788.00 N/A N/A 27203874 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 2.5X15 MM 5F BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $407.25 $407.25 $407.25 $407.25 $750.00 $750.00 $750.00 $156.32 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $148.86 $750.00 $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 27203875 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 2.5X20 MM 5F BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $407.25 $407.25 $407.25 $407.25 $750.00 $750.00 $750.00 $156.32 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $148.86 $750.00 $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 27203876 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 3.0X10 MM 6F BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $407.25 $407.25 $407.25 $407.25 $750.00 $750.00 $750.00 $156.32 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $148.86 $750.00 $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 27203878 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 3.0X20 MM 6F BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $407.25 $407.25 $407.25 $407.25 $750.00 $750.00 $750.00 $156.32 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $148.86 $750.00 $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 27203879 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 3.5X10 MM 6F BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $407.25 $407.25 $407.25 $407.25 $750.00 $750.00 $750.00 $156.32 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $148.86 $750.00 $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 27203880 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 3.5X15 MM 6F BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $407.25 $407.25 $407.25 $407.25 $750.00 $750.00 $750.00 $156.32 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $148.86 $750.00 $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 27203881 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 3.5X20 MM 6F BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $407.25 $407.25 $407.25 $407.25 $750.00 $750.00 $750.00 $156.32 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $148.86 $750.00 $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 27203882 EAP HCPCS C1887 CATHETER DLV SYS .062IN 5MAX MAX TRK TCH 125CM 129 BOTH IP/OP "$4,175.00" "$3,089.50" $828.63 "$4,175.00" "$2,267.03" "$2,267.03" "$2,267.03" "$2,267.03" "$4,175.00" "$4,175.00" "$4,175.00" $870.17 "$4,175.00" "$3,098.69" "$3,098.69" "$3,218.09" "$2,060.15" $870.12 "$4,175.00" "$4,175.00" "$2,469.51" "$4,175.00" "$4,175.00" "$4,175.00" "$4,175.00" "$3,131.25" "$4,175.00" "$4,175.00" "$4,175.00" "$2,087.50" "$2,087.50" "$3,306.60" "$4,175.00" "$3,340.00" "$2,713.75" $828.63 "$4,175.00" "$2,421.50" "$4,175.00" "$4,175.00" "$4,175.00" $870.07 "$4,175.00" N/A N/A 27203891 EAP Custom 27203891 KIT GEL PAD LARGE ARCTIC SUN BOTH IP/OP "$6,305.00" "$4,666.00" "$1,122.29" "$6,305.00" "$6,305.00" "$6,305.00" "$6,305.00" "$6,305.00" "$6,305.00" "$6,305.00" "$1,122.29" "$6,305.00" "$6,305.00" "$4,181.12" "$4,181.12" "$4,859.89" "$2,060.15" "$1,314.03" "$6,305.00" "$2,522.00" "$6,305.00" "$6,305.00" "$6,305.00" "$6,305.00" "$6,305.00" "$4,728.75" "$6,305.00" "$6,305.00" "$6,305.00" "$3,152.50" "$3,152.50" "$4,993.56" "$6,305.00" "$5,044.00" "$4,098.25" "$6,305.00" "$6,305.00" "$3,656.90" "$6,305.00" "$3,783.00" "$6,305.00" "$6,305.00" "$6,305.00" N/A N/A 27203895 EAP Custom 27203895 BALLON-TREK RX 3.50MM X 12MM BOTH IP/OP $652.00 $482.50 $116.06 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $116.06 $652.00 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $652.00 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $652.00 $652.00 $378.16 $652.00 $391.20 $652.00 $652.00 $652.00 N/A N/A 27203896 EAP Custom 27203896 BALLON-TREK RX 3.50MM X 15MM BOTH IP/OP $652.00 $482.50 $116.06 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $116.06 $652.00 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $652.00 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $652.00 $652.00 $378.16 $652.00 $391.20 $652.00 $652.00 $652.00 N/A N/A 27203897 EAP Custom 27203897 BALLON-TREK RX 4.0MM X 15MM BOTH IP/OP $652.00 $482.50 $116.06 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $652.00 $116.06 $652.00 $652.00 $483.91 $483.91 $502.56 $339.69 $135.88 $652.00 $260.80 $652.00 $652.00 $652.00 $652.00 $652.00 $489.00 $652.00 $652.00 $652.00 $326.00 $326.00 $516.38 $652.00 $521.60 $423.80 $652.00 $652.00 $378.16 $652.00 $391.20 $652.00 $652.00 $652.00 N/A N/A 27203899 EAP Custom 27203899 "CATHETER, TIGER 4.5 RADIAL ACCESS" BOTH IP/OP $31.00 $23.00 $5.52 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $5.52 $31.00 $31.00 $23.01 $23.01 $23.89 $16.15 $6.46 $31.00 $12.40 $31.00 $31.00 $31.00 $31.00 $31.00 $23.25 $31.00 $31.00 $31.00 $15.50 $15.50 $24.55 $31.00 $24.80 $20.15 $31.00 $31.00 $17.98 $31.00 $18.60 $31.00 $31.00 $31.00 N/A N/A 27203900 EAP Custom 27203900 DEVICE SPEC RTRVL XTRT PRO XL 7-6FR 12-15MM 200CM BOTH IP/OP "$2,500.00" "$1,850.00" $445.00 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $445.00 "$2,500.00" "$2,500.00" "$1,855.50" "$1,855.50" "$1,927.00" "$1,302.50" $521.03 "$2,500.00" "$1,000.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,625.00" "$2,500.00" "$2,500.00" "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 27203901 EAP Custom 27203901 TRAY FOLEY 16FR WITH UNRINEMETER BOTH IP/OP $35.00 $26.00 $6.23 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $6.23 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 27203902 EAP HCPCS C1751 FA-55150-1030 CATHETER MARKSMAN BOTH IP/OP "$3,104.00" "$2,297.00" $616.07 "$3,104.00" "$1,685.47" "$1,685.47" "$1,685.47" "$1,685.47" "$3,104.00" "$3,104.00" "$3,104.00" $646.95 "$3,104.00" "$2,303.79" "$2,303.79" "$2,392.56" "$1,617.18" $646.91 "$3,104.00" "$3,104.00" "$1,836.02" "$3,104.00" "$3,104.00" "$3,104.00" "$3,104.00" "$2,328.00" "$3,104.00" "$3,104.00" "$3,104.00" "$1,552.00" "$1,552.00" "$2,458.37" "$3,104.00" "$2,483.20" "$2,017.60" $616.07 "$3,104.00" "$1,800.32" "$3,104.00" "$3,104.00" "$3,104.00" $646.87 "$3,104.00" N/A N/A 27203903 EAP HCPCS C1725 CATHETER BALLOON UDT 16-449 5-10/5/75 BOTH IP/OP $634.00 $469.50 $125.83 $634.00 $344.26 $344.26 $344.26 $344.26 $634.00 $634.00 $634.00 $132.14 $634.00 $470.55 $470.55 $488.69 $330.31 $132.13 $634.00 $634.00 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $412.10 $125.83 $634.00 $367.72 $634.00 $634.00 $634.00 $132.13 $634.00 N/A N/A 27203904 EAP HCPCS C1894 CL-07690 SHEATH SET SUPER ARROW FLEX 90CM BOTH IP/OP $347.00 $257.00 $68.87 $347.00 $188.42 $188.42 $188.42 $188.42 $347.00 $347.00 $347.00 $72.32 $347.00 $257.54 $257.54 $267.47 $180.79 $72.32 $347.00 $347.00 $205.25 $347.00 $347.00 $347.00 $347.00 $260.25 $347.00 $347.00 $347.00 $173.50 $173.50 $274.82 $347.00 $277.60 $225.55 $68.87 $347.00 $201.26 $347.00 $347.00 $347.00 $72.31 $347.00 N/A N/A 27203905 EAP HCPCS C1894 CL - 07665 SHEATH SET SUPER ARROW FLEX 65CM BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $157.47 $157.47 $157.47 $157.47 $290.00 $290.00 $290.00 $60.44 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $57.56 $290.00 $168.20 $290.00 $290.00 $290.00 $60.44 $290.00 N/A N/A 27203907 EAP Custom 27203907 CATHETER SITESEER AL 1 5 FR 5A0018 BOTH IP/OP $31.00 $23.00 $5.52 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $5.52 $31.00 $31.00 $23.01 $23.01 $23.89 $16.15 $6.46 $31.00 $12.40 $31.00 $31.00 $31.00 $31.00 $31.00 $23.25 $31.00 $31.00 $31.00 $15.50 $15.50 $24.55 $31.00 $24.80 $20.15 $31.00 $31.00 $17.98 $31.00 $18.60 $31.00 $31.00 $31.00 N/A N/A 27203908 EAP HCPCS C1769 GUIDEWIRE ASAHI GRAND SLAM .014X300CM 14940 BOTH IP/OP $234.00 $173.50 $46.44 $234.00 $127.06 $127.06 $127.06 $127.06 $234.00 $234.00 $234.00 $48.77 $234.00 $173.67 $173.67 $180.37 $121.91 $48.77 $234.00 $234.00 $138.41 $234.00 $234.00 $234.00 $234.00 $175.50 $234.00 $234.00 $234.00 $117.00 $117.00 $185.33 $234.00 $187.20 $152.10 $46.44 $234.00 $135.72 $234.00 $234.00 $234.00 $48.77 $234.00 N/A N/A 27203909 EAP HCPCS C1887 LA6EBU375 CATHETER GUIDINGEBU 3.75 BOTH IP/OP $464.00 $343.50 $92.09 $464.00 $251.95 $251.95 $251.95 $251.95 $464.00 $464.00 $464.00 $96.71 $464.00 $344.38 $344.38 $357.65 $241.74 $96.70 $464.00 $464.00 $274.46 $464.00 $464.00 $464.00 $464.00 $348.00 $464.00 $464.00 $464.00 $232.00 $232.00 $367.49 $464.00 $371.20 $301.60 $92.09 $464.00 $269.12 $464.00 $464.00 $464.00 $96.70 $464.00 N/A N/A 27203912 EAP HCPCS C1887 CATHETER GUIDELINER 5571 BOTH IP/OP "$1,227.00" $908.00 $243.53 "$1,227.00" $666.26 $666.26 $666.26 $666.26 "$1,227.00" "$1,227.00" "$1,227.00" $255.74 "$1,227.00" $910.68 $910.68 $945.77 $639.27 $255.72 "$1,227.00" "$1,227.00" $725.77 "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" $920.25 "$1,227.00" "$1,227.00" "$1,227.00" $613.50 $613.50 $971.78 "$1,227.00" $981.60 $797.55 $243.53 "$1,227.00" $711.66 "$1,227.00" "$1,227.00" "$1,227.00" $255.71 "$1,227.00" N/A N/A 27203913 EAP HCPCS C1887 LA7EBU375 CATHETER GUIDING EBU 3.75 BOTH IP/OP $464.00 $343.50 $92.09 $464.00 $251.95 $251.95 $251.95 $251.95 $464.00 $464.00 $464.00 $96.71 $464.00 $344.38 $344.38 $357.65 $241.74 $96.70 $464.00 $464.00 $274.46 $464.00 $464.00 $464.00 $464.00 $348.00 $464.00 $464.00 $464.00 $232.00 $232.00 $367.49 $464.00 $371.20 $301.60 $92.09 $464.00 $269.12 $464.00 $464.00 $464.00 $96.70 $464.00 N/A N/A 27203914 EAP Custom 27203914 CATHETER SITESEER ANGLED PIGTAILED 5FR 5A0070 BOTH IP/OP $31.00 $23.00 $5.52 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $5.52 $31.00 $31.00 $23.01 $23.01 $23.89 $16.15 $6.46 $31.00 $12.40 $31.00 $31.00 $31.00 $31.00 $31.00 $23.25 $31.00 $31.00 $31.00 $15.50 $15.50 $24.55 $31.00 $24.80 $20.15 $31.00 $31.00 $17.98 $31.00 $18.60 $31.00 $31.00 $31.00 N/A N/A 27203916 EAP HCPCS C1892 FRENCH LARGE PEEL AWAY INTRODUCER 20 BOTH IP/OP $51.00 $38.00 $10.12 $51.00 $27.69 $27.69 $27.69 $27.69 $51.00 $51.00 $51.00 $10.63 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $51.00 $30.17 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $10.12 $51.00 $29.58 $51.00 $30.60 $51.00 $10.63 $51.00 N/A N/A 27203917 EAP HCPCS C1892 FRENCH LARGE PEEL AWAY INTRODUCER 22 BOTH IP/OP $51.00 $38.00 $10.12 $51.00 $27.69 $27.69 $27.69 $27.69 $51.00 $51.00 $51.00 $10.63 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $51.00 $30.17 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $10.12 $51.00 $29.58 $51.00 $30.60 $51.00 $10.63 $51.00 N/A N/A 27203918 EAP HCPCS C1892 FRENCH LARGE PEEL AWAY INTRODUCER 24 BOTH IP/OP $51.00 $38.00 $10.12 $51.00 $27.69 $27.69 $27.69 $27.69 $51.00 $51.00 $51.00 $10.63 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $51.00 $30.17 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $10.12 $51.00 $29.58 $51.00 $51.00 $51.00 $10.63 $51.00 N/A N/A 27203919 EAP HCPCS C1892 FRENCH LARGE PEEL AWAY INTRODUCER 26 BOTH IP/OP $51.00 $38.00 $10.12 $51.00 $27.69 $27.69 $27.69 $27.69 $51.00 $51.00 $51.00 $10.63 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $51.00 $30.17 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $10.12 $51.00 $29.58 $51.00 $51.00 $51.00 $10.63 $51.00 N/A N/A 27203920 EAP HCPCS C1894 FLEXOR CECKFLO INTRODUCER BOTH IP/OP $76.00 $56.50 $15.08 $76.00 $41.27 $41.27 $41.27 $41.27 $76.00 $76.00 $76.00 $15.84 $76.00 $56.41 $56.41 $58.58 $39.60 $15.84 $76.00 $76.00 $44.95 $76.00 $76.00 $76.00 $76.00 $57.00 $76.00 $76.00 $76.00 $38.00 $38.00 $60.19 $76.00 $60.80 $49.40 $15.08 $76.00 $44.08 $76.00 $76.00 $76.00 $15.84 $76.00 N/A N/A 27203921 EAP HCPCS C1750 FRENCH X 36 CM TITAN HEMODIALYSIS CATHETER BOTH IP/OP $237.00 $175.50 $47.04 $237.00 $128.69 $128.69 $128.69 $128.69 $237.00 $237.00 $237.00 $49.40 $237.00 $175.90 $175.90 $182.68 $123.48 $49.39 $237.00 $237.00 $140.19 $237.00 $237.00 $237.00 $237.00 $177.75 $237.00 $237.00 $237.00 $118.50 $118.50 $187.70 $237.00 $189.60 $154.05 $47.04 $237.00 $137.46 $237.00 $237.00 $237.00 $49.39 $237.00 N/A N/A 27203922 EAP HCPCS C1750 FRENCH X 40 CM TITAN HEMODIALYSIS CATHETER BOTH IP/OP $237.00 $175.50 $47.04 $237.00 $128.69 $128.69 $128.69 $128.69 $237.00 $237.00 $237.00 $49.40 $237.00 $175.90 $175.90 $182.68 $123.48 $49.39 $237.00 $237.00 $140.19 $237.00 $237.00 $237.00 $237.00 $177.75 $237.00 $237.00 $237.00 $118.50 $118.50 $187.70 $237.00 $189.60 $154.05 $47.04 $237.00 $137.46 $237.00 $237.00 $237.00 $49.39 $237.00 N/A N/A 27203923 EAP HCPCS C1750 SET CATHETER 15.5FR 55CM 2 LUMEN TITAN HD LONG TERM BOTH IP/OP $475.00 $351.50 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 $475.00 $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A 27203925 EAP HCPCS C1752 FRENCH X 32 CM TITAN HEMODIALYSIS CATHETER T- 3 TRIPLE 5 BOTH IP/OP $237.00 $175.50 $49.39 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $175.90 $175.90 $182.68 $123.48 $49.39 $237.00 $94.80 $237.00 $237.00 $237.00 $237.00 $237.00 $177.75 $237.00 $237.00 $237.00 $118.50 $118.50 $187.70 $237.00 $189.60 $154.05 $237.00 $237.00 $137.46 $237.00 $142.20 $237.00 $237.00 $237.00 N/A N/A 27203926 EAP HCPCS C1752 TITAN HEMODIALYSIS CATHETER 14F X 30 CM BOTH IP/OP $237.00 $175.50 $49.39 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $175.90 $175.90 $182.68 $123.48 $49.39 $237.00 $94.80 $237.00 $237.00 $237.00 $237.00 $237.00 $177.75 $237.00 $237.00 $237.00 $118.50 $118.50 $187.70 $237.00 $189.60 $154.05 $237.00 $237.00 $137.46 $237.00 $142.20 $237.00 $237.00 $237.00 N/A N/A 27203927 EAP HCPCS C1892 TEAR AWAY SHEATH INTRODUCER BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $105.00 $175.00 $36.47 $175.00 N/A N/A 27203928 EAP Custom 27203928 DRESSING ADHERENT MEPILEX BORDER 9.2 X 9.2 282400 BOTH IP/OP $37.00 $27.50 $6.59 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $6.59 $37.00 $37.00 $27.46 $27.46 $28.52 $19.28 $7.71 $37.00 $14.80 $37.00 $37.00 $37.00 $37.00 $37.00 $27.75 $37.00 $37.00 $37.00 $18.50 $18.50 $29.30 $37.00 $29.60 $24.05 $37.00 $37.00 $21.46 $37.00 $22.20 $37.00 $37.00 $37.00 N/A N/A 27203929 EAP HCPCS C1892 LARGE PEEL AWAY INTRODUCER BOTH IP/OP $51.00 $38.00 $10.12 $51.00 $27.69 $27.69 $27.69 $27.69 $51.00 $51.00 $51.00 $10.63 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $51.00 $30.17 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $10.12 $51.00 $29.58 $51.00 $51.00 $51.00 $10.63 $51.00 N/A N/A 27203930 EAP HCPCS C1769 G131660 INTRODUCER TRACHEOSTOMY PERCUTANEOUS CIAGLIA BM BOTH IP/OP "$1,124.00" $832.00 $223.09 "$1,124.00" $610.33 $610.33 $610.33 $610.33 "$1,124.00" "$1,124.00" "$1,124.00" $234.27 "$1,124.00" $834.23 $834.23 $866.38 $585.60 $234.25 "$1,124.00" "$1,124.00" $664.85 "$1,124.00" "$1,124.00" "$1,124.00" "$1,124.00" $843.00 "$1,124.00" "$1,124.00" "$1,124.00" $562.00 $562.00 $890.21 "$1,124.00" $899.20 $730.60 $223.09 "$1,124.00" $651.92 "$1,124.00" "$1,124.00" "$1,124.00" $234.24 "$1,124.00" N/A N/A 27203931 EAP HCPCS C1769 G12565 INTRODUCER TRACHEOSTOMY PERCUTANEOUS CIAGLIA BLM BOTH IP/OP "$1,124.00" $832.00 $223.09 "$1,124.00" $610.33 $610.33 $610.33 $610.33 "$1,124.00" "$1,124.00" "$1,124.00" $234.27 "$1,124.00" $834.23 $834.23 $866.38 $585.60 $234.25 "$1,124.00" "$1,124.00" $664.85 "$1,124.00" "$1,124.00" "$1,124.00" "$1,124.00" $843.00 "$1,124.00" "$1,124.00" "$1,124.00" $562.00 $562.00 $890.21 "$1,124.00" $899.20 $730.60 $223.09 "$1,124.00" $651.92 "$1,124.00" "$1,124.00" "$1,124.00" $234.24 "$1,124.00" N/A N/A 27203933 EAP HCPCS C1769 UM-04018 FEMORAL ARTERIAL LINE KIT BOTH IP/OP $91.00 $67.50 $18.06 $91.00 $49.41 $49.41 $49.41 $49.41 $91.00 $91.00 $91.00 $18.97 $91.00 $67.54 $67.54 $70.14 $47.41 $18.97 $91.00 $91.00 $53.83 $91.00 $91.00 $91.00 $91.00 $68.25 $91.00 $91.00 $91.00 $45.50 $45.50 $72.07 $91.00 $72.80 $59.15 $18.06 $91.00 $52.78 $91.00 $91.00 $91.00 $18.96 $91.00 N/A N/A 27203937 EAP Custom 27203937 M827057/10.S T.R.A.C. PAD BOTH IP/OP $57.00 $42.50 $10.15 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $10.15 $57.00 $57.00 $42.31 $42.31 $43.94 $29.70 $11.88 $57.00 $22.80 $57.00 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $37.05 $57.00 $57.00 $33.06 $57.00 $34.20 $57.00 $57.00 $57.00 N/A N/A 27203938 EAP HCPCS C1887 FA-55150-1030 CATHETER MARKSMAN BOTH IP/OP "$3,259.00" "$2,412.00" $646.83 "$3,259.00" "$1,769.64" "$1,769.64" "$1,769.64" "$1,769.64" "$3,259.00" "$3,259.00" "$3,259.00" $679.26 "$3,259.00" "$2,418.83" "$2,418.83" "$2,512.04" "$1,697.94" $679.21 "$3,259.00" "$3,259.00" "$1,927.70" "$3,259.00" "$3,259.00" "$3,259.00" "$3,259.00" "$2,444.25" "$3,259.00" "$3,259.00" "$3,259.00" "$1,629.50" "$1,629.50" "$2,581.13" "$3,259.00" "$2,607.20" "$2,118.35" $646.83 "$3,259.00" "$1,890.22" "$3,259.00" "$1,955.40" "$3,259.00" $679.18 "$3,259.00" N/A N/A 27203939 EAP HCPCS C1725 BALOON 2.5 X 15MM RAPTOR 573-125 BOTH IP/OP $743.00 $550.00 $147.47 $743.00 $403.45 $403.45 $403.45 $403.45 $743.00 $743.00 $743.00 $154.86 $743.00 $551.45 $551.45 $572.70 $387.10 $154.85 $743.00 $743.00 $439.48 $743.00 $743.00 $743.00 $743.00 $557.25 $743.00 $743.00 $743.00 $371.50 $371.50 $588.46 $743.00 $594.40 $482.95 $147.47 $743.00 $430.94 $743.00 $445.80 $743.00 $154.84 $743.00 N/A N/A 27203940 EAP Custom 27203940 CATHETER SITESEER AL1 5FR 5A0018 BOTH IP/OP $31.00 $23.00 $5.52 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $5.52 $31.00 $31.00 $23.01 $23.01 $23.89 $16.15 $6.46 $31.00 $12.40 $31.00 $31.00 $31.00 $31.00 $31.00 $23.25 $31.00 $31.00 $31.00 $15.50 $15.50 $24.55 $31.00 $24.80 $20.15 $31.00 $31.00 $17.98 $31.00 $18.60 $31.00 $31.00 $31.00 N/A N/A 27203941 EAP Custom 27203941 CL-07665 SHEATH SET SUPER ARROW FLEX 65CM BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27203942 EAP Custom 27203942 NEEDLE GUIDE STERILE 9001C0212 BOTH IP/OP $48.00 $36.00 $8.54 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $8.54 $48.00 $48.00 $35.63 $35.63 $37.00 $25.01 $10.00 $48.00 $19.20 $48.00 $48.00 $48.00 $48.00 $48.00 $36.00 $48.00 $48.00 $48.00 $24.00 $24.00 $38.02 $48.00 $38.40 $31.20 $48.00 $48.00 $27.84 $48.00 $28.80 $48.00 $48.00 $48.00 N/A N/A 27203943 EAP HCPCS C1895 "RELIANCE LEAD,AICD, ENDO DUAL COIL" BOTH IP/OP "$11,794.00" "$8,728.00" "$2,060.15" "$11,794.00" "$6,404.14" "$6,404.14" "$6,404.14" "$6,404.14" "$11,794.00" "$11,794.00" "$11,794.00" "$2,458.16" "$11,794.00" "$4,181.12" "$4,181.12" "$9,090.82" "$2,060.15" "$2,458.00" "$11,794.00" "$11,794.00" "$3,094.73" "$11,794.00" "$11,794.00" "$11,794.00" "$11,794.00" "$8,845.50" "$11,794.00" "$11,794.00" "$11,794.00" "$5,897.00" "$5,897.00" "$9,340.85" "$11,794.00" "$9,435.20" "$7,666.10" "$2,340.81" "$11,794.00" "$6,840.52" "$11,794.00" "$11,794.00" "$11,794.00" "$2,457.87" "$11,794.00" N/A N/A 27203945 EAP HCPCS C1887 "6FR ACUITY CATH, GUIDING W DEL SYS" BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $263.36 $263.36 $263.36 $263.36 $485.00 $485.00 $485.00 $101.09 $485.00 $359.97 $359.97 $373.84 $252.69 $101.08 $485.00 $485.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $315.25 $96.26 $485.00 $281.30 $485.00 $485.00 $485.00 $101.07 $485.00 N/A N/A 27203946 EAP HCPCS C1887 "8FR ACUITY CATH, GUIDING W DEL SYS" BOTH IP/OP "$1,104.00" $817.00 $219.12 "$1,104.00" $599.47 $599.47 $599.47 $599.47 "$1,104.00" "$1,104.00" "$1,104.00" $230.10 "$1,104.00" $819.39 $819.39 $850.96 $575.18 $230.09 "$1,104.00" "$1,104.00" $653.02 "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" $828.00 "$1,104.00" "$1,104.00" "$1,104.00" $552.00 $552.00 $874.37 "$1,104.00" $883.20 $717.60 $219.12 "$1,104.00" $640.32 "$1,104.00" "$1,104.00" "$1,104.00" $230.07 "$1,104.00" N/A N/A 27203947 EAP HCPCS C1887 "EP DS2C002 SLIT/OUTER CATH, GUIDING" BOTH IP/OP "$1,551.00" "$1,148.00" $307.83 "$1,551.00" $842.19 $842.19 $842.19 $842.19 "$1,551.00" "$1,551.00" "$1,551.00" $323.27 "$1,551.00" "$1,151.15" "$1,151.15" "$1,195.51" $808.07 $323.25 "$1,551.00" "$1,551.00" $917.42 "$1,551.00" "$1,551.00" "$1,551.00" "$1,551.00" "$1,163.25" "$1,551.00" "$1,551.00" "$1,551.00" $775.50 $775.50 "$1,228.39" "$1,551.00" "$1,240.80" "$1,008.15" $307.83 "$1,551.00" $899.58 "$1,551.00" "$1,551.00" "$1,551.00" $323.23 "$1,551.00" N/A N/A 27203950 EAP HCPCS C1769 NEUROSCOUT 14 STANDARD 601314 BOTH IP/OP "$1,111.00" $822.50 $220.51 "$1,111.00" $603.27 $603.27 $603.27 $603.27 "$1,111.00" "$1,111.00" "$1,111.00" $231.56 "$1,111.00" $824.58 $824.58 $856.36 $578.83 $231.54 "$1,111.00" "$1,111.00" $657.16 "$1,111.00" "$1,111.00" "$1,111.00" "$1,111.00" $833.25 "$1,111.00" "$1,111.00" "$1,111.00" $555.50 $555.50 $879.91 "$1,111.00" $888.80 $722.15 $220.51 "$1,111.00" $644.38 "$1,111.00" "$1,111.00" "$1,111.00" $231.53 "$1,111.00" N/A N/A 27203951 EAP HCPCS C1769 NEUROSCOUT 14 SOFT XL 601414 BOTH IP/OP "$1,111.00" $822.50 $220.51 "$1,111.00" $499.95 $499.95 $499.95 $499.95 "$1,111.00" "$1,111.00" "$1,111.00" $231.56 "$1,111.00" "$1,111.00" "$1,111.00" "$1,111.00" "$1,111.00" $231.54 "$1,111.00" "$1,111.00" $657.16 "$1,111.00" "$1,111.00" "$1,111.00" "$1,111.00" $833.25 "$1,111.00" "$1,111.00" "$1,111.00" $555.50 $555.50 $879.91 "$1,111.00" $888.80 $499.95 $220.51 "$1,111.00" $644.38 "$1,111.00" "$1,111.00" "$1,111.00" $231.53 "$1,111.00" N/A N/A 27203952 EAP HCPCS C1887 PROWLER 27 MICROCATHETER BOTH IP/OP "$2,468.00" "$1,826.50" $489.84 "$2,468.00" "$1,340.12" "$1,340.12" "$1,340.12" "$1,340.12" "$2,468.00" "$2,468.00" "$2,468.00" $514.39 "$2,468.00" "$1,831.75" "$1,831.75" "$1,902.33" "$1,285.83" $514.36 "$2,468.00" "$2,468.00" "$1,459.82" "$2,468.00" "$2,468.00" "$2,468.00" "$2,468.00" "$1,851.00" "$2,468.00" "$2,468.00" "$2,468.00" "$1,234.00" "$1,234.00" "$1,954.66" "$2,468.00" "$1,974.40" "$1,604.20" $489.84 "$2,468.00" "$1,431.44" "$2,468.00" "$2,468.00" "$2,468.00" $514.33 "$2,468.00" N/A N/A 27203953 EAP HCPCS C1887 CATHETER DELIVERY SYSTEM PX SLIM 130 D 0-.02 IN MICRO LM BOTH IP/OP "$2,749.00" "$2,034.50" $545.61 "$2,749.00" "$1,492.71" "$1,492.71" "$1,492.71" "$1,492.71" "$2,749.00" "$2,749.00" "$2,749.00" $572.96 "$2,749.00" "$2,040.31" "$2,040.31" "$2,118.93" "$1,432.23" $572.92 "$2,749.00" "$2,749.00" "$1,626.03" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,061.75" "$2,749.00" "$2,749.00" "$2,749.00" "$1,374.50" "$1,374.50" "$2,177.21" "$2,749.00" "$2,199.20" "$1,786.85" $545.61 "$2,749.00" "$1,594.42" "$2,749.00" "$2,749.00" "$2,749.00" $572.89 "$2,749.00" N/A N/A 27203954 EAP HCPCS C1887 CATHETER DELIVERY SYS PX SLIM 45 D 0-.02 IN MICRO L150 M BOTH IP/OP "$2,749.00" "$2,034.50" $545.61 "$2,749.00" "$1,492.71" "$1,492.71" "$1,492.71" "$1,492.71" "$2,749.00" "$2,749.00" "$2,749.00" $572.96 "$2,749.00" "$2,040.31" "$2,040.31" "$2,118.93" "$1,432.23" $572.92 "$2,749.00" "$2,749.00" "$1,626.03" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,061.75" "$2,749.00" "$2,749.00" "$2,749.00" "$1,374.50" "$1,374.50" "$2,177.21" "$2,749.00" "$2,199.20" "$1,786.85" $545.61 "$2,749.00" "$1,594.42" "$2,749.00" "$2,749.00" "$2,749.00" $572.89 "$2,749.00" N/A N/A 27203955 EAP HCPCS C1887 CATHETER DELIVERY SYSPX SLIM 90 D 0-.02 IN MICRO L150 CM BOTH IP/OP "$2,749.00" "$2,034.50" $545.61 "$2,749.00" "$1,492.71" "$1,492.71" "$1,492.71" "$1,492.71" "$2,749.00" "$2,749.00" "$2,749.00" $572.96 "$2,749.00" "$2,040.31" "$2,040.31" "$2,118.93" "$1,432.23" $572.92 "$2,749.00" "$2,749.00" "$1,626.03" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,061.75" "$2,749.00" "$2,749.00" "$2,749.00" "$1,374.50" "$1,374.50" "$2,177.21" "$2,749.00" "$2,199.20" "$1,786.85" $545.61 "$2,749.00" "$1,594.42" "$2,749.00" "$2,749.00" "$2,749.00" $572.89 "$2,749.00" N/A N/A 27203956 EAP HCPCS C1887 CATHETER DELIVERY SYS PX SLIM 130 D 0-.02 IN MICRO L150M BOTH IP/OP "$2,749.00" "$2,034.50" $545.61 "$2,749.00" "$1,492.71" "$1,492.71" "$1,492.71" "$1,492.71" "$2,749.00" "$2,749.00" "$2,749.00" $572.96 "$2,749.00" "$2,040.31" "$2,040.31" "$2,118.93" "$1,432.23" $572.92 "$2,749.00" "$1,099.60" "$1,626.03" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,061.75" "$2,749.00" "$2,749.00" "$2,749.00" "$1,374.50" "$1,374.50" "$2,177.21" "$2,749.00" "$2,199.20" "$1,786.85" $545.61 "$2,749.00" "$1,594.42" "$2,749.00" "$2,749.00" "$2,749.00" $572.89 "$2,749.00" N/A N/A 27203957 EAP HCPCS C1887 COIL DETACHMENT HANDLE BOTH IP/OP $739.00 $547.00 $146.67 $739.00 $401.28 $401.28 $401.28 $401.28 $739.00 $739.00 $739.00 $154.03 $739.00 $548.49 $548.49 $569.62 $385.02 $154.02 $739.00 $739.00 $437.12 $739.00 $739.00 $739.00 $739.00 $554.25 $739.00 $739.00 $739.00 $369.50 $369.50 $585.29 $739.00 $591.20 $480.35 $146.67 $739.00 $428.62 $739.00 $739.00 $739.00 $154.01 $739.00 N/A N/A 27203958 EAP HCPCS C1725 CATHETER DELIVERY SYSTEM .038IN SIMS CURVE 5FR .04 BOTH IP/OP $329.00 $243.50 $65.30 $329.00 $178.65 $178.65 $178.65 $178.65 $329.00 $329.00 $329.00 $68.57 $329.00 $244.18 $244.18 $253.59 $171.41 $68.57 $329.00 $131.60 $194.60 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $213.85 $65.30 $329.00 $190.82 $329.00 $329.00 $329.00 $68.56 $329.00 N/A N/A 27203999 EAP Custom 27203999 TURNPIKE CATHETER LP 150CM BOTH IP/OP "$1,488.00" "$1,101.50" $264.86 "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" $264.86 "$1,488.00" "$1,488.00" "$1,104.39" "$1,104.39" "$1,146.95" $775.25 $310.12 "$1,488.00" $595.20 "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" "$1,116.00" "$1,488.00" "$1,488.00" "$1,488.00" $744.00 $744.00 "$1,178.50" "$1,488.00" "$1,190.40" $967.20 "$1,488.00" "$1,488.00" $863.04 "$1,488.00" $892.80 "$1,488.00" "$1,488.00" "$1,488.00" N/A N/A 27204010 EAP Custom 27204010 CAMINO ICP CATHETER WITH LICOX BOLT FITTING BOTH IP/OP "$2,352.00" "$1,740.50" $418.66 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $418.66 "$2,352.00" "$2,352.00" "$1,745.65" "$1,745.65" "$1,812.92" "$1,225.39" $490.18 "$2,352.00" $940.80 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,528.80" "$2,352.00" "$2,352.00" "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" "$2,352.00" "$2,352.00" N/A N/A 27204011 EAP Custom 27204011 BRAIN TISSUE MONITORING KIT BOTH IP/OP "$3,646.00" "$2,698.50" $648.99 "$3,646.00" "$3,646.00" "$3,646.00" "$3,646.00" "$3,646.00" "$3,646.00" "$3,646.00" $648.99 "$3,646.00" "$3,646.00" "$2,706.06" "$2,706.06" "$2,810.34" "$1,899.57" $759.87 "$3,646.00" "$1,458.40" "$3,646.00" "$3,646.00" "$3,646.00" "$3,646.00" "$3,646.00" "$2,734.50" "$3,646.00" "$3,646.00" "$3,646.00" "$1,823.00" "$1,823.00" "$2,887.63" "$3,646.00" "$2,916.80" "$2,369.90" "$3,646.00" "$3,646.00" "$2,114.68" "$3,646.00" "$2,187.60" "$3,646.00" "$3,646.00" "$3,646.00" N/A N/A 27204012 EAP Custom 27204012 TUBE BLAKEMORE ADULT 20 FR BOTH IP/OP $975.00 $721.50 $173.55 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $173.55 $975.00 $975.00 $723.65 $723.65 $751.53 $507.98 $203.20 $975.00 $390.00 $975.00 $975.00 $975.00 $975.00 $975.00 $731.25 $975.00 $975.00 $975.00 $487.50 $487.50 $772.20 $975.00 $780.00 $633.75 $975.00 $975.00 $565.50 $975.00 $585.00 $975.00 $975.00 $975.00 N/A N/A 27204013 EAP Custom 27204013 "RETRIEVER, CLOT,TREVO PRO 4 KIT, W GUIDEWIRE TIP" BOTH IP/OP "$15,192.00" "$11,242.50" "$2,060.15" "$15,192.00" "$15,192.00" "$15,192.00" "$15,192.00" "$15,192.00" "$15,192.00" "$15,192.00" "$2,704.18" "$15,192.00" "$15,192.00" "$4,181.12" "$4,181.12" "$11,709.99" "$2,060.15" "$3,166.18" "$15,192.00" "$6,076.80" "$15,192.00" "$15,192.00" "$15,192.00" "$15,192.00" "$15,192.00" "$11,394.00" "$15,192.00" "$15,192.00" "$15,192.00" "$7,596.00" "$7,596.00" "$12,032.06" "$15,192.00" "$12,153.60" "$9,874.80" "$15,192.00" "$15,192.00" "$8,811.36" "$15,192.00" "$9,115.20" "$15,192.00" "$15,192.00" "$15,192.00" N/A N/A 27204014 EAP HCPCS C1886 S-1304-CPS-7-25-LS-BD SAFIRE BLU BOTH IP/OP "$4,717.00" "$3,491.00" $983.07 "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$3,500.96" "$3,500.96" "$3,635.86" "$2,060.15" $983.07 "$4,717.00" "$1,886.80" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$3,537.75" "$4,717.00" "$4,717.00" "$4,717.00" "$2,358.50" "$2,358.50" "$3,735.86" "$4,717.00" "$3,773.60" "$3,066.05" "$4,717.00" "$4,717.00" "$2,735.86" "$4,717.00" "$2,830.20" "$4,717.00" "$4,717.00" "$4,717.00" N/A N/A 27204015 EAP HCPCS C1886 S-1304-CPS-7-25-MS-BD SAFIRE BLU BOTH IP/OP "$4,717.00" "$3,491.00" $983.07 "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$3,500.96" "$3,500.96" "$3,635.86" "$2,060.15" $983.07 "$4,717.00" "$1,886.80" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$3,537.75" "$4,717.00" "$4,717.00" "$4,717.00" "$2,358.50" "$2,358.50" "$3,735.86" "$4,717.00" "$3,773.60" "$3,066.05" "$4,717.00" "$4,717.00" "$2,735.86" "$4,717.00" "$2,830.20" "$4,717.00" "$4,717.00" "$4,717.00" N/A N/A 27204016 EAP HCPCS C1886 MEDIUM SWEEP THERAPY COOL PATH BI-DIRECTIONAL BOTH IP/OP "$4,717.00" "$3,491.00" $983.07 "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$3,500.96" "$3,500.96" "$3,635.86" "$2,060.15" $983.07 "$4,717.00" "$1,886.80" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$3,537.75" "$4,717.00" "$4,717.00" "$4,717.00" "$2,358.50" "$2,358.50" "$3,735.86" "$4,717.00" "$3,773.60" "$3,066.05" "$4,717.00" "$4,717.00" "$2,735.86" "$4,717.00" "$2,830.20" "$4,717.00" "$4,717.00" "$4,717.00" N/A N/A 27204017 EAP HCPCS C1886 LARGE SWEEP     THERAPY COOL PATH BI-DIRECTIONAL BOTH IP/OP "$4,717.00" "$3,491.00" $983.07 "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$3,500.96" "$3,500.96" "$3,635.86" "$2,060.15" $983.07 "$4,717.00" "$1,886.80" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$3,537.75" "$4,717.00" "$4,717.00" "$4,717.00" "$2,358.50" "$2,358.50" "$3,735.86" "$4,717.00" "$3,773.60" "$3,066.05" "$4,717.00" "$4,717.00" "$2,735.86" "$4,717.00" "$2,830.20" "$4,717.00" "$4,717.00" "$4,717.00" N/A N/A 27204020 EAP HCPCS C1733 SAFIRE TX CATHETER 8MM LARGE CURL BOTH IP/OP "$3,388.00" "$2,507.50" $672.43 "$3,388.00" "$1,839.68" "$1,839.68" "$1,839.68" "$1,839.68" "$3,388.00" "$3,388.00" "$3,388.00" $706.14 "$3,388.00" "$2,514.57" "$2,514.57" "$2,611.47" "$1,765.15" $706.10 "$3,388.00" "$3,388.00" "$2,004.00" "$3,388.00" "$3,388.00" "$3,388.00" "$3,388.00" "$2,541.00" "$3,388.00" "$3,388.00" "$3,388.00" "$1,694.00" "$1,694.00" "$2,683.30" "$3,388.00" "$2,710.40" "$2,202.20" $672.43 "$3,388.00" "$1,965.04" "$3,388.00" "$3,388.00" "$3,388.00" $706.06 "$3,388.00" N/A N/A 27204021 EAP HCPCS C1733 SAFIRE CATH 7F 4MM LGCRL (US) BOTH IP/OP "$2,138.00" "$1,582.50" $424.34 "$2,138.00" "$1,160.93" "$1,160.93" "$1,160.93" "$1,160.93" "$2,138.00" "$2,138.00" "$2,138.00" $445.61 "$2,138.00" "$1,586.82" "$1,586.82" "$1,647.97" "$1,113.90" $445.58 "$2,138.00" "$2,138.00" "$1,264.63" "$2,138.00" "$2,138.00" "$2,138.00" "$2,138.00" "$1,603.50" "$2,138.00" "$2,138.00" "$2,138.00" "$1,069.00" "$1,069.00" "$1,693.30" "$2,138.00" "$1,710.40" "$1,389.70" $424.34 "$2,138.00" "$1,240.04" "$2,138.00" "$2,138.00" "$2,138.00" $445.56 "$2,138.00" N/A N/A 27204022 EAP HCPCS C1733 SAFIRE TX CATHETER 8MM XLARGE CURL BOTH IP/OP "$3,227.00" "$2,388.00" $640.48 "$3,227.00" "$1,752.26" "$1,752.26" "$1,752.26" "$1,752.26" "$3,227.00" "$3,227.00" "$3,227.00" $672.59 "$3,227.00" "$2,395.08" "$2,395.08" "$2,487.37" "$1,681.27" $672.54 "$3,227.00" "$3,227.00" "$1,908.77" "$3,227.00" "$3,227.00" "$3,227.00" "$3,227.00" "$2,420.25" "$3,227.00" "$3,227.00" "$3,227.00" "$1,613.50" "$1,613.50" "$2,555.78" "$3,227.00" "$2,581.60" "$2,097.55" $640.48 "$3,227.00" "$1,871.66" "$3,227.00" "$3,227.00" "$3,227.00" $672.51 "$3,227.00" N/A N/A 27204023 EAP HCPCS C1733 SAFIRE CATH 7F 5MM LG SWP (US) BOTH IP/OP "$2,062.00" "$1,526.00" $409.26 "$2,062.00" "$1,119.67" "$1,119.67" "$1,119.67" "$1,119.67" "$2,062.00" "$2,062.00" "$2,062.00" $429.77 "$2,062.00" "$1,530.42" "$1,530.42" "$1,589.39" "$1,074.30" $429.74 "$2,062.00" "$2,062.00" "$1,219.67" "$2,062.00" "$2,062.00" "$2,062.00" "$2,062.00" "$1,546.50" "$2,062.00" "$2,062.00" "$2,062.00" "$1,031.00" "$1,031.00" "$1,633.10" "$2,062.00" "$1,649.60" "$1,340.30" $409.26 "$2,062.00" "$1,195.96" "$2,062.00" "$2,062.00" "$2,062.00" $429.72 "$2,062.00" N/A N/A 27204024 EAP HCPCS C1733 SAFIRE CATH 7F 5MM LG CRL (US) BOTH IP/OP "$2,165.00" "$1,602.50" $429.70 "$2,165.00" "$1,175.60" "$1,175.60" "$1,175.60" "$1,175.60" "$2,165.00" "$2,165.00" "$2,165.00" $451.24 "$2,165.00" "$1,606.86" "$1,606.86" "$1,668.78" "$1,127.97" $451.21 "$2,165.00" "$2,165.00" "$1,280.60" "$2,165.00" "$2,165.00" "$2,165.00" "$2,165.00" "$1,623.75" "$2,165.00" "$2,165.00" "$2,165.00" "$1,082.50" "$1,082.50" "$1,714.68" "$2,165.00" "$1,732.00" "$1,407.25" $429.70 "$2,165.00" "$1,255.70" "$2,165.00" "$2,165.00" "$2,165.00" $451.19 "$2,165.00" N/A N/A 27204025 EAP HCPCS C1733 SAFIRE CATH 7F 4MM MDCRL (US) BOTH IP/OP "$2,036.00" "$1,507.00" $404.10 "$2,036.00" "$1,105.55" "$1,105.55" "$1,105.55" "$1,105.55" "$2,036.00" "$2,036.00" "$2,036.00" $424.35 "$2,036.00" "$1,511.12" "$1,511.12" "$1,569.35" "$1,060.76" $424.32 "$2,036.00" "$2,036.00" "$1,204.29" "$2,036.00" "$2,036.00" "$2,036.00" "$2,036.00" "$1,527.00" "$2,036.00" "$2,036.00" "$2,036.00" "$1,018.00" "$1,018.00" "$1,612.51" "$2,036.00" "$1,628.80" "$1,323.40" $404.10 "$2,036.00" "$1,180.88" "$2,036.00" "$2,036.00" "$2,036.00" $424.30 "$2,036.00" N/A N/A 27204026 EAP HCPCS C1733 SAFIRE CATH 7F 4MM SM CRL (US) BOTH IP/OP "$2,036.00" "$1,507.00" $404.10 "$2,036.00" "$1,105.55" "$1,105.55" "$1,105.55" "$1,105.55" "$2,036.00" "$2,036.00" "$2,036.00" $424.35 "$2,036.00" "$1,511.12" "$1,511.12" "$1,569.35" "$1,060.76" $424.32 "$2,036.00" "$2,036.00" "$1,204.29" "$2,036.00" "$2,036.00" "$2,036.00" "$2,036.00" "$1,527.00" "$2,036.00" "$2,036.00" "$2,036.00" "$1,018.00" "$1,018.00" "$1,612.51" "$2,036.00" "$1,628.80" "$1,323.40" $404.10 "$2,036.00" "$1,180.88" "$2,036.00" "$2,036.00" "$2,036.00" $424.30 "$2,036.00" N/A N/A 27204041 EAP HCPCS C1893 "AGILIS NXT 8.5F STEER SM CRL,G2" BOTH IP/OP "$2,914.00" "$2,156.50" $578.36 "$2,914.00" "$1,582.30" "$1,582.30" "$1,582.30" "$1,582.30" "$2,914.00" "$2,914.00" "$2,914.00" $607.35 "$2,914.00" "$2,162.77" "$2,162.77" "$2,246.11" "$1,518.19" $607.31 "$2,914.00" "$2,914.00" "$1,723.63" "$2,914.00" "$2,914.00" "$2,914.00" "$2,914.00" "$2,185.50" "$2,914.00" "$2,914.00" "$2,914.00" "$1,457.00" "$1,457.00" "$2,307.89" "$2,914.00" "$2,331.20" "$1,894.10" $578.36 "$2,914.00" "$1,690.12" "$2,914.00" "$2,914.00" "$2,914.00" $607.28 "$2,914.00" N/A N/A 27204042 EAP HCPCS C1893 "TRNS INTRO 8.5F 63CM SL1 032GW,G2" BOTH IP/OP $497.00 $368.00 $98.64 $497.00 $269.87 $269.87 $269.87 $269.87 $497.00 $497.00 $497.00 $103.59 $497.00 $368.87 $368.87 $383.09 $258.94 $103.58 $497.00 $497.00 $293.98 $497.00 $497.00 $497.00 $497.00 $372.75 $497.00 $497.00 $497.00 $248.50 $248.50 $393.62 $497.00 $397.60 $323.05 $98.64 $497.00 $288.26 $497.00 $497.00 $497.00 $103.57 $497.00 N/A N/A 27204043 EAP HCPCS C1893 "TRNS INTRO 8F 62 CM SL1 TM,G2" BOTH IP/OP $397.00 $294.00 $78.79 $397.00 $215.57 $215.57 $215.57 $215.57 $397.00 $397.00 $397.00 $82.74 $397.00 $294.65 $294.65 $306.01 $206.84 $82.74 $397.00 $397.00 $234.83 $397.00 $397.00 $397.00 $397.00 $297.75 $397.00 $397.00 $397.00 $198.50 $198.50 $314.42 $397.00 $317.60 $258.05 $78.79 $397.00 $230.26 $397.00 $397.00 $397.00 $82.73 $397.00 N/A N/A 27204044 EAP HCPCS C1893 "TRNS INTRO 8F 62CM SL2 TM,G2" BOTH IP/OP $397.00 $294.00 $78.79 $397.00 $215.57 $215.57 $215.57 $215.57 $397.00 $397.00 $397.00 $82.74 $397.00 $294.65 $294.65 $306.01 $206.84 $82.74 $397.00 $397.00 $234.83 $397.00 $397.00 $397.00 $397.00 $297.75 $397.00 $397.00 $397.00 $198.50 $198.50 $314.42 $397.00 $317.60 $258.05 $78.79 $397.00 $230.26 $397.00 $397.00 $397.00 $82.73 $397.00 N/A N/A 27204045 EAP HCPCS C1766 "TRNS INTRO 8F 63CM SL1 032GW,G2" BOTH IP/OP $497.00 $368.00 $103.58 $497.00 $497.00 $497.00 $497.00 $497.00 $497.00 $497.00 $497.00 $497.00 $497.00 $368.87 $368.87 $383.09 $258.94 $103.58 $497.00 $198.80 $497.00 $497.00 $497.00 $497.00 $497.00 $372.75 $497.00 $497.00 $497.00 $248.50 $248.50 $393.62 $497.00 $397.60 $323.05 $497.00 $497.00 $288.26 $497.00 $298.20 $497.00 $497.00 $497.00 N/A N/A 27204046 EAP HCPCS C1894 C-LOCK HEMO 8F 12CM 038GW-G2 BOTH IP/OP $59.00 $44.00 $11.71 $59.00 $32.04 $32.04 $32.04 $32.04 $59.00 $59.00 $59.00 $12.30 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $59.00 $34.90 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $11.71 $59.00 $34.22 $59.00 $59.00 $59.00 $12.30 $59.00 N/A N/A 27204047 EAP HCPCS C1894 C-LOCK HEMO 7F 12CM 038GW-G2 BOTH IP/OP $56.00 $41.50 $11.11 $56.00 $30.41 $30.41 $30.41 $30.41 $56.00 $56.00 $56.00 $11.67 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $56.00 $33.12 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $11.11 $56.00 $32.48 $56.00 $56.00 $56.00 $11.67 $56.00 N/A N/A 27204048 EAP HCPCS C1894 C-LOCK HEMO 6F 12CM 038GW-G2 BOTH IP/OP $56.00 $41.50 $11.11 $56.00 $30.41 $30.41 $30.41 $30.41 $56.00 $56.00 $56.00 $11.67 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $56.00 $33.12 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $11.11 $56.00 $32.48 $56.00 $56.00 $56.00 $11.67 $56.00 N/A N/A 27204049 EAP HCPCS C1894 "DUO HEMO 8F 12CM 038GW,G2" BOTH IP/OP $91.00 $67.50 $18.06 $91.00 $49.41 $49.41 $49.41 $49.41 $91.00 $91.00 $91.00 $18.97 $91.00 $67.54 $67.54 $70.14 $47.41 $18.97 $91.00 $91.00 $53.83 $91.00 $91.00 $91.00 $91.00 $68.25 $91.00 $91.00 $91.00 $45.50 $45.50 $72.07 $91.00 $72.80 $59.15 $18.06 $91.00 $52.78 $91.00 $91.00 $91.00 $18.96 $91.00 N/A N/A 27204050 EAP HCPCS C1893 "HEMO INTRO 8F 60CM SEPT GW,G2" BOTH IP/OP $482.00 $357.00 $95.66 $482.00 $261.73 $261.73 $261.73 $261.73 $482.00 $482.00 $482.00 $100.46 $482.00 $357.74 $357.74 $371.53 $251.12 $100.45 $482.00 $482.00 $285.10 $482.00 $482.00 $482.00 $482.00 $361.50 $482.00 $482.00 $482.00 $241.00 $241.00 $381.74 $482.00 $385.60 $313.30 $95.66 $482.00 $279.56 $482.00 $482.00 $482.00 $100.45 $482.00 N/A N/A 27204051 EAP HCPCS C1893 "HEMO INTRO 8F 60CM SR0 TM,G2" BOTH IP/OP $397.00 $294.00 $78.79 $397.00 $215.57 $215.57 $215.57 $215.57 $397.00 $397.00 $397.00 $82.74 $397.00 $294.65 $294.65 $306.01 $206.84 $82.74 $397.00 $397.00 $234.83 $397.00 $397.00 $397.00 $397.00 $297.75 $397.00 $397.00 $397.00 $198.50 $198.50 $314.42 $397.00 $317.60 $258.05 $78.79 $397.00 $230.26 $397.00 $397.00 $397.00 $82.73 $397.00 N/A N/A 27204052 EAP HCPCS C1893 "HEMO INTRO 8F 60CM RAMP 038GW,G2" BOTH IP/OP $497.00 $368.00 $98.64 $497.00 $269.87 $269.87 $269.87 $269.87 $497.00 $497.00 $497.00 $103.59 $497.00 $368.87 $368.87 $383.09 $258.94 $103.58 $497.00 $497.00 $293.98 $497.00 $497.00 $497.00 $497.00 $372.75 $497.00 $497.00 $497.00 $248.50 $248.50 $393.62 $497.00 $397.60 $323.05 $98.64 $497.00 $288.26 $497.00 $497.00 $497.00 $103.57 $497.00 N/A N/A 27204053 EAP HCPCS C1893 "HEMO INTRO 8.5F 60CM SEPT GW,G2" BOTH IP/OP $482.00 $357.00 $95.66 $482.00 $261.73 $261.73 $261.73 $261.73 $482.00 $482.00 $482.00 $100.46 $482.00 $357.74 $357.74 $371.53 $251.12 $100.45 $482.00 $482.00 $285.10 $482.00 $482.00 $482.00 $482.00 $361.50 $482.00 $482.00 $482.00 $241.00 $241.00 $381.74 $482.00 $385.60 $313.30 $95.66 $482.00 $279.56 $482.00 $482.00 $482.00 $100.45 $482.00 N/A N/A 27204054 EAP HCPCS C1893 "HEMO INTRO 8F 60CM SR4 TM,G2" BOTH IP/OP $397.00 $294.00 $78.79 $397.00 $215.57 $215.57 $215.57 $215.57 $397.00 $397.00 $397.00 $82.74 $397.00 $294.65 $294.65 $306.01 $206.84 $82.74 $397.00 $397.00 $234.83 $397.00 $397.00 $397.00 $397.00 $297.75 $397.00 $397.00 $397.00 $198.50 $198.50 $314.42 $397.00 $317.60 $258.05 $78.79 $397.00 $230.26 $397.00 $397.00 $397.00 $82.73 $397.00 N/A N/A 27204055 EAP HCPCS C1893 "HEMO INTRO 8.5F 63CM SR0 038GW,G2" BOTH IP/OP $508.00 $376.00 $100.83 $508.00 $275.84 $275.84 $275.84 $275.84 $508.00 $508.00 $508.00 $105.88 $508.00 $377.04 $377.04 $391.57 $264.67 $105.87 $508.00 $508.00 $300.48 $508.00 $508.00 $508.00 $508.00 $381.00 $508.00 $508.00 $508.00 $254.00 $254.00 $402.34 $508.00 $406.40 $330.20 $100.83 $508.00 $294.64 $508.00 $508.00 $508.00 $105.87 $508.00 N/A N/A 27204056 EAP HCPCS C1893 "HEMO INTRO 8F 60CM SAFL 038GW,G2" BOTH IP/OP $508.00 $376.00 $100.83 $508.00 $275.84 $275.84 $275.84 $275.84 $508.00 $508.00 $508.00 $105.88 $508.00 $377.04 $377.04 $391.57 $264.67 $105.87 $508.00 $508.00 $300.48 $508.00 $508.00 $508.00 $508.00 $381.00 $508.00 $508.00 $508.00 $254.00 $254.00 $402.34 $508.00 $406.40 $330.20 $100.83 $508.00 $294.64 $508.00 $508.00 $508.00 $105.87 $508.00 N/A N/A 27204057 EAP HCPCS C1893 "HEMO INTRO 8.5F 63CM SR2 038GW,G2" BOTH IP/OP $508.00 $376.00 $100.83 $508.00 $275.84 $275.84 $275.84 $275.84 $508.00 $508.00 $508.00 $105.88 $508.00 $377.04 $377.04 $391.57 $264.67 $105.87 $508.00 $508.00 $300.48 $508.00 $508.00 $508.00 $508.00 $381.00 $508.00 $508.00 $508.00 $254.00 $254.00 $402.34 $508.00 $406.40 $330.20 $100.83 $508.00 $294.64 $508.00 $508.00 $508.00 $105.87 $508.00 N/A N/A 27204058 EAP HCPCS C1893 "HEMO INTRO 8.5F 60CM CSTA GW,G2" BOTH IP/OP $508.00 $376.00 $100.83 $508.00 $275.84 $275.84 $275.84 $275.84 $508.00 $508.00 $508.00 $105.88 $508.00 $377.04 $377.04 $391.57 $264.67 $105.87 $508.00 $508.00 $300.48 $508.00 $508.00 $508.00 $508.00 $381.00 $508.00 $508.00 $508.00 $254.00 $254.00 $402.34 $508.00 $406.40 $330.20 $100.83 $508.00 $294.64 $508.00 $508.00 $508.00 $105.87 $508.00 N/A N/A 27204059 EAP HCPCS C1893 "HEMO INTRO 8F 60CM SR2 TM,G2" BOTH IP/OP $397.00 $294.00 $78.79 $397.00 $215.57 $215.57 $215.57 $215.57 $397.00 $397.00 $397.00 $82.74 $397.00 $294.65 $294.65 $306.01 $206.84 $82.74 $397.00 $397.00 $234.83 $397.00 $397.00 $397.00 $397.00 $297.75 $397.00 $397.00 $397.00 $198.50 $198.50 $314.42 $397.00 $317.60 $258.05 $78.79 $397.00 $230.26 $397.00 $397.00 $397.00 $82.73 $397.00 N/A N/A 27204060 EAP HCPCS C1766 EPICARDIAL CATHETER SYSTEM BOTH IP/OP "$3,278.00" "$2,426.00" $683.17 "$3,278.00" "$3,278.00" "$3,278.00" "$3,278.00" "$3,278.00" "$3,278.00" "$3,278.00" "$3,278.00" "$3,278.00" "$3,278.00" "$2,432.93" "$2,432.93" "$2,526.68" "$1,707.84" $683.17 "$3,278.00" "$1,311.20" "$3,278.00" "$3,278.00" "$3,278.00" "$3,278.00" "$3,278.00" "$2,458.50" "$3,278.00" "$3,278.00" "$3,278.00" "$1,639.00" "$1,639.00" "$2,596.18" "$3,278.00" "$2,622.40" "$2,130.70" "$3,278.00" "$3,278.00" "$1,901.24" "$3,278.00" "$1,966.80" "$3,278.00" "$3,278.00" "$3,278.00" N/A N/A 27204061 EAP HCPCS C1730 "EP 5F QUAD 5MM 120CM CRD,G2" BOTH IP/OP $795.00 $588.50 $157.79 $795.00 $431.69 $431.69 $431.69 $431.69 $795.00 $795.00 $795.00 $165.70 $795.00 $590.05 $590.05 $612.79 $414.20 $165.69 $795.00 $795.00 $470.24 $795.00 $795.00 $795.00 $795.00 $596.25 $795.00 $795.00 $795.00 $397.50 $397.50 $629.64 $795.00 $636.00 $516.75 $157.79 $795.00 $461.10 $795.00 $795.00 $795.00 $165.68 $795.00 N/A N/A 27204062 EAP HCPCS C1730 "EP 6F DEC 2/8MM 65CM CSL,G2" BOTH IP/OP "$1,087.00" $804.50 $215.74 "$1,087.00" $590.24 $590.24 $590.24 $590.24 "$1,087.00" "$1,087.00" "$1,087.00" $226.56 "$1,087.00" $806.77 $806.77 $837.86 $566.33 $226.54 "$1,087.00" "$1,087.00" $642.96 "$1,087.00" "$1,087.00" "$1,087.00" "$1,087.00" $815.25 "$1,087.00" "$1,087.00" "$1,087.00" $543.50 $543.50 $860.90 "$1,087.00" $869.60 $706.55 $215.74 "$1,087.00" $630.46 "$1,087.00" "$1,087.00" "$1,087.00" $226.53 "$1,087.00" N/A N/A 27204063 EAP HCPCS C1730 "EP 5F QUAD 5MM 120CM JSN,G2" BOTH IP/OP $835.00 $618.00 $165.73 $835.00 $453.41 $453.41 $453.41 $453.41 $835.00 $835.00 $835.00 $174.03 $835.00 $619.74 $619.74 $643.62 $435.04 $174.02 $835.00 $835.00 $493.90 $835.00 $835.00 $835.00 $835.00 $626.25 $835.00 $835.00 $835.00 $417.50 $417.50 $661.32 $835.00 $668.00 $542.75 $165.73 $835.00 $484.30 $835.00 $835.00 $835.00 $174.01 $835.00 N/A N/A 27204064 EAP HCPCS C1730 "EPS 4F QUAD 5MM CRD,G2" BOTH IP/OP "$1,031.00" $763.00 $204.63 "$1,031.00" $559.83 $559.83 $559.83 $559.83 "$1,031.00" "$1,031.00" "$1,031.00" $214.89 "$1,031.00" $765.21 $765.21 $794.69 $537.15 $214.87 "$1,031.00" "$1,031.00" $609.84 "$1,031.00" "$1,031.00" "$1,031.00" "$1,031.00" $773.25 "$1,031.00" "$1,031.00" "$1,031.00" $515.50 $515.50 $816.55 "$1,031.00" $824.80 $670.15 $204.63 "$1,031.00" $597.98 "$1,031.00" "$1,031.00" "$1,031.00" $214.86 "$1,031.00" N/A N/A 27204065 EAP HCPCS C1730 "EPS 4F HEX 5MM CRD-2,G2" BOTH IP/OP "$1,093.00" $809.00 $216.93 "$1,093.00" $593.50 $593.50 $593.50 $593.50 "$1,093.00" "$1,093.00" "$1,093.00" $227.81 "$1,093.00" $811.22 $811.22 $842.48 $569.45 $227.79 "$1,093.00" "$1,093.00" $646.51 "$1,093.00" "$1,093.00" "$1,093.00" "$1,093.00" $819.75 "$1,093.00" "$1,093.00" "$1,093.00" $546.50 $546.50 $865.66 "$1,093.00" $874.40 $710.45 $216.93 "$1,093.00" $633.94 "$1,093.00" "$1,093.00" "$1,093.00" $227.78 "$1,093.00" N/A N/A 27204066 EAP HCPCS C1730 "EPS 5F HEX UNI 120CM JSN X,G2" BOTH IP/OP $931.00 $689.00 $184.78 $931.00 $505.53 $505.53 $505.53 $505.53 $931.00 $931.00 $931.00 $194.04 $931.00 $690.99 $690.99 $717.61 $485.05 $194.03 $931.00 $931.00 $550.69 $931.00 $931.00 $931.00 $931.00 $698.25 $931.00 $931.00 $931.00 $465.50 $465.50 $737.35 $931.00 $744.80 $605.15 $184.78 $931.00 $539.98 $931.00 $931.00 $931.00 $194.02 $931.00 N/A N/A 27204067 EAP HCPCS C1730 "EPS 4F QUAD 5MM JSN,G2" BOTH IP/OP "$1,031.00" $763.00 $204.63 "$1,031.00" $559.83 $559.83 $559.83 $559.83 "$1,031.00" "$1,031.00" "$1,031.00" $214.89 "$1,031.00" $765.21 $765.21 $794.69 $537.15 $214.87 "$1,031.00" "$1,031.00" $609.84 "$1,031.00" "$1,031.00" "$1,031.00" "$1,031.00" $773.25 "$1,031.00" "$1,031.00" "$1,031.00" $515.50 $515.50 $816.55 "$1,031.00" $824.80 $670.15 $204.63 "$1,031.00" $597.98 "$1,031.00" "$1,031.00" "$1,031.00" $214.86 "$1,031.00" N/A N/A 27204068 EAP HCPCS C1730 "EPS 4F QUAD 2MM JSN,G2" BOTH IP/OP "$1,031.00" $763.00 $204.63 "$1,031.00" $559.83 $559.83 $559.83 $559.83 "$1,031.00" "$1,031.00" "$1,031.00" $214.89 "$1,031.00" $765.21 $765.21 $794.69 $537.15 $214.87 "$1,031.00" "$1,031.00" $609.84 "$1,031.00" "$1,031.00" "$1,031.00" "$1,031.00" $773.25 "$1,031.00" "$1,031.00" "$1,031.00" $515.50 $515.50 $816.55 "$1,031.00" $824.80 $670.15 $204.63 "$1,031.00" $597.98 "$1,031.00" "$1,031.00" "$1,031.00" $214.86 "$1,031.00" N/A N/A 27204069 EAP HCPCS C1730 "EP 6F DEC 5/5MM 120CM CSL,G2" BOTH IP/OP "$1,087.00" $804.50 $215.74 "$1,087.00" $590.24 $590.24 $590.24 $590.24 "$1,087.00" "$1,087.00" "$1,087.00" $226.56 "$1,087.00" $806.77 $806.77 $837.86 $566.33 $226.54 "$1,087.00" "$1,087.00" $642.96 "$1,087.00" "$1,087.00" "$1,087.00" "$1,087.00" $815.25 "$1,087.00" "$1,087.00" "$1,087.00" $543.50 $543.50 $860.90 "$1,087.00" $869.60 $706.55 $215.74 "$1,087.00" $630.46 "$1,087.00" "$1,087.00" "$1,087.00" $226.53 "$1,087.00" N/A N/A 27204070 EAP HCPCS C1730 "EPS 5F QUAD 5MM CRD SUPERIOR,G2" BOTH IP/OP $844.00 $625.00 $167.51 $844.00 $458.29 $458.29 $458.29 $458.29 $844.00 $844.00 $844.00 $175.91 $844.00 $626.42 $626.42 $650.56 $439.72 $175.90 $844.00 $844.00 $499.23 $844.00 $844.00 $844.00 $844.00 $633.00 $844.00 $844.00 $844.00 $422.00 $422.00 $668.45 $844.00 $675.20 $548.60 $167.51 $844.00 $489.52 $844.00 $844.00 $844.00 $175.89 $844.00 N/A N/A 27204071 EAP HCPCS C1730 "EPS 6F HEX UNI 120CM JSN X,G2" BOTH IP/OP $931.00 $689.00 $184.78 $931.00 $505.53 $505.53 $505.53 $505.53 $931.00 $931.00 $931.00 $194.04 $931.00 $690.99 $690.99 $717.61 $485.05 $194.03 $931.00 $931.00 $550.69 $931.00 $931.00 $931.00 $931.00 $698.25 $931.00 $931.00 $931.00 $465.50 $465.50 $737.35 $931.00 $744.80 $605.15 $184.78 $931.00 $539.98 $931.00 $931.00 $931.00 $194.02 $931.00 N/A N/A 27204072 EAP HCPCS C1730 "EPS 5F DEC 2/8MM 120CM CSL X,G2" BOTH IP/OP "$1,119.00" $828.50 $222.09 "$1,119.00" $607.62 $607.62 $607.62 $607.62 "$1,119.00" "$1,119.00" "$1,119.00" $233.23 "$1,119.00" $830.52 $830.52 $862.53 $583.00 $233.21 "$1,119.00" "$1,119.00" $661.89 "$1,119.00" "$1,119.00" "$1,119.00" "$1,119.00" $839.25 "$1,119.00" "$1,119.00" "$1,119.00" $559.50 $559.50 $886.25 "$1,119.00" $895.20 $727.35 $222.09 "$1,119.00" $649.02 "$1,119.00" "$1,119.00" "$1,119.00" $233.20 "$1,119.00" N/A N/A 27204080 EAP HCPCS C1731 "EPL 7F DUO 2/10 2M 95 S-LGCRL,G2" BOTH IP/OP "$2,932.00" "$2,170.00" $581.93 "$2,932.00" "$1,592.08" "$1,592.08" "$1,592.08" "$1,592.08" "$2,932.00" "$2,932.00" "$2,932.00" $611.10 "$2,932.00" "$2,176.13" "$2,176.13" "$2,259.99" "$1,527.57" $611.06 "$2,932.00" "$2,932.00" "$1,734.28" "$2,932.00" "$2,932.00" "$2,932.00" "$2,932.00" "$2,199.00" "$2,932.00" "$2,932.00" "$2,932.00" "$1,466.00" "$1,466.00" "$2,322.14" "$2,932.00" "$2,345.60" "$1,905.80" $581.93 "$2,932.00" "$1,700.56" "$2,932.00" "$2,932.00" "$2,932.00" $611.03 "$2,932.00" N/A N/A 27204081 EAP Custom 27204081 "EPS EXT CABLE B/T/Q BLU 150 US,G2 SUPREME QUAD CABLE" BOTH IP/OP $225.00 $166.50 $40.05 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $40.05 $225.00 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $90.00 $225.00 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $225.00 $225.00 $130.50 $225.00 $135.00 $225.00 $225.00 $225.00 N/A N/A 27204082 EAP HCPCS C1731 "EPL 7F DUO DEC 2/2 115CM MED,G2 ""CATERPILLAR""" BOTH IP/OP "$2,792.00" "$2,066.50" $554.14 "$2,792.00" "$1,516.06" "$1,516.06" "$1,516.06" "$1,516.06" "$2,792.00" "$2,792.00" "$2,792.00" $581.92 "$2,792.00" "$2,072.22" "$2,072.22" "$2,152.07" "$1,454.63" $581.88 "$2,792.00" "$2,792.00" "$1,651.47" "$2,792.00" "$2,792.00" "$2,792.00" "$2,792.00" "$2,094.00" "$2,792.00" "$2,792.00" "$2,792.00" "$1,396.00" "$1,396.00" "$2,211.26" "$2,792.00" "$2,233.60" "$1,814.80" $554.14 "$2,792.00" "$1,619.36" "$2,792.00" "$2,792.00" "$2,792.00" $581.85 "$2,792.00" N/A N/A 27204083 EAP HCPCS C1731 INQUIRY AFOCUSIL DIAGNOSTIC CATHETER 20 POLE WITH DOUBLE LOOP BOTH IP/OP "$4,717.00" "$3,491.00" $936.21 "$4,717.00" "$2,561.33" "$2,561.33" "$2,561.33" "$2,561.33" "$4,717.00" "$4,717.00" "$4,717.00" $983.14 "$4,717.00" "$3,500.96" "$3,500.96" "$3,635.86" "$2,060.15" $983.07 "$4,717.00" "$4,717.00" "$2,790.11" "$4,717.00" "$4,717.00" "$4,717.00" "$4,717.00" "$3,537.75" "$4,717.00" "$4,717.00" "$4,717.00" "$2,358.50" "$2,358.50" "$3,735.86" "$4,717.00" "$3,773.60" "$3,066.05" $936.21 "$4,717.00" "$2,735.86" "$4,717.00" "$4,717.00" "$4,717.00" $983.02 "$4,717.00" N/A N/A 27204084 EAP HCPCS C1731 INQUIRY AFOCUS II EB FIXED RADIUS LOOP CIRCULAR MAPPING CATHETER 20 POLE 20MM DIAMETER BOTH IP/OP "$2,979.00" "$2,204.50" $591.26 "$2,979.00" "$1,617.60" "$1,617.60" "$1,617.60" "$1,617.60" "$2,979.00" "$2,979.00" "$2,979.00" $620.90 "$2,979.00" "$2,211.01" "$2,211.01" "$2,296.21" "$1,552.06" $620.86 "$2,979.00" "$2,979.00" "$1,762.08" "$2,979.00" "$2,979.00" "$2,979.00" "$2,979.00" "$2,234.25" "$2,979.00" "$2,979.00" "$2,979.00" "$1,489.50" "$1,489.50" "$2,359.37" "$2,979.00" "$2,383.20" "$1,936.35" $591.26 "$2,979.00" "$1,727.82" "$2,979.00" "$2,979.00" "$2,979.00" $620.82 "$2,979.00" N/A N/A 27204085 EAP HCPCS C1730 INQUIRY AFOCUS II EB FIXED RADIUS LOOP CIRCULAR MAPPING CATHETER 10 POLE 20MM DIAMETER BOTH IP/OP "$2,979.00" "$2,204.50" $591.26 "$2,979.00" "$1,617.60" "$1,617.60" "$1,617.60" "$1,617.60" "$2,979.00" "$2,979.00" "$2,979.00" $620.90 "$2,979.00" "$2,211.01" "$2,211.01" "$2,296.21" "$1,552.06" $620.86 "$2,979.00" "$2,979.00" "$1,762.08" "$2,979.00" "$2,979.00" "$2,979.00" "$2,979.00" "$2,234.25" "$2,979.00" "$2,979.00" "$2,979.00" "$1,489.50" "$1,489.50" "$2,359.37" "$2,979.00" "$2,383.20" "$1,936.35" $591.26 "$2,979.00" "$1,727.82" "$2,979.00" "$2,979.00" "$2,979.00" $620.82 "$2,979.00" N/A N/A 27204086 EAP HCPCS C1730 INQUIRY AFOCUS II EB FIXED RADIUS LOOP CIRCULAR MAPPING CATHETER 10 POLE 15MM DIAMETER BOTH IP/OP "$2,979.00" "$2,204.50" $591.26 "$2,979.00" "$1,617.60" "$1,617.60" "$1,617.60" "$1,617.60" "$2,979.00" "$2,979.00" "$2,979.00" $620.90 "$2,979.00" "$2,211.01" "$2,211.01" "$2,296.21" "$1,552.06" $620.86 "$2,979.00" "$2,979.00" "$1,762.08" "$2,979.00" "$2,979.00" "$2,979.00" "$2,979.00" "$2,234.25" "$2,979.00" "$2,979.00" "$2,979.00" "$1,489.50" "$1,489.50" "$2,359.37" "$2,979.00" "$2,383.20" "$1,936.35" $591.26 "$2,979.00" "$1,727.82" "$2,979.00" "$2,979.00" "$2,979.00" $620.82 "$2,979.00" N/A N/A 27204087 EAP Custom 27204087 ENSITE NAVX SURFACE ELECTRODE KIT BOTH IP/OP "$2,948.00" "$2,182.00" $524.74 "$2,948.00" "$2,948.00" "$2,948.00" "$2,948.00" "$2,948.00" "$2,948.00" "$2,948.00" $524.74 "$2,948.00" "$2,948.00" "$2,188.01" "$2,188.01" "$2,272.32" "$1,535.91" $614.40 "$2,948.00" "$1,179.20" "$2,948.00" "$2,948.00" "$2,948.00" "$2,948.00" "$2,948.00" "$2,211.00" "$2,948.00" "$2,948.00" "$2,948.00" "$1,474.00" "$1,474.00" "$2,334.82" "$2,948.00" "$2,358.40" "$1,916.20" "$2,948.00" "$2,948.00" "$1,709.84" "$2,948.00" "$1,768.80" "$2,948.00" "$2,948.00" "$2,948.00" N/A N/A 27204088 EAP Custom 27204088 "VELOCITY, ASSEMBLY, NAVX PATCH, ENSITE" BOTH IP/OP "$2,948.00" "$2,182.00" $524.74 "$2,948.00" "$2,948.00" "$2,948.00" "$2,948.00" "$2,948.00" "$2,948.00" "$2,948.00" $524.74 "$2,948.00" "$2,948.00" "$2,188.01" "$2,188.01" "$2,272.32" "$1,535.91" $614.40 "$2,948.00" "$1,179.20" "$2,948.00" "$2,948.00" "$2,948.00" "$2,948.00" "$2,948.00" "$2,211.00" "$2,948.00" "$2,948.00" "$2,948.00" "$1,474.00" "$1,474.00" "$2,334.82" "$2,948.00" "$2,358.40" "$1,916.20" "$2,948.00" "$2,948.00" "$1,709.84" "$2,948.00" "$1,768.80" "$2,948.00" "$2,948.00" "$2,948.00" N/A N/A 27204089 EAP Custom 27204089 ENSITE ARRAY CATHETER - DOMESTIC BOTH IP/OP "$10,553.00" "$7,809.50" "$1,878.43" "$10,553.00" "$10,553.00" "$10,553.00" "$10,553.00" "$10,553.00" "$10,553.00" "$10,553.00" "$1,878.43" "$10,553.00" "$10,553.00" "$4,181.12" "$4,181.12" "$8,134.25" "$2,060.15" "$2,199.36" "$10,553.00" "$4,221.20" "$10,553.00" "$10,553.00" "$10,553.00" "$10,553.00" "$10,553.00" "$7,914.75" "$10,553.00" "$10,553.00" "$10,553.00" "$5,276.50" "$5,276.50" "$8,357.98" "$10,553.00" "$8,442.40" "$6,859.45" "$10,553.00" "$10,553.00" "$6,120.74" "$10,553.00" "$6,331.80" "$10,553.00" "$10,553.00" "$10,553.00" N/A N/A 27204090 EAP HCPCS C1888 11403001 - KIT PROCEDURE NEVERTOUCLVET L45 CM BOTH IP/OP "$1,197.00" $886.00 $249.47 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $888.41 $888.41 $922.65 $623.64 $249.47 "$1,197.00" $478.80 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $897.75 "$1,197.00" "$1,197.00" "$1,197.00" $598.50 $598.50 $948.02 "$1,197.00" $957.60 $778.05 "$1,197.00" "$1,197.00" $694.26 "$1,197.00" $718.20 "$1,197.00" "$1,197.00" "$1,197.00" N/A N/A 27204091 EAP HCPCS C1888 11403002 - KIT PROCEDURE NEVERTOUC BOTH IP/OP "$1,197.00" $886.00 $249.47 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $888.41 $888.41 $922.65 $623.64 $249.47 "$1,197.00" $478.80 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $897.75 "$1,197.00" "$1,197.00" "$1,197.00" $598.50 $598.50 $948.02 "$1,197.00" $957.60 $778.05 "$1,197.00" "$1,197.00" $694.26 "$1,197.00" $718.20 "$1,197.00" "$1,197.00" "$1,197.00" N/A N/A 27204092 EAP Custom 27204092 COIL DETACHMENT HANDLE BOTH IP/OP $739.00 $547.00 $131.54 $739.00 $739.00 $739.00 $739.00 $739.00 $739.00 $739.00 $131.54 $739.00 $739.00 $548.49 $548.49 $569.62 $385.02 $154.02 $739.00 $295.60 $739.00 $739.00 $739.00 $739.00 $739.00 $554.25 $739.00 $739.00 $739.00 $369.50 $369.50 $585.29 $739.00 $591.20 $480.35 $739.00 $739.00 $428.62 $739.00 $443.40 $739.00 $739.00 $739.00 N/A N/A 27204093 EAP Custom 27204093 QUATRO CATH KIT BOTH IP/OP "$2,341.00" "$1,732.50" $416.70 "$2,341.00" "$2,341.00" "$2,341.00" "$2,341.00" "$2,341.00" "$2,341.00" "$2,341.00" $416.70 "$2,341.00" "$2,341.00" "$1,737.49" "$1,737.49" "$1,804.44" "$1,219.66" $487.89 "$2,341.00" $936.40 "$2,341.00" "$2,341.00" "$2,341.00" "$2,341.00" "$2,341.00" "$1,755.75" "$2,341.00" "$2,341.00" "$2,341.00" "$1,170.50" "$1,170.50" "$1,854.07" "$2,341.00" "$1,872.80" "$1,521.65" "$2,341.00" "$2,341.00" "$1,357.78" "$2,341.00" "$1,404.60" "$2,341.00" "$2,341.00" "$2,341.00" N/A N/A 27204095 EAP HCPCS C1887 ORION 21 MICROCATHETER BOTH IP/OP "$2,172.00" "$1,607.50" $431.09 "$2,172.00" "$1,179.40" "$1,179.40" "$1,179.40" "$1,179.40" "$2,172.00" "$2,172.00" "$2,172.00" $452.70 "$2,172.00" "$1,612.06" "$1,612.06" "$1,674.18" "$1,131.61" $452.67 "$2,172.00" "$2,172.00" "$1,284.74" "$2,172.00" "$2,172.00" "$2,172.00" "$2,172.00" "$1,629.00" "$2,172.00" "$2,172.00" "$2,172.00" "$1,086.00" "$1,086.00" "$1,720.22" "$2,172.00" "$1,737.60" "$1,411.80" $431.09 "$2,172.00" "$1,259.76" "$2,172.00" "$2,172.00" "$2,172.00" $452.64 "$2,172.00" N/A N/A 27204096 EAP Custom 27204096 MINI ATTACHABLE CATHETER 5F BOTH IP/OP $591.00 $437.50 $105.20 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $591.00 $105.20 $591.00 $591.00 $438.64 $438.64 $455.54 $307.91 $123.17 $591.00 $236.40 $591.00 $591.00 $591.00 $591.00 $591.00 $443.25 $591.00 $591.00 $591.00 $295.50 $295.50 $468.07 $591.00 $472.80 $384.15 $591.00 $591.00 $342.78 $591.00 $354.60 $591.00 $591.00 $591.00 N/A N/A 27204097 EAP Custom 27204097 CAPTIVATOR SNARE LARGE OVAL STIFF BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 $16.00 $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 27204098 EAP HCPCS C1726 CRE WG 8-10MM BOTH IP/OP $266.00 $197.00 $52.79 $266.00 $144.44 $144.44 $144.44 $144.44 $266.00 $266.00 $266.00 $55.44 $266.00 $197.43 $197.43 $205.03 $138.59 $55.44 $266.00 $266.00 $157.34 $266.00 $266.00 $266.00 $266.00 $199.50 $266.00 $266.00 $266.00 $133.00 $133.00 $210.67 $266.00 $212.80 $172.90 $52.79 $266.00 $154.28 $266.00 $266.00 $266.00 $55.43 $266.00 N/A N/A 27204099 EAP HCPCS C1726 CRE WG 10-12MM BOTH IP/OP $266.00 $197.00 $52.79 $266.00 $144.44 $144.44 $144.44 $144.44 $266.00 $266.00 $266.00 $55.44 $266.00 $197.43 $197.43 $205.03 $138.59 $55.44 $266.00 $266.00 $157.34 $266.00 $266.00 $266.00 $266.00 $199.50 $266.00 $266.00 $266.00 $133.00 $133.00 $210.67 $266.00 $212.80 $172.90 $52.79 $266.00 $154.28 $266.00 $266.00 $266.00 $55.43 $266.00 N/A N/A 27204100 EAP HCPCS C1726 CRE WG 12-15MM BOTH IP/OP $266.00 $197.00 $52.79 $266.00 $144.44 $144.44 $144.44 $144.44 $266.00 $266.00 $266.00 $55.44 $266.00 $197.43 $197.43 $205.03 $138.59 $55.44 $266.00 $266.00 $157.34 $266.00 $266.00 $266.00 $266.00 $199.50 $266.00 $266.00 $266.00 $133.00 $133.00 $210.67 $266.00 $212.80 $172.90 $52.79 $266.00 $154.28 $266.00 $266.00 $266.00 $55.43 $266.00 N/A N/A 27204101 EAP HCPCS C1726 CRE WF 15-18MM BOTH IP/OP $266.00 $197.00 $52.79 $266.00 $144.44 $144.44 $144.44 $144.44 $266.00 $266.00 $266.00 $55.44 $266.00 $197.43 $197.43 $205.03 $138.59 $55.44 $266.00 $266.00 $157.34 $266.00 $266.00 $266.00 $266.00 $199.50 $266.00 $266.00 $266.00 $133.00 $133.00 $210.67 $266.00 $212.80 $172.90 $52.79 $266.00 $154.28 $266.00 $266.00 $266.00 $55.43 $266.00 N/A N/A 27204102 EAP HCPCS C1769 DREAMWIRE .035 260 STR STND BOTH IP/OP $230.00 $170.50 $45.65 $230.00 $124.89 $124.89 $124.89 $124.89 $230.00 $230.00 $230.00 $47.94 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $230.00 $136.05 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $45.65 $230.00 $133.40 $230.00 $230.00 $230.00 $47.93 $230.00 N/A N/A 27204103 EAP HCPCS C1769 GLIDEWIRE .035 260 STR BOTH IP/OP $230.00 $170.50 $45.65 $230.00 $124.89 $124.89 $124.89 $124.89 $230.00 $230.00 $230.00 $47.94 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $230.00 $136.05 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $45.65 $230.00 $133.40 $230.00 $230.00 $230.00 $47.93 $230.00 N/A N/A 27204105 EAP Custom 27404105 EXTRACTOR RX 9-12 MM BOTH IP/OP $189.00 $140.00 $33.64 $189.00 $189.00 $189.00 $189.00 $189.00 $189.00 $189.00 $33.64 $189.00 $189.00 $140.28 $140.28 $145.68 $98.47 $39.39 $189.00 $75.60 $189.00 $189.00 $189.00 $189.00 $189.00 $141.75 $189.00 $189.00 $189.00 $94.50 $94.50 $149.69 $189.00 $151.20 $122.85 $189.00 $189.00 $109.62 $189.00 $113.40 $189.00 $189.00 $189.00 N/A N/A 27204106 EAP Custom 27204106 EXTRACTOR RX 12-15 MM BOTH IP/OP $189.00 $140.00 $33.64 $189.00 $189.00 $189.00 $189.00 $189.00 $189.00 $189.00 $33.64 $189.00 $189.00 $140.28 $140.28 $145.68 $98.47 $39.39 $189.00 $75.60 $189.00 $189.00 $189.00 $189.00 $189.00 $141.75 $189.00 $189.00 $189.00 $94.50 $94.50 $149.69 $189.00 $151.20 $122.85 $189.00 $189.00 $109.62 $189.00 $113.40 $189.00 $189.00 $189.00 N/A N/A 27204107 EAP Custom 272040107 CYTOLOGY BRUSH BOTH IP/OP $134.00 $99.50 $23.85 $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $23.85 $134.00 $134.00 $99.45 $99.45 $103.29 $69.81 $27.93 $134.00 $53.60 $134.00 $134.00 $134.00 $134.00 $134.00 $100.50 $134.00 $134.00 $134.00 $67.00 $67.00 $106.13 $134.00 $107.20 $87.10 $134.00 $134.00 $77.72 $134.00 $80.40 $134.00 $134.00 $134.00 N/A N/A 27204108 EAP Custom 27204108 ROTH NET BOTH IP/OP $105.00 $78.00 $18.69 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $18.69 $105.00 $105.00 $77.93 $77.93 $80.93 $54.71 $21.88 $105.00 $42.00 $105.00 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $68.25 $105.00 $105.00 $60.90 $105.00 $63.00 $105.00 $105.00 $105.00 N/A N/A 27204109 EAP Custom 27204109 FIAPC PROBE BOTH IP/OP $245.00 $181.50 $43.61 $245.00 $245.00 $245.00 $245.00 $245.00 $245.00 $245.00 $43.61 $245.00 $245.00 $181.84 $181.84 $188.85 $127.65 $51.06 $245.00 $98.00 $245.00 $245.00 $245.00 $245.00 $245.00 $183.75 $245.00 $245.00 $245.00 $122.50 $122.50 $194.04 $245.00 $196.00 $159.25 $245.00 $245.00 $142.10 $245.00 $147.00 $245.00 $245.00 $245.00 N/A N/A 27204110 EAP HCPCS C1757 SOLITAIRE FR 4X15 BOTH IP/OP "$11,643.00" "$8,616.00" "$2,060.15" "$11,643.00" "$6,322.15" "$6,322.15" "$6,322.15" "$6,322.15" "$11,643.00" "$11,643.00" "$11,643.00" "$2,426.69" "$11,643.00" "$4,181.12" "$4,181.12" "$8,974.42" "$2,060.15" "$2,426.53" "$11,643.00" "$11,643.00" "$3,094.73" "$11,643.00" "$11,643.00" "$11,643.00" "$11,643.00" "$8,732.25" "$11,643.00" "$11,643.00" "$11,643.00" "$5,821.50" "$5,821.50" "$9,221.26" "$11,643.00" "$9,314.40" "$7,567.95" "$2,310.84" "$11,643.00" "$6,752.94" "$11,643.00" "$11,643.00" "$11,643.00" "$2,426.40" "$11,643.00" N/A N/A 27204111 EAP HCPCS C1757 SOLITAIRE FR 4X20 BOTH IP/OP "$12,225.00" "$9,046.50" "$2,060.15" "$12,225.00" "$6,638.18" "$6,638.18" "$6,638.18" "$6,638.18" "$12,225.00" "$12,225.00" "$12,225.00" "$2,548.00" "$12,225.00" "$4,181.12" "$4,181.12" "$9,423.03" "$2,060.15" "$2,547.82" "$12,225.00" "$12,225.00" "$3,094.73" "$12,225.00" "$12,225.00" "$12,225.00" "$12,225.00" "$9,168.75" "$12,225.00" "$12,225.00" "$12,225.00" "$6,112.50" "$6,112.50" "$9,682.20" "$12,225.00" "$9,780.00" "$7,946.25" "$2,426.36" "$12,225.00" "$7,090.50" "$12,225.00" "$12,225.00" "$12,225.00" "$2,547.69" "$12,225.00" N/A N/A 27204112 EAP HCPCS C1757 SOLITAIRE FR 6X20 BOTH IP/OP "$11,643.00" "$8,616.00" "$2,060.15" "$11,643.00" "$6,322.15" "$6,322.15" "$6,322.15" "$6,322.15" "$11,643.00" "$11,643.00" "$11,643.00" "$2,426.69" "$11,643.00" "$4,181.12" "$4,181.12" "$8,974.42" "$2,060.15" "$2,426.53" "$11,643.00" "$11,643.00" "$3,094.73" "$11,643.00" "$11,643.00" "$11,643.00" "$11,643.00" "$8,732.25" "$11,643.00" "$11,643.00" "$11,643.00" "$5,821.50" "$5,821.50" "$9,221.26" "$11,643.00" "$9,314.40" "$7,567.95" "$2,310.84" "$11,643.00" "$6,752.94" "$11,643.00" "$11,643.00" "$11,643.00" "$2,426.40" "$11,643.00" N/A N/A 27204113 EAP HCPCS C1757 SOLITAIRE FR 6X30 BOTH IP/OP "$12,225.00" "$9,046.50" "$2,060.15" "$12,225.00" "$6,638.18" "$6,638.18" "$6,638.18" "$6,638.18" "$12,225.00" "$12,225.00" "$12,225.00" "$2,548.00" "$12,225.00" "$4,181.12" "$4,181.12" "$9,423.03" "$2,060.15" "$2,547.82" "$12,225.00" "$12,225.00" "$3,094.73" "$12,225.00" "$12,225.00" "$12,225.00" "$12,225.00" "$9,168.75" "$12,225.00" "$12,225.00" "$12,225.00" "$6,112.50" "$6,112.50" "$9,682.20" "$12,225.00" "$9,780.00" "$7,946.25" "$2,426.36" "$12,225.00" "$7,090.50" "$12,225.00" "$12,225.00" "$12,225.00" "$2,547.69" "$12,225.00" N/A N/A 27204114 EAP HCPCS C1887 NAVIEN INTRACRANIAL CATHETER 6FX 1 BOTH IP/OP $680.00 $503.50 $134.96 $680.00 $369.24 $369.24 $369.24 $369.24 $680.00 $680.00 $680.00 $141.73 $680.00 $504.70 $504.70 $524.14 $354.28 $141.72 $680.00 $680.00 $402.22 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $442.00 $134.96 $680.00 $394.40 $680.00 $408.00 $680.00 $141.71 $680.00 N/A N/A 27204115 EAP HCPCS C1887 NAVIEN INTRACRANIAL CATHETER 6FX 115CM BOTH IP/OP $714.00 $528.50 $141.71 $714.00 $387.70 $387.70 $387.70 $387.70 $714.00 $714.00 $714.00 $148.82 $714.00 $529.93 $529.93 $550.35 $371.99 $148.81 $714.00 $714.00 $422.33 $714.00 $714.00 $714.00 $714.00 $535.50 $714.00 $714.00 $714.00 $357.00 $357.00 $565.49 $714.00 $571.20 $464.10 $141.71 $714.00 $414.12 $714.00 $714.00 $714.00 $148.80 $714.00 N/A N/A 27204116 EAP HCPCS C1887 NAVIEN INTRACRANIAL CATHETER 5FX 115CM BOTH IP/OP "$1,176.00" $870.50 $233.41 "$1,176.00" $638.57 $638.57 $638.57 $638.57 "$1,176.00" "$1,176.00" "$1,176.00" $245.11 "$1,176.00" $872.83 $872.83 $906.46 $612.70 $245.09 "$1,176.00" "$1,176.00" $695.60 "$1,176.00" "$1,176.00" "$1,176.00" "$1,176.00" $882.00 "$1,176.00" "$1,176.00" "$1,176.00" $588.00 $588.00 $931.39 "$1,176.00" $940.80 $764.40 $233.41 "$1,176.00" $682.08 "$1,176.00" "$1,176.00" "$1,176.00" $245.08 "$1,176.00" N/A N/A 27204117 EAP HCPCS C1887 NAVIEN INTRACRANIAL CATHETER 5FX 125CM BOTH IP/OP "$1,235.00" $914.00 $245.12 "$1,235.00" $670.61 $670.61 $670.61 $670.61 "$1,235.00" "$1,235.00" "$1,235.00" $257.40 "$1,235.00" $916.62 $916.62 $951.94 $643.44 $257.39 "$1,235.00" "$1,235.00" $730.50 "$1,235.00" "$1,235.00" "$1,235.00" "$1,235.00" $926.25 "$1,235.00" "$1,235.00" "$1,235.00" $617.50 $617.50 $978.12 "$1,235.00" $988.00 $802.75 $245.12 "$1,235.00" $716.30 "$1,235.00" "$1,235.00" "$1,235.00" $257.37 "$1,235.00" N/A N/A 27204118 EAP HCPCS C1887 NAVIEN INTRACRANIAL CATHETER 5FX 130CM BOTH IP/OP "$1,176.00" $870.50 $233.41 "$1,176.00" $638.57 $638.57 $638.57 $638.57 "$1,176.00" "$1,176.00" "$1,176.00" $245.11 "$1,176.00" $872.83 $872.83 $906.46 $612.70 $245.09 "$1,176.00" "$1,176.00" $695.60 "$1,176.00" "$1,176.00" "$1,176.00" "$1,176.00" $882.00 "$1,176.00" "$1,176.00" "$1,176.00" $588.00 $588.00 $931.39 "$1,176.00" $940.80 $764.40 $233.41 "$1,176.00" $682.08 "$1,176.00" "$1,176.00" "$1,176.00" $245.08 "$1,176.00" N/A N/A 27204119 EAP HCPCS C2629 PINNACLE RDC SHEATH 6FR BOTH IP/OP "$2,374.00" "$1,757.00" $471.18 "$2,374.00" "$1,289.08" "$1,289.08" "$1,289.08" "$1,289.08" "$2,374.00" "$2,374.00" "$2,374.00" $494.80 "$2,374.00" "$1,761.98" "$1,761.98" "$1,829.88" "$1,236.85" $494.77 "$2,374.00" "$2,374.00" "$1,404.22" "$2,374.00" "$2,374.00" "$2,374.00" "$2,374.00" "$1,780.50" "$2,374.00" "$2,374.00" "$2,374.00" "$1,187.00" "$1,187.00" "$1,880.21" "$2,374.00" "$1,899.20" "$1,543.10" $471.18 "$2,374.00" "$1,376.92" "$2,374.00" "$2,374.00" "$2,374.00" $494.74 "$2,374.00" N/A N/A 27204120 EAP Custom 27204120 TC CATHETER BOTH IP/OP $151.00 $112.00 $26.88 $151.00 $151.00 $151.00 $151.00 $151.00 $151.00 $151.00 $26.88 $151.00 $151.00 $112.07 $112.07 $116.39 $78.67 $31.47 $151.00 $60.40 $151.00 $151.00 $151.00 $151.00 $151.00 $113.25 $151.00 $151.00 $151.00 $75.50 $75.50 $119.59 $151.00 $120.80 $98.15 $151.00 $151.00 $87.58 $151.00 $90.60 $151.00 $151.00 $151.00 N/A N/A 27204121 EAP HCPCS C1887 VAN AMAN CATHTER BOTH IP/OP $56.00 $41.50 $11.11 $56.00 $30.41 $30.41 $30.41 $30.41 $56.00 $56.00 $56.00 $11.67 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $56.00 $33.12 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $11.11 $56.00 $32.48 $56.00 $56.00 $56.00 $11.67 $56.00 N/A N/A 27204124 EAP HCPCS C1788 DIGNITY PORT 6.6F BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $271.50 $271.50 $271.50 $271.50 $500.00 $500.00 $500.00 $104.21 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $99.24 $500.00 $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 27204125 EAP Custom 27204125 LONG RODCH LEFT GASTRIC CATHETER 5FR 65CM BOTH IP/OP $56.00 $41.50 $9.97 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $9.97 $56.00 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $22.40 $56.00 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $56.00 $56.00 $32.48 $56.00 $33.60 $56.00 $56.00 $56.00 N/A N/A 27204126 EAP Custom 27204126 LONG RODCH LEFT GASTRIC CATHETER 5FR 80CM BOTH IP/OP $56.00 $41.50 $9.97 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $9.97 $56.00 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $22.40 $56.00 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $56.00 $56.00 $32.48 $56.00 $33.60 $56.00 $56.00 $56.00 N/A N/A 27204127 EAP HCPCS C1769 AVIGO GUIDEWIRE BOTH IP/OP "$1,168.00" $864.50 $231.82 "$1,168.00" $634.22 $634.22 $634.22 $634.22 "$1,168.00" "$1,168.00" "$1,168.00" $243.44 "$1,168.00" $866.89 $866.89 $900.29 $608.53 $243.42 "$1,168.00" "$1,168.00" $690.87 "$1,168.00" "$1,168.00" "$1,168.00" "$1,168.00" $876.00 "$1,168.00" "$1,168.00" "$1,168.00" $584.00 $584.00 $925.06 "$1,168.00" $934.40 $759.20 $231.82 "$1,168.00" $677.44 "$1,168.00" "$1,168.00" "$1,168.00" $243.41 "$1,168.00" N/A N/A 27204128 EAP HCPCS C1887 EXCEISIOR XT-27 MICROCATHETER 135CM/6CM STRAIGHT BOTH IP/OP "$2,807.00" "$2,077.50" $557.12 "$2,807.00" "$1,524.20" "$1,524.20" "$1,524.20" "$1,524.20" "$2,807.00" "$2,807.00" "$2,807.00" $585.05 "$2,807.00" "$2,083.36" "$2,083.36" "$2,163.64" "$1,462.45" $585.01 "$2,807.00" "$2,807.00" "$1,660.34" "$2,807.00" "$2,807.00" "$2,807.00" "$2,807.00" "$2,105.25" "$2,807.00" "$2,807.00" "$2,807.00" "$1,403.50" "$1,403.50" "$2,223.14" "$2,807.00" "$2,245.60" "$1,824.55" $557.12 "$2,807.00" "$1,628.06" "$2,807.00" "$2,807.00" "$2,807.00" $584.98 "$2,807.00" N/A N/A 27204129 EAP HCPCS C1887 EXCEISIOR XT-27 MICROCATHETER 135CM/6CM PRE-SHAPED BOTH IP/OP "$2,807.00" "$2,077.50" $557.12 "$2,807.00" "$1,524.20" "$1,524.20" "$1,524.20" "$1,524.20" "$2,807.00" "$2,807.00" "$2,807.00" $585.05 "$2,807.00" "$2,083.36" "$2,083.36" "$2,163.64" "$1,462.45" $585.01 "$2,807.00" "$2,807.00" "$1,660.34" "$2,807.00" "$2,807.00" "$2,807.00" "$2,807.00" "$2,105.25" "$2,807.00" "$2,807.00" "$2,807.00" "$1,403.50" "$1,403.50" "$2,223.14" "$2,807.00" "$2,245.60" "$1,824.55" $557.12 "$2,807.00" "$1,628.06" "$2,807.00" "$2,807.00" "$2,807.00" $584.98 "$2,807.00" N/A N/A 27204130 EAP HCPCS C1887 EXCEISIOR XT-27 MICROCATHETER 150 CM/80CM STRAIGHT BOTH IP/OP "$2,807.00" "$2,077.50" $557.12 "$2,807.00" "$1,524.20" "$1,524.20" "$1,524.20" "$1,524.20" "$2,807.00" "$2,807.00" "$2,807.00" $585.05 "$2,807.00" "$2,083.36" "$2,083.36" "$2,163.64" "$1,462.45" $585.01 "$2,807.00" "$2,807.00" "$1,660.34" "$2,807.00" "$2,807.00" "$2,807.00" "$2,807.00" "$2,105.25" "$2,807.00" "$2,807.00" "$2,807.00" "$1,403.50" "$1,403.50" "$2,223.14" "$2,807.00" "$2,245.60" "$1,824.55" $557.12 "$2,807.00" "$1,628.06" "$2,807.00" "$2,807.00" "$2,807.00" $584.98 "$2,807.00" N/A N/A 27204131 EAP HCPCS C1887 EXCEISIOR XT-27 MICROCATHETER 150CM/18CM STRAIGHT BOTH IP/OP "$2,807.00" "$2,077.50" $557.12 "$2,807.00" "$1,524.20" "$1,524.20" "$1,524.20" "$1,524.20" "$2,807.00" "$2,807.00" "$2,807.00" $585.05 "$2,807.00" "$2,083.36" "$2,083.36" "$2,163.64" "$1,462.45" $585.01 "$2,807.00" "$2,807.00" "$1,660.34" "$2,807.00" "$2,807.00" "$2,807.00" "$2,807.00" "$2,105.25" "$2,807.00" "$2,807.00" "$2,807.00" "$1,403.50" "$1,403.50" "$2,223.14" "$2,807.00" "$2,245.60" "$1,824.55" $557.12 "$2,807.00" "$1,628.06" "$2,807.00" "$2,807.00" "$2,807.00" $584.98 "$2,807.00" N/A N/A 27204132 EAP HCPCS C1887 EXCEISIOR XT-27 MICROCATHETER 135CM/6CM PRE-SHAPED BOTH IP/OP "$2,807.00" "$2,077.50" $557.12 "$2,807.00" "$1,524.20" "$1,524.20" "$1,524.20" "$1,524.20" "$2,807.00" "$2,807.00" "$2,807.00" $585.05 "$2,807.00" "$2,083.36" "$2,083.36" "$2,163.64" "$1,462.45" $585.01 "$2,807.00" "$2,807.00" "$1,660.34" "$2,807.00" "$2,807.00" "$2,807.00" "$2,807.00" "$2,105.25" "$2,807.00" "$2,807.00" "$2,807.00" "$1,403.50" "$1,403.50" "$2,223.14" "$2,807.00" "$2,245.60" "$1,824.55" $557.12 "$2,807.00" "$1,628.06" "$2,807.00" "$2,807.00" "$2,807.00" $584.98 "$2,807.00" N/A N/A 27204140 EAP Custom 27204140 KIT CATHETER PRESEP OLIGON HEPARIN L16 CM OD8.5 FR CENTL BOTH IP/OP "$1,330.00" $984.50 $236.74 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $236.74 "$1,330.00" "$1,330.00" $987.13 $987.13 "$1,025.16" $692.93 $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $864.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27204141 EAP Custom 27204141 KIT CATHETER PRESEP OLIGON L20 CM OD8.5 FR ARTERIAL 3 LN BOTH IP/OP "$1,330.00" $984.50 $236.74 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $236.74 "$1,330.00" "$1,330.00" $987.13 $987.13 "$1,025.16" $692.93 $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $864.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27204142 EAP HCPCS C1894 INTROD SHTH 8FR 150CM 12CM 2 DISTAL GWIRE HMST VLV SDPRT BOTH IP/OP $56.00 $41.50 $11.11 $56.00 $30.41 $30.41 $30.41 $30.41 $56.00 $56.00 $56.00 $11.67 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $56.00 $33.12 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $11.11 $56.00 $32.48 $56.00 $56.00 $56.00 $11.67 $56.00 N/A N/A 27204143 EAP HCPCS C1894 INTROD SHTH 9FR 150CM 12CM 2 DISTAL GWIRE HMST VLV SDPRT BOTH IP/OP $63.00 $47.00 $12.50 $63.00 $34.21 $34.21 $34.21 $34.21 $63.00 $63.00 $63.00 $13.13 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $63.00 $37.26 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $31.50 $31.50 $49.90 $63.00 $50.40 $40.95 $12.50 $63.00 $36.54 $63.00 $63.00 $63.00 $13.13 $63.00 N/A N/A 27204144 EAP HCPCS C1894 INTROD CATH 12CM 10FR .038IN TRNSPT FSTCTH HMSTS BOTH IP/OP $70.00 $52.00 $13.89 $70.00 $38.01 $38.01 $38.01 $38.01 $70.00 $70.00 $70.00 $14.59 $70.00 $51.95 $51.95 $53.96 $36.47 $14.59 $70.00 $70.00 $41.41 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $45.50 $13.89 $70.00 $40.60 $70.00 $70.00 $70.00 $14.59 $70.00 N/A N/A 27204145 EAP HCPCS C1893 INTROD SHTH 8.5FR 180CM 63CM SUPERSTIFF GUIEWIRE GUID BRAID BOTH IP/OP $532.00 $394.00 $105.59 $532.00 $288.88 $288.88 $288.88 $288.88 $532.00 $532.00 $532.00 $110.88 $532.00 $394.85 $394.85 $410.07 $277.17 $110.87 $532.00 $532.00 $314.68 $532.00 $532.00 $532.00 $532.00 $399.00 $532.00 $532.00 $532.00 $266.00 $266.00 $421.34 $532.00 $425.60 $345.80 $105.59 $532.00 $308.56 $532.00 $532.00 $532.00 $110.87 $532.00 N/A N/A 27204146 EAP Custom 27204146 NEEDLE 71CM 18GA CURVE PRC TRNSPT BRK-1 ADLT BOTH IP/OP $576.00 $426.50 $102.53 $576.00 $576.00 $576.00 $576.00 $576.00 $576.00 $576.00 $102.53 $576.00 $576.00 $427.51 $427.51 $443.98 $300.10 $120.04 $576.00 $230.40 $576.00 $576.00 $576.00 $576.00 $576.00 $432.00 $576.00 $576.00 $576.00 $288.00 $288.00 $456.19 $576.00 $460.80 $374.40 $576.00 $576.00 $334.08 $576.00 $345.60 $576.00 $576.00 $576.00 N/A N/A 27204147 EAP HCPCS C1766 INTROD SHTH 8.5FR 91CM 71CM DUAL REACH BIDIR ERG HNDL ATRM BOTH IP/OP "$2,642.00" "$1,955.50" $550.62 "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$1,960.89" "$1,960.89" "$2,036.45" "$1,376.48" $550.62 "$2,642.00" "$1,056.80" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$1,981.50" "$2,642.00" "$2,642.00" "$2,642.00" "$1,321.00" "$1,321.00" "$2,092.46" "$2,642.00" "$2,113.60" "$1,717.30" "$2,642.00" "$2,642.00" "$1,532.36" "$2,642.00" "$1,585.20" "$2,642.00" "$2,642.00" "$2,642.00" N/A N/A 27204148 EAP HCPCS C1766 INTROD SHTH 8.5FR 71CM 50MM STRBL ERG HNDL ATRM TIP INTGR BOTH IP/OP "$2,642.00" "$1,955.50" $550.62 "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$1,960.89" "$1,960.89" "$2,036.45" "$1,376.48" $550.62 "$2,642.00" "$1,056.80" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$2,642.00" "$1,981.50" "$2,642.00" "$2,642.00" "$2,642.00" "$1,321.00" "$1,321.00" "$2,092.46" "$2,642.00" "$2,113.60" "$1,717.30" "$2,642.00" "$2,642.00" "$1,532.36" "$2,642.00" "$1,585.20" "$2,642.00" "$2,642.00" "$2,642.00" N/A N/A 27204149 EAP HCPCS C1730 CABLE CATH BLUE 150CM RSPN EP BIPOL TRPLR QDPL BOTH IP/OP $213.00 $158.00 $42.28 $213.00 $115.66 $115.66 $115.66 $115.66 $213.00 $213.00 $213.00 $44.39 $213.00 $158.09 $158.09 $164.18 $110.97 $44.39 $213.00 $213.00 $125.99 $213.00 $213.00 $213.00 $213.00 $159.75 $213.00 $213.00 $213.00 $106.50 $106.50 $168.70 $213.00 $170.40 $138.45 $42.28 $213.00 $123.54 $213.00 $213.00 $213.00 $44.39 $213.00 N/A N/A 27204150 EAP Custom 27204150 CABLE CATH BLK 150CM RSPN EP HEXPL BOTH IP/OP $225.00 $166.50 $40.05 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $40.05 $225.00 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $90.00 $225.00 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $225.00 $225.00 $130.50 $225.00 $135.00 $225.00 $225.00 $225.00 N/A N/A 27204152 EAP Custom 27204152 CABLE CATH RED 150CM RSPN EP HEXPL OCTPL DCAPL EXTN BOTH IP/OP $266.00 $197.00 $47.35 $266.00 $266.00 $266.00 $266.00 $266.00 $266.00 $266.00 $47.35 $266.00 $266.00 $197.43 $197.43 $205.03 $138.59 $55.44 $266.00 $106.40 $266.00 $266.00 $266.00 $266.00 $266.00 $199.50 $266.00 $266.00 $266.00 $133.00 $133.00 $210.67 $266.00 $212.80 $172.90 $266.00 $266.00 $154.28 $266.00 $159.60 $266.00 $266.00 $266.00 N/A N/A 27204153 EAP HCPCS C1730 CATH EP 2-5-2MM SPC 1MM 6FR 115CM 4MM QDPL MED SWP STRBL BOTH IP/OP "$1,490.00" "$1,103.00" $295.73 "$1,490.00" $809.07 $809.07 $809.07 $809.07 "$1,490.00" "$1,490.00" "$1,490.00" $310.55 "$1,490.00" "$1,105.88" "$1,105.88" "$1,148.49" $776.29 $310.53 "$1,490.00" "$1,490.00" $881.34 "$1,490.00" "$1,490.00" "$1,490.00" "$1,490.00" "$1,117.50" "$1,490.00" "$1,490.00" "$1,490.00" $745.00 $745.00 "$1,180.08" "$1,490.00" "$1,192.00" $968.50 $295.73 "$1,490.00" $864.20 "$1,490.00" "$1,490.00" "$1,490.00" $310.52 "$1,490.00" N/A N/A 27204154 EAP HCPCS C1730 CATH EP 5MM SPC 1MM 5FR 115CM 2MM HEXPL MED SWP STRBL LVWR BOTH IP/OP "$1,608.00" "$1,190.00" $319.15 "$1,608.00" $873.14 $873.14 $873.14 $873.14 "$1,608.00" "$1,608.00" "$1,608.00" $335.15 "$1,608.00" "$1,193.46" "$1,193.46" "$1,239.45" $837.77 $335.12 "$1,608.00" "$1,608.00" $951.13 "$1,608.00" "$1,608.00" "$1,608.00" "$1,608.00" "$1,206.00" "$1,608.00" "$1,608.00" "$1,608.00" $804.00 $804.00 "$1,273.54" "$1,608.00" "$1,286.40" "$1,045.20" $319.15 "$1,608.00" $932.64 "$1,608.00" "$1,608.00" "$1,608.00" $335.11 "$1,608.00" N/A N/A 27204157 EAP Custom 27204157 CABLE CATH SAFIRE EP GNTR INTFC BOTH IP/OP $449.00 $332.50 $79.92 $449.00 $449.00 $449.00 $449.00 $449.00 $449.00 $449.00 $79.92 $449.00 $449.00 $333.25 $333.25 $346.09 $233.93 $93.58 $449.00 $179.60 $449.00 $449.00 $449.00 $449.00 $449.00 $336.75 $449.00 $449.00 $449.00 $224.50 $224.50 $355.61 $449.00 $359.20 $291.85 $449.00 $449.00 $260.42 $449.00 $269.40 $449.00 $449.00 $449.00 N/A N/A 27204158 EAP Custom 27204158 CABLE CATH SAFIRE EP EXTN BOTH IP/OP $461.00 $341.50 $82.06 $461.00 $461.00 $461.00 $461.00 $461.00 $461.00 $461.00 $82.06 $461.00 $461.00 $342.15 $342.15 $355.34 $240.18 $96.08 $461.00 $184.40 $461.00 $461.00 $461.00 $461.00 $461.00 $345.75 $461.00 $461.00 $461.00 $230.50 $230.50 $365.11 $461.00 $368.80 $299.65 $461.00 $461.00 $267.38 $461.00 $276.60 $461.00 $461.00 $461.00 N/A N/A 27204164 EAP HCPCS C1887 CATHETER REPERFUSION BOTH IP/OP "$6,176.00" "$4,570.50" "$1,225.78" "$6,176.00" "$3,353.57" "$3,353.57" "$3,353.57" "$3,353.57" "$6,176.00" "$6,176.00" "$6,176.00" "$1,287.23" "$6,176.00" "$4,181.12" "$4,181.12" "$4,760.46" "$2,060.15" "$1,287.15" "$6,176.00" "$6,176.00" "$3,094.73" "$6,176.00" "$6,176.00" "$6,176.00" "$6,176.00" "$4,632.00" "$6,176.00" "$6,176.00" "$6,176.00" "$3,088.00" "$3,088.00" "$4,891.39" "$6,176.00" "$4,940.80" "$4,014.40" "$1,225.78" "$6,176.00" "$3,582.08" "$6,176.00" "$6,176.00" "$6,176.00" "$1,287.08" "$6,176.00" N/A N/A 27204168 EAP HCPCS C1894 FLEXOR ANSEL GUIDING SHEATH/ STR BOTH IP/OP $248.00 $184.00 $49.22 $248.00 $134.66 $134.66 $134.66 $134.66 $248.00 $248.00 $248.00 $51.69 $248.00 $184.07 $184.07 $191.16 $129.21 $51.69 $248.00 $99.20 $146.69 $248.00 $248.00 $248.00 $248.00 $186.00 $248.00 $248.00 $248.00 $124.00 $124.00 $196.42 $248.00 $198.40 $161.20 $49.22 $248.00 $143.84 $248.00 $248.00 $248.00 $51.68 $248.00 N/A N/A 27204169 EAP HCPCS C1894 FLEXOR ANSEL GUIDING SHEATH/ MP BOTH IP/OP $248.00 $184.00 $49.22 $248.00 $134.66 $134.66 $134.66 $134.66 $248.00 $248.00 $248.00 $51.69 $248.00 $184.07 $184.07 $191.16 $129.21 $51.69 $248.00 $99.20 $146.69 $248.00 $248.00 $248.00 $248.00 $186.00 $248.00 $248.00 $248.00 $124.00 $124.00 $196.42 $248.00 $198.40 $161.20 $49.22 $248.00 $143.84 $248.00 $248.00 $248.00 $51.68 $248.00 N/A N/A 27204170 EAP HCPCS C1894 INTRODUCER SHTH 10 FR/ 40CM BOTH IP/OP $216.00 $160.00 $42.87 $216.00 $117.29 $117.29 $117.29 $117.29 $216.00 $216.00 $216.00 $45.02 $216.00 $160.32 $160.32 $166.49 $112.54 $45.02 $216.00 $216.00 $127.76 $216.00 $216.00 $216.00 $216.00 $162.00 $216.00 $216.00 $216.00 $108.00 $108.00 $171.07 $216.00 $172.80 $140.40 $42.87 $216.00 $125.28 $216.00 $216.00 $216.00 $45.01 $216.00 N/A N/A 27204171 EAP HCPCS C1887 CATHETER ANGIO SIM 3 CRV 5FR BOTH IP/OP $123.00 $91.50 $24.41 $123.00 $66.79 $66.79 $66.79 $66.79 $123.00 $123.00 $123.00 $25.64 $123.00 $91.29 $91.29 $94.81 $64.08 $25.63 $123.00 $123.00 $72.75 $123.00 $123.00 $123.00 $123.00 $92.25 $123.00 $123.00 $123.00 $61.50 $61.50 $97.42 $123.00 $98.40 $79.95 $24.41 $123.00 $71.34 $123.00 $123.00 $123.00 $25.63 $123.00 N/A N/A 27204210 EAP HCPCS C1769 GUIDEWIRE VASCULAR X-CELER HYDRO L300 CM L10 CM OD.01 BOTH IP/OP $975.00 $721.50 $193.51 $975.00 $529.43 $529.43 $529.43 $529.43 $975.00 $975.00 $975.00 $203.21 $975.00 $723.65 $723.65 $751.53 $507.98 $203.20 $975.00 $975.00 $576.71 $975.00 $975.00 $975.00 $975.00 $731.25 $975.00 $975.00 $975.00 $487.50 $487.50 $772.20 $975.00 $780.00 $633.75 $193.51 $975.00 $565.50 $975.00 $975.00 $975.00 $203.19 $975.00 N/A N/A 27204211 EAP HCPCS C2629 SET INTRODUCER APRIMA HYDROPHILIC L15 CM OD6 FR ODSEC22A BOTH IP/OP $212.00 $157.00 $42.08 $212.00 $115.12 $115.12 $115.12 $115.12 $212.00 $212.00 $212.00 $44.19 $212.00 $157.35 $157.35 $163.41 $110.45 $44.18 $212.00 $212.00 $125.40 $212.00 $212.00 $212.00 $212.00 $159.00 $212.00 $212.00 $212.00 $106.00 $106.00 $167.90 $212.00 $169.60 $137.80 $42.08 $212.00 $122.96 $212.00 $212.00 $212.00 $44.18 $212.00 N/A N/A 27204212 EAP Custom 27204212 BIOTRONIK LEAD DELIVERY SYSTEM BOTH IP/OP "$1,478.00" "$1,094.00" $263.08 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $263.08 "$1,478.00" "$1,478.00" "$1,096.97" "$1,096.97" "$1,139.24" $770.04 $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $960.70 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27204214 EAP HCPCS C1769 GWIRE VASC .035IN 15MM 260CM 4CM 2 CVD EXCH XSTIF LNDRQS SS BOTH IP/OP $620.00 $459.00 $123.05 $620.00 $336.66 $336.66 $336.66 $336.66 $620.00 $620.00 $620.00 $129.22 $620.00 $460.16 $460.16 $477.90 $323.02 $129.21 $620.00 $620.00 $366.73 $620.00 $620.00 $620.00 $620.00 $465.00 $620.00 $620.00 $620.00 $310.00 $310.00 $491.04 $620.00 $496.00 $403.00 $123.05 $620.00 $359.60 $620.00 $620.00 $620.00 $129.21 $620.00 N/A N/A 27204216 EAP Custom 27204216 SITE-RITE 6 ULTRASOUND SYSTEM 21 GA NEEDLE GUIDE KIT BOTH IP/OP $60.00 $44.50 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 $60.00 $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A 27204217 EAP HCPCS C1894 MICRO MICROINTRUDUCER 7CM 5.0FR FLECURA GUIDEWIRE BOTH IP/OP $98.00 $73.00 $19.45 $98.00 $53.21 $53.21 $53.21 $53.21 $98.00 $98.00 $98.00 $20.43 $98.00 $72.74 $72.74 $75.54 $51.06 $20.42 $98.00 $98.00 $57.97 $98.00 $98.00 $98.00 $98.00 $73.50 $98.00 $98.00 $98.00 $49.00 $49.00 $77.62 $98.00 $78.40 $63.70 $19.45 $98.00 $56.84 $98.00 $98.00 $98.00 $20.42 $98.00 N/A N/A 27204218 EAP HCPCS C1726 BALLOON DILATATION CATHETER 6MMX40MMX135CM BOTH IP/OP $550.00 $407.00 $109.16 $550.00 $298.65 $298.65 $298.65 $298.65 $550.00 $550.00 $550.00 $114.63 $550.00 $408.21 $408.21 $423.94 $286.55 $114.63 $550.00 $550.00 $325.33 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $357.50 $109.16 $550.00 $319.00 $550.00 $550.00 $550.00 $114.62 $550.00 N/A N/A 27204220 EAP HCPCS C1769 SPHNTM 30MM 5MM 3.9FR ATME BIL PNCR GWIRE CANN CHNL C MD BOTH IP/OP "$4,433.00" "$3,280.50" $879.84 "$4,433.00" "$2,407.12" "$2,407.12" "$2,407.12" "$2,407.12" "$4,433.00" "$4,433.00" "$4,433.00" $923.95 "$4,433.00" "$3,290.17" "$3,290.17" "$3,416.96" "$2,060.15" $923.89 "$4,433.00" "$4,433.00" "$2,622.12" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$3,324.75" "$4,433.00" "$4,433.00" "$4,433.00" "$2,216.50" "$2,216.50" "$3,510.94" "$4,433.00" "$3,546.40" "$2,881.45" $879.84 "$4,433.00" "$2,571.14" "$4,433.00" "$4,433.00" "$4,433.00" $923.84 "$4,433.00" N/A N/A 27204228 EAP HCPCS C1894 INTROD LEAD BL CODE 9.7% HE 21% OZ 27% CO 42.35% N2 BOTH IP/OP "$2,660.00" "$1,968.50" $527.94 "$2,660.00" "$1,444.38" "$1,444.38" "$1,444.38" "$1,444.38" "$2,660.00" "$2,660.00" "$2,660.00" $554.41 "$2,660.00" "$1,974.25" "$1,974.25" "$2,050.33" "$1,385.86" $554.37 "$2,660.00" "$1,064.00" "$1,573.39" "$2,660.00" "$2,660.00" "$2,660.00" "$2,660.00" "$1,995.00" "$2,660.00" "$2,660.00" "$2,660.00" "$1,330.00" "$1,330.00" "$2,106.72" "$2,660.00" "$2,128.00" "$1,729.00" $527.94 "$2,660.00" "$1,542.80" "$2,660.00" "$2,660.00" "$2,660.00" $554.34 "$2,660.00" N/A N/A 27204239 EAP HCPCS C1887 ACUITY CUTAWAY LEAD DELIVERY SYSTEM - PERCUTANEOUS CATHETERS BOTH IP/OP "$5,010.00" "$3,707.50" $994.36 "$5,010.00" "$2,720.43" "$2,720.43" "$2,720.43" "$2,720.43" "$5,010.00" "$5,010.00" "$5,010.00" "$1,044.21" "$5,010.00" "$3,718.42" "$3,718.42" "$3,861.71" "$2,060.15" "$1,044.14" "$5,010.00" "$5,010.00" "$2,963.42" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$3,757.50" "$5,010.00" "$5,010.00" "$5,010.00" "$2,505.00" "$2,505.00" "$3,967.92" "$5,010.00" "$4,008.00" "$3,256.50" $994.36 "$5,010.00" "$2,905.80" "$5,010.00" "$5,010.00" "$5,010.00" "$1,044.08" "$5,010.00" N/A N/A 27204240 EAP HCPCS C1769 SPHNTM 20MM 7-5FR BIL PNCR GWIRE 3 LUM SHRT NOSE CANN RAPEX BOTH IP/OP "$4,433.00" "$3,280.50" $879.84 "$4,433.00" "$2,407.12" "$2,407.12" "$2,407.12" "$2,407.12" "$4,433.00" "$4,433.00" "$4,433.00" $923.95 "$4,433.00" "$3,290.17" "$3,290.17" "$3,416.96" "$2,060.15" $923.89 "$4,433.00" "$4,433.00" "$2,622.12" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$3,324.75" "$4,433.00" "$4,433.00" "$4,433.00" "$2,216.50" "$2,216.50" "$3,510.94" "$4,433.00" "$3,546.40" "$2,881.45" $879.84 "$4,433.00" "$2,571.14" "$4,433.00" "$4,433.00" "$4,433.00" $923.84 "$4,433.00" N/A N/A 27204241 EAP Custom 27204241 DEVICE LCK BIOP CAP RAPEX RX BL BIL PNTX ESCP BOTH IP/OP "$4,433.00" "$3,280.50" $789.07 "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" $789.07 "$4,433.00" "$4,433.00" "$3,290.17" "$3,290.17" "$3,416.96" "$2,060.15" $923.89 "$4,433.00" "$1,773.20" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$3,324.75" "$4,433.00" "$4,433.00" "$4,433.00" "$2,216.50" "$2,216.50" "$3,510.94" "$4,433.00" "$3,546.40" "$2,881.45" "$4,433.00" "$4,433.00" "$2,571.14" "$4,433.00" "$2,659.80" "$4,433.00" "$4,433.00" "$4,433.00" N/A N/A 27204243 EAP HCPCS C1769 SPHNTM 30MM 5MM 4.4FR ATME RX BOTH IP/OP "$4,433.00" "$3,280.50" $879.84 "$4,433.00" "$2,407.12" "$2,407.12" "$2,407.12" "$2,407.12" "$4,433.00" "$4,433.00" "$4,433.00" $923.95 "$4,433.00" "$3,290.17" "$3,290.17" "$3,416.96" "$2,060.15" $923.89 "$4,433.00" "$4,433.00" "$2,622.12" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$3,324.75" "$4,433.00" "$4,433.00" "$4,433.00" "$2,216.50" "$2,216.50" "$3,510.94" "$4,433.00" "$3,546.40" "$2,881.45" $879.84 "$4,433.00" "$2,571.14" "$4,433.00" "$4,433.00" "$4,433.00" $923.84 "$4,433.00" N/A N/A 27204245 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 3.0MM X 20MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $219.20 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204246 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 3.0MM X 40MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $548.00 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204247 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 4.0MM X 20MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $548.00 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204248 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 4.0MM X 40MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $219.20 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204249 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 4.0MM X 80MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $219.20 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204250 EAP HCPCS C1887 CXI SUPPORT CATHETER STR / 2.6FR-.018-150CM BOTH IP/OP $501.00 $371.00 $99.44 $501.00 $272.04 $272.04 $272.04 $272.04 $501.00 $501.00 $501.00 $104.42 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $501.00 $296.34 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $99.44 $501.00 $290.58 $501.00 $501.00 $501.00 $104.41 $501.00 N/A N/A 27204251 EAP HCPCS C1725 CXI SUPPORT CATHETER ANG/ 2.6FR-.018-150CM BOTH IP/OP $501.00 $371.00 $99.44 $501.00 $272.04 $272.04 $272.04 $272.04 $501.00 $501.00 $501.00 $104.42 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $501.00 $296.34 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $99.44 $501.00 $290.58 $501.00 $501.00 $501.00 $104.41 $501.00 N/A N/A 27204253 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 6.0MM X 80MM X 135CM BOTH IP/OP $501.00 $371.00 $99.44 $501.00 $272.04 $272.04 $272.04 $272.04 $501.00 $501.00 $501.00 $104.42 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $200.40 $296.34 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $99.44 $501.00 $290.58 $501.00 $501.00 $501.00 $104.41 $501.00 N/A N/A 27204254 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 6.0MM X 100MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $219.20 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204255 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 6.0MM X 120MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $548.00 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204256 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 6.0MM X 150MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $548.00 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204257 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 6.0MM X 220MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $548.00 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204258 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 7.0MM X 40MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $548.00 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204259 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 8.0MM X 40MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $548.00 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204260 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 9.0MM X 40MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $548.00 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $328.80 $548.00 $114.20 $548.00 N/A N/A 27204261 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 5.0MM X 40MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $219.20 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204262 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 5.0MM X 100MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $219.20 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204263 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 6.0MM X 40MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $219.20 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204270 EAP HCPCS C1725 MUSTANG BALLOON CATHETER 10.0MM X 40MM X 135CM BOTH IP/OP $548.00 $406.00 $108.76 $548.00 $297.56 $297.56 $297.56 $297.56 $548.00 $548.00 $548.00 $114.22 $548.00 $406.73 $406.73 $422.40 $285.51 $114.21 $548.00 $548.00 $324.14 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $356.20 $108.76 $548.00 $317.84 $548.00 $548.00 $548.00 $114.20 $548.00 N/A N/A 27204280 EAP HCPCS C1755 KYPHOPAST FIRST FRACTURE KIT-KPE1003 BOTH IP/OP "$10,626.00" "$7,863.50" "$2,060.15" "$10,626.00" "$10,626.00" "$10,626.00" "$10,626.00" "$10,626.00" "$10,626.00" "$10,626.00" "$10,626.00" "$10,626.00" "$10,626.00" "$4,181.12" "$4,181.12" "$8,190.52" "$2,060.15" "$2,214.58" "$10,626.00" "$4,250.40" "$10,626.00" "$10,626.00" "$10,626.00" "$10,626.00" "$10,626.00" "$7,969.50" "$10,626.00" "$10,626.00" "$10,626.00" "$5,313.00" "$5,313.00" "$8,415.79" "$10,626.00" "$8,500.80" "$6,906.90" "$10,626.00" "$10,626.00" "$6,163.08" "$10,626.00" "$6,375.60" "$10,626.00" "$10,626.00" "$10,626.00" N/A N/A 27204281 EAP HCPCS C1755 KYPHOPASTY ADDITONAL FRACTURE KIT-KPE1003 BOTH IP/OP "$7,079.00" "$5,238.50" "$1,475.34" "$7,079.00" "$7,079.00" "$7,079.00" "$7,079.00" "$7,079.00" "$7,079.00" "$7,079.00" "$7,079.00" "$7,079.00" "$7,079.00" "$4,181.12" "$4,181.12" "$5,456.49" "$2,060.15" "$1,475.34" "$7,079.00" "$2,831.60" "$7,079.00" "$7,079.00" "$7,079.00" "$7,079.00" "$7,079.00" "$5,309.25" "$7,079.00" "$7,079.00" "$7,079.00" "$3,539.50" "$3,539.50" "$5,606.57" "$7,079.00" "$5,663.20" "$4,601.35" "$7,079.00" "$7,079.00" "$4,105.82" "$7,079.00" "$4,247.40" "$7,079.00" "$7,079.00" "$7,079.00" N/A N/A 27204282 EAP HCPCS C1713 KYPHOPLASTY CEMEMNT MIXER-A07A BOTH IP/OP $237.00 $175.50 $47.04 $237.00 $128.69 $128.69 $128.69 $128.69 $237.00 $237.00 $237.00 $49.40 $237.00 $175.90 $175.90 $182.68 $123.48 $49.39 $237.00 $237.00 $140.19 $237.00 $237.00 $237.00 $237.00 $177.75 $237.00 $237.00 $237.00 $118.50 $118.50 $187.70 $237.00 $189.60 $154.05 $47.04 $237.00 $137.46 $237.00 $142.20 $237.00 $49.39 $237.00 N/A N/A 27204283 EAP HCPCS C1713 KYPHOASTY ACTIVOS CEMENT-C10A BOTH IP/OP $901.00 $667.00 $178.83 $901.00 $489.24 $489.24 $489.24 $489.24 $901.00 $901.00 $901.00 $187.79 $901.00 $668.72 $668.72 $694.49 $469.42 $187.78 $901.00 $901.00 $532.94 $901.00 $901.00 $901.00 $901.00 $675.75 $901.00 $901.00 $901.00 $450.50 $450.50 $713.59 $901.00 $720.80 $585.65 $178.83 $901.00 $522.58 $901.00 $540.60 $901.00 $187.77 $901.00 N/A N/A 27204284 EAP HCPCS C1884 RX EMOSHEILD NAV6 5.0 MM BOTH IP/OP "$4,581.00" "$3,390.00" $909.21 "$4,581.00" "$2,487.48" "$2,487.48" "$2,487.48" "$2,487.48" "$4,581.00" "$4,581.00" "$4,581.00" $954.79 "$4,581.00" "$3,400.02" "$3,400.02" "$3,531.03" "$2,060.15" $954.73 "$4,581.00" "$4,581.00" "$2,709.66" "$4,581.00" "$4,581.00" "$4,581.00" "$4,581.00" "$3,435.75" "$4,581.00" "$4,581.00" "$4,581.00" "$2,290.50" "$2,290.50" "$3,628.15" "$4,581.00" "$3,664.80" "$2,977.65" $909.21 "$4,581.00" "$2,656.98" "$4,581.00" "$2,748.60" "$4,581.00" $954.68 "$4,581.00" N/A N/A 27204286 EAP HCPCS C1884 RX EMBOSHEILD NAV6 7.2 MM BOTH IP/OP "$4,581.00" "$3,390.00" $909.21 "$4,581.00" "$2,487.48" "$2,487.48" "$2,487.48" "$2,487.48" "$4,581.00" "$4,581.00" "$4,581.00" $954.79 "$4,581.00" "$3,400.02" "$3,400.02" "$3,531.03" "$2,060.15" $954.73 "$4,581.00" "$4,581.00" "$2,709.66" "$4,581.00" "$4,581.00" "$4,581.00" "$4,581.00" "$3,435.75" "$4,581.00" "$4,581.00" "$4,581.00" "$2,290.50" "$2,290.50" "$3,628.15" "$4,581.00" "$3,664.80" "$2,977.65" $909.21 "$4,581.00" "$2,656.98" "$4,581.00" "$2,748.60" "$4,581.00" $954.68 "$4,581.00" N/A N/A 27204292 EAP HCPCS C1769 GUIDEWIRE X-PEDION-10 RE 2 BOTH IP/OP $778.00 $576.00 $154.41 $778.00 $422.45 $422.45 $422.45 $422.45 $778.00 $778.00 $778.00 $162.15 $778.00 $577.43 $577.43 $599.68 $405.34 $162.14 $778.00 $778.00 $460.19 $778.00 $778.00 $778.00 $778.00 $583.50 $778.00 $778.00 $778.00 $389.00 $389.00 $616.18 $778.00 $622.40 $505.70 $154.41 $778.00 $451.24 $778.00 $778.00 $778.00 $162.14 $778.00 N/A N/A 27204293 EAP HCPCS C1769 MIRAGE RE .008 BOTH IP/OP "$1,288.00" $953.50 $255.64 "$1,288.00" $699.38 $699.38 $699.38 $699.38 "$1,288.00" "$1,288.00" "$1,288.00" $268.45 "$1,288.00" $955.95 $955.95 $992.79 $671.05 $268.43 "$1,288.00" "$1,288.00" $761.85 "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" $966.00 "$1,288.00" "$1,288.00" "$1,288.00" $644.00 $644.00 "$1,020.10" "$1,288.00" "$1,030.40" $837.20 $255.64 "$1,288.00" $747.04 "$1,288.00" "$1,288.00" "$1,288.00" $268.42 "$1,288.00" N/A N/A 27204294 EAP HCPCS C1887 CATHETER MARATHON BOTH IP/OP "$1,861.00" "$1,377.50" $369.36 "$1,861.00" "$1,010.52" "$1,010.52" "$1,010.52" "$1,010.52" "$1,861.00" "$1,861.00" "$1,861.00" $387.88 "$1,861.00" "$1,381.23" "$1,381.23" "$1,434.46" $969.58 $387.85 "$1,861.00" "$1,861.00" "$1,100.78" "$1,861.00" "$1,861.00" "$1,861.00" "$1,861.00" "$1,395.75" "$1,861.00" "$1,861.00" "$1,861.00" $930.50 $930.50 "$1,473.91" "$1,861.00" "$1,488.80" "$1,209.65" $369.36 "$1,861.00" "$1,079.38" "$1,861.00" "$1,861.00" "$1,861.00" $387.83 "$1,861.00" N/A N/A 27204299 EAP Custom 27204299 TURNPIKE CATHETER LP 135CM BOTH IP/OP "$1,313.00" $972.00 $233.71 "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" $233.71 "$1,313.00" "$1,313.00" $974.51 $974.51 "$1,012.06" $684.07 $273.64 "$1,313.00" $525.20 "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" $984.75 "$1,313.00" "$1,313.00" "$1,313.00" $656.50 $656.50 "$1,039.90" "$1,313.00" "$1,050.40" $853.45 "$1,313.00" "$1,313.00" $761.54 "$1,313.00" $787.80 "$1,313.00" "$1,313.00" "$1,313.00" N/A N/A 27204300 EAP Custom 27204300 TORQUE DELIVERY SYSTEM 10 FR BOTH IP/OP "$1,797.00" "$1,330.00" $319.87 "$1,797.00" "$1,797.00" "$1,797.00" "$1,797.00" "$1,797.00" "$1,797.00" "$1,797.00" $319.87 "$1,797.00" "$1,797.00" "$1,333.73" "$1,333.73" "$1,385.13" $936.24 $374.51 "$1,797.00" $718.80 "$1,797.00" "$1,797.00" "$1,797.00" "$1,797.00" "$1,797.00" "$1,347.75" "$1,797.00" "$1,797.00" "$1,797.00" $898.50 $898.50 "$1,423.22" "$1,797.00" "$1,437.60" "$1,168.05" "$1,797.00" "$1,797.00" "$1,042.26" "$1,797.00" "$1,078.20" "$1,797.00" "$1,797.00" "$1,797.00" N/A N/A 27204301 EAP Custom 27204301 SPIDER STANDARD SURGICAL PLATFORM BOTH IP/OP "$1,034.00" $765.50 $184.05 "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" $184.05 "$1,034.00" "$1,034.00" $767.43 $767.43 $797.01 $538.71 $215.50 "$1,034.00" $413.60 "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" $775.50 "$1,034.00" "$1,034.00" "$1,034.00" $517.00 $517.00 $818.93 "$1,034.00" $827.20 $672.10 "$1,034.00" "$1,034.00" $599.72 "$1,034.00" $620.40 "$1,034.00" "$1,034.00" "$1,034.00" N/A N/A 27204302 EAP HCPCS C1884 SYSTEM EMBOLIC SPIDERFX.014 IN L320 CM BOTH IP/OP "$4,124.00" "$3,052.00" $818.51 "$4,124.00" "$2,239.33" "$2,239.33" "$2,239.33" "$2,239.33" "$4,124.00" "$4,124.00" "$4,124.00" $859.54 "$4,124.00" "$3,060.83" "$3,060.83" "$3,178.78" "$2,060.15" $859.49 "$4,124.00" "$4,124.00" "$2,439.35" "$4,124.00" "$4,124.00" "$4,124.00" "$4,124.00" "$3,093.00" "$4,124.00" "$4,124.00" "$4,124.00" "$2,062.00" "$2,062.00" "$3,266.21" "$4,124.00" "$3,299.20" "$2,680.60" $818.51 "$4,124.00" "$2,391.92" "$4,124.00" "$4,124.00" "$4,124.00" $859.44 "$4,124.00" N/A N/A 27204303 EAP HCPCS C1725 CATH BALL DILATATION VIATRAC 14 PLUS XCELON .014 IN L BOTH IP/OP $739.00 $547.00 $146.67 $739.00 $401.28 $401.28 $401.28 $401.28 $739.00 $739.00 $739.00 $154.03 $739.00 $548.49 $548.49 $569.62 $385.02 $154.02 $739.00 $739.00 $437.12 $739.00 $739.00 $739.00 $739.00 $554.25 $739.00 $739.00 $739.00 $369.50 $369.50 $585.29 $739.00 $591.20 $480.35 $146.67 $739.00 $428.62 $739.00 $739.00 $739.00 $154.01 $739.00 N/A N/A 27204304 EAP HCPCS C1894 SHEATH CHECK-FLO FLEXOR .035 IN L55 CM OD6 FR MULTI BOTH IP/OP $68.00 $50.50 $13.50 $68.00 $36.92 $36.92 $36.92 $36.92 $68.00 $68.00 $68.00 $14.17 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $68.00 $40.22 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $13.50 $68.00 $39.44 $68.00 $68.00 $68.00 $14.17 $68.00 N/A N/A 27204305 EAP HCPCS C1894 SHEATH CHECK-FLO FLEXOR .035 IN L55 CM OD6 FR CURV STRAT BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $65.20 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204307 EAP HCPCS C1769 GUIDEWIRE VAS PT GRAPH HYDRO POLY STRAIGHT BOTH IP/OP "$2,572.00" "$1,903.50" $510.48 "$2,572.00" "$1,396.60" "$1,396.60" "$1,396.60" "$1,396.60" "$2,572.00" "$2,572.00" "$2,572.00" $536.07 "$2,572.00" "$1,908.94" "$1,908.94" "$1,982.50" "$1,340.01" $536.03 "$2,572.00" "$1,028.80" "$1,521.34" "$2,572.00" "$2,572.00" "$2,572.00" "$2,572.00" "$1,929.00" "$2,572.00" "$2,572.00" "$2,572.00" "$1,286.00" "$1,286.00" "$2,037.02" "$2,572.00" "$2,057.60" "$1,671.80" $510.48 "$2,572.00" "$1,491.76" "$2,572.00" "$2,572.00" "$2,572.00" $536.00 "$2,572.00" N/A N/A 27204308 EAP HCPCS C1769 GUIDEWIRE VASCULAR PT GRAPHIX HYDRO POLYMER J L300 CM BOTH IP/OP "$2,572.00" "$1,903.50" $510.48 "$2,572.00" "$1,396.60" "$1,396.60" "$1,396.60" "$1,396.60" "$2,572.00" "$2,572.00" "$2,572.00" $536.07 "$2,572.00" "$1,908.94" "$1,908.94" "$1,982.50" "$1,340.01" $536.03 "$2,572.00" "$2,572.00" "$1,521.34" "$2,572.00" "$2,572.00" "$2,572.00" "$2,572.00" "$1,929.00" "$2,572.00" "$2,572.00" "$2,572.00" "$1,286.00" "$1,286.00" "$2,037.02" "$2,572.00" "$2,057.60" "$1,671.80" $510.48 "$2,572.00" "$1,491.76" "$2,572.00" "$2,572.00" "$2,572.00" $536.00 "$2,572.00" N/A N/A 27204309 EAP HCPCS C2628 TRANSFORM COMPLIANT 3MM X 10MM BOTH IP/OP "$4,222.00" "$3,124.50" $837.96 "$4,222.00" "$2,292.55" "$2,292.55" "$2,292.55" "$2,292.55" "$4,222.00" "$4,222.00" "$4,222.00" $879.97 "$4,222.00" "$3,133.57" "$3,133.57" "$3,254.32" "$2,060.15" $879.91 "$4,222.00" "$4,222.00" "$2,497.31" "$4,222.00" "$4,222.00" "$4,222.00" "$4,222.00" "$3,166.50" "$4,222.00" "$4,222.00" "$4,222.00" "$2,111.00" "$2,111.00" "$3,343.82" "$4,222.00" "$3,377.60" "$2,744.30" $837.96 "$4,222.00" "$2,448.76" "$4,222.00" "$4,222.00" "$4,222.00" $879.86 "$4,222.00" N/A N/A 27204310 EAP HCPCS C2628 TRANSFORM COMPLIANT 3MM X 15MM BOTH IP/OP "$4,021.00" "$2,976.00" $798.07 "$4,021.00" "$2,183.40" "$2,183.40" "$2,183.40" "$2,183.40" "$4,021.00" "$4,021.00" "$4,021.00" $838.08 "$4,021.00" "$2,984.39" "$2,984.39" "$3,099.39" "$2,060.15" $838.02 "$4,021.00" "$4,021.00" "$2,378.42" "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" "$3,015.75" "$4,021.00" "$4,021.00" "$4,021.00" "$2,010.50" "$2,010.50" "$3,184.63" "$4,021.00" "$3,216.80" "$2,613.65" $798.07 "$4,021.00" "$2,332.18" "$4,021.00" "$4,021.00" "$4,021.00" $837.98 "$4,021.00" N/A N/A 27204311 EAP HCPCS C2628 TRANSFORM COMPLIANT 4MM X 10MM BOTH IP/OP "$4,021.00" "$2,976.00" $798.07 "$4,021.00" "$2,183.40" "$2,183.40" "$2,183.40" "$2,183.40" "$4,021.00" "$4,021.00" "$4,021.00" $838.08 "$4,021.00" "$2,984.39" "$2,984.39" "$3,099.39" "$2,060.15" $838.02 "$4,021.00" "$4,021.00" "$2,378.42" "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" "$3,015.75" "$4,021.00" "$4,021.00" "$4,021.00" "$2,010.50" "$2,010.50" "$3,184.63" "$4,021.00" "$3,216.80" "$2,613.65" $798.07 "$4,021.00" "$2,332.18" "$4,021.00" "$4,021.00" "$4,021.00" $837.98 "$4,021.00" N/A N/A 27204312 EAP HCPCS C2628 TRANSFORM COMPLIANT 4MM X 15MM BOTH IP/OP "$4,222.00" "$3,124.50" $837.96 "$4,222.00" "$2,292.55" "$2,292.55" "$2,292.55" "$2,292.55" "$4,222.00" "$4,222.00" "$4,222.00" $879.97 "$4,222.00" "$3,133.57" "$3,133.57" "$3,254.32" "$2,060.15" $879.91 "$4,222.00" "$4,222.00" "$2,497.31" "$4,222.00" "$4,222.00" "$4,222.00" "$4,222.00" "$3,166.50" "$4,222.00" "$4,222.00" "$4,222.00" "$2,111.00" "$2,111.00" "$3,343.82" "$4,222.00" "$3,377.60" "$2,744.30" $837.96 "$4,222.00" "$2,448.76" "$4,222.00" "$4,222.00" "$4,222.00" $879.86 "$4,222.00" N/A N/A 27204313 EAP HCPCS C2628 TRANSFORM COMPLIANT 4MM X 20MM BOTH IP/OP "$4,021.00" "$2,976.00" $798.07 "$4,021.00" "$2,183.40" "$2,183.40" "$2,183.40" "$2,183.40" "$4,021.00" "$4,021.00" "$4,021.00" $838.08 "$4,021.00" "$2,984.39" "$2,984.39" "$3,099.39" "$2,060.15" $838.02 "$4,021.00" "$4,021.00" "$2,378.42" "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" "$3,015.75" "$4,021.00" "$4,021.00" "$4,021.00" "$2,010.50" "$2,010.50" "$3,184.63" "$4,021.00" "$3,216.80" "$2,613.65" $798.07 "$4,021.00" "$2,332.18" "$4,021.00" "$4,021.00" "$4,021.00" $837.98 "$4,021.00" N/A N/A 27204314 EAP HCPCS C2628 TRANSFORM COMPLIANT 4MM X 30MM BOTH IP/OP "$4,021.00" "$2,976.00" $798.07 "$4,021.00" "$2,183.40" "$2,183.40" "$2,183.40" "$2,183.40" "$4,021.00" "$4,021.00" "$4,021.00" $838.08 "$4,021.00" "$2,984.39" "$2,984.39" "$3,099.39" "$2,060.15" $838.02 "$4,021.00" "$4,021.00" "$2,378.42" "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" "$3,015.75" "$4,021.00" "$4,021.00" "$4,021.00" "$2,010.50" "$2,010.50" "$3,184.63" "$4,021.00" "$3,216.80" "$2,613.65" $798.07 "$4,021.00" "$2,332.18" "$4,021.00" "$4,021.00" "$4,021.00" $837.98 "$4,021.00" N/A N/A 27204315 EAP HCPCS C2628 TRANSFORM COMPLIANT 5MM X 10MM BOTH IP/OP "$4,021.00" "$2,976.00" $798.07 "$4,021.00" "$2,183.40" "$2,183.40" "$2,183.40" "$2,183.40" "$4,021.00" "$4,021.00" "$4,021.00" $838.08 "$4,021.00" "$2,984.39" "$2,984.39" "$3,099.39" "$2,060.15" $838.02 "$4,021.00" "$4,021.00" "$2,378.42" "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" "$3,015.75" "$4,021.00" "$4,021.00" "$4,021.00" "$2,010.50" "$2,010.50" "$3,184.63" "$4,021.00" "$3,216.80" "$2,613.65" $798.07 "$4,021.00" "$2,332.18" "$4,021.00" "$4,021.00" "$4,021.00" $837.98 "$4,021.00" N/A N/A 27204316 EAP HCPCS C2628 TRANSFORM COMPLIANT 5MM X 10MM BOTH IP/OP "$4,021.00" "$2,976.00" $798.07 "$4,021.00" "$2,183.40" "$2,183.40" "$2,183.40" "$2,183.40" "$4,021.00" "$4,021.00" "$4,021.00" $838.08 "$4,021.00" "$2,984.39" "$2,984.39" "$3,099.39" "$2,060.15" $838.02 "$4,021.00" "$4,021.00" "$2,378.42" "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" "$3,015.75" "$4,021.00" "$4,021.00" "$4,021.00" "$2,010.50" "$2,010.50" "$3,184.63" "$4,021.00" "$3,216.80" "$2,613.65" $798.07 "$4,021.00" "$2,332.18" "$4,021.00" "$4,021.00" "$4,021.00" $837.98 "$4,021.00" N/A N/A 27204317 EAP HCPCS C2628 TRANSFORM COMPLIANT 5MM X 20MM BOTH IP/OP "$4,021.00" "$2,976.00" $798.07 "$4,021.00" "$2,183.40" "$2,183.40" "$2,183.40" "$2,183.40" "$4,021.00" "$4,021.00" "$4,021.00" $838.08 "$4,021.00" "$2,984.39" "$2,984.39" "$3,099.39" "$2,060.15" $838.02 "$4,021.00" "$4,021.00" "$2,378.42" "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" "$3,015.75" "$4,021.00" "$4,021.00" "$4,021.00" "$2,010.50" "$2,010.50" "$3,184.63" "$4,021.00" "$3,216.80" "$2,613.65" $798.07 "$4,021.00" "$2,332.18" "$4,021.00" "$4,021.00" "$4,021.00" $837.98 "$4,021.00" N/A N/A 27204318 EAP HCPCS C2628 TRANSFORM COMPLIANT 5MM X 30MM BOTH IP/OP "$4,021.00" "$2,976.00" $798.07 "$4,021.00" "$2,183.40" "$2,183.40" "$2,183.40" "$2,183.40" "$4,021.00" "$4,021.00" "$4,021.00" $838.08 "$4,021.00" "$2,984.39" "$2,984.39" "$3,099.39" "$2,060.15" $838.02 "$4,021.00" "$4,021.00" "$2,378.42" "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" "$3,015.75" "$4,021.00" "$4,021.00" "$4,021.00" "$2,010.50" "$2,010.50" "$3,184.63" "$4,021.00" "$3,216.80" "$2,613.65" $798.07 "$4,021.00" "$2,332.18" "$4,021.00" "$4,021.00" "$4,021.00" $837.98 "$4,021.00" N/A N/A 27204319 EAP HCPCS C2628 TRANSFORM SUPER COMPLIANT 3MM X 5MM BOTH IP/OP "$4,222.00" "$3,124.50" $837.96 "$4,222.00" "$2,292.55" "$2,292.55" "$2,292.55" "$2,292.55" "$4,222.00" "$4,222.00" "$4,222.00" $879.97 "$4,222.00" "$3,133.57" "$3,133.57" "$3,254.32" "$2,060.15" $879.91 "$4,222.00" "$4,222.00" "$2,497.31" "$4,222.00" "$4,222.00" "$4,222.00" "$4,222.00" "$3,166.50" "$4,222.00" "$4,222.00" "$4,222.00" "$2,111.00" "$2,111.00" "$3,343.82" "$4,222.00" "$3,377.60" "$2,744.30" $837.96 "$4,222.00" "$2,448.76" "$4,222.00" "$4,222.00" "$4,222.00" $879.86 "$4,222.00" N/A N/A 27204320 EAP HCPCS C2628 TRANSFORM SUPER COMPLIANT 4MM X 10MM BOTH IP/OP "$4,021.00" "$2,976.00" $798.07 "$4,021.00" "$2,183.40" "$2,183.40" "$2,183.40" "$2,183.40" "$4,021.00" "$4,021.00" "$4,021.00" $838.08 "$4,021.00" "$2,984.39" "$2,984.39" "$3,099.39" "$2,060.15" $838.02 "$4,021.00" "$4,021.00" "$2,378.42" "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" "$3,015.75" "$4,021.00" "$4,021.00" "$4,021.00" "$2,010.50" "$2,010.50" "$3,184.63" "$4,021.00" "$3,216.80" "$2,613.65" $798.07 "$4,021.00" "$2,332.18" "$4,021.00" "$4,021.00" "$4,021.00" $837.98 "$4,021.00" N/A N/A 27204321 EAP HCPCS C2628 TRANSFORM SUPER COMPLIANT 4MM X 7MM BOTH IP/OP "$4,021.00" "$2,976.00" $798.07 "$4,021.00" "$2,183.40" "$2,183.40" "$2,183.40" "$2,183.40" "$4,021.00" "$4,021.00" "$4,021.00" $838.08 "$4,021.00" "$2,984.39" "$2,984.39" "$3,099.39" "$2,060.15" $838.02 "$4,021.00" "$4,021.00" "$2,378.42" "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" "$3,015.75" "$4,021.00" "$4,021.00" "$4,021.00" "$2,010.50" "$2,010.50" "$3,184.63" "$4,021.00" "$3,216.80" "$2,613.65" $798.07 "$4,021.00" "$2,332.18" "$4,021.00" "$4,021.00" "$4,021.00" $837.98 "$4,021.00" N/A N/A 27204322 EAP HCPCS C2628 TRANSFORM SUPER COMPLIANT 7MM X 10MM BOTH IP/OP "$4,021.00" "$2,976.00" $798.07 "$4,021.00" "$2,183.40" "$2,183.40" "$2,183.40" "$2,183.40" "$4,021.00" "$4,021.00" "$4,021.00" $838.08 "$4,021.00" "$2,984.39" "$2,984.39" "$3,099.39" "$2,060.15" $838.02 "$4,021.00" "$4,021.00" "$2,378.42" "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" "$3,015.75" "$4,021.00" "$4,021.00" "$4,021.00" "$2,010.50" "$2,010.50" "$3,184.63" "$4,021.00" "$3,216.80" "$2,613.65" $798.07 "$4,021.00" "$2,332.18" "$4,021.00" "$4,021.00" "$4,021.00" $837.98 "$4,021.00" N/A N/A 27204323 EAP HCPCS C2628 TRANSFORM SUPER COMPLIANT 7MM X 15MM BOTH IP/OP "$4,021.00" "$2,976.00" $798.07 "$4,021.00" "$2,183.40" "$2,183.40" "$2,183.40" "$2,183.40" "$4,021.00" "$4,021.00" "$4,021.00" $838.08 "$4,021.00" "$2,984.39" "$2,984.39" "$3,099.39" "$2,060.15" $838.02 "$4,021.00" "$4,021.00" "$2,378.42" "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" "$3,015.75" "$4,021.00" "$4,021.00" "$4,021.00" "$2,010.50" "$2,010.50" "$3,184.63" "$4,021.00" "$3,216.80" "$2,613.65" $798.07 "$4,021.00" "$2,332.18" "$4,021.00" "$4,021.00" "$4,021.00" $837.98 "$4,021.00" N/A N/A 27204324 EAP HCPCS C2628 TRANSFORM SUPER COMPLIANT 7MM X 7MM BOTH IP/OP "$4,021.00" "$2,976.00" $798.07 "$4,021.00" "$2,183.40" "$2,183.40" "$2,183.40" "$2,183.40" "$4,021.00" "$4,021.00" "$4,021.00" $838.08 "$4,021.00" "$2,984.39" "$2,984.39" "$3,099.39" "$2,060.15" $838.02 "$4,021.00" "$4,021.00" "$2,378.42" "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" "$3,015.75" "$4,021.00" "$4,021.00" "$4,021.00" "$2,010.50" "$2,010.50" "$3,184.63" "$4,021.00" "$3,216.80" "$2,613.65" $798.07 "$4,021.00" "$2,332.18" "$4,021.00" "$4,021.00" "$4,021.00" $837.98 "$4,021.00" N/A N/A 27204330 EAP Custom 27204330 PROBE STEREO MAMMO REVOLVE L9 CM OD8 GA BOTH IP/OP "$1,378.00" "$1,020.00" $245.28 "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" $245.28 "$1,378.00" "$1,378.00" "$1,022.75" "$1,022.75" "$1,062.16" $717.94 $287.19 "$1,378.00" $551.20 "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" "$1,033.50" "$1,378.00" "$1,378.00" "$1,378.00" $689.00 $689.00 "$1,091.38" "$1,378.00" "$1,102.40" $895.70 "$1,378.00" "$1,378.00" $799.24 "$1,378.00" $826.80 "$1,378.00" "$1,378.00" "$1,378.00" N/A N/A 27204334 EAP Custom 27204334 GLIDESHEATH SLENDER 6F BOTH IP/OP $160.00 $118.50 $28.48 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $28.48 $160.00 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $64.00 $160.00 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $160.00 $160.00 $92.80 $160.00 $96.00 $160.00 $160.00 $160.00 N/A N/A 27204335 EAP Custom 27204335 TORQUE DELIVERY SYSTEM 12 FR BOTH IP/OP "$1,797.00" "$1,330.00" $319.87 "$1,797.00" "$1,797.00" "$1,797.00" "$1,797.00" "$1,797.00" "$1,797.00" "$1,797.00" $319.87 "$1,797.00" "$1,797.00" "$1,333.73" "$1,333.73" "$1,385.13" $936.24 $374.51 "$1,797.00" $718.80 "$1,797.00" "$1,797.00" "$1,797.00" "$1,797.00" "$1,797.00" "$1,347.75" "$1,797.00" "$1,797.00" "$1,797.00" $898.50 $898.50 "$1,423.22" "$1,797.00" "$1,437.60" "$1,168.05" "$1,797.00" "$1,797.00" "$1,042.26" "$1,797.00" "$1,078.20" "$1,797.00" "$1,797.00" "$1,797.00" N/A N/A 27204336 EAP Custom 27204336 AMPLATZER SIZING BALLOONS 34 MM BOTH IP/OP $821.00 $608.00 $146.14 $821.00 $821.00 $821.00 $821.00 $821.00 $821.00 $821.00 $146.14 $821.00 $821.00 $609.35 $609.35 $632.83 $427.74 $171.11 $821.00 $328.40 $821.00 $821.00 $821.00 $821.00 $821.00 $615.75 $821.00 $821.00 $821.00 $410.50 $410.50 $650.23 $821.00 $656.80 $533.65 $821.00 $821.00 $476.18 $821.00 $492.60 $821.00 $821.00 $821.00 N/A N/A 27204337 EAP HCPCS C1759 VIEWFLEX ICE PLUS CATHETER BOTH IP/OP "$8,102.00" "$5,995.50" "$1,688.55" "$8,102.00" "$8,102.00" "$8,102.00" "$8,102.00" "$8,102.00" "$8,102.00" "$8,102.00" "$8,102.00" "$8,102.00" "$8,102.00" "$4,181.12" "$4,181.12" "$6,245.02" "$2,060.15" "$1,688.55" "$8,102.00" "$3,240.80" "$8,102.00" "$8,102.00" "$8,102.00" "$8,102.00" "$8,102.00" "$6,076.50" "$8,102.00" "$8,102.00" "$8,102.00" "$4,051.00" "$4,051.00" "$6,416.78" "$8,102.00" "$6,481.60" "$5,266.30" "$8,102.00" "$8,102.00" "$4,699.16" "$8,102.00" "$4,861.20" "$8,102.00" "$8,102.00" "$8,102.00" N/A N/A 27204338 EAP Custom 27204338 SYSTEM FEC MGMT 60CC NS LF DIGNISHIELD CATH SYR CL BOTH IP/OP $298.00 $221.00 $53.04 $298.00 $298.00 $298.00 $298.00 $298.00 $298.00 $298.00 $53.04 $298.00 $298.00 $221.18 $221.18 $229.70 $155.26 $62.11 $298.00 $119.20 $298.00 $298.00 $298.00 $298.00 $298.00 $223.50 $298.00 $298.00 $298.00 $149.00 $149.00 $236.02 $298.00 $238.40 $193.70 $298.00 $298.00 $172.84 $298.00 $178.80 $298.00 $298.00 $298.00 N/A N/A 27204354 EAP HCPCS C1725 CATH BALDILAT .014IN 5FR 2.5MM 20MM CORON RAPEX ULT LP GUID BOTH IP/OP $390.00 $289.00 $77.41 $390.00 $211.77 $211.77 $211.77 $211.77 $390.00 $390.00 $390.00 $81.29 $390.00 $289.46 $289.46 $300.61 $203.19 $81.28 $390.00 $156.00 $230.69 $390.00 $390.00 $390.00 $390.00 $292.50 $390.00 $390.00 $390.00 $195.00 $195.00 $308.88 $390.00 $312.00 $253.50 $77.41 $390.00 $226.20 $390.00 $390.00 $390.00 $81.28 $390.00 N/A N/A 27204360 EAP HCPCS C1725 CATH BALDILAT .014IN 5FR 3.5MM 20MM CORON RAPEX ULT LP GUID BOTH IP/OP $336.00 $249.00 $66.69 $336.00 $182.45 $182.45 $182.45 $182.45 $336.00 $336.00 $336.00 $70.03 $336.00 $249.38 $249.38 $258.99 $175.06 $70.03 $336.00 $134.40 $198.74 $336.00 $336.00 $336.00 $336.00 $252.00 $336.00 $336.00 $336.00 $168.00 $168.00 $266.11 $336.00 $268.80 $218.40 $66.69 $336.00 $194.88 $336.00 $336.00 $336.00 $70.02 $336.00 N/A N/A 27204362 EAP HCPCS C1725 CATH BALDILAT .021IN 5FR 4MM 8MM CORON RAPEX HYPOTUBE SLIM BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $201.45 $201.45 $201.45 $201.45 $371.00 $371.00 $371.00 $77.33 $371.00 $275.36 $275.36 $285.97 $193.29 $77.32 $371.00 $371.00 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $241.15 $73.63 $371.00 $215.18 $371.00 $371.00 $371.00 $77.32 $371.00 N/A N/A 27204363 EAP HCPCS C1725 CATH BALDILAT .021IN 5FR 4MM 12MM CORON RAPEX LP FLXB TUNG BOTH IP/OP $353.00 $261.50 $70.06 $353.00 $191.68 $191.68 $191.68 $191.68 $353.00 $353.00 $353.00 $73.57 $353.00 $262.00 $262.00 $272.09 $183.91 $73.57 $353.00 $141.20 $208.80 $353.00 $353.00 $353.00 $353.00 $264.75 $353.00 $353.00 $353.00 $176.50 $176.50 $279.58 $353.00 $282.40 $229.45 $70.06 $353.00 $204.74 $353.00 $353.00 $353.00 $73.57 $353.00 N/A N/A 27204368 EAP HCPCS C1725 CATH BALDILAT 2.25MM 15MM CORON RAPEX FLXB DUAL TUNG MRKR BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $201.45 $201.45 $201.45 $201.45 $371.00 $371.00 $371.00 $77.33 $371.00 $275.36 $275.36 $285.97 $193.29 $77.32 $371.00 $148.40 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $241.15 $73.63 $371.00 $215.18 $371.00 $371.00 $371.00 $77.32 $371.00 N/A N/A 27204371 EAP HCPCS C1725 CATH BALDILAT 3.25MM 8MM CORON RAPEX DUAL TUNG MRKR FLXB BOTH IP/OP $336.00 $249.00 $66.69 $336.00 $182.45 $182.45 $182.45 $182.45 $336.00 $336.00 $336.00 $70.03 $336.00 $249.38 $249.38 $258.99 $175.06 $70.03 $336.00 $336.00 $198.74 $336.00 $336.00 $336.00 $336.00 $252.00 $336.00 $336.00 $336.00 $168.00 $168.00 $266.11 $336.00 $268.80 $218.40 $66.69 $336.00 $194.88 $336.00 $336.00 $336.00 $70.02 $336.00 N/A N/A 27204372 EAP HCPCS C1725 CATH BALDILAT 3.25MM 20MM CORON RAPEX DUAL TUNG MRKR FLXB BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $201.45 $201.45 $201.45 $201.45 $371.00 $371.00 $371.00 $77.33 $371.00 $275.36 $275.36 $285.97 $193.29 $77.32 $371.00 $148.40 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $241.15 $73.63 $371.00 $215.18 $371.00 $371.00 $371.00 $77.32 $371.00 N/A N/A 27204374 EAP HCPCS C1725 CATH BALDILAT 4.5MM 8MM CORON RAPEX FLXB DUAL TUNG MRKR SMTH BOTH IP/OP $353.00 $261.50 $70.06 $353.00 $191.68 $191.68 $191.68 $191.68 $353.00 $353.00 $353.00 $73.57 $353.00 $262.00 $262.00 $272.09 $183.91 $73.57 $353.00 $353.00 $208.80 $353.00 $353.00 $353.00 $353.00 $264.75 $353.00 $353.00 $353.00 $176.50 $176.50 $279.58 $353.00 $282.40 $229.45 $70.06 $353.00 $204.74 $353.00 $353.00 $353.00 $73.57 $353.00 N/A N/A 27204375 EAP HCPCS C1725 CATH BALDILAT 4.5MM 15MM CORON RAPEX DUAL TUNG MRKR FLXB BOTH IP/OP $336.00 $249.00 $66.69 $336.00 $182.45 $182.45 $182.45 $182.45 $336.00 $336.00 $336.00 $70.03 $336.00 $249.38 $249.38 $258.99 $175.06 $70.03 $336.00 $134.40 $198.74 $336.00 $336.00 $336.00 $336.00 $252.00 $336.00 $336.00 $336.00 $168.00 $168.00 $266.11 $336.00 $268.80 $218.40 $66.69 $336.00 $194.88 $336.00 $336.00 $336.00 $70.02 $336.00 N/A N/A 27204376 EAP HCPCS C1725 CATH BALDILAT 5MM 15MM CORON RAPEX FLXB DUAL TUNG MRKR SMTH BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $201.45 $201.45 $201.45 $201.45 $371.00 $371.00 $371.00 $77.33 $371.00 $275.36 $275.36 $285.97 $193.29 $77.32 $371.00 $371.00 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $241.15 $73.63 $371.00 $215.18 $371.00 $371.00 $371.00 $77.32 $371.00 N/A N/A 27204404 EAP HCPCS C1892 SHEATH LONG NEURONMAX 90/4 STRAIGHT 6F 088 BOTH IP/OP "$1,086.00" $804.00 $215.54 "$1,086.00" $589.70 $589.70 $589.70 $589.70 "$1,086.00" "$1,086.00" "$1,086.00" $226.35 "$1,086.00" $806.03 $806.03 $837.09 $565.81 $226.33 "$1,086.00" "$1,086.00" $642.37 "$1,086.00" "$1,086.00" "$1,086.00" "$1,086.00" $814.50 "$1,086.00" "$1,086.00" "$1,086.00" $543.00 $543.00 $860.11 "$1,086.00" $868.80 $705.90 $215.54 "$1,086.00" $629.88 "$1,086.00" "$1,086.00" "$1,086.00" $226.32 "$1,086.00" N/A N/A 27204405 EAP HCPCS C1753 CATHETER ULTRASOUND EAGLE EYE GOLD OD5 FR SHORT TIP BOTH IP/OP "$1,999.00" "$1,479.50" $396.75 "$1,999.00" "$1,085.46" "$1,085.46" "$1,085.46" "$1,085.46" "$1,999.00" "$1,999.00" "$1,999.00" $416.64 "$1,999.00" "$1,483.66" "$1,483.66" "$1,540.83" "$1,041.48" $416.61 "$1,999.00" "$1,999.00" "$1,182.41" "$1,999.00" "$1,999.00" "$1,999.00" "$1,999.00" "$1,499.25" "$1,999.00" "$1,999.00" "$1,999.00" $999.50 $999.50 "$1,583.21" "$1,999.00" "$1,599.20" "$1,299.35" $396.75 "$1,999.00" "$1,159.42" "$1,999.00" "$1,999.00" "$1,999.00" $416.59 "$1,999.00" N/A N/A 27204406 EAP Custom 27204406 CATHETER STEERABLE 3.2 OUTER DIAM 2MM WORKING CHANNEL BOTH IP/OP "$1,653.00" "$1,223.50" $294.23 "$1,653.00" "$1,653.00" "$1,653.00" "$1,653.00" "$1,653.00" "$1,653.00" "$1,653.00" $294.23 "$1,653.00" "$1,653.00" "$1,226.86" "$1,226.86" "$1,274.13" $861.21 $344.50 "$1,653.00" $661.20 "$1,653.00" "$1,653.00" "$1,653.00" "$1,653.00" "$1,653.00" "$1,239.75" "$1,653.00" "$1,653.00" "$1,653.00" $826.50 $826.50 "$1,309.18" "$1,653.00" "$1,322.40" "$1,074.45" "$1,653.00" "$1,653.00" $958.74 "$1,653.00" $991.80 "$1,653.00" "$1,653.00" "$1,653.00" N/A N/A 27204407 EAP HCPCS C1887 TREVO MICROCATHETER BOTH IP/OP "$1,147.00" $849.00 $227.65 "$1,147.00" $622.82 $622.82 $622.82 $622.82 "$1,147.00" "$1,147.00" "$1,147.00" $239.06 "$1,147.00" $851.30 $851.30 $884.11 $597.59 $239.05 "$1,147.00" "$1,147.00" $678.45 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $860.25 "$1,147.00" "$1,147.00" "$1,147.00" $573.50 $573.50 $908.42 "$1,147.00" $917.60 $745.55 $227.65 "$1,147.00" $665.26 "$1,147.00" "$1,147.00" "$1,147.00" $239.03 "$1,147.00" N/A N/A 27204408 EAP HCPCS C1757 RETRIEVER STENT TREVO XP 4 X 20 BOTH IP/OP "$12,766.00" "$9,447.00" "$2,060.15" "$12,766.00" "$6,931.94" "$6,931.94" "$6,931.94" "$6,931.94" "$12,766.00" "$12,766.00" "$12,766.00" "$2,660.75" "$12,766.00" "$4,181.12" "$4,181.12" "$9,840.03" "$2,060.15" "$2,660.57" "$12,766.00" "$12,766.00" "$3,094.73" "$12,766.00" "$12,766.00" "$12,766.00" "$12,766.00" "$9,574.50" "$12,766.00" "$12,766.00" "$12,766.00" "$6,383.00" "$6,383.00" "$10,110.67" "$12,766.00" "$10,212.80" "$8,297.90" "$2,533.73" "$12,766.00" "$7,404.28" "$12,766.00" "$12,766.00" "$12,766.00" "$2,660.43" "$12,766.00" N/A N/A 27204409 EAP HCPCS C1757 RETRIEVER STENT TREVO XP 3 X 20 BOTH IP/OP "$14,776.00" "$10,934.50" "$2,060.15" "$14,776.00" "$8,023.37" "$8,023.37" "$8,023.37" "$8,023.37" "$14,776.00" "$14,776.00" "$14,776.00" "$3,079.69" "$14,776.00" "$4,181.12" "$4,181.12" "$11,389.34" "$2,060.15" "$3,079.48" "$14,776.00" "$14,776.00" "$3,094.73" "$14,776.00" "$14,776.00" "$14,776.00" "$14,776.00" "$11,082.00" "$14,776.00" "$14,776.00" "$14,776.00" "$7,388.00" "$7,388.00" "$11,702.59" "$14,776.00" "$11,820.80" "$9,604.40" "$2,932.67" "$14,776.00" "$8,570.08" "$14,776.00" "$14,776.00" "$14,776.00" "$3,079.32" "$14,776.00" N/A N/A 27204416 EAP HCPCS C1757 SET CATH 135CM 5FR 3MM SPIROFLEX VG ANGJT .014IN THRMB GWIRE BOTH IP/OP "$5,925.00" "$4,384.50" "$1,175.96" "$5,925.00" "$3,217.28" "$3,217.28" "$3,217.28" "$3,217.28" "$5,925.00" "$5,925.00" "$5,925.00" "$1,234.92" "$5,925.00" "$4,181.12" "$4,181.12" "$4,566.99" "$2,060.15" "$1,234.84" "$5,925.00" "$5,925.00" "$3,094.73" "$5,925.00" "$5,925.00" "$5,925.00" "$5,925.00" "$4,443.75" "$5,925.00" "$5,925.00" "$5,925.00" "$2,962.50" "$2,962.50" "$4,692.60" "$5,925.00" "$4,740.00" "$3,851.25" "$1,175.96" "$5,925.00" "$3,436.50" "$5,925.00" "$5,925.00" "$5,925.00" "$1,234.77" "$5,925.00" N/A N/A 27204417 EAP HCPCS C1714 CATHETER TURBOHAWK HIGH EFFICIENCY CUTTER- LARGE VESSEL STANDARD CALCIUM BOTH IP/OP "$9,081.00" "$6,720.00" "$1,892.58" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$4,181.12" "$4,181.12" "$6,999.63" "$2,060.15" "$1,892.58" "$9,081.00" "$3,632.40" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$6,810.75" "$9,081.00" "$9,081.00" "$9,081.00" "$4,540.50" "$4,540.50" "$7,192.15" "$9,081.00" "$7,264.80" "$5,902.65" "$9,081.00" "$9,081.00" "$5,266.98" "$9,081.00" "$5,448.60" "$9,081.00" "$9,081.00" "$9,081.00" N/A N/A 27204418 EAP HCPCS C1714 CATHETER TURBOHAWK  HIGH EFFICIENCY CUTTER- LARGE VESSEL XTENDED CALCIUM TIP LX-C BOTH IP/OP "$9,081.00" "$6,720.00" "$1,892.58" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$4,181.12" "$4,181.12" "$6,999.63" "$2,060.15" "$1,892.58" "$9,081.00" "$3,632.40" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$6,810.75" "$9,081.00" "$9,081.00" "$9,081.00" "$4,540.50" "$4,540.50" "$7,192.15" "$9,081.00" "$7,264.80" "$5,902.65" "$9,081.00" "$9,081.00" "$5,266.98" "$9,081.00" "$5,448.60" "$9,081.00" "$9,081.00" "$9,081.00" N/A N/A 27204419 EAP HCPCS C1714 CATHETER TURBOHAWK SMOOTH CUTTER- LARGE VESSEL XTENDED TIP  LX-M BOTH IP/OP "$9,081.00" "$6,720.00" "$1,892.58" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$4,181.12" "$4,181.12" "$6,999.63" "$2,060.15" "$1,892.58" "$9,081.00" "$3,632.40" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$6,810.75" "$9,081.00" "$9,081.00" "$9,081.00" "$4,540.50" "$4,540.50" "$7,192.15" "$9,081.00" "$7,264.80" "$5,902.65" "$9,081.00" "$9,081.00" "$5,266.98" "$9,081.00" "$5,448.60" "$9,081.00" "$9,081.00" "$9,081.00" N/A N/A 27204420 EAP HCPCS C1714 CATHETER TURBOHAWK   HIGH EFFICIENCY CUTTER- SMALL VESSEL XTENDED CALCIUM TIP SX-C BOTH IP/OP "$9,081.00" "$6,720.00" "$1,892.58" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$4,181.12" "$4,181.12" "$6,999.63" "$2,060.15" "$1,892.58" "$9,081.00" "$3,632.40" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$6,810.75" "$9,081.00" "$9,081.00" "$9,081.00" "$4,540.50" "$4,540.50" "$7,192.15" "$9,081.00" "$7,264.80" "$5,902.65" "$9,081.00" "$9,081.00" "$5,266.98" "$9,081.00" "$5,448.60" "$9,081.00" "$9,081.00" "$9,081.00" N/A N/A 27204421 EAP HCPCS C1714 CATHETER TURBOHAWK  HIGH EFFICIENCY CUTTER SMALL VESSEL STANDARD CALCIUM TIP LONG CATHETER  SS-CL BOTH IP/OP "$9,081.00" "$6,720.00" "$1,892.58" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$4,181.12" "$4,181.12" "$6,999.63" "$2,060.15" "$1,892.58" "$9,081.00" "$3,632.40" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$6,810.75" "$9,081.00" "$9,081.00" "$9,081.00" "$4,540.50" "$4,540.50" "$7,192.15" "$9,081.00" "$7,264.80" "$5,902.65" "$9,081.00" "$9,081.00" "$5,266.98" "$9,081.00" "$5,448.60" "$9,081.00" "$9,081.00" "$9,081.00" N/A N/A 27204422 EAP HCPCS C1714 CATHETER TURBOHAWK SMOOTH CUTTER- LARGE VESSEL STANDARD TIP   LS-M BOTH IP/OP "$9,081.00" "$6,720.00" "$1,892.58" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$4,181.12" "$4,181.12" "$6,999.63" "$2,060.15" "$1,892.58" "$9,081.00" "$3,632.40" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$9,081.00" "$6,810.75" "$9,081.00" "$9,081.00" "$9,081.00" "$4,540.50" "$4,540.50" "$7,192.15" "$9,081.00" "$7,264.80" "$5,902.65" "$9,081.00" "$9,081.00" "$5,266.98" "$9,081.00" "$5,448.60" "$9,081.00" "$9,081.00" "$9,081.00" N/A N/A 27204423 EAP HCPCS C1769 GWIRE VASC 190CM .014IN CORE TO TIP STR 16CM A FLDR XT BOTH IP/OP $414.00 $306.50 $82.17 $414.00 $224.80 $224.80 $224.80 $224.80 $414.00 $414.00 $414.00 $86.29 $414.00 $307.27 $307.27 $319.11 $215.69 $86.28 $414.00 $414.00 $244.88 $414.00 $414.00 $414.00 $414.00 $310.50 $414.00 $414.00 $414.00 $207.00 $207.00 $327.89 $414.00 $331.20 $269.10 $82.17 $414.00 $240.12 $414.00 $414.00 $414.00 $86.28 $414.00 N/A N/A 27204424 EAP HCPCS C1769 GWIRE VASC 300CM .014IN CORE TO TIP STR 16CM A FLDR XT BOTH IP/OP $414.00 $306.50 $82.17 $414.00 $224.80 $224.80 $224.80 $224.80 $414.00 $414.00 $414.00 $86.29 $414.00 $307.27 $307.27 $319.11 $215.69 $86.28 $414.00 $414.00 $244.88 $414.00 $414.00 $414.00 $414.00 $310.50 $414.00 $414.00 $414.00 $207.00 $207.00 $327.89 $414.00 $331.20 $269.10 $82.17 $414.00 $240.12 $414.00 $414.00 $414.00 $86.28 $414.00 N/A N/A 27204426 EAP Custom 27204426 CERTUS LK ABLATION 15CM-17 GAUGE BOTH IP/OP "$6,063.00" "$4,487.00" "$1,079.21" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$1,079.21" "$6,063.00" "$6,063.00" "$4,181.12" "$4,181.12" "$4,673.36" "$2,060.15" "$1,263.60" "$6,063.00" "$2,425.20" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$4,547.25" "$6,063.00" "$6,063.00" "$6,063.00" "$3,031.50" "$3,031.50" "$4,801.90" "$6,063.00" "$4,850.40" "$3,940.95" "$6,063.00" "$6,063.00" "$3,516.54" "$6,063.00" "$3,637.80" "$6,063.00" "$6,063.00" "$6,063.00" N/A N/A 27204427 EAP Custom 27204427 CERTUS LK ABLATION 20CM-17 GAUGE BOTH IP/OP "$6,063.00" "$4,487.00" "$1,079.21" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$1,079.21" "$6,063.00" "$6,063.00" "$4,181.12" "$4,181.12" "$4,673.36" "$2,060.15" "$1,263.60" "$6,063.00" "$2,425.20" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$4,547.25" "$6,063.00" "$6,063.00" "$6,063.00" "$3,031.50" "$3,031.50" "$4,801.90" "$6,063.00" "$4,850.40" "$3,940.95" "$6,063.00" "$6,063.00" "$3,516.54" "$6,063.00" "$3,637.80" "$6,063.00" "$6,063.00" "$6,063.00" N/A N/A 27204428 EAP Custom 27204428 CERTUS LN ABLATION 15CM-17 GAUGE BOTH IP/OP "$6,063.00" "$4,487.00" "$1,079.21" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$1,079.21" "$6,063.00" "$6,063.00" "$4,181.12" "$4,181.12" "$4,673.36" "$2,060.15" "$1,263.60" "$6,063.00" "$2,425.20" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$4,547.25" "$6,063.00" "$6,063.00" "$6,063.00" "$3,031.50" "$3,031.50" "$4,801.90" "$6,063.00" "$4,850.40" "$3,940.95" "$6,063.00" "$6,063.00" "$3,516.54" "$6,063.00" "$3,637.80" "$6,063.00" "$6,063.00" "$6,063.00" N/A N/A 27204429 EAP Custom 27204429 CERTUS LN ABLATION 20CM-17 GAUGE BOTH IP/OP "$6,063.00" "$4,487.00" "$1,079.21" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$1,079.21" "$6,063.00" "$6,063.00" "$4,181.12" "$4,181.12" "$4,673.36" "$2,060.15" "$1,263.60" "$6,063.00" "$2,425.20" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$4,547.25" "$6,063.00" "$6,063.00" "$6,063.00" "$3,031.50" "$3,031.50" "$4,801.90" "$6,063.00" "$4,850.40" "$3,940.95" "$6,063.00" "$6,063.00" "$3,516.54" "$6,063.00" "$3,637.80" "$6,063.00" "$6,063.00" "$6,063.00" N/A N/A 27204431 EAP HCPCS C1769 GWIRE VASC RSN CURVE J CURVE LNG .035IN 260CM 1.5MM EXCH BOTH IP/OP $82.00 $61.00 $16.27 $82.00 $44.53 $44.53 $44.53 $44.53 $82.00 $82.00 $82.00 $17.09 $82.00 $60.86 $60.86 $63.21 $42.72 $17.09 $82.00 $32.80 $48.50 $82.00 $82.00 $82.00 $82.00 $61.50 $82.00 $82.00 $82.00 $41.00 $41.00 $64.94 $82.00 $65.60 $53.30 $16.27 $82.00 $47.56 $82.00 $82.00 $82.00 $17.09 $82.00 N/A N/A 27204432 EAP HCPCS C1773 KIT VASC 120CM 15MM 6FR AGN NTNL GOLD TUNG LOOP CATH NTNL BOTH IP/OP $882.00 $653.00 $175.05 $882.00 $478.93 $478.93 $478.93 $478.93 $882.00 $882.00 $882.00 $183.83 $882.00 $654.62 $654.62 $679.85 $459.52 $183.82 $882.00 $882.00 $521.70 $882.00 $882.00 $882.00 $882.00 $661.50 $882.00 $882.00 $882.00 $441.00 $441.00 $698.54 $882.00 $705.60 $573.30 $175.05 $882.00 $511.56 $882.00 $882.00 $882.00 $183.81 $882.00 N/A N/A 27204433 EAP HCPCS C1773 KIT VASC 120CM 25MM 6FR AGN NTNL GOLD TUNG LOOP CATH NTNL BOTH IP/OP $882.00 $653.00 $175.05 $882.00 $478.93 $478.93 $478.93 $478.93 $882.00 $882.00 $882.00 $183.83 $882.00 $654.62 $654.62 $679.85 $459.52 $183.82 $882.00 $882.00 $521.70 $882.00 $882.00 $882.00 $882.00 $661.50 $882.00 $882.00 $882.00 $441.00 $441.00 $698.54 $882.00 $705.60 $573.30 $175.05 $882.00 $511.56 $882.00 $882.00 $882.00 $183.81 $882.00 N/A N/A 27204434 EAP HCPCS C1773 KIT VASC 120CM 10MM 4FR AGN NTNL GOLD TUNG LOOP CATH NTNL BOTH IP/OP $882.00 $653.00 $175.05 $882.00 $478.93 $478.93 $478.93 $478.93 $882.00 $882.00 $882.00 $183.83 $882.00 $654.62 $654.62 $679.85 $459.52 $183.82 $882.00 $882.00 $521.70 $882.00 $882.00 $882.00 $882.00 $661.50 $882.00 $882.00 $882.00 $441.00 $441.00 $698.54 $882.00 $705.60 $573.30 $175.05 $882.00 $511.56 $882.00 $882.00 $882.00 $183.81 $882.00 N/A N/A 27204436 EAP HCPCS C1757 TREVO XP - 4MM X 20MM BOTH IP/OP "$14,072.00" "$10,413.50" "$2,060.15" "$14,072.00" "$7,641.10" "$7,641.10" "$7,641.10" "$7,641.10" "$14,072.00" "$14,072.00" "$14,072.00" "$2,932.96" "$14,072.00" "$4,181.12" "$4,181.12" "$10,846.70" "$2,060.15" "$2,932.76" "$14,072.00" "$14,072.00" "$3,094.73" "$14,072.00" "$14,072.00" "$14,072.00" "$14,072.00" "$10,554.00" "$14,072.00" "$14,072.00" "$14,072.00" "$7,036.00" "$7,036.00" "$11,145.02" "$14,072.00" "$11,257.60" "$9,146.80" "$2,792.94" "$14,072.00" "$8,161.76" "$14,072.00" "$14,072.00" "$14,072.00" "$2,932.60" "$14,072.00" N/A N/A 27204437 EAP HCPCS C1887 FLOWGATE BALLOON GUIDE CATHETER 8F X 95CM BOTH IP/OP "$2,746.00" "$2,032.50" $545.01 "$2,746.00" "$1,491.08" "$1,491.08" "$1,491.08" "$1,491.08" "$2,746.00" "$2,746.00" "$2,746.00" $572.34 "$2,746.00" "$2,038.08" "$2,038.08" "$2,116.62" "$1,430.67" $572.30 "$2,746.00" "$2,746.00" "$1,624.26" "$2,746.00" "$2,746.00" "$2,746.00" "$2,746.00" "$2,059.50" "$2,746.00" "$2,746.00" "$2,746.00" "$1,373.00" "$1,373.00" "$2,174.83" "$2,746.00" "$2,196.80" "$1,784.90" $545.01 "$2,746.00" "$1,592.68" "$2,746.00" "$2,746.00" "$2,746.00" $572.27 "$2,746.00" N/A N/A 27204438 EAP CPT® C1725 BLN SPLXXX SPRINTER LEGEND XXXXXX BOTH IP/OP $456.00 $337.50 $90.50 $456.00 $247.61 $247.61 $247.61 $247.61 $456.00 $456.00 $456.00 $95.04 $456.00 $338.44 $338.44 $351.48 $237.58 $95.04 $456.00 $456.00 $269.72 $456.00 $456.00 $456.00 $456.00 $342.00 $456.00 $456.00 $456.00 $228.00 $228.00 $361.15 $456.00 $364.80 $296.40 $90.50 $456.00 $264.48 $456.00 $456.00 $456.00 $95.03 $456.00 N/A N/A 27204439 EAP HCPCS C1887 FLOWGATE BALLOON GUIDE CATHETER 8F X 85CM BOTH IP/OP "$2,746.00" "$2,032.50" $545.01 "$2,746.00" "$1,491.08" "$1,491.08" "$1,491.08" "$1,491.08" "$2,746.00" "$2,746.00" "$2,746.00" $572.34 "$2,746.00" "$2,038.08" "$2,038.08" "$2,116.62" "$1,430.67" $572.30 "$2,746.00" "$2,746.00" "$1,624.26" "$2,746.00" "$2,746.00" "$2,746.00" "$2,746.00" "$2,059.50" "$2,746.00" "$2,746.00" "$2,746.00" "$1,373.00" "$1,373.00" "$2,174.83" "$2,746.00" "$2,196.80" "$1,784.90" $545.01 "$2,746.00" "$1,592.68" "$2,746.00" "$2,746.00" "$2,746.00" $572.27 "$2,746.00" N/A N/A 27204440 EAP Custom 27204440 CERTUS PR ABLATION 15CM-17 GAUGE BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$4,082.10" "$4,082.10" "$4,239.40" "$2,060.15" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$3,575.00" "$5,500.00" "$5,500.00" "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 27204441 EAP Custom 27204441 CERTUS PR ABLATION 20CM-17 GAUGE BOTH IP/OP "$6,063.00" "$4,487.00" "$1,079.21" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$1,079.21" "$6,063.00" "$6,063.00" "$4,181.12" "$4,181.12" "$4,673.36" "$2,060.15" "$1,263.60" "$6,063.00" "$2,425.20" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$6,063.00" "$4,547.25" "$6,063.00" "$6,063.00" "$6,063.00" "$3,031.50" "$3,031.50" "$4,801.90" "$6,063.00" "$4,850.40" "$3,940.95" "$6,063.00" "$6,063.00" "$3,516.54" "$6,063.00" "$3,637.80" "$6,063.00" "$6,063.00" "$6,063.00" N/A N/A 27204442 EAP HCPCS C1724 CATH ATHRCM 135CM .58IN RTBL RTL 1.25MM PTFE SHTH PRECNCT BOTH IP/OP "$1,364.00" "$1,009.50" $284.27 "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,012.36" "$1,012.36" "$1,051.37" $710.64 $284.27 "$1,364.00" $545.60 "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,023.00" "$1,364.00" "$1,364.00" "$1,364.00" $682.00 $682.00 "$1,080.29" "$1,364.00" "$1,091.20" $886.60 "$1,364.00" "$1,364.00" $791.12 "$1,364.00" $818.40 "$1,364.00" "$1,364.00" "$1,364.00" N/A N/A 27204443 EAP HCPCS C1724 CATH ATHRCM 135CM .58IN RTBL RTL 1.5MM PTFE SHTH PRECNCT BOTH IP/OP "$1,364.00" "$1,009.50" $284.27 "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,012.36" "$1,012.36" "$1,051.37" $710.64 $284.27 "$1,364.00" $545.60 "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,023.00" "$1,364.00" "$1,364.00" "$1,364.00" $682.00 $682.00 "$1,080.29" "$1,364.00" "$1,091.20" $886.60 "$1,364.00" "$1,364.00" $791.12 "$1,364.00" $818.40 "$1,364.00" "$1,364.00" "$1,364.00" N/A N/A 27204444 EAP HCPCS C1724 CATH ATHRCM 135CM .58IN RTBL RTL 1.75MM PRECNCT EXCHGL ROT BOTH IP/OP "$1,364.00" "$1,009.50" $284.27 "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,012.36" "$1,012.36" "$1,051.37" $710.64 $284.27 "$1,364.00" $545.60 "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,364.00" "$1,023.00" "$1,364.00" "$1,364.00" "$1,364.00" $682.00 $682.00 "$1,080.29" "$1,364.00" "$1,091.20" $886.60 "$1,364.00" "$1,364.00" $791.12 "$1,364.00" $818.40 "$1,364.00" "$1,364.00" "$1,364.00" N/A N/A 27204445 EAP Custom 27204445 PCMKR CRD THK6MM SM 50X46MM ENDURITY 2 CHMBR IS-1 CONCTR W ADAPTER BOTH IP/OP "$6,669.00" "$4,935.50" "$1,187.08" "$6,669.00" "$6,669.00" "$6,669.00" "$6,669.00" "$6,669.00" "$6,669.00" "$6,669.00" "$1,187.08" "$6,669.00" "$6,669.00" "$4,181.12" "$4,181.12" "$5,140.47" "$2,060.15" "$1,389.89" "$6,669.00" "$2,667.60" "$6,669.00" "$6,669.00" "$6,669.00" "$6,669.00" "$6,669.00" "$5,001.75" "$6,669.00" "$6,669.00" "$6,669.00" "$3,334.50" "$3,334.50" "$5,281.85" "$6,669.00" "$5,335.20" "$4,334.85" "$6,669.00" "$6,669.00" "$3,868.02" "$6,669.00" "$4,001.40" "$6,669.00" "$6,669.00" "$6,669.00" N/A N/A 27204446 EAP HCPCS C1887 CATHETER GUID .035IN 4.8-3.7FR 90CM LOW CROSSING P BOTH IP/OP $418.00 $309.50 $82.96 $418.00 $226.97 $226.97 $226.97 $226.97 $418.00 $418.00 $418.00 $87.12 $418.00 $310.24 $310.24 $322.19 $217.78 $87.12 $418.00 $418.00 $247.25 $418.00 $418.00 $418.00 $418.00 $313.50 $418.00 $418.00 $418.00 $209.00 $209.00 $331.06 $418.00 $334.40 $271.70 $82.96 $418.00 $242.44 $418.00 $418.00 $418.00 $87.11 $418.00 N/A N/A 27204447 EAP HCPCS C1887 CATHETER GD .035IN MPB 9FR 7.2FR 45CM ATN CMND SUR BOTH IP/OP $588.00 $435.50 $116.70 $588.00 $319.28 $319.28 $319.28 $319.28 $588.00 $588.00 $588.00 $122.55 $588.00 $436.41 $436.41 $453.23 $306.35 $122.55 $588.00 $588.00 $347.80 $588.00 $588.00 $588.00 $588.00 $441.00 $588.00 $588.00 $588.00 $294.00 $294.00 $465.70 $588.00 $470.40 $382.20 $116.70 $588.00 $341.04 $588.00 $588.00 $588.00 $122.54 $588.00 N/A N/A 27204448 EAP HCPCS C1887 CATHETER GD 90D 2.4MM 1.9MM 65CM STRL ATN SLCT II BOTH IP/OP $540.00 $400.00 $107.18 $540.00 $293.22 $293.22 $293.22 $293.22 $540.00 $540.00 $540.00 $112.55 $540.00 $400.79 $400.79 $416.23 $281.34 $112.54 $540.00 $540.00 $319.41 $540.00 $540.00 $540.00 $540.00 $405.00 $540.00 $540.00 $540.00 $270.00 $270.00 $427.68 $540.00 $432.00 $351.00 $107.18 $540.00 $313.20 $540.00 $540.00 $540.00 $112.54 $540.00 N/A N/A 27204449 EAP Custom 27204449 CATHETER GD 3DRC CRV 6FR .070IN 100CM BLU YLW STRL BOTH IP/OP $120.00 $89.00 $21.36 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $21.36 $120.00 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $48.00 $120.00 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $120.00 $120.00 $69.60 $120.00 $72.00 $120.00 $120.00 $120.00 N/A N/A 27204450 EAP HCPCS C1750 PACK CATH 28/45CM 14.5FR CARBOTHANE MH MXD 2 LUM SH HMDIAL BOTH IP/OP $921.00 $682.00 $182.80 $921.00 $500.10 $500.10 $500.10 $500.10 $921.00 $921.00 $921.00 $191.96 $921.00 $683.57 $683.57 $709.91 $479.84 $191.95 $921.00 $921.00 $544.77 $921.00 $921.00 $921.00 $921.00 $690.75 $921.00 $921.00 $921.00 $460.50 $460.50 $729.43 $921.00 $736.80 $598.65 $182.80 $921.00 $534.18 $921.00 $921.00 $921.00 $191.94 $921.00 N/A N/A 27204451 EAP HCPCS C1750 PACK CATH 33/50CM 14.5FR CARBOTHANE MH MXD 2 LUM SH HMDIAL BOTH IP/OP $248.00 $184.00 $49.22 $248.00 $134.66 $134.66 $134.66 $134.66 $248.00 $248.00 $248.00 $51.69 $248.00 $184.07 $184.07 $191.16 $129.21 $51.69 $248.00 $248.00 $146.69 $248.00 $248.00 $248.00 $248.00 $186.00 $248.00 $248.00 $248.00 $124.00 $124.00 $196.42 $248.00 $198.40 $161.20 $49.22 $248.00 $143.84 $248.00 $248.00 $248.00 $51.68 $248.00 N/A N/A 27204453 EAP Custom 27204453 OBT SHTH 10CM 6FR FLXB 5MM BOTH IP/OP "$4,908.00" "$3,632.00" $873.62 "$4,908.00" "$4,908.00" "$4,908.00" "$4,908.00" "$4,908.00" "$4,908.00" "$4,908.00" $873.62 "$4,908.00" "$4,908.00" "$3,642.72" "$3,642.72" "$3,783.09" "$2,060.15" "$1,022.88" "$4,908.00" "$1,963.20" "$4,908.00" "$4,908.00" "$4,908.00" "$4,908.00" "$4,908.00" "$3,681.00" "$4,908.00" "$4,908.00" "$4,908.00" "$2,454.00" "$2,454.00" "$3,887.14" "$4,908.00" "$3,926.40" "$3,190.20" "$4,908.00" "$4,908.00" "$2,846.64" "$4,908.00" "$2,944.80" "$4,908.00" "$4,908.00" "$4,908.00" N/A N/A 27204454 EAP HCPCS C1769 GWIRE VASC 300CM .014IN SHP TIP STR 3CM RUNTHROUGH NS PTFE BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $127.61 $127.61 $127.61 $127.61 $235.00 $235.00 $235.00 $48.98 $235.00 $174.42 $174.42 $181.14 $122.44 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $152.75 $46.64 $235.00 $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 27204456 EAP HCPCS C1887 CATH EP .014IN 2.6-1.8FR .021-.018IN 150CM 70CM CORON MIC BOTH IP/OP "$1,621.00" "$1,200.00" $321.73 "$1,621.00" $880.20 $880.20 $880.20 $880.20 "$1,621.00" "$1,621.00" "$1,621.00" $337.86 "$1,621.00" "$1,203.11" "$1,203.11" "$1,249.47" $844.54 $337.83 "$1,621.00" "$1,621.00" $958.82 "$1,621.00" "$1,621.00" "$1,621.00" "$1,621.00" "$1,215.75" "$1,621.00" "$1,621.00" "$1,621.00" $810.50 $810.50 "$1,283.83" "$1,621.00" "$1,296.80" "$1,053.65" $321.73 "$1,621.00" $940.18 "$1,621.00" "$1,621.00" "$1,621.00" $337.82 "$1,621.00" N/A N/A 27204457 EAP HCPCS C1769 GWIRE VASC .014IN 180CM 3CM STR SHP TIP RUNTHROUGH NS CORON BOTH IP/OP $247.00 $183.00 $49.02 $247.00 $134.12 $134.12 $134.12 $134.12 $247.00 $247.00 $247.00 $51.48 $247.00 $183.32 $183.32 $190.39 $128.69 $51.48 $247.00 $247.00 $146.10 $247.00 $247.00 $247.00 $247.00 $185.25 $247.00 $247.00 $247.00 $123.50 $123.50 $195.62 $247.00 $197.60 $160.55 $49.02 $247.00 $143.26 $247.00 $247.00 $247.00 $51.47 $247.00 N/A N/A 27204458 EAP HCPCS C1733 ARCTIC FRONT ADVANCE CRYOABLATION CATHETER 23MM BOTH IP/OP "$12,401.00" "$9,177.00" "$2,060.15" "$12,401.00" "$6,733.74" "$6,733.74" "$6,733.74" "$6,733.74" "$12,401.00" "$12,401.00" "$12,401.00" "$2,584.68" "$12,401.00" "$4,181.12" "$4,181.12" "$9,558.69" "$2,060.15" "$2,584.50" "$12,401.00" "$12,401.00" "$3,094.73" "$12,401.00" "$12,401.00" "$12,401.00" "$12,401.00" "$9,300.75" "$12,401.00" "$12,401.00" "$12,401.00" "$6,200.50" "$6,200.50" "$9,821.59" "$12,401.00" "$9,920.80" "$8,060.65" "$2,461.29" "$12,401.00" "$7,192.58" "$12,401.00" "$12,401.00" "$12,401.00" "$2,584.37" "$12,401.00" N/A N/A 27204459 EAP HCPCS C1733 ARCTIC FRONT ADVANCE CRYOABLATION CATHETER 28MM BOTH IP/OP "$12,401.00" "$9,177.00" "$2,060.15" "$12,401.00" "$6,733.74" "$6,733.74" "$6,733.74" "$6,733.74" "$12,401.00" "$12,401.00" "$12,401.00" "$2,584.68" "$12,401.00" "$4,181.12" "$4,181.12" "$9,558.69" "$2,060.15" "$2,584.50" "$12,401.00" "$12,401.00" "$3,094.73" "$12,401.00" "$12,401.00" "$12,401.00" "$12,401.00" "$9,300.75" "$12,401.00" "$12,401.00" "$12,401.00" "$6,200.50" "$6,200.50" "$9,821.59" "$12,401.00" "$9,920.80" "$8,060.65" "$2,461.29" "$12,401.00" "$7,192.58" "$12,401.00" "$12,401.00" "$12,401.00" "$2,584.37" "$12,401.00" N/A N/A 27204461 EAP HCPCS C1733 FREEZOR MAX CARDIAC CRYOABLATION CATHETER LRG BOTH IP/OP "$5,236.00" "$3,875.00" "$1,039.22" "$5,236.00" "$2,843.15" "$2,843.15" "$2,843.15" "$2,843.15" "$5,236.00" "$5,236.00" "$5,236.00" "$1,091.31" "$5,236.00" "$3,886.16" "$3,886.16" "$4,035.91" "$2,060.15" "$1,091.24" "$5,236.00" "$5,236.00" "$3,094.73" "$5,236.00" "$5,236.00" "$5,236.00" "$5,236.00" "$3,927.00" "$5,236.00" "$5,236.00" "$5,236.00" "$2,618.00" "$2,618.00" "$4,146.91" "$5,236.00" "$4,188.80" "$3,403.40" "$1,039.22" "$5,236.00" "$3,036.88" "$5,236.00" "$5,236.00" "$5,236.00" "$1,091.18" "$5,236.00" N/A N/A 27204462 EAP HCPCS C1733 FREEZOR CARDIAC CRYOABLATION CATHETER SM BOTH IP/OP "$3,444.00" "$2,549.00" $683.55 "$3,444.00" "$1,870.09" "$1,870.09" "$1,870.09" "$1,870.09" "$3,444.00" "$3,444.00" "$3,444.00" $717.82 "$3,444.00" "$2,556.14" "$2,556.14" "$2,654.64" "$1,794.32" $717.77 "$3,444.00" "$3,444.00" "$2,037.13" "$3,444.00" "$3,444.00" "$3,444.00" "$3,444.00" "$2,583.00" "$3,444.00" "$3,444.00" "$3,444.00" "$1,722.00" "$1,722.00" "$2,727.65" "$3,444.00" "$2,755.20" "$2,238.60" $683.55 "$3,444.00" "$1,997.52" "$3,444.00" "$3,444.00" "$3,444.00" $717.73 "$3,444.00" N/A N/A 27204463 EAP HCPCS C1733 FREEZOR CARDIAC CRYOABLATION CATHETER MED BOTH IP/OP "$3,444.00" "$2,549.00" $683.55 "$3,444.00" "$1,870.09" "$1,870.09" "$1,870.09" "$1,870.09" "$3,444.00" "$3,444.00" "$3,444.00" $717.82 "$3,444.00" "$2,556.14" "$2,556.14" "$2,654.64" "$1,794.32" $717.77 "$3,444.00" "$3,444.00" "$2,037.13" "$3,444.00" "$3,444.00" "$3,444.00" "$3,444.00" "$2,583.00" "$3,444.00" "$3,444.00" "$3,444.00" "$1,722.00" "$1,722.00" "$2,727.65" "$3,444.00" "$2,755.20" "$2,238.60" $683.55 "$3,444.00" "$1,997.52" "$3,444.00" "$3,444.00" "$3,444.00" $717.73 "$3,444.00" N/A N/A 27204464 EAP HCPCS C1733 FREEZOR CARDIAC CRYOABLATION CATHETER LRG BOTH IP/OP "$3,444.00" "$2,549.00" $683.55 "$3,444.00" "$1,870.09" "$1,870.09" "$1,870.09" "$1,870.09" "$3,444.00" "$3,444.00" "$3,444.00" $717.82 "$3,444.00" "$2,556.14" "$2,556.14" "$2,654.64" "$1,794.32" $717.77 "$3,444.00" "$3,444.00" "$2,037.13" "$3,444.00" "$3,444.00" "$3,444.00" "$3,444.00" "$2,583.00" "$3,444.00" "$3,444.00" "$3,444.00" "$1,722.00" "$1,722.00" "$2,727.65" "$3,444.00" "$2,755.20" "$2,238.60" $683.55 "$3,444.00" "$1,997.52" "$3,444.00" "$3,444.00" "$3,444.00" $717.73 "$3,444.00" N/A N/A 27204472 EAP HCPCS C1766 FLEXCATH ADVANCE 12 STEERABLE SHEATH - 12 FR BOTH IP/OP "$3,307.00" "$2,447.50" $689.22 "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$2,454.46" "$2,454.46" "$2,549.04" "$1,722.95" $689.22 "$3,307.00" "$1,322.80" "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$2,480.25" "$3,307.00" "$3,307.00" "$3,307.00" "$1,653.50" "$1,653.50" "$2,619.14" "$3,307.00" "$2,645.60" "$2,149.55" "$3,307.00" "$3,307.00" "$1,918.06" "$3,307.00" "$1,984.20" "$3,307.00" "$3,307.00" "$3,307.00" N/A N/A 27204473 EAP HCPCS C1766 FLEXCATH 10 STEERABLE SHEATH - 10 FR BOTH IP/OP "$2,067.00" "$1,530.00" $430.79 "$2,067.00" "$2,067.00" "$2,067.00" "$2,067.00" "$2,067.00" "$2,067.00" "$2,067.00" "$2,067.00" "$2,067.00" "$2,067.00" "$1,534.13" "$1,534.13" "$1,593.24" "$1,076.91" $430.79 "$2,067.00" $826.80 "$2,067.00" "$2,067.00" "$2,067.00" "$2,067.00" "$2,067.00" "$1,550.25" "$2,067.00" "$2,067.00" "$2,067.00" "$1,033.50" "$1,033.50" "$1,637.06" "$2,067.00" "$1,653.60" "$1,343.55" "$2,067.00" "$2,067.00" "$1,198.86" "$2,067.00" "$1,240.20" "$2,067.00" "$2,067.00" "$2,067.00" N/A N/A 27204474 EAP HCPCS C1730 ACHIEVE MAPPING CATHETER SM BOTH IP/OP "$2,618.00" "$1,937.50" $519.61 "$2,618.00" "$1,421.57" "$1,421.57" "$1,421.57" "$1,421.57" "$2,618.00" "$2,618.00" "$2,618.00" $545.66 "$2,618.00" "$1,943.08" "$1,943.08" "$2,017.95" "$1,363.98" $545.62 "$2,618.00" "$2,618.00" "$1,548.55" "$2,618.00" "$2,618.00" "$2,618.00" "$2,618.00" "$1,963.50" "$2,618.00" "$2,618.00" "$2,618.00" "$1,309.00" "$1,309.00" "$2,073.46" "$2,618.00" "$2,094.40" "$1,701.70" $519.61 "$2,618.00" "$1,518.44" "$2,618.00" "$2,618.00" "$2,618.00" $545.59 "$2,618.00" N/A N/A 27204475 EAP HCPCS C1730 ACHIEVE MAPPING CATHETER LRG BOTH IP/OP "$2,618.00" "$1,937.50" $519.61 "$2,618.00" "$1,421.57" "$1,421.57" "$1,421.57" "$1,421.57" "$2,618.00" "$2,618.00" "$2,618.00" $545.66 "$2,618.00" "$1,943.08" "$1,943.08" "$2,017.95" "$1,363.98" $545.62 "$2,618.00" "$2,618.00" "$1,548.55" "$2,618.00" "$2,618.00" "$2,618.00" "$2,618.00" "$1,963.50" "$2,618.00" "$2,618.00" "$2,618.00" "$1,309.00" "$1,309.00" "$2,073.46" "$2,618.00" "$2,094.40" "$1,701.70" $519.61 "$2,618.00" "$1,518.44" "$2,618.00" "$2,618.00" "$2,618.00" $545.59 "$2,618.00" N/A N/A 27204478 EAP HCPCS C1730 CATH EP 5-5-5MM SPC CSL CURVE 6FR 65CM MP DCAPL FIX CURVE BOTH IP/OP $965.00 $714.50 $191.53 $965.00 $524.00 $524.00 $524.00 $524.00 $965.00 $965.00 $965.00 $201.13 $965.00 $716.22 $716.22 $743.82 $502.77 $201.12 $965.00 $965.00 $570.80 $965.00 $965.00 $965.00 $965.00 $723.75 $965.00 $965.00 $965.00 $482.50 $482.50 $764.28 $965.00 $772.00 $627.25 $191.53 $965.00 $559.70 $965.00 $965.00 $965.00 $201.11 $965.00 N/A N/A 27204479 EAP HCPCS C1769 GWIRE VASC 325CM .009IN FLPY WRCLP TRQ FLXB LNG TPR 2.8CM BOTH IP/OP $457.00 $338.50 $90.70 $457.00 $248.15 $248.15 $248.15 $248.15 $457.00 $457.00 $457.00 $95.25 $457.00 $339.19 $339.19 $352.26 $238.10 $95.24 $457.00 $457.00 $270.32 $457.00 $457.00 $457.00 $457.00 $342.75 $457.00 $457.00 $457.00 $228.50 $228.50 $361.94 $457.00 $365.60 $297.05 $90.70 $457.00 $265.06 $457.00 $457.00 $457.00 $95.24 $457.00 N/A N/A 27204480 EAP HCPCS C1769 GWIRE VASC 325CM .009IN FLPY WRCLP TRQ FLXB LNG TPR 2.2CM BOTH IP/OP $457.00 $338.50 $90.70 $457.00 $248.15 $248.15 $248.15 $248.15 $457.00 $457.00 $457.00 $95.25 $457.00 $339.19 $339.19 $352.26 $238.10 $95.24 $457.00 $457.00 $270.32 $457.00 $457.00 $457.00 $457.00 $342.75 $457.00 $457.00 $457.00 $228.50 $228.50 $361.94 $457.00 $365.60 $297.05 $90.70 $457.00 $265.06 $457.00 $457.00 $457.00 $95.24 $457.00 N/A N/A 27204481 EAP Custom 27204481 LUBRICANT ROTAGLIDE BOTH IP/OP $301.00 $223.00 $53.58 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $53.58 $301.00 $301.00 $223.40 $223.40 $232.01 $156.82 $62.73 $301.00 $120.40 $301.00 $301.00 $301.00 $301.00 $301.00 $225.75 $301.00 $301.00 $301.00 $150.50 $150.50 $238.39 $301.00 $240.80 $195.65 $301.00 $301.00 $174.58 $301.00 $180.60 $301.00 $301.00 $301.00 N/A N/A 27204482 EAP HCPCS C1887 CATH INFUS MIC 1.9FR 1.25MM .5MM 1.5CM DLV DRBLTY DTCH TIP BOTH IP/OP "$5,498.00" "$4,069.00" "$1,091.22" "$5,498.00" "$2,985.41" "$2,985.41" "$2,985.41" "$2,985.41" "$5,498.00" "$5,498.00" "$5,498.00" "$1,145.92" "$5,498.00" "$4,080.62" "$4,080.62" "$4,237.86" "$2,060.15" "$1,145.84" "$5,498.00" "$5,498.00" "$3,094.73" "$5,498.00" "$5,498.00" "$5,498.00" "$5,498.00" "$4,123.50" "$5,498.00" "$5,498.00" "$5,498.00" "$2,749.00" "$2,749.00" "$4,354.42" "$5,498.00" "$4,398.40" "$3,573.70" "$1,091.22" "$5,498.00" "$3,188.84" "$5,498.00" "$5,498.00" "$5,498.00" "$1,145.78" "$5,498.00" N/A N/A 27204484 EAP HCPCS C1769 GWIRE VASC 190CM .014IN RADIOPQ MRKR CORE TO TIP STR 3CM BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 27204485 EAP HCPCS C1769 GWIRE VASC 300CM .014IN RADIOPQ MRKR CORE TO TIP STR 3CM BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 27204486 EAP HCPCS C1769 GWIRE VASC 300CM .014IN STRBL CORE TO TIP RADIOPQ STR 3CM BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 27204487 EAP HCPCS C1769 GWIRE VASC 180CM .014IN RADIOPQ MRKR STR 3CM A FLDR FC BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 27204488 EAP HCPCS C1769 GWIRE VASC 300CM .014IN RADIOPQ MRKR STR 3CM A FLDR FC BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 27204489 EAP HCPCS C1769 GWIRE VASC 190CM .014IN STR 3CM HTORQ WHSPR MS SS HYDPHI BOTH IP/OP $217.00 $161.00 $43.07 $217.00 $117.83 $117.83 $117.83 $117.83 $217.00 $217.00 $217.00 $45.23 $217.00 $161.06 $161.06 $167.26 $113.06 $45.23 $217.00 $217.00 $128.36 $217.00 $217.00 $217.00 $217.00 $162.75 $217.00 $217.00 $217.00 $108.50 $108.50 $171.86 $217.00 $173.60 $141.05 $43.07 $217.00 $125.86 $217.00 $217.00 $217.00 $45.22 $217.00 N/A N/A 27204492 EAP HCPCS C1769 GWIRE VASC 180CM .035IN JKT CORE TO TIP ATRM 1.5MM RAD STD J BOTH IP/OP $117.00 $87.00 $23.22 $117.00 $63.53 $63.53 $63.53 $63.53 $117.00 $117.00 $117.00 $24.39 $117.00 $86.84 $86.84 $90.18 $60.96 $24.38 $117.00 $117.00 $69.21 $117.00 $117.00 $117.00 $117.00 $87.75 $117.00 $117.00 $117.00 $58.50 $58.50 $92.66 $117.00 $93.60 $76.05 $23.22 $117.00 $67.86 $117.00 $117.00 $117.00 $24.38 $117.00 N/A N/A 27204493 EAP HCPCS C1769 GWIRE VASC 260CM .035IN JKT CORE TO TIP ATRM 1.5MM RAD STD J BOTH IP/OP $131.00 $97.00 $26.00 $131.00 $71.13 $71.13 $71.13 $71.13 $131.00 $131.00 $131.00 $27.30 $131.00 $97.23 $97.23 $100.97 $68.25 $27.30 $131.00 $131.00 $77.49 $131.00 $131.00 $131.00 $131.00 $98.25 $131.00 $131.00 $131.00 $65.50 $65.50 $103.75 $131.00 $104.80 $85.15 $26.00 $131.00 $75.98 $131.00 $131.00 $131.00 $27.30 $131.00 N/A N/A 27204494 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM 3CM STRG MED SPRT HTORQ WHSPR MS BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 27204495 EAP HCPCS C1887 MICROCATHETER HEADWAY 21 BOTH IP/OP "$2,288.00" "$1,693.50" $454.11 "$2,288.00" "$1,242.38" "$1,242.38" "$1,242.38" "$1,242.38" "$2,288.00" "$2,288.00" "$2,288.00" $476.88 "$2,288.00" "$1,698.15" "$1,698.15" "$1,763.59" "$1,192.05" $476.84 "$2,288.00" "$2,288.00" "$1,353.35" "$2,288.00" "$2,288.00" "$2,288.00" "$2,288.00" "$1,716.00" "$2,288.00" "$2,288.00" "$2,288.00" "$1,144.00" "$1,144.00" "$1,812.10" "$2,288.00" "$1,830.40" "$1,487.20" $454.11 "$2,288.00" "$1,327.04" "$2,288.00" "$2,288.00" "$2,288.00" $476.82 "$2,288.00" N/A N/A 27204496 EAP HCPCS C1887 MICROCATHETER HEADWAY DUO 17 BOTH IP/OP "$2,563.00" "$1,897.00" $508.69 "$2,563.00" "$1,391.71" "$1,391.71" "$1,391.71" "$1,391.71" "$2,563.00" "$2,563.00" "$2,563.00" $534.19 "$2,563.00" "$1,902.26" "$1,902.26" "$1,975.56" "$1,335.32" $534.16 "$2,563.00" "$2,563.00" "$1,516.01" "$2,563.00" "$2,563.00" "$2,563.00" "$2,563.00" "$1,922.25" "$2,563.00" "$2,563.00" "$2,563.00" "$1,281.50" "$1,281.50" "$2,029.90" "$2,563.00" "$2,050.40" "$1,665.95" $508.69 "$2,563.00" "$1,486.54" "$2,563.00" "$2,563.00" "$2,563.00" $534.13 "$2,563.00" N/A N/A 27204497 EAP HCPCS C1887 6FR JR 5 GUIDE CATHETER BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $67.33 $67.33 $67.33 $67.33 $124.00 $124.00 $124.00 $25.84 $124.00 $92.03 $92.03 $95.58 $64.60 $25.84 $124.00 $124.00 $73.35 $124.00 $124.00 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $80.60 $24.61 $124.00 $71.92 $124.00 $124.00 $124.00 $25.84 $124.00 N/A N/A 27204498 EAP HCPCS C1887 6FR LCB GUIDE CATHETER BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $67.33 $67.33 $67.33 $67.33 $124.00 $124.00 $124.00 $25.84 $124.00 $92.03 $92.03 $95.58 $64.60 $25.84 $124.00 $124.00 $73.35 $124.00 $124.00 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $80.60 $24.61 $124.00 $71.92 $124.00 $124.00 $124.00 $25.84 $124.00 N/A N/A 27204499 EAP HCPCS C1887 7FR AL2 GUIDE CATHETER BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $67.33 $67.33 $67.33 $67.33 $124.00 $124.00 $124.00 $25.84 $124.00 $92.03 $92.03 $95.58 $64.60 $25.84 $124.00 $124.00 $73.35 $124.00 $124.00 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $80.60 $24.61 $124.00 $71.92 $124.00 $124.00 $124.00 $25.84 $124.00 N/A N/A 27204500 EAP HCPCS C1887 7FR AL 1.5 GUIDE CATHETER BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $67.33 $67.33 $67.33 $67.33 $124.00 $124.00 $124.00 $25.84 $124.00 $92.03 $92.03 $95.58 $64.60 $25.84 $124.00 $124.00 $73.35 $124.00 $124.00 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $80.60 $24.61 $124.00 $71.92 $124.00 $124.00 $124.00 $25.84 $124.00 N/A N/A 27204501 EAP HCPCS C1887 7FR AL 1.0 GUIDE CATHETER BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $67.33 $67.33 $67.33 $67.33 $124.00 $124.00 $124.00 $25.84 $124.00 $92.03 $92.03 $95.58 $64.60 $25.84 $124.00 $124.00 $73.35 $124.00 $124.00 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $80.60 $24.61 $124.00 $71.92 $124.00 $124.00 $124.00 $25.84 $124.00 N/A N/A 27204502 EAP HCPCS C1887 6FR MRADIAL GUIDE CATHETER BOTH IP/OP $130.00 $96.50 $25.80 $130.00 $70.59 $70.59 $70.59 $70.59 $130.00 $130.00 $130.00 $27.10 $130.00 $96.49 $96.49 $100.20 $67.73 $27.09 $130.00 $130.00 $76.90 $130.00 $130.00 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $65.00 $65.00 $102.96 $130.00 $104.00 $84.50 $25.80 $130.00 $75.40 $130.00 $130.00 $130.00 $27.09 $130.00 N/A N/A 27204503 EAP HCPCS C1887 6FR LARA CURVE GUIDE CATHETER BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $67.33 $67.33 $67.33 $67.33 $124.00 $124.00 $124.00 $25.84 $124.00 $92.03 $92.03 $95.58 $64.60 $25.84 $124.00 $124.00 $73.35 $124.00 $124.00 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $80.60 $24.61 $124.00 $71.92 $124.00 $124.00 $124.00 $25.84 $124.00 N/A N/A 27204504 EAP HCPCS C1887 6FR MAC3030 GUIDE CATHETER BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $67.33 $67.33 $67.33 $67.33 $124.00 $124.00 $124.00 $25.84 $124.00 $92.03 $92.03 $95.58 $64.60 $25.84 $124.00 $124.00 $73.35 $124.00 $124.00 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $80.60 $24.61 $124.00 $71.92 $124.00 $124.00 $124.00 $25.84 $124.00 N/A N/A 27204505 EAP HCPCS C1887 6FR IMA GUIDE CATHETER BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $67.33 $67.33 $67.33 $67.33 $124.00 $124.00 $124.00 $25.84 $124.00 $92.03 $92.03 $95.58 $64.60 $25.84 $124.00 $124.00 $73.35 $124.00 $124.00 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $80.60 $24.61 $124.00 $71.92 $124.00 $124.00 $124.00 $25.84 $124.00 N/A N/A 27204506 EAP HCPCS C1887 5FR JR4 DIAGNOSTIC CATHETER 125CM BOTH IP/OP $193.00 $143.00 $38.31 $193.00 $104.80 $104.80 $104.80 $104.80 $193.00 $193.00 $193.00 $40.23 $193.00 $143.24 $143.24 $148.76 $100.55 $40.22 $193.00 $193.00 $114.16 $193.00 $193.00 $193.00 $193.00 $144.75 $193.00 $193.00 $193.00 $96.50 $96.50 $152.86 $193.00 $154.40 $125.45 $38.31 $193.00 $111.94 $193.00 $193.00 $193.00 $40.22 $193.00 N/A N/A 27204507 EAP HCPCS C1887 5FR JL4 DIAGNOSTIC CATHETER 125CM BOTH IP/OP $193.00 $143.00 $38.31 $193.00 $104.80 $104.80 $104.80 $104.80 $193.00 $193.00 $193.00 $40.23 $193.00 $143.24 $143.24 $148.76 $100.55 $40.22 $193.00 $193.00 $114.16 $193.00 $193.00 $193.00 $193.00 $144.75 $193.00 $193.00 $193.00 $96.50 $96.50 $152.86 $193.00 $154.40 $125.45 $38.31 $193.00 $111.94 $193.00 $193.00 $193.00 $40.22 $193.00 N/A N/A 27204510 EAP HCPCS C1724 CATH ATHRCM 135CM RTBL RTL+ 2.25MM BUR PRECNCT EXCHGL ROT BOTH IP/OP "$3,409.00" "$2,523.00" $710.47 "$3,409.00" "$3,409.00" "$3,409.00" "$3,409.00" "$3,409.00" "$3,409.00" "$3,409.00" "$3,409.00" "$3,409.00" "$3,409.00" "$2,530.16" "$2,530.16" "$2,627.66" "$1,776.09" $710.47 "$3,409.00" "$1,363.60" "$3,409.00" "$3,409.00" "$3,409.00" "$3,409.00" "$3,409.00" "$2,556.75" "$3,409.00" "$3,409.00" "$3,409.00" "$1,704.50" "$1,704.50" "$2,699.93" "$3,409.00" "$2,727.20" "$2,215.85" "$3,409.00" "$3,409.00" "$1,977.22" "$3,409.00" "$2,045.40" "$3,409.00" "$3,409.00" "$3,409.00" N/A N/A 27204513 EAP HCPCS C1725 OTW MINI TREK II 1.20 X 6MM BDC BOTH IP/OP $551.00 $408.00 $109.36 $551.00 $299.19 $299.19 $299.19 $299.19 $551.00 $551.00 $551.00 $114.84 $551.00 $408.95 $408.95 $424.71 $287.07 $114.83 $551.00 $551.00 $325.92 $551.00 $551.00 $551.00 $551.00 $413.25 $551.00 $551.00 $551.00 $275.50 $275.50 $436.39 $551.00 $440.80 $358.15 $109.36 $551.00 $319.58 $551.00 $551.00 $551.00 $114.83 $551.00 N/A N/A 27204514 EAP HCPCS C1725 OTW MINI TREK II 1.20 X 8MM BDC BOTH IP/OP $551.00 $408.00 $109.36 $551.00 $299.19 $299.19 $299.19 $299.19 $551.00 $551.00 $551.00 $114.84 $551.00 $408.95 $408.95 $424.71 $287.07 $114.83 $551.00 $551.00 $325.92 $551.00 $551.00 $551.00 $551.00 $413.25 $551.00 $551.00 $551.00 $275.50 $275.50 $436.39 $551.00 $440.80 $358.15 $109.36 $551.00 $319.58 $551.00 $551.00 $551.00 $114.83 $551.00 N/A N/A 27204516 EAP HCPCS C1725 OTW MINI TREK II 1.20 X 15MM BDC BOTH IP/OP $551.00 $408.00 $109.36 $551.00 $299.19 $299.19 $299.19 $299.19 $551.00 $551.00 $551.00 $114.84 $551.00 $408.95 $408.95 $424.71 $287.07 $114.83 $551.00 $551.00 $325.92 $551.00 $551.00 $551.00 $551.00 $413.25 $551.00 $551.00 $551.00 $275.50 $275.50 $436.39 $551.00 $440.80 $358.15 $109.36 $551.00 $319.58 $551.00 $551.00 $551.00 $114.83 $551.00 N/A N/A 27204517 EAP HCPCS C1725 OTW MINI TREK II 1.20 X 20MM BDC BOTH IP/OP $551.00 $408.00 $109.36 $551.00 $299.19 $299.19 $299.19 $299.19 $551.00 $551.00 $551.00 $114.84 $551.00 $408.95 $408.95 $424.71 $287.07 $114.83 $551.00 $551.00 $325.92 $551.00 $551.00 $551.00 $551.00 $413.25 $551.00 $551.00 $551.00 $275.50 $275.50 $436.39 $551.00 $440.80 $358.15 $109.36 $551.00 $319.58 $551.00 $551.00 $551.00 $114.83 $551.00 N/A N/A 27204518 EAP HCPCS C1725 OTW MINI TREK II 1.50 X 6MM BDC BOTH IP/OP $551.00 $408.00 $109.36 $551.00 $299.19 $299.19 $299.19 $299.19 $551.00 $551.00 $551.00 $114.84 $551.00 $408.95 $408.95 $424.71 $287.07 $114.83 $551.00 $551.00 $325.92 $551.00 $551.00 $551.00 $551.00 $413.25 $551.00 $551.00 $551.00 $275.50 $275.50 $436.39 $551.00 $440.80 $358.15 $109.36 $551.00 $319.58 $551.00 $551.00 $551.00 $114.83 $551.00 N/A N/A 27204519 EAP HCPCS C1725 OTW MINI TREK II 1.50 X 20MM BDC BOTH IP/OP $551.00 $408.00 $109.36 $551.00 $299.19 $299.19 $299.19 $299.19 $551.00 $551.00 $551.00 $114.84 $551.00 $408.95 $408.95 $424.71 $287.07 $114.83 $551.00 $551.00 $325.92 $551.00 $551.00 $551.00 $551.00 $413.25 $551.00 $551.00 $551.00 $275.50 $275.50 $436.39 $551.00 $440.80 $358.15 $109.36 $551.00 $319.58 $551.00 $551.00 $551.00 $114.83 $551.00 N/A N/A 27204520 EAP HCPCS C1725 OTW MINI TREK II 2.00 X 6MM BDC BOTH IP/OP $551.00 $408.00 $109.36 $551.00 $299.19 $299.19 $299.19 $299.19 $551.00 $551.00 $551.00 $114.84 $551.00 $408.95 $408.95 $424.71 $287.07 $114.83 $551.00 $551.00 $325.92 $551.00 $551.00 $551.00 $551.00 $413.25 $551.00 $551.00 $551.00 $275.50 $275.50 $436.39 $551.00 $440.80 $358.15 $109.36 $551.00 $319.58 $551.00 $551.00 $551.00 $114.83 $551.00 N/A N/A 27204521 EAP HCPCS C1725 OTW MINI TREK II 2.00 X 20MM BDC BOTH IP/OP $551.00 $408.00 $109.36 $551.00 $299.19 $299.19 $299.19 $299.19 $551.00 $551.00 $551.00 $114.84 $551.00 $408.95 $408.95 $424.71 $287.07 $114.83 $551.00 $551.00 $325.92 $551.00 $551.00 $551.00 $551.00 $413.25 $551.00 $551.00 $551.00 $275.50 $275.50 $436.39 $551.00 $440.80 $358.15 $109.36 $551.00 $319.58 $551.00 $551.00 $551.00 $114.83 $551.00 N/A N/A 27204522 EAP HCPCS C1725 MINI TREK RX 1.20 X 6MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204523 EAP HCPCS C1725 MINI TREK RX 1.20 X 8MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204524 EAP HCPCS C1725 MINI TREK RX 1.20 X 12MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204525 EAP HCPCS C1725 MINI TREK RX 1.20 X 15MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204526 EAP HCPCS C1725 MINI TREK RX 1.20 X 20MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204527 EAP HCPCS C1725 MINI TREK RX 1.50 X 6MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204528 EAP HCPCS C1725 MINI TREK RX 1.50 X 8MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204529 EAP HCPCS C1725 MINI TREK RX 1.50 X 12MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204530 EAP HCPCS C1725 MINI TREK RX 1.50 X 20MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204532 EAP HCPCS C1725 MINI TREK RX 2.00 X 25MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204533 EAP HCPCS C1725 MINI TREK RX 2.00 X 30MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204536 EAP HCPCS C1725 MINI TREK RX 2.25 X 12MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204537 EAP HCPCS C1725 MINI TREK RX 2.25 X 15MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204541 EAP HCPCS C1725 TREK RX 2.50 X 6MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204542 EAP HCPCS C1725 TREK RX 2.50 X 30MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204544 EAP HCPCS C1725 TREK RX 2.75 X 8MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204547 EAP HCPCS C1725 TREK RX 2.75 X 20MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204548 EAP HCPCS C1725 TREK RX 2.75 X 25MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204549 EAP HCPCS C1725 TREK RX 2.75 X 30MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204550 EAP HCPCS C1725 TREK RX 3.00 X 6MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204551 EAP HCPCS C1725 TREK RX 3.00 X 30MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204552 EAP HCPCS C1725 TREK RX 3.25 X 6MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204553 EAP HCPCS C1725 TREK RX 3.25 X 8MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204555 EAP HCPCS C1725 TREK RX 3.25 X 15MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204556 EAP HCPCS C1725 TREK RX 3.25 X 20MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204557 EAP HCPCS C1725 TREK RX 3.25 X 25MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204558 EAP HCPCS C1725 TREK RX 3.25 X 30MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204559 EAP HCPCS C1725 TREK RX 3.50 X 6MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204560 EAP HCPCS C1725 TREK RX 3.50 X 30MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204561 EAP HCPCS C1725 TREK RX 3.75 X 6MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204562 EAP HCPCS C1725 TREK RX 3.75 X 8MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204563 EAP HCPCS C1725 TREK RX 3.75 X 12MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204564 EAP HCPCS C1725 TREK RX 3.75 X 15MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204565 EAP HCPCS C1725 TREK RX 3.75 X 20MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204566 EAP HCPCS C1725 TREK RX 3.75 X 25MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204567 EAP HCPCS C1725 TREK RX 3.75 X 30MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204568 EAP HCPCS C1725 TREK RX 4.00 X 06MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204569 EAP HCPCS C1725 TREK RX 4.00 X 20MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204570 EAP HCPCS C1725 TREK RX 4.00 X 25MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204571 EAP HCPCS C1725 TREK RX 4.00 X 30MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204572 EAP HCPCS C1725 NC TREK RX 1.50 X 06MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204573 EAP HCPCS C1725 NC TREK RX 1.50 X 08MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204574 EAP HCPCS C1725 NC TREK RX 1.50 X 12MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204575 EAP HCPCS C1725 NC TREK RX 1.50 X 15MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204576 EAP HCPCS C1725 NC TREK RX 1.50 X 20MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204577 EAP HCPCS C1725 NC TREK RX 2.00 X 15MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204578 EAP HCPCS C1725 NC TREK RX 2.00 X 20MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204580 EAP HCPCS C1725 NC TREK RX 3.00 X 8MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204582 EAP HCPCS C1725 NC TREK RX 4.50 X 20MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204583 EAP HCPCS C1725 NC TREK RX 5.00 X 20MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204584 EAP HCPCS C1769 ASAHI PROWATER PTCA GUIDE WIRE 180CM BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 27204585 EAP HCPCS C1769 HI-TORQUE IRON MAN GUIDE WIRE BOTH IP/OP $217.00 $161.00 $43.07 $217.00 $117.83 $117.83 $117.83 $117.83 $217.00 $217.00 $217.00 $45.23 $217.00 $161.06 $161.06 $167.26 $113.06 $45.23 $217.00 $217.00 $128.36 $217.00 $217.00 $217.00 $217.00 $162.75 $217.00 $217.00 $217.00 $108.50 $108.50 $171.86 $217.00 $173.60 $141.05 $43.07 $217.00 $125.86 $217.00 $217.00 $217.00 $45.22 $217.00 N/A N/A 27204586 EAP HCPCS C1769 ASAHI PROWATER PTCA GUIDE WIRE 300CM BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 27204587 EAP Custom 27204587 TEMPORARY PACING CATHETER 5FR BOTH IP/OP $509.00 $377.00 $90.60 $509.00 $509.00 $509.00 $509.00 $509.00 $509.00 $509.00 $90.60 $509.00 $509.00 $377.78 $377.78 $392.34 $265.19 $106.08 $509.00 $203.60 $509.00 $509.00 $509.00 $509.00 $509.00 $381.75 $509.00 $509.00 $509.00 $254.50 $254.50 $403.13 $509.00 $407.20 $330.85 $509.00 $509.00 $295.22 $509.00 $305.40 $509.00 $509.00 $509.00 N/A N/A 27204588 EAP HCPCS C1757 CATH DX 135CM 4.2FR FETCH 2 .014IN HYDPHI RAPEX ASPIRAT BOTH IP/OP $63.00 $47.00 $12.50 $63.00 $34.21 $34.21 $34.21 $34.21 $63.00 $63.00 $63.00 $13.13 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $63.00 $37.26 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $31.50 $31.50 $49.90 $63.00 $50.40 $40.95 $12.50 $63.00 $36.54 $63.00 $63.00 $63.00 $13.13 $63.00 N/A N/A 27204589 EAP HCPCS C1769 HI TORQUE 150 GIDE WIRE 0.014 STRAIGHT TIP 3.0 X 190CM BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 27204590 EAP HCPCS C1725 NC TREK RX 2.00 X 06MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204591 EAP HCPCS C1725 NC TREK RX 2.50 X 6MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204592 EAP HCPCS C1725 NC TREK RX 2.75 X 06MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204593 EAP HCPCS C1725 NC TREK RX 3.00 X 6MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204594 EAP HCPCS C1725 NC TREK RX 3.50 X 6MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204595 EAP HCPCS C1725 NC TREK RX 3.50 X 25MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204596 EAP HCPCS C1725 NC TREK RX 3.75 X 20MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204597 EAP HCPCS C1725 NC TREK RX 5.00 X 08MM BDC BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204598 EAP HCPCS C1769 EXTN GWIRE VASC ASA BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 27204599 EAP HCPCS C1877 HEADWAY DUO MICROTHETER BOTH IP/OP "$2,307.00" "$1,707.50" $457.88 "$2,307.00" "$1,252.70" "$1,252.70" "$1,252.70" "$1,252.70" "$2,307.00" "$2,307.00" "$2,307.00" $480.84 "$2,307.00" "$1,712.26" "$1,712.26" "$1,778.24" "$1,201.95" $480.80 "$2,307.00" "$2,307.00" "$1,364.59" "$2,307.00" "$2,307.00" "$2,307.00" "$2,307.00" "$1,730.25" "$2,307.00" "$2,307.00" "$2,307.00" "$1,153.50" "$1,153.50" "$1,827.14" "$2,307.00" "$1,845.60" "$1,499.55" $457.88 "$2,307.00" "$1,338.06" "$2,307.00" "$2,307.00" "$2,307.00" $480.78 "$2,307.00" N/A N/A 27204600 EAP HCPCS C2628 COMPLIANT OCCLUSION BALLOON 4.0MM X 10MM BOTH IP/OP "$3,473.00" "$2,570.50" $689.30 "$3,473.00" "$1,885.84" "$1,885.84" "$1,885.84" "$1,885.84" "$3,473.00" "$3,473.00" "$3,473.00" $723.86 "$3,473.00" "$2,577.66" "$2,577.66" "$2,676.99" "$1,809.43" $723.81 "$3,473.00" "$3,473.00" "$2,054.28" "$3,473.00" "$3,473.00" "$3,473.00" "$3,473.00" "$2,604.75" "$3,473.00" "$3,473.00" "$3,473.00" "$1,736.50" "$1,736.50" "$2,750.62" "$3,473.00" "$2,778.40" "$2,257.45" $689.30 "$3,473.00" "$2,014.34" "$3,473.00" "$3,473.00" "$3,473.00" $723.77 "$3,473.00" N/A N/A 27204601 EAP HCPCS C2628 COMPLIANT OCCLUSION BALLOON 4.0MM X 15MM BOTH IP/OP "$3,473.00" "$2,570.50" $689.30 "$3,473.00" "$1,885.84" "$1,885.84" "$1,885.84" "$1,885.84" "$3,473.00" "$3,473.00" "$3,473.00" $723.86 "$3,473.00" "$2,577.66" "$2,577.66" "$2,676.99" "$1,809.43" $723.81 "$3,473.00" "$3,473.00" "$2,054.28" "$3,473.00" "$3,473.00" "$3,473.00" "$3,473.00" "$2,604.75" "$3,473.00" "$3,473.00" "$3,473.00" "$1,736.50" "$1,736.50" "$2,750.62" "$3,473.00" "$2,778.40" "$2,257.45" $689.30 "$3,473.00" "$2,014.34" "$3,473.00" "$3,473.00" "$3,473.00" $723.77 "$3,473.00" N/A N/A 27204602 EAP HCPCS C2628 COMPLIANT OCCLUSION BALLOON 4.0MM X 20MM BOTH IP/OP "$3,473.00" "$2,570.50" $689.30 "$3,473.00" "$1,885.84" "$1,885.84" "$1,885.84" "$1,885.84" "$3,473.00" "$3,473.00" "$3,473.00" $723.86 "$3,473.00" "$2,577.66" "$2,577.66" "$2,676.99" "$1,809.43" $723.81 "$3,473.00" "$3,473.00" "$2,054.28" "$3,473.00" "$3,473.00" "$3,473.00" "$3,473.00" "$2,604.75" "$3,473.00" "$3,473.00" "$3,473.00" "$1,736.50" "$1,736.50" "$2,750.62" "$3,473.00" "$2,778.40" "$2,257.45" $689.30 "$3,473.00" "$2,014.34" "$3,473.00" "$3,473.00" "$3,473.00" $723.77 "$3,473.00" N/A N/A 27204603 EAP HCPCS C2628 OCCLUSION BALLOON XC CATHETER 4MM X 11MM BOTH IP/OP "$3,647.00" "$2,699.00" $723.84 "$3,647.00" "$1,980.32" "$1,980.32" "$1,980.32" "$1,980.32" "$3,647.00" "$3,647.00" "$3,647.00" $760.13 "$3,647.00" "$2,706.80" "$2,706.80" "$2,811.11" "$1,900.09" $760.07 "$3,647.00" "$3,647.00" "$2,157.20" "$3,647.00" "$3,647.00" "$3,647.00" "$3,647.00" "$2,735.25" "$3,647.00" "$3,647.00" "$3,647.00" "$1,823.50" "$1,823.50" "$2,888.42" "$3,647.00" "$2,917.60" "$2,370.55" $723.84 "$3,647.00" "$2,115.26" "$3,647.00" "$3,647.00" "$3,647.00" $760.03 "$3,647.00" N/A N/A 27204608 EAP HCPCS C1725 CATH BALDILAT ULT LP 5FR 5MM 12MM CORON 2 LUM RAPEX FLXB BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204610 EAP HCPCS C1725 CATH BALDILAT RND 4.5MM 12MM 2 MRKR RAPEX ML LR SMTH FLXB BOTH IP/OP $362.00 $268.00 $71.85 $362.00 $196.57 $196.57 $196.57 $196.57 $362.00 $362.00 $362.00 $75.45 $362.00 $268.68 $268.68 $279.03 $188.60 $75.44 $362.00 $362.00 $214.12 $362.00 $362.00 $362.00 $362.00 $271.50 $362.00 $362.00 $362.00 $181.00 $181.00 $286.70 $362.00 $289.60 $235.30 $71.85 $362.00 $209.96 $362.00 $362.00 $362.00 $75.44 $362.00 N/A N/A 27204611 EAP HCPCS C1769 CATH BALDILAT RND 2MM 12MM 2 MRKR RAPEX ML LR SMTH FLXB BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 27204613 EAP HCPCS C1757 SOLITAIRE FR 4X40 BOTH IP/OP "$11,643.00" "$8,616.00" "$2,060.15" "$11,643.00" "$6,322.15" "$6,322.15" "$6,322.15" "$6,322.15" "$11,643.00" "$11,643.00" "$11,643.00" "$2,426.69" "$11,643.00" "$4,181.12" "$4,181.12" "$8,974.42" "$2,060.15" "$2,426.53" "$11,643.00" "$11,643.00" "$3,094.73" "$11,643.00" "$11,643.00" "$11,643.00" "$11,643.00" "$8,732.25" "$11,643.00" "$11,643.00" "$11,643.00" "$5,821.50" "$5,821.50" "$9,221.26" "$11,643.00" "$9,314.40" "$7,567.95" "$2,310.84" "$11,643.00" "$6,752.94" "$11,643.00" "$11,643.00" "$11,643.00" "$2,426.40" "$11,643.00" N/A N/A 27204614 EAP Custom 27204614 NEEDLE BIOP 17GA 13.8CM TRGD COAX DISP MNPTY MXCOR BOTH IP/OP $153.00 $113.50 $27.23 $153.00 $153.00 $153.00 $153.00 $153.00 $153.00 $153.00 $27.23 $153.00 $153.00 $113.56 $113.56 $117.93 $79.71 $31.89 $153.00 $61.20 $153.00 $153.00 $153.00 $153.00 $153.00 $114.75 $153.00 $153.00 $153.00 $76.50 $76.50 $121.18 $153.00 $122.40 $99.45 $153.00 $153.00 $88.74 $153.00 $91.80 $153.00 $153.00 $153.00 N/A N/A 27204615 EAP Custom 27204615 NEEDLE BIOP 18GA 16CM 22MM MXCOR AUTOMATE STRL DISP BOTH IP/OP $412.00 $305.00 $73.34 $412.00 $412.00 $412.00 $412.00 $412.00 $412.00 $412.00 $73.34 $412.00 $412.00 $305.79 $305.79 $317.57 $214.65 $85.87 $412.00 $164.80 $412.00 $412.00 $412.00 $412.00 $412.00 $309.00 $412.00 $412.00 $412.00 $206.00 $206.00 $326.30 $412.00 $329.60 $267.80 $412.00 $412.00 $238.96 $412.00 $247.20 $412.00 $412.00 $412.00 N/A N/A 27204616 EAP HCPCS C1769 GWIRE VASC .012IN 200CM 55CM SFT PSHP ACCES LGTH SYNCHRO2 BOTH IP/OP "$1,283.00" $949.50 $254.64 "$1,283.00" $696.67 $696.67 $696.67 $696.67 "$1,283.00" "$1,283.00" "$1,283.00" $267.41 "$1,283.00" $952.24 $952.24 $988.94 $668.44 $267.39 "$1,283.00" "$1,283.00" $758.89 "$1,283.00" "$1,283.00" "$1,283.00" "$1,283.00" $962.25 "$1,283.00" "$1,283.00" "$1,283.00" $641.50 $641.50 "$1,016.14" "$1,283.00" "$1,026.40" $833.95 $254.64 "$1,283.00" $744.14 "$1,283.00" "$1,283.00" "$1,283.00" $267.38 "$1,283.00" N/A N/A 27204617 EAP HCPCS C1769 GWIRE VASC .012IN 300CM 55CM SFT PSHP ACCES LGTH SYNCHRO2 BOTH IP/OP "$1,593.00" "$1,179.00" $316.17 "$1,593.00" $865.00 $865.00 $865.00 $865.00 "$1,593.00" "$1,593.00" "$1,593.00" $332.02 "$1,593.00" "$1,182.32" "$1,182.32" "$1,227.88" $829.95 $332.00 "$1,593.00" "$1,593.00" $942.26 "$1,593.00" "$1,593.00" "$1,593.00" "$1,593.00" "$1,194.75" "$1,593.00" "$1,593.00" "$1,593.00" $796.50 $796.50 "$1,261.66" "$1,593.00" "$1,274.40" "$1,035.45" $316.17 "$1,593.00" $923.94 "$1,593.00" $955.80 "$1,593.00" $331.98 "$1,593.00" N/A N/A 27204618 EAP Custom 27204618 DRSG 6X3.5IN GNTL PS STRP ANMC FLXB BRTHBL IONIC SLVR SIL BOTH IP/OP $53.00 $39.50 $9.43 $53.00 $53.00 $53.00 $53.00 $53.00 $53.00 $53.00 $9.43 $53.00 $53.00 $39.34 $39.34 $40.85 $27.61 $11.05 $53.00 $21.20 $53.00 $53.00 $53.00 $53.00 $53.00 $39.75 $53.00 $53.00 $53.00 $26.50 $26.50 $41.98 $53.00 $42.40 $34.45 $53.00 $53.00 $30.74 $53.00 $31.80 $53.00 $53.00 $53.00 N/A N/A 27204619 EAP Custom 27204619 DRSG 10X3.5IN GNTL PS STRP ANMC FLXB BRTHBL IONIC SLVR SIL BOTH IP/OP $62.00 $46.00 $11.04 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $11.04 $62.00 $62.00 $46.02 $46.02 $47.79 $32.30 $12.92 $62.00 $24.80 $62.00 $62.00 $62.00 $62.00 $62.00 $46.50 $62.00 $62.00 $62.00 $31.00 $31.00 $49.10 $62.00 $49.60 $40.30 $62.00 $62.00 $35.96 $62.00 $37.20 $62.00 $62.00 $62.00 N/A N/A 27204620 EAP Custom 27204620 DRSG 14X3.5IN GNTL PS NSTN ADH HI ABS SIL LATEX OPTFM AG BOTH IP/OP $72.00 $53.50 $12.82 $72.00 $72.00 $72.00 $72.00 $72.00 $72.00 $72.00 $12.82 $72.00 $72.00 $53.44 $53.44 $55.50 $37.51 $15.01 $72.00 $28.80 $72.00 $72.00 $72.00 $72.00 $72.00 $54.00 $72.00 $72.00 $72.00 $36.00 $36.00 $57.02 $72.00 $57.60 $46.80 $72.00 $72.00 $41.76 $72.00 $43.20 $72.00 $72.00 $72.00 N/A N/A 27204621 EAP Custom 27204621 SENSOR FLW MICROFLOW BYNT HNDL FLXB NECK 1.5MM DISP BOTH IP/OP "$2,612.00" "$1,933.00" $464.94 "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" $464.94 "$2,612.00" "$2,612.00" "$1,938.63" "$1,938.63" "$2,013.33" "$1,360.85" $544.37 "$2,612.00" "$1,044.80" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$1,959.00" "$2,612.00" "$2,612.00" "$2,612.00" "$1,306.00" "$1,306.00" "$2,068.70" "$2,612.00" "$2,089.60" "$1,697.80" "$2,612.00" "$2,612.00" "$1,514.96" "$2,612.00" "$1,567.20" "$2,612.00" "$2,612.00" "$2,612.00" N/A N/A 27204622 EAP Custom 27204622 PROBE SURG MICROFLOW BYNT HNDL FLXB NECK DISP 2MM BOTH IP/OP "$2,612.00" "$1,933.00" $464.94 "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" $464.94 "$2,612.00" "$2,612.00" "$1,938.63" "$1,938.63" "$2,013.33" "$1,360.85" $544.37 "$2,612.00" "$1,044.80" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$1,959.00" "$2,612.00" "$2,612.00" "$2,612.00" "$1,306.00" "$1,306.00" "$2,068.70" "$2,612.00" "$2,089.60" "$1,697.80" "$2,612.00" "$2,612.00" "$1,514.96" "$2,612.00" "$1,567.20" "$2,612.00" "$2,612.00" "$2,612.00" N/A N/A 27204623 EAP Custom 27204623 PROBE SURG MICROFLOW BYNT HNDL FLXB NECK DISP 3MM BOTH IP/OP "$2,612.00" "$1,933.00" $464.94 "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" $464.94 "$2,612.00" "$2,612.00" "$1,938.63" "$1,938.63" "$2,013.33" "$1,360.85" $544.37 "$2,612.00" "$1,044.80" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$1,959.00" "$2,612.00" "$2,612.00" "$2,612.00" "$1,306.00" "$1,306.00" "$2,068.70" "$2,612.00" "$2,089.60" "$1,697.80" "$2,612.00" "$2,612.00" "$1,514.96" "$2,612.00" "$1,567.20" "$2,612.00" "$2,612.00" "$2,612.00" N/A N/A 27204624 EAP HCPCS C1769 "GWIRE VSC 190CM .014"" MKR TP STR 3CM HTRQ BL MWT U" BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 27204625 EAP HCPCS C1788 TRAY INFUS PORT STD 1 LUM PLFLW CATH INTROD NDL BOTH IP/OP $525.00 $388.50 $104.20 $525.00 $236.25 $236.25 $236.25 $236.25 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $310.54 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $236.25 $104.20 $525.00 $304.50 $525.00 $525.00 $525.00 $109.41 $525.00 N/A N/A 27204627 EAP HCPCS C1788 TRAY INFUS PORT J LP 1 LUM CATH INTROD NDL GWIRE BOTH IP/OP $525.00 $388.50 $104.20 $525.00 $285.08 $285.08 $285.08 $285.08 $525.00 $525.00 $525.00 $109.42 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $525.00 $310.54 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $104.20 $525.00 $304.50 $525.00 $525.00 $525.00 $109.41 $525.00 N/A N/A 27204628 EAP HCPCS C1757 FLOW RESTORATION CATHETER (6-10MM) X 155CM BOTH IP/OP "$11,238.00" "$8,316.50" "$2,060.15" "$11,238.00" "$6,102.23" "$6,102.23" "$6,102.23" "$6,102.23" "$11,238.00" "$11,238.00" "$11,238.00" "$2,342.28" "$11,238.00" "$4,181.12" "$4,181.12" "$8,662.25" "$2,060.15" "$2,342.12" "$11,238.00" "$11,238.00" "$3,094.73" "$11,238.00" "$11,238.00" "$11,238.00" "$11,238.00" "$8,428.50" "$11,238.00" "$11,238.00" "$11,238.00" "$5,619.00" "$5,619.00" "$8,900.50" "$11,238.00" "$8,990.40" "$7,304.70" "$2,230.46" "$11,238.00" "$6,518.04" "$11,238.00" "$11,238.00" "$11,238.00" "$2,342.00" "$11,238.00" N/A N/A 27204629 EAP HCPCS C1757 FLOW RESTORATION CATHETER (11-14MM) X 155CM BOTH IP/OP "$11,238.00" "$8,316.50" "$2,060.15" "$11,238.00" "$6,102.23" "$6,102.23" "$6,102.23" "$6,102.23" "$11,238.00" "$11,238.00" "$11,238.00" "$2,342.28" "$11,238.00" "$4,181.12" "$4,181.12" "$8,662.25" "$2,060.15" "$2,342.12" "$11,238.00" "$11,238.00" "$3,094.73" "$11,238.00" "$11,238.00" "$11,238.00" "$11,238.00" "$8,428.50" "$11,238.00" "$11,238.00" "$11,238.00" "$5,619.00" "$5,619.00" "$8,900.50" "$11,238.00" "$8,990.40" "$7,304.70" "$2,230.46" "$11,238.00" "$6,518.04" "$11,238.00" "$11,238.00" "$11,238.00" "$2,342.00" "$11,238.00" N/A N/A 27204630 EAP HCPCS C1757 FLOW RESTORATION CATHETER (15-18MM) X 155CM BOTH IP/OP "$11,238.00" "$8,316.50" "$2,060.15" "$11,238.00" "$6,102.23" "$6,102.23" "$6,102.23" "$6,102.23" "$11,238.00" "$11,238.00" "$11,238.00" "$2,342.28" "$11,238.00" "$4,181.12" "$4,181.12" "$8,662.25" "$2,060.15" "$2,342.12" "$11,238.00" "$11,238.00" "$3,094.73" "$11,238.00" "$11,238.00" "$11,238.00" "$11,238.00" "$8,428.50" "$11,238.00" "$11,238.00" "$11,238.00" "$5,619.00" "$5,619.00" "$8,900.50" "$11,238.00" "$8,990.40" "$7,304.70" "$2,230.46" "$11,238.00" "$6,518.04" "$11,238.00" "$11,238.00" "$11,238.00" "$2,342.00" "$11,238.00" N/A N/A 27204631 EAP HCPCS C1757 ASPIRATION GUIDE CATHETER 20F X 95CM BOTH IP/OP "$5,738.00" "$4,246.50" "$1,138.85" "$5,738.00" "$3,115.73" "$3,115.73" "$3,115.73" "$3,115.73" "$5,738.00" "$5,738.00" "$5,738.00" "$1,195.94" "$5,738.00" "$4,181.12" "$4,181.12" "$4,422.85" "$2,060.15" "$1,195.86" "$5,738.00" "$5,738.00" "$3,094.73" "$5,738.00" "$5,738.00" "$5,738.00" "$5,738.00" "$4,303.50" "$5,738.00" "$5,738.00" "$5,738.00" "$2,869.00" "$2,869.00" "$4,544.50" "$5,738.00" "$4,590.40" "$3,729.70" "$1,138.85" "$5,738.00" "$3,328.04" "$5,738.00" "$5,738.00" "$5,738.00" "$1,195.80" "$5,738.00" N/A N/A 27204632 EAP HCPCS C1773 RETRACTION ASPIRATOR DEVICE BOTH IP/OP $787.00 $582.50 $156.20 $787.00 $427.34 $427.34 $427.34 $427.34 $787.00 $787.00 $787.00 $164.03 $787.00 $584.11 $584.11 $606.62 $410.03 $164.02 $787.00 $787.00 $465.51 $787.00 $787.00 $787.00 $787.00 $590.25 $787.00 $787.00 $787.00 $393.50 $393.50 $623.30 $787.00 $629.60 $511.55 $156.20 $787.00 $456.46 $787.00 $787.00 $787.00 $164.01 $787.00 N/A N/A 27204633 EAP HCPCS C1757 TREVO XP 6MM X 25MM BOTH IP/OP "$13,402.00" "$9,917.50" "$2,060.15" "$13,402.00" "$7,277.29" "$7,277.29" "$7,277.29" "$7,277.29" "$13,402.00" "$13,402.00" "$13,402.00" "$2,793.31" "$13,402.00" "$4,181.12" "$4,181.12" "$10,330.26" "$2,060.15" "$2,793.12" "$13,402.00" "$13,402.00" "$3,094.73" "$13,402.00" "$13,402.00" "$13,402.00" "$13,402.00" "$10,051.50" "$13,402.00" "$13,402.00" "$13,402.00" "$6,701.00" "$6,701.00" "$10,614.38" "$13,402.00" "$10,721.60" "$8,711.30" "$2,659.96" "$13,402.00" "$7,773.16" "$13,402.00" "$13,402.00" "$13,402.00" "$2,792.98" "$13,402.00" N/A N/A 27204634 EAP HCPCS C1757 TREVO XP PROVUE RETRIEVER 4.0 X 30MM BOTH IP/OP "$14,072.00" "$10,413.50" "$2,060.15" "$14,072.00" "$7,641.10" "$7,641.10" "$7,641.10" "$7,641.10" "$14,072.00" "$14,072.00" "$14,072.00" "$2,932.96" "$14,072.00" "$4,181.12" "$4,181.12" "$10,846.70" "$2,060.15" "$2,932.76" "$14,072.00" "$14,072.00" "$3,094.73" "$14,072.00" "$14,072.00" "$14,072.00" "$14,072.00" "$10,554.00" "$14,072.00" "$14,072.00" "$14,072.00" "$7,036.00" "$7,036.00" "$11,145.02" "$14,072.00" "$11,257.60" "$9,146.80" "$2,792.94" "$14,072.00" "$8,161.76" "$14,072.00" "$14,072.00" "$14,072.00" "$2,932.60" "$14,072.00" N/A N/A 27204635 EAP HCPCS C1887 "MICRCATHETER STD STRAIGHT, 2 TIP-MARKER, 150CM-15CM" BOTH IP/OP "$2,324.00" "$1,720.00" $461.26 "$2,324.00" "$1,261.93" "$1,261.93" "$1,261.93" "$1,261.93" "$2,324.00" "$2,324.00" "$2,324.00" $484.38 "$2,324.00" "$1,724.87" "$1,724.87" "$1,791.34" "$1,210.80" $484.35 "$2,324.00" "$2,324.00" "$1,374.65" "$2,324.00" "$2,324.00" "$2,324.00" "$2,324.00" "$1,743.00" "$2,324.00" "$2,324.00" "$2,324.00" "$1,162.00" "$1,162.00" "$1,840.61" "$2,324.00" "$1,859.20" "$1,510.60" $461.26 "$2,324.00" "$1,347.92" "$2,324.00" "$2,324.00" "$2,324.00" $484.32 "$2,324.00" N/A N/A 27204636 EAP HCPCS C1887 "MICROCATHETER STANDARD PRE-SHAPED 45, 2-TIP MKR, 150CM/7.5CM" BOTH IP/OP "$2,381.00" "$1,762.00" $472.57 "$2,381.00" "$1,292.88" "$1,292.88" "$1,292.88" "$1,292.88" "$2,381.00" "$2,381.00" "$2,381.00" $496.26 "$2,381.00" "$1,767.18" "$1,767.18" "$1,835.27" "$1,240.50" $496.23 "$2,381.00" "$2,381.00" "$1,408.36" "$2,381.00" "$2,381.00" "$2,381.00" "$2,381.00" "$1,785.75" "$2,381.00" "$2,381.00" "$2,381.00" "$1,190.50" "$1,190.50" "$1,885.75" "$2,381.00" "$1,904.80" "$1,547.65" $472.57 "$2,381.00" "$1,380.98" "$2,381.00" "$2,381.00" "$2,381.00" $496.20 "$2,381.00" N/A N/A 27204637 EAP HCPCS C1887 "MICRCATHETER STD PRE-SHP 90, 2-TIP MKR, 150CM/7.5CM" BOTH IP/OP "$2,381.00" "$1,762.00" $472.57 "$2,381.00" "$1,292.88" "$1,292.88" "$1,292.88" "$1,292.88" "$2,381.00" "$2,381.00" "$2,381.00" $496.26 "$2,381.00" "$1,767.18" "$1,767.18" "$1,835.27" "$1,240.50" $496.23 "$2,381.00" "$2,381.00" "$1,408.36" "$2,381.00" "$2,381.00" "$2,381.00" "$2,381.00" "$1,785.75" "$2,381.00" "$2,381.00" "$2,381.00" "$1,190.50" "$1,190.50" "$1,885.75" "$2,381.00" "$1,904.80" "$1,547.65" $472.57 "$2,381.00" "$1,380.98" "$2,381.00" "$2,381.00" "$2,381.00" $496.20 "$2,381.00" N/A N/A 27204639 EAP HCPCS C1769 GUIDEWIRE VASCULAR STR .035IN 150CM BENTSON SMOOTH BOTH IP/OP $33.00 $24.50 $6.55 $33.00 $17.92 $17.92 $17.92 $17.92 $33.00 $33.00 $33.00 $6.88 $33.00 $24.49 $24.49 $25.44 $17.19 $6.88 $33.00 $33.00 $19.52 $33.00 $33.00 $33.00 $33.00 $24.75 $33.00 $33.00 $33.00 $16.50 $16.50 $26.14 $33.00 $26.40 $21.45 $6.55 $33.00 $19.14 $33.00 $33.00 $33.00 $6.88 $33.00 N/A N/A 27204640 EAP HCPCS C1725 CATHETER BALDILAT .035IN 8FR 18MM 80CM 4CM GOLD BOTH IP/OP $722.00 $534.50 $143.30 $722.00 $392.05 $392.05 $392.05 $392.05 $722.00 $722.00 $722.00 $150.48 $722.00 $535.87 $535.87 $556.52 $376.16 $150.47 $722.00 $722.00 $427.06 $722.00 $722.00 $722.00 $722.00 $541.50 $722.00 $722.00 $722.00 $361.00 $361.00 $571.82 $722.00 $577.60 $469.30 $143.30 $722.00 $418.76 $722.00 $722.00 $722.00 $150.46 $722.00 N/A N/A 27204641 EAP HCPCS C1725 CATHETER BALDILAT .035IN 8FR 16MM 80CM 4CM GOLD BOTH IP/OP $722.00 $534.50 $143.30 $722.00 $392.05 $392.05 $392.05 $392.05 $722.00 $722.00 $722.00 $150.48 $722.00 $535.87 $535.87 $556.52 $376.16 $150.47 $722.00 $722.00 $427.06 $722.00 $722.00 $722.00 $722.00 $541.50 $722.00 $722.00 $722.00 $361.00 $361.00 $571.82 $722.00 $577.60 $469.30 $143.30 $722.00 $418.76 $722.00 $722.00 $722.00 $150.46 $722.00 N/A N/A 27204642 EAP HCPCS C1725 CATHETER BALDILAT .035IN 7FR 14MM 80CM 4CM GOLD BOTH IP/OP $688.00 $509.50 $136.55 $688.00 $373.58 $373.58 $373.58 $373.58 $688.00 $688.00 $688.00 $143.40 $688.00 $510.63 $510.63 $530.31 $358.45 $143.39 $688.00 $688.00 $406.95 $688.00 $688.00 $688.00 $688.00 $516.00 $688.00 $688.00 $688.00 $344.00 $344.00 $544.90 $688.00 $550.40 $447.20 $136.55 $688.00 $399.04 $688.00 $688.00 $688.00 $143.38 $688.00 N/A N/A 27204643 EAP HCPCS C1725 CATHETER XTRT 120CM 14FR XL .035IN STR TIP GWIRE BOTH IP/OP "$1,956.00" "$1,447.50" $388.22 "$1,956.00" "$1,062.11" "$1,062.11" "$1,062.11" "$1,062.11" "$1,956.00" "$1,956.00" "$1,956.00" $407.68 "$1,956.00" "$1,451.74" "$1,451.74" "$1,507.68" "$1,019.08" $407.65 "$1,956.00" "$1,956.00" "$1,156.97" "$1,956.00" "$1,956.00" "$1,956.00" "$1,956.00" "$1,467.00" "$1,956.00" "$1,956.00" "$1,956.00" $978.00 $978.00 "$1,549.15" "$1,956.00" "$1,564.80" "$1,271.40" $388.22 "$1,956.00" "$1,134.48" "$1,956.00" "$1,956.00" "$1,956.00" $407.63 "$1,956.00" N/A N/A 27204644 EAP HCPCS C1757 SET INTROD 70CM 14FR 15MM CK-Z TRCHBR GNT RSCH BOTH IP/OP $749.00 $554.50 $148.66 $749.00 $406.71 $406.71 $406.71 $406.71 $749.00 $749.00 $749.00 $156.11 $749.00 $555.91 $555.91 $577.33 $390.23 $156.10 $749.00 $749.00 $443.03 $749.00 $749.00 $749.00 $749.00 $561.75 $749.00 $749.00 $749.00 $374.50 $374.50 $593.21 $749.00 $599.20 $486.85 $148.66 $749.00 $434.42 $749.00 $749.00 $749.00 $156.09 $749.00 N/A N/A 27204645 EAP HCPCS C1757 COIL EMBL 132CM .064MM PENUMBRA RUBY ACE 5MAX BOTH IP/OP "$5,484.00" "$4,058.50" "$1,088.44" "$5,484.00" "$2,977.81" "$2,977.81" "$2,977.81" "$2,977.81" "$5,484.00" "$5,484.00" "$5,484.00" "$1,143.00" "$5,484.00" "$4,070.22" "$4,070.22" "$4,227.07" "$2,060.15" "$1,142.93" "$5,484.00" "$5,484.00" "$3,094.73" "$5,484.00" "$5,484.00" "$5,484.00" "$5,484.00" "$4,113.00" "$5,484.00" "$5,484.00" "$5,484.00" "$2,742.00" "$2,742.00" "$4,343.33" "$5,484.00" "$4,387.20" "$3,564.60" "$1,088.44" "$5,484.00" "$3,180.72" "$5,484.00" "$5,484.00" "$5,484.00" "$1,142.87" "$5,484.00" N/A N/A 27204647 EAP HCPCS C1894 INTRODUCER SHTH PED 5FR 21GA 40CM 7CM GRY HUB BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 27204648 EAP HCPCS C1894 INTRODUCER SHTH PED 6FR 21GA 40CM 7CM GRN HUB BOTH IP/OP $108.00 $80.00 $21.44 $108.00 $58.64 $58.64 $58.64 $58.64 $108.00 $108.00 $108.00 $22.51 $108.00 $80.16 $80.16 $83.25 $56.27 $22.51 $108.00 $108.00 $63.88 $108.00 $108.00 $108.00 $108.00 $81.00 $108.00 $108.00 $108.00 $54.00 $54.00 $85.54 $108.00 $86.40 $70.20 $21.44 $108.00 $62.64 $108.00 $108.00 $108.00 $22.51 $108.00 N/A N/A 27204649 EAP HCPCS C1884 SYSTEM EMBL PRTC 190CM .014IN 110UM CRTD GWIRE BOTH IP/OP "$4,397.00" "$3,254.00" $872.69 "$4,397.00" "$2,387.57" "$2,387.57" "$2,387.57" "$2,387.57" "$4,397.00" "$4,397.00" "$4,397.00" $916.44 "$4,397.00" "$3,263.45" "$3,263.45" "$3,389.21" "$2,060.15" $916.38 "$4,397.00" "$4,397.00" "$2,600.83" "$4,397.00" "$4,397.00" "$4,397.00" "$4,397.00" "$3,297.75" "$4,397.00" "$4,397.00" "$4,397.00" "$2,198.50" "$2,198.50" "$3,482.42" "$4,397.00" "$3,517.60" "$2,858.05" $872.69 "$4,397.00" "$2,550.26" "$4,397.00" "$4,397.00" "$4,397.00" $916.33 "$4,397.00" N/A N/A 27204650 EAP HCPCS C1884 SYSTEM EMBL PRTC 190CM .014IN 110UM SPRG CRTD BOTH IP/OP "$4,397.00" "$3,254.00" $872.69 "$4,397.00" "$2,387.57" "$2,387.57" "$2,387.57" "$2,387.57" "$4,397.00" "$4,397.00" "$4,397.00" $916.44 "$4,397.00" "$3,263.45" "$3,263.45" "$3,389.21" "$2,060.15" $916.38 "$4,397.00" "$4,397.00" "$2,600.83" "$4,397.00" "$4,397.00" "$4,397.00" "$4,397.00" "$3,297.75" "$4,397.00" "$4,397.00" "$4,397.00" "$2,198.50" "$2,198.50" "$3,482.42" "$4,397.00" "$3,517.60" "$2,858.05" $872.69 "$4,397.00" "$2,550.26" "$4,397.00" "$4,397.00" "$4,397.00" $916.33 "$4,397.00" N/A N/A 27204658 EAP HCPCS C2630 CATHETER ABLT 115CM 8FR 4MM D CURVE FLEXABILITY 4 BOTH IP/OP "$5,249.00" "$3,884.50" "$1,093.95" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$3,895.81" "$3,895.81" "$4,045.93" "$2,060.15" "$1,093.95" "$5,249.00" "$2,099.60" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$3,936.75" "$5,249.00" "$5,249.00" "$5,249.00" "$2,624.50" "$2,624.50" "$4,157.21" "$5,249.00" "$4,199.20" "$3,411.85" "$5,249.00" "$5,249.00" "$3,044.42" "$5,249.00" "$3,149.40" "$5,249.00" "$5,249.00" "$5,249.00" N/A N/A 27204661 EAP HCPCS C1885 CATHETER ANGIO JACKY RADL CURVE 5FR 3.5MM 100CM 2 BOTH IP/OP $438.00 $324.50 $91.28 $438.00 $438.00 $438.00 $438.00 $438.00 $438.00 $438.00 $438.00 $438.00 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $175.20 $438.00 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $438.00 $438.00 $254.04 $438.00 $262.80 $438.00 $438.00 $438.00 N/A N/A 27204662 EAP HCPCS C1725 CORONARY BALLOON BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 27204663 EAP CPT® C1769 GUIDEWIRE VASC 80CM .035IN JKT CORE TO TIP ATRM BOTH IP/OP $80.00 $59.50 $15.88 $80.00 $43.44 $43.44 $43.44 $43.44 $80.00 $80.00 $80.00 $16.67 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $80.00 $47.32 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $15.88 $80.00 $46.40 $80.00 $80.00 $80.00 $16.67 $80.00 N/A N/A 27204664 EAP HCPCS C1769 035IN 150CM 7CM STANDARD TIP FIX BOTH IP/OP $20.00 $15.00 $3.97 $20.00 $10.86 $10.86 $10.86 $10.86 $20.00 $20.00 $20.00 $4.17 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $20.00 $11.83 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $3.97 $20.00 $11.60 $20.00 $20.00 $20.00 $4.17 $20.00 N/A N/A 27204673 EAP HCPCS C1887 CATHETER GUID JR4 CURVE 6FR 100CM SITESEER STAINLESS STEEL BOTH IP/OP $294.00 $218.00 $58.35 $294.00 $159.64 $159.64 $159.64 $159.64 $294.00 $294.00 $294.00 $61.28 $294.00 $218.21 $218.21 $226.62 $153.17 $61.27 $294.00 $294.00 $173.90 $294.00 $294.00 $294.00 $294.00 $220.50 $294.00 $294.00 $294.00 $147.00 $147.00 $232.85 $294.00 $235.20 $191.10 $58.35 $294.00 $170.52 $294.00 $294.00 $294.00 $61.27 $294.00 N/A N/A 27204674 EAP HCPCS C1887 "CATHETER,6FR AL2 SITESEER" BOTH IP/OP $158.00 $117.00 $31.36 $158.00 $85.79 $85.79 $85.79 $85.79 $158.00 $158.00 $158.00 $32.93 $158.00 $117.27 $117.27 $121.79 $82.32 $32.93 $158.00 $63.20 $93.46 $158.00 $158.00 $158.00 $158.00 $118.50 $158.00 $158.00 $158.00 $79.00 $79.00 $125.14 $158.00 $126.40 $102.70 $31.36 $158.00 $91.64 $158.00 $158.00 $158.00 $32.93 $158.00 N/A N/A 27204675 EAP HCPCS C1894 SET INTROD .018IN 4FR 10CM 40C BOTH IP/OP $123.00 $91.50 $24.41 $123.00 $66.79 $66.79 $66.79 $66.79 $123.00 $123.00 $123.00 $25.64 $123.00 $91.29 $91.29 $94.81 $64.08 $25.63 $123.00 $123.00 $72.75 $123.00 $123.00 $123.00 $123.00 $92.25 $123.00 $123.00 $123.00 $61.50 $61.50 $97.42 $123.00 $98.40 $79.95 $24.41 $123.00 $71.34 $123.00 $123.00 $123.00 $25.63 $123.00 N/A N/A 27204676 EAP HCPCS C1769 SET INTROD 24-26-28FR CGL BRHN BOTH IP/OP $905.00 $670.00 $179.62 $905.00 $491.42 $491.42 $491.42 $491.42 $905.00 $905.00 $905.00 $188.62 $905.00 $671.69 $671.69 $697.57 $471.51 $188.61 $905.00 $362.00 $535.31 $905.00 $905.00 $905.00 $905.00 $678.75 $905.00 $905.00 $905.00 $452.50 $452.50 $716.76 $905.00 $724.00 $588.25 $179.62 $905.00 $524.90 $905.00 $905.00 $905.00 $188.60 $905.00 N/A N/A 27204677 EAP HCPCS C1894 SET INTROD .018IN 4FR 21GA 40C BOTH IP/OP $83.00 $61.50 $16.47 $83.00 $45.07 $45.07 $45.07 $45.07 $83.00 $83.00 $83.00 $17.30 $83.00 $61.60 $61.60 $63.98 $43.24 $17.30 $83.00 $83.00 $49.09 $83.00 $83.00 $83.00 $83.00 $62.25 $83.00 $83.00 $83.00 $41.50 $41.50 $65.74 $83.00 $66.40 $53.95 $16.47 $83.00 $48.14 $83.00 $83.00 $83.00 $17.30 $83.00 N/A N/A 27204678 EAP Custom 27204678 SET INTROD .018IN LONG 5FR 21G BOTH IP/OP $95.00 $70.50 $16.91 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $16.91 $95.00 $95.00 $70.51 $70.51 $73.23 $49.50 $19.80 $95.00 $38.00 $95.00 $95.00 $95.00 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $61.75 $95.00 $95.00 $55.10 $95.00 $57.00 $95.00 $95.00 $95.00 N/A N/A 27204679 EAP Custom 27204679 SET INTROD .018IN LONG 5FR 70C BOTH IP/OP $95.00 $70.50 $16.91 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $16.91 $95.00 $95.00 $70.51 $70.51 $73.23 $49.50 $19.80 $95.00 $38.00 $95.00 $95.00 $95.00 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $61.75 $95.00 $95.00 $55.10 $95.00 $57.00 $95.00 $95.00 $95.00 N/A N/A 27204680 EAP HCPCS C1894 SET INTROD 6FR 13CM 20CM SIDEA BOTH IP/OP $40.00 $30.00 $7.94 $40.00 $21.72 $21.72 $21.72 $21.72 $40.00 $40.00 $40.00 $8.34 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.00 $23.66 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $7.94 $40.00 $23.20 $40.00 $40.00 $40.00 $8.34 $40.00 N/A N/A 27204681 EAP HCPCS C1894 SET INTROD .038IN 11FR 15.5CM BOTH IP/OP $106.00 $78.50 $21.04 $106.00 $57.56 $57.56 $57.56 $57.56 $106.00 $106.00 $106.00 $22.09 $106.00 $78.67 $78.67 $81.70 $55.23 $22.09 $106.00 $106.00 $62.70 $106.00 $106.00 $106.00 $106.00 $79.50 $106.00 $106.00 $106.00 $53.00 $53.00 $83.95 $106.00 $84.80 $68.90 $21.04 $106.00 $61.48 $106.00 $106.00 $106.00 $22.09 $106.00 N/A N/A 27204682 EAP HCPCS C1894 SET INTROD .038IN 12FR 15.5CM BOTH IP/OP $106.00 $78.50 $21.04 $106.00 $57.56 $57.56 $57.56 $57.56 $106.00 $106.00 $106.00 $22.09 $106.00 $78.67 $78.67 $81.70 $55.23 $22.09 $106.00 $106.00 $62.70 $106.00 $106.00 $106.00 $106.00 $79.50 $106.00 $106.00 $106.00 $53.00 $53.00 $83.95 $106.00 $84.80 $68.90 $21.04 $106.00 $61.48 $106.00 $106.00 $106.00 $22.09 $106.00 N/A N/A 27204683 EAP HCPCS C1894 SET INTROD .038IN 14FR 15.5CM BOTH IP/OP $106.00 $78.50 $21.04 $106.00 $57.56 $57.56 $57.56 $57.56 $106.00 $106.00 $106.00 $22.09 $106.00 $78.67 $78.67 $81.70 $55.23 $22.09 $106.00 $42.40 $62.70 $106.00 $106.00 $106.00 $106.00 $79.50 $106.00 $106.00 $106.00 $53.00 $53.00 $83.95 $106.00 $84.80 $68.90 $21.04 $106.00 $61.48 $106.00 $106.00 $106.00 $22.09 $106.00 N/A N/A 27204684 EAP HCPCS C1894 SET INTROD 18FR 15.5CM PEEL-AW BOTH IP/OP $106.00 $78.50 $21.04 $106.00 $57.56 $57.56 $57.56 $57.56 $106.00 $106.00 $106.00 $22.09 $106.00 $78.67 $78.67 $81.70 $55.23 $22.09 $106.00 $106.00 $62.70 $106.00 $106.00 $106.00 $106.00 $79.50 $106.00 $106.00 $106.00 $53.00 $53.00 $83.95 $106.00 $84.80 $68.90 $21.04 $106.00 $61.48 $106.00 $106.00 $106.00 $22.09 $106.00 N/A N/A 27204686 EAP Custom 27204686 SET INTROD .018IN MICRO STR 7F BOTH IP/OP $153.00 $113.50 $27.23 $153.00 $153.00 $153.00 $153.00 $153.00 $153.00 $153.00 $27.23 $153.00 $153.00 $113.56 $113.56 $117.93 $79.71 $31.89 $153.00 $61.20 $153.00 $153.00 $153.00 $153.00 $153.00 $114.75 $153.00 $153.00 $153.00 $76.50 $76.50 $121.18 $153.00 $122.40 $99.45 $153.00 $153.00 $88.74 $153.00 $91.80 $153.00 $153.00 $153.00 N/A N/A 27204687 EAP HCPCS C1894 SET INTROD 16FR 20-35MM 70CM G BOTH IP/OP $713.00 $528.00 $141.51 $713.00 $387.16 $387.16 $387.16 $387.16 $713.00 $713.00 $713.00 $148.61 $713.00 $529.19 $529.19 $549.58 $371.47 $148.60 $713.00 $285.20 $421.74 $713.00 $713.00 $713.00 $713.00 $534.75 $713.00 $713.00 $713.00 $356.50 $356.50 $564.70 $713.00 $570.40 $463.45 $141.51 $713.00 $413.54 $713.00 $713.00 $713.00 $148.59 $713.00 N/A N/A 27204688 EAP HCPCS C1894 SET INTROD 6FR 8FR 13.75IN 3 W BOTH IP/OP $249.00 $184.50 $49.42 $249.00 $135.21 $135.21 $135.21 $135.21 $249.00 $249.00 $249.00 $51.90 $249.00 $184.81 $184.81 $191.93 $129.73 $51.89 $249.00 $249.00 $147.28 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $161.85 $49.42 $249.00 $144.42 $249.00 $249.00 $249.00 $51.89 $249.00 N/A N/A 27204689 EAP HCPCS C1894 SET INTROD 6FR 8FR 17.75IN 3 W BOTH IP/OP $249.00 $184.50 $49.42 $249.00 $135.21 $135.21 $135.21 $135.21 $249.00 $249.00 $249.00 $51.90 $249.00 $184.81 $184.81 $191.93 $129.73 $51.89 $249.00 $249.00 $147.28 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $161.85 $49.42 $249.00 $144.42 $249.00 $249.00 $249.00 $51.89 $249.00 N/A N/A 27204691 EAP HCPCS C1887 CATHETER ANGIOGRAPHIC COBRA 2 CURVE 4FR .041IN 65C BOTH IP/OP $613.00 $454.00 $121.67 $613.00 $332.86 $332.86 $332.86 $332.86 $613.00 $613.00 $613.00 $127.76 $613.00 $454.97 $454.97 $472.50 $319.37 $127.76 $613.00 $245.20 $362.59 $613.00 $613.00 $613.00 $613.00 $459.75 $613.00 $613.00 $613.00 $306.50 $306.50 $485.50 $613.00 $490.40 $398.45 $121.67 $613.00 $355.54 $613.00 $613.00 $613.00 $127.75 $613.00 N/A N/A 27204694 EAP HCPCS C1769 GUIDEWIRE VASC 300CM RND PRFL AGILE TIP SMTR ROT BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $814.50 $814.50 $814.50 $814.50 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 27204695 EAP HCPCS C1757 "INDIGO CATHETER 8, XTORQ TIP 115CM" BOTH IP/OP "$7,255.00" "$5,369.00" "$1,439.94" "$7,255.00" "$3,939.47" "$3,939.47" "$3,939.47" "$3,939.47" "$7,255.00" "$7,255.00" "$7,255.00" "$1,512.12" "$7,255.00" "$4,181.12" "$4,181.12" "$5,592.15" "$2,060.15" "$1,512.02" "$7,255.00" "$7,255.00" "$3,094.73" "$7,255.00" "$7,255.00" "$7,255.00" "$7,255.00" "$5,441.25" "$7,255.00" "$7,255.00" "$7,255.00" "$3,627.50" "$3,627.50" "$5,745.96" "$7,255.00" "$5,804.00" "$4,715.75" "$1,439.94" "$7,255.00" "$4,207.90" "$7,255.00" "$7,255.00" "$7,255.00" "$1,511.94" "$7,255.00" N/A N/A 27204696 EAP Custom 27204696 INDIGO SEPARATOR 8 BOTH IP/OP "$4,700.00" "$3,478.00" $836.60 "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" $836.60 "$4,700.00" "$4,700.00" "$3,488.34" "$3,488.34" "$3,622.76" "$2,060.15" $979.53 "$4,700.00" "$1,880.00" "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" "$3,525.00" "$4,700.00" "$4,700.00" "$4,700.00" "$2,350.00" "$2,350.00" "$3,722.40" "$4,700.00" "$3,760.00" "$3,055.00" "$4,700.00" "$4,700.00" "$2,726.00" "$4,700.00" "$2,820.00" "$4,700.00" "$4,700.00" "$4,700.00" N/A N/A 27204697 EAP Custom 27204697 MAX ASPIRATION TUBING 3 BOTH IP/OP "$1,095.00" $810.50 $194.91 "$1,095.00" "$1,095.00" "$1,095.00" "$1,095.00" "$1,095.00" "$1,095.00" "$1,095.00" $194.91 "$1,095.00" "$1,095.00" $812.71 $812.71 $844.03 $570.50 $228.21 "$1,095.00" $438.00 "$1,095.00" "$1,095.00" "$1,095.00" "$1,095.00" "$1,095.00" $821.25 "$1,095.00" "$1,095.00" "$1,095.00" $547.50 $547.50 $867.24 "$1,095.00" $876.00 $711.75 "$1,095.00" "$1,095.00" $635.10 "$1,095.00" $657.00 "$1,095.00" "$1,095.00" "$1,095.00" N/A N/A 27204698 EAP Custom 27204698 SEALANT HEMOSTATIC NEEDLE FREE ADAPTER FLOSEAL MATRIX 10ML BOTH IP/OP $913.00 $676.00 $162.51 $913.00 $913.00 $913.00 $913.00 $913.00 $913.00 $913.00 $162.51 $913.00 $913.00 $677.63 $677.63 $703.74 $475.67 $190.28 $913.00 $365.20 $913.00 $913.00 $913.00 $913.00 $913.00 $684.75 $913.00 $913.00 $913.00 $456.50 $456.50 $723.10 $913.00 $730.40 $593.45 $913.00 $913.00 $529.54 $913.00 $547.80 $913.00 $913.00 $913.00 N/A N/A 27204699 EAP Custom 27204699 SEALANT HEMOSTATIC NEEDLE FREE ADAPTER FLOSEAL MATRIX 5ML BOTH IP/OP $499.00 $369.50 $88.82 $499.00 $499.00 $499.00 $499.00 $499.00 $499.00 $499.00 $88.82 $499.00 $499.00 $370.36 $370.36 $384.63 $259.98 $104.00 $499.00 $199.60 $499.00 $499.00 $499.00 $499.00 $499.00 $374.25 $499.00 $499.00 $499.00 $249.50 $249.50 $395.21 $499.00 $399.20 $324.35 $499.00 $499.00 $289.42 $499.00 $299.40 $499.00 $499.00 $499.00 N/A N/A 27204700 EAP HCPCS C1887 CATHETER INTERVENTIONAL 6FR .07IN .056IN 145CM 20C BOTH IP/OP "$1,183.00" $875.50 $234.80 "$1,183.00" $642.37 $642.37 $642.37 $642.37 "$1,183.00" "$1,183.00" "$1,183.00" $246.57 "$1,183.00" $878.02 $878.02 $911.86 $616.34 $246.55 "$1,183.00" $473.20 $699.74 "$1,183.00" "$1,183.00" "$1,183.00" "$1,183.00" $887.25 "$1,183.00" "$1,183.00" "$1,183.00" $591.50 $591.50 $936.94 "$1,183.00" $946.40 $768.95 $234.80 "$1,183.00" $686.14 "$1,183.00" "$1,183.00" "$1,183.00" $246.54 "$1,183.00" N/A N/A 27204702 EAP HCPCS C1766 INTRODUCER SHTH 8.8FR 7FR 55CM HI FLX DILAT BOTH IP/OP $138.00 $102.50 $28.76 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 $138.00 $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 27204705 EAP CATHETER ECHELON 10 MICRO BOTH IP/OP "$1,687.00" "$1,248.50" $300.29 "$1,687.00" "$1,687.00" "$1,687.00" "$1,687.00" "$1,687.00" "$1,687.00" "$1,687.00" $300.29 "$1,687.00" "$1,687.00" "$1,252.09" "$1,252.09" "$1,300.34" $878.93 $351.59 "$1,687.00" $674.80 "$1,687.00" "$1,687.00" "$1,687.00" "$1,687.00" "$1,687.00" "$1,265.25" "$1,687.00" "$1,687.00" "$1,687.00" $843.50 $843.50 "$1,336.10" "$1,687.00" "$1,349.60" "$1,096.55" "$1,687.00" "$1,687.00" $978.46 "$1,687.00" "$1,012.20" "$1,687.00" "$1,687.00" "$1,687.00" N/A N/A 27204708 EAP HCPCS C1769 GUIDEWIRE .016 FATHOM BOTH IP/OP $893.00 $661.00 $177.24 $893.00 $484.90 $484.90 $484.90 $484.90 $893.00 $893.00 $893.00 $186.12 $893.00 $662.78 $662.78 $688.32 $465.25 $186.11 $893.00 $357.20 $528.21 $893.00 $893.00 $893.00 $893.00 $669.75 $893.00 $893.00 $893.00 $446.50 $446.50 $707.26 $893.00 $714.40 $580.45 $177.24 $893.00 $517.94 $893.00 $893.00 $893.00 $186.10 $893.00 N/A N/A 27204710 EAP Custom 27204710 MANIFOLD KIT BOTH IP/OP $58.00 $43.00 $10.32 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $10.32 $58.00 $58.00 $43.05 $43.05 $44.71 $30.22 $12.09 $58.00 $23.20 $58.00 $58.00 $58.00 $58.00 $58.00 $43.50 $58.00 $58.00 $58.00 $29.00 $29.00 $45.94 $58.00 $46.40 $37.70 $58.00 $58.00 $33.64 $58.00 $34.80 $58.00 $58.00 $58.00 N/A N/A 27204711 EAP HCPCS C1887 AXS CATALYST 5 DISTAL ACCESS CATHETER 0.058IN X 11 BOTH IP/OP "$3,878.00" "$2,870.00" $769.69 "$3,878.00" "$2,105.75" "$2,105.75" "$2,105.75" "$2,105.75" "$3,878.00" "$3,878.00" "$3,878.00" $808.27 "$3,878.00" "$2,878.25" "$2,878.25" "$2,989.16" "$2,020.44" $808.22 "$3,878.00" "$3,878.00" "$2,293.84" "$3,878.00" "$3,878.00" "$3,878.00" "$3,878.00" "$2,908.50" "$3,878.00" "$3,878.00" "$3,878.00" "$1,939.00" "$1,939.00" "$3,071.38" "$3,878.00" "$3,102.40" "$2,520.70" $769.69 "$3,878.00" "$2,249.24" "$3,878.00" "$3,878.00" "$3,878.00" $808.18 "$3,878.00" N/A N/A 27204714 EAP HCPCS C1894 INTRODUCER SHTH 8FR 2.9MM 80CM FLXR STRL ACPT .038 BOTH IP/OP $125.00 $92.50 $24.81 $125.00 $67.88 $67.88 $67.88 $67.88 $125.00 $125.00 $125.00 $26.05 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $24.81 $125.00 $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 27204715 EAP HCPCS C1894 INTRODUCER SHTH 8FR 90CM SM VLV ASMBLY RADIOPQ BOTH IP/OP $145.00 $107.50 $28.78 $145.00 $78.74 $78.74 $78.74 $78.74 $145.00 $145.00 $145.00 $30.22 $145.00 $107.62 $107.62 $111.77 $75.55 $30.22 $145.00 $145.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $94.25 $28.78 $145.00 $84.10 $145.00 $145.00 $145.00 $30.22 $145.00 N/A N/A 27204716 EAP Custom 27204716 KIT PRICRDCTS 40CM 8FR PGTL CURVE CATH BOTH IP/OP $313.00 $232.00 $55.71 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $55.71 $313.00 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $125.20 $313.00 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $313.00 $313.00 $181.54 $313.00 $187.80 $313.00 $313.00 $313.00 N/A N/A 27204717 EAP Custom 27204717 CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 80CM TORCON NB BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 27204718 EAP HCPCS C1887 CATHETER ANGIOGRAPHIC .046IN UAC CURVE 5FR .046IN 90CM BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $90.00 $150.00 $31.26 $150.00 N/A N/A 27204722 EAP HCPCS C1894 INTRODUCER SHEATH .035IN 10FR .134IN 45CM ANL0 CURVE STR TIP BOTH IP/OP $113.00 $84.00 $22.43 $113.00 $61.36 $61.36 $61.36 $61.36 $113.00 $113.00 $113.00 $23.55 $113.00 $83.87 $83.87 $87.10 $58.87 $23.55 $113.00 $113.00 $66.84 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $73.45 $22.43 $113.00 $65.54 $113.00 $113.00 $113.00 $23.55 $113.00 N/A N/A 27204723 EAP HCPCS C1894 INTRODUCER SHEATH .035IN 12FR .162IN 45CM ANL0 CURVE STR TIP BOTH IP/OP $138.00 $102.50 $27.39 $138.00 $74.93 $74.93 $74.93 $74.93 $138.00 $138.00 $138.00 $28.76 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $138.00 $81.63 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $27.39 $138.00 $80.04 $138.00 $138.00 $138.00 $28.76 $138.00 N/A N/A 27204724 EAP Custom 27204724 SET NDL 45MM 15GA EZIO SS 1 PORT SHRP BLOCK DRSG BOTH IP/OP "$1,663.00" "$1,231.00" $296.01 "$1,663.00" "$1,663.00" "$1,663.00" "$1,663.00" "$1,663.00" "$1,663.00" "$1,663.00" $296.01 "$1,663.00" "$1,663.00" "$1,234.28" "$1,234.28" "$1,281.84" $866.42 $346.59 "$1,663.00" $665.20 "$1,663.00" "$1,663.00" "$1,663.00" "$1,663.00" "$1,663.00" "$1,247.25" "$1,663.00" "$1,663.00" "$1,663.00" $831.50 $831.50 "$1,317.10" "$1,663.00" "$1,330.40" "$1,080.95" "$1,663.00" "$1,663.00" $964.54 "$1,663.00" $997.80 "$1,663.00" "$1,663.00" "$1,663.00" N/A N/A 27204725 EAP HCPCS C1773 SNARE ENDSCP .98IN 47IN 1 LOOP GOLD PLATED TUNGSTEN BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $488.70 $488.70 $488.70 $488.70 $900.00 $900.00 $900.00 $187.58 $900.00 $667.98 $667.98 $693.72 $468.90 $187.57 $900.00 $900.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $585.00 $178.63 $900.00 $522.00 $900.00 $900.00 $900.00 $187.56 $900.00 N/A N/A 27204726 EAP HCPCS C1773 SEPARATOR THRMB INDG 6 LATEX FREE BOTH IP/OP "$2,700.00" "$1,998.00" $535.88 "$2,700.00" "$1,466.10" "$1,466.10" "$1,466.10" "$1,466.10" "$2,700.00" "$2,700.00" "$2,700.00" $562.75 "$2,700.00" "$2,003.94" "$2,003.94" "$2,081.16" "$1,406.70" $562.71 "$2,700.00" "$2,700.00" "$1,597.05" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,025.00" "$2,700.00" "$2,700.00" "$2,700.00" "$1,350.00" "$1,350.00" "$2,138.40" "$2,700.00" "$2,160.00" "$1,755.00" $535.88 "$2,700.00" "$1,566.00" "$2,700.00" "$2,700.00" "$2,700.00" $562.68 "$2,700.00" N/A N/A 27204729 EAP HCPCS C1757 CATHETER THRMB 6FR INDG ASPIRAT LATEX FREE BOTH IP/OP "$4,725.00" "$3,496.50" $937.79 "$4,725.00" "$2,565.68" "$2,565.68" "$2,565.68" "$2,565.68" "$4,725.00" "$4,725.00" "$4,725.00" $984.81 "$4,725.00" "$3,506.90" "$3,506.90" "$3,642.03" "$2,060.15" $984.74 "$4,725.00" "$4,725.00" "$2,794.84" "$4,725.00" "$4,725.00" "$4,725.00" "$4,725.00" "$3,543.75" "$4,725.00" "$4,725.00" "$4,725.00" "$2,362.50" "$2,362.50" "$3,742.20" "$4,725.00" "$3,780.00" "$3,071.25" $937.79 "$4,725.00" "$2,740.50" "$4,725.00" "$4,725.00" "$4,725.00" $984.69 "$4,725.00" N/A N/A 27204730 EAP HCPCS C1757 CATHETER THRMB 132CM 5-6FR .064IN .054IN PERI UNQ BOTH IP/OP "$2,908.00" "$2,152.00" $577.17 "$2,908.00" "$1,579.04" "$1,579.04" "$1,579.04" "$1,579.04" "$2,908.00" "$2,908.00" "$2,908.00" $606.10 "$2,908.00" "$2,158.32" "$2,158.32" "$2,241.49" "$1,515.07" $606.06 "$2,908.00" "$2,908.00" "$1,720.08" "$2,908.00" "$2,908.00" "$2,908.00" "$2,908.00" "$2,181.00" "$2,908.00" "$2,908.00" "$2,908.00" "$1,454.00" "$1,454.00" "$2,303.14" "$2,908.00" "$2,326.40" "$1,890.20" $577.17 "$2,908.00" "$1,686.64" "$2,908.00" "$2,908.00" "$2,908.00" $606.03 "$2,908.00" N/A N/A 27204731 EAP HCPCS C1757 CATHETER THRMB 150CM 3.4-4.1FR .041IN .032IN PERI BOTH IP/OP "$2,908.00" "$2,152.00" $577.17 "$2,908.00" "$1,579.04" "$1,579.04" "$1,579.04" "$1,579.04" "$2,908.00" "$2,908.00" "$2,908.00" $606.10 "$2,908.00" "$2,158.32" "$2,158.32" "$2,241.49" "$1,515.07" $606.06 "$2,908.00" "$2,908.00" "$1,720.08" "$2,908.00" "$2,908.00" "$2,908.00" "$2,908.00" "$2,181.00" "$2,908.00" "$2,908.00" "$2,908.00" "$1,454.00" "$1,454.00" "$2,303.14" "$2,908.00" "$2,326.40" "$1,890.20" $577.17 "$2,908.00" "$1,686.64" "$2,908.00" "$2,908.00" "$2,908.00" $606.03 "$2,908.00" N/A N/A 27204733 EAP HCPCS C1757 CATHETER THRMB 85CM 8FR INDG ASPIRAT TRQ TIP LATEX BOTH IP/OP "$7,225.00" "$5,346.50" "$1,433.98" "$7,225.00" "$3,923.18" "$3,923.18" "$3,923.18" "$3,923.18" "$7,225.00" "$7,225.00" "$7,225.00" "$1,505.87" "$7,225.00" "$4,181.12" "$4,181.12" "$5,569.03" "$2,060.15" "$1,505.77" "$7,225.00" "$7,225.00" "$3,094.73" "$7,225.00" "$7,225.00" "$7,225.00" "$7,225.00" "$5,418.75" "$7,225.00" "$7,225.00" "$7,225.00" "$3,612.50" "$3,612.50" "$5,722.20" "$7,225.00" "$5,780.00" "$4,696.25" "$1,433.98" "$7,225.00" "$4,190.50" "$7,225.00" "$7,225.00" "$7,225.00" "$1,505.69" "$7,225.00" N/A N/A 27204736 EAP HCPCS C1887 SIX FR ASAHI FUBUKI GUIDE CATHETER DILATOR KIT/90CM/STRAIGHT BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $162.90 $162.90 $162.90 $162.90 $300.00 $300.00 $300.00 $62.53 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $59.54 $300.00 $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 27204737 EAP HCPCS C1887 SIX FR ASAHI FUBUKI GUIDE CATHETER DILATOR KIT 80CM/STRAIGHT BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $162.90 $162.90 $162.90 $162.90 $300.00 $300.00 $300.00 $62.53 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $59.54 $300.00 $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 27204738 EAP HCPCS C1894 INTRODUCER SHTH 7FR 2.5CM 10CM DILAT RADIOPQ MRKR BOTH IP/OP $56.00 $41.50 $11.11 $56.00 $30.41 $30.41 $30.41 $30.41 $56.00 $56.00 $56.00 $11.67 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $56.00 $33.12 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $11.11 $56.00 $32.48 $56.00 $56.00 $56.00 $11.67 $56.00 N/A N/A 27204739 EAP HCPCS C1894 INTRODUCER SHTH 8FR 2.5CM 10CM GWIRE DILAT RADIOPQ BOTH IP/OP $56.00 $41.50 $11.11 $56.00 $30.41 $30.41 $30.41 $30.41 $56.00 $56.00 $56.00 $11.67 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $22.40 $33.12 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $11.11 $56.00 $32.48 $56.00 $56.00 $56.00 $11.67 $56.00 N/A N/A 27204741 EAP HCPCS C1894 INTRODUCER SHTH 8FR 2.5CM 25CM DILAT RADIOPQ MRKR BOTH IP/OP $71.00 $53.00 $14.09 $71.00 $38.55 $38.55 $38.55 $38.55 $71.00 $71.00 $71.00 $14.80 $71.00 $52.70 $52.70 $54.73 $36.99 $14.80 $71.00 $71.00 $42.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $46.15 $14.09 $71.00 $41.18 $71.00 $71.00 $71.00 $14.80 $71.00 N/A N/A 27204742 EAP HCPCS C1887 CATHETER ANGIOGRAPHIC JUDKINS RIGHT 4 CURVE 5FR 10 BOTH IP/OP $111.00 $82.50 $22.03 $111.00 $60.27 $60.27 $60.27 $60.27 $111.00 $111.00 $111.00 $23.14 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $111.00 $65.66 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $22.03 $111.00 $64.38 $111.00 $111.00 $111.00 $23.13 $111.00 N/A N/A 27204747 EAP Custom 27204747 KIT PRESSURE MONITR 14GA BASIC TRANSDUCER TUOHY NEEDLE BOTH IP/OP "$1,883.00" "$1,393.50" $335.17 "$1,883.00" "$1,883.00" "$1,883.00" "$1,883.00" "$1,883.00" "$1,883.00" "$1,883.00" $335.17 "$1,883.00" "$1,883.00" "$1,397.56" "$1,397.56" "$1,451.42" $981.04 $392.44 "$1,883.00" $753.20 "$1,883.00" "$1,883.00" "$1,883.00" "$1,883.00" "$1,883.00" "$1,412.25" "$1,883.00" "$1,883.00" "$1,883.00" $941.50 $941.50 "$1,491.34" "$1,883.00" "$1,506.40" "$1,223.95" "$1,883.00" "$1,883.00" "$1,092.14" "$1,883.00" "$1,129.80" "$1,883.00" "$1,883.00" "$1,883.00" N/A N/A 27204748 EAP Custom 27204748 KIT CRANIOTOMY CRANIAL ACCES CODMAN BOTH IP/OP $635.00 $470.00 $113.03 $635.00 $635.00 $635.00 $635.00 $635.00 $635.00 $635.00 $113.03 $635.00 $635.00 $471.30 $471.30 $489.46 $330.84 $132.34 $635.00 $254.00 $635.00 $635.00 $635.00 $635.00 $635.00 $476.25 $635.00 $635.00 $635.00 $317.50 $317.50 $502.92 $635.00 $508.00 $412.75 $635.00 $635.00 $368.30 $635.00 $381.00 $635.00 $635.00 $635.00 N/A N/A 27204750 EAP HCPCS C1751 CATHETER CEN VEN .032IN 9.3FR 38CM 75CM 3 INFUS LUMEN EXTN BOTH IP/OP "$1,995.00" "$1,476.50" $395.96 "$1,995.00" "$1,083.29" "$1,083.29" "$1,083.29" "$1,083.29" "$1,995.00" "$1,995.00" "$1,995.00" $415.81 "$1,995.00" "$1,480.69" "$1,480.69" "$1,537.75" "$1,039.40" $415.78 "$1,995.00" "$1,995.00" "$1,180.04" "$1,995.00" "$1,995.00" "$1,995.00" "$1,995.00" "$1,496.25" "$1,995.00" "$1,995.00" "$1,995.00" $997.50 $997.50 "$1,580.04" "$1,995.00" "$1,596.00" "$1,296.75" $395.96 "$1,995.00" "$1,157.10" "$1,995.00" "$1,995.00" "$1,995.00" $415.76 "$1,995.00" N/A N/A 27204751 EAP HCPCS C1751 CATHETER CEN VEN 9.3FR 22CM 58MM ODS BOTH IP/OP "$1,228.00" $909.00 $243.73 "$1,228.00" $666.80 $666.80 $666.80 $666.80 "$1,228.00" "$1,228.00" "$1,228.00" $255.95 "$1,228.00" $911.42 $911.42 $946.54 $639.79 $255.93 "$1,228.00" "$1,228.00" $726.36 "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" $921.00 "$1,228.00" "$1,228.00" "$1,228.00" $614.00 $614.00 $972.58 "$1,228.00" $982.40 $798.20 $243.73 "$1,228.00" $712.24 "$1,228.00" "$1,228.00" "$1,228.00" $255.92 "$1,228.00" N/A N/A 27204752 EAP HCPCS C1757 "DAWN IDE, TREVO XP 6X25 KIT" BOTH IP/OP "$12,766.00" "$9,447.00" "$2,060.15" "$12,766.00" "$6,931.94" "$6,931.94" "$6,931.94" "$6,931.94" "$12,766.00" "$12,766.00" "$12,766.00" "$2,660.75" "$12,766.00" "$4,181.12" "$4,181.12" "$9,840.03" "$2,060.15" "$2,660.57" "$12,766.00" "$12,766.00" "$3,094.73" "$12,766.00" "$12,766.00" "$12,766.00" "$12,766.00" "$9,574.50" "$12,766.00" "$12,766.00" "$12,766.00" "$6,383.00" "$6,383.00" "$10,110.67" "$12,766.00" "$10,212.80" "$8,297.90" "$2,533.73" "$12,766.00" "$7,404.28" "$12,766.00" "$12,766.00" "$12,766.00" "$2,660.43" "$12,766.00" N/A N/A 27204753 EAP HCPCS C1757 "DAWN IDE, TREVO XP 4X30 KIT" BOTH IP/OP "$12,766.00" "$9,447.00" "$2,060.15" "$12,766.00" "$6,931.94" "$6,931.94" "$6,931.94" "$6,931.94" "$12,766.00" "$12,766.00" "$12,766.00" "$2,660.75" "$12,766.00" "$4,181.12" "$4,181.12" "$9,840.03" "$2,060.15" "$2,660.57" "$12,766.00" "$12,766.00" "$3,094.73" "$12,766.00" "$12,766.00" "$12,766.00" "$12,766.00" "$9,574.50" "$12,766.00" "$12,766.00" "$12,766.00" "$6,383.00" "$6,383.00" "$10,110.67" "$12,766.00" "$10,212.80" "$8,297.90" "$2,533.73" "$12,766.00" "$7,404.28" "$12,766.00" "$12,766.00" "$12,766.00" "$2,660.43" "$12,766.00" N/A N/A 27204754 EAP HCPCS C1769 GUIDEWIRE VASCULAR .014IN 300CM 11CM RADIOPQ STR T BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 27204755 EAP HCPCS C1769 GUIDEWIRE VASC 180CM ASAHI PTCA SION BLUE BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 27204756 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN STR 3CM SION ASAHI SS BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 27204757 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN 3 RADIOPQ SEG STR 3CM BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 27204758 EAP HCPCS C1769 GUIDEWIRE VASC RG3 BOTH IP/OP $575.00 $425.50 $114.12 $575.00 $312.23 $312.23 $312.23 $312.23 $575.00 $575.00 $575.00 $119.84 $575.00 $426.77 $426.77 $443.21 $299.58 $119.84 $575.00 $575.00 $340.11 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $373.75 $114.12 $575.00 $333.50 $575.00 $575.00 $575.00 $119.83 $575.00 N/A N/A 27204759 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN RADIOPQ STR TIP 11CM BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 27204760 EAP HCPCS C1769 CATHETER GUID EXTRA BACKUP 4.5 LEFT CURVE 6FR .071 BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $65.20 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204761 EAP HCPCS C1769 CATHETER GUID XB 5 LEFT CURVE 6FR .071IN 100CM BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204762 EAP HCPCS C1769 CATHETER ATHERECTOMY .017IN .018IN 165CM SHAPABLE BOTH IP/OP "$4,800.00" "$3,552.00" $952.68 "$4,800.00" "$2,606.40" "$2,606.40" "$2,606.40" "$2,606.40" "$4,800.00" "$4,800.00" "$4,800.00" "$1,000.44" "$4,800.00" "$3,562.56" "$3,562.56" "$3,699.84" "$2,060.15" "$1,000.37" "$4,800.00" "$4,800.00" "$2,839.20" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$3,600.00" "$4,800.00" "$4,800.00" "$4,800.00" "$2,400.00" "$2,400.00" "$3,801.60" "$4,800.00" "$3,840.00" "$3,120.00" $952.68 "$4,800.00" "$2,784.00" "$4,800.00" "$4,800.00" "$4,800.00" "$1,000.32" "$4,800.00" N/A N/A 27204763 EAP HCPCS C1882 CATHETER ANGIO .035IN VERT CURVE 5FR .046IN 125CM BOTH IP/OP $35.00 $26.00 $6.95 $35.00 $19.01 $19.01 $19.01 $19.01 $35.00 $35.00 $35.00 $7.29 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $35.00 $20.70 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $6.95 $35.00 $20.30 $35.00 $35.00 $35.00 $7.29 $35.00 N/A N/A 27204764 EAP HCPCS C1887 CATHETER GUID JR4 CURVE 8FR 90CM CORON SH LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204765 EAP HCPCS C1887 CATHETER GUID AL1 CURVE 8FR 90CM CORON SH LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $65.20 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204766 EAP HCPCS C1887 CATHETER GUID 3DRC CURVE 8FR 90CM CORON LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204767 EAP HCPCS C1887 CATHETER GUID 3 DMN RIGHT CURVE 8FR .09IN 90CM BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204768 EAP HCPCS C1887 CATHETER GUID AL1.5 CURVE 8FR .09IN 90CM CORON BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204769 EAP HCPCS C1887 CATHETER GUID AL1.5 CURVE 8FR 90CM CORON SH LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204770 EAP HCPCS C1887 CATHETER GUID AL2 CURVE 8FR 90CM CORON LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204771 EAP HCPCS C1887 CATHETER GUID AL2 CURVE 8FR .09IN 90CM CORON SH BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $65.20 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204772 EAP HCPCS C1887 CATHETER GUID XB4 CURVE 8FR 90CM CORON LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $65.20 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204773 EAP HCPCS C1887 CATHETER GUID XB3.5 CURVE 8FR 90CM CORON SH LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204774 EAP HCPCS C1887 CATHETER GUID EBU3.75 CURVE 8FR .09IN 90CM CORON BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204775 EAP HCPCS C1887 CATHETER GUID XB4 CURVE 8FR 90CM CORON SH LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204776 EAP HCPCS C1887 CATHETER GUID AL1 CURVE 8FR 90CM CORON LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204777 EAP HCPCS C1725 CATHETER BALDILAT LP TAPER 4.8FR 6MM 135CM 80MM OT BOTH IP/OP $686.00 $508.00 $136.15 $686.00 $372.50 $372.50 $372.50 $372.50 $686.00 $686.00 $686.00 $142.98 $686.00 $509.15 $509.15 $528.77 $357.41 $142.97 $686.00 $686.00 $405.77 $686.00 $686.00 $686.00 $686.00 $514.50 $686.00 $686.00 $686.00 $343.00 $343.00 $543.31 $686.00 $548.80 $445.90 $136.15 $686.00 $397.88 $686.00 $686.00 $686.00 $142.96 $686.00 N/A N/A 27204779 EAP HCPCS C1887 CATHETER THRMB 125CM 6FR NEURON SIM CURVE SLCT BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 27204782 EAP HCPCS C1725 CATHETER BALDILAT LP TAPER 3.8FR 4MM 135CM 80MM OTW INFLAT BOTH IP/OP $686.00 $508.00 $136.15 $686.00 $372.50 $372.50 $372.50 $372.50 $686.00 $686.00 $686.00 $142.98 $686.00 $509.15 $509.15 $528.77 $357.41 $142.97 $686.00 $686.00 $405.77 $686.00 $686.00 $686.00 $686.00 $514.50 $686.00 $686.00 $686.00 $343.00 $343.00 $543.31 $686.00 $548.80 $445.90 $136.15 $686.00 $397.88 $686.00 $686.00 $686.00 $142.96 $686.00 N/A N/A 27204783 EAP HCPCS C1753 CATHETER ULTRASOUND .035IN 8.5FR 90CM 100CM OTW RADIOPQ BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$1,855.50" "$1,855.50" "$1,927.00" "$1,302.50" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,625.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 27204785 EAP HCPCS C1725 CATHETER BALDILAT ULTRA LP TAPER 6FR 4MM 150CM 220MM COYOTE BOTH IP/OP $857.00 $634.50 $170.09 $857.00 $465.35 $465.35 $465.35 $465.35 $857.00 $857.00 $857.00 $178.62 $857.00 $636.07 $636.07 $660.58 $446.50 $178.61 $857.00 $857.00 $506.92 $857.00 $857.00 $857.00 $857.00 $642.75 $857.00 $857.00 $857.00 $428.50 $428.50 $678.74 $857.00 $685.60 $557.05 $170.09 $857.00 $497.06 $857.00 $857.00 $857.00 $178.60 $857.00 N/A N/A 27204786 EAP HCPCS C1769 GUIDEWIRE VASCULAR STR SHORT TAPER .014IN 300CM 8CM ROBUST BOTH IP/OP $343.00 $254.00 $68.08 $343.00 $186.25 $186.25 $186.25 $186.25 $343.00 $343.00 $343.00 $71.49 $343.00 $254.57 $254.57 $264.38 $178.70 $71.48 $343.00 $343.00 $202.88 $343.00 $343.00 $343.00 $343.00 $257.25 $343.00 $343.00 $343.00 $171.50 $171.50 $271.66 $343.00 $274.40 $222.95 $68.08 $343.00 $198.94 $343.00 $343.00 $343.00 $71.48 $343.00 N/A N/A 27204787 EAP Custom 27204787 OMNI FLUSH (VCF) 5FR 100CM BOTH IP/OP $35.00 $26.00 $6.23 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $6.23 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 27204790 EAP HCPCS C1884 SYSTEM EMBL PRTC 104.5CM .035IN PROX CRBRL CATH BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$2,172.00" "$2,172.00" "$2,172.00" "$2,172.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$2,968.80" "$2,968.80" "$3,083.20" "$2,060.15" $833.64 "$4,000.00" "$4,000.00" "$2,366.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$2,600.00" $793.90 "$4,000.00" "$2,320.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.60 "$4,000.00" N/A N/A 27204795 EAP HCPCS C1894 INTRODUCER SHEATH .021IN STR THIN WALL 6FR 20GA 10CM 45CM BOTH IP/OP $138.00 $102.50 $27.39 $138.00 $74.93 $74.93 $74.93 $74.93 $138.00 $138.00 $138.00 $28.76 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $138.00 $81.63 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $27.39 $138.00 $80.04 $138.00 $138.00 $138.00 $28.76 $138.00 N/A N/A 27204796 EAP Custom 27204796 TRAY AMNIOCENTESIS 20GA 3.5IN BOTH IP/OP $32.00 $24.00 $5.70 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $5.70 $32.00 $32.00 $23.75 $23.75 $24.67 $16.67 $6.67 $32.00 $12.80 $32.00 $32.00 $32.00 $32.00 $32.00 $24.00 $32.00 $32.00 $32.00 $16.00 $16.00 $25.34 $32.00 $25.60 $20.80 $32.00 $32.00 $18.56 $32.00 $19.20 $32.00 $32.00 $32.00 N/A N/A 27204797 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STRBL RADIOPQ KINK RST BOTH IP/OP $38.00 $28.50 $7.54 $38.00 $20.63 $20.63 $20.63 $20.63 $38.00 $38.00 $38.00 $7.92 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $15.20 $22.48 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $7.54 $38.00 $22.04 $38.00 $38.00 $38.00 $7.92 $38.00 N/A N/A 27204798 EAP Custom 27204798 TUBE GASTROSTOMY 20FR 14.25X11.25X9IN HANDRAIL CHR BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 27204799 EAP Custom 27204799 NEEDLE INTRAOSSEOUS 15GA 25MM EZ CONNECT WRIST BAN BOTH IP/OP "$1,375.00" "$1,017.50" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,020.53" "$1,020.53" "$1,059.85" $716.38 $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $893.75 "$1,375.00" "$1,375.00" $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 27204802 EAP HCPCS C1725 CATHETER BALDILAT 5FR 4MM 130CM 80MM PCLTXL BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,900.50" "$1,900.50" "$1,900.50" "$1,900.50" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$3,500.00" "$2,070.25" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" $694.66 "$3,500.00" "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 27204807 EAP HCPCS C1725 CATHETER BALDILAT 5FR 5MM 130CM 60MM PCLTXL BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,900.50" "$1,900.50" "$1,900.50" "$1,900.50" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$3,500.00" "$2,070.25" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" $694.66 "$3,500.00" "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 27204810 EAP HCPCS C1757 SOLITAIRE REVASCULARIZATION DEVICE 4-20-10 BOTH IP/OP "$10,563.00" "$7,817.00" "$2,060.15" "$10,563.00" "$5,735.71" "$5,735.71" "$5,735.71" "$5,735.71" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.59" "$10,563.00" "$4,181.12" "$4,181.12" "$8,141.96" "$2,060.15" "$2,201.45" "$10,563.00" "$10,563.00" "$3,094.73" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$7,922.25" "$10,563.00" "$10,563.00" "$10,563.00" "$5,281.50" "$5,281.50" "$8,365.90" "$10,563.00" "$8,450.40" "$6,865.95" "$2,096.49" "$10,563.00" "$6,126.54" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.33" "$10,563.00" N/A N/A 27204811 EAP HCPCS C1757 SOLITAIRE PLATINUM 6X20 BOTH IP/OP "$10,563.00" "$7,817.00" "$2,060.15" "$10,563.00" "$5,735.71" "$5,735.71" "$5,735.71" "$5,735.71" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.59" "$10,563.00" "$4,181.12" "$4,181.12" "$8,141.96" "$2,060.15" "$2,201.45" "$10,563.00" "$10,563.00" "$3,094.73" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$7,922.25" "$10,563.00" "$10,563.00" "$10,563.00" "$5,281.50" "$5,281.50" "$8,365.90" "$10,563.00" "$8,450.40" "$6,865.95" "$2,096.49" "$10,563.00" "$6,126.54" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.33" "$10,563.00" N/A N/A 27204812 EAP HCPCS C1757 SOLITAIRE PLATINUM REVASCULARIZATION DEVICE 4-40 BOTH IP/OP "$10,563.00" "$7,817.00" "$2,096.49" "$10,563.00" "$4,753.35" "$4,753.35" "$4,753.35" "$4,753.35" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.59" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.45" "$10,563.00" "$10,563.00" "$5,207.56" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$7,922.25" "$10,563.00" "$10,563.00" "$10,563.00" "$5,281.50" "$5,281.50" "$8,365.90" "$10,563.00" "$8,450.40" "$4,753.35" "$2,096.49" "$10,563.00" "$6,126.54" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.33" "$10,563.00" N/A N/A 27204813 EAP HCPCS C1758 CATHETER URETHRAL 16FR FOLEY 2 WAY MEDIUM OLIVE COUDE TIP 1 BOTH IP/OP $26.00 $19.50 $5.16 $26.00 $14.12 $14.12 $14.12 $14.12 $26.00 $26.00 $26.00 $5.42 $26.00 $19.30 $19.30 $20.04 $13.55 $5.42 $26.00 $26.00 $15.38 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $16.90 $5.16 $26.00 $15.08 $26.00 $26.00 $26.00 $5.42 $26.00 N/A N/A 27204817 EAP HCPCS C1725 CATHETER BALDILAT 6MM 130CM 40MM LUTONIX ACPT 6FR BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,900.50" "$1,900.50" "$1,900.50" "$1,900.50" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$3,500.00" "$2,070.25" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" $694.66 "$3,500.00" "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 27204818 EAP HCPCS C1725 CATHETER BALDILAT 6FR 6MM 130CM 60MM PCLTXL BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,900.50" "$1,900.50" "$1,900.50" "$1,900.50" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$3,500.00" "$2,070.25" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" $694.66 "$3,500.00" "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 27204819 EAP HCPCS C1725 CATHETER BALDILAT 6FR 6MM 130CM 80MM PCLTXL BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,900.50" "$1,900.50" "$1,900.50" "$1,900.50" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$3,500.00" "$2,070.25" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" $694.66 "$3,500.00" "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 27204822 EAP HCPCS C1725 CATHETER BALDILAT 6FR 6MM 130CM 150MM PCLTXL BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,900.50" "$1,900.50" "$1,900.50" "$1,900.50" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$2,070.25" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" $694.66 "$3,500.00" "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 27204823 EAP HCPCS C1894 INTRODUCER SHEATH .038IN STAND BOTH IP/OP $45.00 $33.50 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $45.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 $45.00 $26.10 $45.00 $45.00 $45.00 $9.38 $45.00 N/A N/A 27204824 EAP Custom 27204824 SET TUBING 2.6MR 2 WAY COMMUNICATION IRRIGATION PUMP BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 $200.00 $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A 27204826 EAP HCPCS C1751 AXS CATALYST 5 DISTAL ACCESS CATHETER BOTH IP/OP "$4,875.00" "$3,607.50" $967.57 "$4,875.00" "$2,647.13" "$2,647.13" "$2,647.13" "$2,647.13" "$4,875.00" "$4,875.00" "$4,875.00" "$1,016.07" "$4,875.00" "$3,618.23" "$3,618.23" "$3,757.65" "$2,060.15" "$1,016.00" "$4,875.00" "$4,875.00" "$2,883.56" "$4,875.00" "$4,875.00" "$4,875.00" "$4,875.00" "$3,656.25" "$4,875.00" "$4,875.00" "$4,875.00" "$2,437.50" "$2,437.50" "$3,861.00" "$4,875.00" "$3,900.00" "$3,168.75" $967.57 "$4,875.00" "$2,827.50" "$4,875.00" "$4,875.00" "$4,875.00" "$1,015.95" "$4,875.00" N/A N/A 27204828 EAP Custom 27204828 BIT DRILL 25MM 4MM STRL BOTH IP/OP $143.00 $106.00 $25.45 $143.00 $143.00 $143.00 $143.00 $143.00 $143.00 $143.00 $25.45 $143.00 $143.00 $106.13 $106.13 $110.22 $74.50 $29.80 $143.00 $57.20 $143.00 $143.00 $143.00 $143.00 $143.00 $107.25 $143.00 $143.00 $143.00 $71.50 $71.50 $113.26 $143.00 $114.40 $92.95 $143.00 $143.00 $82.94 $143.00 $85.80 $143.00 $143.00 $143.00 N/A N/A 27204830 EAP Custom 27204830 IMPELLA RP US HDE PUMP SET BOTH IP/OP "$102,500.00" "$75,850.00" "$2,060.15" "$102,500.00" "$102,500.00" "$102,500.00" "$102,500.00" "$102,500.00" "$102,500.00" "$102,500.00" "$18,245.00" "$102,500.00" "$102,500.00" "$4,181.12" "$4,181.12" "$79,007.00" "$2,060.15" "$21,362.13" "$102,500.00" "$41,000.00" "$102,500.00" "$102,500.00" "$102,500.00" "$102,500.00" "$102,500.00" "$76,875.00" "$102,500.00" "$102,500.00" "$102,500.00" "$51,250.00" "$51,250.00" "$81,180.00" "$102,500.00" "$82,000.00" "$66,625.00" "$102,500.00" "$102,500.00" "$59,450.00" "$102,500.00" "$61,500.00" "$102,500.00" "$102,500.00" "$102,500.00" N/A N/A 27204832 EAP HCPCS C1894 SHEATH INTROD 16FR 6.2MM 5.3MM 28CM DRYSEAL DILAT BOTH IP/OP $668.00 $494.50 $132.58 $668.00 $362.72 $362.72 $362.72 $362.72 $668.00 $668.00 $668.00 $139.23 $668.00 $495.79 $495.79 $514.89 $348.03 $139.22 $668.00 $267.20 $395.12 $668.00 $668.00 $668.00 $668.00 $501.00 $668.00 $668.00 $668.00 $334.00 $334.00 $529.06 $668.00 $534.40 $434.20 $132.58 $668.00 $387.44 $668.00 $668.00 $668.00 $139.21 $668.00 N/A N/A 27204833 EAP Custom 27204833 CATHETER BALDILAT TPR 10-50MM 65CM STENT GFT FLX BOTH IP/OP "$1,213.00" $898.00 $215.91 "$1,213.00" "$1,213.00" "$1,213.00" "$1,213.00" "$1,213.00" "$1,213.00" "$1,213.00" $215.91 "$1,213.00" "$1,213.00" $900.29 $900.29 $934.98 $631.97 $252.80 "$1,213.00" $485.20 "$1,213.00" "$1,213.00" "$1,213.00" "$1,213.00" "$1,213.00" $909.75 "$1,213.00" "$1,213.00" "$1,213.00" $606.50 $606.50 $960.70 "$1,213.00" $970.40 $788.45 "$1,213.00" "$1,213.00" $703.54 "$1,213.00" $727.80 "$1,213.00" "$1,213.00" "$1,213.00" N/A N/A 27204835 EAP HCPCS C1757 SYSTEM THRMB ZELANTEDVT BOTH IP/OP "$7,313.00" "$5,412.00" "$1,451.45" "$7,313.00" "$3,970.96" "$3,970.96" "$3,970.96" "$3,970.96" "$7,313.00" "$7,313.00" "$7,313.00" "$1,524.21" "$7,313.00" "$4,181.12" "$4,181.12" "$5,636.86" "$2,060.15" "$1,524.11" "$7,313.00" "$7,313.00" "$3,094.73" "$7,313.00" "$7,313.00" "$7,313.00" "$7,313.00" "$5,484.75" "$7,313.00" "$7,313.00" "$7,313.00" "$3,656.50" "$3,656.50" "$5,791.90" "$7,313.00" "$5,850.40" "$4,753.45" "$1,451.45" "$7,313.00" "$4,241.54" "$7,313.00" "$7,313.00" "$7,313.00" "$1,524.03" "$7,313.00" N/A N/A 27204840 EAP HCPCS C1884 AXS INFINITY LS .088 LONG GUIDE SHEATH 90CM BOTH IP/OP "$1,463.00" "$1,083.00" $290.37 "$1,463.00" $794.41 $794.41 $794.41 $794.41 "$1,463.00" "$1,463.00" "$1,463.00" $304.93 "$1,463.00" "$1,085.84" "$1,085.84" "$1,127.68" $762.22 $304.91 "$1,463.00" "$1,463.00" $865.36 "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,097.25" "$1,463.00" "$1,463.00" "$1,463.00" $731.50 $731.50 "$1,158.70" "$1,463.00" "$1,170.40" $950.95 $290.37 "$1,463.00" $848.54 "$1,463.00" "$1,463.00" "$1,463.00" $304.89 "$1,463.00" N/A N/A 27204841 EAP HCPCS C1894 AXS INFINITY LS .088 LONG GUIDE SHEATH 80CM BOTH IP/OP "$1,463.00" "$1,083.00" $290.37 "$1,463.00" $794.41 $794.41 $794.41 $794.41 "$1,463.00" "$1,463.00" "$1,463.00" $304.93 "$1,463.00" "$1,085.84" "$1,085.84" "$1,127.68" $762.22 $304.91 "$1,463.00" $585.20 $865.36 "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,097.25" "$1,463.00" "$1,463.00" "$1,463.00" $731.50 $731.50 "$1,158.70" "$1,463.00" "$1,170.40" $950.95 $290.37 "$1,463.00" $848.54 "$1,463.00" "$1,463.00" "$1,463.00" $304.89 "$1,463.00" N/A N/A 27204842 EAP HCPCS C1773 SNARE VASC 175CM .16-.32IN 3.2FR ENSNR MINI NTNL 3 BOTH IP/OP "$1,638.00" "$1,212.50" $325.10 "$1,638.00" $889.43 $889.43 $889.43 $889.43 "$1,638.00" "$1,638.00" "$1,638.00" $341.40 "$1,638.00" "$1,215.72" "$1,215.72" "$1,262.57" $853.40 $341.38 "$1,638.00" "$1,638.00" $968.88 "$1,638.00" "$1,638.00" "$1,638.00" "$1,638.00" "$1,228.50" "$1,638.00" "$1,638.00" "$1,638.00" $819.00 $819.00 "$1,297.30" "$1,638.00" "$1,310.40" "$1,064.70" $325.10 "$1,638.00" $950.04 "$1,638.00" "$1,638.00" "$1,638.00" $341.36 "$1,638.00" N/A N/A 27204843 EAP HCPCS C2628 ER-REBOA CATHETER BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,708.48" "$2,708.48" "$2,708.48" "$2,708.48" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$3,702.09" "$3,702.09" "$3,844.75" "$2,060.15" "$1,039.55" "$4,988.00" "$4,988.00" "$2,950.40" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$3,242.20" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27204844 EAP HCPCS C1773 SNARE VASC 47IN .71-1.18IN .055IN .074IN ENSNR BOTH IP/OP $888.00 $657.50 $176.25 $888.00 $482.18 $482.18 $482.18 $482.18 $888.00 $888.00 $888.00 $185.08 $888.00 $659.07 $659.07 $684.47 $462.65 $185.07 $888.00 $888.00 $525.25 $888.00 $888.00 $888.00 $888.00 $666.00 $888.00 $888.00 $888.00 $444.00 $444.00 $703.30 $888.00 $710.40 $577.20 $176.25 $888.00 $515.04 $888.00 $888.00 $888.00 $185.06 $888.00 N/A N/A 27204845 EAP HCPCS C1894 PERCUTANEOUS SHEATH INTRO KIT 6F .035IN X 10CM BOTH IP/OP $788.00 $583.50 $156.40 $788.00 $427.88 $427.88 $427.88 $427.88 $788.00 $788.00 $788.00 $164.24 $788.00 $584.85 $584.85 $607.39 $410.55 $164.23 $788.00 $788.00 $466.10 $788.00 $788.00 $788.00 $788.00 $591.00 $788.00 $788.00 $788.00 $394.00 $394.00 $624.10 $788.00 $630.40 $512.20 $156.40 $788.00 $457.04 $788.00 $788.00 $788.00 $164.22 $788.00 N/A N/A 27204846 EAP HCPCS C1769 PERICARDIO SET AND TRAY BOTH IP/OP $474.00 $351.00 $94.08 $474.00 $257.38 $257.38 $257.38 $257.38 $474.00 $474.00 $474.00 $98.79 $474.00 $351.80 $351.80 $365.36 $246.95 $98.79 $474.00 $474.00 $280.37 $474.00 $474.00 $474.00 $474.00 $355.50 $474.00 $474.00 $474.00 $237.00 $237.00 $375.41 $474.00 $379.20 $308.10 $94.08 $474.00 $274.92 $474.00 $474.00 $474.00 $98.78 $474.00 N/A N/A 27204848 EAP "FLEXOR ANSEL GUIDING SHEATH W/HFD, CHECK-FLO 8F 2.9MM X 70CM MP" BOTH IP/OP $163.00 $121.00 $29.01 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $29.01 $163.00 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $65.20 $163.00 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $163.00 $163.00 $94.54 $163.00 $97.80 $163.00 $163.00 $163.00 N/A N/A 27204849 EAP HCPCS C1894 FLEXOR ANSEL GUIDING SHEATH W/CHECK-FLO 7F 2.5MM X 45CM STR BOTH IP/OP $113.00 $84.00 $22.43 $113.00 $61.36 $61.36 $61.36 $61.36 $113.00 $113.00 $113.00 $23.55 $113.00 $83.87 $83.87 $87.10 $58.87 $23.55 $113.00 $113.00 $66.84 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $73.45 $22.43 $113.00 $65.54 $113.00 $113.00 $113.00 $23.55 $113.00 N/A N/A 27204850 EAP HCPCS C1725 VIATRAC 14 PLUS RX 5MM X 30MM X 135CM BOTH IP/OP $625.00 $462.50 $124.05 $625.00 $339.38 $339.38 $339.38 $339.38 $625.00 $625.00 $625.00 $130.27 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $124.05 $625.00 $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A 27204851 EAP HCPCS C1769 X-CELERATOR .010 10CM X 300CM BOTH IP/OP $825.00 $610.50 $163.74 $825.00 $447.98 $447.98 $447.98 $447.98 $825.00 $825.00 $825.00 $171.95 $825.00 $612.32 $612.32 $635.91 $429.83 $171.94 $825.00 $825.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $536.25 $163.74 $825.00 $478.50 $825.00 $825.00 $825.00 $171.93 $825.00 N/A N/A 27204852 EAP HCPCS C1725 "MUSTANG 7FR 12.0MM X 60MM, 135CM" BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $271.50 $271.50 $271.50 $271.50 $500.00 $500.00 $500.00 $104.21 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $99.24 $500.00 $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 27204853 EAP Custom 27204853 STERLING OTW 4MM X 60MM X 135CM BOTH IP/OP $685.00 $507.00 $121.93 $685.00 $685.00 $685.00 $685.00 $685.00 $685.00 $685.00 $121.93 $685.00 $685.00 $508.41 $508.41 $528.00 $356.89 $142.76 $685.00 $274.00 $685.00 $685.00 $685.00 $685.00 $685.00 $513.75 $685.00 $685.00 $685.00 $342.50 $342.50 $542.52 $685.00 $548.00 $445.25 $685.00 $685.00 $397.30 $685.00 $411.00 $685.00 $685.00 $685.00 N/A N/A 27204854 EAP HCPCS C1725 STERLING OTW 5MM X 100MM X 135CM BOTH IP/OP $685.00 $507.00 $135.96 $685.00 $371.96 $371.96 $371.96 $371.96 $685.00 $685.00 $685.00 $142.77 $685.00 $508.41 $508.41 $528.00 $356.89 $142.76 $685.00 $685.00 $405.18 $685.00 $685.00 $685.00 $685.00 $513.75 $685.00 $685.00 $685.00 $342.50 $342.50 $542.52 $685.00 $548.00 $445.25 $135.96 $685.00 $397.30 $685.00 $685.00 $685.00 $142.75 $685.00 N/A N/A 27204855 EAP HCPCS C1725 STERLING OTW 6MM X 100MM X 135CM BOTH IP/OP $685.00 $507.00 $135.96 $685.00 $371.96 $371.96 $371.96 $371.96 $685.00 $685.00 $685.00 $142.77 $685.00 $508.41 $508.41 $528.00 $356.89 $142.76 $685.00 $685.00 $405.18 $685.00 $685.00 $685.00 $685.00 $513.75 $685.00 $685.00 $685.00 $342.50 $342.50 $542.52 $685.00 $548.00 $445.25 $135.96 $685.00 $397.30 $685.00 $685.00 $685.00 $142.75 $685.00 N/A N/A 27204856 EAP HCPCS C1725 COYOTE 3.5MM X 220MM X 150CM BOTH IP/OP $856.00 $633.50 $169.89 $856.00 $464.81 $464.81 $464.81 $464.81 $856.00 $856.00 $856.00 $178.41 $856.00 $635.32 $635.32 $659.80 $445.98 $178.40 $856.00 $856.00 $506.32 $856.00 $856.00 $856.00 $856.00 $642.00 $856.00 $856.00 $856.00 $428.00 $428.00 $677.95 $856.00 $684.80 $556.40 $169.89 $856.00 $496.48 $856.00 $856.00 $856.00 $178.39 $856.00 N/A N/A 27204857 EAP HCPCS C1894 TEAR-AWAY INTRO SHEATH 8F 30CM BOTH IP/OP $477.00 $353.00 $94.67 $477.00 $259.01 $259.01 $259.01 $259.01 $477.00 $477.00 $477.00 $99.42 $477.00 $354.03 $354.03 $367.67 $248.52 $99.41 $477.00 $477.00 $282.15 $477.00 $477.00 $477.00 $477.00 $357.75 $477.00 $477.00 $477.00 $238.50 $238.50 $377.78 $477.00 $381.60 $310.05 $94.67 $477.00 $276.66 $477.00 $477.00 $477.00 $99.41 $477.00 N/A N/A 27204858 EAP STERLING OTW 4MM X 220MM X 135CM BOTH IP/OP $830.00 $614.50 $147.74 $830.00 $830.00 $830.00 $830.00 $830.00 $830.00 $830.00 $147.74 $830.00 $830.00 $616.03 $616.03 $639.76 $432.43 $172.98 $830.00 $332.00 $830.00 $830.00 $830.00 $830.00 $830.00 $622.50 $830.00 $830.00 $830.00 $415.00 $415.00 $657.36 $830.00 $664.00 $539.50 $830.00 $830.00 $481.40 $830.00 $498.00 $830.00 $830.00 $830.00 N/A N/A 27204860 EAP HCPCS C1887 CATHETER GUID 47CM CPS DIR 115D UPSIZE LATEX FREE BOTH IP/OP "$1,721.00" "$1,274.00" $341.58 "$1,721.00" $934.50 $934.50 $934.50 $934.50 "$1,721.00" "$1,721.00" "$1,721.00" $358.70 "$1,721.00" "$1,277.33" "$1,277.33" "$1,326.55" $896.64 $358.68 "$1,721.00" "$1,721.00" "$1,017.97" "$1,721.00" "$1,721.00" "$1,721.00" "$1,721.00" "$1,290.75" "$1,721.00" "$1,721.00" "$1,721.00" $860.50 $860.50 "$1,363.03" "$1,721.00" "$1,376.80" "$1,118.65" $341.58 "$1,721.00" $998.18 "$1,721.00" "$1,721.00" "$1,721.00" $358.66 "$1,721.00" N/A N/A 27204863 EAP Custom 27204863 NEEDLE PORT 1IN 20GA 5ML/SEC GRPR PLUS DELTEC PCTH BOTH IP/OP $203.00 $150.50 $36.13 $203.00 $203.00 $203.00 $203.00 $203.00 $203.00 $203.00 $36.13 $203.00 $203.00 $150.67 $150.67 $156.47 $105.76 $42.31 $203.00 $81.20 $203.00 $203.00 $203.00 $203.00 $203.00 $152.25 $203.00 $203.00 $203.00 $101.50 $101.50 $160.78 $203.00 $162.40 $131.95 $203.00 $203.00 $117.74 $203.00 $121.80 $203.00 $203.00 $203.00 N/A N/A 27204864 EAP Custom 27204864 NEEDLE PORT 1.25IN 20GA 5ML/SEC GRPR PLUS DELTEC BOTH IP/OP $203.00 $150.50 $36.13 $203.00 $203.00 $203.00 $203.00 $203.00 $203.00 $203.00 $36.13 $203.00 $203.00 $150.67 $150.67 $156.47 $105.76 $42.31 $203.00 $81.20 $203.00 $203.00 $203.00 $203.00 $203.00 $152.25 $203.00 $203.00 $203.00 $101.50 $101.50 $160.78 $203.00 $162.40 $131.95 $203.00 $203.00 $117.74 $203.00 $121.80 $203.00 $203.00 $203.00 N/A N/A 27204865 EAP Custom 27204865 INTROD SHTH 9FR 14CM HMSTS GWIRE PLWY .038IN TRNSP BOTH IP/OP $75.00 $55.50 $13.35 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $13.35 $75.00 $75.00 $55.67 $55.67 $57.81 $39.08 $15.63 $75.00 $30.00 $75.00 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $48.75 $75.00 $75.00 $43.50 $75.00 $45.00 $75.00 $75.00 $75.00 N/A N/A 27204870 EAP HCPCS C1887 CATHETER DELIVERY SYSTEM 0-.02IN MICRO STR 2.6-2.95FR .025IN BOTH IP/OP "$2,325.00" "$1,720.50" $461.45 "$2,325.00" "$1,262.48" "$1,262.48" "$1,262.48" "$1,262.48" "$2,325.00" "$2,325.00" "$2,325.00" $484.59 "$2,325.00" "$1,725.62" "$1,725.62" "$1,792.11" "$1,211.33" $484.56 "$2,325.00" "$2,325.00" "$1,375.24" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$1,743.75" "$2,325.00" "$2,325.00" "$2,325.00" "$1,162.50" "$1,162.50" "$1,841.40" "$2,325.00" "$1,860.00" "$1,511.25" $461.45 "$2,325.00" "$1,348.50" "$2,325.00" "$2,325.00" "$2,325.00" $484.53 "$2,325.00" N/A N/A 27204876 EAP HCPCS C1887 CATHETER ANGIO RADIALTIGER CURVE 6FR 4MM 110CM BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $175.20 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 27204880 EAP HCPCS C1769 GUI VAS ST STR .035IN 260CM FLEXIBLE TIP BOTH IP/OP $100.00 $74.00 $19.85 $100.00 $54.30 $54.30 $54.30 $54.30 $100.00 $100.00 $100.00 $20.84 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $100.00 $59.15 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $19.85 $100.00 $58.00 $100.00 $100.00 $100.00 $20.84 $100.00 N/A N/A 27204883 EAP HCPCS C1894 INT SHEATH .035IN 7FR .1IN 70CM ANL0 CURVE STR TIP BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204885 EAP HCPCS C1725 CAT BALD 6MM 75CM 40MM HIGH PRES LP INFLA PT BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 27204887 EAP HCPCS C1725 CAT BALD 5FR 9MM 75CM 60MM HIGH PRES LP INFL BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 27204888 EAP HCPCS C1725 CAT BALD LP 5.8FR 12MM 75CM 60MM HIGH PRES BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 27204889 EAP HCPCS C1894 STH GUI .018-.038IN ANL2 CRVE 6FR .087IN 90CM RADI BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27204890 EAP HCPCS C1725 CAT BALD ULT LP TAP 6FR 2.5MM 150CM 100MM OTW BOTH IP/OP $686.00 $508.00 $136.15 $686.00 $372.50 $372.50 $372.50 $372.50 $686.00 $686.00 $686.00 $142.98 $686.00 $509.15 $509.15 $528.77 $357.41 $142.97 $686.00 $686.00 $405.77 $686.00 $686.00 $686.00 $686.00 $514.50 $686.00 $686.00 $686.00 $343.00 $343.00 $543.31 $686.00 $548.80 $445.90 $136.15 $686.00 $397.88 $686.00 $686.00 $686.00 $142.96 $686.00 N/A N/A 27204892 EAP HCPCS C1725 CAT BALD LP 5.3FR 5MM 75CM 20MM HIGH PRES BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 27204896 EAP HCPCS C1725 CAT BALD LP 5.3FR 7MM 135CM 100MM HIGH PRES BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 27204899 EAP HCPCS C1725 CAT BALD LP 5.3FR 6MM 135CM 60MM HIGH PRES BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 27204901 EAP HCPCS C1892 INTROD SHTH 7FR .092IN 25CM RBST VLV SPLT SDPRT BOTH IP/OP $105.00 $78.00 $20.84 $105.00 $57.02 $57.02 $57.02 $57.02 $105.00 $105.00 $105.00 $21.88 $105.00 $77.93 $77.93 $80.93 $54.71 $21.88 $105.00 $105.00 $62.11 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $68.25 $20.84 $105.00 $60.90 $105.00 $105.00 $105.00 $21.88 $105.00 N/A N/A 27204903 EAP Custom 27204903 SYSTEM EMBOLIZATION NONADHESIVE DELIVERY SYRINGE L BOTH IP/OP "$5,625.00" "$4,162.50" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,001.25" "$5,625.00" "$5,625.00" "$4,174.88" "$4,174.88" "$4,335.75" "$2,060.15" "$1,172.31" "$5,625.00" "$2,250.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$3,656.25" "$5,625.00" "$5,625.00" "$3,262.50" "$5,625.00" "$3,375.00" "$5,625.00" "$5,625.00" "$5,625.00" N/A N/A 27204910 EAP HCPCS C1894 SHTH GU .018/.038IN ANL1 CVE 6FR .087IN 45CM RAD BOTH IP/OP $113.00 $84.00 $22.43 $113.00 $61.36 $61.36 $61.36 $61.36 $113.00 $113.00 $113.00 $23.55 $113.00 $83.87 $83.87 $87.10 $58.87 $23.55 $113.00 $113.00 $66.84 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $73.45 $22.43 $113.00 $65.54 $113.00 $113.00 $113.00 $23.55 $113.00 N/A N/A 27204912 EAP HCPCS C1725 CATR BALD 14 ATM LP TAER 7FR 5MM 150CM 150MM BOTH IP/OP $754.00 $558.00 $149.65 $754.00 $409.42 $409.42 $409.42 $409.42 $754.00 $754.00 $754.00 $157.15 $754.00 $559.62 $559.62 $581.18 $392.83 $157.14 $754.00 $754.00 $445.99 $754.00 $754.00 $754.00 $754.00 $565.50 $754.00 $754.00 $754.00 $377.00 $377.00 $597.17 $754.00 $603.20 $490.10 $149.65 $754.00 $437.32 $754.00 $754.00 $754.00 $157.13 $754.00 N/A N/A 27204913 EAP HCPCS C1725 CATBALD LP 5.3FR 7MM 135CM 60MM HIGH PRES BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 27204914 EAP HCPCS C1725 CAT BALD .035IN 7MM 75CM 60MM HIGH PRES LP BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 27204916 EAP HCPCS C1725 CAT BALD .035IN 8MM 75CM 60MM HIGH PRE LP BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 27204917 EAP HCPCS C1725 CAT BALD LP 5.8FR 9MM 135CM 60MM HIGH PRES BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 27204918 EAP HCPCS C1725 CAT GUID EBU3.75 CURVE 7FR .081IN 100CM LUCH BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27204919 EAP HCPCS C1725 CAT BALD .035IN 6MM 75CM 60MM HIGH PRES LP BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 27204920 EAP HCPCS C1830 BIOPSY SYSTEM COMPREHENSIVE TRAY 102MM BOTH IP/OP $350.00 $259.00 $72.94 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 $350.00 $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A 27204921 EAP HCPCS C1830 BIOPSY SYSTEM COMPREHENSIVE TRAY 152MM BOTH IP/OP $350.00 $259.00 $72.94 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 $350.00 $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A 27204923 EAP HCPCS C1830 ONCONTROL BIOPSY SYSTEM TRAY 152MM BOTH IP/OP $325.00 $240.50 $67.73 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 $325.00 $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A 27204924 EAP Custom 27204924 ONCONTROL COAXIAL TRAY 6CM 11/13 GAUGE BOTH IP/OP $938.00 $694.50 $166.96 $938.00 $938.00 $938.00 $938.00 $938.00 $938.00 $938.00 $166.96 $938.00 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $375.20 $938.00 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $938.00 $938.00 $544.04 $938.00 $562.80 $938.00 $938.00 $938.00 N/A N/A 27204925 EAP Custom 27204925 ONCONTROL COAXIAL TRAY 10CM 11/13 GAUGE BOTH IP/OP $938.00 $694.50 $166.96 $938.00 $938.00 $938.00 $938.00 $938.00 $938.00 $938.00 $166.96 $938.00 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $375.20 $938.00 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $938.00 $938.00 $544.04 $938.00 $562.80 $938.00 $938.00 $938.00 N/A N/A 27204926 EAP Custom 27204926 ONCONTROL COAXIAL TRAY 15CM 11/13 GAUGE BOTH IP/OP $938.00 $694.50 $166.96 $938.00 $938.00 $938.00 $938.00 $938.00 $938.00 $938.00 $166.96 $938.00 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $375.20 $938.00 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $938.00 $938.00 $544.04 $938.00 $562.80 $938.00 $938.00 $938.00 N/A N/A 27204927 EAP HCPCS C1769 GUIDEWIRE VASC 185CM STRL LF VERRATA + PRSS DISP BOTH IP/OP "$1,688.00" "$1,249.50" $335.03 "$1,688.00" $916.58 $916.58 $916.58 $916.58 "$1,688.00" "$1,688.00" "$1,688.00" $351.82 "$1,688.00" "$1,252.83" "$1,252.83" "$1,301.11" $879.45 $351.80 "$1,688.00" "$1,688.00" $998.45 "$1,688.00" "$1,688.00" "$1,688.00" "$1,688.00" "$1,266.00" "$1,688.00" "$1,688.00" "$1,688.00" $844.00 $844.00 "$1,336.90" "$1,688.00" "$1,350.40" "$1,097.20" $335.03 "$1,688.00" $979.04 "$1,688.00" "$1,688.00" "$1,688.00" $351.78 "$1,688.00" N/A N/A 27204928 EAP HCPCS C2628 CATHETER BALDILAT 9FR 32MM 120CM 2 LUM RADIOPQ BOTH IP/OP "$1,430.00" "$1,058.50" $283.82 "$1,430.00" $776.49 $776.49 $776.49 $776.49 "$1,430.00" "$1,430.00" "$1,430.00" $298.05 "$1,430.00" "$1,061.35" "$1,061.35" "$1,102.24" $745.03 $298.03 "$1,430.00" "$1,430.00" $845.85 "$1,430.00" "$1,430.00" "$1,430.00" "$1,430.00" "$1,072.50" "$1,430.00" "$1,430.00" "$1,430.00" $715.00 $715.00 "$1,132.56" "$1,430.00" "$1,144.00" $929.50 $283.82 "$1,430.00" $829.40 "$1,430.00" "$1,430.00" "$1,430.00" $298.01 "$1,430.00" N/A N/A 27204930 EAP HCPCS C1769 GWIRE VASC .038IN 180CM STRL 3CM MERIT LAUREA BOTH IP/OP $80.00 $59.50 $15.88 $80.00 $43.44 $43.44 $43.44 $43.44 $80.00 $80.00 $80.00 $16.67 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $80.00 $47.32 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $15.88 $80.00 $46.40 $80.00 $80.00 $80.00 $16.67 $80.00 N/A N/A 27204933 EAP HCPCS C1769 SET CAT 15.5FR 24CM 3 LUMEN BAS GWIRE DIL SCAL BOTH IP/OP $278.00 $206.00 $55.18 $278.00 $150.95 $150.95 $150.95 $150.95 $278.00 $278.00 $278.00 $57.94 $278.00 $206.33 $206.33 $214.28 $144.84 $57.94 $278.00 $278.00 $164.44 $278.00 $278.00 $278.00 $278.00 $208.50 $278.00 $278.00 $278.00 $139.00 $139.00 $220.18 $278.00 $222.40 $180.70 $55.18 $278.00 $161.24 $278.00 $166.80 $278.00 $57.94 $278.00 N/A N/A 27204942 EAP HCPCS C1753 CATHETER US KODAMA BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $814.50 $814.50 $814.50 $814.50 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 27204943 EAP Custom 27204943 GLOVE COMPRESSION LARGE OPEN FINGER SEAMLESS LATEX FREE PR BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27204944 EAP Custom 27204944 GLOVE CMPR XS 5-6IN LF ISTNR F F THRP MACH WSHBL 80% NYL 20% PR BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27204945 EAP Custom 27204945 GLOVE CMPR MED LF ISTNR ANEMB F F L/R HND EDEMA CNTRL PR BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27204946 EAP Custom 27204946 GLOVE CMPR SM 23-32 MMHG 6-7IN LF ISTNR F F THRP NYL SPNDX PR BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27204947 EAP Custom 27204947 GLOVE CMPR LG 23-32 MMHG 8-9IN LF ISTNR F F THRP NYL SPNDX PR BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27204948 EAP Custom 27204948 GLOVE CMPR XS 5-6IN LF ISTNR OPN FNGR LTWT BLND SMLS SPRT PR BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27204949 EAP Custom 27204949 GLOVE CMPR SM LF ISTNR OPN FNGR SMLS 80% NYL 20% SPNDX 23-32 PR BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27204950 EAP Custom 27204950 GLOVE CMPR MD LF ISTNR OPN FNGR SMLS 80% NYL 20% SPNDX 23-32 PR BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 27204951 EAP Custom 27204951 SPHERE EMBL YLW EMBSPH 100-300UM MCSPH NS PREFL BOTH IP/OP $608.00 $450.00 $108.22 $608.00 $608.00 $608.00 $608.00 $608.00 $608.00 $608.00 $108.22 $608.00 $608.00 $451.26 $451.26 $468.65 $316.77 $126.71 $608.00 $243.20 $608.00 $608.00 $608.00 $608.00 $608.00 $456.00 $608.00 $608.00 $608.00 $304.00 $304.00 $481.54 $608.00 $486.40 $395.20 $608.00 $608.00 $352.64 $608.00 $364.80 $608.00 $608.00 $608.00 N/A N/A 27204952 EAP Custom 27204952 SPHERE EMBL BLUE EMBSPH 300-500UM MCSPH NS PREFL BOTH IP/OP $608.00 $450.00 $108.22 $608.00 $608.00 $608.00 $608.00 $608.00 $608.00 $608.00 $108.22 $608.00 $608.00 $451.26 $451.26 $468.65 $316.77 $126.71 $608.00 $243.20 $608.00 $608.00 $608.00 $608.00 $608.00 $456.00 $608.00 $608.00 $608.00 $304.00 $304.00 $481.54 $608.00 $486.40 $395.20 $608.00 $608.00 $352.64 $608.00 $364.80 $608.00 $608.00 $608.00 N/A N/A 27205000 EAP HCPCS C1769 GUIDEWIRE VASC 175CM .014IN RADIOPQ TIP SNSR ELMT BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27205001 EAP Custom 27205001 INTROD SHTH 11FR .144IN 25CM RBST VLV SPLT SDPRT BOTH IP/OP $105.00 $78.00 $18.69 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $18.69 $105.00 $105.00 $77.93 $77.93 $80.93 $54.71 $21.88 $105.00 $42.00 $105.00 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $68.25 $105.00 $105.00 $60.90 $105.00 $63.00 $105.00 $105.00 $105.00 N/A N/A 27205003 EAP Custom 27205003 INTROD SHTH 10FR .131IN 25CM RBST VLV SPLT SDPRT BOTH IP/OP $105.00 $78.00 $18.69 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $18.69 $105.00 $105.00 $77.93 $77.93 $80.93 $54.71 $21.88 $105.00 $42.00 $105.00 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $68.25 $105.00 $105.00 $60.90 $105.00 $63.00 $105.00 $105.00 $105.00 N/A N/A 27205004 EAP Custom 27205004 INTROD SHTH 10.5FR .138IN 13CM RBST VLV SPLT SDPRT BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27205005 EAP Custom 27205005 INTROD SHTH 10FR .131IN 13CM RBST VLV SPLT SDPRT BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27205006 EAP Custom 27205006 INTROD SHTH 11FR .144IN 13CM RBST VLV SPLT SDPRT BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27205007 EAP Custom 27205007 INTROD SHTH 12.5FR .164IN 13CM RBST VLV SPLT SDPRT BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27205008 EAP Custom 27205008 INTROD SHTH 12FR .158IN 13CM RBST VLV SPLT SDPRT BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27205010 EAP Custom 27205010 INTROD SHTH 8.5FR .112IN 13CM RBST VLV SPLT SDPRT BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27205012 EAP Custom 27205012 INTROD SHTH 9.5FR .125IN 13CM RBST VLV SPLT SDPRT BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27205014 EAP Custom 27205014 INTROD SHTH 6FR .083IN 25CM RBST VLV SPLT SDPRT BOTH IP/OP $105.00 $78.00 $18.69 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $18.69 $105.00 $105.00 $77.93 $77.93 $80.93 $54.71 $21.88 $105.00 $42.00 $105.00 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $68.25 $105.00 $105.00 $60.90 $105.00 $63.00 $105.00 $105.00 $105.00 N/A N/A 27205015 EAP Custom 27205015 INTROD SHTH 9FR .118IN 25CM RBST VLV SPLT SDPRT BOTH IP/OP $105.00 $78.00 $18.69 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $18.69 $105.00 $105.00 $77.93 $77.93 $80.93 $54.71 $21.88 $105.00 $42.00 $105.00 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $68.25 $105.00 $105.00 $60.90 $105.00 $63.00 $105.00 $105.00 $105.00 N/A N/A 27205016 EAP Custom 27205016 INTROD SHTH 8FR .083IN 25CM RBST VLV SPLT SDPRT BOTH IP/OP $105.00 $78.00 $18.69 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $18.69 $105.00 $105.00 $77.93 $77.93 $80.93 $54.71 $21.88 $105.00 $42.00 $105.00 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $68.25 $105.00 $105.00 $60.90 $105.00 $63.00 $105.00 $105.00 $105.00 N/A N/A 27205017 EAP HCPCS C1894 INTROD SHTH 7FR 13CM 19.5CM 3W STPCK TRAW HMST VLV BOTH IP/OP $146.00 $108.50 $28.98 $146.00 $79.28 $79.28 $79.28 $79.28 $146.00 $146.00 $146.00 $30.43 $146.00 $108.36 $108.36 $112.54 $76.07 $30.43 $146.00 $146.00 $86.36 $146.00 $146.00 $146.00 $146.00 $109.50 $146.00 $146.00 $146.00 $73.00 $73.00 $115.63 $146.00 $116.80 $94.90 $28.98 $146.00 $84.68 $146.00 $146.00 $146.00 $30.43 $146.00 N/A N/A 27205018 EAP HCPCS C1894 INTROD SHTH 9FR 13CM 19.5CM 3W STPCK TRAW HMST VLV BOTH IP/OP $146.00 $108.50 $28.98 $146.00 $79.28 $79.28 $79.28 $79.28 $146.00 $146.00 $146.00 $30.43 $146.00 $108.36 $108.36 $112.54 $76.07 $30.43 $146.00 $146.00 $86.36 $146.00 $146.00 $146.00 $146.00 $109.50 $146.00 $146.00 $146.00 $73.00 $73.00 $115.63 $146.00 $116.80 $94.90 $28.98 $146.00 $84.68 $146.00 $146.00 $146.00 $30.43 $146.00 N/A N/A 27205019 EAP HCPCS C1894 INTROD LEAD 23CM 7FR SFSHTH ULT HMST VLV LP TRAW BOTH IP/OP $146.00 $108.50 $28.98 $146.00 $79.28 $79.28 $79.28 $79.28 $146.00 $146.00 $146.00 $30.43 $146.00 $108.36 $108.36 $112.54 $76.07 $30.43 $146.00 $146.00 $86.36 $146.00 $146.00 $146.00 $146.00 $109.50 $146.00 $146.00 $146.00 $73.00 $73.00 $115.63 $146.00 $116.80 $94.90 $28.98 $146.00 $84.68 $146.00 $146.00 $146.00 $30.43 $146.00 N/A N/A 27205021 EAP HCPCS C1887 CATHETER INFUS MIC .027IN PHENOM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" "$1,086.00" "$1,086.00" "$1,086.00" "$1,086.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$1,484.40" "$1,484.40" "$1,541.60" "$1,042.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" "$1,300.00" $396.95 "$2,000.00" "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 27205022 EAP HCPCS C1887 CATHETER INFUS 30CM .040IN .036IN .027IN PHENOM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" "$1,086.00" "$1,086.00" "$1,086.00" "$1,086.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$1,484.40" "$1,484.40" "$1,541.60" "$1,042.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" "$1,300.00" $396.95 "$2,000.00" "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 27205023 EAP HCPCS C1887 CATHETER INFS MIC .17IN PHENOM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" "$1,086.00" "$1,086.00" "$1,086.00" "$1,086.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$1,484.40" "$1,484.40" "$1,541.60" "$1,042.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" "$1,300.00" $396.95 "$2,000.00" "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 27205024 EAP HCPCS C1887 CATHETER INFUS 105CM .061IN .055IN .044IN PHENOM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" "$1,086.00" "$1,086.00" "$1,086.00" "$1,086.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$1,484.40" "$1,484.40" "$1,541.60" "$1,042.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" "$1,300.00" $396.95 "$2,000.00" "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 27205025 EAP HCPCS C1887 CATHETER INFS MIC .45IN PHENOM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" "$1,086.00" "$1,086.00" "$1,086.00" "$1,086.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$1,484.40" "$1,484.40" "$1,541.60" "$1,042.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" "$1,300.00" $396.95 "$2,000.00" "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 27205026 EAP HCPCS C1769 KIT CATH 13.5FR 16CM STRL MH Q+ STRG XTN PU HMDIAL BOTH IP/OP $115.00 $85.50 $22.82 $115.00 $62.45 $62.45 $62.45 $62.45 $115.00 $115.00 $115.00 $23.97 $115.00 $85.35 $85.35 $88.64 $59.92 $23.97 $115.00 $115.00 $68.02 $115.00 $115.00 $115.00 $115.00 $86.25 $115.00 $115.00 $115.00 $57.50 $57.50 $91.08 $115.00 $92.00 $74.75 $22.82 $115.00 $66.70 $115.00 $69.00 $115.00 $23.97 $115.00 N/A N/A 27205027 EAP HCPCS C1769 KIT CATH 19.5CM 13.5FR PU MH Q+ STR EXTN HMDIAL BOTH IP/OP $115.00 $85.50 $22.82 $115.00 $62.45 $62.45 $62.45 $62.45 $115.00 $115.00 $115.00 $23.97 $115.00 $85.35 $85.35 $88.64 $59.92 $23.97 $115.00 $115.00 $68.02 $115.00 $115.00 $115.00 $115.00 $86.25 $115.00 $115.00 $115.00 $57.50 $57.50 $91.08 $115.00 $92.00 $74.75 $22.82 $115.00 $66.70 $115.00 $115.00 $115.00 $23.97 $115.00 N/A N/A 27205028 EAP HCPCS C1769 KIT CATH STRG 13.5FR 24CM 7CM MH Q+ 2 LUM XTN PU HMDIAL BOTH IP/OP $115.00 $85.50 $22.82 $115.00 $62.45 $62.45 $62.45 $62.45 $115.00 $115.00 $115.00 $23.97 $115.00 $85.35 $85.35 $88.64 $59.92 $23.97 $115.00 $115.00 $68.02 $115.00 $115.00 $115.00 $115.00 $86.25 $115.00 $115.00 $115.00 $57.50 $57.50 $91.08 $115.00 $92.00 $74.75 $22.82 $115.00 $66.70 $115.00 $69.00 $115.00 $23.97 $115.00 N/A N/A 27205029 EAP HCPCS C1769 GUIDEWIRE VASCULAR 15D .018IN 180CM 5CM INTERMEDIA BOTH IP/OP $216.00 $160.00 $42.87 $216.00 $117.29 $117.29 $117.29 $117.29 $216.00 $216.00 $216.00 $45.02 $216.00 $160.32 $160.32 $166.49 $112.54 $45.02 $216.00 $216.00 $127.76 $216.00 $216.00 $216.00 $216.00 $162.00 $216.00 $216.00 $216.00 $108.00 $108.00 $171.07 $216.00 $172.80 $140.40 $42.87 $216.00 $125.28 $216.00 $216.00 $216.00 $45.01 $216.00 N/A N/A 27205032 EAP Custom 27205032 KIT BIOPSY TLAB METAL STRAIGHT CURVE L60 CM L65 CM BOTH IP/OP "$1,350.00" $999.00 $240.30 "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" $240.30 "$1,350.00" "$1,350.00" "$1,001.97" "$1,001.97" "$1,040.58" $703.35 $281.35 "$1,350.00" $540.00 "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,012.50" "$1,350.00" "$1,350.00" "$1,350.00" $675.00 $675.00 "$1,069.20" "$1,350.00" "$1,080.00" $877.50 "$1,350.00" "$1,350.00" $783.00 "$1,350.00" $810.00 "$1,350.00" "$1,350.00" "$1,350.00" N/A N/A 27205033 EAP HCPCS C1884 SYSTEM EMBOLIC PROTECTION 3.2-4.2FR 6MM 320CM 190C BOTH IP/OP "$3,488.00" "$2,581.50" $692.28 "$3,488.00" "$1,893.98" "$1,893.98" "$1,893.98" "$1,893.98" "$3,488.00" "$3,488.00" "$3,488.00" $726.99 "$3,488.00" "$2,588.79" "$2,588.79" "$2,688.55" "$1,817.25" $726.94 "$3,488.00" "$3,488.00" "$2,063.15" "$3,488.00" "$3,488.00" "$3,488.00" "$3,488.00" "$2,616.00" "$3,488.00" "$3,488.00" "$3,488.00" "$1,744.00" "$1,744.00" "$2,762.50" "$3,488.00" "$2,790.40" "$2,267.20" $692.28 "$3,488.00" "$2,023.04" "$3,488.00" "$3,488.00" "$3,488.00" $726.90 "$3,488.00" N/A N/A 27205035 EAP Custom 27205035 CATHETER INTVN 180- D 2.4-2.9FR .021IN 125CM SWIFT BOTH IP/OP "$6,000.00" "$4,440.00" "$1,068.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,068.00" "$6,000.00" "$6,000.00" "$4,181.12" "$4,181.12" "$4,624.80" "$2,060.15" "$1,250.47" "$6,000.00" "$2,400.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$4,500.00" "$6,000.00" "$6,000.00" "$6,000.00" "$3,000.00" "$3,000.00" "$4,752.00" "$6,000.00" "$4,800.00" "$3,900.00" "$6,000.00" "$6,000.00" "$3,480.00" "$6,000.00" "$3,600.00" "$6,000.00" "$6,000.00" "$6,000.00" N/A N/A 27205036 EAP HCPCS C1725 CATHETER BALDILAT ULTRA LP 5FR 1.5MM 12MM 2 LUMEN BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $162.90 $162.90 $162.90 $162.90 $300.00 $300.00 $300.00 $62.53 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $59.54 $300.00 $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A 27205037 EAP HCPCS C1725 CATHETER BALDILAT ULTRA LP 5FR 1.5MM 15MM 2 LUMEN BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $162.90 $162.90 $162.90 $162.90 $300.00 $300.00 $300.00 $62.53 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $59.54 $300.00 $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 27205038 EAP HCPCS C1725 CATHETER BALDILAT 2.25MM 10MM RAPEX LEGEND SEMICOM BOTH IP/OP "$1,033.00" $764.50 $205.02 "$1,033.00" $560.92 $560.92 $560.92 $560.92 "$1,033.00" "$1,033.00" "$1,033.00" $215.30 "$1,033.00" $766.69 $766.69 $796.24 $538.19 $215.29 "$1,033.00" "$1,033.00" $611.02 "$1,033.00" "$1,033.00" "$1,033.00" "$1,033.00" $774.75 "$1,033.00" "$1,033.00" "$1,033.00" $516.50 $516.50 $818.14 "$1,033.00" $826.40 $671.45 $205.02 "$1,033.00" $599.14 "$1,033.00" "$1,033.00" "$1,033.00" $215.28 "$1,033.00" N/A N/A 27205039 EAP HCPCS C1725 CATHETER BALDILAT LP 5.3FR 4MM 75CM 20MM HIGH PRES BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 27205040 EAP HCPCS C1725 CATHETER BALDILAT ULTRA LP 5FR 1.5MM 20MM 2 LUMEN BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $162.90 $162.90 $162.90 $162.90 $300.00 $300.00 $300.00 $62.53 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $59.54 $300.00 $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 27205041 EAP HCPCS C1725 CATHETER BALDILAT ULTRA LP 5FR 1.5MM 6MM 2 LUMEN R BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $162.90 $162.90 $162.90 $162.90 $300.00 $300.00 $300.00 $62.53 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $59.54 $300.00 $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 27205042 EAP HCPCS C1725 CATHETER BALDILAT ULTRA LP 5FR 1.5MM 8MM 2 LUMEN R BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $162.90 $162.90 $162.90 $162.90 $300.00 $300.00 $300.00 $62.53 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $59.54 $300.00 $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 27205051 EAP HCPCS C1769 CATHETER GD STRG 6FR 115CM STRL LF SOFIA DISP STRK BOTH IP/OP "$4,990.00" "$3,693.00" $990.39 "$4,990.00" "$2,709.57" "$2,709.57" "$2,709.57" "$2,709.57" "$4,990.00" "$4,990.00" "$4,990.00" "$1,040.04" "$4,990.00" "$3,703.58" "$3,703.58" "$3,846.29" "$2,060.15" "$1,039.97" "$4,990.00" "$4,990.00" "$2,951.59" "$4,990.00" "$4,990.00" "$4,990.00" "$4,990.00" "$3,742.50" "$4,990.00" "$4,990.00" "$4,990.00" "$2,495.00" "$2,495.00" "$3,952.08" "$4,990.00" "$3,992.00" "$3,243.50" $990.39 "$4,990.00" "$2,894.20" "$4,990.00" "$4,990.00" "$4,990.00" "$1,039.92" "$4,990.00" N/A N/A 27205055 EAP HCPCS C1769 GUIDEWIRE VASC 90D .018IN 180CM 25CM GLDWR GT HDRPH BOTH IP/OP $430.00 $318.50 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 $430.00 $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A 27205056 EAP Custom 27205056 CATHETER BALLOON  6X100MM 135C BOTH IP/OP $285.00 $211.00 $50.73 $285.00 $285.00 $285.00 $285.00 $285.00 $285.00 $285.00 $50.73 $285.00 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $114.00 $285.00 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $285.00 $285.00 $165.30 $285.00 $171.00 $285.00 $285.00 $285.00 N/A N/A 27205089 EAP CATHETER ANGIO RBT CRV 5FR 90CM TRNB AD ACPT .035IN GW BOTH IP/OP $32.50 $24.50 $5.79 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $5.79 $32.50 $32.50 $24.12 $24.12 $25.05 $16.93 $6.77 $32.50 $13.00 $32.50 $32.50 $32.50 $32.50 $32.50 $24.38 $32.50 $32.50 $32.50 $16.25 $16.25 $25.74 $32.50 $26.00 $21.13 $32.50 $32.50 $18.85 $32.50 $19.50 $32.50 $32.50 $32.50 N/A N/A 27205098 EAP HCPCS C1725 CATHETER BLNDIL .035IN 6FR 3MM 90CM 120MM METACROSS RX PERI BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205099 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM 150CM 200MM CROSPERIO OTW PTA BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205100 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 1.5MM 150CM 20MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205101 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 1.5MM 150CM 40MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205102 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 1.5MM 150CM 80MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205103 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 1.5MM 90CM 120MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205104 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 1.5MM 90CM 20MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205105 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 1.5MM 90CM 40MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205106 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 1.5MM 90CM 80MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205107 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2.5MM 150CM 120MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205108 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2.5MM 150CM 200MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205109 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2.5MM 150CM 40MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205110 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2.5MM 150CM 80MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205111 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2.5MM 90CM 120MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205112 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2.5MM 90CM 150MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205113 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2.5MM 90CM 200MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205114 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2.5MM 90CM 40MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205115 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2.5MM 90CM 80MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205116 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2MM 150CM 150MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205117 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2MM 150CM 40MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205118 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2MM 150CM 80MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205119 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2MM 90CM 120MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205120 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2MM 90CM 150MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205121 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2MM 90CM 200MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205122 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2MM 90CM 40MM CROSPERIO RX TPR COR WRE BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205123 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 2MM 90CM 80MM CROSPERIO RX TPR COR WRE BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205124 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 3.5MM 150CM 40MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205125 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 3.5MM 150CM 80MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205126 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 3.5MM 90CM 120MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205127 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 3.5MM 90CM 150MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205128 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 3.5MM 90CM 200MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205129 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 3.5MM 90CM 40MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205130 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 3.5MM 90CM 80MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205131 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 3MM 150CM 150MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205132 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 3MM 150CM 40MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205133 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 3MM 150CM 80MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205134 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 3MM 90CM 120MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205135 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 3MM 90CM 150MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205136 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 3MM 90CM 200MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205138 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 3MM 90CM 80MM CROSPERIO RX TPR COR WRE BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205139 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 4MM 150CM 40MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205140 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 4MM 150CM 80MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205141 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 4MM 90CM 120MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205142 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 4MM 90CM 150MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205143 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 4MM 90CM 40MM CROSPERIO RX TPR COR WRE BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205144 EAP HCPCS C1725 CATHETER BLNDIL 3.5FR 4MM 90CM 80MM CROSPERIO RX TPR COR WRE BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205145 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 1.5MM 150CM 120MM CROSPERIO OTW TPR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205146 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 1.5MM 150CM 20MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205147 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 1.5MM 150CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205148 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 1.5MM 150CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205149 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 1.5MM 65CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205150 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 1.5MM 65CM 20MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205151 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 1.5MM 65CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205152 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 1.5MM 65CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205153 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 1.5MM 90CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205154 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 1.5MM 90CM 20MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205155 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 1.5MM 90CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205156 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 1.5MM 90CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205157 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2.5MM 150CM 120MM CROSPERIO OTW TPR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205158 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2.5MM 150CM 150MM CROSPERIO OTW TPR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205159 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2.5MM 150CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205161 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2.5MM 65CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205162 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2.5MM 65CM 150MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205163 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2.5MM 65CM 200MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205164 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2.5MM 65CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205165 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2.5MM 65CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205166 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2.5MM 90CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205167 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2.5MM 90CM 150MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205168 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2.5MM 90CM 200MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205169 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2.5MM 90CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205170 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2.5MM 90CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205171 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 150CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205172 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 150CM 150MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205173 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 150CM 200MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205174 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 150CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205175 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 150CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205176 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 65CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205177 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 65CM 150MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205178 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 65CM 200MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205179 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 65CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205180 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 65CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205181 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 90CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205182 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 90CM 150MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205183 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 90CM 200MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205184 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 90CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205185 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 2MM 90CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205186 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 150CM 120MM CROSPERIO OTW TPR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205187 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 150CM 150MM CROSPERIO OTW TPR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205188 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 150CM 200MM CROSPERIO OTW TPR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205189 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 150CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205190 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 150CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205191 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 65CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205192 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 65CM 150MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205193 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 65CM 200MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205194 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 65CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205195 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 65CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205196 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 90CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205197 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 90CM 150MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205198 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 90CM 200MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205199 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 90CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205200 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3.5MM 90CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205201 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3MM 150CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205202 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3MM 150CM 150MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205203 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3MM 150CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205204 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3MM 150CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205205 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3MM 65CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205206 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3MM 65CM 150MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205207 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3MM 65CM 200MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205208 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3MM 65CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205209 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3MM 65CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205210 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3MM 90CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205211 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3MM 90CM 150MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205212 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3MM 90CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205213 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 3MM 90CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205214 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 4MM 150CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205215 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 4MM 150CM 150MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205216 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 4MM 150CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205217 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 4MM 150CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205218 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 4MM 65CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205219 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 4MM 65CM 150MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205220 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 4MM 65CM 200MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205221 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 4MM 65CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205222 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 4MM 65CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205223 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 4MM 90CM 120MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 27205224 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 4MM 90CM 200MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205225 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 4MM 90CM 40MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205226 EAP HCPCS C1725 CATHETER BLNDIL 3.8FR 4MM 90CM 80MM CROSPERIO OTW TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205227 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 150CM 100MM CROSSTELLA OTW TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205228 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 150CM 120MM CROSSTELLA OTW TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205229 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 150CM 150MM CROSSTELLA OTW TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205230 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 150CM 200MM CROSSTELLA OTW TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205231 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 150CM 20MM CROSSTELLA OTW TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205232 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 150CM 40MM CROSSTELLA OTW TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205233 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 150CM 60MM CROSSTELLA OTW TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205234 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 150CM 80MM CROSSTELLA OTW TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205235 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 90CM 100MM CROSSTELLA OTW TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205236 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 90CM 120MM CROSSTELLA OTW TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205237 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 90CM 150MM CROSSTELLA OTW TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205238 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 90CM 200MM CROSSTELLA OTW TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205239 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 90CM 20MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205240 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 90CM 40MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205241 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 90CM 60MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205242 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2.5MM 90CM 80MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205243 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 150CM 100MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205244 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 150CM 120MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205245 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 150CM 150MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205246 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 150CM 200MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205247 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 150CM 20MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205248 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 150CM 40MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205249 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 150CM 60MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205250 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 150CM 80MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205251 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 90CM 100MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205252 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 90CM 120MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205253 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 90CM 150MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205254 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 90CM 200MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205255 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 90CM 20MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205256 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 90CM 40MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205257 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 90CM 60MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205258 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 2MM 90CM 80MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205259 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 150CM 100MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205260 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 150CM 120MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205261 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 150CM 150MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205262 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 150CM 200MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205263 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 150CM 20MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205264 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 150CM 40MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205265 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 150CM 60MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205266 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 150CM 80MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205267 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 90CM 100MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205268 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 90CM 120MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205269 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 90CM 150MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205270 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 90CM 200MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205271 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 90CM 20MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205272 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 90CM 40MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205273 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 90CM 60MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205274 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 3MM 90CM 80MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205275 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 150CM 100MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205276 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 150CM 120MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205277 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 150CM 150MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205278 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 150CM 200MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205279 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 150CM 20MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205280 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 150CM 40MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205281 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 150CM 60MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205282 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 150CM 80MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205283 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 90CM 100MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205284 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 90CM 120MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205285 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 90CM 150MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205286 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 90CM 200MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205287 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 90CM 20MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205288 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 90CM 40MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205289 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 90CM 60MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205290 EAP HCPCS C1725 CATHETER BLNDIL 3.9FR 4MM 90CM 80MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205291 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 150CM 100MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205292 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 150CM 120MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205293 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 150CM 150MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205294 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 150CM 200MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205295 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 150CM 20MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205296 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 150CM 20MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205297 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 150CM 40MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205298 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 150CM 40MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205299 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 150CM 60MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205300 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 150CM 80MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205301 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 90CM 100MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205302 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 90CM 120MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205303 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 90CM 150MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205304 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 90CM 200MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205305 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 90CM 20MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205306 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 90CM 40MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205307 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 90CM 40MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205308 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 90CM 60MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205309 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 5MM 90CM 80MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205310 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 6MM 150CM 100MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205311 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 6MM 150CM 120MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205312 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 6MM 150CM 150MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205313 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 6MM 150CM 200MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205314 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 6MM 150CM 60MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205315 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 6MM 150CM 80MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205316 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 6MM 90CM 100MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205317 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 6MM 90CM 120MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205318 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 6MM 90CM 150MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205319 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 6MM 90CM 200MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205320 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 6MM 90CM 20MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205321 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 6MM 90CM 60MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205322 EAP HCPCS C1725 CATHETER BLNDIL 4.3FR 6MM 90CM 80MM CROSSTELLA OTW TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205323 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 150CM 100MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205324 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 150CM 120MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205325 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 150CM 150MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205326 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 150CM 200MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205327 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 150CM 20MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205328 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 150CM 40MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205329 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 150CM 60MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205330 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 150CM 80MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205331 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 90CM 100MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205332 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 90CM 120MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205333 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 90CM 150MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205334 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 90CM 200MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205335 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 90CM 20MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205336 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 90CM 40MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205337 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 90CM 60MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205338 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2.5MM 90CM 80MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205339 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 150CM 100MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205340 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 150CM 120MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205341 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 150CM 150MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205342 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 150CM 200MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205343 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 150CM 200MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205344 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 150CM 20MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205345 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 150CM 40MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205346 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 150CM 60MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205347 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 150CM 80MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205348 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 90CM 100MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205349 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 90CM 120MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205350 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 90CM 150MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205351 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 90CM 200MM CROSPERIO RX TPR COR BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205352 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 90CM 200MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205353 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 90CM 20MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205354 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 90CM 40MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205355 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 90CM 60MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205356 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 2MM 90CM 80MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205357 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 150CM 100MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205358 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 150CM 120MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205359 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 150CM 150MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205360 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 150CM 200MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205361 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 150CM 20MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205362 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 150CM 40MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205363 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 150CM 60MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205364 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 150CM 80MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205365 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 90CM 100MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205366 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 90CM 120MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205367 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 90CM 150MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205368 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 90CM 200MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205369 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 90CM 20MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205370 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 90CM 40MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205371 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 90CM 60MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205372 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 3MM 90CM 80MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205373 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 150CM 100MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205374 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 150CM 120MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205375 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 150CM 150MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205376 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 150CM 200MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205377 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 150CM 20MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205378 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 150CM 40MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205379 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 150CM 60MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205380 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 150CM 80MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205381 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 90CM 100MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205382 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 90CM 120MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205383 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 90CM 150MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205384 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 90CM 200MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205385 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 90CM 20MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205386 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 90CM 40MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205387 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 90CM 60MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205388 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 4MM 90CM 80MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205389 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 5MM 150CM 100MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205390 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 5MM 150CM 20MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205391 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 5MM 150CM 40MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205392 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 5MM 150CM 60MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205393 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 5MM 150CM 80MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205394 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 5MM 90CM 40MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205395 EAP HCPCS C1725 CATHETER BLNDIL 4-3.4FR 5MM 90CM 60MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205396 EAP HCPCS C1725 CATHETER BLNDIL 4-3.9FR 6MM 150CM 20MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205397 EAP HCPCS C1725 CATHETER BLNDIL 4-3.9FR 6MM 150CM 40MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205398 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 5MM 150CM 120MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205399 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 5MM 150CM 150MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205401 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 5MM 90CM 100MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205402 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 5MM 90CM 120MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205403 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 5MM 90CM 150MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205404 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 5MM 90CM 200MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205405 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 5MM 90CM 20MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205406 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 5MM 90CM 80MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205407 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 6MM 150CM 100MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205408 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 6MM 150CM 120MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205409 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 6MM 150CM 150MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205410 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 6MM 150CM 200MM CROSSTELLA RX TPR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A 27205411 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 6MM 150CM 60MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205412 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 6MM 150CM 80MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205413 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 6MM 90CM 100MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205414 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 6MM 90CM 120MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205415 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 6MM 90CM 150MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205416 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 6MM 90CM 200MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205417 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 6MM 90CM 20MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205419 EAP HCPCS C1725 CATHETER BLNDIL 4-4.1FR 6MM 90CM 80MM CROSSTELLA RX TPR COR BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205420 EAP HCPCS C1725 CATHETER BLNDIL 4FR 1.5MM 150CM 120MM CROSPERIO RX ACPT .014 BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205421 EAP HCPCS C1725 CATHETER BLNDIL 4FR 2.5MM 150CM 150MM CROSPERIO RX ACPT .014 BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205422 EAP HCPCS C1725 CATHETER BLNDIL 4FR 2MM 150CM 120MM CROSPERIO RX ACPT .014IN BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205423 EAP HCPCS C1725 CATHETER BLNDIL 4FR 2MM 150CM 200MM CROSPERIO RX ACPT .014IN BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205424 EAP HCPCS C1725 CATHETER BLNDIL 4FR 3.5MM 150CM 120MM CROSPERIO RX ACPT .014 BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205425 EAP HCPCS C1725 CATHETER BLNDIL 4FR 3.5MM 150CM 150MM CROSPERIO RX ACPT .014 BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205427 EAP HCPCS C1725 CATHETER BLNDIL 4FR 3MM 150CM 120MM CROSPERIO RX ACPT .014IN BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205428 EAP HCPCS C1725 CATHETER BLNDIL 4FR 3MM 150CM 200MM CROSPERIO RX ACPT .014IN BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205429 EAP HCPCS C1725 CATHETER BLNDIL 4FR 3MM 150CM 200MM CROSPERIO RX OTW ACPT BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205430 EAP HCPCS C1725 CATHETER BLNDIL 4FR 3MM 90CM 200MM CROSPERIO RX OTW ACPT BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205431 EAP HCPCS C1725 CATHETER BLNDIL 4FR 4MM 150CM 120MM CROSPERIO RX ACPT .014IN BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205432 EAP HCPCS C1725 CATHETER BLNDIL 4FR 4MM 150CM 150MM CROSPERIO RX ACPT .014IN BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205433 EAP HCPCS C1725 CATHETER BLNDIL 4FR 4MM 150CM 200MM CROSPERIO RX OTW ACPT BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205434 EAP HCPCS C1725 CATHETER BLNDIL 4MM 90CM 150MM CROSPERIO OTW PTA BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 $537.50 $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A 27205435 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 135CM 100MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205436 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 135CM 120MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205437 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 135CM 150MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205438 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 135CM 200MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205439 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 135CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205440 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 135CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205441 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 135CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205442 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 65CM 100MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205443 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 65CM 120MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205444 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 65CM 150MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205445 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 65CM 200MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205446 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 65CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205447 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 65CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205448 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 65CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205449 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 65CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205450 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 90CM 100MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205451 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 90CM 120MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205452 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 90CM 120MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205453 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 90CM 150MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205454 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 90CM 200MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205455 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 90CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205456 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 90CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205457 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 90CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205458 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 3MM 90CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205459 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 135CM 100MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205460 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 135CM 150MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205461 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 135CM 200MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205462 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 135CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205463 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 135CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205464 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 135CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205465 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 135CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205466 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 65CM 100MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205467 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 65CM 120MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205468 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 65CM 150MM METACROSS OTW TPR COR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205469 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 65CM 200MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205470 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 65CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205471 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 65CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205472 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 65CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205473 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 65CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205474 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 90CM 100MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205475 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 90CM 120MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205476 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 90CM 150MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205477 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 90CM 200MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205478 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 90CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205479 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 90CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205480 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 90CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205481 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 4MM 90CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205482 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 135CM 100MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205483 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 135CM 120MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205484 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 135CM 150MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205485 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 135CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205486 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 135CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205487 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 135CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205488 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 65CM 100MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205489 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 65CM 120MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205490 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 65CM 150MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205491 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 65CM 200MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205492 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 65CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205493 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 65CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205494 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 65CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205495 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 65CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205496 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 90CM 100MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205497 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 90CM 120MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205498 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 90CM 150MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205499 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 90CM 200MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205500 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 90CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205501 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 90CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205502 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 90CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205503 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 5MM 90CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205504 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 135CM 100MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205505 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 135CM 120MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205506 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 135CM 150MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205507 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 135CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205508 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 135CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205509 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 135CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205510 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 135CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205511 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 135CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205512 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 65CM 100MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205513 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 65CM 120MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205514 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 65CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205515 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 65CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205516 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 90CM 120MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205518 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 90CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205519 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 90CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205520 EAP HCPCS C1725 CATHETER BLNDIL 5.4FR 6MM 90CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205521 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.6-9FR 9MM 90CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205522 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 10MM 135CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205523 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 10MM 135CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205524 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 10MM 135CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205526 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 10MM 90CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205527 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 10MM 90CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205528 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 10MM 90CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205529 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 10MM 90CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205530 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 12MM 135CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205531 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 12MM 135CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205532 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 12MM 90CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205534 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 3MM 135CM 100MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205535 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 3MM 135CM 120MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205536 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 3MM 135CM 150MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205537 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 3MM 135CM 200MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205538 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 3MM 135CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205539 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 3MM 135CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205540 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 3MM 135CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205542 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 3MM 90CM 150MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205543 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 3MM 90CM 200MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205544 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 3MM 90CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205545 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 3MM 90CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205546 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 3MM 90CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205547 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 135CM 100MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205548 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 135CM 120MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205549 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 135CM 150MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205550 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 135CM 200MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205551 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 135CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205552 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 135CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205553 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 135CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205554 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 135CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205555 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 90CM 100MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205556 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 90CM 120MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205557 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 90CM 150MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205559 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 90CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205560 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 90CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205561 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 90CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205562 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 90CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205563 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 4MM 90CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205564 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 5MM 135CM 100MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205565 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 5MM 135CM 120MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205567 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 5MM 135CM 200MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205568 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 5MM 135CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205569 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 5MM 135CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205570 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 5MM 135CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205571 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 5MM 135CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205572 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 5MM 90CM 100MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205573 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 5MM 90CM 120MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205575 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 5MM 90CM 200MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205576 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 5MM 90CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205577 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 5MM 90CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205578 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 5MM 90CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205579 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 5MM 90CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205580 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 6MM 135CM 120MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205581 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 6MM 135CM 150MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205583 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 6MM 135CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205584 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 6MM 135CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205585 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 6MM 135CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205586 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 6MM 90CM 100MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205587 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 6MM 90CM 120MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205588 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 6MM 90CM 150MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205589 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 6MM 90CM 200MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205590 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 6MM 90CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205591 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 6MM 90CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205592 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 6MM 90CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205593 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 6MM 90CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205594 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 135CM 100MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205595 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 135CM 120MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205596 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 135CM 150MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205597 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 135CM 200MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205598 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 135CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205599 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 135CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205600 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 135CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205601 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 135CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205602 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 90CM 100MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205603 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 90CM 120MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205604 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 90CM 150MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205605 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 90CM 200MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205606 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 90CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205607 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 90CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205608 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 90CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205609 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 7MM 90CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205610 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 8MM 135CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205611 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 8MM 135CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205612 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 8MM 135CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205613 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 8MM 135CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205614 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 8MM 90CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205615 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 8MM 90CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205616 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 8MM 90CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205617 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 8MM 90CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205618 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 9MM 135CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205619 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 9MM 135CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205620 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 9MM 135CM 60MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205621 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 9MM 135CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205622 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 9MM 90CM 20MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205623 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 9MM 90CM 40MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205624 EAP HCPCS C1725 CATHETER BLNDIL 5.7-3.9FR 9MM 90CM 80MM METACROSS RX GW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205625 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 10MM 135CM 20MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205626 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 10MM 135CM 40MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205627 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 10MM 135CM 60MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205628 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 10MM 135CM 80MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205629 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 10MM 65CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205630 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 10MM 65CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205631 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 10MM 65CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205633 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 10MM 90CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205634 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 10MM 90CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205635 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 10MM 90CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205636 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 10MM 90CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205637 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 12MM 135CM 20MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205638 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 12MM 135CM 40MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205639 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 12MM 65CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205641 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 12MM 90CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205642 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 12MM 90CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 27205643 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 6MM 135CM 200MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205644 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 6MM 65CM 150MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205645 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 6MM 65CM 200MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205646 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 6MM 65CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205647 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 6MM 90CM 100MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205648 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 6MM 90CM 150MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205649 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 6MM 90CM 200MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205650 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 135CM 100MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205651 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 135CM 120MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205652 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 135CM 150MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205653 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 135CM 200MM METACROSS 2 LUM OTW BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205654 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 135CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205655 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 135CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205656 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 135CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205658 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 65CM 120MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205659 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 65CM 150MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205660 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 65CM 200MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205661 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 65CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205662 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 65CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205663 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 65CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205664 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 65CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205666 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 90CM 120MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205667 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 90CM 150MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205668 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 90CM 200MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205669 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 90CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205670 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 90CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205671 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 7MM 90CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205672 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 8MM 135CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205673 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 8MM 135CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205674 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 8MM 135CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205675 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 8MM 135CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205676 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 8MM 65CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205677 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 8MM 65CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205678 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 8MM 65CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205679 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 8MM 65CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205680 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 8MM 90CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205682 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 8MM 90CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205683 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 8MM 90CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205684 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 9MM 135CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205685 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 9MM 135CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205686 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 9MM 135CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205687 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 9MM 135CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205688 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 9MM 65CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205689 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 9MM 65CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205690 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 9MM 65CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205691 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 9MM 65CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205692 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 9MM 90CM 20MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205693 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 9MM 90CM 40MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205694 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 9MM 90CM 60MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205695 EAP HCPCS C1725 CATHETER BLNDIL 5.7FR 9MM 90CM 80MM METACROSS 2 LUM OTW TPR BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205696 EAP HCPCS C1725 CATHETER BLNDIL 5FR 4MM 135CM 120MM METACROSS OTW 2 LUM SHFT BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205697 EAP HCPCS C1725 CATHETER BLNDIL 5FR 5MM 135CM 200MM METACROSS OTW 2 LUM SHFT BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205698 EAP HCPCS C1725 CATHETER BLNDIL 5FR 5MM 135CM 20MM METACROSS OTW 2 LUM SHFT BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205700 EAP HCPCS C1725 CATHETER BLNDIL 5FR 6MM 90CM 40MM CROSSTELLA RX TPR COR WRE BOTH IP/OP $462.50 $342.50 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 $462.50 $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 27205701 EAP HCPCS C1725 CATHETER BLNDIL 5FR 6MM 90CM 40MM METACROSS OTW 2 LUM SHFT BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205702 EAP HCPCS C1725 CATHETER BLNDIL 6FR 4MM 135CM 60MM METACROSS RX LOOW PRFL BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205703 EAP HCPCS C1725 CATHETER BLNDIL 6MM 135CM 40MM METACROSS RX SM PRFL ACPT BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $154.76 $154.76 $154.76 $154.76 $285.00 $285.00 $285.00 $59.40 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $56.57 $285.00 $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 27205704 EAP HCPCS C1887 CATHETER INTVN .021IN 2.8FR 150CM 160CM PROGREAT GLDWR BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $705.90 $705.90 $705.90 $705.90 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" $964.86 $964.86 "$1,002.04" $677.30 $270.93 "$1,300.00" "$1,300.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $845.00 $258.02 "$1,300.00" $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A 27205705 EAP HCPCS C1887 CATHETER INTVN .021IN 750 PSI 2.4FR 150CM 90CM PROGREAT MCTH BOTH IP/OP $775.00 $573.50 $153.82 $775.00 $420.83 $420.83 $420.83 $420.83 $775.00 $775.00 $775.00 $161.53 $775.00 $575.21 $575.21 $597.37 $403.78 $161.52 $775.00 $775.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $503.75 $153.82 $775.00 $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A 27205706 EAP HCPCS C1887 CATHETER INTVN .021IN MIC 2.4-2.9FR .022IN 130CM PROGREAT BOTH IP/OP $775.00 $573.50 $153.82 $775.00 $420.83 $420.83 $420.83 $420.83 $775.00 $775.00 $775.00 $161.53 $775.00 $575.21 $575.21 $597.37 $403.78 $161.52 $775.00 $775.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $503.75 $153.82 $775.00 $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A 27205708 EAP HCPCS C1887 CATHETER INTVN 2.7-2.9FR .021IN 130CM PROGREAT MCTH COAX BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $705.90 $705.90 $705.90 $705.90 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" $964.86 $964.86 "$1,002.04" $677.30 $270.93 "$1,300.00" "$1,300.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $845.00 $258.02 "$1,300.00" $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A 27205709 EAP HCPCS C1887 CATHETER INTVN 2.7-2.9FR .025IN 110CM PROGREAT MCTH COAX BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $705.90 $705.90 $705.90 $705.90 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" $964.86 $964.86 "$1,002.04" $677.30 $270.93 "$1,300.00" "$1,300.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $845.00 $258.02 "$1,300.00" $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A 27205710 EAP HCPCS C1887 CATHETER INTVN 2.7FR .021IN 110CM 50CM PROGREAT MCTH SHP TIP BOTH IP/OP $775.00 $573.50 $153.82 $775.00 $420.83 $420.83 $420.83 $420.83 $775.00 $775.00 $775.00 $161.53 $775.00 $575.21 $575.21 $597.37 $403.78 $161.52 $775.00 $775.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $503.75 $153.82 $775.00 $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A 27205711 EAP HCPCS C1887 CATHETER INTVN MIC 2.4-2.9FR .022IN 110CM PROGREAT COAX BOTH IP/OP $775.00 $573.50 $153.82 $775.00 $420.83 $420.83 $420.83 $420.83 $775.00 $775.00 $775.00 $161.53 $775.00 $575.21 $575.21 $597.37 $403.78 $161.52 $775.00 $775.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $503.75 $153.82 $775.00 $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A 27205712 EAP HCPCS C1887 CATHETER INTVN MIC 2.8-3FR .027IN 110CM 50CM PROGREAT COAX BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $705.90 $705.90 $705.90 $705.90 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" $964.86 $964.86 "$1,002.04" $677.30 $270.93 "$1,300.00" "$1,300.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $845.00 $258.02 "$1,300.00" $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A 27205713 EAP HCPCS C1887 CATHETER INTVN MIC 2.8-3FR .027IN 130CM 17CM PROGREAT MRKR BOTH IP/OP $775.00 $573.50 $153.82 $775.00 $420.83 $420.83 $420.83 $420.83 $775.00 $775.00 $775.00 $161.53 $775.00 $575.21 $575.21 $597.37 $403.78 $161.52 $775.00 $775.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $503.75 $153.82 $775.00 $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A 27205715 EAP HCPCS C1887 CATHETER SPRT 30D 12MM 90CM STRL LF 40CM NAVICROSS RADOPQ BOTH IP/OP $427.50 $316.50 $84.85 $427.50 $232.13 $232.13 $232.13 $232.13 $427.50 $427.50 $427.50 $89.10 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $427.50 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $84.85 $427.50 $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A 27205716 EAP Custom 27205716 DEVICE INFL 25CC STRL SOLOPATH STPCK BOTH IP/OP $110.00 $81.50 $19.58 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $19.58 $110.00 $110.00 $81.64 $81.64 $84.79 $57.31 $22.93 $110.00 $44.00 $110.00 $110.00 $110.00 $110.00 $110.00 $82.50 $110.00 $110.00 $110.00 $55.00 $55.00 $87.12 $110.00 $88.00 $71.50 $110.00 $110.00 $63.80 $110.00 $66.00 $110.00 $110.00 $110.00 N/A N/A 27205717 EAP Custom 27205717 DEVICE INFL 30 ATM 25ML STRL SOLOPATH EXCEL STPCK BOTH IP/OP $110.00 $81.50 $19.58 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $19.58 $110.00 $110.00 $81.64 $81.64 $84.79 $57.31 $22.93 $110.00 $44.00 $110.00 $110.00 $110.00 $110.00 $110.00 $82.50 $110.00 $110.00 $110.00 $55.00 $55.00 $87.12 $110.00 $88.00 $71.50 $110.00 $110.00 $63.80 $110.00 $66.00 $110.00 $110.00 $110.00 N/A N/A 27205720 EAP HCPCS C1769 GUIDEWIRE SRG 45D .018IN 180CM 5CM GLDWR HDRPH BOTH IP/OP $301.25 $223.00 $59.79 $301.25 $163.58 $163.58 $163.58 $163.58 $301.25 $301.25 $301.25 $62.79 $301.25 $223.59 $223.59 $232.20 $156.95 $62.78 $301.25 $301.25 $178.19 $301.25 $301.25 $301.25 $301.25 $225.94 $301.25 $301.25 $301.25 $150.63 $150.63 $238.59 $301.25 $241.00 $195.81 $59.79 $301.25 $174.73 $301.25 $301.25 $301.25 $62.78 $301.25 N/A N/A 27205721 EAP HCPCS C1769 GUIDEWIRE SRG 70D .018IN 180CM 3CM GLDWR AU TIP ANG HDRPH BOTH IP/OP $301.25 $223.00 $59.79 $301.25 $163.58 $163.58 $163.58 $163.58 $301.25 $301.25 $301.25 $62.79 $301.25 $223.59 $223.59 $232.20 $156.95 $62.78 $301.25 $301.25 $178.19 $301.25 $301.25 $301.25 $301.25 $225.94 $301.25 $301.25 $301.25 $150.63 $150.63 $238.59 $301.25 $241.00 $195.81 $59.79 $301.25 $174.73 $301.25 $301.25 $301.25 $62.78 $301.25 N/A N/A 27205722 EAP HCPCS C1769 GUIDEWIRE SRG ANG .018IN 180CM 5CM GLDWR HDRPH BOTH IP/OP $301.25 $223.00 $59.79 $301.25 $163.58 $163.58 $163.58 $163.58 $301.25 $301.25 $301.25 $62.79 $301.25 $223.59 $223.59 $232.20 $156.95 $62.78 $301.25 $301.25 $178.19 $301.25 $301.25 $301.25 $301.25 $225.94 $301.25 $301.25 $301.25 $150.63 $150.63 $238.59 $301.25 $241.00 $195.81 $59.79 $301.25 $174.73 $301.25 $301.25 $301.25 $62.78 $301.25 N/A N/A 27205723 EAP HCPCS C1769 GUIDEWIRE VASC 3MM STD .035IN 150CM 3CM GLDWR JTP NTNL HDRPH BOTH IP/OP $72.50 $54.00 $14.39 $72.50 $39.37 $39.37 $39.37 $39.37 $72.50 $72.50 $72.50 $15.11 $72.50 $53.81 $53.81 $55.88 $37.77 $15.11 $72.50 $72.50 $42.88 $72.50 $72.50 $72.50 $72.50 $54.38 $72.50 $72.50 $72.50 $36.25 $36.25 $57.42 $72.50 $58.00 $47.13 $14.39 $72.50 $42.05 $72.50 $72.50 $72.50 $15.11 $72.50 N/A N/A 27205724 EAP HCPCS C1769 GUIDEWIRE VASC 3MM STD .038IN 150CM 3CM GLDWR JTP NTNL HDRPH BOTH IP/OP $72.50 $54.00 $14.39 $72.50 $39.37 $39.37 $39.37 $39.37 $72.50 $72.50 $72.50 $15.11 $72.50 $53.81 $53.81 $55.88 $37.77 $15.11 $72.50 $72.50 $42.88 $72.50 $72.50 $72.50 $72.50 $54.38 $72.50 $72.50 $72.50 $36.25 $36.25 $57.42 $72.50 $58.00 $47.13 $14.39 $72.50 $42.05 $72.50 $72.50 $72.50 $15.11 $72.50 N/A N/A 27205725 EAP HCPCS C1769 GUIDEWIRE VASC 45D .018IN 300CM 3CM GLDWR HDRPH BOTH IP/OP $427.50 $316.50 $84.85 $427.50 $232.13 $232.13 $232.13 $232.13 $427.50 $427.50 $427.50 $89.10 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $427.50 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $84.85 $427.50 $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A 27205726 EAP HCPCS C1769 GUIDEWIRE VASC 45D .018IN 300CM 5CM GLDWR HDRPH BOTH IP/OP $427.50 $316.50 $84.85 $427.50 $232.13 $232.13 $232.13 $232.13 $427.50 $427.50 $427.50 $89.10 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $427.50 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $84.85 $427.50 $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A 27205727 EAP HCPCS C1769 GUIDEWIRE VASC 45D STD .018IN 180CM 25CM GRIND FLXB BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $264.71 $264.71 $264.71 $264.71 $487.50 $487.50 $487.50 $101.61 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $487.50 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $96.76 $487.50 $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A 27205728 EAP HCPCS C1769 GUIDEWIRE VASC 70D .018IN 300CM 3CM GLDWR HDRPH BOTH IP/OP $427.50 $316.50 $84.85 $427.50 $232.13 $232.13 $232.13 $232.13 $427.50 $427.50 $427.50 $89.10 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $427.50 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $84.85 $427.50 $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A 27205729 EAP HCPCS C1769 GUIDEWIRE VASC 70D .018IN 300CM 5CM GLDWR HDRPH BOTH IP/OP $427.50 $316.50 $84.85 $427.50 $232.13 $232.13 $232.13 $232.13 $427.50 $427.50 $427.50 $89.10 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $427.50 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $84.85 $427.50 $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A 27205730 EAP HCPCS C1769 GUIDEWIRE VASC ANG .014IN 180CM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $271.50 $271.50 $271.50 $271.50 $500.00 $500.00 $500.00 $104.21 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $99.24 $500.00 $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 27205731 EAP HCPCS C1769 GUIDEWIRE VASC ANG .014IN 300CM BOTH IP/OP $562.50 $416.50 $111.64 $562.50 $305.44 $305.44 $305.44 $305.44 $562.50 $562.50 $562.50 $117.24 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $562.50 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $111.64 $562.50 $326.25 $562.50 $562.50 $562.50 $117.23 $562.50 N/A N/A 27205732 EAP HCPCS C1769 GUIDEWIRE VASC ANG .018IN 150CM 3CM GLDWR HDRPH BOTH IP/OP $134.38 $99.50 $26.67 $134.38 $72.97 $72.97 $72.97 $72.97 $134.38 $134.38 $134.38 $28.01 $134.38 $99.74 $99.74 $103.58 $70.01 $28.01 $134.38 $134.38 $79.49 $134.38 $134.38 $134.38 $134.38 $100.79 $134.38 $134.38 $134.38 $67.19 $67.19 $106.43 $134.38 $107.50 $87.35 $26.67 $134.38 $77.94 $134.38 $134.38 $134.38 $28.00 $134.38 N/A N/A 27205733 EAP HCPCS C1769 GUIDEWIRE VASC ANG .018IN 80CM 3CM GLDWR HDRPH BOTH IP/OP $134.38 $99.50 $26.67 $134.38 $72.97 $72.97 $72.97 $72.97 $134.38 $134.38 $134.38 $28.01 $134.38 $99.74 $99.74 $103.58 $70.01 $28.01 $134.38 $134.38 $79.49 $134.38 $134.38 $134.38 $134.38 $100.79 $134.38 $134.38 $134.38 $67.19 $67.19 $106.43 $134.38 $107.50 $87.35 $26.67 $134.38 $77.94 $134.38 $134.38 $134.38 $28.00 $134.38 N/A N/A 27205734 EAP HCPCS C1769 GUIDEWIRE VASC ANG .025IN 150CM 3CM GLDWR HDRPH BOTH IP/OP $101.13 $75.00 $20.07 $101.13 $54.91 $54.91 $54.91 $54.91 $101.13 $101.13 $101.13 $21.08 $101.13 $75.06 $75.06 $77.95 $52.69 $21.08 $101.13 $101.13 $59.82 $101.13 $101.13 $101.13 $101.13 $75.85 $101.13 $101.13 $101.13 $50.57 $50.57 $80.09 $101.13 $80.90 $65.73 $20.07 $101.13 $58.66 $101.13 $101.13 $101.13 $21.08 $101.13 N/A N/A 27205735 EAP HCPCS C1769 GUIDEWIRE VASC ANG .025IN 180CM 3CM GLDWR HDRPH BOTH IP/OP $134.38 $99.50 $26.67 $134.38 $72.97 $72.97 $72.97 $72.97 $134.38 $134.38 $134.38 $28.01 $134.38 $99.74 $99.74 $103.58 $70.01 $28.01 $134.38 $134.38 $79.49 $134.38 $134.38 $134.38 $134.38 $100.79 $134.38 $134.38 $134.38 $67.19 $67.19 $106.43 $134.38 $107.50 $87.35 $26.67 $134.38 $77.94 $134.38 $134.38 $134.38 $28.00 $134.38 N/A N/A 27205736 EAP HCPCS C1769 GUIDEWIRE VASC ANG .025IN 260CM 3CM GLDWR HDRPH BOTH IP/OP $144.00 $107.00 $28.58 $144.00 $78.19 $78.19 $78.19 $78.19 $144.00 $144.00 $144.00 $30.01 $144.00 $106.88 $106.88 $111.00 $75.02 $30.01 $144.00 $144.00 $85.18 $144.00 $144.00 $144.00 $144.00 $108.00 $144.00 $144.00 $144.00 $72.00 $72.00 $114.05 $144.00 $115.20 $93.60 $28.58 $144.00 $83.52 $144.00 $144.00 $144.00 $30.01 $144.00 N/A N/A 27205737 EAP HCPCS C1769 GUIDEWIRE VASC ANG .035IN 80CM 3CM GLDWR STF SHFT HDRPH BOTH IP/OP $112.88 $84.00 $22.40 $112.88 $61.29 $61.29 $61.29 $61.29 $112.88 $112.88 $112.88 $23.53 $112.88 $83.78 $83.78 $87.01 $58.81 $23.53 $112.88 $112.88 $66.77 $112.88 $112.88 $112.88 $112.88 $84.66 $112.88 $112.88 $112.88 $56.44 $56.44 $89.40 $112.88 $90.30 $73.37 $22.40 $112.88 $65.47 $112.88 $112.88 $112.88 $23.52 $112.88 N/A N/A 27205738 EAP HCPCS C1769 GUIDEWIRE VASC ANG .038IN 150CM 3CM GLDWR HDRPH BOTH IP/OP $72.50 $54.00 $14.39 $72.50 $39.37 $39.37 $39.37 $39.37 $72.50 $72.50 $72.50 $15.11 $72.50 $53.81 $53.81 $55.88 $37.77 $15.11 $72.50 $72.50 $42.88 $72.50 $72.50 $72.50 $72.50 $54.38 $72.50 $72.50 $72.50 $36.25 $36.25 $57.42 $72.50 $58.00 $47.13 $14.39 $72.50 $42.05 $72.50 $72.50 $72.50 $15.11 $72.50 N/A N/A 27205739 EAP HCPCS C1769 GUIDEWIRE VASC ANG .038IN 80CM 3CM GLDWR HDRPH BOTH IP/OP $72.50 $54.00 $14.39 $72.50 $39.37 $39.37 $39.37 $39.37 $72.50 $72.50 $72.50 $15.11 $72.50 $53.81 $53.81 $55.88 $37.77 $15.11 $72.50 $72.50 $42.88 $72.50 $72.50 $72.50 $72.50 $54.38 $72.50 $72.50 $72.50 $36.25 $36.25 $57.42 $72.50 $58.00 $47.13 $14.39 $72.50 $42.05 $72.50 $72.50 $72.50 $15.11 $72.50 N/A N/A 27205740 EAP HCPCS C1769 GUIDEWIRE VASC ANG .038IN 80CM 3CM GLDWR STF SHFT HDRPH BOTH IP/OP $112.88 $84.00 $22.40 $112.88 $61.29 $61.29 $61.29 $61.29 $112.88 $112.88 $112.88 $23.53 $112.88 $83.78 $83.78 $87.01 $58.81 $23.53 $112.88 $112.88 $66.77 $112.88 $112.88 $112.88 $112.88 $84.66 $112.88 $112.88 $112.88 $56.44 $56.44 $89.40 $112.88 $90.30 $73.37 $22.40 $112.88 $65.47 $112.88 $112.88 $112.88 $23.52 $112.88 N/A N/A 27205741 EAP HCPCS C1769 GUIDEWIRE VASC ANG LNG TPR .035IN 150CM 5CM GLDWR STF SHFT BOTH IP/OP $112.88 $84.00 $22.40 $112.88 $61.29 $61.29 $61.29 $61.29 $112.88 $112.88 $112.88 $23.53 $112.88 $83.78 $83.78 $87.01 $58.81 $23.53 $112.88 $112.88 $66.77 $112.88 $112.88 $112.88 $112.88 $84.66 $112.88 $112.88 $112.88 $56.44 $56.44 $89.40 $112.88 $90.30 $73.37 $22.40 $112.88 $65.47 $112.88 $112.88 $112.88 $23.52 $112.88 N/A N/A 27205742 EAP HCPCS C1769 GUIDEWIRE VASC ANG LNG TPR .035IN 260CM 5CM GLDWR STF SHFT BOTH IP/OP $124.63 $92.50 $24.74 $124.63 $67.67 $67.67 $67.67 $67.67 $124.63 $124.63 $124.63 $25.98 $124.63 $92.50 $92.50 $96.06 $64.93 $25.97 $124.63 $124.63 $73.72 $124.63 $124.63 $124.63 $124.63 $93.47 $124.63 $124.63 $124.63 $62.32 $62.32 $98.71 $124.63 $99.70 $81.01 $24.74 $124.63 $72.29 $124.63 $124.63 $124.63 $25.97 $124.63 N/A N/A 27205743 EAP HCPCS C1769 GUIDEWIRE VASC ANG LNG TPR .038IN 150CM 5CM GLDWR STF SHFT BOTH IP/OP $112.88 $84.00 $22.40 $112.88 $61.29 $61.29 $61.29 $61.29 $112.88 $112.88 $112.88 $23.53 $112.88 $83.78 $83.78 $87.01 $58.81 $23.53 $112.88 $112.88 $66.77 $112.88 $112.88 $112.88 $112.88 $84.66 $112.88 $112.88 $112.88 $56.44 $56.44 $89.40 $112.88 $90.30 $73.37 $22.40 $112.88 $65.47 $112.88 $112.88 $112.88 $23.52 $112.88 N/A N/A 27205744 EAP HCPCS C1769 GUIDEWIRE VASC ANG STD .035IN 120CM 3CM GLDWR JKT COR TO TIP BOTH IP/OP $72.50 $54.00 $14.39 $72.50 $39.37 $39.37 $39.37 $39.37 $72.50 $72.50 $72.50 $15.11 $72.50 $53.81 $53.81 $55.88 $37.77 $15.11 $72.50 $72.50 $42.88 $72.50 $72.50 $72.50 $72.50 $54.38 $72.50 $72.50 $72.50 $36.25 $36.25 $57.42 $72.50 $58.00 $47.13 $14.39 $72.50 $42.05 $72.50 $72.50 $72.50 $15.11 $72.50 N/A N/A 27205745 EAP HCPCS C1769 GUIDEWIRE VASC ANG STD .035IN 150CM 1CM GLDWR JKT COR TO TIP BOTH IP/OP $72.50 $54.00 $14.39 $72.50 $39.37 $39.37 $39.37 $39.37 $72.50 $72.50 $72.50 $15.11 $72.50 $53.81 $53.81 $55.88 $37.77 $15.11 $72.50 $72.50 $42.88 $72.50 $72.50 $72.50 $72.50 $54.38 $72.50 $72.50 $72.50 $36.25 $36.25 $57.42 $72.50 $58.00 $47.13 $14.39 $72.50 $42.05 $72.50 $72.50 $72.50 $15.11 $72.50 N/A N/A 27205746 EAP HCPCS C1769 GUIDEWIRE VASC ANG STD .035IN 180CM 1CM GLDWR JKT COR TO TIP BOTH IP/OP $99.25 $73.50 $19.70 $99.25 $53.89 $53.89 $53.89 $53.89 $99.25 $99.25 $99.25 $20.69 $99.25 $73.66 $73.66 $76.50 $51.71 $20.68 $99.25 $99.25 $58.71 $99.25 $99.25 $99.25 $99.25 $74.44 $99.25 $99.25 $99.25 $49.63 $49.63 $78.61 $99.25 $79.40 $64.51 $19.70 $99.25 $57.57 $99.25 $99.25 $99.25 $20.68 $99.25 N/A N/A 27205747 EAP HCPCS C1769 GUIDEWIRE VASC ANG STD .035IN 260CM 1CM GLDWR JKT COR TO TIP BOTH IP/OP $111.00 $82.50 $22.03 $111.00 $60.27 $60.27 $60.27 $60.27 $111.00 $111.00 $111.00 $23.14 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $111.00 $65.66 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $22.03 $111.00 $64.38 $111.00 $111.00 $111.00 $23.13 $111.00 N/A N/A 27205748 EAP HCPCS C1769 GUIDEWIRE VASC ANG TPR .035IN 150CM 1CM GLDWR HDRPH BOTH IP/OP $112.88 $84.00 $22.40 $112.88 $61.29 $61.29 $61.29 $61.29 $112.88 $112.88 $112.88 $23.53 $112.88 $83.78 $83.78 $87.01 $58.81 $23.53 $112.88 $112.88 $66.77 $112.88 $112.88 $112.88 $112.88 $84.66 $112.88 $112.88 $112.88 $56.44 $56.44 $89.40 $112.88 $90.30 $73.37 $22.40 $112.88 $65.47 $112.88 $112.88 $112.88 $23.52 $112.88 N/A N/A 27205749 EAP HCPCS C1769 GUIDEWIRE VASC BOLIA CRV STD .035IN 180CM 5CM GLDWR JKT COR BOTH IP/OP $101.13 $75.00 $20.07 $101.13 $54.91 $54.91 $54.91 $54.91 $101.13 $101.13 $101.13 $21.08 $101.13 $75.06 $75.06 $77.95 $52.69 $21.08 $101.13 $101.13 $59.82 $101.13 $101.13 $101.13 $101.13 $75.85 $101.13 $101.13 $101.13 $50.57 $50.57 $80.09 $101.13 $80.90 $65.73 $20.07 $101.13 $58.66 $101.13 $101.13 $101.13 $21.08 $101.13 N/A N/A 27205750 EAP HCPCS C1769 GUIDEWIRE VASC BOLIA CRV STD .035IN 180CM 8CM GLDWR JKT COR BOTH IP/OP $101.13 $75.00 $20.07 $101.13 $54.91 $54.91 $54.91 $54.91 $101.13 $101.13 $101.13 $21.08 $101.13 $75.06 $75.06 $77.95 $52.69 $21.08 $101.13 $101.13 $59.82 $101.13 $101.13 $101.13 $101.13 $75.85 $101.13 $101.13 $101.13 $50.57 $50.57 $80.09 $101.13 $80.90 $65.73 $20.07 $101.13 $58.66 $101.13 $101.13 $101.13 $21.08 $101.13 N/A N/A 27205751 EAP HCPCS C1769 GUIDEWIRE VASC STD ANG .018IN 180CM 3CM GLDWR TRMO GLD TCH BOTH IP/OP $134.38 $99.50 $26.67 $134.38 $72.97 $72.97 $72.97 $72.97 $134.38 $134.38 $134.38 $28.01 $134.38 $99.74 $99.74 $103.58 $70.01 $28.01 $134.38 $134.38 $79.49 $134.38 $134.38 $134.38 $134.38 $100.79 $134.38 $134.38 $134.38 $67.19 $67.19 $106.43 $134.38 $107.50 $87.35 $26.67 $134.38 $77.94 $134.38 $134.38 $134.38 $28.00 $134.38 N/A N/A 27205752 EAP HCPCS C1769 GUIDEWIRE VASC STD STRG .035IN 150CM 1CM GLDWR JKT COR TO BOTH IP/OP $72.50 $54.00 $14.39 $72.50 $39.37 $39.37 $39.37 $39.37 $72.50 $72.50 $72.50 $15.11 $72.50 $53.81 $53.81 $55.88 $37.77 $15.11 $72.50 $72.50 $42.88 $72.50 $72.50 $72.50 $72.50 $54.38 $72.50 $72.50 $72.50 $36.25 $36.25 $57.42 $72.50 $58.00 $47.13 $14.39 $72.50 $42.05 $72.50 $72.50 $72.50 $15.11 $72.50 N/A N/A 27205753 EAP HCPCS C1769 GUIDEWIRE VASC STD STRG .035IN 180CM 1CM GLDWR JKT COR TO BOTH IP/OP $99.25 $73.50 $19.70 $99.25 $53.89 $53.89 $53.89 $53.89 $99.25 $99.25 $99.25 $20.69 $99.25 $73.66 $73.66 $76.50 $51.71 $20.68 $99.25 $99.25 $58.71 $99.25 $99.25 $99.25 $99.25 $74.44 $99.25 $99.25 $99.25 $49.63 $49.63 $78.61 $99.25 $79.40 $64.51 $19.70 $99.25 $57.57 $99.25 $99.25 $99.25 $20.68 $99.25 N/A N/A 27205754 EAP HCPCS C1769 GUIDEWIRE VASC STD STRG .035IN 260CM 1CM GLDWR JKT COR TO BOTH IP/OP $111.00 $82.50 $22.03 $111.00 $60.27 $60.27 $60.27 $60.27 $111.00 $111.00 $111.00 $23.14 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $111.00 $65.66 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $22.03 $111.00 $64.38 $111.00 $111.00 $111.00 $23.13 $111.00 N/A N/A 27205755 EAP HCPCS C1769 GUIDEWIRE VASC STRG .018IN 150CM 3CM GLDWR HDRPH BOTH IP/OP $134.38 $99.50 $26.67 $134.38 $72.97 $72.97 $72.97 $72.97 $134.38 $134.38 $134.38 $28.01 $134.38 $99.74 $99.74 $103.58 $70.01 $28.01 $134.38 $134.38 $79.49 $134.38 $134.38 $134.38 $134.38 $100.79 $134.38 $134.38 $134.38 $67.19 $67.19 $106.43 $134.38 $107.50 $87.35 $26.67 $134.38 $77.94 $134.38 $134.38 $134.38 $28.00 $134.38 N/A N/A 27205756 EAP HCPCS C1769 GUIDEWIRE VASC STRG .018IN 150CM 3CM GLDWR SHP TIP HDRPH BOTH IP/OP $137.38 $102.00 $27.27 $137.38 $74.60 $74.60 $74.60 $74.60 $137.38 $137.38 $137.38 $28.63 $137.38 $101.96 $101.96 $105.89 $71.57 $28.63 $137.38 $137.38 $81.26 $137.38 $137.38 $137.38 $137.38 $103.04 $137.38 $137.38 $137.38 $68.69 $68.69 $108.80 $137.38 $109.90 $89.30 $27.27 $137.38 $79.68 $137.38 $137.38 $137.38 $28.63 $137.38 N/A N/A 27205757 EAP HCPCS C1769 GUIDEWIRE VASC STRG .018IN 180CM 3CM GLDWR HDRPH BOTH IP/OP $134.38 $99.50 $26.67 $134.38 $72.97 $72.97 $72.97 $72.97 $134.38 $134.38 $134.38 $28.01 $134.38 $99.74 $99.74 $103.58 $70.01 $28.01 $134.38 $134.38 $79.49 $134.38 $134.38 $134.38 $134.38 $100.79 $134.38 $134.38 $134.38 $67.19 $67.19 $106.43 $134.38 $107.50 $87.35 $26.67 $134.38 $77.94 $134.38 $134.38 $134.38 $28.00 $134.38 N/A N/A 27205758 EAP HCPCS C1769 GUIDEWIRE VASC STRG .018IN 260CM 3CM GLDWR HDRPH BOTH IP/OP $185.00 $137.00 $36.72 $185.00 $100.46 $100.46 $100.46 $100.46 $185.00 $185.00 $185.00 $38.56 $185.00 $137.31 $137.31 $142.60 $96.39 $38.56 $185.00 $185.00 $109.43 $185.00 $185.00 $185.00 $185.00 $138.75 $185.00 $185.00 $185.00 $92.50 $92.50 $146.52 $185.00 $148.00 $120.25 $36.72 $185.00 $107.30 $185.00 $185.00 $185.00 $38.55 $185.00 N/A N/A 27205759 EAP HCPCS C1769 GUIDEWIRE VASC STRG .025IN 150CM 3CM GLDWR HDRPH BOTH IP/OP $101.13 $75.00 $20.07 $101.13 $54.91 $54.91 $54.91 $54.91 $101.13 $101.13 $101.13 $21.08 $101.13 $75.06 $75.06 $77.95 $52.69 $21.08 $101.13 $101.13 $59.82 $101.13 $101.13 $101.13 $101.13 $75.85 $101.13 $101.13 $101.13 $50.57 $50.57 $80.09 $101.13 $80.90 $65.73 $20.07 $101.13 $58.66 $101.13 $101.13 $101.13 $21.08 $101.13 N/A N/A 27205760 EAP HCPCS C1769 GUIDEWIRE VASC STRG .025IN 180CM 3CM GLDWR HDRPH BOTH IP/OP $134.38 $99.50 $26.67 $134.38 $72.97 $72.97 $72.97 $72.97 $134.38 $134.38 $134.38 $28.01 $134.38 $99.74 $99.74 $103.58 $70.01 $28.01 $134.38 $134.38 $79.49 $134.38 $134.38 $134.38 $134.38 $100.79 $134.38 $134.38 $134.38 $67.19 $67.19 $106.43 $134.38 $107.50 $87.35 $26.67 $134.38 $77.94 $134.38 $134.38 $134.38 $28.00 $134.38 N/A N/A 27205761 EAP HCPCS C1769 GUIDEWIRE VASC STRG .025IN 260CM 3CM GLDWR HDRPH BOTH IP/OP $144.00 $107.00 $28.58 $144.00 $78.19 $78.19 $78.19 $78.19 $144.00 $144.00 $144.00 $30.01 $144.00 $106.88 $106.88 $111.00 $75.02 $30.01 $144.00 $144.00 $85.18 $144.00 $144.00 $144.00 $144.00 $108.00 $144.00 $144.00 $144.00 $72.00 $72.00 $114.05 $144.00 $115.20 $93.60 $28.58 $144.00 $83.52 $144.00 $144.00 $144.00 $30.01 $144.00 N/A N/A 27205762 EAP HCPCS C1769 GUIDEWIRE VASC STRG .032IN 150CM 3CM GLDWR HDRPH BOTH IP/OP $74.00 $55.00 $14.69 $74.00 $40.18 $40.18 $40.18 $40.18 $74.00 $74.00 $74.00 $15.42 $74.00 $54.92 $54.92 $57.04 $38.55 $15.42 $74.00 $74.00 $43.77 $74.00 $74.00 $74.00 $74.00 $55.50 $74.00 $74.00 $74.00 $37.00 $37.00 $58.61 $74.00 $59.20 $48.10 $14.69 $74.00 $42.92 $74.00 $74.00 $74.00 $15.42 $74.00 N/A N/A 27205763 EAP HCPCS C1769 GUIDEWIRE VASC STRG .035IN 150CM 3CM GLDWR SHP TIP HDRPH BOTH IP/OP $79.75 $59.50 $15.83 $79.75 $43.30 $43.30 $43.30 $43.30 $79.75 $79.75 $79.75 $16.62 $79.75 $59.19 $59.19 $61.47 $41.55 $16.62 $79.75 $79.75 $47.17 $79.75 $79.75 $79.75 $79.75 $59.81 $79.75 $79.75 $79.75 $39.88 $39.88 $63.16 $79.75 $63.80 $51.84 $15.83 $79.75 $46.26 $79.75 $79.75 $79.75 $16.62 $79.75 N/A N/A 27205764 EAP HCPCS C1769 GUIDEWIRE VASC STRG .035IN 180CM 3CM GLDWR SHP TIP HDRPH BOTH IP/OP $107.00 $79.50 $21.24 $107.00 $58.10 $58.10 $58.10 $58.10 $107.00 $107.00 $107.00 $22.30 $107.00 $79.42 $79.42 $82.48 $55.75 $22.30 $107.00 $107.00 $63.29 $107.00 $107.00 $107.00 $107.00 $80.25 $107.00 $107.00 $107.00 $53.50 $53.50 $84.74 $107.00 $85.60 $69.55 $21.24 $107.00 $62.06 $107.00 $107.00 $107.00 $22.30 $107.00 N/A N/A 27205765 EAP HCPCS C1769 GUIDEWIRE VASC STRG .038IN 150CM 3CM GLDWR HDRPH BOTH IP/OP $72.50 $54.00 $14.39 $72.50 $39.37 $39.37 $39.37 $39.37 $72.50 $72.50 $72.50 $15.11 $72.50 $53.81 $53.81 $55.88 $37.77 $15.11 $72.50 $72.50 $42.88 $72.50 $72.50 $72.50 $72.50 $54.38 $72.50 $72.50 $72.50 $36.25 $36.25 $57.42 $72.50 $58.00 $47.13 $14.39 $72.50 $42.05 $72.50 $72.50 $72.50 $15.11 $72.50 N/A N/A 27205766 EAP HCPCS C1769 GUIDEWIRE VASC STRG .038IN 150CM 3CM GLDWR SHP TIP HDRPH BOTH IP/OP $79.75 $59.50 $15.83 $79.75 $43.30 $43.30 $43.30 $43.30 $79.75 $79.75 $79.75 $16.62 $79.75 $59.19 $59.19 $61.47 $41.55 $16.62 $79.75 $79.75 $47.17 $79.75 $79.75 $79.75 $79.75 $59.81 $79.75 $79.75 $79.75 $39.88 $39.88 $63.16 $79.75 $63.80 $51.84 $15.83 $79.75 $46.26 $79.75 $79.75 $79.75 $16.62 $79.75 N/A N/A 27205767 EAP HCPCS C1769 GUIDEWIRE VASC STRG .038IN 150CM 3CM GLDWR STF SHFT HDRPH BOTH IP/OP $112.88 $84.00 $22.40 $112.88 $61.29 $61.29 $61.29 $61.29 $112.88 $112.88 $112.88 $23.53 $112.88 $83.78 $83.78 $87.01 $58.81 $23.53 $112.88 $112.88 $66.77 $112.88 $112.88 $112.88 $112.88 $84.66 $112.88 $112.88 $112.88 $56.44 $56.44 $89.40 $112.88 $90.30 $73.37 $22.40 $112.88 $65.47 $112.88 $112.88 $112.88 $23.52 $112.88 N/A N/A 27205768 EAP HCPCS C1769 GUIDEWIRE VASC STRG .038IN 180CM 3CM GLDWR HDRPH BOTH IP/OP $99.25 $73.50 $19.70 $99.25 $53.89 $53.89 $53.89 $53.89 $99.25 $99.25 $99.25 $20.69 $99.25 $73.66 $73.66 $76.50 $51.71 $20.68 $99.25 $99.25 $58.71 $99.25 $99.25 $99.25 $99.25 $74.44 $99.25 $99.25 $99.25 $49.63 $49.63 $78.61 $99.25 $79.40 $64.51 $19.70 $99.25 $57.57 $99.25 $99.25 $99.25 $20.68 $99.25 N/A N/A 27205769 EAP HCPCS C1769 GUIDEWIRE VASC STRG .038IN 180CM 3CM GLDWR STF SHFT HDRPH BOTH IP/OP $116.75 $86.50 $23.17 $116.75 $63.40 $63.40 $63.40 $63.40 $116.75 $116.75 $116.75 $24.33 $116.75 $86.65 $86.65 $89.99 $60.83 $24.33 $116.75 $116.75 $69.06 $116.75 $116.75 $116.75 $116.75 $87.56 $116.75 $116.75 $116.75 $58.38 $58.38 $92.47 $116.75 $93.40 $75.89 $23.17 $116.75 $67.72 $116.75 $116.75 $116.75 $24.33 $116.75 N/A N/A 27205770 EAP HCPCS C1769 GUIDEWIRE VASC STRG .038IN 260CM 3CM GLDWR HDRPH BOTH IP/OP $111.00 $82.50 $22.03 $111.00 $60.27 $60.27 $60.27 $60.27 $111.00 $111.00 $111.00 $23.14 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $111.00 $65.66 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $22.03 $111.00 $64.38 $111.00 $111.00 $111.00 $23.13 $111.00 N/A N/A 27205771 EAP HCPCS C1769 GUIDEWIRE VASC STRG LNG TPR .035IN 150CM 5CM GLDWR STF SHFT BOTH IP/OP $112.88 $84.00 $22.40 $112.88 $61.29 $61.29 $61.29 $61.29 $112.88 $112.88 $112.88 $23.53 $112.88 $83.78 $83.78 $87.01 $58.81 $23.53 $112.88 $112.88 $66.77 $112.88 $112.88 $112.88 $112.88 $84.66 $112.88 $112.88 $112.88 $56.44 $56.44 $89.40 $112.88 $90.30 $73.37 $22.40 $112.88 $65.47 $112.88 $112.88 $112.88 $23.52 $112.88 N/A N/A 27205772 EAP HCPCS C1769 GUIDEWIRE VASC STRG LNG TPR .035IN 150CM 8CM GLDWR JKT COR BOTH IP/OP $81.75 $60.50 $16.23 $81.75 $44.39 $44.39 $44.39 $44.39 $81.75 $81.75 $81.75 $17.04 $81.75 $60.67 $60.67 $63.01 $42.59 $17.04 $81.75 $81.75 $48.36 $81.75 $81.75 $81.75 $81.75 $61.31 $81.75 $81.75 $81.75 $40.88 $40.88 $64.75 $81.75 $65.40 $53.14 $16.23 $81.75 $47.42 $81.75 $81.75 $81.75 $17.04 $81.75 N/A N/A 27205773 EAP HCPCS C1769 GUIDEWIRE VASC STRG LNG TPR .038IN 150CM 5CM GLDWR STF SHFT BOTH IP/OP $112.88 $84.00 $22.40 $112.88 $61.29 $61.29 $61.29 $61.29 $112.88 $112.88 $112.88 $23.53 $112.88 $83.78 $83.78 $87.01 $58.81 $23.53 $112.88 $112.88 $66.77 $112.88 $112.88 $112.88 $112.88 $84.66 $112.88 $112.88 $112.88 $56.44 $56.44 $89.40 $112.88 $90.30 $73.37 $22.40 $112.88 $65.47 $112.88 $112.88 $112.88 $23.52 $112.88 N/A N/A 27205774 EAP HCPCS C1769 GUIDEWIRE VASC STRG TPR .038IN 150CM 8CM GLDWR HDRPH BOTH IP/OP $81.75 $60.50 $16.23 $81.75 $44.39 $44.39 $44.39 $44.39 $81.75 $81.75 $81.75 $17.04 $81.75 $60.67 $60.67 $63.01 $42.59 $17.04 $81.75 $81.75 $48.36 $81.75 $81.75 $81.75 $81.75 $61.31 $81.75 $81.75 $81.75 $40.88 $40.88 $64.75 $81.75 $65.40 $53.14 $16.23 $81.75 $47.42 $81.75 $49.05 $81.75 $17.04 $81.75 N/A N/A 27205775 EAP HCPCS C1894 INTRODUCER CATH 17FR 5.3FR 14FR 25CM SOLOPATH BLN EXPANDABLE BOTH IP/OP "$1,325.00" $980.50 $262.98 "$1,325.00" $719.48 $719.48 $719.48 $719.48 "$1,325.00" "$1,325.00" "$1,325.00" $276.16 "$1,325.00" $983.42 $983.42 "$1,021.31" $690.33 $276.14 "$1,325.00" "$1,325.00" $783.74 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $861.25 $262.98 "$1,325.00" $768.50 "$1,325.00" "$1,325.00" "$1,325.00" $276.13 "$1,325.00" N/A N/A 27205776 EAP HCPCS C1894 INTRODUCER CATH 21FR 13FR 18FR 25CM STRL 20CM SOLOPATH BOTH IP/OP "$1,325.00" $980.50 $262.98 "$1,325.00" $719.48 $719.48 $719.48 $719.48 "$1,325.00" "$1,325.00" "$1,325.00" $276.16 "$1,325.00" $983.42 $983.42 "$1,021.31" $690.33 $276.14 "$1,325.00" "$1,325.00" $783.74 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $861.25 $262.98 "$1,325.00" $768.50 "$1,325.00" "$1,325.00" "$1,325.00" $276.13 "$1,325.00" N/A N/A 27205777 EAP HCPCS C1894 INTRODUCER CATH 21FR 5.3FR 18FR 35CM STRL 30CM SOLOPATH BLN BOTH IP/OP "$1,325.00" $980.50 $262.98 "$1,325.00" $719.48 $719.48 $719.48 $719.48 "$1,325.00" "$1,325.00" "$1,325.00" $276.16 "$1,325.00" $983.42 $983.42 "$1,021.31" $690.33 $276.14 "$1,325.00" "$1,325.00" $783.74 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $861.25 $262.98 "$1,325.00" $768.50 "$1,325.00" "$1,325.00" "$1,325.00" $276.13 "$1,325.00" N/A N/A 27205778 EAP HCPCS C1894 INTRODUCER CATH 22FR 14FR 19FR 35CM STRL 30CM SOLOPATH BOTH IP/OP "$1,325.00" $980.50 $262.98 "$1,325.00" $719.48 $719.48 $719.48 $719.48 "$1,325.00" "$1,325.00" "$1,325.00" $276.16 "$1,325.00" $983.42 $983.42 "$1,021.31" $690.33 $276.14 "$1,325.00" "$1,325.00" $783.74 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $861.25 $262.98 "$1,325.00" $768.50 "$1,325.00" "$1,325.00" "$1,325.00" $276.13 "$1,325.00" N/A N/A 27205779 EAP HCPCS C1894 INTRODUCER CATH 22FR 5.3FR 19FR 25CM 20CM SOLOPATH BLN BOTH IP/OP "$1,325.00" $980.50 $262.98 "$1,325.00" $719.48 $719.48 $719.48 $719.48 "$1,325.00" "$1,325.00" "$1,325.00" $276.16 "$1,325.00" $983.42 $983.42 "$1,021.31" $690.33 $276.14 "$1,325.00" "$1,325.00" $783.74 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $861.25 $262.98 "$1,325.00" $768.50 "$1,325.00" "$1,325.00" "$1,325.00" $276.13 "$1,325.00" N/A N/A 27205780 EAP HCPCS C1894 INTRODUCER CATH 23FR 5.3FR 20FR 35CM STRL 25CM SOLOPATH BLN BOTH IP/OP "$1,325.00" $980.50 $262.98 "$1,325.00" $719.48 $719.48 $719.48 $719.48 "$1,325.00" "$1,325.00" "$1,325.00" $276.16 "$1,325.00" $983.42 $983.42 "$1,021.31" $690.33 $276.14 "$1,325.00" "$1,325.00" $783.74 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $861.25 $262.98 "$1,325.00" $768.50 "$1,325.00" "$1,325.00" "$1,325.00" $276.13 "$1,325.00" N/A N/A 27205781 EAP HCPCS C1894 INTRODUCER CATH 24FR 14FR 21FR 35CM STRL 30CM SOLOPATH BOTH IP/OP "$1,325.00" $980.50 $262.98 "$1,325.00" $719.48 $719.48 $719.48 $719.48 "$1,325.00" "$1,325.00" "$1,325.00" $276.16 "$1,325.00" $983.42 $983.42 "$1,021.31" $690.33 $276.14 "$1,325.00" "$1,325.00" $783.74 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $861.25 $262.98 "$1,325.00" $768.50 "$1,325.00" "$1,325.00" "$1,325.00" $276.13 "$1,325.00" N/A N/A 27205782 EAP HCPCS C1894 INTRODUCER CATH 24FR 5.3FR 21FR 25CM 20CM SOLOPATH BLN BOTH IP/OP "$1,325.00" $980.50 $262.98 "$1,325.00" $719.48 $719.48 $719.48 $719.48 "$1,325.00" "$1,325.00" "$1,325.00" $276.16 "$1,325.00" $983.42 $983.42 "$1,021.31" $690.33 $276.14 "$1,325.00" "$1,325.00" $783.74 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $861.25 $262.98 "$1,325.00" $768.50 "$1,325.00" "$1,325.00" "$1,325.00" $276.13 "$1,325.00" N/A N/A 27205783 EAP HCPCS C1894 INTRODUCER CATH LOPRFL 11.5-17FR 5.3FR 14FR 35CM 30CM BOTH IP/OP "$1,325.00" $980.50 $262.98 "$1,325.00" $719.48 $719.48 $719.48 $719.48 "$1,325.00" "$1,325.00" "$1,325.00" $276.16 "$1,325.00" $983.42 $983.42 "$1,021.31" $690.33 $276.14 "$1,325.00" "$1,325.00" $783.74 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $861.25 $262.98 "$1,325.00" $768.50 "$1,325.00" "$1,325.00" "$1,325.00" $276.13 "$1,325.00" N/A N/A 27205784 EAP HCPCS C1894 INTRODUCER CATH LOPRFL 15-19FR 5.3FR 16FR 25CM 20CM SOLOPATH BOTH IP/OP "$1,325.00" $980.50 $262.98 "$1,325.00" $719.48 $719.48 $719.48 $719.48 "$1,325.00" "$1,325.00" "$1,325.00" $276.16 "$1,325.00" $983.42 $983.42 "$1,021.31" $690.33 $276.14 "$1,325.00" "$1,325.00" $783.74 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $861.25 $262.98 "$1,325.00" $768.50 "$1,325.00" "$1,325.00" "$1,325.00" $276.13 "$1,325.00" N/A N/A 27205785 EAP HCPCS C1894 INTRODUCER CATH LOPRFL 15-19FR 5.3FR 16FR 35CM 30CM SOLOPATH BOTH IP/OP "$1,325.00" $980.50 $262.98 "$1,325.00" $719.48 $719.48 $719.48 $719.48 "$1,325.00" "$1,325.00" "$1,325.00" $276.16 "$1,325.00" $983.42 $983.42 "$1,021.31" $690.33 $276.14 "$1,325.00" "$1,325.00" $783.74 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $861.25 $262.98 "$1,325.00" $768.50 "$1,325.00" "$1,325.00" "$1,325.00" $276.13 "$1,325.00" N/A N/A 27205786 EAP HCPCS C1894 INTRODUCER CATH LOPRFL 15-23FR 5.3FR 20FR 25CM 20CM SOLOPATH BOTH IP/OP "$1,325.00" $980.50 $262.98 "$1,325.00" $719.48 $719.48 $719.48 $719.48 "$1,325.00" "$1,325.00" "$1,325.00" $276.16 "$1,325.00" $983.42 $983.42 "$1,021.31" $690.33 $276.14 "$1,325.00" "$1,325.00" $783.74 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $861.25 $262.98 "$1,325.00" $768.50 "$1,325.00" "$1,325.00" "$1,325.00" $276.13 "$1,325.00" N/A N/A 27205787 EAP HCPCS C1894 INTRODUCER SHTH .035IN 4FR 10CM 2.5CM PN RO2 GW DIL RADOPQ BOTH IP/OP $57.50 $43.00 $11.41 $57.50 $31.22 $31.22 $31.22 $31.22 $57.50 $57.50 $57.50 $11.98 $57.50 $42.68 $42.68 $44.32 $29.96 $11.98 $57.50 $57.50 $34.01 $57.50 $57.50 $57.50 $57.50 $43.13 $57.50 $57.50 $57.50 $28.75 $28.75 $45.54 $57.50 $46.00 $37.38 $11.41 $57.50 $33.35 $57.50 $57.50 $57.50 $11.98 $57.50 N/A N/A 27205788 EAP HCPCS C1894 INTRODUCER SHTH .035IN 4FR 6CM 2.5CM PNCL R/O II GW DIL BOTH IP/OP $52.50 $39.00 $10.42 $52.50 $28.51 $28.51 $28.51 $28.51 $52.50 $52.50 $52.50 $10.94 $52.50 $38.97 $38.97 $40.47 $27.35 $10.94 $52.50 $52.50 $31.05 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $34.13 $10.42 $52.50 $30.45 $52.50 $52.50 $52.50 $10.94 $52.50 N/A N/A 27205789 EAP HCPCS C1894 INTRODUCER SHTH .035IN SHRT 7FR 4CM 40CM PNCL R/O II HIFLO BOTH IP/OP $60.00 $44.50 $11.91 $60.00 $32.58 $32.58 $32.58 $32.58 $60.00 $60.00 $60.00 $12.51 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $60.00 $35.49 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $11.91 $60.00 $34.80 $60.00 $60.00 $60.00 $12.50 $60.00 N/A N/A 27205790 EAP HCPCS C1894 INTRODUCER SHTH .035IN SHRT 8FR 4CM 2.5CM PNCL R/O II HIFLO BOTH IP/OP $60.00 $44.50 $11.91 $60.00 $32.58 $32.58 $32.58 $32.58 $60.00 $60.00 $60.00 $12.51 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $60.00 $35.49 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $11.91 $60.00 $34.80 $60.00 $60.00 $60.00 $12.50 $60.00 N/A N/A 27205791 EAP HCPCS C1894 INTRODUCER SHTH .038IN 5FR 10CM 2.5CM PN RO2 GW DIL RADOPQ BOTH IP/OP $57.50 $43.00 $11.41 $57.50 $31.22 $31.22 $31.22 $31.22 $57.50 $57.50 $57.50 $11.98 $57.50 $42.68 $42.68 $44.32 $29.96 $11.98 $57.50 $57.50 $34.01 $57.50 $57.50 $57.50 $57.50 $43.13 $57.50 $57.50 $57.50 $28.75 $28.75 $45.54 $57.50 $46.00 $37.38 $11.41 $57.50 $33.35 $57.50 $57.50 $57.50 $11.98 $57.50 N/A N/A 27205792 EAP HCPCS C1894 INTRODUCER SHTH .038IN 5FR 6CM 2.5CM PN RO2 GW DIL RADOPQ BOTH IP/OP $52.50 $39.00 $10.42 $52.50 $28.51 $28.51 $28.51 $28.51 $52.50 $52.50 $52.50 $10.94 $52.50 $38.97 $38.97 $40.47 $27.35 $10.94 $52.50 $52.50 $31.05 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $34.13 $10.42 $52.50 $30.45 $52.50 $52.50 $52.50 $10.94 $52.50 N/A N/A 27205793 EAP HCPCS C1894 INTRODUCER SHTH .038IN 6FR 10CM 2.5CM PN RO2 GW DIL RADOPQ BOTH IP/OP $57.50 $43.00 $11.41 $57.50 $31.22 $31.22 $31.22 $31.22 $57.50 $57.50 $57.50 $11.98 $57.50 $42.68 $42.68 $44.32 $29.96 $11.98 $57.50 $57.50 $34.01 $57.50 $57.50 $57.50 $57.50 $43.13 $57.50 $57.50 $57.50 $28.75 $28.75 $45.54 $57.50 $46.00 $37.38 $11.41 $57.50 $33.35 $57.50 $57.50 $57.50 $11.98 $57.50 N/A N/A 27205794 EAP HCPCS C1894 INTRODUCER SHTH .038IN 6FR 4CM PNCL R/O II HIFLO DIL RADOPQ BOTH IP/OP $58.13 $43.50 $11.54 $58.13 $31.56 $31.56 $31.56 $31.56 $58.13 $58.13 $58.13 $12.12 $58.13 $43.14 $43.14 $44.81 $30.29 $12.11 $58.13 $58.13 $34.38 $58.13 $58.13 $58.13 $58.13 $43.60 $58.13 $58.13 $58.13 $29.07 $29.07 $46.04 $58.13 $46.50 $37.78 $11.54 $58.13 $33.72 $58.13 $58.13 $58.13 $12.11 $58.13 N/A N/A 27205795 EAP HCPCS C1894 INTRODUCER SHTH .038IN 6FR 6CM 2.5CM PN RO2 GW DIL RADOPQ BOTH IP/OP $52.50 $39.00 $10.42 $52.50 $28.51 $28.51 $28.51 $28.51 $52.50 $52.50 $52.50 $10.94 $52.50 $38.97 $38.97 $40.47 $27.35 $10.94 $52.50 $52.50 $31.05 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $34.13 $10.42 $52.50 $30.45 $52.50 $52.50 $52.50 $10.94 $52.50 N/A N/A 27205796 EAP HCPCS C1894 INTRODUCER SHTH .038IN 7FR 10CM 2.5CM PN RO2 GW DIL RADOPQ BOTH IP/OP $57.50 $43.00 $11.41 $57.50 $31.22 $31.22 $31.22 $31.22 $57.50 $57.50 $57.50 $11.98 $57.50 $42.68 $42.68 $44.32 $29.96 $11.98 $57.50 $57.50 $34.01 $57.50 $57.50 $57.50 $57.50 $43.13 $57.50 $57.50 $57.50 $28.75 $28.75 $45.54 $57.50 $46.00 $37.38 $11.41 $57.50 $33.35 $57.50 $57.50 $57.50 $11.98 $57.50 N/A N/A 27205797 EAP HCPCS C1894 INTRODUCER SHTH .038IN 7FR 6CM 2.5CM PN RO2 GW DIL RADOPQ BOTH IP/OP $52.50 $39.00 $10.42 $52.50 $28.51 $28.51 $28.51 $28.51 $52.50 $52.50 $52.50 $10.94 $52.50 $38.97 $38.97 $40.47 $27.35 $10.94 $52.50 $52.50 $31.05 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $34.13 $10.42 $52.50 $30.45 $52.50 $52.50 $52.50 $10.94 $52.50 N/A N/A 27205798 EAP HCPCS C1894 INTRODUCER SHTH .038IN 8FR 10CM 2.5CM PN RO2 GW DIL RADOPQ BOTH IP/OP $57.50 $43.00 $11.41 $57.50 $31.22 $31.22 $31.22 $31.22 $57.50 $57.50 $57.50 $11.98 $57.50 $42.68 $42.68 $44.32 $29.96 $11.98 $57.50 $57.50 $34.01 $57.50 $57.50 $57.50 $57.50 $43.13 $57.50 $57.50 $57.50 $28.75 $28.75 $45.54 $57.50 $46.00 $37.38 $11.41 $57.50 $33.35 $57.50 $57.50 $57.50 $11.98 $57.50 N/A N/A 27205799 EAP HCPCS C1894 INTRODUCER SHTH .038IN 8FR 6CM 2.5CM PNCL R/O II GW DIL BOTH IP/OP $52.50 $39.00 $10.42 $52.50 $28.51 $28.51 $28.51 $28.51 $52.50 $52.50 $52.50 $10.94 $52.50 $38.97 $38.97 $40.47 $27.35 $10.94 $52.50 $52.50 $31.05 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $34.13 $10.42 $52.50 $30.45 $52.50 $52.50 $52.50 $10.94 $52.50 N/A N/A 27205800 EAP HCPCS C1894 INTRODUCER SHTH .038IN 9FR 10CM 2.5CM PN RO2 GW DIL RADOPQ BOTH IP/OP $57.50 $43.00 $11.41 $57.50 $31.22 $31.22 $31.22 $31.22 $57.50 $57.50 $57.50 $11.98 $57.50 $42.68 $42.68 $44.32 $29.96 $11.98 $57.50 $57.50 $34.01 $57.50 $57.50 $57.50 $57.50 $43.13 $57.50 $57.50 $57.50 $28.75 $28.75 $45.54 $57.50 $46.00 $37.38 $11.41 $57.50 $33.35 $57.50 $57.50 $57.50 $11.98 $57.50 N/A N/A 27205801 EAP HCPCS C1894 INTRODUCER SHTH .038IN 9FR 6CM 2.5CM PNCL R/O II GW DIL BOTH IP/OP $52.50 $39.00 $10.42 $52.50 $28.51 $28.51 $28.51 $28.51 $52.50 $52.50 $52.50 $10.94 $52.50 $38.97 $38.97 $40.47 $27.35 $10.94 $52.50 $52.50 $31.05 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $34.13 $10.42 $52.50 $30.45 $52.50 $52.50 $52.50 $10.94 $52.50 N/A N/A 27205802 EAP HCPCS C1894 INTRODUCER SHTH 11FR 25CM 2.5CM PNCL DIL KINK RST HDRPH PTFE BOTH IP/OP $49.88 $37.00 $9.90 $49.88 $27.08 $27.08 $27.08 $27.08 $49.88 $49.88 $49.88 $10.40 $49.88 $37.02 $37.02 $38.45 $25.99 $10.40 $49.88 $49.88 $29.50 $49.88 $49.88 $49.88 $49.88 $37.41 $49.88 $49.88 $49.88 $24.94 $24.94 $39.50 $49.88 $39.90 $32.42 $9.90 $49.88 $28.93 $49.88 $49.88 $49.88 $10.39 $49.88 N/A N/A 27205803 EAP HCPCS C1894 INTRODUCER SHTH 4FR 10CM 2.5CM PNCL R/O II DIL RADOPQ BOTH IP/OP $53.50 $40.00 $10.62 $53.50 $29.05 $29.05 $29.05 $29.05 $53.50 $53.50 $53.50 $11.15 $53.50 $39.71 $39.71 $41.24 $27.87 $11.15 $53.50 $53.50 $31.65 $53.50 $53.50 $53.50 $53.50 $40.13 $53.50 $53.50 $53.50 $26.75 $26.75 $42.37 $53.50 $42.80 $34.78 $10.62 $53.50 $31.03 $53.50 $53.50 $53.50 $11.15 $53.50 N/A N/A 27205804 EAP HCPCS C1894 INTRODUCER SHTH 4FR 25CM 2.5CM PNCL R/O II DIL RADOPQ BOTH IP/OP $65.00 $48.50 $12.90 $65.00 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $65.00 $38.45 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 $65.00 $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 27205805 EAP HCPCS C1894 INTRODUCER SHTH 4FR 6CM 2.5CM PNCL R/O II DIL RADOPQ BOTH IP/OP $46.88 $35.00 $9.30 $46.88 $25.46 $25.46 $25.46 $25.46 $46.88 $46.88 $46.88 $9.77 $46.88 $34.79 $34.79 $36.14 $24.42 $9.77 $46.88 $46.88 $27.73 $46.88 $46.88 $46.88 $46.88 $35.16 $46.88 $46.88 $46.88 $23.44 $23.44 $37.13 $46.88 $37.50 $30.47 $9.30 $46.88 $27.19 $46.88 $46.88 $46.88 $9.77 $46.88 N/A N/A 27205806 EAP HCPCS C1894 INTRODUCER SHTH 5FR 10CM 2.5CM PNCL RADOPQ DIL NO MN GW BOTH IP/OP $53.50 $40.00 $10.62 $53.50 $29.05 $29.05 $29.05 $29.05 $53.50 $53.50 $53.50 $11.15 $53.50 $39.71 $39.71 $41.24 $27.87 $11.15 $53.50 $53.50 $31.65 $53.50 $53.50 $53.50 $53.50 $40.13 $53.50 $53.50 $53.50 $26.75 $26.75 $42.37 $53.50 $42.80 $34.78 $10.62 $53.50 $31.03 $53.50 $53.50 $53.50 $11.15 $53.50 N/A N/A 27205807 EAP HCPCS C1894 INTRODUCER SHTH 5FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST BOTH IP/OP $65.00 $48.50 $12.90 $65.00 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $65.00 $38.45 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 $65.00 $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 27205808 EAP HCPCS C1894 INTRODUCER SHTH 5FR 6CM 2.5CM PNCL RADOPQ DIL NO MN GW BOTH IP/OP $46.88 $35.00 $9.30 $46.88 $25.46 $25.46 $25.46 $25.46 $46.88 $46.88 $46.88 $9.77 $46.88 $34.79 $34.79 $36.14 $24.42 $9.77 $46.88 $46.88 $27.73 $46.88 $46.88 $46.88 $46.88 $35.16 $46.88 $46.88 $46.88 $23.44 $23.44 $37.13 $46.88 $37.50 $30.47 $9.30 $46.88 $27.19 $46.88 $46.88 $46.88 $9.77 $46.88 N/A N/A 27205809 EAP HCPCS C1894 INTRODUCER SHTH 6FR 10CM 2.5CM PN RO2 DIL RADOPQ KINK RST BOTH IP/OP $53.50 $40.00 $10.62 $53.50 $29.05 $29.05 $29.05 $29.05 $53.50 $53.50 $53.50 $11.15 $53.50 $39.71 $39.71 $41.24 $27.87 $11.15 $53.50 $53.50 $31.65 $53.50 $53.50 $53.50 $53.50 $40.13 $53.50 $53.50 $53.50 $26.75 $26.75 $42.37 $53.50 $42.80 $34.78 $10.62 $53.50 $31.03 $53.50 $53.50 $53.50 $11.15 $53.50 N/A N/A 27205810 EAP HCPCS C1894 INTRODUCER SHTH 6FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST BOTH IP/OP $65.00 $48.50 $12.90 $65.00 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $65.00 $38.45 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 $65.00 $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 27205811 EAP HCPCS C1894 INTRODUCER SHTH 6FR 45CM DESTINATION GD HDRPH PTFE BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205812 EAP HCPCS C1894 INTRODUCER SHTH 6FR 45CM PN DSTN GD HDRPH PTFE BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205813 EAP HCPCS C1894 INTRODUCER SHTH 6FR 45CM PN DSTN GD LIMA CRV XCUT VLV HDRPH BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205814 EAP HCPCS C1894 INTRODUCER SHTH 6FR 45CM PN DSTN GD MP CRV T-B VLV HDRPH BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205815 EAP HCPCS C1894 INTRODUCER SHTH 6FR 45CM PN DSTN GD RDC CRV T-B VLV HDRPH BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205816 EAP HCPCS C1894 INTRODUCER SHTH 6FR 45CM PN DSTN HDRPH PTFE BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205817 EAP HCPCS C1894 INTRODUCER SHTH 6FR 4CM 40CM PNCL RADOPQ DIL GW BOTH IP/OP $60.00 $44.50 $11.91 $60.00 $32.58 $32.58 $32.58 $32.58 $60.00 $60.00 $60.00 $12.51 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $60.00 $35.49 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $11.91 $60.00 $34.80 $60.00 $60.00 $60.00 $12.50 $60.00 N/A N/A 27205818 EAP HCPCS C1894 INTRODUCER SHTH 6FR 65CM PN DSTN GD STRG T-B VLV HDRPH PTFE BOTH IP/OP $225.00 $166.50 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 $225.00 $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 27205819 EAP HCPCS C1894 INTRODUCER SHTH 6FR 6CM 2.5CM PN RO2 DIL RADOPQ KINK RST BOTH IP/OP $46.88 $35.00 $9.30 $46.88 $25.46 $25.46 $25.46 $25.46 $46.88 $46.88 $46.88 $9.77 $46.88 $34.79 $34.79 $36.14 $24.42 $9.77 $46.88 $46.88 $27.73 $46.88 $46.88 $46.88 $46.88 $35.16 $46.88 $46.88 $46.88 $23.44 $23.44 $37.13 $46.88 $37.50 $30.47 $9.30 $46.88 $27.19 $46.88 $46.88 $46.88 $9.77 $46.88 N/A N/A 27205820 EAP HCPCS C1894 INTRODUCER SHTH 7FR 45CM PN DSTN GD HS CRV T-B VLV HDRPH BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205821 EAP HCPCS C1894 INTRODUCER SHTH 7FR 45CM PN DSTN GD LIMA CRV T-B VLV HDRPH BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205822 EAP HCPCS C1894 INTRODUCER SHTH 7FR 45CM PN DSTN GD MP CRV T-B VLV HDRPH BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205823 EAP HCPCS C1894 INTRODUCER SHTH 7FR 45CM PN DSTN GD RDC CRV T-B VLV HDRPH BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205824 EAP HCPCS C1894 INTRODUCER SHTH 7FR 45CM PN DSTN GD STRG T-B VLV HDRPH PTFE BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205825 EAP HCPCS C1894 INTRODUCER SHTH 7FR 4CM PNCL R/O II HIFLO DIL RADOPQ BOTH IP/OP $58.13 $43.50 $11.54 $58.13 $31.56 $31.56 $31.56 $31.56 $58.13 $58.13 $58.13 $12.12 $58.13 $43.14 $43.14 $44.81 $30.29 $12.11 $58.13 $58.13 $34.38 $58.13 $58.13 $58.13 $58.13 $43.60 $58.13 $58.13 $58.13 $29.07 $29.07 $46.04 $58.13 $46.50 $37.78 $11.54 $58.13 $33.72 $58.13 $58.13 $58.13 $12.11 $58.13 N/A N/A 27205826 EAP HCPCS C1894 INTRODUCER SHTH 7FR 65CM PN DSTN GD HDRPH PTFE BOTH IP/OP $225.00 $166.50 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 $225.00 $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 27205827 EAP HCPCS C1894 INTRODUCER SHTH 7FR 6CM 2.5CM PNCL RADOPQ DIL NO MN GW BOTH IP/OP $46.88 $35.00 $9.30 $46.88 $25.46 $25.46 $25.46 $25.46 $46.88 $46.88 $46.88 $9.77 $46.88 $34.79 $34.79 $36.14 $24.42 $9.77 $46.88 $46.88 $27.73 $46.88 $46.88 $46.88 $46.88 $35.16 $46.88 $46.88 $46.88 $23.44 $23.44 $37.13 $46.88 $37.50 $30.47 $9.30 $46.88 $27.19 $46.88 $46.88 $46.88 $9.77 $46.88 N/A N/A 27205828 EAP HCPCS C1894 INTRODUCER SHTH 8FR 4CM 2.5CM PNCL R/O II HIFLO DIL RADOPQ BOTH IP/OP $58.13 $43.50 $11.54 $58.13 $31.56 $31.56 $31.56 $31.56 $58.13 $58.13 $58.13 $12.12 $58.13 $43.14 $43.14 $44.81 $30.29 $12.11 $58.13 $58.13 $34.38 $58.13 $58.13 $58.13 $58.13 $43.60 $58.13 $58.13 $58.13 $29.07 $29.07 $46.04 $58.13 $46.50 $37.78 $11.54 $58.13 $33.72 $58.13 $58.13 $58.13 $12.11 $58.13 N/A N/A 27205829 EAP HCPCS C1894 INTRODUCER SHTH 8FR 6CM 2.5CM PN RO2 DIL RADOPQ KINK RST BOTH IP/OP $46.88 $35.00 $9.30 $46.88 $25.46 $25.46 $25.46 $25.46 $46.88 $46.88 $46.88 $9.77 $46.88 $34.79 $34.79 $36.14 $24.42 $9.77 $46.88 $46.88 $27.73 $46.88 $46.88 $46.88 $46.88 $35.16 $46.88 $46.88 $46.88 $23.44 $23.44 $37.13 $46.88 $37.50 $30.47 $9.30 $46.88 $27.19 $46.88 $46.88 $46.88 $9.77 $46.88 N/A N/A 27205830 EAP HCPCS C1894 INTRODUCER SHTH 9FR 10CM 2.5CM PN RO2 DIL RADOPQ KINK RST BOTH IP/OP $53.50 $40.00 $10.62 $53.50 $29.05 $29.05 $29.05 $29.05 $53.50 $53.50 $53.50 $11.15 $53.50 $39.71 $39.71 $41.24 $27.87 $11.15 $53.50 $53.50 $31.65 $53.50 $53.50 $53.50 $53.50 $40.13 $53.50 $53.50 $53.50 $26.75 $26.75 $42.37 $53.50 $42.80 $34.78 $10.62 $53.50 $31.03 $53.50 $53.50 $53.50 $11.15 $53.50 N/A N/A 27205831 EAP HCPCS C1894 INTRODUCER SHTH 9FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST BOTH IP/OP $65.00 $48.50 $12.90 $65.00 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $65.00 $38.45 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 $65.00 $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 27205832 EAP HCPCS C1894 INTRODUCER SHTH 9FR 6CM 2.5CM PNCL R/O II DIL RADOPQ BOTH IP/OP $46.88 $35.00 $9.30 $46.88 $25.46 $25.46 $25.46 $25.46 $46.88 $46.88 $46.88 $9.77 $46.88 $34.79 $34.79 $36.14 $24.42 $9.77 $46.88 $46.88 $27.73 $46.88 $46.88 $46.88 $46.88 $35.16 $46.88 $46.88 $46.88 $23.44 $23.44 $37.13 $46.88 $37.50 $30.47 $9.30 $46.88 $27.19 $46.88 $46.88 $46.88 $9.77 $46.88 N/A N/A 27205833 EAP HCPCS C1894 SHEATH ESCP 7FR 45CM PN DSTN GD DESTINATION HDRPH PTFE BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205834 EAP HCPCS C1887 SHEATH GD .038IN 6FR 45CM 2CM PN DSTN T-B VLV STRG HDRPH BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205835 EAP HCPCS C1887 SHEATH GD .038IN 7FR 45CM 2CM PN DSTN T-B VLV STRG HDRPH BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205836 EAP HCPCS C1894 SHEATH GD .038IN HS CRV 5FR 45CM 2CM PN DSTN XCUT VLV HDRPH BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205837 EAP HCPCS C1894 SHEATH GD .038IN LIMA CRV 5FR 45CM 2CM PN DSTN XCUT VLV BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205838 EAP HCPCS C1894 SHEATH GD .038IN MP CRV 5FR 45CM 2CM PN DSTN XCUT VLV KINK BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205839 EAP HCPCS C1894 SHEATH GD .038IN MP CRV 6FR 90CM 5CM PN DSTN T-B VLV HDRPH BOTH IP/OP $230.00 $170.50 $45.65 $230.00 $124.89 $124.89 $124.89 $124.89 $230.00 $230.00 $230.00 $47.94 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $230.00 $136.05 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $45.65 $230.00 $133.40 $230.00 $230.00 $230.00 $47.93 $230.00 N/A N/A 27205840 EAP HCPCS C1894 SHEATH GD .038IN MP CRV 7FR 90CM 5CM PN DSTN T-B VLV HDRPH BOTH IP/OP $230.00 $170.50 $45.65 $230.00 $124.89 $124.89 $124.89 $124.89 $230.00 $230.00 $230.00 $47.94 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $230.00 $136.05 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $45.65 $230.00 $133.40 $230.00 $230.00 $230.00 $47.93 $230.00 N/A N/A 27205841 EAP HCPCS C1894 SHEATH GD .038IN MP CRV 7FR 90CM 5CM PN DSTN XCUT VLV HDRPH BOTH IP/OP $230.00 $170.50 $45.65 $230.00 $124.89 $124.89 $124.89 $124.89 $230.00 $230.00 $230.00 $47.94 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $230.00 $136.05 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $45.65 $230.00 $133.40 $230.00 $230.00 $230.00 $47.93 $230.00 N/A N/A 27205842 EAP HCPCS C1894 SHEATH GD 22FR X 35CM SOLOPATH BOTH IP/OP "$1,525.00" "$1,128.50" $302.67 "$1,525.00" $828.08 $828.08 $828.08 $828.08 "$1,525.00" "$1,525.00" "$1,525.00" $317.85 "$1,525.00" "$1,131.86" "$1,131.86" "$1,175.47" $794.53 $317.83 "$1,525.00" "$1,525.00" $902.04 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,143.75" "$1,525.00" "$1,525.00" "$1,525.00" $762.50 $762.50 "$1,207.80" "$1,525.00" "$1,220.00" $991.25 $302.67 "$1,525.00" $884.50 "$1,525.00" "$1,525.00" "$1,525.00" $317.81 "$1,525.00" N/A N/A 27205843 EAP HCPCS C1894 SHEATH GD 23FR 13.5FR 19FR 25CM 20CM SOLOPATH EXPANDABLE BOTH IP/OP "$1,525.00" "$1,128.50" $302.67 "$1,525.00" $828.08 $828.08 $828.08 $828.08 "$1,525.00" "$1,525.00" "$1,525.00" $317.85 "$1,525.00" "$1,131.86" "$1,131.86" "$1,175.47" $794.53 $317.83 "$1,525.00" "$1,525.00" $902.04 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,143.75" "$1,525.00" "$1,525.00" "$1,525.00" $762.50 $762.50 "$1,207.80" "$1,525.00" "$1,220.00" $991.25 $302.67 "$1,525.00" $884.50 "$1,525.00" "$1,525.00" "$1,525.00" $317.81 "$1,525.00" N/A N/A 27205844 EAP HCPCS C1894 SHEATH GD 23FR 13.5FR 19FR 35CM 30CM SOLOPATH EXPANDABLE BOTH IP/OP "$1,525.00" "$1,128.50" $302.67 "$1,525.00" $828.08 $828.08 $828.08 $828.08 "$1,525.00" "$1,525.00" "$1,525.00" $317.85 "$1,525.00" "$1,131.86" "$1,131.86" "$1,175.47" $794.53 $317.83 "$1,525.00" "$1,525.00" $902.04 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,143.75" "$1,525.00" "$1,525.00" "$1,525.00" $762.50 $762.50 "$1,207.80" "$1,525.00" "$1,220.00" $991.25 $302.67 "$1,525.00" $884.50 "$1,525.00" "$1,525.00" "$1,525.00" $317.81 "$1,525.00" N/A N/A 27205845 EAP HCPCS C1894 SHEATH GD 24FR X 35CM SOLOPATH BOTH IP/OP "$1,525.00" "$1,128.50" $302.67 "$1,525.00" $828.08 $828.08 $828.08 $828.08 "$1,525.00" "$1,525.00" "$1,525.00" $317.85 "$1,525.00" "$1,131.86" "$1,131.86" "$1,175.47" $794.53 $317.83 "$1,525.00" "$1,525.00" $902.04 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,143.75" "$1,525.00" "$1,525.00" "$1,525.00" $762.50 $762.50 "$1,207.80" "$1,525.00" "$1,220.00" $991.25 $302.67 "$1,525.00" $884.50 "$1,525.00" "$1,525.00" "$1,525.00" $317.81 "$1,525.00" N/A N/A 27205846 EAP HCPCS C1894 SHEATH GD 26FR 15FR 22FR 35CM 30CM SOLOPATH EXPANDABLE BOTH IP/OP "$1,525.00" "$1,128.50" $302.67 "$1,525.00" $828.08 $828.08 $828.08 $828.08 "$1,525.00" "$1,525.00" "$1,525.00" $317.85 "$1,525.00" "$1,131.86" "$1,131.86" "$1,175.47" $794.53 $317.83 "$1,525.00" "$1,525.00" $902.04 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,143.75" "$1,525.00" "$1,525.00" "$1,525.00" $762.50 $762.50 "$1,207.80" "$1,525.00" "$1,220.00" $991.25 $302.67 "$1,525.00" $884.50 "$1,525.00" "$1,525.00" "$1,525.00" $317.81 "$1,525.00" N/A N/A 27205847 EAP HCPCS C1894 SHEATH GD 28.5FR 15FR 24FR 25CM 20CM SOLOPATH EXPANDABLE BOTH IP/OP "$1,525.00" "$1,128.50" $302.67 "$1,525.00" $828.08 $828.08 $828.08 $828.08 "$1,525.00" "$1,525.00" "$1,525.00" $317.85 "$1,525.00" "$1,131.86" "$1,131.86" "$1,175.47" $794.53 $317.83 "$1,525.00" "$1,525.00" $902.04 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,143.75" "$1,525.00" "$1,525.00" "$1,525.00" $762.50 $762.50 "$1,207.80" "$1,525.00" "$1,220.00" $991.25 $302.67 "$1,525.00" $884.50 "$1,525.00" "$1,525.00" "$1,525.00" $317.81 "$1,525.00" N/A N/A 27205848 EAP HCPCS C1894 SHEATH GD 4FR STRL PNCL PRCS ACC SYS TL INTGR FIT ECHGN TPR BOTH IP/OP $81.25 $60.50 $16.13 $81.25 $44.12 $44.12 $44.12 $44.12 $81.25 $81.25 $81.25 $16.93 $81.25 $60.30 $60.30 $62.63 $42.33 $16.93 $81.25 $81.25 $48.06 $81.25 $81.25 $81.25 $81.25 $60.94 $81.25 $81.25 $81.25 $40.63 $40.63 $64.35 $81.25 $65.00 $52.81 $16.13 $81.25 $47.13 $81.25 $81.25 $81.25 $16.93 $81.25 N/A N/A 27205849 EAP HCPCS C1894 SHEATH GD HS CRV 7FR 45CM 5CM PN DSTN RADOPQ XCUT VLV SS BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205850 EAP HCPCS C1894 SHEATH GD MP CRV 6FR 45CM 5CM PN DSTN RADOPQ XCUT VLV SS BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205851 EAP HCPCS C1894 SHEATH GD MP CRV 6FR 90CM 15CM PN DSTN RADOPQ XCUT VLV SS BOTH IP/OP $230.00 $170.50 $45.65 $230.00 $124.89 $124.89 $124.89 $124.89 $230.00 $230.00 $230.00 $47.94 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $230.00 $136.05 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $45.65 $230.00 $133.40 $230.00 $230.00 $230.00 $47.93 $230.00 N/A N/A 27205852 EAP HCPCS C1894 SHEATH GD MP CRV 7FR 45CM 5CM PN DSTN RADOPQ XCUT VLV SS BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205853 EAP HCPCS C1894 SHEATH GD RNL 2 CRV 5FR 45CM 5CM PN DSTN RADOPQ XCUT VLV SS BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205854 EAP HCPCS C1894 SHEATH GD STRG 5FR 45CM 35CM PN DSTN RADOPQ XCUT VLV SS PTFE BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205855 EAP HCPCS C1894 SHEATH GD STRG 6FR 45CM 35CM PN DSTN RADOPQ XCUT VLV SS PTFE BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205856 EAP HCPCS C1894 SHEATH GD STRG 6FR 90CM 15CM PN DSTN RADOPQ XCUT VLV SS PTFE BOTH IP/OP $230.00 $170.50 $45.65 $230.00 $124.89 $124.89 $124.89 $124.89 $230.00 $230.00 $230.00 $47.94 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $230.00 $136.05 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $45.65 $230.00 $133.40 $230.00 $138.00 $230.00 $47.93 $230.00 N/A N/A 27205857 EAP HCPCS C1894 SHEATH GD STRG 6FR 90CM 15CM PN DSTN T-B RADOPQ VLV SS PTFE BOTH IP/OP $230.00 $170.50 $45.65 $230.00 $124.89 $124.89 $124.89 $124.89 $230.00 $230.00 $230.00 $47.94 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $230.00 $136.05 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $45.65 $230.00 $133.40 $230.00 $230.00 $230.00 $47.93 $230.00 N/A N/A 27205858 EAP HCPCS C1894 SHEATH GD STRG 7FR 45CM 35CM PN DSTN RADOPQ XCUT VLV SS PTFE BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205859 EAP HCPCS C1894 SHEATH GD STRG 7FR 45CM 5CM PN DSTN RADOPQ XCUT VLV SS PTFE BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205860 EAP HCPCS C1894 SHEATH GD STRG 7FR 65CM 35CM PN DSTN RADOPQ XCUT VLV SS PTFE BOTH IP/OP $225.00 $166.50 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 $225.00 $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 27205861 EAP HCPCS C1894 SHEATH GD STRG 7FR 90CM 15CM PN DSTN RADOPQ XCUT VLV SS PTFE BOTH IP/OP $230.00 $170.50 $45.65 $230.00 $124.89 $124.89 $124.89 $124.89 $230.00 $230.00 $230.00 $47.94 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $230.00 $136.05 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $45.65 $230.00 $133.40 $230.00 $230.00 $230.00 $47.93 $230.00 N/A N/A 27205862 EAP HCPCS C1894 SHEATH GD STRG 7FR 90CM 15CM PN DSTN T-B RADOPQ VLV SS PTFE BOTH IP/OP $230.00 $170.50 $45.65 $230.00 $124.89 $124.89 $124.89 $124.89 $230.00 $230.00 $230.00 $47.94 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $230.00 $136.05 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $45.65 $230.00 $133.40 $230.00 $230.00 $230.00 $47.93 $230.00 N/A N/A 27205863 EAP HCPCS C1894 SHEATH GD STRG 8FR 45CM 35CM PN DSTN T-B RADOPQ VLV SS PTFE BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27205864 EAP HCPCS C1894 SHEATH GD STRG 8FR 65CM 35CM PN DSTN T-B RADOPQ VLV SS PTFE BOTH IP/OP $225.00 $166.50 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 $225.00 $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 27205865 EAP HCPCS C1894 SHEATH GD STRG 8FR 90CM 60CM PN DSTN T-B RADOPQ VLV SS PTFE BOTH IP/OP $230.00 $170.50 $45.65 $230.00 $124.89 $124.89 $124.89 $124.89 $230.00 $230.00 $230.00 $47.94 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $230.00 $136.05 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $45.65 $230.00 $133.40 $230.00 $230.00 $230.00 $47.93 $230.00 N/A N/A 27205866 EAP HCPCS C1894 SYSTEM INTRO .018IN 4FR 21GA 40CM GLIDEACCESS ECHGN NDL GW BOTH IP/OP $66.25 $49.50 $13.15 $66.25 $35.97 $35.97 $35.97 $35.97 $66.25 $66.25 $66.25 $13.81 $66.25 $49.17 $49.17 $51.07 $34.52 $13.81 $66.25 $66.25 $39.19 $66.25 $66.25 $66.25 $66.25 $49.69 $66.25 $66.25 $66.25 $33.13 $33.13 $52.47 $66.25 $53.00 $43.06 $13.15 $66.25 $38.43 $66.25 $66.25 $66.25 $13.81 $66.25 N/A N/A 27205867 EAP HCPCS C1894 SYSTEM INTRO .018IN 4FR 21GA 40CM GLIDEACCESS NON ECHGN NDL BOTH IP/OP $76.88 $57.00 $15.26 $76.88 $41.75 $41.75 $41.75 $41.75 $76.88 $76.88 $76.88 $16.02 $76.88 $57.06 $57.06 $59.26 $40.05 $16.02 $76.88 $76.88 $45.47 $76.88 $76.88 $76.88 $76.88 $57.66 $76.88 $76.88 $76.88 $38.44 $38.44 $60.89 $76.88 $61.50 $49.97 $15.26 $76.88 $44.59 $76.88 $76.88 $76.88 $16.02 $76.88 N/A N/A 27205868 EAP HCPCS C1894 SYSTEM INTRO .018IN 4FR 40CM GLIDEACCESS COAX GW ECHGN NDL BOTH IP/OP $79.38 $59.00 $15.75 $79.38 $43.10 $43.10 $43.10 $43.10 $79.38 $79.38 $79.38 $16.54 $79.38 $58.92 $58.92 $61.19 $41.36 $16.54 $79.38 $79.38 $46.95 $79.38 $79.38 $79.38 $79.38 $59.54 $79.38 $79.38 $79.38 $39.69 $39.69 $62.87 $79.38 $63.50 $51.60 $15.75 $79.38 $46.04 $79.38 $79.38 $79.38 $16.54 $79.38 N/A N/A 27205869 EAP HCPCS C1894 SYSTEM INTRO .018IN 5FR 21GA 40CM GLIDEACCESS ECHGN NDL GW BOTH IP/OP $66.25 $49.50 $13.15 $66.25 $35.97 $35.97 $35.97 $35.97 $66.25 $66.25 $66.25 $13.81 $66.25 $49.17 $49.17 $51.07 $34.52 $13.81 $66.25 $66.25 $39.19 $66.25 $66.25 $66.25 $66.25 $49.69 $66.25 $66.25 $66.25 $33.13 $33.13 $52.47 $66.25 $53.00 $43.06 $13.15 $66.25 $38.43 $66.25 $66.25 $66.25 $13.81 $66.25 N/A N/A 27205870 EAP HCPCS C1894 SYSTEM INTRO .018IN 5FR 21GA 40CM GLIDEACCESS NON ECHGN NDL BOTH IP/OP $76.88 $57.00 $15.26 $76.88 $41.75 $41.75 $41.75 $41.75 $76.88 $76.88 $76.88 $16.02 $76.88 $57.06 $57.06 $59.26 $40.05 $16.02 $76.88 $76.88 $45.47 $76.88 $76.88 $76.88 $76.88 $57.66 $76.88 $76.88 $76.88 $38.44 $38.44 $60.89 $76.88 $61.50 $49.97 $15.26 $76.88 $44.59 $76.88 $76.88 $76.88 $16.02 $76.88 N/A N/A 27205871 EAP HCPCS C1894 SYSTEM INTRO .018IN 5FR 40CM GLIDEACCESS COAX GW ECHGN NDL BOTH IP/OP $79.38 $59.00 $15.75 $79.38 $43.10 $43.10 $43.10 $43.10 $79.38 $79.38 $79.38 $16.54 $79.38 $58.92 $58.92 $61.19 $41.36 $16.54 $79.38 $79.38 $46.95 $79.38 $79.38 $79.38 $79.38 $59.54 $79.38 $79.38 $79.38 $39.69 $39.69 $62.87 $79.38 $63.50 $51.60 $15.75 $79.38 $46.04 $79.38 $79.38 $79.38 $16.54 $79.38 N/A N/A 27205872 EAP HCPCS C1894 SYSTEM INTRO 5FR 21-19GA 45CM 10CM PNCL PRCS ACC SYS STF BOTH IP/OP $81.25 $60.50 $16.13 $81.25 $44.12 $44.12 $44.12 $44.12 $81.25 $81.25 $81.25 $16.93 $81.25 $60.30 $60.30 $62.63 $42.33 $16.93 $81.25 $81.25 $48.06 $81.25 $81.25 $81.25 $81.25 $60.94 $81.25 $81.25 $81.25 $40.63 $40.63 $64.35 $81.25 $65.00 $52.81 $16.13 $81.25 $47.13 $81.25 $81.25 $81.25 $16.93 $81.25 N/A N/A 27205873 EAP HCPCS C1894 SYSTEM INTRO REG 4FR ECHGN NDL FXCR GW NINITOL BOTH IP/OP $81.25 $60.50 $16.13 $81.25 $44.12 $44.12 $44.12 $44.12 $81.25 $81.25 $81.25 $16.93 $81.25 $60.30 $60.30 $62.63 $42.33 $16.93 $81.25 $81.25 $48.06 $81.25 $81.25 $81.25 $81.25 $60.94 $81.25 $81.25 $81.25 $40.63 $40.63 $64.35 $81.25 $65.00 $52.81 $16.13 $81.25 $47.13 $81.25 $81.25 $81.25 $16.93 $81.25 N/A N/A 27205874 EAP HCPCS C1894 SYSTEM INTRO REG 4FR ECHGN NDL GW SS BOTH IP/OP $75.00 $55.50 $14.89 $75.00 $40.73 $40.73 $40.73 $40.73 $75.00 $75.00 $75.00 $15.63 $75.00 $55.67 $55.67 $57.81 $39.08 $15.63 $75.00 $75.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $48.75 $14.89 $75.00 $43.50 $75.00 $75.00 $75.00 $15.63 $75.00 N/A N/A 27205875 EAP HCPCS C1894 SYSTEM INTRO REG 5FR ECHGN NDL FXCR GW NINITOL BOTH IP/OP $81.25 $60.50 $16.13 $81.25 $44.12 $44.12 $44.12 $44.12 $81.25 $81.25 $81.25 $16.93 $81.25 $60.30 $60.30 $62.63 $42.33 $16.93 $81.25 $81.25 $48.06 $81.25 $81.25 $81.25 $81.25 $60.94 $81.25 $81.25 $81.25 $40.63 $40.63 $64.35 $81.25 $65.00 $52.81 $16.13 $81.25 $47.13 $81.25 $81.25 $81.25 $16.93 $81.25 N/A N/A 27205876 EAP HCPCS C1894 SYSTEM INTRO REG 5FR ECHGN NDL GW SS BOTH IP/OP $75.00 $55.50 $14.89 $75.00 $40.73 $40.73 $40.73 $40.73 $75.00 $75.00 $75.00 $15.63 $75.00 $55.67 $55.67 $57.81 $39.08 $15.63 $75.00 $75.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $48.75 $14.89 $75.00 $43.50 $75.00 $75.00 $75.00 $15.63 $75.00 N/A N/A 27205877 EAP HCPCS C1894 SYSTEM INTRO REG 6FR ECHGN NDL FXCR GW NINITOL BOTH IP/OP $81.25 $60.50 $16.13 $81.25 $44.12 $44.12 $44.12 $44.12 $81.25 $81.25 $81.25 $16.93 $81.25 $60.30 $60.30 $62.63 $42.33 $16.93 $81.25 $81.25 $48.06 $81.25 $81.25 $81.25 $81.25 $60.94 $81.25 $81.25 $81.25 $40.63 $40.63 $64.35 $81.25 $65.00 $52.81 $16.13 $81.25 $47.13 $81.25 $81.25 $81.25 $16.93 $81.25 N/A N/A 27205878 EAP HCPCS C1894 SYSTEM INTRO REG 6FR ECHGN NDL GW SS BOTH IP/OP $75.00 $55.50 $14.89 $75.00 $40.73 $40.73 $40.73 $40.73 $75.00 $75.00 $75.00 $15.63 $75.00 $55.67 $55.67 $57.81 $39.08 $15.63 $75.00 $75.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $48.75 $14.89 $75.00 $43.50 $75.00 $75.00 $75.00 $15.63 $75.00 N/A N/A 27205879 EAP HCPCS C1894 SYSTEM INTRO REG 7FR ECHGN NDL FXCR GW NINITOL BOTH IP/OP $81.25 $60.50 $16.13 $81.25 $44.12 $44.12 $44.12 $44.12 $81.25 $81.25 $81.25 $16.93 $81.25 $60.30 $60.30 $62.63 $42.33 $16.93 $81.25 $81.25 $48.06 $81.25 $81.25 $81.25 $81.25 $60.94 $81.25 $81.25 $81.25 $40.63 $40.63 $64.35 $81.25 $65.00 $52.81 $16.13 $81.25 $47.13 $81.25 $81.25 $81.25 $16.93 $81.25 N/A N/A 27205880 EAP HCPCS C1894 SYSTEM INTRO REG 7FR ECHGN NDL GW SS BOTH IP/OP $75.00 $55.50 $14.89 $75.00 $40.73 $40.73 $40.73 $40.73 $75.00 $75.00 $75.00 $15.63 $75.00 $55.67 $55.67 $57.81 $39.08 $15.63 $75.00 $75.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $48.75 $14.89 $75.00 $43.50 $75.00 $75.00 $75.00 $15.63 $75.00 N/A N/A 27205881 EAP HCPCS C1894 SYSTEM INTRO REG 8FR ECHGN NDL GW SS BOTH IP/OP $75.00 $55.50 $14.89 $75.00 $40.73 $40.73 $40.73 $40.73 $75.00 $75.00 $75.00 $15.63 $75.00 $55.67 $55.67 $57.81 $39.08 $15.63 $75.00 $75.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $48.75 $14.89 $75.00 $43.50 $75.00 $75.00 $75.00 $15.63 $75.00 N/A N/A 27205882 EAP HCPCS C1894 SYSTEM INTRO STRG 4FR ECHGN NDL FXCR GW SS BOTH IP/OP $75.00 $55.50 $14.89 $75.00 $40.73 $40.73 $40.73 $40.73 $75.00 $75.00 $75.00 $15.63 $75.00 $55.67 $55.67 $57.81 $39.08 $15.63 $75.00 $75.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $48.75 $14.89 $75.00 $43.50 $75.00 $75.00 $75.00 $15.63 $75.00 N/A N/A 27205883 EAP HCPCS C1894 SYSTEM INTRO STRG 5FR ECHGN NDL FXCR GW SS BOTH IP/OP $75.00 $55.50 $14.89 $75.00 $33.75 $33.75 $33.75 $33.75 $75.00 $75.00 $75.00 $15.63 $75.00 $75.00 $75.00 $75.00 $75.00 $15.63 $75.00 $75.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $33.75 $14.89 $75.00 $43.50 $75.00 $75.00 $75.00 $15.63 $75.00 N/A N/A 27205884 EAP HCPCS C1894 SYSTEM INTRO TPR 8FR 19-21GA 45CM 10CM PRCS ACC SYS PNCL BOTH IP/OP $81.25 $60.50 $16.13 $81.25 $36.56 $36.56 $36.56 $36.56 $81.25 $81.25 $81.25 $16.93 $81.25 $81.25 $81.25 $81.25 $81.25 $16.93 $81.25 $81.25 $48.06 $81.25 $81.25 $81.25 $81.25 $60.94 $81.25 $81.25 $81.25 $40.63 $40.63 $64.35 $81.25 $65.00 $36.56 $16.13 $81.25 $47.13 $81.25 $81.25 $81.25 $16.93 $81.25 N/A N/A 27205908 EAP STABILIT FULL FRACTURE KIT - 2 LEVEL KIT BOTH IP/OP "$4,500.00" "$3,330.00" $801.00 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $801.00 "$4,500.00" "$4,500.00" "$3,339.90" "$3,339.90" "$3,468.60" "$2,060.15" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,925.00" "$4,500.00" "$4,500.00" "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A 27205910 EAP Custom 27205910 SET NDL 15GA 15MM STRL LF ARW BOTH IP/OP "$1,563.00" "$1,157.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $278.21 "$1,563.00" "$1,563.00" "$1,160.06" "$1,160.06" "$1,204.76" $814.32 $325.75 "$1,563.00" $625.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,172.25" "$1,563.00" "$1,563.00" "$1,563.00" $781.50 $781.50 "$1,237.90" "$1,563.00" "$1,250.40" "$1,015.95" "$1,563.00" "$1,563.00" $906.54 "$1,563.00" $937.80 "$1,563.00" "$1,563.00" "$1,563.00" N/A N/A 27205911 EAP Custom 27205911 KIT PERITONEAL LAVAGE .035IN 8 BOTH IP/OP $85.00 $63.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 $85.00 $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 27205912 EAP Custom 27205912 LENS IRRIGATION THERAPEUTIC TU BOTH IP/OP $780.00 $577.50 $138.84 $780.00 $780.00 $780.00 $780.00 $780.00 $780.00 $780.00 $138.84 $780.00 $780.00 $578.92 $578.92 $601.22 $406.38 $162.56 $780.00 $312.00 $780.00 $780.00 $780.00 $780.00 $780.00 $585.00 $780.00 $780.00 $780.00 $390.00 $390.00 $617.76 $780.00 $624.00 $507.00 $780.00 $780.00 $452.40 $780.00 $468.00 $780.00 $780.00 $780.00 N/A N/A 27205913 EAP Custom 27205913 DRESSING NASAL STANDARD 8CM CO BOTH IP/OP $430.00 $318.50 $76.54 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $76.54 $430.00 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $172.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $430.00 $430.00 $249.40 $430.00 $258.00 $430.00 $430.00 $430.00 N/A N/A 27205914 EAP HCPCS C1769 TRAY SURG 14FR 18GA 29CM 5CM 1 BOTH IP/OP $417.00 $309.00 $82.76 $417.00 $226.43 $226.43 $226.43 $226.43 $417.00 $417.00 $417.00 $86.91 $417.00 $309.50 $309.50 $321.42 $217.26 $86.91 $417.00 $417.00 $246.66 $417.00 $417.00 $417.00 $417.00 $312.75 $417.00 $417.00 $417.00 $208.50 $208.50 $330.26 $417.00 $333.60 $271.05 $82.76 $417.00 $241.86 $417.00 $417.00 $417.00 $86.90 $417.00 N/A N/A 27205915 EAP Custom 27205915 KIT INCISION AND DRAINAGE ECC BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 $400.00 $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A 27205916 EAP HCPCS C1727 BALLOON CATHETER INTRODUCER KI BOTH IP/OP $375.00 $277.50 $78.15 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $150.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $375.00 $375.00 $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 27205917 EAP Custom 27205917 KIT INTROD .035IN 9FR 18GA 10C BOTH IP/OP $309.00 $229.00 $55.00 $309.00 $309.00 $309.00 $309.00 $309.00 $309.00 $309.00 $55.00 $309.00 $309.00 $229.34 $229.34 $238.18 $160.99 $64.40 $309.00 $123.60 $309.00 $309.00 $309.00 $309.00 $309.00 $231.75 $309.00 $309.00 $309.00 $154.50 $154.50 $244.73 $309.00 $247.20 $200.85 $309.00 $309.00 $179.22 $309.00 $185.40 $309.00 $309.00 $309.00 N/A N/A 27205918 EAP Custom 27205918 KIT PRSS MONITR 1 LN TRNDCR 1 BOTH IP/OP $261.00 $193.50 $46.46 $261.00 $261.00 $261.00 $261.00 $261.00 $261.00 $261.00 $46.46 $261.00 $261.00 $193.71 $193.71 $201.18 $135.98 $54.40 $261.00 $104.40 $261.00 $261.00 $261.00 $261.00 $261.00 $195.75 $261.00 $261.00 $261.00 $130.50 $130.50 $206.71 $261.00 $208.80 $169.65 $261.00 $261.00 $151.38 $261.00 $156.60 $261.00 $261.00 $261.00 N/A N/A 27205920 EAP HCPCS C1769 GUIDEWIRE VASC .038IN 180CM STRL 3CM MERIT LAUREAT BOTH IP/OP $80.00 $59.50 $15.88 $80.00 $43.44 $43.44 $43.44 $43.44 $80.00 $80.00 $80.00 $16.67 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $80.00 $47.32 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $15.88 $80.00 $46.40 $80.00 $80.00 $80.00 $16.67 $80.00 N/A N/A 27205921 EAP HCPCS C1769 GUIDEWIRE VASC ANG .035IN 150CM 3CM LAUREATE FXCR BOTH IP/OP $75.00 $55.50 $14.89 $75.00 $40.73 $40.73 $40.73 $40.73 $75.00 $75.00 $75.00 $15.63 $75.00 $55.67 $55.67 $57.81 $39.08 $15.63 $75.00 $75.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $48.75 $14.89 $75.00 $43.50 $75.00 $75.00 $75.00 $15.63 $75.00 N/A N/A 27205922 EAP HCPCS C1751 CATHETER CEN VEN 9FR 3MM 1.3MM .7MM 90CM 2 LUMEN T BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $192.77 $192.77 $192.77 $192.77 $355.00 $355.00 $355.00 $73.99 $355.00 $263.48 $263.48 $273.63 $184.96 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $230.75 $70.46 $355.00 $205.90 $355.00 $355.00 $355.00 $73.98 $355.00 N/A N/A 27205930 EAP HCPCS C1729 CATHETER URETHRAL STANDARD 24F BOTH IP/OP $259.00 $192.00 $51.41 $259.00 $140.64 $140.64 $140.64 $140.64 $259.00 $259.00 $259.00 $53.98 $259.00 $192.23 $192.23 $199.64 $134.94 $53.98 $259.00 $259.00 $153.20 $259.00 $259.00 $259.00 $259.00 $194.25 $259.00 $259.00 $259.00 $129.50 $129.50 $205.13 $259.00 $207.20 $168.35 $51.41 $259.00 $150.22 $259.00 $259.00 $259.00 $53.98 $259.00 N/A N/A 27205931 EAP Custom 27205931 NEEDLE BIOP 13 1/16IN 15GA 15/ BOTH IP/OP $214.00 $158.50 $38.09 $214.00 $214.00 $214.00 $214.00 $214.00 $214.00 $214.00 $38.09 $214.00 $214.00 $158.83 $158.83 $164.95 $111.49 $44.60 $214.00 $85.60 $214.00 $214.00 $214.00 $214.00 $214.00 $160.50 $214.00 $214.00 $214.00 $107.00 $107.00 $169.49 $214.00 $171.20 $139.10 $214.00 $214.00 $124.12 $214.00 $128.40 $214.00 $214.00 $214.00 N/A N/A 27205932 EAP Custom 27205932 SPECULUM VAG MED GRN NS LF ER- BOTH IP/OP $168.00 $124.50 $29.90 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $29.90 $168.00 $168.00 $124.69 $124.69 $129.49 $87.53 $35.01 $168.00 $67.20 $168.00 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $109.20 $168.00 $168.00 $97.44 $168.00 $100.80 $168.00 $168.00 $168.00 N/A N/A 27205934 EAP HCPCS C1729 TRAY CATHETERIZATION 16FR 2 CO BOTH IP/OP $73.00 $54.50 $14.49 $73.00 $39.64 $39.64 $39.64 $39.64 $73.00 $73.00 $73.00 $15.22 $73.00 $54.18 $54.18 $56.27 $38.03 $15.21 $73.00 $73.00 $43.18 $73.00 $73.00 $73.00 $73.00 $54.75 $73.00 $73.00 $73.00 $36.50 $36.50 $57.82 $73.00 $58.40 $47.45 $14.49 $73.00 $42.34 $73.00 $73.00 $73.00 $15.21 $73.00 N/A N/A 27205938 EAP Custom 27205938 SENSOR OXIMETER 18IN ADHESIVE BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27205939 EAP Custom 27205939 KIT LACERATION BOTH IP/OP $26.00 $19.50 $4.63 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $4.63 $26.00 $26.00 $19.30 $19.30 $20.04 $13.55 $5.42 $26.00 $10.40 $26.00 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $16.90 $26.00 $26.00 $15.08 $26.00 $15.60 $26.00 $26.00 $26.00 N/A N/A 27205941 EAP HCPCS C1729 CATHETER URETHRAL 14FR FOLEY 2 BOTH IP/OP $26.00 $19.50 $5.16 $26.00 $14.12 $14.12 $14.12 $14.12 $26.00 $26.00 $26.00 $5.42 $26.00 $19.30 $19.30 $20.04 $13.55 $5.42 $26.00 $26.00 $15.38 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $16.90 $5.16 $26.00 $15.08 $26.00 $26.00 $26.00 $5.42 $26.00 N/A N/A 27205943 EAP ENVELOPE DEFIBRILLATOR 3.35X3IN RESORB AIGISRX MINO BOTH IP/OP "$2,488.00" "$1,841.50" $442.86 "$2,488.00" "$2,488.00" "$2,488.00" "$2,488.00" "$2,488.00" "$2,488.00" "$2,488.00" $442.86 "$2,488.00" "$2,488.00" "$1,846.59" "$1,846.59" "$1,917.75" "$1,296.25" $518.53 "$2,488.00" $995.20 "$2,488.00" "$2,488.00" "$2,488.00" "$2,488.00" "$2,488.00" "$1,866.00" "$2,488.00" "$2,488.00" "$2,488.00" "$1,244.00" "$1,244.00" "$1,970.50" "$2,488.00" "$1,990.40" "$1,617.20" "$2,488.00" "$2,488.00" "$1,443.04" "$2,488.00" "$1,492.80" "$2,488.00" "$2,488.00" "$2,488.00" N/A N/A 27205944 EAP HCPCS c1769 GUIDEWIRE VASC 190CM MIC J ASAHI GAIA 1ST CORON BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 $150.00 $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A 27205945 EAP HCPCS c1769 GUIDEWIRE VASC 300CM JTP MIC ASAHI GAIA 1ST CORON BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 $150.00 $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A 27205946 EAP HCPCS C1769 GUIDEWIRE VASC 190CM GAIA 2 MCTIP J ASAHI BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $90.00 $150.00 $31.26 $150.00 N/A N/A 27205947 EAP HCPCS C1769 GUIDEWIRE VASC 300CM JTP MIC ASAHI GAIA SEC CORON BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27205948 EAP HCPCS C1769 GUIDEWIRE VASC 190CM GAIA 3 MCTIP J ASAHI BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27205949 EAP HCPCS C1769 GUIDEWIRE VASC 300CM 3RD MIC J ASAHI GAIA CORON BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27205950 EAP CATHETER ANGIO BRNSTN 1 CRV 5FR .046IN 125CM PRFM WNG HUB BOTH IP/OP $138.00 $102.50 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 $138.00 $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 27206307 EAP Custom 27206307 SHEATH GUID STR 8FR 45CM 35CM 3 RADIOPQ CROSS CUT BOTH IP/OP "$1,550.00" "$1,147.00" $275.90 "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" $275.90 "$1,550.00" "$1,550.00" "$1,150.41" "$1,150.41" "$1,194.74" $807.55 $323.04 "$1,550.00" $620.00 "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" "$1,162.50" "$1,550.00" "$1,550.00" "$1,550.00" $775.00 $775.00 "$1,227.60" "$1,550.00" "$1,240.00" "$1,007.50" "$1,550.00" "$1,550.00" $899.00 "$1,550.00" $930.00 "$1,550.00" "$1,550.00" "$1,550.00" N/A N/A 27206308 EAP HCPCS C1894 INTRODUCER SHTH 23FR 55.7CM 69.9CM MICRA STPCK RADOPQ DIL BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $814.50 $814.50 $814.50 $814.50 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 27206309 EAP HCPCS C1769 "GUIDEWIRE HI-TORQUE COMM ES .014"" 300CM" BOTH IP/OP $988.00 $731.50 $196.09 $988.00 $536.48 $536.48 $536.48 $536.48 $988.00 $988.00 $988.00 $205.92 $988.00 $733.29 $733.29 $761.55 $514.75 $205.91 $988.00 $988.00 $584.40 $988.00 $988.00 $988.00 $988.00 $741.00 $988.00 $988.00 $988.00 $494.00 $494.00 $782.50 $988.00 $790.40 $642.20 $196.09 $988.00 $573.04 $988.00 $988.00 $988.00 $205.90 $988.00 N/A N/A 27219613 EAP HCPCS C1751 TRAY CATHETERIZATION 16FR URINE METER FOLEY STATLO BOTH IP/OP $40.00 $30.00 $7.94 $40.00 $21.72 $21.72 $21.72 $21.72 $40.00 $40.00 $40.00 $8.34 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $40.00 $23.66 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $7.94 $40.00 $23.20 $40.00 $24.00 $40.00 $8.34 $40.00 N/A N/A 27219614 EAP Custom 27219614 5FR MICRO STICK BOTH IP/OP $50.00 $37.00 $8.90 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $8.90 $50.00 $50.00 $37.11 $37.11 $38.54 $26.05 $10.42 $50.00 $20.00 $50.00 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $32.50 $50.00 $50.00 $29.00 $50.00 $30.00 $50.00 $50.00 $50.00 N/A N/A 27219615 EAP TUBE GSTRM 18FR 10CM 5-10ML ENTUIT ENFIT BLN RTNT FD BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27219617 EAP TUBE FD 22FR 10CM 20ML ENTUIT BLN RTNT MR CONDITIONAL LG BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27219618 EAP HCPCS C1769 SET GSTRM LG 20-24FR 22-26FR STRL ENTUIT SRT COONS DIL PLWY BOTH IP/OP $213.00 $158.00 $42.28 $213.00 $115.66 $115.66 $115.66 $115.66 $213.00 $213.00 $213.00 $44.39 $213.00 $158.09 $158.09 $164.18 $110.97 $44.39 $213.00 $213.00 $125.99 $213.00 $213.00 $213.00 $213.00 $159.75 $213.00 $213.00 $213.00 $106.50 $106.50 $168.70 $213.00 $170.40 $138.45 $42.28 $213.00 $123.54 $213.00 $213.00 $213.00 $44.39 $213.00 N/A N/A 27219620 EAP INST ABLAT SPINESTAR 5-10 GEN2 BOTH IP/OP "$7,250.00" "$5,365.00" "$1,290.50" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$1,290.50" "$7,250.00" "$7,250.00" "$4,181.12" "$4,181.12" "$5,588.30" "$2,060.15" "$1,510.98" "$7,250.00" "$2,900.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$5,437.50" "$7,250.00" "$7,250.00" "$7,250.00" "$3,625.00" "$3,625.00" "$5,742.00" "$7,250.00" "$5,800.00" "$4,712.50" "$7,250.00" "$7,250.00" "$4,205.00" "$7,250.00" "$4,350.00" "$7,250.00" "$7,250.00" "$7,250.00" N/A N/A 27219622 EAP HCPCS C2623 CATHETER BLNDIL 5MM 40CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219623 EAP HCPCS C2623 CATHETER BLNDIL 5MM 40CM 60MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219624 EAP HCPCS C2623 CATHETER BLNDIL 5MM 40CM 80MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219625 EAP HCPCS C2623 CATHETER BLNDIL 5MM 40CM 100MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219626 EAP HCPCS C2623 CATHETER BLNDIL 6MM 40CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219627 EAP HCPCS C2623 CATHETER BLNDIL 6MM 40CM 60MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219628 EAP HCPCS C2623 CATHETER BLNDIL 6MM 40CM 80MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219629 EAP HCPCS C2623 CATHETER BLNDIL 6MM 40CM 100MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219630 EAP HCPCS C2623 CATHETER BLNDIL 7MM 40CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219631 EAP HCPCS C2623 CATHETER BLNDIL 7MM 40CM 60MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219632 EAP HCPCS C2623 CATHETER BLNDIL 8MM 40CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219633 EAP HCPCS C2623 CATHETER BLNDIL 7FR 8MM 40CM 60MM LUTONIX DRG COAT ACPT .035 BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219634 EAP HCPCS C2623 CATHETER BLNDIL 4MM 75CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219635 EAP HCPCS C2623 CATHETER BLNDIL 4MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219636 EAP HCPCS C2623 CATHETER BLNDIL 4MM 75CM 80MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219637 EAP HCPCS C2623 CATHETER BLNDIL 4MM 75CM 100MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219638 EAP HCPCS C2623 CATHETER BLNDIL 5MM 75CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219639 EAP HCPCS C2623 CATHETER BLNDIL 5MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219640 EAP HCPCS C2623 CATHETER BLNDIL 5MM 75CM 80MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219641 EAP HCPCS C2623 CATHETER BLNDIL 5MM 75CM 100MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219642 EAP HCPCS C2623 CATHETER BLNDIL 6MM 75CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219643 EAP HCPCS C2623 CATHETER BLNDIL 6MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219644 EAP HCPCS C2623 CATHETER BLNDIL 6MM 75CM 80MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219645 EAP HCPCS C2623 CATHETER BLNDIL 6MM 75CM 100MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219646 EAP HCPCS C2623 CATHETER BLNDIL 7MM 75CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219647 EAP HCPCS C2623 CATHETER BLNDIL 7MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219648 EAP HCPCS C2623 CATHETER BLNDIL 8MM 75CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219649 EAP HCPCS C2623 CATHETER BLNDIL 8MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219650 EAP HCPCS C2623 CATHETER BLNDIL 9MM 75CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219651 EAP HCPCS C2623 CATHETER BLNDIL 9MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219652 EAP HCPCS C2623 CATHETER BLNDIL 10MM 75CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219653 EAP HCPCS C2623 CATHETER BLNDIL 10MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219654 EAP HCPCS C2623 CATHETER BLNDIL 12MM 75CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219655 EAP HCPCS C2623 CATHETER BLNDIL 8MM 100CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219656 EAP HCPCS C2623 CATHETER BLNDIL 8MM 100CM 60MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219657 EAP HCPCS C2623 CATHETER BLNDIL 9MM 100CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219658 EAP HCPCS C2623 CATHETER BLNDIL 9MM 100CM 60MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219659 EAP HCPCS C2623 CATHETER BLNDIL 10MM 100CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219660 EAP HCPCS C2623 CATHETER BLNDIL 8FR 10MM 100CM 60MM LUTONIX DRG COAT ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219661 EAP HCPCS C2623 CATHETER BLNDIL 12MM 100CM 40MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 27219662 EAP TUBE FD 24FR 10CM 20ML ENTUIT BLN RTNT MR CONDITIONAL LG BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 27219665 EAP HCPCS C1729 STENT INTRACRANIAL PULSERIDER T L10 MM OD4 MM BOTH IP/OP "$31,250.00" "$23,125.00" "$2,060.15" "$31,250.00" "$16,968.75" "$16,968.75" "$16,968.75" "$16,968.75" "$31,250.00" "$31,250.00" "$31,250.00" "$6,513.28" "$31,250.00" "$4,181.12" "$4,181.12" "$24,087.50" "$2,060.15" "$6,512.84" "$31,250.00" "$31,250.00" "$3,094.73" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$23,437.50" "$31,250.00" "$31,250.00" "$31,250.00" "$15,625.00" "$15,625.00" "$24,750.00" "$31,250.00" "$25,000.00" "$20,312.50" "$6,202.34" "$31,250.00" "$18,125.00" "$31,250.00" "$31,250.00" "$31,250.00" "$6,512.50" "$31,250.00" N/A N/A 27219667 EAP HCPCS C1769 GUIDEWIRE VASC STRG .035IN 260CM 6CM HIWIRE BNTSN ATRM X BOTH IP/OP $57.00 $42.50 $11.31 $57.00 $30.95 $30.95 $30.95 $30.95 $57.00 $57.00 $57.00 $11.88 $57.00 $42.31 $42.31 $43.94 $29.70 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $37.05 $11.31 $57.00 $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 27219668 EAP HCPCS C1887 CATHETER GD 10D 2.1-3.5FR 135CM 7MM TWNPS 2 LUM OTW TRQ BRD BOTH IP/OP "$1,123.00" $831.50 $222.89 "$1,123.00" $609.79 $609.79 $609.79 $609.79 "$1,123.00" "$1,123.00" "$1,123.00" $234.06 "$1,123.00" $833.49 $833.49 $865.61 $585.08 $234.05 "$1,123.00" "$1,123.00" $664.25 "$1,123.00" "$1,123.00" "$1,123.00" "$1,123.00" $842.25 "$1,123.00" "$1,123.00" "$1,123.00" $561.50 $561.50 $889.42 "$1,123.00" $898.40 $729.95 $222.89 "$1,123.00" $651.34 "$1,123.00" "$1,123.00" "$1,123.00" $234.03 "$1,123.00" N/A N/A 27219669 EAP DRILL SRG VERTECOR BN BOTH IP/OP $550.00 $407.00 $97.90 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $97.90 $550.00 $550.00 $408.21 $408.21 $423.94 $286.55 $114.63 $550.00 $220.00 $550.00 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $357.50 $550.00 $550.00 $319.00 $550.00 $330.00 $550.00 $550.00 $550.00 N/A N/A 27219670 EAP CATHETER CHLGM SPYSCOPE DS ACC DLV DISP BOTH IP/OP "$6,875.00" "$5,087.50" "$1,223.75" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$1,223.75" "$6,875.00" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$2,750.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$6,875.00" "$6,875.00" "$3,987.50" "$6,875.00" "$4,125.00" "$6,875.00" "$6,875.00" "$6,875.00" N/A N/A 27219671 EAP HCPCS C1887 CATHETER INTVN 5.1FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 27219672 EAP HCPCS C1887 CATHETER INTVN 5.7FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 27219673 EAP HCPCS C1887 CATHETER INTVN 6.5FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 27219674 EAP HCPCS C1750 CATHETER HMDIAL 14.5FR 19CM MH MXD SPORTPACK 2 LUM KINK RST BOTH IP/OP $225.00 $166.50 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 $225.00 $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 27219675 EAP HCPCS C1894 SHEATH GD 8FR 2.9MM 40CM STRL FLXR CHFL BLKN DISP ACPT .038 BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219676 EAP HCPCS C1887 MICROCATHETER CRBRVASC THNWL 2FR .019IN 130CM 70CM PROGREAT BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 27219677 EAP HCPCS C1887 MICROCATHETER CRBRVASC THNWL 2FR .019IN 150CM 90CM PROGREAT BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 27219678 EAP HCPCS C1769 EMBROTRAP II REVASCULARIZATION DEVICE (5X21) BOTH IP/OP "$9,500.00" "$7,030.00" "$1,885.51" "$9,500.00" "$5,158.50" "$5,158.50" "$5,158.50" "$5,158.50" "$9,500.00" "$9,500.00" "$9,500.00" "$1,980.04" "$9,500.00" "$4,181.12" "$4,181.12" "$7,322.60" "$2,060.15" "$1,979.90" "$9,500.00" "$9,500.00" "$3,094.73" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$7,125.00" "$9,500.00" "$9,500.00" "$9,500.00" "$4,750.00" "$4,750.00" "$7,524.00" "$9,500.00" "$7,600.00" "$6,175.00" "$1,885.51" "$9,500.00" "$5,510.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.80" "$9,500.00" N/A N/A 27219679 EAP HCPCS C1769 EMBROTRAP II REVASCULARIZATION DEVICE (5X33) BOTH IP/OP "$9,500.00" "$7,030.00" "$1,885.51" "$9,500.00" "$5,158.50" "$5,158.50" "$5,158.50" "$5,158.50" "$9,500.00" "$9,500.00" "$9,500.00" "$1,980.04" "$9,500.00" "$4,181.12" "$4,181.12" "$7,322.60" "$2,060.15" "$1,979.90" "$9,500.00" "$9,500.00" "$3,094.73" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$7,125.00" "$9,500.00" "$9,500.00" "$9,500.00" "$4,750.00" "$4,750.00" "$7,524.00" "$9,500.00" "$7,600.00" "$6,175.00" "$1,885.51" "$9,500.00" "$5,510.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.80" "$9,500.00" N/A N/A 27219680 EAP CATHETER ANGIO.038IN CHGB CRV 5FR BOTH IP/OP $313.00 $232.00 $55.71 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $55.71 $313.00 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $125.20 $313.00 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $313.00 $313.00 $181.54 $313.00 $187.80 $313.00 $313.00 $313.00 N/A N/A 27219681 EAP CATHETER ANGIO ROSCH INFR MES CRV TPR 5FR 65CM STRL 41 BOTH IP/OP $313.00 $232.00 $55.71 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $55.71 $313.00 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $125.20 $313.00 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $313.00 $313.00 $181.54 $313.00 $187.80 $313.00 $313.00 $313.00 N/A N/A 27219682 EAP HCPCS C1725 CATHETER ANGIOGRAPHIC ANGLE 4FR.041IN 65CM 15CM 2 BRAID BOTH IP/OP $123.00 $91.50 $24.41 $123.00 $66.79 $66.79 $66.79 $66.79 $123.00 $123.00 $123.00 $25.64 $123.00 $91.29 $91.29 $94.81 $64.08 $25.63 $123.00 $123.00 $72.75 $123.00 $123.00 $123.00 $123.00 $92.25 $123.00 $123.00 $123.00 $61.50 $61.50 $97.42 $123.00 $98.40 $79.95 $24.41 $123.00 $71.34 $123.00 $123.00 $123.00 $25.63 $123.00 N/A N/A 27219690 EAP Custom 27219690 DEVICE INDFLTR PLUS 30 10ML INFLAT 30 ATM DISP BOTH IP/OP $175.00 $129.50 $31.15 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $31.15 $175.00 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $70.00 $175.00 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $175.00 $175.00 $101.50 $175.00 $105.00 $175.00 $175.00 $175.00 N/A N/A 27219691 EAP Custom 27219691 KIT INFLAT INDFLTR PLUS 30 .096IN CORON ROT HMST BOTH IP/OP $138.00 $102.50 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 $138.00 $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 27219692 EAP Custom 27219692 DEVICE INDFLTR PLUS 30 10ML ROT HMST VLV GWIRE BOTH IP/OP $138.00 $102.50 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 $138.00 $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 27219693 EAP Custom 27219693 KIT INFLAT INDFLTR .096IN ROT HMST VLV GWIRE BOTH IP/OP $138.00 $102.50 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 $138.00 $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 27219694 EAP Custom 27219694 DEVICE 20/30 INDFLTR 20ML ROT HMST VLV GWIRE BOTH IP/OP $138.00 $102.50 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 $138.00 $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 27219695 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ STR RBN 3CM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219696 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ J RBN 4.5CM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219697 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ STR RBN 3CM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219698 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN JTP SHAPING RBN BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219699 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STRBL CORE TO TIP BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219700 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN JTP CORE TO TIP BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219701 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN CORE TO TIP RADIOPQ J BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219702 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ KINK RST J 3CM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219703 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ KINK RST STR 3 BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219704 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN J 3CM HTRQ BL MWT BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219705 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN JTP SHAPING RBN BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219706 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ KINK RST STR 3 BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219707 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN JTP SHAPING RBN BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219708 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN JTP SHAPING RBN BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219709 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN .01IN RADIOPQ COIL STR BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219710 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN .01IN RADIOPQ COIL J BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219711 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN .01IN RADIOPQ COIL STR BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219712 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN JTP CORE TO TIP BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219713 EAP Custom 27219713 VALVE HMSTS .096- IN COPLT 20 ATM INFLAT TRQ DEV BOTH IP/OP $168.00 $124.50 $29.90 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $29.90 $168.00 $168.00 $124.69 $124.69 $129.49 $87.53 $35.01 $168.00 $67.20 $168.00 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $109.20 $168.00 $168.00 $97.44 $168.00 $100.80 $168.00 $168.00 $168.00 N/A N/A 27219714 EAP Custom 27219714 VALVE HMSTS .096- IN COPLT KIT BLDBCK CNTRL VLV BOTH IP/OP $163.00 $121.00 $29.01 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $29.01 $163.00 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $65.20 $163.00 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $163.00 $163.00 $94.54 $163.00 $97.80 $163.00 $163.00 $163.00 N/A N/A 27219715 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR 3CM HTORQ WHSPR LS BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219716 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN J 3CM HTORQ WHSPR LS BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219717 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR 3CM HTORQ WHSPR LS BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $112.80 $188.00 $39.18 $188.00 N/A N/A 27219718 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN J 3CM HTORQ WHSPR MS BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219719 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN J 3CM HTORQ WHSPR MS BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219720 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN J 3CM HTRQ BL MWT U BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219721 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ J 3CM HTRQ BL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219722 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN W/O MRKR SHAPING RBN BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $112.80 $188.00 $39.18 $188.00 N/A N/A 27219723 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR 3CM HTRQ BL MWT U BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219724 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN J 3CM HTRQ BL MWT U BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219725 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ COVER STR RBN BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219726 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ J 3CM HTRQ BL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219727 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ STR 3CM HTRQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219728 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ J 3CM HTRQ BL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219729 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN MRKR TIP STR 3CM HTRQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219730 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN J 3CM HTRQ BL MWT U II BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219731 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR 3CM HTRQ BL MWT U BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219732 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN J 3CM HTRQ BL MWT U II BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219733 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ MRKR CORE TO BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219734 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ MRKR CORE TO BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219735 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN JTP CORE TO TIP BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219736 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ CORE TO TIP BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219737 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ MRKR CORE TO BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219738 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ MRKR CORE TO BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219739 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ MRKR CORE TO BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219740 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ MRKR CORE TO BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219741 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ MRKR STR 3CM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219742 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ MRKR J 3CM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219743 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ MRKR STR 3CM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219744 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ MRKR J 3CM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219745 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ MRKR STR 3CM BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 27219746 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ MRKR STR 3CM BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 27219747 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ MRKR STR 3CM BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 27219748 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ MRKR STR 3CM BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 27219749 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ MRKR STR TPR 3 BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 27219750 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ MRKR STR TPR 3 BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 27219751 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ STR TPR 3CM BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 27219752 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ MRKR STR TPR 3 BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 27219753 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ MRKR STR 3CM BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 27219754 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ MRKR STR 3CM BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 27219755 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN MRKR STR 3CM HTRQ BL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219756 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ J 3CM HTRQ BL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219757 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ STR 3CM HTRQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219758 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ J 3CM HTRQ BL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219759 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN W/O MRKR STR 3CM HTRQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219760 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN J 3CM HTRQ BL MWT ELT BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219761 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR 3CM HTRQ BL MWT BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219762 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN J 3CM HTRQ BL MWT ELT BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219763 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR 3CM HTORQ BAL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219764 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR 3CM HTORQ BAL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219765 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN J 3CM HTORQ BAL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219766 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN J 3CM HTORQ BAL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219767 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR 3CM HTORQ BAL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219768 EAP HCPCS C1769 GUIDEWIRE VASC 175CM .014IN STR 3CM HTORQ BAL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219769 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ STR 3CM HTORQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219770 EAP Custom 27219770 VALVE HMSTS .115IN DUOSTAT ROT BOTH IP/OP $58.00 $43.00 $10.32 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $10.32 $58.00 $58.00 $43.05 $43.05 $44.71 $30.22 $12.09 $58.00 $23.20 $58.00 $58.00 $58.00 $58.00 $58.00 $43.50 $58.00 $58.00 $58.00 $29.00 $29.00 $45.94 $58.00 $46.40 $37.70 $58.00 $58.00 $33.64 $58.00 $34.80 $58.00 $58.00 $58.00 N/A N/A 27219771 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR 30CM HTRQ WG SS BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219772 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN J TPR 3CM HTRQ TRNS SS BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219773 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR TPR 3CM HTRQ TRNS BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219774 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR TIP TPR 3CM HTRQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219775 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN JTP LGHT SPRT SHAPING BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219776 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR 2CM HTRQ WG SS BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219777 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN X SPRT STR 2CM HTRQ FL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219778 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR TIP LGHT SPRT BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219779 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR SPRG TPR 3CM HTRQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219780 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR SPRG TPR 3CM HTRQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219781 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN JTP LGHT SPRT SHAPING BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219782 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN LGHT SPRT STR 30CM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219783 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .018IN LGHT SPRT STR 2CM HTRQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219784 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR TIP STR 2CM HTRQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219785 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR 2CM HTRQ FL2 SS BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219786 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR 2CM HTORQ STD SS BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219787 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN J 2CM HTORQ STD SS BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219788 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR 2CM HTORQ STD SS BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219789 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN RADIOPQ J 3CM HTRQ INM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219790 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR 3CM HTRQ INM MCGLD BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219791 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN J 3CM HTRQ INM HDRCT BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219792 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR 3CM HTRQ INM HDRCT BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219793 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR 3CM HTRQ INM HDRCT BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219794 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR RBN 30CM HTRQ WG BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219795 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR SHAPING RBN 2CM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219796 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN LGHT SPRT STR 30CM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219797 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN LGHT SPRT STR TIP 2CM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219798 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR 2CM HTRQ FL2 SS BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219799 EAP Custom 27219799 KIT GWIRE .009-.018IN .115IN INTROD TRQ DEV ROT BOTH IP/OP $88.00 $65.50 $15.66 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $15.66 $88.00 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $35.20 $88.00 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $88.00 $88.00 $51.04 $88.00 $52.80 $88.00 $88.00 $88.00 N/A N/A 27219800 EAP Custom 27219800 KIT GWIRE .01-.018IN BOTH IP/OP $88.00 $65.50 $15.66 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $88.00 $15.66 $88.00 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $35.20 $88.00 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $88.00 $88.00 $51.04 $88.00 $52.80 $88.00 $88.00 $88.00 N/A N/A 27219801 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN X SPRT J 3CM HTORQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219802 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR TIP CORE TO TIP BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219803 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN X SPRT J 3CM HTRQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219804 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR TIP STR 3CM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219821 EAP HCPCS C1725 CATHETER BALDILAT 3MM 143CM 6MM OTW SMTH RND TIP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219822 EAP HCPCS C1725 CATHETER BALDILAT 3MM 143CM 12MM OTW SMTH RND TIP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219823 EAP HCPCS C1725 CATHETER BALDILAT 3MM 143CM 15MM OTW SMTH RND TIP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219824 EAP HCPCS C1725 CATHETER BALDILAT 3MM 143CM 20MM OTW SMTH RND TIP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219825 EAP HCPCS C1725 CATHETER BALDILAT 3MM 143CM 25MM OTW SMTH RND TIP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219830 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 143CM 6MM OTW SMTH RND TIP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219831 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 143CM 12MM OTW SMTH RND BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 27219832 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 143CM 15MM OTW SMTH RND BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219833 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 143CM 20MM OTW SMTH RND BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219834 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 143CM 25MM OTW SMTH RND BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219835 EAP HCPCS C1725 CATHETER BALDILAT 3.75MM 143CM 12MM OTW SMTH RND BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219836 EAP HCPCS C1725 CATHETER BALDILAT 3.75MM 143CM 15MM OTW SMTH RND BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219837 EAP HCPCS C1725 CATHETER BALDILAT 3.75MM 143CM 20MM OTW SMTH RND BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219838 EAP HCPCS C1725 CATHETER BALDILAT 4MM 143CM 8MM OTW SMTH RND TIP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219839 EAP HCPCS C1725 CATHETER BALDILAT 4MM 143CM 12MM OTW SMTH RND TIP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219840 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 143CM 8MM OTW SMTH RND TIP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219841 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 143CM 12MM OTW SMTH RND BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219842 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 143CM 15MM OTW SMTH RND BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219843 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 143CM 20MM OTW SMTH RND BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219844 EAP HCPCS C1725 CATHETER BALDILAT 5MM 143CM 8MM OTW SMTH RND TIP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219845 EAP HCPCS C1725 CATHETER BALDILAT 5MM 143CM 20MM OTW SMTH RND TIP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 27219846 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR 3CM HTORQ ADV LT BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219847 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STR 3CM HTORQ ADV BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219848 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN J 3CM HTORQ ADV BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219849 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR 3CM HTORQ ADV BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219850 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN J 3CM HTORQ ADV BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 27219851 EAP HCPCS C1769 GUIDEWIRE VASC 300CM PTCA ASAHI ULTIMATEBROS 3 BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219852 EAP HCPCS C1769 GUIDEWIRE VASC 180CM PTCA ASAHI ULTIMATEBROS 3 BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219853 EAP HCPCS C1769 GUIDEWIRE VASC 300CM 3CM STR ASAHI SUOH PTCA BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219854 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN SION ASAHI PTCA BLUE BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219855 EAP HCPCS C1769 GUIDEWIRE VASC 300CM WIRE J ASAHI PTCA SION BLUE BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219856 EAP HCPCS C1769 GUIDEWIRE VASC 190CM STR 3CM ASAHI SUOH PTCA BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219857 EAP HCPCS C1769 GUIDEWIRE VASC 190CM PSHP MINI 3CM ASAHI SUOH PTCA BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219858 EAP HCPCS C1769 GUIDEWIRE VASC 180CM WIRE J ASAHI PTCA SION BLUE BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219859 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN CORE TO TIP J 3CM A BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219860 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN JTP 3CM A FLDR FC PLMR BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219861 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ CORE TO TIP BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219862 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN CORE TO TIP STR 11CM A BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219863 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN HBRD RADIOPQ STR TIP BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219864 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN CORE TO TIP J 3CM A BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219865 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN CORE TO TIP J 3CM A BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219866 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN CORE TO TIP STR 3CM A BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219867 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN CORE TO TIP STR 3CM A BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219868 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN CORE TO TIP J 3CM BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219869 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN CORE TO TIP J 3CM BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219870 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN HBRD RADIOPQ STR TIP 3 BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219871 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN HBRD RADIOPQ STR TIP 3 BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219872 EAP HCPCS C1769 GUIDEWIRE VASC 300CM PTCA A CFNZ PRO BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219873 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .009IN RADIOPQ STR TIP 20CM A BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219874 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN RADIOPQ CORE TO TIP J BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219875 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN RADIOPQ STR TIP 11CM BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219876 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN RADIOPQ STR TIP 11CM BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219877 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN RADIOPQ STR TIP 3CM BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219878 EAP HCPCS C1769 GUIDEWIRE VASC 180CM J ASAHI SFT PTCA BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219879 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN RADIOPQ CORE TO TIP BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219880 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN RADIOPQ CORE TO TIP J BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219881 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN RADIOPQ STR TIP 3CM BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219882 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN RADIOPQ CORE TO TIP BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219883 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN .009IN RADIOPQ STR TIP BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219884 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN RADIOPQ STR TIP 3CM BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219885 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ CORE TO TIP J BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219886 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ CORE TO TIP BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219887 EAP HCPCS C1769 GUIDEWIRE VASC 300CM J ASAHI SFT PTCA BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219888 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ CORE TO TIP J BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219889 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ CORE TO TIP BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219890 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ CORE TO TIP BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219891 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ STR TPR TIP 3 BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 27219892 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ CORE TO TIP BOTH IP/OP $938.00 $694.50 $186.17 $938.00 $509.33 $509.33 $509.33 $509.33 $938.00 $938.00 $938.00 $195.50 $938.00 $696.18 $696.18 $723.01 $488.70 $195.49 $938.00 $938.00 $554.83 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $609.70 $186.17 $938.00 $544.04 $938.00 $938.00 $938.00 $195.48 $938.00 N/A N/A 27219893 EAP HCPCS C1769 INTROD GWIRE .009-.018IN CORON BOTH IP/OP $75.00 $55.50 $14.89 $75.00 $40.73 $40.73 $40.73 $40.73 $75.00 $75.00 $75.00 $15.63 $75.00 $55.67 $55.67 $57.81 $39.08 $15.63 $75.00 $75.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $48.75 $14.89 $75.00 $43.50 $75.00 $75.00 $75.00 $15.63 $75.00 N/A N/A 27219894 EAP Custom 27219894 DEVICE TRQ GWIRE ACPT .009-.018 IN GWIRE BOTH IP/OP $125.00 $92.50 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 $125.00 $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 27219896 EAP HCPCS C1887 CATHETER INFS MIC 2.1-1.7FR 5FR .017IN 155CM .34ML 150CM BOTH IP/OP "$1,588.00" "$1,175.50" $315.18 "$1,588.00" $862.28 $862.28 $862.28 $862.28 "$1,588.00" "$1,588.00" "$1,588.00" $330.98 "$1,588.00" "$1,178.61" "$1,178.61" "$1,224.03" $827.35 $330.96 "$1,588.00" "$1,588.00" $939.30 "$1,588.00" "$1,588.00" "$1,588.00" "$1,588.00" "$1,191.00" "$1,588.00" "$1,588.00" "$1,588.00" $794.00 $794.00 "$1,257.70" "$1,588.00" "$1,270.40" "$1,032.20" $315.18 "$1,588.00" $921.04 "$1,588.00" "$1,588.00" "$1,588.00" $330.94 "$1,588.00" N/A N/A 27219897 EAP HCPCS C1757 RETRIEVER ESCP TREVO XP PROVUE BOTH IP/OP "$13,641.00" "$10,094.50" "$2,060.15" "$13,641.00" "$7,407.06" "$7,407.06" "$7,407.06" "$7,407.06" "$13,641.00" "$13,641.00" "$13,641.00" "$2,843.13" "$13,641.00" "$4,181.12" "$4,181.12" "$10,514.48" "$2,060.15" "$2,842.93" "$13,641.00" "$13,641.00" "$3,094.73" "$13,641.00" "$13,641.00" "$13,641.00" "$13,641.00" "$10,230.75" "$13,641.00" "$13,641.00" "$13,641.00" "$6,820.50" "$6,820.50" "$10,803.67" "$13,641.00" "$10,912.80" "$8,866.65" "$2,707.40" "$13,641.00" "$7,911.78" "$13,641.00" "$13,641.00" "$13,641.00" "$2,842.78" "$13,641.00" N/A N/A 27219898 EAP HCPCS C1725 CATHETER BALDILAT LP 5.3FR 4MM 75CM 60MM HIGH PRESSURE BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 27219899 EAP HCPCS C1894 INTRODUCER SHEATH .035IN ANL1 CURVE 11.4FR 10FR 45CM HIGH BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 $200.00 $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 27219900 EAP HCPCS C1751 CATHETER CV 9.3FR 22CM STRL LF CL LN HEAT EXCH KT BOTH IP/OP "$1,288.00" $953.50 $255.64 "$1,288.00" $699.38 $699.38 $699.38 $699.38 "$1,288.00" "$1,288.00" "$1,288.00" $268.45 "$1,288.00" $955.95 $955.95 $992.79 $671.05 $268.43 "$1,288.00" "$1,288.00" $761.85 "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" $966.00 "$1,288.00" "$1,288.00" "$1,288.00" $644.00 $644.00 "$1,020.10" "$1,288.00" "$1,030.40" $837.20 $255.64 "$1,288.00" $747.04 "$1,288.00" "$1,288.00" "$1,288.00" $268.42 "$1,288.00" N/A N/A 27219901 EAP HCPCS C1751 KIT CATH 9.3FR 38CM ICY CV BOTH IP/OP "$2,053.00" "$1,519.50" $407.47 "$2,053.00" "$1,114.78" "$1,114.78" "$1,114.78" "$1,114.78" "$2,053.00" "$2,053.00" "$2,053.00" $427.90 "$2,053.00" "$1,523.74" "$1,523.74" "$1,582.45" "$1,069.61" $427.87 "$2,053.00" "$2,053.00" "$1,214.35" "$2,053.00" "$2,053.00" "$2,053.00" "$2,053.00" "$1,539.75" "$2,053.00" "$2,053.00" "$2,053.00" "$1,026.50" "$1,026.50" "$1,625.98" "$2,053.00" "$1,642.40" "$1,334.45" $407.47 "$2,053.00" "$1,190.74" "$2,053.00" "$2,053.00" "$2,053.00" $427.85 "$2,053.00" N/A N/A 27219902 EAP HCPCS C1887 KIT CATH 9.3FR 45CM QUATTRO HEAT EXCH 3 LUM LL APPLAUSE HEP BOTH IP/OP "$2,299.00" "$1,701.50" $456.29 "$2,299.00" "$1,248.36" "$1,248.36" "$1,248.36" "$1,248.36" "$2,299.00" "$2,299.00" "$2,299.00" $479.17 "$2,299.00" "$1,706.32" "$1,706.32" "$1,772.07" "$1,197.78" $479.14 "$2,299.00" "$2,299.00" "$1,359.86" "$2,299.00" "$2,299.00" "$2,299.00" "$2,299.00" "$1,724.25" "$2,299.00" "$2,299.00" "$2,299.00" "$1,149.50" "$1,149.50" "$1,820.81" "$2,299.00" "$1,839.20" "$1,494.35" $456.29 "$2,299.00" "$1,333.42" "$2,299.00" "$2,299.00" "$2,299.00" $479.11 "$2,299.00" N/A N/A 27219903 EAP KIT IV CLGRD 3K SRT BOTH IP/OP $455.00 $337.00 $80.99 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $80.99 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 27219904 EAP TUBING XTN 9FT BOTH IP/OP $511.00 $378.50 $90.96 $511.00 $511.00 $511.00 $511.00 $511.00 $511.00 $511.00 $90.96 $511.00 $511.00 $379.26 $379.26 $393.88 $266.23 $106.50 $511.00 $204.40 $511.00 $511.00 $511.00 $511.00 $511.00 $383.25 $511.00 $511.00 $511.00 $255.50 $255.50 $404.71 $511.00 $408.80 $332.15 $511.00 $511.00 $296.38 $511.00 $306.60 $511.00 $511.00 $511.00 N/A N/A 27219905 EAP PACK SRG 6FT IVTM COOL LINE SRT UP DISP BOTH IP/OP "$6,725.00" "$4,976.50" "$1,197.05" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$1,197.05" "$6,725.00" "$6,725.00" "$4,181.12" "$4,181.12" "$5,183.63" "$2,060.15" "$1,401.56" "$6,725.00" "$2,690.00" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$5,043.75" "$6,725.00" "$6,725.00" "$6,725.00" "$3,362.50" "$3,362.50" "$5,326.20" "$6,725.00" "$5,380.00" "$4,371.25" "$6,725.00" "$6,725.00" "$3,900.50" "$6,725.00" "$4,035.00" "$6,725.00" "$6,725.00" "$6,725.00" N/A N/A 27219906 EAP PACK SRG 6FT IVTM ICY SRT UP DISP BOTH IP/OP "$9,640.00" "$7,134.00" "$1,715.92" "$9,640.00" "$9,640.00" "$9,640.00" "$9,640.00" "$9,640.00" "$9,640.00" "$9,640.00" "$1,715.92" "$9,640.00" "$9,640.00" "$4,181.12" "$4,181.12" "$7,430.51" "$2,060.15" "$2,009.08" "$9,640.00" "$3,856.00" "$9,640.00" "$9,640.00" "$9,640.00" "$9,640.00" "$9,640.00" "$7,230.00" "$9,640.00" "$9,640.00" "$9,640.00" "$4,820.00" "$4,820.00" "$7,634.88" "$9,640.00" "$7,712.00" "$6,266.00" "$9,640.00" "$9,640.00" "$5,591.20" "$9,640.00" "$5,784.00" "$9,640.00" "$9,640.00" "$9,640.00" N/A N/A 27219907 EAP PACK SRG 6FT IVTM QUATTRO SRT UP DISP BOTH IP/OP "$10,579.00" "$7,828.50" "$1,883.06" "$10,579.00" "$10,579.00" "$10,579.00" "$10,579.00" "$10,579.00" "$10,579.00" "$10,579.00" "$1,883.06" "$10,579.00" "$10,579.00" "$4,181.12" "$4,181.12" "$8,154.29" "$2,060.15" "$2,204.78" "$10,579.00" "$4,231.60" "$10,579.00" "$10,579.00" "$10,579.00" "$10,579.00" "$10,579.00" "$7,934.25" "$10,579.00" "$10,579.00" "$10,579.00" "$5,289.50" "$5,289.50" "$8,378.57" "$10,579.00" "$8,463.20" "$6,876.35" "$10,579.00" "$10,579.00" "$6,135.82" "$10,579.00" "$6,347.40" "$10,579.00" "$10,579.00" "$10,579.00" N/A N/A 27219911 EAP DRAIN INCS STRL LF OAS BLD RCVR DRY SCT ATS CMPT 1 PT TUBE BOTH IP/OP $93.00 $69.00 $16.55 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $16.55 $93.00 $93.00 $69.02 $69.02 $71.68 $48.45 $19.38 $93.00 $37.20 $93.00 $93.00 $93.00 $93.00 $93.00 $69.75 $93.00 $93.00 $93.00 $46.50 $46.50 $73.66 $93.00 $74.40 $60.45 $93.00 $93.00 $53.94 $93.00 $55.80 $93.00 $93.00 $93.00 N/A N/A 27219912 EAP SEPARATOR THRMB STRL LF INDG SYS 4 DISP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$1,632.84" "$1,632.84" "$1,695.76" "$1,146.20" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" "$1,430.00" "$2,200.00" "$2,200.00" "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 27219913 EAP CATHETER SCT 16MM 105CM STRL LF CLOTTRIEVER DISP BOTH IP/OP "$11,988.00" "$8,871.50" "$2,060.15" "$11,988.00" "$11,988.00" "$11,988.00" "$11,988.00" "$11,988.00" "$11,988.00" "$11,988.00" "$2,133.86" "$11,988.00" "$11,988.00" "$4,181.12" "$4,181.12" "$9,240.35" "$2,060.15" "$2,498.43" "$11,988.00" "$4,795.20" "$11,988.00" "$11,988.00" "$11,988.00" "$11,988.00" "$11,988.00" "$8,991.00" "$11,988.00" "$11,988.00" "$11,988.00" "$5,994.00" "$5,994.00" "$9,494.50" "$11,988.00" "$9,590.40" "$7,792.20" "$11,988.00" "$11,988.00" "$6,953.04" "$11,988.00" "$7,192.80" "$11,988.00" "$11,988.00" "$11,988.00" N/A N/A 27219914 EAP CATHETER SCT 4.6MM 15CM STRL LF CLOTTRIEVER SHTH DISP BOTH IP/OP "$3,238.00" "$2,396.50" $576.36 "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" $576.36 "$3,238.00" "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$1,295.20" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" "$3,238.00" "$3,238.00" "$1,878.04" "$3,238.00" "$1,942.80" "$3,238.00" "$3,238.00" "$3,238.00" N/A N/A 27219915 EAP HCPCS C1757 SET THROMBECTOMY 6FR 3MM 120CM 15MM OTW CONTRAST INJEC PORT BOTH IP/OP "$5,013.00" "$3,710.00" $994.96 "$5,013.00" "$5,013.00" "$5,013.00" "$5,013.00" "$5,013.00" "$5,013.00" "$5,013.00" "$5,013.00" "$1,044.83" "$5,013.00" "$3,720.65" "$3,720.65" "$3,864.02" "$2,060.15" "$1,044.76" "$5,013.00" "$5,013.00" "$2,965.19" "$5,013.00" "$5,013.00" "$5,013.00" "$5,013.00" "$3,759.75" "$5,013.00" "$5,013.00" "$5,013.00" "$2,506.50" "$2,506.50" "$3,970.30" "$5,013.00" "$4,010.40" "$3,258.45" $994.96 "$5,013.00" "$2,907.54" "$5,013.00" "$5,013.00" "$5,013.00" "$1,044.71" "$5,013.00" N/A N/A 27219916 EAP HCPCS C1769 GUIDEWIRE VASC ANG .035IN 150CM HIWIRE RADOPQ FLX TP STF BOTH IP/OP $423.00 $313.50 $83.95 $423.00 $229.69 $229.69 $229.69 $229.69 $423.00 $423.00 $423.00 $88.16 $423.00 $313.95 $313.95 $326.05 $220.38 $88.16 $423.00 $423.00 $250.20 $423.00 $423.00 $423.00 $423.00 $317.25 $423.00 $423.00 $423.00 $211.50 $211.50 $335.02 $423.00 $338.40 $274.95 $83.95 $423.00 $245.34 $423.00 $423.00 $423.00 $88.15 $423.00 N/A N/A 27219917 EAP CATHETER ANGIOGRAPHIC KMP CURVE 5FR 40CM TORCON NB ADVANTAGE BOTH IP/OP $194.00 $144.00 $34.53 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $194.00 $34.53 $194.00 $194.00 $143.99 $143.99 $149.54 $101.07 $40.43 $194.00 $77.60 $194.00 $194.00 $194.00 $194.00 $194.00 $145.50 $194.00 $194.00 $194.00 $97.00 $97.00 $153.65 $194.00 $155.20 $126.10 $194.00 $194.00 $112.52 $194.00 $116.40 $194.00 $194.00 $194.00 N/A N/A 27219918 EAP HCPCS C1769 GUIDEWIRE VASC 3CM STRG .014IN 190CM 25CM SPECTRE 2 COR KINK BOTH IP/OP $47.00 $35.00 $9.33 $47.00 $25.52 $25.52 $25.52 $25.52 $47.00 $47.00 $47.00 $9.80 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $47.00 $27.80 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $9.33 $47.00 $27.26 $47.00 $47.00 $47.00 $9.79 $47.00 N/A N/A 27219919 EAP HCPCS C1769 GUIDEWIRE VASC 3CM STRG .014IN 300CM 25CM SPECTRE 2 COR KINK BOTH IP/OP $48.00 $36.00 $9.53 $48.00 $26.06 $26.06 $26.06 $26.06 $48.00 $48.00 $48.00 $10.00 $48.00 $35.63 $35.63 $37.00 $25.01 $10.00 $48.00 $48.00 $28.39 $48.00 $48.00 $48.00 $48.00 $36.00 $48.00 $48.00 $48.00 $24.00 $24.00 $38.02 $48.00 $38.40 $31.20 $9.53 $48.00 $27.84 $48.00 $48.00 $48.00 $10.00 $48.00 N/A N/A 27219920 EAP HCPCS C1753 CATHETER ULTRASOUND 20MHZ 3.4FR 135CM SCANNER TRANSDUCER BOTH IP/OP "$1,688.00" "$1,249.50" $335.03 "$1,688.00" $916.58 $916.58 $916.58 $916.58 "$1,688.00" "$1,688.00" "$1,688.00" $351.82 "$1,688.00" "$1,252.83" "$1,252.83" "$1,301.11" $879.45 $351.80 "$1,688.00" "$1,688.00" $998.45 "$1,688.00" "$1,688.00" "$1,688.00" "$1,688.00" "$1,266.00" "$1,688.00" "$1,688.00" "$1,688.00" $844.00 $844.00 "$1,336.90" "$1,688.00" "$1,350.40" "$1,097.20" $335.03 "$1,688.00" $979.04 "$1,688.00" "$1,688.00" "$1,688.00" $351.78 "$1,688.00" N/A N/A 27219921 EAP HCPCS C1887 CATHETER GD MPC CRV 6FR 100CM ENV LG INR LUM RADOPQ BRD SFT BOTH IP/OP $928.00 $687.00 $184.18 $928.00 $503.90 $503.90 $503.90 $503.90 $928.00 $928.00 $928.00 $193.42 $928.00 $688.76 $688.76 $715.30 $483.49 $193.41 $928.00 $928.00 $548.91 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $603.20 $184.18 $928.00 $538.24 $928.00 $556.80 $928.00 $193.40 $928.00 N/A N/A 27219922 EAP HCPCS C1725 CATHETER BLNDIL 8MM 90CM 20MM PR CTBLN OTW TPR TIP INFL PORT BOTH IP/OP "$1,759.00" "$1,302.00" $349.12 "$1,759.00" $955.14 $955.14 $955.14 $955.14 "$1,759.00" "$1,759.00" "$1,759.00" $366.62 "$1,759.00" "$1,305.53" "$1,305.53" "$1,355.84" $916.44 $366.59 "$1,759.00" "$1,759.00" "$1,040.45" "$1,759.00" "$1,759.00" "$1,759.00" "$1,759.00" "$1,319.25" "$1,759.00" "$1,759.00" "$1,759.00" $879.50 $879.50 "$1,393.13" "$1,759.00" "$1,407.20" "$1,143.35" $349.12 "$1,759.00" "$1,020.22" "$1,759.00" "$1,759.00" "$1,759.00" $366.58 "$1,759.00" N/A N/A 27219923 EAP PAD THRP UNV SM NS LF ARCTICGEL INLT/OTLT CNCT DDRGL DISP BOTH IP/OP $218.00 $161.50 $38.80 $218.00 $218.00 $218.00 $218.00 $218.00 $218.00 $218.00 $38.80 $218.00 $218.00 $161.80 $161.80 $168.03 $113.58 $45.43 $218.00 $87.20 $218.00 $218.00 $218.00 $218.00 $218.00 $163.50 $218.00 $218.00 $218.00 $109.00 $109.00 $172.66 $218.00 $174.40 $141.70 $218.00 $218.00 $126.44 $218.00 $130.80 $218.00 $218.00 $218.00 N/A N/A 27219924 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 180CM STRL LF CNFNZ PRO 12 DISP BOTH IP/OP $333.00 $246.50 $66.09 $333.00 $180.82 $180.82 $180.82 $180.82 $333.00 $333.00 $333.00 $69.41 $333.00 $247.15 $247.15 $256.68 $173.49 $69.40 $333.00 $333.00 $196.97 $333.00 $333.00 $333.00 $333.00 $249.75 $333.00 $333.00 $333.00 $166.50 $166.50 $263.74 $333.00 $266.40 $216.45 $66.09 $333.00 $193.14 $333.00 $333.00 $333.00 $69.40 $333.00 N/A N/A 27219925 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM STRL LF FIELDER FC DISP BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 $200.00 $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 27219926 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 180CM STRL LF FIELDER FC DISP BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 $200.00 $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 27219927 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM STRL LF GRAND SLAM DISP BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 27219928 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 180CM STRL LF MRCLBRS 6 DISP BOTH IP/OP $333.00 $246.50 $66.09 $333.00 $180.82 $180.82 $180.82 $180.82 $333.00 $333.00 $333.00 $69.41 $333.00 $247.15 $247.15 $256.68 $173.49 $69.40 $333.00 $333.00 $196.97 $333.00 $333.00 $333.00 $333.00 $249.75 $333.00 $333.00 $333.00 $166.50 $166.50 $263.74 $333.00 $266.40 $216.45 $66.09 $333.00 $193.14 $333.00 $333.00 $333.00 $69.40 $333.00 N/A N/A 27219929 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM STRL LF MRCLBRS 6 DISP BOTH IP/OP $333.00 $246.50 $66.09 $333.00 $180.82 $180.82 $180.82 $180.82 $333.00 $333.00 $333.00 $69.41 $333.00 $247.15 $247.15 $256.68 $173.49 $69.40 $333.00 $333.00 $196.97 $333.00 $333.00 $333.00 $333.00 $249.75 $333.00 $333.00 $333.00 $166.50 $166.50 $263.74 $333.00 $266.40 $216.45 $66.09 $333.00 $193.14 $333.00 $333.00 $333.00 $69.40 $333.00 N/A N/A 27219930 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM STRL LF MRCLBRS 3 DISP BOTH IP/OP $333.00 $246.50 $66.09 $333.00 $180.82 $180.82 $180.82 $180.82 $333.00 $333.00 $333.00 $69.41 $333.00 $247.15 $247.15 $256.68 $173.49 $69.40 $333.00 $333.00 $196.97 $333.00 $333.00 $333.00 $333.00 $249.75 $333.00 $333.00 $333.00 $166.50 $166.50 $263.74 $333.00 $266.40 $216.45 $66.09 $333.00 $193.14 $333.00 $333.00 $333.00 $69.40 $333.00 N/A N/A 27219931 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 180CM STRL LF P-H2O DISP BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 $200.00 $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 27219932 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM STRL LF P-H2O DISP BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 $200.00 $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 27219933 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM 45CM SNCHR14 BOTH IP/OP "$1,798.00" "$1,331.00" $356.86 "$1,798.00" $976.31 $976.31 $976.31 $976.31 "$1,798.00" "$1,798.00" "$1,798.00" $374.75 "$1,798.00" "$1,334.48" "$1,334.48" "$1,385.90" $936.76 $374.72 "$1,798.00" "$1,798.00" "$1,063.52" "$1,798.00" "$1,798.00" "$1,798.00" "$1,798.00" "$1,348.50" "$1,798.00" "$1,798.00" "$1,798.00" $899.00 $899.00 "$1,424.02" "$1,798.00" "$1,438.40" "$1,168.70" $356.86 "$1,798.00" "$1,042.84" "$1,798.00" "$1,798.00" "$1,798.00" $374.70 "$1,798.00" N/A N/A 27219934 EAP MEDTRONIC AORTIC AND PERIPHERAL VASCULAR - DIV MED BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$3,525.45" "$3,525.45" "$3,661.30" "$2,060.15" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$3,087.50" "$4,750.00" "$4,750.00" "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A 27219935 EAP HCPCS C1894 INTRODUCER GW GRDN II NC HMSTS VLV BOTH IP/OP "$1,688.00" "$1,249.50" $335.03 "$1,688.00" $916.58 $916.58 $916.58 $916.58 "$1,688.00" "$1,688.00" "$1,688.00" $351.82 "$1,688.00" "$1,252.83" "$1,252.83" "$1,301.11" $879.45 $351.80 "$1,688.00" "$1,688.00" $998.45 "$1,688.00" "$1,688.00" "$1,688.00" "$1,688.00" "$1,266.00" "$1,688.00" "$1,688.00" "$1,688.00" $844.00 $844.00 "$1,336.90" "$1,688.00" "$1,350.40" "$1,097.20" $335.03 "$1,688.00" $979.04 "$1,688.00" "$1,688.00" "$1,688.00" $351.78 "$1,688.00" N/A N/A 27219936 EAP BRONCHOSCOPE FLXB 600MM 3.8MM 1.2MM SLIM AMBU BOTH IP/OP $650.00 $481.00 $115.70 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $115.70 $650.00 $650.00 $482.43 $482.43 $501.02 $338.65 $135.47 $650.00 $260.00 $650.00 $650.00 $650.00 $650.00 $650.00 $487.50 $650.00 $650.00 $650.00 $325.00 $325.00 $514.80 $650.00 $520.00 $422.50 $650.00 $650.00 $377.00 $650.00 $390.00 $650.00 $650.00 $650.00 N/A N/A 27219937 EAP BRONCHOSCOPE FLXB 600MM 5MM 2.2MM AMBU ASCOPE 3 BOTH IP/OP $985.00 $729.00 $175.33 $985.00 $985.00 $985.00 $985.00 $985.00 $985.00 $985.00 $175.33 $985.00 $985.00 $731.07 $731.07 $759.24 $513.19 $205.28 $985.00 $394.00 $985.00 $985.00 $985.00 $985.00 $985.00 $738.75 $985.00 $985.00 $985.00 $492.50 $492.50 $780.12 $985.00 $788.00 $640.25 $985.00 $985.00 $571.30 $985.00 $591.00 $985.00 $985.00 $985.00 N/A N/A 27219938 EAP BLADE LRNSCP MAC S3 SPCTRM TI DISP GLIDESCOPE BOTH IP/OP $100.00 $74.00 $17.80 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $17.80 $100.00 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $40.00 $100.00 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $100.00 $100.00 $58.00 $100.00 $60.00 $100.00 $100.00 $100.00 N/A N/A 27219939 EAP BLADE LRNSCP MAC S4 SPCTRM TI DISP GLIDESCOPE BOTH IP/OP $100.00 $74.00 $17.80 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $17.80 $100.00 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $40.00 $100.00 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $100.00 $100.00 $58.00 $100.00 $60.00 $100.00 $100.00 $100.00 N/A N/A 27219940 EAP INTRODUCER TUBE 15FR 70CM STRL LF CLBRT CDE BOUG LDPE ADLT BOTH IP/OP $322.00 $238.50 $57.32 $322.00 $322.00 $322.00 $322.00 $322.00 $322.00 $322.00 $57.32 $322.00 $322.00 $238.99 $238.99 $248.20 $167.76 $67.11 $322.00 $128.80 $322.00 $322.00 $322.00 $322.00 $322.00 $241.50 $322.00 $322.00 $322.00 $161.00 $161.00 $255.02 $322.00 $257.60 $209.30 $322.00 $322.00 $186.76 $322.00 $193.20 $322.00 $322.00 $322.00 N/A N/A 27219941 EAP CATHETER PRIMAFIT SAGE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 27219942 EAP HCPCS C1729 DRAIN INCISION SMALL STATURE 1 CHAMBER SUCTION CONTROL BOTH IP/OP $51.00 $38.00 $10.12 $51.00 $27.69 $27.69 $27.69 $27.69 $51.00 $51.00 $51.00 $10.63 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $51.00 $30.17 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $10.12 $51.00 $29.58 $51.00 $51.00 $51.00 $10.63 $51.00 N/A N/A 27219943 EAP HCPCS C1729 CATHETER EXTERNAL DRAIN LARGE 1.9MM LATEX FREE BACTISEAL EVD BOTH IP/OP "$1,229.00" $909.50 $243.93 "$1,229.00" $667.35 $667.35 $667.35 $667.35 "$1,229.00" "$1,229.00" "$1,229.00" $256.15 "$1,229.00" $912.16 $912.16 $947.31 $640.31 $256.14 "$1,229.00" "$1,229.00" $726.95 "$1,229.00" "$1,229.00" "$1,229.00" "$1,229.00" $921.75 "$1,229.00" "$1,229.00" "$1,229.00" $614.50 $614.50 $973.37 "$1,229.00" $983.20 $798.85 $243.93 "$1,229.00" $712.82 "$1,229.00" "$1,229.00" "$1,229.00" $256.12 "$1,229.00" N/A N/A 27219946 EAP Custom 27219946 CANISTER WOUND DRAIN C500ML GEL TUBE CLMP CONCTR CHARCOAL BOTH IP/OP $84.00 $62.50 $14.95 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $84.00 $14.95 $84.00 $84.00 $62.34 $62.34 $64.75 $43.76 $17.51 $84.00 $33.60 $84.00 $84.00 $84.00 $84.00 $84.00 $63.00 $84.00 $84.00 $84.00 $42.00 $42.00 $66.53 $84.00 $67.20 $54.60 $84.00 $84.00 $48.72 $84.00 $50.40 $84.00 $84.00 $84.00 N/A N/A 27219947 EAP Custom 27219947 PAD WOUND DRAIN TUBE CLMP CONCTR SENSATRAC VAC STERILE BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27219948 EAP Custom 27219948 AIRWAY ESOPHAGEAL 3 STANDARD STR MASK LATEX FREE AURAONCE BOTH IP/OP $47.00 $35.00 $8.37 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $8.37 $47.00 $47.00 $34.88 $34.88 $36.23 $24.49 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $30.55 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27219949 EAP HCPCS C1769 GUIDEWIRE VASCULAR .035IN 26 13/16IN 1 END MARK SPRING STR BOTH IP/OP $44.00 $33.00 $8.73 $44.00 $23.89 $23.89 $23.89 $23.89 $44.00 $44.00 $44.00 $9.17 $44.00 $32.66 $32.66 $33.92 $22.92 $9.17 $44.00 $44.00 $26.03 $44.00 $44.00 $44.00 $44.00 $33.00 $44.00 $44.00 $44.00 $22.00 $22.00 $34.85 $44.00 $35.20 $28.60 $8.73 $44.00 $25.52 $44.00 $44.00 $44.00 $9.17 $44.00 N/A N/A 27219950 EAP Custom 27219950 KIT ARTERIAL LINE .018IN 20GA 22GA 1.75IN CATHETER RADIOPQ BOTH IP/OP $29.00 $21.50 $5.16 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $5.16 $29.00 $29.00 $21.52 $21.52 $22.35 $15.11 $6.04 $29.00 $11.60 $29.00 $29.00 $29.00 $29.00 $29.00 $21.75 $29.00 $29.00 $29.00 $14.50 $14.50 $22.97 $29.00 $23.20 $18.85 $29.00 $29.00 $16.82 $29.00 $17.40 $29.00 $29.00 $29.00 N/A N/A 27219953 EAP Custom 27219953 SOLUTION DIALYSATE 2 COMPARTMENT BAG PEEL SEAM PUREFLOW BOTH IP/OP $125.00 $92.50 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 $125.00 $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 27219954 EAP Custom 27219954 DEVICE SECURING 6FR KIT BLUE RETRIVAL PROBE WHITE CATHETER BOTH IP/OP $232.00 $172.00 $41.30 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $41.30 $232.00 $232.00 $172.19 $172.19 $178.83 $120.87 $48.35 $232.00 $92.80 $232.00 $232.00 $232.00 $232.00 $232.00 $174.00 $232.00 $232.00 $232.00 $116.00 $116.00 $183.74 $232.00 $185.60 $150.80 $232.00 $232.00 $134.56 $232.00 $139.20 $232.00 $232.00 $232.00 N/A N/A 27219955 EAP Custom 27219955 DEVICE SECURING STANDARD 8FR KIT RETRIEVAL PROBE CATHETER BOTH IP/OP $232.00 $172.00 $41.30 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $41.30 $232.00 $232.00 $172.19 $172.19 $178.83 $120.87 $48.35 $232.00 $92.80 $232.00 $232.00 $232.00 $232.00 $232.00 $174.00 $232.00 $232.00 $232.00 $116.00 $116.00 $183.74 $232.00 $185.60 $150.80 $232.00 $232.00 $134.56 $232.00 $139.20 $232.00 $232.00 $232.00 N/A N/A 27219956 EAP Custom 27219956 DEVICE SECURING STANDARD 10FR KIT RETRIEVAL PROBE CATHETER BOTH IP/OP $232.00 $172.00 $41.30 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $41.30 $232.00 $232.00 $172.19 $172.19 $178.83 $120.87 $48.35 $232.00 $92.80 $232.00 $232.00 $232.00 $232.00 $232.00 $174.00 $232.00 $232.00 $232.00 $116.00 $116.00 $183.74 $232.00 $185.60 $150.80 $232.00 $232.00 $134.56 $232.00 $139.20 $232.00 $232.00 $232.00 N/A N/A 27219957 EAP Custom 27219957 DEVICE SCR STD 14FR YLW NS LF AMT BRIDLE PREATTACH CLIP STY BOTH IP/OP $232.00 $172.00 $41.30 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $232.00 $41.30 $232.00 $232.00 $172.19 $172.19 $178.83 $120.87 $48.35 $232.00 $92.80 $232.00 $232.00 $232.00 $232.00 $232.00 $174.00 $232.00 $232.00 $232.00 $116.00 $116.00 $183.74 $232.00 $185.60 $150.80 $232.00 $232.00 $134.56 $232.00 $139.20 $232.00 $232.00 $232.00 N/A N/A 27219959 EAP Custom 27219959 KIT CATH .032IN 8.5FR 18GA 16CM LF 2.5IN BLU FLXTP ARWG+ARD BOTH IP/OP $327.00 $242.00 $58.21 $327.00 $327.00 $327.00 $327.00 $327.00 $327.00 $327.00 $58.21 $327.00 $327.00 $242.70 $242.70 $252.05 $170.37 $68.15 $327.00 $130.80 $327.00 $327.00 $327.00 $327.00 $327.00 $245.25 $327.00 $327.00 $327.00 $163.50 $163.50 $258.98 $327.00 $261.60 $212.55 $327.00 $327.00 $189.66 $327.00 $196.20 $327.00 $327.00 $327.00 N/A N/A 27219960 EAP Custom 27219960 KIT UROSTOMY CUT TO FIT 2.25- IN 2.75IN 9IN 2 PIECE BELT TAB BOTH IP/OP $42.00 $31.50 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $7.48 $42.00 $42.00 $31.17 $31.17 $32.37 $21.88 $8.75 $42.00 $16.80 $42.00 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $27.30 $42.00 $42.00 $24.36 $42.00 $25.20 $42.00 $42.00 $42.00 N/A N/A 27219961 EAP Custom 27219961 SUTURE ABSORBABLE 3-0 SH-1 27IN BRAID COATED VICRYL UNDYED BOTH IP/OP $185.00 $137.00 $32.93 $185.00 $185.00 $185.00 $185.00 $185.00 $185.00 $185.00 $32.93 $185.00 $185.00 $137.31 $137.31 $142.60 $96.39 $38.56 $185.00 $74.00 $185.00 $185.00 $185.00 $185.00 $185.00 $138.75 $185.00 $185.00 $185.00 $92.50 $92.50 $146.52 $185.00 $148.00 $120.25 $185.00 $185.00 $107.30 $185.00 $111.00 $185.00 $185.00 $185.00 N/A N/A 27219962 EAP Custom 27219962 KIT REPR 21-18GA PILT TUBE SYR REINFLATE CUF 10ML BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 27219963 EAP Custom 27219963 DRESSING ABTHERA SNSA TRC FOAM OPN ABD NEG PRSS BOTH IP/OP $920.00 $681.00 $163.76 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $163.76 $920.00 $920.00 $682.82 $682.82 $709.14 $479.32 $191.74 $920.00 $368.00 $920.00 $920.00 $920.00 $920.00 $920.00 $690.00 $920.00 $920.00 $920.00 $460.00 $460.00 $728.64 $920.00 $736.00 $598.00 $920.00 $920.00 $533.60 $920.00 $552.00 $920.00 $920.00 $920.00 N/A N/A 27219967 EAP Custom 27219967 DEVICE SECURING 12FR KIT DK BLUE BOTH IP/OP $225.00 $166.50 $40.05 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $40.05 $225.00 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $90.00 $225.00 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $225.00 $225.00 $130.50 $225.00 $135.00 $225.00 $225.00 $225.00 N/A N/A 27219968 EAP Custom 27219968 DEVICE SECURING 18FR KIT LT BLUE BOTH IP/OP $225.00 $166.50 $40.05 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $40.05 $225.00 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $90.00 $225.00 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $225.00 $225.00 $130.50 $225.00 $135.00 $225.00 $225.00 $225.00 N/A N/A 27219969 EAP HCPCS C1752 KIT CATH STRG 13FR 30CM STRL PWR-TRIALYSIS 3 LUM KINK RST BOTH IP/OP $563.00 $417.00 $117.34 $563.00 $563.00 $563.00 $563.00 $563.00 $563.00 $563.00 $563.00 $563.00 $563.00 $417.86 $417.86 $433.96 $293.32 $117.34 $563.00 $225.20 $563.00 $563.00 $563.00 $563.00 $563.00 $422.25 $563.00 $563.00 $563.00 $281.50 $281.50 $445.90 $563.00 $450.40 $365.95 $563.00 $563.00 $326.54 $563.00 $337.80 $563.00 $563.00 $563.00 N/A N/A 27219971 EAP HCPCS C1752 CATHETER HMDIAL 15CM SCHN XL KINK RST TIP CLIP SH REM STY BOTH IP/OP $119.00 $88.50 $24.80 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $88.32 $88.32 $91.73 $62.00 $24.80 $119.00 $47.60 $119.00 $119.00 $119.00 $119.00 $119.00 $89.25 $119.00 $119.00 $119.00 $59.50 $59.50 $94.25 $119.00 $95.20 $77.35 $119.00 $119.00 $69.02 $119.00 $71.40 $119.00 $119.00 $119.00 N/A N/A 27219972 EAP HCPCS C1752 SET CATH 24CM SCHN XL BSC SIL ACUTE HMDIAL BOTH IP/OP $238.00 $176.50 $49.60 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $176.64 $176.64 $183.45 $124.00 $49.60 $238.00 $95.20 $238.00 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $154.70 $238.00 $238.00 $138.04 $238.00 $142.80 $238.00 $238.00 $238.00 N/A N/A 27219974 EAP HCPCS C1755 KIT EPIDURAL CATHETERIZATION BOTH IP/OP $146.00 $108.50 $30.43 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $108.36 $108.36 $112.54 $76.07 $30.43 $146.00 $58.40 $146.00 $146.00 $146.00 $146.00 $146.00 $109.50 $146.00 $146.00 $146.00 $73.00 $73.00 $115.63 $146.00 $116.80 $94.90 $146.00 $146.00 $84.68 $146.00 $87.60 $146.00 $146.00 $146.00 N/A N/A 27219975 EAP Custom 27219975 KIT DRESSING MIDLINE CUSTOM CHANGE TRAY BOTH IP/OP $48.00 $36.00 $8.54 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $8.54 $48.00 $48.00 $35.63 $35.63 $37.00 $25.01 $10.00 $48.00 $19.20 $48.00 $48.00 $48.00 $48.00 $48.00 $36.00 $48.00 $48.00 $48.00 $24.00 $24.00 $38.02 $48.00 $38.40 $31.20 $48.00 $48.00 $27.84 $48.00 $28.80 $48.00 $48.00 $48.00 N/A N/A 27219976 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM 142CM 35MM MOZEC RX NYL PTCA BOTH IP/OP $248.00 $184.00 $49.22 $248.00 $134.66 $134.66 $134.66 $134.66 $248.00 $248.00 $248.00 $51.69 $248.00 $184.07 $184.07 $191.16 $129.21 $51.69 $248.00 $248.00 $146.69 $248.00 $248.00 $248.00 $248.00 $186.00 $248.00 $248.00 $248.00 $124.00 $124.00 $196.42 $248.00 $198.40 $161.20 $49.22 $248.00 $143.84 $248.00 $248.00 $248.00 $51.68 $248.00 N/A N/A 27219977 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM 142CM 35MM MOZEC RX NYL PTCA BOTH IP/OP $248.00 $184.00 $49.22 $248.00 $134.66 $134.66 $134.66 $134.66 $248.00 $248.00 $248.00 $51.69 $248.00 $184.07 $184.07 $191.16 $129.21 $51.69 $248.00 $248.00 $146.69 $248.00 $248.00 $248.00 $248.00 $186.00 $248.00 $248.00 $248.00 $124.00 $124.00 $196.42 $248.00 $198.40 $161.20 $49.22 $248.00 $143.84 $248.00 $248.00 $248.00 $51.68 $248.00 N/A N/A 27219978 EAP HCPCS C1725 CATHETER BLNDIL 2.75MM 142CM 35MM MOZEC RX NYL PTCA BOTH IP/OP $248.00 $184.00 $49.22 $248.00 $134.66 $134.66 $134.66 $134.66 $248.00 $248.00 $248.00 $51.69 $248.00 $184.07 $184.07 $191.16 $129.21 $51.69 $248.00 $248.00 $146.69 $248.00 $248.00 $248.00 $248.00 $186.00 $248.00 $248.00 $248.00 $124.00 $124.00 $196.42 $248.00 $198.40 $161.20 $49.22 $248.00 $143.84 $248.00 $248.00 $248.00 $51.68 $248.00 N/A N/A 27219979 EAP HCPCS C1725 CATHETER BLNDIL 3MM LF CRDS MOZEC RX PTCA BOTH IP/OP $248.00 $184.00 $49.22 $248.00 $134.66 $134.66 $134.66 $134.66 $248.00 $248.00 $248.00 $51.69 $248.00 $184.07 $184.07 $191.16 $129.21 $51.69 $248.00 $248.00 $146.69 $248.00 $248.00 $248.00 $248.00 $186.00 $248.00 $248.00 $248.00 $124.00 $124.00 $196.42 $248.00 $198.40 $161.20 $49.22 $248.00 $143.84 $248.00 $248.00 $248.00 $51.68 $248.00 N/A N/A 27219980 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM 142CM 35MM MOZEC RX NYL PTCA BOTH IP/OP $248.00 $184.00 $49.22 $248.00 $134.66 $134.66 $134.66 $134.66 $248.00 $248.00 $248.00 $51.69 $248.00 $184.07 $184.07 $191.16 $129.21 $51.69 $248.00 $99.20 $146.69 $248.00 $248.00 $248.00 $248.00 $186.00 $248.00 $248.00 $248.00 $124.00 $124.00 $196.42 $248.00 $198.40 $161.20 $49.22 $248.00 $143.84 $248.00 $248.00 $248.00 $51.68 $248.00 N/A N/A 27219981 EAP HCPCS C1725 CATHETER BLNDIL 4MM 142CM 35MM MOZEC RX NYL PTCA BOTH IP/OP $248.00 $184.00 $49.22 $248.00 $134.66 $134.66 $134.66 $134.66 $248.00 $248.00 $248.00 $51.69 $248.00 $184.07 $184.07 $191.16 $129.21 $51.69 $248.00 $99.20 $146.69 $248.00 $248.00 $248.00 $248.00 $186.00 $248.00 $248.00 $248.00 $124.00 $124.00 $196.42 $248.00 $198.40 $161.20 $49.22 $248.00 $143.84 $248.00 $248.00 $248.00 $51.68 $248.00 N/A N/A 27219982 EAP HCPCS C1894 SET INTRO 8FR 80CM LF S ARWFLX 3W STPCK SHTH RADOPQ INTGR BOTH IP/OP $331.00 $245.00 $65.70 $331.00 $179.73 $179.73 $179.73 $179.73 $331.00 $331.00 $331.00 $68.99 $331.00 $245.67 $245.67 $255.13 $172.45 $68.98 $331.00 $331.00 $195.79 $331.00 $331.00 $331.00 $331.00 $248.25 $331.00 $331.00 $331.00 $165.50 $165.50 $262.15 $331.00 $264.80 $215.15 $65.70 $331.00 $191.98 $331.00 $331.00 $331.00 $68.98 $331.00 N/A N/A 27219983 EAP Custom 27219983 CATH UMB 3.5F PU 15IN BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27219984 EAP Custom 27219984 CATH UMB 5F PU 15IN BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27219985 EAP Custom 27219985 "CATHETER, 8F THORACIC" BOTH IP/OP $35.00 $26.00 $6.23 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $6.23 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 27219986 EAP Custom 27219986 CATH TROCAR FNL 10F 9IN BOTH IP/OP $35.00 $26.00 $6.23 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $6.23 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 27219988 EAP Custom 27219988 "KIT, CHEST TUBE" BOTH IP/OP $74.00 $55.00 $13.17 $74.00 $74.00 $74.00 $74.00 $74.00 $74.00 $74.00 $13.17 $74.00 $74.00 $54.92 $54.92 $57.04 $38.55 $15.42 $74.00 $29.60 $74.00 $74.00 $74.00 $74.00 $74.00 $55.50 $74.00 $74.00 $74.00 $37.00 $37.00 $58.61 $74.00 $59.20 $48.10 $74.00 $74.00 $42.92 $74.00 $44.40 $74.00 $74.00 $74.00 N/A N/A 27219989 EAP Custom 27219989 UMBILICAL VESSEL CATHETER TRAY 88-160408 BOTH IP/OP $127.00 $94.00 $22.61 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $22.61 $127.00 $127.00 $94.26 $94.26 $97.89 $66.17 $26.47 $127.00 $50.80 $127.00 $127.00 $127.00 $127.00 $127.00 $95.25 $127.00 $127.00 $127.00 $63.50 $63.50 $100.58 $127.00 $101.60 $82.55 $127.00 $127.00 $73.66 $127.00 $76.20 $127.00 $127.00 $127.00 N/A N/A 27219990 EAP HCPCS C1887 CATHETER GD STRG 5FR .068IN .055IN 115CM 17CM SOFIA DIST ACC BOTH IP/OP "$3,040.00" "$2,250.00" $603.36 "$3,040.00" "$1,650.72" "$1,650.72" "$1,650.72" "$1,650.72" "$3,040.00" "$3,040.00" "$3,040.00" $633.61 "$3,040.00" "$2,256.29" "$2,256.29" "$2,343.23" "$1,583.84" $633.57 "$3,040.00" "$3,040.00" "$1,798.16" "$3,040.00" "$3,040.00" "$3,040.00" "$3,040.00" "$2,280.00" "$3,040.00" "$3,040.00" "$3,040.00" "$1,520.00" "$1,520.00" "$2,407.68" "$3,040.00" "$2,432.00" "$1,976.00" $603.36 "$3,040.00" "$1,763.20" "$3,040.00" "$3,040.00" "$3,040.00" $633.54 "$3,040.00" N/A N/A 27219991 EAP HCPCS C1887 CATHETER GD STRG 5FR .068IN .055IN 125CM 17CM SOFIA DIST ACC BOTH IP/OP "$3,230.00" "$2,390.50" $641.07 "$3,230.00" "$1,753.89" "$1,753.89" "$1,753.89" "$1,753.89" "$3,230.00" "$3,230.00" "$3,230.00" $673.21 "$3,230.00" "$2,397.31" "$2,397.31" "$2,489.68" "$1,682.83" $673.17 "$3,230.00" "$3,230.00" "$1,910.55" "$3,230.00" "$3,230.00" "$3,230.00" "$3,230.00" "$2,422.50" "$3,230.00" "$3,230.00" "$3,230.00" "$1,615.00" "$1,615.00" "$2,558.16" "$3,230.00" "$2,584.00" "$2,099.50" $641.07 "$3,230.00" "$1,873.40" "$3,230.00" "$3,230.00" "$3,230.00" $673.13 "$3,230.00" N/A N/A 27219992 EAP HCPCS C1725 CATHETER BLNDIL 1MM 5MM STRL LF SPHR II PRO PERC PTCA BOTH IP/OP $563.00 $417.00 $111.74 $563.00 $305.71 $305.71 $305.71 $305.71 $563.00 $563.00 $563.00 $117.34 $563.00 $417.86 $417.86 $433.96 $293.32 $117.34 $563.00 $225.20 $333.01 $563.00 $563.00 $563.00 $563.00 $422.25 $563.00 $563.00 $563.00 $281.50 $281.50 $445.90 $563.00 $450.40 $365.95 $111.74 $563.00 $326.54 $563.00 $563.00 $563.00 $117.33 $563.00 N/A N/A 27219993 EAP HCPCS C1725 CATHETER BLNDIL 1MM 8MM STRL LF SPHR II PRO PERC PTCA BOTH IP/OP $563.00 $417.00 $111.74 $563.00 $305.71 $305.71 $305.71 $305.71 $563.00 $563.00 $563.00 $117.34 $563.00 $417.86 $417.86 $433.96 $293.32 $117.34 $563.00 $563.00 $333.01 $563.00 $563.00 $563.00 $563.00 $422.25 $563.00 $563.00 $563.00 $281.50 $281.50 $445.90 $563.00 $450.40 $365.95 $111.74 $563.00 $326.54 $563.00 $563.00 $563.00 $117.33 $563.00 N/A N/A 27219994 EAP HCPCS C1725 CATHETER BLNDIL 1MM 10MM STRL LF SPHR II PRO PERC PTCA BOTH IP/OP $563.00 $417.00 $111.74 $563.00 $305.71 $305.71 $305.71 $305.71 $563.00 $563.00 $563.00 $117.34 $563.00 $417.86 $417.86 $433.96 $293.32 $117.34 $563.00 $563.00 $333.01 $563.00 $563.00 $563.00 $563.00 $422.25 $563.00 $563.00 $563.00 $281.50 $281.50 $445.90 $563.00 $450.40 $365.95 $111.74 $563.00 $326.54 $563.00 $563.00 $563.00 $117.33 $563.00 N/A N/A 27219995 EAP HCPCS C1725 CATHETER BLNDIL 1MM 15MM STRL LF SPHR II PRO PERC PTCA BOTH IP/OP $563.00 $417.00 $111.74 $563.00 $305.71 $305.71 $305.71 $305.71 $563.00 $563.00 $563.00 $117.34 $563.00 $417.86 $417.86 $433.96 $293.32 $117.34 $563.00 $225.20 $333.01 $563.00 $563.00 $563.00 $563.00 $422.25 $563.00 $563.00 $563.00 $281.50 $281.50 $445.90 $563.00 $450.40 $365.95 $111.74 $563.00 $326.54 $563.00 $337.80 $563.00 $117.33 $563.00 N/A N/A 27219996 EAP HCPCS C1725 CATHETER BLNDIL 1.25MM 5MM SPHR II PRO COR BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27219997 EAP HCPCS C1725 CATHETER BLNDIL 1.25MM 8MM SPHR II PRO COR BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27219998 EAP HCPCS C1725 CATHETER BLNDIL 1.25MM 10MM SPHR II PRO COR BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27219999 EAP HCPCS C1725 CATHETER BLNDIL 1.25MM 15MM SPHR II PRO COR BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220000 EAP HCPCS C1725 CATHETER BLNDIL 1.5MM STRL LF 10MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220001 EAP HCPCS C1725 CATHETER BLNDIL 1.5MM STRL LF 12MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220002 EAP HCPCS C1725 CATHETER BLNDIL 1.5MM STRL LF 15MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220003 EAP HCPCS C1725 CATHETER BLNDIL 1.5MM STRL LF 20MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220004 EAP HCPCS C1725 CATHETER BLNDIL 1.75MM STRL LF 10MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220005 EAP HCPCS C1725 CATHETER BLNDIL 1.75MM STRL LF 15MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220006 EAP HCPCS C1725 CATHETER BLNDIL 1.75MM STRL LF 20MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220007 EAP HCPCS C1725 CATHETER BLNDIL 2MM STRL LF 10MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220008 EAP HCPCS C1725 CATHETER BLNDIL 2MM STRL LF 12MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220009 EAP HCPCS C1725 CATHETER BLNDIL 2MM STRL LF 15MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220010 EAP HCPCS C1725 CATHETER BLNDIL 2MM STRL LF 20MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220011 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM STRL LF 10MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220012 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM STRL LF 15MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $240.00 $400.00 $83.36 $400.00 N/A N/A 27220013 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM STRL LF 20MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220014 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM STRL LF 10MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $240.00 $400.00 $83.36 $400.00 N/A N/A 27220015 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM STRL LF 12MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $240.00 $400.00 $83.36 $400.00 N/A N/A 27220016 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM STRL LF 15MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220017 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM STRL LF 20MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220018 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM STRL LF 30MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220019 EAP HCPCS C1725 CATHETER BLNDIL 2.75MM STRL LF 10MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220020 EAP HCPCS C1725 CATHETER BLNDIL 2.75MM STRL LF 15MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220021 EAP HCPCS C1725 CATHETER BLNDIL 2.75MM STRL LF 20MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220022 EAP HCPCS C1725 CATHETER BLNDIL 3MM STRL LF 10MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220023 EAP HCPCS C1725 CATHETER BLNDIL 3MM STRL LF 12MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220024 EAP HCPCS C1725 CATHETER BLNDIL 3MM STRL LF 15MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220025 EAP HCPCS C1725 CATHETER BLNDIL 3MM STRL LF 20MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220026 EAP HCPCS C1725 CATHETER BLNDIL 3MM STRL LF 30MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220027 EAP HCPCS C1725 CATHETER BLNDIL 3.25MM STRL LF 10MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220028 EAP HCPCS C1725 CATHETER BLNDIL 3.25MM STRL LF 15MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220029 EAP HCPCS C1725 CATHETER BLNDIL 3.25MM STRL LF 15MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220030 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM STRL LF 10MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220031 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM STRL LF 15MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $240.00 $400.00 $83.36 $400.00 N/A N/A 27220032 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM STRL LF 20MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220033 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM STRL LF 30MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220034 EAP HCPCS C1725 CATHETER BLNDIL 4MM STRL LF 10MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220035 EAP HCPCS C1725 CATHETER BLNDIL 4MM STRL LF 15MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220036 EAP HCPCS C1725 CATHETER BLNDIL 4MM STRL LF 20MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220037 EAP HCPCS C1725 CATHETER BLNDIL 2MM STRL LF 8MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220038 EAP HCPCS C1725 CATHETER BLNDIL 2MM STRL LF 10MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220039 EAP HCPCS C1725 CATHETER BLNDIL 2MM STRL LF 12MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220040 EAP HCPCS C1725 CATHETER BLNDIL 2MM STRL LF 15MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220041 EAP HCPCS C1725 CATHETER BLNDIL 2MM STRL LF 18MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220042 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM STRL LF 8MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220043 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM STRL LF 10MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220044 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM STRL LF 12MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220045 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM STRL LF 15MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220046 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM STRL LF 18MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220047 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM STRL LF 8MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220048 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM STRL LF 10MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220049 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM STRL LF 12MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220050 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM STRL LF 16MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220051 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM STRL LF 18MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220052 EAP HCPCS C1725 CATHETER BLNDIL 2.75MM STRL LF 8MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220053 EAP HCPCS C1725 CATHETER BLNDIL 2.75MM STRL LF 10MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220054 EAP HCPCS C1725 CATHETER BLNDIL 2.75MM STRL LF 12MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220055 EAP HCPCS C1725 CATHETER BLNDIL 2.75MM STRL LF 15MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220056 EAP HCPCS C1725 CATHETER BLNDIL 2.75MM STRL LF 18MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220057 EAP HCPCS C1725 CATHETER BLNDIL 3MM STRL LF 8MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220058 EAP HCPCS C1725 CATHETER BLNDIL 3MM STRL LF 10MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220059 EAP HCPCS C1725 CATHETER BLNDIL 3MM STRL LF 12MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220060 EAP HCPCS C1725 CATHETER BLNDIL 3MM STRL LF 15MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220061 EAP HCPCS C1725 CATHETER BLNDIL 3MM STRL LF 18MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220062 EAP HCPCS C1725 CATHETER BLNDIL 3.25MM STRL LF 8MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220063 EAP HCPCS C1725 CATHETER BLNDIL 3.25MM STRL LF 10MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220064 EAP HCPCS C1725 CATHETER BLNDIL 3.25MM STRL LF 12MM SPHR II PRO PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220065 EAP HCPCS C1725 CATHETER BLNDIL 3.25MM STRL LF 15MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220066 EAP HCPCS C1725 CATHETER BLNDIL 3.25MM STRL LF 18MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220067 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM STRL LF 8MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220068 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM STRL LF 10MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220069 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM STRL LF 12MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220070 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM STRL LF 15MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220071 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM STRL LF 18MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220072 EAP HCPCS C1725 CATHETER BLNDIL 3.75MM NS LF 8MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220073 EAP HCPCS C1725 CATHETER BLNDIL 3.75MM STRL LF 10MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220074 EAP HCPCS C1725 CATHETER BLNDIL 3.75MM STRL LF 12MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220075 EAP HCPCS C1725 CATHETER BLNDIL 3.75MM STRL LF 15MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220076 EAP HCPCS C1725 CATHETER BLNDIL 3.75MM STRL LF 18MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220077 EAP HCPCS C1725 CATHETER BLNDIL 4MM STRL LF 8MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220078 EAP HCPCS C1725 CATHETER BLNDIL 4MM STRL LF 10MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220079 EAP HCPCS C1725 CATHETER BLNDIL 4MM STRL LF 12MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220080 EAP HCPCS C1725 CATHETER BLNDIL 4MM STRL LF 15MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220081 EAP HCPCS C1725 CATHETER BLNDIL 4MM STRL LF 18MM SPHR NC + PTCA BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 27220083 EAP HCPCS C1757 CATHETER ASP .082-.085IN .071IN 125CM AXS VECTA 71 SCOUT BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,665.25" "$3,665.25" "$3,665.25" "$3,665.25" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$4,181.12" "$4,181.12" "$5,202.90" "$2,060.15" "$1,406.77" "$6,750.00" "$6,750.00" "$3,094.73" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$4,387.50" "$1,339.71" "$6,750.00" "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A 27220084 EAP HCPCS C1757 CATH THROMB AXS VECTA 71 2-4 MM L132 CM L150 CM OD.082-.085 BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,665.25" "$3,665.25" "$3,665.25" "$3,665.25" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$4,181.12" "$4,181.12" "$5,202.90" "$2,060.15" "$1,406.77" "$6,750.00" "$6,750.00" "$3,094.73" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$4,387.50" "$1,339.71" "$6,750.00" "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A 27220090 EAP CABLE CATH 150CM BLK RSPN HEXPL OCTPL DCAPL EP REPRO BOTH IP/OP $99.00 $73.50 $17.62 $99.00 $99.00 $99.00 $99.00 $99.00 $99.00 $99.00 $17.62 $99.00 $99.00 $73.48 $73.48 $76.31 $51.58 $20.63 $99.00 $39.60 $99.00 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $64.35 $99.00 $99.00 $57.42 $99.00 $59.40 $99.00 $99.00 $99.00 N/A N/A 27220091 EAP CATHETER EP 150CM RSPN LVWR HEXPL OCTPL DCAPL BOTH IP/OP $99.00 $73.50 $17.62 $99.00 $99.00 $99.00 $99.00 $99.00 $99.00 $99.00 $17.62 $99.00 $99.00 $73.48 $73.48 $76.31 $51.58 $20.63 $99.00 $39.60 $99.00 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $64.35 $99.00 $99.00 $57.42 $99.00 $59.40 $99.00 $99.00 $99.00 N/A N/A 27220092 EAP CABLE CATH XTN SJM GNTR BOTH IP/OP $222.00 $164.50 $39.52 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $222.00 $39.52 $222.00 $222.00 $164.77 $164.77 $171.12 $115.66 $46.27 $222.00 $88.80 $222.00 $222.00 $222.00 $222.00 $222.00 $166.50 $222.00 $222.00 $222.00 $111.00 $111.00 $175.82 $222.00 $177.60 $144.30 $222.00 $222.00 $128.76 $222.00 $133.20 $222.00 $222.00 $222.00 N/A N/A 27220093 EAP HCPCS C1894 INTRODUCER SHEATH .038IN LARGE 18FR 30CM 42CM RADIOPQ BAND BOTH IP/OP $318.00 $235.50 $63.12 $318.00 $172.67 $172.67 $172.67 $172.67 $318.00 $318.00 $318.00 $66.28 $318.00 $236.02 $236.02 $245.11 $165.68 $66.27 $318.00 $318.00 $188.10 $318.00 $318.00 $318.00 $318.00 $238.50 $318.00 $318.00 $318.00 $159.00 $159.00 $251.86 $318.00 $254.40 $206.70 $63.12 $318.00 $184.44 $318.00 $318.00 $318.00 $66.27 $318.00 N/A N/A 27220094 EAP CATHETER ANGIO CHUANG 2.5 CRV 5FR 80CM TRNB AD BCNTP MP SS BOTH IP/OP $313.00 $232.00 $55.71 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $55.71 $313.00 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $125.20 $313.00 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $313.00 $313.00 $181.54 $313.00 $187.80 $313.00 $313.00 $313.00 N/A N/A 27220095 EAP FT RETRACTION ASPIRATOR DEVICE SE BOTH IP/OP "$3,238.00" "$2,396.50" $576.36 "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" $576.36 "$3,238.00" "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$1,295.20" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" "$3,238.00" "$3,238.00" "$1,878.04" "$3,238.00" "$1,942.80" "$3,238.00" "$3,238.00" "$3,238.00" N/A N/A 27220096 EAP FLOWTRIEVER BUNDLE BOTH IP/OP "$22,500.00" "$16,650.00" "$2,060.15" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$4,005.00" "$22,500.00" "$22,500.00" "$4,181.12" "$4,181.12" "$17,343.00" "$2,060.15" "$4,689.25" "$22,500.00" "$9,000.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$16,875.00" "$22,500.00" "$22,500.00" "$22,500.00" "$11,250.00" "$11,250.00" "$17,820.00" "$22,500.00" "$18,000.00" "$14,625.00" "$22,500.00" "$22,500.00" "$13,050.00" "$22,500.00" "$13,500.00" "$22,500.00" "$22,500.00" "$22,500.00" N/A N/A 27220097 EAP TUBE NASOGASTRIC 10FR 1.22MR 24 PORT VENTED VINYL PEDIATRIC BOTH IP/OP $37.00 $27.50 $6.59 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $37.00 $6.59 $37.00 $37.00 $27.46 $27.46 $28.52 $19.28 $7.71 $37.00 $14.80 $37.00 $37.00 $37.00 $37.00 $37.00 $27.75 $37.00 $37.00 $37.00 $18.50 $18.50 $29.30 $37.00 $29.60 $24.05 $37.00 $37.00 $21.46 $37.00 $22.20 $37.00 $37.00 $37.00 N/A N/A 27220098 EAP TUBE NG 8FR 36IN LF ENTFLX FD STY Y ST BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 27220099 EAP CUFF BLOOD PRESSURE CLEARSIGHT SMALL FINGER BOTH IP/OP $625.00 $462.50 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $625.00 $625.00 $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 27220100 EAP CUFF BLOOD PRESSURE CLEARSIGHT MEDIUM FINGER BOTH IP/OP $625.00 $462.50 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $625.00 $625.00 $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 27220101 EAP CUFF BLOOD PRESSURE CLEARSIGHT LARGE FINGER BOTH IP/OP $625.00 $462.50 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $625.00 $625.00 $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 27220103 EAP CENTRAL LINE 10CM 18G BASIC BOTH IP/OP $145.00 $107.50 $25.81 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $25.81 $145.00 $145.00 $107.62 $107.62 $111.77 $75.55 $30.22 $145.00 $58.00 $145.00 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $94.25 $145.00 $145.00 $84.10 $145.00 $87.00 $145.00 $145.00 $145.00 N/A N/A 27220104 EAP CENTRAL LINE 10CM 18G FULL BOTH IP/OP $238.00 $176.50 $42.36 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $42.36 $238.00 $238.00 $176.64 $176.64 $183.45 $124.00 $49.60 $238.00 $95.20 $238.00 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $154.70 $238.00 $238.00 $138.04 $238.00 $142.80 $238.00 $238.00 $238.00 N/A N/A 27220105 EAP CENTRAL LINE 8CM 18G BASIC BOTH IP/OP $145.00 $107.50 $25.81 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $25.81 $145.00 $145.00 $107.62 $107.62 $111.77 $75.55 $30.22 $145.00 $58.00 $145.00 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $94.25 $145.00 $145.00 $84.10 $145.00 $87.00 $145.00 $145.00 $145.00 N/A N/A 27220106 EAP CENTRAL LINE 8CM 18G FULL BOTH IP/OP $238.00 $176.50 $42.36 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $42.36 $238.00 $238.00 $176.64 $176.64 $183.45 $124.00 $49.60 $238.00 $95.20 $238.00 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $154.70 $238.00 $238.00 $138.04 $238.00 $142.80 $238.00 $238.00 $238.00 N/A N/A 27220107 EAP SOEHENDRA BILIARY DILATION CATHETER BOTH IP/OP $198.00 $147.00 $35.24 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $35.24 $198.00 $198.00 $146.96 $146.96 $152.62 $103.16 $41.27 $198.00 $79.20 $198.00 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $128.70 $198.00 $198.00 $114.84 $198.00 $118.80 $198.00 $198.00 $198.00 N/A N/A 27220108 EAP SPYBITE BIOPSY FORCEPS BOTH IP/OP "$1,338.00" $990.50 $238.16 "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $238.16 "$1,338.00" "$1,338.00" $993.06 $993.06 "$1,031.33" $697.10 $278.85 "$1,338.00" $535.20 "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,003.50" "$1,338.00" "$1,338.00" "$1,338.00" $669.00 $669.00 "$1,059.70" "$1,338.00" "$1,070.40" $869.70 "$1,338.00" "$1,338.00" $776.04 "$1,338.00" $802.80 "$1,338.00" "$1,338.00" "$1,338.00" N/A N/A 27220109 EAP PANCREATIC STENT 5FR BOTH IP/OP $115.00 $85.50 $20.47 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $20.47 $115.00 $115.00 $85.35 $85.35 $88.64 $59.92 $23.97 $115.00 $46.00 $115.00 $115.00 $115.00 $115.00 $115.00 $86.25 $115.00 $115.00 $115.00 $57.50 $57.50 $91.08 $115.00 $92.00 $74.75 $115.00 $115.00 $66.70 $115.00 $69.00 $115.00 $115.00 $115.00 N/A N/A 27220110 EAP LIGATING DEVICE BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 $220.00 $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A 27220111 EAP ECHOTIP PROCORE BIOPSY NEEDLE BOTH IP/OP "$1,013.00" $750.00 $180.31 "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" $180.31 "$1,013.00" "$1,013.00" $751.85 $751.85 $780.82 $527.77 $211.12 "$1,013.00" $405.20 "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" $759.75 "$1,013.00" "$1,013.00" "$1,013.00" $506.50 $506.50 $802.30 "$1,013.00" $810.40 $658.45 "$1,013.00" "$1,013.00" $587.54 "$1,013.00" $607.80 "$1,013.00" "$1,013.00" "$1,013.00" N/A N/A 27220112 EAP MISC CENTRAL LINE SUPPLY BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 $220.00 $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A 27220113 EAP HCPCS C1726 CATHETER BLNDIL 5MM 135CM 20MM PR CTBLN OTW TPR TIP INFL BOTH IP/OP "$1,759.00" "$1,302.00" $349.12 "$1,759.00" $955.14 $955.14 $955.14 $955.14 "$1,759.00" "$1,759.00" "$1,759.00" $366.62 "$1,759.00" "$1,305.53" "$1,305.53" "$1,355.84" $916.44 $366.59 "$1,759.00" "$1,759.00" "$1,040.45" "$1,759.00" "$1,759.00" "$1,759.00" "$1,759.00" "$1,319.25" "$1,759.00" "$1,759.00" "$1,759.00" $879.50 $879.50 "$1,393.13" "$1,759.00" "$1,407.20" "$1,143.35" $349.12 "$1,759.00" "$1,020.22" "$1,759.00" "$1,759.00" "$1,759.00" $366.58 "$1,759.00" N/A N/A 27220114 EAP HCPCS C1753 CATHETER BALDILAT LP 5.3FR 4MM 135CM 60MM HIGH PRESSURE BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 27220117 EAP HCPCS C1887 CATHETER AXS CATALYST 7 .068 ID X132CM BOTH IP/OP "$5,288.00" "$3,913.50" "$1,049.54" "$5,288.00" "$2,871.38" "$2,871.38" "$2,871.38" "$2,871.38" "$5,288.00" "$5,288.00" "$5,288.00" "$1,102.15" "$5,288.00" "$3,924.75" "$3,924.75" "$4,075.99" "$2,060.15" "$1,102.08" "$5,288.00" "$5,288.00" "$3,094.73" "$5,288.00" "$5,288.00" "$5,288.00" "$5,288.00" "$3,966.00" "$5,288.00" "$5,288.00" "$5,288.00" "$2,644.00" "$2,644.00" "$4,188.10" "$5,288.00" "$4,230.40" "$3,437.20" "$1,049.54" "$5,288.00" "$3,067.04" "$5,288.00" "$5,288.00" "$5,288.00" "$1,102.02" "$5,288.00" N/A N/A 27220120 EAP HCPCS C1751 "KIT TRIPLE LUMEN CVC, 7FR 20 CM" BOTH IP/OP $360.00 $266.50 $71.45 $360.00 $195.48 $195.48 $195.48 $195.48 $360.00 $360.00 $360.00 $75.03 $360.00 $267.19 $267.19 $277.49 $187.56 $75.03 $360.00 $360.00 $212.94 $360.00 $360.00 $360.00 $360.00 $270.00 $360.00 $360.00 $360.00 $180.00 $180.00 $285.12 $360.00 $288.00 $234.00 $71.45 $360.00 $208.80 $360.00 $360.00 $360.00 $75.02 $360.00 N/A N/A 27220121 EAP HCPCS C1751 MISC SWAN GANZ CATHETER BOTH IP/OP $700.00 $518.00 $138.93 $700.00 $380.10 $380.10 $380.10 $380.10 $700.00 $700.00 $700.00 $145.90 $700.00 $519.54 $519.54 $539.56 $364.70 $145.89 $700.00 $700.00 $414.05 $700.00 $700.00 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $350.00 $350.00 $554.40 $700.00 $560.00 $455.00 $138.93 $700.00 $406.00 $700.00 $700.00 $700.00 $145.88 $700.00 N/A N/A 27220122 EAP Custom 27220122 CATHETER URETHRAL 8FR FOLEY 2 WAY LATEX DOVER SILICONE BOTH IP/OP $107.00 $79.50 $19.05 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $19.05 $107.00 $107.00 $79.42 $79.42 $82.48 $55.75 $22.30 $107.00 $42.80 $107.00 $107.00 $107.00 $107.00 $107.00 $80.25 $107.00 $107.00 $107.00 $53.50 $53.50 $84.74 $107.00 $85.60 $69.55 $107.00 $107.00 $62.06 $107.00 $64.20 $107.00 $107.00 $107.00 N/A N/A 27220123 EAP Custom 27220123 DRESSING WOUND SQUARE 6X6IN 2 LAYER ABSORBENT NONWOVEN SOFT BOTH IP/OP $56.00 $41.50 $9.97 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $56.00 $9.97 $56.00 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $22.40 $56.00 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $56.00 $56.00 $32.48 $56.00 $33.60 $56.00 $56.00 $56.00 N/A N/A 27220124 EAP Custom 27220124 TRAY SPNL 20GA 3.5IN STRL LF 3 SPNG STK PRP WELL BNDG ADLT BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 27220125 EAP Custom 27220125 TRAY SPNL 22GA 1.5IN 10ML STRL SPEC VL PRENUMBER CAP PT ID BOTH IP/OP $44.00 $33.00 $7.83 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $7.83 $44.00 $44.00 $32.66 $32.66 $33.92 $22.92 $9.17 $44.00 $17.60 $44.00 $44.00 $44.00 $44.00 $44.00 $33.00 $44.00 $44.00 $44.00 $22.00 $22.00 $34.85 $44.00 $35.20 $28.60 $44.00 $44.00 $25.52 $44.00 $26.40 $44.00 $44.00 $44.00 N/A N/A 27220127 EAP Custom 27220127 BANDAGE COMPRESSION 10YDX4IN 5YDX4IN 1 SELF ADHERENT ELAST BOTH IP/OP $26.00 $19.50 $4.63 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $4.63 $26.00 $26.00 $19.30 $19.30 $20.04 $13.55 $5.42 $26.00 $10.40 $26.00 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $16.90 $26.00 $26.00 $15.08 $26.00 $15.60 $26.00 $26.00 $26.00 N/A N/A 27220129 EAP Custom 27220129 VALVE DRN SM 30ML PNMST GRAD GRMNT ATCH MLT CHST TUBE CNCT BOTH IP/OP $70.00 $52.00 $12.46 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $12.46 $70.00 $70.00 $51.95 $51.95 $53.96 $36.47 $14.59 $70.00 $28.00 $70.00 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $45.50 $70.00 $70.00 $40.60 $70.00 $42.00 $70.00 $70.00 $70.00 N/A N/A 27220130 EAP Custom 27220130 DRESSING PRFY H2O CALCIUM ALG NA CMC GNTL DBRD BOTH IP/OP $31.00 $23.00 $5.52 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $31.00 $5.52 $31.00 $31.00 $23.01 $23.01 $23.89 $16.15 $6.46 $31.00 $12.40 $31.00 $31.00 $31.00 $31.00 $31.00 $23.25 $31.00 $31.00 $31.00 $15.50 $15.50 $24.55 $31.00 $24.80 $20.15 $31.00 $31.00 $17.98 $31.00 $18.60 $31.00 $31.00 $31.00 N/A N/A 27220131 EAP Custom 27220131 DRESSING BIATAIN AG 4X4IN 1 PC REM ABS WND ALG BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 27220132 EAP Custom 27220132 DRESSING BRN 48X4IN STRL LF ACTCT FLX 3 ANMC BRR 1 LYR KNIT BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 $200.00 $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A 27220133 EAP Custom 27220133 DRESSING WND 8X8IN MEDIHONEY ABS LGHT DDRGL CLLD SHT BOTH IP/OP $67.00 $50.00 $11.93 $67.00 $67.00 $67.00 $67.00 $67.00 $67.00 $67.00 $11.93 $67.00 $67.00 $49.73 $49.73 $51.64 $34.91 $13.96 $67.00 $26.80 $67.00 $67.00 $67.00 $67.00 $67.00 $50.25 $67.00 $67.00 $67.00 $33.50 $33.50 $53.06 $67.00 $53.60 $43.55 $67.00 $67.00 $38.86 $67.00 $40.20 $67.00 $67.00 $67.00 N/A N/A 27220134 EAP Custom 27220134 GEL DRSG LF MEDIHONEY TUB 400GM BOTH IP/OP $188.00 $139.50 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $188.00 $188.00 $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 27220135 EAP Custom 27220135 TRAY DRESSING CARDINAL CENTRAL LINE GRADY CUSTOM BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 27220137 EAP DEVICE INFLAT 12FR 3IN PRESSURE GAUGE LATEX FREE ENCORE 26 BOTH IP/OP $94.00 $70.00 $16.73 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $94.00 $16.73 $94.00 $94.00 $69.77 $69.77 $72.46 $48.97 $19.59 $94.00 $37.60 $94.00 $94.00 $94.00 $94.00 $94.00 $70.50 $94.00 $94.00 $94.00 $47.00 $47.00 $74.45 $94.00 $75.20 $61.10 $94.00 $94.00 $54.52 $94.00 $56.40 $94.00 $94.00 $94.00 N/A N/A 27220138 EAP DEVICE CMPR LG 29CM TR BAND 2 BLN TRNS ADJ STRAP AIR TRTN BOTH IP/OP $83.00 $61.50 $14.77 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $14.77 $83.00 $83.00 $61.60 $61.60 $63.98 $43.24 $17.30 $83.00 $33.20 $83.00 $83.00 $83.00 $83.00 $83.00 $62.25 $83.00 $83.00 $83.00 $41.50 $41.50 $65.74 $83.00 $66.40 $53.95 $83.00 $83.00 $48.14 $83.00 $49.80 $83.00 $83.00 $83.00 N/A N/A 27220139 EAP UMBILICAL CATHETER 3.5 BOTH IP/OP $85.00 $63.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 $85.00 $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 27220140 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 142CM 25MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220141 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 142CM 30MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220142 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 142CM 38MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220143 EAP HCPCS C1725 CATHETER BALDILAT 4MM 142CM 9MM RAPEX ELONGATE TIP BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220144 EAP HCPCS C1725 CATHETER BALDILAT 4MM 142CM 14MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220145 EAP HCPCS C1725 CATHETER BALDILAT 4MM 142CM 17MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220146 EAP HCPCS C1725 CATHETER BALDILAT 4MM 142CM 20MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220147 EAP HCPCS C1725 CATHETER BALDILAT 4MM 142CM 30MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220148 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 142CM 9MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220149 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 142CM 14MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220150 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 142CM 17MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220151 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 142CM 20MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220156 EAP HCPCS C1725 CATHETER BALDILAT 3MM 139CM 6MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220158 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 139CM 6MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220159 EAP HCPCS C1725 CATHETER BALDILAT 4MM 139CM 6MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220164 EAP HCPCS C1725 CATHETER BALDILAT 3MM 139CM 10MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220166 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 139CM 10MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220167 EAP HCPCS C1725 CATHETER BALDILAT 3.75MM 139CM 10MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220168 EAP HCPCS C1725 CATHETER BALDILAT 4MM 139CM 10MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $97.80 $163.00 $33.97 $163.00 N/A N/A 27220173 EAP HCPCS C1725 CATHETER BALDILAT 3MM 139CM 12MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220175 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 139CM 12MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220176 EAP HCPCS C1725 CATHETER BALDILAT 3.75MM 139CM 12MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220177 EAP HCPCS C1725 CATHETER BALDILAT 4MM 139CM 12MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220182 EAP HCPCS C1725 CATHETER BALDILAT 3MM 139CM 15MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $97.80 $163.00 $33.97 $163.00 N/A N/A 27220184 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 139CM 15MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220185 EAP HCPCS C1725 CATHETER BALDILAT 3.75MM 139CM 15MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220186 EAP HCPCS C1725 CATHETER BALDILAT 4MM 139CM 15MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220191 EAP HCPCS C1725 CATHETER BALDILAT 3MM 139CM 20MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $97.80 $163.00 $33.97 $163.00 N/A N/A 27220193 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 139CM 20MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220194 EAP HCPCS C1725 CATHETER BALDILAT 3.75MM 139CM 20MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $97.80 $163.00 $33.97 $163.00 N/A N/A 27220195 EAP HCPCS C1725 CATHETER BALDILAT 4MM 139CM 20MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220198 EAP HCPCS C1725 CATHETER BALDILAT 3MM 139CM 25MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220199 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 139CM 25MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $97.80 $163.00 $33.97 $163.00 N/A N/A 27220200 EAP HCPCS C1725 CATHETER BALDILAT 4MM 139CM 25MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220202 EAP HCPCS C1725 CATHETER BALDILAT 3MM 139CM 30MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220203 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 139CM 30MM RAPEX POST DIL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220213 EAP HCPCS C1725 CATHETER BALDILAT 3MM 139CM 10MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $97.80 $163.00 $33.97 $163.00 N/A N/A 27220214 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 139CM 10MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $97.80 $163.00 $33.97 $163.00 N/A N/A 27220215 EAP HCPCS C1725 CATHETER BALDILAT 4MM 139CM 10MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220221 EAP HCPCS C1725 CATHETER BALDILAT 3MM 139CM 12MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $97.80 $163.00 $33.97 $163.00 N/A N/A 27220222 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 139CM 12MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220223 EAP HCPCS C1725 CATHETER BALDILAT 4MM 139CM 12MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220229 EAP HCPCS C1725 CATHETER BALDILAT 3MM 139CM 15MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220231 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 139CM 15MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220232 EAP HCPCS C1725 CATHETER BALDILAT 3.75MM 139CM 15MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220233 EAP HCPCS C1725 CATHETER BALDILAT 4MM 139CM 15MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220239 EAP HCPCS C1725 CATHETER BALDILAT 3MM 139CM 20MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220240 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 139CM 20MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220241 EAP HCPCS C1725 CATHETER BALDILAT 3.75MM 139CM 20MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220242 EAP HCPCS C1725 CATHETER BALDILAT 4MM 139CM 20MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $97.80 $163.00 $33.97 $163.00 N/A N/A 27220246 EAP HCPCS C1725 CATHETER BALDILAT 3MM 139CM 30MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220247 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 139CM 30MM RAPEX BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 27220277 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 8MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220278 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 10MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220279 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 13MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220280 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 15MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220281 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 18MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220282 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 23MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220283 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 28MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220284 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 142CM 8MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220285 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 142CM 10MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220286 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 142CM 13MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220287 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 142CM 15MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220288 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 142CM 18MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220289 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 142CM 23MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220290 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 142CM 28MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220291 EAP HCPCS C1725 CATHETER BALDILAT 4MM 142CM 8MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220292 EAP HCPCS C1725 CATHETER BALDILAT 4MM 142CM 10MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220293 EAP HCPCS C1725 CATHETER BALDILAT 4MM 142CM 13MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220294 EAP HCPCS C1725 CATHETER BALDILAT 4MM 142CM 15MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220295 EAP HCPCS C1725 CATHETER BALDILAT 4MM 142CM 18MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220296 EAP HCPCS C1725 CATHETER BALDILAT 4MM 142CM 23MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $90.00 $150.00 $31.26 $150.00 N/A N/A 27220297 EAP HCPCS C1725 CATHETER BALDILAT 4MM 142CM 28MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $90.00 $150.00 $31.26 $150.00 N/A N/A 27220298 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 142CM 8MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220299 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 142CM 10MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $90.00 $150.00 $31.26 $150.00 N/A N/A 27220300 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 142CM 13MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220301 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 142CM 15MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220302 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 142CM 18MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220303 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 142CM 23MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220304 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 142CM 28MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220305 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 142CM 35MM RAPEX NYL MOZEC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220328 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 9MM RAPEX ELONGATE TIP BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220329 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 14MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220330 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 17MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220331 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 20MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220332 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 25MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220333 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 30MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220334 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 38MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220335 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 41MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220336 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 142CM 9MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220337 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 142CM 14MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220338 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 142CM 17MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $90.00 $150.00 $31.26 $150.00 N/A N/A 27220339 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 142CM 20MM RAPEX ELONGATE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 27220340 EAP HCPCS C1725 CATHETER ANGIOGRAPHIC ANGLE 5FR .047IN 65CM 25CM 1 BRAID BOTH IP/OP $123.00 $91.50 $24.41 $123.00 $66.79 $66.79 $66.79 $66.79 $123.00 $123.00 $123.00 $25.64 $123.00 $91.29 $91.29 $94.81 $64.08 $25.63 $123.00 $123.00 $72.75 $123.00 $123.00 $123.00 $123.00 $92.25 $123.00 $123.00 $123.00 $61.50 $61.50 $97.42 $123.00 $98.40 $79.95 $24.41 $123.00 $71.34 $123.00 $123.00 $123.00 $25.63 $123.00 N/A N/A 27220341 EAP HCPCS C1887 CATHETER INTVN 900- PSI 2.2-2.9FR 6- MM .02IN 110 BOTH IP/OP "$2,488.00" "$1,841.50" $493.81 "$2,488.00" "$1,350.98" "$1,350.98" "$1,350.98" "$1,350.98" "$2,488.00" "$2,488.00" "$2,488.00" $518.56 "$2,488.00" "$1,846.59" "$1,846.59" "$1,917.75" "$1,296.25" $518.53 "$2,488.00" "$2,488.00" "$1,471.65" "$2,488.00" "$2,488.00" "$2,488.00" "$2,488.00" "$1,866.00" "$2,488.00" "$2,488.00" "$2,488.00" "$1,244.00" "$1,244.00" "$1,970.50" "$2,488.00" "$1,990.40" "$1,617.20" $493.81 "$2,488.00" "$1,443.04" "$2,488.00" "$2,488.00" "$2,488.00" $518.50 "$2,488.00" N/A N/A 27220342 EAP HCPCS C1887 CATHETER BLNOCC 900- PSI 2.2-2.9FR 6- MM .02IN 130 BOTH IP/OP "$2,488.00" "$1,841.50" $493.81 "$2,488.00" "$1,350.98" "$1,350.98" "$1,350.98" "$1,350.98" "$2,488.00" "$2,488.00" "$2,488.00" $518.56 "$2,488.00" "$1,846.59" "$1,846.59" "$1,917.75" "$1,296.25" $518.53 "$2,488.00" "$2,488.00" "$1,471.65" "$2,488.00" "$2,488.00" "$2,488.00" "$2,488.00" "$1,866.00" "$2,488.00" "$2,488.00" "$2,488.00" "$1,244.00" "$1,244.00" "$1,970.50" "$2,488.00" "$1,990.40" "$1,617.20" $493.81 "$2,488.00" "$1,443.04" "$2,488.00" "$2,488.00" "$2,488.00" $518.50 "$2,488.00" N/A N/A 27220343 EAP HCPCS C1887 CATHETER BLNOCC 900- PSI 2.2-2.9FR 6- MM .02IN 150 BOTH IP/OP "$2,488.00" "$1,841.50" $493.81 "$2,488.00" "$1,350.98" "$1,350.98" "$1,350.98" "$1,350.98" "$2,488.00" "$2,488.00" "$2,488.00" $518.56 "$2,488.00" "$1,846.59" "$1,846.59" "$1,917.75" "$1,296.25" $518.53 "$2,488.00" "$2,488.00" "$1,471.65" "$2,488.00" "$2,488.00" "$2,488.00" "$2,488.00" "$1,866.00" "$2,488.00" "$2,488.00" "$2,488.00" "$1,244.00" "$1,244.00" "$1,970.50" "$2,488.00" "$1,990.40" "$1,617.20" $493.81 "$2,488.00" "$1,443.04" "$2,488.00" "$1,492.80" "$2,488.00" $518.50 "$2,488.00" N/A N/A 27220344 EAP HCPCS C1887 CATHETER INFUS 110CM 2 LUM ANG TIP RADIOPQ GWIRE BOTH IP/OP "$2,488.00" "$1,841.50" $493.81 "$2,488.00" "$1,350.98" "$1,350.98" "$1,350.98" "$1,350.98" "$2,488.00" "$2,488.00" "$2,488.00" $518.56 "$2,488.00" "$1,846.59" "$1,846.59" "$1,917.75" "$1,296.25" $518.53 "$2,488.00" "$2,488.00" "$1,471.65" "$2,488.00" "$2,488.00" "$2,488.00" "$2,488.00" "$1,866.00" "$2,488.00" "$2,488.00" "$2,488.00" "$1,244.00" "$1,244.00" "$1,970.50" "$2,488.00" "$1,990.40" "$1,617.20" $493.81 "$2,488.00" "$1,443.04" "$2,488.00" "$2,488.00" "$2,488.00" $518.50 "$2,488.00" N/A N/A 27220345 EAP HCPCS C1887 CATHETER INFUS 130CM 2 LUM ANG TIP RADIOPQ GWIRE BOTH IP/OP "$2,488.00" "$1,841.50" $493.81 "$2,488.00" "$1,350.98" "$1,350.98" "$1,350.98" "$1,350.98" "$2,488.00" "$2,488.00" "$2,488.00" $518.56 "$2,488.00" "$1,846.59" "$1,846.59" "$1,917.75" "$1,296.25" $518.53 "$2,488.00" "$2,488.00" "$1,471.65" "$2,488.00" "$2,488.00" "$2,488.00" "$2,488.00" "$1,866.00" "$2,488.00" "$2,488.00" "$2,488.00" "$1,244.00" "$1,244.00" "$1,970.50" "$2,488.00" "$1,990.40" "$1,617.20" $493.81 "$2,488.00" "$1,443.04" "$2,488.00" "$2,488.00" "$2,488.00" $518.50 "$2,488.00" N/A N/A 27220346 EAP HCPCS C1887 CATHETER INFUS 150CM 2 LUM ANG TIP RADIOPQ GWIRE BOTH IP/OP "$2,488.00" "$1,841.50" $493.81 "$2,488.00" "$1,350.98" "$1,350.98" "$1,350.98" "$1,350.98" "$2,488.00" "$2,488.00" "$2,488.00" $518.56 "$2,488.00" "$1,846.59" "$1,846.59" "$1,917.75" "$1,296.25" $518.53 "$2,488.00" "$2,488.00" "$1,471.65" "$2,488.00" "$2,488.00" "$2,488.00" "$2,488.00" "$1,866.00" "$2,488.00" "$2,488.00" "$2,488.00" "$1,244.00" "$1,244.00" "$1,970.50" "$2,488.00" "$1,990.40" "$1,617.20" $493.81 "$2,488.00" "$1,443.04" "$2,488.00" "$2,488.00" "$2,488.00" $518.50 "$2,488.00" N/A N/A 27220347 EAP HCPCS C1887 CATHETER ANGIO JL 4 CRV 5FR .047IN 100CM INFNT THRLMN RADOPQ BOTH IP/OP $97.00 $72.00 $19.25 $97.00 $52.67 $52.67 $52.67 $52.67 $97.00 $97.00 $97.00 $20.22 $97.00 $71.99 $71.99 $74.77 $50.54 $20.22 $97.00 $97.00 $57.38 $97.00 $97.00 $97.00 $97.00 $72.75 $97.00 $97.00 $97.00 $48.50 $48.50 $76.82 $97.00 $77.60 $63.05 $19.25 $97.00 $56.26 $97.00 $97.00 $97.00 $20.21 $97.00 N/A N/A 27220348 EAP HCPCS C1887 CATHETER ANGIO AL 1 CRV 6FR 100CM INFNT LT COR BOTH IP/OP $97.00 $72.00 $19.25 $97.00 $52.67 $52.67 $52.67 $52.67 $97.00 $97.00 $97.00 $20.22 $97.00 $71.99 $71.99 $74.77 $50.54 $20.22 $97.00 $97.00 $57.38 $97.00 $97.00 $97.00 $97.00 $72.75 $97.00 $97.00 $97.00 $48.50 $48.50 $76.82 $97.00 $77.60 $63.05 $19.25 $97.00 $56.26 $97.00 $97.00 $97.00 $20.21 $97.00 N/A N/A 27220349 EAP KIT PICC DRESSING CHANGE TRAY 215 BOTH IP/OP $59.00 $44.00 $10.50 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $59.00 $10.50 $59.00 $59.00 $43.79 $43.79 $45.48 $30.74 $12.30 $59.00 $23.60 $59.00 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $38.35 $59.00 $59.00 $34.22 $59.00 $35.40 $59.00 $59.00 $59.00 N/A N/A 27220352 EAP HCPCS C1769 GUIDEWIRE VASC 90D 60D 2CM .018IN 180CM 25CM GLDWR GT TIP BOTH IP/OP $393.00 $291.00 $78.00 $393.00 $213.40 $213.40 $213.40 $213.40 $393.00 $393.00 $393.00 $81.91 $393.00 $291.68 $291.68 $302.92 $204.75 $81.91 $393.00 $393.00 $232.46 $393.00 $393.00 $393.00 $393.00 $294.75 $393.00 $393.00 $393.00 $196.50 $196.50 $311.26 $393.00 $314.40 $255.45 $78.00 $393.00 $227.94 $393.00 $393.00 $393.00 $81.90 $393.00 N/A N/A 27220353 EAP DEVICE INFLAT 12FR PRESSURE GAUGE ENCORE 26 20ML BOTH IP/OP $367.00 $272.00 $65.33 $367.00 $367.00 $367.00 $367.00 $367.00 $367.00 $367.00 $65.33 $367.00 $367.00 $272.39 $272.39 $282.88 $191.21 $76.49 $367.00 $146.80 $367.00 $367.00 $367.00 $367.00 $367.00 $275.25 $367.00 $367.00 $367.00 $183.50 $183.50 $290.66 $367.00 $293.60 $238.55 $367.00 $367.00 $212.86 $367.00 $220.20 $367.00 $367.00 $367.00 N/A N/A 27220360 EAP HCPCS C1729 SAFE-T-CENTESIS TRAY 8FR (CAREFUSION) BOTH IP/OP $443.00 $328.00 $87.92 $443.00 $240.55 $240.55 $240.55 $240.55 $443.00 $443.00 $443.00 $92.33 $443.00 $328.79 $328.79 $341.46 $230.80 $92.33 $443.00 $443.00 $262.03 $443.00 $443.00 $443.00 $443.00 $332.25 $443.00 $443.00 $443.00 $221.50 $221.50 $350.86 $443.00 $354.40 $287.95 $87.92 $443.00 $256.94 $443.00 $443.00 $443.00 $92.32 $443.00 N/A N/A 27220361 EAP HCPCS C1729 SAFE-T-CENTESIS TRAY 6FR (CAREFUSION) BOTH IP/OP $481.00 $356.00 $95.47 $481.00 $261.18 $261.18 $261.18 $261.18 $481.00 $481.00 $481.00 $100.25 $481.00 $357.00 $357.00 $370.75 $250.60 $100.25 $481.00 $481.00 $284.51 $481.00 $481.00 $481.00 $481.00 $360.75 $481.00 $481.00 $481.00 $240.50 $240.50 $380.95 $481.00 $384.80 $312.65 $95.47 $481.00 $278.98 $481.00 $481.00 $481.00 $100.24 $481.00 N/A N/A 27300022 EAP STOCKING COMPRESSION 20-30 MMHG LARGE BK OD15.5-18 BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 27300023 EAP STOCKING COMPRESSION 20-30 MMHG X-LARGE BK OD17.5-20 BOTH IP/OP $49.00 $36.50 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $8.72 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $49.00 $49.00 $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A 27400001 EAP HCPCS A5121 "SKIN BARRIER, SOLID 6X6 OR EQUIVAL" BOTH IP/OP $36.00 $27.00 $5.22 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $5.22 $36.00 $36.00 $36.00 $36.00 $36.00 $36.00 $7.50 $36.00 $14.40 $36.00 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $16.20 $36.00 $36.00 $20.88 $36.00 $21.60 $36.00 $36.00 $36.00 N/A N/A 27400002 EAP HCPCS A5122 "SKIN BARRIER, SOLID 8X8 OR EQUIVALENT" BOTH IP/OP $135.00 $100.00 $10.43 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $10.43 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $60.75 $135.00 $135.00 $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A 27400003 EAP HCPCS L0170 NECK EXT. SPLINT BOTH IP/OP $94.00 $70.00 $19.59 $556.60 $42.30 $42.30 $42.30 $42.30 $94.00 $94.00 $437.21 $556.60 $94.00 $94.00 $94.00 $94.00 $94.00 $19.59 $94.00 $37.60 $55.60 $94.00 $94.00 $94.00 $94.00 $70.50 $94.00 $94.00 $94.00 $47.00 $47.00 $74.45 $94.00 $75.20 $42.30 $94.00 $94.00 $54.52 $94.00 $56.40 $94.00 $540.87 $94.00 N/A N/A 27400004 EAP HCPCS L0150 CERVICAL COLLAR BOTH IP/OP $202.00 $149.50 $42.10 $202.00 $202.00 $202.00 $202.00 $202.00 $202.00 $202.00 $73.13 $202.00 $202.00 $202.00 $202.00 $202.00 $202.00 $42.10 $202.00 $80.80 $202.00 $202.00 $202.00 $202.00 $202.00 $151.50 $202.00 $202.00 $202.00 $101.00 $101.00 $159.98 $202.00 $161.60 $90.90 $202.00 $202.00 $117.16 $202.00 $121.20 $202.00 $202.00 $202.00 N/A N/A 27400005 EAP HCPCS L0172 ASPEN COLLAR BOTH IP/OP $524.00 $388.00 $86.19 $524.00 $235.80 $235.80 $235.80 $235.80 $524.00 $524.00 $86.19 $112.86 $524.00 $524.00 $524.00 $524.00 $524.00 $109.21 $524.00 $209.60 $309.95 $524.00 $524.00 $524.00 $524.00 $393.00 $524.00 $524.00 $524.00 $262.00 $262.00 $415.01 $524.00 $419.20 $235.80 $107.46 $524.00 $303.92 $524.00 $314.40 $524.00 $109.67 $524.00 N/A N/A 27400006 EAP HCPCS L0174 MIAMI COLLAR BOTH IP/OP $938.00 $694.50 $186.22 $938.00 $938.00 $938.00 $938.00 $938.00 $938.00 $938.00 $186.22 $938.00 $938.00 $938.00 $938.00 $938.00 $938.00 $195.49 $938.00 $375.20 $938.00 $938.00 $938.00 $938.00 $938.00 $703.50 $938.00 $938.00 $938.00 $469.00 $469.00 $742.90 $938.00 $750.40 $422.10 $938.00 $938.00 $544.04 $938.00 $562.80 $938.00 $938.00 $938.00 N/A N/A 27400007 EAP HCPCS L0190 SOMI BRACE BOTH IP/OP "$1,827.00" "$1,352.00" $335.87 "$1,827.00" "$1,827.00" "$1,827.00" "$1,827.00" "$1,827.00" "$1,827.00" "$1,827.00" $335.87 "$1,827.00" "$1,827.00" "$1,827.00" "$1,827.00" "$1,827.00" "$1,827.00" $380.77 "$1,827.00" $730.80 "$1,827.00" "$1,827.00" "$1,827.00" "$1,827.00" "$1,827.00" "$1,370.25" "$1,827.00" "$1,827.00" "$1,827.00" $913.50 $913.50 "$1,446.98" "$1,827.00" "$1,461.60" $822.15 "$1,827.00" "$1,827.00" "$1,059.66" "$1,827.00" "$1,096.20" "$1,827.00" "$1,827.00" "$1,827.00" N/A N/A 27400008 EAP HCPCS L0200 CERVICAL THORACIC ORTHOSIS(CTO BOTH IP/OP "$1,679.00" "$1,242.50" $349.92 "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" $349.97 "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" $349.92 "$1,679.00" $671.60 "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" "$1,259.25" "$1,679.00" "$1,679.00" "$1,679.00" $839.50 $839.50 "$1,329.77" "$1,679.00" "$1,343.20" $755.55 "$1,679.00" "$1,679.00" $973.82 "$1,679.00" "$1,007.40" "$1,679.00" "$1,679.00" "$1,679.00" N/A N/A 27400009 EAP HCPCS L0450 TLSO BRACE BOTH IP/OP $929.00 $687.50 $74.17 $929.00 $929.00 $929.00 $929.00 $929.00 $929.00 $929.00 $74.17 $929.00 $929.00 $929.00 $929.00 $929.00 $929.00 $193.61 $929.00 $371.60 $929.00 $929.00 $929.00 $929.00 $929.00 $696.75 $929.00 $929.00 $929.00 $464.50 $464.50 $735.77 $929.00 $743.20 $418.05 $929.00 $929.00 $538.82 $929.00 $557.40 $929.00 $929.00 $929.00 N/A N/A 27400010 EAP HCPCS L0472 JEWETT BRACE BOTH IP/OP "$1,496.00" "$1,107.50" $274.23 "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" $274.23 "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" $311.78 "$1,496.00" $598.40 "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" "$1,122.00" "$1,496.00" "$1,496.00" "$1,496.00" $748.00 $748.00 "$1,184.83" "$1,496.00" "$1,196.80" $673.20 "$1,496.00" "$1,496.00" $867.68 "$1,496.00" $897.60 "$1,496.00" "$1,496.00" "$1,496.00" N/A N/A 27400011 EAP HCPCS L0486 CUSTOM TO FIT TLSO BOTH IP/OP "$6,431.00" "$4,759.00" "$1,278.19" "$6,431.00" "$6,431.00" "$6,431.00" "$6,431.00" "$6,431.00" "$6,431.00" "$6,431.00" "$1,278.19" "$6,431.00" "$6,431.00" "$6,431.00" "$6,431.00" "$6,431.00" "$6,431.00" "$1,340.29" "$6,431.00" "$2,572.40" "$6,431.00" "$6,431.00" "$6,431.00" "$6,431.00" "$6,431.00" "$4,823.25" "$6,431.00" "$6,431.00" "$6,431.00" "$3,215.50" "$3,215.50" "$5,093.35" "$6,431.00" "$5,144.80" "$2,893.95" "$6,431.00" "$6,431.00" "$3,729.98" "$6,431.00" "$3,858.60" "$6,431.00" "$6,431.00" "$6,431.00" N/A N/A 27400012 EAP HCPCS L0637 LSO CYBERTECH BOTH IP/OP "$4,041.00" "$2,990.50" $760.28 "$4,041.00" "$4,041.00" "$4,041.00" "$4,041.00" "$4,041.00" "$4,041.00" "$4,041.00" $760.28 "$4,041.00" "$4,041.00" "$4,041.00" "$4,041.00" "$4,041.00" "$4,041.00" $842.19 "$4,041.00" "$1,616.40" "$4,041.00" "$4,041.00" "$4,041.00" "$4,041.00" "$4,041.00" "$3,030.75" "$4,041.00" "$4,041.00" "$4,041.00" "$2,020.50" "$2,020.50" "$3,200.47" "$4,041.00" "$3,232.80" "$1,818.45" "$4,041.00" "$4,041.00" "$2,343.78" "$4,041.00" "$2,424.60" "$4,041.00" "$4,041.00" "$4,041.00" N/A N/A 27400013 EAP HCPCS L0638 LSO BRACE BOTH IP/OP "$3,917.00" "$2,899.00" $816.35 "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" $854.30 "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" $816.35 "$3,917.00" "$1,566.80" "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" "$2,937.75" "$3,917.00" "$3,917.00" "$3,917.00" "$1,958.50" "$1,958.50" "$3,102.26" "$3,917.00" "$3,133.60" "$1,762.65" "$3,917.00" "$3,917.00" "$2,271.86" "$3,917.00" "$2,350.20" "$3,917.00" "$3,917.00" "$3,917.00" N/A N/A 27400014 EAP HCPCS L0700 CTLSO BRACE BOTH IP/OP "$6,393.00" "$4,731.00" "$1,332.37" "$6,393.00" "$6,393.00" "$6,393.00" "$6,393.00" "$6,393.00" "$6,393.00" "$6,393.00" "$1,370.65" "$6,393.00" "$6,393.00" "$6,393.00" "$6,393.00" "$6,393.00" "$6,393.00" "$1,332.37" "$6,393.00" "$2,557.20" "$6,393.00" "$6,393.00" "$6,393.00" "$6,393.00" "$6,393.00" "$4,794.75" "$6,393.00" "$6,393.00" "$6,393.00" "$3,196.50" "$3,196.50" "$5,063.26" "$6,393.00" "$5,114.40" "$2,876.85" "$6,393.00" "$6,393.00" "$3,707.94" "$6,393.00" "$3,835.80" "$6,393.00" "$6,393.00" "$6,393.00" N/A N/A 27400015 EAP HCPCS L1686 HIP ABDUCTION BRACE BOTH IP/OP "$4,383.00" "$3,243.50" $618.46 "$4,383.00" "$4,383.00" "$4,383.00" "$4,383.00" "$4,383.00" "$4,383.00" "$4,383.00" $618.46 "$4,383.00" "$4,383.00" "$4,383.00" "$4,383.00" "$4,383.00" "$4,383.00" $913.47 "$4,383.00" "$1,753.20" "$4,383.00" "$4,383.00" "$4,383.00" "$4,383.00" "$4,383.00" "$3,287.25" "$4,383.00" "$4,383.00" "$4,383.00" "$2,191.50" "$2,191.50" "$3,471.34" "$4,383.00" "$3,506.40" "$1,972.35" "$4,383.00" "$4,383.00" "$2,542.14" "$4,383.00" "$2,629.80" "$4,383.00" "$4,383.00" "$4,383.00" N/A N/A 27400017 EAP HCPCS L1830 KNEE IMMOBILIZER BOTH IP/OP $371.00 $275.00 $48.84 $371.00 $371.00 $371.00 $371.00 $371.00 $371.00 $371.00 $48.84 $371.00 $371.00 $371.00 $371.00 $371.00 $371.00 $77.32 $371.00 $148.40 $371.00 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $166.95 $371.00 $371.00 $215.18 $371.00 $222.60 $371.00 $371.00 $371.00 N/A N/A 27400019 EAP HCPCS L1940 ANKLE FOOT ORTHOSIS BOTH IP/OP $345.00 $255.50 $71.90 $394.54 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $335.35 $394.54 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $138.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $345.00 $345.00 $200.10 $345.00 $207.00 $345.00 $383.39 $345.00 N/A N/A 27400020 EAP HCPCS L1834 KNEE EXT. SPLINT BOTH IP/OP $243.00 $180.00 $50.64 $526.27 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $526.27 $243.00 $243.00 $243.00 $243.00 $243.00 $243.00 $50.64 $243.00 $97.20 $243.00 $243.00 $243.00 $243.00 $243.00 $182.25 $243.00 $243.00 $243.00 $121.50 $121.50 $192.46 $243.00 $194.40 $109.35 $243.00 $243.00 $140.94 $243.00 $145.80 $243.00 $243.00 $243.00 N/A N/A 27400021 EAP HCPCS L3650 SHOULDER IMMOBILIZER BOTH IP/OP $371.00 $275.00 $39.44 $371.00 $371.00 $371.00 $371.00 $371.00 $371.00 $371.00 $39.44 $371.00 $371.00 $371.00 $371.00 $371.00 $371.00 $77.32 $371.00 $148.40 $371.00 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $166.95 $371.00 $371.00 $215.18 $371.00 $222.60 $371.00 $371.00 $371.00 N/A N/A 27400022 EAP HCPCS L3670 SHOULDER ABDUCTION BOTH IP/OP $388.00 $287.50 $74.96 $388.00 $174.60 $174.60 $174.60 $174.60 $388.00 $388.00 $74.96 $103.47 $388.00 $388.00 $388.00 $388.00 $388.00 $80.86 $388.00 $155.20 $229.50 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $174.60 $98.52 $388.00 $225.04 $388.00 $232.80 $388.00 $100.55 $388.00 N/A N/A 27400024 EAP HCPCS L3702 CUSTOM ELBOW BOTH IP/OP $97.00 $72.00 $20.22 $208.54 $43.65 $43.65 $43.65 $43.65 $97.00 $97.00 $170.29 $208.54 $97.00 $97.00 $97.00 $97.00 $97.00 $20.22 $97.00 $38.80 $57.38 $97.00 $97.00 $97.00 $97.00 $72.75 $97.00 $97.00 $97.00 $48.50 $48.50 $76.82 $97.00 $77.60 $43.65 $97.00 $97.00 $56.26 $97.00 $58.20 $97.00 $202.65 $97.00 N/A N/A 27400025 EAP HCPCS L3967 AIRPLANE SPLINT BOTH IP/OP $406.00 $300.50 $84.61 "$1,169.28" $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 "$1,169.28" $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $84.61 $406.00 $162.40 $406.00 $406.00 $406.00 $406.00 $406.00 $304.50 $406.00 $406.00 $406.00 $203.00 $203.00 $321.55 $406.00 $324.80 $182.70 $406.00 $406.00 $235.48 $406.00 $243.60 $406.00 $406.00 $406.00 N/A N/A 27400026 EAP HCPCS L3905 DYNAMIC WRIST SPLINT BOTH IP/OP $107.00 $79.50 $22.30 $584.51 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $584.51 $107.00 $107.00 $107.00 $107.00 $107.00 $107.00 $22.30 $107.00 $42.80 $107.00 $107.00 $107.00 $107.00 $107.00 $80.25 $107.00 $107.00 $107.00 $53.50 $53.50 $84.74 $107.00 $85.60 $48.15 $107.00 $107.00 $62.06 $107.00 $64.20 $107.00 $107.00 $107.00 N/A N/A 27400027 EAP HCPCS L3935 ANY FINGER SPLINT BOTH IP/OP $198.00 $147.00 $41.27 $198.00 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $130.33 $159.57 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $79.20 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $151.93 $198.00 $114.84 $198.00 $118.80 $198.00 $155.06 $198.00 N/A N/A 27400028 EAP HCPCS L3808 ULNAR/RADIAL GUTTER BOTH IP/OP $69.00 $51.50 $14.38 $247.75 $31.05 $31.05 $31.05 $31.05 $69.00 $69.00 $219.65 $247.75 $69.00 $69.00 $69.00 $69.00 $69.00 $14.38 $69.00 $27.60 $40.81 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $31.05 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $240.75 $69.00 N/A N/A 27400029 EAP HCPCS L3906 WRIST COCKUP SPLINT BOTH IP/OP $202.00 $149.50 $42.10 $304.68 $90.90 $90.90 $90.90 $90.90 $202.00 $202.00 $262.22 $304.68 $202.00 $202.00 $202.00 $202.00 $202.00 $42.10 $202.00 $80.80 $119.48 $202.00 $202.00 $202.00 $202.00 $151.50 $202.00 $202.00 $202.00 $101.00 $101.00 $159.98 $202.00 $161.60 $90.90 $202.00 $202.00 $117.16 $202.00 $121.20 $202.00 $296.07 $202.00 N/A N/A 27400030 EAP HCPCS L3925 SPRING WIRE ASSIST SPLINT PREFAB BOTH IP/OP $195.00 $144.50 $32.65 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $32.65 $39.19 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $37.31 $195.00 $113.10 $195.00 $117.00 $195.00 $38.08 $195.00 N/A N/A 27400033 EAP HCPCS L3671 CUSTOM HUMERUS BOTH IP/OP $420.00 $311.00 $87.53 $531.23 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $531.23 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $87.53 $420.00 $168.00 $420.00 $420.00 $420.00 $420.00 $420.00 $315.00 $420.00 $420.00 $420.00 $210.00 $210.00 $332.64 $420.00 $336.00 $189.00 $420.00 $420.00 $243.60 $420.00 $252.00 $420.00 $420.00 $420.00 N/A N/A 27400034 EAP HCPCS L3982 RESTING HAND SPLINT-CUSTOM BOTH IP/OP $214.00 $158.50 $44.60 $275.84 $96.30 $96.30 $96.30 $96.30 $214.00 $214.00 $247.59 $275.84 $214.00 $214.00 $214.00 $214.00 $214.00 $44.60 $214.00 $85.60 $126.58 $214.00 $214.00 $214.00 $214.00 $160.50 $214.00 $214.00 $214.00 $107.00 $107.00 $169.49 $214.00 $171.20 $96.30 $214.00 $214.00 $124.12 $214.00 $128.40 $214.00 $268.05 $214.00 N/A N/A 27400038 EAP HCPCS L3334 HEEL LIFT BOTH IP/OP $127.00 $94.00 $24.81 $127.00 $57.15 $57.15 $57.15 $57.15 $127.00 $127.00 $24.81 $30.28 $127.00 $127.00 $127.00 $127.00 $127.00 $26.47 $127.00 $50.80 $75.12 $127.00 $127.00 $127.00 $127.00 $95.25 $127.00 $127.00 $127.00 $63.50 $63.50 $100.58 $127.00 $101.60 $57.15 $28.83 $127.00 $73.66 $127.00 $76.20 $127.00 $29.42 $127.00 N/A N/A 27400039 EAP HCPCS L3710 HINGED ELBOW BRACE BOTH IP/OP $431.00 $319.00 $82.01 $431.00 $431.00 $431.00 $431.00 $431.00 $431.00 $431.00 $82.01 $431.00 $431.00 $431.00 $431.00 $431.00 $431.00 $89.83 $431.00 $172.40 $431.00 $431.00 $431.00 $431.00 $431.00 $323.25 $431.00 $431.00 $431.00 $215.50 $215.50 $341.35 $431.00 $344.80 $193.95 $431.00 $431.00 $249.98 $431.00 $258.60 $431.00 $431.00 $431.00 N/A N/A 27400040 EAP HCPCS L3806 DORSAL BLOCK SPLINT W/KLEINE BOTH IP/OP $47.00 $35.00 $9.80 $267.70 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $267.70 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $21.15 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27400050 EAP HCPCS L3913 SIMPLE HAND BASED SPL BOTH IP/OP $55.00 $41.00 $11.46 $195.60 $24.75 $24.75 $24.75 $24.75 $55.00 $55.00 $159.58 $195.60 $55.00 $55.00 $55.00 $55.00 $55.00 $11.46 $55.00 $22.00 $32.53 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $24.75 $55.00 $55.00 $31.90 $55.00 $33.00 $55.00 $190.08 $55.00 N/A N/A 27400051 EAP HCPCS L3808 DORSAL BLOCK SPLINT BOTH IP/OP $34.00 $25.50 $7.09 $247.75 $15.30 $15.30 $15.30 $15.30 $34.00 $34.00 $219.65 $247.75 $34.00 $34.00 $34.00 $34.00 $34.00 $7.09 $34.00 $13.60 $20.11 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $15.30 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $240.75 $34.00 N/A N/A 27400052 EAP HCPCS L3931 WHFO FINGER EXTEN W/WRIST SUPP BOTH IP/OP $126.00 $93.50 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $120.92 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $126.00 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $126.00 $126.00 $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 27400053 EAP HCPCS L3807 BALL SPLINT/FINGER ABD SPLINT BOTH IP/OP $161.00 $119.50 $33.55 $180.59 $72.45 $72.45 $72.45 $72.45 $161.00 $161.00 $147.30 $180.59 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $64.40 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $161.00 $161.00 $93.38 $161.00 $96.60 $161.00 $175.48 $161.00 N/A N/A 27400054 EAP HCPCS L3908 CANV/LEATH/EZY-ON WRIST SPLINT BOTH IP/OP $99.00 $73.50 $20.63 $99.00 $44.55 $44.55 $44.55 $44.55 $99.00 $99.00 $39.70 $43.26 $99.00 $99.00 $99.00 $99.00 $99.00 $20.63 $99.00 $39.60 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $44.55 $41.19 $99.00 $57.42 $99.00 $59.40 $99.00 $42.04 $99.00 N/A N/A 27400055 EAP HCPCS L3808 GAUNTLET WITH THUMB SPICA BOTH IP/OP $91.00 $67.50 $18.97 $247.75 $40.95 $40.95 $40.95 $40.95 $91.00 $91.00 $219.65 $247.75 $91.00 $91.00 $91.00 $91.00 $91.00 $18.97 $91.00 $36.40 $53.83 $91.00 $91.00 $91.00 $91.00 $68.25 $91.00 $91.00 $91.00 $45.50 $45.50 $72.07 $91.00 $72.80 $40.95 $91.00 $91.00 $52.78 $91.00 $54.60 $91.00 $240.75 $91.00 N/A N/A 27400056 EAP HCPCS L3807 PREFAB BURN SPLINT BOTH IP/OP $349.00 $258.50 $72.74 $349.00 $157.05 $157.05 $157.05 $157.05 $349.00 $349.00 $147.30 $180.59 $349.00 $349.00 $349.00 $349.00 $349.00 $72.74 $349.00 $139.60 $206.43 $349.00 $349.00 $349.00 $349.00 $261.75 $349.00 $349.00 $349.00 $174.50 $174.50 $276.41 $349.00 $279.20 $157.05 $171.95 $349.00 $202.42 $349.00 $209.40 $349.00 $175.48 $349.00 N/A N/A 27400057 EAP HCPCS L3923 SPASTICITY SPLINT BOTH IP/OP $164.00 $121.50 $34.18 $164.00 $164.00 $164.00 $164.00 $164.00 $164.00 $164.00 $57.72 $164.00 $164.00 $164.00 $164.00 $164.00 $164.00 $34.18 $164.00 $65.60 $164.00 $164.00 $164.00 $164.00 $164.00 $123.00 $164.00 $164.00 $164.00 $82.00 $82.00 $129.89 $164.00 $131.20 $73.80 $164.00 $164.00 $95.12 $164.00 $98.40 $164.00 $164.00 $164.00 N/A N/A 27400058 EAP HCPCS L3763 FOREARM SARMIENTO BOTH IP/OP $195.00 $144.50 $40.64 $433.81 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $433.81 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $195.00 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $195.00 $195.00 $113.10 $195.00 $117.00 $195.00 $195.00 $195.00 N/A N/A 27400059 EAP HCPCS L3931 WHFO - PALMER BOTH IP/OP $312.00 $231.00 $65.02 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $120.92 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $65.02 $312.00 $124.80 $312.00 $312.00 $312.00 $312.00 $312.00 $234.00 $312.00 $312.00 $312.00 $156.00 $156.00 $247.10 $312.00 $249.60 $140.40 $312.00 $312.00 $180.96 $312.00 $187.20 $312.00 $312.00 $312.00 N/A N/A 27400060 EAP HCPCS L3808 THUMB SPICA BOTH IP/OP $72.00 $53.50 $15.01 $247.75 $32.40 $32.40 $32.40 $32.40 $72.00 $72.00 $219.65 $247.75 $72.00 $72.00 $72.00 $72.00 $72.00 $15.01 $72.00 $28.80 $42.59 $72.00 $72.00 $72.00 $72.00 $54.00 $72.00 $72.00 $72.00 $36.00 $36.00 $57.02 $72.00 $57.60 $32.40 $72.00 $72.00 $41.76 $72.00 $43.20 $72.00 $240.75 $72.00 N/A N/A 27400061 EAP HCPCS L3808 WHFO WR GAUNLET/THUMB SPICA BOTH IP/OP $185.00 $137.00 $38.56 $247.75 $83.25 $83.25 $83.25 $83.25 $185.00 $185.00 $219.65 $247.75 $185.00 $185.00 $185.00 $185.00 $185.00 $38.56 $185.00 $74.00 $109.43 $185.00 $185.00 $185.00 $185.00 $138.75 $185.00 $185.00 $185.00 $92.50 $92.50 $146.52 $185.00 $148.00 $83.25 $185.00 $185.00 $107.30 $185.00 $111.00 $185.00 $240.75 $185.00 N/A N/A 27400062 EAP HCPCS L3808 "WHFO,LONG OPPONENS NO ATTACHME" BOTH IP/OP $65.00 $48.50 $13.55 $247.75 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $219.65 $247.75 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.00 $38.45 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $240.75 $65.00 N/A N/A 27400066 EAP HCPCS L3808 SAFE POSITION SPLINT BOTH IP/OP $107.00 $79.50 $22.30 $247.75 $48.15 $48.15 $48.15 $48.15 $107.00 $107.00 $219.65 $247.75 $107.00 $107.00 $107.00 $107.00 $107.00 $22.30 $107.00 $42.80 $63.29 $107.00 $107.00 $107.00 $107.00 $80.25 $107.00 $107.00 $107.00 $53.50 $53.50 $84.74 $107.00 $85.60 $48.15 $107.00 $107.00 $62.06 $107.00 $64.20 $107.00 $240.75 $107.00 N/A N/A 27400067 EAP HCPCS L4398 FOAM FOOT DROP STOP-PREFAB BOTH IP/OP $47.00 $35.00 $9.80 $49.88 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $49.88 $47.00 $47.00 $47.00 $47.00 $47.00 $47.00 $9.80 $47.00 $18.80 $47.00 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $21.15 $47.00 $47.00 $27.26 $47.00 $28.20 $47.00 $47.00 $47.00 N/A N/A 27400070 EAP HCPCS L3808 CANV/LEATH/EZY-ON WRIST SPLINT BOTH IP/OP $19.00 $14.50 $3.96 $247.75 $8.55 $8.55 $8.55 $8.55 $19.00 $19.00 $219.65 $247.75 $19.00 $19.00 $19.00 $19.00 $19.00 $3.96 $19.00 $7.60 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $8.55 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $240.75 $19.00 N/A N/A 27400071 EAP HCPCS L3905 FOREARM BASED OUTRIGGER BOTH IP/OP $160.00 $118.50 $33.35 $584.51 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $584.51 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $33.35 $160.00 $64.00 $160.00 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $72.00 $160.00 $160.00 $92.80 $160.00 $96.00 $160.00 $160.00 $160.00 N/A N/A 27400078 EAP HCPCS L1834 KNEE EXTENSION SPLINT(S/P BKA) BOTH IP/OP $215.00 $159.50 $44.81 $526.27 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $526.27 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $44.81 $215.00 $86.00 $215.00 $215.00 $215.00 $215.00 $215.00 $161.25 $215.00 $215.00 $215.00 $107.50 $107.50 $170.28 $215.00 $172.00 $96.75 $215.00 $215.00 $124.70 $215.00 $129.00 $215.00 $215.00 $215.00 N/A N/A 27400080 EAP HCPCS L3807 RESTING HAND SPLINT-PREFAB BOTH IP/OP $328.00 $243.00 $68.36 $328.00 $147.60 $147.60 $147.60 $147.60 $328.00 $328.00 $147.30 $180.59 $328.00 $328.00 $328.00 $328.00 $328.00 $68.36 $328.00 $131.20 $194.01 $328.00 $328.00 $328.00 $328.00 $246.00 $328.00 $328.00 $328.00 $164.00 $164.00 $259.78 $328.00 $262.40 $147.60 $171.95 $328.00 $190.24 $328.00 $196.80 $328.00 $175.48 $328.00 N/A N/A 27400085 EAP HCPCS L3921 HAND BASED OUTRIGGER BOTH IP/OP $118.00 $87.50 $24.59 $189.35 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $189.35 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $24.59 $118.00 $47.20 $118.00 $118.00 $118.00 $118.00 $118.00 $88.50 $118.00 $118.00 $118.00 $59.00 $59.00 $93.46 $118.00 $94.40 $53.10 $118.00 $118.00 $68.44 $118.00 $70.80 $118.00 $118.00 $118.00 N/A N/A 27400086 EAP HCPCS A4467 POSTERIOR ELBOW SPLINT-PREFAB BOTH IP/OP $105.00 $78.00 $21.88 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $21.88 $105.00 $42.00 $105.00 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $47.25 $105.00 $105.00 $60.90 $105.00 $63.00 $105.00 $105.00 $105.00 N/A N/A 27400087 EAP HCPCS L4396 FOOT DROP SPLINT PREFAB BOTH IP/OP $278.00 $206.00 $57.94 $278.00 $125.10 $125.10 $125.10 $125.10 $278.00 $278.00 $108.39 $133.19 $278.00 $278.00 $278.00 $278.00 $278.00 $57.94 $278.00 $111.20 $164.44 $278.00 $278.00 $278.00 $278.00 $208.50 $278.00 $278.00 $278.00 $139.00 $139.00 $220.18 $278.00 $222.40 $125.10 $126.82 $278.00 $161.24 $278.00 $166.80 $278.00 $129.42 $278.00 N/A N/A 27400090 EAP HCPCS L1960 FOOT DROP SPLINT-CUSTOM BOTH IP/OP $237.00 $175.50 $49.39 $375.83 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $375.83 $237.00 $237.00 $237.00 $237.00 $237.00 $237.00 $49.39 $237.00 $94.80 $237.00 $237.00 $237.00 $237.00 $237.00 $177.75 $237.00 $237.00 $237.00 $118.50 $118.50 $187.70 $237.00 $189.60 $106.65 $237.00 $237.00 $137.46 $237.00 $142.20 $237.00 $237.00 $237.00 N/A N/A 27400091 EAP HCPCS L3808 RESTING HAND/VOLAR WRIST CUSTOM BOTH IP/OP $209.00 $155.00 $43.56 $247.75 $94.05 $94.05 $94.05 $94.05 $209.00 $209.00 $219.65 $247.75 $209.00 $209.00 $209.00 $209.00 $209.00 $43.56 $209.00 $83.60 $123.62 $209.00 $209.00 $209.00 $209.00 $156.75 $209.00 $209.00 $209.00 $104.50 $104.50 $165.53 $209.00 $167.20 $94.05 $209.00 $209.00 $121.22 $209.00 $125.40 $209.00 $240.75 $209.00 N/A N/A 27400097 EAP HCPCS L3931 RESTING HAND PREFAB HAND REHAB BOTH IP/OP $199.00 $147.50 $41.47 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $120.92 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $41.47 $199.00 $79.60 $199.00 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $89.55 $199.00 $199.00 $115.42 $199.00 $119.40 $199.00 $199.00 $199.00 N/A N/A 27400098 EAP HCPCS L3808 CUSTOM RESTING HAND BOTH IP/OP $198.00 $147.00 $41.27 $247.75 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $219.65 $247.75 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $79.20 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $198.00 $198.00 $114.84 $198.00 $118.80 $198.00 $240.75 $198.00 N/A N/A 27400099 EAP HCPCS L0810 HALO AND VEST BOTH IP/OP "$7,045.00" "$5,213.50" "$1,468.26" "$7,045.00" "$7,045.00" "$7,045.00" "$7,045.00" "$7,045.00" "$7,045.00" "$7,045.00" "$1,748.57" "$7,045.00" "$7,045.00" "$7,045.00" "$7,045.00" "$7,045.00" "$7,045.00" "$1,468.26" "$7,045.00" "$2,818.00" "$7,045.00" "$7,045.00" "$7,045.00" "$7,045.00" "$7,045.00" "$5,283.75" "$7,045.00" "$7,045.00" "$7,045.00" "$3,522.50" "$3,522.50" "$5,579.64" "$7,045.00" "$5,636.00" "$3,170.25" "$7,045.00" "$7,045.00" "$4,086.10" "$7,045.00" "$4,227.00" "$7,045.00" "$7,045.00" "$7,045.00" N/A N/A 27400105 EAP HCPCS L3808 EXTENSOR TENDON SPLINT BOTH IP/OP $132.00 $98.00 $27.51 $247.75 $59.40 $59.40 $59.40 $59.40 $132.00 $132.00 $219.65 $247.75 $132.00 $132.00 $132.00 $132.00 $132.00 $27.51 $132.00 $52.80 $78.08 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $59.40 $132.00 $132.00 $76.56 $132.00 $79.20 $132.00 $240.75 $132.00 N/A N/A 27400108 EAP HCPCS L3980 HUMERAL FX BRACE BOTH IP/OP $179.00 $132.50 $37.31 $223.26 $80.55 $80.55 $80.55 $80.55 $179.00 $179.00 $205.02 $223.26 $179.00 $179.00 $179.00 $179.00 $179.00 $37.31 $179.00 $71.60 $105.88 $179.00 $179.00 $179.00 $179.00 $134.25 $179.00 $179.00 $179.00 $89.50 $89.50 $141.77 $179.00 $143.20 $80.55 $179.00 $179.00 $103.82 $179.00 $107.40 $179.00 $216.95 $179.00 N/A N/A 27400109 EAP HCPCS L3760 HINGED ELBOW BRACE BOTH IP/OP "$1,285.00" $951.00 $267.81 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $294.87 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" $514.00 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 "$1,285.00" "$1,285.00" $745.30 "$1,285.00" $771.00 "$1,285.00" "$1,285.00" "$1,285.00" N/A N/A 27400113 EAP HCPCS A4467 POSTERIOR ELBOW SPLINT-PREFAB BOTH IP/OP $105.00 $78.00 $21.88 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $21.88 $105.00 $42.00 $105.00 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $47.25 $105.00 $105.00 $60.90 $105.00 $63.00 $105.00 $105.00 $105.00 N/A N/A 27400114 EAP SPLINT ORTHOPEDIC 5YDX6IN FAST BOTH IP/OP $46.00 $34.50 $8.19 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $8.19 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $9.59 $46.00 $18.40 $46.00 $46.00 $46.00 $46.00 $46.00 $34.50 $46.00 $46.00 $46.00 $23.00 $23.00 $36.43 $46.00 $36.80 $20.70 $46.00 $46.00 $26.68 $46.00 $27.60 $46.00 $46.00 $46.00 N/A N/A 27400115 EAP HCPCS L1830 IMMOBILIZER ORTHOPEDIC UNIVERS BOTH IP/OP $45.00 $33.50 $9.38 $48.84 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $48.84 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $20.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 27400116 EAP HCPCS L0150 COLLAR CERV 2-5YR SHORT 35-45IN CHIN DOT TRACHEOSTOMY OPEN BOTH IP/OP $108.00 $80.00 $22.51 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $73.13 $108.00 $108.00 $108.00 $108.00 $108.00 $108.00 $22.51 $108.00 $43.20 $108.00 $108.00 $108.00 $108.00 $108.00 $81.00 $108.00 $108.00 $108.00 $54.00 $54.00 $85.54 $108.00 $86.40 $48.60 $108.00 $108.00 $62.64 $108.00 $64.80 $108.00 $108.00 $108.00 N/A N/A 27400117 EAP HCPCS L0150 COLLAR CERV 3-6YR REGULAR 37-48IN CHIN DOT TRACHEOSTOMY OPEN BOTH IP/OP $109.00 $81.00 $22.72 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $73.13 $109.00 $109.00 $109.00 $109.00 $109.00 $109.00 $22.72 $109.00 $43.60 $109.00 $109.00 $109.00 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $49.05 $109.00 $109.00 $63.22 $109.00 $65.40 $109.00 $109.00 $109.00 N/A N/A 27400118 EAP HCPCS L0172 COLLAR CERV SHORT LATEX FREE ADULT BOTH IP/OP $103.00 $76.50 $21.47 $112.86 $46.35 $46.35 $46.35 $46.35 $103.00 $103.00 $86.19 $112.86 $103.00 $103.00 $103.00 $103.00 $103.00 $21.47 $103.00 $41.20 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $46.35 $103.00 $103.00 $59.74 $103.00 $61.80 $103.00 $109.67 $103.00 N/A N/A 27400119 EAP HCPCS L0172 COLLAR CERV REGULAR CHIN REST TRACHEOSTOMY OPENING BOTH IP/OP $100.00 $74.00 $20.84 $112.86 $45.00 $45.00 $45.00 $45.00 $100.00 $100.00 $86.19 $112.86 $100.00 $100.00 $100.00 $100.00 $100.00 $20.84 $100.00 $40.00 $59.15 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $45.00 $100.00 $100.00 $58.00 $100.00 $60.00 $100.00 $109.67 $100.00 N/A N/A 27400120 EAP HCPCS L0172 COLLAR CERV TALL CHIN REST TRACHEOSTOMY OPENING ADJUSTABLE BOTH IP/OP $97.00 $72.00 $20.22 $112.86 $43.65 $43.65 $43.65 $43.65 $97.00 $97.00 $86.19 $112.86 $97.00 $97.00 $97.00 $97.00 $97.00 $20.22 $97.00 $38.80 $57.38 $97.00 $97.00 $97.00 $97.00 $72.75 $97.00 $97.00 $97.00 $48.50 $48.50 $76.82 $97.00 $77.60 $43.65 $97.00 $97.00 $56.26 $97.00 $58.20 $97.00 $109.67 $97.00 N/A N/A 27400121 EAP HCPCS L0113 COLLAR CERV 1-3YR TOT 33-40IN CHIN DOT TRACHEOSTOMY OPEN BOTH IP/OP $101.00 $75.00 $21.05 $185.17 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $185.17 $101.00 $101.00 $101.00 $101.00 $101.00 $101.00 $21.05 $101.00 $40.40 $101.00 $101.00 $101.00 $101.00 $101.00 $75.75 $101.00 $101.00 $101.00 $50.50 $50.50 $79.99 $101.00 $80.80 $45.45 $101.00 $101.00 $58.58 $101.00 $60.60 $101.00 $101.00 $101.00 N/A N/A 27400122 EAP HCPCS L0172 COLLAR CERV SHORT CHIN REST TRACHEOSTOMY OPENING ADJUSTABLE BOTH IP/OP $115.00 $85.50 $23.97 $115.00 $51.75 $51.75 $51.75 $51.75 $115.00 $115.00 $86.19 $112.86 $115.00 $115.00 $115.00 $115.00 $115.00 $23.97 $115.00 $46.00 $68.02 $115.00 $115.00 $115.00 $115.00 $86.25 $115.00 $115.00 $115.00 $57.50 $57.50 $91.08 $115.00 $92.00 $51.75 $107.46 $115.00 $66.70 $115.00 $69.00 $115.00 $109.67 $115.00 N/A N/A 27400123 EAP HCPCS L0172 COLLAR CERV 9-24 MONTH REGULAR 29-37IN CHIN DOT TRACHEOSTOMY BOTH IP/OP $114.00 $84.50 $23.76 $114.00 $51.30 $51.30 $51.30 $51.30 $114.00 $114.00 $86.19 $112.86 $114.00 $114.00 $114.00 $114.00 $114.00 $23.76 $114.00 $45.60 $67.43 $114.00 $114.00 $114.00 $114.00 $85.50 $114.00 $114.00 $114.00 $57.00 $57.00 $90.29 $114.00 $91.20 $51.30 $107.46 $114.00 $66.12 $114.00 $68.40 $114.00 $109.67 $114.00 N/A N/A 27400124 EAP HCPCS L0172 COLLAR CRV UNV OCCIAN BCK INTUITECH BOTH IP/OP $188.00 $139.50 $39.18 $188.00 $84.60 $84.60 $84.60 $84.60 $188.00 $188.00 $86.19 $112.86 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $107.46 $188.00 $109.04 $188.00 $112.80 $188.00 $109.67 $188.00 N/A N/A 27403807 EAP HCPCS L3807 SPLINT (PREFAB) WRIST HAND FINGER W/O JOINT BOTH IP/OP $251.00 $186.00 $52.31 $251.00 $112.95 $112.95 $112.95 $112.95 $251.00 $251.00 $147.30 $180.59 $251.00 $251.00 $251.00 $251.00 $251.00 $52.31 $251.00 $100.40 $148.47 $251.00 $251.00 $251.00 $251.00 $188.25 $251.00 $251.00 $251.00 $125.50 $125.50 $198.79 $251.00 $200.80 $112.95 $171.95 $251.00 $145.58 $251.00 $150.60 $251.00 $175.48 $251.00 N/A N/A 27403808 EAP HCPCS L3808 SPLINT (CUSTOM-FAB) WRIST HAND FINGER W/O JOINT BOTH IP/OP $125.00 $92.50 $26.05 $247.75 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $219.65 $247.75 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $50.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $125.00 $125.00 $72.50 $125.00 $75.00 $125.00 $240.75 $125.00 N/A N/A 27403905 EAP HCPCS L3905 SPLINT (CUSTOM-FAB) WRIST HAND FINGER INCL JOINT BOTH IP/OP $134.00 $99.50 $27.93 $584.51 $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $584.51 $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $27.93 $134.00 $53.60 $134.00 $134.00 $134.00 $134.00 $134.00 $100.50 $134.00 $134.00 $134.00 $67.00 $67.00 $106.13 $134.00 $107.20 $60.30 $134.00 $134.00 $77.72 $134.00 $80.40 $134.00 $134.00 $134.00 N/A N/A 27403960 EAP HCPCS L3960 SPLINT (PREFABRICATED) SHOULDER ELBOW WRIST HAND (AIRPLANE) ABDUCTION BOTH IP/OP $406.00 $300.50 $84.61 $487.61 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $487.61 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $84.61 $406.00 $162.40 $406.00 $406.00 $406.00 $406.00 $406.00 $304.50 $406.00 $406.00 $406.00 $203.00 $203.00 $321.55 $406.00 $324.80 $182.70 $406.00 $406.00 $235.48 $406.00 $243.60 $406.00 $406.00 $406.00 N/A N/A 27500001 EAP HCPCS C1721 2207-36 CURRENT DR ICD BOTH IP/OP "$52,001.00" "$38,481.00" "$10,837.58" "$52,001.00" "$52,001.00" "$52,001.00" "$52,001.00" "$52,001.00" "$52,001.00" "$52,001.00" "$52,001.00" "$52,001.00" "$52,001.00" "$52,001.00" "$52,001.00" "$52,001.00" "$52,001.00" "$10,837.58" "$52,001.00" "$20,800.40" "$52,001.00" "$52,001.00" "$52,001.00" "$52,001.00" "$52,001.00" "$39,000.75" "$52,001.00" "$52,001.00" "$52,001.00" "$26,000.50" "$26,000.50" "$41,184.79" "$52,001.00" "$41,600.80" "$23,400.45" "$52,001.00" "$52,001.00" "$30,160.58" "$52,001.00" "$31,200.60" "$52,001.00" "$52,001.00" "$52,001.00" N/A N/A 27500003 EAP HCPCS C1722 1207-36 CURRENT VR ICD BOTH IP/OP "$43,036.00" "$31,847.00" "$7,712.84" "$43,036.00" "$19,366.20" "$19,366.20" "$19,366.20" "$19,366.20" "$43,036.00" "$43,036.00" "$43,036.00" "$8,969.78" "$43,036.00" "$43,036.00" "$43,036.00" "$43,036.00" "$43,036.00" "$8,969.18" "$43,036.00" "$43,036.00" "$21,216.75" "$43,036.00" "$43,036.00" "$43,036.00" "$43,036.00" "$32,277.00" "$43,036.00" "$43,036.00" "$43,036.00" "$21,518.00" "$21,518.00" "$34,084.51" "$43,036.00" "$34,428.80" "$19,366.20" "$7,712.84" "$43,036.00" "$24,960.88" "$43,036.00" "$43,036.00" "$43,036.00" "$8,098.48" "$43,036.00" N/A N/A 27500004 EAP HCPCS C1722 "AICD, SINGLE CHAMBER" BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 27500006 EAP HCPCS C1779 CAPSURENOVUSFIX LEAD BOTH IP/OP "$8,340.00" "$6,172.00" "$1,738.15" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$1,738.15" "$8,340.00" "$3,336.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$6,255.00" "$8,340.00" "$8,340.00" "$8,340.00" "$4,170.00" "$4,170.00" "$6,605.28" "$8,340.00" "$6,672.00" "$3,753.00" "$8,340.00" "$8,340.00" "$4,837.20" "$8,340.00" "$5,004.00" "$8,340.00" "$8,340.00" "$8,340.00" N/A N/A 27500007 EAP HCPCS C1785 PHILOS DR PACEMAKER BOTH IP/OP "$10,400.00" "$7,696.00" "$2,064.14" "$10,400.00" "$4,680.00" "$4,680.00" "$4,680.00" "$4,680.00" "$10,400.00" "$10,400.00" "$10,400.00" "$2,167.62" "$10,400.00" "$10,400.00" "$10,400.00" "$10,400.00" "$10,400.00" "$2,167.47" "$10,400.00" "$10,400.00" "$5,127.20" "$10,400.00" "$10,400.00" "$10,400.00" "$10,400.00" "$7,800.00" "$10,400.00" "$10,400.00" "$10,400.00" "$5,200.00" "$5,200.00" "$8,236.80" "$10,400.00" "$8,320.00" "$4,680.00" "$2,064.14" "$10,400.00" "$6,032.00" "$10,400.00" "$10,400.00" "$10,400.00" "$2,167.36" "$10,400.00" N/A N/A 27500008 EAP HCPCS C1785 RHASPSODY DR 2530 PACEMAKER BOTH IP/OP "$14,582.00" "$10,791.00" "$2,894.16" "$14,582.00" "$6,561.90" "$6,561.90" "$6,561.90" "$6,561.90" "$14,582.00" "$14,582.00" "$14,582.00" "$3,039.25" "$14,582.00" "$14,582.00" "$14,582.00" "$14,582.00" "$14,582.00" "$3,039.05" "$14,582.00" "$14,582.00" "$7,188.93" "$14,582.00" "$14,582.00" "$14,582.00" "$14,582.00" "$10,936.50" "$14,582.00" "$14,582.00" "$14,582.00" "$7,291.00" "$7,291.00" "$11,548.94" "$14,582.00" "$11,665.60" "$6,561.90" "$2,894.16" "$14,582.00" "$8,457.56" "$14,582.00" "$14,582.00" "$14,582.00" "$3,038.89" "$14,582.00" N/A N/A 27500009 EAP HCPCS C1785 5386 IDENTITY ADX XLR PCMKR BOTH IP/OP "$12,195.00" "$9,024.50" "$2,420.40" "$12,195.00" "$5,487.75" "$5,487.75" "$5,487.75" "$5,487.75" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.74" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.57" "$12,195.00" "$12,195.00" "$6,012.14" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$9,146.25" "$12,195.00" "$12,195.00" "$12,195.00" "$6,097.50" "$6,097.50" "$9,658.44" "$12,195.00" "$9,756.00" "$5,487.75" "$2,420.40" "$12,195.00" "$7,073.10" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.44" "$12,195.00" N/A N/A 27500010 EAP HCPCS C1785 PHILOS II DR SYSTEM BOTH IP/OP "$14,735.00" "$10,904.00" "$2,924.53" "$14,735.00" "$6,630.75" "$6,630.75" "$6,630.75" "$6,630.75" "$14,735.00" "$14,735.00" "$14,735.00" "$3,071.14" "$14,735.00" "$14,735.00" "$14,735.00" "$14,735.00" "$14,735.00" "$3,070.94" "$14,735.00" "$14,735.00" "$7,264.36" "$14,735.00" "$14,735.00" "$14,735.00" "$14,735.00" "$11,051.25" "$14,735.00" "$14,735.00" "$14,735.00" "$7,367.50" "$7,367.50" "$11,670.12" "$14,735.00" "$11,788.00" "$6,630.75" "$2,924.53" "$14,735.00" "$8,546.30" "$14,735.00" "$14,735.00" "$14,735.00" "$3,070.77" "$14,735.00" N/A N/A 27500011 EAP HCPCS C1785 SENSIA DR PACEMAKER BOTH IP/OP "$12,195.00" "$9,024.50" "$2,420.40" "$12,195.00" "$5,487.75" "$5,487.75" "$5,487.75" "$5,487.75" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.74" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.57" "$12,195.00" "$12,195.00" "$6,012.14" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$9,146.25" "$12,195.00" "$12,195.00" "$12,195.00" "$6,097.50" "$6,097.50" "$9,658.44" "$12,195.00" "$9,756.00" "$5,487.75" "$2,420.40" "$12,195.00" "$7,073.10" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.44" "$12,195.00" N/A N/A 27500012 EAP HCPCS C1785 SYMPHONY DR 2550 PACEMAKER BOTH IP/OP "$15,349.00" "$11,358.50" "$3,046.39" "$15,349.00" "$6,907.05" "$6,907.05" "$6,907.05" "$6,907.05" "$15,349.00" "$15,349.00" "$15,349.00" "$3,199.12" "$15,349.00" "$15,349.00" "$15,349.00" "$15,349.00" "$15,349.00" "$3,198.90" "$15,349.00" "$15,349.00" "$7,567.06" "$15,349.00" "$15,349.00" "$15,349.00" "$15,349.00" "$11,511.75" "$15,349.00" "$15,349.00" "$15,349.00" "$7,674.50" "$7,674.50" "$12,156.41" "$15,349.00" "$12,279.20" "$6,907.05" "$3,046.39" "$15,349.00" "$8,902.42" "$15,349.00" "$15,349.00" "$15,349.00" "$3,198.73" "$15,349.00" N/A N/A 27500013 EAP HCPCS C1785 REPY DR PACEMAKER BOTH IP/OP "$15,063.00" "$11,147.00" "$2,989.63" "$15,063.00" "$6,778.35" "$6,778.35" "$6,778.35" "$6,778.35" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.51" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.29" "$15,063.00" "$15,063.00" "$7,426.06" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$11,297.25" "$15,063.00" "$15,063.00" "$15,063.00" "$7,531.50" "$7,531.50" "$11,929.90" "$15,063.00" "$12,050.40" "$6,778.35" "$2,989.63" "$15,063.00" "$8,736.54" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.13" "$15,063.00" N/A N/A 27500014 EAP HCPCS C1785 CYLOS DR/CLS PACEMAKER BOTH IP/OP "$12,195.00" "$9,024.50" "$2,420.40" "$12,195.00" "$5,487.75" "$5,487.75" "$5,487.75" "$5,487.75" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.74" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.57" "$12,195.00" "$12,195.00" "$6,012.14" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$9,146.25" "$12,195.00" "$12,195.00" "$12,195.00" "$6,097.50" "$6,097.50" "$9,658.44" "$12,195.00" "$9,756.00" "$5,487.75" "$2,420.40" "$12,195.00" "$7,073.10" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.44" "$12,195.00" N/A N/A 27500015 EAP HCPCS C1785 ADAPTA DR PACEMAKER BOTH IP/OP "$16,139.00" "$11,943.00" "$3,203.19" "$16,139.00" "$7,262.55" "$7,262.55" "$7,262.55" "$7,262.55" "$16,139.00" "$16,139.00" "$16,139.00" "$3,363.77" "$16,139.00" "$16,139.00" "$16,139.00" "$16,139.00" "$16,139.00" "$3,363.55" "$16,139.00" "$16,139.00" "$7,956.53" "$16,139.00" "$16,139.00" "$16,139.00" "$16,139.00" "$12,104.25" "$16,139.00" "$16,139.00" "$16,139.00" "$8,069.50" "$8,069.50" "$12,782.09" "$16,139.00" "$12,911.20" "$7,262.55" "$3,203.19" "$16,139.00" "$9,360.62" "$16,139.00" "$16,139.00" "$16,139.00" "$3,363.37" "$16,139.00" N/A N/A 27500016 EAP HCPCS C1785 PHILOS DR SYSTEM BOTH IP/OP "$12,195.00" "$9,024.50" "$2,420.40" "$12,195.00" "$5,487.75" "$5,487.75" "$5,487.75" "$5,487.75" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.74" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.57" "$12,195.00" "$12,195.00" "$6,012.14" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$9,146.25" "$12,195.00" "$12,195.00" "$12,195.00" "$6,097.50" "$6,097.50" "$9,658.44" "$12,195.00" "$9,756.00" "$5,487.75" "$2,420.40" "$12,195.00" "$7,073.10" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.44" "$12,195.00" N/A N/A 27500017 EAP HCPCS C1785 RHASPSODY DR 2530 SYSTEM BOTH IP/OP "$16,497.00" "$12,208.00" "$3,274.24" "$16,497.00" "$7,423.65" "$7,423.65" "$7,423.65" "$7,423.65" "$16,497.00" "$16,497.00" "$16,497.00" "$3,438.39" "$16,497.00" "$16,497.00" "$16,497.00" "$16,497.00" "$16,497.00" "$3,438.16" "$16,497.00" "$16,497.00" "$8,133.02" "$16,497.00" "$16,497.00" "$16,497.00" "$16,497.00" "$12,372.75" "$16,497.00" "$16,497.00" "$16,497.00" "$8,248.50" "$8,248.50" "$13,065.62" "$16,497.00" "$13,197.60" "$7,423.65" "$3,274.24" "$16,497.00" "$9,568.26" "$16,497.00" "$16,497.00" "$16,497.00" "$3,437.97" "$16,497.00" N/A N/A 27500018 EAP HCPCS C1785 SYMPHONY DR 2550 SYSTEM BOTH IP/OP "$18,420.00" "$13,631.00" "$3,655.91" "$18,420.00" "$8,289.00" "$8,289.00" "$8,289.00" "$8,289.00" "$18,420.00" "$18,420.00" "$18,420.00" "$3,839.19" "$18,420.00" "$18,420.00" "$18,420.00" "$18,420.00" "$18,420.00" "$3,838.93" "$18,420.00" "$18,420.00" "$9,081.06" "$18,420.00" "$18,420.00" "$18,420.00" "$18,420.00" "$13,815.00" "$18,420.00" "$18,420.00" "$18,420.00" "$9,210.00" "$9,210.00" "$14,588.64" "$18,420.00" "$14,736.00" "$8,289.00" "$3,655.91" "$18,420.00" "$10,683.60" "$18,420.00" "$18,420.00" "$18,420.00" "$3,838.73" "$18,420.00" N/A N/A 27500019 EAP HCPCS C1785 REPLY DR SYSTEM BOTH IP/OP "$17,932.00" "$13,270.00" "$3,559.05" "$17,932.00" "$8,069.40" "$8,069.40" "$8,069.40" "$8,069.40" "$17,932.00" "$17,932.00" "$17,932.00" "$3,737.48" "$17,932.00" "$17,932.00" "$17,932.00" "$17,932.00" "$17,932.00" "$3,737.23" "$17,932.00" "$17,932.00" "$8,840.48" "$17,932.00" "$17,932.00" "$17,932.00" "$17,932.00" "$13,449.00" "$17,932.00" "$17,932.00" "$17,932.00" "$8,966.00" "$8,966.00" "$14,202.14" "$17,932.00" "$14,345.60" "$8,069.40" "$3,559.05" "$17,932.00" "$10,400.56" "$17,932.00" "$17,932.00" "$17,932.00" "$3,737.03" "$17,932.00" N/A N/A 27500020 EAP HCPCS C1785 CYLOS DR/CLS SYSTEM BOTH IP/OP "$15,063.00" "$11,147.00" "$2,989.63" "$15,063.00" "$6,778.35" "$6,778.35" "$6,778.35" "$6,778.35" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.51" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.29" "$15,063.00" "$15,063.00" "$7,426.06" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$11,297.25" "$15,063.00" "$15,063.00" "$15,063.00" "$7,531.50" "$7,531.50" "$11,929.90" "$15,063.00" "$12,050.40" "$6,778.35" "$2,989.63" "$15,063.00" "$8,736.54" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.13" "$15,063.00" N/A N/A 27500021 EAP HCPCS C1785 S403 ALTRUA PACEMAKER BOTH IP/OP "$22,045.00" "$16,313.50" "$4,375.38" "$22,045.00" "$9,920.25" "$9,920.25" "$9,920.25" "$9,920.25" "$22,045.00" "$22,045.00" "$22,045.00" "$4,594.73" "$22,045.00" "$22,045.00" "$22,045.00" "$22,045.00" "$22,045.00" "$4,594.42" "$22,045.00" "$22,045.00" "$10,868.19" "$22,045.00" "$22,045.00" "$22,045.00" "$22,045.00" "$16,533.75" "$22,045.00" "$22,045.00" "$22,045.00" "$11,022.50" "$11,022.50" "$17,459.64" "$22,045.00" "$17,636.00" "$9,920.25" "$4,375.38" "$22,045.00" "$12,786.10" "$22,045.00" "$22,045.00" "$22,045.00" "$4,594.18" "$22,045.00" N/A N/A 27500024 EAP HCPCS C1786 SENSIA SR PACEMAKER BOTH IP/OP "$11,110.00" "$8,221.50" "$2,205.06" "$11,110.00" "$4,999.50" "$4,999.50" "$4,999.50" "$4,999.50" "$11,110.00" "$11,110.00" "$11,110.00" "$2,315.60" "$11,110.00" "$11,110.00" "$11,110.00" "$11,110.00" "$11,110.00" "$2,315.45" "$11,110.00" "$11,110.00" "$5,477.23" "$11,110.00" "$11,110.00" "$11,110.00" "$11,110.00" "$8,332.50" "$11,110.00" "$11,110.00" "$11,110.00" "$5,555.00" "$5,555.00" "$8,799.12" "$11,110.00" "$8,888.00" "$4,999.50" "$2,205.06" "$11,110.00" "$6,443.80" "$11,110.00" "$11,110.00" "$11,110.00" "$2,315.32" "$11,110.00" N/A N/A 27500025 EAP HCPCS C1786 RHAPSODY SR 2210 PACEMAKER BOTH IP/OP "$11,130.00" "$8,236.50" "$2,209.03" "$11,130.00" "$5,008.50" "$5,008.50" "$5,008.50" "$5,008.50" "$11,130.00" "$11,130.00" "$11,130.00" "$2,319.77" "$11,130.00" "$11,130.00" "$11,130.00" "$11,130.00" "$11,130.00" "$2,319.61" "$11,130.00" "$11,130.00" "$5,487.09" "$11,130.00" "$11,130.00" "$11,130.00" "$11,130.00" "$8,347.50" "$11,130.00" "$11,130.00" "$11,130.00" "$5,565.00" "$5,565.00" "$8,814.96" "$11,130.00" "$8,904.00" "$5,008.50" "$2,209.03" "$11,130.00" "$6,455.40" "$11,130.00" "$11,130.00" "$11,130.00" "$2,319.49" "$11,130.00" N/A N/A 27500026 EAP HCPCS C1786 PHILOS SR PACEMAKER BOTH IP/OP "$11,130.00" "$8,236.50" "$2,209.03" "$11,130.00" "$5,008.50" "$5,008.50" "$5,008.50" "$5,008.50" "$11,130.00" "$11,130.00" "$11,130.00" "$2,319.77" "$11,130.00" "$11,130.00" "$11,130.00" "$11,130.00" "$11,130.00" "$2,319.61" "$11,130.00" "$11,130.00" "$5,487.09" "$11,130.00" "$11,130.00" "$11,130.00" "$11,130.00" "$8,347.50" "$11,130.00" "$11,130.00" "$11,130.00" "$5,565.00" "$5,565.00" "$8,814.96" "$11,130.00" "$8,904.00" "$5,008.50" "$2,209.03" "$11,130.00" "$6,455.40" "$11,130.00" "$11,130.00" "$11,130.00" "$2,319.49" "$11,130.00" N/A N/A 27500027 EAP HCPCS C1786 RHAPSODY SR 2210 SYSTEM BOTH IP/OP "$11,835.00" "$8,758.00" "$2,348.95" "$11,835.00" "$5,325.75" "$5,325.75" "$5,325.75" "$5,325.75" "$11,835.00" "$11,835.00" "$11,835.00" "$2,466.71" "$11,835.00" "$11,835.00" "$11,835.00" "$11,835.00" "$11,835.00" "$2,466.54" "$11,835.00" "$11,835.00" "$5,834.66" "$11,835.00" "$11,835.00" "$11,835.00" "$11,835.00" "$8,876.25" "$11,835.00" "$11,835.00" "$11,835.00" "$5,917.50" "$5,917.50" "$9,373.32" "$11,835.00" "$9,468.00" "$5,325.75" "$2,348.95" "$11,835.00" "$6,864.30" "$11,835.00" "$11,835.00" "$11,835.00" "$2,466.41" "$11,835.00" N/A N/A 27500028 EAP HCPCS C1786 PHILOS SR SYSTEM BOTH IP/OP "$12,664.00" "$9,371.50" "$2,513.49" "$12,664.00" "$5,698.80" "$5,698.80" "$5,698.80" "$5,698.80" "$12,664.00" "$12,664.00" "$12,664.00" "$2,639.49" "$12,664.00" "$12,664.00" "$12,664.00" "$12,664.00" "$12,664.00" "$2,639.32" "$12,664.00" "$12,664.00" "$6,243.35" "$12,664.00" "$12,664.00" "$12,664.00" "$12,664.00" "$9,498.00" "$12,664.00" "$12,664.00" "$12,664.00" "$6,332.00" "$6,332.00" "$10,029.89" "$12,664.00" "$10,131.20" "$5,698.80" "$2,513.49" "$12,664.00" "$7,345.12" "$12,664.00" "$12,664.00" "$12,664.00" "$2,639.18" "$12,664.00" N/A N/A 27500029 EAP HCPCS C1786 PHILOS II SR PACEMAKER BOTH IP/OP "$12,854.00" "$9,512.00" "$2,551.20" "$12,854.00" "$5,784.30" "$5,784.30" "$5,784.30" "$5,784.30" "$12,854.00" "$12,854.00" "$12,854.00" "$2,679.09" "$12,854.00" "$12,854.00" "$12,854.00" "$12,854.00" "$12,854.00" "$2,678.91" "$12,854.00" "$12,854.00" "$6,337.02" "$12,854.00" "$12,854.00" "$12,854.00" "$12,854.00" "$9,640.50" "$12,854.00" "$12,854.00" "$12,854.00" "$6,427.00" "$6,427.00" "$10,180.37" "$12,854.00" "$10,283.20" "$5,784.30" "$2,551.20" "$12,854.00" "$7,455.32" "$12,854.00" "$12,854.00" "$12,854.00" "$2,678.77" "$12,854.00" N/A N/A 27500030 EAP HCPCS C1786 SYMPNONY SR 2550 PACEMAKER BOTH IP/OP "$13,047.00" "$9,655.00" "$2,589.50" "$13,047.00" "$5,871.15" "$5,871.15" "$5,871.15" "$5,871.15" "$13,047.00" "$13,047.00" "$13,047.00" "$2,719.32" "$13,047.00" "$13,047.00" "$13,047.00" "$13,047.00" "$13,047.00" "$2,719.14" "$13,047.00" "$13,047.00" "$6,432.17" "$13,047.00" "$13,047.00" "$13,047.00" "$13,047.00" "$9,785.25" "$13,047.00" "$13,047.00" "$13,047.00" "$6,523.50" "$6,523.50" "$10,333.22" "$13,047.00" "$10,437.60" "$5,871.15" "$2,589.50" "$13,047.00" "$7,567.26" "$13,047.00" "$13,047.00" "$13,047.00" "$2,718.99" "$13,047.00" N/A N/A 27500031 EAP HCPCS C1786 PHILLOS II SR PCMKR SYST BOTH IP/OP "$13,813.00" "$10,222.00" "$2,741.54" "$13,813.00" "$6,215.85" "$6,215.85" "$6,215.85" "$6,215.85" "$13,813.00" "$13,813.00" "$13,813.00" "$2,878.97" "$13,813.00" "$13,813.00" "$13,813.00" "$13,813.00" "$13,813.00" "$2,878.78" "$13,813.00" "$13,813.00" "$6,809.81" "$13,813.00" "$13,813.00" "$13,813.00" "$13,813.00" "$10,359.75" "$13,813.00" "$13,813.00" "$13,813.00" "$6,906.50" "$6,906.50" "$10,939.90" "$13,813.00" "$11,050.40" "$6,215.85" "$2,741.54" "$13,813.00" "$8,011.54" "$13,813.00" "$13,813.00" "$13,813.00" "$2,878.63" "$13,813.00" N/A N/A 27500032 EAP HCPCS C1786 SYMPHONY SR 2550 SYSTEM BOTH IP/OP "$13,628.00" "$10,085.00" "$2,704.82" "$13,628.00" "$6,132.60" "$6,132.60" "$6,132.60" "$6,132.60" "$13,628.00" "$13,628.00" "$13,628.00" "$2,840.42" "$13,628.00" "$13,628.00" "$13,628.00" "$13,628.00" "$13,628.00" "$2,840.23" "$13,628.00" "$13,628.00" "$6,718.60" "$13,628.00" "$13,628.00" "$13,628.00" "$13,628.00" "$10,221.00" "$13,628.00" "$13,628.00" "$13,628.00" "$6,814.00" "$6,814.00" "$10,793.38" "$13,628.00" "$10,902.40" "$6,132.60" "$2,704.82" "$13,628.00" "$7,904.24" "$13,628.00" "$13,628.00" "$13,628.00" "$2,840.08" "$13,628.00" N/A N/A 27500033 EAP HCPCS C1786 CYLOS VR/CLS PACEMAKER BOTH IP/OP "$12,195.00" "$9,024.50" "$2,420.40" "$12,195.00" "$5,487.75" "$5,487.75" "$5,487.75" "$5,487.75" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.74" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.57" "$12,195.00" "$12,195.00" "$6,012.14" "$12,195.00" "$12,195.00" "$12,195.00" "$12,195.00" "$9,146.25" "$12,195.00" "$12,195.00" "$12,195.00" "$6,097.50" "$6,097.50" "$9,658.44" "$12,195.00" "$9,756.00" "$5,487.75" "$2,420.40" "$12,195.00" "$7,073.10" "$12,195.00" "$12,195.00" "$12,195.00" "$2,541.44" "$12,195.00" N/A N/A 27500034 EAP HCPCS C1786 REPLY SR SYSTEM BOTH IP/OP "$16,497.00" "$12,208.00" "$3,274.24" "$16,497.00" "$7,423.65" "$7,423.65" "$7,423.65" "$7,423.65" "$16,497.00" "$16,497.00" "$16,497.00" "$3,438.39" "$16,497.00" "$16,497.00" "$16,497.00" "$16,497.00" "$16,497.00" "$3,438.16" "$16,497.00" "$16,497.00" "$8,133.02" "$16,497.00" "$16,497.00" "$16,497.00" "$16,497.00" "$12,372.75" "$16,497.00" "$16,497.00" "$16,497.00" "$8,248.50" "$8,248.50" "$13,065.62" "$16,497.00" "$13,197.60" "$7,423.65" "$3,274.24" "$16,497.00" "$9,568.26" "$16,497.00" "$16,497.00" "$16,497.00" "$3,437.97" "$16,497.00" N/A N/A 27500035 EAP HCPCS C1786 CYLOS VR/CLS SYSTEM BOTH IP/OP "$13,628.00" "$10,085.00" "$2,704.82" "$13,628.00" "$6,132.60" "$6,132.60" "$6,132.60" "$6,132.60" "$13,628.00" "$13,628.00" "$13,628.00" "$2,840.42" "$13,628.00" "$13,628.00" "$13,628.00" "$13,628.00" "$13,628.00" "$2,840.23" "$13,628.00" "$13,628.00" "$6,718.60" "$13,628.00" "$13,628.00" "$13,628.00" "$13,628.00" "$10,221.00" "$13,628.00" "$13,628.00" "$13,628.00" "$6,814.00" "$6,814.00" "$10,793.38" "$13,628.00" "$10,902.40" "$6,132.60" "$2,704.82" "$13,628.00" "$7,904.24" "$13,628.00" "$13,628.00" "$13,628.00" "$2,840.08" "$13,628.00" N/A N/A 27500036 EAP HCPCS C1786 REPLY SR SYSTEM BOTH IP/OP "$16,497.00" "$12,208.00" "$3,274.24" "$16,497.00" "$7,423.65" "$7,423.65" "$7,423.65" "$7,423.65" "$16,497.00" "$16,497.00" "$16,497.00" "$3,438.39" "$16,497.00" "$16,497.00" "$16,497.00" "$16,497.00" "$16,497.00" "$3,438.16" "$16,497.00" "$16,497.00" "$8,133.02" "$16,497.00" "$16,497.00" "$16,497.00" "$16,497.00" "$12,372.75" "$16,497.00" "$16,497.00" "$16,497.00" "$8,248.50" "$8,248.50" "$13,065.62" "$16,497.00" "$13,197.60" "$7,423.65" "$3,274.24" "$16,497.00" "$9,568.26" "$16,497.00" "$16,497.00" "$16,497.00" "$3,437.97" "$16,497.00" N/A N/A 27500039 EAP HCPCS C1898 1688TC PACEMAKER LEAD BOTH IP/OP "$1,793.00" "$1,327.00" $373.68 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" $373.68 "$1,793.00" $717.20 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,344.75" "$1,793.00" "$1,793.00" "$1,793.00" $896.50 $896.50 "$1,420.06" "$1,793.00" "$1,434.40" $806.85 "$1,793.00" "$1,793.00" "$1,039.94" "$1,793.00" "$1,075.80" "$1,793.00" "$1,793.00" "$1,793.00" N/A N/A 27500040 EAP HCPCS C1898 TENDRIL ST PKG LEAD BOTH IP/OP "$1,920.00" "$1,421.00" $400.15 "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" $400.15 "$1,920.00" $768.00 "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,440.00" "$1,920.00" "$1,920.00" "$1,920.00" $960.00 $960.00 "$1,520.64" "$1,920.00" "$1,536.00" $864.00 "$1,920.00" "$1,920.00" "$1,113.60" "$1,920.00" "$1,152.00" "$1,920.00" "$1,920.00" "$1,920.00" N/A N/A 27500041 EAP HCPCS C1898 TENDRIL 1688 LEAD BOTH IP/OP "$1,793.00" "$1,327.00" $373.68 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" $373.68 "$1,793.00" $717.20 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,344.75" "$1,793.00" "$1,793.00" "$1,793.00" $896.50 $896.50 "$1,420.06" "$1,793.00" "$1,434.40" $806.85 "$1,793.00" "$1,793.00" "$1,039.94" "$1,793.00" "$1,075.80" "$1,793.00" "$1,793.00" "$1,793.00" N/A N/A 27500042 EAP HCPCS C1898 TENDRIL SDX LEAD BOTH IP/OP "$1,793.00" "$1,327.00" $373.68 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" $373.68 "$1,793.00" $717.20 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,344.75" "$1,793.00" "$1,793.00" "$1,793.00" $896.50 $896.50 "$1,420.06" "$1,793.00" "$1,434.40" $806.85 "$1,793.00" "$1,793.00" "$1,039.94" "$1,793.00" "$1,075.80" "$1,793.00" "$1,793.00" "$1,793.00" N/A N/A 27500043 EAP HCPCS C1898 TENDRIL ST 1700 LEAD BOTH IP/OP "$1,793.00" "$1,327.00" $373.68 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" $373.68 "$1,793.00" $717.20 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,344.75" "$1,793.00" "$1,793.00" "$1,793.00" $896.50 $896.50 "$1,420.06" "$1,793.00" "$1,434.40" $806.85 "$1,793.00" "$1,793.00" "$1,039.94" "$1,793.00" "$1,075.80" "$1,793.00" "$1,793.00" "$1,793.00" N/A N/A 27500044 EAP HCPCS C1900 CORONARY SINUS LEAD SYSTEM BOTH IP/OP "$1,920.00" "$1,421.00" $381.07 "$1,920.00" $864.00 $864.00 $864.00 $864.00 "$1,920.00" "$1,920.00" "$1,920.00" $400.18 "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" $400.15 "$1,920.00" "$1,920.00" "$1,135.68" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,440.00" "$1,920.00" "$1,920.00" "$1,920.00" $960.00 $960.00 "$1,520.64" "$1,920.00" "$1,536.00" $864.00 $381.07 "$1,920.00" "$1,113.60" "$1,920.00" "$1,920.00" "$1,920.00" $400.13 "$1,920.00" N/A N/A 27500045 EAP HCPCS C1900 SCOUT PRO LEAD SYSTEM BOTH IP/OP "$1,920.00" "$1,421.00" $381.07 "$1,920.00" $864.00 $864.00 $864.00 $864.00 "$1,920.00" "$1,920.00" "$1,920.00" $400.18 "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" $400.15 "$1,920.00" "$1,920.00" "$1,135.68" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,440.00" "$1,920.00" "$1,920.00" "$1,920.00" $960.00 $960.00 "$1,520.64" "$1,920.00" "$1,536.00" $864.00 $381.07 "$1,920.00" "$1,113.60" "$1,920.00" "$1,920.00" "$1,920.00" $400.13 "$1,920.00" N/A N/A 27500046 EAP HCPCS C1900 COROX BIPOLAR LEAD BOTH IP/OP "$5,739.00" "$4,247.00" "$1,139.05" "$5,739.00" "$2,582.55" "$2,582.55" "$2,582.55" "$2,582.55" "$5,739.00" "$5,739.00" "$5,739.00" "$1,196.15" "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" "$1,196.07" "$5,739.00" "$5,739.00" "$2,829.33" "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" "$4,304.25" "$5,739.00" "$5,739.00" "$5,739.00" "$2,869.50" "$2,869.50" "$4,545.29" "$5,739.00" "$4,591.20" "$2,582.55" "$1,139.05" "$5,739.00" "$3,328.62" "$5,739.00" "$5,739.00" "$5,739.00" "$1,196.01" "$5,739.00" N/A N/A 27500047 EAP HCPCS C1900 COROX UNIPOLAR LEAD BOTH IP/OP "$5,739.00" "$4,247.00" "$1,139.05" "$5,739.00" "$2,582.55" "$2,582.55" "$2,582.55" "$2,582.55" "$5,739.00" "$5,739.00" "$5,739.00" "$1,196.15" "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" "$1,196.07" "$5,739.00" "$5,739.00" "$2,829.33" "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" "$4,304.25" "$5,739.00" "$5,739.00" "$5,739.00" "$2,869.50" "$2,869.50" "$4,545.29" "$5,739.00" "$4,591.20" "$2,582.55" "$1,139.05" "$5,739.00" "$3,328.62" "$5,739.00" "$5,739.00" "$5,739.00" "$1,196.01" "$5,739.00" N/A N/A 27500055 EAP HCPCS C1882 CRT-D DTBA1QQ VIVA QUAD XT US IS4 DF4 CRT BOTH IP/OP "$50,260.00" "$37,192.50" "$7,712.84" "$50,260.00" "$22,617.00" "$22,617.00" "$22,617.00" "$22,617.00" "$50,260.00" "$50,260.00" "$50,260.00" "$9,417.94" "$50,260.00" "$50,260.00" "$50,260.00" "$50,260.00" "$50,260.00" "$10,474.74" "$50,260.00" "$50,260.00" "$24,778.18" "$50,260.00" "$50,260.00" "$50,260.00" "$50,260.00" "$37,695.00" "$50,260.00" "$50,260.00" "$50,260.00" "$25,130.00" "$25,130.00" "$39,805.92" "$50,260.00" "$40,208.00" "$22,617.00" "$7,712.84" "$50,260.00" "$29,150.80" "$50,260.00" "$50,260.00" "$50,260.00" "$8,098.48" "$50,260.00" N/A N/A 27500056 EAP HCPCS C1882 DFBR CRD VIVA QD XT CRT-D ICD DF-1 BIPHASIC WVFRM 35ML 80GM BOTH IP/OP "$50,228.00" "$37,169.00" "$7,712.84" "$50,228.00" "$22,602.60" "$22,602.60" "$22,602.60" "$22,602.60" "$50,228.00" "$50,228.00" "$50,228.00" "$9,417.94" "$50,228.00" "$50,228.00" "$50,228.00" "$50,228.00" "$50,228.00" "$10,468.07" "$50,228.00" "$50,228.00" "$24,762.40" "$50,228.00" "$50,228.00" "$50,228.00" "$50,228.00" "$37,671.00" "$50,228.00" "$50,228.00" "$50,228.00" "$25,114.00" "$25,114.00" "$39,780.58" "$50,228.00" "$40,182.40" "$22,602.60" "$7,712.84" "$50,228.00" "$29,132.24" "$50,228.00" "$50,228.00" "$50,228.00" "$8,098.48" "$50,228.00" N/A N/A 27500057 EAP HCPCS C1882 DFBR CRD VIVA CRT D QD S IS-4 DF1 US BOTH IP/OP "$47,766.00" "$35,347.00" "$7,712.84" "$47,766.00" "$21,494.70" "$21,494.70" "$21,494.70" "$21,494.70" "$47,766.00" "$47,766.00" "$47,766.00" "$9,417.94" "$47,766.00" "$47,766.00" "$47,766.00" "$47,766.00" "$47,766.00" "$9,954.96" "$47,766.00" "$47,766.00" "$23,548.64" "$47,766.00" "$47,766.00" "$47,766.00" "$47,766.00" "$35,824.50" "$47,766.00" "$47,766.00" "$47,766.00" "$23,883.00" "$23,883.00" "$37,830.67" "$47,766.00" "$38,212.80" "$21,494.70" "$7,712.84" "$47,766.00" "$27,704.28" "$47,766.00" "$47,766.00" "$47,766.00" "$8,098.48" "$47,766.00" N/A N/A 27500058 EAP HCPCS C1882 DFBR CRD VIVA CRT D QD S IS-4 DF4 US BOTH IP/OP "$47,766.00" "$35,347.00" "$7,712.84" "$47,766.00" "$21,494.70" "$21,494.70" "$21,494.70" "$21,494.70" "$47,766.00" "$47,766.00" "$47,766.00" "$9,417.94" "$47,766.00" "$47,766.00" "$47,766.00" "$47,766.00" "$47,766.00" "$9,954.96" "$47,766.00" "$47,766.00" "$23,548.64" "$47,766.00" "$47,766.00" "$47,766.00" "$47,766.00" "$35,824.50" "$47,766.00" "$47,766.00" "$47,766.00" "$23,883.00" "$23,883.00" "$37,830.67" "$47,766.00" "$38,212.80" "$21,494.70" "$7,712.84" "$47,766.00" "$27,704.28" "$47,766.00" "$47,766.00" "$47,766.00" "$8,098.48" "$47,766.00" N/A N/A 27500059 EAP HCPCS C1900 LEAD ATTAIN PERFORMA USA CRT BOTH IP/OP "$5,840.00" "$4,322.00" "$1,159.09" "$5,840.00" "$2,628.00" "$2,628.00" "$2,628.00" "$2,628.00" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.20" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.12" "$5,840.00" "$5,840.00" "$2,879.12" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$4,380.00" "$5,840.00" "$5,840.00" "$5,840.00" "$2,920.00" "$2,920.00" "$4,625.28" "$5,840.00" "$4,672.00" "$2,628.00" "$1,159.09" "$5,840.00" "$3,387.20" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.06" "$5,840.00" N/A N/A 27500060 EAP HCPCS C1900 ATTAIN BIPOLDR LEAD BOTH IP/OP "$6,276.00" "$4,644.50" "$1,245.63" "$6,276.00" "$2,824.20" "$2,824.20" "$2,824.20" "$2,824.20" "$6,276.00" "$6,276.00" "$6,276.00" "$1,308.08" "$6,276.00" "$6,276.00" "$6,276.00" "$6,276.00" "$6,276.00" "$1,307.99" "$6,276.00" "$6,276.00" "$3,094.07" "$6,276.00" "$6,276.00" "$6,276.00" "$6,276.00" "$4,707.00" "$6,276.00" "$6,276.00" "$6,276.00" "$3,138.00" "$3,138.00" "$4,970.59" "$6,276.00" "$5,020.80" "$2,824.20" "$1,245.63" "$6,276.00" "$3,640.08" "$6,276.00" "$6,276.00" "$6,276.00" "$1,307.92" "$6,276.00" N/A N/A 27500062 EAP HCPCS C1900 LV QUICKFLEX LEAD BOTH IP/OP "$5,739.00" "$4,247.00" "$1,139.05" "$5,739.00" "$2,582.55" "$2,582.55" "$2,582.55" "$2,582.55" "$5,739.00" "$5,739.00" "$5,739.00" "$1,196.15" "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" "$1,196.07" "$5,739.00" "$5,739.00" "$2,829.33" "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" "$4,304.25" "$5,739.00" "$5,739.00" "$5,739.00" "$2,869.50" "$2,869.50" "$4,545.29" "$5,739.00" "$4,591.20" "$2,582.55" "$1,139.05" "$5,739.00" "$3,328.62" "$5,739.00" "$5,739.00" "$5,739.00" "$1,196.01" "$5,739.00" N/A N/A 27500063 EAP HCPCS C1900 LV QUICKSITE LEADS BOTH IP/OP "$5,739.00" "$4,247.00" "$1,139.05" "$5,739.00" "$2,582.55" "$2,582.55" "$2,582.55" "$2,582.55" "$5,739.00" "$5,739.00" "$5,739.00" "$1,196.15" "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" "$1,196.07" "$5,739.00" "$5,739.00" "$2,829.33" "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" "$4,304.25" "$5,739.00" "$5,739.00" "$5,739.00" "$2,869.50" "$2,869.50" "$4,545.29" "$5,739.00" "$4,591.20" "$2,582.55" "$1,139.05" "$5,739.00" "$3,328.62" "$5,739.00" "$5,739.00" "$5,739.00" "$1,196.01" "$5,739.00" N/A N/A 27500070 EAP HCPCS C1786 ZEPHER DR PACEMAKER BOTH IP/OP "$14,346.00" "$10,616.50" "$2,847.32" "$14,346.00" "$6,455.70" "$6,455.70" "$6,455.70" "$6,455.70" "$14,346.00" "$14,346.00" "$14,346.00" "$2,990.07" "$14,346.00" "$14,346.00" "$14,346.00" "$14,346.00" "$14,346.00" "$2,989.86" "$14,346.00" "$14,346.00" "$7,072.58" "$14,346.00" "$14,346.00" "$14,346.00" "$14,346.00" "$10,759.50" "$14,346.00" "$14,346.00" "$14,346.00" "$7,173.00" "$7,173.00" "$11,362.03" "$14,346.00" "$11,476.80" "$6,455.70" "$2,847.32" "$14,346.00" "$8,320.68" "$14,346.00" "$14,346.00" "$14,346.00" "$2,989.71" "$14,346.00" N/A N/A 27500078 EAP HCPCS C1721 TELIGEN RF HE DR DUAL ICD BOTH IP/OP "$50,042.00" "$37,031.50" "$10,429.30" "$50,042.00" "$50,042.00" "$50,042.00" "$50,042.00" "$50,042.00" "$50,042.00" "$50,042.00" "$50,042.00" "$50,042.00" "$50,042.00" "$50,042.00" "$50,042.00" "$50,042.00" "$50,042.00" "$10,429.30" "$50,042.00" "$20,016.80" "$50,042.00" "$50,042.00" "$50,042.00" "$50,042.00" "$50,042.00" "$37,531.50" "$50,042.00" "$50,042.00" "$50,042.00" "$25,021.00" "$25,021.00" "$39,633.26" "$50,042.00" "$40,033.60" "$22,518.90" "$50,042.00" "$50,042.00" "$29,024.36" "$50,042.00" "$30,025.20" "$50,042.00" "$50,042.00" "$50,042.00" N/A N/A 27500079 EAP HCPCS C1721 CONFIENT RF HE DUAL ICD BOTH IP/OP "$41,702.00" "$30,859.50" "$8,691.16" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$8,691.16" "$41,702.00" "$16,680.80" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$31,276.50" "$41,702.00" "$41,702.00" "$41,702.00" "$20,851.00" "$20,851.00" "$33,027.98" "$41,702.00" "$33,361.60" "$18,765.90" "$41,702.00" "$41,702.00" "$24,187.16" "$41,702.00" "$25,021.20" "$41,702.00" "$41,702.00" "$41,702.00" N/A N/A 27500080 EAP HCPCS C1722 TELIGEN RF HE VR ICD BOTH IP/OP "$41,702.00" "$30,859.50" "$7,712.84" "$41,702.00" "$18,765.90" "$18,765.90" "$18,765.90" "$18,765.90" "$41,702.00" "$41,702.00" "$41,702.00" "$8,691.74" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$8,691.16" "$41,702.00" "$41,702.00" "$20,559.09" "$41,702.00" "$41,702.00" "$41,702.00" "$41,702.00" "$31,276.50" "$41,702.00" "$41,702.00" "$41,702.00" "$20,851.00" "$20,851.00" "$33,027.98" "$41,702.00" "$33,361.60" "$18,765.90" "$7,712.84" "$41,702.00" "$24,187.16" "$41,702.00" "$41,702.00" "$41,702.00" "$8,098.48" "$41,702.00" N/A N/A 27500081 EAP HCPCS C1722 VITALITY 2 EL VR ICD BOTH IP/OP "$38,365.00" "$28,390.50" "$7,614.49" "$38,365.00" "$17,264.25" "$17,264.25" "$17,264.25" "$17,264.25" "$38,365.00" "$38,365.00" "$38,365.00" "$7,996.23" "$38,365.00" "$38,365.00" "$38,365.00" "$38,365.00" "$38,365.00" "$7,995.69" "$38,365.00" "$38,365.00" "$18,913.95" "$38,365.00" "$38,365.00" "$38,365.00" "$38,365.00" "$28,773.75" "$38,365.00" "$38,365.00" "$38,365.00" "$19,182.50" "$19,182.50" "$30,385.08" "$38,365.00" "$30,692.00" "$17,264.25" "$7,614.49" "$38,365.00" "$22,251.70" "$38,365.00" "$38,365.00" "$38,365.00" "$7,995.27" "$38,365.00" N/A N/A 27500082 EAP HCPCS C1786 ALTRUA 40 SR PACEMAKER BOTH IP/OP "$11,343.00" "$8,394.00" "$2,251.30" "$11,343.00" "$5,104.35" "$5,104.35" "$5,104.35" "$5,104.35" "$11,343.00" "$11,343.00" "$11,343.00" "$2,364.16" "$11,343.00" "$11,343.00" "$11,343.00" "$11,343.00" "$11,343.00" "$2,364.01" "$11,343.00" "$11,343.00" "$5,592.10" "$11,343.00" "$11,343.00" "$11,343.00" "$11,343.00" "$8,507.25" "$11,343.00" "$11,343.00" "$11,343.00" "$5,671.50" "$5,671.50" "$8,983.66" "$11,343.00" "$9,074.40" "$5,104.35" "$2,251.30" "$11,343.00" "$6,578.94" "$11,343.00" "$11,343.00" "$11,343.00" "$2,363.88" "$11,343.00" N/A N/A 27500083 EAP HCPCS C1785 ALTRUA 40 DR EL DUAL PACEMAKER BOTH IP/OP "$6,340.00" "$4,692.00" "$1,258.33" "$6,340.00" "$2,853.00" "$2,853.00" "$2,853.00" "$2,853.00" "$6,340.00" "$6,340.00" "$6,340.00" "$1,321.41" "$6,340.00" "$6,340.00" "$6,340.00" "$6,340.00" "$6,340.00" "$1,321.33" "$6,340.00" "$6,340.00" "$3,125.62" "$6,340.00" "$6,340.00" "$6,340.00" "$6,340.00" "$4,755.00" "$6,340.00" "$6,340.00" "$6,340.00" "$3,170.00" "$3,170.00" "$5,021.28" "$6,340.00" "$5,072.00" "$2,853.00" "$1,258.33" "$6,340.00" "$3,677.20" "$6,340.00" "$6,340.00" "$6,340.00" "$1,321.26" "$6,340.00" N/A N/A 27500084 EAP HCPCS C1785 ALTRUA 40 DR DUAL PACEMAKER BOTH IP/OP "$6,340.00" "$4,692.00" "$1,258.33" "$6,340.00" "$2,853.00" "$2,853.00" "$2,853.00" "$2,853.00" "$6,340.00" "$6,340.00" "$6,340.00" "$1,321.41" "$6,340.00" "$6,340.00" "$6,340.00" "$6,340.00" "$6,340.00" "$1,321.33" "$6,340.00" "$6,340.00" "$3,125.62" "$6,340.00" "$6,340.00" "$6,340.00" "$6,340.00" "$4,755.00" "$6,340.00" "$6,340.00" "$6,340.00" "$3,170.00" "$3,170.00" "$5,021.28" "$6,340.00" "$5,072.00" "$2,853.00" "$1,258.33" "$6,340.00" "$3,677.20" "$6,340.00" "$6,340.00" "$6,340.00" "$1,321.26" "$6,340.00" N/A N/A 27500085 EAP HCPCS C1882 COGNIS RF HE CRT-D BOTH IP/OP "$73,393.00" "$54,311.00" "$7,712.84" "$73,393.00" "$33,026.85" "$33,026.85" "$33,026.85" "$33,026.85" "$73,393.00" "$73,393.00" "$73,393.00" "$9,417.94" "$73,393.00" "$73,393.00" "$73,393.00" "$73,393.00" "$73,393.00" "$15,295.91" "$73,393.00" "$73,393.00" "$36,182.75" "$73,393.00" "$73,393.00" "$73,393.00" "$73,393.00" "$55,044.75" "$73,393.00" "$73,393.00" "$73,393.00" "$36,696.50" "$36,696.50" "$58,127.26" "$73,393.00" "$58,714.40" "$33,026.85" "$7,712.84" "$73,393.00" "$42,567.94" "$73,393.00" "$73,393.00" "$73,393.00" "$8,098.48" "$73,393.00" N/A N/A 27500086 EAP HCPCS C1882 LIVIAN RF HE CRT-D BOTH IP/OP "$56,714.00" "$41,968.50" "$7,712.84" "$56,714.00" "$25,521.30" "$25,521.30" "$25,521.30" "$25,521.30" "$56,714.00" "$56,714.00" "$56,714.00" "$9,417.94" "$56,714.00" "$56,714.00" "$56,714.00" "$56,714.00" "$56,714.00" "$11,819.82" "$56,714.00" "$56,714.00" "$27,960.00" "$56,714.00" "$56,714.00" "$56,714.00" "$56,714.00" "$42,535.50" "$56,714.00" "$56,714.00" "$56,714.00" "$28,357.00" "$28,357.00" "$44,917.49" "$56,714.00" "$45,371.20" "$25,521.30" "$7,712.84" "$56,714.00" "$32,894.12" "$56,714.00" "$56,714.00" "$56,714.00" "$8,098.48" "$56,714.00" N/A N/A 27500087 EAP HCPCS C1882 LIVIAN RF CRT-D BOTH IP/OP "$56,714.00" "$41,968.50" "$7,712.84" "$56,714.00" "$25,521.30" "$25,521.30" "$25,521.30" "$25,521.30" "$56,714.00" "$56,714.00" "$56,714.00" "$9,417.94" "$56,714.00" "$56,714.00" "$56,714.00" "$56,714.00" "$56,714.00" "$11,819.82" "$56,714.00" "$56,714.00" "$27,960.00" "$56,714.00" "$56,714.00" "$56,714.00" "$56,714.00" "$42,535.50" "$56,714.00" "$56,714.00" "$56,714.00" "$28,357.00" "$28,357.00" "$44,917.49" "$56,714.00" "$45,371.20" "$25,521.30" "$7,712.84" "$56,714.00" "$32,894.12" "$56,714.00" "$56,714.00" "$56,714.00" "$8,098.48" "$56,714.00" N/A N/A 27500088 EAP HCPCS C1882 CONTAK RENEWAL TR CRT-P BOTH IP/OP "$21,350.00" "$15,799.00" "$4,237.44" "$21,350.00" "$9,607.50" "$9,607.50" "$9,607.50" "$9,607.50" "$21,350.00" "$21,350.00" "$21,350.00" "$4,449.87" "$21,350.00" "$21,350.00" "$21,350.00" "$21,350.00" "$21,350.00" "$4,449.57" "$21,350.00" "$21,350.00" "$10,525.55" "$21,350.00" "$21,350.00" "$21,350.00" "$21,350.00" "$16,012.50" "$21,350.00" "$21,350.00" "$21,350.00" "$10,675.00" "$10,675.00" "$16,909.20" "$21,350.00" "$17,080.00" "$9,607.50" "$4,237.44" "$21,350.00" "$12,383.00" "$21,350.00" "$21,350.00" "$21,350.00" "$4,449.34" "$21,350.00" N/A N/A 27500089 EAP HCPCS C1895 RELIANCE G AF LEAD BOTH IP/OP "$15,012.00" "$11,109.00" "$2,979.51" "$15,012.00" "$6,755.40" "$6,755.40" "$6,755.40" "$6,755.40" "$15,012.00" "$15,012.00" "$15,012.00" "$3,128.88" "$15,012.00" "$15,012.00" "$15,012.00" "$15,012.00" "$15,012.00" "$3,128.67" "$15,012.00" "$15,012.00" "$7,400.92" "$15,012.00" "$15,012.00" "$15,012.00" "$15,012.00" "$11,259.00" "$15,012.00" "$15,012.00" "$15,012.00" "$7,506.00" "$7,506.00" "$11,889.50" "$15,012.00" "$12,009.60" "$6,755.40" "$2,979.51" "$15,012.00" "$8,706.96" "$15,012.00" "$15,012.00" "$15,012.00" "$3,128.50" "$15,012.00" N/A N/A 27500090 EAP HCPCS C1895 RELIANCE G PF LEAD BOTH IP/OP "$15,012.00" "$11,109.00" "$2,979.51" "$15,012.00" "$6,755.40" "$6,755.40" "$6,755.40" "$6,755.40" "$15,012.00" "$15,012.00" "$15,012.00" "$3,128.88" "$15,012.00" "$15,012.00" "$15,012.00" "$15,012.00" "$15,012.00" "$3,128.67" "$15,012.00" "$15,012.00" "$7,400.92" "$15,012.00" "$15,012.00" "$15,012.00" "$15,012.00" "$11,259.00" "$15,012.00" "$15,012.00" "$15,012.00" "$7,506.00" "$7,506.00" "$11,889.50" "$15,012.00" "$12,009.60" "$6,755.40" "$2,979.51" "$15,012.00" "$8,706.96" "$15,012.00" "$15,012.00" "$15,012.00" "$3,128.50" "$15,012.00" N/A N/A 27500091 EAP HCPCS C1895 RELAINCE AF LEAD BOTH IP/OP "$12,676.00" "$9,380.50" "$2,515.87" "$12,676.00" "$5,704.20" "$5,704.20" "$5,704.20" "$5,704.20" "$12,676.00" "$12,676.00" "$12,676.00" "$2,642.00" "$12,676.00" "$12,676.00" "$12,676.00" "$12,676.00" "$12,676.00" "$2,641.82" "$12,676.00" "$12,676.00" "$6,249.27" "$12,676.00" "$12,676.00" "$12,676.00" "$12,676.00" "$9,507.00" "$12,676.00" "$12,676.00" "$12,676.00" "$6,338.00" "$6,338.00" "$10,039.39" "$12,676.00" "$10,140.80" "$5,704.20" "$2,515.87" "$12,676.00" "$7,352.08" "$12,676.00" "$12,676.00" "$12,676.00" "$2,641.68" "$12,676.00" N/A N/A 27500092 EAP HCPCS C1895 RELAINCE PF LEAD BOTH IP/OP "$12,676.00" "$9,380.50" "$2,515.87" "$12,676.00" "$5,704.20" "$5,704.20" "$5,704.20" "$5,704.20" "$12,676.00" "$12,676.00" "$12,676.00" "$2,642.00" "$12,676.00" "$12,676.00" "$12,676.00" "$12,676.00" "$12,676.00" "$2,641.82" "$12,676.00" "$12,676.00" "$6,249.27" "$12,676.00" "$12,676.00" "$12,676.00" "$12,676.00" "$9,507.00" "$12,676.00" "$12,676.00" "$12,676.00" "$6,338.00" "$6,338.00" "$10,039.39" "$12,676.00" "$10,140.80" "$5,704.20" "$2,515.87" "$12,676.00" "$7,352.08" "$12,676.00" "$12,676.00" "$12,676.00" "$2,641.68" "$12,676.00" N/A N/A 27500093 EAP HCPCS C1898 "MYOCARDIAL LEAD,PMKR,OTHER THAN TRANS" BOTH IP/OP "$1,650.00" "$1,221.00" $343.88 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 "$1,650.00" "$1,650.00" $957.00 "$1,650.00" $990.00 "$1,650.00" "$1,650.00" "$1,650.00" N/A N/A 27500094 EAP HCPCS C1898 FLEXION - OSCOR LEAD BOTH IP/OP "$1,650.00" "$1,221.00" $343.88 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 "$1,650.00" "$1,650.00" $957.00 "$1,650.00" $990.00 "$1,650.00" "$1,650.00" "$1,650.00" N/A N/A 27500095 EAP HCPCS C1898 "FINELINE II STEROX LEAD,PMKR,OTHER THAN TRANS" BOTH IP/OP "$1,650.00" "$1,221.00" $343.88 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 "$1,650.00" "$1,650.00" $957.00 "$1,650.00" $990.00 "$1,650.00" "$1,650.00" "$1,650.00" N/A N/A 27500096 EAP HCPCS C1898 "FINELINE II STEROX EZ LEAD,PMKR,OTHER THAN TRANS" BOTH IP/OP "$1,650.00" "$1,221.00" $343.88 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 "$1,650.00" "$1,650.00" $957.00 "$1,650.00" $990.00 "$1,650.00" "$1,650.00" "$1,650.00" N/A N/A 27500099 EAP HCPCS C1900 ACUITY STEERABLE/SPIRAL LEAD BOTH IP/OP "$6,672.00" "$4,937.50" "$1,324.23" "$6,672.00" "$3,002.40" "$3,002.40" "$3,002.40" "$3,002.40" "$6,672.00" "$6,672.00" "$6,672.00" "$1,390.61" "$6,672.00" "$6,672.00" "$6,672.00" "$6,672.00" "$6,672.00" "$1,390.52" "$6,672.00" "$6,672.00" "$3,289.30" "$6,672.00" "$6,672.00" "$6,672.00" "$6,672.00" "$5,004.00" "$6,672.00" "$6,672.00" "$6,672.00" "$3,336.00" "$3,336.00" "$5,284.22" "$6,672.00" "$5,337.60" "$3,002.40" "$1,324.23" "$6,672.00" "$3,869.76" "$6,672.00" "$4,003.20" "$6,672.00" "$1,390.44" "$6,672.00" N/A N/A 27500100 EAP HCPCS C1900 EASYTRACK 3 BOTH IP/OP "$5,004.00" "$3,703.00" $993.17 "$5,004.00" "$2,251.80" "$2,251.80" "$2,251.80" "$2,251.80" "$5,004.00" "$5,004.00" "$5,004.00" "$1,042.96" "$5,004.00" "$5,004.00" "$5,004.00" "$5,004.00" "$5,004.00" "$1,042.89" "$5,004.00" "$5,004.00" "$2,466.97" "$5,004.00" "$5,004.00" "$5,004.00" "$5,004.00" "$3,753.00" "$5,004.00" "$5,004.00" "$5,004.00" "$2,502.00" "$2,502.00" "$3,963.17" "$5,004.00" "$4,003.20" "$2,251.80" $993.17 "$5,004.00" "$2,902.32" "$5,004.00" "$3,002.40" "$5,004.00" "$1,042.83" "$5,004.00" N/A N/A 27500101 EAP HCPCS C1900 EASYTRACK 2 BOTH IP/OP "$5,004.00" "$3,703.00" $993.17 "$5,004.00" "$2,251.80" "$2,251.80" "$2,251.80" "$2,251.80" "$5,004.00" "$5,004.00" "$5,004.00" "$1,042.96" "$5,004.00" "$5,004.00" "$5,004.00" "$5,004.00" "$5,004.00" "$1,042.89" "$5,004.00" "$5,004.00" "$2,466.97" "$5,004.00" "$5,004.00" "$5,004.00" "$5,004.00" "$3,753.00" "$5,004.00" "$5,004.00" "$5,004.00" "$2,502.00" "$2,502.00" "$3,963.17" "$5,004.00" "$4,003.20" "$2,251.80" $993.17 "$5,004.00" "$2,902.32" "$5,004.00" "$5,004.00" "$5,004.00" "$1,042.83" "$5,004.00" N/A N/A 27500102 EAP HCPCS C1721 EVERA MRI XT DR DEVICE- SINGLE CHAMBER BOTH IP/OP "$41,500.00" "$30,710.00" "$8,649.06" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$8,649.06" "$41,500.00" "$16,600.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$31,125.00" "$41,500.00" "$41,500.00" "$41,500.00" "$20,750.00" "$20,750.00" "$32,868.00" "$41,500.00" "$33,200.00" "$18,675.00" "$41,500.00" "$41,500.00" "$24,070.00" "$41,500.00" "$24,900.00" "$41,500.00" "$41,500.00" "$41,500.00" N/A N/A 27500103 EAP HCPCS C1722 EVERA MRI XT VR DEVICE - DUAL CHAMBER BOTH IP/OP "$36,500.00" "$27,010.00" "$2,060.15" "$36,500.00" "$19,819.50" "$19,819.50" "$19,819.50" "$19,819.50" "$36,500.00" "$36,500.00" "$36,500.00" "$7,607.51" "$36,500.00" "$4,181.12" "$4,181.12" "$28,134.20" "$2,060.15" "$7,607.00" "$36,500.00" "$36,500.00" "$3,094.73" "$36,500.00" "$36,500.00" "$36,500.00" "$36,500.00" "$27,375.00" "$36,500.00" "$36,500.00" "$36,500.00" "$18,250.00" "$18,250.00" "$28,908.00" "$36,500.00" "$29,200.00" "$23,725.00" "$7,244.34" "$36,500.00" "$21,170.00" "$36,500.00" "$36,500.00" "$36,500.00" "$7,606.60" "$36,500.00" N/A N/A 27500105 EAP HCPCS C1721 FORTIFY ASSURA DR 40 DF4 CON ICD/DEFIB/RESYNC BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 27500106 EAP HCPCS C1722 DRBR CRD VISIA AF MRI DF4 VR BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 27500150 EAP HCPCS C1785 "PACEMAKER, DUAL ACCENT DR" BOTH IP/OP "$19,351.00" "$14,320.00" "$3,840.69" "$19,351.00" "$8,707.95" "$8,707.95" "$8,707.95" "$8,707.95" "$19,351.00" "$19,351.00" "$19,351.00" "$4,033.23" "$19,351.00" "$19,351.00" "$19,351.00" "$19,351.00" "$19,351.00" "$4,032.96" "$19,351.00" "$19,351.00" "$9,540.04" "$19,351.00" "$19,351.00" "$19,351.00" "$19,351.00" "$14,513.25" "$19,351.00" "$19,351.00" "$19,351.00" "$9,675.50" "$9,675.50" "$15,325.99" "$19,351.00" "$15,480.80" "$8,707.95" "$3,840.69" "$19,351.00" "$11,223.58" "$19,351.00" "$19,351.00" "$19,351.00" "$4,032.75" "$19,351.00" N/A N/A 27500151 EAP HCPCS C1786 "PACEMAKER, SINGLE ACCENT SR" BOTH IP/OP "$17,681.00" "$13,084.00" "$3,509.24" "$17,681.00" "$7,956.45" "$7,956.45" "$7,956.45" "$7,956.45" "$17,681.00" "$17,681.00" "$17,681.00" "$3,685.16" "$17,681.00" "$17,681.00" "$17,681.00" "$17,681.00" "$17,681.00" "$3,684.91" "$17,681.00" "$17,681.00" "$8,716.73" "$17,681.00" "$17,681.00" "$17,681.00" "$17,681.00" "$13,260.75" "$17,681.00" "$17,681.00" "$17,681.00" "$8,840.50" "$8,840.50" "$14,003.35" "$17,681.00" "$14,144.80" "$7,956.45" "$3,509.24" "$17,681.00" "$10,254.98" "$17,681.00" "$17,681.00" "$17,681.00" "$3,684.72" "$17,681.00" N/A N/A 27500152 EAP HCPCS C2621 "PACEMAKER, BI-V ANTHEM CRT-P" BOTH IP/OP "$11,209.00" "$8,295.00" "$2,224.71" "$11,209.00" "$5,044.05" "$5,044.05" "$5,044.05" "$5,044.05" "$11,209.00" "$11,209.00" "$11,209.00" "$2,336.24" "$11,209.00" "$11,209.00" "$11,209.00" "$11,209.00" "$11,209.00" "$2,336.08" "$11,209.00" "$11,209.00" "$5,526.04" "$11,209.00" "$11,209.00" "$11,209.00" "$11,209.00" "$8,406.75" "$11,209.00" "$11,209.00" "$11,209.00" "$5,604.50" "$5,604.50" "$8,877.53" "$11,209.00" "$8,967.20" "$5,044.05" "$2,224.71" "$11,209.00" "$6,501.22" "$11,209.00" "$11,209.00" "$11,209.00" "$2,335.96" "$11,209.00" N/A N/A 27500153 EAP HCPCS C1898 LEAD PCNG 45CM BIPOL ACT FIX SOLIA S STRD ELUT BOTH IP/OP "$1,125.00" $832.50 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 27500154 EAP HCPCS C1898 LEAD PCNG 53CM SOLIA S ECRDL STRD ELUTE BIPOL ACT BOTH IP/OP "$1,125.00" $832.50 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 27500155 EAP HCPCS C1898 LEAD PCNG 60CM PROMRI SOLIA S STRD ELUT BOTH IP/OP "$1,125.00" $832.50 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 27500162 EAP HCPCS C1882 PACEMAKER CRD VIVA CRT-P BOTH IP/OP "$28,585.00" "$21,153.00" "$5,673.41" "$28,585.00" "$12,863.25" "$12,863.25" "$12,863.25" "$12,863.25" "$28,585.00" "$28,585.00" "$28,585.00" "$5,957.83" "$28,585.00" "$28,585.00" "$28,585.00" "$28,585.00" "$28,585.00" "$5,957.43" "$28,585.00" "$28,585.00" "$14,092.41" "$28,585.00" "$28,585.00" "$28,585.00" "$28,585.00" "$21,438.75" "$28,585.00" "$28,585.00" "$28,585.00" "$14,292.50" "$14,292.50" "$22,639.32" "$28,585.00" "$22,868.00" "$12,863.25" "$5,673.41" "$28,585.00" "$16,579.30" "$28,585.00" "$28,585.00" "$28,585.00" "$5,957.11" "$28,585.00" N/A N/A 27500163 EAP HCPCS C1786 PACEMAKER CRD ADVISA SR MR SURESCAN 1 CHMBR UNPLR BOTH IP/OP "$11,000.00" "$8,140.00" "$2,183.23" "$11,000.00" "$4,950.00" "$4,950.00" "$4,950.00" "$4,950.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.68" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.52" "$11,000.00" "$11,000.00" "$5,423.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$8,250.00" "$11,000.00" "$11,000.00" "$11,000.00" "$5,500.00" "$5,500.00" "$8,712.00" "$11,000.00" "$8,800.00" "$4,950.00" "$2,183.23" "$11,000.00" "$6,380.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.40" "$11,000.00" N/A N/A 27500200 EAP HCPCS C1786 REPLY SR SYSTEM BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500201 EAP HCPCS C1786 REPLY SR BOTH IP/OP "$10,344.00" "$7,655.00" "$2,053.03" "$10,344.00" "$4,654.80" "$4,654.80" "$4,654.80" "$4,654.80" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.95" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.80" "$10,344.00" "$10,344.00" "$5,099.59" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$7,758.00" "$10,344.00" "$10,344.00" "$10,344.00" "$5,172.00" "$5,172.00" "$8,192.45" "$10,344.00" "$8,275.20" "$4,654.80" "$2,053.03" "$10,344.00" "$5,999.52" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.69" "$10,344.00" N/A N/A 27500202 EAP HCPCS C1722 PARADYM RF CRT 9750 SYSTEM BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27500203 EAP HCPCS C1722 PARADYM RF CRT 9750 BOTH IP/OP "$53,791.00" "$39,805.50" "$7,712.84" "$53,791.00" "$24,205.95" "$24,205.95" "$24,205.95" "$24,205.95" "$53,791.00" "$53,791.00" "$53,791.00" "$9,417.94" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$11,210.64" "$53,791.00" "$53,791.00" "$26,518.96" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$40,343.25" "$53,791.00" "$53,791.00" "$53,791.00" "$26,895.50" "$26,895.50" "$42,602.47" "$53,791.00" "$43,032.80" "$24,205.95" "$7,712.84" "$53,791.00" "$31,198.78" "$53,791.00" "$53,791.00" "$53,791.00" "$8,098.48" "$53,791.00" N/A N/A 27500204 EAP HCPCS C1722 PARADYM 9250 RF VR BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27500205 EAP HCPCS C1900 QUICKFLEX+++PMM#:89271 BOTH IP/OP "$4,729.00" "$3,499.50" $938.59 "$4,729.00" "$2,128.05" "$2,128.05" "$2,128.05" "$2,128.05" "$4,729.00" "$4,729.00" "$4,729.00" $985.64 "$4,729.00" "$4,729.00" "$4,729.00" "$4,729.00" "$4,729.00" $985.58 "$4,729.00" "$4,729.00" "$2,331.40" "$4,729.00" "$4,729.00" "$4,729.00" "$4,729.00" "$3,546.75" "$4,729.00" "$4,729.00" "$4,729.00" "$2,364.50" "$2,364.50" "$3,745.37" "$4,729.00" "$3,783.20" "$2,128.05" $938.59 "$4,729.00" "$2,742.82" "$4,729.00" "$4,729.00" "$4,729.00" $985.52 "$4,729.00" N/A N/A 27500206 EAP HCPCS C1900 QUICKFLEX+++PMM#:89272 BOTH IP/OP "$4,729.00" "$3,499.50" $938.59 "$4,729.00" "$2,128.05" "$2,128.05" "$2,128.05" "$2,128.05" "$4,729.00" "$4,729.00" "$4,729.00" $985.64 "$4,729.00" "$4,729.00" "$4,729.00" "$4,729.00" "$4,729.00" $985.58 "$4,729.00" "$4,729.00" "$2,331.40" "$4,729.00" "$4,729.00" "$4,729.00" "$4,729.00" "$3,546.75" "$4,729.00" "$4,729.00" "$4,729.00" "$2,364.50" "$2,364.50" "$3,745.37" "$4,729.00" "$3,783.20" "$2,128.05" $938.59 "$4,729.00" "$2,742.82" "$4,729.00" "$4,729.00" "$4,729.00" $985.52 "$4,729.00" N/A N/A 27500207 EAP HCPCS C1900 QUICKFLEX+++PMM#:89273 BOTH IP/OP "$4,729.00" "$3,499.50" $938.59 "$4,729.00" "$2,128.05" "$2,128.05" "$2,128.05" "$2,128.05" "$4,729.00" "$4,729.00" "$4,729.00" $985.64 "$4,729.00" "$4,729.00" "$4,729.00" "$4,729.00" "$4,729.00" $985.58 "$4,729.00" "$4,729.00" "$2,331.40" "$4,729.00" "$4,729.00" "$4,729.00" "$4,729.00" "$3,546.75" "$4,729.00" "$4,729.00" "$4,729.00" "$2,364.50" "$2,364.50" "$3,745.37" "$4,729.00" "$3,783.20" "$2,128.05" $938.59 "$4,729.00" "$2,742.82" "$4,729.00" "$4,729.00" "$4,729.00" $985.52 "$4,729.00" N/A N/A 27500208 EAP HCPCS C1900 QUICKFLEX MICRO BOTH IP/OP "$5,202.00" "$3,849.50" "$1,032.47" "$5,202.00" "$2,340.90" "$2,340.90" "$2,340.90" "$2,340.90" "$5,202.00" "$5,202.00" "$5,202.00" "$1,084.23" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$1,084.15" "$5,202.00" "$5,202.00" "$2,564.59" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$3,901.50" "$5,202.00" "$5,202.00" "$5,202.00" "$2,601.00" "$2,601.00" "$4,119.98" "$5,202.00" "$4,161.60" "$2,340.90" "$1,032.47" "$5,202.00" "$3,017.16" "$5,202.00" "$5,202.00" "$5,202.00" "$1,084.10" "$5,202.00" N/A N/A 27500209 EAP HCPCS C1900 QUICKFLEX MICRO BOTH IP/OP "$5,202.00" "$3,849.50" "$1,032.47" "$5,202.00" "$2,340.90" "$2,340.90" "$2,340.90" "$2,340.90" "$5,202.00" "$5,202.00" "$5,202.00" "$1,084.23" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$1,084.15" "$5,202.00" "$5,202.00" "$2,564.59" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$3,901.50" "$5,202.00" "$5,202.00" "$5,202.00" "$2,601.00" "$2,601.00" "$4,119.98" "$5,202.00" "$4,161.60" "$2,340.90" "$1,032.47" "$5,202.00" "$3,017.16" "$5,202.00" "$5,202.00" "$5,202.00" "$1,084.10" "$5,202.00" N/A N/A 27500210 EAP HCPCS C1898 OPTISENSE BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27500211 EAP HCPCS C1898 OPTISENSE BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27500212 EAP HCPCS C1898 OPTISENSE+++PMM#:89078 BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27500213 EAP HCPCS C1898 OPTISENSE BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27500214 EAP HCPCS C1898 OPTISENSE BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27500215 EAP HCPCS C1898 TENDRIL ST OPTIM BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27500216 EAP HCPCS C1898 TENDRIL ST OPTIM BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27500217 EAP HCPCS C1898 TENDRIL ST OPTIM BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27500218 EAP HCPCS C1898 ISOFLEX OPTIM BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27500219 EAP HCPCS C1898 ISOFLEX OPTIM BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27500220 EAP HCPCS C1898 ISOFLEX OPTIM BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27500221 EAP HCPCS C1898 ISOFLEX OPTIM BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27500223 EAP HCPCS C1786 5157M/S BOTH IP/OP "$10,344.00" "$7,655.00" "$2,053.03" "$10,344.00" "$4,654.80" "$4,654.80" "$4,654.80" "$4,654.80" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.95" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.80" "$10,344.00" "$10,344.00" "$5,099.59" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$7,758.00" "$10,344.00" "$10,344.00" "$10,344.00" "$5,172.00" "$5,172.00" "$8,192.45" "$10,344.00" "$8,275.20" "$4,654.80" "$2,053.03" "$10,344.00" "$5,999.52" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.69" "$10,344.00" N/A N/A 27500224 EAP HCPCS C1785 5357M/S BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500225 EAP HCPCS C1895 DURATA BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500226 EAP HCPCS C1895 DURATA BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500227 EAP HCPCS C1895 DURATA+++PMM#:87533 BOTH IP/OP "$12,413.00" "$9,186.00" "$2,463.67" "$12,413.00" "$5,585.85" "$5,585.85" "$5,585.85" "$5,585.85" "$12,413.00" "$12,413.00" "$12,413.00" "$2,587.18" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$2,587.01" "$12,413.00" "$12,413.00" "$6,119.61" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$9,309.75" "$12,413.00" "$12,413.00" "$12,413.00" "$6,206.50" "$6,206.50" "$9,831.10" "$12,413.00" "$9,930.40" "$5,585.85" "$2,463.67" "$12,413.00" "$7,199.54" "$12,413.00" "$12,413.00" "$12,413.00" "$2,586.87" "$12,413.00" N/A N/A 27500228 EAP HCPCS C1895 DURATA BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500229 EAP HCPCS C1895 DURATA BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500230 EAP HCPCS C1895 DURATA DF4 - ACTIVE TBP SINGLE SHOCK BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500231 EAP HCPCS C1895 DURATA DF4 - ACTIVE TBP SINGLE SHOCK BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500232 EAP HCPCS C1895 DURATA DF4 - ACTIVE TBP SINGLE SHOCK BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500233 EAP HCPCS C1895 DURATA BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500234 EAP HCPCS C1895 DURATA BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500235 EAP HCPCS C1895 DURATA BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500236 EAP HCPCS C1895 DURATA+++PMM#:96295 BOTH IP/OP "$12,413.00" "$9,186.00" "$2,463.67" "$12,413.00" "$5,585.85" "$5,585.85" "$5,585.85" "$5,585.85" "$12,413.00" "$12,413.00" "$12,413.00" "$2,587.18" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$2,587.01" "$12,413.00" "$12,413.00" "$6,119.61" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$9,309.75" "$12,413.00" "$12,413.00" "$12,413.00" "$6,206.50" "$6,206.50" "$9,831.10" "$12,413.00" "$9,930.40" "$5,585.85" "$2,463.67" "$12,413.00" "$7,199.54" "$12,413.00" "$12,413.00" "$12,413.00" "$2,586.87" "$12,413.00" N/A N/A 27500237 EAP HCPCS C1895 DURATA+++PMM#:96296 BOTH IP/OP "$12,413.00" "$9,186.00" "$2,463.67" "$12,413.00" "$5,585.85" "$5,585.85" "$5,585.85" "$5,585.85" "$12,413.00" "$12,413.00" "$12,413.00" "$2,587.18" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$2,587.01" "$12,413.00" "$12,413.00" "$6,119.61" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$9,309.75" "$12,413.00" "$12,413.00" "$12,413.00" "$6,206.50" "$6,206.50" "$9,831.10" "$12,413.00" "$9,930.40" "$5,585.85" "$2,463.67" "$12,413.00" "$7,199.54" "$12,413.00" "$12,413.00" "$12,413.00" "$2,586.87" "$12,413.00" N/A N/A 27500238 EAP HCPCS C1895 DURATA BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500239 EAP HCPCS C1895 DURATA SJ4 - PASSIVE BOTH IP/OP "$12,413.00" "$9,186.00" "$2,463.67" "$12,413.00" "$5,585.85" "$5,585.85" "$5,585.85" "$5,585.85" "$12,413.00" "$12,413.00" "$12,413.00" "$2,587.18" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$2,587.01" "$12,413.00" "$12,413.00" "$6,119.61" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$9,309.75" "$12,413.00" "$12,413.00" "$12,413.00" "$6,206.50" "$6,206.50" "$9,831.10" "$12,413.00" "$9,930.40" "$5,585.85" "$2,463.67" "$12,413.00" "$7,199.54" "$12,413.00" "$12,413.00" "$12,413.00" "$2,586.87" "$12,413.00" N/A N/A 27500240 EAP HCPCS C1895 DURATA DF4 - PASSIVE TBP DUAL SHOCK BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500241 EAP HCPCS C1895 DURATA DF4 - PASSIVE TBP DUAL SHOCK BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500242 EAP HCPCS C1895 DURATA SJ4 - PASSIVE BOTH IP/OP "$12,413.00" "$9,186.00" "$2,463.67" "$12,413.00" "$5,585.85" "$5,585.85" "$5,585.85" "$5,585.85" "$12,413.00" "$12,413.00" "$12,413.00" "$2,587.18" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$2,587.01" "$12,413.00" "$12,413.00" "$6,119.61" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$9,309.75" "$12,413.00" "$12,413.00" "$12,413.00" "$6,206.50" "$6,206.50" "$9,831.10" "$12,413.00" "$9,930.40" "$5,585.85" "$2,463.67" "$12,413.00" "$7,199.54" "$12,413.00" "$12,413.00" "$12,413.00" "$2,586.87" "$12,413.00" N/A N/A 27500243 EAP HCPCS C1895 DURATA DF4 - PASSIVE TBP DUAL SHOCK BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500244 EAP HCPCS C1895 DURATA DF4 - PASSIVE TBP DUAL SHOCK BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500245 EAP HCPCS C1893 CPS DIRECT? SL II STRAIGHT 47CM BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500246 EAP HCPCS C1893 CPS DIRECT? SL II 135 DEGREES 47CM BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500247 EAP HCPCS C1893 CPS DIRECT? SL II WIDE 47CM BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500248 EAP HCPCS C1893 CPS DIRECT? SL II X-WIDE 47CM BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500249 EAP HCPCS C1893 CPS DIRECT? SL II RIGHT SIDE 47CM BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500250 EAP HCPCS C1893 CPS DIRECT? SL II STRAIGHT 54CM BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500251 EAP HCPCS C1893 CPS DIRECT? SL II 115 DEGREES 54CM BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500252 EAP HCPCS C1893 CPS DIRECT? SL II 135 DEGREES 54CM BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500253 EAP HCPCS C1893 CPS DIRECT? SL II WIDE 54CM BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500254 EAP HCPCS C1893 CPS DIRECT? SL II X-WIDE 54CM BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500255 EAP HCPCS C1893 CPS AIM S BOTH IP/OP $591.00 $437.50 $117.30 $591.00 $265.95 $265.95 $265.95 $265.95 $591.00 $591.00 $591.00 $123.18 $591.00 $591.00 $591.00 $591.00 $591.00 $123.17 $591.00 $591.00 $349.58 $591.00 $591.00 $591.00 $591.00 $443.25 $591.00 $591.00 $591.00 $295.50 $295.50 $468.07 $591.00 $472.80 $265.95 $117.30 $591.00 $342.78 $591.00 $591.00 $591.00 $123.16 $591.00 N/A N/A 27500256 EAP HCPCS C1893 CPS AIM SL BOTH IP/OP $591.00 $437.50 $117.30 $591.00 $265.95 $265.95 $265.95 $265.95 $591.00 $591.00 $591.00 $123.18 $591.00 $591.00 $591.00 $591.00 $591.00 $123.17 $591.00 $591.00 $349.58 $591.00 $591.00 $591.00 $591.00 $443.25 $591.00 $591.00 $591.00 $295.50 $295.50 $468.07 $591.00 $472.80 $265.95 $117.30 $591.00 $342.78 $591.00 $591.00 $591.00 $123.16 $591.00 N/A N/A 27500257 EAP HCPCS C1893 CPS AIM S BOTH IP/OP $591.00 $437.50 $117.30 $591.00 $265.95 $265.95 $265.95 $265.95 $591.00 $591.00 $591.00 $123.18 $591.00 $591.00 $591.00 $591.00 $591.00 $123.17 $591.00 $591.00 $349.58 $591.00 $591.00 $591.00 $591.00 $443.25 $591.00 $591.00 $591.00 $295.50 $295.50 $468.07 $591.00 $472.80 $265.95 $117.30 $591.00 $342.78 $591.00 $591.00 $591.00 $123.16 $591.00 N/A N/A 27500258 EAP HCPCS C1893 CPS AIM SL BOTH IP/OP $591.00 $437.50 $117.30 $591.00 $265.95 $265.95 $265.95 $265.95 $591.00 $591.00 $591.00 $123.18 $591.00 $591.00 $591.00 $591.00 $591.00 $123.17 $591.00 $591.00 $349.58 $591.00 $591.00 $591.00 $591.00 $443.25 $591.00 $591.00 $591.00 $295.50 $295.50 $468.07 $591.00 $472.80 $265.95 $117.30 $591.00 $342.78 $591.00 $591.00 $591.00 $123.16 $591.00 N/A N/A 27500259 EAP HCPCS C1893 CPS AIM SL BOTH IP/OP $591.00 $437.50 $117.30 $591.00 $265.95 $265.95 $265.95 $265.95 $591.00 $591.00 $591.00 $123.18 $591.00 $591.00 $591.00 $591.00 $591.00 $123.17 $591.00 $591.00 $349.58 $591.00 $591.00 $591.00 $591.00 $443.25 $591.00 $591.00 $591.00 $295.50 $295.50 $468.07 $591.00 $472.80 $265.95 $117.30 $591.00 $342.78 $591.00 $591.00 $591.00 $123.16 $591.00 N/A N/A 27500260 EAP HCPCS C1893 CPS AIM SL BOTH IP/OP $591.00 $437.50 $117.30 $591.00 $265.95 $265.95 $265.95 $265.95 $591.00 $591.00 $591.00 $123.18 $591.00 $591.00 $591.00 $591.00 $591.00 $123.17 $591.00 $591.00 $349.58 $591.00 $591.00 $591.00 $591.00 $443.25 $591.00 $591.00 $591.00 $295.50 $295.50 $468.07 $591.00 $472.80 $265.95 $117.30 $591.00 $342.78 $591.00 $591.00 $591.00 $123.16 $591.00 N/A N/A 27500261 EAP HCPCS C1893 CPS AIM SL BOTH IP/OP $591.00 $437.50 $117.30 $591.00 $265.95 $265.95 $265.95 $265.95 $591.00 $591.00 $591.00 $123.18 $591.00 $591.00 $591.00 $591.00 $591.00 $123.17 $591.00 $591.00 $349.58 $591.00 $591.00 $591.00 $591.00 $443.25 $591.00 $591.00 $591.00 $295.50 $295.50 $468.07 $591.00 $472.80 $265.95 $117.30 $591.00 $342.78 $591.00 $591.00 $591.00 $123.16 $591.00 N/A N/A 27500262 EAP HCPCS C1786 PACEMAKERS SINGLE ACCENT SR RF BOTH IP/OP "$15,665.00" "$11,592.50" "$3,109.11" "$15,665.00" "$7,049.25" "$7,049.25" "$7,049.25" "$7,049.25" "$15,665.00" "$15,665.00" "$15,665.00" "$3,264.98" "$15,665.00" "$15,665.00" "$15,665.00" "$15,665.00" "$15,665.00" "$3,264.76" "$15,665.00" "$15,665.00" "$7,722.85" "$15,665.00" "$15,665.00" "$15,665.00" "$15,665.00" "$11,748.75" "$15,665.00" "$15,665.00" "$15,665.00" "$7,832.50" "$7,832.50" "$12,406.68" "$15,665.00" "$12,532.00" "$7,049.25" "$3,109.11" "$15,665.00" "$9,085.70" "$15,665.00" "$15,665.00" "$15,665.00" "$3,264.59" "$15,665.00" N/A N/A 27500263 EAP HCPCS C1722 ATLAS PLUS C HEADER BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27500264 EAP HCPCS C1898 MYOPORE EPICARDIAL LEAD 54 CM BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27500265 EAP HCPCS C1898 PASSIVE FIXATION PACING LEAD J-SHAPE SILICONE INSULATION BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27500266 EAP HCPCS C1898 PASSIVE FIXATION PACING LEAD J-SHAPE SILICONE INSULATION BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27500267 EAP HCPCS C1898 PASSIVE FIXATION PACING LEAD STRAIGHT SILICONE INSULATION BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27500268 EAP HCPCS C1898 PASSIVE FIXATION PACING LEAD STRAIGHT SILICONE INSULATION BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27500269 EAP HCPCS C1898 ACTIVE FIXATION PACING LEAD ELECTRICALLY ACTIVE HELIX SILI BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27500270 EAP HCPCS C1898 ACTIVE FIXATION PACING LEAD ELECTRICALLY ACTIVE HELIX SILI BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27500271 EAP HCPCS C1898 ACTIVE FIXATION PACING LEAD ELECTRICALLY ACTIVE HELIX SILI BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27500272 EAP HCPCS C1898 ACTIVE FIXATION SINGLE COIL SILICONE INSULATION 65 CM BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27500273 EAP HCPCS C1898 PASSIVE FIXATION DUAL COIL SILICONE INSULATION 65 CM 18 BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27500274 EAP HCPCS C1898 ACTIVE FIXATION DUAL COIL SILICONE INSULATION 60 CM 16 C BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27500275 EAP HCPCS C1898 ACTIVE FIXATION DUAL COIL SILICONE INSULATION 65 CM 18 C BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27500276 EAP HCPCS C1900 LEFT VENTRICULAR LEAD WITH 3D PRE-SHAPED HELIX AT DISTAL END BOTH IP/OP "$5,911.00" "$4,374.50" "$1,173.19" "$5,911.00" "$2,659.95" "$2,659.95" "$2,659.95" "$2,659.95" "$5,911.00" "$5,911.00" "$5,911.00" "$1,232.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.92" "$5,911.00" "$5,911.00" "$2,914.12" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$4,433.25" "$5,911.00" "$5,911.00" "$5,911.00" "$2,955.50" "$2,955.50" "$4,681.51" "$5,911.00" "$4,728.80" "$2,659.95" "$1,173.19" "$5,911.00" "$3,428.38" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.85" "$5,911.00" N/A N/A 27500277 EAP HCPCS C1900 LEFT VENTRICULAR LEAD WITH PRE-SHAPED BEND AND THREAD FIXATI BOTH IP/OP "$5,911.00" "$4,374.50" "$1,173.19" "$5,911.00" "$2,659.95" "$2,659.95" "$2,659.95" "$2,659.95" "$5,911.00" "$5,911.00" "$5,911.00" "$1,232.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.92" "$5,911.00" "$5,911.00" "$2,914.12" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$4,433.25" "$5,911.00" "$5,911.00" "$5,911.00" "$2,955.50" "$2,955.50" "$4,681.51" "$5,911.00" "$4,728.80" "$2,659.95" "$1,173.19" "$5,911.00" "$3,428.38" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.85" "$5,911.00" N/A N/A 27500278 EAP HCPCS C1900 LEFT VENTRICULAR LEAD WITH 2D PRE-SHAPED BEND AT DISTAL END BOTH IP/OP "$5,911.00" "$4,374.50" "$1,173.19" "$5,911.00" "$2,659.95" "$2,659.95" "$2,659.95" "$2,659.95" "$5,911.00" "$5,911.00" "$5,911.00" "$1,232.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.92" "$5,911.00" "$5,911.00" "$2,914.12" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$4,433.25" "$5,911.00" "$5,911.00" "$5,911.00" "$2,955.50" "$2,955.50" "$4,681.51" "$5,911.00" "$4,728.80" "$2,659.95" "$1,173.19" "$5,911.00" "$3,428.38" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.85" "$5,911.00" N/A N/A 27500279 EAP HCPCS C1895 IS-1 SILICONE 35CM V PLACEMENT BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500280 EAP HCPCS C1895 IS-1 SILICONE 54CM V PLACEMENT BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500281 EAP HCPCS C1892 IS-1 POLYURETHANE 44CM 7F INTRODUCER 11MM ELECTRODE SPAC BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500282 EAP HCPCS C1892 IS-1 POLYURETHANE 52CM 7F INTRODUCER 11MM ELECTRODE SPAC BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500283 EAP HCPCS C1892 IS-1 POLYURETHANE 58CM 7F INTRODUCER 11MM ELECTRODE SPAC BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500284 EAP HCPCS C1892 IS-1 POLYURETHANE 7F 11MM ELECTRODE SPACING 48CM PREFOR BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500285 EAP HCPCS C1892 IS-1 POLYURETHANE 7F 11MM ELECTRODE SPACING 52CM PREFOR BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500286 EAP HCPCS C1892 IS-1 POLYURETHANE 7F 11MM ELECTRODE SPACING 52CM STRAIG BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500287 EAP HCPCS C1892 IS-1 POLYURETHANE 7F 11MM ELECTRODE SPACING 58CM STRAIG BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500288 EAP HCPCS C1892 IS-1 POLYURETHANE 7F 11MM ELECTRODE SPACING 44CM PREFOR BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500289 EAP HCPCS C1892 IS-1 POLYURETHANE 7F 11MM ELECTRODE SPACING 52CM PREFOR BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27500290 EAP HCPCS C1785 REPLY DR V2 BOTH IP/OP "$12,413.00" "$9,186.00" "$2,463.67" "$12,413.00" "$5,585.85" "$5,585.85" "$5,585.85" "$5,585.85" "$12,413.00" "$12,413.00" "$12,413.00" "$2,587.18" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$2,587.01" "$12,413.00" "$12,413.00" "$6,119.61" "$12,413.00" "$12,413.00" "$12,413.00" "$12,413.00" "$9,309.75" "$12,413.00" "$12,413.00" "$12,413.00" "$6,206.50" "$6,206.50" "$9,831.10" "$12,413.00" "$9,930.40" "$5,585.85" "$2,463.67" "$12,413.00" "$7,199.54" "$12,413.00" "$12,413.00" "$12,413.00" "$2,586.87" "$12,413.00" N/A N/A 27500291 EAP HCPCS C1785 REPLY DR V2 SYSTEM BOTH IP/OP "$14,777.00" "$10,935.00" "$2,932.87" "$14,777.00" "$6,649.65" "$6,649.65" "$6,649.65" "$6,649.65" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.90" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.69" "$14,777.00" "$14,777.00" "$7,285.06" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$11,082.75" "$14,777.00" "$14,777.00" "$14,777.00" "$7,388.50" "$7,388.50" "$11,703.38" "$14,777.00" "$11,821.60" "$6,649.65" "$2,932.87" "$14,777.00" "$8,570.66" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.53" "$14,777.00" N/A N/A 27500292 EAP HCPCS C1785 ESPRIT DR BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500293 EAP HCPCS C1785 ESPRIT DR SYSTEM BOTH IP/OP "$14,777.00" "$10,935.00" "$2,932.87" "$14,777.00" "$6,649.65" "$6,649.65" "$6,649.65" "$6,649.65" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.90" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.69" "$14,777.00" "$14,777.00" "$7,285.06" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$11,082.75" "$14,777.00" "$14,777.00" "$14,777.00" "$7,388.50" "$7,388.50" "$11,703.38" "$14,777.00" "$11,821.60" "$6,649.65" "$2,932.87" "$14,777.00" "$8,570.66" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.53" "$14,777.00" N/A N/A 27500294 EAP HCPCS C1786 REPLY SR V2 BOTH IP/OP "$9,753.00" "$7,217.50" "$1,935.73" "$9,753.00" "$4,388.85" "$4,388.85" "$4,388.85" "$4,388.85" "$9,753.00" "$9,753.00" "$9,753.00" "$2,032.77" "$9,753.00" "$9,753.00" "$9,753.00" "$9,753.00" "$9,753.00" "$2,032.63" "$9,753.00" "$9,753.00" "$4,808.23" "$9,753.00" "$9,753.00" "$9,753.00" "$9,753.00" "$7,314.75" "$9,753.00" "$9,753.00" "$9,753.00" "$4,876.50" "$4,876.50" "$7,724.38" "$9,753.00" "$7,802.40" "$4,388.85" "$1,935.73" "$9,753.00" "$5,656.74" "$9,753.00" "$9,753.00" "$9,753.00" "$2,032.53" "$9,753.00" N/A N/A 27500295 EAP HCPCS C1786 REPLY SR V2 SYSTEM BOTH IP/OP "$11,231.00" "$8,311.00" "$2,229.07" "$11,231.00" "$5,053.95" "$5,053.95" "$5,053.95" "$5,053.95" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.82" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$11,231.00" "$5,536.88" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$2,229.07" "$11,231.00" "$6,513.98" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.54" "$11,231.00" N/A N/A 27500296 EAP HCPCS C1786 ESPRIT SR BOTH IP/OP "$10,344.00" "$7,655.00" "$2,053.03" "$10,344.00" "$4,654.80" "$4,654.80" "$4,654.80" "$4,654.80" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.95" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.80" "$10,344.00" "$10,344.00" "$5,099.59" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$7,758.00" "$10,344.00" "$10,344.00" "$10,344.00" "$5,172.00" "$5,172.00" "$8,192.45" "$10,344.00" "$8,275.20" "$4,654.80" "$2,053.03" "$10,344.00" "$5,999.52" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.69" "$10,344.00" N/A N/A 27500297 EAP HCPCS C1786 ESPRIT SR SYSTEM BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500298 EAP HCPCS C1882 PARADYM CRT-D 8750 BOTH IP/OP "$55,268.00" "$40,898.50" "$7,712.84" "$55,268.00" "$24,870.60" "$24,870.60" "$24,870.60" "$24,870.60" "$55,268.00" "$55,268.00" "$55,268.00" "$9,417.94" "$55,268.00" "$55,268.00" "$55,268.00" "$55,268.00" "$55,268.00" "$11,518.46" "$55,268.00" "$55,268.00" "$27,247.12" "$55,268.00" "$55,268.00" "$55,268.00" "$55,268.00" "$41,451.00" "$55,268.00" "$55,268.00" "$55,268.00" "$27,634.00" "$27,634.00" "$43,772.26" "$55,268.00" "$44,214.40" "$24,870.60" "$7,712.84" "$55,268.00" "$32,055.44" "$55,268.00" "$55,268.00" "$55,268.00" "$8,098.48" "$55,268.00" N/A N/A 27500299 EAP HCPCS C1882 PARADYM CRT-D 8750 SYSTEM BOTH IP/OP "$65,318.00" "$48,335.50" "$7,712.84" "$65,318.00" "$29,393.10" "$29,393.10" "$29,393.10" "$29,393.10" "$65,318.00" "$65,318.00" "$65,318.00" "$9,417.94" "$65,318.00" "$65,318.00" "$65,318.00" "$65,318.00" "$65,318.00" "$13,612.99" "$65,318.00" "$65,318.00" "$32,201.77" "$65,318.00" "$65,318.00" "$65,318.00" "$65,318.00" "$48,988.50" "$65,318.00" "$65,318.00" "$65,318.00" "$32,659.00" "$32,659.00" "$51,731.86" "$65,318.00" "$52,254.40" "$29,393.10" "$7,712.84" "$65,318.00" "$37,884.44" "$65,318.00" "$65,318.00" "$65,318.00" "$8,098.48" "$65,318.00" N/A N/A 27500300 EAP HCPCS C1882 PARADYM 8250 VR BOTH IP/OP "$41,378.00" "$30,620.00" "$7,712.84" "$41,378.00" "$18,620.10" "$18,620.10" "$18,620.10" "$18,620.10" "$41,378.00" "$41,378.00" "$41,378.00" "$8,624.21" "$41,378.00" "$41,378.00" "$41,378.00" "$41,378.00" "$41,378.00" "$8,623.63" "$41,378.00" "$41,378.00" "$20,399.35" "$41,378.00" "$41,378.00" "$41,378.00" "$41,378.00" "$31,033.50" "$41,378.00" "$41,378.00" "$41,378.00" "$20,689.00" "$20,689.00" "$32,771.38" "$41,378.00" "$33,102.40" "$18,620.10" "$7,712.84" "$41,378.00" "$23,999.24" "$41,378.00" "$41,378.00" "$41,378.00" "$8,098.48" "$41,378.00" N/A N/A 27500301 EAP HCPCS C1882 PARADYM 8550 DR BOTH IP/OP "$48,767.00" "$36,088.00" "$7,712.84" "$48,767.00" "$21,945.15" "$21,945.15" "$21,945.15" "$21,945.15" "$48,767.00" "$48,767.00" "$48,767.00" "$9,417.94" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$10,163.58" "$48,767.00" "$48,767.00" "$24,042.13" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$36,575.25" "$48,767.00" "$48,767.00" "$48,767.00" "$24,383.50" "$24,383.50" "$38,623.46" "$48,767.00" "$39,013.60" "$21,945.15" "$7,712.84" "$48,767.00" "$28,284.86" "$48,767.00" "$48,767.00" "$48,767.00" "$8,098.48" "$48,767.00" N/A N/A 27500302 EAP HCPCS C1785 REPLY DR BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27500303 EAP HCPCS C1785 REPLY DR SYSTEM BOTH IP/OP "$14,777.00" "$10,935.00" "$2,932.87" "$14,777.00" "$6,649.65" "$6,649.65" "$6,649.65" "$6,649.65" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.90" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.69" "$14,777.00" "$14,777.00" "$7,285.06" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$11,082.75" "$14,777.00" "$14,777.00" "$14,777.00" "$7,388.50" "$7,388.50" "$11,703.38" "$14,777.00" "$11,821.60" "$6,649.65" "$2,932.87" "$14,777.00" "$8,570.66" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.53" "$14,777.00" N/A N/A 27500304 EAP HCPCS C1883 IS-1/DF-1 SILICONE 58CM INTEGRATED BIPOLAR ACTIVE FIXATION BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27500305 EAP HCPCS C1722 PARADYM 9550 RF DR BOTH IP/OP "$45,811.00" "$33,900.50" "$7,712.84" "$45,811.00" "$20,614.95" "$20,614.95" "$20,614.95" "$20,614.95" "$45,811.00" "$45,811.00" "$45,811.00" "$9,417.94" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$45,811.00" "$22,584.82" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$7,712.84" "$45,811.00" "$26,570.38" "$45,811.00" "$45,811.00" "$45,811.00" "$8,098.48" "$45,811.00" N/A N/A 27500310 EAP HCPCS C1722 DEFIB CARDIAC PROTECTA VR IMPLANTABLE CARDIOVERTER BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$23,940.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27500311 EAP HCPCS C1882 DEFIBRILLATOR CARDIAC CONSULTA D.59 IN W2.01 IN X H2.72D BOTH IP/OP "$45,811.00" "$33,900.50" "$7,712.84" "$45,811.00" "$20,614.95" "$20,614.95" "$20,614.95" "$20,614.95" "$45,811.00" "$45,811.00" "$45,811.00" "$9,417.94" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$45,811.00" "$22,584.82" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$7,712.84" "$45,811.00" "$26,570.38" "$45,811.00" "$45,811.00" "$45,811.00" "$8,098.48" "$45,811.00" N/A N/A 27500312 EAP HCPCS C1786 DFBR CRD INVENTRA 7 VR-T DX IMPLTABLE HOME MONITR BOTH IP/OP "$49,688.00" "$36,769.50" "$7,712.84" "$49,688.00" "$22,359.60" "$22,359.60" "$22,359.60" "$22,359.60" "$49,688.00" "$49,688.00" "$49,688.00" "$9,417.94" "$49,688.00" "$49,688.00" "$49,688.00" "$49,688.00" "$49,688.00" "$10,355.53" "$49,688.00" "$49,688.00" "$24,496.18" "$49,688.00" "$49,688.00" "$49,688.00" "$49,688.00" "$37,266.00" "$49,688.00" "$49,688.00" "$49,688.00" "$24,844.00" "$24,844.00" "$39,352.90" "$49,688.00" "$39,750.40" "$22,359.60" "$7,712.84" "$49,688.00" "$28,819.04" "$49,688.00" "$49,688.00" "$49,688.00" "$8,098.48" "$49,688.00" N/A N/A 27500350 EAP HCPCS C1721 EVERA XT DR SYSTEM - MMEM BOTH IP/OP "$58,889.00" "$43,578.00" "$12,273.12" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$12,273.12" "$58,889.00" "$23,555.60" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$44,166.75" "$58,889.00" "$58,889.00" "$58,889.00" "$29,444.50" "$29,444.50" "$46,640.09" "$58,889.00" "$47,111.20" "$26,500.05" "$58,889.00" "$58,889.00" "$34,155.62" "$58,889.00" "$35,333.40" "$58,889.00" "$58,889.00" "$58,889.00" N/A N/A 27500351 EAP HCPCS C1721 EVERA XT DR SYSTEM - MMEE BOTH IP/OP "$58,889.00" "$43,578.00" "$12,273.12" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$12,273.12" "$58,889.00" "$23,555.60" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$44,166.75" "$58,889.00" "$58,889.00" "$58,889.00" "$29,444.50" "$29,444.50" "$46,640.09" "$58,889.00" "$47,111.20" "$26,500.05" "$58,889.00" "$58,889.00" "$34,155.62" "$58,889.00" "$35,333.40" "$58,889.00" "$58,889.00" "$58,889.00" N/A N/A 27500352 EAP HCPCS C1721 EVERA S DR SYSTEM - MMEM BOTH IP/OP "$58,889.00" "$43,578.00" "$12,273.12" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$12,273.12" "$58,889.00" "$23,555.60" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$44,166.75" "$58,889.00" "$58,889.00" "$58,889.00" "$29,444.50" "$29,444.50" "$46,640.09" "$58,889.00" "$47,111.20" "$26,500.05" "$58,889.00" "$58,889.00" "$34,155.62" "$58,889.00" "$35,333.40" "$58,889.00" "$58,889.00" "$58,889.00" N/A N/A 27500353 EAP HCPCS C1721 EVERA S DR SYSTEM - MMEE BOTH IP/OP "$58,889.00" "$43,578.00" "$12,273.12" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$12,273.12" "$58,889.00" "$23,555.60" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$44,166.75" "$58,889.00" "$58,889.00" "$58,889.00" "$29,444.50" "$29,444.50" "$46,640.09" "$58,889.00" "$47,111.20" "$26,500.05" "$58,889.00" "$58,889.00" "$34,155.62" "$58,889.00" "$35,333.40" "$58,889.00" "$58,889.00" "$58,889.00" N/A N/A 27500354 EAP HCPCS C1721 PROTECTA XT DR SYSTEM - MMEM BOTH IP/OP "$58,889.00" "$43,578.00" "$12,273.12" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$12,273.12" "$58,889.00" "$23,555.60" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$44,166.75" "$58,889.00" "$58,889.00" "$58,889.00" "$29,444.50" "$29,444.50" "$46,640.09" "$58,889.00" "$47,111.20" "$26,500.05" "$58,889.00" "$58,889.00" "$34,155.62" "$58,889.00" "$35,333.40" "$58,889.00" "$58,889.00" "$58,889.00" N/A N/A 27500355 EAP HCPCS C1721 PROTECTA XT DR SYSTEM - MMEE BOTH IP/OP "$58,889.00" "$43,578.00" "$12,273.12" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$12,273.12" "$58,889.00" "$23,555.60" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$44,166.75" "$58,889.00" "$58,889.00" "$58,889.00" "$29,444.50" "$29,444.50" "$46,640.09" "$58,889.00" "$47,111.20" "$26,500.05" "$58,889.00" "$58,889.00" "$34,155.62" "$58,889.00" "$35,333.40" "$58,889.00" "$58,889.00" "$58,889.00" N/A N/A 27500356 EAP HCPCS C1722 EVERA XT VR SYSTEM - MMEM BOTH IP/OP "$51,722.00" "$38,274.50" "$7,712.84" "$51,722.00" "$23,274.90" "$23,274.90" "$23,274.90" "$23,274.90" "$51,722.00" "$51,722.00" "$51,722.00" "$9,417.94" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$51,722.00" "$25,498.95" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$7,712.84" "$51,722.00" "$29,998.76" "$51,722.00" "$51,722.00" "$51,722.00" "$8,098.48" "$51,722.00" N/A N/A 27500357 EAP HCPCS C1722 EVERA XT VR SYSTEM - MMEE BOTH IP/OP "$51,722.00" "$38,274.50" "$7,712.84" "$51,722.00" "$23,274.90" "$23,274.90" "$23,274.90" "$23,274.90" "$51,722.00" "$51,722.00" "$51,722.00" "$9,417.94" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$51,722.00" "$25,498.95" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$7,712.84" "$51,722.00" "$29,998.76" "$51,722.00" "$51,722.00" "$51,722.00" "$8,098.48" "$51,722.00" N/A N/A 27500358 EAP HCPCS C1722 EVERA S VR SYSTEM - MMEM BOTH IP/OP "$51,722.00" "$38,274.50" "$7,712.84" "$51,722.00" "$23,274.90" "$23,274.90" "$23,274.90" "$23,274.90" "$51,722.00" "$51,722.00" "$51,722.00" "$9,417.94" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$51,722.00" "$25,498.95" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$7,712.84" "$51,722.00" "$29,998.76" "$51,722.00" "$51,722.00" "$51,722.00" "$8,098.48" "$51,722.00" N/A N/A 27500359 EAP HCPCS C1722 EVERA S VR SYSTEM - MMEE BOTH IP/OP "$51,722.00" "$38,274.50" "$7,712.84" "$51,722.00" "$23,274.90" "$23,274.90" "$23,274.90" "$23,274.90" "$51,722.00" "$51,722.00" "$51,722.00" "$9,417.94" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$51,722.00" "$25,498.95" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$7,712.84" "$51,722.00" "$29,998.76" "$51,722.00" "$51,722.00" "$51,722.00" "$8,098.48" "$51,722.00" N/A N/A 27500360 EAP HCPCS C1722 PROTECTA XT VR SYSTEM - EMEM BOTH IP/OP "$51,722.00" "$38,274.50" "$7,712.84" "$51,722.00" "$23,274.90" "$23,274.90" "$23,274.90" "$23,274.90" "$51,722.00" "$51,722.00" "$51,722.00" "$9,417.94" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$51,722.00" "$25,498.95" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$7,712.84" "$51,722.00" "$29,998.76" "$51,722.00" "$51,722.00" "$51,722.00" "$8,098.48" "$51,722.00" N/A N/A 27500361 EAP HCPCS C1722 PROTECTA XT VR SYSTEM - EMEE BOTH IP/OP "$51,722.00" "$38,274.50" "$7,712.84" "$51,722.00" "$23,274.90" "$23,274.90" "$23,274.90" "$23,274.90" "$51,722.00" "$51,722.00" "$51,722.00" "$9,417.94" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$51,722.00" "$25,498.95" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$7,712.84" "$51,722.00" "$29,998.76" "$51,722.00" "$51,722.00" "$51,722.00" "$8,098.48" "$51,722.00" N/A N/A 27500362 EAP HCPCS C1721 ICD-DR DDBB1D1 EVERA XT US IS1/DF1 BOTH IP/OP "$45,811.00" "$33,900.50" "$9,547.52" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$18,324.40" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$45,811.00" "$45,811.00" "$26,570.38" "$45,811.00" "$27,486.60" "$45,811.00" "$45,811.00" "$45,811.00" N/A N/A 27500363 EAP HCPCS C1721 ICD-DR DDBB1D4 EVERA XT US IS1/DF4 BOTH IP/OP "$45,811.00" "$33,900.50" "$9,547.52" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$18,324.40" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$45,811.00" "$45,811.00" "$26,570.38" "$45,811.00" "$27,486.60" "$45,811.00" "$45,811.00" "$45,811.00" N/A N/A 27500364 EAP HCPCS C1721 ICD-DR DDBC3D1 EVERA S IS1/DF1 GLOB BOTH IP/OP "$45,811.00" "$33,900.50" "$9,547.52" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$18,324.40" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$45,811.00" "$45,811.00" "$26,570.38" "$45,811.00" "$27,486.60" "$45,811.00" "$45,811.00" "$45,811.00" N/A N/A 27500365 EAP HCPCS C1721 ICD-DR DDBC3D4 EVERA S IS1/DF4 GLOB BOTH IP/OP "$45,811.00" "$33,900.50" "$9,547.52" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$18,324.40" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$45,811.00" "$45,811.00" "$26,570.38" "$45,811.00" "$27,486.60" "$45,811.00" "$45,811.00" "$45,811.00" N/A N/A 27500366 EAP HCPCS C1721 ICD D314DRG PROTECTA XT DR IS-1/DF-1 US BOTH IP/OP "$45,811.00" "$33,900.50" "$9,547.52" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$18,324.40" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$45,811.00" "$45,811.00" "$26,570.38" "$45,811.00" "$27,486.60" "$45,811.00" "$45,811.00" "$45,811.00" N/A N/A 27500367 EAP HCPCS C1721 ICD D314DRM PROTECTA XT DR US MR DF4 BOTH IP/OP "$45,811.00" "$33,900.50" "$9,547.52" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$18,324.40" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$45,811.00" "$45,811.00" "$26,570.38" "$45,811.00" "$27,486.60" "$45,811.00" "$45,811.00" "$45,811.00" N/A N/A 27500368 EAP HCPCS C1722 ICD-VR DVBB1D1 EVERA XT IS1/DF1 US BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27500369 EAP HCPCS C1722 ICD-VR DVBB1D4 EVERA XT US IS1/DF4 BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27500370 EAP HCPCS C1722 ICD-VR DVBC3D1 EVERA S IS1/DF1 GLOB BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27500371 EAP HCPCS C1722 ICD-VR DVBC3D4 EVERA S DF4 GLOB BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27500372 EAP HCPCS C1722 ICD D314VRG PROTECTA XT VR US MR BCP BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27500373 EAP HCPCS C1722 ICD D314VRM PROTECTA XT VR US MR DF4 BCP BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27500374 EAP HCPCS C1882 CRT D314TRG PROTECTA XT CRT-D US MR BOTH IP/OP "$53,791.00" "$39,805.50" "$7,712.84" "$53,791.00" "$24,205.95" "$24,205.95" "$24,205.95" "$24,205.95" "$53,791.00" "$53,791.00" "$53,791.00" "$9,417.94" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$11,210.64" "$53,791.00" "$53,791.00" "$26,518.96" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$40,343.25" "$53,791.00" "$53,791.00" "$53,791.00" "$26,895.50" "$26,895.50" "$42,602.47" "$53,791.00" "$43,032.80" "$24,205.95" "$7,712.84" "$53,791.00" "$31,198.78" "$53,791.00" "$53,791.00" "$53,791.00" "$8,098.48" "$53,791.00" N/A N/A 27500375 EAP HCPCS C1882 CRT D314TRM PROTECTA XT CRT-D US MR DF4 BOTH IP/OP "$53,791.00" "$39,805.50" "$7,712.84" "$53,791.00" "$24,205.95" "$24,205.95" "$24,205.95" "$24,205.95" "$53,791.00" "$53,791.00" "$53,791.00" "$9,417.94" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$11,210.64" "$53,791.00" "$53,791.00" "$26,518.96" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$40,343.25" "$53,791.00" "$53,791.00" "$53,791.00" "$26,895.50" "$26,895.50" "$42,602.47" "$53,791.00" "$43,032.80" "$24,205.95" "$7,712.84" "$53,791.00" "$31,198.78" "$53,791.00" "$53,791.00" "$53,791.00" "$8,098.48" "$53,791.00" N/A N/A 27500376 EAP HCPCS C1882 PROTECTA XT CRTD SYS - MMMM BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27500377 EAP HCPCS C1882 PROTECTA XT CRTD SYS - MMME BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27500378 EAP HCPCS C1882 PROTECTA XT CRTD SYS - MMPM BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27500379 EAP HCPCS C1882 PROTECTA XT CRTD SYS - MMPE BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27500380 EAP HCPCS C1882 PROTECTA XT CRTD SYS - MMAM BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27500381 EAP HCPCS C1882 PROTECTA XT CRTD SYS - MMAE BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27500382 EAP HCPCS C1779 LEAD 5038S-58 CAPSURE VDD QUAD AV 11.5CM BOTH IP/OP "$2,069.00" "$1,531.50" $431.20 "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" $431.20 "$2,069.00" $827.60 "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$1,551.75" "$2,069.00" "$2,069.00" "$2,069.00" "$1,034.50" "$1,034.50" "$1,638.65" "$2,069.00" "$1,655.20" $931.05 "$2,069.00" "$2,069.00" "$1,200.02" "$2,069.00" "$1,241.40" "$2,069.00" "$2,069.00" "$2,069.00" N/A N/A 27500383 EAP HCPCS C1779 LEAD 5038-58 LEAD-QUAD SNGL-P A/V 58CM BOTH IP/OP "$2,069.00" "$1,531.50" $431.20 "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" $431.20 "$2,069.00" $827.60 "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$1,551.75" "$2,069.00" "$2,069.00" "$2,069.00" "$1,034.50" "$1,034.50" "$1,638.65" "$2,069.00" "$1,655.20" $931.05 "$2,069.00" "$2,069.00" "$1,200.02" "$2,069.00" "$1,241.40" "$2,069.00" "$2,069.00" "$2,069.00" N/A N/A 27500384 EAP HCPCS C1779 LEAD 5038L-65 CAPSURE VDD LEAD 65CM BOTH IP/OP "$2,069.00" "$1,531.50" $431.20 "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" $431.20 "$2,069.00" $827.60 "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$2,069.00" "$1,551.75" "$2,069.00" "$2,069.00" "$2,069.00" "$1,034.50" "$1,034.50" "$1,638.65" "$2,069.00" "$1,655.20" $931.05 "$2,069.00" "$2,069.00" "$1,200.02" "$2,069.00" "$1,241.40" "$2,069.00" "$2,069.00" "$2,069.00" N/A N/A 27500385 EAP HCPCS C1785 IPG A2DR01 ADVISA MRI DR. BOTH IP/OP "$15,073.00" "$11,154.50" "$2,991.61" "$15,073.00" "$6,782.85" "$6,782.85" "$6,782.85" "$6,782.85" "$15,073.00" "$15,073.00" "$15,073.00" "$3,141.59" "$15,073.00" "$15,073.00" "$15,073.00" "$15,073.00" "$15,073.00" "$3,141.38" "$15,073.00" "$15,073.00" "$7,430.99" "$15,073.00" "$15,073.00" "$15,073.00" "$15,073.00" "$11,304.75" "$15,073.00" "$15,073.00" "$15,073.00" "$7,536.50" "$7,536.50" "$11,937.82" "$15,073.00" "$12,058.40" "$6,782.85" "$2,991.61" "$15,073.00" "$8,742.34" "$15,073.00" "$15,073.00" "$15,073.00" "$3,141.21" "$15,073.00" N/A N/A 27500386 EAP HCPCS C1785 IPG RVDR01 REVO MRI 1.5T BOTH IP/OP "$14,187.00" "$10,498.50" "$2,815.76" "$14,187.00" "$6,384.15" "$6,384.15" "$6,384.15" "$6,384.15" "$14,187.00" "$14,187.00" "$14,187.00" "$2,956.93" "$14,187.00" "$14,187.00" "$14,187.00" "$14,187.00" "$14,187.00" "$2,956.73" "$14,187.00" "$14,187.00" "$6,994.19" "$14,187.00" "$14,187.00" "$14,187.00" "$14,187.00" "$10,640.25" "$14,187.00" "$14,187.00" "$14,187.00" "$7,093.50" "$7,093.50" "$11,236.10" "$14,187.00" "$11,349.60" "$6,384.15" "$2,815.76" "$14,187.00" "$8,228.46" "$14,187.00" "$14,187.00" "$14,187.00" "$2,956.57" "$14,187.00" N/A N/A 27500387 EAP HCPCS C1785 ADVISA MRI SYSTEM - PEEM BOTH IP/OP "$18,029.00" "$13,341.50" "$3,578.31" "$18,029.00" "$8,113.05" "$8,113.05" "$8,113.05" "$8,113.05" "$18,029.00" "$18,029.00" "$18,029.00" "$3,757.69" "$18,029.00" "$18,029.00" "$18,029.00" "$18,029.00" "$18,029.00" "$3,757.44" "$18,029.00" "$18,029.00" "$8,888.30" "$18,029.00" "$18,029.00" "$18,029.00" "$18,029.00" "$13,521.75" "$18,029.00" "$18,029.00" "$18,029.00" "$9,014.50" "$9,014.50" "$14,278.97" "$18,029.00" "$14,423.20" "$8,113.05" "$3,578.31" "$18,029.00" "$10,456.82" "$18,029.00" "$18,029.00" "$18,029.00" "$3,757.24" "$18,029.00" N/A N/A 27500388 EAP HCPCS C1785 REVO MRI SYSTEM - PEEM BOTH IP/OP "$17,142.00" "$12,685.50" "$3,402.26" "$17,142.00" "$7,713.90" "$7,713.90" "$7,713.90" "$7,713.90" "$17,142.00" "$17,142.00" "$17,142.00" "$3,572.82" "$17,142.00" "$17,142.00" "$17,142.00" "$17,142.00" "$17,142.00" "$3,572.58" "$17,142.00" "$17,142.00" "$8,451.01" "$17,142.00" "$17,142.00" "$17,142.00" "$17,142.00" "$12,856.50" "$17,142.00" "$17,142.00" "$17,142.00" "$8,571.00" "$8,571.00" "$13,576.46" "$17,142.00" "$13,713.60" "$7,713.90" "$3,402.26" "$17,142.00" "$9,942.36" "$17,142.00" "$17,142.00" "$17,142.00" "$3,572.39" "$17,142.00" N/A N/A 27500389 EAP HCPCS C1882 CRT-D DTBB1D1 VIVA SIS1/DF1 US BOTH IP/OP "$53,791.00" "$39,805.50" "$7,712.84" "$53,791.00" "$24,205.95" "$24,205.95" "$24,205.95" "$24,205.95" "$53,791.00" "$53,791.00" "$53,791.00" "$9,417.94" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$11,210.64" "$53,791.00" "$53,791.00" "$26,518.96" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$40,343.25" "$53,791.00" "$53,791.00" "$53,791.00" "$26,895.50" "$26,895.50" "$42,602.47" "$53,791.00" "$43,032.80" "$24,205.95" "$7,712.84" "$53,791.00" "$31,198.78" "$53,791.00" "$53,791.00" "$53,791.00" "$8,098.48" "$53,791.00" N/A N/A 27500390 EAP HCPCS C1882 CRT-D DTBB1D4 VIVA SIS1/DF4 US BOTH IP/OP "$53,791.00" "$39,805.50" "$7,712.84" "$53,791.00" "$24,205.95" "$24,205.95" "$24,205.95" "$24,205.95" "$53,791.00" "$53,791.00" "$53,791.00" "$9,417.94" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$11,210.64" "$53,791.00" "$53,791.00" "$26,518.96" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$40,343.25" "$53,791.00" "$53,791.00" "$53,791.00" "$26,895.50" "$26,895.50" "$42,602.47" "$53,791.00" "$43,032.80" "$24,205.95" "$7,712.84" "$53,791.00" "$31,198.78" "$53,791.00" "$53,791.00" "$53,791.00" "$8,098.48" "$53,791.00" N/A N/A 27500391 EAP HCPCS C1882 VIVA S CRTD SYSTEM - MMMM BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27500392 EAP HCPCS C1882 VIVA S CRTD SYSTEM - MMPM BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27500393 EAP HCPCS C1882 VIVA S CRTD SYSTEM - MMAM BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27500394 EAP HCPCS C1786 PCMKR CRD THK6MM SM 50X41MM ENDURITY 1 CHMBR IS-1 CONCTR BOTH IP/OP "$11,942.00" "$8,837.50" "$2,370.19" "$11,942.00" "$5,373.90" "$5,373.90" "$5,373.90" "$5,373.90" "$11,942.00" "$11,942.00" "$11,942.00" "$2,489.01" "$11,942.00" "$11,942.00" "$11,942.00" "$11,942.00" "$11,942.00" "$2,488.84" "$11,942.00" "$11,942.00" "$5,887.41" "$11,942.00" "$11,942.00" "$11,942.00" "$11,942.00" "$8,956.50" "$11,942.00" "$11,942.00" "$11,942.00" "$5,971.00" "$5,971.00" "$9,458.06" "$11,942.00" "$9,553.60" "$5,373.90" "$2,370.19" "$11,942.00" "$6,926.36" "$11,942.00" "$11,942.00" "$11,942.00" "$2,488.71" "$11,942.00" N/A N/A 27500395 EAP HCPCS C1785 PCMKR CRD THK6MM SM 50X47MM ASSURITY DR 2 CHMBR IS-1 CONCTR BOTH IP/OP "$18,765.00" "$13,886.50" "$3,910.63" "$18,765.00" "$8,444.25" "$8,444.25" "$8,444.25" "$8,444.25" "$18,765.00" "$18,765.00" "$18,765.00" "$3,911.10" "$18,765.00" "$18,765.00" "$18,765.00" "$18,765.00" "$18,765.00" "$3,910.83" "$18,765.00" "$18,765.00" "$9,251.15" "$18,765.00" "$18,765.00" "$18,765.00" "$18,765.00" "$14,073.75" "$18,765.00" "$18,765.00" "$18,765.00" "$9,382.50" "$9,382.50" "$14,861.88" "$18,765.00" "$15,012.00" "$8,444.25" "$18,765.00" "$18,765.00" "$10,883.70" "$18,765.00" "$18,765.00" "$18,765.00" "$3,910.63" "$18,765.00" N/A N/A 27500396 EAP HCPCS C1785 PCMKR CRD THK6MM SM 46X50X6 ENDURITY DR 2 CHMBR IS-1 CONCTR BOTH IP/OP "$16,141.00" "$11,944.50" "$3,363.78" "$16,141.00" "$7,263.45" "$7,263.45" "$7,263.45" "$7,263.45" "$16,141.00" "$16,141.00" "$16,141.00" "$3,364.19" "$16,141.00" "$16,141.00" "$16,141.00" "$16,141.00" "$16,141.00" "$3,363.96" "$16,141.00" "$16,141.00" "$7,957.51" "$16,141.00" "$16,141.00" "$16,141.00" "$16,141.00" "$12,105.75" "$16,141.00" "$16,141.00" "$16,141.00" "$8,070.50" "$8,070.50" "$12,783.67" "$16,141.00" "$12,912.80" "$7,263.45" "$16,141.00" "$16,141.00" "$9,361.78" "$16,141.00" "$16,141.00" "$16,141.00" "$3,363.78" "$16,141.00" N/A N/A 27500397 EAP HCPCS C1786 PCMKR CRD THK6MM SM 50X47MM ASSURITY SR 1 CHMBR IS-1 CONCTR BOTH IP/OP "$14,960.00" "$11,070.50" "$2,969.19" "$14,960.00" "$6,732.00" "$6,732.00" "$6,732.00" "$6,732.00" "$14,960.00" "$14,960.00" "$14,960.00" "$3,118.04" "$14,960.00" "$14,960.00" "$14,960.00" "$14,960.00" "$14,960.00" "$3,117.83" "$14,960.00" "$14,960.00" "$7,375.28" "$14,960.00" "$14,960.00" "$14,960.00" "$14,960.00" "$11,220.00" "$14,960.00" "$14,960.00" "$14,960.00" "$7,480.00" "$7,480.00" "$11,848.32" "$14,960.00" "$11,968.00" "$6,732.00" "$2,969.19" "$14,960.00" "$8,676.80" "$14,960.00" "$14,960.00" "$14,960.00" "$3,117.66" "$14,960.00" N/A N/A 27500398 EAP HCPCS C1786 PCMKR CRD THK6MM SM 41X50 X6 ENDURITY SR 1 CHMBR IS-1 CONCTR BOTH IP/OP "$12,335.00" "$9,128.00" "$2,448.19" "$12,335.00" "$5,550.75" "$5,550.75" "$5,550.75" "$5,550.75" "$12,335.00" "$12,335.00" "$12,335.00" "$2,570.92" "$12,335.00" "$12,335.00" "$12,335.00" "$12,335.00" "$12,335.00" "$2,570.75" "$12,335.00" "$12,335.00" "$6,081.16" "$12,335.00" "$12,335.00" "$12,335.00" "$12,335.00" "$9,251.25" "$12,335.00" "$12,335.00" "$12,335.00" "$6,167.50" "$6,167.50" "$9,769.32" "$12,335.00" "$9,868.00" "$5,550.75" "$2,448.19" "$12,335.00" "$7,154.30" "$12,335.00" "$12,335.00" "$12,335.00" "$2,570.61" "$12,335.00" N/A N/A 27500399 EAP HCPCS C1785 PCMKR CRD THK6MM SM 50X47MM ASSURITY DR RF CHMBR IS-1 CONCTR BOTH IP/OP "$19,946.00" "$14,760.50" "$3,958.78" "$19,946.00" "$8,975.70" "$8,975.70" "$8,975.70" "$8,975.70" "$19,946.00" "$19,946.00" "$19,946.00" "$4,157.25" "$19,946.00" "$19,946.00" "$19,946.00" "$19,946.00" "$19,946.00" "$4,156.97" "$19,946.00" "$19,946.00" "$9,833.38" "$19,946.00" "$19,946.00" "$19,946.00" "$19,946.00" "$14,959.50" "$19,946.00" "$19,946.00" "$19,946.00" "$9,973.00" "$9,973.00" "$15,797.23" "$19,946.00" "$15,956.80" "$8,975.70" "$3,958.78" "$19,946.00" "$11,568.68" "$19,946.00" "$19,946.00" "$19,946.00" "$4,156.75" "$19,946.00" N/A N/A 27500400 EAP HCPCS C1785 PCMKR CRD THK6MM SM ENDURITY DR RF CHMBR IS-1 CONCTR ATCPT BOTH IP/OP "$17,322.00" "$12,818.50" "$3,437.98" "$17,322.00" "$7,794.90" "$7,794.90" "$7,794.90" "$7,794.90" "$17,322.00" "$17,322.00" "$17,322.00" "$3,610.34" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$3,610.10" "$17,322.00" "$17,322.00" "$8,539.75" "$17,322.00" "$17,322.00" "$17,322.00" "$17,322.00" "$12,991.50" "$17,322.00" "$17,322.00" "$17,322.00" "$8,661.00" "$8,661.00" "$13,719.02" "$17,322.00" "$13,857.60" "$7,794.90" "$3,437.98" "$17,322.00" "$10,046.76" "$17,322.00" "$17,322.00" "$17,322.00" "$3,609.90" "$17,322.00" N/A N/A 27500401 EAP HCPCS C1786 PCMKR CRD THK6MM SM 50X47MM ASSURITY 1 CHMBR IS-1 CONCTR BOTH IP/OP "$16,141.00" "$11,944.50" "$3,203.58" "$16,141.00" "$7,263.45" "$7,263.45" "$7,263.45" "$7,263.45" "$16,141.00" "$16,141.00" "$16,141.00" "$3,364.19" "$16,141.00" "$16,141.00" "$16,141.00" "$16,141.00" "$16,141.00" "$3,363.96" "$16,141.00" "$16,141.00" "$7,957.51" "$16,141.00" "$16,141.00" "$16,141.00" "$16,141.00" "$12,105.75" "$16,141.00" "$16,141.00" "$16,141.00" "$8,070.50" "$8,070.50" "$12,783.67" "$16,141.00" "$12,912.80" "$7,263.45" "$3,203.58" "$16,141.00" "$9,361.78" "$16,141.00" "$16,141.00" "$16,141.00" "$3,363.78" "$16,141.00" N/A N/A 27500402 EAP HCPCS C1786 PCMKR CRD THK6MM SM 50X47MM ENDURITY 1 CHMBR IS-1 CONCTR BOTH IP/OP "$13,516.00" "$10,002.00" "$2,682.59" "$13,516.00" "$6,082.20" "$6,082.20" "$6,082.20" "$6,082.20" "$13,516.00" "$13,516.00" "$13,516.00" "$2,817.07" "$13,516.00" "$13,516.00" "$13,516.00" "$13,516.00" "$13,516.00" "$2,816.88" "$13,516.00" "$13,516.00" "$6,663.39" "$13,516.00" "$13,516.00" "$13,516.00" "$13,516.00" "$10,137.00" "$13,516.00" "$13,516.00" "$13,516.00" "$6,758.00" "$6,758.00" "$10,704.67" "$13,516.00" "$10,812.80" "$6,082.20" "$2,682.59" "$13,516.00" "$7,839.28" "$13,516.00" "$13,516.00" "$13,516.00" "$2,816.73" "$13,516.00" N/A N/A 27500403 EAP HCPCS C2621 PCMKR CRD THK6MM 59X56MM ALR QD RF IS4-LLLL CONCTR IS-1 BOTH IP/OP "$18,372.00" "$13,595.50" "$3,646.38" "$18,372.00" "$8,267.40" "$8,267.40" "$8,267.40" "$8,267.40" "$18,372.00" "$18,372.00" "$18,372.00" "$3,829.18" "$18,372.00" "$18,372.00" "$18,372.00" "$18,372.00" "$18,372.00" "$3,828.93" "$18,372.00" "$18,372.00" "$9,057.40" "$18,372.00" "$18,372.00" "$18,372.00" "$18,372.00" "$13,779.00" "$18,372.00" "$18,372.00" "$18,372.00" "$9,186.00" "$9,186.00" "$14,550.62" "$18,372.00" "$14,697.60" "$8,267.40" "$3,646.38" "$18,372.00" "$10,655.76" "$18,372.00" "$18,372.00" "$18,372.00" "$3,828.72" "$18,372.00" N/A N/A 27500404 EAP HCPCS C2621 PCMKR CRD THK6MM 59X55MM ALR RF IS-1 CONCTR CORVUE THOR BOTH IP/OP "$15,747.00" "$11,653.00" "$3,125.39" "$15,747.00" "$7,086.15" "$7,086.15" "$7,086.15" "$7,086.15" "$15,747.00" "$15,747.00" "$15,747.00" "$3,282.07" "$15,747.00" "$15,747.00" "$15,747.00" "$15,747.00" "$15,747.00" "$3,281.85" "$15,747.00" "$15,747.00" "$7,763.27" "$15,747.00" "$15,747.00" "$15,747.00" "$15,747.00" "$11,810.25" "$15,747.00" "$15,747.00" "$15,747.00" "$7,873.50" "$7,873.50" "$12,471.62" "$15,747.00" "$12,597.60" "$7,086.15" "$3,125.39" "$15,747.00" "$9,133.26" "$15,747.00" "$15,747.00" "$15,747.00" "$3,281.67" "$15,747.00" N/A N/A 27500405 EAP HCPCS C2621 PCMKR CRD THK6MM 59X56MM ALR QD PKG IS4-LLLL CONCTR IS-1 BOTH IP/OP "$19,553.00" "$14,469.50" "$3,880.78" "$19,553.00" "$8,798.85" "$8,798.85" "$8,798.85" "$8,798.85" "$19,553.00" "$19,553.00" "$19,553.00" "$4,075.33" "$19,553.00" "$19,553.00" "$19,553.00" "$19,553.00" "$19,553.00" "$4,075.06" "$19,553.00" "$19,553.00" "$9,639.63" "$19,553.00" "$19,553.00" "$19,553.00" "$19,553.00" "$14,664.75" "$19,553.00" "$19,553.00" "$19,553.00" "$9,776.50" "$9,776.50" "$15,485.98" "$19,553.00" "$15,642.40" "$8,798.85" "$3,880.78" "$19,553.00" "$11,340.74" "$19,553.00" "$19,553.00" "$19,553.00" "$4,074.85" "$19,553.00" N/A N/A 27500406 EAP HCPCS C2621 PCMKR CRD THK6MM 59X55MM ALR PKG IS-1 CONCTR CORVUE THOR BOTH IP/OP "$16,928.00" "$12,527.00" "$3,359.78" "$16,928.00" "$7,617.60" "$7,617.60" "$7,617.60" "$7,617.60" "$16,928.00" "$16,928.00" "$16,928.00" "$3,528.22" "$16,928.00" "$16,928.00" "$16,928.00" "$16,928.00" "$16,928.00" "$3,527.98" "$16,928.00" "$16,928.00" "$8,345.50" "$16,928.00" "$16,928.00" "$16,928.00" "$16,928.00" "$12,696.00" "$16,928.00" "$16,928.00" "$16,928.00" "$8,464.00" "$8,464.00" "$13,406.98" "$16,928.00" "$13,542.40" "$7,617.60" "$3,359.78" "$16,928.00" "$9,818.24" "$16,928.00" "$16,928.00" "$16,928.00" "$3,527.80" "$16,928.00" N/A N/A 27500407 EAP HCPCS C2621 PCMKR CRD THK6MM 59X56MM ALR QD RF SYS IS4-LLLL CONCTR IS-1 BOTH IP/OP "$29,001.00" "$21,461.00" "$5,755.97" "$29,001.00" "$13,050.45" "$13,050.45" "$13,050.45" "$13,050.45" "$29,001.00" "$29,001.00" "$29,001.00" "$6,044.53" "$29,001.00" "$29,001.00" "$29,001.00" "$29,001.00" "$29,001.00" "$6,044.13" "$29,001.00" "$29,001.00" "$14,297.49" "$29,001.00" "$29,001.00" "$29,001.00" "$29,001.00" "$21,750.75" "$29,001.00" "$29,001.00" "$29,001.00" "$14,500.50" "$14,500.50" "$22,968.79" "$29,001.00" "$23,200.80" "$13,050.45" "$5,755.97" "$29,001.00" "$16,820.58" "$29,001.00" "$29,001.00" "$29,001.00" "$6,043.81" "$29,001.00" N/A N/A 27500408 EAP HCPCS C2621 PCMKR CRD THK6MM 59X55MM ALR RF SYS IS-1 CONCTR CORVUE THOR BOTH IP/OP "$26,377.00" "$19,519.00" "$5,235.18" "$26,377.00" "$11,869.65" "$11,869.65" "$11,869.65" "$11,869.65" "$26,377.00" "$26,377.00" "$26,377.00" "$5,497.63" "$26,377.00" "$26,377.00" "$26,377.00" "$26,377.00" "$26,377.00" "$5,497.26" "$26,377.00" "$26,377.00" "$13,003.86" "$26,377.00" "$26,377.00" "$26,377.00" "$26,377.00" "$19,782.75" "$26,377.00" "$26,377.00" "$26,377.00" "$13,188.50" "$13,188.50" "$20,890.58" "$26,377.00" "$21,101.60" "$11,869.65" "$5,235.18" "$26,377.00" "$15,298.66" "$26,377.00" "$26,377.00" "$26,377.00" "$5,496.97" "$26,377.00" N/A N/A 27500409 EAP HCPCS C2621 PCMKR CRD THK6MM 59X56MM ALR CRT-P SYS IS4-LLLL CONCTR IS-1 BOTH IP/OP "$30,182.00" "$22,335.00" "$5,990.37" "$30,182.00" "$13,581.90" "$13,581.90" "$13,581.90" "$13,581.90" "$30,182.00" "$30,182.00" "$30,182.00" "$6,290.68" "$30,182.00" "$30,182.00" "$30,182.00" "$30,182.00" "$30,182.00" "$6,290.26" "$30,182.00" "$30,182.00" "$14,879.73" "$30,182.00" "$30,182.00" "$30,182.00" "$30,182.00" "$22,636.50" "$30,182.00" "$30,182.00" "$30,182.00" "$15,091.00" "$15,091.00" "$23,904.14" "$30,182.00" "$24,145.60" "$13,581.90" "$5,990.37" "$30,182.00" "$17,505.56" "$30,182.00" "$30,182.00" "$30,182.00" "$6,289.93" "$30,182.00" N/A N/A 27500410 EAP HCPCS C2621 PCMKR CRD THK6MM 59X55MM ALR CRT-P SYS IS-1 CON CORVUE THOR BOTH IP/OP "$27,558.00" "$20,393.00" "$5,469.57" "$27,558.00" "$12,401.10" "$12,401.10" "$12,401.10" "$12,401.10" "$27,558.00" "$27,558.00" "$27,558.00" "$5,743.78" "$27,558.00" "$27,558.00" "$27,558.00" "$27,558.00" "$27,558.00" "$5,743.39" "$27,558.00" "$27,558.00" "$13,586.09" "$27,558.00" "$27,558.00" "$27,558.00" "$27,558.00" "$20,668.50" "$27,558.00" "$27,558.00" "$27,558.00" "$13,779.00" "$13,779.00" "$21,825.94" "$27,558.00" "$22,046.40" "$12,401.10" "$5,469.57" "$27,558.00" "$15,983.64" "$27,558.00" "$27,558.00" "$27,558.00" "$5,743.09" "$27,558.00" N/A N/A 27500411 EAP HCPCS C1785 PCMKR CD 7.5MM MD ELLIPSE 44.5X47MM ING RYTHMIQ BOTH IP/OP "$10,498.00" "$7,769.00" "$2,083.59" "$10,498.00" "$4,724.10" "$4,724.10" "$4,724.10" "$4,724.10" "$10,498.00" "$10,498.00" "$10,498.00" "$2,188.05" "$10,498.00" "$10,498.00" "$10,498.00" "$10,498.00" "$10,498.00" "$2,187.90" "$10,498.00" "$10,498.00" "$5,175.51" "$10,498.00" "$10,498.00" "$10,498.00" "$10,498.00" "$7,873.50" "$10,498.00" "$10,498.00" "$10,498.00" "$5,249.00" "$5,249.00" "$8,314.42" "$10,498.00" "$8,398.40" "$4,724.10" "$2,083.59" "$10,498.00" "$6,088.84" "$10,498.00" "$10,498.00" "$10,498.00" "$2,187.78" "$10,498.00" N/A N/A 27500412 EAP HCPCS C1786 PCMKR CD 7.5MM MD ELLIPSE 44.5X45.7MM ING RYTHMIQ BOTH IP/OP "$9,186.00" "$6,798.00" "$1,823.19" "$9,186.00" "$4,133.70" "$4,133.70" "$4,133.70" "$4,133.70" "$9,186.00" "$9,186.00" "$9,186.00" "$1,914.59" "$9,186.00" "$9,186.00" "$9,186.00" "$9,186.00" "$9,186.00" "$1,914.46" "$9,186.00" "$9,186.00" "$4,528.70" "$9,186.00" "$9,186.00" "$9,186.00" "$9,186.00" "$6,889.50" "$9,186.00" "$9,186.00" "$9,186.00" "$4,593.00" "$4,593.00" "$7,275.31" "$9,186.00" "$7,348.80" "$4,133.70" "$1,823.19" "$9,186.00" "$5,327.88" "$9,186.00" "$9,186.00" "$9,186.00" "$1,914.36" "$9,186.00" N/A N/A 27500413 EAP HCPCS C1896 DUAL CHAMBER ADAPTIVE RATE INGENIOR DR SYSTEM 8N22 BOTH IP/OP "$13,123.00" "$9,711.50" "$2,604.59" "$13,123.00" "$5,905.35" "$5,905.35" "$5,905.35" "$5,905.35" "$13,123.00" "$13,123.00" "$13,123.00" "$2,735.16" "$13,123.00" "$13,123.00" "$13,123.00" "$13,123.00" "$13,123.00" "$2,734.98" "$13,123.00" "$13,123.00" "$6,469.64" "$13,123.00" "$13,123.00" "$13,123.00" "$13,123.00" "$9,842.25" "$13,123.00" "$13,123.00" "$13,123.00" "$6,561.50" "$6,561.50" "$10,393.42" "$13,123.00" "$10,498.40" "$5,905.35" "$2,604.59" "$13,123.00" "$7,611.34" "$13,123.00" "$13,123.00" "$13,123.00" "$2,734.83" "$13,123.00" N/A N/A 27500414 EAP HCPCS C1896 SINGLE CHMBR ADPTIV RT INGENIO SR SYSTEM 8N32 BOTH IP/OP "$10,236.00" "$7,575.00" "$2,031.59" "$10,236.00" "$4,606.20" "$4,606.20" "$4,606.20" "$4,606.20" "$10,236.00" "$10,236.00" "$10,236.00" "$2,133.44" "$10,236.00" "$10,236.00" "$10,236.00" "$10,236.00" "$10,236.00" "$2,133.29" "$10,236.00" "$10,236.00" "$5,046.35" "$10,236.00" "$10,236.00" "$10,236.00" "$10,236.00" "$7,677.00" "$10,236.00" "$10,236.00" "$10,236.00" "$5,118.00" "$5,118.00" "$8,106.91" "$10,236.00" "$8,188.80" "$4,606.20" "$2,031.59" "$10,236.00" "$5,936.88" "$10,236.00" "$10,236.00" "$10,236.00" "$2,133.18" "$10,236.00" N/A N/A 27500415 EAP HCPCS C1722 ITREVIA VR-T DF-1 HGH ENG W/TI W/HM MONITORING BOTH IP/OP "$34,906.00" "$25,830.50" "$6,927.97" "$34,906.00" "$15,707.70" "$15,707.70" "$15,707.70" "$15,707.70" "$34,906.00" "$34,906.00" "$34,906.00" "$7,275.28" "$34,906.00" "$34,906.00" "$34,906.00" "$34,906.00" "$34,906.00" "$7,274.79" "$34,906.00" "$34,906.00" "$17,208.66" "$34,906.00" "$34,906.00" "$34,906.00" "$34,906.00" "$26,179.50" "$34,906.00" "$34,906.00" "$34,906.00" "$17,453.00" "$17,453.00" "$27,645.55" "$34,906.00" "$27,924.80" "$15,707.70" "$6,927.97" "$34,906.00" "$20,245.48" "$34,906.00" "$34,906.00" "$34,906.00" "$7,274.41" "$34,906.00" N/A N/A 27500416 EAP HCPCS C1721 DFBR CRD EVERA MRI SURESCAN DF-1 PIN PLG XT DR BOTH IP/OP "$41,500.00" "$30,710.00" "$8,649.06" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$8,649.06" "$41,500.00" "$16,600.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$31,125.00" "$41,500.00" "$41,500.00" "$41,500.00" "$20,750.00" "$20,750.00" "$32,868.00" "$41,500.00" "$33,200.00" "$18,675.00" "$41,500.00" "$41,500.00" "$24,070.00" "$41,500.00" "$24,900.00" "$41,500.00" "$41,500.00" "$41,500.00" N/A N/A 27500417 EAP HCPCS C1721 EVERA MRI XT DR ICD (DUAL CHAMBER ICD) DF4 HEADER BOTH IP/OP "$41,500.00" "$30,710.00" "$8,649.06" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$8,649.06" "$41,500.00" "$16,600.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$41,500.00" "$31,125.00" "$41,500.00" "$41,500.00" "$41,500.00" "$20,750.00" "$20,750.00" "$32,868.00" "$41,500.00" "$33,200.00" "$18,675.00" "$41,500.00" "$41,500.00" "$24,070.00" "$41,500.00" "$24,900.00" "$41,500.00" "$41,500.00" "$41,500.00" N/A N/A 27500418 EAP HCPCS C1722 DFBR CRD VISIA AF MRI DF4 VR BOTH IP/OP "$36,500.00" "$27,010.00" "$7,244.34" "$36,500.00" "$16,425.00" "$16,425.00" "$16,425.00" "$16,425.00" "$36,500.00" "$36,500.00" "$36,500.00" "$7,607.51" "$36,500.00" "$36,500.00" "$36,500.00" "$36,500.00" "$36,500.00" "$7,607.00" "$36,500.00" "$36,500.00" "$17,994.50" "$36,500.00" "$36,500.00" "$36,500.00" "$36,500.00" "$27,375.00" "$36,500.00" "$36,500.00" "$36,500.00" "$18,250.00" "$18,250.00" "$28,908.00" "$36,500.00" "$29,200.00" "$16,425.00" "$7,244.34" "$36,500.00" "$21,170.00" "$36,500.00" "$36,500.00" "$36,500.00" "$7,606.60" "$36,500.00" N/A N/A 27500419 EAP HCPCS C1722 VISIA VR ICD (SINGLE CHAMBER ICD) DF 1 HEADER BOTH IP/OP "$36,500.00" "$27,010.00" "$7,244.34" "$36,500.00" "$16,425.00" "$16,425.00" "$16,425.00" "$16,425.00" "$36,500.00" "$36,500.00" "$36,500.00" "$7,607.51" "$36,500.00" "$36,500.00" "$36,500.00" "$36,500.00" "$36,500.00" "$7,607.00" "$36,500.00" "$36,500.00" "$17,994.50" "$36,500.00" "$36,500.00" "$36,500.00" "$36,500.00" "$27,375.00" "$36,500.00" "$36,500.00" "$36,500.00" "$18,250.00" "$18,250.00" "$28,908.00" "$36,500.00" "$29,200.00" "$16,425.00" "$7,244.34" "$36,500.00" "$21,170.00" "$36,500.00" "$36,500.00" "$36,500.00" "$7,606.60" "$36,500.00" N/A N/A 27500420 EAP HCPCS C1786 PACEMAKER CARDIAC .75CM 4.45X4.81CM 1 CHAMBER IS1 CONCTR BOTH IP/OP "$8,600.00" "$6,364.00" "$1,706.89" "$8,600.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$8,600.00" "$8,600.00" "$8,600.00" "$1,792.46" "$8,600.00" "$8,600.00" "$8,600.00" "$8,600.00" "$8,600.00" "$1,792.33" "$8,600.00" "$8,600.00" "$4,239.80" "$8,600.00" "$8,600.00" "$8,600.00" "$8,600.00" "$6,450.00" "$8,600.00" "$8,600.00" "$8,600.00" "$4,300.00" "$4,300.00" "$6,811.20" "$8,600.00" "$6,880.00" "$3,870.00" "$1,706.89" "$8,600.00" "$4,988.00" "$8,600.00" "$8,600.00" "$8,600.00" "$1,792.24" "$8,600.00" N/A N/A 27500421 EAP HCPCS C1722 DEFIBRILLATOR CARDIAC .99CM 5.37X7.79CM 1 CHAMBER IS-1 DF-4 BOTH IP/OP "$33,750.00" "$24,975.00" "$6,698.53" "$33,750.00" "$15,187.50" "$15,187.50" "$15,187.50" "$15,187.50" "$33,750.00" "$33,750.00" "$33,750.00" "$7,034.34" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$7,033.87" "$33,750.00" "$33,750.00" "$16,638.75" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$25,312.50" "$33,750.00" "$33,750.00" "$33,750.00" "$16,875.00" "$16,875.00" "$26,730.00" "$33,750.00" "$27,000.00" "$15,187.50" "$6,698.53" "$33,750.00" "$19,575.00" "$33,750.00" "$33,750.00" "$33,750.00" "$7,033.50" "$33,750.00" N/A N/A 27500422 EAP HCPCS C1721 DEFIBRILLATOR CARDIAC .99CM 5.37X7.68CM 2 CHAMBER EXTEND BOTH IP/OP "$37,500.00" "$27,750.00" "$7,815.41" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$7,815.41" "$37,500.00" "$15,000.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$28,125.00" "$37,500.00" "$37,500.00" "$37,500.00" "$18,750.00" "$18,750.00" "$29,700.00" "$37,500.00" "$30,000.00" "$16,875.00" "$37,500.00" "$37,500.00" "$21,750.00" "$37,500.00" "$22,500.00" "$37,500.00" "$37,500.00" "$37,500.00" N/A N/A 27500423 EAP HCPCS C1721 DEFIBRILLATOR CARDIAC .99CM 5.37X7.79CM 2 CHAMBER EXTEND BOTH IP/OP "$37,500.00" "$27,750.00" "$7,815.41" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$7,815.41" "$37,500.00" "$15,000.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$28,125.00" "$37,500.00" "$37,500.00" "$37,500.00" "$18,750.00" "$18,750.00" "$29,700.00" "$37,500.00" "$30,000.00" "$16,875.00" "$37,500.00" "$37,500.00" "$21,750.00" "$37,500.00" "$22,500.00" "$37,500.00" "$37,500.00" "$37,500.00" N/A N/A 27500424 EAP HCPCS C1882 DEFIBRILLATOR CARDIAC .99CM 5.37X8.08CM IS-1 DF-1 LV-1 BOTH IP/OP "$44,750.00" "$33,115.00" "$7,712.84" "$44,750.00" "$20,137.50" "$20,137.50" "$20,137.50" "$20,137.50" "$44,750.00" "$44,750.00" "$44,750.00" "$9,327.02" "$44,750.00" "$44,750.00" "$44,750.00" "$44,750.00" "$44,750.00" "$9,326.39" "$44,750.00" "$44,750.00" "$22,061.75" "$44,750.00" "$44,750.00" "$44,750.00" "$44,750.00" "$33,562.50" "$44,750.00" "$44,750.00" "$44,750.00" "$22,375.00" "$22,375.00" "$35,442.00" "$44,750.00" "$35,800.00" "$20,137.50" "$7,712.84" "$44,750.00" "$25,955.00" "$44,750.00" "$44,750.00" "$44,750.00" "$8,098.48" "$44,750.00" N/A N/A 27500425 EAP HCPCS C1893 ACUITY PRO IMPLANT TOOLS/LEAD DELIVERY SYSTEM BOTH IP/OP "$15,250.00" "$11,285.00" "$3,026.74" "$15,250.00" "$6,862.50" "$6,862.50" "$6,862.50" "$6,862.50" "$15,250.00" "$15,250.00" "$15,250.00" "$3,178.48" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$3,178.27" "$15,250.00" "$15,250.00" "$7,518.25" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$11,437.50" "$15,250.00" "$15,250.00" "$15,250.00" "$7,625.00" "$7,625.00" "$12,078.00" "$15,250.00" "$12,200.00" "$6,862.50" "$3,026.74" "$15,250.00" "$8,845.00" "$15,250.00" "$15,250.00" "$15,250.00" "$3,178.10" "$15,250.00" N/A N/A 27500426 EAP HCPCS C2621 PACEMAKER CARDIAC 3D .75CM 16.2CU CM SPIRAL 2.6FR 4.45X6.13 BOTH IP/OP "$15,250.00" "$11,285.00" "$3,026.74" "$15,250.00" "$6,862.50" "$6,862.50" "$6,862.50" "$6,862.50" "$15,250.00" "$15,250.00" "$15,250.00" "$3,178.48" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$3,178.27" "$15,250.00" "$15,250.00" "$7,518.25" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$11,437.50" "$15,250.00" "$15,250.00" "$15,250.00" "$7,625.00" "$7,625.00" "$12,078.00" "$15,250.00" "$12,200.00" "$6,862.50" "$3,026.74" "$15,250.00" "$8,845.00" "$15,250.00" "$15,250.00" "$15,250.00" "$3,178.10" "$15,250.00" N/A N/A 27500427 EAP HCPCS C1882 DEFIBRILLATOR CARDIAC .99IN MINI 5.37X8.18CM IS-1 DF-4 IS-4 BOTH IP/OP "$44,750.00" "$33,115.00" "$7,712.84" "$44,750.00" "$20,137.50" "$20,137.50" "$20,137.50" "$20,137.50" "$44,750.00" "$44,750.00" "$44,750.00" "$9,327.02" "$44,750.00" "$44,750.00" "$44,750.00" "$44,750.00" "$44,750.00" "$9,326.39" "$44,750.00" "$44,750.00" "$22,061.75" "$44,750.00" "$44,750.00" "$44,750.00" "$44,750.00" "$33,562.50" "$44,750.00" "$44,750.00" "$44,750.00" "$22,375.00" "$22,375.00" "$35,442.00" "$44,750.00" "$35,800.00" "$20,137.50" "$7,712.84" "$44,750.00" "$25,955.00" "$44,750.00" "$44,750.00" "$44,750.00" "$8,098.48" "$44,750.00" N/A N/A 27500428 EAP HCPCS C1882 DEFIBRILLATOR CARDIAC .99IN MINI 5.37X8.08CM IS-1 DF-1 IS-4 BOTH IP/OP "$44,750.00" "$33,115.00" "$7,712.84" "$44,750.00" "$20,137.50" "$20,137.50" "$20,137.50" "$20,137.50" "$44,750.00" "$44,750.00" "$44,750.00" "$9,327.02" "$44,750.00" "$44,750.00" "$44,750.00" "$44,750.00" "$44,750.00" "$9,326.39" "$44,750.00" "$44,750.00" "$22,061.75" "$44,750.00" "$44,750.00" "$44,750.00" "$44,750.00" "$33,562.50" "$44,750.00" "$44,750.00" "$44,750.00" "$22,375.00" "$22,375.00" "$35,442.00" "$44,750.00" "$35,800.00" "$20,137.50" "$7,712.84" "$44,750.00" "$25,955.00" "$44,750.00" "$44,750.00" "$44,750.00" "$8,098.48" "$44,750.00" N/A N/A 27500429 EAP HCPCS C1900 LEAD PACING X4 95 CMCONCTR ACUITY LEFT VENTRICLE SPIRAL L BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" "$6,750.00" "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A 27500430 EAP HCPCS C1900 LEAD PACING X4 86CM CONCTR ACUITY LEFT VENTRICLE SPIRAL L BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" "$6,750.00" "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A 27500431 EAP HCPCS C1900 LEAD PACING X4 95CM CONCTR ACUITY LEFT VENTRICLE STRAIGHT BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" "$6,750.00" "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A 27500432 EAP HCPCS C1900 LEAD PACING X4 86 CM CONCTR ACUITY LEFT VENTRICLE SPIRAL S BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" "$6,750.00" "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A 27500433 EAP HCPCS C1900 LEAD PACING X4 95 CM CONCTR ACUITY LEFT VENTRICLE SPIRAL S BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" "$6,750.00" "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A 27500434 EAP HCPCS C1900 LEAD PACING X4 86 CM CONCTR ACUITY LEFT VENTRICLE STRAIGHT BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" "$6,750.00" "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A 27500435 EAP HCPCS C1882 INVENTRA 7 VR-T DX BOTH IP/OP "$49,688.00" "$36,769.50" "$7,712.84" "$49,688.00" "$22,359.60" "$22,359.60" "$22,359.60" "$22,359.60" "$49,688.00" "$49,688.00" "$49,688.00" "$9,417.94" "$49,688.00" "$49,688.00" "$49,688.00" "$49,688.00" "$49,688.00" "$10,355.53" "$49,688.00" "$49,688.00" "$24,496.18" "$49,688.00" "$49,688.00" "$49,688.00" "$49,688.00" "$37,266.00" "$49,688.00" "$49,688.00" "$49,688.00" "$24,844.00" "$24,844.00" "$39,352.90" "$49,688.00" "$39,750.40" "$22,359.60" "$7,712.84" "$49,688.00" "$28,819.04" "$49,688.00" "$49,688.00" "$49,688.00" "$8,098.48" "$49,688.00" N/A N/A 27500440 EAP HCPCS C1785 PACEMAKER CRD PROMRI 2 CHMBR ELUNA DR-T BOTH IP/OP "$14,000.00" "$10,360.00" "$2,778.65" "$14,000.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$14,000.00" "$14,000.00" "$14,000.00" "$2,917.95" "$14,000.00" "$14,000.00" "$14,000.00" "$14,000.00" "$14,000.00" "$2,917.75" "$14,000.00" "$14,000.00" "$6,902.00" "$14,000.00" "$14,000.00" "$14,000.00" "$14,000.00" "$10,500.00" "$14,000.00" "$14,000.00" "$14,000.00" "$7,000.00" "$7,000.00" "$11,088.00" "$14,000.00" "$11,200.00" "$6,300.00" "$2,778.65" "$14,000.00" "$8,120.00" "$14,000.00" "$14,000.00" "$14,000.00" "$2,917.60" "$14,000.00" N/A N/A 27500441 EAP HCPCS C1785 PACEMAKER CRD PROMRI ELUNA DR-T LEAD CLLR HOME BOTH IP/OP "$16,500.00" "$12,210.00" "$3,274.84" "$16,500.00" "$7,425.00" "$7,425.00" "$7,425.00" "$7,425.00" "$16,500.00" "$16,500.00" "$16,500.00" "$3,439.01" "$16,500.00" "$16,500.00" "$16,500.00" "$16,500.00" "$16,500.00" "$3,438.78" "$16,500.00" "$16,500.00" "$8,134.50" "$16,500.00" "$16,500.00" "$16,500.00" "$16,500.00" "$12,375.00" "$16,500.00" "$16,500.00" "$16,500.00" "$8,250.00" "$8,250.00" "$13,068.00" "$16,500.00" "$13,200.00" "$7,425.00" "$3,274.84" "$16,500.00" "$9,570.00" "$16,500.00" "$16,500.00" "$16,500.00" "$3,438.60" "$16,500.00" N/A N/A 27500442 EAP HCPCS C1786 PACEMAKER CRD ELUNA SR-T PROMRI BOTH IP/OP "$12,125.00" "$8,972.50" "$2,406.51" "$12,125.00" "$5,456.25" "$5,456.25" "$5,456.25" "$5,456.25" "$12,125.00" "$12,125.00" "$12,125.00" "$2,527.15" "$12,125.00" "$12,125.00" "$12,125.00" "$12,125.00" "$12,125.00" "$2,526.98" "$12,125.00" "$12,125.00" "$5,977.63" "$12,125.00" "$12,125.00" "$12,125.00" "$12,125.00" "$9,093.75" "$12,125.00" "$12,125.00" "$12,125.00" "$6,062.50" "$6,062.50" "$9,603.00" "$12,125.00" "$9,700.00" "$5,456.25" "$2,406.51" "$12,125.00" "$7,032.50" "$12,125.00" "$12,125.00" "$12,125.00" "$2,526.85" "$12,125.00" N/A N/A 27500443 EAP HCPCS C1786 PACEMAKER CRD PROMRI ELUNA SR-T LEAD CLLR HOME BOTH IP/OP "$13,250.00" "$9,805.00" "$2,629.79" "$13,250.00" "$5,962.50" "$5,962.50" "$5,962.50" "$5,962.50" "$13,250.00" "$13,250.00" "$13,250.00" "$2,761.63" "$13,250.00" "$13,250.00" "$13,250.00" "$13,250.00" "$13,250.00" "$2,761.45" "$13,250.00" "$13,250.00" "$6,532.25" "$13,250.00" "$13,250.00" "$13,250.00" "$13,250.00" "$9,937.50" "$13,250.00" "$13,250.00" "$13,250.00" "$6,625.00" "$6,625.00" "$10,494.00" "$13,250.00" "$10,600.00" "$5,962.50" "$2,629.79" "$13,250.00" "$7,685.00" "$13,250.00" "$13,250.00" "$13,250.00" "$2,761.30" "$13,250.00" N/A N/A 27503012 EAP HCPCS C1785 "ALTRUA 60 PMKR, DUAL, RATE-RESP" BOTH IP/OP "$12,375.00" "$9,157.50" "$2,456.13" "$12,375.00" "$5,568.75" "$5,568.75" "$5,568.75" "$5,568.75" "$12,375.00" "$12,375.00" "$12,375.00" "$2,579.26" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$2,579.09" "$12,375.00" "$12,375.00" "$6,100.88" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$9,281.25" "$12,375.00" "$12,375.00" "$12,375.00" "$6,187.50" "$6,187.50" "$9,801.00" "$12,375.00" "$9,900.00" "$5,568.75" "$2,456.13" "$12,375.00" "$7,177.50" "$12,375.00" "$12,375.00" "$12,375.00" "$2,578.95" "$12,375.00" N/A N/A 27503013 EAP HCPCS C1786 "ALTRUA PMKR, SINGLE, RATE-RESP" BOTH IP/OP "$10,553.00" "$7,809.50" "$2,094.51" "$10,553.00" "$4,748.85" "$4,748.85" "$4,748.85" "$4,748.85" "$10,553.00" "$10,553.00" "$10,553.00" "$2,199.51" "$10,553.00" "$10,553.00" "$10,553.00" "$10,553.00" "$10,553.00" "$2,199.36" "$10,553.00" "$10,553.00" "$5,202.63" "$10,553.00" "$10,553.00" "$10,553.00" "$10,553.00" "$7,914.75" "$10,553.00" "$10,553.00" "$10,553.00" "$5,276.50" "$5,276.50" "$8,357.98" "$10,553.00" "$8,442.40" "$4,748.85" "$2,094.51" "$10,553.00" "$6,120.74" "$10,553.00" "$10,553.00" "$10,553.00" "$2,199.25" "$10,553.00" N/A N/A 27503014 EAP HCPCS C1721 ENERGEN DR AICD DUAL CHAMBER BOTH IP/OP "$46,552.00" "$34,448.50" "$9,701.95" "$46,552.00" "$46,552.00" "$46,552.00" "$46,552.00" "$46,552.00" "$46,552.00" "$46,552.00" "$46,552.00" "$46,552.00" "$46,552.00" "$46,552.00" "$46,552.00" "$46,552.00" "$46,552.00" "$9,701.95" "$46,552.00" "$18,620.80" "$46,552.00" "$46,552.00" "$46,552.00" "$46,552.00" "$46,552.00" "$34,914.00" "$46,552.00" "$46,552.00" "$46,552.00" "$23,276.00" "$23,276.00" "$36,869.18" "$46,552.00" "$37,241.60" "$20,948.40" "$46,552.00" "$46,552.00" "$27,000.16" "$46,552.00" "$27,931.20" "$46,552.00" "$46,552.00" "$46,552.00" N/A N/A 27503015 EAP HCPCS C1722 ENERGEN VR AICD SINGLE CHAMBER BOTH IP/OP "$38,792.00" "$28,706.50" "$7,699.24" "$38,792.00" "$17,456.40" "$17,456.40" "$17,456.40" "$17,456.40" "$38,792.00" "$38,792.00" "$38,792.00" "$8,085.22" "$38,792.00" "$38,792.00" "$38,792.00" "$38,792.00" "$38,792.00" "$8,084.68" "$38,792.00" "$38,792.00" "$19,124.46" "$38,792.00" "$38,792.00" "$38,792.00" "$38,792.00" "$29,094.00" "$38,792.00" "$38,792.00" "$38,792.00" "$19,396.00" "$19,396.00" "$30,723.26" "$38,792.00" "$31,033.60" "$17,456.40" "$7,699.24" "$38,792.00" "$22,499.36" "$38,792.00" "$38,792.00" "$38,792.00" "$8,084.25" "$38,792.00" N/A N/A 27503016 EAP HCPCS C1895 "RELIANCE GORE LEAD,AICD, ENDO DUAL COIL" BOTH IP/OP "$13,964.00" "$10,333.50" "$2,771.50" "$13,964.00" "$6,283.80" "$6,283.80" "$6,283.80" "$6,283.80" "$13,964.00" "$13,964.00" "$13,964.00" "$2,910.45" "$13,964.00" "$13,964.00" "$13,964.00" "$13,964.00" "$13,964.00" "$2,910.25" "$13,964.00" "$13,964.00" "$6,884.25" "$13,964.00" "$13,964.00" "$13,964.00" "$13,964.00" "$10,473.00" "$13,964.00" "$13,964.00" "$13,964.00" "$6,982.00" "$6,982.00" "$11,059.49" "$13,964.00" "$11,171.20" "$6,283.80" "$2,771.50" "$13,964.00" "$8,099.12" "$13,964.00" "$13,964.00" "$13,964.00" "$2,910.10" "$13,964.00" N/A N/A 27503017 EAP HCPCS C2621 CONTAK RENEWAL TR CRT-P BOTH IP/OP "$19,861.00" "$14,697.50" "$3,941.91" "$19,861.00" "$8,937.45" "$8,937.45" "$8,937.45" "$8,937.45" "$19,861.00" "$19,861.00" "$19,861.00" "$4,139.53" "$19,861.00" "$19,861.00" "$19,861.00" "$19,861.00" "$19,861.00" "$4,139.25" "$19,861.00" "$19,861.00" "$9,791.47" "$19,861.00" "$19,861.00" "$19,861.00" "$19,861.00" "$14,895.75" "$19,861.00" "$19,861.00" "$19,861.00" "$9,930.50" "$9,930.50" "$15,729.91" "$19,861.00" "$15,888.80" "$8,937.45" "$3,941.91" "$19,861.00" "$11,519.38" "$19,861.00" "$19,861.00" "$19,861.00" "$4,139.03" "$19,861.00" N/A N/A 27503018 EAP HCPCS C1900 "ACUITY STEERABLE LEAD, CORONARY VENOUS" BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27503019 EAP HCPCS C1900 "ACUITY SPIRAL LEAD,CORONARY VENOUS" BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27503020 EAP HCPCS C1900 "EASYTRAK 2 LEAD,CORONARY VENOUS" BOTH IP/OP "$4,656.00" "$3,445.50" $924.10 "$4,656.00" "$2,095.20" "$2,095.20" "$2,095.20" "$2,095.20" "$4,656.00" "$4,656.00" "$4,656.00" $970.43 "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" $970.36 "$4,656.00" "$4,656.00" "$2,295.41" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$3,492.00" "$4,656.00" "$4,656.00" "$4,656.00" "$2,328.00" "$2,328.00" "$3,687.55" "$4,656.00" "$3,724.80" "$2,095.20" $924.10 "$4,656.00" "$2,700.48" "$4,656.00" "$4,656.00" "$4,656.00" $970.31 "$4,656.00" N/A N/A 27503021 EAP HCPCS C1900 "EASYTRAK 3 LEAD,CORONARY VENOUS" BOTH IP/OP "$4,656.00" "$3,445.50" $924.10 "$4,656.00" "$2,095.20" "$2,095.20" "$2,095.20" "$2,095.20" "$4,656.00" "$4,656.00" "$4,656.00" $970.43 "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" $970.36 "$4,656.00" "$4,656.00" "$2,295.41" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$3,492.00" "$4,656.00" "$4,656.00" "$4,656.00" "$2,328.00" "$2,328.00" "$3,687.55" "$4,656.00" "$3,724.80" "$2,095.20" $924.10 "$4,656.00" "$2,700.48" "$4,656.00" "$4,656.00" "$4,656.00" $970.31 "$4,656.00" N/A N/A 27503022 EAP HCPCS C1721 FORTIFY DR AICD DUAL CHAMBER BOTH IP/OP "$64,394.00" "$47,652.00" "$13,420.42" "$64,394.00" "$64,394.00" "$64,394.00" "$64,394.00" "$64,394.00" "$64,394.00" "$64,394.00" "$64,394.00" "$64,394.00" "$64,394.00" "$64,394.00" "$64,394.00" "$64,394.00" "$64,394.00" "$13,420.42" "$64,394.00" "$25,757.60" "$64,394.00" "$64,394.00" "$64,394.00" "$64,394.00" "$64,394.00" "$48,295.50" "$64,394.00" "$64,394.00" "$64,394.00" "$32,197.00" "$32,197.00" "$51,000.05" "$64,394.00" "$51,515.20" "$28,977.30" "$64,394.00" "$64,394.00" "$37,348.52" "$64,394.00" "$38,636.40" "$64,394.00" "$64,394.00" "$64,394.00" N/A N/A 27503023 EAP HCPCS C1785 ACCENT DR BOTH IP/OP "$17,142.00" "$12,685.50" "$3,402.26" "$17,142.00" "$7,713.90" "$7,713.90" "$7,713.90" "$7,713.90" "$17,142.00" "$17,142.00" "$17,142.00" "$3,572.82" "$17,142.00" "$17,142.00" "$17,142.00" "$17,142.00" "$17,142.00" "$3,572.58" "$17,142.00" "$17,142.00" "$8,451.01" "$17,142.00" "$17,142.00" "$17,142.00" "$17,142.00" "$12,856.50" "$17,142.00" "$17,142.00" "$17,142.00" "$8,571.00" "$8,571.00" "$13,576.46" "$17,142.00" "$13,713.60" "$7,713.90" "$3,402.26" "$17,142.00" "$9,942.36" "$17,142.00" "$17,142.00" "$17,142.00" "$3,572.39" "$17,142.00" N/A N/A 27503024 EAP HCPCS C1786 ACCENT SR BOTH IP/OP "$1,566.00" "$1,159.00" $310.81 "$1,566.00" $704.70 $704.70 $704.70 $704.70 "$1,566.00" "$1,566.00" "$1,566.00" $326.39 "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" $326.37 "$1,566.00" "$1,566.00" $926.29 "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" "$1,174.50" "$1,566.00" "$1,566.00" "$1,566.00" $783.00 $783.00 "$1,240.27" "$1,566.00" "$1,252.80" $704.70 $310.81 "$1,566.00" $908.28 "$1,566.00" "$1,566.00" "$1,566.00" $326.35 "$1,566.00" N/A N/A 27503025 EAP HCPCS C1898 TENDRIL STS 2088TC/46 BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503028 EAP HCPCS C1721 FORTIFY ASSURA DR 40 BOTH IP/OP "$61,328.00" "$45,383.00" "$12,781.43" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$12,781.43" "$61,328.00" "$24,531.20" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$45,996.00" "$61,328.00" "$61,328.00" "$61,328.00" "$30,664.00" "$30,664.00" "$48,571.78" "$61,328.00" "$49,062.40" "$27,597.60" "$61,328.00" "$61,328.00" "$35,570.24" "$61,328.00" "$36,796.80" "$61,328.00" "$61,328.00" "$61,328.00" N/A N/A 27503029 EAP HCPCS C1721 FORTIFY ASSURA DR 40 DF4 CONNECTOR BOTH IP/OP "$61,328.00" "$45,383.00" "$12,781.43" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$12,781.43" "$61,328.00" "$24,531.20" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$45,996.00" "$61,328.00" "$61,328.00" "$61,328.00" "$30,664.00" "$30,664.00" "$48,571.78" "$61,328.00" "$49,062.40" "$27,597.60" "$61,328.00" "$61,328.00" "$35,570.24" "$61,328.00" "$36,796.80" "$61,328.00" "$61,328.00" "$61,328.00" N/A N/A 27503030 EAP HCPCS C1721 ELLIPSE DR 36 BOTH IP/OP "$61,328.00" "$45,383.00" "$12,781.43" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$12,781.43" "$61,328.00" "$24,531.20" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$45,996.00" "$61,328.00" "$61,328.00" "$61,328.00" "$30,664.00" "$30,664.00" "$48,571.78" "$61,328.00" "$49,062.40" "$27,597.60" "$61,328.00" "$61,328.00" "$35,570.24" "$61,328.00" "$36,796.80" "$61,328.00" "$61,328.00" "$61,328.00" N/A N/A 27503031 EAP HCPCS C1722 ELLIPSE DR 36 DF4 CONNECTOR BOTH IP/OP "$61,328.00" "$45,383.00" "$7,712.84" "$61,328.00" "$27,597.60" "$27,597.60" "$27,597.60" "$27,597.60" "$61,328.00" "$61,328.00" "$61,328.00" "$9,417.94" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$12,781.43" "$61,328.00" "$61,328.00" "$30,234.70" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$45,996.00" "$61,328.00" "$61,328.00" "$61,328.00" "$30,664.00" "$30,664.00" "$48,571.78" "$61,328.00" "$49,062.40" "$27,597.60" "$7,712.84" "$61,328.00" "$35,570.24" "$61,328.00" "$61,328.00" "$61,328.00" "$8,098.48" "$61,328.00" N/A N/A 27503032 EAP HCPCS C1722 FORTIFY ASSURA VR 40 BOTH IP/OP "$53,200.00" "$39,368.00" "$7,712.84" "$53,200.00" "$23,940.00" "$23,940.00" "$23,940.00" "$23,940.00" "$53,200.00" "$53,200.00" "$53,200.00" "$9,417.94" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$11,087.47" "$53,200.00" "$53,200.00" "$26,227.60" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$39,900.00" "$53,200.00" "$53,200.00" "$53,200.00" "$26,600.00" "$26,600.00" "$42,134.40" "$53,200.00" "$42,560.00" "$23,940.00" "$7,712.84" "$53,200.00" "$30,856.00" "$53,200.00" "$53,200.00" "$53,200.00" "$8,098.48" "$53,200.00" N/A N/A 27503033 EAP HCPCS C1722 FORTIFY ASSURA VR 40 DF4 CONNECTOR BOTH IP/OP "$53,200.00" "$39,368.00" "$7,712.84" "$53,200.00" "$23,940.00" "$23,940.00" "$23,940.00" "$23,940.00" "$53,200.00" "$53,200.00" "$53,200.00" "$9,417.94" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$11,087.47" "$53,200.00" "$53,200.00" "$26,227.60" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$39,900.00" "$53,200.00" "$53,200.00" "$53,200.00" "$26,600.00" "$26,600.00" "$42,134.40" "$53,200.00" "$42,560.00" "$23,940.00" "$7,712.84" "$53,200.00" "$30,856.00" "$53,200.00" "$53,200.00" "$53,200.00" "$8,098.48" "$53,200.00" N/A N/A 27503034 EAP HCPCS C1722 ELLIPSE VR 36 BOTH IP/OP "$53,200.00" "$39,368.00" "$7,712.84" "$53,200.00" "$23,940.00" "$23,940.00" "$23,940.00" "$23,940.00" "$53,200.00" "$53,200.00" "$53,200.00" "$9,417.94" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$11,087.47" "$53,200.00" "$53,200.00" "$26,227.60" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$39,900.00" "$53,200.00" "$53,200.00" "$53,200.00" "$26,600.00" "$26,600.00" "$42,134.40" "$53,200.00" "$42,560.00" "$23,940.00" "$7,712.84" "$53,200.00" "$30,856.00" "$53,200.00" "$53,200.00" "$53,200.00" "$8,098.48" "$53,200.00" N/A N/A 27503035 EAP HCPCS C1722 ELLIPSE VR 36 DF4 CONNECTOR BOTH IP/OP "$53,200.00" "$39,368.00" "$7,712.84" "$53,200.00" "$23,940.00" "$23,940.00" "$23,940.00" "$23,940.00" "$53,200.00" "$53,200.00" "$53,200.00" "$9,417.94" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$11,087.47" "$53,200.00" "$53,200.00" "$26,227.60" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$39,900.00" "$53,200.00" "$53,200.00" "$53,200.00" "$26,600.00" "$26,600.00" "$42,134.40" "$53,200.00" "$42,560.00" "$23,940.00" "$7,712.84" "$53,200.00" "$30,856.00" "$53,200.00" "$53,200.00" "$53,200.00" "$8,098.48" "$53,200.00" N/A N/A 27503036 EAP HCPCS C1882 QUADRA ASSURA CRT-D 40 BOTH IP/OP "$8,512.00" "$6,299.00" "$1,689.42" "$8,512.00" "$3,830.40" "$3,830.40" "$3,830.40" "$3,830.40" "$8,512.00" "$8,512.00" "$8,512.00" "$1,774.11" "$8,512.00" "$8,512.00" "$8,512.00" "$8,512.00" "$8,512.00" "$1,773.99" "$8,512.00" "$8,512.00" "$4,196.42" "$8,512.00" "$8,512.00" "$8,512.00" "$8,512.00" "$6,384.00" "$8,512.00" "$8,512.00" "$8,512.00" "$4,256.00" "$4,256.00" "$6,741.50" "$8,512.00" "$6,809.60" "$3,830.40" "$1,689.42" "$8,512.00" "$4,936.96" "$8,512.00" "$8,512.00" "$8,512.00" "$1,773.90" "$8,512.00" N/A N/A 27503037 EAP HCPCS C1882 QUADRA ASSURA CRT-D 40 DF4 CONNECTOR BOTH IP/OP "$85,120.00" "$62,989.00" "$7,712.84" "$85,120.00" "$38,304.00" "$38,304.00" "$38,304.00" "$38,304.00" "$85,120.00" "$85,120.00" "$85,120.00" "$9,417.94" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$17,739.94" "$85,120.00" "$85,120.00" "$41,964.16" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$63,840.00" "$85,120.00" "$85,120.00" "$85,120.00" "$42,560.00" "$42,560.00" "$67,415.04" "$85,120.00" "$68,096.00" "$38,304.00" "$7,712.84" "$85,120.00" "$49,369.60" "$85,120.00" "$85,120.00" "$85,120.00" "$8,098.48" "$85,120.00" N/A N/A 27503038 EAP HCPCS C1882 UNIFY ASSURA CRT-D 40 BOTH IP/OP "$85,120.00" "$62,989.00" "$7,712.84" "$85,120.00" "$38,304.00" "$38,304.00" "$38,304.00" "$38,304.00" "$85,120.00" "$85,120.00" "$85,120.00" "$9,417.94" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$17,739.94" "$85,120.00" "$85,120.00" "$41,964.16" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$63,840.00" "$85,120.00" "$85,120.00" "$85,120.00" "$42,560.00" "$42,560.00" "$67,415.04" "$85,120.00" "$68,096.00" "$38,304.00" "$7,712.84" "$85,120.00" "$49,369.60" "$85,120.00" "$85,120.00" "$85,120.00" "$8,098.48" "$85,120.00" N/A N/A 27503039 EAP HCPCS C1882 UNIFY ASSURA CRT-D 40 DF4 CONNECTOR BOTH IP/OP "$85,120.00" "$62,989.00" "$7,712.84" "$85,120.00" "$38,304.00" "$38,304.00" "$38,304.00" "$38,304.00" "$85,120.00" "$85,120.00" "$85,120.00" "$9,417.94" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$17,739.94" "$85,120.00" "$85,120.00" "$41,964.16" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$63,840.00" "$85,120.00" "$85,120.00" "$85,120.00" "$42,560.00" "$42,560.00" "$67,415.04" "$85,120.00" "$68,096.00" "$38,304.00" "$7,712.84" "$85,120.00" "$49,369.60" "$85,120.00" "$85,120.00" "$85,120.00" "$8,098.48" "$85,120.00" N/A N/A 27503040 EAP HCPCS C1898 TENDRIL STS 2088TC/65 BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503041 EAP HCPCS C1898 TENDRIL STS 2088TC/100 BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503042 EAP HCPCS C1785 "ADAPTA VDD, IS-I" BOTH IP/OP "$4,729.00" "$3,499.50" $938.59 "$4,729.00" "$2,128.05" "$2,128.05" "$2,128.05" "$2,128.05" "$4,729.00" "$4,729.00" "$4,729.00" $985.64 "$4,729.00" "$4,729.00" "$4,729.00" "$4,729.00" "$4,729.00" $985.58 "$4,729.00" "$4,729.00" "$2,331.40" "$4,729.00" "$4,729.00" "$4,729.00" "$4,729.00" "$3,546.75" "$4,729.00" "$4,729.00" "$4,729.00" "$2,364.50" "$2,364.50" "$3,745.37" "$4,729.00" "$3,783.20" "$2,128.05" $938.59 "$4,729.00" "$2,742.82" "$4,729.00" "$4,729.00" "$4,729.00" $985.52 "$4,729.00" N/A N/A 27503043 EAP HCPCS C1898 CAPSURE VDD2 LEAD 5038S-52 BOTH IP/OP $828.00 $613.00 $172.56 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $172.56 $828.00 $331.20 $828.00 $828.00 $828.00 $828.00 $828.00 $621.00 $828.00 $828.00 $828.00 $414.00 $414.00 $655.78 $828.00 $662.40 $372.60 $828.00 $828.00 $480.24 $828.00 $496.80 $828.00 $828.00 $828.00 N/A N/A 27503044 EAP HCPCS C1898 CAPSURE VDD2 LEAD 5032S-58 BOTH IP/OP $828.00 $613.00 $172.56 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $172.56 $828.00 $331.20 $828.00 $828.00 $828.00 $828.00 $828.00 $621.00 $828.00 $828.00 $828.00 $414.00 $414.00 $655.78 $828.00 $662.40 $372.60 $828.00 $828.00 $480.24 $828.00 $496.80 $828.00 $828.00 $828.00 N/A N/A 27503045 EAP HCPCS C1898 CAPSURE VDD2 LEAD 50038-58 BOTH IP/OP $828.00 $613.00 $172.56 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $172.56 $828.00 $331.20 $828.00 $828.00 $828.00 $828.00 $828.00 $621.00 $828.00 $828.00 $828.00 $414.00 $414.00 $655.78 $828.00 $662.40 $372.60 $828.00 $828.00 $480.24 $828.00 $496.80 $828.00 $828.00 $828.00 N/A N/A 27503046 EAP HCPCS C1898 CAPSURE VDD2 LEAD 5038-65 BOTH IP/OP $828.00 $613.00 $172.56 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $828.00 $172.56 $828.00 $331.20 $828.00 $828.00 $828.00 $828.00 $828.00 $621.00 $828.00 $828.00 $828.00 $414.00 $414.00 $655.78 $828.00 $662.40 $372.60 $828.00 $828.00 $480.24 $828.00 $496.80 $828.00 $828.00 $828.00 N/A N/A 27503050 EAP HCPCS C1785 ACCENT DR PACEMAKER GENERATOR BOTH IP/OP "$17,142.00" "$12,685.50" "$3,402.26" "$17,142.00" "$7,713.90" "$7,713.90" "$7,713.90" "$7,713.90" "$17,142.00" "$17,142.00" "$17,142.00" "$3,572.82" "$17,142.00" "$17,142.00" "$17,142.00" "$17,142.00" "$17,142.00" "$3,572.58" "$17,142.00" "$17,142.00" "$8,451.01" "$17,142.00" "$17,142.00" "$17,142.00" "$17,142.00" "$12,856.50" "$17,142.00" "$17,142.00" "$17,142.00" "$8,571.00" "$8,571.00" "$13,576.46" "$17,142.00" "$13,713.60" "$7,713.90" "$3,402.26" "$17,142.00" "$9,942.36" "$17,142.00" "$17,142.00" "$17,142.00" "$3,572.39" "$17,142.00" N/A N/A 27503051 EAP HCPCS C1786 ACCENT SR PACEMAKER GENERATOR BOTH IP/OP "$15,665.00" "$11,592.50" "$3,109.11" "$15,665.00" "$7,049.25" "$7,049.25" "$7,049.25" "$7,049.25" "$15,665.00" "$15,665.00" "$15,665.00" "$3,264.98" "$15,665.00" "$15,665.00" "$15,665.00" "$15,665.00" "$15,665.00" "$3,264.76" "$15,665.00" "$15,665.00" "$7,722.85" "$15,665.00" "$15,665.00" "$15,665.00" "$15,665.00" "$11,748.75" "$15,665.00" "$15,665.00" "$15,665.00" "$7,832.50" "$7,832.50" "$12,406.68" "$15,665.00" "$12,532.00" "$7,049.25" "$3,109.11" "$15,665.00" "$9,085.70" "$15,665.00" "$15,665.00" "$15,665.00" "$3,264.59" "$15,665.00" N/A N/A 27503052 EAP HCPCS C1898 TENDRIL STS 2088TC/46 LEAD/ELECTRODE/ACCESS BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503053 EAP HCPCS C1898 TENDRIL STS 2088TC/52 LEAD/ELECTRODE/ACCESS BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503055 EAP HCPCS C1721 FORTIFY ASSURA DR 40 DF4 CONNECTOR ICD/DEFIB/RESYNC BOTH IP/OP "$61,328.00" "$45,383.00" "$12,781.43" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$12,781.43" "$61,328.00" "$24,531.20" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$45,996.00" "$61,328.00" "$61,328.00" "$61,328.00" "$30,664.00" "$30,664.00" "$48,571.78" "$61,328.00" "$49,062.40" "$27,597.60" "$61,328.00" "$61,328.00" "$35,570.24" "$61,328.00" "$36,796.80" "$61,328.00" "$61,328.00" "$61,328.00" N/A N/A 27503056 EAP HCPCS C1721 FORTIFY ASSURA DR 40 DF4 CONNECTOR ICD/DEFIB/RESYNC BOTH IP/OP "$61,328.00" "$45,383.00" "$12,781.43" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$12,781.43" "$61,328.00" "$24,531.20" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$45,996.00" "$61,328.00" "$61,328.00" "$61,328.00" "$30,664.00" "$30,664.00" "$48,571.78" "$61,328.00" "$49,062.40" "$27,597.60" "$61,328.00" "$61,328.00" "$35,570.24" "$61,328.00" "$36,796.80" "$61,328.00" "$61,328.00" "$61,328.00" N/A N/A 27503057 EAP HCPCS C1721 ELLIPSE DR 36 DF4 CONNECTOR ICD/DEFIB/RESYNC BOTH IP/OP "$61,328.00" "$45,383.00" "$12,781.43" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$12,781.43" "$61,328.00" "$24,531.20" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$45,996.00" "$61,328.00" "$61,328.00" "$61,328.00" "$30,664.00" "$30,664.00" "$48,571.78" "$61,328.00" "$49,062.40" "$27,597.60" "$61,328.00" "$61,328.00" "$35,570.24" "$61,328.00" "$36,796.80" "$61,328.00" "$61,328.00" "$61,328.00" N/A N/A 27503058 EAP HCPCS C1721 ELLIPSE DR 36 DF4 CONNECTOR ICD/DEFIB/RESYNC BOTH IP/OP "$61,328.00" "$45,383.00" "$12,781.43" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$12,781.43" "$61,328.00" "$24,531.20" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$61,328.00" "$45,996.00" "$61,328.00" "$61,328.00" "$61,328.00" "$30,664.00" "$30,664.00" "$48,571.78" "$61,328.00" "$49,062.40" "$27,597.60" "$61,328.00" "$61,328.00" "$35,570.24" "$61,328.00" "$36,796.80" "$61,328.00" "$61,328.00" "$61,328.00" N/A N/A 27503059 EAP HCPCS C1722 FORTIFY ASSURA VR 40 DF4 CONNECTOR ICD/DEFIB/RESYNC BOTH IP/OP "$53,200.00" "$39,368.00" "$7,712.84" "$53,200.00" "$23,940.00" "$23,940.00" "$23,940.00" "$23,940.00" "$53,200.00" "$53,200.00" "$53,200.00" "$9,417.94" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$11,087.47" "$53,200.00" "$53,200.00" "$26,227.60" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$39,900.00" "$53,200.00" "$53,200.00" "$53,200.00" "$26,600.00" "$26,600.00" "$42,134.40" "$53,200.00" "$42,560.00" "$23,940.00" "$7,712.84" "$53,200.00" "$30,856.00" "$53,200.00" "$53,200.00" "$53,200.00" "$8,098.48" "$53,200.00" N/A N/A 27503060 EAP HCPCS C1722 FORTIFY ASSURA VR 40 DF4 CONNECTOR ICD/DEFIB/RESYNC BOTH IP/OP "$53,200.00" "$39,368.00" "$7,712.84" "$53,200.00" "$23,940.00" "$23,940.00" "$23,940.00" "$23,940.00" "$53,200.00" "$53,200.00" "$53,200.00" "$9,417.94" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$11,087.47" "$53,200.00" "$53,200.00" "$26,227.60" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$39,900.00" "$53,200.00" "$53,200.00" "$53,200.00" "$26,600.00" "$26,600.00" "$42,134.40" "$53,200.00" "$42,560.00" "$23,940.00" "$7,712.84" "$53,200.00" "$30,856.00" "$53,200.00" "$53,200.00" "$53,200.00" "$8,098.48" "$53,200.00" N/A N/A 27503061 EAP HCPCS C1722 ELLIPSE VR 36 DF4 CONNECTOR ICD/DEFIB/RESYNC BOTH IP/OP "$53,200.00" "$39,368.00" "$7,712.84" "$53,200.00" "$23,940.00" "$23,940.00" "$23,940.00" "$23,940.00" "$53,200.00" "$53,200.00" "$53,200.00" "$9,417.94" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$11,087.47" "$53,200.00" "$53,200.00" "$26,227.60" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$39,900.00" "$53,200.00" "$53,200.00" "$53,200.00" "$26,600.00" "$26,600.00" "$42,134.40" "$53,200.00" "$42,560.00" "$23,940.00" "$7,712.84" "$53,200.00" "$30,856.00" "$53,200.00" "$53,200.00" "$53,200.00" "$8,098.48" "$53,200.00" N/A N/A 27503062 EAP HCPCS C1722 ELLIPSE VR 36 DF4 CONNECTOR ICD/DEFIB/RESYNC BOTH IP/OP "$53,200.00" "$39,368.00" "$7,712.84" "$53,200.00" "$23,940.00" "$23,940.00" "$23,940.00" "$23,940.00" "$53,200.00" "$53,200.00" "$53,200.00" "$9,417.94" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$11,087.47" "$53,200.00" "$53,200.00" "$26,227.60" "$53,200.00" "$53,200.00" "$53,200.00" "$53,200.00" "$39,900.00" "$53,200.00" "$53,200.00" "$53,200.00" "$26,600.00" "$26,600.00" "$42,134.40" "$53,200.00" "$42,560.00" "$23,940.00" "$7,712.84" "$53,200.00" "$30,856.00" "$53,200.00" "$53,200.00" "$53,200.00" "$8,098.48" "$53,200.00" N/A N/A 27503063 EAP HCPCS C1882 QUADRA ASSURA CRT-D 40 DF4 CONNECTOR ICD/DEFIB/RESYNC BOTH IP/OP "$8,512.00" "$6,299.00" "$1,689.42" "$8,512.00" "$3,830.40" "$3,830.40" "$3,830.40" "$3,830.40" "$8,512.00" "$8,512.00" "$8,512.00" "$1,774.11" "$8,512.00" "$8,512.00" "$8,512.00" "$8,512.00" "$8,512.00" "$1,773.99" "$8,512.00" "$8,512.00" "$4,196.42" "$8,512.00" "$8,512.00" "$8,512.00" "$8,512.00" "$6,384.00" "$8,512.00" "$8,512.00" "$8,512.00" "$4,256.00" "$4,256.00" "$6,741.50" "$8,512.00" "$6,809.60" "$3,830.40" "$1,689.42" "$8,512.00" "$4,936.96" "$8,512.00" "$8,512.00" "$8,512.00" "$1,773.90" "$8,512.00" N/A N/A 27503064 EAP HCPCS C1882 QUADRA ASSURA CRT-D 40 DF4 CONNECTOR ICD/DEFIB/RESYNC BOTH IP/OP "$85,120.00" "$62,989.00" "$7,712.84" "$85,120.00" "$38,304.00" "$38,304.00" "$38,304.00" "$38,304.00" "$85,120.00" "$85,120.00" "$85,120.00" "$9,417.94" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$17,739.94" "$85,120.00" "$85,120.00" "$41,964.16" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$63,840.00" "$85,120.00" "$85,120.00" "$85,120.00" "$42,560.00" "$42,560.00" "$67,415.04" "$85,120.00" "$68,096.00" "$38,304.00" "$7,712.84" "$85,120.00" "$49,369.60" "$85,120.00" "$85,120.00" "$85,120.00" "$8,098.48" "$85,120.00" N/A N/A 27503065 EAP HCPCS C1882 UNIFY ASSURA CRT-D 40 DF4 CONNECTOR ICD/DEFIB/RESYNC BOTH IP/OP "$85,120.00" "$62,989.00" "$7,712.84" "$85,120.00" "$38,304.00" "$38,304.00" "$38,304.00" "$38,304.00" "$85,120.00" "$85,120.00" "$85,120.00" "$9,417.94" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$17,739.94" "$85,120.00" "$85,120.00" "$41,964.16" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$63,840.00" "$85,120.00" "$85,120.00" "$85,120.00" "$42,560.00" "$42,560.00" "$67,415.04" "$85,120.00" "$68,096.00" "$38,304.00" "$7,712.84" "$85,120.00" "$49,369.60" "$85,120.00" "$85,120.00" "$85,120.00" "$8,098.48" "$85,120.00" N/A N/A 27503066 EAP HCPCS C1882 UNIFY ASSURA CRT-D 40 DF4 CONNECTOR ICD/DEFIB/RESYNC BOTH IP/OP "$85,120.00" "$62,989.00" "$7,712.84" "$85,120.00" "$38,304.00" "$38,304.00" "$38,304.00" "$38,304.00" "$85,120.00" "$85,120.00" "$85,120.00" "$9,417.94" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$17,739.94" "$85,120.00" "$85,120.00" "$41,964.16" "$85,120.00" "$85,120.00" "$85,120.00" "$85,120.00" "$63,840.00" "$85,120.00" "$85,120.00" "$85,120.00" "$42,560.00" "$42,560.00" "$67,415.04" "$85,120.00" "$68,096.00" "$38,304.00" "$7,712.84" "$85,120.00" "$49,369.60" "$85,120.00" "$85,120.00" "$85,120.00" "$8,098.48" "$85,120.00" N/A N/A 27503067 EAP HCPCS C1898 TENDRIL STS 2088TC/100 LEAD/ELECTRODE/ACCESS BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503068 EAP HCPCS C1898 TENDRIL STS 2088TC/65 LEAD/ELECTRODE/ACCESS BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503070 EAP HCPCS C1898 LEAD 4076110 PKG ASSY LEAD 4076 MDT US BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503071 EAP HCPCS C1898 LEAD 407625 PKG ASSY LEAD 4076 MDT US M BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503072 EAP HCPCS C1898 LEAD 407635 CAPSUREFIX NOVUS BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503073 EAP HCPCS C1898 LEAD 407645 PKG ASSY LEAD 4076 MDT US M BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503074 EAP HCPCS C1898 LEAD 407652 PKG ASSY LEAD 4076 MDT US M BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503075 EAP HCPCS C1898 LEAD 407658 PKG ASSY LEAD 4076 MDT US M BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503076 EAP HCPCS C1898 LEAD 407665 CAPSUREFIX NOVUS BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503077 EAP HCPCS C1898 LEAD 407685 CAPSUREFIX NOVUS BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503081 EAP HCPCS C1898 LEAD 5076-35 LEAD-BIPOLAR SIL SCREW-IN BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503082 EAP HCPCS C1898 LEAD 5076-65 LEAD-BIPOLAR SIL SCREW-IN BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503083 EAP HCPCS C1898 LEAD 5076-85 LEAD-BIPOLAR SIL SCREW-IN BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503084 EAP HCPCS C1898 LEAD 5076110 CAPSUREFIX NOVUS PACING BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" $591.20 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 "$1,478.00" "$1,478.00" $857.24 "$1,478.00" $886.80 "$1,478.00" "$1,478.00" "$1,478.00" N/A N/A 27503085 EAP HCPCS C1895 LEAD 6947100 LEAD-QUADRIPOLAR RV/SVC 10 BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27503086 EAP HCPCS C1895 LEAD 694758 LEAD-QUADRIPOLAR RV/SVC 58C BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27503087 EAP HCPCS C1895 LEAD 694765 SPRINT QUAD CAN RV/SVC BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27503088 EAP HCPCS C1895 LEAD 694775 LEAD-QUADRIPOLAR RV/SVC 75C BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27503089 EAP HCPCS C1895 LEAD 6947M55 DF4 ACTIVE DC SPRINT 55 CM BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27503090 EAP HCPCS C1895 LEAD 6947M62 DF4 ACTIVE DC SPRINT 62 CM BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27503091 EAP HCPCS C1895 LEAD 6947M72 DF4 ACTIVE DC SPRINT 72 CM BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27503092 EAP HCPCS C1895 LEAD 6947M97 DF4 ACTIVE DC SPRINT 97 CM BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27503093 EAP HCPCS C1786 PACEMAKER SINGLE CHAMBER ADAPTA SR BOTH IP/OP "$10,344.00" "$7,655.00" "$2,053.03" "$10,344.00" "$4,654.80" "$4,654.80" "$4,654.80" "$4,654.80" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.95" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.80" "$10,344.00" "$10,344.00" "$5,099.59" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$7,758.00" "$10,344.00" "$10,344.00" "$10,344.00" "$5,172.00" "$5,172.00" "$8,192.45" "$10,344.00" "$8,275.20" "$4,654.80" "$2,053.03" "$10,344.00" "$5,999.52" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.69" "$10,344.00" N/A N/A 27503094 EAP HCPCS C1882 GENERATOR CRT-D MAXIMO II BOTH IP/OP "$53,791.00" "$39,805.50" "$7,712.84" "$53,791.00" "$24,205.95" "$24,205.95" "$24,205.95" "$24,205.95" "$53,791.00" "$53,791.00" "$53,791.00" "$9,417.94" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$11,210.64" "$53,791.00" "$53,791.00" "$26,518.96" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$40,343.25" "$53,791.00" "$53,791.00" "$53,791.00" "$26,895.50" "$26,895.50" "$42,602.47" "$53,791.00" "$43,032.80" "$24,205.95" "$7,712.84" "$53,791.00" "$31,198.78" "$53,791.00" "$53,791.00" "$53,791.00" "$8,098.48" "$53,791.00" N/A N/A 27503095 EAP HCPCS C1721 ICD DUAL CHAMBER MAXIMO II DR BOTH IP/OP "$45,811.00" "$33,900.50" "$9,547.52" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$18,324.40" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$45,811.00" "$45,811.00" "$26,570.38" "$45,811.00" "$27,486.60" "$45,811.00" "$45,811.00" "$45,811.00" N/A N/A 27503096 EAP HCPCS C1721 DFBR CRD MXMO 2 VR IMPLTABLE CARDVRT SYS BOTH IP/OP "$38,422.00" "$28,432.50" "$8,007.57" "$38,422.00" "$38,422.00" "$38,422.00" "$38,422.00" "$38,422.00" "$38,422.00" "$38,422.00" "$38,422.00" "$38,422.00" "$38,422.00" "$38,422.00" "$38,422.00" "$38,422.00" "$38,422.00" "$8,007.57" "$38,422.00" "$15,368.80" "$38,422.00" "$38,422.00" "$38,422.00" "$38,422.00" "$38,422.00" "$28,816.50" "$38,422.00" "$38,422.00" "$38,422.00" "$19,211.00" "$19,211.00" "$30,430.22" "$38,422.00" "$30,737.60" "$17,289.90" "$38,422.00" "$38,422.00" "$22,284.76" "$38,422.00" "$23,053.20" "$38,422.00" "$38,422.00" "$38,422.00" N/A N/A 27503097 EAP HCPCS C1900 PHILOS DR BOTH IP/OP "$8,572.00" "$6,343.50" "$1,701.33" "$8,572.00" "$3,857.40" "$3,857.40" "$3,857.40" "$3,857.40" "$8,572.00" "$8,572.00" "$8,572.00" "$1,786.62" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$1,786.50" "$8,572.00" "$8,572.00" "$4,226.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$6,429.00" "$8,572.00" "$8,572.00" "$8,572.00" "$4,286.00" "$4,286.00" "$6,789.02" "$8,572.00" "$6,857.60" "$3,857.40" "$1,701.33" "$8,572.00" "$4,971.76" "$8,572.00" "$8,572.00" "$8,572.00" "$1,786.40" "$8,572.00" N/A N/A 27503098 EAP HCPCS C1900 PHILOS SR BOTH IP/OP "$8,276.00" "$6,124.50" "$1,642.58" "$8,276.00" "$3,724.20" "$3,724.20" "$3,724.20" "$3,724.20" "$8,276.00" "$8,276.00" "$8,276.00" "$1,724.93" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$1,724.81" "$8,276.00" "$8,276.00" "$4,080.07" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$6,207.00" "$8,276.00" "$8,276.00" "$8,276.00" "$4,138.00" "$4,138.00" "$6,554.59" "$8,276.00" "$6,620.80" "$3,724.20" "$1,642.58" "$8,276.00" "$4,800.08" "$8,276.00" "$8,276.00" "$8,276.00" "$1,724.72" "$8,276.00" N/A N/A 27503099 EAP HCPCS C1900 PHILOS DR SYSTEM BOTH IP/OP "$10,049.00" "$7,436.50" "$1,994.48" "$10,049.00" "$4,522.05" "$4,522.05" "$4,522.05" "$4,522.05" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.46" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.32" "$10,049.00" "$10,049.00" "$4,954.16" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$7,536.75" "$10,049.00" "$10,049.00" "$10,049.00" "$5,024.50" "$5,024.50" "$7,958.81" "$10,049.00" "$8,039.20" "$4,522.05" "$1,994.48" "$10,049.00" "$5,828.42" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.21" "$10,049.00" N/A N/A 27503100 EAP HCPCS C1900 PHILOS SR SYSTEM BOTH IP/OP "$9,458.00" "$6,999.00" "$1,877.18" "$9,458.00" "$4,256.10" "$4,256.10" "$4,256.10" "$4,256.10" "$9,458.00" "$9,458.00" "$9,458.00" "$1,971.28" "$9,458.00" "$9,458.00" "$9,458.00" "$9,458.00" "$9,458.00" "$1,971.15" "$9,458.00" "$9,458.00" "$4,662.79" "$9,458.00" "$9,458.00" "$9,458.00" "$9,458.00" "$7,093.50" "$9,458.00" "$9,458.00" "$9,458.00" "$4,729.00" "$4,729.00" "$7,490.74" "$9,458.00" "$7,566.40" "$4,256.10" "$1,877.18" "$9,458.00" "$5,485.64" "$9,458.00" "$9,458.00" "$9,458.00" "$1,971.05" "$9,458.00" N/A N/A 27503101 EAP HCPCS C1900 AROX 60 BP LEAD BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27503102 EAP HCPCS C1900 AROX 53 BP LEAD BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27503103 EAP HCPCS C1898 SELOX ST 53 LEAD BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27503104 EAP HCPCS C1898 SELOX ST 60 LEAD BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27503105 EAP HCPCS C1898 SELOX JT 53 LEAD BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27503106 EAP HCPCS C1898 SELOX JT 45 LEAD BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27503107 EAP HCPCS C1900 PHILOS II DR SYSTEM BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27503108 EAP HCPCS C1900 CYLOS DR WITH CLS AUTONOMIC RESPONSE BOTH IP/OP "$10,049.00" "$7,436.50" "$1,994.48" "$10,049.00" "$4,522.05" "$4,522.05" "$4,522.05" "$4,522.05" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.46" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.32" "$10,049.00" "$10,049.00" "$4,954.16" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$7,536.75" "$10,049.00" "$10,049.00" "$10,049.00" "$5,024.50" "$5,024.50" "$7,958.81" "$10,049.00" "$8,039.20" "$4,522.05" "$1,994.48" "$10,049.00" "$5,828.42" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.21" "$10,049.00" N/A N/A 27503109 EAP HCPCS C1900 CYLOS VR WITH CLS AUTONOMIC RESPONSE BOTH IP/OP "$10,049.00" "$7,436.50" "$1,994.48" "$10,049.00" "$4,522.05" "$4,522.05" "$4,522.05" "$4,522.05" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.46" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.32" "$10,049.00" "$10,049.00" "$4,954.16" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$7,536.75" "$10,049.00" "$10,049.00" "$10,049.00" "$5,024.50" "$5,024.50" "$7,958.81" "$10,049.00" "$8,039.20" "$4,522.05" "$1,994.48" "$10,049.00" "$5,828.42" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.21" "$10,049.00" N/A N/A 27503110 EAP HCPCS C1895 LINOX SD STEROID 65/16 BOTH IP/OP "$8,867.00" "$6,562.00" "$1,759.88" "$8,867.00" "$3,990.15" "$3,990.15" "$3,990.15" "$3,990.15" "$8,867.00" "$8,867.00" "$8,867.00" "$1,848.10" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$1,847.98" "$8,867.00" "$8,867.00" "$4,371.43" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$6,650.25" "$8,867.00" "$8,867.00" "$8,867.00" "$4,433.50" "$4,433.50" "$7,022.66" "$8,867.00" "$7,093.60" "$3,990.15" "$1,759.88" "$8,867.00" "$5,142.86" "$8,867.00" "$8,867.00" "$8,867.00" "$1,847.88" "$8,867.00" N/A N/A 27503111 EAP HCPCS C1895 LINOX SD STEROID 75/18 BOTH IP/OP "$8,867.00" "$6,562.00" "$1,759.88" "$8,867.00" "$3,990.15" "$3,990.15" "$3,990.15" "$3,990.15" "$8,867.00" "$8,867.00" "$8,867.00" "$1,848.10" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$1,847.98" "$8,867.00" "$8,867.00" "$4,371.43" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$6,650.25" "$8,867.00" "$8,867.00" "$8,867.00" "$4,433.50" "$4,433.50" "$7,022.66" "$8,867.00" "$7,093.60" "$3,990.15" "$1,759.88" "$8,867.00" "$5,142.86" "$8,867.00" "$8,867.00" "$8,867.00" "$1,847.88" "$8,867.00" N/A N/A 27503112 EAP HCPCS C1898 SETROX S 53 LEAD BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27503113 EAP HCPCS C1898 SETROX S 60 LEAD BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27503114 EAP HCPCS C1777 LINOX S 65 STEROID BOTH IP/OP "$8,867.00" "$6,562.00" "$1,759.88" "$8,867.00" "$3,990.15" "$3,990.15" "$3,990.15" "$3,990.15" "$8,867.00" "$8,867.00" "$8,867.00" "$1,848.10" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$1,847.98" "$8,867.00" "$8,867.00" "$4,371.43" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$6,650.25" "$8,867.00" "$8,867.00" "$8,867.00" "$4,433.50" "$4,433.50" "$7,022.66" "$8,867.00" "$7,093.60" "$3,990.15" "$1,759.88" "$8,867.00" "$5,142.86" "$8,867.00" "$8,867.00" "$8,867.00" "$1,847.88" "$8,867.00" N/A N/A 27503115 EAP HCPCS C1777 LINOX S 75 STEROID BOTH IP/OP "$8,867.00" "$6,562.00" "$1,759.88" "$8,867.00" "$3,990.15" "$3,990.15" "$3,990.15" "$3,990.15" "$8,867.00" "$8,867.00" "$8,867.00" "$1,848.10" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$1,847.98" "$8,867.00" "$8,867.00" "$4,371.43" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$6,650.25" "$8,867.00" "$8,867.00" "$8,867.00" "$4,433.50" "$4,433.50" "$7,022.66" "$8,867.00" "$7,093.60" "$3,990.15" "$1,759.88" "$8,867.00" "$5,142.86" "$8,867.00" "$8,867.00" "$8,867.00" "$1,847.88" "$8,867.00" N/A N/A 27503116 EAP HCPCS C1895 LINOX TD STEROID 65/16 CM BOTH IP/OP "$8,867.00" "$6,562.00" "$1,759.88" "$8,867.00" "$3,990.15" "$3,990.15" "$3,990.15" "$3,990.15" "$8,867.00" "$8,867.00" "$8,867.00" "$1,848.10" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$1,847.98" "$8,867.00" "$8,867.00" "$4,371.43" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$6,650.25" "$8,867.00" "$8,867.00" "$8,867.00" "$4,433.50" "$4,433.50" "$7,022.66" "$8,867.00" "$7,093.60" "$3,990.15" "$1,759.88" "$8,867.00" "$5,142.86" "$8,867.00" "$8,867.00" "$8,867.00" "$1,847.88" "$8,867.00" N/A N/A 27503117 EAP HCPCS C1777 LINOX T 65 STEROID BOTH IP/OP "$8,867.00" "$6,562.00" "$1,759.88" "$8,867.00" "$3,990.15" "$3,990.15" "$3,990.15" "$3,990.15" "$8,867.00" "$8,867.00" "$8,867.00" "$1,848.10" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$1,847.98" "$8,867.00" "$8,867.00" "$4,371.43" "$8,867.00" "$8,867.00" "$8,867.00" "$8,867.00" "$6,650.25" "$8,867.00" "$8,867.00" "$8,867.00" "$4,433.50" "$4,433.50" "$7,022.66" "$8,867.00" "$7,093.60" "$3,990.15" "$1,759.88" "$8,867.00" "$5,142.86" "$8,867.00" "$8,867.00" "$8,867.00" "$1,847.88" "$8,867.00" N/A N/A 27503118 EAP HCPCS C1900 COROX OTW 75 BP LEAD BOTH IP/OP "$5,911.00" "$4,374.50" "$1,173.19" "$5,911.00" "$2,659.95" "$2,659.95" "$2,659.95" "$2,659.95" "$5,911.00" "$5,911.00" "$5,911.00" "$1,232.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.92" "$5,911.00" "$5,911.00" "$2,914.12" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$4,433.25" "$5,911.00" "$5,911.00" "$5,911.00" "$2,955.50" "$2,955.50" "$4,681.51" "$5,911.00" "$4,728.80" "$2,659.95" "$1,173.19" "$5,911.00" "$3,428.38" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.85" "$5,911.00" N/A N/A 27503119 EAP HCPCS C1900 COROX OTW 85 BP LEAD BOTH IP/OP "$5,911.00" "$4,374.50" "$1,173.19" "$5,911.00" "$2,659.95" "$2,659.95" "$2,659.95" "$2,659.95" "$5,911.00" "$5,911.00" "$5,911.00" "$1,232.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.92" "$5,911.00" "$5,911.00" "$2,914.12" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$4,433.25" "$5,911.00" "$5,911.00" "$5,911.00" "$2,955.50" "$2,955.50" "$4,681.51" "$5,911.00" "$4,728.80" "$2,659.95" "$1,173.19" "$5,911.00" "$3,428.38" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.85" "$5,911.00" N/A N/A 27503120 EAP HCPCS C1900 COROX OTW 75 BP-S LEAD BOTH IP/OP "$5,911.00" "$4,374.50" "$1,173.19" "$5,911.00" "$2,659.95" "$2,659.95" "$2,659.95" "$2,659.95" "$5,911.00" "$5,911.00" "$5,911.00" "$1,232.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.92" "$5,911.00" "$5,911.00" "$2,914.12" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$4,433.25" "$5,911.00" "$5,911.00" "$5,911.00" "$2,955.50" "$2,955.50" "$4,681.51" "$5,911.00" "$4,728.80" "$2,659.95" "$1,173.19" "$5,911.00" "$3,428.38" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.85" "$5,911.00" N/A N/A 27503121 EAP HCPCS C1900 COROX OTW 85 BP-S LEAD BOTH IP/OP "$5,911.00" "$4,374.50" "$1,173.19" "$5,911.00" "$2,659.95" "$2,659.95" "$2,659.95" "$2,659.95" "$5,911.00" "$5,911.00" "$5,911.00" "$1,232.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.92" "$5,911.00" "$5,911.00" "$2,914.12" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$4,433.25" "$5,911.00" "$5,911.00" "$5,911.00" "$2,955.50" "$2,955.50" "$4,681.51" "$5,911.00" "$4,728.80" "$2,659.95" "$1,173.19" "$5,911.00" "$3,428.38" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.85" "$5,911.00" N/A N/A 27503122 EAP HCPCS C1882 LUMAX 340 HF-T HIGH ENERGY WITH HM LANDLINE BOTH IP/OP "$52,461.00" "$38,821.50" "$7,712.84" "$52,461.00" "$23,607.45" "$23,607.45" "$23,607.45" "$23,607.45" "$52,461.00" "$52,461.00" "$52,461.00" "$9,417.94" "$52,461.00" "$52,461.00" "$52,461.00" "$52,461.00" "$52,461.00" "$10,933.45" "$52,461.00" "$52,461.00" "$25,863.27" "$52,461.00" "$52,461.00" "$52,461.00" "$52,461.00" "$39,345.75" "$52,461.00" "$52,461.00" "$52,461.00" "$26,230.50" "$26,230.50" "$41,549.11" "$52,461.00" "$41,968.80" "$23,607.45" "$7,712.84" "$52,461.00" "$30,427.38" "$52,461.00" "$52,461.00" "$52,461.00" "$8,098.48" "$52,461.00" N/A N/A 27503123 EAP HCPCS C1900 CYLOS VR SYSTEM WITH CLS AUTONOMIC RESPONSE BOTH IP/OP "$11,231.00" "$8,311.00" "$2,229.07" "$11,231.00" "$5,053.95" "$5,053.95" "$5,053.95" "$5,053.95" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.82" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$11,231.00" "$5,536.88" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$2,229.07" "$11,231.00" "$6,513.98" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.54" "$11,231.00" N/A N/A 27503124 EAP HCPCS C1721 LUMAX 340 DR-T HIGH ENERGY WITH HM MOBILE GSM BOTH IP/OP "$42,855.00" "$31,713.00" "$8,931.45" "$42,855.00" "$42,855.00" "$42,855.00" "$42,855.00" "$42,855.00" "$42,855.00" "$42,855.00" "$42,855.00" "$42,855.00" "$42,855.00" "$42,855.00" "$42,855.00" "$42,855.00" "$42,855.00" "$8,931.45" "$42,855.00" "$17,142.00" "$42,855.00" "$42,855.00" "$42,855.00" "$42,855.00" "$42,855.00" "$32,141.25" "$42,855.00" "$42,855.00" "$42,855.00" "$21,427.50" "$21,427.50" "$33,941.16" "$42,855.00" "$34,284.00" "$19,284.75" "$42,855.00" "$42,855.00" "$24,855.90" "$42,855.00" "$25,713.00" "$42,855.00" "$42,855.00" "$42,855.00" N/A N/A 27503125 EAP HCPCS C1721 LUMAX 340 DR-T HIGH ENERGY SYSTEM WITH HM MOBILE GSM BOTH IP/OP "$51,722.00" "$38,274.50" "$10,779.43" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$20,688.80" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$51,722.00" "$51,722.00" "$29,998.76" "$51,722.00" "$31,033.20" "$51,722.00" "$51,722.00" "$51,722.00" N/A N/A 27503126 EAP HCPCS C1721 LUMAX 340 DR-T HIGH ENERGY SYSTEM WITH HM LANDLINE BOTH IP/OP "$48,767.00" "$36,088.00" "$10,163.58" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$10,163.58" "$48,767.00" "$19,506.80" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$48,767.00" "$36,575.25" "$48,767.00" "$48,767.00" "$48,767.00" "$24,383.50" "$24,383.50" "$38,623.46" "$48,767.00" "$39,013.60" "$21,945.15" "$48,767.00" "$48,767.00" "$28,284.86" "$48,767.00" "$29,260.20" "$48,767.00" "$48,767.00" "$48,767.00" N/A N/A 27503127 EAP HCPCS C1882 LUMAX 340 HF-T HIGH ENERGY WITH HM MOBILE GSM BOTH IP/OP "$56,895.00" "$42,102.50" "$7,712.84" "$56,895.00" "$25,602.75" "$25,602.75" "$25,602.75" "$25,602.75" "$56,895.00" "$56,895.00" "$56,895.00" "$9,417.94" "$56,895.00" "$56,895.00" "$56,895.00" "$56,895.00" "$56,895.00" "$11,857.54" "$56,895.00" "$56,895.00" "$28,049.24" "$56,895.00" "$56,895.00" "$56,895.00" "$56,895.00" "$42,671.25" "$56,895.00" "$56,895.00" "$56,895.00" "$28,447.50" "$28,447.50" "$45,060.84" "$56,895.00" "$45,516.00" "$25,602.75" "$7,712.84" "$56,895.00" "$32,999.10" "$56,895.00" "$56,895.00" "$56,895.00" "$8,098.48" "$56,895.00" N/A N/A 27503128 EAP HCPCS C1882 LUMAX 340 HF-T HIGH ENERGY SYSTEM WITH HM MOBILE GSM BOTH IP/OP "$74,628.00" "$55,225.00" "$7,712.84" "$74,628.00" "$33,582.60" "$33,582.60" "$33,582.60" "$33,582.60" "$74,628.00" "$74,628.00" "$74,628.00" "$9,417.94" "$74,628.00" "$74,628.00" "$74,628.00" "$74,628.00" "$74,628.00" "$15,553.30" "$74,628.00" "$74,628.00" "$36,791.60" "$74,628.00" "$74,628.00" "$74,628.00" "$74,628.00" "$55,971.00" "$74,628.00" "$74,628.00" "$74,628.00" "$37,314.00" "$37,314.00" "$59,105.38" "$74,628.00" "$59,702.40" "$33,582.60" "$7,712.84" "$74,628.00" "$43,284.24" "$74,628.00" "$74,628.00" "$74,628.00" "$8,098.48" "$74,628.00" N/A N/A 27503130 EAP HCPCS C1882 LUMAX 340 HF-T HIGH ENERGY SYSTEM WITH HM LANDLINE BOTH IP/OP "$68,716.00" "$50,850.00" "$7,712.84" "$68,716.00" "$30,922.20" "$30,922.20" "$30,922.20" "$30,922.20" "$68,716.00" "$68,716.00" "$68,716.00" "$9,417.94" "$68,716.00" "$68,716.00" "$68,716.00" "$68,716.00" "$68,716.00" "$14,321.17" "$68,716.00" "$68,716.00" "$33,876.99" "$68,716.00" "$68,716.00" "$68,716.00" "$68,716.00" "$51,537.00" "$68,716.00" "$68,716.00" "$68,716.00" "$34,358.00" "$34,358.00" "$54,423.07" "$68,716.00" "$54,972.80" "$30,922.20" "$7,712.84" "$68,716.00" "$39,855.28" "$68,716.00" "$68,716.00" "$68,716.00" "$8,098.48" "$68,716.00" N/A N/A 27503131 EAP HCPCS C1722 LUMAX 340 VR-T HIGH ENERGY WITH HM MOBILE GSM BOTH IP/OP "$35,467.00" "$26,246.00" "$7,039.31" "$35,467.00" "$15,960.15" "$15,960.15" "$15,960.15" "$15,960.15" "$35,467.00" "$35,467.00" "$35,467.00" "$7,392.21" "$35,467.00" "$35,467.00" "$35,467.00" "$35,467.00" "$35,467.00" "$7,391.71" "$35,467.00" "$35,467.00" "$17,485.23" "$35,467.00" "$35,467.00" "$35,467.00" "$35,467.00" "$26,600.25" "$35,467.00" "$35,467.00" "$35,467.00" "$17,733.50" "$17,733.50" "$28,089.86" "$35,467.00" "$28,373.60" "$15,960.15" "$7,039.31" "$35,467.00" "$20,570.86" "$35,467.00" "$35,467.00" "$35,467.00" "$7,391.32" "$35,467.00" N/A N/A 27503132 EAP HCPCS C1772 LUMAX 340 VR-T HIGH ENERGY SYSTEM WITH HM MOBILE GSM BOTH IP/OP "$44,334.00" "$32,807.50" "$9,239.69" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$9,239.69" "$44,334.00" "$17,733.60" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$33,250.50" "$44,334.00" "$44,334.00" "$44,334.00" "$22,167.00" "$22,167.00" "$35,112.53" "$44,334.00" "$35,467.20" "$19,950.30" "$44,334.00" "$44,334.00" "$25,713.72" "$44,334.00" "$26,600.40" "$44,334.00" "$44,334.00" "$44,334.00" N/A N/A 27503133 EAP HCPCS C1900 AROX 45 JBP LEAD BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27503136 EAP HCPCS C1722 DFBR CRD THK1.1CM 6.3X7.1CM VTL 2VR HE 1 CHMBR IMPLTABLE 35 BOTH IP/OP "$33,989.00" "$25,152.00" "$6,745.97" "$33,989.00" "$15,295.05" "$15,295.05" "$15,295.05" "$15,295.05" "$33,989.00" "$33,989.00" "$33,989.00" "$7,084.16" "$33,989.00" "$33,989.00" "$33,989.00" "$33,989.00" "$33,989.00" "$7,083.68" "$33,989.00" "$33,989.00" "$16,756.58" "$33,989.00" "$33,989.00" "$33,989.00" "$33,989.00" "$25,491.75" "$33,989.00" "$33,989.00" "$33,989.00" "$16,994.50" "$16,994.50" "$26,919.29" "$33,989.00" "$27,191.20" "$15,295.05" "$6,745.97" "$33,989.00" "$19,713.62" "$33,989.00" "$33,989.00" "$33,989.00" "$7,083.31" "$33,989.00" N/A N/A 27503137 EAP HCPCS C1722 DFBR CRD .99CM 6.17X7.45CM TELIGEN VR DF-1 IS-1 BIPHASIC BOTH IP/OP "$36,945.00" "$27,339.50" "$7,332.66" "$36,945.00" "$16,625.25" "$16,625.25" "$16,625.25" "$16,625.25" "$36,945.00" "$36,945.00" "$36,945.00" "$7,700.26" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$7,699.74" "$36,945.00" "$36,945.00" "$18,213.89" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$27,708.75" "$36,945.00" "$36,945.00" "$36,945.00" "$18,472.50" "$18,472.50" "$29,260.44" "$36,945.00" "$29,556.00" "$16,625.25" "$7,332.66" "$36,945.00" "$21,428.10" "$36,945.00" "$36,945.00" "$36,945.00" "$7,699.34" "$36,945.00" N/A N/A 27503138 EAP HCPCS C1721 DFBR CRD TELIGEN DR HE DF-1 CONCTR NONPROGRAMMBALE CARDVRT BOTH IP/OP "$44,334.00" "$32,807.50" "$9,239.69" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$9,239.69" "$44,334.00" "$17,733.60" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$33,250.50" "$44,334.00" "$44,334.00" "$44,334.00" "$22,167.00" "$22,167.00" "$35,112.53" "$44,334.00" "$35,467.20" "$19,950.30" "$44,334.00" "$44,334.00" "$25,713.72" "$44,334.00" "$26,600.40" "$44,334.00" "$44,334.00" "$44,334.00" N/A N/A 27503139 EAP HCPCS C1722 DFBR CRD PUNCTUA VR ICD 1 CHMBR IMPLTABLE CARDVRT BOTH IP/OP "$33,989.00" "$25,152.00" "$6,745.97" "$33,989.00" "$15,295.05" "$15,295.05" "$15,295.05" "$15,295.05" "$33,989.00" "$33,989.00" "$33,989.00" "$7,084.16" "$33,989.00" "$33,989.00" "$33,989.00" "$33,989.00" "$33,989.00" "$7,083.68" "$33,989.00" "$33,989.00" "$16,756.58" "$33,989.00" "$33,989.00" "$33,989.00" "$33,989.00" "$25,491.75" "$33,989.00" "$33,989.00" "$33,989.00" "$16,994.50" "$16,994.50" "$26,919.29" "$33,989.00" "$27,191.20" "$15,295.05" "$6,745.97" "$33,989.00" "$19,713.62" "$33,989.00" "$33,989.00" "$33,989.00" "$7,083.31" "$33,989.00" N/A N/A 27503140 EAP HCPCS C1772 DFBR CRD THK9.9MM 61.7MMX32.5MM PUNCTUA AV IMPLTABLE 2CH BOTH IP/OP "$36,945.00" "$27,339.50" "$7,699.74" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$7,699.74" "$36,945.00" "$14,778.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$27,708.75" "$36,945.00" "$36,945.00" "$36,945.00" "$18,472.50" "$18,472.50" "$29,260.44" "$36,945.00" "$29,556.00" "$16,625.25" "$36,945.00" "$36,945.00" "$21,428.10" "$36,945.00" "$22,167.00" "$36,945.00" "$36,945.00" "$36,945.00" N/A N/A 27503141 EAP HCPCS C1882 DFBR CRD PUNCTUA CRT-D RSYN THRP HI ENRG IMPLTABLE CARDVRT BOTH IP/OP "$50,244.00" "$37,181.00" "$7,712.84" "$50,244.00" "$22,609.80" "$22,609.80" "$22,609.80" "$22,609.80" "$50,244.00" "$50,244.00" "$50,244.00" "$9,417.94" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$10,471.40" "$50,244.00" "$50,244.00" "$24,770.29" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$37,683.00" "$50,244.00" "$50,244.00" "$50,244.00" "$25,122.00" "$25,122.00" "$39,793.25" "$50,244.00" "$40,195.20" "$22,609.80" "$7,712.84" "$50,244.00" "$29,141.52" "$50,244.00" "$50,244.00" "$50,244.00" "$8,098.48" "$50,244.00" N/A N/A 27503142 EAP HCPCS C1882 DFBR CRD INCEPTA CRT-D IMPLTABLE CARDVRT HI ENRG DF1 IS1 PLS BOTH IP/OP "$53,791.00" "$39,805.50" "$7,712.84" "$53,791.00" "$24,205.95" "$24,205.95" "$24,205.95" "$24,205.95" "$53,791.00" "$53,791.00" "$53,791.00" "$9,417.94" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$11,210.64" "$53,791.00" "$53,791.00" "$26,518.96" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$40,343.25" "$53,791.00" "$53,791.00" "$53,791.00" "$26,895.50" "$26,895.50" "$42,602.47" "$53,791.00" "$43,032.80" "$24,205.95" "$7,712.84" "$53,791.00" "$31,198.78" "$53,791.00" "$53,791.00" "$53,791.00" "$8,098.48" "$53,791.00" N/A N/A 27503143 EAP HCPCS C1722 DFBR CRD THK14.5MM 63.5X77.5MM LIVIAN RF IS-1 DF-1 IMPLTABLE BOTH IP/OP "$50,244.00" "$37,181.00" "$7,712.84" "$50,244.00" "$22,609.80" "$22,609.80" "$22,609.80" "$22,609.80" "$50,244.00" "$50,244.00" "$50,244.00" "$9,417.94" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$10,471.40" "$50,244.00" "$50,244.00" "$24,770.29" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$37,683.00" "$50,244.00" "$50,244.00" "$50,244.00" "$25,122.00" "$25,122.00" "$39,793.25" "$50,244.00" "$40,195.20" "$22,609.80" "$7,712.84" "$50,244.00" "$29,141.52" "$50,244.00" "$50,244.00" "$50,244.00" "$8,098.48" "$50,244.00" N/A N/A 27503144 EAP HCPCS C1722 DFBR CRD THK14.5MM 63.5X77.5MM LIVIAN RF IMPLTABLE CRD RSYN BOTH IP/OP "$50,244.00" "$37,181.00" "$7,712.84" "$50,244.00" "$22,609.80" "$22,609.80" "$22,609.80" "$22,609.80" "$50,244.00" "$50,244.00" "$50,244.00" "$9,417.94" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$10,471.40" "$50,244.00" "$20,097.60" "$24,770.29" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$37,683.00" "$50,244.00" "$50,244.00" "$50,244.00" "$25,122.00" "$25,122.00" "$39,793.25" "$50,244.00" "$40,195.20" "$22,609.80" "$7,712.84" "$50,244.00" "$29,141.52" "$50,244.00" "$50,244.00" "$50,244.00" "$8,098.48" "$50,244.00" N/A N/A 27503145 EAP HCPCS C1722 DFBR CRD THK14.5MM 67X82.5MM LIVIAN RF HE IMPLTABLE RSYN BOTH IP/OP "$50,244.00" "$37,181.00" "$7,712.84" "$50,244.00" "$22,609.80" "$22,609.80" "$22,609.80" "$22,609.80" "$50,244.00" "$50,244.00" "$50,244.00" "$9,417.94" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$10,471.40" "$50,244.00" "$50,244.00" "$24,770.29" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$37,683.00" "$50,244.00" "$50,244.00" "$50,244.00" "$25,122.00" "$25,122.00" "$39,793.25" "$50,244.00" "$40,195.20" "$22,609.80" "$7,712.84" "$50,244.00" "$29,141.52" "$50,244.00" "$50,244.00" "$50,244.00" "$8,098.48" "$50,244.00" N/A N/A 27503146 EAP HCPCS C1722 DFBR CRD LIVIAN RF HE CARDVRT BOTH IP/OP "$50,244.00" "$37,181.00" "$7,712.84" "$50,244.00" "$22,609.80" "$22,609.80" "$22,609.80" "$22,609.80" "$50,244.00" "$50,244.00" "$50,244.00" "$9,417.94" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$10,471.40" "$50,244.00" "$50,244.00" "$24,770.29" "$50,244.00" "$50,244.00" "$50,244.00" "$50,244.00" "$37,683.00" "$50,244.00" "$50,244.00" "$50,244.00" "$25,122.00" "$25,122.00" "$39,793.25" "$50,244.00" "$40,195.20" "$22,609.80" "$7,712.84" "$50,244.00" "$29,141.52" "$50,244.00" "$50,244.00" "$50,244.00" "$8,098.48" "$50,244.00" N/A N/A 27503147 EAP HCPCS C2621 INVIVE / EASYTRAK OR ACUITY: CARDIAC RESYNCHRONIZATION THERA BOTH IP/OP "$26,452.00" "$19,574.50" "$5,250.06" "$26,452.00" "$11,903.40" "$11,903.40" "$11,903.40" "$11,903.40" "$26,452.00" "$26,452.00" "$26,452.00" "$5,513.26" "$26,452.00" "$26,452.00" "$26,452.00" "$26,452.00" "$26,452.00" "$5,512.89" "$26,452.00" "$26,452.00" "$13,040.84" "$26,452.00" "$26,452.00" "$26,452.00" "$26,452.00" "$19,839.00" "$26,452.00" "$26,452.00" "$26,452.00" "$13,226.00" "$13,226.00" "$20,949.98" "$26,452.00" "$21,161.60" "$11,903.40" "$5,250.06" "$26,452.00" "$15,342.16" "$26,452.00" "$26,452.00" "$26,452.00" "$5,512.60" "$26,452.00" N/A N/A 27503148 EAP HCPCS C1785 PCMKR CRD THK7.5MM 61X44.5MM INVIVE SMRT DELAY BIVENTRICLE BOTH IP/OP "$18,324.00" "$13,560.00" "$3,636.86" "$18,324.00" "$8,245.80" "$8,245.80" "$8,245.80" "$8,245.80" "$18,324.00" "$18,324.00" "$18,324.00" "$3,819.18" "$18,324.00" "$18,324.00" "$18,324.00" "$18,324.00" "$18,324.00" "$3,818.92" "$18,324.00" "$18,324.00" "$9,033.73" "$18,324.00" "$18,324.00" "$18,324.00" "$18,324.00" "$13,743.00" "$18,324.00" "$18,324.00" "$18,324.00" "$9,162.00" "$9,162.00" "$14,512.61" "$18,324.00" "$14,659.20" "$8,245.80" "$3,636.86" "$18,324.00" "$10,627.92" "$18,324.00" "$18,324.00" "$18,324.00" "$3,818.72" "$18,324.00" N/A N/A 27503149 EAP HCPCS C1785 PCMKR CRD THK7.5MM 61X44.5MM INVIVE SMRT DELAY BIVENTRICLE BOTH IP/OP "$18,324.00" "$13,560.00" "$3,636.86" "$18,324.00" "$8,245.80" "$8,245.80" "$8,245.80" "$8,245.80" "$18,324.00" "$18,324.00" "$18,324.00" "$3,819.18" "$18,324.00" "$18,324.00" "$18,324.00" "$18,324.00" "$18,324.00" "$3,818.92" "$18,324.00" "$18,324.00" "$9,033.73" "$18,324.00" "$18,324.00" "$18,324.00" "$18,324.00" "$13,743.00" "$18,324.00" "$18,324.00" "$18,324.00" "$9,162.00" "$9,162.00" "$14,512.61" "$18,324.00" "$14,659.20" "$8,245.80" "$3,636.86" "$18,324.00" "$10,627.92" "$18,324.00" "$18,324.00" "$18,324.00" "$3,818.72" "$18,324.00" N/A N/A 27503150 EAP HCPCS C1722 DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR BOTH IP/OP "$51,722.00" "$38,274.50" "$7,712.84" "$51,722.00" "$23,274.90" "$23,274.90" "$23,274.90" "$23,274.90" "$51,722.00" "$51,722.00" "$51,722.00" "$9,417.94" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$51,722.00" "$25,498.95" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$7,712.84" "$51,722.00" "$29,998.76" "$51,722.00" "$51,722.00" "$51,722.00" "$8,098.48" "$51,722.00" N/A N/A 27503151 EAP HCPCS C1721 DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR BOTH IP/OP "$51,722.00" "$38,274.50" "$10,779.43" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$20,688.80" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$51,722.00" "$51,722.00" "$29,998.76" "$51,722.00" "$31,033.20" "$51,722.00" "$51,722.00" "$51,722.00" N/A N/A 27503152 EAP HCPCS C1722 DFBR CRD THK.39IN 2.43X2.93IN INCEPTA VR 1 CHMBR IMPLTABLE BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27503153 EAP HCPCS C1722 DFBR CRD THK.39IN 2.43X2.93IN INCEPTA VR 1 CHMBR DF-4 BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27503154 EAP HCPCS C1721 DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG BOTH IP/OP "$51,722.00" "$38,274.50" "$10,779.43" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$20,688.80" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$51,722.00" "$51,722.00" "$29,998.76" "$51,722.00" "$31,033.20" "$51,722.00" "$51,722.00" "$51,722.00" N/A N/A 27503155 EAP HCPCS C1882 DFBR CRD INCEPTA VR IMPLTABLE CARDVRT HI ENRG BOTH IP/OP "$51,722.00" "$38,274.50" "$7,712.84" "$51,722.00" "$23,274.90" "$23,274.90" "$23,274.90" "$23,274.90" "$51,722.00" "$51,722.00" "$51,722.00" "$9,417.94" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$51,722.00" "$25,498.95" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$7,712.84" "$51,722.00" "$29,998.76" "$51,722.00" "$51,722.00" "$51,722.00" "$8,098.48" "$51,722.00" N/A N/A 27503156 EAP HCPCS C1882 INCEPTA LV-1 / EASYTRAK OR ACUITY / ENDOTAK: CARDIAC RESYNCH BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27503157 EAP HCPCS C1721 DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR BOTH IP/OP "$58,889.00" "$43,578.00" "$12,273.12" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$12,273.12" "$58,889.00" "$23,555.60" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$44,166.75" "$58,889.00" "$58,889.00" "$58,889.00" "$29,444.50" "$29,444.50" "$46,640.09" "$58,889.00" "$47,111.20" "$26,500.05" "$58,889.00" "$58,889.00" "$34,155.62" "$58,889.00" "$35,333.40" "$58,889.00" "$58,889.00" "$58,889.00" N/A N/A 27503158 EAP HCPCS C1721 DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR BOTH IP/OP "$58,889.00" "$43,578.00" "$12,273.12" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$12,273.12" "$58,889.00" "$23,555.60" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$44,166.75" "$58,889.00" "$58,889.00" "$58,889.00" "$29,444.50" "$29,444.50" "$46,640.09" "$58,889.00" "$47,111.20" "$26,500.05" "$58,889.00" "$58,889.00" "$34,155.62" "$58,889.00" "$35,333.40" "$58,889.00" "$58,889.00" "$58,889.00" N/A N/A 27503159 EAP HCPCS C1721 DFBR CRD THK.39IN 2.43X2.69-2.89IN INCEPTA DR 2CH IMPLTABLE BOTH IP/OP "$45,811.00" "$33,900.50" "$9,547.52" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$18,324.40" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$45,811.00" "$45,811.00" "$26,570.38" "$45,811.00" "$27,486.60" "$45,811.00" "$45,811.00" "$45,811.00" N/A N/A 27503160 EAP HCPCS C1779 PCMKR CRD 7.5IN MOD ELIP 44.5X47IN ADVANTIO 2CH IS-1 CONCTR BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27503161 EAP HCPCS C2619 ADVANTIO DR IMPLANTABLE PACEMAKER SYSTEM (INCLUDES 2 LEADS) BOTH IP/OP "$14,777.00" "$10,935.00" "$3,079.69" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.69" "$14,777.00" "$5,910.80" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$11,082.75" "$14,777.00" "$14,777.00" "$14,777.00" "$7,388.50" "$7,388.50" "$11,703.38" "$14,777.00" "$11,821.60" "$6,649.65" "$14,777.00" "$14,777.00" "$8,570.66" "$14,777.00" "$8,866.20" "$14,777.00" "$14,777.00" "$14,777.00" N/A N/A 27503162 EAP HCPCS C1785 PCMKR CRD THK7.5MM 44.5X45.7MM ADVANTIO RIGHTRATE ATR VNTRC BOTH IP/OP "$10,344.00" "$7,655.00" "$2,053.03" "$10,344.00" "$4,654.80" "$4,654.80" "$4,654.80" "$4,654.80" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.95" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.80" "$10,344.00" "$10,344.00" "$5,099.59" "$10,344.00" "$10,344.00" "$10,344.00" "$10,344.00" "$7,758.00" "$10,344.00" "$10,344.00" "$10,344.00" "$5,172.00" "$5,172.00" "$8,192.45" "$10,344.00" "$8,275.20" "$4,654.80" "$2,053.03" "$10,344.00" "$5,999.52" "$10,344.00" "$10,344.00" "$10,344.00" "$2,155.69" "$10,344.00" N/A N/A 27503163 EAP HCPCS C1785 ADVANTIO SR IMPLANTABLE PACEMAKER SYSTEM (INCLUDES 1 LEAD) BOTH IP/OP "$11,527.00" "$8,530.00" "$2,287.82" "$11,527.00" "$5,187.15" "$5,187.15" "$5,187.15" "$5,187.15" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.51" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.35" "$11,527.00" "$11,527.00" "$5,682.81" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$8,645.25" "$11,527.00" "$11,527.00" "$11,527.00" "$5,763.50" "$5,763.50" "$9,129.38" "$11,527.00" "$9,221.60" "$5,187.15" "$2,287.82" "$11,527.00" "$6,685.66" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.23" "$11,527.00" N/A N/A 27503164 EAP HCPCS C1721 DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG BOTH IP/OP "$58,889.00" "$43,578.00" "$12,273.12" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$12,273.12" "$58,889.00" "$23,555.60" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$44,166.75" "$58,889.00" "$58,889.00" "$58,889.00" "$29,444.50" "$29,444.50" "$46,640.09" "$58,889.00" "$47,111.20" "$26,500.05" "$58,889.00" "$58,889.00" "$34,155.62" "$58,889.00" "$35,333.40" "$58,889.00" "$58,889.00" "$58,889.00" N/A N/A 27503165 EAP HCPCS C1721 DFBR CRD INCEPTA DR IMPLTABLE CARDVRT HI ENRG BOTH IP/OP "$58,889.00" "$43,578.00" "$12,273.12" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$12,273.12" "$58,889.00" "$23,555.60" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$44,166.75" "$58,889.00" "$58,889.00" "$58,889.00" "$29,444.50" "$29,444.50" "$46,640.09" "$58,889.00" "$47,111.20" "$26,500.05" "$58,889.00" "$58,889.00" "$34,155.62" "$58,889.00" "$35,333.40" "$58,889.00" "$58,889.00" "$58,889.00" N/A N/A 27503166 EAP HCPCS C1721 DFBR CRD THK.39IN 2.43X2.69-2.89IN INCEPTA DR 2CH IMPLTABLE BOTH IP/OP "$45,811.00" "$33,900.50" "$9,547.52" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$18,324.40" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$45,811.00" "$45,811.00" "$26,570.38" "$45,811.00" "$27,486.60" "$45,811.00" "$45,811.00" "$45,811.00" N/A N/A 27503167 EAP HCPCS C1722 DFBR CRD THK9.9MM 61.7MM X 79.5MM ENERGEN VR VNTRC IMPLTABLE BOTH IP/OP "$36,945.00" "$27,339.50" "$7,332.66" "$36,945.00" "$16,625.25" "$16,625.25" "$16,625.25" "$16,625.25" "$36,945.00" "$36,945.00" "$36,945.00" "$7,700.26" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$7,699.74" "$36,945.00" "$36,945.00" "$18,213.89" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$27,708.75" "$36,945.00" "$36,945.00" "$36,945.00" "$18,472.50" "$18,472.50" "$29,260.44" "$36,945.00" "$29,556.00" "$16,625.25" "$7,332.66" "$36,945.00" "$21,428.10" "$36,945.00" "$36,945.00" "$36,945.00" "$7,699.34" "$36,945.00" N/A N/A 27503168 EAP HCPCS C1722 ENERGEN VR DF4 ICD SYSTEMS (1 RELIANCE NON-GORE LEAD) BOTH IP/OP "$49,062.00" "$36,306.00" "$7,712.84" "$49,062.00" "$22,077.90" "$22,077.90" "$22,077.90" "$22,077.90" "$49,062.00" "$49,062.00" "$49,062.00" "$9,417.94" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$10,225.06" "$49,062.00" "$49,062.00" "$24,187.57" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$36,796.50" "$49,062.00" "$49,062.00" "$49,062.00" "$24,531.00" "$24,531.00" "$38,857.10" "$49,062.00" "$39,249.60" "$22,077.90" "$7,712.84" "$49,062.00" "$28,455.96" "$49,062.00" "$49,062.00" "$49,062.00" "$8,098.48" "$49,062.00" N/A N/A 27503169 EAP HCPCS C1785 PCMKR CRD 2.8V 8MM MOD ELIP 43X49MM ALTRUA 60DR ATR VNTRC BOTH IP/OP "$11,527.00" "$8,530.00" "$2,287.82" "$11,527.00" "$5,187.15" "$5,187.15" "$5,187.15" "$5,187.15" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.51" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.35" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$8,645.25" "$11,527.00" "$11,527.00" "$11,527.00" "$5,763.50" "$5,763.50" "$9,129.38" "$11,527.00" "$9,221.60" "$5,187.15" "$2,287.82" "$11,527.00" "$6,685.66" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.23" "$11,527.00" N/A N/A 27503170 EAP HCPCS C1785 PCMKR CRD ALTRUA 60 DDDR 2 CHMBR IS-1 MV BLND SNSR STOR EGMS BOTH IP/OP "$11,527.00" "$8,530.00" "$2,287.82" "$11,527.00" "$5,187.15" "$5,187.15" "$5,187.15" "$5,187.15" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.51" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.35" "$11,527.00" "$11,527.00" "$5,682.81" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$8,645.25" "$11,527.00" "$11,527.00" "$11,527.00" "$5,763.50" "$5,763.50" "$9,129.38" "$11,527.00" "$9,221.60" "$5,187.15" "$2,287.82" "$11,527.00" "$6,685.66" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.23" "$11,527.00" N/A N/A 27503171 EAP HCPCS C1785 PCMKR CRD 8MM MOD ELLIPSE 43X49MM ALTRUA 60 ATR VNTRC 2 BOTH IP/OP "$11,527.00" "$8,530.00" "$2,287.82" "$11,527.00" "$5,187.15" "$5,187.15" "$5,187.15" "$5,187.15" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.51" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.35" "$11,527.00" "$11,527.00" "$5,682.81" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$8,645.25" "$11,527.00" "$11,527.00" "$11,527.00" "$5,763.50" "$5,763.50" "$9,129.38" "$11,527.00" "$9,221.60" "$5,187.15" "$2,287.82" "$11,527.00" "$6,685.66" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.23" "$11,527.00" N/A N/A 27503172 EAP HCPCS C1785 PCMKR CRD THK8MM 49X43MM ALTRUA 60DR ATR VNTRC IMPLTABLE 2 BOTH IP/OP "$14,482.00" "$10,717.00" "$2,874.31" "$14,482.00" "$6,516.90" "$6,516.90" "$6,516.90" "$6,516.90" "$14,482.00" "$14,482.00" "$14,482.00" "$3,018.41" "$14,482.00" "$14,482.00" "$14,482.00" "$14,482.00" "$14,482.00" "$3,018.21" "$14,482.00" "$14,482.00" "$7,139.63" "$14,482.00" "$14,482.00" "$14,482.00" "$14,482.00" "$10,861.50" "$14,482.00" "$14,482.00" "$14,482.00" "$7,241.00" "$7,241.00" "$11,469.74" "$14,482.00" "$11,585.60" "$6,516.90" "$2,874.31" "$14,482.00" "$8,399.56" "$14,482.00" "$14,482.00" "$14,482.00" "$3,018.05" "$14,482.00" N/A N/A 27503173 EAP HCPCS C1900 PCMKR CRD THK8MM 42X42MM ALTRUA 60SR ATR VNTRC IMPLTABLE 1 BOTH IP/OP "$10,049.00" "$7,436.50" "$1,994.48" "$10,049.00" "$4,522.05" "$4,522.05" "$4,522.05" "$4,522.05" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.46" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.32" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$7,536.75" "$10,049.00" "$10,049.00" "$10,049.00" "$5,024.50" "$5,024.50" "$7,958.81" "$10,049.00" "$8,039.20" "$4,522.05" "$1,994.48" "$10,049.00" "$5,828.42" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.21" "$10,049.00" N/A N/A 27503174 EAP HCPCS C1785 PCMKR CRD THK3MM 42MMX42MM ALTRUA 60SR IMPLTABLE 1 CHMBR RR BOTH IP/OP "$11,231.00" "$8,311.00" "$2,229.07" "$11,231.00" "$5,053.95" "$5,053.95" "$5,053.95" "$5,053.95" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.82" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$11,231.00" "$5,536.88" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$2,229.07" "$11,231.00" "$6,513.98" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.54" "$11,231.00" N/A N/A 27503175 EAP HCPCS C1722 DFBR CRD .99CM THK.39IN SM 2.43X3.13IN COGNIS ATR VNTRC IS-1 BOTH IP/OP "$53,791.00" "$39,805.50" "$7,712.84" "$53,791.00" "$24,205.95" "$24,205.95" "$24,205.95" "$24,205.95" "$53,791.00" "$53,791.00" "$53,791.00" "$9,417.94" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$11,210.64" "$53,791.00" "$53,791.00" "$26,518.96" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$40,343.25" "$53,791.00" "$53,791.00" "$53,791.00" "$26,895.50" "$26,895.50" "$42,602.47" "$53,791.00" "$43,032.80" "$24,205.95" "$7,712.84" "$53,791.00" "$31,198.78" "$53,791.00" "$32,274.60" "$53,791.00" "$8,098.48" "$53,791.00" N/A N/A 27503176 EAP HCPCS C1772 DFBR CRD ENERGEN VR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR BOTH IP/OP "$49,062.00" "$36,306.00" "$10,225.06" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$10,225.06" "$49,062.00" "$19,624.80" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$36,796.50" "$49,062.00" "$49,062.00" "$49,062.00" "$24,531.00" "$24,531.00" "$38,857.10" "$49,062.00" "$39,249.60" "$22,077.90" "$49,062.00" "$49,062.00" "$28,455.96" "$49,062.00" "$29,437.20" "$49,062.00" "$49,062.00" "$49,062.00" N/A N/A 27503177 EAP HCPCS C1882 DFBR CRD COGNIS CNTK RNWL 3 RF HI ENRG BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$42,914.40" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27503178 EAP HCPCS C1882 DFBR CRD 1.45CM 6.7X8.25CM CONFIENT RF HE ATR VNTRC 2CH BOTH IP/OP "$36,945.00" "$27,339.50" "$7,332.66" "$36,945.00" "$16,625.25" "$16,625.25" "$16,625.25" "$16,625.25" "$36,945.00" "$36,945.00" "$36,945.00" "$7,700.26" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$7,699.74" "$36,945.00" "$36,945.00" "$18,213.89" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$27,708.75" "$36,945.00" "$36,945.00" "$36,945.00" "$18,472.50" "$18,472.50" "$29,260.44" "$36,945.00" "$29,556.00" "$16,625.25" "$7,332.66" "$36,945.00" "$21,428.10" "$36,945.00" "$36,945.00" "$36,945.00" "$7,699.34" "$36,945.00" N/A N/A 27503179 EAP HCPCS C2621 PCMKR CRD CNTK RNWL TR ATR VNTRC 2 WRNCH IS-1 IMPLTABLE BOTH IP/OP "$18,916.00" "$13,998.00" "$3,754.35" "$18,916.00" "$8,512.20" "$8,512.20" "$8,512.20" "$8,512.20" "$18,916.00" "$18,916.00" "$18,916.00" "$3,942.57" "$18,916.00" "$18,916.00" "$18,916.00" "$18,916.00" "$18,916.00" "$3,942.30" "$18,916.00" "$18,916.00" "$9,325.59" "$18,916.00" "$18,916.00" "$18,916.00" "$18,916.00" "$14,187.00" "$18,916.00" "$18,916.00" "$18,916.00" "$9,458.00" "$9,458.00" "$14,981.47" "$18,916.00" "$15,132.80" "$8,512.20" "$3,754.35" "$18,916.00" "$10,971.28" "$18,916.00" "$18,916.00" "$18,916.00" "$3,942.09" "$18,916.00" N/A N/A 27503180 EAP HCPCS C2621 PCMKR CRD CNTK RNWL TR LV-1 IMPLTABLE BOTH IP/OP "$18,916.00" "$13,998.00" "$3,754.35" "$18,916.00" "$8,512.20" "$8,512.20" "$8,512.20" "$8,512.20" "$18,916.00" "$18,916.00" "$18,916.00" "$3,942.57" "$18,916.00" "$18,916.00" "$18,916.00" "$18,916.00" "$18,916.00" "$3,942.30" "$18,916.00" "$18,916.00" "$9,325.59" "$18,916.00" "$18,916.00" "$18,916.00" "$18,916.00" "$14,187.00" "$18,916.00" "$18,916.00" "$18,916.00" "$9,458.00" "$9,458.00" "$14,981.47" "$18,916.00" "$15,132.80" "$8,512.20" "$3,754.35" "$18,916.00" "$10,971.28" "$18,916.00" "$18,916.00" "$18,916.00" "$3,942.09" "$18,916.00" N/A N/A 27503181 EAP HCPCS C1722 DFBR CRD THK.39IN 2.43X2.69-2.89IN ENERGEN VR VNTRC 1 CHMBR BOTH IP/OP "$36,945.00" "$27,339.50" "$7,332.66" "$36,945.00" "$16,625.25" "$16,625.25" "$16,625.25" "$16,625.25" "$36,945.00" "$36,945.00" "$36,945.00" "$7,700.26" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$7,699.74" "$36,945.00" "$36,945.00" "$18,213.89" "$36,945.00" "$36,945.00" "$36,945.00" "$36,945.00" "$27,708.75" "$36,945.00" "$36,945.00" "$36,945.00" "$18,472.50" "$18,472.50" "$29,260.44" "$36,945.00" "$29,556.00" "$16,625.25" "$7,332.66" "$36,945.00" "$21,428.10" "$36,945.00" "$36,945.00" "$36,945.00" "$7,699.34" "$36,945.00" N/A N/A 27503182 EAP HCPCS C1898 LEAD PCNG 53CM 6.7FR 10MM SPC RIGHT AV BIPOL XTD-RETRAC HLX BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27503183 EAP HCPCS C1722 ENERGEN VR ICD SYSTEM (1 RELIANCE NON-GORE LEAD) BOTH IP/OP "$49,062.00" "$36,306.00" "$7,712.84" "$49,062.00" "$22,077.90" "$22,077.90" "$22,077.90" "$22,077.90" "$49,062.00" "$49,062.00" "$49,062.00" "$9,417.94" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$10,225.06" "$49,062.00" "$49,062.00" "$24,187.57" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$36,796.50" "$49,062.00" "$49,062.00" "$49,062.00" "$24,531.00" "$24,531.00" "$38,857.10" "$49,062.00" "$39,249.60" "$22,077.90" "$7,712.84" "$49,062.00" "$28,455.96" "$49,062.00" "$49,062.00" "$49,062.00" "$8,098.48" "$49,062.00" N/A N/A 27503184 EAP HCPCS C1722 DFBR CRD ENERGEN VR IMPLTABLE CARDVRT HI ENRG BOTH IP/OP "$49,062.00" "$36,306.00" "$7,712.84" "$49,062.00" "$22,077.90" "$22,077.90" "$22,077.90" "$22,077.90" "$49,062.00" "$49,062.00" "$49,062.00" "$9,417.94" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$10,225.06" "$49,062.00" "$49,062.00" "$24,187.57" "$49,062.00" "$49,062.00" "$49,062.00" "$49,062.00" "$36,796.50" "$49,062.00" "$49,062.00" "$49,062.00" "$24,531.00" "$24,531.00" "$38,857.10" "$49,062.00" "$39,249.60" "$22,077.90" "$7,712.84" "$49,062.00" "$28,455.96" "$49,062.00" "$49,062.00" "$49,062.00" "$8,098.48" "$49,062.00" N/A N/A 27503185 EAP HCPCS C1721 DFBR CRD THK9.9MM 61.7X74.5MM ENERGEN DR ATR ENTRICULAR BOTH IP/OP "$44,334.00" "$32,807.50" "$9,239.69" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$9,239.69" "$44,334.00" "$17,733.60" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$33,250.50" "$44,334.00" "$44,334.00" "$44,334.00" "$22,167.00" "$22,167.00" "$35,112.53" "$44,334.00" "$35,467.20" "$19,950.30" "$44,334.00" "$44,334.00" "$25,713.72" "$44,334.00" "$26,600.40" "$44,334.00" "$44,334.00" "$44,334.00" N/A N/A 27503186 EAP HCPCS C1721 ENERGEN DR DF4 ICD SYSTEMS (2 RELIANCE NON-GORE LEADS) BOTH IP/OP "$57,781.00" "$42,758.00" "$12,042.20" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$12,042.20" "$57,781.00" "$23,112.40" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$43,335.75" "$57,781.00" "$57,781.00" "$57,781.00" "$28,890.50" "$28,890.50" "$45,762.55" "$57,781.00" "$46,224.80" "$26,001.45" "$57,781.00" "$57,781.00" "$33,512.98" "$57,781.00" "$34,668.60" "$57,781.00" "$57,781.00" "$57,781.00" N/A N/A 27503187 EAP HCPCS C1721 DFBR CRD ENERGEN DR IMPLTABLE CARDVRT HI ENRG DF4 CONCTR BOTH IP/OP "$57,781.00" "$42,758.00" "$12,042.20" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$12,042.20" "$57,781.00" "$23,112.40" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$43,335.75" "$57,781.00" "$57,781.00" "$57,781.00" "$28,890.50" "$28,890.50" "$45,762.55" "$57,781.00" "$46,224.80" "$26,001.45" "$57,781.00" "$57,781.00" "$33,512.98" "$57,781.00" "$34,668.60" "$57,781.00" "$57,781.00" "$57,781.00" N/A N/A 27503188 EAP HCPCS C1721 DFBR CRD SM ENERGEN DR DF-4 2CH IMPLTABLE CARDVRT BTR-PWR BOTH IP/OP "$44,334.00" "$32,807.50" "$9,239.69" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$9,239.69" "$44,334.00" "$17,733.60" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$44,334.00" "$33,250.50" "$44,334.00" "$44,334.00" "$44,334.00" "$22,167.00" "$22,167.00" "$35,112.53" "$44,334.00" "$35,467.20" "$19,950.30" "$44,334.00" "$44,334.00" "$25,713.72" "$44,334.00" "$26,600.40" "$44,334.00" "$44,334.00" "$44,334.00" N/A N/A 27503189 EAP HCPCS C1721 ENERGEN DR ICD SYSTEM (2 RELIANCE NON-GORE LEADS) BOTH IP/OP "$57,781.00" "$42,758.00" "$12,042.20" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$12,042.20" "$57,781.00" "$23,112.40" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$43,335.75" "$57,781.00" "$57,781.00" "$57,781.00" "$28,890.50" "$28,890.50" "$45,762.55" "$57,781.00" "$46,224.80" "$26,001.45" "$57,781.00" "$57,781.00" "$33,512.98" "$57,781.00" "$34,668.60" "$57,781.00" "$57,781.00" "$57,781.00" N/A N/A 27503190 EAP HCPCS C1722 DFBR CRD ENERGEN VR IMPLTABLE CARDVRT HI ENRG BOTH IP/OP "$57,781.00" "$42,758.00" "$7,712.84" "$57,781.00" "$26,001.45" "$26,001.45" "$26,001.45" "$26,001.45" "$57,781.00" "$57,781.00" "$57,781.00" "$9,417.94" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$12,042.20" "$57,781.00" "$57,781.00" "$28,486.03" "$57,781.00" "$57,781.00" "$57,781.00" "$57,781.00" "$43,335.75" "$57,781.00" "$57,781.00" "$57,781.00" "$28,890.50" "$28,890.50" "$45,762.55" "$57,781.00" "$46,224.80" "$26,001.45" "$7,712.84" "$57,781.00" "$33,512.98" "$57,781.00" "$57,781.00" "$57,781.00" "$8,098.48" "$57,781.00" N/A N/A 27503191 EAP HCPCS C1882 ENERGEN RF HE DF4 (WITH BRADY LEAD) BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27503192 EAP HCPCS C1882 ENERGEN RF HE DF4 (WITHOUT BRADY LEAD) BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27503193 EAP HCPCS C1721 DFBR CRD THK9.9MM 79.5MMX61.7MM ENERGEN CRT-D VNTRC BOTH IP/OP "$53,791.00" "$39,805.50" "$11,210.64" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$11,210.64" "$53,791.00" "$21,516.40" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$40,343.25" "$53,791.00" "$53,791.00" "$53,791.00" "$26,895.50" "$26,895.50" "$42,602.47" "$53,791.00" "$43,032.80" "$24,205.95" "$53,791.00" "$53,791.00" "$31,198.78" "$53,791.00" "$32,274.60" "$53,791.00" "$53,791.00" "$53,791.00" N/A N/A 27503194 EAP HCPCS C1721 DFBR CRD ENERGEN CRT-D IMPLTABLE CARDVRT BOTH IP/OP "$53,791.00" "$39,805.50" "$11,210.64" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$11,210.64" "$53,791.00" "$21,516.40" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$40,343.25" "$53,791.00" "$53,791.00" "$53,791.00" "$26,895.50" "$26,895.50" "$42,602.47" "$53,791.00" "$43,032.80" "$24,205.95" "$53,791.00" "$53,791.00" "$31,198.78" "$53,791.00" "$32,274.60" "$53,791.00" "$53,791.00" "$53,791.00" N/A N/A 27503195 EAP HCPCS C1882 ENERGEN RF HE (WITH BRADY LEAD) BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27503211 EAP HCPCS C1721 FORTIFY ASSURA NEXT NENE DR 40 BOTH IP/OP "$45,811.00" "$33,900.50" "$9,547.52" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$18,324.40" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$45,811.00" "$45,811.00" "$26,570.38" "$45,811.00" "$27,486.60" "$45,811.00" "$45,811.00" "$45,811.00" N/A N/A 27503212 EAP HCPCS C1721 FORTIFY ASSURA NEXT GENE DR 40 DF4 CONN BOTH IP/OP "$45,811.00" "$33,900.50" "$9,547.52" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$18,324.40" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$45,811.00" "$45,811.00" "$26,570.38" "$45,811.00" "$27,486.60" "$45,811.00" "$45,811.00" "$45,811.00" N/A N/A 27503213 EAP HCPCS C1722 ELLIPSE NEXT GENE DR 36 BOTH IP/OP "$45,811.00" "$33,900.50" "$7,712.84" "$45,811.00" "$20,614.95" "$20,614.95" "$20,614.95" "$20,614.95" "$45,811.00" "$45,811.00" "$45,811.00" "$9,417.94" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$45,811.00" "$22,584.82" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$7,712.84" "$45,811.00" "$26,570.38" "$45,811.00" "$45,811.00" "$45,811.00" "$8,098.48" "$45,811.00" N/A N/A 27503214 EAP HCPCS C1722 ELLIPSE NEXT GENE DR 36 DF4 CONN BOTH IP/OP "$45,811.00" "$33,900.50" "$7,712.84" "$45,811.00" "$20,614.95" "$20,614.95" "$20,614.95" "$20,614.95" "$45,811.00" "$45,811.00" "$45,811.00" "$9,417.94" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$45,811.00" "$22,584.82" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$7,712.84" "$45,811.00" "$26,570.38" "$45,811.00" "$45,811.00" "$45,811.00" "$8,098.48" "$45,811.00" N/A N/A 27503215 EAP HCPCS C1722 FORTIFY ASSURA NEXT GENE VR 40 BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27503216 EAP HCPCS C1722 FORTIFY ASSURA NEXT GENE VR 40 DF4 CONN BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27503217 EAP HCPCS C1722 ELLIPSE NEXT GENE VR 36 BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27503218 EAP HCPCS C1722 ELLIPSE NEXT GENE VR 36 DF4 CONN BOTH IP/OP "$39,900.00" "$29,526.00" "$7,712.84" "$39,900.00" "$17,955.00" "$17,955.00" "$17,955.00" "$17,955.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,316.16" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,315.60" "$39,900.00" "$39,900.00" "$19,670.70" "$39,900.00" "$39,900.00" "$39,900.00" "$39,900.00" "$29,925.00" "$39,900.00" "$39,900.00" "$39,900.00" "$19,950.00" "$19,950.00" "$31,600.80" "$39,900.00" "$31,920.00" "$17,955.00" "$7,712.84" "$39,900.00" "$23,142.00" "$39,900.00" "$39,900.00" "$39,900.00" "$8,098.48" "$39,900.00" N/A N/A 27503219 EAP HCPCS C1721 FORTIFY ASSURA NEXT GENE DR 40 SYSTEM BOTH IP/OP "$58,889.00" "$43,578.00" "$12,273.12" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$12,273.12" "$58,889.00" "$23,555.60" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$44,166.75" "$58,889.00" "$58,889.00" "$58,889.00" "$29,444.50" "$29,444.50" "$46,640.09" "$58,889.00" "$47,111.20" "$26,500.05" "$58,889.00" "$58,889.00" "$34,155.62" "$58,889.00" "$35,333.40" "$58,889.00" "$58,889.00" "$58,889.00" N/A N/A 27503220 EAP HCPCS C1721 FORTIFY ASSURA NEXT GENE DR 40 DF4 CONN SYSTEM BOTH IP/OP "$58,889.00" "$43,578.00" "$12,273.12" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$12,273.12" "$58,889.00" "$23,555.60" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$44,166.75" "$58,889.00" "$58,889.00" "$58,889.00" "$29,444.50" "$29,444.50" "$46,640.09" "$58,889.00" "$47,111.20" "$26,500.05" "$58,889.00" "$58,889.00" "$34,155.62" "$58,889.00" "$35,333.40" "$58,889.00" "$58,889.00" "$58,889.00" N/A N/A 27503221 EAP HCPCS C1722 ELLIPSE NEXT GENE DR 36 SYSTEM BOTH IP/OP "$58,889.00" "$43,578.00" "$7,712.84" "$58,889.00" "$26,500.05" "$26,500.05" "$26,500.05" "$26,500.05" "$58,889.00" "$58,889.00" "$58,889.00" "$9,417.94" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$12,273.12" "$58,889.00" "$58,889.00" "$29,032.28" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$44,166.75" "$58,889.00" "$58,889.00" "$58,889.00" "$29,444.50" "$29,444.50" "$46,640.09" "$58,889.00" "$47,111.20" "$26,500.05" "$7,712.84" "$58,889.00" "$34,155.62" "$58,889.00" "$58,889.00" "$58,889.00" "$8,098.48" "$58,889.00" N/A N/A 27503222 EAP HCPCS C1722 ELLIPSE NEXT GENE DR 36 DF4 CONN SYSTEM BOTH IP/OP "$58,889.00" "$43,578.00" "$7,712.84" "$58,889.00" "$26,500.05" "$26,500.05" "$26,500.05" "$26,500.05" "$58,889.00" "$58,889.00" "$58,889.00" "$9,417.94" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$12,273.12" "$58,889.00" "$58,889.00" "$29,032.28" "$58,889.00" "$58,889.00" "$58,889.00" "$58,889.00" "$44,166.75" "$58,889.00" "$58,889.00" "$58,889.00" "$29,444.50" "$29,444.50" "$46,640.09" "$58,889.00" "$47,111.20" "$26,500.05" "$7,712.84" "$58,889.00" "$34,155.62" "$58,889.00" "$58,889.00" "$58,889.00" "$8,098.48" "$58,889.00" N/A N/A 27503223 EAP HCPCS C1722 FORTIFY ASSURA NEXT GENE VR 40 SYSTEM BOTH IP/OP "$51,722.00" "$38,274.50" "$7,712.84" "$51,722.00" "$23,274.90" "$23,274.90" "$23,274.90" "$23,274.90" "$51,722.00" "$51,722.00" "$51,722.00" "$9,417.94" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$51,722.00" "$25,498.95" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$7,712.84" "$51,722.00" "$29,998.76" "$51,722.00" "$51,722.00" "$51,722.00" "$8,098.48" "$51,722.00" N/A N/A 27503224 EAP HCPCS C1722 FORTIFY ASSURA NEXT GENE VR 40 DF4 CONN SYSTEM BOTH IP/OP "$51,722.00" "$38,274.50" "$7,712.84" "$51,722.00" "$23,274.90" "$23,274.90" "$23,274.90" "$23,274.90" "$51,722.00" "$51,722.00" "$51,722.00" "$9,417.94" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$51,722.00" "$25,498.95" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$7,712.84" "$51,722.00" "$29,998.76" "$51,722.00" "$51,722.00" "$51,722.00" "$8,098.48" "$51,722.00" N/A N/A 27503225 EAP HCPCS C1722 ELLIPSE NEXT GENE VR 36 SYSTEM BOTH IP/OP "$51,722.00" "$38,274.50" "$7,712.84" "$51,722.00" "$23,274.90" "$23,274.90" "$23,274.90" "$23,274.90" "$51,722.00" "$51,722.00" "$51,722.00" "$9,417.94" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$51,722.00" "$25,498.95" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$7,712.84" "$51,722.00" "$29,998.76" "$51,722.00" "$51,722.00" "$51,722.00" "$8,098.48" "$51,722.00" N/A N/A 27503226 EAP HCPCS C1722 ELLIPSE NEXT GENE VR 36 36 DF4 CONN SYSTEM BOTH IP/OP "$51,722.00" "$38,274.50" "$7,712.84" "$51,722.00" "$23,274.90" "$23,274.90" "$23,274.90" "$23,274.90" "$51,722.00" "$51,722.00" "$51,722.00" "$9,417.94" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$10,779.43" "$51,722.00" "$51,722.00" "$25,498.95" "$51,722.00" "$51,722.00" "$51,722.00" "$51,722.00" "$38,791.50" "$51,722.00" "$51,722.00" "$51,722.00" "$25,861.00" "$25,861.00" "$40,963.82" "$51,722.00" "$41,377.60" "$23,274.90" "$7,712.84" "$51,722.00" "$29,998.76" "$51,722.00" "$51,722.00" "$51,722.00" "$8,098.48" "$51,722.00" N/A N/A 27503227 EAP HCPCS C1882 QUADRA ASSURA NEXT GENE CRT-D 40 BOTH IP/OP "$59,111.00" "$43,742.50" "$7,712.84" "$59,111.00" "$26,599.95" "$26,599.95" "$26,599.95" "$26,599.95" "$59,111.00" "$59,111.00" "$59,111.00" "$9,417.94" "$59,111.00" "$59,111.00" "$59,111.00" "$59,111.00" "$59,111.00" "$12,319.38" "$59,111.00" "$59,111.00" "$29,141.72" "$59,111.00" "$59,111.00" "$59,111.00" "$59,111.00" "$44,333.25" "$59,111.00" "$59,111.00" "$59,111.00" "$29,555.50" "$29,555.50" "$46,815.91" "$59,111.00" "$47,288.80" "$26,599.95" "$7,712.84" "$59,111.00" "$34,284.38" "$59,111.00" "$59,111.00" "$59,111.00" "$8,098.48" "$59,111.00" N/A N/A 27503228 EAP HCPCS C1882 QUADRA ASSURA NEXT GENE CRT-D 40 DF4 CC BOTH IP/OP "$59,111.00" "$43,742.50" "$7,712.84" "$59,111.00" "$26,599.95" "$26,599.95" "$26,599.95" "$26,599.95" "$59,111.00" "$59,111.00" "$59,111.00" "$9,417.94" "$59,111.00" "$59,111.00" "$59,111.00" "$59,111.00" "$59,111.00" "$12,319.38" "$59,111.00" "$59,111.00" "$29,141.72" "$59,111.00" "$59,111.00" "$59,111.00" "$59,111.00" "$44,333.25" "$59,111.00" "$59,111.00" "$59,111.00" "$29,555.50" "$29,555.50" "$46,815.91" "$59,111.00" "$47,288.80" "$26,599.95" "$7,712.84" "$59,111.00" "$34,284.38" "$59,111.00" "$59,111.00" "$59,111.00" "$8,098.48" "$59,111.00" N/A N/A 27503229 EAP HCPCS C1882 UNIFY ASSURA NEXT GENE CRT-D 40 BOTH IP/OP "$53,791.00" "$39,805.50" "$7,712.84" "$53,791.00" "$24,205.95" "$24,205.95" "$24,205.95" "$24,205.95" "$53,791.00" "$53,791.00" "$53,791.00" "$9,417.94" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$11,210.64" "$53,791.00" "$53,791.00" "$26,518.96" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$40,343.25" "$53,791.00" "$53,791.00" "$53,791.00" "$26,895.50" "$26,895.50" "$42,602.47" "$53,791.00" "$43,032.80" "$24,205.95" "$7,712.84" "$53,791.00" "$31,198.78" "$53,791.00" "$53,791.00" "$53,791.00" "$8,098.48" "$53,791.00" N/A N/A 27503230 EAP HCPCS C1882 UNIFY ASSURA NEXT GENE CRT-D 40 DF4 CONN BOTH IP/OP "$53,791.00" "$39,805.50" "$7,712.84" "$53,791.00" "$24,205.95" "$24,205.95" "$24,205.95" "$24,205.95" "$53,791.00" "$53,791.00" "$53,791.00" "$9,417.94" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$11,210.64" "$53,791.00" "$53,791.00" "$26,518.96" "$53,791.00" "$53,791.00" "$53,791.00" "$53,791.00" "$40,343.25" "$53,791.00" "$53,791.00" "$53,791.00" "$26,895.50" "$26,895.50" "$42,602.47" "$53,791.00" "$43,032.80" "$24,205.95" "$7,712.84" "$53,791.00" "$31,198.78" "$53,791.00" "$53,791.00" "$53,791.00" "$8,098.48" "$53,791.00" N/A N/A 27503231 EAP HCPCS C1882 QUADRA ASSURA NEXT GENE CRT-D 40 SYSTEM BOTH IP/OP "$78,677.00" "$58,221.00" "$7,712.84" "$78,677.00" "$35,404.65" "$35,404.65" "$35,404.65" "$35,404.65" "$78,677.00" "$78,677.00" "$78,677.00" "$9,417.94" "$78,677.00" "$78,677.00" "$78,677.00" "$78,677.00" "$78,677.00" "$16,397.15" "$78,677.00" "$78,677.00" "$38,787.76" "$78,677.00" "$78,677.00" "$78,677.00" "$78,677.00" "$59,007.75" "$78,677.00" "$78,677.00" "$78,677.00" "$39,338.50" "$39,338.50" "$62,312.18" "$78,677.00" "$62,941.60" "$35,404.65" "$7,712.84" "$78,677.00" "$45,632.66" "$78,677.00" "$78,677.00" "$78,677.00" "$8,098.48" "$78,677.00" N/A N/A 27503232 EAP HCPCS C1882 QUADRA ASSURA NEXT GENE CRT-D DF4 CONN SYSTEM BOTH IP/OP "$78,677.00" "$58,221.00" "$7,712.84" "$78,677.00" "$35,404.65" "$35,404.65" "$35,404.65" "$35,404.65" "$78,677.00" "$78,677.00" "$78,677.00" "$9,417.94" "$78,677.00" "$78,677.00" "$78,677.00" "$78,677.00" "$78,677.00" "$16,397.15" "$78,677.00" "$78,677.00" "$38,787.76" "$78,677.00" "$78,677.00" "$78,677.00" "$78,677.00" "$59,007.75" "$78,677.00" "$78,677.00" "$78,677.00" "$39,338.50" "$39,338.50" "$62,312.18" "$78,677.00" "$62,941.60" "$35,404.65" "$7,712.84" "$78,677.00" "$45,632.66" "$78,677.00" "$78,677.00" "$78,677.00" "$8,098.48" "$78,677.00" N/A N/A 27503233 EAP HCPCS C1882 UNIFY ASSURA NEXT GENE CRT-D 40 SYSTEM BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27503234 EAP HCPCS C1882 UNIFY ASSURA NEXT GENE CRT-D 40 DF4 CONN SYSTEM BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27503235 EAP HCPCS C1722 GENERATOR PULSE SQ-RX AND Q-TRAK ELECTRODE BOTH IP/OP "$71,926.00" "$53,225.50" "$7,712.84" "$71,926.00" "$32,366.70" "$32,366.70" "$32,366.70" "$32,366.70" "$71,926.00" "$71,926.00" "$71,926.00" "$9,417.94" "$71,926.00" "$71,926.00" "$71,926.00" "$71,926.00" "$71,926.00" "$14,990.17" "$71,926.00" "$71,926.00" "$35,459.52" "$71,926.00" "$71,926.00" "$71,926.00" "$71,926.00" "$53,944.50" "$71,926.00" "$71,926.00" "$71,926.00" "$35,963.00" "$35,963.00" "$56,965.39" "$71,926.00" "$57,540.80" "$32,366.70" "$7,712.84" "$71,926.00" "$41,717.08" "$71,926.00" "$71,926.00" "$71,926.00" "$8,098.48" "$71,926.00" N/A N/A 27503236 EAP CPT® C1722 GENERATOR PULSE SQ-RX BOTH IP/OP "$59,249.00" "$43,844.50" "$7,712.84" "$59,249.00" "$26,662.05" "$26,662.05" "$26,662.05" "$26,662.05" "$59,249.00" "$59,249.00" "$59,249.00" "$9,417.94" "$59,249.00" "$59,249.00" "$59,249.00" "$59,249.00" "$59,249.00" "$12,348.14" "$59,249.00" "$59,249.00" "$29,209.76" "$59,249.00" "$59,249.00" "$59,249.00" "$59,249.00" "$44,436.75" "$59,249.00" "$59,249.00" "$59,249.00" "$29,624.50" "$29,624.50" "$46,925.21" "$59,249.00" "$47,399.20" "$26,662.05" "$7,712.84" "$59,249.00" "$34,364.42" "$59,249.00" "$59,249.00" "$59,249.00" "$8,098.48" "$59,249.00" N/A N/A 27503237 EAP HCPCS C1785 PCMKR CRD THK6MM SM 50X47MM ASSURITY 2 CHMBR IS-1 CONCTR BOTH IP/OP "$19,566.00" "$14,479.00" "$3,883.36" "$19,566.00" "$8,804.70" "$8,804.70" "$8,804.70" "$8,804.70" "$19,566.00" "$19,566.00" "$19,566.00" "$4,078.04" "$19,566.00" "$19,566.00" "$19,566.00" "$19,566.00" "$19,566.00" "$4,077.77" "$19,566.00" "$19,566.00" "$9,646.04" "$19,566.00" "$19,566.00" "$19,566.00" "$19,566.00" "$14,674.50" "$19,566.00" "$19,566.00" "$19,566.00" "$9,783.00" "$9,783.00" "$15,496.27" "$19,566.00" "$15,652.80" "$8,804.70" "$3,883.36" "$19,566.00" "$11,348.28" "$19,566.00" "$19,566.00" "$19,566.00" "$4,077.55" "$19,566.00" N/A N/A 27503238 EAP HCPCS C1785 PCMKR CRD THK6MM SM 50X46MM ENDURITY 2 CHMBR IS-1 CONCTR BOTH IP/OP "$15,432.00" "$11,420.00" "$3,062.87" "$15,432.00" "$6,944.40" "$6,944.40" "$6,944.40" "$6,944.40" "$15,432.00" "$15,432.00" "$15,432.00" "$3,216.41" "$15,432.00" "$15,432.00" "$15,432.00" "$15,432.00" "$15,432.00" "$3,216.20" "$15,432.00" "$15,432.00" "$7,607.98" "$15,432.00" "$15,432.00" "$15,432.00" "$15,432.00" "$11,574.00" "$15,432.00" "$15,432.00" "$15,432.00" "$7,716.00" "$7,716.00" "$12,222.14" "$15,432.00" "$12,345.60" "$6,944.40" "$3,062.87" "$15,432.00" "$8,950.56" "$15,432.00" "$15,432.00" "$15,432.00" "$3,216.03" "$15,432.00" N/A N/A 27503239 EAP HCPCS C1785 PCMKR CRD THK6MM SM 50X47MM ASSURITY CHMBR IS-1 CONCTR ATCPT BOTH IP/OP "$20,669.00" "$15,295.50" "$4,102.28" "$20,669.00" "$9,301.05" "$9,301.05" "$9,301.05" "$9,301.05" "$20,669.00" "$20,669.00" "$20,669.00" "$4,307.94" "$20,669.00" "$20,669.00" "$20,669.00" "$20,669.00" "$20,669.00" "$4,307.65" "$20,669.00" "$20,669.00" "$10,189.82" "$20,669.00" "$20,669.00" "$20,669.00" "$20,669.00" "$15,501.75" "$20,669.00" "$20,669.00" "$20,669.00" "$10,334.50" "$10,334.50" "$16,369.85" "$20,669.00" "$16,535.20" "$9,301.05" "$4,102.28" "$20,669.00" "$11,988.02" "$20,669.00" "$20,669.00" "$20,669.00" "$4,307.42" "$20,669.00" N/A N/A 27503240 EAP HCPCS C1785 PCMKR CRD THK6MM SM 50X47MM ASSURITY 1 CHMBR IS-1 CONCTR BOTH IP/OP "$17,774.00" "$13,153.00" "$3,527.69" "$17,774.00" "$7,998.30" "$7,998.30" "$7,998.30" "$7,998.30" "$17,774.00" "$17,774.00" "$17,774.00" "$3,704.55" "$17,774.00" "$17,774.00" "$17,774.00" "$17,774.00" "$17,774.00" "$3,704.30" "$17,774.00" "$17,774.00" "$8,762.58" "$17,774.00" "$17,774.00" "$17,774.00" "$17,774.00" "$13,330.50" "$17,774.00" "$17,774.00" "$17,774.00" "$8,887.00" "$8,887.00" "$14,077.01" "$17,774.00" "$14,219.20" "$7,998.30" "$3,527.69" "$17,774.00" "$10,308.92" "$17,774.00" "$17,774.00" "$17,774.00" "$3,704.10" "$17,774.00" N/A N/A 27503241 EAP HCPCS C1785 ENTOVIS DR-T PROMRI WITH LANDLINE HM(R) BRADYCARDIA BOTH IP/OP "$19,759.00" "$14,622.00" "$3,921.67" "$19,759.00" "$8,891.55" "$8,891.55" "$8,891.55" "$8,891.55" "$19,759.00" "$19,759.00" "$19,759.00" "$4,118.27" "$19,759.00" "$19,759.00" "$19,759.00" "$19,759.00" "$19,759.00" "$4,117.99" "$19,759.00" "$19,759.00" "$9,741.19" "$19,759.00" "$19,759.00" "$19,759.00" "$19,759.00" "$14,819.25" "$19,759.00" "$19,759.00" "$19,759.00" "$9,879.50" "$9,879.50" "$15,649.13" "$19,759.00" "$15,807.20" "$8,891.55" "$3,921.67" "$19,759.00" "$11,460.22" "$19,759.00" "$19,759.00" "$19,759.00" "$4,117.78" "$19,759.00" N/A N/A 27503242 EAP HCPCS C1785 ENTOVIS DR-T PROMRI SYSTEM WITH LANDLINE HM(R) BRADYCARDIA BOTH IP/OP "$22,460.00" "$16,620.50" "$4,457.75" "$22,460.00" "$10,107.00" "$10,107.00" "$10,107.00" "$10,107.00" "$22,460.00" "$22,460.00" "$22,460.00" "$4,681.23" "$22,460.00" "$22,460.00" "$22,460.00" "$22,460.00" "$22,460.00" "$4,680.91" "$22,460.00" "$22,460.00" "$11,072.78" "$22,460.00" "$22,460.00" "$22,460.00" "$22,460.00" "$16,845.00" "$22,460.00" "$22,460.00" "$22,460.00" "$11,230.00" "$11,230.00" "$17,788.32" "$22,460.00" "$17,968.00" "$10,107.00" "$4,457.75" "$22,460.00" "$13,026.80" "$22,460.00" "$22,460.00" "$22,460.00" "$4,680.66" "$22,460.00" N/A N/A 27503243 EAP HCPCS C1785 ENTOVIS DR-T PROMRI SYSTEM WITH CELLULAR HM(R) BRADYCARDIA BOTH IP/OP "$22,460.00" "$16,620.50" "$4,457.75" "$22,460.00" "$10,107.00" "$10,107.00" "$10,107.00" "$10,107.00" "$22,460.00" "$22,460.00" "$22,460.00" "$4,681.23" "$22,460.00" "$22,460.00" "$22,460.00" "$22,460.00" "$22,460.00" "$4,680.91" "$22,460.00" "$22,460.00" "$11,072.78" "$22,460.00" "$22,460.00" "$22,460.00" "$22,460.00" "$16,845.00" "$22,460.00" "$22,460.00" "$22,460.00" "$11,230.00" "$11,230.00" "$17,788.32" "$22,460.00" "$17,968.00" "$10,107.00" "$4,457.75" "$22,460.00" "$13,026.80" "$22,460.00" "$22,460.00" "$22,460.00" "$4,680.66" "$22,460.00" N/A N/A 27503244 EAP HCPCS C1786 ENTOVIS SR-T PROMRI WITH LANDLINE HM(R) BRADYCARDIA BOTH IP/OP "$18,408.00" "$13,622.00" "$3,653.53" "$18,408.00" "$8,283.60" "$8,283.60" "$8,283.60" "$8,283.60" "$18,408.00" "$18,408.00" "$18,408.00" "$3,836.69" "$18,408.00" "$18,408.00" "$18,408.00" "$18,408.00" "$18,408.00" "$3,836.43" "$18,408.00" "$18,408.00" "$9,075.14" "$18,408.00" "$18,408.00" "$18,408.00" "$18,408.00" "$13,806.00" "$18,408.00" "$18,408.00" "$18,408.00" "$9,204.00" "$9,204.00" "$14,579.14" "$18,408.00" "$14,726.40" "$8,283.60" "$3,653.53" "$18,408.00" "$10,676.64" "$18,408.00" "$18,408.00" "$18,408.00" "$3,836.23" "$18,408.00" N/A N/A 27503245 EAP HCPCS C1786 ENTOVIS SR-T PROMRI WITH CELLULAR HM(R) BRADYCARDIA BOTH IP/OP "$18,408.00" "$13,622.00" "$3,653.53" "$18,408.00" "$8,283.60" "$8,283.60" "$8,283.60" "$8,283.60" "$18,408.00" "$18,408.00" "$18,408.00" "$3,836.69" "$18,408.00" "$18,408.00" "$18,408.00" "$18,408.00" "$18,408.00" "$3,836.43" "$18,408.00" "$18,408.00" "$9,075.14" "$18,408.00" "$18,408.00" "$18,408.00" "$18,408.00" "$13,806.00" "$18,408.00" "$18,408.00" "$18,408.00" "$9,204.00" "$9,204.00" "$14,579.14" "$18,408.00" "$14,726.40" "$8,283.60" "$3,653.53" "$18,408.00" "$10,676.64" "$18,408.00" "$18,408.00" "$18,408.00" "$3,836.23" "$18,408.00" N/A N/A 27503246 EAP HCPCS C1786 ENTOVIS SR-T PROMRI SYSTEM WITH LANDLINE HM(R) BRADYCARDIA BOTH IP/OP "$19,759.00" "$14,622.00" "$3,921.67" "$19,759.00" "$8,891.55" "$8,891.55" "$8,891.55" "$8,891.55" "$19,759.00" "$19,759.00" "$19,759.00" "$4,118.27" "$19,759.00" "$19,759.00" "$19,759.00" "$19,759.00" "$19,759.00" "$4,117.99" "$19,759.00" "$19,759.00" "$9,741.19" "$19,759.00" "$19,759.00" "$19,759.00" "$19,759.00" "$14,819.25" "$19,759.00" "$19,759.00" "$19,759.00" "$9,879.50" "$9,879.50" "$15,649.13" "$19,759.00" "$15,807.20" "$8,891.55" "$3,921.67" "$19,759.00" "$11,460.22" "$19,759.00" "$19,759.00" "$19,759.00" "$4,117.78" "$19,759.00" N/A N/A 27503247 EAP HCPCS C1786 ENTOVIS SR-T PROMRI SYSTEM WITH CELLULAR HM(R) BRADYCARDIA BOTH IP/OP "$19,759.00" "$14,622.00" "$3,921.67" "$19,759.00" "$8,891.55" "$8,891.55" "$8,891.55" "$8,891.55" "$19,759.00" "$19,759.00" "$19,759.00" "$4,118.27" "$19,759.00" "$19,759.00" "$19,759.00" "$19,759.00" "$19,759.00" "$4,117.99" "$19,759.00" "$19,759.00" "$9,741.19" "$19,759.00" "$19,759.00" "$19,759.00" "$19,759.00" "$14,819.25" "$19,759.00" "$19,759.00" "$19,759.00" "$9,879.50" "$9,879.50" "$15,649.13" "$19,759.00" "$15,807.20" "$8,891.55" "$3,921.67" "$19,759.00" "$11,460.22" "$19,759.00" "$19,759.00" "$19,759.00" "$4,117.78" "$19,759.00" N/A N/A 27503248 EAP HCPCS C1785 EVIA DR-T WITH CLS WITH LANDLINE HMBRADYCARDIADUAL CHAMBER BOTH IP/OP "$11,023.00" "$8,157.50" "$2,187.79" "$11,023.00" "$4,960.35" "$4,960.35" "$4,960.35" "$4,960.35" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.47" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.31" "$11,023.00" "$11,023.00" "$5,434.34" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$8,267.25" "$11,023.00" "$11,023.00" "$11,023.00" "$5,511.50" "$5,511.50" "$8,730.22" "$11,023.00" "$8,818.40" "$4,960.35" "$2,187.79" "$11,023.00" "$6,393.34" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.19" "$11,023.00" N/A N/A 27503249 EAP HCPCS C1785 EVIA DR-T WITH CLS WITH CELLULAR GSM HMBRADYCARDIADUAL CHAMBER BOTH IP/OP "$17,003.00" "$12,582.50" "$3,374.67" "$17,003.00" "$7,651.35" "$7,651.35" "$7,651.35" "$7,651.35" "$17,003.00" "$17,003.00" "$17,003.00" "$3,543.85" "$17,003.00" "$17,003.00" "$17,003.00" "$17,003.00" "$17,003.00" "$3,543.61" "$17,003.00" "$17,003.00" "$8,382.48" "$17,003.00" "$17,003.00" "$17,003.00" "$17,003.00" "$12,752.25" "$17,003.00" "$17,003.00" "$17,003.00" "$8,501.50" "$8,501.50" "$13,466.38" "$17,003.00" "$13,602.40" "$7,651.35" "$3,374.67" "$17,003.00" "$9,861.74" "$17,003.00" "$17,003.00" "$17,003.00" "$3,543.43" "$17,003.00" N/A N/A 27503250 EAP HCPCS C1785 EVIA DR-T SYSTEM WITH CLS WITH LANDLINE HMBRADYCARDIADUAL CHAMBER SYS BOTH IP/OP "$13,779.00" "$10,196.50" "$2,734.79" "$13,779.00" "$6,200.55" "$6,200.55" "$6,200.55" "$6,200.55" "$13,779.00" "$13,779.00" "$13,779.00" "$2,871.89" "$13,779.00" "$13,779.00" "$13,779.00" "$13,779.00" "$13,779.00" "$2,871.70" "$13,779.00" "$13,779.00" "$6,793.05" "$13,779.00" "$13,779.00" "$13,779.00" "$13,779.00" "$10,334.25" "$13,779.00" "$13,779.00" "$13,779.00" "$6,889.50" "$6,889.50" "$10,912.97" "$13,779.00" "$11,023.20" "$6,200.55" "$2,734.79" "$13,779.00" "$7,991.82" "$13,779.00" "$13,779.00" "$13,779.00" "$2,871.54" "$13,779.00" N/A N/A 27503251 EAP HCPCS C1785 EVIA DR-T SYSTEM WITH CLS A WITH CELLULAR GSM HMBRADYCARDIADUAL CHAM BOTH IP/OP "$19,704.00" "$14,581.00" "$3,910.75" "$19,704.00" "$8,866.80" "$8,866.80" "$8,866.80" "$8,866.80" "$19,704.00" "$19,704.00" "$19,704.00" "$4,106.81" "$19,704.00" "$19,704.00" "$19,704.00" "$19,704.00" "$19,704.00" "$4,106.53" "$19,704.00" "$19,704.00" "$9,714.07" "$19,704.00" "$19,704.00" "$19,704.00" "$19,704.00" "$14,778.00" "$19,704.00" "$19,704.00" "$19,704.00" "$9,852.00" "$9,852.00" "$15,605.57" "$19,704.00" "$15,763.20" "$8,866.80" "$3,910.75" "$19,704.00" "$11,428.32" "$19,704.00" "$19,704.00" "$19,704.00" "$4,106.31" "$19,704.00" N/A N/A 27503252 EAP HCPCS C1786 EVIA SR-T WITH CLS WITH LANDLINE HMBRADYCARDIASINGLE CHAMBER BOTH IP/OP "$9,646.00" "$7,138.50" "$1,914.49" "$9,646.00" "$4,340.70" "$4,340.70" "$4,340.70" "$4,340.70" "$9,646.00" "$9,646.00" "$9,646.00" "$2,010.47" "$9,646.00" "$9,646.00" "$9,646.00" "$9,646.00" "$9,646.00" "$2,010.33" "$9,646.00" "$9,646.00" "$4,755.48" "$9,646.00" "$9,646.00" "$9,646.00" "$9,646.00" "$7,234.50" "$9,646.00" "$9,646.00" "$9,646.00" "$4,823.00" "$4,823.00" "$7,639.63" "$9,646.00" "$7,716.80" "$4,340.70" "$1,914.49" "$9,646.00" "$5,594.68" "$9,646.00" "$9,646.00" "$9,646.00" "$2,010.23" "$9,646.00" N/A N/A 27503253 EAP HCPCS C1786 EVIA SR-T WITH CLS WITH CELLULAR GSM HMBRADYCARDIASINGLE CHAMBER BOTH IP/OP "$15,653.00" "$11,583.50" "$3,106.73" "$15,653.00" "$7,043.85" "$7,043.85" "$7,043.85" "$7,043.85" "$15,653.00" "$15,653.00" "$15,653.00" "$3,262.48" "$15,653.00" "$15,653.00" "$15,653.00" "$15,653.00" "$15,653.00" "$3,262.26" "$15,653.00" "$15,653.00" "$7,716.93" "$15,653.00" "$15,653.00" "$15,653.00" "$15,653.00" "$11,739.75" "$15,653.00" "$15,653.00" "$15,653.00" "$7,826.50" "$7,826.50" "$12,397.18" "$15,653.00" "$12,522.40" "$7,043.85" "$3,106.73" "$15,653.00" "$9,078.74" "$15,653.00" "$15,653.00" "$15,653.00" "$3,262.09" "$15,653.00" N/A N/A 27503254 EAP HCPCS C1786 EVIA SR-T SYSTEM WITH CLS WITH LANDLINE HMBRADYCARDIASINGLE CHAMBER S BOTH IP/OP "$11,023.00" "$8,157.50" "$2,187.79" "$11,023.00" "$4,960.35" "$4,960.35" "$4,960.35" "$4,960.35" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.47" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.31" "$11,023.00" "$11,023.00" "$5,434.34" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$8,267.25" "$11,023.00" "$11,023.00" "$11,023.00" "$5,511.50" "$5,511.50" "$8,730.22" "$11,023.00" "$8,818.40" "$4,960.35" "$2,187.79" "$11,023.00" "$6,393.34" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.19" "$11,023.00" N/A N/A 27503255 EAP HCPCS C1786 EVIA SR-T SYSTEM WITH CLS WITH CELLULAR GSM HMBRADYCARDIASINGLE CHAMB BOTH IP/OP "$17,003.00" "$12,582.50" "$3,374.67" "$17,003.00" "$7,651.35" "$7,651.35" "$7,651.35" "$7,651.35" "$17,003.00" "$17,003.00" "$17,003.00" "$3,543.85" "$17,003.00" "$17,003.00" "$17,003.00" "$17,003.00" "$17,003.00" "$3,543.61" "$17,003.00" "$17,003.00" "$8,382.48" "$17,003.00" "$17,003.00" "$17,003.00" "$17,003.00" "$12,752.25" "$17,003.00" "$17,003.00" "$17,003.00" "$8,501.50" "$8,501.50" "$13,466.38" "$17,003.00" "$13,602.40" "$7,651.35" "$3,374.67" "$17,003.00" "$9,861.74" "$17,003.00" "$17,003.00" "$17,003.00" "$3,543.43" "$17,003.00" N/A N/A 27503256 EAP HCPCS C2621 EVIA HF-T WITH LANDLINE HMCRTDEVICE BOTH IP/OP "$21,771.00" "$16,111.00" "$4,321.00" "$21,771.00" "$9,796.95" "$9,796.95" "$9,796.95" "$9,796.95" "$21,771.00" "$21,771.00" "$21,771.00" "$4,537.62" "$21,771.00" "$21,771.00" "$21,771.00" "$21,771.00" "$21,771.00" "$4,537.32" "$21,771.00" "$21,771.00" "$10,733.10" "$21,771.00" "$21,771.00" "$21,771.00" "$21,771.00" "$16,328.25" "$21,771.00" "$21,771.00" "$21,771.00" "$10,885.50" "$10,885.50" "$17,242.63" "$21,771.00" "$17,416.80" "$9,796.95" "$4,321.00" "$21,771.00" "$12,627.18" "$21,771.00" "$21,771.00" "$21,771.00" "$4,537.08" "$21,771.00" N/A N/A 27503257 EAP HCPCS C2621 EVIA HF-T WITH CELLULAR GSM HMCRTDEVICE BOTH IP/OP "$22,597.00" "$16,722.00" "$4,484.94" "$22,597.00" "$10,168.65" "$10,168.65" "$10,168.65" "$10,168.65" "$22,597.00" "$22,597.00" "$22,597.00" "$4,709.78" "$22,597.00" "$22,597.00" "$22,597.00" "$22,597.00" "$22,597.00" "$4,709.46" "$22,597.00" "$22,597.00" "$11,140.32" "$22,597.00" "$22,597.00" "$22,597.00" "$22,597.00" "$16,947.75" "$22,597.00" "$22,597.00" "$22,597.00" "$11,298.50" "$11,298.50" "$17,896.82" "$22,597.00" "$18,077.60" "$10,168.65" "$4,484.94" "$22,597.00" "$13,106.26" "$22,597.00" "$22,597.00" "$22,597.00" "$4,709.21" "$22,597.00" N/A N/A 27503258 EAP HCPCS C2621 EVIA HF-T SYSTEM WITH LANDLINE HMCRTSYSTEM BOTH IP/OP "$31,141.00" "$23,044.50" "$6,180.71" "$31,141.00" "$14,013.45" "$14,013.45" "$14,013.45" "$14,013.45" "$31,141.00" "$31,141.00" "$31,141.00" "$6,490.56" "$31,141.00" "$31,141.00" "$31,141.00" "$31,141.00" "$31,141.00" "$6,490.13" "$31,141.00" "$31,141.00" "$15,352.51" "$31,141.00" "$31,141.00" "$31,141.00" "$31,141.00" "$23,355.75" "$31,141.00" "$31,141.00" "$31,141.00" "$15,570.50" "$15,570.50" "$24,663.67" "$31,141.00" "$24,912.80" "$14,013.45" "$6,180.71" "$31,141.00" "$18,061.78" "$31,141.00" "$31,141.00" "$31,141.00" "$6,489.78" "$31,141.00" N/A N/A 27503259 EAP HCPCS C2621 EVIA HF-T SYSTEM WITH CELLULAR GSM HMCRTSYSTEM BOTH IP/OP "$31,692.00" "$23,452.50" "$6,290.07" "$31,692.00" "$14,261.40" "$14,261.40" "$14,261.40" "$14,261.40" "$31,692.00" "$31,692.00" "$31,692.00" "$6,605.41" "$31,692.00" "$31,692.00" "$31,692.00" "$31,692.00" "$31,692.00" "$6,604.96" "$31,692.00" "$31,692.00" "$15,624.16" "$31,692.00" "$31,692.00" "$31,692.00" "$31,692.00" "$23,769.00" "$31,692.00" "$31,692.00" "$31,692.00" "$15,846.00" "$15,846.00" "$25,100.06" "$31,692.00" "$25,353.60" "$14,261.40" "$6,290.07" "$31,692.00" "$18,381.36" "$31,692.00" "$31,692.00" "$31,692.00" "$6,604.61" "$31,692.00" N/A N/A 27503260 EAP HCPCS C1900 COROX OTW-L 75-BP LEADCRTLEAD BOTH IP/OP "$5,512.00" "$4,079.00" "$1,093.99" "$5,512.00" "$2,480.40" "$2,480.40" "$2,480.40" "$2,480.40" "$5,512.00" "$5,512.00" "$5,512.00" "$1,148.84" "$5,512.00" "$5,512.00" "$5,512.00" "$5,512.00" "$5,512.00" "$1,148.76" "$5,512.00" "$5,512.00" "$2,717.42" "$5,512.00" "$5,512.00" "$5,512.00" "$5,512.00" "$4,134.00" "$5,512.00" "$5,512.00" "$5,512.00" "$2,756.00" "$2,756.00" "$4,365.50" "$5,512.00" "$4,409.60" "$2,480.40" "$1,093.99" "$5,512.00" "$3,196.96" "$5,512.00" "$5,512.00" "$5,512.00" "$1,148.70" "$5,512.00" N/A N/A 27503261 EAP HCPCS C1900 COROX OTW-L 85-BP LEADCRTLEAD BOTH IP/OP "$5,512.00" "$4,079.00" "$1,093.99" "$5,512.00" "$2,480.40" "$2,480.40" "$2,480.40" "$2,480.40" "$5,512.00" "$5,512.00" "$5,512.00" "$1,148.84" "$5,512.00" "$5,512.00" "$5,512.00" "$5,512.00" "$5,512.00" "$1,148.76" "$5,512.00" "$5,512.00" "$2,717.42" "$5,512.00" "$5,512.00" "$5,512.00" "$5,512.00" "$4,134.00" "$5,512.00" "$5,512.00" "$5,512.00" "$2,756.00" "$2,756.00" "$4,365.50" "$5,512.00" "$4,409.60" "$2,480.40" "$1,093.99" "$5,512.00" "$3,196.96" "$5,512.00" "$5,512.00" "$5,512.00" "$1,148.70" "$5,512.00" N/A N/A 27503262 EAP HCPCS C1898 LEAD PCNG 45CM ECRDL BIPOL ACT FIX IS 1 CONCTR RING ELTRD BOTH IP/OP $551.00 $408.00 $114.83 $551.00 $551.00 $551.00 $551.00 $551.00 $551.00 $551.00 $551.00 $551.00 $551.00 $551.00 $551.00 $551.00 $551.00 $114.83 $551.00 $220.40 $551.00 $551.00 $551.00 $551.00 $551.00 $413.25 $551.00 $551.00 $551.00 $275.50 $275.50 $436.39 $551.00 $440.80 $247.95 $551.00 $551.00 $319.58 $551.00 $330.60 $551.00 $551.00 $551.00 N/A N/A 27503263 EAP HCPCS C1785 GNTR PCMKR ENTOVIS DR-T PROMRI CRD BOTH IP/OP "$19,759.00" "$14,622.00" "$3,921.67" "$19,759.00" "$8,891.55" "$8,891.55" "$8,891.55" "$8,891.55" "$19,759.00" "$19,759.00" "$19,759.00" "$4,118.27" "$19,759.00" "$19,759.00" "$19,759.00" "$19,759.00" "$19,759.00" "$4,117.99" "$19,759.00" "$19,759.00" "$9,741.19" "$19,759.00" "$19,759.00" "$19,759.00" "$19,759.00" "$14,819.25" "$19,759.00" "$19,759.00" "$19,759.00" "$9,879.50" "$9,879.50" "$15,649.13" "$19,759.00" "$15,807.20" "$8,891.55" "$3,921.67" "$19,759.00" "$11,460.22" "$19,759.00" "$19,759.00" "$19,759.00" "$4,117.78" "$19,759.00" N/A N/A 27503265 EAP HCPCS C1882 DFBR CRD .99CM THN 5.37X8.08CM INOGEN EASYVIEW RIGHT ATR RV BOTH IP/OP "$38,056.00" "$28,161.50" "$7,553.16" "$38,056.00" "$17,125.20" "$17,125.20" "$17,125.20" "$17,125.20" "$38,056.00" "$38,056.00" "$38,056.00" "$7,931.82" "$38,056.00" "$38,056.00" "$38,056.00" "$38,056.00" "$38,056.00" "$7,931.29" "$38,056.00" "$38,056.00" "$18,761.61" "$38,056.00" "$38,056.00" "$38,056.00" "$38,056.00" "$28,542.00" "$38,056.00" "$38,056.00" "$38,056.00" "$19,028.00" "$19,028.00" "$30,140.35" "$38,056.00" "$30,444.80" "$17,125.20" "$7,553.16" "$38,056.00" "$22,072.48" "$38,056.00" "$38,056.00" "$38,056.00" "$7,930.87" "$38,056.00" N/A N/A 27503266 EAP HCPCS C1785 PACEMAKER CRD .75CM 4.45X5.02CM ACLD; LTD NXT; BOTH IP/OP "$10,213.00" "$7,558.00" "$2,027.03" "$10,213.00" "$4,595.85" "$4,595.85" "$4,595.85" "$4,595.85" "$10,213.00" "$10,213.00" "$10,213.00" "$2,128.64" "$10,213.00" "$10,213.00" "$10,213.00" "$10,213.00" "$10,213.00" "$2,128.50" "$10,213.00" "$10,213.00" "$5,035.01" "$10,213.00" "$10,213.00" "$10,213.00" "$10,213.00" "$7,659.75" "$10,213.00" "$10,213.00" "$10,213.00" "$5,106.50" "$5,106.50" "$8,088.70" "$10,213.00" "$8,170.40" "$4,595.85" "$2,027.03" "$10,213.00" "$5,923.54" "$10,213.00" "$10,213.00" "$10,213.00" "$2,128.39" "$10,213.00" N/A N/A 27503267 EAP HCPCS C1721 PACEMAKER CRD 7.5MM 42.9X43.3MM ADAPTA SR ATR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,823.60" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 27503268 EAP Custom 27503268 ENVELOPE DEFIBRILLATOR MEDIUM 2.5X2.75IN PACEMAKER BOTH IP/OP "$1,738.00" "$1,286.50" $309.36 "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" $309.36 "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" $362.22 "$1,738.00" $695.20 "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" "$1,303.50" "$1,738.00" "$1,738.00" "$1,738.00" $869.00 $869.00 "$1,376.50" "$1,738.00" "$1,390.40" $782.10 "$1,738.00" "$1,738.00" "$1,008.04" "$1,738.00" "$1,042.80" "$1,738.00" "$1,738.00" "$1,738.00" N/A N/A 27503269 EAP Custom 27503269 CATHETER BALLOON OCCLUSION .01IN 2MM 2.5-2.8FR 4MM BOTH IP/OP "$3,312.00" "$2,451.00" $589.54 "$3,312.00" "$3,312.00" "$3,312.00" "$3,312.00" "$3,312.00" "$3,312.00" "$3,312.00" $589.54 "$3,312.00" "$3,312.00" "$3,312.00" "$3,312.00" "$3,312.00" "$3,312.00" $690.26 "$3,312.00" "$1,324.80" "$3,312.00" "$3,312.00" "$3,312.00" "$3,312.00" "$3,312.00" "$2,484.00" "$3,312.00" "$3,312.00" "$3,312.00" "$1,656.00" "$1,656.00" "$2,623.10" "$3,312.00" "$2,649.60" "$1,490.40" "$3,312.00" "$3,312.00" "$1,920.96" "$3,312.00" "$1,987.20" "$3,312.00" "$3,312.00" "$3,312.00" N/A N/A 27503271 EAP HCPCS C2621 "QUADRA ALLURE MP RF CRT-P, MERLINPKG" BOTH IP/OP "$17,625.00" "$13,042.50" "$3,498.12" "$17,625.00" "$7,931.25" "$7,931.25" "$7,931.25" "$7,931.25" "$17,625.00" "$17,625.00" "$17,625.00" "$3,673.49" "$17,625.00" "$17,625.00" "$17,625.00" "$17,625.00" "$17,625.00" "$3,673.24" "$17,625.00" "$17,625.00" "$8,689.13" "$17,625.00" "$17,625.00" "$17,625.00" "$17,625.00" "$13,218.75" "$17,625.00" "$17,625.00" "$17,625.00" "$8,812.50" "$8,812.50" "$13,959.00" "$17,625.00" "$14,100.00" "$7,931.25" "$3,498.12" "$17,625.00" "$10,222.50" "$17,625.00" "$17,625.00" "$17,625.00" "$3,673.05" "$17,625.00" N/A N/A 27503272 EAP HCPCS C2621 QUADRA ALLURE MP RF CRT-P SYSTEM BOTH IP/OP "$23,875.00" "$17,667.50" "$4,738.59" "$23,875.00" "$10,743.75" "$10,743.75" "$10,743.75" "$10,743.75" "$23,875.00" "$23,875.00" "$23,875.00" "$4,976.15" "$23,875.00" "$23,875.00" "$23,875.00" "$23,875.00" "$23,875.00" "$4,975.81" "$23,875.00" "$23,875.00" "$11,770.38" "$23,875.00" "$23,875.00" "$23,875.00" "$23,875.00" "$17,906.25" "$23,875.00" "$23,875.00" "$23,875.00" "$11,937.50" "$11,937.50" "$18,909.00" "$23,875.00" "$19,100.00" "$10,743.75" "$4,738.59" "$23,875.00" "$13,847.50" "$23,875.00" "$23,875.00" "$23,875.00" "$4,975.55" "$23,875.00" N/A N/A 27503273 EAP HCPCS C2621 "QUADRA ALLURE MP CRT-P SYSTEM, MERLINPKG" BOTH IP/OP "$25,000.00" "$18,500.00" "$4,961.88" "$25,000.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.63" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.28" "$25,000.00" "$25,000.00" "$12,325.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$18,750.00" "$25,000.00" "$25,000.00" "$25,000.00" "$12,500.00" "$12,500.00" "$19,800.00" "$25,000.00" "$20,000.00" "$11,250.00" "$4,961.88" "$25,000.00" "$14,500.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.00" "$25,000.00" N/A N/A 27503274 EAP HCPCS C1898 LEAD PCNG 45CM SOLIA S BP ACTFX STRD ELUT BOTH IP/OP "$1,125.00" $832.50 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 27503275 EAP HCPCS C1898 LEAD PCNG 53CM SOLIA S STRD ELUTE BP ACTFX ECRDL BOTH IP/OP "$1,125.00" $832.50 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 27503300 EAP HCPCS C1785 PACEMAKER CRD 2 CHMBR DR-T ETRINSA BOTH IP/OP "$9,500.00" "$7,030.00" "$1,885.51" "$9,500.00" "$4,275.00" "$4,275.00" "$4,275.00" "$4,275.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,980.04" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.90" "$9,500.00" "$9,500.00" "$4,683.50" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$7,125.00" "$9,500.00" "$9,500.00" "$9,500.00" "$4,750.00" "$4,750.00" "$7,524.00" "$9,500.00" "$7,600.00" "$4,275.00" "$1,885.51" "$9,500.00" "$5,510.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.80" "$9,500.00" N/A N/A 27503301 EAP HCPCS C1785 ETRINSA DR-T SYSTEM WITH CLS WITH HOME MONITORING BOTH IP/OP "$12,000.00" "$8,880.00" "$2,381.70" "$12,000.00" "$5,400.00" "$5,400.00" "$5,400.00" "$5,400.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,501.10" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,500.93" "$12,000.00" "$12,000.00" "$5,916.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$9,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$6,000.00" "$6,000.00" "$9,504.00" "$12,000.00" "$9,600.00" "$5,400.00" "$2,381.70" "$12,000.00" "$6,960.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,500.80" "$12,000.00" N/A N/A 27503302 EAP HCPCS C1786 PACEMAKER CRD 1 CHMBR ETRINSA SR-T BOTH IP/OP "$8,375.00" "$6,197.50" "$1,662.23" "$8,375.00" "$3,768.75" "$3,768.75" "$3,768.75" "$3,768.75" "$8,375.00" "$8,375.00" "$8,375.00" "$1,745.56" "$8,375.00" "$8,375.00" "$8,375.00" "$8,375.00" "$8,375.00" "$1,745.44" "$8,375.00" "$8,375.00" "$4,128.88" "$8,375.00" "$8,375.00" "$8,375.00" "$8,375.00" "$6,281.25" "$8,375.00" "$8,375.00" "$8,375.00" "$4,187.50" "$4,187.50" "$6,633.00" "$8,375.00" "$6,700.00" "$3,768.75" "$1,662.23" "$8,375.00" "$4,857.50" "$8,375.00" "$8,375.00" "$8,375.00" "$1,745.35" "$8,375.00" N/A N/A 27503303 EAP HCPCS C1786 ETRINSA SR-T SYSTEM WITH CLS WITH HOME MONITORING BOTH IP/OP "$9,500.00" "$7,030.00" "$1,885.51" "$9,500.00" "$4,275.00" "$4,275.00" "$4,275.00" "$4,275.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,980.04" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.90" "$9,500.00" "$9,500.00" "$4,683.50" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$7,125.00" "$9,500.00" "$9,500.00" "$9,500.00" "$4,750.00" "$4,750.00" "$7,524.00" "$9,500.00" "$7,600.00" "$4,275.00" "$1,885.51" "$9,500.00" "$5,510.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.80" "$9,500.00" N/A N/A 27503305 EAP HCPCS C2621 PERCEPTA BIPOLAR CRTP BOTH IP/OP "$29,835.00" "$22,078.00" "$5,921.50" "$29,835.00" "$13,425.75" "$13,425.75" "$13,425.75" "$13,425.75" "$29,835.00" "$29,835.00" "$29,835.00" "$6,218.36" "$29,835.00" "$29,835.00" "$29,835.00" "$29,835.00" "$29,835.00" "$6,217.94" "$29,835.00" "$29,835.00" "$14,708.66" "$29,835.00" "$29,835.00" "$29,835.00" "$29,835.00" "$22,376.25" "$29,835.00" "$29,835.00" "$29,835.00" "$14,917.50" "$14,917.50" "$23,629.32" "$29,835.00" "$23,868.00" "$13,425.75" "$5,921.50" "$29,835.00" "$17,304.30" "$29,835.00" "$29,835.00" "$29,835.00" "$6,217.61" "$29,835.00" N/A N/A 27503320 EAP CPT® C1898 LEAD PCNG STRG 52CM INGEVITY MRI PSV FX RV BOTH IP/OP "$1,125.00" $832.50 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 27503321 EAP CPT® C1898 LEAD PCNG J CRV 45CM INGEVITY MRI PSV FX PREFRM ATR BOTH IP/OP "$1,125.00" $832.50 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 27503322 EAP CPT® C1898 LEAD PCNG J CRV 52CM INGEVITY MRI PSV FX PREFRM ATR BOTH IP/OP "$1,125.00" $832.50 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 27503323 EAP LEAD PCNG STRG 45CM INGEVITY MRI ACT BP FLX TP STY AV BOTH IP/OP "$1,125.00" $832.50 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 27503324 EAP CPT® C1898 LEAD PCNG STRG 52CM INGEVITY MRI ACT BP FLX TP STY AV BOTH IP/OP "$1,125.00" $832.50 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 27503326 EAP HCPCS C1785 PACEMAKER CRD AZURE WIRELESSLY BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" "$13,750.00" "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 27503327 EAP HCPCS C1786 PACEMAKER CRD AZURE BOTH IP/OP "$12,000.00" "$8,880.00" "$2,381.70" "$12,000.00" "$5,400.00" "$5,400.00" "$5,400.00" "$5,400.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,501.10" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,500.93" "$12,000.00" "$12,000.00" "$5,916.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$9,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$6,000.00" "$6,000.00" "$9,504.00" "$12,000.00" "$9,600.00" "$5,400.00" "$2,381.70" "$12,000.00" "$6,960.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,500.80" "$12,000.00" N/A N/A 27503329 EAP HCPCS C1898 LEAD PCNG 10MM SPC SM STRG 6.2FR 2MM 45CM STRL CP NV BP SCR BOTH IP/OP "$1,250.00" $925.00 $260.51 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" "$1,250.00" $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 27503330 EAP HCPCS C1786 EDORA PROMRI SR-T-SING CHMBR PACEMAKER-RATE-AD BOTH IP/OP "$13,375.00" "$9,897.50" "$2,654.60" "$13,375.00" "$6,018.75" "$6,018.75" "$6,018.75" "$6,018.75" "$13,375.00" "$13,375.00" "$13,375.00" "$2,787.68" "$13,375.00" "$13,375.00" "$13,375.00" "$13,375.00" "$13,375.00" "$2,787.50" "$13,375.00" "$13,375.00" "$6,593.88" "$13,375.00" "$13,375.00" "$13,375.00" "$13,375.00" "$10,031.25" "$13,375.00" "$13,375.00" "$13,375.00" "$6,687.50" "$6,687.50" "$10,593.00" "$13,375.00" "$10,700.00" "$6,018.75" "$2,654.60" "$13,375.00" "$7,757.50" "$13,375.00" "$13,375.00" "$13,375.00" "$2,787.35" "$13,375.00" N/A N/A 27503331 EAP HCPCS C1785 PM CARDIAC ACLD LAT NXT DR-EL 4.45 X 5.88 X 0.75 BOTH IP/OP "$7,625.00" "$5,642.50" "$1,513.37" "$7,625.00" "$3,431.25" "$3,431.25" "$3,431.25" "$3,431.25" "$7,625.00" "$7,625.00" "$7,625.00" "$1,589.24" "$7,625.00" "$7,625.00" "$7,625.00" "$7,625.00" "$7,625.00" "$1,589.13" "$7,625.00" "$7,625.00" "$3,759.13" "$7,625.00" "$7,625.00" "$7,625.00" "$7,625.00" "$5,718.75" "$7,625.00" "$7,625.00" "$7,625.00" "$3,812.50" "$3,812.50" "$6,039.00" "$7,625.00" "$6,100.00" "$3,431.25" "$1,513.37" "$7,625.00" "$4,422.50" "$7,625.00" "$7,625.00" "$7,625.00" "$1,589.05" "$7,625.00" N/A N/A 27503332 EAP HCPCS C1722 DFBR CRD .99CM 5.37X7.36CM RESONATE HEARTLOGIC BOTH IP/OP "$23,893.00" "$17,681.00" "$4,742.16" "$23,893.00" "$10,751.85" "$10,751.85" "$10,751.85" "$10,751.85" "$23,893.00" "$23,893.00" "$23,893.00" "$4,979.90" "$23,893.00" "$23,893.00" "$23,893.00" "$23,893.00" "$23,893.00" "$4,979.56" "$23,893.00" "$23,893.00" "$11,779.25" "$23,893.00" "$23,893.00" "$23,893.00" "$23,893.00" "$17,919.75" "$23,893.00" "$23,893.00" "$23,893.00" "$11,946.50" "$11,946.50" "$18,923.26" "$23,893.00" "$19,114.40" "$10,751.85" "$4,742.16" "$23,893.00" "$13,857.94" "$23,893.00" "$23,893.00" "$23,893.00" "$4,979.30" "$23,893.00" N/A N/A 27800001 EAP HCPCS V2790 PROKERA BOTH IP/OP "$2,140.00" "$1,584.00" $424.74 "$2,140.00" $963.00 $963.00 $963.00 $963.00 "$2,140.00" "$2,140.00" "$2,140.00" $446.03 "$2,140.00" "$2,140.00" "$2,140.00" "$2,140.00" "$2,140.00" $446.00 "$2,140.00" "$2,140.00" "$1,265.81" "$2,140.00" "$2,140.00" "$2,140.00" "$2,140.00" "$1,605.00" "$2,140.00" "$2,140.00" "$2,140.00" "$1,070.00" "$1,070.00" "$1,694.88" "$2,140.00" "$1,712.00" $963.00 $424.74 "$2,140.00" "$1,241.20" "$2,140.00" "$2,140.00" "$2,140.00" $445.98 "$2,140.00" N/A N/A 27800002 EAP Custom 27800002 COIL EMBL 20MM .014IN 3MM TRFL PSH CMPLX PLTN NYL BOTH IP/OP $406.00 $300.50 $72.27 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $72.27 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $84.61 $406.00 $162.40 $406.00 $406.00 $406.00 $406.00 $406.00 $304.50 $406.00 $406.00 $406.00 $203.00 $203.00 $321.55 $406.00 $324.80 $182.70 $406.00 $406.00 $235.48 $406.00 $243.60 $406.00 $406.00 $406.00 N/A N/A 27800003 EAP Custom 27800003 COIL EMBL 30MM .014IN 4MM TRFL PSH CMPLX PLTN NYL BOTH IP/OP $406.00 $300.50 $72.27 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $72.27 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $84.61 $406.00 $162.40 $406.00 $406.00 $406.00 $406.00 $406.00 $304.50 $406.00 $406.00 $406.00 $203.00 $203.00 $321.55 $406.00 $324.80 $182.70 $406.00 $406.00 $235.48 $406.00 $243.60 $406.00 $406.00 $406.00 N/A N/A 27800004 EAP Custom 27800004 PUSHER SURG 195CM TRUPUSH EMBL COIL .016IN BOTH IP/OP "$1,244.00" $921.00 $221.43 "$1,244.00" "$1,244.00" "$1,244.00" "$1,244.00" "$1,244.00" "$1,244.00" "$1,244.00" $221.43 "$1,244.00" "$1,244.00" "$1,244.00" "$1,244.00" "$1,244.00" "$1,244.00" $259.26 "$1,244.00" $497.60 "$1,244.00" "$1,244.00" "$1,244.00" "$1,244.00" "$1,244.00" $933.00 "$1,244.00" "$1,244.00" "$1,244.00" $622.00 $622.00 $985.25 "$1,244.00" $995.20 $559.80 "$1,244.00" "$1,244.00" $721.52 "$1,244.00" $746.40 "$1,244.00" "$1,244.00" "$1,244.00" N/A N/A 27800005 EAP Custom 27800005 COIL EMBL 30CM 20MM .038IN AZUR FRME ELC DTCH LOOP BOTH IP/OP "$3,188.00" "$2,359.50" $567.46 "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" $567.46 "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" $664.41 "$3,188.00" "$1,275.20" "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" "$2,391.00" "$3,188.00" "$3,188.00" "$3,188.00" "$1,594.00" "$1,594.00" "$2,524.90" "$3,188.00" "$2,550.40" "$1,434.60" "$3,188.00" "$3,188.00" "$1,849.04" "$3,188.00" "$1,912.80" "$3,188.00" "$3,188.00" "$3,188.00" N/A N/A 27800006 EAP Custom 27800006 COIL EMBL 30CM 20MM AZUR DTCH DDRGL PERI 35 SYS BOTH IP/OP "$3,000.00" "$2,220.00" $534.00 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $534.00 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$1,200.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" "$3,000.00" "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" "$3,000.00" "$3,000.00" N/A N/A 27800007 EAP Custom 27800007 COIL EMBL 30CM 15MM AZUR DTCH DDRGL PERI 35 SYS BOTH IP/OP "$3,000.00" "$2,220.00" $534.00 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $534.00 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$1,200.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" "$3,000.00" "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" "$3,000.00" "$3,000.00" N/A N/A 27800008 EAP Custom 27800008 AZUR CX 35 DETACHABLE 20MM/39CM BOTH IP/OP "$2,800.00" "$2,072.00" $498.40 "$2,800.00" "$2,800.00" "$2,800.00" "$2,800.00" "$2,800.00" "$2,800.00" "$2,800.00" $498.40 "$2,800.00" "$2,800.00" "$2,800.00" "$2,800.00" "$2,800.00" "$2,800.00" $583.55 "$2,800.00" "$1,120.00" "$2,800.00" "$2,800.00" "$2,800.00" "$2,800.00" "$2,800.00" "$2,100.00" "$2,800.00" "$2,800.00" "$2,800.00" "$1,400.00" "$1,400.00" "$2,217.60" "$2,800.00" "$2,240.00" "$1,260.00" "$2,800.00" "$2,800.00" "$1,624.00" "$2,800.00" "$1,680.00" "$2,800.00" "$2,800.00" "$2,800.00" N/A N/A 27800010 EAP HCPCS C1882 DEFIBRILLATOR CARDIAC ICD DF-1 BIPHASIC WAVEFORM V BOTH IP/OP "$47,875.00" "$35,427.50" "$7,712.84" "$47,875.00" "$21,543.75" "$21,543.75" "$21,543.75" "$21,543.75" "$47,875.00" "$47,875.00" "$47,875.00" "$9,417.94" "$47,875.00" "$47,875.00" "$47,875.00" "$47,875.00" "$47,875.00" "$9,977.68" "$47,875.00" "$47,875.00" "$23,602.38" "$47,875.00" "$47,875.00" "$47,875.00" "$47,875.00" "$35,906.25" "$47,875.00" "$47,875.00" "$47,875.00" "$23,937.50" "$23,937.50" "$37,917.00" "$47,875.00" "$38,300.00" "$21,543.75" "$7,712.84" "$47,875.00" "$27,767.50" "$47,875.00" "$47,875.00" "$47,875.00" "$8,098.48" "$47,875.00" N/A N/A 27800011 EAP HCPCS C1876 STENT VASC 8MM 40MM 75CM SLF XPD ILC ART EP NTNL ACPT 6FR BOTH IP/OP "$2,887.00" "$2,136.50" $573.00 "$2,887.00" "$1,299.15" "$1,299.15" "$1,299.15" "$1,299.15" "$2,887.00" "$2,887.00" "$2,887.00" $601.72 "$2,887.00" "$2,887.00" "$2,887.00" "$2,887.00" "$2,887.00" $601.68 "$2,887.00" "$2,887.00" "$1,423.29" "$2,887.00" "$2,887.00" "$2,887.00" "$2,887.00" "$2,165.25" "$2,887.00" "$2,887.00" "$2,887.00" "$1,443.50" "$1,443.50" "$2,286.50" "$2,887.00" "$2,309.60" "$1,299.15" $573.00 "$2,887.00" "$1,674.46" "$2,887.00" "$2,887.00" "$2,887.00" $601.65 "$2,887.00" N/A N/A 27800012 EAP HCPCS C1876 STENT BIL 8MM 6FR 37MM 75CM BLN EXPANDABLE PRMNT XPR LD MTL BOTH IP/OP "$2,955.00" "$2,187.00" $586.49 "$2,955.00" "$1,329.75" "$1,329.75" "$1,329.75" "$1,329.75" "$2,955.00" "$2,955.00" "$2,955.00" $615.90 "$2,955.00" "$2,955.00" "$2,955.00" "$2,955.00" "$2,955.00" $615.85 "$2,955.00" "$2,955.00" "$1,456.82" "$2,955.00" "$2,955.00" "$2,955.00" "$2,955.00" "$2,216.25" "$2,955.00" "$2,955.00" "$2,955.00" "$1,477.50" "$1,477.50" "$2,340.36" "$2,955.00" "$2,364.00" "$1,329.75" $586.49 "$2,955.00" "$1,713.90" "$2,955.00" "$2,955.00" "$2,955.00" $615.82 "$2,955.00" N/A N/A 27800013 EAP HCPCS C1876 STENT BIL 8MM 6FR 27MM 75CM BLN EXPANDABLE PRMNT XPR LD MTL BOTH IP/OP "$2,955.00" "$2,187.00" $586.49 "$2,955.00" "$1,329.75" "$1,329.75" "$1,329.75" "$1,329.75" "$2,955.00" "$2,955.00" "$2,955.00" $615.90 "$2,955.00" "$2,955.00" "$2,955.00" "$2,955.00" "$2,955.00" $615.85 "$2,955.00" "$2,955.00" "$1,456.82" "$2,955.00" "$2,955.00" "$2,955.00" "$2,955.00" "$2,216.25" "$2,955.00" "$2,955.00" "$2,955.00" "$1,477.50" "$1,477.50" "$2,340.36" "$2,955.00" "$2,364.00" "$1,329.75" $586.49 "$2,955.00" "$1,713.90" "$2,955.00" "$2,955.00" "$2,955.00" $615.82 "$2,955.00" N/A N/A 27800015 EAP HCPCS C1874 STENT TRACHEOBRONCHIAL 16MM COVER ICAST 6MM 6FR BOTH IP/OP "$6,009.00" "$4,447.00" "$1,192.64" "$6,009.00" "$2,704.05" "$2,704.05" "$2,704.05" "$2,704.05" "$6,009.00" "$6,009.00" "$6,009.00" "$1,252.43" "$6,009.00" "$6,009.00" "$6,009.00" "$6,009.00" "$6,009.00" "$1,252.34" "$6,009.00" "$6,009.00" "$2,962.44" "$6,009.00" "$6,009.00" "$6,009.00" "$6,009.00" "$4,506.75" "$6,009.00" "$6,009.00" "$6,009.00" "$3,004.50" "$3,004.50" "$4,759.13" "$6,009.00" "$4,807.20" "$2,704.05" "$1,192.64" "$6,009.00" "$3,485.22" "$6,009.00" "$6,009.00" "$6,009.00" "$1,252.28" "$6,009.00" N/A N/A 27800016 EAP Custom 27800016 DVC EMBL 20MM 4.75MM PPLN FLX 55D 75% CCR 25% PLTN BOTH IP/OP "$34,230.00" "$25,330.50" "$6,092.94" "$34,230.00" "$34,230.00" "$34,230.00" "$34,230.00" "$34,230.00" "$34,230.00" "$34,230.00" "$6,092.94" "$34,230.00" "$34,230.00" "$34,230.00" "$34,230.00" "$34,230.00" "$34,230.00" "$7,133.91" "$34,230.00" "$13,692.00" "$34,230.00" "$34,230.00" "$34,230.00" "$34,230.00" "$34,230.00" "$25,672.50" "$34,230.00" "$34,230.00" "$34,230.00" "$17,115.00" "$17,115.00" "$27,110.16" "$34,230.00" "$27,384.00" "$15,403.50" "$34,230.00" "$34,230.00" "$19,853.40" "$34,230.00" "$20,538.00" "$34,230.00" "$34,230.00" "$34,230.00" N/A N/A 27800017 EAP HCPCS C1752 MAHURKAR ELITE SE CATHETER ONLY 16CM BOTH IP/OP $121.00 $90.00 $25.22 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $25.22 $121.00 $48.40 $121.00 $121.00 $121.00 $121.00 $121.00 $90.75 $121.00 $121.00 $121.00 $60.50 $60.50 $95.83 $121.00 $96.80 $54.45 $121.00 $121.00 $70.18 $121.00 $72.60 $121.00 $121.00 $121.00 N/A N/A 27800018 EAP HCPCS C1752 MAHURKAR ELITE SE CATHETER ONLY 20CM BOTH IP/OP $127.00 $94.00 $26.47 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $26.47 $127.00 $50.80 $127.00 $127.00 $127.00 $127.00 $127.00 $95.25 $127.00 $127.00 $127.00 $63.50 $63.50 $100.58 $127.00 $101.60 $57.15 $127.00 $127.00 $73.66 $127.00 $76.20 $127.00 $127.00 $127.00 N/A N/A 27800019 EAP HCPCS C1752 MAHURKAR ELITE SE CATHETER ONLY 24CM BOTH IP/OP $121.00 $90.00 $25.22 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $121.00 $25.22 $121.00 $48.40 $121.00 $121.00 $121.00 $121.00 $121.00 $90.75 $121.00 $121.00 $121.00 $60.50 $60.50 $95.83 $121.00 $96.80 $54.45 $121.00 $121.00 $70.18 $121.00 $72.60 $121.00 $121.00 $121.00 N/A N/A 27800020 EAP HCPCS C1874 STENT TRACHEOBRONCHIAL 16MM CVR ICAST 120CM 7MM 7F BOTH IP/OP "$6,009.00" "$4,447.00" "$1,192.64" "$6,009.00" "$2,704.05" "$2,704.05" "$2,704.05" "$2,704.05" "$6,009.00" "$6,009.00" "$6,009.00" "$1,252.43" "$6,009.00" "$6,009.00" "$6,009.00" "$6,009.00" "$6,009.00" "$1,252.34" "$6,009.00" "$6,009.00" "$2,962.44" "$6,009.00" "$6,009.00" "$6,009.00" "$6,009.00" "$4,506.75" "$6,009.00" "$6,009.00" "$6,009.00" "$3,004.50" "$3,004.50" "$4,759.13" "$6,009.00" "$4,807.20" "$2,704.05" "$1,192.64" "$6,009.00" "$3,485.22" "$6,009.00" "$6,009.00" "$6,009.00" "$1,252.28" "$6,009.00" N/A N/A 27800021 EAP HCPCS C2616 "YTTRIUM-90,PER SOURCE" BOTH IP/OP "$60,196.00" "$44,545.50" "$7,712.84" "$60,196.00" "$27,088.20" "$27,088.20" "$27,088.20" "$27,088.20" "$17,763.21" "$17,763.21" "$17,763.21" "$9,417.94" "$17,763.21" "$60,196.00" "$60,196.00" "$60,196.00" "$60,196.00" "$12,545.51" "$28,421.14" "$25,404.88" "$29,676.63" "$17,763.21" "$60,196.00" "$17,763.21" "$18,651.37" "$45,147.00" "$17,763.21" "$17,763.21" "$17,763.21" "$30,098.00" "$30,098.00" "$47,675.23" "$17,763.21" "$48,156.80" "$27,088.20" "$7,712.84" "$17,763.21" "$34,913.68" "$18,651.37" "$25,756.65" "$17,763.21" "$8,098.48" "$17,763.21" N/A N/A 27800022 EAP HCPCS C1874 STENT ENDOPRSTH 5CM 5MM HEP NTNL EPTFE VBHN 120CM BOTH IP/OP "$8,123.00" "$6,011.50" "$1,612.21" "$8,123.00" "$3,655.35" "$3,655.35" "$3,655.35" "$3,655.35" "$8,123.00" "$8,123.00" "$8,123.00" "$1,693.04" "$8,123.00" "$8,123.00" "$8,123.00" "$8,123.00" "$8,123.00" "$1,692.92" "$8,123.00" "$8,123.00" "$4,004.64" "$8,123.00" "$8,123.00" "$8,123.00" "$8,123.00" "$6,092.25" "$8,123.00" "$8,123.00" "$8,123.00" "$4,061.50" "$4,061.50" "$6,433.42" "$8,123.00" "$6,498.40" "$3,655.35" "$1,612.21" "$8,123.00" "$4,711.34" "$8,123.00" "$4,873.80" "$8,123.00" "$1,692.83" "$8,123.00" N/A N/A 27800023 EAP HCPCS C1874 STENT ENDOPRSTH 10CM 5MM HEP NTNL EPTFE VBHN 120CM BOTH IP/OP "$8,123.00" "$6,011.50" "$1,612.21" "$8,123.00" "$3,655.35" "$3,655.35" "$3,655.35" "$3,655.35" "$8,123.00" "$8,123.00" "$8,123.00" "$1,693.04" "$8,123.00" "$8,123.00" "$8,123.00" "$8,123.00" "$8,123.00" "$1,692.92" "$8,123.00" "$8,123.00" "$4,004.64" "$8,123.00" "$8,123.00" "$8,123.00" "$8,123.00" "$6,092.25" "$8,123.00" "$8,123.00" "$8,123.00" "$4,061.50" "$4,061.50" "$6,433.42" "$8,123.00" "$6,498.40" "$3,655.35" "$1,612.21" "$8,123.00" "$4,711.34" "$8,123.00" "$4,873.80" "$8,123.00" "$1,692.83" "$8,123.00" N/A N/A 27800024 EAP HCPCS C1874 STENT ENDOPRSTH 5CM 7MM HEP NTNL EPTFE VBHN 120CM BOTH IP/OP "$8,123.00" "$6,011.50" "$1,612.21" "$8,123.00" "$3,655.35" "$3,655.35" "$3,655.35" "$3,655.35" "$8,123.00" "$8,123.00" "$8,123.00" "$1,693.04" "$8,123.00" "$8,123.00" "$8,123.00" "$8,123.00" "$8,123.00" "$1,692.92" "$8,123.00" "$8,123.00" "$4,004.64" "$8,123.00" "$8,123.00" "$8,123.00" "$8,123.00" "$6,092.25" "$8,123.00" "$8,123.00" "$8,123.00" "$4,061.50" "$4,061.50" "$6,433.42" "$8,123.00" "$6,498.40" "$3,655.35" "$1,612.21" "$8,123.00" "$4,711.34" "$8,123.00" "$4,873.80" "$8,123.00" "$1,692.83" "$8,123.00" N/A N/A 27800025 EAP HCPCS C1874 STENT ENDOPRSTH 10CM 7MM HEP NTNL EPTFE VBHN 120CM BOTH IP/OP "$8,123.00" "$6,011.50" "$1,612.21" "$8,123.00" "$3,655.35" "$3,655.35" "$3,655.35" "$3,655.35" "$8,123.00" "$8,123.00" "$8,123.00" "$1,693.04" "$8,123.00" "$8,123.00" "$8,123.00" "$8,123.00" "$8,123.00" "$1,692.92" "$8,123.00" "$8,123.00" "$4,004.64" "$8,123.00" "$8,123.00" "$8,123.00" "$8,123.00" "$6,092.25" "$8,123.00" "$8,123.00" "$8,123.00" "$4,061.50" "$4,061.50" "$6,433.42" "$8,123.00" "$6,498.40" "$3,655.35" "$1,612.21" "$8,123.00" "$4,711.34" "$8,123.00" "$8,123.00" "$8,123.00" "$1,692.83" "$8,123.00" N/A N/A 27800026 EAP HCPCS C1757 MINDFRAME CAPTURE LP 3X2 REVASCULARIZATION DEVICE BOTH IP/OP "$11,643.00" "$8,616.00" "$2,310.84" "$11,643.00" "$5,239.35" "$5,239.35" "$5,239.35" "$5,239.35" "$11,643.00" "$11,643.00" "$11,643.00" "$2,426.69" "$11,643.00" "$11,643.00" "$11,643.00" "$11,643.00" "$11,643.00" "$2,426.53" "$11,643.00" "$11,643.00" "$5,740.00" "$11,643.00" "$11,643.00" "$11,643.00" "$11,643.00" "$8,732.25" "$11,643.00" "$11,643.00" "$11,643.00" "$5,821.50" "$5,821.50" "$9,221.26" "$11,643.00" "$9,314.40" "$5,239.35" "$2,310.84" "$11,643.00" "$6,752.94" "$11,643.00" "$11,643.00" "$11,643.00" "$2,426.40" "$11,643.00" N/A N/A 27800029 EAP HCPCS C1876 STENT VASC 13MM 2.5MM LVIS JR INTRLUM NTNL 3 FLR BOTH IP/OP "$17,219.00" "$12,742.50" "$3,417.54" "$17,219.00" "$7,748.55" "$7,748.55" "$7,748.55" "$7,748.55" "$17,219.00" "$17,219.00" "$17,219.00" "$3,588.87" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$3,588.63" "$17,219.00" "$17,219.00" "$8,488.97" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$12,914.25" "$17,219.00" "$17,219.00" "$17,219.00" "$8,609.50" "$8,609.50" "$13,637.45" "$17,219.00" "$13,775.20" "$7,748.55" "$3,417.54" "$17,219.00" "$9,987.02" "$17,219.00" "$10,331.40" "$17,219.00" "$3,588.44" "$17,219.00" N/A N/A 27800030 EAP HCPCS C1876 STENT VASC 17MM 2.5MM LVIS JR INTRLUM NTNL 3 FLR BOTH IP/OP "$17,219.00" "$12,742.50" "$3,417.54" "$17,219.00" "$7,748.55" "$7,748.55" "$7,748.55" "$7,748.55" "$17,219.00" "$17,219.00" "$17,219.00" "$3,588.87" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$3,588.63" "$17,219.00" "$17,219.00" "$8,488.97" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$12,914.25" "$17,219.00" "$17,219.00" "$17,219.00" "$8,609.50" "$8,609.50" "$13,637.45" "$17,219.00" "$13,775.20" "$7,748.55" "$3,417.54" "$17,219.00" "$9,987.02" "$17,219.00" "$17,219.00" "$17,219.00" "$3,588.44" "$17,219.00" N/A N/A 27800031 EAP HCPCS C1876 STENT VASC 23MM 2.5MM LVIS JR INTRLUM NTNL 3 FLR BOTH IP/OP "$17,219.00" "$12,742.50" "$3,417.54" "$17,219.00" "$7,748.55" "$7,748.55" "$7,748.55" "$7,748.55" "$17,219.00" "$17,219.00" "$17,219.00" "$3,588.87" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$3,588.63" "$17,219.00" "$17,219.00" "$8,488.97" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$12,914.25" "$17,219.00" "$17,219.00" "$17,219.00" "$8,609.50" "$8,609.50" "$13,637.45" "$17,219.00" "$13,775.20" "$7,748.55" "$3,417.54" "$17,219.00" "$9,987.02" "$17,219.00" "$17,219.00" "$17,219.00" "$3,588.44" "$17,219.00" N/A N/A 27800032 EAP HCPCS C1876 STENT VASC 34MM 2.5MM LVIS JR INTRLUM NTNL 3 FLR BOTH IP/OP "$17,219.00" "$12,742.50" "$3,417.54" "$17,219.00" "$7,748.55" "$7,748.55" "$7,748.55" "$7,748.55" "$17,219.00" "$17,219.00" "$17,219.00" "$3,588.87" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$3,588.63" "$17,219.00" "$17,219.00" "$8,488.97" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$12,914.25" "$17,219.00" "$17,219.00" "$17,219.00" "$8,609.50" "$8,609.50" "$13,637.45" "$17,219.00" "$13,775.20" "$7,748.55" "$3,417.54" "$17,219.00" "$9,987.02" "$17,219.00" "$17,219.00" "$17,219.00" "$3,588.44" "$17,219.00" N/A N/A 27800033 EAP HCPCS C1764 SYSTEM CRD MONITR RVL IMPLTABLE INS LOOP BOTH IP/OP "$13,900.00" "$10,286.00" "$2,758.80" "$13,900.00" "$6,255.00" "$6,255.00" "$6,255.00" "$6,255.00" "$13,900.00" "$13,900.00" "$13,900.00" "$2,897.11" "$13,900.00" "$13,900.00" "$13,900.00" "$13,900.00" "$13,900.00" "$2,896.91" "$13,900.00" "$13,900.00" "$6,852.70" "$13,900.00" "$13,900.00" "$13,900.00" "$13,900.00" "$10,425.00" "$13,900.00" "$13,900.00" "$13,900.00" "$6,950.00" "$6,950.00" "$11,008.80" "$13,900.00" "$11,120.00" "$6,255.00" "$2,758.80" "$13,900.00" "$8,062.00" "$13,900.00" "$13,900.00" "$13,900.00" "$2,896.76" "$13,900.00" N/A N/A 27800035 EAP HCPCS C1778 LEAD NRSTM 50CM PRCS .014IN TRL LNR STR TIP PRELD BOTH IP/OP "$1,250.00" $925.00 $260.51 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" "$1,250.00" $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 27800039 EAP HCPCS C1876 STENT ENDO 100CM 12MM 8FR 60MM 75CM FLEXIBLE DELIV BOTH IP/OP "$2,625.00" "$1,942.50" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 "$2,625.00" "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 27800040 EAP HCPCS C1876 STENT ENDO 100CM 14MM 40MM 75CM UNCONSTRAIN FLEX BOTH IP/OP "$2,625.00" "$1,942.50" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 "$2,625.00" "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 27800041 EAP HCPCS C1876 STENT ENDO 100CM 14MM 9FR 60MM 75CM CATH BOTH IP/OP "$2,625.00" "$1,942.50" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 "$2,625.00" "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 27800042 EAP HCPCS C1874 STENT ENDOPRSTH 8MM 7FR 5CM 120CM DELIVERY SYSTEM BOTH IP/OP "$7,738.00" "$5,726.50" "$1,535.80" "$7,738.00" "$3,482.10" "$3,482.10" "$3,482.10" "$3,482.10" "$7,738.00" "$7,738.00" "$7,738.00" "$1,612.79" "$7,738.00" "$7,738.00" "$7,738.00" "$7,738.00" "$7,738.00" "$1,612.68" "$7,738.00" "$7,738.00" "$3,814.83" "$7,738.00" "$7,738.00" "$7,738.00" "$7,738.00" "$5,803.50" "$7,738.00" "$7,738.00" "$7,738.00" "$3,869.00" "$3,869.00" "$6,128.50" "$7,738.00" "$6,190.40" "$3,482.10" "$1,535.80" "$7,738.00" "$4,488.04" "$7,738.00" "$7,738.00" "$7,738.00" "$1,612.60" "$7,738.00" N/A N/A 27800043 EAP HCPCS C1876 STENT VASC 6.5MM 6FR 100MM 120CM OTW SLF BOTH IP/OP "$1,988.00" "$1,471.50" $394.57 "$1,988.00" $894.60 $894.60 $894.60 $894.60 "$1,988.00" "$1,988.00" "$1,988.00" $414.35 "$1,988.00" "$1,988.00" "$1,988.00" "$1,988.00" "$1,988.00" $414.32 "$1,988.00" "$1,988.00" "$1,175.90" "$1,988.00" "$1,988.00" "$1,988.00" "$1,988.00" "$1,491.00" "$1,988.00" "$1,988.00" "$1,988.00" $994.00 $994.00 "$1,574.50" "$1,988.00" "$1,590.40" $894.60 $394.57 "$1,988.00" "$1,153.04" "$1,988.00" "$1,988.00" "$1,988.00" $414.30 "$1,988.00" N/A N/A 27800044 EAP HCPCS C1874 GRAFT EVAS 32MM 8.1MM 20FR 124MM ZNTH 2 INTNL STNT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27800045 EAP HCPCS C1874 GRAFT EVAS 2 BRCH 12MM 8.1MM 20FR 91MM 62MM ZNTH I BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27800046 EAP SPACE OAR HYDROGEL BOTH IP/OP "$7,125.00" "$5,272.50" "$1,268.25" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$1,268.25" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$1,484.93" "$7,125.00" "$2,850.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$5,343.75" "$7,125.00" "$7,125.00" "$7,125.00" "$3,562.50" "$3,562.50" "$5,643.00" "$7,125.00" "$5,700.00" "$3,206.25" "$7,125.00" "$7,125.00" "$4,132.50" "$7,125.00" "$4,275.00" "$7,125.00" "$7,125.00" "$7,125.00" N/A N/A 27800053 EAP HCPCS C1757 ACE68 REPERFUSION CATHETER KIT BOTH IP/OP "$6,988.00" "$5,171.50" "$1,386.94" "$6,988.00" "$3,144.60" "$3,144.60" "$3,144.60" "$3,144.60" "$6,988.00" "$6,988.00" "$6,988.00" "$1,456.47" "$6,988.00" "$6,988.00" "$6,988.00" "$6,988.00" "$6,988.00" "$1,456.38" "$6,988.00" "$6,988.00" "$3,445.08" "$6,988.00" "$6,988.00" "$6,988.00" "$6,988.00" "$5,241.00" "$6,988.00" "$6,988.00" "$6,988.00" "$3,494.00" "$3,494.00" "$5,534.50" "$6,988.00" "$5,590.40" "$3,144.60" "$1,386.94" "$6,988.00" "$4,053.04" "$6,988.00" "$4,192.80" "$6,988.00" "$1,456.30" "$6,988.00" N/A N/A 27800055 EAP HCPCS C1880 OPTION ELITE VENA CAVA FILTER SYSTEM BOTH IP/OP "$2,941.00" "$2,176.50" $612.94 "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" $612.94 "$2,941.00" "$1,176.40" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,205.75" "$2,941.00" "$2,941.00" "$2,941.00" "$1,470.50" "$1,470.50" "$2,329.27" "$2,941.00" "$2,352.80" "$1,323.45" "$2,941.00" "$2,941.00" "$1,705.78" "$2,941.00" "$1,764.60" "$2,941.00" "$2,941.00" "$2,941.00" N/A N/A 27800056 EAP Custom 27800056 COIL EMBL 3CM 2MM NST 4.8 LOOP SFT ENH RADOPC MCIOL .01N BOTH IP/OP $279.00 $206.50 $49.66 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $49.66 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $58.15 $279.00 $111.60 $279.00 $279.00 $279.00 $279.00 $279.00 $209.25 $279.00 $279.00 $279.00 $139.50 $139.50 $220.97 $279.00 $223.20 $125.55 $279.00 $279.00 $161.82 $279.00 $167.40 $279.00 $279.00 $279.00 N/A N/A 27800057 EAP Custom 27800057 COIL EMBL 3CM 3MM NST 3.2 LOOP SFT ENH RADOPC MCIOL .01N BOTH IP/OP $279.00 $206.50 $49.66 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $49.66 $279.00 $279.00 $279.00 $279.00 $279.00 $279.00 $58.15 $279.00 $111.60 $279.00 $279.00 $279.00 $279.00 $279.00 $209.25 $279.00 $279.00 $279.00 $139.50 $139.50 $220.97 $279.00 $223.20 $125.55 $279.00 $279.00 $161.82 $279.00 $167.40 $279.00 $279.00 $279.00 N/A N/A 27800058 EAP Custom 27800058 COIL EMBL 5CM 3MM NST 5.3 LOOP SFT ENH RADOPC MCIOL .01N BOTH IP/OP $271.00 $201.00 $48.24 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $48.24 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $56.48 $271.00 $108.40 $271.00 $271.00 $271.00 $271.00 $271.00 $203.25 $271.00 $271.00 $271.00 $135.50 $135.50 $214.63 $271.00 $216.80 $121.95 $271.00 $271.00 $157.18 $271.00 $162.60 $271.00 $271.00 $271.00 N/A N/A 27800059 EAP Custom 27800059 COIL EMBL 7CM 6MM NST 3.7 LOOP SFT ENH RADOPC .035IN PLN BOTH IP/OP $294.00 $218.00 $52.33 $294.00 $294.00 $294.00 $294.00 $294.00 $294.00 $294.00 $52.33 $294.00 $294.00 $294.00 $294.00 $294.00 $294.00 $61.27 $294.00 $117.60 $294.00 $294.00 $294.00 $294.00 $294.00 $220.50 $294.00 $294.00 $294.00 $147.00 $147.00 $232.85 $294.00 $235.20 $132.30 $294.00 $294.00 $170.52 $294.00 $176.40 $294.00 $294.00 $294.00 N/A N/A 27800060 EAP Custom 27800060 COIL EMBL 7CM 8MM NST 2.8 LOOP SFT ENH RADOPC .035IN PLN BOTH IP/OP $294.00 $218.00 $52.33 $294.00 $294.00 $294.00 $294.00 $294.00 $294.00 $294.00 $52.33 $294.00 $294.00 $294.00 $294.00 $294.00 $294.00 $61.27 $294.00 $117.60 $294.00 $294.00 $294.00 $294.00 $294.00 $220.50 $294.00 $294.00 $294.00 $147.00 $147.00 $232.85 $294.00 $235.20 $132.30 $294.00 $294.00 $170.52 $294.00 $176.40 $294.00 $294.00 $294.00 N/A N/A 27800061 EAP Custom 27800061 COIL EMBL 14CM 16MM NST 2.8 LOOP SFT ENH RADOPC .035IN N BOTH IP/OP $320.00 $237.00 $56.96 $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $56.96 $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $66.69 $320.00 $128.00 $320.00 $320.00 $320.00 $320.00 $320.00 $240.00 $320.00 $320.00 $320.00 $160.00 $160.00 $253.44 $320.00 $256.00 $144.00 $320.00 $320.00 $185.60 $320.00 $192.00 $320.00 $320.00 $320.00 N/A N/A 27800062 EAP HCPCS C1874 DRUG ELUTING STENT BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 27800063 EAP HCPCS C1876 BARE METAL STENT BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 27800064 EAP HCPCS C1894 GLIDESHEATH SLENDER SS (.021) 5FR 10CM BOTH IP/OP $138.00 $102.50 $27.39 $138.00 $62.10 $62.10 $62.10 $62.10 $138.00 $138.00 $138.00 $28.76 $138.00 $138.00 $138.00 $138.00 $138.00 $28.76 $138.00 $138.00 $81.63 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $62.10 $27.39 $138.00 $80.04 $138.00 $138.00 $138.00 $28.76 $138.00 N/A N/A 27800065 EAP HCPCS C1894 GLIDESHEATH SLENDER SS (.021) 7FR 10CM BOTH IP/OP $138.00 $102.50 $27.39 $138.00 $62.10 $62.10 $62.10 $62.10 $138.00 $138.00 $138.00 $28.76 $138.00 $138.00 $138.00 $138.00 $138.00 $28.76 $138.00 $138.00 $81.63 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $62.10 $27.39 $138.00 $80.04 $138.00 $138.00 $138.00 $28.76 $138.00 N/A N/A 27800066 EAP HCPCS A4648 VISICOIL LUNG GOLD SEEDS 0.50MM X 0.50CM LENGTH BOTH IP/OP $338.00 $250.50 $67.08 $338.00 $152.10 $152.10 $152.10 $152.10 $338.00 $338.00 $338.00 $70.45 $338.00 $338.00 $338.00 $338.00 $338.00 $70.44 $338.00 $338.00 $199.93 $338.00 $338.00 $338.00 $338.00 $253.50 $338.00 $338.00 $338.00 $169.00 $169.00 $267.70 $338.00 $270.40 $152.10 $67.08 $338.00 $196.04 $338.00 $338.00 $338.00 $70.44 $338.00 N/A N/A 27800100 EAP CATHETER DLV SYS 130CM 5FR .04IN NEURON .035IN BOTH IP/OP $329.00 $243.50 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $58.56 $329.00 $329.00 $329.00 $329.00 $329.00 $329.00 $68.57 $329.00 $131.60 $329.00 $329.00 $329.00 $329.00 $329.00 $246.75 $329.00 $329.00 $329.00 $164.50 $164.50 $260.57 $329.00 $263.20 $148.05 $329.00 $329.00 $190.82 $329.00 $197.40 $329.00 $329.00 $329.00 N/A N/A 27800101 EAP HCPCS C1817 OCCLUDER CARDIO 15MM SPT SFT WIRE FRM FLRSCP IMG BOTH IP/OP "$17,493.00" "$12,945.00" "$3,645.73" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$3,645.73" "$17,493.00" "$6,997.20" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$13,119.75" "$17,493.00" "$17,493.00" "$17,493.00" "$8,746.50" "$8,746.50" "$13,854.46" "$17,493.00" "$13,994.40" "$7,871.85" "$17,493.00" "$17,493.00" "$10,145.94" "$17,493.00" "$10,495.80" "$17,493.00" "$17,493.00" "$17,493.00" N/A N/A 27800102 EAP HCPCS C1817 OCCLUDER CARDIO 20MM SPT SFT WIRE FRM FLRSCP IMG BOTH IP/OP "$17,493.00" "$12,945.00" "$3,645.73" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$3,645.73" "$17,493.00" "$6,997.20" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$13,119.75" "$17,493.00" "$17,493.00" "$17,493.00" "$8,746.50" "$8,746.50" "$13,854.46" "$17,493.00" "$13,994.40" "$7,871.85" "$17,493.00" "$17,493.00" "$10,145.94" "$17,493.00" "$10,495.80" "$17,493.00" "$17,493.00" "$17,493.00" N/A N/A 27800103 EAP HCPCS C1817 OCCLUDER CARDIO 25MM SPT SFT WIRE FRM FLRSCP IMG BOTH IP/OP "$17,493.00" "$12,945.00" "$3,645.73" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$3,645.73" "$17,493.00" "$6,997.20" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$13,119.75" "$17,493.00" "$17,493.00" "$17,493.00" "$8,746.50" "$8,746.50" "$13,854.46" "$17,493.00" "$13,994.40" "$7,871.85" "$17,493.00" "$17,493.00" "$10,145.94" "$17,493.00" "$10,495.80" "$17,493.00" "$17,493.00" "$17,493.00" N/A N/A 27800104 EAP HCPCS C1817 OCCLUDER CARDIO 30MM SPT SFT WIRE FRM FLRSCP IMG BOTH IP/OP "$17,493.00" "$12,945.00" "$3,645.73" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$3,645.73" "$17,493.00" "$6,997.20" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$17,493.00" "$13,119.75" "$17,493.00" "$17,493.00" "$17,493.00" "$8,746.50" "$8,746.50" "$13,854.46" "$17,493.00" "$13,994.40" "$7,871.85" "$17,493.00" "$17,493.00" "$10,145.94" "$17,493.00" "$10,495.80" "$17,493.00" "$17,493.00" "$17,493.00" N/A N/A 27801001 EAP HCPCS C1721 LIVIAN DUAL CRT-D DEVICE BOTH IP/OP "$102,209.00" "$75,635.00" "$21,301.48" "$102,209.00" "$102,209.00" "$102,209.00" "$102,209.00" "$102,209.00" "$102,209.00" "$102,209.00" "$102,209.00" "$102,209.00" "$102,209.00" "$102,209.00" "$102,209.00" "$102,209.00" "$102,209.00" "$21,301.48" "$102,209.00" "$40,883.60" "$102,209.00" "$102,209.00" "$102,209.00" "$102,209.00" "$102,209.00" "$76,656.75" "$102,209.00" "$102,209.00" "$102,209.00" "$51,104.50" "$51,104.50" "$80,949.53" "$102,209.00" "$81,767.20" "$45,994.05" "$102,209.00" "$102,209.00" "$59,281.22" "$102,209.00" "$61,325.40" "$102,209.00" "$102,209.00" "$102,209.00" N/A N/A 27801002 EAP HCPCS C1721 ENTRUST AT DUAL ICD BOTH IP/OP "$63,028.00" "$46,641.00" "$13,135.73" "$63,028.00" "$63,028.00" "$63,028.00" "$63,028.00" "$63,028.00" "$63,028.00" "$63,028.00" "$63,028.00" "$63,028.00" "$63,028.00" "$63,028.00" "$63,028.00" "$63,028.00" "$63,028.00" "$13,135.73" "$63,028.00" "$25,211.20" "$63,028.00" "$63,028.00" "$63,028.00" "$63,028.00" "$63,028.00" "$47,271.00" "$63,028.00" "$63,028.00" "$63,028.00" "$31,514.00" "$31,514.00" "$49,918.18" "$63,028.00" "$50,422.40" "$28,362.60" "$63,028.00" "$63,028.00" "$36,556.24" "$63,028.00" "$37,816.80" "$63,028.00" "$63,028.00" "$63,028.00" N/A N/A 27801003 EAP HCPCS C1721 MAXIMO DR DUAL ICD BOTH IP/OP "$48,414.00" "$35,826.50" "$10,090.01" "$48,414.00" "$48,414.00" "$48,414.00" "$48,414.00" "$48,414.00" "$48,414.00" "$48,414.00" "$48,414.00" "$48,414.00" "$48,414.00" "$48,414.00" "$48,414.00" "$48,414.00" "$48,414.00" "$10,090.01" "$48,414.00" "$19,365.60" "$48,414.00" "$48,414.00" "$48,414.00" "$48,414.00" "$48,414.00" "$36,310.50" "$48,414.00" "$48,414.00" "$48,414.00" "$24,207.00" "$24,207.00" "$38,343.89" "$48,414.00" "$38,731.20" "$21,786.30" "$48,414.00" "$48,414.00" "$28,080.12" "$48,414.00" "$29,048.40" "$48,414.00" "$48,414.00" "$48,414.00" N/A N/A 27801004 EAP HCPCS C1722 ENTRUST VR SINGLE ICD BOTH IP/OP "$51,104.00" "$37,817.00" "$7,712.84" "$51,104.00" "$22,996.80" "$22,996.80" "$22,996.80" "$22,996.80" "$51,104.00" "$51,104.00" "$51,104.00" "$9,417.94" "$51,104.00" "$51,104.00" "$51,104.00" "$51,104.00" "$51,104.00" "$10,650.64" "$51,104.00" "$51,104.00" "$25,194.27" "$51,104.00" "$51,104.00" "$51,104.00" "$51,104.00" "$38,328.00" "$51,104.00" "$51,104.00" "$51,104.00" "$25,552.00" "$25,552.00" "$40,474.37" "$51,104.00" "$40,883.20" "$22,996.80" "$7,712.84" "$51,104.00" "$29,640.32" "$51,104.00" "$51,104.00" "$51,104.00" "$8,098.48" "$51,104.00" N/A N/A 27801005 EAP HCPCS C1722 MAXIMO VR SINDLE ICD BOTH IP/OP "$39,450.00" "$29,193.00" "$7,712.84" "$39,450.00" "$17,752.50" "$17,752.50" "$17,752.50" "$17,752.50" "$39,450.00" "$39,450.00" "$39,450.00" "$8,222.37" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$8,221.81" "$39,450.00" "$39,450.00" "$19,448.85" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$29,587.50" "$39,450.00" "$39,450.00" "$39,450.00" "$19,725.00" "$19,725.00" "$31,244.40" "$39,450.00" "$31,560.00" "$17,752.50" "$7,712.84" "$39,450.00" "$22,881.00" "$39,450.00" "$39,450.00" "$39,450.00" "$8,098.48" "$39,450.00" N/A N/A 27801007 EAP HCPCS C1721 VENTAK PRIZM DR ICD BOTH IP/OP "$53,793.00" "$39,807.00" "$11,211.05" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$11,211.05" "$53,793.00" "$21,517.20" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$40,344.75" "$53,793.00" "$53,793.00" "$53,793.00" "$26,896.50" "$26,896.50" "$42,604.06" "$53,793.00" "$43,034.40" "$24,206.85" "$53,793.00" "$53,793.00" "$31,199.94" "$53,793.00" "$32,275.80" "$53,793.00" "$53,793.00" "$53,793.00" N/A N/A 27801008 EAP HCPCS C1895 SPRINT 6947 RV LEAD BOTH IP/OP "$16,139.00" "$11,943.00" "$3,203.19" "$16,139.00" "$7,262.55" "$7,262.55" "$7,262.55" "$7,262.55" "$16,139.00" "$16,139.00" "$16,139.00" "$3,363.77" "$16,139.00" "$16,139.00" "$16,139.00" "$16,139.00" "$16,139.00" "$3,363.55" "$16,139.00" "$16,139.00" "$7,956.53" "$16,139.00" "$16,139.00" "$16,139.00" "$16,139.00" "$12,104.25" "$16,139.00" "$16,139.00" "$16,139.00" "$8,069.50" "$8,069.50" "$12,782.09" "$16,139.00" "$12,911.20" "$7,262.55" "$3,203.19" "$16,139.00" "$9,360.62" "$16,139.00" "$16,139.00" "$16,139.00" "$3,363.37" "$16,139.00" N/A N/A 27801009 EAP HCPCS C1895 LINOX SD LEAD BOTH IP/OP "$10,761.00" "$7,963.50" "$2,135.79" "$10,761.00" "$4,842.45" "$4,842.45" "$4,842.45" "$4,842.45" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.86" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.71" "$10,761.00" "$10,761.00" "$5,305.17" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$8,070.75" "$10,761.00" "$10,761.00" "$10,761.00" "$5,380.50" "$5,380.50" "$8,522.71" "$10,761.00" "$8,608.80" "$4,842.45" "$2,135.79" "$10,761.00" "$6,241.38" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.59" "$10,761.00" N/A N/A 27801010 EAP HCPCS C1895 ISOLINE PASSIVE FIX LEAD BOTH IP/OP "$15,063.00" "$11,147.00" "$2,989.63" "$15,063.00" "$6,778.35" "$6,778.35" "$6,778.35" "$6,778.35" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.51" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.29" "$15,063.00" "$15,063.00" "$7,426.06" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$11,297.25" "$15,063.00" "$15,063.00" "$15,063.00" "$7,531.50" "$7,531.50" "$11,929.90" "$15,063.00" "$12,050.40" "$6,778.35" "$2,989.63" "$15,063.00" "$8,736.54" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.13" "$15,063.00" N/A N/A 27801011 EAP HCPCS C1895 TACHYCARDIA LEAD BOTH IP/OP "$15,063.00" "$11,147.00" "$2,989.63" "$15,063.00" "$6,778.35" "$6,778.35" "$6,778.35" "$6,778.35" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.51" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.29" "$15,063.00" "$15,063.00" "$7,426.06" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$11,297.25" "$15,063.00" "$15,063.00" "$15,063.00" "$7,531.50" "$7,531.50" "$11,929.90" "$15,063.00" "$12,050.40" "$6,778.35" "$2,989.63" "$15,063.00" "$8,736.54" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.13" "$15,063.00" N/A N/A 27801012 EAP HCPCS C1895 7120 DURATA PKG LEAD BOTH IP/OP "$15,063.00" "$11,147.00" "$2,989.63" "$15,063.00" "$6,778.35" "$6,778.35" "$6,778.35" "$6,778.35" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.51" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.29" "$15,063.00" "$15,063.00" "$7,426.06" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$11,297.25" "$15,063.00" "$15,063.00" "$15,063.00" "$7,531.50" "$7,531.50" "$11,929.90" "$15,063.00" "$12,050.40" "$6,778.35" "$2,989.63" "$15,063.00" "$8,736.54" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.13" "$15,063.00" N/A N/A 27801013 EAP HCPCS C1721 ATLAS PLUS DR DUAL ICD BOTH IP/OP "$50,207.00" "$37,153.50" "$10,463.69" "$50,207.00" "$50,207.00" "$50,207.00" "$50,207.00" "$50,207.00" "$50,207.00" "$50,207.00" "$50,207.00" "$50,207.00" "$50,207.00" "$50,207.00" "$50,207.00" "$50,207.00" "$50,207.00" "$10,463.69" "$50,207.00" "$20,082.80" "$50,207.00" "$50,207.00" "$50,207.00" "$50,207.00" "$50,207.00" "$37,655.25" "$50,207.00" "$50,207.00" "$50,207.00" "$25,103.50" "$25,103.50" "$39,763.94" "$50,207.00" "$40,165.60" "$22,593.15" "$50,207.00" "$50,207.00" "$29,120.06" "$50,207.00" "$30,124.20" "$50,207.00" "$50,207.00" "$50,207.00" N/A N/A 27801014 EAP HCPCS C1722 ATLAS PLUS VR SNGL ICD BOTH IP/OP "$39,450.00" "$29,193.00" "$7,712.84" "$39,450.00" "$17,752.50" "$17,752.50" "$17,752.50" "$17,752.50" "$39,450.00" "$39,450.00" "$39,450.00" "$8,222.37" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$8,221.81" "$39,450.00" "$39,450.00" "$19,448.85" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$29,587.50" "$39,450.00" "$39,450.00" "$39,450.00" "$19,725.00" "$19,725.00" "$31,244.40" "$39,450.00" "$31,560.00" "$17,752.50" "$7,712.84" "$39,450.00" "$22,881.00" "$39,450.00" "$39,450.00" "$39,450.00" "$8,098.48" "$39,450.00" N/A N/A 27801015 EAP HCPCS C1722 ATLAS PLUS C HEADER ICD BOTH IP/OP "$39,450.00" "$29,193.00" "$7,712.84" "$39,450.00" "$17,752.50" "$17,752.50" "$17,752.50" "$17,752.50" "$39,450.00" "$39,450.00" "$39,450.00" "$8,222.37" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$8,221.81" "$39,450.00" "$39,450.00" "$19,448.85" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$29,587.50" "$39,450.00" "$39,450.00" "$39,450.00" "$19,725.00" "$19,725.00" "$31,244.40" "$39,450.00" "$31,560.00" "$17,752.50" "$7,712.84" "$39,450.00" "$22,881.00" "$39,450.00" "$39,450.00" "$39,450.00" "$8,098.48" "$39,450.00" N/A N/A 27801016 EAP HCPCS C1722 ATLAS II VR SNGL ICD BOTH IP/OP "$39,450.00" "$29,193.00" "$7,712.84" "$39,450.00" "$17,752.50" "$17,752.50" "$17,752.50" "$17,752.50" "$39,450.00" "$39,450.00" "$39,450.00" "$8,222.37" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$8,221.81" "$39,450.00" "$39,450.00" "$19,448.85" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$29,587.50" "$39,450.00" "$39,450.00" "$39,450.00" "$19,725.00" "$19,725.00" "$31,244.40" "$39,450.00" "$31,560.00" "$17,752.50" "$7,712.84" "$39,450.00" "$22,881.00" "$39,450.00" "$39,450.00" "$39,450.00" "$8,098.48" "$39,450.00" N/A N/A 27801017 EAP HCPCS C1722 LUMAX 340 VR-T SINGLE ICD BOTH IP/OP "$39,450.00" "$29,193.00" "$7,712.84" "$39,450.00" "$17,752.50" "$17,752.50" "$17,752.50" "$17,752.50" "$39,450.00" "$39,450.00" "$39,450.00" "$8,222.37" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$8,221.81" "$39,450.00" "$39,450.00" "$19,448.85" "$39,450.00" "$39,450.00" "$39,450.00" "$39,450.00" "$29,587.50" "$39,450.00" "$39,450.00" "$39,450.00" "$19,725.00" "$19,725.00" "$31,244.40" "$39,450.00" "$31,560.00" "$17,752.50" "$7,712.84" "$39,450.00" "$22,881.00" "$39,450.00" "$39,450.00" "$39,450.00" "$8,098.48" "$39,450.00" N/A N/A 27801018 EAP HCPCS C1721 LUMAX 340 DR-T DUAL ICD BOTH IP/OP "$46,622.00" "$34,500.50" "$9,716.54" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$9,716.54" "$46,622.00" "$18,648.80" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$34,966.50" "$46,622.00" "$46,622.00" "$46,622.00" "$23,311.00" "$23,311.00" "$36,924.62" "$46,622.00" "$37,297.60" "$20,979.90" "$46,622.00" "$46,622.00" "$27,040.76" "$46,622.00" "$27,973.20" "$46,622.00" "$46,622.00" "$46,622.00" N/A N/A 27801019 EAP HCPCS C1721 ATLAS II+ DR DUAL ICD BOTH IP/OP "$66,346.00" "$49,096.50" "$13,827.24" "$66,346.00" "$66,346.00" "$66,346.00" "$66,346.00" "$66,346.00" "$66,346.00" "$66,346.00" "$66,346.00" "$66,346.00" "$66,346.00" "$66,346.00" "$66,346.00" "$66,346.00" "$66,346.00" "$13,827.24" "$66,346.00" "$26,538.40" "$66,346.00" "$66,346.00" "$66,346.00" "$66,346.00" "$66,346.00" "$49,759.50" "$66,346.00" "$66,346.00" "$66,346.00" "$33,173.00" "$33,173.00" "$52,546.03" "$66,346.00" "$53,076.80" "$29,855.70" "$66,346.00" "$66,346.00" "$38,480.68" "$66,346.00" "$39,807.60" "$66,346.00" "$66,346.00" "$66,346.00" N/A N/A 27801020 EAP HCPCS C1898 BRADYCARDIA LEAD BOTH IP/OP "$1,920.00" "$1,421.00" $400.15 "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" $400.15 "$1,920.00" $768.00 "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,920.00" "$1,440.00" "$1,920.00" "$1,920.00" "$1,920.00" $960.00 $960.00 "$1,520.64" "$1,920.00" "$1,536.00" $864.00 "$1,920.00" "$1,920.00" "$1,113.60" "$1,920.00" "$1,152.00" "$1,920.00" "$1,920.00" "$1,920.00" N/A N/A 27801021 EAP HCPCS C1721 OVATIO OH60U DR 6550 ICD BOTH IP/OP "$53,793.00" "$39,807.00" "$11,211.05" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$11,211.05" "$53,793.00" "$21,517.20" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$53,793.00" "$40,344.75" "$53,793.00" "$53,793.00" "$53,793.00" "$26,896.50" "$26,896.50" "$42,604.06" "$53,793.00" "$43,034.40" "$24,206.85" "$53,793.00" "$53,793.00" "$31,199.94" "$53,793.00" "$32,275.80" "$53,793.00" "$53,793.00" "$53,793.00" N/A N/A 27801022 EAP HCPCS C1722 OVATIO OH61U VR ICD BOTH IP/OP "$43,036.00" "$31,847.00" "$7,712.84" "$43,036.00" "$19,366.20" "$19,366.20" "$19,366.20" "$19,366.20" "$43,036.00" "$43,036.00" "$43,036.00" "$8,969.78" "$43,036.00" "$43,036.00" "$43,036.00" "$43,036.00" "$43,036.00" "$8,969.18" "$43,036.00" "$43,036.00" "$21,216.75" "$43,036.00" "$43,036.00" "$43,036.00" "$43,036.00" "$32,277.00" "$43,036.00" "$43,036.00" "$43,036.00" "$21,518.00" "$21,518.00" "$34,084.51" "$43,036.00" "$34,428.80" "$19,366.20" "$7,712.84" "$43,036.00" "$24,960.88" "$43,036.00" "$43,036.00" "$43,036.00" "$8,098.48" "$43,036.00" N/A N/A 27801023 EAP HCPCS C1882 OVATIO CRT 6750 ICD BOTH IP/OP "$69,035.00" "$51,086.00" "$7,712.84" "$69,035.00" "$31,065.75" "$31,065.75" "$31,065.75" "$31,065.75" "$69,035.00" "$69,035.00" "$69,035.00" "$9,417.94" "$69,035.00" "$69,035.00" "$69,035.00" "$69,035.00" "$69,035.00" "$14,387.65" "$69,035.00" "$69,035.00" "$34,034.26" "$69,035.00" "$69,035.00" "$69,035.00" "$69,035.00" "$51,776.25" "$69,035.00" "$69,035.00" "$69,035.00" "$34,517.50" "$34,517.50" "$54,675.72" "$69,035.00" "$55,228.00" "$31,065.75" "$7,712.84" "$69,035.00" "$40,040.30" "$69,035.00" "$69,035.00" "$69,035.00" "$8,098.48" "$69,035.00" N/A N/A 27801024 EAP HCPCS C1882 LUMAX 340 HF-T CRT BOTH IP/OP "$63,656.00" "$47,105.50" "$7,712.84" "$63,656.00" "$28,645.20" "$28,645.20" "$28,645.20" "$28,645.20" "$63,656.00" "$63,656.00" "$63,656.00" "$9,417.94" "$63,656.00" "$63,656.00" "$63,656.00" "$63,656.00" "$63,656.00" "$13,266.61" "$63,656.00" "$63,656.00" "$31,382.41" "$63,656.00" "$63,656.00" "$63,656.00" "$63,656.00" "$47,742.00" "$63,656.00" "$63,656.00" "$63,656.00" "$31,828.00" "$31,828.00" "$50,415.55" "$63,656.00" "$50,924.80" "$28,645.20" "$7,712.84" "$63,656.00" "$36,920.48" "$63,656.00" "$63,656.00" "$63,656.00" "$8,098.48" "$63,656.00" N/A N/A 27801025 EAP HCPCS C1882 CONCERTO BI-V ICD BOTH IP/OP "$81,588.00" "$60,375.50" "$7,712.84" "$81,588.00" "$36,714.60" "$36,714.60" "$36,714.60" "$36,714.60" "$81,588.00" "$81,588.00" "$81,588.00" "$9,417.94" "$81,588.00" "$81,588.00" "$81,588.00" "$81,588.00" "$81,588.00" "$17,003.84" "$81,588.00" "$81,588.00" "$40,222.88" "$81,588.00" "$81,588.00" "$81,588.00" "$81,588.00" "$61,191.00" "$81,588.00" "$81,588.00" "$81,588.00" "$40,794.00" "$40,794.00" "$64,617.70" "$81,588.00" "$65,270.40" "$36,714.60" "$7,712.84" "$81,588.00" "$47,321.04" "$81,588.00" "$81,588.00" "$81,588.00" "$8,098.48" "$81,588.00" N/A N/A 27801026 EAP HCPCS C1895 LINOX S 65 BOTH IP/OP "$10,761.00" "$7,963.50" "$2,135.79" "$10,761.00" "$4,842.45" "$4,842.45" "$4,842.45" "$4,842.45" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.86" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.71" "$10,761.00" "$10,761.00" "$5,305.17" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$8,070.75" "$10,761.00" "$10,761.00" "$10,761.00" "$5,380.50" "$5,380.50" "$8,522.71" "$10,761.00" "$8,608.80" "$4,842.45" "$2,135.79" "$10,761.00" "$6,241.38" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.59" "$10,761.00" N/A N/A 27801027 EAP HCPCS C1895 KAINOX S 60 BOTH IP/OP "$10,761.00" "$7,963.50" "$2,135.79" "$10,761.00" "$4,842.45" "$4,842.45" "$4,842.45" "$4,842.45" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.86" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.71" "$10,761.00" "$10,761.00" "$5,305.17" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$8,070.75" "$10,761.00" "$10,761.00" "$10,761.00" "$5,380.50" "$5,380.50" "$8,522.71" "$10,761.00" "$8,608.80" "$4,842.45" "$2,135.79" "$10,761.00" "$6,241.38" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.59" "$10,761.00" N/A N/A 27801028 EAP HCPCS C1882 PROMOTE BI-V BOTH IP/OP "$73,870.00" "$54,664.00" "$7,712.84" "$73,870.00" "$33,241.50" "$33,241.50" "$33,241.50" "$33,241.50" "$73,870.00" "$73,870.00" "$73,870.00" "$9,417.94" "$73,870.00" "$73,870.00" "$73,870.00" "$73,870.00" "$73,870.00" "$15,395.32" "$73,870.00" "$73,870.00" "$36,417.91" "$73,870.00" "$73,870.00" "$73,870.00" "$73,870.00" "$55,402.50" "$73,870.00" "$73,870.00" "$73,870.00" "$36,935.00" "$36,935.00" "$58,505.04" "$73,870.00" "$59,096.00" "$33,241.50" "$7,712.84" "$73,870.00" "$42,844.60" "$73,870.00" "$73,870.00" "$73,870.00" "$8,098.48" "$73,870.00" N/A N/A 27801029 EAP HCPCS C1882 MAXIMO II CRT-D BOTH IP/OP "$77,107.00" "$57,059.50" "$7,712.84" "$77,107.00" "$34,698.15" "$34,698.15" "$34,698.15" "$34,698.15" "$77,107.00" "$77,107.00" "$77,107.00" "$9,417.94" "$77,107.00" "$77,107.00" "$77,107.00" "$77,107.00" "$77,107.00" "$16,069.95" "$77,107.00" "$77,107.00" "$38,013.75" "$77,107.00" "$77,107.00" "$77,107.00" "$77,107.00" "$57,830.25" "$77,107.00" "$77,107.00" "$77,107.00" "$38,553.50" "$38,553.50" "$61,068.74" "$77,107.00" "$61,685.60" "$34,698.15" "$7,712.84" "$77,107.00" "$44,722.06" "$77,107.00" "$77,107.00" "$77,107.00" "$8,098.48" "$77,107.00" N/A N/A 27801030 EAP HCPCS C1895 SETROX S 45 LEAD BOTH IP/OP "$1,793.00" "$1,327.00" $355.87 "$1,793.00" $806.85 $806.85 $806.85 $806.85 "$1,793.00" "$1,793.00" "$1,793.00" $373.71 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" $373.68 "$1,793.00" "$1,793.00" "$1,060.56" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,344.75" "$1,793.00" "$1,793.00" "$1,793.00" $896.50 $896.50 "$1,420.06" "$1,793.00" "$1,434.40" $806.85 $355.87 "$1,793.00" "$1,039.94" "$1,793.00" "$1,793.00" "$1,793.00" $373.66 "$1,793.00" N/A N/A 27801031 EAP HCPCS C1895 SETROX S 53 LEAD BOTH IP/OP "$1,793.00" "$1,327.00" $355.87 "$1,793.00" $806.85 $806.85 $806.85 $806.85 "$1,793.00" "$1,793.00" "$1,793.00" $373.71 "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" $373.68 "$1,793.00" "$1,793.00" "$1,060.56" "$1,793.00" "$1,793.00" "$1,793.00" "$1,793.00" "$1,344.75" "$1,793.00" "$1,793.00" "$1,793.00" $896.50 $896.50 "$1,420.06" "$1,793.00" "$1,434.40" $806.85 $355.87 "$1,793.00" "$1,039.94" "$1,793.00" "$1,793.00" "$1,793.00" $373.66 "$1,793.00" N/A N/A 27801032 EAP HCPCS C1882 PARADYM CRT-D 8750 BOTH IP/OP "$82,842.00" "$61,303.50" "$7,712.84" "$82,842.00" "$37,278.90" "$37,278.90" "$37,278.90" "$37,278.90" "$82,842.00" "$82,842.00" "$82,842.00" "$9,417.94" "$82,842.00" "$82,842.00" "$82,842.00" "$82,842.00" "$82,842.00" "$17,265.18" "$82,842.00" "$82,842.00" "$40,841.11" "$82,842.00" "$82,842.00" "$82,842.00" "$82,842.00" "$62,131.50" "$82,842.00" "$82,842.00" "$82,842.00" "$41,421.00" "$41,421.00" "$65,610.86" "$82,842.00" "$66,273.60" "$37,278.90" "$7,712.84" "$82,842.00" "$48,048.36" "$82,842.00" "$82,842.00" "$82,842.00" "$8,098.48" "$82,842.00" N/A N/A 27801033 EAP HCPCS C1721 MAXIMO II DR DUAL ICD BOTH IP/OP "$55,588.00" "$41,135.50" "$11,585.15" "$55,588.00" "$55,588.00" "$55,588.00" "$55,588.00" "$55,588.00" "$55,588.00" "$55,588.00" "$55,588.00" "$55,588.00" "$55,588.00" "$55,588.00" "$55,588.00" "$55,588.00" "$55,588.00" "$11,585.15" "$55,588.00" "$22,235.20" "$55,588.00" "$55,588.00" "$55,588.00" "$55,588.00" "$55,588.00" "$41,691.00" "$55,588.00" "$55,588.00" "$55,588.00" "$27,794.00" "$27,794.00" "$44,025.70" "$55,588.00" "$44,470.40" "$25,014.60" "$55,588.00" "$55,588.00" "$32,241.04" "$55,588.00" "$33,352.80" "$55,588.00" "$55,588.00" "$55,588.00" N/A N/A 27801034 EAP HCPCS C1722 MAXIMO II VR SINGLE ICD BOTH IP/OP "$46,622.00" "$34,500.50" "$7,712.84" "$46,622.00" "$20,979.90" "$20,979.90" "$20,979.90" "$20,979.90" "$46,622.00" "$46,622.00" "$46,622.00" "$9,417.94" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$9,716.54" "$46,622.00" "$46,622.00" "$22,984.65" "$46,622.00" "$46,622.00" "$46,622.00" "$46,622.00" "$34,966.50" "$46,622.00" "$46,622.00" "$46,622.00" "$23,311.00" "$23,311.00" "$36,924.62" "$46,622.00" "$37,297.60" "$20,979.90" "$7,712.84" "$46,622.00" "$27,040.76" "$46,622.00" "$46,622.00" "$46,622.00" "$8,098.48" "$46,622.00" N/A N/A 27801035 EAP HCPCS C1722 1211-36 CURRENT VR ICD BOTH IP/OP "$59,175.00" "$43,789.50" "$7,712.84" "$59,175.00" "$26,628.75" "$26,628.75" "$26,628.75" "$26,628.75" "$59,175.00" "$59,175.00" "$59,175.00" "$9,417.94" "$59,175.00" "$59,175.00" "$59,175.00" "$59,175.00" "$59,175.00" "$12,332.72" "$59,175.00" "$59,175.00" "$29,173.28" "$59,175.00" "$59,175.00" "$59,175.00" "$59,175.00" "$44,381.25" "$59,175.00" "$59,175.00" "$59,175.00" "$29,587.50" "$29,587.50" "$46,866.60" "$59,175.00" "$47,340.00" "$26,628.75" "$7,712.84" "$59,175.00" "$34,321.50" "$59,175.00" "$59,175.00" "$59,175.00" "$8,098.48" "$59,175.00" N/A N/A 27801040 EAP HCPCS C1880 VENA TECH LP FILTER BOTH IP/OP "$3,618.00" "$2,677.50" $754.03 "$3,618.00" "$3,618.00" "$3,618.00" "$3,618.00" "$3,618.00" "$3,618.00" "$3,618.00" "$3,618.00" "$3,618.00" "$3,618.00" "$3,618.00" "$3,618.00" "$3,618.00" "$3,618.00" $754.03 "$3,618.00" "$1,447.20" "$3,618.00" "$3,618.00" "$3,618.00" "$3,618.00" "$3,618.00" "$2,713.50" "$3,618.00" "$3,618.00" "$3,618.00" "$1,809.00" "$1,809.00" "$2,865.46" "$3,618.00" "$2,894.40" "$1,628.10" "$3,618.00" "$3,618.00" "$2,098.44" "$3,618.00" "$2,170.80" "$3,618.00" "$3,618.00" "$3,618.00" N/A N/A 27801041 EAP HCPCS C1876 6FR-75CM 10X49 WALL BOTH IP/OP "$3,307.00" "$2,447.50" $656.36 "$3,307.00" "$1,488.15" "$1,488.15" "$1,488.15" "$1,488.15" "$3,307.00" "$3,307.00" "$3,307.00" $689.26 "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" $689.22 "$3,307.00" "$3,307.00" "$1,630.35" "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$2,480.25" "$3,307.00" "$3,307.00" "$3,307.00" "$1,653.50" "$1,653.50" "$2,619.14" "$3,307.00" "$2,645.60" "$1,488.15" $656.36 "$3,307.00" "$1,918.06" "$3,307.00" "$3,307.00" "$3,307.00" $689.18 "$3,307.00" N/A N/A 27801042 EAP HCPCS C1876 6FR-8X80-75CMWALLST BOTH IP/OP "$3,307.00" "$2,447.50" $656.36 "$3,307.00" "$1,488.15" "$1,488.15" "$1,488.15" "$1,488.15" "$3,307.00" "$3,307.00" "$3,307.00" $689.26 "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" $689.22 "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$3,307.00" "$2,480.25" "$3,307.00" "$3,307.00" "$3,307.00" "$1,653.50" "$1,653.50" "$2,619.14" "$3,307.00" "$2,645.60" "$1,488.15" $656.36 "$3,307.00" "$1,918.06" "$3,307.00" "$3,307.00" "$3,307.00" $689.18 "$3,307.00" N/A N/A 27801043 EAP HCPCS C1876 7FR-75CM 10X94 WALL BOTH IP/OP "$5,303.00" "$3,924.50" "$1,052.51" "$5,303.00" "$2,386.35" "$2,386.35" "$2,386.35" "$2,386.35" "$5,303.00" "$5,303.00" "$5,303.00" "$1,105.28" "$5,303.00" "$5,303.00" "$5,303.00" "$5,303.00" "$5,303.00" "$1,105.20" "$5,303.00" "$5,303.00" "$5,303.00" "$5,303.00" "$5,303.00" "$5,303.00" "$5,303.00" "$3,977.25" "$5,303.00" "$5,303.00" "$5,303.00" "$2,651.50" "$2,651.50" "$4,199.98" "$5,303.00" "$4,242.40" "$2,386.35" "$1,052.51" "$5,303.00" "$3,075.74" "$5,303.00" "$5,303.00" "$5,303.00" "$1,105.15" "$5,303.00" N/A N/A 27801044 EAP HCPCS C2625 8FR-26CM URETERAL S BOTH IP/OP $404.00 $299.00 $80.18 $404.00 $181.80 $181.80 $181.80 $181.80 $404.00 $404.00 $404.00 $84.20 $404.00 $404.00 $404.00 $404.00 $404.00 $84.20 $404.00 $404.00 $238.97 $404.00 $404.00 $404.00 $404.00 $303.00 $404.00 $404.00 $404.00 $202.00 $202.00 $319.97 $404.00 $323.20 $181.80 $80.18 $404.00 $234.32 $404.00 $404.00 $404.00 $84.19 $404.00 N/A N/A 27801045 EAP HCPCS C1876 8MMX40MM WALLSTENT BOTH IP/OP "$5,303.00" "$3,924.50" "$1,052.51" "$5,303.00" "$2,386.35" "$2,386.35" "$2,386.35" "$2,386.35" "$5,303.00" "$5,303.00" "$5,303.00" "$1,105.28" "$5,303.00" "$5,303.00" "$5,303.00" "$5,303.00" "$5,303.00" "$1,105.20" "$5,303.00" "$5,303.00" "$2,614.38" "$5,303.00" "$5,303.00" "$5,303.00" "$5,303.00" "$3,977.25" "$5,303.00" "$5,303.00" "$5,303.00" "$2,651.50" "$2,651.50" "$4,199.98" "$5,303.00" "$4,242.40" "$2,386.35" "$1,052.51" "$5,303.00" "$3,075.74" "$5,303.00" "$5,303.00" "$5,303.00" "$1,105.15" "$5,303.00" N/A N/A 27801046 EAP HCPCS C1874 9FRX16X90-75CM WALL BOTH IP/OP "$5,303.00" "$3,924.50" "$1,052.51" "$5,303.00" "$2,386.35" "$2,386.35" "$2,386.35" "$2,386.35" "$5,303.00" "$5,303.00" "$5,303.00" "$1,105.28" "$5,303.00" "$5,303.00" "$5,303.00" "$5,303.00" "$5,303.00" "$1,105.20" "$5,303.00" "$5,303.00" "$2,614.38" "$5,303.00" "$5,303.00" "$5,303.00" "$5,303.00" "$3,977.25" "$5,303.00" "$5,303.00" "$5,303.00" "$2,651.50" "$2,651.50" "$4,199.98" "$5,303.00" "$4,242.40" "$2,386.35" "$1,052.51" "$5,303.00" "$3,075.74" "$5,303.00" "$5,303.00" "$5,303.00" "$1,105.15" "$5,303.00" N/A N/A 27801047 EAP HCPCS C1874 WALL GRAFT 7MM X 3 BOTH IP/OP "$6,506.00" "$4,814.50" "$1,291.28" "$6,506.00" "$2,927.70" "$2,927.70" "$2,927.70" "$2,927.70" "$6,506.00" "$6,506.00" "$6,506.00" "$1,356.01" "$6,506.00" "$6,506.00" "$6,506.00" "$6,506.00" "$6,506.00" "$1,355.92" "$6,506.00" "$6,506.00" "$3,207.46" "$6,506.00" "$6,506.00" "$6,506.00" "$6,506.00" "$4,879.50" "$6,506.00" "$6,506.00" "$6,506.00" "$3,253.00" "$3,253.00" "$5,152.75" "$6,506.00" "$5,204.80" "$2,927.70" "$1,291.28" "$6,506.00" "$3,773.48" "$6,506.00" "$6,506.00" "$6,506.00" "$1,355.85" "$6,506.00" N/A N/A 27801048 EAP HCPCS C1874 WALLGRAFT 10 X 50M BOTH IP/OP "$6,506.00" "$4,814.50" "$1,291.28" "$6,506.00" "$2,927.70" "$2,927.70" "$2,927.70" "$2,927.70" "$6,506.00" "$6,506.00" "$6,506.00" "$1,356.01" "$6,506.00" "$6,506.00" "$6,506.00" "$6,506.00" "$6,506.00" "$1,355.92" "$6,506.00" "$6,506.00" "$3,207.46" "$6,506.00" "$6,506.00" "$6,506.00" "$6,506.00" "$4,879.50" "$6,506.00" "$6,506.00" "$6,506.00" "$3,253.00" "$3,253.00" "$5,152.75" "$6,506.00" "$5,204.80" "$2,927.70" "$1,291.28" "$6,506.00" "$3,773.48" "$6,506.00" "$6,506.00" "$6,506.00" "$1,355.85" "$6,506.00" N/A N/A 27801049 EAP HCPCS C1874 WALLGRAFT 12 X 70M BOTH IP/OP "$7,505.00" "$5,554.00" "$1,489.55" "$7,505.00" "$3,377.25" "$3,377.25" "$3,377.25" "$3,377.25" "$7,505.00" "$7,505.00" "$7,505.00" "$1,564.23" "$7,505.00" "$7,505.00" "$7,505.00" "$7,505.00" "$7,505.00" "$1,564.12" "$7,505.00" "$7,505.00" "$3,699.97" "$7,505.00" "$7,505.00" "$7,505.00" "$7,505.00" "$5,628.75" "$7,505.00" "$7,505.00" "$7,505.00" "$3,752.50" "$3,752.50" "$5,943.96" "$7,505.00" "$6,004.00" "$3,377.25" "$1,489.55" "$7,505.00" "$4,352.90" "$7,505.00" "$7,505.00" "$7,505.00" "$1,564.04" "$7,505.00" N/A N/A 27801050 EAP HCPCS C1876 21V7-7-80-8.0-30 ST BOTH IP/OP "$5,245.00" "$3,881.50" "$1,041.00" "$5,245.00" "$2,360.25" "$2,360.25" "$2,360.25" "$2,360.25" "$5,245.00" "$5,245.00" "$5,245.00" "$1,093.19" "$5,245.00" "$5,245.00" "$5,245.00" "$5,245.00" "$5,245.00" "$1,093.12" "$5,245.00" "$5,245.00" "$2,585.79" "$5,245.00" "$5,245.00" "$5,245.00" "$5,245.00" "$3,933.75" "$5,245.00" "$5,245.00" "$5,245.00" "$2,622.50" "$2,622.50" "$4,154.04" "$5,245.00" "$4,196.00" "$2,360.25" "$1,041.00" "$5,245.00" "$3,042.10" "$5,245.00" "$5,245.00" "$5,245.00" "$1,093.06" "$5,245.00" N/A N/A 27801051 EAP HCPCS C2625 8.5FR-22CM NEPHROUR BOTH IP/OP $361.00 $267.50 $71.65 $361.00 $162.45 $162.45 $162.45 $162.45 $361.00 $361.00 $361.00 $75.24 $361.00 $361.00 $361.00 $361.00 $361.00 $75.24 $361.00 $361.00 $213.53 $361.00 $361.00 $361.00 $361.00 $270.75 $361.00 $361.00 $361.00 $180.50 $180.50 $285.91 $361.00 $288.80 $162.45 $71.65 $361.00 $209.38 $361.00 $361.00 $361.00 $75.23 $361.00 N/A N/A 27801052 EAP HCPCS C2625 8.5FR-24CM NEPHROUR BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 $350.00 $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A 27801053 EAP HCPCS C2625 8.5FR-28CM NEPHROUR BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 $350.00 $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A 27801054 EAP HCPCS C1876 ZIV7-80-8.0-60 STEN BOTH IP/OP "$5,245.00" "$3,881.50" "$1,041.00" "$5,245.00" "$2,360.25" "$2,360.25" "$2,360.25" "$2,360.25" "$5,245.00" "$5,245.00" "$5,245.00" "$1,093.19" "$5,245.00" "$5,245.00" "$5,245.00" "$5,245.00" "$5,245.00" "$1,093.12" "$5,245.00" "$5,245.00" "$2,585.79" "$5,245.00" "$5,245.00" "$5,245.00" "$5,245.00" "$3,933.75" "$5,245.00" "$5,245.00" "$5,245.00" "$2,622.50" "$2,622.50" "$4,154.04" "$5,245.00" "$4,196.00" "$2,360.25" "$1,041.00" "$5,245.00" "$3,042.10" "$5,245.00" "$3,147.00" "$5,245.00" "$1,093.06" "$5,245.00" N/A N/A 27801055 EAP HCPCS C1875 6X 40 FLUENCY STENT GRAFT OLD BOTH IP/OP "$7,656.00" "$5,665.50" "$1,595.59" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$1,595.59" "$7,656.00" "$3,062.40" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$5,742.00" "$7,656.00" "$7,656.00" "$7,656.00" "$3,828.00" "$3,828.00" "$6,063.55" "$7,656.00" "$6,124.80" "$3,445.20" "$7,656.00" "$7,656.00" "$4,440.48" "$7,656.00" "$4,593.60" "$7,656.00" "$7,656.00" "$7,656.00" N/A N/A 27801056 EAP HCPCS C1876 10 X 40 LUMINEXX STENT BOTH IP/OP "$4,186.00" "$3,098.00" $830.82 "$4,186.00" "$1,883.70" "$1,883.70" "$1,883.70" "$1,883.70" "$4,186.00" "$4,186.00" "$4,186.00" $872.47 "$4,186.00" "$4,186.00" "$4,186.00" "$4,186.00" "$4,186.00" $872.41 "$4,186.00" "$4,186.00" "$2,063.70" "$4,186.00" "$4,186.00" "$4,186.00" "$4,186.00" "$3,139.50" "$4,186.00" "$4,186.00" "$4,186.00" "$2,093.00" "$2,093.00" "$3,315.31" "$4,186.00" "$3,348.80" "$1,883.70" $830.82 "$4,186.00" "$2,427.88" "$4,186.00" "$4,186.00" "$4,186.00" $872.36 "$4,186.00" N/A N/A 27801057 EAP HCPCS C1880 SIMON NITINOL FILTE BOTH IP/OP "$2,836.00" "$2,099.00" $591.05 "$2,836.00" "$2,836.00" "$2,836.00" "$2,836.00" "$2,836.00" "$2,836.00" "$2,836.00" "$2,836.00" "$2,836.00" "$2,836.00" "$2,836.00" "$2,836.00" "$2,836.00" "$2,836.00" $591.05 "$2,836.00" "$1,134.40" "$2,836.00" "$2,836.00" "$2,836.00" "$2,836.00" "$2,836.00" "$2,127.00" "$2,836.00" "$2,836.00" "$2,836.00" "$1,418.00" "$1,418.00" "$2,246.11" "$2,836.00" "$2,268.80" "$1,276.20" "$2,836.00" "$2,836.00" "$1,644.88" "$2,836.00" "$1,701.60" "$2,836.00" "$2,836.00" "$2,836.00" N/A N/A 27801058 EAP HCPCS C1874 WALL STENT 8FR/ 12X BOTH IP/OP "$3,605.00" "$2,668.00" $715.50 "$3,605.00" "$1,622.25" "$1,622.25" "$1,622.25" "$1,622.25" "$3,605.00" "$3,605.00" "$3,605.00" $751.37 "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" $751.32 "$3,605.00" "$3,605.00" "$1,777.27" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$2,703.75" "$3,605.00" "$3,605.00" "$3,605.00" "$1,802.50" "$1,802.50" "$2,855.16" "$3,605.00" "$2,884.00" "$1,622.25" $715.50 "$3,605.00" "$2,090.90" "$3,605.00" "$3,605.00" "$3,605.00" $751.28 "$3,605.00" N/A N/A 27801059 EAP HCPCS C1874 WALL STENT 8FR/ 12X BOTH IP/OP "$5,778.00" "$4,276.00" "$1,146.79" "$5,778.00" "$2,600.10" "$2,600.10" "$2,600.10" "$2,600.10" "$5,778.00" "$5,778.00" "$5,778.00" "$1,204.28" "$5,778.00" "$5,778.00" "$5,778.00" "$5,778.00" "$5,778.00" "$1,204.20" "$5,778.00" "$5,778.00" "$2,848.55" "$5,778.00" "$5,778.00" "$5,778.00" "$5,778.00" "$4,333.50" "$5,778.00" "$5,778.00" "$5,778.00" "$2,889.00" "$2,889.00" "$4,576.18" "$5,778.00" "$4,622.40" "$2,600.10" "$1,146.79" "$5,778.00" "$3,351.24" "$5,778.00" "$5,778.00" "$5,778.00" "$1,204.14" "$5,778.00" N/A N/A 27801060 EAP HCPCS C1875 10X40 LUMINEXX STEN BOTH IP/OP "$7,321.00" "$5,418.00" "$1,525.78" "$7,321.00" "$7,321.00" "$7,321.00" "$7,321.00" "$7,321.00" "$7,321.00" "$7,321.00" "$7,321.00" "$7,321.00" "$7,321.00" "$7,321.00" "$7,321.00" "$7,321.00" "$7,321.00" "$1,525.78" "$7,321.00" "$2,928.40" "$7,321.00" "$7,321.00" "$7,321.00" "$7,321.00" "$7,321.00" "$5,490.75" "$7,321.00" "$7,321.00" "$7,321.00" "$3,660.50" "$3,660.50" "$5,798.23" "$7,321.00" "$5,856.80" "$3,294.45" "$7,321.00" "$7,321.00" "$4,246.18" "$7,321.00" "$4,392.60" "$7,321.00" "$7,321.00" "$7,321.00" N/A N/A 27801061 EAP HCPCS C2625 8.5FR-26CM NEPHRO-U BOTH IP/OP $361.00 $267.50 $71.65 $361.00 $162.45 $162.45 $162.45 $162.45 $361.00 $361.00 $361.00 $75.24 $361.00 $361.00 $361.00 $361.00 $361.00 $75.24 $361.00 $361.00 $213.53 $361.00 $361.00 $361.00 $361.00 $270.75 $361.00 $361.00 $361.00 $180.50 $180.50 $285.91 $361.00 $288.80 $162.45 $71.65 $361.00 $209.38 $361.00 $361.00 $361.00 $75.23 $361.00 N/A N/A 27801063 EAP HCPCS C1880 FILTER RECOVERY FEMORAL BOTH IP/OP "$3,669.00" "$2,715.50" $764.66 "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" $764.66 "$3,669.00" "$1,467.60" "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" "$2,751.75" "$3,669.00" "$3,669.00" "$3,669.00" "$1,834.50" "$1,834.50" "$2,905.85" "$3,669.00" "$2,935.20" "$1,651.05" "$3,669.00" "$3,669.00" "$2,128.02" "$3,669.00" "$2,201.40" "$3,669.00" "$3,669.00" "$3,669.00" N/A N/A 27801064 EAP HCPCS C2625 8FR-28CM URETERAL S BOTH IP/OP $360.00 $266.50 $71.45 $360.00 $162.00 $162.00 $162.00 $162.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $212.94 $360.00 $360.00 $360.00 $360.00 $270.00 $360.00 $360.00 $360.00 $180.00 $180.00 $285.12 $360.00 $288.00 $162.00 $71.45 $360.00 $208.80 $360.00 $360.00 $360.00 $75.02 $360.00 N/A N/A 27801065 EAP HCPCS C1788 LOW PROFILE PORT BOTH IP/OP $751.00 $556.00 $149.05 $751.00 $337.95 $337.95 $337.95 $337.95 $751.00 $751.00 $751.00 $156.53 $751.00 $751.00 $751.00 $751.00 $751.00 $156.52 $751.00 $751.00 $444.22 $751.00 $751.00 $751.00 $751.00 $563.25 $751.00 $751.00 $751.00 $375.50 $375.50 $594.79 $751.00 $600.80 $337.95 $149.05 $751.00 $435.58 $751.00 $751.00 $751.00 $156.51 $751.00 N/A N/A 27801066 EAP HCPCS C1880 FILTER-FEMORAL BOTH IP/OP "$3,156.00" "$2,335.50" $657.75 "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" $657.75 "$3,156.00" "$1,262.40" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$2,367.00" "$3,156.00" "$3,156.00" "$3,156.00" "$1,578.00" "$1,578.00" "$2,499.55" "$3,156.00" "$2,524.80" "$1,420.20" "$3,156.00" "$3,156.00" "$1,830.48" "$3,156.00" "$1,893.60" "$3,156.00" "$3,156.00" "$3,156.00" N/A N/A 27801067 EAP HCPCS C1880 GREENFIELD FILTER-J BOTH IP/OP "$3,156.00" "$2,335.50" $657.75 "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" $657.75 "$3,156.00" "$1,262.40" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$3,156.00" "$2,367.00" "$3,156.00" "$3,156.00" "$3,156.00" "$1,578.00" "$1,578.00" "$2,499.55" "$3,156.00" "$2,524.80" "$1,420.20" "$3,156.00" "$3,156.00" "$1,830.48" "$3,156.00" "$1,893.60" "$3,156.00" "$3,156.00" "$3,156.00" N/A N/A 27801068 EAP HCPCS C2625 STENT URETERAL 8FR 24CM BOTH IP/OP $418.00 $309.50 $82.96 $418.00 $188.10 $188.10 $188.10 $188.10 $418.00 $418.00 $418.00 $87.12 $418.00 $418.00 $418.00 $418.00 $418.00 $87.12 $418.00 $418.00 $247.25 $418.00 $418.00 $418.00 $418.00 $313.50 $418.00 $418.00 $418.00 $209.00 $209.00 $331.06 $418.00 $334.40 $188.10 $82.96 $418.00 $242.44 $418.00 $418.00 $418.00 $87.11 $418.00 N/A N/A 27801070 EAP HCPCS C1876 80-6.0X40CM STENT BOTH IP/OP "$5,245.00" "$3,881.50" "$1,041.00" "$5,245.00" "$2,360.25" "$2,360.25" "$2,360.25" "$2,360.25" "$5,245.00" "$5,245.00" "$5,245.00" "$1,093.19" "$5,245.00" "$5,245.00" "$5,245.00" "$5,245.00" "$5,245.00" "$1,093.12" "$5,245.00" "$5,245.00" "$2,585.79" "$5,245.00" "$5,245.00" "$5,245.00" "$5,245.00" "$3,933.75" "$5,245.00" "$5,245.00" "$5,245.00" "$2,622.50" "$2,622.50" "$4,154.04" "$5,245.00" "$4,196.00" "$2,360.25" "$1,041.00" "$5,245.00" "$3,042.10" "$5,245.00" "$5,245.00" "$5,245.00" "$1,093.06" "$5,245.00" N/A N/A 27801071 EAP HCPCS C1880 FILTER BIRDS NEST VENA CAVA FE BOTH IP/OP "$3,442.00" "$2,547.50" $717.35 "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" $717.35 "$3,442.00" "$1,376.80" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$2,581.50" "$3,442.00" "$3,442.00" "$3,442.00" "$1,721.00" "$1,721.00" "$2,726.06" "$3,442.00" "$2,753.60" "$1,548.90" "$3,442.00" "$3,442.00" "$1,996.36" "$3,442.00" "$2,065.20" "$3,442.00" "$3,442.00" "$3,442.00" N/A N/A 27801072 EAP HCPCS C1880 FILTER BIRDS NEST VENA CAVA JU BOTH IP/OP "$3,442.00" "$2,547.50" $717.35 "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" $717.35 "$3,442.00" "$1,376.80" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$3,442.00" "$2,581.50" "$3,442.00" "$3,442.00" "$3,442.00" "$1,721.00" "$1,721.00" "$2,726.06" "$3,442.00" "$2,753.60" "$1,548.90" "$3,442.00" "$3,442.00" "$1,996.36" "$3,442.00" "$2,065.20" "$3,442.00" "$3,442.00" "$3,442.00" N/A N/A 27801073 EAP HCPCS C1880 FILTER GUNTHER-TULIP FEMORAL BOTH IP/OP "$3,586.00" "$2,654.00" $747.36 "$3,586.00" "$3,586.00" "$3,586.00" "$3,586.00" "$3,586.00" "$3,586.00" "$3,586.00" "$3,586.00" "$3,586.00" "$3,586.00" "$3,586.00" "$3,586.00" "$3,586.00" "$3,586.00" $747.36 "$3,586.00" "$1,434.40" "$3,586.00" "$3,586.00" "$3,586.00" "$3,586.00" "$3,586.00" "$2,689.50" "$3,586.00" "$3,586.00" "$3,586.00" "$1,793.00" "$1,793.00" "$2,840.11" "$3,586.00" "$2,868.80" "$1,613.70" "$3,586.00" "$3,586.00" "$2,079.88" "$3,586.00" "$2,151.60" "$3,586.00" "$3,586.00" "$3,586.00" N/A N/A 27801074 EAP HCPCS C1880 FILTER GUNTHER-TULIP JUGULAR BOTH IP/OP "$3,216.00" "$2,380.00" $670.25 "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" $670.25 "$3,216.00" "$1,286.40" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$2,412.00" "$3,216.00" "$3,216.00" "$3,216.00" "$1,608.00" "$1,608.00" "$2,547.07" "$3,216.00" "$2,572.80" "$1,447.20" "$3,216.00" "$3,216.00" "$1,865.28" "$3,216.00" "$1,929.60" "$3,216.00" "$3,216.00" "$3,216.00" N/A N/A 27801075 EAP HCPCS C1880 TRAPEAZE FEMORALVE BOTH IP/OP "$4,154.00" "$3,074.00" $865.74 "$4,154.00" "$4,154.00" "$4,154.00" "$4,154.00" "$4,154.00" "$4,154.00" "$4,154.00" "$4,154.00" "$4,154.00" "$4,154.00" "$4,154.00" "$4,154.00" "$4,154.00" "$4,154.00" $865.74 "$4,154.00" "$1,661.60" "$4,154.00" "$4,154.00" "$4,154.00" "$4,154.00" "$4,154.00" "$3,115.50" "$4,154.00" "$4,154.00" "$4,154.00" "$2,077.00" "$2,077.00" "$3,289.97" "$4,154.00" "$3,323.20" "$1,869.30" "$4,154.00" "$4,154.00" "$2,409.32" "$4,154.00" "$2,492.40" "$4,154.00" "$4,154.00" "$4,154.00" N/A N/A 27801076 EAP HCPCS C1875 "COVERED STENT, 5MMX" BOTH IP/OP "$8,174.00" "$6,049.00" "$1,703.55" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$1,703.55" "$8,174.00" "$3,269.60" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$6,130.50" "$8,174.00" "$8,174.00" "$8,174.00" "$4,087.00" "$4,087.00" "$6,473.81" "$8,174.00" "$6,539.20" "$3,678.30" "$8,174.00" "$8,174.00" "$4,740.92" "$8,174.00" "$4,904.40" "$8,174.00" "$8,174.00" "$8,174.00" N/A N/A 27801077 EAP HCPCS C1874 "COVERED STENT, 6MMX" BOTH IP/OP "$8,174.00" "$6,049.00" "$1,622.33" "$8,174.00" "$3,678.30" "$3,678.30" "$3,678.30" "$3,678.30" "$8,174.00" "$8,174.00" "$8,174.00" "$1,703.67" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$1,703.55" "$8,174.00" "$8,174.00" "$4,029.78" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$6,130.50" "$8,174.00" "$8,174.00" "$8,174.00" "$4,087.00" "$4,087.00" "$6,473.81" "$8,174.00" "$6,539.20" "$3,678.30" "$1,622.33" "$8,174.00" "$4,740.92" "$8,174.00" "$8,174.00" "$8,174.00" "$1,703.46" "$8,174.00" N/A N/A 27801078 EAP HCPCS C1874 "COVERED STENT, 8MMX" BOTH IP/OP "$8,174.00" "$6,049.00" "$1,622.33" "$8,174.00" "$3,678.30" "$3,678.30" "$3,678.30" "$3,678.30" "$8,174.00" "$8,174.00" "$8,174.00" "$1,703.67" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$1,703.55" "$8,174.00" "$8,174.00" "$4,029.78" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$6,130.50" "$8,174.00" "$8,174.00" "$8,174.00" "$4,087.00" "$4,087.00" "$6,473.81" "$8,174.00" "$6,539.20" "$3,678.30" "$1,622.33" "$8,174.00" "$4,740.92" "$8,174.00" "$8,174.00" "$8,174.00" "$1,703.46" "$8,174.00" N/A N/A 27801079 EAP HCPCS C1874 "COVERED STENT, 9MMX" BOTH IP/OP "$8,174.00" "$6,049.00" "$1,622.33" "$8,174.00" "$3,678.30" "$3,678.30" "$3,678.30" "$3,678.30" "$8,174.00" "$8,174.00" "$8,174.00" "$1,703.67" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$1,703.55" "$8,174.00" "$8,174.00" "$4,029.78" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$6,130.50" "$8,174.00" "$8,174.00" "$8,174.00" "$4,087.00" "$4,087.00" "$6,473.81" "$8,174.00" "$6,539.20" "$3,678.30" "$1,622.33" "$8,174.00" "$4,740.92" "$8,174.00" "$8,174.00" "$8,174.00" "$1,703.46" "$8,174.00" N/A N/A 27801080 EAP HCPCS C1874 "COVERED STENT, 10MM" BOTH IP/OP "$8,174.00" "$6,049.00" "$1,622.33" "$8,174.00" "$3,678.30" "$3,678.30" "$3,678.30" "$3,678.30" "$8,174.00" "$8,174.00" "$8,174.00" "$1,703.67" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$1,703.55" "$8,174.00" "$8,174.00" "$4,029.78" "$8,174.00" "$8,174.00" "$8,174.00" "$8,174.00" "$6,130.50" "$8,174.00" "$8,174.00" "$8,174.00" "$4,087.00" "$4,087.00" "$6,473.81" "$8,174.00" "$6,539.20" "$3,678.30" "$1,622.33" "$8,174.00" "$4,740.92" "$8,174.00" "$8,174.00" "$8,174.00" "$1,703.46" "$8,174.00" N/A N/A 27801081 EAP HCPCS C1874 "COVERED STENT, 12MM" BOTH IP/OP "$18,351.00" "$13,580.00" "$3,642.21" "$18,351.00" "$8,257.95" "$8,257.95" "$8,257.95" "$8,257.95" "$18,351.00" "$18,351.00" "$18,351.00" "$3,824.81" "$18,351.00" "$18,351.00" "$18,351.00" "$18,351.00" "$18,351.00" "$3,824.55" "$18,351.00" "$18,351.00" "$9,047.04" "$18,351.00" "$18,351.00" "$18,351.00" "$18,351.00" "$13,763.25" "$18,351.00" "$18,351.00" "$18,351.00" "$9,175.50" "$9,175.50" "$14,533.99" "$18,351.00" "$14,680.80" "$8,257.95" "$3,642.21" "$18,351.00" "$10,643.58" "$18,351.00" "$18,351.00" "$18,351.00" "$3,824.35" "$18,351.00" N/A N/A 27801082 EAP HCPCS C1874 COIL COMPLEX HELICA BOTH IP/OP "$1,287.00" $952.50 $255.44 "$1,287.00" $579.15 $579.15 $579.15 $579.15 "$1,287.00" "$1,287.00" "$1,287.00" $268.24 "$1,287.00" "$1,287.00" "$1,287.00" "$1,287.00" "$1,287.00" $268.22 "$1,287.00" "$1,287.00" $761.26 "$1,287.00" "$1,287.00" "$1,287.00" "$1,287.00" $965.25 "$1,287.00" "$1,287.00" "$1,287.00" $643.50 $643.50 "$1,019.30" "$1,287.00" "$1,029.60" $579.15 $255.44 "$1,287.00" $746.46 "$1,287.00" "$1,287.00" "$1,287.00" $268.21 "$1,287.00" N/A N/A 27801083 EAP HCPCS C1760 CLOSURE DEVICE VASC BOTH IP/OP "$5,062.00" "$3,746.00" "$1,004.68" "$5,062.00" "$2,277.90" "$2,277.90" "$2,277.90" "$2,277.90" "$5,062.00" "$5,062.00" "$5,062.00" "$1,055.05" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$1,054.98" "$5,062.00" "$5,062.00" "$2,495.57" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$3,796.50" "$5,062.00" "$5,062.00" "$5,062.00" "$2,531.00" "$2,531.00" "$4,009.10" "$5,062.00" "$4,049.60" "$2,277.90" "$1,004.68" "$5,062.00" "$2,935.96" "$5,062.00" "$5,062.00" "$5,062.00" "$1,054.92" "$5,062.00" N/A N/A 27801084 EAP HCPCS C1876 ZILVER STENT 10X40 BOTH IP/OP "$4,170.00" "$3,086.00" $827.64 "$4,170.00" "$1,876.50" "$1,876.50" "$1,876.50" "$1,876.50" "$4,170.00" "$4,170.00" "$4,170.00" $869.13 "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" $869.07 "$4,170.00" "$4,170.00" "$2,055.81" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$1,876.50" $827.64 "$4,170.00" "$2,418.60" "$4,170.00" "$4,170.00" "$4,170.00" $869.03 "$4,170.00" N/A N/A 27801085 EAP HCPCS C1876 ZILVER STENT 10X30 BOTH IP/OP "$4,170.00" "$3,086.00" $827.64 "$4,170.00" "$1,876.50" "$1,876.50" "$1,876.50" "$1,876.50" "$4,170.00" "$4,170.00" "$4,170.00" $869.13 "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" $869.07 "$4,170.00" "$4,170.00" "$2,055.81" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$1,876.50" $827.64 "$4,170.00" "$2,418.60" "$4,170.00" "$4,170.00" "$4,170.00" $869.03 "$4,170.00" N/A N/A 27801086 EAP HCPCS C1876 ZILVER STENT 8X60 BOTH IP/OP "$4,170.00" "$3,086.00" $827.64 "$4,170.00" "$1,876.50" "$1,876.50" "$1,876.50" "$1,876.50" "$4,170.00" "$4,170.00" "$4,170.00" $869.13 "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" $869.07 "$4,170.00" "$4,170.00" "$2,055.81" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$1,876.50" $827.64 "$4,170.00" "$2,418.60" "$4,170.00" "$4,170.00" "$4,170.00" $869.03 "$4,170.00" N/A N/A 27801087 EAP HCPCS C1876 ZILVER STENT 8X40 BOTH IP/OP "$4,170.00" "$3,086.00" $827.64 "$4,170.00" "$1,876.50" "$1,876.50" "$1,876.50" "$1,876.50" "$4,170.00" "$4,170.00" "$4,170.00" $869.13 "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" $869.07 "$4,170.00" "$4,170.00" "$2,055.81" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$1,876.50" $827.64 "$4,170.00" "$2,418.60" "$4,170.00" "$4,170.00" "$4,170.00" $869.03 "$4,170.00" N/A N/A 27801089 EAP HCPCS C1876 ZILVER STENT 7X40 BOTH IP/OP "$4,170.00" "$3,086.00" $827.64 "$4,170.00" "$1,876.50" "$1,876.50" "$1,876.50" "$1,876.50" "$4,170.00" "$4,170.00" "$4,170.00" $869.13 "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" $869.07 "$4,170.00" "$4,170.00" "$2,055.81" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$1,876.50" $827.64 "$4,170.00" "$2,418.60" "$4,170.00" "$4,170.00" "$4,170.00" $869.03 "$4,170.00" N/A N/A 27801090 EAP HCPCS C1876 ZILVER STENT 7X30 BOTH IP/OP "$4,170.00" "$3,086.00" $827.64 "$4,170.00" "$1,876.50" "$1,876.50" "$1,876.50" "$1,876.50" "$4,170.00" "$4,170.00" "$4,170.00" $869.13 "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" $869.07 "$4,170.00" "$4,170.00" "$2,055.81" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$1,876.50" $827.64 "$4,170.00" "$2,418.60" "$4,170.00" "$4,170.00" "$4,170.00" $869.03 "$4,170.00" N/A N/A 27801091 EAP HCPCS C1876 ZILVER STENT 6X40 BOTH IP/OP "$4,170.00" "$3,086.00" $827.64 "$4,170.00" "$1,876.50" "$1,876.50" "$1,876.50" "$1,876.50" "$4,170.00" "$4,170.00" "$4,170.00" $869.13 "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" $869.07 "$4,170.00" "$4,170.00" "$2,055.81" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$1,876.50" $827.64 "$4,170.00" "$2,418.60" "$4,170.00" "$4,170.00" "$4,170.00" $869.03 "$4,170.00" N/A N/A 27801092 EAP HCPCS C1876 ZILVER STENT 6X30 BOTH IP/OP "$4,170.00" "$3,086.00" $827.64 "$4,170.00" "$1,876.50" "$1,876.50" "$1,876.50" "$1,876.50" "$4,170.00" "$4,170.00" "$4,170.00" $869.13 "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" $869.07 "$4,170.00" "$4,170.00" "$2,055.81" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$1,876.50" $827.64 "$4,170.00" "$2,418.60" "$4,170.00" "$4,170.00" "$4,170.00" $869.03 "$4,170.00" N/A N/A 27801093 EAP HCPCS C1760 BMRANG CLS DEVICE5- BOTH IP/OP "$5,004.00" "$3,703.00" $993.17 "$5,004.00" "$2,251.80" "$2,251.80" "$2,251.80" "$2,251.80" "$5,004.00" "$5,004.00" "$5,004.00" "$1,042.96" "$5,004.00" "$5,004.00" "$5,004.00" "$5,004.00" "$5,004.00" "$1,042.89" "$5,004.00" "$5,004.00" "$2,466.97" "$5,004.00" "$5,004.00" "$5,004.00" "$5,004.00" "$3,753.00" "$5,004.00" "$5,004.00" "$5,004.00" "$2,502.00" "$2,502.00" "$3,963.17" "$5,004.00" "$4,003.20" "$2,251.80" $993.17 "$5,004.00" "$2,902.32" "$5,004.00" "$5,004.00" "$5,004.00" "$1,042.83" "$5,004.00" N/A N/A 27801094 EAP HCPCS C1760 BMRANG CLS DVICE 6- BOTH IP/OP $113.00 $84.00 $22.43 $113.00 $50.85 $50.85 $50.85 $50.85 $113.00 $113.00 $113.00 $23.55 $113.00 $113.00 $113.00 $113.00 $113.00 $23.55 $113.00 $113.00 $66.84 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $50.85 $22.43 $113.00 $65.54 $113.00 $113.00 $113.00 $23.55 $113.00 N/A N/A 27801095 EAP HCPCS C1760 6FT PROGLIDE CLOSUR BOTH IP/OP $863.00 $639.00 $171.28 $863.00 $388.35 $388.35 $388.35 $388.35 $863.00 $863.00 $863.00 $179.87 $863.00 $863.00 $863.00 $863.00 $863.00 $179.86 $863.00 $863.00 $510.46 $863.00 $863.00 $863.00 $863.00 $647.25 $863.00 $863.00 $863.00 $431.50 $431.50 $683.50 $863.00 $690.40 $388.35 $171.28 $863.00 $500.54 $863.00 $863.00 $863.00 $179.85 $863.00 N/A N/A 27801096 EAP Custom 27801096 COIL MICROPLEX 18RE BOTH IP/OP "$2,050.00" "$1,517.00" $364.90 "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" $364.90 "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" $427.24 "$2,050.00" $820.00 "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" "$1,537.50" "$2,050.00" "$2,050.00" "$2,050.00" "$1,025.00" "$1,025.00" "$1,623.60" "$2,050.00" "$1,640.00" $922.50 "$2,050.00" "$2,050.00" "$1,189.00" "$2,050.00" "$1,230.00" "$2,050.00" "$2,050.00" "$2,050.00" N/A N/A 27801097 EAP Custom 27801097 COIL MICROPLEX 18RE BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" "$1,500.00" $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 27801098 EAP Custom 27801098 COIL MICROPLEX 18SO BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" "$1,500.00" $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 27801099 EAP Custom 27801099 COIL MICROPLEX 18SO BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" "$1,500.00" $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 27801100 EAP Custom 27801100 COIL MICROPLEX 18SO BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" "$1,500.00" $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 27801101 EAP Custom 27801101 COIL MICROPLEX 18SO BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" "$1,500.00" $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 27801102 EAP Custom 27801102 COIL MICROPLEX 18SO BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" "$1,500.00" $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 27801103 EAP Custom 27801103 COIL MICROPLEX 18SO BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" "$1,500.00" $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 27801104 EAP Custom 27801104 "COIL, TRUFILL PUSHA" BOTH IP/OP $466.00 $345.00 $82.95 $466.00 $466.00 $466.00 $466.00 $466.00 $466.00 $466.00 $82.95 $466.00 $466.00 $466.00 $466.00 $466.00 $466.00 $97.12 $466.00 $186.40 $466.00 $466.00 $466.00 $466.00 $466.00 $349.50 $466.00 $466.00 $466.00 $233.00 $233.00 $369.07 $466.00 $372.80 $209.70 $466.00 $466.00 $270.28 $466.00 $279.60 $466.00 $466.00 $466.00 N/A N/A 27801105 EAP Custom 27801105 COIL TRUFIL COMPLX BOTH IP/OP $466.00 $345.00 $82.95 $466.00 $466.00 $466.00 $466.00 $466.00 $466.00 $466.00 $82.95 $466.00 $466.00 $466.00 $466.00 $466.00 $466.00 $97.12 $466.00 $186.40 $466.00 $466.00 $466.00 $466.00 $466.00 $349.50 $466.00 $466.00 $466.00 $233.00 $233.00 $369.07 $466.00 $372.80 $209.70 $466.00 $466.00 $270.28 $466.00 $279.60 $466.00 $466.00 $466.00 N/A N/A 27801106 EAP Custom 27801106 COIL TRUFIL COMPLEX BOTH IP/OP $466.00 $345.00 $82.95 $466.00 $466.00 $466.00 $466.00 $466.00 $466.00 $466.00 $82.95 $466.00 $466.00 $466.00 $466.00 $466.00 $466.00 $97.12 $466.00 $186.40 $466.00 $466.00 $466.00 $466.00 $466.00 $349.50 $466.00 $466.00 $466.00 $233.00 $233.00 $369.07 $466.00 $372.80 $209.70 $466.00 $466.00 $270.28 $466.00 $279.60 $466.00 $466.00 $466.00 N/A N/A 27801107 EAP Custom 27801107 COIL TRUFIL COMPLEX BOTH IP/OP $230.00 $170.50 $40.94 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $40.94 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $47.93 $230.00 $92.00 $230.00 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $103.50 $230.00 $230.00 $133.40 $230.00 $138.00 $230.00 $230.00 $230.00 N/A N/A 27801108 EAP Custom 27801108 COIL TRUFIL EMBOLIC BOTH IP/OP "$7,924.00" "$5,864.00" "$1,410.47" "$7,924.00" "$7,924.00" "$7,924.00" "$7,924.00" "$7,924.00" "$7,924.00" "$7,924.00" "$1,410.47" "$7,924.00" "$7,924.00" "$7,924.00" "$7,924.00" "$7,924.00" "$7,924.00" "$1,651.45" "$7,924.00" "$3,169.60" "$7,924.00" "$7,924.00" "$7,924.00" "$7,924.00" "$7,924.00" "$5,943.00" "$7,924.00" "$7,924.00" "$7,924.00" "$3,962.00" "$3,962.00" "$6,275.81" "$7,924.00" "$6,339.20" "$3,565.80" "$7,924.00" "$7,924.00" "$4,595.92" "$7,924.00" "$4,754.40" "$7,924.00" "$7,924.00" "$7,924.00" N/A N/A 27801109 EAP HCPCS C1874 WALLSTENT ILIAC SPV BOTH IP/OP "$8,767.00" "$6,488.00" "$1,740.03" "$8,767.00" "$3,945.15" "$3,945.15" "$3,945.15" "$3,945.15" "$8,767.00" "$8,767.00" "$8,767.00" "$1,827.26" "$8,767.00" "$8,767.00" "$8,767.00" "$8,767.00" "$8,767.00" "$1,827.14" "$8,767.00" "$8,767.00" "$4,322.13" "$8,767.00" "$8,767.00" "$8,767.00" "$8,767.00" "$6,575.25" "$8,767.00" "$8,767.00" "$8,767.00" "$4,383.50" "$4,383.50" "$6,943.46" "$8,767.00" "$7,013.60" "$3,945.15" "$1,740.03" "$8,767.00" "$5,084.86" "$8,767.00" "$8,767.00" "$8,767.00" "$1,827.04" "$8,767.00" N/A N/A 27801110 EAP HCPCS C1874 "STENT, BILIARY, PAL" BOTH IP/OP "$9,320.00" "$6,897.00" "$1,849.79" "$9,320.00" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$9,320.00" "$9,320.00" "$9,320.00" "$1,942.52" "$9,320.00" "$9,320.00" "$9,320.00" "$9,320.00" "$9,320.00" "$1,942.39" "$9,320.00" "$9,320.00" "$4,594.76" "$9,320.00" "$9,320.00" "$9,320.00" "$9,320.00" "$6,990.00" "$9,320.00" "$9,320.00" "$9,320.00" "$4,660.00" "$4,660.00" "$7,381.44" "$9,320.00" "$7,456.00" "$4,194.00" "$1,849.79" "$9,320.00" "$5,405.60" "$9,320.00" "$9,320.00" "$9,320.00" "$1,942.29" "$9,320.00" N/A N/A 27801111 EAP HCPCS C1874 "WALLSTENT, TRACHEOB" BOTH IP/OP "$8,767.00" "$6,488.00" "$1,740.03" "$8,767.00" "$3,945.15" "$3,945.15" "$3,945.15" "$3,945.15" "$8,767.00" "$8,767.00" "$8,767.00" "$1,827.26" "$8,767.00" "$8,767.00" "$8,767.00" "$8,767.00" "$8,767.00" "$1,827.14" "$8,767.00" "$8,767.00" "$4,322.13" "$8,767.00" "$8,767.00" "$8,767.00" "$8,767.00" "$6,575.25" "$8,767.00" "$8,767.00" "$8,767.00" "$4,383.50" "$4,383.50" "$6,943.46" "$8,767.00" "$7,013.60" "$3,945.15" "$1,740.03" "$8,767.00" "$5,084.86" "$8,767.00" "$8,767.00" "$8,767.00" "$1,827.04" "$8,767.00" N/A N/A 27801112 EAP HCPCS C1874 "WALLSTENT, ENTERAL" BOTH IP/OP "$8,767.00" "$6,488.00" "$1,740.03" "$8,767.00" "$3,945.15" "$3,945.15" "$3,945.15" "$3,945.15" "$8,767.00" "$8,767.00" "$8,767.00" "$1,827.26" "$8,767.00" "$8,767.00" "$8,767.00" "$8,767.00" "$8,767.00" "$1,827.14" "$8,767.00" "$8,767.00" "$4,322.13" "$8,767.00" "$8,767.00" "$8,767.00" "$8,767.00" "$6,575.25" "$8,767.00" "$8,767.00" "$8,767.00" "$4,383.50" "$4,383.50" "$6,943.46" "$8,767.00" "$7,013.60" "$3,945.15" "$1,740.03" "$8,767.00" "$5,084.86" "$8,767.00" "$8,767.00" "$8,767.00" "$1,827.04" "$8,767.00" N/A N/A 27801113 EAP HCPCS C1874 VIATORR SENTS 8MMX6 BOTH IP/OP "$12,472.00" "$9,229.50" "$2,475.38" "$12,472.00" "$5,612.40" "$5,612.40" "$5,612.40" "$5,612.40" "$12,472.00" "$12,472.00" "$12,472.00" "$2,599.48" "$12,472.00" "$12,472.00" "$12,472.00" "$12,472.00" "$12,472.00" "$2,599.30" "$12,472.00" "$12,472.00" "$6,148.70" "$12,472.00" "$12,472.00" "$12,472.00" "$12,472.00" "$9,354.00" "$12,472.00" "$12,472.00" "$12,472.00" "$6,236.00" "$6,236.00" "$9,877.82" "$12,472.00" "$9,977.60" "$5,612.40" "$2,475.38" "$12,472.00" "$7,233.76" "$12,472.00" "$12,472.00" "$12,472.00" "$2,599.16" "$12,472.00" N/A N/A 27801114 EAP HCPCS C1874 VIATORR SENTS 8MMX7 BOTH IP/OP "$16,213.00" "$11,998.00" "$3,217.88" "$16,213.00" "$7,295.85" "$7,295.85" "$7,295.85" "$7,295.85" "$16,213.00" "$16,213.00" "$16,213.00" "$3,379.19" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.97" "$16,213.00" "$16,213.00" "$7,993.01" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$12,159.75" "$16,213.00" "$16,213.00" "$16,213.00" "$8,106.50" "$8,106.50" "$12,840.70" "$16,213.00" "$12,970.40" "$7,295.85" "$3,217.88" "$16,213.00" "$9,403.54" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.79" "$16,213.00" N/A N/A 27801115 EAP HCPCS C1874 VIATORR SENTS 8MMX8 BOTH IP/OP "$16,213.00" "$11,998.00" "$3,217.88" "$16,213.00" "$7,295.85" "$7,295.85" "$7,295.85" "$7,295.85" "$16,213.00" "$16,213.00" "$16,213.00" "$3,379.19" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.97" "$16,213.00" "$16,213.00" "$7,993.01" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$12,159.75" "$16,213.00" "$16,213.00" "$16,213.00" "$8,106.50" "$8,106.50" "$12,840.70" "$16,213.00" "$12,970.40" "$7,295.85" "$3,217.88" "$16,213.00" "$9,403.54" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.79" "$16,213.00" N/A N/A 27801116 EAP HCPCS C1874 VIATORR SENTS 10MMX BOTH IP/OP "$16,213.00" "$11,998.00" "$3,217.88" "$16,213.00" "$7,295.85" "$7,295.85" "$7,295.85" "$7,295.85" "$16,213.00" "$16,213.00" "$16,213.00" "$3,379.19" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.97" "$16,213.00" "$16,213.00" "$7,993.01" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$12,159.75" "$16,213.00" "$16,213.00" "$16,213.00" "$8,106.50" "$8,106.50" "$12,840.70" "$16,213.00" "$12,970.40" "$7,295.85" "$3,217.88" "$16,213.00" "$9,403.54" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.79" "$16,213.00" N/A N/A 27801117 EAP HCPCS C1874 VIATORR SENTS 10MMX BOTH IP/OP "$16,213.00" "$11,998.00" "$3,217.88" "$16,213.00" "$7,295.85" "$7,295.85" "$7,295.85" "$7,295.85" "$16,213.00" "$16,213.00" "$16,213.00" "$3,379.19" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.97" "$16,213.00" "$16,213.00" "$7,993.01" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$12,159.75" "$16,213.00" "$16,213.00" "$16,213.00" "$8,106.50" "$8,106.50" "$12,840.70" "$16,213.00" "$12,970.40" "$7,295.85" "$3,217.88" "$16,213.00" "$9,403.54" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.79" "$16,213.00" N/A N/A 27801118 EAP HCPCS C1874 VIATORR SENTS 10MMX BOTH IP/OP "$16,213.00" "$11,998.00" "$3,217.88" "$16,213.00" "$7,295.85" "$7,295.85" "$7,295.85" "$7,295.85" "$16,213.00" "$16,213.00" "$16,213.00" "$3,379.19" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.97" "$16,213.00" "$16,213.00" "$7,993.01" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$12,159.75" "$16,213.00" "$16,213.00" "$16,213.00" "$8,106.50" "$8,106.50" "$12,840.70" "$16,213.00" "$12,970.40" "$7,295.85" "$3,217.88" "$16,213.00" "$9,403.54" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.79" "$16,213.00" N/A N/A 27801119 EAP HCPCS C1874 VIATORR SENTS 10MMX BOTH IP/OP "$16,213.00" "$11,998.00" "$3,217.88" "$16,213.00" "$7,295.85" "$7,295.85" "$7,295.85" "$7,295.85" "$16,213.00" "$16,213.00" "$16,213.00" "$3,379.19" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.97" "$16,213.00" "$16,213.00" "$7,993.01" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$12,159.75" "$16,213.00" "$16,213.00" "$16,213.00" "$8,106.50" "$8,106.50" "$12,840.70" "$16,213.00" "$12,970.40" "$7,295.85" "$3,217.88" "$16,213.00" "$9,403.54" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.79" "$16,213.00" N/A N/A 27801120 EAP HCPCS C1874 VIATORR SENTS 10MMX BOTH IP/OP "$16,213.00" "$11,998.00" "$3,217.88" "$16,213.00" "$7,295.85" "$7,295.85" "$7,295.85" "$7,295.85" "$16,213.00" "$16,213.00" "$16,213.00" "$3,379.19" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.97" "$16,213.00" "$16,213.00" "$7,993.01" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$12,159.75" "$16,213.00" "$16,213.00" "$16,213.00" "$8,106.50" "$8,106.50" "$12,840.70" "$16,213.00" "$12,970.40" "$7,295.85" "$3,217.88" "$16,213.00" "$9,403.54" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.79" "$16,213.00" N/A N/A 27801121 EAP HCPCS C1874 VIATORR SENTS 12MMX BOTH IP/OP "$16,213.00" "$11,998.00" "$3,217.88" "$16,213.00" "$7,295.85" "$7,295.85" "$7,295.85" "$7,295.85" "$16,213.00" "$16,213.00" "$16,213.00" "$3,379.19" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.97" "$16,213.00" "$16,213.00" "$7,993.01" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$12,159.75" "$16,213.00" "$16,213.00" "$16,213.00" "$8,106.50" "$8,106.50" "$12,840.70" "$16,213.00" "$12,970.40" "$7,295.85" "$3,217.88" "$16,213.00" "$9,403.54" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.79" "$16,213.00" N/A N/A 27801122 EAP HCPCS C1874 VIATORR SENTS 12MMX BOTH IP/OP "$16,213.00" "$11,998.00" "$3,217.88" "$16,213.00" "$7,295.85" "$7,295.85" "$7,295.85" "$7,295.85" "$16,213.00" "$16,213.00" "$16,213.00" "$3,379.19" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.97" "$16,213.00" "$16,213.00" "$7,993.01" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$12,159.75" "$16,213.00" "$16,213.00" "$16,213.00" "$8,106.50" "$8,106.50" "$12,840.70" "$16,213.00" "$12,970.40" "$7,295.85" "$3,217.88" "$16,213.00" "$9,403.54" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.79" "$16,213.00" N/A N/A 27801123 EAP HCPCS C1874 VIATORR SENTS 12MMX BOTH IP/OP "$16,213.00" "$11,998.00" "$3,217.88" "$16,213.00" "$7,295.85" "$7,295.85" "$7,295.85" "$7,295.85" "$16,213.00" "$16,213.00" "$16,213.00" "$3,379.19" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.97" "$16,213.00" "$16,213.00" "$7,993.01" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$12,159.75" "$16,213.00" "$16,213.00" "$16,213.00" "$8,106.50" "$8,106.50" "$12,840.70" "$16,213.00" "$12,970.40" "$7,295.85" "$3,217.88" "$16,213.00" "$9,403.54" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.79" "$16,213.00" N/A N/A 27801124 EAP HCPCS C1874 VIATORR SENTS 8MMX4 BOTH IP/OP "$15,988.00" "$11,831.50" "$3,173.22" "$15,988.00" "$7,194.60" "$7,194.60" "$7,194.60" "$7,194.60" "$15,988.00" "$15,988.00" "$15,988.00" "$3,332.30" "$15,988.00" "$15,988.00" "$15,988.00" "$15,988.00" "$15,988.00" "$3,332.08" "$15,988.00" "$15,988.00" "$7,882.08" "$15,988.00" "$15,988.00" "$15,988.00" "$15,988.00" "$11,991.00" "$15,988.00" "$15,988.00" "$15,988.00" "$7,994.00" "$7,994.00" "$12,662.50" "$15,988.00" "$12,790.40" "$7,194.60" "$3,173.22" "$15,988.00" "$9,273.04" "$15,988.00" "$15,988.00" "$15,988.00" "$3,331.90" "$15,988.00" N/A N/A 27801125 EAP HCPCS C1874 VIATORR SENTS 8MMX5 BOTH IP/OP "$16,213.00" "$11,998.00" "$3,217.88" "$16,213.00" "$7,295.85" "$7,295.85" "$7,295.85" "$7,295.85" "$16,213.00" "$16,213.00" "$16,213.00" "$3,379.19" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.97" "$16,213.00" "$16,213.00" "$7,993.01" "$16,213.00" "$16,213.00" "$16,213.00" "$16,213.00" "$12,159.75" "$16,213.00" "$16,213.00" "$16,213.00" "$8,106.50" "$8,106.50" "$12,840.70" "$16,213.00" "$12,970.40" "$7,295.85" "$3,217.88" "$16,213.00" "$9,403.54" "$16,213.00" "$16,213.00" "$16,213.00" "$3,378.79" "$16,213.00" N/A N/A 27801126 EAP HCPCS C1876 WALL STENT 18MMX40M BOTH IP/OP "$3,972.00" "$2,939.50" $788.34 "$3,972.00" "$1,787.40" "$1,787.40" "$1,787.40" "$1,787.40" "$3,972.00" "$3,972.00" "$3,972.00" $827.86 "$3,972.00" "$3,972.00" "$3,972.00" "$3,972.00" "$3,972.00" $827.81 "$3,972.00" "$3,972.00" "$1,958.20" "$3,972.00" "$3,972.00" "$3,972.00" "$3,972.00" "$2,979.00" "$3,972.00" "$3,972.00" "$3,972.00" "$1,986.00" "$1,986.00" "$3,145.82" "$3,972.00" "$3,177.60" "$1,787.40" $788.34 "$3,972.00" "$2,303.76" "$3,972.00" "$3,972.00" "$3,972.00" $827.76 "$3,972.00" N/A N/A 27801127 EAP HCPCS C1876 WALL STENT 16MMX20M BOTH IP/OP "$3,918.00" "$2,899.50" $777.63 "$3,918.00" "$1,763.10" "$1,763.10" "$1,763.10" "$1,763.10" "$3,918.00" "$3,918.00" "$3,918.00" $816.61 "$3,918.00" "$3,918.00" "$3,918.00" "$3,918.00" "$3,918.00" $816.55 "$3,918.00" "$3,918.00" "$1,931.57" "$3,918.00" "$3,918.00" "$3,918.00" "$3,918.00" "$2,938.50" "$3,918.00" "$3,918.00" "$3,918.00" "$1,959.00" "$1,959.00" "$3,103.06" "$3,918.00" "$3,134.40" "$1,763.10" $777.63 "$3,918.00" "$2,272.44" "$3,918.00" "$3,918.00" "$3,918.00" $816.51 "$3,918.00" N/A N/A 27801128 EAP HCPCS C1874 VIABHNEND.COV.STENT BOTH IP/OP "$15,609.00" "$11,551.00" "$3,098.00" "$15,609.00" "$7,024.05" "$7,024.05" "$7,024.05" "$7,024.05" "$15,609.00" "$15,609.00" "$15,609.00" "$3,253.31" "$15,609.00" "$15,609.00" "$15,609.00" "$15,609.00" "$15,609.00" "$3,253.09" "$15,609.00" "$15,609.00" "$7,695.24" "$15,609.00" "$15,609.00" "$15,609.00" "$15,609.00" "$11,706.75" "$15,609.00" "$15,609.00" "$15,609.00" "$7,804.50" "$7,804.50" "$12,362.33" "$15,609.00" "$12,487.20" "$7,024.05" "$3,098.00" "$15,609.00" "$9,053.22" "$15,609.00" "$15,609.00" "$15,609.00" "$3,252.92" "$15,609.00" N/A N/A 27801129 EAP HCPCS C1874 VIABHNEND.COV.STENT BOTH IP/OP "$14,496.00" "$10,727.50" "$2,877.09" "$14,496.00" "$6,523.20" "$6,523.20" "$6,523.20" "$6,523.20" "$14,496.00" "$14,496.00" "$14,496.00" "$3,021.33" "$14,496.00" "$14,496.00" "$14,496.00" "$14,496.00" "$14,496.00" "$3,021.13" "$14,496.00" "$14,496.00" "$7,146.53" "$14,496.00" "$14,496.00" "$14,496.00" "$14,496.00" "$10,872.00" "$14,496.00" "$14,496.00" "$14,496.00" "$7,248.00" "$7,248.00" "$11,480.83" "$14,496.00" "$11,596.80" "$6,523.20" "$2,877.09" "$14,496.00" "$8,407.68" "$14,496.00" "$14,496.00" "$14,496.00" "$3,020.97" "$14,496.00" N/A N/A 27801130 EAP HCPCS C1874 VIABHNEND.COV.STENT BOTH IP/OP "$17,381.00" "$12,862.00" "$3,449.69" "$17,381.00" "$7,821.45" "$7,821.45" "$7,821.45" "$7,821.45" "$17,381.00" "$17,381.00" "$17,381.00" "$3,622.63" "$17,381.00" "$17,381.00" "$17,381.00" "$17,381.00" "$17,381.00" "$3,622.39" "$17,381.00" "$17,381.00" "$8,568.83" "$17,381.00" "$17,381.00" "$17,381.00" "$17,381.00" "$13,035.75" "$17,381.00" "$17,381.00" "$17,381.00" "$8,690.50" "$8,690.50" "$13,765.75" "$17,381.00" "$13,904.80" "$7,821.45" "$3,449.69" "$17,381.00" "$10,080.98" "$17,381.00" "$17,381.00" "$17,381.00" "$3,622.20" "$17,381.00" N/A N/A 27801131 EAP HCPCS C1874 VIABHNEND.COV.STENT BOTH IP/OP "$20,235.00" "$14,974.00" "$4,016.14" "$20,235.00" "$9,105.75" "$9,105.75" "$9,105.75" "$9,105.75" "$20,235.00" "$20,235.00" "$20,235.00" "$4,217.48" "$20,235.00" "$20,235.00" "$20,235.00" "$20,235.00" "$20,235.00" "$4,217.20" "$20,235.00" "$20,235.00" "$9,975.86" "$20,235.00" "$20,235.00" "$20,235.00" "$20,235.00" "$15,176.25" "$20,235.00" "$20,235.00" "$20,235.00" "$10,117.50" "$10,117.50" "$16,026.12" "$20,235.00" "$16,188.00" "$9,105.75" "$4,016.14" "$20,235.00" "$11,736.30" "$20,235.00" "$20,235.00" "$20,235.00" "$4,216.97" "$20,235.00" N/A N/A 27801134 EAP HCPCS C1874 PERCUT(MMXCM)8X4COV BOTH IP/OP "$13,684.00" "$10,126.50" "$2,715.93" "$13,684.00" "$6,157.80" "$6,157.80" "$6,157.80" "$6,157.80" "$13,684.00" "$13,684.00" "$13,684.00" "$2,852.09" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.90" "$13,684.00" "$13,684.00" "$6,746.21" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$10,263.00" "$13,684.00" "$13,684.00" "$13,684.00" "$6,842.00" "$6,842.00" "$10,837.73" "$13,684.00" "$10,947.20" "$6,157.80" "$2,715.93" "$13,684.00" "$7,936.72" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.75" "$13,684.00" N/A N/A 27801135 EAP HCPCS C1874 PERCUT(MMXCM)8X6COV BOTH IP/OP "$13,684.00" "$10,126.50" "$2,715.93" "$13,684.00" "$6,157.80" "$6,157.80" "$6,157.80" "$6,157.80" "$13,684.00" "$13,684.00" "$13,684.00" "$2,852.09" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.90" "$13,684.00" "$13,684.00" "$6,746.21" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$10,263.00" "$13,684.00" "$13,684.00" "$13,684.00" "$6,842.00" "$6,842.00" "$10,837.73" "$13,684.00" "$10,947.20" "$6,157.80" "$2,715.93" "$13,684.00" "$7,936.72" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.75" "$13,684.00" N/A N/A 27801136 EAP HCPCS C1874 PERCUT(MMXCM)8X8COV BOTH IP/OP "$13,684.00" "$10,126.50" "$2,715.93" "$13,684.00" "$6,157.80" "$6,157.80" "$6,157.80" "$6,157.80" "$13,684.00" "$13,684.00" "$13,684.00" "$2,852.09" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.90" "$13,684.00" "$13,684.00" "$6,746.21" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$10,263.00" "$13,684.00" "$13,684.00" "$13,684.00" "$6,842.00" "$6,842.00" "$10,837.73" "$13,684.00" "$10,947.20" "$6,157.80" "$2,715.93" "$13,684.00" "$7,936.72" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.75" "$13,684.00" N/A N/A 27801137 EAP HCPCS C1874 PERCUT(MMXCM)8X10CO BOTH IP/OP "$13,684.00" "$10,126.50" "$2,715.93" "$13,684.00" "$6,157.80" "$6,157.80" "$6,157.80" "$6,157.80" "$13,684.00" "$13,684.00" "$13,684.00" "$2,852.09" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.90" "$13,684.00" "$13,684.00" "$6,746.21" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$10,263.00" "$13,684.00" "$13,684.00" "$13,684.00" "$6,842.00" "$6,842.00" "$10,837.73" "$13,684.00" "$10,947.20" "$6,157.80" "$2,715.93" "$13,684.00" "$7,936.72" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.75" "$13,684.00" N/A N/A 27801138 EAP HCPCS C1874 PERCUT(MMXCM)10X4CO BOTH IP/OP "$13,684.00" "$10,126.50" "$2,715.93" "$13,684.00" "$6,157.80" "$6,157.80" "$6,157.80" "$6,157.80" "$13,684.00" "$13,684.00" "$13,684.00" "$2,852.09" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.90" "$13,684.00" "$13,684.00" "$6,746.21" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$10,263.00" "$13,684.00" "$13,684.00" "$13,684.00" "$6,842.00" "$6,842.00" "$10,837.73" "$13,684.00" "$10,947.20" "$6,157.80" "$2,715.93" "$13,684.00" "$7,936.72" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.75" "$13,684.00" N/A N/A 27801139 EAP HCPCS C1874 PERCUT(MMXCM)10X6 C BOTH IP/OP "$13,684.00" "$10,126.50" "$2,715.93" "$13,684.00" "$6,157.80" "$6,157.80" "$6,157.80" "$6,157.80" "$13,684.00" "$13,684.00" "$13,684.00" "$2,852.09" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.90" "$13,684.00" "$13,684.00" "$6,746.21" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$10,263.00" "$13,684.00" "$13,684.00" "$13,684.00" "$6,842.00" "$6,842.00" "$10,837.73" "$13,684.00" "$10,947.20" "$6,157.80" "$2,715.93" "$13,684.00" "$7,936.72" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.75" "$13,684.00" N/A N/A 27801140 EAP HCPCS C1875 PERCUT(MMXCM)10X8 C BOTH IP/OP "$13,684.00" "$10,126.50" "$2,851.90" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.90" "$13,684.00" "$5,473.60" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$10,263.00" "$13,684.00" "$13,684.00" "$13,684.00" "$6,842.00" "$6,842.00" "$10,837.73" "$13,684.00" "$10,947.20" "$6,157.80" "$13,684.00" "$13,684.00" "$7,936.72" "$13,684.00" "$8,210.40" "$13,684.00" "$13,684.00" "$13,684.00" N/A N/A 27801141 EAP HCPCS C1874 PERCUT(MMXCM)10X10 BOTH IP/OP "$13,684.00" "$10,126.50" "$2,715.93" "$13,684.00" "$6,157.80" "$6,157.80" "$6,157.80" "$6,157.80" "$13,684.00" "$13,684.00" "$13,684.00" "$2,852.09" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.90" "$13,684.00" "$13,684.00" "$6,746.21" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$10,263.00" "$13,684.00" "$13,684.00" "$13,684.00" "$6,842.00" "$6,842.00" "$10,837.73" "$13,684.00" "$10,947.20" "$6,157.80" "$2,715.93" "$13,684.00" "$7,936.72" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.75" "$13,684.00" N/A N/A 27801142 EAP HCPCS C1874 PERCUT(MMXCM)8X6UNC BOTH IP/OP "$13,684.00" "$10,126.50" "$2,715.93" "$13,684.00" "$6,157.80" "$6,157.80" "$6,157.80" "$6,157.80" "$13,684.00" "$13,684.00" "$13,684.00" "$2,852.09" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.90" "$13,684.00" "$13,684.00" "$6,746.21" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$10,263.00" "$13,684.00" "$13,684.00" "$13,684.00" "$6,842.00" "$6,842.00" "$10,837.73" "$13,684.00" "$10,947.20" "$6,157.80" "$2,715.93" "$13,684.00" "$7,936.72" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.75" "$13,684.00" N/A N/A 27801143 EAP HCPCS C1874 PERCUT(MMXCM)8X10UN BOTH IP/OP "$13,684.00" "$10,126.50" "$2,715.93" "$13,684.00" "$6,157.80" "$6,157.80" "$6,157.80" "$6,157.80" "$13,684.00" "$13,684.00" "$13,684.00" "$2,852.09" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.90" "$13,684.00" "$13,684.00" "$6,746.21" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$10,263.00" "$13,684.00" "$13,684.00" "$13,684.00" "$6,842.00" "$6,842.00" "$10,837.73" "$13,684.00" "$10,947.20" "$6,157.80" "$2,715.93" "$13,684.00" "$7,936.72" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.75" "$13,684.00" N/A N/A 27801144 EAP HCPCS C1874 PERCUT(MMXCM)10X6UN BOTH IP/OP "$13,684.00" "$10,126.50" "$2,715.93" "$13,684.00" "$6,157.80" "$6,157.80" "$6,157.80" "$6,157.80" "$13,684.00" "$13,684.00" "$13,684.00" "$2,852.09" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.90" "$13,684.00" "$13,684.00" "$6,746.21" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$10,263.00" "$13,684.00" "$13,684.00" "$13,684.00" "$6,842.00" "$6,842.00" "$10,837.73" "$13,684.00" "$10,947.20" "$6,157.80" "$2,715.93" "$13,684.00" "$7,936.72" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.75" "$13,684.00" N/A N/A 27801145 EAP HCPCS C1874 PERCUT(MMXCM)10X8UN BOTH IP/OP "$13,684.00" "$10,126.50" "$2,715.93" "$13,684.00" "$6,157.80" "$6,157.80" "$6,157.80" "$6,157.80" "$13,684.00" "$13,684.00" "$13,684.00" "$2,852.09" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.90" "$13,684.00" "$13,684.00" "$6,746.21" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$10,263.00" "$13,684.00" "$13,684.00" "$13,684.00" "$6,842.00" "$6,842.00" "$10,837.73" "$13,684.00" "$10,947.20" "$6,157.80" "$2,715.93" "$13,684.00" "$7,936.72" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.75" "$13,684.00" N/A N/A 27801146 EAP HCPCS C1874 PERCUT(MMXCM)10X10U BOTH IP/OP "$13,684.00" "$10,126.50" "$2,715.93" "$13,684.00" "$6,157.80" "$6,157.80" "$6,157.80" "$6,157.80" "$13,684.00" "$13,684.00" "$13,684.00" "$2,852.09" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.90" "$13,684.00" "$13,684.00" "$6,746.21" "$13,684.00" "$13,684.00" "$13,684.00" "$13,684.00" "$10,263.00" "$13,684.00" "$13,684.00" "$13,684.00" "$6,842.00" "$6,842.00" "$10,837.73" "$13,684.00" "$10,947.20" "$6,157.80" "$2,715.93" "$13,684.00" "$7,936.72" "$13,684.00" "$13,684.00" "$13,684.00" "$2,851.75" "$13,684.00" N/A N/A 27801147 EAP HCPCS C1874 ENDSC(MMXCM) 8X4 CO BOTH IP/OP "$12,810.00" "$9,479.50" "$2,542.46" "$12,810.00" "$5,764.50" "$5,764.50" "$5,764.50" "$5,764.50" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.92" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.74" "$12,810.00" "$12,810.00" "$6,315.33" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$9,607.50" "$12,810.00" "$12,810.00" "$12,810.00" "$6,405.00" "$6,405.00" "$10,145.52" "$12,810.00" "$10,248.00" "$5,764.50" "$2,542.46" "$12,810.00" "$7,429.80" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.60" "$12,810.00" N/A N/A 27801148 EAP HCPCS C1874 ENDSC(MMXCM) 8X6 CO BOTH IP/OP "$12,810.00" "$9,479.50" "$2,542.46" "$12,810.00" "$5,764.50" "$5,764.50" "$5,764.50" "$5,764.50" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.92" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.74" "$12,810.00" "$12,810.00" "$6,315.33" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$9,607.50" "$12,810.00" "$12,810.00" "$12,810.00" "$6,405.00" "$6,405.00" "$10,145.52" "$12,810.00" "$10,248.00" "$5,764.50" "$2,542.46" "$12,810.00" "$7,429.80" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.60" "$12,810.00" N/A N/A 27801149 EAP HCPCS C1874 ENDSC(MMXCM) 8X8 CO BOTH IP/OP "$12,810.00" "$9,479.50" "$2,542.46" "$12,810.00" "$5,764.50" "$5,764.50" "$5,764.50" "$5,764.50" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.92" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.74" "$12,810.00" "$12,810.00" "$6,315.33" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$9,607.50" "$12,810.00" "$12,810.00" "$12,810.00" "$6,405.00" "$6,405.00" "$10,145.52" "$12,810.00" "$10,248.00" "$5,764.50" "$2,542.46" "$12,810.00" "$7,429.80" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.60" "$12,810.00" N/A N/A 27801150 EAP HCPCS C1874 ENDSC(MMXCM) 8X10 C BOTH IP/OP "$12,810.00" "$9,479.50" "$2,542.46" "$12,810.00" "$5,764.50" "$5,764.50" "$5,764.50" "$5,764.50" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.92" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.74" "$12,810.00" "$12,810.00" "$6,315.33" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$9,607.50" "$12,810.00" "$12,810.00" "$12,810.00" "$6,405.00" "$6,405.00" "$10,145.52" "$12,810.00" "$10,248.00" "$5,764.50" "$2,542.46" "$12,810.00" "$7,429.80" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.60" "$12,810.00" N/A N/A 27801151 EAP HCPCS C1874 ENDSC(MMXCM) 10X4 C BOTH IP/OP "$12,902.00" "$9,547.50" "$2,560.72" "$12,902.00" "$5,805.90" "$5,805.90" "$5,805.90" "$5,805.90" "$12,902.00" "$12,902.00" "$12,902.00" "$2,689.10" "$12,902.00" "$12,902.00" "$12,902.00" "$12,902.00" "$12,902.00" "$2,688.92" "$12,902.00" "$12,902.00" "$6,360.69" "$12,902.00" "$12,902.00" "$12,902.00" "$12,902.00" "$9,676.50" "$12,902.00" "$12,902.00" "$12,902.00" "$6,451.00" "$6,451.00" "$10,218.38" "$12,902.00" "$10,321.60" "$5,805.90" "$2,560.72" "$12,902.00" "$7,483.16" "$12,902.00" "$12,902.00" "$12,902.00" "$2,688.78" "$12,902.00" N/A N/A 27801152 EAP HCPCS C1874 ENDSC (MMXCM) 10X6 BOTH IP/OP "$12,810.00" "$9,479.50" "$2,542.46" "$12,810.00" "$5,764.50" "$5,764.50" "$5,764.50" "$5,764.50" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.92" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.74" "$12,810.00" "$12,810.00" "$6,315.33" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$9,607.50" "$12,810.00" "$12,810.00" "$12,810.00" "$6,405.00" "$6,405.00" "$10,145.52" "$12,810.00" "$10,248.00" "$5,764.50" "$2,542.46" "$12,810.00" "$7,429.80" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.60" "$12,810.00" N/A N/A 27801153 EAP HCPCS C1874 ENDSC(MMXCM) 10X8 C BOTH IP/OP "$12,810.00" "$9,479.50" "$2,542.46" "$12,810.00" "$5,764.50" "$5,764.50" "$5,764.50" "$5,764.50" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.92" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.74" "$12,810.00" "$12,810.00" "$6,315.33" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$9,607.50" "$12,810.00" "$12,810.00" "$12,810.00" "$6,405.00" "$6,405.00" "$10,145.52" "$12,810.00" "$10,248.00" "$5,764.50" "$2,542.46" "$12,810.00" "$7,429.80" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.60" "$12,810.00" N/A N/A 27801154 EAP HCPCS C1874 ENDSC(MMXCM)10X10 C BOTH IP/OP "$12,810.00" "$9,479.50" "$2,542.46" "$12,810.00" "$5,764.50" "$5,764.50" "$5,764.50" "$5,764.50" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.92" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.74" "$12,810.00" "$12,810.00" "$6,315.33" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$9,607.50" "$12,810.00" "$12,810.00" "$12,810.00" "$6,405.00" "$6,405.00" "$10,145.52" "$12,810.00" "$10,248.00" "$5,764.50" "$2,542.46" "$12,810.00" "$7,429.80" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.60" "$12,810.00" N/A N/A 27801155 EAP HCPCS C1874 ENDSC(MMXCM) 8X6 UN BOTH IP/OP "$12,810.00" "$9,479.50" "$2,542.46" "$12,810.00" "$5,764.50" "$5,764.50" "$5,764.50" "$5,764.50" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.92" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.74" "$12,810.00" "$12,810.00" "$6,315.33" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$9,607.50" "$12,810.00" "$12,810.00" "$12,810.00" "$6,405.00" "$6,405.00" "$10,145.52" "$12,810.00" "$10,248.00" "$5,764.50" "$2,542.46" "$12,810.00" "$7,429.80" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.60" "$12,810.00" N/A N/A 27801156 EAP HCPCS C1874 ENDSC(MMXCM) 8X8 UN BOTH IP/OP "$12,810.00" "$9,479.50" "$2,542.46" "$12,810.00" "$5,764.50" "$5,764.50" "$5,764.50" "$5,764.50" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.92" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.74" "$12,810.00" "$12,810.00" "$6,315.33" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$9,607.50" "$12,810.00" "$12,810.00" "$12,810.00" "$6,405.00" "$6,405.00" "$10,145.52" "$12,810.00" "$10,248.00" "$5,764.50" "$2,542.46" "$12,810.00" "$7,429.80" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.60" "$12,810.00" N/A N/A 27801157 EAP HCPCS C1874 ENDSC(MMXCM)8X10 UN BOTH IP/OP "$12,810.00" "$9,479.50" "$2,542.46" "$12,810.00" "$5,764.50" "$5,764.50" "$5,764.50" "$5,764.50" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.92" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.74" "$12,810.00" "$12,810.00" "$6,315.33" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$9,607.50" "$12,810.00" "$12,810.00" "$12,810.00" "$6,405.00" "$6,405.00" "$10,145.52" "$12,810.00" "$10,248.00" "$5,764.50" "$2,542.46" "$12,810.00" "$7,429.80" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.60" "$12,810.00" N/A N/A 27801158 EAP HCPCS C1874 ENDSC(MMXCM)10X6 UN BOTH IP/OP "$12,810.00" "$9,479.50" "$2,542.46" "$12,810.00" "$5,764.50" "$5,764.50" "$5,764.50" "$5,764.50" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.92" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.74" "$12,810.00" "$12,810.00" "$6,315.33" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$9,607.50" "$12,810.00" "$12,810.00" "$12,810.00" "$6,405.00" "$6,405.00" "$10,145.52" "$12,810.00" "$10,248.00" "$5,764.50" "$2,542.46" "$12,810.00" "$7,429.80" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.60" "$12,810.00" N/A N/A 27801159 EAP HCPCS C1874 ENDSC(MMXCM)10X8 UN BOTH IP/OP "$12,810.00" "$9,479.50" "$2,542.46" "$12,810.00" "$5,764.50" "$5,764.50" "$5,764.50" "$5,764.50" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.92" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.74" "$12,810.00" "$12,810.00" "$6,315.33" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$9,607.50" "$12,810.00" "$12,810.00" "$12,810.00" "$6,405.00" "$6,405.00" "$10,145.52" "$12,810.00" "$10,248.00" "$5,764.50" "$2,542.46" "$12,810.00" "$7,429.80" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.60" "$12,810.00" N/A N/A 27801160 EAP HCPCS C1874 ENDSC(MMXCM)10X10UN BOTH IP/OP "$12,810.00" "$9,479.50" "$2,542.46" "$12,810.00" "$5,764.50" "$5,764.50" "$5,764.50" "$5,764.50" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.92" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.74" "$12,810.00" "$12,810.00" "$6,315.33" "$12,810.00" "$12,810.00" "$12,810.00" "$12,810.00" "$9,607.50" "$12,810.00" "$12,810.00" "$12,810.00" "$6,405.00" "$6,405.00" "$10,145.52" "$12,810.00" "$10,248.00" "$5,764.50" "$2,542.46" "$12,810.00" "$7,429.80" "$12,810.00" "$12,810.00" "$12,810.00" "$2,669.60" "$12,810.00" N/A N/A 27801161 EAP HCPCS C1874 "STENT,ILIAC,WALLSTE" BOTH IP/OP "$6,980.00" "$5,165.50" "$1,385.36" "$6,980.00" "$3,141.00" "$3,141.00" "$3,141.00" "$3,141.00" "$6,980.00" "$6,980.00" "$6,980.00" "$1,454.81" "$6,980.00" "$6,980.00" "$6,980.00" "$6,980.00" "$6,980.00" "$1,454.71" "$6,980.00" "$6,980.00" "$3,441.14" "$6,980.00" "$6,980.00" "$6,980.00" "$6,980.00" "$5,235.00" "$6,980.00" "$6,980.00" "$6,980.00" "$3,490.00" "$3,490.00" "$5,528.16" "$6,980.00" "$5,584.00" "$3,141.00" "$1,385.36" "$6,980.00" "$4,048.40" "$6,980.00" "$6,980.00" "$6,980.00" "$1,454.63" "$6,980.00" N/A N/A 27801162 EAP HCPCS C1880 VENA CAVA FILTER BOTH IP/OP "$4,656.00" "$3,445.50" $970.36 "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" $970.36 "$4,656.00" "$1,862.40" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$4,656.00" "$3,492.00" "$4,656.00" "$4,656.00" "$4,656.00" "$2,328.00" "$2,328.00" "$3,687.55" "$4,656.00" "$3,724.80" "$2,095.20" "$4,656.00" "$4,656.00" "$2,700.48" "$4,656.00" "$2,793.60" "$4,656.00" "$4,656.00" "$4,656.00" N/A N/A 27801163 EAP HCPCS C1874 "STE.,BIL MEMMOTHERM" BOTH IP/OP "$6,980.00" "$5,165.50" "$1,385.36" "$6,980.00" "$3,141.00" "$3,141.00" "$3,141.00" "$3,141.00" "$6,980.00" "$6,980.00" "$6,980.00" "$1,454.81" "$6,980.00" "$6,980.00" "$6,980.00" "$6,980.00" "$6,980.00" "$1,454.71" "$6,980.00" "$6,980.00" "$3,441.14" "$6,980.00" "$6,980.00" "$6,980.00" "$6,980.00" "$5,235.00" "$6,980.00" "$6,980.00" "$6,980.00" "$3,490.00" "$3,490.00" "$5,528.16" "$6,980.00" "$5,584.00" "$3,141.00" "$1,385.36" "$6,980.00" "$4,048.40" "$6,980.00" "$6,980.00" "$6,980.00" "$1,454.63" "$6,980.00" N/A N/A 27801164 EAP HCPCS C1874 "STE.,BIL WALLSTENT," BOTH IP/OP "$5,991.00" "$4,433.50" "$1,189.06" "$5,991.00" "$2,695.95" "$2,695.95" "$2,695.95" "$2,695.95" "$5,991.00" "$5,991.00" "$5,991.00" "$1,248.67" "$5,991.00" "$5,991.00" "$5,991.00" "$5,991.00" "$5,991.00" "$1,248.59" "$5,991.00" "$5,991.00" "$2,953.56" "$5,991.00" "$5,991.00" "$5,991.00" "$5,991.00" "$4,493.25" "$5,991.00" "$5,991.00" "$5,991.00" "$2,995.50" "$2,995.50" "$4,744.87" "$5,991.00" "$4,792.80" "$2,695.95" "$1,189.06" "$5,991.00" "$3,474.78" "$5,991.00" "$5,991.00" "$5,991.00" "$1,248.52" "$5,991.00" N/A N/A 27801165 EAP HCPCS C1874 "STE,BIL W/S RP-20,4" BOTH IP/OP "$5,991.00" "$4,433.50" "$1,189.06" "$5,991.00" "$2,695.95" "$2,695.95" "$2,695.95" "$2,695.95" "$5,991.00" "$5,991.00" "$5,991.00" "$1,248.67" "$5,991.00" "$5,991.00" "$5,991.00" "$5,991.00" "$5,991.00" "$1,248.59" "$5,991.00" "$5,991.00" "$2,953.56" "$5,991.00" "$5,991.00" "$5,991.00" "$5,991.00" "$4,493.25" "$5,991.00" "$5,991.00" "$5,991.00" "$2,995.50" "$2,995.50" "$4,744.87" "$5,991.00" "$4,792.80" "$2,695.95" "$1,189.06" "$5,991.00" "$3,474.78" "$5,991.00" "$5,991.00" "$5,991.00" "$1,248.52" "$5,991.00" N/A N/A 27801166 EAP HCPCS C1874 "STE.,BIL WALLSTENT" BOTH IP/OP "$10,078.00" "$7,458.00" "$2,000.23" "$10,078.00" "$4,535.10" "$4,535.10" "$4,535.10" "$4,535.10" "$10,078.00" "$10,078.00" "$10,078.00" "$2,100.51" "$10,078.00" "$10,078.00" "$10,078.00" "$10,078.00" "$10,078.00" "$2,100.37" "$10,078.00" "$10,078.00" "$4,968.45" "$10,078.00" "$10,078.00" "$10,078.00" "$10,078.00" "$7,558.50" "$10,078.00" "$10,078.00" "$10,078.00" "$5,039.00" "$5,039.00" "$7,981.78" "$10,078.00" "$8,062.40" "$4,535.10" "$2,000.23" "$10,078.00" "$5,845.24" "$10,078.00" "$10,078.00" "$10,078.00" "$2,100.26" "$10,078.00" N/A N/A 27801167 EAP HCPCS C1874 "STE.,ENT W/STENT,UN" BOTH IP/OP "$10,078.00" "$7,458.00" "$2,000.23" "$10,078.00" "$4,535.10" "$4,535.10" "$4,535.10" "$4,535.10" "$10,078.00" "$10,078.00" "$10,078.00" "$2,100.51" "$10,078.00" "$10,078.00" "$10,078.00" "$10,078.00" "$10,078.00" "$2,100.37" "$10,078.00" "$10,078.00" "$4,968.45" "$10,078.00" "$10,078.00" "$10,078.00" "$10,078.00" "$7,558.50" "$10,078.00" "$10,078.00" "$10,078.00" "$5,039.00" "$5,039.00" "$7,981.78" "$10,078.00" "$8,062.40" "$4,535.10" "$2,000.23" "$10,078.00" "$5,845.24" "$10,078.00" "$10,078.00" "$10,078.00" "$2,100.26" "$10,078.00" N/A N/A 27801168 EAP HCPCS C1874 "ST.,WALLGRAFT UNIST" BOTH IP/OP "$11,656.00" "$8,625.50" "$2,313.42" "$11,656.00" "$5,245.20" "$5,245.20" "$5,245.20" "$5,245.20" "$11,656.00" "$11,656.00" "$11,656.00" "$2,429.40" "$11,656.00" "$11,656.00" "$11,656.00" "$11,656.00" "$11,656.00" "$2,429.24" "$11,656.00" "$11,656.00" "$5,746.41" "$11,656.00" "$11,656.00" "$11,656.00" "$11,656.00" "$8,742.00" "$11,656.00" "$11,656.00" "$11,656.00" "$5,828.00" "$5,828.00" "$9,231.55" "$11,656.00" "$9,324.80" "$5,245.20" "$2,313.42" "$11,656.00" "$6,760.48" "$11,656.00" "$11,656.00" "$11,656.00" "$2,429.11" "$11,656.00" N/A N/A 27801169 EAP HCPCS C1874 "STE., W/G UNISTEP-2" BOTH IP/OP "$11,656.00" "$8,625.50" "$2,313.42" "$11,656.00" "$5,245.20" "$5,245.20" "$5,245.20" "$5,245.20" "$11,656.00" "$11,656.00" "$11,656.00" "$2,429.40" "$11,656.00" "$11,656.00" "$11,656.00" "$11,656.00" "$11,656.00" "$2,429.24" "$11,656.00" "$11,656.00" "$5,746.41" "$11,656.00" "$11,656.00" "$11,656.00" "$11,656.00" "$8,742.00" "$11,656.00" "$11,656.00" "$11,656.00" "$5,828.00" "$5,828.00" "$9,231.55" "$11,656.00" "$9,324.80" "$5,245.20" "$2,313.42" "$11,656.00" "$6,760.48" "$11,656.00" "$11,656.00" "$11,656.00" "$2,429.11" "$11,656.00" N/A N/A 27801170 EAP HCPCS L8670 AORTIC EXT ENDOPROS BOTH IP/OP "$10,150.00" "$7,511.00" $361.73 "$10,150.00" "$10,150.00" "$10,150.00" "$10,150.00" "$10,150.00" "$10,150.00" "$10,150.00" $361.73 "$10,150.00" "$10,150.00" "$10,150.00" "$10,150.00" "$10,150.00" "$10,150.00" "$2,115.37" "$10,150.00" "$4,060.00" "$10,150.00" "$10,150.00" "$10,150.00" "$10,150.00" "$10,150.00" "$7,612.50" "$10,150.00" "$10,150.00" "$10,150.00" "$5,075.00" "$5,075.00" "$8,038.80" "$10,150.00" "$8,120.00" "$4,567.50" "$10,150.00" "$10,150.00" "$5,887.00" "$10,150.00" "$6,090.00" "$10,150.00" "$10,150.00" "$10,150.00" N/A N/A 27801171 EAP Custom 27801171 PFO IMPLANT BOTH IP/OP "$24,270.00" "$17,960.00" "$4,320.06" "$24,270.00" "$24,270.00" "$24,270.00" "$24,270.00" "$24,270.00" "$24,270.00" "$24,270.00" "$4,320.06" "$24,270.00" "$24,270.00" "$24,270.00" "$24,270.00" "$24,270.00" "$24,270.00" "$5,058.13" "$24,270.00" "$9,708.00" "$24,270.00" "$24,270.00" "$24,270.00" "$24,270.00" "$24,270.00" "$18,202.50" "$24,270.00" "$24,270.00" "$24,270.00" "$12,135.00" "$12,135.00" "$19,221.84" "$24,270.00" "$19,416.00" "$10,921.50" "$24,270.00" "$24,270.00" "$14,076.60" "$24,270.00" "$14,562.00" "$24,270.00" "$24,270.00" "$24,270.00" N/A N/A 27801172 EAP Custom 27801172 ASD IMPLANT BOTH IP/OP "$14,800.00" "$10,952.00" "$2,634.40" "$14,800.00" "$14,800.00" "$14,800.00" "$14,800.00" "$14,800.00" "$14,800.00" "$14,800.00" "$2,634.40" "$14,800.00" "$14,800.00" "$14,800.00" "$14,800.00" "$14,800.00" "$14,800.00" "$3,084.48" "$14,800.00" "$5,920.00" "$14,800.00" "$14,800.00" "$14,800.00" "$14,800.00" "$14,800.00" "$11,100.00" "$14,800.00" "$14,800.00" "$14,800.00" "$7,400.00" "$7,400.00" "$11,721.60" "$14,800.00" "$11,840.00" "$6,660.00" "$14,800.00" "$14,800.00" "$8,584.00" "$14,800.00" "$8,880.00" "$14,800.00" "$14,800.00" "$14,800.00" N/A N/A 27801173 EAP HCPCS C1760 "CLOSURE DEVICE, VAS" BOTH IP/OP "$1,363.00" "$1,009.00" $270.52 "$1,363.00" $613.35 $613.35 $613.35 $613.35 "$1,363.00" "$1,363.00" "$1,363.00" $284.08 "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" $284.06 "$1,363.00" "$1,363.00" $806.21 "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" "$1,022.25" "$1,363.00" "$1,363.00" "$1,363.00" $681.50 $681.50 "$1,079.50" "$1,363.00" "$1,090.40" $613.35 $270.52 "$1,363.00" $790.54 "$1,363.00" "$1,363.00" "$1,363.00" $284.05 "$1,363.00" N/A N/A 27801190 EAP HCPCS C1876 3.0X8MM VISION RX S BOTH IP/OP "$2,920.00" "$2,161.00" $579.55 "$2,920.00" "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.60 "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.56 "$2,920.00" "$2,920.00" "$1,439.56" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,190.00" "$2,920.00" "$2,920.00" "$2,920.00" "$1,460.00" "$1,460.00" "$2,312.64" "$2,920.00" "$2,336.00" "$1,314.00" $579.55 "$2,920.00" "$1,693.60" "$2,920.00" "$2,920.00" "$2,920.00" $608.53 "$2,920.00" N/A N/A 27801191 EAP HCPCS C1876 3.5X8MM VISION RX S BOTH IP/OP "$3,836.00" "$2,839.00" $761.35 "$3,836.00" "$1,726.20" "$1,726.20" "$1,726.20" "$1,726.20" "$3,836.00" "$3,836.00" "$3,836.00" $799.52 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $799.46 "$3,836.00" "$3,836.00" "$1,891.15" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$1,726.20" $761.35 "$3,836.00" "$2,224.88" "$3,836.00" "$3,836.00" "$3,836.00" $799.42 "$3,836.00" N/A N/A 27801192 EAP HCPCS C1876 4.0X8MM VISION RX S BOTH IP/OP "$3,836.00" "$2,839.00" $761.35 "$3,836.00" "$1,726.20" "$1,726.20" "$1,726.20" "$1,726.20" "$3,836.00" "$3,836.00" "$3,836.00" $799.52 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $799.46 "$3,836.00" "$3,836.00" "$1,891.15" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$1,726.20" $761.35 "$3,836.00" "$2,224.88" "$3,836.00" "$3,836.00" "$3,836.00" $799.42 "$3,836.00" N/A N/A 27801193 EAP HCPCS C1876 3.0X12MM VISION RX BOTH IP/OP "$3,836.00" "$2,839.00" $761.35 "$3,836.00" "$1,726.20" "$1,726.20" "$1,726.20" "$1,726.20" "$3,836.00" "$3,836.00" "$3,836.00" $799.52 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $799.46 "$3,836.00" "$3,836.00" "$1,891.15" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$1,726.20" $761.35 "$3,836.00" "$2,224.88" "$3,836.00" "$3,836.00" "$3,836.00" $799.42 "$3,836.00" N/A N/A 27801194 EAP HCPCS C1876 3.5X12MM VISION RX BOTH IP/OP "$2,920.00" "$2,161.00" $579.55 "$2,920.00" "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.60 "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.56 "$2,920.00" "$2,920.00" "$1,439.56" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,190.00" "$2,920.00" "$2,920.00" "$2,920.00" "$1,460.00" "$1,460.00" "$2,312.64" "$2,920.00" "$2,336.00" "$1,314.00" $579.55 "$2,920.00" "$1,693.60" "$2,920.00" "$2,920.00" "$2,920.00" $608.53 "$2,920.00" N/A N/A 27801195 EAP HCPCS C1876 4.0X12MM VISION RX BOTH IP/OP "$3,836.00" "$2,839.00" $761.35 "$3,836.00" "$1,726.20" "$1,726.20" "$1,726.20" "$1,726.20" "$3,836.00" "$3,836.00" "$3,836.00" $799.52 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $799.46 "$3,836.00" "$3,836.00" "$1,891.15" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$1,726.20" $761.35 "$3,836.00" "$2,224.88" "$3,836.00" "$3,836.00" "$3,836.00" $799.42 "$3,836.00" N/A N/A 27801196 EAP HCPCS C1876 3.0X15MM VISION RX BOTH IP/OP "$2,920.00" "$2,161.00" $579.55 "$2,920.00" "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.60 "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.56 "$2,920.00" "$2,920.00" "$1,439.56" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,190.00" "$2,920.00" "$2,920.00" "$2,920.00" "$1,460.00" "$1,460.00" "$2,312.64" "$2,920.00" "$2,336.00" "$1,314.00" $579.55 "$2,920.00" "$1,693.60" "$2,920.00" "$2,920.00" "$2,920.00" $608.53 "$2,920.00" N/A N/A 27801197 EAP HCPCS C1876 3.5X15MM VISION RX BOTH IP/OP "$2,920.00" "$2,161.00" $579.55 "$2,920.00" "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.60 "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.56 "$2,920.00" "$2,920.00" "$1,439.56" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,190.00" "$2,920.00" "$2,920.00" "$2,920.00" "$1,460.00" "$1,460.00" "$2,312.64" "$2,920.00" "$2,336.00" "$1,314.00" $579.55 "$2,920.00" "$1,693.60" "$2,920.00" "$2,920.00" "$2,920.00" $608.53 "$2,920.00" N/A N/A 27801198 EAP HCPCS C1876 4.0X15MM VISION RX BOTH IP/OP "$2,920.00" "$2,161.00" $579.55 "$2,920.00" "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.60 "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.56 "$2,920.00" "$2,920.00" "$1,439.56" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,190.00" "$2,920.00" "$2,920.00" "$2,920.00" "$1,460.00" "$1,460.00" "$2,312.64" "$2,920.00" "$2,336.00" "$1,314.00" $579.55 "$2,920.00" "$1,693.60" "$2,920.00" "$2,920.00" "$2,920.00" $608.53 "$2,920.00" N/A N/A 27801199 EAP HCPCS C1876 3.0X18MM VISION RX BOTH IP/OP "$2,920.00" "$2,161.00" $579.55 "$2,920.00" "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.60 "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.56 "$2,920.00" "$2,920.00" "$1,439.56" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,190.00" "$2,920.00" "$2,920.00" "$2,920.00" "$1,460.00" "$1,460.00" "$2,312.64" "$2,920.00" "$2,336.00" "$1,314.00" $579.55 "$2,920.00" "$1,693.60" "$2,920.00" "$2,920.00" "$2,920.00" $608.53 "$2,920.00" N/A N/A 27801200 EAP HCPCS C1876 3.5X18MM VISION RX BOTH IP/OP "$3,836.00" "$2,839.00" $761.35 "$3,836.00" "$1,726.20" "$1,726.20" "$1,726.20" "$1,726.20" "$3,836.00" "$3,836.00" "$3,836.00" $799.52 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $799.46 "$3,836.00" "$3,836.00" "$1,891.15" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$1,726.20" $761.35 "$3,836.00" "$2,224.88" "$3,836.00" "$3,836.00" "$3,836.00" $799.42 "$3,836.00" N/A N/A 27801201 EAP HCPCS C1876 4.0X18MM VISION RX BOTH IP/OP "$3,836.00" "$2,839.00" $761.35 "$3,836.00" "$1,726.20" "$1,726.20" "$1,726.20" "$1,726.20" "$3,836.00" "$3,836.00" "$3,836.00" $799.52 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $799.46 "$3,836.00" "$3,836.00" "$1,891.15" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$1,726.20" $761.35 "$3,836.00" "$2,224.88" "$3,836.00" "$3,836.00" "$3,836.00" $799.42 "$3,836.00" N/A N/A 27801202 EAP HCPCS C1874 3.0X23MM VISION RX BOTH IP/OP "$3,836.00" "$2,839.00" $761.35 "$3,836.00" "$1,726.20" "$1,726.20" "$1,726.20" "$1,726.20" "$3,836.00" "$3,836.00" "$3,836.00" $799.52 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $799.46 "$3,836.00" "$3,836.00" "$1,891.15" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$1,726.20" $761.35 "$3,836.00" "$2,224.88" "$3,836.00" "$3,836.00" "$3,836.00" $799.42 "$3,836.00" N/A N/A 27801203 EAP HCPCS C1876 3.5X23MM VISION RX BOTH IP/OP "$3,836.00" "$2,839.00" $761.35 "$3,836.00" "$1,726.20" "$1,726.20" "$1,726.20" "$1,726.20" "$3,836.00" "$3,836.00" "$3,836.00" $799.52 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $799.46 "$3,836.00" "$3,836.00" "$1,891.15" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$1,726.20" $761.35 "$3,836.00" "$2,224.88" "$3,836.00" "$3,836.00" "$3,836.00" $799.42 "$3,836.00" N/A N/A 27801204 EAP HCPCS C1876 4.0X23MM VISION RX BOTH IP/OP "$3,836.00" "$2,839.00" $761.35 "$3,836.00" "$1,726.20" "$1,726.20" "$1,726.20" "$1,726.20" "$3,836.00" "$3,836.00" "$3,836.00" $799.52 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $799.46 "$3,836.00" "$3,836.00" "$1,891.15" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$1,726.20" $761.35 "$3,836.00" "$2,224.88" "$3,836.00" "$3,836.00" "$3,836.00" $799.42 "$3,836.00" N/A N/A 27801205 EAP HCPCS C1876 3.0X28MM VISION RX BOTH IP/OP "$2,920.00" "$2,161.00" $579.55 "$2,920.00" "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.60 "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.56 "$2,920.00" "$2,920.00" "$1,439.56" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,190.00" "$2,920.00" "$2,920.00" "$2,920.00" "$1,460.00" "$1,460.00" "$2,312.64" "$2,920.00" "$2,336.00" "$1,314.00" $579.55 "$2,920.00" "$1,693.60" "$2,920.00" "$2,920.00" "$2,920.00" $608.53 "$2,920.00" N/A N/A 27801206 EAP HCPCS C1876 3.5X28MM VISION RX BOTH IP/OP "$3,836.00" "$2,839.00" $761.35 "$3,836.00" "$1,726.20" "$1,726.20" "$1,726.20" "$1,726.20" "$3,836.00" "$3,836.00" "$3,836.00" $799.52 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $799.46 "$3,836.00" "$3,836.00" "$1,891.15" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$1,726.20" $761.35 "$3,836.00" "$2,224.88" "$3,836.00" "$3,836.00" "$3,836.00" $799.42 "$3,836.00" N/A N/A 27801207 EAP HCPCS C1876 4.0X28MM VISION RX BOTH IP/OP "$3,836.00" "$2,839.00" $761.35 "$3,836.00" "$1,726.20" "$1,726.20" "$1,726.20" "$1,726.20" "$3,836.00" "$3,836.00" "$3,836.00" $799.52 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $799.46 "$3,836.00" "$3,836.00" "$1,891.15" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$1,726.20" $761.35 "$3,836.00" "$2,224.88" "$3,836.00" "$3,836.00" "$3,836.00" $799.42 "$3,836.00" N/A N/A 27801214 EAP HCPCS C1874 3.0 X 12MM GRAFTMAS BOTH IP/OP "$17,938.00" "$13,274.50" "$3,560.24" "$17,938.00" "$8,072.10" "$8,072.10" "$8,072.10" "$8,072.10" "$17,938.00" "$17,938.00" "$17,938.00" "$3,738.73" "$17,938.00" "$17,938.00" "$17,938.00" "$17,938.00" "$17,938.00" "$3,738.48" "$17,938.00" "$17,938.00" "$8,843.43" "$17,938.00" "$17,938.00" "$17,938.00" "$17,938.00" "$13,453.50" "$17,938.00" "$17,938.00" "$17,938.00" "$8,969.00" "$8,969.00" "$14,206.90" "$17,938.00" "$14,350.40" "$8,072.10" "$3,560.24" "$17,938.00" "$10,404.04" "$17,938.00" "$17,938.00" "$17,938.00" "$3,738.28" "$17,938.00" N/A N/A 27801215 EAP HCPCS C1876 2.50 X 8MM MINI-VIS BOTH IP/OP "$3,836.00" "$2,839.00" $761.35 "$3,836.00" "$1,726.20" "$1,726.20" "$1,726.20" "$1,726.20" "$3,836.00" "$3,836.00" "$3,836.00" $799.52 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $799.46 "$3,836.00" "$3,836.00" "$1,891.15" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$1,726.20" $761.35 "$3,836.00" "$2,224.88" "$3,836.00" "$3,836.00" "$3,836.00" $799.42 "$3,836.00" N/A N/A 27801216 EAP HCPCS C1876 2.50 X 12 MM MINI V BOTH IP/OP "$2,920.00" "$2,161.00" $579.55 "$2,920.00" "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.60 "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.56 "$2,920.00" "$2,920.00" "$1,439.56" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,190.00" "$2,920.00" "$2,920.00" "$2,920.00" "$1,460.00" "$1,460.00" "$2,312.64" "$2,920.00" "$2,336.00" "$1,314.00" $579.55 "$2,920.00" "$1,693.60" "$2,920.00" "$2,920.00" "$2,920.00" $608.53 "$2,920.00" N/A N/A 27801217 EAP HCPCS C1876 2.5 X 15MM MINI-VIS BOTH IP/OP "$2,920.00" "$2,161.00" $579.55 "$2,920.00" "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.60 "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.56 "$2,920.00" "$2,920.00" "$1,439.56" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,190.00" "$2,920.00" "$2,920.00" "$2,920.00" "$1,460.00" "$1,460.00" "$2,312.64" "$2,920.00" "$2,336.00" "$1,314.00" $579.55 "$2,920.00" "$1,693.60" "$2,920.00" "$2,920.00" "$2,920.00" $608.53 "$2,920.00" N/A N/A 27801218 EAP HCPCS C1876 2.5 X 18MM MINI-VIS BOTH IP/OP "$3,836.00" "$2,839.00" $761.35 "$3,836.00" "$1,726.20" "$1,726.20" "$1,726.20" "$1,726.20" "$3,836.00" "$3,836.00" "$3,836.00" $799.52 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $799.46 "$3,836.00" "$3,836.00" "$1,891.15" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$1,726.20" $761.35 "$3,836.00" "$2,224.88" "$3,836.00" "$3,836.00" "$3,836.00" $799.42 "$3,836.00" N/A N/A 27801219 EAP HCPCS C1876 205 X 23MM MINI-VIS BOTH IP/OP "$7,782.00" "$5,759.00" "$1,544.53" "$7,782.00" "$3,501.90" "$3,501.90" "$3,501.90" "$3,501.90" "$7,782.00" "$7,782.00" "$7,782.00" "$1,621.96" "$7,782.00" "$7,782.00" "$7,782.00" "$7,782.00" "$7,782.00" "$1,621.85" "$7,782.00" "$7,782.00" "$3,836.53" "$7,782.00" "$7,782.00" "$7,782.00" "$7,782.00" "$5,836.50" "$7,782.00" "$7,782.00" "$7,782.00" "$3,891.00" "$3,891.00" "$6,163.34" "$7,782.00" "$6,225.60" "$3,501.90" "$1,544.53" "$7,782.00" "$4,513.56" "$7,782.00" "$7,782.00" "$7,782.00" "$1,621.77" "$7,782.00" N/A N/A 27801220 EAP HCPCS C1876 2.5 X 28MM MINI-VIS BOTH IP/OP "$2,920.00" "$2,161.00" $579.55 "$2,920.00" "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.60 "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.56 "$2,920.00" "$2,920.00" "$1,439.56" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,190.00" "$2,920.00" "$2,920.00" "$2,920.00" "$1,460.00" "$1,460.00" "$2,312.64" "$2,920.00" "$2,336.00" "$1,314.00" $579.55 "$2,920.00" "$1,693.60" "$2,920.00" "$2,920.00" "$2,920.00" $608.53 "$2,920.00" N/A N/A 27801221 EAP HCPCS C1874 3.0 X 12 GRAFTMASTE BOTH IP/OP "$17,938.00" "$13,274.50" "$3,560.24" "$17,938.00" "$8,072.10" "$8,072.10" "$8,072.10" "$8,072.10" "$17,938.00" "$17,938.00" "$17,938.00" "$3,738.73" "$17,938.00" "$17,938.00" "$17,938.00" "$17,938.00" "$17,938.00" "$3,738.48" "$17,938.00" "$17,938.00" "$8,843.43" "$17,938.00" "$17,938.00" "$17,938.00" "$17,938.00" "$13,453.50" "$17,938.00" "$17,938.00" "$17,938.00" "$8,969.00" "$8,969.00" "$14,206.90" "$17,938.00" "$14,350.40" "$8,072.10" "$3,560.24" "$17,938.00" "$10,404.04" "$17,938.00" "$17,938.00" "$17,938.00" "$3,738.28" "$17,938.00" N/A N/A 27801222 EAP HCPCS C1722 LUMAX 340 VR ICD SY BOTH IP/OP "$49,886.00" "$36,916.00" "$7,712.84" "$49,886.00" "$22,448.70" "$22,448.70" "$22,448.70" "$22,448.70" "$49,886.00" "$49,886.00" "$49,886.00" "$9,417.94" "$49,886.00" "$49,886.00" "$49,886.00" "$49,886.00" "$49,886.00" "$10,396.79" "$49,886.00" "$49,886.00" "$24,593.80" "$49,886.00" "$49,886.00" "$49,886.00" "$49,886.00" "$37,414.50" "$49,886.00" "$49,886.00" "$49,886.00" "$24,943.00" "$24,943.00" "$39,509.71" "$49,886.00" "$39,908.80" "$22,448.70" "$7,712.84" "$49,886.00" "$28,933.88" "$49,886.00" "$49,886.00" "$49,886.00" "$8,098.48" "$49,886.00" N/A N/A 27801223 EAP HCPCS C1721 INTRINSIC DR DUAL I BOTH IP/OP "$10,215.00" "$7,559.50" "$2,128.92" "$10,215.00" "$10,215.00" "$10,215.00" "$10,215.00" "$10,215.00" "$10,215.00" "$10,215.00" "$10,215.00" "$10,215.00" "$10,215.00" "$10,215.00" "$10,215.00" "$10,215.00" "$10,215.00" "$2,128.92" "$10,215.00" "$4,086.00" "$10,215.00" "$10,215.00" "$10,215.00" "$10,215.00" "$10,215.00" "$7,661.25" "$10,215.00" "$10,215.00" "$10,215.00" "$5,107.50" "$5,107.50" "$8,090.28" "$10,215.00" "$8,172.00" "$4,596.75" "$10,215.00" "$10,215.00" "$5,924.70" "$10,215.00" "$6,129.00" "$10,215.00" "$10,215.00" "$10,215.00" N/A N/A 27801224 EAP HCPCS C1721 GEM III DR DUAL ICD BOTH IP/OP "$3,890.00" "$2,879.00" $810.72 "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" $810.72 "$3,890.00" "$1,556.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$2,917.50" "$3,890.00" "$3,890.00" "$3,890.00" "$1,945.00" "$1,945.00" "$3,080.88" "$3,890.00" "$3,112.00" "$1,750.50" "$3,890.00" "$3,890.00" "$2,256.20" "$3,890.00" "$2,334.00" "$3,890.00" "$3,890.00" "$3,890.00" N/A N/A 27801225 EAP HCPCS C1722 GEM III VR SINGLE I BOTH IP/OP "$11,351.00" "$8,400.00" "$2,252.89" "$11,351.00" "$5,107.95" "$5,107.95" "$5,107.95" "$5,107.95" "$11,351.00" "$11,351.00" "$11,351.00" "$2,365.83" "$11,351.00" "$11,351.00" "$11,351.00" "$11,351.00" "$11,351.00" "$2,365.67" "$11,351.00" "$11,351.00" "$5,596.04" "$11,351.00" "$11,351.00" "$11,351.00" "$11,351.00" "$8,513.25" "$11,351.00" "$11,351.00" "$11,351.00" "$5,675.50" "$5,675.50" "$8,989.99" "$11,351.00" "$9,080.80" "$5,107.95" "$2,252.89" "$11,351.00" "$6,583.58" "$11,351.00" "$11,351.00" "$11,351.00" "$2,365.55" "$11,351.00" N/A N/A 27801226 EAP HCPCS C1721 CONFIENT HE DUAL IC BOTH IP/OP "$15,364.00" "$11,369.50" "$3,202.03" "$15,364.00" "$15,364.00" "$15,364.00" "$15,364.00" "$15,364.00" "$15,364.00" "$15,364.00" "$15,364.00" "$15,364.00" "$15,364.00" "$15,364.00" "$15,364.00" "$15,364.00" "$15,364.00" "$3,202.03" "$15,364.00" "$6,145.60" "$15,364.00" "$15,364.00" "$15,364.00" "$15,364.00" "$15,364.00" "$11,523.00" "$15,364.00" "$15,364.00" "$15,364.00" "$7,682.00" "$7,682.00" "$12,168.29" "$15,364.00" "$12,291.20" "$6,913.80" "$15,364.00" "$15,364.00" "$8,911.12" "$15,364.00" "$9,218.40" "$15,364.00" "$15,364.00" "$15,364.00" N/A N/A 27801227 EAP HCPCS C1760 ANGIOSEAL VASC CLOS BOTH IP/OP "$1,906.00" "$1,410.50" $378.29 "$1,906.00" $857.70 $857.70 $857.70 $857.70 "$1,906.00" "$1,906.00" "$1,906.00" $397.26 "$1,906.00" "$1,906.00" "$1,906.00" "$1,906.00" "$1,906.00" $397.23 "$1,906.00" "$1,906.00" "$1,127.40" "$1,906.00" "$1,906.00" "$1,906.00" "$1,906.00" "$1,429.50" "$1,906.00" "$1,906.00" "$1,906.00" $953.00 $953.00 "$1,509.55" "$1,906.00" "$1,524.80" $857.70 $378.29 "$1,906.00" "$1,105.48" "$1,906.00" "$1,906.00" "$1,906.00" $397.21 "$1,906.00" N/A N/A 27801228 EAP HCPCS C1898 SETROX S LEAD BOTH IP/OP "$2,869.00" "$2,123.50" $597.93 "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" $597.93 "$2,869.00" "$1,147.60" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,151.75" "$2,869.00" "$2,869.00" "$2,869.00" "$1,434.50" "$1,434.50" "$2,272.25" "$2,869.00" "$2,295.20" "$1,291.05" "$2,869.00" "$2,869.00" "$1,664.02" "$2,869.00" "$1,721.40" "$2,869.00" "$2,869.00" "$2,869.00" N/A N/A 27801229 EAP HCPCS C1898 SELOX SR LEAD BOTH IP/OP "$2,681.00" "$1,984.00" $558.75 "$2,681.00" "$2,681.00" "$2,681.00" "$2,681.00" "$2,681.00" "$2,681.00" "$2,681.00" "$2,681.00" "$2,681.00" "$2,681.00" "$2,681.00" "$2,681.00" "$2,681.00" "$2,681.00" $558.75 "$2,681.00" "$1,072.40" "$2,681.00" "$2,681.00" "$2,681.00" "$2,681.00" "$2,681.00" "$2,010.75" "$2,681.00" "$2,681.00" "$2,681.00" "$1,340.50" "$1,340.50" "$2,123.35" "$2,681.00" "$2,144.80" "$1,206.45" "$2,681.00" "$2,681.00" "$1,554.98" "$2,681.00" "$1,608.60" "$2,681.00" "$2,681.00" "$2,681.00" N/A N/A 27801230 EAP HCPCS C1722 OVATIO VR SINGLE IC BOTH IP/OP "$14,505.00" "$10,734.00" "$2,878.88" "$14,505.00" "$6,527.25" "$6,527.25" "$6,527.25" "$6,527.25" "$14,505.00" "$14,505.00" "$14,505.00" "$3,023.20" "$14,505.00" "$14,505.00" "$14,505.00" "$14,505.00" "$14,505.00" "$3,023.00" "$14,505.00" "$14,505.00" "$7,150.97" "$14,505.00" "$14,505.00" "$14,505.00" "$14,505.00" "$10,878.75" "$14,505.00" "$14,505.00" "$14,505.00" "$7,252.50" "$7,252.50" "$11,487.96" "$14,505.00" "$11,604.00" "$6,527.25" "$2,878.88" "$14,505.00" "$8,412.90" "$14,505.00" "$14,505.00" "$14,505.00" "$3,022.84" "$14,505.00" N/A N/A 27801231 EAP HCPCS C1721 OVATIO DR DUAL ICD BOTH IP/OP "$61,398.00" "$45,435.00" "$12,796.02" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$12,796.02" "$61,398.00" "$24,559.20" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$46,048.50" "$61,398.00" "$61,398.00" "$61,398.00" "$30,699.00" "$30,699.00" "$48,627.22" "$61,398.00" "$49,118.40" "$27,629.10" "$61,398.00" "$61,398.00" "$35,610.84" "$61,398.00" "$36,838.80" "$61,398.00" "$61,398.00" "$61,398.00" N/A N/A 27801232 EAP HCPCS C1721 VITALITY 2 EL DR DU BOTH IP/OP "$19,454.00" "$14,396.00" "$4,054.43" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$4,054.43" "$19,454.00" "$7,781.60" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$14,590.50" "$19,454.00" "$19,454.00" "$19,454.00" "$9,727.00" "$9,727.00" "$15,407.57" "$19,454.00" "$15,563.20" "$8,754.30" "$19,454.00" "$19,454.00" "$11,283.32" "$19,454.00" "$11,672.40" "$19,454.00" "$19,454.00" "$19,454.00" N/A N/A 27801233 EAP HCPCS C1721 VITALITY 2 DR DUAL BOTH IP/OP "$12,969.00" "$9,597.50" "$2,702.88" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$2,702.88" "$12,969.00" "$5,187.60" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$9,726.75" "$12,969.00" "$12,969.00" "$12,969.00" "$6,484.50" "$6,484.50" "$10,271.45" "$12,969.00" "$10,375.20" "$5,836.05" "$12,969.00" "$12,969.00" "$7,522.02" "$12,969.00" "$7,781.40" "$12,969.00" "$12,969.00" "$12,969.00" N/A N/A 27801234 EAP HCPCS C1721 VITALITY AVT DR DUA BOTH IP/OP "$19,454.00" "$14,396.00" "$4,054.43" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$4,054.43" "$19,454.00" "$7,781.60" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$19,454.00" "$14,590.50" "$19,454.00" "$19,454.00" "$19,454.00" "$9,727.00" "$9,727.00" "$15,407.57" "$19,454.00" "$15,563.20" "$8,754.30" "$19,454.00" "$19,454.00" "$11,283.32" "$19,454.00" "$11,672.40" "$19,454.00" "$19,454.00" "$19,454.00" N/A N/A 27801235 EAP HCPCS C1721 VITALITY HE DUAL IC BOTH IP/OP "$3,369.00" "$2,493.50" $702.14 "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" $702.14 "$3,369.00" "$1,347.60" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$2,526.75" "$3,369.00" "$3,369.00" "$3,369.00" "$1,684.50" "$1,684.50" "$2,668.25" "$3,369.00" "$2,695.20" "$1,516.05" "$3,369.00" "$3,369.00" "$1,954.02" "$3,369.00" "$2,021.40" "$3,369.00" "$3,369.00" "$3,369.00" N/A N/A 27801236 EAP HCPCS C1721 VITALITY EL DUAL IC BOTH IP/OP "$3,243.00" "$2,400.00" $675.88 "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" $675.88 "$3,243.00" "$1,297.20" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$2,432.25" "$3,243.00" "$3,243.00" "$3,243.00" "$1,621.50" "$1,621.50" "$2,568.46" "$3,243.00" "$2,594.40" "$1,459.35" "$3,243.00" "$3,243.00" "$1,880.94" "$3,243.00" "$1,945.80" "$3,243.00" "$3,243.00" "$3,243.00" N/A N/A 27801237 EAP HCPCS C1721 VITALITY DS DR DUAL BOTH IP/OP "$79,815.00" "$59,063.50" "$16,634.32" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$16,634.32" "$79,815.00" "$31,926.00" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$59,861.25" "$79,815.00" "$79,815.00" "$79,815.00" "$39,907.50" "$39,907.50" "$63,213.48" "$79,815.00" "$63,852.00" "$35,916.75" "$79,815.00" "$79,815.00" "$46,292.70" "$79,815.00" "$47,889.00" "$79,815.00" "$79,815.00" "$79,815.00" N/A N/A 27801238 EAP HCPCS C1722 VITALITY 2 EL VR SN BOTH IP/OP "$3,243.00" "$2,400.00" $643.65 "$3,243.00" "$1,459.35" "$1,459.35" "$1,459.35" "$1,459.35" "$3,243.00" "$3,243.00" "$3,243.00" $675.92 "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" $675.88 "$3,243.00" "$3,243.00" "$1,598.80" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$2,432.25" "$3,243.00" "$3,243.00" "$3,243.00" "$1,621.50" "$1,621.50" "$2,568.46" "$3,243.00" "$2,594.40" "$1,459.35" $643.65 "$3,243.00" "$1,880.94" "$3,243.00" "$3,243.00" "$3,243.00" $675.84 "$3,243.00" N/A N/A 27801239 EAP HCPCS C1722 VITALITY 2 VR SNGL BOTH IP/OP "$79,815.00" "$59,063.50" "$7,712.84" "$79,815.00" "$35,916.75" "$35,916.75" "$35,916.75" "$35,916.75" "$79,815.00" "$79,815.00" "$79,815.00" "$9,417.94" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$16,634.32" "$79,815.00" "$79,815.00" "$39,348.80" "$79,815.00" "$79,815.00" "$79,815.00" "$79,815.00" "$59,861.25" "$79,815.00" "$79,815.00" "$79,815.00" "$39,907.50" "$39,907.50" "$63,213.48" "$79,815.00" "$63,852.00" "$35,916.75" "$7,712.84" "$79,815.00" "$46,292.70" "$79,815.00" "$79,815.00" "$79,815.00" "$8,098.48" "$79,815.00" N/A N/A 27801240 EAP HCPCS C1722 VITALITY DS VR SNGL BOTH IP/OP "$16,836.00" "$12,459.00" "$3,341.53" "$16,836.00" "$7,576.20" "$7,576.20" "$7,576.20" "$7,576.20" "$16,836.00" "$16,836.00" "$16,836.00" "$3,509.04" "$16,836.00" "$16,836.00" "$16,836.00" "$16,836.00" "$16,836.00" "$3,508.81" "$16,836.00" "$16,836.00" "$8,300.15" "$16,836.00" "$16,836.00" "$16,836.00" "$16,836.00" "$12,627.00" "$16,836.00" "$16,836.00" "$16,836.00" "$8,418.00" "$8,418.00" "$13,334.11" "$16,836.00" "$13,468.80" "$7,576.20" "$3,341.53" "$16,836.00" "$9,764.88" "$16,836.00" "$16,836.00" "$16,836.00" "$3,508.62" "$16,836.00" N/A N/A 27801241 EAP HCPCS C1895 RELIANCE G ACTIVE F BOTH IP/OP "$9,730.00" "$7,200.50" "$1,931.16" "$9,730.00" "$4,378.50" "$4,378.50" "$4,378.50" "$4,378.50" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.98" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.84" "$9,730.00" "$9,730.00" "$4,796.89" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$7,297.50" "$9,730.00" "$9,730.00" "$9,730.00" "$4,865.00" "$4,865.00" "$7,706.16" "$9,730.00" "$7,784.00" "$4,378.50" "$1,931.16" "$9,730.00" "$5,643.40" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.73" "$9,730.00" N/A N/A 27801242 EAP HCPCS C1895 RELIANCE G ACTIVE F BOTH IP/OP "$10,102.00" "$7,475.50" "$2,004.99" "$10,102.00" "$4,545.90" "$4,545.90" "$4,545.90" "$4,545.90" "$10,102.00" "$10,102.00" "$10,102.00" "$2,105.51" "$10,102.00" "$10,102.00" "$10,102.00" "$10,102.00" "$10,102.00" "$2,105.37" "$10,102.00" "$10,102.00" "$4,980.29" "$10,102.00" "$10,102.00" "$10,102.00" "$10,102.00" "$7,576.50" "$10,102.00" "$10,102.00" "$10,102.00" "$5,051.00" "$5,051.00" "$8,000.78" "$10,102.00" "$8,081.60" "$4,545.90" "$2,004.99" "$10,102.00" "$5,859.16" "$10,102.00" "$10,102.00" "$10,102.00" "$2,105.26" "$10,102.00" N/A N/A 27801243 EAP HCPCS C1895 RELIANCE G PASSIVE BOTH IP/OP "$9,730.00" "$7,200.50" "$1,931.16" "$9,730.00" "$4,378.50" "$4,378.50" "$4,378.50" "$4,378.50" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.98" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.84" "$9,730.00" "$9,730.00" "$4,796.89" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$7,297.50" "$9,730.00" "$9,730.00" "$9,730.00" "$4,865.00" "$4,865.00" "$7,706.16" "$9,730.00" "$7,784.00" "$4,378.50" "$1,931.16" "$9,730.00" "$5,643.40" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.73" "$9,730.00" N/A N/A 27801244 EAP HCPCS C1895 RELIANCE G PASSIVE BOTH IP/OP "$9,730.00" "$7,200.50" "$1,931.16" "$9,730.00" "$4,378.50" "$4,378.50" "$4,378.50" "$4,378.50" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.98" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.84" "$9,730.00" "$9,730.00" "$4,796.89" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$7,297.50" "$9,730.00" "$9,730.00" "$9,730.00" "$4,865.00" "$4,865.00" "$7,706.16" "$9,730.00" "$7,784.00" "$4,378.50" "$1,931.16" "$9,730.00" "$5,643.40" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.73" "$9,730.00" N/A N/A 27801245 EAP HCPCS C1895 RELIANCE ACTIVE FIX BOTH IP/OP "$6,985.00" "$5,169.00" "$1,386.35" "$6,985.00" "$3,143.25" "$3,143.25" "$3,143.25" "$3,143.25" "$6,985.00" "$6,985.00" "$6,985.00" "$1,455.85" "$6,985.00" "$6,985.00" "$6,985.00" "$6,985.00" "$6,985.00" "$1,455.75" "$6,985.00" "$6,985.00" "$3,443.61" "$6,985.00" "$6,985.00" "$6,985.00" "$6,985.00" "$5,238.75" "$6,985.00" "$6,985.00" "$6,985.00" "$3,492.50" "$3,492.50" "$5,532.12" "$6,985.00" "$5,588.00" "$3,143.25" "$1,386.35" "$6,985.00" "$4,051.30" "$6,985.00" "$6,985.00" "$6,985.00" "$1,455.67" "$6,985.00" N/A N/A 27801246 EAP HCPCS C1895 RELIANCE ACTIVE FIX BOTH IP/OP "$7,253.00" "$5,367.50" "$1,439.54" "$7,253.00" "$3,263.85" "$3,263.85" "$3,263.85" "$3,263.85" "$7,253.00" "$7,253.00" "$7,253.00" "$1,511.71" "$7,253.00" "$7,253.00" "$7,253.00" "$7,253.00" "$7,253.00" "$1,511.60" "$7,253.00" "$7,253.00" "$3,575.73" "$7,253.00" "$7,253.00" "$7,253.00" "$7,253.00" "$5,439.75" "$7,253.00" "$7,253.00" "$7,253.00" "$3,626.50" "$3,626.50" "$5,744.38" "$7,253.00" "$5,802.40" "$3,263.85" "$1,439.54" "$7,253.00" "$4,206.74" "$7,253.00" "$7,253.00" "$7,253.00" "$1,511.53" "$7,253.00" N/A N/A 27801247 EAP HCPCS C1895 RELIANCE PASSIVE FI BOTH IP/OP "$9,730.00" "$7,200.50" "$1,931.16" "$9,730.00" "$4,378.50" "$4,378.50" "$4,378.50" "$4,378.50" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.98" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.84" "$9,730.00" "$9,730.00" "$4,796.89" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$7,297.50" "$9,730.00" "$9,730.00" "$9,730.00" "$4,865.00" "$4,865.00" "$7,706.16" "$9,730.00" "$7,784.00" "$4,378.50" "$1,931.16" "$9,730.00" "$5,643.40" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.73" "$9,730.00" N/A N/A 27801248 EAP HCPCS C1895 RELIANCE PASSIVE FI BOTH IP/OP "$9,730.00" "$7,200.50" "$1,931.16" "$9,730.00" "$4,378.50" "$4,378.50" "$4,378.50" "$4,378.50" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.98" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.84" "$9,730.00" "$9,730.00" "$4,796.89" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$7,297.50" "$9,730.00" "$9,730.00" "$9,730.00" "$4,865.00" "$4,865.00" "$7,706.16" "$9,730.00" "$7,784.00" "$4,378.50" "$1,931.16" "$9,730.00" "$5,643.40" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.73" "$9,730.00" N/A N/A 27801249 EAP HCPCS C1721 ATLAS DR DUAL ICD BOTH IP/OP "$9,730.00" "$7,200.50" "$2,027.84" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.84" "$9,730.00" "$3,892.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$7,297.50" "$9,730.00" "$9,730.00" "$9,730.00" "$4,865.00" "$4,865.00" "$7,706.16" "$9,730.00" "$7,784.00" "$4,378.50" "$9,730.00" "$9,730.00" "$5,643.40" "$9,730.00" "$5,838.00" "$9,730.00" "$9,730.00" "$9,730.00" N/A N/A 27801250 EAP HCPCS C1895 RIATA DUAL COIL LEA BOTH IP/OP "$17,833.00" "$13,196.50" "$3,539.40" "$17,833.00" "$8,024.85" "$8,024.85" "$8,024.85" "$8,024.85" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.84" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.59" "$17,833.00" "$17,833.00" "$8,791.67" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$13,374.75" "$17,833.00" "$17,833.00" "$17,833.00" "$8,916.50" "$8,916.50" "$14,123.74" "$17,833.00" "$14,266.40" "$8,024.85" "$3,539.40" "$17,833.00" "$10,343.14" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.40" "$17,833.00" N/A N/A 27801251 EAP HCPCS C1895 RIATA DUAL COIL LEA BOTH IP/OP "$17,833.00" "$13,196.50" "$3,539.40" "$17,833.00" "$8,024.85" "$8,024.85" "$8,024.85" "$8,024.85" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.84" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.59" "$17,833.00" "$17,833.00" "$8,791.67" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$13,374.75" "$17,833.00" "$17,833.00" "$17,833.00" "$8,916.50" "$8,916.50" "$14,123.74" "$17,833.00" "$14,266.40" "$8,024.85" "$3,539.40" "$17,833.00" "$10,343.14" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.40" "$17,833.00" N/A N/A 27801252 EAP HCPCS C1895 RIATA I DUAL COIL L BOTH IP/OP "$17,833.00" "$13,196.50" "$3,539.40" "$17,833.00" "$8,024.85" "$8,024.85" "$8,024.85" "$8,024.85" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.84" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.59" "$17,833.00" "$17,833.00" "$8,791.67" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$13,374.75" "$17,833.00" "$17,833.00" "$17,833.00" "$8,916.50" "$8,916.50" "$14,123.74" "$17,833.00" "$14,266.40" "$8,024.85" "$3,539.40" "$17,833.00" "$10,343.14" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.40" "$17,833.00" N/A N/A 27801253 EAP HCPCS C1895 RIATA SINGLE COIL L BOTH IP/OP "$17,833.00" "$13,196.50" "$3,539.40" "$17,833.00" "$8,024.85" "$8,024.85" "$8,024.85" "$8,024.85" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.84" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.59" "$17,833.00" "$17,833.00" "$8,791.67" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$13,374.75" "$17,833.00" "$17,833.00" "$17,833.00" "$8,916.50" "$8,916.50" "$14,123.74" "$17,833.00" "$14,266.40" "$8,024.85" "$3,539.40" "$17,833.00" "$10,343.14" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.40" "$17,833.00" N/A N/A 27801254 EAP HCPCS C1895 RIATA SINGLE COIL L BOTH IP/OP "$17,833.00" "$13,196.50" "$3,539.40" "$17,833.00" "$8,024.85" "$8,024.85" "$8,024.85" "$8,024.85" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.84" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.59" "$17,833.00" "$17,833.00" "$8,791.67" "$17,833.00" "$17,833.00" "$17,833.00" "$17,833.00" "$13,374.75" "$17,833.00" "$17,833.00" "$17,833.00" "$8,916.50" "$8,916.50" "$14,123.74" "$17,833.00" "$14,266.40" "$8,024.85" "$3,539.40" "$17,833.00" "$10,343.14" "$17,833.00" "$17,833.00" "$17,833.00" "$3,716.40" "$17,833.00" N/A N/A 27801255 EAP HCPCS C1895 RIATA ST DUAL COIL BOTH IP/OP "$13,714.00" "$10,148.50" "$2,721.89" "$13,714.00" "$6,171.30" "$6,171.30" "$6,171.30" "$6,171.30" "$13,714.00" "$13,714.00" "$13,714.00" "$2,858.34" "$13,714.00" "$13,714.00" "$13,714.00" "$13,714.00" "$13,714.00" "$2,858.15" "$13,714.00" "$13,714.00" "$6,761.00" "$13,714.00" "$13,714.00" "$13,714.00" "$13,714.00" "$10,285.50" "$13,714.00" "$13,714.00" "$13,714.00" "$6,857.00" "$6,857.00" "$10,861.49" "$13,714.00" "$10,971.20" "$6,171.30" "$2,721.89" "$13,714.00" "$7,954.12" "$13,714.00" "$13,714.00" "$13,714.00" "$2,858.00" "$13,714.00" N/A N/A 27801256 EAP HCPCS C1895 RIATA ST SNGL COIL BOTH IP/OP "$11,221.00" "$8,304.00" "$2,227.09" "$11,221.00" "$5,049.45" "$5,049.45" "$5,049.45" "$5,049.45" "$11,221.00" "$11,221.00" "$11,221.00" "$2,338.74" "$11,221.00" "$11,221.00" "$11,221.00" "$11,221.00" "$11,221.00" "$2,338.58" "$11,221.00" "$11,221.00" "$5,531.95" "$11,221.00" "$11,221.00" "$11,221.00" "$11,221.00" "$8,415.75" "$11,221.00" "$11,221.00" "$11,221.00" "$5,610.50" "$5,610.50" "$8,887.03" "$11,221.00" "$8,976.80" "$5,049.45" "$2,227.09" "$11,221.00" "$6,508.18" "$11,221.00" "$11,221.00" "$11,221.00" "$2,338.46" "$11,221.00" N/A N/A 27801257 EAP HCPCS C1895 SPL LEADS BOTH IP/OP "$5,189.00" "$3,840.00" "$1,029.89" "$5,189.00" "$2,335.05" "$2,335.05" "$2,335.05" "$2,335.05" "$5,189.00" "$5,189.00" "$5,189.00" "$1,081.52" "$5,189.00" "$5,189.00" "$5,189.00" "$5,189.00" "$5,189.00" "$1,081.44" "$5,189.00" "$5,189.00" "$2,558.18" "$5,189.00" "$5,189.00" "$5,189.00" "$5,189.00" "$3,891.75" "$5,189.00" "$5,189.00" "$5,189.00" "$2,594.50" "$2,594.50" "$4,109.69" "$5,189.00" "$4,151.20" "$2,335.05" "$1,029.89" "$5,189.00" "$3,009.62" "$5,189.00" "$5,189.00" "$5,189.00" "$1,081.39" "$5,189.00" N/A N/A 27801258 EAP HCPCS C1895 TVL-ADX LEADS BOTH IP/OP "$5,189.00" "$3,840.00" "$1,029.89" "$5,189.00" "$2,335.05" "$2,335.05" "$2,335.05" "$2,335.05" "$5,189.00" "$5,189.00" "$5,189.00" "$1,081.52" "$5,189.00" "$5,189.00" "$5,189.00" "$5,189.00" "$5,189.00" "$1,081.44" "$5,189.00" "$5,189.00" "$2,558.18" "$5,189.00" "$5,189.00" "$5,189.00" "$5,189.00" "$3,891.75" "$5,189.00" "$5,189.00" "$5,189.00" "$2,594.50" "$2,594.50" "$4,109.69" "$5,189.00" "$4,151.20" "$2,335.05" "$1,029.89" "$5,189.00" "$3,009.62" "$5,189.00" "$5,189.00" "$5,189.00" "$1,081.39" "$5,189.00" N/A N/A 27801259 EAP HCPCS C1895 BIPOLAR ENDOCARD PA BOTH IP/OP "$2,792.00" "$2,066.50" $554.14 "$2,792.00" "$1,256.40" "$1,256.40" "$1,256.40" "$1,256.40" "$2,792.00" "$2,792.00" "$2,792.00" $581.92 "$2,792.00" "$2,792.00" "$2,792.00" "$2,792.00" "$2,792.00" $581.88 "$2,792.00" "$2,792.00" "$1,376.46" "$2,792.00" "$2,792.00" "$2,792.00" "$2,792.00" "$2,094.00" "$2,792.00" "$2,792.00" "$2,792.00" "$1,396.00" "$1,396.00" "$2,211.26" "$2,792.00" "$2,233.60" "$1,256.40" $554.14 "$2,792.00" "$1,619.36" "$2,792.00" "$2,792.00" "$2,792.00" $581.85 "$2,792.00" N/A N/A 27801260 EAP HCPCS C1721 LUMAX 300 DR-T DUAL BOTH IP/OP "$3,243.00" "$2,400.00" $675.88 "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" $675.88 "$3,243.00" "$1,297.20" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$3,243.00" "$2,432.25" "$3,243.00" "$3,243.00" "$3,243.00" "$1,621.50" "$1,621.50" "$2,568.46" "$3,243.00" "$2,594.40" "$1,459.35" "$3,243.00" "$3,243.00" "$1,880.94" "$3,243.00" "$1,945.80" "$3,243.00" "$3,243.00" "$3,243.00" N/A N/A 27801261 EAP HCPCS C1722 LUMAX 300 VR-T SING BOTH IP/OP "$15,437.00" "$11,423.50" "$3,063.86" "$15,437.00" "$6,946.65" "$6,946.65" "$6,946.65" "$6,946.65" "$15,437.00" "$15,437.00" "$15,437.00" "$3,217.46" "$15,437.00" "$15,437.00" "$15,437.00" "$15,437.00" "$15,437.00" "$3,217.24" "$15,437.00" "$15,437.00" "$7,610.44" "$15,437.00" "$15,437.00" "$15,437.00" "$15,437.00" "$11,577.75" "$15,437.00" "$15,437.00" "$15,437.00" "$7,718.50" "$7,718.50" "$12,226.10" "$15,437.00" "$12,349.60" "$6,946.65" "$3,063.86" "$15,437.00" "$8,953.46" "$15,437.00" "$15,437.00" "$15,437.00" "$3,217.07" "$15,437.00" N/A N/A 27801262 EAP HCPCS C1895 RIATA LEAD BOTH IP/OP "$14,592.00" "$10,798.50" "$2,896.15" "$14,592.00" "$6,566.40" "$6,566.40" "$6,566.40" "$6,566.40" "$14,592.00" "$14,592.00" "$14,592.00" "$3,041.34" "$14,592.00" "$14,592.00" "$14,592.00" "$14,592.00" "$14,592.00" "$3,041.13" "$14,592.00" "$14,592.00" "$7,193.86" "$14,592.00" "$14,592.00" "$14,592.00" "$14,592.00" "$10,944.00" "$14,592.00" "$14,592.00" "$14,592.00" "$7,296.00" "$7,296.00" "$11,556.86" "$14,592.00" "$11,673.60" "$6,566.40" "$2,896.15" "$14,592.00" "$8,463.36" "$14,592.00" "$14,592.00" "$14,592.00" "$3,040.97" "$14,592.00" N/A N/A 27801263 EAP HCPCS C1895 RIATA ST LEAD BOTH IP/OP "$14,592.00" "$10,798.50" "$2,896.15" "$14,592.00" "$6,566.40" "$6,566.40" "$6,566.40" "$6,566.40" "$14,592.00" "$14,592.00" "$14,592.00" "$3,041.34" "$14,592.00" "$14,592.00" "$14,592.00" "$14,592.00" "$14,592.00" "$3,041.13" "$14,592.00" "$14,592.00" "$7,193.86" "$14,592.00" "$14,592.00" "$14,592.00" "$14,592.00" "$10,944.00" "$14,592.00" "$14,592.00" "$14,592.00" "$7,296.00" "$7,296.00" "$11,556.86" "$14,592.00" "$11,673.60" "$6,566.40" "$2,896.15" "$14,592.00" "$8,463.36" "$14,592.00" "$14,592.00" "$14,592.00" "$3,040.97" "$14,592.00" N/A N/A 27801264 EAP HCPCS C1777 RIATA ST PKG BOTH IP/OP "$14,592.00" "$10,798.50" "$2,896.15" "$14,592.00" "$6,566.40" "$6,566.40" "$6,566.40" "$6,566.40" "$14,592.00" "$14,592.00" "$14,592.00" "$3,041.34" "$14,592.00" "$14,592.00" "$14,592.00" "$14,592.00" "$14,592.00" "$3,041.13" "$14,592.00" "$14,592.00" "$7,193.86" "$14,592.00" "$14,592.00" "$14,592.00" "$14,592.00" "$10,944.00" "$14,592.00" "$14,592.00" "$14,592.00" "$7,296.00" "$7,296.00" "$11,556.86" "$14,592.00" "$11,673.60" "$6,566.40" "$2,896.15" "$14,592.00" "$8,463.36" "$14,592.00" "$14,592.00" "$14,592.00" "$3,040.97" "$14,592.00" N/A N/A 27801265 EAP HCPCS C1721 ATLAS II DR DUAL IC BOTH IP/OP "$9,730.00" "$7,200.50" "$2,027.84" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$2,027.84" "$9,730.00" "$3,892.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$9,730.00" "$7,297.50" "$9,730.00" "$9,730.00" "$9,730.00" "$4,865.00" "$4,865.00" "$7,706.16" "$9,730.00" "$7,784.00" "$4,378.50" "$9,730.00" "$9,730.00" "$5,643.40" "$9,730.00" "$5,838.00" "$9,730.00" "$9,730.00" "$9,730.00" N/A N/A 27801266 EAP HCPCS C1779 4457 FINELINE 11 LE BOTH IP/OP "$2,973.00" "$2,200.50" $619.61 "$2,973.00" "$2,973.00" "$2,973.00" "$2,973.00" "$2,973.00" "$2,973.00" "$2,973.00" "$2,973.00" "$2,973.00" "$2,973.00" "$2,973.00" "$2,973.00" "$2,973.00" "$2,973.00" $619.61 "$2,973.00" "$1,189.20" "$2,973.00" "$2,973.00" "$2,973.00" "$2,973.00" "$2,973.00" "$2,229.75" "$2,973.00" "$2,973.00" "$2,973.00" "$1,486.50" "$1,486.50" "$2,354.62" "$2,973.00" "$2,378.40" "$1,337.85" "$2,973.00" "$2,973.00" "$1,724.34" "$2,973.00" "$1,783.80" "$2,973.00" "$2,973.00" "$2,973.00" N/A N/A 27801267 EAP HCPCS C1721 TELIGEN IS VR SNGL BOTH IP/OP "$61,398.00" "$45,435.00" "$12,796.02" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$12,796.02" "$61,398.00" "$24,559.20" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$46,048.50" "$61,398.00" "$61,398.00" "$61,398.00" "$30,699.00" "$30,699.00" "$48,627.22" "$61,398.00" "$49,118.40" "$27,629.10" "$61,398.00" "$61,398.00" "$35,610.84" "$61,398.00" "$36,838.80" "$61,398.00" "$61,398.00" "$61,398.00" N/A N/A 27801268 EAP HCPCS C1882 INSYNC MAXIMO DUAL BOTH IP/OP "$68,113.00" "$50,404.00" "$7,712.84" "$68,113.00" "$30,650.85" "$30,650.85" "$30,650.85" "$30,650.85" "$68,113.00" "$68,113.00" "$68,113.00" "$9,417.94" "$68,113.00" "$68,113.00" "$68,113.00" "$68,113.00" "$68,113.00" "$14,195.50" "$68,113.00" "$68,113.00" "$33,579.71" "$68,113.00" "$68,113.00" "$68,113.00" "$68,113.00" "$51,084.75" "$68,113.00" "$68,113.00" "$68,113.00" "$34,056.50" "$34,056.50" "$53,945.50" "$68,113.00" "$54,490.40" "$30,650.85" "$7,712.84" "$68,113.00" "$39,505.54" "$68,113.00" "$68,113.00" "$68,113.00" "$8,098.48" "$68,113.00" N/A N/A 27801269 EAP HCPCS C1721 OVATIO OH60U DR 655 BOTH IP/OP "$40,295.00" "$29,818.50" "$8,397.92" "$40,295.00" "$40,295.00" "$40,295.00" "$40,295.00" "$40,295.00" "$40,295.00" "$40,295.00" "$40,295.00" "$40,295.00" "$40,295.00" "$40,295.00" "$40,295.00" "$40,295.00" "$40,295.00" "$8,397.92" "$40,295.00" "$16,118.00" "$40,295.00" "$40,295.00" "$40,295.00" "$40,295.00" "$40,295.00" "$30,221.25" "$40,295.00" "$40,295.00" "$40,295.00" "$20,147.50" "$20,147.50" "$31,913.64" "$40,295.00" "$32,236.00" "$18,132.75" "$40,295.00" "$40,295.00" "$23,371.10" "$40,295.00" "$24,177.00" "$40,295.00" "$40,295.00" "$40,295.00" N/A N/A 27801270 EAP HCPCS C1722 OVATIO OH61U VR SYS BOTH IP/OP "$57,559.00" "$42,594.00" "$7,712.84" "$57,559.00" "$25,901.55" "$25,901.55" "$25,901.55" "$25,901.55" "$57,559.00" "$57,559.00" "$57,559.00" "$9,417.94" "$57,559.00" "$57,559.00" "$57,559.00" "$57,559.00" "$57,559.00" "$11,995.93" "$57,559.00" "$57,559.00" "$28,376.59" "$57,559.00" "$57,559.00" "$57,559.00" "$57,559.00" "$43,169.25" "$57,559.00" "$57,559.00" "$57,559.00" "$28,779.50" "$28,779.50" "$45,586.73" "$57,559.00" "$46,047.20" "$25,901.55" "$7,712.84" "$57,559.00" "$33,384.22" "$57,559.00" "$57,559.00" "$57,559.00" "$8,098.48" "$57,559.00" N/A N/A 27801271 EAP HCPCS C1882 OVATIO CRT 6750 SYS BOTH IP/OP "$46,048.00" "$34,076.00" "$7,712.84" "$46,048.00" "$20,721.60" "$20,721.60" "$20,721.60" "$20,721.60" "$46,048.00" "$46,048.00" "$46,048.00" "$9,417.94" "$46,048.00" "$46,048.00" "$46,048.00" "$46,048.00" "$46,048.00" "$9,596.91" "$46,048.00" "$46,048.00" "$22,701.66" "$46,048.00" "$46,048.00" "$46,048.00" "$46,048.00" "$34,536.00" "$46,048.00" "$46,048.00" "$46,048.00" "$23,024.00" "$23,024.00" "$36,470.02" "$46,048.00" "$36,838.40" "$20,721.60" "$7,712.84" "$46,048.00" "$26,707.84" "$46,048.00" "$46,048.00" "$46,048.00" "$8,098.48" "$46,048.00" N/A N/A 27801272 EAP HCPCS C1721 LUMAX 340 DR-T SYST BOTH IP/OP "$69,071.00" "$51,113.00" "$14,395.16" "$69,071.00" "$69,071.00" "$69,071.00" "$69,071.00" "$69,071.00" "$69,071.00" "$69,071.00" "$69,071.00" "$69,071.00" "$69,071.00" "$69,071.00" "$69,071.00" "$69,071.00" "$69,071.00" "$14,395.16" "$69,071.00" "$27,628.40" "$69,071.00" "$69,071.00" "$69,071.00" "$69,071.00" "$69,071.00" "$51,803.25" "$69,071.00" "$69,071.00" "$69,071.00" "$34,535.50" "$34,535.50" "$54,704.23" "$69,071.00" "$55,256.80" "$31,081.95" "$69,071.00" "$69,071.00" "$40,061.18" "$69,071.00" "$41,442.60" "$69,071.00" "$69,071.00" "$69,071.00" N/A N/A 27801273 EAP HCPCS C1721 LUMOS DR-T SYSTEM BOTH IP/OP "$65,235.00" "$48,274.00" "$13,595.69" "$65,235.00" "$65,235.00" "$65,235.00" "$65,235.00" "$65,235.00" "$65,235.00" "$65,235.00" "$65,235.00" "$65,235.00" "$65,235.00" "$65,235.00" "$65,235.00" "$65,235.00" "$65,235.00" "$13,595.69" "$65,235.00" "$26,094.00" "$65,235.00" "$65,235.00" "$65,235.00" "$65,235.00" "$65,235.00" "$48,926.25" "$65,235.00" "$65,235.00" "$65,235.00" "$32,617.50" "$32,617.50" "$51,666.12" "$65,235.00" "$52,188.00" "$29,355.75" "$65,235.00" "$65,235.00" "$37,836.30" "$65,235.00" "$39,141.00" "$65,235.00" "$65,235.00" "$65,235.00" N/A N/A 27801274 EAP HCPCS C1722 LUMAX 340 VR-T SYST BOTH IP/OP "$61,398.00" "$45,435.00" "$7,712.84" "$61,398.00" "$27,629.10" "$27,629.10" "$27,629.10" "$27,629.10" "$61,398.00" "$61,398.00" "$61,398.00" "$9,417.94" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$12,796.02" "$61,398.00" "$61,398.00" "$30,269.21" "$61,398.00" "$61,398.00" "$61,398.00" "$61,398.00" "$46,048.50" "$61,398.00" "$61,398.00" "$61,398.00" "$30,699.00" "$30,699.00" "$48,627.22" "$61,398.00" "$49,118.40" "$27,629.10" "$7,712.84" "$61,398.00" "$35,610.84" "$61,398.00" "$61,398.00" "$61,398.00" "$8,098.48" "$61,398.00" N/A N/A 27801275 EAP HCPCS C1722 LUMOS VR-T SYSTEM BOTH IP/OP "$57,559.00" "$42,594.00" "$7,712.84" "$57,559.00" "$25,901.55" "$25,901.55" "$25,901.55" "$25,901.55" "$57,559.00" "$57,559.00" "$57,559.00" "$9,417.94" "$57,559.00" "$57,559.00" "$57,559.00" "$57,559.00" "$57,559.00" "$11,995.93" "$57,559.00" "$57,559.00" "$28,376.59" "$57,559.00" "$57,559.00" "$57,559.00" "$57,559.00" "$43,169.25" "$57,559.00" "$57,559.00" "$57,559.00" "$28,779.50" "$28,779.50" "$45,586.73" "$57,559.00" "$46,047.20" "$25,901.55" "$7,712.84" "$57,559.00" "$33,384.22" "$57,559.00" "$57,559.00" "$57,559.00" "$8,098.48" "$57,559.00" N/A N/A 27801276 EAP HCPCS C1882 LUMAX 340 HF-T SYST BOTH IP/OP "$100,923.00" "$74,683.50" "$7,712.84" "$100,923.00" "$45,415.35" "$45,415.35" "$45,415.35" "$45,415.35" "$100,923.00" "$100,923.00" "$100,923.00" "$9,417.94" "$100,923.00" "$100,923.00" "$100,923.00" "$100,923.00" "$100,923.00" "$21,033.46" "$100,923.00" "$100,923.00" "$49,755.04" "$100,923.00" "$100,923.00" "$100,923.00" "$100,923.00" "$75,692.25" "$100,923.00" "$100,923.00" "$100,923.00" "$50,461.50" "$50,461.50" "$79,931.02" "$100,923.00" "$80,738.40" "$45,415.35" "$7,712.84" "$100,923.00" "$58,535.34" "$100,923.00" "$100,923.00" "$100,923.00" "$8,098.48" "$100,923.00" N/A N/A 27801277 EAP HCPCS C1876 2.25 X 12MM MINI-VI BOTH IP/OP "$2,920.00" "$2,161.00" $579.55 "$2,920.00" "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.60 "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.56 "$2,920.00" "$2,920.00" "$1,439.56" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,190.00" "$2,920.00" "$2,920.00" "$2,920.00" "$1,460.00" "$1,460.00" "$2,312.64" "$2,920.00" "$2,336.00" "$1,314.00" $579.55 "$2,920.00" "$1,693.60" "$2,920.00" "$2,920.00" "$2,920.00" $608.53 "$2,920.00" N/A N/A 27801278 EAP HCPCS C1876 4.5 X 13MM ULTRA RX BOTH IP/OP "$2,586.00" "$1,914.00" $513.26 "$2,586.00" "$1,163.70" "$1,163.70" "$1,163.70" "$1,163.70" "$2,586.00" "$2,586.00" "$2,586.00" $538.99 "$2,586.00" "$2,586.00" "$2,586.00" "$2,586.00" "$2,586.00" $538.95 "$2,586.00" "$1,034.40" "$1,274.90" "$2,586.00" "$2,586.00" "$2,586.00" "$2,586.00" "$1,939.50" "$2,586.00" "$2,586.00" "$2,586.00" "$1,293.00" "$1,293.00" "$2,048.11" "$2,586.00" "$2,068.80" "$1,163.70" $513.26 "$2,586.00" "$1,499.88" "$2,586.00" "$2,586.00" "$2,586.00" $538.92 "$2,586.00" N/A N/A 27801279 EAP HCPCS C1876 4.5 X 18MM ULTRA RX BOTH IP/OP "$9,175.00" "$6,789.50" "$1,821.01" "$9,175.00" "$4,128.75" "$4,128.75" "$4,128.75" "$4,128.75" "$9,175.00" "$9,175.00" "$9,175.00" "$1,912.30" "$9,175.00" "$9,175.00" "$9,175.00" "$9,175.00" "$9,175.00" "$1,912.17" "$9,175.00" "$3,670.00" "$4,523.28" "$9,175.00" "$9,175.00" "$9,175.00" "$9,175.00" "$6,881.25" "$9,175.00" "$9,175.00" "$9,175.00" "$4,587.50" "$4,587.50" "$7,266.60" "$9,175.00" "$7,340.00" "$4,128.75" "$1,821.01" "$9,175.00" "$5,321.50" "$9,175.00" "$9,175.00" "$9,175.00" "$1,912.07" "$9,175.00" N/A N/A 27801280 EAP HCPCS C1876 4.5 X 28MM ULTRA RX BOTH IP/OP "$9,175.00" "$6,789.50" "$1,821.01" "$9,175.00" "$4,128.75" "$4,128.75" "$4,128.75" "$4,128.75" "$9,175.00" "$9,175.00" "$9,175.00" "$1,912.30" "$9,175.00" "$9,175.00" "$9,175.00" "$9,175.00" "$9,175.00" "$1,912.17" "$9,175.00" "$9,175.00" "$4,523.28" "$9,175.00" "$9,175.00" "$9,175.00" "$9,175.00" "$6,881.25" "$9,175.00" "$9,175.00" "$9,175.00" "$4,587.50" "$4,587.50" "$7,266.60" "$9,175.00" "$7,340.00" "$4,128.75" "$1,821.01" "$9,175.00" "$5,321.50" "$9,175.00" "$9,175.00" "$9,175.00" "$1,912.07" "$9,175.00" N/A N/A 27801282 EAP HCPCS C1874 3.0 X 16MM GRAFTMAS BOTH IP/OP "$7,990.00" "$5,913.00" "$1,585.82" "$7,990.00" "$3,595.50" "$3,595.50" "$3,595.50" "$3,595.50" "$7,990.00" "$7,990.00" "$7,990.00" "$1,665.32" "$7,990.00" "$7,990.00" "$7,990.00" "$7,990.00" "$7,990.00" "$1,665.20" "$7,990.00" "$7,990.00" "$3,939.07" "$7,990.00" "$7,990.00" "$7,990.00" "$7,990.00" "$5,992.50" "$7,990.00" "$7,990.00" "$7,990.00" "$3,995.00" "$3,995.00" "$6,328.08" "$7,990.00" "$6,392.00" "$3,595.50" "$1,585.82" "$7,990.00" "$4,634.20" "$7,990.00" "$7,990.00" "$7,990.00" "$1,665.12" "$7,990.00" N/A N/A 27801283 EAP HCPCS C1874 3.5 X 16MM GRAFTMAS BOTH IP/OP "$7,990.00" "$5,913.00" "$1,585.82" "$7,990.00" "$3,595.50" "$3,595.50" "$3,595.50" "$3,595.50" "$7,990.00" "$7,990.00" "$7,990.00" "$1,665.32" "$7,990.00" "$7,990.00" "$7,990.00" "$7,990.00" "$7,990.00" "$1,665.20" "$7,990.00" "$7,990.00" "$3,939.07" "$7,990.00" "$7,990.00" "$7,990.00" "$7,990.00" "$5,992.50" "$7,990.00" "$7,990.00" "$7,990.00" "$3,995.00" "$3,995.00" "$6,328.08" "$7,990.00" "$6,392.00" "$3,595.50" "$1,585.82" "$7,990.00" "$4,634.20" "$7,990.00" "$7,990.00" "$7,990.00" "$1,665.12" "$7,990.00" N/A N/A 27801284 EAP HCPCS C1776 2MM MINI SNARE BOTH IP/OP "$1,870.00" "$1,384.00" $371.15 "$1,870.00" $841.50 $841.50 $841.50 $841.50 "$1,870.00" "$1,870.00" "$1,870.00" $389.75 "$1,870.00" "$1,870.00" "$1,870.00" "$1,870.00" "$1,870.00" $389.73 "$1,870.00" "$1,870.00" "$1,106.11" "$1,870.00" "$1,870.00" "$1,870.00" "$1,870.00" "$1,402.50" "$1,870.00" "$1,870.00" "$1,870.00" $935.00 $935.00 "$1,481.04" "$1,870.00" "$1,496.00" $841.50 $371.15 "$1,870.00" "$1,084.60" "$1,870.00" "$1,870.00" "$1,870.00" $389.71 "$1,870.00" N/A N/A 27801285 EAP HCPCS C1776 4MM MINI SNARE BOTH IP/OP "$1,870.00" "$1,384.00" $371.15 "$1,870.00" $841.50 $841.50 $841.50 $841.50 "$1,870.00" "$1,870.00" "$1,870.00" $389.75 "$1,870.00" "$1,870.00" "$1,870.00" "$1,870.00" "$1,870.00" $389.73 "$1,870.00" "$1,870.00" "$1,106.11" "$1,870.00" "$1,870.00" "$1,870.00" "$1,870.00" "$1,402.50" "$1,870.00" "$1,870.00" "$1,870.00" $935.00 $935.00 "$1,481.04" "$1,870.00" "$1,496.00" $841.50 $371.15 "$1,870.00" "$1,084.60" "$1,870.00" "$1,870.00" "$1,870.00" $389.71 "$1,870.00" N/A N/A 27801357 EAP HCPCS C1874 ENDEAVOR SPRINT DES BOTH IP/OP "$5,755.00" "$4,259.00" "$1,142.22" "$5,755.00" "$2,589.75" "$2,589.75" "$2,589.75" "$2,589.75" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.49" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.41" "$5,755.00" "$5,755.00" "$2,837.22" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$4,316.25" "$5,755.00" "$5,755.00" "$5,755.00" "$2,877.50" "$2,877.50" "$4,557.96" "$5,755.00" "$4,604.00" "$2,589.75" "$1,142.22" "$5,755.00" "$3,337.90" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.34" "$5,755.00" N/A N/A 27801367 EAP HCPCS C1760 MYNX VASCULAR CLOSU BOTH IP/OP "$5,839.00" "$4,321.00" "$1,158.90" "$5,839.00" "$2,627.55" "$2,627.55" "$2,627.55" "$2,627.55" "$5,839.00" "$5,839.00" "$5,839.00" "$1,216.99" "$5,839.00" "$5,839.00" "$5,839.00" "$5,839.00" "$5,839.00" "$1,216.91" "$5,839.00" "$5,839.00" "$2,878.63" "$5,839.00" "$5,839.00" "$5,839.00" "$5,839.00" "$4,379.25" "$5,839.00" "$5,839.00" "$5,839.00" "$2,919.50" "$2,919.50" "$4,624.49" "$5,839.00" "$4,671.20" "$2,627.55" "$1,158.90" "$5,839.00" "$3,386.62" "$5,839.00" "$5,839.00" "$5,839.00" "$1,216.85" "$5,839.00" N/A N/A 27801369 EAP HCPCS C1785 PHILOS II DR PACEMA BOTH IP/OP "$11,477.00" "$8,493.00" "$2,277.90" "$11,477.00" "$5,164.65" "$5,164.65" "$5,164.65" "$5,164.65" "$11,477.00" "$11,477.00" "$11,477.00" "$2,392.09" "$11,477.00" "$11,477.00" "$11,477.00" "$11,477.00" "$11,477.00" "$2,391.93" "$11,477.00" "$11,477.00" "$5,658.16" "$11,477.00" "$11,477.00" "$11,477.00" "$11,477.00" "$8,607.75" "$11,477.00" "$11,477.00" "$11,477.00" "$5,738.50" "$5,738.50" "$9,089.78" "$11,477.00" "$9,181.60" "$5,164.65" "$2,277.90" "$11,477.00" "$6,656.66" "$11,477.00" "$11,477.00" "$11,477.00" "$2,391.81" "$11,477.00" N/A N/A 27801370 EAP HCPCS C1882 INSYNC MAXIMO BOTH IP/OP "$63,656.00" "$47,105.50" "$7,712.84" "$63,656.00" "$28,645.20" "$28,645.20" "$28,645.20" "$28,645.20" "$63,656.00" "$63,656.00" "$63,656.00" "$9,417.94" "$63,656.00" "$63,656.00" "$63,656.00" "$63,656.00" "$63,656.00" "$13,266.61" "$63,656.00" "$63,656.00" "$31,382.41" "$63,656.00" "$63,656.00" "$63,656.00" "$63,656.00" "$47,742.00" "$63,656.00" "$63,656.00" "$63,656.00" "$31,828.00" "$31,828.00" "$50,415.55" "$63,656.00" "$50,924.80" "$28,645.20" "$7,712.84" "$63,656.00" "$36,920.48" "$63,656.00" "$63,656.00" "$63,656.00" "$8,098.48" "$63,656.00" N/A N/A 27801371 EAP Custom 27801371 COIL EMBL 14CM 3MM .018IN NST 14.9 LOOP SFT RADOPC BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27801372 EAP Custom 27801372 COIL EMBL 14CM 4MM NST 11.1 LOOP SFT RADOPC .018IN BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27801373 EAP Custom 27801373 COIL EMBL 14CM 5MM NST 8.9 LOOP SFT ENH RADOPC BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27801374 EAP Custom 27801374 COIL EMBL 5CM 2MM NST 8 LOOP SFT ENH RADOPC MCIOL BOTH IP/OP $229.00 $169.50 $40.76 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $40.76 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $47.73 $229.00 $91.60 $229.00 $229.00 $229.00 $229.00 $229.00 $171.75 $229.00 $229.00 $229.00 $114.50 $114.50 $181.37 $229.00 $183.20 $103.05 $229.00 $229.00 $132.82 $229.00 $137.40 $229.00 $229.00 $229.00 N/A N/A 27801376 EAP Custom 27801376 COIL EMBL 7CM 10MM NST 2.2 LOOP SFT ENH RADOPC BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27801377 EAP Custom 27801377 COIL EMBL 7CM 2MM NST 11.1 LOOP SFT ENH RADOPC BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27801378 EAP Custom 27801378 COIL EMBL 7CM 5MM NST 4.5 LOOP SFT ENH RADOPC BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27801379 EAP Custom 27801379 COIL EMBL 7CM 6MM NST 3.7 LOOP SFT ENH RADOPC BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27801381 EAP Custom 27801381 3 CM VERSATILE RNG FILL ADV COILS 1MM-3MM BOTH IP/OP "$4,547.00" "$3,365.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $947.64 "$4,547.00" "$1,818.80" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$3,410.25" "$4,547.00" "$4,547.00" "$4,547.00" "$2,273.50" "$2,273.50" "$3,601.22" "$4,547.00" "$3,637.60" "$2,046.15" "$4,547.00" "$4,547.00" "$2,637.26" "$4,547.00" "$2,728.20" "$4,547.00" "$4,547.00" "$4,547.00" N/A N/A 27801382 EAP Custom 27801382 6CM VERSATILE RNG FILL ADV COILS 3MM-6MM BOTH IP/OP "$4,547.00" "$3,365.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $947.64 "$4,547.00" "$1,818.80" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$3,410.25" "$4,547.00" "$4,547.00" "$4,547.00" "$2,273.50" "$2,273.50" "$3,601.22" "$4,547.00" "$3,637.60" "$2,046.15" "$4,547.00" "$4,547.00" "$2,637.26" "$4,547.00" "$2,728.20" "$4,547.00" "$4,547.00" "$4,547.00" N/A N/A 27801383 EAP Custom 27801383 10CM VERSATILE RNG FILL ADV COILS 3MM-6MM BOTH IP/OP "$4,547.00" "$3,365.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $947.64 "$4,547.00" "$1,818.80" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$3,410.25" "$4,547.00" "$4,547.00" "$4,547.00" "$2,273.50" "$2,273.50" "$3,601.22" "$4,547.00" "$3,637.60" "$2,046.15" "$4,547.00" "$4,547.00" "$2,637.26" "$4,547.00" "$2,728.20" "$4,547.00" "$4,547.00" "$4,547.00" N/A N/A 27801384 EAP Custom 27801384 15CM VERSATILE RNG FILL ADV COILS 3MM-6MM BOTH IP/OP "$4,547.00" "$3,365.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $947.64 "$4,547.00" "$1,818.80" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$3,410.25" "$4,547.00" "$4,547.00" "$4,547.00" "$2,273.50" "$2,273.50" "$3,601.22" "$4,547.00" "$3,637.60" "$2,046.15" "$4,547.00" "$4,547.00" "$2,637.26" "$4,547.00" "$2,728.20" "$4,547.00" "$4,547.00" "$4,547.00" N/A N/A 27801385 EAP Custom 27801385 20CM VERSATILE RNG FILL ADV COILS 6MM-10MM BOTH IP/OP "$4,547.00" "$3,365.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $947.64 "$4,547.00" "$1,818.80" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$3,410.25" "$4,547.00" "$4,547.00" "$4,547.00" "$2,273.50" "$2,273.50" "$3,601.22" "$4,547.00" "$3,637.60" "$2,046.15" "$4,547.00" "$4,547.00" "$2,637.26" "$4,547.00" "$2,728.20" "$4,547.00" "$4,547.00" "$4,547.00" N/A N/A 27801386 EAP Custom 27801386 30CM VERSATILE RNG FILL ADV COILS 6MM-10MM BOTH IP/OP "$4,547.00" "$3,365.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $947.64 "$4,547.00" "$1,818.80" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$3,410.25" "$4,547.00" "$4,547.00" "$4,547.00" "$2,273.50" "$2,273.50" "$3,601.22" "$4,547.00" "$3,637.60" "$2,046.15" "$4,547.00" "$4,547.00" "$2,637.26" "$4,547.00" "$2,728.20" "$4,547.00" "$4,547.00" "$4,547.00" N/A N/A 27801387 EAP Custom 27801387 30CM VERSATILE RNG FILL ADV COILS 10MM-15MM BOTH IP/OP "$4,547.00" "$3,365.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $947.64 "$4,547.00" "$1,818.80" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$3,410.25" "$4,547.00" "$4,547.00" "$4,547.00" "$2,273.50" "$2,273.50" "$3,601.22" "$4,547.00" "$3,637.60" "$2,046.15" "$4,547.00" "$4,547.00" "$2,637.26" "$4,547.00" "$2,728.20" "$4,547.00" "$4,547.00" "$4,547.00" N/A N/A 27801388 EAP Custom 27801388 30CM VERSATILE RNG FILL ADV COILS 10MM-15MM BOTH IP/OP "$4,547.00" "$3,365.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $947.64 "$4,547.00" "$1,818.80" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$3,410.25" "$4,547.00" "$4,547.00" "$4,547.00" "$2,273.50" "$2,273.50" "$3,601.22" "$4,547.00" "$3,637.60" "$2,046.15" "$4,547.00" "$4,547.00" "$2,637.26" "$4,547.00" "$2,728.20" "$4,547.00" "$4,547.00" "$4,547.00" N/A N/A 27801389 EAP Custom 27801389 40CM VERSATILE RNG FILL ADV COILS 15MM-20MM BOTH IP/OP "$4,547.00" "$3,365.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $809.37 "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" $947.64 "$4,547.00" "$1,818.80" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$4,547.00" "$3,410.25" "$4,547.00" "$4,547.00" "$4,547.00" "$2,273.50" "$2,273.50" "$3,601.22" "$4,547.00" "$3,637.60" "$2,046.15" "$4,547.00" "$4,547.00" "$2,637.26" "$4,547.00" "$2,728.20" "$4,547.00" "$4,547.00" "$4,547.00" N/A N/A 27801392 EAP HCPCS C1757 CATHETER THROMBECTOMY SOLITAIRE 6MM 40MM BOTH IP/OP "$10,563.00" "$7,817.00" "$2,096.49" "$10,563.00" "$4,753.35" "$4,753.35" "$4,753.35" "$4,753.35" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.59" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.45" "$10,563.00" "$10,563.00" "$5,207.56" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$7,922.25" "$10,563.00" "$10,563.00" "$10,563.00" "$5,281.50" "$5,281.50" "$8,365.90" "$10,563.00" "$8,450.40" "$4,753.35" "$2,096.49" "$10,563.00" "$6,126.54" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.33" "$10,563.00" N/A N/A 27801400 EAP Custom 27801400 COIL EMBL 7CM 8MM NST 2.8 LOOP SFT ENH RADOPC BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27801404 EAP Custom 27801404 COIL EMBL 7CM 16MM NST 1.4 LOOP SFT ENH RADOPC BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27801405 EAP Custom 27801405 COIL EMBL 7CM 18MM NST 1.2 LOOP SFT ENH RADOPC BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27801406 EAP Custom 27801406 COIL EMBL 7CM 20MM NST 1.1 LOOP SFT ENH RADOPC BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27801407 EAP Custom 27801407 COIL EMBL 7CM 5MM NST PLTN SYNTH FBR ACPT .035IN BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27801409 EAP Custom 27801409 COIL EMBL 4CM 4-2MM TRND MCL MLFRM SFT .018IN PLTN BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27801410 EAP Custom 27801410 COIL EMBL 5CM 5-2MM TRND MCL CATH .018IN PLTN STRL BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27801411 EAP Custom 27801411 COIL EMBL 9CM 7-3MM TRND MLFRM SFT XSECT IDEALLY BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27801412 EAP HCPCS C1887 "CATH, SOFIA 6FR 131CM" BOTH IP/OP "$5,302.00" "$3,923.50" "$1,052.31" "$5,302.00" "$2,385.90" "$2,385.90" "$2,385.90" "$2,385.90" "$5,302.00" "$5,302.00" "$5,302.00" "$1,105.07" "$5,302.00" "$5,302.00" "$5,302.00" "$5,302.00" "$5,302.00" "$1,105.00" "$5,302.00" "$2,120.80" "$2,613.89" "$5,302.00" "$5,302.00" "$5,302.00" "$5,302.00" "$3,976.50" "$5,302.00" "$5,302.00" "$5,302.00" "$2,651.00" "$2,651.00" "$4,199.18" "$5,302.00" "$4,241.60" "$2,385.90" "$1,052.31" "$5,302.00" "$3,075.16" "$5,302.00" "$5,302.00" "$5,302.00" "$1,104.94" "$5,302.00" N/A N/A 27801413 EAP HCPCS C1887 "CATH, SOFIA 6FR 125CM" BOTH IP/OP "$5,302.00" "$3,923.50" "$1,052.31" "$5,302.00" "$2,385.90" "$2,385.90" "$2,385.90" "$2,385.90" "$5,302.00" "$5,302.00" "$5,302.00" "$1,105.07" "$5,302.00" "$5,302.00" "$5,302.00" "$5,302.00" "$5,302.00" "$1,105.00" "$5,302.00" "$5,302.00" "$2,613.89" "$5,302.00" "$5,302.00" "$5,302.00" "$5,302.00" "$3,976.50" "$5,302.00" "$5,302.00" "$5,302.00" "$2,651.00" "$2,651.00" "$4,199.18" "$5,302.00" "$4,241.60" "$2,385.90" "$1,052.31" "$5,302.00" "$3,075.16" "$5,302.00" "$5,302.00" "$5,302.00" "$1,104.94" "$5,302.00" N/A N/A 27801414 EAP Custom 27801414 PLUG CARDIO 7MM 10MM AMPLZR NTNL TYPE II DLV SYS BOTH IP/OP "$2,080.00" "$1,539.50" $370.24 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $370.24 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $433.49 "$2,080.00" $832.00 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,560.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,040.00" "$1,040.00" "$1,647.36" "$2,080.00" "$1,664.00" $936.00 "$2,080.00" "$2,080.00" "$1,206.40" "$2,080.00" "$1,248.00" "$2,080.00" "$2,080.00" "$2,080.00" N/A N/A 27801415 EAP Custom 27801415 PLUG CARDIO 9MM 12MM AMPLZR NTNL TYPE II DLV SYS BOTH IP/OP "$2,080.00" "$1,539.50" $370.24 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $370.24 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $433.49 "$2,080.00" $832.00 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,560.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,040.00" "$1,040.00" "$1,647.36" "$2,080.00" "$1,664.00" $936.00 "$2,080.00" "$2,080.00" "$1,206.40" "$2,080.00" "$1,248.00" "$2,080.00" "$2,080.00" "$2,080.00" N/A N/A 27801417 EAP Custom 27801417 COIL EMBL 12.5CM 10-5MM TRND SM STD PLTN BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27801419 EAP Custom 27801419 COIL EMBL 8CM 8-4MM TRND .035IN STD SM PLTN BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27801420 EAP Custom 27801420 COIL EMBL 8.2CM 8-5MM TRND MLFRM PLTN BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27801421 EAP Custom 27801421 COIL EMBL 2CM 1MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801422 EAP Custom 27801422 COIL EMBL 3CM 1MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801423 EAP Custom 27801423 COIL EMBL 4CM 1MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801424 EAP Custom 27801424 COIL EMBL 2CM 1.5MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801425 EAP Custom 27801425 COIL EMBL 3CM 1.5MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801426 EAP Custom 27801426 COIL EMBL 4CM 1.5MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801427 EAP Custom 27801427 COIL EMBL 2CM 2MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801428 EAP Custom 27801428 COIL EMBL 3CM 2MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801429 EAP Custom 27801429 COIL EMBL 4CM 2MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801430 EAP Custom 27801430 COIL EMBL 3CM 2.5MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801431 EAP Custom 27801431 COIL EMBL 6CM 2.5MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801432 EAP Custom 27801432 COIL EMBL 4CM 3MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801433 EAP Custom 27801433 COIL EMBL 6CM 3MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801434 EAP Custom 27801434 COIL EMBL 8CM 3MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801435 EAP Custom 27801435 COIL EMBL 6CM 3.5MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801436 EAP Custom 27801436 COIL EMBL 8CM 3.5MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801437 EAP Custom 27801437 COIL EMBL 10CM 3.5MM AXIUM PRM X SFT 3D BOTH IP/OP "$3,988.00" "$2,951.50" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $709.86 "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" $831.14 "$3,988.00" "$1,595.20" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$1,794.60" "$3,988.00" "$3,988.00" "$2,313.04" "$3,988.00" "$2,392.80" "$3,988.00" "$3,988.00" "$3,988.00" N/A N/A 27801438 EAP Custom 27801438 COIL EMBL 1CM 1MM AXIUM PRM X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801439 EAP Custom 27801439 COIL EMBL 2CM 1MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801440 EAP Custom 27801440 COIL EMBL 3CM 1MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801441 EAP Custom 27801441 COIL EMBL 1CM 1.5MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801442 EAP Custom 27801442 COIL EMBL 2CM 1.5MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801443 EAP Custom 27801443 COIL EMBL 3CM 1.5MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801444 EAP Custom 27801444 COIL EMBL 4CM 1.5MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801445 EAP Custom 27801445 COIL EMBL 1CM 2MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801446 EAP Custom 27801446 COIL EMBL 2CM 2MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801447 EAP Custom 27801447 COIL EMBL 3CM 2MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801448 EAP Custom 27801448 COIL EMBL 4CM 2MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801449 EAP Custom 27801449 COIL EMBL 6CM 2MM AXIUM PRM X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801450 EAP HCPCS C1877 "STENT, NON-COAT/COV W/O DEL" BOTH IP/OP "$12,969.00" "$9,597.50" "$2,574.02" "$12,969.00" "$5,836.05" "$5,836.05" "$5,836.05" "$5,836.05" "$12,969.00" "$12,969.00" "$12,969.00" "$2,703.06" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$2,702.88" "$12,969.00" "$12,969.00" "$6,393.72" "$12,969.00" "$12,969.00" "$12,969.00" "$12,969.00" "$9,726.75" "$12,969.00" "$12,969.00" "$12,969.00" "$6,484.50" "$6,484.50" "$10,271.45" "$12,969.00" "$10,375.20" "$5,836.05" "$2,574.02" "$12,969.00" "$7,522.02" "$12,969.00" "$12,969.00" "$12,969.00" "$2,702.74" "$12,969.00" N/A N/A 27801451 EAP HCPCS C1876 MINI VISION RX 2.75 X 08 MM US BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27801452 EAP HCPCS C1876 MINI VISION RX 2.75 X 12 MM US BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27801453 EAP HCPCS C1876 MINI VISION RX 2.75 X 15 MM US BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27801454 EAP HCPCS C1876 MINI VISION RX 2.75 X 18 MM US BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27801455 EAP HCPCS C1876 MINI VISION RX 2.75 X 23 MM US BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27801456 EAP HCPCS C1876 MINI VISION RX 2.75 X 28 MM US BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $93.15 $93.15 $93.15 $93.15 $207.00 $207.00 $207.00 $43.14 $207.00 $207.00 $207.00 $207.00 $207.00 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $93.15 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 27801457 EAP HCPCS C1721 ILESTO DR-T HIGH ENERGY WITH TI WITH LANDLINE HMTACHYCARDIA BOTH IP/OP "$54,233.00" "$40,132.50" "$11,302.75" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$11,302.75" "$54,233.00" "$21,693.20" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$40,674.75" "$54,233.00" "$54,233.00" "$54,233.00" "$27,116.50" "$27,116.50" "$42,952.54" "$54,233.00" "$43,386.40" "$24,404.85" "$54,233.00" "$54,233.00" "$31,455.14" "$54,233.00" "$32,539.80" "$54,233.00" "$54,233.00" "$54,233.00" N/A N/A 27801458 EAP HCPCS C1721 ILESTO DR-T HIGH ENERGY WITH TI WITH CELLULAR GSM HMTACHYCARDIA BOTH IP/OP "$56,934.00" "$42,131.50" "$11,865.67" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$11,865.67" "$56,934.00" "$22,773.60" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$42,700.50" "$56,934.00" "$56,934.00" "$56,934.00" "$28,467.00" "$28,467.00" "$45,091.73" "$56,934.00" "$45,547.20" "$25,620.30" "$56,934.00" "$56,934.00" "$33,021.72" "$56,934.00" "$34,160.40" "$56,934.00" "$56,934.00" "$56,934.00" N/A N/A 27801459 EAP HCPCS C1722 ILESTO DX HIGH ENERGY WITH ATRIAL DIAGNOSTICS & TI WITH LANDLINE HMTAC BOTH IP/OP "$54,233.00" "$40,132.50" "$7,712.84" "$54,233.00" "$24,404.85" "$24,404.85" "$24,404.85" "$24,404.85" "$54,233.00" "$54,233.00" "$54,233.00" "$9,417.94" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$11,302.75" "$54,233.00" "$54,233.00" "$26,736.87" "$54,233.00" "$54,233.00" "$54,233.00" "$54,233.00" "$40,674.75" "$54,233.00" "$54,233.00" "$54,233.00" "$27,116.50" "$27,116.50" "$42,952.54" "$54,233.00" "$43,386.40" "$24,404.85" "$7,712.84" "$54,233.00" "$31,455.14" "$54,233.00" "$54,233.00" "$54,233.00" "$8,098.48" "$54,233.00" N/A N/A 27801460 EAP HCPCS C1722 ILESTO DX HIGH ENERGY WITH ATRIAL DIAGNOSTICS & TI WITH CELLULAR GSM H BOTH IP/OP "$56,934.00" "$42,131.50" "$7,712.84" "$56,934.00" "$25,620.30" "$25,620.30" "$25,620.30" "$25,620.30" "$56,934.00" "$56,934.00" "$56,934.00" "$9,417.94" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$11,865.67" "$56,934.00" "$56,934.00" "$28,068.46" "$56,934.00" "$56,934.00" "$56,934.00" "$56,934.00" "$42,700.50" "$56,934.00" "$56,934.00" "$56,934.00" "$28,467.00" "$28,467.00" "$45,091.73" "$56,934.00" "$45,547.20" "$25,620.30" "$7,712.84" "$56,934.00" "$33,021.72" "$56,934.00" "$56,934.00" "$56,934.00" "$8,098.48" "$56,934.00" N/A N/A 27801461 EAP HCPCS C1722 ILESTO VR-T HIGH ENERGY WITH TI WITH LANDLINE HMTACHYCARDIA BOTH IP/OP "$50,182.00" "$37,135.00" "$7,712.84" "$50,182.00" "$22,581.90" "$22,581.90" "$22,581.90" "$22,581.90" "$50,182.00" "$50,182.00" "$50,182.00" "$9,417.94" "$50,182.00" "$50,182.00" "$50,182.00" "$50,182.00" "$50,182.00" "$10,458.48" "$50,182.00" "$50,182.00" "$24,739.73" "$50,182.00" "$50,182.00" "$50,182.00" "$50,182.00" "$37,636.50" "$50,182.00" "$50,182.00" "$50,182.00" "$25,091.00" "$25,091.00" "$39,744.14" "$50,182.00" "$40,145.60" "$22,581.90" "$7,712.84" "$50,182.00" "$29,105.56" "$50,182.00" "$50,182.00" "$50,182.00" "$8,098.48" "$50,182.00" N/A N/A 27801462 EAP HCPCS C1722 ILESTO VR-T HIGH ENERGY WITH TI WITH CELLULAR GSM HMTACHYCARDIA BOTH IP/OP "$52,883.00" "$39,133.50" "$7,712.84" "$52,883.00" "$23,797.35" "$23,797.35" "$23,797.35" "$23,797.35" "$52,883.00" "$52,883.00" "$52,883.00" "$9,417.94" "$52,883.00" "$52,883.00" "$52,883.00" "$52,883.00" "$52,883.00" "$11,021.40" "$52,883.00" "$52,883.00" "$26,071.32" "$52,883.00" "$52,883.00" "$52,883.00" "$52,883.00" "$39,662.25" "$52,883.00" "$52,883.00" "$52,883.00" "$26,441.50" "$26,441.50" "$41,883.34" "$52,883.00" "$42,306.40" "$23,797.35" "$7,712.84" "$52,883.00" "$30,672.14" "$52,883.00" "$52,883.00" "$52,883.00" "$8,098.48" "$52,883.00" N/A N/A 27801463 EAP HCPCS C1895 LINOXSMART SD STEROID 60/16TACHYCARDIALEAD BOTH IP/OP "$11,023.00" "$8,157.50" "$2,187.79" "$11,023.00" "$4,960.35" "$4,960.35" "$4,960.35" "$4,960.35" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.47" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.31" "$11,023.00" "$11,023.00" "$5,434.34" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$8,267.25" "$11,023.00" "$11,023.00" "$11,023.00" "$5,511.50" "$5,511.50" "$8,730.22" "$11,023.00" "$8,818.40" "$4,960.35" "$2,187.79" "$11,023.00" "$6,393.34" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.19" "$11,023.00" N/A N/A 27801464 EAP HCPCS C1895 LINOXSMART SD STEROID 65/16TACHYCARDIALEAD BOTH IP/OP "$11,023.00" "$8,157.50" "$2,187.79" "$11,023.00" "$4,960.35" "$4,960.35" "$4,960.35" "$4,960.35" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.47" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.31" "$11,023.00" "$11,023.00" "$5,434.34" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$8,267.25" "$11,023.00" "$11,023.00" "$11,023.00" "$5,511.50" "$5,511.50" "$8,730.22" "$11,023.00" "$8,818.40" "$4,960.35" "$2,187.79" "$11,023.00" "$6,393.34" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.19" "$11,023.00" N/A N/A 27801465 EAP HCPCS C1895 LINOXSMART SD STEROID 65/18TACHYCARDIALEAD BOTH IP/OP "$11,023.00" "$8,157.50" "$2,187.79" "$11,023.00" "$4,960.35" "$4,960.35" "$4,960.35" "$4,960.35" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.47" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.31" "$11,023.00" "$11,023.00" "$5,434.34" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$8,267.25" "$11,023.00" "$11,023.00" "$11,023.00" "$5,511.50" "$5,511.50" "$8,730.22" "$11,023.00" "$8,818.40" "$4,960.35" "$2,187.79" "$11,023.00" "$6,393.34" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.19" "$11,023.00" N/A N/A 27801466 EAP HCPCS C1895 LINOXSMART SD STEROID 75/18TACHYCARDIALEAD BOTH IP/OP "$11,023.00" "$8,157.50" "$2,187.79" "$11,023.00" "$4,960.35" "$4,960.35" "$4,960.35" "$4,960.35" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.47" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.31" "$11,023.00" "$11,023.00" "$5,434.34" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$8,267.25" "$11,023.00" "$11,023.00" "$11,023.00" "$5,511.50" "$5,511.50" "$8,730.22" "$11,023.00" "$8,818.40" "$4,960.35" "$2,187.79" "$11,023.00" "$6,393.34" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.19" "$11,023.00" N/A N/A 27801467 EAP HCPCS C1777 LINOXSMART S STEROID 60TACHYCARDIALEAD BOTH IP/OP "$11,023.00" "$8,157.50" "$2,187.79" "$11,023.00" "$4,960.35" "$4,960.35" "$4,960.35" "$4,960.35" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.47" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.31" "$11,023.00" "$11,023.00" "$5,434.34" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$8,267.25" "$11,023.00" "$11,023.00" "$11,023.00" "$5,511.50" "$5,511.50" "$8,730.22" "$11,023.00" "$8,818.40" "$4,960.35" "$2,187.79" "$11,023.00" "$6,393.34" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.19" "$11,023.00" N/A N/A 27801468 EAP HCPCS C1777 LINOXSMART S STEROID 65TACHYCARDIALEAD BOTH IP/OP "$11,023.00" "$8,157.50" "$2,187.79" "$11,023.00" "$4,960.35" "$4,960.35" "$4,960.35" "$4,960.35" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.47" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.31" "$11,023.00" "$11,023.00" "$5,434.34" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$8,267.25" "$11,023.00" "$11,023.00" "$11,023.00" "$5,511.50" "$5,511.50" "$8,730.22" "$11,023.00" "$8,818.40" "$4,960.35" "$2,187.79" "$11,023.00" "$6,393.34" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.19" "$11,023.00" N/A N/A 27801469 EAP HCPCS C1777 LINOXSMART S STEROID 75TACHYCARDIALEAD BOTH IP/OP "$11,023.00" "$8,157.50" "$2,187.79" "$11,023.00" "$4,960.35" "$4,960.35" "$4,960.35" "$4,960.35" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.47" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.31" "$11,023.00" "$11,023.00" "$5,434.34" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$8,267.25" "$11,023.00" "$11,023.00" "$11,023.00" "$5,511.50" "$5,511.50" "$8,730.22" "$11,023.00" "$8,818.40" "$4,960.35" "$2,187.79" "$11,023.00" "$6,393.34" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.19" "$11,023.00" N/A N/A 27801470 EAP HCPCS C1777 LINOXSMART S DX 65/15TACHYCARDIALEAD BOTH IP/OP "$11,023.00" "$8,157.50" "$2,187.79" "$11,023.00" "$4,960.35" "$4,960.35" "$4,960.35" "$4,960.35" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.47" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.31" "$11,023.00" "$11,023.00" "$5,434.34" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$8,267.25" "$11,023.00" "$11,023.00" "$11,023.00" "$5,511.50" "$5,511.50" "$8,730.22" "$11,023.00" "$8,818.40" "$4,960.35" "$2,187.79" "$11,023.00" "$6,393.34" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.19" "$11,023.00" N/A N/A 27801471 EAP HCPCS C1895 LINOXSMART TD STEROID 65/16 CMTACHYCARDIALEAD BOTH IP/OP "$11,023.00" "$8,157.50" "$2,187.79" "$11,023.00" "$4,960.35" "$4,960.35" "$4,960.35" "$4,960.35" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.47" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.31" "$11,023.00" "$11,023.00" "$5,434.34" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$8,267.25" "$11,023.00" "$11,023.00" "$11,023.00" "$5,511.50" "$5,511.50" "$8,730.22" "$11,023.00" "$8,818.40" "$4,960.35" "$2,187.79" "$11,023.00" "$6,393.34" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.19" "$11,023.00" N/A N/A 27801472 EAP HCPCS C1895 LINOXSMART TD STEROID 65/18 CMTACHYCARDIALEAD BOTH IP/OP "$11,023.00" "$8,157.50" "$2,187.79" "$11,023.00" "$4,960.35" "$4,960.35" "$4,960.35" "$4,960.35" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.47" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.31" "$11,023.00" "$11,023.00" "$5,434.34" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$8,267.25" "$11,023.00" "$11,023.00" "$11,023.00" "$5,511.50" "$5,511.50" "$8,730.22" "$11,023.00" "$8,818.40" "$4,960.35" "$2,187.79" "$11,023.00" "$6,393.34" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.19" "$11,023.00" N/A N/A 27801473 EAP HCPCS C1777 LINOXSMART T STEROID 65TACHYCARDIALEAD BOTH IP/OP "$11,023.00" "$8,157.50" "$2,187.79" "$11,023.00" "$4,960.35" "$4,960.35" "$4,960.35" "$4,960.35" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.47" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.31" "$11,023.00" "$11,023.00" "$5,434.34" "$11,023.00" "$11,023.00" "$11,023.00" "$11,023.00" "$8,267.25" "$11,023.00" "$11,023.00" "$11,023.00" "$5,511.50" "$5,511.50" "$8,730.22" "$11,023.00" "$8,818.40" "$4,960.35" "$2,187.79" "$11,023.00" "$6,393.34" "$11,023.00" "$11,023.00" "$11,023.00" "$2,297.19" "$11,023.00" N/A N/A 27801474 EAP HCPCS C1882 ILESTO HF-T HIGH ENERGY WITH TI WITH LANDLINE HMCRT HEART FAILURE BOTH IP/OP "$65,477.00" "$48,453.00" "$7,712.84" "$65,477.00" "$29,464.65" "$29,464.65" "$29,464.65" "$29,464.65" "$65,477.00" "$65,477.00" "$65,477.00" "$9,417.94" "$65,477.00" "$65,477.00" "$65,477.00" "$65,477.00" "$65,477.00" "$13,646.13" "$65,477.00" "$65,477.00" "$32,280.16" "$65,477.00" "$65,477.00" "$65,477.00" "$65,477.00" "$49,107.75" "$65,477.00" "$65,477.00" "$65,477.00" "$32,738.50" "$32,738.50" "$51,857.78" "$65,477.00" "$52,381.60" "$29,464.65" "$7,712.84" "$65,477.00" "$37,976.66" "$65,477.00" "$65,477.00" "$65,477.00" "$8,098.48" "$65,477.00" N/A N/A 27801475 EAP HCPCS C1882 ILESTO HF-T HIGH ENERGY WITH TI WITH CELLULAR GSM HMCRT HEART FAILURE BOTH IP/OP "$68,178.00" "$50,452.00" "$7,712.84" "$68,178.00" "$30,680.10" "$30,680.10" "$30,680.10" "$30,680.10" "$68,178.00" "$68,178.00" "$68,178.00" "$9,417.94" "$68,178.00" "$68,178.00" "$68,178.00" "$68,178.00" "$68,178.00" "$14,209.05" "$68,178.00" "$68,178.00" "$33,611.75" "$68,178.00" "$68,178.00" "$68,178.00" "$68,178.00" "$51,133.50" "$68,178.00" "$68,178.00" "$68,178.00" "$34,089.00" "$34,089.00" "$53,996.98" "$68,178.00" "$54,542.40" "$30,680.10" "$7,712.84" "$68,178.00" "$39,543.24" "$68,178.00" "$68,178.00" "$68,178.00" "$8,098.48" "$68,178.00" N/A N/A 27801476 EAP Custom 27801476 COIL EMBL 8CM 2MM AXIUM PRM X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801478 EAP Custom 27801478 COIL EMBL 4CM 2.5MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801479 EAP Custom 27801479 COIL EMBL 6CM 2.5MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801480 EAP Custom 27801480 COIL EMBL 8CM 2.5MM AXIUM PRM X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801481 EAP Custom 27801481 COIL EMBL 4CM 3MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801482 EAP Custom 27801482 COIL EMBL 6CM 3MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801483 EAP Custom 27801483 COIL EMBL 8CM 3MM AXIUM PRM DTCH X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801484 EAP Custom 27801484 COIL EMBL 10CM 3MM AXIUM PRM X SFT HLX BOTH IP/OP "$2,988.00" "$2,211.50" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $531.86 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,344.60" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 27801486 EAP Custom 27801486 COIL EMBL 2CM 3MM MREYE 2.1 LOOP PLTN A/V STRL BOTH IP/OP $196.00 $145.50 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $40.85 $196.00 $78.40 $196.00 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $88.20 $196.00 $196.00 $113.68 $196.00 $117.60 $196.00 $196.00 $196.00 N/A N/A 27801487 EAP Custom 27801487 COIL EMBL 3CM 2MM MREYE 4.8 LOOP .035IN PLTN STRL BOTH IP/OP $196.00 $145.50 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $40.85 $196.00 $78.40 $196.00 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $88.20 $196.00 $196.00 $113.68 $196.00 $117.60 $196.00 $196.00 $196.00 N/A N/A 27801488 EAP Custom 27801488 COIL EMBL 3CM 3MM MREYE 3.1 LOOP PLTN A/V STRL BOTH IP/OP $196.00 $145.50 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $40.85 $196.00 $78.40 $196.00 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $88.20 $196.00 $196.00 $113.68 $196.00 $117.60 $196.00 $196.00 $196.00 N/A N/A 27801489 EAP Custom 27801489 COIL EMBL 4CM 3MM MREYE 4.2 LOOP PLTN A/V STRL BOTH IP/OP $196.00 $145.50 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $40.85 $196.00 $78.40 $196.00 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $88.20 $196.00 $196.00 $113.68 $196.00 $117.60 $196.00 $196.00 $196.00 N/A N/A 27801490 EAP Custom 27801490 COIL EMBL 5CM 6MM MREYE 2.7 LOOP END HOLE GRT RADL BOTH IP/OP $196.00 $145.50 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $40.85 $196.00 $78.40 $196.00 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $88.20 $196.00 $196.00 $113.68 $196.00 $117.60 $196.00 $196.00 $196.00 N/A N/A 27801491 EAP Custom 27801491 COIL EMBL 5CM 7MM MREYE 2.3 LOOP .035IN PLTN STRL BOTH IP/OP $196.00 $145.50 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $40.85 $196.00 $78.40 $196.00 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $88.20 $196.00 $196.00 $113.68 $196.00 $117.60 $196.00 $196.00 $196.00 N/A N/A 27801492 EAP Custom 27801492 COIL EMBL 5CM 10MM MREYE 1.6 LOOP PLTN ACPT .035IN BOTH IP/OP $196.00 $145.50 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $40.85 $196.00 $78.40 $196.00 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $88.20 $196.00 $196.00 $113.68 $196.00 $117.60 $196.00 $196.00 $196.00 N/A N/A 27801493 EAP Custom 27801493 COIL EMBL 8CM 5MM MREYE 5.1 LOOP .035IN PLTN STRL BOTH IP/OP $196.00 $145.50 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $40.85 $196.00 $78.40 $196.00 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $88.20 $196.00 $196.00 $113.68 $196.00 $117.60 $196.00 $196.00 $196.00 N/A N/A 27801494 EAP HCPCS C1752 TRAY CATHETER POWER-TRIALYSIS STRAIGHT L30 CM OD13 BOTH IP/OP $693.00 $513.00 $144.43 $693.00 $693.00 $693.00 $693.00 $693.00 $693.00 $693.00 $693.00 $693.00 $693.00 $693.00 $693.00 $693.00 $693.00 $144.43 $693.00 $277.20 $693.00 $693.00 $693.00 $693.00 $693.00 $519.75 $693.00 $693.00 $693.00 $346.50 $346.50 $548.86 $693.00 $554.40 $311.85 $693.00 $693.00 $401.94 $693.00 $415.80 $693.00 $693.00 $693.00 N/A N/A 27801495 EAP Custom 27801495 COIL EMBL 8CM 8MM MREYE 3.2 LOOP .035IN PLTN STRL BOTH IP/OP $196.00 $145.50 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $40.85 $196.00 $78.40 $196.00 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $88.20 $196.00 $196.00 $113.68 $196.00 $117.60 $196.00 $196.00 $196.00 N/A N/A 27801496 EAP Custom 27801496 COIL EMBL 8CM 10MM MREYE 2.5 LOOP .035IN PLTN STRL BOTH IP/OP $196.00 $145.50 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $34.89 $196.00 $196.00 $196.00 $196.00 $196.00 $196.00 $40.85 $196.00 $78.40 $196.00 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $88.20 $196.00 $196.00 $113.68 $196.00 $117.60 $196.00 $196.00 $196.00 N/A N/A 27801497 EAP HCPCS C1788 PORT IMPLINFN 11.4FR 12FR VTX PEELPRO 2 DTCH CATH BOTH IP/OP "$1,455.00" "$1,077.00" $288.78 "$1,455.00" $654.75 $654.75 $654.75 $654.75 "$1,455.00" "$1,455.00" "$1,455.00" $303.26 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" $303.24 "$1,455.00" "$1,455.00" $860.63 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,091.25" "$1,455.00" "$1,455.00" "$1,455.00" $727.50 $727.50 "$1,152.36" "$1,455.00" "$1,164.00" $654.75 $288.78 "$1,455.00" $843.90 "$1,455.00" "$1,455.00" "$1,455.00" $303.22 "$1,455.00" N/A N/A 27801498 EAP HCPCS C1757 SOLITAIRE CATHETER THROMBECTOMY 6X40 BOTH IP/OP "$10,563.00" "$7,817.00" "$2,096.49" "$10,563.00" "$4,753.35" "$4,753.35" "$4,753.35" "$4,753.35" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.59" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.45" "$10,563.00" "$10,563.00" "$5,207.56" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$7,922.25" "$10,563.00" "$10,563.00" "$10,563.00" "$5,281.50" "$5,281.50" "$8,365.90" "$10,563.00" "$8,450.40" "$4,753.35" "$2,096.49" "$10,563.00" "$6,126.54" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.33" "$10,563.00" N/A N/A 27801499 EAP HCPCS C1777 LEAD PCNG 62CM RV TRPLR SCR IN XTD-RETRAC HLX BOTH IP/OP "$6,100.00" "$4,514.00" "$1,210.70" "$6,100.00" "$2,745.00" "$2,745.00" "$2,745.00" "$2,745.00" "$6,100.00" "$6,100.00" "$6,100.00" "$1,271.39" "$6,100.00" "$6,100.00" "$6,100.00" "$6,100.00" "$6,100.00" "$1,271.31" "$6,100.00" "$6,100.00" "$3,007.30" "$6,100.00" "$6,100.00" "$6,100.00" "$6,100.00" "$4,575.00" "$6,100.00" "$6,100.00" "$6,100.00" "$3,050.00" "$3,050.00" "$4,831.20" "$6,100.00" "$4,880.00" "$2,745.00" "$1,210.70" "$6,100.00" "$3,538.00" "$6,100.00" "$6,100.00" "$6,100.00" "$1,271.24" "$6,100.00" N/A N/A 27801500 EAP Custom 27801500 COIL EMBL .018IN 2MM 2CM AZUR CX HDRCL DTCH LOOP S BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27801501 EAP Custom 27801501 COIL EMBL .018IN 2MM 4CM AZUR CX HDRCL DTCH LOOP S BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27801502 EAP Custom 27801502 COIL EMBL .018IN 3MM 4CM AZUR CX HDRCL DTCH LOOP S BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27801503 EAP Custom 27801503 COIL EMBL .018IN 3MM 8CM AZUR CX HDRCL DTCH LOOP S BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27801504 EAP HCPCS C1752 CATHETER HMDIAL LG 12.5FR 16CM GRN MHRKR ELT DBL-D BOTH IP/OP $178.00 $132.00 $37.10 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $37.10 $178.00 $71.20 $178.00 $178.00 $178.00 $178.00 $178.00 $133.50 $178.00 $178.00 $178.00 $89.00 $89.00 $140.98 $178.00 $142.40 $80.10 $178.00 $178.00 $103.24 $178.00 $106.80 $178.00 $178.00 $178.00 N/A N/A 27801505 EAP HCPCS C1752 CATHETER HMDIAL LG 12.5FR 20CM GRN MHRKR ELT DBL-D BOTH IP/OP $178.00 $132.00 $37.10 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $37.10 $178.00 $71.20 $178.00 $178.00 $178.00 $178.00 $178.00 $133.50 $178.00 $178.00 $178.00 $89.00 $89.00 $140.98 $178.00 $142.40 $80.10 $178.00 $178.00 $103.24 $178.00 $106.80 $178.00 $178.00 $178.00 N/A N/A 27801507 EAP HCPCS C1764 SYSTEM CRD MONITR RVL LINQ INS BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 27801508 EAP Custom 27801508 DEVICE PERCLOSE BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 27801520 EAP HCPCS C1874 STENT EPRSTH 5MM 5CM STRL 120CM VBHN FLXB SLF XPD BOTH IP/OP "$8,188.00" "$6,059.50" "$1,625.11" "$8,188.00" "$3,684.60" "$3,684.60" "$3,684.60" "$3,684.60" "$8,188.00" "$8,188.00" "$8,188.00" "$1,706.58" "$8,188.00" "$8,188.00" "$8,188.00" "$8,188.00" "$8,188.00" "$1,706.47" "$8,188.00" "$8,188.00" "$4,036.68" "$8,188.00" "$8,188.00" "$8,188.00" "$8,188.00" "$6,141.00" "$8,188.00" "$8,188.00" "$8,188.00" "$4,094.00" "$4,094.00" "$6,484.90" "$8,188.00" "$6,550.40" "$3,684.60" "$1,625.11" "$8,188.00" "$4,749.04" "$8,188.00" "$8,188.00" "$8,188.00" "$1,706.38" "$8,188.00" N/A N/A 27801522 EAP Custom 27801522 COIL EMBL 15CM 12MM .038IN AZUR DTCH .035IN PLTN BOTH IP/OP "$2,975.00" "$2,201.50" $529.55 "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" $529.55 "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" $620.02 "$2,975.00" "$1,190.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,231.25" "$2,975.00" "$2,975.00" "$2,975.00" "$1,487.50" "$1,487.50" "$2,356.20" "$2,975.00" "$2,380.00" "$1,338.75" "$2,975.00" "$2,975.00" "$1,725.50" "$2,975.00" "$1,785.00" "$2,975.00" "$2,975.00" "$2,975.00" N/A N/A 27801523 EAP Custom 27801523 COIL EMBL 20CM 10MM AZUR DTCH DDRGL PERI 35 SYS BOTH IP/OP "$3,188.00" "$2,359.50" $567.46 "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" $567.46 "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" $664.41 "$3,188.00" "$1,275.20" "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" "$3,188.00" "$2,391.00" "$3,188.00" "$3,188.00" "$3,188.00" "$1,594.00" "$1,594.00" "$2,524.90" "$3,188.00" "$2,550.40" "$1,434.60" "$3,188.00" "$3,188.00" "$1,849.04" "$3,188.00" "$1,912.80" "$3,188.00" "$3,188.00" "$3,188.00" N/A N/A 27801524 EAP Custom 27801524 COIL EMBL 15CM 15MM AZUR HDRCL 18 COILS DTCH BOTH IP/OP "$2,127.00" "$1,574.00" $378.61 "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" $378.61 "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" $443.29 "$2,127.00" $850.80 "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" "$1,595.25" "$2,127.00" "$2,127.00" "$2,127.00" "$1,063.50" "$1,063.50" "$1,684.58" "$2,127.00" "$1,701.60" $957.15 "$2,127.00" "$2,127.00" "$1,233.66" "$2,127.00" "$1,276.20" "$2,127.00" "$2,127.00" "$2,127.00" N/A N/A 27801525 EAP Custom 27801525 COIL EMBL 20CM 10MM AZUR HDRCL 18 COILS DTCH BOTH IP/OP "$2,249.00" "$1,664.50" $400.32 "$2,249.00" "$2,249.00" "$2,249.00" "$2,249.00" "$2,249.00" "$2,249.00" "$2,249.00" $400.32 "$2,249.00" "$2,249.00" "$2,249.00" "$2,249.00" "$2,249.00" "$2,249.00" $468.72 "$2,249.00" $899.60 "$2,249.00" "$2,249.00" "$2,249.00" "$2,249.00" "$2,249.00" "$1,686.75" "$2,249.00" "$2,249.00" "$2,249.00" "$1,124.50" "$1,124.50" "$1,781.21" "$2,249.00" "$1,799.20" "$1,012.05" "$2,249.00" "$2,249.00" "$1,304.42" "$2,249.00" "$1,349.40" "$2,249.00" "$2,249.00" "$2,249.00" N/A N/A 27801526 EAP Custom 27801526 COIL EMBL 20CM 8MM .022IN AZUR HDRCL FRME 6 LOOP BOTH IP/OP "$1,020.00" $755.00 $181.56 "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" $181.56 "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" $212.58 "$1,020.00" $408.00 "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" $765.00 "$1,020.00" "$1,020.00" "$1,020.00" $510.00 $510.00 $807.84 "$1,020.00" $816.00 $459.00 "$1,020.00" "$1,020.00" $591.60 "$1,020.00" $612.00 "$1,020.00" "$1,020.00" "$1,020.00" N/A N/A 27801527 EAP Custom 27801527 COIL EMBL 34CM 14MM AZUR HDRCL DTCH NONHYDROGEL BOTH IP/OP "$2,975.00" "$2,201.50" $529.55 "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" $529.55 "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" $620.02 "$2,975.00" "$1,190.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,231.25" "$2,975.00" "$2,975.00" "$2,975.00" "$1,487.50" "$1,487.50" "$2,356.20" "$2,975.00" "$2,380.00" "$1,338.75" "$2,975.00" "$2,975.00" "$1,725.50" "$2,975.00" "$1,785.00" "$2,975.00" "$2,975.00" "$2,975.00" N/A N/A 27801528 EAP Custom 27801528 COIL EMBL 4MM .018IN 15CM AZUR DTCH PLTN BOTH IP/OP "$2,127.00" "$1,574.00" $378.61 "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" $378.61 "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" $443.29 "$2,127.00" $850.80 "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" "$2,127.00" "$1,595.25" "$2,127.00" "$2,127.00" "$2,127.00" "$1,063.50" "$1,063.50" "$1,684.58" "$2,127.00" "$1,701.60" $957.15 "$2,127.00" "$2,127.00" "$1,233.66" "$2,127.00" "$1,276.20" "$2,127.00" "$2,127.00" "$2,127.00" N/A N/A 27801529 EAP Custom 27801529 COIL EMBL 3MM .018IN 10CM AZUR DTCH PLTN BOTH IP/OP "$1,987.00" "$1,470.50" $353.69 "$1,987.00" "$1,987.00" "$1,987.00" "$1,987.00" "$1,987.00" "$1,987.00" "$1,987.00" $353.69 "$1,987.00" "$1,987.00" "$1,987.00" "$1,987.00" "$1,987.00" "$1,987.00" $414.11 "$1,987.00" $794.80 "$1,987.00" "$1,987.00" "$1,987.00" "$1,987.00" "$1,987.00" "$1,490.25" "$1,987.00" "$1,987.00" "$1,987.00" $993.50 $993.50 "$1,573.70" "$1,987.00" "$1,589.60" $894.15 "$1,987.00" "$1,987.00" "$1,152.46" "$1,987.00" "$1,192.20" "$1,987.00" "$1,987.00" "$1,987.00" N/A N/A 27801530 EAP Custom 27801530 COIL EMBL 6MM .018IN 20CM AZUR DTCH PLTN BOTH IP/OP "$2,244.00" "$1,661.00" $399.43 "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" $399.43 "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" $467.67 "$2,244.00" $897.60 "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" "$1,683.00" "$2,244.00" "$2,244.00" "$2,244.00" "$1,122.00" "$1,122.00" "$1,777.25" "$2,244.00" "$1,795.20" "$1,009.80" "$2,244.00" "$2,244.00" "$1,301.52" "$2,244.00" "$1,346.40" "$2,244.00" "$2,244.00" "$2,244.00" N/A N/A 27801531 EAP Custom 27801531 COIL EMBL 4MM .018IN 20CM AZUR DTCH PLTN BOTH IP/OP "$2,244.00" "$1,661.00" $399.43 "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" $399.43 "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" $467.67 "$2,244.00" $897.60 "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" "$2,244.00" "$1,683.00" "$2,244.00" "$2,244.00" "$2,244.00" "$1,122.00" "$1,122.00" "$1,777.25" "$2,244.00" "$1,795.20" "$1,009.80" "$2,244.00" "$2,244.00" "$1,301.52" "$2,244.00" "$1,346.40" "$2,244.00" "$2,244.00" "$2,244.00" N/A N/A 27802002 EAP Custom 27802002 COIL EMBL 14CM 6MM NST 7.4 LOOP SFT RADOPC .018IN BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27802003 EAP Custom 27802003 COIL EMBL 14CM 8MM NST 5.6 LOOP SFT RADOPC .018IN BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27802004 EAP Custom 27802004 COIL EMBL 14CM 10MM NST 4.5 LOOP SFT RADOPC .018IN BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27802005 EAP Custom 27802005 COIL EMBL 14CM 8MM NST 5.6 LOOP PLTN SYNTH FBR ART BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27802006 EAP Custom 27802006 COIL EMBL 14CM 10MM NST 4.5 LOOP SFT .035IN PLTN BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27802008 EAP Custom 27802008 COIL EMBL 9.5CM 8-4MM TRND MCL MCIOL SFT SPC PUSH BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27802009 EAP Custom 27802009 COIL EMBL 4.1CM 5-3MM TRND SFT .035IN STD SM PLTN BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27802010 EAP Custom 27802010 COIL EMBL 8CM 7-3MM TRND PLTN ARTERIOVENOUS ACPT BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27802011 EAP Custom 27802011 COIL EMBL 14CM 6MM NST SFT CATH XTD EMBL ENDHOLE BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27802012 EAP Custom 27802012 COIL EMBL 7CM 4MM NST 5.6 LOOP SFT ENH RADOPC .035 BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27802013 EAP Custom 27802013 COIL EMBOLIZATION .035IN 10MM 7CM 2.2 LOOP SOFT ENHANCED BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27802014 EAP Custom 27802014 COIL EMBL 14CM 20MM NST 2.2 LOOP SFT ENH RADOPC BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27802015 EAP Custom 27802015 COIL EMBL 3CM 2MM NST 4.8 LOOP SFT ENH RADOPC BOTH IP/OP $229.00 $169.50 $40.76 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $40.76 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $47.73 $229.00 $91.60 $229.00 $229.00 $229.00 $229.00 $229.00 $171.75 $229.00 $229.00 $229.00 $114.50 $114.50 $181.37 $229.00 $183.20 $103.05 $229.00 $229.00 $132.82 $229.00 $137.40 $229.00 $229.00 $229.00 N/A N/A 27802016 EAP Custom 27802016 COIL EMBL 3CM 3MM NST 3.2 LOOP SFT ENH RADOPC BOTH IP/OP $229.00 $169.50 $40.76 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $40.76 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $47.73 $229.00 $91.60 $229.00 $229.00 $229.00 $229.00 $229.00 $171.75 $229.00 $229.00 $229.00 $114.50 $114.50 $181.37 $229.00 $183.20 $103.05 $229.00 $229.00 $132.82 $229.00 $137.40 $229.00 $229.00 $229.00 N/A N/A 27802017 EAP Custom 27802017 COIL EMBL 5CM 3MM NST 5.3 LOOP SFT ENH RADOPC BOTH IP/OP $229.00 $169.50 $40.76 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $40.76 $229.00 $229.00 $229.00 $229.00 $229.00 $229.00 $47.73 $229.00 $91.60 $229.00 $229.00 $229.00 $229.00 $229.00 $171.75 $229.00 $229.00 $229.00 $114.50 $114.50 $181.37 $229.00 $183.20 $103.05 $229.00 $229.00 $132.82 $229.00 $137.40 $229.00 $229.00 $229.00 N/A N/A 27802018 EAP Custom 27802018 COIL EMBL 7CM 6MM NST 3.7 LOOP SFT ENH RADOPC .035 BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27802020 EAP Custom 27802020 COIL EMBL 14CM 16MM NST 2.8 LOOP SFT XTD ENH BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27802021 EAP Custom 27802021 COIL EMBL 7CM 3MM NST 7.4 LOOP SFT ENH RADOPC BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27802022 EAP Custom 27802022 COIL EMBL 7CM 4MM .018IN NST CATH LOOP SFT STR WG BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27802023 EAP Custom 27802023 COIL EMBL 2CM 3-2MM TRND MCIOL MLFRM SFT .018IN BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 $270.00 $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 27802024 EAP Custom 27802024 COIL EMBL 7CM 3MM NST 7.4 LOOP PLTN SYNTH FBR STRL BOTH IP/OP $249.00 $184.50 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $44.32 $249.00 $249.00 $249.00 $249.00 $249.00 $249.00 $51.89 $249.00 $99.60 $249.00 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $112.05 $249.00 $249.00 $144.42 $249.00 $149.40 $249.00 $249.00 $249.00 N/A N/A 27802025 EAP HCPCS C1882 QUADRA ASSURA MP CRT-D BOTH IP/OP "$42,750.00" "$31,635.00" "$7,712.84" "$42,750.00" "$19,237.50" "$19,237.50" "$19,237.50" "$19,237.50" "$42,750.00" "$42,750.00" "$42,750.00" "$8,910.17" "$42,750.00" "$42,750.00" "$42,750.00" "$42,750.00" "$42,750.00" "$8,909.57" "$42,750.00" "$42,750.00" "$21,075.75" "$42,750.00" "$42,750.00" "$42,750.00" "$42,750.00" "$32,062.50" "$42,750.00" "$42,750.00" "$42,750.00" "$21,375.00" "$21,375.00" "$33,858.00" "$42,750.00" "$34,200.00" "$19,237.50" "$7,712.84" "$42,750.00" "$24,795.00" "$42,750.00" "$42,750.00" "$42,750.00" "$8,098.48" "$42,750.00" N/A N/A 27802026 EAP HCPCS C2621 QUADRA ASSURA MP CRT-D DF4 CONNECTOR BOTH IP/OP "$42,750.00" "$31,635.00" "$7,712.84" "$42,750.00" "$19,237.50" "$19,237.50" "$19,237.50" "$19,237.50" "$42,750.00" "$42,750.00" "$42,750.00" "$8,910.17" "$42,750.00" "$42,750.00" "$42,750.00" "$42,750.00" "$42,750.00" "$8,909.57" "$42,750.00" "$42,750.00" "$21,075.75" "$42,750.00" "$42,750.00" "$42,750.00" "$42,750.00" "$32,062.50" "$42,750.00" "$42,750.00" "$42,750.00" "$21,375.00" "$21,375.00" "$33,858.00" "$42,750.00" "$34,200.00" "$19,237.50" "$7,712.84" "$42,750.00" "$24,795.00" "$42,750.00" "$42,750.00" "$42,750.00" "$8,098.48" "$42,750.00" N/A N/A 27802027 EAP HCPCS C1882 "QUADRA ASSURA MP CRT-D, MERLINPKG" BOTH IP/OP "$43,875.00" "$32,467.50" "$7,712.84" "$43,875.00" "$19,743.75" "$19,743.75" "$19,743.75" "$19,743.75" "$43,875.00" "$43,875.00" "$43,875.00" "$9,144.65" "$43,875.00" "$43,875.00" "$43,875.00" "$43,875.00" "$43,875.00" "$9,144.03" "$43,875.00" "$43,875.00" "$21,630.38" "$43,875.00" "$43,875.00" "$43,875.00" "$43,875.00" "$32,906.25" "$43,875.00" "$43,875.00" "$43,875.00" "$21,937.50" "$21,937.50" "$34,749.00" "$43,875.00" "$35,100.00" "$19,743.75" "$7,712.84" "$43,875.00" "$25,447.50" "$43,875.00" "$43,875.00" "$43,875.00" "$8,098.48" "$43,875.00" N/A N/A 27802028 EAP HCPCS C1882 "QUADRA ASSURA MP CRT-D DF4, MERLINPKG" BOTH IP/OP "$43,875.00" "$32,467.50" "$7,712.84" "$43,875.00" "$19,743.75" "$19,743.75" "$19,743.75" "$19,743.75" "$43,875.00" "$43,875.00" "$43,875.00" "$9,144.65" "$43,875.00" "$43,875.00" "$43,875.00" "$43,875.00" "$43,875.00" "$9,144.03" "$43,875.00" "$43,875.00" "$21,630.38" "$43,875.00" "$43,875.00" "$43,875.00" "$43,875.00" "$32,906.25" "$43,875.00" "$43,875.00" "$43,875.00" "$21,937.50" "$21,937.50" "$34,749.00" "$43,875.00" "$35,100.00" "$19,743.75" "$7,712.84" "$43,875.00" "$25,447.50" "$43,875.00" "$43,875.00" "$43,875.00" "$8,098.48" "$43,875.00" N/A N/A 27802029 EAP HCPCS C1882 QUADRA ASSURA MP CRT-D SYSTEM BOTH IP/OP "$56,250.00" "$41,625.00" "$7,712.84" "$56,250.00" "$25,312.50" "$25,312.50" "$25,312.50" "$25,312.50" "$56,250.00" "$56,250.00" "$56,250.00" "$9,417.94" "$56,250.00" "$56,250.00" "$56,250.00" "$56,250.00" "$56,250.00" "$11,723.12" "$56,250.00" "$56,250.00" "$27,731.25" "$56,250.00" "$56,250.00" "$56,250.00" "$56,250.00" "$42,187.50" "$56,250.00" "$56,250.00" "$56,250.00" "$28,125.00" "$28,125.00" "$44,550.00" "$56,250.00" "$45,000.00" "$25,312.50" "$7,712.84" "$56,250.00" "$32,625.00" "$56,250.00" "$56,250.00" "$56,250.00" "$8,098.48" "$56,250.00" N/A N/A 27802030 EAP HCPCS C1882 QUADRA ASSURA MP CRT-D DF4 CONNECTOR SYSTEM BOTH IP/OP "$56,250.00" "$41,625.00" "$7,712.84" "$56,250.00" "$25,312.50" "$25,312.50" "$25,312.50" "$25,312.50" "$56,250.00" "$56,250.00" "$56,250.00" "$9,417.94" "$56,250.00" "$56,250.00" "$56,250.00" "$56,250.00" "$56,250.00" "$11,723.12" "$56,250.00" "$56,250.00" "$27,731.25" "$56,250.00" "$56,250.00" "$56,250.00" "$56,250.00" "$42,187.50" "$56,250.00" "$56,250.00" "$56,250.00" "$28,125.00" "$28,125.00" "$44,550.00" "$56,250.00" "$45,000.00" "$25,312.50" "$7,712.84" "$56,250.00" "$32,625.00" "$56,250.00" "$56,250.00" "$56,250.00" "$8,098.48" "$56,250.00" N/A N/A 27802031 EAP HCPCS C1882 "QUADRA ASSURA MP CRT-D SYSTEM, MERLINPKG" BOTH IP/OP "$58,500.00" "$43,290.00" "$7,712.84" "$58,500.00" "$26,325.00" "$26,325.00" "$26,325.00" "$26,325.00" "$58,500.00" "$58,500.00" "$58,500.00" "$9,417.94" "$58,500.00" "$58,500.00" "$58,500.00" "$58,500.00" "$58,500.00" "$12,192.04" "$58,500.00" "$58,500.00" "$28,840.50" "$58,500.00" "$58,500.00" "$58,500.00" "$58,500.00" "$43,875.00" "$58,500.00" "$58,500.00" "$58,500.00" "$29,250.00" "$29,250.00" "$46,332.00" "$58,500.00" "$46,800.00" "$26,325.00" "$7,712.84" "$58,500.00" "$33,930.00" "$58,500.00" "$58,500.00" "$58,500.00" "$8,098.48" "$58,500.00" N/A N/A 27802032 EAP HCPCS C1882 "QUADRA ASSURA MP CRT-D DF4 SYSTEM, MERLINPKG" BOTH IP/OP "$58,500.00" "$43,290.00" "$7,712.84" "$58,500.00" "$26,325.00" "$26,325.00" "$26,325.00" "$26,325.00" "$58,500.00" "$58,500.00" "$58,500.00" "$9,417.94" "$58,500.00" "$58,500.00" "$58,500.00" "$58,500.00" "$58,500.00" "$12,192.04" "$58,500.00" "$58,500.00" "$28,840.50" "$58,500.00" "$58,500.00" "$58,500.00" "$58,500.00" "$43,875.00" "$58,500.00" "$58,500.00" "$58,500.00" "$29,250.00" "$29,250.00" "$46,332.00" "$58,500.00" "$46,800.00" "$26,325.00" "$7,712.84" "$58,500.00" "$33,930.00" "$58,500.00" "$58,500.00" "$58,500.00" "$8,098.48" "$58,500.00" N/A N/A 27802033 EAP HCPCS C1900 "QUARTET, SMALL-S 75CM" BOTH IP/OP "$5,375.00" "$3,977.50" "$1,066.80" "$5,375.00" "$2,418.75" "$2,418.75" "$2,418.75" "$2,418.75" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.28" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.21" "$5,375.00" "$5,375.00" "$2,649.88" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$4,031.25" "$5,375.00" "$5,375.00" "$5,375.00" "$2,687.50" "$2,687.50" "$4,257.00" "$5,375.00" "$4,300.00" "$2,418.75" "$1,066.80" "$5,375.00" "$3,117.50" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.15" "$5,375.00" N/A N/A 27802034 EAP HCPCS C1900 "QUARTET, SMALL-S 86CM" BOTH IP/OP "$5,375.00" "$3,977.50" "$1,066.80" "$5,375.00" "$2,418.75" "$2,418.75" "$2,418.75" "$2,418.75" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.28" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.21" "$5,375.00" "$5,375.00" "$2,649.88" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$4,031.25" "$5,375.00" "$5,375.00" "$5,375.00" "$2,687.50" "$2,687.50" "$4,257.00" "$5,375.00" "$4,300.00" "$2,418.75" "$1,066.80" "$5,375.00" "$3,117.50" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.15" "$5,375.00" N/A N/A 27802035 EAP HCPCS C1900 "QUARTET, WIDE SPACING 75CM" BOTH IP/OP "$5,375.00" "$3,977.50" "$1,066.80" "$5,375.00" "$2,418.75" "$2,418.75" "$2,418.75" "$2,418.75" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.28" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.21" "$5,375.00" "$5,375.00" "$2,649.88" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$4,031.25" "$5,375.00" "$5,375.00" "$5,375.00" "$2,687.50" "$2,687.50" "$4,257.00" "$5,375.00" "$4,300.00" "$2,418.75" "$1,066.80" "$5,375.00" "$3,117.50" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.15" "$5,375.00" N/A N/A 27802036 EAP HCPCS C1900 "QUARTET, WIDE SPACING 86CM" BOTH IP/OP "$5,375.00" "$3,977.50" "$1,066.80" "$5,375.00" "$2,418.75" "$2,418.75" "$2,418.75" "$2,418.75" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.28" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.21" "$5,375.00" "$5,375.00" "$2,649.88" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$4,031.25" "$5,375.00" "$5,375.00" "$5,375.00" "$2,687.50" "$2,687.50" "$4,257.00" "$5,375.00" "$4,300.00" "$2,418.75" "$1,066.80" "$5,375.00" "$3,117.50" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.15" "$5,375.00" N/A N/A 27802040 EAP HCPCS C1874 STENT VASC 80MM 6MM GORE TIGRIS CBAS NTNL FLPLMR BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" $779.00 "$3,738.00" N/A N/A 27802041 EAP HCPCS C1874 STENT VASC 60MM 5MM GORE TIGRIS CBAS NTNL FLPLMR BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$3,738.00" "$3,738.00" $779.00 "$3,738.00" N/A N/A 27802042 EAP HCPCS C1874 STENT VASC 80MM 5MM GORE TIGRIS CBAS NTNL FLPLMR BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$3,738.00" "$3,738.00" $779.00 "$3,738.00" N/A N/A 27802043 EAP HCPCS C1874 STENT VASC 100MM 5MM GORE TIGRIS CBAS NTNL FLPLMR BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$3,738.00" "$3,738.00" $779.00 "$3,738.00" N/A N/A 27802044 EAP HCPCS C1874 STENT VASC 40MM 6MM GORE TIGRIS CBAS NTNL FLPLMR BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$3,738.00" "$3,738.00" $779.00 "$3,738.00" N/A N/A 27802045 EAP HCPCS C1874 STENT VASC 60MM 6MM GORE TIGRIS CBAS NTNL FLPLMR BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$3,738.00" "$3,738.00" $779.00 "$3,738.00" N/A N/A 27802046 EAP HCPCS C1874 STENT CORON 40MM 5MM GORE TIGRIS VASC CBAS NTNL BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$3,738.00" "$3,738.00" $779.00 "$3,738.00" N/A N/A 27802047 EAP HCPCS C1874 STENT VASC 100MM 6MM GORE TIGRIS CBAS NTNL FLPLMR BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$3,738.00" "$3,738.00" $779.00 "$3,738.00" N/A N/A 27802048 EAP HCPCS C1874 STENT VASC 40MM 7MM GORE TIGRIS CBAS NTNL FLPLMR BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" $779.00 "$3,738.00" N/A N/A 27802050 EAP HCPCS C1874 STENT VASC 80MM 7MM GORE TIGRIS CBAS NTNL FLPLMR BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$3,738.00" "$3,738.00" $779.00 "$3,738.00" N/A N/A 27802051 EAP HCPCS C1874 STENT VASC 100MM 7MM GORE TIGRIS CBAS NTNL FLPLMR BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" $779.00 "$3,738.00" N/A N/A 27803013 EAP HCPCS C1781 MESH IMPLT BOTH IP/OP $650.00 $481.00 $129.01 $650.00 $292.50 $292.50 $292.50 $292.50 $650.00 $650.00 $650.00 $135.48 $650.00 $650.00 $650.00 $650.00 $650.00 $135.47 $650.00 $650.00 $384.48 $650.00 $650.00 $650.00 $650.00 $487.50 $650.00 $650.00 $650.00 $325.00 $325.00 $514.80 $650.00 $520.00 $292.50 $129.01 $650.00 $377.00 $650.00 $650.00 $650.00 $135.46 $650.00 N/A N/A 27803015 EAP Custom 27803015 COIL EMBOLIZATION .018IN STANDARD LENGTH 2D 2MM 4C BOTH IP/OP $943.00 $698.00 $167.85 $943.00 $943.00 $943.00 $943.00 $943.00 $943.00 $943.00 $167.85 $943.00 $943.00 $943.00 $943.00 $943.00 $943.00 $196.53 $943.00 $377.20 $943.00 $943.00 $943.00 $943.00 $943.00 $707.25 $943.00 $943.00 $943.00 $471.50 $471.50 $746.86 $943.00 $754.40 $424.35 $943.00 $943.00 $546.94 $943.00 $565.80 $943.00 $943.00 $943.00 N/A N/A 27803030 EAP HCPCS C1897 SJM PERCUTANEOUS LEAD BOTH IP/OP "$2,869.00" "$2,123.50" $569.42 "$2,869.00" "$1,291.05" "$1,291.05" "$1,291.05" "$1,291.05" "$2,869.00" "$2,869.00" "$2,869.00" $597.97 "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" $597.93 "$2,869.00" "$2,869.00" "$1,414.42" "$2,869.00" "$2,869.00" "$2,869.00" "$2,869.00" "$2,151.75" "$2,869.00" "$2,869.00" "$2,869.00" "$1,434.50" "$1,434.50" "$2,272.25" "$2,869.00" "$2,295.20" "$1,291.05" $569.42 "$2,869.00" "$1,664.02" "$2,869.00" "$2,869.00" "$2,869.00" $597.90 "$2,869.00" N/A N/A 27803050 EAP Custom 27803050 BILIARY METAL STENTS BOTH IP/OP "$5,087.00" "$3,764.50" $905.49 "$5,087.00" "$5,087.00" "$5,087.00" "$5,087.00" "$5,087.00" "$5,087.00" "$5,087.00" $905.49 "$5,087.00" "$5,087.00" "$5,087.00" "$5,087.00" "$5,087.00" "$5,087.00" "$1,060.19" "$5,087.00" "$2,034.80" "$5,087.00" "$5,087.00" "$5,087.00" "$5,087.00" "$5,087.00" "$3,815.25" "$5,087.00" "$5,087.00" "$5,087.00" "$2,543.50" "$2,543.50" "$4,028.90" "$5,087.00" "$4,069.60" "$2,289.15" "$5,087.00" "$5,087.00" "$2,950.46" "$5,087.00" "$3,052.20" "$5,087.00" "$5,087.00" "$5,087.00" N/A N/A 27803051 EAP Custom 27803051 ULTRAFLEX DIAMOND METAL STENT BOTH IP/OP "$9,045.00" "$6,693.50" "$1,610.01" "$9,045.00" "$9,045.00" "$9,045.00" "$9,045.00" "$9,045.00" "$9,045.00" "$9,045.00" "$1,610.01" "$9,045.00" "$9,045.00" "$9,045.00" "$9,045.00" "$9,045.00" "$9,045.00" "$1,885.08" "$9,045.00" "$3,618.00" "$9,045.00" "$9,045.00" "$9,045.00" "$9,045.00" "$9,045.00" "$6,783.75" "$9,045.00" "$9,045.00" "$9,045.00" "$4,522.50" "$4,522.50" "$7,163.64" "$9,045.00" "$7,236.00" "$4,070.25" "$9,045.00" "$9,045.00" "$5,246.10" "$9,045.00" "$5,427.00" "$9,045.00" "$9,045.00" "$9,045.00" N/A N/A 27803052 EAP Custom 27803052 POLYFLEX ESOPHAGEAL STENT BOTH IP/OP "$13,618.00" "$10,077.50" "$2,424.00" "$13,618.00" "$13,618.00" "$13,618.00" "$13,618.00" "$13,618.00" "$13,618.00" "$13,618.00" "$2,424.00" "$13,618.00" "$13,618.00" "$13,618.00" "$13,618.00" "$13,618.00" "$13,618.00" "$2,838.14" "$13,618.00" "$5,447.20" "$13,618.00" "$13,618.00" "$13,618.00" "$13,618.00" "$13,618.00" "$10,213.50" "$13,618.00" "$13,618.00" "$13,618.00" "$6,809.00" "$6,809.00" "$10,785.46" "$13,618.00" "$10,894.40" "$6,128.10" "$13,618.00" "$13,618.00" "$7,898.44" "$13,618.00" "$8,170.80" "$13,618.00" "$13,618.00" "$13,618.00" N/A N/A 27803053 EAP Custom 27803053 STENT CORON 8MM 2.5MM ABS GT1 POLY L LACTD PLD BOTH IP/OP "$3,625.00" "$2,682.50" $645.25 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $645.25 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$1,450.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" "$3,625.00" "$3,625.00" "$2,102.50" "$3,625.00" "$2,175.00" "$3,625.00" "$3,625.00" "$3,625.00" N/A N/A 27803055 EAP HCPCS C1874 STENT CORON 12MM 2.5MM ABS GT1 POLY L LACTD PLD BOTH IP/OP "$3,625.00" "$2,682.50" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 "$3,625.00" "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 27803056 EAP HCPCS C1874 STENT CORON 18MM 2.5MM ABS GT1 POLY L LACTD PLD BOTH IP/OP "$3,625.00" "$2,682.50" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 "$3,625.00" "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 27803057 EAP HCPCS C1874 STENT CORON 23MM 2.5MM ABS GT1 POLY L LACTD PLD BOTH IP/OP "$3,625.00" "$2,682.50" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 "$3,625.00" "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 27803058 EAP HCPCS C1874 STENT CORON 28MM 2.5MM ABS GT1 POLY L LACTD PLD BOTH IP/OP "$3,625.00" "$2,682.50" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 "$3,625.00" "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 27803059 EAP HCPCS C1874 STENT CORON 8MM 3MM ABS GT1 POLY L LACTD PLD LACTD BOTH IP/OP "$3,625.00" "$2,682.50" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 "$3,625.00" "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 27803061 EAP HCPCS C1874 STENT CORON 12MM 3MM ABS GT1 POLY L LACTD PLD BOTH IP/OP "$3,625.00" "$2,682.50" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 "$3,625.00" "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 27803062 EAP HCPCS C1874 STENT CORON 18MM 3MM ABS GT1 POLY L LACTD PLD BOTH IP/OP "$3,625.00" "$2,682.50" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 "$3,625.00" "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 27803063 EAP HCPCS C1874 STENT CORON 23MM 3MM ABS GT1 POLY L LACTD PLD BOTH IP/OP "$3,625.00" "$2,682.50" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 "$3,625.00" "$2,102.50" "$3,625.00" "$2,175.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 27803064 EAP HCPCS C1874 STENT CORON 28MM 3MM ABS GT1 POLY L LACTD PLD BOTH IP/OP "$3,625.00" "$2,682.50" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 "$3,625.00" "$2,102.50" "$3,625.00" "$2,175.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 27803065 EAP HCPCS C1874 STENT CORON 12MM 3.5MM ABS GT1 POLY L LACTD PLD BOTH IP/OP "$3,625.00" "$2,682.50" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 "$3,625.00" "$2,102.50" "$3,625.00" "$2,175.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 27803066 EAP HCPCS C1874 STENT CORON 18MM 3.5MM ABS GT1 POLY L LACTD PLD BOTH IP/OP "$3,625.00" "$2,682.50" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 "$3,625.00" "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 27803067 EAP HCPCS C1874 STENT CORON 23MM 3.5MM ABS GT1 POLY L LACTD PLD BOTH IP/OP "$3,625.00" "$2,682.50" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 "$3,625.00" "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 27803068 EAP HCPCS C1874 STENT CORON 28MM 3.5MM ABS GT1 POLY L LACTD PLD BOTH IP/OP "$3,625.00" "$2,682.50" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 "$3,625.00" "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 27803070 EAP Custom 27803070 RX STENT 7X5 CM BOTH IP/OP $169.00 $125.50 $30.08 $169.00 $169.00 $169.00 $169.00 $169.00 $169.00 $169.00 $30.08 $169.00 $169.00 $169.00 $169.00 $169.00 $169.00 $35.22 $169.00 $67.60 $169.00 $169.00 $169.00 $169.00 $169.00 $126.75 $169.00 $169.00 $169.00 $84.50 $84.50 $133.85 $169.00 $135.20 $76.05 $169.00 $169.00 $98.02 $169.00 $101.40 $169.00 $169.00 $169.00 N/A N/A 27803071 EAP Custom 27803071 RX STENT 7X7 CM BOTH IP/OP $161.00 $119.50 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $64.40 $161.00 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $161.00 $161.00 $93.38 $161.00 $96.60 $161.00 $161.00 $161.00 N/A N/A 27803072 EAP Custom 27803072 RX STENT 7X12 CM BOTH IP/OP $161.00 $119.50 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $64.40 $161.00 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $161.00 $161.00 $93.38 $161.00 $96.60 $161.00 $161.00 $161.00 N/A N/A 27803073 EAP Custom 27803073 RX STENT 10X5 BOTH IP/OP $161.00 $119.50 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $64.40 $161.00 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $161.00 $161.00 $93.38 $161.00 $96.60 $161.00 $161.00 $161.00 N/A N/A 27803074 EAP Custom 27803074 RX STENT 10X7CM BOTH IP/OP $161.00 $119.50 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $64.40 $161.00 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $161.00 $161.00 $93.38 $161.00 $96.60 $161.00 $161.00 $161.00 N/A N/A 27803075 EAP Custom 27803075 RX STENT 10X10 CM BOTH IP/OP $161.00 $119.50 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $64.40 $161.00 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $161.00 $161.00 $93.38 $161.00 $96.60 $161.00 $161.00 $161.00 N/A N/A 27803076 EAP Custom 27803076 RX STENT 10X12 CM BOTH IP/OP $161.00 $119.50 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $64.40 $161.00 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $161.00 $161.00 $93.38 $161.00 $96.60 $161.00 $161.00 $161.00 N/A N/A 27803077 EAP Custom 27803077 RX STENT 8.5 X5 CM BOTH IP/OP $161.00 $119.50 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $64.40 $161.00 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $161.00 $161.00 $93.38 $161.00 $96.60 $161.00 $161.00 $161.00 N/A N/A 27803078 EAP Custom 27803078 RX STENT 8.5 X7CM BOTH IP/OP $161.00 $119.50 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $64.40 $161.00 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $161.00 $161.00 $93.38 $161.00 $96.60 $161.00 $161.00 $161.00 N/A N/A 27803079 EAP Custom 27803079 RX STENT 8.5 X 10CM BOTH IP/OP $161.00 $119.50 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $64.40 $161.00 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $161.00 $161.00 $93.38 $161.00 $96.60 $161.00 $161.00 $161.00 N/A N/A 27803080 EAP Custom 27803080 RX STENT 8.5X12 CM BOTH IP/OP $161.00 $119.50 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $64.40 $161.00 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $161.00 $161.00 $93.38 $161.00 $96.60 $161.00 $161.00 $161.00 N/A N/A 27803081 EAP Custom 27803081 RX STENT 7X10 CM BOTH IP/OP $161.00 $119.50 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $28.66 $161.00 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $64.40 $161.00 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $161.00 $161.00 $93.38 $161.00 $96.60 $161.00 $161.00 $161.00 N/A N/A 27803082 EAP HCPCS C1874 GRAFT EVAS 74MM 24MM 16FR ZNTH SPRLZ Z-TRK ABD BOTH IP/OP "$7,713.00" "$5,708.00" "$1,530.84" "$7,713.00" "$3,470.85" "$3,470.85" "$3,470.85" "$3,470.85" "$7,713.00" "$7,713.00" "$7,713.00" "$1,607.58" "$7,713.00" "$7,713.00" "$7,713.00" "$7,713.00" "$7,713.00" "$1,607.47" "$7,713.00" "$7,713.00" "$3,802.51" "$7,713.00" "$7,713.00" "$7,713.00" "$7,713.00" "$5,784.75" "$7,713.00" "$7,713.00" "$7,713.00" "$3,856.50" "$3,856.50" "$6,108.70" "$7,713.00" "$6,170.40" "$3,470.85" "$1,530.84" "$7,713.00" "$4,473.54" "$7,713.00" "$7,713.00" "$7,713.00" "$1,607.39" "$7,713.00" N/A N/A 27803083 EAP HCPCS C1874 GRAFT EVAS 56MM 24MM 6MM 5.3MM ZNTH SPRLZ AAA ILC BOTH IP/OP "$7,713.00" "$5,708.00" "$1,530.84" "$7,713.00" "$3,470.85" "$3,470.85" "$3,470.85" "$3,470.85" "$7,713.00" "$7,713.00" "$7,713.00" "$1,607.58" "$7,713.00" "$7,713.00" "$7,713.00" "$7,713.00" "$7,713.00" "$1,607.47" "$7,713.00" "$7,713.00" "$3,802.51" "$7,713.00" "$7,713.00" "$7,713.00" "$7,713.00" "$5,784.75" "$7,713.00" "$7,713.00" "$7,713.00" "$3,856.50" "$3,856.50" "$6,108.70" "$7,713.00" "$6,170.40" "$3,470.85" "$1,530.84" "$7,713.00" "$4,473.54" "$7,713.00" "$7,713.00" "$7,713.00" "$1,607.39" "$7,713.00" N/A N/A 27803090 EAP HCPCS C1777 7120 DURATA PKG LEAD BOTH IP/OP "$15,063.00" "$11,147.00" "$2,989.63" "$15,063.00" "$6,778.35" "$6,778.35" "$6,778.35" "$6,778.35" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.51" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.29" "$15,063.00" "$15,063.00" "$7,426.06" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$11,297.25" "$15,063.00" "$15,063.00" "$15,063.00" "$7,531.50" "$7,531.50" "$11,929.90" "$15,063.00" "$12,050.40" "$6,778.35" "$2,989.63" "$15,063.00" "$8,736.54" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.13" "$15,063.00" N/A N/A 27803091 EAP HCPCS C1777 7121 DURATA PKG LEAD BOTH IP/OP "$15,063.00" "$11,147.00" "$2,989.63" "$15,063.00" "$6,778.35" "$6,778.35" "$6,778.35" "$6,778.35" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.51" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.29" "$15,063.00" "$15,063.00" "$7,426.06" "$15,063.00" "$15,063.00" "$15,063.00" "$15,063.00" "$11,297.25" "$15,063.00" "$15,063.00" "$15,063.00" "$7,531.50" "$7,531.50" "$11,929.90" "$15,063.00" "$12,050.40" "$6,778.35" "$2,989.63" "$15,063.00" "$8,736.54" "$15,063.00" "$15,063.00" "$15,063.00" "$3,139.13" "$15,063.00" N/A N/A 27803092 EAP HCPCS C1874 WALLFLEX ESOP PCOVERDSTENT SPV BOTH IP/OP "$9,055.00" "$6,701.00" "$1,797.19" "$9,055.00" "$4,074.75" "$4,074.75" "$4,074.75" "$4,074.75" "$9,055.00" "$9,055.00" "$9,055.00" "$1,887.29" "$9,055.00" "$9,055.00" "$9,055.00" "$9,055.00" "$9,055.00" "$1,887.16" "$9,055.00" "$9,055.00" "$4,464.12" "$9,055.00" "$9,055.00" "$9,055.00" "$9,055.00" "$6,791.25" "$9,055.00" "$9,055.00" "$9,055.00" "$4,527.50" "$4,527.50" "$7,171.56" "$9,055.00" "$7,244.00" "$4,074.75" "$1,797.19" "$9,055.00" "$5,251.90" "$9,055.00" "$9,055.00" "$9,055.00" "$1,887.06" "$9,055.00" N/A N/A 27803093 EAP HCPCS C1896 SUBCUTANEOUS LD SYSTEM 6996-SQ BOTH IP/OP "$8,967.00" "$6,636.00" "$1,779.73" "$8,967.00" "$4,035.15" "$4,035.15" "$4,035.15" "$4,035.15" "$8,967.00" "$8,967.00" "$8,967.00" "$1,868.95" "$8,967.00" "$8,967.00" "$8,967.00" "$8,967.00" "$8,967.00" "$1,868.82" "$8,967.00" "$8,967.00" "$4,420.73" "$8,967.00" "$8,967.00" "$8,967.00" "$8,967.00" "$6,725.25" "$8,967.00" "$8,967.00" "$8,967.00" "$4,483.50" "$4,483.50" "$7,101.86" "$8,967.00" "$7,173.60" "$4,035.15" "$1,779.73" "$8,967.00" "$5,200.86" "$8,967.00" "$8,967.00" "$8,967.00" "$1,868.72" "$8,967.00" N/A N/A 27803094 EAP HCPCS C1877 TRANSHEPATIC BILIARY STENT SPV BOTH IP/OP "$6,456.00" "$4,777.50" "$1,281.35" "$6,456.00" "$2,905.20" "$2,905.20" "$2,905.20" "$2,905.20" "$6,456.00" "$6,456.00" "$6,456.00" "$1,345.59" "$6,456.00" "$6,456.00" "$6,456.00" "$6,456.00" "$6,456.00" "$1,345.50" "$6,456.00" "$6,456.00" "$3,182.81" "$6,456.00" "$6,456.00" "$6,456.00" "$6,456.00" "$4,842.00" "$6,456.00" "$6,456.00" "$6,456.00" "$3,228.00" "$3,228.00" "$5,113.15" "$6,456.00" "$5,164.80" "$2,905.20" "$1,281.35" "$6,456.00" "$3,744.48" "$6,456.00" "$6,456.00" "$6,456.00" "$1,345.43" "$6,456.00" N/A N/A 27803095 EAP HCPCS C1897 "LEAD, NEUROSTIM TEST KIT" BOTH IP/OP "$3,411.00" "$2,524.50" $677.00 "$3,411.00" "$1,534.95" "$1,534.95" "$1,534.95" "$1,534.95" "$3,411.00" "$3,411.00" "$3,411.00" $710.94 "$3,411.00" "$3,411.00" "$3,411.00" "$3,411.00" "$3,411.00" $710.89 "$3,411.00" "$3,411.00" "$1,681.62" "$3,411.00" "$3,411.00" "$3,411.00" "$3,411.00" "$2,558.25" "$3,411.00" "$3,411.00" "$3,411.00" "$1,705.50" "$1,705.50" "$2,701.51" "$3,411.00" "$2,728.80" "$1,534.95" $677.00 "$3,411.00" "$1,978.38" "$3,411.00" "$3,411.00" "$3,411.00" $710.85 "$3,411.00" N/A N/A 27803096 EAP HCPCS C1725 PTA DILATATION CATHETER 18 SPV BOTH IP/OP "$1,435.00" "$1,062.00" $284.81 "$1,435.00" $645.75 $645.75 $645.75 $645.75 "$1,435.00" "$1,435.00" "$1,435.00" $299.09 "$1,435.00" "$1,435.00" "$1,435.00" "$1,435.00" "$1,435.00" $299.07 "$1,435.00" $574.00 $848.80 "$1,435.00" "$1,435.00" "$1,435.00" "$1,435.00" "$1,076.25" "$1,435.00" "$1,435.00" "$1,435.00" $717.50 $717.50 "$1,136.52" "$1,435.00" "$1,148.00" $645.75 $284.81 "$1,435.00" $832.30 "$1,435.00" "$1,435.00" "$1,435.00" $299.05 "$1,435.00" N/A N/A 27803097 EAP HCPCS C1725 PTA DILATATION CATHETER 16 SPV BOTH IP/OP "$1,435.00" "$1,062.00" $284.81 "$1,435.00" $645.75 $645.75 $645.75 $645.75 "$1,435.00" "$1,435.00" "$1,435.00" $299.09 "$1,435.00" "$1,435.00" "$1,435.00" "$1,435.00" "$1,435.00" $299.07 "$1,435.00" "$1,435.00" $848.80 "$1,435.00" "$1,435.00" "$1,435.00" "$1,435.00" "$1,076.25" "$1,435.00" "$1,435.00" "$1,435.00" $717.50 $717.50 "$1,136.52" "$1,435.00" "$1,148.00" $645.75 $284.81 "$1,435.00" $832.30 "$1,435.00" "$1,435.00" "$1,435.00" $299.05 "$1,435.00" N/A N/A 27803098 EAP HCPCS C1880 80078352 - FILTER OPTION IVC BOTH IP/OP "$1,429.00" "$1,057.50" $297.82 "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" $297.82 "$1,429.00" $571.60 "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,071.75" "$1,429.00" "$1,429.00" "$1,429.00" $714.50 $714.50 "$1,131.77" "$1,429.00" "$1,143.20" $643.05 "$1,429.00" "$1,429.00" $828.82 "$1,429.00" $857.40 "$1,429.00" "$1,429.00" "$1,429.00" N/A N/A 27803099 EAP HCPCS A4301 FEMORAL ARTERIAL LINE KIT BOTH IP/OP $972.00 $719.50 $202.58 $972.00 $972.00 $972.00 $972.00 $972.00 $972.00 $972.00 $972.00 $972.00 $972.00 $972.00 $972.00 $972.00 $972.00 $202.58 $972.00 $388.80 $972.00 $972.00 $972.00 $972.00 $972.00 $729.00 $972.00 $972.00 $972.00 $486.00 $486.00 $769.82 $972.00 $777.60 $437.40 $972.00 $972.00 $563.76 $972.00 $583.20 $972.00 $972.00 $972.00 N/A N/A 27803100 EAP HCPCS C2625 RX STENT 7X5 CM BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $72.45 $72.45 $72.45 $72.45 $161.00 $161.00 $161.00 $33.56 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27803101 EAP HCPCS C2625 RX STENT 7X7 CM BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $72.45 $72.45 $72.45 $72.45 $161.00 $161.00 $161.00 $33.56 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27803102 EAP HCPCS C2625 RX STENT 7X10 CM BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $72.45 $72.45 $72.45 $72.45 $161.00 $161.00 $161.00 $33.56 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27803103 EAP HCPCS C2625 RX STENT 7X12 CM BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $72.45 $72.45 $72.45 $72.45 $161.00 $161.00 $161.00 $33.56 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27803104 EAP HCPCS C2625 RX STENT 10X5 BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $72.45 $72.45 $72.45 $72.45 $161.00 $161.00 $161.00 $33.56 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27803105 EAP HCPCS C2625 RX STENT 10X7CM BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $72.45 $72.45 $72.45 $72.45 $161.00 $161.00 $161.00 $33.56 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27803106 EAP HCPCS C2625 RX STENT 10X10 CM BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $72.45 $72.45 $72.45 $72.45 $161.00 $161.00 $161.00 $33.56 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27803107 EAP HCPCS C2625 RX STENT 10X12 CM BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $72.45 $72.45 $72.45 $72.45 $161.00 $161.00 $161.00 $33.56 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27803108 EAP HCPCS C2625 RX STENT 8.5 X5 CM BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $72.45 $72.45 $72.45 $72.45 $161.00 $161.00 $161.00 $33.56 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27803109 EAP HCPCS C2625 RX STENT 8.5 X7CM BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $72.45 $72.45 $72.45 $72.45 $161.00 $161.00 $161.00 $33.56 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27803110 EAP HCPCS C2625 RX STENT 8.5 X 10CM BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $72.45 $72.45 $72.45 $72.45 $161.00 $161.00 $161.00 $33.56 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27803111 EAP HCPCS C2625 RX STENT 8.5X12 CM BOTH IP/OP $161.00 $119.50 $31.95 $161.00 $72.45 $72.45 $72.45 $72.45 $161.00 $161.00 $161.00 $33.56 $161.00 $161.00 $161.00 $161.00 $161.00 $33.55 $161.00 $161.00 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $31.95 $161.00 $93.38 $161.00 $161.00 $161.00 $33.55 $161.00 N/A N/A 27803152 EAP HCPCS C1760 STARCLOSE SE BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $129.60 $129.60 $129.60 $129.60 $288.00 $288.00 $288.00 $60.03 $288.00 $288.00 $288.00 $288.00 $288.00 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $129.60 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 27803160 EAP HCPCS C2625 3.0 XMM VISION RX STENT BOTH IP/OP "$4,987.00" "$3,690.50" $989.79 "$4,987.00" "$2,244.15" "$2,244.15" "$2,244.15" "$2,244.15" "$4,987.00" "$4,987.00" "$4,987.00" "$1,039.42" "$4,987.00" "$4,987.00" "$4,987.00" "$4,987.00" "$4,987.00" "$1,039.35" "$4,987.00" "$4,987.00" "$2,458.59" "$4,987.00" "$4,987.00" "$4,987.00" "$4,987.00" "$3,740.25" "$4,987.00" "$4,987.00" "$4,987.00" "$2,493.50" "$2,493.50" "$3,949.70" "$4,987.00" "$3,989.60" "$2,244.15" $989.79 "$4,987.00" "$2,892.46" "$4,987.00" "$4,987.00" "$4,987.00" "$1,039.29" "$4,987.00" N/A N/A 27803161 EAP HCPCS C2625 2.50 X 8MM MINI-VISION STENT BOTH IP/OP "$4,987.00" "$3,690.50" $989.79 "$4,987.00" "$2,244.15" "$2,244.15" "$2,244.15" "$2,244.15" "$4,987.00" "$4,987.00" "$4,987.00" "$1,039.42" "$4,987.00" "$4,987.00" "$4,987.00" "$4,987.00" "$4,987.00" "$1,039.35" "$4,987.00" "$4,987.00" "$2,458.59" "$4,987.00" "$4,987.00" "$4,987.00" "$4,987.00" "$3,740.25" "$4,987.00" "$4,987.00" "$4,987.00" "$2,493.50" "$2,493.50" "$3,949.70" "$4,987.00" "$3,989.60" "$2,244.15" $989.79 "$4,987.00" "$2,892.46" "$4,987.00" "$4,987.00" "$4,987.00" "$1,039.29" "$4,987.00" N/A N/A 27803162 EAP Custom 27803162 LC BEAD 500-700 BOTH IP/OP "$4,654.00" "$3,444.00" $828.41 "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" $828.41 "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" $969.94 "$4,654.00" "$1,861.60" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$3,490.50" "$4,654.00" "$4,654.00" "$4,654.00" "$2,327.00" "$2,327.00" "$3,685.97" "$4,654.00" "$3,723.20" "$2,094.30" "$4,654.00" "$4,654.00" "$2,699.32" "$4,654.00" "$2,792.40" "$4,654.00" "$4,654.00" "$4,654.00" N/A N/A 27803163 EAP Custom 27803163 LC BEAD 300-500 BOTH IP/OP "$4,654.00" "$3,444.00" $828.41 "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" $828.41 "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" $969.94 "$4,654.00" "$1,861.60" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$4,654.00" "$3,490.50" "$4,654.00" "$4,654.00" "$4,654.00" "$2,327.00" "$2,327.00" "$3,685.97" "$4,654.00" "$3,723.20" "$2,094.30" "$4,654.00" "$4,654.00" "$2,699.32" "$4,654.00" "$2,792.40" "$4,654.00" "$4,654.00" "$4,654.00" N/A N/A 27803164 EAP HCPCS C1880 80078352 - FILTER OPTION IVC BOTH IP/OP "$1,429.00" "$1,057.50" $297.82 "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" $297.82 "$1,429.00" $571.60 "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,071.75" "$1,429.00" "$1,429.00" "$1,429.00" $714.50 $714.50 "$1,131.77" "$1,429.00" "$1,143.20" $643.05 "$1,429.00" "$1,429.00" $828.82 "$1,429.00" $857.40 "$1,429.00" "$1,429.00" "$1,429.00" N/A N/A 27803172 EAP HCPCS C1874 VBH081502 CATHETER VIABAHN 8MM BOTH IP/OP "$5,107.00" "$3,779.50" "$1,013.61" "$5,107.00" "$2,298.15" "$2,298.15" "$2,298.15" "$2,298.15" "$5,107.00" "$5,107.00" "$5,107.00" "$1,064.43" "$5,107.00" "$5,107.00" "$5,107.00" "$5,107.00" "$5,107.00" "$1,064.35" "$5,107.00" "$5,107.00" "$2,517.75" "$5,107.00" "$5,107.00" "$5,107.00" "$5,107.00" "$3,830.25" "$5,107.00" "$5,107.00" "$5,107.00" "$2,553.50" "$2,553.50" "$4,044.74" "$5,107.00" "$4,085.60" "$2,298.15" "$1,013.61" "$5,107.00" "$2,962.06" "$5,107.00" "$5,107.00" "$5,107.00" "$1,064.30" "$5,107.00" N/A N/A 27803173 EAP HCPCS C1874 VBH071502 CATHETER VIABAHN 8MM BOTH IP/OP "$5,107.00" "$3,779.50" "$1,013.61" "$5,107.00" "$2,298.15" "$2,298.15" "$2,298.15" "$2,298.15" "$5,107.00" "$5,107.00" "$5,107.00" "$1,064.43" "$5,107.00" "$5,107.00" "$5,107.00" "$5,107.00" "$5,107.00" "$1,064.35" "$5,107.00" "$5,107.00" "$2,517.75" "$5,107.00" "$5,107.00" "$5,107.00" "$5,107.00" "$3,830.25" "$5,107.00" "$5,107.00" "$5,107.00" "$2,553.50" "$2,553.50" "$4,044.74" "$5,107.00" "$4,085.60" "$2,298.15" "$1,013.61" "$5,107.00" "$2,962.06" "$5,107.00" "$3,064.20" "$5,107.00" "$1,064.30" "$5,107.00" N/A N/A 27803184 EAP HCPCS C1894 9FR-30 TEAR-AWAY INTRODUCER BOTH IP/OP $579.00 $428.50 $114.92 $579.00 $260.55 $260.55 $260.55 $260.55 $579.00 $579.00 $579.00 $120.68 $579.00 $579.00 $579.00 $579.00 $579.00 $120.67 $579.00 $579.00 $342.48 $579.00 $579.00 $579.00 $579.00 $434.25 $579.00 $579.00 $579.00 $289.50 $289.50 $458.57 $579.00 $463.20 $260.55 $114.92 $579.00 $335.82 $579.00 $347.40 $579.00 $120.66 $579.00 N/A N/A 27803185 EAP HCPCS C1894 10FR-30CM TEAR AWAY INTRODUCER BOTH IP/OP $579.00 $428.50 $114.92 $579.00 $260.55 $260.55 $260.55 $260.55 $579.00 $579.00 $579.00 $120.68 $579.00 $579.00 $579.00 $579.00 $579.00 $120.67 $579.00 $579.00 $342.48 $579.00 $579.00 $579.00 $579.00 $434.25 $579.00 $579.00 $579.00 $289.50 $289.50 $458.57 $579.00 $463.20 $260.55 $114.92 $579.00 $335.82 $579.00 $579.00 $579.00 $120.66 $579.00 N/A N/A 27803186 EAP HCPCS C1894 16FR-3OCM TEAR-AWAY INTRODUCER BOTH IP/OP $579.00 $428.50 $114.92 $579.00 $260.55 $260.55 $260.55 $260.55 $579.00 $579.00 $579.00 $120.68 $579.00 $579.00 $579.00 $579.00 $579.00 $120.67 $579.00 $579.00 $342.48 $579.00 $579.00 $579.00 $579.00 $434.25 $579.00 $579.00 $579.00 $289.50 $289.50 $458.57 $579.00 $463.20 $260.55 $114.92 $579.00 $335.82 $579.00 $579.00 $579.00 $120.66 $579.00 N/A N/A 27803187 EAP HCPCS C1769 WIRE GUIDE LUNDERQUIST EXTRA S BOTH IP/OP $347.00 $257.00 $68.87 $347.00 $156.15 $156.15 $156.15 $156.15 $347.00 $347.00 $347.00 $72.32 $347.00 $347.00 $347.00 $347.00 $347.00 $72.32 $347.00 $347.00 $205.25 $347.00 $347.00 $347.00 $347.00 $260.25 $347.00 $347.00 $347.00 $173.50 $173.50 $274.82 $347.00 $277.60 $156.15 $68.87 $347.00 $201.26 $347.00 $347.00 $347.00 $72.31 $347.00 N/A N/A 27803188 EAP HCPCS C1894 SHEATH PRELUDE BOTH IP/OP $277.00 $205.00 $54.98 $277.00 $124.65 $124.65 $124.65 $124.65 $277.00 $277.00 $277.00 $57.73 $277.00 $277.00 $277.00 $277.00 $277.00 $57.73 $277.00 $277.00 $163.85 $277.00 $277.00 $277.00 $277.00 $207.75 $277.00 $277.00 $277.00 $138.50 $138.50 $219.38 $277.00 $221.60 $124.65 $54.98 $277.00 $160.66 $277.00 $166.20 $277.00 $57.73 $277.00 N/A N/A 27803189 EAP HCPCS C2625 3.0 X 8MM VISION RX STENT BOTH IP/OP "$2,920.00" "$2,161.00" $579.55 "$2,920.00" "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.60 "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" $608.56 "$2,920.00" "$2,920.00" "$1,439.56" "$2,920.00" "$2,920.00" "$2,920.00" "$2,920.00" "$2,190.00" "$2,920.00" "$2,920.00" "$2,920.00" "$1,460.00" "$1,460.00" "$2,312.64" "$2,920.00" "$2,336.00" "$1,314.00" $579.55 "$2,920.00" "$1,693.60" "$2,920.00" "$2,920.00" "$2,920.00" $608.53 "$2,920.00" N/A N/A 27803190 EAP HCPCS C2625 2.50 X 8MM MINI-VISION STENT BOTH IP/OP "$3,836.00" "$2,839.00" $761.35 "$3,836.00" "$1,726.20" "$1,726.20" "$1,726.20" "$1,726.20" "$3,836.00" "$3,836.00" "$3,836.00" $799.52 "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" $799.46 "$3,836.00" "$3,836.00" "$1,891.15" "$3,836.00" "$3,836.00" "$3,836.00" "$3,836.00" "$2,877.00" "$3,836.00" "$3,836.00" "$3,836.00" "$1,918.00" "$1,918.00" "$3,038.11" "$3,836.00" "$3,068.80" "$1,726.20" $761.35 "$3,836.00" "$2,224.88" "$3,836.00" "$3,836.00" "$3,836.00" $799.42 "$3,836.00" N/A N/A 27803191 EAP Custom 27803191 LC BEAD 500-700 BOTH IP/OP "$1,335.00" $988.00 $237.63 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $237.63 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 "$1,335.00" "$1,335.00" $774.30 "$1,335.00" $801.00 "$1,335.00" "$1,335.00" "$1,335.00" N/A N/A 27803192 EAP HCPCS C1876 STENT MICRODELIVE WINGSPAN 4 1 BOTH IP/OP "$20,400.00" "$15,096.00" "$4,048.89" "$20,400.00" "$9,180.00" "$9,180.00" "$9,180.00" "$9,180.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.87" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$20,400.00" "$10,057.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$4,048.89" "$20,400.00" "$11,832.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.36" "$20,400.00" N/A N/A 27803193 EAP HCPCS C1876 STENT MICRODELIVE WINGSPAN 4 2 BOTH IP/OP "$20,400.00" "$15,096.00" "$4,048.89" "$20,400.00" "$9,180.00" "$9,180.00" "$9,180.00" "$9,180.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.87" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$20,400.00" "$10,057.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$4,048.89" "$20,400.00" "$11,832.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.36" "$20,400.00" N/A N/A 27803194 EAP HCPCS C1876 STENT MICRODELIVE WINGSPAN 3 1 BOTH IP/OP "$20,400.00" "$15,096.00" "$4,048.89" "$20,400.00" "$9,180.00" "$9,180.00" "$9,180.00" "$9,180.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.87" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$20,400.00" "$10,057.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$4,048.89" "$20,400.00" "$11,832.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.36" "$20,400.00" N/A N/A 27803195 EAP HCPCS C1876 STENT MICRODELIVE WINGSPAN 3 2 BOTH IP/OP "$20,400.00" "$15,096.00" "$4,048.89" "$20,400.00" "$9,180.00" "$9,180.00" "$9,180.00" "$9,180.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.87" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$20,400.00" "$10,057.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$4,048.89" "$20,400.00" "$11,832.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.36" "$20,400.00" N/A N/A 27803196 EAP HCPCS C1876 STENT MICRODELIVERY 3.0 X 15.0 BOTH IP/OP "$20,400.00" "$15,096.00" "$4,048.89" "$20,400.00" "$9,180.00" "$9,180.00" "$9,180.00" "$9,180.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.87" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$20,400.00" "$10,057.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$4,048.89" "$20,400.00" "$11,832.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.36" "$20,400.00" N/A N/A 27803197 EAP HCPCS C1876 STENT MICRODELIVE WINGSPAN 3 3 BOTH IP/OP "$20,400.00" "$15,096.00" "$4,048.89" "$20,400.00" "$9,180.00" "$9,180.00" "$9,180.00" "$9,180.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.87" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$20,400.00" "$10,057.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$4,048.89" "$20,400.00" "$11,832.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.36" "$20,400.00" N/A N/A 27803198 EAP HCPCS C1876 STENT MICRODELIVERY WINGSPAN BOTH IP/OP "$20,400.00" "$15,096.00" "$4,048.89" "$20,400.00" "$9,180.00" "$9,180.00" "$9,180.00" "$9,180.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.87" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$20,400.00" "$10,057.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$4,048.89" "$20,400.00" "$11,832.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.36" "$20,400.00" N/A N/A 27803199 EAP HCPCS C1876 STENT MIRCRODELIVERY WINGSPAN2 BOTH IP/OP "$20,400.00" "$15,096.00" "$4,048.89" "$20,400.00" "$9,180.00" "$9,180.00" "$9,180.00" "$9,180.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.87" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$20,400.00" "$10,057.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$4,048.89" "$20,400.00" "$11,832.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.36" "$20,400.00" N/A N/A 27803200 EAP HCPCS C1876 STENT MICRODELIVERY 4.5X30MM BOTH IP/OP "$19,181.00" "$14,194.00" "$3,806.95" "$19,181.00" "$8,631.45" "$8,631.45" "$8,631.45" "$8,631.45" "$19,181.00" "$19,181.00" "$19,181.00" "$3,997.80" "$19,181.00" "$19,181.00" "$19,181.00" "$19,181.00" "$19,181.00" "$3,997.53" "$19,181.00" "$19,181.00" "$9,456.23" "$19,181.00" "$19,181.00" "$19,181.00" "$19,181.00" "$14,385.75" "$19,181.00" "$19,181.00" "$19,181.00" "$9,590.50" "$9,590.50" "$15,191.35" "$19,181.00" "$15,344.80" "$8,631.45" "$3,806.95" "$19,181.00" "$11,124.98" "$19,181.00" "$11,508.60" "$19,181.00" "$3,997.32" "$19,181.00" N/A N/A 27803201 EAP HCPCS C1876 STENT MICRODELIVERY 4.5X20MM BOTH IP/OP "$19,181.00" "$14,194.00" "$3,806.95" "$19,181.00" "$8,631.45" "$8,631.45" "$8,631.45" "$8,631.45" "$19,181.00" "$19,181.00" "$19,181.00" "$3,997.80" "$19,181.00" "$19,181.00" "$19,181.00" "$19,181.00" "$19,181.00" "$3,997.53" "$19,181.00" "$19,181.00" "$9,456.23" "$19,181.00" "$19,181.00" "$19,181.00" "$19,181.00" "$14,385.75" "$19,181.00" "$19,181.00" "$19,181.00" "$9,590.50" "$9,590.50" "$15,191.35" "$19,181.00" "$15,344.80" "$8,631.45" "$3,806.95" "$19,181.00" "$11,124.98" "$19,181.00" "$19,181.00" "$19,181.00" "$3,997.32" "$19,181.00" N/A N/A 27803202 EAP HCPCS C1876 STENT MICRDELIVERY 4.0 X20MM BOTH IP/OP "$19,181.00" "$14,194.00" "$3,806.95" "$19,181.00" "$8,631.45" "$8,631.45" "$8,631.45" "$8,631.45" "$19,181.00" "$19,181.00" "$19,181.00" "$3,997.80" "$19,181.00" "$19,181.00" "$19,181.00" "$19,181.00" "$19,181.00" "$3,997.53" "$19,181.00" "$19,181.00" "$9,456.23" "$19,181.00" "$19,181.00" "$19,181.00" "$19,181.00" "$14,385.75" "$19,181.00" "$19,181.00" "$19,181.00" "$9,590.50" "$9,590.50" "$15,191.35" "$19,181.00" "$15,344.80" "$8,631.45" "$3,806.95" "$19,181.00" "$11,124.98" "$19,181.00" "$11,508.60" "$19,181.00" "$3,997.32" "$19,181.00" N/A N/A 27803203 EAP HCPCS C1876 STENT MICRODELIVERY 3.5X20MM BOTH IP/OP "$19,181.00" "$14,194.00" "$3,806.95" "$19,181.00" "$8,631.45" "$8,631.45" "$8,631.45" "$8,631.45" "$19,181.00" "$19,181.00" "$19,181.00" "$3,997.80" "$19,181.00" "$19,181.00" "$19,181.00" "$19,181.00" "$19,181.00" "$3,997.53" "$19,181.00" "$19,181.00" "$9,456.23" "$19,181.00" "$19,181.00" "$19,181.00" "$19,181.00" "$14,385.75" "$19,181.00" "$19,181.00" "$19,181.00" "$9,590.50" "$9,590.50" "$15,191.35" "$19,181.00" "$15,344.80" "$8,631.45" "$3,806.95" "$19,181.00" "$11,124.98" "$19,181.00" "$19,181.00" "$19,181.00" "$3,997.32" "$19,181.00" N/A N/A 27803204 EAP HCPCS C1876 NEUROFORM ATLAS STENT SYSTEM BOTH IP/OP "$17,038.00" "$12,608.50" "$3,381.62" "$17,038.00" "$7,667.10" "$7,667.10" "$7,667.10" "$7,667.10" "$17,038.00" "$17,038.00" "$17,038.00" "$3,551.15" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$3,550.91" "$17,038.00" "$17,038.00" "$8,399.73" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$12,778.50" "$17,038.00" "$17,038.00" "$17,038.00" "$8,519.00" "$8,519.00" "$13,494.10" "$17,038.00" "$13,630.40" "$7,667.10" "$3,381.62" "$17,038.00" "$9,882.04" "$17,038.00" "$17,038.00" "$17,038.00" "$3,550.72" "$17,038.00" N/A N/A 27803205 EAP Custom 27803205 COIL TORNADO 5/3 .036 BOTH IP/OP $298.00 $221.00 $53.04 $298.00 $298.00 $298.00 $298.00 $298.00 $298.00 $298.00 $53.04 $298.00 $298.00 $298.00 $298.00 $298.00 $298.00 $62.11 $298.00 $119.20 $298.00 $298.00 $298.00 $298.00 $298.00 $223.50 $298.00 $298.00 $298.00 $149.00 $149.00 $236.02 $298.00 $238.40 $134.10 $298.00 $298.00 $172.84 $298.00 $178.80 $298.00 $298.00 $298.00 N/A N/A 27803206 EAP Custom 27803206 COIL TORNADO 4/3 .035 BOTH IP/OP $298.00 $221.00 $53.04 $298.00 $298.00 $298.00 $298.00 $298.00 $298.00 $298.00 $53.04 $298.00 $298.00 $298.00 $298.00 $298.00 $298.00 $62.11 $298.00 $119.20 $298.00 $298.00 $298.00 $298.00 $298.00 $223.50 $298.00 $298.00 $298.00 $149.00 $149.00 $236.02 $298.00 $238.40 $134.10 $298.00 $298.00 $172.84 $298.00 $178.80 $298.00 $298.00 $298.00 N/A N/A 27803207 EAP HCPCS C1874 CATH.VIABAHN 8MM X 15CM 1 BOTH IP/OP "$5,107.00" "$3,779.50" "$1,013.61" "$5,107.00" "$2,298.15" "$2,298.15" "$2,298.15" "$2,298.15" "$5,107.00" "$5,107.00" "$5,107.00" "$1,064.43" "$5,107.00" "$5,107.00" "$5,107.00" "$5,107.00" "$5,107.00" "$1,064.35" "$5,107.00" "$5,107.00" "$2,517.75" "$5,107.00" "$5,107.00" "$5,107.00" "$5,107.00" "$3,830.25" "$5,107.00" "$5,107.00" "$5,107.00" "$2,553.50" "$2,553.50" "$4,044.74" "$5,107.00" "$4,085.60" "$2,298.15" "$1,013.61" "$5,107.00" "$2,962.06" "$5,107.00" "$5,107.00" "$5,107.00" "$1,064.30" "$5,107.00" N/A N/A 27803208 EAP HCPCS C1874 CATH.VIABAHN 8MM X 15CM 2 BOTH IP/OP "$5,107.00" "$3,779.50" "$1,013.61" "$5,107.00" "$2,298.15" "$2,298.15" "$2,298.15" "$2,298.15" "$5,107.00" "$5,107.00" "$5,107.00" "$1,064.43" "$5,107.00" "$5,107.00" "$5,107.00" "$5,107.00" "$5,107.00" "$1,064.35" "$5,107.00" "$5,107.00" "$2,517.75" "$5,107.00" "$5,107.00" "$5,107.00" "$5,107.00" "$3,830.25" "$5,107.00" "$5,107.00" "$5,107.00" "$2,553.50" "$2,553.50" "$4,044.74" "$5,107.00" "$4,085.60" "$2,298.15" "$1,013.61" "$5,107.00" "$2,962.06" "$5,107.00" "$3,064.20" "$5,107.00" "$1,064.30" "$5,107.00" N/A N/A 27803209 EAP HCPCS C1876 MICROCATHETER ENTERPRISE 4.5X3 BOTH IP/OP "$17,347.00" "$12,837.00" "$3,442.95" "$17,347.00" "$7,806.15" "$7,806.15" "$7,806.15" "$7,806.15" "$17,347.00" "$17,347.00" "$17,347.00" "$3,615.55" "$17,347.00" "$17,347.00" "$17,347.00" "$17,347.00" "$17,347.00" "$3,615.31" "$17,347.00" "$17,347.00" "$8,552.07" "$17,347.00" "$17,347.00" "$17,347.00" "$17,347.00" "$13,010.25" "$17,347.00" "$17,347.00" "$17,347.00" "$8,673.50" "$8,673.50" "$13,738.82" "$17,347.00" "$13,877.60" "$7,806.15" "$3,442.95" "$17,347.00" "$10,061.26" "$17,347.00" "$17,347.00" "$17,347.00" "$3,615.11" "$17,347.00" N/A N/A 27803210 EAP HCPCS C1876 MICROCATH.ENTERPRISE 4.5X2 1 BOTH IP/OP "$17,347.00" "$12,837.00" "$3,442.95" "$17,347.00" "$7,806.15" "$7,806.15" "$7,806.15" "$7,806.15" "$17,347.00" "$17,347.00" "$17,347.00" "$3,615.55" "$17,347.00" "$17,347.00" "$17,347.00" "$17,347.00" "$17,347.00" "$3,615.31" "$17,347.00" "$17,347.00" "$8,552.07" "$17,347.00" "$17,347.00" "$17,347.00" "$17,347.00" "$13,010.25" "$17,347.00" "$17,347.00" "$17,347.00" "$8,673.50" "$8,673.50" "$13,738.82" "$17,347.00" "$13,877.60" "$7,806.15" "$3,442.95" "$17,347.00" "$10,061.26" "$17,347.00" "$17,347.00" "$17,347.00" "$3,615.11" "$17,347.00" N/A N/A 27803211 EAP HCPCS C1876 MICROCATH.ENTERPRISE 4.5X2 2 BOTH IP/OP "$17,347.00" "$12,837.00" "$3,442.95" "$17,347.00" "$7,806.15" "$7,806.15" "$7,806.15" "$7,806.15" "$17,347.00" "$17,347.00" "$17,347.00" "$3,615.55" "$17,347.00" "$17,347.00" "$17,347.00" "$17,347.00" "$17,347.00" "$3,615.31" "$17,347.00" "$17,347.00" "$8,552.07" "$17,347.00" "$17,347.00" "$17,347.00" "$17,347.00" "$13,010.25" "$17,347.00" "$17,347.00" "$17,347.00" "$8,673.50" "$8,673.50" "$13,738.82" "$17,347.00" "$13,877.60" "$7,806.15" "$3,442.95" "$17,347.00" "$10,061.26" "$17,347.00" "$17,347.00" "$17,347.00" "$3,615.11" "$17,347.00" N/A N/A 27803212 EAP HCPCS C1876 STENT ICAST 6MM X 22MM BOTH IP/OP "$8,391.00" "$6,209.50" "$1,665.40" "$8,391.00" "$3,775.95" "$3,775.95" "$3,775.95" "$3,775.95" "$8,391.00" "$8,391.00" "$8,391.00" "$1,748.89" "$8,391.00" "$8,391.00" "$8,391.00" "$8,391.00" "$8,391.00" "$1,748.78" "$8,391.00" "$8,391.00" "$4,136.76" "$8,391.00" "$8,391.00" "$8,391.00" "$8,391.00" "$6,293.25" "$8,391.00" "$8,391.00" "$8,391.00" "$4,195.50" "$4,195.50" "$6,645.67" "$8,391.00" "$6,712.80" "$3,775.95" "$1,665.40" "$8,391.00" "$4,866.78" "$8,391.00" "$8,391.00" "$8,391.00" "$1,748.68" "$8,391.00" N/A N/A 27803213 EAP HCPCS C1876 STENT CAROT PROTEGE RX 40X13 1 BOTH IP/OP "$2,941.00" "$2,176.50" $583.71 "$2,941.00" "$1,323.45" "$1,323.45" "$1,323.45" "$1,323.45" "$2,941.00" "$2,941.00" "$2,941.00" $612.98 "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" $612.94 "$2,941.00" "$2,941.00" "$1,449.91" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,205.75" "$2,941.00" "$2,941.00" "$2,941.00" "$1,470.50" "$1,470.50" "$2,329.27" "$2,941.00" "$2,352.80" "$1,323.45" $583.71 "$2,941.00" "$1,705.78" "$2,941.00" "$2,941.00" "$2,941.00" $612.90 "$2,941.00" N/A N/A 27803214 EAP HCPCS C1876 STENT CAROTID PROTEGE RX 30X13 BOTH IP/OP "$6,843.00" "$5,064.00" "$1,358.16" "$6,843.00" "$3,079.35" "$3,079.35" "$3,079.35" "$3,079.35" "$6,843.00" "$6,843.00" "$6,843.00" "$1,426.25" "$6,843.00" "$6,843.00" "$6,843.00" "$6,843.00" "$6,843.00" "$1,426.16" "$6,843.00" "$6,843.00" "$3,373.60" "$6,843.00" "$6,843.00" "$6,843.00" "$6,843.00" "$5,132.25" "$6,843.00" "$6,843.00" "$6,843.00" "$3,421.50" "$3,421.50" "$5,419.66" "$6,843.00" "$5,474.40" "$3,079.35" "$1,358.16" "$6,843.00" "$3,968.94" "$6,843.00" "$6,843.00" "$6,843.00" "$1,426.08" "$6,843.00" N/A N/A 27803215 EAP HCPCS C1876 STENT CAROT PROTEGE RX 40X13 2 BOTH IP/OP "$2,941.00" "$2,176.50" $583.71 "$2,941.00" "$1,323.45" "$1,323.45" "$1,323.45" "$1,323.45" "$2,941.00" "$2,941.00" "$2,941.00" $612.98 "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" $612.94 "$2,941.00" "$2,941.00" "$1,449.91" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,205.75" "$2,941.00" "$2,941.00" "$2,941.00" "$1,470.50" "$1,470.50" "$2,329.27" "$2,941.00" "$2,352.80" "$1,323.45" $583.71 "$2,941.00" "$1,705.78" "$2,941.00" "$2,941.00" "$2,941.00" $612.90 "$2,941.00" N/A N/A 27803216 EAP HCPCS C1876 STENT CAROTID PROTEGE RX BOTH IP/OP "$6,843.00" "$5,064.00" "$1,358.16" "$6,843.00" "$3,079.35" "$3,079.35" "$3,079.35" "$3,079.35" "$6,843.00" "$6,843.00" "$6,843.00" "$1,426.25" "$6,843.00" "$6,843.00" "$6,843.00" "$6,843.00" "$6,843.00" "$1,426.16" "$6,843.00" "$6,843.00" "$3,373.60" "$6,843.00" "$6,843.00" "$6,843.00" "$6,843.00" "$5,132.25" "$6,843.00" "$6,843.00" "$6,843.00" "$3,421.50" "$3,421.50" "$5,419.66" "$6,843.00" "$5,474.40" "$3,079.35" "$1,358.16" "$6,843.00" "$3,968.94" "$6,843.00" "$6,843.00" "$6,843.00" "$1,426.08" "$6,843.00" N/A N/A 27803217 EAP HCPCS C1760 SPH100250-20 MICROCOIL PLATINU BOTH IP/OP "$3,169.00" "$2,345.50" $628.97 "$3,169.00" "$1,426.05" "$1,426.05" "$1,426.05" "$1,426.05" "$3,169.00" "$3,169.00" "$3,169.00" $660.50 "$3,169.00" "$3,169.00" "$3,169.00" "$3,169.00" "$3,169.00" $660.45 "$3,169.00" "$3,169.00" "$1,562.32" "$3,169.00" "$3,169.00" "$3,169.00" "$3,169.00" "$2,376.75" "$3,169.00" "$3,169.00" "$3,169.00" "$1,584.50" "$1,584.50" "$2,509.85" "$3,169.00" "$2,535.20" "$1,426.05" $628.97 "$3,169.00" "$1,838.02" "$3,169.00" "$3,169.00" "$3,169.00" $660.42 "$3,169.00" N/A N/A 27803218 EAP HCPCS C1726 SPH100300-20 MICROCOIL PLATINU BOTH IP/OP "$3,186.00" "$2,358.00" $632.34 "$3,186.00" "$1,433.70" "$1,433.70" "$1,433.70" "$1,433.70" "$3,186.00" "$3,186.00" "$3,186.00" $664.04 "$3,186.00" "$3,186.00" "$3,186.00" "$3,186.00" "$3,186.00" $664.00 "$3,186.00" "$3,186.00" "$1,570.70" "$3,186.00" "$3,186.00" "$3,186.00" "$3,186.00" "$2,389.50" "$3,186.00" "$3,186.00" "$3,186.00" "$1,593.00" "$1,593.00" "$2,523.31" "$3,186.00" "$2,548.80" "$1,433.70" $632.34 "$3,186.00" "$1,847.88" "$3,186.00" "$3,186.00" "$3,186.00" $663.96 "$3,186.00" N/A N/A 27803219 EAP HCPCS C1894 SPH100350-20 MICROCOIL PLATINU BOTH IP/OP "$3,198.00" "$2,367.00" $634.72 "$3,198.00" "$1,439.10" "$1,439.10" "$1,439.10" "$1,439.10" "$3,198.00" "$3,198.00" "$3,198.00" $666.54 "$3,198.00" "$3,198.00" "$3,198.00" "$3,198.00" "$3,198.00" $666.50 "$3,198.00" "$3,198.00" "$1,576.61" "$3,198.00" "$3,198.00" "$3,198.00" "$3,198.00" "$2,398.50" "$3,198.00" "$3,198.00" "$3,198.00" "$1,599.00" "$1,599.00" "$2,532.82" "$3,198.00" "$2,558.40" "$1,439.10" $634.72 "$3,198.00" "$1,854.84" "$3,198.00" "$3,198.00" "$3,198.00" $666.46 "$3,198.00" N/A N/A 27803220 EAP HCPCS C1769 WIRE GUIDE LUNDERQUIST EXTRA S BOTH IP/OP $28.00 $21.00 $5.56 $28.00 $12.60 $12.60 $12.60 $12.60 $28.00 $28.00 $28.00 $5.84 $28.00 $28.00 $28.00 $28.00 $28.00 $5.84 $28.00 $28.00 $16.56 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $12.60 $5.56 $28.00 $16.24 $28.00 $28.00 $28.00 $5.84 $28.00 N/A N/A 27803221 EAP HCPCS C1894 PRELUDE SHEATH BOTH IP/OP $43.00 $32.00 $8.53 $43.00 $23.35 $23.35 $23.35 $23.35 $43.00 $43.00 $43.00 $8.96 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $43.00 $25.43 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $8.53 $43.00 $24.94 $43.00 $43.00 $43.00 $8.96 $43.00 N/A N/A 27803230 EAP HCPCS C1729 10.2FR 22CM NEPHROURETEROSTOM BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 $350.00 $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A 27803232 EAP HCPCS C1892 16FR CHECK-FLO SHEATH 30CM RAD BOTH IP/OP $378.00 $280.00 $75.02 $378.00 $170.10 $170.10 $170.10 $170.10 $378.00 $378.00 $378.00 $78.78 $378.00 $378.00 $378.00 $378.00 $378.00 $78.78 $378.00 $378.00 $223.59 $378.00 $378.00 $378.00 $378.00 $283.50 $378.00 $378.00 $378.00 $189.00 $189.00 $299.38 $378.00 $302.40 $170.10 $75.02 $378.00 $219.24 $378.00 $226.80 $378.00 $78.78 $378.00 N/A N/A 27803233 EAP HCPCS C1751 5FR/65CM MPA CATHETER BOTH IP/OP $312.00 $231.00 $61.92 $312.00 $140.40 $140.40 $140.40 $140.40 $312.00 $312.00 $312.00 $65.03 $312.00 $312.00 $312.00 $312.00 $312.00 $65.02 $312.00 $312.00 $184.55 $312.00 $312.00 $312.00 $312.00 $234.00 $312.00 $312.00 $312.00 $156.00 $156.00 $247.10 $312.00 $249.60 $140.40 $61.92 $312.00 $180.96 $312.00 $312.00 $312.00 $65.02 $312.00 N/A N/A 27803234 EAP HCPCS C1892 7FR TEAR-AWAY INTRODUCER BOTH IP/OP $462.00 $342.00 $91.70 $462.00 $207.90 $207.90 $207.90 $207.90 $462.00 $462.00 $462.00 $96.29 $462.00 $462.00 $462.00 $462.00 $462.00 $96.29 $462.00 $462.00 $273.27 $462.00 $462.00 $462.00 $462.00 $346.50 $462.00 $462.00 $462.00 $231.00 $231.00 $365.90 $462.00 $369.60 $207.90 $91.70 $462.00 $267.96 $462.00 $462.00 $462.00 $96.28 $462.00 N/A N/A 27803235 EAP HCPCS C1874 8X60 LUMINEXX STENT BOTH IP/OP "$4,186.00" "$3,098.00" $830.82 "$4,186.00" "$1,883.70" "$1,883.70" "$1,883.70" "$1,883.70" "$4,186.00" "$4,186.00" "$4,186.00" $872.47 "$4,186.00" "$4,186.00" "$4,186.00" "$4,186.00" "$4,186.00" $872.41 "$4,186.00" "$4,186.00" "$2,063.70" "$4,186.00" "$4,186.00" "$4,186.00" "$4,186.00" "$3,139.50" "$4,186.00" "$4,186.00" "$4,186.00" "$2,093.00" "$2,093.00" "$3,315.31" "$4,186.00" "$3,348.80" "$1,883.70" $830.82 "$4,186.00" "$2,427.88" "$4,186.00" "$2,511.60" "$4,186.00" $872.36 "$4,186.00" N/A N/A 27803237 EAP HCPCS C1726 BALLON CATHER 4-2/5/75 BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 $916.00 $531.28 $916.00 $916.00 $916.00 $190.89 $916.00 N/A N/A 27803238 EAP HCPCS C1726 BALLOON BMQ 10-4/5.8/75 BOTH IP/OP $884.00 $654.50 $175.45 $884.00 $397.80 $397.80 $397.80 $397.80 $884.00 $884.00 $884.00 $184.25 $884.00 $884.00 $884.00 $884.00 $884.00 $184.24 $884.00 $884.00 $522.89 $884.00 $884.00 $884.00 $884.00 $663.00 $884.00 $884.00 $884.00 $442.00 $442.00 $700.13 $884.00 $707.20 $397.80 $175.45 $884.00 $512.72 $884.00 $884.00 $884.00 $184.23 $884.00 N/A N/A 27803239 EAP HCPCS C1726 BALLOON UDT 4-10/5/75 BOTH IP/OP $681.00 $504.00 $135.16 $681.00 $306.45 $306.45 $306.45 $306.45 $681.00 $681.00 $681.00 $141.94 $681.00 $681.00 $681.00 $681.00 $681.00 $141.93 $681.00 $681.00 $402.81 $681.00 $681.00 $681.00 $681.00 $510.75 $681.00 $681.00 $681.00 $340.50 $340.50 $539.35 $681.00 $544.80 $306.45 $135.16 $681.00 $394.98 $681.00 $408.60 $681.00 $141.92 $681.00 N/A N/A 27803240 EAP HCPCS C1726 BALLOON UDT 5-10/5/75 BOTH IP/OP $681.00 $504.00 $135.16 $681.00 $306.45 $306.45 $306.45 $306.45 $681.00 $681.00 $681.00 $141.94 $681.00 $681.00 $681.00 $681.00 $681.00 $141.93 $681.00 $681.00 $402.81 $681.00 $681.00 $681.00 $681.00 $510.75 $681.00 $681.00 $681.00 $340.50 $340.50 $539.35 $681.00 $544.80 $306.45 $135.16 $681.00 $394.98 $681.00 $681.00 $681.00 $141.92 $681.00 N/A N/A 27803244 EAP HCPCS C1751 CATH MICRO MC 2.8F 130CM BOTH IP/OP "$1,890.00" "$1,399.00" $375.12 "$1,890.00" $850.50 $850.50 $850.50 $850.50 "$1,890.00" "$1,890.00" "$1,890.00" $393.92 "$1,890.00" "$1,890.00" "$1,890.00" "$1,890.00" "$1,890.00" $393.90 "$1,890.00" "$1,890.00" "$1,117.94" "$1,890.00" "$1,890.00" "$1,890.00" "$1,890.00" "$1,417.50" "$1,890.00" "$1,890.00" "$1,890.00" $945.00 $945.00 "$1,496.88" "$1,890.00" "$1,512.00" $850.50 $375.12 "$1,890.00" "$1,096.20" "$1,890.00" "$1,890.00" "$1,890.00" $393.88 "$1,890.00" N/A N/A 27803245 EAP Custom 27803245 CYTOLOGY BRUSHES 3X120X1.7 BOTH IP/OP $34.00 $25.50 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $6.05 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $15.30 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 27803246 EAP HCPCS C1751 DUAL PICC LINE BOTH IP/OP $307.00 $227.50 $60.93 $307.00 $138.15 $138.15 $138.15 $138.15 $307.00 $307.00 $307.00 $63.99 $307.00 $307.00 $307.00 $307.00 $307.00 $63.98 $307.00 $307.00 $181.59 $307.00 $307.00 $307.00 $307.00 $230.25 $307.00 $307.00 $307.00 $153.50 $153.50 $243.14 $307.00 $245.60 $138.15 $60.93 $307.00 $178.06 $307.00 $307.00 $307.00 $63.98 $307.00 N/A N/A 27803247 EAP Custom 27803247 GASTTOSTOMY (PEG KIT) PULL TYP BOTH IP/OP $271.00 $201.00 $48.24 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $48.24 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $56.48 $271.00 $108.40 $271.00 $271.00 $271.00 $271.00 $271.00 $203.25 $271.00 $271.00 $271.00 $135.50 $135.50 $214.63 $271.00 $216.80 $121.95 $271.00 $271.00 $157.18 $271.00 $162.60 $271.00 $271.00 $271.00 N/A N/A 27803248 EAP Custom 27803248 "GELFOAM, SPONGE" BOTH IP/OP $103.00 $76.50 $18.33 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $18.33 $103.00 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $41.20 $103.00 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $103.00 $103.00 $59.74 $103.00 $61.80 $103.00 $103.00 $103.00 N/A N/A 27803249 EAP HCPCS C1874 IC AST STENT 5MM X 2MM BOTH IP/OP "$8,391.00" "$6,209.50" "$1,665.40" "$8,391.00" "$3,775.95" "$3,775.95" "$3,775.95" "$3,775.95" "$8,391.00" "$8,391.00" "$8,391.00" "$1,748.89" "$8,391.00" "$8,391.00" "$8,391.00" "$8,391.00" "$8,391.00" "$1,748.78" "$8,391.00" "$8,391.00" "$4,136.76" "$8,391.00" "$8,391.00" "$8,391.00" "$8,391.00" "$6,293.25" "$8,391.00" "$8,391.00" "$8,391.00" "$4,195.50" "$4,195.50" "$6,645.67" "$8,391.00" "$6,712.80" "$3,775.95" "$1,665.40" "$8,391.00" "$4,866.78" "$8,391.00" "$5,034.60" "$8,391.00" "$1,748.68" "$8,391.00" N/A N/A 27803250 EAP HCPCS C1721 PARADYM DR DUAL ICD BOTH IP/OP "$55,047.00" "$40,735.00" "$11,472.40" "$55,047.00" "$55,047.00" "$55,047.00" "$55,047.00" "$55,047.00" "$55,047.00" "$55,047.00" "$55,047.00" "$55,047.00" "$55,047.00" "$55,047.00" "$55,047.00" "$55,047.00" "$55,047.00" "$11,472.40" "$55,047.00" "$22,018.80" "$55,047.00" "$55,047.00" "$55,047.00" "$55,047.00" "$55,047.00" "$41,285.25" "$55,047.00" "$55,047.00" "$55,047.00" "$27,523.50" "$27,523.50" "$43,597.22" "$55,047.00" "$44,037.60" "$24,771.15" "$55,047.00" "$55,047.00" "$31,927.26" "$55,047.00" "$33,028.20" "$55,047.00" "$55,047.00" "$55,047.00" N/A N/A 27803251 EAP HCPCS C1722 PARADYM VR SINGLE ICD BOTH IP/OP "$46,706.00" "$34,562.50" "$7,712.84" "$46,706.00" "$21,017.70" "$21,017.70" "$21,017.70" "$21,017.70" "$46,706.00" "$46,706.00" "$46,706.00" "$9,417.94" "$46,706.00" "$46,706.00" "$46,706.00" "$46,706.00" "$46,706.00" "$9,734.04" "$46,706.00" "$46,706.00" "$23,026.06" "$46,706.00" "$46,706.00" "$46,706.00" "$46,706.00" "$35,029.50" "$46,706.00" "$46,706.00" "$46,706.00" "$23,353.00" "$23,353.00" "$36,991.15" "$46,706.00" "$37,364.80" "$21,017.70" "$7,712.84" "$46,706.00" "$27,089.48" "$46,706.00" "$46,706.00" "$46,706.00" "$8,098.48" "$46,706.00" N/A N/A 27803252 EAP Custom 27803252 "LC BEAD,100-300UM" BOTH IP/OP "$4,887.00" "$3,616.50" $869.89 "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" $869.89 "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" "$1,018.50" "$4,887.00" "$1,954.80" "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" "$3,665.25" "$4,887.00" "$4,887.00" "$4,887.00" "$2,443.50" "$2,443.50" "$3,870.50" "$4,887.00" "$3,909.60" "$2,199.15" "$4,887.00" "$4,887.00" "$2,834.46" "$4,887.00" "$2,932.20" "$4,887.00" "$4,887.00" "$4,887.00" N/A N/A 27803253 EAP PICC LINE TRAY W/O DEVICE BOTH IP/OP $134.00 $99.50 $23.85 $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $134.00 $23.85 $134.00 $134.00 $99.45 $99.45 $103.29 $69.81 $27.93 $134.00 $53.60 $134.00 $134.00 $134.00 $134.00 $134.00 $100.50 $134.00 $134.00 $134.00 $67.00 $67.00 $106.13 $134.00 $107.20 $87.10 $134.00 $134.00 $77.72 $134.00 $80.40 $134.00 $134.00 $134.00 N/A N/A 27803254 EAP HCPCS C1769 PINNACLE GUIDEWIRE 6FR STRAIGH BOTH IP/OP $278.00 $206.00 $55.18 $278.00 $125.10 $125.10 $125.10 $125.10 $278.00 $278.00 $278.00 $57.94 $278.00 $278.00 $278.00 $278.00 $278.00 $57.94 $278.00 $278.00 $164.44 $278.00 $278.00 $278.00 $278.00 $208.50 $278.00 $278.00 $278.00 $139.00 $139.00 $220.18 $278.00 $222.40 $125.10 $55.18 $278.00 $161.24 $278.00 $278.00 $278.00 $57.94 $278.00 N/A N/A 27803255 EAP HCPCS C1894 SHEATH GD LIMA CRV 6FR 45CM 5CM PN DSTN XCUT VLV RADOPQ SS BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 27803256 EAP HCPCS A4300 PORT-A-CATH II LOW PROFILE DUA BOTH IP/OP "$1,429.00" "$1,057.50" $297.82 "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" $297.82 "$1,429.00" $571.60 "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,429.00" "$1,071.75" "$1,429.00" "$1,429.00" "$1,429.00" $714.50 $714.50 "$1,131.77" "$1,429.00" "$1,143.20" $643.05 "$1,429.00" "$1,429.00" $828.82 "$1,429.00" $857.40 "$1,429.00" "$1,429.00" "$1,429.00" N/A N/A 27803257 EAP HCPCS C1752 SET SCHON XL TEMP DIALYSIS 15C BOTH IP/OP "$1,635.00" "$1,210.00" $340.75 "$1,635.00" "$1,635.00" "$1,635.00" "$1,635.00" "$1,635.00" "$1,635.00" "$1,635.00" "$1,635.00" "$1,635.00" "$1,635.00" "$1,635.00" "$1,635.00" "$1,635.00" "$1,635.00" $340.75 "$1,635.00" $654.00 "$1,635.00" "$1,635.00" "$1,635.00" "$1,635.00" "$1,635.00" "$1,226.25" "$1,635.00" "$1,635.00" "$1,635.00" $817.50 $817.50 "$1,294.92" "$1,635.00" "$1,308.00" $735.75 "$1,635.00" "$1,635.00" $948.30 "$1,635.00" $981.00 "$1,635.00" "$1,635.00" "$1,635.00" N/A N/A 27803258 EAP HCPCS C1751 SINGLE PICC LINE BOTH IP/OP $216.00 $160.00 $42.87 $216.00 $97.20 $97.20 $97.20 $97.20 $216.00 $216.00 $216.00 $45.02 $216.00 $216.00 $216.00 $216.00 $216.00 $45.02 $216.00 $216.00 $127.76 $216.00 $216.00 $216.00 $216.00 $162.00 $216.00 $216.00 $216.00 $108.00 $108.00 $171.07 $216.00 $172.80 $97.20 $42.87 $216.00 $125.28 $216.00 $216.00 $216.00 $45.01 $216.00 N/A N/A 27803259 EAP HCPCS C1751 TRIPLE LUMEN CATHETER SIZE 20 BOTH IP/OP $384.00 $284.50 $76.21 $384.00 $172.80 $172.80 $172.80 $172.80 $384.00 $384.00 $384.00 $80.04 $384.00 $384.00 $384.00 $384.00 $384.00 $80.03 $384.00 $384.00 $227.14 $384.00 $384.00 $384.00 $384.00 $288.00 $384.00 $384.00 $384.00 $192.00 $192.00 $304.13 $384.00 $307.20 $172.80 $76.21 $384.00 $222.72 $384.00 $384.00 $384.00 $80.03 $384.00 N/A N/A 27803260 EAP HCPCS C1729 TUBE GASTROSTOMY 24FR BOTH IP/OP $59.00 $44.00 $11.71 $59.00 $26.55 $26.55 $26.55 $26.55 $59.00 $59.00 $59.00 $12.30 $59.00 $59.00 $59.00 $59.00 $59.00 $12.30 $59.00 $59.00 $34.90 $59.00 $59.00 $59.00 $59.00 $44.25 $59.00 $59.00 $59.00 $29.50 $29.50 $46.73 $59.00 $47.20 $26.55 $11.71 $59.00 $34.22 $59.00 $59.00 $59.00 $12.30 $59.00 N/A N/A 27803261 EAP HCPCS C1751 "UHF PIGTAIL SIZING CATH 5 FR,1" BOTH IP/OP $315.00 $233.50 $62.52 $315.00 $141.75 $141.75 $141.75 $141.75 $315.00 $315.00 $315.00 $65.65 $315.00 $315.00 $315.00 $315.00 $315.00 $65.65 $315.00 $315.00 $186.32 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $141.75 $62.52 $315.00 $182.70 $315.00 $315.00 $315.00 $65.65 $315.00 N/A N/A 27803262 EAP HCPCS C1751 "UHF PIGTAIL SIZING CATH 5FR,2" BOTH IP/OP $71.00 $53.00 $14.09 $71.00 $31.95 $31.95 $31.95 $31.95 $71.00 $71.00 $71.00 $14.80 $71.00 $71.00 $71.00 $71.00 $71.00 $14.80 $71.00 $71.00 $42.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $31.95 $14.09 $71.00 $41.18 $71.00 $71.00 $71.00 $14.80 $71.00 N/A N/A 27803263 EAP HCPCS C1751 VENOUS ACCESS BOTH IP/OP $165.00 $122.50 $32.75 $165.00 $74.25 $74.25 $74.25 $74.25 $165.00 $165.00 $165.00 $34.39 $165.00 $165.00 $165.00 $165.00 $165.00 $34.39 $165.00 $165.00 $97.60 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $74.25 $32.75 $165.00 $95.70 $165.00 $165.00 $165.00 $34.39 $165.00 N/A N/A 27803264 EAP HCPCS A4300 ISP PORT PLAS LUMEN BOTH IP/OP $734.00 $543.50 $152.97 $734.00 $734.00 $734.00 $734.00 $734.00 $734.00 $734.00 $734.00 $734.00 $734.00 $734.00 $734.00 $734.00 $734.00 $152.97 $734.00 $293.60 $734.00 $734.00 $734.00 $734.00 $734.00 $550.50 $734.00 $734.00 $734.00 $367.00 $367.00 $581.33 $734.00 $587.20 $330.30 $734.00 $734.00 $425.72 $734.00 $440.40 $734.00 $734.00 $734.00 N/A N/A 27803265 EAP Custom 27803265 JCD 12.0-38-20 BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $8.55 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 27803270 EAP Custom 27803270 TRAY CENTRAL LINE DRESSING WITHOUT BIOPATCH BOTH IP/OP $102.00 $75.50 $18.16 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $18.16 $102.00 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $40.80 $102.00 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $102.00 $102.00 $59.16 $102.00 $61.20 $102.00 $102.00 $102.00 N/A N/A 27803294 EAP HCPCS C1725 BAND TR 24CM BOTH IP/OP $123.00 $91.50 $24.41 $123.00 $55.35 $55.35 $55.35 $55.35 $123.00 $123.00 $123.00 $25.64 $123.00 $123.00 $123.00 $123.00 $123.00 $25.63 $123.00 $123.00 $72.75 $123.00 $123.00 $123.00 $123.00 $92.25 $123.00 $123.00 $123.00 $61.50 $61.50 $97.42 $123.00 $98.40 $55.35 $24.41 $123.00 $71.34 $123.00 $123.00 $123.00 $25.63 $123.00 N/A N/A 27803295 EAP HCPCS C1725 BAND TR 29CM BOTH IP/OP $123.00 $91.50 $24.41 $123.00 $55.35 $55.35 $55.35 $55.35 $123.00 $123.00 $123.00 $25.64 $123.00 $123.00 $123.00 $123.00 $123.00 $25.63 $123.00 $49.20 $72.75 $123.00 $123.00 $123.00 $123.00 $92.25 $123.00 $123.00 $123.00 $61.50 $61.50 $97.42 $123.00 $98.40 $55.35 $24.41 $123.00 $71.34 $123.00 $123.00 $123.00 $25.63 $123.00 N/A N/A 27803302 EAP Custom 27803302 EMBOLIZATION COIL - AZUR 35D SYSTEM 10MM X 20CM BOTH IP/OP "$3,754.00" "$2,778.00" $668.21 "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" $668.21 "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" $782.37 "$3,754.00" "$1,501.60" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$2,815.50" "$3,754.00" "$3,754.00" "$3,754.00" "$1,877.00" "$1,877.00" "$2,973.17" "$3,754.00" "$3,003.20" "$1,689.30" "$3,754.00" "$3,754.00" "$2,177.32" "$3,754.00" "$2,252.40" "$3,754.00" "$3,754.00" "$3,754.00" N/A N/A 27803303 EAP Custom 27803303 EMBOLIZATION COIL - AZUR 35D SYSTEM 12MM X 20CM BOTH IP/OP "$3,754.00" "$2,778.00" $668.21 "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" $668.21 "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" $782.37 "$3,754.00" "$1,501.60" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$2,815.50" "$3,754.00" "$3,754.00" "$3,754.00" "$1,877.00" "$1,877.00" "$2,973.17" "$3,754.00" "$3,003.20" "$1,689.30" "$3,754.00" "$3,754.00" "$2,177.32" "$3,754.00" "$2,252.40" "$3,754.00" "$3,754.00" "$3,754.00" N/A N/A 27803304 EAP Custom 27803304 EMBOLIZATION COIL - AZUR 35D SYSTEM 15MM X 20CM BOTH IP/OP "$3,754.00" "$2,778.00" $668.21 "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" $668.21 "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" $782.37 "$3,754.00" "$1,501.60" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$3,754.00" "$2,815.50" "$3,754.00" "$3,754.00" "$3,754.00" "$1,877.00" "$1,877.00" "$2,973.17" "$3,754.00" "$3,003.20" "$1,689.30" "$3,754.00" "$3,754.00" "$2,177.32" "$3,754.00" "$2,252.40" "$3,754.00" "$3,754.00" "$3,754.00" N/A N/A 27803305 EAP Custom 27803305 EMBOLIZATION COIL - AZUR 35D SYSTEM 12MM X 30CM BOTH IP/OP "$4,005.00" "$2,964.00" $712.89 "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" $712.89 "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" $834.69 "$4,005.00" "$1,602.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$3,003.75" "$4,005.00" "$4,005.00" "$4,005.00" "$2,002.50" "$2,002.50" "$3,171.96" "$4,005.00" "$3,204.00" "$1,802.25" "$4,005.00" "$4,005.00" "$2,322.90" "$4,005.00" "$2,403.00" "$4,005.00" "$4,005.00" "$4,005.00" N/A N/A 27803306 EAP Custom 27803306 EMBOLIZATION COIL -AZUR 35D SYSTEM 15MM X 30CM BOTH IP/OP "$4,005.00" "$2,964.00" $712.89 "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" $712.89 "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" $834.69 "$4,005.00" "$1,602.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$3,003.75" "$4,005.00" "$4,005.00" "$4,005.00" "$2,002.50" "$2,002.50" "$3,171.96" "$4,005.00" "$3,204.00" "$1,802.25" "$4,005.00" "$4,005.00" "$2,322.90" "$4,005.00" "$2,403.00" "$4,005.00" "$4,005.00" "$4,005.00" N/A N/A 27803307 EAP Custom 27803307 EMBOLIZATION COIL - AZUR 35D SYSTEM 20MM X 30CM BOTH IP/OP "$4,005.00" "$2,964.00" $712.89 "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" $712.89 "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" $834.69 "$4,005.00" "$1,602.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$3,003.75" "$4,005.00" "$4,005.00" "$4,005.00" "$2,002.50" "$2,002.50" "$3,171.96" "$4,005.00" "$3,204.00" "$1,802.25" "$4,005.00" "$4,005.00" "$2,322.90" "$4,005.00" "$2,403.00" "$4,005.00" "$4,005.00" "$4,005.00" N/A N/A 27803308 EAP HCPCS C1876 STENT BILINARY XPERT OTW 5X30X120 CM BOTH IP/OP "$5,755.00" "$4,259.00" "$1,142.22" "$5,755.00" "$2,589.75" "$2,589.75" "$2,589.75" "$2,589.75" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.49" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.41" "$5,755.00" "$5,755.00" "$2,837.22" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$4,316.25" "$5,755.00" "$5,755.00" "$5,755.00" "$2,877.50" "$2,877.50" "$4,557.96" "$5,755.00" "$4,604.00" "$2,589.75" "$1,142.22" "$5,755.00" "$3,337.90" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.34" "$5,755.00" N/A N/A 27803309 EAP HCPCS C1876 STENT BILINARY XPERT OTW 5X40X120 CM BOTH IP/OP "$5,755.00" "$4,259.00" "$1,142.22" "$5,755.00" "$2,589.75" "$2,589.75" "$2,589.75" "$2,589.75" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.49" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.41" "$5,755.00" "$5,755.00" "$2,837.22" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$4,316.25" "$5,755.00" "$5,755.00" "$5,755.00" "$2,877.50" "$2,877.50" "$4,557.96" "$5,755.00" "$4,604.00" "$2,589.75" "$1,142.22" "$5,755.00" "$3,337.90" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.34" "$5,755.00" N/A N/A 27803310 EAP HCPCS C1876 STENT BILINARY XPERT OTW 6X30X120 CM BOTH IP/OP "$5,755.00" "$4,259.00" "$1,142.22" "$5,755.00" "$2,589.75" "$2,589.75" "$2,589.75" "$2,589.75" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.49" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.41" "$5,755.00" "$5,755.00" "$2,837.22" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$4,316.25" "$5,755.00" "$5,755.00" "$5,755.00" "$2,877.50" "$2,877.50" "$4,557.96" "$5,755.00" "$4,604.00" "$2,589.75" "$1,142.22" "$5,755.00" "$3,337.90" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.34" "$5,755.00" N/A N/A 27803311 EAP HCPCS C1876 STENT BILINARY XPERT OTW 6X40X120 CM BOTH IP/OP "$5,755.00" "$4,259.00" "$1,142.22" "$5,755.00" "$2,589.75" "$2,589.75" "$2,589.75" "$2,589.75" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.49" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.41" "$5,755.00" "$5,755.00" "$2,837.22" "$5,755.00" "$5,755.00" "$5,755.00" "$5,755.00" "$4,316.25" "$5,755.00" "$5,755.00" "$5,755.00" "$2,877.50" "$2,877.50" "$4,557.96" "$5,755.00" "$4,604.00" "$2,589.75" "$1,142.22" "$5,755.00" "$3,337.90" "$5,755.00" "$5,755.00" "$5,755.00" "$1,199.34" "$5,755.00" N/A N/A 27803312 EAP HCPCS C1876 STENT COROTID STRAIGHT RX ACCULINK 6X40 BOTH IP/OP "$6,590.00" "$4,877.00" "$1,307.95" "$6,590.00" "$2,965.50" "$2,965.50" "$2,965.50" "$2,965.50" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.52" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$6,590.00" "$3,248.87" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$1,307.95" "$6,590.00" "$3,822.20" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.36" "$6,590.00" N/A N/A 27803313 EAP HCPCS C1876 STENT COROTID STRAIGHT RX ACCULINK 7X40 BOTH IP/OP "$6,590.00" "$4,877.00" "$1,307.95" "$6,590.00" "$2,965.50" "$2,965.50" "$2,965.50" "$2,965.50" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.52" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$6,590.00" "$3,248.87" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$1,307.95" "$6,590.00" "$3,822.20" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.36" "$6,590.00" N/A N/A 27803314 EAP HCPCS C1876 STENT COROTID STRAIGHT RX ACCULINK 8X40 BOTH IP/OP "$6,590.00" "$4,877.00" "$1,307.95" "$6,590.00" "$2,965.50" "$2,965.50" "$2,965.50" "$2,965.50" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.52" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$6,590.00" "$3,248.87" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$1,307.95" "$6,590.00" "$3,822.20" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.36" "$6,590.00" N/A N/A 27803315 EAP HCPCS C1876 STENT COROTID STRAIGHT RX ACCULINK 9X40 BOTH IP/OP "$6,590.00" "$4,877.00" "$1,307.95" "$6,590.00" "$2,965.50" "$2,965.50" "$2,965.50" "$2,965.50" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.52" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$6,590.00" "$3,248.87" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$1,307.95" "$6,590.00" "$3,822.20" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.36" "$6,590.00" N/A N/A 27803317 EAP HCPCS C1876 STENT COROTID TAPPED RX ACCULINK 6-8X40 BOTH IP/OP "$6,590.00" "$4,877.00" "$1,307.95" "$6,590.00" "$2,965.50" "$2,965.50" "$2,965.50" "$2,965.50" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.52" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$6,590.00" "$3,248.87" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$1,307.95" "$6,590.00" "$3,822.20" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.36" "$6,590.00" N/A N/A 27803318 EAP HCPCS C1876 STENT COROTID TAPPED RX ACCULINK 7-10X40 BOTH IP/OP "$6,590.00" "$4,877.00" "$1,307.95" "$6,590.00" "$2,965.50" "$2,965.50" "$2,965.50" "$2,965.50" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.52" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$6,590.00" "$3,248.87" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$1,307.95" "$6,590.00" "$3,822.20" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.36" "$6,590.00" N/A N/A 27803319 EAP HCPCS C1882 DEFIBRILLATOR CRD AMPLIA MRI CRT-D VNTRC LEFT DF4 BOTH IP/OP "$52,375.00" "$38,757.50" "$7,712.84" "$52,375.00" "$23,568.75" "$23,568.75" "$23,568.75" "$23,568.75" "$52,375.00" "$52,375.00" "$52,375.00" "$9,417.94" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$10,915.53" "$52,375.00" "$52,375.00" "$25,820.88" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$39,281.25" "$52,375.00" "$52,375.00" "$52,375.00" "$26,187.50" "$26,187.50" "$41,481.00" "$52,375.00" "$41,900.00" "$23,568.75" "$7,712.84" "$52,375.00" "$30,377.50" "$52,375.00" "$52,375.00" "$52,375.00" "$8,098.48" "$52,375.00" N/A N/A 27803320 EAP HCPCS C1882 DEFIBRILLATOR CRD AMPLIA MRI CRT-D 2 PLR LEFT BOTH IP/OP "$52,375.00" "$38,757.50" "$7,712.84" "$52,375.00" "$23,568.75" "$23,568.75" "$23,568.75" "$23,568.75" "$52,375.00" "$52,375.00" "$52,375.00" "$9,417.94" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$10,915.53" "$52,375.00" "$52,375.00" "$25,820.88" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$39,281.25" "$52,375.00" "$52,375.00" "$52,375.00" "$26,187.50" "$26,187.50" "$41,481.00" "$52,375.00" "$41,900.00" "$23,568.75" "$7,712.84" "$52,375.00" "$30,377.50" "$52,375.00" "$52,375.00" "$52,375.00" "$8,098.48" "$52,375.00" N/A N/A 27803420 EAP HCPCS C1769 GUIDEWIRE AMPLATZ SUPER STIFF 0.038 X 260 BOTH IP/OP $50.00 $37.00 $9.92 $50.00 $22.50 $22.50 $22.50 $22.50 $50.00 $50.00 $50.00 $10.42 $50.00 $50.00 $50.00 $50.00 $50.00 $10.42 $50.00 $50.00 $29.58 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $22.50 $9.92 $50.00 $29.00 $50.00 $50.00 $50.00 $10.42 $50.00 N/A N/A 27803421 EAP HCPCS C1769 GUIDEWIRE HYDROPHILIC NITINOL BOTH IP/OP $388.00 $287.50 $77.01 $388.00 $174.60 $174.60 $174.60 $174.60 $388.00 $388.00 $388.00 $80.87 $388.00 $388.00 $388.00 $388.00 $388.00 $80.86 $388.00 $388.00 $229.50 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $174.60 $77.01 $388.00 $225.04 $388.00 $388.00 $388.00 $80.86 $388.00 N/A N/A 27803441 EAP Custom 27803441 STENT METAL BARE INT35012UX BOTH IP/OP "$2,422.00" "$1,792.50" $431.12 "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" $431.12 "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" $504.77 "$2,422.00" $968.80 "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$1,816.50" "$2,422.00" "$2,422.00" "$2,422.00" "$1,211.00" "$1,211.00" "$1,918.22" "$2,422.00" "$1,937.60" "$1,089.90" "$2,422.00" "$2,422.00" "$1,404.76" "$2,422.00" "$1,453.20" "$2,422.00" "$2,422.00" "$2,422.00" N/A N/A 27803450 EAP Custom 27803450 TARGET DETACHABLE COLIS 360 SOFT 4MM X 6CM BOTH IP/OP "$2,270.00" "$1,680.00" $404.06 "$2,270.00" "$2,270.00" "$2,270.00" "$2,270.00" "$2,270.00" "$2,270.00" "$2,270.00" $404.06 "$2,270.00" "$2,270.00" "$2,270.00" "$2,270.00" "$2,270.00" "$2,270.00" $473.09 "$2,270.00" $908.00 "$2,270.00" "$2,270.00" "$2,270.00" "$2,270.00" "$2,270.00" "$1,702.50" "$2,270.00" "$2,270.00" "$2,270.00" "$1,135.00" "$1,135.00" "$1,797.84" "$2,270.00" "$1,816.00" "$1,021.50" "$2,270.00" "$2,270.00" "$1,316.60" "$2,270.00" "$1,362.00" "$2,270.00" "$2,270.00" "$2,270.00" N/A N/A 27803451 EAP Custom 27803451 TARGET DETACHABLE COLIS ULTRA 3MMX8CM BOTH IP/OP "$2,401.00" "$1,777.00" $427.38 "$2,401.00" "$2,401.00" "$2,401.00" "$2,401.00" "$2,401.00" "$2,401.00" "$2,401.00" $427.38 "$2,401.00" "$2,401.00" "$2,401.00" "$2,401.00" "$2,401.00" "$2,401.00" $500.39 "$2,401.00" $960.40 "$2,401.00" "$2,401.00" "$2,401.00" "$2,401.00" "$2,401.00" "$1,800.75" "$2,401.00" "$2,401.00" "$2,401.00" "$1,200.50" "$1,200.50" "$1,901.59" "$2,401.00" "$1,920.80" "$1,080.45" "$2,401.00" "$2,401.00" "$1,392.58" "$2,401.00" "$1,440.60" "$2,401.00" "$2,401.00" "$2,401.00" N/A N/A 27803452 EAP Custom 27803452 INZONE DETACHMENT SYSTEM BOTH IP/OP $260.00 $192.50 $46.28 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $46.28 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $54.19 $260.00 $104.00 $260.00 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $117.00 $260.00 $260.00 $150.80 $260.00 $156.00 $260.00 $260.00 $260.00 N/A N/A 27803490 EAP HCPCS C2625 RX STENT/11.5 X 5 BOTH IP/OP $64.00 $47.50 $12.70 $64.00 $28.80 $28.80 $28.80 $28.80 $64.00 $64.00 $64.00 $13.34 $64.00 $64.00 $64.00 $64.00 $64.00 $13.34 $64.00 $64.00 $37.86 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $28.80 $12.70 $64.00 $37.12 $64.00 $64.00 $64.00 $13.34 $64.00 N/A N/A 27803491 EAP HCPCS C2625 RX STENT/11.5 X 7 BOTH IP/OP $64.00 $47.50 $12.70 $64.00 $28.80 $28.80 $28.80 $28.80 $64.00 $64.00 $64.00 $13.34 $64.00 $64.00 $64.00 $64.00 $64.00 $13.34 $64.00 $64.00 $37.86 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $28.80 $12.70 $64.00 $37.12 $64.00 $64.00 $64.00 $13.34 $64.00 N/A N/A 27803492 EAP HCPCS C2625 RX STENT/11.5 X 10 BOTH IP/OP $64.00 $47.50 $12.70 $64.00 $28.80 $28.80 $28.80 $28.80 $64.00 $64.00 $64.00 $13.34 $64.00 $64.00 $64.00 $64.00 $64.00 $13.34 $64.00 $64.00 $37.86 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $28.80 $12.70 $64.00 $37.12 $64.00 $64.00 $64.00 $13.34 $64.00 N/A N/A 27803493 EAP HCPCS C2625 RX STENT/11.5 X 12 BOTH IP/OP $64.00 $47.50 $12.70 $64.00 $28.80 $28.80 $28.80 $28.80 $64.00 $64.00 $64.00 $13.34 $64.00 $64.00 $64.00 $64.00 $64.00 $13.34 $64.00 $64.00 $37.86 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $28.80 $12.70 $64.00 $37.12 $64.00 $64.00 $64.00 $13.34 $64.00 N/A N/A 27803494 EAP HCPCS C2625 RX STENT/11.5 X 15 BOTH IP/OP $64.00 $47.50 $12.70 $64.00 $28.80 $28.80 $28.80 $28.80 $64.00 $64.00 $64.00 $13.34 $64.00 $64.00 $64.00 $64.00 $64.00 $13.34 $64.00 $64.00 $37.86 $64.00 $64.00 $64.00 $64.00 $48.00 $64.00 $64.00 $64.00 $32.00 $32.00 $50.69 $64.00 $51.20 $28.80 $12.70 $64.00 $37.12 $64.00 $64.00 $64.00 $13.34 $64.00 N/A N/A 27803496 EAP HCPCS C1874 "ICAST COVERED STENT 6MM X16MM, 120 CM CATH LENGTH" BOTH IP/OP "$8,340.00" "$6,172.00" "$1,655.28" "$8,340.00" "$3,753.00" "$3,753.00" "$3,753.00" "$3,753.00" "$8,340.00" "$8,340.00" "$8,340.00" "$1,738.26" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$1,738.15" "$8,340.00" "$8,340.00" "$4,111.62" "$8,340.00" "$8,340.00" "$8,340.00" "$8,340.00" "$6,255.00" "$8,340.00" "$8,340.00" "$8,340.00" "$4,170.00" "$4,170.00" "$6,605.28" "$8,340.00" "$6,672.00" "$3,753.00" "$1,655.28" "$8,340.00" "$4,837.20" "$8,340.00" "$8,340.00" "$8,340.00" "$1,738.06" "$8,340.00" N/A N/A 27803499 EAP Custom 27803499 CENTRAL LINE TRAY W /BIOPATCH BOTH IP/OP $264.00 $195.50 $46.99 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $46.99 $264.00 $264.00 $195.94 $195.94 $203.49 $137.54 $55.02 $264.00 $105.60 $264.00 $264.00 $264.00 $264.00 $264.00 $198.00 $264.00 $264.00 $264.00 $132.00 $132.00 $209.09 $264.00 $211.20 $171.60 $264.00 $264.00 $153.12 $264.00 $158.40 $264.00 $264.00 $264.00 N/A N/A 27803510 EAP HCPCS C2628 BOSTON SCIENTIFIC OCCLUSION BALLOON CATHETER 27MM X 100M BOTH IP/OP $885.00 $655.00 $175.65 $885.00 $398.25 $398.25 $398.25 $398.25 $885.00 $885.00 $885.00 $184.46 $885.00 $885.00 $885.00 $885.00 $885.00 $184.44 $885.00 $885.00 $885.00 $885.00 $885.00 $885.00 $885.00 $663.75 $885.00 $885.00 $885.00 $442.50 $442.50 $700.92 $885.00 $708.00 $398.25 $175.65 $885.00 $513.30 $885.00 $885.00 $885.00 $184.43 $885.00 N/A N/A 27803520 EAP HCPCS C1876 WALLFLEX BIL UNCOVERED 10X60 BOTH IP/OP "$6,005.00" "$4,444.00" "$1,191.84" "$6,005.00" "$2,702.25" "$2,702.25" "$2,702.25" "$2,702.25" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.59" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.51" "$6,005.00" "$6,005.00" "$2,960.47" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$4,503.75" "$6,005.00" "$6,005.00" "$6,005.00" "$3,002.50" "$3,002.50" "$4,755.96" "$6,005.00" "$4,804.00" "$2,702.25" "$1,191.84" "$6,005.00" "$3,482.90" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.44" "$6,005.00" N/A N/A 27803521 EAP HCPCS C1876 WALLFLEX BIL UNCOVERED 10X80 BOTH IP/OP "$6,005.00" "$4,444.00" "$1,191.84" "$6,005.00" "$2,702.25" "$2,702.25" "$2,702.25" "$2,702.25" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.59" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.51" "$6,005.00" "$6,005.00" "$2,960.47" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$4,503.75" "$6,005.00" "$6,005.00" "$6,005.00" "$3,002.50" "$3,002.50" "$4,755.96" "$6,005.00" "$4,804.00" "$2,702.25" "$1,191.84" "$6,005.00" "$3,482.90" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.44" "$6,005.00" N/A N/A 27803522 EAP HCPCS C1876 WALLFLEX BIL UNCOVERED 10X100 BOTH IP/OP "$6,005.00" "$4,444.00" "$1,191.84" "$6,005.00" "$2,702.25" "$2,702.25" "$2,702.25" "$2,702.25" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.59" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.51" "$6,005.00" "$6,005.00" "$2,960.47" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$4,503.75" "$6,005.00" "$6,005.00" "$6,005.00" "$3,002.50" "$3,002.50" "$4,755.96" "$6,005.00" "$4,804.00" "$2,702.25" "$1,191.84" "$6,005.00" "$3,482.90" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.44" "$6,005.00" N/A N/A 27803523 EAP HCPCS C1876 WALLFLEX BIL UNCOVERED 10X40 BOTH IP/OP "$6,005.00" "$4,444.00" "$1,191.84" "$6,005.00" "$2,702.25" "$2,702.25" "$2,702.25" "$2,702.25" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.59" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.51" "$6,005.00" "$6,005.00" "$2,960.47" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$4,503.75" "$6,005.00" "$6,005.00" "$6,005.00" "$3,002.50" "$3,002.50" "$4,755.96" "$6,005.00" "$4,804.00" "$2,702.25" "$1,191.84" "$6,005.00" "$3,482.90" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.44" "$6,005.00" N/A N/A 27803524 EAP HCPCS C1874 WALLFLEX BIL COVERED 10X40 BOTH IP/OP "$9,476.00" "$7,012.50" "$1,880.75" "$9,476.00" "$4,264.20" "$4,264.20" "$4,264.20" "$4,264.20" "$9,476.00" "$9,476.00" "$9,476.00" "$1,975.04" "$9,476.00" "$9,476.00" "$9,476.00" "$9,476.00" "$9,476.00" "$1,974.90" "$9,476.00" "$9,476.00" "$4,671.67" "$9,476.00" "$9,476.00" "$9,476.00" "$9,476.00" "$7,107.00" "$9,476.00" "$9,476.00" "$9,476.00" "$4,738.00" "$4,738.00" "$7,504.99" "$9,476.00" "$7,580.80" "$4,264.20" "$1,880.75" "$9,476.00" "$5,496.08" "$9,476.00" "$9,476.00" "$9,476.00" "$1,974.80" "$9,476.00" N/A N/A 27803525 EAP HCPCS C1874 WALLFLEX BIL COVERED 10X60 BOTH IP/OP "$9,476.00" "$7,012.50" "$1,880.75" "$9,476.00" "$4,264.20" "$4,264.20" "$4,264.20" "$4,264.20" "$9,476.00" "$9,476.00" "$9,476.00" "$1,975.04" "$9,476.00" "$9,476.00" "$9,476.00" "$9,476.00" "$9,476.00" "$1,974.90" "$9,476.00" "$9,476.00" "$4,671.67" "$9,476.00" "$9,476.00" "$9,476.00" "$9,476.00" "$7,107.00" "$9,476.00" "$9,476.00" "$9,476.00" "$4,738.00" "$4,738.00" "$7,504.99" "$9,476.00" "$7,580.80" "$4,264.20" "$1,880.75" "$9,476.00" "$5,496.08" "$9,476.00" "$9,476.00" "$9,476.00" "$1,974.80" "$9,476.00" N/A N/A 27803526 EAP HCPCS C1874 WALLFLEX BIL COVERED 10X80 BOTH IP/OP "$9,476.00" "$7,012.50" "$1,880.75" "$9,476.00" "$4,264.20" "$4,264.20" "$4,264.20" "$4,264.20" "$9,476.00" "$9,476.00" "$9,476.00" "$1,975.04" "$9,476.00" "$9,476.00" "$9,476.00" "$9,476.00" "$9,476.00" "$1,974.90" "$9,476.00" "$9,476.00" "$4,671.67" "$9,476.00" "$9,476.00" "$9,476.00" "$9,476.00" "$7,107.00" "$9,476.00" "$9,476.00" "$9,476.00" "$4,738.00" "$4,738.00" "$7,504.99" "$9,476.00" "$7,580.80" "$4,264.20" "$1,880.75" "$9,476.00" "$5,496.08" "$9,476.00" "$9,476.00" "$9,476.00" "$1,974.80" "$9,476.00" N/A N/A 27803527 EAP HCPCS C1874 WALLFLEX BIL PC COVERED 10X40 BOTH IP/OP "$9,142.00" "$6,765.50" "$1,814.46" "$9,142.00" "$4,113.90" "$4,113.90" "$4,113.90" "$4,113.90" "$9,142.00" "$9,142.00" "$9,142.00" "$1,905.42" "$9,142.00" "$9,142.00" "$9,142.00" "$9,142.00" "$9,142.00" "$1,905.29" "$9,142.00" "$9,142.00" "$4,507.01" "$9,142.00" "$9,142.00" "$9,142.00" "$9,142.00" "$6,856.50" "$9,142.00" "$9,142.00" "$9,142.00" "$4,571.00" "$4,571.00" "$7,240.46" "$9,142.00" "$7,313.60" "$4,113.90" "$1,814.46" "$9,142.00" "$5,302.36" "$9,142.00" "$9,142.00" "$9,142.00" "$1,905.19" "$9,142.00" N/A N/A 27803528 EAP HCPCS C1874 WALLFLEX BIL PC COVERED 10X60 BOTH IP/OP "$9,142.00" "$6,765.50" "$1,814.46" "$9,142.00" "$4,113.90" "$4,113.90" "$4,113.90" "$4,113.90" "$9,142.00" "$9,142.00" "$9,142.00" "$1,905.42" "$9,142.00" "$9,142.00" "$9,142.00" "$9,142.00" "$9,142.00" "$1,905.29" "$9,142.00" "$9,142.00" "$4,507.01" "$9,142.00" "$9,142.00" "$9,142.00" "$9,142.00" "$6,856.50" "$9,142.00" "$9,142.00" "$9,142.00" "$4,571.00" "$4,571.00" "$7,240.46" "$9,142.00" "$7,313.60" "$4,113.90" "$1,814.46" "$9,142.00" "$5,302.36" "$9,142.00" "$9,142.00" "$9,142.00" "$1,905.19" "$9,142.00" N/A N/A 27803529 EAP HCPCS C1874 WALLFLEX BIL PC COVERED 10X80 BOTH IP/OP "$9,142.00" "$6,765.50" "$1,814.46" "$9,142.00" "$4,113.90" "$4,113.90" "$4,113.90" "$4,113.90" "$9,142.00" "$9,142.00" "$9,142.00" "$1,905.42" "$9,142.00" "$9,142.00" "$9,142.00" "$9,142.00" "$9,142.00" "$1,905.29" "$9,142.00" "$9,142.00" "$4,507.01" "$9,142.00" "$9,142.00" "$9,142.00" "$9,142.00" "$6,856.50" "$9,142.00" "$9,142.00" "$9,142.00" "$4,571.00" "$4,571.00" "$7,240.46" "$9,142.00" "$7,313.60" "$4,113.90" "$1,814.46" "$9,142.00" "$5,302.36" "$9,142.00" "$9,142.00" "$9,142.00" "$1,905.19" "$9,142.00" N/A N/A 27803531 EAP HCPCS C1876 WALLFLEX ENT DUO 27/22X6 230CM BOTH IP/OP "$8,756.00" "$6,479.50" "$1,737.85" "$8,756.00" "$3,940.20" "$3,940.20" "$3,940.20" "$3,940.20" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.97" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.85" "$8,756.00" "$8,756.00" "$4,316.71" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$6,567.00" "$8,756.00" "$8,756.00" "$8,756.00" "$4,378.00" "$4,378.00" "$6,934.75" "$8,756.00" "$7,004.80" "$3,940.20" "$1,737.85" "$8,756.00" "$5,078.48" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.75" "$8,756.00" N/A N/A 27803532 EAP HCPCS C1876 WALLFLEX ENT DUO 27/22X9 230CM BOTH IP/OP "$8,756.00" "$6,479.50" "$1,737.85" "$8,756.00" "$3,940.20" "$3,940.20" "$3,940.20" "$3,940.20" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.97" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.85" "$8,756.00" "$8,756.00" "$4,316.71" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$6,567.00" "$8,756.00" "$8,756.00" "$8,756.00" "$4,378.00" "$4,378.00" "$6,934.75" "$8,756.00" "$7,004.80" "$3,940.20" "$1,737.85" "$8,756.00" "$5,078.48" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.75" "$8,756.00" N/A N/A 27803533 EAP HCPCS C1876 WALLFLEX ENT DUO 27/22X12 230CM BOTH IP/OP "$8,756.00" "$6,479.50" "$1,737.85" "$8,756.00" "$3,940.20" "$3,940.20" "$3,940.20" "$3,940.20" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.97" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.85" "$8,756.00" "$8,756.00" "$4,316.71" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$6,567.00" "$8,756.00" "$8,756.00" "$8,756.00" "$4,378.00" "$4,378.00" "$6,934.75" "$8,756.00" "$7,004.80" "$3,940.20" "$1,737.85" "$8,756.00" "$5,078.48" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.75" "$8,756.00" N/A N/A 27803534 EAP HCPCS C1876 WALLFLEX ENT COL 30/25X6 230CM BOTH IP/OP "$8,756.00" "$6,479.50" "$1,737.85" "$8,756.00" "$3,940.20" "$3,940.20" "$3,940.20" "$3,940.20" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.97" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.85" "$8,756.00" "$8,756.00" "$4,316.71" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$6,567.00" "$8,756.00" "$8,756.00" "$8,756.00" "$4,378.00" "$4,378.00" "$6,934.75" "$8,756.00" "$7,004.80" "$3,940.20" "$1,737.85" "$8,756.00" "$5,078.48" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.75" "$8,756.00" N/A N/A 27803535 EAP HCPCS C1876 WALLFLEX ENT COL 30/25X9 230CM BOTH IP/OP "$8,756.00" "$6,479.50" "$1,737.85" "$8,756.00" "$3,940.20" "$3,940.20" "$3,940.20" "$3,940.20" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.97" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.85" "$8,756.00" "$8,756.00" "$4,316.71" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$6,567.00" "$8,756.00" "$8,756.00" "$8,756.00" "$4,378.00" "$4,378.00" "$6,934.75" "$8,756.00" "$7,004.80" "$3,940.20" "$1,737.85" "$8,756.00" "$5,078.48" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.75" "$8,756.00" N/A N/A 27803536 EAP HCPCS C1876 WALLFLEX ENT COL 30/25X12 230CM BOTH IP/OP "$8,756.00" "$6,479.50" "$1,737.85" "$8,756.00" "$3,940.20" "$3,940.20" "$3,940.20" "$3,940.20" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.97" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.85" "$8,756.00" "$8,756.00" "$4,316.71" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$6,567.00" "$8,756.00" "$8,756.00" "$8,756.00" "$4,378.00" "$4,378.00" "$6,934.75" "$8,756.00" "$7,004.80" "$3,940.20" "$1,737.85" "$8,756.00" "$5,078.48" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.75" "$8,756.00" N/A N/A 27803537 EAP HCPCS C1876 WALLFLEX ENT COL 27/22X6 230CM BOTH IP/OP "$8,756.00" "$6,479.50" "$1,737.85" "$8,756.00" "$3,940.20" "$3,940.20" "$3,940.20" "$3,940.20" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.97" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.85" "$8,756.00" "$8,756.00" "$4,316.71" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$6,567.00" "$8,756.00" "$8,756.00" "$8,756.00" "$4,378.00" "$4,378.00" "$6,934.75" "$8,756.00" "$7,004.80" "$3,940.20" "$1,737.85" "$8,756.00" "$5,078.48" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.75" "$8,756.00" N/A N/A 27803538 EAP HCPCS C1876 WALLFLEX ENT COL 27/22X9 230CM BOTH IP/OP "$8,756.00" "$6,479.50" "$1,737.85" "$8,756.00" "$3,940.20" "$3,940.20" "$3,940.20" "$3,940.20" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.97" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.85" "$8,756.00" "$8,756.00" "$4,316.71" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$6,567.00" "$8,756.00" "$8,756.00" "$8,756.00" "$4,378.00" "$4,378.00" "$6,934.75" "$8,756.00" "$7,004.80" "$3,940.20" "$1,737.85" "$8,756.00" "$5,078.48" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.75" "$8,756.00" N/A N/A 27803539 EAP HCPCS C1876 WALLFLEX ENT COL 27/22X12 230CM BOTH IP/OP "$8,756.00" "$6,479.50" "$1,737.85" "$8,756.00" "$3,940.20" "$3,940.20" "$3,940.20" "$3,940.20" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.97" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.85" "$8,756.00" "$8,756.00" "$4,316.71" "$8,756.00" "$8,756.00" "$8,756.00" "$8,756.00" "$6,567.00" "$8,756.00" "$8,756.00" "$8,756.00" "$4,378.00" "$4,378.00" "$6,934.75" "$8,756.00" "$7,004.80" "$3,940.20" "$1,737.85" "$8,756.00" "$5,078.48" "$8,756.00" "$8,756.00" "$8,756.00" "$1,824.75" "$8,756.00" N/A N/A 27803541 EAP HCPCS C1874 WALLFLEX ESOPH FULL COV 18/10 BOTH IP/OP "$8,507.00" "$6,295.50" "$1,688.43" "$8,507.00" "$3,828.15" "$3,828.15" "$3,828.15" "$3,828.15" "$8,507.00" "$8,507.00" "$8,507.00" "$1,773.07" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.95" "$8,507.00" "$8,507.00" "$4,193.95" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$6,380.25" "$8,507.00" "$8,507.00" "$8,507.00" "$4,253.50" "$4,253.50" "$6,737.54" "$8,507.00" "$6,805.60" "$3,828.15" "$1,688.43" "$8,507.00" "$4,934.06" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.86" "$8,507.00" N/A N/A 27803542 EAP HCPCS C1874 WALLFLEX ESOPH FULL COV 18/12 BOTH IP/OP "$8,507.00" "$6,295.50" "$1,688.43" "$8,507.00" "$3,828.15" "$3,828.15" "$3,828.15" "$3,828.15" "$8,507.00" "$8,507.00" "$8,507.00" "$1,773.07" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.95" "$8,507.00" "$8,507.00" "$4,193.95" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$6,380.25" "$8,507.00" "$8,507.00" "$8,507.00" "$4,253.50" "$4,253.50" "$6,737.54" "$8,507.00" "$6,805.60" "$3,828.15" "$1,688.43" "$8,507.00" "$4,934.06" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.86" "$8,507.00" N/A N/A 27803543 EAP HCPCS C1874 WALLFLEX ESOPH FULL COV 18/15 BOTH IP/OP "$8,507.00" "$6,295.50" "$1,688.43" "$8,507.00" "$3,828.15" "$3,828.15" "$3,828.15" "$3,828.15" "$8,507.00" "$8,507.00" "$8,507.00" "$1,773.07" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.95" "$8,507.00" "$8,507.00" "$4,193.95" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$6,380.25" "$8,507.00" "$8,507.00" "$8,507.00" "$4,253.50" "$4,253.50" "$6,737.54" "$8,507.00" "$6,805.60" "$3,828.15" "$1,688.43" "$8,507.00" "$4,934.06" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.86" "$8,507.00" N/A N/A 27803544 EAP HCPCS C1874 WALLFLEX ESOPH FULL COV 23/10 BOTH IP/OP "$8,507.00" "$6,295.50" "$1,688.43" "$8,507.00" "$3,828.15" "$3,828.15" "$3,828.15" "$3,828.15" "$8,507.00" "$8,507.00" "$8,507.00" "$1,773.07" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.95" "$8,507.00" "$8,507.00" "$4,193.95" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$6,380.25" "$8,507.00" "$8,507.00" "$8,507.00" "$4,253.50" "$4,253.50" "$6,737.54" "$8,507.00" "$6,805.60" "$3,828.15" "$1,688.43" "$8,507.00" "$4,934.06" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.86" "$8,507.00" N/A N/A 27803545 EAP HCPCS C1874 WALLFLEX ESOPH FULL COV 23/12 BOTH IP/OP "$8,507.00" "$6,295.50" "$1,688.43" "$8,507.00" "$3,828.15" "$3,828.15" "$3,828.15" "$3,828.15" "$8,507.00" "$8,507.00" "$8,507.00" "$1,773.07" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.95" "$8,507.00" "$8,507.00" "$4,193.95" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$6,380.25" "$8,507.00" "$8,507.00" "$8,507.00" "$4,253.50" "$4,253.50" "$6,737.54" "$8,507.00" "$6,805.60" "$3,828.15" "$1,688.43" "$8,507.00" "$4,934.06" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.86" "$8,507.00" N/A N/A 27803546 EAP HCPCS C1874 WALLFLEX ESOPH FULL COV 23/15 BOTH IP/OP "$8,507.00" "$6,295.50" "$1,688.43" "$8,507.00" "$3,828.15" "$3,828.15" "$3,828.15" "$3,828.15" "$8,507.00" "$8,507.00" "$8,507.00" "$1,773.07" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.95" "$8,507.00" "$8,507.00" "$4,193.95" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$6,380.25" "$8,507.00" "$8,507.00" "$8,507.00" "$4,253.50" "$4,253.50" "$6,737.54" "$8,507.00" "$6,805.60" "$3,828.15" "$1,688.43" "$8,507.00" "$4,934.06" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.86" "$8,507.00" N/A N/A 27803547 EAP HCPCS C1874 WALLFLEX ESOPH PART COV 18/10 BOTH IP/OP "$8,507.00" "$6,295.50" "$1,688.43" "$8,507.00" "$3,828.15" "$3,828.15" "$3,828.15" "$3,828.15" "$8,507.00" "$8,507.00" "$8,507.00" "$1,773.07" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.95" "$8,507.00" "$8,507.00" "$4,193.95" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$6,380.25" "$8,507.00" "$8,507.00" "$8,507.00" "$4,253.50" "$4,253.50" "$6,737.54" "$8,507.00" "$6,805.60" "$3,828.15" "$1,688.43" "$8,507.00" "$4,934.06" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.86" "$8,507.00" N/A N/A 27803548 EAP HCPCS C1874 WALLFLEX ESOPH PART COV 18/12 BOTH IP/OP "$8,507.00" "$6,295.50" "$1,688.43" "$8,507.00" "$3,828.15" "$3,828.15" "$3,828.15" "$3,828.15" "$8,507.00" "$8,507.00" "$8,507.00" "$1,773.07" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.95" "$8,507.00" "$8,507.00" "$4,193.95" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$6,380.25" "$8,507.00" "$8,507.00" "$8,507.00" "$4,253.50" "$4,253.50" "$6,737.54" "$8,507.00" "$6,805.60" "$3,828.15" "$1,688.43" "$8,507.00" "$4,934.06" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.86" "$8,507.00" N/A N/A 27803549 EAP HCPCS C1874 WALLFLEX ESOPH PART COV 18/23X103 BOTH IP/OP "$8,507.00" "$6,295.50" "$1,688.43" "$8,507.00" "$3,828.15" "$3,828.15" "$3,828.15" "$3,828.15" "$8,507.00" "$8,507.00" "$8,507.00" "$1,773.07" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.95" "$8,507.00" "$8,507.00" "$4,193.95" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$6,380.25" "$8,507.00" "$8,507.00" "$8,507.00" "$4,253.50" "$4,253.50" "$6,737.54" "$8,507.00" "$6,805.60" "$3,828.15" "$1,688.43" "$8,507.00" "$4,934.06" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.86" "$8,507.00" N/A N/A 27803550 EAP HCPCS C1874 WALLFLEX ESOPH PART COV 23/128X105 BOTH IP/OP "$8,507.00" "$6,295.50" "$1,688.43" "$8,507.00" "$3,828.15" "$3,828.15" "$3,828.15" "$3,828.15" "$8,507.00" "$8,507.00" "$8,507.00" "$1,773.07" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.95" "$8,507.00" "$8,507.00" "$4,193.95" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$6,380.25" "$8,507.00" "$8,507.00" "$8,507.00" "$4,253.50" "$4,253.50" "$6,737.54" "$8,507.00" "$6,805.60" "$3,828.15" "$1,688.43" "$8,507.00" "$4,934.06" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.86" "$8,507.00" N/A N/A 27803551 EAP HCPCS C1874 WALLFLEX ESOPH PART COV 23/28X125 BOTH IP/OP "$8,507.00" "$6,295.50" "$1,688.43" "$8,507.00" "$3,828.15" "$3,828.15" "$3,828.15" "$3,828.15" "$8,507.00" "$8,507.00" "$8,507.00" "$1,773.07" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.95" "$8,507.00" "$8,507.00" "$4,193.95" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$6,380.25" "$8,507.00" "$8,507.00" "$8,507.00" "$4,253.50" "$4,253.50" "$6,737.54" "$8,507.00" "$6,805.60" "$3,828.15" "$1,688.43" "$8,507.00" "$4,934.06" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.86" "$8,507.00" N/A N/A 27803552 EAP HCPCS C1874 WALLFLEX ESOPH PART COV 23/28X155 BOTH IP/OP "$8,507.00" "$6,295.50" "$1,688.43" "$8,507.00" "$3,828.15" "$3,828.15" "$3,828.15" "$3,828.15" "$8,507.00" "$8,507.00" "$8,507.00" "$1,773.07" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.95" "$8,507.00" "$3,402.80" "$4,193.95" "$8,507.00" "$8,507.00" "$8,507.00" "$8,507.00" "$6,380.25" "$8,507.00" "$8,507.00" "$8,507.00" "$4,253.50" "$4,253.50" "$6,737.54" "$8,507.00" "$6,805.60" "$3,828.15" "$1,688.43" "$8,507.00" "$4,934.06" "$8,507.00" "$8,507.00" "$8,507.00" "$1,772.86" "$8,507.00" N/A N/A 27803554 EAP HCPCS C1874 POLYFLEX ESOPH 20/16MM X 90MM BOTH IP/OP "$6,756.00" "$4,999.50" "$1,340.90" "$6,756.00" "$3,040.20" "$3,040.20" "$3,040.20" "$3,040.20" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.12" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.02" "$6,756.00" "$6,756.00" "$3,330.71" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$5,067.00" "$6,756.00" "$6,756.00" "$6,756.00" "$3,378.00" "$3,378.00" "$5,350.75" "$6,756.00" "$5,404.80" "$3,040.20" "$1,340.90" "$6,756.00" "$3,918.48" "$6,756.00" "$6,756.00" "$6,756.00" "$1,407.95" "$6,756.00" N/A N/A 27803555 EAP HCPCS C1874 POLYFLEX ESOPH 20/16MM X 120MM BOTH IP/OP "$6,756.00" "$4,999.50" "$1,340.90" "$6,756.00" "$3,040.20" "$3,040.20" "$3,040.20" "$3,040.20" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.12" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.02" "$6,756.00" "$6,756.00" "$3,330.71" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$5,067.00" "$6,756.00" "$6,756.00" "$6,756.00" "$3,378.00" "$3,378.00" "$5,350.75" "$6,756.00" "$5,404.80" "$3,040.20" "$1,340.90" "$6,756.00" "$3,918.48" "$6,756.00" "$6,756.00" "$6,756.00" "$1,407.95" "$6,756.00" N/A N/A 27803556 EAP HCPCS C1874 POLYFLEX ESOPH 20/16MM X 150MM BOTH IP/OP "$6,756.00" "$4,999.50" "$1,340.90" "$6,756.00" "$3,040.20" "$3,040.20" "$3,040.20" "$3,040.20" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.12" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.02" "$6,756.00" "$6,756.00" "$3,330.71" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$5,067.00" "$6,756.00" "$6,756.00" "$6,756.00" "$3,378.00" "$3,378.00" "$5,350.75" "$6,756.00" "$5,404.80" "$3,040.20" "$1,340.90" "$6,756.00" "$3,918.48" "$6,756.00" "$6,756.00" "$6,756.00" "$1,407.95" "$6,756.00" N/A N/A 27803557 EAP HCPCS C1874 POLYFLEX ESOPH 23/18MM X 90MM BOTH IP/OP "$6,756.00" "$4,999.50" "$1,340.90" "$6,756.00" "$3,040.20" "$3,040.20" "$3,040.20" "$3,040.20" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.12" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.02" "$6,756.00" "$6,756.00" "$3,330.71" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$5,067.00" "$6,756.00" "$6,756.00" "$6,756.00" "$3,378.00" "$3,378.00" "$5,350.75" "$6,756.00" "$5,404.80" "$3,040.20" "$1,340.90" "$6,756.00" "$3,918.48" "$6,756.00" "$6,756.00" "$6,756.00" "$1,407.95" "$6,756.00" N/A N/A 27803558 EAP HCPCS C1874 POLYFLEX ESOPH 23/18MM X 120MM BOTH IP/OP "$6,756.00" "$4,999.50" "$1,340.90" "$6,756.00" "$3,040.20" "$3,040.20" "$3,040.20" "$3,040.20" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.12" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.02" "$6,756.00" "$6,756.00" "$3,330.71" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$5,067.00" "$6,756.00" "$6,756.00" "$6,756.00" "$3,378.00" "$3,378.00" "$5,350.75" "$6,756.00" "$5,404.80" "$3,040.20" "$1,340.90" "$6,756.00" "$3,918.48" "$6,756.00" "$6,756.00" "$6,756.00" "$1,407.95" "$6,756.00" N/A N/A 27803559 EAP HCPCS C1874 POLYFLEX ESOPH 23/18MM X 150MM BOTH IP/OP "$6,756.00" "$4,999.50" "$1,340.90" "$6,756.00" "$3,040.20" "$3,040.20" "$3,040.20" "$3,040.20" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.12" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.02" "$6,756.00" "$6,756.00" "$3,330.71" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$5,067.00" "$6,756.00" "$6,756.00" "$6,756.00" "$3,378.00" "$3,378.00" "$5,350.75" "$6,756.00" "$5,404.80" "$3,040.20" "$1,340.90" "$6,756.00" "$3,918.48" "$6,756.00" "$6,756.00" "$6,756.00" "$1,407.95" "$6,756.00" N/A N/A 27803560 EAP HCPCS C1874 POLYFLEX ESOPH 25/21MM X 90MM BOTH IP/OP "$6,756.00" "$4,999.50" "$1,340.90" "$6,756.00" "$3,040.20" "$3,040.20" "$3,040.20" "$3,040.20" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.12" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.02" "$6,756.00" "$6,756.00" "$3,330.71" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$5,067.00" "$6,756.00" "$6,756.00" "$6,756.00" "$3,378.00" "$3,378.00" "$5,350.75" "$6,756.00" "$5,404.80" "$3,040.20" "$1,340.90" "$6,756.00" "$3,918.48" "$6,756.00" "$6,756.00" "$6,756.00" "$1,407.95" "$6,756.00" N/A N/A 27803561 EAP HCPCS C1874 POLYFLEX ESOPH 25/21MM X 120MM BOTH IP/OP "$6,756.00" "$4,999.50" "$1,340.90" "$6,756.00" "$3,040.20" "$3,040.20" "$3,040.20" "$3,040.20" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.12" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.02" "$6,756.00" "$6,756.00" "$3,330.71" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$5,067.00" "$6,756.00" "$6,756.00" "$6,756.00" "$3,378.00" "$3,378.00" "$5,350.75" "$6,756.00" "$5,404.80" "$3,040.20" "$1,340.90" "$6,756.00" "$3,918.48" "$6,756.00" "$6,756.00" "$6,756.00" "$1,407.95" "$6,756.00" N/A N/A 27803562 EAP HCPCS C1874 POLYFLEX ESOPH 25/21MM X 150MM BOTH IP/OP "$6,756.00" "$4,999.50" "$1,340.90" "$6,756.00" "$3,040.20" "$3,040.20" "$3,040.20" "$3,040.20" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.12" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$1,408.02" "$6,756.00" "$6,756.00" "$3,330.71" "$6,756.00" "$6,756.00" "$6,756.00" "$6,756.00" "$5,067.00" "$6,756.00" "$6,756.00" "$6,756.00" "$3,378.00" "$3,378.00" "$5,350.75" "$6,756.00" "$5,404.80" "$3,040.20" "$1,340.90" "$6,756.00" "$3,918.48" "$6,756.00" "$6,756.00" "$6,756.00" "$1,407.95" "$6,756.00" N/A N/A 27803576 EAP Custom 44697837 STENT BARE METAL INT30012UX BOTH IP/OP "$2,422.00" "$1,792.50" $431.12 "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" $431.12 "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" $504.77 "$2,422.00" $968.80 "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$1,816.50" "$2,422.00" "$2,422.00" "$2,422.00" "$1,211.00" "$1,211.00" "$1,918.22" "$2,422.00" "$1,937.60" "$1,089.90" "$2,422.00" "$2,422.00" "$1,404.76" "$2,422.00" "$1,453.20" "$2,422.00" "$2,422.00" "$2,422.00" N/A N/A 27803585 EAP Custom 44697928 STENT BARE METAL INT40015UX BOTH IP/OP "$2,422.00" "$1,792.50" $431.12 "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" $431.12 "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" $504.77 "$2,422.00" $968.80 "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$1,816.50" "$2,422.00" "$2,422.00" "$2,422.00" "$1,211.00" "$1,211.00" "$1,918.22" "$2,422.00" "$1,937.60" "$1,089.90" "$2,422.00" "$2,422.00" "$1,404.76" "$2,422.00" "$1,453.20" "$2,422.00" "$2,422.00" "$2,422.00" N/A N/A 27803600 EAP HCPCS C1713 PLATE XLNG 134MM SS 2.7/3.5MM SCR 6 HOLE VAR ANG BOTH IP/OP $840.58 $622.50 $166.83 $840.58 $378.26 $378.26 $378.26 $378.26 $840.58 $840.58 $840.58 $175.20 $840.58 $840.58 $840.58 $840.58 $840.58 $175.19 $840.58 $840.58 $497.20 $840.58 $840.58 $840.58 $840.58 $630.44 $840.58 $840.58 $840.58 $420.29 $420.29 $665.74 $840.58 $672.46 $378.26 $166.83 $840.58 $487.54 $840.58 $504.35 $840.58 $175.18 $840.58 N/A N/A 27803601 EAP HCPCS C1713 SCREW BONE 3.5MM 30MM LINEUM TI OCT SPN SMTH SHNK BOTH IP/OP "$1,877.60" "$1,389.50" $372.66 "$1,877.60" $844.92 $844.92 $844.92 $844.92 "$1,877.60" "$1,877.60" "$1,877.60" $391.34 "$1,877.60" "$1,877.60" "$1,877.60" "$1,877.60" "$1,877.60" $391.31 "$1,877.60" "$1,877.60" "$1,110.60" "$1,877.60" "$1,877.60" "$1,877.60" "$1,877.60" "$1,408.20" "$1,877.60" "$1,877.60" "$1,877.60" $938.80 $938.80 "$1,487.06" "$1,877.60" "$1,502.08" $844.92 $372.66 "$1,877.60" "$1,089.01" "$1,877.60" "$1,877.60" "$1,877.60" $391.29 "$1,877.60" N/A N/A 27803602 EAP HCPCS C1713 ROD SPNL 90MM 4.75MM STR PERC CCM PLUS BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 $300.00 $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 27803603 EAP HCPCS C1713 SCREW BONE 1.5MM 8MM HEXALOBE PTHRD HAND LAG BOTH IP/OP $129.00 $95.50 $25.60 $129.00 $58.05 $58.05 $58.05 $58.05 $129.00 $129.00 $129.00 $26.89 $129.00 $129.00 $129.00 $129.00 $129.00 $26.89 $129.00 $129.00 $76.30 $129.00 $129.00 $129.00 $129.00 $96.75 $129.00 $129.00 $129.00 $64.50 $64.50 $102.17 $129.00 $103.20 $58.05 $25.60 $129.00 $74.82 $129.00 $129.00 $129.00 $26.88 $129.00 N/A N/A 27803604 EAP HCPCS C1713 SCREW BONE 1.5MM 11MM TI HAND MTCRPL PHALANGES BOTH IP/OP $129.00 $95.50 $25.60 $129.00 $58.05 $58.05 $58.05 $58.05 $129.00 $129.00 $129.00 $26.89 $129.00 $129.00 $129.00 $129.00 $129.00 $26.89 $129.00 $129.00 $76.30 $129.00 $129.00 $129.00 $129.00 $96.75 $129.00 $129.00 $129.00 $64.50 $64.50 $102.17 $129.00 $103.20 $58.05 $25.60 $129.00 $74.82 $129.00 $129.00 $129.00 $26.88 $129.00 N/A N/A 27803605 EAP HCPCS C1713 SPACER SPNL 22MMX10MM CPSTN CNTRL 12D PEEK INTRBD BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 27803606 EAP HCPCS C1713 SCREW BONE 4.5MM 45MM SOLERA CD HZN COCR SPN BOTH IP/OP "$1,558.20" "$1,153.50" $309.26 "$1,558.20" $701.19 $701.19 $701.19 $701.19 "$1,558.20" "$1,558.20" "$1,558.20" $324.77 "$1,558.20" "$1,558.20" "$1,558.20" "$1,558.20" "$1,558.20" $324.75 "$1,558.20" "$1,558.20" $921.68 "$1,558.20" "$1,558.20" "$1,558.20" "$1,558.20" "$1,168.65" "$1,558.20" "$1,558.20" "$1,558.20" $779.10 $779.10 "$1,234.09" "$1,558.20" "$1,246.56" $701.19 $309.26 "$1,558.20" $903.76 "$1,558.20" $934.92 "$1,558.20" $324.73 "$1,558.20" N/A N/A 27803607 EAP HCPCS C1713 SCREW BONE 5.5MM 35MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$1,558.20" "$1,153.50" $309.26 "$1,558.20" $701.19 $701.19 $701.19 $701.19 "$1,558.20" "$1,558.20" "$1,558.20" $324.77 "$1,558.20" "$1,558.20" "$1,558.20" "$1,558.20" "$1,558.20" $324.75 "$1,558.20" "$1,558.20" $921.68 "$1,558.20" "$1,558.20" "$1,558.20" "$1,558.20" "$1,168.65" "$1,558.20" "$1,558.20" "$1,558.20" $779.10 $779.10 "$1,234.09" "$1,558.20" "$1,246.56" $701.19 $309.26 "$1,558.20" $903.76 "$1,558.20" $934.92 "$1,558.20" $324.73 "$1,558.20" N/A N/A 27803608 EAP HCPCS C1713 SCREW BONE 6.5MM 35MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$1,558.20" "$1,153.50" $309.26 "$1,558.20" $701.19 $701.19 $701.19 $701.19 "$1,558.20" "$1,558.20" "$1,558.20" $324.77 "$1,558.20" "$1,558.20" "$1,558.20" "$1,558.20" "$1,558.20" $324.75 "$1,558.20" "$1,558.20" $921.68 "$1,558.20" "$1,558.20" "$1,558.20" "$1,558.20" "$1,168.65" "$1,558.20" "$1,558.20" "$1,558.20" $779.10 $779.10 "$1,234.09" "$1,558.20" "$1,246.56" $701.19 $309.26 "$1,558.20" $903.76 "$1,558.20" "$1,558.20" "$1,558.20" $324.73 "$1,558.20" N/A N/A 27803609 EAP HCPCS C1713 CAGE SPNL 15-20MM 12MM BOTH IP/OP "$4,498.00" "$3,329.00" $892.74 "$4,498.00" "$2,442.41" "$2,442.41" "$2,442.41" "$2,442.41" "$4,498.00" "$4,498.00" "$4,498.00" $937.50 "$4,498.00" "$3,338.42" "$3,338.42" "$3,467.06" "$2,060.15" $937.43 "$4,498.00" "$4,498.00" "$2,660.57" "$4,498.00" "$4,498.00" "$4,498.00" "$4,498.00" "$3,373.50" "$4,498.00" "$4,498.00" "$4,498.00" "$2,249.00" "$2,249.00" "$3,562.42" "$4,498.00" "$3,598.40" "$2,923.70" $892.74 "$4,498.00" "$2,608.84" "$4,498.00" "$4,498.00" "$4,498.00" $937.38 "$4,498.00" N/A N/A 27803610 EAP HCPCS C1713 SPACER SPNL 50X18X8MM CRNT XL PEEK TLIF RDLCNT BOTH IP/OP "$4,500.00" "$3,330.00" $893.14 "$4,500.00" "$2,025.00" "$2,025.00" "$2,025.00" "$2,025.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.91 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 "$4,500.00" "$4,500.00" "$2,218.50" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,025.00" $893.14 "$4,500.00" "$2,610.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.80 "$4,500.00" N/A N/A 27803611 EAP HCPCS C1713 CAGE SPNL 45X18X12MM CRNT XL PEEK-OPTM LAT LMBR BOTH IP/OP "$4,500.00" "$3,330.00" $893.14 "$4,500.00" "$2,025.00" "$2,025.00" "$2,025.00" "$2,025.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.91 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 "$4,500.00" "$4,500.00" "$2,218.50" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,025.00" $893.14 "$4,500.00" "$2,610.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.80 "$4,500.00" N/A N/A 27803612 EAP HCPCS C1713 SPACER SPNL 38X16X28MM BRIGADE 12D SPN ANT BOTH IP/OP "$5,513.00" "$4,080.00" "$1,094.19" "$5,513.00" "$2,480.85" "$2,480.85" "$2,480.85" "$2,480.85" "$5,513.00" "$5,513.00" "$5,513.00" "$1,149.05" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$1,148.97" "$5,513.00" "$5,513.00" "$2,717.91" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$4,134.75" "$5,513.00" "$5,513.00" "$5,513.00" "$2,756.50" "$2,756.50" "$4,366.30" "$5,513.00" "$4,410.40" "$2,480.85" "$1,094.19" "$5,513.00" "$3,197.54" "$5,513.00" "$5,513.00" "$5,513.00" "$1,148.91" "$5,513.00" N/A N/A 27803613 EAP HCPCS C1713 SCREW BONE 5MM 62.5MM TRGN FEM LP BOTH IP/OP $259.20 $192.00 $51.44 $259.20 $116.64 $116.64 $116.64 $116.64 $259.20 $259.20 $259.20 $54.02 $259.20 $259.20 $259.20 $259.20 $259.20 $54.02 $259.20 $259.20 $153.32 $259.20 $259.20 $259.20 $259.20 $194.40 $259.20 $259.20 $259.20 $129.60 $129.60 $205.29 $259.20 $207.36 $116.64 $51.44 $259.20 $150.34 $259.20 $259.20 $259.20 $54.02 $259.20 N/A N/A 27803614 EAP HCPCS C1713 NAIL 10MM 38CM RIGHT TROC TRGN IM 130D SET ANTGRD BOTH IP/OP "$2,280.00" "$1,687.50" $452.52 "$2,280.00" "$1,026.00" "$1,026.00" "$1,026.00" "$1,026.00" "$2,280.00" "$2,280.00" "$2,280.00" $475.21 "$2,280.00" "$2,280.00" "$2,280.00" "$2,280.00" "$2,280.00" $475.18 "$2,280.00" "$2,280.00" "$1,348.62" "$2,280.00" "$2,280.00" "$2,280.00" "$2,280.00" "$1,710.00" "$2,280.00" "$2,280.00" "$2,280.00" "$1,140.00" "$1,140.00" "$1,805.76" "$2,280.00" "$1,824.00" "$1,026.00" $452.52 "$2,280.00" "$1,322.40" "$2,280.00" "$2,280.00" "$2,280.00" $475.15 "$2,280.00" N/A N/A 27803616 EAP HCPCS C1713 NAIL 10MM 38CM TIB MT-NAIL IM TI BOTH IP/OP "$2,108.00" "$1,560.00" $418.39 "$2,108.00" $948.60 $948.60 $948.60 $948.60 "$2,108.00" "$2,108.00" "$2,108.00" $439.36 "$2,108.00" "$2,108.00" "$2,108.00" "$2,108.00" "$2,108.00" $439.33 "$2,108.00" "$2,108.00" "$1,246.88" "$2,108.00" "$2,108.00" "$2,108.00" "$2,108.00" "$1,581.00" "$2,108.00" "$2,108.00" "$2,108.00" "$1,054.00" "$1,054.00" "$1,669.54" "$2,108.00" "$1,686.40" $948.60 $418.39 "$2,108.00" "$1,222.64" "$2,108.00" "$2,108.00" "$2,108.00" $439.31 "$2,108.00" N/A N/A 27803618 EAP HCPCS C1713 SCREW BONE 11MM 30MM INTERTAN TROCH CMPR BOTH IP/OP $388.00 $287.50 $77.01 $388.00 $174.60 $174.60 $174.60 $174.60 $388.00 $388.00 $388.00 $80.87 $388.00 $388.00 $388.00 $388.00 $388.00 $80.86 $388.00 $388.00 $229.50 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $174.60 $77.01 $388.00 $225.04 $388.00 $388.00 $388.00 $80.86 $388.00 N/A N/A 27803620 EAP HCPCS C1713 KIT SCR 90MM 4.5MM INTERTAN TROCH TI LAG CMPR BOTH IP/OP $836.00 $619.00 $165.93 $836.00 $376.20 $376.20 $376.20 $376.20 $836.00 $836.00 $836.00 $174.24 $836.00 $836.00 $836.00 $836.00 $836.00 $174.23 $836.00 $836.00 $494.49 $836.00 $836.00 $836.00 $836.00 $627.00 $836.00 $836.00 $836.00 $418.00 $418.00 $662.11 $836.00 $668.80 $376.20 $165.93 $836.00 $484.88 $836.00 $836.00 $836.00 $174.22 $836.00 N/A N/A 27803621 EAP HCPCS C1713 PLATE 2MM STR FRAC BONE BOTH IP/OP "$1,416.00" "$1,048.00" $281.04 "$1,416.00" $637.20 $637.20 $637.20 $637.20 "$1,416.00" "$1,416.00" "$1,416.00" $295.13 "$1,416.00" "$1,416.00" "$1,416.00" "$1,416.00" "$1,416.00" $295.11 "$1,416.00" "$1,416.00" $837.56 "$1,416.00" "$1,416.00" "$1,416.00" "$1,416.00" "$1,062.00" "$1,416.00" "$1,416.00" "$1,416.00" $708.00 $708.00 "$1,121.47" "$1,416.00" "$1,132.80" $637.20 $281.04 "$1,416.00" $821.28 "$1,416.00" "$1,416.00" "$1,416.00" $295.09 "$1,416.00" N/A N/A 27803622 EAP HCPCS C1713 NAIL 10MM 39CM TIB MT-NAIL IM TI BOTH IP/OP "$2,108.00" "$1,560.00" $418.39 "$2,108.00" $948.60 $948.60 $948.60 $948.60 "$2,108.00" "$2,108.00" "$2,108.00" $439.36 "$2,108.00" "$2,108.00" "$2,108.00" "$2,108.00" "$2,108.00" $439.33 "$2,108.00" "$2,108.00" "$1,246.88" "$2,108.00" "$2,108.00" "$2,108.00" "$2,108.00" "$1,581.00" "$2,108.00" "$2,108.00" "$2,108.00" "$1,054.00" "$1,054.00" "$1,669.54" "$2,108.00" "$1,686.40" $948.60 $418.39 "$2,108.00" "$1,222.64" "$2,108.00" "$1,264.80" "$2,108.00" $439.31 "$2,108.00" N/A N/A 27803788 EAP HCPCS C1726 DFS100410-20MICROCOIL PLATINUM DELTAPAPAQ4M BOTH IP/OP "$2,923.00" "$2,163.50" $580.14 "$2,923.00" "$1,315.35" "$1,315.35" "$1,315.35" "$1,315.35" "$2,923.00" "$2,923.00" "$2,923.00" $609.23 "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" $609.19 "$2,923.00" "$2,923.00" "$1,441.04" "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" "$2,192.25" "$2,923.00" "$2,923.00" "$2,923.00" "$1,461.50" "$1,461.50" "$2,315.02" "$2,923.00" "$2,338.40" "$1,315.35" $580.14 "$2,923.00" "$1,695.34" "$2,923.00" "$2,923.00" "$2,923.00" $609.15 "$2,923.00" N/A N/A 27803789 EAP HCPCS C1717 "BRACHYTX, NON-STR,HDR IR-192" BOTH IP/OP $700.00 $518.00 $138.93 $700.00 $315.00 $315.00 $315.00 $315.00 $341.72 $341.72 $341.72 $145.90 $341.72 $700.00 $700.00 $700.00 $700.00 $145.89 $546.75 $484.31 $414.05 $341.72 $700.00 $341.72 $358.81 $525.00 $341.72 $341.72 $341.72 $350.00 $350.00 $554.40 $341.72 $560.00 $315.00 $138.93 $341.72 $406.00 $358.81 $495.49 $341.72 $145.88 $341.72 N/A N/A 27803795 EAP HCPCS C1757 CATHETER THRMB 6FR 65CM CLEANERXT ROT 2 PWR CELL L BOTH IP/OP "$1,488.00" "$1,101.50" $295.33 "$1,488.00" $669.60 $669.60 $669.60 $669.60 "$1,488.00" "$1,488.00" "$1,488.00" $310.14 "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" $310.12 "$1,488.00" "$1,488.00" $880.15 "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" "$1,116.00" "$1,488.00" "$1,488.00" "$1,488.00" $744.00 $744.00 "$1,178.50" "$1,488.00" "$1,190.40" $669.60 $295.33 "$1,488.00" $863.04 "$1,488.00" "$1,488.00" "$1,488.00" $310.10 "$1,488.00" N/A N/A 27803803 EAP HCPCS C1726 HEL181830-20MICROCOIL PLATINUM HELIPAQ18 BOTH IP/OP "$1,895.00" "$1,402.50" $376.11 "$1,895.00" $852.75 $852.75 $852.75 $852.75 "$1,895.00" "$1,895.00" "$1,895.00" $394.97 "$1,895.00" "$1,895.00" "$1,895.00" "$1,895.00" "$1,895.00" $394.94 "$1,895.00" "$1,895.00" "$1,120.89" "$1,895.00" "$1,895.00" "$1,895.00" "$1,895.00" "$1,421.25" "$1,895.00" "$1,895.00" "$1,895.00" $947.50 $947.50 "$1,500.84" "$1,895.00" "$1,516.00" $852.75 $376.11 "$1,895.00" "$1,099.10" "$1,895.00" "$1,895.00" "$1,895.00" $394.92 "$1,895.00" N/A N/A 27803857 EAP HCPCS C1726 DFS100250-20MICROCOIL PLATINUM DELTAPAQ2 BOTH IP/OP "$2,923.00" "$2,163.50" $580.14 "$2,923.00" "$1,315.35" "$1,315.35" "$1,315.35" "$1,315.35" "$2,923.00" "$2,923.00" "$2,923.00" $609.23 "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" $609.19 "$2,923.00" "$2,923.00" "$1,441.04" "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" "$2,192.25" "$2,923.00" "$2,923.00" "$2,923.00" "$1,461.50" "$1,461.50" "$2,315.02" "$2,923.00" "$2,338.40" "$1,315.35" $580.14 "$2,923.00" "$1,695.34" "$2,923.00" "$2,923.00" "$2,923.00" $609.15 "$2,923.00" N/A N/A 27803858 EAP HCPCS C1726 DFS100408-20 MICROCOIL PLATINUM DELTAPAQ4M BOTH IP/OP "$2,923.00" "$2,163.50" $580.14 "$2,923.00" "$1,315.35" "$1,315.35" "$1,315.35" "$1,315.35" "$2,923.00" "$2,923.00" "$2,923.00" $609.23 "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" $609.19 "$2,923.00" "$2,923.00" "$1,441.04" "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" "$2,192.25" "$2,923.00" "$2,923.00" "$2,923.00" "$1,461.50" "$1,461.50" "$2,315.02" "$2,923.00" "$2,338.40" "$1,315.35" $580.14 "$2,923.00" "$1,695.34" "$2,923.00" "$2,923.00" "$2,923.00" $609.15 "$2,923.00" N/A N/A 27803860 EAP HCPCS C1726 DFS100510-20MICROCOIL PLATINUM DELTAPAQ5M BOTH IP/OP "$2,923.00" "$2,163.50" $580.14 "$2,923.00" "$1,315.35" "$1,315.35" "$1,315.35" "$1,315.35" "$2,923.00" "$2,923.00" "$2,923.00" $609.23 "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" $609.19 "$2,923.00" "$2,923.00" "$1,441.04" "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" "$2,192.25" "$2,923.00" "$2,923.00" "$2,923.00" "$1,461.50" "$1,461.50" "$2,315.02" "$2,923.00" "$2,338.40" "$1,315.35" $580.14 "$2,923.00" "$1,695.34" "$2,923.00" "$1,753.80" "$2,923.00" $609.15 "$2,923.00" N/A N/A 27803861 EAP HCPCS C1726 DFS100515-20 MICROCOIL PLATINUM DELTAPAQ5M BOTH IP/OP "$2,923.00" "$2,163.50" $580.14 "$2,923.00" "$1,315.35" "$1,315.35" "$1,315.35" "$1,315.35" "$2,923.00" "$2,923.00" "$2,923.00" $609.23 "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" $609.19 "$2,923.00" "$2,923.00" "$1,441.04" "$2,923.00" "$2,923.00" "$2,923.00" "$2,923.00" "$2,192.25" "$2,923.00" "$2,923.00" "$2,923.00" "$1,461.50" "$1,461.50" "$2,315.02" "$2,923.00" "$2,338.40" "$1,315.35" $580.14 "$2,923.00" "$1,695.34" "$2,923.00" "$2,923.00" "$2,923.00" $609.15 "$2,923.00" N/A N/A 27803863 EAP HCPCS C1726 DPL 100153-20MICROCOIL PLATINUM DELTAPLUSH BOTH IP/OP "$3,217.00" "$2,381.00" $638.49 "$3,217.00" "$1,447.65" "$1,447.65" "$1,447.65" "$1,447.65" "$3,217.00" "$3,217.00" "$3,217.00" $670.50 "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" $670.46 "$3,217.00" "$3,217.00" "$1,585.98" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$2,412.75" "$3,217.00" "$3,217.00" "$3,217.00" "$1,608.50" "$1,608.50" "$2,547.86" "$3,217.00" "$2,573.60" "$1,447.65" $638.49 "$3,217.00" "$1,865.86" "$3,217.00" "$3,217.00" "$3,217.00" $670.42 "$3,217.00" N/A N/A 27803864 EAP HCPCS C1726 DPL 100201-20 MICROCOIL PLATINUM DELTAPLUSH BOTH IP/OP "$3,654.00" "$2,704.00" $725.23 "$3,654.00" "$1,644.30" "$1,644.30" "$1,644.30" "$1,644.30" "$3,654.00" "$3,654.00" "$3,654.00" $761.58 "$3,654.00" "$3,654.00" "$3,654.00" "$3,654.00" "$3,654.00" $761.53 "$3,654.00" "$3,654.00" "$1,801.42" "$3,654.00" "$3,654.00" "$3,654.00" "$3,654.00" "$2,740.50" "$3,654.00" "$3,654.00" "$3,654.00" "$1,827.00" "$1,827.00" "$2,893.97" "$3,654.00" "$2,923.20" "$1,644.30" $725.23 "$3,654.00" "$2,119.32" "$3,654.00" "$3,654.00" "$3,654.00" $761.49 "$3,654.00" N/A N/A 27803865 EAP HCPCS C1726 DPL100202-20 MICROCOIL PLATINUM DELTAPLUSH BOTH IP/OP "$3,654.00" "$2,704.00" $725.23 "$3,654.00" "$1,644.30" "$1,644.30" "$1,644.30" "$1,644.30" "$3,654.00" "$3,654.00" "$3,654.00" $761.58 "$3,654.00" "$3,654.00" "$3,654.00" "$3,654.00" "$3,654.00" $761.53 "$3,654.00" "$3,654.00" "$1,801.42" "$3,654.00" "$3,654.00" "$3,654.00" "$3,654.00" "$2,740.50" "$3,654.00" "$3,654.00" "$3,654.00" "$1,827.00" "$1,827.00" "$2,893.97" "$3,654.00" "$2,923.20" "$1,644.30" $725.23 "$3,654.00" "$2,119.32" "$3,654.00" "$3,654.00" "$3,654.00" $761.49 "$3,654.00" N/A N/A 27803866 EAP HCPCS C1726 DPL 100203-20 MICROCOIL PLATINUM DELIAPLUSH BOTH IP/OP "$3,217.00" "$2,381.00" $638.49 "$3,217.00" "$1,447.65" "$1,447.65" "$1,447.65" "$1,447.65" "$3,217.00" "$3,217.00" "$3,217.00" $670.50 "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" $670.46 "$3,217.00" "$3,217.00" "$1,585.98" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$2,412.75" "$3,217.00" "$3,217.00" "$3,217.00" "$1,608.50" "$1,608.50" "$2,547.86" "$3,217.00" "$2,573.60" "$1,447.65" $638.49 "$3,217.00" "$1,865.86" "$3,217.00" "$3,217.00" "$3,217.00" $670.42 "$3,217.00" N/A N/A 27803867 EAP HCPCS C1726 DPL 100206-20MICOCOIL PLATINUM DELTAPLUSH BOTH IP/OP "$3,654.00" "$2,704.00" $725.23 "$3,654.00" "$1,644.30" "$1,644.30" "$1,644.30" "$1,644.30" "$3,654.00" "$3,654.00" "$3,654.00" $761.58 "$3,654.00" "$3,654.00" "$3,654.00" "$3,654.00" "$3,654.00" $761.53 "$3,654.00" "$3,654.00" "$1,801.42" "$3,654.00" "$3,654.00" "$3,654.00" "$3,654.00" "$2,740.50" "$3,654.00" "$3,654.00" "$3,654.00" "$1,827.00" "$1,827.00" "$2,893.97" "$3,654.00" "$2,923.20" "$1,644.30" $725.23 "$3,654.00" "$2,119.32" "$3,654.00" "$3,654.00" "$3,654.00" $761.49 "$3,654.00" N/A N/A 27803868 EAP HCPCS C1726 HEL 180730-20 MICROCOIL PLATINUM HELIPAQ 7M BOTH IP/OP "$1,701.00" "$1,259.00" $337.61 "$1,701.00" $765.45 $765.45 $765.45 $765.45 "$1,701.00" "$1,701.00" "$1,701.00" $354.53 "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" $354.51 "$1,701.00" "$1,701.00" "$1,006.14" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,275.75" "$1,701.00" "$1,701.00" "$1,701.00" $850.50 $850.50 "$1,347.19" "$1,701.00" "$1,360.80" $765.45 $337.61 "$1,701.00" $986.58 "$1,701.00" "$1,701.00" "$1,701.00" $354.49 "$1,701.00" N/A N/A 27803869 EAP HCPCS C1726 HEL180930-20MICROCOIL PLATINUM HELIPAQ9M BOTH IP/OP "$1,701.00" "$1,259.00" $337.61 "$1,701.00" $765.45 $765.45 $765.45 $765.45 "$1,701.00" "$1,701.00" "$1,701.00" $354.53 "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" $354.51 "$1,701.00" "$1,701.00" "$1,006.14" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,275.75" "$1,701.00" "$1,701.00" "$1,701.00" $850.50 $850.50 "$1,347.19" "$1,701.00" "$1,360.80" $765.45 $337.61 "$1,701.00" $986.58 "$1,701.00" "$1,701.00" "$1,701.00" $354.49 "$1,701.00" N/A N/A 27803870 EAP HCPCS C1726 HEL181030-20 MICROCOIL PLATINUM HELIPAQ10 BOTH IP/OP "$1,701.00" "$1,259.00" $337.61 "$1,701.00" $765.45 $765.45 $765.45 $765.45 "$1,701.00" "$1,701.00" "$1,701.00" $354.53 "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" $354.51 "$1,701.00" "$1,701.00" "$1,006.14" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,275.75" "$1,701.00" "$1,701.00" "$1,701.00" $850.50 $850.50 "$1,347.19" "$1,701.00" "$1,360.80" $765.45 $337.61 "$1,701.00" $986.58 "$1,701.00" "$1,701.00" "$1,701.00" $354.49 "$1,701.00" N/A N/A 27803871 EAP HCPCS C1726 HEL181230-20 MICROCOIL PLATINUM HELIPAQ12 BOTH IP/OP "$2,051.00" "$1,518.00" $407.07 "$2,051.00" $922.95 $922.95 $922.95 $922.95 "$2,051.00" "$2,051.00" "$2,051.00" $427.48 "$2,051.00" "$2,051.00" "$2,051.00" "$2,051.00" "$2,051.00" $427.45 "$2,051.00" "$2,051.00" "$1,213.17" "$2,051.00" "$2,051.00" "$2,051.00" "$2,051.00" "$1,538.25" "$2,051.00" "$2,051.00" "$2,051.00" "$1,025.50" "$1,025.50" "$1,624.39" "$2,051.00" "$1,640.80" $922.95 $407.07 "$2,051.00" "$1,189.58" "$2,051.00" "$2,051.00" "$2,051.00" $427.43 "$2,051.00" N/A N/A 27803872 EAP HCPCS C1726 HEL181430-20 MICROCOIL PLATINUM HELIPAQ14 BOTH IP/OP "$1,805.00" "$1,336.00" $358.25 "$1,805.00" $812.25 $812.25 $812.25 $812.25 "$1,805.00" "$1,805.00" "$1,805.00" $376.21 "$1,805.00" "$1,805.00" "$1,805.00" "$1,805.00" "$1,805.00" $376.18 "$1,805.00" "$1,805.00" "$1,067.66" "$1,805.00" "$1,805.00" "$1,805.00" "$1,805.00" "$1,353.75" "$1,805.00" "$1,805.00" "$1,805.00" $902.50 $902.50 "$1,429.56" "$1,805.00" "$1,444.00" $812.25 $358.25 "$1,805.00" "$1,046.90" "$1,805.00" "$1,805.00" "$1,805.00" $376.16 "$1,805.00" N/A N/A 27803873 EAP HCPCS C1726 HEL181630-20 MICROCOIL PLATINUM HELIPAQ16 BOTH IP/OP "$1,601.00" "$1,185.00" $317.76 "$1,601.00" $720.45 $720.45 $720.45 $720.45 "$1,601.00" "$1,601.00" "$1,601.00" $333.69 "$1,601.00" "$1,601.00" "$1,601.00" "$1,601.00" "$1,601.00" $333.67 "$1,601.00" "$1,601.00" $946.99 "$1,601.00" "$1,601.00" "$1,601.00" "$1,601.00" "$1,200.75" "$1,601.00" "$1,601.00" "$1,601.00" $800.50 $800.50 "$1,267.99" "$1,601.00" "$1,280.80" $720.45 $317.76 "$1,601.00" $928.58 "$1,601.00" "$1,601.00" "$1,601.00" $333.65 "$1,601.00" N/A N/A 27803875 EAP HCPCS C1726 HEL182030-20 MICROCOIL PLATINUM HELIPAQ 20 BOTH IP/OP "$1,895.00" "$1,402.50" $376.11 "$1,895.00" $852.75 $852.75 $852.75 $852.75 "$1,895.00" "$1,895.00" "$1,895.00" $394.97 "$1,895.00" "$1,895.00" "$1,895.00" "$1,895.00" "$1,895.00" $394.94 "$1,895.00" "$1,895.00" "$1,120.89" "$1,895.00" "$1,895.00" "$1,895.00" "$1,895.00" "$1,421.25" "$1,895.00" "$1,895.00" "$1,895.00" $947.50 $947.50 "$1,500.84" "$1,895.00" "$1,516.00" $852.75 $376.11 "$1,895.00" "$1,099.10" "$1,895.00" "$1,895.00" "$1,895.00" $394.92 "$1,895.00" N/A N/A 27803876 EAP HCPCS C1726 DPL 100152-20 MICROCOIL PLATINUM DELTAPLUSH BOTH IP/OP "$3,217.00" "$2,381.00" $638.49 "$3,217.00" "$1,447.65" "$1,447.65" "$1,447.65" "$1,447.65" "$3,217.00" "$3,217.00" "$3,217.00" $670.50 "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" $670.46 "$3,217.00" "$3,217.00" "$1,585.98" "$3,217.00" "$3,217.00" "$3,217.00" "$3,217.00" "$2,412.75" "$3,217.00" "$3,217.00" "$3,217.00" "$1,608.50" "$1,608.50" "$2,547.86" "$3,217.00" "$2,573.60" "$1,447.65" $638.49 "$3,217.00" "$1,865.86" "$3,217.00" "$3,217.00" "$3,217.00" $670.42 "$3,217.00" N/A N/A 27803880 EAP Custom 27803880 DEVICE PERCLOSE BOTH IP/OP $789.00 $584.00 $140.44 $789.00 $789.00 $789.00 $789.00 $789.00 $789.00 $789.00 $140.44 $789.00 $789.00 $789.00 $789.00 $789.00 $789.00 $164.44 $789.00 $315.60 $789.00 $789.00 $789.00 $789.00 $789.00 $591.75 $789.00 $789.00 $789.00 $394.50 $394.50 $624.89 $789.00 $631.20 $355.05 $789.00 $789.00 $457.62 $789.00 $473.40 $789.00 $789.00 $789.00 N/A N/A 27803881 EAP HCPCS C1760 SPH100500-20 MIRCROCOIL PLATIN BOTH IP/OP "$3,686.00" "$2,728.00" $731.58 "$3,686.00" "$1,658.70" "$1,658.70" "$1,658.70" "$1,658.70" "$3,686.00" "$3,686.00" "$3,686.00" $768.25 "$3,686.00" "$3,686.00" "$3,686.00" "$3,686.00" "$3,686.00" $768.20 "$3,686.00" "$3,686.00" "$1,817.20" "$3,686.00" "$3,686.00" "$3,686.00" "$3,686.00" "$2,764.50" "$3,686.00" "$3,686.00" "$3,686.00" "$1,843.00" "$1,843.00" "$2,919.31" "$3,686.00" "$2,948.80" "$1,658.70" $731.58 "$3,686.00" "$2,137.88" "$3,686.00" "$3,686.00" "$3,686.00" $768.16 "$3,686.00" N/A N/A 27803882 EAP HCPCS C1760 SPH100620-20 MICROCOIL PLATINU BOTH IP/OP "$3,885.00" "$2,875.00" $771.08 "$3,885.00" "$1,748.25" "$1,748.25" "$1,748.25" "$1,748.25" "$3,885.00" "$3,885.00" "$3,885.00" $809.73 "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" $809.68 "$3,885.00" "$3,885.00" "$1,915.31" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$2,913.75" "$3,885.00" "$3,885.00" "$3,885.00" "$1,942.50" "$1,942.50" "$3,076.92" "$3,885.00" "$3,108.00" "$1,748.25" $771.08 "$3,885.00" "$2,253.30" "$3,885.00" "$3,885.00" "$3,885.00" $809.63 "$3,885.00" N/A N/A 27803883 EAP HCPCS C1760 SPH100700-20 MICROCOIL PLATINU BOTH IP/OP "$3,770.00" "$2,790.00" $748.25 "$3,770.00" "$1,696.50" "$1,696.50" "$1,696.50" "$1,696.50" "$3,770.00" "$3,770.00" "$3,770.00" $785.76 "$3,770.00" "$3,770.00" "$3,770.00" "$3,770.00" "$3,770.00" $785.71 "$3,770.00" "$3,770.00" "$1,858.61" "$3,770.00" "$3,770.00" "$3,770.00" "$3,770.00" "$2,827.50" "$3,770.00" "$3,770.00" "$3,770.00" "$1,885.00" "$1,885.00" "$2,985.84" "$3,770.00" "$3,016.00" "$1,696.50" $748.25 "$3,770.00" "$2,186.60" "$3,770.00" "$3,770.00" "$3,770.00" $785.67 "$3,770.00" N/A N/A 27803884 EAP HCPCS C1760 SPH100720-20 MICROCOIL PLATINU BOTH IP/OP "$3,885.00" "$2,875.00" $771.08 "$3,885.00" "$1,748.25" "$1,748.25" "$1,748.25" "$1,748.25" "$3,885.00" "$3,885.00" "$3,885.00" $809.73 "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" $809.68 "$3,885.00" "$3,885.00" "$1,915.31" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$2,913.75" "$3,885.00" "$3,885.00" "$3,885.00" "$1,942.50" "$1,942.50" "$3,076.92" "$3,885.00" "$3,108.00" "$1,748.25" $771.08 "$3,885.00" "$2,253.30" "$3,885.00" "$3,885.00" "$3,885.00" $809.63 "$3,885.00" N/A N/A 27803885 EAP HCPCS C1760 SPH100800-20 MICROIL PLATINUM BOTH IP/OP "$3,819.00" "$2,826.50" $757.98 "$3,819.00" "$1,718.55" "$1,718.55" "$1,718.55" "$1,718.55" "$3,819.00" "$3,819.00" "$3,819.00" $795.98 "$3,819.00" "$3,819.00" "$3,819.00" "$3,819.00" "$3,819.00" $795.92 "$3,819.00" "$3,819.00" "$1,882.77" "$3,819.00" "$3,819.00" "$3,819.00" "$3,819.00" "$2,864.25" "$3,819.00" "$3,819.00" "$3,819.00" "$1,909.50" "$1,909.50" "$3,024.65" "$3,819.00" "$3,055.20" "$1,718.55" $757.98 "$3,819.00" "$2,215.02" "$3,819.00" "$3,819.00" "$3,819.00" $795.88 "$3,819.00" N/A N/A 27803886 EAP HCPCS C1760 SPH100825-20 MICROCOIL PLATINU BOTH IP/OP "$3,986.00" "$2,950.00" $791.12 "$3,986.00" "$1,793.70" "$1,793.70" "$1,793.70" "$1,793.70" "$3,986.00" "$3,986.00" "$3,986.00" $830.78 "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" $830.73 "$3,986.00" "$3,986.00" "$1,965.10" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$2,989.50" "$3,986.00" "$3,986.00" "$3,986.00" "$1,993.00" "$1,993.00" "$3,156.91" "$3,986.00" "$3,188.80" "$1,793.70" $791.12 "$3,986.00" "$2,311.88" "$3,986.00" "$3,986.00" "$3,986.00" $830.68 "$3,986.00" N/A N/A 27803887 EAP HCPCS C1760 SPH100925-20 MICROCOIL PLATINU BOTH IP/OP "$3,986.00" "$2,950.00" $791.12 "$3,986.00" "$1,793.70" "$1,793.70" "$1,793.70" "$1,793.70" "$3,986.00" "$3,986.00" "$3,986.00" $830.78 "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" $830.73 "$3,986.00" "$3,986.00" "$1,965.10" "$3,986.00" "$3,986.00" "$3,986.00" "$3,986.00" "$2,989.50" "$3,986.00" "$3,986.00" "$3,986.00" "$1,993.00" "$1,993.00" "$3,156.91" "$3,986.00" "$3,188.80" "$1,793.70" $791.12 "$3,986.00" "$2,311.88" "$3,986.00" "$3,986.00" "$3,986.00" $830.68 "$3,986.00" N/A N/A 27803888 EAP HCPCS C1760 SPH101000-20 MICROCOIL PLATINU BOTH IP/OP "$3,885.00" "$2,875.00" $771.08 "$3,885.00" "$1,748.25" "$1,748.25" "$1,748.25" "$1,748.25" "$3,885.00" "$3,885.00" "$3,885.00" $809.73 "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" $809.68 "$3,885.00" "$3,885.00" "$1,915.31" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$2,913.75" "$3,885.00" "$3,885.00" "$3,885.00" "$1,942.50" "$1,942.50" "$3,076.92" "$3,885.00" "$3,108.00" "$1,748.25" $771.08 "$3,885.00" "$2,253.30" "$3,885.00" "$3,885.00" "$3,885.00" $809.63 "$3,885.00" N/A N/A 27803889 EAP HCPCS C1760 SPH181100-20 MICROCOIL PLATINU BOTH IP/OP "$3,885.00" "$2,875.00" $771.08 "$3,885.00" "$1,748.25" "$1,748.25" "$1,748.25" "$1,748.25" "$3,885.00" "$3,885.00" "$3,885.00" $809.73 "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" $809.68 "$3,885.00" "$3,885.00" "$1,915.31" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$2,913.75" "$3,885.00" "$3,885.00" "$3,885.00" "$1,942.50" "$1,942.50" "$3,076.92" "$3,885.00" "$3,108.00" "$1,748.25" $771.08 "$3,885.00" "$2,253.30" "$3,885.00" "$3,885.00" "$3,885.00" $809.63 "$3,885.00" N/A N/A 27803890 EAP HCPCS C1760 SPH181200-20 MICROCOIL PLATINU BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 "$3,920.00" "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A 27803891 EAP HCPCS C1760 SPH181300-20 MICROCOIL PLATINU BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 "$3,920.00" "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A 27803892 EAP HCPCS C1760 SPH181400-20 MICROCOIL PLATINU BOTH IP/OP "$3,955.00" "$2,927.00" $784.97 "$3,955.00" "$1,779.75" "$1,779.75" "$1,779.75" "$1,779.75" "$3,955.00" "$3,955.00" "$3,955.00" $824.32 "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" $824.27 "$3,955.00" "$3,955.00" "$1,949.82" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$2,966.25" "$3,955.00" "$3,955.00" "$3,955.00" "$1,977.50" "$1,977.50" "$3,132.36" "$3,955.00" "$3,164.00" "$1,779.75" $784.97 "$3,955.00" "$2,293.90" "$3,955.00" "$3,955.00" "$3,955.00" $824.22 "$3,955.00" N/A N/A 27803893 EAP HCPCS C1760 SPH181500-20 MICROCOIL PLATINU BOTH IP/OP "$4,005.00" "$2,964.00" $794.89 "$4,005.00" "$1,802.25" "$1,802.25" "$1,802.25" "$1,802.25" "$4,005.00" "$4,005.00" "$4,005.00" $834.74 "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" $834.69 "$4,005.00" "$4,005.00" "$1,974.47" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$3,003.75" "$4,005.00" "$4,005.00" "$4,005.00" "$2,002.50" "$2,002.50" "$3,171.96" "$4,005.00" "$3,204.00" "$1,802.25" $794.89 "$4,005.00" "$2,322.90" "$4,005.00" "$4,005.00" "$4,005.00" $834.64 "$4,005.00" N/A N/A 27803894 EAP HCPCS C1760 SPH181600-20 MICROCOIL PLATINU BOTH IP/OP "$4,020.00" "$2,975.00" $797.87 "$4,020.00" "$1,809.00" "$1,809.00" "$1,809.00" "$1,809.00" "$4,020.00" "$4,020.00" "$4,020.00" $837.87 "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" $837.81 "$4,020.00" "$4,020.00" "$1,981.86" "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" "$3,015.00" "$4,020.00" "$4,020.00" "$4,020.00" "$2,010.00" "$2,010.00" "$3,183.84" "$4,020.00" "$3,216.00" "$1,809.00" $797.87 "$4,020.00" "$2,331.60" "$4,020.00" "$4,020.00" "$4,020.00" $837.77 "$4,020.00" N/A N/A 27803895 EAP HCPCS C1760 SPH181700-20 MICROCOIL PLATINU BOTH IP/OP "$4,071.00" "$3,013.00" $807.99 "$4,071.00" "$1,831.95" "$1,831.95" "$1,831.95" "$1,831.95" "$4,071.00" "$4,071.00" "$4,071.00" $848.50 "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" $848.44 "$4,071.00" "$4,071.00" "$2,007.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$3,053.25" "$4,071.00" "$4,071.00" "$4,071.00" "$2,035.50" "$2,035.50" "$3,224.23" "$4,071.00" "$3,256.80" "$1,831.95" $807.99 "$4,071.00" "$2,361.18" "$4,071.00" "$4,071.00" "$4,071.00" $848.40 "$4,071.00" N/A N/A 27803896 EAP HCPCS C1760 SPH181800-20 MICROCOIL PLATINU BOTH IP/OP "$4,071.00" "$3,013.00" $807.99 "$4,071.00" "$1,831.95" "$1,831.95" "$1,831.95" "$1,831.95" "$4,071.00" "$4,071.00" "$4,071.00" $848.50 "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" $848.44 "$4,071.00" "$4,071.00" "$2,007.00" "$4,071.00" "$4,071.00" "$4,071.00" "$4,071.00" "$3,053.25" "$4,071.00" "$4,071.00" "$4,071.00" "$2,035.50" "$2,035.50" "$3,224.23" "$4,071.00" "$3,256.80" "$1,831.95" $807.99 "$4,071.00" "$2,361.18" "$4,071.00" "$4,071.00" "$4,071.00" $848.40 "$4,071.00" N/A N/A 27803897 EAP HCPCS C1760 SRC140306-20 MICROCOIL PLATINU BOTH IP/OP "$3,885.00" "$2,875.00" $771.08 "$3,885.00" "$1,748.25" "$1,748.25" "$1,748.25" "$1,748.25" "$3,885.00" "$3,885.00" "$3,885.00" $809.73 "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" $809.68 "$3,885.00" "$3,885.00" "$1,915.31" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$2,913.75" "$3,885.00" "$3,885.00" "$3,885.00" "$1,942.50" "$1,942.50" "$3,076.92" "$3,885.00" "$3,108.00" "$1,748.25" $771.08 "$3,885.00" "$2,253.30" "$3,885.00" "$3,885.00" "$3,885.00" $809.63 "$3,885.00" N/A N/A 27803898 EAP HCPCS C1760 SRC140445-20MICROCOIL PLATINUM BOTH IP/OP "$3,885.00" "$2,875.00" $771.08 "$3,885.00" "$1,748.25" "$1,748.25" "$1,748.25" "$1,748.25" "$3,885.00" "$3,885.00" "$3,885.00" $809.73 "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" $809.68 "$3,885.00" "$3,885.00" "$1,915.31" "$3,885.00" "$3,885.00" "$3,885.00" "$3,885.00" "$2,913.75" "$3,885.00" "$3,885.00" "$3,885.00" "$1,942.50" "$1,942.50" "$3,076.92" "$3,885.00" "$3,108.00" "$1,748.25" $771.08 "$3,885.00" "$2,253.30" "$3,885.00" "$3,885.00" "$3,885.00" $809.63 "$3,885.00" N/A N/A 27803899 EAP HCPCS C1760 SRC140406-20 MICROCOIL PLATINU BOTH IP/OP "$3,903.00" "$2,888.50" $774.65 "$3,903.00" "$1,756.35" "$1,756.35" "$1,756.35" "$1,756.35" "$3,903.00" "$3,903.00" "$3,903.00" $813.48 "$3,903.00" "$3,903.00" "$3,903.00" "$3,903.00" "$3,903.00" $813.43 "$3,903.00" "$3,903.00" "$1,924.18" "$3,903.00" "$3,903.00" "$3,903.00" "$3,903.00" "$2,927.25" "$3,903.00" "$3,903.00" "$3,903.00" "$1,951.50" "$1,951.50" "$3,091.18" "$3,903.00" "$3,122.40" "$1,756.35" $774.65 "$3,903.00" "$2,263.74" "$3,903.00" "$3,903.00" "$3,903.00" $813.39 "$3,903.00" N/A N/A 27803900 EAP HCPCS C1760 SRC140408-20 MICROCOIL PLATINU BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 "$3,920.00" "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A 27803901 EAP HCPCS C1760 SRC140507-20 MICROCOIL MICRUSP BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 "$3,920.00" "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A 27803902 EAP HCPCS C1760 SRC140512-20 MICROCOIL PLATINU BOTH IP/OP "$3,955.00" "$2,927.00" $784.97 "$3,955.00" "$1,779.75" "$1,779.75" "$1,779.75" "$1,779.75" "$3,955.00" "$3,955.00" "$3,955.00" $824.32 "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" $824.27 "$3,955.00" "$3,955.00" "$1,949.82" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$2,966.25" "$3,955.00" "$3,955.00" "$3,955.00" "$1,977.50" "$1,977.50" "$3,132.36" "$3,955.00" "$3,164.00" "$1,779.75" $784.97 "$3,955.00" "$2,293.90" "$3,955.00" "$3,955.00" "$3,955.00" $824.22 "$3,955.00" N/A N/A 27803903 EAP HCPCS C1760 SRC140609-20 MICROCOIL PLATINU BOTH IP/OP "$3,936.00" "$2,913.00" $781.20 "$3,936.00" "$1,771.20" "$1,771.20" "$1,771.20" "$1,771.20" "$3,936.00" "$3,936.00" "$3,936.00" $820.36 "$3,936.00" "$3,936.00" "$3,936.00" "$3,936.00" "$3,936.00" $820.31 "$3,936.00" "$3,936.00" "$1,940.45" "$3,936.00" "$3,936.00" "$3,936.00" "$3,936.00" "$2,952.00" "$3,936.00" "$3,936.00" "$3,936.00" "$1,968.00" "$1,968.00" "$3,117.31" "$3,936.00" "$3,148.80" "$1,771.20" $781.20 "$3,936.00" "$2,282.88" "$3,936.00" "$3,936.00" "$3,936.00" $820.26 "$3,936.00" N/A N/A 27803904 EAP HCPCS C1760 SRC140615-20 MICROCOIL PLAINUM BOTH IP/OP "$4,005.00" "$2,964.00" $794.89 "$4,005.00" "$1,802.25" "$1,802.25" "$1,802.25" "$1,802.25" "$4,005.00" "$4,005.00" "$4,005.00" $834.74 "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" $834.69 "$4,005.00" "$4,005.00" "$1,974.47" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$3,003.75" "$4,005.00" "$4,005.00" "$4,005.00" "$2,002.50" "$2,002.50" "$3,171.96" "$4,005.00" "$3,204.00" "$1,802.25" $794.89 "$4,005.00" "$2,322.90" "$4,005.00" "$4,005.00" "$4,005.00" $834.64 "$4,005.00" N/A N/A 27803905 EAP HCPCS C1760 SRC140711-20 MICROCOIL PLATINU BOTH IP/OP "$3,955.00" "$2,927.00" $784.97 "$3,955.00" "$1,779.75" "$1,779.75" "$1,779.75" "$1,779.75" "$3,955.00" "$3,955.00" "$3,955.00" $824.32 "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" $824.27 "$3,955.00" "$3,955.00" "$1,949.82" "$3,955.00" "$3,955.00" "$3,955.00" "$3,955.00" "$2,966.25" "$3,955.00" "$3,955.00" "$3,955.00" "$1,977.50" "$1,977.50" "$3,132.36" "$3,955.00" "$3,164.00" "$1,779.75" $784.97 "$3,955.00" "$2,293.90" "$3,955.00" "$3,955.00" "$3,955.00" $824.22 "$3,955.00" N/A N/A 27803906 EAP HCPCS C1760 SRC140717-20 MICROCOIL PLATINU BOTH IP/OP "$4,105.00" "$3,038.00" $814.74 "$4,105.00" "$1,847.25" "$1,847.25" "$1,847.25" "$1,847.25" "$4,105.00" "$4,105.00" "$4,105.00" $855.58 "$4,105.00" "$4,105.00" "$4,105.00" "$4,105.00" "$4,105.00" $855.53 "$4,105.00" "$4,105.00" "$2,023.77" "$4,105.00" "$4,105.00" "$4,105.00" "$4,105.00" "$3,078.75" "$4,105.00" "$4,105.00" "$4,105.00" "$2,052.50" "$2,052.50" "$3,251.16" "$4,105.00" "$3,284.00" "$1,847.25" $814.74 "$4,105.00" "$2,380.90" "$4,105.00" "$4,105.00" "$4,105.00" $855.48 "$4,105.00" N/A N/A 27803907 EAP HCPCS C1760 SRC140812-20 MICROCOIL PLATINU BOTH IP/OP "$4,020.00" "$2,975.00" $797.87 "$4,020.00" "$1,809.00" "$1,809.00" "$1,809.00" "$1,809.00" "$4,020.00" "$4,020.00" "$4,020.00" $837.87 "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" $837.81 "$4,020.00" "$4,020.00" "$1,981.86" "$4,020.00" "$4,020.00" "$4,020.00" "$4,020.00" "$3,015.00" "$4,020.00" "$4,020.00" "$4,020.00" "$2,010.00" "$2,010.00" "$3,183.84" "$4,020.00" "$3,216.00" "$1,809.00" $797.87 "$4,020.00" "$2,331.60" "$4,020.00" "$4,020.00" "$4,020.00" $837.77 "$4,020.00" N/A N/A 27803908 EAP HCPCS C1760 SRC140820-20 MICROCOIL PLATINU BOTH IP/OP "$4,170.00" "$3,086.00" $827.64 "$4,170.00" "$1,876.50" "$1,876.50" "$1,876.50" "$1,876.50" "$4,170.00" "$4,170.00" "$4,170.00" $869.13 "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" $869.07 "$4,170.00" "$4,170.00" "$2,055.81" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$1,876.50" $827.64 "$4,170.00" "$2,418.60" "$4,170.00" "$4,170.00" "$4,170.00" $869.03 "$4,170.00" N/A N/A 27803909 EAP HCPCS C1760 SRC140922-20 MICROCOIL PLATINU BOTH IP/OP "$4,204.00" "$3,111.00" $834.39 "$4,204.00" "$1,891.80" "$1,891.80" "$1,891.80" "$1,891.80" "$4,204.00" "$4,204.00" "$4,204.00" $876.22 "$4,204.00" "$4,204.00" "$4,204.00" "$4,204.00" "$4,204.00" $876.16 "$4,204.00" "$4,204.00" "$2,072.57" "$4,204.00" "$4,204.00" "$4,204.00" "$4,204.00" "$3,153.00" "$4,204.00" "$4,204.00" "$4,204.00" "$2,102.00" "$2,102.00" "$3,329.57" "$4,204.00" "$3,363.20" "$1,891.80" $834.39 "$4,204.00" "$2,438.32" "$4,204.00" "$4,204.00" "$4,204.00" $876.11 "$4,204.00" N/A N/A 27803910 EAP HCPCS C1760 SRC141016-20 MICROCOIL PLATINU BOTH IP/OP "$4,105.00" "$3,038.00" $814.74 "$4,105.00" "$1,847.25" "$1,847.25" "$1,847.25" "$1,847.25" "$4,105.00" "$4,105.00" "$4,105.00" $855.58 "$4,105.00" "$4,105.00" "$4,105.00" "$4,105.00" "$4,105.00" $855.53 "$4,105.00" "$4,105.00" "$2,023.77" "$4,105.00" "$4,105.00" "$4,105.00" "$4,105.00" "$3,078.75" "$4,105.00" "$4,105.00" "$4,105.00" "$2,052.50" "$2,052.50" "$3,251.16" "$4,105.00" "$3,284.00" "$1,847.25" $814.74 "$4,105.00" "$2,380.90" "$4,105.00" "$4,105.00" "$4,105.00" $855.48 "$4,105.00" N/A N/A 27803911 EAP HCPCS C1760 SRC141025-20 MICROCOIL PLATINU BOTH IP/OP "$4,255.00" "$3,149.00" $844.51 "$4,255.00" "$1,914.75" "$1,914.75" "$1,914.75" "$1,914.75" "$4,255.00" "$4,255.00" "$4,255.00" $886.85 "$4,255.00" "$4,255.00" "$4,255.00" "$4,255.00" "$4,255.00" $886.79 "$4,255.00" "$4,255.00" "$2,097.72" "$4,255.00" "$4,255.00" "$4,255.00" "$4,255.00" "$3,191.25" "$4,255.00" "$4,255.00" "$4,255.00" "$2,127.50" "$2,127.50" "$3,369.96" "$4,255.00" "$3,404.00" "$1,914.75" $844.51 "$4,255.00" "$2,467.90" "$4,255.00" "$4,255.00" "$4,255.00" $886.74 "$4,255.00" N/A N/A 27803912 EAP HCPCS C1760 SRC141118-20 MICROCOIL PLATINU BOTH IP/OP "$4,170.00" "$3,086.00" $827.64 "$4,170.00" "$1,876.50" "$1,876.50" "$1,876.50" "$1,876.50" "$4,170.00" "$4,170.00" "$4,170.00" $869.13 "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" $869.07 "$4,170.00" "$4,170.00" "$2,055.81" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$1,876.50" $827.64 "$4,170.00" "$2,418.60" "$4,170.00" "$4,170.00" "$4,170.00" $869.03 "$4,170.00" N/A N/A 27803913 EAP HCPCS C1760 SRC141127-20 MICROCOIL PLATINU BOTH IP/OP "$4,304.00" "$3,185.00" $854.24 "$4,304.00" "$1,936.80" "$1,936.80" "$1,936.80" "$1,936.80" "$4,304.00" "$4,304.00" "$4,304.00" $897.06 "$4,304.00" "$4,304.00" "$4,304.00" "$4,304.00" "$4,304.00" $897.00 "$4,304.00" "$4,304.00" "$2,121.87" "$4,304.00" "$4,304.00" "$4,304.00" "$4,304.00" "$3,228.00" "$4,304.00" "$4,304.00" "$4,304.00" "$2,152.00" "$2,152.00" "$3,408.77" "$4,304.00" "$3,443.20" "$1,936.80" $854.24 "$4,304.00" "$2,496.32" "$4,304.00" "$4,304.00" "$4,304.00" $896.95 "$4,304.00" N/A N/A 27803914 EAP HCPCS C1760 SRC141219-20 MICROCOIL [PLATIN BOTH IP/OP "$4,204.00" "$3,111.00" $834.39 "$4,204.00" "$1,891.80" "$1,891.80" "$1,891.80" "$1,891.80" "$4,204.00" "$4,204.00" "$4,204.00" $876.22 "$4,204.00" "$4,204.00" "$4,204.00" "$4,204.00" "$4,204.00" $876.16 "$4,204.00" "$4,204.00" "$2,072.57" "$4,204.00" "$4,204.00" "$4,204.00" "$4,204.00" "$3,153.00" "$4,204.00" "$4,204.00" "$4,204.00" "$2,102.00" "$2,102.00" "$3,329.57" "$4,204.00" "$3,363.20" "$1,891.80" $834.39 "$4,204.00" "$2,438.32" "$4,204.00" "$4,204.00" "$4,204.00" $876.11 "$4,204.00" N/A N/A 27803915 EAP HCPCS C1760 SRC141230-20 MICROCOIL PLATINU BOTH IP/OP "$4,355.00" "$3,223.00" $864.36 "$4,355.00" "$1,959.75" "$1,959.75" "$1,959.75" "$1,959.75" "$4,355.00" "$4,355.00" "$4,355.00" $907.69 "$4,355.00" "$4,355.00" "$4,355.00" "$4,355.00" "$4,355.00" $907.63 "$4,355.00" "$4,355.00" "$2,147.02" "$4,355.00" "$4,355.00" "$4,355.00" "$4,355.00" "$3,266.25" "$4,355.00" "$4,355.00" "$4,355.00" "$2,177.50" "$2,177.50" "$3,449.16" "$4,355.00" "$3,484.00" "$1,959.75" $864.36 "$4,355.00" "$2,525.90" "$4,355.00" "$4,355.00" "$4,355.00" $907.58 "$4,355.00" N/A N/A 27803916 EAP HCPCS C1760 FSR100201-20 MICROCOIL PLATINU BOTH IP/OP "$3,135.00" "$2,320.00" $622.22 "$3,135.00" "$1,410.75" "$1,410.75" "$1,410.75" "$1,410.75" "$3,135.00" "$3,135.00" "$3,135.00" $653.41 "$3,135.00" "$3,135.00" "$3,135.00" "$3,135.00" "$3,135.00" $653.37 "$3,135.00" "$3,135.00" "$1,545.56" "$3,135.00" "$3,135.00" "$3,135.00" "$3,135.00" "$2,351.25" "$3,135.00" "$3,135.00" "$3,135.00" "$1,567.50" "$1,567.50" "$2,482.92" "$3,135.00" "$2,508.00" "$1,410.75" $622.22 "$3,135.00" "$1,818.30" "$3,135.00" "$3,135.00" "$3,135.00" $653.33 "$3,135.00" N/A N/A 27803917 EAP HCPCS C1760 FSR100202-20 MICROCOIL PLATINU BOTH IP/OP "$3,169.00" "$2,345.50" $628.97 "$3,169.00" "$1,426.05" "$1,426.05" "$1,426.05" "$1,426.05" "$3,169.00" "$3,169.00" "$3,169.00" $660.50 "$3,169.00" "$3,169.00" "$3,169.00" "$3,169.00" "$3,169.00" $660.45 "$3,169.00" "$3,169.00" "$1,562.32" "$3,169.00" "$3,169.00" "$3,169.00" "$3,169.00" "$2,376.75" "$3,169.00" "$3,169.00" "$3,169.00" "$1,584.50" "$1,584.50" "$2,509.85" "$3,169.00" "$2,535.20" "$1,426.05" $628.97 "$3,169.00" "$1,838.02" "$3,169.00" "$3,169.00" "$3,169.00" $660.42 "$3,169.00" N/A N/A 27803918 EAP HCPCS C1760 FSR100203-20 MICROCOIL PLATINU BOTH IP/OP "$3,186.00" "$2,358.00" $632.34 "$3,186.00" "$1,433.70" "$1,433.70" "$1,433.70" "$1,433.70" "$3,186.00" "$3,186.00" "$3,186.00" $664.04 "$3,186.00" "$3,186.00" "$3,186.00" "$3,186.00" "$3,186.00" $664.00 "$3,186.00" "$3,186.00" "$1,570.70" "$3,186.00" "$3,186.00" "$3,186.00" "$3,186.00" "$2,389.50" "$3,186.00" "$3,186.00" "$3,186.00" "$1,593.00" "$1,593.00" "$2,523.31" "$3,186.00" "$2,548.80" "$1,433.70" $632.34 "$3,186.00" "$1,847.88" "$3,186.00" "$3,186.00" "$3,186.00" $663.96 "$3,186.00" N/A N/A 27803919 EAP HCPCS C1760 FRS100204-20 MICROCOIL PLATINU BOTH IP/OP "$3,203.00" "$2,370.50" $635.72 "$3,203.00" "$1,441.35" "$1,441.35" "$1,441.35" "$1,441.35" "$3,203.00" "$3,203.00" "$3,203.00" $667.59 "$3,203.00" "$3,203.00" "$3,203.00" "$3,203.00" "$3,203.00" $667.54 "$3,203.00" "$3,203.00" "$1,579.08" "$3,203.00" "$3,203.00" "$3,203.00" "$3,203.00" "$2,402.25" "$3,203.00" "$3,203.00" "$3,203.00" "$1,601.50" "$1,601.50" "$2,536.78" "$3,203.00" "$2,562.40" "$1,441.35" $635.72 "$3,203.00" "$1,857.74" "$3,203.00" "$3,203.00" "$3,203.00" $667.51 "$3,203.00" N/A N/A 27803920 EAP HCPCS C1760 FSR100206-20 MICROCOIL PLATINU BOTH IP/OP "$3,236.00" "$2,395.00" $642.27 "$3,236.00" "$1,456.20" "$1,456.20" "$1,456.20" "$1,456.20" "$3,236.00" "$3,236.00" "$3,236.00" $674.46 "$3,236.00" "$3,236.00" "$3,236.00" "$3,236.00" "$3,236.00" $674.42 "$3,236.00" "$3,236.00" "$1,595.35" "$3,236.00" "$3,236.00" "$3,236.00" "$3,236.00" "$2,427.00" "$3,236.00" "$3,236.00" "$3,236.00" "$1,618.00" "$1,618.00" "$2,562.91" "$3,236.00" "$2,588.80" "$1,456.20" $642.27 "$3,236.00" "$1,876.88" "$3,236.00" "$3,236.00" "$3,236.00" $674.38 "$3,236.00" N/A N/A 27803921 EAP HCPCS C1760 FSR100208-20 MICROCOIL PLATINU BOTH IP/OP "$3,270.00" "$2,420.00" $649.01 "$3,270.00" "$1,471.50" "$1,471.50" "$1,471.50" "$1,471.50" "$3,270.00" "$3,270.00" "$3,270.00" $681.55 "$3,270.00" "$3,270.00" "$3,270.00" "$3,270.00" "$3,270.00" $681.50 "$3,270.00" "$3,270.00" "$1,612.11" "$3,270.00" "$3,270.00" "$3,270.00" "$3,270.00" "$2,452.50" "$3,270.00" "$3,270.00" "$3,270.00" "$1,635.00" "$1,635.00" "$2,589.84" "$3,270.00" "$2,616.00" "$1,471.50" $649.01 "$3,270.00" "$1,896.60" "$3,270.00" "$3,270.00" "$3,270.00" $681.47 "$3,270.00" N/A N/A 27803922 EAP HCPCS C1760 FSR100252-20 MICROCOIL PLATINU BOTH IP/OP "$3,169.00" "$2,345.50" $628.97 "$3,169.00" "$1,426.05" "$1,426.05" "$1,426.05" "$1,426.05" "$3,169.00" "$3,169.00" "$3,169.00" $660.50 "$3,169.00" "$3,169.00" "$3,169.00" "$3,169.00" "$3,169.00" $660.45 "$3,169.00" "$3,169.00" "$1,562.32" "$3,169.00" "$3,169.00" "$3,169.00" "$3,169.00" "$2,376.75" "$3,169.00" "$3,169.00" "$3,169.00" "$1,584.50" "$1,584.50" "$2,509.85" "$3,169.00" "$2,535.20" "$1,426.05" $628.97 "$3,169.00" "$1,838.02" "$3,169.00" "$3,169.00" "$3,169.00" $660.42 "$3,169.00" N/A N/A 27803923 EAP HCPCS C1760 FSR100254-20 MICROCOIL PLATINU BOTH IP/OP "$3,203.00" "$2,370.50" $635.72 "$3,203.00" "$1,441.35" "$1,441.35" "$1,441.35" "$1,441.35" "$3,203.00" "$3,203.00" "$3,203.00" $667.59 "$3,203.00" "$3,203.00" "$3,203.00" "$3,203.00" "$3,203.00" $667.54 "$3,203.00" "$3,203.00" "$1,579.08" "$3,203.00" "$3,203.00" "$3,203.00" "$3,203.00" "$2,402.25" "$3,203.00" "$3,203.00" "$3,203.00" "$1,601.50" "$1,601.50" "$2,536.78" "$3,203.00" "$2,562.40" "$1,441.35" $635.72 "$3,203.00" "$1,857.74" "$3,203.00" "$3,203.00" "$3,203.00" $667.51 "$3,203.00" N/A N/A 27803924 EAP HCPCS C1760 FSR100256-20 MICROCOIL PLATINU BOTH IP/OP "$3,236.00" "$2,395.00" $642.27 "$3,236.00" "$1,456.20" "$1,456.20" "$1,456.20" "$1,456.20" "$3,236.00" "$3,236.00" "$3,236.00" $674.46 "$3,236.00" "$3,236.00" "$3,236.00" "$3,236.00" "$3,236.00" $674.42 "$3,236.00" "$3,236.00" "$1,595.35" "$3,236.00" "$3,236.00" "$3,236.00" "$3,236.00" "$2,427.00" "$3,236.00" "$3,236.00" "$3,236.00" "$1,618.00" "$1,618.00" "$2,562.91" "$3,236.00" "$2,588.80" "$1,456.20" $642.27 "$3,236.00" "$1,876.88" "$3,236.00" "$3,236.00" "$3,236.00" $674.38 "$3,236.00" N/A N/A 27803925 EAP HCPCS C1760 FSR100258-20 MICROCOIL PLATINU BOTH IP/OP "$3,270.00" "$2,420.00" $649.01 "$3,270.00" "$1,471.50" "$1,471.50" "$1,471.50" "$1,471.50" "$3,270.00" "$3,270.00" "$3,270.00" $681.55 "$3,270.00" "$3,270.00" "$3,270.00" "$3,270.00" "$3,270.00" $681.50 "$3,270.00" "$3,270.00" "$1,612.11" "$3,270.00" "$3,270.00" "$3,270.00" "$3,270.00" "$2,452.50" "$3,270.00" "$3,270.00" "$3,270.00" "$1,635.00" "$1,635.00" "$2,589.84" "$3,270.00" "$2,616.00" "$1,471.50" $649.01 "$3,270.00" "$1,896.60" "$3,270.00" "$3,270.00" "$3,270.00" $681.47 "$3,270.00" N/A N/A 27803926 EAP HCPCS C1760 FSR100306-20 MICROCOIL PLATINU BOTH IP/OP "$3,236.00" "$2,395.00" $642.27 "$3,236.00" "$1,456.20" "$1,456.20" "$1,456.20" "$1,456.20" "$3,236.00" "$3,236.00" "$3,236.00" $674.46 "$3,236.00" "$3,236.00" "$3,236.00" "$3,236.00" "$3,236.00" $674.42 "$3,236.00" "$3,236.00" "$1,595.35" "$3,236.00" "$3,236.00" "$3,236.00" "$3,236.00" "$2,427.00" "$3,236.00" "$3,236.00" "$3,236.00" "$1,618.00" "$1,618.00" "$2,562.91" "$3,236.00" "$2,588.80" "$1,456.20" $642.27 "$3,236.00" "$1,876.88" "$3,236.00" "$3,236.00" "$3,236.00" $674.38 "$3,236.00" N/A N/A 27803927 EAP HCPCS C1760 FSR100308-20 MICROCOIL PLATINU BOTH IP/OP "$3,270.00" "$2,420.00" $649.01 "$3,270.00" "$1,471.50" "$1,471.50" "$1,471.50" "$1,471.50" "$3,270.00" "$3,270.00" "$3,270.00" $681.55 "$3,270.00" "$3,270.00" "$3,270.00" "$3,270.00" "$3,270.00" $681.50 "$3,270.00" "$3,270.00" "$1,612.11" "$3,270.00" "$3,270.00" "$3,270.00" "$3,270.00" "$2,452.50" "$3,270.00" "$3,270.00" "$3,270.00" "$1,635.00" "$1,635.00" "$2,589.84" "$3,270.00" "$2,616.00" "$1,471.50" $649.01 "$3,270.00" "$1,896.60" "$3,270.00" "$3,270.00" "$3,270.00" $681.47 "$3,270.00" N/A N/A 27803928 EAP HCPCS C1760 FSR100406-20 MICROCOIL PLATINU BOTH IP/OP "$3,236.00" "$2,395.00" $642.27 "$3,236.00" "$1,456.20" "$1,456.20" "$1,456.20" "$1,456.20" "$3,236.00" "$3,236.00" "$3,236.00" $674.46 "$3,236.00" "$3,236.00" "$3,236.00" "$3,236.00" "$3,236.00" $674.42 "$3,236.00" "$3,236.00" "$1,595.35" "$3,236.00" "$3,236.00" "$3,236.00" "$3,236.00" "$2,427.00" "$3,236.00" "$3,236.00" "$3,236.00" "$1,618.00" "$1,618.00" "$2,562.91" "$3,236.00" "$2,588.80" "$1,456.20" $642.27 "$3,236.00" "$1,876.88" "$3,236.00" "$3,236.00" "$3,236.00" $674.38 "$3,236.00" N/A N/A 27803929 EAP HCPCS C1760 FSR100408-20 MICROCOIL PLATINU BOTH IP/OP "$3,270.00" "$2,420.00" $649.01 "$3,270.00" "$1,471.50" "$1,471.50" "$1,471.50" "$1,471.50" "$3,270.00" "$3,270.00" "$3,270.00" $681.55 "$3,270.00" "$3,270.00" "$3,270.00" "$3,270.00" "$3,270.00" $681.50 "$3,270.00" "$3,270.00" "$1,612.11" "$3,270.00" "$3,270.00" "$3,270.00" "$3,270.00" "$2,452.50" "$3,270.00" "$3,270.00" "$3,270.00" "$1,635.00" "$1,635.00" "$2,589.84" "$3,270.00" "$2,616.00" "$1,471.50" $649.01 "$3,270.00" "$1,896.60" "$3,270.00" "$3,270.00" "$3,270.00" $681.47 "$3,270.00" N/A N/A 27803940 EAP HCPCS C1888 "ENDOVASCULAR LASER CATHETER, ABL" BOTH IP/OP "$1,226.00" $907.50 $255.51 "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" $255.51 "$1,226.00" $490.40 "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" $919.50 "$1,226.00" "$1,226.00" "$1,226.00" $613.00 $613.00 $970.99 "$1,226.00" $980.80 $551.70 "$1,226.00" "$1,226.00" $711.08 "$1,226.00" $735.60 "$1,226.00" "$1,226.00" "$1,226.00" N/A N/A 27803941 EAP HCPCS C1874 VIATOR STENT 10 X 4 BOTH IP/OP "$11,885.00" "$8,795.00" "$2,358.88" "$11,885.00" "$5,348.25" "$5,348.25" "$5,348.25" "$5,348.25" "$11,885.00" "$11,885.00" "$11,885.00" "$2,477.13" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$2,476.96" "$11,885.00" "$11,885.00" "$5,859.31" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$8,913.75" "$11,885.00" "$11,885.00" "$11,885.00" "$5,942.50" "$5,942.50" "$9,412.92" "$11,885.00" "$9,508.00" "$5,348.25" "$2,358.88" "$11,885.00" "$6,893.30" "$11,885.00" "$7,131.00" "$11,885.00" "$2,476.83" "$11,885.00" N/A N/A 27803942 EAP HCPCS C1874 VIATOR STENT 10 X 5 BOTH IP/OP "$11,885.00" "$8,795.00" "$2,358.88" "$11,885.00" "$5,348.25" "$5,348.25" "$5,348.25" "$5,348.25" "$11,885.00" "$11,885.00" "$11,885.00" "$2,477.13" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$2,476.96" "$11,885.00" "$11,885.00" "$5,859.31" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$8,913.75" "$11,885.00" "$11,885.00" "$11,885.00" "$5,942.50" "$5,942.50" "$9,412.92" "$11,885.00" "$9,508.00" "$5,348.25" "$2,358.88" "$11,885.00" "$6,893.30" "$11,885.00" "$7,131.00" "$11,885.00" "$2,476.83" "$11,885.00" N/A N/A 27803943 EAP HCPCS C1874 VIATOR STENT 10 X 6 BOTH IP/OP "$11,885.00" "$8,795.00" "$2,358.88" "$11,885.00" "$5,348.25" "$5,348.25" "$5,348.25" "$5,348.25" "$11,885.00" "$11,885.00" "$11,885.00" "$2,477.13" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$2,476.96" "$11,885.00" "$11,885.00" "$5,859.31" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$8,913.75" "$11,885.00" "$11,885.00" "$11,885.00" "$5,942.50" "$5,942.50" "$9,412.92" "$11,885.00" "$9,508.00" "$5,348.25" "$2,358.88" "$11,885.00" "$6,893.30" "$11,885.00" "$7,131.00" "$11,885.00" "$2,476.83" "$11,885.00" N/A N/A 27803944 EAP HCPCS C1874 VIATOR STENT 10 X 7 BOTH IP/OP "$11,885.00" "$8,795.00" "$2,358.88" "$11,885.00" "$5,348.25" "$5,348.25" "$5,348.25" "$5,348.25" "$11,885.00" "$11,885.00" "$11,885.00" "$2,477.13" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$2,476.96" "$11,885.00" "$11,885.00" "$5,859.31" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$8,913.75" "$11,885.00" "$11,885.00" "$11,885.00" "$5,942.50" "$5,942.50" "$9,412.92" "$11,885.00" "$9,508.00" "$5,348.25" "$2,358.88" "$11,885.00" "$6,893.30" "$11,885.00" "$7,131.00" "$11,885.00" "$2,476.83" "$11,885.00" N/A N/A 27803945 EAP HCPCS C1874 VIATOR STENT 10 X 8 BOTH IP/OP "$11,885.00" "$8,795.00" "$2,358.88" "$11,885.00" "$5,348.25" "$5,348.25" "$5,348.25" "$5,348.25" "$11,885.00" "$11,885.00" "$11,885.00" "$2,477.13" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$2,476.96" "$11,885.00" "$11,885.00" "$5,859.31" "$11,885.00" "$11,885.00" "$11,885.00" "$11,885.00" "$8,913.75" "$11,885.00" "$11,885.00" "$11,885.00" "$5,942.50" "$5,942.50" "$9,412.92" "$11,885.00" "$9,508.00" "$5,348.25" "$2,358.88" "$11,885.00" "$6,893.30" "$11,885.00" "$11,885.00" "$11,885.00" "$2,476.83" "$11,885.00" N/A N/A 27803950 EAP HCPCS V2790 PROKERA (AMNIOGRAFT) RING 16MM BOTH IP/OP "$3,167.00" "$2,344.00" $628.57 "$3,167.00" "$1,425.15" "$1,425.15" "$1,425.15" "$1,425.15" "$3,167.00" "$3,167.00" "$3,167.00" $660.08 "$3,167.00" "$3,167.00" "$3,167.00" "$3,167.00" "$3,167.00" $660.04 "$3,167.00" "$3,167.00" "$1,561.33" "$3,167.00" "$3,167.00" "$3,167.00" "$3,167.00" "$2,375.25" "$3,167.00" "$3,167.00" "$3,167.00" "$1,583.50" "$1,583.50" "$2,508.26" "$3,167.00" "$2,533.60" "$1,425.15" $628.57 "$3,167.00" "$1,836.86" "$3,167.00" "$3,167.00" "$3,167.00" $660.00 "$3,167.00" N/A N/A 27803951 EAP HCPCS C1882 CRT-D 40 UNIFY (ICD) BOTH IP/OP "$89,408.00" "$66,162.00" "$7,712.84" "$89,408.00" "$40,233.60" "$40,233.60" "$40,233.60" "$40,233.60" "$89,408.00" "$89,408.00" "$89,408.00" "$9,417.94" "$89,408.00" "$89,408.00" "$89,408.00" "$89,408.00" "$89,408.00" "$18,633.61" "$89,408.00" "$89,408.00" "$44,078.14" "$89,408.00" "$89,408.00" "$89,408.00" "$89,408.00" "$67,056.00" "$89,408.00" "$89,408.00" "$89,408.00" "$44,704.00" "$44,704.00" "$70,811.14" "$89,408.00" "$71,526.40" "$40,233.60" "$7,712.84" "$89,408.00" "$51,856.64" "$89,408.00" "$89,408.00" "$89,408.00" "$8,098.48" "$89,408.00" N/A N/A 27803952 EAP HCPCS C1722 FORTIFY ICD-VR40 BOTH IP/OP "$60,048.00" "$44,436.00" "$7,712.84" "$60,048.00" "$27,021.60" "$27,021.60" "$27,021.60" "$27,021.60" "$60,048.00" "$60,048.00" "$60,048.00" "$9,417.94" "$60,048.00" "$60,048.00" "$60,048.00" "$60,048.00" "$60,048.00" "$12,514.66" "$60,048.00" "$60,048.00" "$29,603.66" "$60,048.00" "$60,048.00" "$60,048.00" "$60,048.00" "$45,036.00" "$60,048.00" "$60,048.00" "$60,048.00" "$30,024.00" "$30,024.00" "$47,558.02" "$60,048.00" "$48,038.40" "$27,021.60" "$7,712.84" "$60,048.00" "$34,827.84" "$60,048.00" "$60,048.00" "$60,048.00" "$8,098.48" "$60,048.00" N/A N/A 27803960 EAP HCPCS C1886 "CATHETER, ABLATION" BOTH IP/OP $310.00 $229.50 $64.61 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $64.61 $310.00 $124.00 $310.00 $310.00 $310.00 $310.00 $310.00 $232.50 $310.00 $310.00 $310.00 $155.00 $155.00 $245.52 $310.00 $248.00 $139.50 $310.00 $310.00 $179.80 $310.00 $186.00 $310.00 $310.00 $310.00 N/A N/A 27803961 EAP HCPCS C2617 GORE VIATORR TIPS ENDOPROSTHESIS 4CM X 2CM X12MM BOTH IP/OP "$4,843.00" "$3,584.00" $961.21 "$4,843.00" "$2,179.35" "$2,179.35" "$2,179.35" "$2,179.35" "$4,843.00" "$4,843.00" "$4,843.00" "$1,009.40" "$4,843.00" "$4,843.00" "$4,843.00" "$4,843.00" "$4,843.00" "$1,009.33" "$4,843.00" "$4,843.00" "$2,387.60" "$4,843.00" "$4,843.00" "$4,843.00" "$4,843.00" "$3,632.25" "$4,843.00" "$4,843.00" "$4,843.00" "$2,421.50" "$2,421.50" "$3,835.66" "$4,843.00" "$3,874.40" "$2,179.35" $961.21 "$4,843.00" "$2,808.94" "$4,843.00" "$4,843.00" "$4,843.00" "$1,009.28" "$4,843.00" N/A N/A 27803962 EAP HCPCS C2617 GORE VIATORR TIPS ENDOPROSTHESIS 6CM X 2CM X 12MM BOTH IP/OP "$4,843.00" "$3,584.00" $961.21 "$4,843.00" "$2,179.35" "$2,179.35" "$2,179.35" "$2,179.35" "$4,843.00" "$4,843.00" "$4,843.00" "$1,009.40" "$4,843.00" "$4,843.00" "$4,843.00" "$4,843.00" "$4,843.00" "$1,009.33" "$4,843.00" "$4,843.00" "$2,387.60" "$4,843.00" "$4,843.00" "$4,843.00" "$4,843.00" "$3,632.25" "$4,843.00" "$4,843.00" "$4,843.00" "$2,421.50" "$2,421.50" "$3,835.66" "$4,843.00" "$3,874.40" "$2,179.35" $961.21 "$4,843.00" "$2,808.94" "$4,843.00" "$4,843.00" "$4,843.00" "$1,009.28" "$4,843.00" N/A N/A 27803963 EAP HCPCS C2617 GORE VIATORR TIPS ENDOPROSTHESIS 8CM X 2CM X 12MM BOTH IP/OP "$4,843.00" "$3,584.00" $961.21 "$4,843.00" "$2,179.35" "$2,179.35" "$2,179.35" "$2,179.35" "$4,843.00" "$4,843.00" "$4,843.00" "$1,009.40" "$4,843.00" "$4,843.00" "$4,843.00" "$4,843.00" "$4,843.00" "$1,009.33" "$4,843.00" "$4,843.00" "$2,387.60" "$4,843.00" "$4,843.00" "$4,843.00" "$4,843.00" "$3,632.25" "$4,843.00" "$4,843.00" "$4,843.00" "$2,421.50" "$2,421.50" "$3,835.66" "$4,843.00" "$3,874.40" "$2,179.35" $961.21 "$4,843.00" "$2,808.94" "$4,843.00" "$4,843.00" "$4,843.00" "$1,009.28" "$4,843.00" N/A N/A 27803964 EAP HCPCS C2617 GORE VIABIL ENDOPROSTHESIS 10MM X 4CM X 40CM BOTH IP/OP "$3,216.00" "$2,380.00" $638.30 "$3,216.00" "$1,447.20" "$1,447.20" "$1,447.20" "$1,447.20" "$3,216.00" "$3,216.00" "$3,216.00" $670.29 "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" $670.25 "$3,216.00" "$3,216.00" "$1,585.49" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$2,412.00" "$3,216.00" "$3,216.00" "$3,216.00" "$1,608.00" "$1,608.00" "$2,547.07" "$3,216.00" "$2,572.80" "$1,447.20" $638.30 "$3,216.00" "$1,865.28" "$3,216.00" "$3,216.00" "$3,216.00" $670.21 "$3,216.00" N/A N/A 27803965 EAP HCPCS C2617 GORE VIABIL ENDOPROSTHESIS 10MM X 6CM X 40CM BOTH IP/OP "$3,216.00" "$2,380.00" $638.30 "$3,216.00" "$1,447.20" "$1,447.20" "$1,447.20" "$1,447.20" "$3,216.00" "$3,216.00" "$3,216.00" $670.29 "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" $670.25 "$3,216.00" "$3,216.00" "$1,585.49" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$2,412.00" "$3,216.00" "$3,216.00" "$3,216.00" "$1,608.00" "$1,608.00" "$2,547.07" "$3,216.00" "$2,572.80" "$1,447.20" $638.30 "$3,216.00" "$1,865.28" "$3,216.00" "$3,216.00" "$3,216.00" $670.21 "$3,216.00" N/A N/A 27803966 EAP HCPCS C2617 GORE VIABIL ENDOPROSTHESIS 10MM X 8CM X 40CM BOTH IP/OP "$3,216.00" "$2,380.00" $638.30 "$3,216.00" "$1,746.29" "$1,746.29" "$1,746.29" "$1,746.29" "$3,216.00" "$3,216.00" "$3,216.00" $670.29 "$3,216.00" "$2,386.92" "$2,386.92" "$2,478.89" "$1,675.54" $670.25 "$3,216.00" "$3,216.00" "$1,902.26" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$2,412.00" "$3,216.00" "$3,216.00" "$3,216.00" "$1,608.00" "$1,608.00" "$2,547.07" "$3,216.00" "$2,572.80" "$2,090.40" $638.30 "$3,216.00" "$1,865.28" "$3,216.00" "$3,216.00" "$3,216.00" $670.21 "$3,216.00" N/A N/A 27803967 EAP HCPCS C2617 GORE VIABIL ENDOPROSTHESIS 10MM X 10CM X 40CM BOTH IP/OP "$3,216.00" "$2,380.00" $638.30 "$3,216.00" "$1,447.20" "$1,447.20" "$1,447.20" "$1,447.20" "$3,216.00" "$3,216.00" "$3,216.00" $670.29 "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" $670.25 "$3,216.00" "$3,216.00" "$1,585.49" "$3,216.00" "$3,216.00" "$3,216.00" "$3,216.00" "$2,412.00" "$3,216.00" "$3,216.00" "$3,216.00" "$1,608.00" "$1,608.00" "$2,547.07" "$3,216.00" "$2,572.80" "$1,447.20" $638.30 "$3,216.00" "$1,865.28" "$3,216.00" "$3,216.00" "$3,216.00" $670.21 "$3,216.00" N/A N/A 27803968 EAP HCPCS C1713 AMPLATZ ANCHOR SYSTEM 8 X 30 BOTH IP/OP $117.00 $87.00 $23.22 $117.00 $52.65 $52.65 $52.65 $52.65 $117.00 $117.00 $117.00 $24.39 $117.00 $117.00 $117.00 $117.00 $117.00 $24.38 $117.00 $117.00 $69.21 $117.00 $117.00 $117.00 $117.00 $87.75 $117.00 $117.00 $117.00 $58.50 $58.50 $92.66 $117.00 $93.60 $52.65 $23.22 $117.00 $67.86 $117.00 $117.00 $117.00 $24.38 $117.00 N/A N/A 27803969 EAP HCPCS C1713 AMPLATZ ANCHOR SYSTEM 10 X 30 BOTH IP/OP $117.00 $87.00 $23.22 $117.00 $52.65 $52.65 $52.65 $52.65 $117.00 $117.00 $117.00 $24.39 $117.00 $117.00 $117.00 $117.00 $117.00 $24.38 $117.00 $117.00 $69.21 $117.00 $117.00 $117.00 $117.00 $87.75 $117.00 $117.00 $117.00 $58.50 $58.50 $92.66 $117.00 $93.60 $52.65 $23.22 $117.00 $67.86 $117.00 $117.00 $117.00 $24.38 $117.00 N/A N/A 27803970 EAP HCPCS C1876 M001711300 STENT WALL 6FR 8/80/75CM BOTH IP/OP "$4,931.00" "$3,649.00" $978.68 "$4,931.00" "$2,218.95" "$2,218.95" "$2,218.95" "$2,218.95" "$4,931.00" "$4,931.00" "$4,931.00" "$1,027.74" "$4,931.00" "$4,931.00" "$4,931.00" "$4,931.00" "$4,931.00" "$1,027.67" "$4,931.00" "$4,931.00" "$2,430.98" "$4,931.00" "$4,931.00" "$4,931.00" "$4,931.00" "$3,698.25" "$4,931.00" "$4,931.00" "$4,931.00" "$2,465.50" "$2,465.50" "$3,905.35" "$4,931.00" "$3,944.80" "$2,218.95" $978.68 "$4,931.00" "$2,859.98" "$4,931.00" "$4,931.00" "$4,931.00" "$1,027.62" "$4,931.00" N/A N/A 27803971 EAP HCPCS C1894 RETRIEVER MERCI L6 90060 BOTH IP/OP "$10,536.00" "$7,797.00" "$2,091.13" "$10,536.00" "$4,741.20" "$4,741.20" "$4,741.20" "$4,741.20" "$10,536.00" "$10,536.00" "$10,536.00" "$2,195.97" "$10,536.00" "$10,536.00" "$10,536.00" "$10,536.00" "$10,536.00" "$2,195.82" "$10,536.00" "$10,536.00" "$5,194.25" "$10,536.00" "$10,536.00" "$10,536.00" "$10,536.00" "$7,902.00" "$10,536.00" "$10,536.00" "$10,536.00" "$5,268.00" "$5,268.00" "$8,344.51" "$10,536.00" "$8,428.80" "$4,741.20" "$2,091.13" "$10,536.00" "$6,110.88" "$10,536.00" "$10,536.00" "$10,536.00" "$2,195.70" "$10,536.00" N/A N/A 27804055 EAP HCPCS C1874 TEST NAME NEW BOTH IP/OP "$7,990.00" "$5,913.00" "$1,585.82" "$7,990.00" "$3,595.50" "$3,595.50" "$3,595.50" "$3,595.50" "$7,990.00" "$7,990.00" "$7,990.00" "$1,665.32" "$7,990.00" "$7,990.00" "$7,990.00" "$7,990.00" "$7,990.00" "$1,665.20" "$7,990.00" "$7,990.00" "$3,939.07" "$7,990.00" "$7,990.00" "$7,990.00" "$7,990.00" "$5,992.50" "$7,990.00" "$7,990.00" "$7,990.00" "$3,995.00" "$3,995.00" "$6,328.08" "$7,990.00" "$6,392.00" "$3,595.50" "$1,585.82" "$7,990.00" "$4,634.20" "$7,990.00" "$7,990.00" "$7,990.00" "$1,665.12" "$7,990.00" N/A N/A 27804056 EAP Custom 27804056 "RETRIEVER MERCL L6, 90060" BOTH IP/OP "$10,536.00" "$7,797.00" "$1,875.41" "$10,536.00" "$10,536.00" "$10,536.00" "$10,536.00" "$10,536.00" "$10,536.00" "$10,536.00" "$1,875.41" "$10,536.00" "$10,536.00" "$10,536.00" "$10,536.00" "$10,536.00" "$10,536.00" "$2,195.82" "$10,536.00" "$4,214.40" "$10,536.00" "$10,536.00" "$10,536.00" "$10,536.00" "$10,536.00" "$7,902.00" "$10,536.00" "$10,536.00" "$10,536.00" "$5,268.00" "$5,268.00" "$8,344.51" "$10,536.00" "$8,428.80" "$4,741.20" "$10,536.00" "$10,536.00" "$6,110.88" "$10,536.00" "$6,321.60" "$10,536.00" "$10,536.00" "$10,536.00" N/A N/A 27804060 EAP HCPCS C1764 "IMPLANTABLE CARDIAC MONITOR, CONFIRM IC" BOTH IP/OP "$11,676.00" "$8,640.50" "$2,317.39" "$11,676.00" "$5,254.20" "$5,254.20" "$5,254.20" "$5,254.20" "$11,676.00" "$11,676.00" "$11,676.00" "$2,433.57" "$11,676.00" "$11,676.00" "$11,676.00" "$11,676.00" "$11,676.00" "$2,433.41" "$11,676.00" "$11,676.00" "$5,756.27" "$11,676.00" "$11,676.00" "$11,676.00" "$11,676.00" "$8,757.00" "$11,676.00" "$11,676.00" "$11,676.00" "$5,838.00" "$5,838.00" "$9,247.39" "$11,676.00" "$9,340.80" "$5,254.20" "$2,317.39" "$11,676.00" "$6,772.08" "$11,676.00" "$11,676.00" "$11,676.00" "$2,433.28" "$11,676.00" N/A N/A 27804067 EAP HCPCS C1880 MD800F FILTER PERIPHERAL VENA CAVA FEMORAL BOTH IP/OP "$2,933.00" "$2,170.50" $611.27 "$2,933.00" "$2,933.00" "$2,933.00" "$2,933.00" "$2,933.00" "$2,933.00" "$2,933.00" "$2,933.00" "$2,933.00" "$2,933.00" "$2,933.00" "$2,933.00" "$2,933.00" "$2,933.00" $611.27 "$2,933.00" "$1,173.20" "$2,933.00" "$2,933.00" "$2,933.00" "$2,933.00" "$2,933.00" "$2,199.75" "$2,933.00" "$2,933.00" "$2,933.00" "$1,466.50" "$1,466.50" "$2,322.94" "$2,933.00" "$2,346.40" "$1,319.85" "$2,933.00" "$2,933.00" "$1,701.14" "$2,933.00" "$1,759.80" "$2,933.00" "$2,933.00" "$2,933.00" N/A N/A 27804068 EAP HCPCS C1880 MD800J FILTER PERIPHERAL VENA CAVA JUGULAR BOTH IP/OP "$3,080.00" "$2,279.50" $641.91 "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" $641.91 "$3,080.00" "$1,232.00" "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" "$2,310.00" "$3,080.00" "$3,080.00" "$3,080.00" "$1,540.00" "$1,540.00" "$2,439.36" "$3,080.00" "$2,464.00" "$1,386.00" "$3,080.00" "$3,080.00" "$1,786.40" "$3,080.00" "$1,848.00" "$3,080.00" "$3,080.00" "$3,080.00" N/A N/A 27804070 EAP HCPCS C1757 SFR-4-15 DEVICE THROMBECTOMY SOLITAIRE FR 4X15 BOTH IP/OP "$18,930.00" "$14,008.50" "$3,757.13" "$18,930.00" "$8,518.50" "$8,518.50" "$8,518.50" "$8,518.50" "$18,930.00" "$18,930.00" "$18,930.00" "$3,945.49" "$18,930.00" "$18,930.00" "$18,930.00" "$18,930.00" "$18,930.00" "$3,945.22" "$18,930.00" "$18,930.00" "$9,332.49" "$18,930.00" "$18,930.00" "$18,930.00" "$18,930.00" "$14,197.50" "$18,930.00" "$18,930.00" "$18,930.00" "$9,465.00" "$9,465.00" "$14,992.56" "$18,930.00" "$15,144.00" "$8,518.50" "$3,757.13" "$18,930.00" "$10,979.40" "$18,930.00" "$18,930.00" "$18,930.00" "$3,945.01" "$18,930.00" N/A N/A 27804071 EAP HCPCS C1757 SFR-4-20 DEVICE THROMBECTOMY SOLITAIRE FR 4X20 BOTH IP/OP "$18,930.00" "$14,008.50" "$3,757.13" "$18,930.00" "$8,518.50" "$8,518.50" "$8,518.50" "$8,518.50" "$18,930.00" "$18,930.00" "$18,930.00" "$3,945.49" "$18,930.00" "$18,930.00" "$18,930.00" "$18,930.00" "$18,930.00" "$3,945.22" "$18,930.00" "$18,930.00" "$9,332.49" "$18,930.00" "$18,930.00" "$18,930.00" "$18,930.00" "$14,197.50" "$18,930.00" "$18,930.00" "$18,930.00" "$9,465.00" "$9,465.00" "$14,992.56" "$18,930.00" "$15,144.00" "$8,518.50" "$3,757.13" "$18,930.00" "$10,979.40" "$18,930.00" "$18,930.00" "$18,930.00" "$3,945.01" "$18,930.00" N/A N/A 27804072 EAP HCPCS C1757 SFR-6-20 DEVICE THROMBECTOMY SOLITAIRE FR 6X20 BOTH IP/OP "$18,930.00" "$14,008.50" "$3,757.13" "$18,930.00" "$8,518.50" "$8,518.50" "$8,518.50" "$8,518.50" "$18,930.00" "$18,930.00" "$18,930.00" "$3,945.49" "$18,930.00" "$18,930.00" "$18,930.00" "$18,930.00" "$18,930.00" "$3,945.22" "$18,930.00" "$18,930.00" "$9,332.49" "$18,930.00" "$18,930.00" "$18,930.00" "$18,930.00" "$14,197.50" "$18,930.00" "$18,930.00" "$18,930.00" "$9,465.00" "$9,465.00" "$14,992.56" "$18,930.00" "$15,144.00" "$8,518.50" "$3,757.13" "$18,930.00" "$10,979.40" "$18,930.00" "$18,930.00" "$18,930.00" "$3,945.01" "$18,930.00" N/A N/A 27804073 EAP HCPCS C1757 SFR-6-30 DEVICE THROMBECTOMY SOLITAIRE FR 6X30 BOTH IP/OP "$18,930.00" "$14,008.50" "$3,757.13" "$18,930.00" "$8,518.50" "$8,518.50" "$8,518.50" "$8,518.50" "$18,930.00" "$18,930.00" "$18,930.00" "$3,945.49" "$18,930.00" "$18,930.00" "$18,930.00" "$18,930.00" "$18,930.00" "$3,945.22" "$18,930.00" "$18,930.00" "$9,332.49" "$18,930.00" "$18,930.00" "$18,930.00" "$18,930.00" "$14,197.50" "$18,930.00" "$18,930.00" "$18,930.00" "$9,465.00" "$9,465.00" "$14,992.56" "$18,930.00" "$15,144.00" "$8,518.50" "$3,757.13" "$18,930.00" "$10,979.40" "$18,930.00" "$18,930.00" "$18,930.00" "$3,945.01" "$18,930.00" N/A N/A 27804080 EAP Custom 27804080 G08261 EMBOLIZATION COIL BOTH IP/OP $278.00 $206.00 $49.48 $278.00 $278.00 $278.00 $278.00 $278.00 $278.00 $278.00 $49.48 $278.00 $278.00 $278.00 $278.00 $278.00 $278.00 $57.94 $278.00 $111.20 $278.00 $278.00 $278.00 $278.00 $278.00 $208.50 $278.00 $278.00 $278.00 $139.00 $139.00 $220.18 $278.00 $222.40 $125.10 $278.00 $278.00 $161.24 $278.00 $166.80 $278.00 $278.00 $278.00 N/A N/A 27804088 EAP HCPCS C1777 "RELIANCE DF4 LEAD, AICD, ENDO SINGLE COIL" BOTH IP/OP "$13,964.00" "$10,333.50" "$2,771.50" "$13,964.00" "$6,283.80" "$6,283.80" "$6,283.80" "$6,283.80" "$13,964.00" "$13,964.00" "$13,964.00" "$2,910.45" "$13,964.00" "$13,964.00" "$13,964.00" "$13,964.00" "$13,964.00" "$2,910.25" "$13,964.00" "$13,964.00" "$6,884.25" "$13,964.00" "$13,964.00" "$13,964.00" "$13,964.00" "$10,473.00" "$13,964.00" "$13,964.00" "$13,964.00" "$6,982.00" "$6,982.00" "$11,059.49" "$13,964.00" "$11,171.20" "$6,283.80" "$2,771.50" "$13,964.00" "$8,099.12" "$13,964.00" "$13,964.00" "$13,964.00" "$2,910.10" "$13,964.00" N/A N/A 27804089 EAP HCPCS C1777 "RELIANCE GORE DF4 LEAD,AICD, ENDO SINGLE COIL" BOTH IP/OP "$13,964.00" "$10,333.50" "$2,771.50" "$13,964.00" "$6,283.80" "$6,283.80" "$6,283.80" "$6,283.80" "$13,964.00" "$13,964.00" "$13,964.00" "$2,910.45" "$13,964.00" "$13,964.00" "$13,964.00" "$13,964.00" "$13,964.00" "$2,910.25" "$13,964.00" "$13,964.00" "$6,884.25" "$13,964.00" "$13,964.00" "$13,964.00" "$13,964.00" "$10,473.00" "$13,964.00" "$13,964.00" "$13,964.00" "$6,982.00" "$6,982.00" "$11,059.49" "$13,964.00" "$11,171.20" "$6,283.80" "$2,771.50" "$13,964.00" "$8,099.12" "$13,964.00" "$13,964.00" "$13,964.00" "$2,910.10" "$13,964.00" N/A N/A 27804090 EAP HCPCS C1882 "ENERGEN DF4 CRT-D AICD, OTHER THAN SING/DUAL" BOTH IP/OP "$68,273.00" "$50,522.50" "$7,712.84" "$68,273.00" "$30,722.85" "$30,722.85" "$30,722.85" "$30,722.85" "$68,273.00" "$68,273.00" "$68,273.00" "$9,417.94" "$68,273.00" "$68,273.00" "$68,273.00" "$68,273.00" "$68,273.00" "$14,228.84" "$68,273.00" "$68,273.00" "$33,658.59" "$68,273.00" "$68,273.00" "$68,273.00" "$68,273.00" "$51,204.75" "$68,273.00" "$68,273.00" "$68,273.00" "$34,136.50" "$34,136.50" "$54,072.22" "$68,273.00" "$54,618.40" "$30,722.85" "$7,712.84" "$68,273.00" "$39,598.34" "$68,273.00" "$68,273.00" "$68,273.00" "$8,098.48" "$68,273.00" N/A N/A 27804091 EAP HCPCS C1882 "ENERGEN CRT-D AICD, OTHER THAN SING/DUAL" BOTH IP/OP "$68,273.00" "$50,522.50" "$7,712.84" "$68,273.00" "$30,722.85" "$30,722.85" "$30,722.85" "$30,722.85" "$68,273.00" "$68,273.00" "$68,273.00" "$9,417.94" "$68,273.00" "$68,273.00" "$68,273.00" "$68,273.00" "$68,273.00" "$14,228.84" "$68,273.00" "$68,273.00" "$33,658.59" "$68,273.00" "$68,273.00" "$68,273.00" "$68,273.00" "$51,204.75" "$68,273.00" "$68,273.00" "$68,273.00" "$34,136.50" "$34,136.50" "$54,072.22" "$68,273.00" "$54,618.40" "$30,722.85" "$7,712.84" "$68,273.00" "$39,598.34" "$68,273.00" "$68,273.00" "$68,273.00" "$8,098.48" "$68,273.00" N/A N/A 27804092 EAP HCPCS C1882 "UNIFY QUADRA AICD, OTHER THAN SING/DUAL" BOTH IP/OP "$89,376.00" "$66,138.50" "$7,712.84" "$89,376.00" "$40,219.20" "$40,219.20" "$40,219.20" "$40,219.20" "$89,376.00" "$89,376.00" "$89,376.00" "$9,417.94" "$89,376.00" "$89,376.00" "$89,376.00" "$89,376.00" "$89,376.00" "$18,626.94" "$89,376.00" "$89,376.00" "$44,062.37" "$89,376.00" "$89,376.00" "$89,376.00" "$89,376.00" "$67,032.00" "$89,376.00" "$89,376.00" "$89,376.00" "$44,688.00" "$44,688.00" "$70,785.79" "$89,376.00" "$71,500.80" "$40,219.20" "$7,712.84" "$89,376.00" "$51,838.08" "$89,376.00" "$89,376.00" "$89,376.00" "$8,098.48" "$89,376.00" N/A N/A 27804093 EAP HCPCS C1898 "TC-1888 TENDRIL LEAD PMKR, OTHER THAN TRANS" BOTH IP/OP "$1,551.00" "$1,148.00" $323.25 "$1,551.00" "$1,551.00" "$1,551.00" "$1,551.00" "$1,551.00" "$1,551.00" "$1,551.00" "$1,551.00" "$1,551.00" "$1,551.00" "$1,551.00" "$1,551.00" "$1,551.00" "$1,551.00" $323.25 "$1,551.00" $620.40 "$1,551.00" "$1,551.00" "$1,551.00" "$1,551.00" "$1,551.00" "$1,163.25" "$1,551.00" "$1,551.00" "$1,551.00" $775.50 $775.50 "$1,228.39" "$1,551.00" "$1,240.80" $697.95 "$1,551.00" "$1,551.00" $899.58 "$1,551.00" $930.60 "$1,551.00" "$1,551.00" "$1,551.00" N/A N/A 27804094 EAP HCPCS C1900 "Q-1458 QUARTET LEAD, AICD, ENDO SINGLE COIL" BOTH IP/OP "$8,566.00" "$6,339.00" "$1,700.14" "$8,566.00" "$3,854.70" "$3,854.70" "$3,854.70" "$3,854.70" "$8,566.00" "$8,566.00" "$8,566.00" "$1,785.37" "$8,566.00" "$8,566.00" "$8,566.00" "$8,566.00" "$8,566.00" "$1,785.25" "$8,566.00" "$8,566.00" "$4,223.04" "$8,566.00" "$8,566.00" "$8,566.00" "$8,566.00" "$6,424.50" "$8,566.00" "$8,566.00" "$8,566.00" "$4,283.00" "$4,283.00" "$6,784.27" "$8,566.00" "$6,852.80" "$3,854.70" "$1,700.14" "$8,566.00" "$4,968.28" "$8,566.00" "$8,566.00" "$8,566.00" "$1,785.15" "$8,566.00" N/A N/A 27804098 EAP HCPCS C1876 ENTERPRISE 22MM STENT NO-TIP BOTH IP/OP "$16,138.00" "$11,942.50" "$3,202.99" "$16,138.00" "$7,262.10" "$7,262.10" "$7,262.10" "$7,262.10" "$16,138.00" "$16,138.00" "$16,138.00" "$3,363.56" "$16,138.00" "$16,138.00" "$16,138.00" "$16,138.00" "$16,138.00" "$3,363.34" "$16,138.00" "$16,138.00" "$7,956.03" "$16,138.00" "$16,138.00" "$16,138.00" "$16,138.00" "$12,103.50" "$16,138.00" "$16,138.00" "$16,138.00" "$8,069.00" "$8,069.00" "$12,781.30" "$16,138.00" "$12,910.40" "$7,262.10" "$3,202.99" "$16,138.00" "$9,360.04" "$16,138.00" "$16,138.00" "$16,138.00" "$3,363.16" "$16,138.00" N/A N/A 27804099 EAP HCPCS C1876 ENTERPRISE 38MM STENT NO-TIP BOTH IP/OP "$16,138.00" "$11,942.50" "$3,202.99" "$16,138.00" "$7,262.10" "$7,262.10" "$7,262.10" "$7,262.10" "$16,138.00" "$16,138.00" "$16,138.00" "$3,363.56" "$16,138.00" "$16,138.00" "$16,138.00" "$16,138.00" "$16,138.00" "$3,363.34" "$16,138.00" "$16,138.00" "$7,956.03" "$16,138.00" "$16,138.00" "$16,138.00" "$16,138.00" "$12,103.50" "$16,138.00" "$16,138.00" "$16,138.00" "$8,069.00" "$8,069.00" "$12,781.30" "$16,138.00" "$12,910.40" "$7,262.10" "$3,202.99" "$16,138.00" "$9,360.04" "$16,138.00" "$16,138.00" "$16,138.00" "$3,363.16" "$16,138.00" N/A N/A 27804100 EAP HCPCS C1876 ENTERPRISE 37MM STENT NO-TIP BOTH IP/OP "$16,138.00" "$11,942.50" "$3,202.99" "$16,138.00" "$7,262.10" "$7,262.10" "$7,262.10" "$7,262.10" "$16,138.00" "$16,138.00" "$16,138.00" "$3,363.56" "$16,138.00" "$16,138.00" "$16,138.00" "$16,138.00" "$16,138.00" "$3,363.34" "$16,138.00" "$16,138.00" "$7,956.03" "$16,138.00" "$16,138.00" "$16,138.00" "$16,138.00" "$12,103.50" "$16,138.00" "$16,138.00" "$16,138.00" "$8,069.00" "$8,069.00" "$12,781.30" "$16,138.00" "$12,910.40" "$7,262.10" "$3,202.99" "$16,138.00" "$9,360.04" "$16,138.00" "$16,138.00" "$16,138.00" "$3,363.16" "$16,138.00" N/A N/A 27804103 EAP Custom 27804103 "PX 400,STRAIGHT" BOTH IP/OP "$2,749.00" "$2,034.50" $489.32 "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" $489.32 "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" $572.92 "$2,749.00" "$1,099.60" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,061.75" "$2,749.00" "$2,749.00" "$2,749.00" "$1,374.50" "$1,374.50" "$2,177.21" "$2,749.00" "$2,199.20" "$1,237.05" "$2,749.00" "$2,749.00" "$1,594.42" "$2,749.00" "$1,649.40" "$2,749.00" "$2,749.00" "$2,749.00" N/A N/A 27804104 EAP Custom 27804104 "PX 400, 45" BOTH IP/OP "$2,749.00" "$2,034.50" $489.32 "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" $489.32 "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" $572.92 "$2,749.00" "$1,099.60" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,061.75" "$2,749.00" "$2,749.00" "$2,749.00" "$1,374.50" "$1,374.50" "$2,177.21" "$2,749.00" "$2,199.20" "$1,237.05" "$2,749.00" "$2,749.00" "$1,594.42" "$2,749.00" "$1,649.40" "$2,749.00" "$2,749.00" "$2,749.00" N/A N/A 27804105 EAP Custom 27804105 "PX 400, J" BOTH IP/OP "$2,749.00" "$2,034.50" $489.32 "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" $489.32 "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" $572.92 "$2,749.00" "$1,099.60" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,061.75" "$2,749.00" "$2,749.00" "$2,749.00" "$1,374.50" "$1,374.50" "$2,177.21" "$2,749.00" "$2,199.20" "$1,237.05" "$2,749.00" "$2,749.00" "$1,594.42" "$2,749.00" "$1,649.40" "$2,749.00" "$2,749.00" "$2,749.00" N/A N/A 27804106 EAP Custom 27804106 START UP KIT BOTH IP/OP $798.00 $591.00 $142.04 $798.00 $798.00 $798.00 $798.00 $798.00 $798.00 $798.00 $142.04 $798.00 $798.00 $798.00 $798.00 $798.00 $798.00 $166.31 $798.00 $319.20 $798.00 $798.00 $798.00 $798.00 $798.00 $598.50 $798.00 $798.00 $798.00 $399.00 $399.00 $632.02 $798.00 $638.40 $359.10 $798.00 $798.00 $462.84 $798.00 $478.80 $798.00 $798.00 $798.00 N/A N/A 27804107 EAP Custom 27804107 SENOR FLOTRAC BOTH IP/OP $993.00 $735.00 $176.75 $993.00 $993.00 $993.00 $993.00 $993.00 $993.00 $993.00 $176.75 $993.00 $993.00 $993.00 $993.00 $993.00 $993.00 $206.95 $993.00 $397.20 $993.00 $993.00 $993.00 $993.00 $993.00 $744.75 $993.00 $993.00 $993.00 $496.50 $496.50 $786.46 $993.00 $794.40 $446.85 $993.00 $993.00 $575.94 $993.00 $595.80 $993.00 $993.00 $993.00 N/A N/A 27804108 EAP Custom 27804108 "COIL 400 COMPLEX STANDARD, 15MM X 57CM" BOTH IP/OP "$7,642.00" "$5,655.50" "$1,360.28" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$1,360.28" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$1,592.68" "$7,642.00" "$3,056.80" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$5,731.50" "$7,642.00" "$7,642.00" "$7,642.00" "$3,821.00" "$3,821.00" "$6,052.46" "$7,642.00" "$6,113.60" "$3,438.90" "$7,642.00" "$7,642.00" "$4,432.36" "$7,642.00" "$4,585.20" "$7,642.00" "$7,642.00" "$7,642.00" N/A N/A 27804109 EAP Custom 27804109 "COIL 400 COMPLEX STANDARD, 16MM X 60CM" BOTH IP/OP "$7,685.00" "$5,687.00" "$1,367.93" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$1,367.93" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$1,601.64" "$7,685.00" "$3,074.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$5,763.75" "$7,685.00" "$7,685.00" "$7,685.00" "$3,842.50" "$3,842.50" "$6,086.52" "$7,685.00" "$6,148.00" "$3,458.25" "$7,685.00" "$7,685.00" "$4,457.30" "$7,685.00" "$4,611.00" "$7,685.00" "$7,685.00" "$7,685.00" N/A N/A 27804113 EAP HCPCS A4648 IMPLANTABLE TISSUE MARKER BOTH IP/OP $520.00 $385.00 $103.21 $520.00 $234.00 $234.00 $234.00 $234.00 $520.00 $520.00 $520.00 $108.38 $520.00 $520.00 $520.00 $520.00 $520.00 $108.37 $520.00 $520.00 $307.58 $520.00 $520.00 $520.00 $520.00 $390.00 $520.00 $520.00 $520.00 $260.00 $260.00 $411.84 $520.00 $416.00 $234.00 $103.21 $520.00 $301.60 $520.00 $520.00 $520.00 $108.37 $520.00 N/A N/A 27804116 EAP Custom 27804116 "COIL 400 COMPLEX STANDARD, 18MM X 57CM" BOTH IP/OP "$7,642.00" "$5,655.50" "$1,360.28" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$1,360.28" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$1,592.68" "$7,642.00" "$3,056.80" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$5,731.50" "$7,642.00" "$7,642.00" "$7,642.00" "$3,821.00" "$3,821.00" "$6,052.46" "$7,642.00" "$6,113.60" "$3,438.90" "$7,642.00" "$7,642.00" "$4,432.36" "$7,642.00" "$4,585.20" "$7,642.00" "$7,642.00" "$7,642.00" N/A N/A 27804117 EAP Custom 27804117 "COIL 400 COMPLEX STANDARD, 20MM X 60CM" BOTH IP/OP "$7,685.00" "$5,687.00" "$1,367.93" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$1,367.93" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$1,601.64" "$7,685.00" "$3,074.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$5,763.75" "$7,685.00" "$7,685.00" "$7,685.00" "$3,842.50" "$3,842.50" "$6,086.52" "$7,685.00" "$6,148.00" "$3,458.25" "$7,685.00" "$7,685.00" "$4,457.30" "$7,685.00" "$4,611.00" "$7,685.00" "$7,685.00" "$7,685.00" N/A N/A 27804118 EAP Custom 27804118 "COIL 400 COMPLEX STANDARD, 22MM X 60CM" BOTH IP/OP "$7,685.00" "$5,687.00" "$1,367.93" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$1,367.93" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$1,601.64" "$7,685.00" "$3,074.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$5,763.75" "$7,685.00" "$7,685.00" "$7,685.00" "$3,842.50" "$3,842.50" "$6,086.52" "$7,685.00" "$6,148.00" "$3,458.25" "$7,685.00" "$7,685.00" "$4,457.30" "$7,685.00" "$4,611.00" "$7,685.00" "$7,685.00" "$7,685.00" N/A N/A 27804119 EAP Custom 27804119 "COIL 400 COMPLEX STANDARD, 24MM X 57CM" BOTH IP/OP "$7,642.00" "$5,655.50" "$1,360.28" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$1,360.28" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$1,592.68" "$7,642.00" "$3,056.80" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$5,731.50" "$7,642.00" "$7,642.00" "$7,642.00" "$3,821.00" "$3,821.00" "$6,052.46" "$7,642.00" "$6,113.60" "$3,438.90" "$7,642.00" "$7,642.00" "$4,432.36" "$7,642.00" "$4,585.20" "$7,642.00" "$7,642.00" "$7,642.00" N/A N/A 27804120 EAP Custom 27804120 "COIL 400 COMPLEX STANDARD, 28MM X 60 CM" BOTH IP/OP "$8,572.00" "$6,343.50" "$1,525.82" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$1,525.82" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$1,786.50" "$8,572.00" "$3,428.80" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$6,429.00" "$8,572.00" "$8,572.00" "$8,572.00" "$4,286.00" "$4,286.00" "$6,789.02" "$8,572.00" "$6,857.60" "$3,857.40" "$8,572.00" "$8,572.00" "$4,971.76" "$8,572.00" "$5,143.20" "$8,572.00" "$8,572.00" "$8,572.00" N/A N/A 27804121 EAP Custom 27804121 PX 400 90 BOTH IP/OP "$2,749.00" "$2,034.50" $489.32 "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" $489.32 "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" $572.92 "$2,749.00" "$1,099.60" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,749.00" "$2,061.75" "$2,749.00" "$2,749.00" "$2,749.00" "$1,374.50" "$1,374.50" "$2,177.21" "$2,749.00" "$2,199.20" "$1,237.05" "$2,749.00" "$2,749.00" "$1,594.42" "$2,749.00" "$1,649.40" "$2,749.00" "$2,749.00" "$2,749.00" N/A N/A 27804122 EAP Custom 27804122 "COIL 400 COMPLEX STANDARD, 32MM X 60 CM" BOTH IP/OP "$8,572.00" "$6,343.50" "$1,525.82" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$1,525.82" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$1,786.50" "$8,572.00" "$3,428.80" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$6,429.00" "$8,572.00" "$8,572.00" "$8,572.00" "$4,286.00" "$4,286.00" "$6,789.02" "$8,572.00" "$6,857.60" "$3,857.40" "$8,572.00" "$8,572.00" "$4,971.76" "$8,572.00" "$5,143.20" "$8,572.00" "$8,572.00" "$8,572.00" N/A N/A 27804123 EAP Custom 27804123 "COIL 400 COMPLEX SOFT, 3 MM X 3 CM" BOTH IP/OP "$7,034.00" "$5,205.50" "$1,252.05" "$7,034.00" "$7,034.00" "$7,034.00" "$7,034.00" "$7,034.00" "$7,034.00" "$7,034.00" "$1,252.05" "$7,034.00" "$7,034.00" "$7,034.00" "$7,034.00" "$7,034.00" "$7,034.00" "$1,465.96" "$7,034.00" "$2,813.60" "$7,034.00" "$7,034.00" "$7,034.00" "$7,034.00" "$7,034.00" "$5,275.50" "$7,034.00" "$7,034.00" "$7,034.00" "$3,517.00" "$3,517.00" "$5,570.93" "$7,034.00" "$5,627.20" "$3,165.30" "$7,034.00" "$7,034.00" "$4,079.72" "$7,034.00" "$4,220.40" "$7,034.00" "$7,034.00" "$7,034.00" N/A N/A 27804124 EAP Custom 27804124 "COIL 400 COMPLEX EXTRA SOFT, 4MM X 10CM" BOTH IP/OP "$8,157.00" "$6,036.50" "$1,451.95" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$1,451.95" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$1,700.01" "$8,157.00" "$3,262.80" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$6,117.75" "$8,157.00" "$8,157.00" "$8,157.00" "$4,078.50" "$4,078.50" "$6,460.34" "$8,157.00" "$6,525.60" "$3,670.65" "$8,157.00" "$8,157.00" "$4,731.06" "$8,157.00" "$4,894.20" "$8,157.00" "$8,157.00" "$8,157.00" N/A N/A 27804125 EAP Custom 27804125 "COIL 400 COMPLEX SOFT, 13MM X 35CM" BOTH IP/OP "$7,980.00" "$5,905.50" "$1,420.44" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$1,420.44" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$1,663.12" "$7,980.00" "$3,192.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$5,985.00" "$7,980.00" "$7,980.00" "$7,980.00" "$3,990.00" "$3,990.00" "$6,320.16" "$7,980.00" "$6,384.00" "$3,591.00" "$7,980.00" "$7,980.00" "$4,628.40" "$7,980.00" "$4,788.00" "$7,980.00" "$7,980.00" "$7,980.00" N/A N/A 27804126 EAP Custom 27804126 "COIL 400 COMPLEX SOFT, 13MM X 48CM" BOTH IP/OP "$8,364.00" "$6,189.50" "$1,488.79" "$8,364.00" "$8,364.00" "$8,364.00" "$8,364.00" "$8,364.00" "$8,364.00" "$8,364.00" "$1,488.79" "$8,364.00" "$8,364.00" "$8,364.00" "$8,364.00" "$8,364.00" "$8,364.00" "$1,743.15" "$8,364.00" "$3,345.60" "$8,364.00" "$8,364.00" "$8,364.00" "$8,364.00" "$8,364.00" "$6,273.00" "$8,364.00" "$8,364.00" "$8,364.00" "$4,182.00" "$4,182.00" "$6,624.29" "$8,364.00" "$6,691.20" "$3,763.80" "$8,364.00" "$8,364.00" "$4,851.12" "$8,364.00" "$5,018.40" "$8,364.00" "$8,364.00" "$8,364.00" N/A N/A 27804127 EAP Custom 27804127 "COIL 400 COMPLEX SOFT, 14MM X 40CM" BOTH IP/OP "$8,128.00" "$6,015.00" "$1,446.78" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$1,446.78" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$1,693.96" "$8,128.00" "$3,251.20" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$6,096.00" "$8,128.00" "$8,128.00" "$8,128.00" "$4,064.00" "$4,064.00" "$6,437.38" "$8,128.00" "$6,502.40" "$3,657.60" "$8,128.00" "$8,128.00" "$4,714.24" "$8,128.00" "$4,876.80" "$8,128.00" "$8,128.00" "$8,128.00" N/A N/A 27804128 EAP Custom 27804128 "COIL 400 COMPLEX SOFT, 14MM X 50CM" BOTH IP/OP "$8,424.00" "$6,234.00" "$1,499.47" "$8,424.00" "$8,424.00" "$8,424.00" "$8,424.00" "$8,424.00" "$8,424.00" "$8,424.00" "$1,499.47" "$8,424.00" "$8,424.00" "$8,424.00" "$8,424.00" "$8,424.00" "$8,424.00" "$1,755.65" "$8,424.00" "$3,369.60" "$8,424.00" "$8,424.00" "$8,424.00" "$8,424.00" "$8,424.00" "$6,318.00" "$8,424.00" "$8,424.00" "$8,424.00" "$4,212.00" "$4,212.00" "$6,671.81" "$8,424.00" "$6,739.20" "$3,790.80" "$8,424.00" "$8,424.00" "$4,885.92" "$8,424.00" "$5,054.40" "$8,424.00" "$8,424.00" "$8,424.00" N/A N/A 27804129 EAP Custom 27804129 "COIL 400 COMPLEX SOFT, 16MM X 45CM" BOTH IP/OP "$8,276.00" "$6,124.50" "$1,473.13" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$1,473.13" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$1,724.81" "$8,276.00" "$3,310.40" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$6,207.00" "$8,276.00" "$8,276.00" "$8,276.00" "$4,138.00" "$4,138.00" "$6,554.59" "$8,276.00" "$6,620.80" "$3,724.20" "$8,276.00" "$8,276.00" "$4,800.08" "$8,276.00" "$4,965.60" "$8,276.00" "$8,276.00" "$8,276.00" N/A N/A 27804130 EAP Custom 27804130 "COIL 400 J, 7CM" BOTH IP/OP "$6,680.00" "$4,943.50" "$1,189.04" "$6,680.00" "$6,680.00" "$6,680.00" "$6,680.00" "$6,680.00" "$6,680.00" "$6,680.00" "$1,189.04" "$6,680.00" "$6,680.00" "$6,680.00" "$6,680.00" "$6,680.00" "$6,680.00" "$1,392.19" "$6,680.00" "$2,672.00" "$6,680.00" "$6,680.00" "$6,680.00" "$6,680.00" "$6,680.00" "$5,010.00" "$6,680.00" "$6,680.00" "$6,680.00" "$3,340.00" "$3,340.00" "$5,290.56" "$6,680.00" "$5,344.00" "$3,006.00" "$6,680.00" "$6,680.00" "$3,874.40" "$6,680.00" "$4,008.00" "$6,680.00" "$6,680.00" "$6,680.00" N/A N/A 27804131 EAP Custom 27804131 "COIL 400 J, 10CM" BOTH IP/OP "$7,448.00" "$5,512.00" "$1,325.74" "$7,448.00" "$7,448.00" "$7,448.00" "$7,448.00" "$7,448.00" "$7,448.00" "$7,448.00" "$1,325.74" "$7,448.00" "$7,448.00" "$7,448.00" "$7,448.00" "$7,448.00" "$7,448.00" "$1,552.25" "$7,448.00" "$2,979.20" "$7,448.00" "$7,448.00" "$7,448.00" "$7,448.00" "$7,448.00" "$5,586.00" "$7,448.00" "$7,448.00" "$7,448.00" "$3,724.00" "$3,724.00" "$5,898.82" "$7,448.00" "$5,958.40" "$3,351.60" "$7,448.00" "$7,448.00" "$4,319.84" "$7,448.00" "$4,468.80" "$7,448.00" "$7,448.00" "$7,448.00" N/A N/A 27804132 EAP Custom 27804132 "COIL 400 J, 15CM" BOTH IP/OP "$7,743.00" "$5,730.00" "$1,378.25" "$7,743.00" "$7,743.00" "$7,743.00" "$7,743.00" "$7,743.00" "$7,743.00" "$7,743.00" "$1,378.25" "$7,743.00" "$7,743.00" "$7,743.00" "$7,743.00" "$7,743.00" "$7,743.00" "$1,613.73" "$7,743.00" "$3,097.20" "$7,743.00" "$7,743.00" "$7,743.00" "$7,743.00" "$7,743.00" "$5,807.25" "$7,743.00" "$7,743.00" "$7,743.00" "$3,871.50" "$3,871.50" "$6,132.46" "$7,743.00" "$6,194.40" "$3,484.35" "$7,743.00" "$7,743.00" "$4,490.94" "$7,743.00" "$4,645.80" "$7,743.00" "$7,743.00" "$7,743.00" N/A N/A 27804133 EAP Custom 27804133 "COIL 400 J, 25CM" BOTH IP/OP "$8,334.00" "$6,167.50" "$1,483.45" "$8,334.00" "$8,334.00" "$8,334.00" "$8,334.00" "$8,334.00" "$8,334.00" "$8,334.00" "$1,483.45" "$8,334.00" "$8,334.00" "$8,334.00" "$8,334.00" "$8,334.00" "$8,334.00" "$1,736.90" "$8,334.00" "$3,333.60" "$8,334.00" "$8,334.00" "$8,334.00" "$8,334.00" "$8,334.00" "$6,250.50" "$8,334.00" "$8,334.00" "$8,334.00" "$4,167.00" "$4,167.00" "$6,600.53" "$8,334.00" "$6,667.20" "$3,750.30" "$8,334.00" "$8,334.00" "$4,833.72" "$8,334.00" "$5,000.40" "$8,334.00" "$8,334.00" "$8,334.00" N/A N/A 27804134 EAP Custom 27804134 "COIL 400 COMPLEX STANDARD, 3 MM X 6 CM" BOTH IP/OP "$6,532.00" "$4,834.00" "$1,162.70" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$1,162.70" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$1,361.34" "$6,532.00" "$2,612.80" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$4,899.00" "$6,532.00" "$6,532.00" "$6,532.00" "$3,266.00" "$3,266.00" "$5,173.34" "$6,532.00" "$5,225.60" "$2,939.40" "$6,532.00" "$6,532.00" "$3,788.56" "$6,532.00" "$3,919.20" "$6,532.00" "$6,532.00" "$6,532.00" N/A N/A 27804135 EAP Custom 27804135 "COIL 400 COMPLEX STANDARD, 3 MM X 10 CM" BOTH IP/OP "$6,651.00" "$4,922.00" "$1,183.88" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$1,183.88" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$1,386.14" "$6,651.00" "$2,660.40" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$4,988.25" "$6,651.00" "$6,651.00" "$6,651.00" "$3,325.50" "$3,325.50" "$5,267.59" "$6,651.00" "$5,320.80" "$2,992.95" "$6,651.00" "$6,651.00" "$3,857.58" "$6,651.00" "$3,990.60" "$6,651.00" "$6,651.00" "$6,651.00" N/A N/A 27804136 EAP Custom 27804136 "COIL 400 COMPLEX STANDARD, 4 MM X 8 CM" BOTH IP/OP "$6,591.00" "$4,877.50" "$1,173.20" "$6,591.00" "$6,591.00" "$6,591.00" "$6,591.00" "$6,591.00" "$6,591.00" "$6,591.00" "$1,173.20" "$6,591.00" "$6,591.00" "$6,591.00" "$6,591.00" "$6,591.00" "$6,591.00" "$1,373.64" "$6,591.00" "$2,636.40" "$6,591.00" "$6,591.00" "$6,591.00" "$6,591.00" "$6,591.00" "$4,943.25" "$6,591.00" "$6,591.00" "$6,591.00" "$3,295.50" "$3,295.50" "$5,220.07" "$6,591.00" "$5,272.80" "$2,965.95" "$6,591.00" "$6,591.00" "$3,822.78" "$6,591.00" "$3,954.60" "$6,591.00" "$6,591.00" "$6,591.00" N/A N/A 27804137 EAP Custom 27804137 "COIL 400 COMPLEX STANDARD, 4 MM X 12 CM" BOTH IP/OP "$6,708.00" "$4,964.00" "$1,194.02" "$6,708.00" "$6,708.00" "$6,708.00" "$6,708.00" "$6,708.00" "$6,708.00" "$6,708.00" "$1,194.02" "$6,708.00" "$6,708.00" "$6,708.00" "$6,708.00" "$6,708.00" "$6,708.00" "$1,398.02" "$6,708.00" "$2,683.20" "$6,708.00" "$6,708.00" "$6,708.00" "$6,708.00" "$6,708.00" "$5,031.00" "$6,708.00" "$6,708.00" "$6,708.00" "$3,354.00" "$3,354.00" "$5,312.74" "$6,708.00" "$5,366.40" "$3,018.60" "$6,708.00" "$6,708.00" "$3,890.64" "$6,708.00" "$4,024.80" "$6,708.00" "$6,708.00" "$6,708.00" N/A N/A 27804138 EAP Custom 27804138 "COIL 400 COMPLEX STANDARD, 5 MM X 6 CM" BOTH IP/OP "$6,532.00" "$4,834.00" "$1,162.70" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$1,162.70" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$1,361.34" "$6,532.00" "$2,612.80" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$4,899.00" "$6,532.00" "$6,532.00" "$6,532.00" "$3,266.00" "$3,266.00" "$5,173.34" "$6,532.00" "$5,225.60" "$2,939.40" "$6,532.00" "$6,532.00" "$3,788.56" "$6,532.00" "$3,919.20" "$6,532.00" "$6,532.00" "$6,532.00" N/A N/A 27804139 EAP Custom 27804139 "COIL 400 COMPLEX STANDARD, 5MM X 10CM" BOTH IP/OP "$6,651.00" "$4,922.00" "$1,183.88" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$1,183.88" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$1,386.14" "$6,651.00" "$2,660.40" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$4,988.25" "$6,651.00" "$6,651.00" "$6,651.00" "$3,325.50" "$3,325.50" "$5,267.59" "$6,651.00" "$5,320.80" "$2,992.95" "$6,651.00" "$6,651.00" "$3,857.58" "$6,651.00" "$3,990.60" "$6,651.00" "$6,651.00" "$6,651.00" N/A N/A 27804140 EAP Custom 27804140 "COIL 400 COMPLEX STANDARD, 6MM X 10CM" BOTH IP/OP "$6,651.00" "$4,922.00" "$1,183.88" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$1,183.88" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$1,386.14" "$6,651.00" "$2,660.40" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$4,988.25" "$6,651.00" "$6,651.00" "$6,651.00" "$3,325.50" "$3,325.50" "$5,267.59" "$6,651.00" "$5,320.80" "$2,992.95" "$6,651.00" "$6,651.00" "$3,857.58" "$6,651.00" "$3,990.60" "$6,651.00" "$6,651.00" "$6,651.00" N/A N/A 27804141 EAP Custom 27804141 "COIL 400 COMPLEX STANDARD, 6MM X 15CM" BOTH IP/OP "$6,798.00" "$5,031.00" "$1,210.04" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$1,210.04" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$1,416.78" "$6,798.00" "$2,719.20" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$5,098.50" "$6,798.00" "$6,798.00" "$6,798.00" "$3,399.00" "$3,399.00" "$5,384.02" "$6,798.00" "$5,438.40" "$3,059.10" "$6,798.00" "$6,798.00" "$3,942.84" "$6,798.00" "$4,078.80" "$6,798.00" "$6,798.00" "$6,798.00" N/A N/A 27804142 EAP Custom 27804142 "COIL 400 COMPLEX STANDARD, 7MM X 10CM" BOTH IP/OP "$6,651.00" "$4,922.00" "$1,183.88" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$1,183.88" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$1,386.14" "$6,651.00" "$2,660.40" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$6,651.00" "$4,988.25" "$6,651.00" "$6,651.00" "$6,651.00" "$3,325.50" "$3,325.50" "$5,267.59" "$6,651.00" "$5,320.80" "$2,992.95" "$6,651.00" "$6,651.00" "$3,857.58" "$6,651.00" "$3,990.60" "$6,651.00" "$6,651.00" "$6,651.00" N/A N/A 27804143 EAP Custom 27804143 "COIL 400 COMPLEX SOFT, 3 MM X 4 CM" BOTH IP/OP "$7,063.00" "$5,227.00" "$1,257.21" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$1,257.21" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$1,472.01" "$7,063.00" "$2,825.20" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$5,297.25" "$7,063.00" "$7,063.00" "$7,063.00" "$3,531.50" "$3,531.50" "$5,593.90" "$7,063.00" "$5,650.40" "$3,178.35" "$7,063.00" "$7,063.00" "$4,096.54" "$7,063.00" "$4,237.80" "$7,063.00" "$7,063.00" "$7,063.00" N/A N/A 27804144 EAP Custom 27804144 "COIL 400 COMPLEX SOFT, 3 MM X 6 CM" BOTH IP/OP "$7,123.00" "$5,271.50" "$1,267.89" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$1,267.89" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$1,484.51" "$7,123.00" "$2,849.20" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$5,342.25" "$7,123.00" "$7,123.00" "$7,123.00" "$3,561.50" "$3,561.50" "$5,641.42" "$7,123.00" "$5,698.40" "$3,205.35" "$7,123.00" "$7,123.00" "$4,131.34" "$7,123.00" "$4,273.80" "$7,123.00" "$7,123.00" "$7,123.00" N/A N/A 27804145 EAP Custom 27804145 "COIL 400 COMPLEX SOFT, 3 MM X 10 CM" BOTH IP/OP "$7,241.00" "$5,358.50" "$1,288.90" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$1,288.90" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$1,509.10" "$7,241.00" "$2,896.40" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$5,430.75" "$7,241.00" "$7,241.00" "$7,241.00" "$3,620.50" "$3,620.50" "$5,734.87" "$7,241.00" "$5,792.80" "$3,258.45" "$7,241.00" "$7,241.00" "$4,199.78" "$7,241.00" "$4,344.60" "$7,241.00" "$7,241.00" "$7,241.00" N/A N/A 27804146 EAP Custom 27804146 "COIL 400 COMPLEX SOFT, 4 MM X 4 CM" BOTH IP/OP "$7,063.00" "$5,227.00" "$1,257.21" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$1,257.21" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$1,472.01" "$7,063.00" "$2,825.20" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$7,063.00" "$5,297.25" "$7,063.00" "$7,063.00" "$7,063.00" "$3,531.50" "$3,531.50" "$5,593.90" "$7,063.00" "$5,650.40" "$3,178.35" "$7,063.00" "$7,063.00" "$4,096.54" "$7,063.00" "$4,237.80" "$7,063.00" "$7,063.00" "$7,063.00" N/A N/A 27804147 EAP Custom 27804147 "COIL 400 COMPLEX SOFT, 4 MM X 6 CM" BOTH IP/OP "$7,123.00" "$5,271.50" "$1,267.89" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$1,267.89" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$1,484.51" "$7,123.00" "$2,849.20" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$7,123.00" "$5,342.25" "$7,123.00" "$7,123.00" "$7,123.00" "$3,561.50" "$3,561.50" "$5,641.42" "$7,123.00" "$5,698.40" "$3,205.35" "$7,123.00" "$7,123.00" "$4,131.34" "$7,123.00" "$4,273.80" "$7,123.00" "$7,123.00" "$7,123.00" N/A N/A 27804148 EAP Custom 27804148 "COIL 400 COMPLEX SOFT, 4 MM X 8 CM" BOTH IP/OP "$7,182.00" "$5,315.00" "$1,278.40" "$7,182.00" "$7,182.00" "$7,182.00" "$7,182.00" "$7,182.00" "$7,182.00" "$7,182.00" "$1,278.40" "$7,182.00" "$7,182.00" "$7,182.00" "$7,182.00" "$7,182.00" "$7,182.00" "$1,496.81" "$7,182.00" "$2,872.80" "$7,182.00" "$7,182.00" "$7,182.00" "$7,182.00" "$7,182.00" "$5,386.50" "$7,182.00" "$7,182.00" "$7,182.00" "$3,591.00" "$3,591.00" "$5,688.14" "$7,182.00" "$5,745.60" "$3,231.90" "$7,182.00" "$7,182.00" "$4,165.56" "$7,182.00" "$4,309.20" "$7,182.00" "$7,182.00" "$7,182.00" N/A N/A 27804149 EAP Custom 27804149 "COIL 400 COMPLEX SOFT, 4 MM X 12 CM" BOTH IP/OP "$7,300.00" "$5,402.00" "$1,299.40" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$1,299.40" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$1,521.40" "$7,300.00" "$2,920.00" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$5,475.00" "$7,300.00" "$7,300.00" "$7,300.00" "$3,650.00" "$3,650.00" "$5,781.60" "$7,300.00" "$5,840.00" "$3,285.00" "$7,300.00" "$7,300.00" "$4,234.00" "$7,300.00" "$4,380.00" "$7,300.00" "$7,300.00" "$7,300.00" N/A N/A 27804150 EAP Custom 27804150 "COIL 400 COMPLEX SOFT, 5MM X 9CM" BOTH IP/OP "$7,211.00" "$5,336.50" "$1,283.56" "$7,211.00" "$7,211.00" "$7,211.00" "$7,211.00" "$7,211.00" "$7,211.00" "$7,211.00" "$1,283.56" "$7,211.00" "$7,211.00" "$7,211.00" "$7,211.00" "$7,211.00" "$7,211.00" "$1,502.85" "$7,211.00" "$2,884.40" "$7,211.00" "$7,211.00" "$7,211.00" "$7,211.00" "$7,211.00" "$5,408.25" "$7,211.00" "$7,211.00" "$7,211.00" "$3,605.50" "$3,605.50" "$5,711.11" "$7,211.00" "$5,768.80" "$3,244.95" "$7,211.00" "$7,211.00" "$4,182.38" "$7,211.00" "$4,326.60" "$7,211.00" "$7,211.00" "$7,211.00" N/A N/A 27804151 EAP Custom 27804151 "COIL 400 COMPLEX SOFT, 5MM X 13CM" BOTH IP/OP "$7,331.00" "$5,425.00" "$1,304.92" "$7,331.00" "$7,331.00" "$7,331.00" "$7,331.00" "$7,331.00" "$7,331.00" "$7,331.00" "$1,304.92" "$7,331.00" "$7,331.00" "$7,331.00" "$7,331.00" "$7,331.00" "$7,331.00" "$1,527.86" "$7,331.00" "$2,932.40" "$7,331.00" "$7,331.00" "$7,331.00" "$7,331.00" "$7,331.00" "$5,498.25" "$7,331.00" "$7,331.00" "$7,331.00" "$3,665.50" "$3,665.50" "$5,806.15" "$7,331.00" "$5,864.80" "$3,298.95" "$7,331.00" "$7,331.00" "$4,251.98" "$7,331.00" "$4,398.60" "$7,331.00" "$7,331.00" "$7,331.00" N/A N/A 27804152 EAP Custom 27804152 "COIL 400 COMPLEX STANDARD, 10MM X 30CM" BOTH IP/OP "$7,241.00" "$5,358.50" "$1,288.90" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$1,288.90" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$1,509.10" "$7,241.00" "$2,896.40" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$5,430.75" "$7,241.00" "$7,241.00" "$7,241.00" "$3,620.50" "$3,620.50" "$5,734.87" "$7,241.00" "$5,792.80" "$3,258.45" "$7,241.00" "$7,241.00" "$4,199.78" "$7,241.00" "$4,344.60" "$7,241.00" "$7,241.00" "$7,241.00" N/A N/A 27804153 EAP Custom 27804153 "COIL 400 COMPLEX STANDARD, 10MM X 40CM" BOTH IP/OP "$7,389.00" "$5,468.00" "$1,315.24" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$1,315.24" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$1,539.95" "$7,389.00" "$2,955.60" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$5,541.75" "$7,389.00" "$7,389.00" "$7,389.00" "$3,694.50" "$3,694.50" "$5,852.09" "$7,389.00" "$5,911.20" "$3,325.05" "$7,389.00" "$7,389.00" "$4,285.62" "$7,389.00" "$4,433.40" "$7,389.00" "$7,389.00" "$7,389.00" N/A N/A 27804154 EAP Custom 27804154 "COIL 400 COMPLEX STANDARD, 11MM X 35CM" BOTH IP/OP "$7,316.00" "$5,414.00" "$1,302.25" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$1,302.25" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$1,524.73" "$7,316.00" "$2,926.40" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$5,487.00" "$7,316.00" "$7,316.00" "$7,316.00" "$3,658.00" "$3,658.00" "$5,794.27" "$7,316.00" "$5,852.80" "$3,292.20" "$7,316.00" "$7,316.00" "$4,243.28" "$7,316.00" "$4,389.60" "$7,316.00" "$7,316.00" "$7,316.00" N/A N/A 27804155 EAP Custom 27804155 "COIL 400 COMPLEX STANDARD, 11MM X 45CM" BOTH IP/OP "$7,464.00" "$5,523.50" "$1,328.59" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$1,328.59" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$1,555.58" "$7,464.00" "$2,985.60" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$5,598.00" "$7,464.00" "$7,464.00" "$7,464.00" "$3,732.00" "$3,732.00" "$5,911.49" "$7,464.00" "$5,971.20" "$3,358.80" "$7,464.00" "$7,464.00" "$4,329.12" "$7,464.00" "$4,478.40" "$7,464.00" "$7,464.00" "$7,464.00" N/A N/A 27804156 EAP Custom 27804156 "COIL 400 COMPLEX STANDARD, 12MM X 35CM" BOTH IP/OP "$7,316.00" "$5,414.00" "$1,302.25" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$1,302.25" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$1,524.73" "$7,316.00" "$2,926.40" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$5,487.00" "$7,316.00" "$7,316.00" "$7,316.00" "$3,658.00" "$3,658.00" "$5,794.27" "$7,316.00" "$5,852.80" "$3,292.20" "$7,316.00" "$7,316.00" "$4,243.28" "$7,316.00" "$4,389.60" "$7,316.00" "$7,316.00" "$7,316.00" N/A N/A 27804157 EAP Custom 27804157 "COIL 400 COMPLEX STANDARD, 12MM X 45CM" BOTH IP/OP "$7,464.00" "$5,523.50" "$1,328.59" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$1,328.59" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$1,555.58" "$7,464.00" "$2,985.60" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$7,464.00" "$5,598.00" "$7,464.00" "$7,464.00" "$7,464.00" "$3,732.00" "$3,732.00" "$5,911.49" "$7,464.00" "$5,971.20" "$3,358.80" "$7,464.00" "$7,464.00" "$4,329.12" "$7,464.00" "$4,478.40" "$7,464.00" "$7,464.00" "$7,464.00" N/A N/A 27804158 EAP Custom 27804158 "COIL 400 COMPLEX STANDARD, 13MM X 35CM" BOTH IP/OP "$7,316.00" "$5,414.00" "$1,302.25" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$1,302.25" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$1,524.73" "$7,316.00" "$2,926.40" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$7,316.00" "$5,487.00" "$7,316.00" "$7,316.00" "$7,316.00" "$3,658.00" "$3,658.00" "$5,794.27" "$7,316.00" "$5,852.80" "$3,292.20" "$7,316.00" "$7,316.00" "$4,243.28" "$7,316.00" "$4,389.60" "$7,316.00" "$7,316.00" "$7,316.00" N/A N/A 27804159 EAP Custom 27804159 "COIL 400 COMPLEX STANDARD, 13MM X 48CM" BOTH IP/OP "$7,507.00" "$5,555.50" "$1,336.25" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$1,336.25" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$1,564.54" "$7,507.00" "$3,002.80" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$5,630.25" "$7,507.00" "$7,507.00" "$7,507.00" "$3,753.50" "$3,753.50" "$5,945.54" "$7,507.00" "$6,005.60" "$3,378.15" "$7,507.00" "$7,507.00" "$4,354.06" "$7,507.00" "$4,504.20" "$7,507.00" "$7,507.00" "$7,507.00" N/A N/A 27804160 EAP Custom 27804160 "COIL 400 COMPLEX STANDARD, 14MM X 50CM" BOTH IP/OP "$7,537.00" "$5,577.50" "$1,341.59" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$1,341.59" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$1,570.79" "$7,537.00" "$3,014.80" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$5,652.75" "$7,537.00" "$7,537.00" "$7,537.00" "$3,768.50" "$3,768.50" "$5,969.30" "$7,537.00" "$6,029.60" "$3,391.65" "$7,537.00" "$7,537.00" "$4,371.46" "$7,537.00" "$4,522.20" "$7,537.00" "$7,537.00" "$7,537.00" N/A N/A 27804161 EAP Custom 27804161 "COIL 400 COMPLEX SOFT, 6MM X 10CM" BOTH IP/OP "$7,241.00" "$5,358.50" "$1,288.90" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$1,288.90" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$1,509.10" "$7,241.00" "$2,896.40" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$5,430.75" "$7,241.00" "$7,241.00" "$7,241.00" "$3,620.50" "$3,620.50" "$5,734.87" "$7,241.00" "$5,792.80" "$3,258.45" "$7,241.00" "$7,241.00" "$4,199.78" "$7,241.00" "$4,344.60" "$7,241.00" "$7,241.00" "$7,241.00" N/A N/A 27804162 EAP Custom 27804162 "COIL 400 COMPLEX SOFT, 6MM X 15CM" BOTH IP/OP "$7,389.00" "$5,468.00" "$1,315.24" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$1,315.24" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$1,539.95" "$7,389.00" "$2,955.60" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$5,541.75" "$7,389.00" "$7,389.00" "$7,389.00" "$3,694.50" "$3,694.50" "$5,852.09" "$7,389.00" "$5,911.20" "$3,325.05" "$7,389.00" "$7,389.00" "$4,285.62" "$7,389.00" "$4,433.40" "$7,389.00" "$7,389.00" "$7,389.00" N/A N/A 27804163 EAP Custom 27804163 "COIL 400 COMPLEX SOFT, 6MM X 20CM" BOTH IP/OP "$7,537.00" "$5,577.50" "$1,341.59" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$1,341.59" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$1,570.79" "$7,537.00" "$3,014.80" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$5,652.75" "$7,537.00" "$7,537.00" "$7,537.00" "$3,768.50" "$3,768.50" "$5,969.30" "$7,537.00" "$6,029.60" "$3,391.65" "$7,537.00" "$7,537.00" "$4,371.46" "$7,537.00" "$4,522.20" "$7,537.00" "$7,537.00" "$7,537.00" N/A N/A 27804164 EAP Custom 27804164 "COIL 400 COMPLEX SOFT, 7 MM X 10 CM" BOTH IP/OP "$7,241.00" "$5,358.50" "$1,288.90" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$1,288.90" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$1,509.10" "$7,241.00" "$2,896.40" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$5,430.75" "$7,241.00" "$7,241.00" "$7,241.00" "$3,620.50" "$3,620.50" "$5,734.87" "$7,241.00" "$5,792.80" "$3,258.45" "$7,241.00" "$7,241.00" "$4,199.78" "$7,241.00" "$4,344.60" "$7,241.00" "$7,241.00" "$7,241.00" N/A N/A 27804165 EAP Custom 27804165 "COIL 400 COMPLEX SOFT, 7MM X 15CM" BOTH IP/OP "$7,389.00" "$5,468.00" "$1,315.24" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$1,315.24" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$1,539.95" "$7,389.00" "$2,955.60" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$5,541.75" "$7,389.00" "$7,389.00" "$7,389.00" "$3,694.50" "$3,694.50" "$5,852.09" "$7,389.00" "$5,911.20" "$3,325.05" "$7,389.00" "$7,389.00" "$4,285.62" "$7,389.00" "$4,433.40" "$7,389.00" "$7,389.00" "$7,389.00" N/A N/A 27804166 EAP Custom 27804166 "COIL 400 COMPLEX SOFT, 7MM X 20CM" BOTH IP/OP "$7,537.00" "$5,577.50" "$1,341.59" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$1,341.59" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$1,570.79" "$7,537.00" "$3,014.80" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$5,652.75" "$7,537.00" "$7,537.00" "$7,537.00" "$3,768.50" "$3,768.50" "$5,969.30" "$7,537.00" "$6,029.60" "$3,391.65" "$7,537.00" "$7,537.00" "$4,371.46" "$7,537.00" "$4,522.20" "$7,537.00" "$7,537.00" "$7,537.00" N/A N/A 27804167 EAP Custom 27804167 "COIL 400 COMPLEX SOFT, 8MM X 15CM" BOTH IP/OP "$7,389.00" "$5,468.00" "$1,315.24" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$1,315.24" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$1,539.95" "$7,389.00" "$2,955.60" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$5,541.75" "$7,389.00" "$7,389.00" "$7,389.00" "$3,694.50" "$3,694.50" "$5,852.09" "$7,389.00" "$5,911.20" "$3,325.05" "$7,389.00" "$7,389.00" "$4,285.62" "$7,389.00" "$4,433.40" "$7,389.00" "$7,389.00" "$7,389.00" N/A N/A 27804168 EAP Custom 27804168 "COIL 400 COMPLEX SOFT, 8MM X 20CM" BOTH IP/OP "$7,389.00" "$5,468.00" "$1,315.24" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$1,315.24" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$1,539.95" "$7,389.00" "$2,955.60" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$7,389.00" "$5,541.75" "$7,389.00" "$7,389.00" "$7,389.00" "$3,694.50" "$3,694.50" "$5,852.09" "$7,389.00" "$5,911.20" "$3,325.05" "$7,389.00" "$7,389.00" "$4,285.62" "$7,389.00" "$4,433.40" "$7,389.00" "$7,389.00" "$7,389.00" N/A N/A 27804169 EAP Custom 27804169 "COIL 400 COMPLEX SOFT, 8MM X 30CM" BOTH IP/OP "$7,832.00" "$5,796.00" "$1,394.10" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$1,394.10" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$1,632.27" "$7,832.00" "$3,132.80" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$5,874.00" "$7,832.00" "$7,832.00" "$7,832.00" "$3,916.00" "$3,916.00" "$6,202.94" "$7,832.00" "$6,265.60" "$3,524.40" "$7,832.00" "$7,832.00" "$4,542.56" "$7,832.00" "$4,699.20" "$7,832.00" "$7,832.00" "$7,832.00" N/A N/A 27804170 EAP Custom 27804170 "COIL 400 CURVE EXTRA SOFT, 3MM X 8CM" BOTH IP/OP "$7,241.00" "$5,358.50" "$1,288.90" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$1,288.90" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$1,509.10" "$7,241.00" "$2,896.40" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$5,430.75" "$7,241.00" "$7,241.00" "$7,241.00" "$3,620.50" "$3,620.50" "$5,734.87" "$7,241.00" "$5,792.80" "$3,258.45" "$7,241.00" "$7,241.00" "$4,199.78" "$7,241.00" "$4,344.60" "$7,241.00" "$7,241.00" "$7,241.00" N/A N/A 27804171 EAP Custom 27804171 "COIL 400 CURVE EXTRA SOFT, 3MM X 10CM" BOTH IP/OP "$7,699.00" "$5,697.50" "$1,370.42" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$1,370.42" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$1,604.56" "$7,699.00" "$3,079.60" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$5,774.25" "$7,699.00" "$7,699.00" "$7,699.00" "$3,849.50" "$3,849.50" "$6,097.61" "$7,699.00" "$6,159.20" "$3,464.55" "$7,699.00" "$7,699.00" "$4,465.42" "$7,699.00" "$4,619.40" "$7,699.00" "$7,699.00" "$7,699.00" N/A N/A 27804172 EAP Custom 27804172 "COIL 400 CURVE EXTRA SOFT, 4MM X 4CM" BOTH IP/OP "$6,000.00" "$4,440.00" "$1,068.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,068.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.47" "$6,000.00" "$2,400.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$4,500.00" "$6,000.00" "$6,000.00" "$6,000.00" "$3,000.00" "$3,000.00" "$4,752.00" "$6,000.00" "$4,800.00" "$2,700.00" "$6,000.00" "$6,000.00" "$3,480.00" "$6,000.00" "$3,600.00" "$6,000.00" "$6,000.00" "$6,000.00" N/A N/A 27804173 EAP Custom 27804173 "COIL 400 CURVE EXTRA SOFT, 4MM X 6CM" BOTH IP/OP "$6,000.00" "$4,440.00" "$1,068.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,068.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.47" "$6,000.00" "$2,400.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$4,500.00" "$6,000.00" "$6,000.00" "$6,000.00" "$3,000.00" "$3,000.00" "$4,752.00" "$6,000.00" "$4,800.00" "$2,700.00" "$6,000.00" "$6,000.00" "$3,480.00" "$6,000.00" "$3,600.00" "$6,000.00" "$6,000.00" "$6,000.00" N/A N/A 27804174 EAP Custom 27804174 "COIL 400 CURVE EXTRA SOFT, 4MM X 8CM" BOTH IP/OP "$7,241.00" "$5,358.50" "$1,288.90" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$1,288.90" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$1,509.10" "$7,241.00" "$2,896.40" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$5,430.75" "$7,241.00" "$7,241.00" "$7,241.00" "$3,620.50" "$3,620.50" "$5,734.87" "$7,241.00" "$5,792.80" "$3,258.45" "$7,241.00" "$7,241.00" "$4,199.78" "$7,241.00" "$4,344.60" "$7,241.00" "$7,241.00" "$7,241.00" N/A N/A 27804175 EAP Custom 27804175 "COIL 400 CURVE EXTRA SOFT, 4MM X 10CM" BOTH IP/OP "$7,699.00" "$5,697.50" "$1,370.42" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$1,370.42" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$1,604.56" "$7,699.00" "$3,079.60" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$7,699.00" "$5,774.25" "$7,699.00" "$7,699.00" "$7,699.00" "$3,849.50" "$3,849.50" "$6,097.61" "$7,699.00" "$6,159.20" "$3,464.55" "$7,699.00" "$7,699.00" "$4,465.42" "$7,699.00" "$4,619.40" "$7,699.00" "$7,699.00" "$7,699.00" N/A N/A 27804176 EAP Custom 27804176 "COIL 400 COMPLEX EXTRA SOFT, 2MM X 2CM" BOTH IP/OP "$5,674.00" "$4,199.00" "$1,009.97" "$5,674.00" "$5,674.00" "$5,674.00" "$5,674.00" "$5,674.00" "$5,674.00" "$5,674.00" "$1,009.97" "$5,674.00" "$5,674.00" "$5,674.00" "$5,674.00" "$5,674.00" "$5,674.00" "$1,182.52" "$5,674.00" "$2,269.60" "$5,674.00" "$5,674.00" "$5,674.00" "$5,674.00" "$5,674.00" "$4,255.50" "$5,674.00" "$5,674.00" "$5,674.00" "$2,837.00" "$2,837.00" "$4,493.81" "$5,674.00" "$4,539.20" "$2,553.30" "$5,674.00" "$5,674.00" "$3,290.92" "$5,674.00" "$3,404.40" "$5,674.00" "$5,674.00" "$5,674.00" N/A N/A 27804177 EAP Custom 27804177 "COIL 400 COMPLEX EXTRA SOFT, 2MM X 3CM" BOTH IP/OP "$5,986.00" "$4,430.00" "$1,065.51" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$1,065.51" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$1,247.55" "$5,986.00" "$2,394.40" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$4,489.50" "$5,986.00" "$5,986.00" "$5,986.00" "$2,993.00" "$2,993.00" "$4,740.91" "$5,986.00" "$4,788.80" "$2,693.70" "$5,986.00" "$5,986.00" "$3,471.88" "$5,986.00" "$3,591.60" "$5,986.00" "$5,986.00" "$5,986.00" N/A N/A 27804178 EAP Custom 27804178 "COIL 400 COMPLEX EXTRA SOFT, 2MM X 4CM" BOTH IP/OP "$6,296.00" "$4,659.50" "$1,120.69" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$1,120.69" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$1,312.16" "$6,296.00" "$2,518.40" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$4,722.00" "$6,296.00" "$6,296.00" "$6,296.00" "$3,148.00" "$3,148.00" "$4,986.43" "$6,296.00" "$5,036.80" "$2,833.20" "$6,296.00" "$6,296.00" "$3,651.68" "$6,296.00" "$3,777.60" "$6,296.00" "$6,296.00" "$6,296.00" N/A N/A 27804179 EAP Custom 27804179 "COIL 400 COMPLEX SOFT, 9MM X 25CM" BOTH IP/OP "$7,685.00" "$5,687.00" "$1,367.93" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$1,367.93" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$1,601.64" "$7,685.00" "$3,074.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$5,763.75" "$7,685.00" "$7,685.00" "$7,685.00" "$3,842.50" "$3,842.50" "$6,086.52" "$7,685.00" "$6,148.00" "$3,458.25" "$7,685.00" "$7,685.00" "$4,457.30" "$7,685.00" "$4,611.00" "$7,685.00" "$7,685.00" "$7,685.00" N/A N/A 27804180 EAP Custom 27804180 "COIL 400 COMPLEX SOFT, 9MM X 35CM" BOTH IP/OP "$7,980.00" "$5,905.50" "$1,420.44" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$1,420.44" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$1,663.12" "$7,980.00" "$3,192.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$5,985.00" "$7,980.00" "$7,980.00" "$7,980.00" "$3,990.00" "$3,990.00" "$6,320.16" "$7,980.00" "$6,384.00" "$3,591.00" "$7,980.00" "$7,980.00" "$4,628.40" "$7,980.00" "$4,788.00" "$7,980.00" "$7,980.00" "$7,980.00" N/A N/A 27804181 EAP Custom 27804181 "COIL 400 COMPLEX SOFT, 10MM X 20CM" BOTH IP/OP "$7,537.00" "$5,577.50" "$1,341.59" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$1,341.59" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$1,570.79" "$7,537.00" "$3,014.80" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$5,652.75" "$7,537.00" "$7,537.00" "$7,537.00" "$3,768.50" "$3,768.50" "$5,969.30" "$7,537.00" "$6,029.60" "$3,391.65" "$7,537.00" "$7,537.00" "$4,371.46" "$7,537.00" "$4,522.20" "$7,537.00" "$7,537.00" "$7,537.00" N/A N/A 27804182 EAP Custom 27804182 "COIL 400 COMPLEX SOFT, 10MM X 30CM" BOTH IP/OP "$7,832.00" "$5,796.00" "$1,394.10" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$1,394.10" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$1,632.27" "$7,832.00" "$3,132.80" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$7,832.00" "$5,874.00" "$7,832.00" "$7,832.00" "$7,832.00" "$3,916.00" "$3,916.00" "$6,202.94" "$7,832.00" "$6,265.60" "$3,524.40" "$7,832.00" "$7,832.00" "$4,542.56" "$7,832.00" "$4,699.20" "$7,832.00" "$7,832.00" "$7,832.00" N/A N/A 27804183 EAP Custom 27804183 "COIL 400 COMPLEX SOFT, 10MM X 40CM" BOTH IP/OP "$8,128.00" "$6,015.00" "$1,446.78" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$1,446.78" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$1,693.96" "$8,128.00" "$3,251.20" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$8,128.00" "$6,096.00" "$8,128.00" "$8,128.00" "$8,128.00" "$4,064.00" "$4,064.00" "$6,437.38" "$8,128.00" "$6,502.40" "$3,657.60" "$8,128.00" "$8,128.00" "$4,714.24" "$8,128.00" "$4,876.80" "$8,128.00" "$8,128.00" "$8,128.00" N/A N/A 27804184 EAP Custom 27804184 "COIL 400 COMPLEX SOFT, 11MM X 35CM" BOTH IP/OP "$7,980.00" "$5,905.50" "$1,420.44" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$1,420.44" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$1,663.12" "$7,980.00" "$3,192.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$5,985.00" "$7,980.00" "$7,980.00" "$7,980.00" "$3,990.00" "$3,990.00" "$6,320.16" "$7,980.00" "$6,384.00" "$3,591.00" "$7,980.00" "$7,980.00" "$4,628.40" "$7,980.00" "$4,788.00" "$7,980.00" "$7,980.00" "$7,980.00" N/A N/A 27804185 EAP Custom 27804185 "COIL 400 COMPLEX SOFT, 11MM X 45CM" BOTH IP/OP "$8,276.00" "$6,124.50" "$1,473.13" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$1,473.13" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$1,724.81" "$8,276.00" "$3,310.40" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$6,207.00" "$8,276.00" "$8,276.00" "$8,276.00" "$4,138.00" "$4,138.00" "$6,554.59" "$8,276.00" "$6,620.80" "$3,724.20" "$8,276.00" "$8,276.00" "$4,800.08" "$8,276.00" "$4,965.60" "$8,276.00" "$8,276.00" "$8,276.00" N/A N/A 27804186 EAP Custom 27804186 "COIL 400 COMPLEX SOFT, 12MM X 35CM" BOTH IP/OP "$7,980.00" "$5,905.50" "$1,420.44" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$1,420.44" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$1,663.12" "$7,980.00" "$3,192.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$7,980.00" "$5,985.00" "$7,980.00" "$7,980.00" "$7,980.00" "$3,990.00" "$3,990.00" "$6,320.16" "$7,980.00" "$6,384.00" "$3,591.00" "$7,980.00" "$7,980.00" "$4,628.40" "$7,980.00" "$4,788.00" "$7,980.00" "$7,980.00" "$7,980.00" N/A N/A 27804187 EAP Custom 27804187 "COIL 400 COMPLEX SOFT, 12MM X 45CM" BOTH IP/OP "$8,276.00" "$6,124.50" "$1,473.13" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$1,473.13" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$1,724.81" "$8,276.00" "$3,310.40" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$8,276.00" "$6,207.00" "$8,276.00" "$8,276.00" "$8,276.00" "$4,138.00" "$4,138.00" "$6,554.59" "$8,276.00" "$6,620.80" "$3,724.20" "$8,276.00" "$8,276.00" "$4,800.08" "$8,276.00" "$4,965.60" "$8,276.00" "$8,276.00" "$8,276.00" N/A N/A 27804188 EAP Custom 27804188 "COIL 400 CURVE EXTRA SOFT, 2MM X 1CM" BOTH IP/OP "$5,070.00" "$3,752.00" $902.46 "$5,070.00" "$5,070.00" "$5,070.00" "$5,070.00" "$5,070.00" "$5,070.00" "$5,070.00" $902.46 "$5,070.00" "$5,070.00" "$5,070.00" "$5,070.00" "$5,070.00" "$5,070.00" "$1,056.64" "$5,070.00" "$2,028.00" "$5,070.00" "$5,070.00" "$5,070.00" "$5,070.00" "$5,070.00" "$3,802.50" "$5,070.00" "$5,070.00" "$5,070.00" "$2,535.00" "$2,535.00" "$4,015.44" "$5,070.00" "$4,056.00" "$2,281.50" "$5,070.00" "$5,070.00" "$2,940.60" "$5,070.00" "$3,042.00" "$5,070.00" "$5,070.00" "$5,070.00" N/A N/A 27804189 EAP Custom 27804189 "COIL 400 CURVE EXTRA SOFT, 2MM X 2CM" BOTH IP/OP "$5,379.00" "$3,980.50" $957.46 "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" $957.46 "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$1,121.04" "$5,379.00" "$2,151.60" "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$4,034.25" "$5,379.00" "$5,379.00" "$5,379.00" "$2,689.50" "$2,689.50" "$4,260.17" "$5,379.00" "$4,303.20" "$2,420.55" "$5,379.00" "$5,379.00" "$3,119.82" "$5,379.00" "$3,227.40" "$5,379.00" "$5,379.00" "$5,379.00" N/A N/A 27804190 EAP Custom 27804190 "COIL 400 CURVE EXTRA SOFT, 2MM X 3CM" BOTH IP/OP "$5,690.00" "$4,211.00" "$1,012.82" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$1,012.82" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$1,185.86" "$5,690.00" "$2,276.00" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$4,267.50" "$5,690.00" "$5,690.00" "$5,690.00" "$2,845.00" "$2,845.00" "$4,506.48" "$5,690.00" "$4,552.00" "$2,560.50" "$5,690.00" "$5,690.00" "$3,300.20" "$5,690.00" "$3,414.00" "$5,690.00" "$5,690.00" "$5,690.00" N/A N/A 27804191 EAP Custom 27804191 "COIL 400 CURVE EXTRA SOFT, 2MM X 4CM" BOTH IP/OP "$6,000.00" "$4,440.00" "$1,068.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,068.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.47" "$6,000.00" "$2,400.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$4,500.00" "$6,000.00" "$6,000.00" "$6,000.00" "$3,000.00" "$3,000.00" "$4,752.00" "$6,000.00" "$4,800.00" "$2,700.00" "$6,000.00" "$6,000.00" "$3,480.00" "$6,000.00" "$3,600.00" "$6,000.00" "$6,000.00" "$6,000.00" N/A N/A 27804192 EAP Custom 27804192 "COIL 400 CURVE EXTRA SOFT, 3MM X 2CM" BOTH IP/OP "$5,379.00" "$3,980.50" $957.46 "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" $957.46 "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$1,121.04" "$5,379.00" "$2,151.60" "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$5,379.00" "$4,034.25" "$5,379.00" "$5,379.00" "$5,379.00" "$2,689.50" "$2,689.50" "$4,260.17" "$5,379.00" "$4,303.20" "$2,420.55" "$5,379.00" "$5,379.00" "$3,119.82" "$5,379.00" "$3,227.40" "$5,379.00" "$5,379.00" "$5,379.00" N/A N/A 27804193 EAP Custom 27804193 "COIL 400 CURVE EXTRA SOFT, 3MM X 3CM" BOTH IP/OP "$5,690.00" "$4,211.00" "$1,012.82" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$1,012.82" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$1,185.86" "$5,690.00" "$2,276.00" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$5,690.00" "$4,267.50" "$5,690.00" "$5,690.00" "$5,690.00" "$2,845.00" "$2,845.00" "$4,506.48" "$5,690.00" "$4,552.00" "$2,560.50" "$5,690.00" "$5,690.00" "$3,300.20" "$5,690.00" "$3,414.00" "$5,690.00" "$5,690.00" "$5,690.00" N/A N/A 27804194 EAP Custom 27804194 "COIL 400 CURVE EXTRA SOFT, 3MM X 4CM" BOTH IP/OP "$6,000.00" "$4,440.00" "$1,068.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,068.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.47" "$6,000.00" "$2,400.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$4,500.00" "$6,000.00" "$6,000.00" "$6,000.00" "$3,000.00" "$3,000.00" "$4,752.00" "$6,000.00" "$4,800.00" "$2,700.00" "$6,000.00" "$6,000.00" "$3,480.00" "$6,000.00" "$3,600.00" "$6,000.00" "$6,000.00" "$6,000.00" N/A N/A 27804195 EAP Custom 27804195 "COIL 400 CURVE EXTRA SOFT, 3MM X 5CM" BOTH IP/OP "$6,310.00" "$4,669.50" "$1,123.18" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$1,123.18" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$1,315.07" "$6,310.00" "$2,524.00" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$6,310.00" "$4,732.50" "$6,310.00" "$6,310.00" "$6,310.00" "$3,155.00" "$3,155.00" "$4,997.52" "$6,310.00" "$5,048.00" "$2,839.50" "$6,310.00" "$6,310.00" "$3,659.80" "$6,310.00" "$3,786.00" "$6,310.00" "$6,310.00" "$6,310.00" N/A N/A 27804196 EAP Custom 27804196 "COIL 400 CURVE EXTRA SOFT, 3MM X 6CM" BOTH IP/OP "$6,620.00" "$4,899.00" "$1,178.36" "$6,620.00" "$6,620.00" "$6,620.00" "$6,620.00" "$6,620.00" "$6,620.00" "$6,620.00" "$1,178.36" "$6,620.00" "$6,620.00" "$6,620.00" "$6,620.00" "$6,620.00" "$6,620.00" "$1,379.68" "$6,620.00" "$2,648.00" "$6,620.00" "$6,620.00" "$6,620.00" "$6,620.00" "$6,620.00" "$4,965.00" "$6,620.00" "$6,620.00" "$6,620.00" "$3,310.00" "$3,310.00" "$5,243.04" "$6,620.00" "$5,296.00" "$2,979.00" "$6,620.00" "$6,620.00" "$3,839.60" "$6,620.00" "$3,972.00" "$6,620.00" "$6,620.00" "$6,620.00" N/A N/A 27804197 EAP Custom 27804197 "COIL 400 COMPLEX EXTRA SOFT, 3MM X 3CM" BOTH IP/OP "$5,986.00" "$4,430.00" "$1,065.51" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$1,065.51" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$1,247.55" "$5,986.00" "$2,394.40" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$5,986.00" "$4,489.50" "$5,986.00" "$5,986.00" "$5,986.00" "$2,993.00" "$2,993.00" "$4,740.91" "$5,986.00" "$4,788.80" "$2,693.70" "$5,986.00" "$5,986.00" "$3,471.88" "$5,986.00" "$3,591.60" "$5,986.00" "$5,986.00" "$5,986.00" N/A N/A 27804198 EAP Custom 27804198 "COIL 400 COMPLEX EXTRA SOFT, 3MM X 4CM" BOTH IP/OP "$6,296.00" "$4,659.50" "$1,120.69" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$1,120.69" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$1,312.16" "$6,296.00" "$2,518.40" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$4,722.00" "$6,296.00" "$6,296.00" "$6,296.00" "$3,148.00" "$3,148.00" "$4,986.43" "$6,296.00" "$5,036.80" "$2,833.20" "$6,296.00" "$6,296.00" "$3,651.68" "$6,296.00" "$3,777.60" "$6,296.00" "$6,296.00" "$6,296.00" N/A N/A 27804199 EAP Custom 27804199 "COIL 400 COMPLEX EXTRA SOFT, 3MM X 5CM" BOTH IP/OP "$6,606.00" "$4,888.50" "$1,175.87" "$6,606.00" "$6,606.00" "$6,606.00" "$6,606.00" "$6,606.00" "$6,606.00" "$6,606.00" "$1,175.87" "$6,606.00" "$6,606.00" "$6,606.00" "$6,606.00" "$6,606.00" "$6,606.00" "$1,376.76" "$6,606.00" "$2,642.40" "$6,606.00" "$6,606.00" "$6,606.00" "$6,606.00" "$6,606.00" "$4,954.50" "$6,606.00" "$6,606.00" "$6,606.00" "$3,303.00" "$3,303.00" "$5,231.95" "$6,606.00" "$5,284.80" "$2,972.70" "$6,606.00" "$6,606.00" "$3,831.48" "$6,606.00" "$3,963.60" "$6,606.00" "$6,606.00" "$6,606.00" N/A N/A 27804200 EAP Custom 27804200 "COIL 400 COMPLEX EXTRA SOFT, 3MM X 6CM" BOTH IP/OP "$6,916.00" "$5,118.00" "$1,231.05" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$1,231.05" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$1,441.37" "$6,916.00" "$2,766.40" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$5,187.00" "$6,916.00" "$6,916.00" "$6,916.00" "$3,458.00" "$3,458.00" "$5,477.47" "$6,916.00" "$5,532.80" "$3,112.20" "$6,916.00" "$6,916.00" "$4,011.28" "$6,916.00" "$4,149.60" "$6,916.00" "$6,916.00" "$6,916.00" N/A N/A 27804201 EAP Custom 27804201 "COIL 400 COMPLEX EXTRA SOFT, 3MM X 8CM" BOTH IP/OP "$7,537.00" "$5,577.50" "$1,341.59" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$1,341.59" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$1,570.79" "$7,537.00" "$3,014.80" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$5,652.75" "$7,537.00" "$7,537.00" "$7,537.00" "$3,768.50" "$3,768.50" "$5,969.30" "$7,537.00" "$6,029.60" "$3,391.65" "$7,537.00" "$7,537.00" "$4,371.46" "$7,537.00" "$4,522.20" "$7,537.00" "$7,537.00" "$7,537.00" N/A N/A 27804202 EAP Custom 27804202 "COIL 400 COMPLEX EXTRA SOFT, 3MM X 10CM" BOTH IP/OP "$8,157.00" "$6,036.50" "$1,451.95" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$1,451.95" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$1,700.01" "$8,157.00" "$3,262.80" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$8,157.00" "$6,117.75" "$8,157.00" "$8,157.00" "$8,157.00" "$4,078.50" "$4,078.50" "$6,460.34" "$8,157.00" "$6,525.60" "$3,670.65" "$8,157.00" "$8,157.00" "$4,731.06" "$8,157.00" "$4,894.20" "$8,157.00" "$8,157.00" "$8,157.00" N/A N/A 27804203 EAP Custom 27804203 "COIL 400 COMPLEX EXTRA SOFT, 4MM X 4CM" BOTH IP/OP "$6,296.00" "$4,659.50" "$1,120.69" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$1,120.69" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$1,312.16" "$6,296.00" "$2,518.40" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$6,296.00" "$4,722.00" "$6,296.00" "$6,296.00" "$6,296.00" "$3,148.00" "$3,148.00" "$4,986.43" "$6,296.00" "$5,036.80" "$2,833.20" "$6,296.00" "$6,296.00" "$3,651.68" "$6,296.00" "$3,777.60" "$6,296.00" "$6,296.00" "$6,296.00" N/A N/A 27804204 EAP Custom 27804204 "COIL 400 COMPLEX EXTRA SOFT, 4MM X 6CM" BOTH IP/OP "$6,916.00" "$5,118.00" "$1,231.05" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$1,231.05" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$1,441.37" "$6,916.00" "$2,766.40" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$6,916.00" "$5,187.00" "$6,916.00" "$6,916.00" "$6,916.00" "$3,458.00" "$3,458.00" "$5,477.47" "$6,916.00" "$5,532.80" "$3,112.20" "$6,916.00" "$6,916.00" "$4,011.28" "$6,916.00" "$4,149.60" "$6,916.00" "$6,916.00" "$6,916.00" N/A N/A 27804205 EAP Custom 27804205 "COIL 400 COMPLEX EXTRA SOFT, 4MM X 8CM" BOTH IP/OP "$7,537.00" "$5,577.50" "$1,341.59" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$1,341.59" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$1,570.79" "$7,537.00" "$3,014.80" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$7,537.00" "$5,652.75" "$7,537.00" "$7,537.00" "$7,537.00" "$3,768.50" "$3,768.50" "$5,969.30" "$7,537.00" "$6,029.60" "$3,391.65" "$7,537.00" "$7,537.00" "$4,371.46" "$7,537.00" "$4,522.20" "$7,537.00" "$7,537.00" "$7,537.00" N/A N/A 27804206 EAP Custom 27804206 "COIL 400 COMPLEX STANDARD, 7 MM X 15 CM" BOTH IP/OP "$6,798.00" "$5,031.00" "$1,210.04" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$1,210.04" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$1,416.78" "$6,798.00" "$2,719.20" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$5,098.50" "$6,798.00" "$6,798.00" "$6,798.00" "$3,399.00" "$3,399.00" "$5,384.02" "$6,798.00" "$5,438.40" "$3,059.10" "$6,798.00" "$6,798.00" "$3,942.84" "$6,798.00" "$4,078.80" "$6,798.00" "$6,798.00" "$6,798.00" N/A N/A 27804207 EAP Custom 27804207 "COIL 400 COMPLEX STANDARD, 7MM X 20CM" BOTH IP/OP "$6,946.00" "$5,140.50" "$1,236.39" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$1,236.39" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$1,447.62" "$6,946.00" "$2,778.40" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$5,209.50" "$6,946.00" "$6,946.00" "$6,946.00" "$3,473.00" "$3,473.00" "$5,501.23" "$6,946.00" "$5,556.80" "$3,125.70" "$6,946.00" "$6,946.00" "$4,028.68" "$6,946.00" "$4,167.60" "$6,946.00" "$6,946.00" "$6,946.00" N/A N/A 27804208 EAP Custom 27804208 "COIL 400 COMPLEX STANDARD, 8 MM X 15 CM" BOTH IP/OP "$6,798.00" "$5,031.00" "$1,210.04" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$1,210.04" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$1,416.78" "$6,798.00" "$2,719.20" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$5,098.50" "$6,798.00" "$6,798.00" "$6,798.00" "$3,399.00" "$3,399.00" "$5,384.02" "$6,798.00" "$5,438.40" "$3,059.10" "$6,798.00" "$6,798.00" "$3,942.84" "$6,798.00" "$4,078.80" "$6,798.00" "$6,798.00" "$6,798.00" N/A N/A 27804209 EAP Custom 27804209 "COIL 400 COMPLEX STANDARD, 8MM X 20CM" BOTH IP/OP "$6,798.00" "$5,031.00" "$1,210.04" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$1,210.04" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$1,416.78" "$6,798.00" "$2,719.20" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$5,098.50" "$6,798.00" "$6,798.00" "$6,798.00" "$3,399.00" "$3,399.00" "$5,384.02" "$6,798.00" "$5,438.40" "$3,059.10" "$6,798.00" "$6,798.00" "$3,942.84" "$6,798.00" "$4,078.80" "$6,798.00" "$6,798.00" "$6,798.00" N/A N/A 27804210 EAP Custom 27804210 "COIL 400 COMPLEX STANDARD, 8MM X 30CM" BOTH IP/OP "$7,241.00" "$5,358.50" "$1,288.90" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$1,288.90" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$1,509.10" "$7,241.00" "$2,896.40" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$7,241.00" "$5,430.75" "$7,241.00" "$7,241.00" "$7,241.00" "$3,620.50" "$3,620.50" "$5,734.87" "$7,241.00" "$5,792.80" "$3,258.45" "$7,241.00" "$7,241.00" "$4,199.78" "$7,241.00" "$4,344.60" "$7,241.00" "$7,241.00" "$7,241.00" N/A N/A 27804211 EAP Custom 27804211 "COIL 400 COMPLEX STANDARD, 9 MM X 15 CM" BOTH IP/OP "$6,798.00" "$5,031.00" "$1,210.04" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$1,210.04" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$1,416.78" "$6,798.00" "$2,719.20" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$6,798.00" "$5,098.50" "$6,798.00" "$6,798.00" "$6,798.00" "$3,399.00" "$3,399.00" "$5,384.02" "$6,798.00" "$5,438.40" "$3,059.10" "$6,798.00" "$6,798.00" "$3,942.84" "$6,798.00" "$4,078.80" "$6,798.00" "$6,798.00" "$6,798.00" N/A N/A 27804212 EAP Custom 27804212 "COIL 400 COMPLEX STANDARD, 9MM X 25CM" BOTH IP/OP "$7,094.00" "$5,250.00" "$1,262.73" "$7,094.00" "$7,094.00" "$7,094.00" "$7,094.00" "$7,094.00" "$7,094.00" "$7,094.00" "$1,262.73" "$7,094.00" "$7,094.00" "$7,094.00" "$7,094.00" "$7,094.00" "$7,094.00" "$1,478.47" "$7,094.00" "$2,837.60" "$7,094.00" "$7,094.00" "$7,094.00" "$7,094.00" "$7,094.00" "$5,320.50" "$7,094.00" "$7,094.00" "$7,094.00" "$3,547.00" "$3,547.00" "$5,618.45" "$7,094.00" "$5,675.20" "$3,192.30" "$7,094.00" "$7,094.00" "$4,114.52" "$7,094.00" "$4,256.40" "$7,094.00" "$7,094.00" "$7,094.00" N/A N/A 27804213 EAP Custom 27804213 "COIL 400 COMPLEX STANDARD, 9MM X 35CM" BOTH IP/OP "$7,300.00" "$5,402.00" "$1,299.40" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$1,299.40" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$1,521.40" "$7,300.00" "$2,920.00" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$7,300.00" "$5,475.00" "$7,300.00" "$7,300.00" "$7,300.00" "$3,650.00" "$3,650.00" "$5,781.60" "$7,300.00" "$5,840.00" "$3,285.00" "$7,300.00" "$7,300.00" "$4,234.00" "$7,300.00" "$4,380.00" "$7,300.00" "$7,300.00" "$7,300.00" N/A N/A 27804214 EAP Custom 27804214 "COIL 400 COMPLEX STANDARD, 10 MM X 20 CM" BOTH IP/OP "$6,946.00" "$5,140.50" "$1,236.39" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$1,236.39" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$1,447.62" "$6,946.00" "$2,778.40" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$6,946.00" "$5,209.50" "$6,946.00" "$6,946.00" "$6,946.00" "$3,473.00" "$3,473.00" "$5,501.23" "$6,946.00" "$5,556.80" "$3,125.70" "$6,946.00" "$6,946.00" "$4,028.68" "$6,946.00" "$4,167.60" "$6,946.00" "$6,946.00" "$6,946.00" N/A N/A 27804250 EAP HCPCS C1751 CATHETER CENTRAL VENOUS PRO-FUSE TRINIFLEX OD8 FR ATTACE BOTH IP/OP $591.00 $437.50 $117.30 $591.00 $265.95 $265.95 $265.95 $265.95 $591.00 $591.00 $591.00 $123.18 $591.00 $591.00 $591.00 $591.00 $591.00 $123.17 $591.00 $591.00 $349.58 $591.00 $591.00 $591.00 $591.00 $443.25 $591.00 $591.00 $591.00 $295.50 $295.50 $468.07 $591.00 $472.80 $265.95 $117.30 $591.00 $342.78 $591.00 $591.00 $591.00 $123.16 $591.00 N/A N/A 27804254 EAP HCPCS C1713 SCREW BONE MINI LONG POST 7.5MM 55MM POLYAX MPA TS BOTH IP/OP "$1,550.00" "$1,147.00" $307.64 "$1,550.00" $697.50 $697.50 $697.50 $697.50 "$1,550.00" "$1,550.00" "$1,550.00" $323.06 "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" $323.04 "$1,550.00" "$1,550.00" $916.83 "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" "$1,162.50" "$1,550.00" "$1,550.00" "$1,550.00" $775.00 $775.00 "$1,227.60" "$1,550.00" "$1,240.00" $697.50 $307.64 "$1,550.00" $899.00 "$1,550.00" "$1,550.00" "$1,550.00" $323.02 "$1,550.00" N/A N/A 27804261 EAP HCPCS C1896 ELECTRODE DFBR 45CM 3 PLR S-ICD COIL CONCTR PIN BOTH IP/OP "$12,500.00" "$9,250.00" "$2,480.94" "$12,500.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,605.31" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,605.14" "$12,500.00" "$12,500.00" "$6,162.50" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$9,375.00" "$12,500.00" "$12,500.00" "$12,500.00" "$6,250.00" "$6,250.00" "$9,900.00" "$12,500.00" "$10,000.00" "$5,625.00" "$2,480.94" "$12,500.00" "$7,250.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,605.00" "$12,500.00" N/A N/A 27804871 EAP Custom 27804871 COIL EMBOLIZATION .02IN COMPLEX 11MM 35CM SOFT THE PENUMBRA BOTH IP/OP "$6,750.00" "$4,995.00" "$1,201.50" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,201.50" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$2,700.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$6,750.00" "$6,750.00" "$3,915.00" "$6,750.00" "$4,050.00" "$6,750.00" "$6,750.00" "$6,750.00" N/A N/A 27804872 EAP Custom 27804872 COIL EMBOLIZATION .02IN COMPLEX 5MM 13CM SOFT THE PENUMBRA BOTH IP/OP "$6,108.00" "$4,520.00" "$1,087.22" "$6,108.00" "$6,108.00" "$6,108.00" "$6,108.00" "$6,108.00" "$6,108.00" "$6,108.00" "$1,087.22" "$6,108.00" "$6,108.00" "$6,108.00" "$6,108.00" "$6,108.00" "$6,108.00" "$1,272.97" "$6,108.00" "$2,443.20" "$6,108.00" "$6,108.00" "$6,108.00" "$6,108.00" "$6,108.00" "$4,581.00" "$6,108.00" "$6,108.00" "$6,108.00" "$3,054.00" "$3,054.00" "$4,837.54" "$6,108.00" "$4,886.40" "$2,748.60" "$6,108.00" "$6,108.00" "$3,542.64" "$6,108.00" "$3,664.80" "$6,108.00" "$6,108.00" "$6,108.00" N/A N/A 27804880 EAP Custom 27804880 COIL EMBOLIZATION .02IN COMPLEX 6MM 15CM SOFT THE PENUMBRA BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" "$6,250.00" "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 27804881 EAP Custom 27804881 COIL EMBOLIZATION .02IN COMPLEX 7MM 20CM SOFT THE PENUMBRA BOTH IP/OP "$6,375.00" "$4,717.50" "$1,134.75" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$1,134.75" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$1,328.62" "$6,375.00" "$2,550.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$4,781.25" "$6,375.00" "$6,375.00" "$6,375.00" "$3,187.50" "$3,187.50" "$5,049.00" "$6,375.00" "$5,100.00" "$2,868.75" "$6,375.00" "$6,375.00" "$3,697.50" "$6,375.00" "$3,825.00" "$6,375.00" "$6,375.00" "$6,375.00" N/A N/A 27804882 EAP Custom 27804882 COIL EMBOLIZATION .02IN COMPLEX 8MM 20CM SOFT THE PENUMBRA BOTH IP/OP "$6,375.00" "$4,717.50" "$1,134.75" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$1,134.75" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$1,328.62" "$6,375.00" "$2,550.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$4,781.25" "$6,375.00" "$6,375.00" "$6,375.00" "$3,187.50" "$3,187.50" "$5,049.00" "$6,375.00" "$5,100.00" "$2,868.75" "$6,375.00" "$6,375.00" "$3,697.50" "$6,375.00" "$3,825.00" "$6,375.00" "$6,375.00" "$6,375.00" N/A N/A 27804883 EAP Custom 27804883 COIL EMBOLIZATION .02IN COMPLEX 9MM 25CM SOFT THE PENUMBRA BOTH IP/OP "$6,500.00" "$4,810.00" "$1,157.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,157.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.67" "$6,500.00" "$2,600.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$4,875.00" "$6,500.00" "$6,500.00" "$6,500.00" "$3,250.00" "$3,250.00" "$5,148.00" "$6,500.00" "$5,200.00" "$2,925.00" "$6,500.00" "$6,500.00" "$3,770.00" "$6,500.00" "$3,900.00" "$6,500.00" "$6,500.00" "$6,500.00" N/A N/A 27804884 EAP Custom 27804884 COIL EMBOLIZATION .02IN STANDARD COMPLEX 11MM 35CM COMPLEX BOTH IP/OP "$6,188.00" "$4,579.50" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,289.65" "$6,188.00" "$2,475.20" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$4,641.00" "$6,188.00" "$6,188.00" "$6,188.00" "$3,094.00" "$3,094.00" "$4,900.90" "$6,188.00" "$4,950.40" "$2,784.60" "$6,188.00" "$6,188.00" "$3,589.04" "$6,188.00" "$3,712.80" "$6,188.00" "$6,188.00" "$6,188.00" N/A N/A 27804885 EAP Custom 27804885 COIL EMBOLIZATION .02IN STANDARD COMPLEX 6MM 15CM COMPLEX BOTH IP/OP "$5,175.00" "$3,829.50" $921.15 "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" $921.15 "$5,175.00" "$5,175.00" "$3,840.89" "$3,840.89" "$3,988.89" "$2,060.15" "$1,078.53" "$5,175.00" "$2,070.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$3,881.25" "$5,175.00" "$5,175.00" "$5,175.00" "$2,587.50" "$2,587.50" "$4,098.60" "$5,175.00" "$4,140.00" "$3,363.75" "$5,175.00" "$5,175.00" "$3,001.50" "$5,175.00" "$3,105.00" "$5,175.00" "$5,175.00" "$5,175.00" N/A N/A 27804886 EAP Custom 27804886 COIL EMBOLIZATION .02IN STANDARD COMPLEX 7MM 20CM COMPLEX BOTH IP/OP "$5,875.00" "$4,347.50" "$1,045.75" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,045.75" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$5,875.00" "$5,875.00" "$3,407.50" "$5,875.00" "$3,525.00" "$5,875.00" "$5,875.00" "$5,875.00" N/A N/A 27805011 EAP Custom 27805011 20 FR SAFETY PEG KIT PULL BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $63.90 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27805012 EAP Custom 27805012 24 FR SAFETY PEG KIT PULL BOTH IP/OP $142.00 $105.50 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $25.28 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $29.59 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $63.90 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 27805013 EAP Custom 27805013 "18 FR REPLACEMENT G-TUBE, RIGHT AN 18" BOTH IP/OP $42.00 $31.50 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $8.75 $42.00 $16.80 $42.00 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $18.90 $42.00 $42.00 $24.36 $42.00 $25.20 $42.00 $42.00 $42.00 N/A N/A 27805014 EAP Custom 27805014 "20 FR REPLACEMENT G-TUBE, RIGHT-AN 20" BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $18.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27805015 EAP Custom 27805015 "22 FR REPLACEMENT G-TUBE, RIGHT-AN" BOTH IP/OP $40.00 $30.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $8.34 $40.00 $16.00 $40.00 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $18.00 $40.00 $40.00 $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A 27805016 EAP HCPCS C2625 RX STENT 7X7CM BOTH IP/OP $133.00 $98.50 $26.40 $133.00 $59.85 $59.85 $59.85 $59.85 $133.00 $133.00 $133.00 $27.72 $133.00 $133.00 $133.00 $133.00 $133.00 $27.72 $133.00 $133.00 $78.67 $133.00 $133.00 $133.00 $133.00 $99.75 $133.00 $133.00 $133.00 $66.50 $66.50 $105.34 $133.00 $106.40 $59.85 $26.40 $133.00 $77.14 $133.00 $133.00 $133.00 $27.72 $133.00 N/A N/A 27805017 EAP HCPCS C2625 RX STENT 7X10CM BOTH IP/OP $133.00 $98.50 $26.40 $133.00 $59.85 $59.85 $59.85 $59.85 $133.00 $133.00 $133.00 $27.72 $133.00 $133.00 $133.00 $133.00 $133.00 $27.72 $133.00 $133.00 $78.67 $133.00 $133.00 $133.00 $133.00 $99.75 $133.00 $133.00 $133.00 $66.50 $66.50 $105.34 $133.00 $106.40 $59.85 $26.40 $133.00 $77.14 $133.00 $133.00 $133.00 $27.72 $133.00 N/A N/A 27805018 EAP HCPCS C2625 RX STENT 10X5CM BOTH IP/OP $133.00 $98.50 $26.40 $133.00 $59.85 $59.85 $59.85 $59.85 $133.00 $133.00 $133.00 $27.72 $133.00 $133.00 $133.00 $133.00 $133.00 $27.72 $133.00 $133.00 $78.67 $133.00 $133.00 $133.00 $133.00 $99.75 $133.00 $133.00 $133.00 $66.50 $66.50 $105.34 $133.00 $106.40 $59.85 $26.40 $133.00 $77.14 $133.00 $133.00 $133.00 $27.72 $133.00 N/A N/A 27805019 EAP HCPCS C2625 RX STENT 10X10CM BOTH IP/OP $133.00 $98.50 $26.40 $133.00 $59.85 $59.85 $59.85 $59.85 $133.00 $133.00 $133.00 $27.72 $133.00 $133.00 $133.00 $133.00 $133.00 $27.72 $133.00 $133.00 $78.67 $133.00 $133.00 $133.00 $133.00 $99.75 $133.00 $133.00 $133.00 $66.50 $66.50 $105.34 $133.00 $106.40 $59.85 $26.40 $133.00 $77.14 $133.00 $133.00 $133.00 $27.72 $133.00 N/A N/A 27805020 EAP Custom 27805020 PILL CAM CAPSULE BOTH IP/OP $532.00 $394.00 $94.70 $532.00 $532.00 $532.00 $532.00 $532.00 $532.00 $532.00 $94.70 $532.00 $532.00 $532.00 $532.00 $532.00 $532.00 $110.87 $532.00 $212.80 $532.00 $532.00 $532.00 $532.00 $532.00 $399.00 $532.00 $532.00 $532.00 $266.00 $266.00 $421.34 $532.00 $425.60 $239.40 $532.00 $532.00 $308.56 $532.00 $319.20 $532.00 $532.00 $532.00 N/A N/A 27805021 EAP HCPCS L8614 COCHLEAR IMPLANT BOTH IP/OP "$106,399.00" "$78,735.50" "$12,551.80" "$106,399.00" "$106,399.00" "$106,399.00" "$106,399.00" "$106,399.00" "$106,399.00" "$106,399.00" "$12,551.80" "$106,399.00" "$106,399.00" "$106,399.00" "$106,399.00" "$106,399.00" "$106,399.00" "$22,174.72" "$106,399.00" "$42,559.60" "$106,399.00" "$106,399.00" "$106,399.00" "$106,399.00" "$106,399.00" "$79,799.25" "$106,399.00" "$106,399.00" "$106,399.00" "$53,199.50" "$53,199.50" "$84,268.01" "$106,399.00" "$85,119.20" "$47,879.55" "$106,399.00" "$106,399.00" "$61,711.42" "$106,399.00" "$63,839.40" "$106,399.00" "$106,399.00" "$106,399.00" N/A N/A 27805022 EAP HCPCS C1878 RADIESSE VOICE MATERIAL FOR VOCAL CORD MEDIALIZATION BOTH IP/OP $638.00 $472.50 $132.97 $638.00 $638.00 $638.00 $638.00 $638.00 $638.00 $638.00 $638.00 $638.00 $638.00 $638.00 $638.00 $638.00 $638.00 $132.97 $638.00 $255.20 $638.00 $638.00 $638.00 $638.00 $638.00 $478.50 $638.00 $638.00 $638.00 $319.00 $319.00 $505.30 $638.00 $510.40 $287.10 $638.00 $638.00 $370.04 $638.00 $382.80 $638.00 $638.00 $638.00 N/A N/A 27805040 EAP Custom 27805040 SENSOR MONITOR FLOTRAC ADULT L60 IN VAMP LATEX FREE BOTH IP/OP $961.00 $711.50 $171.06 $961.00 $961.00 $961.00 $961.00 $961.00 $961.00 $961.00 $171.06 $961.00 $961.00 $961.00 $961.00 $961.00 $961.00 $200.28 $961.00 $384.40 $961.00 $961.00 $961.00 $961.00 $961.00 $720.75 $961.00 $961.00 $961.00 $480.50 $480.50 $761.11 $961.00 $768.80 $432.45 $961.00 $961.00 $557.38 $961.00 $576.60 $961.00 $961.00 $961.00 N/A N/A 27805041 EAP Custom 27805041 SENSOR MONITOR FLOTRAC ADLT L60 IN VAMP BIFURCATED PRES BOTH IP/OP $961.00 $711.50 $171.06 $961.00 $961.00 $961.00 $961.00 $961.00 $961.00 $961.00 $171.06 $961.00 $961.00 $961.00 $961.00 $961.00 $961.00 $200.28 $961.00 $384.40 $961.00 $961.00 $961.00 $961.00 $961.00 $720.75 $961.00 $961.00 $961.00 $480.50 $480.50 $761.11 $961.00 $768.80 $432.45 $961.00 $961.00 $557.38 $961.00 $576.60 $961.00 $961.00 $961.00 N/A N/A 27805044 EAP Custom 27805044 "ACCESSORY KIT, SLIT SUTURE SLEEVE, SS-1056" BOTH IP/OP $72.00 $53.50 $12.82 $72.00 $72.00 $72.00 $72.00 $72.00 $72.00 $72.00 $12.82 $72.00 $72.00 $72.00 $72.00 $72.00 $72.00 $15.01 $72.00 $28.80 $72.00 $72.00 $72.00 $72.00 $72.00 $54.00 $72.00 $72.00 $72.00 $36.00 $36.00 $57.02 $72.00 $57.60 $32.40 $72.00 $72.00 $41.76 $72.00 $43.20 $72.00 $72.00 $72.00 N/A N/A 27805045 EAP Custom 27805045 COIL EMBL 14CM 6MM NST SFT CATH XTD EMBL ENDHOLE .035IN4 BOTH IP/OP $320.00 $237.00 $56.96 $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $56.96 $320.00 $320.00 $320.00 $320.00 $320.00 $320.00 $66.69 $320.00 $128.00 $320.00 $320.00 $320.00 $320.00 $320.00 $240.00 $320.00 $320.00 $320.00 $160.00 $160.00 $253.44 $320.00 $256.00 $144.00 $320.00 $320.00 $185.60 $320.00 $192.00 $320.00 $320.00 $320.00 N/A N/A 27805048 EAP HCPCS C1874 XIENCE XPEDITION SV DES 2.25 MM X 8 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805049 EAP HCPCS C1874 XIENCE XPEDITION SV DES 2.25 MM X 12 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805050 EAP HCPCS C1874 XIENCE XPEDITION SV DES 2.25 MM X 15 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805051 EAP HCPCS C1874 XIENCE XPEDITION SV DES 2.25 MM X 18 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805052 EAP HCPCS C1874 XIENCE XPEDITION SV DES 2.25 MM X 23 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805053 EAP HCPCS C1874 XIENCE XPEDITION SV DES 2.25 MM X 28 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805054 EAP HCPCS C1874 XIENCE XPEDITION DES 2.50 MM X 8 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805055 EAP HCPCS C1874 XIENCE XPEDITION DES 2.50 MM X 12 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805056 EAP HCPCS C1874 XIENCE XPEDITION DES 2.50 MM X 15 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805057 EAP HCPCS C1874 XIENCE XPEDITION DES 2.50 MM X 18 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805058 EAP HCPCS C1874 XIENCE XPEDITION DES 2.50 MM X 23 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805059 EAP HCPCS C1874 XIENCE XPEDITION DES 2.50 MM X 28 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805060 EAP HCPCS C1874 XIENCE XPEDITION LL DES 2.50 MM X 33 MM BOTH IP/OP "$6,429.00" "$4,757.50" "$1,276.00" "$6,429.00" "$2,893.05" "$2,893.05" "$2,893.05" "$2,893.05" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.96" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.87" "$6,429.00" "$6,429.00" "$3,169.50" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$4,821.75" "$6,429.00" "$6,429.00" "$6,429.00" "$3,214.50" "$3,214.50" "$5,091.77" "$6,429.00" "$5,143.20" "$2,893.05" "$1,276.00" "$6,429.00" "$3,728.82" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.80" "$6,429.00" N/A N/A 27805061 EAP HCPCS C1874 XIENCE XPEDITION LL DES 2.50 MM X 38 MM BOTH IP/OP "$6,429.00" "$4,757.50" "$1,276.00" "$6,429.00" "$2,893.05" "$2,893.05" "$2,893.05" "$2,893.05" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.96" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.87" "$6,429.00" "$6,429.00" "$3,169.50" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$4,821.75" "$6,429.00" "$6,429.00" "$6,429.00" "$3,214.50" "$3,214.50" "$5,091.77" "$6,429.00" "$5,143.20" "$2,893.05" "$1,276.00" "$6,429.00" "$3,728.82" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.80" "$6,429.00" N/A N/A 27805062 EAP HCPCS C1874 XIENCE XPEDITION DES 2.75 MM X 8 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805063 EAP HCPCS C1874 XIENCE XPEDITION DES 2.75 MM X 12 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" 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"$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805081 EAP HCPCS C1874 XIENCE XPEDITION DES 3.25 MM X 18 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805082 EAP HCPCS C1874 XIENCE XPEDITION DES 3.25 MM X 23 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805083 EAP HCPCS C1874 XIENCE XPEDITION DES 3.25 MM X 28 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805084 EAP HCPCS C1874 XIENCE XPEDITION LL DES 3.25 MM X 33 MM BOTH IP/OP "$6,429.00" "$4,757.50" "$1,276.00" "$6,429.00" "$2,893.05" "$2,893.05" "$2,893.05" "$2,893.05" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.96" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.87" "$6,429.00" "$6,429.00" "$3,169.50" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$4,821.75" "$6,429.00" "$6,429.00" "$6,429.00" "$3,214.50" "$3,214.50" "$5,091.77" "$6,429.00" "$5,143.20" "$2,893.05" "$1,276.00" "$6,429.00" "$3,728.82" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.80" "$6,429.00" N/A N/A 27805085 EAP HCPCS C1874 XIENCE XPEDITION LL DES 3.25 MM X 38 MM BOTH IP/OP "$6,429.00" "$4,757.50" "$1,276.00" "$6,429.00" "$2,893.05" "$2,893.05" "$2,893.05" "$2,893.05" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.96" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.87" "$6,429.00" "$6,429.00" "$3,169.50" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$4,821.75" "$6,429.00" "$6,429.00" "$6,429.00" "$3,214.50" "$3,214.50" "$5,091.77" "$6,429.00" "$5,143.20" "$2,893.05" "$1,276.00" "$6,429.00" "$3,728.82" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.80" "$6,429.00" N/A N/A 27805086 EAP HCPCS C1874 XIENCE XPEDITION DES 3.50 MM X 8 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$3,724.80" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805087 EAP HCPCS C1874 XIENCE XPEDITION DES 3.50 MM X 12 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805088 EAP HCPCS C1874 XIENCE XPEDITION DES 3.50 MM X 15 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805089 EAP HCPCS C1874 XIENCE XPEDITION DES 3.50 MM X 18 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805090 EAP HCPCS C1874 XIENCE XPEDITION DES 3.50 MM X 23 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805091 EAP HCPCS C1874 XIENCE XPEDITION DES 3.50 MM X 28 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805092 EAP HCPCS C1874 XIENCE XPEDITION LL DES 3.50 MM X 33 MM BOTH IP/OP "$6,429.00" "$4,757.50" "$1,276.00" "$6,429.00" "$2,893.05" "$2,893.05" "$2,893.05" "$2,893.05" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.96" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.87" "$6,429.00" "$6,429.00" "$3,169.50" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$4,821.75" "$6,429.00" "$6,429.00" "$6,429.00" "$3,214.50" "$3,214.50" "$5,091.77" "$6,429.00" "$5,143.20" "$2,893.05" "$1,276.00" "$6,429.00" "$3,728.82" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.80" "$6,429.00" N/A N/A 27805093 EAP HCPCS C1874 XIENCE XPEDITION LL DES 3.50 MM X 38 MM BOTH IP/OP "$6,429.00" "$4,757.50" "$1,276.00" "$6,429.00" "$2,893.05" "$2,893.05" "$2,893.05" "$2,893.05" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.96" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.87" "$6,429.00" "$6,429.00" "$3,169.50" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$4,821.75" "$6,429.00" "$6,429.00" "$6,429.00" "$3,214.50" "$3,214.50" "$5,091.77" "$6,429.00" "$5,143.20" "$2,893.05" "$1,276.00" "$6,429.00" "$3,728.82" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.80" "$6,429.00" N/A N/A 27805094 EAP HCPCS C1874 XIENCE XPEDITION DES 4.00 MM X 8 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805095 EAP HCPCS C1874 XIENCE XPEDITION DES 4.00 MM X 12 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805096 EAP HCPCS C1874 XIENCE XPEDITION DES 4.00 MM X 15 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805097 EAP HCPCS C1874 XIENCE XPEDITION DES 4.00 MM X 18 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805098 EAP HCPCS C1874 XIENCE XPEDITION DES 4.00 MM X 23 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805099 EAP HCPCS C1874 XIENCE XPEDITION DES 4.00 MM X 28 MM BOTH IP/OP "$6,208.00" "$4,594.00" "$1,232.13" "$6,208.00" "$2,793.60" "$2,793.60" "$2,793.60" "$2,793.60" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.90" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.82" "$6,208.00" "$6,208.00" "$3,060.54" "$6,208.00" "$6,208.00" "$6,208.00" "$6,208.00" "$4,656.00" "$6,208.00" "$6,208.00" "$6,208.00" "$3,104.00" "$3,104.00" "$4,916.74" "$6,208.00" "$4,966.40" "$2,793.60" "$1,232.13" "$6,208.00" "$3,600.64" "$6,208.00" "$6,208.00" "$6,208.00" "$1,293.75" "$6,208.00" N/A N/A 27805101 EAP Custom 27805101 PIPELINE EMBOLIZATION DEVICE BOTH IP/OP "$41,378.00" "$30,620.00" "$7,365.28" "$41,378.00" "$41,378.00" "$41,378.00" "$41,378.00" "$41,378.00" "$41,378.00" "$41,378.00" "$7,365.28" "$41,378.00" "$41,378.00" "$41,378.00" "$41,378.00" "$41,378.00" "$41,378.00" "$8,623.63" "$41,378.00" "$16,551.20" "$41,378.00" "$41,378.00" "$41,378.00" "$41,378.00" "$41,378.00" "$31,033.50" "$41,378.00" "$41,378.00" "$41,378.00" "$20,689.00" "$20,689.00" "$32,771.38" "$41,378.00" "$33,102.40" "$18,620.10" "$41,378.00" "$41,378.00" "$23,999.24" "$41,378.00" "$24,826.80" "$41,378.00" "$41,378.00" "$41,378.00" N/A N/A 27805102 EAP HCPCS C1874 XIENCE XPEDITION LL DES 4.00 MM X 33 MM BOTH IP/OP "$6,429.00" "$4,757.50" "$1,276.00" "$6,429.00" "$2,893.05" "$2,893.05" "$2,893.05" "$2,893.05" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.96" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.87" "$6,429.00" "$6,429.00" "$3,169.50" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$4,821.75" "$6,429.00" "$6,429.00" "$6,429.00" "$3,214.50" "$3,214.50" "$5,091.77" "$6,429.00" "$5,143.20" "$2,893.05" "$1,276.00" "$6,429.00" "$3,728.82" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.80" "$6,429.00" N/A N/A 27805103 EAP HCPCS C1874 XIENCE XPEDITION LL DES 4.00 MM X 38 MM BOTH IP/OP "$6,429.00" "$4,757.50" "$1,276.00" "$6,429.00" "$2,893.05" "$2,893.05" "$2,893.05" "$2,893.05" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.96" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.87" "$6,429.00" "$6,429.00" "$3,169.50" "$6,429.00" "$6,429.00" "$6,429.00" "$6,429.00" "$4,821.75" "$6,429.00" "$6,429.00" "$6,429.00" "$3,214.50" "$3,214.50" "$5,091.77" "$6,429.00" "$5,143.20" "$2,893.05" "$1,276.00" "$6,429.00" "$3,728.82" "$6,429.00" "$6,429.00" "$6,429.00" "$1,339.80" "$6,429.00" N/A N/A 27805104 EAP Custom 27805104 COIL EMBL 4.1CM 5-3MM TRND .035IN STD SM PLTN ARTERIOVES BOTH IP/OP $264.00 $195.50 $46.99 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $46.99 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $55.02 $264.00 $105.60 $264.00 $264.00 $264.00 $264.00 $264.00 $198.00 $264.00 $264.00 $264.00 $132.00 $132.00 $209.09 $264.00 $211.20 $118.80 $264.00 $264.00 $153.12 $264.00 $158.40 $264.00 $264.00 $264.00 N/A N/A 27805106 EAP HCPCS C1876 SE BILIARY STENT 6MMX40MMX120CM BOTH IP/OP "$4,138.00" "$3,062.50" $821.29 "$4,138.00" "$1,862.10" "$1,862.10" "$1,862.10" "$1,862.10" "$4,138.00" "$4,138.00" "$4,138.00" $862.46 "$4,138.00" "$4,138.00" "$4,138.00" "$4,138.00" "$4,138.00" $862.40 "$4,138.00" "$4,138.00" "$2,040.03" "$4,138.00" "$4,138.00" "$4,138.00" "$4,138.00" "$3,103.50" "$4,138.00" "$4,138.00" "$4,138.00" "$2,069.00" "$2,069.00" "$3,277.30" "$4,138.00" "$3,310.40" "$1,862.10" $821.29 "$4,138.00" "$2,400.04" "$4,138.00" "$4,138.00" "$4,138.00" $862.36 "$4,138.00" N/A N/A 27805107 EAP HCPCS C1876 SE PERIPHERAL STENT 7MMX80MMX120CM BOTH IP/OP "$5,024.00" "$3,718.00" $997.14 "$5,024.00" "$2,260.80" "$2,260.80" "$2,260.80" "$2,260.80" "$5,024.00" "$5,024.00" "$5,024.00" "$1,047.13" "$5,024.00" "$5,024.00" "$5,024.00" "$5,024.00" "$5,024.00" "$1,047.06" "$5,024.00" "$5,024.00" "$2,476.83" "$5,024.00" "$5,024.00" "$5,024.00" "$5,024.00" "$3,768.00" "$5,024.00" "$5,024.00" "$5,024.00" "$2,512.00" "$2,512.00" "$3,979.01" "$5,024.00" "$4,019.20" "$2,260.80" $997.14 "$5,024.00" "$2,913.92" "$5,024.00" "$5,024.00" "$5,024.00" "$1,047.00" "$5,024.00" N/A N/A 27805108 EAP Custom 27805108 "COIL 400 COMPLEX STANDARD, 22 MM X 60 CM" BOTH IP/OP "$7,685.00" "$5,687.00" "$1,367.93" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$1,367.93" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$1,601.64" "$7,685.00" "$3,074.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$7,685.00" "$5,763.75" "$7,685.00" "$7,685.00" "$7,685.00" "$3,842.50" "$3,842.50" "$6,086.52" "$7,685.00" "$6,148.00" "$3,458.25" "$7,685.00" "$7,685.00" "$4,457.30" "$7,685.00" "$4,611.00" "$7,685.00" "$7,685.00" "$7,685.00" N/A N/A 27805112 EAP HCPCS Q4107 COIL EMBOLIZATION 7CM 3MM NESTER 7.4 LOOP MICROCOIL .018 BOTH IP/OP $295.00 $218.50 $61.48 $295.00 $295.00 $295.00 $295.00 $295.00 $295.00 $295.00 $80.90 $295.00 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $118.00 $295.00 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $295.00 $295.00 $171.10 $295.00 $177.00 $295.00 $295.00 $295.00 N/A N/A 27805113 EAP Custom 27805113 COIL EMBOLIZATION 7CM 4MM NESTER 5.6 LOOP MICROCOIL .018 BOTH IP/OP "$3,403.00" "$2,518.50" $605.73 "$3,403.00" "$3,403.00" "$3,403.00" "$3,403.00" "$3,403.00" "$3,403.00" "$3,403.00" $605.73 "$3,403.00" "$3,403.00" "$3,403.00" "$3,403.00" "$3,403.00" "$3,403.00" $709.22 "$3,403.00" "$1,361.20" "$3,403.00" "$3,403.00" "$3,403.00" "$3,403.00" "$3,403.00" "$2,552.25" "$3,403.00" "$3,403.00" "$3,403.00" "$1,701.50" "$1,701.50" "$2,695.18" "$3,403.00" "$2,722.40" "$1,531.35" "$3,403.00" "$3,403.00" "$1,973.74" "$3,403.00" "$2,041.80" "$3,403.00" "$3,403.00" "$3,403.00" N/A N/A 27805115 EAP Custom 27805115 "COIL 400 COMPLEX STANDARD, 24 MM X 57 CM" BOTH IP/OP "$7,642.00" "$5,655.50" "$1,360.28" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$1,360.28" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$1,592.68" "$7,642.00" "$3,056.80" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$7,642.00" "$5,731.50" "$7,642.00" "$7,642.00" "$7,642.00" "$3,821.00" "$3,821.00" "$6,052.46" "$7,642.00" "$6,113.60" "$3,438.90" "$7,642.00" "$7,642.00" "$4,432.36" "$7,642.00" "$4,585.20" "$7,642.00" "$7,642.00" "$7,642.00" N/A N/A 27805116 EAP Custom 27805116 "COIL 400 COMPLEX STANDARD, 28 MM X 60 CM" BOTH IP/OP "$8,572.00" "$6,343.50" "$1,525.82" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$1,525.82" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$1,786.50" "$8,572.00" "$3,428.80" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$8,572.00" "$6,429.00" "$8,572.00" "$8,572.00" "$8,572.00" "$4,286.00" "$4,286.00" "$6,789.02" "$8,572.00" "$6,857.60" "$3,857.40" "$8,572.00" "$8,572.00" "$4,971.76" "$8,572.00" "$5,143.20" "$8,572.00" "$8,572.00" "$8,572.00" N/A N/A 27805118 EAP Custom 27805118 COIL EMBL 2CM 1MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805119 EAP Custom 27805119 COIL EMBL 3CM 1MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805120 EAP Custom 27805120 COIL EMBL 2CM 1.5MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805121 EAP Custom 27805121 COIL EMBL 3CM 1.5MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805122 EAP Custom 27805122 COIL EMBL 4CM 1.5MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805123 EAP Custom 27805123 COIL EMBL 3CM 2MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805124 EAP Custom 27805124 COIL EMBL 4CM 2MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805125 EAP Custom 27805125 COIL EMBL 6CM 2MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805126 EAP Custom 27805126 COIL EMBL 4CM 2.5MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805127 EAP Custom 27805127 COIL EMBL 4CM 3MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805128 EAP Custom 27805128 COIL EMBL 6CM 3MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805129 EAP Custom 27805129 COIL EMBL 8CM 3MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805130 EAP Custom 27805130 COIL EMBL 10CM 3MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805131 EAP Custom 27805131 COIL EMBL 6CM 4MM TRGT DTCH ULT 360D BOTH IP/OP "$5,352.00" "$3,960.50" $952.66 "$5,352.00" "$5,352.00" "$5,352.00" "$5,352.00" "$5,352.00" "$5,352.00" "$5,352.00" $952.66 "$5,352.00" "$5,352.00" "$5,352.00" "$5,352.00" "$5,352.00" "$5,352.00" "$1,115.42" "$5,352.00" "$2,140.80" "$5,352.00" "$5,352.00" "$5,352.00" "$5,352.00" "$5,352.00" "$4,014.00" "$5,352.00" "$5,352.00" "$5,352.00" "$2,676.00" "$2,676.00" "$4,238.78" "$5,352.00" "$4,281.60" "$2,408.40" "$5,352.00" "$5,352.00" "$3,104.16" "$5,352.00" "$3,211.20" "$5,352.00" "$5,352.00" "$5,352.00" N/A N/A 27805132 EAP Custom 27805132 COIL EMBL 8CM 4MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805133 EAP Custom 27805133 COIL EMBL 10CM 5MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805134 EAP Custom 27805134 COIL EMBL 15CM 5MM TRGT DTCH ULT 360D BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805137 EAP HCPCS C1898 LEAD PCNG BRKWY DLV SYS IMPLTABLE HRT FAIL ACTY BOTH IP/OP "$5,010.00" "$3,707.50" "$1,044.14" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$1,044.14" "$5,010.00" "$2,004.00" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$3,757.50" "$5,010.00" "$5,010.00" "$5,010.00" "$2,505.00" "$2,505.00" "$3,967.92" "$5,010.00" "$4,008.00" "$2,254.50" "$5,010.00" "$5,010.00" "$2,905.80" "$5,010.00" "$3,006.00" "$5,010.00" "$5,010.00" "$5,010.00" N/A N/A 27805138 EAP HCPCS C1900 LEAD PCNG 59CM 9FR ECRDL BIPOL ACT FIX 1 COIL RTRCT HLX TIP BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27805139 EAP HCPCS C1777 LEAD PCNG 64CM 9FR ECRDM 1 COIL ACT FIX BIPOL CARDVRT DFBR BOTH IP/OP "$11,231.00" "$8,311.00" "$2,229.07" "$11,231.00" "$5,053.95" "$5,053.95" "$5,053.95" "$5,053.95" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.82" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$11,231.00" "$5,536.88" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$2,229.07" "$11,231.00" "$6,513.98" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.54" "$11,231.00" N/A N/A 27805140 EAP HCPCS C1898 LEAD PCNG 54CM MYOCRD BIPOL SUTLS INNOMEDICA SIL BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805141 EAP HCPCS C1898 LEAD PCNG 52CM 3.2MM ECRDM ATR VNTRC PCMKR FLXTND BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805142 EAP HCPCS C1895 LEAD PCNG 90CM ECRDM DUAL COIL PSV FIX CARDVRT DFBR BOTH IP/OP "$11,231.00" "$8,311.00" "$2,229.07" "$11,231.00" "$5,053.95" "$5,053.95" "$5,053.95" "$5,053.95" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.82" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$11,231.00" "$5,536.88" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$2,229.07" "$11,231.00" "$6,513.98" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.54" "$11,231.00" N/A N/A 27805143 EAP HCPCS C1898 LEAD PCNG 64CM 9FR 18CM SPC ECRDM IS-1 CONCTR DUAL COIL BOTH IP/OP "$11,231.00" "$8,311.00" "$2,340.66" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$4,492.40" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$11,231.00" "$11,231.00" "$6,513.98" "$11,231.00" "$6,738.60" "$11,231.00" "$11,231.00" "$11,231.00" N/A N/A 27805144 EAP HCPCS C1898 LEAD PCNG 59CM 9FR 18CM SPC ECRDL BIPOL PSV FIX 2 COIL TN BOTH IP/OP "$11,231.00" "$8,311.00" "$2,340.66" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$4,492.40" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$11,231.00" "$11,231.00" "$6,513.98" "$11,231.00" "$6,738.60" "$11,231.00" "$11,231.00" "$11,231.00" N/A N/A 27805145 EAP HCPCS C1876 STENT BIL 10MM 8FR 80MM 3.2MM .035IN RAPEX UNCVR GWIRE BOTH IP/OP $461.00 $341.50 $91.50 $461.00 $207.45 $207.45 $207.45 $207.45 $461.00 $461.00 $461.00 $96.08 $461.00 $461.00 $461.00 $461.00 $461.00 $96.08 $461.00 $461.00 $272.68 $461.00 $461.00 $461.00 $461.00 $345.75 $461.00 $461.00 $461.00 $230.50 $230.50 $365.11 $461.00 $368.80 $207.45 $91.50 $461.00 $267.38 $461.00 $461.00 $461.00 $96.07 $461.00 N/A N/A 27805146 EAP HCPCS C1876 STENT BIL 10MM 8FR 60MM .035IN RAPEX UNCVR GWIRE DLV SYS BOTH IP/OP $461.00 $341.50 $91.50 $461.00 $207.45 $207.45 $207.45 $207.45 $461.00 $461.00 $461.00 $96.08 $461.00 $461.00 $461.00 $461.00 $461.00 $96.08 $461.00 $461.00 $272.68 $461.00 $461.00 $461.00 $461.00 $345.75 $461.00 $461.00 $461.00 $230.50 $230.50 $365.11 $461.00 $368.80 $207.45 $91.50 $461.00 $267.38 $461.00 $461.00 $461.00 $96.07 $461.00 N/A N/A 27805147 EAP HCPCS C1876 STENT BIL 8MM 8FR 100MM .035IN RAPEX NCT UNCVR DLV SYS BOTH IP/OP $461.00 $341.50 $91.50 $461.00 $207.45 $207.45 $207.45 $207.45 $461.00 $461.00 $461.00 $96.08 $461.00 $461.00 $461.00 $461.00 $461.00 $96.08 $461.00 $461.00 $272.68 $461.00 $461.00 $461.00 $461.00 $345.75 $461.00 $461.00 $461.00 $230.50 $230.50 $365.11 $461.00 $368.80 $207.45 $91.50 $461.00 $267.38 $461.00 $461.00 $461.00 $96.07 $461.00 N/A N/A 27805148 EAP HCPCS C1777 LEAD PCNG 64CM 9FR ECRDM 1 COIL PSV FIX BIPOL CARDVRT DFBR BOTH IP/OP "$11,231.00" "$8,311.00" "$2,229.07" "$11,231.00" "$5,053.95" "$5,053.95" "$5,053.95" "$5,053.95" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.82" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$11,231.00" "$5,536.88" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$2,229.07" "$11,231.00" "$6,513.98" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.54" "$11,231.00" N/A N/A 27805149 EAP HCPCS C1898 LEAD PCNG 59CM 9FR 18CM SPC ECRDM 1 COIL PSV FIX BIPOL BOTH IP/OP "$11,231.00" "$8,311.00" "$2,340.66" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$4,492.40" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$11,231.00" "$11,231.00" "$6,513.98" "$11,231.00" "$6,738.60" "$11,231.00" "$11,231.00" "$11,231.00" N/A N/A 27805150 EAP HCPCS C1777 ENDOTAK RELIANCE PF (PASSIVE FIXATION) LEADS BOTH IP/OP "$11,231.00" "$8,311.00" "$2,229.07" "$11,231.00" "$5,053.95" "$5,053.95" "$5,053.95" "$5,053.95" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.82" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$11,231.00" "$5,536.88" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$2,229.07" "$11,231.00" "$6,513.98" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.54" "$11,231.00" N/A N/A 27805151 EAP HCPCS C1777 ENDOTAK RELIANCE S PF (PASSIVE FIXATION) LEADS BOTH IP/OP "$11,231.00" "$8,311.00" "$2,229.07" "$11,231.00" "$5,053.95" "$5,053.95" "$5,053.95" "$5,053.95" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.82" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$11,231.00" "$5,536.88" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$2,229.07" "$11,231.00" "$6,513.98" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.54" "$11,231.00" N/A N/A 27805152 EAP HCPCS C1898 LEAD PCNG 90CM 18CM SPC ECRDM BIPOL PSV FIX 2 COIL IS-1 DF-1 BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805153 EAP HCPCS C1895 LEAD PCNG ECRDM DUAL COIL ICD PSV FIX CARDVRT DFBR IMPLTABLE BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27805154 EAP HCPCS C1898 LEAD PCNG 64CM 9FR 18CM SPC ECRDL BIPOL PSV FIX 2 COIL TN BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805155 EAP HCPCS C1875 STENT BIL 8MM 8.5FR 80MM 70MM .035IN RAPEX PRT RMLM COVERED BOTH IP/OP "$1,053.00" $779.50 $219.46 "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" $219.46 "$1,053.00" $421.20 "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" $789.75 "$1,053.00" "$1,053.00" "$1,053.00" $526.50 $526.50 $833.98 "$1,053.00" $842.40 $473.85 "$1,053.00" "$1,053.00" $610.74 "$1,053.00" $631.80 "$1,053.00" "$1,053.00" "$1,053.00" N/A N/A 27805156 EAP HCPCS C1898 LEAD PCNG 59CM 9FR 18CM SPC ECRDM BIPOL PSV FIX 2 COIL IS-1 BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805157 EAP HCPCS C1900 LEAD PCNG 80CM 4.1-2.6FR SPRL LV CORON VNS ACTY BOTH IP/OP "$5,911.00" "$4,374.50" "$1,173.19" "$5,911.00" "$2,659.95" "$2,659.95" "$2,659.95" "$2,659.95" "$5,911.00" "$5,911.00" "$5,911.00" "$1,232.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.92" "$5,911.00" "$5,911.00" "$2,914.12" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$4,433.25" "$5,911.00" "$5,911.00" "$5,911.00" "$2,955.50" "$2,955.50" "$4,681.51" "$5,911.00" "$4,728.80" "$2,659.95" "$1,173.19" "$5,911.00" "$3,428.38" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.85" "$5,911.00" N/A N/A 27805158 EAP HCPCS C1779 LEAD PCNG 90CM 4.1-2.6FR SPRL LV CORON VNS IMPLTABLE ACTY BOTH IP/OP "$5,911.00" "$4,374.50" "$1,231.92" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.92" "$5,911.00" "$2,364.40" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$4,433.25" "$5,911.00" "$5,911.00" "$5,911.00" "$2,955.50" "$2,955.50" "$4,681.51" "$5,911.00" "$4,728.80" "$2,659.95" "$5,911.00" "$5,911.00" "$3,428.38" "$5,911.00" "$3,546.60" "$5,911.00" "$5,911.00" "$5,911.00" N/A N/A 27805159 EAP HCPCS C1777 LEAD PCNG ECRDM 1 COIL ICD CARDVRT DFBR IMPLTABLE ETAK RLNC BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27805160 EAP HCPCS C1900 LEAD PCNG 80CM CORON VNS STRBL BIPOL ACTY STRD ELUT BOTH IP/OP "$5,911.00" "$4,374.50" "$1,173.19" "$5,911.00" "$2,659.95" "$2,659.95" "$2,659.95" "$2,659.95" "$5,911.00" "$5,911.00" "$5,911.00" "$1,232.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.92" "$5,911.00" "$5,911.00" "$2,914.12" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$4,433.25" "$5,911.00" "$5,911.00" "$5,911.00" "$2,955.50" "$2,955.50" "$4,681.51" "$5,911.00" "$4,728.80" "$2,659.95" "$1,173.19" "$5,911.00" "$3,428.38" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.85" "$5,911.00" N/A N/A 27805161 EAP HCPCS C2625 STENT BIL 7FR 5CM RAPEX NONCORONARY TEMP DLV SYS PLST DISP BOTH IP/OP "$5,911.00" "$4,374.50" "$1,173.19" "$5,911.00" "$2,659.95" "$2,659.95" "$2,659.95" "$2,659.95" "$5,911.00" "$5,911.00" "$5,911.00" "$1,232.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.92" "$5,911.00" "$5,911.00" "$2,914.12" "$5,911.00" "$5,911.00" "$5,911.00" "$5,911.00" "$4,433.25" "$5,911.00" "$5,911.00" "$5,911.00" "$2,955.50" "$2,955.50" "$4,681.51" "$5,911.00" "$4,728.80" "$2,659.95" "$1,173.19" "$5,911.00" "$3,428.38" "$5,911.00" "$5,911.00" "$5,911.00" "$1,231.85" "$5,911.00" N/A N/A 27805162 EAP HCPCS C1777 LEAD PCNG ECRDM 1 COIL ICD CARDVRT DFBR IMPLTABLE ETAK RLNC BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27805163 EAP HCPCS C1777 LEAD DFBR ETAK RLNC G ACT FIX BOTH IP/OP "$13,300.00" "$9,842.00" "$2,639.72" "$13,300.00" "$5,985.00" "$5,985.00" "$5,985.00" "$5,985.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,772.05" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,771.87" "$13,300.00" "$13,300.00" "$6,556.90" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$9,975.00" "$13,300.00" "$13,300.00" "$13,300.00" "$6,650.00" "$6,650.00" "$10,533.60" "$13,300.00" "$10,640.00" "$5,985.00" "$2,639.72" "$13,300.00" "$7,714.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,771.72" "$13,300.00" N/A N/A 27805164 EAP HCPCS C1777 LEAD DFBR ETAK RLNC G PSV FIX BOTH IP/OP "$13,300.00" "$9,842.00" "$2,639.72" "$13,300.00" "$5,985.00" "$5,985.00" "$5,985.00" "$5,985.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,772.05" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,771.87" "$13,300.00" "$13,300.00" "$6,556.90" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$9,975.00" "$13,300.00" "$13,300.00" "$13,300.00" "$6,650.00" "$6,650.00" "$10,533.60" "$13,300.00" "$10,640.00" "$5,985.00" "$2,639.72" "$13,300.00" "$7,714.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,771.72" "$13,300.00" N/A N/A 27805165 EAP HCPCS C1898 LEAD PCNG 90CM 18CM SPC ECRDM DUAL COIL ACT DISTAL TIP ELTRD BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805166 EAP HCPCS C1785 PCMKR CRD THK8MM 49X43MM ALTRUA 40DR ATR VNTRC IMPLTABLE 2 BOTH IP/OP "$11,527.00" "$8,530.00" "$2,287.82" "$11,527.00" "$5,187.15" "$5,187.15" "$5,187.15" "$5,187.15" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.51" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.35" "$11,527.00" "$11,527.00" "$5,682.81" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$8,645.25" "$11,527.00" "$11,527.00" "$11,527.00" "$5,763.50" "$5,763.50" "$9,129.38" "$11,527.00" "$9,221.60" "$5,187.15" "$2,287.82" "$11,527.00" "$6,685.66" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.23" "$11,527.00" N/A N/A 27805167 EAP HCPCS C1786 PCMKR CRD 8MM 43X49MM ALTRUA 40 IS-1 CONCTR BOTH IP/OP "$11,527.00" "$8,530.00" "$2,287.82" "$11,527.00" "$5,187.15" "$5,187.15" "$5,187.15" "$5,187.15" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.51" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.35" "$11,527.00" "$11,527.00" "$5,682.81" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$8,645.25" "$11,527.00" "$11,527.00" "$11,527.00" "$5,763.50" "$5,763.50" "$9,129.38" "$11,527.00" "$9,221.60" "$5,187.15" "$2,287.82" "$11,527.00" "$6,685.66" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.23" "$11,527.00" N/A N/A 27805168 EAP HCPCS C1785 PCMKR CRD THK8MM 44X42MM ALTRUA 40DR ATR VNTRC IMPLTABLE 2 BOTH IP/OP "$11,527.00" "$8,530.00" "$2,287.82" "$11,527.00" "$5,187.15" "$5,187.15" "$5,187.15" "$5,187.15" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.51" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.35" "$11,527.00" "$11,527.00" "$5,682.81" "$11,527.00" "$11,527.00" "$11,527.00" "$11,527.00" "$8,645.25" "$11,527.00" "$11,527.00" "$11,527.00" "$5,763.50" "$5,763.50" "$9,129.38" "$11,527.00" "$9,221.60" "$5,187.15" "$2,287.82" "$11,527.00" "$6,685.66" "$11,527.00" "$11,527.00" "$11,527.00" "$2,402.23" "$11,527.00" N/A N/A 27805169 EAP HCPCS C1786 PCMKR CRD THK8MM 42X42MM ALTRUA 40SR 1 CHMBR RT RSPN BOTH IP/OP "$10,049.00" "$7,436.50" "$1,994.48" "$10,049.00" "$4,522.05" "$4,522.05" "$4,522.05" "$4,522.05" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.46" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.32" "$10,049.00" "$10,049.00" "$4,954.16" "$10,049.00" "$10,049.00" "$10,049.00" "$10,049.00" "$7,536.75" "$10,049.00" "$10,049.00" "$10,049.00" "$5,024.50" "$5,024.50" "$7,958.81" "$10,049.00" "$8,039.20" "$4,522.05" "$1,994.48" "$10,049.00" "$5,828.42" "$10,049.00" "$10,049.00" "$10,049.00" "$2,094.21" "$10,049.00" N/A N/A 27805170 EAP HCPCS C1785 PCMKR CRD ALTURA 2 LEAD SYS BOTH IP/OP "$14,482.00" "$10,717.00" "$2,874.31" "$14,482.00" "$6,516.90" "$6,516.90" "$6,516.90" "$6,516.90" "$14,482.00" "$14,482.00" "$14,482.00" "$3,018.41" "$14,482.00" "$14,482.00" "$14,482.00" "$14,482.00" "$14,482.00" "$3,018.21" "$14,482.00" "$14,482.00" "$7,139.63" "$14,482.00" "$14,482.00" "$14,482.00" "$14,482.00" "$10,861.50" "$14,482.00" "$14,482.00" "$14,482.00" "$7,241.00" "$7,241.00" "$11,469.74" "$14,482.00" "$11,585.60" "$6,516.90" "$2,874.31" "$14,482.00" "$8,399.56" "$14,482.00" "$14,482.00" "$14,482.00" "$3,018.05" "$14,482.00" N/A N/A 27805171 EAP HCPCS C1898 LEAD PCNG 70CM 9FR 18CM SPC ECRDM DUALCOIL XTD-RETRAC DF-1 BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805172 EAP HCPCS C1898 LEAD PCNG 64CM 9FR ECRDM BIPOL ACT FIX DUAL COIL XTD-RETRAC BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805173 EAP HCPCS C1898 LEAD PCNG 59CM 18CM SPC ECRDM BIPOL ACT FIX XTD-RETRAC 2 BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805174 EAP HCPCS C1898 LEAD PCNG 64CM HLX ECRDM 1 COIL BIPOL ACT FIX XTD-RETRAC BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805175 EAP HCPCS C1777 ENDOTAK RELIANCE G AF (ACTIVE FIXATION) LEADS BOTH IP/OP "$13,300.00" "$9,842.00" "$2,639.72" "$13,300.00" "$5,985.00" "$5,985.00" "$5,985.00" "$5,985.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,772.05" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,771.87" "$13,300.00" "$13,300.00" "$6,556.90" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$9,975.00" "$13,300.00" "$13,300.00" "$13,300.00" "$6,650.00" "$6,650.00" "$10,533.60" "$13,300.00" "$10,640.00" "$5,985.00" "$2,639.72" "$13,300.00" "$7,714.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,771.72" "$13,300.00" N/A N/A 27805176 EAP HCPCS C1777 LEAD DFBR ETAK RLNC G ACT FIX BOTH IP/OP "$13,300.00" "$9,842.00" "$2,639.72" "$13,300.00" "$5,985.00" "$5,985.00" "$5,985.00" "$5,985.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,772.05" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,771.87" "$13,300.00" "$13,300.00" "$6,556.90" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$9,975.00" "$13,300.00" "$13,300.00" "$13,300.00" "$6,650.00" "$6,650.00" "$10,533.60" "$13,300.00" "$10,640.00" "$5,985.00" "$2,639.72" "$13,300.00" "$7,714.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,771.72" "$13,300.00" N/A N/A 27805177 EAP HCPCS C1876 STENT TRCHBR 7MM 8MM 30MM SLF XPD ARWY DLV SYS PLFX SIL BOTH IP/OP "$1,478.00" "$1,094.00" $293.35 "$1,478.00" $665.10 $665.10 $665.10 $665.10 "$1,478.00" "$1,478.00" "$1,478.00" $308.05 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,478.00" "$1,478.00" $874.24 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,108.50" "$1,478.00" "$1,478.00" "$1,478.00" $739.00 $739.00 "$1,170.58" "$1,478.00" "$1,182.40" $665.10 $293.35 "$1,478.00" $857.24 "$1,478.00" "$1,478.00" "$1,478.00" $308.02 "$1,478.00" N/A N/A 27805178 EAP HCPCS C1882 COGNIS / ACUITY/ ENDOTAK - CARDIAC RESYNCHRONIZATION THERAPY BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27805179 EAP HCPCS C1898 LEAD PCNG 90CM 9FR 18CM SPC ECRDM DUAL COIL ACT FIX BIPOL BOTH IP/OP "$11,231.00" "$8,311.00" "$2,340.66" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$4,492.40" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$11,231.00" "$11,231.00" "$6,513.98" "$11,231.00" "$6,738.60" "$11,231.00" "$11,231.00" "$11,231.00" N/A N/A 27805180 EAP HCPCS C1898 LEAD PCNG 64CM 9FR 18CM SPC ECRDL DUAL COIL IMPLTABLE BOTH IP/OP "$11,231.00" "$8,311.00" "$2,340.66" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$4,492.40" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$11,231.00" "$11,231.00" "$6,513.98" "$11,231.00" "$6,738.60" "$11,231.00" "$11,231.00" "$11,231.00" N/A N/A 27805181 EAP HCPCS C1898 LEAD PCNG 59CM 9FR 18CM SPC ECRDL BIPOL ACT FIX 2 COIL BOTH IP/OP "$11,231.00" "$8,311.00" "$2,340.66" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$4,492.40" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$11,231.00" "$11,231.00" "$6,513.98" "$11,231.00" "$6,738.60" "$11,231.00" "$11,231.00" "$11,231.00" N/A N/A 27805182 EAP HCPCS C1896 LEAD PCNG ECRDL 1 COIL ACT FIX CARDVRT DFBR IMPLTABLE ETAK BOTH IP/OP "$11,231.00" "$8,311.00" "$2,229.07" "$11,231.00" "$5,053.95" "$5,053.95" "$5,053.95" "$5,053.95" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.82" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$11,231.00" "$5,536.88" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$2,229.07" "$11,231.00" "$6,513.98" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.54" "$11,231.00" N/A N/A 27805183 EAP HCPCS C1898 LEAD PCNG 45CM 6.7FR 10MM SPC RIGHT AV XTD-RETRAC ACT FIX BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805184 EAP HCPCS C1777 ENDOTAK RELIANCE AF (ACTIVE FIXATION) LEADS BOTH IP/OP "$11,231.00" "$8,311.00" "$2,229.07" "$11,231.00" "$5,053.95" "$5,053.95" "$5,053.95" "$5,053.95" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.82" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$11,231.00" "$5,536.88" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$2,229.07" "$11,231.00" "$6,513.98" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.54" "$11,231.00" N/A N/A 27805185 EAP HCPCS C1898 LEAD PCNG 60CM 6.7FR 10MM SPC RIGHT AV ECRDL IS-1 CONCTR BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805186 EAP HCPCS C1900 EASYTRACK 2 BOTH IP/OP "$4,433.00" "$3,280.50" $879.84 "$4,433.00" "$1,994.85" "$1,994.85" "$1,994.85" "$1,994.85" "$4,433.00" "$4,433.00" "$4,433.00" $923.95 "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" $923.89 "$4,433.00" "$4,433.00" "$2,185.47" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$3,324.75" "$4,433.00" "$4,433.00" "$4,433.00" "$2,216.50" "$2,216.50" "$3,510.94" "$4,433.00" "$3,546.40" "$1,994.85" $879.84 "$4,433.00" "$2,571.14" "$4,433.00" "$4,433.00" "$4,433.00" $923.84 "$4,433.00" N/A N/A 27805187 EAP HCPCS C1898 LEAD PCNG SM ACT FIX RLNC BOTH IP/OP "$11,231.00" "$8,311.00" "$2,340.66" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$2,340.66" "$11,231.00" "$4,492.40" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$11,231.00" "$8,423.25" "$11,231.00" "$11,231.00" "$11,231.00" "$5,615.50" "$5,615.50" "$8,894.95" "$11,231.00" "$8,984.80" "$5,053.95" "$11,231.00" "$11,231.00" "$6,513.98" "$11,231.00" "$6,738.60" "$11,231.00" "$11,231.00" "$11,231.00" N/A N/A 27805188 EAP HCPCS C1887 RAPIDO ADVANCE LEAD DELIVERY SYSTEM BOTH IP/OP "$2,941.00" "$2,176.50" $583.71 "$2,941.00" "$1,323.45" "$1,323.45" "$1,323.45" "$1,323.45" "$2,941.00" "$2,941.00" "$2,941.00" $612.98 "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" $612.94 "$2,941.00" "$2,941.00" "$1,449.91" "$2,941.00" "$2,941.00" "$2,941.00" "$2,941.00" "$2,205.75" "$2,941.00" "$2,941.00" "$2,941.00" "$1,470.50" "$1,470.50" "$2,329.27" "$2,941.00" "$2,352.80" "$1,323.45" $583.71 "$2,941.00" "$1,705.78" "$2,941.00" "$2,941.00" "$2,941.00" $612.90 "$2,941.00" N/A N/A 27805189 EAP HCPCS C1900 LEAD PCNG 80CM 5.4FR CORON VNS LV IS 1 BIPOL OTW EZTRK 2 BOTH IP/OP "$4,433.00" "$3,280.50" $879.84 "$4,433.00" "$1,994.85" "$1,994.85" "$1,994.85" "$1,994.85" "$4,433.00" "$4,433.00" "$4,433.00" $923.95 "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" $923.89 "$4,433.00" "$4,433.00" "$2,185.47" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$3,324.75" "$4,433.00" "$4,433.00" "$4,433.00" "$2,216.50" "$2,216.50" "$3,510.94" "$4,433.00" "$3,546.40" "$1,994.85" $879.84 "$4,433.00" "$2,571.14" "$4,433.00" "$4,433.00" "$4,433.00" $923.84 "$4,433.00" N/A N/A 27805190 EAP HCPCS C1898 LEAD PCNG CORON VNS IS 1 EZTRK 2 BOTH IP/OP "$4,433.00" "$3,280.50" $923.89 "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" $923.89 "$4,433.00" "$1,773.20" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$3,324.75" "$4,433.00" "$4,433.00" "$4,433.00" "$2,216.50" "$2,216.50" "$3,510.94" "$4,433.00" "$3,546.40" "$1,994.85" "$4,433.00" "$4,433.00" "$2,571.14" "$4,433.00" "$2,659.80" "$4,433.00" "$4,433.00" "$4,433.00" N/A N/A 27805191 EAP HCPCS C1898 LEAD PCNG 100CM 7-5FR 8.5MM .035IN CORON VNS LV IS-1 DUAL BOTH IP/OP "$4,433.00" "$3,280.50" $923.89 "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" $923.89 "$4,433.00" "$1,773.20" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$3,324.75" "$4,433.00" "$4,433.00" "$4,433.00" "$2,216.50" "$2,216.50" "$3,510.94" "$4,433.00" "$3,546.40" "$1,994.85" "$4,433.00" "$4,433.00" "$2,571.14" "$4,433.00" "$2,659.80" "$4,433.00" "$4,433.00" "$4,433.00" N/A N/A 27805192 EAP HCPCS C1898 LEAD PCNG 80CM 8FR J ECRDL RIGHT ARTIAL BIPOL IS-1 LV-1 DUAL BOTH IP/OP "$4,433.00" "$3,280.50" $923.89 "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" $923.89 "$4,433.00" "$1,773.20" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$3,324.75" "$4,433.00" "$4,433.00" "$4,433.00" "$2,216.50" "$2,216.50" "$3,510.94" "$4,433.00" "$3,546.40" "$1,994.85" "$4,433.00" "$4,433.00" "$2,571.14" "$4,433.00" "$2,659.80" "$4,433.00" "$4,433.00" "$4,433.00" N/A N/A 27805193 EAP HCPCS C1898 LEAD PCNG 90CM CORON VNS LV LV-1 DUAL ELTRD CONCTR BIPOL PSV BOTH IP/OP "$4,433.00" "$3,280.50" $923.89 "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" $923.89 "$4,433.00" "$1,773.20" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$3,324.75" "$4,433.00" "$4,433.00" "$4,433.00" "$2,216.50" "$2,216.50" "$3,510.94" "$4,433.00" "$3,546.40" "$1,994.85" "$4,433.00" "$4,433.00" "$2,571.14" "$4,433.00" "$2,659.80" "$4,433.00" "$4,433.00" "$4,433.00" N/A N/A 27805194 EAP HCPCS C1779 LEAD PCNG 35CM MYOCARDIUM VNTRC IS-1 CONCTR SCR FIX UNPLR BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805195 EAP HCPCS C1898 LEAD PCNG 80CM 8FR CORON VNS BIPOL DUAL ELTRD SPRL FIX IS-1 BOTH IP/OP "$4,433.00" "$3,280.50" $923.89 "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" $923.89 "$4,433.00" "$1,773.20" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$3,324.75" "$4,433.00" "$4,433.00" "$4,433.00" "$2,216.50" "$2,216.50" "$3,510.94" "$4,433.00" "$3,546.40" "$1,994.85" "$4,433.00" "$4,433.00" "$2,571.14" "$4,433.00" "$2,659.80" "$4,433.00" "$4,433.00" "$4,433.00" N/A N/A 27805196 EAP HCPCS C1898 LEAD PCNG 90CM CORON VNS LV IS-1 EZTRK 3IS-1 STRD ELUT SIL BOTH IP/OP "$4,433.00" "$3,280.50" $923.89 "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" $923.89 "$4,433.00" "$1,773.20" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$4,433.00" "$3,324.75" "$4,433.00" "$4,433.00" "$4,433.00" "$2,216.50" "$2,216.50" "$3,510.94" "$4,433.00" "$3,546.40" "$1,994.85" "$4,433.00" "$4,433.00" "$2,571.14" "$4,433.00" "$2,659.80" "$4,433.00" "$4,433.00" "$4,433.00" N/A N/A 27805197 EAP HCPCS C1779 LEAD PCNG 35CM MYOCARDIUM EPICARDIUM RV IS-1 CONCTR OTHR BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805198 EAP HCPCS C1899 LEAD PCNG 59CM ECRDL 4 ST DUAL COIL IMPLTABLE CARDVRT DFBR BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805199 EAP HCPCS C1898 LEAD PCNG 64CM ECRDL 4 ST DUAL COIL ACT FIX IMPLTABLE BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805200 EAP HCPCS C1898 LEAD PCNG 59CM ECRDM 4-ST DUAL COIL ACT DF4 TRM CONCTR BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805201 EAP HCPCS C1898 LEAD PCNG 64CM ECRDM 4-ST DUAL COIL ACT DF4 TRM CONCTR BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805202 EAP HCPCS C1898 LEAD PCNG 59CM ECRDM 4-ST DUAL COIL PSV DF4 TRM CONCTR BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805203 EAP HCPCS C1898 LEAD PCNG 64CM ECRDL 4 ST DUAL COIL ACT FIX IMPLTABLE BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805204 EAP HCPCS C1898 LEAD PCNG 59CM ECRDL 4 ST DUAL COIL PSV FIX IMPLTABLE BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805205 EAP HCPCS C1898 LEAD PCNG 64CM ECRDL 4 ST DUAL COIL PSV FIX IMPLTABLE BOTH IP/OP "$11,822.00" "$8,748.50" "$2,463.83" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$4,728.80" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$11,822.00" "$11,822.00" "$6,856.76" "$11,822.00" "$7,093.20" "$11,822.00" "$11,822.00" "$11,822.00" N/A N/A 27805206 EAP HCPCS C1777 LEAD PCNG 59CM ECRDM 4-ST 1 COIL ACT DF4 TRM CONCTR CARDVRT BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27805207 EAP HCPCS C1777 LEAD PCNG 64CM ECRDL 4 ST 1 COIL PSV FIX IMPLTABLE CARDVRT BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27805208 EAP HCPCS C1777 LEAD PCNG 59CM ECRDL 4 ST 1 COIL PSV FIX IMPLTABLE CARDVRT BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27805209 EAP HCPCS C1777 LEAD PCNG 64CM ECRDL 4 ST 1 COIL PSV FIX IMPLTABLE CARDVRT BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27805210 EAP HCPCS C1900 INVIVE / EASYTRAK OR ACUITY / W RV OR AV LEAD: CARDIAC RESYN BOTH IP/OP "$26,452.00" "$19,574.50" "$5,250.06" "$26,452.00" "$11,903.40" "$11,903.40" "$11,903.40" "$11,903.40" "$26,452.00" "$26,452.00" "$26,452.00" "$5,513.26" "$26,452.00" "$26,452.00" "$26,452.00" "$26,452.00" "$26,452.00" "$5,512.89" "$26,452.00" "$26,452.00" "$13,040.84" "$26,452.00" "$26,452.00" "$26,452.00" "$26,452.00" "$19,839.00" "$26,452.00" "$26,452.00" "$26,452.00" "$13,226.00" "$13,226.00" "$20,949.98" "$26,452.00" "$21,161.60" "$11,903.40" "$5,250.06" "$26,452.00" "$15,342.16" "$26,452.00" "$26,452.00" "$26,452.00" "$5,512.60" "$26,452.00" N/A N/A 27805211 EAP HCPCS C1900 INVIVE / EASYTRAK OR ACUITY / W RV & AV LEAD: CARDIAC RESYNC BOTH IP/OP "$26,452.00" "$19,574.50" "$5,250.06" "$26,452.00" "$11,903.40" "$11,903.40" "$11,903.40" "$11,903.40" "$26,452.00" "$26,452.00" "$26,452.00" "$5,513.26" "$26,452.00" "$26,452.00" "$26,452.00" "$26,452.00" "$26,452.00" "$5,512.89" "$26,452.00" "$26,452.00" "$13,040.84" "$26,452.00" "$26,452.00" "$26,452.00" "$26,452.00" "$19,839.00" "$26,452.00" "$26,452.00" "$26,452.00" "$13,226.00" "$13,226.00" "$20,949.98" "$26,452.00" "$21,161.60" "$11,903.40" "$5,250.06" "$26,452.00" "$15,342.16" "$26,452.00" "$26,452.00" "$26,452.00" "$5,512.60" "$26,452.00" N/A N/A 27805212 EAP HCPCS C1722 INCEPTA LV-1 / EASYTRAK OR ACUITY / ENDOTAK W ATRIAL LEAD: C BOTH IP/OP "$71,524.00" "$52,928.00" "$7,712.84" "$71,524.00" "$32,185.80" "$32,185.80" "$32,185.80" "$32,185.80" "$71,524.00" "$71,524.00" "$71,524.00" "$9,417.94" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$14,906.39" "$71,524.00" "$71,524.00" "$35,261.33" "$71,524.00" "$71,524.00" "$71,524.00" "$71,524.00" "$53,643.00" "$71,524.00" "$71,524.00" "$71,524.00" "$35,762.00" "$35,762.00" "$56,647.01" "$71,524.00" "$57,219.20" "$32,185.80" "$7,712.84" "$71,524.00" "$41,483.92" "$71,524.00" "$71,524.00" "$71,524.00" "$8,098.48" "$71,524.00" N/A N/A 27805213 EAP HCPCS C1898 LEAD PCNG 59CM 2.4MM STR ATR VNTRC BIPOL ACT FIX RTRCT HLX BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805214 EAP HCPCS C1898 LEAD PCNG 45CM ECRDM ATR VNTRC IS-1 CONCTR ACT FIX BIPOL SIL BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805215 EAP HCPCS C1898 LEAD PCNG ECRDL RIGHT ATR RV IS-1 CONCTR BIPOL XTD-RETRAC BOTH IP/OP "$1,463.00" "$1,083.00" $304.91 "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" $304.91 "$1,463.00" $585.20 "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,097.25" "$1,463.00" "$1,463.00" "$1,463.00" $731.50 $731.50 "$1,158.70" "$1,463.00" "$1,170.40" $658.35 "$1,463.00" "$1,463.00" $848.54 "$1,463.00" $877.80 "$1,463.00" "$1,463.00" "$1,463.00" N/A N/A 27805216 EAP HCPCS C1898 LEAD PCNG ECRDM RIGHT ATR LV BIPOL IS-1 SCR FIX SIL INSL FLN BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805217 EAP HCPCS C1898 LEAD PCNG 52CM 7FR RIGHT ATR VNTRC ECRDM IS-1 CONCTR BIPOL BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805218 EAP HCPCS C1898 LEAD PCNG 45CM 6FR ECRDL OTHR THAN TRNVNS VDD 1 PASS BIPOL BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805219 EAP HCPCS C1898 LEAD PCNG 58CM 5FR ECRDM AV BIPOL ACT FIX SCR IN IS-1 FLN2 BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805220 EAP HCPCS C1898 LEAD PCNG 52CM 7FR STR ECRDM RIGHT ATR LV BIPOL IS-1 SCR FIX BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805221 EAP HCPCS C1779 LEAD PCNG 45CM 7FR THK1.7MM STR ATR VNTRC BIPOL ACT FIX FLN2 BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805222 EAP HCPCS C1898 LEAD PCNG 52CM OTHR THAN TRNVNS VDD 1 PASS IMPLTABLE FLN2 BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805223 EAP HCPCS C1898 LEAD PCNG 45CM 8FR J ECRDM RIGHT ATR BIPOL IS-1 PSV FIX POLY BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805224 EAP HCPCS C1900 LEAD PCNG 58CM 6FR ECRDM VNTRC BIPOL IS-1 PSV FIX FLN2 BOTH IP/OP "$1,330.00" $984.50 $263.97 "$1,330.00" $598.50 $598.50 $598.50 $598.50 "$1,330.00" "$1,330.00" "$1,330.00" $277.21 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 $263.97 "$1,330.00" $771.40 "$1,330.00" "$1,330.00" "$1,330.00" $277.17 "$1,330.00" N/A N/A 27805225 EAP HCPCS C1779 LEAD PCNG 52CM 9FR RV ECRDM BIPOL IS-1 PSV FIX TRNVNS VDD 1 BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805226 EAP HCPCS C1898 LEAD PCNG RV ECRDM BIPOL PSV FIX IS-1 FLN2 STRX PU BOTH IP/OP "$1,330.00" $984.50 $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" "$1,330.00" $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27805227 EAP HCPCS C1900 LEAD PCNG 52CM VNTRC ECRDL OTHR THAN TRNVNS VDD 1 PASS BIPOL BOTH IP/OP "$1,330.00" $984.50 $263.97 "$1,330.00" $598.50 $598.50 $598.50 $598.50 "$1,330.00" "$1,330.00" "$1,330.00" $277.21 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 $263.97 "$1,330.00" $771.40 "$1,330.00" "$1,330.00" "$1,330.00" $277.17 "$1,330.00" N/A N/A 27805228 EAP Custom 27805228 SENSOR FLOTRAC VAMP ADULT 60IN 152CM STERILE BOTH IP/OP $961.00 $711.50 $171.06 $961.00 $961.00 $961.00 $961.00 $961.00 $961.00 $961.00 $171.06 $961.00 $961.00 $961.00 $961.00 $961.00 $961.00 $200.28 $961.00 $384.40 $961.00 $961.00 $961.00 $961.00 $961.00 $720.75 $961.00 $961.00 $961.00 $480.50 $480.50 $761.11 $961.00 $768.80 $432.45 $961.00 $961.00 $557.38 $961.00 $576.60 $961.00 $961.00 $961.00 N/A N/A 27805229 EAP Custom 27805229 SENSOR MONITOR FLOTRAC ADLT L60 IN VAMP BIFURCATED PRES BOTH IP/OP $961.00 $711.50 $171.06 $961.00 $961.00 $961.00 $961.00 $961.00 $961.00 $961.00 $171.06 $961.00 $961.00 $961.00 $961.00 $961.00 $961.00 $200.28 $961.00 $384.40 $961.00 $961.00 $961.00 $961.00 $961.00 $720.75 $961.00 $961.00 $961.00 $480.50 $480.50 $761.11 $961.00 $768.80 $432.45 $961.00 $961.00 $557.38 $961.00 $576.60 $961.00 $961.00 $961.00 N/A N/A 27805231 EAP HCPCS C1874 STENT ENDOPRSTH 8MM 5CM 120CM .035IN DLV SYS TIP TO HUBL BOTH IP/OP "$7,966.00" "$5,895.00" "$1,581.05" "$7,966.00" "$3,584.70" "$3,584.70" "$3,584.70" "$3,584.70" "$7,966.00" "$7,966.00" "$7,966.00" "$1,660.31" "$7,966.00" "$7,966.00" "$7,966.00" "$7,966.00" "$7,966.00" "$1,660.20" "$7,966.00" "$7,966.00" "$3,927.24" "$7,966.00" "$7,966.00" "$7,966.00" "$7,966.00" "$5,974.50" "$7,966.00" "$7,966.00" "$7,966.00" "$3,983.00" "$3,983.00" "$6,309.07" "$7,966.00" "$6,372.80" "$3,584.70" "$1,581.05" "$7,966.00" "$4,620.28" "$7,966.00" "$7,966.00" "$7,966.00" "$1,660.11" "$7,966.00" N/A N/A 27805232 EAP HCPCS C1874 STENT ENDOPRSTH 8MM 10CM 120CM .035IN DLV SYS TIP TO HUL BOTH IP/OP "$9,148.00" "$6,770.00" "$1,815.65" "$9,148.00" "$4,116.60" "$4,116.60" "$4,116.60" "$4,116.60" "$9,148.00" "$9,148.00" "$9,148.00" "$1,906.67" "$9,148.00" "$9,148.00" "$9,148.00" "$9,148.00" "$9,148.00" "$1,906.54" "$9,148.00" "$9,148.00" "$4,509.96" "$9,148.00" "$9,148.00" "$9,148.00" "$9,148.00" "$6,861.00" "$9,148.00" "$9,148.00" "$9,148.00" "$4,574.00" "$4,574.00" "$7,245.22" "$9,148.00" "$7,318.40" "$4,116.60" "$1,815.65" "$9,148.00" "$5,305.84" "$9,148.00" "$9,148.00" "$9,148.00" "$1,906.44" "$9,148.00" N/A N/A 27805233 EAP HCPCS C1874 STENT ENDOPRSTH 10MM 5CM 120CM .035IN DLV SYS TIP TO HUL BOTH IP/OP "$7,966.00" "$5,895.00" "$1,581.05" "$7,966.00" "$3,584.70" "$3,584.70" "$3,584.70" "$3,584.70" "$7,966.00" "$7,966.00" "$7,966.00" "$1,660.31" "$7,966.00" "$7,966.00" "$7,966.00" "$7,966.00" "$7,966.00" "$1,660.20" "$7,966.00" "$7,966.00" "$3,927.24" "$7,966.00" "$7,966.00" "$7,966.00" "$7,966.00" "$5,974.50" "$7,966.00" "$7,966.00" "$7,966.00" "$3,983.00" "$3,983.00" "$6,309.07" "$7,966.00" "$6,372.80" "$3,584.70" "$1,581.05" "$7,966.00" "$4,620.28" "$7,966.00" "$7,966.00" "$7,966.00" "$1,660.11" "$7,966.00" N/A N/A 27805234 EAP HCPCS C1874 STENT ENDOPRSTH 10MM 10CM 120CM .035IN DLV SYS TIP TO HB BOTH IP/OP "$9,148.00" "$6,770.00" "$1,815.65" "$9,148.00" "$4,116.60" "$4,116.60" "$4,116.60" "$4,116.60" "$9,148.00" "$9,148.00" "$9,148.00" "$1,906.67" "$9,148.00" "$9,148.00" "$9,148.00" "$9,148.00" "$9,148.00" "$1,906.54" "$9,148.00" "$9,148.00" "$4,509.96" "$9,148.00" "$9,148.00" "$9,148.00" "$9,148.00" "$6,861.00" "$9,148.00" "$9,148.00" "$9,148.00" "$4,574.00" "$4,574.00" "$7,245.22" "$9,148.00" "$7,318.40" "$4,116.60" "$1,815.65" "$9,148.00" "$5,305.84" "$9,148.00" "$9,148.00" "$9,148.00" "$1,906.44" "$9,148.00" N/A N/A 27805235 EAP HCPCS C1874 STENT ENDOPRSTH 6MM 7FR 5CM 120CM .035IN HEP BIOACTIVE C BOTH IP/OP "$7,061.00" "$5,225.50" "$1,401.43" "$7,061.00" "$3,177.45" "$3,177.45" "$3,177.45" "$3,177.45" "$7,061.00" "$7,061.00" "$7,061.00" "$1,471.69" "$7,061.00" "$7,061.00" "$7,061.00" "$7,061.00" "$7,061.00" "$1,471.59" "$7,061.00" "$7,061.00" "$3,481.07" "$7,061.00" "$7,061.00" "$7,061.00" "$7,061.00" "$5,295.75" "$7,061.00" "$7,061.00" "$7,061.00" "$3,530.50" "$3,530.50" "$5,592.31" "$7,061.00" "$5,648.80" "$3,177.45" "$1,401.43" "$7,061.00" "$4,095.38" "$7,061.00" "$7,061.00" "$7,061.00" "$1,471.51" "$7,061.00" N/A N/A 27805236 EAP HCPCS C1874 STENT ENDOPRSTH 6MM 10CM 120CM .035IN DLV SYS TIP TO HUL BOTH IP/OP "$9,604.00" "$7,107.00" "$1,906.15" "$9,604.00" "$4,321.80" "$4,321.80" "$4,321.80" "$4,321.80" "$9,604.00" "$9,604.00" "$9,604.00" "$2,001.71" "$9,604.00" "$9,604.00" "$9,604.00" "$9,604.00" "$9,604.00" "$2,001.58" "$9,604.00" "$9,604.00" "$4,734.77" "$9,604.00" "$9,604.00" "$9,604.00" "$9,604.00" "$7,203.00" "$9,604.00" "$9,604.00" "$9,604.00" "$4,802.00" "$4,802.00" "$7,606.37" "$9,604.00" "$7,683.20" "$4,321.80" "$1,906.15" "$9,604.00" "$5,570.32" "$9,604.00" "$9,604.00" "$9,604.00" "$2,001.47" "$9,604.00" N/A N/A 27805240 EAP HCPCS V2790 GRAFT CRNL 16MM PROKERA AMNIO MEMBR CRPRS RING SET BOTH IP/OP "$2,646.00" "$1,958.50" $525.16 "$2,646.00" "$1,190.70" "$1,190.70" "$1,190.70" "$1,190.70" "$2,646.00" "$2,646.00" "$2,646.00" $551.49 "$2,646.00" "$2,646.00" "$2,646.00" "$2,646.00" "$2,646.00" $551.46 "$2,646.00" "$2,646.00" "$1,304.48" "$2,646.00" "$2,646.00" "$2,646.00" "$2,646.00" "$1,984.50" "$2,646.00" "$2,646.00" "$2,646.00" "$1,323.00" "$1,323.00" "$2,095.63" "$2,646.00" "$2,116.80" "$1,190.70" $525.16 "$2,646.00" "$1,534.68" "$2,646.00" "$2,646.00" "$2,646.00" $551.43 "$2,646.00" N/A N/A 27805252 EAP Custom 27805252 PIPELINE EMBOLIZATION DEVICE 2.75 CM 10MM BOTH IP/OP "$38,126.00" "$28,213.50" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$7,945.88" "$38,126.00" "$15,250.40" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$28,594.50" "$38,126.00" "$38,126.00" "$38,126.00" "$19,063.00" "$19,063.00" "$30,195.79" "$38,126.00" "$30,500.80" "$17,156.70" "$38,126.00" "$38,126.00" "$22,113.08" "$38,126.00" "$22,875.60" "$38,126.00" "$38,126.00" "$38,126.00" N/A N/A 27805253 EAP Custom 27805253 PIPELINE EMBOLIZATION DEVICE 2.75 CM 12MM BOTH IP/OP "$38,126.00" "$28,213.50" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$7,945.88" "$38,126.00" "$15,250.40" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$28,594.50" "$38,126.00" "$38,126.00" "$38,126.00" "$19,063.00" "$19,063.00" "$30,195.79" "$38,126.00" "$30,500.80" "$17,156.70" "$38,126.00" "$38,126.00" "$22,113.08" "$38,126.00" "$22,875.60" "$38,126.00" "$38,126.00" "$38,126.00" N/A N/A 27805254 EAP Custom 27805254 PIPELINE EMBOLIZATION DEVICE 2.75CM 16MM BOTH IP/OP "$38,126.00" "$28,213.50" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$7,945.88" "$38,126.00" "$15,250.40" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$28,594.50" "$38,126.00" "$38,126.00" "$38,126.00" "$19,063.00" "$19,063.00" "$30,195.79" "$38,126.00" "$30,500.80" "$17,156.70" "$38,126.00" "$38,126.00" "$22,113.08" "$38,126.00" "$22,875.60" "$38,126.00" "$38,126.00" "$38,126.00" N/A N/A 27805255 EAP Custom 27805255 PIPELINE EMBOLIZATION DEVICE 3.00CM 10MM BOTH IP/OP "$38,126.00" "$28,213.50" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$7,945.88" "$38,126.00" "$15,250.40" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$28,594.50" "$38,126.00" "$38,126.00" "$38,126.00" "$19,063.00" "$19,063.00" "$30,195.79" "$38,126.00" "$30,500.80" "$17,156.70" "$38,126.00" "$38,126.00" "$22,113.08" "$38,126.00" "$22,875.60" "$38,126.00" "$38,126.00" "$38,126.00" N/A N/A 27805256 EAP Custom 27805256 PIPELINE EMBOLIZATION DEVICE 3.00CM 12MM BOTH IP/OP "$38,126.00" "$28,213.50" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$7,945.88" "$38,126.00" "$15,250.40" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$28,594.50" "$38,126.00" "$38,126.00" "$38,126.00" "$19,063.00" "$19,063.00" "$30,195.79" "$38,126.00" "$30,500.80" "$17,156.70" "$38,126.00" "$38,126.00" "$22,113.08" "$38,126.00" "$22,875.60" "$38,126.00" "$38,126.00" "$38,126.00" N/A N/A 27805257 EAP Custom 27805257 PIPELINE EMBOLIZATION DEVICE 3.00CM 16MM BOTH IP/OP "$38,126.00" "$28,213.50" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$7,945.88" "$38,126.00" "$15,250.40" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$28,594.50" "$38,126.00" "$38,126.00" "$38,126.00" "$19,063.00" "$19,063.00" "$30,195.79" "$38,126.00" "$30,500.80" "$17,156.70" "$38,126.00" "$38,126.00" "$22,113.08" "$38,126.00" "$22,875.60" "$38,126.00" "$38,126.00" "$38,126.00" N/A N/A 27805258 EAP Custom 27805258 PIPELINE EMBOLIZATION DEVICE 3.50CM 10MM BOTH IP/OP "$38,126.00" "$28,213.50" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$7,945.88" "$38,126.00" "$15,250.40" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$28,594.50" "$38,126.00" "$38,126.00" "$38,126.00" "$19,063.00" "$19,063.00" "$30,195.79" "$38,126.00" "$30,500.80" "$17,156.70" "$38,126.00" "$38,126.00" "$22,113.08" "$38,126.00" "$22,875.60" "$38,126.00" "$38,126.00" "$38,126.00" N/A N/A 27805259 EAP Custom 27805259 PIPELINE EMBOLIZATION DEVICE 3.5CM 12MM BOTH IP/OP "$38,126.00" "$28,213.50" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$7,945.88" "$38,126.00" "$15,250.40" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$28,594.50" "$38,126.00" "$38,126.00" "$38,126.00" "$19,063.00" "$19,063.00" "$30,195.79" "$38,126.00" "$30,500.80" "$17,156.70" "$38,126.00" "$38,126.00" "$22,113.08" "$38,126.00" "$22,875.60" "$38,126.00" "$38,126.00" "$38,126.00" N/A N/A 27805260 EAP Custom 27805260 PIPELINE EMBOLIZATION DEVICE 3.5CM 16MM BOTH IP/OP "$38,126.00" "$28,213.50" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$6,786.43" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$7,945.88" "$38,126.00" "$15,250.40" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$38,126.00" "$28,594.50" "$38,126.00" "$38,126.00" "$38,126.00" "$19,063.00" "$19,063.00" "$30,195.79" "$38,126.00" "$30,500.80" "$17,156.70" "$38,126.00" "$38,126.00" "$22,113.08" "$38,126.00" "$22,875.60" "$38,126.00" "$38,126.00" "$38,126.00" N/A N/A 27805265 EAP HCPCS C1777 LINOX SMART DX 65/17 BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27805266 EAP HCPCS C1777 LINOX SMART DX 65/15 BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27805267 EAP HCPCS C1777 LUMAX 740 VR-T DX W/GSM HM BOTH IP/OP "$45,811.00" "$33,900.50" "$7,712.84" "$45,811.00" "$20,614.95" "$20,614.95" "$20,614.95" "$20,614.95" "$45,811.00" "$45,811.00" "$45,811.00" "$9,417.94" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$9,547.52" "$45,811.00" "$45,811.00" "$22,584.82" "$45,811.00" "$45,811.00" "$45,811.00" "$45,811.00" "$34,358.25" "$45,811.00" "$45,811.00" "$45,811.00" "$22,905.50" "$22,905.50" "$36,282.31" "$45,811.00" "$36,648.80" "$20,614.95" "$7,712.84" "$45,811.00" "$26,570.38" "$45,811.00" "$45,811.00" "$45,811.00" "$8,098.48" "$45,811.00" N/A N/A 27805268 EAP HCPCS C1777 LUMAX 740 VR-T DX SYSTEM W/GSM HM BOTH IP/OP "$57,560.00" "$42,594.50" "$7,712.84" "$57,560.00" "$25,902.00" "$25,902.00" "$25,902.00" "$25,902.00" "$57,560.00" "$57,560.00" "$57,560.00" "$9,417.94" "$57,560.00" "$57,560.00" "$57,560.00" "$57,560.00" "$57,560.00" "$11,996.14" "$57,560.00" "$57,560.00" "$28,377.08" "$57,560.00" "$57,560.00" "$57,560.00" "$57,560.00" "$43,170.00" "$57,560.00" "$57,560.00" "$57,560.00" "$28,780.00" "$28,780.00" "$45,587.52" "$57,560.00" "$46,048.00" "$25,902.00" "$7,712.84" "$57,560.00" "$33,384.80" "$57,560.00" "$57,560.00" "$57,560.00" "$8,098.48" "$57,560.00" N/A N/A 27805269 EAP HCPCS C1781 "MESH SURG CRANIOCURVE .6MM OCCPTL CRNM ETCH LBL ANTM, 01-9520" BOTH IP/OP "$11,822.00" "$8,748.50" "$2,346.37" "$11,822.00" "$5,319.90" "$5,319.90" "$5,319.90" "$5,319.90" "$11,822.00" "$11,822.00" "$11,822.00" "$2,464.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.83" "$11,822.00" "$11,822.00" "$5,828.25" "$11,822.00" "$11,822.00" "$11,822.00" "$11,822.00" "$8,866.50" "$11,822.00" "$11,822.00" "$11,822.00" "$5,911.00" "$5,911.00" "$9,363.02" "$11,822.00" "$9,457.60" "$5,319.90" "$2,346.37" "$11,822.00" "$6,856.76" "$11,822.00" "$11,822.00" "$11,822.00" "$2,463.70" "$11,822.00" N/A N/A 27805270 EAP Custom 27805270 TARGET COILS 360 STANDARD 3MM X 6CM BOTH IP/OP "$4,559.00" "$3,374.00" $811.50 "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" $811.50 "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" $950.15 "$4,559.00" "$1,823.60" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$3,419.25" "$4,559.00" "$4,559.00" "$4,559.00" "$2,279.50" "$2,279.50" "$3,610.73" "$4,559.00" "$3,647.20" "$2,051.55" "$4,559.00" "$4,559.00" "$2,644.22" "$4,559.00" "$2,735.40" "$4,559.00" "$4,559.00" "$4,559.00" N/A N/A 27805271 EAP Custom 27805271 TARGET COILS 360 STANDARD 3MM X 8CM BOTH IP/OP "$4,559.00" "$3,374.00" $811.50 "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" $811.50 "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" $950.15 "$4,559.00" "$1,823.60" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$3,419.25" "$4,559.00" "$4,559.00" "$4,559.00" "$2,279.50" "$2,279.50" "$3,610.73" "$4,559.00" "$3,647.20" "$2,051.55" "$4,559.00" "$4,559.00" "$2,644.22" "$4,559.00" "$2,735.40" "$4,559.00" "$4,559.00" "$4,559.00" N/A N/A 27805272 EAP Custom 27805272 TARGET COILS 360 STANDARD 4MM X 8CM BOTH IP/OP "$4,559.00" "$3,374.00" $811.50 "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" $811.50 "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" $950.15 "$4,559.00" "$1,823.60" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$3,419.25" "$4,559.00" "$4,559.00" "$4,559.00" "$2,279.50" "$2,279.50" "$3,610.73" "$4,559.00" "$3,647.20" "$2,051.55" "$4,559.00" "$4,559.00" "$2,644.22" "$4,559.00" "$2,735.40" "$4,559.00" "$4,559.00" "$4,559.00" N/A N/A 27805273 EAP Custom 27805273 TARGET COILS 360 STANDARD 4MM X 10CM BOTH IP/OP "$4,559.00" "$3,374.00" $811.50 "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" $811.50 "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" $950.15 "$4,559.00" "$1,823.60" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$3,419.25" "$4,559.00" "$4,559.00" "$4,559.00" "$2,279.50" "$2,279.50" "$3,610.73" "$4,559.00" "$3,647.20" "$2,051.55" "$4,559.00" "$4,559.00" "$2,644.22" "$4,559.00" "$2,735.40" "$4,559.00" "$4,559.00" "$4,559.00" N/A N/A 27805274 EAP Custom 27805274 TARGET COILS 360 STANDARD 4MM X 15CM BOTH IP/OP "$4,559.00" "$3,374.00" $811.50 "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" $811.50 "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" $950.15 "$4,559.00" "$1,823.60" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$3,419.25" "$4,559.00" "$4,559.00" "$4,559.00" "$2,279.50" "$2,279.50" "$3,610.73" "$4,559.00" "$3,647.20" "$2,051.55" "$4,559.00" "$4,559.00" "$2,644.22" "$4,559.00" "$2,735.40" "$4,559.00" "$4,559.00" "$4,559.00" N/A N/A 27805275 EAP Custom 27805275 TARGET COILS 360 STANDARD 5MM X 15CM BOTH IP/OP "$4,559.00" "$3,374.00" $811.50 "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" $811.50 "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" $950.15 "$4,559.00" "$1,823.60" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$3,419.25" "$4,559.00" "$4,559.00" "$4,559.00" "$2,279.50" "$2,279.50" "$3,610.73" "$4,559.00" "$3,647.20" "$2,051.55" "$4,559.00" "$4,559.00" "$2,644.22" "$4,559.00" "$2,735.40" "$4,559.00" "$4,559.00" "$4,559.00" N/A N/A 27805276 EAP Custom 27805276 TARGET COILS 360 STANDARD 5MM X 20CM BOTH IP/OP "$4,559.00" "$3,374.00" $811.50 "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" $811.50 "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" $950.15 "$4,559.00" "$1,823.60" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$4,559.00" "$3,419.25" "$4,559.00" "$4,559.00" "$4,559.00" "$2,279.50" "$2,279.50" "$3,610.73" "$4,559.00" "$3,647.20" "$2,051.55" "$4,559.00" "$4,559.00" "$2,644.22" "$4,559.00" "$2,735.40" "$4,559.00" "$4,559.00" "$4,559.00" N/A N/A 27805277 EAP Custom 27805277 TARGET COILS 360 STANDARD 6MM X 15CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805278 EAP Custom 27805278 TARGET COILS 360 STANDARD 6MM X 20CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805279 EAP Custom 27805279 TARGET COILS 360 STANDARD 6MM X 30CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805280 EAP Custom 27805280 TARGET COILS 360 STANDARD 7MM X 15CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805281 EAP Custom 27805281 TARGET COILS 360 STANDARD 7MM X 20CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805282 EAP Custom 27805282 TARGET COILS 360 STANDARD 7MM X 30CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805283 EAP Custom 27805283 TARGET COILS 360 STANDARD 8MM X 20CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805284 EAP Custom 27805284 TARGET COILS 360 STANDARD 8MM X 30CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805285 EAP Custom 27805285 TARGET COILS 360 STANDARD 9MM X 20CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805286 EAP Custom 27805286 TARGET COILS 360 STANDARD 9MM X 30CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805287 EAP Custom 27805287 TARGET COILS 360 STANDARD 10MM X 30CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805288 EAP Custom 27805288 TARGET COILS 360 STANDARD 11MM X 30CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805289 EAP Custom 27805289 TARGET COILS 360 STANDARD 12MM X 30CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805290 EAP Custom 27805290 TARGET COILS 360 STANDARD 13MM X 30CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805291 EAP Custom 27805291 TARGET COILS 360 STANDARD 14MM X 30CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805292 EAP Custom 27805292 TARGET COILS 360 STANDARD 15MM X 40CM BOTH IP/OP "$5,097.00" "$3,772.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" $907.27 "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$1,062.27" "$5,097.00" "$2,038.80" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$5,097.00" "$3,822.75" "$5,097.00" "$5,097.00" "$5,097.00" "$2,548.50" "$2,548.50" "$4,036.82" "$5,097.00" "$4,077.60" "$2,293.65" "$5,097.00" "$5,097.00" "$2,956.26" "$5,097.00" "$3,058.20" "$5,097.00" "$5,097.00" "$5,097.00" N/A N/A 27805293 EAP Custom 27805293 TARGET COILS 360 SOFT 2MM X 4CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805294 EAP Custom 27805294 TARGET COILS 360 SOFT 3MM X 6CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805295 EAP Custom 27805295 TARGET COILS 360 SOFT 3MM X 8CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805296 EAP Custom 27805296 TARGET COILS 360 SOFT 3MM X 10CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805297 EAP Custom 27805297 TARGET COILS 360 SOFT 4MM X 6CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805298 EAP Custom 27805298 TARGET COILS 360 SOFT 4MM X 8CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805299 EAP Custom 27805299 TARGET COILS 360 SOFT 4MM X 10CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805300 EAP Custom 27805300 TARGET COILS 360 SOFT 4MM X 15CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805301 EAP Custom 27805301 TARGET COILS 360 SOFT 5MM X 10CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805302 EAP Custom 27805302 TARGET COILS 360 SOFT 5MM X 15CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805303 EAP Custom 27805303 TARGET COILS 360 SOFT 5MM X 20CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805304 EAP Custom 27805304 TARGET COILS 360 SOFT 6MM X 10CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805305 EAP Custom 27805305 TARGET COILS 360 SOFT 6MM X 15CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805306 EAP Custom 27805306 TARGET COILS 360 SOFT 6MM X 20CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805307 EAP Custom 27805307 TARGET COILS 360 SOFT 6MM X 30CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805309 EAP Custom 27805309 TARGET COILS 360 SOFT 7MM X 20CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805310 EAP Custom 27805310 TARGET COILS 360 SOFT 7MM X 30CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805312 EAP Custom 27805312 TARGET COILS 360 SOFT 8MM X 30CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805313 EAP Custom 27805313 TARGET COILS 360 SOFT 9MM X 20CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805314 EAP Custom 27805314 TARGET COILS 360 SOFT 9MM X 30CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805315 EAP Custom 27805315 TARGET COILS 360 SOFT 10MM X 30CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805316 EAP Custom 27805316 TARGET COILS 360 SOFT 11MM X 30CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805317 EAP Custom 27805317 TARGET COILS 360 SOFT 12MM X 30CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805318 EAP Custom 27805318 TARGET COILS 360 SOFT 13MM X 30CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805319 EAP Custom 27805319 TARGET COILS 360 SOFT 14MM X 30CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805320 EAP Custom 27805320 TARGET COILS HELICAL ULTRA 1MM X 1CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805321 EAP Custom 27805321 TARGET COILS HELICAL ULTRA 1MM X 2CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805322 EAP Custom 27805322 TARGET COILS HELICAL ULTRA 1MM X 3CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805323 EAP Custom 27805323 TARGET COILS HELICAL ULTRA 1.5MM X 1CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805324 EAP Custom 27805324 TARGET COILS HELICAL ULTRA 1.5MM X 2CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805325 EAP Custom 27805325 TARGET COILS HELICAL ULTRA 1.5MM X 3CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805326 EAP Custom 27805326 TARGET COILS HELICAL ULTRA 1.5MM X 4CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805327 EAP Custom 27805327 TARGET COILS HELICAL ULTRA 2MM X 1CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805328 EAP Custom 27805328 TARGET COILS HELICAL ULTRA 2MM X 2CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805329 EAP Custom 27805329 TARGET COILS HELICAL ULTRA 2MM X 3CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805330 EAP Custom 27805330 TARGET COILS HELICAL ULTRA 2MM X 4CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805331 EAP Custom 27805331 TARGET COILS HELICAL ULTRA 2MM X 6CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805332 EAP Custom 27805332 TARGET COILS HELICAL ULTRA 2MM X 8CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805333 EAP Custom 27805333 TARGET COILS HELICAL ULTRA 2.5MM X 3CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805334 EAP Custom 27805334 TARGET COILS HELICAL ULTRA 2.5MM X 4CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805335 EAP Custom 27805335 TARGET COILS HELICAL ULTRA 2.5MM X 6CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805336 EAP Custom 27805336 TARGET COILS HELICAL ULTRA 3MM X 4CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805337 EAP Custom 27805337 TARGET COILS HELICAL ULTRA 3MM X 6CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805338 EAP Custom 27805338 TARGET COILS HELICAL ULTRA 3MM X 8CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805339 EAP Custom 27805339 TARGET COILS HELICAL ULTRA 3MM X 10CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805340 EAP Custom 27805340 TARGET COILS HELICAL ULTRA 4MM X 6CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805341 EAP Custom 27805341 TARGET COILS HELICAL ULTRA 4MM X 8CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805342 EAP Custom 27805342 TARGET COILS HELICAL ULTRA 4MM X 15CM BOTH IP/OP "$3,483.00" "$2,577.50" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $619.97 "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" $725.90 "$3,483.00" "$1,393.20" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$3,483.00" "$2,612.25" "$3,483.00" "$3,483.00" "$3,483.00" "$1,741.50" "$1,741.50" "$2,758.54" "$3,483.00" "$2,786.40" "$1,567.35" "$3,483.00" "$3,483.00" "$2,020.14" "$3,483.00" "$2,089.80" "$3,483.00" "$3,483.00" "$3,483.00" N/A N/A 27805343 EAP Custom 27805343 TARGET XL DETACHABLE COILS 360 SOFT 6 X 20CM BOTH IP/OP "$5,903.00" "$4,368.50" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,230.25" "$5,903.00" "$2,361.20" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$4,427.25" "$5,903.00" "$5,903.00" "$5,903.00" "$2,951.50" "$2,951.50" "$4,675.18" "$5,903.00" "$4,722.40" "$2,656.35" "$5,903.00" "$5,903.00" "$3,423.74" "$5,903.00" "$3,541.80" "$5,903.00" "$5,903.00" "$5,903.00" N/A N/A 27805344 EAP Custom 27805344 TARGET XL DETACHABLE COILS 360 SOFT 7 X 20CM BOTH IP/OP "$5,903.00" "$4,368.50" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,230.25" "$5,903.00" "$2,361.20" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$4,427.25" "$5,903.00" "$5,903.00" "$5,903.00" "$2,951.50" "$2,951.50" "$4,675.18" "$5,903.00" "$4,722.40" "$2,656.35" "$5,903.00" "$5,903.00" "$3,423.74" "$5,903.00" "$3,541.80" "$5,903.00" "$5,903.00" "$5,903.00" N/A N/A 27805345 EAP Custom 27805345 TARGET XL DETACHABLE COILS 360 SOFT 8 X 30CM BOTH IP/OP "$5,903.00" "$4,368.50" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,230.25" "$5,903.00" "$2,361.20" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$4,427.25" "$5,903.00" "$5,903.00" "$5,903.00" "$2,951.50" "$2,951.50" "$4,675.18" "$5,903.00" "$4,722.40" "$2,656.35" "$5,903.00" "$5,903.00" "$3,423.74" "$5,903.00" "$3,541.80" "$5,903.00" "$5,903.00" "$5,903.00" N/A N/A 27805346 EAP Custom 27805346 TARGET XL DETACHABLE COILS 360 SOFT 9 X 30CM BOTH IP/OP "$5,903.00" "$4,368.50" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,230.25" "$5,903.00" "$2,361.20" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$4,427.25" "$5,903.00" "$5,903.00" "$5,903.00" "$2,951.50" "$2,951.50" "$4,675.18" "$5,903.00" "$4,722.40" "$2,656.35" "$5,903.00" "$5,903.00" "$3,423.74" "$5,903.00" "$3,541.80" "$5,903.00" "$5,903.00" "$5,903.00" N/A N/A 27805347 EAP Custom 27805347 TARGET XL DETACHABLE COILS 360 SOFT 10 X 40CM BOTH IP/OP "$5,903.00" "$4,368.50" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,230.25" "$5,903.00" "$2,361.20" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$4,427.25" "$5,903.00" "$5,903.00" "$5,903.00" "$2,951.50" "$2,951.50" "$4,675.18" "$5,903.00" "$4,722.40" "$2,656.35" "$5,903.00" "$5,903.00" "$3,423.74" "$5,903.00" "$3,541.80" "$5,903.00" "$5,903.00" "$5,903.00" N/A N/A 27805348 EAP Custom 27805348 TARGET XL DETACHABLE COILS 360 SOFT 12 X 45CM BOTH IP/OP "$5,903.00" "$4,368.50" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,230.25" "$5,903.00" "$2,361.20" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$4,427.25" "$5,903.00" "$5,903.00" "$5,903.00" "$2,951.50" "$2,951.50" "$4,675.18" "$5,903.00" "$4,722.40" "$2,656.35" "$5,903.00" "$5,903.00" "$3,423.74" "$5,903.00" "$3,541.80" "$5,903.00" "$5,903.00" "$5,903.00" N/A N/A 27805349 EAP Custom 27805349 TARGET XL DETACHABLE COILS 360 SOFT 14 X 50CM BOTH IP/OP "$6,441.00" "$4,766.50" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,342.38" "$6,441.00" "$2,576.40" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$4,830.75" "$6,441.00" "$6,441.00" "$6,441.00" "$3,220.50" "$3,220.50" "$5,101.27" "$6,441.00" "$5,152.80" "$2,898.45" "$6,441.00" "$6,441.00" "$3,735.78" "$6,441.00" "$3,864.60" "$6,441.00" "$6,441.00" "$6,441.00" N/A N/A 27805350 EAP Custom 27805350 TARGET XL DETACHABLE COILS 360 SOFT 16 X 50CM BOTH IP/OP "$6,441.00" "$4,766.50" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,342.38" "$6,441.00" "$2,576.40" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$4,830.75" "$6,441.00" "$6,441.00" "$6,441.00" "$3,220.50" "$3,220.50" "$5,101.27" "$6,441.00" "$5,152.80" "$2,898.45" "$6,441.00" "$6,441.00" "$3,735.78" "$6,441.00" "$3,864.60" "$6,441.00" "$6,441.00" "$6,441.00" N/A N/A 27805353 EAP Custom 27805353 TARGET XL DETACHABLE COILS 360 STANDARD 6 X 20CM BOTH IP/OP "$5,903.00" "$4,368.50" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,230.25" "$5,903.00" "$2,361.20" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$4,427.25" "$5,903.00" "$5,903.00" "$5,903.00" "$2,951.50" "$2,951.50" "$4,675.18" "$5,903.00" "$4,722.40" "$2,656.35" "$5,903.00" "$5,903.00" "$3,423.74" "$5,903.00" "$3,541.80" "$5,903.00" "$5,903.00" "$5,903.00" N/A N/A 27805354 EAP Custom 27805354 TARGET XL DETACHABLE COILS 360 STANDARD 7 X 20CM BOTH IP/OP "$5,903.00" "$4,368.50" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,230.25" "$5,903.00" "$2,361.20" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$4,427.25" "$5,903.00" "$5,903.00" "$5,903.00" "$2,951.50" "$2,951.50" "$4,675.18" "$5,903.00" "$4,722.40" "$2,656.35" "$5,903.00" "$5,903.00" "$3,423.74" "$5,903.00" "$3,541.80" "$5,903.00" "$5,903.00" "$5,903.00" N/A N/A 27805355 EAP Custom 27805355 TARGET XL DETACHABLE COILS 360 STANDARD 8 X 30CM BOTH IP/OP "$5,903.00" "$4,368.50" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,230.25" "$5,903.00" "$2,361.20" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$4,427.25" "$5,903.00" "$5,903.00" "$5,903.00" "$2,951.50" "$2,951.50" "$4,675.18" "$5,903.00" "$4,722.40" "$2,656.35" "$5,903.00" "$5,903.00" "$3,423.74" "$5,903.00" "$3,541.80" "$5,903.00" "$5,903.00" "$5,903.00" N/A N/A 27805356 EAP Custom 27805356 TARGET XL DETACHABLE COILS 360 STANDARD 9 X 30CM BOTH IP/OP "$5,903.00" "$4,368.50" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,230.25" "$5,903.00" "$2,361.20" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$4,427.25" "$5,903.00" "$5,903.00" "$5,903.00" "$2,951.50" "$2,951.50" "$4,675.18" "$5,903.00" "$4,722.40" "$2,656.35" "$5,903.00" "$5,903.00" "$3,423.74" "$5,903.00" "$3,541.80" "$5,903.00" "$5,903.00" "$5,903.00" N/A N/A 27805357 EAP Custom 27805357 TARGET XL DETACHABLE COILS 360 STANDARD 10 X 40CM BOTH IP/OP "$5,903.00" "$4,368.50" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,050.73" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$1,230.25" "$5,903.00" "$2,361.20" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$5,903.00" "$4,427.25" "$5,903.00" "$5,903.00" "$5,903.00" "$2,951.50" "$2,951.50" "$4,675.18" "$5,903.00" "$4,722.40" "$2,656.35" "$5,903.00" "$5,903.00" "$3,423.74" "$5,903.00" "$3,541.80" "$5,903.00" "$5,903.00" "$5,903.00" N/A N/A 27805359 EAP Custom 27805359 TARGET XL DETACHABLE COILS 360 STANDARD 14 X 50CM BOTH IP/OP "$6,441.00" "$4,766.50" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,342.38" "$6,441.00" "$2,576.40" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$4,830.75" "$6,441.00" "$6,441.00" "$6,441.00" "$3,220.50" "$3,220.50" "$5,101.27" "$6,441.00" "$5,152.80" "$2,898.45" "$6,441.00" "$6,441.00" "$3,735.78" "$6,441.00" "$3,864.60" "$6,441.00" "$6,441.00" "$6,441.00" N/A N/A 27805360 EAP Custom 27805360 TARGET XL DETACHABLE COILS 360 STANDARD 16 X 50CM BOTH IP/OP "$6,441.00" "$4,766.50" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,342.38" "$6,441.00" "$2,576.40" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$4,830.75" "$6,441.00" "$6,441.00" "$6,441.00" "$3,220.50" "$3,220.50" "$5,101.27" "$6,441.00" "$5,152.80" "$2,898.45" "$6,441.00" "$6,441.00" "$3,735.78" "$6,441.00" "$3,864.60" "$6,441.00" "$6,441.00" "$6,441.00" N/A N/A 27805361 EAP Custom 27805361 TARGET XL DETACHABLE COILS 360 STANDARD 18 X 50CM BOTH IP/OP "$6,441.00" "$4,766.50" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,342.38" "$6,441.00" "$2,576.40" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$4,830.75" "$6,441.00" "$6,441.00" "$6,441.00" "$3,220.50" "$3,220.50" "$5,101.27" "$6,441.00" "$5,152.80" "$2,898.45" "$6,441.00" "$6,441.00" "$3,735.78" "$6,441.00" "$3,864.60" "$6,441.00" "$6,441.00" "$6,441.00" N/A N/A 27805362 EAP Custom 27805362 TARGET XL DETACHABLE COILS 360 STANDARD 20 X 50CM BOTH IP/OP "$6,441.00" "$4,766.50" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,342.38" "$6,441.00" "$2,576.40" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$4,830.75" "$6,441.00" "$6,441.00" "$6,441.00" "$3,220.50" "$3,220.50" "$5,101.27" "$6,441.00" "$5,152.80" "$2,898.45" "$6,441.00" "$6,441.00" "$3,735.78" "$6,441.00" "$3,864.60" "$6,441.00" "$6,441.00" "$6,441.00" N/A N/A 27805363 EAP Custom 27805363 TARGET XL DETACHABLE COILS 360 STANDARD 22 X 50CM BOTH IP/OP "$6,441.00" "$4,766.50" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,342.38" "$6,441.00" "$2,576.40" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$4,830.75" "$6,441.00" "$6,441.00" "$6,441.00" "$3,220.50" "$3,220.50" "$5,101.27" "$6,441.00" "$5,152.80" "$2,898.45" "$6,441.00" "$6,441.00" "$3,735.78" "$6,441.00" "$3,864.60" "$6,441.00" "$6,441.00" "$6,441.00" N/A N/A 27805364 EAP Custom 27805364 TARGET XL DETACHABLE COILS 360 STANDARD 24 X 50CM BOTH IP/OP "$6,441.00" "$4,766.50" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,146.50" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$1,342.38" "$6,441.00" "$2,576.40" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$6,441.00" "$4,830.75" "$6,441.00" "$6,441.00" "$6,441.00" "$3,220.50" "$3,220.50" "$5,101.27" "$6,441.00" "$5,152.80" "$2,898.45" "$6,441.00" "$6,441.00" "$3,735.78" "$6,441.00" "$3,864.60" "$6,441.00" "$6,441.00" "$6,441.00" N/A N/A 27805365 EAP Custom 27805365 TARGET XL DETACHABLE COILS HELICAL 10 X 40CM BOTH IP/OP "$4,290.00" "$3,175.00" $763.62 "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" $763.62 "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" $894.08 "$4,290.00" "$1,716.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$3,217.50" "$4,290.00" "$4,290.00" "$4,290.00" "$2,145.00" "$2,145.00" "$3,397.68" "$4,290.00" "$3,432.00" "$1,930.50" "$4,290.00" "$4,290.00" "$2,488.20" "$4,290.00" "$2,574.00" "$4,290.00" "$4,290.00" "$4,290.00" N/A N/A 27805366 EAP Custom 27805366 TARGET XL DETACHABLE COILS HELICAL 12 X 50CM BOTH IP/OP "$4,290.00" "$3,175.00" $763.62 "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" $763.62 "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" $894.08 "$4,290.00" "$1,716.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$3,217.50" "$4,290.00" "$4,290.00" "$4,290.00" "$2,145.00" "$2,145.00" "$3,397.68" "$4,290.00" "$3,432.00" "$1,930.50" "$4,290.00" "$4,290.00" "$2,488.20" "$4,290.00" "$2,574.00" "$4,290.00" "$4,290.00" "$4,290.00" N/A N/A 27805367 EAP Custom 27805367 TARGET XL DETACHABLE COILS HELICAL 14 X 50CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805368 EAP Custom 27805368 TARGET XL DETACHABLE COILS HELICAL 16 X 50CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805369 EAP Custom 27805369 TARGET XL DETACHABLE COILS HELICAL 18 X 50CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805370 EAP Custom 27805370 TARGET XL DETACHABLE COILS HELICAL 20 X 50CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805371 EAP Custom 27805371 TARGET XL DETACHABLE COILS HELICAL 22 X 50CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805372 EAP Custom 27805372 TARGET XL DETACHABLE COILS HELICAL 24 X 50CM BOTH IP/OP "$4,827.00" "$3,572.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" $859.21 "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$1,006.00" "$4,827.00" "$1,930.80" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$4,827.00" "$3,620.25" "$4,827.00" "$4,827.00" "$4,827.00" "$2,413.50" "$2,413.50" "$3,822.98" "$4,827.00" "$3,861.60" "$2,172.15" "$4,827.00" "$4,827.00" "$2,799.66" "$4,827.00" "$2,896.20" "$4,827.00" "$4,827.00" "$4,827.00" N/A N/A 27805373 EAP Custom 27805373 TARGET XL DETACHABLE COILS HELICAL 5 X 15CM BOTH IP/OP "$4,290.00" "$3,175.00" $763.62 "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" $763.62 "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" $894.08 "$4,290.00" "$1,716.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$3,217.50" "$4,290.00" "$4,290.00" "$4,290.00" "$2,145.00" "$2,145.00" "$3,397.68" "$4,290.00" "$3,432.00" "$1,930.50" "$4,290.00" "$4,290.00" "$2,488.20" "$4,290.00" "$2,574.00" "$4,290.00" "$4,290.00" "$4,290.00" N/A N/A 27805374 EAP Custom 27805374 TARGET XL DETACHABLE COILS HELICAL 6 X 20CM BOTH IP/OP "$4,290.00" "$3,175.00" $763.62 "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" $763.62 "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" $894.08 "$4,290.00" "$1,716.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$3,217.50" "$4,290.00" "$4,290.00" "$4,290.00" "$2,145.00" "$2,145.00" "$3,397.68" "$4,290.00" "$3,432.00" "$1,930.50" "$4,290.00" "$4,290.00" "$2,488.20" "$4,290.00" "$2,574.00" "$4,290.00" "$4,290.00" "$4,290.00" N/A N/A 27805375 EAP Custom 27805375 TARGET XL DETACHABLE COILS HELICAL 7 X 20CM BOTH IP/OP "$4,290.00" "$3,175.00" $763.62 "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" $763.62 "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" $894.08 "$4,290.00" "$1,716.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$3,217.50" "$4,290.00" "$4,290.00" "$4,290.00" "$2,145.00" "$2,145.00" "$3,397.68" "$4,290.00" "$3,432.00" "$1,930.50" "$4,290.00" "$4,290.00" "$2,488.20" "$4,290.00" "$2,574.00" "$4,290.00" "$4,290.00" "$4,290.00" N/A N/A 27805376 EAP Custom 27805376 TARGET XL DETACHABLE COILS HELICAL 8 X 30CM BOTH IP/OP "$4,290.00" "$3,175.00" $763.62 "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" $763.62 "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" $894.08 "$4,290.00" "$1,716.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$3,217.50" "$4,290.00" "$4,290.00" "$4,290.00" "$2,145.00" "$2,145.00" "$3,397.68" "$4,290.00" "$3,432.00" "$1,930.50" "$4,290.00" "$4,290.00" "$2,488.20" "$4,290.00" "$2,574.00" "$4,290.00" "$4,290.00" "$4,290.00" N/A N/A 27805377 EAP Custom 27805377 TARGET XL DETACHABLE COILS HELICAL 9 X 30CM BOTH IP/OP "$4,290.00" "$3,175.00" $763.62 "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" $763.62 "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" $894.08 "$4,290.00" "$1,716.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$4,290.00" "$3,217.50" "$4,290.00" "$4,290.00" "$4,290.00" "$2,145.00" "$2,145.00" "$3,397.68" "$4,290.00" "$3,432.00" "$1,930.50" "$4,290.00" "$4,290.00" "$2,488.20" "$4,290.00" "$2,574.00" "$4,290.00" "$4,290.00" "$4,290.00" N/A N/A 27805378 EAP HCPCS C1781 "MESH SURG CRANIOCURVE .6MM LEFT PRTL SM CRNM ETCH LBL ANTM, 01-9521" BOTH IP/OP "$13,300.00" "$9,842.00" "$2,639.72" "$13,300.00" "$5,985.00" "$5,985.00" "$5,985.00" "$5,985.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,772.05" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,771.87" "$13,300.00" "$13,300.00" "$6,556.90" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$9,975.00" "$13,300.00" "$13,300.00" "$13,300.00" "$6,650.00" "$6,650.00" "$10,533.60" "$13,300.00" "$10,640.00" "$5,985.00" "$2,639.72" "$13,300.00" "$7,714.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,771.72" "$13,300.00" N/A N/A 27805379 EAP HCPCS C1781 "MESH SURG CRANIOCURVE .6MM RIGHT PRTL SM CRNM ETCH LBL ANTM, 01-9522" BOTH IP/OP "$13,300.00" "$9,842.00" "$2,639.72" "$13,300.00" "$5,985.00" "$5,985.00" "$5,985.00" "$5,985.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,772.05" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,771.87" "$13,300.00" "$13,300.00" "$6,556.90" "$13,300.00" "$13,300.00" "$13,300.00" "$13,300.00" "$9,975.00" "$13,300.00" "$13,300.00" "$13,300.00" "$6,650.00" "$6,650.00" "$10,533.60" "$13,300.00" "$10,640.00" "$5,985.00" "$2,639.72" "$13,300.00" "$7,714.00" "$13,300.00" "$13,300.00" "$13,300.00" "$2,771.72" "$13,300.00" N/A N/A 27805380 EAP HCPCS C1781 "MESH SURG CRANIOCURVE .6MM LEFT PRTL LG CRNM ETCH LBL ANTM, 01-9523" BOTH IP/OP "$14,777.00" "$10,935.00" "$2,932.87" "$14,777.00" "$6,649.65" "$6,649.65" "$6,649.65" "$6,649.65" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.90" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.69" "$14,777.00" "$14,777.00" "$7,285.06" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$11,082.75" "$14,777.00" "$14,777.00" "$14,777.00" "$7,388.50" "$7,388.50" "$11,703.38" "$14,777.00" "$11,821.60" "$6,649.65" "$2,932.87" "$14,777.00" "$8,570.66" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.53" "$14,777.00" N/A N/A 27805381 EAP HCPCS C1781 "MESH SURG CRANIOCURVE .6MM RIGHT PRTL LG CRNM ETCH LBL ANTM, 01-9524" BOTH IP/OP "$14,777.00" "$10,935.00" "$2,932.87" "$14,777.00" "$6,649.65" "$6,649.65" "$6,649.65" "$6,649.65" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.90" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.69" "$14,777.00" "$14,777.00" "$7,285.06" "$14,777.00" "$14,777.00" "$14,777.00" "$14,777.00" "$11,082.75" "$14,777.00" "$14,777.00" "$14,777.00" "$7,388.50" "$7,388.50" "$11,703.38" "$14,777.00" "$11,821.60" "$6,649.65" "$2,932.87" "$14,777.00" "$8,570.66" "$14,777.00" "$14,777.00" "$14,777.00" "$3,079.53" "$14,777.00" N/A N/A 27805382 EAP HCPCS C1876 PROTEGE EVERFLEX STENT 6X40X120 BOTH IP/OP "$3,990.00" "$2,953.00" $791.92 "$3,990.00" "$1,795.50" "$1,795.50" "$1,795.50" "$1,795.50" "$3,990.00" "$3,990.00" "$3,990.00" $831.62 "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" $831.56 "$3,990.00" "$3,990.00" "$1,967.07" "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" "$2,992.50" "$3,990.00" "$3,990.00" "$3,990.00" "$1,995.00" "$1,995.00" "$3,160.08" "$3,990.00" "$3,192.00" "$1,795.50" $791.92 "$3,990.00" "$2,314.20" "$3,990.00" "$3,990.00" "$3,990.00" $831.52 "$3,990.00" N/A N/A 27805383 EAP HCPCS C1876 PROTEGE EVERFLEX STENT 6X60X120 BOTH IP/OP "$3,990.00" "$2,953.00" $791.92 "$3,990.00" "$1,795.50" "$1,795.50" "$1,795.50" "$1,795.50" "$3,990.00" "$3,990.00" "$3,990.00" $831.62 "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" $831.56 "$3,990.00" "$3,990.00" "$1,967.07" "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" "$2,992.50" "$3,990.00" "$3,990.00" "$3,990.00" "$1,995.00" "$1,995.00" "$3,160.08" "$3,990.00" "$3,192.00" "$1,795.50" $791.92 "$3,990.00" "$2,314.20" "$3,990.00" "$3,990.00" "$3,990.00" $831.52 "$3,990.00" N/A N/A 27805384 EAP HCPCS C1876 PROTEGE EVERFLEX STENT 6X80X120 BOTH IP/OP "$3,990.00" "$2,953.00" $791.92 "$3,990.00" "$1,795.50" "$1,795.50" "$1,795.50" "$1,795.50" "$3,990.00" "$3,990.00" "$3,990.00" $831.62 "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" $831.56 "$3,990.00" "$3,990.00" "$1,967.07" "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" "$2,992.50" "$3,990.00" "$3,990.00" "$3,990.00" "$1,995.00" "$1,995.00" "$3,160.08" "$3,990.00" "$3,192.00" "$1,795.50" $791.92 "$3,990.00" "$2,314.20" "$3,990.00" "$3,990.00" "$3,990.00" $831.52 "$3,990.00" N/A N/A 27805385 EAP HCPCS C1876 PROTEGE EVERFLEX STENT 8X40X120 BOTH IP/OP "$3,990.00" "$2,953.00" $791.92 "$3,990.00" "$1,795.50" "$1,795.50" "$1,795.50" "$1,795.50" "$3,990.00" "$3,990.00" "$3,990.00" $831.62 "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" $831.56 "$3,990.00" "$3,990.00" "$1,967.07" "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" "$2,992.50" "$3,990.00" "$3,990.00" "$3,990.00" "$1,995.00" "$1,995.00" "$3,160.08" "$3,990.00" "$3,192.00" "$1,795.50" $791.92 "$3,990.00" "$2,314.20" "$3,990.00" "$3,990.00" "$3,990.00" $831.52 "$3,990.00" N/A N/A 27805386 EAP HCPCS C1876 PROTEGE EVERFLEX STENT 8X60X120 BOTH IP/OP "$3,990.00" "$2,953.00" $791.92 "$3,990.00" "$1,795.50" "$1,795.50" "$1,795.50" "$1,795.50" "$3,990.00" "$3,990.00" "$3,990.00" $831.62 "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" $831.56 "$3,990.00" "$3,990.00" "$1,967.07" "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" "$2,992.50" "$3,990.00" "$3,990.00" "$3,990.00" "$1,995.00" "$1,995.00" "$3,160.08" "$3,990.00" "$3,192.00" "$1,795.50" $791.92 "$3,990.00" "$2,314.20" "$3,990.00" "$3,990.00" "$3,990.00" $831.52 "$3,990.00" N/A N/A 27805387 EAP HCPCS C1876 PROTEGE EVERFLEX STENT 8X80X120 BOTH IP/OP "$3,990.00" "$2,953.00" $791.92 "$3,990.00" "$1,795.50" "$1,795.50" "$1,795.50" "$1,795.50" "$3,990.00" "$3,990.00" "$3,990.00" $831.62 "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" $831.56 "$3,990.00" "$3,990.00" "$1,967.07" "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" "$2,992.50" "$3,990.00" "$3,990.00" "$3,990.00" "$1,995.00" "$1,995.00" "$3,160.08" "$3,990.00" "$3,192.00" "$1,795.50" $791.92 "$3,990.00" "$2,314.20" "$3,990.00" "$3,990.00" "$3,990.00" $831.52 "$3,990.00" N/A N/A 27805388 EAP HCPCS C1876 PROTEGE STENT 10X40X120 BOTH IP/OP "$3,990.00" "$2,953.00" $791.92 "$3,990.00" "$1,795.50" "$1,795.50" "$1,795.50" "$1,795.50" "$3,990.00" "$3,990.00" "$3,990.00" $831.62 "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" $831.56 "$3,990.00" "$3,990.00" "$1,967.07" "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" "$2,992.50" "$3,990.00" "$3,990.00" "$3,990.00" "$1,995.00" "$1,995.00" "$3,160.08" "$3,990.00" "$3,192.00" "$1,795.50" $791.92 "$3,990.00" "$2,314.20" "$3,990.00" "$3,990.00" "$3,990.00" $831.52 "$3,990.00" N/A N/A 27805389 EAP HCPCS C1876 PROTEGE STENT 10X60X120 BOTH IP/OP "$3,990.00" "$2,953.00" $791.92 "$3,990.00" "$1,795.50" "$1,795.50" "$1,795.50" "$1,795.50" "$3,990.00" "$3,990.00" "$3,990.00" $831.62 "$3,990.00" "$3,990.00" "$3,990.00" "$3,990.00" 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"$2,427.75" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.45" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.38" "$5,395.00" "$5,395.00" "$2,659.74" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$4,046.25" "$5,395.00" "$5,395.00" "$5,395.00" "$2,697.50" "$2,697.50" "$4,272.84" "$5,395.00" "$4,316.00" "$2,427.75" "$1,070.77" "$5,395.00" "$3,129.10" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.32" "$5,395.00" N/A N/A 27805421 EAP HCPCS C1876 STENT BIL 10MM 80MM UNCVR WALLFLEX BOTH IP/OP "$5,395.00" "$3,992.50" "$1,070.77" "$5,395.00" "$2,427.75" "$2,427.75" "$2,427.75" "$2,427.75" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.45" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.38" "$5,395.00" "$5,395.00" "$2,659.74" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$4,046.25" "$5,395.00" "$5,395.00" "$5,395.00" "$2,697.50" "$2,697.50" "$4,272.84" "$5,395.00" "$4,316.00" "$2,427.75" "$1,070.77" "$5,395.00" "$3,129.10" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.32" "$5,395.00" N/A N/A 27805422 EAP HCPCS C1876 STENT BIL 10MM 10MM UNCVR WALLFLEX BOTH IP/OP "$5,395.00" "$3,992.50" "$1,070.77" "$5,395.00" "$2,427.75" "$2,427.75" "$2,427.75" "$2,427.75" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.45" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.38" "$5,395.00" "$5,395.00" "$2,659.74" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$4,046.25" "$5,395.00" "$5,395.00" "$5,395.00" "$2,697.50" "$2,697.50" "$4,272.84" "$5,395.00" "$4,316.00" "$2,427.75" "$1,070.77" "$5,395.00" "$3,129.10" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.32" "$5,395.00" N/A N/A 27805423 EAP HCPCS C1876 STENT BIL 10MM 40MM UNCVR WALLFLEX BOTH IP/OP "$5,395.00" "$3,992.50" "$1,070.77" "$5,395.00" "$2,427.75" "$2,427.75" "$2,427.75" "$2,427.75" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.45" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.38" "$5,395.00" "$5,395.00" "$2,659.74" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$4,046.25" "$5,395.00" "$5,395.00" "$5,395.00" "$2,697.50" "$2,697.50" "$4,272.84" "$5,395.00" "$4,316.00" "$2,427.75" "$1,070.77" "$5,395.00" "$3,129.10" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.32" "$5,395.00" N/A N/A 27805424 EAP HCPCS C1876 STENT BIL 10MM 60MM UNCVR WALLFLEX BOTH IP/OP "$5,395.00" "$3,992.50" "$1,070.77" "$5,395.00" "$2,427.75" "$2,427.75" "$2,427.75" "$2,427.75" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.45" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.38" "$5,395.00" "$5,395.00" "$2,659.74" "$5,395.00" "$5,395.00" "$5,395.00" "$5,395.00" "$4,046.25" "$5,395.00" "$5,395.00" "$5,395.00" "$2,697.50" "$2,697.50" "$4,272.84" "$5,395.00" "$4,316.00" "$2,427.75" "$1,070.77" "$5,395.00" "$3,129.10" "$5,395.00" "$5,395.00" "$5,395.00" "$1,124.32" "$5,395.00" N/A N/A 27805431 EAP Custom 27805431 PIPELINE EMBOLIZATION DEVICE 3.00MM X 25MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805432 EAP Custom 27805432 BOWTIE SHAPE - 10G MAMMOMARK - BIOPSY SITE IDENTTFIER BOTH IP/OP $689.00 $510.00 $122.64 $689.00 $689.00 $689.00 $689.00 $689.00 $689.00 $689.00 $122.64 $689.00 $689.00 $689.00 $689.00 $689.00 $689.00 $143.60 $689.00 $275.60 $689.00 $689.00 $689.00 $689.00 $689.00 $516.75 $689.00 $689.00 $689.00 $344.50 $344.50 $545.69 $689.00 $551.20 $310.05 $689.00 $689.00 $399.62 $689.00 $413.40 $689.00 $689.00 $689.00 N/A N/A 27805437 EAP C1817 AMPLATZER SEPTAL OCCLUDER 20 MM BOTH IP/OP "$16,714.00" "$12,368.50" "$3,483.38" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$3,483.38" "$16,714.00" "$6,685.60" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$12,535.50" "$16,714.00" "$16,714.00" "$16,714.00" "$8,357.00" "$8,357.00" "$13,237.49" "$16,714.00" "$13,371.20" "$7,521.30" "$16,714.00" "$16,714.00" "$9,694.12" "$16,714.00" "$10,028.40" "$16,714.00" "$16,714.00" "$16,714.00" N/A N/A 27805438 EAP C1817 AMPLATZER SEPTAL OCCLUDER 22 MM BOTH IP/OP "$16,714.00" "$12,368.50" "$3,483.38" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$3,483.38" "$16,714.00" "$6,685.60" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$12,535.50" "$16,714.00" "$16,714.00" "$16,714.00" "$8,357.00" "$8,357.00" "$13,237.49" "$16,714.00" "$13,371.20" "$7,521.30" "$16,714.00" "$16,714.00" "$9,694.12" "$16,714.00" "$10,028.40" "$16,714.00" "$16,714.00" "$16,714.00" N/A N/A 27805439 EAP HCPCS C1817 AMPLATZER SEPTAL OCCLUDER 24 MM BOTH IP/OP "$16,714.00" "$12,368.50" "$3,483.38" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$3,483.38" "$16,714.00" "$6,685.60" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$12,535.50" "$16,714.00" "$16,714.00" "$16,714.00" "$8,357.00" "$8,357.00" "$13,237.49" "$16,714.00" "$13,371.20" "$7,521.30" "$16,714.00" "$16,714.00" "$9,694.12" "$16,714.00" "$10,028.40" "$16,714.00" "$16,714.00" "$16,714.00" N/A N/A 27805440 EAP CPT® C1817 AMPLATZER SEPTAL OCCLUDER 26 MM BOTH IP/OP "$16,714.00" "$12,368.50" "$3,483.38" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$3,483.38" "$16,714.00" "$6,685.60" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$16,714.00" "$12,535.50" "$16,714.00" "$16,714.00" "$16,714.00" "$8,357.00" "$8,357.00" "$13,237.49" "$16,714.00" "$13,371.20" "$7,521.30" "$16,714.00" "$16,714.00" "$9,694.12" "$16,714.00" "$10,028.40" "$16,714.00" "$16,714.00" "$16,714.00" N/A N/A 27805441 EAP CPT® C1896 Q-TRAK ELECTRODE BOTH IP/OP "$13,779.00" "$10,196.50" "$2,734.79" "$13,779.00" "$6,200.55" "$6,200.55" "$6,200.55" "$6,200.55" "$13,779.00" "$13,779.00" "$13,779.00" "$2,871.89" "$13,779.00" "$13,779.00" "$13,779.00" "$13,779.00" "$13,779.00" "$2,871.70" "$13,779.00" "$13,779.00" "$6,793.05" "$13,779.00" "$13,779.00" "$13,779.00" "$13,779.00" "$10,334.25" "$13,779.00" "$13,779.00" "$13,779.00" "$6,889.50" "$6,889.50" "$10,912.97" "$13,779.00" "$11,023.20" "$6,200.55" "$2,734.79" "$13,779.00" "$7,991.82" "$13,779.00" "$13,779.00" "$13,779.00" "$2,871.54" "$13,779.00" N/A N/A 27805442 EAP HCPCS C1781 OCCLUDER SEPTAL 15MM BOTH IP/OP "$18,552.00" "$13,728.50" "$3,682.11" "$18,552.00" "$8,348.40" "$8,348.40" "$8,348.40" "$8,348.40" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.70" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.44" "$18,552.00" "$18,552.00" "$9,146.14" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$13,914.00" "$18,552.00" "$18,552.00" "$18,552.00" "$9,276.00" "$9,276.00" "$14,693.18" "$18,552.00" "$14,841.60" "$8,348.40" "$3,682.11" "$18,552.00" "$10,760.16" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.24" "$18,552.00" N/A N/A 27805443 EAP HCPCS C1781 OCCLUDER SEPTAL 20MM BOTH IP/OP "$18,552.00" "$13,728.50" "$3,682.11" "$18,552.00" "$8,348.40" "$8,348.40" "$8,348.40" "$8,348.40" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.70" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.44" "$18,552.00" "$18,552.00" "$9,146.14" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$13,914.00" "$18,552.00" "$18,552.00" "$18,552.00" "$9,276.00" "$9,276.00" "$14,693.18" "$18,552.00" "$14,841.60" "$8,348.40" "$3,682.11" "$18,552.00" "$10,760.16" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.24" "$18,552.00" N/A N/A 27805444 EAP HCPCS C1781 OCCLUDER SEPTAL 25MM BOTH IP/OP "$18,552.00" "$13,728.50" "$3,682.11" "$18,552.00" "$8,348.40" "$8,348.40" "$8,348.40" "$8,348.40" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.70" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.44" "$18,552.00" "$18,552.00" "$9,146.14" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$13,914.00" "$18,552.00" "$18,552.00" "$18,552.00" "$9,276.00" "$9,276.00" "$14,693.18" "$18,552.00" "$14,841.60" "$8,348.40" "$3,682.11" "$18,552.00" "$10,760.16" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.24" "$18,552.00" N/A N/A 27805445 EAP HCPCS C1781 OCCLUDER SEPTAL 30MM BOTH IP/OP "$18,552.00" "$13,728.50" "$3,682.11" "$18,552.00" "$8,348.40" "$8,348.40" "$8,348.40" "$8,348.40" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.70" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.44" "$18,552.00" "$18,552.00" "$9,146.14" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$13,914.00" "$18,552.00" "$18,552.00" "$18,552.00" "$9,276.00" "$9,276.00" "$14,693.18" "$18,552.00" "$14,841.60" "$8,348.40" "$3,682.11" "$18,552.00" "$10,760.16" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.24" "$18,552.00" N/A N/A 27805446 EAP HCPCS C1781 OCCLUDER SEPTAL 35MM BOTH IP/OP "$18,552.00" "$13,728.50" "$3,682.11" "$18,552.00" "$8,348.40" "$8,348.40" "$8,348.40" "$8,348.40" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.70" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.44" "$18,552.00" "$18,552.00" "$9,146.14" "$18,552.00" "$18,552.00" "$18,552.00" "$18,552.00" "$13,914.00" "$18,552.00" "$18,552.00" "$18,552.00" "$9,276.00" "$9,276.00" "$14,693.18" "$18,552.00" "$14,841.60" "$8,348.40" "$3,682.11" "$18,552.00" "$10,760.16" "$18,552.00" "$18,552.00" "$18,552.00" "$3,866.24" "$18,552.00" N/A N/A 27805447 EAP Custom 27805447 PIPELINE EMBOLIZATION DEVICE 3.00MM X 30MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805448 EAP Custom 27805448 PIPELINE EMBOLIZATION DEVICE 3.00MM X 35MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805449 EAP Custom 27805449 PIPELINE EMBOLIZATION DEVICE 3.25MM X 25MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805450 EAP Custom 27805450 PIPELINE EMBOLIZATION DEVICE 3.25MM X 30MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805451 EAP Custom 27805451 PIPELINE EMBOLIZATION DEVICE 3.25MM X 35MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805452 EAP Custom 27805452 PIPELINE EMBOLIZATION DEVICE 3.50MM X 25MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805453 EAP Custom 27805453 PIPELINE EMBOLIZATION DEVICE 3.50MM X 30MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805454 EAP Custom 27805454 PIPELINE EMBOLIZATION DEVICE 3.50MM X 35MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805455 EAP Custom 27805455 PIPELINE EMBOLIZATION DEVICE 3.75MM X 25MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805456 EAP Custom 27805456 PIPELINE EMBOLIZATION DEVICE 3.75MM X 30MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805457 EAP Custom 27805457 PIPELINE EMBOLIZATION DEVICE 3.75MM X 35MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805458 EAP Custom 27805458 PIPELINE EMBOLIZATION DEVICE 4.00MM X 25MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805459 EAP Custom 27805459 PIPELINE EMBOLIZATION DEVICE 4.00MM X 30MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805460 EAP Custom 27805460 PIPELINE EMBOLIZATION DEVICE 4.00MM X 35MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805461 EAP Custom 27805461 PIPELINE EMBOLIZATION DEVICE 4.25MM X 25MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805462 EAP Custom 27805462 PIPELINE EMBOLIZATION DEVICE 4.25MM X 30MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805463 EAP Custom 27805463 PIPELINE EMBOLIZATION DEVICE 4.25MM X 35MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805464 EAP Custom 27805464 PIPELINE EMBOLIZATION DEVICE 4.50MM X 25MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805465 EAP Custom 27805465 PIPELINE EMBOLIZATION DEVICE 4.50MM X 30MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805466 EAP Custom 27805466 PIPELINE EMBOLIZATION DEVICE 4.50MM X 35MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805467 EAP Custom 27805467 PIPELINE EMBOLIZATION DEVICE 4.75MM X 25MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805468 EAP Custom 27805468 PIPELINE EMBOLIZATION DEVICE 4.75MM X 30MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805469 EAP Custom 27805469 PIPELINE EMBOLIZATION DEVICE 4.75MM X 35MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805470 EAP Custom 27805470 PIPELINE EMBOLIZATION DEVICE 5.00MM X 25MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805471 EAP Custom 27805471 PIPELINE EMBOLIZATION DEVICE 5.00MM X 30MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805472 EAP Custom 27805472 PIPELINE EMBOLIZATION DEVICE 5.00MM X 35MM BOTH IP/OP "$38,029.00" "$28,141.50" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$6,769.16" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$7,925.66" "$38,029.00" "$15,211.60" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$38,029.00" "$28,521.75" "$38,029.00" "$38,029.00" "$38,029.00" "$19,014.50" "$19,014.50" "$30,118.97" "$38,029.00" "$30,423.20" "$17,113.05" "$38,029.00" "$38,029.00" "$22,056.82" "$38,029.00" "$22,817.40" "$38,029.00" "$38,029.00" "$38,029.00" N/A N/A 27805473 EAP Custom 27805473 PIPELINE EMBOLIZATION DEVICE 2.50MM X 10MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805474 EAP Custom 27805474 PIPELINE EMBOLIZATION DEVICE 2.50MM X 12MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805475 EAP Custom 27805475 PIPELINE EMBOLIZATION DEVICE 2.50MM X 14MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805476 EAP Custom 27805476 PIPELINE EMBOLIZATION DEVICE 2.50MM X 16MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805477 EAP Custom 27805477 PIPELINE EMBOLIZATION DEVICE 2.50MM X 18MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805478 EAP Custom 27805478 PIPELINE EMBOLIZATION DEVICE 2.50MM X 20MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805479 EAP Custom 27805479 PIPELINE EMBOLIZATION DEVICE 2.75MM X 14MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805480 EAP Custom 27805480 PIPELINE EMBOLIZATION DEVICE 2.75MM X 18MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805481 EAP Custom 27805481 PIPELINE EMBOLIZATION DEVICE 2.75MM X 20MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805482 EAP Custom 27805482 PIPELINE EMBOLIZATION DEVICE 3.00MM X 14MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805483 EAP Custom 27805483 PIPELINE EMBOLIZATION DEVICE 3.00MM X 18MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805484 EAP Custom 27805484 PIPELINE EMBOLIZATION DEVICE 3.00MM X 20MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805485 EAP Custom 27805485 PIPELINE EMBOLIZATION DEVICE 3.25MM X 10MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805486 EAP Custom 27805486 PIPELINE EMBOLIZATION DEVICE 3.25MM X 12MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805487 EAP Custom 27805487 PIPELINE EMBOLIZATION DEVICE 3.25MM X 14MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805488 EAP Custom 27805488 PIPELINE EMBOLIZATION DEVICE 3.25MM X 16MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805489 EAP Custom 27805489 PIPELINE EMBOLIZATION DEVICE 3.25MM X 18MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805490 EAP Custom 27805490 PIPELINE EMBOLIZATION DEVICE 3.25MM X 20MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805491 EAP Custom 27805491 PIPELINE EMBOLIZATION DEVICE 3.50MM X 14MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805492 EAP Custom 27805492 PIPELINE EMBOLIZATION DEVICE 3.50MM X 18MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805493 EAP Custom 27805493 PIPELINE EMBOLIZATION DEVICE 3.50MM X 20MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805494 EAP Custom 27805494 PIPELINE EMBOLIZATION DEVICE 3.75MM X 10MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805495 EAP Custom 27805495 PIPELINE EMBOLIZATION DEVICE 3.75MM X 12MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805496 EAP Custom 27805496 PIPELINE EMBOLIZATION DEVICE 3.75MM X 14MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805497 EAP Custom 27805497 PIPELINE EMBOLIZATION DEVICE 3.75MM X 16MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805498 EAP Custom 27805498 PIPELINE EMBOLIZATION DEVICE 3.75MM X 18MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805499 EAP Custom 27805499 PIPELINE EMBOLIZATION DEVICE 3.75MM X 20MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805500 EAP Custom 27805500 PIPELINE EMBOLIZATION DEVICE 4.00MM X 10MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805501 EAP Custom 27805501 PIPELINE EMBOLIZATION DEVICE 4.00MM X 12MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805502 EAP Custom 27805502 PIPELINE EMBOLIZATION DEVICE 4.00MM X 14MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805503 EAP Custom 27805503 PIPELINE EMBOLIZATION DEVICE 4.00MM X 16MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805504 EAP Custom 27805504 PIPELINE EMBOLIZATION DEVICE 4.00MM X 18MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805505 EAP Custom 27805505 PIPELINE EMBOLIZATION DEVICE 4.00MM X 20MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805506 EAP Custom 27805506 PIPELINE EMBOLIZATION DEVICE 4.25MM X 10MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805507 EAP Custom 27805507 PIPELINE EMBOLIZATION DEVICE 4.25MM X 12MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805508 EAP Custom 27805508 PIPELINE EMBOLIZATION DEVICE 4.25MM X 14MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805509 EAP Custom 27805509 PIPELINE EMBOLIZATION DEVICE 4.25MM X 16MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805510 EAP Custom 27805510 PIPELINE EMBOLIZATION DEVICE 4.25MM X 18MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805511 EAP Custom 27805511 PIPELINE EMBOLIZATION DEVICE 4.25MM X 20MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805512 EAP Custom 27805512 PIPELINE EMBOLIZATION DEVICE 4.50MM X 10MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805513 EAP Custom 27805513 PIPELINE EMBOLIZATION DEVICE 4.50MM X 12MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805514 EAP Custom 27805514 PIPELINE EMBOLIZATION DEVICE 4.50MM X 14MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805515 EAP Custom 27805515 PIPELINE EMBOLIZATION DEVICE 4.50MM X 16MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805516 EAP Custom 27805516 PIPELINE EMBOLIZATION DEVICE 4.50MM X 18MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805517 EAP Custom 27805517 PIPELINE EMBOLIZATION DEVICE 4.50MM X 20MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805518 EAP Custom 27805518 PIPELINE EMBOLIZATION DEVICE 4.75MM X 10MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805519 EAP Custom 27805519 PIPELINE EMBOLIZATION DEVICE 4.75MM X 12MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805520 EAP Custom 27805520 PIPELINE EMBOLIZATION DEVICE 4.75MM X 14MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805521 EAP Custom 27805521 PIPELINE EMBOLIZATION DEVICE 4.75MM X 16MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805522 EAP Custom 27805522 PIPELINE EMBOLIZATION DEVICE 4.75MM X 18MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805523 EAP Custom 27805523 PIPELINE EMBOLIZATION DEVICE 4.75MM X 20MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805524 EAP Custom 27805524 PIPELINE EMBOLIZATION DEVICE 5.00MM X 10MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805525 EAP Custom 27805525 PIPELINE EMBOLIZATION DEVICE 5.00MM X 12MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805526 EAP Custom 27805526 PIPELINE EMBOLIZATION DEVICE 5.00MM X 14MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805527 EAP Custom 27805527 PIPELINE EMBOLIZATION DEVICE 5.00MM X 16MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805528 EAP Custom 27805528 PIPELINE EMBOLIZATION DEVICE 5.00MM X 18MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805529 EAP Custom 27805529 PIPELINE EMBOLIZATION DEVICE 5.00MM X 20MM BOTH IP/OP "$35,550.00" "$26,307.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$6,327.90" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$7,409.01" "$35,550.00" "$14,220.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$35,550.00" "$26,662.50" "$35,550.00" "$35,550.00" "$35,550.00" "$17,775.00" "$17,775.00" "$28,155.60" "$35,550.00" "$28,440.00" "$15,997.50" "$35,550.00" "$35,550.00" "$20,619.00" "$35,550.00" "$21,330.00" "$35,550.00" "$35,550.00" "$35,550.00" N/A N/A 27805530 EAP HCPCS C1876 STENT CORON 4MM 18MM .014IN RAPEX FLXB LP MTLNK VSN COCR BOTH IP/OP $717.00 $531.00 $142.31 $717.00 $322.65 $322.65 $322.65 $322.65 $717.00 $717.00 $717.00 $149.44 $717.00 $717.00 $717.00 $717.00 $717.00 $149.43 $717.00 $717.00 $424.11 $717.00 $717.00 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $358.50 $358.50 $567.86 $717.00 $573.60 $322.65 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 27805531 EAP HCPCS C1876 STENT CORON 4MM 28MM .014IN RAPEX FLXB LP MTLNK VSN COCR BOTH IP/OP $717.00 $531.00 $142.31 $717.00 $322.65 $322.65 $322.65 $322.65 $717.00 $717.00 $717.00 $149.44 $717.00 $717.00 $717.00 $717.00 $717.00 $149.43 $717.00 $717.00 $424.11 $717.00 $717.00 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $358.50 $358.50 $567.86 $717.00 $573.60 $322.65 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 27805532 EAP HCPCS C1874 STENT CORON 3.5MM 24MM DRG ELUDING ENDVR SPRNT ZOTAROLIMUS BOTH IP/OP "$1,847.00" "$1,367.00" $366.58 "$1,847.00" $831.15 $831.15 $831.15 $831.15 "$1,847.00" "$1,847.00" "$1,847.00" $384.96 "$1,847.00" "$1,847.00" "$1,847.00" "$1,847.00" "$1,847.00" $384.94 "$1,847.00" "$1,847.00" "$1,092.50" "$1,847.00" "$1,847.00" "$1,847.00" "$1,847.00" "$1,385.25" "$1,847.00" "$1,847.00" "$1,847.00" $923.50 $923.50 "$1,462.82" "$1,847.00" "$1,477.60" $831.15 $366.58 "$1,847.00" "$1,071.26" "$1,847.00" "$1,847.00" "$1,847.00" $384.91 "$1,847.00" N/A N/A 27805533 EAP HCPCS C1874 STENT CORON 3.5MM 12MM DRG ELUDING ENDVR SPRNT ZOTAROLIMUS BOTH IP/OP "$1,847.00" "$1,367.00" $366.58 "$1,847.00" $831.15 $831.15 $831.15 $831.15 "$1,847.00" "$1,847.00" "$1,847.00" $384.96 "$1,847.00" "$1,847.00" "$1,847.00" "$1,847.00" "$1,847.00" $384.94 "$1,847.00" "$1,847.00" "$1,092.50" "$1,847.00" "$1,847.00" "$1,847.00" "$1,847.00" "$1,385.25" "$1,847.00" "$1,847.00" "$1,847.00" $923.50 $923.50 "$1,462.82" "$1,847.00" "$1,477.60" $831.15 $366.58 "$1,847.00" "$1,071.26" "$1,847.00" "$1,847.00" "$1,847.00" $384.91 "$1,847.00" N/A N/A 27805534 EAP HCPCS C1874 STENT CORON 3.5MM 18MM DRG ELUDING ENDVR SPRNT ZOTAROLIMUS BOTH IP/OP "$1,847.00" "$1,367.00" $366.58 "$1,847.00" $831.15 $831.15 $831.15 $831.15 "$1,847.00" "$1,847.00" "$1,847.00" $384.96 "$1,847.00" "$1,847.00" "$1,847.00" "$1,847.00" "$1,847.00" $384.94 "$1,847.00" "$1,847.00" "$1,092.50" "$1,847.00" "$1,847.00" "$1,847.00" "$1,847.00" "$1,385.25" "$1,847.00" "$1,847.00" "$1,847.00" $923.50 $923.50 "$1,462.82" "$1,847.00" "$1,477.60" $831.15 $366.58 "$1,847.00" "$1,071.26" "$1,847.00" "$1,847.00" "$1,847.00" $384.91 "$1,847.00" N/A N/A 27805535 EAP HCPCS C1874 STENT CORON 2.5MM 12MM DRG ELUDING ENDVR SPRNT ZOTAROLIMUS BOTH IP/OP "$1,847.00" "$1,367.00" $366.58 "$1,847.00" $831.15 $831.15 $831.15 $831.15 "$1,847.00" "$1,847.00" "$1,847.00" $384.96 "$1,847.00" "$1,847.00" "$1,847.00" "$1,847.00" "$1,847.00" $384.94 "$1,847.00" "$1,847.00" "$1,092.50" "$1,847.00" "$1,847.00" "$1,847.00" "$1,847.00" "$1,385.25" "$1,847.00" "$1,847.00" "$1,847.00" $923.50 $923.50 "$1,462.82" "$1,847.00" "$1,477.60" $831.15 $366.58 "$1,847.00" "$1,071.26" "$1,847.00" "$1,847.00" "$1,847.00" $384.91 "$1,847.00" N/A N/A 27805536 EAP Custom 27805536 COIL TARGET 3D 3MM X 6CM BOTH IP/OP "$4,502.00" "$3,331.50" $801.36 "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" $801.36 "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" $938.27 "$4,502.00" "$1,800.80" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$3,376.50" "$4,502.00" "$4,502.00" "$4,502.00" "$2,251.00" "$2,251.00" "$3,565.58" "$4,502.00" "$3,601.60" "$2,025.90" "$4,502.00" "$4,502.00" "$2,611.16" "$4,502.00" "$2,701.20" "$4,502.00" "$4,502.00" "$4,502.00" N/A N/A 27805537 EAP Custom 27805537 COIL TARGET 3D 4MM X 8CM BOTH IP/OP "$4,502.00" "$3,331.50" $801.36 "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" $801.36 "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" $938.27 "$4,502.00" "$1,800.80" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$3,376.50" "$4,502.00" "$4,502.00" "$4,502.00" "$2,251.00" "$2,251.00" "$3,565.58" "$4,502.00" "$3,601.60" "$2,025.90" "$4,502.00" "$4,502.00" "$2,611.16" "$4,502.00" "$2,701.20" "$4,502.00" "$4,502.00" "$4,502.00" N/A N/A 27805538 EAP Custom 27805538 COIL TARGET 3D 5MM X 10CM BOTH IP/OP "$4,502.00" "$3,331.50" $801.36 "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" $801.36 "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" $938.27 "$4,502.00" "$1,800.80" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$3,376.50" "$4,502.00" "$4,502.00" "$4,502.00" "$2,251.00" "$2,251.00" "$3,565.58" "$4,502.00" "$3,601.60" "$2,025.90" "$4,502.00" "$4,502.00" "$2,611.16" "$4,502.00" "$2,701.20" "$4,502.00" "$4,502.00" "$4,502.00" N/A N/A 27805539 EAP Custom 27805539 COIL TARGET 3D 6MM X 15CM BOTH IP/OP "$4,502.00" "$3,331.50" $801.36 "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" $801.36 "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" $938.27 "$4,502.00" "$1,800.80" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$3,376.50" "$4,502.00" "$4,502.00" "$4,502.00" "$2,251.00" "$2,251.00" "$3,565.58" "$4,502.00" "$3,601.60" "$2,025.90" "$4,502.00" "$4,502.00" "$2,611.16" "$4,502.00" "$2,701.20" "$4,502.00" "$4,502.00" "$4,502.00" N/A N/A 27805540 EAP Custom 27805540 COIL TARGET 3D 7MM X 15CM BOTH IP/OP "$4,502.00" "$3,331.50" $801.36 "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" $801.36 "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" $938.27 "$4,502.00" "$1,800.80" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$3,376.50" "$4,502.00" "$4,502.00" "$4,502.00" "$2,251.00" "$2,251.00" "$3,565.58" "$4,502.00" "$3,601.60" "$2,025.90" "$4,502.00" "$4,502.00" "$2,611.16" "$4,502.00" "$2,701.20" "$4,502.00" "$4,502.00" "$4,502.00" N/A N/A 27805541 EAP Custom 27805541 COIL TARGET 3D 8MM X 25CM BOTH IP/OP "$4,502.00" "$3,331.50" $801.36 "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" $801.36 "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" $938.27 "$4,502.00" "$1,800.80" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$3,376.50" "$4,502.00" "$4,502.00" "$4,502.00" "$2,251.00" "$2,251.00" "$3,565.58" "$4,502.00" "$3,601.60" "$2,025.90" "$4,502.00" "$4,502.00" "$2,611.16" "$4,502.00" "$2,701.20" "$4,502.00" "$4,502.00" "$4,502.00" N/A N/A 27805542 EAP Custom 27805542 COIL TARGET 3D 10MM X 30CM BOTH IP/OP "$4,502.00" "$3,331.50" $801.36 "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" $801.36 "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" $938.27 "$4,502.00" "$1,800.80" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$4,502.00" "$3,376.50" "$4,502.00" "$4,502.00" "$4,502.00" "$2,251.00" "$2,251.00" "$3,565.58" "$4,502.00" "$3,601.60" "$2,025.90" "$4,502.00" "$4,502.00" "$2,611.16" "$4,502.00" "$2,701.20" "$4,502.00" "$4,502.00" "$4,502.00" N/A N/A 27805543 EAP Custom 27805543 COIL EMBL 10CM 4MM TRGT DTCH ULT 360D BOTH IP/OP "$4,752.00" "$3,516.50" $845.86 "$4,752.00" "$4,752.00" "$4,752.00" "$4,752.00" "$4,752.00" "$4,752.00" "$4,752.00" $845.86 "$4,752.00" "$4,752.00" "$4,752.00" "$4,752.00" "$4,752.00" "$4,752.00" $990.37 "$4,752.00" "$1,900.80" "$4,752.00" "$4,752.00" "$4,752.00" "$4,752.00" "$4,752.00" "$3,564.00" "$4,752.00" "$4,752.00" "$4,752.00" "$2,376.00" "$2,376.00" "$3,763.58" "$4,752.00" "$3,801.60" "$2,138.40" "$4,752.00" "$4,752.00" "$2,756.16" "$4,752.00" "$2,851.20" "$4,752.00" "$4,752.00" "$4,752.00" N/A N/A 27805544 EAP Custom 27805544 COIL TARGET 360 ULTRA 3.5MM X 8CM BOTH IP/OP "$5,401.00" "$3,997.00" $961.38 "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" $961.38 "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$1,125.63" "$5,401.00" "$2,160.40" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$4,050.75" "$5,401.00" "$5,401.00" "$5,401.00" "$2,700.50" "$2,700.50" "$4,277.59" "$5,401.00" "$4,320.80" "$2,430.45" "$5,401.00" "$5,401.00" "$3,132.58" "$5,401.00" "$3,240.60" "$5,401.00" "$5,401.00" "$5,401.00" N/A N/A 27805545 EAP Custom 27805545 COIL TARGET 360 ULTRA 4.5MM X 10CM BOTH IP/OP "$5,671.00" "$4,197.00" "$1,009.44" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$1,009.44" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$1,181.90" "$5,671.00" "$2,268.40" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$4,253.25" "$5,671.00" "$5,671.00" "$5,671.00" "$2,835.50" "$2,835.50" "$4,491.43" "$5,671.00" "$4,536.80" "$2,551.95" "$5,671.00" "$5,671.00" "$3,289.18" "$5,671.00" "$3,402.60" "$5,671.00" "$5,671.00" "$5,671.00" N/A N/A 27805546 EAP Custom 27805546 COIL TARGET 360 NANO 2MM X 3CM BOTH IP/OP "$5,671.00" "$4,197.00" "$1,009.44" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$1,009.44" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$1,181.90" "$5,671.00" "$2,268.40" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$4,253.25" "$5,671.00" "$5,671.00" "$5,671.00" "$2,835.50" "$2,835.50" "$4,491.43" "$5,671.00" "$4,536.80" "$2,551.95" "$5,671.00" "$5,671.00" "$3,289.18" "$5,671.00" "$3,402.60" "$5,671.00" "$5,671.00" "$5,671.00" N/A N/A 27805547 EAP Custom 27805547 COIL TARGET 360 NANO 2MM X 4CM BOTH IP/OP "$5,671.00" "$4,197.00" "$1,009.44" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$1,009.44" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$1,181.90" "$5,671.00" "$2,268.40" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$4,253.25" "$5,671.00" "$5,671.00" "$5,671.00" "$2,835.50" "$2,835.50" "$4,491.43" "$5,671.00" "$4,536.80" "$2,551.95" "$5,671.00" "$5,671.00" "$3,289.18" "$5,671.00" "$3,402.60" "$5,671.00" "$5,671.00" "$5,671.00" N/A N/A 27805548 EAP Custom 27805548 COIL TARGET 360 NANO 2.5MM X 4CM BOTH IP/OP "$5,401.00" "$3,997.00" $961.38 "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" $961.38 "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$1,125.63" "$5,401.00" "$2,160.40" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$4,050.75" "$5,401.00" "$5,401.00" "$5,401.00" "$2,700.50" "$2,700.50" "$4,277.59" "$5,401.00" "$4,320.80" "$2,430.45" "$5,401.00" "$5,401.00" "$3,132.58" "$5,401.00" "$3,240.60" "$5,401.00" "$5,401.00" "$5,401.00" N/A N/A 27805549 EAP Custom 27805549 COIL TARGET 360 NANO 3MM X 4CM BOTH IP/OP "$5,671.00" "$4,197.00" "$1,009.44" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$1,009.44" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$1,181.90" "$5,671.00" "$2,268.40" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$4,253.25" "$5,671.00" "$5,671.00" "$5,671.00" "$2,835.50" "$2,835.50" "$4,491.43" "$5,671.00" "$4,536.80" "$2,551.95" "$5,671.00" "$5,671.00" "$3,289.18" "$5,671.00" "$3,402.60" "$5,671.00" "$5,671.00" "$5,671.00" N/A N/A 27805550 EAP Custom 27805550 COIL TARGET 360 NANO 3MM X 6CM BOTH IP/OP "$5,401.00" "$3,997.00" $961.38 "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" $961.38 "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$1,125.63" "$5,401.00" "$2,160.40" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$4,050.75" "$5,401.00" "$5,401.00" "$5,401.00" "$2,700.50" "$2,700.50" "$4,277.59" "$5,401.00" "$4,320.80" "$2,430.45" "$5,401.00" "$5,401.00" "$3,132.58" "$5,401.00" "$3,240.60" "$5,401.00" "$5,401.00" "$5,401.00" N/A N/A 27805551 EAP Custom 27805551 COIL TARGET 360 NANO 3.5MM X 6CM BOTH IP/OP "$5,671.00" "$4,197.00" "$1,009.44" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$1,009.44" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$1,181.90" "$5,671.00" "$2,268.40" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$5,671.00" "$4,253.25" "$5,671.00" "$5,671.00" "$5,671.00" "$2,835.50" "$2,835.50" "$4,491.43" "$5,671.00" "$4,536.80" "$2,551.95" "$5,671.00" "$5,671.00" "$3,289.18" "$5,671.00" "$3,402.60" "$5,671.00" "$5,671.00" "$5,671.00" N/A N/A 27805552 EAP Custom 27805552 SENSATION PLUS 40CC IAB 7.5 BOTH IP/OP "$3,004.00" "$2,223.00" $534.71 "$3,004.00" "$3,004.00" "$3,004.00" "$3,004.00" "$3,004.00" "$3,004.00" "$3,004.00" $534.71 "$3,004.00" "$3,004.00" "$3,004.00" "$3,004.00" "$3,004.00" "$3,004.00" $626.07 "$3,004.00" "$1,201.60" "$3,004.00" "$3,004.00" "$3,004.00" "$3,004.00" "$3,004.00" "$2,253.00" "$3,004.00" "$3,004.00" "$3,004.00" "$1,502.00" "$1,502.00" "$2,379.17" "$3,004.00" "$2,403.20" "$1,351.80" "$3,004.00" "$3,004.00" "$1,742.32" "$3,004.00" "$1,802.40" "$3,004.00" "$3,004.00" "$3,004.00" N/A N/A 27805553 EAP Custom 27805553 SENSATION PLUS 50CC IAB 8.0 BOTH IP/OP "$3,154.00" "$2,334.00" $561.41 "$3,154.00" "$3,154.00" "$3,154.00" "$3,154.00" "$3,154.00" "$3,154.00" "$3,154.00" $561.41 "$3,154.00" "$3,154.00" "$3,154.00" "$3,154.00" "$3,154.00" "$3,154.00" $657.33 "$3,154.00" "$1,261.60" "$3,154.00" "$3,154.00" "$3,154.00" "$3,154.00" "$3,154.00" "$2,365.50" "$3,154.00" "$3,154.00" "$3,154.00" "$1,577.00" "$1,577.00" "$2,497.97" "$3,154.00" "$2,523.20" "$1,419.30" "$3,154.00" "$3,154.00" "$1,829.32" "$3,154.00" "$1,892.40" "$3,154.00" "$3,154.00" "$3,154.00" N/A N/A 27805554 EAP HCPCS C1760 VASCADE VASCULAR CLOSURE DEVICE 5FR BOTH IP/OP $550.00 $407.00 $109.16 $550.00 $247.50 $247.50 $247.50 $247.50 $550.00 $550.00 $550.00 $114.63 $550.00 $550.00 $550.00 $550.00 $550.00 $114.63 $550.00 $550.00 $325.33 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $247.50 $109.16 $550.00 $319.00 $550.00 $550.00 $550.00 $114.62 $550.00 N/A N/A 27805555 EAP HCPCS C1760 VASCADE VASCULAR CLOSURE DEVICE 6/7FR BOTH IP/OP $550.00 $407.00 $109.16 $550.00 $247.50 $247.50 $247.50 $247.50 $550.00 $550.00 $550.00 $114.63 $550.00 $550.00 $550.00 $550.00 $550.00 $114.63 $550.00 $550.00 $325.33 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $247.50 $109.16 $550.00 $319.00 $550.00 $550.00 $550.00 $114.62 $550.00 N/A N/A 27805556 EAP HCPCS C1876 STENT BIL 9MM 6FR 20MM 80CM .035IN 7.5-8.5MM GWIRE LUM SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805557 EAP HCPCS C1876 STENT BIL 9MM 6FR 30MM 80CM .035IN 7.5-8.5MM GWIRE LUM SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805558 EAP HCPCS C1876 STENT BIL 9MM 6FR 40MM 80CM .035IN SLF XPD FLXB LP TNTLM BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805559 EAP HCPCS C1876 STENT BIL 9MM 6FR 60MM 80CM .35IN 7.5-8.5MM SLF EXPANDABLE BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805560 EAP HCPCS C1876 STENT BIL 9MM 6FR 80MM 80CM .035IN 7.5-8.5MM GWIRE LUM SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805561 EAP HCPCS C1876 STENT BIL 10MM 6FR 20MM 80CM .035IN 8.5-9.5MM SLF XPD LP BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805562 EAP HCPCS C1876 STENT BIL 10MM 6FR 30MM 80CM .035IN 8.5-9.5MM SLF XPD LP BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805563 EAP HCPCS C1876 STENT BIL 10MM 6FR 40MM 80CM 8.5-9.5MM .035IN SLF XPD FLXB BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805564 EAP HCPCS C1876 STENT BIL 10MM 6FR 60MM 80CM .035IN 8.5-9.5MM SLF XPD DLV BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805565 EAP HCPCS C1876 STENT BIL 10MM 6FR 80MM 80CM .035IN 8.5-9.5MM SLF XPD LP BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805566 EAP HCPCS C1876 STENT BIL 12MM 6FR 20MM 80CM .35IN 9.5-11MM SLF XPD LP PRCS BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805567 EAP HCPCS C1876 STENT BIL 12MM 6FR 30MM 80CM .035IN 9.5-11MM SLF XPD LP PRCS BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805568 EAP HCPCS C1876 STENT BIL 12MM 6FR 80MM 80CM .035IN OTW SLF XPD LP TNTLM BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805569 EAP HCPCS C1876 STENT BIL 14MM 6FR 20MM 80CM .035IN 11.5-13MM SLF XPD LP BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805570 EAP HCPCS C1876 STENT BIL 14MM 6FR 30MM 80CM .035IN 11.5-13MM SLF XPD LP BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805571 EAP HCPCS C1876 STENT BIL 14MM 6FR 60MM 80CM .035IN SLF XPD CMPT FLXB LP BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805572 EAP HCPCS C1876 STENT BIL 9MM 6FR 20MM 120CM .035IN SLF XPD FLXB LP TNTLM BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805573 EAP HCPCS C1876 STENT BIL 9MM 6FR 30MM 120CM LG DIA LP SLF XPD OPN LTC DSGN BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805574 EAP HCPCS C1876 STENT BIL 9MM 6FR 40MM 120CM .035IN 7.5-8.5MM GWIRE LUM SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805575 EAP HCPCS C1876 STENT BIL 9MM 6FR 60MM 120CM .035IN 7.5-8.5MM GWIRE LUM SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805576 EAP HCPCS C1876 STENT BIL 9MM 6FR 80MM 120CM .035IN 7.5-8.5MM GWIRE LUM SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805577 EAP HCPCS C1876 STENT BIL 10MM 6FR 20MM 120CM .035IN 8.5-9.5MM GWIRE LUM SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805578 EAP HCPCS C1876 STENT BIL 10MM 6FR 30MM 120CM .018IN 8.5-9.5MM GWIRE LUM SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805579 EAP HCPCS C1876 STENT BIL 10MM 6FR 80MM 120CM .035IN 8.5-9.5MM GWIRE LUM SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805580 EAP HCPCS C1876 STENT BIL 12MM 6FR 20MM 120CM LG DIA LP SLF XPD OPN LTC DSGN BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805581 EAP HCPCS C1876 STENT BIL 12MM 6FR 30MM 120CM .035IN 9.5-11MM GWIRE LUM SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805582 EAP HCPCS C1876 STENT BIL 12MM 6FR 40MM 120CM .035IN 9.5-11MM GWIRE LUM SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805583 EAP HCPCS C1876 STENT BIL 12MM 6FR 60MM 120CM LP SLF XPD FLXB RADL STRTH GPS BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805584 EAP HCPCS C1876 STENT BIL 12MM 9.5-11FR 80MM 120CM .035IN SLF XPD FLXB LP BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805585 EAP HCPCS C1876 STENT BIL 14MM 6FR 20MM 120CM .035IN SLF XPD CMPT FLXB LP BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805586 EAP HCPCS C1876 STENT BIL 14MM 6FR 30MM 120CM .035IN 11.5-13MM GWIRE LUM SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805587 EAP HCPCS C1876 STENT BIL 14MM 6FR 40MM 120CM .035IN 11.5-13MM GWIRE LUM SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805588 EAP HCPCS C1876 STENT BIL 14MM 6FR 60MM 120CM .035IN SLF XPD FLXB LP TNTLM BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805589 EAP HCPCS C1876 STENT BIL 14MM 6FR 80MM 120CM .035IN SLF XPD FLXB LP TNTLM BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805590 EAP CPT® C1876 INTEGRITY RX CORONARY STENT SYSTEM MM BOTH IP/OP "$1,930.00" "$1,428.50" $383.06 "$1,930.00" $868.50 $868.50 $868.50 $868.50 "$1,930.00" "$1,930.00" "$1,930.00" $402.26 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" "$1,930.00" "$1,141.60" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 $383.06 "$1,930.00" "$1,119.40" "$1,930.00" "$1,930.00" "$1,930.00" $402.21 "$1,930.00" N/A N/A 27805591 EAP HCPCS C1876 STENT PRTG EVERFLEX 6MM 6FR 80CM 20MM .035IN PERI OTW SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805592 EAP HCPCS C1876 STENT EVERFLEX 6MM 6FR 80CM 30MM .035IN PERI OTW SLF XPD BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805593 EAP HCPCS C1876 STENT EVERFLEX 6MM 6FR 80CM 40MM .035IN PERI SLF XPD FLXB BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805594 EAP HCPCS C1876 STENT BIL 6MM 6FR 60MM 80CM .035IN SLF XPD FLXB DRBLTY SPRL BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805595 EAP HCPCS C1876 STENT BIL 6MM 6FR 80MM 80CM .035IN 3 WV PEAK DSGN SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805596 EAP HCPCS C1876 STENT BIL 6MM 6FR 100MM 80CM .035IN OTW SLF XPD FLXB DRBLE BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805597 EAP HCPCS C1876 STENT BIL 6MM 6FR 120MM 80CM .035IN 3 WV PEAK DSGN SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805598 EAP HCPCS C1876 STENT BIL 6MM 6FR 150MM 80CM .035IN OTW SLF XPD FLXB DRBLE BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805599 EAP HCPCS C1876 STENT BIL 7MM 6FR 20MM 80CM .035IN SPRL 3 WV PEAK DSGN GWIRE BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805600 EAP HCPCS C1876 STENT EVERFLEX PRTG 7MM 6FR 80CM 30MM .035IN PERI 3 WV PEAK BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805601 EAP HCPCS C1876 STENT EVERFLEX 7MM 6FR 80CM 40MM .035IN PERI 3 WV PEAK BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805602 EAP HCPCS C1876 STENT PRTG EVERFLEX 7MM 6FR 80CM 60MM .035IN PERI 3 WV PEAK BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805603 EAP HCPCS C1876 STENT BIL 7MM 6FR 80MM 80CM .035IN 3 WV PEAK INTROD SHTH SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805604 EAP HCPCS C1876 STENT BIL 7MM 6FR 100MM 80CM .035IN 3 WV PEAK DSGN SLF XPD BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805605 EAP HCPCS C1876 STENT BIL 7MM 6FR 120MM 80CM .035IN 3 WV PEAK DSGN SLF XPD BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805606 EAP HCPCS C1876 STENT BIL 7MM 6FR 150MM 80CM .035IN 3 WV PEAK DSGN SLF XPD BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805607 EAP HCPCS C1876 STENT BIL 8MM 6FR 20MM 80CM .035IN 3 WV PEAK DSGN OTW SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805608 EAP HCPCS C1876 STENT PRTG EVERFLEX 8MM 6FR 80MM 30CM .035IN PERI 3 WV PEAK BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805609 EAP HCPCS C1876 STENT EVERFLEX 8MM 6FR 80CM 40MM .035IN PERI SLF XPD FLXB BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805610 EAP HCPCS C1876 STENT VASC 8MM 6FR 60MM 80CM .035IN SLF XPD GWIRE DRBLTY BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805611 EAP HCPCS C1876 STENT PRTG EVERFLEX 8MM 6FR 80MM 80CM .035IN PERI 3 WV PEAK BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805612 EAP HCPCS C1876 STENT BIL 8MM 6FR 100MM 80CM .035IN 3 WV PEAK DSGN SLF XPD BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805613 EAP HCPCS C1876 STENT BIL 8MM 6FR 120MM 80CM .035IN 3 WV PEAK DSGN SLF XPD BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805614 EAP HCPCS C1876 STENT BIL 8MM 6FR 150MM 80CM .035IN 3 WV PEAK DSGN SLF XPD BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805615 EAP HCPCS C1876 STENT EVERFLEX 6MM 6FR 120CM 20MM .035IN PERI SLF XPD FLXB BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805616 EAP HCPCS C1876 STENT BIL 6MM 6FR 30MM 120CM .035IN SLF XPD FLXB DRBLTY SPRL BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805617 EAP HCPCS C1876 STENT EVERFLEX 6MM 6FR 120CM 100MM .035IN PERI 3 WV PEAK BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805618 EAP HCPCS C1876 STENT EVERFLEX 6MM 6FR 120CM 120MM .035IN PERI 3 WV PEAK BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805619 EAP HCPCS C1876 STENT VASC 6MM 6FR 200MM 120CM .035IN SLF EXPANDABLE FLXB BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805620 EAP HCPCS C1876 STENT VASC 7MM 6FR 20MM 120CM .035IN 3 WV PEAK SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805621 EAP HCPCS C1876 STENT EVERFLEX 7MM 6FR 120CM 30MM .035IN PERI 3 WV PEAK SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805622 EAP HCPCS C1876 STENT VASC 7MM 6FR 40MM 120CM .035IN SLF EXPANDABLE FLXB BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805623 EAP HCPCS C1876 STENT BIL 7MM 6FR 60MM 120CM 3 WV PEAK DSGN SLF XPD FLXB BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805624 EAP HCPCS C1876 STENT VASC 7MM 6FR 80MM 120CM .035IN 3 WV PEAK INTROD SHTH BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805625 EAP HCPCS C1876 STENT VASC 7MM 6FR 100MM 120CM .035IN 3 WV PEAK INTROD SHTH BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805626 EAP HCPCS C1876 STENT VASC 7MM 6FR 120MM 120CM .035IN 3 WV PEAK INTROD SHTH BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805627 EAP HCPCS C1876 STENT BIL 7MM 6FR 150MM 120CM .035IN 3 WV PEAK DSGN SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805628 EAP HCPCS C1876 STENT VASC 7MM 6FR 200MM 120CM .035IN 5.5-6.5MM SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805629 EAP HCPCS C1876 STENT PRTG EVERFLEX 8MM 6FR 120MM 20CM .035IN PERI 3 WV PEAK BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805630 EAP HCPCS C1876 STENT BIL 8MM 6FR 30MM 120CM .035IN SLF XPD FLXB DRBLE SPRL BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805631 EAP HCPCS C1876 STENT EVERFLEX PRTG 8MM 6FR 120CM 100MM .035IN PERI 3 WV BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805632 EAP HCPCS C1876 STENT PRTG EVERFLEX 8MM 6FR 120CM 120MM .035IN PERI OTW SLF BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$2,232.60" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805633 EAP HCPCS C1876 STENT PRTG EVERFLEX 8MM 6FR 120CM 150MM .035IN PERI 3 WV BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$2,232.60" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805634 EAP HCPCS C1876 STENT VASC 8MM 6FR 200MM 120CM .035IN 6.5-7.5MM SLF XPD SHTH BOTH IP/OP "$3,721.00" "$2,754.00" $738.53 "$3,721.00" "$1,674.45" "$1,674.45" "$1,674.45" "$1,674.45" "$3,721.00" "$3,721.00" "$3,721.00" $775.55 "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" $775.50 "$3,721.00" "$3,721.00" "$1,834.45" "$3,721.00" "$3,721.00" "$3,721.00" "$3,721.00" "$2,790.75" "$3,721.00" "$3,721.00" "$3,721.00" "$1,860.50" "$1,860.50" "$2,947.03" "$3,721.00" "$2,976.80" "$1,674.45" $738.53 "$3,721.00" "$2,158.18" "$3,721.00" "$3,721.00" "$3,721.00" $775.46 "$3,721.00" N/A N/A 27805635 EAP HCPCS C1876 STENT VASC 10-8MM 40MM TPR SLF EXPANDABLE ERG HNDL FLXB CRTD BOTH IP/OP "$6,739.00" "$4,987.00" "$1,337.52" "$6,739.00" "$3,032.55" "$3,032.55" "$3,032.55" "$3,032.55" "$6,739.00" "$6,739.00" "$6,739.00" "$1,404.58" "$6,739.00" "$6,739.00" "$6,739.00" "$6,739.00" "$6,739.00" "$1,404.48" "$6,739.00" "$6,739.00" "$3,322.33" "$6,739.00" "$6,739.00" "$6,739.00" "$6,739.00" "$5,054.25" "$6,739.00" "$6,739.00" "$6,739.00" "$3,369.50" "$3,369.50" "$5,337.29" "$6,739.00" "$5,391.20" "$3,032.55" "$1,337.52" "$6,739.00" "$3,908.62" "$6,739.00" "$6,739.00" "$6,739.00" "$1,404.41" "$6,739.00" N/A N/A 27805636 EAP HCPCS C1876 STENT VASC 9-7MM 40MM TPR SLF EXPANDABLE ERG HNDL FLXB CRTD BOTH IP/OP "$6,739.00" "$4,987.00" "$1,337.52" "$6,739.00" "$3,032.55" "$3,032.55" "$3,032.55" "$3,032.55" "$6,739.00" "$6,739.00" "$6,739.00" "$1,404.58" "$6,739.00" "$6,739.00" "$6,739.00" "$6,739.00" "$6,739.00" "$1,404.48" "$6,739.00" "$6,739.00" "$3,322.33" "$6,739.00" "$6,739.00" "$6,739.00" "$6,739.00" "$5,054.25" "$6,739.00" "$6,739.00" "$6,739.00" "$3,369.50" "$3,369.50" "$5,337.29" "$6,739.00" "$5,391.20" "$3,032.55" "$1,337.52" "$6,739.00" "$3,908.62" "$6,739.00" "$6,739.00" "$6,739.00" "$1,404.41" "$6,739.00" N/A N/A 27805637 EAP HCPCS C1876 STENT VASC 8-6MM 40MM TPR SLF EXPANDABLE ERG HNDL FLXB CRTD BOTH IP/OP "$6,739.00" "$4,987.00" "$1,337.52" "$6,739.00" "$3,032.55" "$3,032.55" "$3,032.55" "$3,032.55" "$6,739.00" "$6,739.00" "$6,739.00" "$1,404.58" "$6,739.00" "$6,739.00" "$6,739.00" "$6,739.00" "$6,739.00" "$1,404.48" "$6,739.00" "$6,739.00" "$3,322.33" "$6,739.00" "$6,739.00" "$6,739.00" "$6,739.00" "$5,054.25" "$6,739.00" "$6,739.00" "$6,739.00" "$3,369.50" "$3,369.50" "$5,337.29" "$6,739.00" "$5,391.20" "$3,032.55" "$1,337.52" "$6,739.00" "$3,908.62" "$6,739.00" "$6,739.00" "$6,739.00" "$1,404.41" "$6,739.00" N/A N/A 27805638 EAP Custom 27805638 OG CMPLX FILL COIL 2X1.5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805639 EAP Custom 27805639 OG CMPLX FILL COIL 2X2 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805640 EAP Custom 27805640 OG CMPLX FILL COIL 3X4 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805641 EAP Custom 27805641 OG CMPLX FILL COIL 3X6 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805642 EAP Custom 27805642 OG CMPLX FILL COIL 3X8 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805643 EAP Custom 27805643 OG TDL CMPLX FILL COIL 4X4 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805644 EAP Custom 27805644 OG TDL CMPLX FILL COIL 4X7 BOTH IP/OP "$4,327.00" "$3,202.00" $770.21 "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" $770.21 "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" $901.79 "$4,327.00" "$1,730.80" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$3,245.25" "$4,327.00" "$4,327.00" "$4,327.00" "$2,163.50" "$2,163.50" "$3,426.98" "$4,327.00" "$3,461.60" "$1,947.15" "$4,327.00" "$4,327.00" "$2,509.66" "$4,327.00" "$2,596.20" "$4,327.00" "$4,327.00" "$4,327.00" N/A N/A 27805645 EAP Custom 27805645 OG TDL CMPLX FILL COIL 4X10 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805646 EAP Custom 27805646 OG TDL CMPLX FILL COIL 4X12 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805647 EAP Custom 27805647 OG TDL CMPLX FILL COIL 5X5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805648 EAP Custom 27805648 OG TDL CMPLX FILL COIL 5X10 BOTH IP/OP "$4,327.00" "$3,202.00" $770.21 "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" $770.21 "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" $901.79 "$4,327.00" "$1,730.80" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$3,245.25" "$4,327.00" "$4,327.00" "$4,327.00" "$2,163.50" "$2,163.50" "$3,426.98" "$4,327.00" "$3,461.60" "$1,947.15" "$4,327.00" "$4,327.00" "$2,509.66" "$4,327.00" "$2,596.20" "$4,327.00" "$4,327.00" "$4,327.00" N/A N/A 27805649 EAP Custom 27805649 COIL EMBOLIZATION .012IN 5MM 15CM COMPLEX FILL DETACHABLE BOTH IP/OP "$3,738.00" "$2,766.50" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$1,495.20" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" "$3,738.00" "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" "$3,738.00" "$3,738.00" N/A N/A 27805650 EAP Custom 27805650 OG TDL CMPLX FILL COIL 6X10 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805651 EAP Custom 27805651 OG TDL CMPLX FILL COIL 6X15 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805652 EAP Custom 27805652 OG TDL CMPLX FILL COIL 6X20 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805653 EAP Custom 27805653 OG TDL CMPLX FILL COIL 7X15 BOTH IP/OP "$4,327.00" "$3,202.00" $770.21 "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" $770.21 "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" $901.79 "$4,327.00" "$1,730.80" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$3,245.25" "$4,327.00" "$4,327.00" "$4,327.00" "$2,163.50" "$2,163.50" "$3,426.98" "$4,327.00" "$3,461.60" "$1,947.15" "$4,327.00" "$4,327.00" "$2,509.66" "$4,327.00" "$2,596.20" "$4,327.00" "$4,327.00" "$4,327.00" N/A N/A 27805654 EAP Custom 27805654 OG TDL CMPLX FILL COIL 7X21 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805655 EAP Custom 27805655 OG TDL CMPLX FILL COIL 8X15 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805657 EAP Custom 27805657 OG TDL CMPLX FILL COIL 9X15 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805658 EAP Custom 27805658 OG TDL CMPLX FILL COIL 9X25 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805659 EAP Custom 27805659 OG TDL CMPLX FILL COIL 10X30 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805660 EAP Custom 27805660 OG TDL CMPLX FILL COIL 12X30 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805661 EAP Custom 27805661 OG CMPLX FILL COIL 3.5X7.5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805662 EAP Custom 27805662 OG TDL CMPLX FRAME COIL 6X20 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805663 EAP Custom 27805663 OG TDL CMPLX FRAME COIL 7X25 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805664 EAP Custom 27805664 OG TDL CMPLX FRAME COIL 8X30 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805665 EAP Custom 27805665 OG TDL CMPLX FRAME COIL 9X30 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805666 EAP Custom 27805666 OG TDL CMPLX FRAME COIL 10X30 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805667 EAP Custom 27805667 OG TDL CMPLX FRAME COIL 12X30 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805668 EAP Custom 27805668 OG TDL CMPLX FRAME COIL 14X30 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805669 EAP Custom 27805669 OG TDL CMPLX FRAME COIL 16X30 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805670 EAP Custom 27805670 OG TDL CMPLX FRAME COIL 18X30 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805671 EAP Custom 27805671 OG TDL CMPLX FRAME COIL 20X30 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805672 EAP Custom 27805672 G2 COMPLEX FILL COIL 2X1.5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805673 EAP Custom 27805673 G2 COMPLEX FILL COIL 2X2 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805674 EAP Custom 27805674 G2 COMPLEX FILL COIL 3X4 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805675 EAP Custom 27805675 G2 COMPLEX FILL COIL 3X6 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805676 EAP Custom 27805676 G2 COMPLEX FILL COIL 3X8 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805677 EAP Custom 27805677 G2 TDL COMPLEX FILL COIL 4X7 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805678 EAP Custom 27805678 G2 TDL COMPLEX FILL COIL 4X10 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805679 EAP Custom 27805679 G2 TDL COMPLEX FILL COIL 4X12 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805680 EAP Custom 27805680 G2 TDL COMPLEX FILL COIL 5X10 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805681 EAP Custom 27805681 G2 TDL COMPLEX FILL COIL 5X15 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805682 EAP Custom 27805682 G2 TDL COMPLEX FILL COIL 6X15 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805683 EAP Custom 27805683 G2 TDL COMPLEX FILL COIL 6X20 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805684 EAP Custom 27805684 G2 TDL COMPLEX FILL COIL 7X15 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805685 EAP Custom 27805685 G2 TDL COMPLEX FILL COIL 7X21 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805686 EAP Custom 27805686 G2 TDL COMPLEX FILL COIL 8X15 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805687 EAP Custom 27805687 G2 TDL COMPLEX FILL COIL 8X24 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805688 EAP Custom 27805688 G2 TDL COMPLEX FILL COIL 9X25 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805689 EAP Custom 27805689 G2 TDL COMPLEX FILL COIL 10X30 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805690 EAP Custom 27805690 G2 TDL COMPLEX FILL COIL 12X30 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805691 EAP Custom 27805691 G2 COMPLEX FILL COIL 2.5X5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805692 EAP Custom 27805692 G2 COMPLEX FILL COIL 2.5X3.5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805693 EAP Custom 27805693 G2 COMPLEX FILL COIL 3.5X9 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805694 EAP Custom 27805694 G2 COMPLEX FILL COIL 3.5X7.5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805695 EAP Custom 27805695 G2 COMPLEX XTRASOFT COIL 2X1.5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805696 EAP Custom 27805696 G2 COMPLEX XTRASOFT COIL 2X2 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805697 EAP Custom 27805697 G2 COMPLEX XTRASOFT COIL 3X4 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805698 EAP Custom 27805698 G2 COMPLEX XTRASOFT COIL 3X6 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805700 EAP Custom 27805700 G2 TDL COMPLEX XTRASOFT COIL 4 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805701 EAP Custom 27805701 G2 COMPLEX XTRASOFT COIL 2.5X5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805702 EAP Custom 27805702 G2 COMPLEX XTRASOFT COIL 2.5X2 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805703 EAP Custom 27805703 G2 COMPLEX XTRASOFT COIL 2.5X3 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805704 EAP Custom 27805704 G2 COMPLEX XTRASOFT COIL 3.5X5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805705 EAP Custom 27805705 G2 COMPLEX XTRASOFT COIL 3.5X9 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805706 EAP Custom 27805706 G2 COMPLEX XTRASOFT COIL 3.5X7 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805707 EAP Custom 27805707 G2 HELICAL XTRASOFT COIL 2X4 BOTH IP/OP "$3,148.00" "$2,330.00" $560.34 "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" $560.34 "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" $656.08 "$3,148.00" "$1,259.20" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$2,361.00" "$3,148.00" "$3,148.00" "$3,148.00" "$1,574.00" "$1,574.00" "$2,493.22" "$3,148.00" "$2,518.40" "$1,416.60" "$3,148.00" "$3,148.00" "$1,825.84" "$3,148.00" "$1,888.80" "$3,148.00" "$3,148.00" "$3,148.00" N/A N/A 27805708 EAP Custom 27805708 G2 HELICAL XTRASOFT COIL 2X6 BOTH IP/OP "$3,148.00" "$2,330.00" $560.34 "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" $560.34 "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" $656.08 "$3,148.00" "$1,259.20" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$2,361.00" "$3,148.00" "$3,148.00" "$3,148.00" "$1,574.00" "$1,574.00" "$2,493.22" "$3,148.00" "$2,518.40" "$1,416.60" "$3,148.00" "$3,148.00" "$1,825.84" "$3,148.00" "$1,888.80" "$3,148.00" "$3,148.00" "$3,148.00" N/A N/A 27805709 EAP Custom 27805709 G2 HELICAL XTRASOFT COIL 2X8 BOTH IP/OP "$3,148.00" "$2,330.00" $560.34 "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" $560.34 "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" $656.08 "$3,148.00" "$1,259.20" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$2,361.00" "$3,148.00" "$3,148.00" "$3,148.00" "$1,574.00" "$1,574.00" "$2,493.22" "$3,148.00" "$2,518.40" "$1,416.60" "$3,148.00" "$3,148.00" "$1,825.84" "$3,148.00" "$1,888.80" "$3,148.00" "$3,148.00" "$3,148.00" N/A N/A 27805710 EAP Custom 27805710 OG CMPLX XTRASOFT COIL 2X1.5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805711 EAP Custom 27805711 OG CMPLX XTRASOFT COIL 2X2 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805712 EAP Custom 27805712 OG CMPLX XTRASOFT COIL 3X3 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805713 EAP Custom 27805713 OG CMPLX XTRASOFT COIL 3X4 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805714 EAP Custom 27805714 OG CMPLX XTRASOFT COIL 3X6 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805715 EAP Custom 27805715 OG CMPLX XTRASOFT COIL 3X8 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805716 EAP Custom 27805716 OG CMPLX XTRASOFT COIL 4X4 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805717 EAP Custom 27805717 OG CMPLX XTRASOFT COIL 4X6 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805718 EAP Custom 27805718 OG CMPLX XTRASOFT COIL 4X8 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805719 EAP Custom 27805719 OG CMPLX XTRASOFT COIL 4X10 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805720 EAP Custom 27805720 OG CMPLX XTRASOFT COIL 2.5X5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805721 EAP Custom 27805721 OG CMPLX XTRASOFT COIL 2.5X2.5 BOTH IP/OP "$4,327.00" "$3,202.00" $770.21 "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" $770.21 "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" $901.79 "$4,327.00" "$1,730.80" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$4,327.00" "$3,245.25" "$4,327.00" "$4,327.00" "$4,327.00" "$2,163.50" "$2,163.50" "$3,426.98" "$4,327.00" "$3,461.60" "$1,947.15" "$4,327.00" "$4,327.00" "$2,509.66" "$4,327.00" "$2,596.20" "$4,327.00" "$4,327.00" "$4,327.00" N/A N/A 27805722 EAP Custom 27805722 OG CMPLX XTRASOFT COIL 2.5X3.5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805723 EAP Custom 27805723 OG CMPLX XTRASOFT COIL 3.5X5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805724 EAP Custom 27805724 OG CMPLX XTRASOFT COIL 3.5X9 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805725 EAP Custom 27805725 OG CMPLX XTRASOFT COIL 3.5X7.5 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805726 EAP Custom 27805726 OG HELICAL XTRSOFT COIL 2X4 BOTH IP/OP "$3,148.00" "$2,330.00" $560.34 "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" $560.34 "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" $656.08 "$3,148.00" "$1,259.20" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$2,361.00" "$3,148.00" "$3,148.00" "$3,148.00" "$1,574.00" "$1,574.00" "$2,493.22" "$3,148.00" "$2,518.40" "$1,416.60" "$3,148.00" "$3,148.00" "$1,825.84" "$3,148.00" "$1,888.80" "$3,148.00" "$3,148.00" "$3,148.00" N/A N/A 27805727 EAP Custom 27805727 OG HELICAL XTRSOFT COIL 2X6 BOTH IP/OP "$3,148.00" "$2,330.00" $560.34 "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" $560.34 "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" $656.08 "$3,148.00" "$1,259.20" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$2,361.00" "$3,148.00" "$3,148.00" "$3,148.00" "$1,574.00" "$1,574.00" "$2,493.22" "$3,148.00" "$2,518.40" "$1,416.60" "$3,148.00" "$3,148.00" "$1,825.84" "$3,148.00" "$1,888.80" "$3,148.00" "$3,148.00" "$3,148.00" N/A N/A 27805728 EAP Custom 27805728 OG HELICAL XTRSOFT COIL 2X8 BOTH IP/OP "$3,148.00" "$2,330.00" $560.34 "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" $560.34 "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" $656.08 "$3,148.00" "$1,259.20" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$2,361.00" "$3,148.00" "$3,148.00" "$3,148.00" "$1,574.00" "$1,574.00" "$2,493.22" "$3,148.00" "$2,518.40" "$1,416.60" "$3,148.00" "$3,148.00" "$1,825.84" "$3,148.00" "$1,888.80" "$3,148.00" "$3,148.00" "$3,148.00" N/A N/A 27805729 EAP Custom 27805729 G2 TDL COMPLEX XTRASOFT COIL 4X8 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805730 EAP Custom 27805730 G2 TDL COMPLEX XTRASOFT COIL 4X10 BOTH IP/OP "$4,121.00" "$3,050.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $733.54 "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" $858.86 "$4,121.00" "$1,648.40" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$4,121.00" "$3,090.75" "$4,121.00" "$4,121.00" "$4,121.00" "$2,060.50" "$2,060.50" "$3,263.83" "$4,121.00" "$3,296.80" "$1,854.45" "$4,121.00" "$4,121.00" "$2,390.18" "$4,121.00" "$2,472.60" "$4,121.00" "$4,121.00" "$4,121.00" N/A N/A 27805731 EAP Custom 27805731 KIT PRSS MONITR 14GA CDMN MCSNSR BASIC TRNDCR TUO NDL BOTH IP/OP "$2,074.00" "$1,535.00" $369.17 "$2,074.00" "$2,074.00" "$2,074.00" "$2,074.00" "$2,074.00" "$2,074.00" "$2,074.00" $369.17 "$2,074.00" "$2,074.00" "$2,074.00" "$2,074.00" "$2,074.00" "$2,074.00" $432.24 "$2,074.00" $829.60 "$2,074.00" "$2,074.00" "$2,074.00" "$2,074.00" "$2,074.00" "$1,555.50" "$2,074.00" "$2,074.00" "$2,074.00" "$1,037.00" "$1,037.00" "$1,642.61" "$2,074.00" "$1,659.20" $933.30 "$2,074.00" "$2,074.00" "$1,202.92" "$2,074.00" "$1,244.40" "$2,074.00" "$2,074.00" "$2,074.00" N/A N/A 27805732 EAP Custom 27805732 KIT PRSS MONITR MCSNSR .7MM SBDRL INPRENCH SKL BOLT BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" "$2,147.00" "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 27805733 EAP Custom 27805733 KIT PRSS MONITR 38CM CDMN INTRCRAN VNTRC TRNDCR CATH TNL BOTH IP/OP "$2,235.00" "$1,654.00" $397.83 "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" $397.83 "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" $465.80 "$2,235.00" $894.00 "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$1,676.25" "$2,235.00" "$2,235.00" "$2,235.00" "$1,117.50" "$1,117.50" "$1,770.12" "$2,235.00" "$1,788.00" "$1,005.75" "$2,235.00" "$2,235.00" "$1,296.30" "$2,235.00" "$1,341.00" "$2,235.00" "$2,235.00" "$2,235.00" N/A N/A 27805734 EAP Custom 27805734 STENT LVIS 4.5 23MM BOTH IP/OP "$17,913.00" "$13,256.00" "$3,188.51" "$17,913.00" "$17,913.00" "$17,913.00" "$17,913.00" "$17,913.00" "$17,913.00" "$17,913.00" "$3,188.51" "$17,913.00" "$17,913.00" "$17,913.00" "$17,913.00" "$17,913.00" "$17,913.00" "$3,733.27" "$17,913.00" "$7,165.20" "$17,913.00" "$17,913.00" "$17,913.00" "$17,913.00" "$17,913.00" "$13,434.75" "$17,913.00" "$17,913.00" "$17,913.00" "$8,956.50" "$8,956.50" "$14,187.10" "$17,913.00" "$14,330.40" "$8,060.85" "$17,913.00" "$17,913.00" "$10,389.54" "$17,913.00" "$10,747.80" "$17,913.00" "$17,913.00" "$17,913.00" N/A N/A 27805735 EAP Custom 27805735 DEVICE CMPR GOLD FMSTP PNEUM DOME INTGR DGT MNMTR ADJ BELT BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $290.00 $290.00 $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 27805736 EAP Custom 27805736 PRTCL EMBL 2 VL LQ SYS TRFL NBCA 1GM BOTH IP/OP "$11,437.00" "$8,463.50" "$2,035.79" "$11,437.00" "$11,437.00" "$11,437.00" "$11,437.00" "$11,437.00" "$11,437.00" "$11,437.00" "$2,035.79" "$11,437.00" "$11,437.00" "$11,437.00" "$11,437.00" "$11,437.00" "$11,437.00" "$2,383.60" "$11,437.00" "$4,574.80" "$11,437.00" "$11,437.00" "$11,437.00" "$11,437.00" "$11,437.00" "$8,577.75" "$11,437.00" "$11,437.00" "$11,437.00" "$5,718.50" "$5,718.50" "$9,058.10" "$11,437.00" "$9,149.60" "$5,146.65" "$11,437.00" "$11,437.00" "$6,633.46" "$11,437.00" "$6,862.20" "$11,437.00" "$11,437.00" "$11,437.00" N/A N/A 27805737 EAP Custom 27805737 PRTCL EMBL 1 VL LQ SYS TRFL NBCA 1GM BOTH IP/OP "$6,546.00" "$4,844.50" "$1,165.19" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$1,165.19" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$1,364.26" "$6,546.00" "$2,618.40" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$4,909.50" "$6,546.00" "$6,546.00" "$6,546.00" "$3,273.00" "$3,273.00" "$5,184.43" "$6,546.00" "$5,236.80" "$2,945.70" "$6,546.00" "$6,546.00" "$3,796.68" "$6,546.00" "$3,927.60" "$6,546.00" "$6,546.00" "$6,546.00" N/A N/A 27805739 EAP Custom 27805739 STENT 3.5 X 19 COIL ASSIST HEADWAY 21 BOTH IP/OP "$16,121.00" "$11,930.00" "$2,869.54" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$2,869.54" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$3,359.79" "$16,121.00" "$6,448.40" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$12,090.75" "$16,121.00" "$16,121.00" "$16,121.00" "$8,060.50" "$8,060.50" "$12,767.83" "$16,121.00" "$12,896.80" "$7,254.45" "$16,121.00" "$16,121.00" "$9,350.18" "$16,121.00" "$9,672.60" "$16,121.00" "$16,121.00" "$16,121.00" N/A N/A 27805740 EAP Custom 27805740 STENT 3.5 X 24 COIL ASSIST HEADWAY 21 BOTH IP/OP "$16,121.00" "$11,930.00" "$2,869.54" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$2,869.54" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$3,359.79" "$16,121.00" "$6,448.40" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$12,090.75" "$16,121.00" "$16,121.00" "$16,121.00" "$8,060.50" "$8,060.50" "$12,767.83" "$16,121.00" "$12,896.80" "$7,254.45" "$16,121.00" "$16,121.00" "$9,350.18" "$16,121.00" "$9,672.60" "$16,121.00" "$16,121.00" "$16,121.00" N/A N/A 27805741 EAP Custom 27805741 STENT 4.5 X 16 COIL ASSIST HEADWAY 21 BOTH IP/OP "$16,121.00" "$11,930.00" "$2,869.54" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$2,869.54" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$3,359.79" "$16,121.00" "$6,448.40" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$12,090.75" "$16,121.00" "$16,121.00" "$16,121.00" "$8,060.50" "$8,060.50" "$12,767.83" "$16,121.00" "$12,896.80" "$7,254.45" "$16,121.00" "$16,121.00" "$9,350.18" "$16,121.00" "$9,672.60" "$16,121.00" "$16,121.00" "$16,121.00" N/A N/A 27805742 EAP Custom 27805742 STENT 4.5 X 34 COIL ASSIST HEADWAY 21 BOTH IP/OP "$16,121.00" "$11,930.00" "$2,869.54" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$2,869.54" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$3,359.79" "$16,121.00" "$6,448.40" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$12,090.75" "$16,121.00" "$16,121.00" "$16,121.00" "$8,060.50" "$8,060.50" "$12,767.83" "$16,121.00" "$12,896.80" "$7,254.45" "$16,121.00" "$16,121.00" "$9,350.18" "$16,121.00" "$9,672.60" "$16,121.00" "$16,121.00" "$16,121.00" N/A N/A 27805743 EAP Custom 27805743 STENT 5.5 X 27 COIL ASSIST HEADWAY 21 BOTH IP/OP "$16,121.00" "$11,930.00" "$2,869.54" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$2,869.54" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$3,359.79" "$16,121.00" "$6,448.40" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$12,090.75" "$16,121.00" "$16,121.00" "$16,121.00" "$8,060.50" "$8,060.50" "$12,767.83" "$16,121.00" "$12,896.80" "$7,254.45" "$16,121.00" "$16,121.00" "$9,350.18" "$16,121.00" "$9,672.60" "$16,121.00" "$16,121.00" "$16,121.00" N/A N/A 27805744 EAP Custom 27805744 STENT 5.5 X 34 COIL ASSIST HEADWAY 21 BOTH IP/OP "$16,121.00" "$11,930.00" "$2,869.54" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$2,869.54" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$3,359.79" "$16,121.00" "$6,448.40" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$16,121.00" "$12,090.75" "$16,121.00" "$16,121.00" "$16,121.00" "$8,060.50" "$8,060.50" "$12,767.83" "$16,121.00" "$12,896.80" "$7,254.45" "$16,121.00" "$16,121.00" "$9,350.18" "$16,121.00" "$9,672.60" "$16,121.00" "$16,121.00" "$16,121.00" N/A N/A 27805745 EAP Custom 27805745 STENT 3.5 X 18 COIL ASSIST HEADWAY 17 BOTH IP/OP "$18,980.00" "$14,045.50" "$3,378.44" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$3,378.44" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$3,955.64" "$18,980.00" "$7,592.00" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$14,235.00" "$18,980.00" "$18,980.00" "$18,980.00" "$9,490.00" "$9,490.00" "$15,032.16" "$18,980.00" "$15,184.00" "$8,541.00" "$18,980.00" "$18,980.00" "$11,008.40" "$18,980.00" "$11,388.00" "$18,980.00" "$18,980.00" "$18,980.00" N/A N/A 27805746 EAP Custom 27805746 STENT 3.5 X 23 COIL ASSIST HEADWAY 17 BOTH IP/OP "$18,980.00" "$14,045.50" "$3,378.44" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$3,378.44" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$3,955.64" "$18,980.00" "$7,592.00" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$18,980.00" "$14,235.00" "$18,980.00" "$18,980.00" "$18,980.00" "$9,490.00" "$9,490.00" "$15,032.16" "$18,980.00" "$15,184.00" "$8,541.00" "$18,980.00" "$18,980.00" "$11,008.40" "$18,980.00" "$11,388.00" "$18,980.00" "$18,980.00" "$18,980.00" N/A N/A 27805747 EAP Custom 27805747 STENT 3.5 X 28 COIL ASSIST HEADWAY 17 BOTH IP/OP "$18,981.00" "$14,046.00" "$3,378.62" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$3,378.62" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$3,955.85" "$18,981.00" "$7,592.40" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$14,235.75" "$18,981.00" "$18,981.00" "$18,981.00" "$9,490.50" "$9,490.50" "$15,032.95" "$18,981.00" "$15,184.80" "$8,541.45" "$18,981.00" "$18,981.00" "$11,008.98" "$18,981.00" "$11,388.60" "$18,981.00" "$18,981.00" "$18,981.00" N/A N/A 27805748 EAP Custom 27805748 STENT 3.5 X 33 COIL ASSIST HEADWAY 17 BOTH IP/OP "$18,981.00" "$14,046.00" "$3,378.62" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$3,378.62" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$3,955.85" "$18,981.00" "$7,592.40" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$18,981.00" "$14,235.75" "$18,981.00" "$18,981.00" "$18,981.00" "$9,490.50" "$9,490.50" "$15,032.95" "$18,981.00" "$15,184.80" "$8,541.45" "$18,981.00" "$18,981.00" "$11,008.98" "$18,981.00" "$11,388.60" "$18,981.00" "$18,981.00" "$18,981.00" N/A N/A 27805750 EAP HCPCS C1764 SYSTEM CRD MONITR RVL LINQ INS BOTH IP/OP "$14,592.00" "$10,798.50" "$2,896.15" "$14,592.00" "$6,566.40" "$6,566.40" "$6,566.40" "$6,566.40" "$14,592.00" "$14,592.00" "$14,592.00" "$3,041.34" "$14,592.00" "$14,592.00" "$14,592.00" "$14,592.00" "$14,592.00" "$3,041.13" "$14,592.00" "$14,592.00" "$7,193.86" "$14,592.00" "$14,592.00" "$14,592.00" "$14,592.00" "$10,944.00" "$14,592.00" "$14,592.00" "$14,592.00" "$7,296.00" "$7,296.00" "$11,556.86" "$14,592.00" "$11,673.60" "$6,566.40" "$2,896.15" "$14,592.00" "$8,463.36" "$14,592.00" "$14,592.00" "$14,592.00" "$3,040.97" "$14,592.00" N/A N/A 27805751 EAP HCPCS C1880 FILTER EMBL VC FEMORAL NAVALIGN DLV SET STRL DISP PLTN CELECT BOTH IP/OP "$3,032.00" "$2,244.00" $631.90 "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" $631.90 "$3,032.00" "$1,212.80" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$2,274.00" "$3,032.00" "$3,032.00" "$3,032.00" "$1,516.00" "$1,516.00" "$2,401.34" "$3,032.00" "$2,425.60" "$1,364.40" "$3,032.00" "$3,032.00" "$1,758.56" "$3,032.00" "$1,819.20" "$3,032.00" "$3,032.00" "$3,032.00" N/A N/A 27805752 EAP HCPCS C1880 FILTER EMBL VC JUG NAVALIGN DLV SET STRL DISP PLTN CELECT BOTH IP/OP "$3,032.00" "$2,244.00" $631.90 "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" $631.90 "$3,032.00" "$1,212.80" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$2,274.00" "$3,032.00" "$3,032.00" "$3,032.00" "$1,516.00" "$1,516.00" "$2,401.34" "$3,032.00" "$2,425.60" "$1,364.40" "$3,032.00" "$3,032.00" "$1,758.56" "$3,032.00" "$1,819.20" "$3,032.00" "$3,032.00" "$3,032.00" N/A N/A 27805753 EAP HCPCS C1880 FILTER EMBL NAVALIGN DLV UNISET STRL DISP PLTN CELECT BOTH IP/OP "$3,032.00" "$2,244.00" $631.90 "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" $631.90 "$3,032.00" "$1,212.80" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$3,032.00" "$2,274.00" "$3,032.00" "$3,032.00" "$3,032.00" "$1,516.00" "$1,516.00" "$2,401.34" "$3,032.00" "$2,425.60" "$1,364.40" "$3,032.00" "$3,032.00" "$1,758.56" "$3,032.00" "$1,819.20" "$3,032.00" "$3,032.00" "$3,032.00" N/A N/A 27805754 EAP Custom 27805754 SYR INFLAT DFL INDFLTR EMBL COIL TRF DCS 2 PLTN BOTH IP/OP $816.00 $604.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $170.06 $816.00 $326.40 $816.00 $816.00 $816.00 $816.00 $816.00 $612.00 $816.00 $816.00 $816.00 $408.00 $408.00 $646.27 $816.00 $652.80 $367.20 $816.00 $816.00 $473.28 $816.00 $489.60 $816.00 $816.00 $816.00 N/A N/A 27805755 EAP HCPCS C1876 STENT CORON 8MM 2MM COCR MTLNK MVSN 2 RADIOPQ MRKR BLN BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27805756 EAP HCPCS C1876 STENT CORON 12MM 2MM COCR MTLNK MVSN 2 RADIOPQ MRKR BLN BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27805757 EAP HCPCS C1876 STENT CORON 15MM 2MM COCR MTLNK MVSN 2 RADIOPQ MRKR BLN BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27805758 EAP HCPCS C1876 STENT CORON 18MM 2MM COCR MTLNK MVSN 2 RADIOPQ MRKR BLN BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27805759 EAP HCPCS C1876 STENT CORON 23MM 2MM COCR MTLNK MVSN 2 RADIOPQ MRKR BLN BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27805760 EAP HCPCS C1876 STENT CORON 28MM 2MM COCR MTLNK MVSN 2 RADIOPQ MRKR BLN BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27805761 EAP HCPCS C1876 STENT CORON 15MM 2.25MM COCR MTLNK MVSN 2 RADIOPQ MRKR BLN BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27805762 EAP HCPCS C1876 STENT CORON 18MM 2.25MM COCR MTLNK MVSN 2 RADIOPQ MRKR BLN BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27805763 EAP HCPCS C1876 STENT CORON 23MM 2.25MM COCR MTLNK MVSN 2 RADIOPQ MRKR BLN BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27805764 EAP HCPCS C1876 STENT CORON 28MM 2.25MM COCR MTLNK MVSN 2 RADIOPQ MRKR BLN BOTH IP/OP "$1,791.00" "$1,325.50" $355.47 "$1,791.00" $805.95 $805.95 $805.95 $805.95 "$1,791.00" "$1,791.00" "$1,791.00" $373.29 "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" $373.26 "$1,791.00" "$1,791.00" "$1,059.38" "$1,791.00" "$1,791.00" "$1,791.00" "$1,791.00" "$1,343.25" "$1,791.00" "$1,791.00" "$1,791.00" $895.50 $895.50 "$1,418.47" "$1,791.00" "$1,432.80" $805.95 $355.47 "$1,791.00" "$1,038.78" "$1,791.00" "$1,791.00" "$1,791.00" $373.24 "$1,791.00" N/A N/A 27805765 EAP Custom 27805765 CATH ANGIO 5FR 8MM 110CM 2 LUM BLN SYR WDG PRSS STRL LATEX BOTH IP/OP $138.00 $102.50 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $62.10 $138.00 $138.00 $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 27805766 EAP HCPCS V2790 AMNIOFIX 16MM DISC BOTH IP/OP $971.00 $719.00 $192.72 $971.00 $436.95 $436.95 $436.95 $436.95 $971.00 $971.00 $971.00 $202.38 $971.00 $971.00 $971.00 $971.00 $971.00 $202.37 $971.00 $971.00 $574.35 $971.00 $971.00 $971.00 $971.00 $728.25 $971.00 $971.00 $971.00 $485.50 $485.50 $769.03 $971.00 $776.80 $436.95 $192.72 $971.00 $563.18 $971.00 $971.00 $971.00 $202.36 $971.00 N/A N/A 27805767 EAP HCPCS V2790 AMNIOFIX 2X3CM BOTH IP/OP "$2,756.00" "$2,039.50" $547.00 "$2,756.00" "$1,240.20" "$1,240.20" "$1,240.20" "$1,240.20" "$2,756.00" "$2,756.00" "$2,756.00" $574.42 "$2,756.00" "$2,756.00" "$2,756.00" "$2,756.00" "$2,756.00" $574.38 "$2,756.00" "$2,756.00" "$1,358.71" "$2,756.00" "$2,756.00" "$2,756.00" "$2,756.00" "$2,067.00" "$2,756.00" "$2,756.00" "$2,756.00" "$1,378.00" "$1,378.00" "$2,182.75" "$2,756.00" "$2,204.80" "$1,240.20" $547.00 "$2,756.00" "$1,598.48" "$2,756.00" "$2,756.00" "$2,756.00" $574.35 "$2,756.00" N/A N/A 27805768 EAP HCPCS V2790 AMNIOFIX 3X3CM BOTH IP/OP "$3,662.00" "$2,710.00" $726.82 "$3,662.00" "$1,647.90" "$1,647.90" "$1,647.90" "$1,647.90" "$3,662.00" "$3,662.00" "$3,662.00" $763.25 "$3,662.00" "$3,662.00" "$3,662.00" "$3,662.00" "$3,662.00" $763.20 "$3,662.00" "$3,662.00" "$1,805.37" "$3,662.00" "$3,662.00" "$3,662.00" "$3,662.00" "$2,746.50" "$3,662.00" "$3,662.00" "$3,662.00" "$1,831.00" "$1,831.00" "$2,900.30" "$3,662.00" "$2,929.60" "$1,647.90" $726.82 "$3,662.00" "$2,123.96" "$3,662.00" "$3,662.00" "$3,662.00" $763.16 "$3,662.00" N/A N/A 27805769 EAP HCPCS V2790 AMNIOFIX 4X4CM BOTH IP/OP "$3,925.00" "$2,904.50" $779.01 "$3,925.00" "$1,766.25" "$1,766.25" "$1,766.25" "$1,766.25" "$3,925.00" "$3,925.00" "$3,925.00" $818.07 "$3,925.00" "$3,925.00" "$3,925.00" "$3,925.00" "$3,925.00" $818.01 "$3,925.00" "$3,925.00" "$1,935.03" "$3,925.00" "$3,925.00" "$3,925.00" "$3,925.00" "$2,943.75" "$3,925.00" "$3,925.00" "$3,925.00" "$1,962.50" "$1,962.50" "$3,108.60" "$3,925.00" "$3,140.00" "$1,766.25" $779.01 "$3,925.00" "$2,276.50" "$3,925.00" "$3,925.00" "$3,925.00" $817.97 "$3,925.00" N/A N/A 27805770 EAP HCPCS V2790 AMNIOFIX 4X6CM BOTH IP/OP "$5,629.00" "$4,165.50" "$1,117.22" "$5,629.00" "$2,533.05" "$2,533.05" "$2,533.05" "$2,533.05" "$5,629.00" "$5,629.00" "$5,629.00" "$1,173.22" "$5,629.00" "$5,629.00" "$5,629.00" "$5,629.00" "$5,629.00" "$1,173.15" "$5,629.00" "$5,629.00" "$2,775.10" "$5,629.00" "$5,629.00" "$5,629.00" "$5,629.00" "$4,221.75" "$5,629.00" "$5,629.00" "$5,629.00" "$2,814.50" "$2,814.50" "$4,458.17" "$5,629.00" "$4,503.20" "$2,533.05" "$1,117.22" "$5,629.00" "$3,264.82" "$5,629.00" "$5,629.00" "$5,629.00" "$1,173.08" "$5,629.00" N/A N/A 27805771 EAP HCPCS V2790 AMNIOFIX 2X12CM BOTH IP/OP "$2,612.00" "$1,933.00" $518.42 "$2,612.00" "$1,175.40" "$1,175.40" "$1,175.40" "$1,175.40" "$2,612.00" "$2,612.00" "$2,612.00" $544.41 "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" $544.37 "$2,612.00" "$2,612.00" "$1,287.72" "$2,612.00" "$2,612.00" "$2,612.00" "$2,612.00" "$1,959.00" "$2,612.00" "$2,612.00" "$2,612.00" "$1,306.00" "$1,306.00" "$2,068.70" "$2,612.00" "$2,089.60" "$1,175.40" $518.42 "$2,612.00" "$1,514.96" "$2,612.00" "$2,612.00" "$2,612.00" $544.34 "$2,612.00" N/A N/A 27805772 EAP HCPCS V2790 AMNIOFIX 6X16CM BOTH IP/OP "$9,005.00" "$6,664.00" "$1,787.27" "$9,005.00" "$4,052.25" "$4,052.25" "$4,052.25" "$4,052.25" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.87" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.74" "$9,005.00" "$9,005.00" "$4,439.47" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$6,753.75" "$9,005.00" "$9,005.00" "$9,005.00" "$4,502.50" "$4,502.50" "$7,131.96" "$9,005.00" "$7,204.00" "$4,052.25" "$1,787.27" "$9,005.00" "$5,222.90" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.64" "$9,005.00" N/A N/A 27805773 EAP HCPCS V2790 AMNIOFIX 9X20CM BOTH IP/OP "$21,453.00" "$15,875.50" "$4,257.88" "$21,453.00" "$9,653.85" "$9,653.85" "$9,653.85" "$9,653.85" "$21,453.00" "$21,453.00" "$21,453.00" "$4,471.34" "$21,453.00" "$21,453.00" "$21,453.00" "$21,453.00" "$21,453.00" "$4,471.04" "$21,453.00" "$21,453.00" "$10,576.33" "$21,453.00" "$21,453.00" "$21,453.00" "$21,453.00" "$16,089.75" "$21,453.00" "$21,453.00" "$21,453.00" "$10,726.50" "$10,726.50" "$16,990.78" "$21,453.00" "$17,162.40" "$9,653.85" "$4,257.88" "$21,453.00" "$12,442.74" "$21,453.00" "$21,453.00" "$21,453.00" "$4,470.81" "$21,453.00" N/A N/A 27805774 EAP HCPCS V2790 AMNIOFIX WRAP 2X2 CM BOTH IP/OP "$1,903.00" "$1,408.50" $377.70 "$1,903.00" $856.35 $856.35 $856.35 $856.35 "$1,903.00" "$1,903.00" "$1,903.00" $396.63 "$1,903.00" "$1,903.00" "$1,903.00" "$1,903.00" "$1,903.00" $396.61 "$1,903.00" "$1,903.00" "$1,125.62" "$1,903.00" "$1,903.00" "$1,903.00" "$1,903.00" "$1,427.25" "$1,903.00" "$1,903.00" "$1,903.00" $951.50 $951.50 "$1,507.18" "$1,903.00" "$1,522.40" $856.35 $377.70 "$1,903.00" "$1,103.74" "$1,903.00" "$1,903.00" "$1,903.00" $396.59 "$1,903.00" N/A N/A 27805775 EAP HCPCS V2790 AMNIOFIX WRAP 2X4 CM BOTH IP/OP "$3,399.00" "$2,515.50" $674.62 "$3,399.00" "$1,529.55" "$1,529.55" "$1,529.55" "$1,529.55" "$3,399.00" "$3,399.00" "$3,399.00" $708.44 "$3,399.00" "$3,399.00" "$3,399.00" "$3,399.00" "$3,399.00" $708.39 "$3,399.00" "$3,399.00" "$1,675.71" "$3,399.00" "$3,399.00" "$3,399.00" "$3,399.00" "$2,549.25" "$3,399.00" "$3,399.00" "$3,399.00" "$1,699.50" "$1,699.50" "$2,692.01" "$3,399.00" "$2,719.20" "$1,529.55" $674.62 "$3,399.00" "$1,971.42" "$3,399.00" "$3,399.00" "$3,399.00" $708.35 "$3,399.00" N/A N/A 27805776 EAP HCPCS V2790 AMNIOFIX WRAP 4X6 CM BOTH IP/OP "$5,772.00" "$4,271.50" "$1,145.60" "$5,772.00" "$2,597.40" "$2,597.40" "$2,597.40" "$2,597.40" "$5,772.00" "$5,772.00" "$5,772.00" "$1,203.03" "$5,772.00" "$5,772.00" "$5,772.00" "$5,772.00" "$5,772.00" "$1,202.95" "$5,772.00" "$5,772.00" "$2,845.60" "$5,772.00" "$5,772.00" "$5,772.00" "$5,772.00" "$4,329.00" "$5,772.00" "$5,772.00" "$5,772.00" "$2,886.00" "$2,886.00" "$4,571.42" "$5,772.00" "$4,617.60" "$2,597.40" "$1,145.60" "$5,772.00" "$3,347.76" "$5,772.00" "$5,772.00" "$5,772.00" "$1,202.88" "$5,772.00" N/A N/A 27805777 EAP HCPCS C1777 LEAD DFBR 65CM 8FR OPTISURE ECRDM OPTIM 1 COIL DF1IS-1 BOTH IP/OP "$10,761.00" "$7,963.50" "$2,135.79" "$10,761.00" "$4,842.45" "$4,842.45" "$4,842.45" "$4,842.45" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.86" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.71" "$10,761.00" "$10,761.00" "$5,305.17" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$8,070.75" "$10,761.00" "$10,761.00" "$10,761.00" "$5,380.50" "$5,380.50" "$8,522.71" "$10,761.00" "$8,608.80" "$4,842.45" "$2,135.79" "$10,761.00" "$6,241.38" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.59" "$10,761.00" N/A N/A 27805778 EAP HCPCS C1777 LEAD DFBR 52CM 8FR OPTISURE ECRDM 1 COIL DF4 CONCTR TRUE BOTH IP/OP "$10,761.00" "$7,963.50" "$2,135.79" "$10,761.00" "$4,842.45" "$4,842.45" "$4,842.45" "$4,842.45" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.86" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.71" "$10,761.00" "$10,761.00" "$5,305.17" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$8,070.75" "$10,761.00" "$10,761.00" "$10,761.00" "$5,380.50" "$5,380.50" "$8,522.71" "$10,761.00" "$8,608.80" "$4,842.45" "$2,135.79" "$10,761.00" "$6,241.38" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.59" "$10,761.00" N/A N/A 27805779 EAP HCPCS C1777 LEAD DFBR 58CM 8FR OPTISURE ECRDM OPTIM 1 COIL DF4 CONCTR BOTH IP/OP "$10,761.00" "$7,963.50" "$2,135.79" "$10,761.00" "$4,842.45" "$4,842.45" "$4,842.45" "$4,842.45" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.86" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.71" "$10,761.00" "$10,761.00" "$5,305.17" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$8,070.75" "$10,761.00" "$10,761.00" "$10,761.00" "$5,380.50" "$5,380.50" "$8,522.71" "$10,761.00" "$8,608.80" "$4,842.45" "$2,135.79" "$10,761.00" "$6,241.38" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.59" "$10,761.00" N/A N/A 27805780 EAP HCPCS C1777 LEAD DFBR 65CM 8FR OPTISURE ECRDM 1 COIL DF4 CONCTR TRUE BOTH IP/OP "$10,761.00" "$7,963.50" "$2,135.79" "$10,761.00" "$4,842.45" "$4,842.45" "$4,842.45" "$4,842.45" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.86" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.71" "$10,761.00" "$10,761.00" "$5,305.17" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$8,070.75" "$10,761.00" "$10,761.00" "$10,761.00" "$5,380.50" "$5,380.50" "$8,522.71" "$10,761.00" "$8,608.80" "$4,842.45" "$2,135.79" "$10,761.00" "$6,241.38" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.59" "$10,761.00" N/A N/A 27805781 EAP HCPCS C1895 LEAD DFBR 65CM 8FR OPTISURE ECRDM 2 COIL DF1 DF4 CONCTR TRUE BOTH IP/OP "$10,761.00" "$7,963.50" "$2,135.79" "$10,761.00" "$4,842.45" "$4,842.45" "$4,842.45" "$4,842.45" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.86" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.71" "$10,761.00" "$10,761.00" "$5,305.17" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$8,070.75" "$10,761.00" "$10,761.00" "$10,761.00" "$5,380.50" "$5,380.50" "$8,522.71" "$10,761.00" "$8,608.80" "$4,842.45" "$2,135.79" "$10,761.00" "$6,241.38" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.59" "$10,761.00" N/A N/A 27805782 EAP HCPCS C1895 LEAD DFBR 52CM 8FR OPTISURE ECRDM 2 COIL DF4 CONCTR TRUE BOTH IP/OP "$10,761.00" "$7,963.50" "$2,135.79" "$10,761.00" "$4,842.45" "$4,842.45" "$4,842.45" "$4,842.45" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.86" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.71" "$10,761.00" "$10,761.00" "$5,305.17" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$8,070.75" "$10,761.00" "$10,761.00" "$10,761.00" "$5,380.50" "$5,380.50" "$8,522.71" "$10,761.00" "$8,608.80" "$4,842.45" "$2,135.79" "$10,761.00" "$6,241.38" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.59" "$10,761.00" N/A N/A 27805783 EAP HCPCS C1895 LEAD DFBR 58CM 8FR OPTISURE ECRDM 2 COIL DF4 CONCTR TRUE BOTH IP/OP "$10,761.00" "$7,963.50" "$2,135.79" "$10,761.00" "$4,842.45" "$4,842.45" "$4,842.45" "$4,842.45" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.86" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.71" "$10,761.00" "$10,761.00" "$5,305.17" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$8,070.75" "$10,761.00" "$10,761.00" "$10,761.00" "$5,380.50" "$5,380.50" "$8,522.71" "$10,761.00" "$8,608.80" "$4,842.45" "$2,135.79" "$10,761.00" "$6,241.38" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.59" "$10,761.00" N/A N/A 27805784 EAP HCPCS C1895 LEAD DFBR 65CM 8FR OPTISURE ECRDM 2 COIL DF4 220 DUAL SHOCK BOTH IP/OP "$10,761.00" "$7,963.50" "$2,135.79" "$10,761.00" "$4,842.45" "$4,842.45" "$4,842.45" "$4,842.45" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.86" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.71" "$10,761.00" "$10,761.00" "$5,305.17" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$8,070.75" "$10,761.00" "$10,761.00" "$10,761.00" "$5,380.50" "$5,380.50" "$8,522.71" "$10,761.00" "$8,608.80" "$4,842.45" "$2,135.79" "$10,761.00" "$6,241.38" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.59" "$10,761.00" N/A N/A 27805785 EAP HCPCS C1895 LEAD DFBR 65CM 8FR OPTISURE ECRDM 2 COIL DF4 230 DUAL SHOCK BOTH IP/OP "$10,761.00" "$7,963.50" "$2,135.79" "$10,761.00" "$4,842.45" "$4,842.45" "$4,842.45" "$4,842.45" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.86" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.71" "$10,761.00" "$10,761.00" "$5,305.17" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$8,070.75" "$10,761.00" "$10,761.00" "$10,761.00" "$5,380.50" "$5,380.50" "$8,522.71" "$10,761.00" "$8,608.80" "$4,842.45" "$2,135.79" "$10,761.00" "$6,241.38" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.59" "$10,761.00" N/A N/A 27805786 EAP HCPCS C1895 LEAD DFBR 65CM 8FR OPTISURE ECRDM 2 COIL DF4 PASS DUAL SHOCK BOTH IP/OP "$10,761.00" "$7,963.50" "$2,135.79" "$10,761.00" "$4,842.45" "$4,842.45" "$4,842.45" "$4,842.45" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.86" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.71" "$10,761.00" "$10,761.00" "$5,305.17" "$10,761.00" "$10,761.00" "$10,761.00" "$10,761.00" "$8,070.75" "$10,761.00" "$10,761.00" "$10,761.00" "$5,380.50" "$5,380.50" "$8,522.71" "$10,761.00" "$8,608.80" "$4,842.45" "$2,135.79" "$10,761.00" "$6,241.38" "$10,761.00" "$10,761.00" "$10,761.00" "$2,242.59" "$10,761.00" N/A N/A 27805787 EAP HCPCS C1777 LEAD PCNG 64CM 9FR ECRDM 1 COIL ACT FIX BIPOL CARDVRT DFBR BOTH IP/OP "$9,175.00" "$6,789.50" "$1,821.01" "$9,175.00" "$4,128.75" "$4,128.75" "$4,128.75" "$4,128.75" "$9,175.00" "$9,175.00" "$9,175.00" "$1,912.30" "$9,175.00" "$9,175.00" "$9,175.00" "$9,175.00" "$9,175.00" "$1,912.17" "$9,175.00" "$9,175.00" "$4,523.28" "$9,175.00" "$9,175.00" "$9,175.00" "$9,175.00" "$6,881.25" "$9,175.00" "$9,175.00" "$9,175.00" "$4,587.50" "$4,587.50" "$7,266.60" "$9,175.00" "$7,340.00" "$4,128.75" "$1,821.01" "$9,175.00" "$5,321.50" "$9,175.00" "$9,175.00" "$9,175.00" "$1,912.07" "$9,175.00" N/A N/A 27805788 EAP HCPCS C1874 STENT CORON 8MM 2.25MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805789 EAP HCPCS C1874 STENT CORON 12MM 2.25MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805790 EAP HCPCS C1874 STENT CORON 15MM 2.25MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805791 EAP HCPCS C1874 STENT CORON 18MM 2.25MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$2,283.60" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805792 EAP HCPCS C1874 STENT CORON 23MM 2.25MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805793 EAP HCPCS C1874 STENT CORON 28MM 2.25MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805794 EAP HCPCS C1874 STENT CORON 8MM 2.5MM .034-.029IN 5FR COCR BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805795 EAP HCPCS C1874 STENT CORON 12MM 2.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805796 EAP HCPCS C1874 STENT CORON 15MM 2.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805797 EAP HCPCS C1874 STENT CORON 18MM 2.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805798 EAP HCPCS C1874 STENT CORON 23MM 2.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805799 EAP HCPCS C1874 STENT CORON 28MM 2.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805800 EAP HCPCS C1874 STENT CORON 33MM 2.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805801 EAP HCPCS C1874 STENT CORON 38MM 2.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,996.00" "$2,957.50" $793.11 "$3,996.00" "$1,798.20" "$1,798.20" "$1,798.20" "$1,798.20" "$3,996.00" "$3,996.00" "$3,996.00" $832.87 "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" $832.81 "$3,996.00" "$3,996.00" "$1,970.03" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$2,997.00" "$3,996.00" "$3,996.00" "$3,996.00" "$1,998.00" "$1,998.00" "$3,164.83" "$3,996.00" "$3,196.80" "$1,798.20" $793.11 "$3,996.00" "$2,317.68" "$3,996.00" "$3,996.00" "$3,996.00" $832.77 "$3,996.00" N/A N/A 27805802 EAP HCPCS C1874 STENT CORON 8MM 2.75MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805803 EAP HCPCS C1874 STENT CORON 12MM 2.75MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805804 EAP HCPCS C1874 STENT CORON 15MM 2.75MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805805 EAP HCPCS C1874 STENT CORON 18MM 2.75MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805806 EAP HCPCS C1874 STENT CORON 23MM 2.75MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805807 EAP HCPCS C1874 STENT CORON 28MM 2.75MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805808 EAP HCPCS C1874 STENT CORON 33MM 2.75MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805809 EAP HCPCS C1874 STENT CORON 38MM 2.75MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805810 EAP HCPCS C1874 STENT CORON 8MM 3MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805811 EAP HCPCS C1874 STENT CORON 12MM 3MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805812 EAP HCPCS C1874 STENT CORON 15MM 3MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805813 EAP HCPCS C1874 STENT CORON 18MM 3MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,996.00" "$2,957.50" $793.11 "$3,996.00" "$1,798.20" "$1,798.20" "$1,798.20" "$1,798.20" "$3,996.00" "$3,996.00" "$3,996.00" $832.87 "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" $832.81 "$3,996.00" "$3,996.00" "$1,970.03" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$2,997.00" "$3,996.00" "$3,996.00" "$3,996.00" "$1,998.00" "$1,998.00" "$3,164.83" "$3,996.00" "$3,196.80" "$1,798.20" $793.11 "$3,996.00" "$2,317.68" "$3,996.00" "$3,996.00" "$3,996.00" $832.77 "$3,996.00" N/A N/A 27805814 EAP HCPCS C1874 STENT CORON 23MM 3MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,996.00" "$2,957.50" $793.11 "$3,996.00" "$1,798.20" "$1,798.20" "$1,798.20" "$1,798.20" "$3,996.00" "$3,996.00" "$3,996.00" $832.87 "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" $832.81 "$3,996.00" "$3,996.00" "$1,970.03" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$2,997.00" "$3,996.00" "$3,996.00" "$3,996.00" "$1,998.00" "$1,998.00" "$3,164.83" "$3,996.00" "$3,196.80" "$1,798.20" $793.11 "$3,996.00" "$2,317.68" "$3,996.00" "$3,996.00" "$3,996.00" $832.77 "$3,996.00" N/A N/A 27805815 EAP HCPCS C1874 STENT CORON 28MM 3MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805816 EAP HCPCS C1874 STENT CORON 33MM 3MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805817 EAP HCPCS C1874 STENT CORON 38MM 3MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,996.00" "$2,957.50" $793.11 "$3,996.00" "$1,798.20" "$1,798.20" "$1,798.20" "$1,798.20" "$3,996.00" "$3,996.00" "$3,996.00" $832.87 "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" $832.81 "$3,996.00" "$3,996.00" "$1,970.03" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$2,997.00" "$3,996.00" "$3,996.00" "$3,996.00" "$1,998.00" "$1,998.00" "$3,164.83" "$3,996.00" "$3,196.80" "$1,798.20" $793.11 "$3,996.00" "$2,317.68" "$3,996.00" "$3,996.00" "$3,996.00" $832.77 "$3,996.00" N/A N/A 27805818 EAP HCPCS C1874 STENT CORON 8MM 3.25MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805819 EAP HCPCS C1874 STENT CORON 12MM 3.25MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805820 EAP HCPCS C1874 STENT CORON 15MM 3.25MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805821 EAP HCPCS C1874 STENT CORON 18MM 3.25MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805822 EAP HCPCS C1874 STENT CORON 23MM 3.25MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$2,283.60" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805823 EAP HCPCS C1874 STENT CORON 28MM 3.25MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$2,283.60" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805824 EAP HCPCS C1874 STENT CORON 33MM 3.25MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,996.00" "$2,957.50" $793.11 "$3,996.00" "$1,798.20" "$1,798.20" "$1,798.20" "$1,798.20" "$3,996.00" "$3,996.00" "$3,996.00" $832.87 "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" $832.81 "$3,996.00" "$3,996.00" "$1,970.03" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$2,997.00" "$3,996.00" "$3,996.00" "$3,996.00" "$1,998.00" "$1,998.00" "$3,164.83" "$3,996.00" "$3,196.80" "$1,798.20" $793.11 "$3,996.00" "$2,317.68" "$3,996.00" "$3,996.00" "$3,996.00" $832.77 "$3,996.00" N/A N/A 27805825 EAP HCPCS C1874 STENT CORON 38MM 3.25MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805826 EAP HCPCS C1874 STENT CORON 8MM 3.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805827 EAP HCPCS C1874 STENT CORON 12MM 3.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,996.00" "$2,957.50" $793.11 "$3,996.00" "$1,798.20" "$1,798.20" "$1,798.20" "$1,798.20" "$3,996.00" "$3,996.00" "$3,996.00" $832.87 "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" $832.81 "$3,996.00" "$3,996.00" "$1,970.03" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$2,997.00" "$3,996.00" "$3,996.00" "$3,996.00" "$1,998.00" "$1,998.00" "$3,164.83" "$3,996.00" "$3,196.80" "$1,798.20" $793.11 "$3,996.00" "$2,317.68" "$3,996.00" "$3,996.00" "$3,996.00" $832.77 "$3,996.00" N/A N/A 27805828 EAP HCPCS C1874 STENT CORON 15MM 3.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805829 EAP HCPCS C1874 STENT CORON 18MM 3.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805830 EAP HCPCS C1874 STENT CORON 23MM 3.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,996.00" "$2,957.50" $793.11 "$3,996.00" "$1,798.20" "$1,798.20" "$1,798.20" "$1,798.20" "$3,996.00" "$3,996.00" "$3,996.00" $832.87 "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" $832.81 "$3,996.00" "$3,996.00" "$1,970.03" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$2,997.00" "$3,996.00" "$3,996.00" "$3,996.00" "$1,998.00" "$1,998.00" "$3,164.83" "$3,996.00" "$3,196.80" "$1,798.20" $793.11 "$3,996.00" "$2,317.68" "$3,996.00" "$3,996.00" "$3,996.00" $832.77 "$3,996.00" N/A N/A 27805831 EAP HCPCS C1874 STENT CORON 28MM 3.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805832 EAP HCPCS C1874 STENT CORON 33MM 3.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,806.00" "$2,816.50" $755.40 "$3,806.00" "$1,712.70" "$1,712.70" "$1,712.70" "$1,712.70" "$3,806.00" "$3,806.00" "$3,806.00" $793.27 "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" $793.21 "$3,806.00" "$3,806.00" "$1,876.36" "$3,806.00" "$3,806.00" "$3,806.00" "$3,806.00" "$2,854.50" "$3,806.00" "$3,806.00" "$3,806.00" "$1,903.00" "$1,903.00" "$3,014.35" "$3,806.00" "$3,044.80" "$1,712.70" $755.40 "$3,806.00" "$2,207.48" "$3,806.00" "$3,806.00" "$3,806.00" $793.17 "$3,806.00" N/A N/A 27805833 EAP HCPCS C1874 STENT CORON 38MM 3.5MM .034-.029IN 5FR EVEROLIMUS BOTH IP/OP "$3,996.00" "$2,957.50" $793.11 "$3,996.00" "$1,798.20" "$1,798.20" "$1,798.20" "$1,798.20" "$3,996.00" "$3,996.00" "$3,996.00" $832.87 "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" $832.81 "$3,996.00" "$3,996.00" "$1,970.03" "$3,996.00" "$3,996.00" "$3,996.00" "$3,996.00" "$2,997.00" "$3,996.00" "$3,996.00" "$3,996.00" "$1,998.00" "$1,998.00" "$3,164.83" "$3,996.00" "$3,196.80" "$1,798.20" $793.11 "$3,996.00" "$2,317.68" "$3,996.00" "$3,996.00" "$3,996.00" $832.77 "$3,996.00" N/A N/A 27805834 EAP HCPCS C1877 STENT TRCHBR 15MM 14FR 5CM INTROD SLF XPD GNT RSCH BOTH IP/OP "$5,249.00" "$3,884.50" "$1,041.80" "$5,249.00" "$2,362.05" "$2,362.05" "$2,362.05" "$2,362.05" "$5,249.00" "$5,249.00" "$5,249.00" "$1,094.02" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$1,093.95" "$5,249.00" "$5,249.00" "$2,587.76" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$3,936.75" "$5,249.00" "$5,249.00" "$5,249.00" "$2,624.50" "$2,624.50" "$4,157.21" "$5,249.00" "$4,199.20" "$2,362.05" "$1,041.80" "$5,249.00" "$3,044.42" "$5,249.00" "$5,249.00" "$5,249.00" "$1,093.89" "$5,249.00" N/A N/A 27805836 EAP HCPCS C1877 STENT TRCHBR 20MM 16FR 5CM INTROD SLF XPD GNT RSCH BOTH IP/OP "$5,249.00" "$3,884.50" "$1,041.80" "$5,249.00" "$2,362.05" "$2,362.05" "$2,362.05" "$2,362.05" "$5,249.00" "$5,249.00" "$5,249.00" "$1,094.02" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$1,093.95" "$5,249.00" "$5,249.00" "$2,587.76" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$3,936.75" "$5,249.00" "$5,249.00" "$5,249.00" "$2,624.50" "$2,624.50" "$4,157.21" "$5,249.00" "$4,199.20" "$2,362.05" "$1,041.80" "$5,249.00" "$3,044.42" "$5,249.00" "$5,249.00" "$5,249.00" "$1,093.89" "$5,249.00" N/A N/A 27805837 EAP HCPCS C1877 STENT TRCHBR 25MM 16FR 5CM INTROD SLF XPD GNT RSCH BOTH IP/OP "$5,249.00" "$3,884.50" "$1,041.80" "$5,249.00" "$2,362.05" "$2,362.05" "$2,362.05" "$2,362.05" "$5,249.00" "$5,249.00" "$5,249.00" "$1,094.02" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$1,093.95" "$5,249.00" "$5,249.00" "$2,587.76" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$3,936.75" "$5,249.00" "$5,249.00" "$5,249.00" "$2,624.50" "$2,624.50" "$4,157.21" "$5,249.00" "$4,199.20" "$2,362.05" "$1,041.80" "$5,249.00" "$3,044.42" "$5,249.00" "$5,249.00" "$5,249.00" "$1,093.89" "$5,249.00" N/A N/A 27805838 EAP HCPCS C1877 STENT TRCHBR 30MM 16FR 5CM INTROD SLF XPD GNT RSCH BOTH IP/OP "$5,249.00" "$3,884.50" "$1,041.80" "$5,249.00" "$2,362.05" "$2,362.05" "$2,362.05" "$2,362.05" "$5,249.00" "$5,249.00" "$5,249.00" "$1,094.02" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$1,093.95" "$5,249.00" "$5,249.00" "$2,587.76" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$3,936.75" "$5,249.00" "$5,249.00" "$5,249.00" "$2,624.50" "$2,624.50" "$4,157.21" "$5,249.00" "$4,199.20" "$2,362.05" "$1,041.80" "$5,249.00" "$3,044.42" "$5,249.00" "$5,249.00" "$5,249.00" "$1,093.89" "$5,249.00" N/A N/A 27805839 EAP HCPCS C1877 STENT TRCHBR 35MM 16FR 5CM INTROD SLF XPD GNT RSCH BOTH IP/OP "$5,249.00" "$3,884.50" "$1,041.80" "$5,249.00" "$2,362.05" "$2,362.05" "$2,362.05" "$2,362.05" "$5,249.00" "$5,249.00" "$5,249.00" "$1,094.02" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$1,093.95" "$5,249.00" "$5,249.00" "$2,587.76" "$5,249.00" "$5,249.00" "$5,249.00" "$5,249.00" "$3,936.75" "$5,249.00" "$5,249.00" "$5,249.00" "$2,624.50" "$2,624.50" "$4,157.21" "$5,249.00" "$4,199.20" "$2,362.05" "$1,041.80" "$5,249.00" "$3,044.42" "$5,249.00" "$5,249.00" "$5,249.00" "$1,093.89" "$5,249.00" N/A N/A 27805841 EAP HCPCS C1874 STENT CORON 8MM 4MM 2.3-2.7FR EVEROLIMUS ELUT PLTN BOTH IP/OP "$3,412.00" "$2,525.00" $677.20 "$3,412.00" "$1,535.40" "$1,535.40" "$1,535.40" "$1,535.40" "$3,412.00" "$3,412.00" "$3,412.00" $711.15 "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" $711.10 "$3,412.00" "$3,412.00" "$1,682.12" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$2,559.00" "$3,412.00" "$3,412.00" "$3,412.00" "$1,706.00" "$1,706.00" "$2,702.30" "$3,412.00" "$2,729.60" "$1,535.40" $677.20 "$3,412.00" "$1,978.96" "$3,412.00" "$3,412.00" "$3,412.00" $711.06 "$3,412.00" N/A N/A 27805842 EAP HCPCS C1874 STENT CORON 12MM 4MM 2.3-2.7FR EVEROLIMUS ELUT BOTH IP/OP "$3,412.00" "$2,525.00" $677.20 "$3,412.00" "$1,535.40" "$1,535.40" "$1,535.40" "$1,535.40" "$3,412.00" "$3,412.00" "$3,412.00" $711.15 "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" $711.10 "$3,412.00" "$3,412.00" "$1,682.12" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$2,559.00" "$3,412.00" "$3,412.00" "$3,412.00" "$1,706.00" "$1,706.00" "$2,702.30" "$3,412.00" "$2,729.60" "$1,535.40" $677.20 "$3,412.00" "$1,978.96" "$3,412.00" "$3,412.00" "$3,412.00" $711.06 "$3,412.00" N/A N/A 27805843 EAP HCPCS C1874 STENT CORON 16MM 4MM 2.3-2.7FR EVEROLIMUS ELUT BOTH IP/OP "$3,412.00" "$2,525.00" $677.20 "$3,412.00" "$1,535.40" "$1,535.40" "$1,535.40" "$1,535.40" "$3,412.00" "$3,412.00" "$3,412.00" $711.15 "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" $711.10 "$3,412.00" "$3,412.00" "$1,682.12" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$2,559.00" "$3,412.00" "$3,412.00" "$3,412.00" "$1,706.00" "$1,706.00" "$2,702.30" "$3,412.00" "$2,729.60" "$1,535.40" $677.20 "$3,412.00" "$1,978.96" "$3,412.00" "$3,412.00" "$3,412.00" $711.06 "$3,412.00" N/A N/A 27805844 EAP HCPCS C1874 STENT CORON 20MM 4MM 2.3-2.7FR EVEROLIMUS ELUT BOTH IP/OP "$3,412.00" "$2,525.00" $677.20 "$3,412.00" "$1,535.40" "$1,535.40" "$1,535.40" "$1,535.40" "$3,412.00" "$3,412.00" "$3,412.00" $711.15 "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" $711.10 "$3,412.00" "$3,412.00" "$1,682.12" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$2,559.00" "$3,412.00" "$3,412.00" "$3,412.00" "$1,706.00" "$1,706.00" "$2,702.30" "$3,412.00" "$2,729.60" "$1,535.40" $677.20 "$3,412.00" "$1,978.96" "$3,412.00" "$3,412.00" "$3,412.00" $711.06 "$3,412.00" N/A N/A 27805845 EAP HCPCS C1874 STENT CORON 24MM 4MM 2.3-2.7FR EVEROLIMUS ELUT BOTH IP/OP "$3,412.00" "$2,525.00" $677.20 "$3,412.00" "$1,535.40" "$1,535.40" "$1,535.40" "$1,535.40" "$3,412.00" "$3,412.00" "$3,412.00" $711.15 "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" $711.10 "$3,412.00" "$3,412.00" "$1,682.12" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$2,559.00" "$3,412.00" "$3,412.00" "$3,412.00" "$1,706.00" "$1,706.00" "$2,702.30" "$3,412.00" "$2,729.60" "$1,535.40" $677.20 "$3,412.00" "$1,978.96" "$3,412.00" "$3,412.00" "$3,412.00" $711.06 "$3,412.00" N/A N/A 27805846 EAP HCPCS C1874 STENT CORON 28MM 4MM 2.3-2.7FR EVEROLIMUS ELUT BOTH IP/OP "$3,412.00" "$2,525.00" $677.20 "$3,412.00" "$1,535.40" "$1,535.40" "$1,535.40" "$1,535.40" "$3,412.00" "$3,412.00" "$3,412.00" $711.15 "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" $711.10 "$3,412.00" "$3,412.00" "$1,682.12" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$2,559.00" "$3,412.00" "$3,412.00" "$3,412.00" "$1,706.00" "$1,706.00" "$2,702.30" "$3,412.00" "$2,729.60" "$1,535.40" $677.20 "$3,412.00" "$1,978.96" "$3,412.00" "$3,412.00" "$3,412.00" $711.06 "$3,412.00" N/A N/A 27805847 EAP HCPCS C1874 STENT CORON 32MM 4MM 2.3-2.7FR EVEROLIMUS ELUT BOTH IP/OP "$3,412.00" "$2,525.00" $677.20 "$3,412.00" "$1,535.40" "$1,535.40" "$1,535.40" "$1,535.40" "$3,412.00" "$3,412.00" "$3,412.00" $711.15 "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" $711.10 "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$2,559.00" "$3,412.00" "$3,412.00" "$3,412.00" "$1,706.00" "$1,706.00" "$2,702.30" "$3,412.00" "$2,729.60" "$1,535.40" $677.20 "$3,412.00" "$1,978.96" "$3,412.00" "$3,412.00" "$3,412.00" $711.06 "$3,412.00" N/A N/A 27805848 EAP HCPCS C1874 STENT CORON 38MM 4MM 2.3-2.7FR EVEROLIMUS ELUT BOTH IP/OP "$3,412.00" "$2,525.00" $677.20 "$3,412.00" "$1,535.40" "$1,535.40" "$1,535.40" "$1,535.40" "$3,412.00" "$3,412.00" "$3,412.00" $711.15 "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" $711.10 "$3,412.00" "$3,412.00" "$1,682.12" "$3,412.00" "$3,412.00" "$3,412.00" "$3,412.00" "$2,559.00" "$3,412.00" "$3,412.00" "$3,412.00" "$1,706.00" "$1,706.00" "$2,702.30" "$3,412.00" "$2,729.60" "$1,535.40" $677.20 "$3,412.00" "$1,978.96" "$3,412.00" "$2,047.20" "$3,412.00" $711.06 "$3,412.00" N/A N/A 27805850 EAP HCPCS C1900 LEAD PCNG 78CM 5.3FR 5.1FR .014-.018IN LV QDPL BOTH IP/OP "$5,840.00" "$4,322.00" "$1,159.09" "$5,840.00" "$2,628.00" "$2,628.00" "$2,628.00" "$2,628.00" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.20" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.12" "$5,840.00" "$5,840.00" "$2,879.12" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$4,380.00" "$5,840.00" "$5,840.00" "$5,840.00" "$2,920.00" "$2,920.00" "$4,625.28" "$5,840.00" "$4,672.00" "$2,628.00" "$1,159.09" "$5,840.00" "$3,387.20" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.06" "$5,840.00" N/A N/A 27805851 EAP HCPCS C1900 LEAD PCNG LV ATN STARFIX BOTH IP/OP "$5,840.00" "$4,322.00" "$1,159.09" "$5,840.00" "$2,628.00" "$2,628.00" "$2,628.00" "$2,628.00" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.20" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.12" "$5,840.00" "$5,840.00" "$2,879.12" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$4,380.00" "$5,840.00" "$5,840.00" "$5,840.00" "$2,920.00" "$2,920.00" "$4,625.28" "$5,840.00" "$4,672.00" "$2,628.00" "$1,159.09" "$5,840.00" "$3,387.20" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.06" "$5,840.00" N/A N/A 27805852 EAP HCPCS C1900 LEAD PCNG 78CM 5.3FR 5.1FR .014-.018IN OFFST S LV BOTH IP/OP "$5,840.00" "$4,322.00" "$1,159.09" "$5,840.00" "$2,628.00" "$2,628.00" "$2,628.00" "$2,628.00" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.20" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.12" "$5,840.00" "$5,840.00" "$2,879.12" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$4,380.00" "$5,840.00" "$5,840.00" "$5,840.00" "$2,920.00" "$2,920.00" "$4,625.28" "$5,840.00" "$4,672.00" "$2,628.00" "$1,159.09" "$5,840.00" "$3,387.20" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.06" "$5,840.00" N/A N/A 27805853 EAP HCPCS C1900 LEAD PCNG 88CM 5.3FR 5.1FR .014-.018IN OFFST S LV BOTH IP/OP "$5,840.00" "$4,322.00" "$1,159.09" "$5,840.00" "$2,628.00" "$2,628.00" "$2,628.00" "$2,628.00" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.20" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.12" "$5,840.00" "$5,840.00" "$2,879.12" "$5,840.00" "$5,840.00" "$5,840.00" "$5,840.00" "$4,380.00" "$5,840.00" "$5,840.00" "$5,840.00" "$2,920.00" "$2,920.00" "$4,625.28" "$5,840.00" "$4,672.00" "$2,628.00" "$1,159.09" "$5,840.00" "$3,387.20" "$5,840.00" "$5,840.00" "$5,840.00" "$1,217.06" "$5,840.00" N/A N/A 27805860 EAP HCPCS C1767 GENERATOR ESURG DEMIPULSE NCP BOTH IP/OP "$57,141.00" "$42,284.50" "$11,908.81" "$57,141.00" "$57,141.00" "$57,141.00" "$57,141.00" "$57,141.00" "$57,141.00" "$57,141.00" "$57,141.00" "$57,141.00" "$57,141.00" "$57,141.00" "$57,141.00" "$57,141.00" "$57,141.00" "$11,908.81" "$57,141.00" "$22,856.40" "$57,141.00" "$57,141.00" "$57,141.00" "$57,141.00" "$57,141.00" "$42,855.75" "$57,141.00" "$57,141.00" "$57,141.00" "$28,570.50" "$28,570.50" "$45,255.67" "$57,141.00" "$45,712.80" "$25,713.45" "$57,141.00" "$57,141.00" "$33,141.78" "$57,141.00" "$34,284.60" "$57,141.00" "$57,141.00" "$57,141.00" N/A N/A 27805861 EAP HCPCS C1778 LEAD NRSTM 43CM 3MM PERENNIAFLEX VAGUS NRV SIL BOTH IP/OP "$17,920.00" "$13,261.00" "$3,734.73" "$17,920.00" "$17,920.00" "$17,920.00" "$17,920.00" "$17,920.00" "$17,920.00" "$17,920.00" "$17,920.00" "$17,920.00" "$17,920.00" "$17,920.00" "$17,920.00" "$17,920.00" "$17,920.00" "$3,734.73" "$17,920.00" "$7,168.00" "$17,920.00" "$17,920.00" "$17,920.00" "$17,920.00" "$17,920.00" "$13,440.00" "$17,920.00" "$17,920.00" "$17,920.00" "$8,960.00" "$8,960.00" "$14,192.64" "$17,920.00" "$14,336.00" "$8,064.00" "$17,920.00" "$17,920.00" "$10,393.60" "$17,920.00" "$10,752.00" "$17,920.00" "$17,920.00" "$17,920.00" N/A N/A 27805862 EAP HCPCS C1876 "STNT TRCHBR 9MM 7FR 59MM 120CM .035"" CVD ULT LW CX" BOTH IP/OP "$6,591.00" "$4,877.50" "$1,308.15" "$6,591.00" "$2,965.95" "$2,965.95" "$2,965.95" "$2,965.95" "$6,591.00" "$6,591.00" "$6,591.00" "$1,373.73" "$6,591.00" "$6,591.00" "$6,591.00" "$6,591.00" "$6,591.00" "$1,373.64" "$6,591.00" "$6,591.00" "$3,249.36" "$6,591.00" "$6,591.00" "$6,591.00" "$6,591.00" "$4,943.25" "$6,591.00" "$6,591.00" "$6,591.00" "$3,295.50" "$3,295.50" "$5,220.07" "$6,591.00" "$5,272.80" "$2,965.95" "$1,308.15" "$6,591.00" "$3,822.78" "$6,591.00" "$6,591.00" "$6,591.00" "$1,373.56" "$6,591.00" N/A N/A 27805863 EAP Custom 27805863 PIPELINE EMBOL. DEVICE 3.00MM X 25MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805864 EAP Custom 27805864 PIPELINE EMBOL. DEVICE 3.00MM X 30MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805865 EAP Custom 27805865 PIPELINE EMBOL. DEVICE 3.00MM X 35MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805866 EAP Custom 27805866 PIPELINE EMBOL. DEVICE 3.25MM X 25MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805867 EAP Custom 27805867 PIPELINE EMBOL. DEVICE 3.25MM X 30MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805868 EAP Custom 27805868 PIPELINE EMBOL. DEVICE 3.25MM X 35MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805869 EAP Custom 27805869 PIPELINE EMBOL. DEVICE 3.50MM X 25MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805870 EAP Custom 27805870 PIPELINE EMBOL. DEVICE 3.50MM X 30MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805871 EAP Custom 27805871 PIPELINE EMBOL. DEVICE 3.50MM X 35MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805872 EAP Custom 27805872 PIPELINE EMBOL. DEVICE 3.75MM X 25MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805873 EAP Custom 27805873 PIPELINE EMBOL. DEVICE 3.75MM X 30MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805874 EAP Custom 27805874 PIPELINE EMBOL. DEVICE 3.75MM X 35MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805875 EAP Custom 27805875 PIPELINE EMBOL. DEVICE 4.00MM X 25MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805876 EAP Custom 27805876 PIPELINE EMBOL. DEVICE 4.00MM X 30MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805877 EAP Custom 27805877 PIPELINE EMBOL. DEVICE 4.00MM X 35MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805878 EAP Custom 27805878 PIPELINE EMBOL. DEVICE 4.25MM X 25MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805879 EAP Custom 27805879 PIPELINE EMBOL. DEVICE 4.25MM X 30MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805880 EAP Custom 27805880 PIPELINE EMBOL. DEVICE 4.25MM X 35MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805881 EAP Custom 27805881 PIPELINE EMBOL. DEVICE 4.50MM X 25MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805882 EAP Custom 27805882 PIPELINE EMBOL. DEVICE 4.50MM X 30MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805883 EAP Custom 27805883 PIPELINE EMBOL. DEVICE 4.50MM X 35MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805884 EAP Custom 27805884 PIPELINE EMBOL. DEVICE 4.75MM X 25MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805885 EAP Custom 27805885 PIPELINE EMBOL. DEVICE 4.75MM X 30MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805886 EAP Custom 27805886 PIPELINE EMBOL. DEVICE 4.75MM X 35MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805887 EAP Custom 27805887 PIPELINE EMBOL. DEVICE 5.00MM X 25MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805888 EAP Custom 27805888 PIPELINE EMBOL. DEVICE 5.00MM X 30MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805889 EAP Custom 27805889 PIPELINE EMBOL. DEVICE 5.00MM X 35MM BOTH IP/OP "$36,219.00" "$26,802.50" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$6,446.98" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$7,548.44" "$36,219.00" "$14,487.60" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$36,219.00" "$27,164.25" "$36,219.00" "$36,219.00" "$36,219.00" "$18,109.50" "$18,109.50" "$28,685.45" "$36,219.00" "$28,975.20" "$16,298.55" "$36,219.00" "$36,219.00" "$21,007.02" "$36,219.00" "$21,731.40" "$36,219.00" "$36,219.00" "$36,219.00" N/A N/A 27805890 EAP Custom 27805890 PIPELINE EMBOL. DEVICE 2.50MM X 10MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805891 EAP Custom 27805891 PIPELINE EMBOL. DEVICE 2.50MM X 12MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805892 EAP Custom 27805892 PIPELINE EMBOL. DEVICE 2.50MM X 14MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805893 EAP Custom 27805893 PIPELINE EMBOL. DEVICE 2.50MM X 16MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805894 EAP Custom 27805894 PIPELINE EMBOL. DEVICE 2.50MM X 18MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805895 EAP Custom 27805895 PIPELINE EMBOL. DEVICE 2.50MM X 20MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805896 EAP Custom 27805896 PIPELINE EMBOL. DEVICE 2.75MM X 10MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805897 EAP Custom 27805897 PIPELINE EMBOL. DEVICE 2.75MM X 12MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805898 EAP Custom 27805898 PIPELINE EMBOL. DEVICE 2.75MM X 14MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805899 EAP Custom 27805899 PIPELINE EMBOL. DEVICE 2.75MM X 16MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805900 EAP Custom 27805900 PIPELINE EMBOL. DEVICE 2.75MM X 18MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805901 EAP Custom 27805901 PIPELINE EMBOL. DEVICE 2.75MM X 20MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805902 EAP Custom 27805902 PIPELINE EMBOL. DEVICE 3.00MM X 10MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805903 EAP Custom 27805903 PIPELINE EMBOL. DEVICE 3.00MM X 12MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805904 EAP Custom 27805904 PIPELINE EMBOL. DEVICE 3.00MM X 14MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805905 EAP Custom 27805905 PIPELINE EMBOL. DEVICE 3.00MM X 16MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805906 EAP Custom 27805906 PIPELINE EMBOL. DEVICE 3.00MM X 18MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805907 EAP Custom 27805907 PIPELINE EMBOL. DEVICE 3.00MM X 20MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805908 EAP Custom 27805908 PIPELINE EMBOL. DEVICE 3.25MM X 10MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805909 EAP Custom 27805909 PIPELINE EMBOL. DEVICE 3.25MM X 12MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805910 EAP Custom 27805910 PIPELINE EMBOL. DEVICE 3.25MM X 14MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805911 EAP Custom 27805911 PIPELINE EMBOL. DEVICE 3.25MM X 16MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805912 EAP Custom 27805912 PIPELINE EMBOL. DEVICE 3.25MM X 18MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805913 EAP Custom 27805913 PIPELINE EMBOL. DEVICE 3.25MM X 20MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805914 EAP Custom 27805914 PIPELINE EMBOL. DEVICE 3.50MM X 10MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805915 EAP Custom 27805915 PIPELINE EMBOL. DEVICE 3.50MM X 12MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805916 EAP Custom 27805916 PIPELINE EMBOL. DEVICE 3.50MM X 14MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805917 EAP Custom 27805917 PIPELINE EMBOL. DEVICE 3.50MM X 16MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805918 EAP Custom 27805918 PIPELINE EMBOL. DEVICE 3.50MM X 18MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805919 EAP Custom 27805919 PIPELINE EMBOL. DEVICE 3.50MM X 20MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805920 EAP Custom 27805920 PIPELINE EMBOL. DEVICE 3.75MM X 10MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805921 EAP Custom 27805921 PIPELINE EMBOL. DEVICE 3.75MM X 12MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805922 EAP Custom 27805922 PIPELINE EMBOL. DEVICE 3.75MM X 14MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805923 EAP Custom 27805923 PIPELINE EMBOL. DEVICE 3.75MM X 16MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805924 EAP Custom 27805924 PIPELINE EMBOL. DEVICE 3.75MM X 18MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805925 EAP Custom 27805925 PIPELINE EMBOL. DEVICE 3.75MM X 20MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805926 EAP Custom 27805926 PIPELINE EMBOL. DEVICE 4.00MM X 10MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805927 EAP Custom 27805927 PIPELINE EMBOL. DEVICE 4.00MM X 12MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805928 EAP Custom 27805928 PIPELINE EMBOL. DEVICE 4.00MM X 14MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805929 EAP Custom 27805929 PIPELINE EMBOL. DEVICE 4.00MM X 16MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805930 EAP Custom 27805930 PIPELINE EMBOL. DEVICE 4.00MM X 18MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805931 EAP Custom 27805931 PIPELINE EMBOL. DEVICE 4.00MM X 20MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805932 EAP Custom 27805932 PIPELINE EMBOL. DEVICE 4.25MM X 10MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805933 EAP Custom 27805933 PIPELINE EMBOL. DEVICE 4.25MM X 12MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805934 EAP Custom 27805934 PIPELINE EMBOL. DEVICE 4.25MM X 14MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805935 EAP Custom 27805935 PIPELINE EMBOL. DEVICE 4.25MM X 16MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805936 EAP Custom 27805936 PIPELINE EMBOL. DEVICE 4.25MM X 18MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805937 EAP Custom 27805937 PIPELINE EMBOL. DEVICE 4.25MM X 20MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805938 EAP Custom 27805938 PIPELINE EMBOL. DEVICE 4.50MM X 10MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805939 EAP Custom 27805939 PIPELINE EMBOL. DEVICE 4.50MM X 12MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805940 EAP Custom 27805940 PIPELINE EMBOL. DEVICE 4.50MM X 14MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805941 EAP Custom 27805941 PIPELINE EMBOL. DEVICE 4.50MM X 16MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805942 EAP Custom 27805942 PIPELINE EMBOL. DEVICE 4.50MM X 18MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805943 EAP Custom 27805943 PIPELINE EMBOL. DEVICE 4.50MM X 20MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805944 EAP Custom 27805944 PIPELINE EMBOL. DEVICE 4.75MM X 10MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805945 EAP Custom 27805945 PIPELINE EMBOL. DEVICE 4.75MM X 12MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805946 EAP Custom 27805946 PIPELINE EMBOL. DEVICE 4.75MM X 14MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805947 EAP Custom 27805947 PIPELINE EMBOL. DEVICE 4.75MM X 16MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805948 EAP Custom 27805948 PIPELINE EMBOL. DEVICE 4.75MM X 18MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805949 EAP Custom 27805949 PIPELINE EMBOL. DEVICE 4.75MM X 20MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805950 EAP Custom 27805950 PIPELINE EMBOL. DEVICE 5.00MM X 10MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805951 EAP Custom 27805951 PIPELINE EMBOL. DEVICE 5.00MM X 12MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805952 EAP Custom 27805952 PIPELINE EMBOL. DEVICE 5.00MM X 14MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805953 EAP Custom 27805953 PIPELINE EMBOL. DEVICE 5.00MM X 16MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805954 EAP Custom 27805954 PIPELINE EMBOL. DEVICE 5.00MM X 18MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805955 EAP Custom 27805955 PIPELINE EMBOL. DEVICE 5.00MM X 20MM BOTH IP/OP "$33,856.00" "$25,053.50" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$6,026.37" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$7,055.96" "$33,856.00" "$13,542.40" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$33,856.00" "$25,392.00" "$33,856.00" "$33,856.00" "$33,856.00" "$16,928.00" "$16,928.00" "$26,813.95" "$33,856.00" "$27,084.80" "$15,235.20" "$33,856.00" "$33,856.00" "$19,636.48" "$33,856.00" "$20,313.60" "$33,856.00" "$33,856.00" "$33,856.00" N/A N/A 27805956 EAP Custom 27805956 "PIPELINE FLEX, 3.00MM X 25MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805957 EAP Custom 27805957 "PIPELINE FLEX, 3.00MM X 30MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805958 EAP Custom 27805958 "PIPELINE FLEX, 3.00MM X 35MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805959 EAP Custom 27805959 "PIPELINE FLEX, 3.25MM X 25MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805960 EAP Custom 27805960 "PIPELINE FLEX, 3.25MM X 30MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805961 EAP Custom 27805961 "PIPELINE FLEX, 3.25MM X 35MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805962 EAP Custom 27805962 "PIPELINE FLEX, 3.50MM X 25MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805963 EAP Custom 27805963 "PIPELINE FLEX, 3.50MM X 30MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805964 EAP Custom 27805964 "PIPELINE FLEX, 3.50MM X 35MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805965 EAP Custom 27805965 "PIPELINE FLEX, 3.75MM X 25MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805966 EAP Custom 27805966 "PIPELINE FLEX, 3.75MM X 30MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805967 EAP Custom 27805967 "PIPELINE FLEX, 3.75MM X 35MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805968 EAP Custom 27805968 "PIPELINE FLEX, 4.00MM X 25MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805969 EAP Custom 27805969 "PIPELINE FLEX, 4.00MM X 30MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805970 EAP Custom 27805970 "PIPELINE FLEX, 4.00MM X 35MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805971 EAP Custom 27805971 "PIPELINE FLEX, 4.25MM X 25MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805972 EAP Custom 27805972 "PIPELINE FLEX, 4.25MM X 30MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805973 EAP Custom 27805973 "PIPELINE FLEX, 4.25MM X 35MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805974 EAP Custom 27805974 "PIPELINE FLEX, 4.50MM X 25MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805975 EAP Custom 27805975 "PIPELINE FLEX, 4.50MM X 30MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805976 EAP Custom 27805976 "PIPELINE FLEX, 4.50MM X 35MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805977 EAP Custom 27805977 "PIPELINE FLEX, 4.75MM X 25MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805978 EAP Custom 27805978 "PIPELINE FLEX, 4.75MM X 30MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805979 EAP Custom 27805979 "PIPELINE FLEX, 4.75MM X 35MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805980 EAP Custom 27805980 "PIPELINE FLEX, 5.00MM X 25MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805981 EAP Custom 27805981 "PIPELINE FLEX, 5.00MM X 30MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805982 EAP Custom 27805982 "PIPELINE FLEX, 5.00MM X 35MM" BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27805983 EAP Custom 27805983 "PIPELINE FLEX, 2.50MM X 10MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805984 EAP Custom 27805984 "PIPELINE FLEX, 2.50MM X 12MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805985 EAP Custom 27805985 "PIPELINE FLEX, 2.50MM X 14MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805986 EAP Custom 27805986 "PIPELINE FLEX, 2.50MM X 16MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805987 EAP Custom 27805987 "PIPELINE FLEX, 2.50MM X 18MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805988 EAP Custom 27805988 "PIPELINE FLEX, 2.50MM X 20MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805989 EAP Custom 27805989 "PIPELINE FLEX, 2.75MM X 10MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805990 EAP Custom 27805990 "PIPELINE FLEX, 2.75MM X 12MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805991 EAP Custom 27805991 "PIPELINE FLEX, 2.75MM X 14MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805992 EAP Custom 27805992 "PIPELINE FLEX, 2.75MM X 16MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805993 EAP Custom 27805993 "PIPELINE FLEX, 2.75MM X 18MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805994 EAP Custom 27805994 "PIPELINE FLEX, 2.75MM X 20MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805995 EAP Custom 27805995 "PIPELINE FLEX, 3.00MM X 10MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805996 EAP Custom 27805996 "PIPELINE FLEX, 3.00MM X 12MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805997 EAP Custom 27805997 "PIPELINE FLEX, 3.00MM X 14MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805998 EAP Custom 27805998 "PIPELINE FLEX, 3.00MM X 16MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27805999 EAP Custom 27805999 "PIPELINE FLEX, 3.00MM X 18MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806000 EAP Custom 27806000 "PIPELINE FLEX, 3.00MM X 20MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806001 EAP Custom 27806001 "PIPELINE FLEX, 3.25MM X 10MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806002 EAP Custom 27806002 "PIPELINE FLEX, 3.25MM X 12MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806003 EAP Custom 27806003 "PIPELINE FLEX, 3.25MM X 14MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806004 EAP Custom 27806004 "PIPELINE FLEX, 3.25MM X 16MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806005 EAP Custom 27806005 "PIPELINE FLEX, 3.25MM X 18MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806006 EAP Custom 27806006 "PIPELINE FLEX, 3.25MM X 20MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806007 EAP Custom 27806007 "PIPELINE FLEX, 3.50MM X 10MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806008 EAP Custom 27806008 "PIPELINE FLEX, 3.50MM X 12MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806009 EAP Custom 27806009 "PIPELINE FLEX, 3.50MM X 14MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806010 EAP Custom 27806010 "PIPELINE FLEX, 3.50MM X 16MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806011 EAP Custom 27806011 "PIPELINE FLEX, 3.50MM X 18MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806012 EAP Custom 27806012 "PIPELINE FLEX, 3.50MM X 20MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806013 EAP Custom 27806013 "PIPELINE FLEX, 3.75MM X 10MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806014 EAP Custom 27806014 "PIPELINE FLEX, 3.75MM X 12MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806015 EAP Custom 27806015 "PIPELINE FLEX, 3.75MM X 14MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806016 EAP Custom 27806016 "PIPELINE FLEX, 3.75MM X 16MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806017 EAP Custom 27806017 "PIPELINE FLEX, 3.75MM X 18MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806018 EAP Custom 27806018 "PIPELINE FLEX, 3.75MM X 20MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806019 EAP Custom 27806019 "PIPELINE FLEX, 4.00MM X 10MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806020 EAP Custom 27806020 "PIPELINE FLEX, 4.00MM X 12MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806021 EAP Custom 27806021 "PIPELINE FLEX, 4.00MM X 14MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806022 EAP Custom 27806022 "PIPELINE FLEX, 4.00MM X 16MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806023 EAP Custom 27806023 "PIPELINE FLEX, 4.00MM X 18MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806024 EAP Custom 27806024 "PIPELINE FLEX, 4.00MM X 20MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806025 EAP Custom 27806025 "PIPELINE FLEX, 4.25MM X 10MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806026 EAP Custom 27806026 "PIPELINE FLEX, 4.25MM X 12MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806027 EAP Custom 27806027 "PIPELINE FLEX, 4.25MM X 14MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806028 EAP Custom 27806028 "PIPELINE FLEX, 4.25MM X 16MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806029 EAP Custom 27806029 "PIPELINE FLEX, 4.25MM X 18MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806030 EAP Custom 27806030 "PIPELINE FLEX, 4.25MM X 20MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806031 EAP Custom 27806031 "PIPELINE FLEX, 4.50MM X 10MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806032 EAP Custom 27806032 "PIPELINE FLEX, 4.50MM X 12MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806033 EAP Custom 27806033 "PIPELINE FLEX, 4.50MM X 14MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806034 EAP Custom 27806034 "PIPELINE FLEX, 4.50MM X 16MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806035 EAP Custom 27806035 "PIPELINE FLEX, 4.50MM X 18MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806036 EAP Custom 27806036 "PIPELINE FLEX, 4.50MM X 20MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806037 EAP Custom 27806037 "PIPELINE FLEX, 4.75MM X 10MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806038 EAP Custom 27806038 "PIPELINE FLEX, 4.75MM X 12MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806039 EAP Custom 27806039 "PIPELINE FLEX, 4.75MM X 14MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806040 EAP Custom 27806040 "PIPELINE FLEX, 4.75MM X 16MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806041 EAP Custom 27806041 "PIPELINE FLEX, 4.75MM X 18MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806042 EAP Custom 27806042 "PIPELINE FLEX, 4.75MM X 20MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806043 EAP Custom 27806043 "PIPELINE FLEX, 5.00MM X 10MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806044 EAP Custom 27806044 "PIPELINE FLEX, 5.00MM X 12MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806045 EAP Custom 27806045 "PIPELINE FLEX, 5.00MM X 14MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806046 EAP Custom 27806046 "PIPELINE FLEX, 5.00MM X 16MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806047 EAP Custom 27806047 "PIPELINE FLEX, 5.00MM X 18MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806048 EAP Custom 27806048 "PIPELINE FLEX, 5.00MM X 20MM" BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806050 EAP Custom 27806050 DEVICE EMBL 25MM 3MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806051 EAP Custom 27806051 DEVICE EMBL 30MM 3MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806052 EAP Custom 27806052 DEVICE EMBL 35MM 3MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806053 EAP Custom 27806053 DEVICE EMBL 25MM 3.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806054 EAP Custom 27806054 DEVICE EMBL 30MM 3.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806055 EAP Custom 27806055 DEVICE EMBL 35MM 3.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806056 EAP Custom 27806056 DEVICE EMBL 25MM 3.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806057 EAP Custom 27806057 DEVICE EMBL 30MM 3.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806058 EAP Custom 27806058 DEVICE EMBL 35MM 3.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806059 EAP Custom 27806059 DEVICE EMBL 25MM 3.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806060 EAP Custom 27806060 DEVICE EMBL 30MM 3.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806061 EAP Custom 27806061 DEVICE EMBL 35MM 3.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806062 EAP Custom 27806062 DEVICE EMBL 25MM 4MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806063 EAP Custom 27806063 DEVICE EMBL 30MM 4MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806064 EAP Custom 27806064 DEVICE EMBL 35MM 4MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806065 EAP Custom 27806065 DEVICE EMBL 25MM 4.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806066 EAP Custom 27806066 DEVICE EMBL 30MM 4.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806067 EAP Custom 27806067 DEVICE EMBL 35MM 4.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806068 EAP Custom 27806068 DEVICE EMBL 30MM 4.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806069 EAP Custom 27806069 DEVICE EMBL 35MM 4.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806070 EAP Custom 27806070 DEVICE EMBL 25MM 4.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806071 EAP Custom 27806071 DEVICE EMBL 30MM 4.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806072 EAP Custom 27806072 DEVICE EMBL 35MM 4.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806074 EAP Custom 27806074 DEVICE EMBL 30MM 5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$36,689.00" "$27,150.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$6,530.64" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$7,646.39" "$36,689.00" "$14,675.60" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$36,689.00" "$27,516.75" "$36,689.00" "$36,689.00" "$36,689.00" "$18,344.50" "$18,344.50" "$29,057.69" "$36,689.00" "$29,351.20" "$16,510.05" "$36,689.00" "$36,689.00" "$21,279.62" "$36,689.00" "$22,013.40" "$36,689.00" "$36,689.00" "$36,689.00" N/A N/A 27806076 EAP Custom 27806076 DEVICE EMBL 10MM 2.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806077 EAP Custom 27806077 DEVICE EMBL 12MM 2.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806078 EAP Custom 27806078 DEVICE EMBL 16MM 2.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806079 EAP Custom 27806079 DEVICE EMBL 18MM 2.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806080 EAP Custom 27806080 DEVICE EMBL 20MM 2.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806081 EAP Custom 27806081 DEVICE EMBL 10MM 2.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806082 EAP Custom 27806082 DEVICE EMBL 12MM 2.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806083 EAP Custom 27806083 DEVICE EMBL 14MM 2.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806084 EAP Custom 27806084 DEVICE EMBL 16MM 2.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$35,938.00" "$26,594.50" "$6,396.96" "$35,938.00" "$35,938.00" "$35,938.00" "$35,938.00" "$35,938.00" "$35,938.00" "$35,938.00" "$6,396.96" "$35,938.00" "$35,938.00" "$35,938.00" "$35,938.00" "$35,938.00" "$35,938.00" "$7,489.87" "$35,938.00" "$14,375.20" "$35,938.00" "$35,938.00" "$35,938.00" "$35,938.00" "$35,938.00" "$26,953.50" "$35,938.00" "$35,938.00" "$35,938.00" "$17,969.00" "$17,969.00" "$28,462.90" "$35,938.00" "$28,750.40" "$16,172.10" "$35,938.00" "$35,938.00" "$20,844.04" "$35,938.00" "$21,562.80" "$35,938.00" "$35,938.00" "$35,938.00" N/A N/A 27806085 EAP Custom 27806085 DEVICE EMBL 18MM 2.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806086 EAP Custom 27806086 DEVICE EMBL 20MM 2.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806087 EAP Custom 27806087 DEVICE EMBL 10MM 3MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806088 EAP Custom 27806088 DEVICE EMBL 12MM 3MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806089 EAP Custom 27806089 DEVICE EMBL 14MM 3MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806090 EAP Custom 27806090 DEVICE EMBL 16MM 3MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806091 EAP Custom 27806091 DEVICE EMBL 18MM 3MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806092 EAP Custom 27806092 DEVICE EMBL 20MM 3MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806093 EAP Custom 27806093 DEVICE EMBL 10MM 3.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806094 EAP Custom 27806094 DEVICE EMBL 12MM 3.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806095 EAP Custom 27806095 DEVICE EMBL 14MM 3.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806096 EAP Custom 27806096 DEVICE EMBL 16MM 3.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806097 EAP Custom 27806097 DEVICE EMBL 18MM 3.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806098 EAP Custom 27806098 DEVICE EMBL 20MM 3.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806099 EAP Custom 27806099 DEVICE EMBL 10MM 3.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806100 EAP Custom 27806100 DEVICE EMBL 12MM 3.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806101 EAP Custom 27806101 DEVICE EMBL 14MM 3.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806102 EAP Custom 27806102 DEVICE EMBL 16MM 3.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806103 EAP Custom 27806103 DEVICE EMBL 18MM 3.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806104 EAP Custom 27806104 DEVICE EMBL 20MM 3.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806105 EAP Custom 27806105 DEVICE EMBL 10MM 3.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806106 EAP Custom 27806106 DEVICE EMBL 12MM 3.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806107 EAP Custom 27806107 DEVICE EMBL 14MM 3.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806108 EAP Custom 27806108 DEVICE EMBL 16MM 3.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806109 EAP Custom 27806109 DEVICE EMBL 18MM 3.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806110 EAP Custom 27806110 DEVICE EMBL 20MM 3.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806111 EAP Custom 27806111 DEVICE EMBL 10MM 4MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806112 EAP Custom 27806112 DEVICE EMBL 12MM 4MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806113 EAP Custom 27806113 DEVICE EMBL 14MM 4MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806114 EAP Custom 27806114 DEVICE EMBL 16MM 4MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806115 EAP Custom 27806115 DEVICE EMBL 18MM 4MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806116 EAP Custom 27806116 DEVICE EMBL 20MM 4MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806117 EAP Custom 27806117 DEVICE EMBL 10MM 4.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806118 EAP Custom 27806118 DEVICE EMBL 12MM 4.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806119 EAP Custom 27806119 DEVICE EMBL 14MM 4.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806120 EAP Custom 27806120 DEVICE EMBL 16MM 4.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806121 EAP Custom 27806121 DEVICE EMBL 18MM 4.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806122 EAP Custom 27806122 DEVICE EMBL 20MM 4.25MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806123 EAP Custom 27806123 DEVICE EMBL 10MM 4.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806124 EAP Custom 27806124 DEVICE EMBL 12MM 4.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806126 EAP Custom 27806126 DEVICE EMBL 16MM 4.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806127 EAP Custom 27806127 DEVICE EMBL 18MM 4.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806128 EAP Custom 27806128 DEVICE EMBL 20MM 4.5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806129 EAP Custom 27806129 DEVICE EMBL 10MM 4.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806131 EAP Custom 27806131 DEVICE EMBL 14MM 4.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806132 EAP Custom 27806132 DEVICE EMBL 16MM 4.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806133 EAP Custom 27806133 DEVICE EMBL 18MM 4.75MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806134 EAP Custom 27806134 DEVICE EMBL 10MM 5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806135 EAP Custom 27806135 DEVICE EMBL 12MM 5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806136 EAP Custom 27806136 DEVICE EMBL 14MM 5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806137 EAP Custom 27806137 DEVICE EMBL 16MM 5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806138 EAP Custom 27806138 DEVICE EMBL 18MM 5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806139 EAP Custom 27806139 DEVICE EMBL 20MM 5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,227.00" "$25,328.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$6,092.41" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$7,133.28" "$34,227.00" "$13,690.80" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$34,227.00" "$25,670.25" "$34,227.00" "$34,227.00" "$34,227.00" "$17,113.50" "$17,113.50" "$27,107.78" "$34,227.00" "$27,381.60" "$15,402.15" "$34,227.00" "$34,227.00" "$19,851.66" "$34,227.00" "$20,536.20" "$34,227.00" "$34,227.00" "$34,227.00" N/A N/A 27806156 EAP HCPCS C2625 STENT URET 10.2FR 28CM PGTL CURVE LP RADIOPQ SDPRT BOTH IP/OP $281.00 $208.00 $55.77 $281.00 $126.45 $126.45 $126.45 $126.45 $281.00 $281.00 $281.00 $58.57 $281.00 $281.00 $281.00 $281.00 $281.00 $58.56 $281.00 $281.00 $166.21 $281.00 $281.00 $281.00 $281.00 $210.75 $281.00 $281.00 $281.00 $140.50 $140.50 $222.55 $281.00 $224.80 $126.45 $55.77 $281.00 $162.98 $281.00 $281.00 $281.00 $58.56 $281.00 N/A N/A 27806157 EAP HCPCS C1876 STENT VASC 4.5MM 6FR 20MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806158 EAP HCPCS C1876 STENT VASC 4.5MM 6FR 30MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806159 EAP HCPCS C1876 STENT BIL 4.5MM 6FR 40MM 120CM BRD SLF XPD RAPEX BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806165 EAP HCPCS C1769 COIL EMBL 8CM 4MM .0125IN AXIUM 1 HAND OP DTCH BOTH IP/OP $575.00 $425.50 $114.12 $575.00 $258.75 $258.75 $258.75 $258.75 $575.00 $575.00 $575.00 $119.84 $575.00 $575.00 $575.00 $575.00 $575.00 $119.84 $575.00 $575.00 $340.11 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $258.75 $114.12 $575.00 $333.50 $575.00 $575.00 $575.00 $119.83 $575.00 N/A N/A 27806166 EAP HCPCS C1880 COIL EMBL 30CM 8MM HELIPAQ 18 MCIOL HLCL LOOP DTCH BOTH IP/OP "$1,000.00" $740.00 $208.41 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" $400.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 "$1,000.00" "$1,000.00" $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A 27806167 EAP HCPCS C1887 COIL EMBL 6CM 3MM .0115IN AXIUM 1 HAND OP DTCH BOTH IP/OP "$1,668.00" "$1,234.50" $331.06 "$1,668.00" $750.60 $750.60 $750.60 $750.60 "$1,668.00" "$1,668.00" "$1,668.00" $347.65 "$1,668.00" "$1,668.00" "$1,668.00" "$1,668.00" "$1,668.00" $347.63 "$1,668.00" "$1,668.00" $986.62 "$1,668.00" "$1,668.00" "$1,668.00" "$1,668.00" "$1,251.00" "$1,668.00" "$1,668.00" "$1,668.00" $834.00 $834.00 "$1,321.06" "$1,668.00" "$1,334.40" $750.60 $331.06 "$1,668.00" $967.44 "$1,668.00" "$1,668.00" "$1,668.00" $347.61 "$1,668.00" N/A N/A 27806168 EAP HCPCS C1887 COIL EMBL 50CM 25MM .0145IN AXIUM 1 HAND OP DTCH BOTH IP/OP "$1,575.00" "$1,165.50" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 "$1,575.00" $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 27806169 EAP Custom 27806169 SYSTEM EMBOLIZATION NONADHESIVE DELIVERY SYRINGE LOWER BOTH IP/OP "$5,908.00" "$4,372.00" "$1,051.62" "$5,908.00" "$5,908.00" "$5,908.00" "$5,908.00" "$5,908.00" "$5,908.00" "$5,908.00" "$1,051.62" "$5,908.00" "$5,908.00" "$5,908.00" "$5,908.00" "$5,908.00" "$5,908.00" "$1,231.29" "$5,908.00" "$2,363.20" "$5,908.00" "$5,908.00" "$5,908.00" "$5,908.00" "$5,908.00" "$4,431.00" "$5,908.00" "$5,908.00" "$5,908.00" "$2,954.00" "$2,954.00" "$4,679.14" "$5,908.00" "$4,726.40" "$2,658.60" "$5,908.00" "$5,908.00" "$3,426.64" "$5,908.00" "$3,544.80" "$5,908.00" "$5,908.00" "$5,908.00" N/A N/A 27806170 EAP Custom 27806170 COIL EMBOLIZATION SPHERE 10MM 30CM 10 MICROCOIL SPHERICAL BOTH IP/OP "$2,830.00" "$2,094.50" $503.74 "$2,830.00" "$2,830.00" "$2,830.00" "$2,830.00" "$2,830.00" "$2,830.00" "$2,830.00" $503.74 "$2,830.00" "$2,830.00" "$2,830.00" "$2,830.00" "$2,830.00" "$2,830.00" $589.80 "$2,830.00" "$1,132.00" "$2,830.00" "$2,830.00" "$2,830.00" "$2,830.00" "$2,830.00" "$2,122.50" "$2,830.00" "$2,830.00" "$2,830.00" "$1,415.00" "$1,415.00" "$2,241.36" "$2,830.00" "$2,264.00" "$1,273.50" "$2,830.00" "$2,830.00" "$1,641.40" "$2,830.00" "$1,698.00" "$2,830.00" "$2,830.00" "$2,830.00" N/A N/A 27806171 EAP Custom 27806171 COIL EMBOLIZATION 9MM 14CM 14 MICROCOIL 2 HELICAL MULTIPLE BOTH IP/OP "$2,960.00" "$2,190.50" $526.88 "$2,960.00" "$2,960.00" "$2,960.00" "$2,960.00" "$2,960.00" "$2,960.00" "$2,960.00" $526.88 "$2,960.00" "$2,960.00" "$2,960.00" "$2,960.00" "$2,960.00" "$2,960.00" $616.90 "$2,960.00" "$1,184.00" "$2,960.00" "$2,960.00" "$2,960.00" "$2,960.00" "$2,960.00" "$2,220.00" "$2,960.00" "$2,960.00" "$2,960.00" "$1,480.00" "$1,480.00" "$2,344.32" "$2,960.00" "$2,368.00" "$1,332.00" "$2,960.00" "$2,960.00" "$1,716.80" "$2,960.00" "$1,776.00" "$2,960.00" "$2,960.00" "$2,960.00" N/A N/A 27806172 EAP Custom 27806172 COIL EMBL 10CM 2MM DELTAPAQ 10 MCIOL LOOP DTCH SFT RST DFLC BOTH IP/OP "$2,294.00" "$1,698.00" $408.33 "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" $408.33 "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" $478.09 "$2,294.00" $917.60 "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$1,720.50" "$2,294.00" "$2,294.00" "$2,294.00" "$1,147.00" "$1,147.00" "$1,816.85" "$2,294.00" "$1,835.20" "$1,032.30" "$2,294.00" "$2,294.00" "$1,330.52" "$2,294.00" "$1,376.40" "$2,294.00" "$2,294.00" "$2,294.00" N/A N/A 27806173 EAP Custom 27806173 COIL EMBOLIZATION 4MM 6CM 10 MICROCOIL STRETCH RESISTANT BOTH IP/OP "$2,294.00" "$1,698.00" $408.33 "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" $408.33 "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" $478.09 "$2,294.00" $917.60 "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$1,720.50" "$2,294.00" "$2,294.00" "$2,294.00" "$1,147.00" "$1,147.00" "$1,816.85" "$2,294.00" "$1,835.20" "$1,032.30" "$2,294.00" "$2,294.00" "$1,330.52" "$2,294.00" "$1,376.40" "$2,294.00" "$2,294.00" "$2,294.00" N/A N/A 27806174 EAP Custom 27806174 COIL EMBOLIZATION 8MM 30CM 18 MICROCOIL HELICAL LOOP BOTH IP/OP "$1,358.00" "$1,005.00" $241.72 "$1,358.00" "$1,358.00" "$1,358.00" "$1,358.00" "$1,358.00" "$1,358.00" "$1,358.00" $241.72 "$1,358.00" "$1,358.00" "$1,358.00" "$1,358.00" "$1,358.00" "$1,358.00" $283.02 "$1,358.00" $543.20 "$1,358.00" "$1,358.00" "$1,358.00" "$1,358.00" "$1,358.00" "$1,018.50" "$1,358.00" "$1,358.00" "$1,358.00" $679.00 $679.00 "$1,075.54" "$1,358.00" "$1,086.40" $611.10 "$1,358.00" "$1,358.00" $787.64 "$1,358.00" $814.80 "$1,358.00" "$1,358.00" "$1,358.00" N/A N/A 27806175 EAP Custom 27806175 COIL EMBOLIZATION HELIX 4MM .0125IN 8CM 1 HAND OPERATION BOTH IP/OP "$1,893.00" "$1,401.00" $336.95 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $336.95 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 "$1,893.00" "$1,893.00" "$1,097.94" "$1,893.00" "$1,135.80" "$1,893.00" "$1,893.00" "$1,893.00" N/A N/A 27806176 EAP Custom 27806176 COIL EMBOLIZATION 3D 3MM .0115IN 6CM 1 HAND OPERATION BOTH IP/OP "$2,555.00" "$1,891.00" $454.79 "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" $454.79 "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" $532.49 "$2,555.00" "$1,022.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$1,916.25" "$2,555.00" "$2,555.00" "$2,555.00" "$1,277.50" "$1,277.50" "$2,023.56" "$2,555.00" "$2,044.00" "$1,149.75" "$2,555.00" "$2,555.00" "$1,481.90" "$2,555.00" "$1,533.00" "$2,555.00" "$2,555.00" "$2,555.00" N/A N/A 27806177 EAP Custom 27806177 COIL EMBOLIZATION 3D 25MM .0145IN 50CM 1 HAND OPERATION BOTH IP/OP "$2,555.00" "$1,891.00" $454.79 "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" $454.79 "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" $532.49 "$2,555.00" "$1,022.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$1,916.25" "$2,555.00" "$2,555.00" "$2,555.00" "$1,277.50" "$1,277.50" "$2,023.56" "$2,555.00" "$2,044.00" "$1,149.75" "$2,555.00" "$2,555.00" "$1,481.90" "$2,555.00" "$1,533.00" "$2,555.00" "$2,555.00" "$2,555.00" N/A N/A 27806178 EAP HCPCS C1757 SYSTEM DLV ANGJT PWR PLS Y SPK IRR 1 WY STPCK THRMB CATH BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 27806179 EAP HCPCS C1874 STENT VASCULAR 4.5MM 28MM W/O DISTAL TIP ENTERPRISE NITINOL BOTH IP/OP "$13,910.00" "$10,293.50" "$2,760.79" "$13,910.00" "$6,259.50" "$6,259.50" "$6,259.50" "$6,259.50" "$13,910.00" "$13,910.00" "$13,910.00" "$2,899.19" "$13,910.00" "$13,910.00" "$13,910.00" "$13,910.00" "$13,910.00" "$2,899.00" "$13,910.00" "$13,910.00" "$6,857.63" "$13,910.00" "$13,910.00" "$13,910.00" "$13,910.00" "$10,432.50" "$13,910.00" "$13,910.00" "$13,910.00" "$6,955.00" "$6,955.00" "$11,016.72" "$13,910.00" "$11,128.00" "$6,259.50" "$2,760.79" "$13,910.00" "$8,067.80" "$13,910.00" "$13,910.00" "$13,910.00" "$2,898.84" "$13,910.00" N/A N/A 27806180 EAP HCPCS C1874 STENT VASCULAR 4.5MM 37MM W/O DISTAL TIP ENTERPRISE NITINOL BOTH IP/OP "$13,910.00" "$10,293.50" "$2,760.79" "$13,910.00" "$6,259.50" "$6,259.50" "$6,259.50" "$6,259.50" "$13,910.00" "$13,910.00" "$13,910.00" "$2,899.19" "$13,910.00" "$13,910.00" "$13,910.00" "$13,910.00" "$13,910.00" "$2,899.00" "$13,910.00" "$13,910.00" "$6,857.63" "$13,910.00" "$13,910.00" "$13,910.00" "$13,910.00" "$10,432.50" "$13,910.00" "$13,910.00" "$13,910.00" "$6,955.00" "$6,955.00" "$11,016.72" "$13,910.00" "$11,128.00" "$6,259.50" "$2,760.79" "$13,910.00" "$8,067.80" "$13,910.00" "$13,910.00" "$13,910.00" "$2,898.84" "$13,910.00" N/A N/A 27806181 EAP HCPCS C1769 GUIDEWIRE VASCULAR J .014IN 205CM 42CM SOFT TIP STEERABLE BOTH IP/OP "$1,150.00" $851.00 $228.25 "$1,150.00" $517.50 $517.50 $517.50 $517.50 "$1,150.00" "$1,150.00" "$1,150.00" $239.69 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 $680.23 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 $228.25 "$1,150.00" $667.00 "$1,150.00" "$1,150.00" "$1,150.00" $239.66 "$1,150.00" N/A N/A 27806182 EAP HCPCS C1769 GUIDEWIRE VASCULAR J .014IN 205CM 43CM SOFT TIP STEERABLE BOTH IP/OP "$1,150.00" $851.00 $228.25 "$1,150.00" $517.50 $517.50 $517.50 $517.50 "$1,150.00" "$1,150.00" "$1,150.00" $239.69 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" "$1,150.00" $680.23 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 $228.25 "$1,150.00" $667.00 "$1,150.00" $690.00 "$1,150.00" $239.66 "$1,150.00" N/A N/A 27806183 EAP HCPCS C1722 DEFIBRILLATOR CRD .99CM 5.37X7.36CM DYNAGEN BOTH IP/OP "$33,750.00" "$24,975.00" "$6,698.53" "$33,750.00" "$15,187.50" "$15,187.50" "$15,187.50" "$15,187.50" "$33,750.00" "$33,750.00" "$33,750.00" "$7,034.34" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$7,033.87" "$33,750.00" "$33,750.00" "$16,638.75" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$25,312.50" "$33,750.00" "$33,750.00" "$33,750.00" "$16,875.00" "$16,875.00" "$26,730.00" "$33,750.00" "$27,000.00" "$15,187.50" "$6,698.53" "$33,750.00" "$19,575.00" "$33,750.00" "$33,750.00" "$33,750.00" "$7,033.50" "$33,750.00" N/A N/A 27806184 EAP HCPCS C1788 CATHETER CENTRAL VENOUS PRO-FUSE TRINIFLEX OD8 FR ATTACHABLE BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 $500.00 $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 27806189 EAP Custom 27806189 GRAFT EVAS 10CM 12MM XCLDR CNTRLT LEG STENT XTD BOTH IP/OP "$11,275.00" "$8,343.50" "$2,006.95" "$11,275.00" "$11,275.00" "$11,275.00" "$11,275.00" "$11,275.00" "$11,275.00" "$11,275.00" "$2,006.95" "$11,275.00" "$11,275.00" "$11,275.00" "$11,275.00" "$11,275.00" "$11,275.00" "$2,349.83" "$11,275.00" "$4,510.00" "$11,275.00" "$11,275.00" "$11,275.00" "$11,275.00" "$11,275.00" "$8,456.25" "$11,275.00" "$11,275.00" "$11,275.00" "$5,637.50" "$5,637.50" "$8,929.80" "$11,275.00" "$9,020.00" "$5,073.75" "$11,275.00" "$11,275.00" "$6,539.50" "$11,275.00" "$6,765.00" "$11,275.00" "$11,275.00" "$11,275.00" N/A N/A 27806190 EAP Custom 27806190 GRAFT EVAS 3.3CM 23MM 19-21MM AORTA BOTH IP/OP "$7,938.00" "$5,874.50" "$1,412.96" "$7,938.00" "$7,938.00" "$7,938.00" "$7,938.00" "$7,938.00" "$7,938.00" "$7,938.00" "$1,412.96" "$7,938.00" "$7,938.00" "$7,938.00" "$7,938.00" "$7,938.00" "$7,938.00" "$1,654.37" "$7,938.00" "$3,175.20" "$7,938.00" "$7,938.00" "$7,938.00" "$7,938.00" "$7,938.00" "$5,953.50" "$7,938.00" "$7,938.00" "$7,938.00" "$3,969.00" "$3,969.00" "$6,286.90" "$7,938.00" "$6,350.40" "$3,572.10" "$7,938.00" "$7,938.00" "$4,604.04" "$7,938.00" "$4,762.80" "$7,938.00" "$7,938.00" "$7,938.00" N/A N/A 27806195 EAP HCPCS C1882 CLARIA MRI QUAD CRT-D DEVICE BOTH IP/OP "$52,375.00" "$38,757.50" "$7,712.84" "$52,375.00" "$23,568.75" "$23,568.75" "$23,568.75" "$23,568.75" "$52,375.00" "$52,375.00" "$52,375.00" "$9,417.94" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$10,915.53" "$52,375.00" "$52,375.00" "$25,820.88" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$39,281.25" "$52,375.00" "$52,375.00" "$52,375.00" "$26,187.50" "$26,187.50" "$41,481.00" "$52,375.00" "$41,900.00" "$23,568.75" "$7,712.84" "$52,375.00" "$30,377.50" "$52,375.00" "$52,375.00" "$52,375.00" "$8,098.48" "$52,375.00" N/A N/A 27806196 EAP HCPCS C1882 DFBR CRD 13MM 51X74MM CLARIA MRI CRT-D SURESCAN BOTH IP/OP "$52,375.00" "$38,757.50" "$7,712.84" "$52,375.00" "$23,568.75" "$23,568.75" "$23,568.75" "$23,568.75" "$52,375.00" "$52,375.00" "$52,375.00" "$9,417.94" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$10,915.53" "$52,375.00" "$52,375.00" "$25,820.88" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$39,281.25" "$52,375.00" "$52,375.00" "$52,375.00" "$26,187.50" "$26,187.50" "$41,481.00" "$52,375.00" "$41,900.00" "$23,568.75" "$7,712.84" "$52,375.00" "$30,377.50" "$52,375.00" "$52,375.00" "$52,375.00" "$8,098.48" "$52,375.00" N/A N/A 27806197 EAP HCPCS C1882 DFBR CRD 13MM 51X71MM SURESCAN CLARIA MRI BOTH IP/OP "$52,375.00" "$38,757.50" "$7,712.84" "$52,375.00" "$23,568.75" "$23,568.75" "$23,568.75" "$23,568.75" "$52,375.00" "$52,375.00" "$52,375.00" "$9,417.94" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$10,915.53" "$52,375.00" "$52,375.00" "$25,820.88" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$39,281.25" "$52,375.00" "$52,375.00" "$52,375.00" "$26,187.50" "$26,187.50" "$41,481.00" "$52,375.00" "$41,900.00" "$23,568.75" "$7,712.84" "$52,375.00" "$30,377.50" "$52,375.00" "$52,375.00" "$52,375.00" "$8,098.48" "$52,375.00" N/A N/A 27806199 EAP HCPCS C1882 CLARIA MRI CRT-D SYSTEM MMAM BOTH IP/OP "$67,375.00" "$49,857.50" "$7,712.84" "$67,375.00" "$30,318.75" "$30,318.75" "$30,318.75" "$30,318.75" "$67,375.00" "$67,375.00" "$67,375.00" "$9,417.94" "$67,375.00" "$67,375.00" "$67,375.00" "$67,375.00" "$67,375.00" "$14,041.69" "$67,375.00" "$67,375.00" "$33,215.88" "$67,375.00" "$67,375.00" "$67,375.00" "$67,375.00" "$50,531.25" "$67,375.00" "$67,375.00" "$67,375.00" "$33,687.50" "$33,687.50" "$53,361.00" "$67,375.00" "$53,900.00" "$30,318.75" "$7,712.84" "$67,375.00" "$39,077.50" "$67,375.00" "$67,375.00" "$67,375.00" "$8,098.48" "$67,375.00" N/A N/A 27806200 EAP Custom 27806200 TARGET XL SOFT 2MM X 3CM -COIL BOTH IP/OP "$5,904.00" "$4,369.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,230.46" "$5,904.00" "$2,361.60" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$4,428.00" "$5,904.00" "$5,904.00" "$5,904.00" "$2,952.00" "$2,952.00" "$4,675.97" "$5,904.00" "$4,723.20" "$2,656.80" "$5,904.00" "$5,904.00" "$3,424.32" "$5,904.00" "$3,542.40" "$5,904.00" "$5,904.00" "$5,904.00" N/A N/A 27806201 EAP Custom 27806201 TARGET XL SOFT 2MM X 6CM -COIL BOTH IP/OP "$5,904.00" "$4,369.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,230.46" "$5,904.00" "$2,361.60" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$4,428.00" "$5,904.00" "$5,904.00" "$5,904.00" "$2,952.00" "$2,952.00" "$4,675.97" "$5,904.00" "$4,723.20" "$2,656.80" "$5,904.00" "$5,904.00" "$3,424.32" "$5,904.00" "$3,542.40" "$5,904.00" "$5,904.00" "$5,904.00" N/A N/A 27806202 EAP Custom 27806202 TARGET XL SOFT 3MM X 6CM -COIL BOTH IP/OP "$5,904.00" "$4,369.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,230.46" "$5,904.00" "$2,361.60" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$4,428.00" "$5,904.00" "$5,904.00" "$5,904.00" "$2,952.00" "$2,952.00" "$4,675.97" "$5,904.00" "$4,723.20" "$2,656.80" "$5,904.00" "$5,904.00" "$3,424.32" "$5,904.00" "$3,542.40" "$5,904.00" "$5,904.00" "$5,904.00" N/A N/A 27806203 EAP Custom 27806203 TARGET XL SOFT 3MM X 9CM - COIL BOTH IP/OP "$5,904.00" "$4,369.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,230.46" "$5,904.00" "$2,361.60" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$4,428.00" "$5,904.00" "$5,904.00" "$5,904.00" "$2,952.00" "$2,952.00" "$4,675.97" "$5,904.00" "$4,723.20" "$2,656.80" "$5,904.00" "$5,904.00" "$3,424.32" "$5,904.00" "$3,542.40" "$5,904.00" "$5,904.00" "$5,904.00" N/A N/A 27806204 EAP Custom 27806204 TARGET XL SOFT 4MM X 8CM - COIL BOTH IP/OP "$5,904.00" "$4,369.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,230.46" "$5,904.00" "$2,361.60" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$4,428.00" "$5,904.00" "$5,904.00" "$5,904.00" "$2,952.00" "$2,952.00" "$4,675.97" "$5,904.00" "$4,723.20" "$2,656.80" "$5,904.00" "$5,904.00" "$3,424.32" "$5,904.00" "$3,542.40" "$5,904.00" "$5,904.00" "$5,904.00" N/A N/A 27806205 EAP Custom 27806205 TARGET XL SOFT 4MM X 12CM -COIL BOTH IP/OP "$5,904.00" "$4,369.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,230.46" "$5,904.00" "$2,361.60" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$4,428.00" "$5,904.00" "$5,904.00" "$5,904.00" "$2,952.00" "$2,952.00" "$4,675.97" "$5,904.00" "$4,723.20" "$2,656.80" "$5,904.00" "$5,904.00" "$3,424.32" "$5,904.00" "$3,542.40" "$5,904.00" "$5,904.00" "$5,904.00" N/A N/A 27806206 EAP Custom 27806206 TARGET XL SOFT 5MM X 10CM COIL BOTH IP/OP "$5,904.00" "$4,369.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,230.46" "$5,904.00" "$2,361.60" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$4,428.00" "$5,904.00" "$5,904.00" "$5,904.00" "$2,952.00" "$2,952.00" "$4,675.97" "$5,904.00" "$4,723.20" "$2,656.80" "$5,904.00" "$5,904.00" "$3,424.32" "$5,904.00" "$3,542.40" "$5,904.00" "$5,904.00" "$5,904.00" N/A N/A 27806207 EAP Custom 27806207 TARGET XL SOFT 5MM X 15CM -COIL BOTH IP/OP "$5,904.00" "$4,369.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,230.46" "$5,904.00" "$2,361.60" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$4,428.00" "$5,904.00" "$5,904.00" "$5,904.00" "$2,952.00" "$2,952.00" "$4,675.97" "$5,904.00" "$4,723.20" "$2,656.80" "$5,904.00" "$5,904.00" "$3,424.32" "$5,904.00" "$3,542.40" "$5,904.00" "$5,904.00" "$5,904.00" N/A N/A 27806208 EAP Custom 27806208 DEV EMB 25MM 3MM BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806210 EAP HCPCS C1882 CLARIA MRI QUAD CRTD SYSTEM MMQM BOTH IP/OP "$67,375.00" "$49,857.50" "$7,712.84" "$67,375.00" "$30,318.75" "$30,318.75" "$30,318.75" "$30,318.75" "$67,375.00" "$67,375.00" "$67,375.00" "$9,417.94" "$67,375.00" "$67,375.00" "$67,375.00" "$67,375.00" "$67,375.00" "$14,041.69" "$67,375.00" "$67,375.00" "$33,215.88" "$67,375.00" "$67,375.00" "$67,375.00" "$67,375.00" "$50,531.25" "$67,375.00" "$67,375.00" "$67,375.00" "$33,687.50" "$33,687.50" "$53,361.00" "$67,375.00" "$53,900.00" "$30,318.75" "$7,712.84" "$67,375.00" "$39,077.50" "$67,375.00" "$67,375.00" "$67,375.00" "$8,098.48" "$67,375.00" N/A N/A 27806211 EAP HCPCS C1876 STENT VASC 4.5MM 6FR 60MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806212 EAP HCPCS C1876 STENT VASC 4.5MM 6FR 80MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806213 EAP HCPCS C1876 STENT VASC 4.5MM 6FR 100MM 120CM OTW SLF BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806214 EAP HCPCS C1876 STENT VASC 4.5MM 6FR 120MM 120CM OTW SLF BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806215 EAP HCPCS C1876 STENT VASC 5MM 6FR 20MM 120CM PERI SUPERA BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806216 EAP HCPCS C1876 STENT VASC 5MM 6FR 30MM 120CM PERI SUPERA BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806217 EAP HCPCS C1876 STENT VASC 5MM 6FR 40MM 120CM PERI SUPERA BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806218 EAP HCPCS C1876 STENT VASC 5MM 6FR 60MM 120CM PERI SUPERA BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806219 EAP HCPCS C1876 STENT VASC 5MM 6FR 80MM 120CM PERI SUPERA BOTH IP/OP "$5,375.00" "$3,977.50" "$1,066.80" "$5,375.00" "$2,418.75" "$2,418.75" "$2,418.75" "$2,418.75" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.28" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.21" "$5,375.00" "$5,375.00" "$2,649.88" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$4,031.25" "$5,375.00" "$5,375.00" "$5,375.00" "$2,687.50" "$2,687.50" "$4,257.00" "$5,375.00" "$4,300.00" "$2,418.75" "$1,066.80" "$5,375.00" "$3,117.50" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.15" "$5,375.00" N/A N/A 27806220 EAP HCPCS C1876 STENT VASC 5MM 6FR 100MM 120CM PERI SUPERA BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806221 EAP HCPCS C1876 STENT VASC 5MM 6FR 120MM 120CM PERI SUPERA BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806222 EAP HCPCS C1876 STENT VASC 5.5MM 6FR 20MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806223 EAP HCPCS C1876 STENT VASC 5.5MM 6FR 30MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806224 EAP HCPCS C1876 STENT VASC 5.5MM 6FR 40MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806225 EAP HCPCS C1876 STENT VASC 5.5MM 6FR 60MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806227 EAP HCPCS C1876 STENT BIL 5.5MM 6FR 100MM 120CM MIMETIC DSGN FLXB BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806228 EAP HCPCS C1876 STENT BIL 5.5MM 6FR 120MM 120CM MIMETIC DSGN FLXB BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806229 EAP HCPCS C1876 STENT VASC 6MM 6FR 20MM 120CM PERI SUPERA BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806230 EAP HCPCS C1876 STENT VASC 6MM 6FR 30MM 120CM PERI SUPERA BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806231 EAP HCPCS C1876 STENT VASC 6MM 6FR 40MM 120CM PERI SUPERA BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806232 EAP HCPCS C1876 STENT VASC 6MM 6FR 60MM 120CM PERI SUPERA BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806233 EAP HCPCS C1876 STENT VASC 6MM 6FR 80MM 120CM PERI SUPERA BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806234 EAP HCPCS C1876 STENT VASC 6MM 6FR 100MM 120CM PERI SUPERA BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806235 EAP HCPCS C1876 STENT VASC 6MM 6FR 120MM 120CM PERI SUPERA BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806236 EAP HCPCS C1876 STENT VASC 6MM 6FR 150MM 120CM PERI SUPERA BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806237 EAP HCPCS C1876 STENT VASC 6.5MM 6FR 20MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806238 EAP HCPCS C1876 STENT VASC 6.5MM 6FR 30MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806239 EAP HCPCS C1876 STENT VASC 6.5MM 6FR 40MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806240 EAP HCPCS C1876 STENT VASC 6.5MM 6FR 60MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806241 EAP HCPCS C1876 STENT VASC 6.5MM 6FR 120MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806242 EAP HCPCS C1876 STENT VASC 6.5MM 6FR 150MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806243 EAP HCPCS C1876 STENT BIL 5.5MM 6FR 150MM 120CM MIMETIC DSGN FLXB BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 27806244 EAP Custom 27806244 STENT VASC 6.5MM 6FR 80MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$4,988.00" "$3,691.50" $887.86 "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" $887.86 "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$1,995.20" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" "$4,988.00" "$4,988.00" "$2,893.04" "$4,988.00" "$2,992.80" "$4,988.00" "$4,988.00" "$4,988.00" N/A N/A 27806245 EAP Custom 27806245 DEV EMB 30MM 3MM BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806246 EAP Custom 27806246 DEV EMB 25MM 3.25 BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806247 EAP Custom 27806247 DEV EMB 35MM 3MM BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806248 EAP Custom 27806248 DEV EMB 30MM 3.25 BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806249 EAP Custom 27806249 DEV EMB 35MM 3.25 BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806250 EAP Custom 27806250 DEV EMB 25MM 3.5M BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806251 EAP Custom 27806251 DEV EMB 30MM 3.5M BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806252 EAP Custom 27806252 DEV EMB 55D 3.5MM BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806253 EAP Custom 27806253 DEV EMB 25MM 3.75 BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806254 EAP Custom 27806254 DEV EMB 30MM 3.75 BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806255 EAP Custom 27806255 DEV EMB 55D 3.75MM BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806256 EAP Custom 27806256 DEV EMB 25MM 4MM BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806257 EAP Custom 27806257 DEV EMB 30MM 4MM BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806258 EAP Custom 27806258 DEV EMB 55D 4MM 35 BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806259 EAP Custom 27806259 DEV EMB 25MM 4.25 BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806260 EAP Custom 27806260 DEV EMB 30MM 4.25 BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806261 EAP Custom 27806261 DEV EMB 55D 4.25MM BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806263 EAP Custom 27806263 DEV EMB 55D 4.5MM BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806264 EAP Custom 27806264 DEV EMB 25MM 4.75 BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806265 EAP Custom 27806265 DEV EMB 30MM 4.75 BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806266 EAP Custom 27806266 DEV EMB 55D 4.75MM BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806267 EAP Custom 27806267 DEV EMB 55D 5MM 25 BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806268 EAP Custom 27806268 DEV EMB 30MM 5MM BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806269 EAP Custom 27806269 DEV EMB 55D 5MM 33 BOTH IP/OP "$13,979.00" "$10,344.50" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,488.26" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$2,913.38" "$13,979.00" "$5,591.60" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$13,979.00" "$10,484.25" "$13,979.00" "$13,979.00" "$13,979.00" "$6,989.50" "$6,989.50" "$11,071.37" "$13,979.00" "$11,183.20" "$6,290.55" "$13,979.00" "$13,979.00" "$8,107.82" "$13,979.00" "$8,387.40" "$13,979.00" "$13,979.00" "$13,979.00" N/A N/A 27806270 EAP Custom 27806270 DEV EMB 55D 2.5MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806271 EAP Custom 27806271 DEV EMB 12MM 2.5M BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806272 EAP Custom 27806272 DEV EMB 16MM 2.5M BOTH IP/OP "$32,603.00" "$24,126.50" "$5,803.33" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$5,803.33" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$6,794.82" "$32,603.00" "$13,041.20" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$24,452.25" "$32,603.00" "$32,603.00" "$32,603.00" "$16,301.50" "$16,301.50" "$25,821.58" "$32,603.00" "$26,082.40" "$14,671.35" "$32,603.00" "$32,603.00" "$18,909.74" "$32,603.00" "$19,561.80" "$32,603.00" "$32,603.00" "$32,603.00" N/A N/A 27806273 EAP Custom 27806273 DEV EMB 18MM 2.5M BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806274 EAP Custom 27806274 DEV EMB 55D 2.5MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806275 EAP Custom 27806275 DEV EMB 10MM 2.75 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806276 EAP Custom 27806276 DEV EMB 12MM 2.75 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806277 EAP Custom 27806277 DEV EMB 14MM 2.75 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806278 EAP Custom 27806278 DEV EMB 55D 2.75MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806279 EAP Custom 27806279 DEV EMB 18MM 2.75 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806280 EAP Custom 27806280 DEV EMB 55D 2.75MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806281 EAP Custom 27806281 DEV EMB 10MM 3MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806282 EAP Custom 27806282 DEV EMB 12MM 3MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806283 EAP Custom 27806283 DEV EMB 55D 3MM 14 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806284 EAP Custom 27806284 DEV EMB 16MM 3MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806285 EAP Custom 27806285 DEV EMB 55D 3MM 18 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806286 EAP Custom 27806286 DEV EMB 55D 3MM 20 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806287 EAP Custom 27806287 DEV EMB 10MM 3.25 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806288 EAP Custom 27806288 DEV EMB 12MM 3.25 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806289 EAP Custom 27806289 DEV EMB 55D 3.25MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806290 EAP Custom 27806290 DEV EMB 16MM 3.25 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806291 EAP Custom 27806291 DEV EMB 55D 3.25MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806292 EAP Custom 27806292 DEV EMB 55D 3.25MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806293 EAP Custom 27806293 DEV EMB 10MM 3.5M BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806294 EAP Custom 27806294 DEV EMB 55D 3.5MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806295 EAP Custom 27806295 DEV EMB 55D 3.5MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806296 EAP Custom 27806296 DEV EMB 55D 3.5MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806297 EAP Custom 27806297 DEV EMB 55D 3.5MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806298 EAP Custom 27806298 DEV EMB 55D 3.5MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806299 EAP Custom 27806299 DEV EMB 10MM 3.75 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806300 EAP Custom 27806300 DEV EMB 12MM 3.75 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806301 EAP Custom 27806301 DEV EMB 55D 3.75MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806302 EAP Custom 27806302 DEV EMB 16MM 3.75 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806303 EAP Custom 27806303 DEV EMB 55D 3.75MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806304 EAP Custom 27806304 DEV EMB 55D 3.75MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806305 EAP Custom 27806305 DEV EMB 55D 4MM 10 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806306 EAP Custom 27806306 DEV EMB 55D 4MM 12 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806307 EAP Custom 27806307 DEV EMB 55D 4MM 14 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806308 EAP Custom 27806308 DEV EMB 55D 4MM 16 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806309 EAP Custom 27806309 DEV EMB 55D 4MM 18 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806310 EAP Custom 27806310 DEV EMB 55D 4MM 20 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806311 EAP Custom 27806311 DEV EMB 10MM 4.25 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806312 EAP Custom 27806312 DEV EMB 55D 4.25MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806313 EAP Custom 27806313 DEV EMB 55D 4.25MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806314 EAP Custom 27806314 DEV EMB 55D 4.25MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806315 EAP Custom 27806315 DEV EMB 55D 4.25MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806316 EAP Custom 27806316 DEV EMB 55D 4.25MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806317 EAP Custom 27806317 DEV EMB 10MM 4.5M BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806318 EAP Custom 27806318 DEV EMB 55D 4.5MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806319 EAP Custom 27806319 DEV EMB 55D 4.5MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806320 EAP Custom 27806320 DEV EMB 55D 4.5MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806321 EAP Custom 27806321 DEV EMB 55D 4.5MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806322 EAP Custom 27806322 DEV EMB 10MM 4.75 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806323 EAP Custom 27806323 DEV EMB 55D 4.75MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806324 EAP Custom 27806324 DEV EMB 55D 4.75MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806325 EAP Custom 27806325 DEV EMB 55D 4.75MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806327 EAP Custom 27806327 DEV EMB 10MM 5MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806328 EAP Custom 27806328 DEV EMB 12MM 5MM BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806329 EAP Custom 27806329 DEV EMB 55D 5MM 14 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806330 EAP Custom 27806330 DEV EMB 55D 5MM 16 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806331 EAP Custom 27806331 DEV EMB 55D 5MM 18 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806332 EAP Custom 27806332 DEV EMB 55D 5MM 20 BOTH IP/OP "$13,041.00" "$9,650.50" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,321.30" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$2,717.89" "$13,041.00" "$5,216.40" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$13,041.00" "$9,780.75" "$13,041.00" "$13,041.00" "$13,041.00" "$6,520.50" "$6,520.50" "$10,328.47" "$13,041.00" "$10,432.80" "$5,868.45" "$13,041.00" "$13,041.00" "$7,563.78" "$13,041.00" "$7,824.60" "$13,041.00" "$13,041.00" "$13,041.00" N/A N/A 27806333 EAP INNOVA 5MM X 20MM X 75CM BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806334 EAP HCPCS C1876 INNOVA 5MM X 40MM X 75CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806335 EAP HCPCS C1876 INNOVA 5MM X 60MM X 75CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806336 EAP HCPCS C1876 INNOVA 5MM X 80MM X 75CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806337 EAP HCPCS C1876 INNOVA 5MM X 100MM X 75CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806338 EAP HCPCS C1876 INNOVA 5MM X 120MM X 75CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806339 EAP HCPCS C1876 INNOVA 6MM X 20MM X 75CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806340 EAP HCPCS C1876 STENT VASC BLUE 40MM 6MM INNOVA SLF XPD RADIOPQ BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806341 EAP HCPCS C1876 STENT VASC BLUE 60MM 6MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806342 EAP HCPCS C1876 STENT VASC BLUE 80MM 6MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806343 EAP HCPCS C1876 STENT VASC BLUE 100MM 6MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806344 EAP HCPCS C1876 INNOVA 6MM X 120MM X 75CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806345 EAP HCPCS C1876 INNOVA 7MM X 20MM X 75CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806346 EAP HCPCS C1876 STENT VASC BLUE 40MM 7MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806347 EAP HCPCS C1876 STENT VASC BLUE 60MM 7MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806348 EAP HCPCS C1876 STENT VASC BLUE 80MM 7MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806349 EAP HCPCS C1876 STENT VASC BLUE 100MM 7MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806350 EAP HCPCS C1876 INNOVA 7MM X 120MM X 75CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806351 EAP HCPCS C1876 STENT VASC BLUE 20MM 7MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806352 EAP HCPCS C1876 STENT VASC BLUE 40MM 8MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806353 EAP HCPCS C1876 STENT VASC BLUE 60MM 8MM INNOVA SLF XPD RADIOPQ BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806354 EAP HCPCS C1876 STENT VASC BLUE 80MM 8MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806355 EAP HCPCS C1876 INNOVA 8MM X 100MM X 75CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806356 EAP HCPCS C1876 INNOVA 8MM X 120MM X 75CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806357 EAP HCPCS C1876 INNOVA 5MM X 20MM X 130CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806358 EAP HCPCS C1876 STENT VASC BLUE 40MM 5MM INNOVA SLF XPD RADIOPQ BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806359 EAP HCPCS C1876 STENT VASC BLUE 60MM 5MM INNOVA SLF XPD RADIOPQ BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806360 EAP HCPCS C1876 STENT VASC BLUE 80MM 5MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806361 EAP HCPCS C1876 STENT VASC BLUE 100MM 5MM INNOVA SLF XPD RADIOPQ BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806362 EAP HCPCS C1876 STENT VASC BLUE 120MM 5MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806363 EAP HCPCS C1876 INNOVA 6MM X 20MM X 130CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806364 EAP HCPCS C1876 STENT VASC BLUE 40MM 6MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806365 EAP HCPCS C1876 STENT VASC 60MM 6MM INNOVA SLF XPD RADIOPQ BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806366 EAP HCPCS C1876 STENT VASC BLUE 80MM 6MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806367 EAP HCPCS C1876 STENT VASC 100MM 6MM INNOVA SLF XPD RADIOPQ BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806368 EAP HCPCS C1876 STENT VASC BLUE 120MM 6MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806369 EAP HCPCS C1876 INNOVA 7MM X 20MM X 130CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806370 EAP HCPCS C1876 STENT VASC BLUE 40MM 7MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806371 EAP HCPCS C1876 STENT VASC BLUE 60MM 7MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806372 EAP HCPCS C1876 STENT VASC BLUE 80MM 7MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806373 EAP HCPCS C1876 STENT VASC BLUE 100MM 7MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806374 EAP HCPCS C1876 STENT VASC BLUE 120MM 7MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806375 EAP HCPCS C1876 INNOVA 8MM X 20MM X 130CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806376 EAP HCPCS C1876 INNOVA 8MM X 40MM X 130CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806377 EAP HCPCS C1876 INNOVA 8MM X 60MM X 130CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806378 EAP HCPCS C1876 INNOVA 8MM X 80MM X 130CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806379 EAP HCPCS C1876 INNOVA 8MM X 100MM X 130CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806380 EAP HCPCS C1876 INNOVA 8MM X 120MM X 130CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 27806381 EAP Custom 27806381 COIL EMBL 18D .018IN 2MM 2CM AZUR HDRCL DTCH PLTN DDRGL PERI BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806382 EAP Custom 27806382 COIL EMBL 18D .018IN 2MM 4CM AZUR HDRCL DTCH PLTN DDRGL PERI BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806383 EAP Custom 27806383 COIL EMBL 3MM .018IN 2CM AZUR HDRCL 18 COIL DTCH PLTN DDRGL BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806384 EAP Custom 27806384 COIL EMBL .018IN 3MM .021IN 5CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806385 EAP Custom 27806385 COIL EMBL .018IN 4MM 5CM AZUR BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806386 EAP Custom 27806386 SYSTEM EMBL 5MM .018IN 5CM AZUR HDRCL 18 DTCH PLTN DDRGL BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806387 EAP HCPCS C1882 "CLARIA MRI CRT-D SYSTEM, MMAE" BOTH IP/OP "$67,375.00" "$49,857.50" "$7,712.84" "$67,375.00" "$30,318.75" "$30,318.75" "$30,318.75" "$30,318.75" "$67,375.00" "$67,375.00" "$67,375.00" "$9,417.94" "$67,375.00" "$67,375.00" "$67,375.00" "$67,375.00" "$67,375.00" "$14,041.69" "$67,375.00" "$67,375.00" "$33,215.88" "$67,375.00" "$67,375.00" "$67,375.00" "$67,375.00" "$50,531.25" "$67,375.00" "$67,375.00" "$67,375.00" "$33,687.50" "$33,687.50" "$53,361.00" "$67,375.00" "$53,900.00" "$30,318.75" "$7,712.84" "$67,375.00" "$39,077.50" "$67,375.00" "$67,375.00" "$67,375.00" "$8,098.48" "$67,375.00" N/A N/A 27806388 EAP HCPCS C1882 "CLARIA MRI QUAD CRTD SYSTEM, MMQE" BOTH IP/OP "$67,375.00" "$49,857.50" "$7,712.84" "$67,375.00" "$30,318.75" "$30,318.75" "$30,318.75" "$30,318.75" "$67,375.00" "$67,375.00" "$67,375.00" "$9,417.94" "$67,375.00" "$67,375.00" "$67,375.00" "$67,375.00" "$67,375.00" "$14,041.69" "$67,375.00" "$67,375.00" "$33,215.88" "$67,375.00" "$67,375.00" "$67,375.00" "$67,375.00" "$50,531.25" "$67,375.00" "$67,375.00" "$67,375.00" "$33,687.50" "$33,687.50" "$53,361.00" "$67,375.00" "$53,900.00" "$30,318.75" "$7,712.84" "$67,375.00" "$39,077.50" "$67,375.00" "$67,375.00" "$67,375.00" "$8,098.48" "$67,375.00" N/A N/A 27806389 EAP Custom 27806389 SYSTEM EMBL 5MM .018IN 10CM AZUR HDRCL 18 DTCH PLTN DDRGL BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806390 EAP Custom 27806390 SYSTEM EMBL 5MM .018IN 15CM AZUR 18 DTCH HDRCL PERI BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806391 EAP Custom 27806391 SYSTEM EMBL 5MM .018IN 20CM AZUR 18 DTCH HDRCL PERI BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806392 EAP Custom 27806392 COIL EMBL 4MM .018IN 10CM 135CM AZUR DTCH PLTN DDRGL PERI BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806393 EAP Custom 27806393 COIL EMBL .018IN 6MM .021IN 10CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806394 EAP Custom 27806394 COIL EMBL .018IN 8MM .021IN 10CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806395 EAP Custom 27806395 COIL EMBL .018IN 10MM .021IN 10CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806396 EAP Custom 27806396 COIL EMBL 6MM .018IN 15CM 135CM AZUR 18 COIL DTCH HDRCL PLTN BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806397 EAP Custom 27806397 COIL EMBL .018IN 8MM .021IN 15CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806398 EAP Custom 27806398 COIL EMBL .018IN 10MM .021IN 15CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806399 EAP Custom 27806399 COIL EMBL .018IN 12MM .021IN 15CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806400 EAP HCPCS C2617 SET STENT 2 PIGTAIL CURVE 8FR 26CM RADIOPQ GRADUAT BOTH IP/OP $269.00 $199.50 $53.39 $269.00 $121.05 $121.05 $121.05 $121.05 $269.00 $269.00 $269.00 $56.07 $269.00 $269.00 $269.00 $269.00 $269.00 $56.06 $269.00 $269.00 $159.11 $269.00 $269.00 $269.00 $269.00 $201.75 $269.00 $269.00 $269.00 $134.50 $134.50 $213.05 $269.00 $215.20 $121.05 $53.39 $269.00 $156.02 $269.00 $269.00 $269.00 $56.06 $269.00 N/A N/A 27806401 EAP HCPCS C1874 GRAFT EVAS 106MM 12MM H&L-B 1-SHOT ZNTH FENESTRATE BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27806405 EAP Custom 27806405 COIL EMBL 8MM 20CM AZUR HDRCL 18 COILS DTCH BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806406 EAP Custom 27806406 COIL EMBL .018IN 12MM .021IN 20CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806407 EAP Custom 27806407 COIL EMBL 15MM 20CM AZUR HDRCL 18 COILS DTCH BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806408 EAP Custom 27806408 COIL EMBL 20MM .018IN 20CM STRL AZUR HDRCL DTCH PLTN DDRGL BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806409 EAP Custom 27806409 COIL EMBL 15MM .018IN 30CM STRL AZUR HDRCL 18 COIL DTCH PLTN BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806410 EAP Custom 27806410 COIL EMBL 20MM .018IN 30CM STRL AZUR 18 COIL DTCH HDRCL PLTN BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806411 EAP Custom 27806411 COIL EMBL .018IN 4MM .021-.027IN 13CM STRL AZUR CX DTCH PLTN BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806412 EAP Custom 27806412 COIL EMBL .018IN 5MM .021-.027IN 16CM AZUR CX DTCH SFT FLXB BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806413 EAP Custom 27806413 COIL EMBL .018IN 6MM .021-.027IN 20CM AZUR CX DTCH SFT FLXB BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806414 EAP Custom 27806414 COIL EMBL .018IN 7MM .021-.027IN 24CM AZUR CX DTCH SFT FLXB BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806415 EAP Custom 27806415 COIL EMBL .018IN 8MM .021-.027IN 28CM AZUR CX HDRCL DTCH SFT BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806416 EAP Custom 27806416 COIL EMBL .018IN 9MM .021-.027IN 28CM AZUR CX HDRCL DTCH SFT BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806417 EAP Custom 27806417 COIL EMBL .018IN 10MM .021-.027IN 32CM AZUR CX HDRCL DTCH BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806418 EAP Custom 27806418 COIL EMBL .018IN 12MM .021-.027IN 38CM AZUR CX HDRCL DTCH BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806419 EAP Custom 27806419 COIL EMBL .018IN 14MM .021-.027IN 34CM AZUR CX HDRCL DTCH BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806420 EAP Custom 27806420 COIL EMBL .018IN 16MM .021-.027IN 39CM AZUR CX HDRCL DTCH BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806421 EAP Custom 27806421 COIL EMBL .018IN 18MM .021-.027IN 36CM AZUR CX HDRCL DTCH BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806422 EAP Custom 27806422 COIL EMBL .018IN 20MM .021-.027IN 40CM AZUR CX HDRCL DTCH BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806423 EAP Custom 27806423 COIL EMBL .035IN 4MM .038IN 5CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806424 EAP Custom 27806424 COIL EMBL 4MM 10CM AZUR DTCH DDRGL PERI 35 SYS BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806425 EAP Custom 27806425 COIL EMBL .035IN 6MM .038IN 10CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806426 EAP Custom 27806426 COIL EMBL .035IN 4MM 15CM AZUR DTCH DDRGL PERI BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806427 EAP Custom 27806427 COIL EMBL .035IN 6MM .038IN 15CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806428 EAP Custom 27806428 COIL EMBL .035IN 8MM .038IN 15CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806429 EAP Custom 27806429 COIL EMBL .035IN 10MM .038IN 15CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806430 EAP Custom 27806430 COIL EMBL 6MM 20CM AZUR DTCH DDRGL PERI 35 SYS BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806431 EAP Custom 27806431 COIL EMBL .035IN 8MM .038IN 20CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806432 EAP Custom 27806432 COIL EMBL .035IN 12MM .038IN 20CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806433 EAP Custom 27806433 COIL EMBL .035IN 15MM .038IN 20CM 135CM AZUR DTCH PLTN DDRGL BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806434 EAP Custom 27806434 COIL EMBL 20MM 20CM AZUR DTCH DDRGL PERI 35 SYS BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806435 EAP Custom 27806435 COIL EMBL 12MM 30CM AZUR DTCH DDRGL PERI 35 SYS BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806436 EAP Custom 27806436 COIL EMBL .035IN 4MM 7CM AZUR CX DTCH SFT SLD COR FLXB DDRGL BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806437 EAP Custom 27806437 COIL EMBL .035IN 5MM 11CM AZUR CX DTCH SFT SLD COR FLXB BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806438 EAP Custom 27806438 COIL EMBL .035IN 6MM 9CM AZUR CX DTCH SFT SLD COR FLXB DDRGL BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806439 EAP Custom 27806439 COIL EMBL .035IN 6MM 17CM AZUR CX DTCH CX SECT CVRGLS FLXB BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806440 EAP Custom 27806440 COIL EMBL .035IN 8MM 12CM AZUR CX DTCH SFT SLD COR FLXB BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806441 EAP Custom 27806441 COIL EMBL .035IN 8MM 24CM AZUR CX DTCH SFT SLD COR FLXB BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806442 EAP Custom 27806442 COIL EMBL .035IN 10MM 19CM AZUR CX DTCH SFT SLD COR FLXB BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806443 EAP Custom 27806443 COIL EMBL .035IN 13MM 24CM AZUR CX DTCH SFT SLD COR FLXB BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806444 EAP Custom 27806444 COIL EMBL .035IN 16MM 32CM AZUR CX DTCH SFT SLD COR FLXB BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806445 EAP Custom 27806445 COIL EMBL .035IN 10MM .038IN 26CM 150CM AZUR FRME ELC DTCH BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 27806446 EAP Custom 27806446 COIL EMBL 8MM 20CM AZUR FRM BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806447 EAP Custom 27806447 COIL EMBL .018IN 10MM .021IN 26CM 150CM AZUR FRME ELC DTCH BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806448 EAP Custom 27806448 COIL EMBL .018IN 14MM 34MM AZUR FRME NONHYDROGEL DTCH LOOP BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806449 EAP Custom 27806449 COIL EMBL .018IN 20MM .021IN 50CM 150CM AZUR FRME ELC DTCH BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 27806450 EAP Custom 27806450 COIL EMBL AZUR DTCH CNTRLR BOTH IP/OP $425.00 $314.50 $75.65 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $75.65 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $425.00 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $425.00 $425.00 $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 27806493 EAP HCPCS C1874 GRAFT EVAS 91MM 12FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$5,562.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27806494 EAP HCPCS C1874 GRAFT EVAS 124MM 32MM H&L-B 1-SHOT ZNTH 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$16,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27806596 EAP HCPCS C1874 GRAFT EVAS 121MM 12MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27806798 EAP HCPCS C1874 GRAFT EVAS 76MM 16FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27806899 EAP HCPCS C1874 GRAFT EVAS 76MM 20FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27807101 EAP HCPCS C1874 GRAFT EVAS 91MM 16FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27807202 EAP HCPCS C1874 GRAFT EVAS 91MM 20FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$5,562.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27807303 EAP HCPCS C1874 GRAFT EVAS 106MM 16FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27807404 EAP HCPCS C1874 GRAFT EVAS 106MM 20FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27807505 EAP HCPCS C1874 GRAFT EVAS 121MM 16FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27807606 EAP HCPCS C1874 GRAFT EVAS 121MM 20FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27807707 EAP HCPCS C1874 GRAFT EVAS 76MM 12FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$5,562.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27807808 EAP HCPCS C1874 GRAFT EVAS 76MM 16FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27807909 EAP HCPCS C1874 GRAFT EVAS 76MM 20FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27808010 EAP HCPCS C1874 GRAFT EVAS 76MM 24FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27808111 EAP HCPCS C1874 GRAFT EVAS 91MM 12FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$5,562.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27808212 EAP HCPCS C1874 GRAFT EVAS 91MM 16FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27808313 EAP HCPCS C1874 GRAFT EVAS 91MM 20FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$3,708.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27808414 EAP HCPCS C1874 GRAFT EVAS 91MM 24FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27808515 EAP HCPCS C1874 GRAFT EVAS 106MM 12FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27808616 EAP HCPCS C1874 GRAFT EVAS 106MM 16FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27808717 EAP HCPCS C1874 GRAFT EVAS 106MM 20FR ZNTH H&L-B 1-SHOT VSCR FEN BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27808818 EAP HCPCS C1874 GRAFT EVAS 106MM 24FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27808919 EAP HCPCS C1874 GRAFT EVAS 121MM 12FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$5,562.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27809020 EAP HCPCS C1874 GRAFT EVAS 121MM 16FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$5,562.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27809021 EAP HCPCS C1876 TENT VASC STRG 10MM 30MM XACT SLF XPD CLS CELL FL BOTH IP/OP "$4,938.00" "$3,654.50" $980.07 "$4,938.00" "$2,222.10" "$2,222.10" "$2,222.10" "$2,222.10" "$4,938.00" "$4,938.00" "$4,938.00" "$1,029.20" "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" "$1,029.13" "$4,938.00" "$4,938.00" "$2,434.43" "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" "$3,703.50" "$4,938.00" "$4,938.00" "$4,938.00" "$2,469.00" "$2,469.00" "$3,910.90" "$4,938.00" "$3,950.40" "$2,222.10" $980.07 "$4,938.00" "$2,864.04" "$4,938.00" "$4,938.00" "$4,938.00" "$1,029.08" "$4,938.00" N/A N/A 27809121 EAP HCPCS C1874 GRAFT EVAS 121MM 20FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27809222 EAP HCPCS C1874 GRAFT EVAS 121MM 24FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27809323 EAP HCPCS C1874 GRAFT EVAS 76MM 12FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27809424 EAP HCPCS C1874 GRAFT EVAS 76MM 20MM 8.1MM 20FR ZNTH AAA DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27809525 EAP HCPCS C1874 GRAFT EVAS 76MM 24FR ZNTH 1-SHOT AAA 2 BRCH VSCR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27809626 EAP HCPCS C1874 GRAFT EVAS 91MM 12FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$3,708.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27809727 EAP HCPCS C1874 GRAFT EVAS 91MM 16FR ZNTH AAA FENST DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$3,708.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$5,562.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27809828 EAP HCPCS C1874 GRAFT EVAS 91MM 20FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$3,708.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$5,562.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27809929 EAP HCPCS C1874 GRAFT EVAS 91MM 24FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$3,708.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27809930 EAP HCPCS C1876 STENT ENDOTH 12MM 8FR 40MM 100CM FLEX RECONS BOTH IP/OP "$2,438.00" "$1,804.50" $483.88 "$2,438.00" "$1,097.10" "$1,097.10" "$1,097.10" "$1,097.10" "$2,438.00" "$2,438.00" "$2,438.00" $508.14 "$2,438.00" "$2,438.00" "$2,438.00" "$2,438.00" "$2,438.00" $508.11 "$2,438.00" "$2,438.00" "$1,442.08" "$2,438.00" "$2,438.00" "$2,438.00" "$2,438.00" "$1,828.50" "$2,438.00" "$2,438.00" "$2,438.00" "$1,219.00" "$1,219.00" "$1,930.90" "$2,438.00" "$1,950.40" "$1,097.10" $483.88 "$2,438.00" "$1,414.04" "$2,438.00" "$2,438.00" "$2,438.00" $508.08 "$2,438.00" N/A N/A 27809931 EAP HCPCS C1788 SET HMDIAL 33ML LF AQDX BLD CRCT UF-500 BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 "$2,250.00" "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 27810030 EAP HCPCS C1874 GRAFT EVAS 106MM 12FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27810131 EAP HCPCS C1874 GRAFT EVAS 106MM 16FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27810232 EAP HCPCS C1874 GRAFT EVAS 106MM 20FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27810333 EAP HCPCS C1874 GRAFT EVAS 106MM 24FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27810434 EAP HCPCS C1874 GRAFT EVAS 121MM 12FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27810535 EAP HCPCS C1874 GRAFT EVAS 121MM 16FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$5,562.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27810636 EAP HCPCS C1874 GRAFT EVAS 121MM 20FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27810737 EAP HCPCS C1874 GRAFT EVAS 121MM 24FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27810838 EAP HCPCS C1874 GRAFT EVAS 76MM 16FR ZNTH AAA VSCR FEN DISTAL BFUR BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27810939 EAP HCPCS C1874 GRAFT EVAS 76MM 24MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$5,562.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27811040 EAP HCPCS C1874 GRAFT EVAS 76MM 26MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$16,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27811141 EAP HCPCS C1874 GRAFT EVAS 76MM 28MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$16,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27811242 EAP HCPCS C1874 GRAFT EVAS 76MM 30MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$16,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27811343 EAP HCPCS C1874 GRAFT EVAS 76MM 32MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27811444 EAP HCPCS C1874 GRAFT EVAS 91MM 24MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$16,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27811545 EAP HCPCS C1874 GRAFT EVAS 91MM 26MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27811646 EAP HCPCS C1874 GRAFT EVAS 91MM 28MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$16,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27811747 EAP HCPCS C1874 GRAFT EVAS 91MM 30MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27811848 EAP HCPCS C1874 GRAFT EVAS 91MM 32MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27811949 EAP HCPCS C1874 GRAFT EVAS 106MM 24MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27812050 EAP HCPCS C1874 GRAFT EVAS 106MM 26MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27812151 EAP HCPCS C1874 GRAFT EVAS 106MM 28MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27812252 EAP HCPCS C1874 GRAFT EVAS 106MM 30MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27812353 EAP HCPCS C1874 GRAFT EVAS 106MM 32MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27812454 EAP HCPCS C1874 GRAFT EVAS 121MM 24MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27812555 EAP HCPCS C1874 GRAFT EVAS 121MM 26MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27812656 EAP HCPCS C1874 GRAFT EVAS 121MM 28MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27812757 EAP HCPCS C1874 GRAFT EVAS 121MM 30MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27812858 EAP HCPCS C1874 GRAFT EVAS 121MM 32MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27812959 EAP HCPCS C1874 GRAFT EVAS 84MM 34MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27813060 EAP HCPCS C1874 GRAFT EVAS 84MM 36MM 8.5MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27813161 EAP HCPCS C1874 GRAFT EVAS 99MM 34MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27813262 EAP HCPCS C1874 GRAFT EVAS 99MM 36MM 8.5MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27813363 EAP HCPCS C1874 GRAFT EVAS 114MM 34MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27813464 EAP HCPCS C1874 GRAFT EVAS 114MM 36MM 8.5MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27813565 EAP HCPCS C1874 GRAFT EVAS 129MM 34MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27813666 EAP HCPCS C1874 GRAFT EVAS 129MM 36MM 8.5MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27813767 EAP HCPCS C1874 GRAFT EVAS 94MM 24MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27813868 EAP HCPCS C1874 GRAFT EVAS 94MM 26MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27813969 EAP HCPCS C1874 GRAFT EVAS 94MM 20FR ZNTH AAA VSCR FEN PROX BFUR BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27814070 EAP HCPCS C1874 GRAFT EVAS 94MM 30MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27814171 EAP HCPCS C1874 GRAFT EVAS 94MM 32MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27814272 EAP HCPCS C1874 GRAFT EVAS 109MM 24MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27814373 EAP HCPCS C1874 GRAFT EVAS 109MM 26MM H&L-B 1-SHOT ZNTH 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27814474 EAP HCPCS C1874 GRAFT EVAS 109MM 28MM H&L-B 1-SHOT ZNTH 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27814575 EAP HCPCS C1874 GRAFT EVAS 109MM 30MM H&L-B 1-SHOT ZNTH 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27814676 EAP HCPCS C1874 GRAFT EVAS 109MM 32MM H&L-B 1-SHOT ZNTH 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27814777 EAP HCPCS C1874 GRAFT EVAS 124MM 24MM 7.7MM 20FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27814878 EAP HCPCS C1874 GRAFT EVAS 124MM 12FR ZNTH AAA VSCR FEN DISTAL BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27814979 EAP HCPCS C1874 GRAFT EVAS 124MM 2FR ZNTH AAA FENST PROX BODY 28MM BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27815080 EAP HCPCS C1874 GRAFT EVAS 124MM 30MM H&L-B 1-SHOT ZNTH 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27815282 EAP HCPCS C1874 GRAFT EVAS 107MM 34MM H&L-B 1-SHOT ZNTH 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27815383 EAP HCPCS C1874 GRAFT EVAS 107MM 36MM H&L-B 1-SHOT ZNTH 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27815484 EAP HCPCS C1874 GRAFT EVAS 122MM 34MM 20FR H L-B 1-SHOT ZNTH 2 BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27815585 EAP HCPCS C1874 GRAFT EVAS 122MM 36MM 8.5MM 22FR ZNTH H&L-B 1-SHOT BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27815686 EAP HCPCS C1874 GRAFT EVAS 137MM 34MM H&L-B 1-SHOT ZNTH 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27815787 EAP HCPCS C1874 GRAFT EVAS 137MM 36MM ZNTH H&L-B 1-SHOT 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" "$27,500.00" "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A 27815888 EAP HCPCS C1874 GRAFT EVAS 109MM 20MM 7.7MM 20FR ZNTH FENESTRATE 2 BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" "$9,270.00" "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A 27815889 EAP HCPCS C1881 CATHETER INTVN MIC 2.7FR L130C BOTH IP/OP $818.13 $605.50 $170.51 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $170.51 $818.13 $327.25 $818.13 $818.13 $818.13 $818.13 $818.13 $613.60 $818.13 $818.13 $818.13 $409.07 $409.07 $647.96 $818.13 $654.50 $368.16 $818.13 $818.13 $474.52 $818.13 $490.88 $818.13 $818.13 $818.13 N/A N/A 27815890 EAP Custom 27815890 COIL EMBOL L14CM LOOP OD5MM 0.018IN PLATINUM HYDROGEL POLYME BOTH IP/OP $818.13 $605.50 $145.63 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $145.63 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $170.51 $818.13 $327.25 $818.13 $818.13 $818.13 $818.13 $818.13 $613.60 $818.13 $818.13 $818.13 $409.07 $409.07 $647.96 $818.13 $654.50 $368.16 $818.13 $818.13 $474.52 $818.13 $490.88 $818.13 $818.13 $818.13 N/A N/A 27815891 EAP Custom 27815891 COIL EMBOL L20CM OD6MM 0.018IN HYDROCOIL PUSHABLE AZUR 18P BOTH IP/OP $818.13 $605.50 $145.63 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $145.63 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $170.51 $818.13 $327.25 $818.13 $818.13 $818.13 $818.13 $818.13 $613.60 $818.13 $818.13 $818.13 $409.07 $409.07 $647.96 $818.13 $654.50 $368.16 $818.13 $818.13 $474.52 $818.13 $490.88 $818.13 $818.13 $818.13 N/A N/A 27815892 EAP Custom 27815892 COIL EMBOL L20CM LOOP OD8MM 0.018IN PLATINUM HYDROGEL POLYME BOTH IP/OP $923.33 $683.50 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $192.43 $923.33 $369.33 $923.33 $923.33 $923.33 $923.33 $923.33 $692.50 $923.33 $923.33 $923.33 $461.67 $461.67 $731.28 $923.33 $738.66 $415.50 $923.33 $923.33 $535.53 $923.33 $554.00 $923.33 $923.33 $923.33 N/A N/A 27815893 EAP Custom 27815893 COIL EMBOL L14CM LOOP OD6MM 0.035IN PLATINUM HYDROGEL POLYME BOTH IP/OP $923.33 $683.50 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $192.43 $923.33 $369.33 $923.33 $923.33 $923.33 $923.33 $923.33 $692.50 $923.33 $923.33 $923.33 $461.67 $461.67 $731.28 $923.33 $738.66 $415.50 $923.33 $923.33 $535.53 $923.33 $554.00 $923.33 $923.33 $923.33 N/A N/A 27815894 EAP Custom 27815894 COIL EMBOL L20CM LOOP OD8MM 0.035IN PLATINUM HYDROGEL POLYME BOTH IP/OP $923.33 $683.50 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $192.43 $923.33 $369.33 $923.33 $923.33 $923.33 $923.33 $923.33 $692.50 $923.33 $923.33 $923.33 $461.67 $461.67 $731.28 $923.33 $738.66 $415.50 $923.33 $923.33 $535.53 $923.33 $554.00 $923.33 $923.33 $923.33 N/A N/A 27815895 EAP Custom 27815895 COIL EMBOL L20CM LOOP OD10MM 0.035IN PLATINUM HYDROGEL POLYM BOTH IP/OP $923.33 $683.50 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $192.43 $923.33 $369.33 $923.33 $923.33 $923.33 $923.33 $923.33 $692.50 $923.33 $923.33 $923.33 $461.67 $461.67 $731.28 $923.33 $738.66 $415.50 $923.33 $923.33 $535.53 $923.33 $554.00 $923.33 $923.33 $923.33 N/A N/A 27815896 EAP Custom 27815896 COIL EMBOL L20CM LOOP OD15MM 0 BOTH IP/OP $923.33 $683.50 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $192.43 $923.33 $369.33 $923.33 $923.33 $923.33 $923.33 $923.33 $692.50 $923.33 $923.33 $923.33 $461.67 $461.67 $731.28 $923.33 $738.66 $415.50 $923.33 $923.33 $535.53 $923.33 $554.00 $923.33 $923.33 $923.33 N/A N/A 27815897 EAP Custom 27815897 COIL EMBOL L20CM LOOP OD16MM 0 BOTH IP/OP $818.13 $605.50 $145.63 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $145.63 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $170.51 $818.13 $327.25 $818.13 $818.13 $818.13 $818.13 $818.13 $613.60 $818.13 $818.13 $818.13 $409.07 $409.07 $647.96 $818.13 $654.50 $368.16 $818.13 $818.13 $474.52 $818.13 $490.88 $818.13 $818.13 $818.13 N/A N/A 27815898 EAP Custom 27815898 COIL EMBL .018IN 10MM 14CM AZUR HDRCL PSH PERI 18 SYS BOTH IP/OP $350.63 $259.50 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $262.97 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $157.78 $350.63 $350.63 $203.37 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A 27815899 EAP Custom 27815899 COIL EMBL .018IN 2MM 2CM AZUR HDRCL PSH PERM MECH OCL DDRGL BOTH IP/OP $350.63 $259.50 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $262.97 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $157.78 $350.63 $350.63 $203.37 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A 27815900 EAP Custom 27815900 COIL EMBL .018IN 3MM 2CM AZUR HDRCL PSH LOOP PLTN DDRGL PERI BOTH IP/OP $467.50 $346.00 $83.22 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $83.22 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $97.43 $467.50 $187.00 $467.50 $467.50 $467.50 $467.50 $467.50 $350.63 $467.50 $467.50 $467.50 $233.75 $233.75 $370.26 $467.50 $374.00 $210.38 $467.50 $467.50 $271.15 $467.50 $280.50 $467.50 $467.50 $467.50 N/A N/A 27815901 EAP Custom 27815901 COIL EMBL .018IN 3MM 4CM AZUR HDRCL PSH PERM MECH OCL DDRGL BOTH IP/OP $350.63 $259.50 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $262.97 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $157.78 $350.63 $350.63 $203.37 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A 27815902 EAP Custom 27815902 COIL EMBL .018IN 4MM 2CM AZUR HDRCL PSH PERI 18 SYS BOTH IP/OP $467.50 $346.00 $83.22 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $83.22 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $97.43 $467.50 $187.00 $467.50 $467.50 $467.50 $467.50 $467.50 $350.63 $467.50 $467.50 $467.50 $233.75 $233.75 $370.26 $467.50 $374.00 $210.38 $467.50 $467.50 $271.15 $467.50 $280.50 $467.50 $467.50 $467.50 N/A N/A 27815903 EAP Custom 27815903 COIL EMBL .018IN 4MM 4CM AZUR HDRCL PSH PERI 18 SYS BOTH IP/OP $584.38 $432.50 $104.02 $584.38 $584.38 $584.38 $584.38 $584.38 $584.38 $584.38 $104.02 $584.38 $584.38 $584.38 $584.38 $584.38 $584.38 $121.79 $584.38 $233.75 $584.38 $584.38 $584.38 $584.38 $584.38 $438.29 $584.38 $584.38 $584.38 $292.19 $292.19 $462.83 $584.38 $467.50 $262.97 $584.38 $584.38 $338.94 $584.38 $350.63 $584.38 $584.38 $584.38 N/A N/A 27815904 EAP Custom 27815904 COIL EMBL .018IN 4MM 6CM AZUR HDRCL PSH PERI 18 SYS BOTH IP/OP $689.58 $510.50 $122.75 $689.58 $689.58 $689.58 $689.58 $689.58 $689.58 $689.58 $122.75 $689.58 $689.58 $689.58 $689.58 $689.58 $689.58 $143.72 $689.58 $275.83 $689.58 $689.58 $689.58 $689.58 $689.58 $517.19 $689.58 $689.58 $689.58 $344.79 $344.79 $546.15 $689.58 $551.66 $310.31 $689.58 $689.58 $399.96 $689.58 $413.75 $689.58 $689.58 $689.58 N/A N/A 27815905 EAP Custom 27815905 COIL EMBL .018IN 4MM 6CM AZUR HDRCL PSH PERM MECH OCL DDRGL BOTH IP/OP $701.25 $519.00 $124.82 $701.25 $701.25 $701.25 $701.25 $701.25 $701.25 $701.25 $124.82 $701.25 $701.25 $701.25 $701.25 $701.25 $701.25 $146.15 $701.25 $280.50 $701.25 $701.25 $701.25 $701.25 $701.25 $525.94 $701.25 $701.25 $701.25 $350.63 $350.63 $555.39 $701.25 $561.00 $315.56 $701.25 $701.25 $406.73 $701.25 $420.75 $701.25 $701.25 $701.25 N/A N/A 27815906 EAP Custom 27815906 COIL EMBL .018IN 5MM 10CM AZUR HDRCL PSH PERI 18 SYS BOTH IP/OP $467.50 $346.00 $83.22 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $83.22 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $97.43 $467.50 $187.00 $467.50 $467.50 $467.50 $467.50 $467.50 $350.63 $467.50 $467.50 $467.50 $233.75 $233.75 $370.26 $467.50 $374.00 $210.38 $467.50 $467.50 $271.15 $467.50 $280.50 $467.50 $467.50 $467.50 N/A N/A 27815907 EAP Custom 27815907 COIL EMBL .018IN 5MM 4CM AZUR HDRCL PSH PERI 18 SYS BOTH IP/OP $584.38 $432.50 $104.02 $584.38 $584.38 $584.38 $584.38 $584.38 $584.38 $584.38 $104.02 $584.38 $584.38 $584.38 $584.38 $584.38 $584.38 $121.79 $584.38 $233.75 $584.38 $584.38 $584.38 $584.38 $584.38 $438.29 $584.38 $584.38 $584.38 $292.19 $292.19 $462.83 $584.38 $467.50 $262.97 $584.38 $584.38 $338.94 $584.38 $350.63 $584.38 $584.38 $584.38 N/A N/A 27815908 EAP Custom 27815908 COIL EMBL .018IN 5MM 6CM AZUR HDRCL PSH 18 SYS BOTH IP/OP $689.58 $510.50 $122.75 $689.58 $689.58 $689.58 $689.58 $689.58 $689.58 $689.58 $122.75 $689.58 $689.58 $689.58 $689.58 $689.58 $689.58 $143.72 $689.58 $275.83 $689.58 $689.58 $689.58 $689.58 $689.58 $517.19 $689.58 $689.58 $689.58 $344.79 $344.79 $546.15 $689.58 $551.66 $310.31 $689.58 $689.58 $399.96 $689.58 $413.75 $689.58 $689.58 $689.58 N/A N/A 27815909 EAP Custom 27815909 COIL EMBL .018IN 5MM 6CM AZUR HDRCL PSH PERM MECH OCL DDRGL BOTH IP/OP $701.25 $519.00 $124.82 $701.25 $701.25 $701.25 $701.25 $701.25 $701.25 $701.25 $124.82 $701.25 $701.25 $701.25 $701.25 $701.25 $701.25 $146.15 $701.25 $280.50 $701.25 $701.25 $701.25 $701.25 $701.25 $525.94 $701.25 $701.25 $701.25 $350.63 $350.63 $555.39 $701.25 $561.00 $315.56 $701.25 $701.25 $406.73 $701.25 $420.75 $701.25 $701.25 $701.25 N/A N/A 27815910 EAP Custom 27815910 COIL EMBL .018IN 6MM 10CM AZUR HDRCL PSH PERI 18 SYS BOTH IP/OP $818.13 $605.50 $145.63 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $145.63 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $170.51 $818.13 $327.25 $818.13 $818.13 $818.13 $818.13 $818.13 $613.60 $818.13 $818.13 $818.13 $409.07 $409.07 $647.96 $818.13 $654.50 $368.16 $818.13 $818.13 $474.52 $818.13 $490.88 $818.13 $818.13 $818.13 N/A N/A 27815911 EAP Custom 27815911 COIL EMBL .018IN 6MM 14CM AZUR HDRCL PSH PERI 18 SYS BOTH IP/OP $584.38 $432.50 $104.02 $584.38 $584.38 $584.38 $584.38 $584.38 $584.38 $584.38 $104.02 $584.38 $584.38 $584.38 $584.38 $584.38 $584.38 $121.79 $584.38 $233.75 $584.38 $584.38 $584.38 $584.38 $584.38 $438.29 $584.38 $584.38 $584.38 $292.19 $292.19 $462.83 $584.38 $467.50 $262.97 $584.38 $584.38 $338.94 $584.38 $350.63 $584.38 $584.38 $584.38 N/A N/A 27815912 EAP Custom 27815912 COIL EMBL .018IN 6MM 6CM AZUR HDRCL PSH PERI 18 SYS BOTH IP/OP $701.25 $519.00 $124.82 $701.25 $701.25 $701.25 $701.25 $701.25 $701.25 $701.25 $124.82 $701.25 $701.25 $701.25 $701.25 $701.25 $701.25 $146.15 $701.25 $280.50 $701.25 $701.25 $701.25 $701.25 $701.25 $525.94 $701.25 $701.25 $701.25 $350.63 $350.63 $555.39 $701.25 $561.00 $315.56 $701.25 $701.25 $406.73 $701.25 $420.75 $701.25 $701.25 $701.25 N/A N/A 27815913 EAP Custom 27815913 COIL EMBL .018IN 8MM 10CM AZUR HDRCL PSH PERI 18 SYS BOTH IP/OP $818.13 $605.50 $145.63 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $145.63 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $170.51 $818.13 $327.25 $818.13 $818.13 $818.13 $818.13 $818.13 $613.60 $818.13 $818.13 $818.13 $409.07 $409.07 $647.96 $818.13 $654.50 $368.16 $818.13 $818.13 $474.52 $818.13 $490.88 $818.13 $818.13 $818.13 N/A N/A 27815914 EAP Custom 27815914 COIL EMBL .018IN 8MM 14CM AZUR HDRCL PSH PERI 18 SYS BOTH IP/OP $923.33 $683.50 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $192.43 $923.33 $369.33 $923.33 $923.33 $923.33 $923.33 $923.33 $692.50 $923.33 $923.33 $923.33 $461.67 $461.67 $731.28 $923.33 $738.66 $415.50 $923.33 $923.33 $535.53 $923.33 $554.00 $923.33 $923.33 $923.33 N/A N/A 27815915 EAP Custom 27815915 COIL EMBL .035IN 10MM 14CM AZUR HDRCL PSH PERI 35 SYS BOTH IP/OP $923.33 $683.50 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $192.43 $923.33 $369.33 $923.33 $923.33 $923.33 $923.33 $923.33 $692.50 $923.33 $923.33 $923.33 $461.67 $461.67 $731.28 $923.33 $738.66 $415.50 $923.33 $923.33 $535.53 $923.33 $554.00 $923.33 $923.33 $923.33 N/A N/A 27815916 EAP Custom 27815916 COIL EMBL .035IN 15MM 14CM AZUR HDRCL PSH LOOP PLTN DDRGL BOTH IP/OP $572.70 $424.00 $101.94 $572.70 $572.70 $572.70 $572.70 $572.70 $572.70 $572.70 $101.94 $572.70 $572.70 $572.70 $572.70 $572.70 $572.70 $119.36 $572.70 $229.08 $572.70 $572.70 $572.70 $572.70 $572.70 $429.53 $572.70 $572.70 $572.70 $286.35 $286.35 $453.58 $572.70 $458.16 $257.72 $572.70 $572.70 $332.17 $572.70 $343.62 $572.70 $572.70 $572.70 N/A N/A 27815917 EAP Custom 27815917 COIL EMBL .035IN 4MM 4CM AZUR HDRCL PSH PERI 35 SYS BOTH IP/OP $806.45 $597.00 $143.55 $806.45 $806.45 $806.45 $806.45 $806.45 $806.45 $806.45 $143.55 $806.45 $806.45 $806.45 $806.45 $806.45 $806.45 $168.07 $806.45 $322.58 $806.45 $806.45 $806.45 $806.45 $806.45 $604.84 $806.45 $806.45 $806.45 $403.23 $403.23 $638.71 $806.45 $645.16 $362.90 $806.45 $806.45 $467.74 $806.45 $483.87 $806.45 $806.45 $806.45 N/A N/A 27815918 EAP Custom 27815918 COIL EMBL .035IN 5MM 10CM AZUR HDRCL PSH BOTH IP/OP $806.45 $597.00 $143.55 $806.45 $806.45 $806.45 $806.45 $806.45 $806.45 $806.45 $143.55 $806.45 $806.45 $806.45 $806.45 $806.45 $806.45 $168.07 $806.45 $322.58 $806.45 $806.45 $806.45 $806.45 $806.45 $604.84 $806.45 $806.45 $806.45 $403.23 $403.23 $638.71 $806.45 $645.16 $362.90 $806.45 $806.45 $467.74 $806.45 $483.87 $806.45 $806.45 $806.45 N/A N/A 27815919 EAP Custom 27815919 COIL EMBL .035IN 6MM 10CM AZUR HDRCL PSH BOTH IP/OP $806.45 $597.00 $143.55 $806.45 $806.45 $806.45 $806.45 $806.45 $806.45 $806.45 $143.55 $806.45 $806.45 $806.45 $806.45 $806.45 $806.45 $168.07 $806.45 $322.58 $806.45 $806.45 $806.45 $806.45 $806.45 $604.84 $806.45 $806.45 $806.45 $403.23 $403.23 $638.71 $806.45 $645.16 $362.90 $806.45 $806.45 $467.74 $806.45 $483.87 $806.45 $806.45 $806.45 N/A N/A 27815920 EAP Custom 27815920 COIL EMBL .035IN 8MM 10CM AZUR HDRCL PSH PERI 35 SYS BOTH IP/OP $923.33 $683.50 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $164.35 $923.33 $923.33 $923.33 $923.33 $923.33 $923.33 $192.43 $923.33 $369.33 $923.33 $923.33 $923.33 $923.33 $923.33 $692.50 $923.33 $923.33 $923.33 $461.67 $461.67 $731.28 $923.33 $738.66 $415.50 $923.33 $923.33 $535.53 $923.33 $554.00 $923.33 $923.33 $923.33 N/A N/A 27815922 EAP Custom 27815922 COIL EMBOL L20CM OD10MM 0.018IN HYDROCOIL PUSHABLE AZUR 18P BOTH IP/OP $775.00 $573.50 $137.95 $775.00 $775.00 $775.00 $775.00 $775.00 $775.00 $775.00 $137.95 $775.00 $775.00 $575.21 $575.21 $597.37 $403.78 $161.52 $775.00 $310.00 $775.00 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $503.75 $775.00 $775.00 $449.50 $775.00 $465.00 $775.00 $775.00 $775.00 N/A N/A 27815923 EAP HCPCS C1874 STENT ENDOPRSTH 29MM 7MM 11MM 7FR GORE VBHN 135CM BOTH IP/OP "$6,725.00" "$4,976.50" "$1,334.74" "$6,725.00" "$3,026.25" "$3,026.25" "$3,026.25" "$3,026.25" "$6,725.00" "$6,725.00" "$6,725.00" "$1,401.66" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$1,401.56" "$6,725.00" "$6,725.00" "$3,315.43" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$5,043.75" "$6,725.00" "$6,725.00" "$6,725.00" "$3,362.50" "$3,362.50" "$5,326.20" "$6,725.00" "$5,380.00" "$3,026.25" "$1,334.74" "$6,725.00" "$3,900.50" "$6,725.00" "$6,725.00" "$6,725.00" "$1,401.49" "$6,725.00" N/A N/A 27815924 EAP HCPCS C1874 STENT ENDOPRSTH 29MM 8MM 11MM 7FR GORE VBHN 135CM BOTH IP/OP "$6,725.00" "$4,976.50" "$1,334.74" "$6,725.00" "$3,026.25" "$3,026.25" "$3,026.25" "$3,026.25" "$6,725.00" "$6,725.00" "$6,725.00" "$1,401.66" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$1,401.56" "$6,725.00" "$6,725.00" "$3,315.43" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$5,043.75" "$6,725.00" "$6,725.00" "$6,725.00" "$3,362.50" "$3,362.50" "$5,326.20" "$6,725.00" "$5,380.00" "$3,026.25" "$1,334.74" "$6,725.00" "$3,900.50" "$6,725.00" "$6,725.00" "$6,725.00" "$1,401.49" "$6,725.00" N/A N/A 27815925 EAP HCPCS C1874 STENT ENDOPRSTH 29MM 11MM 16SQ MM 8FR GORE VBHN BOTH IP/OP "$8,138.00" "$6,022.50" "$1,615.19" "$8,138.00" "$3,662.10" "$3,662.10" "$3,662.10" "$3,662.10" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.16" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.05" "$8,138.00" "$8,138.00" "$4,012.03" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$6,103.50" "$8,138.00" "$8,138.00" "$8,138.00" "$4,069.00" "$4,069.00" "$6,445.30" "$8,138.00" "$6,510.40" "$3,662.10" "$1,615.19" "$8,138.00" "$4,720.04" "$8,138.00" "$8,138.00" "$8,138.00" "$1,695.96" "$8,138.00" N/A N/A 27815926 EAP HCPCS C1874 STENT ENDOPRSTH 39MM 7MM 11MM 7FR GORE VBHN 135CM BOTH IP/OP "$8,138.00" "$6,022.50" "$1,615.19" "$8,138.00" "$3,662.10" "$3,662.10" "$3,662.10" "$3,662.10" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.16" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.05" "$8,138.00" "$8,138.00" "$4,012.03" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$6,103.50" "$8,138.00" "$8,138.00" "$8,138.00" "$4,069.00" "$4,069.00" "$6,445.30" "$8,138.00" "$6,510.40" "$3,662.10" "$1,615.19" "$8,138.00" "$4,720.04" "$8,138.00" "$8,138.00" "$8,138.00" "$1,695.96" "$8,138.00" N/A N/A 27815927 EAP HCPCS C1874 STENT ENDOPRSTH 39MM 8MM 11MM 7FR GORE VBHN 135CM BOTH IP/OP "$8,138.00" "$6,022.50" "$1,615.19" "$8,138.00" "$3,662.10" "$3,662.10" "$3,662.10" "$3,662.10" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.16" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.05" "$8,138.00" "$8,138.00" "$4,012.03" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$6,103.50" "$8,138.00" "$8,138.00" "$8,138.00" "$4,069.00" "$4,069.00" "$6,445.30" "$8,138.00" "$6,510.40" "$3,662.10" "$1,615.19" "$8,138.00" "$4,720.04" "$8,138.00" "$8,138.00" "$8,138.00" "$1,695.96" "$8,138.00" N/A N/A 27815928 EAP HCPCS c1874 STENT ENDOPRSTH 39MM 11MM 16SQ MM 8FR GORE VBHN BOTH IP/OP "$8,138.00" "$6,022.50" "$1,448.56" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$1,448.56" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.05" "$8,138.00" "$3,255.20" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$6,103.50" "$8,138.00" "$8,138.00" "$8,138.00" "$4,069.00" "$4,069.00" "$6,445.30" "$8,138.00" "$6,510.40" "$3,662.10" "$8,138.00" "$8,138.00" "$4,720.04" "$8,138.00" "$4,882.80" "$8,138.00" "$8,138.00" "$8,138.00" N/A N/A 27815929 EAP HCPCS C1874 STENT ENDOPRSTH 59MM 7MM 11MM 7FR GORE VBHN 135CM BOTH IP/OP "$8,138.00" "$6,022.50" "$1,615.19" "$8,138.00" "$3,662.10" "$3,662.10" "$3,662.10" "$3,662.10" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.16" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.05" "$8,138.00" "$8,138.00" "$4,012.03" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$6,103.50" "$8,138.00" "$8,138.00" "$8,138.00" "$4,069.00" "$4,069.00" "$6,445.30" "$8,138.00" "$6,510.40" "$3,662.10" "$1,615.19" "$8,138.00" "$4,720.04" "$8,138.00" "$8,138.00" "$8,138.00" "$1,695.96" "$8,138.00" N/A N/A 27815930 EAP HCPCS C1874 STENT ENDOPRSTH 59MM 8MM 11MM 7FR GORE VBHN 135CM BOTH IP/OP "$8,138.00" "$6,022.50" "$1,615.19" "$8,138.00" "$3,662.10" "$3,662.10" "$3,662.10" "$3,662.10" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.16" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.05" "$8,138.00" "$8,138.00" "$4,012.03" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$6,103.50" "$8,138.00" "$8,138.00" "$8,138.00" "$4,069.00" "$4,069.00" "$6,445.30" "$8,138.00" "$6,510.40" "$3,662.10" "$1,615.19" "$8,138.00" "$4,720.04" "$8,138.00" "$8,138.00" "$8,138.00" "$1,695.96" "$8,138.00" N/A N/A 27815931 EAP HCPCS C1874 STENT ENDOPRSTH 59MM 11MM 16SQ MM 8FR GORE VBHN BOTH IP/OP "$8,138.00" "$6,022.50" "$1,615.19" "$8,138.00" "$3,662.10" "$3,662.10" "$3,662.10" "$3,662.10" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.16" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.05" "$8,138.00" "$8,138.00" "$4,012.03" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$6,103.50" "$8,138.00" "$8,138.00" "$8,138.00" "$4,069.00" "$4,069.00" "$6,445.30" "$8,138.00" "$6,510.40" "$3,662.10" "$1,615.19" "$8,138.00" "$4,720.04" "$8,138.00" "$8,138.00" "$8,138.00" "$1,695.96" "$8,138.00" N/A N/A 27815932 EAP CATHETER INFUS 18FR TREVO PRO MIC NRVSC BOTH IP/OP "$1,269.00" $939.50 $225.88 "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" $225.88 "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" $264.47 "$1,269.00" $507.60 "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" $951.75 "$1,269.00" "$1,269.00" "$1,269.00" $634.50 $634.50 "$1,005.05" "$1,269.00" "$1,015.20" $571.05 "$1,269.00" "$1,269.00" $736.02 "$1,269.00" $761.40 "$1,269.00" "$1,269.00" "$1,269.00" N/A N/A 27815933 EAP HCPCS C1874 STENT EPRSTH 8MM 7FR 10CM 120CM VBHN DLV SYS HEP SPRFC FEM BOTH IP/OP "$8,738.00" "$6,466.50" "$1,734.27" "$8,738.00" "$3,932.10" "$3,932.10" "$3,932.10" "$3,932.10" "$8,738.00" "$8,738.00" "$8,738.00" "$1,821.22" "$8,738.00" "$8,738.00" "$8,738.00" "$8,738.00" "$8,738.00" "$1,821.10" "$8,738.00" "$8,738.00" "$4,307.83" "$8,738.00" "$8,738.00" "$8,738.00" "$8,738.00" "$6,553.50" "$8,738.00" "$8,738.00" "$8,738.00" "$4,369.00" "$4,369.00" "$6,920.50" "$8,738.00" "$6,990.40" "$3,932.10" "$1,734.27" "$8,738.00" "$5,068.04" "$8,738.00" "$8,738.00" "$8,738.00" "$1,821.00" "$8,738.00" N/A N/A 27815934 EAP COIL EMBOLIZATION 4MM 12CM COMPLEX FILL TRUFILL DCS ORBIT BOTH IP/OP "$3,738.00" "$2,766.50" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$1,495.20" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" "$3,738.00" "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" "$3,738.00" "$3,738.00" N/A N/A 27815935 EAP HCPCS C1876 STENT COR .02IN 2.5MM 19MM 140CM TRYTON RX DLV SYS RADOPQ SD BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" "$1,300.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 "$1,300.00" $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A 27815936 EAP HCPCS C1876 STENT COR .02IN 2.5-3MM 19MM 140CM TRYTON RX DLV SYS RADOPQ BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" "$1,300.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 "$1,300.00" $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A 27815937 EAP HCPCS C1876 STENT COR .02IN 2.5-3.5MM 19MM 140CM TRYTON RX DLV SYS BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" "$1,300.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 "$1,300.00" $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A 27815939 EAP HCPCS C1876 STENT COR .02IN 3.5-4MM 15MM 140CM TRYTON RX DLV SYS RADOPQ BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" "$1,300.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 "$1,300.00" $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A 27815940 EAP Custom 27815940 PIN HALF 5MM 4MM 300MM 50MM TR BOTH IP/OP $256.00 $189.50 $45.57 $256.00 $256.00 $256.00 $256.00 $256.00 $256.00 $256.00 $45.57 $256.00 $256.00 $256.00 $256.00 $256.00 $256.00 $53.35 $256.00 $102.40 $256.00 $256.00 $256.00 $256.00 $256.00 $192.00 $256.00 $256.00 $256.00 $128.00 $128.00 $202.75 $256.00 $204.80 $115.20 $256.00 $256.00 $148.48 $256.00 $153.60 $256.00 $256.00 $256.00 N/A N/A 27815941 EAP HCPCS C1874 SYSTEM COR STNT 4.5MM 12MM 140CM RSLT ONYX RX DLV SYS RADOPQ BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$2,055.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 27815942 EAP Custom 27815942 COIL EMBL 3D 3MM 6CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815943 EAP Custom 27815943 COIL EMBL 3D 3MM 8CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815944 EAP Custom 27815944 COIL EMBL 3D 3MM 10CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815945 EAP Custom 27815945 COIL EMBL 3D 3.5MM 6CM AXIUM PRM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815946 EAP Custom 27815946 COIL EMBL 3D 3.5MM 8CM AXIUM FRM NRVSC V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815947 EAP Custom 27815947 COIL EMBL 3D 3.5MM 10CM AXIUM FRM NRVSC V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815948 EAP Custom 27815948 COIL EMBL 3D 4MM 6CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815949 EAP Custom 27815949 COIL EMBL 3D 4MM 8CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815950 EAP Custom 27815950 COIL EMBL 3D 4MM 10CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815951 EAP Custom 27815951 COIL EMBL 3D 4MM 12CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815952 EAP Custom 27815952 COIL EMBL 3D 4MM 15CM AXIUM FRM NRVSC V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815953 EAP Custom 27815953 COIL EMBL 3D 5MM 8CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815954 EAP Custom 27815954 COIL EMBL 3D 5MM 10CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815955 EAP Custom 27815955 COIL EMBL 3D 5MM 15CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815956 EAP Custom 27815956 COIL EMBL 3D 5MM 20CM AXIUM FRM NRVSC V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815957 EAP Custom 27815957 COIL EMBL 3D 6MM 10CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815958 EAP Custom 27815958 COIL EMBL 3D 6MM 15CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815959 EAP Custom 27815959 COIL EMBL 3D 6MM 20CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815960 EAP Custom 27815960 COIL EMBL 3D 6MM 25CM AXIUM FRM NRVSC V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815961 EAP Custom 27815961 COIL EMBL 3D 7MM 12CM AXIUM FRM NRVSC V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815962 EAP Custom 27815962 COIL EMBL 3D 7MM 15CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815963 EAP Custom 27815963 COIL EMBL 3D 7MM 20CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815964 EAP Custom 27815964 COIL EMBL 3D 7MM 30CM AXIUM FRM V01 BOTH IP/OP "$4,488.00" "$3,321.50" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" "$4,488.00" "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 27815965 EAP Custom 27815965 COIL EMBL 3D 8MM 15CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815966 EAP Custom 27815966 COIL EMBL 3D 8MM 20CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815967 EAP Custom 27815967 COIL EMBL 3D 8MM 30CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815968 EAP Custom 27815968 COIL EMBL 3D 9MM 20CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815970 EAP Custom 27815970 COIL EMBL 3D 10MM 20CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815971 EAP Custom 27815971 COIL EMBL 3D 10MM 30CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815972 EAP Custom 27815972 COIL EMBL 3D 10MM 40CM AXIUM FRM NRVSC V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815973 EAP Custom 27815973 COIL EMBL 3D 12MM 30CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815974 EAP Custom 27815974 COIL EMBL 3D 12MM 40CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815975 EAP Custom 27815975 COIL EMBL 3D 12MM 50CM AXIUM FRM NRVSC V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815976 EAP Custom 27815976 COIL EMBL 3D 14MM 30CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815977 EAP Custom 27815977 COIL EMBL 3D 14MM 40CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815978 EAP Custom 27815978 COIL EMBL 3D 14MM 50CM AXIUM FRM NRVSC V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815979 EAP Custom 27815979 COIL EMBL 3D 16MM 40CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815980 EAP Custom 27815980 COIL EMBL 3D 16MM 50CM AXIUM FRM NRVSC V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815981 EAP Custom 27815981 COIL EMBL 3D 18MM 40CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815982 EAP Custom 27815982 COIL EMBL 3D 18MM 50CM AXIUM FRM NRVSC V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815983 EAP Custom 27815983 COIL EMBL 3D 20MM 50CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815984 EAP Custom 27815984 COIL EMBL 3D 22MM 50CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815985 EAP Custom 27815985 COIL EMBL 3D 25MM 50CM AXIUM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 27815986 EAP HCPCS C1876 STENT 4.5MM 30MM 5.0MM NEUROFORM ATLAS BOTH IP/OP "$18,125.00" "$13,412.50" "$3,597.36" "$18,125.00" "$8,156.25" "$8,156.25" "$8,156.25" "$8,156.25" "$18,125.00" "$18,125.00" "$18,125.00" "$3,777.70" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,777.45" "$18,125.00" "$18,125.00" "$8,935.63" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$13,593.75" "$18,125.00" "$18,125.00" "$18,125.00" "$9,062.50" "$9,062.50" "$14,355.00" "$18,125.00" "$14,500.00" "$8,156.25" "$3,597.36" "$18,125.00" "$10,512.50" "$18,125.00" "$18,125.00" "$18,125.00" "$3,777.25" "$18,125.00" N/A N/A 27815987 EAP HCPCS C1876 NEUROFORM ATLAS 4.5X21MM BOTH IP/OP "$17,038.00" "$12,608.50" "$3,381.62" "$17,038.00" "$7,667.10" "$7,667.10" "$7,667.10" "$7,667.10" "$17,038.00" "$17,038.00" "$17,038.00" "$3,551.15" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$3,550.91" "$17,038.00" "$17,038.00" "$8,399.73" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$12,778.50" "$17,038.00" "$17,038.00" "$17,038.00" "$8,519.00" "$8,519.00" "$13,494.10" "$17,038.00" "$13,630.40" "$7,667.10" "$3,381.62" "$17,038.00" "$9,882.04" "$17,038.00" "$17,038.00" "$17,038.00" "$3,550.72" "$17,038.00" N/A N/A 27815988 EAP HCPCS C1876 NEUROFORM ATLAS 4.0X24MM BOTH IP/OP "$17,038.00" "$12,608.50" "$3,381.62" "$17,038.00" "$7,667.10" "$7,667.10" "$7,667.10" "$7,667.10" "$17,038.00" "$17,038.00" "$17,038.00" "$3,551.15" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$3,550.91" "$17,038.00" "$17,038.00" "$8,399.73" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$12,778.50" "$17,038.00" "$17,038.00" "$17,038.00" "$8,519.00" "$8,519.00" "$13,494.10" "$17,038.00" "$13,630.40" "$7,667.10" "$3,381.62" "$17,038.00" "$9,882.04" "$17,038.00" "$17,038.00" "$17,038.00" "$3,550.72" "$17,038.00" N/A N/A 27815989 EAP HCPCS C1876 NEUROFORM ATLAS 4.0X21MM BOTH IP/OP "$17,038.00" "$12,608.50" "$3,381.62" "$17,038.00" "$7,667.10" "$7,667.10" "$7,667.10" "$7,667.10" "$17,038.00" "$17,038.00" "$17,038.00" "$3,551.15" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$3,550.91" "$17,038.00" "$17,038.00" "$8,399.73" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$12,778.50" "$17,038.00" "$17,038.00" "$17,038.00" "$8,519.00" "$8,519.00" "$13,494.10" "$17,038.00" "$13,630.40" "$7,667.10" "$3,381.62" "$17,038.00" "$9,882.04" "$17,038.00" "$17,038.00" "$17,038.00" "$3,550.72" "$17,038.00" N/A N/A 27815990 EAP HCPCS C1876 NEUROFORM ATLAS 3.0X24MM BOTH IP/OP "$17,038.00" "$12,608.50" "$3,381.62" "$17,038.00" "$7,667.10" "$7,667.10" "$7,667.10" "$7,667.10" "$17,038.00" "$17,038.00" "$17,038.00" "$3,551.15" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$3,550.91" "$17,038.00" "$17,038.00" "$8,399.73" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$12,778.50" "$17,038.00" "$17,038.00" "$17,038.00" "$8,519.00" "$8,519.00" "$13,494.10" "$17,038.00" "$13,630.40" "$7,667.10" "$3,381.62" "$17,038.00" "$9,882.04" "$17,038.00" "$17,038.00" "$17,038.00" "$3,550.72" "$17,038.00" N/A N/A 27815991 EAP HCPCS C1876 NEUROFORM ATLAS 3.0X21MM BOTH IP/OP "$17,038.00" "$12,608.50" "$3,381.62" "$17,038.00" "$7,667.10" "$7,667.10" "$7,667.10" "$7,667.10" "$17,038.00" "$17,038.00" "$17,038.00" "$3,551.15" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$3,550.91" "$17,038.00" "$17,038.00" "$8,399.73" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$12,778.50" "$17,038.00" "$17,038.00" "$17,038.00" "$8,519.00" "$8,519.00" "$13,494.10" "$17,038.00" "$13,630.40" "$7,667.10" "$3,381.62" "$17,038.00" "$9,882.04" "$17,038.00" "$10,222.80" "$17,038.00" "$3,550.72" "$17,038.00" N/A N/A 27815992 EAP HCPCS C1876 NEUROFORM ATLAS 3.0X15MM BOTH IP/OP "$17,038.00" "$12,608.50" "$3,381.62" "$17,038.00" "$7,667.10" "$7,667.10" "$7,667.10" "$7,667.10" "$17,038.00" "$17,038.00" "$17,038.00" "$3,551.15" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$3,550.91" "$17,038.00" "$17,038.00" "$8,399.73" "$17,038.00" "$17,038.00" "$17,038.00" "$17,038.00" "$12,778.50" "$17,038.00" "$17,038.00" "$17,038.00" "$8,519.00" "$8,519.00" "$13,494.10" "$17,038.00" "$13,630.40" "$7,667.10" "$3,381.62" "$17,038.00" "$9,882.04" "$17,038.00" "$17,038.00" "$17,038.00" "$3,550.72" "$17,038.00" N/A N/A 27815993 EAP HCPCS C1874 STENT TRCHBR 16MM 22FR 40MM 61CM GMTR OTW FLLY BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$3,450.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27815994 EAP HCPCS C1874 STENT TRCHBR 12MM 16FR 30MM 62CM GMTR OTW FLLY BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$3,450.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27815995 EAP HCPCS C1874 STENT TRCHBR 14MM 16FR 20MM 63CM GMTR OTW FLLY BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$3,450.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27815996 EAP HCPCS C1874 STENT TRCHBR 14MM 16FR 40MM 61CM GMTR OTW FLLY BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$3,450.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27815997 EAP HCPCS C1874 STENT TRCHBR 20MM 22FR 40MM 61CM GMTR OTW FLLY BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$3,450.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27815998 EAP HCPCS C1874 STENT TRCHBR 20MM 60MM OTW FLLY COVERED AERO BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27815999 EAP HCPCS C1874 STENT TRCHBR 16MM 60MM FLLY COVERED PURSE STNG DIR BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816000 EAP HCPCS C1874 STENT TRCHBR 14MM 40MM FLLY COVERED PURSE STNG DIR BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816001 EAP Custom 27816001 SIZER SURG AEROSIZER STENT MSR DEV BOTH IP/OP $375.00 $277.50 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $375.00 $375.00 $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 27816002 EAP HCPCS C1874 STENT ESPH 16FR 18MM 67CM 70MM FULL COVER PROX BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816003 EAP HCPCS C1874 STENT ESPH 18MM 22FR 100CM REM COVERED RADIOPQ BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816004 EAP HCPCS C1874 STENT ESPH 22FR 18MM 120CM REM COVERED ALIMAXX-E BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816005 EAP HCPCS C1874 STENT ESPH 22MM 22FR 70CM REM COVERED RADIOPQ BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816006 EAP HCPCS C1874 STENT ESPH 22FR 100CM SYS ALIMAXX-E MTL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816007 EAP HCPCS C1874 STENT ESPH 22FR 120CM SLF XPD ALIMAXX-E MTL DISP BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816008 EAP HCPCS C1874 STENT ESPH 12MM 70CM FLLY COVERED ALIMAXX-ES BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816009 EAP HCPCS C1874 STENT ESPH 22MM 100CM PU COVER ANTIMIGRATION STRUT BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816010 EAP HCPCS C1874 STENT ESPH 12MM 16FR 120MM 62CM GMTR FLLY COVERED BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816011 EAP HCPCS C1874 STENT ESPH 14MM 70CM FLLY COVERED ALIMAXX-ES BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816012 EAP HCPCS C1874 STENT ESPH 14MM 16FR 100MM 64CM FLLY COVERED SMTH BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816013 EAP HCPCS C1874 STENT ESPH 14MM 16FR 62CM 120MM FLLY COVERED GMTR BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816014 EAP HCPCS C1874 STENT ESPH 16MM 70CM GMTR FLLY COVERED PU COVER BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816015 EAP HCPCS C1874 STENT ESPH 16MM 16FR 100MM 64CM FLLY COVERED SMTH BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816016 EAP HCPCS C1874 STENT ESPH 16MM 62CM 120MM FLLY COVERED GMTR PU BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816017 EAP HCPCS C1874 STENT TRCHBR 18MM 22FR 56MM LP OTW FULL COVER FLXB BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$3,450.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27816018 EAP HCPCS C1874 STENT TRCHBR 16MM 22FR 56MM LP OTW FULL COVER FLXB BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$3,450.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27816019 EAP HCPCS C1874 STENT TRCHBR 10MM 16FR 20MM 63CM GMTR OTW FLLY BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27816020 EAP HCPCS C1874 STENT TRCHBR 10MM 16FR 40MM 61CM GMTR OTW FLLY BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27816021 EAP HCPCS C1874 STENT TRCHBR 12MM 16FR 20MM 63CM FLLY COVER BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27816022 EAP HCPCS C1874 STENT TRCHBR 14MM 16FR 30MM 62CM GMTR OTW FLLY BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27816023 EAP HCPCS C1874 STENT TRCH 20MM 80MM FLLY COVERED AERO BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816024 EAP HCPCS C1874 STENT TRCHBR 18MM 40MM FLLY COVERED DIR VIS SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816025 EAP HCPCS C1874 STENT TRCHBR 18MM 60MM FLLY COVERED DIR VIS SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816026 EAP HCPCS C1874 STENT TRCHBR 18MM 80MM FLLY COVERED DIR VSN DLV BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816027 EAP HCPCS C1874 STENT TRCHBR 16MM 30MM 40MM 39MM OTW DIR VIS NOVEL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816028 EAP HCPCS C1874 STENT TRCHBR 16MM 80MM FLLY COVERED DIR VSN DLV BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816029 EAP HCPCS C1874 STENT TRCHBR 12MM 20MM FLLY COVERED DIR VSN DLV BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816030 EAP HCPCS C1874 STENT TRCHBR 12MM 28FR 30MM 40CM GMTR LP FULL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816031 EAP HCPCS C1874 STENT TRCHBR 28FR 12MM 40MM 39CM GMTR LP FULL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816032 EAP HCPCS C1874 STENT TRCHBR 14MM 20MM FLLY COVERED DIR VSN DLV BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816033 EAP HCPCS C1874 STENT TRCHBR 14MM 30MM FLLY COVERED DIR VIS SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816034 EAP HCPCS C1874 STENT TRCHBR 20MM 40MM FLLY COVERED DIR VIS SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816036 EAP HCPCS C1874 STENT TRCHBR 20MM 80MM FLLY COVERED DIR VIS SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 27816037 EAP HCPCS C1874 STENT ESPH 19MM 24MM 70MM FLLY COVERED BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27816038 EAP Custom 27816038 HOLDER TUBE 100MM BLUE TIO UNQ ORAL ARWY DSGN CNV BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $9.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27816039 EAP Custom 27816039 BLOCK BITE TIO 110MM BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $9.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27816040 EAP Custom 27816040 HOLDER TUBE 90MM YLW TIO UNQ ORAL ARWY DSGN CNV BOTH IP/OP $20.00 $15.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $3.56 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $4.17 $20.00 $8.00 $20.00 $20.00 $20.00 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $9.00 $20.00 $20.00 $11.60 $20.00 $12.00 $20.00 $20.00 $20.00 N/A N/A 27816041 EAP Custom 27816041 DEVICE BASIXCOMPAK 20ML ANLG LMSCNT DSPL INFLAT BOTH IP/OP $62.50 $46.50 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $28.13 $62.50 $62.50 $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A 27816042 EAP HCPCS C1874 STENT ESPH 19MM 24FR 150MM 90CM OTW FLLY COVERED BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$3,450.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27816043 EAP HCPCS C1874 STENT ESPH 23MM 24FR 70MM 90CM 28MM OTW FLLY COVER BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" "$5,750.00" "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 27816050 EAP HCPCS C1876 SYSTEM CORON STENT 38MM 4.5MM MTLNK UL XCELON BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" $712.80 "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816051 EAP HCPCS C1876 SYSTEM CORON STENT 18MM 5MM MTLNK UL XCELON MCGLD BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" $712.80 "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816052 EAP HCPCS C1876 SYSTEM CORON STENT 38MM 5MM MTLNK UL XCELON MCGLD BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" $712.80 "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816053 EAP HCPCS C1876 SYSTEM CORON STENT 8MM 2.75MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816054 EAP HCPCS C1876 SYSTEM CORON STENT 12MM 2.75MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816055 EAP HCPCS C1876 SYSTEM CORON STENT 15MM 2.75MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816056 EAP HCPCS C1876 SYSTEM CORON STENT 18MM 2.75MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816057 EAP HCPCS C1876 SYSTEM CORON STENT 23MM 2.75MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816058 EAP HCPCS C1876 SYSTEM CORON STENT 28MM 2.75MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816059 EAP HCPCS C1876 SYSTEM CORON STENT 8MM 3MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816060 EAP HCPCS C1876 SYSTEM CORON STENT 12MM 3MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816061 EAP HCPCS C1876 SYSTEM CORON STENT 15MM 3MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816062 EAP HCPCS C1876 SYSTEM CORON STENT 18MM 3MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816063 EAP HCPCS C1876 SYSTEM CORON STENT 23MM 3MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816064 EAP HCPCS C1876 SYSTEM CORON STENT 28MM 3MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816065 EAP HCPCS C1876 SYSTEM CORON STENT 8MM 3.5MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816066 EAP HCPCS C1876 SYSTEM CORON STENT 12MM 3.5MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816067 EAP HCPCS C1876 SYSTEM CORON STENT 15MM 3.5MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816068 EAP HCPCS C1876 SYSTEM CORON STENT 18MM 3.5MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816069 EAP HCPCS C1876 SYSTEM CORON STENT 23MM 3.5MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816070 EAP HCPCS C1876 SYSTEM CORON STENT 28MM 3.5MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" $712.80 "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816071 EAP HCPCS C1876 SYSTEM CORON STENT 8MM 4MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" $712.80 "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816072 EAP HCPCS C1876 SYSTEM CORON STENT 12MM 4MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" $712.80 "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816073 EAP HCPCS C1876 SYSTEM CORON STENT 15MM 4MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816074 EAP HCPCS C1876 SYSTEM CORON STENT 18MM 4MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816075 EAP HCPCS C1876 SYSTEM CORON STENT 23MM 4MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816076 EAP HCPCS C1876 SYSTEM CORON STENT 28MM 4MM MTLNK MVSN COCR OTW BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 27816077 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816078 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816079 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816080 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816081 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816082 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816083 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816084 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816085 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 3.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816086 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 3.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816087 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816088 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 3.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816089 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 3.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816090 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 3.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816091 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816092 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 3.5MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816093 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816094 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816095 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816096 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816097 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816098 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816099 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816100 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816101 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816102 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816103 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816104 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816105 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816106 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816107 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816108 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816109 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816110 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816111 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816112 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816113 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816114 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816115 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816116 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816117 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 2.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816118 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 2.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816119 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 2.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816120 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 2.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816121 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 2.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816122 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 2.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816123 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 4MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816124 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 4MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816125 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 4MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816126 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 4MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816127 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 4MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816128 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 2.25MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816129 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 2.25MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816130 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 2.25MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816131 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 2.25MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816132 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 2.25MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816133 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 2.25MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816134 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 2.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816135 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 2.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816136 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 2.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816137 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 2.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816138 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 2.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816139 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 2.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816140 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 2.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816141 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 2.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816142 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 2.75MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816143 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 2.75MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816144 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 2.75MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816145 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 2.75MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816146 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 2.75MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816147 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 2.75MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816148 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 2.75MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816149 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 2.75MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816150 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 3MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816151 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816152 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 3MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816153 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 3MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816154 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 3MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816155 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816156 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 3MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816157 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 3MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816158 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 3.25MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816159 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3.25MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816160 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 3.25MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816161 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 3.25MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816162 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 3.25MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816163 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3.25MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816164 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 3.25MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816165 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 3.25MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816166 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 3.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816167 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816168 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 3.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816169 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 3.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816170 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 3.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816171 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816172 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 3.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816173 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 3.5MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816174 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 4MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816175 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 4MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816176 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 4MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816177 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 4MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816178 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 4MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816179 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 4MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816180 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 4MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816181 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 4MM XIENCE ALPINE BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816182 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 2.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816183 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 2.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816184 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 2.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816185 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 2.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816186 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 2.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 27816187 EAP COIL EMBOLIZATION 360D 5MM 15CM DETACHABLE SOFT TARGET BOTH IP/OP "$4,539.00" "$3,359.00" $807.94 "$4,539.00" "$4,539.00" "$4,539.00" "$4,539.00" "$4,539.00" "$4,539.00" "$4,539.00" $807.94 "$4,539.00" "$4,539.00" "$4,539.00" "$4,539.00" "$4,539.00" "$4,539.00" $945.98 "$4,539.00" "$1,815.60" "$4,539.00" "$4,539.00" "$4,539.00" "$4,539.00" "$4,539.00" "$3,404.25" "$4,539.00" "$4,539.00" "$4,539.00" "$2,269.50" "$2,269.50" "$3,594.89" "$4,539.00" "$3,631.20" "$2,042.55" "$4,539.00" "$4,539.00" "$2,632.62" "$4,539.00" "$2,723.40" "$4,539.00" "$4,539.00" "$4,539.00" N/A N/A 27816188 EAP COIL EMBOLIZATION STANDARD LARGE 22MM 50CM DETACHABLE SMOOTH BOTH IP/OP "$5,904.00" "$4,369.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,050.91" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$1,230.46" "$5,904.00" "$2,361.60" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$5,904.00" "$4,428.00" "$5,904.00" "$5,904.00" "$5,904.00" "$2,952.00" "$2,952.00" "$4,675.97" "$5,904.00" "$4,723.20" "$2,656.80" "$5,904.00" "$5,904.00" "$3,424.32" "$5,904.00" "$3,542.40" "$5,904.00" "$5,904.00" "$5,904.00" N/A N/A 27816190 EAP COIL EMBL .02IN CMPLX 4MM 10CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$6,900.00" "$5,106.00" "$1,228.20" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$1,228.20" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$1,438.04" "$6,900.00" "$2,760.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$5,175.00" "$6,900.00" "$6,900.00" "$6,900.00" "$3,450.00" "$3,450.00" "$5,464.80" "$6,900.00" "$5,520.00" "$3,105.00" "$6,900.00" "$6,900.00" "$4,002.00" "$6,900.00" "$4,140.00" "$6,900.00" "$6,900.00" "$6,900.00" N/A N/A 27816191 EAP COIL EMBL .02IN CMPLX 4MM 8CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$6,075.00" "$4,495.50" "$1,081.35" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$1,081.35" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$1,266.10" "$6,075.00" "$2,430.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$4,556.25" "$6,075.00" "$6,075.00" "$6,075.00" "$3,037.50" "$3,037.50" "$4,811.40" "$6,075.00" "$4,860.00" "$2,733.75" "$6,075.00" "$6,075.00" "$3,523.50" "$6,075.00" "$3,645.00" "$6,075.00" "$6,075.00" "$6,075.00" N/A N/A 27816192 EAP COIL EMBL CRV 4MM 10CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$6,513.00" "$4,820.00" "$1,159.31" "$6,513.00" "$6,513.00" "$6,513.00" "$6,513.00" "$6,513.00" "$6,513.00" "$6,513.00" "$1,159.31" "$6,513.00" "$6,513.00" "$6,513.00" "$6,513.00" "$6,513.00" "$6,513.00" "$1,357.38" "$6,513.00" "$2,605.20" "$6,513.00" "$6,513.00" "$6,513.00" "$6,513.00" "$6,513.00" "$4,884.75" "$6,513.00" "$6,513.00" "$6,513.00" "$3,256.50" "$3,256.50" "$5,158.30" "$6,513.00" "$5,210.40" "$2,930.85" "$6,513.00" "$6,513.00" "$3,777.54" "$6,513.00" "$3,907.80" "$6,513.00" "$6,513.00" "$6,513.00" N/A N/A 27816193 EAP COIL EMBOLIZATION CURVE 4MM 8CM XSOFT THE PENUMBRA COIL 400 BOTH IP/OP "$6,125.00" "$4,532.50" "$1,090.25" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$1,090.25" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.52" "$6,125.00" "$2,450.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$4,593.75" "$6,125.00" "$6,125.00" "$6,125.00" "$3,062.50" "$3,062.50" "$4,851.00" "$6,125.00" "$4,900.00" "$2,756.25" "$6,125.00" "$6,125.00" "$3,552.50" "$6,125.00" "$3,675.00" "$6,125.00" "$6,125.00" "$6,125.00" N/A N/A 27816194 EAP COIL EMBOLIZATION 10CM J SOFT FILL COIL 400 NITINOL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,121.40" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,121.40" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$6,300.00" "$6,300.00" "$3,654.00" "$6,300.00" "$3,780.00" "$6,300.00" "$6,300.00" "$6,300.00" N/A N/A 27816195 EAP COIL EMBOLIZATION 15CM J COIL 400 BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" "$6,550.00" "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 27816196 EAP Custom 27816196 GRAFT EVAS 26MM 22-23MM 3.3CM AORTA BOTH IP/OP "$8,135.00" "$6,020.00" "$1,448.03" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$1,448.03" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$1,695.42" "$8,135.00" "$3,254.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$6,101.25" "$8,135.00" "$8,135.00" "$8,135.00" "$4,067.50" "$4,067.50" "$6,442.92" "$8,135.00" "$6,508.00" "$3,660.75" "$8,135.00" "$8,135.00" "$4,718.30" "$8,135.00" "$4,881.00" "$8,135.00" "$8,135.00" "$8,135.00" N/A N/A 27816197 EAP Custom 27816197 GRAFT EVAS 28.5MM 24-26MM 3.3CM AORTA BOTH IP/OP "$8,135.00" "$6,020.00" "$1,448.03" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$1,448.03" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$1,695.42" "$8,135.00" "$3,254.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$6,101.25" "$8,135.00" "$8,135.00" "$8,135.00" "$4,067.50" "$4,067.50" "$6,442.92" "$8,135.00" "$6,508.00" "$3,660.75" "$8,135.00" "$8,135.00" "$4,718.30" "$8,135.00" "$4,881.00" "$8,135.00" "$8,135.00" "$8,135.00" N/A N/A 27816198 EAP Custom 27816198 GRAFT EVAS 32MM 27-29MM 4.5CM XCLDR STNT XTD ABRSN RST BOTH IP/OP "$8,135.00" "$6,020.00" "$1,448.03" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$1,448.03" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$1,695.42" "$8,135.00" "$3,254.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$6,101.25" "$8,135.00" "$8,135.00" "$8,135.00" "$4,067.50" "$4,067.50" "$6,442.92" "$8,135.00" "$6,508.00" "$3,660.75" "$8,135.00" "$8,135.00" "$4,718.30" "$8,135.00" "$4,881.00" "$8,135.00" "$8,135.00" "$8,135.00" N/A N/A 27816199 EAP Custom 27816199 GRAFT EVAS 36MM 30-32MM 4.5CM XCLDR SINUSOIDAL STNT SL CUF BOTH IP/OP "$8,135.00" "$6,020.00" "$1,448.03" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$1,448.03" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$1,695.42" "$8,135.00" "$3,254.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$6,101.25" "$8,135.00" "$8,135.00" "$8,135.00" "$4,067.50" "$4,067.50" "$6,442.92" "$8,135.00" "$6,508.00" "$3,660.75" "$8,135.00" "$8,135.00" "$4,718.30" "$8,135.00" "$4,881.00" "$8,135.00" "$8,135.00" "$8,135.00" N/A N/A 27816200 EAP Custom 27816200 GRAFT EVAS 12MM 10CM GORE XCLDR CNTRLT LG BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816201 EAP Custom 27816201 GRAFT EVAS 12MM 12CM GORE XCLDR CNTRLT LG BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816202 EAP Custom 27816202 GRAFT EVAS 12MM 14CM GORE XCLDR CNTRLT LG BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816203 EAP Custom 27816203 GRAFT EVAS 14.5MM 10CM GORE XCLDR CNTRLT LG BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816204 EAP Custom 27816204 GRAFT EVAS 14.5MM 12CM GORE XCLDR CNTRLT LG BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816205 EAP Custom 27816205 GRAFT EVAS 14.5MM 12-13.5MM 14CM GORE XCLDR CNTRLT LG AAA BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816206 EAP Custom 27816206 GRAFT EVAS 16MM 13.5-14.5MM 11.5CM XCLDR STNT ABRSN RST BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816207 EAP Custom 27816207 GRAFT EVAS 16MM 13.5-14.5MM 13.5CM XCLDR STNT ABRSN RST BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816208 EAP Custom 27816208 GRAFT EVAS 18MM 14.5-16.5MM 9.5CM XCLDR STNT ABRSN RST BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816209 EAP Custom 27816209 GRAFT EVAS 18MM 14.5-16.5MM 11.5CM XCLDR STNT ABRSN RST BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816210 EAP Custom 27816210 GRAFT EVAS 18MM 14.5-16.5MM 13.5CM XCLDR STNT ABRSN RST BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816211 EAP Custom 27816211 GRAFT EVAS 20MM 16.5-18.5MM 9.5CM XCLDR STNT ABRSN RST BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816212 EAP Custom 27816212 GRAFT EVAS 20MM 16.5-18.5MM 13.5CM GRTX XCLDR SINUSOIDAL BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816213 EAP Custom 27816213 GRAFT EVAS 23MM 18.5-21.5MM 12CM XCLDR STNT ABRSN RST BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816214 EAP Custom 27816214 GRAFT EVAS 23MM 18.5-21.5MM 14CM XCLDR STNT ABRSN RST BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816215 EAP Custom 27816215 GRAFT EVAS 27MM 21.5-25MM 10CM GRTX XCLDR SINUSOIDAL STNT SL BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816216 EAP Custom 27816216 GRAFT EVAS 27MM 21.5-25MM 12CM XCLDR STNT ABRSN RST BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816217 EAP Custom 27816217 GRAFT EVAS 27MM 21.5-25MM 14CM XCLDR STNT ABRSN RST BOTH IP/OP "$11,558.00" "$8,553.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,057.32" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$2,408.81" "$11,558.00" "$4,623.20" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$11,558.00" "$8,668.50" "$11,558.00" "$11,558.00" "$11,558.00" "$5,779.00" "$5,779.00" "$9,153.94" "$11,558.00" "$9,246.40" "$5,201.10" "$11,558.00" "$11,558.00" "$6,703.64" "$11,558.00" "$6,934.80" "$11,558.00" "$11,558.00" "$11,558.00" N/A N/A 27816218 EAP Custom 27816218 GRAFT STNT 10MM 7CM GORE XCLDR XTD ILC AAA BOTH IP/OP "$8,135.00" "$6,020.00" "$1,448.03" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$1,448.03" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$1,695.42" "$8,135.00" "$3,254.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$6,101.25" "$8,135.00" "$8,135.00" "$8,135.00" "$4,067.50" "$4,067.50" "$6,442.92" "$8,135.00" "$6,508.00" "$3,660.75" "$8,135.00" "$8,135.00" "$4,718.30" "$8,135.00" "$4,881.00" "$8,135.00" "$8,135.00" "$8,135.00" N/A N/A 27816219 EAP Custom 27816219 GRAFT EVAS 12MM 7CM XCLDR STNT XTD SL CUF NTNL EPTFE ILC AAA BOTH IP/OP "$8,135.00" "$6,020.00" "$1,448.03" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$1,448.03" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$1,695.42" "$8,135.00" "$3,254.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$6,101.25" "$8,135.00" "$8,135.00" "$8,135.00" "$4,067.50" "$4,067.50" "$6,442.92" "$8,135.00" "$6,508.00" "$3,660.75" "$8,135.00" "$8,135.00" "$4,718.30" "$8,135.00" "$4,881.00" "$8,135.00" "$8,135.00" "$8,135.00" N/A N/A 27816220 EAP Custom 27816220 GRAFT EVAS 14.5MM 12-13.5MM 7CM GORE XCLDR XTD ILC ART ACPT BOTH IP/OP "$8,135.00" "$6,020.00" "$1,448.03" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$1,448.03" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$1,695.42" "$8,135.00" "$3,254.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$8,135.00" "$6,101.25" "$8,135.00" "$8,135.00" "$8,135.00" "$4,067.50" "$4,067.50" "$6,442.92" "$8,135.00" "$6,508.00" "$3,660.75" "$8,135.00" "$8,135.00" "$4,718.30" "$8,135.00" "$4,881.00" "$8,135.00" "$8,135.00" "$8,135.00" N/A N/A 27816221 EAP Custom 27816221 GRAFT EVAS 23MM 12MM 19-21MM 10-11MM 12CM GORE XCLDR C3 BOND BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816222 EAP Custom 27816222 GRAFT EVAS 23MM 12MM 19-21MM 10-11MM 14CM GORE XCLDR C3 BOND BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816223 EAP Custom 27816223 GRAFT EVAS 23MM 12MM 19-21MM 10-11MM 16CM GORE XCLDR C3 BOND BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816224 EAP Custom 27816224 GRAFT EVAS 23MM 12MM 19-21MM 10-11MM 18CM GORE XCLDR C3 BOND BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816225 EAP Custom 27816225 GRAFT EVAS 23MM 14.5MM 19-21MM 12-13.5MM 12CM GORE XCLDR C3 BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816226 EAP Custom 27816226 GRAFT EVAS 23MM 14.5MM 19-21MM 12-13.5MM 14CM GORE XCLDR C3 BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816227 EAP Custom 27816227 GRAFT EVAS 23MM 14.5MM 19-21MM 12-13.5MM 16CM GORE XCLDR C3 BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816228 EAP Custom 27816228 GRAFT EVAS 23MM 14.5MM 19-21MM 12-13.5MM 18CM GORE XCLDR C3 BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816229 EAP Custom 27816229 GRAFT EVAS 26MM 12MM 22-23MM 10-11MM 12CM GORE XCLDR C3 BOND BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816230 EAP Custom 27816230 GRAFT EVAS 26MM 12MM 22-23MM 10-11MM 14CM GORE XCLDR C3 BOND BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816231 EAP Custom 27816231 GRAFT EVAS 26MM 12MM 22-23MM 10-11MM 16CM GORE XCLDR C3 BOND BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816232 EAP Custom 27816232 GRAFT EVAS 26MM 12MM 22-23MM 10-11MM 18CM GORE XCLDR C3 BOND BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816233 EAP Custom 27816233 GRAFT EVAS 26MM 14.5MM 22-23MM 12-13.5MM 12CM GORE XCLDR C3 BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816234 EAP Custom 27816234 GRAFT EVAS 26MM 14.5MM 14CM GORE XCLDR C3 TRNKIPSL LG AAA BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816235 EAP Custom 27816235 GRAFT EVAS 26MM 14.5MM 16CM GORE XCLDR C3 TRNKIPSL LG AAA BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816236 EAP Custom 27816236 GRAFT EVAS 26MM 14.5MM 22-23MM 12-13.5MM 18CM GORE XCLDR C3 BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816237 EAP Custom 27816237 GRAFT EVAS 28.5MM 12MM 24-26MM 10-11MM 12CM GORE XCLDR C3 BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816238 EAP Custom 27816238 GRAFT EVAS 28.5MM 12MM 24-26MM 10-11MM 14CM GORE XCLDR C3 BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816239 EAP Custom 27816239 GRAFT EVAS 28.5MM 12MM 24-26MM 10-11MM 16CM GORE XCLDR C3 BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816240 EAP Custom 27816240 GRAFT EVAS 28.5MM 12MM 24-26MM 10-11MM 18CM GORE XCLDR C3 BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816241 EAP Custom 27816241 GRAFT EVAS 28.5MM 14.5MM 24-26MM 12-13.5MM 14CM GORE XCLDR C BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816242 EAP Custom 27816242 GRAFT EVAS 28.5MM 14.5MM 24-26MM 12-13.5MM 16CM GORE XCLDR C BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816243 EAP Custom 27816243 GRAFT EVAS 28.5MM 14.5MM 24-26MM 12-13.5MM 18CM GORE XCLDR C BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816244 EAP Custom 27816244 GRAFT EVAS 31MM 14.5MM 13CM XCLDR C3 STNT DLV SYS GRTX NTNL BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816245 EAP Custom 27816245 GRAFT EVAS 31MM 14.5MM 15CM XCLDR C3 STNT DLV SYS GRTX NTNL BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816246 EAP Custom 27816246 GRAFT EVAS 31MM 14.5MM 17CM XCLDR C3 STNT DLV SYS GRTX NTNL BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816247 EAP Custom 27816247 GRAFT EVAS 35MM 14.5MM 30-32MM 12-13.5MM 14CM STRL GORE BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816248 EAP Custom 27816248 GRAFT EVAS 35MM 14.5MM 16CM XCLDR C3 STNT DLV SYS GRTX NTNL BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816249 EAP Custom 27816249 GRAFT EVAS 35MM 14.5MM 30-32MM 12-13.5MM 18CM GORE XCLDR C3 BOTH IP/OP "$28,188.00" "$20,859.50" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,017.46" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$5,874.69" "$28,188.00" "$11,275.20" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$28,188.00" "$21,141.00" "$28,188.00" "$28,188.00" "$28,188.00" "$14,094.00" "$14,094.00" "$22,324.90" "$28,188.00" "$22,550.40" "$12,684.60" "$28,188.00" "$28,188.00" "$16,349.04" "$28,188.00" "$16,912.80" "$28,188.00" "$28,188.00" "$28,188.00" N/A N/A 27816250 EAP HCPCS C1752 CATHETER HMDIAL 20CM SCHN XL KINK RST TIP CLIP SH REM STY BOTH IP/OP $119.00 $88.50 $24.80 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $119.00 $24.80 $119.00 $47.60 $119.00 $119.00 $119.00 $119.00 $119.00 $89.25 $119.00 $119.00 $119.00 $59.50 $59.50 $94.25 $119.00 $95.20 $53.55 $119.00 $119.00 $69.02 $119.00 $71.40 $119.00 $119.00 $119.00 N/A N/A 27816251 EAP HCPCS C1876 STENT INTRCRAN T 2.7-3.5MM 8MM PULSERIDER ARCH BOTH IP/OP "$31,250.00" "$23,125.00" "$6,202.34" "$31,250.00" "$14,062.50" "$14,062.50" "$14,062.50" "$14,062.50" "$31,250.00" "$31,250.00" "$31,250.00" "$6,513.28" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$6,512.84" "$31,250.00" "$31,250.00" "$15,406.25" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$23,437.50" "$31,250.00" "$31,250.00" "$31,250.00" "$15,625.00" "$15,625.00" "$24,750.00" "$31,250.00" "$25,000.00" "$14,062.50" "$6,202.34" "$31,250.00" "$18,125.00" "$31,250.00" "$31,250.00" "$31,250.00" "$6,512.50" "$31,250.00" N/A N/A 27816252 EAP HCPCS C1876 STENT INTRCRAN T 3.5-4.5MM 8MM PULSERIDER ARCH BOTH IP/OP "$31,250.00" "$23,125.00" "$6,202.34" "$31,250.00" "$14,062.50" "$14,062.50" "$14,062.50" "$14,062.50" "$31,250.00" "$31,250.00" "$31,250.00" "$6,513.28" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$6,512.84" "$31,250.00" "$31,250.00" "$15,406.25" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$23,437.50" "$31,250.00" "$31,250.00" "$31,250.00" "$15,625.00" "$15,625.00" "$24,750.00" "$31,250.00" "$25,000.00" "$14,062.50" "$6,202.34" "$31,250.00" "$18,125.00" "$31,250.00" "$18,750.00" "$31,250.00" "$6,512.50" "$31,250.00" N/A N/A 27816253 EAP HCPCS C1876 STENT INTRCRAN T 2.7-3.5MM 10MM PULSERIDER ARCH BOTH IP/OP "$31,250.00" "$23,125.00" "$6,202.34" "$31,250.00" "$14,062.50" "$14,062.50" "$14,062.50" "$14,062.50" "$31,250.00" "$31,250.00" "$31,250.00" "$6,513.28" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$6,512.84" "$31,250.00" "$31,250.00" "$15,406.25" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$23,437.50" "$31,250.00" "$31,250.00" "$31,250.00" "$15,625.00" "$15,625.00" "$24,750.00" "$31,250.00" "$25,000.00" "$14,062.50" "$6,202.34" "$31,250.00" "$18,125.00" "$31,250.00" "$31,250.00" "$31,250.00" "$6,512.50" "$31,250.00" N/A N/A 27816254 EAP HCPCS C1876 STENT INTRCRAN Y 2.7-3.5MM 8MM PULSERIDER ARCH BOTH IP/OP "$31,250.00" "$23,125.00" "$6,202.34" "$31,250.00" "$14,062.50" "$14,062.50" "$14,062.50" "$14,062.50" "$31,250.00" "$31,250.00" "$31,250.00" "$6,513.28" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$6,512.84" "$31,250.00" "$31,250.00" "$15,406.25" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$23,437.50" "$31,250.00" "$31,250.00" "$31,250.00" "$15,625.00" "$15,625.00" "$24,750.00" "$31,250.00" "$25,000.00" "$14,062.50" "$6,202.34" "$31,250.00" "$18,125.00" "$31,250.00" "$31,250.00" "$31,250.00" "$6,512.50" "$31,250.00" N/A N/A 27816255 EAP HCPCS C1876 STENT INTRCRAN Y 3.5-4.5MM 8MM PULSERIDER ARCH BOTH IP/OP "$31,250.00" "$23,125.00" "$6,202.34" "$31,250.00" "$14,062.50" "$14,062.50" "$14,062.50" "$14,062.50" "$31,250.00" "$31,250.00" "$31,250.00" "$6,513.28" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$6,512.84" "$31,250.00" "$31,250.00" "$15,406.25" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$23,437.50" "$31,250.00" "$31,250.00" "$31,250.00" "$15,625.00" "$15,625.00" "$24,750.00" "$31,250.00" "$25,000.00" "$14,062.50" "$6,202.34" "$31,250.00" "$18,125.00" "$31,250.00" "$31,250.00" "$31,250.00" "$6,512.50" "$31,250.00" N/A N/A 27816256 EAP HCPCS C1876 STENT INTRCRAN Y 2.7-3.5MM 10MM PULSERIDER ARCH BOTH IP/OP "$31,250.00" "$23,125.00" "$6,202.34" "$31,250.00" "$14,062.50" "$14,062.50" "$14,062.50" "$14,062.50" "$31,250.00" "$31,250.00" "$31,250.00" "$6,513.28" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$6,512.84" "$31,250.00" "$31,250.00" "$15,406.25" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$23,437.50" "$31,250.00" "$31,250.00" "$31,250.00" "$15,625.00" "$15,625.00" "$24,750.00" "$31,250.00" "$25,000.00" "$14,062.50" "$6,202.34" "$31,250.00" "$18,125.00" "$31,250.00" "$31,250.00" "$31,250.00" "$6,512.50" "$31,250.00" N/A N/A 27816257 EAP HCPCS C1876 STENT INTRCRAN Y 3.5-4.5MM 10MM PULSERIDER ARCH BOTH IP/OP "$31,250.00" "$23,125.00" "$6,202.34" "$31,250.00" "$14,062.50" "$14,062.50" "$14,062.50" "$14,062.50" "$31,250.00" "$31,250.00" "$31,250.00" "$6,513.28" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$6,512.84" "$31,250.00" "$31,250.00" "$15,406.25" "$31,250.00" "$31,250.00" "$31,250.00" "$31,250.00" "$23,437.50" "$31,250.00" "$31,250.00" "$31,250.00" "$15,625.00" "$15,625.00" "$24,750.00" "$31,250.00" "$25,000.00" "$14,062.50" "$6,202.34" "$31,250.00" "$18,125.00" "$31,250.00" "$31,250.00" "$31,250.00" "$6,512.50" "$31,250.00" N/A N/A 27816259 EAP HCPCS C1874 SYSTEM COR STNT 4.5MM 15MM 140CM RSLT ONYX RX DLV SYS RADOPQ BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$3,425.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 27816260 EAP HCPCS C1874 SYSTEM COR STNT 4.5MM 18MM 140CM RSLT ONYX RX DLV SYS RADOPQ BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$2,055.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 27816261 EAP HCPCS C1874 SYSTEM COR STNT 4.5MM 22MM 140CM RSLT ONYX RX DLV SYS RADOPQ BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$2,055.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 27816262 EAP HCPCS C1874 SYSTEM COR STNT 4.5MM 26MM 140CM RSLT ONYX RX DLV SYS RADOPQ BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$2,055.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 27816263 EAP HCPCS C1874 SYSTEM COR STNT 4.5MM 30MM 140CM RSLT ONYX RX DLV SYS RADOPQ BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$3,425.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 27816264 EAP HCPCS C1874 SYSTEM COR STNT 5MM 12MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1 BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$2,055.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 27816265 EAP HCPCS C1874 SYSTEM COR STNT 5MM 15MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1 BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$3,425.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 27816266 EAP HCPCS C1874 SYSTEM COR STNT 5MM 18MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1 BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$3,425.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 27816267 EAP HCPCS C1874 SYSTEM COR STNT 5MM 22MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1 BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$3,425.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 27816268 EAP HCPCS C1874 SYSTEM COR STNT 5MM 26MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1 BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$3,425.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 27816269 EAP HCPCS C1874 SYSTEM COR STNT 5MM 30MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1 BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$3,425.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 27816270 EAP HCPCS C1757 CATHETER THRMB .044IN 140CM STRL LF INDG SYS ASP KT COR BOTH IP/OP "$4,850.00" "$3,589.00" $962.60 "$4,850.00" "$2,182.50" "$2,182.50" "$2,182.50" "$2,182.50" "$4,850.00" "$4,850.00" "$4,850.00" "$1,010.86" "$4,850.00" "$4,850.00" "$4,850.00" "$4,850.00" "$4,850.00" "$1,010.79" "$4,850.00" "$4,850.00" "$2,391.05" "$4,850.00" "$4,850.00" "$4,850.00" "$4,850.00" "$3,637.50" "$4,850.00" "$4,850.00" "$4,850.00" "$2,425.00" "$2,425.00" "$3,841.20" "$4,850.00" "$3,880.00" "$2,182.50" $962.60 "$4,850.00" "$2,813.00" "$4,850.00" "$4,850.00" "$4,850.00" "$1,010.74" "$4,850.00" N/A N/A 27816280 EAP Custom 27816280 STENT EPRSTH 21MM 10CM STRL GORE TAG CNFRM FLXB RADOPQ EPTFE BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816281 EAP Custom 27816281 STENT EPRSTH 21-26MM 10CM STRL GORE TAG CNFRM FLXB RADOPQ BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816282 EAP Custom 27816282 STENT EPRSTH 26MM 10CM STRL GORE TAG FLXB RADOPQ NTNL FEP BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816283 EAP Custom 27816283 STENT EPRSTH 28MM 10CM STRL GORE TAG FLXB RADOPQ NTNL FEP BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816284 EAP Custom 27816284 STENT EPRSTH 28MM 15CM STRL GORE TAG FLXB RADOPQ NTNL FEP BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816285 EAP Custom 27816285 STENT EPRSTH 26-31MM 10CM STRL GORE TAG CNFRM FLXB RADOPQ BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816286 EAP Custom 27816286 STENT EPRSTH 31MM 10CM STRL GORE TAG FLXB RADOPQ NTNL FEP BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816287 EAP Custom 27816287 STENT EPRSTH 31MM 15CM STRL GORE TAG CNFRM FLXB RADOPQ EPTFE BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816288 EAP Custom 27816288 STENT EPRSTH 34MM 10CM STRL GORE TAG FLXB RADOPQ NTNL FEP BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816289 EAP Custom 27816289 STENT EPRSTH 34MM 15CM STRL GORE TAG CNFRM FLXB RADOPQ EPTFE BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816290 EAP Custom 27816290 STENT EPRSTH 34MM 20CM STRL GORE TAG CNFRM FLXB RADOPQ EPTFE BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816291 EAP Custom 27816291 STENT EPRSTH 37MM 10CM STRL GORE TAG CNFRM FLXB RADOPQ EPTFE BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816292 EAP Custom 27816292 STENT EPRSTH 37MM 15CM STRL GORE TAG CNFRM FLXB RADOPQ EPTFE BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816293 EAP Custom 27816293 STENT EPRSTH 37MM 20CM STRL GORE TAG CNFRM FLXB RADOPQ EPTFE BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816294 EAP Custom 27816294 STENT EPRSTH 40MM 10CM STRL GORE TAG CNFRM FLXB RADOPQ EPTFE BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816295 EAP Custom 27816295 STENT EPRSTH 40MM 15CM STRL GORE TAG CNFRM FLXB RADOPQ EPTFE BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816296 EAP Custom 27816296 STENT EPRSTH 40MM 20CM STRL GORE TAG CNFRM FLXB RADOPQ EPTFE BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816297 EAP Custom 27816297 STENT EPRSTH 45MM 10CM STRL GORE TAG CNFRM FLXB RADOPQ EPTFE BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816298 EAP Custom 27816298 STENT EPRSTH 45MM 15CM STRL GORE TAG CNFRM FLXB RADOPQ EPTFE BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816299 EAP Custom 27816299 STENT EPRSTH 45MM 20CM STRL GORE TAG CNFRM FLXB RADOPQ EPTFE BOTH IP/OP "$41,640.00" "$30,814.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$7,411.92" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$8,678.23" "$41,640.00" "$16,656.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$41,640.00" "$31,230.00" "$41,640.00" "$41,640.00" "$41,640.00" "$20,820.00" "$20,820.00" "$32,978.88" "$41,640.00" "$33,312.00" "$18,738.00" "$41,640.00" "$41,640.00" "$24,151.20" "$41,640.00" "$24,984.00" "$41,640.00" "$41,640.00" "$41,640.00" N/A N/A 27816300 EAP PLUG OCL 3MM 12X5.3MM MVP MECH DTCH FULL RESHEATHABLE NTNL BOTH IP/OP "$3,738.00" "$2,766.50" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$1,495.20" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" "$3,738.00" "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" "$3,738.00" "$3,738.00" N/A N/A 27816301 EAP PLUG OCL 5MM 12X6.5MM STRL LF MVP MECH DTCH FULL BOTH IP/OP "$3,738.00" "$2,766.50" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$1,495.20" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" "$3,738.00" "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" "$3,738.00" "$3,738.00" N/A N/A 27816302 EAP PLUG OCL MIC 7MM STRL LF MVP MECH VASC DISP V03 BOTH IP/OP "$3,738.00" "$2,766.50" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$1,495.20" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" "$3,738.00" "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" "$3,738.00" "$3,738.00" N/A N/A 27816303 EAP PLUG OCL 9MM STRL LF MVP V03 BOTH IP/OP "$3,738.00" "$2,766.50" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$1,495.20" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" "$3,738.00" "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" "$3,738.00" "$3,738.00" N/A N/A 27816304 EAP Custom 27816304 GRAFT EVAS 10MM 10CM GORE XCLDR BRCH CMPNT ILC AAA BOTH IP/OP "$27,548.00" "$20,386.00" "$4,903.54" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$4,903.54" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$5,741.31" "$27,548.00" "$11,019.20" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$20,661.00" "$27,548.00" "$27,548.00" "$27,548.00" "$13,774.00" "$13,774.00" "$21,818.02" "$27,548.00" "$22,038.40" "$12,396.60" "$27,548.00" "$27,548.00" "$15,977.84" "$27,548.00" "$16,528.80" "$27,548.00" "$27,548.00" "$27,548.00" N/A N/A 27816305 EAP Custom 27816305 GRAFT EVAS 12MM 10CM GORE XCLDR BRCH CMPNT ILC AAA BOTH IP/OP "$27,548.00" "$20,386.00" "$4,903.54" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$4,903.54" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$5,741.31" "$27,548.00" "$11,019.20" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$20,661.00" "$27,548.00" "$27,548.00" "$27,548.00" "$13,774.00" "$13,774.00" "$21,818.02" "$27,548.00" "$22,038.40" "$12,396.60" "$27,548.00" "$27,548.00" "$15,977.84" "$27,548.00" "$16,528.80" "$27,548.00" "$27,548.00" "$27,548.00" N/A N/A 27816306 EAP Custom 27816306 GRAFT EVAS 14.5MM 10CM GORE XCLDR BRCH CMPNT ILC AAA BOTH IP/OP "$27,548.00" "$20,386.00" "$4,903.54" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$4,903.54" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$5,741.31" "$27,548.00" "$11,019.20" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$27,548.00" "$20,661.00" "$27,548.00" "$27,548.00" "$27,548.00" "$13,774.00" "$13,774.00" "$21,818.02" "$27,548.00" "$22,038.40" "$12,396.60" "$27,548.00" "$27,548.00" "$15,977.84" "$27,548.00" "$16,528.80" "$27,548.00" "$27,548.00" "$27,548.00" N/A N/A 27816307 EAP Custom 27816307 GRAFT EVAS 14.5MM 7CM GORE XCLDR INTNL CMPNT ILC AAA BOTH IP/OP "$7,688.00" "$5,689.50" "$1,368.46" "$7,688.00" "$7,688.00" "$7,688.00" "$7,688.00" "$7,688.00" "$7,688.00" "$7,688.00" "$1,368.46" "$7,688.00" "$7,688.00" "$7,688.00" "$7,688.00" "$7,688.00" "$7,688.00" "$1,602.26" "$7,688.00" "$3,075.20" "$7,688.00" "$7,688.00" "$7,688.00" "$7,688.00" "$7,688.00" "$5,766.00" "$7,688.00" "$7,688.00" "$7,688.00" "$3,844.00" "$3,844.00" "$6,088.90" "$7,688.00" "$6,150.40" "$3,459.60" "$7,688.00" "$7,688.00" "$4,459.04" "$7,688.00" "$4,612.80" "$7,688.00" "$7,688.00" "$7,688.00" N/A N/A 27816308 EAP HCPCS C1783 STENT OPTH 50UM 230UM 80UM 360UM STRL ISTENT INJ 2 PRELD 1 BOTH IP/OP "$3,688.00" "$2,729.50" $731.98 "$3,688.00" "$1,659.60" "$1,659.60" "$1,659.60" "$1,659.60" "$3,688.00" "$3,688.00" "$3,688.00" $768.67 "$3,688.00" "$3,688.00" "$3,688.00" "$3,688.00" "$3,688.00" $768.62 "$3,688.00" "$3,688.00" "$1,818.18" "$3,688.00" "$3,688.00" "$3,688.00" "$3,688.00" "$2,766.00" "$3,688.00" "$3,688.00" "$3,688.00" "$1,844.00" "$1,844.00" "$2,920.90" "$3,688.00" "$2,950.40" "$1,659.60" $731.98 "$3,688.00" "$2,139.04" "$3,688.00" "$3,688.00" "$3,688.00" $768.58 "$3,688.00" N/A N/A 27816309 EAP HCPCS C1874 AXIOS STENT AND ELECTROCAUTERY 15X10 BOTH IP/OP "$11,625.00" "$8,602.50" "$2,307.27" "$11,625.00" "$5,231.25" "$5,231.25" "$5,231.25" "$5,231.25" "$11,625.00" "$11,625.00" "$11,625.00" "$2,422.94" "$11,625.00" "$11,625.00" "$11,625.00" "$11,625.00" "$11,625.00" "$2,422.78" "$11,625.00" "$11,625.00" "$5,731.13" "$11,625.00" "$11,625.00" "$11,625.00" "$11,625.00" "$8,718.75" "$11,625.00" "$11,625.00" "$11,625.00" "$5,812.50" "$5,812.50" "$9,207.00" "$11,625.00" "$9,300.00" "$5,231.25" "$2,307.27" "$11,625.00" "$6,742.50" "$11,625.00" "$11,625.00" "$11,625.00" "$2,422.65" "$11,625.00" N/A N/A 27816310 EAP HCPCS C1874 WALLFLEX BILIARY STENT BOTH IP/OP "$6,738.00" "$4,986.50" "$1,337.32" "$6,738.00" "$3,032.10" "$3,032.10" "$3,032.10" "$3,032.10" "$6,738.00" "$6,738.00" "$6,738.00" "$1,404.37" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$1,404.27" "$6,738.00" "$6,738.00" "$3,321.83" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$5,053.50" "$6,738.00" "$6,738.00" "$6,738.00" "$3,369.00" "$3,369.00" "$5,336.50" "$6,738.00" "$5,390.40" "$3,032.10" "$1,337.32" "$6,738.00" "$3,908.04" "$6,738.00" "$6,738.00" "$6,738.00" "$1,404.20" "$6,738.00" N/A N/A 27816311 EAP HCPCS C1768 ENVELOPE TISS 5X5.4CM CORMATRIX CANGAROO SM SFT BOTH IP/OP "$12,063.00" "$8,927.00" "$2,394.20" "$12,063.00" "$5,428.35" "$5,428.35" "$5,428.35" "$5,428.35" "$12,063.00" "$12,063.00" "$12,063.00" "$2,514.23" "$12,063.00" "$12,063.00" "$12,063.00" "$12,063.00" "$12,063.00" "$2,514.06" "$12,063.00" "$12,063.00" "$5,947.06" "$12,063.00" "$12,063.00" "$12,063.00" "$12,063.00" "$9,047.25" "$12,063.00" "$12,063.00" "$12,063.00" "$6,031.50" "$6,031.50" "$9,553.90" "$12,063.00" "$9,650.40" "$5,428.35" "$2,394.20" "$12,063.00" "$6,996.54" "$12,063.00" "$12,063.00" "$12,063.00" "$2,513.93" "$12,063.00" N/A N/A 27816312 EAP HCPCS C1768 ENVELOPE TISS 6.9X6.5CM CORMATRIX CANGAROO MED SFT BOTH IP/OP "$12,063.00" "$8,927.00" "$2,394.20" "$12,063.00" "$5,428.35" "$5,428.35" "$5,428.35" "$5,428.35" "$12,063.00" "$12,063.00" "$12,063.00" "$2,514.23" "$12,063.00" "$12,063.00" "$12,063.00" "$12,063.00" "$12,063.00" "$2,514.06" "$12,063.00" "$12,063.00" "$5,947.06" "$12,063.00" "$12,063.00" "$12,063.00" "$12,063.00" "$9,047.25" "$12,063.00" "$12,063.00" "$12,063.00" "$6,031.50" "$6,031.50" "$9,553.90" "$12,063.00" "$9,650.40" "$5,428.35" "$2,394.20" "$12,063.00" "$6,996.54" "$12,063.00" "$12,063.00" "$12,063.00" "$2,513.93" "$12,063.00" N/A N/A 27816313 EAP HCPCS C1768 ENVELOPE TISS 8X6.9CM CORMATRIX CANGAROO LG SFT BOTH IP/OP "$12,063.00" "$8,927.00" "$2,394.20" "$12,063.00" "$5,428.35" "$5,428.35" "$5,428.35" "$5,428.35" "$12,063.00" "$12,063.00" "$12,063.00" "$2,514.23" "$12,063.00" "$12,063.00" "$12,063.00" "$12,063.00" "$12,063.00" "$2,514.06" "$12,063.00" "$12,063.00" "$5,947.06" "$12,063.00" "$12,063.00" "$12,063.00" "$12,063.00" "$9,047.25" "$12,063.00" "$12,063.00" "$12,063.00" "$6,031.50" "$6,031.50" "$9,553.90" "$12,063.00" "$9,650.40" "$5,428.35" "$2,394.20" "$12,063.00" "$6,996.54" "$12,063.00" "$12,063.00" "$12,063.00" "$2,513.93" "$12,063.00" N/A N/A 27816314 EAP HCPCS C1768 ENVELOPE TISS 9.5X6.9CM CORMATRIX CANGAROO XL SFT BOTH IP/OP "$12,063.00" "$8,927.00" "$2,394.20" "$12,063.00" "$5,428.35" "$5,428.35" "$5,428.35" "$5,428.35" "$12,063.00" "$12,063.00" "$12,063.00" "$2,514.23" "$12,063.00" "$12,063.00" "$12,063.00" "$12,063.00" "$12,063.00" "$2,514.06" "$12,063.00" "$12,063.00" "$5,947.06" "$12,063.00" "$12,063.00" "$12,063.00" "$12,063.00" "$9,047.25" "$12,063.00" "$12,063.00" "$12,063.00" "$6,031.50" "$6,031.50" "$9,553.90" "$12,063.00" "$9,650.40" "$5,428.35" "$2,394.20" "$12,063.00" "$6,996.54" "$12,063.00" "$12,063.00" "$12,063.00" "$2,513.93" "$12,063.00" N/A N/A 27816315 EAP HCPCS C1768 ENVELOPE TISS 10.8X8.9CM CANGAROO 2XL SFT REINF BOTH IP/OP "$16,563.00" "$12,257.00" "$3,287.34" "$16,563.00" "$7,453.35" "$7,453.35" "$7,453.35" "$7,453.35" "$16,563.00" "$16,563.00" "$16,563.00" "$3,452.14" "$16,563.00" "$16,563.00" "$16,563.00" "$16,563.00" "$16,563.00" "$3,451.91" "$16,563.00" "$16,563.00" "$8,165.56" "$16,563.00" "$16,563.00" "$16,563.00" "$16,563.00" "$12,422.25" "$16,563.00" "$16,563.00" "$16,563.00" "$8,281.50" "$8,281.50" "$13,117.90" "$16,563.00" "$13,250.40" "$7,453.35" "$3,287.34" "$16,563.00" "$9,606.54" "$16,563.00" "$16,563.00" "$16,563.00" "$3,451.73" "$16,563.00" N/A N/A 27816316 EAP HCPCS C1874 STENT ENDOPRSTH 2.5CM 5MM HEP NTNL EPTFE VBHN 120 BOTH IP/OP "$8,808.00" "$6,518.00" "$1,748.17" "$8,808.00" "$3,963.60" "$3,963.60" "$3,963.60" "$3,963.60" "$8,808.00" "$8,808.00" "$8,808.00" "$1,835.81" "$8,808.00" "$8,808.00" "$8,808.00" "$8,808.00" "$8,808.00" "$1,835.68" "$8,808.00" "$8,808.00" "$4,342.34" "$8,808.00" "$8,808.00" "$8,808.00" "$8,808.00" "$6,606.00" "$8,808.00" "$8,808.00" "$8,808.00" "$4,404.00" "$4,404.00" "$6,975.94" "$8,808.00" "$7,046.40" "$3,963.60" "$1,748.17" "$8,808.00" "$5,108.64" "$8,808.00" "$8,808.00" "$8,808.00" "$1,835.59" "$8,808.00" N/A N/A 27816317 EAP HCPCS C1874 STENT ENDOPRSTH 2.5CM 6MM HEP NTNL EPTFE VBHN 120 BOTH IP/OP "$8,808.00" "$6,518.00" "$1,748.17" "$8,808.00" "$3,963.60" "$3,963.60" "$3,963.60" "$3,963.60" "$8,808.00" "$8,808.00" "$8,808.00" "$1,835.81" "$8,808.00" "$8,808.00" "$8,808.00" "$8,808.00" "$8,808.00" "$1,835.68" "$8,808.00" "$8,808.00" "$4,342.34" "$8,808.00" "$8,808.00" "$8,808.00" "$8,808.00" "$6,606.00" "$8,808.00" "$8,808.00" "$8,808.00" "$4,404.00" "$4,404.00" "$6,975.94" "$8,808.00" "$7,046.40" "$3,963.60" "$1,748.17" "$8,808.00" "$5,108.64" "$8,808.00" "$8,808.00" "$8,808.00" "$1,835.59" "$8,808.00" N/A N/A 27816318 EAP HCPCS C1874 STENT ENDOPRSTH 2.5CM 8MM HEP NTNL EPTFE VBHN 120 BOTH IP/OP "$8,808.00" "$6,518.00" "$1,748.17" "$8,808.00" "$3,963.60" "$3,963.60" "$3,963.60" "$3,963.60" "$8,808.00" "$8,808.00" "$8,808.00" "$1,835.81" "$8,808.00" "$8,808.00" "$8,808.00" "$8,808.00" "$8,808.00" "$1,835.68" "$8,808.00" "$8,808.00" "$4,342.34" "$8,808.00" "$8,808.00" "$8,808.00" "$8,808.00" "$6,606.00" "$8,808.00" "$8,808.00" "$8,808.00" "$4,404.00" "$4,404.00" "$6,975.94" "$8,808.00" "$7,046.40" "$3,963.60" "$1,748.17" "$8,808.00" "$5,108.64" "$8,808.00" "$8,808.00" "$8,808.00" "$1,835.59" "$8,808.00" N/A N/A 27816320 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 2.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816321 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 2.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816322 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 2.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816323 EAP HCPCS C1874 SYSTEM CORON STENT 17MM 2.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816324 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 2.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816325 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 2.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816326 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 2.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816327 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 2.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816328 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 2.75MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816329 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 2.75MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816330 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 2.75MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816331 EAP HCPCS C1874 SYSTEM CORON STENT 17MM 2.75MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816332 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 2.75MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816333 EAP HCPCS C1874 STENT CORON 24MM 2.75MM CARBOSIL 20 55D BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816334 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 2.75MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816335 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 2.75MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816336 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 2.75MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816337 EAP HCPCS C1874 SYSTEM CORON STENT 44MM 2.75MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816338 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 3MM ELUNIR THK90UM CARBOSIL BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816339 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816340 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 3MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816341 EAP HCPCS C1874 SYSTEM CORON STENT 17MM 3MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816342 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 3MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816343 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 3MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816344 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816345 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 3MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816346 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 3MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816347 EAP HCPCS C1874 SYSTEM CORON STENT 44MM 3MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816348 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 3.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816349 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816350 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 3.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816351 EAP HCPCS C1874 SYSTEM CORON STENT 17MM 3.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816352 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 3.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816353 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 3.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816354 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816355 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 3.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816356 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 3.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816357 EAP HCPCS C1874 SYSTEM CORON STENT 44MM 3.5MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816358 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 4MM ELUNIR THK90UM CARBOSIL BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816359 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 4MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816360 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 4MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816361 EAP HCPCS C1874 SYSTEM CORON STENT 17MM 4MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816362 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 4MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816363 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 4MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816364 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 4MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816365 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 4MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816366 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 4MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816367 EAP HCPCS C1874 SYSTEM CORON STENT 44MM 4MM ELUNIR THK90UM BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 27816371 EAP HCPCS C1874 STENT ENDOPROSTHESIS VIABAHN HEPARIN NITINOL EPTFE L25 CM L120 CM OD6 MM BOTH IP/OP "$15,988.00" "$11,831.50" "$3,173.22" "$15,988.00" "$7,194.60" "$7,194.60" "$7,194.60" "$7,194.60" "$15,988.00" "$15,988.00" "$15,988.00" "$3,332.30" "$15,988.00" "$15,988.00" "$15,988.00" "$15,988.00" "$15,988.00" "$3,332.08" "$15,988.00" "$15,988.00" "$7,882.08" "$15,988.00" "$15,988.00" "$15,988.00" "$15,988.00" "$11,991.00" "$15,988.00" "$15,988.00" "$15,988.00" "$7,994.00" "$7,994.00" "$12,662.50" "$15,988.00" "$12,790.40" "$7,194.60" "$3,173.22" "$15,988.00" "$9,273.04" "$15,988.00" "$15,988.00" "$15,988.00" "$3,331.90" "$15,988.00" N/A N/A 27816375 EAP HCPCS C1889 REV 278-C1889- IMPLANT/INSERTED DEVICE NOC BOTH IP/OP "$7,413.00" "$5,486.00" "$1,471.30" "$7,413.00" "$3,335.85" "$3,335.85" "$3,335.85" "$3,335.85" "$7,413.00" "$7,413.00" "$7,413.00" "$1,545.05" "$7,413.00" "$7,413.00" "$7,413.00" "$7,413.00" "$7,413.00" "$1,544.95" "$7,413.00" "$7,413.00" "$3,654.61" "$7,413.00" "$7,413.00" "$7,413.00" "$7,413.00" "$5,559.75" "$7,413.00" "$7,413.00" "$7,413.00" "$3,706.50" "$3,706.50" "$5,871.10" "$7,413.00" "$5,930.40" "$3,335.85" "$1,471.30" "$7,413.00" "$4,299.54" "$7,413.00" "$7,413.00" "$7,413.00" "$1,544.87" "$7,413.00" N/A N/A 28000001 EAP CPT® 96522 REFILL/MAINT IMPLANT PUMP BOTH IP/OP $497.00 $368.00 $98.64 $497.00 $319.47 $319.47 $319.47 $319.47 $201.23 $201.23 $200.34 $103.59 $201.23 $497.00 $497.00 $497.00 $497.00 $103.58 $321.97 $298.01 $293.98 $201.23 $117.75 $201.23 $211.29 $372.75 $201.23 $201.23 $201.23 $248.50 $248.50 $393.62 $201.23 $397.60 $323.05 $98.64 $201.23 $288.26 $211.29 $291.13 $201.23 $103.57 $201.23 N/A N/A 30000002 EAP CPT® 80053 COMP METABOLIC PANEL BOTH IP/OP $472.00 $349.50 $5.28 $472.00 $20.73 $20.73 $20.73 $20.73 $10.56 $10.56 $5.28 $5.28 $10.56 $16.06 $16.06 $16.68 $11.72 $15.61 $16.90 $16.90 $279.19 $10.56 $10.56 $10.56 $472.00 $354.00 $10.56 $10.56 $10.56 $59.08 $59.08 $373.82 $10.56 $377.60 $17.42 $14.87 $10.56 $273.76 $472.00 $15.31 $10.56 $11.68 $10.56 N/A N/A 30000003 EAP CPT® 81340 "T CELL RECEPTOR (TCR) BETA GENE REARRANG, PCR (SO)" BOTH IP/OP $690.00 $511.00 $46.99 $690.00 $690.00 $690.00 $690.00 $690.00 $208.92 $208.92 $104.46 $690.00 $208.92 $296.42 $296.42 $307.82 $216.38 $46.99 $334.27 $334.27 $690.00 $208.92 $208.92 $208.92 $690.00 $517.50 $208.92 $208.92 $208.92 $345.00 $345.00 $546.48 $208.92 $552.00 $690.00 $690.00 $208.92 $400.20 $690.00 $302.93 $208.92 $690.00 $208.92 N/A N/A 30000004 EAP CPT® 84999 UNLISTED CHEMISTRY PROCEDURE (SO)GENE BOTH IP/OP $143.00 $106.00 $28.38 $143.00 $143.00 $143.00 $143.00 $143.00 $143.00 $143.00 $143.00 $29.80 $143.00 $106.13 $106.13 $110.22 $74.50 $29.80 $143.00 $57.20 $84.58 $143.00 $143.00 $143.00 $143.00 $107.25 $143.00 $143.00 $143.00 $143.00 $143.00 $113.26 $143.00 $114.40 $92.95 $28.38 $143.00 $82.94 $143.00 $85.80 $143.00 $29.80 $143.00 N/A N/A 30000005 EAP CPT® 81340 T -CELL ANTIGEN RECEPTOR BETA (SO) CLON BOTH IP/OP $690.00 $511.00 $46.99 $690.00 $690.00 $690.00 $690.00 $690.00 $208.92 $208.92 $104.46 $690.00 $208.92 $296.42 $296.42 $307.82 $216.38 $46.99 $334.27 $334.27 $690.00 $208.92 $208.92 $208.92 $690.00 $517.50 $208.92 $208.92 $208.92 $345.00 $345.00 $546.48 $208.92 $552.00 $690.00 $690.00 $208.92 $400.20 $690.00 $302.93 $208.92 $690.00 $208.92 N/A N/A 30000006 EAP CPT® 81342 T -CELL ANTIGEN RECEPTOR GAMMA (SO) CLON BOTH IP/OP $954.00 $706.00 $100.75 $954.00 $954.00 $954.00 $954.00 $954.00 $201.50 $201.50 $100.75 $954.00 $201.50 $285.90 $285.90 $296.89 $208.70 $192.65 $322.40 $322.40 $954.00 $201.50 $201.50 $201.50 $954.00 $715.50 $201.50 $201.50 $201.50 $477.00 $477.00 $755.57 $201.50 $763.20 $954.00 $954.00 $201.50 $553.32 $954.00 $292.18 $201.50 $954.00 $201.50 N/A N/A 30000007 EAP CPT® 84999 UNLISTED CHEMISTRY PROCEDURE (SO) CLON BOTH IP/OP $143.00 $106.00 $28.38 $143.00 $143.00 $143.00 $143.00 $143.00 $143.00 $143.00 $143.00 $29.80 $143.00 $106.13 $106.13 $110.22 $74.50 $29.80 $143.00 $57.20 $84.58 $143.00 $143.00 $143.00 $143.00 $107.25 $143.00 $143.00 $143.00 $143.00 $143.00 $113.26 $143.00 $114.40 $92.95 $28.38 $143.00 $82.94 $143.00 $85.80 $143.00 $29.80 $143.00 N/A N/A 30000008 EAP CPT® 81381 HLA- B57:01 DETERMINATION-PCR (QUEST) BOTH IP/OP $370.00 $274.00 $35.15 $370.00 $185.61 $185.61 $185.61 $185.61 $169.90 $169.90 $84.95 $76.46 $169.90 $134.19 $134.19 $139.35 $97.96 $46.99 $271.84 $271.84 $218.86 $169.90 $169.90 $169.90 $370.00 $277.50 $169.90 $169.90 $169.90 $185.00 $185.00 $293.04 $169.90 $296.00 $280.34 $44.75 $169.90 $214.60 $370.00 $246.36 $169.90 $35.15 $169.90 N/A N/A 30000009 EAP CPT® 81380 HLA -B HIGH RESOLUTION- PCR (QUEST) BOTH IP/OP $573.00 $424.50 $88.63 $573.00 $573.00 $573.00 $573.00 $573.00 $177.25 $177.25 $88.63 $573.00 $177.25 $251.48 $251.48 $261.15 $183.58 $192.65 $283.60 $283.60 $573.00 $177.25 $177.25 $177.25 $573.00 $429.75 $177.25 $177.25 $177.25 $286.50 $286.50 $453.82 $177.25 $458.40 $573.00 $573.00 $177.25 $332.34 $573.00 $257.01 $177.25 $573.00 $177.25 N/A N/A 30000010 EAP CPT® 87798 "EBOLA -CDC,RT-PCR,EVD" BOTH IP/OP $114.00 $84.50 $17.55 $114.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $67.43 $35.09 $35.09 $35.09 $114.00 $85.50 $35.09 $35.09 $35.09 $109.64 $109.64 $90.29 $35.09 $91.20 $74.10 $27.60 $35.09 $66.12 $114.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30000018 EAP CPT® 80346 "BENZODIAZPNE,UR-EIA" BOTH IP/OP $374.00 $277.00 $12.01 $374.00 $374.00 $374.00 $374.00 $374.00 $374.00 $374.00 $12.01 $374.00 $374.00 $277.58 $277.58 $288.28 $194.85 $27.32 $374.00 $127.20 $374.00 $374.00 $318.00 $374.00 $374.00 $280.50 $374.00 $374.00 $374.00 $187.00 $187.00 $296.21 $374.00 $299.20 $243.10 $374.00 $374.00 $216.92 $374.00 $224.40 $374.00 $374.00 $374.00 N/A N/A 30000019 EAP CPT® 80353 COCAIN METAB.UR-EIA BOTH IP/OP $374.00 $277.00 $0.03 $374.00 $0.03 $0.03 $0.03 $0.03 $374.00 $374.00 $12.01 $9.31 $374.00 $277.58 $277.58 $288.28 $194.85 $14.16 $374.00 $125.20 $221.22 $374.00 $313.00 $374.00 $374.00 $280.50 $374.00 $374.00 $374.00 $187.00 $187.00 $296.21 $374.00 $299.20 $243.10 $13.49 $374.00 $216.92 $374.00 $224.40 $374.00 $10.60 $374.00 N/A N/A 30000020 EAP CPT® 83992 "PHENCYCLIDNE,UR-EIA" BOTH IP/OP $374.00 $277.00 $16.29 $374.00 $374.00 $374.00 $374.00 $374.00 $374.00 $374.00 $20.72 $374.00 $374.00 $22.32 $22.32 $23.18 $16.29 $21.72 $374.00 $98.00 $374.00 $374.00 $245.00 $374.00 $374.00 $280.50 $374.00 $374.00 $374.00 $82.16 $82.16 $296.21 $374.00 $299.20 $243.10 $374.00 $374.00 $216.92 $374.00 $224.40 $374.00 $374.00 $374.00 N/A N/A 30000021 EAP CPT® 80361 "OPIATES,UR-EIA" BOTH IP/OP $495.00 $366.50 $0.03 $495.00 $0.03 $0.03 $0.03 $0.03 $495.00 $495.00 $12.01 $11.94 $495.00 $367.39 $367.39 $381.55 $257.90 $30.51 $495.00 $198.00 $292.79 $495.00 $495.00 $495.00 $495.00 $371.25 $495.00 $495.00 $495.00 $247.50 $247.50 $392.04 $495.00 $396.00 $321.75 $29.06 $495.00 $287.10 $495.00 $297.00 $495.00 $22.83 $495.00 N/A N/A 30000022 EAP CPT® 80349 "THC, UR-EIA" BOTH IP/OP $374.00 $277.00 $0.03 $374.00 $0.03 $0.03 $0.03 $0.03 $114.43 $114.43 $57.22 $14.54 $114.43 $277.58 $277.58 $288.28 $194.85 $77.95 $183.09 $183.09 $221.22 $114.43 $114.43 $114.43 $374.00 $280.50 $114.43 $114.43 $114.43 $187.00 $187.00 $296.21 $114.43 $299.20 $243.10 $74.23 $114.43 $216.92 $374.00 $224.40 $374.00 $77.94 $114.43 N/A N/A 30000023 EAP CPT® 80345 "BARBITURATE,UR-EIA" BOTH IP/OP $245.00 $181.50 $0.03 $245.00 $0.03 $0.03 $0.03 $0.03 $245.00 $245.00 $12.01 $7.03 $245.00 $181.84 $181.84 $188.85 $127.65 $16.93 $245.00 $98.00 $144.92 $245.00 $245.00 $245.00 $245.00 $183.75 $245.00 $245.00 $245.00 $122.50 $122.50 $194.04 $245.00 $196.00 $159.25 $16.12 $245.00 $142.10 $245.00 $147.00 $245.00 $12.66 $245.00 N/A N/A 30000024 EAP CPT® 80150 AMIKACIN-RANDOM BOTH IP/OP $265.00 $196.50 $7.54 $265.00 $265.00 $265.00 $265.00 $265.00 $15.08 $15.08 $7.54 $265.00 $15.08 $22.89 $22.89 $23.77 $16.71 $22.26 $24.13 $24.13 $265.00 $15.08 $15.08 $15.08 $265.00 $198.75 $15.08 $15.08 $15.08 $84.24 $84.24 $209.88 $15.08 $212.00 $172.25 $265.00 $15.08 $153.70 $265.00 $21.87 $15.08 $265.00 $15.08 N/A N/A 30000025 EAP CPT® 80335 AMITRIPTYLINE-RANDOM BOTH IP/OP $93.00 $69.00 $12.01 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $93.00 $12.01 $93.00 $93.00 $69.02 $69.02 $71.68 $48.45 $26.44 $93.00 $37.20 $93.00 $93.00 $93.00 $93.00 $93.00 $69.75 $93.00 $93.00 $93.00 $46.50 $46.50 $73.66 $93.00 $74.40 $60.45 $93.00 $93.00 $53.94 $93.00 $55.80 $93.00 $93.00 $93.00 N/A N/A 30000026 EAP CPT® 80159 CLOZAPINE (SO) BOTH IP/OP $299.00 $221.50 $9.25 $299.00 $36.29 $36.29 $36.29 $36.29 $20.15 $20.15 $10.08 $9.25 $20.15 $26.24 $26.24 $27.25 $19.15 $23.71 $32.24 $32.24 $176.86 $20.15 $20.15 $20.15 $299.00 $224.25 $20.15 $20.15 $20.15 $149.50 $149.50 $236.81 $20.15 $239.20 $194.35 $22.58 $20.15 $173.42 $299.00 $29.22 $20.15 $17.74 $20.15 N/A N/A 30000027 EAP CPT® 80156 CARBAMAZPINE-RANDOM BOTH IP/OP $279.00 $206.50 $7.28 $279.00 $28.59 $28.59 $28.59 $28.59 $14.57 $14.57 $7.29 $7.28 $14.57 $22.11 $22.11 $22.96 $16.14 $21.51 $23.31 $23.31 $165.03 $14.57 $14.57 $14.57 $279.00 $209.25 $14.57 $14.57 $14.57 $81.36 $81.36 $220.97 $14.57 $223.20 $181.35 $20.49 $14.57 $161.82 $279.00 $21.13 $14.57 $16.09 $14.57 N/A N/A 30000028 EAP CPT® 80158 CYCLOSPORINE BOTH IP/OP $238.00 $176.50 $6.59 $238.00 $11.70 $11.70 $11.70 $11.70 $18.05 $18.05 $9.03 $9.03 $18.05 $9.05 $9.05 $9.40 $6.60 $8.81 $28.88 $28.88 $140.78 $18.05 $18.05 $18.05 $238.00 $178.50 $18.05 $18.05 $18.05 $33.32 $33.32 $188.50 $18.05 $190.40 $154.70 $8.39 $18.05 $138.04 $238.00 $26.17 $18.05 $6.59 $18.05 N/A N/A 30000029 EAP CPT® 80335 DESIPRAMINE-RANDOM BOTH IP/OP $124.00 $92.00 $12.01 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $12.01 $124.00 $124.00 $92.03 $92.03 $95.58 $64.60 $26.44 $124.00 $49.60 $124.00 $124.00 $124.00 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $80.60 $124.00 $124.00 $71.92 $124.00 $74.40 $124.00 $124.00 $124.00 N/A N/A 30000030 EAP CPT® 80162 "DIGOXIN, TOTAL" BOTH IP/OP $281.00 $208.00 $6.64 $281.00 $26.05 $26.05 $26.05 $26.05 $13.28 $13.28 $6.64 $6.64 $13.28 $20.17 $20.17 $20.94 $14.72 $19.61 $21.25 $21.25 $166.21 $13.28 $13.28 $13.28 $281.00 $210.75 $13.28 $13.28 $13.28 $74.20 $74.20 $222.55 $13.28 $224.80 $182.65 $18.68 $13.28 $162.98 $281.00 $19.26 $13.28 $14.67 $13.28 N/A N/A 30000031 EAP CPT® 80164 "VALPROIC ACID, TOTAL" BOTH IP/OP $319.00 $236.50 $6.77 $319.00 $22.29 $22.29 $22.29 $22.29 $13.54 $13.54 $6.77 $6.77 $13.54 $17.23 $17.23 $17.90 $12.58 $16.77 $21.66 $21.66 $188.69 $13.54 $13.54 $13.54 $319.00 $239.25 $13.54 $13.54 $13.54 $63.44 $63.44 $252.65 $13.54 $255.20 $207.35 $15.97 $13.54 $185.02 $319.00 $19.63 $13.54 $12.54 $13.54 N/A N/A 30000032 EAP CPT® 80335 DOXEPIN-RANDOM BOTH IP/OP $123.00 $91.50 $12.01 $123.00 $123.00 $123.00 $123.00 $123.00 $123.00 $123.00 $12.01 $123.00 $123.00 $91.29 $91.29 $94.81 $64.08 $26.44 $123.00 $49.20 $123.00 $123.00 $123.00 $123.00 $123.00 $92.25 $123.00 $123.00 $123.00 $61.50 $61.50 $97.42 $123.00 $98.40 $79.95 $123.00 $123.00 $71.34 $123.00 $73.80 $123.00 $123.00 $123.00 N/A N/A 30000033 EAP CPT® 80168 ETHOSUXIMIDE-RANDOM BOTH IP/OP $86.00 $64.00 $8.17 $86.00 $86.00 $86.00 $86.00 $86.00 $16.34 $16.34 $8.17 $86.00 $16.34 $24.81 $24.81 $25.77 $18.11 $24.14 $26.14 $26.14 $86.00 $16.34 $16.34 $16.34 $86.00 $64.50 $16.34 $16.34 $16.34 $86.00 $86.00 $68.11 $16.34 $68.80 $55.90 $86.00 $16.34 $49.88 $86.00 $23.69 $16.34 $86.00 $16.34 N/A N/A 30000034 EAP CPT® 80170 GENTAMICIN-RANDOM BOTH IP/OP $201.00 $149.00 $8.19 $201.00 $32.15 $32.15 $32.15 $32.15 $16.38 $16.38 $8.19 $8.19 $16.38 $24.89 $24.89 $25.84 $18.17 $24.21 $26.21 $26.21 $118.89 $16.38 $16.38 $16.38 $201.00 $150.75 $16.38 $16.38 $16.38 $91.60 $91.60 $159.19 $16.38 $160.80 $130.65 $23.06 $16.38 $116.58 $201.00 $23.75 $16.38 $18.11 $16.38 N/A N/A 30000035 EAP CPT® 80173 HALOPERIDOL BOTH IP/OP $120.00 $89.00 $7.89 $120.00 $120.00 $120.00 $120.00 $120.00 $15.78 $15.78 $7.89 $120.00 $15.78 $22.11 $22.11 $22.96 $16.14 $21.51 $25.25 $25.25 $120.00 $15.78 $15.78 $15.78 $120.00 $90.00 $15.78 $15.78 $15.78 $81.36 $81.36 $95.04 $15.78 $96.00 $78.00 $120.00 $15.78 $69.60 $120.00 $22.88 $15.78 $120.00 $15.78 N/A N/A 30000036 EAP CPT® 80335 IMIPRAMINE-RANDOM BOTH IP/OP $135.00 $100.00 $12.01 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $12.01 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $26.44 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 $135.00 $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A 30000037 EAP CPT® 80176 LIDOCAINE-RANDOM BOTH IP/OP $159.00 $118.00 $7.34 $183.09 $28.84 $28.84 $28.84 $28.84 $114.43 $114.43 $57.22 $7.34 $114.43 $22.31 $22.31 $23.17 $16.28 $21.69 $183.09 $183.09 $94.05 $114.43 $114.43 $114.43 $159.00 $119.25 $114.43 $114.43 $114.43 $82.08 $82.08 $125.93 $114.43 $127.20 $103.35 $20.66 $114.43 $92.22 $159.00 $21.30 $14.69 $16.23 $114.43 N/A N/A 30000038 EAP CPT® 80178 LITHIUM-RANDOM BOTH IP/OP $225.00 $166.50 $3.31 $225.00 $12.98 $12.98 $12.98 $12.98 $6.61 $6.61 $3.31 $3.31 $6.61 $10.04 $10.04 $10.42 $7.33 $9.78 $10.58 $10.58 $133.09 $6.61 $6.61 $6.61 $225.00 $168.75 $6.61 $6.61 $6.61 $36.96 $36.96 $178.20 $6.61 $180.00 $146.25 $9.31 $6.61 $130.50 $225.00 $9.58 $6.61 $7.31 $6.61 N/A N/A 30000039 EAP CPT® 80335 NORTRIPTYLINE-RANDOM BOTH IP/OP $117.00 $87.00 $26.44 $183.09 $117.00 $117.00 $117.00 $117.00 $114.43 $114.43 $57.22 $117.00 $114.43 $86.84 $86.84 $90.18 $60.96 $26.44 $183.09 $183.09 $117.00 $114.43 $114.43 $114.43 $117.00 $87.75 $114.43 $114.43 $114.43 $58.50 $58.50 $92.66 $114.43 $93.60 $76.05 $117.00 $114.43 $67.86 $117.00 $70.20 $117.00 $117.00 $114.43 N/A N/A 30000040 EAP CPT® 80184 PHENOBARB-RANDOM BOTH IP/OP $236.00 $175.00 $6.89 $236.00 $21.89 $21.89 $21.89 $21.89 $15.30 $15.30 $7.65 $6.89 $15.30 $17.39 $17.39 $18.06 $12.69 $16.93 $24.48 $24.48 $139.59 $15.30 $15.30 $15.30 $236.00 $177.00 $15.30 $15.30 $15.30 $64.04 $64.04 $186.91 $15.30 $188.80 $153.40 $16.12 $15.30 $136.88 $236.00 $22.19 $15.30 $12.66 $15.30 N/A N/A 30000041 EAP CPT® 80185 DILANTIN-RANDOM BOTH IP/OP $287.00 $212.50 $6.63 $287.00 $26.00 $26.00 $26.00 $26.00 $13.25 $13.25 $6.63 $6.63 $13.25 $20.13 $20.13 $20.91 $14.70 $19.58 $21.20 $21.20 $169.76 $13.25 $13.25 $13.25 $287.00 $215.25 $13.25 $13.25 $13.25 $74.08 $74.08 $227.30 $13.25 $229.60 $186.55 $18.65 $13.25 $166.46 $287.00 $19.21 $13.25 $14.65 $13.25 N/A N/A 30000042 EAP CPT® 80186 PHENYTOIN FREE (SO) BOTH IP/OP $205.00 $152.00 $6.88 $205.00 $27.01 $27.01 $27.01 $27.01 $13.76 $13.76 $6.88 $6.88 $13.76 $20.90 $20.90 $21.71 $15.26 $20.34 $22.02 $22.02 $121.26 $13.76 $13.76 $13.76 $205.00 $153.75 $13.76 $13.76 $13.76 $76.92 $76.92 $162.36 $13.76 $164.00 $133.25 $19.37 $13.76 $118.90 $205.00 $19.95 $13.76 $15.22 $13.76 N/A N/A 30000043 EAP CPT® 80188 PRIMIDONE/MYSO-RAND. BOTH IP/OP $188.00 $139.50 $8.30 $188.00 $188.00 $188.00 $188.00 $188.00 $16.59 $16.59 $8.30 $188.00 $16.59 $25.20 $25.20 $26.17 $18.40 $24.51 $26.54 $26.54 $188.00 $16.59 $16.59 $16.59 $188.00 $141.00 $16.59 $16.59 $16.59 $92.72 $92.72 $148.90 $16.59 $150.40 $122.20 $188.00 $16.59 $109.04 $188.00 $24.06 $16.59 $188.00 $16.59 N/A N/A 30000044 EAP CPT® 80192 PROCAINAMIDE-RANDOM BOTH IP/OP $191.00 $141.50 $8.38 $191.00 $191.00 $191.00 $191.00 $191.00 $16.75 $16.75 $8.38 $191.00 $16.75 $25.44 $25.44 $26.42 $18.57 $24.75 $26.80 $26.80 $191.00 $16.75 $16.75 $16.75 $191.00 $143.25 $16.75 $16.75 $16.75 $93.64 $93.64 $151.27 $16.75 $152.80 $124.15 $191.00 $16.75 $110.78 $191.00 $24.29 $16.75 $191.00 $16.75 N/A N/A 30000045 EAP CPT® 80194 QUINIDINE-RANDOM BOTH IP/OP $160.00 $118.50 $7.30 $160.00 $160.00 $160.00 $160.00 $160.00 $14.60 $14.60 $7.30 $160.00 $14.60 $22.16 $22.16 $23.01 $16.18 $21.56 $23.36 $23.36 $160.00 $14.60 $14.60 $14.60 $160.00 $120.00 $14.60 $14.60 $14.60 $81.56 $81.56 $126.72 $14.60 $128.00 $104.00 $160.00 $14.60 $92.80 $160.00 $21.17 $14.60 $160.00 $14.60 N/A N/A 30000046 EAP CPT® 80204 DRUG ASSAY METHOTREXATE BOTH IP/OP $388.00 $287.50 $19.29 $388.00 $388.00 $388.00 $388.00 $388.00 $38.57 $38.57 $19.29 $388.00 $38.57 $287.97 $287.97 $299.07 $202.15 $36.26 $61.71 $61.71 $388.00 $38.57 $38.57 $38.57 $388.00 $291.00 $38.57 $38.57 $38.57 $194.00 $194.00 $307.30 $38.57 $310.40 $388.00 $388.00 $38.57 $225.04 $388.00 $55.93 $38.57 $388.00 $38.57 N/A N/A 30000047 EAP CPT® 80198 THEOPHYLLINE-RANDOM BOTH IP/OP $173.00 $128.50 $7.07 $173.00 $173.00 $173.00 $173.00 $173.00 $14.14 $14.14 $7.07 $173.00 $14.14 $21.49 $21.49 $22.31 $15.68 $20.90 $22.62 $22.62 $173.00 $14.14 $14.14 $14.14 $173.00 $129.75 $14.14 $14.14 $14.14 $79.08 $79.08 $137.02 $14.14 $138.40 $112.45 $173.00 $14.14 $100.34 $173.00 $20.50 $14.14 $173.00 $14.14 N/A N/A 30000048 EAP CPT® 80200 TOBRAMYCIN-RANDOM BOTH IP/OP $263.00 $195.00 $8.07 $263.00 $263.00 $263.00 $263.00 $263.00 $16.13 $16.13 $8.07 $263.00 $16.13 $22.74 $22.74 $23.62 $16.60 $22.13 $25.81 $25.81 $263.00 $16.13 $16.13 $16.13 $263.00 $197.25 $16.13 $16.13 $16.13 $83.72 $83.72 $208.30 $16.13 $210.40 $170.95 $263.00 $16.13 $152.54 $263.00 $23.39 $16.13 $263.00 $16.13 N/A N/A 30000049 EAP CPT® 80201 TOPIRAMATE/TOPAMAZ BOTH IP/OP $94.00 $70.00 $5.96 $94.00 $23.39 $23.39 $23.39 $23.39 $11.92 $11.92 $5.96 $5.96 $11.92 $18.10 $18.10 $18.79 $13.21 $17.61 $19.07 $19.07 $55.60 $11.92 $11.92 $11.92 $94.00 $70.50 $11.92 $11.92 $11.92 $66.64 $66.64 $74.45 $11.92 $75.20 $61.10 $16.77 $11.92 $54.52 $94.00 $17.28 $11.92 $13.17 $11.92 N/A N/A 30000050 EAP CPT® 80202 VANCOMYCIN-RANDOM BOTH IP/OP $292.00 $216.50 $6.77 $292.00 $22.29 $22.29 $22.29 $22.29 $13.54 $13.54 $6.77 $6.77 $13.54 $17.23 $17.23 $17.90 $12.58 $16.77 $21.66 $21.66 $172.72 $13.54 $13.54 $13.54 $292.00 $219.00 $13.54 $13.54 $13.54 $63.44 $63.44 $231.26 $13.54 $233.60 $189.80 $15.97 $13.54 $169.36 $292.00 $19.63 $13.54 $12.54 $13.54 N/A N/A 30000051 EAP CPT® 80179 DRUG ASSAY SALICYLATE BOTH IP/OP $217.00 $161.00 $9.32 $217.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $45.23 $18.64 $161.06 $161.06 $167.26 $113.06 $17.51 $29.82 $29.82 $128.36 $18.64 $18.64 $18.64 $217.00 $162.75 $18.64 $18.64 $18.64 $108.50 $108.50 $171.86 $18.64 $173.60 $30.76 $16.68 $18.64 $125.86 $217.00 $27.03 $18.64 $13.10 $18.64 N/A N/A 30000052 EAP CPT® 80171 "GABAPENTIN, WHL BLD/SER/PLASMA" BOTH IP/OP $431.00 $319.00 $10.84 $431.00 $431.00 $431.00 $431.00 $431.00 $21.67 $21.67 $10.84 $431.00 $21.67 $18.81 $18.81 $19.54 $13.73 $17.00 $34.67 $34.67 $431.00 $21.67 $21.67 $21.67 $431.00 $323.25 $21.67 $21.67 $21.67 $215.50 $215.50 $341.35 $21.67 $344.80 $280.15 $431.00 $21.67 $249.98 $431.00 $31.42 $21.67 $431.00 $21.67 N/A N/A 30000053 EAP CPT® 80151 DRUG ASSAY AMIODARONE BOTH IP/OP $217.00 $161.00 $9.32 $217.00 $217.00 $217.00 $217.00 $217.00 $18.64 $18.64 $9.32 $217.00 $18.64 $161.06 $161.06 $167.26 $113.06 $17.51 $29.82 $29.82 $217.00 $18.64 $18.64 $18.64 $217.00 $162.75 $18.64 $18.64 $18.64 $108.50 $108.50 $171.86 $18.64 $173.60 $141.05 $217.00 $18.64 $125.86 $217.00 $27.03 $18.64 $217.00 $18.64 N/A N/A 30000054 EAP CPT® 80175 LAMOTRIGINE (SO) BOTH IP/OP $431.00 $319.00 $6.63 $431.00 $26.00 $26.00 $26.00 $26.00 $13.25 $13.25 $6.63 $6.63 $13.25 $18.81 $18.81 $19.54 $13.73 $17.00 $21.20 $21.20 $254.94 $13.25 $13.25 $13.25 $431.00 $323.25 $13.25 $13.25 $13.25 $215.50 $215.50 $341.35 $13.25 $344.80 $280.15 $16.19 $13.25 $249.98 $431.00 $19.21 $13.25 $12.72 $13.25 N/A N/A 30000055 EAP CPT® 80299 OLANZAPINE/ZYPREXA BOTH IP/OP $217.00 $161.00 $8.39 $217.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $128.36 $18.64 $18.64 $18.64 $217.00 $162.75 $18.64 $18.64 $18.64 $67.28 $67.28 $171.86 $18.64 $173.60 $141.05 $16.94 $18.64 $125.86 $217.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30000056 EAP CPT® 82013 ACETYLCHOLINESTERASE-AMNIO BOTH IP/OP $37.00 $27.50 $6.15 $37.00 $37.00 $37.00 $37.00 $37.00 $12.29 $12.29 $6.15 $37.00 $12.29 $16.96 $16.96 $17.61 $12.38 $16.51 $19.66 $19.66 $37.00 $12.29 $12.29 $12.29 $37.00 $27.75 $12.29 $12.29 $12.29 $37.00 $37.00 $29.30 $12.29 $29.60 $24.05 $37.00 $12.29 $21.46 $37.00 $17.82 $12.29 $37.00 $12.29 N/A N/A 30000057 EAP CPT® 82017 "CARNITINE, ESTER" BOTH IP/OP $131.00 $97.00 $8.44 $131.00 $131.00 $131.00 $131.00 $131.00 $16.87 $16.87 $8.44 $131.00 $16.87 $25.62 $25.62 $26.60 $18.70 $24.92 $26.99 $26.99 $131.00 $16.87 $16.87 $16.87 $131.00 $98.25 $16.87 $16.87 $16.87 $94.28 $94.28 $103.75 $16.87 $104.80 $131.00 $131.00 $16.87 $75.98 $131.00 $24.46 $16.87 $131.00 $16.87 N/A N/A 30000058 EAP CPT® 82270 FECAL OCCULT BLOOD TEST BOTH IP/OP $57.00 $42.50 $2.19 $57.00 $57.00 $57.00 $57.00 $57.00 $4.38 $4.38 $2.19 $57.00 $4.38 $4.88 $4.88 $5.07 $3.56 $4.75 $7.01 $7.01 $57.00 $4.38 $4.38 $4.38 $57.00 $42.75 $4.38 $4.38 $4.38 $17.96 $17.96 $45.14 $4.38 $45.60 $37.05 $57.00 $4.38 $33.06 $57.00 $6.35 $4.38 $57.00 $4.38 N/A N/A 30000060 EAP CPT® 82330 "CALCIUM, IONIZED" BOTH IP/OP $375.00 $277.50 $6.84 $375.00 $26.83 $26.83 $26.83 $26.83 $13.68 $13.68 $6.84 $6.84 $13.68 $20.75 $20.75 $21.55 $15.15 $20.18 $21.89 $21.89 $221.81 $13.68 $13.68 $13.68 $375.00 $281.25 $13.68 $13.68 $13.68 $76.36 $76.36 $297.00 $13.68 $300.00 $22.57 $19.22 $13.68 $217.50 $375.00 $19.84 $13.68 $15.10 $13.68 N/A N/A 30000062 EAP CPT® 82948 "GLUCOSE-2HR PP,WB" BOTH IP/OP $251.00 $186.00 $2.52 $251.00 $251.00 $251.00 $251.00 $251.00 $5.04 $5.04 $2.52 $251.00 $5.04 $4.82 $4.82 $5.00 $3.52 $4.68 $8.06 $8.06 $251.00 $5.04 $5.04 $5.04 $251.00 $188.25 $5.04 $5.04 $5.04 $17.72 $17.72 $198.79 $5.04 $200.80 $163.15 $251.00 $5.04 $145.58 $251.00 $7.31 $5.04 $251.00 $5.04 N/A N/A 30000063 EAP CPT® 82948 "GLUCOSE-FBS,WB" BOTH IP/OP $251.00 $186.00 $2.52 $251.00 $251.00 $251.00 $251.00 $251.00 $5.04 $5.04 $2.52 $251.00 $5.04 $4.82 $4.82 $5.00 $3.52 $4.68 $8.06 $8.06 $251.00 $5.04 $5.04 $5.04 $251.00 $188.25 $5.04 $5.04 $5.04 $17.72 $17.72 $198.79 $5.04 $200.80 $163.15 $251.00 $5.04 $145.58 $251.00 $7.31 $5.04 $251.00 $5.04 N/A N/A 30000064 EAP CPT® 82948 "GLUCOSE-FBS,WB MICRO" BOTH IP/OP $251.00 $186.00 $2.52 $251.00 $251.00 $251.00 $251.00 $251.00 $5.04 $5.04 $2.52 $251.00 $5.04 $4.82 $4.82 $5.00 $3.52 $4.68 $8.06 $8.06 $251.00 $5.04 $5.04 $5.04 $251.00 $188.25 $5.04 $5.04 $5.04 $17.72 $17.72 $198.79 $5.04 $200.80 $163.15 $251.00 $5.04 $145.58 $251.00 $7.31 $5.04 $251.00 $5.04 N/A N/A 30000065 EAP CPT® 82948 "GLUCOSE-RANDOM,WB" BOTH IP/OP $251.00 $186.00 $2.52 $251.00 $251.00 $251.00 $251.00 $251.00 $5.04 $5.04 $2.52 $251.00 $5.04 $4.82 $4.82 $5.00 $3.52 $4.68 $8.06 $8.06 $251.00 $5.04 $5.04 $5.04 $251.00 $188.25 $5.04 $5.04 $5.04 $17.72 $17.72 $198.79 $5.04 $200.80 $163.15 $251.00 $5.04 $145.58 $251.00 $7.31 $5.04 $251.00 $5.04 N/A N/A 30000066 EAP CPT® 82948 "GLU-RANDOM,WB MICRO" BOTH IP/OP $251.00 $186.00 $2.52 $251.00 $251.00 $251.00 $251.00 $251.00 $5.04 $5.04 $2.52 $251.00 $5.04 $4.82 $4.82 $5.00 $3.52 $4.68 $8.06 $8.06 $251.00 $5.04 $5.04 $5.04 $251.00 $188.25 $5.04 $5.04 $5.04 $17.72 $17.72 $198.79 $5.04 $200.80 $163.15 $251.00 $5.04 $145.58 $251.00 $7.31 $5.04 $251.00 $5.04 N/A N/A 30000067 EAP CPT® 83020 NEWBORN SCREEN BOTH IP/OP $204.00 $151.00 $6.44 $204.00 $19.18 $19.18 $19.18 $19.18 $12.87 $12.87 $6.44 $6.44 $12.87 $14.84 $14.84 $15.41 $10.83 $14.44 $20.59 $20.59 $120.67 $12.87 $12.87 $12.87 $204.00 $153.00 $12.87 $12.87 $12.87 $54.64 $54.64 $161.57 $12.87 $163.20 $21.24 $13.75 $12.87 $118.32 $204.00 $18.66 $12.87 $10.80 $12.87 N/A N/A 30000068 EAP CPT® 83516 T-TRANSGLUTAMIN IGG BOTH IP/OP $181.00 $134.00 $5.76 $181.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $107.06 $11.53 $11.53 $11.53 $181.00 $135.75 $11.53 $11.53 $11.53 $59.76 $59.76 $143.35 $11.53 $144.80 $117.65 $15.05 $11.53 $104.98 $181.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30000069 EAP CPT® 83520 ANTI GM1 AB TITER BOTH IP/OP $477.00 $353.00 $7.77 $477.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $282.15 $17.27 $17.27 $17.27 $477.00 $357.75 $17.27 $17.27 $17.27 $72.36 $72.36 $377.78 $17.27 $381.60 $310.05 $18.21 $17.27 $276.66 $477.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30000070 EAP CPT® 83520 ANTI ASIALO-GM-AB BOTH IP/OP $411.00 $304.50 $7.77 $411.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $243.11 $17.27 $17.27 $17.27 $411.00 $308.25 $17.27 $17.27 $17.27 $72.36 $72.36 $325.51 $17.27 $328.80 $267.15 $18.21 $17.27 $238.38 $411.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30000071 EAP CPT® 83520 ANTI GQ1B AB TITER BOTH IP/OP $477.00 $353.00 $7.77 $477.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $282.15 $17.27 $17.27 $17.27 $477.00 $357.75 $17.27 $17.27 $17.27 $72.36 $72.36 $377.78 $17.27 $381.60 $310.05 $18.21 $17.27 $276.66 $477.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30000072 EAP CPT® 83520 ANTI GD 1B AB TITER BOTH IP/OP $411.00 $304.50 $7.77 $411.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $243.11 $17.27 $17.27 $17.27 $411.00 $308.25 $17.27 $17.27 $17.27 $72.36 $72.36 $325.51 $17.27 $328.80 $267.15 $18.21 $17.27 $238.38 $411.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30000073 EAP CPT® 83520 MITOCHONDRIAL AB BOTH IP/OP $477.00 $353.00 $7.77 $477.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $282.15 $17.27 $17.27 $17.27 $477.00 $357.75 $17.27 $17.27 $17.27 $72.36 $72.36 $377.78 $17.27 $381.60 $310.05 $18.21 $17.27 $276.66 $477.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30000074 EAP CPT® 83605 "LACTATE, PLASMA" BOTH IP/OP $258.00 $191.00 $5.34 $258.00 $20.96 $20.96 $20.96 $20.96 $11.57 $11.57 $5.79 $5.34 $11.57 $16.21 $16.21 $16.84 $11.84 $15.78 $18.51 $18.51 $152.61 $11.57 $11.57 $11.57 $258.00 $193.50 $11.57 $11.57 $11.57 $59.68 $59.68 $204.34 $11.57 $206.40 $19.09 $15.03 $11.57 $149.64 $258.00 $16.78 $11.57 $11.81 $11.57 N/A N/A 30000083 EAP CPT® 84030 "PHENYLALANINE (PKU), BLOOD" BOTH IP/OP $48.00 $36.00 $2.75 $48.00 $48.00 $48.00 $48.00 $48.00 $5.50 $5.50 $2.75 $48.00 $5.50 $8.36 $8.36 $8.68 $6.10 $8.13 $8.80 $8.80 $48.00 $5.50 $5.50 $5.50 $48.00 $36.00 $5.50 $5.50 $5.50 $30.76 $30.76 $38.02 $5.50 $38.40 $31.20 $48.00 $5.50 $27.84 $48.00 $7.98 $5.50 $48.00 $5.50 N/A N/A 30000084 EAP CPT® 84066 PROSTATIC ACID PHOSPHATASE BOTH IP/OP $100.00 $74.00 $4.83 $100.00 $18.95 $18.95 $18.95 $18.95 $9.66 $9.66 $4.83 $4.83 $9.66 $14.66 $14.66 $15.23 $10.70 $14.27 $15.46 $15.46 $59.15 $9.66 $9.66 $9.66 $100.00 $75.00 $9.66 $9.66 $9.66 $54.00 $54.00 $79.20 $9.66 $80.00 $15.94 $13.59 $9.66 $58.00 $100.00 $14.01 $9.66 $10.67 $9.66 N/A N/A 30000085 EAP CPT® 84100 "PHOSPHORUS, SERUM" BOTH IP/OP $128.00 $95.00 $2.37 $128.00 $9.31 $9.31 $9.31 $9.31 $4.74 $4.74 $2.37 $2.37 $4.74 $7.21 $7.21 $7.48 $5.26 $7.01 $7.58 $7.58 $75.71 $4.74 $4.74 $4.74 $128.00 $96.00 $4.74 $4.74 $4.74 $26.52 $26.52 $101.38 $4.74 $102.40 $83.20 $6.68 $4.74 $74.24 $128.00 $6.87 $4.74 $5.25 $4.74 N/A N/A 30000086 EAP CPT® 84152 "PSA, TOTAL SCREENING" BOTH IP/OP $237.00 $175.50 $9.20 $237.00 $36.09 $36.09 $36.09 $36.09 $19.31 $19.31 $9.66 $9.20 $19.31 $27.92 $27.92 $29.00 $20.38 $27.17 $30.90 $30.90 $140.19 $19.31 $19.31 $19.31 $237.00 $177.75 $19.31 $19.31 $19.31 $102.80 $102.80 $187.70 $19.31 $189.60 $154.05 $25.88 $19.31 $137.46 $237.00 $26.67 $18.39 $20.33 $19.31 N/A N/A 30000087 EAP CPT® 84163 PREG ASSOC PLASMA PROTEIN BOTH IP/OP $96.00 $71.50 $7.09 $96.00 $12.60 $12.60 $12.60 $12.60 $15.05 $15.05 $7.53 $7.53 $15.05 $9.74 $9.74 $10.12 $7.11 $9.48 $24.08 $24.08 $56.78 $15.05 $15.05 $15.05 $96.00 $72.00 $15.05 $15.05 $15.05 $35.88 $35.88 $76.03 $15.05 $76.80 $24.83 $9.03 $15.05 $55.68 $96.00 $21.82 $15.05 $7.09 $15.05 N/A N/A 30000089 EAP CPT® 84702 D-HCG FREE & INTACT BOTH IP/OP $419.00 $310.50 $7.09 $419.00 $12.60 $12.60 $12.60 $12.60 $15.05 $15.05 $7.53 $7.53 $15.05 $9.74 $9.74 $10.12 $7.11 $9.48 $24.08 $24.08 $247.84 $15.05 $15.05 $15.05 $419.00 $314.25 $15.05 $15.05 $15.05 $35.88 $35.88 $331.85 $15.05 $335.20 $272.35 $9.03 $15.05 $243.02 $419.00 $21.82 $15.05 $7.09 $15.05 N/A N/A 30000090 EAP CPT® 85461 FETAL SCREEN RHIG BOTH IP/OP $150.00 $111.00 $4.68 $150.00 $150.00 $150.00 $150.00 $150.00 $9.36 $9.36 $4.68 $150.00 $9.36 $10.08 $10.08 $10.47 $7.36 $9.79 $14.98 $14.98 $150.00 $9.36 $9.36 $9.36 $150.00 $112.50 $9.36 $9.36 $9.36 $37.04 $37.04 $118.80 $9.36 $120.00 $97.50 $150.00 $9.36 $87.00 $150.00 $13.57 $9.36 $150.00 $9.36 N/A N/A 30000091 EAP CPT® 85557 "OSMOTIC FRAGILITY,ERYTHROCYTES" BOTH IP/OP $264.00 $195.50 $6.68 $264.00 $264.00 $264.00 $264.00 $264.00 $13.36 $13.36 $6.68 $264.00 $13.36 $20.28 $20.28 $21.06 $14.80 $19.72 $21.38 $21.38 $264.00 $13.36 $13.36 $13.36 $264.00 $198.00 $13.36 $13.36 $13.36 $74.64 $74.64 $209.09 $13.36 $211.20 $264.00 $264.00 $13.36 $153.12 $264.00 $19.37 $13.36 $264.00 $13.36 N/A N/A 30000092 EAP CPT® 85660 DONOR HGB S (ARC) BOTH IP/OP $201.00 $149.00 $2.75 $201.00 $10.82 $10.82 $10.82 $10.82 $5.51 $5.51 $2.76 $2.75 $5.51 $8.38 $8.38 $8.70 $6.12 $8.15 $8.82 $8.82 $118.89 $5.51 $5.51 $5.51 $201.00 $150.75 $5.51 $5.51 $5.51 $30.84 $30.84 $159.19 $5.51 $160.80 $9.09 $7.76 $5.51 $116.58 $201.00 $7.99 $5.51 $6.10 $5.51 N/A N/A 30000093 EAP CPT® 86003 EPICOCCUM PURPURASCN BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30000095 EAP CPT® 86022 PLATELET AB SCREEN (ARC) BOTH IP/OP $457.00 $338.50 $9.19 $457.00 $457.00 $457.00 $457.00 $457.00 $18.37 $18.37 $9.19 $457.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $457.00 $18.37 $18.37 $18.37 $457.00 $342.75 $18.37 $18.37 $18.37 $102.64 $102.64 $361.94 $18.37 $365.60 $457.00 $457.00 $18.37 $265.06 $457.00 $26.64 $18.37 $457.00 $18.37 N/A N/A 30000096 EAP CPT® 86147 ANTIPHOSPHOLIPID IGG BOTH IP/OP $581.00 $430.00 $12.73 $581.00 $49.95 $49.95 $49.95 $49.95 $25.45 $25.45 $12.73 $12.73 $25.45 $38.63 $38.63 $40.11 $28.20 $37.58 $40.72 $40.72 $343.66 $25.45 $25.45 $25.45 $581.00 $435.75 $25.45 $25.45 $25.45 $142.16 $142.16 $460.15 $25.45 $464.80 $41.99 $35.79 $25.45 $336.98 $581.00 $36.90 $25.45 $28.11 $25.45 N/A N/A 30000097 EAP CPT® 86147 ANTIPHOSPHOLIPID IGM BOTH IP/OP $581.00 $430.00 $12.73 $581.00 $49.95 $49.95 $49.95 $49.95 $25.45 $25.45 $12.73 $12.73 $25.45 $38.63 $38.63 $40.11 $28.20 $37.58 $40.72 $40.72 $343.66 $25.45 $25.45 $25.45 $581.00 $435.75 $25.45 $25.45 $25.45 $142.16 $142.16 $460.15 $25.45 $464.80 $41.99 $35.79 $25.45 $336.98 $581.00 $36.90 $25.45 $28.11 $25.45 N/A N/A 30000098 EAP CPT® 86235 ANTIHISTONE AB BOTH IP/OP $344.00 $255.00 $8.97 $344.00 $35.19 $35.19 $35.19 $35.19 $17.93 $17.93 $8.97 $8.97 $17.93 $27.23 $27.23 $28.27 $19.88 $26.49 $28.69 $28.69 $203.48 $17.93 $17.93 $17.93 $344.00 $258.00 $17.93 $17.93 $17.93 $100.24 $100.24 $272.45 $17.93 $275.20 $223.60 $25.23 $17.93 $199.52 $344.00 $26.00 $17.93 $19.82 $17.93 N/A N/A 30000099 EAP CPT® 86255 MURINE TYPHUS IGG BOTH IP/OP $59.00 $44.00 $6.03 $59.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $34.90 $12.05 $12.05 $12.05 $59.00 $44.25 $12.05 $12.05 $12.05 $59.00 $59.00 $46.73 $12.05 $47.20 $38.35 $16.96 $12.05 $34.22 $59.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30000100 EAP CPT® 86331 PIGEON SERUM BOTH IP/OP $38.00 $28.50 $5.99 $38.00 $38.00 $38.00 $38.00 $38.00 $11.98 $11.98 $5.99 $38.00 $11.98 $18.20 $18.20 $18.90 $13.29 $17.71 $19.17 $19.17 $38.00 $11.98 $11.98 $11.98 $38.00 $28.50 $11.98 $11.98 $11.98 $38.00 $38.00 $30.10 $11.98 $30.40 $38.00 $38.00 $11.98 $22.04 $38.00 $17.37 $11.98 $38.00 $11.98 N/A N/A 30000101 EAP CPT® 86331 T. CANDIDUS BOTH IP/OP $38.00 $28.50 $5.99 $38.00 $38.00 $38.00 $38.00 $38.00 $11.98 $11.98 $5.99 $38.00 $11.98 $18.20 $18.20 $18.90 $13.29 $17.71 $19.17 $19.17 $38.00 $11.98 $11.98 $11.98 $38.00 $28.50 $11.98 $11.98 $11.98 $38.00 $38.00 $30.10 $11.98 $30.40 $38.00 $38.00 $11.98 $22.04 $38.00 $17.37 $11.98 $38.00 $11.98 N/A N/A 30000102 EAP CPT® 86331 T.VULGARIS BOTH IP/OP $38.00 $28.50 $5.99 $38.00 $38.00 $38.00 $38.00 $38.00 $11.98 $11.98 $5.99 $38.00 $11.98 $18.20 $18.20 $18.90 $13.29 $17.71 $19.17 $19.17 $38.00 $11.98 $11.98 $11.98 $38.00 $28.50 $11.98 $11.98 $11.98 $38.00 $38.00 $30.10 $11.98 $30.40 $38.00 $38.00 $11.98 $22.04 $38.00 $17.37 $11.98 $38.00 $11.98 N/A N/A 30000103 EAP CPT® 86331 S. VIRIDIS BOTH IP/OP $38.00 $28.50 $5.99 $38.00 $38.00 $38.00 $38.00 $38.00 $11.98 $11.98 $5.99 $38.00 $11.98 $18.20 $18.20 $18.90 $13.29 $17.71 $19.17 $19.17 $38.00 $11.98 $11.98 $11.98 $38.00 $28.50 $11.98 $11.98 $11.98 $38.00 $38.00 $30.10 $11.98 $30.40 $38.00 $38.00 $11.98 $22.04 $38.00 $17.37 $11.98 $38.00 $11.98 N/A N/A 30000104 EAP CPT® 86355 "CD19,TOTAL B %" BOTH IP/OP $210.00 $155.50 $18.86 $210.00 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $124.22 $37.73 $37.73 $37.73 $210.00 $157.50 $37.73 $37.73 $37.73 $131.64 $131.64 $166.32 $37.73 $168.00 $62.25 $33.14 $37.73 $121.80 $210.00 $54.71 $37.73 $26.03 $37.73 N/A N/A 30000105 EAP CPT® 86357 "NATURAL KILLER (NK)CELLS,TOTAL" BOTH IP/OP $210.00 $155.50 $18.87 $210.00 $210.00 $210.00 $210.00 $210.00 $37.73 $37.73 $18.87 $210.00 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $210.00 $37.73 $37.73 $37.73 $210.00 $157.50 $37.73 $37.73 $37.73 $131.64 $131.64 $166.32 $37.73 $168.00 $210.00 $210.00 $37.73 $121.80 $210.00 $54.71 $37.73 $210.00 $37.73 N/A N/A 30000106 EAP CPT® 86357 "CD56+16,NK%" BOTH IP/OP $210.00 $155.50 $18.87 $210.00 $210.00 $210.00 $210.00 $210.00 $37.73 $37.73 $18.87 $210.00 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $210.00 $37.73 $37.73 $37.73 $210.00 $157.50 $37.73 $37.73 $37.73 $131.64 $131.64 $166.32 $37.73 $168.00 $210.00 $210.00 $37.73 $121.80 $210.00 $54.71 $37.73 $210.00 $37.73 N/A N/A 30000107 EAP CPT® 86485 CANDIDA SKIN TEST BOTH IP/OP $262.00 $194.00 $7.30 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $7.30 $262.00 $262.00 $13.03 $13.03 $13.53 $9.51 $18.61 $262.00 $104.80 $262.00 $262.00 $262.00 $262.00 $262.00 $196.50 $262.00 $262.00 $262.00 $131.00 $131.00 $207.50 $262.00 $209.60 $170.30 $262.00 $262.00 $151.96 $262.00 $157.20 $262.00 $262.00 $262.00 N/A N/A 30000108 EAP CPT® 86603 ADENOVIRUS AB BOTH IP/OP $64.00 $47.50 $6.44 $64.00 $64.00 $64.00 $64.00 $64.00 $12.87 $12.87 $6.44 $64.00 $12.87 $19.54 $19.54 $20.29 $14.27 $19.01 $20.59 $20.59 $64.00 $12.87 $12.87 $12.87 $64.00 $48.00 $12.87 $12.87 $12.87 $64.00 $64.00 $50.69 $12.87 $51.20 $41.60 $64.00 $12.87 $37.12 $64.00 $18.66 $12.87 $64.00 $12.87 N/A N/A 30000109 EAP CPT® 86612 BLASTOMYCES AB BOTH IP/OP $101.00 $75.00 $6.45 $101.00 $25.33 $25.33 $25.33 $25.33 $12.90 $12.90 $6.45 $6.45 $12.90 $19.59 $19.59 $20.35 $14.30 $19.07 $20.64 $20.64 $59.74 $12.90 $12.90 $12.90 $101.00 $75.75 $12.90 $12.90 $12.90 $72.12 $72.12 $79.99 $12.90 $80.80 $65.65 $18.16 $12.90 $58.58 $101.00 $18.71 $12.90 $14.26 $12.90 N/A N/A 30000110 EAP CPT® 86635 COCCIDIODES AB BOTH IP/OP $155.00 $115.00 $5.74 $155.00 $155.00 $155.00 $155.00 $155.00 $11.47 $11.47 $5.74 $155.00 $11.47 $17.42 $17.42 $18.09 $12.72 $16.95 $18.35 $18.35 $155.00 $11.47 $11.47 $11.47 $155.00 $116.25 $11.47 $11.47 $11.47 $64.12 $64.12 $122.76 $11.47 $124.00 $100.75 $155.00 $11.47 $89.90 $155.00 $16.63 $11.47 $155.00 $11.47 N/A N/A 30000113 EAP CPT® 86710 INFLUENZA A AB BOTH IP/OP $134.00 $99.50 $6.78 $134.00 $26.61 $26.61 $26.61 $26.61 $13.55 $13.55 $6.78 $6.78 $13.55 $20.59 $20.59 $21.38 $15.03 $20.03 $21.68 $21.68 $79.26 $13.55 $13.55 $13.55 $134.00 $100.50 $13.55 $13.55 $13.55 $75.76 $75.76 $106.13 $13.55 $107.20 $87.10 $19.08 $13.55 $77.72 $134.00 $19.65 $13.55 $14.99 $13.55 N/A N/A 30000114 EAP CPT® 86710 INFLUENZA B AB BOTH IP/OP $134.00 $99.50 $6.78 $134.00 $26.61 $26.61 $26.61 $26.61 $13.55 $13.55 $6.78 $6.78 $13.55 $20.59 $20.59 $21.38 $15.03 $20.03 $21.68 $21.68 $79.26 $13.55 $13.55 $13.55 $134.00 $100.50 $13.55 $13.55 $13.55 $75.76 $75.76 $106.13 $13.55 $107.20 $87.10 $19.08 $13.55 $77.72 $134.00 $19.65 $13.55 $14.99 $13.55 N/A N/A 30000115 EAP CPT® 86710 PARAINFLUENZA-1 AB BOTH IP/OP $133.00 $98.50 $6.78 $133.00 $26.61 $26.61 $26.61 $26.61 $13.55 $13.55 $6.78 $6.78 $13.55 $20.59 $20.59 $21.38 $15.03 $20.03 $21.68 $21.68 $78.67 $13.55 $13.55 $13.55 $133.00 $99.75 $13.55 $13.55 $13.55 $75.76 $75.76 $105.34 $13.55 $106.40 $86.45 $19.08 $13.55 $77.14 $133.00 $19.65 $13.55 $14.99 $13.55 N/A N/A 30000116 EAP CPT® 86710 PARAINFLUENZA-2 AB BOTH IP/OP $133.00 $98.50 $6.78 $133.00 $26.61 $26.61 $26.61 $26.61 $13.55 $13.55 $6.78 $6.78 $13.55 $20.59 $20.59 $21.38 $15.03 $20.03 $21.68 $21.68 $78.67 $13.55 $13.55 $13.55 $133.00 $99.75 $13.55 $13.55 $13.55 $75.76 $75.76 $105.34 $13.55 $106.40 $86.45 $19.08 $13.55 $77.14 $133.00 $19.65 $13.55 $14.99 $13.55 N/A N/A 30000117 EAP CPT® 86710 PARAINFLUENZA-3 AB BOTH IP/OP $133.00 $98.50 $6.78 $133.00 $26.61 $26.61 $26.61 $26.61 $13.55 $13.55 $6.78 $6.78 $13.55 $20.59 $20.59 $21.38 $15.03 $20.03 $21.68 $21.68 $78.67 $13.55 $13.55 $13.55 $133.00 $99.75 $13.55 $13.55 $13.55 $75.76 $75.76 $105.34 $13.55 $106.40 $86.45 $19.08 $13.55 $77.14 $133.00 $19.65 $13.55 $14.99 $13.55 N/A N/A 30000118 EAP CPT® 86735 MUMPS IGM BOTH IP/OP $130.00 $96.50 $6.53 $130.00 $25.60 $25.60 $25.60 $25.60 $13.05 $13.05 $6.53 $6.53 $13.05 $19.82 $19.82 $20.58 $14.47 $19.28 $20.88 $20.88 $76.90 $13.05 $13.05 $13.05 $130.00 $97.50 $13.05 $13.05 $13.05 $72.92 $72.92 $102.96 $13.05 $104.00 $84.50 $18.36 $13.05 $75.40 $130.00 $18.92 $13.05 $14.42 $13.05 N/A N/A 30000119 EAP CPT® 86735 MUMPS IGG BOTH IP/OP $131.00 $97.00 $6.53 $131.00 $25.60 $25.60 $25.60 $25.60 $13.05 $13.05 $6.53 $6.53 $13.05 $19.82 $19.82 $20.58 $14.47 $19.28 $20.88 $20.88 $77.49 $13.05 $13.05 $13.05 $131.00 $98.25 $13.05 $13.05 $13.05 $72.92 $72.92 $103.75 $13.05 $104.80 $85.15 $18.36 $13.05 $75.98 $131.00 $18.92 $13.05 $14.42 $13.05 N/A N/A 30000120 EAP CPT® 86744 MICROPOLYSPORA FAENI BOTH IP/OP $40.00 $30.00 $8.00 $40.00 $40.00 $40.00 $40.00 $40.00 $15.99 $15.99 $8.00 $40.00 $15.99 $20.02 $20.02 $20.79 $14.61 $19.49 $25.58 $25.58 $40.00 $15.99 $15.99 $15.99 $40.00 $30.00 $15.99 $15.99 $15.99 $40.00 $40.00 $31.68 $15.99 $32.00 $40.00 $40.00 $15.99 $23.20 $40.00 $23.19 $15.99 $40.00 $15.99 N/A N/A 30000121 EAP CPT® 86756 RSV AB BOTH IP/OP $186.00 $138.00 $7.95 $186.00 $186.00 $186.00 $186.00 $186.00 $15.89 $15.89 $7.95 $186.00 $15.89 $19.57 $19.57 $20.33 $14.29 $19.05 $25.42 $25.42 $186.00 $15.89 $15.89 $15.89 $186.00 $139.50 $15.89 $15.89 $15.89 $72.04 $72.04 $147.31 $15.89 $148.80 $120.90 $186.00 $15.89 $107.88 $186.00 $23.04 $15.89 $186.00 $15.89 N/A N/A 30000124 EAP CPT® 86850 ANTIBODY SCREEN (ARC) BOTH IP/OP $366.00 $271.00 $4.40 $292.80 $7.50 $7.50 $7.50 $7.50 $48.88 $48.88 $48.66 $4.40 $48.88 $16.59 $16.59 $17.23 $12.11 $17.89 $78.21 $72.33 $216.49 $48.88 $9.77 $48.88 $51.32 $274.50 $48.88 $48.88 $48.88 $74.44 $74.44 $289.87 $48.88 $292.80 $237.90 $17.04 $48.88 $212.28 $51.32 $70.72 $48.88 $13.38 $48.88 N/A N/A 30000126 EAP CPT® 86850 ANTIBODY SCREEN BOTH IP/OP $366.00 $271.00 $4.40 $292.80 $7.50 $7.50 $7.50 $7.50 $48.88 $48.88 $48.66 $4.40 $48.88 $16.59 $16.59 $17.23 $12.11 $17.89 $78.21 $72.33 $216.49 $48.88 $9.77 $48.88 $51.32 $274.50 $48.88 $48.88 $48.88 $74.44 $74.44 $289.87 $48.88 $292.80 $237.90 $17.04 $48.88 $212.28 $51.32 $70.72 $48.88 $13.38 $48.88 N/A N/A 30000128 EAP CPT® 86860 RBC ELUTION (ARC) BOTH IP/OP $563.00 $417.00 $5.38 $518.00 $44.73 $44.73 $44.73 $44.73 $146.71 $146.71 $146.06 $117.34 $146.71 $19.75 $19.75 $20.51 $14.42 $7.19 $234.73 $226.86 $333.01 $146.71 $518.00 $146.71 $154.04 $422.25 $146.71 $146.71 $146.71 $89.32 $89.32 $445.90 $146.71 $450.40 $365.95 $6.85 $146.71 $326.54 $154.04 $212.25 $146.71 $5.38 $146.71 N/A N/A 30000129 EAP CPT® 86860 RBC ELUTION BOTH IP/OP $563.00 $417.00 $5.38 $518.00 $44.73 $44.73 $44.73 $44.73 $146.71 $146.71 $146.06 $117.34 $146.71 $19.75 $19.75 $20.51 $14.42 $7.19 $234.73 $226.86 $333.01 $146.71 $518.00 $146.71 $154.04 $422.25 $146.71 $146.71 $146.71 $89.32 $89.32 $445.90 $146.71 $450.40 $365.95 $6.85 $146.71 $326.54 $154.04 $212.25 $146.71 $5.38 $146.71 N/A N/A 30000130 EAP CPT® 86870 ANTIBODY ID BOTH IP/OP $634.00 $469.50 $5.38 $634.00 $61.17 $61.17 $61.17 $61.17 $286.49 $286.49 $285.22 $132.14 $286.49 $30.41 $30.41 $31.58 $22.20 $7.19 $458.39 $467.58 $375.01 $286.49 $634.00 $286.49 $300.82 $475.50 $286.49 $286.49 $286.49 $138.92 $138.92 $502.13 $286.49 $507.20 $412.10 $6.85 $286.49 $367.72 $300.82 $414.48 $286.49 $5.38 $286.49 N/A N/A 30000131 EAP CPT® 86870 ANTIBODY ID (ARC) BOTH IP/OP $634.00 $469.50 $5.38 $634.00 $61.17 $61.17 $61.17 $61.17 $286.49 $286.49 $285.22 $132.14 $286.49 $30.41 $30.41 $31.58 $22.20 $7.19 $458.39 $467.58 $375.01 $286.49 $634.00 $286.49 $300.82 $475.50 $286.49 $286.49 $286.49 $138.92 $138.92 $502.13 $286.49 $507.20 $412.10 $6.85 $286.49 $367.72 $300.82 $414.48 $286.49 $5.38 $286.49 N/A N/A 30000136 EAP CPT® 86880 DIRECT COOMBS (ARC) BOTH IP/OP $140.00 $104.00 $2.70 $112.00 $10.57 $10.57 $10.57 $10.57 $54.76 $54.76 $54.51 $2.70 $54.76 $8.15 $8.15 $8.47 $5.95 $7.93 $87.61 $82.92 $82.81 $54.76 $5.39 $54.76 $57.49 $105.00 $54.76 $54.76 $54.76 $30.00 $30.00 $110.88 $54.76 $112.00 $91.00 $7.55 $54.76 $81.20 $57.49 $79.22 $54.76 $5.93 $54.76 N/A N/A 30000146 EAP CPT® 86900 "BLOOD TYPING, SEROLOGIC, ABO (ARC)" BOTH IP/OP $165.00 $122.50 $1.49 $177.47 $5.87 $5.87 $5.87 $5.87 $110.92 $110.92 $110.43 $1.49 $110.92 $4.52 $4.52 $4.70 $3.30 $4.41 $177.47 $167.51 $97.60 $110.92 $2.99 $110.92 $116.46 $123.75 $110.92 $110.92 $110.92 $16.68 $16.68 $130.68 $110.92 $132.00 $107.25 $4.20 $110.92 $95.70 $116.46 $160.47 $110.92 $3.30 $110.92 N/A N/A 30000149 EAP CPT® 86901 "BLOOD TYPING, SEROLOGIC, RH (D) (ARC)" BOTH IP/OP $165.00 $122.50 $1.49 $132.00 $5.87 $5.87 $5.87 $5.87 $33.30 $33.30 $33.15 $1.49 $33.30 $4.52 $4.52 $4.70 $3.30 $17.04 $53.27 $48.99 $97.60 $33.30 $2.99 $33.30 $34.96 $123.75 $33.30 $33.30 $33.30 $16.68 $16.68 $130.68 $33.30 $132.00 $107.25 $16.23 $33.30 $95.70 $34.96 $48.17 $33.30 $12.75 $33.30 N/A N/A 30000153 EAP CPT® 86902 BLOOD TYPE AG DONOR EA BOTH IP/OP $828.00 $613.00 $2.86 $662.40 $7.50 $7.50 $7.50 $7.50 $286.49 $286.49 $285.22 $2.86 $286.49 $5.60 $5.60 $5.81 $4.08 $5.05 $458.39 $467.58 $489.76 $286.49 $6.35 $286.49 $300.82 $621.00 $286.49 $286.49 $286.49 $414.00 $414.00 $655.78 $286.49 $662.40 $538.20 $4.81 $286.49 $480.24 $300.82 $414.48 $286.49 $3.78 $286.49 N/A N/A 30000154 EAP CPT® 86902 BLOOD TYPE AG DONOR EA (ARC) BOTH IP/OP $828.00 $613.00 $2.86 $662.40 $7.50 $7.50 $7.50 $7.50 $286.49 $286.49 $285.22 $2.86 $286.49 $5.60 $5.60 $5.81 $4.08 $5.05 $458.39 $467.58 $489.76 $286.49 $6.35 $286.49 $300.82 $621.00 $286.49 $286.49 $286.49 $414.00 $414.00 $655.78 $286.49 $662.40 $538.20 $4.81 $286.49 $480.24 $300.82 $414.48 $286.49 $3.78 $286.49 N/A N/A 30000155 EAP CPT® 86904 AG SCREEN PT SERUM EA UNIT (ARC) BOTH IP/OP "$2,572.00" "$1,903.50" $8.17 "$2,572.00" "$2,572.00" "$2,572.00" "$2,572.00" "$2,572.00" $16.34 $16.34 $8.17 "$2,572.00" $16.34 $14.44 $14.44 $14.99 $10.54 $14.04 $26.14 $26.14 "$2,572.00" $16.34 $16.34 $16.34 "$2,572.00" "$1,929.00" $16.34 $16.34 $16.34 $53.12 $53.12 "$2,037.02" $16.34 "$2,057.60" "$1,671.80" "$2,572.00" $16.34 "$1,491.76" "$2,572.00" $23.69 $16.34 "$2,572.00" $16.34 N/A N/A 30000160 EAP CPT® 86905 PATIENT AG TYPING (ARC) BOTH IP/OP $353.00 $261.50 $1.91 $467.58 $7.50 $7.50 $7.50 $7.50 $286.49 $286.49 $285.22 $1.91 $286.49 $5.80 $5.80 $6.03 $4.24 $5.65 $458.39 $467.58 $208.80 $286.49 $3.83 $286.49 $300.82 $264.75 $286.49 $286.49 $286.49 $21.36 $21.36 $279.58 $286.49 $282.40 $229.45 $5.38 $286.49 $204.74 $300.82 $353.00 $286.49 $4.23 $286.49 N/A N/A 30000161 EAP CPT® 86905 PATIENT AG TYPING BOTH IP/OP $353.00 $261.50 $1.91 $467.58 $7.50 $7.50 $7.50 $7.50 $286.49 $286.49 $285.22 $1.91 $286.49 $5.80 $5.80 $6.03 $4.24 $5.65 $458.39 $467.58 $208.80 $286.49 $3.83 $286.49 $300.82 $264.75 $286.49 $286.49 $286.49 $21.36 $21.36 $279.58 $286.49 $282.40 $229.45 $5.38 $286.49 $204.74 $300.82 $353.00 $286.49 $4.23 $286.49 N/A N/A 30000179 EAP CPT® 86906 RH PHENOTYPE (ARC) BOTH IP/OP $786.00 $582.00 $3.88 $786.00 $786.00 $786.00 $786.00 $786.00 $7.75 $7.75 $3.88 $786.00 $7.75 $11.76 $11.76 $12.21 $8.59 $11.46 $12.40 $12.40 $786.00 $7.75 $7.75 $7.75 $786.00 $589.50 $7.75 $7.75 $7.75 $43.32 $43.32 $622.51 $7.75 $628.80 $510.90 $786.00 $7.75 $455.88 $786.00 $11.24 $7.75 $786.00 $7.75 N/A N/A 30000180 EAP CPT® 86920 CROSSMATCH IS EA UNIT BOTH IP/OP $314.00 $232.50 $19.89 $314.00 $49.35 $49.35 $49.35 $49.35 $146.71 $146.71 $146.06 $65.45 $146.71 $27.25 $27.25 $28.30 $19.89 $65.44 $234.73 $226.86 $185.73 $146.71 $314.00 $146.71 $154.04 $235.50 $146.71 $146.71 $146.71 $124.04 $124.04 $248.69 $146.71 $251.20 $204.10 $62.32 $146.71 $182.12 $154.04 $212.25 $146.71 $65.44 $146.71 N/A N/A 30000182 EAP CPT® 86920 COMPATIBILITY EA- MT BOTH IP/OP $263.00 $195.00 $19.89 $263.00 $49.35 $49.35 $49.35 $49.35 $146.71 $146.71 $146.06 $54.82 $146.71 $27.25 $27.25 $28.30 $19.89 $54.81 $234.73 $226.86 $155.56 $146.71 $263.00 $146.71 $154.04 $197.25 $146.71 $146.71 $146.71 $124.04 $124.04 $208.30 $146.71 $210.40 $170.95 $52.20 $146.71 $152.54 $154.04 $212.25 $146.71 $54.81 $146.71 N/A N/A 30000185 EAP CPT® 86921 CROSSMATCH INCUB EA UNIT BOTH IP/OP $502.00 $371.50 $16.15 $502.00 $502.00 $502.00 $502.00 $502.00 $502.00 $502.00 $16.37 $502.00 $502.00 $22.12 $22.12 $22.97 $16.15 $104.62 $502.00 $182.00 $502.00 $502.00 $455.00 $502.00 $502.00 $376.50 $502.00 $502.00 $502.00 $100.88 $100.88 $397.58 $502.00 $401.60 $326.30 $502.00 $502.00 $291.16 $502.00 $301.20 $502.00 $502.00 $502.00 N/A N/A 30000187 EAP CPT® 86921 PLATELET CROSSMATCH (ARC) BOTH IP/OP $502.00 $371.50 $16.15 $502.00 $502.00 $502.00 $502.00 $502.00 $502.00 $502.00 $16.37 $502.00 $502.00 $22.12 $22.12 $22.97 $16.15 $104.62 $502.00 $182.00 $502.00 $502.00 $455.00 $502.00 $502.00 $376.50 $502.00 $502.00 $502.00 $100.88 $100.88 $397.58 $502.00 $401.60 $326.30 $502.00 $502.00 $291.16 $502.00 $301.20 $502.00 $502.00 $502.00 N/A N/A 30000190 EAP CPT® 86922 CROSSMATCH AHG (ARC) BOTH IP/OP $528.00 $391.00 $18.17 $475.00 $52.94 $52.94 $52.94 $52.94 $146.71 $146.71 $146.06 $110.05 $146.71 $24.89 $24.89 $25.84 $18.17 $110.04 $234.73 $226.86 $312.31 $146.71 $475.00 $146.71 $154.04 $396.00 $146.71 $146.71 $146.71 $112.48 $112.48 $418.18 $146.71 $422.40 $343.20 $104.79 $146.71 $306.24 $154.04 $212.25 $146.71 $110.04 $146.71 N/A N/A 30000191 EAP CPT® 86922 CROSSMATCH AHG BOTH IP/OP $528.00 $391.00 $18.17 $528.00 $52.94 $52.94 $52.94 $52.94 $146.71 $146.71 $146.06 $110.05 $146.71 $24.89 $24.89 $25.84 $18.17 $110.04 $234.73 $226.86 $312.31 $146.71 $528.00 $146.71 $154.04 $396.00 $146.71 $146.71 $146.71 $112.48 $112.48 $418.18 $146.71 $422.40 $343.20 $104.79 $146.71 $306.24 $154.04 $212.25 $146.71 $110.04 $146.71 N/A N/A 30000192 EAP CPT® 86923 CROSSMATCH ELECTRONIC BOTH IP/OP $463.00 $343.00 $14.42 $463.00 $39.58 $39.58 $39.58 $39.58 $146.71 $146.71 $146.06 $96.50 $146.71 $19.75 $19.75 $20.51 $14.42 $96.49 $234.73 $226.86 $273.86 $146.71 $463.00 $146.71 $154.04 $347.25 $146.71 $146.71 $146.71 $89.32 $89.32 $366.70 $146.71 $370.40 $300.95 $91.89 $146.71 $268.54 $154.04 $212.25 $146.71 $96.49 $146.71 N/A N/A 30000195 EAP CPT® 86940 HEMOLYSINS/AGGLUTININS AUTO EA (ARC) BOTH IP/OP $139.00 $103.00 $4.39 $139.00 $139.00 $139.00 $139.00 $139.00 $8.77 $8.77 $4.39 $139.00 $8.77 $12.45 $12.45 $12.93 $9.09 $12.11 $14.03 $14.03 $139.00 $8.77 $8.77 $8.77 $139.00 $104.25 $8.77 $8.77 $8.77 $45.84 $45.84 $110.09 $8.77 $111.20 $90.35 $139.00 $8.77 $80.62 $139.00 $12.72 $8.77 $139.00 $8.77 N/A N/A 30000196 EAP CPT® 86941 HEMOLYSINS/AGGLUTININS INCUBATED (ARC) BOTH IP/OP $139.00 $103.00 $6.06 $139.00 $139.00 $139.00 $139.00 $139.00 $12.11 $12.11 $6.06 $139.00 $12.11 $18.39 $18.39 $19.09 $13.42 $17.89 $19.38 $19.38 $139.00 $12.11 $12.11 $12.11 $139.00 $104.25 $12.11 $12.11 $12.11 $67.68 $67.68 $110.09 $12.11 $111.20 $90.35 $139.00 $12.11 $80.62 $139.00 $17.56 $12.11 $139.00 $12.11 N/A N/A 30000198 EAP CPT® 86970 RBC PRETX CHEM (ARC) BOTH IP/OP $810.00 $599.50 $12.11 $648.00 $41.11 $41.11 $41.11 $41.11 $33.30 $33.30 $33.15 $168.82 $33.30 $16.59 $16.59 $17.23 $12.11 $168.81 $53.27 $48.99 $479.12 $33.30 $298.00 $33.30 $34.96 $607.50 $33.30 $33.30 $33.30 $74.44 $74.44 $641.52 $33.30 $648.00 $526.50 $160.76 $33.30 $469.80 $34.96 $48.17 $33.30 $168.80 $33.30 N/A N/A 30000199 EAP CPT® 86971 RBC PRETX ENZ (ARC) BOTH IP/OP $383.00 $283.50 $12.01 $383.00 $383.00 $383.00 $383.00 $383.00 $383.00 $383.00 $12.01 $383.00 $383.00 $16.59 $16.59 $17.23 $12.11 $79.82 $383.00 $153.20 $383.00 $383.00 $383.00 $383.00 $383.00 $287.25 $383.00 $383.00 $383.00 $74.44 $74.44 $303.34 $383.00 $306.40 $248.95 $383.00 $383.00 $222.14 $383.00 $229.80 $383.00 $383.00 $383.00 N/A N/A 30000200 EAP CPT® 86972 RBC PRETX DENS GRAD (ARC) BOTH IP/OP $827.00 $612.00 $19.32 $827.00 $827.00 $827.00 $827.00 $827.00 $827.00 $827.00 $21.07 $827.00 $827.00 $26.47 $26.47 $27.49 $19.32 $172.36 $827.00 $175.60 $827.00 $827.00 $439.00 $827.00 $827.00 $620.25 $827.00 $827.00 $827.00 $120.72 $120.72 $654.98 $827.00 $661.60 $537.55 $827.00 $827.00 $479.66 $827.00 $496.20 $827.00 $827.00 $827.00 N/A N/A 30000201 EAP CPT® 86975 RBC PRETX DRUG (ARC) BOTH IP/OP $810.00 $599.50 $16.15 $810.00 $810.00 $810.00 $810.00 $810.00 $810.00 $810.00 $16.37 $810.00 $810.00 $22.12 $22.12 $22.97 $16.15 $168.81 $810.00 $132.80 $810.00 $810.00 $332.00 $810.00 $810.00 $607.50 $810.00 $810.00 $810.00 $100.88 $100.88 $641.52 $810.00 $648.00 $526.50 $810.00 $810.00 $469.80 $810.00 $486.00 $810.00 $810.00 $810.00 N/A N/A 30000202 EAP CPT® 86976 "RBC DILUTION OF SERUM, PER ALIQUOT (ARC)" BOTH IP/OP $264.00 $195.50 $18.11 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $18.11 $264.00 $264.00 $24.89 $24.89 $25.84 $18.17 $55.02 $264.00 $66.40 $264.00 $264.00 $166.00 $264.00 $264.00 $198.00 $264.00 $264.00 $264.00 $112.48 $112.48 $209.09 $264.00 $211.20 $171.60 $264.00 $264.00 $153.12 $264.00 $158.40 $264.00 $264.00 $264.00 N/A N/A 30000203 EAP CPT® 86977 "RBC INCUBATION WITH INHIBITORS, PER ALIQUOT (ARC)" BOTH IP/OP $751.00 $556.00 $16.15 $751.00 $751.00 $751.00 $751.00 $751.00 $751.00 $751.00 $18.11 $751.00 $751.00 $22.12 $22.12 $22.97 $16.15 $156.52 $751.00 $161.20 $751.00 $751.00 $403.00 $751.00 $751.00 $563.25 $751.00 $751.00 $751.00 $100.88 $100.88 $594.79 $751.00 $600.80 $488.15 $751.00 $751.00 $435.58 $751.00 $450.60 $751.00 $751.00 $751.00 N/A N/A 30000204 EAP CPT® 86978 RBC PRETX AB ID DIFF EA ABSORP (ARC) BOTH IP/OP $640.00 $474.00 $16.15 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $18.11 $640.00 $640.00 $22.12 $22.12 $22.97 $16.15 $133.38 $640.00 $159.60 $640.00 $640.00 $399.00 $640.00 $640.00 $480.00 $640.00 $640.00 $640.00 $100.88 $100.88 $506.88 $640.00 $512.00 $416.00 $640.00 $640.00 $371.20 $640.00 $384.00 $640.00 $640.00 $640.00 N/A N/A 30000205 EAP CPT® 86985 ALIQUOT BLOOD PRODUCTS EA BOTH IP/OP $376.00 $278.50 $12.11 $376.00 $36.50 $36.50 $36.50 $36.50 $146.71 $146.71 $146.06 $78.37 $146.71 $16.59 $16.59 $17.23 $12.11 $78.36 $234.73 $226.86 $222.40 $146.71 $376.00 $146.71 $154.04 $282.00 $146.71 $146.71 $146.71 $74.44 $74.44 $297.79 $146.71 $300.80 $244.40 $74.63 $146.71 $218.08 $154.04 $212.25 $146.71 $78.36 $146.71 N/A N/A 30000208 EAP CPT® 87015 CONCENTRATION BOTH IP/OP $132.00 $98.00 $3.34 $132.00 $13.10 $13.10 $13.10 $13.10 $6.68 $6.68 $3.34 $3.34 $6.68 $10.14 $10.14 $10.53 $7.40 $9.87 $10.69 $10.69 $78.08 $6.68 $6.68 $6.68 $132.00 $99.00 $6.68 $6.68 $6.68 $37.32 $37.32 $104.54 $6.68 $105.60 $11.02 $9.40 $6.68 $76.56 $132.00 $9.69 $6.68 $7.38 $6.68 N/A N/A 30000209 EAP CPT® 87046 "STOOL CULT, AEROBIC-CAMPY" BOTH IP/OP $143.00 $106.00 $2.61 $143.00 $18.52 $18.52 $18.52 $18.52 $9.44 $9.44 $4.72 $4.72 $9.44 $14.32 $14.32 $14.87 $10.45 $3.49 $15.10 $15.10 $84.58 $9.44 $9.44 $9.44 $143.00 $107.25 $9.44 $9.44 $9.44 $52.72 $52.72 $113.26 $9.44 $114.40 $15.58 $3.32 $9.44 $82.94 $143.00 $13.69 $9.44 $2.61 $9.44 N/A N/A 30000210 EAP CPT® 87046 "STOOL, CULT, AEROBIC-YERSINNIA" BOTH IP/OP $143.00 $106.00 $2.61 $143.00 $18.52 $18.52 $18.52 $18.52 $9.44 $9.44 $4.72 $4.72 $9.44 $14.32 $14.32 $14.87 $10.45 $3.49 $15.10 $15.10 $84.58 $9.44 $9.44 $9.44 $143.00 $107.25 $9.44 $9.44 $9.44 $52.72 $52.72 $113.26 $9.44 $114.40 $15.58 $3.32 $9.44 $82.94 $143.00 $13.69 $9.44 $2.61 $9.44 N/A N/A 30000211 EAP CPT® 87176 "HOMOGENIZATION, TISSUE" BOTH IP/OP $101.00 $75.00 $2.94 $101.00 $11.55 $11.55 $11.55 $11.55 $5.88 $5.88 $2.94 $2.94 $5.88 $8.93 $8.93 $9.28 $6.52 $8.69 $9.41 $9.41 $59.74 $5.88 $5.88 $5.88 $101.00 $75.75 $5.88 $5.88 $5.88 $32.88 $32.88 $79.99 $5.88 $80.80 $9.70 $8.28 $5.88 $58.58 $101.00 $8.53 $5.88 $6.50 $5.88 N/A N/A 30000212 EAP CPT® 87177 WET PREP BOTH IP/OP $112.00 $83.00 $4.45 $112.00 $17.47 $17.47 $17.47 $17.47 $8.90 $8.90 $4.45 $4.45 $8.90 $13.51 $13.51 $14.03 $9.86 $13.15 $14.24 $14.24 $66.25 $8.90 $8.90 $8.90 $112.00 $84.00 $8.90 $8.90 $8.90 $49.72 $49.72 $88.70 $8.90 $89.60 $72.80 $12.52 $8.90 $64.96 $112.00 $12.91 $8.90 $9.83 $8.90 N/A N/A 30000213 EAP CPT® 87220 SKIN PREP: 10% KOH BOTH IP/OP $198.00 $147.00 $2.14 $198.00 $8.38 $8.38 $8.38 $8.38 $4.27 $4.27 $2.14 $2.14 $4.27 $6.48 $6.48 $6.73 $4.73 $6.30 $6.83 $6.83 $117.12 $4.27 $4.27 $4.27 $198.00 $148.50 $4.27 $4.27 $4.27 $23.84 $23.84 $156.82 $4.27 $158.40 $128.70 $6.00 $4.27 $114.84 $198.00 $6.19 $4.27 $4.71 $4.27 N/A N/A 30000214 EAP CPT® 87250 HERPES VIRAL CULTURE BOTH IP/OP $367.00 $272.00 $9.78 $367.00 $38.38 $38.38 $38.38 $38.38 $19.56 $19.56 $9.78 $9.78 $19.56 $29.69 $29.69 $30.83 $21.67 $28.89 $31.30 $31.30 $217.08 $19.56 $19.56 $19.56 $367.00 $275.25 $19.56 $19.56 $19.56 $109.28 $109.28 $290.66 $19.56 $293.60 $32.27 $27.51 $19.56 $212.86 $367.00 $28.36 $19.56 $21.61 $19.56 N/A N/A 30000215 EAP CPT® 87497 "CYTOMEGALOVIRUS, DNA" BOTH IP/OP "$1,040.00" $770.00 $21.42 "$1,040.00" $84.06 $84.06 $84.06 $84.06 $42.84 $42.84 $21.42 $21.42 $42.84 $65.04 $65.04 $67.54 $47.48 $63.28 $68.54 $68.54 $615.16 $42.84 $42.84 $42.84 "$1,040.00" $780.00 $42.84 $42.84 $42.84 $239.40 $239.40 $823.68 $42.84 $832.00 $676.00 $60.27 $42.84 $603.20 "$1,040.00" $62.12 $42.84 $47.34 $42.84 N/A N/A 30000217 EAP CPT® 87536 HIV /RNA PCR QUANT BOTH IP/OP $842.00 $623.50 $42.55 $842.00 $101.83 $101.83 $101.83 $101.83 $85.10 $85.10 $42.55 $42.55 $85.10 $78.80 $78.80 $81.83 $57.52 $66.37 $136.16 $136.16 $498.04 $85.10 $85.10 $85.10 $842.00 $631.50 $85.10 $85.10 $85.10 $290.04 $290.04 $666.86 $85.10 $673.60 $140.42 $63.21 $85.10 $488.36 $842.00 $123.40 $85.10 $49.65 $85.10 N/A N/A 30000218 EAP CPT® 87536 "HIV-1 RNA ULTRA, QNT" BOTH IP/OP $790.00 $585.00 $42.55 $790.00 $101.83 $101.83 $101.83 $101.83 $85.10 $85.10 $42.55 $42.55 $85.10 $78.80 $78.80 $81.83 $57.52 $66.37 $136.16 $136.16 $467.29 $85.10 $85.10 $85.10 $790.00 $592.50 $85.10 $85.10 $85.10 $290.04 $290.04 $625.68 $85.10 $632.00 $140.42 $63.21 $85.10 $458.20 $790.00 $123.40 $85.10 $49.65 $85.10 N/A N/A 30000220 EAP CPT® 87798 "EBV DNA-PCR, QUAL" BOTH IP/OP $900.00 $666.00 $17.55 $900.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $532.35 $35.09 $35.09 $35.09 $900.00 $675.00 $35.09 $35.09 $35.09 $109.64 $109.64 $712.80 $35.09 $720.00 $585.00 $27.60 $35.09 $522.00 $900.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30000221 EAP CPT® 89050 CSF EXAM-HEMATOLOGY BOTH IP/OP $227.00 $168.00 $2.36 $227.00 $9.26 $9.26 $9.26 $9.26 $4.72 $4.72 $2.36 $2.36 $4.72 $7.18 $7.18 $7.45 $5.24 $6.99 $7.55 $7.55 $134.27 $4.72 $4.72 $4.72 $227.00 $170.25 $4.72 $4.72 $4.72 $26.44 $26.44 $179.78 $4.72 $181.60 $147.55 $6.66 $4.72 $131.66 $227.00 $6.84 $4.72 $5.23 $4.72 N/A N/A 30000222 EAP CPT® 89050 FLUID EXAM-HEME BOTH IP/OP $227.00 $168.00 $2.36 $227.00 $9.26 $9.26 $9.26 $9.26 $4.72 $4.72 $2.36 $2.36 $4.72 $7.18 $7.18 $7.45 $5.24 $6.99 $7.55 $7.55 $134.27 $4.72 $4.72 $4.72 $227.00 $170.25 $4.72 $4.72 $4.72 $26.44 $26.44 $179.78 $4.72 $181.60 $147.55 $6.66 $4.72 $131.66 $227.00 $6.84 $4.72 $5.23 $4.72 N/A N/A 30000223 EAP CPT® 89060 SYNOVIAL FLUID CRYSTAL ID BOTH IP/OP $150.00 $111.00 $3.58 $150.00 $14.03 $14.03 $14.03 $14.03 $7.33 $7.33 $3.67 $3.58 $7.33 $10.86 $10.86 $11.28 $7.93 $10.56 $11.73 $11.73 $88.73 $7.33 $7.33 $7.33 $150.00 $112.50 $7.33 $7.33 $7.33 $39.96 $39.96 $118.80 $7.33 $120.00 $97.50 $10.06 $7.33 $87.00 $150.00 $10.63 $7.33 $7.90 $7.33 N/A N/A 30000225 EAP CPT® 87081 "PERTUSSIS,STATE LAB" BOTH IP/OP $631.00 $467.00 $3.31 $631.00 $13.00 $13.00 $13.00 $13.00 $6.63 $6.63 $3.32 $3.31 $6.63 $10.08 $10.08 $10.47 $7.36 $9.79 $10.61 $10.61 $373.24 $6.63 $6.63 $6.63 $631.00 $473.25 $6.63 $6.63 $6.63 $37.04 $37.04 $499.75 $6.63 $504.80 $10.94 $9.32 $6.63 $365.98 $631.00 $9.61 $6.63 $7.32 $6.63 N/A N/A 30000228 EAP CPT® 88275 "FISH,AML, AML1/ETO,TRANSLOCATION8,21,PROBE" BOTH IP/OP $435.00 $322.00 $23.04 $435.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $257.30 $51.19 $51.19 $51.19 $435.00 $326.25 $51.19 $51.19 $51.19 $224.44 $224.44 $344.52 $51.19 $348.00 $282.75 $56.50 $51.19 $252.30 $435.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000229 EAP CPT® 88271 "FISH,AML, AML1/ETO,TRANSLOCATION8,21,100-300 CELLS" BOTH IP/OP $435.00 $322.00 $10.71 $435.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $257.30 $21.42 $21.42 $21.42 $435.00 $326.25 $21.42 $21.42 $21.42 $119.72 $119.72 $344.52 $21.42 $348.00 $282.75 $30.14 $21.42 $252.30 $435.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000230 EAP CPT® 88275 "FISH,MLL,11G23,GENE REARRANG,PROBE" BOTH IP/OP $397.00 $294.00 $23.04 $397.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $234.83 $51.19 $51.19 $51.19 $397.00 $297.75 $51.19 $51.19 $51.19 $224.44 $224.44 $314.42 $51.19 $317.60 $258.05 $56.50 $51.19 $230.26 $397.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000231 EAP CPT® 88271 "FISH,MLL,11G23,GENE REARRANG,100-300 CELLS" BOTH IP/OP $397.00 $294.00 $10.71 $397.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $234.83 $21.42 $21.42 $21.42 $397.00 $297.75 $21.42 $21.42 $21.42 $119.72 $119.72 $314.42 $21.42 $317.60 $258.05 $30.14 $21.42 $230.26 $397.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000232 EAP CPT® 88235 "SC ANEMIA,DNA PROBE,FETUS" BOTH IP/OP $258.00 $191.00 $75.15 $258.00 $258.00 $258.00 $258.00 $258.00 $150.30 $150.30 $75.15 $258.00 $150.30 $223.60 $223.60 $232.20 $163.23 $217.53 $240.48 $240.48 $258.00 $150.30 $150.30 $150.30 $258.00 $193.50 $150.30 $150.30 $150.30 $258.00 $258.00 $204.34 $150.30 $206.40 $167.70 $258.00 $150.30 $149.64 $258.00 $217.94 $150.30 $258.00 $150.30 N/A N/A 30000234 EAP HCPCS 88271 "FISH,DUP 22Q11.2, PROBE" BOTH IP/OP $330.00 $244.50 $10.71 $330.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $195.20 $21.42 $21.42 $21.42 $330.00 $247.50 $21.42 $21.42 $21.42 $119.72 $119.72 $261.36 $21.42 $264.00 $214.50 $30.14 $21.42 $191.40 $330.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000235 EAP CPT® 88271 "FISH,DUP 22Q11.2, 100-300 CELLS" BOTH IP/OP $364.00 $269.50 $10.71 $364.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $215.31 $21.42 $21.42 $21.42 $364.00 $273.00 $21.42 $21.42 $21.42 $119.72 $119.72 $288.29 $21.42 $291.20 $236.60 $30.14 $21.42 $211.12 $364.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000236 EAP CPT® 84432 THYROGLOBULIN PANEL BOTH IP/OP $68.00 $50.50 $8.03 $68.00 $31.53 $31.53 $31.53 $31.53 $16.06 $16.06 $8.03 $8.03 $16.06 $24.39 $24.39 $25.33 $17.80 $23.73 $25.70 $25.70 $40.22 $16.06 $16.06 $16.06 $68.00 $51.00 $16.06 $16.06 $16.06 $68.00 $68.00 $53.86 $16.06 $54.40 $44.20 $22.60 $16.06 $39.44 $68.00 $23.29 $16.06 $17.75 $16.06 N/A N/A 30000237 EAP CPT® 86800 "THYROGLOBULIN PANEL, ANTIBODY" BOTH IP/OP $69.00 $51.50 $7.95 $69.00 $31.22 $31.22 $31.22 $31.22 $15.91 $15.91 $7.96 $7.95 $15.91 $24.15 $24.15 $25.08 $17.63 $23.50 $25.46 $25.46 $40.81 $15.91 $15.91 $15.91 $69.00 $51.75 $15.91 $15.91 $15.91 $69.00 $69.00 $54.65 $15.91 $55.20 $44.85 $22.38 $15.91 $40.02 $69.00 $23.07 $15.91 $17.58 $15.91 N/A N/A 30000240 EAP CPT® 83520 "VASC ENDOTHELIAL GF,ELISA" BOTH IP/OP $593.00 $439.00 $7.77 $593.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $350.76 $17.27 $17.27 $17.27 $593.00 $444.75 $17.27 $17.27 $17.27 $72.36 $72.36 $469.66 $17.27 $474.40 $385.45 $18.21 $17.27 $343.94 $593.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30000241 EAP CPT® 83605 POCT LACTATE VENOUS (METER) BOTH IP/OP $239.00 $177.00 $5.34 $239.00 $20.96 $20.96 $20.96 $20.96 $11.57 $11.57 $5.79 $5.34 $11.57 $16.21 $16.21 $16.84 $11.84 $15.78 $18.51 $18.51 $141.37 $11.57 $11.57 $11.57 $239.00 $179.25 $11.57 $11.57 $11.57 $59.68 $59.68 $189.29 $11.57 $191.20 $155.35 $15.03 $11.57 $138.62 $239.00 $16.78 $11.57 $11.81 $11.57 N/A N/A 30000242 EAP CPT® 84484 POCT TROPONIN VENOUS (METER) BOTH IP/OP $283.00 $209.50 $5.61 $283.00 $19.33 $19.33 $19.33 $19.33 $12.47 $12.47 $6.24 $5.61 $12.47 $14.94 $14.94 $15.52 $10.91 $14.54 $19.95 $19.95 $167.39 $12.47 $12.47 $12.47 $283.00 $212.25 $12.47 $12.47 $12.47 $55.00 $55.00 $224.14 $12.47 $226.40 $183.95 $13.85 $12.47 $164.14 $283.00 $18.08 $12.47 $10.88 $12.47 N/A N/A 30000251 EAP CPT® 86828 HLA I/II AB SCR PLT TRANS (ARC) BOTH IP/OP $587.00 $434.50 $32.10 $587.00 $587.00 $587.00 $587.00 $587.00 $64.19 $64.19 $32.10 $587.00 $64.19 $57.46 $57.46 $59.67 $41.95 $122.34 $102.70 $102.70 $587.00 $64.19 $64.19 $64.19 $587.00 $440.25 $64.19 $64.19 $64.19 $293.50 $293.50 $464.90 $64.19 $469.60 $381.55 $587.00 $64.19 $340.46 $587.00 $93.08 $64.19 $587.00 $64.19 N/A N/A 30000300 EAP CPT® 80358 METHADONE - URINE BOTH IP/OP $375.00 $277.50 $0.03 $375.00 $0.03 $0.03 $0.03 $0.03 $114.43 $114.43 $57.22 $10.03 $114.43 $278.33 $278.33 $289.05 $195.38 $24.12 $183.09 $183.09 $221.81 $114.43 $114.43 $114.43 $375.00 $281.25 $114.43 $114.43 $114.43 $187.50 $187.50 $297.00 $114.43 $300.00 $188.81 $22.97 $114.43 $217.50 $375.00 $225.00 $375.00 $18.04 $114.43 N/A N/A 30000302 EAP CPT® 86885 ABID EA SELECTED CELL BOTH IP/OP $168.00 $124.50 $2.86 $168.00 $168.00 $168.00 $168.00 $168.00 $5.72 $5.72 $2.86 $168.00 $5.72 $8.68 $8.68 $9.02 $6.34 $8.44 $9.15 $9.15 $168.00 $5.72 $5.72 $5.72 $168.00 $126.00 $5.72 $5.72 $5.72 $31.96 $31.96 $133.06 $5.72 $134.40 $109.20 $168.00 $5.72 $97.44 $168.00 $8.29 $5.72 $168.00 $5.72 N/A N/A 30000411 EAP CPT® 86927 FFP THAWING EA UNIT BOTH IP/OP $318.00 $235.50 $7.78 $318.00 $318.00 $318.00 $318.00 $318.00 $318.00 $318.00 $10.27 $318.00 $318.00 $10.66 $10.66 $11.07 $7.78 $66.27 $318.00 $127.20 $318.00 $318.00 $318.00 $318.00 $318.00 $238.50 $318.00 $318.00 $318.00 $49.60 $49.60 $251.86 $318.00 $254.40 $206.70 $318.00 $318.00 $184.44 $318.00 $190.80 $318.00 $318.00 $318.00 N/A N/A 30000412 EAP CPT® 84702 D-HCG FREE & INTACT BOTH IP/OP $214.00 $158.50 $7.09 $214.00 $12.60 $12.60 $12.60 $12.60 $15.05 $15.05 $7.53 $7.53 $15.05 $9.74 $9.74 $10.12 $7.11 $9.48 $24.08 $24.08 $126.58 $15.05 $15.05 $15.05 $214.00 $160.50 $15.05 $15.05 $15.05 $35.88 $35.88 $169.49 $15.05 $171.20 $24.83 $9.03 $15.05 $124.12 $214.00 $21.82 $15.05 $7.09 $15.05 N/A N/A 30000413 EAP CPT® 86920 "CHARGE: XMATCH, SALINE" BOTH IP/OP $263.00 $195.00 $19.89 $263.00 $49.35 $49.35 $49.35 $49.35 $146.71 $146.71 $146.06 $54.82 $146.71 $27.25 $27.25 $28.30 $19.89 $54.81 $234.73 $226.86 $155.56 $146.71 $263.00 $146.71 $154.04 $197.25 $146.71 $146.71 $146.71 $124.04 $124.04 $208.30 $146.71 $210.40 $170.95 $52.20 $146.71 $152.54 $154.04 $212.25 $146.71 $54.81 $146.71 N/A N/A 30000420 EAP CPT® 36415 VENIPUNCTURE BOTH IP/OP $43.00 $32.00 $1.35 $43.00 $23.35 $23.35 $23.35 $23.35 $3.00 $3.00 $1.50 $1.35 $3.00 $3.12 $3.12 $3.24 $2.28 $8.96 $4.80 $4.80 $25.43 $3.00 $3.00 $3.00 $43.00 $32.25 $3.00 $3.00 $3.00 $21.50 $21.50 $34.06 $3.00 $34.40 $27.95 $8.53 $3.00 $24.94 $43.00 $4.35 $3.00 $8.96 $3.00 N/A N/A 30000425 EAP CPT® 86923 CROSSMATCH - MASS TRANSFUSION BOTH IP/OP $314.00 $232.50 $14.42 $314.00 $39.58 $39.58 $39.58 $39.58 $146.71 $146.71 $146.06 $65.45 $146.71 $19.75 $19.75 $20.51 $14.42 $65.44 $234.73 $226.86 $185.73 $146.71 $314.00 $146.71 $154.04 $235.50 $146.71 $146.71 $146.71 $89.32 $89.32 $248.69 $146.71 $251.20 $204.10 $62.32 $146.71 $182.12 $154.04 $212.25 $146.71 $65.44 $146.71 N/A N/A 30000426 EAP CPT® 86480 QUANTIFERON-TB GOLD BOTH IP/OP $315.00 $233.50 $30.99 $315.00 $121.63 $121.63 $121.63 $121.63 $61.98 $61.98 $30.99 $30.99 $61.98 $94.11 $94.11 $97.73 $68.70 $91.55 $99.17 $99.17 $186.32 $61.98 $61.98 $61.98 $315.00 $236.25 $61.98 $61.98 $61.98 $315.00 $315.00 $249.48 $61.98 $252.00 $204.75 $87.19 $61.98 $182.70 $315.00 $89.87 $61.98 $68.49 $61.98 N/A N/A 30000427 EAP CPT® 86022 SEROTONIN RELEASE ASSAY (SRA) UNFRACTIONATED BOTH IP/OP $315.00 $233.50 $9.19 $315.00 $315.00 $315.00 $315.00 $315.00 $18.37 $18.37 $9.19 $315.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $315.00 $18.37 $18.37 $18.37 $315.00 $236.25 $18.37 $18.37 $18.37 $102.64 $102.64 $249.48 $18.37 $252.00 $204.75 $315.00 $18.37 $182.70 $315.00 $26.64 $18.37 $315.00 $18.37 N/A N/A 30000428 EAP CPT® 86022 SEROTONIN RELEASE ASSAY (SRA) LMWH BOTH IP/OP $290.00 $215.00 $9.19 $290.00 $290.00 $290.00 $290.00 $290.00 $18.37 $18.37 $9.19 $290.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $290.00 $18.37 $18.37 $18.37 $290.00 $217.50 $18.37 $18.37 $18.37 $102.64 $102.64 $229.68 $18.37 $232.00 $188.50 $290.00 $18.37 $168.20 $290.00 $26.64 $18.37 $290.00 $18.37 N/A N/A 30000429 EAP CPT® 81599 MATERNI T21™ PLUS BOTH IP/OP "$1,153.00" $853.50 $240.30 "$1,153.00" "$1,153.00" "$1,153.00" "$1,153.00" "$1,153.00" "$1,153.00" "$1,153.00" "$1,153.00" "$1,153.00" "$1,153.00" $855.76 $855.76 $888.73 $600.71 $240.30 "$1,153.00" $461.20 "$1,153.00" "$1,153.00" "$1,153.00" "$1,153.00" "$1,153.00" $864.75 "$1,153.00" "$1,153.00" "$1,153.00" $576.50 $576.50 $913.18 "$1,153.00" $922.40 $749.45 "$1,153.00" "$1,153.00" $668.74 "$1,153.00" $691.80 "$1,153.00" "$1,153.00" "$1,153.00" N/A N/A 30000502 EAP CPT® 83516 IMMUNOASSAY NONANTIBODY BOTH IP/OP $68.00 $50.50 $5.76 $68.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $40.22 $11.53 $11.53 $11.53 $68.00 $51.00 $11.53 $11.53 $11.53 $59.76 $59.76 $53.86 $11.53 $54.40 $19.02 $15.05 $11.53 $39.44 $68.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30000503 EAP CPT® 86235 NUCLEAR ANTIGEN ANTIBODY BOTH IP/OP $71.00 $53.00 $8.97 $71.00 $35.19 $35.19 $35.19 $35.19 $17.93 $17.93 $8.97 $8.97 $17.93 $27.23 $27.23 $28.27 $19.88 $26.49 $28.69 $28.69 $42.00 $17.93 $17.93 $17.93 $71.00 $53.25 $17.93 $17.93 $17.93 $71.00 $71.00 $56.23 $17.93 $56.80 $29.58 $25.23 $17.93 $41.18 $71.00 $26.00 $17.93 $19.82 $17.93 N/A N/A 30000504 EAP CPT® 86003 ALLERGEN SPECIFIC IGE BOTH IP/OP $32.00 $24.00 $2.61 $32.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $18.93 $5.22 $5.22 $5.22 $32.00 $24.00 $5.22 $5.22 $5.22 $29.20 $29.20 $25.34 $5.22 $25.60 $8.61 $7.35 $5.22 $18.56 $32.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30000505 EAP CPT® 86735 MUMPS ANTIBODY BOTH IP/OP $32.00 $24.00 $6.53 $32.00 $25.60 $25.60 $25.60 $25.60 $13.05 $13.05 $6.53 $6.53 $13.05 $19.82 $19.82 $20.58 $14.47 $19.28 $20.88 $20.88 $18.93 $13.05 $13.05 $13.05 $32.00 $24.00 $13.05 $13.05 $13.05 $32.00 $32.00 $25.34 $13.05 $25.60 $21.53 $18.36 $13.05 $18.56 $32.00 $18.92 $13.05 $14.42 $13.05 N/A N/A 30000506 EAP CPT® 86644 CMV ANTIBODY BOTH IP/OP $24.00 $18.00 $7.20 $24.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $14.20 $14.39 $14.39 $14.39 $24.00 $18.00 $14.39 $14.39 $14.39 $24.00 $24.00 $19.01 $14.39 $19.20 $23.74 $16.37 $14.39 $13.92 $24.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30000507 EAP CPT® 86710 INFLUENZA VIRUS ANTIBODY BOTH IP/OP $25.00 $18.50 $6.78 $25.00 $25.00 $25.00 $25.00 $25.00 $13.55 $13.55 $6.78 $6.78 $13.55 $20.59 $20.59 $21.38 $15.03 $20.03 $21.68 $21.68 $14.79 $13.55 $13.55 $13.55 $25.00 $18.75 $13.55 $13.55 $13.55 $25.00 $25.00 $19.80 $13.55 $20.00 $22.36 $19.08 $13.55 $14.50 $25.00 $19.65 $13.55 $14.99 $13.55 N/A N/A 30000508 EAP CPT® 84702 CHORIONIC GONADOTROPIN TEST BOTH IP/OP $162.00 $120.00 $7.09 $162.00 $12.60 $12.60 $12.60 $12.60 $15.05 $15.05 $7.53 $7.53 $15.05 $9.74 $9.74 $10.12 $7.11 $9.48 $24.08 $24.08 $95.82 $15.05 $15.05 $15.05 $162.00 $121.50 $15.05 $15.05 $15.05 $35.88 $35.88 $128.30 $15.05 $129.60 $24.83 $9.03 $15.05 $93.96 $162.00 $21.82 $15.05 $7.09 $15.05 N/A N/A 30000509 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $402.00 $297.50 $8.39 $402.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $237.78 $18.64 $18.64 $18.64 $402.00 $301.50 $18.64 $18.64 $18.64 $67.28 $67.28 $318.38 $18.64 $321.60 $30.76 $16.94 $18.64 $233.16 $402.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30000510 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $201.00 $149.00 $8.39 $201.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $118.89 $18.64 $18.64 $18.64 $201.00 $150.75 $18.64 $18.64 $18.64 $67.28 $67.28 $159.19 $18.64 $160.80 $30.76 $16.94 $18.64 $116.58 $201.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30000515 EAP CPT® 86022 PLATELET ANTIBODIES BOTH IP/OP $347.00 $257.00 $9.19 $347.00 $347.00 $347.00 $347.00 $347.00 $18.37 $18.37 $9.19 $347.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $347.00 $18.37 $18.37 $18.37 $347.00 $260.25 $18.37 $18.37 $18.37 $102.64 $102.64 $274.82 $18.37 $277.60 $347.00 $347.00 $18.37 $201.26 $347.00 $26.64 $18.37 $347.00 $18.37 N/A N/A 30000519 EAP CPT® 86003 ALLERGEN SPECIFIC IGE BOTH IP/OP $378.00 $280.00 $2.61 $378.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $223.59 $5.22 $5.22 $5.22 $378.00 $283.50 $5.22 $5.22 $5.22 $29.20 $29.20 $299.38 $5.22 $302.40 $8.61 $7.35 $5.22 $219.24 $378.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30000521 EAP CPT® 86235 NUCLEAR ANTIGEN ANTIBODY BOTH IP/OP $144.00 $107.00 $8.97 $144.00 $35.19 $35.19 $35.19 $35.19 $17.93 $17.93 $8.97 $8.97 $17.93 $27.23 $27.23 $28.27 $19.88 $26.49 $28.69 $28.69 $85.18 $17.93 $17.93 $17.93 $144.00 $108.00 $17.93 $17.93 $17.93 $100.24 $100.24 $114.05 $17.93 $115.20 $29.58 $25.23 $17.93 $83.52 $144.00 $26.00 $17.93 $19.82 $17.93 N/A N/A 30000525 EAP CPT® 82962 BLOOD GLUCOSE CHECK BOTH IP/OP $58.00 $43.00 $1.48 $58.00 $4.59 $4.59 $4.59 $4.59 $3.28 $3.28 $1.64 $1.48 $3.28 $3.56 $3.56 $3.69 $2.60 $3.45 $5.25 $5.25 $34.31 $3.28 $3.28 $3.28 $58.00 $43.50 $3.28 $3.28 $3.28 $13.08 $13.08 $45.94 $3.28 $46.40 $37.70 $3.29 $3.28 $33.64 $58.00 $4.76 $3.28 $2.58 $3.28 N/A N/A 30000526 EAP CPT® 86003 ALLEGEN - MOSQUITO Q BOTH IP/OP $96.00 $71.50 $2.61 $96.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $56.78 $5.22 $5.22 $5.22 $96.00 $72.00 $5.22 $5.22 $5.22 $29.20 $29.20 $76.03 $5.22 $76.80 $62.40 $7.35 $5.22 $55.68 $96.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30000527 EAP CPT® 83916 "OLIGOCLONAL BANDS,CSF(SO)" BOTH IP/OP $56.00 $41.50 $12.33 $56.00 $39.48 $39.48 $39.48 $39.48 $27.39 $27.39 $13.70 $12.33 $27.39 $30.53 $30.53 $31.71 $22.29 $29.69 $43.82 $43.82 $33.12 $27.39 $27.39 $27.39 $56.00 $42.00 $27.39 $27.39 $27.39 $56.00 $56.00 $44.35 $27.39 $44.80 $36.40 $28.28 $27.39 $32.48 $56.00 $39.72 $27.39 $22.21 $27.39 N/A N/A 30000528 EAP CPT® 84157 "PROTEIN,TOTAL AND ELECTROPHORESIS,CSF(SO)" BOTH IP/OP $103.00 $76.50 $1.83 $103.00 $7.20 $7.20 $7.20 $7.20 $4.00 $4.00 $2.00 $1.83 $4.00 $5.56 $5.56 $5.78 $4.06 $5.42 $6.40 $6.40 $60.92 $4.00 $4.00 $4.00 $103.00 $77.25 $4.00 $4.00 $4.00 $20.48 $20.48 $81.58 $4.00 $82.40 $66.95 $5.16 $4.00 $59.74 $103.00 $5.80 $4.00 $4.05 $4.00 N/A N/A 30000529 EAP CPT® 84166 "PROTEIN,TOTAL AND ELECTROPHORESIS,QNT,CSF(SO)" BOTH IP/OP $89.00 $66.00 $8.91 $89.00 $34.99 $34.99 $34.99 $34.99 $17.83 $17.83 $8.92 $8.91 $17.83 $27.08 $27.08 $28.12 $19.77 $26.34 $28.53 $28.53 $52.64 $17.83 $17.83 $17.83 $89.00 $66.75 $17.83 $17.83 $17.83 $89.00 $89.00 $70.49 $17.83 $71.20 $57.85 $25.09 $17.83 $51.62 $89.00 $25.85 $17.83 $19.71 $17.83 N/A N/A 30000530 EAP CPT® 85810 "VISCOSITY, SERUM(SO)" BOTH IP/OP $76.00 $56.50 $5.84 $76.00 $22.92 $22.92 $22.92 $22.92 $11.67 $11.67 $5.84 $5.84 $11.67 $17.73 $17.73 $18.41 $12.94 $17.26 $18.67 $18.67 $44.95 $11.67 $11.67 $11.67 $76.00 $57.00 $11.67 $11.67 $11.67 $65.28 $65.28 $60.19 $11.67 $60.80 $49.40 $16.44 $11.67 $44.08 $76.00 $16.92 $11.67 $12.91 $11.67 N/A N/A 30000570 EAP CPT® 86341 IA-2 ISLET CELL AB (SO) BOTH IP/OP $193.00 $143.00 $10.61 $193.00 $38.83 $38.83 $38.83 $38.83 $23.57 $23.57 $11.79 $10.61 $23.57 $30.05 $30.05 $31.20 $21.93 $29.24 $37.71 $37.71 $114.16 $23.57 $23.57 $23.57 $193.00 $144.75 $23.57 $23.57 $23.57 $110.60 $110.60 $152.86 $23.57 $154.40 $125.45 $27.85 $23.57 $111.94 $193.00 $34.18 $23.57 $21.88 $23.57 N/A N/A 30000571 EAP CPT® 86355 LYMPH SUB 1 B CELLS TOT (SO) BOTH IP/OP $206.00 $152.50 $18.86 $206.00 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $121.85 $37.73 $37.73 $37.73 $206.00 $154.50 $37.73 $37.73 $37.73 $131.64 $131.64 $163.15 $37.73 $164.80 $133.90 $33.14 $37.73 $119.48 $206.00 $54.71 $37.73 $26.03 $37.73 N/A N/A 30000572 EAP CPT® 86357 LYMPH SUB 1 NK CELLS TOT (SO) BOTH IP/OP $196.00 $145.50 $18.87 $196.00 $196.00 $196.00 $196.00 $196.00 $37.73 $37.73 $18.87 $196.00 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $196.00 $37.73 $37.73 $37.73 $196.00 $147.00 $37.73 $37.73 $37.73 $131.64 $131.64 $155.23 $37.73 $156.80 $127.40 $196.00 $37.73 $113.68 $196.00 $54.71 $37.73 $196.00 $37.73 N/A N/A 30000573 EAP CPT® 86359 LYMPH SUB 1 T CELLS TOT (SO) BOTH IP/OP $210.00 $155.50 $18.86 $210.00 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $124.22 $37.73 $37.73 $37.73 $210.00 $157.50 $37.73 $37.73 $37.73 $131.64 $131.64 $166.32 $37.73 $168.00 $136.50 $33.14 $37.73 $121.80 $210.00 $54.71 $37.73 $26.03 $37.73 N/A N/A 30000574 EAP CPT® 86360 LYMPH SUB 1 T CELL RATIO (SO) BOTH IP/OP $311.00 $230.50 $23.49 $311.00 $92.22 $92.22 $92.22 $92.22 $46.98 $46.98 $23.49 $23.49 $46.98 $71.34 $71.34 $74.09 $52.08 $69.42 $75.17 $75.17 $183.96 $46.98 $46.98 $46.98 $311.00 $233.25 $46.98 $46.98 $46.98 $262.60 $262.60 $246.31 $46.98 $248.80 $202.15 $66.11 $46.98 $180.38 $311.00 $68.12 $46.98 $51.93 $46.98 N/A N/A 30000602 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $94.00 $70.00 $10.71 $94.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $55.60 $21.42 $21.42 $21.42 $94.00 $70.50 $21.42 $21.42 $21.42 $94.00 $94.00 $74.45 $21.42 $75.20 $61.10 $30.14 $21.42 $54.52 $94.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000604 EAP CPT® 86603 ADENOVIRUS ANTIBODY BOTH IP/OP $88.00 $65.50 $6.44 $88.00 $88.00 $88.00 $88.00 $88.00 $12.87 $12.87 $6.44 $88.00 $12.87 $19.54 $19.54 $20.29 $14.27 $19.01 $20.59 $20.59 $88.00 $12.87 $12.87 $12.87 $88.00 $66.00 $12.87 $12.87 $12.87 $71.92 $71.92 $69.70 $12.87 $70.40 $57.20 $88.00 $12.87 $51.04 $88.00 $18.66 $12.87 $88.00 $12.87 N/A N/A 30000605 EAP CPT® 84182 PROTEIN WESTERN BLOT TEST BOTH IP/OP $513.00 $380.00 $13.14 $513.00 $35.32 $35.32 $35.32 $35.32 $29.21 $29.21 $14.61 $13.14 $29.21 $27.33 $27.33 $28.38 $19.95 $26.60 $46.74 $46.74 $303.44 $29.21 $29.21 $29.21 $513.00 $384.75 $29.21 $29.21 $29.21 $100.60 $100.60 $406.30 $29.21 $410.40 $333.45 $25.33 $29.21 $297.54 $513.00 $42.35 $29.21 $19.90 $29.21 N/A N/A 30000610 EAP CPT® 86316 IMMUNOASSAY TUMOR OTHER BOTH IP/OP $217.00 $161.00 $10.41 $217.00 $40.84 $40.84 $40.84 $40.84 $20.81 $20.81 $10.41 $10.41 $20.81 $31.60 $31.60 $32.81 $23.06 $30.73 $33.30 $33.30 $128.36 $20.81 $20.81 $20.81 $217.00 $162.75 $20.81 $20.81 $20.81 $116.28 $116.28 $171.86 $20.81 $173.60 $141.05 $29.27 $20.81 $125.86 $217.00 $30.17 $20.81 $22.99 $20.81 N/A N/A 30000611 EAP CPT® 88305 TISSUE EXAM BY PATHOLOGIST BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 30000612 EAP CPT® 88311 DECALCIFY TISSUE BOTH IP/OP $103.00 $76.50 $4.67 $103.00 $32.38 $32.38 $32.38 $32.38 $103.00 $103.00 $103.00 $9.89 $103.00 $6.40 $6.40 $6.64 $4.67 $18.15 $103.00 $103.00 $60.92 $103.00 $8.46 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $24.60 $24.60 $81.58 $103.00 $82.40 $66.95 $17.29 $103.00 $59.74 $103.00 $103.00 $103.00 $13.58 $103.00 N/A N/A 30000613 EAP CPT® 88313 SPECIAL STAINS GROUP 2 BOTH IP/OP $146.00 $108.50 $33.15 $146.00 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $86.36 $33.30 $70.69 $33.30 $34.96 $109.50 $33.30 $33.30 $33.30 $146.00 $146.00 $115.63 $33.30 $116.80 $94.90 $50.25 $33.30 $84.68 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 30000614 EAP CPT® 85097 BONE MARROW INTERPRETATION BOTH IP/OP $700.00 $518.00 $24.50 $700.00 $700.00 $700.00 $700.00 $700.00 $48.25 $48.25 $24.50 $700.00 $48.25 $48.62 $48.62 $50.49 $35.49 $75.35 $77.20 $76.43 $700.00 $48.25 $47.77 $48.25 $700.00 $525.00 $48.25 $48.25 $48.25 $426.96 $426.96 $554.40 $48.25 $560.00 $455.00 $700.00 $48.25 $406.00 $700.00 $51.21 $48.25 $700.00 $48.25 N/A N/A 30000615 EAP CPT® 82507 ASSAY OF CITRATE BOTH IP/OP $192.00 $142.50 $13.90 $192.00 $192.00 $192.00 $192.00 $192.00 $27.80 $27.80 $13.90 $192.00 $27.80 $42.22 $42.22 $43.85 $30.82 $41.08 $44.48 $44.48 $192.00 $27.80 $27.80 $27.80 $192.00 $144.00 $27.80 $27.80 $27.80 $155.40 $155.40 $152.06 $27.80 $153.60 $124.80 $192.00 $27.80 $111.36 $192.00 $40.31 $27.80 $192.00 $27.80 N/A N/A 30000616 EAP CPT® 82131 AMINO ACIDS SINGLE QUANT BOTH IP/OP $68.00 $50.50 $10.34 $68.00 $33.11 $33.11 $33.11 $33.11 $22.98 $22.98 $11.49 $10.34 $22.98 $25.62 $25.62 $26.60 $18.70 $24.92 $36.77 $36.77 $40.22 $22.98 $22.98 $22.98 $68.00 $51.00 $22.98 $22.98 $22.98 $68.00 $68.00 $53.86 $22.98 $54.40 $44.20 $23.73 $22.98 $39.44 $68.00 $33.32 $22.98 $18.64 $22.98 N/A N/A 30000617 EAP CPT® 86480 TB TEST CELL IMMUN MEASURE BOTH IP/OP $500.00 $370.00 $30.99 $500.00 $121.63 $121.63 $121.63 $121.63 $61.98 $61.98 $30.99 $30.99 $61.98 $94.11 $94.11 $97.73 $68.70 $91.55 $99.17 $99.17 $295.75 $61.98 $61.98 $61.98 $500.00 $375.00 $61.98 $61.98 $61.98 $346.36 $346.36 $396.00 $61.98 $400.00 $325.00 $87.19 $61.98 $290.00 $500.00 $89.87 $61.98 $68.49 $61.98 N/A N/A 30000618 EAP CPT® 83516 IMMUNOASSAY NONANTIBODY BOTH IP/OP "$2,073.00" "$1,534.50" $5.76 "$2,073.00" $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 "$1,226.18" $11.53 $11.53 $11.53 "$2,073.00" "$1,554.75" $11.53 $11.53 $11.53 $59.76 $59.76 "$1,641.82" $11.53 "$1,658.40" "$1,347.45" $15.05 $11.53 "$1,202.34" "$2,073.00" $16.72 $11.53 $11.82 $11.53 N/A N/A 30000621 EAP CPT® 82943 ASSAY OF GLUCAGON BOTH IP/OP $82.00 $61.00 $7.15 $82.00 $82.00 $82.00 $82.00 $82.00 $14.29 $14.29 $7.15 $82.00 $14.29 $21.69 $21.69 $22.53 $15.84 $21.11 $22.86 $22.86 $82.00 $14.29 $14.29 $14.29 $82.00 $61.50 $14.29 $14.29 $14.29 $79.88 $79.88 $64.94 $14.29 $65.60 $53.30 $82.00 $14.29 $47.56 $82.00 $20.72 $14.29 $82.00 $14.29 N/A N/A 30000622 EAP CPT® 82040 ASSAY OF SERUM ALBUMIN BOTH IP/OP $10.00 $7.50 $2.48 $10.00 $5.65 $5.65 $5.65 $5.65 $4.95 $4.95 $2.48 $2.48 $4.95 $4.37 $4.37 $4.54 $3.19 $4.25 $7.92 $7.92 $5.92 $4.95 $4.95 $4.95 $10.00 $7.50 $4.95 $4.95 $4.95 $10.00 $10.00 $7.92 $4.95 $8.00 $6.50 $4.05 $4.95 $5.80 $10.00 $7.18 $4.95 $3.18 $4.95 N/A N/A 30000623 EAP CPT® 84270 ASSAY OF SEX HORMONE GLOBUL BOTH IP/OP $35.00 $26.00 $10.87 $35.00 $35.00 $35.00 $35.00 $35.00 $21.73 $21.73 $10.87 $35.00 $21.73 $33.00 $33.00 $34.27 $24.09 $32.10 $34.77 $34.77 $35.00 $21.73 $21.73 $21.73 $35.00 $26.25 $21.73 $21.73 $21.73 $35.00 $35.00 $27.72 $21.73 $28.00 $22.75 $35.00 $21.73 $20.30 $35.00 $31.51 $21.73 $35.00 $21.73 N/A N/A 30000624 EAP CPT® 84403 ASSAY OF TOTAL TESTOSTERONE BOTH IP/OP $50.00 $37.00 $12.91 $50.00 $50.00 $50.00 $50.00 $50.00 $25.81 $25.81 $12.91 $12.91 $25.81 $39.21 $39.21 $40.72 $28.62 $38.15 $41.30 $41.30 $29.58 $25.81 $25.81 $25.81 $50.00 $37.50 $25.81 $25.81 $25.81 $50.00 $50.00 $39.60 $25.81 $40.00 $32.50 $36.33 $25.81 $29.00 $50.00 $37.42 $25.81 $28.54 $25.81 N/A N/A 30000625 EAP CPT® 83520 IMMUNOASSAY QUANT NOS NONAB BOTH IP/OP $996.00 $737.50 $7.77 $996.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $589.13 $17.27 $17.27 $17.27 $996.00 $747.00 $17.27 $17.27 $17.27 $72.36 $72.36 $788.83 $17.27 $796.80 $647.40 $18.21 $17.27 $577.68 $996.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30000626 EAP CPT® 87906 GENOTYPE DNA HIV REVERSE T BOTH IP/OP $159.00 $118.00 $43.14 $205.97 $85.59 $85.59 $85.59 $85.59 $128.73 $128.73 $64.37 $64.36 $128.73 $63.81 $63.81 $66.27 $46.58 $57.67 $205.97 $205.97 $94.05 $128.73 $128.73 $128.73 $159.00 $119.25 $128.73 $128.73 $128.73 $79.50 $79.50 $125.93 $128.73 $127.20 $103.35 $54.92 $128.73 $92.22 $159.00 $159.00 $128.73 $43.14 $128.73 N/A N/A 30000627 EAP CPT® 87903 PHENOTYPE DNA HIV W/CULTURE BOTH IP/OP $855.00 $633.00 $244.33 $855.00 $855.00 $855.00 $855.00 $855.00 $488.66 $488.66 $244.33 $855.00 $488.66 $513.58 $513.58 $533.34 $374.91 $499.62 $781.86 $781.86 $855.00 $488.66 $488.66 $488.66 $855.00 $641.25 $488.66 $488.66 $488.66 $855.00 $855.00 $677.16 $488.66 $684.00 $555.75 $855.00 $488.66 $495.90 $855.00 $708.56 $488.66 $855.00 $488.66 N/A N/A 30000628 EAP CPT® 87904 PHENOTYPE DNA HIV W/CLT ADD BOTH IP/OP $172.00 $127.50 $13.04 $172.00 $172.00 $172.00 $172.00 $172.00 $26.07 $26.07 $13.04 $172.00 $26.07 $33.57 $33.57 $34.86 $24.51 $32.66 $41.71 $41.71 $172.00 $26.07 $26.07 $26.07 $172.00 $129.00 $26.07 $26.07 $26.07 $123.56 $123.56 $136.22 $26.07 $137.60 $111.80 $172.00 $26.07 $99.76 $172.00 $37.80 $26.07 $172.00 $26.07 N/A N/A 30000629 EAP CPT® 83785 ASSAY OF MANGANESE BOTH IP/OP $69.00 $51.50 $12.30 $69.00 $48.27 $48.27 $48.27 $48.27 $26.65 $26.65 $13.33 $12.30 $26.65 $37.34 $37.34 $38.77 $27.25 $36.32 $42.64 $42.64 $40.81 $26.65 $26.65 $26.65 $69.00 $51.75 $26.65 $26.65 $26.65 $69.00 $69.00 $54.65 $26.65 $55.20 $44.85 $34.59 $26.65 $40.02 $69.00 $38.64 $26.65 $27.17 $26.65 N/A N/A 30000630 EAP CPT® 82300 ASSAY OF CADMIUM BOTH IP/OP $67.00 $50.00 $11.57 $67.00 $45.43 $45.43 $45.43 $45.43 $23.64 $23.64 $11.82 $11.57 $23.64 $35.14 $35.14 $36.49 $25.65 $34.19 $37.82 $37.82 $39.63 $23.64 $23.64 $23.64 $67.00 $50.25 $23.64 $23.64 $23.64 $67.00 $67.00 $53.06 $23.64 $53.60 $43.55 $32.56 $23.64 $38.86 $67.00 $34.28 $23.64 $25.58 $23.64 N/A N/A 30000631 EAP CPT® 82570 ASSAY OF URINE CREATININE BOTH IP/OP $77.00 $57.00 $2.59 $77.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $45.55 $5.18 $5.18 $5.18 $77.00 $57.75 $5.18 $5.18 $5.18 $28.92 $28.92 $60.98 $5.18 $61.60 $50.05 $7.28 $5.18 $44.66 $77.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30000632 EAP CPT® 83885 ASSAY OF NICKEL BOTH IP/OP $69.00 $51.50 $12.26 $69.00 $69.00 $69.00 $69.00 $69.00 $24.51 $24.51 $12.26 $69.00 $24.51 $37.20 $37.20 $38.63 $27.16 $36.19 $39.22 $39.22 $69.00 $24.51 $24.51 $24.51 $69.00 $51.75 $24.51 $24.51 $24.51 $69.00 $69.00 $54.65 $24.51 $55.20 $44.85 $69.00 $24.51 $40.02 $69.00 $35.54 $24.51 $69.00 $24.51 N/A N/A 30000633 EAP CPT® 83018 QUANTITATIVE SCREEN METALS BOTH IP/OP $114.00 $84.50 $10.98 $114.00 $43.10 $43.10 $43.10 $43.10 $21.96 $21.96 $10.98 $10.98 $21.96 $33.34 $33.34 $34.62 $24.34 $32.43 $35.14 $35.14 $67.43 $21.96 $21.96 $21.96 $114.00 $85.50 $21.96 $21.96 $21.96 $114.00 $114.00 $90.29 $21.96 $91.20 $74.10 $30.89 $21.96 $66.12 $114.00 $31.84 $21.96 $24.26 $21.96 N/A N/A 30000634 EAP CPT® 83785 ASSAY OF MANGANESE BOTH IP/OP $79.00 $58.50 $12.30 $79.00 $48.27 $48.27 $48.27 $48.27 $26.65 $26.65 $13.33 $12.30 $26.65 $37.34 $37.34 $38.77 $27.25 $36.32 $42.64 $42.64 $46.73 $26.65 $26.65 $26.65 $79.00 $59.25 $26.65 $26.65 $26.65 $79.00 $79.00 $62.57 $26.65 $63.20 $51.35 $34.59 $26.65 $45.82 $79.00 $38.64 $26.65 $27.17 $26.65 N/A N/A 30000635 EAP CPT® 82525 ASSAY OF COPPER BOTH IP/OP $61.00 $45.50 $6.21 $61.00 $24.35 $24.35 $24.35 $24.35 $12.41 $12.41 $6.21 $6.21 $12.41 $18.84 $18.84 $19.57 $13.76 $18.33 $19.86 $19.86 $36.08 $12.41 $12.41 $12.41 $61.00 $45.75 $12.41 $12.41 $12.41 $61.00 $61.00 $48.31 $12.41 $48.80 $39.65 $17.46 $12.41 $35.38 $61.00 $17.99 $12.41 $13.71 $12.41 N/A N/A 30000636 EAP CPT® 83520 IMMUNOASSAY QUANT NOS NONAB BOTH IP/OP $974.00 $721.00 $7.77 $974.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $576.12 $17.27 $17.27 $17.27 $974.00 $730.50 $17.27 $17.27 $17.27 $72.36 $72.36 $771.41 $17.27 $779.20 $633.10 $18.21 $17.27 $564.92 $974.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30000637 EAP CPT® 80361 ASSAY OF DIHYDROCODEINONE BOTH IP/OP $257.00 $190.50 $0.03 $257.00 $0.03 $0.03 $0.03 $0.03 $257.00 $257.00 $12.01 $11.94 $257.00 $190.75 $190.75 $198.10 $133.90 $30.51 $257.00 $102.80 $152.02 $257.00 $257.00 $257.00 $257.00 $192.75 $257.00 $257.00 $257.00 $128.50 $128.50 $203.54 $257.00 $205.60 $167.05 $29.06 $257.00 $149.06 $257.00 $154.20 $257.00 $22.83 $257.00 N/A N/A 30000706 EAP CPT® 81479 RHD VARIANT BY SNP (ARC) BOTH IP/OP "$1,150.00" $851.00 $239.69 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.69 "$1,150.00" $853.53 $853.53 $886.42 $599.15 "$1,045.61" "$1,150.00" $460.00 $680.23 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $747.50 $995.82 "$1,150.00" $667.00 "$1,150.00" $690.00 "$1,150.00" $782.22 "$1,150.00" N/A N/A 30000710 EAP CPT® 81479 RHCE VARIANT BY SNP (ARC) BOTH IP/OP $994.00 $736.00 $207.17 $994.00 $994.00 $994.00 $994.00 $994.00 $994.00 $994.00 $994.00 $207.17 $994.00 $737.75 $737.75 $766.18 $517.87 $994.00 $994.00 $397.60 $587.95 $994.00 $994.00 $994.00 $994.00 $745.50 $994.00 $994.00 $994.00 $497.00 $497.00 $787.25 $994.00 $795.20 $646.10 $994.00 $994.00 $576.52 $994.00 $596.40 $994.00 $782.22 $994.00 N/A N/A 30000715 EAP CPT® 86355 CD19 B-CELLS (FLOW CYTOMETRY) SO BOTH IP/OP $81.00 $60.00 $18.86 $81.00 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $47.91 $37.73 $37.73 $37.73 $81.00 $60.75 $37.73 $37.73 $37.73 $81.00 $81.00 $64.15 $37.73 $64.80 $52.65 $33.14 $37.73 $46.98 $81.00 $54.71 $37.73 $26.03 $37.73 N/A N/A 30000716 EAP CPT® 81403 XHEA LICENSED RBC PANEL (ARC) BOTH IP/OP $831.00 $615.00 $83.34 $831.00 $251.00 $251.00 $251.00 $251.00 $185.20 $185.20 $92.60 $83.34 $185.20 $616.77 $616.77 $640.53 $432.95 $220.85 $296.32 $296.32 $491.54 $185.20 $185.20 $185.20 $831.00 $623.25 $185.20 $185.20 $185.20 $415.50 $415.50 $658.15 $185.20 $664.80 $305.58 $210.33 $185.20 $481.98 $831.00 $268.54 $185.20 $165.21 $185.20 N/A N/A 30000750 EAP CPT® 85335 ADAMTS 13 INHIBITOR (SO) BOTH IP/OP $375.00 $277.50 $6.44 $375.00 $25.28 $25.28 $25.28 $25.28 $12.87 $12.87 $6.44 $6.44 $12.87 $19.55 $19.55 $20.30 $14.27 $19.02 $20.59 $20.59 $221.81 $12.87 $12.87 $12.87 $375.00 $281.25 $12.87 $12.87 $12.87 $71.96 $71.96 $297.00 $12.87 $300.00 $243.75 $18.11 $12.87 $217.50 $375.00 $18.66 $12.87 $14.23 $12.87 N/A N/A 30000751 EAP CPT® 87900 HIV GENOTYPING BOTH IP/OP "$1,201.00" $889.00 $65.18 "$1,201.00" "$1,201.00" "$1,201.00" "$1,201.00" "$1,201.00" $130.35 $130.35 $65.18 "$1,201.00" $130.35 $167.86 $167.86 $174.31 $122.53 $163.30 $208.56 $208.56 "$1,201.00" $130.35 $130.35 $130.35 "$1,201.00" $900.75 $130.35 $130.35 $130.35 $617.80 $617.80 $951.19 $130.35 $960.80 $780.65 "$1,201.00" $130.35 $696.58 "$1,201.00" $189.01 $130.35 "$1,201.00" $130.35 N/A N/A 30000753 EAP CPT® 86830 HLA AB ID (ARC) BOTH IP/OP $560.00 $414.50 $47.76 $560.00 $560.00 $560.00 $560.00 $560.00 $95.52 $95.52 $47.76 $560.00 $95.52 $117.08 $117.08 $121.59 $85.47 $116.71 $152.83 $152.83 $560.00 $95.52 $95.52 $95.52 $560.00 $420.00 $95.52 $95.52 $95.52 $280.00 $280.00 $443.52 $95.52 $448.00 $364.00 $560.00 $95.52 $324.80 $560.00 $138.50 $95.52 $560.00 $95.52 N/A N/A 30000755 EAP CPT® 81310 "NPM (EXON 12) MUTATION,GENE ANALY(SO)" BOTH IP/OP $612.00 $453.00 $46.99 $612.00 $612.00 $612.00 $612.00 $612.00 $246.52 $246.52 $123.26 $612.00 $246.52 $257.03 $257.03 $266.91 $187.63 $46.99 $394.43 $394.43 $612.00 $246.52 $246.52 $246.52 $612.00 $459.00 $246.52 $246.52 $246.52 $306.00 $306.00 $484.70 $246.52 $489.60 $612.00 $612.00 $246.52 $354.96 $612.00 $357.45 $246.52 $612.00 $246.52 N/A N/A 30000761 EAP CPT® 81245 "FLT3 ITD AND TKD MUTATION,VARIANTS(SO)" BOTH IP/OP $445.00 $329.50 $82.76 $445.00 $445.00 $445.00 $445.00 $445.00 $165.51 $165.51 $82.76 $445.00 $165.51 $172.56 $172.56 $179.19 $125.96 $115.59 $264.82 $264.82 $445.00 $165.51 $165.51 $165.51 $445.00 $333.75 $165.51 $165.51 $165.51 $222.50 $222.50 $352.44 $165.51 $356.00 $445.00 $445.00 $165.51 $258.10 $445.00 $239.99 $165.51 $445.00 $165.51 N/A N/A 30000762 EAP CPT® 81246 CEBPA MUTATION(SO) BOTH IP/OP $576.00 $426.50 $41.50 $576.00 $576.00 $576.00 $576.00 $576.00 $83.00 $83.00 $41.50 $576.00 $83.00 $427.51 $427.51 $443.98 $300.10 $120.04 $132.80 $132.80 $576.00 $83.00 $83.00 $83.00 $576.00 $432.00 $83.00 $83.00 $83.00 $288.00 $288.00 $456.19 $83.00 $460.80 $576.00 $576.00 $83.00 $334.08 $576.00 $120.35 $83.00 $576.00 $83.00 N/A N/A 30000764 EAP CPT® 81450 MYELOPROLIFERATIVE NEOPLASM MUT(SO) BOTH IP/OP "$1,655.00" "$1,225.00" $344.92 "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" $759.53 $759.53 $379.77 "$1,655.00" $759.53 "$1,228.34" "$1,228.34" "$1,275.67" $862.26 $344.92 "$1,215.25" "$1,215.25" "$1,655.00" $759.53 $759.53 $759.53 "$1,655.00" "$1,241.25" $759.53 $759.53 $759.53 $827.50 $827.50 "$1,310.76" $759.53 "$1,324.00" "$1,655.00" "$1,655.00" $759.53 $959.90 "$1,655.00" "$1,101.32" $759.53 "$1,655.00" $759.53 N/A N/A 30000766 EAP CPT® 81261 "LYMPHO CLONAL PANEL, IGK,PCR(SO)" BOTH IP/OP $878.00 $650.00 $99.00 $878.00 $878.00 $878.00 $878.00 $878.00 $197.99 $197.99 $99.00 $878.00 $197.99 $280.91 $280.91 $291.72 $205.07 $286.64 $316.78 $316.78 $878.00 $197.99 $197.99 $197.99 $878.00 $658.50 $197.99 $197.99 $197.99 $439.00 $439.00 $695.38 $197.99 $702.40 $878.00 $878.00 $197.99 $509.24 $878.00 $287.09 $197.99 $878.00 $197.99 N/A N/A 30000767 EAP CPT® 81264 "LYMPHO CLONAL PANEL,TRB PCR(SO)" BOTH IP/OP $913.00 $676.00 $86.37 $913.00 $913.00 $913.00 $913.00 $913.00 $172.73 $172.73 $86.37 $913.00 $172.73 $211.87 $211.87 $220.02 $154.66 $115.59 $276.37 $276.37 $913.00 $172.73 $172.73 $172.73 $913.00 $684.75 $172.73 $172.73 $172.73 $456.50 $456.50 $723.10 $172.73 $730.40 $913.00 $913.00 $172.73 $529.54 $913.00 $250.46 $172.73 $913.00 $172.73 N/A N/A 30000768 EAP CPT® 81340 "LYMPHO CLONAL PANEL,TRG PCR(SO)" BOTH IP/OP $526.00 $389.50 $46.99 $526.00 $526.00 $526.00 $526.00 $526.00 $208.92 $208.92 $104.46 $526.00 $208.92 $296.42 $296.42 $307.82 $216.38 $46.99 $334.27 $334.27 $526.00 $208.92 $208.92 $208.92 $526.00 $394.50 $208.92 $208.92 $208.92 $263.00 $263.00 $416.59 $208.92 $420.80 $526.00 $526.00 $208.92 $305.08 $526.00 $302.93 $208.92 $526.00 $208.92 N/A N/A 30000769 EAP CPT® 81342 "LYMPHO CLONAL PANEL, PCR,UNLISTED PROC(SO)" BOTH IP/OP $624.00 $462.00 $100.75 $624.00 $624.00 $624.00 $624.00 $624.00 $201.50 $201.50 $100.75 $624.00 $201.50 $285.90 $285.90 $296.89 $208.70 $192.65 $322.40 $322.40 $624.00 $201.50 $201.50 $201.50 $624.00 $468.00 $201.50 $201.50 $201.50 $312.00 $312.00 $494.21 $201.50 $499.20 $624.00 $624.00 $201.50 $361.92 $624.00 $292.18 $201.50 $624.00 $201.50 N/A N/A 30000770 EAP CPT® 84999 B-CELL CLONALITY PANEL (IGH)(SO) BOTH IP/OP $517.00 $383.00 $74.40 $517.00 $517.00 $517.00 $517.00 $517.00 $517.00 $517.00 $517.00 $107.76 $517.00 $383.72 $383.72 $398.50 $269.36 $107.75 $517.00 $74.40 $305.81 $517.00 $186.00 $517.00 $517.00 $387.75 $517.00 $517.00 $517.00 $517.00 $517.00 $409.46 $517.00 $413.60 $336.05 $102.61 $517.00 $299.86 $517.00 $310.20 $517.00 $107.74 $517.00 N/A N/A 30000771 EAP CPT® 81261 B-CELL CLONALITY PANEL (IGK)(SO) BOTH IP/OP $755.00 $559.00 $99.00 $755.00 $755.00 $755.00 $755.00 $755.00 $197.99 $197.99 $99.00 $755.00 $197.99 $280.91 $280.91 $291.72 $205.07 $286.64 $316.78 $316.78 $755.00 $197.99 $197.99 $197.99 $755.00 $566.25 $197.99 $197.99 $197.99 $377.50 $377.50 $597.96 $197.99 $604.00 $755.00 $755.00 $197.99 $437.90 $755.00 $287.09 $197.99 $755.00 $197.99 N/A N/A 30000772 EAP CPT® 81264 "B-CELL CLONALITY PANEL,UNLISTED PROC(SO)" BOTH IP/OP $636.00 $471.00 $86.37 $636.00 $636.00 $636.00 $636.00 $636.00 $172.73 $172.73 $86.37 $636.00 $172.73 $211.87 $211.87 $220.02 $154.66 $115.59 $276.37 $276.37 $636.00 $172.73 $172.73 $172.73 $636.00 $477.00 $172.73 $172.73 $172.73 $318.00 $318.00 $503.71 $172.73 $508.80 $636.00 $636.00 $172.73 $368.88 $636.00 $250.46 $172.73 $636.00 $172.73 N/A N/A 30000773 EAP CPT® 84999 "MYD88, MUTATION ANALYSIS(SO)" BOTH IP/OP $970.00 $718.00 $74.40 $970.00 $970.00 $970.00 $970.00 $970.00 $970.00 $970.00 $970.00 $202.17 $970.00 $719.93 $719.93 $747.68 $505.37 $202.16 $970.00 $74.40 $573.76 $970.00 $186.00 $970.00 $970.00 $727.50 $970.00 $970.00 $970.00 $970.00 $970.00 $768.24 $970.00 $776.00 $630.50 $192.52 $970.00 $562.60 $970.00 $582.00 $970.00 $202.15 $970.00 N/A N/A 30000774 EAP CPT® 81479 "KIT D816, MUTATION ANALYSIS (SO)" BOTH IP/OP "$1,437.00" "$1,063.50" $299.51 "$1,437.00" "$1,437.00" "$1,437.00" "$1,437.00" "$1,437.00" "$1,437.00" "$1,437.00" "$1,437.00" $299.51 "$1,437.00" "$1,066.54" "$1,066.54" "$1,107.64" $748.68 "$1,045.61" "$1,437.00" $574.80 $849.99 "$1,437.00" "$1,437.00" "$1,437.00" "$1,437.00" "$1,077.75" "$1,437.00" "$1,437.00" "$1,437.00" $718.50 $718.50 "$1,138.10" "$1,437.00" "$1,149.60" $934.05 $995.82 "$1,437.00" $833.46 "$1,437.00" $862.20 "$1,437.00" $782.22 "$1,437.00" N/A N/A 30000777 EAP CPT® 88271 "FISH, ALL, TEL/ AML1 TRANSL,100-300 CELLS(SO)" BOTH IP/OP $357.00 $264.50 $10.71 $357.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $211.17 $21.42 $21.42 $21.42 $357.00 $267.75 $21.42 $21.42 $21.42 $119.72 $119.72 $282.74 $21.42 $285.60 $232.05 $30.14 $21.42 $207.06 $357.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000778 EAP CPT® 88275 "CHROMOSOME ANALYSIS, LYMPH NODE,BM(SO)" BOTH IP/OP "$1,347.00" $997.00 $23.04 "$1,347.00" $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $796.75 $51.19 $51.19 $51.19 "$1,347.00" "$1,010.25" $51.19 $51.19 $51.19 $224.44 $224.44 "$1,066.82" $51.19 "$1,077.60" $875.55 $56.50 $51.19 $781.26 "$1,347.00" $74.23 $51.19 $44.38 $51.19 N/A N/A 30000779 EAP CPT® 88237 "CHROMANALY, LYMPH NODE,20-25 CELLS(SO)" BOTH IP/OP "$1,567.00" "$1,160.00" $64.69 "$1,567.00" $173.27 $173.27 $173.27 $173.27 $143.75 $143.75 $71.88 $64.69 $143.75 $134.06 $134.06 $139.21 $97.86 $130.42 $230.00 $230.00 $926.88 $143.75 $143.75 $143.75 "$1,567.00" "$1,175.25" $143.75 $143.75 $143.75 $493.40 $493.40 "$1,241.06" $143.75 "$1,253.60" "$1,018.55" $124.21 $143.75 $908.86 "$1,567.00" $208.44 $143.75 $97.57 $143.75 N/A N/A 30000780 EAP CPT® 88264 "FISH, B-CELL MALIGNANCY, IGH, 14Q32(SO)" BOTH IP/OP $460.00 $340.50 $65.07 $460.00 $244.62 $244.62 $244.62 $244.62 $144.61 $144.61 $72.31 $65.07 $144.61 $189.26 $189.26 $196.54 $138.16 $184.12 $231.38 $231.38 $272.09 $144.61 $144.61 $144.61 $460.00 $345.00 $144.61 $144.61 $144.61 $460.00 $460.00 $364.32 $144.61 $368.00 $299.00 $175.35 $144.61 $266.80 $460.00 $209.68 $144.61 $137.74 $144.61 N/A N/A 30000781 EAP CPT® 88271 "FISH, B-CELL MALIG, IGH, 14Q32,100-300 CELLS(SO)" BOTH IP/OP $398.00 $295.00 $10.71 $398.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $235.42 $21.42 $21.42 $21.42 $398.00 $298.50 $21.42 $21.42 $21.42 $119.72 $119.72 $315.22 $21.42 $318.40 $258.70 $30.14 $21.42 $230.84 $398.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000782 EAP CPT® 88275 ZAP -70(SO) BOTH IP/OP $233.00 $172.50 $23.04 $233.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $137.82 $51.19 $51.19 $51.19 $233.00 $174.75 $51.19 $51.19 $51.19 $224.44 $224.44 $184.54 $51.19 $186.40 $151.45 $56.50 $51.19 $135.14 $233.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000783 EAP CPT® 88184 "ZAP -70,ADD MARKER(SO)" BOTH IP/OP $303.00 $224.50 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $179.22 $286.49 $75.09 $286.49 $300.82 $227.25 $286.49 $286.49 $286.49 $267.48 $267.48 $239.98 $286.49 $242.40 $196.95 $51.58 $286.49 $175.74 $300.82 $303.00 $286.49 $40.52 $286.49 N/A N/A 30000784 EAP CPT® 88185 "CLL PROGNOSTIC PANEL,FIRST MARKER(SO)" BOTH IP/OP $130.00 $96.50 $11.19 $130.00 $53.97 $53.97 $53.97 $53.97 $130.00 $130.00 $130.00 $11.19 $130.00 $48.93 $48.93 $50.81 $35.72 $26.63 $130.00 $130.00 $76.90 $130.00 $24.01 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $130.00 $130.00 $102.96 $130.00 $104.00 $84.50 $25.36 $130.00 $75.40 $130.00 $130.00 $130.00 $19.92 $130.00 N/A N/A 30000785 EAP CPT® 88184 "CLL PROGNOSTIC PANEL,ADD MARKER(SO)-1" BOTH IP/OP $303.00 $224.50 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $179.22 $286.49 $75.09 $286.49 $300.82 $227.25 $286.49 $286.49 $286.49 $267.48 $267.48 $239.98 $286.49 $242.40 $196.95 $51.58 $286.49 $175.74 $300.82 $303.00 $286.49 $40.52 $286.49 N/A N/A 30000786 EAP CPT® 88185 "CLL PROGNOSTIC PANEL,ADD MARKER(SO)-2" BOTH IP/OP $130.00 $96.50 $11.19 $130.00 $53.97 $53.97 $53.97 $53.97 $130.00 $130.00 $130.00 $11.19 $130.00 $48.93 $48.93 $50.81 $35.72 $26.63 $130.00 $130.00 $76.90 $130.00 $24.01 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $130.00 $130.00 $102.96 $130.00 $104.00 $84.50 $25.36 $130.00 $75.40 $130.00 $130.00 $130.00 $19.92 $130.00 N/A N/A 30000787 EAP CPT® 88185 "CLL PROGNOSTIC PANEL,IGH(SO)" BOTH IP/OP $463.00 $343.00 $11.19 $463.00 $53.97 $53.97 $53.97 $53.97 $463.00 $463.00 $463.00 $11.19 $463.00 $48.93 $48.93 $50.81 $35.72 $26.63 $463.00 $203.00 $273.86 $463.00 $24.01 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $143.44 $143.44 $366.70 $463.00 $370.40 $300.95 $25.36 $463.00 $268.54 $463.00 $463.00 $463.00 $19.92 $463.00 N/A N/A 30000788 EAP CPT® 81263 "CLL PROGNOSTIC PANEL,BETA-2(SO)" BOTH IP/OP $559.00 $414.00 $86.48 $559.00 $559.00 $559.00 $559.00 $559.00 $294.52 $294.52 $147.26 $147.26 $294.52 $417.86 $417.86 $433.93 $305.04 $115.59 $471.23 $471.23 $330.65 $294.52 $294.52 $294.52 $559.00 $419.25 $294.52 $294.52 $294.52 $279.50 $279.50 $442.73 $294.52 $447.20 $485.96 $110.09 $294.52 $324.22 $559.00 $427.05 $294.52 $86.48 $294.52 N/A N/A 30000789 EAP CPT® 82232 "CLL PROGNOSTIC PANEL,DNA PROBE(SO)-1" BOTH IP/OP $327.00 $242.00 $8.09 $327.00 $31.75 $31.75 $31.75 $31.75 $16.18 $16.18 $8.09 $8.09 $16.18 $24.56 $24.56 $25.51 $17.93 $23.91 $25.89 $25.89 $193.42 $16.18 $16.18 $16.18 $327.00 $245.25 $16.18 $16.18 $16.18 $90.44 $90.44 $258.98 $16.18 $261.60 $26.70 $22.77 $16.18 $189.66 $327.00 $23.46 $16.18 $17.89 $16.18 N/A N/A 30000790 EAP CPT® 88271 "CLL PROGNOSTIC PANEL,DNA PROBE(SO)-2" BOTH IP/OP $218.00 $161.50 $10.71 $218.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $128.95 $21.42 $21.42 $21.42 $218.00 $163.50 $21.42 $21.42 $21.42 $119.72 $119.72 $172.66 $21.42 $174.40 $35.34 $30.14 $21.42 $126.44 $218.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000791 EAP CPT® 88271 "CLL PROGNOSTIC PANEL,DNA PROBE(SO)-3" BOTH IP/OP $218.00 $161.50 $10.71 $218.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $128.95 $21.42 $21.42 $21.42 $218.00 $163.50 $21.42 $21.42 $21.42 $119.72 $119.72 $172.66 $21.42 $174.40 $35.34 $30.14 $21.42 $126.44 $218.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000792 EAP CPT® 88271 "CLL PROGNOSTIC PANEL,DNA PROBE(SO)-4" BOTH IP/OP $218.00 $161.50 $10.71 $218.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $128.95 $21.42 $21.42 $21.42 $218.00 $163.50 $21.42 $21.42 $21.42 $119.72 $119.72 $172.66 $21.42 $174.40 $35.34 $30.14 $21.42 $126.44 $218.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000793 EAP CPT® 88271 "CLL PROGNOSTIC PANEL,DNA PROBE(SO)-5" BOTH IP/OP $218.00 $161.50 $10.71 $218.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $128.95 $21.42 $21.42 $21.42 $218.00 $163.50 $21.42 $21.42 $21.42 $119.72 $119.72 $172.66 $21.42 $174.40 $35.34 $30.14 $21.42 $126.44 $218.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000794 EAP CPT® 88271 "CLL PROGNOSTIC PANEL,100-300 CELLS(SO)-1" BOTH IP/OP $218.00 $161.50 $10.71 $218.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $128.95 $21.42 $21.42 $21.42 $218.00 $163.50 $21.42 $21.42 $21.42 $119.72 $119.72 $172.66 $21.42 $174.40 $35.34 $30.14 $21.42 $126.44 $218.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000795 EAP CPT® 88275 "CLL PROGNOSTIC PANEL,100-300 CELLS(SO)-2" BOTH IP/OP $218.00 $161.50 $23.04 $218.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $128.95 $51.19 $51.19 $51.19 $218.00 $163.50 $51.19 $51.19 $51.19 $218.00 $218.00 $172.66 $51.19 $174.40 $84.46 $56.50 $51.19 $126.44 $218.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000796 EAP CPT® 88275 "CLL PROGNOSTIC PANEL,100-300 CELLS(SO)-3" BOTH IP/OP $218.00 $161.50 $23.04 $218.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $128.95 $51.19 $51.19 $51.19 $218.00 $163.50 $51.19 $51.19 $51.19 $218.00 $218.00 $172.66 $51.19 $174.40 $84.46 $56.50 $51.19 $126.44 $218.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000797 EAP CPT® 88275 "CLL PROGNOSTIC PANEL,100-300 CELLS(SO)-4" BOTH IP/OP $218.00 $161.50 $23.04 $218.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $128.95 $51.19 $51.19 $51.19 $218.00 $163.50 $51.19 $51.19 $51.19 $218.00 $218.00 $172.66 $51.19 $174.40 $84.46 $56.50 $51.19 $126.44 $218.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000798 EAP CPT® 88275 "CLL PROGNOSTIC PANEL,100-300 CELLS(SO)-5" BOTH IP/OP $218.00 $161.50 $23.04 $218.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $128.95 $51.19 $51.19 $51.19 $218.00 $163.50 $51.19 $51.19 $51.19 $218.00 $218.00 $172.66 $51.19 $174.40 $84.46 $56.50 $51.19 $126.44 $218.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000799 EAP CPT® 88275 "CLL PROGNOSTIC PANEL,BM(SO)" BOTH IP/OP $233.00 $172.50 $23.04 $233.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $137.82 $51.19 $51.19 $51.19 $233.00 $174.75 $51.19 $51.19 $51.19 $224.44 $224.44 $184.54 $51.19 $186.40 $84.46 $56.50 $51.19 $135.14 $233.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000800 EAP CPT® 88237 "CLL PROGNOSTIC PANEL,20-25 CELLS(SO)" BOTH IP/OP $382.00 $283.00 $64.69 $382.00 $173.27 $173.27 $173.27 $173.27 $143.75 $143.75 $71.88 $64.69 $143.75 $134.06 $134.06 $139.21 $97.86 $130.42 $230.00 $230.00 $225.95 $143.75 $143.75 $143.75 $382.00 $286.50 $143.75 $143.75 $143.75 $382.00 $382.00 $302.54 $143.75 $305.60 $237.19 $124.21 $143.75 $221.56 $382.00 $208.44 $143.75 $97.57 $143.75 N/A N/A 30000801 EAP CPT® 88264 "CHROM, CLL/LPD,BM(SO)" BOTH IP/OP $592.00 $438.50 $65.07 $592.00 $244.62 $244.62 $244.62 $244.62 $144.61 $144.61 $72.31 $65.07 $144.61 $189.26 $189.26 $196.54 $138.16 $184.12 $231.38 $231.38 $350.17 $144.61 $144.61 $144.61 $592.00 $444.00 $144.61 $144.61 $144.61 $592.00 $592.00 $468.86 $144.61 $473.60 $238.61 $175.35 $144.61 $343.36 $592.00 $209.68 $144.61 $137.74 $144.61 N/A N/A 30000802 EAP CPT® 88237 "CHROM, CLL/LPD, 20-25 CELLS(SO)" BOTH IP/OP $592.00 $438.50 $64.69 $592.00 $173.27 $173.27 $173.27 $173.27 $143.75 $143.75 $71.88 $64.69 $143.75 $134.06 $134.06 $139.21 $97.86 $130.42 $230.00 $230.00 $350.17 $143.75 $143.75 $143.75 $592.00 $444.00 $143.75 $143.75 $143.75 $493.40 $493.40 $468.86 $143.75 $473.60 $384.80 $124.21 $143.75 $343.36 $592.00 $208.44 $143.75 $97.57 $143.75 N/A N/A 30000803 EAP CPT® 88264 "CHROM, CLL/LPD,INTERP(SO)" BOTH IP/OP $592.00 $438.50 $65.07 $592.00 $244.62 $244.62 $244.62 $244.62 $144.61 $144.61 $72.31 $65.07 $144.61 $189.26 $189.26 $196.54 $138.16 $184.12 $231.38 $231.38 $350.17 $144.61 $144.61 $144.61 $592.00 $444.00 $144.61 $144.61 $144.61 $592.00 $592.00 $468.86 $144.61 $473.60 $384.80 $175.35 $144.61 $343.36 $592.00 $209.68 $144.61 $137.74 $144.61 N/A N/A 30000805 EAP CPT® 88271 "FISH, ALL, PRE-B,100-300 CELLS(SO)" BOTH IP/OP "$1,002.00" $741.50 $10.71 "$1,002.00" $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $592.68 $21.42 $21.42 $21.42 "$1,002.00" $751.50 $21.42 $21.42 $21.42 $119.72 $119.72 $793.58 $21.42 $801.60 $651.30 $30.14 $21.42 $581.16 "$1,002.00" $31.06 $21.42 $23.67 $21.42 N/A N/A 30000806 EAP CPT® 88275 "FISH, MALT LYMPH, REA18Q21,DNA PROBE(SO)-1" BOTH IP/OP $303.00 $224.50 $23.04 $303.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $179.22 $51.19 $51.19 $51.19 $303.00 $227.25 $51.19 $51.19 $51.19 $224.44 $224.44 $239.98 $51.19 $242.40 $196.95 $56.50 $51.19 $175.74 $303.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000807 EAP CPT® 88271 "FISH, MALT LYMPH, REA18Q21,DNA PROBE(SO)-2" BOTH IP/OP $303.00 $224.50 $10.71 $303.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $179.22 $21.42 $21.42 $21.42 $303.00 $227.25 $21.42 $21.42 $21.42 $119.72 $119.72 $239.98 $21.42 $242.40 $196.95 $30.14 $21.42 $175.74 $303.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000808 EAP CPT® 88271 "FISH, MALT LYMPH, REA18Q21100-300 CELLS(SO)" BOTH IP/OP $303.00 $224.50 $10.71 $303.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $179.22 $21.42 $21.42 $21.42 $303.00 $227.25 $21.42 $21.42 $21.42 $119.72 $119.72 $239.98 $21.42 $242.40 $196.95 $30.14 $21.42 $175.74 $303.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000809 EAP CPT® 88275 "FISH, TCL1, 14Q32.1,DNA PROBE(SO)-1" BOTH IP/OP $231.00 $171.00 $23.04 $231.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $136.64 $51.19 $51.19 $51.19 $231.00 $173.25 $51.19 $51.19 $51.19 $224.44 $224.44 $182.95 $51.19 $184.80 $150.15 $56.50 $51.19 $133.98 $231.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000810 EAP CPT® 88271 "FISH, TCL1, 14Q32.1,DNA PROBE(SO)-2" BOTH IP/OP $231.00 $171.00 $10.71 $231.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $136.64 $21.42 $21.42 $21.42 $231.00 $173.25 $21.42 $21.42 $21.42 $119.72 $119.72 $182.95 $21.42 $184.80 $150.15 $30.14 $21.42 $133.98 $231.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000811 EAP CPT® 88271 "FISH, TCL1, 14Q32.1,100-300 CELLS(SO)" BOTH IP/OP $231.00 $171.00 $10.71 $231.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $136.64 $21.42 $21.42 $21.42 $231.00 $173.25 $21.42 $21.42 $21.42 $119.72 $119.72 $182.95 $21.42 $184.80 $150.15 $30.14 $21.42 $133.98 $231.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000812 EAP CPT® 88275 "FISH, T-CELL RECEPTOR ALPHA/ DELTA,DNA PROBE(SO)-1" BOTH IP/OP $231.00 $171.00 $23.04 $231.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $136.64 $51.19 $51.19 $51.19 $231.00 $173.25 $51.19 $51.19 $51.19 $224.44 $224.44 $182.95 $51.19 $184.80 $150.15 $56.50 $51.19 $133.98 $231.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000813 EAP CPT® 88271 "FISH, T-CELL RECEPTOR ALPHA/ DELTA,DNA PROBE(SO)-2" BOTH IP/OP $231.00 $171.00 $10.71 $231.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $136.64 $21.42 $21.42 $21.42 $231.00 $173.25 $21.42 $21.42 $21.42 $119.72 $119.72 $182.95 $21.42 $184.80 $150.15 $30.14 $21.42 $133.98 $231.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000814 EAP CPT® 88271 "FISH, T-CELL RECEPTOR ALPHA/ DELTA,100-300 CELLS(SO)" BOTH IP/OP $231.00 $171.00 $10.71 $231.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $136.64 $21.42 $21.42 $21.42 $231.00 $173.25 $21.42 $21.42 $21.42 $119.72 $119.72 $182.95 $21.42 $184.80 $150.15 $30.14 $21.42 $133.98 $231.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000815 EAP CPT® 88275 "CHROM. MICROARRAY, HEMATOLOGIC MALIG.(SO)" BOTH IP/OP "$2,718.00" "$2,011.50" $23.04 "$2,718.00" $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 "$1,607.70" $51.19 $51.19 $51.19 "$2,718.00" "$2,038.50" $51.19 $51.19 $51.19 $224.44 $224.44 "$2,152.66" $51.19 "$2,174.40" "$1,766.70" $56.50 $51.19 "$1,576.44" "$2,718.00" $74.23 $51.19 $44.38 $51.19 N/A N/A 30000816 EAP CPT® 81406 "FISH, MULT MYEL, IGH/ MAFB,DNA PROBE(SO)-1" BOTH IP/OP $283.00 $209.50 $141.44 $452.61 $283.00 $283.00 $283.00 $283.00 $282.88 $282.88 $141.44 $283.00 $282.88 $210.04 $210.04 $218.14 $147.44 $283.00 $452.61 $452.61 $283.00 $282.88 $282.88 $282.88 $283.00 $212.25 $282.88 $282.88 $282.88 $141.50 $141.50 $224.14 $282.88 $226.40 $283.00 $283.00 $282.88 $164.14 $283.00 $283.00 $282.88 $283.00 $282.88 N/A N/A 30000817 EAP CPT® 88271 "FISH, MULT MYEL, IGH/ MAFB,DNA PROBE(SO)-2" BOTH IP/OP $231.00 $171.00 $10.71 $231.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $136.64 $21.42 $21.42 $21.42 $231.00 $173.25 $21.42 $21.42 $21.42 $119.72 $119.72 $182.95 $21.42 $184.80 $150.15 $30.14 $21.42 $133.98 $231.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000818 EAP CPT® 88271 "FISH, MULT MYEL, IGH/ MAFB,100-300 CELLS(SO)" BOTH IP/OP $231.00 $171.00 $10.71 $231.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $136.64 $21.42 $21.42 $21.42 $231.00 $173.25 $21.42 $21.42 $21.42 $119.72 $119.72 $182.95 $21.42 $184.80 $150.15 $30.14 $21.42 $133.98 $231.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000819 EAP CPT® 88275 "FISH, MULT MYEL, 1Q21,DNA PROBE(SO)-1" BOTH IP/OP $231.00 $171.00 $23.04 $231.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $136.64 $51.19 $51.19 $51.19 $231.00 $173.25 $51.19 $51.19 $51.19 $224.44 $224.44 $182.95 $51.19 $184.80 $150.15 $56.50 $51.19 $133.98 $231.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000820 EAP CPT® 88271 "FISH, MULT MYEL, 1Q21,DNA PROBE(SO)-2" BOTH IP/OP $231.00 $171.00 $10.71 $231.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $136.64 $21.42 $21.42 $21.42 $231.00 $173.25 $21.42 $21.42 $21.42 $119.72 $119.72 $182.95 $21.42 $184.80 $150.15 $30.14 $21.42 $133.98 $231.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000821 EAP CPT® 88271 "FISH, MULT MYEL, 1Q21,100-300 CELLS(SO)" BOTH IP/OP $231.00 $171.00 $10.71 $231.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $136.64 $21.42 $21.42 $21.42 $231.00 $173.25 $21.42 $21.42 $21.42 $119.72 $119.72 $182.95 $21.42 $184.80 $150.15 $30.14 $21.42 $133.98 $231.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000822 EAP CPT® 88275 "FISH, MYELOID NEOPL, MECOM,DNA PROBE(SO)-1" BOTH IP/OP $251.00 $186.00 $23.04 $251.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $148.47 $51.19 $51.19 $51.19 $251.00 $188.25 $51.19 $51.19 $51.19 $224.44 $224.44 $198.79 $51.19 $200.80 $163.15 $56.50 $51.19 $145.58 $251.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000823 EAP CPT® 88271 "FISH, MYELOID NEOPL, MECOM,DNA PROBE(SO)-2" BOTH IP/OP $251.00 $186.00 $10.71 $251.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $148.47 $21.42 $21.42 $21.42 $251.00 $188.25 $21.42 $21.42 $21.42 $119.72 $119.72 $198.79 $21.42 $200.80 $163.15 $30.14 $21.42 $145.58 $251.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000824 EAP CPT® 88271 "FISH, MYELOID NEOPL, MECOM,DNA PROBE(SO)-3" BOTH IP/OP $251.00 $186.00 $10.71 $251.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $148.47 $21.42 $21.42 $21.42 $251.00 $188.25 $21.42 $21.42 $21.42 $119.72 $119.72 $198.79 $21.42 $200.80 $163.15 $30.14 $21.42 $145.58 $251.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000825 EAP CPT® 88271 "FISH, MYELOID NEOPLASMS, MECOM,100-300 CELLS(SO)" BOTH IP/OP $251.00 $186.00 $10.71 $251.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $148.47 $21.42 $21.42 $21.42 $251.00 $188.25 $21.42 $21.42 $21.42 $119.72 $119.72 $198.79 $21.42 $200.80 $163.15 $30.14 $21.42 $145.58 $251.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000826 EAP CPT® 88275 "FISH, HIGH-GRADE LYMPHPANEL,DNA PROBE(SO)-1" BOTH IP/OP $312.00 $231.00 $23.04 $312.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $184.55 $51.19 $51.19 $51.19 $312.00 $234.00 $51.19 $51.19 $51.19 $224.44 $224.44 $247.10 $51.19 $249.60 $202.80 $56.50 $51.19 $180.96 $312.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000827 EAP CPT® 88271 "FISH, HIGH-GRADE LYMPHPANEL,DNA PROBE(SO)-2" BOTH IP/OP $314.00 $232.50 $10.71 $314.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $185.73 $21.42 $21.42 $21.42 $314.00 $235.50 $21.42 $21.42 $21.42 $119.72 $119.72 $248.69 $21.42 $251.20 $204.10 $30.14 $21.42 $182.12 $314.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000828 EAP CPT® 88271 "FISH, HIGH-GRADE LYMPHPANEL,DNA PROBE(SO)-3" BOTH IP/OP $314.00 $232.50 $10.71 $314.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $185.73 $21.42 $21.42 $21.42 $314.00 $235.50 $21.42 $21.42 $21.42 $119.72 $119.72 $248.69 $21.42 $251.20 $204.10 $30.14 $21.42 $182.12 $314.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000829 EAP CPT® 88271 "FISH, HIGH-GRADE LYMPHPANEL,DNA PROBE(SO)-4" BOTH IP/OP $314.00 $232.50 $10.71 $314.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $185.73 $21.42 $21.42 $21.42 $314.00 $235.50 $21.42 $21.42 $21.42 $119.72 $119.72 $248.69 $21.42 $251.20 $204.10 $30.14 $21.42 $182.12 $314.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000830 EAP CPT® 88271 "FISH, HIGH-GRADE LYMPHPANEL,DNA PROBE(SO)-5" BOTH IP/OP $314.00 $232.50 $10.71 $314.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $185.73 $21.42 $21.42 $21.42 $314.00 $235.50 $21.42 $21.42 $21.42 $119.72 $119.72 $248.69 $21.42 $251.20 $204.10 $30.14 $21.42 $182.12 $314.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000831 EAP CPT® 88271 "FISH, HIGH-GRADE LYMPHPANEL,DNA PROBE(SO)-6" BOTH IP/OP $314.00 $232.50 $10.71 $314.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $185.73 $21.42 $21.42 $21.42 $314.00 $235.50 $21.42 $21.42 $21.42 $119.72 $119.72 $248.69 $21.42 $251.20 $204.10 $30.14 $21.42 $182.12 $314.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000832 EAP CPT® 88271 "FISH, HIGH-GRADE LYMPHPANEL,100-300 CELLS(SO)-1" BOTH IP/OP $314.00 $232.50 $10.71 $314.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $185.73 $21.42 $21.42 $21.42 $314.00 $235.50 $21.42 $21.42 $21.42 $119.72 $119.72 $248.69 $21.42 $251.20 $204.10 $30.14 $21.42 $182.12 $314.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000833 EAP CPT® 88275 "FISH, HIGH-GRADE LYMPHPANEL,100-300 CELLS(SO)-2" BOTH IP/OP $314.00 $232.50 $23.04 $314.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $185.73 $51.19 $51.19 $51.19 $314.00 $235.50 $51.19 $51.19 $51.19 $224.44 $224.44 $248.69 $51.19 $251.20 $204.10 $56.50 $51.19 $182.12 $314.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000834 EAP CPT® 88275 "FISH, HIGH-GRADE LYMPHPANEL,100-300 CELLS(SO)-3" BOTH IP/OP $314.00 $232.50 $23.04 $314.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $185.73 $51.19 $51.19 $51.19 $314.00 $235.50 $51.19 $51.19 $51.19 $224.44 $224.44 $248.69 $51.19 $251.20 $204.10 $56.50 $51.19 $182.12 $314.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000835 EAP CPT® 88275 "CLL PROGNOSTIC PANEL, COMP,FIRST MARKER(SO)" BOTH IP/OP $130.00 $96.50 $23.04 $130.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $76.90 $51.19 $51.19 $51.19 $130.00 $97.50 $51.19 $51.19 $51.19 $130.00 $130.00 $102.96 $51.19 $104.00 $84.50 $56.50 $51.19 $75.40 $130.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000836 EAP CPT® 88184 "CLL PROGNOSTIC PANEL, COMP,ADD MARKER(SO)-1" BOTH IP/OP $500.00 $370.00 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $295.75 $286.49 $75.09 $286.49 $300.82 $375.00 $286.49 $286.49 $286.49 $267.48 $267.48 $396.00 $286.49 $400.00 $325.00 $51.58 $286.49 $290.00 $300.82 $414.48 $286.49 $40.52 $286.49 N/A N/A 30000837 EAP CPT® 88185 "CLL PROGNOSTIC PANEL, COMP,ADD MARKER(SO)-2" BOTH IP/OP $77.00 $57.00 $11.19 $77.00 $53.97 $53.97 $53.97 $53.97 $77.00 $77.00 $77.00 $11.19 $77.00 $48.93 $48.93 $50.81 $35.72 $26.63 $77.00 $77.00 $45.55 $77.00 $24.01 $77.00 $77.00 $57.75 $77.00 $77.00 $77.00 $77.00 $77.00 $60.98 $77.00 $61.60 $50.05 $25.36 $77.00 $44.66 $77.00 $77.00 $77.00 $19.92 $77.00 N/A N/A 30000838 EAP CPT® 88185 "CLL PROGNOSTIC PANEL,COMP,BETA-2(SO)" BOTH IP/OP $77.00 $57.00 $11.19 $77.00 $53.97 $53.97 $53.97 $53.97 $77.00 $77.00 $77.00 $11.19 $77.00 $48.93 $48.93 $50.81 $35.72 $26.63 $77.00 $77.00 $45.55 $77.00 $24.01 $77.00 $77.00 $57.75 $77.00 $77.00 $77.00 $77.00 $77.00 $60.98 $77.00 $61.60 $50.05 $25.36 $77.00 $44.66 $77.00 $77.00 $77.00 $19.92 $77.00 N/A N/A 30000839 EAP CPT® 82232 "CLL PROGNOSTIC PANEL, COMP,DNA PROBE(SO)-1" BOTH IP/OP $194.00 $144.00 $8.09 $194.00 $31.75 $31.75 $31.75 $31.75 $16.18 $16.18 $8.09 $8.09 $16.18 $24.56 $24.56 $25.51 $17.93 $23.91 $25.89 $25.89 $114.75 $16.18 $16.18 $16.18 $194.00 $145.50 $16.18 $16.18 $16.18 $90.44 $90.44 $153.65 $16.18 $155.20 $126.10 $22.77 $16.18 $112.52 $194.00 $23.46 $16.18 $17.89 $16.18 N/A N/A 30000840 EAP CPT® 88271 "CLL PROGNOSTIC PANEL, COMP,DNA PROBE(SO)-2" BOTH IP/OP $129.00 $95.50 $10.71 $129.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $76.30 $21.42 $21.42 $21.42 $129.00 $96.75 $21.42 $21.42 $21.42 $119.72 $119.72 $102.17 $21.42 $103.20 $83.85 $30.14 $21.42 $74.82 $129.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000841 EAP CPT® 88271 "CLL PROGNOSTIC PANEL, COMP,DNA PROBE(SO)-3" BOTH IP/OP $129.00 $95.50 $10.71 $129.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $76.30 $21.42 $21.42 $21.42 $129.00 $96.75 $21.42 $21.42 $21.42 $119.72 $119.72 $102.17 $21.42 $103.20 $83.85 $30.14 $21.42 $74.82 $129.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000842 EAP CPT® 88271 "CLL PROGNOSTIC PANEL, COMP,DNA PROBE(SO)-4" BOTH IP/OP $129.00 $95.50 $10.71 $129.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $76.30 $21.42 $21.42 $21.42 $129.00 $96.75 $21.42 $21.42 $21.42 $119.72 $119.72 $102.17 $21.42 $103.20 $83.85 $30.14 $21.42 $74.82 $129.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000843 EAP CPT® 88271 "CLL PROGNOSTIC PANEL, COMP,DNA PROBE(SO)-5" BOTH IP/OP $129.00 $95.50 $10.71 $129.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $76.30 $21.42 $21.42 $21.42 $129.00 $96.75 $21.42 $21.42 $21.42 $119.72 $119.72 $102.17 $21.42 $103.20 $83.85 $30.14 $21.42 $74.82 $129.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000844 EAP CPT® 88271 "CLL PROGNOSTIC PANEL, COMP,100-300 CELLS(SO)-1" BOTH IP/OP $129.00 $95.50 $10.71 $129.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $76.30 $21.42 $21.42 $21.42 $129.00 $96.75 $21.42 $21.42 $21.42 $119.72 $119.72 $102.17 $21.42 $103.20 $83.85 $30.14 $21.42 $74.82 $129.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30000845 EAP CPT® 88275 "CLL PROGNOSTIC PANEL, COMP,100-300 CELLS(SO)-2" BOTH IP/OP $129.00 $95.50 $23.04 $129.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $76.30 $51.19 $51.19 $51.19 $129.00 $96.75 $51.19 $51.19 $51.19 $129.00 $129.00 $102.17 $51.19 $103.20 $83.85 $56.50 $51.19 $74.82 $129.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000846 EAP CPT® 88275 "CLL PROGNOSTIC PANEL, COMP,100-300 CELLS(SO)-3" BOTH IP/OP $129.00 $95.50 $23.04 $129.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $76.30 $51.19 $51.19 $51.19 $129.00 $96.75 $51.19 $51.19 $51.19 $129.00 $129.00 $102.17 $51.19 $103.20 $83.85 $56.50 $51.19 $74.82 $129.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000847 EAP CPT® 88275 "CLL PROGNOSTIC PANEL, COMP,100-300 CELLS(SO)-4" BOTH IP/OP $129.00 $95.50 $23.04 $129.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $76.30 $51.19 $51.19 $51.19 $129.00 $96.75 $51.19 $51.19 $51.19 $129.00 $129.00 $102.17 $51.19 $103.20 $83.85 $56.50 $51.19 $74.82 $129.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000848 EAP CPT® 88275 "CLL PROGNOSTIC PANEL, COMP,100-300 CELLS(SO)-5" BOTH IP/OP $129.00 $95.50 $23.04 $129.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $76.30 $51.19 $51.19 $51.19 $129.00 $96.75 $51.19 $51.19 $51.19 $129.00 $129.00 $102.17 $51.19 $103.20 $83.85 $56.50 $51.19 $74.82 $129.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000849 EAP CPT® 88275 "CLL LYMPHOMA FOLLOW-UP PANEL,FIRST MARKER(SO)" BOTH IP/OP $119.00 $88.50 $23.04 $119.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $70.39 $51.19 $51.19 $51.19 $119.00 $89.25 $51.19 $51.19 $51.19 $119.00 $119.00 $94.25 $51.19 $95.20 $77.35 $56.50 $51.19 $69.02 $119.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30000850 EAP CPT® 88184 "CLL LYMPHOMA FOLLOW-UP PANEL,ADD MARKER(SO)-1" BOTH IP/OP $500.00 $370.00 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $295.75 $286.49 $75.09 $286.49 $300.82 $375.00 $286.49 $286.49 $286.49 $267.48 $267.48 $396.00 $286.49 $400.00 $325.00 $51.58 $286.49 $290.00 $300.82 $414.48 $286.49 $40.52 $286.49 N/A N/A 30000851 EAP CPT® 88185 "CLL LYMPHOMA FOLLOW-UP PANEL,ADD MARKER(SO)-2" BOTH IP/OP $71.00 $53.00 $11.19 $71.00 $53.97 $53.97 $53.97 $53.97 $71.00 $71.00 $71.00 $11.19 $71.00 $48.93 $48.93 $50.81 $35.72 $26.63 $71.00 $71.00 $42.00 $71.00 $24.01 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $25.36 $71.00 $41.18 $71.00 $71.00 $71.00 $19.92 $71.00 N/A N/A 30000852 EAP CPT® 88185 "CLL LYMPHOMA FOLLOW-UP PANEL,ADD MARKER(SO)-3" BOTH IP/OP $71.00 $53.00 $11.19 $71.00 $53.97 $53.97 $53.97 $53.97 $71.00 $71.00 $71.00 $11.19 $71.00 $48.93 $48.93 $50.81 $35.72 $26.63 $71.00 $71.00 $42.00 $71.00 $24.01 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $25.36 $71.00 $41.18 $71.00 $71.00 $71.00 $19.92 $71.00 N/A N/A 30000853 EAP CPT® 88185 "CLL LYMPHOMA FOLLOW-UP PANEL,ADD MARKER(SO)-4" BOTH IP/OP $71.00 $53.00 $11.19 $71.00 $53.97 $53.97 $53.97 $53.97 $71.00 $71.00 $71.00 $11.19 $71.00 $48.93 $48.93 $50.81 $35.72 $26.63 $71.00 $71.00 $42.00 $71.00 $24.01 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $25.36 $71.00 $41.18 $71.00 $71.00 $71.00 $19.92 $71.00 N/A N/A 30000854 EAP CPT® 88185 "CLL LYMPHOMA FOLLOW-UP PANEL,ADD MARKER(SO)-5" BOTH IP/OP $71.00 $53.00 $11.19 $71.00 $53.97 $53.97 $53.97 $53.97 $71.00 $71.00 $71.00 $11.19 $71.00 $48.93 $48.93 $50.81 $35.72 $26.63 $71.00 $71.00 $42.00 $71.00 $24.01 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $25.36 $71.00 $41.18 $71.00 $71.00 $71.00 $19.92 $71.00 N/A N/A 30000855 EAP CPT® 88185 "CLL LYMPHOMA FOLLOW-UP PANEL,ADD MARKER(SO)-6" BOTH IP/OP $71.00 $53.00 $11.19 $71.00 $53.97 $53.97 $53.97 $53.97 $71.00 $71.00 $71.00 $11.19 $71.00 $48.93 $48.93 $50.81 $35.72 $26.63 $71.00 $71.00 $42.00 $71.00 $24.01 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $25.36 $71.00 $41.18 $71.00 $71.00 $71.00 $19.92 $71.00 N/A N/A 30000856 EAP CPT® 88185 "CLL LYMPHOMA FOLLOW-UP PANEL,ADD MARKER(SO)-7" BOTH IP/OP $71.00 $53.00 $11.19 $71.00 $53.97 $53.97 $53.97 $53.97 $71.00 $71.00 $71.00 $11.19 $71.00 $48.93 $48.93 $50.81 $35.72 $26.63 $71.00 $71.00 $42.00 $71.00 $24.01 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $25.36 $71.00 $41.18 $71.00 $71.00 $71.00 $19.92 $71.00 N/A N/A 30000857 EAP CPT® 88185 "CLL LYMPHOMA FOLLOW-UP PANEL,ADD MARKER(SO)-8" BOTH IP/OP $71.00 $53.00 $11.19 $71.00 $53.97 $53.97 $53.97 $53.97 $71.00 $71.00 $71.00 $11.19 $71.00 $48.93 $48.93 $50.81 $35.72 $26.63 $71.00 $71.00 $42.00 $71.00 $24.01 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $25.36 $71.00 $41.18 $71.00 $71.00 $71.00 $19.92 $71.00 N/A N/A 30000858 EAP CPT® 88185 "CLL LYMPHOMA FOLLOW-UP PANEL,ADD MARKER(SO)-9" BOTH IP/OP $71.00 $53.00 $11.19 $71.00 $53.97 $53.97 $53.97 $53.97 $71.00 $71.00 $71.00 $11.19 $71.00 $48.93 $48.93 $50.81 $35.72 $26.63 $71.00 $71.00 $42.00 $71.00 $24.01 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $25.36 $71.00 $41.18 $71.00 $71.00 $71.00 $19.92 $71.00 N/A N/A 30000859 EAP CPT® 88185 "CLL LYMPHOMA FOLLOW-UP PANEL,ADD MARKER(SO)-10" BOTH IP/OP $71.00 $53.00 $11.19 $71.00 $53.97 $53.97 $53.97 $53.97 $71.00 $71.00 $71.00 $11.19 $71.00 $48.93 $48.93 $50.81 $35.72 $26.63 $71.00 $71.00 $42.00 $71.00 $24.01 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $25.36 $71.00 $41.18 $71.00 $71.00 $71.00 $19.92 $71.00 N/A N/A 30000860 EAP CPT® 88185 "CLL LYMPHOMA FOLLOW-UP PANEL,ADD MARKER(SO)-11" BOTH IP/OP $71.00 $53.00 $11.19 $71.00 $53.97 $53.97 $53.97 $53.97 $71.00 $71.00 $71.00 $11.19 $71.00 $48.93 $48.93 $50.81 $35.72 $26.63 $71.00 $71.00 $42.00 $71.00 $24.01 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $25.36 $71.00 $41.18 $71.00 $71.00 $71.00 $19.92 $71.00 N/A N/A 30000861 EAP CPT® 88185 "CLL LYMPHOMA FOLLOW-UP PANEL,ADD MARKER(SO)-12" BOTH IP/OP $71.00 $53.00 $11.19 $71.00 $53.97 $53.97 $53.97 $53.97 $71.00 $71.00 $71.00 $11.19 $71.00 $48.93 $48.93 $50.81 $35.72 $26.63 $71.00 $71.00 $42.00 $71.00 $24.01 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $25.36 $71.00 $41.18 $71.00 $71.00 $71.00 $19.92 $71.00 N/A N/A 30000862 EAP CPT® 88185 "CLL LYMPHOMA FOLLOW-UP PANEL,ADD MARKER(SO)-13" BOTH IP/OP $71.00 $53.00 $11.19 $71.00 $53.97 $53.97 $53.97 $53.97 $71.00 $71.00 $71.00 $11.19 $71.00 $48.93 $48.93 $50.81 $35.72 $26.63 $71.00 $71.00 $42.00 $71.00 $24.01 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $25.36 $71.00 $41.18 $71.00 $71.00 $71.00 $19.92 $71.00 N/A N/A 30000863 EAP CPT® 88185 "CLL LYMPHOMA FOLLOW-UP PANEL,ADD MARKER(SO)-14" BOTH IP/OP $71.00 $53.00 $11.19 $71.00 $53.97 $53.97 $53.97 $53.97 $71.00 $71.00 $71.00 $11.19 $71.00 $48.93 $48.93 $50.81 $35.72 $26.63 $71.00 $71.00 $42.00 $71.00 $24.01 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $25.36 $71.00 $41.18 $71.00 $71.00 $71.00 $19.92 $71.00 N/A N/A 30000864 EAP CPT® 88185 "CLL LYMPHOMA FOLLOW-UP PANEL,9-15 MARKERS(SO)" BOTH IP/OP $71.00 $53.00 $11.19 $71.00 $53.97 $53.97 $53.97 $53.97 $71.00 $71.00 $71.00 $11.19 $71.00 $48.93 $48.93 $50.81 $35.72 $26.63 $71.00 $71.00 $42.00 $71.00 $24.01 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $25.36 $71.00 $41.18 $71.00 $71.00 $71.00 $19.92 $71.00 N/A N/A 30000865 EAP CPT® 88188 "CLL LYMPHOMA FOLLOW-UP PANEL,9-15 MARKERS(SO)" BOTH IP/OP $71.00 $53.00 $31.30 $100.29 $71.00 $71.00 $71.00 $71.00 $62.68 $62.68 $31.30 $71.00 $62.68 $52.70 $52.70 $54.73 $36.99 $71.00 $100.29 $98.67 $71.00 $62.68 $61.67 $62.68 $71.00 $53.25 $62.68 $62.68 $62.68 $71.00 $71.00 $56.23 $62.68 $56.80 $46.15 $71.00 $62.68 $41.18 $71.00 $65.99 $62.68 $71.00 $62.68 N/A N/A 30000866 EAP CPT® 83520 HMGCR ANTIBODY (IGG) - QD (SO) BOTH IP/OP $215.00 $159.50 $7.77 $215.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $127.17 $17.27 $17.27 $17.27 $215.00 $161.25 $17.27 $17.27 $17.27 $72.36 $72.36 $170.28 $17.27 $172.00 $139.75 $18.21 $17.27 $124.70 $215.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30005065 EAP CPT® 82948 "GLU-RANDOM,WB MICRO" BOTH IP/OP $251.00 $186.00 $2.52 $251.00 $251.00 $251.00 $251.00 $251.00 $5.04 $5.04 $2.52 $251.00 $5.04 $4.82 $4.82 $5.00 $3.52 $4.68 $8.06 $8.06 $251.00 $5.04 $5.04 $5.04 $251.00 $188.25 $5.04 $5.04 $5.04 $17.72 $17.72 $198.79 $5.04 $200.80 $163.15 $251.00 $5.04 $145.58 $251.00 $7.31 $5.04 $251.00 $5.04 N/A N/A 30040001 EAP CPT® 86885 ABID EA SELECTED CELL (ARC) BOTH IP/OP $149.00 $110.50 $2.86 $149.00 $149.00 $149.00 $149.00 $149.00 $5.72 $5.72 $2.86 $149.00 $5.72 $8.68 $8.68 $9.02 $6.34 $8.44 $9.15 $9.15 $149.00 $5.72 $5.72 $5.72 $149.00 $111.75 $5.72 $5.72 $5.72 $31.96 $31.96 $118.01 $5.72 $119.20 $96.85 $149.00 $5.72 $86.42 $149.00 $8.29 $5.72 $149.00 $5.72 N/A N/A 30050138 EAP CPT® 86880 DIRECT COOMBS BOTH IP/OP $140.00 $104.00 $2.70 $112.00 $10.57 $10.57 $10.57 $10.57 $54.76 $54.76 $54.51 $2.70 $54.76 $8.15 $8.15 $8.47 $5.95 $7.93 $87.61 $82.92 $82.81 $54.76 $5.39 $54.76 $57.49 $105.00 $54.76 $54.76 $54.76 $30.00 $30.00 $110.88 $54.76 $112.00 $91.00 $7.55 $54.76 $81.20 $57.49 $79.22 $54.76 $5.93 $54.76 N/A N/A 30050139 EAP CPT® 86880 "DCT,ANTI-IGG" BOTH IP/OP $140.00 $104.00 $2.70 $112.00 $10.57 $10.57 $10.57 $10.57 $54.76 $54.76 $54.51 $2.70 $54.76 $8.15 $8.15 $8.47 $5.95 $7.93 $87.61 $82.92 $82.81 $54.76 $5.39 $54.76 $57.49 $105.00 $54.76 $54.76 $54.76 $30.00 $30.00 $110.88 $54.76 $112.00 $91.00 $7.55 $54.76 $81.20 $57.49 $79.22 $54.76 $5.93 $54.76 N/A N/A 30050140 EAP CPT® 86880 "DCT,ANTI-C3D" BOTH IP/OP $140.00 $104.00 $2.70 $112.00 $10.57 $10.57 $10.57 $10.57 $54.76 $54.76 $54.51 $2.70 $54.76 $8.15 $8.15 $8.47 $5.95 $7.93 $87.61 $82.92 $82.81 $54.76 $5.39 $54.76 $57.49 $105.00 $54.76 $54.76 $54.76 $30.00 $30.00 $110.88 $54.76 $112.00 $91.00 $7.55 $54.76 $81.20 $57.49 $79.22 $54.76 $5.93 $54.76 N/A N/A 30050141 EAP CPT® 86886 ANTIBODY TITER BOTH IP/OP $146.00 $108.50 $2.59 $234.73 $9.11 $9.11 $9.11 $9.11 $146.71 $146.71 $146.06 $2.59 $146.71 $7.06 $7.06 $7.33 $5.15 $6.87 $234.73 $226.86 $86.36 $146.71 $5.18 $146.71 $154.04 $109.50 $146.71 $146.71 $146.71 $26.00 $26.00 $115.63 $146.71 $116.80 $94.90 $6.54 $146.71 $84.68 $154.04 $146.00 $146.71 $5.14 $146.71 N/A N/A 30050148 EAP CPT® 86900 "BLOOD TYPING, SEROLOGIC, ABO" BOTH IP/OP $165.00 $122.50 $1.49 $177.47 $5.87 $5.87 $5.87 $5.87 $110.92 $110.92 $110.43 $1.49 $110.92 $4.52 $4.52 $4.70 $3.30 $4.41 $177.47 $167.51 $97.60 $110.92 $2.99 $110.92 $116.46 $123.75 $110.92 $110.92 $110.92 $16.68 $16.68 $130.68 $110.92 $132.00 $107.25 $4.20 $110.92 $95.70 $116.46 $160.47 $110.92 $3.30 $110.92 N/A N/A 30050149 EAP CPT® 86901 "BLOOD TYPING, SEROLOGIC, RH (D)" BOTH IP/OP $165.00 $122.50 $1.49 $132.00 $5.87 $5.87 $5.87 $5.87 $33.30 $33.30 $33.15 $1.49 $33.30 $4.52 $4.52 $4.70 $3.30 $17.04 $53.27 $48.99 $97.60 $33.30 $2.99 $33.30 $34.96 $123.75 $33.30 $33.30 $33.30 $16.68 $16.68 $130.68 $33.30 $132.00 $107.25 $16.23 $33.30 $95.70 $34.96 $48.17 $33.30 $12.75 $33.30 N/A N/A 30050300 EAP CPT® 80354 FENTANYL - URINE BOTH IP/OP $260.00 $192.50 $0.03 $260.00 $0.03 $0.03 $0.03 $0.03 $260.00 $260.00 $12.01 $11.94 $260.00 $192.97 $192.97 $200.41 $135.46 $54.19 $260.00 $104.00 $153.79 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $169.00 $51.60 $260.00 $150.80 $260.00 $156.00 $260.00 $54.18 $260.00 N/A N/A 30050301 EAP CPT® 80324 AMPHETAMINE - URINE BOTH IP/OP $260.00 $192.50 $12.01 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $12.01 $260.00 $260.00 $192.97 $192.97 $200.41 $135.46 $22.96 $260.00 $104.00 $260.00 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $169.00 $260.00 $260.00 $150.80 $260.00 $156.00 $260.00 $260.00 $260.00 N/A N/A 30050302 EAP CPT® 80307 METHAQUALONE - URINE BOTH IP/OP $241.00 $178.50 $29.09 $241.00 $109.39 $109.39 $109.39 $109.39 $62.14 $62.14 $31.07 $29.09 $62.14 $79.51 $79.51 $82.57 $58.04 $71.85 $99.42 $99.42 $142.55 $62.14 $62.14 $62.14 $241.00 $180.75 $62.14 $62.14 $62.14 $120.50 $120.50 $190.87 $62.14 $192.80 $102.53 $68.43 $62.14 $139.78 $241.00 $90.10 $62.14 $53.75 $62.14 N/A N/A 30050303 EAP CPT® 80367 PROPOXYPHENE - URINE BOTH IP/OP $260.00 $192.50 $0.03 $260.00 $0.03 $0.03 $0.03 $0.03 $260.00 $260.00 $12.01 $11.94 $260.00 $192.97 $192.97 $200.41 $135.46 $54.19 $260.00 $53.60 $153.79 $260.00 $134.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $169.00 $51.60 $260.00 $150.80 $260.00 $156.00 $260.00 $54.18 $260.00 N/A N/A 30050420 EAP CPT® 85347 ACT BOTH IP/OP $103.00 $76.50 $2.13 $103.00 $8.36 $8.36 $8.36 $8.36 $4.28 $4.28 $2.14 $2.13 $4.28 $6.47 $6.47 $6.72 $4.72 $6.30 $6.85 $6.85 $60.92 $4.28 $4.28 $4.28 $103.00 $77.25 $4.28 $4.28 $4.28 $23.80 $23.80 $81.58 $4.28 $82.40 $66.95 $6.00 $4.28 $59.74 $103.00 $6.21 $4.28 $4.71 $4.28 N/A N/A 30050421 EAP CPT® 83018 QUANTITATIVE SCREEN METALS BOTH IP/OP $210.00 $155.50 $10.98 $210.00 $43.10 $43.10 $43.10 $43.10 $21.96 $21.96 $10.98 $10.98 $21.96 $33.34 $33.34 $34.62 $24.34 $32.43 $35.14 $35.14 $124.22 $21.96 $21.96 $21.96 $210.00 $157.50 $21.96 $21.96 $21.96 $122.72 $122.72 $166.32 $21.96 $168.00 $136.50 $30.89 $21.96 $121.80 $210.00 $31.84 $21.96 $24.26 $21.96 N/A N/A 30050422 EAP CPT® 84311 SPECTROPHOTOMETRY BOTH IP/OP $210.00 $155.50 $4.05 $210.00 $210.00 $210.00 $210.00 $210.00 $8.10 $8.10 $4.05 $210.00 $8.10 $10.61 $10.61 $11.02 $7.74 $10.32 $12.96 $12.96 $210.00 $8.10 $8.10 $8.10 $210.00 $157.50 $8.10 $8.10 $8.10 $39.08 $39.08 $166.32 $8.10 $168.00 $136.50 $210.00 $8.10 $121.80 $210.00 $11.75 $8.10 $210.00 $8.10 N/A N/A 30050423 EAP CPT® 83519 RIA NONANTIBODY BOTH IP/OP "$1,284.00" $950.50 $8.28 "$1,284.00" $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $759.49 $18.40 $18.40 $18.40 "$1,284.00" $963.00 $18.40 $18.40 $18.40 $75.52 $75.52 "$1,016.93" $18.40 "$1,027.20" $834.60 $19.01 $18.40 $744.72 "$1,284.00" $26.68 $18.40 $14.93 $18.40 N/A N/A 30050424 EAP CPT® 86765 RUBEOLA ANTIBODY BOTH IP/OP $100.00 $74.00 $6.44 $100.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $59.15 $12.88 $12.88 $12.88 $100.00 $75.00 $12.88 $12.88 $12.88 $72.00 $72.00 $79.20 $12.88 $80.00 $65.00 $18.12 $12.88 $58.00 $100.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30050425 EAP CPT® 86022 PLATELET ANTIBODIES BOTH IP/OP $112.00 $83.00 $9.19 $112.00 $112.00 $112.00 $112.00 $112.00 $18.37 $18.37 $9.19 $112.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $112.00 $18.37 $18.37 $18.37 $112.00 $84.00 $18.37 $18.37 $18.37 $102.64 $102.64 $88.70 $18.37 $89.60 $72.80 $112.00 $18.37 $64.96 $112.00 $26.64 $18.37 $112.00 $18.37 N/A N/A 30050426 EAP CPT® 82480 ASSAY SERUM CHOLINESTERASE BOTH IP/OP $43.00 $32.00 $3.94 $43.00 $43.00 $43.00 $43.00 $43.00 $7.87 $7.87 $3.94 $43.00 $7.87 $11.97 $11.97 $12.43 $8.74 $11.64 $12.59 $12.59 $43.00 $7.87 $7.87 $7.87 $43.00 $32.25 $7.87 $7.87 $7.87 $43.00 $43.00 $34.06 $7.87 $34.40 $27.95 $43.00 $7.87 $24.94 $43.00 $11.41 $7.87 $43.00 $7.87 N/A N/A 30050427 EAP CPT® 82638 ASSAY OF DIBUCAINE NUMBER BOTH IP/OP $49.00 $36.50 $6.13 $49.00 $49.00 $49.00 $49.00 $49.00 $12.25 $12.25 $6.13 $49.00 $12.25 $18.60 $18.60 $19.31 $13.57 $18.09 $19.60 $19.60 $49.00 $12.25 $12.25 $12.25 $49.00 $36.75 $12.25 $12.25 $12.25 $49.00 $49.00 $38.81 $12.25 $39.20 $31.85 $49.00 $12.25 $28.42 $49.00 $17.76 $12.25 $49.00 $12.25 N/A N/A 30050428 EAP CPT® 88360 TUMOR IMMUNOHISTOCHEM/MANUAL BOTH IP/OP $911.00 $674.50 $49.88 $728.80 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $538.86 $146.71 $78.13 $146.71 $154.04 $683.25 $146.71 $146.71 $146.71 $242.68 $242.68 $721.51 $146.71 $728.80 $592.15 $109.25 $146.71 $528.38 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 30050435 EAP CPT® 86790 VIRUS ANTIBODY NOS BOTH IP/OP $368.00 $272.50 $6.44 $368.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $217.67 $12.88 $12.88 $12.88 $368.00 $276.00 $12.88 $12.88 $12.88 $72.00 $72.00 $291.46 $12.88 $294.40 $239.20 $18.12 $12.88 $213.44 $368.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30050436 EAP CPT® 87380 HEPATITIS DELTA AG EIA BOTH IP/OP $202.00 $149.50 $9.18 $202.00 $202.00 $202.00 $202.00 $202.00 $18.36 $18.36 $9.18 $202.00 $18.36 $24.94 $24.94 $25.90 $18.21 $24.26 $29.38 $29.38 $202.00 $18.36 $18.36 $18.36 $202.00 $151.50 $18.36 $18.36 $18.36 $91.76 $91.76 $159.98 $18.36 $161.60 $131.30 $202.00 $18.36 $117.16 $202.00 $26.62 $18.36 $202.00 $18.36 N/A N/A 30050437 EAP CPT® 87502 INFLUENZA DNA AMP PROBE BOTH IP/OP $627.00 $464.00 $47.90 $627.00 $627.00 $627.00 $627.00 $627.00 $95.80 $95.80 $47.90 $627.00 $95.80 $75.96 $75.96 $78.88 $55.45 $68.64 $153.28 $153.28 $627.00 $95.80 $95.80 $95.80 $627.00 $470.25 $95.80 $95.80 $95.80 $313.50 $313.50 $496.58 $95.80 $501.60 $407.55 $627.00 $95.80 $363.66 $627.00 $138.91 $95.80 $627.00 $95.80 N/A N/A 30050438 EAP CPT® 83520 IMMUNOASSAY AUANT NOS NONAB BOTH IP/OP "$2,216.00" "$1,640.00" $7.77 "$2,216.00" $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 "$1,310.76" $17.27 $17.27 $17.27 "$2,216.00" "$1,662.00" $17.27 $17.27 $17.27 $72.36 $72.36 "$1,755.07" $17.27 "$1,772.80" "$1,440.40" $18.21 $17.27 "$1,285.28" "$2,216.00" $25.04 $17.27 $14.30 $17.27 N/A N/A 30050439 EAP CPT® 84145 PROCALCITONIN - SERUM BOTH IP/OP $205.00 $152.00 $13.40 $205.00 $52.58 $52.58 $52.58 $52.58 $27.22 $27.22 $13.61 $13.40 $27.22 $28.87 $28.87 $29.98 $21.08 $28.27 $43.55 $43.55 $121.26 $27.22 $27.22 $27.22 $205.00 $153.75 $27.22 $27.22 $27.22 $102.50 $102.50 $162.36 $27.22 $164.00 $133.25 $26.92 $27.22 $118.90 $205.00 $39.47 $27.22 $21.15 $27.22 N/A N/A 30050440 EAP CPT® 85999 "EOSINOPHIL SMEAR, URINE" BOTH IP/OP $63.00 $47.00 $13.13 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $25.20 $63.00 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $63.00 $63.00 $49.90 $63.00 $50.40 $40.95 $63.00 $63.00 $36.54 $63.00 $37.80 $63.00 $63.00 $63.00 N/A N/A 30050441 EAP HCPCS 89055 FECAL LEUKOCYTE SMEAR BOTH IP/OP $118.00 $87.50 $2.14 $118.00 $118.00 $118.00 $118.00 $118.00 $4.27 $4.27 $2.14 $118.00 $4.27 $3.57 $3.57 $3.70 $2.60 $3.47 $6.83 $6.83 $118.00 $4.27 $4.27 $4.27 $118.00 $88.50 $4.27 $4.27 $4.27 $13.12 $13.12 $93.46 $4.27 $94.40 $76.70 $118.00 $4.27 $68.44 $118.00 $6.19 $4.27 $118.00 $4.27 N/A N/A 30050442 EAP CPT® 87498 "ENTEROVIRUS RNA, QUAL, RT-PCR SO" BOTH IP/OP $114.00 $84.50 $17.55 $114.00 $114.00 $114.00 $114.00 $114.00 $35.09 $35.09 $17.55 $114.00 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $114.00 $35.09 $35.09 $35.09 $114.00 $85.50 $35.09 $35.09 $35.09 $109.64 $109.64 $90.29 $35.09 $91.20 $74.10 $114.00 $35.09 $66.12 $114.00 $50.88 $35.09 $114.00 $35.09 N/A N/A 30050443 EAP CPT® 89055 FECAL LEUKOCYTE SMEAR BOTH IP/OP $118.00 $87.50 $2.14 $118.00 $118.00 $118.00 $118.00 $118.00 $4.27 $4.27 $2.14 $118.00 $4.27 $3.57 $3.57 $3.70 $2.60 $3.47 $6.83 $6.83 $118.00 $4.27 $4.27 $4.27 $118.00 $88.50 $4.27 $4.27 $4.27 $13.12 $13.12 $93.46 $4.27 $94.40 $76.70 $118.00 $4.27 $68.44 $118.00 $6.19 $4.27 $118.00 $4.27 N/A N/A 30050445 EAP CPT® 81279 JAK2 R/X-EXON12 (SO) BOTH IP/OP $846.00 $626.50 $92.60 $846.00 $264.96 $264.96 $264.96 $264.96 $185.20 $185.20 $92.60 $176.33 $185.20 $627.90 $627.90 $652.10 $440.77 $174.05 $296.32 $296.32 $500.41 $185.20 $185.20 $185.20 $846.00 $634.50 $185.20 $185.20 $185.20 $423.00 $423.00 $670.03 $185.20 $676.80 $305.58 $165.76 $185.20 $490.68 $846.00 $268.54 $185.20 $130.20 $185.20 N/A N/A 30050446 EAP CPT® 86021 PROTEINASE -3 ANTIBODY (SO) BOTH IP/OP $163.00 $121.00 $7.53 $163.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $96.41 $15.05 $15.05 $15.05 $163.00 $122.25 $15.05 $15.05 $15.05 $84.12 $84.12 $129.10 $15.05 $130.40 $105.95 $21.18 $15.05 $94.54 $163.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30050447 EAP CPT® 81261 "B-CELL RECEP IGH GENE REARRANGEMENT , PCR (SO)" BOTH IP/OP $607.00 $449.50 $99.00 $607.00 $607.00 $607.00 $607.00 $607.00 $197.99 $197.99 $99.00 $607.00 $197.99 $280.91 $280.91 $291.72 $205.07 $286.64 $316.78 $316.78 $607.00 $197.99 $197.99 $197.99 $607.00 $455.25 $197.99 $197.99 $197.99 $303.50 $303.50 $480.74 $197.99 $485.60 $607.00 $607.00 $197.99 $352.06 $607.00 $287.09 $197.99 $607.00 $197.99 N/A N/A 30050448 EAP CPT® 81264 "B-CELL RECEP IGK GENE REARRANGEMENT , PCR (SO)" BOTH IP/OP $607.00 $449.50 $86.37 $607.00 $607.00 $607.00 $607.00 $607.00 $172.73 $172.73 $86.37 $607.00 $172.73 $211.87 $211.87 $220.02 $154.66 $115.59 $276.37 $276.37 $607.00 $172.73 $172.73 $172.73 $607.00 $455.25 $172.73 $172.73 $172.73 $303.50 $303.50 $480.74 $172.73 $485.60 $607.00 $607.00 $172.73 $352.06 $607.00 $250.46 $172.73 $607.00 $172.73 N/A N/A 30050449 EAP CPT® 88271 MOLECULAR CYTOGENETICS; DNA PROBE( FISH) (SO) BOTH IP/OP "$1,071.00" $793.00 $10.71 "$1,071.00" $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $633.50 $21.42 $21.42 $21.42 "$1,071.00" $803.25 $21.42 $21.42 $21.42 $119.72 $119.72 $848.23 $21.42 $856.80 $696.15 $30.14 $21.42 $621.18 "$1,071.00" $31.06 $21.42 $23.67 $21.42 N/A N/A 30050450 EAP CPT® 88274 INTERPHASE IN SITU HYBRIDIZATION (25-99) CELLS (SO) BOTH IP/OP $537.00 $397.50 $19.07 $537.00 $68.32 $68.32 $68.32 $68.32 $42.38 $42.38 $21.19 $19.07 $42.38 $52.85 $52.85 $54.89 $38.58 $51.42 $67.81 $67.81 $317.64 $42.38 $42.38 $42.38 $537.00 $402.75 $42.38 $42.38 $42.38 $194.52 $194.52 $425.30 $42.38 $429.60 $349.05 $48.97 $42.38 $311.46 $537.00 $61.45 $42.38 $38.47 $42.38 N/A N/A 30050451 EAP CPT® 81342 "T - CELL RECEPTOR GAMMA GENE REARRANGEMENT, PCR (SO)" BOTH IP/OP "$1,177.00" $871.00 $100.75 "$1,177.00" "$1,177.00" "$1,177.00" "$1,177.00" "$1,177.00" $201.50 $201.50 $100.75 "$1,177.00" $201.50 $285.90 $285.90 $296.89 $208.70 $192.65 $322.40 $322.40 "$1,177.00" $201.50 $201.50 $201.50 "$1,177.00" $882.75 $201.50 $201.50 $201.50 $588.50 $588.50 $932.18 $201.50 $941.60 "$1,177.00" "$1,177.00" $201.50 $682.66 "$1,177.00" $292.18 $201.50 "$1,177.00" $201.50 N/A N/A 30050452 EAP CPT® 88271 MOLECULAR CYTOGENETICS; DNA PROBE( FISH) (SO) BOTH IP/OP $504.00 $373.00 $10.71 $504.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $298.12 $21.42 $21.42 $21.42 $504.00 $378.00 $21.42 $21.42 $21.42 $119.72 $119.72 $399.17 $21.42 $403.20 $327.60 $30.14 $21.42 $292.32 $504.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30050454 EAP CPT® 88271 MOLECULAR CYTOGENETICS; DNA PROBE( FISH) (SO) BOTH IP/OP $559.00 $414.00 $10.71 $559.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $330.65 $21.42 $21.42 $21.42 $559.00 $419.25 $21.42 $21.42 $21.42 $119.72 $119.72 $442.73 $21.42 $447.20 $363.35 $30.14 $21.42 $324.22 $559.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30050455 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION (100-300) CELLS (SO) BOTH IP/OP $280.00 $207.50 $23.04 $280.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $165.62 $51.19 $51.19 $51.19 $280.00 $210.00 $51.19 $51.19 $51.19 $224.44 $224.44 $221.76 $51.19 $224.00 $182.00 $56.50 $51.19 $162.40 $280.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30050456 EAP CPT® 81331 "PRADER-WILLI/ANGELMAN SYNDROME , DNA METHYLATION (SO)" BOTH IP/OP $588.00 $435.50 $25.54 $588.00 $588.00 $588.00 $588.00 $588.00 $51.07 $51.07 $25.54 $588.00 $51.07 $436.41 $436.41 $453.23 $306.35 $46.99 $81.71 $81.71 $588.00 $51.07 $51.07 $51.07 $588.00 $441.00 $51.07 $51.07 $51.07 $294.00 $294.00 $465.70 $51.07 $470.40 $588.00 $588.00 $51.07 $341.04 $588.00 $74.05 $51.07 $588.00 $51.07 N/A N/A 30050457 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION (100-300) CELLS (SO) BOTH IP/OP $253.00 $187.50 $23.04 $253.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $149.65 $51.19 $51.19 $51.19 $253.00 $189.75 $51.19 $51.19 $51.19 $224.44 $224.44 $200.38 $51.19 $202.40 $164.45 $56.50 $51.19 $146.74 $253.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30050458 EAP CPT® 88271 MOLECULAR CYTOGENETICS; DNA PROBE( FISH) (SO) BOTH IP/OP $481.00 $356.00 $10.71 $481.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $284.51 $21.42 $21.42 $21.42 $481.00 $360.75 $21.42 $21.42 $21.42 $119.72 $119.72 $380.95 $21.42 $384.80 $312.65 $30.14 $21.42 $278.98 $481.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30050459 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION (100-300) CELLS (SO) BOTH IP/OP $242.00 $179.50 $23.04 $242.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $143.14 $51.19 $51.19 $51.19 $242.00 $181.50 $51.19 $51.19 $51.19 $224.44 $224.44 $191.66 $51.19 $193.60 $157.30 $56.50 $51.19 $140.36 $242.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30050460 EAP CPT® 88271 MOLECULAR CYTOGENETICS; DNA PROBE( FISH) (SO)CML BOTH IP/OP $481.00 $356.00 $10.71 $481.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $284.51 $21.42 $21.42 $21.42 $481.00 $360.75 $21.42 $21.42 $21.42 $119.72 $119.72 $380.95 $21.42 $384.80 $312.65 $30.14 $21.42 $278.98 $481.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30050461 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION (100-300) CELLS (SO)CML BOTH IP/OP $242.00 $179.50 $23.04 $242.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $143.14 $51.19 $51.19 $51.19 $242.00 $181.50 $51.19 $51.19 $51.19 $224.44 $224.44 $191.66 $51.19 $193.60 $157.30 $56.50 $51.19 $140.36 $242.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30050462 EAP CPT® 81315 PML/RARA T(15;17) QUANT (PCR) (SO) BOTH IP/OP $771.00 $571.00 $103.66 $771.00 $771.00 $771.00 $771.00 $771.00 $207.31 $207.31 $103.66 $771.00 $207.31 $294.14 $294.14 $305.46 $214.72 $115.59 $331.70 $331.70 $771.00 $207.31 $207.31 $207.31 $771.00 $578.25 $207.31 $207.31 $207.31 $385.50 $385.50 $610.63 $207.31 $616.80 $771.00 $771.00 $207.31 $447.18 $771.00 $300.60 $207.31 $771.00 $207.31 N/A N/A 30050463 EAP CPT® 81210 BRAF MUTATION ANALYSIS (SO) BOTH IP/OP "$1,079.00" $798.50 $78.93 "$1,079.00" $257.85 $257.85 $257.85 $257.85 $175.40 $175.40 $87.70 $78.93 $175.40 $186.42 $186.42 $193.59 $136.08 $115.59 $280.64 $280.64 $638.23 $175.40 $175.40 $175.40 "$1,079.00" $809.25 $175.40 $175.40 $175.40 $539.50 $539.50 $854.57 $175.40 $863.20 $289.41 $110.09 $175.40 $625.82 "$1,079.00" $254.33 $175.40 $86.48 $175.40 N/A N/A 30050464 EAP CPT® 82172 APOLIPROTEIN (SO) BOTH IP/OP $57.00 $42.50 $9.49 $57.00 $30.42 $30.42 $30.42 $30.42 $21.09 $21.09 $10.55 $9.49 $21.09 $23.52 $23.52 $24.43 $17.17 $22.90 $33.74 $33.74 $33.72 $21.09 $21.09 $21.09 $57.00 $42.75 $21.09 $21.09 $21.09 $57.00 $57.00 $45.14 $21.09 $45.60 $37.05 $21.81 $21.09 $33.06 $57.00 $30.58 $21.09 $17.13 $21.09 N/A N/A 30050465 EAP CPT® 86738 "MYCOPLASMA PNEUMONIAE ANTIBODY (IGG), IFA, CSF (SO)" BOTH IP/OP $95.00 $70.50 $6.62 $95.00 $95.00 $95.00 $95.00 $95.00 $13.24 $13.24 $6.62 $95.00 $13.24 $20.11 $20.11 $20.89 $14.68 $19.57 $21.18 $21.18 $95.00 $13.24 $13.24 $13.24 $95.00 $71.25 $13.24 $13.24 $13.24 $74.04 $74.04 $75.24 $13.24 $76.00 $61.75 $95.00 $13.24 $55.10 $95.00 $19.20 $13.24 $95.00 $13.24 N/A N/A 30050466 EAP CPT® 81401 CBFB/MYH11 INV(16) QUANT PCR (SO) BOTH IP/OP $648.00 $480.00 $61.65 $648.00 $61.75 $61.75 $61.75 $61.75 $137.00 $137.00 $68.50 $61.65 $137.00 $480.95 $480.95 $499.48 $337.61 $131.58 $219.20 $219.20 $383.29 $137.00 $137.00 $137.00 $648.00 $486.00 $137.00 $137.00 $137.00 $324.00 $324.00 $513.22 $137.00 $518.40 $226.05 $125.31 $137.00 $375.84 $648.00 $198.65 $137.00 $98.43 $137.00 N/A N/A 30050467 EAP CPT® 81404 C-KIT MUTATION ANALYSIS (SO) BOTH IP/OP "$2,106.00" "$1,558.50" $123.67 "$2,106.00" $439.25 $439.25 $439.25 $439.25 $274.83 $274.83 $137.42 $123.67 $274.83 "$1,563.07" "$1,563.07" "$1,623.30" "$1,097.23" $286.64 $439.73 $439.73 "$1,245.70" $274.83 $274.83 $274.83 "$2,106.00" "$1,579.50" $274.83 $274.83 $274.83 "$1,053.00" "$1,053.00" "$1,667.95" $274.83 "$1,684.80" $453.47 $272.99 $274.83 "$1,221.48" "$2,106.00" $398.50 $274.83 $214.43 $274.83 N/A N/A 30050468 EAP CPT® 87798 "BORDETELLA PERTUSSIS/PARAPERTUSSIS DNA, PCR (SO)" BOTH IP/OP $470.00 $348.00 $17.55 $470.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $278.01 $35.09 $35.09 $35.09 $470.00 $352.50 $35.09 $35.09 $35.09 $109.64 $109.64 $372.24 $35.09 $376.00 $305.50 $27.60 $35.09 $272.60 $470.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30050469 EAP CPT® 86255 "NMDA- RECEPTOR ANTIBODY , CSF(MAYO)" BOTH IP/OP $371.00 $275.00 $6.03 $371.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $219.45 $12.05 $12.05 $12.05 $371.00 $278.25 $12.05 $12.05 $12.05 $67.36 $67.36 $293.83 $12.05 $296.80 $241.15 $16.96 $12.05 $215.18 $371.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30050470 EAP CPT® 87661 "TRICHOMONAS VAGINALIS RNA, QUALITATIVE, TMA (SO)" BOTH IP/OP $153.00 $113.50 $17.55 $153.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $27.84 $27.84 $28.91 $20.32 $25.16 $56.14 $56.14 $90.50 $35.09 $35.09 $35.09 $153.00 $114.75 $35.09 $35.09 $35.09 $70.20 $70.20 $121.18 $35.09 $122.40 $99.45 $23.96 $35.09 $88.74 $153.00 $50.88 $35.09 $18.82 $35.09 N/A N/A 30050471 EAP CPT® 86256 AGNA-1 (MAYO) BOTH IP/OP $86.00 $64.00 $6.03 $86.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $50.87 $12.05 $12.05 $12.05 $86.00 $64.50 $12.05 $12.05 $12.05 $67.36 $67.36 $68.11 $12.05 $68.80 $55.90 $16.96 $12.05 $49.88 $86.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30050472 EAP CPT® 86256 AMPHIPHYSIN (MAYO) BOTH IP/OP $56.00 $41.50 $6.03 $56.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $33.12 $12.05 $12.05 $12.05 $56.00 $42.00 $12.05 $12.05 $12.05 $56.00 $56.00 $44.35 $12.05 $44.80 $36.40 $16.96 $12.05 $32.48 $56.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30050473 EAP CPT® 86256 ANNA-1 (MAYO) BOTH IP/OP $56.00 $41.50 $6.03 $56.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $33.12 $12.05 $12.05 $12.05 $56.00 $42.00 $12.05 $12.05 $12.05 $56.00 $56.00 $44.35 $12.05 $44.80 $36.40 $16.96 $12.05 $32.48 $56.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30050474 EAP CPT® 86256 ANNA-2 (MAYO) BOTH IP/OP $56.00 $41.50 $6.03 $56.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $33.12 $12.05 $12.05 $12.05 $56.00 $42.00 $12.05 $12.05 $12.05 $56.00 $56.00 $44.35 $12.05 $44.80 $36.40 $16.96 $12.05 $32.48 $56.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30050475 EAP CPT® 86256 ANNA-3 (MAYO) BOTH IP/OP $56.00 $41.50 $6.03 $56.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $33.12 $12.05 $12.05 $12.05 $56.00 $42.00 $12.05 $12.05 $12.05 $56.00 $56.00 $44.35 $12.05 $44.80 $36.40 $16.96 $12.05 $32.48 $56.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30050476 EAP CPT® 86256 CRMP-5-IGG BOTH IP/OP $56.00 $41.50 $6.03 $56.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $33.12 $12.05 $12.05 $12.05 $56.00 $42.00 $12.05 $12.05 $12.05 $56.00 $56.00 $44.35 $12.05 $44.80 $36.40 $16.96 $12.05 $32.48 $56.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30050477 EAP CPT® 86256 PCA-1 (MAYO) BOTH IP/OP $56.00 $41.50 $6.03 $56.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $33.12 $12.05 $12.05 $12.05 $56.00 $42.00 $12.05 $12.05 $12.05 $56.00 $56.00 $44.35 $12.05 $44.80 $36.40 $16.96 $12.05 $32.48 $56.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30050478 EAP CPT® 86256 PCA-2 (MAYO) BOTH IP/OP $56.00 $41.50 $6.03 $56.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $33.12 $12.05 $12.05 $12.05 $56.00 $42.00 $12.05 $12.05 $12.05 $56.00 $56.00 $44.35 $12.05 $44.80 $36.40 $16.96 $12.05 $32.48 $56.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30050479 EAP CPT® 86256 PCA-TR (MAYO) BOTH IP/OP $56.00 $41.50 $6.03 $56.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $33.12 $12.05 $12.05 $12.05 $56.00 $42.00 $12.05 $12.05 $12.05 $56.00 $56.00 $44.35 $12.05 $44.80 $36.40 $16.96 $12.05 $32.48 $56.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30050481 EAP CPT® 87912 "HEPATITIS B VIRUS DRUG RESISTANCE, GENOTYPE (SO)" BOTH IP/OP $600.00 $444.00 $84.28 $600.00 $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $373.52 $373.52 $387.88 $272.66 $112.65 $411.92 $411.92 $600.00 $257.45 $257.45 $257.45 $600.00 $450.00 $257.45 $257.45 $257.45 $300.00 $300.00 $475.20 $257.45 $480.00 $390.00 $107.29 $257.45 $348.00 $600.00 $373.30 $257.45 $84.28 $257.45 N/A N/A 30050482 EAP CPT® 81402 "FOLLICULAR LYMPHOMA, PCR (SO)" BOTH IP/OP "$1,042.00" $771.50 $75.17 "$1,042.00" "$1,042.00" "$1,042.00" "$1,042.00" "$1,042.00" $150.33 $150.33 $75.17 "$1,042.00" $150.33 $773.37 $773.37 $803.17 $542.88 $192.65 $240.53 $240.53 "$1,042.00" $150.33 $150.33 $150.33 "$1,042.00" $781.50 $150.33 $150.33 $150.33 $521.00 $521.00 $825.26 $150.33 $833.60 "$1,042.00" "$1,042.00" $150.33 $604.36 "$1,042.00" $217.98 $150.33 "$1,042.00" $150.33 N/A N/A 30050483 EAP CPT® 81401 "MANTLE CELL LYMPHOMA, PCR (SO)" BOTH IP/OP "$1,163.00" $861.00 $61.65 "$1,163.00" $61.75 $61.75 $61.75 $61.75 $137.00 $137.00 $68.50 $61.65 $137.00 $863.18 $863.18 $896.44 $605.92 $131.58 $219.20 $219.20 $687.91 $137.00 $137.00 $137.00 "$1,163.00" $872.25 $137.00 $137.00 $137.00 $581.50 $581.50 $921.10 $137.00 $930.40 $226.05 $125.31 $137.00 $674.54 "$1,163.00" $198.65 $137.00 $98.43 $137.00 N/A N/A 30050484 EAP CPT® 88271 MOLECULAR CYTOGENETICS: DNA PROBE (FISH) (SO) NHL BOTH IP/OP $514.00 $380.50 $10.71 $514.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $304.03 $21.42 $21.42 $21.42 $514.00 $385.50 $21.42 $21.42 $21.42 $119.72 $119.72 $407.09 $21.42 $411.20 $334.10 $30.14 $21.42 $298.12 $514.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30050485 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION(100-300) CELLS (SO) NHL BOTH IP/OP $258.00 $191.00 $23.04 $258.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $152.61 $51.19 $51.19 $51.19 $258.00 $193.50 $51.19 $51.19 $51.19 $224.44 $224.44 $204.34 $51.19 $206.40 $167.70 $56.50 $51.19 $149.64 $258.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30050486 EAP CPT® 88271 MOLECULAR CYTOGENETICS: DNA PROBE (FISH) (SO) FOL BOTH IP/OP $617.00 $457.00 $10.71 $617.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $364.96 $21.42 $21.42 $21.42 $617.00 $462.75 $21.42 $21.42 $21.42 $119.72 $119.72 $488.66 $21.42 $493.60 $401.05 $30.14 $21.42 $357.86 $617.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30050487 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION(100-300) CELLS (SO) FOL BOTH IP/OP $309.00 $229.00 $23.04 $309.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $182.77 $51.19 $51.19 $51.19 $309.00 $231.75 $51.19 $51.19 $51.19 $224.44 $224.44 $244.73 $51.19 $247.20 $200.85 $56.50 $51.19 $179.22 $309.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30050488 EAP CPT® 83520 GANGLIOSIDE GQ1B ANTIBODY (IGG)(SO) BOTH IP/OP $296.00 $219.50 $7.77 $296.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $175.08 $17.27 $17.27 $17.27 $296.00 $222.00 $17.27 $17.27 $17.27 $72.36 $72.36 $234.43 $17.27 $236.80 $192.40 $18.21 $17.27 $171.68 $296.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30050489 EAP CPT® 81210 "MELANOMA, BRAF V600 MUTATION (SO)" BOTH IP/OP "$1,482.00" "$1,097.00" $78.93 "$1,482.00" $257.85 $257.85 $257.85 $257.85 $175.40 $175.40 $87.70 $78.93 $175.40 $186.42 $186.42 $193.59 $136.08 $115.59 $280.64 $280.64 $876.60 $175.40 $175.40 $175.40 "$1,482.00" "$1,111.50" $175.40 $175.40 $175.40 $741.00 $741.00 "$1,173.74" $175.40 "$1,185.60" $289.41 $110.09 $175.40 $859.56 "$1,482.00" $254.33 $175.40 $86.48 $175.40 N/A N/A 30050490 EAP CPT® 81404 "NRAS, MUTATION ANALYSIS (SO)" BOTH IP/OP $771.00 $571.00 $123.67 $771.00 $439.25 $439.25 $439.25 $439.25 $274.83 $274.83 $137.42 $123.67 $274.83 $572.24 $572.24 $594.29 $401.69 $286.64 $439.73 $439.73 $456.05 $274.83 $274.83 $274.83 $771.00 $578.25 $274.83 $274.83 $274.83 $385.50 $385.50 $610.63 $274.83 $616.80 $453.47 $272.99 $274.83 $447.18 $771.00 $398.50 $274.83 $214.43 $274.83 N/A N/A 30050491 EAP CPT® 83520 INTERLEUKIN -2 (IL-2) (SO) BOTH IP/OP $284.00 $210.50 $7.77 $284.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $167.99 $17.27 $17.27 $17.27 $284.00 $213.00 $17.27 $17.27 $17.27 $72.36 $72.36 $224.93 $17.27 $227.20 $184.60 $18.21 $17.27 $164.72 $284.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30050492 EAP CPT® 86255 NMO/AQP4-IGG CBA (MAYO) BOTH IP/OP $55.00 $41.00 $6.03 $55.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $32.53 $12.05 $12.05 $12.05 $55.00 $41.25 $12.05 $12.05 $12.05 $55.00 $55.00 $43.56 $12.05 $44.00 $35.75 $16.96 $12.05 $31.90 $55.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30050493 EAP CPT® 86341 GAD65 ABS (MAYO) BOTH IP/OP $66.00 $49.00 $10.61 $66.00 $38.83 $38.83 $38.83 $38.83 $23.57 $23.57 $11.79 $10.61 $23.57 $30.05 $30.05 $31.20 $21.93 $29.24 $37.71 $37.71 $39.04 $23.57 $23.57 $23.57 $66.00 $49.50 $23.57 $23.57 $23.57 $66.00 $66.00 $52.27 $23.57 $52.80 $42.90 $27.85 $23.57 $38.28 $66.00 $34.18 $23.57 $21.88 $23.57 N/A N/A 30050495 EAP CPT® 86255 "NMO/AQP4-IGG CBA, CSF (MAYO)" BOTH IP/OP $462.00 $342.00 $6.03 $462.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $273.27 $12.05 $12.05 $12.05 $462.00 $346.50 $12.05 $12.05 $12.05 $67.36 $67.36 $365.90 $12.05 $369.60 $300.30 $16.96 $12.05 $267.96 $462.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30050496 EAP CPT® 81170 ABL KINASE DOMAIN MUTATION IN CML (SO) BOTH IP/OP "$1,150.00" $851.00 $150.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $300.00 $300.00 $150.00 "$1,150.00" $300.00 $342.69 $342.69 $355.87 $250.16 $309.68 $480.00 $480.00 "$1,150.00" $300.00 $300.00 $300.00 "$1,150.00" $862.50 $300.00 $300.00 $300.00 $575.00 $575.00 $910.80 $300.00 $920.00 "$1,150.00" "$1,150.00" $300.00 $667.00 "$1,150.00" $435.00 $300.00 "$1,150.00" $300.00 N/A N/A 30050497 EAP CPT® 86003 ALLERGEN SPECIFIC (MOLD GROUP) BOTH IP/OP $247.00 $183.00 $2.61 $247.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $146.10 $5.22 $5.22 $5.22 $247.00 $185.25 $5.22 $5.22 $5.22 $29.20 $29.20 $195.62 $5.22 $197.60 $160.55 $7.35 $5.22 $143.26 $247.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30050500 EAP CPT® 80361 MONACETYLMORPHINE-FREE-6 BOTH IP/OP $516.00 $382.00 $0.03 $516.00 $0.03 $0.03 $0.03 $0.03 $516.00 $516.00 $12.01 $11.94 $516.00 $382.98 $382.98 $397.73 $268.84 $30.51 $516.00 $165.60 $305.21 $516.00 $414.00 $516.00 $516.00 $387.00 $516.00 $516.00 $516.00 $258.00 $258.00 $408.67 $516.00 $412.80 $335.40 $29.06 $516.00 $299.28 $516.00 $309.60 $516.00 $22.83 $516.00 N/A N/A 30050501 EAP CPT® 87902 HEPATITS C VIRAL RNA NS3 GENOTYPE (SO) BOTH IP/OP "$1,252.00" $926.50 $96.38 "$1,252.00" $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $132.42 $132.42 $137.52 $96.67 $128.84 $411.92 $411.92 $740.56 $257.45 $257.45 $257.45 "$1,252.00" $939.00 $257.45 $257.45 $257.45 $487.40 $487.40 $991.58 $257.45 "$1,001.60" $813.80 $122.70 $257.45 $726.16 "$1,252.00" $373.30 $257.45 $96.38 $257.45 N/A N/A 30050503 EAP CPT® 85576 PLATELET FUNCTION P2Y12 BOTH IP/OP $326.00 $241.50 $11.21 $326.00 $42.17 $42.17 $42.17 $42.17 $24.91 $24.91 $12.46 $11.21 $24.91 $32.62 $32.62 $33.88 $23.82 $31.73 $39.86 $39.86 $192.83 $24.91 $24.91 $24.91 $326.00 $244.50 $24.91 $24.91 $24.91 $120.04 $120.04 $258.19 $24.91 $260.80 $211.90 $30.22 $24.91 $189.08 $326.00 $36.12 $24.91 $23.74 $24.91 N/A N/A 30050520 EAP CPT® 86361 T CELL; ABSOLUTE CD4 COUNT BOTH IP/OP $114.00 $84.50 $13.39 $114.00 $51.25 $51.25 $51.25 $51.25 $26.78 $26.78 $13.39 $13.39 $26.78 $39.63 $39.63 $41.16 $28.93 $38.56 $42.85 $42.85 $67.43 $26.78 $26.78 $26.78 $114.00 $85.50 $26.78 $26.78 $26.78 $114.00 $114.00 $90.29 $26.78 $91.20 $74.10 $36.72 $26.78 $66.12 $114.00 $38.83 $26.78 $28.84 $26.78 N/A N/A 30050521 EAP CPT® 85004 AUTOMATED DIFFERENTIAL WBC COUNT BOTH IP/OP $83.00 $61.50 $3.24 $83.00 $83.00 $83.00 $83.00 $83.00 $6.47 $6.47 $3.24 $83.00 $6.47 $9.83 $9.83 $10.21 $7.17 $9.57 $10.35 $10.35 $83.00 $6.47 $6.47 $6.47 $83.00 $62.25 $6.47 $6.47 $6.47 $36.16 $36.16 $65.74 $6.47 $66.40 $53.95 $83.00 $6.47 $48.14 $83.00 $9.38 $6.47 $83.00 $6.47 N/A N/A 30050550 EAP CPT® 83520 PHOSPHOLIPASE A2 AB QUANT (SO) BOTH IP/OP $424.00 $314.00 $7.77 $424.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $250.80 $17.27 $17.27 $17.27 $424.00 $318.00 $17.27 $17.27 $17.27 $72.36 $72.36 $335.81 $17.27 $339.20 $28.50 $18.21 $17.27 $245.92 $424.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30050560 EAP CPT® 86255 PHOSPHOLIPASE A2 SCRN (SO) BOTH IP/OP $263.00 $195.00 $6.03 $263.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $155.56 $12.05 $12.05 $12.05 $263.00 $197.25 $12.05 $12.05 $12.05 $67.36 $67.36 $208.30 $12.05 $210.40 $170.95 $16.96 $12.05 $152.54 $263.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30050561 EAP CPT® 81162 BRCA1&2 SEQ & FULL DUP/DEL (SO) BOTH IP/OP "$3,730.00" "$2,760.50" $912.44 "$3,730.00" "$3,730.00" "$3,730.00" "$3,730.00" "$3,730.00" "$1,824.88" "$1,824.88" $912.44 "$3,730.00" "$1,824.88" "$2,585.29" "$2,585.29" "$2,684.73" "$1,887.24" "$2,336.20" "$2,919.81" "$2,919.81" "$3,730.00" "$1,824.88" "$1,824.88" "$1,824.88" "$3,730.00" "$2,797.50" "$1,824.88" "$1,824.88" "$1,824.88" "$1,865.00" "$1,865.00" "$2,954.16" "$1,824.88" "$2,984.00" "$3,730.00" "$3,730.00" "$1,824.88" "$2,163.40" "$3,730.00" "$2,646.08" "$1,824.88" "$3,730.00" "$1,824.88" N/A N/A 30050562 EAP HCPCS C9803 OP SPECIMEN COLLECTION FOR (SARS-COV-2) COVID-19 BOTH IP/OP $57.00 $42.50 $11.88 $57.00 $30.95 $30.95 $30.95 $30.95 $24.30 $24.30 $24.19 $22.38 $24.30 $42.31 $42.31 $41.31 $42.31 $11.88 $38.88 $36.00 $33.72 $24.30 $57.00 $24.30 $25.52 $42.75 $24.30 $24.30 $24.30 $28.50 $28.50 $45.14 $24.30 $45.60 $57.00 $22.38 $24.30 $33.06 $25.52 $35.16 $24.30 $22.38 $24.30 N/A N/A 30100001 EAP CPT® 80299 OXYCARBAZEPINE SO BOTH IP/OP $122.00 $90.50 $8.39 $122.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $72.16 $18.64 $18.64 $18.64 $122.00 $91.50 $18.64 $18.64 $18.64 $67.28 $67.28 $96.62 $18.64 $97.60 $30.76 $16.94 $18.64 $70.76 $122.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30100003 EAP CPT® 80051 "CHEM 4, ELECTROLYTE PANEL" BOTH IP/OP $228.00 $169.00 $3.51 $228.00 $13.75 $13.75 $13.75 $13.75 $7.01 $7.01 $3.51 $3.51 $7.01 $10.65 $10.65 $11.06 $7.77 $10.36 $11.22 $11.22 $134.86 $7.01 $7.01 $7.01 $228.00 $171.00 $7.01 $7.01 $7.01 $39.20 $39.20 $180.58 $7.01 $182.40 $11.57 $9.87 $7.01 $132.24 $228.00 $10.16 $7.01 $7.75 $7.01 N/A N/A 30100005 EAP CPT® 80053 "COMPREHENSIVE METABOLIC PANEL, EVD" BOTH IP/OP $472.00 $349.50 $5.28 $472.00 $20.73 $20.73 $20.73 $20.73 $10.56 $10.56 $5.28 $5.28 $10.56 $16.06 $16.06 $16.68 $11.72 $15.61 $16.90 $16.90 $279.19 $10.56 $10.56 $10.56 $472.00 $354.00 $10.56 $10.56 $10.56 $59.08 $59.08 $373.82 $10.56 $377.60 $17.42 $14.87 $10.56 $273.76 $472.00 $15.31 $10.56 $11.68 $10.56 N/A N/A 30100006 EAP CPT® 80047 "BASIC METABOLIC PANEL, EVD" BOTH IP/OP $370.00 $274.00 $6.87 $370.00 $370.00 $370.00 $370.00 $370.00 $13.73 $13.73 $6.87 $370.00 $13.73 $12.85 $12.85 $13.35 $9.38 $32.26 $21.97 $21.97 $370.00 $13.73 $13.73 $13.73 $370.00 $277.50 $13.73 $13.73 $13.73 $185.00 $185.00 $293.04 $13.73 $296.00 $370.00 $370.00 $13.73 $214.60 $370.00 $19.91 $13.73 $370.00 $13.73 N/A N/A 30100007 EAP CPT® 80061 "CHEM 3, LIPID PANEL" BOTH IP/OP $282.00 $209.00 $6.70 $282.00 $26.28 $26.28 $26.28 $26.28 $13.39 $13.39 $6.70 $6.70 $13.39 $20.35 $20.35 $21.14 $14.86 $19.79 $21.42 $21.42 $166.80 $13.39 $13.39 $13.39 $282.00 $211.50 $13.39 $13.39 $13.39 $74.88 $74.88 $223.34 $13.39 $225.60 $22.09 $18.85 $13.39 $163.56 $282.00 $19.42 $13.39 $14.81 $13.39 N/A N/A 30100008 EAP CPT® 80069 "RENAL FUNCTION PANEL, EVD" BOTH IP/OP $230.00 $170.50 $4.34 $230.00 $17.04 $17.04 $17.04 $17.04 $8.68 $8.68 $4.34 $4.34 $8.68 $13.19 $13.19 $13.69 $9.63 $12.83 $13.89 $13.89 $136.05 $8.68 $8.68 $8.68 $230.00 $172.50 $8.68 $8.68 $8.68 $48.52 $48.52 $182.16 $8.68 $184.00 $14.32 $12.22 $8.68 $133.40 $230.00 $12.59 $8.68 $9.60 $8.68 N/A N/A 30100009 EAP CPT® 80069 RENAL PANEL BOTH IP/OP $230.00 $170.50 $4.34 $230.00 $17.04 $17.04 $17.04 $17.04 $8.68 $8.68 $4.34 $4.34 $8.68 $13.19 $13.19 $13.69 $9.63 $12.83 $13.89 $13.89 $136.05 $8.68 $8.68 $8.68 $230.00 $172.50 $8.68 $8.68 $8.68 $48.52 $48.52 $182.16 $8.68 $184.00 $14.32 $12.22 $8.68 $133.40 $230.00 $12.59 $8.68 $9.60 $8.68 N/A N/A 30100010 EAP CPT® 83986 "PH, MISC FLUIDS" BOTH IP/OP $70.00 $52.00 $1.79 $70.00 $7.03 $7.03 $7.03 $7.03 $3.58 $3.58 $1.79 $1.79 $3.58 $5.43 $5.43 $5.64 $3.96 $5.28 $5.73 $5.73 $70.00 $3.58 $3.58 $3.58 $70.00 $52.50 $3.58 $3.58 $3.58 $20.00 $20.00 $55.44 $3.58 $56.00 $5.91 $5.03 $3.58 $40.60 $70.00 $5.19 $3.58 $3.95 $3.58 N/A N/A 30100011 EAP CPT® 80076 HEPATIC PROFILE BOTH IP/OP $333.00 $246.50 $4.09 $333.00 $16.04 $16.04 $16.04 $16.04 $8.17 $8.17 $4.09 $4.09 $8.17 $12.41 $12.41 $12.88 $9.06 $12.08 $13.07 $13.07 $196.97 $8.17 $8.17 $8.17 $333.00 $249.75 $8.17 $8.17 $8.17 $45.68 $45.68 $263.74 $8.17 $266.40 $13.48 $11.50 $8.17 $193.14 $333.00 $11.85 $8.17 $9.03 $8.17 N/A N/A 30100013 EAP CPT® 80346 CLONAZEPAM/KLONOPIN BOTH IP/OP $238.00 $176.50 $12.01 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $12.01 $238.00 $238.00 $176.64 $176.64 $183.45 $124.00 $27.32 $238.00 $95.20 $238.00 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $154.70 $238.00 $238.00 $138.04 $238.00 $142.80 $238.00 $238.00 $238.00 N/A N/A 30100014 EAP CPT® 80197 TACROLIMUS BOTH IP/OP $393.00 $291.00 $6.87 $393.00 $26.96 $26.96 $26.96 $26.96 $13.73 $13.73 $6.87 $6.87 $13.73 $20.84 $20.84 $21.64 $15.21 $20.27 $21.97 $21.97 $232.46 $13.73 $13.73 $13.73 $393.00 $294.75 $13.73 $13.73 $13.73 $76.68 $76.68 $311.26 $13.73 $314.40 $22.65 $19.30 $13.73 $227.94 $393.00 $19.91 $13.73 $15.16 $13.73 N/A N/A 30100015 EAP CPT® 80299 "DIGITOXIN, SERUM" BOTH IP/OP $218.00 $161.50 $8.39 $218.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $128.95 $18.64 $18.64 $18.64 $218.00 $163.50 $18.64 $18.64 $18.64 $67.28 $67.28 $172.66 $18.64 $174.40 $30.76 $16.94 $18.64 $126.44 $218.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30100016 EAP CPT® 80167 DRUG ASSAY FELBAMATE BOTH IP/OP $217.00 $161.00 $9.32 $217.00 $217.00 $217.00 $217.00 $217.00 $18.64 $18.64 $9.32 $217.00 $18.64 $161.06 $161.06 $167.26 $113.06 $17.51 $29.82 $29.82 $217.00 $18.64 $18.64 $18.64 $217.00 $162.75 $18.64 $18.64 $18.64 $108.50 $108.50 $171.86 $18.64 $173.60 $217.00 $217.00 $18.64 $125.86 $217.00 $27.03 $18.64 $217.00 $18.64 N/A N/A 30100017 EAP CPT® 80299 BUPROPION/WELLBUTRIN BOTH IP/OP $217.00 $161.00 $8.39 $217.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $128.36 $18.64 $18.64 $18.64 $217.00 $162.75 $18.64 $18.64 $18.64 $67.28 $67.28 $171.86 $18.64 $173.60 $30.76 $16.94 $18.64 $125.86 $217.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30100018 EAP CPT® 80307 ACETAMINOPHEN BOTH IP/OP $585.00 $433.00 $29.09 $585.00 $109.39 $109.39 $109.39 $109.39 $62.14 $62.14 $31.07 $29.09 $62.14 $79.51 $79.51 $82.57 $58.04 $71.85 $99.42 $99.42 $346.03 $62.14 $62.14 $62.14 $585.00 $438.75 $62.14 $62.14 $62.14 $292.50 $292.50 $463.32 $62.14 $468.00 $102.53 $68.43 $62.14 $339.30 $585.00 $90.10 $62.14 $53.75 $62.14 N/A N/A 30100019 EAP CPT® 80076 "HEPATIC FUNCTION PANEL, EVD" BOTH IP/OP $333.00 $246.50 $4.09 $333.00 $16.04 $16.04 $16.04 $16.04 $8.17 $8.17 $4.09 $4.09 $8.17 $12.41 $12.41 $12.88 $9.06 $12.08 $13.07 $13.07 $196.97 $8.17 $8.17 $8.17 $333.00 $249.75 $8.17 $8.17 $8.17 $45.68 $45.68 $263.74 $8.17 $266.40 $13.48 $11.50 $8.17 $193.14 $333.00 $11.85 $8.17 $9.03 $8.17 N/A N/A 30100020 EAP CPT® 82009 ACETOACETATE-QUALITATIVE BOTH IP/OP $64.00 $47.50 $2.26 $64.00 $64.00 $64.00 $64.00 $64.00 $4.52 $4.52 $2.26 $64.00 $4.52 $4.99 $4.99 $5.18 $3.64 $4.85 $7.23 $7.23 $64.00 $4.52 $4.52 $4.52 $64.00 $48.00 $4.52 $4.52 $4.52 $18.36 $18.36 $50.69 $4.52 $51.20 $64.00 $64.00 $4.52 $37.12 $64.00 $6.55 $4.52 $64.00 $4.52 N/A N/A 30100021 EAP CPT® 82010 B-OH BUTYRIC ACID BOTH IP/OP $192.00 $142.50 $4.09 $192.00 $16.04 $16.04 $16.04 $16.04 $8.17 $8.17 $4.09 $4.09 $8.17 $12.41 $12.41 $12.88 $9.06 $12.08 $13.07 $13.07 $113.57 $8.17 $8.17 $8.17 $192.00 $144.00 $8.17 $8.17 $8.17 $45.68 $45.68 $152.06 $8.17 $153.60 $13.48 $11.50 $8.17 $111.36 $192.00 $11.85 $8.17 $9.03 $8.17 N/A N/A 30100022 EAP CPT® 82024 "ACTH, PLASMA" BOTH IP/OP $461.00 $341.50 $19.31 $461.00 $75.80 $75.80 $75.80 $75.80 $38.62 $38.62 $19.31 $19.31 $38.62 $58.66 $58.66 $60.91 $42.82 $57.06 $61.79 $61.79 $272.68 $38.62 $38.62 $38.62 $461.00 $345.75 $38.62 $38.62 $38.62 $215.88 $215.88 $365.11 $38.62 $368.80 $63.72 $54.34 $38.62 $267.38 $461.00 $56.00 $38.62 $42.68 $38.62 N/A N/A 30100023 EAP CPT® 82040 ALBUMIN (BCG) BOTH IP/OP $75.00 $55.50 $2.48 $75.00 $5.65 $5.65 $5.65 $5.65 $4.95 $4.95 $2.48 $2.48 $4.95 $4.37 $4.37 $4.54 $3.19 $4.25 $7.92 $7.92 $44.36 $4.95 $4.95 $4.95 $75.00 $56.25 $4.95 $4.95 $4.95 $16.08 $16.08 $59.40 $4.95 $60.00 $8.17 $4.05 $4.95 $43.50 $75.00 $7.18 $4.95 $3.18 $4.95 N/A N/A 30100024 EAP CPT® 82042 "ALBUMIN,FLUID" BOTH IP/OP $128.00 $95.00 $3.50 $128.00 $10.17 $10.17 $10.17 $10.17 $7.78 $7.78 $3.89 $3.50 $7.78 $7.86 $7.86 $8.16 $5.74 $7.64 $12.45 $12.45 $75.71 $7.78 $7.78 $7.78 $128.00 $96.00 $7.78 $7.78 $7.78 $28.92 $28.92 $101.38 $7.78 $102.40 $12.84 $7.28 $7.78 $74.24 $128.00 $11.28 $7.78 $5.72 $7.78 N/A N/A 30100025 EAP CPT® 82043 "MICROALBUMIN, UR" BOTH IP/OP $222.00 $164.50 $2.89 $222.00 $11.35 $11.35 $11.35 $11.35 $5.78 $5.78 $2.89 $2.89 $5.78 $8.79 $8.79 $9.13 $6.42 $8.55 $9.25 $9.25 $131.31 $5.78 $5.78 $5.78 $222.00 $166.50 $5.78 $5.78 $5.78 $32.36 $32.36 $175.82 $5.78 $177.60 $9.54 $8.14 $5.78 $128.76 $222.00 $8.38 $5.78 $6.39 $5.78 N/A N/A 30100026 EAP CPT® 83615 "LACTATE DEHYDROGENASE (LDH), EVD" BOTH IP/OP $139.00 $103.00 $3.02 $139.00 $11.85 $11.85 $11.85 $11.85 $6.04 $6.04 $3.02 $3.02 $6.04 $9.16 $9.16 $9.51 $6.69 $7.46 $9.66 $9.66 $82.22 $6.04 $6.04 $6.04 $139.00 $104.25 $6.04 $6.04 $6.04 $33.76 $33.76 $110.09 $6.04 $111.20 $9.97 $7.10 $6.04 $80.62 $139.00 $8.76 $6.04 $5.58 $6.04 N/A N/A 30100027 EAP CPT® 80320 ALCOHOL SCREEN BLOOD OR BODY FLUID BOTH IP/OP $399.00 $295.50 $0.03 $399.00 $0.03 $0.03 $0.03 $0.03 $114.43 $114.43 $57.22 $6.63 $114.43 $296.14 $296.14 $307.55 $207.88 $15.96 $183.09 $183.09 $236.01 $114.43 $114.43 $114.43 $399.00 $299.25 $114.43 $114.43 $114.43 $199.50 $199.50 $316.01 $114.43 $319.20 $188.81 $15.20 $114.43 $231.42 $399.00 $239.40 $399.00 $11.94 $114.43 N/A N/A 30100028 EAP CPT® 82085 "ALDOLASE, SERUM" BOTH IP/OP $122.00 $90.50 $4.86 $122.00 $19.05 $19.05 $19.05 $19.05 $9.71 $9.71 $4.86 $4.86 $9.71 $14.74 $14.74 $15.30 $10.76 $14.33 $15.54 $15.54 $72.16 $9.71 $9.71 $9.71 $122.00 $91.50 $9.71 $9.71 $9.71 $54.24 $54.24 $96.62 $9.71 $97.60 $16.02 $13.65 $9.71 $70.76 $122.00 $14.08 $9.71 $10.72 $9.71 N/A N/A 30100029 EAP CPT® 82088 "ALDOSTERONE, SERUM" BOTH IP/OP $177.00 $131.00 $20.38 $177.00 $79.97 $79.97 $79.97 $79.97 $40.75 $40.75 $20.38 $20.38 $40.75 $61.88 $61.88 $64.26 $45.17 $60.21 $65.20 $65.20 $104.70 $40.75 $40.75 $40.75 $177.00 $132.75 $40.75 $40.75 $40.75 $177.00 $177.00 $140.18 $40.75 $141.60 $67.24 $57.34 $40.75 $102.66 $177.00 $59.09 $40.75 $45.04 $40.75 N/A N/A 30100030 EAP CPT® 82088 "ALDOSTERONE, UR-24HR" BOTH IP/OP $177.00 $131.00 $20.38 $177.00 $79.97 $79.97 $79.97 $79.97 $40.75 $40.75 $20.38 $20.38 $40.75 $61.88 $61.88 $64.26 $45.17 $60.21 $65.20 $65.20 $104.70 $40.75 $40.75 $40.75 $177.00 $132.75 $40.75 $40.75 $40.75 $177.00 $177.00 $140.18 $40.75 $141.60 $67.24 $57.34 $40.75 $102.66 $177.00 $59.09 $40.75 $45.04 $40.75 N/A N/A 30100031 EAP CPT® 82103 ALPHA-1-ANTITRYPSIN BOTH IP/OP $299.00 $221.50 $6.72 $299.00 $26.38 $26.38 $26.38 $26.38 $13.44 $13.44 $6.72 $6.72 $13.44 $20.39 $20.39 $21.18 $14.89 $19.85 $21.50 $21.50 $176.86 $13.44 $13.44 $13.44 $299.00 $224.25 $13.44 $13.44 $13.44 $75.08 $75.08 $236.81 $13.44 $239.20 $22.18 $18.90 $13.44 $173.42 $299.00 $19.49 $13.44 $14.85 $13.44 N/A N/A 30100032 EAP CPT® 82104 ALPHA-1 AT PHENOTYPE BOTH IP/OP $137.00 $101.50 $7.23 $137.00 $137.00 $137.00 $137.00 $137.00 $14.46 $14.46 $7.23 $137.00 $14.46 $21.95 $21.95 $22.80 $16.03 $21.36 $23.14 $23.14 $137.00 $14.46 $14.46 $14.46 $137.00 $102.75 $14.46 $14.46 $14.46 $80.80 $80.80 $108.50 $14.46 $109.60 $137.00 $137.00 $14.46 $79.46 $137.00 $20.97 $14.46 $137.00 $14.46 N/A N/A 30100033 EAP CPT® 82105 ALPHA-FETOPROTEIN BOTH IP/OP $258.00 $191.00 $8.39 $258.00 $32.93 $32.93 $32.93 $32.93 $16.77 $16.77 $8.39 $8.39 $16.77 $25.47 $25.47 $26.45 $18.59 $24.79 $26.83 $26.83 $152.61 $16.77 $16.77 $16.77 $258.00 $193.50 $16.77 $16.77 $16.77 $93.76 $93.76 $204.34 $16.77 $206.40 $27.67 $23.61 $16.77 $149.64 $258.00 $24.32 $16.77 $18.55 $16.77 N/A N/A 30100034 EAP CPT® 82105 "AFP,MATERNAL SERUM" BOTH IP/OP $239.00 $177.00 $8.39 $239.00 $32.93 $32.93 $32.93 $32.93 $16.77 $16.77 $8.39 $8.39 $16.77 $25.47 $25.47 $26.45 $18.59 $24.79 $26.83 $26.83 $141.37 $16.77 $16.77 $16.77 $239.00 $179.25 $16.77 $16.77 $16.77 $93.76 $93.76 $189.29 $16.77 $191.20 $27.67 $23.61 $16.77 $138.62 $239.00 $24.32 $16.77 $18.55 $16.77 N/A N/A 30100035 EAP CPT® 82105 ALPHA-FETOPROTEIN BOTH IP/OP $257.00 $190.50 $8.39 $257.00 $32.93 $32.93 $32.93 $32.93 $16.77 $16.77 $8.39 $8.39 $16.77 $25.47 $25.47 $26.45 $18.59 $24.79 $26.83 $26.83 $152.02 $16.77 $16.77 $16.77 $257.00 $192.75 $16.77 $16.77 $16.77 $93.76 $93.76 $203.54 $16.77 $205.60 $27.67 $23.61 $16.77 $149.06 $257.00 $24.32 $16.77 $18.55 $16.77 N/A N/A 30100036 EAP CPT® 82106 "AFP, AMNIOTIC FLUID" BOTH IP/OP $238.00 $176.50 $8.39 $238.00 $32.93 $32.93 $32.93 $32.93 $17.00 $17.00 $8.50 $8.39 $17.00 $25.47 $25.47 $26.45 $18.59 $24.79 $27.20 $27.20 $140.78 $17.00 $17.00 $17.00 $238.00 $178.50 $17.00 $17.00 $17.00 $93.76 $93.76 $188.50 $17.00 $190.40 $28.05 $23.61 $17.00 $138.04 $238.00 $24.65 $17.00 $18.55 $17.00 N/A N/A 30100037 EAP CPT® 82108 ALUMINUM BOTH IP/OP $88.00 $65.50 $12.74 $88.00 $88.00 $88.00 $88.00 $88.00 $25.48 $25.48 $12.74 $88.00 $25.48 $25.59 $25.59 $26.58 $18.68 $24.91 $40.77 $40.77 $88.00 $25.48 $25.48 $25.48 $88.00 $66.00 $25.48 $25.48 $25.48 $88.00 $88.00 $69.70 $25.48 $70.40 $88.00 $88.00 $25.48 $51.04 $88.00 $36.95 $25.48 $88.00 $25.48 N/A N/A 30100038 EAP CPT® 82128 "METABOLIC SCREEN,UR" BOTH IP/OP $278.00 $206.00 $6.94 $278.00 $278.00 $278.00 $278.00 $278.00 $13.87 $13.87 $6.94 $278.00 $13.87 $21.05 $21.05 $21.86 $15.37 $20.48 $22.19 $22.19 $278.00 $13.87 $13.87 $13.87 $278.00 $208.50 $13.87 $13.87 $13.87 $77.48 $77.48 $220.18 $13.87 $222.40 $278.00 $278.00 $13.87 $161.24 $278.00 $20.11 $13.87 $278.00 $13.87 N/A N/A 30100039 EAP CPT® 82128 "AMINO ACID-SCN,URINE" BOTH IP/OP $278.00 $206.00 $6.94 $278.00 $278.00 $278.00 $278.00 $278.00 $13.87 $13.87 $6.94 $278.00 $13.87 $21.05 $21.05 $21.86 $15.37 $20.48 $22.19 $22.19 $278.00 $13.87 $13.87 $13.87 $278.00 $208.50 $13.87 $13.87 $13.87 $77.48 $77.48 $220.18 $13.87 $222.40 $278.00 $278.00 $13.87 $161.24 $278.00 $20.11 $13.87 $278.00 $13.87 N/A N/A 30100040 EAP CPT® 82131 HOMOCYSTEINE BOTH IP/OP $158.00 $117.00 $10.34 $158.00 $33.11 $33.11 $33.11 $33.11 $22.98 $22.98 $11.49 $10.34 $22.98 $25.62 $25.62 $26.60 $18.70 $24.92 $36.77 $36.77 $93.46 $22.98 $22.98 $22.98 $158.00 $118.50 $22.98 $22.98 $22.98 $94.28 $94.28 $125.14 $22.98 $126.40 $37.92 $23.73 $22.98 $91.64 $158.00 $33.32 $22.98 $18.64 $22.98 N/A N/A 30100041 EAP CPT® 82131 "CYSTINE, URINE-24HR" BOTH IP/OP $165.00 $122.50 $10.34 $165.00 $33.11 $33.11 $33.11 $33.11 $22.98 $22.98 $11.49 $10.34 $22.98 $25.62 $25.62 $26.60 $18.70 $24.92 $36.77 $36.77 $97.60 $22.98 $22.98 $22.98 $165.00 $123.75 $22.98 $22.98 $22.98 $94.28 $94.28 $130.68 $22.98 $132.00 $37.92 $23.73 $22.98 $95.70 $165.00 $33.32 $22.98 $18.64 $22.98 N/A N/A 30100042 EAP CPT® 82139 "AMINO ACIDS-QNT,PLAS" BOTH IP/OP $490.00 $363.00 $8.44 $490.00 $490.00 $490.00 $490.00 $490.00 $16.87 $16.87 $8.44 $490.00 $16.87 $25.62 $25.62 $26.60 $18.70 $24.92 $26.99 $26.99 $490.00 $16.87 $16.87 $16.87 $490.00 $367.50 $16.87 $16.87 $16.87 $94.28 $94.28 $388.08 $16.87 $392.00 $490.00 $490.00 $16.87 $284.20 $490.00 $24.46 $16.87 $490.00 $16.87 N/A N/A 30100043 EAP CPT® 82139 AMINO ACIDS - QNT BOTH IP/OP $490.00 $363.00 $8.44 $490.00 $490.00 $490.00 $490.00 $490.00 $16.87 $16.87 $8.44 $490.00 $16.87 $25.62 $25.62 $26.60 $18.70 $24.92 $26.99 $26.99 $490.00 $16.87 $16.87 $16.87 $490.00 $367.50 $16.87 $16.87 $16.87 $94.28 $94.28 $388.08 $16.87 $392.00 $490.00 $490.00 $16.87 $284.20 $490.00 $24.46 $16.87 $490.00 $16.87 N/A N/A 30100044 EAP CPT® 82140 "AMMONIA,BLOOD" BOTH IP/OP $317.00 $235.00 $7.29 $317.00 $19.40 $19.40 $19.40 $19.40 $14.57 $14.57 $7.29 $7.29 $14.57 $15.02 $15.02 $15.60 $10.96 $14.62 $23.31 $23.31 $187.51 $14.57 $14.57 $14.57 $317.00 $237.75 $14.57 $14.57 $14.57 $55.28 $55.28 $251.06 $14.57 $253.60 $24.04 $13.92 $14.57 $183.86 $317.00 $21.13 $14.57 $10.93 $14.57 N/A N/A 30100045 EAP CPT® 83605 "LACTATE ( LACTIC ACID),EVD" BOTH IP/OP $258.00 $191.00 $5.34 $258.00 $20.96 $20.96 $20.96 $20.96 $11.57 $11.57 $5.79 $5.34 $11.57 $16.21 $16.21 $16.84 $11.84 $15.78 $18.51 $18.51 $152.61 $11.57 $11.57 $11.57 $258.00 $193.50 $11.57 $11.57 $11.57 $59.68 $59.68 $204.34 $11.57 $206.40 $19.09 $15.03 $11.57 $149.64 $258.00 $16.78 $11.57 $11.81 $11.57 N/A N/A 30100046 EAP CPT® 82150 "AMYLASE,SERUM" BOTH IP/OP $301.00 $223.00 $3.24 $301.00 $12.73 $12.73 $12.73 $12.73 $6.48 $6.48 $3.24 $3.24 $6.48 $9.84 $9.84 $10.22 $7.18 $9.58 $10.37 $10.37 $178.04 $6.48 $6.48 $6.48 $301.00 $225.75 $6.48 $6.48 $6.48 $36.24 $36.24 $238.39 $6.48 $240.80 $10.69 $9.12 $6.48 $174.58 $301.00 $9.40 $6.48 $7.16 $6.48 N/A N/A 30100047 EAP CPT® 82150 "AMYLASE,FLUID" BOTH IP/OP $301.00 $223.00 $3.24 $301.00 $12.73 $12.73 $12.73 $12.73 $6.48 $6.48 $3.24 $3.24 $6.48 $9.84 $9.84 $10.22 $7.18 $9.58 $10.37 $10.37 $178.04 $6.48 $6.48 $6.48 $301.00 $225.75 $6.48 $6.48 $6.48 $36.24 $36.24 $238.39 $6.48 $240.80 $10.69 $9.12 $6.48 $174.58 $301.00 $9.40 $6.48 $7.16 $6.48 N/A N/A 30100048 EAP CPT® 82150 "AMYLASE,URINE" BOTH IP/OP $283.00 $209.50 $3.24 $283.00 $12.73 $12.73 $12.73 $12.73 $6.48 $6.48 $3.24 $3.24 $6.48 $9.84 $9.84 $10.22 $7.18 $9.58 $10.37 $10.37 $167.39 $6.48 $6.48 $6.48 $283.00 $212.25 $6.48 $6.48 $6.48 $36.24 $36.24 $224.14 $6.48 $226.40 $10.69 $9.12 $6.48 $164.14 $283.00 $9.40 $6.48 $7.16 $6.48 N/A N/A 30100049 EAP CPT® 82157 ANDROSTENEDIONE BOTH IP/OP $251.00 $186.00 $14.64 $251.00 $57.45 $57.45 $57.45 $57.45 $29.28 $29.28 $14.64 $14.64 $29.28 $44.45 $44.45 $46.16 $32.45 $43.24 $46.85 $46.85 $148.47 $29.28 $29.28 $29.28 $251.00 $188.25 $29.28 $29.28 $29.28 $163.60 $163.60 $198.79 $29.28 $200.80 $48.31 $41.18 $29.28 $145.58 $251.00 $42.46 $29.28 $32.35 $29.28 N/A N/A 30100050 EAP CPT® 82164 ANGIO-1 CONVERT ENZ. BOTH IP/OP $325.00 $240.50 $7.30 $325.00 $28.66 $28.66 $28.66 $28.66 $14.60 $14.60 $7.30 $7.30 $14.60 $22.16 $22.16 $23.01 $16.18 $21.56 $23.36 $23.36 $192.24 $14.60 $14.60 $14.60 $325.00 $243.75 $14.60 $14.60 $14.60 $81.56 $81.56 $257.40 $14.60 $260.00 $24.09 $20.53 $14.60 $188.50 $325.00 $21.17 $14.60 $16.13 $14.60 N/A N/A 30100051 EAP CPT® 82164 ANGIO-1 CONV ENZ-CSF BOTH IP/OP $325.00 $240.50 $7.30 $325.00 $28.66 $28.66 $28.66 $28.66 $14.60 $14.60 $7.30 $7.30 $14.60 $22.16 $22.16 $23.01 $16.18 $21.56 $23.36 $23.36 $192.24 $14.60 $14.60 $14.60 $325.00 $243.75 $14.60 $14.60 $14.60 $81.56 $81.56 $257.40 $14.60 $260.00 $24.09 $20.53 $14.60 $188.50 $325.00 $21.17 $14.60 $16.13 $14.60 N/A N/A 30100052 EAP CPT® 82175 "ARSENIC,URINE-24HR" BOTH IP/OP $97.00 $72.00 $9.49 $97.00 $37.22 $37.22 $37.22 $37.22 $18.97 $18.97 $9.49 $9.49 $18.97 $28.81 $28.81 $29.92 $21.03 $28.02 $30.35 $30.35 $57.38 $18.97 $18.97 $18.97 $97.00 $72.75 $18.97 $18.97 $18.97 $97.00 $97.00 $76.82 $18.97 $77.60 $31.30 $26.69 $18.97 $56.26 $97.00 $27.51 $18.97 $20.96 $18.97 N/A N/A 30100053 EAP CPT® 82180 "VITAMIN C, SERUM" BOTH IP/OP $155.00 $115.00 $4.94 $155.00 $17.32 $17.32 $17.32 $17.32 $9.89 $9.89 $4.95 $4.94 $9.89 $13.42 $13.42 $13.93 $9.79 $13.05 $15.82 $15.82 $91.68 $9.89 $9.89 $9.89 $155.00 $116.25 $9.89 $9.89 $9.89 $49.36 $49.36 $122.76 $9.89 $124.00 $16.32 $12.43 $9.89 $89.90 $155.00 $14.34 $9.89 $9.76 $9.89 N/A N/A 30100054 EAP CPT® 80345 PENTOBARBITAL-QUANT BOTH IP/OP $245.00 $181.50 $0.03 $245.00 $0.03 $0.03 $0.03 $0.03 $245.00 $245.00 $12.01 $7.03 $245.00 $181.84 $181.84 $188.85 $127.65 $16.93 $245.00 $98.00 $144.92 $245.00 $245.00 $245.00 $245.00 $183.75 $245.00 $245.00 $245.00 $122.50 $122.50 $194.04 $245.00 $196.00 $159.25 $16.12 $245.00 $142.10 $245.00 $147.00 $245.00 $12.66 $245.00 N/A N/A 30100055 EAP CPT® 82232 BETA-2 MICROGLOBULIN BOTH IP/OP $219.00 $162.50 $8.09 $219.00 $31.75 $31.75 $31.75 $31.75 $16.18 $16.18 $8.09 $8.09 $16.18 $24.56 $24.56 $25.51 $17.93 $23.91 $25.89 $25.89 $129.54 $16.18 $16.18 $16.18 $219.00 $164.25 $16.18 $16.18 $16.18 $90.44 $90.44 $173.45 $16.18 $175.20 $26.70 $22.77 $16.18 $127.02 $219.00 $23.46 $16.18 $17.89 $16.18 N/A N/A 30100056 EAP CPT® 82239 "BILE ACIDS, SERUM" BOTH IP/OP $261.00 $193.50 $8.56 $261.00 $33.61 $33.61 $33.61 $33.61 $17.12 $17.12 $8.56 $8.56 $17.12 $26.01 $26.01 $27.01 $18.99 $25.32 $27.39 $27.39 $154.38 $17.12 $17.12 $17.12 $261.00 $195.75 $17.12 $17.12 $17.12 $95.76 $95.76 $206.71 $17.12 $208.80 $28.25 $24.11 $17.12 $151.38 $261.00 $24.82 $17.12 $18.94 $17.12 N/A N/A 30100057 EAP CPT® 82247 "BILIRUBIN,TOTAL" BOTH IP/OP $117.00 $87.00 $2.51 $117.00 $9.84 $9.84 $9.84 $9.84 $5.02 $5.02 $2.51 $2.51 $5.02 $7.62 $7.62 $7.92 $5.56 $7.42 $8.03 $8.03 $69.21 $5.02 $5.02 $5.02 $117.00 $87.75 $5.02 $5.02 $5.02 $28.08 $28.08 $92.66 $5.02 $93.60 $8.28 $7.07 $5.02 $67.86 $117.00 $7.28 $5.02 $5.55 $5.02 N/A N/A 30100058 EAP CPT® 82150 "AMYLASE, EVD" BOTH IP/OP $283.00 $209.50 $3.24 $283.00 $12.73 $12.73 $12.73 $12.73 $6.48 $6.48 $3.24 $3.24 $6.48 $9.84 $9.84 $10.22 $7.18 $9.58 $10.37 $10.37 $167.39 $6.48 $6.48 $6.48 $283.00 $212.25 $6.48 $6.48 $6.48 $36.24 $36.24 $224.14 $6.48 $226.40 $10.69 $9.12 $6.48 $164.14 $283.00 $9.40 $6.48 $7.16 $6.48 N/A N/A 30100059 EAP CPT® 82247 "BILI, TOTAL-FLUID" BOTH IP/OP $118.00 $87.50 $2.51 $118.00 $9.84 $9.84 $9.84 $9.84 $5.02 $5.02 $2.51 $2.51 $5.02 $7.62 $7.62 $7.92 $5.56 $7.42 $8.03 $8.03 $69.80 $5.02 $5.02 $5.02 $118.00 $88.50 $5.02 $5.02 $5.02 $28.08 $28.08 $93.46 $5.02 $94.40 $8.28 $7.07 $5.02 $68.44 $118.00 $7.28 $5.02 $5.55 $5.02 N/A N/A 30100060 EAP CPT® 82248 "BILIRUBIN,DIRECT" BOTH IP/OP $117.00 $87.00 $2.51 $117.00 $9.84 $9.84 $9.84 $9.84 $5.02 $5.02 $2.51 $2.51 $5.02 $7.62 $7.62 $7.92 $5.56 $7.42 $8.03 $8.03 $69.21 $5.02 $5.02 $5.02 $117.00 $87.75 $5.02 $5.02 $5.02 $28.08 $28.08 $92.66 $5.02 $93.60 $8.28 $7.07 $5.02 $67.86 $117.00 $7.28 $5.02 $5.55 $5.02 N/A N/A 30100061 EAP CPT® 82248 "BILI, DIRECT - FLUID" BOTH IP/OP $117.00 $87.00 $2.51 $117.00 $9.84 $9.84 $9.84 $9.84 $5.02 $5.02 $2.51 $2.51 $5.02 $7.62 $7.62 $7.92 $5.56 $7.42 $8.03 $8.03 $69.21 $5.02 $5.02 $5.02 $117.00 $87.75 $5.02 $5.02 $5.02 $28.08 $28.08 $92.66 $5.02 $93.60 $8.28 $7.07 $5.02 $67.86 $117.00 $7.28 $5.02 $5.55 $5.02 N/A N/A 30100062 EAP CPT® 84100 "PHOSPHORUS, EVD" BOTH IP/OP $128.00 $95.00 $2.37 $128.00 $9.31 $9.31 $9.31 $9.31 $4.74 $4.74 $2.37 $2.37 $4.74 $7.21 $7.21 $7.48 $5.26 $7.01 $7.58 $7.58 $75.71 $4.74 $4.74 $4.74 $128.00 $96.00 $4.74 $4.74 $4.74 $26.52 $26.52 $101.38 $4.74 $102.40 $7.82 $6.68 $4.74 $74.24 $128.00 $6.87 $4.74 $5.25 $4.74 N/A N/A 30100063 EAP CPT® 83735 "MAGNESIUM,EVD" BOTH IP/OP $160.00 $118.50 $3.35 $160.00 $13.15 $13.15 $13.15 $13.15 $6.70 $6.70 $3.35 $3.35 $6.70 $10.17 $10.17 $10.56 $7.42 $9.89 $10.72 $10.72 $94.64 $6.70 $6.70 $6.70 $160.00 $120.00 $6.70 $6.70 $6.70 $37.44 $37.44 $126.72 $6.70 $128.00 $11.06 $9.42 $6.70 $92.80 $160.00 $9.72 $6.70 $7.40 $6.70 N/A N/A 30100064 EAP CPT® 87536 "HIV -1 RNA, QUANT,RT-PCR (QUEST)" BOTH IP/OP $269.00 $199.50 $42.55 $269.00 $101.83 $101.83 $101.83 $101.83 $85.10 $85.10 $42.55 $42.55 $85.10 $78.80 $78.80 $81.83 $57.52 $66.37 $136.16 $136.16 $159.11 $85.10 $85.10 $85.10 $269.00 $201.75 $85.10 $85.10 $85.10 $269.00 $269.00 $213.05 $85.10 $215.20 $140.42 $63.21 $85.10 $156.02 $269.00 $123.40 $85.10 $49.65 $85.10 N/A N/A 30100065 EAP CPT® 83519 PTH-REALATED PROTEIN SO BOTH IP/OP $434.00 $321.50 $8.28 $434.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $256.71 $18.40 $18.40 $18.40 $434.00 $325.50 $18.40 $18.40 $18.40 $75.52 $75.52 $343.73 $18.40 $347.20 $30.36 $19.01 $18.40 $251.72 $434.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30100066 EAP CPT® 82270 "OCCULT BLOOD, STOOL" BOTH IP/OP $58.00 $43.00 $2.19 $58.00 $58.00 $58.00 $58.00 $58.00 $4.38 $4.38 $2.19 $58.00 $4.38 $4.88 $4.88 $5.07 $3.56 $4.75 $7.01 $7.01 $58.00 $4.38 $4.38 $4.38 $58.00 $43.50 $4.38 $4.38 $4.38 $17.96 $17.96 $45.94 $4.38 $46.40 $58.00 $58.00 $4.38 $33.64 $58.00 $6.35 $4.38 $58.00 $4.38 N/A N/A 30100067 EAP CPT® 82271 "OCCULT BLOOD, GASTRIC" BOTH IP/OP $57.00 $42.50 $2.66 $57.00 $57.00 $57.00 $57.00 $57.00 $5.32 $5.32 $2.66 $57.00 $5.32 $4.88 $4.88 $5.07 $3.56 $4.75 $8.51 $8.51 $57.00 $5.32 $5.32 $5.32 $57.00 $42.75 $5.32 $5.32 $5.32 $17.96 $17.96 $45.14 $5.32 $45.60 $57.00 $57.00 $5.32 $33.06 $57.00 $7.71 $5.32 $57.00 $5.32 N/A N/A 30100068 EAP CPT® 82306 "VITAMIN D, SERUM" BOTH IP/OP $279.00 $206.50 $14.80 $279.00 $58.11 $58.11 $58.11 $58.11 $29.60 $29.60 $14.80 $14.80 $29.60 $44.95 $44.95 $46.68 $32.81 $43.72 $47.36 $47.36 $165.03 $29.60 $29.60 $29.60 $279.00 $209.25 $29.60 $29.60 $29.60 $165.44 $165.44 $220.97 $29.60 $223.20 $48.84 $41.64 $29.60 $161.82 $279.00 $42.92 $29.60 $32.71 $29.60 N/A N/A 30100069 EAP CPT® 82308 "CALCITONIN, SERUM" BOTH IP/OP $138.00 $102.50 $13.40 $138.00 $52.58 $52.58 $52.58 $52.58 $26.79 $26.79 $13.40 $13.40 $26.79 $40.66 $40.66 $42.23 $29.68 $39.55 $42.86 $42.86 $81.63 $26.79 $26.79 $26.79 $138.00 $103.50 $26.79 $26.79 $26.79 $138.00 $138.00 $109.30 $26.79 $110.40 $44.20 $37.67 $26.79 $80.04 $138.00 $38.85 $26.79 $29.59 $26.79 N/A N/A 30100070 EAP CPT® 82310 CALCIUM BOTH IP/OP $102.00 $75.50 $2.58 $102.00 $10.14 $10.14 $10.14 $10.14 $5.16 $5.16 $2.58 $2.58 $5.16 $7.83 $7.83 $8.13 $5.72 $7.46 $8.26 $8.26 $60.33 $5.16 $5.16 $5.16 $102.00 $76.50 $5.16 $5.16 $5.16 $28.80 $28.80 $80.78 $5.16 $81.60 $8.51 $7.10 $5.16 $59.16 $102.00 $7.48 $5.16 $5.58 $5.16 N/A N/A 30100071 EAP CPT® 82310 "CALCIUM,SYNVL FLUID" BOTH IP/OP $102.00 $75.50 $2.58 $102.00 $10.14 $10.14 $10.14 $10.14 $5.16 $5.16 $2.58 $2.58 $5.16 $7.83 $7.83 $8.13 $5.72 $7.46 $8.26 $8.26 $60.33 $5.16 $5.16 $5.16 $102.00 $76.50 $5.16 $5.16 $5.16 $28.80 $28.80 $80.78 $5.16 $81.60 $8.51 $7.10 $5.16 $59.16 $102.00 $7.48 $5.16 $5.58 $5.16 N/A N/A 30100072 EAP CPT® 82310 "CALCIUM, URINE" BOTH IP/OP $90.00 $67.00 $2.58 $90.00 $10.14 $10.14 $10.14 $10.14 $5.16 $5.16 $2.58 $2.58 $5.16 $7.83 $7.83 $8.13 $5.72 $7.46 $8.26 $8.26 $53.24 $5.16 $5.16 $5.16 $90.00 $67.50 $5.16 $5.16 $5.16 $28.80 $28.80 $71.28 $5.16 $72.00 $8.51 $7.10 $5.16 $52.20 $90.00 $7.48 $5.16 $5.58 $5.16 N/A N/A 30100073 EAP CPT® 82330 "CALCIUM,IONIZED,WB" BOTH IP/OP $375.00 $277.50 $6.84 $375.00 $26.83 $26.83 $26.83 $26.83 $13.68 $13.68 $6.84 $6.84 $13.68 $20.75 $20.75 $21.55 $15.15 $20.18 $21.89 $21.89 $221.81 $13.68 $13.68 $13.68 $375.00 $281.25 $13.68 $13.68 $13.68 $76.36 $76.36 $297.00 $13.68 $300.00 $22.57 $19.22 $13.68 $217.50 $375.00 $19.84 $13.68 $15.10 $13.68 N/A N/A 30100074 EAP CPT® 82365 STONE ANALYSIS BOTH IP/OP $399.00 $295.50 $6.45 $399.00 $25.30 $25.30 $25.30 $25.30 $12.90 $12.90 $6.45 $6.45 $12.90 $19.58 $19.58 $20.34 $14.30 $19.05 $20.64 $20.64 $236.01 $12.90 $12.90 $12.90 $399.00 $299.25 $12.90 $12.90 $12.90 $72.04 $72.04 $316.01 $12.90 $319.20 $21.29 $18.14 $12.90 $231.42 $399.00 $18.71 $12.90 $14.25 $12.90 N/A N/A 30100075 EAP CPT® 82374 CO2 CONTENT BOTH IP/OP $35.00 $26.00 $2.44 $35.00 $35.00 $35.00 $35.00 $35.00 $4.88 $4.88 $2.44 $35.00 $4.88 $7.43 $7.43 $7.71 $5.42 $7.22 $7.81 $7.81 $35.00 $4.88 $4.88 $4.88 $35.00 $26.25 $4.88 $4.88 $4.88 $27.32 $27.32 $27.72 $4.88 $28.00 $35.00 $35.00 $4.88 $20.30 $35.00 $7.08 $4.88 $35.00 $4.88 N/A N/A 30100076 EAP CPT® 82378 CEA BOTH IP/OP $302.00 $223.50 $9.48 $302.00 $37.22 $37.22 $37.22 $37.22 $18.96 $18.96 $9.48 $9.48 $18.96 $28.81 $28.81 $29.92 $21.03 $28.02 $30.34 $30.34 $178.63 $18.96 $18.96 $18.96 $302.00 $226.50 $18.96 $18.96 $18.96 $106.04 $106.04 $239.18 $18.96 $241.60 $31.28 $26.69 $18.96 $175.16 $302.00 $27.49 $18.96 $20.96 $18.96 N/A N/A 30100077 EAP CPT® 82379 "CARNITINE, TOTAL" BOTH IP/OP $157.00 $116.50 $8.44 $157.00 $157.00 $157.00 $157.00 $157.00 $16.87 $16.87 $8.44 $157.00 $16.87 $25.62 $25.62 $26.60 $18.70 $24.92 $26.99 $26.99 $157.00 $16.87 $16.87 $16.87 $157.00 $117.75 $16.87 $16.87 $16.87 $94.28 $94.28 $124.34 $16.87 $125.60 $157.00 $157.00 $16.87 $91.06 $157.00 $24.46 $16.87 $157.00 $16.87 N/A N/A 30100078 EAP CPT® 82379 "CARNITINE, FREE" BOTH IP/OP $157.00 $116.50 $8.44 $157.00 $157.00 $157.00 $157.00 $157.00 $16.87 $16.87 $8.44 $157.00 $16.87 $25.62 $25.62 $26.60 $18.70 $24.92 $26.99 $26.99 $157.00 $16.87 $16.87 $16.87 $157.00 $117.75 $16.87 $16.87 $16.87 $94.28 $94.28 $124.34 $16.87 $125.60 $157.00 $157.00 $16.87 $91.06 $157.00 $24.46 $16.87 $157.00 $16.87 N/A N/A 30100079 EAP CPT® 82380 "CAROTENE, SERUM" BOTH IP/OP $120.00 $89.00 $4.61 $120.00 $120.00 $120.00 $120.00 $120.00 $9.22 $9.22 $4.61 $120.00 $9.22 $14.01 $14.01 $14.55 $10.23 $13.63 $14.75 $14.75 $120.00 $9.22 $9.22 $9.22 $120.00 $90.00 $9.22 $9.22 $9.22 $51.56 $51.56 $95.04 $9.22 $96.00 $120.00 $120.00 $9.22 $69.60 $120.00 $13.37 $9.22 $120.00 $9.22 N/A N/A 30100080 EAP CPT® 82384 "CATECHOLAMINES,PLASM" BOTH IP/OP $173.00 $128.50 $12.63 $173.00 $49.55 $49.55 $49.55 $49.55 $25.25 $25.25 $12.63 $12.63 $25.25 $38.34 $38.34 $39.82 $27.99 $37.30 $40.40 $40.40 $102.33 $25.25 $25.25 $25.25 $173.00 $129.75 $25.25 $25.25 $25.25 $141.12 $141.12 $137.02 $25.25 $138.40 $41.66 $35.52 $25.25 $100.34 $173.00 $36.61 $25.25 $27.90 $25.25 N/A N/A 30100081 EAP CPT® 82384 "CATECHOLAM.,UR FRAC" BOTH IP/OP $173.00 $128.50 $12.63 $173.00 $49.55 $49.55 $49.55 $49.55 $25.25 $25.25 $12.63 $12.63 $25.25 $38.34 $38.34 $39.82 $27.99 $37.30 $40.40 $40.40 $102.33 $25.25 $25.25 $25.25 $173.00 $129.75 $25.25 $25.25 $25.25 $141.12 $141.12 $137.02 $25.25 $138.40 $41.66 $35.52 $25.25 $100.34 $173.00 $36.61 $25.25 $27.90 $25.25 N/A N/A 30100082 EAP CPT® 82390 "CERULOPLASMIN,SERUM" BOTH IP/OP $236.00 $175.00 $5.37 $236.00 $21.08 $21.08 $21.08 $21.08 $10.74 $10.74 $5.37 $5.37 $10.74 $16.31 $16.31 $16.93 $11.90 $15.87 $17.18 $17.18 $139.59 $10.74 $10.74 $10.74 $236.00 $177.00 $10.74 $10.74 $10.74 $60.04 $60.04 $186.91 $10.74 $188.80 $17.72 $15.11 $10.74 $136.88 $236.00 $15.57 $10.74 $11.87 $10.74 N/A N/A 30100083 EAP CPT® 82415 CHLORAMPHEN-PEAK BOTH IP/OP $145.00 $107.50 $6.34 $145.00 $145.00 $145.00 $145.00 $145.00 $12.67 $12.67 $6.34 $145.00 $12.67 $19.24 $19.24 $19.98 $14.05 $18.71 $20.27 $20.27 $145.00 $12.67 $12.67 $12.67 $145.00 $108.75 $12.67 $12.67 $12.67 $70.80 $70.80 $114.84 $12.67 $116.00 $145.00 $145.00 $12.67 $84.10 $145.00 $18.37 $12.67 $145.00 $12.67 N/A N/A 30100084 EAP CPT® 82435 CHLORIDE BOTH IP/OP $117.00 $87.00 $2.30 $117.00 $9.04 $9.04 $9.04 $9.04 $4.60 $4.60 $2.30 $2.30 $4.60 $6.97 $6.97 $7.24 $5.09 $6.79 $7.36 $7.36 $69.21 $4.60 $4.60 $4.60 $117.00 $87.75 $4.60 $4.60 $4.60 $25.68 $25.68 $92.66 $4.60 $93.60 $7.59 $6.47 $4.60 $67.86 $117.00 $6.67 $4.60 $5.08 $4.60 N/A N/A 30100085 EAP CPT® 82436 "CHLORIDE, URINE" BOTH IP/OP $123.00 $91.50 $2.59 $123.00 $9.86 $9.86 $9.86 $9.86 $5.75 $5.75 $2.88 $2.59 $5.75 $7.63 $7.63 $7.93 $5.57 $7.42 $9.20 $9.20 $72.75 $5.75 $5.75 $5.75 $123.00 $92.25 $5.75 $5.75 $5.75 $28.08 $28.08 $97.42 $5.75 $98.40 $9.49 $7.07 $5.75 $71.34 $123.00 $8.34 $5.75 $5.55 $5.75 N/A N/A 30100086 EAP CPT® 82438 "CHLORIDE,FLUID" BOTH IP/OP $105.00 $78.00 $2.50 $105.00 $105.00 $105.00 $105.00 $105.00 $5.00 $5.00 $2.50 $105.00 $5.00 $7.43 $7.43 $7.71 $5.42 $7.22 $8.00 $8.00 $105.00 $5.00 $5.00 $5.00 $105.00 $78.75 $5.00 $5.00 $5.00 $27.32 $27.32 $83.16 $5.00 $84.00 $105.00 $105.00 $5.00 $60.90 $105.00 $7.25 $5.00 $105.00 $5.00 N/A N/A 30100087 EAP CPT® 87798 "TOXOPLASMA GONDII DNA,QUAL,PCR SO" BOTH IP/OP $422.00 $312.50 $17.55 $422.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $249.61 $35.09 $35.09 $35.09 $422.00 $316.50 $35.09 $35.09 $35.09 $109.64 $109.64 $334.22 $35.09 $337.60 $57.90 $27.60 $35.09 $244.76 $422.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30100088 EAP CPT® 82465 CHOLESTEROL BOTH IP/OP $91.00 $67.50 $2.18 $91.00 $8.53 $8.53 $8.53 $8.53 $4.35 $4.35 $2.18 $2.18 $4.35 $6.61 $6.61 $6.87 $4.83 $6.43 $6.96 $6.96 $53.83 $4.35 $4.35 $4.35 $91.00 $68.25 $4.35 $4.35 $4.35 $24.32 $24.32 $72.07 $4.35 $72.80 $7.18 $6.12 $4.35 $52.78 $91.00 $6.31 $4.35 $4.81 $4.35 N/A N/A 30100090 EAP CPT® 82384 "CATACHOLAMINES,FRAC,UR SO" BOTH IP/OP $46.00 $34.50 $12.63 $46.00 $46.00 $46.00 $46.00 $46.00 $25.25 $25.25 $12.63 $12.63 $25.25 $38.34 $38.34 $39.82 $27.99 $37.30 $40.40 $40.40 $27.21 $25.25 $25.25 $25.25 $46.00 $34.50 $25.25 $25.25 $25.25 $46.00 $46.00 $36.43 $25.25 $36.80 $41.66 $35.52 $25.25 $26.68 $46.00 $36.61 $25.25 $27.90 $25.25 N/A N/A 30100096 EAP CPT® 82507 "CITRIC ACID, UR-24HR" BOTH IP/OP $129.00 $95.50 $13.90 $129.00 $129.00 $129.00 $129.00 $129.00 $27.80 $27.80 $13.90 $129.00 $27.80 $42.22 $42.22 $43.85 $30.82 $41.08 $44.48 $44.48 $129.00 $27.80 $27.80 $27.80 $129.00 $96.75 $27.80 $27.80 $27.80 $129.00 $129.00 $102.17 $27.80 $103.20 $129.00 $129.00 $27.80 $74.82 $129.00 $40.31 $27.80 $129.00 $27.80 N/A N/A 30100097 EAP CPT® 82523 PYRIDINOLINE BOTH IP/OP $88.00 $65.50 $9.34 $88.00 $88.00 $88.00 $88.00 $88.00 $18.68 $18.68 $9.34 $88.00 $18.68 $28.38 $28.38 $29.47 $20.72 $27.60 $29.89 $29.89 $88.00 $18.68 $18.68 $18.68 $88.00 $66.00 $18.68 $18.68 $18.68 $88.00 $88.00 $69.70 $18.68 $70.40 $88.00 $88.00 $18.68 $51.04 $88.00 $27.09 $18.68 $88.00 $18.68 N/A N/A 30100098 EAP CPT® 82525 "COPPER, SERUM" BOTH IP/OP $127.00 $94.00 $6.21 $127.00 $24.35 $24.35 $24.35 $24.35 $12.41 $12.41 $6.21 $6.21 $12.41 $18.84 $18.84 $19.57 $13.76 $18.33 $19.86 $19.86 $75.12 $12.41 $12.41 $12.41 $127.00 $95.25 $12.41 $12.41 $12.41 $69.36 $69.36 $100.58 $12.41 $101.60 $20.48 $17.46 $12.41 $73.66 $127.00 $17.99 $12.41 $13.71 $12.41 N/A N/A 30100099 EAP CPT® 82525 "COPPER, URINE-24HR" BOTH IP/OP $127.00 $94.00 $6.21 $127.00 $24.35 $24.35 $24.35 $24.35 $12.41 $12.41 $6.21 $6.21 $12.41 $18.84 $18.84 $19.57 $13.76 $18.33 $19.86 $19.86 $75.12 $12.41 $12.41 $12.41 $127.00 $95.25 $12.41 $12.41 $12.41 $69.36 $69.36 $100.58 $12.41 $101.60 $20.48 $17.46 $12.41 $73.66 $127.00 $17.99 $12.41 $13.71 $12.41 N/A N/A 30100100 EAP CPT® 82530 "CORTISOL FREE, UR-24H" BOTH IP/OP $302.00 $223.50 $8.36 $302.00 $32.78 $32.78 $32.78 $32.78 $16.71 $16.71 $8.36 $8.36 $16.71 $25.39 $25.39 $26.36 $18.53 $24.70 $26.74 $26.74 $178.63 $16.71 $16.71 $16.71 $302.00 $226.50 $16.71 $16.71 $16.71 $93.40 $93.40 $239.18 $16.71 $241.60 $27.57 $23.52 $16.71 $175.16 $302.00 $24.23 $16.71 $18.47 $16.71 N/A N/A 30100101 EAP CPT® 82533 "CORTISOL,SERUM" BOTH IP/OP $650.00 $481.00 $8.15 $650.00 $32.00 $32.00 $32.00 $32.00 $16.30 $16.30 $8.15 $8.15 $16.30 $24.76 $24.76 $25.71 $18.08 $24.09 $26.08 $26.08 $384.48 $16.30 $16.30 $16.30 $650.00 $487.50 $16.30 $16.30 $16.30 $91.12 $91.12 $514.80 $16.30 $520.00 $26.90 $22.94 $16.30 $377.00 $650.00 $23.64 $16.30 $18.02 $16.30 N/A N/A 30100102 EAP CPT® 82542 "THIOPURINE METHYL TRANSFERASE, QT" BOTH IP/OP $791.00 $585.50 $6.64 $791.00 $35.44 $35.44 $35.44 $35.44 $24.09 $24.09 $12.05 $10.84 $24.09 $9.12 $9.12 $9.47 $6.66 $8.87 $38.54 $38.54 $467.88 $24.09 $24.09 $24.09 $791.00 $593.25 $24.09 $24.09 $24.09 $33.56 $33.56 $626.47 $24.09 $632.80 $39.75 $8.45 $24.09 $458.78 $791.00 $34.93 $24.09 $6.64 $24.09 N/A N/A 30100103 EAP CPT® 82550 "CPK,TOTAL-SERUM" BOTH IP/OP $176.00 $130.50 $3.25 $176.00 $12.78 $12.78 $12.78 $12.78 $6.51 $6.51 $3.26 $3.25 $6.51 $9.89 $9.89 $10.27 $7.22 $7.46 $10.42 $10.42 $104.10 $6.51 $6.51 $6.51 $176.00 $132.00 $6.51 $6.51 $6.51 $36.40 $36.40 $139.39 $6.51 $140.80 $10.74 $7.10 $6.51 $102.08 $176.00 $9.44 $6.51 $5.58 $6.51 N/A N/A 30100104 EAP CPT® 82656 PANCREATIC ELASTASE-1 SO BOTH IP/OP $226.00 $167.50 $5.76 $226.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $47.10 $18.45 $18.45 $133.68 $11.53 $11.53 $11.53 $226.00 $169.50 $11.53 $11.53 $11.53 $59.76 $59.76 $178.99 $11.53 $180.80 $19.02 $44.86 $11.53 $131.08 $226.00 $16.72 $11.53 $47.10 $11.53 N/A N/A 30100105 EAP CPT® 82553 CKMB-MEIA BOTH IP/OP $355.00 $263.00 $5.77 $355.00 $22.67 $22.67 $22.67 $22.67 $11.55 $11.55 $5.78 $5.77 $11.55 $17.53 $17.53 $18.21 $12.80 $17.05 $18.48 $18.48 $209.98 $11.55 $11.55 $11.55 $355.00 $266.25 $11.55 $11.55 $11.55 $64.52 $64.52 $281.16 $11.55 $284.00 $19.06 $16.24 $11.55 $205.90 $355.00 $16.75 $11.55 $12.76 $11.55 N/A N/A 30100106 EAP CPT® 82565 CREATININE BOTH IP/OP $139.00 $103.00 $2.56 $139.00 $10.07 $10.07 $10.07 $10.07 $5.12 $5.12 $2.56 $2.56 $5.12 $7.78 $7.78 $8.08 $5.68 $7.46 $8.19 $8.19 $82.22 $5.12 $5.12 $5.12 $139.00 $104.25 $5.12 $5.12 $5.12 $28.64 $28.64 $110.09 $5.12 $111.20 $8.45 $7.10 $5.12 $80.62 $139.00 $7.42 $5.12 $5.58 $5.12 N/A N/A 30100107 EAP CPT® 82570 "CREATININE,FLUID" BOTH IP/OP $122.00 $90.50 $2.59 $122.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $72.16 $5.18 $5.18 $5.18 $122.00 $91.50 $5.18 $5.18 $5.18 $28.92 $28.92 $96.62 $5.18 $97.60 $8.55 $7.28 $5.18 $70.76 $122.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30100108 EAP CPT® 82570 "CREAT,AMNIOTIC FLD" BOTH IP/OP $129.00 $95.50 $2.59 $129.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $76.30 $5.18 $5.18 $5.18 $129.00 $96.75 $5.18 $5.18 $5.18 $28.92 $28.92 $102.17 $5.18 $103.20 $8.55 $7.28 $5.18 $74.82 $129.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30100109 EAP CPT® 82570 "CREATININE, URINE" BOTH IP/OP $122.00 $90.50 $2.59 $122.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $72.16 $5.18 $5.18 $5.18 $122.00 $91.50 $5.18 $5.18 $5.18 $28.92 $28.92 $96.62 $5.18 $97.60 $8.55 $7.28 $5.18 $70.76 $122.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30100110 EAP CPT® 82108 "ALUMINUM, 24HR URINE SO" BOTH IP/OP $69.00 $51.50 $12.74 $69.00 $69.00 $69.00 $69.00 $69.00 $25.48 $25.48 $12.74 $69.00 $25.48 $25.59 $25.59 $26.58 $18.68 $24.91 $40.77 $40.77 $69.00 $25.48 $25.48 $25.48 $69.00 $51.75 $25.48 $25.48 $25.48 $69.00 $69.00 $54.65 $25.48 $55.20 $69.00 $69.00 $25.48 $40.02 $69.00 $36.95 $25.48 $69.00 $25.48 N/A N/A 30100111 EAP CPT® 82575 CREATININE CLEARANCE BOTH IP/OP $248.00 $184.00 $4.73 $248.00 $248.00 $248.00 $248.00 $248.00 $9.46 $9.46 $4.73 $248.00 $9.46 $14.34 $14.34 $14.89 $10.47 $13.95 $15.14 $15.14 $248.00 $9.46 $9.46 $9.46 $248.00 $186.00 $9.46 $9.46 $9.46 $52.80 $52.80 $196.42 $9.46 $198.40 $248.00 $248.00 $9.46 $143.84 $248.00 $13.72 $9.46 $248.00 $9.46 N/A N/A 30100112 EAP CPT® 82595 "CRYOGLOBULIN,SERUM" BOTH IP/OP $88.00 $65.50 $3.23 $88.00 $12.70 $12.70 $12.70 $12.70 $6.47 $6.47 $3.24 $3.23 $6.47 $9.83 $9.83 $10.21 $7.17 $9.57 $10.35 $10.35 $52.05 $6.47 $6.47 $6.47 $88.00 $66.00 $6.47 $6.47 $6.47 $36.16 $36.16 $69.70 $6.47 $70.40 $10.68 $9.11 $6.47 $51.04 $88.00 $9.38 $6.47 $7.16 $6.47 N/A N/A 30100113 EAP CPT® 82595 "CRYOCRIT,SERUM" BOTH IP/OP $88.00 $65.50 $3.23 $88.00 $12.70 $12.70 $12.70 $12.70 $6.47 $6.47 $3.24 $3.23 $6.47 $9.83 $9.83 $10.21 $7.17 $9.57 $10.35 $10.35 $52.05 $6.47 $6.47 $6.47 $88.00 $66.00 $6.47 $6.47 $6.47 $36.16 $36.16 $69.70 $6.47 $70.40 $10.68 $9.11 $6.47 $51.04 $88.00 $9.38 $6.47 $7.16 $6.47 N/A N/A 30100114 EAP CPT® 82600 CYANIDE BOTH IP/OP $135.00 $100.00 $9.70 $135.00 $135.00 $135.00 $135.00 $135.00 $19.40 $19.40 $9.70 $135.00 $19.40 $29.46 $29.46 $30.60 $21.51 $28.67 $31.04 $31.04 $135.00 $19.40 $19.40 $19.40 $135.00 $101.25 $19.40 $19.40 $19.40 $108.44 $108.44 $106.92 $19.40 $108.00 $135.00 $135.00 $19.40 $78.30 $135.00 $28.13 $19.40 $135.00 $19.40 N/A N/A 30100115 EAP CPT® 82607 "VITAMIN B12,SERUM" BOTH IP/OP $398.00 $295.00 $7.54 $398.00 $29.59 $29.59 $29.59 $29.59 $15.08 $15.08 $7.54 $7.54 $15.08 $22.89 $22.89 $23.77 $16.71 $22.26 $24.13 $24.13 $235.42 $15.08 $15.08 $15.08 $398.00 $298.50 $15.08 $15.08 $15.08 $84.24 $84.24 $315.22 $15.08 $318.40 $24.88 $21.20 $15.08 $230.84 $398.00 $21.87 $15.08 $16.65 $15.08 N/A N/A 30100116 EAP CPT® 82627 "DHEA-SO4, SERUM" BOTH IP/OP $428.00 $317.00 $11.12 $428.00 $43.65 $43.65 $43.65 $43.65 $22.23 $22.23 $11.12 $11.12 $22.23 $33.76 $33.76 $35.06 $24.64 $32.84 $35.57 $35.57 $253.16 $22.23 $22.23 $22.23 $428.00 $321.00 $22.23 $22.23 $22.23 $124.28 $124.28 $338.98 $22.23 $342.40 $36.68 $31.28 $22.23 $248.24 $428.00 $32.23 $22.23 $24.57 $22.23 N/A N/A 30100117 EAP CPT® 82634 "DEOXYCORTISOL,11-BLD" BOTH IP/OP $129.00 $95.50 $14.64 $129.00 $129.00 $129.00 $129.00 $129.00 $29.28 $29.28 $14.64 $129.00 $29.28 $44.45 $44.45 $46.16 $32.45 $43.24 $46.85 $46.85 $129.00 $29.28 $29.28 $29.28 $129.00 $96.75 $29.28 $29.28 $29.28 $129.00 $129.00 $102.17 $29.28 $103.20 $129.00 $129.00 $29.28 $74.82 $129.00 $42.46 $29.28 $129.00 $29.28 N/A N/A 30100118 EAP CPT® 80327 DIHYDROTESTOSTERONE BOTH IP/OP $142.00 $105.50 $12.01 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $142.00 $12.01 $142.00 $142.00 $105.39 $105.39 $109.45 $73.98 $38.14 $142.00 $56.80 $142.00 $142.00 $142.00 $142.00 $142.00 $106.50 $142.00 $142.00 $142.00 $71.00 $71.00 $112.46 $142.00 $113.60 $92.30 $142.00 $142.00 $82.36 $142.00 $85.20 $142.00 $142.00 $142.00 N/A N/A 30100119 EAP CPT® 82652 "VIT D,1,25-DIHYDROXY" BOTH IP/OP $355.00 $263.00 $19.25 $355.00 $75.55 $75.55 $75.55 $75.55 $38.50 $38.50 $19.25 $19.25 $38.50 $58.45 $58.45 $60.70 $42.67 $56.86 $61.60 $61.60 $209.98 $38.50 $38.50 $38.50 $355.00 $266.25 $38.50 $38.50 $38.50 $215.12 $215.12 $281.16 $38.50 $284.00 $63.53 $54.15 $38.50 $205.90 $355.00 $55.83 $38.50 $42.53 $38.50 N/A N/A 30100120 EAP CPT® 82664 "AMYLASE, ISOENZYMES" BOTH IP/OP $501.00 $371.00 $30.75 $501.00 $501.00 $501.00 $501.00 $501.00 $61.50 $61.50 $30.75 $501.00 $61.50 $52.17 $52.17 $54.17 $38.08 $50.75 $98.40 $98.40 $501.00 $61.50 $61.50 $61.50 $501.00 $375.75 $61.50 $61.50 $61.50 $192.00 $192.00 $396.79 $61.50 $400.80 $501.00 $501.00 $61.50 $290.58 $501.00 $89.18 $61.50 $501.00 $61.50 N/A N/A 30100121 EAP CPT® 82668 "ERYTHROPOIETIN,SERUM" BOTH IP/OP $246.00 $182.50 $9.40 $246.00 $36.87 $36.87 $36.87 $36.87 $18.79 $18.79 $9.40 $9.40 $18.79 $28.55 $28.55 $29.65 $20.84 $27.76 $30.06 $30.06 $145.51 $18.79 $18.79 $18.79 $246.00 $184.50 $18.79 $18.79 $18.79 $105.04 $105.04 $194.83 $18.79 $196.80 $31.00 $26.44 $18.79 $142.68 $246.00 $27.25 $18.79 $20.77 $18.79 N/A N/A 30100122 EAP CPT® 82670 ESTRADIOL; TOTAL BOTH IP/OP $405.00 $300.00 $13.97 $405.00 $54.82 $54.82 $54.82 $54.82 $27.94 $27.94 $13.97 $13.97 $27.94 $42.43 $42.43 $44.06 $30.97 $41.28 $44.70 $44.70 $239.56 $27.94 $27.94 $27.94 $405.00 $303.75 $27.94 $27.94 $27.94 $156.16 $156.16 $320.76 $27.94 $324.00 $46.10 $39.31 $27.94 $234.90 $405.00 $40.51 $27.94 $30.88 $27.94 N/A N/A 30100123 EAP CPT® 82677 "ESTRIOL(FREE),SERUM" BOTH IP/OP $139.00 $103.00 $12.09 $139.00 $47.46 $47.46 $47.46 $47.46 $24.18 $24.18 $12.09 $12.09 $24.18 $36.72 $36.72 $38.13 $26.81 $35.72 $38.69 $38.69 $82.22 $24.18 $24.18 $24.18 $139.00 $104.25 $24.18 $24.18 $24.18 $135.16 $135.16 $110.09 $24.18 $111.20 $39.90 $34.02 $24.18 $80.62 $139.00 $35.06 $24.18 $26.72 $24.18 N/A N/A 30100124 EAP CPT® 82677 "ESTRIOL, URINE-REF" BOTH IP/OP $139.00 $103.00 $12.09 $139.00 $47.46 $47.46 $47.46 $47.46 $24.18 $24.18 $12.09 $12.09 $24.18 $36.72 $36.72 $38.13 $26.81 $35.72 $38.69 $38.69 $82.22 $24.18 $24.18 $24.18 $139.00 $104.25 $24.18 $24.18 $24.18 $135.16 $135.16 $110.09 $24.18 $111.20 $39.90 $34.02 $24.18 $80.62 $139.00 $35.06 $24.18 $26.72 $24.18 N/A N/A 30100125 EAP CPT® 82677 "ESTRIOL, MATERNAL SERUM" BOTH IP/OP $139.00 $103.00 $12.09 $139.00 $47.46 $47.46 $47.46 $47.46 $24.18 $24.18 $12.09 $12.09 $24.18 $36.72 $36.72 $38.13 $26.81 $35.72 $38.69 $38.69 $82.22 $24.18 $24.18 $24.18 $139.00 $104.25 $24.18 $24.18 $24.18 $135.16 $135.16 $110.09 $24.18 $111.20 $39.90 $34.02 $24.18 $80.62 $139.00 $35.06 $24.18 $26.72 $24.18 N/A N/A 30100126 EAP CPT® 82679 "ESTRONE, SERUM" BOTH IP/OP $118.00 $87.50 $12.48 $118.00 $48.97 $48.97 $48.97 $48.97 $24.95 $24.95 $12.48 $12.48 $24.95 $37.91 $37.91 $39.37 $27.67 $36.88 $39.92 $39.92 $69.80 $24.95 $24.95 $24.95 $118.00 $88.50 $24.95 $24.95 $24.95 $118.00 $118.00 $93.46 $24.95 $94.40 $41.17 $35.12 $24.95 $68.44 $118.00 $36.18 $24.95 $27.59 $24.95 N/A N/A 30100127 EAP CPT® 82693 "ETHYLENE GLYCOL,BLD" BOTH IP/OP $364.00 $269.50 $7.45 $364.00 $364.00 $364.00 $364.00 $364.00 $14.90 $14.90 $7.45 $364.00 $14.90 $22.62 $22.62 $23.49 $16.51 $22.02 $23.84 $23.84 $364.00 $14.90 $14.90 $14.90 $364.00 $273.00 $14.90 $14.90 $14.90 $83.28 $83.28 $288.29 $14.90 $291.20 $364.00 $364.00 $14.90 $211.12 $364.00 $21.61 $14.90 $364.00 $14.90 N/A N/A 30100128 EAP CPT® 82705 "STOOL FAT, QUAL" BOTH IP/OP $64.00 $47.50 $2.55 $64.00 $9.99 $9.99 $9.99 $9.99 $5.10 $5.10 $2.55 $2.55 $5.10 $7.73 $7.73 $8.02 $5.64 $7.52 $8.16 $8.16 $37.86 $5.10 $5.10 $5.10 $64.00 $48.00 $5.10 $5.10 $5.10 $28.44 $28.44 $50.69 $5.10 $51.20 $8.42 $7.16 $5.10 $37.12 $64.00 $7.40 $5.10 $5.62 $5.10 N/A N/A 30100129 EAP CPT® 82710 "FECAL FAT, QUANT" BOTH IP/OP $89.00 $66.00 $8.40 $89.00 $32.98 $32.98 $32.98 $32.98 $16.80 $16.80 $8.40 $8.40 $16.80 $25.51 $25.51 $26.49 $18.62 $24.81 $26.88 $26.88 $52.64 $16.80 $16.80 $16.80 $89.00 $66.75 $16.80 $16.80 $16.80 $89.00 $89.00 $70.49 $16.80 $71.20 $27.72 $23.63 $16.80 $51.62 $89.00 $24.36 $16.80 $18.56 $16.80 N/A N/A 30100130 EAP CPT® 82725 "FATTY ACIDS,ESS-SER" BOTH IP/OP $212.00 $157.00 $9.39 $212.00 $212.00 $212.00 $212.00 $212.00 $18.77 $18.77 $9.39 $212.00 $18.77 $20.22 $20.22 $21.00 $14.76 $19.67 $30.03 $30.03 $212.00 $18.77 $18.77 $18.77 $212.00 $159.00 $18.77 $18.77 $18.77 $74.40 $74.40 $167.90 $18.77 $169.60 $212.00 $212.00 $18.77 $122.96 $212.00 $27.22 $18.77 $212.00 $18.77 N/A N/A 30100131 EAP CPT® 82728 "FERRITIN,SERUM" BOTH IP/OP $247.00 $183.00 $6.82 $247.00 $26.76 $26.76 $26.76 $26.76 $13.63 $13.63 $6.82 $6.82 $13.63 $20.69 $20.69 $21.48 $15.10 $20.13 $21.81 $21.81 $146.10 $13.63 $13.63 $13.63 $247.00 $185.25 $13.63 $13.63 $13.63 $76.12 $76.12 $195.62 $13.63 $197.60 $22.49 $19.17 $13.63 $143.26 $247.00 $19.76 $13.63 $15.06 $13.63 N/A N/A 30100132 EAP CPT® 82731 FETAL FIBRONECTIN BOTH IP/OP $614.00 $454.50 $32.21 $614.00 $126.43 $126.43 $126.43 $126.43 $64.41 $64.41 $32.21 $32.21 $64.41 $97.80 $97.80 $101.56 $71.39 $95.14 $103.06 $103.06 $363.18 $64.41 $64.41 $64.41 $614.00 $460.50 $64.41 $64.41 $64.41 $359.96 $359.96 $486.29 $64.41 $491.20 $106.28 $90.61 $64.41 $356.12 $614.00 $93.39 $64.41 $71.17 $64.41 N/A N/A 30100133 EAP CPT® 82746 "FOLATE,SERUM" BOTH IP/OP $292.00 $216.50 $7.35 $292.00 $28.87 $28.87 $28.87 $28.87 $14.70 $14.70 $7.35 $7.35 $14.70 $22.33 $22.33 $23.19 $16.30 $21.72 $23.52 $23.52 $172.72 $14.70 $14.70 $14.70 $292.00 $219.00 $14.70 $14.70 $14.70 $82.16 $82.16 $231.26 $14.70 $233.60 $24.26 $20.69 $14.70 $169.36 $292.00 $21.32 $14.70 $16.25 $14.70 N/A N/A 30100134 EAP CPT® 82747 "FOLATE, RBC" BOTH IP/OP $434.00 $321.50 $8.66 $434.00 $33.99 $33.99 $33.99 $33.99 $17.65 $17.65 $8.83 $8.66 $17.65 $26.30 $26.30 $27.31 $19.20 $25.59 $28.24 $28.24 $256.71 $17.65 $17.65 $17.65 $434.00 $325.50 $17.65 $17.65 $17.65 $96.80 $96.80 $343.73 $17.65 $347.20 $29.12 $24.37 $17.65 $251.72 $434.00 $25.59 $17.65 $19.14 $17.65 N/A N/A 30100135 EAP CPT® 82775 GALACTOSE-1-PUT BOTH IP/OP $224.00 $166.00 $10.54 $224.00 $224.00 $224.00 $224.00 $224.00 $21.07 $21.07 $10.54 $224.00 $21.07 $31.98 $31.98 $33.21 $23.35 $31.12 $33.71 $33.71 $224.00 $21.07 $21.07 $21.07 $224.00 $168.00 $21.07 $21.07 $21.07 $117.72 $117.72 $177.41 $21.07 $179.20 $224.00 $224.00 $21.07 $129.92 $224.00 $30.55 $21.07 $224.00 $21.07 N/A N/A 30100136 EAP CPT® 82775 GALACTOSE-1-PHOS BOTH IP/OP $224.00 $166.00 $10.54 $224.00 $224.00 $224.00 $224.00 $224.00 $21.07 $21.07 $10.54 $224.00 $21.07 $31.98 $31.98 $33.21 $23.35 $31.12 $33.71 $33.71 $224.00 $21.07 $21.07 $21.07 $224.00 $168.00 $21.07 $21.07 $21.07 $117.72 $117.72 $177.41 $21.07 $179.20 $224.00 $224.00 $21.07 $129.92 $224.00 $30.55 $21.07 $224.00 $21.07 N/A N/A 30100137 EAP CPT® 82784 "IMMUNOGLOB-A,SERUM" BOTH IP/OP $273.00 $202.50 $4.65 $273.00 $18.25 $18.25 $18.25 $18.25 $9.30 $9.30 $4.65 $4.65 $9.30 $14.12 $14.12 $14.67 $10.31 $13.73 $14.88 $14.88 $161.48 $9.30 $9.30 $9.30 $273.00 $204.75 $9.30 $9.30 $9.30 $51.96 $51.96 $216.22 $9.30 $218.40 $15.35 $13.08 $9.30 $158.34 $273.00 $13.49 $9.30 $10.27 $9.30 N/A N/A 30100138 EAP CPT® 82784 "IMMUNOGLOB-G,SERUM" BOTH IP/OP $273.00 $202.50 $4.65 $273.00 $18.25 $18.25 $18.25 $18.25 $9.30 $9.30 $4.65 $4.65 $9.30 $14.12 $14.12 $14.67 $10.31 $13.73 $14.88 $14.88 $161.48 $9.30 $9.30 $9.30 $273.00 $204.75 $9.30 $9.30 $9.30 $51.96 $51.96 $216.22 $9.30 $218.40 $15.35 $13.08 $9.30 $158.34 $273.00 $13.49 $9.30 $10.27 $9.30 N/A N/A 30100139 EAP CPT® 82784 "IMMUNOGLOB-M,SERUM" BOTH IP/OP $273.00 $202.50 $4.65 $273.00 $18.25 $18.25 $18.25 $18.25 $9.30 $9.30 $4.65 $4.65 $9.30 $14.12 $14.12 $14.67 $10.31 $13.73 $14.88 $14.88 $161.48 $9.30 $9.30 $9.30 $273.00 $204.75 $9.30 $9.30 $9.30 $51.96 $51.96 $216.22 $9.30 $218.40 $15.35 $13.08 $9.30 $158.34 $273.00 $13.49 $9.30 $10.27 $9.30 N/A N/A 30100140 EAP CPT® 82784 "IMMUNO-IGG,CSF" BOTH IP/OP $165.00 $122.50 $4.65 $165.00 $18.25 $18.25 $18.25 $18.25 $9.30 $9.30 $4.65 $4.65 $9.30 $14.12 $14.12 $14.67 $10.31 $13.73 $14.88 $14.88 $97.60 $9.30 $9.30 $9.30 $165.00 $123.75 $9.30 $9.30 $9.30 $51.96 $51.96 $130.68 $9.30 $132.00 $15.35 $13.08 $9.30 $95.70 $165.00 $13.49 $9.30 $10.27 $9.30 N/A N/A 30100141 EAP CPT® 82784 "IMMUNOGLOB-IGD,SERUM" BOTH IP/OP $251.00 $186.00 $4.65 $251.00 $18.25 $18.25 $18.25 $18.25 $9.30 $9.30 $4.65 $4.65 $9.30 $14.12 $14.12 $14.67 $10.31 $13.73 $14.88 $14.88 $148.47 $9.30 $9.30 $9.30 $251.00 $188.25 $9.30 $9.30 $9.30 $51.96 $51.96 $198.79 $9.30 $200.80 $15.35 $13.08 $9.30 $145.58 $251.00 $13.49 $9.30 $10.27 $9.30 N/A N/A 30100142 EAP CPT® 82785 "IMMUNOGLOB-IGE,SERUM" BOTH IP/OP $202.00 $149.50 $8.23 $202.00 $32.30 $32.30 $32.30 $32.30 $16.46 $16.46 $8.23 $8.23 $16.46 $25.01 $25.01 $25.97 $18.26 $24.33 $26.34 $26.34 $119.48 $16.46 $16.46 $16.46 $202.00 $151.50 $16.46 $16.46 $16.46 $92.04 $92.04 $159.98 $16.46 $161.60 $27.16 $23.17 $16.46 $117.16 $202.00 $23.87 $16.46 $18.20 $16.46 N/A N/A 30100143 EAP CPT® 82800 "PH, VEN." BOTH IP/OP $222.00 $164.50 $5.50 $222.00 $222.00 $222.00 $222.00 $222.00 $11.00 $11.00 $5.50 $222.00 $11.00 $12.86 $12.86 $13.36 $9.39 $12.52 $17.60 $17.60 $222.00 $11.00 $11.00 $11.00 $222.00 $166.50 $11.00 $11.00 $11.00 $47.32 $47.32 $175.82 $11.00 $177.60 $222.00 $222.00 $11.00 $128.76 $222.00 $15.95 $11.00 $222.00 $11.00 N/A N/A 30100144 EAP CPT® 82800 "PH, ART." BOTH IP/OP $222.00 $164.50 $5.50 $222.00 $222.00 $222.00 $222.00 $222.00 $11.00 $11.00 $5.50 $222.00 $11.00 $12.86 $12.86 $13.36 $9.39 $12.52 $17.60 $17.60 $222.00 $11.00 $11.00 $11.00 $222.00 $166.50 $11.00 $11.00 $11.00 $47.32 $47.32 $175.82 $11.00 $177.60 $222.00 $222.00 $11.00 $128.76 $222.00 $15.95 $11.00 $222.00 $11.00 N/A N/A 30100145 EAP CPT® 82800 "PH, CORD, ART." BOTH IP/OP $201.00 $149.00 $5.50 $201.00 $201.00 $201.00 $201.00 $201.00 $11.00 $11.00 $5.50 $201.00 $11.00 $12.86 $12.86 $13.36 $9.39 $12.52 $17.60 $17.60 $201.00 $11.00 $11.00 $11.00 $201.00 $150.75 $11.00 $11.00 $11.00 $47.32 $47.32 $159.19 $11.00 $160.80 $201.00 $201.00 $11.00 $116.58 $201.00 $15.95 $11.00 $201.00 $11.00 N/A N/A 30100148 EAP CPT® 82803 BLOOD GAS-VENOUS BOTH IP/OP $510.00 $377.50 $11.73 $510.00 $37.98 $37.98 $37.98 $37.98 $26.07 $26.07 $13.04 $11.73 $26.07 $29.38 $29.38 $30.51 $21.45 $28.59 $41.71 $41.71 $301.67 $26.07 $26.07 $26.07 $510.00 $382.50 $26.07 $26.07 $26.07 $108.16 $108.16 $403.92 $26.07 $408.00 $43.02 $27.23 $26.07 $295.80 $510.00 $37.80 $26.07 $21.39 $26.07 N/A N/A 30100149 EAP CPT® 82803 BLOOD GAS-ARTERIAL BOTH IP/OP $510.00 $377.50 $11.73 $510.00 $37.98 $37.98 $37.98 $37.98 $26.07 $26.07 $13.04 $11.73 $26.07 $29.38 $29.38 $30.51 $21.45 $28.59 $41.71 $41.71 $301.67 $26.07 $26.07 $26.07 $510.00 $382.50 $26.07 $26.07 $26.07 $108.16 $108.16 $403.92 $26.07 $408.00 $43.02 $27.23 $26.07 $295.80 $510.00 $37.80 $26.07 $21.39 $26.07 N/A N/A 30100150 EAP CPT® 82803 BLOOD GAS-MICRO BOTH IP/OP $510.00 $377.50 $11.73 $510.00 $37.98 $37.98 $37.98 $37.98 $26.07 $26.07 $13.04 $11.73 $26.07 $29.38 $29.38 $30.51 $21.45 $28.59 $41.71 $41.71 $301.67 $26.07 $26.07 $26.07 $510.00 $382.50 $26.07 $26.07 $26.07 $108.16 $108.16 $403.92 $26.07 $408.00 $43.02 $27.23 $26.07 $295.80 $510.00 $37.80 $26.07 $21.39 $26.07 N/A N/A 30100151 EAP CPT® 82803 BLOOD GAS-CORD ART. BOTH IP/OP $510.00 $377.50 $11.73 $510.00 $37.98 $37.98 $37.98 $37.98 $26.07 $26.07 $13.04 $11.73 $26.07 $29.38 $29.38 $30.51 $21.45 $28.59 $41.71 $41.71 $301.67 $26.07 $26.07 $26.07 $510.00 $382.50 $26.07 $26.07 $26.07 $108.16 $108.16 $403.92 $26.07 $408.00 $43.02 $27.23 $26.07 $295.80 $510.00 $37.80 $26.07 $21.39 $26.07 N/A N/A 30100152 EAP CPT® 82803 BLOOD GAS-CORD VEN. BOTH IP/OP $462.00 $342.00 $11.73 $462.00 $37.98 $37.98 $37.98 $37.98 $26.07 $26.07 $13.04 $11.73 $26.07 $29.38 $29.38 $30.51 $21.45 $28.59 $41.71 $41.71 $273.27 $26.07 $26.07 $26.07 $462.00 $346.50 $26.07 $26.07 $26.07 $108.16 $108.16 $365.90 $26.07 $369.60 $43.02 $27.23 $26.07 $267.96 $462.00 $37.80 $26.07 $21.39 $26.07 N/A N/A 30100153 EAP CPT® 82172 APOLIPOPROTEINA 1 (SO) BOTH IP/OP $176.00 $130.50 $9.49 $176.00 $30.42 $30.42 $30.42 $30.42 $21.09 $21.09 $10.55 $9.49 $21.09 $23.52 $23.52 $24.43 $17.17 $22.90 $33.74 $33.74 $104.10 $21.09 $21.09 $21.09 $176.00 $132.00 $21.09 $21.09 $21.09 $86.60 $86.60 $139.39 $21.09 $140.80 $34.80 $21.81 $21.09 $102.08 $176.00 $30.58 $21.09 $17.13 $21.09 N/A N/A 30100158 EAP CPT® 82805 "BLD. GAS+SAT. PROF, ART" BOTH IP/OP $533.00 $394.50 $31.37 $533.00 $55.67 $55.67 $55.67 $55.67 $78.77 $78.77 $39.39 $35.45 $78.77 $43.09 $43.09 $44.74 $31.45 $41.93 $126.03 $126.03 $315.27 $78.77 $78.77 $78.77 $533.00 $399.75 $78.77 $78.77 $78.77 $158.60 $158.60 $422.14 $78.77 $426.40 $129.97 $39.93 $78.77 $309.14 $533.00 $114.22 $78.77 $31.37 $78.77 N/A N/A 30100159 EAP CPT® 82805 "BLD. GAS+SAT. PROF, VEN" BOTH IP/OP $533.00 $394.50 $31.37 $533.00 $55.67 $55.67 $55.67 $55.67 $78.77 $78.77 $39.39 $35.45 $78.77 $43.09 $43.09 $44.74 $31.45 $41.93 $126.03 $126.03 $315.27 $78.77 $78.77 $78.77 $533.00 $399.75 $78.77 $78.77 $78.77 $158.60 $158.60 $422.14 $78.77 $426.40 $129.97 $39.93 $78.77 $309.14 $533.00 $114.22 $78.77 $31.37 $78.77 N/A N/A 30100160 EAP CPT® 82805 "BLD. GAS+SAT. PROF, MCR" BOTH IP/OP $483.00 $357.50 $31.37 $483.00 $55.67 $55.67 $55.67 $55.67 $78.77 $78.77 $39.39 $35.45 $78.77 $43.09 $43.09 $44.74 $31.45 $41.93 $126.03 $126.03 $285.69 $78.77 $78.77 $78.77 $483.00 $362.25 $78.77 $78.77 $78.77 $158.60 $158.60 $382.54 $78.77 $386.40 $129.97 $39.93 $78.77 $280.14 $483.00 $114.22 $78.77 $31.37 $78.77 N/A N/A 30100161 EAP CPT® 82810 "SATURATION PROF, VEN." BOTH IP/OP $113.00 $84.00 $4.89 $113.00 $113.00 $113.00 $113.00 $113.00 $9.77 $9.77 $4.89 $113.00 $9.77 $13.25 $13.25 $13.76 $9.67 $12.89 $15.63 $15.63 $113.00 $9.77 $9.77 $9.77 $113.00 $84.75 $9.77 $9.77 $9.77 $48.80 $48.80 $89.50 $9.77 $90.40 $113.00 $113.00 $9.77 $65.54 $113.00 $14.17 $9.77 $113.00 $9.77 N/A N/A 30100162 EAP CPT® 82810 "SATURATION PROF, ART." BOTH IP/OP $113.00 $84.00 $4.89 $113.00 $113.00 $113.00 $113.00 $113.00 $9.77 $9.77 $4.89 $113.00 $9.77 $13.25 $13.25 $13.76 $9.67 $12.89 $15.63 $15.63 $113.00 $9.77 $9.77 $9.77 $113.00 $84.75 $9.77 $9.77 $9.77 $48.80 $48.80 $89.50 $9.77 $90.40 $113.00 $113.00 $9.77 $65.54 $113.00 $14.17 $9.77 $113.00 $9.77 N/A N/A 30100163 EAP CPT® 82810 "SATURATION PROF, MICRO" BOTH IP/OP $103.00 $76.50 $4.89 $103.00 $103.00 $103.00 $103.00 $103.00 $9.77 $9.77 $4.89 $103.00 $9.77 $13.25 $13.25 $13.76 $9.67 $12.89 $15.63 $15.63 $103.00 $9.77 $9.77 $9.77 $103.00 $77.25 $9.77 $9.77 $9.77 $48.80 $48.80 $81.58 $9.77 $82.40 $103.00 $103.00 $9.77 $59.74 $103.00 $14.17 $9.77 $103.00 $9.77 N/A N/A 30100165 EAP CPT® 82941 "GASTRIN,SERUM" BOTH IP/OP $281.00 $208.00 $8.82 $281.00 $34.61 $34.61 $34.61 $34.61 $17.63 $17.63 $8.82 $8.82 $17.63 $26.78 $26.78 $27.81 $19.55 $26.05 $28.21 $28.21 $166.21 $17.63 $17.63 $17.63 $281.00 $210.75 $17.63 $17.63 $17.63 $98.56 $98.56 $222.55 $17.63 $224.80 $29.09 $24.81 $17.63 $162.98 $281.00 $25.56 $17.63 $19.49 $17.63 N/A N/A 30100167 EAP CPT® 82945 "GLUCOSE,FLUID" BOTH IP/OP $341.00 $252.50 $1.97 $341.00 $7.71 $7.71 $7.71 $7.71 $3.93 $3.93 $1.97 $1.97 $3.93 $5.96 $5.96 $6.19 $4.35 $5.80 $6.29 $6.29 $201.70 $3.93 $3.93 $3.93 $341.00 $255.75 $3.93 $3.93 $3.93 $21.92 $21.92 $270.07 $3.93 $272.80 $6.48 $5.52 $3.93 $197.78 $341.00 $5.70 $3.93 $4.34 $3.93 N/A N/A 30100168 EAP CPT® 82945 "GLUCOSE,CSF" BOTH IP/OP $341.00 $252.50 $1.97 $341.00 $7.71 $7.71 $7.71 $7.71 $3.93 $3.93 $1.97 $1.97 $3.93 $5.96 $5.96 $6.19 $4.35 $5.80 $6.29 $6.29 $201.70 $3.93 $3.93 $3.93 $341.00 $255.75 $3.93 $3.93 $3.93 $21.92 $21.92 $270.07 $3.93 $272.80 $6.48 $5.52 $3.93 $197.78 $341.00 $5.70 $3.93 $4.34 $3.93 N/A N/A 30100169 EAP CPT® 82945 "GLUCOSE,URINE(QUANT)" BOTH IP/OP $251.00 $186.00 $1.97 $251.00 $7.71 $7.71 $7.71 $7.71 $3.93 $3.93 $1.97 $1.97 $3.93 $5.96 $5.96 $6.19 $4.35 $5.80 $6.29 $6.29 $148.47 $3.93 $3.93 $3.93 $251.00 $188.25 $3.93 $3.93 $3.93 $21.92 $21.92 $198.79 $3.93 $200.80 $6.48 $5.52 $3.93 $145.58 $251.00 $5.70 $3.93 $4.34 $3.93 N/A N/A 30100171 EAP CPT® 82947 GLUCOSE BOTH IP/OP $358.00 $265.00 $1.97 $358.00 $7.71 $7.71 $7.71 $7.71 $3.93 $3.93 $1.97 $1.97 $3.93 $5.96 $5.96 $6.19 $4.35 $5.80 $6.29 $6.29 $211.76 $3.93 $3.93 $3.93 $358.00 $268.50 $3.93 $3.93 $3.93 $21.92 $21.92 $283.54 $3.93 $286.40 $6.48 $5.52 $3.93 $207.64 $358.00 $5.70 $3.93 $4.34 $3.93 N/A N/A 30100173 EAP CPT® 82947 "GLUCOSE,FASTING BLD" BOTH IP/OP $358.00 $265.00 $1.97 $358.00 $7.71 $7.71 $7.71 $7.71 $3.93 $3.93 $1.97 $1.97 $3.93 $5.96 $5.96 $6.19 $4.35 $5.80 $6.29 $6.29 $211.76 $3.93 $3.93 $3.93 $358.00 $268.50 $3.93 $3.93 $3.93 $21.92 $21.92 $283.54 $3.93 $286.40 $6.48 $5.52 $3.93 $207.64 $358.00 $5.70 $3.93 $4.34 $3.93 N/A N/A 30100174 EAP CPT® 82947 GLUCOSE-WB BOTH IP/OP $358.00 $265.00 $1.97 $358.00 $7.71 $7.71 $7.71 $7.71 $3.93 $3.93 $1.97 $1.97 $3.93 $5.96 $5.96 $6.19 $4.35 $5.80 $6.29 $6.29 $211.76 $3.93 $3.93 $3.93 $358.00 $268.50 $3.93 $3.93 $3.93 $21.92 $21.92 $283.54 $3.93 $286.40 $6.48 $5.52 $3.93 $207.64 $358.00 $5.70 $3.93 $4.34 $3.93 N/A N/A 30100176 EAP CPT® 82947 "GTT,ORAL-1HR INDIV" BOTH IP/OP $263.00 $195.00 $1.97 $263.00 $7.71 $7.71 $7.71 $7.71 $3.93 $3.93 $1.97 $1.97 $3.93 $5.96 $5.96 $6.19 $4.35 $5.80 $6.29 $6.29 $155.56 $3.93 $3.93 $3.93 $263.00 $197.25 $3.93 $3.93 $3.93 $21.92 $21.92 $208.30 $3.93 $210.40 $6.48 $5.52 $3.93 $152.54 $263.00 $5.70 $3.93 $4.34 $3.93 N/A N/A 30100177 EAP CPT® 82947 "GTT,ORAL-2HR INDIV" BOTH IP/OP $263.00 $195.00 $1.97 $263.00 $7.71 $7.71 $7.71 $7.71 $3.93 $3.93 $1.97 $1.97 $3.93 $5.96 $5.96 $6.19 $4.35 $5.80 $6.29 $6.29 $155.56 $3.93 $3.93 $3.93 $263.00 $197.25 $3.93 $3.93 $3.93 $21.92 $21.92 $208.30 $3.93 $210.40 $6.48 $5.52 $3.93 $152.54 $263.00 $5.70 $3.93 $4.34 $3.93 N/A N/A 30100178 EAP CPT® 82947 "POCT, GLUCOSE (METER)" BOTH IP/OP $92.00 $68.50 $1.97 $92.00 $7.71 $7.71 $7.71 $7.71 $3.93 $3.93 $1.97 $1.97 $3.93 $5.96 $5.96 $6.19 $4.35 $5.80 $6.29 $6.29 $54.42 $3.93 $3.93 $3.93 $92.00 $69.00 $3.93 $3.93 $3.93 $21.92 $21.92 $72.86 $3.93 $73.60 $6.48 $5.52 $3.93 $53.36 $92.00 $5.70 $3.93 $4.34 $3.93 N/A N/A 30100180 EAP HCPCS G0480 DRUG TEST DEFINITIVE 1-7 CLASSES BOTH IP/OP $293.00 $217.00 $57.22 $293.00 $293.00 $293.00 $293.00 $293.00 $114.43 $114.43 $57.22 $293.00 $114.43 $217.46 $217.46 $225.84 $152.65 $110.57 $183.09 $183.09 $293.00 $114.43 $114.43 $114.43 $293.00 $219.75 $114.43 $114.43 $114.43 $146.50 $146.50 $232.06 $114.43 $234.40 $293.00 $293.00 $114.43 $169.94 $293.00 $165.92 $114.43 $293.00 $114.43 N/A N/A 30100181 EAP HCPCS G0481 DRUG TEST DEFINITIVE 8-14 CLASSES BOTH IP/OP $322.00 $238.50 $78.30 $322.00 $322.00 $322.00 $322.00 $322.00 $156.59 $156.59 $78.30 $322.00 $156.59 $238.99 $238.99 $248.20 $167.76 $151.29 $250.54 $250.54 $322.00 $156.59 $156.59 $156.59 $322.00 $241.50 $156.59 $156.59 $156.59 $161.00 $161.00 $255.02 $156.59 $257.60 $322.00 $322.00 $156.59 $186.76 $322.00 $227.06 $156.59 $322.00 $156.59 N/A N/A 30100182 EAP HCPCS G0482 DRUG TEST DEFINITIVE 15-21 CLASSES BOTH IP/OP $354.00 $262.00 $99.37 $354.00 $354.00 $354.00 $354.00 $354.00 $198.74 $198.74 $99.37 $354.00 $198.74 $262.74 $262.74 $272.86 $184.43 $192.03 $317.98 $317.98 $354.00 $198.74 $198.74 $198.74 $354.00 $265.50 $198.74 $198.74 $198.74 $177.00 $177.00 $280.37 $198.74 $283.20 $354.00 $354.00 $198.74 $205.32 $354.00 $288.17 $198.74 $354.00 $198.74 N/A N/A 30100183 EAP HCPCS G0483 DRUG TEST DEFINITIVE 22+ CLASSES BOTH IP/OP $389.00 $288.00 $123.46 $395.07 $389.00 $389.00 $389.00 $389.00 $246.92 $246.92 $123.46 $389.00 $246.92 $288.72 $288.72 $299.84 $202.67 $238.59 $395.07 $395.07 $389.00 $246.92 $246.92 $246.92 $389.00 $291.75 $246.92 $246.92 $246.92 $194.50 $194.50 $308.09 $246.92 $311.20 $389.00 $389.00 $246.92 $225.62 $389.00 $358.03 $246.92 $389.00 $246.92 N/A N/A 30100186 EAP CPT® 82948 "GLU-2HR PP, WB-MICRO" BOTH IP/OP $251.00 $186.00 $2.52 $251.00 $251.00 $251.00 $251.00 $251.00 $5.04 $5.04 $2.52 $251.00 $5.04 $4.82 $4.82 $5.00 $3.52 $4.68 $8.06 $8.06 $251.00 $5.04 $5.04 $5.04 $251.00 $188.25 $5.04 $5.04 $5.04 $17.72 $17.72 $198.79 $5.04 $200.80 $251.00 $251.00 $5.04 $145.58 $251.00 $7.31 $5.04 $251.00 $5.04 N/A N/A 30100187 EAP CPT® 82950 "GLUCOSE,BLD-2HR PP" BOTH IP/OP $341.00 $252.50 $2.37 $341.00 $9.31 $9.31 $9.31 $9.31 $4.75 $4.75 $2.38 $2.37 $4.75 $7.21 $7.21 $7.48 $5.26 $7.02 $7.60 $7.60 $201.70 $4.75 $4.75 $4.75 $341.00 $255.75 $4.75 $4.75 $4.75 $26.56 $26.56 $270.07 $4.75 $272.80 $7.84 $6.69 $4.75 $197.78 $341.00 $6.89 $4.75 $5.25 $4.75 N/A N/A 30100188 EAP CPT® 82950 "GLUCOSE, 1HR (75GM)" BOTH IP/OP $251.00 $186.00 $2.37 $251.00 $9.31 $9.31 $9.31 $9.31 $4.75 $4.75 $2.38 $2.37 $4.75 $7.21 $7.21 $7.48 $5.26 $7.02 $7.60 $7.60 $148.47 $4.75 $4.75 $4.75 $251.00 $188.25 $4.75 $4.75 $4.75 $26.56 $26.56 $198.79 $4.75 $200.80 $7.84 $6.69 $4.75 $145.58 $251.00 $6.89 $4.75 $5.25 $4.75 N/A N/A 30100189 EAP CPT® 82950 "GLUCOSE,1HR (50GM)" BOTH IP/OP $251.00 $186.00 $2.37 $251.00 $9.31 $9.31 $9.31 $9.31 $4.75 $4.75 $2.38 $2.37 $4.75 $7.21 $7.21 $7.48 $5.26 $7.02 $7.60 $7.60 $148.47 $4.75 $4.75 $4.75 $251.00 $188.25 $4.75 $4.75 $4.75 $26.56 $26.56 $198.79 $4.75 $200.80 $7.84 $6.69 $4.75 $145.58 $251.00 $6.89 $4.75 $5.25 $4.75 N/A N/A 30100192 EAP CPT® 82951 "GTT,PRENATAL(75 GM)" BOTH IP/OP $201.00 $149.00 $6.44 $201.00 $25.28 $25.28 $25.28 $25.28 $12.87 $12.87 $6.44 $6.44 $12.87 $19.55 $19.55 $20.30 $14.27 $19.02 $20.59 $20.59 $118.89 $12.87 $12.87 $12.87 $201.00 $150.75 $12.87 $12.87 $12.87 $71.96 $71.96 $159.19 $12.87 $160.80 $21.24 $18.11 $12.87 $116.58 $201.00 $18.66 $12.87 $14.23 $12.87 N/A N/A 30100193 EAP CPT® 82951 "GTT,ORAL-3HR GTT" BOTH IP/OP $199.00 $147.50 $6.44 $199.00 $25.28 $25.28 $25.28 $25.28 $12.87 $12.87 $6.44 $6.44 $12.87 $19.55 $19.55 $20.30 $14.27 $19.02 $20.59 $20.59 $117.71 $12.87 $12.87 $12.87 $199.00 $149.25 $12.87 $12.87 $12.87 $71.96 $71.96 $157.61 $12.87 $159.20 $21.24 $18.11 $12.87 $115.42 $199.00 $18.66 $12.87 $14.23 $12.87 N/A N/A 30100194 EAP CPT® 82951 "GTT,ORAL-4HR GTT" BOTH IP/OP $201.00 $149.00 $6.44 $201.00 $25.28 $25.28 $25.28 $25.28 $12.87 $12.87 $6.44 $6.44 $12.87 $19.55 $19.55 $20.30 $14.27 $19.02 $20.59 $20.59 $118.89 $12.87 $12.87 $12.87 $201.00 $150.75 $12.87 $12.87 $12.87 $71.96 $71.96 $159.19 $12.87 $160.80 $21.24 $18.11 $12.87 $116.58 $201.00 $18.66 $12.87 $14.23 $12.87 N/A N/A 30100195 EAP CPT® 82951 "GTT,ORAL-5HR GTT" BOTH IP/OP $201.00 $149.00 $6.44 $201.00 $25.28 $25.28 $25.28 $25.28 $12.87 $12.87 $6.44 $6.44 $12.87 $19.55 $19.55 $20.30 $14.27 $19.02 $20.59 $20.59 $118.89 $12.87 $12.87 $12.87 $201.00 $150.75 $12.87 $12.87 $12.87 $71.96 $71.96 $159.19 $12.87 $160.80 $21.24 $18.11 $12.87 $116.58 $201.00 $18.66 $12.87 $14.23 $12.87 N/A N/A 30100196 EAP CPT® 82951 "GTT,ORAL-6HR GTT" BOTH IP/OP $201.00 $149.00 $6.44 $201.00 $25.28 $25.28 $25.28 $25.28 $12.87 $12.87 $6.44 $6.44 $12.87 $19.55 $19.55 $20.30 $14.27 $19.02 $20.59 $20.59 $118.89 $12.87 $12.87 $12.87 $201.00 $150.75 $12.87 $12.87 $12.87 $71.96 $71.96 $159.19 $12.87 $160.80 $21.24 $18.11 $12.87 $116.58 $201.00 $18.66 $12.87 $14.23 $12.87 N/A N/A 30100197 EAP CPT® 82951 "GTT,PRENATAL(100GM)" BOTH IP/OP $199.00 $147.50 $6.44 $199.00 $25.28 $25.28 $25.28 $25.28 $12.87 $12.87 $6.44 $6.44 $12.87 $19.55 $19.55 $20.30 $14.27 $19.02 $20.59 $20.59 $117.71 $12.87 $12.87 $12.87 $199.00 $149.25 $12.87 $12.87 $12.87 $71.96 $71.96 $157.61 $12.87 $159.20 $21.24 $18.11 $12.87 $115.42 $199.00 $18.66 $12.87 $14.23 $12.87 N/A N/A 30100200 EAP CPT® 82952 3RD HOUR-GTT SPECIMEN BOTH IP/OP $102.00 $75.50 $1.96 $102.00 $7.71 $7.71 $7.71 $7.71 $3.92 $3.92 $1.96 $1.96 $3.92 $5.95 $5.95 $6.18 $4.34 $5.80 $6.27 $6.27 $60.33 $3.92 $3.92 $3.92 $102.00 $76.50 $3.92 $3.92 $3.92 $21.92 $21.92 $80.78 $3.92 $81.60 $6.47 $5.52 $3.92 $59.16 $102.00 $5.68 $3.92 $4.34 $3.92 N/A N/A 30100201 EAP CPT® 82952 4TH HOUR-GTT SPECIMEN BOTH IP/OP $103.00 $76.50 $1.96 $103.00 $7.71 $7.71 $7.71 $7.71 $3.92 $3.92 $1.96 $1.96 $3.92 $5.95 $5.95 $6.18 $4.34 $5.80 $6.27 $6.27 $60.92 $3.92 $3.92 $3.92 $103.00 $77.25 $3.92 $3.92 $3.92 $21.92 $21.92 $81.58 $3.92 $82.40 $6.47 $5.52 $3.92 $59.74 $103.00 $5.68 $3.92 $4.34 $3.92 N/A N/A 30100202 EAP CPT® 82952 5TH HOUR GTT SPECIMEN BOTH IP/OP $103.00 $76.50 $1.96 $103.00 $7.71 $7.71 $7.71 $7.71 $3.92 $3.92 $1.96 $1.96 $3.92 $5.95 $5.95 $6.18 $4.34 $5.80 $6.27 $6.27 $60.92 $3.92 $3.92 $3.92 $103.00 $77.25 $3.92 $3.92 $3.92 $21.92 $21.92 $81.58 $3.92 $82.40 $6.47 $5.52 $3.92 $59.74 $103.00 $5.68 $3.92 $4.34 $3.92 N/A N/A 30100203 EAP CPT® 82955 "G6PD, RBC QUANT" BOTH IP/OP $242.00 $179.50 $4.85 $242.00 $15.29 $15.29 $15.29 $15.29 $9.70 $9.70 $4.85 $4.85 $9.70 $11.86 $11.86 $12.31 $8.65 $11.54 $15.52 $15.52 $143.14 $9.70 $9.70 $9.70 $242.00 $181.50 $9.70 $9.70 $9.70 $43.64 $43.64 $191.66 $9.70 $193.60 $16.01 $10.99 $9.70 $140.36 $242.00 $14.07 $9.70 $8.63 $9.70 N/A N/A 30100205 EAP CPT® 82977 "GGTP,SERUM" BOTH IP/OP $162.00 $120.00 $3.60 $162.00 $14.13 $14.13 $14.13 $14.13 $7.20 $7.20 $3.60 $3.60 $7.20 $10.93 $10.93 $11.35 $7.98 $7.46 $11.52 $11.52 $95.82 $7.20 $7.20 $7.20 $162.00 $121.50 $7.20 $7.20 $7.20 $40.24 $40.24 $128.30 $7.20 $129.60 $11.88 $7.10 $7.20 $93.96 $162.00 $10.44 $7.20 $5.58 $7.20 N/A N/A 30100206 EAP CPT® 83001 "FSH,SERUM" BOTH IP/OP $480.00 $355.50 $9.29 $480.00 $36.47 $36.47 $36.47 $36.47 $18.58 $18.58 $9.29 $9.29 $18.58 $28.23 $28.23 $29.31 $20.60 $27.46 $29.73 $29.73 $283.92 $18.58 $18.58 $18.58 $480.00 $360.00 $18.58 $18.58 $18.58 $103.88 $103.88 $380.16 $18.58 $384.00 $30.66 $26.15 $18.58 $278.40 $480.00 $26.94 $18.58 $20.54 $18.58 N/A N/A 30100207 EAP CPT® 83002 "LH,SERUM" BOTH IP/OP $532.00 $394.00 $9.26 $532.00 $36.34 $36.34 $36.34 $36.34 $18.52 $18.52 $9.26 $9.26 $18.52 $28.12 $28.12 $29.20 $20.53 $27.36 $29.63 $29.63 $314.68 $18.52 $18.52 $18.52 $532.00 $399.00 $18.52 $18.52 $18.52 $103.52 $103.52 $421.34 $18.52 $425.60 $30.56 $26.06 $18.52 $308.56 $532.00 $26.85 $18.52 $20.47 $18.52 N/A N/A 30100208 EAP CPT® 83003 GROWTH HORMONE BOTH IP/OP $133.00 $98.50 $8.33 $133.00 $27.94 $27.94 $27.94 $27.94 $16.67 $16.67 $8.34 $8.33 $16.67 $21.62 $21.62 $22.45 $15.78 $21.03 $26.67 $26.67 $78.67 $16.67 $16.67 $16.67 $133.00 $99.75 $16.67 $16.67 $16.67 $79.56 $79.56 $105.34 $16.67 $106.40 $27.51 $20.03 $16.67 $77.14 $133.00 $24.17 $16.67 $15.73 $16.67 N/A N/A 30100209 EAP CPT® 83010 "HAPTOGLOBIN,SERUM" BOTH IP/OP $333.00 $246.50 $4.12 $333.00 $7.33 $7.33 $7.33 $7.33 $12.58 $12.58 $6.29 $6.29 $12.58 $5.66 $5.66 $5.88 $4.13 $5.51 $20.13 $20.13 $196.97 $12.58 $12.58 $12.58 $333.00 $249.75 $12.58 $12.58 $12.58 $20.84 $20.84 $263.74 $12.58 $266.40 $20.76 $5.25 $12.58 $193.14 $333.00 $18.24 $12.58 $4.12 $12.58 N/A N/A 30100211 EAP CPT® 83020 HGB ELECT - FAMILY BOTH IP/OP $218.00 $161.50 $6.44 $218.00 $19.18 $19.18 $19.18 $19.18 $12.87 $12.87 $6.44 $6.44 $12.87 $14.84 $14.84 $15.41 $10.83 $14.44 $20.59 $20.59 $128.95 $12.87 $12.87 $12.87 $218.00 $163.50 $12.87 $12.87 $12.87 $54.64 $54.64 $172.66 $12.87 $174.40 $21.24 $13.75 $12.87 $126.44 $218.00 $18.66 $12.87 $10.80 $12.87 N/A N/A 30100212 EAP CPT® 83020 HGB ELECTROPHORESIS BOTH IP/OP $218.00 $161.50 $6.44 $218.00 $19.18 $19.18 $19.18 $19.18 $12.87 $12.87 $6.44 $6.44 $12.87 $14.84 $14.84 $15.41 $10.83 $14.44 $20.59 $20.59 $128.95 $12.87 $12.87 $12.87 $218.00 $163.50 $12.87 $12.87 $12.87 $54.64 $54.64 $172.66 $12.87 $174.40 $21.24 $13.75 $12.87 $126.44 $218.00 $18.66 $12.87 $10.80 $12.87 N/A N/A 30100213 EAP CPT® 83020 CITRATE AGAR ELECT. BOTH IP/OP $217.00 $161.00 $6.44 $217.00 $19.18 $19.18 $19.18 $19.18 $12.87 $12.87 $6.44 $6.44 $12.87 $14.84 $14.84 $15.41 $10.83 $14.44 $20.59 $20.59 $128.36 $12.87 $12.87 $12.87 $217.00 $162.75 $12.87 $12.87 $12.87 $54.64 $54.64 $171.86 $12.87 $173.60 $21.24 $13.75 $12.87 $125.86 $217.00 $18.66 $12.87 $10.80 $12.87 N/A N/A 30100214 EAP CPT® 83020 HGB ELECT. QUANT BOTH IP/OP $217.00 $161.00 $6.44 $217.00 $19.18 $19.18 $19.18 $19.18 $12.87 $12.87 $6.44 $6.44 $12.87 $14.84 $14.84 $15.41 $10.83 $14.44 $20.59 $20.59 $128.36 $12.87 $12.87 $12.87 $217.00 $162.75 $12.87 $12.87 $12.87 $54.64 $54.64 $171.86 $12.87 $173.60 $21.24 $13.75 $12.87 $125.86 $217.00 $18.66 $12.87 $10.80 $12.87 N/A N/A 30100215 EAP CPT® 83020 HGB ELECT. CORD BLD BOTH IP/OP $217.00 $161.00 $6.44 $217.00 $19.18 $19.18 $19.18 $19.18 $12.87 $12.87 $6.44 $6.44 $12.87 $14.84 $14.84 $15.41 $10.83 $14.44 $20.59 $20.59 $128.36 $12.87 $12.87 $12.87 $217.00 $162.75 $12.87 $12.87 $12.87 $54.64 $54.64 $171.86 $12.87 $173.60 $21.24 $13.75 $12.87 $125.86 $217.00 $18.66 $12.87 $10.80 $12.87 N/A N/A 30100216 EAP CPT® 83021 "HGB PHENOTYPING, FAMILY MEMBER" BOTH IP/OP $218.00 $161.50 $6.64 $218.00 $11.80 $11.80 $11.80 $11.80 $18.06 $18.06 $9.03 $9.03 $18.06 $9.12 $9.12 $9.47 $6.66 $8.87 $28.90 $28.90 $128.95 $18.06 $18.06 $18.06 $218.00 $163.50 $18.06 $18.06 $18.06 $33.56 $33.56 $172.66 $18.06 $174.40 $29.80 $8.45 $18.06 $126.44 $218.00 $26.19 $18.06 $6.64 $18.06 N/A N/A 30100217 EAP CPT® 83021 "HGB A, S, AND C QUANT, HPLC" BOTH IP/OP $217.00 $161.00 $6.64 $217.00 $11.80 $11.80 $11.80 $11.80 $18.06 $18.06 $9.03 $9.03 $18.06 $9.12 $9.12 $9.47 $6.66 $8.87 $28.90 $28.90 $128.36 $18.06 $18.06 $18.06 $217.00 $162.75 $18.06 $18.06 $18.06 $33.56 $33.56 $171.86 $18.06 $173.60 $29.80 $8.45 $18.06 $125.86 $217.00 $26.19 $18.06 $6.64 $18.06 N/A N/A 30100218 EAP CPT® 83021 "HGB PHENOTYPING, COMPLETE" BOTH IP/OP $218.00 $161.50 $6.64 $218.00 $11.80 $11.80 $11.80 $11.80 $18.06 $18.06 $9.03 $9.03 $18.06 $9.12 $9.12 $9.47 $6.66 $8.87 $28.90 $28.90 $128.95 $18.06 $18.06 $18.06 $218.00 $163.50 $18.06 $18.06 $18.06 $33.56 $33.56 $172.66 $18.06 $174.40 $29.80 $8.45 $18.06 $126.44 $218.00 $26.19 $18.06 $6.64 $18.06 N/A N/A 30100219 EAP CPT® 83021 "FETAL HGB QUANT, HPLC" BOTH IP/OP $217.00 $161.00 $6.64 $217.00 $11.80 $11.80 $11.80 $11.80 $18.06 $18.06 $9.03 $9.03 $18.06 $9.12 $9.12 $9.47 $6.66 $8.87 $28.90 $28.90 $128.36 $18.06 $18.06 $18.06 $217.00 $162.75 $18.06 $18.06 $18.06 $33.56 $33.56 $171.86 $18.06 $173.60 $29.80 $8.45 $18.06 $125.86 $217.00 $26.19 $18.06 $6.64 $18.06 N/A N/A 30100221 EAP CPT® 83036 HGB GLUCOSE A1C BOTH IP/OP $219.00 $162.50 $4.86 $219.00 $19.05 $19.05 $19.05 $19.05 $9.71 $9.71 $4.86 $4.86 $9.71 $14.74 $14.74 $15.30 $10.76 $14.33 $15.54 $15.54 $129.54 $9.71 $9.71 $9.71 $219.00 $164.25 $9.71 $9.71 $9.71 $54.24 $54.24 $173.45 $9.71 $175.20 $16.02 $13.65 $9.71 $127.02 $219.00 $14.08 $9.71 $10.72 $9.71 N/A N/A 30100222 EAP CPT® 83051 "HGB,PLASMA-QUANT" BOTH IP/OP $165.00 $122.50 $3.66 $165.00 $165.00 $165.00 $165.00 $165.00 $7.31 $7.31 $3.66 $165.00 $7.31 $11.10 $11.10 $11.52 $8.10 $10.79 $11.70 $11.70 $165.00 $7.31 $7.31 $7.31 $165.00 $123.75 $7.31 $7.31 $7.31 $40.84 $40.84 $130.68 $7.31 $132.00 $165.00 $165.00 $7.31 $95.70 $165.00 $10.60 $7.31 $165.00 $7.31 N/A N/A 30100223 EAP CPT® 83060 "SULFHEMOGLOBIN,BLD" BOTH IP/OP $164.00 $121.50 $4.40 $164.00 $164.00 $164.00 $164.00 $164.00 $8.80 $8.80 $4.40 $164.00 $8.80 $12.56 $12.56 $13.05 $9.17 $12.22 $14.08 $14.08 $164.00 $8.80 $8.80 $8.80 $164.00 $123.00 $8.80 $8.80 $8.80 $46.24 $46.24 $129.89 $8.80 $131.20 $164.00 $164.00 $8.80 $95.12 $164.00 $12.76 $8.80 $164.00 $8.80 N/A N/A 30100224 EAP CPT® 83065 "HGB DENATURAT.,HEAT" BOTH IP/OP $146.00 $108.50 $4.50 $146.00 $146.00 $146.00 $146.00 $146.00 $9.00 $9.00 $4.50 $146.00 $9.00 $10.46 $10.46 $10.86 $7.64 $10.17 $14.40 $14.40 $146.00 $9.00 $9.00 $9.00 $146.00 $109.50 $9.00 $9.00 $9.00 $38.48 $38.48 $115.63 $9.00 $116.80 $146.00 $146.00 $9.00 $84.68 $146.00 $13.05 $9.00 $146.00 $9.00 N/A N/A 30100225 EAP CPT® 83068 "HGB PP'T,ISOPROPANOL" BOTH IP/OP $176.00 $130.50 $4.74 $176.00 $176.00 $176.00 $176.00 $176.00 $9.47 $9.47 $4.74 $176.00 $9.47 $12.86 $12.86 $13.36 $9.39 $12.52 $15.15 $15.15 $176.00 $9.47 $9.47 $9.47 $176.00 $132.00 $9.47 $9.47 $9.47 $47.32 $47.32 $139.39 $9.47 $140.80 $176.00 $176.00 $9.47 $102.08 $176.00 $13.73 $9.47 $176.00 $9.47 N/A N/A 30100226 EAP CPT® 83069 "HEMOGLOBIN,URINE-QNT" BOTH IP/OP $88.00 $65.50 $1.98 $88.00 $88.00 $88.00 $88.00 $88.00 $3.95 $3.95 $1.98 $88.00 $3.95 $5.99 $5.99 $6.22 $4.37 $5.83 $6.32 $6.32 $88.00 $3.95 $3.95 $3.95 $88.00 $66.00 $3.95 $3.95 $3.95 $22.04 $22.04 $69.70 $3.95 $70.40 $88.00 $88.00 $3.95 $51.04 $88.00 $5.73 $3.95 $88.00 $3.95 N/A N/A 30100227 EAP CPT® 83070 "HEMOSIDERIN, URINE" BOTH IP/OP $58.00 $43.00 $2.38 $58.00 $58.00 $58.00 $58.00 $58.00 $4.75 $4.75 $2.38 $58.00 $4.75 $7.21 $7.21 $7.48 $5.26 $7.02 $7.60 $7.60 $58.00 $4.75 $4.75 $4.75 $58.00 $43.50 $4.75 $4.75 $4.75 $26.56 $26.56 $45.94 $4.75 $46.40 $58.00 $58.00 $4.75 $33.64 $58.00 $6.89 $4.75 $58.00 $4.75 N/A N/A 30100228 EAP CPT® 83080 HEXOSAMINIDASE-1 BOTH IP/OP $525.00 $388.50 $8.44 $525.00 $525.00 $525.00 $525.00 $525.00 $16.87 $16.87 $8.44 $525.00 $16.87 $25.62 $25.62 $26.60 $18.70 $24.92 $26.99 $26.99 $525.00 $16.87 $16.87 $16.87 $525.00 $393.75 $16.87 $16.87 $16.87 $94.28 $94.28 $415.80 $16.87 $420.00 $525.00 $525.00 $16.87 $304.50 $525.00 $24.46 $16.87 $525.00 $16.87 N/A N/A 30100229 EAP CPT® 83150 HOMOVANILLIC ACID-24H BOTH IP/OP $94.00 $70.00 $11.21 $94.00 $94.00 $94.00 $94.00 $94.00 $22.41 $22.41 $11.21 $94.00 $22.41 $29.38 $29.38 $30.51 $21.45 $28.59 $35.86 $35.86 $94.00 $22.41 $22.41 $22.41 $94.00 $70.50 $22.41 $22.41 $22.41 $94.00 $94.00 $74.45 $22.41 $75.20 $94.00 $94.00 $22.41 $54.52 $94.00 $32.49 $22.41 $94.00 $22.41 N/A N/A 30100230 EAP CPT® 83491 "STEROIDS-17OH,24H UR" BOTH IP/OP $94.00 $70.00 $8.95 $94.00 $94.00 $94.00 $94.00 $94.00 $17.90 $17.90 $8.95 $94.00 $17.90 $26.59 $26.59 $27.62 $19.41 $25.87 $28.64 $28.64 $94.00 $17.90 $17.90 $17.90 $94.00 $70.50 $17.90 $17.90 $17.90 $94.00 $94.00 $74.45 $17.90 $75.20 $94.00 $94.00 $17.90 $54.52 $94.00 $25.96 $17.90 $94.00 $17.90 N/A N/A 30100231 EAP CPT® 83497 "SEROTONIN,URINE-24" BOTH IP/OP $154.00 $114.00 $6.45 $154.00 $25.30 $25.30 $25.30 $25.30 $12.90 $12.90 $6.45 $6.45 $12.90 $19.58 $19.58 $20.34 $14.30 $19.05 $20.64 $20.64 $91.09 $12.90 $12.90 $12.90 $154.00 $115.50 $12.90 $12.90 $12.90 $72.04 $72.04 $121.97 $12.90 $123.20 $21.29 $18.14 $12.90 $89.32 $154.00 $18.71 $12.90 $14.25 $12.90 N/A N/A 30100232 EAP CPT® 83498 "PROGESTERONE,17A-OH" BOTH IP/OP $286.00 $212.00 $13.59 $286.00 $53.31 $53.31 $53.31 $53.31 $27.17 $27.17 $13.59 $13.59 $27.17 $41.25 $41.25 $42.83 $30.11 $40.13 $43.47 $43.47 $169.17 $27.17 $27.17 $27.17 $286.00 $214.50 $27.17 $27.17 $27.17 $151.80 $151.80 $226.51 $27.17 $228.80 $44.83 $38.22 $27.17 $165.88 $286.00 $39.40 $27.17 $30.02 $27.17 N/A N/A 30100233 EAP CPT® 83516 T-TRANSGLUTAMINASE IGA BOTH IP/OP $181.00 $134.00 $5.76 $181.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $107.06 $11.53 $11.53 $11.53 $181.00 $135.75 $11.53 $11.53 $11.53 $59.76 $59.76 $143.35 $11.53 $144.80 $19.02 $15.05 $11.53 $104.98 $181.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30100234 EAP CPT® 83516 GLIADIN AB IGG BOTH IP/OP $313.00 $232.00 $5.76 $313.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $185.14 $11.53 $11.53 $11.53 $313.00 $234.75 $11.53 $11.53 $11.53 $59.76 $59.76 $247.90 $11.53 $250.40 $19.02 $15.05 $11.53 $181.54 $313.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30100235 EAP CPT® 83516 GLIADIN AB IGA BOTH IP/OP $269.00 $199.50 $5.76 $269.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $159.11 $11.53 $11.53 $11.53 $269.00 $201.75 $11.53 $11.53 $11.53 $59.76 $59.76 $213.05 $11.53 $215.20 $19.02 $15.05 $11.53 $156.02 $269.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30100236 EAP CPT® 83519 IGF BINDING PROTEIN-3 BOTH IP/OP $260.00 $192.50 $8.28 $260.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $153.79 $18.40 $18.40 $18.40 $260.00 $195.00 $18.40 $18.40 $18.40 $75.52 $75.52 $205.92 $18.40 $208.00 $30.36 $19.01 $18.40 $150.80 $260.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30100237 EAP CPT® 83519 GAD-65 AUTOANTIBODY BOTH IP/OP $260.00 $192.50 $8.28 $260.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $153.79 $18.40 $18.40 $18.40 $260.00 $195.00 $18.40 $18.40 $18.40 $75.52 $75.52 $205.92 $18.40 $208.00 $30.36 $19.01 $18.40 $150.80 $260.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30100238 EAP CPT® 84490 "TRYPSIN,FECAL" BOTH IP/OP $119.00 $88.50 $4.97 $119.00 $119.00 $119.00 $119.00 $119.00 $9.93 $9.93 $4.97 $119.00 $9.93 $11.55 $11.55 $12.00 $8.43 $11.25 $15.89 $15.89 $119.00 $9.93 $9.93 $9.93 $119.00 $89.25 $9.93 $9.93 $9.93 $42.52 $42.52 $94.25 $9.93 $95.20 $119.00 $119.00 $9.93 $69.02 $119.00 $14.40 $9.93 $119.00 $9.93 N/A N/A 30100239 EAP CPT® 80155 CAFFEINE (SO) BOTH IP/OP $570.00 $422.00 $14.65 $570.00 $570.00 $570.00 $570.00 $570.00 $38.57 $38.57 $19.29 $570.00 $38.57 $20.07 $20.07 $20.84 $14.65 $18.13 $61.71 $61.71 $570.00 $38.57 $38.57 $38.57 $570.00 $427.50 $38.57 $38.57 $38.57 $285.00 $285.00 $451.44 $38.57 $456.00 $570.00 $570.00 $38.57 $330.60 $570.00 $55.93 $38.57 $570.00 $38.57 N/A N/A 30100240 EAP CPT® 83525 "INSULIN, SERUM" BOTH IP/OP $324.00 $240.00 $5.72 $324.00 $22.44 $22.44 $22.44 $22.44 $11.43 $11.43 $5.72 $5.72 $11.43 $17.36 $17.36 $18.03 $12.67 $16.89 $18.29 $18.29 $191.65 $11.43 $11.43 $11.43 $324.00 $243.00 $11.43 $11.43 $11.43 $63.92 $63.92 $256.61 $11.43 $259.20 $18.86 $16.09 $11.43 $187.92 $324.00 $16.57 $11.43 $12.64 $11.43 N/A N/A 30100241 EAP CPT® 83540 "IRON-TOTAL,SERUM" BOTH IP/OP $202.00 $149.50 $3.24 $202.00 $12.70 $12.70 $12.70 $12.70 $6.47 $6.47 $3.24 $3.24 $6.47 $9.84 $9.84 $10.22 $7.18 $9.58 $10.35 $10.35 $119.48 $6.47 $6.47 $6.47 $202.00 $151.50 $6.47 $6.47 $6.47 $36.20 $36.20 $159.98 $6.47 $161.60 $10.68 $9.12 $6.47 $117.16 $202.00 $9.38 $6.47 $7.16 $6.47 N/A N/A 30100242 EAP CPT® 83540 "IRON, LIVER TISSUE" BOTH IP/OP $186.00 $138.00 $3.24 $186.00 $12.70 $12.70 $12.70 $12.70 $6.47 $6.47 $3.24 $3.24 $6.47 $9.84 $9.84 $10.22 $7.18 $9.58 $10.35 $10.35 $110.02 $6.47 $6.47 $6.47 $186.00 $139.50 $6.47 $6.47 $6.47 $36.20 $36.20 $147.31 $6.47 $148.80 $10.68 $9.12 $6.47 $107.88 $186.00 $9.38 $6.47 $7.16 $6.47 N/A N/A 30100243 EAP CPT® 83582 "STEROIDS-17KG,24H UR" BOTH IP/OP $93.00 $69.00 $7.74 $93.00 $93.00 $93.00 $93.00 $93.00 $15.47 $15.47 $7.74 $93.00 $15.47 $21.52 $21.52 $22.35 $15.71 $20.94 $24.75 $24.75 $93.00 $15.47 $15.47 $15.47 $93.00 $69.75 $15.47 $15.47 $15.47 $79.20 $79.20 $73.66 $15.47 $74.40 $93.00 $93.00 $15.47 $53.94 $93.00 $22.43 $15.47 $93.00 $15.47 N/A N/A 30100244 EAP CPT® 83593 "STEROIDS-17KETO,24HR" BOTH IP/OP $367.00 $272.00 $14.25 $367.00 $367.00 $367.00 $367.00 $367.00 $28.50 $28.50 $14.25 $367.00 $28.50 $39.94 $39.94 $41.47 $29.15 $38.86 $45.60 $45.60 $367.00 $28.50 $28.50 $28.50 $367.00 $275.25 $28.50 $28.50 $28.50 $147.00 $147.00 $290.66 $28.50 $293.60 $367.00 $367.00 $28.50 $212.86 $367.00 $41.33 $28.50 $367.00 $28.50 N/A N/A 30100247 EAP CPT® 83605 "LACTIC ACID, BLOOD" BOTH IP/OP $341.00 $252.50 $5.34 $341.00 $20.96 $20.96 $20.96 $20.96 $11.57 $11.57 $5.79 $5.34 $11.57 $16.21 $16.21 $16.84 $11.84 $15.78 $18.51 $18.51 $201.70 $11.57 $11.57 $11.57 $341.00 $255.75 $11.57 $11.57 $11.57 $59.68 $59.68 $270.07 $11.57 $272.80 $19.09 $15.03 $11.57 $197.78 $341.00 $16.78 $11.57 $11.81 $11.57 N/A N/A 30100248 EAP CPT® 83605 "LACTIC ACID, CSF" BOTH IP/OP $341.00 $252.50 $5.34 $341.00 $20.96 $20.96 $20.96 $20.96 $11.57 $11.57 $5.79 $5.34 $11.57 $16.21 $16.21 $16.84 $11.84 $15.78 $18.51 $18.51 $201.70 $11.57 $11.57 $11.57 $341.00 $255.75 $11.57 $11.57 $11.57 $59.68 $59.68 $270.07 $11.57 $272.80 $19.09 $15.03 $11.57 $197.78 $341.00 $16.78 $11.57 $11.81 $11.57 N/A N/A 30100249 EAP CPT® 83605 "LACTIC ACID, FLUID" BOTH IP/OP $258.00 $191.00 $5.34 $258.00 $20.96 $20.96 $20.96 $20.96 $11.57 $11.57 $5.79 $5.34 $11.57 $16.21 $16.21 $16.84 $11.84 $15.78 $18.51 $18.51 $152.61 $11.57 $11.57 $11.57 $258.00 $193.50 $11.57 $11.57 $11.57 $59.68 $59.68 $204.34 $11.57 $206.40 $19.09 $15.03 $11.57 $149.64 $258.00 $16.78 $11.57 $11.81 $11.57 N/A N/A 30100251 EAP CPT® 83615 "LDH,TOTAL-SERUM" BOTH IP/OP $153.00 $113.50 $3.02 $153.00 $11.85 $11.85 $11.85 $11.85 $6.04 $6.04 $3.02 $3.02 $6.04 $9.16 $9.16 $9.51 $6.69 $7.46 $9.66 $9.66 $90.50 $6.04 $6.04 $6.04 $153.00 $114.75 $6.04 $6.04 $6.04 $33.76 $33.76 $121.18 $6.04 $122.40 $9.97 $7.10 $6.04 $88.74 $153.00 $8.76 $6.04 $5.58 $6.04 N/A N/A 30100252 EAP CPT® 83615 "LDH,FLUID" BOTH IP/OP $153.00 $113.50 $3.02 $153.00 $11.85 $11.85 $11.85 $11.85 $6.04 $6.04 $3.02 $3.02 $6.04 $9.16 $9.16 $9.51 $6.69 $7.46 $9.66 $9.66 $90.50 $6.04 $6.04 $6.04 $153.00 $114.75 $6.04 $6.04 $6.04 $33.76 $33.76 $121.18 $6.04 $122.40 $9.97 $7.10 $6.04 $88.74 $153.00 $8.76 $6.04 $5.58 $6.04 N/A N/A 30100253 EAP CPT® 83615 "LDH,CSF" BOTH IP/OP $139.00 $103.00 $3.02 $139.00 $11.85 $11.85 $11.85 $11.85 $6.04 $6.04 $3.02 $3.02 $6.04 $9.16 $9.16 $9.51 $6.69 $7.46 $9.66 $9.66 $82.22 $6.04 $6.04 $6.04 $139.00 $104.25 $6.04 $6.04 $6.04 $33.76 $33.76 $110.09 $6.04 $111.20 $9.97 $7.10 $6.04 $80.62 $139.00 $8.76 $6.04 $5.58 $6.04 N/A N/A 30100254 EAP CPT® 83655 "LEAD,BLOOD" BOTH IP/OP $200.00 $148.00 $6.05 $200.00 $23.77 $23.77 $23.77 $23.77 $12.11 $12.11 $6.06 $6.05 $12.11 $18.38 $18.38 $19.08 $13.41 $11.75 $19.38 $19.38 $118.30 $12.11 $12.11 $12.11 $200.00 $150.00 $12.11 $12.11 $12.11 $67.64 $67.64 $158.40 $12.11 $160.00 $19.98 $11.19 $12.11 $116.00 $200.00 $17.56 $12.11 $8.79 $12.11 N/A N/A 30100255 EAP CPT® 83655 "LEAD,URINE-24HR" BOTH IP/OP $195.00 $144.50 $6.05 $195.00 $23.77 $23.77 $23.77 $23.77 $12.11 $12.11 $6.06 $6.05 $12.11 $18.38 $18.38 $19.08 $13.41 $11.75 $19.38 $19.38 $115.34 $12.11 $12.11 $12.11 $195.00 $146.25 $12.11 $12.11 $12.11 $67.64 $67.64 $154.44 $12.11 $156.00 $19.98 $11.19 $12.11 $113.10 $195.00 $17.56 $12.11 $8.79 $12.11 N/A N/A 30100256 EAP CPT® 83661 FETAL LUNG MATURITY BOTH IP/OP $262.00 $194.00 $11.00 $262.00 $262.00 $262.00 $262.00 $262.00 $21.99 $21.99 $11.00 $262.00 $21.99 $33.37 $33.37 $34.66 $24.36 $32.47 $35.18 $35.18 $262.00 $21.99 $21.99 $21.99 $262.00 $196.50 $21.99 $21.99 $21.99 $122.84 $122.84 $207.50 $21.99 $209.60 $262.00 $262.00 $21.99 $151.96 $262.00 $31.89 $21.99 $262.00 $21.99 N/A N/A 30100258 EAP CPT® 83690 "LIPASE, SERUM" BOTH IP/OP $225.00 $166.50 $3.44 $225.00 $13.53 $13.53 $13.53 $13.53 $6.89 $6.89 $3.45 $3.44 $6.89 $10.46 $10.46 $10.86 $7.64 $10.17 $11.02 $11.02 $133.09 $6.89 $6.89 $6.89 $225.00 $168.75 $6.89 $6.89 $6.89 $38.48 $38.48 $178.20 $6.89 $180.00 $11.37 $9.69 $6.89 $130.50 $225.00 $9.99 $6.89 $7.61 $6.89 N/A N/A 30100259 EAP CPT® 83698 PLAC (LP-PLA2) TEST BOTH IP/OP $453.00 $335.50 $23.16 $453.00 $453.00 $453.00 $453.00 $453.00 $46.31 $46.31 $23.16 $453.00 $46.31 $51.54 $51.54 $53.52 $37.63 $50.15 $74.10 $74.10 $453.00 $46.31 $46.31 $46.31 $453.00 $339.75 $46.31 $46.31 $46.31 $189.72 $189.72 $358.78 $46.31 $362.40 $453.00 $453.00 $46.31 $262.74 $453.00 $67.15 $46.31 $453.00 $46.31 N/A N/A 30100260 EAP CPT® 83718 "CHOL,HDL" BOTH IP/OP $118.00 $87.50 $4.10 $118.00 $16.09 $16.09 $16.09 $16.09 $8.19 $8.19 $4.10 $4.10 $8.19 $12.44 $12.44 $12.92 $9.08 $12.10 $13.10 $13.10 $69.80 $8.19 $8.19 $8.19 $118.00 $88.50 $8.19 $8.19 $8.19 $45.76 $45.76 $93.46 $8.19 $94.40 $13.51 $11.52 $8.19 $68.44 $118.00 $11.88 $8.19 $9.05 $8.19 N/A N/A 30100262 EAP CPT® 83721 "CHOL-LDL, DIRECT" BOTH IP/OP $147.00 $109.00 $4.77 $147.00 $18.72 $18.72 $18.72 $18.72 $10.50 $10.50 $5.25 $4.77 $10.50 $14.49 $14.49 $15.04 $10.58 $14.10 $16.80 $16.80 $86.95 $10.50 $10.50 $10.50 $147.00 $110.25 $10.50 $10.50 $10.50 $53.32 $53.32 $116.42 $10.50 $117.60 $17.33 $13.43 $10.50 $85.26 $147.00 $15.23 $10.50 $10.55 $10.50 N/A N/A 30100263 EAP CPT® 83735 MAGNESIUM BOTH IP/OP $188.00 $139.50 $3.35 $188.00 $13.15 $13.15 $13.15 $13.15 $6.70 $6.70 $3.35 $3.35 $6.70 $10.17 $10.17 $10.56 $7.42 $9.89 $10.72 $10.72 $111.20 $6.70 $6.70 $6.70 $188.00 $141.00 $6.70 $6.70 $6.70 $37.44 $37.44 $148.90 $6.70 $150.40 $11.06 $9.42 $6.70 $109.04 $188.00 $9.72 $6.70 $7.40 $6.70 N/A N/A 30100264 EAP CPT® 83735 "MAGNESIUM, URINE" BOTH IP/OP $160.00 $118.50 $3.35 $160.00 $13.15 $13.15 $13.15 $13.15 $6.70 $6.70 $3.35 $3.35 $6.70 $10.17 $10.17 $10.56 $7.42 $9.89 $10.72 $10.72 $94.64 $6.70 $6.70 $6.70 $160.00 $120.00 $6.70 $6.70 $6.70 $37.44 $37.44 $126.72 $6.70 $128.00 $11.06 $9.42 $6.70 $92.80 $160.00 $9.72 $6.70 $7.40 $6.70 N/A N/A 30100266 EAP CPT® 83825 "MERCURY,URINE-24HR" BOTH IP/OP $84.00 $62.50 $8.13 $84.00 $31.90 $31.90 $31.90 $31.90 $16.26 $16.26 $8.13 $8.13 $16.26 $24.69 $24.69 $25.64 $18.02 $24.02 $26.02 $26.02 $49.69 $16.26 $16.26 $16.26 $84.00 $63.00 $16.26 $16.26 $16.26 $84.00 $84.00 $66.53 $16.26 $67.20 $26.83 $22.88 $16.26 $48.72 $84.00 $23.58 $16.26 $17.97 $16.26 N/A N/A 30100267 EAP CPT® 83835 "METANEPH.TOT,UR" BOTH IP/OP $508.00 $376.00 $8.47 $508.00 $33.26 $33.26 $33.26 $33.26 $16.94 $16.94 $8.47 $8.47 $16.94 $25.73 $25.73 $26.72 $18.78 $25.02 $27.10 $27.10 $300.48 $16.94 $16.94 $16.94 $508.00 $381.00 $16.94 $16.94 $16.94 $94.68 $94.68 $402.34 $16.94 $406.40 $27.95 $23.83 $16.94 $294.64 $508.00 $24.56 $16.94 $18.72 $16.94 N/A N/A 30100268 EAP CPT® 83835 "METANEPHRINES, FRAC, PLASMA" BOTH IP/OP $544.00 $403.00 $8.47 $544.00 $33.26 $33.26 $33.26 $33.26 $16.94 $16.94 $8.47 $8.47 $16.94 $25.73 $25.73 $26.72 $18.78 $25.02 $27.10 $27.10 $321.78 $16.94 $16.94 $16.94 $544.00 $408.00 $16.94 $16.94 $16.94 $94.68 $94.68 $430.85 $16.94 $435.20 $27.95 $23.83 $16.94 $315.52 $544.00 $24.56 $16.94 $18.72 $16.94 N/A N/A 30100269 EAP CPT® 83835 "METANEPHRINES, URINE, RANDOM" BOTH IP/OP $504.00 $373.00 $8.47 $504.00 $33.26 $33.26 $33.26 $33.26 $16.94 $16.94 $8.47 $8.47 $16.94 $25.73 $25.73 $26.72 $18.78 $25.02 $27.10 $27.10 $298.12 $16.94 $16.94 $16.94 $504.00 $378.00 $16.94 $16.94 $16.94 $94.68 $94.68 $399.17 $16.94 $403.20 $27.95 $23.83 $16.94 $292.32 $504.00 $24.56 $16.94 $18.72 $16.94 N/A N/A 30100270 EAP CPT® 83864 MUCOPOLYSACCHA BOTH IP/OP $388.00 $287.50 $14.25 $388.00 $388.00 $388.00 $388.00 $388.00 $28.50 $28.50 $14.25 $388.00 $28.50 $30.23 $30.23 $31.40 $22.07 $15.87 $45.60 $45.60 $388.00 $28.50 $28.50 $28.50 $388.00 $291.00 $28.50 $28.50 $28.50 $111.28 $111.28 $307.30 $28.50 $310.40 $388.00 $388.00 $28.50 $225.04 $388.00 $41.33 $28.50 $388.00 $28.50 N/A N/A 30100271 EAP CPT® 83874 "MYOGLOBIN-QUAL,URINE" BOTH IP/OP $182.00 $135.00 $6.46 $182.00 $25.35 $25.35 $25.35 $25.35 $12.92 $12.92 $6.46 $6.46 $12.92 $19.61 $19.61 $20.37 $14.32 $19.08 $20.67 $20.67 $107.65 $12.92 $12.92 $12.92 $182.00 $136.50 $12.92 $12.92 $12.92 $72.16 $72.16 $144.14 $12.92 $145.60 $21.32 $18.17 $12.92 $105.56 $182.00 $18.73 $12.92 $14.27 $12.92 N/A N/A 30100272 EAP CPT® 83880 B-TYPE NATRIURTIC PEPTIDE BOTH IP/OP $368.00 $272.50 $17.67 $368.00 $66.62 $66.62 $66.62 $66.62 $39.26 $39.26 $19.63 $17.67 $39.26 $51.54 $51.54 $53.52 $37.63 $50.15 $62.82 $62.82 $217.67 $39.26 $39.26 $39.26 $368.00 $276.00 $39.26 $39.26 $39.26 $189.72 $189.72 $291.46 $39.26 $294.40 $64.78 $47.76 $39.26 $213.44 $368.00 $56.93 $39.26 $37.52 $39.26 N/A N/A 30100273 EAP CPT® 83883 ALPHA2-MACROGLBULIN BOTH IP/OP $178.00 $132.00 $6.80 $178.00 $26.68 $26.68 $26.68 $26.68 $13.60 $13.60 $6.80 $6.80 $13.60 $20.64 $20.64 $21.44 $15.07 $20.09 $21.76 $21.76 $105.29 $13.60 $13.60 $13.60 $178.00 $133.50 $13.60 $13.60 $13.60 $76.00 $76.00 $140.98 $13.60 $142.40 $22.44 $19.13 $13.60 $103.24 $178.00 $19.72 $13.60 $15.03 $13.60 N/A N/A 30100274 EAP CPT® 83883 "ALBUMIN-IMMUNO,SER" BOTH IP/OP $176.00 $130.50 $6.80 $176.00 $26.68 $26.68 $26.68 $26.68 $13.60 $13.60 $6.80 $6.80 $13.60 $20.64 $20.64 $21.44 $15.07 $20.09 $21.76 $21.76 $104.10 $13.60 $13.60 $13.60 $176.00 $132.00 $13.60 $13.60 $13.60 $76.00 $76.00 $139.39 $13.60 $140.80 $22.44 $19.13 $13.60 $102.08 $176.00 $19.72 $13.60 $15.03 $13.60 N/A N/A 30100275 EAP CPT® 83883 "ALBUMIN,CSF-IMMUNO" BOTH IP/OP $176.00 $130.50 $6.80 $176.00 $26.68 $26.68 $26.68 $26.68 $13.60 $13.60 $6.80 $6.80 $13.60 $20.64 $20.64 $21.44 $15.07 $20.09 $21.76 $21.76 $104.10 $13.60 $13.60 $13.60 $176.00 $132.00 $13.60 $13.60 $13.60 $76.00 $76.00 $139.39 $13.60 $140.80 $22.44 $19.13 $13.60 $102.08 $176.00 $19.72 $13.60 $15.03 $13.60 N/A N/A 30100276 EAP CPT® 83883 "ALBUMIN,URINE-IMMUNO" BOTH IP/OP $178.00 $132.00 $6.80 $178.00 $26.68 $26.68 $26.68 $26.68 $13.60 $13.60 $6.80 $6.80 $13.60 $20.64 $20.64 $21.44 $15.07 $20.09 $21.76 $21.76 $105.29 $13.60 $13.60 $13.60 $178.00 $133.50 $13.60 $13.60 $13.60 $76.00 $76.00 $140.98 $13.60 $142.40 $22.44 $19.13 $13.60 $103.24 $178.00 $19.72 $13.60 $15.03 $13.60 N/A N/A 30100277 EAP CPT® 83883 C-1 ESTERASE INHIB BOTH IP/OP $168.00 $124.50 $6.80 $168.00 $26.68 $26.68 $26.68 $26.68 $13.60 $13.60 $6.80 $6.80 $13.60 $20.64 $20.64 $21.44 $15.07 $20.09 $21.76 $21.76 $99.37 $13.60 $13.60 $13.60 $168.00 $126.00 $13.60 $13.60 $13.60 $76.00 $76.00 $133.06 $13.60 $134.40 $22.44 $19.13 $13.60 $97.44 $168.00 $19.72 $13.60 $15.03 $13.60 N/A N/A 30100278 EAP CPT® 83883 FREE KAPPA BOTH IP/OP $176.00 $130.50 $6.80 $176.00 $26.68 $26.68 $26.68 $26.68 $13.60 $13.60 $6.80 $6.80 $13.60 $20.64 $20.64 $21.44 $15.07 $20.09 $21.76 $21.76 $104.10 $13.60 $13.60 $13.60 $176.00 $132.00 $13.60 $13.60 $13.60 $76.00 $76.00 $139.39 $13.60 $140.80 $22.44 $19.13 $13.60 $102.08 $176.00 $19.72 $13.60 $15.03 $13.60 N/A N/A 30100279 EAP CPT® 83883 FREE LAMBDA BOTH IP/OP $176.00 $130.50 $6.80 $176.00 $26.68 $26.68 $26.68 $26.68 $13.60 $13.60 $6.80 $6.80 $13.60 $20.64 $20.64 $21.44 $15.07 $20.09 $21.76 $21.76 $104.10 $13.60 $13.60 $13.60 $176.00 $132.00 $13.60 $13.60 $13.60 $76.00 $76.00 $139.39 $13.60 $140.80 $22.44 $19.13 $13.60 $102.08 $176.00 $19.72 $13.60 $15.03 $13.60 N/A N/A 30100280 EAP CPT® 80323 NICOTINE BOTH IP/OP $422.00 $312.50 $0.03 $422.00 $0.03 $0.03 $0.03 $0.03 $422.00 $422.00 $12.01 $18.43 $422.00 $313.21 $313.21 $325.28 $219.86 $44.34 $422.00 $153.60 $249.61 $422.00 $384.00 $422.00 $422.00 $316.50 $422.00 $422.00 $422.00 $211.00 $211.00 $334.22 $422.00 $337.60 $274.30 $42.23 $422.00 $244.76 $422.00 $253.20 $422.00 $33.17 $422.00 N/A N/A 30100296 EAP CPT® 83915 5'-NUCLEOTIDASE BOTH IP/OP $63.00 $47.00 $5.58 $63.00 $63.00 $63.00 $63.00 $63.00 $11.15 $11.15 $5.58 $63.00 $11.15 $16.94 $16.94 $17.59 $12.37 $16.47 $17.84 $17.84 $63.00 $11.15 $11.15 $11.15 $63.00 $47.25 $11.15 $11.15 $11.15 $62.32 $62.32 $49.90 $11.15 $50.40 $63.00 $63.00 $11.15 $36.54 $63.00 $16.17 $11.15 $63.00 $11.15 N/A N/A 30100297 EAP CPT® 83921 METHYLMALONIC ACID BOTH IP/OP $241.00 $178.50 $9.54 $241.00 $32.28 $32.28 $32.28 $32.28 $21.21 $21.21 $10.61 $9.54 $21.21 $25.00 $25.00 $25.96 $18.25 $24.32 $33.94 $33.94 $142.55 $21.21 $21.21 $21.21 $241.00 $180.75 $21.21 $21.21 $21.21 $92.00 $92.00 $190.87 $21.21 $192.80 $35.00 $23.16 $21.21 $139.78 $241.00 $30.75 $21.21 $18.19 $21.21 N/A N/A 30100298 EAP CPT® 83921 ORGANIC ACID BOTH IP/OP $241.00 $178.50 $9.54 $241.00 $32.28 $32.28 $32.28 $32.28 $21.21 $21.21 $10.61 $9.54 $21.21 $25.00 $25.00 $25.96 $18.25 $24.32 $33.94 $33.94 $142.55 $21.21 $21.21 $21.21 $241.00 $180.75 $21.21 $21.21 $21.21 $92.00 $92.00 $190.87 $21.21 $192.80 $35.00 $23.16 $21.21 $139.78 $241.00 $30.75 $21.21 $18.19 $21.21 N/A N/A 30100299 EAP CPT® 83930 "OSMOLALITY,CRYSTAL" BOTH IP/OP $230.00 $170.50 $3.31 $230.00 $12.98 $12.98 $12.98 $12.98 $6.61 $6.61 $3.31 $3.31 $6.61 $10.04 $10.04 $10.42 $7.33 $9.78 $10.58 $10.58 $136.05 $6.61 $6.61 $6.61 $230.00 $172.50 $6.61 $6.61 $6.61 $36.96 $36.96 $182.16 $6.61 $184.00 $10.91 $9.31 $6.61 $133.40 $230.00 $9.58 $6.61 $7.31 $6.61 N/A N/A 30100300 EAP CPT® 83930 OSMOLALITY BOTH IP/OP $265.00 $196.50 $3.31 $265.00 $12.98 $12.98 $12.98 $12.98 $6.61 $6.61 $3.31 $3.31 $6.61 $10.04 $10.04 $10.42 $7.33 $9.78 $10.58 $10.58 $156.75 $6.61 $6.61 $6.61 $265.00 $198.75 $6.61 $6.61 $6.61 $36.96 $36.96 $209.88 $6.61 $212.00 $10.91 $9.31 $6.61 $153.70 $265.00 $9.58 $6.61 $7.31 $6.61 N/A N/A 30100301 EAP CPT® 83935 "OSMOLALITY,FLUID" BOTH IP/OP $272.00 $201.50 $3.41 $272.00 $13.38 $13.38 $13.38 $13.38 $6.82 $6.82 $3.41 $3.41 $6.82 $10.35 $10.35 $10.75 $7.55 $10.07 $10.91 $10.91 $160.89 $6.82 $6.82 $6.82 $272.00 $204.00 $6.82 $6.82 $6.82 $38.08 $38.08 $215.42 $6.82 $217.60 $11.25 $9.59 $6.82 $157.76 $272.00 $9.89 $6.82 $7.53 $6.82 N/A N/A 30100302 EAP CPT® 83935 "OSMOLALITY,URINE" BOTH IP/OP $272.00 $201.50 $3.41 $272.00 $13.38 $13.38 $13.38 $13.38 $6.82 $6.82 $3.41 $3.41 $6.82 $10.35 $10.35 $10.75 $7.55 $10.07 $10.91 $10.91 $160.89 $6.82 $6.82 $6.82 $272.00 $204.00 $6.82 $6.82 $6.82 $38.08 $38.08 $215.42 $6.82 $217.60 $11.25 $9.59 $6.82 $157.76 $272.00 $9.89 $6.82 $7.53 $6.82 N/A N/A 30100303 EAP CPT® 83945 "OXALATE, URINE-24HR" BOTH IP/OP $53.00 $39.50 $7.23 $53.00 $53.00 $53.00 $53.00 $53.00 $14.45 $14.45 $7.23 $53.00 $14.45 $19.55 $19.55 $20.30 $14.27 $19.02 $23.12 $23.12 $53.00 $14.45 $14.45 $14.45 $53.00 $39.75 $14.45 $14.45 $14.45 $53.00 $53.00 $41.98 $14.45 $42.40 $53.00 $53.00 $14.45 $30.74 $53.00 $20.95 $14.45 $53.00 $14.45 N/A N/A 30100304 EAP CPT® 83970 PARATHORMONE INTACT BOTH IP/OP $502.00 $371.50 $20.64 $502.00 $81.00 $81.00 $81.00 $81.00 $41.28 $41.28 $20.64 $20.64 $41.28 $62.68 $62.68 $65.09 $45.76 $60.97 $66.05 $66.05 $296.93 $41.28 $41.28 $41.28 $502.00 $376.50 $41.28 $41.28 $41.28 $230.68 $230.68 $397.58 $41.28 $401.60 $68.11 $58.07 $41.28 $291.16 $502.00 $59.86 $41.28 $45.61 $41.28 N/A N/A 30100306 EAP CPT® 83986 "PH, STOOL" BOTH IP/OP $86.00 $64.00 $1.79 $86.00 $7.03 $7.03 $7.03 $7.03 $3.58 $3.58 $1.79 $1.79 $3.58 $5.43 $5.43 $5.64 $3.96 $5.28 $5.73 $5.73 $50.87 $3.58 $3.58 $3.58 $86.00 $64.50 $3.58 $3.58 $3.58 $20.00 $20.00 $68.11 $3.58 $68.80 $5.91 $5.03 $3.58 $49.88 $86.00 $5.19 $3.58 $3.95 $3.58 N/A N/A 30100307 EAP CPT® 84075 ALK PHOSPHATASE BOTH IP/OP $110.00 $81.50 $2.59 $110.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.46 $8.29 $8.29 $65.07 $5.18 $5.18 $5.18 $110.00 $82.50 $5.18 $5.18 $5.18 $28.92 $28.92 $87.12 $5.18 $88.00 $8.55 $7.10 $5.18 $63.80 $110.00 $7.51 $5.18 $5.58 $5.18 N/A N/A 30100308 EAP CPT® 84075 "ALK PHOS,FLUID" BOTH IP/OP $110.00 $81.50 $2.59 $110.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.46 $8.29 $8.29 $65.07 $5.18 $5.18 $5.18 $110.00 $82.50 $5.18 $5.18 $5.18 $28.92 $28.92 $87.12 $5.18 $88.00 $8.55 $7.10 $5.18 $63.80 $110.00 $7.51 $5.18 $5.58 $5.18 N/A N/A 30100309 EAP CPT® 84080 ALK PHOS ISOENZYMES BOTH IP/OP $316.00 $234.00 $7.39 $316.00 $29.02 $29.02 $29.02 $29.02 $14.78 $14.78 $7.39 $7.39 $14.78 $22.45 $22.45 $23.32 $16.39 $21.84 $23.65 $23.65 $186.91 $14.78 $14.78 $14.78 $316.00 $237.00 $14.78 $14.78 $14.78 $82.64 $82.64 $250.27 $14.78 $252.80 $24.39 $20.80 $14.78 $183.28 $316.00 $21.43 $14.78 $16.34 $14.78 N/A N/A 30100310 EAP CPT® 84081 PG AGGLUTININ TEST BOTH IP/OP $194.00 $144.00 $8.26 $194.00 $194.00 $194.00 $194.00 $194.00 $16.52 $16.52 $8.26 $194.00 $16.52 $25.08 $25.08 $26.05 $18.31 $24.41 $26.43 $26.43 $194.00 $16.52 $16.52 $16.52 $194.00 $145.50 $16.52 $16.52 $16.52 $92.36 $92.36 $153.65 $16.52 $155.20 $194.00 $194.00 $16.52 $112.52 $194.00 $23.95 $16.52 $194.00 $16.52 N/A N/A 30100311 EAP CPT® 84100 PHOSPHORUS BOTH IP/OP $150.00 $111.00 $2.37 $150.00 $9.31 $9.31 $9.31 $9.31 $4.74 $4.74 $2.37 $2.37 $4.74 $7.21 $7.21 $7.48 $5.26 $7.01 $7.58 $7.58 $88.73 $4.74 $4.74 $4.74 $150.00 $112.50 $4.74 $4.74 $4.74 $26.52 $26.52 $118.80 $4.74 $120.00 $7.82 $6.68 $4.74 $87.00 $150.00 $6.87 $4.74 $5.25 $4.74 N/A N/A 30100312 EAP CPT® 84100 "PHOSPORUS, SERUM" BOTH IP/OP $128.00 $95.00 $2.37 $128.00 $9.31 $9.31 $9.31 $9.31 $4.74 $4.74 $2.37 $2.37 $4.74 $7.21 $7.21 $7.48 $5.26 $7.01 $7.58 $7.58 $75.71 $4.74 $4.74 $4.74 $128.00 $96.00 $4.74 $4.74 $4.74 $26.52 $26.52 $101.38 $4.74 $102.40 $7.82 $6.68 $4.74 $74.24 $128.00 $6.87 $4.74 $5.25 $4.74 N/A N/A 30100313 EAP CPT® 84105 "PHOSPHORUS, URINE" BOTH IP/OP $164.00 $121.50 $2.89 $164.00 $164.00 $164.00 $164.00 $164.00 $5.78 $5.78 $2.89 $164.00 $5.78 $7.86 $7.86 $8.16 $5.74 $7.64 $9.25 $9.25 $164.00 $5.78 $5.78 $5.78 $164.00 $123.00 $5.78 $5.78 $5.78 $28.92 $28.92 $129.89 $5.78 $131.20 $164.00 $164.00 $5.78 $95.12 $164.00 $8.38 $5.78 $164.00 $5.78 N/A N/A 30100314 EAP CPT® 84110 PORPHOBILINOGEN-24HR BOTH IP/OP $75.00 $55.50 $4.22 $75.00 $75.00 $75.00 $75.00 $75.00 $8.44 $8.44 $4.22 $75.00 $8.44 $12.83 $12.83 $13.33 $9.37 $12.47 $13.50 $13.50 $75.00 $8.44 $8.44 $8.44 $75.00 $56.25 $8.44 $8.44 $8.44 $47.20 $47.20 $59.40 $8.44 $60.00 $75.00 $75.00 $8.44 $43.50 $75.00 $12.24 $8.44 $75.00 $8.44 N/A N/A 30100315 EAP CPT® 84120 "PORPHYRINS,UR-QUANT" BOTH IP/OP $109.00 $81.00 $7.36 $109.00 $109.00 $109.00 $109.00 $109.00 $14.71 $14.71 $7.36 $109.00 $14.71 $22.33 $22.33 $23.19 $16.30 $21.74 $23.54 $23.54 $109.00 $14.71 $14.71 $14.71 $109.00 $81.75 $14.71 $14.71 $14.71 $82.20 $82.20 $86.33 $14.71 $87.20 $109.00 $109.00 $14.71 $63.22 $109.00 $21.33 $14.71 $109.00 $14.71 N/A N/A 30100316 EAP CPT® 84132 "POTASSIUM, WB" BOTH IP/OP $141.00 $104.50 $2.30 $141.00 $9.04 $9.04 $9.04 $9.04 $4.76 $4.76 $2.38 $2.30 $4.76 $6.97 $6.97 $7.24 $5.09 $6.79 $7.62 $7.62 $83.40 $4.76 $4.76 $4.76 $141.00 $105.75 $4.76 $4.76 $4.76 $25.68 $25.68 $111.67 $4.76 $112.80 $7.85 $6.47 $4.76 $81.78 $141.00 $6.90 $4.76 $5.08 $4.76 N/A N/A 30100317 EAP CPT® 84132 POTASSIUM BOTH IP/OP $141.00 $104.50 $2.30 $141.00 $9.04 $9.04 $9.04 $9.04 $4.76 $4.76 $2.38 $2.30 $4.76 $6.97 $6.97 $7.24 $5.09 $6.79 $7.62 $7.62 $83.40 $4.76 $4.76 $4.76 $141.00 $105.75 $4.76 $4.76 $4.76 $25.68 $25.68 $111.67 $4.76 $112.80 $7.85 $6.47 $4.76 $81.78 $141.00 $6.90 $4.76 $5.08 $4.76 N/A N/A 30100318 EAP CPT® 84132 "POTASSIUM,PLASMA" BOTH IP/OP $141.00 $104.50 $2.30 $141.00 $9.04 $9.04 $9.04 $9.04 $4.76 $4.76 $2.38 $2.30 $4.76 $6.97 $6.97 $7.24 $5.09 $6.79 $7.62 $7.62 $83.40 $4.76 $4.76 $4.76 $141.00 $105.75 $4.76 $4.76 $4.76 $25.68 $25.68 $111.67 $4.76 $112.80 $7.85 $6.47 $4.76 $81.78 $141.00 $6.90 $4.76 $5.08 $4.76 N/A N/A 30100319 EAP CPT® 84133 "POTASSIUM,FLUID" BOTH IP/OP $106.00 $78.50 $2.16 $106.00 $8.46 $8.46 $8.46 $8.46 $4.73 $4.73 $2.37 $2.16 $4.73 $6.53 $6.53 $6.78 $4.77 $6.35 $7.57 $7.57 $62.70 $4.73 $4.73 $4.73 $106.00 $79.50 $4.73 $4.73 $4.73 $24.04 $24.04 $83.95 $4.73 $84.80 $7.80 $6.05 $4.73 $61.48 $106.00 $6.86 $4.73 $4.75 $4.73 N/A N/A 30100320 EAP CPT® 84133 "POTASSIUM, URINE" BOTH IP/OP $106.00 $78.50 $2.16 $106.00 $8.46 $8.46 $8.46 $8.46 $4.73 $4.73 $2.37 $2.16 $4.73 $6.53 $6.53 $6.78 $4.77 $6.35 $7.57 $7.57 $62.70 $4.73 $4.73 $4.73 $106.00 $79.50 $4.73 $4.73 $4.73 $24.04 $24.04 $83.95 $4.73 $84.80 $7.80 $6.05 $4.73 $61.48 $106.00 $6.86 $4.73 $4.75 $4.73 N/A N/A 30100321 EAP CPT® 84134 PREALBUMIN BOTH IP/OP $282.00 $209.00 $7.29 $282.00 $28.64 $28.64 $28.64 $28.64 $14.59 $14.59 $7.30 $7.29 $14.59 $22.15 $22.15 $23.00 $16.17 $21.55 $23.34 $23.34 $166.80 $14.59 $14.59 $14.59 $282.00 $211.50 $14.59 $14.59 $14.59 $81.52 $81.52 $223.34 $14.59 $225.60 $24.07 $20.52 $14.59 $163.56 $282.00 $21.16 $14.59 $16.12 $14.59 N/A N/A 30100322 EAP CPT® 84135 "PREGNANEDIOL,UR-24HR" BOTH IP/OP $210.00 $155.50 $10.64 $210.00 $210.00 $210.00 $210.00 $210.00 $21.27 $21.27 $10.64 $210.00 $21.27 $29.06 $29.06 $30.18 $21.21 $43.77 $34.03 $34.03 $210.00 $21.27 $21.27 $21.27 $210.00 $157.50 $21.27 $21.27 $21.27 $106.92 $106.92 $166.32 $21.27 $168.00 $210.00 $210.00 $21.27 $121.80 $210.00 $30.84 $21.27 $210.00 $21.27 N/A N/A 30100323 EAP CPT® 84138 "PREGNANETRIOL,UR-24H" BOTH IP/OP $209.00 $155.00 $10.53 $209.00 $209.00 $209.00 $209.00 $209.00 $21.05 $21.05 $10.53 $209.00 $21.05 $28.76 $28.76 $29.86 $20.99 $27.97 $33.68 $33.68 $209.00 $21.05 $21.05 $21.05 $209.00 $156.75 $21.05 $21.05 $21.05 $105.84 $105.84 $165.53 $21.05 $167.20 $209.00 $209.00 $21.05 $121.22 $209.00 $30.52 $21.05 $209.00 $21.05 N/A N/A 30100324 EAP CPT® 84144 "PROGESTERONE, SERUM" BOTH IP/OP $222.00 $164.50 $10.43 $222.00 $39.98 $39.98 $39.98 $39.98 $20.86 $20.86 $10.43 $10.43 $20.86 $30.93 $30.93 $32.12 $22.58 $30.08 $33.38 $33.38 $131.31 $20.86 $20.86 $20.86 $222.00 $166.50 $20.86 $20.86 $20.86 $113.84 $113.84 $175.82 $20.86 $177.60 $34.42 $28.65 $20.86 $128.76 $222.00 $30.25 $20.86 $22.50 $20.86 N/A N/A 30100325 EAP CPT® 84146 "PROLACTIN,SERUM" BOTH IP/OP $427.00 $316.00 $9.69 $427.00 $38.03 $38.03 $38.03 $38.03 $19.38 $19.38 $9.69 $9.69 $19.38 $29.43 $29.43 $30.56 $21.49 $28.63 $31.01 $31.01 $252.57 $19.38 $19.38 $19.38 $427.00 $320.25 $19.38 $19.38 $19.38 $108.32 $108.32 $338.18 $19.38 $341.60 $31.98 $27.27 $19.38 $247.66 $427.00 $28.10 $19.38 $21.42 $19.38 N/A N/A 30100326 EAP CPT® 84153 PROSTATIC ANTIGEN BOTH IP/OP $335.00 $248.00 $9.20 $335.00 $36.09 $36.09 $36.09 $36.09 $18.39 $18.39 $9.20 $9.20 $18.39 $27.92 $27.92 $29.00 $20.38 $27.17 $29.42 $29.42 $198.15 $18.39 $18.39 $18.39 $335.00 $251.25 $18.39 $18.39 $18.39 $102.80 $102.80 $265.32 $18.39 $268.00 $30.34 $25.88 $18.39 $194.30 $335.00 $26.67 $18.39 $20.33 $18.39 N/A N/A 30100327 EAP CPT® 84155 "PROTEIN,TOTAL" BOTH IP/OP $132.00 $98.00 $1.83 $132.00 $7.20 $7.20 $7.20 $7.20 $3.67 $3.67 $1.84 $1.83 $3.67 $5.56 $5.56 $5.78 $4.06 $5.42 $5.87 $5.87 $78.08 $3.67 $3.67 $3.67 $132.00 $99.00 $3.67 $3.67 $3.67 $20.48 $20.48 $104.54 $3.67 $105.60 $6.06 $5.16 $3.67 $76.56 $132.00 $5.32 $3.67 $4.05 $3.67 N/A N/A 30100328 EAP CPT® 84155 "PROTEIN, CSF" BOTH IP/OP $132.00 $98.00 $1.83 $132.00 $7.20 $7.20 $7.20 $7.20 $3.67 $3.67 $1.84 $1.83 $3.67 $5.56 $5.56 $5.78 $4.06 $5.42 $5.87 $5.87 $78.08 $3.67 $3.67 $3.67 $132.00 $99.00 $3.67 $3.67 $3.67 $20.48 $20.48 $104.54 $3.67 $105.60 $6.06 $5.16 $3.67 $76.56 $132.00 $5.32 $3.67 $4.05 $3.67 N/A N/A 30100329 EAP CPT® 84155 "PROTEIN,TOTAL" BOTH IP/OP $135.00 $100.00 $1.83 $135.00 $7.20 $7.20 $7.20 $7.20 $3.67 $3.67 $1.84 $1.83 $3.67 $5.56 $5.56 $5.78 $4.06 $5.42 $5.87 $5.87 $79.85 $3.67 $3.67 $3.67 $135.00 $101.25 $3.67 $3.67 $3.67 $20.48 $20.48 $106.92 $3.67 $108.00 $6.06 $5.16 $3.67 $78.30 $135.00 $5.32 $3.67 $4.05 $3.67 N/A N/A 30100330 EAP CPT® 84156 "PROTEIN,UR (QUANT)" BOTH IP/OP $132.00 $98.00 $1.83 $132.00 $7.20 $7.20 $7.20 $7.20 $3.67 $3.67 $1.84 $1.83 $3.67 $5.56 $5.56 $5.78 $4.06 $5.42 $5.87 $5.87 $78.08 $3.67 $3.67 $3.67 $132.00 $99.00 $3.67 $3.67 $3.67 $20.48 $20.48 $104.54 $3.67 $105.60 $6.06 $5.16 $3.67 $76.56 $132.00 $5.32 $3.67 $4.05 $3.67 N/A N/A 30100331 EAP CPT® 84157 "PROTEIN,FLUID" BOTH IP/OP $155.00 $115.00 $1.83 $155.00 $7.20 $7.20 $7.20 $7.20 $4.00 $4.00 $2.00 $1.83 $4.00 $5.56 $5.56 $5.78 $4.06 $5.42 $6.40 $6.40 $91.68 $4.00 $4.00 $4.00 $155.00 $116.25 $4.00 $4.00 $4.00 $20.48 $20.48 $122.76 $4.00 $124.00 $6.60 $5.16 $4.00 $89.90 $155.00 $5.80 $4.00 $4.05 $4.00 N/A N/A 30100332 EAP CPT® 84157 "PROTEIN, CSF" BOTH IP/OP $155.00 $115.00 $1.83 $155.00 $7.20 $7.20 $7.20 $7.20 $4.00 $4.00 $2.00 $1.83 $4.00 $5.56 $5.56 $5.78 $4.06 $5.42 $6.40 $6.40 $91.68 $4.00 $4.00 $4.00 $155.00 $116.25 $4.00 $4.00 $4.00 $20.48 $20.48 $122.76 $4.00 $124.00 $6.60 $5.16 $4.00 $89.90 $155.00 $5.80 $4.00 $4.05 $4.00 N/A N/A 30100333 EAP CPT® 84165 "PROTEIN ELECT, SERUM" BOTH IP/OP $357.00 $264.50 $5.37 $357.00 $21.08 $21.08 $21.08 $21.08 $10.74 $10.74 $5.37 $5.37 $10.74 $16.31 $16.31 $16.93 $11.90 $15.87 $17.18 $17.18 $211.17 $10.74 $10.74 $10.74 $357.00 $267.75 $10.74 $10.74 $10.74 $60.04 $60.04 $282.74 $10.74 $285.60 $17.72 $15.11 $10.74 $207.06 $357.00 $15.57 $10.74 $11.87 $10.74 N/A N/A 30100334 EAP CPT® 84166 "PROTEIN ELECTROPHORESIS, CSF" BOTH IP/OP $350.00 $259.00 $8.91 $350.00 $34.99 $34.99 $34.99 $34.99 $17.83 $17.83 $8.92 $8.91 $17.83 $27.08 $27.08 $28.12 $19.77 $26.34 $28.53 $28.53 $207.03 $17.83 $17.83 $17.83 $350.00 $262.50 $17.83 $17.83 $17.83 $99.68 $99.68 $277.20 $17.83 $280.00 $29.42 $25.09 $17.83 $203.00 $350.00 $25.85 $17.83 $19.71 $17.83 N/A N/A 30100335 EAP CPT® 84166 "PROTEIN ELECT, URINE" BOTH IP/OP $357.00 $264.50 $8.91 $357.00 $34.99 $34.99 $34.99 $34.99 $17.83 $17.83 $8.92 $8.91 $17.83 $27.08 $27.08 $28.12 $19.77 $26.34 $28.53 $28.53 $211.17 $17.83 $17.83 $17.83 $357.00 $267.75 $17.83 $17.83 $17.83 $99.68 $99.68 $282.74 $17.83 $285.60 $29.42 $25.09 $17.83 $207.06 $357.00 $25.85 $17.83 $19.71 $17.83 N/A N/A 30100336 EAP CPT® 84202 "PROTOPORPHYRIN,RBC" BOTH IP/OP $74.00 $55.00 $7.18 $74.00 $74.00 $74.00 $74.00 $74.00 $14.35 $14.35 $7.18 $74.00 $14.35 $21.79 $21.79 $22.63 $15.91 $21.20 $22.96 $22.96 $74.00 $14.35 $14.35 $14.35 $74.00 $55.50 $14.35 $14.35 $14.35 $74.00 $74.00 $58.61 $14.35 $59.20 $74.00 $74.00 $14.35 $42.92 $74.00 $20.81 $14.35 $74.00 $14.35 N/A N/A 30100337 EAP CPT® 84207 VITAMINE B6; PYRIDOXINE BOTH IP/OP $800.00 $592.00 $14.05 $800.00 $800.00 $800.00 $800.00 $800.00 $28.10 $28.10 $14.05 $800.00 $28.10 $42.66 $42.66 $44.30 $31.14 $41.51 $44.96 $44.96 $800.00 $28.10 $28.10 $28.10 $800.00 $600.00 $28.10 $28.10 $28.10 $157.00 $157.00 $633.60 $28.10 $640.00 $800.00 $800.00 $28.10 $464.00 $800.00 $40.75 $28.10 $800.00 $28.10 N/A N/A 30100338 EAP CPT® 84210 "PYRUVIC ACID, BLOOD" BOTH IP/OP $118.00 $87.50 $7.24 $118.00 $118.00 $118.00 $118.00 $118.00 $14.48 $14.48 $7.24 $118.00 $14.48 $16.48 $16.48 $17.12 $12.03 $16.03 $23.17 $23.17 $118.00 $14.48 $14.48 $14.48 $118.00 $88.50 $14.48 $14.48 $14.48 $60.68 $60.68 $93.46 $14.48 $94.40 $118.00 $118.00 $14.48 $68.44 $118.00 $21.00 $14.48 $118.00 $14.48 N/A N/A 30100339 EAP CPT® 84238 ACETCHOLN REPTOR AD BOTH IP/OP $201.00 $149.00 $18.28 $201.00 $71.76 $71.76 $71.76 $71.76 $36.57 $36.57 $18.29 $18.28 $36.57 $55.53 $55.53 $57.66 $40.53 $54.01 $58.51 $58.51 $118.89 $36.57 $36.57 $36.57 $201.00 $150.75 $36.57 $36.57 $36.57 $201.00 $201.00 $159.19 $36.57 $160.80 $60.34 $51.44 $36.57 $116.58 $201.00 $53.03 $36.57 $40.41 $36.57 N/A N/A 30100340 EAP CPT® 84244 "RENIN, BLOOD" BOTH IP/OP $322.00 $238.50 $11.00 $322.00 $43.17 $43.17 $43.17 $43.17 $21.99 $21.99 $11.00 $11.00 $21.99 $33.40 $33.40 $34.69 $24.39 $32.50 $35.18 $35.18 $190.46 $21.99 $21.99 $21.99 $322.00 $241.50 $21.99 $21.99 $21.99 $122.92 $122.92 $255.02 $21.99 $257.60 $36.28 $30.95 $21.99 $186.76 $322.00 $31.89 $21.99 $24.31 $21.99 N/A N/A 30100341 EAP CPT® 84295 "SODIUM, WB" BOTH IP/OP $220.00 $163.00 $2.41 $220.00 $9.44 $9.44 $9.44 $9.44 $4.81 $4.81 $2.41 $2.41 $4.81 $7.30 $7.30 $7.58 $5.33 $7.11 $7.70 $7.70 $130.13 $4.81 $4.81 $4.81 $220.00 $165.00 $4.81 $4.81 $4.81 $26.88 $26.88 $174.24 $4.81 $176.00 $7.94 $6.77 $4.81 $127.60 $220.00 $6.97 $4.81 $5.32 $4.81 N/A N/A 30100342 EAP CPT® 84295 SODIUM BOTH IP/OP $220.00 $163.00 $2.41 $220.00 $9.44 $9.44 $9.44 $9.44 $4.81 $4.81 $2.41 $2.41 $4.81 $7.30 $7.30 $7.58 $5.33 $7.11 $7.70 $7.70 $130.13 $4.81 $4.81 $4.81 $220.00 $165.00 $4.81 $4.81 $4.81 $26.88 $26.88 $174.24 $4.81 $176.00 $7.94 $6.77 $4.81 $127.60 $220.00 $6.97 $4.81 $5.32 $4.81 N/A N/A 30100343 EAP CPT® 84295 SODIUM-DIRECT ISE BOTH IP/OP $190.00 $141.00 $2.41 $190.00 $9.44 $9.44 $9.44 $9.44 $4.81 $4.81 $2.41 $2.41 $4.81 $7.30 $7.30 $7.58 $5.33 $7.11 $7.70 $7.70 $112.39 $4.81 $4.81 $4.81 $190.00 $142.50 $4.81 $4.81 $4.81 $26.88 $26.88 $150.48 $4.81 $152.00 $7.94 $6.77 $4.81 $110.20 $190.00 $6.97 $4.81 $5.32 $4.81 N/A N/A 30100344 EAP CPT® 84300 "SODIUM, URINE" BOTH IP/OP $144.00 $107.00 $2.43 $144.00 $6.78 $6.78 $6.78 $6.78 $5.06 $5.06 $2.53 $2.43 $5.06 $5.25 $5.25 $5.45 $3.83 $5.11 $8.10 $8.10 $85.18 $5.06 $5.06 $5.06 $144.00 $108.00 $5.06 $5.06 $5.06 $19.32 $19.32 $114.05 $5.06 $115.20 $8.35 $4.87 $5.06 $83.52 $144.00 $7.34 $5.06 $3.83 $5.06 N/A N/A 30100345 EAP CPT® 84302 "SODIUM,FLUID" BOTH IP/OP $144.00 $107.00 $2.43 $144.00 $144.00 $144.00 $144.00 $144.00 $4.86 $4.86 $2.43 $144.00 $4.86 $5.25 $5.25 $5.45 $3.83 $5.11 $7.78 $7.78 $144.00 $4.86 $4.86 $4.86 $144.00 $108.00 $4.86 $4.86 $4.86 $19.32 $19.32 $114.05 $4.86 $115.20 $144.00 $144.00 $4.86 $83.52 $144.00 $7.05 $4.86 $144.00 $4.86 N/A N/A 30100346 EAP CPT® 84305 IGF-1(SOMATOMEDIN C) BOTH IP/OP $283.00 $209.50 $10.63 $283.00 $41.74 $41.74 $41.74 $41.74 $21.26 $21.26 $10.63 $10.63 $21.26 $32.28 $32.28 $33.52 $23.57 $31.41 $34.02 $34.02 $167.39 $21.26 $21.26 $21.26 $283.00 $212.25 $21.26 $21.26 $21.26 $118.80 $118.80 $224.14 $21.26 $226.40 $35.08 $29.91 $21.26 $164.14 $283.00 $30.83 $21.26 $23.49 $21.26 N/A N/A 30100347 EAP CPT® 84375 OLIGOSACCHARIDE BOTH IP/OP $134.00 $99.50 $19.50 $134.00 $134.00 $134.00 $134.00 $134.00 $39.00 $39.00 $19.50 $134.00 $39.00 $29.76 $29.76 $30.91 $21.73 $28.96 $62.40 $62.40 $134.00 $39.00 $39.00 $39.00 $134.00 $100.50 $39.00 $39.00 $39.00 $109.56 $109.56 $106.13 $39.00 $107.20 $134.00 $134.00 $39.00 $77.72 $134.00 $56.55 $39.00 $134.00 $39.00 N/A N/A 30100348 EAP CPT® 84402 "TESTOSTERONE, FREE" BOTH IP/OP $95.00 $70.50 $12.74 $95.00 $50.00 $50.00 $50.00 $50.00 $25.47 $25.47 $12.74 $12.74 $25.47 $38.67 $38.67 $40.15 $28.23 $37.60 $40.75 $40.75 $56.19 $25.47 $25.47 $25.47 $95.00 $71.25 $25.47 $25.47 $25.47 $95.00 $95.00 $75.24 $25.47 $76.00 $42.03 $35.81 $25.47 $55.10 $95.00 $36.93 $25.47 $28.13 $25.47 N/A N/A 30100349 EAP CPT® 84403 "TESTOSTERONE, TOTAL" BOTH IP/OP $384.00 $284.50 $12.91 $384.00 $50.65 $50.65 $50.65 $50.65 $25.81 $25.81 $12.91 $12.91 $25.81 $39.21 $39.21 $40.72 $28.62 $38.15 $41.30 $41.30 $227.14 $25.81 $25.81 $25.81 $384.00 $288.00 $25.81 $25.81 $25.81 $144.32 $144.32 $304.13 $25.81 $307.20 $42.59 $36.33 $25.81 $222.72 $384.00 $37.42 $25.81 $28.54 $25.81 N/A N/A 30100350 EAP CPT® 84403 "TESTOSTERONE, SERUM" BOTH IP/OP $384.00 $284.50 $12.91 $384.00 $50.65 $50.65 $50.65 $50.65 $25.81 $25.81 $12.91 $12.91 $25.81 $39.21 $39.21 $40.72 $28.62 $38.15 $41.30 $41.30 $227.14 $25.81 $25.81 $25.81 $384.00 $288.00 $25.81 $25.81 $25.81 $144.32 $144.32 $304.13 $25.81 $307.20 $42.59 $36.33 $25.81 $222.72 $384.00 $37.42 $25.81 $28.54 $25.81 N/A N/A 30100351 EAP CPT® 84425 VITAMINE B1; THYAMIN BOTH IP/OP $276.00 $204.50 $10.62 $276.00 $41.67 $41.67 $41.67 $41.67 $21.23 $21.23 $10.62 $10.62 $21.23 $32.25 $32.25 $33.49 $23.54 $31.36 $33.97 $33.97 $163.25 $21.23 $21.23 $21.23 $276.00 $207.00 $21.23 $21.23 $21.23 $118.68 $118.68 $218.59 $21.23 $220.80 $35.03 $29.87 $21.23 $160.08 $276.00 $30.78 $21.23 $23.46 $21.23 N/A N/A 30100352 EAP CPT® 84430 THIOCYANATE-QUANT BOTH IP/OP $199.00 $147.50 $5.82 $199.00 $199.00 $199.00 $199.00 $199.00 $11.63 $11.63 $5.82 $199.00 $11.63 $8.76 $8.76 $9.09 $6.39 $8.52 $18.61 $18.61 $199.00 $11.63 $11.63 $11.63 $199.00 $149.25 $11.63 $11.63 $11.63 $32.24 $32.24 $157.61 $11.63 $159.20 $199.00 $199.00 $11.63 $115.42 $199.00 $16.86 $11.63 $199.00 $11.63 N/A N/A 30100353 EAP CPT® 84432 "THYROGLOBULIN, QUANT" BOTH IP/OP $214.00 $158.50 $8.03 $214.00 $31.53 $31.53 $31.53 $31.53 $16.06 $16.06 $8.03 $8.03 $16.06 $24.39 $24.39 $25.33 $17.80 $23.73 $25.70 $25.70 $126.58 $16.06 $16.06 $16.06 $214.00 $160.50 $16.06 $16.06 $16.06 $89.76 $89.76 $169.49 $16.06 $171.20 $26.50 $22.60 $16.06 $124.12 $214.00 $23.29 $16.06 $17.75 $16.06 N/A N/A 30100354 EAP CPT® 84436 "THYROXINE,TOTAL(T4)" BOTH IP/OP $322.00 $238.50 $3.43 $322.00 $13.48 $13.48 $13.48 $13.48 $6.87 $6.87 $3.44 $3.43 $6.87 $10.43 $10.43 $10.83 $7.61 $10.16 $10.99 $10.99 $190.46 $6.87 $6.87 $6.87 $322.00 $241.50 $6.87 $6.87 $6.87 $38.44 $38.44 $255.02 $6.87 $257.60 $11.34 $9.68 $6.87 $186.76 $322.00 $9.96 $6.87 $7.60 $6.87 N/A N/A 30100355 EAP CPT® 84439 FREE THYROXINE BOTH IP/OP $215.00 $159.50 $4.51 $215.00 $17.70 $17.70 $17.70 $17.70 $9.02 $9.02 $4.51 $4.51 $9.02 $13.70 $13.70 $14.22 $10.00 $13.32 $14.43 $14.43 $127.17 $9.02 $9.02 $9.02 $215.00 $161.25 $9.02 $9.02 $9.02 $50.40 $50.40 $170.28 $9.02 $172.00 $14.88 $12.69 $9.02 $124.70 $215.00 $13.08 $9.02 $9.97 $9.02 N/A N/A 30100356 EAP CPT® 84442 THYROXINE BIND.GLOB. BOTH IP/OP $63.00 $47.00 $7.39 $63.00 $63.00 $63.00 $63.00 $63.00 $14.78 $14.78 $7.39 $63.00 $14.78 $17.67 $17.67 $18.35 $12.90 $17.19 $23.65 $23.65 $63.00 $14.78 $14.78 $14.78 $63.00 $47.25 $14.78 $14.78 $14.78 $63.00 $63.00 $49.90 $14.78 $50.40 $63.00 $63.00 $14.78 $36.54 $63.00 $21.43 $14.78 $63.00 $14.78 N/A N/A 30100357 EAP CPT® 84443 "TSH,SERUM-IRMA" BOTH IP/OP $275.00 $203.50 $8.40 $275.00 $32.98 $32.98 $32.98 $32.98 $16.80 $16.80 $8.40 $8.40 $16.80 $25.51 $25.51 $26.49 $18.62 $24.81 $26.88 $26.88 $162.66 $16.80 $16.80 $16.80 $275.00 $206.25 $16.80 $16.80 $16.80 $93.88 $93.88 $217.80 $16.80 $220.00 $27.72 $23.63 $16.80 $159.50 $275.00 $24.36 $16.80 $18.56 $16.80 N/A N/A 30100358 EAP CPT® 84446 "VITAMIN E, SERUM" BOTH IP/OP $178.00 $132.00 $7.09 $178.00 $27.84 $27.84 $27.84 $27.84 $14.18 $14.18 $7.09 $7.09 $14.18 $21.53 $21.53 $22.36 $15.72 $20.95 $22.69 $22.69 $105.29 $14.18 $14.18 $14.18 $178.00 $133.50 $14.18 $14.18 $14.18 $79.24 $79.24 $140.98 $14.18 $142.40 $23.40 $19.95 $14.18 $103.24 $178.00 $20.56 $14.18 $15.67 $14.18 N/A N/A 30100359 EAP CPT® 84450 "SGOT(AST),SERUM" BOTH IP/OP $63.00 $47.00 $2.59 $63.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.85 $7.85 $8.15 $5.73 $7.46 $8.29 $8.29 $37.26 $5.18 $5.18 $5.18 $63.00 $47.25 $5.18 $5.18 $5.18 $28.88 $28.88 $49.90 $5.18 $50.40 $8.55 $7.10 $5.18 $36.54 $63.00 $7.51 $5.18 $5.58 $5.18 N/A N/A 30100360 EAP CPT® 84460 SGPT(ALT)-RATE BOTH IP/OP $63.00 $47.00 $2.65 $63.00 $10.39 $10.39 $10.39 $10.39 $5.30 $5.30 $2.65 $2.65 $5.30 $8.04 $8.04 $8.35 $5.87 $7.46 $8.48 $8.48 $37.26 $5.30 $5.30 $5.30 $63.00 $47.25 $5.30 $5.30 $5.30 $29.60 $29.60 $49.90 $5.30 $50.40 $8.75 $7.10 $5.30 $36.54 $63.00 $7.69 $5.30 $5.58 $5.30 N/A N/A 30100361 EAP CPT® 84466 TRANSFERRIN BOTH IP/OP $340.00 $252.00 $6.38 $340.00 $25.05 $25.05 $25.05 $25.05 $12.76 $12.76 $6.38 $6.38 $12.76 $19.39 $19.39 $20.13 $14.15 $18.87 $20.42 $20.42 $201.11 $12.76 $12.76 $12.76 $340.00 $255.00 $12.76 $12.76 $12.76 $71.36 $71.36 $269.28 $12.76 $272.00 $21.05 $17.97 $12.76 $197.20 $340.00 $18.50 $12.76 $14.12 $12.76 N/A N/A 30100362 EAP CPT® 84478 TRIGLYCERIDE-SERUM BOTH IP/OP $131.00 $97.00 $2.87 $131.00 $11.27 $11.27 $11.27 $11.27 $5.74 $5.74 $2.87 $2.87 $5.74 $8.74 $8.74 $9.07 $6.38 $7.46 $9.18 $9.18 $77.49 $5.74 $5.74 $5.74 $131.00 $98.25 $5.74 $5.74 $5.74 $32.16 $32.16 $103.75 $5.74 $104.80 $9.47 $7.10 $5.74 $75.98 $131.00 $8.32 $5.74 $5.58 $5.74 N/A N/A 30100363 EAP CPT® 84478 TRIGLYCERIDE BOTH IP/OP $152.00 $112.50 $2.87 $152.00 $11.27 $11.27 $11.27 $11.27 $5.74 $5.74 $2.87 $2.87 $5.74 $8.74 $8.74 $9.07 $6.38 $7.46 $9.18 $9.18 $89.91 $5.74 $5.74 $5.74 $152.00 $114.00 $5.74 $5.74 $5.74 $32.16 $32.16 $120.38 $5.74 $121.60 $9.47 $7.10 $5.74 $88.16 $152.00 $8.32 $5.74 $5.58 $5.74 N/A N/A 30100364 EAP CPT® 84478 "TRIGLYCERIDE,FLUID" BOTH IP/OP $152.00 $112.50 $2.87 $152.00 $11.27 $11.27 $11.27 $11.27 $5.74 $5.74 $2.87 $2.87 $5.74 $8.74 $8.74 $9.07 $6.38 $7.46 $9.18 $9.18 $89.91 $5.74 $5.74 $5.74 $152.00 $114.00 $5.74 $5.74 $5.74 $32.16 $32.16 $120.38 $5.74 $121.60 $9.47 $7.10 $5.74 $88.16 $152.00 $8.32 $5.74 $5.58 $5.74 N/A N/A 30100365 EAP CPT® 84478 TRIGLYCERIDE BOTH IP/OP $114.00 $84.50 $2.87 $114.00 $11.27 $11.27 $11.27 $11.27 $5.74 $5.74 $2.87 $2.87 $5.74 $8.74 $8.74 $9.07 $6.38 $7.46 $9.18 $9.18 $67.43 $5.74 $5.74 $5.74 $114.00 $85.50 $5.74 $5.74 $5.74 $32.16 $32.16 $90.29 $5.74 $91.20 $9.47 $7.10 $5.74 $66.12 $114.00 $8.32 $5.74 $5.58 $5.74 N/A N/A 30100366 EAP CPT® 84480 T3-TRIIODOTHYRONINE BOTH IP/OP $302.00 $223.50 $7.09 $302.00 $25.05 $25.05 $25.05 $25.05 $14.18 $14.18 $7.09 $7.09 $14.18 $19.35 $19.35 $20.10 $14.13 $18.83 $22.69 $22.69 $178.63 $14.18 $14.18 $14.18 $302.00 $226.50 $14.18 $14.18 $14.18 $71.24 $71.24 $239.18 $14.18 $241.60 $23.40 $17.93 $14.18 $175.16 $302.00 $20.56 $14.18 $14.08 $14.18 N/A N/A 30100367 EAP CPT® 84484 TROPONIN-1 BOTH IP/OP $416.00 $308.00 $5.61 $416.00 $19.33 $19.33 $19.33 $19.33 $12.47 $12.47 $6.24 $5.61 $12.47 $14.94 $14.94 $15.52 $10.91 $14.54 $19.95 $19.95 $246.06 $12.47 $12.47 $12.47 $416.00 $312.00 $12.47 $12.47 $12.47 $55.00 $55.00 $329.47 $12.47 $332.80 $20.58 $13.85 $12.47 $241.28 $416.00 $18.08 $12.47 $10.88 $12.47 N/A N/A 30100368 EAP CPT® 84484 TROPONIN-T BOTH IP/OP $416.00 $308.00 $5.61 $416.00 $19.33 $19.33 $19.33 $19.33 $12.47 $12.47 $6.24 $5.61 $12.47 $14.94 $14.94 $15.52 $10.91 $14.54 $19.95 $19.95 $246.06 $12.47 $12.47 $12.47 $416.00 $312.00 $12.47 $12.47 $12.47 $55.00 $55.00 $329.47 $12.47 $332.80 $20.58 $13.85 $12.47 $241.28 $416.00 $18.08 $12.47 $10.88 $12.47 N/A N/A 30100369 EAP CPT® 84520 UREA NITROGEN BOTH IP/OP $147.00 $109.00 $1.98 $147.00 $7.76 $7.76 $7.76 $7.76 $3.95 $3.95 $1.98 $1.98 $3.95 $5.99 $5.99 $6.22 $4.37 $5.83 $6.32 $6.32 $86.95 $3.95 $3.95 $3.95 $147.00 $110.25 $3.95 $3.95 $3.95 $22.04 $22.04 $116.42 $3.95 $117.60 $6.52 $5.55 $3.95 $85.26 $147.00 $5.73 $3.95 $4.36 $3.95 N/A N/A 30100370 EAP CPT® 84540 "UREA NITROGEN,FLUID" BOTH IP/OP $171.00 $127.00 $2.50 $171.00 $9.31 $9.31 $9.31 $9.31 $5.56 $5.56 $2.78 $2.50 $5.56 $7.21 $7.21 $7.48 $5.26 $7.02 $8.90 $8.90 $101.15 $5.56 $5.56 $5.56 $171.00 $128.25 $5.56 $5.56 $5.56 $26.56 $26.56 $135.43 $5.56 $136.80 $9.17 $6.69 $5.56 $99.18 $171.00 $8.06 $5.56 $5.25 $5.56 N/A N/A 30100371 EAP CPT® 84540 "UREA NITROGEN,URINE" BOTH IP/OP $171.00 $127.00 $2.50 $171.00 $9.31 $9.31 $9.31 $9.31 $5.56 $5.56 $2.78 $2.50 $5.56 $7.21 $7.21 $7.48 $5.26 $7.02 $8.90 $8.90 $101.15 $5.56 $5.56 $5.56 $171.00 $128.25 $5.56 $5.56 $5.56 $26.56 $26.56 $135.43 $5.56 $136.80 $9.17 $6.69 $5.56 $99.18 $171.00 $8.06 $5.56 $5.25 $5.56 N/A N/A 30100372 EAP CPT® 84550 URIC ACID - SERUM BOTH IP/OP $141.00 $104.50 $2.26 $141.00 $8.86 $8.86 $8.86 $8.86 $4.52 $4.52 $2.26 $2.26 $4.52 $6.85 $6.85 $7.12 $5.00 $6.67 $7.23 $7.23 $83.40 $4.52 $4.52 $4.52 $141.00 $105.75 $4.52 $4.52 $4.52 $25.24 $25.24 $111.67 $4.52 $112.80 $7.46 $6.35 $4.52 $81.78 $141.00 $6.55 $4.52 $4.99 $4.52 N/A N/A 30100373 EAP CPT® 84550 URIC ACID BOTH IP/OP $140.00 $104.00 $2.26 $140.00 $8.86 $8.86 $8.86 $8.86 $4.52 $4.52 $2.26 $2.26 $4.52 $6.85 $6.85 $7.12 $5.00 $6.67 $7.23 $7.23 $82.81 $4.52 $4.52 $4.52 $140.00 $105.00 $4.52 $4.52 $4.52 $25.24 $25.24 $110.88 $4.52 $112.00 $7.46 $6.35 $4.52 $81.20 $140.00 $6.55 $4.52 $4.99 $4.52 N/A N/A 30100374 EAP CPT® 84560 "URIC ACID,SYN FLUID" BOTH IP/OP $140.00 $104.00 $2.54 $140.00 $140.00 $140.00 $140.00 $140.00 $5.08 $5.08 $2.54 $140.00 $5.08 $7.21 $7.21 $7.48 $5.26 $7.02 $8.13 $8.13 $140.00 $5.08 $5.08 $5.08 $140.00 $105.00 $5.08 $5.08 $5.08 $26.56 $26.56 $110.88 $5.08 $112.00 $140.00 $140.00 $5.08 $81.20 $140.00 $7.37 $5.08 $140.00 $5.08 N/A N/A 30100375 EAP CPT® 84560 "URIC ACID, URINE" BOTH IP/OP $140.00 $104.00 $2.54 $140.00 $140.00 $140.00 $140.00 $140.00 $5.08 $5.08 $2.54 $140.00 $5.08 $7.21 $7.21 $7.48 $5.26 $7.02 $8.13 $8.13 $140.00 $5.08 $5.08 $5.08 $140.00 $105.00 $5.08 $5.08 $5.08 $26.56 $26.56 $110.88 $5.08 $112.00 $140.00 $140.00 $5.08 $81.20 $140.00 $7.37 $5.08 $140.00 $5.08 N/A N/A 30100376 EAP CPT® 84585 "VMA, URINE-24HR" BOTH IP/OP $85.00 $63.00 $7.75 $85.00 $85.00 $85.00 $85.00 $85.00 $15.50 $15.50 $7.75 $85.00 $15.50 $23.55 $23.55 $24.45 $17.19 $22.90 $24.80 $24.80 $85.00 $15.50 $15.50 $15.50 $85.00 $63.75 $15.50 $15.50 $15.50 $85.00 $85.00 $67.32 $15.50 $68.00 $85.00 $85.00 $15.50 $49.30 $85.00 $22.48 $15.50 $85.00 $15.50 N/A N/A 30100377 EAP CPT® 84586 VASOAC INTES POLYPEP BOTH IP/OP $156.00 $115.50 $17.67 $156.00 $156.00 $156.00 $156.00 $156.00 $35.33 $35.33 $17.67 $156.00 $35.33 $53.65 $53.65 $55.72 $39.17 $52.20 $56.53 $56.53 $156.00 $35.33 $35.33 $35.33 $156.00 $117.00 $35.33 $35.33 $35.33 $156.00 $156.00 $123.55 $35.33 $124.80 $156.00 $156.00 $35.33 $90.48 $156.00 $51.23 $35.33 $156.00 $35.33 N/A N/A 30100378 EAP CPT® 84588 ADH RESULT BOTH IP/OP $263.00 $195.00 $16.97 $263.00 $263.00 $263.00 $263.00 $263.00 $33.94 $33.94 $16.97 $263.00 $33.94 $51.54 $51.54 $53.52 $37.63 $50.15 $54.30 $54.30 $263.00 $33.94 $33.94 $33.94 $263.00 $197.25 $33.94 $33.94 $33.94 $189.72 $189.72 $208.30 $33.94 $210.40 $263.00 $263.00 $33.94 $152.54 $263.00 $49.21 $33.94 $263.00 $33.94 N/A N/A 30100379 EAP CPT® 84590 "VITAMIN A, SERUM" BOTH IP/OP $243.00 $180.00 $5.81 $243.00 $22.77 $22.77 $22.77 $22.77 $11.61 $11.61 $5.81 $5.81 $11.61 $17.61 $17.61 $18.28 $12.85 $17.13 $18.58 $18.58 $143.73 $11.61 $11.61 $11.61 $243.00 $182.25 $11.61 $11.61 $11.61 $64.80 $64.80 $192.46 $11.61 $194.40 $19.16 $16.31 $11.61 $140.94 $243.00 $16.83 $11.61 $12.81 $11.61 N/A N/A 30100380 EAP CPT® 84600 "VOLATILE, DRUG SCREEN" BOTH IP/OP $333.00 $246.50 $8.56 $333.00 $333.00 $333.00 $333.00 $333.00 $17.11 $17.11 $8.56 $333.00 $17.11 $24.41 $24.41 $25.35 $17.82 $23.74 $27.38 $27.38 $333.00 $17.11 $17.11 $17.11 $333.00 $249.75 $17.11 $17.11 $17.11 $89.80 $89.80 $263.74 $17.11 $266.40 $333.00 $333.00 $17.11 $193.14 $333.00 $24.81 $17.11 $333.00 $17.11 N/A N/A 30100381 EAP CPT® 84620 "D-XYLOSE, SERUM" BOTH IP/OP $131.00 $97.00 $6.46 $131.00 $131.00 $131.00 $131.00 $131.00 $12.91 $12.91 $6.46 $131.00 $12.91 $17.98 $17.98 $18.67 $13.13 $17.50 $20.66 $20.66 $131.00 $12.91 $12.91 $12.91 $131.00 $98.25 $12.91 $12.91 $12.91 $66.20 $66.20 $103.75 $12.91 $104.80 $131.00 $131.00 $12.91 $75.98 $131.00 $18.72 $12.91 $131.00 $12.91 N/A N/A 30100382 EAP CPT® 84620 "D-XYLOSE, URINE" BOTH IP/OP $131.00 $97.00 $6.46 $131.00 $131.00 $131.00 $131.00 $131.00 $12.91 $12.91 $6.46 $131.00 $12.91 $17.98 $17.98 $18.67 $13.13 $17.50 $20.66 $20.66 $131.00 $12.91 $12.91 $12.91 $131.00 $98.25 $12.91 $12.91 $12.91 $66.20 $66.20 $103.75 $12.91 $104.80 $131.00 $131.00 $12.91 $75.98 $131.00 $18.72 $12.91 $131.00 $12.91 N/A N/A 30100383 EAP CPT® 84630 "ZINC, SERUM" BOTH IP/OP $81.00 $60.00 $5.69 $81.00 $22.34 $22.34 $22.34 $22.34 $11.39 $11.39 $5.70 $5.69 $11.39 $17.30 $17.30 $17.96 $12.63 $16.82 $18.22 $18.22 $47.91 $11.39 $11.39 $11.39 $81.00 $60.75 $11.39 $11.39 $11.39 $63.64 $63.64 $64.15 $11.39 $64.80 $18.79 $16.02 $11.39 $46.98 $81.00 $16.52 $11.39 $12.58 $11.39 N/A N/A 30100384 EAP CPT® 84681 "C-PEPTIDE, RANDOM" BOTH IP/OP $370.00 $274.00 $10.41 $370.00 $31.20 $31.20 $31.20 $31.20 $20.81 $20.81 $10.41 $10.41 $20.81 $24.13 $24.13 $25.06 $17.61 $23.47 $33.30 $33.30 $218.86 $20.81 $20.81 $20.81 $370.00 $277.50 $20.81 $20.81 $20.81 $88.80 $88.80 $293.04 $20.81 $296.00 $34.34 $22.35 $20.81 $214.60 $370.00 $30.17 $20.81 $17.56 $20.81 N/A N/A 30100385 EAP CPT® 84681 "C-PEPTIDE, FASTING" BOTH IP/OP $374.00 $277.00 $10.41 $374.00 $31.20 $31.20 $31.20 $31.20 $20.81 $20.81 $10.41 $10.41 $20.81 $24.13 $24.13 $25.06 $17.61 $23.47 $33.30 $33.30 $221.22 $20.81 $20.81 $20.81 $374.00 $280.50 $20.81 $20.81 $20.81 $88.80 $88.80 $296.21 $20.81 $299.20 $34.34 $22.35 $20.81 $216.92 $374.00 $30.17 $20.81 $17.56 $20.81 N/A N/A 30100386 EAP CPT® 84681 "C-PEPTIDE, STIMULAT." BOTH IP/OP $374.00 $277.00 $10.41 $374.00 $31.20 $31.20 $31.20 $31.20 $20.81 $20.81 $10.41 $10.41 $20.81 $24.13 $24.13 $25.06 $17.61 $23.47 $33.30 $33.30 $221.22 $20.81 $20.81 $20.81 $374.00 $280.50 $20.81 $20.81 $20.81 $88.80 $88.80 $296.21 $20.81 $299.20 $34.34 $22.35 $20.81 $216.92 $374.00 $30.17 $20.81 $17.56 $20.81 N/A N/A 30100387 EAP CPT® 84702 "*HCG, SERUM, QUANT" BOTH IP/OP $419.00 $310.50 $7.09 $419.00 $12.60 $12.60 $12.60 $12.60 $15.05 $15.05 $7.53 $7.53 $15.05 $9.74 $9.74 $10.12 $7.11 $9.48 $24.08 $24.08 $247.84 $15.05 $15.05 $15.05 $419.00 $314.25 $15.05 $15.05 $15.05 $35.88 $35.88 $331.85 $15.05 $335.20 $24.83 $9.03 $15.05 $243.02 $419.00 $21.82 $15.05 $7.09 $15.05 N/A N/A 30100388 EAP CPT® 84702 "B-HCG,MAT.SERUM" BOTH IP/OP $204.00 $151.00 $7.09 $204.00 $12.60 $12.60 $12.60 $12.60 $15.05 $15.05 $7.53 $7.53 $15.05 $9.74 $9.74 $10.12 $7.11 $9.48 $24.08 $24.08 $120.67 $15.05 $15.05 $15.05 $204.00 $153.00 $15.05 $15.05 $15.05 $35.88 $35.88 $161.57 $15.05 $163.20 $24.83 $9.03 $15.05 $118.32 $204.00 $21.82 $15.05 $7.09 $15.05 N/A N/A 30100389 EAP CPT® 84702 "HCG,SERUM-QUANT" BOTH IP/OP $374.00 $277.00 $7.09 $374.00 $12.60 $12.60 $12.60 $12.60 $15.05 $15.05 $7.53 $7.53 $15.05 $9.74 $9.74 $10.12 $7.11 $9.48 $24.08 $24.08 $221.22 $15.05 $15.05 $15.05 $374.00 $280.50 $15.05 $15.05 $15.05 $35.88 $35.88 $296.21 $15.05 $299.20 $24.83 $9.03 $15.05 $216.92 $374.00 $21.82 $15.05 $7.09 $15.05 N/A N/A 30100390 EAP CPT® 84703 PREGNANCY TEST BOTH IP/OP $67.00 $50.00 $3.76 $67.00 $67.00 $67.00 $67.00 $67.00 $7.52 $7.52 $3.76 $67.00 $7.52 $9.74 $9.74 $10.12 $7.11 $9.48 $12.03 $12.03 $67.00 $7.52 $7.52 $7.52 $67.00 $50.25 $7.52 $7.52 $7.52 $35.88 $35.88 $53.06 $7.52 $53.60 $67.00 $67.00 $7.52 $38.86 $67.00 $10.90 $7.52 $67.00 $7.52 N/A N/A 30100392 EAP CPT® 84999 LYSOSOMAL ENZ.SCRN BOTH IP/OP "$2,308.00" "$1,708.00" $74.40 "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" $481.04 "$2,308.00" "$1,713.00" "$1,713.00" "$1,779.01" "$1,202.47" $481.01 "$2,308.00" $74.40 "$1,365.18" "$2,308.00" $186.00 "$2,308.00" "$2,308.00" "$1,731.00" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$1,827.94" "$2,308.00" "$1,846.40" "$1,500.20" $458.08 "$2,308.00" "$1,338.64" "$2,308.00" "$1,384.80" "$2,308.00" $480.99 "$2,308.00" N/A N/A 30100393 EAP CPT® 84466 "B-2 TRANSFERRIN, FLD" BOTH IP/OP $483.00 $357.50 $6.38 $483.00 $25.05 $25.05 $25.05 $25.05 $12.76 $12.76 $6.38 $6.38 $12.76 $19.39 $19.39 $20.13 $14.15 $18.87 $20.42 $20.42 $285.69 $12.76 $12.76 $12.76 $483.00 $362.25 $12.76 $12.76 $12.76 $71.36 $71.36 $382.54 $12.76 $386.40 $21.05 $17.97 $12.76 $280.14 $483.00 $18.50 $12.76 $14.12 $12.76 N/A N/A 30100395 EAP CPT® 80048 BASIC METABOLIC PANEL BOTH IP/OP $383.00 $283.50 $4.23 $383.00 $16.59 $16.59 $16.59 $16.59 $8.46 $8.46 $4.23 $4.23 $8.46 $12.85 $12.85 $13.35 $9.38 $12.52 $13.54 $13.54 $226.54 $8.46 $8.46 $8.46 $383.00 $287.25 $8.46 $8.46 $8.46 $47.32 $47.32 $303.34 $8.46 $306.40 $13.96 $11.92 $8.46 $222.14 $383.00 $12.27 $8.46 $9.36 $8.46 N/A N/A 30100396 EAP CPT® 88720 "BILIRUBIN,TOTAL-TRANSCUTANEOUS" BOTH IP/OP $56.00 $41.50 $2.51 $56.00 $9.84 $9.84 $9.84 $9.84 $5.02 $5.02 $2.51 $2.51 $5.02 $7.62 $7.62 $7.92 $5.56 $11.67 $8.03 $8.03 $33.12 $5.02 $5.02 $5.02 $56.00 $42.00 $5.02 $5.02 $5.02 $28.00 $28.00 $44.35 $5.02 $44.80 $8.28 $11.11 $5.02 $32.48 $56.00 $7.28 $5.02 $11.67 $5.02 N/A N/A 30100401 EAP CPT® 82274 "FECAL OCCULT BLOOD,FIT" BOTH IP/OP $133.00 $98.50 $7.95 $133.00 $31.22 $31.22 $31.22 $31.22 $15.92 $15.92 $7.96 $7.95 $15.92 $24.15 $24.15 $25.08 $17.63 $25.48 $25.47 $25.47 $78.67 $15.92 $15.92 $15.92 $133.00 $99.75 $15.92 $15.92 $15.92 $88.88 $88.88 $105.34 $15.92 $106.40 $26.27 $24.27 $15.92 $77.14 $133.00 $23.08 $15.92 $19.06 $15.92 N/A N/A 30100403 EAP CPT® 82306 "25-HYDROXYVIT D (D2,D3)(SO)" BOTH IP/OP $86.00 $64.00 $14.80 $86.00 $58.11 $58.11 $58.11 $58.11 $29.60 $29.60 $14.80 $14.80 $29.60 $44.95 $44.95 $46.68 $32.81 $43.72 $47.36 $47.36 $50.87 $29.60 $29.60 $29.60 $86.00 $64.50 $29.60 $29.60 $29.60 $86.00 $86.00 $68.11 $29.60 $68.80 $48.84 $41.64 $29.60 $49.88 $86.00 $42.92 $29.60 $32.71 $29.60 N/A N/A 30100410 EAP CPT® 82009 ACETOACETATE-QUALITATIVE BOTH IP/OP $64.00 $47.50 $2.26 $64.00 $64.00 $64.00 $64.00 $64.00 $4.52 $4.52 $2.26 $64.00 $4.52 $4.99 $4.99 $5.18 $3.64 $4.85 $7.23 $7.23 $64.00 $4.52 $4.52 $4.52 $64.00 $48.00 $4.52 $4.52 $4.52 $18.36 $18.36 $50.69 $4.52 $51.20 $64.00 $64.00 $4.52 $37.12 $64.00 $6.55 $4.52 $64.00 $4.52 N/A N/A 30100411 EAP CPT® 82043 MICROALBUMIN BOTH IP/OP $223.00 $165.50 $2.89 $223.00 $11.35 $11.35 $11.35 $11.35 $5.78 $5.78 $2.89 $2.89 $5.78 $8.79 $8.79 $9.13 $6.42 $8.55 $9.25 $9.25 $131.90 $5.78 $5.78 $5.78 $223.00 $167.25 $5.78 $5.78 $5.78 $32.36 $32.36 $176.62 $5.78 $178.40 $9.54 $8.14 $5.78 $129.34 $223.00 $8.38 $5.78 $6.39 $5.78 N/A N/A 30100412 EAP CPT® 82270 "OCCULT BLOOD, STOOL" BOTH IP/OP $57.00 $42.50 $2.19 $57.00 $57.00 $57.00 $57.00 $57.00 $4.38 $4.38 $2.19 $57.00 $4.38 $4.88 $4.88 $5.07 $3.56 $4.75 $7.01 $7.01 $57.00 $4.38 $4.38 $4.38 $57.00 $42.75 $4.38 $4.38 $4.38 $17.96 $17.96 $45.14 $4.38 $45.60 $57.00 $57.00 $4.38 $33.06 $57.00 $6.35 $4.38 $57.00 $4.38 N/A N/A 30100413 EAP CPT® 82465 CHOLESTEROL BOTH IP/OP $91.00 $67.50 $2.18 $91.00 $8.53 $8.53 $8.53 $8.53 $4.35 $4.35 $2.18 $2.18 $4.35 $6.61 $6.61 $6.87 $4.83 $6.43 $6.96 $6.96 $53.83 $4.35 $4.35 $4.35 $91.00 $68.25 $4.35 $4.35 $4.35 $24.32 $24.32 $72.07 $4.35 $72.80 $7.18 $6.12 $4.35 $52.78 $91.00 $6.31 $4.35 $4.81 $4.35 N/A N/A 30100414 EAP CPT® 82550 "CPK,TOTAL-SERUM" BOTH IP/OP $208.00 $154.00 $3.25 $208.00 $12.78 $12.78 $12.78 $12.78 $6.51 $6.51 $3.26 $3.25 $6.51 $9.89 $9.89 $10.27 $7.22 $7.46 $10.42 $10.42 $123.03 $6.51 $6.51 $6.51 $208.00 $156.00 $6.51 $6.51 $6.51 $36.40 $36.40 $164.74 $6.51 $166.40 $10.74 $7.10 $6.51 $120.64 $208.00 $9.44 $6.51 $5.58 $6.51 N/A N/A 30100415 EAP CPT® 82565 "POCT, CREATININE (METER)" BOTH IP/OP $139.00 $103.00 $2.56 $139.00 $10.07 $10.07 $10.07 $10.07 $5.12 $5.12 $2.56 $2.56 $5.12 $7.78 $7.78 $8.08 $5.68 $7.46 $8.19 $8.19 $82.22 $5.12 $5.12 $5.12 $139.00 $104.25 $5.12 $5.12 $5.12 $28.64 $28.64 $110.09 $5.12 $111.20 $8.45 $7.10 $5.12 $80.62 $139.00 $7.42 $5.12 $5.58 $5.12 N/A N/A 30100416 EAP CPT® 82570 CREATININE URINE BOTH IP/OP $122.00 $90.50 $2.59 $122.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $72.16 $5.18 $5.18 $5.18 $122.00 $91.50 $5.18 $5.18 $5.18 $28.92 $28.92 $96.62 $5.18 $97.60 $8.55 $7.28 $5.18 $70.76 $122.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30100417 EAP CPT® 82947 "GTT, ORAL-2HR INDIV" BOTH IP/OP $263.00 $195.00 $1.97 $263.00 $7.71 $7.71 $7.71 $7.71 $3.93 $3.93 $1.97 $1.97 $3.93 $5.96 $5.96 $6.19 $4.35 $5.80 $6.29 $6.29 $155.56 $3.93 $3.93 $3.93 $263.00 $197.25 $3.93 $3.93 $3.93 $21.92 $21.92 $208.30 $3.93 $210.40 $6.48 $5.52 $3.93 $152.54 $263.00 $5.70 $3.93 $4.34 $3.93 N/A N/A 30100420 EAP CPT® 82950 "GLUCOSE, BLD-2HR PP" BOTH IP/OP $251.00 $186.00 $2.37 $251.00 $9.31 $9.31 $9.31 $9.31 $4.75 $4.75 $2.38 $2.37 $4.75 $7.21 $7.21 $7.48 $5.26 $7.02 $7.60 $7.60 $148.47 $4.75 $4.75 $4.75 $251.00 $188.25 $4.75 $4.75 $4.75 $26.56 $26.56 $198.79 $4.75 $200.80 $7.84 $6.69 $4.75 $145.58 $251.00 $6.89 $4.75 $5.25 $4.75 N/A N/A 30100421 EAP CPT® 83036 HGB GLYCOSY A1C-DDCL BOTH IP/OP $218.00 $161.50 $4.86 $218.00 $19.05 $19.05 $19.05 $19.05 $9.71 $9.71 $4.86 $4.86 $9.71 $14.74 $14.74 $15.30 $10.76 $14.33 $15.54 $15.54 $128.95 $9.71 $9.71 $9.71 $218.00 $163.50 $9.71 $9.71 $9.71 $54.24 $54.24 $172.66 $9.71 $174.40 $16.02 $13.65 $9.71 $126.44 $218.00 $14.08 $9.71 $10.72 $9.71 N/A N/A 30100422 EAP CPT® 83690 "LIPASE, SERUM" BOTH IP/OP $248.00 $184.00 $3.44 $248.00 $13.53 $13.53 $13.53 $13.53 $6.89 $6.89 $3.45 $3.44 $6.89 $10.46 $10.46 $10.86 $7.64 $10.17 $11.02 $11.02 $146.69 $6.89 $6.89 $6.89 $248.00 $186.00 $6.89 $6.89 $6.89 $38.48 $38.48 $196.42 $6.89 $198.40 $11.37 $9.69 $6.89 $143.84 $248.00 $9.99 $6.89 $7.61 $6.89 N/A N/A 30100423 EAP CPT® 83718 "CHOL,HDL" BOTH IP/OP $118.00 $87.50 $4.10 $118.00 $16.09 $16.09 $16.09 $16.09 $8.19 $8.19 $4.10 $4.10 $8.19 $12.44 $12.44 $12.92 $9.08 $12.10 $13.10 $13.10 $69.80 $8.19 $8.19 $8.19 $118.00 $88.50 $8.19 $8.19 $8.19 $45.76 $45.76 $93.46 $8.19 $94.40 $13.51 $11.52 $8.19 $68.44 $118.00 $11.88 $8.19 $9.05 $8.19 N/A N/A 30100424 EAP CPT® 83718 "CHOL, HDL" BOTH IP/OP $118.00 $87.50 $4.10 $118.00 $16.09 $16.09 $16.09 $16.09 $8.19 $8.19 $4.10 $4.10 $8.19 $12.44 $12.44 $12.92 $9.08 $12.10 $13.10 $13.10 $69.80 $8.19 $8.19 $8.19 $118.00 $88.50 $8.19 $8.19 $8.19 $45.76 $45.76 $93.46 $8.19 $94.40 $13.51 $11.52 $8.19 $68.44 $118.00 $11.88 $8.19 $9.05 $8.19 N/A N/A 30100425 EAP CPT® 83721 "CHOL-LDL, DIRECT" BOTH IP/OP $148.00 $110.00 $4.77 $148.00 $18.72 $18.72 $18.72 $18.72 $10.50 $10.50 $5.25 $4.77 $10.50 $14.49 $14.49 $15.04 $10.58 $14.10 $16.80 $16.80 $87.54 $10.50 $10.50 $10.50 $148.00 $111.00 $10.50 $10.50 $10.50 $53.32 $53.32 $117.22 $10.50 $118.40 $17.33 $13.43 $10.50 $85.84 $148.00 $15.23 $10.50 $10.55 $10.50 N/A N/A 30100426 EAP CPT® 83721 "CHOL-LDL, DIRECT" BOTH IP/OP $147.00 $109.00 $4.77 $147.00 $18.72 $18.72 $18.72 $18.72 $10.50 $10.50 $5.25 $4.77 $10.50 $14.49 $14.49 $15.04 $10.58 $14.10 $16.80 $16.80 $86.95 $10.50 $10.50 $10.50 $147.00 $110.25 $10.50 $10.50 $10.50 $53.32 $53.32 $116.42 $10.50 $117.60 $17.33 $13.43 $10.50 $85.26 $147.00 $15.23 $10.50 $10.55 $10.50 N/A N/A 30100427 EAP CPT® 83735 "MAGNESEUM, SERUM" BOTH IP/OP $160.00 $118.50 $3.35 $160.00 $13.15 $13.15 $13.15 $13.15 $6.70 $6.70 $3.35 $3.35 $6.70 $10.17 $10.17 $10.56 $7.42 $9.89 $10.72 $10.72 $94.64 $6.70 $6.70 $6.70 $160.00 $120.00 $6.70 $6.70 $6.70 $37.44 $37.44 $126.72 $6.70 $128.00 $11.06 $9.42 $6.70 $92.80 $160.00 $9.72 $6.70 $7.40 $6.70 N/A N/A 30100430 EAP CPT® 80048 "CHEM 8, METABOLIC PANEL" BOTH IP/OP $383.00 $283.50 $4.23 $383.00 $16.59 $16.59 $16.59 $16.59 $8.46 $8.46 $4.23 $4.23 $8.46 $12.85 $12.85 $13.35 $9.38 $12.52 $13.54 $13.54 $226.54 $8.46 $8.46 $8.46 $383.00 $287.25 $8.46 $8.46 $8.46 $47.32 $47.32 $303.34 $8.46 $306.40 $13.96 $11.92 $8.46 $222.14 $383.00 $12.27 $8.46 $9.36 $8.46 N/A N/A 30100431 EAP CPT® 82270 OCCULT BLOOD BOTH IP/OP $58.00 $43.00 $2.19 $58.00 $58.00 $58.00 $58.00 $58.00 $4.38 $4.38 $2.19 $58.00 $4.38 $4.88 $4.88 $5.07 $3.56 $4.75 $7.01 $7.01 $58.00 $4.38 $4.38 $4.38 $58.00 $43.50 $4.38 $4.38 $4.38 $17.96 $17.96 $45.94 $4.38 $46.40 $58.00 $58.00 $4.38 $33.64 $58.00 $6.35 $4.38 $58.00 $4.38 N/A N/A 30100432 EAP CPT® 82977 GGT-SERUM BOTH IP/OP $162.00 $120.00 $3.60 $162.00 $14.13 $14.13 $14.13 $14.13 $7.20 $7.20 $3.60 $3.60 $7.20 $10.93 $10.93 $11.35 $7.98 $7.46 $11.52 $11.52 $95.82 $7.20 $7.20 $7.20 $162.00 $121.50 $7.20 $7.20 $7.20 $40.24 $40.24 $128.30 $7.20 $129.60 $11.88 $7.10 $7.20 $93.96 $162.00 $10.44 $7.20 $5.58 $7.20 N/A N/A 30100434 EAP CPT® 80069 RENAL PANEL BOTH IP/OP $228.00 $169.00 $4.34 $228.00 $17.04 $17.04 $17.04 $17.04 $8.68 $8.68 $4.34 $4.34 $8.68 $13.19 $13.19 $13.69 $9.63 $12.83 $13.89 $13.89 $134.86 $8.68 $8.68 $8.68 $228.00 $171.00 $8.68 $8.68 $8.68 $48.52 $48.52 $180.58 $8.68 $182.40 $14.32 $12.22 $8.68 $132.24 $228.00 $12.59 $8.68 $9.60 $8.68 N/A N/A 30100435 EAP CPT® 80076 HEPATIC PROFILE BOTH IP/OP $330.00 $244.50 $4.09 $330.00 $16.04 $16.04 $16.04 $16.04 $8.17 $8.17 $4.09 $4.09 $8.17 $12.41 $12.41 $12.88 $9.06 $12.08 $13.07 $13.07 $195.20 $8.17 $8.17 $8.17 $330.00 $247.50 $8.17 $8.17 $8.17 $45.68 $45.68 $261.36 $8.17 $264.00 $13.48 $11.50 $8.17 $191.40 $330.00 $11.85 $8.17 $9.03 $8.17 N/A N/A 30100436 EAP CPT® 80076 HEPATIC PROFILE BOTH IP/OP $333.00 $246.50 $4.09 $333.00 $16.04 $16.04 $16.04 $16.04 $8.17 $8.17 $4.09 $4.09 $8.17 $12.41 $12.41 $12.88 $9.06 $12.08 $13.07 $13.07 $196.97 $8.17 $8.17 $8.17 $333.00 $249.75 $8.17 $8.17 $8.17 $45.68 $45.68 $263.74 $8.17 $266.40 $13.48 $11.50 $8.17 $193.14 $333.00 $11.85 $8.17 $9.03 $8.17 N/A N/A 30100437 EAP CPT® 82465 "CHOLESTEROL,FLUID" BOTH IP/OP $91.00 $67.50 $2.18 $91.00 $8.53 $8.53 $8.53 $8.53 $4.35 $4.35 $2.18 $2.18 $4.35 $6.61 $6.61 $6.87 $4.83 $6.43 $6.96 $6.96 $53.83 $4.35 $4.35 $4.35 $91.00 $68.25 $4.35 $4.35 $4.35 $24.32 $24.32 $72.07 $4.35 $72.80 $7.18 $6.12 $4.35 $52.78 $91.00 $6.31 $4.35 $4.81 $4.35 N/A N/A 30100439 EAP CPT® 82947 "GLUCOSE,FASTING BLD" BOTH IP/OP $263.00 $195.00 $1.97 $263.00 $7.71 $7.71 $7.71 $7.71 $3.93 $3.93 $1.97 $1.97 $3.93 $5.96 $5.96 $6.19 $4.35 $5.80 $6.29 $6.29 $155.56 $3.93 $3.93 $3.93 $263.00 $197.25 $3.93 $3.93 $3.93 $21.92 $21.92 $208.30 $3.93 $210.40 $6.48 $5.52 $3.93 $152.54 $263.00 $5.70 $3.93 $4.34 $3.93 N/A N/A 30100441 EAP CPT® 82950 "GLUCOSE,1HR (50GM)" BOTH IP/OP $341.00 $252.50 $2.37 $341.00 $9.31 $9.31 $9.31 $9.31 $4.75 $4.75 $2.38 $2.37 $4.75 $7.21 $7.21 $7.48 $5.26 $7.02 $7.60 $7.60 $201.70 $4.75 $4.75 $4.75 $341.00 $255.75 $4.75 $4.75 $4.75 $26.56 $26.56 $270.07 $4.75 $272.80 $7.84 $6.69 $4.75 $197.78 $341.00 $6.89 $4.75 $5.25 $4.75 N/A N/A 30100442 EAP CPT® 82977 "GGTP,SERUM" BOTH IP/OP $160.00 $118.50 $3.60 $160.00 $14.13 $14.13 $14.13 $14.13 $7.20 $7.20 $3.60 $3.60 $7.20 $10.93 $10.93 $11.35 $7.98 $7.46 $11.52 $11.52 $94.64 $7.20 $7.20 $7.20 $160.00 $120.00 $7.20 $7.20 $7.20 $40.24 $40.24 $126.72 $7.20 $128.00 $11.88 $7.10 $7.20 $92.80 $160.00 $10.44 $7.20 $5.58 $7.20 N/A N/A 30100443 EAP CPT® 83735 "MAGNESIUM, URINE" BOTH IP/OP $188.00 $139.50 $3.35 $188.00 $13.15 $13.15 $13.15 $13.15 $6.70 $6.70 $3.35 $3.35 $6.70 $10.17 $10.17 $10.56 $7.42 $9.89 $10.72 $10.72 $111.20 $6.70 $6.70 $6.70 $188.00 $141.00 $6.70 $6.70 $6.70 $37.44 $37.44 $148.90 $6.70 $150.40 $11.06 $9.42 $6.70 $109.04 $188.00 $9.72 $6.70 $7.40 $6.70 N/A N/A 30100444 EAP CPT® 80375 THIOPURINE METABOLITES SERUM (SO) BOTH IP/OP $355.00 $263.00 $12.01 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $12.01 $355.00 $355.00 $263.48 $263.48 $273.63 $184.96 $21.44 $355.00 $88.40 $355.00 $355.00 $221.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $230.75 $355.00 $355.00 $205.90 $355.00 $213.00 $355.00 $355.00 $355.00 N/A N/A 30100445 EAP CPT® 83519 RIA NONAB (SO) BOTH IP/OP $782.00 $579.00 $8.28 $782.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $462.55 $18.40 $18.40 $18.40 $782.00 $586.50 $18.40 $18.40 $18.40 $75.52 $75.52 $619.34 $18.40 $625.60 $30.36 $19.01 $18.40 $453.56 $782.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30100446 EAP CPT® 83519 RIA NONAB (SO) BOTH IP/OP $325.00 $240.50 $8.28 $325.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $192.24 $18.40 $18.40 $18.40 $325.00 $243.75 $18.40 $18.40 $18.40 $75.52 $75.52 $257.40 $18.40 $260.00 $30.36 $19.01 $18.40 $188.50 $325.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30100447 EAP CPT® 83519 RIA NONAB (SO) BOTH IP/OP $215.00 $159.50 $8.28 $215.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $127.17 $18.40 $18.40 $18.40 $215.00 $161.25 $18.40 $18.40 $18.40 $75.52 $75.52 $170.28 $18.40 $172.00 $30.36 $19.01 $18.40 $124.70 $215.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30100448 EAP CPT® 83519 RIA NONAB (SO) BOTH IP/OP $448.00 $332.00 $8.28 $448.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $264.99 $18.40 $18.40 $18.40 $448.00 $336.00 $18.40 $18.40 $18.40 $75.52 $75.52 $354.82 $18.40 $358.40 $30.36 $19.01 $18.40 $259.84 $448.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30100449 EAP CPT® 83519 RIA NONAB (SO) BOTH IP/OP $163.00 $121.00 $8.28 $163.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $96.41 $18.40 $18.40 $18.40 $163.00 $122.25 $18.40 $18.40 $18.40 $75.52 $75.52 $129.10 $18.40 $130.40 $30.36 $19.01 $18.40 $94.54 $163.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30100450 EAP CPT® 82803 HEMODYNAMICS BOTH IP/OP $510.00 $377.50 $11.73 $510.00 $37.98 $37.98 $37.98 $37.98 $26.07 $26.07 $13.04 $11.73 $26.07 $29.38 $29.38 $30.51 $21.45 $28.59 $41.71 $41.71 $301.67 $26.07 $26.07 $26.07 $510.00 $382.50 $26.07 $26.07 $26.07 $108.16 $108.16 $403.92 $26.07 $408.00 $43.02 $27.23 $26.07 $295.80 $510.00 $37.80 $26.07 $21.39 $26.07 N/A N/A 30100451 EAP CPT® 82803 ABG ANALYSIS BOTH IP/OP $510.00 $377.50 $11.73 $510.00 $37.98 $37.98 $37.98 $37.98 $26.07 $26.07 $13.04 $11.73 $26.07 $29.38 $29.38 $30.51 $21.45 $28.59 $41.71 $41.71 $301.67 $26.07 $26.07 $26.07 $510.00 $382.50 $26.07 $26.07 $26.07 $108.16 $108.16 $403.92 $26.07 $408.00 $43.02 $27.23 $26.07 $295.80 $510.00 $37.80 $26.07 $21.39 $26.07 N/A N/A 30100452 EAP CPT® 84182 PROTEIN WESTERN BLOT TEST (SO) BOTH IP/OP "$2,867.00" "$2,122.00" $13.14 "$2,867.00" $35.32 $35.32 $35.32 $35.32 $29.21 $29.21 $14.61 $13.14 $29.21 $27.33 $27.33 $28.38 $19.95 $26.60 $46.74 $46.74 "$1,695.83" $29.21 $29.21 $29.21 "$2,867.00" "$2,150.25" $29.21 $29.21 $29.21 $100.60 $100.60 "$2,270.66" $29.21 "$2,293.60" $48.20 $25.33 $29.21 "$1,662.86" "$2,867.00" $42.35 $29.21 $19.90 $29.21 N/A N/A 30100453 EAP CPT® 83519 RIA NONAB (SO) BOTH IP/OP $353.00 $261.50 $8.28 $353.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $208.80 $18.40 $18.40 $18.40 $353.00 $264.75 $18.40 $18.40 $18.40 $75.52 $75.52 $279.58 $18.40 $282.40 $30.36 $19.01 $18.40 $204.74 $353.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30100454 EAP CPT® 82103 ALPHA-1 ANTITRYPSIN-SERUM (SO) BOTH IP/OP $20.75 $15.50 $6.72 $22.18 $20.75 $20.75 $20.75 $20.75 $13.44 $13.44 $6.72 $6.72 $13.44 $20.39 $20.39 $21.18 $14.89 $19.85 $21.50 $21.50 $12.27 $13.44 $13.44 $13.44 $20.75 $15.56 $13.44 $13.44 $13.44 $20.75 $20.75 $16.43 $13.44 $16.60 $22.18 $18.90 $13.44 $12.04 $20.75 $19.49 $13.44 $14.85 $13.44 N/A N/A 30100455 EAP CPT® 82040 ALBUMIN (BCG) BOTH IP/OP $76.00 $56.50 $2.48 $76.00 $5.65 $5.65 $5.65 $5.65 $4.95 $4.95 $2.48 $2.48 $4.95 $4.37 $4.37 $4.54 $3.19 $4.25 $7.92 $7.92 $44.95 $4.95 $4.95 $4.95 $76.00 $57.00 $4.95 $4.95 $4.95 $16.08 $16.08 $60.19 $4.95 $60.80 $8.17 $4.05 $4.95 $44.08 $76.00 $7.18 $4.95 $3.18 $4.95 N/A N/A 30100456 EAP CPT® 81381 HLA B5701 BOTH IP/OP $458.00 $339.00 $35.15 $458.00 $185.61 $185.61 $185.61 $185.61 $169.90 $169.90 $84.95 $76.46 $169.90 $134.19 $134.19 $139.35 $97.96 $46.99 $271.84 $271.84 $270.91 $169.90 $169.90 $169.90 $458.00 $343.50 $169.90 $169.90 $169.90 $229.00 $229.00 $362.74 $169.90 $366.40 $280.34 $44.75 $169.90 $265.64 $458.00 $246.36 $169.90 $35.15 $169.90 N/A N/A 30100457 EAP CPT® 82784 "IMMUNOGLOBULIN,IGG-CSF (SO)" BOTH IP/OP $8.78 $6.50 $4.65 $15.35 $8.78 $8.78 $8.78 $8.78 $9.30 $9.30 $4.65 $4.65 $9.30 $14.12 $14.12 $14.67 $10.31 $8.78 $14.88 $14.88 $5.19 $9.30 $9.30 $9.30 $8.78 $6.59 $9.30 $9.30 $9.30 $8.78 $8.78 $6.95 $9.30 $7.02 $15.35 $8.78 $9.30 $5.09 $8.78 $8.78 $9.30 $10.27 $8.78 N/A N/A 30100458 EAP CPT® 82390 CERULOPLASMIN-SERUM (SO) BOTH IP/OP $8.78 $6.50 $5.09 $17.72 $8.78 $8.78 $8.78 $8.78 $10.74 $10.74 $5.37 $5.37 $10.74 $16.31 $16.31 $16.93 $11.90 $8.78 $17.18 $17.18 $5.19 $10.74 $10.74 $10.74 $8.78 $6.59 $10.74 $10.74 $10.74 $8.78 $8.78 $6.95 $10.74 $7.02 $17.72 $8.78 $10.74 $5.09 $8.78 $8.78 $10.74 $11.87 $8.78 N/A N/A 30100475 EAP CPT® 82172 APOLIPOPROTEIN (SO) BOTH IP/OP $181.00 $134.00 $9.49 $181.00 $30.42 $30.42 $30.42 $30.42 $21.09 $21.09 $10.55 $9.49 $21.09 $23.52 $23.52 $24.43 $17.17 $22.90 $33.74 $33.74 $107.06 $21.09 $21.09 $21.09 $181.00 $135.75 $21.09 $21.09 $21.09 $86.60 $86.60 $143.35 $21.09 $144.80 $34.80 $21.81 $21.09 $104.98 $181.00 $30.58 $21.09 $17.13 $21.09 N/A N/A 30100476 EAP CPT® 82247 TOTAL BILIRUBIN (SO) BOTH IP/OP $88.00 $65.50 $2.51 $88.00 $9.84 $9.84 $9.84 $9.84 $5.02 $5.02 $2.51 $2.51 $5.02 $7.62 $7.62 $7.92 $5.56 $7.42 $8.03 $8.03 $52.05 $5.02 $5.02 $5.02 $88.00 $66.00 $5.02 $5.02 $5.02 $28.08 $28.08 $69.70 $5.02 $70.40 $8.28 $7.07 $5.02 $51.04 $88.00 $7.28 $5.02 $5.55 $5.02 N/A N/A 30100477 EAP CPT® 82977 GGT (SO) BOTH IP/OP $187.00 $138.50 $3.60 $187.00 $14.13 $14.13 $14.13 $14.13 $7.20 $7.20 $3.60 $3.60 $7.20 $10.93 $10.93 $11.35 $7.98 $7.46 $11.52 $11.52 $110.61 $7.20 $7.20 $7.20 $187.00 $140.25 $7.20 $7.20 $7.20 $40.24 $40.24 $148.10 $7.20 $149.60 $11.88 $7.10 $7.20 $108.46 $187.00 $10.44 $7.20 $5.58 $7.20 N/A N/A 30100478 EAP CPT® 83010 HAPTOGLOBIN QUANT (SO) BOTH IP/OP $265.00 $196.50 $4.12 $265.00 $7.33 $7.33 $7.33 $7.33 $12.58 $12.58 $6.29 $6.29 $12.58 $5.66 $5.66 $5.88 $4.13 $5.51 $20.13 $20.13 $156.75 $12.58 $12.58 $12.58 $265.00 $198.75 $12.58 $12.58 $12.58 $20.84 $20.84 $209.88 $12.58 $212.00 $20.76 $5.25 $12.58 $153.70 $265.00 $18.24 $12.58 $4.12 $12.58 N/A N/A 30100479 EAP CPT® 83883 NEPHELOMETRY (SO) BOTH IP/OP $222.00 $164.50 $6.80 $222.00 $26.68 $26.68 $26.68 $26.68 $13.60 $13.60 $6.80 $6.80 $13.60 $20.64 $20.64 $21.44 $15.07 $20.09 $21.76 $21.76 $131.31 $13.60 $13.60 $13.60 $222.00 $166.50 $13.60 $13.60 $13.60 $76.00 $76.00 $175.82 $13.60 $177.60 $22.44 $19.13 $13.60 $128.76 $222.00 $19.72 $13.60 $15.03 $13.60 N/A N/A 30100480 EAP CPT® 84460 ALT (S0) BOTH IP/OP $90.00 $67.00 $2.65 $90.00 $10.39 $10.39 $10.39 $10.39 $5.30 $5.30 $2.65 $2.65 $5.30 $8.04 $8.04 $8.35 $5.87 $7.46 $8.48 $8.48 $53.24 $5.30 $5.30 $5.30 $90.00 $67.50 $5.30 $5.30 $5.30 $29.60 $29.60 $71.28 $5.30 $72.00 $8.75 $7.10 $5.30 $52.20 $90.00 $7.69 $5.30 $5.58 $5.30 N/A N/A 30100481 EAP CPT® 88360 PD-L1 IHC W/INTERP (S0) BOTH IP/OP $488.00 $361.50 $49.88 $390.40 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $288.65 $146.71 $78.13 $146.71 $154.04 $366.00 $146.71 $146.71 $146.71 $242.68 $242.68 $386.50 $146.71 $390.40 $317.20 $109.25 $146.71 $283.04 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 30100482 EAP CPT® 88341 LYNCH SYN PAN ADDL SLIDE (SO) BOTH IP/OP $566.00 $419.00 $42.49 $566.00 $132.08 $132.08 $132.08 $132.08 $566.00 $566.00 $566.00 $42.49 $566.00 $70.50 $70.50 $73.21 $51.47 $67.41 $566.00 $566.00 $334.79 $566.00 $59.18 $566.00 $566.00 $424.50 $566.00 $566.00 $566.00 $283.00 $283.00 $448.27 $566.00 $452.80 $367.90 $64.20 $566.00 $328.28 $566.00 $566.00 $566.00 $50.43 $566.00 N/A N/A 30100483 EAP CPT® 88342 LYNCH SYN PAN 1ST SLIDE (SO) BOTH IP/OP $645.00 $477.50 $43.77 $516.00 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $381.52 $146.71 $66.63 $146.71 $154.04 $483.75 $146.71 $146.71 $146.71 $212.92 $212.92 $510.84 $146.71 $516.00 $419.25 $80.08 $146.71 $374.10 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 30100490 EAP CPT® 80177 LEVETIRACETAM (SO) BOTH IP/OP $333.00 $246.50 $6.63 $333.00 $26.00 $26.00 $26.00 $26.00 $13.25 $13.25 $6.63 $6.63 $13.25 $18.81 $18.81 $19.54 $13.73 $17.00 $21.20 $21.20 $196.97 $13.25 $13.25 $13.25 $333.00 $249.75 $13.25 $13.25 $13.25 $166.50 $166.50 $263.74 $13.25 $266.40 $21.86 $16.19 $13.25 $193.14 $333.00 $19.21 $13.25 $12.72 $13.25 N/A N/A 30100499 EAP CPT® 83520 ANTI MAG Q BOTH IP/OP $68.00 $50.50 $7.77 $68.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $40.22 $17.27 $17.27 $17.27 $68.00 $51.00 $17.27 $17.27 $17.27 $68.00 $68.00 $53.86 $17.27 $54.40 $28.50 $18.21 $17.27 $39.44 $68.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30100500 EAP CPT® 80342 "FLUPHENAZINE, SERUM" BOTH IP/OP $140.00 $104.00 $12.01 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $12.01 $140.00 $140.00 $103.91 $103.91 $107.91 $72.94 $23.01 $140.00 $56.00 $140.00 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $91.00 $140.00 $140.00 $81.20 $140.00 $84.00 $140.00 $140.00 $140.00 N/A N/A 30100501 EAP CPT® 82438 "FECES, CHLORIDE (SO)" BOTH IP/OP $96.00 $71.50 $2.50 $96.00 $96.00 $96.00 $96.00 $96.00 $5.00 $5.00 $2.50 $96.00 $5.00 $7.43 $7.43 $7.71 $5.42 $7.22 $8.00 $8.00 $96.00 $5.00 $5.00 $5.00 $96.00 $72.00 $5.00 $5.00 $5.00 $27.32 $27.32 $76.03 $5.00 $76.80 $96.00 $96.00 $5.00 $55.68 $96.00 $7.25 $5.00 $96.00 $5.00 N/A N/A 30100502 EAP CPT® 84302 "FECES, SODIUM (SO)" BOTH IP/OP $105.00 $78.00 $2.43 $105.00 $105.00 $105.00 $105.00 $105.00 $4.86 $4.86 $2.43 $105.00 $4.86 $5.25 $5.25 $5.45 $3.83 $5.11 $7.78 $7.78 $105.00 $4.86 $4.86 $4.86 $105.00 $78.75 $4.86 $4.86 $4.86 $19.32 $19.32 $83.16 $4.86 $84.00 $105.00 $105.00 $4.86 $60.90 $105.00 $7.05 $4.86 $105.00 $4.86 N/A N/A 30100503 EAP CPT® 84311 "FECES,ELECTROPHORESIS (SO)" BOTH IP/OP $160.00 $118.50 $4.05 $160.00 $160.00 $160.00 $160.00 $160.00 $8.10 $8.10 $4.05 $160.00 $8.10 $10.61 $10.61 $11.02 $7.74 $10.32 $12.96 $12.96 $160.00 $8.10 $8.10 $8.10 $160.00 $120.00 $8.10 $8.10 $8.10 $39.08 $39.08 $126.72 $8.10 $128.00 $160.00 $160.00 $8.10 $92.80 $160.00 $11.75 $8.10 $160.00 $8.10 N/A N/A 30100505 EAP CPT® 84311 "FECES, POTASSIUM (SO)" BOTH IP/OP $198.00 $147.00 $4.05 $198.00 $198.00 $198.00 $198.00 $198.00 $8.10 $8.10 $4.05 $198.00 $8.10 $10.61 $10.61 $11.02 $7.74 $10.32 $12.96 $12.96 $198.00 $8.10 $8.10 $8.10 $198.00 $148.50 $8.10 $8.10 $8.10 $39.08 $39.08 $156.82 $8.10 $158.40 $198.00 $198.00 $8.10 $114.84 $198.00 $11.75 $8.10 $198.00 $8.10 N/A N/A 30100600 EAP CPT® 82248 "BILIRUBIN,DIRECT" BOTH IP/OP $118.00 $87.50 $2.51 $118.00 $9.84 $9.84 $9.84 $9.84 $5.02 $5.02 $2.51 $2.51 $5.02 $7.62 $7.62 $7.92 $5.56 $7.42 $8.03 $8.03 $69.80 $5.02 $5.02 $5.02 $118.00 $88.50 $5.02 $5.02 $5.02 $28.08 $28.08 $93.46 $5.02 $94.40 $8.28 $7.07 $5.02 $68.44 $118.00 $7.28 $5.02 $5.55 $5.02 N/A N/A 30100602 EAP CPT® 80299 VORICONAZOLE QUANT ASSAY (SO) BOTH IP/OP $204.00 $151.00 $8.39 $204.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $120.67 $18.64 $18.64 $18.64 $204.00 $153.00 $18.64 $18.64 $18.64 $67.28 $67.28 $161.57 $18.64 $163.20 $30.76 $16.94 $18.64 $118.32 $204.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30100622 EAP CPT® 80203 ZONISAMIDE (SO) BOTH IP/OP $417.00 $309.00 $6.63 $417.00 $26.00 $26.00 $26.00 $26.00 $13.25 $13.25 $6.63 $6.63 $13.25 $18.81 $18.81 $19.54 $13.73 $17.00 $21.20 $21.20 $246.66 $13.25 $13.25 $13.25 $417.00 $312.75 $13.25 $13.25 $13.25 $208.50 $208.50 $330.26 $13.25 $333.60 $21.86 $16.19 $13.25 $241.86 $417.00 $19.21 $13.25 $12.72 $13.25 N/A N/A 30100634 EAP CPT® 84181 WESTERN BLOT TEST BOTH IP/OP "$1,387.00" "$1,026.50" $8.52 "$1,387.00" "$1,387.00" "$1,387.00" "$1,387.00" "$1,387.00" $17.03 $17.03 $8.52 "$1,387.00" $17.03 $25.86 $25.86 $26.86 $18.88 $25.16 $27.25 $27.25 "$1,387.00" $17.03 $17.03 $17.03 "$1,387.00" "$1,040.25" $17.03 $17.03 $17.03 $95.20 $95.20 "$1,098.50" $17.03 "$1,109.60" "$1,387.00" "$1,387.00" $17.03 $804.46 "$1,387.00" $24.69 $17.03 "$1,387.00" $17.03 N/A N/A 30100635 EAP CPT® 82530 CORTISOL;FREE BOTH IP/OP $200.00 $148.00 $8.36 $200.00 $32.78 $32.78 $32.78 $32.78 $16.71 $16.71 $8.36 $8.36 $16.71 $25.39 $25.39 $26.36 $18.53 $24.70 $26.74 $26.74 $118.30 $16.71 $16.71 $16.71 $200.00 $150.00 $16.71 $16.71 $16.71 $93.40 $93.40 $158.40 $16.71 $160.00 $27.57 $23.52 $16.71 $116.00 $200.00 $24.23 $16.71 $18.47 $16.71 N/A N/A 30100636 EAP CPT® 82570 OTHER SOURCE BOTH IP/OP $91.00 $67.50 $2.59 $91.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $53.83 $5.18 $5.18 $5.18 $91.00 $68.25 $5.18 $5.18 $5.18 $28.92 $28.92 $72.07 $5.18 $72.80 $8.55 $7.28 $5.18 $52.78 $91.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30100637 EAP CPT® 83789 "QUANTITATIVE, EACH SPECIMEN" BOTH IP/OP $142.00 $105.50 $6.66 $142.00 $142.00 $142.00 $142.00 $142.00 $24.11 $24.11 $12.06 $142.00 $24.11 $9.12 $9.12 $9.47 $6.66 $8.87 $38.58 $38.58 $142.00 $24.11 $24.11 $24.11 $142.00 $106.50 $24.11 $24.11 $24.11 $33.56 $33.56 $112.46 $24.11 $113.60 $142.00 $142.00 $24.11 $82.36 $142.00 $34.96 $24.11 $142.00 $24.11 N/A N/A 30100643 EAP CPT® 83789 "QUANTITATIVE, EACH SPECIMEN" BOTH IP/OP $241.00 $178.50 $6.66 $241.00 $241.00 $241.00 $241.00 $241.00 $24.11 $24.11 $12.06 $241.00 $24.11 $9.12 $9.12 $9.47 $6.66 $8.87 $38.58 $38.58 $241.00 $24.11 $24.11 $24.11 $241.00 $180.75 $24.11 $24.11 $24.11 $33.56 $33.56 $190.87 $24.11 $192.80 $241.00 $241.00 $24.11 $139.78 $241.00 $34.96 $24.11 $241.00 $24.11 N/A N/A 30100644 EAP CPT® 83520 "QUANTITATIVE, NOT OTHERWISE SPECIFIED" BOTH IP/OP $103.00 $76.50 $7.77 $103.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $60.92 $17.27 $17.27 $17.27 $103.00 $77.25 $17.27 $17.27 $17.27 $72.36 $72.36 $81.58 $17.27 $82.40 $28.50 $18.21 $17.27 $59.74 $103.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30100645 EAP CPT® 84999 UNLISTED CHEMISTRY PROCEDURE BOTH IP/OP $58.00 $43.00 $11.51 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $12.09 $58.00 $43.05 $43.05 $44.71 $30.22 $12.09 $58.00 $23.20 $34.31 $58.00 $58.00 $58.00 $58.00 $43.50 $58.00 $58.00 $58.00 $58.00 $58.00 $45.94 $58.00 $46.40 $37.70 $11.51 $58.00 $33.64 $58.00 $34.80 $58.00 $12.09 $58.00 N/A N/A 30100652 EAP CPT® 82017 ACYLCARNITIES QUANT BOTH IP/OP $187.00 $138.50 $8.44 $187.00 $187.00 $187.00 $187.00 $187.00 $16.87 $16.87 $8.44 $187.00 $16.87 $25.62 $25.62 $26.60 $18.70 $24.92 $26.99 $26.99 $187.00 $16.87 $16.87 $16.87 $187.00 $140.25 $16.87 $16.87 $16.87 $94.28 $94.28 $148.10 $16.87 $149.60 $187.00 $187.00 $16.87 $108.46 $187.00 $24.46 $16.87 $187.00 $16.87 N/A N/A 30100653 EAP CPT® 82139 "AMINO ACIDS,6 OR MORE AMINO ACIDS,QUANTITATIVE,EACH" BOTH IP/OP $292.00 $216.50 $8.44 $292.00 $292.00 $292.00 $292.00 $292.00 $16.87 $16.87 $8.44 $292.00 $16.87 $25.62 $25.62 $26.60 $18.70 $24.92 $26.99 $26.99 $292.00 $16.87 $16.87 $16.87 $292.00 $219.00 $16.87 $16.87 $16.87 $94.28 $94.28 $231.26 $16.87 $233.60 $292.00 $292.00 $16.87 $169.36 $292.00 $24.46 $16.87 $292.00 $16.87 N/A N/A 30100654 EAP CPT® 82379 "CARNITINE(TOTAL AND FREE),QUANTITATIVE,EACH SPECIMEN" BOTH IP/OP $223.00 $165.50 $8.44 $223.00 $223.00 $223.00 $223.00 $223.00 $16.87 $16.87 $8.44 $223.00 $16.87 $25.62 $25.62 $26.60 $18.70 $24.92 $26.99 $26.99 $223.00 $16.87 $16.87 $16.87 $223.00 $167.25 $16.87 $16.87 $16.87 $94.28 $94.28 $176.62 $16.87 $178.40 $223.00 $223.00 $16.87 $129.34 $223.00 $24.46 $16.87 $223.00 $16.87 N/A N/A 30100656 EAP CPT® 82542 "QUANTITATIVE,SINGLE STATIONARY & MOBILE PHASE, QT" BOTH IP/OP $296.00 $219.50 $6.64 $296.00 $35.44 $35.44 $35.44 $35.44 $24.09 $24.09 $12.05 $10.84 $24.09 $9.12 $9.12 $9.47 $6.66 $8.87 $38.54 $38.54 $175.08 $24.09 $24.09 $24.09 $296.00 $222.00 $24.09 $24.09 $24.09 $33.56 $33.56 $234.43 $24.09 $236.80 $39.75 $8.45 $24.09 $171.68 $296.00 $34.93 $24.09 $6.64 $24.09 N/A N/A 30100660 EAP CPT® 82962 POCT GLUCOSE METER BOTH IP/OP $92.00 $68.50 $1.48 $92.00 $4.59 $4.59 $4.59 $4.59 $3.28 $3.28 $1.64 $1.48 $3.28 $3.56 $3.56 $3.69 $2.60 $3.45 $5.25 $5.25 $54.42 $3.28 $3.28 $3.28 $92.00 $69.00 $3.28 $3.28 $3.28 $13.08 $13.08 $72.86 $3.28 $73.60 $5.41 $3.29 $3.28 $53.36 $92.00 $4.76 $3.28 $2.58 $3.28 N/A N/A 30100662 EAP CPT® 84600 PROPYLENE GLYCOL (NMS) BOTH IP/OP $243.00 $180.00 $8.56 $243.00 $243.00 $243.00 $243.00 $243.00 $17.11 $17.11 $8.56 $243.00 $17.11 $24.41 $24.41 $25.35 $17.82 $23.74 $27.38 $27.38 $243.00 $17.11 $17.11 $17.11 $243.00 $182.25 $17.11 $17.11 $17.11 $89.80 $89.80 $192.46 $17.11 $194.40 $243.00 $243.00 $17.11 $140.94 $243.00 $24.81 $17.11 $243.00 $17.11 N/A N/A 30100665 EAP CPT® 83825 "MERCURY,BLOOD(Q)" BOTH IP/OP $41.00 $30.50 $8.13 $41.00 $31.90 $31.90 $31.90 $31.90 $16.26 $16.26 $8.13 $8.13 $16.26 $24.69 $24.69 $25.64 $18.02 $24.02 $26.02 $26.02 $24.25 $16.26 $16.26 $16.26 $41.00 $30.75 $16.26 $16.26 $16.26 $41.00 $41.00 $32.47 $16.26 $32.80 $26.83 $22.88 $16.26 $23.78 $41.00 $23.58 $16.26 $17.97 $16.26 N/A N/A 30100666 EAP CPT® 80347 QUANTITATIVE BENZO PANEL(Q) BOTH IP/OP $398.00 $295.00 $27.32 $398.00 $398.00 $398.00 $398.00 $398.00 $398.00 $398.00 $398.00 $398.00 $398.00 $295.40 $295.40 $306.78 $207.36 $27.32 $398.00 $60.80 $398.00 $398.00 $152.00 $398.00 $398.00 $298.50 $398.00 $398.00 $398.00 $199.00 $199.00 $315.22 $398.00 $318.40 $258.70 $398.00 $398.00 $230.84 $398.00 $238.80 $398.00 $398.00 $398.00 N/A N/A 30100668 EAP CPT® 86161 "C1 INHIBITOR , FUNCTIONAL (SO)" BOTH IP/OP $169.00 $125.50 $6.00 $169.00 $23.54 $23.54 $23.54 $23.54 $12.00 $12.00 $6.00 $6.00 $12.00 $18.23 $18.23 $18.93 $13.31 $17.73 $19.20 $19.20 $99.96 $12.00 $12.00 $12.00 $169.00 $126.75 $12.00 $12.00 $12.00 $67.12 $67.12 $133.85 $12.00 $135.20 $19.80 $16.89 $12.00 $98.02 $169.00 $17.40 $12.00 $13.27 $12.00 N/A N/A 30100669 EAP CPT® 86774 TETANUS ANTITOXOID (SO) BOTH IP/OP $83.00 $61.50 $7.40 $83.00 $83.00 $83.00 $83.00 $83.00 $14.80 $14.80 $7.40 $83.00 $14.80 $22.47 $22.47 $23.34 $16.41 $21.86 $23.68 $23.68 $83.00 $14.80 $14.80 $14.80 $83.00 $62.25 $14.80 $14.80 $14.80 $82.72 $82.72 $65.74 $14.80 $66.40 $83.00 $83.00 $14.80 $48.14 $83.00 $21.46 $14.80 $83.00 $14.80 N/A N/A 30100670 EAP CPT® 86343 HISTAMINE RELEASE -CU (SO) BOTH IP/OP $234.00 $173.50 $6.23 $234.00 $24.45 $24.45 $24.45 $24.45 $12.46 $12.46 $6.23 $6.23 $12.46 $18.93 $18.93 $19.66 $13.82 $18.41 $19.94 $19.94 $138.41 $12.46 $12.46 $12.46 $234.00 $175.50 $12.46 $12.46 $12.46 $69.64 $69.64 $185.33 $12.46 $187.20 $20.56 $17.53 $12.46 $135.72 $234.00 $18.07 $12.46 $13.77 $12.46 N/A N/A 30100671 EAP CPT® 83520 TRYPTASE (SO) BOTH IP/OP $217.00 $161.00 $7.77 $217.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $128.36 $17.27 $17.27 $17.27 $217.00 $162.75 $17.27 $17.27 $17.27 $72.36 $72.36 $171.86 $17.27 $173.60 $28.50 $18.21 $17.27 $125.86 $217.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30100672 EAP CPT® 82106 ALPHA- FETOPROTEIN AF (SO) BOTH IP/OP $41.00 $30.50 $8.39 $41.00 $32.93 $32.93 $32.93 $32.93 $17.00 $17.00 $8.50 $8.39 $17.00 $25.47 $25.47 $26.45 $18.59 $24.79 $27.20 $27.20 $24.25 $17.00 $17.00 $17.00 $41.00 $30.75 $17.00 $17.00 $17.00 $41.00 $41.00 $32.47 $17.00 $32.80 $28.05 $23.61 $17.00 $23.78 $41.00 $24.65 $17.00 $18.55 $17.00 N/A N/A 30100673 EAP CPT® 83033 FETAL HEMOGLOBIN AF (SO) BOTH IP/OP $76.00 $56.50 $4.00 $76.00 $76.00 $76.00 $76.00 $76.00 $8.00 $8.00 $4.00 $76.00 $8.00 $9.05 $9.05 $9.40 $6.60 $8.81 $12.80 $12.80 $76.00 $8.00 $8.00 $8.00 $76.00 $57.00 $8.00 $8.00 $8.00 $33.32 $33.32 $60.19 $8.00 $60.80 $76.00 $76.00 $8.00 $44.08 $76.00 $11.60 $8.00 $76.00 $8.00 N/A N/A 30100674 EAP CPT® 82664 ACETYLCHOLINESTERASE AF (SO) BOTH IP/OP $156.00 $115.50 $30.75 $156.00 $156.00 $156.00 $156.00 $156.00 $61.50 $61.50 $30.75 $156.00 $61.50 $52.17 $52.17 $54.17 $38.08 $50.75 $98.40 $98.40 $156.00 $61.50 $61.50 $61.50 $156.00 $117.00 $61.50 $61.50 $61.50 $156.00 $156.00 $123.55 $61.50 $124.80 $156.00 $156.00 $61.50 $90.48 $156.00 $89.18 $61.50 $156.00 $61.50 N/A N/A 30100680 EAP CPT® 82105 MATERNAL SERUM AFP (SO) BOTH IP/OP $47.00 $35.00 $8.39 $47.00 $32.93 $32.93 $32.93 $32.93 $16.77 $16.77 $8.39 $8.39 $16.77 $25.47 $25.47 $26.45 $18.59 $24.79 $26.83 $26.83 $27.80 $16.77 $16.77 $16.77 $47.00 $35.25 $16.77 $16.77 $16.77 $47.00 $47.00 $37.22 $16.77 $37.60 $27.67 $23.61 $16.77 $27.26 $47.00 $24.32 $16.77 $18.55 $16.77 N/A N/A 30100681 EAP CPT® 86160 C1 ESTERASE INHIBITOR PROTEIN (SO) BOTH IP/OP $85.00 $63.00 $6.00 $85.00 $23.54 $23.54 $23.54 $23.54 $12.00 $12.00 $6.00 $6.00 $12.00 $18.23 $18.23 $18.93 $13.31 $17.73 $19.20 $19.20 $50.28 $12.00 $12.00 $12.00 $85.00 $63.75 $12.00 $12.00 $12.00 $67.12 $67.12 $67.32 $12.00 $68.00 $19.80 $16.89 $12.00 $49.30 $85.00 $17.40 $12.00 $13.27 $12.00 N/A N/A 30100682 EAP CPT® 84591 VITAMIN B-5( PANTOTHENIC ACID) (SO) BOTH IP/OP $178.00 $132.00 $8.53 $178.00 $178.00 $178.00 $178.00 $178.00 $17.06 $17.06 $8.53 $178.00 $17.06 $17.61 $17.61 $18.28 $12.85 $17.13 $27.30 $27.30 $178.00 $17.06 $17.06 $17.06 $178.00 $133.50 $17.06 $17.06 $17.06 $64.80 $64.80 $140.98 $17.06 $142.40 $178.00 $178.00 $17.06 $103.24 $178.00 $24.74 $17.06 $178.00 $17.06 N/A N/A 30100683 EAP CPT® 82397 LEPTIN (SO) BOTH IP/OP $232.00 $172.00 $7.06 $232.00 $27.71 $27.71 $27.71 $27.71 $14.12 $14.12 $7.06 $7.06 $14.12 $21.46 $21.46 $22.28 $15.66 $20.87 $22.59 $22.59 $137.23 $14.12 $14.12 $14.12 $232.00 $174.00 $14.12 $14.12 $14.12 $78.96 $78.96 $183.74 $14.12 $185.60 $23.30 $19.88 $14.12 $134.56 $232.00 $20.47 $14.12 $15.62 $14.12 N/A N/A 30100684 EAP CPT® 85415 PLASMINOGEN ACTIVATOR INHIBITOR-A (PAI-1) (SO) BOTH IP/OP $220.00 $163.00 $8.60 $220.00 $220.00 $220.00 $220.00 $220.00 $17.19 $17.19 $8.60 $220.00 $17.19 $26.10 $26.10 $27.11 $19.06 $25.40 $27.50 $27.50 $220.00 $17.19 $17.19 $17.19 $220.00 $165.00 $17.19 $17.19 $17.19 $96.08 $96.08 $174.24 $17.19 $176.00 $220.00 $220.00 $17.19 $127.60 $220.00 $24.93 $17.19 $220.00 $17.19 N/A N/A 30100685 EAP CPT® 83516 "RIBOSOMAL P ANTIBODY , CSF (SO)" BOTH IP/OP $240.00 $178.00 $5.76 $240.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $141.96 $11.53 $11.53 $11.53 $240.00 $180.00 $11.53 $11.53 $11.53 $59.76 $59.76 $190.08 $11.53 $192.00 $19.02 $15.05 $11.53 $139.20 $240.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30100686 EAP CPT® 83516 SERINE PROTEASE 3 ANTIBODY (SO)ARUP BOTH IP/OP $302.00 $223.50 $5.76 $302.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $178.63 $11.53 $11.53 $11.53 $302.00 $226.50 $11.53 $11.53 $11.53 $59.76 $59.76 $239.18 $11.53 $241.60 $19.02 $15.05 $11.53 $175.16 $302.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30100687 EAP CPT® 82610 CYSTATIN C (SO) BOTH IP/OP $244.00 $181.00 $8.33 $244.00 $26.68 $26.68 $26.68 $26.68 $18.52 $18.52 $9.26 $8.33 $18.52 $20.64 $20.64 $21.44 $15.07 $20.09 $29.63 $29.63 $144.33 $18.52 $18.52 $18.52 $244.00 $183.00 $18.52 $18.52 $18.52 $122.00 $122.00 $193.25 $18.52 $195.20 $30.56 $19.13 $18.52 $141.52 $244.00 $26.85 $18.52 $15.03 $18.52 N/A N/A 30100688 EAP CPT® 80180 MYCOPHENOLIC ACID (SO) BOTH IP/OP $169.00 $125.50 $6.16 $169.00 $169.00 $169.00 $169.00 $169.00 $18.05 $18.05 $9.03 $169.00 $18.05 $8.44 $8.44 $8.77 $6.16 $7.63 $28.88 $28.88 $169.00 $18.05 $18.05 $18.05 $169.00 $126.75 $18.05 $18.05 $18.05 $84.50 $84.50 $133.85 $18.05 $135.20 $169.00 $169.00 $18.05 $98.02 $169.00 $26.17 $18.05 $169.00 $18.05 N/A N/A 30100689 EAP CPT® 83516 "SACCHARMYCES CEREVISIAE AB, IGG (ARUP)" BOTH IP/OP $174.00 $129.00 $5.76 $174.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $102.92 $11.53 $11.53 $11.53 $174.00 $130.50 $11.53 $11.53 $11.53 $59.76 $59.76 $137.81 $11.53 $139.20 $19.02 $15.05 $11.53 $100.92 $174.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30100690 EAP CPT® 83516 "LAMINARIBIOSIDE CARBOHYDRATE AB, IGG (ARUP)" BOTH IP/OP $174.00 $129.00 $5.76 $174.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $102.92 $11.53 $11.53 $11.53 $174.00 $130.50 $11.53 $11.53 $11.53 $59.76 $59.76 $137.81 $11.53 $139.20 $19.02 $15.05 $11.53 $100.92 $174.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30100691 EAP CPT® 83516 "MANNOBIOSIDE CARBOHYDRATE AB, IGG (ARUP)" BOTH IP/OP $174.00 $129.00 $5.76 $174.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $102.92 $11.53 $11.53 $11.53 $174.00 $130.50 $11.53 $11.53 $11.53 $59.76 $59.76 $137.81 $11.53 $139.20 $19.02 $15.05 $11.53 $100.92 $174.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30100692 EAP CPT® 86671 "CHITOBIOSIDE CARBOHYDRATE AB, IGA (ARUP)" BOTH IP/OP $80.00 $59.50 $6.13 $80.00 $80.00 $80.00 $80.00 $80.00 $12.25 $12.25 $6.13 $80.00 $12.25 $18.62 $18.62 $19.33 $13.59 $18.11 $19.60 $19.60 $80.00 $12.25 $12.25 $12.25 $80.00 $60.00 $12.25 $12.25 $12.25 $68.52 $68.52 $63.36 $12.25 $64.00 $80.00 $80.00 $12.25 $46.40 $80.00 $17.76 $12.25 $80.00 $12.25 N/A N/A 30100693 EAP CPT® 83789 LEVAMISOLE (SO) NMS BOTH IP/OP $298.00 $221.00 $6.66 $298.00 $298.00 $298.00 $298.00 $298.00 $24.11 $24.11 $12.06 $298.00 $24.11 $9.12 $9.12 $9.47 $6.66 $8.87 $38.58 $38.58 $298.00 $24.11 $24.11 $24.11 $298.00 $223.50 $24.11 $24.11 $24.11 $33.56 $33.56 $236.02 $24.11 $238.40 $298.00 $298.00 $24.11 $172.84 $298.00 $34.96 $24.11 $298.00 $24.11 N/A N/A 30100702 EAP CPT® 84182 ZIC4 AB PROTEIN WEST BLOT (SO) BOTH IP/OP $441.00 $326.50 $13.14 $441.00 $35.32 $35.32 $35.32 $35.32 $29.21 $29.21 $14.61 $13.14 $29.21 $27.33 $27.33 $28.38 $19.95 $26.60 $46.74 $46.74 $260.85 $29.21 $29.21 $29.21 $441.00 $330.75 $29.21 $29.21 $29.21 $100.60 $100.60 $349.27 $29.21 $352.80 $48.20 $25.33 $29.21 $255.78 $441.00 $42.35 $29.21 $19.90 $29.21 N/A N/A 30100703 EAP CPT® 83789 DIURECTICS SCREEN URINE (SO) BOTH IP/OP $228.00 $169.00 $6.66 $228.00 $228.00 $228.00 $228.00 $228.00 $24.11 $24.11 $12.06 $228.00 $24.11 $9.12 $9.12 $9.47 $6.66 $8.87 $38.58 $38.58 $228.00 $24.11 $24.11 $24.11 $228.00 $171.00 $24.11 $24.11 $24.11 $33.56 $33.56 $180.58 $24.11 $182.40 $228.00 $228.00 $24.11 $132.24 $228.00 $34.96 $24.11 $228.00 $24.11 N/A N/A 30100704 EAP CPT® 82785 ABPA IGE (SO) BOTH IP/OP $191.00 $141.50 $8.23 $191.00 $32.30 $32.30 $32.30 $32.30 $16.46 $16.46 $8.23 $8.23 $16.46 $25.01 $25.01 $25.97 $18.26 $24.33 $26.34 $26.34 $112.98 $16.46 $16.46 $16.46 $191.00 $143.25 $16.46 $16.46 $16.46 $92.04 $92.04 $151.27 $16.46 $152.80 $27.16 $23.17 $16.46 $110.78 $191.00 $23.87 $16.46 $18.20 $16.46 N/A N/A 30100705 EAP CPT® 84146 MACROPROLACTIN (SO) BOTH IP/OP $322.00 $238.50 $9.69 $322.00 $38.03 $38.03 $38.03 $38.03 $19.38 $19.38 $9.69 $9.69 $19.38 $29.43 $29.43 $30.56 $21.49 $28.63 $31.01 $31.01 $190.46 $19.38 $19.38 $19.38 $322.00 $241.50 $19.38 $19.38 $19.38 $108.32 $108.32 $255.02 $19.38 $257.60 $31.98 $27.27 $19.38 $186.76 $322.00 $28.10 $19.38 $21.42 $19.38 N/A N/A 30100706 EAP CPT® 82570 THIOSULFATE URINE BOTH IP/OP $280.00 $207.50 $2.59 $280.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $165.62 $5.18 $5.18 $5.18 $280.00 $210.00 $5.18 $5.18 $5.18 $28.92 $28.92 $221.76 $5.18 $224.00 $8.55 $7.28 $5.18 $162.40 $280.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30100708 EAP CPT® 83921 SUCCINLYLACETONE URINE (SO) BOTH IP/OP $250.00 $185.00 $9.54 $250.00 $32.28 $32.28 $32.28 $32.28 $21.21 $21.21 $10.61 $9.54 $21.21 $25.00 $25.00 $25.96 $18.25 $24.32 $33.94 $33.94 $147.88 $21.21 $21.21 $21.21 $250.00 $187.50 $21.21 $21.21 $21.21 $92.00 $92.00 $198.00 $21.21 $200.00 $35.00 $23.16 $21.21 $145.00 $250.00 $30.75 $21.21 $18.19 $21.21 N/A N/A 30100709 EAP CPT® 83520 VWF PROPEPTIDE (SO) BOTH IP/OP $365.00 $270.50 $7.77 $365.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $215.90 $17.27 $17.27 $17.27 $365.00 $273.75 $17.27 $17.27 $17.27 $72.36 $72.36 $289.08 $17.27 $292.00 $28.50 $18.21 $17.27 $211.70 $365.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30100710 EAP CPT® 80061 NMR LIPOPROFILE PANEL (SO) BOTH IP/OP $239.00 $177.00 $6.70 $239.00 $26.28 $26.28 $26.28 $26.28 $13.39 $13.39 $6.70 $6.70 $13.39 $20.35 $20.35 $21.14 $14.86 $19.79 $21.42 $21.42 $141.37 $13.39 $13.39 $13.39 $239.00 $179.25 $13.39 $13.39 $13.39 $74.88 $74.88 $189.29 $13.39 $191.20 $22.09 $18.85 $13.39 $138.62 $239.00 $19.42 $13.39 $14.81 $13.39 N/A N/A 30100711 EAP CPT® 83704 NMR LIPOPROFILE BLD (SO) BOTH IP/OP $239.00 $177.00 $17.10 $239.00 $239.00 $239.00 $239.00 $239.00 $34.19 $34.19 $17.10 $239.00 $34.19 $47.91 $47.91 $49.76 $34.98 $46.60 $54.70 $54.70 $239.00 $34.19 $34.19 $34.19 $239.00 $179.25 $34.19 $34.19 $34.19 $176.32 $176.32 $189.29 $34.19 $191.20 $239.00 $239.00 $34.19 $138.62 $239.00 $49.58 $34.19 $239.00 $34.19 N/A N/A 30100712 EAP CPT® 83520 FACTOR H COMP (SO) BOTH IP/OP $365.00 $270.50 $7.77 $365.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $215.90 $17.27 $17.27 $17.27 $365.00 $273.75 $17.27 $17.27 $17.27 $72.36 $72.36 $289.08 $17.27 $292.00 $28.50 $18.21 $17.27 $211.70 $365.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30100714 EAP CPT® 82542 THIOSULFATE CHROMOTOGRAPHY BOTH IP/OP $221.00 $164.00 $6.64 $221.00 $35.44 $35.44 $35.44 $35.44 $24.09 $24.09 $12.05 $10.84 $24.09 $9.12 $9.12 $9.47 $6.66 $8.87 $38.54 $38.54 $130.72 $24.09 $24.09 $24.09 $221.00 $165.75 $24.09 $24.09 $24.09 $33.56 $33.56 $175.03 $24.09 $176.80 $39.75 $8.45 $24.09 $128.18 $221.00 $34.93 $24.09 $6.64 $24.09 N/A N/A 30100715 EAP CPT® 82656 PANCREATITIC ELASTASE SERUM (SO) BOTH IP/OP $326.00 $241.50 $5.76 $326.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $67.94 $18.45 $18.45 $192.83 $11.53 $11.53 $11.53 $326.00 $244.50 $11.53 $11.53 $11.53 $59.76 $59.76 $258.19 $11.53 $260.80 $19.02 $64.70 $11.53 $189.08 $326.00 $16.72 $11.53 $67.94 $11.53 N/A N/A 30100716 EAP CPT® 80189 DRUG ASSAY ITRACONZAOLE (SO) BOTH IP/OP $203.00 $150.50 $13.56 $203.00 $38.78 $38.78 $38.78 $38.78 $27.11 $27.11 $13.56 $42.31 $27.11 $150.67 $150.67 $156.47 $105.76 $25.48 $43.38 $43.38 $120.07 $27.11 $27.11 $27.11 $203.00 $152.25 $27.11 $27.11 $27.11 $101.50 $101.50 $160.78 $27.11 $162.40 $44.73 $24.27 $27.11 $117.74 $203.00 $39.31 $27.11 $19.06 $27.11 N/A N/A 30100717 EAP CPT® 80365 "OXYCODONE AND METABOLITE TOTAL, URINE (SO)" BOTH IP/OP $136.00 $101.00 $0.03 $188.81 $0.03 $0.03 $0.03 $0.03 $114.43 $114.43 $57.22 $11.94 $114.43 $100.94 $100.94 $104.83 $70.86 $28.34 $183.09 $183.09 $80.44 $114.43 $114.43 $114.43 $136.00 $102.00 $114.43 $114.43 $114.43 $68.00 $68.00 $107.71 $114.43 $108.80 $188.81 $26.99 $114.43 $78.88 $136.00 $81.60 $136.00 $28.34 $114.43 N/A N/A 30100718 EAP CPT® 80361 HYDROMORPHONE OPI 1 URINE (SO) BOTH IP/OP $484.00 $358.50 $0.03 $484.00 $0.03 $0.03 $0.03 $0.03 $484.00 $484.00 $12.01 $11.94 $484.00 $359.22 $359.22 $373.07 $252.16 $30.51 $484.00 $165.60 $286.29 $484.00 $414.00 $484.00 $484.00 $363.00 $484.00 $484.00 $484.00 $242.00 $242.00 $383.33 $484.00 $387.20 $314.60 $29.06 $484.00 $280.72 $484.00 $290.40 $484.00 $22.83 $484.00 N/A N/A 30100719 EAP CPT® 83520 THROMBIN-ANTITHROM QUANT (SO) BOTH IP/OP $421.00 $312.00 $7.77 $421.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $249.02 $17.27 $17.27 $17.27 $421.00 $315.75 $17.27 $17.27 $17.27 $72.36 $72.36 $333.43 $17.27 $336.80 $28.50 $18.21 $17.27 $244.18 $421.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30100720 EAP CPT® 84182 REDOMBX (ANTIRECOVERIN AB) (SO) BOTH IP/OP $441.00 $326.50 $13.14 $441.00 $35.32 $35.32 $35.32 $35.32 $29.21 $29.21 $14.61 $13.14 $29.21 $27.33 $27.33 $28.38 $19.95 $26.60 $46.74 $46.74 $260.85 $29.21 $29.21 $29.21 $441.00 $330.75 $29.21 $29.21 $29.21 $100.60 $100.60 $349.27 $29.21 $352.80 $48.20 $25.33 $29.21 $255.78 $441.00 $42.35 $29.21 $19.90 $29.21 N/A N/A 30100721 EAP CPT® 80299 BACLOFIN QUANT BOTH IP/OP $430.00 $318.50 $8.39 $430.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $254.35 $18.64 $18.64 $18.64 $430.00 $322.50 $18.64 $18.64 $18.64 $67.28 $67.28 $340.56 $18.64 $344.00 $30.76 $16.94 $18.64 $249.40 $430.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30100722 EAP CPT® 82726 VERY LONG FATTY ACIDS (SO) BOTH IP/OP $411.00 $304.50 $6.66 $411.00 $411.00 $411.00 $411.00 $411.00 $19.75 $19.75 $9.88 $411.00 $19.75 $9.12 $9.12 $9.47 $6.66 $8.87 $31.60 $31.60 $411.00 $19.75 $19.75 $19.75 $411.00 $308.25 $19.75 $19.75 $19.75 $33.56 $33.56 $325.51 $19.75 $328.80 $411.00 $411.00 $19.75 $238.38 $411.00 $28.64 $19.75 $411.00 $19.75 N/A N/A 30100723 EAP CPT® 83051 HGB FREE PLASMA (SO) BOTH IP/OP $181.00 $134.00 $3.66 $181.00 $181.00 $181.00 $181.00 $181.00 $7.31 $7.31 $3.66 $181.00 $7.31 $11.10 $11.10 $11.52 $8.10 $10.79 $11.70 $11.70 $181.00 $7.31 $7.31 $7.31 $181.00 $135.75 $7.31 $7.31 $7.31 $40.84 $40.84 $143.35 $7.31 $144.80 $181.00 $181.00 $7.31 $104.98 $181.00 $10.60 $7.31 $181.00 $7.31 N/A N/A 30100724 EAP CPT® 83789 LEVAMISOLE BOTH IP/OP $297.00 $220.00 $6.66 $297.00 $297.00 $297.00 $297.00 $297.00 $24.11 $24.11 $12.06 $297.00 $24.11 $9.12 $9.12 $9.47 $6.66 $8.87 $38.58 $38.58 $297.00 $24.11 $24.11 $24.11 $297.00 $222.75 $24.11 $24.11 $24.11 $33.56 $33.56 $235.22 $24.11 $237.60 $297.00 $297.00 $24.11 $172.26 $297.00 $34.96 $24.11 $297.00 $24.11 N/A N/A 30100725 EAP CPT® 83520 INTERLEUK 2 REC CD25 (SO) BOTH IP/OP $424.00 $314.00 $7.77 $424.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $250.80 $17.27 $17.27 $17.27 $424.00 $318.00 $17.27 $17.27 $17.27 $72.36 $72.36 $335.81 $17.27 $339.20 $28.50 $18.21 $17.27 $245.92 $424.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30100726 EAP CPT® 82542 CANNABINOID QUANT (SO) BOTH IP/OP $221.00 $164.00 $6.64 $221.00 $35.44 $35.44 $35.44 $35.44 $24.09 $24.09 $12.05 $10.84 $24.09 $9.12 $9.12 $9.47 $6.66 $8.87 $38.54 $38.54 $130.72 $24.09 $24.09 $24.09 $221.00 $165.75 $24.09 $24.09 $24.09 $33.56 $33.56 $175.03 $24.09 $176.80 $39.75 $8.45 $24.09 $128.18 $221.00 $34.93 $24.09 $6.64 $24.09 N/A N/A 30100729 EAP CPT® 82378 CEA CYST FLUID (SO) BOTH IP/OP $283.00 $209.50 $9.48 $283.00 $37.22 $37.22 $37.22 $37.22 $18.96 $18.96 $9.48 $9.48 $18.96 $28.81 $28.81 $29.92 $21.03 $28.02 $30.34 $30.34 $167.39 $18.96 $18.96 $18.96 $283.00 $212.25 $18.96 $18.96 $18.96 $106.04 $106.04 $224.14 $18.96 $226.40 $31.28 $26.69 $18.96 $164.14 $283.00 $27.49 $18.96 $20.96 $18.96 N/A N/A 30100730 EAP CPT® 83520 PARANEO AUTOAB QUANT RIA(SO) BOTH IP/OP $124.00 $92.00 $7.77 $124.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $73.35 $17.27 $17.27 $17.27 $124.00 $93.00 $17.27 $17.27 $17.27 $72.36 $72.36 $98.21 $17.27 $99.20 $28.50 $18.21 $17.27 $71.92 $124.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30100731 EAP CPT® 82542 "CC/MS SPEC ANAL-GHB, QL (SO)" BOTH IP/OP $239.00 $177.00 $6.64 $239.00 $35.44 $35.44 $35.44 $35.44 $24.09 $24.09 $12.05 $10.84 $24.09 $9.12 $9.12 $9.47 $6.66 $8.87 $38.54 $38.54 $141.37 $24.09 $24.09 $24.09 $239.00 $179.25 $24.09 $24.09 $24.09 $33.56 $33.56 $189.29 $24.09 $191.20 $39.75 $8.45 $24.09 $138.62 $239.00 $34.93 $24.09 $6.64 $24.09 N/A N/A 30100732 EAP CPT® 83880 CARDIO IQ NT PROBNP (SO) BOTH IP/OP $309.00 $229.00 $17.67 $309.00 $66.62 $66.62 $66.62 $66.62 $39.26 $39.26 $19.63 $17.67 $39.26 $51.54 $51.54 $53.52 $37.63 $50.15 $62.82 $62.82 $182.77 $39.26 $39.26 $39.26 $309.00 $231.75 $39.26 $39.26 $39.26 $189.72 $189.72 $244.73 $39.26 $247.20 $64.78 $47.76 $39.26 $179.22 $309.00 $56.93 $39.26 $37.52 $39.26 N/A N/A 30100740 EAP CPT® 80299 ADALIMUMAB QUANT (SO) BOTH IP/OP $210.00 $155.50 $8.39 $210.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $124.22 $18.64 $18.64 $18.64 $210.00 $157.50 $18.64 $18.64 $18.64 $67.28 $67.28 $166.32 $18.64 $168.00 $30.76 $16.94 $18.64 $121.80 $210.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30100741 EAP CPT® 82397 ANTI ADALIMUMAB AB (SO) BOTH IP/OP $286.00 $212.00 $7.06 $286.00 $27.71 $27.71 $27.71 $27.71 $14.12 $14.12 $7.06 $7.06 $14.12 $21.46 $21.46 $22.28 $15.66 $20.87 $22.59 $22.59 $169.17 $14.12 $14.12 $14.12 $286.00 $214.50 $14.12 $14.12 $14.12 $78.96 $78.96 $226.51 $14.12 $228.80 $23.30 $19.88 $14.12 $165.88 $286.00 $20.47 $14.12 $15.62 $14.12 N/A N/A 30100742 EAP CPT® 80354 ACETYL FENTANYL QUAL (SO) BOTH IP/OP $125.00 $92.50 $0.03 $125.00 $0.03 $0.03 $0.03 $0.03 $125.00 $125.00 $12.01 $11.94 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $24.81 $125.00 $72.50 $125.00 $75.00 $125.00 $26.05 $125.00 N/A N/A 30100750 EAP CPT® 83088 HISTAMINE 24HR URINE (SO) BOTH IP/OP $243.00 $180.00 $14.77 $243.00 $243.00 $243.00 $243.00 $243.00 $29.53 $29.53 $14.77 $243.00 $29.53 $44.84 $44.84 $46.57 $32.74 $43.62 $47.25 $47.25 $243.00 $29.53 $29.53 $29.53 $243.00 $182.25 $29.53 $29.53 $29.53 $165.04 $165.04 $192.46 $29.53 $194.40 $243.00 $243.00 $29.53 $140.94 $243.00 $42.82 $29.53 $243.00 $29.53 N/A N/A 30100751 EAP CPT® 80299 METOPROLOL QUANT (SO) BOTH IP/OP $211.00 $156.50 $8.39 $211.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $124.81 $18.64 $18.64 $18.64 $211.00 $158.25 $18.64 $18.64 $18.64 $67.28 $67.28 $167.11 $18.64 $168.80 $30.76 $16.94 $18.64 $122.38 $211.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30100752 EAP CPT® 80361 MORPHINE GLUCURONIDE (SO) BOTH IP/OP $133.00 $98.50 $0.03 $133.00 $0.03 $0.03 $0.03 $0.03 $133.00 $133.00 $12.01 $11.94 $133.00 $98.71 $98.71 $102.52 $69.29 $30.51 $133.00 $53.20 $78.67 $133.00 $133.00 $133.00 $133.00 $99.75 $133.00 $133.00 $133.00 $66.50 $66.50 $105.34 $133.00 $106.40 $86.45 $29.06 $133.00 $77.14 $133.00 $79.80 $133.00 $22.83 $133.00 N/A N/A 30100755 EAP CPT® 84182 RECOMBX MATA AUTOAB (SO) BOTH IP/OP $468.00 $346.50 $13.14 $468.00 $35.32 $35.32 $35.32 $35.32 $29.21 $29.21 $14.61 $13.14 $29.21 $27.33 $27.33 $28.38 $19.95 $26.60 $46.74 $46.74 $276.82 $29.21 $29.21 $29.21 $468.00 $351.00 $29.21 $29.21 $29.21 $100.60 $100.60 $370.66 $29.21 $374.40 $48.20 $25.33 $29.21 $271.44 $468.00 $42.35 $29.21 $19.90 $29.21 N/A N/A 30100756 EAP CPT® 83789 BILE ACIDS URINE (SO) BOTH IP/OP $236.00 $175.00 $6.66 $236.00 $236.00 $236.00 $236.00 $236.00 $24.11 $24.11 $12.06 $236.00 $24.11 $9.12 $9.12 $9.47 $6.66 $8.87 $38.58 $38.58 $236.00 $24.11 $24.11 $24.11 $236.00 $177.00 $24.11 $24.11 $24.11 $33.56 $33.56 $186.91 $24.11 $188.80 $236.00 $236.00 $24.11 $136.88 $236.00 $34.96 $24.11 $236.00 $24.11 N/A N/A 30100757 EAP CPT® 84311 FLUVOXAMINE (SO) BOTH IP/OP $158.00 $117.00 $4.05 $158.00 $158.00 $158.00 $158.00 $158.00 $8.10 $8.10 $4.05 $158.00 $8.10 $10.61 $10.61 $11.02 $7.74 $10.32 $12.96 $12.96 $158.00 $8.10 $8.10 $8.10 $158.00 $118.50 $8.10 $8.10 $8.10 $39.08 $39.08 $125.14 $8.10 $126.40 $158.00 $158.00 $8.10 $91.64 $158.00 $11.75 $8.10 $158.00 $8.10 N/A N/A 30100758 EAP CPT® 84311 FUNGITELL SERUM (SO) BOTH IP/OP $158.00 $117.00 $4.05 $158.00 $158.00 $158.00 $158.00 $158.00 $8.10 $8.10 $4.05 $158.00 $8.10 $10.61 $10.61 $11.02 $7.74 $10.32 $12.96 $12.96 $158.00 $8.10 $8.10 $8.10 $158.00 $118.50 $8.10 $8.10 $8.10 $39.08 $39.08 $125.14 $8.10 $126.40 $158.00 $158.00 $8.10 $91.64 $158.00 $11.75 $8.10 $158.00 $8.10 N/A N/A 30100759 EAP CPT® 83520 GANGLIOSIDE GD1B AB (SO) BOTH IP/OP $335.00 $248.00 $7.77 $335.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $198.15 $17.27 $17.27 $17.27 $335.00 $251.25 $17.27 $17.27 $17.27 $72.36 $72.36 $265.32 $17.27 $268.00 $28.50 $18.21 $17.27 $194.30 $335.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30100760 EAP CPT® 83520 GANGLIOSIDE GM-1 AB (SO) BOTH IP/OP $289.00 $214.00 $7.77 $289.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $170.94 $17.27 $17.27 $17.27 $289.00 $216.75 $17.27 $17.27 $17.27 $72.36 $72.36 $228.89 $17.27 $231.20 $28.50 $18.21 $17.27 $167.62 $289.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30100761 EAP CPT® 83051 HEMOGLOBIN FREE PLASMA (SO) BOTH IP/OP $104.00 $77.00 $3.66 $104.00 $104.00 $104.00 $104.00 $104.00 $7.31 $7.31 $3.66 $104.00 $7.31 $11.10 $11.10 $11.52 $8.10 $10.79 $11.70 $11.70 $104.00 $7.31 $7.31 $7.31 $104.00 $78.00 $7.31 $7.31 $7.31 $40.84 $40.84 $82.37 $7.31 $83.20 $104.00 $104.00 $7.31 $60.32 $104.00 $10.60 $7.31 $104.00 $7.31 N/A N/A 30100762 EAP CPT® 83520 INTERLEUKIN-6 RUO BOTH IP/OP $228.00 $169.00 $7.77 $228.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $134.86 $17.27 $17.27 $17.27 $228.00 $171.00 $17.27 $17.27 $17.27 $72.36 $72.36 $180.58 $17.27 $182.40 $28.50 $18.21 $17.27 $132.24 $228.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30105004 EAP CPT® 80053 COMPREHENSIVE METABOLIC PANEL BOTH IP/OP $472.00 $349.50 $5.28 $472.00 $20.73 $20.73 $20.73 $20.73 $10.56 $10.56 $5.28 $5.28 $10.56 $16.06 $16.06 $16.68 $11.72 $15.61 $16.90 $16.90 $279.19 $10.56 $10.56 $10.56 $472.00 $354.00 $10.56 $10.56 $10.56 $59.08 $59.08 $373.82 $10.56 $377.60 $17.42 $14.87 $10.56 $273.76 $472.00 $15.31 $10.56 $11.68 $10.56 N/A N/A 30105007 EAP CPT® 80061 LIPID PANEL BOTH IP/OP $239.00 $177.00 $6.70 $239.00 $26.28 $26.28 $26.28 $26.28 $13.39 $13.39 $6.70 $6.70 $13.39 $20.35 $20.35 $21.14 $14.86 $19.79 $21.42 $21.42 $141.37 $13.39 $13.39 $13.39 $239.00 $179.25 $13.39 $13.39 $13.39 $74.88 $74.88 $189.29 $13.39 $191.20 $22.09 $18.85 $13.39 $138.62 $239.00 $19.42 $13.39 $14.81 $13.39 N/A N/A 30105047 EAP CPT® 82150 "AMYLASE,URINE" BOTH IP/OP $301.00 $223.00 $3.24 $301.00 $12.73 $12.73 $12.73 $12.73 $6.48 $6.48 $3.24 $3.24 $6.48 $9.84 $9.84 $10.22 $7.18 $9.58 $10.37 $10.37 $178.04 $6.48 $6.48 $6.48 $301.00 $225.75 $6.48 $6.48 $6.48 $36.24 $36.24 $238.39 $6.48 $240.80 $10.69 $9.12 $6.48 $174.58 $301.00 $9.40 $6.48 $7.16 $6.48 N/A N/A 30105057 EAP CPT® 82247 "BILI, TOTAL-FLUID" BOTH IP/OP $117.00 $87.00 $2.51 $117.00 $9.84 $9.84 $9.84 $9.84 $5.02 $5.02 $2.51 $2.51 $5.02 $7.62 $7.62 $7.92 $5.56 $7.42 $8.03 $8.03 $69.21 $5.02 $5.02 $5.02 $117.00 $87.75 $5.02 $5.02 $5.02 $28.08 $28.08 $92.66 $5.02 $93.60 $8.28 $7.07 $5.02 $67.86 $117.00 $7.28 $5.02 $5.55 $5.02 N/A N/A 30105071 EAP CPT® 82310 "CALCIUM, URINE" BOTH IP/OP $102.00 $75.50 $2.58 $102.00 $10.14 $10.14 $10.14 $10.14 $5.16 $5.16 $2.58 $2.58 $5.16 $7.83 $7.83 $8.13 $5.72 $7.46 $8.26 $8.26 $60.33 $5.16 $5.16 $5.16 $102.00 $76.50 $5.16 $5.16 $5.16 $28.80 $28.80 $80.78 $5.16 $81.60 $8.51 $7.10 $5.16 $59.16 $102.00 $7.48 $5.16 $5.58 $5.16 N/A N/A 30105151 EAP CPT® 82803 BLOOD GAS-CORD VEN. BOTH IP/OP $510.00 $377.50 $11.73 $510.00 $37.98 $37.98 $37.98 $37.98 $26.07 $26.07 $13.04 $11.73 $26.07 $29.38 $29.38 $30.51 $21.45 $28.59 $41.71 $41.71 $301.67 $26.07 $26.07 $26.07 $510.00 $382.50 $26.07 $26.07 $26.07 $108.16 $108.16 $403.92 $26.07 $408.00 $43.02 $27.23 $26.07 $295.80 $510.00 $37.80 $26.07 $21.39 $26.07 N/A N/A 30105168 EAP CPT® 82945 "GLUCOSE,URINE(QUANT)" BOTH IP/OP $341.00 $252.50 $1.97 $341.00 $7.71 $7.71 $7.71 $7.71 $3.93 $3.93 $1.97 $1.97 $3.93 $5.96 $5.96 $6.19 $4.35 $5.80 $6.29 $6.29 $201.70 $3.93 $3.93 $3.93 $341.00 $255.75 $3.93 $3.93 $3.93 $21.92 $21.92 $270.07 $3.93 $272.80 $6.48 $5.52 $3.93 $197.78 $341.00 $5.70 $3.93 $4.34 $3.93 N/A N/A 30105171 EAP CPT® 82947 "GTT,ORAL-2HR INDIV" BOTH IP/OP $263.00 $195.00 $1.97 $263.00 $7.71 $7.71 $7.71 $7.71 $3.93 $3.93 $1.97 $1.97 $3.93 $5.96 $5.96 $6.19 $4.35 $5.80 $6.29 $6.29 $155.56 $3.93 $3.93 $3.93 $263.00 $197.25 $3.93 $3.93 $3.93 $21.92 $21.92 $208.30 $3.93 $210.40 $6.48 $5.52 $3.93 $152.54 $263.00 $5.70 $3.93 $4.34 $3.93 N/A N/A 30105196 EAP CPT® 82951 "GTT,PRENATAL(100GM)" BOTH IP/OP $201.00 $149.00 $6.44 $201.00 $25.28 $25.28 $25.28 $25.28 $12.87 $12.87 $6.44 $6.44 $12.87 $19.55 $19.55 $20.30 $14.27 $19.02 $20.59 $20.59 $118.89 $12.87 $12.87 $12.87 $201.00 $150.75 $12.87 $12.87 $12.87 $71.96 $71.96 $159.19 $12.87 $160.80 $21.24 $18.11 $12.87 $116.58 $201.00 $18.66 $12.87 $14.23 $12.87 N/A N/A 30105201 EAP CPT® 82952 5TH HOUR GTT SPECIMEN BOTH IP/OP $103.00 $76.50 $1.96 $103.00 $7.71 $7.71 $7.71 $7.71 $3.92 $3.92 $1.96 $1.96 $3.92 $5.95 $5.95 $6.18 $4.34 $5.80 $6.27 $6.27 $60.92 $3.92 $3.92 $3.92 $103.00 $77.25 $3.92 $3.92 $3.92 $21.92 $21.92 $81.58 $3.92 $82.40 $6.47 $5.52 $3.92 $59.74 $103.00 $5.68 $3.92 $4.34 $3.92 N/A N/A 30105214 EAP CPT® 83020 HGB ELECT. CORD BLD BOTH IP/OP $217.00 $161.00 $6.44 $217.00 $19.18 $19.18 $19.18 $19.18 $12.87 $12.87 $6.44 $6.44 $12.87 $14.84 $14.84 $15.41 $10.83 $14.44 $20.59 $20.59 $128.36 $12.87 $12.87 $12.87 $217.00 $162.75 $12.87 $12.87 $12.87 $54.64 $54.64 $171.86 $12.87 $173.60 $21.24 $13.75 $12.87 $125.86 $217.00 $18.66 $12.87 $10.80 $12.87 N/A N/A 30105248 EAP CPT® 83605 "LACTIC ACID, FLUID" BOTH IP/OP $341.00 $252.50 $5.34 $341.00 $20.96 $20.96 $20.96 $20.96 $11.57 $11.57 $5.79 $5.34 $11.57 $16.21 $16.21 $16.84 $11.84 $15.78 $18.51 $18.51 $201.70 $11.57 $11.57 $11.57 $341.00 $255.75 $11.57 $11.57 $11.57 $59.68 $59.68 $270.07 $11.57 $272.80 $19.09 $15.03 $11.57 $197.78 $341.00 $16.78 $11.57 $11.81 $11.57 N/A N/A 30105252 EAP CPT® 83615 "LDH,CSF" BOTH IP/OP $153.00 $113.50 $3.02 $153.00 $11.85 $11.85 $11.85 $11.85 $6.04 $6.04 $3.02 $3.02 $6.04 $9.16 $9.16 $9.51 $6.69 $7.46 $9.66 $9.66 $90.50 $6.04 $6.04 $6.04 $153.00 $114.75 $6.04 $6.04 $6.04 $33.76 $33.76 $121.18 $6.04 $122.40 $9.97 $7.10 $6.04 $88.74 $153.00 $8.76 $6.04 $5.58 $6.04 N/A N/A 30105255 EAP CPT® 83519 RIA NONANTIBODY BOTH IP/OP "$1,127.00" $834.00 $8.28 "$1,127.00" $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $666.62 $18.40 $18.40 $18.40 "$1,127.00" $845.25 $18.40 $18.40 $18.40 $75.52 $75.52 $892.58 $18.40 $901.60 $30.36 $19.01 $18.40 $653.66 "$1,127.00" $26.68 $18.40 $14.93 $18.40 N/A N/A 30105256 EAP CPT® 84260 ASSAY OF SEROTONIN BOTH IP/OP $199.00 $147.50 $15.49 $199.00 $199.00 $199.00 $199.00 $199.00 $30.98 $30.98 $15.49 $199.00 $30.98 $47.04 $47.04 $48.85 $34.34 $45.76 $49.57 $49.57 $199.00 $30.98 $30.98 $30.98 $199.00 $149.25 $30.98 $30.98 $30.98 $173.12 $173.12 $157.61 $30.98 $159.20 $199.00 $199.00 $30.98 $115.42 $199.00 $44.92 $30.98 $199.00 $30.98 N/A N/A 30105257 EAP CPT® 84252 ASSAY OF VITAMIN B-12 BOTH IP/OP $284.00 $210.50 $10.12 $284.00 $284.00 $284.00 $284.00 $284.00 $20.24 $20.24 $10.12 $284.00 $20.24 $30.73 $30.73 $31.91 $22.43 $29.89 $32.38 $32.38 $284.00 $20.24 $20.24 $20.24 $284.00 $213.00 $20.24 $20.24 $20.24 $113.12 $113.12 $224.93 $20.24 $227.20 $284.00 $284.00 $20.24 $164.72 $284.00 $29.35 $20.24 $284.00 $20.24 N/A N/A 30105258 EAP CPT® 83018 "QUANTITATIVE, EACH" BOTH IP/OP $182.00 $135.00 $10.98 $182.00 $43.10 $43.10 $43.10 $43.10 $21.96 $21.96 $10.98 $10.98 $21.96 $33.34 $33.34 $34.62 $24.34 $32.43 $35.14 $35.14 $107.65 $21.96 $21.96 $21.96 $182.00 $136.50 $21.96 $21.96 $21.96 $122.72 $122.72 $144.14 $21.96 $145.60 $36.23 $30.89 $21.96 $105.56 $182.00 $31.84 $21.96 $24.26 $21.96 N/A N/A 30105261 EAP CPT® 83519 "QUANTITATIVE, BY RADIOIMMUNOASSAY(EG:RIA)" BOTH IP/OP $743.00 $550.00 $8.28 $743.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $439.48 $18.40 $18.40 $18.40 $743.00 $557.25 $18.40 $18.40 $18.40 $75.52 $75.52 $588.46 $18.40 $594.40 $30.36 $19.01 $18.40 $430.94 $743.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30105262 EAP CPT® 83519 "QUANTITATIVE, BY RADIOIMMUNOASSAY(EG:RIA)" BOTH IP/OP $716.00 $530.00 $8.28 $716.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $423.51 $18.40 $18.40 $18.40 $716.00 $537.00 $18.40 $18.40 $18.40 $75.52 $75.52 $567.07 $18.40 $572.80 $30.36 $19.01 $18.40 $415.28 $716.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30105263 EAP CPT® 82378 CEA PANCREATIC CYST FLUID (SO) BOTH IP/OP $152.00 $112.50 $9.48 $152.00 $37.22 $37.22 $37.22 $37.22 $18.96 $18.96 $9.48 $9.48 $18.96 $28.81 $28.81 $29.92 $21.03 $28.02 $30.34 $30.34 $89.91 $18.96 $18.96 $18.96 $152.00 $114.00 $18.96 $18.96 $18.96 $106.04 $106.04 $120.38 $18.96 $121.60 $31.28 $26.69 $18.96 $88.16 $152.00 $27.49 $18.96 $20.96 $18.96 N/A N/A 30105264 EAP CPT® 84432 THYROGLOBULIN (SO) TH BOTH IP/OP $75.00 $55.50 $8.03 $75.00 $31.53 $31.53 $31.53 $31.53 $16.06 $16.06 $8.03 $8.03 $16.06 $24.39 $24.39 $25.33 $17.80 $23.73 $25.70 $25.70 $44.36 $16.06 $16.06 $16.06 $75.00 $56.25 $16.06 $16.06 $16.06 $75.00 $75.00 $59.40 $16.06 $60.00 $26.50 $22.60 $16.06 $43.50 $75.00 $23.29 $16.06 $17.75 $16.06 N/A N/A 30105265 EAP CPT® 86800 THYROGLOBULIN ANTIBODY (SO) TH BOTH IP/OP $54.00 $40.00 $7.95 $54.00 $31.22 $31.22 $31.22 $31.22 $15.91 $15.91 $7.96 $7.95 $15.91 $24.15 $24.15 $25.08 $17.63 $23.50 $25.46 $25.46 $31.94 $15.91 $15.91 $15.91 $54.00 $40.50 $15.91 $15.91 $15.91 $54.00 $54.00 $42.77 $15.91 $43.20 $26.25 $22.38 $15.91 $31.32 $54.00 $23.07 $15.91 $17.58 $15.91 N/A N/A 30105268 EAP CPT® 82108 "ALUMINUM, 24- HOUR URINE (SO)" BOTH IP/OP $69.00 $51.50 $12.74 $69.00 $69.00 $69.00 $69.00 $69.00 $25.48 $25.48 $12.74 $69.00 $25.48 $25.59 $25.59 $26.58 $18.68 $24.91 $40.77 $40.77 $69.00 $25.48 $25.48 $25.48 $69.00 $51.75 $25.48 $25.48 $25.48 $69.00 $69.00 $54.65 $25.48 $55.20 $69.00 $69.00 $25.48 $40.02 $69.00 $36.95 $25.48 $69.00 $25.48 N/A N/A 30105269 EAP CPT® 83789 "ETHAMBUTOL, SERUM (NMS)" BOTH IP/OP $210.00 $155.50 $6.66 $210.00 $210.00 $210.00 $210.00 $210.00 $24.11 $24.11 $12.06 $210.00 $24.11 $9.12 $9.12 $9.47 $6.66 $8.87 $38.58 $38.58 $210.00 $24.11 $24.11 $24.11 $210.00 $157.50 $24.11 $24.11 $24.11 $33.56 $33.56 $166.32 $24.11 $168.00 $210.00 $210.00 $24.11 $121.80 $210.00 $34.96 $24.11 $210.00 $24.11 N/A N/A 30105270 EAP CPT® 83789 "PYRAZINAMIDE, SERUM (NMS)" BOTH IP/OP $505.00 $374.00 $6.66 $505.00 $505.00 $505.00 $505.00 $505.00 $24.11 $24.11 $12.06 $505.00 $24.11 $9.12 $9.12 $9.47 $6.66 $8.87 $38.58 $38.58 $505.00 $24.11 $24.11 $24.11 $505.00 $378.75 $24.11 $24.11 $24.11 $33.56 $33.56 $399.96 $24.11 $404.00 $505.00 $505.00 $24.11 $292.90 $505.00 $34.96 $24.11 $505.00 $24.11 N/A N/A 30105271 EAP CPT® 84999 NEPHROCHECK ACUTE KIDNEY INJURY BOTH IP/OP $301.00 $223.00 $59.74 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $62.74 $301.00 $223.40 $223.40 $232.01 $156.82 $62.73 $301.00 $96.40 $178.04 $301.00 $241.00 $301.00 $301.00 $225.75 $301.00 $301.00 $301.00 $301.00 $301.00 $238.39 $301.00 $240.80 $195.65 $59.74 $301.00 $174.58 $301.00 $180.60 $301.00 $62.73 $301.00 N/A N/A 30105275 EAP CPT® 80186 FREE PHENYTOIN BOTH IP/OP $157.00 $116.50 $6.88 $157.00 $27.01 $27.01 $27.01 $27.01 $13.76 $13.76 $6.88 $6.88 $13.76 $20.90 $20.90 $21.71 $15.26 $20.34 $22.02 $22.02 $92.87 $13.76 $13.76 $13.76 $157.00 $117.75 $13.76 $13.76 $13.76 $76.92 $76.92 $124.34 $13.76 $125.60 $22.70 $19.37 $13.76 $91.06 $157.00 $19.95 $13.76 $15.22 $13.76 N/A N/A 30150004 EAP CPT® 80053 "COMP, METABOLIC PANEL" BOTH IP/OP $489.00 $362.00 $5.28 $489.00 $20.73 $20.73 $20.73 $20.73 $10.56 $10.56 $5.28 $5.28 $10.56 $16.06 $16.06 $16.68 $11.72 $15.61 $16.90 $16.90 $289.24 $10.56 $10.56 $10.56 $489.00 $366.75 $10.56 $10.56 $10.56 $59.08 $59.08 $387.29 $10.56 $391.20 $17.42 $14.87 $10.56 $283.62 $489.00 $15.31 $10.56 $11.68 $10.56 N/A N/A 30150007 EAP CPT® 80061 LIPOPROTEIN PROFILE BOTH IP/OP $239.00 $177.00 $6.70 $239.00 $26.28 $26.28 $26.28 $26.28 $13.39 $13.39 $6.70 $6.70 $13.39 $20.35 $20.35 $21.14 $14.86 $19.79 $21.42 $21.42 $141.37 $13.39 $13.39 $13.39 $239.00 $179.25 $13.39 $13.39 $13.39 $74.88 $74.88 $189.29 $13.39 $191.20 $22.09 $18.85 $13.39 $138.62 $239.00 $19.42 $13.39 $14.81 $13.39 N/A N/A 30150171 EAP CPT® 82947 GLUCOSE BOTH IP/OP $263.00 $195.00 $1.97 $263.00 $7.71 $7.71 $7.71 $7.71 $3.93 $3.93 $1.97 $1.97 $3.93 $5.96 $5.96 $6.19 $4.35 $5.80 $6.29 $6.29 $155.56 $3.93 $3.93 $3.93 $263.00 $197.25 $3.93 $3.93 $3.93 $21.92 $21.92 $208.30 $3.93 $210.40 $6.48 $5.52 $3.93 $152.54 $263.00 $5.70 $3.93 $4.34 $3.93 N/A N/A 30150172 EAP CPT® 82480 CHOLINESTERASE; SERUM BOTH IP/OP $39.00 $29.00 $3.94 $39.00 $39.00 $39.00 $39.00 $39.00 $7.87 $7.87 $3.94 $39.00 $7.87 $11.97 $11.97 $12.43 $8.74 $11.64 $12.59 $12.59 $39.00 $7.87 $7.87 $7.87 $39.00 $29.25 $7.87 $7.87 $7.87 $39.00 $39.00 $30.89 $7.87 $31.20 $39.00 $39.00 $7.87 $22.62 $39.00 $11.41 $7.87 $39.00 $7.87 N/A N/A 30150173 EAP CPT® 82482 RBC BOTH IP/OP $40.00 $30.00 $4.91 $40.00 $40.00 $40.00 $40.00 $40.00 $9.81 $9.81 $4.91 $40.00 $9.81 $11.67 $11.67 $12.12 $8.52 $11.36 $15.70 $15.70 $40.00 $9.81 $9.81 $9.81 $40.00 $30.00 $9.81 $9.81 $9.81 $40.00 $40.00 $31.68 $9.81 $32.00 $40.00 $40.00 $9.81 $23.20 $40.00 $14.22 $9.81 $40.00 $9.81 N/A N/A 30150174 EAP CPT® 86255 "FLUOR NONINFEC AGNT AB SCR,EA" BOTH IP/OP $51.00 $38.00 $6.03 $51.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $30.17 $12.05 $12.05 $12.05 $51.00 $38.25 $12.05 $12.05 $12.05 $51.00 $51.00 $40.39 $12.05 $40.80 $19.88 $16.96 $12.05 $29.58 $51.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30150176 EAP CPT® 86628 CANDIDA BOTH IP/OP $252.00 $186.50 $6.01 $252.00 $252.00 $252.00 $252.00 $252.00 $12.01 $12.01 $6.01 $252.00 $12.01 $18.23 $18.23 $18.93 $13.31 $17.73 $19.22 $19.22 $252.00 $12.01 $12.01 $12.01 $252.00 $189.00 $12.01 $12.01 $12.01 $67.12 $67.12 $199.58 $12.01 $201.60 $252.00 $252.00 $12.01 $146.16 $252.00 $17.41 $12.01 $252.00 $12.01 N/A N/A 30150177 EAP CPT® 83789 "QUANTITATIVE, EACH SPECIMEN" BOTH IP/OP $235.00 $174.00 $6.66 $235.00 $235.00 $235.00 $235.00 $235.00 $24.11 $24.11 $12.06 $235.00 $24.11 $9.12 $9.12 $9.47 $6.66 $8.87 $38.58 $38.58 $235.00 $24.11 $24.11 $24.11 $235.00 $176.25 $24.11 $24.11 $24.11 $33.56 $33.56 $186.12 $24.11 $188.00 $235.00 $235.00 $24.11 $136.30 $235.00 $34.96 $24.11 $235.00 $24.11 N/A N/A 30150178 EAP CPT® 86235 "EXTRACTABLE NUCLEAR ANTIGEN,ANTIBODY TO, ANY METHOD" BOTH IP/OP $130.00 $96.50 $8.97 $130.00 $35.19 $35.19 $35.19 $35.19 $17.93 $17.93 $8.97 $8.97 $17.93 $27.23 $27.23 $28.27 $19.88 $26.49 $28.69 $28.69 $76.90 $17.93 $17.93 $17.93 $130.00 $97.50 $17.93 $17.93 $17.93 $100.24 $100.24 $102.96 $17.93 $104.00 $29.58 $25.23 $17.93 $75.40 $130.00 $26.00 $17.93 $19.82 $17.93 N/A N/A 30150179 EAP CPT® 87798 "AMPLIFIED PROBE TECHNIQUE,EACH ORGANISM" BOTH IP/OP $502.00 $371.50 $17.55 $502.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $296.93 $35.09 $35.09 $35.09 $502.00 $376.50 $35.09 $35.09 $35.09 $109.64 $109.64 $397.58 $35.09 $401.60 $57.90 $27.60 $35.09 $291.16 $502.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30150180 EAP CPT® 86658 ENTEROVIRUS - A BOTH IP/OP $51.00 $38.00 $6.52 $51.00 $51.00 $51.00 $51.00 $51.00 $13.03 $13.03 $6.52 $51.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $51.00 $13.03 $13.03 $13.03 $51.00 $38.25 $13.03 $13.03 $13.03 $51.00 $51.00 $40.39 $13.03 $40.80 $51.00 $51.00 $13.03 $29.58 $51.00 $18.89 $13.03 $51.00 $13.03 N/A N/A 30150181 EAP CPT® 86658 ENTEROVIRUS - B BOTH IP/OP $51.00 $38.00 $6.52 $51.00 $51.00 $51.00 $51.00 $51.00 $13.03 $13.03 $6.52 $51.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $51.00 $13.03 $13.03 $13.03 $51.00 $38.25 $13.03 $13.03 $13.03 $51.00 $51.00 $40.39 $13.03 $40.80 $51.00 $51.00 $13.03 $29.58 $51.00 $18.89 $13.03 $51.00 $13.03 N/A N/A 30150182 EAP CPT® 86750 PLASMODIUM(MALARIA) BOTH IP/OP $60.00 $44.50 $6.60 $60.00 $60.00 $60.00 $60.00 $60.00 $13.19 $13.19 $6.60 $60.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $60.00 $13.19 $13.19 $13.19 $60.00 $45.00 $13.19 $13.19 $13.19 $60.00 $60.00 $47.52 $13.19 $48.00 $60.00 $60.00 $13.19 $34.80 $60.00 $19.13 $13.19 $60.00 $13.19 N/A N/A 30150183 EAP CPT® 86750 PLASMODIUM(MALARIA) BOTH IP/OP $60.00 $44.50 $6.60 $60.00 $60.00 $60.00 $60.00 $60.00 $13.19 $13.19 $6.60 $60.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $60.00 $13.19 $13.19 $13.19 $60.00 $45.00 $13.19 $13.19 $13.19 $60.00 $60.00 $47.52 $13.19 $48.00 $60.00 $60.00 $13.19 $34.80 $60.00 $19.13 $13.19 $60.00 $13.19 N/A N/A 30150184 EAP CPT® 83520 "QUANTITATIVE, NOT OTHERWISE SPECIFIED" BOTH IP/OP $638.00 $472.50 $7.77 $638.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $377.38 $17.27 $17.27 $17.27 $638.00 $478.50 $17.27 $17.27 $17.27 $72.36 $72.36 $505.30 $17.27 $510.40 $28.50 $18.21 $17.27 $370.04 $638.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30150185 EAP CPT® 86635 COCCIDIOIDES BOTH IP/OP $75.00 $55.50 $5.74 $75.00 $75.00 $75.00 $75.00 $75.00 $11.47 $11.47 $5.74 $75.00 $11.47 $17.42 $17.42 $18.09 $12.72 $16.95 $18.35 $18.35 $75.00 $11.47 $11.47 $11.47 $75.00 $56.25 $11.47 $11.47 $11.47 $64.12 $64.12 $59.40 $11.47 $60.00 $75.00 $75.00 $11.47 $43.50 $75.00 $16.63 $11.47 $75.00 $11.47 N/A N/A 30150193 EAP CPT® 83519 "QUANTITATIVE, BY RADIOIMMUNOASSAY" BOTH IP/OP $609.00 $451.00 $8.28 $609.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $360.22 $18.40 $18.40 $18.40 $609.00 $456.75 $18.40 $18.40 $18.40 $75.52 $75.52 $482.33 $18.40 $487.20 $30.36 $19.01 $18.40 $353.22 $609.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30150194 EAP CPT® 88271 "MOLECULAR CYTOGENETICS; DNA PROBE, EACH" BOTH IP/OP $307.00 $227.50 $10.71 $307.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $181.59 $21.42 $21.42 $21.42 $307.00 $230.25 $21.42 $21.42 $21.42 $119.72 $119.72 $243.14 $21.42 $245.60 $35.34 $30.14 $21.42 $178.06 $307.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30150195 EAP CPT® 88275 "INTERPHASE INSITU HYBRID, ANA 10-30 CELLS" BOTH IP/OP $400.00 $296.00 $23.04 $400.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $236.60 $51.19 $51.19 $51.19 $400.00 $300.00 $51.19 $51.19 $51.19 $224.44 $224.44 $316.80 $51.19 $320.00 $84.46 $56.50 $51.19 $232.00 $400.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30150196 EAP CPT® 86255 "FLUOR NONINFECT AGENT AB SCR, EA AB" BOTH IP/OP $85.00 $63.00 $6.03 $85.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $50.28 $12.05 $12.05 $12.05 $85.00 $63.75 $12.05 $12.05 $12.05 $67.36 $67.36 $67.32 $12.05 $68.00 $19.88 $16.96 $12.05 $49.30 $85.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30150197 EAP CPT® 83625 "ISOENZYMES, SEPARATION AND QUANTITATION" BOTH IP/OP $48.00 $36.00 $6.40 $48.00 $48.00 $48.00 $48.00 $48.00 $12.79 $12.79 $6.40 $48.00 $12.79 $17.58 $17.58 $18.25 $12.83 $17.09 $20.46 $20.46 $48.00 $12.79 $12.79 $12.79 $48.00 $36.00 $12.79 $12.79 $12.79 $48.00 $48.00 $38.02 $12.79 $38.40 $48.00 $48.00 $12.79 $27.84 $48.00 $18.55 $12.79 $48.00 $12.79 N/A N/A 30150202 EAP CPT® 82379 "CARNITINE, URINE (QUEST 30338)" BOTH IP/OP $321.00 $238.00 $8.44 $321.00 $321.00 $321.00 $321.00 $321.00 $16.87 $16.87 $8.44 $321.00 $16.87 $25.62 $25.62 $26.60 $18.70 $24.92 $26.99 $26.99 $321.00 $16.87 $16.87 $16.87 $321.00 $240.75 $16.87 $16.87 $16.87 $94.28 $94.28 $254.23 $16.87 $256.80 $321.00 $321.00 $16.87 $186.18 $321.00 $24.46 $16.87 $321.00 $16.87 N/A N/A 30150203 EAP CPT® 84143 C17-HYDROXYPREGNENOLONE(QUEST 8352) BOTH IP/OP $150.00 $111.00 $11.41 $150.00 $150.00 $150.00 $150.00 $150.00 $22.81 $22.81 $11.41 $150.00 $22.81 $34.65 $34.65 $35.99 $25.30 $33.72 $36.50 $36.50 $150.00 $22.81 $22.81 $22.81 $150.00 $112.50 $22.81 $22.81 $22.81 $127.56 $127.56 $118.80 $22.81 $120.00 $150.00 $150.00 $22.81 $87.00 $150.00 $33.07 $22.81 $150.00 $22.81 N/A N/A 30150204 EAP CPT® 86332 IMMUNE COMPLEX DETECTION BY C1Q BINDING(Q 36735) BOTH IP/OP $34.00 $25.50 $12.19 $40.21 $34.00 $34.00 $34.00 $34.00 $24.37 $24.37 $12.19 $12.19 $24.37 $37.01 $37.01 $38.44 $27.02 $34.00 $38.99 $38.99 $20.11 $24.37 $24.37 $24.37 $34.00 $25.50 $24.37 $24.37 $24.37 $34.00 $34.00 $26.93 $24.37 $27.20 $40.21 $34.00 $24.37 $19.72 $34.00 $34.00 $24.37 $26.93 $24.37 N/A N/A 30150205 EAP CPT® 81229 "CHROMOSOMAL MICROARRAY, PRENATAL (QUEST 90927)" BOTH IP/OP "$3,929.00" "$2,907.50" $522.00 "$3,929.00" $768.06 $768.06 $768.06 $768.06 "$1,160.00" "$1,160.00" $580.00 $522.00 "$1,160.00" "$2,916.10" "$2,916.10" "$3,028.47" "$2,047.01" "$2,725.40" "$1,856.00" "$1,856.00" "$2,324.00" "$1,160.00" "$1,160.00" "$1,160.00" "$3,929.00" "$2,946.75" "$1,160.00" "$1,160.00" "$1,160.00" "$1,964.50" "$1,964.50" "$3,111.77" "$1,160.00" "$3,143.20" "$1,914.00" "$2,595.62" "$1,160.00" "$2,278.82" "$3,929.00" "$1,682.00" "$1,160.00" "$2,038.86" "$1,160.00" N/A N/A 30150206 EAP CPT® 86003 "ALLERGY PANEL,MOLD GROUP (QUEST 7911)" BOTH IP/OP $252.00 $186.50 $2.61 $252.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $149.06 $5.22 $5.22 $5.22 $252.00 $189.00 $5.22 $5.22 $5.22 $29.20 $29.20 $199.58 $5.22 $201.60 $8.61 $7.35 $5.22 $146.16 $252.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30150207 EAP CPT® 88271 "FISH,PDGFRB,5Q331.(QUEST 90510)DNA PROBE" BOTH IP/OP $511.00 $378.50 $10.71 $511.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $302.26 $21.42 $21.42 $21.42 $511.00 $383.25 $21.42 $21.42 $21.42 $119.72 $119.72 $404.71 $21.42 $408.80 $35.34 $30.14 $21.42 $296.38 $511.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30150208 EAP CPT® 88275 "FISH,PDGFRB,5Q331.(QUEST 90510)100-300CELLS" BOTH IP/OP $256.00 $189.50 $23.04 $256.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $151.42 $51.19 $51.19 $51.19 $256.00 $192.00 $51.19 $51.19 $51.19 $224.44 $224.44 $202.75 $51.19 $204.80 $84.46 $56.50 $51.19 $148.48 $256.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30150209 EAP CPT® 86235 MYOSITIS ASSESS AUTOAB (Q10185)NUC AG AB BOTH IP/OP $429.00 $317.50 $8.97 $429.00 $35.19 $35.19 $35.19 $35.19 $17.93 $17.93 $8.97 $8.97 $17.93 $27.23 $27.23 $28.27 $19.88 $26.49 $28.69 $28.69 $253.75 $17.93 $17.93 $17.93 $429.00 $321.75 $17.93 $17.93 $17.93 $100.24 $100.24 $339.77 $17.93 $343.20 $29.58 $25.23 $17.93 $248.82 $429.00 $26.00 $17.93 $19.82 $17.93 N/A N/A 30150210 EAP CPT® 83516 MYOSITIS ASSESS AUTOAB (Q10185)NON AB BOTH IP/OP "$1,134.00" $839.50 $5.76 "$1,134.00" $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $670.76 $11.53 $11.53 $11.53 "$1,134.00" $850.50 $11.53 $11.53 $11.53 $59.76 $59.76 $898.13 $11.53 $907.20 $19.02 $15.05 $11.53 $657.72 "$1,134.00" $16.72 $11.53 $11.82 $11.53 N/A N/A 30150211 EAP CPT® 80356 MONOACETLYMORPNINE MAM (SO) BOTH IP/OP $166.00 $123.00 $12.00 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $12.01 $166.00 $166.00 $123.21 $123.21 $127.95 $86.49 $34.60 $166.00 $12.00 $166.00 $166.00 $30.00 $166.00 $166.00 $124.50 $166.00 $166.00 $166.00 $83.00 $83.00 $131.47 $166.00 $132.80 $107.90 $166.00 $166.00 $96.28 $166.00 $99.60 $166.00 $166.00 $166.00 N/A N/A 30150212 EAP CPT® 80377 HYPOGLYCEMIC MASS SPEC (SO) BOTH IP/OP $428.00 $317.00 $12.01 $428.00 $428.00 $428.00 $428.00 $428.00 $428.00 $428.00 $12.01 $428.00 $428.00 $317.66 $317.66 $329.90 $222.99 $89.20 $428.00 $171.20 $428.00 $428.00 $428.00 $428.00 $428.00 $321.00 $428.00 $428.00 $428.00 $214.00 $214.00 $338.98 $428.00 $342.40 $278.20 $428.00 $428.00 $248.24 $428.00 $256.80 $428.00 $428.00 $428.00 N/A N/A 30159005 EAP CPT® 89055 FECAL LEUKOCYTE SMEAR BOTH IP/OP $118.00 $87.50 $2.14 $118.00 $118.00 $118.00 $118.00 $118.00 $4.27 $4.27 $2.14 $118.00 $4.27 $3.57 $3.57 $3.70 $2.60 $3.47 $6.83 $6.83 $118.00 $4.27 $4.27 $4.27 $118.00 $88.50 $4.27 $4.27 $4.27 $13.12 $13.12 $93.46 $4.27 $94.40 $118.00 $118.00 $4.27 $68.44 $118.00 $6.19 $4.27 $118.00 $4.27 N/A N/A 30159016 EAP CPT® 82570 URINE CREATININE (SO) BOTH IP/OP $79.00 $58.50 $2.59 $79.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $46.73 $5.18 $5.18 $5.18 $79.00 $59.25 $5.18 $5.18 $5.18 $28.92 $28.92 $62.57 $5.18 $63.20 $8.55 $7.28 $5.18 $45.82 $79.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30159017 EAP CPT® 83918 ORGANIC ACIDS (SO) BOTH IP/OP $660.00 $488.50 $11.80 $660.00 $660.00 $660.00 $660.00 $660.00 $23.60 $23.60 $11.80 $660.00 $23.60 $25.00 $25.00 $25.96 $18.25 $24.32 $37.76 $37.76 $660.00 $23.60 $23.60 $23.60 $660.00 $495.00 $23.60 $23.60 $23.60 $92.00 $92.00 $522.72 $23.60 $528.00 $660.00 $660.00 $23.60 $382.80 $660.00 $34.22 $23.60 $660.00 $23.60 N/A N/A 30159018 EAP CPT® 83018 "COBALT, PLASMA (SO)" BOTH IP/OP $158.00 $117.00 $10.98 $158.00 $43.10 $43.10 $43.10 $43.10 $21.96 $21.96 $10.98 $10.98 $21.96 $33.34 $33.34 $34.62 $24.34 $32.43 $35.14 $35.14 $93.46 $21.96 $21.96 $21.96 $158.00 $118.50 $21.96 $21.96 $21.96 $122.72 $122.72 $125.14 $21.96 $126.40 $36.23 $30.89 $21.96 $91.64 $158.00 $31.84 $21.96 $24.26 $21.96 N/A N/A 30159019 EAP CPT® 84999 MACROAMYLASE BOTH IP/OP $71.00 $53.00 $14.09 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $14.80 $71.00 $52.70 $52.70 $54.73 $36.99 $14.80 $71.00 $28.40 $42.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $71.00 $71.00 $56.23 $71.00 $56.80 $46.15 $14.09 $71.00 $41.18 $71.00 $42.60 $71.00 $14.80 $71.00 N/A N/A 30159020 EAP CPT® 81511 INTEGRATED MATERNAL SERUM SCREEN (SO) BOTH IP/OP "$1,246.00" $922.50 $69.08 "$1,246.00" $439.25 $439.25 $439.25 $439.25 $153.50 $153.50 $76.75 $69.08 $153.50 $924.78 $924.78 $960.42 $649.17 $144.26 $245.60 $245.60 $737.01 $153.50 $153.50 $153.50 "$1,246.00" $934.50 $153.50 $153.50 $153.50 $623.00 $623.00 $986.83 $153.50 $996.80 $253.28 $137.39 $153.50 $722.68 "$1,246.00" $222.58 $153.50 $107.92 $153.50 N/A N/A 30159021 EAP CPT® 84163 PREGNANCY ASSOCIATED PLASMA PROTEIN (SO) BOTH IP/OP $180.00 $133.50 $7.09 $180.00 $12.60 $12.60 $12.60 $12.60 $15.05 $15.05 $7.53 $7.53 $15.05 $9.74 $9.74 $10.12 $7.11 $9.48 $24.08 $24.08 $106.47 $15.05 $15.05 $15.05 $180.00 $135.00 $15.05 $15.05 $15.05 $35.88 $35.88 $142.56 $15.05 $144.00 $24.83 $9.03 $15.05 $104.40 $180.00 $21.82 $15.05 $7.09 $15.05 N/A N/A 30159024 EAP CPT® 82172 APOLIPOPROTEIN (SO) BOTH IP/OP $155.00 $115.00 $9.49 $155.00 $30.42 $30.42 $30.42 $30.42 $21.09 $21.09 $10.55 $9.49 $21.09 $23.52 $23.52 $24.43 $17.17 $22.90 $33.74 $33.74 $91.68 $21.09 $21.09 $21.09 $155.00 $116.25 $21.09 $21.09 $21.09 $86.60 $86.60 $122.76 $21.09 $124.00 $34.80 $21.81 $21.09 $89.90 $155.00 $30.58 $21.09 $17.13 $21.09 N/A N/A 30159025 EAP CPT® 82247 "BILIRUBIN, TOTAL (SO)" BOTH IP/OP $80.00 $59.50 $2.51 $80.00 $9.84 $9.84 $9.84 $9.84 $5.02 $5.02 $2.51 $2.51 $5.02 $7.62 $7.62 $7.92 $5.56 $7.42 $8.03 $8.03 $47.32 $5.02 $5.02 $5.02 $80.00 $60.00 $5.02 $5.02 $5.02 $28.08 $28.08 $63.36 $5.02 $64.00 $8.28 $7.07 $5.02 $46.40 $80.00 $7.28 $5.02 $5.55 $5.02 N/A N/A 30159026 EAP CPT® 82977 GAMMA - GGT (SO) BOTH IP/OP $144.00 $107.00 $3.60 $144.00 $14.13 $14.13 $14.13 $14.13 $7.20 $7.20 $3.60 $3.60 $7.20 $10.93 $10.93 $11.35 $7.98 $7.46 $11.52 $11.52 $85.18 $7.20 $7.20 $7.20 $144.00 $108.00 $7.20 $7.20 $7.20 $40.24 $40.24 $114.05 $7.20 $115.20 $11.88 $7.10 $7.20 $83.52 $144.00 $10.44 $7.20 $5.58 $7.20 N/A N/A 30159027 EAP CPT® 83010 "HAPTOGLOBIN, QUANT (SO)" BOTH IP/OP $125.00 $92.50 $4.12 $125.00 $7.33 $7.33 $7.33 $7.33 $12.58 $12.58 $6.29 $6.29 $12.58 $5.66 $5.66 $5.88 $4.13 $5.51 $20.13 $20.13 $73.94 $12.58 $12.58 $12.58 $125.00 $93.75 $12.58 $12.58 $12.58 $20.84 $20.84 $99.00 $12.58 $100.00 $20.76 $5.25 $12.58 $72.50 $125.00 $18.24 $12.58 $4.12 $12.58 N/A N/A 30159028 EAP CPT® 83883 "NEPHELOMETRY, EACH ANALYTE (SO)" BOTH IP/OP $145.00 $107.50 $6.80 $145.00 $26.68 $26.68 $26.68 $26.68 $13.60 $13.60 $6.80 $6.80 $13.60 $20.64 $20.64 $21.44 $15.07 $20.09 $21.76 $21.76 $85.77 $13.60 $13.60 $13.60 $145.00 $108.75 $13.60 $13.60 $13.60 $76.00 $76.00 $114.84 $13.60 $116.00 $22.44 $19.13 $13.60 $84.10 $145.00 $19.72 $13.60 $15.03 $13.60 N/A N/A 30159029 EAP CPT® 84460 ALT (ALANINE AMINOTRANSFERASE) (SO) BOTH IP/OP $80.00 $59.50 $2.65 $80.00 $10.39 $10.39 $10.39 $10.39 $5.30 $5.30 $2.65 $2.65 $5.30 $8.04 $8.04 $8.35 $5.87 $7.46 $8.48 $8.48 $47.32 $5.30 $5.30 $5.30 $80.00 $60.00 $5.30 $5.30 $5.30 $29.60 $29.60 $63.36 $5.30 $64.00 $8.75 $7.10 $5.30 $46.40 $80.00 $7.69 $5.30 $5.58 $5.30 N/A N/A 30159062 EAP CPT® 84210 "PYRUVATE, CSF (SO)" BOTH IP/OP $254.00 $188.00 $7.24 $254.00 $254.00 $254.00 $254.00 $254.00 $14.48 $14.48 $7.24 $254.00 $14.48 $16.48 $16.48 $17.12 $12.03 $16.03 $23.17 $23.17 $254.00 $14.48 $14.48 $14.48 $254.00 $190.50 $14.48 $14.48 $14.48 $60.68 $60.68 $201.17 $14.48 $203.20 $254.00 $254.00 $14.48 $147.32 $254.00 $21.00 $14.48 $254.00 $14.48 N/A N/A 30159063 EAP CPT® 86787 "VARICELLA - ZOSTER VIRUS ANTIBODY , CSF (SO)" BOTH IP/OP $109.00 $81.00 $6.44 $109.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $64.47 $12.88 $12.88 $12.88 $109.00 $81.75 $12.88 $12.88 $12.88 $72.00 $72.00 $86.33 $12.88 $87.20 $21.25 $18.12 $12.88 $63.22 $109.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30159064 EAP CPT® 80350 "CANNABINOIDS, SYNTHETIC, 1-3" BOTH IP/OP $140.00 $104.00 $12.01 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $12.01 $140.00 $140.00 $103.91 $103.91 $107.91 $72.94 $29.18 $140.00 $56.00 $140.00 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $91.00 $140.00 $140.00 $81.20 $140.00 $84.00 $140.00 $140.00 $140.00 N/A N/A 30159065 EAP CPT® 80335 "CLOMIPRAMINE, SERUM (NMS), QT" BOTH IP/OP $266.00 $197.00 $26.44 $266.00 $266.00 $266.00 $266.00 $266.00 $114.43 $114.43 $57.22 $266.00 $114.43 $197.43 $197.43 $205.03 $138.59 $26.44 $183.09 $183.09 $266.00 $114.43 $114.43 $114.43 $266.00 $199.50 $114.43 $114.43 $114.43 $133.00 $133.00 $210.67 $114.43 $212.80 $266.00 $266.00 $114.43 $154.28 $266.00 $159.60 $266.00 $266.00 $114.43 N/A N/A 30159066 EAP CPT® 82657 "ALPHA - GALACTOSIDASE, LEUKOCYTES (MAYO)" BOTH IP/OP $385.00 $285.00 $6.64 $385.00 $11.80 $11.80 $11.80 $11.80 $22.17 $22.17 $11.09 $9.98 $22.17 $9.12 $9.12 $9.47 $6.66 $8.87 $35.47 $35.47 $227.73 $22.17 $22.17 $22.17 $385.00 $288.75 $22.17 $22.17 $22.17 $33.56 $33.56 $304.92 $22.17 $308.00 $36.58 $8.45 $22.17 $223.30 $385.00 $32.15 $22.17 $6.64 $22.17 N/A N/A 30159067 EAP CPT® 80307 "HYPOGLYCEMIC AGENT SCREEN, SERUM (MAYO)" BOTH IP/OP $397.00 $294.00 $29.09 $397.00 $109.39 $109.39 $109.39 $109.39 $62.14 $62.14 $31.07 $29.09 $62.14 $79.51 $79.51 $82.57 $58.04 $71.85 $99.42 $99.42 $234.83 $62.14 $62.14 $62.14 $397.00 $297.75 $62.14 $62.14 $62.14 $198.50 $198.50 $314.42 $62.14 $317.60 $102.53 $68.43 $62.14 $230.26 $397.00 $90.10 $62.14 $53.75 $62.14 N/A N/A 30159068 EAP CPT® 80347 BENZODIAZEPINES (SO)NMS BOTH IP/OP $163.00 $121.00 $27.32 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $120.98 $120.98 $125.64 $84.92 $27.32 $163.00 $60.80 $163.00 $163.00 $152.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $163.00 $163.00 $94.54 $163.00 $97.80 $163.00 $163.00 $163.00 N/A N/A 30159069 EAP CPT® 80320 "ALCOHOL( ETHANOL), (SO)NMS" BOTH IP/OP $46.00 $34.50 $0.03 $188.81 $0.03 $0.03 $0.03 $0.03 $114.43 $114.43 $57.22 $6.63 $114.43 $34.14 $34.14 $35.46 $23.97 $15.96 $183.09 $183.09 $27.21 $114.43 $114.43 $114.43 $46.00 $34.50 $114.43 $114.43 $114.43 $23.00 $23.00 $36.43 $114.43 $36.80 $188.81 $15.20 $114.43 $26.68 $46.00 $27.60 $46.00 $11.94 $46.00 N/A N/A 30159070 EAP CPT® 80307 "DRUG SCREEN, QUALITATIVE,(SO)NMS" BOTH IP/OP $270.00 $200.00 $29.09 $270.00 $109.39 $109.39 $109.39 $109.39 $62.14 $62.14 $31.07 $29.09 $62.14 $79.51 $79.51 $82.57 $58.04 $71.85 $99.42 $99.42 $159.71 $62.14 $62.14 $62.14 $270.00 $202.50 $62.14 $62.14 $62.14 $135.00 $135.00 $213.84 $62.14 $216.00 $102.53 $68.43 $62.14 $156.60 $270.00 $90.10 $62.14 $53.75 $62.14 N/A N/A 30159071 EAP CPT® 80307 "SINGLE DRUG CLASS (ELISA), (SO)NMS" BOTH IP/OP $204.00 $151.00 $29.09 $204.00 $109.39 $109.39 $109.39 $109.39 $62.14 $62.14 $31.07 $29.09 $62.14 $79.51 $79.51 $82.57 $58.04 $71.85 $99.42 $99.42 $120.67 $62.14 $62.14 $62.14 $204.00 $153.00 $62.14 $62.14 $62.14 $102.00 $102.00 $161.57 $62.14 $163.20 $102.53 $68.43 $62.14 $118.32 $204.00 $90.10 $62.14 $53.75 $62.14 N/A N/A 30159072 EAP CPT® 83519 ACH RECEPTOR (MUSCLE BINDING ABS) MAYO BOTH IP/OP $145.00 $107.50 $8.28 $145.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $85.77 $18.40 $18.40 $18.40 $145.00 $108.75 $18.40 $18.40 $18.40 $75.52 $75.52 $114.84 $18.40 $116.00 $30.36 $19.01 $18.40 $84.10 $145.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30159073 EAP CPT® 83519 ACHR GANGLIONIC NEURONAL ABS (MAYO) BOTH IP/OP $125.00 $92.50 $8.28 $125.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $73.94 $18.40 $18.40 $18.40 $125.00 $93.75 $18.40 $18.40 $18.40 $75.52 $75.52 $99.00 $18.40 $100.00 $30.36 $19.01 $18.40 $72.50 $125.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30159074 EAP CPT® 83519 NEURONAL VGKC AUTOANTIBODY (MAYO) BOTH IP/OP $125.00 $92.50 $8.28 $125.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $73.94 $18.40 $18.40 $18.40 $125.00 $93.75 $18.40 $18.40 $18.40 $75.52 $75.52 $99.00 $18.40 $100.00 $30.36 $19.01 $18.40 $72.50 $125.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30159075 EAP CPT® 83519 N-TYPE CALCIUM CHANNEL ABS (MAYO) BOTH IP/OP $125.00 $92.50 $8.28 $125.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $73.94 $18.40 $18.40 $18.40 $125.00 $93.75 $18.40 $18.40 $18.40 $75.52 $75.52 $99.00 $18.40 $100.00 $30.36 $19.01 $18.40 $72.50 $125.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30159076 EAP CPT® 83519 P/Q -TYPE CALCIUM CHANNEL ABS (MAYO) BOTH IP/OP $125.00 $92.50 $8.28 $125.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $73.94 $18.40 $18.40 $18.40 $125.00 $93.75 $18.40 $18.40 $18.40 $75.52 $75.52 $99.00 $18.40 $100.00 $30.36 $19.01 $18.40 $72.50 $125.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30159077 EAP CPT® 83519 ACH RECEPTOR (MUSCLE) MODULATING ABS (MAYO) BOTH IP/OP $125.00 $92.50 $8.28 $125.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $73.94 $18.40 $18.40 $18.40 $125.00 $93.75 $18.40 $18.40 $18.40 $75.52 $75.52 $99.00 $18.40 $100.00 $30.36 $19.01 $18.40 $72.50 $125.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30159078 EAP CPT® 83520 STRIATIONAL (STRIATED MUSCLE) ABS (MAYO) BOTH IP/OP $125.00 $92.50 $7.77 $125.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $73.94 $17.27 $17.27 $17.27 $125.00 $93.75 $17.27 $17.27 $17.27 $72.36 $72.36 $99.00 $17.27 $100.00 $28.50 $18.21 $17.27 $72.50 $125.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30159079 EAP CPT® 84182 AMPHIPHYSIN WESTERN BLOT (MAYO) BOTH IP/OP $63.00 $47.00 $13.14 $63.00 $35.32 $35.32 $35.32 $35.32 $29.21 $29.21 $14.61 $13.14 $29.21 $27.33 $27.33 $28.38 $19.95 $26.60 $46.74 $46.74 $37.26 $29.21 $29.21 $29.21 $63.00 $47.25 $29.21 $29.21 $29.21 $63.00 $63.00 $49.90 $29.21 $50.40 $48.20 $25.33 $29.21 $36.54 $63.00 $42.35 $29.21 $19.90 $29.21 N/A N/A 30159080 EAP CPT® 84182 CRMP-5-IGG WESTERN BLOT (MAYO) BOTH IP/OP $63.00 $47.00 $13.14 $63.00 $35.32 $35.32 $35.32 $35.32 $29.21 $29.21 $14.61 $13.14 $29.21 $27.33 $27.33 $28.38 $19.95 $26.60 $46.74 $46.74 $37.26 $29.21 $29.21 $29.21 $63.00 $47.25 $29.21 $29.21 $29.21 $63.00 $63.00 $49.90 $29.21 $50.40 $48.20 $25.33 $29.21 $36.54 $63.00 $42.35 $29.21 $19.90 $29.21 N/A N/A 30159081 EAP CPT® 84182 PARANEOPLASTIC AUTOANTIBODY WESTERN BLOT (MAYO) BOTH IP/OP $63.00 $47.00 $13.14 $63.00 $35.32 $35.32 $35.32 $35.32 $29.21 $29.21 $14.61 $13.14 $29.21 $27.33 $27.33 $28.38 $19.95 $26.60 $46.74 $46.74 $37.26 $29.21 $29.21 $29.21 $63.00 $47.25 $29.21 $29.21 $29.21 $63.00 $63.00 $49.90 $29.21 $50.40 $48.20 $25.33 $29.21 $36.54 $63.00 $42.35 $29.21 $19.90 $29.21 N/A N/A 30159082 EAP CPT® 83519 ALPHA SUBUNIT (SO) BOTH IP/OP $216.00 $160.00 $8.28 $216.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $127.76 $18.40 $18.40 $18.40 $216.00 $162.00 $18.40 $18.40 $18.40 $75.52 $75.52 $171.07 $18.40 $172.80 $30.36 $19.01 $18.40 $125.28 $216.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30159083 EAP CPT® 80299 "METFORMIN QUANTITATIVE, SERUM (ARUP)" BOTH IP/OP $308.00 $228.00 $8.39 $308.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $182.18 $18.64 $18.64 $18.64 $308.00 $231.00 $18.64 $18.64 $18.64 $67.28 $67.28 $243.94 $18.64 $246.40 $30.76 $16.94 $18.64 $178.64 $308.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30159084 EAP CPT® 83872 "MUCIN CLOT, SYNOVIAL (SO)" BOTH IP/OP $60.00 $44.50 $2.93 $60.00 $60.00 $60.00 $60.00 $60.00 $5.86 $5.86 $2.93 $60.00 $5.86 $8.90 $8.90 $9.24 $6.50 $14.54 $9.38 $9.38 $60.00 $5.86 $5.86 $5.86 $60.00 $45.00 $5.86 $5.86 $5.86 $32.76 $32.76 $47.52 $5.86 $48.00 $60.00 $60.00 $5.86 $34.80 $60.00 $8.50 $5.86 $60.00 $5.86 N/A N/A 30159085 EAP CPT® 82379 "CARNITINE, URINE (SO)" BOTH IP/OP $324.00 $240.00 $8.44 $324.00 $324.00 $324.00 $324.00 $324.00 $16.87 $16.87 $8.44 $324.00 $16.87 $25.62 $25.62 $26.60 $18.70 $24.92 $26.99 $26.99 $324.00 $16.87 $16.87 $16.87 $324.00 $243.00 $16.87 $16.87 $16.87 $94.28 $94.28 $256.61 $16.87 $259.20 $324.00 $324.00 $16.87 $187.92 $324.00 $24.46 $16.87 $324.00 $16.87 N/A N/A 30159086 EAP CPT® 83519 "MUSK QUANTITATIVE , ANTIBODY (SO)" BOTH IP/OP "$1,583.00" "$1,171.50" $8.28 "$1,583.00" $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $936.34 $18.40 $18.40 $18.40 "$1,583.00" "$1,187.25" $18.40 $18.40 $18.40 $75.52 $75.52 "$1,253.74" $18.40 "$1,266.40" $30.36 $19.01 $18.40 $918.14 "$1,583.00" $26.68 $18.40 $14.93 $18.40 N/A N/A 30159087 EAP CPT® 82542 "CANNABINOID METABOLITE, URINE (NMS), QT" BOTH IP/OP $284.00 $210.50 $6.64 $284.00 $35.44 $35.44 $35.44 $35.44 $24.09 $24.09 $12.05 $10.84 $24.09 $9.12 $9.12 $9.47 $6.66 $8.87 $38.54 $38.54 $167.99 $24.09 $24.09 $24.09 $284.00 $213.00 $24.09 $24.09 $24.09 $33.56 $33.56 $224.93 $24.09 $227.20 $39.75 $8.45 $24.09 $164.72 $284.00 $34.93 $24.09 $6.64 $24.09 N/A N/A 30159088 EAP CPT® 83520 TSH RECEPTOR BINDING AB TRAB (SO) BOTH IP/OP $270.00 $200.00 $7.77 $270.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $159.71 $17.27 $17.27 $17.27 $270.00 $202.50 $17.27 $17.27 $17.27 $72.36 $72.36 $213.84 $17.27 $216.00 $28.50 $18.21 $17.27 $156.60 $270.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30159089 EAP CPT® 84143 "HYDROXYPREGNENOLONE-17, LC/MS/MS (SO)" BOTH IP/OP $150.00 $111.00 $11.41 $150.00 $150.00 $150.00 $150.00 $150.00 $22.81 $22.81 $11.41 $150.00 $22.81 $34.65 $34.65 $35.99 $25.30 $33.72 $36.50 $36.50 $150.00 $22.81 $22.81 $22.81 $150.00 $112.50 $22.81 $22.81 $22.81 $127.56 $127.56 $118.80 $22.81 $120.00 $150.00 $150.00 $22.81 $87.00 $150.00 $33.07 $22.81 $150.00 $22.81 N/A N/A 30159090 EAP CPT® 80299 INFLIXIMAB DRUG CONCENTRATION BOTH IP/OP $399.00 $295.50 $8.39 $399.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $236.01 $18.64 $18.64 $18.64 $399.00 $299.25 $18.64 $18.64 $18.64 $67.28 $67.28 $316.01 $18.64 $319.20 $30.76 $16.94 $18.64 $231.42 $399.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30159091 EAP CPT® 82397 ANTI-INFLIXIMAB AB BOTH IP/OP $738.00 $546.50 $7.06 $738.00 $27.71 $27.71 $27.71 $27.71 $14.12 $14.12 $7.06 $7.06 $14.12 $21.46 $21.46 $22.28 $15.66 $20.87 $22.59 $22.59 $436.53 $14.12 $14.12 $14.12 $738.00 $553.50 $14.12 $14.12 $14.12 $78.96 $78.96 $584.50 $14.12 $590.40 $23.30 $19.88 $14.12 $428.04 $738.00 $20.47 $14.12 $15.62 $14.12 N/A N/A 30160020 EAP CPT® 82172 APOLIPOPROTEIN A1 (SO) BOTH IP/OP $175.00 $129.50 $9.49 $175.00 $30.42 $30.42 $30.42 $30.42 $21.09 $21.09 $10.55 $9.49 $21.09 $23.52 $23.52 $24.43 $17.17 $22.90 $33.74 $33.74 $103.51 $21.09 $21.09 $21.09 $175.00 $131.25 $21.09 $21.09 $21.09 $86.60 $86.60 $138.60 $21.09 $140.00 $34.80 $21.81 $21.09 $101.50 $175.00 $30.58 $21.09 $17.13 $21.09 N/A N/A 30160023 EAP CPT® 84182 REDOMBX CAR ANTIRECOVERIN (SO) BOTH IP/OP $468.00 $346.50 $13.14 $468.00 $35.32 $35.32 $35.32 $35.32 $29.21 $29.21 $14.61 $13.14 $29.21 $27.33 $27.33 $28.38 $19.95 $26.60 $46.74 $46.74 $276.82 $29.21 $29.21 $29.21 $468.00 $351.00 $29.21 $29.21 $29.21 $100.60 $100.60 $370.66 $29.21 $374.40 $48.20 $25.33 $29.21 $271.44 $468.00 $42.35 $29.21 $19.90 $29.21 N/A N/A 30160024 EAP CPT® 83520 PROTHROM FRAG 1.2 (SO) BOTH IP/OP $367.00 $272.00 $7.77 $367.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $217.08 $17.27 $17.27 $17.27 $367.00 $275.25 $17.27 $17.27 $17.27 $72.36 $72.36 $290.66 $17.27 $293.60 $28.50 $18.21 $17.27 $212.86 $367.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30160025 EAP CPT® 80369 BACLOFIN (SO) BOTH IP/OP $380.00 $281.50 $26.04 $380.00 $380.00 $380.00 $380.00 $380.00 $114.43 $114.43 $57.22 $380.00 $114.43 $282.04 $282.04 $292.90 $197.98 $26.04 $183.09 $183.09 $380.00 $114.43 $114.43 $114.43 $380.00 $285.00 $114.43 $114.43 $114.43 $190.00 $190.00 $300.96 $114.43 $304.00 $380.00 $380.00 $114.43 $220.40 $380.00 $228.00 $380.00 $380.00 $114.43 N/A N/A 30160027 EAP CPT® 82042 "ALBUMIN, CSF (SO)" BOTH IP/OP $18.00 $13.50 $3.50 $18.00 $10.17 $10.17 $10.17 $10.17 $7.78 $7.78 $3.89 $3.50 $7.78 $7.86 $7.86 $8.16 $5.74 $7.64 $12.45 $12.45 $10.65 $7.78 $7.78 $7.78 $18.00 $13.50 $7.78 $7.78 $7.78 $18.00 $18.00 $14.26 $7.78 $14.40 $12.84 $7.28 $7.78 $10.44 $18.00 $11.28 $7.78 $5.72 $7.78 N/A N/A 30160028 EAP CPT® 82272 "OCCULT BLOOD GUAIAC, FECAL" BOTH IP/OP $64.00 $47.50 $2.12 $64.00 $64.00 $64.00 $64.00 $64.00 $4.23 $4.23 $2.12 $64.00 $4.23 $4.88 $4.88 $5.07 $3.56 $4.75 $6.77 $6.77 $64.00 $4.23 $4.23 $4.23 $64.00 $48.00 $4.23 $4.23 $4.23 $17.96 $17.96 $50.69 $4.23 $51.20 $64.00 $64.00 $4.23 $37.12 $64.00 $6.13 $4.23 $64.00 $4.23 N/A N/A 30160029 EAP CPT® 80365 "OXYCODONE AND METABOLITE, QUANT SERUM (SO-QUEST)" BOTH IP/OP $333.00 $246.50 $0.03 $333.00 $0.03 $0.03 $0.03 $0.03 $114.43 $114.43 $57.22 $11.94 $114.43 $247.15 $247.15 $256.68 $173.49 $69.40 $183.09 $183.09 $196.97 $114.43 $114.43 $114.43 $333.00 $249.75 $114.43 $114.43 $114.43 $166.50 $166.50 $263.74 $114.43 $266.40 $188.81 $66.09 $114.43 $193.14 $333.00 $199.80 $333.00 $69.40 $114.43 N/A N/A 30160030 EAP CPT® 82397 "ANTI-MULLERIAN HORMONE (AMH), MALE (SO)" BOTH IP/OP $255.00 $189.00 $7.06 $255.00 $27.71 $27.71 $27.71 $27.71 $14.12 $14.12 $7.06 $7.06 $14.12 $21.46 $21.46 $22.28 $15.66 $20.87 $22.59 $22.59 $150.83 $14.12 $14.12 $14.12 $255.00 $191.25 $14.12 $14.12 $14.12 $78.96 $78.96 $201.96 $14.12 $204.00 $23.30 $19.88 $14.12 $147.90 $255.00 $20.47 $14.12 $15.62 $14.12 N/A N/A 30160031 EAP CPT® 82397 "ANTI-MULLERIAN HORMONE (AMH), FEMALE (SO)" BOTH IP/OP $296.00 $219.50 $7.06 $296.00 $27.71 $27.71 $27.71 $27.71 $14.12 $14.12 $7.06 $7.06 $14.12 $21.46 $21.46 $22.28 $15.66 $20.87 $22.59 $22.59 $175.08 $14.12 $14.12 $14.12 $296.00 $222.00 $14.12 $14.12 $14.12 $78.96 $78.96 $234.43 $14.12 $236.80 $23.30 $19.88 $14.12 $171.68 $296.00 $20.47 $14.12 $15.62 $14.12 N/A N/A 30160032 EAP CPT® 83520 INFLIXIMAB AB - RD (SO) BOTH IP/OP $425.00 $314.50 $7.77 $425.00 $25.40 $25.40 $25.40 $25.40 $114.43 $114.43 $57.22 $7.77 $114.43 $19.67 $19.67 $20.42 $14.36 $19.12 $183.09 $183.09 $251.39 $114.43 $114.43 $114.43 $425.00 $318.75 $114.43 $114.43 $114.43 $72.36 $72.36 $336.60 $114.43 $340.00 $188.81 $18.21 $114.43 $246.50 $425.00 $25.04 $17.27 $14.30 $114.43 N/A N/A 30160033 EAP CPT® 80299 INFLIXIMAB RD (SO) BOTH IP/OP $423.00 $313.50 $8.39 $423.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $250.20 $18.64 $18.64 $18.64 $423.00 $317.25 $18.64 $18.64 $18.64 $67.28 $67.28 $335.02 $18.64 $338.40 $30.76 $16.94 $18.64 $245.34 $423.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30160034 EAP CPT® 83520 INFLIXIMAB AB IBD (SO) BOTH IP/OP $494.00 $366.00 $7.77 $494.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $292.20 $17.27 $17.27 $17.27 $494.00 $370.50 $17.27 $17.27 $17.27 $72.36 $72.36 $391.25 $17.27 $395.20 $28.50 $18.21 $17.27 $286.52 $494.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30160035 EAP CPT® 80299 INFLIXIMAB IBD (SO) BOTH IP/OP $423.00 $313.50 $8.39 $423.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $250.20 $18.64 $18.64 $18.64 $423.00 $317.25 $18.64 $18.64 $18.64 $67.28 $67.28 $335.02 $18.64 $338.40 $30.76 $16.94 $18.64 $245.34 $423.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30160036 EAP CPT® 80050 CHAMPVA GENERAL HEALTH PANEL BOTH IP/OP $836.00 $619.00 $22.10 $836.00 $67.32 $67.32 $67.32 $67.32 $836.00 $836.00 $22.64 $22.10 $836.00 $44.24 $44.24 $45.94 $32.30 $174.23 $836.00 $177.20 $494.49 $836.00 $443.00 $836.00 $836.00 $627.00 $836.00 $836.00 $836.00 $183.56 $183.56 $662.11 $836.00 $668.80 $543.40 $165.93 $836.00 $484.88 $836.00 $501.60 $836.00 $174.22 $836.00 N/A N/A 30160040 EAP CPT® 82570 URINE CREATININE QD (SO) BOTH IP/OP $27.00 $20.00 $2.59 $27.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $15.97 $5.18 $5.18 $5.18 $27.00 $20.25 $5.18 $5.18 $5.18 $27.00 $27.00 $21.38 $5.18 $21.60 $8.55 $7.28 $5.18 $15.66 $27.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30160041 EAP CPT® 84156 URINE PROTEIN QD (SO BOTH IP/OP $28.00 $21.00 $1.83 $28.00 $7.20 $7.20 $7.20 $7.20 $3.67 $3.67 $1.84 $1.83 $3.67 $5.56 $5.56 $5.78 $4.06 $5.42 $5.87 $5.87 $16.56 $3.67 $3.67 $3.67 $28.00 $21.00 $3.67 $3.67 $3.67 $20.48 $20.48 $22.18 $3.67 $22.40 $6.06 $5.16 $3.67 $16.24 $28.00 $5.32 $3.67 $4.05 $3.67 N/A N/A 30160042 EAP CPT® 83001 FOLLICLE STIMULATING HORMONE (SO) BOTH IP/OP $56.00 $41.50 $9.29 $56.00 $36.47 $36.47 $36.47 $36.47 $18.58 $18.58 $9.29 $9.29 $18.58 $28.23 $28.23 $29.31 $20.60 $27.46 $29.73 $29.73 $33.12 $18.58 $18.58 $18.58 $56.00 $42.00 $18.58 $18.58 $18.58 $56.00 $56.00 $44.35 $18.58 $44.80 $30.66 $26.15 $18.58 $32.48 $56.00 $26.94 $18.58 $20.54 $18.58 N/A N/A 30160043 EAP CPT® 83002 LUTEINIZING HORMONE (SO) BOTH IP/OP $56.00 $41.50 $9.26 $56.00 $36.34 $36.34 $36.34 $36.34 $18.52 $18.52 $9.26 $9.26 $18.52 $28.12 $28.12 $29.20 $20.53 $27.36 $29.63 $29.63 $33.12 $18.52 $18.52 $18.52 $56.00 $42.00 $18.52 $18.52 $18.52 $56.00 $56.00 $44.35 $18.52 $44.80 $30.56 $26.06 $18.52 $32.48 $56.00 $26.85 $18.52 $20.47 $18.52 N/A N/A 30160044 EAP CPT® 84182 MYOSITIS SPECIFIC 11 AB PROTEIN WESTERN BLOT (SO) BOTH IP/OP $103.00 $76.50 $13.14 $103.00 $35.32 $35.32 $35.32 $35.32 $29.21 $29.21 $14.61 $13.14 $29.21 $27.33 $27.33 $28.38 $19.95 $26.60 $46.74 $46.74 $60.92 $29.21 $29.21 $29.21 $103.00 $77.25 $29.21 $29.21 $29.21 $100.60 $100.60 $81.58 $29.21 $82.40 $48.20 $25.33 $29.21 $59.74 $103.00 $42.35 $29.21 $19.90 $29.21 N/A N/A 30160050 EAP CPT® 83520 INTERLEUKIN-6 (IL-6) (SO) BOTH IP/OP $257.00 $190.50 $7.77 $257.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $152.02 $17.27 $17.27 $17.27 $257.00 $192.75 $17.27 $17.27 $17.27 $72.36 $72.36 $203.54 $17.27 $205.60 $28.50 $18.21 $17.27 $149.06 $257.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30160055 EAP CPT® 82140 STONE RISK PROFILE - AMMONIA (SO) BOTH IP/OP $21.00 $16.00 $7.29 $24.04 $19.40 $19.40 $19.40 $19.40 $14.57 $14.57 $7.29 $7.29 $14.57 $15.02 $15.02 $15.60 $10.96 $14.62 $23.31 $23.31 $12.42 $14.57 $14.57 $14.57 $21.00 $15.75 $14.57 $14.57 $14.57 $21.00 $21.00 $16.63 $14.57 $16.80 $24.04 $13.92 $14.57 $12.18 $21.00 $21.00 $14.57 $10.93 $14.57 N/A N/A 30160056 EAP CPT® 82340 STONE RISK PROFILE - CALCIUM URINE QUANT (SO) BOTH IP/OP $23.00 $17.50 $3.02 $23.00 $23.00 $23.00 $23.00 $23.00 $6.03 $6.03 $3.02 $23.00 $6.03 $9.16 $9.16 $9.51 $6.69 $8.91 $9.65 $9.65 $23.00 $6.03 $6.03 $6.03 $23.00 $17.25 $6.03 $6.03 $6.03 $23.00 $23.00 $18.22 $6.03 $18.40 $23.00 $23.00 $6.03 $13.34 $23.00 $8.74 $6.03 $23.00 $6.03 N/A N/A 30160057 EAP CPT® 82507 STONE RISK PROFILE - CITRATE (SO) BOTH IP/OP $21.00 $16.00 $12.18 $44.48 $21.00 $21.00 $21.00 $21.00 $27.80 $27.80 $13.90 $21.00 $27.80 $42.22 $42.22 $43.85 $30.82 $21.00 $44.48 $44.48 $21.00 $27.80 $27.80 $27.80 $21.00 $15.75 $27.80 $27.80 $27.80 $21.00 $21.00 $16.63 $27.80 $16.80 $21.00 $21.00 $27.80 $12.18 $21.00 $21.00 $27.80 $21.00 $21.00 N/A N/A 30160058 EAP CPT® 82570 STONE RISK PROFILE - CREATININE (SO) BOTH IP/OP $21.00 $16.00 $2.59 $21.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $12.42 $5.18 $5.18 $5.18 $21.00 $15.75 $5.18 $5.18 $5.18 $21.00 $21.00 $16.63 $5.18 $16.80 $8.55 $7.28 $5.18 $12.18 $21.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30160059 EAP CPT® 83735 STONE RISK PROFILE - MAGNESIUM (SO) BOTH IP/OP $23.00 $17.50 $3.35 $23.00 $13.15 $13.15 $13.15 $13.15 $6.70 $6.70 $3.35 $3.35 $6.70 $10.17 $10.17 $10.56 $7.42 $9.89 $10.72 $10.72 $13.60 $6.70 $6.70 $6.70 $23.00 $17.25 $6.70 $6.70 $6.70 $23.00 $23.00 $18.22 $6.70 $18.40 $11.06 $9.42 $6.70 $13.34 $23.00 $9.72 $6.70 $7.40 $6.70 N/A N/A 30160060 EAP CPT® 83945 STONE RISK PROFILE - OXALATE (SO) BOTH IP/OP $21.00 $16.00 $7.23 $23.12 $21.00 $21.00 $21.00 $21.00 $14.45 $14.45 $7.23 $21.00 $14.45 $19.55 $19.55 $20.30 $14.27 $19.02 $23.12 $23.12 $21.00 $14.45 $14.45 $14.45 $21.00 $15.75 $14.45 $14.45 $14.45 $21.00 $21.00 $16.63 $14.45 $16.80 $21.00 $21.00 $14.45 $12.18 $21.00 $20.95 $14.45 $21.00 $14.45 N/A N/A 30160061 EAP CPT® 83986 STONE RISK PROFILE - PH BODY FLUID (SO) BOTH IP/OP $23.00 $17.50 $1.79 $23.00 $7.03 $7.03 $7.03 $7.03 $3.58 $3.58 $1.79 $1.79 $3.58 $5.43 $5.43 $5.64 $3.96 $5.28 $5.73 $5.73 $13.60 $3.58 $3.58 $3.58 $23.00 $17.25 $3.58 $3.58 $3.58 $20.00 $20.00 $18.22 $3.58 $18.40 $5.91 $5.03 $3.58 $13.34 $23.00 $5.19 $3.58 $3.95 $3.58 N/A N/A 30160062 EAP CPT® 84105 STONE RISK PROFILE - PHOSPHATE URINE (SO) BOTH IP/OP $23.00 $17.50 $2.89 $23.00 $23.00 $23.00 $23.00 $23.00 $5.78 $5.78 $2.89 $23.00 $5.78 $7.86 $7.86 $8.16 $5.74 $7.64 $9.25 $9.25 $23.00 $5.78 $5.78 $5.78 $23.00 $17.25 $5.78 $5.78 $5.78 $23.00 $23.00 $18.22 $5.78 $18.40 $23.00 $23.00 $5.78 $13.34 $23.00 $8.38 $5.78 $23.00 $5.78 N/A N/A 30160063 EAP CPT® 84133 STONE RISK PROFILE - POTASSIUM URINE (SO) BOTH IP/OP $21.00 $16.00 $2.16 $21.00 $8.46 $8.46 $8.46 $8.46 $4.73 $4.73 $2.37 $2.16 $4.73 $6.53 $6.53 $6.78 $4.77 $6.35 $7.57 $7.57 $12.42 $4.73 $4.73 $4.73 $21.00 $15.75 $4.73 $4.73 $4.73 $21.00 $21.00 $16.63 $4.73 $16.80 $7.80 $6.05 $4.73 $12.18 $21.00 $6.86 $4.73 $4.75 $4.73 N/A N/A 30160064 EAP CPT® 84300 STONE RISK PROFILE - SODIUM URINE (SO) BOTH IP/OP $23.00 $17.50 $2.43 $23.00 $6.78 $6.78 $6.78 $6.78 $5.06 $5.06 $2.53 $2.43 $5.06 $5.25 $5.25 $5.45 $3.83 $5.11 $8.10 $8.10 $13.60 $5.06 $5.06 $5.06 $23.00 $17.25 $5.06 $5.06 $5.06 $19.32 $19.32 $18.22 $5.06 $18.40 $8.35 $4.87 $5.06 $13.34 $23.00 $7.34 $5.06 $3.83 $5.06 N/A N/A 30160065 EAP CPT® 84392 STONE RISK PROFILE - SULFATE URINE (SO) BOTH IP/OP $21.00 $16.00 $2.75 $21.00 $21.00 $21.00 $21.00 $21.00 $5.49 $5.49 $2.75 $21.00 $5.49 $7.21 $7.21 $7.48 $5.26 $7.02 $8.78 $8.78 $21.00 $5.49 $5.49 $5.49 $21.00 $15.75 $5.49 $5.49 $5.49 $21.00 $21.00 $16.63 $5.49 $16.80 $21.00 $21.00 $5.49 $12.18 $21.00 $7.96 $5.49 $21.00 $5.49 N/A N/A 30160066 EAP CPT® 84560 STONE RISK PROFILE - URIC ACID (SO) BOTH IP/OP $21.00 $16.00 $2.54 $21.00 $21.00 $21.00 $21.00 $21.00 $5.08 $5.08 $2.54 $21.00 $5.08 $7.21 $7.21 $7.48 $5.26 $7.02 $8.13 $8.13 $21.00 $5.08 $5.08 $5.08 $21.00 $15.75 $5.08 $5.08 $5.08 $21.00 $21.00 $16.63 $5.08 $16.80 $21.00 $21.00 $5.08 $12.18 $21.00 $7.37 $5.08 $21.00 $5.08 N/A N/A 30160070 EAP CPT® 84155 "ASSAY PROTEIN, SERUM (SO)" BOTH IP/OP $21.00 $16.00 $1.83 $21.00 $7.20 $7.20 $7.20 $7.20 $3.67 $3.67 $1.84 $1.83 $3.67 $5.56 $5.56 $5.78 $4.06 $5.42 $5.87 $5.87 $12.42 $3.67 $3.67 $3.67 $21.00 $15.75 $3.67 $3.67 $3.67 $20.48 $20.48 $16.63 $3.67 $16.80 $6.06 $5.16 $3.67 $12.18 $21.00 $5.32 $3.67 $4.05 $3.67 N/A N/A 30160071 EAP CPT® 84165 PROTEIN ELECTROPHORESIS URINE (SO) BOTH IP/OP $21.00 $16.00 $5.37 $21.00 $21.00 $21.00 $21.00 $21.00 $10.74 $10.74 $5.37 $5.37 $10.74 $16.31 $16.31 $16.93 $11.90 $15.87 $17.18 $17.18 $12.42 $10.74 $10.74 $10.74 $21.00 $15.75 $10.74 $10.74 $10.74 $21.00 $21.00 $16.63 $10.74 $16.80 $17.72 $15.11 $10.74 $12.18 $21.00 $15.57 $10.74 $11.87 $10.74 N/A N/A 30160072 EAP CPT® 82570 ASSAY CREATININE URINE (SO) BOTH IP/OP $32.00 $24.00 $2.59 $32.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $18.93 $5.18 $5.18 $5.18 $32.00 $24.00 $5.18 $5.18 $5.18 $28.92 $28.92 $25.34 $5.18 $25.60 $8.55 $7.28 $5.18 $18.56 $32.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30160073 EAP CPT® 84156 ASSAY PROTEIN URINE (SO) BOTH IP/OP $36.00 $27.00 $1.83 $36.00 $7.20 $7.20 $7.20 $7.20 $3.67 $3.67 $1.84 $1.83 $3.67 $5.56 $5.56 $5.78 $4.06 $5.42 $5.87 $5.87 $21.29 $3.67 $3.67 $3.67 $36.00 $27.00 $3.67 $3.67 $3.67 $20.48 $20.48 $28.51 $3.67 $28.80 $6.06 $5.16 $3.67 $20.88 $36.00 $5.32 $3.67 $4.05 $3.67 N/A N/A 30160074 EAP CPT® 84166 "PROTEIN ELECTROPHORESIS, URINE (SO)" BOTH IP/OP $36.00 $27.00 $8.91 $36.00 $34.99 $34.99 $34.99 $34.99 $17.83 $17.83 $8.92 $8.91 $17.83 $27.08 $27.08 $28.12 $19.77 $26.34 $28.53 $28.53 $21.29 $17.83 $17.83 $17.83 $36.00 $27.00 $17.83 $17.83 $17.83 $36.00 $36.00 $28.51 $17.83 $28.80 $29.42 $25.09 $17.83 $20.88 $36.00 $25.85 $17.83 $19.71 $17.83 N/A N/A 30160080 EAP CPT® 83520 KAPPA FREE LIGHT CHAIN AB BOTH IP/OP $53.00 $39.50 $7.77 $53.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $31.35 $17.27 $17.27 $17.27 $53.00 $39.75 $17.27 $17.27 $17.27 $53.00 $53.00 $41.98 $17.27 $42.40 $28.50 $18.21 $17.27 $30.74 $53.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30160081 EAP CPT® 83520 LAMBDA FREE LIGHT CHAIN AB BOTH IP/OP $53.00 $39.50 $7.77 $53.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $31.35 $17.27 $17.27 $17.27 $53.00 $39.75 $17.27 $17.27 $17.27 $53.00 $53.00 $41.98 $17.27 $42.40 $28.50 $18.21 $17.27 $30.74 $53.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30160085 EAP CPT® 83883 ALPHA-2-MACROGLOBULIN (SO) BOTH IP/OP $121.00 $90.00 $6.80 $121.00 $26.68 $26.68 $26.68 $26.68 $13.60 $13.60 $6.80 $6.80 $13.60 $20.64 $20.64 $21.44 $15.07 $20.09 $21.76 $21.76 $71.57 $13.60 $13.60 $13.60 $121.00 $90.75 $13.60 $13.60 $13.60 $76.00 $76.00 $95.83 $13.60 $96.80 $22.44 $19.13 $13.60 $70.18 $121.00 $19.72 $13.60 $15.03 $13.60 N/A N/A 30160086 EAP CPT® 80159 CLOZAPINE DRUG ASSAY BOTH IP/OP $50.00 $37.00 $9.25 $50.00 $36.29 $36.29 $36.29 $36.29 $20.15 $20.15 $10.08 $9.25 $20.15 $26.24 $26.24 $27.25 $19.15 $23.71 $32.24 $32.24 $29.58 $20.15 $20.15 $20.15 $50.00 $37.50 $20.15 $20.15 $20.15 $25.00 $25.00 $39.60 $20.15 $40.00 $33.25 $22.58 $20.15 $29.00 $50.00 $29.22 $20.15 $17.74 $20.15 N/A N/A 30160087 EAP CPT® 80305 DRUG TEST PRESUMPTIVE DIR OPT OBS T-CUP BOTH IP/OP $49.00 $36.50 $5.67 $49.00 $20.51 $20.51 $20.51 $20.51 $12.60 $12.60 $6.30 $5.67 $12.60 $14.00 $14.00 $14.54 $10.22 $13.47 $20.16 $20.16 $28.98 $12.60 $12.60 $12.60 $49.00 $36.75 $12.60 $12.60 $12.60 $24.50 $24.50 $38.81 $12.60 $39.20 $20.79 $12.83 $12.60 $28.42 $49.00 $18.27 $12.60 $10.08 $12.60 N/A N/A 30200001 EAP CPT® 86000 PROTEUS OX-19 AB BOTH IP/OP $320.00 $237.00 $3.49 $320.00 $320.00 $320.00 $320.00 $320.00 $6.98 $6.98 $3.49 $320.00 $6.98 $10.60 $10.60 $11.01 $7.74 $10.31 $11.17 $11.17 $320.00 $6.98 $6.98 $6.98 $320.00 $240.00 $6.98 $6.98 $6.98 $39.00 $39.00 $253.44 $6.98 $256.00 $320.00 $320.00 $6.98 $185.60 $320.00 $10.12 $6.98 $320.00 $6.98 N/A N/A 30200002 EAP CPT® 86000 TYPHOID O ANTIBODY BOTH IP/OP $320.00 $237.00 $3.49 $320.00 $320.00 $320.00 $320.00 $320.00 $6.98 $6.98 $3.49 $320.00 $6.98 $10.60 $10.60 $11.01 $7.74 $10.31 $11.17 $11.17 $320.00 $6.98 $6.98 $6.98 $320.00 $240.00 $6.98 $6.98 $6.98 $39.00 $39.00 $253.44 $6.98 $256.00 $320.00 $320.00 $6.98 $185.60 $320.00 $10.12 $6.98 $320.00 $6.98 N/A N/A 30200003 EAP CPT® 86000 TYPHOID H ANTIBODY BOTH IP/OP $320.00 $237.00 $3.49 $320.00 $320.00 $320.00 $320.00 $320.00 $6.98 $6.98 $3.49 $320.00 $6.98 $10.60 $10.60 $11.01 $7.74 $10.31 $11.17 $11.17 $320.00 $6.98 $6.98 $6.98 $320.00 $240.00 $6.98 $6.98 $6.98 $39.00 $39.00 $253.44 $6.98 $256.00 $320.00 $320.00 $6.98 $185.60 $320.00 $10.12 $6.98 $320.00 $6.98 N/A N/A 30200004 EAP CPT® 86003 *ALTERNARIA ALTERNATA IGE BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200005 EAP CPT® 86003 *PENICILLIUM NOTATUM IGE BOTH IP/OP $207.00 $153.50 $2.61 $207.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $122.44 $5.22 $5.22 $5.22 $207.00 $155.25 $5.22 $5.22 $5.22 $29.20 $29.20 $163.94 $5.22 $165.60 $8.61 $7.35 $5.22 $120.06 $207.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200006 EAP CPT® 86003 *KENTUCKY/JUNE BLUEGRASS IGE BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200007 EAP CPT® 86003 *MOUSE EPITHELIA IGE BOTH IP/OP $207.00 $153.50 $2.61 $207.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $122.44 $5.22 $5.22 $5.22 $207.00 $155.25 $5.22 $5.22 $5.22 $29.20 $29.20 $163.94 $5.22 $165.60 $8.61 $7.35 $5.22 $120.06 $207.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200008 EAP CPT® 86003 *CLAM IGE BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200009 EAP CPT® 86003 *WALNUT (FOOD) IGE BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200010 EAP CPT® 86003 *SCALLOP IGE BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200011 EAP CPT® 86003 IGE ALLERGEN SESAME SEED BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200012 EAP CPT® 86003 IGE ALLERGEN NETTLE BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200013 EAP CPT® 86003 IGE ALLERGEN SHEEP SORREL BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200014 EAP CPT® 86003 MK82 LATEX-RST BOTH IP/OP $207.00 $153.50 $2.61 $207.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $122.44 $5.22 $5.22 $5.22 $207.00 $155.25 $5.22 $5.22 $5.22 $29.20 $29.20 $163.94 $5.22 $165.60 $8.61 $7.35 $5.22 $120.06 $207.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200015 EAP CPT® 86003 CURVULARIA LUNATO BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200016 EAP CPT® 86003 HELUMINTHOSPORIUM I. BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200017 EAP CPT® 86003 "EGG, CHICKEN" BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200018 EAP CPT® 86003 "MILK, COW'S" BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200019 EAP CPT® 86003 WHEAT BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200020 EAP CPT® 86003 OAT BOTH IP/OP $207.00 $153.50 $2.61 $207.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $122.44 $5.22 $5.22 $5.22 $207.00 $155.25 $5.22 $5.22 $5.22 $29.20 $29.20 $163.94 $5.22 $165.60 $8.61 $7.35 $5.22 $120.06 $207.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200021 EAP CPT® 86003 CORN BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200022 EAP CPT® 86003 SOYBEAN BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200023 EAP CPT® 86003 PEANUT BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200024 EAP CPT® 86003 TUNA BOTH IP/OP $180.00 $133.50 $2.61 $180.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $106.47 $5.22 $5.22 $5.22 $180.00 $135.00 $5.22 $5.22 $5.22 $29.20 $29.20 $142.56 $5.22 $144.00 $8.61 $7.35 $5.22 $104.40 $180.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200025 EAP CPT® 86003 CODFISH BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200026 EAP CPT® 86003 ALLERGEN SPECIFIC IGE BOTH IP/OP $180.00 $133.50 $2.61 $180.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $106.47 $5.22 $5.22 $5.22 $180.00 $135.00 $5.22 $5.22 $5.22 $29.20 $29.20 $142.56 $5.22 $144.00 $8.61 $7.35 $5.22 $104.40 $180.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200027 EAP CPT® 86003 SHRIMP BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200028 EAP CPT® 86003 BEEF BOTH IP/OP $180.00 $133.50 $2.61 $180.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $106.47 $5.22 $5.22 $5.22 $180.00 $135.00 $5.22 $5.22 $5.22 $29.20 $29.20 $142.56 $5.22 $144.00 $8.61 $7.35 $5.22 $104.40 $180.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200029 EAP CPT® 86003 RICE BOTH IP/OP $180.00 $133.50 $2.61 $180.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $106.47 $5.22 $5.22 $5.22 $180.00 $135.00 $5.22 $5.22 $5.22 $29.20 $29.20 $142.56 $5.22 $144.00 $8.61 $7.35 $5.22 $104.40 $180.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200030 EAP CPT® 86003 WHITE POTATO BOTH IP/OP $180.00 $133.50 $2.61 $180.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $106.47 $5.22 $5.22 $5.22 $180.00 $135.00 $5.22 $5.22 $5.22 $29.20 $29.20 $142.56 $5.22 $144.00 $8.61 $7.35 $5.22 $104.40 $180.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200031 EAP CPT® 86003 YELLOW ONION BOTH IP/OP $180.00 $133.50 $2.61 $180.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $106.47 $5.22 $5.22 $5.22 $180.00 $135.00 $5.22 $5.22 $5.22 $29.20 $29.20 $142.56 $5.22 $144.00 $8.61 $7.35 $5.22 $104.40 $180.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200032 EAP CPT® 86003 HONEY BEE BOTH IP/OP $207.00 $153.50 $2.61 $207.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $122.44 $5.22 $5.22 $5.22 $207.00 $155.25 $5.22 $5.22 $5.22 $29.20 $29.20 $163.94 $5.22 $165.60 $8.61 $7.35 $5.22 $120.06 $207.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200033 EAP CPT® 86003 WHITE FACED HORNET BOTH IP/OP $207.00 $153.50 $2.61 $207.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $122.44 $5.22 $5.22 $5.22 $207.00 $155.25 $5.22 $5.22 $5.22 $29.20 $29.20 $163.94 $5.22 $165.60 $8.61 $7.35 $5.22 $120.06 $207.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200034 EAP CPT® 86003 YELLOW JACKET BOTH IP/OP $207.00 $153.50 $2.61 $207.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $122.44 $5.22 $5.22 $5.22 $207.00 $155.25 $5.22 $5.22 $5.22 $29.20 $29.20 $163.94 $5.22 $165.60 $8.61 $7.35 $5.22 $120.06 $207.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200035 EAP CPT® 86003 PAPER WASP BOTH IP/OP $207.00 $153.50 $2.61 $207.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $122.44 $5.22 $5.22 $5.22 $207.00 $155.25 $5.22 $5.22 $5.22 $29.20 $29.20 $163.94 $5.22 $165.60 $8.61 $7.35 $5.22 $120.06 $207.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200036 EAP CPT® 86003 YELLOW FACED HORNET BOTH IP/OP $207.00 $153.50 $2.61 $207.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $122.44 $5.22 $5.22 $5.22 $207.00 $155.25 $5.22 $5.22 $5.22 $29.20 $29.20 $163.94 $5.22 $165.60 $8.61 $7.35 $5.22 $120.06 $207.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200037 EAP CPT® 86003 SHORT RAGWEED BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200038 EAP CPT® 86003 YELLOW DOCK BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200039 EAP CPT® 86003 LAMB'S QUARTERS BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200040 EAP CPT® 86003 PIGWEED BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200041 EAP CPT® 86003 MARSH ELDER BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200042 EAP CPT® 86003 ENGLISH PLANTAIN BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200043 EAP CPT® 86003 COCKLEBUR BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200044 EAP CPT® 86003 BERMUDA GRASS BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200045 EAP CPT® 86003 PERENNIAL RYEGRASS BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200046 EAP CPT® 86003 TIMOTHY BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200047 EAP CPT® 86003 JOHNSON GRASS BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200048 EAP CPT® 86003 BAHIA GRASS BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200049 EAP CPT® 86003 WHITE OAK BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200050 EAP CPT® 86003 ELM BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200051 EAP CPT® 86003 BLACK WALNUT BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200052 EAP CPT® 86003 WHITE ASH BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200053 EAP CPT® 86003 WHITE PINE BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200054 EAP CPT® 86003 PECAN BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200055 EAP CPT® 86003 COTTONWOOD BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200056 EAP CPT® 86003 SYCAMORE BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200058 EAP CPT® 86003 EUCALYPTUS BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200059 EAP CPT® 86003 RED CEDAR BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200060 EAP CPT® 86003 RED MAPLE BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200062 EAP CPT® 86003 DOG HAIR BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200063 EAP CPT® 86003 HORSE HAIR BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200064 EAP CPT® 86003 FEATHER MIX BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200065 EAP CPT® 86003 D.PTERONYSSINUS BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200066 EAP CPT® 86003 D.FARINAE MITE BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200067 EAP CPT® 86003 COCKROACH BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200068 EAP CPT® 86003 PEN. BREVICOMP BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200069 EAP CPT® 86003 "CLADO, HERBARIUM" BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200070 EAP CPT® 86003 CANDIDA ALBICANS BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200071 EAP CPT® 86003 ALTERNARIA TENUIS BOTH IP/OP $168.00 $124.50 $2.61 $168.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $99.37 $5.22 $5.22 $5.22 $168.00 $126.00 $5.22 $5.22 $5.22 $29.20 $29.20 $133.06 $5.22 $134.40 $8.61 $7.35 $5.22 $97.44 $168.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200072 EAP CPT® 86021 PERINUCLEAR AB SCRN BOTH IP/OP $326.00 $241.50 $7.53 $326.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $192.83 $15.05 $15.05 $15.05 $326.00 $244.50 $15.05 $15.05 $15.05 $84.12 $84.12 $258.19 $15.05 $260.80 $24.83 $21.18 $15.05 $189.08 $326.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30200073 EAP CPT® 86021 CYTOPLASMIC AB SCRN BOTH IP/OP $355.00 $263.00 $7.53 $355.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $209.98 $15.05 $15.05 $15.05 $355.00 $266.25 $15.05 $15.05 $15.05 $84.12 $84.12 $281.16 $15.05 $284.00 $24.83 $21.18 $15.05 $205.90 $355.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30200074 EAP CPT® 86022 PLT AB: HLA CLASS 1 BOTH IP/OP $420.00 $311.00 $9.19 $420.00 $420.00 $420.00 $420.00 $420.00 $18.37 $18.37 $9.19 $420.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $420.00 $18.37 $18.37 $18.37 $420.00 $315.00 $18.37 $18.37 $18.37 $102.64 $102.64 $332.64 $18.37 $336.00 $420.00 $420.00 $18.37 $243.60 $420.00 $26.64 $18.37 $420.00 $18.37 N/A N/A 30200075 EAP CPT® 86022 PLT AB: GP IIB/IIIA BOTH IP/OP $420.00 $311.00 $9.19 $420.00 $420.00 $420.00 $420.00 $420.00 $18.37 $18.37 $9.19 $420.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $420.00 $18.37 $18.37 $18.37 $420.00 $315.00 $18.37 $18.37 $18.37 $102.64 $102.64 $332.64 $18.37 $336.00 $420.00 $420.00 $18.37 $243.60 $420.00 $26.64 $18.37 $420.00 $18.37 N/A N/A 30200076 EAP CPT® 86022 PLT AB: GP IB/IX BOTH IP/OP $420.00 $311.00 $9.19 $420.00 $420.00 $420.00 $420.00 $420.00 $18.37 $18.37 $9.19 $420.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $420.00 $18.37 $18.37 $18.37 $420.00 $315.00 $18.37 $18.37 $18.37 $102.64 $102.64 $332.64 $18.37 $336.00 $420.00 $420.00 $18.37 $243.60 $420.00 $26.64 $18.37 $420.00 $18.37 N/A N/A 30200077 EAP CPT® 86022 PLT AB: GP IA/IIB BOTH IP/OP $420.00 $311.00 $9.19 $420.00 $420.00 $420.00 $420.00 $420.00 $18.37 $18.37 $9.19 $420.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $420.00 $18.37 $18.37 $18.37 $420.00 $315.00 $18.37 $18.37 $18.37 $102.64 $102.64 $332.64 $18.37 $336.00 $420.00 $420.00 $18.37 $243.60 $420.00 $26.64 $18.37 $420.00 $18.37 N/A N/A 30200078 EAP CPT® 86022 PLT AB: GP IV BOTH IP/OP $420.00 $311.00 $9.19 $420.00 $420.00 $420.00 $420.00 $420.00 $18.37 $18.37 $9.19 $420.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $420.00 $18.37 $18.37 $18.37 $420.00 $315.00 $18.37 $18.37 $18.37 $102.64 $102.64 $332.64 $18.37 $336.00 $420.00 $420.00 $18.37 $243.60 $420.00 $26.64 $18.37 $420.00 $18.37 N/A N/A 30200079 EAP CPT® 86038 ANA SCREEN BOTH IP/OP $291.00 $215.50 $6.04 $291.00 $23.72 $23.72 $23.72 $23.72 $12.09 $12.09 $6.05 $6.04 $12.09 $18.36 $18.36 $19.06 $13.40 $17.86 $19.34 $19.34 $172.13 $12.09 $12.09 $12.09 $291.00 $218.25 $12.09 $12.09 $12.09 $67.56 $67.56 $230.47 $12.09 $232.80 $19.95 $17.01 $12.09 $168.78 $291.00 $17.53 $12.09 $13.36 $12.09 N/A N/A 30200080 EAP CPT® 86060 STREP ASO BOTH IP/OP $79.00 $58.50 $3.65 $79.00 $13.73 $13.73 $13.73 $13.73 $7.30 $7.30 $3.65 $3.65 $7.30 $10.62 $10.62 $11.03 $7.75 $10.32 $11.68 $11.68 $46.73 $7.30 $7.30 $7.30 $79.00 $59.25 $7.30 $7.30 $7.30 $39.08 $39.08 $62.57 $7.30 $63.20 $12.05 $9.83 $7.30 $45.82 $79.00 $10.59 $7.30 $7.72 $7.30 N/A N/A 30200081 EAP CPT® 86140 C-REACTIVE PROTEIN BOTH IP/OP $235.00 $174.00 $2.59 $235.00 $235.00 $235.00 $235.00 $235.00 $5.18 $5.18 $2.59 $235.00 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $235.00 $5.18 $5.18 $5.18 $235.00 $176.25 $5.18 $5.18 $5.18 $28.92 $28.92 $186.12 $5.18 $188.00 $235.00 $235.00 $5.18 $136.30 $235.00 $7.51 $5.18 $235.00 $5.18 N/A N/A 30200082 EAP CPT® 86141 C-REACTIVE PROTEIN-HS BOTH IP/OP $248.00 $184.00 $6.48 $248.00 $25.40 $25.40 $25.40 $25.40 $12.95 $12.95 $6.48 $6.48 $12.95 $19.67 $19.67 $20.42 $14.36 $19.12 $20.72 $20.72 $146.69 $12.95 $12.95 $12.95 $248.00 $186.00 $12.95 $12.95 $12.95 $72.36 $72.36 $196.42 $12.95 $198.40 $21.37 $18.21 $12.95 $143.84 $248.00 $18.78 $12.95 $14.30 $12.95 N/A N/A 30200083 EAP CPT® 86141 "CRP-HS,MICRO" BOTH IP/OP $250.00 $185.00 $6.48 $250.00 $25.40 $25.40 $25.40 $25.40 $12.95 $12.95 $6.48 $6.48 $12.95 $19.67 $19.67 $20.42 $14.36 $19.12 $20.72 $20.72 $147.88 $12.95 $12.95 $12.95 $250.00 $187.50 $12.95 $12.95 $12.95 $72.36 $72.36 $198.00 $12.95 $200.00 $21.37 $18.21 $12.95 $145.00 $250.00 $18.78 $12.95 $14.30 $12.95 N/A N/A 30200084 EAP CPT® 86160 COMPLEMENT-3C BOTH IP/OP $337.00 $249.50 $6.00 $337.00 $23.54 $23.54 $23.54 $23.54 $12.00 $12.00 $6.00 $6.00 $12.00 $18.23 $18.23 $18.93 $13.31 $17.73 $19.20 $19.20 $199.34 $12.00 $12.00 $12.00 $337.00 $252.75 $12.00 $12.00 $12.00 $67.12 $67.12 $266.90 $12.00 $269.60 $19.80 $16.89 $12.00 $195.46 $337.00 $17.40 $12.00 $13.27 $12.00 N/A N/A 30200085 EAP CPT® 86160 COMPLEMENT-4 BOTH IP/OP $337.00 $249.50 $6.00 $337.00 $23.54 $23.54 $23.54 $23.54 $12.00 $12.00 $6.00 $6.00 $12.00 $18.23 $18.23 $18.93 $13.31 $17.73 $19.20 $19.20 $199.34 $12.00 $12.00 $12.00 $337.00 $252.75 $12.00 $12.00 $12.00 $67.12 $67.12 $266.90 $12.00 $269.60 $19.80 $16.89 $12.00 $195.46 $337.00 $17.40 $12.00 $13.27 $12.00 N/A N/A 30200086 EAP CPT® 86160 "COMPLEMENT-C3,SYNVL" BOTH IP/OP $337.00 $249.50 $6.00 $337.00 $23.54 $23.54 $23.54 $23.54 $12.00 $12.00 $6.00 $6.00 $12.00 $18.23 $18.23 $18.93 $13.31 $17.73 $19.20 $19.20 $199.34 $12.00 $12.00 $12.00 $337.00 $252.75 $12.00 $12.00 $12.00 $67.12 $67.12 $266.90 $12.00 $269.60 $19.80 $16.89 $12.00 $195.46 $337.00 $17.40 $12.00 $13.27 $12.00 N/A N/A 30200087 EAP CPT® 86160 "COMPLEMENT-C4,SYNVL" BOTH IP/OP $337.00 $249.50 $6.00 $337.00 $23.54 $23.54 $23.54 $23.54 $12.00 $12.00 $6.00 $6.00 $12.00 $18.23 $18.23 $18.93 $13.31 $17.73 $19.20 $19.20 $199.34 $12.00 $12.00 $12.00 $337.00 $252.75 $12.00 $12.00 $12.00 $67.12 $67.12 $266.90 $12.00 $269.60 $19.80 $16.89 $12.00 $195.46 $337.00 $17.40 $12.00 $13.27 $12.00 N/A N/A 30200088 EAP CPT® 86162 "COMPLEMENT TOT,CH50" BOTH IP/OP $227.00 $168.00 $10.16 $227.00 $227.00 $227.00 $227.00 $227.00 $20.32 $20.32 $10.16 $227.00 $20.32 $30.86 $30.86 $32.04 $22.53 $30.02 $32.51 $32.51 $227.00 $20.32 $20.32 $20.32 $227.00 $170.25 $20.32 $20.32 $20.32 $113.56 $113.56 $179.78 $20.32 $181.60 $227.00 $227.00 $20.32 $131.66 $227.00 $29.46 $20.32 $227.00 $20.32 N/A N/A 30200089 EAP CPT® 86162 "COMPLEMNT TOT,CH100" BOTH IP/OP $199.00 $147.50 $10.16 $199.00 $199.00 $199.00 $199.00 $199.00 $20.32 $20.32 $10.16 $199.00 $20.32 $30.86 $30.86 $32.04 $22.53 $30.02 $32.51 $32.51 $199.00 $20.32 $20.32 $20.32 $199.00 $149.25 $20.32 $20.32 $20.32 $113.56 $113.56 $157.61 $20.32 $159.20 $199.00 $199.00 $20.32 $115.42 $199.00 $29.46 $20.32 $199.00 $20.32 N/A N/A 30200090 EAP CPT® 86171 FUNGAL SEROLOGY BOTH IP/OP $157.00 $116.50 $5.01 $157.00 $157.00 $157.00 $157.00 $157.00 $10.01 $10.01 $5.01 $157.00 $10.01 $10.62 $10.62 $11.03 $7.75 $10.32 $16.02 $16.02 $157.00 $10.01 $10.01 $10.01 $157.00 $117.75 $10.01 $10.01 $10.01 $39.08 $39.08 $124.34 $10.01 $125.60 $157.00 $157.00 $10.01 $91.06 $157.00 $14.51 $10.01 $157.00 $10.01 N/A N/A 30200091 EAP CPT® 86171 PARASITIC SEROLOGY BOTH IP/OP $157.00 $116.50 $5.01 $157.00 $157.00 $157.00 $157.00 $157.00 $10.01 $10.01 $5.01 $157.00 $10.01 $10.62 $10.62 $11.03 $7.75 $10.32 $16.02 $16.02 $157.00 $10.01 $10.01 $10.01 $157.00 $117.75 $10.01 $10.01 $10.01 $39.08 $39.08 $124.34 $10.01 $125.60 $157.00 $157.00 $10.01 $91.06 $157.00 $14.51 $10.01 $157.00 $10.01 N/A N/A 30200092 EAP CPT® 86171 VIRAL SEROLOGY BOTH IP/OP $157.00 $116.50 $5.01 $157.00 $157.00 $157.00 $157.00 $157.00 $10.01 $10.01 $5.01 $157.00 $10.01 $10.62 $10.62 $11.03 $7.75 $10.32 $16.02 $16.02 $157.00 $10.01 $10.01 $10.01 $157.00 $117.75 $10.01 $10.01 $10.01 $39.08 $39.08 $124.34 $10.01 $125.60 $157.00 $157.00 $10.01 $91.06 $157.00 $14.51 $10.01 $157.00 $10.01 N/A N/A 30200093 EAP CPT® 86171 MISC. SEROLOGY BOTH IP/OP $157.00 $116.50 $5.01 $157.00 $157.00 $157.00 $157.00 $157.00 $10.01 $10.01 $5.01 $157.00 $10.01 $10.62 $10.62 $11.03 $7.75 $10.32 $16.02 $16.02 $157.00 $10.01 $10.01 $10.01 $157.00 $117.75 $10.01 $10.01 $10.01 $39.08 $39.08 $124.34 $10.01 $125.60 $157.00 $157.00 $10.01 $91.06 $157.00 $14.51 $10.01 $157.00 $10.01 N/A N/A 30200094 EAP CPT® 86215 STREP ANTID-NASE B BOTH IP/OP $190.00 $141.00 $6.63 $190.00 $190.00 $190.00 $190.00 $190.00 $13.25 $13.25 $6.63 $190.00 $13.25 $20.12 $20.12 $20.90 $14.69 $19.57 $21.20 $21.20 $190.00 $13.25 $13.25 $13.25 $190.00 $142.50 $13.25 $13.25 $13.25 $74.04 $74.04 $150.48 $13.25 $152.00 $190.00 $190.00 $13.25 $110.20 $190.00 $19.21 $13.25 $190.00 $13.25 N/A N/A 30200095 EAP CPT® 86225 "DS-DNA AB,CRITHIDIA" BOTH IP/OP $291.00 $215.50 $6.87 $291.00 $26.96 $26.96 $26.96 $26.96 $13.74 $13.74 $6.87 $6.87 $13.74 $20.86 $20.86 $21.66 $15.23 $20.30 $21.98 $21.98 $172.13 $13.74 $13.74 $13.74 $291.00 $218.25 $13.74 $13.74 $13.74 $76.80 $76.80 $230.47 $13.74 $232.80 $22.67 $19.33 $13.74 $168.78 $291.00 $19.92 $13.74 $15.18 $13.74 N/A N/A 30200096 EAP CPT® 86225 "DS-DNA AB,EIA" BOTH IP/OP $325.00 $240.50 $6.87 $325.00 $26.96 $26.96 $26.96 $26.96 $13.74 $13.74 $6.87 $6.87 $13.74 $20.86 $20.86 $21.66 $15.23 $20.30 $21.98 $21.98 $192.24 $13.74 $13.74 $13.74 $325.00 $243.75 $13.74 $13.74 $13.74 $76.80 $76.80 $257.40 $13.74 $260.00 $22.67 $19.33 $13.74 $188.50 $325.00 $19.92 $13.74 $15.18 $13.74 N/A N/A 30200097 EAP CPT® 86235 "JO-1 AB SCREEN, EIA" BOTH IP/OP $344.00 $255.00 $8.97 $344.00 $35.19 $35.19 $35.19 $35.19 $17.93 $17.93 $8.97 $8.97 $17.93 $27.23 $27.23 $28.27 $19.88 $26.49 $28.69 $28.69 $203.48 $17.93 $17.93 $17.93 $344.00 $258.00 $17.93 $17.93 $17.93 $100.24 $100.24 $272.45 $17.93 $275.20 $29.58 $25.23 $17.93 $199.52 $344.00 $26.00 $17.93 $19.82 $17.93 N/A N/A 30200098 EAP CPT® 86235 "SCL-70 AB SCREEN, EIA" BOTH IP/OP $344.00 $255.00 $8.97 $344.00 $35.19 $35.19 $35.19 $35.19 $17.93 $17.93 $8.97 $8.97 $17.93 $27.23 $27.23 $28.27 $19.88 $26.49 $28.69 $28.69 $203.48 $17.93 $17.93 $17.93 $344.00 $258.00 $17.93 $17.93 $17.93 $100.24 $100.24 $272.45 $17.93 $275.20 $29.58 $25.23 $17.93 $199.52 $344.00 $26.00 $17.93 $19.82 $17.93 N/A N/A 30200099 EAP CPT® 86235 ANTICENTROMERE SCRN BOTH IP/OP $344.00 $255.00 $8.97 $344.00 $35.19 $35.19 $35.19 $35.19 $17.93 $17.93 $8.97 $8.97 $17.93 $27.23 $27.23 $28.27 $19.88 $26.49 $28.69 $28.69 $203.48 $17.93 $17.93 $17.93 $344.00 $258.00 $17.93 $17.93 $17.93 $100.24 $100.24 $272.45 $17.93 $275.20 $29.58 $25.23 $17.93 $199.52 $344.00 $26.00 $17.93 $19.82 $17.93 N/A N/A 30200100 EAP CPT® 86235 SMITH (SM) AB SCREEN BOTH IP/OP $325.00 $240.50 $8.97 $325.00 $35.19 $35.19 $35.19 $35.19 $17.93 $17.93 $8.97 $8.97 $17.93 $27.23 $27.23 $28.27 $19.88 $26.49 $28.69 $28.69 $192.24 $17.93 $17.93 $17.93 $325.00 $243.75 $17.93 $17.93 $17.93 $100.24 $100.24 $257.40 $17.93 $260.00 $29.58 $25.23 $17.93 $188.50 $325.00 $26.00 $17.93 $19.82 $17.93 N/A N/A 30200101 EAP CPT® 86235 RNP AB SCREEN BOTH IP/OP $325.00 $240.50 $8.97 $325.00 $35.19 $35.19 $35.19 $35.19 $17.93 $17.93 $8.97 $8.97 $17.93 $27.23 $27.23 $28.27 $19.88 $26.49 $28.69 $28.69 $192.24 $17.93 $17.93 $17.93 $325.00 $243.75 $17.93 $17.93 $17.93 $100.24 $100.24 $257.40 $17.93 $260.00 $29.58 $25.23 $17.93 $188.50 $325.00 $26.00 $17.93 $19.82 $17.93 N/A N/A 30200102 EAP CPT® 86235 SSA (RO) AB SCREEN BOTH IP/OP $325.00 $240.50 $8.97 $325.00 $35.19 $35.19 $35.19 $35.19 $17.93 $17.93 $8.97 $8.97 $17.93 $27.23 $27.23 $28.27 $19.88 $26.49 $28.69 $28.69 $192.24 $17.93 $17.93 $17.93 $325.00 $243.75 $17.93 $17.93 $17.93 $100.24 $100.24 $257.40 $17.93 $260.00 $29.58 $25.23 $17.93 $188.50 $325.00 $26.00 $17.93 $19.82 $17.93 N/A N/A 30200103 EAP CPT® 86235 SSB (LA) AB SCREEN BOTH IP/OP $325.00 $240.50 $8.97 $325.00 $35.19 $35.19 $35.19 $35.19 $17.93 $17.93 $8.97 $8.97 $17.93 $27.23 $27.23 $28.27 $19.88 $26.49 $28.69 $28.69 $192.24 $17.93 $17.93 $17.93 $325.00 $243.75 $17.93 $17.93 $17.93 $100.24 $100.24 $257.40 $17.93 $260.00 $29.58 $25.23 $17.93 $188.50 $325.00 $26.00 $17.93 $19.82 $17.93 N/A N/A 30200104 EAP CPT® 86255 PERINUCLEAR AB BOTH IP/OP $50.00 $37.00 $6.03 $50.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $29.58 $12.05 $12.05 $12.05 $50.00 $37.50 $12.05 $12.05 $12.05 $50.00 $50.00 $39.60 $12.05 $40.00 $19.88 $16.96 $12.05 $29.00 $50.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30200105 EAP CPT® 86255 SMOOTH MUSCLE AB BOTH IP/OP $59.00 $44.00 $6.03 $59.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $34.90 $12.05 $12.05 $12.05 $59.00 $44.25 $12.05 $12.05 $12.05 $59.00 $59.00 $46.73 $12.05 $47.20 $19.88 $16.96 $12.05 $34.22 $59.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30200106 EAP CPT® 86255 PARIETAL CELL AB BOTH IP/OP $59.00 $44.00 $6.03 $59.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $34.90 $12.05 $12.05 $12.05 $59.00 $44.25 $12.05 $12.05 $12.05 $59.00 $59.00 $46.73 $12.05 $47.20 $19.88 $16.96 $12.05 $34.22 $59.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30200107 EAP CPT® 86256 ADRENAL AB SCREEN BOTH IP/OP $88.00 $65.50 $6.03 $88.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $52.05 $12.05 $12.05 $12.05 $88.00 $66.00 $12.05 $12.05 $12.05 $67.36 $67.36 $69.70 $12.05 $70.40 $19.88 $16.96 $12.05 $51.04 $88.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30200108 EAP CPT® 86256 BASEMENT MEM AB SCRN BOTH IP/OP $88.00 $65.50 $6.03 $88.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $52.05 $12.05 $12.05 $12.05 $88.00 $66.00 $12.05 $12.05 $12.05 $67.36 $67.36 $69.70 $12.05 $70.40 $19.88 $16.96 $12.05 $51.04 $88.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30200109 EAP CPT® 86256 RMSF ANTIBODY IGG BOTH IP/OP $88.00 $65.50 $6.03 $88.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $52.05 $12.05 $12.05 $12.05 $88.00 $66.00 $12.05 $12.05 $12.05 $67.36 $67.36 $69.70 $12.05 $70.40 $19.88 $16.96 $12.05 $51.04 $88.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30200110 EAP CPT® 86256 RMSF ANTIBODY IGM BOTH IP/OP $88.00 $65.50 $6.03 $88.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $52.05 $12.05 $12.05 $12.05 $88.00 $66.00 $12.05 $12.05 $12.05 $67.36 $67.36 $69.70 $12.05 $70.40 $19.88 $16.96 $12.05 $51.04 $88.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30200111 EAP CPT® 86300 CANCER ANTIGEN 15-3 BOTH IP/OP $143.00 $106.00 $10.41 $143.00 $40.84 $40.84 $40.84 $40.84 $20.81 $20.81 $10.41 $10.41 $20.81 $31.60 $31.60 $32.81 $23.06 $30.73 $33.30 $33.30 $84.58 $20.81 $20.81 $20.81 $143.00 $107.25 $20.81 $20.81 $20.81 $116.28 $116.28 $113.26 $20.81 $114.40 $34.34 $29.27 $20.81 $82.94 $143.00 $30.17 $20.81 $22.99 $20.81 N/A N/A 30200112 EAP CPT® 86300 CANCER AG 27-29 BOTH IP/OP $143.00 $106.00 $10.41 $143.00 $40.84 $40.84 $40.84 $40.84 $20.81 $20.81 $10.41 $10.41 $20.81 $31.60 $31.60 $32.81 $23.06 $30.73 $33.30 $33.30 $84.58 $20.81 $20.81 $20.81 $143.00 $107.25 $20.81 $20.81 $20.81 $116.28 $116.28 $113.26 $20.81 $114.40 $34.34 $29.27 $20.81 $82.94 $143.00 $30.17 $20.81 $22.99 $20.81 N/A N/A 30200113 EAP CPT® 86301 CARBOHYDRATE AG 19-9 BOTH IP/OP $206.00 $152.50 $10.41 $206.00 $40.84 $40.84 $40.84 $40.84 $20.81 $20.81 $10.41 $10.41 $20.81 $31.60 $31.60 $32.81 $23.06 $30.73 $33.30 $33.30 $121.85 $20.81 $20.81 $20.81 $206.00 $154.50 $20.81 $20.81 $20.81 $116.28 $116.28 $163.15 $20.81 $164.80 $34.34 $29.27 $20.81 $119.48 $206.00 $30.17 $20.81 $22.99 $20.81 N/A N/A 30200114 EAP CPT® 86308 INFECT MONO SCREEN BOTH IP/OP $203.00 $150.50 $2.59 $203.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $120.07 $5.18 $5.18 $5.18 $203.00 $152.25 $5.18 $5.18 $5.18 $28.92 $28.92 $160.78 $5.18 $162.40 $8.55 $7.28 $5.18 $117.74 $203.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30200115 EAP CPT® 86304 CA-125 IMMUNOASSAY TUMOR ANTIGEN BOTH IP/OP $529.00 $391.50 $10.41 $529.00 $40.84 $40.84 $40.84 $40.84 $20.81 $20.81 $10.41 $10.41 $20.81 $31.60 $31.60 $32.81 $23.06 $30.73 $33.30 $33.30 $312.90 $20.81 $20.81 $20.81 $529.00 $396.75 $20.81 $20.81 $20.81 $116.28 $116.28 $418.97 $20.81 $423.20 $34.34 $29.27 $20.81 $306.82 $529.00 $30.17 $20.81 $22.99 $20.81 N/A N/A 30200116 EAP CPT® 86317 DIPHTHERIA AB BOTH IP/OP $248.00 $184.00 $7.49 $248.00 $23.57 $23.57 $23.57 $23.57 $14.99 $14.99 $7.50 $7.49 $14.99 $18.22 $18.22 $18.92 $13.30 $17.72 $23.98 $23.98 $146.69 $14.99 $14.99 $14.99 $248.00 $186.00 $14.99 $14.99 $14.99 $67.08 $67.08 $196.42 $14.99 $198.40 $24.73 $16.88 $14.99 $143.84 $248.00 $21.74 $14.99 $13.26 $14.99 N/A N/A 30200117 EAP CPT® 86317 DNP ANTIBODY BOTH IP/OP $225.00 $166.50 $7.49 $225.00 $23.57 $23.57 $23.57 $23.57 $14.99 $14.99 $7.50 $7.49 $14.99 $18.22 $18.22 $18.92 $13.30 $17.72 $23.98 $23.98 $133.09 $14.99 $14.99 $14.99 $225.00 $168.75 $14.99 $14.99 $14.99 $67.08 $67.08 $178.20 $14.99 $180.00 $24.73 $16.88 $14.99 $130.50 $225.00 $21.74 $14.99 $13.26 $14.99 N/A N/A 30200118 EAP CPT® 86329 HYPERSENS PNEUMO SCR BOTH IP/OP $204.00 $151.00 $7.02 $204.00 $27.56 $27.56 $27.56 $27.56 $14.05 $14.05 $7.03 $7.02 $14.05 $21.33 $21.33 $22.15 $15.57 $20.75 $22.48 $22.48 $120.67 $14.05 $14.05 $14.05 $204.00 $153.00 $14.05 $14.05 $14.05 $78.48 $78.48 $161.57 $14.05 $163.20 $23.18 $19.76 $14.05 $118.32 $204.00 $20.37 $14.05 $15.52 $14.05 N/A N/A 30200119 EAP CPT® 86332 IMMUNE COMPLEX(C1Q) BOTH IP/OP $116.00 $86.00 $12.19 $116.00 $47.84 $47.84 $47.84 $47.84 $24.37 $24.37 $12.19 $12.19 $24.37 $37.01 $37.01 $38.44 $27.02 $36.00 $38.99 $38.99 $68.61 $24.37 $24.37 $24.37 $116.00 $87.00 $24.37 $24.37 $24.37 $116.00 $116.00 $91.87 $24.37 $92.80 $40.21 $34.29 $24.37 $67.28 $116.00 $35.34 $24.37 $26.93 $24.37 N/A N/A 30200120 EAP CPT® 86334 "IMMUNOFIXATION,SER" BOTH IP/OP $439.00 $325.00 $11.17 $439.00 $43.85 $43.85 $43.85 $43.85 $22.34 $22.34 $11.17 $11.17 $22.34 $33.92 $33.92 $35.23 $24.76 $33.00 $35.74 $35.74 $259.67 $22.34 $22.34 $22.34 $439.00 $329.25 $22.34 $22.34 $22.34 $124.84 $124.84 $347.69 $22.34 $351.20 $36.86 $31.43 $22.34 $254.62 $439.00 $32.39 $22.34 $24.69 $22.34 N/A N/A 30200121 EAP CPT® 86335 "IMMUNOFIXATION,URINE" BOTH IP/OP $462.00 $342.00 $14.67 $462.00 $57.60 $57.60 $57.60 $57.60 $29.35 $29.35 $14.68 $14.67 $29.35 $44.56 $44.56 $46.28 $32.53 $43.34 $46.96 $46.96 $273.27 $29.35 $29.35 $29.35 $462.00 $346.50 $29.35 $29.35 $29.35 $164.00 $164.00 $365.90 $29.35 $369.60 $48.43 $41.28 $29.35 $267.96 $462.00 $42.56 $29.35 $32.43 $29.35 N/A N/A 30200122 EAP CPT® 86336 INHIBIN-A BOTH IP/OP $77.00 $57.00 $7.79 $77.00 $25.43 $25.43 $25.43 $25.43 $15.59 $15.59 $7.80 $7.79 $15.59 $19.66 $19.66 $20.41 $14.35 $19.12 $24.94 $24.94 $45.55 $15.59 $15.59 $15.59 $77.00 $57.75 $15.59 $15.59 $15.59 $72.36 $72.36 $60.98 $15.59 $61.60 $25.72 $18.21 $15.59 $44.66 $77.00 $22.61 $15.59 $14.30 $15.59 N/A N/A 30200123 EAP CPT® 86337 INSULIN AUTO AB BOTH IP/OP $235.00 $174.00 $10.71 $235.00 $42.02 $42.02 $42.02 $42.02 $21.41 $21.41 $10.71 $10.71 $21.41 $32.52 $32.52 $33.77 $23.74 $31.64 $34.26 $34.26 $139.00 $21.41 $21.41 $21.41 $235.00 $176.25 $21.41 $21.41 $21.41 $119.68 $119.68 $186.12 $21.41 $188.00 $35.33 $30.13 $21.41 $136.30 $235.00 $31.04 $21.41 $23.67 $21.41 N/A N/A 30200124 EAP CPT® 86340 INTRINSIC FACTOR AB BOTH IP/OP $230.00 $170.50 $7.54 $230.00 $29.59 $29.59 $29.59 $29.59 $15.08 $15.08 $7.54 $7.54 $15.08 $22.89 $22.89 $23.77 $16.71 $22.26 $24.13 $24.13 $136.05 $15.08 $15.08 $15.08 $230.00 $172.50 $15.08 $15.08 $15.08 $84.24 $84.24 $182.16 $15.08 $184.00 $24.88 $21.20 $15.08 $133.40 $230.00 $21.87 $15.08 $16.65 $15.08 N/A N/A 30200125 EAP CPT® 86341 PANCREATIC ISLET AB BOTH IP/OP $81.00 $60.00 $10.61 $81.00 $38.83 $38.83 $38.83 $38.83 $23.57 $23.57 $11.79 $10.61 $23.57 $30.05 $30.05 $31.20 $21.93 $29.24 $37.71 $37.71 $47.91 $23.57 $23.57 $23.57 $81.00 $60.75 $23.57 $23.57 $23.57 $81.00 $81.00 $64.15 $23.57 $64.80 $38.89 $27.85 $23.57 $46.98 $81.00 $34.18 $23.57 $21.88 $23.57 N/A N/A 30200126 EAP CPT® 86344 PHAGOCYTIC CHARGE BOTH IP/OP $517.00 $383.00 $5.20 $517.00 $517.00 $517.00 $517.00 $517.00 $10.39 $10.39 $5.20 $517.00 $10.39 $12.13 $12.13 $12.59 $8.85 $11.79 $16.62 $16.62 $517.00 $10.39 $10.39 $10.39 $517.00 $387.75 $10.39 $10.39 $10.39 $44.64 $44.64 $409.46 $10.39 $413.60 $517.00 $517.00 $10.39 $299.86 $517.00 $15.07 $10.39 $517.00 $10.39 N/A N/A 30200127 EAP CPT® 86359 "CD3, TOTAL T%" BOTH IP/OP $230.00 $170.50 $18.86 $230.00 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $136.05 $37.73 $37.73 $37.73 $230.00 $172.50 $37.73 $37.73 $37.73 $131.64 $131.64 $182.16 $37.73 $184.00 $62.25 $33.14 $37.73 $133.40 $230.00 $54.71 $37.73 $26.03 $37.73 N/A N/A 30200128 EAP CPT® 86360 LYMPH SUBSETS:CD4&CD8 BOTH IP/OP $495.00 $366.50 $23.49 $495.00 $92.22 $92.22 $92.22 $92.22 $46.98 $46.98 $23.49 $23.49 $46.98 $71.34 $71.34 $74.09 $52.08 $69.42 $75.17 $75.17 $292.79 $46.98 $46.98 $46.98 $495.00 $371.25 $46.98 $46.98 $46.98 $262.60 $262.60 $392.04 $46.98 $396.00 $77.52 $66.11 $46.98 $287.10 $495.00 $68.12 $46.98 $51.93 $46.98 N/A N/A 30200129 EAP CPT® 86376 L-K MICROSOMAL AB BOTH IP/OP $295.00 $218.50 $7.28 $295.00 $28.56 $28.56 $28.56 $28.56 $14.55 $14.55 $7.28 $7.28 $14.55 $22.10 $22.10 $22.95 $16.13 $21.49 $23.28 $23.28 $174.49 $14.55 $14.55 $14.55 $295.00 $221.25 $14.55 $14.55 $14.55 $81.32 $81.32 $233.64 $14.55 $236.00 $24.01 $20.47 $14.55 $171.10 $295.00 $21.10 $14.55 $16.08 $14.55 N/A N/A 30200130 EAP CPT® 86376 MICROSOMAL AB BOTH IP/OP $315.00 $233.50 $7.28 $315.00 $28.56 $28.56 $28.56 $28.56 $14.55 $14.55 $7.28 $7.28 $14.55 $22.10 $22.10 $22.95 $16.13 $21.49 $23.28 $23.28 $186.32 $14.55 $14.55 $14.55 $315.00 $236.25 $14.55 $14.55 $14.55 $81.32 $81.32 $249.48 $14.55 $252.00 $24.01 $20.47 $14.55 $182.70 $315.00 $21.10 $14.55 $16.08 $14.55 N/A N/A 30200131 EAP CPT® 86403 RAPID STREP TEST BOTH IP/OP $204.00 $151.00 $5.19 $204.00 $20.00 $20.00 $20.00 $20.00 $11.54 $11.54 $5.77 $5.19 $11.54 $15.48 $15.48 $16.07 $11.30 $11.75 $18.46 $18.46 $120.67 $11.54 $11.54 $11.54 $204.00 $153.00 $11.54 $11.54 $11.54 $56.96 $56.96 $161.57 $11.54 $163.20 $19.04 $11.19 $11.54 $118.32 $204.00 $16.73 $11.54 $8.79 $11.54 N/A N/A 30200132 EAP CPT® 86403 CRYPTO.ANTIGEN SCRN BOTH IP/OP $204.00 $151.00 $5.19 $204.00 $20.00 $20.00 $20.00 $20.00 $11.54 $11.54 $5.77 $5.19 $11.54 $15.48 $15.48 $16.07 $11.30 $11.75 $18.46 $18.46 $120.67 $11.54 $11.54 $11.54 $204.00 $153.00 $11.54 $11.54 $11.54 $56.96 $56.96 $161.57 $11.54 $163.20 $19.04 $11.19 $11.54 $118.32 $204.00 $16.73 $11.54 $8.79 $11.54 N/A N/A 30200133 EAP CPT® 86403 "CRYPTO.AG,CSF-QUAL" BOTH IP/OP $204.00 $151.00 $5.19 $204.00 $20.00 $20.00 $20.00 $20.00 $11.54 $11.54 $5.77 $5.19 $11.54 $15.48 $15.48 $16.07 $11.30 $11.75 $18.46 $18.46 $120.67 $11.54 $11.54 $11.54 $204.00 $153.00 $11.54 $11.54 $11.54 $56.96 $56.96 $161.57 $11.54 $163.20 $19.04 $11.19 $11.54 $118.32 $204.00 $16.73 $11.54 $8.79 $11.54 N/A N/A 30200134 EAP CPT® 86403 "H.FLU AG,URINE" BOTH IP/OP $196.00 $145.50 $5.19 $196.00 $20.00 $20.00 $20.00 $20.00 $11.54 $11.54 $5.77 $5.19 $11.54 $15.48 $15.48 $16.07 $11.30 $11.75 $18.46 $18.46 $115.93 $11.54 $11.54 $11.54 $196.00 $147.00 $11.54 $11.54 $11.54 $56.96 $56.96 $155.23 $11.54 $156.80 $19.04 $11.19 $11.54 $113.68 $196.00 $16.73 $11.54 $8.79 $11.54 N/A N/A 30200135 EAP CPT® 86403 "N.MENING AG,URINE" BOTH IP/OP $196.00 $145.50 $5.19 $196.00 $20.00 $20.00 $20.00 $20.00 $11.54 $11.54 $5.77 $5.19 $11.54 $15.48 $15.48 $16.07 $11.30 $11.75 $18.46 $18.46 $115.93 $11.54 $11.54 $11.54 $196.00 $147.00 $11.54 $11.54 $11.54 $56.96 $56.96 $155.23 $11.54 $156.80 $19.04 $11.19 $11.54 $113.68 $196.00 $16.73 $11.54 $8.79 $11.54 N/A N/A 30200136 EAP CPT® 86403 "ST.PNEUMO AG,URINE" BOTH IP/OP $196.00 $145.50 $5.19 $196.00 $20.00 $20.00 $20.00 $20.00 $11.54 $11.54 $5.77 $5.19 $11.54 $15.48 $15.48 $16.07 $11.30 $11.75 $18.46 $18.46 $115.93 $11.54 $11.54 $11.54 $196.00 $147.00 $11.54 $11.54 $11.54 $56.96 $56.96 $155.23 $11.54 $156.80 $19.04 $11.19 $11.54 $113.68 $196.00 $16.73 $11.54 $8.79 $11.54 N/A N/A 30200137 EAP CPT® 86403 "STREP-B AG,URINE" BOTH IP/OP $196.00 $145.50 $5.19 $196.00 $20.00 $20.00 $20.00 $20.00 $11.54 $11.54 $5.77 $5.19 $11.54 $15.48 $15.48 $16.07 $11.30 $11.75 $18.46 $18.46 $115.93 $11.54 $11.54 $11.54 $196.00 $147.00 $11.54 $11.54 $11.54 $56.96 $56.96 $155.23 $11.54 $156.80 $19.04 $11.19 $11.54 $113.68 $196.00 $16.73 $11.54 $8.79 $11.54 N/A N/A 30200138 EAP CPT® 86406 "CRYPTO.AG,CSF-QUANT" BOTH IP/OP $244.00 $181.00 $5.32 $244.00 $20.88 $20.88 $20.88 $20.88 $10.64 $10.64 $5.32 $5.32 $10.64 $16.15 $16.15 $16.77 $11.79 $15.72 $17.02 $17.02 $144.33 $10.64 $10.64 $10.64 $244.00 $183.00 $10.64 $10.64 $10.64 $59.48 $59.48 $193.25 $10.64 $195.20 $17.56 $14.97 $10.64 $141.52 $244.00 $15.43 $10.64 $11.76 $10.64 N/A N/A 30200139 EAP CPT® 86406 "CRYPTO.AG,BLD-QUANT" BOTH IP/OP $244.00 $181.00 $5.32 $244.00 $20.88 $20.88 $20.88 $20.88 $10.64 $10.64 $5.32 $5.32 $10.64 $16.15 $16.15 $16.77 $11.79 $15.72 $17.02 $17.02 $144.33 $10.64 $10.64 $10.64 $244.00 $183.00 $10.64 $10.64 $10.64 $59.48 $59.48 $193.25 $10.64 $195.20 $17.56 $14.97 $10.64 $141.52 $244.00 $15.43 $10.64 $11.76 $10.64 N/A N/A 30200140 EAP CPT® 86431 "RHEUMATOID FACTOR, BLD" BOTH IP/OP $183.00 $135.50 $2.84 $183.00 $11.12 $11.12 $11.12 $11.12 $5.67 $5.67 $2.84 $2.84 $5.67 $8.62 $8.62 $8.95 $6.29 $8.39 $9.07 $9.07 $108.24 $5.67 $5.67 $5.67 $183.00 $137.25 $5.67 $5.67 $5.67 $31.72 $31.72 $144.94 $5.67 $146.40 $9.36 $7.99 $5.67 $106.14 $183.00 $8.22 $5.67 $6.28 $5.67 N/A N/A 30200141 EAP CPT® 86431 "RHEUMATOID FACTOR, SYN FLD" BOTH IP/OP $183.00 $135.50 $2.84 $183.00 $11.12 $11.12 $11.12 $11.12 $5.67 $5.67 $2.84 $2.84 $5.67 $8.62 $8.62 $8.95 $6.29 $8.39 $9.07 $9.07 $108.24 $5.67 $5.67 $5.67 $183.00 $137.25 $5.67 $5.67 $5.67 $31.72 $31.72 $144.94 $5.67 $146.40 $9.36 $7.99 $5.67 $106.14 $183.00 $8.22 $5.67 $6.28 $5.67 N/A N/A 30200145 EAP CPT® 86357 NATURAL KILLER CELLLS SO BOTH IP/OP $85.00 $63.00 $18.87 $85.00 $85.00 $85.00 $85.00 $85.00 $37.73 $37.73 $18.87 $85.00 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $85.00 $37.73 $37.73 $37.73 $85.00 $63.75 $37.73 $37.73 $37.73 $85.00 $85.00 $67.32 $37.73 $68.00 $85.00 $85.00 $37.73 $49.30 $85.00 $54.71 $37.73 $85.00 $37.73 N/A N/A 30200146 EAP CPT® 86341 IA-2 AB (SO) BOTH IP/OP $193.00 $143.00 $10.61 $193.00 $38.83 $38.83 $38.83 $38.83 $23.57 $23.57 $11.79 $10.61 $23.57 $30.05 $30.05 $31.20 $21.93 $29.24 $37.71 $37.71 $114.16 $23.57 $23.57 $23.57 $193.00 $144.75 $23.57 $23.57 $23.57 $110.60 $110.60 $152.86 $23.57 $154.40 $38.89 $27.85 $23.57 $111.94 $193.00 $34.18 $23.57 $21.88 $23.57 N/A N/A 30200147 EAP CPT® 86355 LYMPH SUBSET B CELL TOT (SO) BOTH IP/OP $206.00 $152.50 $18.86 $206.00 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $121.85 $37.73 $37.73 $37.73 $206.00 $154.50 $37.73 $37.73 $37.73 $131.64 $131.64 $163.15 $37.73 $164.80 $62.25 $33.14 $37.73 $119.48 $206.00 $54.71 $37.73 $26.03 $37.73 N/A N/A 30200148 EAP CPT® 86357 LYMPH SUBSET NK CELL TOT (SO) BOTH IP/OP $196.00 $145.50 $18.87 $196.00 $196.00 $196.00 $196.00 $196.00 $37.73 $37.73 $18.87 $196.00 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $196.00 $37.73 $37.73 $37.73 $196.00 $147.00 $37.73 $37.73 $37.73 $131.64 $131.64 $155.23 $37.73 $156.80 $196.00 $196.00 $37.73 $113.68 $196.00 $54.71 $37.73 $196.00 $37.73 N/A N/A 30200149 EAP CPT® 86580 "PPD, TB SKIN" BOTH IP/OP $89.00 $66.00 $3.89 $71.20 $11.82 $11.82 $11.82 $11.82 $24.30 $24.30 $24.19 $3.89 $24.30 $7.48 $7.48 $7.77 $5.46 $9.56 $38.88 $36.00 $52.64 $24.30 $10.15 $24.30 $25.52 $66.75 $24.30 $24.30 $24.30 $40.92 $40.92 $70.49 $24.30 $71.20 $57.85 $9.10 $24.30 $51.62 $25.52 $35.16 $24.30 $7.15 $24.30 N/A N/A 30200150 EAP CPT® 86780 FTA - ABS BOTH IP/OP $215.00 $159.50 $6.62 $215.00 $25.98 $25.98 $25.98 $25.98 $13.24 $13.24 $6.62 $6.62 $13.24 $19.73 $19.73 $20.49 $14.40 $44.81 $21.18 $21.18 $127.17 $13.24 $13.24 $13.24 $215.00 $161.25 $13.24 $13.24 $13.24 $107.50 $107.50 $170.28 $13.24 $172.00 $21.85 $42.67 $13.24 $124.70 $215.00 $19.20 $13.24 $44.81 $13.24 N/A N/A 30200157 EAP CPT® 86592 RPR (QUAL) BOTH IP/OP $153.00 $113.50 $2.14 $153.00 $8.38 $8.38 $8.38 $8.38 $4.27 $4.27 $2.14 $2.14 $4.27 $6.48 $6.48 $6.73 $4.73 $5.46 $6.83 $6.83 $90.50 $4.27 $4.27 $4.27 $153.00 $114.75 $4.27 $4.27 $4.27 $8.56 $8.56 $121.18 $4.27 $122.40 $7.05 $5.20 $4.27 $88.74 $153.00 $6.19 $4.27 $4.08 $4.27 N/A N/A 30200158 EAP CPT® 86592 "RPR(QUAL),CAPILLARY" BOTH IP/OP $139.00 $103.00 $2.14 $139.00 $8.38 $8.38 $8.38 $8.38 $4.27 $4.27 $2.14 $2.14 $4.27 $6.48 $6.48 $6.73 $4.73 $5.46 $6.83 $6.83 $82.22 $4.27 $4.27 $4.27 $139.00 $104.25 $4.27 $4.27 $4.27 $8.56 $8.56 $110.09 $4.27 $111.20 $7.05 $5.20 $4.27 $80.62 $139.00 $6.19 $4.27 $4.08 $4.27 N/A N/A 30200159 EAP CPT® 86592 "VDRL,CSF" BOTH IP/OP $153.00 $113.50 $2.14 $153.00 $8.38 $8.38 $8.38 $8.38 $4.27 $4.27 $2.14 $2.14 $4.27 $6.48 $6.48 $6.73 $4.73 $5.46 $6.83 $6.83 $90.50 $4.27 $4.27 $4.27 $153.00 $114.75 $4.27 $4.27 $4.27 $8.56 $8.56 $121.18 $4.27 $122.40 $7.05 $5.20 $4.27 $88.74 $153.00 $6.19 $4.27 $4.08 $4.27 N/A N/A 30200160 EAP CPT® 86593 "VDRL-CSF,QUANT" BOTH IP/OP $153.00 $113.50 $2.20 $153.00 $8.63 $8.63 $8.63 $8.63 $4.40 $4.40 $2.20 $2.20 $4.40 $6.69 $6.69 $6.94 $4.88 $31.89 $7.04 $7.04 $90.50 $4.40 $4.40 $4.40 $153.00 $114.75 $4.40 $4.40 $4.40 $24.64 $24.64 $121.18 $4.40 $122.40 $7.26 $30.37 $4.40 $88.74 $153.00 $6.38 $4.40 $31.89 $4.40 N/A N/A 30200161 EAP CPT® 86593 RPR (QUANT) BOTH IP/OP $153.00 $113.50 $2.20 $153.00 $8.63 $8.63 $8.63 $8.63 $4.40 $4.40 $2.20 $2.20 $4.40 $6.69 $6.69 $6.94 $4.88 $31.89 $7.04 $7.04 $90.50 $4.40 $4.40 $4.40 $153.00 $114.75 $4.40 $4.40 $4.40 $24.64 $24.64 $121.18 $4.40 $122.40 $7.26 $30.37 $4.40 $88.74 $153.00 $6.38 $4.40 $31.89 $4.40 N/A N/A 30200162 EAP CPT® 86606 ASPERGILLUS FUMIGATUS BOTH IP/OP $47.00 $35.00 $7.53 $47.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $27.80 $15.05 $15.05 $15.05 $47.00 $35.25 $15.05 $15.05 $15.05 $47.00 $47.00 $37.22 $15.05 $37.60 $24.83 $21.18 $15.05 $27.26 $47.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30200163 EAP CPT® 86611 B.HENSELAE IGG BOTH IP/OP $80.00 $59.50 $5.09 $80.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $47.32 $10.18 $10.18 $10.18 $80.00 $60.00 $10.18 $10.18 $10.18 $56.88 $56.88 $63.36 $10.18 $64.00 $16.80 $14.32 $10.18 $46.40 $80.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30200164 EAP CPT® 86611 B.HENSELAE IGM BOTH IP/OP $80.00 $59.50 $5.09 $80.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $47.32 $10.18 $10.18 $10.18 $80.00 $60.00 $10.18 $10.18 $10.18 $56.88 $56.88 $63.36 $10.18 $64.00 $16.80 $14.32 $10.18 $46.40 $80.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30200165 EAP CPT® 86611 B.QUINTANA IGG BOTH IP/OP $80.00 $59.50 $5.09 $80.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $47.32 $10.18 $10.18 $10.18 $80.00 $60.00 $10.18 $10.18 $10.18 $56.88 $56.88 $63.36 $10.18 $64.00 $16.80 $14.32 $10.18 $46.40 $80.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30200166 EAP CPT® 86611 B.QUINTANA IGM BOTH IP/OP $80.00 $59.50 $5.09 $80.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $47.32 $10.18 $10.18 $10.18 $80.00 $60.00 $10.18 $10.18 $10.18 $56.88 $56.88 $63.36 $10.18 $64.00 $16.80 $14.32 $10.18 $46.40 $80.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30200167 EAP CPT® 86617 LYME AB WESTERNBLOT BOTH IP/OP $103.00 $76.50 $7.75 $103.00 $103.00 $103.00 $103.00 $103.00 $15.49 $15.49 $7.75 $103.00 $15.49 $23.51 $23.51 $24.42 $17.17 $22.88 $24.78 $24.78 $103.00 $15.49 $15.49 $15.49 $103.00 $77.25 $15.49 $15.49 $15.49 $86.56 $86.56 $81.58 $15.49 $82.40 $103.00 $103.00 $15.49 $59.74 $103.00 $22.46 $15.49 $103.00 $15.49 N/A N/A 30200168 EAP CPT® 86618 LYME AB TOTAL BOTH IP/OP $357.00 $264.50 $8.51 $357.00 $33.43 $33.43 $33.43 $33.43 $17.03 $17.03 $8.52 $8.51 $17.03 $25.86 $25.86 $26.86 $18.88 $25.16 $27.25 $27.25 $211.17 $17.03 $17.03 $17.03 $357.00 $267.75 $17.03 $17.03 $17.03 $95.20 $95.20 $282.74 $17.03 $285.60 $28.10 $23.96 $17.03 $207.06 $357.00 $24.69 $17.03 $18.82 $17.03 N/A N/A 30200169 EAP CPT® 86618 LYME AB-IGM BOTH IP/OP $361.00 $267.50 $8.51 $361.00 $33.43 $33.43 $33.43 $33.43 $17.03 $17.03 $8.52 $8.51 $17.03 $25.86 $25.86 $26.86 $18.88 $25.16 $27.25 $27.25 $213.53 $17.03 $17.03 $17.03 $361.00 $270.75 $17.03 $17.03 $17.03 $95.20 $95.20 $285.91 $17.03 $288.80 $28.10 $23.96 $17.03 $209.38 $361.00 $24.69 $17.03 $18.82 $17.03 N/A N/A 30200170 EAP CPT® 86622 B. ABORTUS IGG BOTH IP/OP $131.00 $97.00 $4.46 $131.00 $17.52 $17.52 $17.52 $17.52 $8.93 $8.93 $4.47 $4.46 $8.93 $13.57 $13.57 $14.09 $9.91 $13.19 $14.29 $14.29 $77.49 $8.93 $8.93 $8.93 $131.00 $98.25 $8.93 $8.93 $8.93 $49.92 $49.92 $103.75 $8.93 $104.80 $14.73 $12.56 $8.93 $75.98 $131.00 $12.95 $8.93 $9.87 $8.93 N/A N/A 30200171 EAP CPT® 86622 B. ABORTUS IGM BOTH IP/OP $131.00 $97.00 $4.46 $131.00 $17.52 $17.52 $17.52 $17.52 $8.93 $8.93 $4.47 $4.46 $8.93 $13.57 $13.57 $14.09 $9.91 $13.19 $14.29 $14.29 $77.49 $8.93 $8.93 $8.93 $131.00 $98.25 $8.93 $8.93 $8.93 $49.92 $49.92 $103.75 $8.93 $104.80 $14.73 $12.56 $8.93 $75.98 $131.00 $12.95 $8.93 $9.87 $8.93 N/A N/A 30200172 EAP CPT® 86631 CHLAM PNUEMO IGG BOTH IP/OP $135.00 $100.00 $5.91 $135.00 $23.22 $23.22 $23.22 $23.22 $11.82 $11.82 $5.91 $5.91 $11.82 $17.96 $17.96 $18.65 $13.11 $17.47 $18.91 $18.91 $79.85 $11.82 $11.82 $11.82 $135.00 $101.25 $11.82 $11.82 $11.82 $66.08 $66.08 $106.92 $11.82 $108.00 $19.50 $16.64 $11.82 $78.30 $135.00 $17.14 $11.82 $13.07 $11.82 N/A N/A 30200173 EAP CPT® 86631 CHLAM PNUEMO IGA BOTH IP/OP $135.00 $100.00 $5.91 $135.00 $23.22 $23.22 $23.22 $23.22 $11.82 $11.82 $5.91 $5.91 $11.82 $17.96 $17.96 $18.65 $13.11 $17.47 $18.91 $18.91 $79.85 $11.82 $11.82 $11.82 $135.00 $101.25 $11.82 $11.82 $11.82 $66.08 $66.08 $106.92 $11.82 $108.00 $19.50 $16.64 $11.82 $78.30 $135.00 $17.14 $11.82 $13.07 $11.82 N/A N/A 30200174 EAP CPT® 86631 CHLAM TRACH IGG BOTH IP/OP $135.00 $100.00 $5.91 $135.00 $23.22 $23.22 $23.22 $23.22 $11.82 $11.82 $5.91 $5.91 $11.82 $17.96 $17.96 $18.65 $13.11 $17.47 $18.91 $18.91 $79.85 $11.82 $11.82 $11.82 $135.00 $101.25 $11.82 $11.82 $11.82 $66.08 $66.08 $106.92 $11.82 $108.00 $19.50 $16.64 $11.82 $78.30 $135.00 $17.14 $11.82 $13.07 $11.82 N/A N/A 30200175 EAP CPT® 86631 CHLAM TRACH IGA BOTH IP/OP $135.00 $100.00 $5.91 $135.00 $23.22 $23.22 $23.22 $23.22 $11.82 $11.82 $5.91 $5.91 $11.82 $17.96 $17.96 $18.65 $13.11 $17.47 $18.91 $18.91 $79.85 $11.82 $11.82 $11.82 $135.00 $101.25 $11.82 $11.82 $11.82 $66.08 $66.08 $106.92 $11.82 $108.00 $19.50 $16.64 $11.82 $78.30 $135.00 $17.14 $11.82 $13.07 $11.82 N/A N/A 30200176 EAP CPT® 86631 CHLAM PSITTACI ICG BOTH IP/OP $135.00 $100.00 $5.91 $135.00 $23.22 $23.22 $23.22 $23.22 $11.82 $11.82 $5.91 $5.91 $11.82 $17.96 $17.96 $18.65 $13.11 $17.47 $18.91 $18.91 $79.85 $11.82 $11.82 $11.82 $135.00 $101.25 $11.82 $11.82 $11.82 $66.08 $66.08 $106.92 $11.82 $108.00 $19.50 $16.64 $11.82 $78.30 $135.00 $17.14 $11.82 $13.07 $11.82 N/A N/A 30200177 EAP CPT® 86631 CHLAM PSITTACI IGA BOTH IP/OP $135.00 $100.00 $5.91 $135.00 $23.22 $23.22 $23.22 $23.22 $11.82 $11.82 $5.91 $5.91 $11.82 $17.96 $17.96 $18.65 $13.11 $17.47 $18.91 $18.91 $79.85 $11.82 $11.82 $11.82 $135.00 $101.25 $11.82 $11.82 $11.82 $66.08 $66.08 $106.92 $11.82 $108.00 $19.50 $16.64 $11.82 $78.30 $135.00 $17.14 $11.82 $13.07 $11.82 N/A N/A 30200178 EAP CPT® 86632 CHLAM PNUEMO IGM BOTH IP/OP $143.00 $106.00 $6.34 $143.00 $143.00 $143.00 $143.00 $143.00 $12.68 $12.68 $6.34 $143.00 $12.68 $19.27 $19.27 $20.01 $14.07 $18.76 $20.29 $20.29 $143.00 $12.68 $12.68 $12.68 $143.00 $107.25 $12.68 $12.68 $12.68 $70.96 $70.96 $113.26 $12.68 $114.40 $143.00 $143.00 $12.68 $82.94 $143.00 $18.39 $12.68 $143.00 $12.68 N/A N/A 30200179 EAP CPT® 86632 CHLAM TRACH IGM BOTH IP/OP $143.00 $106.00 $6.34 $143.00 $143.00 $143.00 $143.00 $143.00 $12.68 $12.68 $6.34 $143.00 $12.68 $19.27 $19.27 $20.01 $14.07 $18.76 $20.29 $20.29 $143.00 $12.68 $12.68 $12.68 $143.00 $107.25 $12.68 $12.68 $12.68 $70.96 $70.96 $113.26 $12.68 $114.40 $143.00 $143.00 $12.68 $82.94 $143.00 $18.39 $12.68 $143.00 $12.68 N/A N/A 30200180 EAP CPT® 86638 "Q FEVER IGG, ACUTE" BOTH IP/OP $250.00 $185.00 $6.06 $250.00 $250.00 $250.00 $250.00 $250.00 $12.12 $12.12 $6.06 $250.00 $12.12 $18.41 $18.41 $19.12 $13.44 $17.91 $19.39 $19.39 $250.00 $12.12 $12.12 $12.12 $250.00 $187.50 $12.12 $12.12 $12.12 $67.76 $67.76 $198.00 $12.12 $200.00 $250.00 $250.00 $12.12 $145.00 $250.00 $17.57 $12.12 $250.00 $12.12 N/A N/A 30200181 EAP CPT® 86638 "Q FEVER IGG, CONVAL." BOTH IP/OP $250.00 $185.00 $6.06 $250.00 $250.00 $250.00 $250.00 $250.00 $12.12 $12.12 $6.06 $250.00 $12.12 $18.41 $18.41 $19.12 $13.44 $17.91 $19.39 $19.39 $250.00 $12.12 $12.12 $12.12 $250.00 $187.50 $12.12 $12.12 $12.12 $67.76 $67.76 $198.00 $12.12 $200.00 $250.00 $250.00 $12.12 $145.00 $250.00 $17.57 $12.12 $250.00 $12.12 N/A N/A 30200182 EAP CPT® 86644 CMV IGG BOTH IP/OP $209.00 $155.00 $7.20 $209.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $123.62 $14.39 $14.39 $14.39 $209.00 $156.75 $14.39 $14.39 $14.39 $65.04 $65.04 $165.53 $14.39 $167.20 $23.74 $16.37 $14.39 $121.22 $209.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30200183 EAP CPT® 86644 CMV IGG AB-EIA BOTH IP/OP $222.00 $164.50 $7.20 $222.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $131.31 $14.39 $14.39 $14.39 $222.00 $166.50 $14.39 $14.39 $14.39 $65.04 $65.04 $175.82 $14.39 $177.60 $23.74 $16.37 $14.39 $128.76 $222.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30200184 EAP CPT® 86645 CMV IGM BOTH IP/OP $141.00 $104.50 $8.42 $141.00 $33.06 $33.06 $33.06 $33.06 $16.85 $16.85 $8.43 $8.42 $16.85 $25.58 $25.58 $26.57 $18.68 $24.90 $26.96 $26.96 $83.40 $16.85 $16.85 $16.85 $141.00 $105.75 $16.85 $16.85 $16.85 $94.16 $94.16 $111.67 $16.85 $112.80 $27.80 $23.71 $16.85 $81.78 $141.00 $24.43 $16.85 $18.62 $16.85 N/A N/A 30200185 EAP CPT® 86645 CMV IGM AB-EIA BOTH IP/OP $138.00 $102.50 $8.42 $138.00 $33.06 $33.06 $33.06 $33.06 $16.85 $16.85 $8.43 $8.42 $16.85 $25.58 $25.58 $26.57 $18.68 $24.90 $26.96 $26.96 $81.63 $16.85 $16.85 $16.85 $138.00 $103.50 $16.85 $16.85 $16.85 $94.16 $94.16 $109.30 $16.85 $110.40 $27.80 $23.71 $16.85 $80.04 $138.00 $24.43 $16.85 $18.62 $16.85 N/A N/A 30200186 EAP CPT® 86651 "ENCEP, CALIFORNIA, CSF, IGG" BOTH IP/OP $125.00 $92.50 $6.60 $125.00 $125.00 $125.00 $125.00 $125.00 $13.19 $13.19 $6.60 $125.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $125.00 $13.19 $13.19 $13.19 $125.00 $93.75 $13.19 $13.19 $13.19 $73.72 $73.72 $99.00 $13.19 $100.00 $125.00 $125.00 $13.19 $72.50 $125.00 $19.13 $13.19 $125.00 $13.19 N/A N/A 30200187 EAP CPT® 86651 "ENCEP, CALIFORNIA, CSF, IGM" BOTH IP/OP $125.00 $92.50 $6.60 $125.00 $125.00 $125.00 $125.00 $125.00 $13.19 $13.19 $6.60 $125.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $125.00 $13.19 $13.19 $13.19 $125.00 $93.75 $13.19 $13.19 $13.19 $73.72 $73.72 $99.00 $13.19 $100.00 $125.00 $125.00 $13.19 $72.50 $125.00 $19.13 $13.19 $125.00 $13.19 N/A N/A 30200188 EAP CPT® 86651 CALFORNIA EQUINE IGM BOTH IP/OP $118.00 $87.50 $6.60 $118.00 $118.00 $118.00 $118.00 $118.00 $13.19 $13.19 $6.60 $118.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $118.00 $13.19 $13.19 $13.19 $118.00 $88.50 $13.19 $13.19 $13.19 $73.72 $73.72 $93.46 $13.19 $94.40 $118.00 $118.00 $13.19 $68.44 $118.00 $19.13 $13.19 $118.00 $13.19 N/A N/A 30200189 EAP CPT® 86651 CALIF. EQUINE ENCEPHALITIS BOTH IP/OP $118.00 $87.50 $6.60 $118.00 $118.00 $118.00 $118.00 $118.00 $13.19 $13.19 $6.60 $118.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $118.00 $13.19 $13.19 $13.19 $118.00 $88.50 $13.19 $13.19 $13.19 $73.72 $73.72 $93.46 $13.19 $94.40 $118.00 $118.00 $13.19 $68.44 $118.00 $19.13 $13.19 $118.00 $13.19 N/A N/A 30200190 EAP CPT® 86652 "ENCEP, E. EQUINE, CSF,IGG" BOTH IP/OP $125.00 $92.50 $6.60 $125.00 $125.00 $125.00 $125.00 $125.00 $13.19 $13.19 $6.60 $125.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $125.00 $13.19 $13.19 $13.19 $125.00 $93.75 $13.19 $13.19 $13.19 $73.72 $73.72 $99.00 $13.19 $100.00 $125.00 $125.00 $13.19 $72.50 $125.00 $19.13 $13.19 $125.00 $13.19 N/A N/A 30200191 EAP CPT® 86652 "ENCEP, E. EQUINE, CSF,IGM" BOTH IP/OP $125.00 $92.50 $6.60 $125.00 $125.00 $125.00 $125.00 $125.00 $13.19 $13.19 $6.60 $125.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $125.00 $13.19 $13.19 $13.19 $125.00 $93.75 $13.19 $13.19 $13.19 $73.72 $73.72 $99.00 $13.19 $100.00 $125.00 $125.00 $13.19 $72.50 $125.00 $19.13 $13.19 $125.00 $13.19 N/A N/A 30200192 EAP CPT® 86652 EASTERN EQUINE IGM BOTH IP/OP $118.00 $87.50 $6.60 $118.00 $118.00 $118.00 $118.00 $118.00 $13.19 $13.19 $6.60 $118.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $118.00 $13.19 $13.19 $13.19 $118.00 $88.50 $13.19 $13.19 $13.19 $73.72 $73.72 $93.46 $13.19 $94.40 $118.00 $118.00 $13.19 $68.44 $118.00 $19.13 $13.19 $118.00 $13.19 N/A N/A 30200193 EAP CPT® 86652 EASTERN EQUINE ENCEPHALITIS BOTH IP/OP $118.00 $87.50 $6.60 $118.00 $118.00 $118.00 $118.00 $118.00 $13.19 $13.19 $6.60 $118.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $118.00 $13.19 $13.19 $13.19 $118.00 $88.50 $13.19 $13.19 $13.19 $73.72 $73.72 $93.46 $13.19 $94.40 $118.00 $118.00 $13.19 $68.44 $118.00 $19.13 $13.19 $118.00 $13.19 N/A N/A 30200194 EAP CPT® 86653 "ENCEP,ST. LOUIS, CSF IGG" BOTH IP/OP $125.00 $92.50 $6.60 $125.00 $125.00 $125.00 $125.00 $125.00 $13.19 $13.19 $6.60 $125.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $125.00 $13.19 $13.19 $13.19 $125.00 $93.75 $13.19 $13.19 $13.19 $73.72 $73.72 $99.00 $13.19 $100.00 $125.00 $125.00 $13.19 $72.50 $125.00 $19.13 $13.19 $125.00 $13.19 N/A N/A 30200195 EAP CPT® 86653 "ENCEP,ST. LOUIS, CSF IGM" BOTH IP/OP $125.00 $92.50 $6.60 $125.00 $125.00 $125.00 $125.00 $125.00 $13.19 $13.19 $6.60 $125.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $125.00 $13.19 $13.19 $13.19 $125.00 $93.75 $13.19 $13.19 $13.19 $73.72 $73.72 $99.00 $13.19 $100.00 $125.00 $125.00 $13.19 $72.50 $125.00 $19.13 $13.19 $125.00 $13.19 N/A N/A 30200196 EAP CPT® 86653 ST. LOUIS EQUINE IGM BOTH IP/OP $118.00 $87.50 $6.60 $118.00 $118.00 $118.00 $118.00 $118.00 $13.19 $13.19 $6.60 $118.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $118.00 $13.19 $13.19 $13.19 $118.00 $88.50 $13.19 $13.19 $13.19 $73.72 $73.72 $93.46 $13.19 $94.40 $118.00 $118.00 $13.19 $68.44 $118.00 $19.13 $13.19 $118.00 $13.19 N/A N/A 30200197 EAP CPT® 86653 ST. LOUIS EQUINE ENCEPHALITIS BOTH IP/OP $118.00 $87.50 $6.60 $118.00 $118.00 $118.00 $118.00 $118.00 $13.19 $13.19 $6.60 $118.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $118.00 $13.19 $13.19 $13.19 $118.00 $88.50 $13.19 $13.19 $13.19 $73.72 $73.72 $93.46 $13.19 $94.40 $118.00 $118.00 $13.19 $68.44 $118.00 $19.13 $13.19 $118.00 $13.19 N/A N/A 30200198 EAP CPT® 86654 "ENCEP, W. EQUINE, CSF,IGG" BOTH IP/OP $125.00 $92.50 $6.60 $125.00 $125.00 $125.00 $125.00 $125.00 $13.19 $13.19 $6.60 $125.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $125.00 $13.19 $13.19 $13.19 $125.00 $93.75 $13.19 $13.19 $13.19 $73.72 $73.72 $99.00 $13.19 $100.00 $125.00 $125.00 $13.19 $72.50 $125.00 $19.13 $13.19 $125.00 $13.19 N/A N/A 30200199 EAP CPT® 86654 "ENCEP, W. EQUINE, CSF,IGM" BOTH IP/OP $125.00 $92.50 $6.60 $125.00 $125.00 $125.00 $125.00 $125.00 $13.19 $13.19 $6.60 $125.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $125.00 $13.19 $13.19 $13.19 $125.00 $93.75 $13.19 $13.19 $13.19 $73.72 $73.72 $99.00 $13.19 $100.00 $125.00 $125.00 $13.19 $72.50 $125.00 $19.13 $13.19 $125.00 $13.19 N/A N/A 30200200 EAP CPT® 86654 WESTERN EQUINE IGM BOTH IP/OP $118.00 $87.50 $6.60 $118.00 $118.00 $118.00 $118.00 $118.00 $13.19 $13.19 $6.60 $118.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $118.00 $13.19 $13.19 $13.19 $118.00 $88.50 $13.19 $13.19 $13.19 $73.72 $73.72 $93.46 $13.19 $94.40 $118.00 $118.00 $13.19 $68.44 $118.00 $19.13 $13.19 $118.00 $13.19 N/A N/A 30200201 EAP CPT® 86654 WESTERN EQUINE ENCEPHALITIS BOTH IP/OP $118.00 $87.50 $6.60 $118.00 $118.00 $118.00 $118.00 $118.00 $13.19 $13.19 $6.60 $118.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $118.00 $13.19 $13.19 $13.19 $118.00 $88.50 $13.19 $13.19 $13.19 $73.72 $73.72 $93.46 $13.19 $94.40 $118.00 $118.00 $13.19 $68.44 $118.00 $19.13 $13.19 $118.00 $13.19 N/A N/A 30200202 EAP CPT® 86658 COXSACKIE B1 TITER BOTH IP/OP $112.00 $83.00 $6.52 $112.00 $112.00 $112.00 $112.00 $112.00 $13.03 $13.03 $6.52 $112.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $112.00 $13.03 $13.03 $13.03 $112.00 $84.00 $13.03 $13.03 $13.03 $72.80 $72.80 $88.70 $13.03 $89.60 $112.00 $112.00 $13.03 $64.96 $112.00 $18.89 $13.03 $112.00 $13.03 N/A N/A 30200203 EAP CPT® 86658 COXSACKIE B2 TITER BOTH IP/OP $112.00 $83.00 $6.52 $112.00 $112.00 $112.00 $112.00 $112.00 $13.03 $13.03 $6.52 $112.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $112.00 $13.03 $13.03 $13.03 $112.00 $84.00 $13.03 $13.03 $13.03 $72.80 $72.80 $88.70 $13.03 $89.60 $112.00 $112.00 $13.03 $64.96 $112.00 $18.89 $13.03 $112.00 $13.03 N/A N/A 30200204 EAP CPT® 86658 COXSACKIE B3 TITER BOTH IP/OP $112.00 $83.00 $6.52 $112.00 $112.00 $112.00 $112.00 $112.00 $13.03 $13.03 $6.52 $112.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $112.00 $13.03 $13.03 $13.03 $112.00 $84.00 $13.03 $13.03 $13.03 $72.80 $72.80 $88.70 $13.03 $89.60 $112.00 $112.00 $13.03 $64.96 $112.00 $18.89 $13.03 $112.00 $13.03 N/A N/A 30200205 EAP CPT® 86658 COXSACKIE B4 TITER BOTH IP/OP $112.00 $83.00 $6.52 $112.00 $112.00 $112.00 $112.00 $112.00 $13.03 $13.03 $6.52 $112.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $112.00 $13.03 $13.03 $13.03 $112.00 $84.00 $13.03 $13.03 $13.03 $72.80 $72.80 $88.70 $13.03 $89.60 $112.00 $112.00 $13.03 $64.96 $112.00 $18.89 $13.03 $112.00 $13.03 N/A N/A 30200206 EAP CPT® 86658 COXSACKIE B5 TITER BOTH IP/OP $112.00 $83.00 $6.52 $112.00 $112.00 $112.00 $112.00 $112.00 $13.03 $13.03 $6.52 $112.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $112.00 $13.03 $13.03 $13.03 $112.00 $84.00 $13.03 $13.03 $13.03 $72.80 $72.80 $88.70 $13.03 $89.60 $112.00 $112.00 $13.03 $64.96 $112.00 $18.89 $13.03 $112.00 $13.03 N/A N/A 30200207 EAP CPT® 86658 COXSACKIE B6 TITER BOTH IP/OP $112.00 $83.00 $6.52 $112.00 $112.00 $112.00 $112.00 $112.00 $13.03 $13.03 $6.52 $112.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $112.00 $13.03 $13.03 $13.03 $112.00 $84.00 $13.03 $13.03 $13.03 $72.80 $72.80 $88.70 $13.03 $89.60 $112.00 $112.00 $13.03 $64.96 $112.00 $18.89 $13.03 $112.00 $13.03 N/A N/A 30200208 EAP CPT® 86658 ECHOVIRUS 4 TITER BOTH IP/OP $112.00 $83.00 $6.52 $112.00 $112.00 $112.00 $112.00 $112.00 $13.03 $13.03 $6.52 $112.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $112.00 $13.03 $13.03 $13.03 $112.00 $84.00 $13.03 $13.03 $13.03 $72.80 $72.80 $88.70 $13.03 $89.60 $112.00 $112.00 $13.03 $64.96 $112.00 $18.89 $13.03 $112.00 $13.03 N/A N/A 30200209 EAP CPT® 86658 ECHOVIRUS 9 TITER BOTH IP/OP $112.00 $83.00 $6.52 $112.00 $112.00 $112.00 $112.00 $112.00 $13.03 $13.03 $6.52 $112.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $112.00 $13.03 $13.03 $13.03 $112.00 $84.00 $13.03 $13.03 $13.03 $72.80 $72.80 $88.70 $13.03 $89.60 $112.00 $112.00 $13.03 $64.96 $112.00 $18.89 $13.03 $112.00 $13.03 N/A N/A 30200210 EAP CPT® 86658 ECHOVIRUS 11 TITER BOTH IP/OP $112.00 $83.00 $6.52 $112.00 $112.00 $112.00 $112.00 $112.00 $13.03 $13.03 $6.52 $112.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $112.00 $13.03 $13.03 $13.03 $112.00 $84.00 $13.03 $13.03 $13.03 $72.80 $72.80 $88.70 $13.03 $89.60 $112.00 $112.00 $13.03 $64.96 $112.00 $18.89 $13.03 $112.00 $13.03 N/A N/A 30200211 EAP CPT® 86658 COXSACKIE A2 TITER BOTH IP/OP $112.00 $83.00 $6.52 $112.00 $112.00 $112.00 $112.00 $112.00 $13.03 $13.03 $6.52 $112.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $112.00 $13.03 $13.03 $13.03 $112.00 $84.00 $13.03 $13.03 $13.03 $72.80 $72.80 $88.70 $13.03 $89.60 $112.00 $112.00 $13.03 $64.96 $112.00 $18.89 $13.03 $112.00 $13.03 N/A N/A 30200212 EAP CPT® 86658 COXSACKIE A4 TITER BOTH IP/OP $112.00 $83.00 $6.52 $112.00 $112.00 $112.00 $112.00 $112.00 $13.03 $13.03 $6.52 $112.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $112.00 $13.03 $13.03 $13.03 $112.00 $84.00 $13.03 $13.03 $13.03 $72.80 $72.80 $88.70 $13.03 $89.60 $112.00 $112.00 $13.03 $64.96 $112.00 $18.89 $13.03 $112.00 $13.03 N/A N/A 30200213 EAP CPT® 86658 COXSACKIE A10 TITER BOTH IP/OP $112.00 $83.00 $6.52 $112.00 $112.00 $112.00 $112.00 $112.00 $13.03 $13.03 $6.52 $112.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $112.00 $13.03 $13.03 $13.03 $112.00 $84.00 $13.03 $13.03 $13.03 $72.80 $72.80 $88.70 $13.03 $89.60 $112.00 $112.00 $13.03 $64.96 $112.00 $18.89 $13.03 $112.00 $13.03 N/A N/A 30200214 EAP CPT® 86658 COXSACKIE A16 TITER BOTH IP/OP $112.00 $83.00 $6.52 $112.00 $112.00 $112.00 $112.00 $112.00 $13.03 $13.03 $6.52 $112.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $112.00 $13.03 $13.03 $13.03 $112.00 $84.00 $13.03 $13.03 $13.03 $72.80 $72.80 $88.70 $13.03 $89.60 $112.00 $112.00 $13.03 $64.96 $112.00 $18.89 $13.03 $112.00 $13.03 N/A N/A 30200215 EAP CPT® 86664 EBV NUCLEAR AB BOTH IP/OP $204.00 $151.00 $7.65 $204.00 $204.00 $204.00 $204.00 $204.00 $15.29 $15.29 $7.65 $204.00 $15.29 $23.23 $23.23 $24.13 $16.96 $22.61 $24.46 $24.46 $204.00 $15.29 $15.29 $15.29 $204.00 $153.00 $15.29 $15.29 $15.29 $85.52 $85.52 $161.57 $15.29 $163.20 $204.00 $204.00 $15.29 $118.32 $204.00 $22.17 $15.29 $204.00 $15.29 N/A N/A 30200216 EAP CPT® 86665 EBV CAPSID IGG AB BOTH IP/OP $229.00 $169.50 $9.07 $229.00 $229.00 $229.00 $229.00 $229.00 $18.14 $18.14 $9.07 $229.00 $18.14 $27.54 $27.54 $28.60 $20.10 $26.81 $29.02 $29.02 $229.00 $18.14 $18.14 $18.14 $229.00 $171.75 $18.14 $18.14 $18.14 $101.40 $101.40 $181.37 $18.14 $183.20 $229.00 $229.00 $18.14 $132.82 $229.00 $26.30 $18.14 $229.00 $18.14 N/A N/A 30200217 EAP CPT® 86665 EBV CAPSID IGM AB BOTH IP/OP $229.00 $169.50 $9.07 $229.00 $229.00 $229.00 $229.00 $229.00 $18.14 $18.14 $9.07 $229.00 $18.14 $27.54 $27.54 $28.60 $20.10 $26.81 $29.02 $29.02 $229.00 $18.14 $18.14 $18.14 $229.00 $171.75 $18.14 $18.14 $18.14 $101.40 $101.40 $181.37 $18.14 $183.20 $229.00 $229.00 $18.14 $132.82 $229.00 $26.30 $18.14 $229.00 $18.14 N/A N/A 30200218 EAP CPT® 86666 EHRLICHIA IGG BOTH IP/OP $155.00 $115.00 $5.09 $155.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $91.68 $10.18 $10.18 $10.18 $155.00 $116.25 $10.18 $10.18 $10.18 $56.88 $56.88 $122.76 $10.18 $124.00 $16.80 $14.32 $10.18 $89.90 $155.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30200219 EAP CPT® 86666 EHRLICHIA IGM BOTH IP/OP $155.00 $115.00 $5.09 $155.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $91.68 $10.18 $10.18 $10.18 $155.00 $116.25 $10.18 $10.18 $10.18 $56.88 $56.88 $122.76 $10.18 $124.00 $16.80 $14.32 $10.18 $89.90 $155.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30200220 EAP CPT® 86668 TULAREMIA ANTIBODY BOTH IP/OP $72.00 $53.50 $6.37 $72.00 $20.41 $20.41 $20.41 $20.41 $14.16 $14.16 $7.08 $6.37 $14.16 $15.79 $15.79 $16.39 $11.52 $15.36 $22.66 $22.66 $42.59 $14.16 $14.16 $14.16 $72.00 $54.00 $14.16 $14.16 $14.16 $58.12 $58.12 $57.02 $14.16 $57.60 $23.36 $14.63 $14.16 $41.76 $72.00 $20.53 $14.16 $11.49 $14.16 N/A N/A 30200221 EAP CPT® 86671 S.CEREVISIAE IGG BOTH IP/OP $139.00 $103.00 $6.13 $139.00 $139.00 $139.00 $139.00 $139.00 $12.25 $12.25 $6.13 $139.00 $12.25 $18.62 $18.62 $19.33 $13.59 $18.11 $19.60 $19.60 $139.00 $12.25 $12.25 $12.25 $139.00 $104.25 $12.25 $12.25 $12.25 $68.52 $68.52 $110.09 $12.25 $111.20 $139.00 $139.00 $12.25 $80.62 $139.00 $17.76 $12.25 $139.00 $12.25 N/A N/A 30200222 EAP CPT® 86671 S.CEREVISIAE IGA BOTH IP/OP $139.00 $103.00 $6.13 $139.00 $139.00 $139.00 $139.00 $139.00 $12.25 $12.25 $6.13 $139.00 $12.25 $18.62 $18.62 $19.33 $13.59 $18.11 $19.60 $19.60 $139.00 $12.25 $12.25 $12.25 $139.00 $104.25 $12.25 $12.25 $12.25 $68.52 $68.52 $110.09 $12.25 $111.20 $139.00 $139.00 $12.25 $80.62 $139.00 $17.76 $12.25 $139.00 $12.25 N/A N/A 30200223 EAP CPT® 86671 SPOROTHRIX IGG BOTH IP/OP $139.00 $103.00 $6.13 $139.00 $139.00 $139.00 $139.00 $139.00 $12.25 $12.25 $6.13 $139.00 $12.25 $18.62 $18.62 $19.33 $13.59 $18.11 $19.60 $19.60 $139.00 $12.25 $12.25 $12.25 $139.00 $104.25 $12.25 $12.25 $12.25 $68.52 $68.52 $110.09 $12.25 $111.20 $139.00 $139.00 $12.25 $80.62 $139.00 $17.76 $12.25 $139.00 $12.25 N/A N/A 30200224 EAP CPT® 86671 SPOROTHRIX IGM BOTH IP/OP $139.00 $103.00 $6.13 $139.00 $139.00 $139.00 $139.00 $139.00 $12.25 $12.25 $6.13 $139.00 $12.25 $18.62 $18.62 $19.33 $13.59 $18.11 $19.60 $19.60 $139.00 $12.25 $12.25 $12.25 $139.00 $104.25 $12.25 $12.25 $12.25 $68.52 $68.52 $110.09 $12.25 $111.20 $139.00 $139.00 $12.25 $80.62 $139.00 $17.76 $12.25 $139.00 $12.25 N/A N/A 30200225 EAP CPT® 86671 SPOROTHRIX IGA BOTH IP/OP $139.00 $103.00 $6.13 $139.00 $139.00 $139.00 $139.00 $139.00 $12.25 $12.25 $6.13 $139.00 $12.25 $18.62 $18.62 $19.33 $13.59 $18.11 $19.60 $19.60 $139.00 $12.25 $12.25 $12.25 $139.00 $104.25 $12.25 $12.25 $12.25 $68.52 $68.52 $110.09 $12.25 $111.20 $139.00 $139.00 $12.25 $80.62 $139.00 $17.76 $12.25 $139.00 $12.25 N/A N/A 30200226 EAP CPT® 86677 H. PYLORI IGG BOTH IP/OP $207.00 $153.50 $7.58 $207.00 $28.46 $28.46 $28.46 $28.46 $16.85 $16.85 $8.43 $7.58 $16.85 $22.04 $22.04 $22.89 $16.09 $21.44 $26.96 $26.96 $122.44 $16.85 $16.85 $16.85 $207.00 $155.25 $16.85 $16.85 $16.85 $81.12 $81.12 $163.94 $16.85 $165.60 $27.80 $20.42 $16.85 $120.06 $207.00 $24.43 $16.85 $16.04 $16.85 N/A N/A 30200227 EAP CPT® 86677 H.PYLORI IGA BOTH IP/OP $207.00 $153.50 $7.58 $207.00 $28.46 $28.46 $28.46 $28.46 $16.85 $16.85 $8.43 $7.58 $16.85 $22.04 $22.04 $22.89 $16.09 $21.44 $26.96 $26.96 $122.44 $16.85 $16.85 $16.85 $207.00 $155.25 $16.85 $16.85 $16.85 $81.12 $81.12 $163.94 $16.85 $165.60 $27.80 $20.42 $16.85 $120.06 $207.00 $24.43 $16.85 $16.04 $16.85 N/A N/A 30200228 EAP CPT® 86677 H.PYLORI IGG AB-EIA BOTH IP/OP $220.00 $163.00 $7.58 $220.00 $28.46 $28.46 $28.46 $28.46 $16.85 $16.85 $8.43 $7.58 $16.85 $22.04 $22.04 $22.89 $16.09 $21.44 $26.96 $26.96 $130.13 $16.85 $16.85 $16.85 $220.00 $165.00 $16.85 $16.85 $16.85 $81.12 $81.12 $174.24 $16.85 $176.00 $27.80 $20.42 $16.85 $127.60 $220.00 $24.43 $16.85 $16.04 $16.85 N/A N/A 30200229 EAP CPT® 86682 CYSTICERCUS IGG BOTH IP/OP $127.00 $94.00 $6.50 $127.00 $25.53 $25.53 $25.53 $25.53 $13.01 $13.01 $6.51 $6.50 $13.01 $19.75 $19.75 $20.51 $14.42 $19.20 $20.82 $20.82 $75.12 $13.01 $13.01 $13.01 $127.00 $95.25 $13.01 $13.01 $13.01 $72.68 $72.68 $100.58 $13.01 $101.60 $21.47 $18.29 $13.01 $73.66 $127.00 $18.86 $13.01 $14.37 $13.01 N/A N/A 30200230 EAP CPT® 86682 ECHINOCOCCUS IGG BOTH IP/OP $127.00 $94.00 $6.50 $127.00 $25.53 $25.53 $25.53 $25.53 $13.01 $13.01 $6.51 $6.50 $13.01 $19.75 $19.75 $20.51 $14.42 $19.20 $20.82 $20.82 $75.12 $13.01 $13.01 $13.01 $127.00 $95.25 $13.01 $13.01 $13.01 $72.68 $72.68 $100.58 $13.01 $101.60 $21.47 $18.29 $13.01 $73.66 $127.00 $18.86 $13.01 $14.37 $13.01 N/A N/A 30200231 EAP CPT® 86682 FILARIA AB BOTH IP/OP $127.00 $94.00 $6.50 $127.00 $25.53 $25.53 $25.53 $25.53 $13.01 $13.01 $6.51 $6.50 $13.01 $19.75 $19.75 $20.51 $14.42 $19.20 $20.82 $20.82 $75.12 $13.01 $13.01 $13.01 $127.00 $95.25 $13.01 $13.01 $13.01 $72.68 $72.68 $100.58 $13.01 $101.60 $21.47 $18.29 $13.01 $73.66 $127.00 $18.86 $13.01 $14.37 $13.01 N/A N/A 30200232 EAP CPT® 86682 STRONGYLOIDES IGG BOTH IP/OP $127.00 $94.00 $6.50 $127.00 $25.53 $25.53 $25.53 $25.53 $13.01 $13.01 $6.51 $6.50 $13.01 $19.75 $19.75 $20.51 $14.42 $19.20 $20.82 $20.82 $75.12 $13.01 $13.01 $13.01 $127.00 $95.25 $13.01 $13.01 $13.01 $72.68 $72.68 $100.58 $13.01 $101.60 $21.47 $18.29 $13.01 $73.66 $127.00 $18.86 $13.01 $14.37 $13.01 N/A N/A 30200233 EAP CPT® 86682 SCHISTOSOMA IGG BOTH IP/OP $127.00 $94.00 $6.50 $127.00 $25.53 $25.53 $25.53 $25.53 $13.01 $13.01 $6.51 $6.50 $13.01 $19.75 $19.75 $20.51 $14.42 $19.20 $20.82 $20.82 $75.12 $13.01 $13.01 $13.01 $127.00 $95.25 $13.01 $13.01 $13.01 $72.68 $72.68 $100.58 $13.01 $101.60 $21.47 $18.29 $13.01 $73.66 $127.00 $18.86 $13.01 $14.37 $13.01 N/A N/A 30200235 EAP CPT® 86689 HIV-AB WESTERN BLOT BOTH IP/OP $388.00 $287.50 $9.68 $388.00 $388.00 $388.00 $388.00 $388.00 $19.35 $19.35 $9.68 $388.00 $19.35 $29.39 $29.39 $30.52 $21.45 $24.81 $30.96 $30.96 $388.00 $19.35 $19.35 $19.35 $388.00 $291.00 $19.35 $19.35 $19.35 $108.20 $108.20 $307.30 $19.35 $310.40 $388.00 $388.00 $19.35 $225.04 $388.00 $28.06 $19.35 $388.00 $19.35 N/A N/A 30200236 EAP CPT® 86692 HEPATITIS DELTA AB BOTH IP/OP $196.00 $145.50 $8.58 $196.00 $33.68 $33.68 $33.68 $33.68 $17.16 $17.16 $8.58 $8.58 $17.16 $26.06 $26.06 $27.06 $19.03 $25.35 $27.46 $27.46 $115.93 $17.16 $17.16 $17.16 $196.00 $147.00 $17.16 $17.16 $17.16 $95.92 $95.92 $155.23 $17.16 $156.80 $28.31 $24.14 $17.16 $113.68 $196.00 $24.88 $17.16 $18.96 $17.16 N/A N/A 30200237 EAP CPT® 86694 HSV 1/2 IGM BOTH IP/OP $185.00 $137.00 $7.20 $185.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $109.43 $14.39 $14.39 $14.39 $185.00 $138.75 $14.39 $14.39 $14.39 $65.04 $65.04 $146.52 $14.39 $148.00 $23.74 $16.37 $14.39 $107.30 $185.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30200238 EAP CPT® 86694 HSV IGM AB TITER BOTH IP/OP $187.00 $138.50 $7.20 $187.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $110.61 $14.39 $14.39 $14.39 $187.00 $140.25 $14.39 $14.39 $14.39 $65.04 $65.04 $148.10 $14.39 $149.60 $23.74 $16.37 $14.39 $108.46 $187.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30200239 EAP CPT® 86694 "HSV2 IGG/IGM AB,CSF" BOTH IP/OP $174.00 $129.00 $7.20 $174.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $102.92 $14.39 $14.39 $14.39 $174.00 $130.50 $14.39 $14.39 $14.39 $65.04 $65.04 $137.81 $14.39 $139.20 $23.74 $16.37 $14.39 $100.92 $174.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30200240 EAP CPT® 86694 "HSV-2 IGM AB,CSF" BOTH IP/OP $174.00 $129.00 $7.20 $174.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $102.92 $14.39 $14.39 $14.39 $174.00 $130.50 $14.39 $14.39 $14.39 $65.04 $65.04 $137.81 $14.39 $139.20 $23.74 $16.37 $14.39 $100.92 $174.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30200241 EAP CPT® 86694 HSV IGG BOTH IP/OP $174.00 $129.00 $7.20 $174.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $102.92 $14.39 $14.39 $14.39 $174.00 $130.50 $14.39 $14.39 $14.39 $65.04 $65.04 $137.81 $14.39 $139.20 $23.74 $16.37 $14.39 $100.92 $174.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30200244 EAP CPT® 86695 HSV-I IGG BOTH IP/OP $133.00 $98.50 $6.59 $133.00 $25.88 $25.88 $25.88 $25.88 $13.19 $13.19 $6.60 $6.59 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $78.67 $13.19 $13.19 $13.19 $133.00 $99.75 $13.19 $13.19 $13.19 $73.72 $73.72 $105.34 $13.19 $106.40 $21.76 $18.56 $13.19 $77.14 $133.00 $19.13 $13.19 $14.58 $13.19 N/A N/A 30200245 EAP CPT® 86696 HSV - II IGG BOTH IP/OP $145.00 $107.50 $9.68 $145.00 $37.98 $37.98 $37.98 $37.98 $19.35 $19.35 $9.68 $9.68 $19.35 $29.39 $29.39 $30.52 $21.45 $28.60 $30.96 $30.96 $85.77 $19.35 $19.35 $19.35 $145.00 $108.75 $19.35 $19.35 $19.35 $108.20 $108.20 $114.84 $19.35 $116.00 $31.93 $27.24 $19.35 $84.10 $145.00 $28.06 $19.35 $21.40 $19.35 N/A N/A 30200246 EAP CPT® 86698 HISTOPLASMA AB (S) BOTH IP/OP $74.00 $55.00 $6.90 $74.00 $74.00 $74.00 $74.00 $74.00 $13.79 $13.79 $6.90 $74.00 $13.79 $18.98 $18.98 $19.71 $13.86 $18.46 $22.06 $22.06 $74.00 $13.79 $13.79 $13.79 $74.00 $55.50 $13.79 $13.79 $13.79 $69.84 $69.84 $58.61 $13.79 $59.20 $74.00 $74.00 $13.79 $42.92 $74.00 $20.00 $13.79 $74.00 $13.79 N/A N/A 30200247 EAP CPT® 86703 HIV-1/2 BOTH IP/OP $255.00 $189.00 $6.85 $255.00 $26.91 $26.91 $26.91 $26.91 $13.71 $13.71 $6.86 $6.85 $13.71 $20.82 $20.82 $21.62 $15.20 $17.58 $21.94 $21.94 $150.83 $13.71 $13.71 $13.71 $255.00 $191.25 $13.71 $13.71 $13.71 $76.68 $76.68 $201.96 $13.71 $204.00 $22.62 $16.74 $13.71 $147.90 $255.00 $19.88 $13.71 $13.15 $13.71 N/A N/A 30200248 EAP CPT® 86704 HBV CORE AB BOTH IP/OP $285.00 $211.00 $6.03 $285.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $168.58 $12.05 $12.05 $12.05 $285.00 $213.75 $12.05 $12.05 $12.05 $67.36 $67.36 $225.72 $12.05 $228.00 $19.88 $16.96 $12.05 $165.30 $285.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30200249 EAP CPT® 86705 HEPATITIS-B CORE M BOTH IP/OP $285.00 $211.00 $5.89 $285.00 $23.12 $23.12 $23.12 $23.12 $11.77 $11.77 $5.89 $5.89 $11.77 $17.87 $17.87 $18.55 $13.04 $17.39 $18.83 $18.83 $168.58 $11.77 $11.77 $11.77 $285.00 $213.75 $11.77 $11.77 $11.77 $65.76 $65.76 $225.72 $11.77 $228.00 $19.42 $16.56 $11.77 $165.30 $285.00 $17.07 $11.77 $13.01 $11.77 N/A N/A 30200250 EAP CPT® 86706 HBV SURFACE AB BOTH IP/OP $257.00 $190.50 $5.37 $257.00 $21.08 $21.08 $21.08 $21.08 $10.74 $10.74 $5.37 $5.37 $10.74 $16.31 $16.31 $16.93 $11.90 $15.87 $17.18 $17.18 $152.02 $10.74 $10.74 $10.74 $257.00 $192.75 $10.74 $10.74 $10.74 $60.04 $60.04 $203.54 $10.74 $205.60 $17.72 $15.11 $10.74 $149.06 $257.00 $15.57 $10.74 $11.87 $10.74 N/A N/A 30200251 EAP CPT® 86707 HBV E AB BOTH IP/OP $134.00 $99.50 $5.78 $134.00 $22.72 $22.72 $22.72 $22.72 $11.57 $11.57 $5.79 $5.78 $11.57 $17.57 $17.57 $18.24 $12.82 $17.08 $18.51 $18.51 $79.26 $11.57 $11.57 $11.57 $134.00 $100.50 $11.57 $11.57 $11.57 $64.64 $64.64 $106.13 $11.57 $107.20 $19.09 $16.27 $11.57 $77.72 $134.00 $16.78 $11.57 $12.78 $11.57 N/A N/A 30200252 EAP CPT® 86708 "HAV AB, TOTAL" BOTH IP/OP $291.00 $215.50 $6.20 $291.00 $291.00 $291.00 $291.00 $291.00 $12.39 $12.39 $6.20 $291.00 $12.39 $18.81 $18.81 $19.54 $13.73 $18.30 $19.82 $19.82 $291.00 $12.39 $12.39 $12.39 $291.00 $218.25 $12.39 $12.39 $12.39 $69.24 $69.24 $230.47 $12.39 $232.80 $291.00 $291.00 $12.39 $168.78 $291.00 $17.97 $12.39 $291.00 $12.39 N/A N/A 30200253 EAP CPT® 86709 HAV IGM AB BOTH IP/OP $275.00 $203.50 $5.63 $275.00 $22.09 $22.09 $22.09 $22.09 $11.26 $11.26 $5.63 $5.63 $11.26 $17.10 $17.10 $17.76 $12.48 $16.63 $18.02 $18.02 $162.66 $11.26 $11.26 $11.26 $275.00 $206.25 $11.26 $11.26 $11.26 $62.92 $62.92 $217.80 $11.26 $220.00 $18.58 $15.84 $11.26 $159.50 $275.00 $16.33 $11.26 $12.44 $11.26 N/A N/A 30200254 EAP CPT® 86713 L. PNEUMOPH. AB - TOTAL BOTH IP/OP $146.00 $108.50 $7.65 $146.00 $146.00 $146.00 $146.00 $146.00 $15.30 $15.30 $7.65 $146.00 $15.30 $23.24 $23.24 $24.14 $16.97 $22.62 $24.48 $24.48 $146.00 $15.30 $15.30 $15.30 $146.00 $109.50 $15.30 $15.30 $15.30 $85.56 $85.56 $115.63 $15.30 $116.80 $146.00 $146.00 $15.30 $84.68 $146.00 $22.19 $15.30 $146.00 $15.30 N/A N/A 30200255 EAP CPT® 86720 LEPTOSPIROSIS AB BOTH IP/OP $80.00 $59.50 $8.10 $80.00 $80.00 $80.00 $80.00 $80.00 $16.20 $16.20 $8.10 $80.00 $16.20 $20.02 $20.02 $20.79 $14.61 $19.49 $25.92 $25.92 $80.00 $16.20 $16.20 $16.20 $80.00 $60.00 $16.20 $16.20 $16.20 $73.72 $73.72 $63.36 $16.20 $64.00 $80.00 $80.00 $16.20 $46.40 $80.00 $23.49 $16.20 $80.00 $16.20 N/A N/A 30200256 EAP CPT® 86631 LGV ANTIBODY SCREEN BOTH IP/OP $212.00 $157.00 $5.91 $212.00 $23.22 $23.22 $23.22 $23.22 $11.82 $11.82 $5.91 $5.91 $11.82 $17.96 $17.96 $18.65 $13.11 $17.47 $18.91 $18.91 $125.40 $11.82 $11.82 $11.82 $212.00 $159.00 $11.82 $11.82 $11.82 $66.08 $66.08 $167.90 $11.82 $169.60 $19.50 $16.64 $11.82 $122.96 $212.00 $17.14 $11.82 $13.07 $11.82 N/A N/A 30200257 EAP CPT® 86738 MYCOPLASMA IGG BOTH IP/OP $99.00 $73.50 $6.62 $99.00 $99.00 $99.00 $99.00 $99.00 $13.24 $13.24 $6.62 $99.00 $13.24 $20.11 $20.11 $20.89 $14.68 $19.57 $21.18 $21.18 $99.00 $13.24 $13.24 $13.24 $99.00 $74.25 $13.24 $13.24 $13.24 $74.04 $74.04 $78.41 $13.24 $79.20 $99.00 $99.00 $13.24 $57.42 $99.00 $19.20 $13.24 $99.00 $13.24 N/A N/A 30200258 EAP CPT® 86738 MYCOPLASMA IGM BOTH IP/OP $99.00 $73.50 $6.62 $99.00 $99.00 $99.00 $99.00 $99.00 $13.24 $13.24 $6.62 $99.00 $13.24 $20.11 $20.11 $20.89 $14.68 $19.57 $21.18 $21.18 $99.00 $13.24 $13.24 $13.24 $99.00 $74.25 $13.24 $13.24 $13.24 $74.04 $74.04 $78.41 $13.24 $79.20 $99.00 $99.00 $13.24 $57.42 $99.00 $19.20 $13.24 $99.00 $13.24 N/A N/A 30200259 EAP CPT® 86747 PARVOVIRUS IGG BOTH IP/OP $124.00 $92.00 $7.52 $124.00 $29.49 $29.49 $29.49 $29.49 $15.03 $15.03 $7.52 $7.52 $15.03 $22.83 $22.83 $23.71 $16.66 $22.21 $24.05 $24.05 $73.35 $15.03 $15.03 $15.03 $124.00 $93.00 $15.03 $15.03 $15.03 $84.00 $84.00 $98.21 $15.03 $99.20 $24.80 $21.15 $15.03 $71.92 $124.00 $21.79 $15.03 $16.61 $15.03 N/A N/A 30200260 EAP CPT® 86747 PARVOVIRUS IGM BOTH IP/OP $124.00 $92.00 $7.52 $124.00 $29.49 $29.49 $29.49 $29.49 $15.03 $15.03 $7.52 $7.52 $15.03 $22.83 $22.83 $23.71 $16.66 $22.21 $24.05 $24.05 $73.35 $15.03 $15.03 $15.03 $124.00 $93.00 $15.03 $15.03 $15.03 $84.00 $84.00 $98.21 $15.03 $99.20 $24.80 $21.15 $15.03 $71.92 $124.00 $21.79 $15.03 $16.61 $15.03 N/A N/A 30200261 EAP CPT® 86753 ENT. HISTOLYTICA AB BOTH IP/OP $96.00 $71.50 $6.20 $96.00 $96.00 $96.00 $96.00 $96.00 $12.39 $12.39 $6.20 $96.00 $12.39 $18.81 $18.81 $19.54 $13.73 $18.31 $19.82 $19.82 $96.00 $12.39 $12.39 $12.39 $96.00 $72.00 $12.39 $12.39 $12.39 $69.28 $69.28 $76.03 $12.39 $76.80 $96.00 $96.00 $12.39 $55.68 $96.00 $17.97 $12.39 $96.00 $12.39 N/A N/A 30200262 EAP CPT® 86762 RUBELLA IMMUNE SCRN BOTH IP/OP $230.00 $170.50 $7.20 $230.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $136.05 $14.39 $14.39 $14.39 $230.00 $172.50 $14.39 $14.39 $14.39 $65.04 $65.04 $182.16 $14.39 $184.00 $23.74 $16.37 $14.39 $133.40 $230.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30200263 EAP CPT® 86762 RUBELLA IGG BOTH IP/OP $216.00 $160.00 $7.20 $216.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $127.76 $14.39 $14.39 $14.39 $216.00 $162.00 $14.39 $14.39 $14.39 $65.04 $65.04 $171.07 $14.39 $172.80 $23.74 $16.37 $14.39 $125.28 $216.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30200264 EAP CPT® 86762 RUBELLA IGM BOTH IP/OP $216.00 $160.00 $7.20 $216.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $127.76 $14.39 $14.39 $14.39 $216.00 $162.00 $14.39 $14.39 $14.39 $65.04 $65.04 $171.07 $14.39 $172.80 $23.74 $16.37 $14.39 $125.28 $216.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30200265 EAP CPT® 86765 RUBEOLA (MEASLES) IGM BOTH IP/OP $130.00 $96.50 $6.44 $130.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $76.90 $12.88 $12.88 $12.88 $130.00 $97.50 $12.88 $12.88 $12.88 $72.00 $72.00 $102.96 $12.88 $104.00 $21.25 $18.12 $12.88 $75.40 $130.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30200266 EAP CPT® 86765 RUBEOLA (MEASLES) IGG BOTH IP/OP $130.00 $96.50 $6.44 $130.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $76.90 $12.88 $12.88 $12.88 $130.00 $97.50 $12.88 $12.88 $12.88 $72.00 $72.00 $102.96 $12.88 $104.00 $21.25 $18.12 $12.88 $75.40 $130.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30200267 EAP CPT® 86777 TOXOPLASMA IGG BOTH IP/OP $248.00 $184.00 $7.20 $248.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $146.69 $14.39 $14.39 $14.39 $248.00 $186.00 $14.39 $14.39 $14.39 $65.04 $65.04 $196.42 $14.39 $198.40 $23.74 $16.37 $14.39 $143.84 $248.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30200268 EAP CPT® 86777 "TOXO AB-IGG,CSF" BOTH IP/OP $248.00 $184.00 $7.20 $248.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $146.69 $14.39 $14.39 $14.39 $248.00 $186.00 $14.39 $14.39 $14.39 $65.04 $65.04 $196.42 $14.39 $198.40 $23.74 $16.37 $14.39 $143.84 $248.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30200269 EAP CPT® 86777 TOXO IGG AB-EIA BOTH IP/OP $216.00 $160.00 $7.20 $216.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $127.76 $14.39 $14.39 $14.39 $216.00 $162.00 $14.39 $14.39 $14.39 $65.04 $65.04 $171.07 $14.39 $172.80 $23.74 $16.37 $14.39 $125.28 $216.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30200270 EAP CPT® 86778 TOXOPLASMA IGM BOTH IP/OP $133.00 $98.50 $7.20 $133.00 $28.26 $28.26 $28.26 $28.26 $14.41 $14.41 $7.21 $7.20 $14.41 $21.87 $21.87 $22.71 $15.97 $21.27 $23.06 $23.06 $78.67 $14.41 $14.41 $14.41 $133.00 $99.75 $14.41 $14.41 $14.41 $80.48 $80.48 $105.34 $14.41 $106.40 $23.78 $20.26 $14.41 $77.14 $133.00 $20.89 $14.41 $15.91 $14.41 N/A N/A 30200271 EAP CPT® 86778 "TOXO AB-IGM,CSF" BOTH IP/OP $133.00 $98.50 $7.20 $133.00 $28.26 $28.26 $28.26 $28.26 $14.41 $14.41 $7.21 $7.20 $14.41 $21.87 $21.87 $22.71 $15.97 $21.27 $23.06 $23.06 $78.67 $14.41 $14.41 $14.41 $133.00 $99.75 $14.41 $14.41 $14.41 $80.48 $80.48 $105.34 $14.41 $106.40 $23.78 $20.26 $14.41 $77.14 $133.00 $20.89 $14.41 $15.91 $14.41 N/A N/A 30200272 EAP CPT® 86780 "TREPONEMAL IGG, CSF" BOTH IP/OP $215.00 $159.50 $6.62 $215.00 $25.98 $25.98 $25.98 $25.98 $13.24 $13.24 $6.62 $6.62 $13.24 $19.73 $19.73 $20.49 $14.40 $44.81 $21.18 $21.18 $127.17 $13.24 $13.24 $13.24 $215.00 $161.25 $13.24 $13.24 $13.24 $107.50 $107.50 $170.28 $13.24 $172.00 $21.85 $42.67 $13.24 $124.70 $215.00 $19.20 $13.24 $44.81 $13.24 N/A N/A 30200273 EAP CPT® 86780 TREPONEMAL-IGG-EIA BOTH IP/OP $215.00 $159.50 $6.62 $215.00 $25.98 $25.98 $25.98 $25.98 $13.24 $13.24 $6.62 $6.62 $13.24 $19.73 $19.73 $20.49 $14.40 $44.81 $21.18 $21.18 $127.17 $13.24 $13.24 $13.24 $215.00 $161.25 $13.24 $13.24 $13.24 $107.50 $107.50 $170.28 $13.24 $172.00 $21.85 $42.67 $13.24 $124.70 $215.00 $19.20 $13.24 $44.81 $13.24 N/A N/A 30200274 EAP CPT® 86780 TREPONEMAL -IGM-EIA BOTH IP/OP $158.00 $117.00 $6.62 $158.00 $25.98 $25.98 $25.98 $25.98 $13.24 $13.24 $6.62 $6.62 $13.24 $19.73 $19.73 $20.49 $14.40 $32.93 $21.18 $21.18 $93.46 $13.24 $13.24 $13.24 $158.00 $118.50 $13.24 $13.24 $13.24 $79.00 $79.00 $125.14 $13.24 $126.40 $21.85 $31.36 $13.24 $91.64 $158.00 $19.20 $13.24 $32.93 $13.24 N/A N/A 30200275 EAP CPT® 86787 VARICELLA ZOSTER IGM BOTH IP/OP $237.00 $175.50 $6.44 $237.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $140.19 $12.88 $12.88 $12.88 $237.00 $177.75 $12.88 $12.88 $12.88 $72.00 $72.00 $187.70 $12.88 $189.60 $21.25 $18.12 $12.88 $137.46 $237.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30200276 EAP CPT® 86787 VARICELLA ZOSTER BOTH IP/OP $254.00 $188.00 $6.44 $254.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $150.24 $12.88 $12.88 $12.88 $254.00 $190.50 $12.88 $12.88 $12.88 $72.00 $72.00 $201.17 $12.88 $203.20 $21.25 $18.12 $12.88 $147.32 $254.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30200277 EAP CPT® 86788 "W. NILE AB, IGM" BOTH IP/OP $352.00 $260.50 $8.43 $352.00 $352.00 $352.00 $352.00 $352.00 $16.85 $16.85 $8.43 $352.00 $16.85 $25.58 $25.58 $26.57 $18.68 $24.90 $26.96 $26.96 $352.00 $16.85 $16.85 $16.85 $352.00 $264.00 $16.85 $16.85 $16.85 $94.16 $94.16 $278.78 $16.85 $281.60 $352.00 $352.00 $16.85 $204.16 $352.00 $24.43 $16.85 $352.00 $16.85 N/A N/A 30200278 EAP CPT® 86788 "W. NILE AB, IGM, CSF" BOTH IP/OP $352.00 $260.50 $8.43 $352.00 $352.00 $352.00 $352.00 $352.00 $16.85 $16.85 $8.43 $352.00 $16.85 $25.58 $25.58 $26.57 $18.68 $24.90 $26.96 $26.96 $352.00 $16.85 $16.85 $16.85 $352.00 $264.00 $16.85 $16.85 $16.85 $94.16 $94.16 $278.78 $16.85 $281.60 $352.00 $352.00 $16.85 $204.16 $352.00 $24.43 $16.85 $352.00 $16.85 N/A N/A 30200279 EAP CPT® 86789 "W. NILE AB, IGG" BOTH IP/OP $352.00 $260.50 $7.20 $352.00 $352.00 $352.00 $352.00 $352.00 $14.39 $14.39 $7.20 $352.00 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $352.00 $14.39 $14.39 $14.39 $352.00 $264.00 $14.39 $14.39 $14.39 $65.04 $65.04 $278.78 $14.39 $281.60 $352.00 $352.00 $14.39 $204.16 $352.00 $20.87 $14.39 $352.00 $14.39 N/A N/A 30200280 EAP CPT® 86789 "W. NILE AB, IGG, CSF" BOTH IP/OP $352.00 $260.50 $7.20 $352.00 $352.00 $352.00 $352.00 $352.00 $14.39 $14.39 $7.20 $352.00 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $352.00 $14.39 $14.39 $14.39 $352.00 $264.00 $14.39 $14.39 $14.39 $65.04 $65.04 $278.78 $14.39 $281.60 $352.00 $352.00 $14.39 $204.16 $352.00 $20.87 $14.39 $352.00 $14.39 N/A N/A 30200281 EAP CPT® 86790 HTLV I/II AB BOTH IP/OP $328.00 $243.00 $6.44 $328.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $194.01 $12.88 $12.88 $12.88 $328.00 $246.00 $12.88 $12.88 $12.88 $72.00 $72.00 $259.78 $12.88 $262.40 $21.25 $18.12 $12.88 $190.24 $328.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30200282 EAP CPT® 86800 "THYROGLOB AB, QUANT" BOTH IP/OP $336.00 $249.00 $7.95 $336.00 $31.22 $31.22 $31.22 $31.22 $15.91 $15.91 $7.96 $7.95 $15.91 $24.15 $24.15 $25.08 $17.63 $23.50 $25.46 $25.46 $198.74 $15.91 $15.91 $15.91 $336.00 $252.00 $15.91 $15.91 $15.91 $88.88 $88.88 $266.11 $15.91 $268.80 $26.25 $22.38 $15.91 $194.88 $336.00 $23.07 $15.91 $17.58 $15.91 N/A N/A 30200283 EAP CPT® 86800 THYROGLOBULIN AB BOTH IP/OP $359.00 $266.00 $7.95 $359.00 $31.22 $31.22 $31.22 $31.22 $15.91 $15.91 $7.96 $7.95 $15.91 $24.15 $24.15 $25.08 $17.63 $23.50 $25.46 $25.46 $212.35 $15.91 $15.91 $15.91 $359.00 $269.25 $15.91 $15.91 $15.91 $88.88 $88.88 $284.33 $15.91 $287.20 $26.25 $22.38 $15.91 $208.22 $359.00 $23.07 $15.91 $17.58 $15.91 N/A N/A 30200284 EAP CPT® 86803 HCV AB (2ND GEN) BOTH IP/OP $343.00 $254.00 $7.13 $343.00 $27.99 $27.99 $27.99 $27.99 $14.27 $14.27 $7.14 $7.13 $14.27 $21.67 $21.67 $22.51 $15.82 $11.75 $22.83 $22.83 $202.88 $14.27 $14.27 $14.27 $343.00 $257.25 $14.27 $14.27 $14.27 $79.76 $79.76 $271.66 $14.27 $274.40 $23.55 $11.19 $14.27 $198.94 $343.00 $20.69 $14.27 $8.79 $14.27 N/A N/A 30200285 EAP CPT® 86812 HLA-B27 BOTH IP/OP $582.00 $431.00 $12.90 $582.00 $50.65 $50.65 $50.65 $50.65 $25.81 $25.81 $12.91 $12.90 $25.81 $39.19 $39.19 $40.69 $28.61 $38.13 $41.30 $41.30 $344.25 $25.81 $25.81 $25.81 $582.00 $436.50 $25.81 $25.81 $25.81 $144.24 $144.24 $460.94 $25.81 $465.60 $42.59 $36.31 $25.81 $337.56 $582.00 $37.42 $25.81 $28.52 $25.81 N/A N/A 30200286 EAP CPT® 86922 "CHARGE: XMATCH, COOMBS" BOTH IP/OP $187.00 $138.50 $18.17 $234.73 $52.94 $52.94 $52.94 $52.94 $146.71 $146.71 $146.06 $38.98 $146.71 $24.89 $24.89 $25.84 $18.17 $38.97 $234.73 $226.86 $110.61 $146.71 $187.00 $146.71 $154.04 $140.25 $146.71 $146.71 $146.71 $112.48 $112.48 $148.10 $146.71 $149.60 $121.55 $37.11 $146.71 $108.46 $154.04 $187.00 $146.71 $38.97 $146.71 N/A N/A 30200287 EAP CPT® 86922 "CHARGE: XMATCH, COOMBS" BOTH IP/OP $187.00 $138.50 $18.17 $234.73 $52.94 $52.94 $52.94 $52.94 $146.71 $146.71 $146.06 $38.98 $146.71 $24.89 $24.89 $25.84 $18.17 $38.97 $234.73 $226.86 $110.61 $146.71 $187.00 $146.71 $154.04 $140.25 $146.71 $146.71 $146.71 $112.48 $112.48 $148.10 $146.71 $149.60 $121.55 $37.11 $146.71 $108.46 $154.04 $187.00 $146.71 $38.97 $146.71 N/A N/A 30200289 EAP CPT® 86359 LYMPH SUBSET T CEL TOT (SO) BOTH IP/OP $210.00 $155.50 $18.86 $210.00 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $124.22 $37.73 $37.73 $37.73 $210.00 $157.50 $37.73 $37.73 $37.73 $131.64 $131.64 $166.32 $37.73 $168.00 $62.25 $33.14 $37.73 $121.80 $210.00 $54.71 $37.73 $26.03 $37.73 N/A N/A 30200292 EAP CPT® 86360 LYMPH SUBSET ABS CT RATIO (SO) BOTH IP/OP $310.00 $229.50 $23.49 $310.00 $92.22 $92.22 $92.22 $92.22 $46.98 $46.98 $23.49 $23.49 $46.98 $71.34 $71.34 $74.09 $52.08 $69.42 $75.17 $75.17 $183.37 $46.98 $46.98 $46.98 $310.00 $232.50 $46.98 $46.98 $46.98 $262.60 $262.60 $245.52 $46.98 $248.00 $77.52 $66.11 $46.98 $179.80 $310.00 $68.12 $46.98 $51.93 $46.98 N/A N/A 30200310 EAP CPT® 86256 SMOOTH MUSCLE AB TITER BOTH IP/OP $70.00 $52.00 $6.03 $70.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $41.41 $12.05 $12.05 $12.05 $70.00 $52.50 $12.05 $12.05 $12.05 $67.36 $67.36 $55.44 $12.05 $56.00 $19.88 $16.96 $12.05 $40.60 $70.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30200315 EAP CPT® 85027 CBC & PLAT BOTH IP/OP $202.00 $149.50 $3.23 $202.00 $12.70 $12.70 $12.70 $12.70 $6.47 $6.47 $3.24 $3.23 $6.47 $9.83 $9.83 $10.21 $7.17 $9.57 $10.35 $10.35 $119.48 $6.47 $6.47 $6.47 $202.00 $151.50 $6.47 $6.47 $6.47 $36.16 $36.16 $159.98 $6.47 $161.60 $10.68 $9.11 $6.47 $117.16 $202.00 $9.38 $6.47 $7.16 $6.47 N/A N/A 30200330 EAP CPT® 86355 LYMPHOCYTE SUB 6 B CELLS (SO) BOTH IP/OP $217.00 $161.00 $18.86 $217.00 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $128.36 $37.73 $37.73 $37.73 $217.00 $162.75 $37.73 $37.73 $37.73 $131.64 $131.64 $171.86 $37.73 $173.60 $62.25 $33.14 $37.73 $125.86 $217.00 $54.71 $37.73 $26.03 $37.73 N/A N/A 30200331 EAP CPT® 86357 LYMPHOCYTE SUB 6 NK TOTAL (SO) BOTH IP/OP $211.00 $156.50 $18.87 $211.00 $211.00 $211.00 $211.00 $211.00 $37.73 $37.73 $18.87 $211.00 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $211.00 $37.73 $37.73 $37.73 $211.00 $158.25 $37.73 $37.73 $37.73 $131.64 $131.64 $167.11 $37.73 $168.80 $211.00 $211.00 $37.73 $122.38 $211.00 $54.71 $37.73 $211.00 $37.73 N/A N/A 30200332 EAP CPT® 86359 LYMPHOCYTE SUB 6 T CELL TOTAL (SO) BOTH IP/OP $220.00 $163.00 $18.86 $220.00 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $130.13 $37.73 $37.73 $37.73 $220.00 $165.00 $37.73 $37.73 $37.73 $131.64 $131.64 $174.24 $37.73 $176.00 $62.25 $33.14 $37.73 $127.60 $220.00 $54.71 $37.73 $26.03 $37.73 N/A N/A 30200333 EAP CPT® 86360 LYMPHOCYTE SUB 6 T CELLS ABS(SO) BOTH IP/OP $312.00 $231.00 $23.49 $312.00 $92.22 $92.22 $92.22 $92.22 $46.98 $46.98 $23.49 $23.49 $46.98 $71.34 $71.34 $74.09 $52.08 $69.42 $75.17 $75.17 $184.55 $46.98 $46.98 $46.98 $312.00 $234.00 $46.98 $46.98 $46.98 $262.60 $262.60 $247.10 $46.98 $249.60 $77.52 $66.11 $46.98 $180.96 $312.00 $68.12 $46.98 $51.93 $46.98 N/A N/A 30200334 EAP CPT® 86356 LYMPHOCYTE SUB 6 AG (SO) BOTH IP/OP $190.00 $141.00 $13.39 $190.00 $190.00 $190.00 $190.00 $190.00 $26.78 $26.78 $13.39 $190.00 $26.78 $39.63 $39.63 $41.16 $28.93 $38.57 $42.85 $42.85 $190.00 $26.78 $26.78 $26.78 $190.00 $142.50 $26.78 $26.78 $26.78 $95.00 $95.00 $150.48 $26.78 $152.00 $190.00 $190.00 $26.78 $110.20 $190.00 $38.83 $26.78 $190.00 $26.78 N/A N/A 30200335 EAP CPT® 86021 NEUTRAPHIL AB ID (SO) BOTH IP/OP $244.00 $181.00 $7.53 $244.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $144.33 $15.05 $15.05 $15.05 $244.00 $183.00 $15.05 $15.05 $15.05 $84.12 $84.12 $193.25 $15.05 $195.20 $24.83 $21.18 $15.05 $141.52 $244.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30200336 EAP CPT® 86828 NEUTRAPHIL AB ID HLA I&II (SO) BOTH IP/OP $591.00 $437.50 $32.10 $591.00 $591.00 $591.00 $591.00 $591.00 $64.19 $64.19 $32.10 $591.00 $64.19 $57.46 $57.46 $59.67 $41.95 $123.17 $102.70 $102.70 $591.00 $64.19 $64.19 $64.19 $591.00 $443.25 $64.19 $64.19 $64.19 $295.50 $295.50 $468.07 $64.19 $472.80 $591.00 $591.00 $64.19 $342.78 $591.00 $93.08 $64.19 $591.00 $64.19 N/A N/A 30200337 EAP CPT® 86658 ECHOVIRUS AB CSF (SO) BOTH IP/OP $183.00 $135.50 $6.52 $183.00 $183.00 $183.00 $183.00 $183.00 $13.03 $13.03 $6.52 $183.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $183.00 $13.03 $13.03 $13.03 $183.00 $137.25 $13.03 $13.03 $13.03 $72.80 $72.80 $144.94 $13.03 $146.40 $183.00 $183.00 $13.03 $106.14 $183.00 $18.89 $13.03 $183.00 $13.03 N/A N/A 30200338 EAP CPT® 83519 ENCEPH AUTO EVAL CSF RIA (SO) BOTH IP/OP $434.00 $321.50 $8.28 $434.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $256.71 $18.40 $18.40 $18.40 $434.00 $325.50 $18.40 $18.40 $18.40 $75.52 $75.52 $343.73 $18.40 $347.20 $30.36 $19.01 $18.40 $251.72 $434.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30200339 EAP CPT® 86255 ENCEPH AB SCREEN CSF (SO) BOTH IP/OP $240.00 $178.00 $6.03 $240.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $141.96 $12.05 $12.05 $12.05 $240.00 $180.00 $12.05 $12.05 $12.05 $67.36 $67.36 $190.08 $12.05 $192.00 $19.88 $16.96 $12.05 $139.20 $240.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30200340 EAP CPT® 86341 ENCEPH ISLET CELL AB CSF (SO) BOTH IP/OP $196.00 $145.50 $10.61 $196.00 $38.83 $38.83 $38.83 $38.83 $23.57 $23.57 $11.79 $10.61 $23.57 $30.05 $30.05 $31.20 $21.93 $29.24 $37.71 $37.71 $115.93 $23.57 $23.57 $23.57 $196.00 $147.00 $23.57 $23.57 $23.57 $110.60 $110.60 $155.23 $23.57 $156.80 $38.89 $27.85 $23.57 $113.68 $196.00 $34.18 $23.57 $21.88 $23.57 N/A N/A 30200341 EAP CPT® 86606 ASPERGILLUS AB (SO) BOTH IP/OP $120.00 $89.00 $7.53 $120.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $70.98 $15.05 $15.05 $15.05 $120.00 $90.00 $15.05 $15.05 $15.05 $84.12 $84.12 $95.04 $15.05 $96.00 $24.83 $21.18 $15.05 $69.60 $120.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30200342 EAP CPT® 86612 BLASTOMYCES AB (SO) BOTH IP/OP $120.00 $89.00 $6.45 $120.00 $25.33 $25.33 $25.33 $25.33 $12.90 $12.90 $6.45 $6.45 $12.90 $19.59 $19.59 $20.35 $14.30 $19.07 $20.64 $20.64 $70.98 $12.90 $12.90 $12.90 $120.00 $90.00 $12.90 $12.90 $12.90 $72.12 $72.12 $95.04 $12.90 $96.00 $21.29 $18.16 $12.90 $69.60 $120.00 $18.71 $12.90 $14.26 $12.90 N/A N/A 30200343 EAP CPT® 86305 HUMAN EPIDIDYMIS PROT 4 (SO) BOTH IP/OP $330.00 $244.50 $10.41 $330.00 $330.00 $330.00 $330.00 $330.00 $20.81 $20.81 $10.41 $330.00 $20.81 $31.00 $31.00 $32.19 $22.63 $68.78 $33.30 $33.30 $330.00 $20.81 $20.81 $20.81 $330.00 $247.50 $20.81 $20.81 $20.81 $165.00 $165.00 $261.36 $20.81 $264.00 $330.00 $330.00 $20.81 $191.40 $330.00 $30.17 $20.81 $330.00 $20.81 N/A N/A 30200344 EAP CPT® 86635 COCCIDIOIDES AB (SO) BOTH IP/OP $180.00 $133.50 $5.74 $180.00 $180.00 $180.00 $180.00 $180.00 $11.47 $11.47 $5.74 $180.00 $11.47 $17.42 $17.42 $18.09 $12.72 $16.95 $18.35 $18.35 $180.00 $11.47 $11.47 $11.47 $180.00 $135.00 $11.47 $11.47 $11.47 $64.12 $64.12 $142.56 $11.47 $144.00 $180.00 $180.00 $11.47 $104.40 $180.00 $16.63 $11.47 $180.00 $11.47 N/A N/A 30200345 EAP CPT® 86698 HISTOPLASMA AB (SO) BOTH IP/OP $116.00 $86.00 $6.90 $116.00 $116.00 $116.00 $116.00 $116.00 $13.79 $13.79 $6.90 $116.00 $13.79 $18.98 $18.98 $19.71 $13.86 $18.46 $22.06 $22.06 $116.00 $13.79 $13.79 $13.79 $116.00 $87.00 $13.79 $13.79 $13.79 $69.84 $69.84 $91.87 $13.79 $92.80 $116.00 $116.00 $13.79 $67.28 $116.00 $20.00 $13.79 $116.00 $13.79 N/A N/A 30200346 EAP CPT® 87449 FUNGITELL CSF (SO) BOTH IP/OP $182.00 $135.00 $5.99 $182.00 $182.00 $182.00 $182.00 $182.00 $11.98 $11.98 $5.99 $182.00 $11.98 $18.22 $18.22 $18.92 $13.30 $17.71 $19.17 $19.17 $182.00 $11.98 $11.98 $11.98 $182.00 $136.50 $11.98 $11.98 $11.98 $67.04 $67.04 $144.14 $11.98 $145.60 $182.00 $182.00 $11.98 $105.56 $182.00 $17.37 $11.98 $182.00 $11.98 N/A N/A 30200347 EAP CPT® 86790 CHIKUNGUNYA AB (SO) BOTH IP/OP $188.00 $139.50 $6.44 $188.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $111.20 $12.88 $12.88 $12.88 $188.00 $141.00 $12.88 $12.88 $12.88 $72.00 $72.00 $148.90 $12.88 $150.40 $21.25 $18.12 $12.88 $109.04 $188.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30200349 EAP CPT® 86580 TB SKIN TEST BOTH IP/OP $75.00 $55.50 $3.89 $60.00 $11.82 $11.82 $11.82 $11.82 $24.30 $24.30 $24.19 $3.89 $24.30 $7.48 $7.48 $7.77 $5.46 $9.56 $38.88 $36.00 $44.36 $24.30 $10.15 $24.30 $25.52 $56.25 $24.30 $24.30 $24.30 $40.92 $40.92 $59.40 $24.30 $60.00 $48.75 $9.10 $24.30 $43.50 $25.52 $35.16 $24.30 $7.15 $24.30 N/A N/A 30200350 EAP CPT® 86580 STEP 2 PPD #1 BOTH IP/OP $62.00 $46.00 $3.89 $49.60 $11.82 $11.82 $11.82 $11.82 $24.30 $24.30 $24.19 $3.89 $24.30 $7.48 $7.48 $7.77 $5.46 $9.56 $38.88 $36.00 $36.67 $24.30 $10.15 $24.30 $25.52 $46.50 $24.30 $24.30 $24.30 $40.92 $40.92 $49.10 $24.30 $49.60 $40.30 $9.10 $24.30 $35.96 $25.52 $35.16 $24.30 $7.15 $24.30 N/A N/A 30200370 EAP CPT® 86701 FOCUS HIV-1 CONFIRMATION BOTH IP/OP $197.00 $146.00 $4.44 $197.00 $17.44 $17.44 $17.44 $17.44 $8.89 $8.89 $4.45 $4.44 $8.89 $13.48 $13.48 $14.00 $9.84 $11.39 $14.22 $14.22 $116.53 $8.89 $8.89 $8.89 $197.00 $147.75 $8.89 $8.89 $8.89 $49.64 $49.64 $156.02 $8.89 $157.60 $14.67 $10.85 $8.89 $114.26 $197.00 $12.89 $8.89 $8.52 $8.89 N/A N/A 30200371 EAP CPT® 86702 FOCUS HIV-2 CONFIRMATION BOTH IP/OP $238.00 $176.50 $6.76 $238.00 $26.53 $26.53 $26.53 $26.53 $13.52 $13.52 $6.76 $6.76 $13.52 $20.53 $20.53 $21.32 $14.99 $17.33 $21.63 $21.63 $140.78 $13.52 $13.52 $13.52 $238.00 $178.50 $13.52 $13.52 $13.52 $75.52 $75.52 $188.50 $13.52 $190.40 $22.31 $16.50 $13.52 $138.04 $238.00 $19.60 $13.52 $12.96 $13.52 N/A N/A 30200372 EAP CPT® 83516 AQUAPORIN 4 RECEP AB (SO) BOTH IP/OP $259.00 $192.00 $5.76 $259.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $153.20 $11.53 $11.53 $11.53 $259.00 $194.25 $11.53 $11.53 $11.53 $59.76 $59.76 $205.13 $11.53 $207.20 $19.02 $15.05 $11.53 $150.22 $259.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30200373 EAP CPT® 86003 ABPA ALLERGEN SPEC IGE (SO) BOTH IP/OP $110.00 $81.50 $2.61 $110.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $65.07 $5.22 $5.22 $5.22 $110.00 $82.50 $5.22 $5.22 $5.22 $29.20 $29.20 $87.12 $5.22 $88.00 $8.61 $7.35 $5.22 $63.80 $110.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200374 EAP CPT® 86606 ASPERGILLUS AB (SO) BOTH IP/OP $113.00 $84.00 $7.53 $113.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $66.84 $15.05 $15.05 $15.05 $113.00 $84.75 $15.05 $15.05 $15.05 $84.12 $84.12 $89.50 $15.05 $90.40 $24.83 $21.18 $15.05 $65.54 $113.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30200375 EAP CPT® 86161 C3 NEPHRITIC FACTOR (SO) BOTH IP/OP $231.00 $171.00 $6.00 $231.00 $23.54 $23.54 $23.54 $23.54 $12.00 $12.00 $6.00 $6.00 $12.00 $18.23 $18.23 $18.93 $13.31 $17.73 $19.20 $19.20 $136.64 $12.00 $12.00 $12.00 $231.00 $173.25 $12.00 $12.00 $12.00 $67.12 $67.12 $182.95 $12.00 $184.80 $19.80 $16.89 $12.00 $133.98 $231.00 $17.40 $12.00 $13.27 $12.00 N/A N/A 30200376 EAP CPT® 86406 TOXO TITR PREGNANCY (SO) BOTH IP/OP $152.00 $112.50 $5.32 $152.00 $20.88 $20.88 $20.88 $20.88 $10.64 $10.64 $5.32 $5.32 $10.64 $16.15 $16.15 $16.77 $11.79 $15.72 $17.02 $17.02 $89.91 $10.64 $10.64 $10.64 $152.00 $114.00 $10.64 $10.64 $10.64 $59.48 $59.48 $120.38 $10.64 $121.60 $17.56 $14.97 $10.64 $88.16 $152.00 $15.43 $10.64 $11.76 $10.64 N/A N/A 30200377 EAP CPT® 86777 TOXOPLASMA AB (SO) BOTH IP/OP $152.00 $112.50 $7.20 $152.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $89.91 $14.39 $14.39 $14.39 $152.00 $114.00 $14.39 $14.39 $14.39 $65.04 $65.04 $120.38 $14.39 $121.60 $23.74 $16.37 $14.39 $88.16 $152.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30200378 EAP CPT® 86778 TOXOPLASMA AB IGM (SO) BOTH IP/OP $155.00 $115.00 $7.20 $155.00 $28.26 $28.26 $28.26 $28.26 $14.41 $14.41 $7.21 $7.20 $14.41 $21.87 $21.87 $22.71 $15.97 $21.27 $23.06 $23.06 $91.68 $14.41 $14.41 $14.41 $155.00 $116.25 $14.41 $14.41 $14.41 $80.48 $80.48 $122.76 $14.41 $124.00 $23.78 $20.26 $14.41 $89.90 $155.00 $20.89 $14.41 $15.91 $14.41 N/A N/A 30200379 EAP CPT® 86038 ANA IFA WITH REFLEX (SO) BOTH IP/OP $201.00 $149.00 $6.04 $201.00 $23.72 $23.72 $23.72 $23.72 $12.09 $12.09 $6.05 $6.04 $12.09 $18.36 $18.36 $19.06 $13.40 $17.86 $19.34 $19.34 $118.89 $12.09 $12.09 $12.09 $201.00 $150.75 $12.09 $12.09 $12.09 $67.56 $67.56 $159.19 $12.09 $160.80 $19.95 $17.01 $12.09 $116.58 $201.00 $17.53 $12.09 $13.36 $12.09 N/A N/A 30200380 EAP CPT® 86021 WBC AB ID (NEUTROPHIL) (SO) BOTH IP/OP $236.00 $175.00 $7.53 $236.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $139.59 $15.05 $15.05 $15.05 $236.00 $177.00 $15.05 $15.05 $15.05 $84.12 $84.12 $186.91 $15.05 $188.80 $24.83 $21.18 $15.05 $136.88 $236.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30200381 EAP CPT® 86828 HLA I & II AB QUAL (SO) BOTH IP/OP $593.00 $439.00 $32.10 $593.00 $593.00 $593.00 $593.00 $593.00 $64.19 $64.19 $32.10 $593.00 $64.19 $57.46 $57.46 $59.67 $41.95 $123.59 $102.70 $102.70 $593.00 $64.19 $64.19 $64.19 $593.00 $444.75 $64.19 $64.19 $64.19 $296.50 $296.50 $469.66 $64.19 $474.40 $593.00 $593.00 $64.19 $343.94 $593.00 $93.08 $64.19 $593.00 $64.19 N/A N/A 30200382 EAP CPT® 86255 AMPA RECEPT FLUOR AB SCREEN (SO) BOTH IP/OP $429.00 $317.50 $6.03 $429.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $253.75 $12.05 $12.05 $12.05 $429.00 $321.75 $12.05 $12.05 $12.05 $67.36 $67.36 $339.77 $12.05 $343.20 $19.88 $16.96 $12.05 $248.82 $429.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30200383 EAP CPT® 86833 HLA II POST TRANS DSA (SO) BOTH IP/OP $326.00 $241.50 $67.94 $521.28 $326.00 $326.00 $326.00 $326.00 $325.80 $325.80 $162.90 $326.00 $325.80 $167.37 $167.37 $173.80 $122.18 $67.94 $521.28 $521.28 $326.00 $325.80 $325.80 $325.80 $326.00 $244.50 $325.80 $325.80 $325.80 $163.00 $163.00 $258.19 $325.80 $260.80 $326.00 $326.00 $325.80 $189.08 $326.00 $326.00 $325.80 $326.00 $325.80 N/A N/A 30200384 EAP CPT® 86832 HLA I POST TRANS DSA (SO) BOTH IP/OP $324.00 $240.00 $67.53 $518.00 $324.00 $324.00 $324.00 $324.00 $323.75 $323.75 $161.88 $324.00 $323.75 $184.25 $184.25 $191.33 $134.50 $67.53 $518.00 $518.00 $324.00 $323.75 $323.75 $323.75 $324.00 $243.00 $323.75 $323.75 $323.75 $162.00 $162.00 $256.61 $323.75 $259.20 $324.00 $324.00 $323.75 $187.92 $324.00 $324.00 $323.75 $324.00 $323.75 N/A N/A 30200385 EAP CPT® 86829 HLA I/II POST TRANS DSA (SO) BOTH IP/OP $245.00 $181.50 $31.46 $245.00 $245.00 $245.00 $245.00 $245.00 $64.19 $64.19 $32.10 $245.00 $64.19 $43.10 $43.10 $44.76 $31.46 $51.06 $102.70 $102.70 $245.00 $64.19 $64.19 $64.19 $245.00 $183.75 $64.19 $64.19 $64.19 $122.50 $122.50 $194.04 $64.19 $196.00 $245.00 $245.00 $64.19 $142.10 $245.00 $93.08 $64.19 $245.00 $64.19 N/A N/A 30200386 EAP CPT® 86671 CROHNS PROGNOSTIC FUNG AB (SO) BOTH IP/OP $145.00 $107.50 $6.13 $145.00 $145.00 $145.00 $145.00 $145.00 $12.25 $12.25 $6.13 $145.00 $12.25 $18.62 $18.62 $19.33 $13.59 $18.11 $19.60 $19.60 $145.00 $12.25 $12.25 $12.25 $145.00 $108.75 $12.25 $12.25 $12.25 $68.52 $68.52 $114.84 $12.25 $116.00 $145.00 $145.00 $12.25 $84.10 $145.00 $17.76 $12.25 $145.00 $12.25 N/A N/A 30200387 EAP CPT® 83516 CROHNS PROGNOSTIC NONAB (SO) BOTH IP/OP $244.00 $181.00 $5.76 $244.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $144.33 $11.53 $11.53 $11.53 $244.00 $183.00 $11.53 $11.53 $11.53 $59.76 $59.76 $193.25 $11.53 $195.20 $19.02 $15.05 $11.53 $141.52 $244.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30200388 EAP CPT® 83519 PARANEO AUTOAB EVAL RIA(SO) BOTH IP/OP $124.00 $92.00 $8.28 $124.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $73.35 $18.40 $18.40 $18.40 $124.00 $93.00 $18.40 $18.40 $18.40 $75.52 $75.52 $98.21 $18.40 $99.20 $30.36 $19.01 $18.40 $71.92 $124.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30200389 EAP CPT® 86256 PARANEO AUTOAB TITER RIA(SO) BOTH IP/OP $80.00 $59.50 $6.03 $80.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $47.32 $12.05 $12.05 $12.05 $80.00 $60.00 $12.05 $12.05 $12.05 $67.36 $67.36 $63.36 $12.05 $64.00 $19.88 $16.96 $12.05 $46.40 $80.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30200390 EAP CPT® 86255 NMDA RECEP AB SERUM BOTH IP/OP $184.00 $136.50 $6.03 $184.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $108.84 $12.05 $12.05 $12.05 $184.00 $138.00 $12.05 $12.05 $12.05 $67.36 $67.36 $145.73 $12.05 $147.20 $19.88 $16.96 $12.05 $106.72 $184.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30200400 EAP CPT® 82963 BETA GLUCOSIDASE SO BOTH IP/OP "$1,282.00" $949.00 $10.74 "$1,282.00" $42.17 $42.17 $42.17 $42.17 $21.48 $21.48 $10.74 $10.74 $21.48 $32.62 $32.62 $33.88 $23.82 $31.73 $34.37 $34.37 $758.30 $21.48 $21.48 $21.48 "$1,282.00" $961.50 $21.48 $21.48 $21.48 $120.04 $120.04 "$1,015.34" $21.48 "$1,025.60" $35.44 $30.22 $21.48 $743.56 "$1,282.00" $31.15 $21.48 $23.74 $21.48 N/A N/A 30200401 EAP CPT® 87389 HIV 1/2 AG/AB 4TH GENERATION SO BOTH IP/OP $104.00 $77.00 $12.04 $104.00 $47.26 $47.26 $47.26 $47.26 $24.08 $24.08 $12.04 $12.04 $24.08 $35.48 $35.48 $36.85 $25.90 $32.07 $38.53 $38.53 $61.52 $24.08 $24.08 $24.08 $104.00 $78.00 $24.08 $24.08 $24.08 $52.00 $52.00 $82.37 $24.08 $83.20 $39.73 $30.54 $24.08 $60.32 $104.00 $34.92 $24.08 $23.99 $24.08 N/A N/A 30200449 EAP CPT® 86580 TB SKIN TEST BOTH IP/OP $75.00 $55.50 $3.89 $60.00 $11.82 $11.82 $11.82 $11.82 $24.30 $24.30 $24.19 $3.89 $24.30 $7.48 $7.48 $7.77 $5.46 $9.56 $38.88 $36.00 $44.36 $24.30 $10.15 $24.30 $25.52 $56.25 $24.30 $24.30 $24.30 $40.92 $40.92 $59.40 $24.30 $60.00 $48.75 $9.10 $24.30 $43.50 $25.52 $35.16 $24.30 $7.15 $24.30 N/A N/A 30200450 EAP CPT® 86021 PROTEINASE-3 ANTIBODY BOTH IP/OP $206.00 $152.50 $7.53 $206.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $121.85 $15.05 $15.05 $15.05 $206.00 $154.50 $15.05 $15.05 $15.05 $84.12 $84.12 $163.15 $15.05 $164.80 $24.83 $21.18 $15.05 $119.48 $206.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30200451 EAP CPT® 86021 MYELOPEROXIDASE ANTIBODY BOTH IP/OP $200.00 $148.00 $7.53 $200.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $118.30 $15.05 $15.05 $15.05 $200.00 $150.00 $15.05 $15.05 $15.05 $84.12 $84.12 $158.40 $15.05 $160.00 $24.83 $21.18 $15.05 $116.00 $200.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30200452 EAP CPT® 86022 "PLATELET IGG AB,INDIRECT" BOTH IP/OP $301.00 $223.00 $9.19 $301.00 $301.00 $301.00 $301.00 $301.00 $18.37 $18.37 $9.19 $301.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $301.00 $18.37 $18.37 $18.37 $301.00 $225.75 $18.37 $18.37 $18.37 $102.64 $102.64 $238.39 $18.37 $240.80 $301.00 $301.00 $18.37 $174.58 $301.00 $26.64 $18.37 $301.00 $18.37 N/A N/A 30200453 EAP CPT® 86023 PLATELET GLYCOPROT. AB BOTH IP/OP $438.00 $324.50 $6.23 $438.00 $438.00 $438.00 $438.00 $438.00 $12.46 $12.46 $6.23 $438.00 $12.46 $18.92 $18.92 $19.65 $13.81 $18.40 $19.94 $19.94 $438.00 $12.46 $12.46 $12.46 $438.00 $328.50 $12.46 $12.46 $12.46 $69.60 $69.60 $346.90 $12.46 $350.40 $438.00 $438.00 $12.46 $254.04 $438.00 $18.07 $12.46 $438.00 $12.46 N/A N/A 30200454 EAP CPT® 86200 CYCLIC CITURULLINATE ANTIBODY BOTH IP/OP $387.00 $286.50 $6.48 $387.00 $25.40 $25.40 $25.40 $25.40 $12.95 $12.95 $6.48 $6.48 $12.95 $19.67 $19.67 $20.42 $14.36 $19.12 $20.72 $20.72 $228.91 $12.95 $12.95 $12.95 $387.00 $290.25 $12.95 $12.95 $12.95 $72.36 $72.36 $306.50 $12.95 $309.60 $21.37 $18.21 $12.95 $224.46 $387.00 $18.78 $12.95 $14.30 $12.95 N/A N/A 30200455 EAP CPT® 86256 PARIETAL ANTIBODY TITER BOTH IP/OP $88.00 $65.50 $6.03 $88.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $52.05 $12.05 $12.05 $12.05 $88.00 $66.00 $12.05 $12.05 $12.05 $67.36 $67.36 $69.70 $12.05 $70.40 $19.88 $16.96 $12.05 $51.04 $88.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30200480 EAP CPT® 83789 TPMT ACTIVITY BOTH IP/OP $690.00 $511.00 $6.66 $690.00 $690.00 $690.00 $690.00 $690.00 $24.11 $24.11 $12.06 $690.00 $24.11 $9.12 $9.12 $9.47 $6.66 $8.87 $38.58 $38.58 $690.00 $24.11 $24.11 $24.11 $690.00 $517.50 $24.11 $24.11 $24.11 $33.56 $33.56 $546.48 $24.11 $552.00 $690.00 $690.00 $24.11 $400.20 $690.00 $34.96 $24.11 $690.00 $24.11 N/A N/A 30200481 EAP CPT® 86689 HTLV AB. WESTERN BLOT BOTH IP/OP $281.00 $208.00 $9.68 $281.00 $281.00 $281.00 $281.00 $281.00 $19.35 $19.35 $9.68 $281.00 $19.35 $29.39 $29.39 $30.52 $21.45 $24.81 $30.96 $30.96 $281.00 $19.35 $19.35 $19.35 $281.00 $210.75 $19.35 $19.35 $19.35 $108.20 $108.20 $222.55 $19.35 $224.80 $281.00 $281.00 $19.35 $162.98 $281.00 $28.06 $19.35 $281.00 $19.35 N/A N/A 30200491 EAP CPT® 86316 "IMMUNOASSAY, TUMOR ANTIGEN, QUANT" BOTH IP/OP $315.00 $233.50 $10.41 $315.00 $40.84 $40.84 $40.84 $40.84 $20.81 $20.81 $10.41 $10.41 $20.81 $31.60 $31.60 $32.81 $23.06 $30.73 $33.30 $33.30 $186.32 $20.81 $20.81 $20.81 $315.00 $236.25 $20.81 $20.81 $20.81 $116.28 $116.28 $249.48 $20.81 $252.00 $34.34 $29.27 $20.81 $182.70 $315.00 $30.17 $20.81 $22.99 $20.81 N/A N/A 30200492 EAP CPT® 86651 ENCEPHAL ANTIBODY CALIF BOTH IP/OP $36.00 $27.00 $6.60 $36.00 $36.00 $36.00 $36.00 $36.00 $13.19 $13.19 $6.60 $36.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $36.00 $13.19 $13.19 $13.19 $36.00 $27.00 $13.19 $13.19 $13.19 $36.00 $36.00 $28.51 $13.19 $28.80 $36.00 $36.00 $13.19 $20.88 $36.00 $19.13 $13.19 $36.00 $13.19 N/A N/A 30200493 EAP CPT® 86652 ENCEPHAL ANTIBODY EAST EQU BOTH IP/OP $36.00 $27.00 $6.60 $36.00 $36.00 $36.00 $36.00 $36.00 $13.19 $13.19 $6.60 $36.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $36.00 $13.19 $13.19 $13.19 $36.00 $27.00 $13.19 $13.19 $13.19 $36.00 $36.00 $28.51 $13.19 $28.80 $36.00 $36.00 $13.19 $20.88 $36.00 $19.13 $13.19 $36.00 $13.19 N/A N/A 30200494 EAP CPT® 86653 ENCEPHAL ANTIBODY ST LOUIS BOTH IP/OP $36.00 $27.00 $6.60 $36.00 $36.00 $36.00 $36.00 $36.00 $13.19 $13.19 $6.60 $36.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $36.00 $13.19 $13.19 $13.19 $36.00 $27.00 $13.19 $13.19 $13.19 $36.00 $36.00 $28.51 $13.19 $28.80 $36.00 $36.00 $13.19 $20.88 $36.00 $19.13 $13.19 $36.00 $13.19 N/A N/A 30200495 EAP CPT® 86654 ENCEPHAL ANTIBODY WEST EQU BOTH IP/OP $36.00 $27.00 $6.60 $36.00 $36.00 $36.00 $36.00 $36.00 $13.19 $13.19 $6.60 $36.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $36.00 $13.19 $13.19 $13.19 $36.00 $27.00 $13.19 $13.19 $13.19 $36.00 $36.00 $28.51 $13.19 $28.80 $36.00 $36.00 $13.19 $20.88 $36.00 $19.13 $13.19 $36.00 $13.19 N/A N/A 30200496 EAP CPT® 88360 TUMOR IMMUNOHISTOCHEM/MANUAL BOTH IP/OP "$1,842.00" "$1,363.50" $49.88 "$1,473.60" $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 "$1,089.54" $146.71 $78.13 $146.71 $154.04 "$1,381.50" $146.71 $146.71 $146.71 $242.68 $242.68 "$1,458.86" $146.71 "$1,473.60" "$1,197.30" $109.25 $146.71 "$1,068.36" $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 30200498 EAP CPT® 82787 "IGG1, 2, 3 OR 4, EACH" BOTH IP/OP $84.00 $62.50 $4.01 $84.00 $15.74 $15.74 $15.74 $15.74 $8.02 $8.02 $4.01 $4.01 $8.02 $12.18 $12.18 $12.65 $8.89 $11.84 $12.83 $12.83 $49.69 $8.02 $8.02 $8.02 $84.00 $63.00 $8.02 $8.02 $8.02 $44.80 $44.80 $66.53 $8.02 $67.20 $13.23 $11.28 $8.02 $48.72 $84.00 $11.63 $8.02 $8.86 $8.02 N/A N/A 30200499 EAP CPT® 86343 LEUKOCYTE HISTAMINE RELEASE BOTH IP/OP $418.00 $309.50 $6.23 $418.00 $24.45 $24.45 $24.45 $24.45 $12.46 $12.46 $6.23 $6.23 $12.46 $18.93 $18.93 $19.66 $13.82 $18.41 $19.94 $19.94 $247.25 $12.46 $12.46 $12.46 $418.00 $313.50 $12.46 $12.46 $12.46 $69.64 $69.64 $331.06 $12.46 $334.40 $20.56 $17.53 $12.46 $242.44 $418.00 $18.07 $12.46 $13.77 $12.46 N/A N/A 30200500 EAP CPT® 86580 TB INTRADERMAL TEST BOTH IP/OP $106.00 $78.50 $3.89 $84.80 $11.82 $11.82 $11.82 $11.82 $24.30 $24.30 $24.19 $3.89 $24.30 $7.48 $7.48 $7.77 $5.46 $9.56 $38.88 $36.00 $62.70 $24.30 $10.15 $24.30 $25.52 $79.50 $24.30 $24.30 $24.30 $40.92 $40.92 $83.95 $24.30 $84.80 $68.90 $9.10 $24.30 $61.48 $25.52 $35.16 $24.30 $7.15 $24.30 N/A N/A 30200501 EAP CPT® 83789 "MASS SPECTROMETRY QUANT,NONSPEC" BOTH IP/OP $126.00 $93.50 $6.66 $126.00 $126.00 $126.00 $126.00 $126.00 $24.11 $24.11 $12.06 $126.00 $24.11 $9.12 $9.12 $9.47 $6.66 $8.87 $38.58 $38.58 $126.00 $24.11 $24.11 $24.11 $126.00 $94.50 $24.11 $24.11 $24.11 $33.56 $33.56 $99.79 $24.11 $100.80 $126.00 $126.00 $24.11 $73.08 $126.00 $34.96 $24.11 $126.00 $24.11 N/A N/A 30200503 EAP CPT® 88189 "FLOWCYTOMETRY/READ, 16 & > MARKERS" BOTH IP/OP $248.00 $184.00 $42.40 $248.00 $248.00 $248.00 $248.00 $248.00 $84.10 $84.10 $42.40 $248.00 $84.10 $184.07 $184.07 $191.16 $129.21 $115.43 $134.56 $133.38 $248.00 $84.10 $83.36 $84.10 $248.00 $186.00 $84.10 $84.10 $84.10 $248.00 $248.00 $196.42 $84.10 $198.40 $161.20 $248.00 $84.10 $143.84 $248.00 $88.72 $84.10 $248.00 $84.10 N/A N/A 30200504 EAP CPT® 88188 "FLOWCYTOMETRY/READ, 9-15 MARKERS" BOTH IP/OP $278.00 $206.00 $31.30 $278.00 $278.00 $278.00 $278.00 $278.00 $62.68 $62.68 $31.30 $278.00 $62.68 $206.33 $206.33 $214.28 $144.84 $87.63 $100.29 $98.67 $278.00 $62.68 $61.67 $62.68 $278.00 $208.50 $62.68 $62.68 $62.68 $278.00 $278.00 $220.18 $62.68 $222.40 $180.70 $278.00 $62.68 $161.24 $278.00 $65.99 $62.68 $278.00 $62.68 N/A N/A 30200505 EAP CPT® 88187 "FLOWCYTOMETRY/READ, 2-8 MARKERS" BOTH IP/OP $180.00 $133.50 $18.24 $180.00 $180.00 $180.00 $180.00 $180.00 $35.84 $35.84 $18.24 $180.00 $35.84 $133.60 $133.60 $138.74 $93.78 $70.22 $57.34 $56.40 $180.00 $35.84 $35.25 $35.84 $180.00 $135.00 $35.84 $35.84 $35.84 $180.00 $180.00 $142.56 $35.84 $144.00 $117.00 $180.00 $35.84 $104.40 $180.00 $39.31 $35.84 $180.00 $35.84 N/A N/A 30200506 EAP CPT® 88368 "INSITU HYBRIDIZATION, MANUAL" BOTH IP/OP "$1,076.00" $796.50 $58.22 $860.80 $169.58 $169.58 $169.58 $169.58 $286.49 $286.49 $285.22 $58.22 $286.49 $151.36 $151.36 $157.18 $110.49 $199.20 $458.39 $467.58 $636.45 $286.49 $102.49 $286.49 $300.82 $807.00 $286.49 $286.49 $286.49 $415.48 $415.48 $852.19 $286.49 $860.80 $699.40 $189.71 $286.49 $624.08 $300.82 $414.48 $286.49 $149.02 $286.49 N/A N/A 30200507 EAP CPT® 86480 "TB TEST,CELL IMMUN MEAS BY GAMMA INTERFRON" BOTH IP/OP $572.00 $423.50 $30.99 $572.00 $121.63 $121.63 $121.63 $121.63 $61.98 $61.98 $30.99 $30.99 $61.98 $94.11 $94.11 $97.73 $68.70 $91.55 $99.17 $99.17 $338.34 $61.98 $61.98 $61.98 $572.00 $429.00 $61.98 $61.98 $61.98 $346.36 $346.36 $453.02 $61.98 $457.60 $102.27 $87.19 $61.98 $331.76 $572.00 $89.87 $61.98 $68.49 $61.98 N/A N/A 30200508 EAP CPT® 87799 "JC VIRUS PCR, URINE (Q)" BOTH IP/OP $743.00 $550.00 $21.42 $743.00 $743.00 $743.00 $743.00 $743.00 $42.84 $42.84 $21.42 $743.00 $42.84 $65.04 $65.04 $67.54 $47.48 $154.85 $68.54 $68.54 $743.00 $42.84 $42.84 $42.84 $743.00 $557.25 $42.84 $42.84 $42.84 $239.40 $239.40 $588.46 $42.84 $594.40 $743.00 $743.00 $42.84 $430.94 $743.00 $62.12 $42.84 $743.00 $42.84 N/A N/A 30200509 EAP CPT® 87799 "BK VIRUS PCR, URINE (Q)" BOTH IP/OP $635.00 $470.00 $21.42 $635.00 $635.00 $635.00 $635.00 $635.00 $42.84 $42.84 $21.42 $635.00 $42.84 $65.04 $65.04 $67.54 $47.48 $132.34 $68.54 $68.54 $635.00 $42.84 $42.84 $42.84 $635.00 $476.25 $42.84 $42.84 $42.84 $239.40 $239.40 $502.92 $42.84 $508.00 $635.00 $635.00 $42.84 $368.30 $635.00 $62.12 $42.84 $635.00 $42.84 N/A N/A 30200510 EAP CPT® 83519 THYROTRPN BNDNG INHIB AB (Q) BOTH IP/OP $225.00 $166.50 $8.28 $225.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $133.09 $18.40 $18.40 $18.40 $225.00 $168.75 $18.40 $18.40 $18.40 $75.52 $75.52 $178.20 $18.40 $180.00 $30.36 $19.01 $18.40 $130.50 $225.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30200511 EAP CPT® 83520 PROTHROMBIN FRAGMENT (E) BOTH IP/OP $232.00 $172.00 $7.77 $232.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $137.23 $17.27 $17.27 $17.27 $232.00 $174.00 $17.27 $17.27 $17.27 $72.36 $72.36 $183.74 $17.27 $185.60 $28.50 $18.21 $17.27 $134.56 $232.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30200512 EAP CPT® 87912 "HEPTIS B RESIST, GENO (Q)" BOTH IP/OP $606.00 $448.50 $84.28 $606.00 $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $373.52 $373.52 $387.88 $272.66 $112.65 $411.92 $411.92 $358.45 $257.45 $257.45 $257.45 $606.00 $454.50 $257.45 $257.45 $257.45 $303.00 $303.00 $479.95 $257.45 $484.80 $424.79 $107.29 $257.45 $351.48 $606.00 $373.30 $257.45 $84.28 $257.45 N/A N/A 30200600 EAP CPT® 88184 FLOWCYTOMETRY/ TC 1 MARKER BOTH IP/OP $300.00 $222.00 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $177.45 $286.49 $75.09 $286.49 $300.82 $225.00 $286.49 $286.49 $286.49 $267.48 $267.48 $237.60 $286.49 $240.00 $195.00 $51.58 $286.49 $174.00 $300.82 $300.00 $286.49 $40.52 $286.49 N/A N/A 30200601 EAP CPT® 88185 FLOWCYTOMETRY/TC ADD-ON BOTH IP/OP $28.00 $21.00 $11.19 $50.81 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $11.19 $28.00 $48.93 $48.93 $50.81 $35.72 $26.63 $28.00 $28.00 $16.56 $28.00 $24.01 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $28.00 $28.00 $22.18 $28.00 $22.40 $18.20 $25.36 $28.00 $16.24 $28.00 $28.00 $28.00 $19.92 $28.00 N/A N/A 30200602 EAP CPT® 86813 HLA TYPING A B OR C BOTH IP/OP $413.00 $306.00 $29.00 $413.00 $413.00 $413.00 $413.00 $413.00 $58.00 $58.00 $29.00 $413.00 $58.00 $88.05 $88.05 $91.43 $64.27 $85.66 $92.80 $92.80 $413.00 $58.00 $58.00 $58.00 $413.00 $309.75 $58.00 $58.00 $58.00 $324.08 $324.08 $327.10 $58.00 $330.40 $413.00 $413.00 $58.00 $239.54 $413.00 $84.10 $58.00 $413.00 $58.00 N/A N/A 30200603 EAP CPT® 87252 VIRUS INOCULATION TISSUE - ACYCLOVIR BOTH IP/OP $496.00 $367.50 $13.04 $496.00 $496.00 $496.00 $496.00 $496.00 $26.07 $26.07 $13.04 $496.00 $26.07 $33.57 $33.57 $34.86 $24.51 $32.66 $41.71 $41.71 $496.00 $26.07 $26.07 $26.07 $496.00 $372.00 $26.07 $26.07 $26.07 $123.56 $123.56 $392.83 $26.07 $396.80 $496.00 $496.00 $26.07 $287.68 $496.00 $37.80 $26.07 $496.00 $26.07 N/A N/A 30200604 EAP CPT® 87253 VIRUS INOCULATE TISSUE ADDL - ACYCLOVIR BOTH IP/OP $471.00 $349.00 $10.10 $471.00 $471.00 $471.00 $471.00 $471.00 $20.20 $20.20 $10.10 $471.00 $20.20 $24.73 $24.73 $25.68 $18.05 $24.06 $32.32 $32.32 $471.00 $20.20 $20.20 $20.20 $471.00 $353.25 $20.20 $20.20 $20.20 $91.04 $91.04 $373.03 $20.20 $376.80 $471.00 $471.00 $20.20 $273.18 $471.00 $29.29 $20.20 $471.00 $20.20 N/A N/A 30200605 EAP CPT® 85246 BLOOD CLOT FACTOR VIII TEST BOTH IP/OP $106.00 $78.50 $11.47 $106.00 $45.03 $45.03 $45.03 $45.03 $22.94 $22.94 $11.47 $11.47 $22.94 $34.85 $34.85 $36.19 $25.44 $33.89 $36.70 $36.70 $62.70 $22.94 $22.94 $22.94 $106.00 $79.50 $22.94 $22.94 $22.94 $106.00 $106.00 $83.95 $22.94 $84.80 $37.85 $32.28 $22.94 $61.48 $106.00 $33.26 $22.94 $25.36 $22.94 N/A N/A 30200606 EAP CPT® 83033 FETAL HEMOGLOBIN ASSAY QUAL BOTH IP/OP $95.00 $70.50 $4.00 $95.00 $95.00 $95.00 $95.00 $95.00 $8.00 $8.00 $4.00 $95.00 $8.00 $9.05 $9.05 $9.40 $6.60 $8.81 $12.80 $12.80 $95.00 $8.00 $8.00 $8.00 $95.00 $71.25 $8.00 $8.00 $8.00 $33.32 $33.32 $75.24 $8.00 $76.00 $95.00 $95.00 $8.00 $55.10 $95.00 $11.60 $8.00 $95.00 $8.00 N/A N/A 30200629 EAP CPT® 80347 ASSAY OF BENZODIAZEPINES BOTH IP/OP $562.00 $416.00 $27.32 $562.00 $562.00 $562.00 $562.00 $562.00 $114.43 $114.43 $57.22 $562.00 $114.43 $417.12 $417.12 $433.19 $292.80 $27.32 $183.09 $183.09 $562.00 $114.43 $114.43 $114.43 $562.00 $421.50 $114.43 $114.43 $114.43 $281.00 $281.00 $445.10 $114.43 $449.60 $562.00 $562.00 $114.43 $325.96 $562.00 $337.20 $562.00 $562.00 $114.43 N/A N/A 30200630 EAP CPT® 88237 TISSUE CULTURE BONE MARROW BOTH IP/OP $507.00 $375.50 $64.69 $507.00 $173.27 $173.27 $173.27 $173.27 $143.75 $143.75 $71.88 $64.69 $143.75 $134.06 $134.06 $139.21 $97.86 $130.42 $230.00 $230.00 $299.89 $143.75 $143.75 $143.75 $507.00 $380.25 $143.75 $143.75 $143.75 $493.40 $493.40 $401.54 $143.75 $405.60 $237.19 $124.21 $143.75 $294.06 $507.00 $208.44 $143.75 $97.57 $143.75 N/A N/A 30200631 EAP CPT® 88264 CHROMOSOME ANALYSIS 20-25 BOTH IP/OP $624.00 $462.00 $65.07 $624.00 $244.62 $244.62 $244.62 $244.62 $144.61 $144.61 $72.31 $65.07 $144.61 $189.26 $189.26 $196.54 $138.16 $184.12 $231.38 $231.38 $369.10 $144.61 $144.61 $144.61 $624.00 $468.00 $144.61 $144.61 $144.61 $624.00 $624.00 $494.21 $144.61 $499.20 $238.61 $175.35 $144.61 $361.92 $624.00 $209.68 $144.61 $137.74 $144.61 N/A N/A 30200633 EAP CPT® 88237 TISSUE CULTURE BONE MARROW BOTH IP/OP $237.00 $175.50 $64.69 $237.19 $173.27 $173.27 $173.27 $173.27 $143.75 $143.75 $71.88 $64.69 $143.75 $134.06 $134.06 $139.21 $97.86 $130.42 $230.00 $230.00 $140.19 $143.75 $143.75 $143.75 $237.00 $177.75 $143.75 $143.75 $143.75 $237.00 $237.00 $187.70 $143.75 $189.60 $237.19 $124.21 $143.75 $137.46 $237.00 $208.44 $143.75 $97.57 $143.75 N/A N/A 30200634 EAP CPT® 88262 CHROMOSOME ANALYSIS 15-20 BOTH IP/OP $199.00 $147.50 $62.32 $207.06 $199.00 $199.00 $199.00 $199.00 $125.49 $125.49 $62.75 $62.32 $125.49 $189.26 $189.26 $196.54 $138.16 $184.12 $200.78 $200.78 $117.71 $125.49 $125.49 $125.49 $199.00 $149.25 $125.49 $125.49 $125.49 $199.00 $199.00 $157.61 $125.49 $159.20 $207.06 $175.35 $125.49 $115.42 $199.00 $181.96 $125.49 $137.74 $125.49 N/A N/A 30200636 EAP CPT® 86343 LEUKOCYTE HISTAMINE RELEASE BOTH IP/OP $52.00 $38.50 $6.23 $52.00 $24.45 $24.45 $24.45 $24.45 $12.46 $12.46 $6.23 $6.23 $12.46 $18.93 $18.93 $19.66 $13.82 $18.41 $19.94 $19.94 $30.76 $12.46 $12.46 $12.46 $52.00 $39.00 $12.46 $12.46 $12.46 $52.00 $52.00 $41.18 $12.46 $41.60 $20.56 $17.53 $12.46 $30.16 $52.00 $18.07 $12.46 $13.77 $12.46 N/A N/A 30200637 EAP CPT® 83088 ASSAY OF HISTAMINE BOTH IP/OP $50.00 $37.00 $14.77 $50.00 $50.00 $50.00 $50.00 $50.00 $29.53 $29.53 $14.77 $50.00 $29.53 $44.84 $44.84 $46.57 $32.74 $43.62 $47.25 $47.25 $50.00 $29.53 $29.53 $29.53 $50.00 $37.50 $29.53 $29.53 $29.53 $50.00 $50.00 $39.60 $29.53 $40.00 $50.00 $50.00 $29.53 $29.00 $50.00 $42.82 $29.53 $50.00 $29.53 N/A N/A 30200638 EAP CPT® 86021 WBC ANTIBODY IDENTIFICATION BOTH IP/OP $31.00 $23.00 $7.53 $31.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $18.34 $15.05 $15.05 $15.05 $31.00 $23.25 $15.05 $15.05 $15.05 $31.00 $31.00 $24.55 $15.05 $24.80 $24.83 $21.18 $15.05 $17.98 $31.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30200639 EAP CPT® 86376 MICROSOMAL ANTIBODY BOTH IP/OP $29.00 $21.50 $7.28 $29.00 $28.56 $28.56 $28.56 $28.56 $14.55 $14.55 $7.28 $7.28 $14.55 $22.10 $22.10 $22.95 $16.13 $21.49 $23.28 $23.28 $17.15 $14.55 $14.55 $14.55 $29.00 $21.75 $14.55 $14.55 $14.55 $29.00 $29.00 $22.97 $14.55 $23.20 $24.01 $20.47 $14.55 $16.82 $29.00 $21.10 $14.55 $16.08 $14.55 N/A N/A 30200640 EAP CPT® 84443 ASSAY THYROID STIM HORMONE BOTH IP/OP $42.00 $31.50 $8.40 $42.00 $32.98 $32.98 $32.98 $32.98 $16.80 $16.80 $8.40 $8.40 $16.80 $25.51 $25.51 $26.49 $18.62 $24.81 $26.88 $26.88 $24.84 $16.80 $16.80 $16.80 $42.00 $31.50 $16.80 $16.80 $16.80 $42.00 $42.00 $33.26 $16.80 $33.60 $27.72 $23.63 $16.80 $24.36 $42.00 $24.36 $16.80 $18.56 $16.80 N/A N/A 30200641 EAP CPT® 86800 THYROGLOBULIN ANTIBODY BOTH IP/OP $75.00 $55.50 $7.95 $75.00 $31.22 $31.22 $31.22 $31.22 $15.91 $15.91 $7.96 $7.95 $15.91 $24.15 $24.15 $25.08 $17.63 $23.50 $25.46 $25.46 $44.36 $15.91 $15.91 $15.91 $75.00 $56.25 $15.91 $15.91 $15.91 $75.00 $75.00 $59.40 $15.91 $60.00 $26.25 $22.38 $15.91 $43.50 $75.00 $23.07 $15.91 $17.58 $15.91 N/A N/A 30200649 EAP CPT® 88321 MICROSLIDE CONSULTATION BOTH IP/OP $364.00 $269.50 $42.22 $364.00 $364.00 $364.00 $364.00 $364.00 $83.74 $83.74 $42.22 $364.00 $83.74 $82.27 $82.27 $85.44 $60.06 $69.33 $133.98 $132.83 $364.00 $83.74 $83.02 $83.74 $364.00 $273.00 $83.74 $83.74 $83.74 $361.28 $361.28 $288.29 $83.74 $291.20 $236.60 $364.00 $83.74 $211.12 $364.00 $87.99 $83.74 $364.00 $83.74 N/A N/A 30200650 EAP CPT® 86343 LEUKOCYTE HISTAMINE RELEASE BOTH IP/OP $48.00 $36.00 $6.23 $48.00 $24.45 $24.45 $24.45 $24.45 $12.46 $12.46 $6.23 $6.23 $12.46 $18.93 $18.93 $19.66 $13.82 $18.41 $19.94 $19.94 $28.39 $12.46 $12.46 $12.46 $48.00 $36.00 $12.46 $12.46 $12.46 $48.00 $48.00 $38.02 $12.46 $38.40 $20.56 $17.53 $12.46 $27.84 $48.00 $18.07 $12.46 $13.77 $12.46 N/A N/A 30200651 EAP CPT® 83088 ASSAY OF HISTAMINE BOTH IP/OP $49.00 $36.50 $14.77 $49.00 $49.00 $49.00 $49.00 $49.00 $29.53 $29.53 $14.77 $49.00 $29.53 $44.84 $44.84 $46.57 $32.74 $43.62 $47.25 $47.25 $49.00 $29.53 $29.53 $29.53 $49.00 $36.75 $29.53 $29.53 $29.53 $49.00 $49.00 $38.81 $29.53 $39.20 $49.00 $49.00 $29.53 $28.42 $49.00 $42.82 $29.53 $49.00 $29.53 N/A N/A 30200652 EAP CPT® 86021 WBC ANTIBODY IDENTIFICATION BOTH IP/OP $29.00 $21.50 $7.53 $29.00 $29.00 $29.00 $29.00 $29.00 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $17.15 $15.05 $15.05 $15.05 $29.00 $21.75 $15.05 $15.05 $15.05 $29.00 $29.00 $22.97 $15.05 $23.20 $24.83 $21.18 $15.05 $16.82 $29.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30200653 EAP CPT® 86376 MICROSOMAL ANTIBODY BOTH IP/OP $27.00 $20.00 $7.28 $27.00 $27.00 $27.00 $27.00 $27.00 $14.55 $14.55 $7.28 $7.28 $14.55 $22.10 $22.10 $22.95 $16.13 $21.49 $23.28 $23.28 $15.97 $14.55 $14.55 $14.55 $27.00 $20.25 $14.55 $14.55 $14.55 $27.00 $27.00 $21.38 $14.55 $21.60 $24.01 $20.47 $14.55 $15.66 $27.00 $21.10 $14.55 $16.08 $14.55 N/A N/A 30200654 EAP CPT® 84443 ASSAY THYROID STIM HORMONE BOTH IP/OP $39.00 $29.00 $8.40 $39.00 $32.98 $32.98 $32.98 $32.98 $16.80 $16.80 $8.40 $8.40 $16.80 $25.51 $25.51 $26.49 $18.62 $24.81 $26.88 $26.88 $23.07 $16.80 $16.80 $16.80 $39.00 $29.25 $16.80 $16.80 $16.80 $39.00 $39.00 $30.89 $16.80 $31.20 $27.72 $23.63 $16.80 $22.62 $39.00 $24.36 $16.80 $18.56 $16.80 N/A N/A 30200655 EAP CPT® 86800 THYROGLOBULIN ANTIBODY BOTH IP/OP $69.00 $51.50 $7.95 $69.00 $31.22 $31.22 $31.22 $31.22 $15.91 $15.91 $7.96 $7.95 $15.91 $24.15 $24.15 $25.08 $17.63 $23.50 $25.46 $25.46 $40.81 $15.91 $15.91 $15.91 $69.00 $51.75 $15.91 $15.91 $15.91 $69.00 $69.00 $54.65 $15.91 $55.20 $26.25 $22.38 $15.91 $40.02 $69.00 $23.07 $15.91 $17.58 $15.91 N/A N/A 30200656 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $77.00 $57.00 $10.71 $77.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $45.55 $21.42 $21.42 $21.42 $77.00 $57.75 $21.42 $21.42 $21.42 $77.00 $77.00 $60.98 $21.42 $61.60 $35.34 $30.14 $21.42 $44.66 $77.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30200657 EAP CPT® 88273 CYTOGENETICS 10-30 BOTH IP/OP $107.00 $79.50 $17.41 $107.00 $107.00 $107.00 $107.00 $107.00 $34.81 $34.81 $17.41 $107.00 $34.81 $48.79 $48.79 $50.66 $35.61 $47.46 $55.70 $55.70 $107.00 $34.81 $34.81 $34.81 $107.00 $80.25 $34.81 $34.81 $34.81 $107.00 $107.00 $84.74 $34.81 $85.60 $107.00 $107.00 $34.81 $62.06 $107.00 $50.47 $34.81 $107.00 $34.81 N/A N/A 30200660 EAP CPT® 88182 CELL MARKER STUDY BOTH IP/OP $93.00 $69.00 $50.33 $197.55 $93.00 $93.00 $93.00 $93.00 $110.39 $110.39 $70.11 $93.00 $110.39 $68.95 $68.95 $71.60 $50.33 $78.66 $176.62 $197.55 $93.00 $110.39 $123.47 $110.39 $93.00 $69.75 $110.39 $110.39 $110.39 $93.00 $93.00 $73.66 $110.39 $74.40 $60.45 $93.00 $110.39 $53.94 $93.00 $93.00 $110.39 $93.00 $93.00 N/A N/A 30200661 EAP CPT® 86817 HLA TYPING DR/DQ BOTH IP/OP $743.00 $550.00 $53.07 $743.00 $743.00 $743.00 $743.00 $743.00 $106.14 $106.14 $53.07 $743.00 $106.14 $97.76 $97.76 $101.52 $71.36 $95.11 $169.82 $169.82 $743.00 $106.14 $106.14 $106.14 $743.00 $557.25 $106.14 $106.14 $106.14 $359.80 $359.80 $588.46 $106.14 $594.40 $743.00 $743.00 $106.14 $430.94 $743.00 $153.90 $106.14 $743.00 $106.14 N/A N/A 30200671 EAP CPT® 88360 TUMOR IMMUNOHISTOCHEM/MANUAL BOTH IP/OP $310.00 $229.50 $49.88 $248.00 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $183.37 $146.71 $78.13 $146.71 $154.04 $232.50 $146.71 $146.71 $146.71 $242.68 $242.68 $245.52 $146.71 $248.00 $201.50 $109.25 $146.71 $179.80 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 30200672 EAP CPT® 88321 MICROSLIDE CONSULTATION BOTH IP/OP $84.00 $62.50 $42.22 $133.98 $84.00 $84.00 $84.00 $84.00 $83.74 $83.74 $42.22 $84.00 $83.74 $82.27 $82.27 $85.44 $60.06 $69.33 $133.98 $132.83 $84.00 $83.74 $83.02 $83.74 $84.00 $63.00 $83.74 $83.74 $83.74 $84.00 $84.00 $66.53 $83.74 $67.20 $54.60 $84.00 $83.74 $48.72 $84.00 $84.00 $83.74 $84.00 $83.74 N/A N/A 30200673 EAP CPT® 84600 ASSAY OF VOLATILES BOTH IP/OP $324.00 $240.00 $8.56 $324.00 $324.00 $324.00 $324.00 $324.00 $17.11 $17.11 $8.56 $324.00 $17.11 $24.41 $24.41 $25.35 $17.82 $23.74 $27.38 $27.38 $324.00 $17.11 $17.11 $17.11 $324.00 $243.00 $17.11 $17.11 $17.11 $89.80 $89.80 $256.61 $17.11 $259.20 $324.00 $324.00 $17.11 $187.92 $324.00 $24.81 $17.11 $324.00 $17.11 N/A N/A 30200674 EAP CPT® 84600 ASSAY OF VOLATILES BOTH IP/OP $324.00 $240.00 $8.56 $324.00 $324.00 $324.00 $324.00 $324.00 $17.11 $17.11 $8.56 $324.00 $17.11 $24.41 $24.41 $25.35 $17.82 $23.74 $27.38 $27.38 $324.00 $17.11 $17.11 $17.11 $324.00 $243.00 $17.11 $17.11 $17.11 $89.80 $89.80 $256.61 $17.11 $259.20 $324.00 $324.00 $17.11 $187.92 $324.00 $24.81 $17.11 $324.00 $17.11 N/A N/A 30200675 EAP CPT® 85210 BLOOD CLOT FACTOR II TEST BOTH IP/OP $111.00 $82.50 $6.49 $111.00 $111.00 $111.00 $111.00 $111.00 $12.98 $12.98 $6.49 $111.00 $12.98 $19.72 $19.72 $20.48 $14.39 $19.18 $20.77 $20.77 $111.00 $12.98 $12.98 $12.98 $111.00 $83.25 $12.98 $12.98 $12.98 $72.56 $72.56 $87.91 $12.98 $88.80 $111.00 $111.00 $12.98 $64.38 $111.00 $18.82 $12.98 $111.00 $12.98 N/A N/A 30200676 EAP CPT® 85210 BLOOD CLOT FACTOR II TEST BOTH IP/OP $126.00 $93.50 $6.49 $126.00 $126.00 $126.00 $126.00 $126.00 $12.98 $12.98 $6.49 $126.00 $12.98 $19.72 $19.72 $20.48 $14.39 $19.18 $20.77 $20.77 $126.00 $12.98 $12.98 $12.98 $126.00 $94.50 $12.98 $12.98 $12.98 $72.56 $72.56 $99.79 $12.98 $100.80 $126.00 $126.00 $12.98 $73.08 $126.00 $18.82 $12.98 $126.00 $12.98 N/A N/A 30200677 EAP CPT® 85260 BLOOD CLOT FACTOR X TEST BOTH IP/OP $105.00 $78.00 $8.95 $105.00 $35.14 $35.14 $35.14 $35.14 $17.90 $17.90 $8.95 $8.95 $17.90 $27.19 $27.19 $28.23 $19.85 $26.46 $28.64 $28.64 $62.11 $17.90 $17.90 $17.90 $105.00 $78.75 $17.90 $17.90 $17.90 $100.08 $100.08 $83.16 $17.90 $84.00 $29.54 $25.20 $17.90 $60.90 $105.00 $25.96 $17.90 $19.79 $17.90 N/A N/A 30200679 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $101.00 $75.00 $10.71 $101.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $59.74 $21.42 $21.42 $21.42 $101.00 $75.75 $21.42 $21.42 $21.42 $101.00 $101.00 $79.99 $21.42 $80.80 $35.34 $30.14 $21.42 $58.58 $101.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30200680 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $117.00 $87.00 $23.04 $117.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $69.21 $51.19 $51.19 $51.19 $117.00 $87.75 $51.19 $51.19 $51.19 $117.00 $117.00 $92.66 $51.19 $93.60 $84.46 $56.50 $51.19 $67.86 $117.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30200681 EAP CPT® 88184 FLOW CYTOMETRY FIRST MARKER BOTH IP/OP $561.00 $415.50 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $331.83 $286.49 $75.09 $286.49 $300.82 $420.75 $286.49 $286.49 $286.49 $267.48 $267.48 $444.31 $286.49 $448.80 $364.65 $51.58 $286.49 $325.38 $300.82 $414.48 $286.49 $40.52 $286.49 N/A N/A 30200682 EAP CPT® 88185 FLOW CYTOMETRY EA ADDL MARKER BOTH IP/OP $33.00 $24.50 $11.19 $50.81 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $11.19 $33.00 $48.93 $48.93 $50.81 $35.72 $26.63 $33.00 $33.00 $19.52 $33.00 $24.01 $33.00 $33.00 $24.75 $33.00 $33.00 $33.00 $33.00 $33.00 $26.14 $33.00 $26.40 $21.45 $25.36 $33.00 $19.14 $33.00 $33.00 $33.00 $19.92 $33.00 N/A N/A 30200683 EAP CPT® 88184 FLOWCYTOMETRY/ TC 1 MARKER BOTH IP/OP $300.00 $222.00 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $177.45 $286.49 $75.09 $286.49 $300.82 $225.00 $286.49 $286.49 $286.49 $267.48 $267.48 $237.60 $286.49 $240.00 $195.00 $51.58 $286.49 $174.00 $300.82 $300.00 $286.49 $40.52 $286.49 N/A N/A 30200684 EAP CPT® 88185 FLOWCYTOMETRY/TC ADD-ON BOTH IP/OP $14.00 $10.50 $8.12 $50.81 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $11.19 $14.00 $48.93 $48.93 $50.81 $35.72 $14.00 $14.00 $14.00 $8.28 $14.00 $24.01 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $14.00 $14.00 $11.09 $14.00 $11.20 $9.10 $14.00 $14.00 $8.12 $14.00 $14.00 $14.00 $19.92 $14.00 N/A N/A 30200685 EAP CPT® 88182 CELL MARKER STUDY BOTH IP/OP $93.00 $69.00 $50.33 $197.55 $93.00 $93.00 $93.00 $93.00 $110.39 $110.39 $70.11 $93.00 $110.39 $68.95 $68.95 $71.60 $50.33 $78.66 $176.62 $197.55 $93.00 $110.39 $123.47 $110.39 $93.00 $69.75 $110.39 $110.39 $110.39 $93.00 $93.00 $73.66 $110.39 $74.40 $60.45 $93.00 $110.39 $53.94 $93.00 $93.00 $110.39 $93.00 $93.00 N/A N/A 30200686 EAP CPT® 85520 HEPARIN ASSAY BOTH IP/OP $199.00 $147.50 $6.55 $199.00 $25.70 $25.70 $25.70 $25.70 $13.09 $13.09 $6.55 $6.55 $13.09 $19.87 $19.87 $20.64 $14.51 $19.34 $20.94 $20.94 $117.71 $13.09 $13.09 $13.09 $199.00 $149.25 $13.09 $13.09 $13.09 $73.16 $73.16 $157.61 $13.09 $159.20 $21.60 $18.42 $13.09 $115.42 $199.00 $18.98 $13.09 $14.47 $13.09 N/A N/A 30200687 EAP CPT® 87252 VIRUS INOCULATION TISSUE BOTH IP/OP $496.00 $367.50 $13.04 $496.00 $496.00 $496.00 $496.00 $496.00 $26.07 $26.07 $13.04 $496.00 $26.07 $33.57 $33.57 $34.86 $24.51 $32.66 $41.71 $41.71 $496.00 $26.07 $26.07 $26.07 $496.00 $372.00 $26.07 $26.07 $26.07 $123.56 $123.56 $392.83 $26.07 $396.80 $496.00 $496.00 $26.07 $287.68 $496.00 $37.80 $26.07 $496.00 $26.07 N/A N/A 30200688 EAP CPT® 87253 VIRUS INOCULATE TISSUE ADDL BOTH IP/OP $476.00 $352.50 $10.10 $476.00 $476.00 $476.00 $476.00 $476.00 $20.20 $20.20 $10.10 $476.00 $20.20 $24.73 $24.73 $25.68 $18.05 $24.06 $32.32 $32.32 $476.00 $20.20 $20.20 $20.20 $476.00 $357.00 $20.20 $20.20 $20.20 $91.04 $91.04 $376.99 $20.20 $380.80 $476.00 $476.00 $20.20 $276.08 $476.00 $29.29 $20.20 $476.00 $20.20 N/A N/A 30200693 EAP CPT® 87449 AG DETECT NOS EIA MULT BOTH IP/OP $317.00 $235.00 $5.99 $317.00 $317.00 $317.00 $317.00 $317.00 $11.98 $11.98 $5.99 $317.00 $11.98 $18.22 $18.22 $18.92 $13.30 $17.71 $19.17 $19.17 $317.00 $11.98 $11.98 $11.98 $317.00 $237.75 $11.98 $11.98 $11.98 $67.04 $67.04 $251.06 $11.98 $253.60 $317.00 $317.00 $11.98 $183.86 $317.00 $17.37 $11.98 $317.00 $11.98 N/A N/A 30200694 EAP CPT® 82570 ASSAY OF URINE CREATININE BOTH IP/OP $165.00 $122.50 $2.59 $165.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $97.60 $5.18 $5.18 $5.18 $165.00 $123.75 $5.18 $5.18 $5.18 $28.92 $28.92 $130.68 $5.18 $132.00 $8.55 $7.28 $5.18 $95.70 $165.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30200695 EAP CPT® 84378 SUGARS SINGLE QUANT BOTH IP/OP $210.00 $155.50 $5.77 $210.00 $210.00 $210.00 $210.00 $210.00 $11.53 $11.53 $5.77 $210.00 $11.53 $17.50 $17.50 $18.18 $12.78 $17.02 $18.45 $18.45 $210.00 $11.53 $11.53 $11.53 $210.00 $157.50 $11.53 $11.53 $11.53 $64.40 $64.40 $166.32 $11.53 $168.00 $210.00 $210.00 $11.53 $121.80 $210.00 $16.72 $11.53 $210.00 $11.53 N/A N/A 30200697 EAP CPT® 87252 VIRUS INOCULATION TISSUE BOTH IP/OP $496.00 $367.50 $13.04 $496.00 $496.00 $496.00 $496.00 $496.00 $26.07 $26.07 $13.04 $496.00 $26.07 $33.57 $33.57 $34.86 $24.51 $32.66 $41.71 $41.71 $496.00 $26.07 $26.07 $26.07 $496.00 $372.00 $26.07 $26.07 $26.07 $123.56 $123.56 $392.83 $26.07 $396.80 $496.00 $496.00 $26.07 $287.68 $496.00 $37.80 $26.07 $496.00 $26.07 N/A N/A 30200698 EAP CPT® 87253 VIRUS INOCULATE TISSUE ADDL BOTH IP/OP $476.00 $352.50 $10.10 $476.00 $476.00 $476.00 $476.00 $476.00 $20.20 $20.20 $10.10 $476.00 $20.20 $24.73 $24.73 $25.68 $18.05 $24.06 $32.32 $32.32 $476.00 $20.20 $20.20 $20.20 $476.00 $357.00 $20.20 $20.20 $20.20 $91.04 $91.04 $376.99 $20.20 $380.80 $476.00 $476.00 $20.20 $276.08 $476.00 $29.29 $20.20 $476.00 $20.20 N/A N/A 30200708 EAP CPT® 88368 INSITU HYBRIDIZATION MANUAL BOTH IP/OP $501.00 $371.00 $58.22 $467.58 $169.58 $169.58 $169.58 $169.58 $286.49 $286.49 $285.22 $58.22 $286.49 $151.36 $151.36 $157.18 $110.49 $199.20 $458.39 $467.58 $296.34 $286.49 $102.49 $286.49 $300.82 $375.75 $286.49 $286.49 $286.49 $415.48 $415.48 $396.79 $286.49 $400.80 $325.65 $189.71 $286.49 $290.58 $300.82 $414.48 $286.49 $149.02 $286.49 N/A N/A 30200711 EAP CPT® 80307 "DRUG SCREEN, ANY NUMBER DRUG CLASSES" BOTH IP/OP $451.00 $334.00 $29.09 $451.00 $109.39 $109.39 $109.39 $109.39 $62.14 $62.14 $31.07 $29.09 $62.14 $79.51 $79.51 $82.57 $58.04 $71.85 $99.42 $99.42 $266.77 $62.14 $62.14 $62.14 $451.00 $338.25 $62.14 $62.14 $62.14 $225.50 $225.50 $357.19 $62.14 $360.80 $102.53 $68.43 $62.14 $261.58 $451.00 $90.10 $62.14 $53.75 $62.14 N/A N/A 30200712 EAP CPT® 87252 VIRUS INOCULATION TISSUE BOTH IP/OP $345.00 $255.50 $13.04 $345.00 $345.00 $345.00 $345.00 $345.00 $26.07 $26.07 $13.04 $345.00 $26.07 $33.57 $33.57 $34.86 $24.51 $32.66 $41.71 $41.71 $345.00 $26.07 $26.07 $26.07 $345.00 $258.75 $26.07 $26.07 $26.07 $123.56 $123.56 $273.24 $26.07 $276.00 $345.00 $345.00 $26.07 $200.10 $345.00 $37.80 $26.07 $345.00 $26.07 N/A N/A 30200713 EAP CPT® 88184 FLOWCYTOMETRY/ TC 1 MARKER BOTH IP/OP $500.00 $370.00 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $295.75 $286.49 $75.09 $286.49 $300.82 $375.00 $286.49 $286.49 $286.49 $267.48 $267.48 $396.00 $286.49 $400.00 $325.00 $51.58 $286.49 $290.00 $300.82 $414.48 $286.49 $40.52 $286.49 N/A N/A 30200714 EAP CPT® 88185 FLOWCYTOMETRY/TC ADD-ON BOTH IP/OP $58.00 $43.00 $11.19 $58.00 $53.97 $53.97 $53.97 $53.97 $58.00 $58.00 $58.00 $11.19 $58.00 $48.93 $48.93 $50.81 $35.72 $26.63 $58.00 $58.00 $34.31 $58.00 $24.01 $58.00 $58.00 $43.50 $58.00 $58.00 $58.00 $58.00 $58.00 $45.94 $58.00 $46.40 $37.70 $25.36 $58.00 $33.64 $58.00 $58.00 $58.00 $19.92 $58.00 N/A N/A 30200719 EAP CPT® 88360 TUMOR IMMUNOHISTOCHEM/MANUAL BOTH IP/OP $310.00 $229.50 $49.88 $248.00 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $183.37 $146.71 $78.13 $146.71 $154.04 $232.50 $146.71 $146.71 $146.71 $242.68 $242.68 $245.52 $146.71 $248.00 $201.50 $109.25 $146.71 $179.80 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 30200720 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $131.00 $97.00 $23.04 $131.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $77.49 $51.19 $51.19 $51.19 $131.00 $98.25 $51.19 $51.19 $51.19 $131.00 $131.00 $103.75 $51.19 $104.80 $84.46 $56.50 $51.19 $75.98 $131.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30200721 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $75.00 $55.50 $10.71 $75.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $44.36 $21.42 $21.42 $21.42 $75.00 $56.25 $21.42 $21.42 $21.42 $75.00 $75.00 $59.40 $21.42 $60.00 $35.34 $30.14 $21.42 $43.50 $75.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30200732 EAP CPT® 87530 HSV DNA QUANT BOTH IP/OP $74.00 $55.00 $15.42 $74.00 $74.00 $74.00 $74.00 $74.00 $42.84 $42.84 $21.42 $74.00 $42.84 $65.04 $65.04 $67.54 $47.48 $15.42 $68.54 $68.54 $74.00 $42.84 $42.84 $42.84 $74.00 $55.50 $42.84 $42.84 $42.84 $74.00 $74.00 $58.61 $42.84 $59.20 $74.00 $74.00 $42.84 $42.92 $74.00 $62.12 $42.84 $74.00 $42.84 N/A N/A 30200740 EAP CPT® 87556 M.TUBERCULO DNA AMP PROBE BOTH IP/OP $220.00 $163.00 $18.76 $220.00 $38.50 $38.50 $38.50 $38.50 $41.68 $41.68 $20.84 $18.76 $41.68 $29.79 $29.79 $30.93 $21.74 $45.85 $66.69 $66.69 $130.13 $41.68 $41.68 $41.68 $220.00 $165.00 $41.68 $41.68 $41.68 $109.64 $109.64 $174.24 $41.68 $176.00 $68.77 $43.66 $41.68 $127.60 $220.00 $60.44 $41.68 $45.85 $41.68 N/A N/A 30200746 EAP CPT® 83018 QUANTITATIVE SCREEN METALS BOTH IP/OP $61.00 $45.50 $10.98 $61.00 $43.10 $43.10 $43.10 $43.10 $21.96 $21.96 $10.98 $10.98 $21.96 $33.34 $33.34 $34.62 $24.34 $32.43 $35.14 $35.14 $36.08 $21.96 $21.96 $21.96 $61.00 $45.75 $21.96 $21.96 $21.96 $61.00 $61.00 $48.31 $21.96 $48.80 $36.23 $30.89 $21.96 $35.38 $61.00 $31.84 $21.96 $24.26 $21.96 N/A N/A 30200747 EAP CPT® 83655 ASSAY OF LEAD BOTH IP/OP $46.00 $34.50 $6.05 $46.00 $23.77 $23.77 $23.77 $23.77 $12.11 $12.11 $6.06 $6.05 $12.11 $18.38 $18.38 $19.08 $13.41 $11.75 $19.38 $19.38 $27.21 $12.11 $12.11 $12.11 $46.00 $34.50 $12.11 $12.11 $12.11 $46.00 $46.00 $36.43 $12.11 $36.80 $19.98 $11.19 $12.11 $26.68 $46.00 $17.56 $12.11 $8.79 $12.11 N/A N/A 30200748 EAP CPT® 83825 ASSAY OF MERCURY BOTH IP/OP $41.00 $30.50 $8.13 $41.00 $31.90 $31.90 $31.90 $31.90 $16.26 $16.26 $8.13 $8.13 $16.26 $24.69 $24.69 $25.64 $18.02 $24.02 $26.02 $26.02 $24.25 $16.26 $16.26 $16.26 $41.00 $30.75 $16.26 $16.26 $16.26 $41.00 $41.00 $32.47 $16.26 $32.80 $26.83 $22.88 $16.26 $23.78 $41.00 $23.58 $16.26 $17.97 $16.26 N/A N/A 30200749 EAP CPT® 84255 ASSAY OF SELENIUM BOTH IP/OP $55.00 $41.00 $12.77 $55.00 $55.00 $55.00 $55.00 $55.00 $25.53 $25.53 $12.77 $55.00 $25.53 $38.76 $38.76 $40.25 $28.30 $37.71 $40.85 $40.85 $55.00 $25.53 $25.53 $25.53 $55.00 $41.25 $25.53 $25.53 $25.53 $55.00 $55.00 $43.56 $25.53 $44.00 $55.00 $55.00 $25.53 $31.90 $55.00 $37.02 $25.53 $55.00 $25.53 N/A N/A 30200750 EAP CPT® 88182 CELL MARKER STUDY BOTH IP/OP $87.00 $64.50 $50.33 $197.55 $87.00 $87.00 $87.00 $87.00 $110.39 $110.39 $70.11 $87.00 $110.39 $68.95 $68.95 $71.60 $50.33 $78.66 $176.62 $197.55 $87.00 $110.39 $123.47 $110.39 $87.00 $65.25 $110.39 $110.39 $110.39 $87.00 $87.00 $68.90 $110.39 $69.60 $56.55 $87.00 $110.39 $50.46 $87.00 $87.00 $110.39 $87.00 $87.00 N/A N/A 30200751 EAP CPT® 88342 IMMUNOHISTOCHEMISTRY BOTH IP/OP $278.00 $206.00 $43.77 $234.73 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $164.44 $146.71 $66.63 $146.71 $154.04 $208.50 $146.71 $146.71 $146.71 $212.92 $212.92 $220.18 $146.71 $222.40 $180.70 $80.08 $146.71 $161.24 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 30200752 EAP CPT® 88230 TISSUE CULTURE LYMPHOCYTE BOTH IP/OP $186.00 $138.00 $58.25 $192.21 $186.00 $186.00 $186.00 $186.00 $116.49 $116.49 $58.25 $58.25 $116.49 $176.90 $176.90 $183.71 $129.14 $172.08 $186.38 $186.38 $110.02 $116.49 $116.49 $116.49 $186.00 $139.50 $116.49 $116.49 $116.49 $186.00 $186.00 $147.31 $116.49 $148.80 $192.21 $163.89 $116.49 $107.88 $186.00 $168.91 $116.49 $128.74 $116.49 N/A N/A 30200753 EAP CPT® 88263 CHROMOSOME ANALYSIS 45 BOTH IP/OP $241.00 $178.50 $75.15 $241.00 $241.00 $241.00 $241.00 $241.00 $150.29 $150.29 $75.15 $241.00 $150.29 $228.20 $228.20 $236.97 $166.58 $221.99 $240.46 $240.46 $241.00 $150.29 $150.29 $150.29 $241.00 $180.75 $150.29 $150.29 $150.29 $241.00 $241.00 $190.87 $150.29 $192.80 $241.00 $241.00 $150.29 $139.78 $241.00 $217.92 $150.29 $241.00 $150.29 N/A N/A 30200754 EAP CPT® 88285 CHROMOSOME COUNT ADDITIONAL BOTH IP/OP $31.00 $23.00 $13.46 $43.06 $31.00 $31.00 $31.00 $31.00 $26.91 $26.91 $13.46 $31.00 $26.91 $28.85 $28.85 $29.96 $21.06 $28.07 $43.06 $43.06 $31.00 $26.91 $26.91 $26.91 $31.00 $23.25 $26.91 $26.91 $26.91 $31.00 $31.00 $24.55 $26.91 $24.80 $31.00 $31.00 $26.91 $17.98 $31.00 $31.00 $26.91 $31.00 $26.91 N/A N/A 30200756 EAP CPT® 82441 TEST FOR CHLOROHYDROCARBONS BOTH IP/OP $183.00 $135.50 $3.01 $183.00 $183.00 $183.00 $183.00 $183.00 $6.01 $6.01 $3.01 $183.00 $6.01 $9.11 $9.11 $9.46 $6.65 $8.86 $9.62 $9.62 $183.00 $6.01 $6.01 $6.01 $183.00 $137.25 $6.01 $6.01 $6.01 $33.52 $33.52 $144.94 $6.01 $146.40 $183.00 $183.00 $6.01 $106.14 $183.00 $8.71 $6.01 $183.00 $6.01 N/A N/A 30200757 EAP CPT® 82570 ASSAY OF URINE CREATININE BOTH IP/OP $83.00 $61.50 $2.59 $83.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $49.09 $5.18 $5.18 $5.18 $83.00 $62.25 $5.18 $5.18 $5.18 $28.92 $28.92 $65.74 $5.18 $66.40 $8.55 $7.28 $5.18 $48.14 $83.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30200758 EAP CPT® 84600 ASSAY OF VOLATILES BOTH IP/OP $100.00 $74.00 $8.56 $100.00 $100.00 $100.00 $100.00 $100.00 $17.11 $17.11 $8.56 $100.00 $17.11 $24.41 $24.41 $25.35 $17.82 $23.74 $27.38 $27.38 $100.00 $17.11 $17.11 $17.11 $100.00 $75.00 $17.11 $17.11 $17.11 $89.80 $89.80 $79.20 $17.11 $80.00 $100.00 $100.00 $17.11 $58.00 $100.00 $24.81 $17.11 $100.00 $17.11 N/A N/A 30200759 EAP CPT® 85576 BLOOD PLATELET AGGREGATION BOTH IP/OP $122.00 $90.50 $11.21 $122.00 $42.17 $42.17 $42.17 $42.17 $24.91 $24.91 $12.46 $11.21 $24.91 $32.62 $32.62 $33.88 $23.82 $31.73 $39.86 $39.86 $72.16 $24.91 $24.91 $24.91 $122.00 $91.50 $24.91 $24.91 $24.91 $120.04 $120.04 $96.62 $24.91 $97.60 $41.10 $30.22 $24.91 $70.76 $122.00 $36.12 $24.91 $23.74 $24.91 N/A N/A 30200760 EAP CPT® 85049 AUTOMATED PLATELET COUNT BOTH IP/OP $24.00 $18.00 $2.24 $24.00 $8.79 $8.79 $8.79 $8.79 $4.48 $4.48 $2.24 $2.24 $4.48 $6.79 $6.79 $7.05 $4.96 $6.62 $7.17 $7.17 $14.20 $4.48 $4.48 $4.48 $24.00 $18.00 $4.48 $4.48 $4.48 $24.00 $24.00 $19.01 $4.48 $19.20 $7.39 $6.30 $4.48 $13.92 $24.00 $6.50 $4.48 $4.95 $4.48 N/A N/A 30200776 EAP CPT® 88184 FLOWCYTOMETRY/ TC 1 MARKER BOTH IP/OP $303.00 $224.50 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $179.22 $286.49 $75.09 $286.49 $300.82 $227.25 $286.49 $286.49 $286.49 $267.48 $267.48 $239.98 $286.49 $242.40 $196.95 $51.58 $286.49 $175.74 $300.82 $303.00 $286.49 $40.52 $286.49 N/A N/A 30200777 EAP CPT® 88185 FLOWCYTOMETRY/TC ADD-ON BOTH IP/OP $26.00 $19.50 $11.19 $50.81 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $11.19 $26.00 $48.93 $48.93 $50.81 $35.72 $26.00 $26.00 $26.00 $15.38 $26.00 $24.01 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $26.00 $26.00 $20.59 $26.00 $20.80 $16.90 $25.36 $26.00 $15.08 $26.00 $26.00 $26.00 $19.92 $26.00 N/A N/A 30200778 EAP CPT® 88187 FLOWCYTOMETRY/READ 2-8 BOTH IP/OP $180.00 $133.50 $18.24 $180.00 $180.00 $180.00 $180.00 $180.00 $35.84 $35.84 $18.24 $180.00 $35.84 $133.60 $133.60 $138.74 $93.78 $70.22 $57.34 $56.40 $180.00 $35.84 $35.25 $35.84 $180.00 $135.00 $35.84 $35.84 $35.84 $180.00 $180.00 $142.56 $35.84 $144.00 $117.00 $180.00 $35.84 $104.40 $180.00 $39.31 $35.84 $180.00 $35.84 N/A N/A 30200785 EAP CPT® 82657 ENZYME CELL ACTIVITY BOTH IP/OP $20.00 $15.00 $6.64 $36.58 $11.80 $11.80 $11.80 $11.80 $22.17 $22.17 $11.09 $9.98 $22.17 $9.12 $9.12 $9.47 $6.66 $8.87 $35.47 $35.47 $11.83 $22.17 $22.17 $22.17 $20.00 $15.00 $22.17 $22.17 $22.17 $20.00 $20.00 $15.84 $22.17 $16.00 $36.58 $8.45 $22.17 $11.60 $20.00 $20.00 $22.17 $6.64 $20.00 N/A N/A 30200790 EAP CPT® 86022 PLATELET ANTIBODIES BOTH IP/OP $184.00 $136.50 $9.19 $184.00 $184.00 $184.00 $184.00 $184.00 $18.37 $18.37 $9.19 $184.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $184.00 $18.37 $18.37 $18.37 $184.00 $138.00 $18.37 $18.37 $18.37 $102.64 $102.64 $145.73 $18.37 $147.20 $184.00 $184.00 $18.37 $106.72 $184.00 $26.64 $18.37 $184.00 $18.37 N/A N/A 30200791 EAP CPT® 86022 PLATELET ANTIBODIES BOTH IP/OP $106.00 $78.50 $9.19 $106.00 $106.00 $106.00 $106.00 $106.00 $18.37 $18.37 $9.19 $106.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $106.00 $18.37 $18.37 $18.37 $106.00 $79.50 $18.37 $18.37 $18.37 $102.64 $102.64 $83.95 $18.37 $84.80 $106.00 $106.00 $18.37 $61.48 $106.00 $26.64 $18.37 $106.00 $18.37 N/A N/A 30200792 EAP CPT® 88239 TISSUE CULTURE TUMOR BOTH IP/OP $276.00 $204.50 $73.76 $276.00 $276.00 $276.00 $276.00 $276.00 $147.52 $147.52 $73.76 $73.76 $147.52 $224.01 $224.01 $232.62 $163.52 $217.93 $236.03 $236.03 $163.25 $147.52 $147.52 $147.52 $276.00 $207.00 $147.52 $147.52 $147.52 $276.00 $276.00 $218.59 $147.52 $220.80 $243.41 $207.55 $147.52 $160.08 $276.00 $213.90 $147.52 $163.03 $147.52 N/A N/A 30200793 EAP CPT® 88237 TISSUE CULTURE BONE MARROW BOTH IP/OP $237.00 $175.50 $64.69 $237.19 $173.27 $173.27 $173.27 $173.27 $143.75 $143.75 $71.88 $64.69 $143.75 $134.06 $134.06 $139.21 $97.86 $130.42 $230.00 $230.00 $140.19 $143.75 $143.75 $143.75 $237.00 $177.75 $143.75 $143.75 $143.75 $237.00 $237.00 $187.70 $143.75 $189.60 $237.19 $124.21 $143.75 $137.46 $237.00 $208.44 $143.75 $97.57 $143.75 N/A N/A 30200804 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $82.00 $61.00 $10.71 $82.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $48.50 $21.42 $21.42 $21.42 $82.00 $61.50 $21.42 $21.42 $21.42 $82.00 $82.00 $64.94 $21.42 $65.60 $35.34 $30.14 $21.42 $47.56 $82.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30200805 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $146.00 $108.50 $23.04 $146.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $86.36 $51.19 $51.19 $51.19 $146.00 $109.50 $51.19 $51.19 $51.19 $146.00 $146.00 $115.63 $51.19 $116.80 $84.46 $56.50 $51.19 $84.68 $146.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30200806 EAP CPT® 86780 TREPONEMA PALLIDUM BOTH IP/OP $179.00 $132.50 $6.62 $179.00 $25.98 $25.98 $25.98 $25.98 $13.24 $13.24 $6.62 $6.62 $13.24 $19.73 $19.73 $20.49 $14.40 $37.31 $21.18 $21.18 $105.88 $13.24 $13.24 $13.24 $179.00 $134.25 $13.24 $13.24 $13.24 $89.50 $89.50 $141.77 $13.24 $143.20 $21.85 $35.53 $13.24 $103.82 $179.00 $19.20 $13.24 $37.30 $13.24 N/A N/A 30200818 EAP CPT® 86003 ALLERGEN SPECIFIC IGE BOTH IP/OP $362.00 $268.00 $2.61 $362.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $214.12 $5.22 $5.22 $5.22 $362.00 $271.50 $5.22 $5.22 $5.22 $29.20 $29.20 $286.70 $5.22 $289.60 $8.61 $7.35 $5.22 $209.96 $362.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200819 EAP CPT® 86003 ALLERGEN SPECIFIC IGE BOTH IP/OP $362.00 $268.00 $2.61 $362.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $214.12 $5.22 $5.22 $5.22 $362.00 $271.50 $5.22 $5.22 $5.22 $29.20 $29.20 $286.70 $5.22 $289.60 $8.61 $7.35 $5.22 $209.96 $362.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200820 EAP CPT® 86003 ALLERGEN SPECIFIC IGE BOTH IP/OP $362.00 $268.00 $2.61 $362.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $214.12 $5.22 $5.22 $5.22 $362.00 $271.50 $5.22 $5.22 $5.22 $29.20 $29.20 $286.70 $5.22 $289.60 $8.61 $7.35 $5.22 $209.96 $362.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200827 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $106.00 $78.50 $10.71 $106.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $62.70 $21.42 $21.42 $21.42 $106.00 $79.50 $21.42 $21.42 $21.42 $106.00 $106.00 $83.95 $21.42 $84.80 $35.34 $30.14 $21.42 $61.48 $106.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30200828 EAP CPT® 88272 CYTOGENETICS 3-5 BOTH IP/OP $126.00 $93.50 $18.32 $126.00 $52.56 $52.56 $52.56 $52.56 $40.70 $40.70 $20.35 $18.32 $40.70 $40.65 $40.65 $42.22 $29.68 $39.55 $65.12 $65.12 $74.53 $40.70 $40.70 $40.70 $126.00 $94.50 $40.70 $40.70 $40.70 $126.00 $126.00 $99.79 $40.70 $100.80 $67.16 $37.67 $40.70 $73.08 $126.00 $59.02 $40.70 $29.59 $40.70 N/A N/A 30200830 EAP CPT® 88237 TISSUE CULTURE BONE MARROW BOTH IP/OP $376.00 $278.50 $64.69 $376.00 $173.27 $173.27 $173.27 $173.27 $143.75 $143.75 $71.88 $64.69 $143.75 $134.06 $134.06 $139.21 $97.86 $130.42 $230.00 $230.00 $222.40 $143.75 $143.75 $143.75 $376.00 $282.00 $143.75 $143.75 $143.75 $376.00 $376.00 $297.79 $143.75 $300.80 $237.19 $124.21 $143.75 $218.08 $376.00 $208.44 $143.75 $97.57 $143.75 N/A N/A 30200831 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $342.00 $253.50 $10.71 $342.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $202.29 $21.42 $21.42 $21.42 $342.00 $256.50 $21.42 $21.42 $21.42 $119.72 $119.72 $270.86 $21.42 $273.60 $35.34 $30.14 $21.42 $198.36 $342.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30200832 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $400.00 $296.00 $23.04 $400.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $236.60 $51.19 $51.19 $51.19 $400.00 $300.00 $51.19 $51.19 $51.19 $224.44 $224.44 $316.80 $51.19 $320.00 $84.46 $56.50 $51.19 $232.00 $400.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30200840 EAP CPT® 88237 TISSUE CULTURE BONE MARROW BOTH IP/OP $262.00 $194.00 $64.69 $262.00 $173.27 $173.27 $173.27 $173.27 $143.75 $143.75 $71.88 $64.69 $143.75 $134.06 $134.06 $139.21 $97.86 $130.42 $230.00 $230.00 $154.97 $143.75 $143.75 $143.75 $262.00 $196.50 $143.75 $143.75 $143.75 $262.00 $262.00 $207.50 $143.75 $209.60 $237.19 $124.21 $143.75 $151.96 $262.00 $208.44 $143.75 $97.57 $143.75 N/A N/A 30200841 EAP CPT® 88262 CHROMOSOME ANALYSIS 15-20 BOTH IP/OP $219.00 $162.50 $62.32 $219.00 $219.00 $219.00 $219.00 $219.00 $125.49 $125.49 $62.75 $62.32 $125.49 $189.26 $189.26 $196.54 $138.16 $184.12 $200.78 $200.78 $129.54 $125.49 $125.49 $125.49 $219.00 $164.25 $125.49 $125.49 $125.49 $219.00 $219.00 $173.45 $125.49 $175.20 $207.06 $175.35 $125.49 $127.02 $219.00 $181.96 $125.49 $137.74 $125.49 N/A N/A 30200843 EAP CPT® 87449 AG DETECT NOS EIA MULT BOTH IP/OP $250.00 $185.00 $5.99 $250.00 $250.00 $250.00 $250.00 $250.00 $11.98 $11.98 $5.99 $250.00 $11.98 $18.22 $18.22 $18.92 $13.30 $17.71 $19.17 $19.17 $250.00 $11.98 $11.98 $11.98 $250.00 $187.50 $11.98 $11.98 $11.98 $67.04 $67.04 $198.00 $11.98 $200.00 $250.00 $250.00 $11.98 $145.00 $250.00 $17.37 $11.98 $250.00 $11.98 N/A N/A 30200844 EAP CPT® 87449 AG DETECT NOS EIA MULT BOTH IP/OP $253.00 $187.50 $5.99 $253.00 $253.00 $253.00 $253.00 $253.00 $11.98 $11.98 $5.99 $253.00 $11.98 $18.22 $18.22 $18.92 $13.30 $17.71 $19.17 $19.17 $253.00 $11.98 $11.98 $11.98 $253.00 $189.75 $11.98 $11.98 $11.98 $67.04 $67.04 $200.38 $11.98 $202.40 $253.00 $253.00 $11.98 $146.74 $253.00 $17.37 $11.98 $253.00 $11.98 N/A N/A 30200845 EAP CPT® 88291 CYTO/MOLECULAR REPORT BOTH IP/OP $29.00 $21.50 $6.04 $53.46 $29.00 $29.00 $29.00 $29.00 $33.41 $33.41 $16.84 $29.00 $33.41 $29.00 $29.00 $29.00 $29.00 $6.04 $53.46 $52.02 $29.00 $33.41 $32.51 $33.41 $29.00 $21.75 $33.41 $33.41 $33.41 $29.00 $29.00 $22.97 $33.41 $23.20 $18.85 $29.00 $33.41 $16.82 $29.00 $29.00 $33.41 $29.00 $29.00 N/A N/A 30200846 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $107.00 $79.50 $10.71 $107.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $63.29 $21.42 $21.42 $21.42 $107.00 $80.25 $21.42 $21.42 $21.42 $107.00 $107.00 $84.74 $21.42 $85.60 $35.34 $30.14 $21.42 $62.06 $107.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30200847 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $136.00 $101.00 $23.04 $136.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $80.44 $51.19 $51.19 $51.19 $136.00 $102.00 $51.19 $51.19 $51.19 $136.00 $136.00 $107.71 $51.19 $108.80 $84.46 $56.50 $51.19 $78.88 $136.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30200848 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $80.00 $59.50 $10.71 $80.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $47.32 $21.42 $21.42 $21.42 $80.00 $60.00 $21.42 $21.42 $21.42 $80.00 $80.00 $63.36 $21.42 $64.00 $35.34 $30.14 $21.42 $46.40 $80.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30200849 EAP CPT® 88272 CYTOGENETICS 3-5 BOTH IP/OP $106.00 $78.50 $18.32 $106.00 $52.56 $52.56 $52.56 $52.56 $40.70 $40.70 $20.35 $18.32 $40.70 $40.65 $40.65 $42.22 $29.68 $39.55 $65.12 $65.12 $62.70 $40.70 $40.70 $40.70 $106.00 $79.50 $40.70 $40.70 $40.70 $106.00 $106.00 $83.95 $40.70 $84.80 $67.16 $37.67 $40.70 $61.48 $106.00 $59.02 $40.70 $29.59 $40.70 N/A N/A 30200856 EAP CPT® 87186 MICROBE SUSCEPTIBLE MIC BOTH IP/OP $308.00 $228.00 $4.32 $308.00 $16.97 $16.97 $16.97 $16.97 $8.65 $8.65 $4.33 $4.32 $8.65 $13.12 $13.12 $13.63 $9.58 $12.77 $13.84 $13.84 $182.18 $8.65 $8.65 $8.65 $308.00 $231.00 $8.65 $8.65 $8.65 $48.32 $48.32 $243.94 $8.65 $246.40 $14.27 $12.16 $8.65 $178.64 $308.00 $12.54 $8.65 $9.55 $8.65 N/A N/A 30200863 EAP CPT® 82136 AMINO ACIDS QUANT 2-5 BOTH IP/OP $338.00 $250.50 $9.81 $338.00 $338.00 $338.00 $338.00 $338.00 $19.61 $19.61 $9.81 $338.00 $19.61 $25.62 $25.62 $26.60 $18.70 $24.92 $31.38 $31.38 $338.00 $19.61 $19.61 $19.61 $338.00 $253.50 $19.61 $19.61 $19.61 $94.28 $94.28 $267.70 $19.61 $270.40 $338.00 $338.00 $19.61 $196.04 $338.00 $28.43 $19.61 $338.00 $19.61 N/A N/A 30200864 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $80.00 $59.50 $10.71 $80.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $47.32 $21.42 $21.42 $21.42 $80.00 $60.00 $21.42 $21.42 $21.42 $80.00 $80.00 $63.36 $21.42 $64.00 $35.34 $30.14 $21.42 $46.40 $80.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30200865 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $139.00 $103.00 $23.04 $139.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $82.22 $51.19 $51.19 $51.19 $139.00 $104.25 $51.19 $51.19 $51.19 $139.00 $139.00 $110.09 $51.19 $111.20 $84.46 $56.50 $51.19 $80.62 $139.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30200867 EAP CPT® 87385 HISTOPLASMA CAPSUL AG EIA BOTH IP/OP $215.00 $159.50 $5.99 $215.00 $23.52 $23.52 $23.52 $23.52 $13.25 $13.25 $6.63 $5.99 $13.25 $18.22 $18.22 $18.92 $13.30 $17.71 $21.20 $21.20 $127.17 $13.25 $13.25 $13.25 $215.00 $161.25 $13.25 $13.25 $13.25 $67.04 $67.04 $170.28 $13.25 $172.00 $21.86 $16.87 $13.25 $124.70 $215.00 $19.21 $13.25 $13.25 $13.25 N/A N/A 30200868 EAP CPT® 87798 DETECT AGENT NOS DNA AMP BOTH IP/OP $386.00 $286.00 $17.55 $386.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $228.32 $35.09 $35.09 $35.09 $386.00 $289.50 $35.09 $35.09 $35.09 $109.64 $109.64 $305.71 $35.09 $308.80 $57.90 $27.60 $35.09 $223.88 $386.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30200869 EAP CPT® 82175 ASSAY OF ARSENIC BOTH IP/OP $34.00 $25.50 $9.49 $34.00 $34.00 $34.00 $34.00 $34.00 $18.97 $18.97 $9.49 $9.49 $18.97 $28.81 $28.81 $29.92 $21.03 $28.02 $30.35 $30.35 $20.11 $18.97 $18.97 $18.97 $34.00 $25.50 $18.97 $18.97 $18.97 $34.00 $34.00 $26.93 $18.97 $27.20 $31.30 $26.69 $18.97 $19.72 $34.00 $27.51 $18.97 $20.96 $18.97 N/A N/A 30200895 EAP CPT® 84481 "T3, FREE" BOTH IP/OP $150.00 $111.00 $8.47 $150.00 $33.26 $33.26 $33.26 $33.26 $16.94 $16.94 $8.47 $8.47 $16.94 $25.73 $25.73 $26.72 $18.78 $25.02 $27.10 $27.10 $88.73 $16.94 $16.94 $16.94 $150.00 $112.50 $16.94 $16.94 $16.94 $94.68 $94.68 $118.80 $16.94 $120.00 $27.95 $23.83 $16.94 $87.00 $150.00 $24.56 $16.94 $18.72 $16.94 N/A N/A 30200896 EAP CPT® 84481 FREE ASSAY(FT-3) BOTH IP/OP $137.00 $101.50 $8.47 $137.00 $33.26 $33.26 $33.26 $33.26 $16.94 $16.94 $8.47 $8.47 $16.94 $25.73 $25.73 $26.72 $18.78 $25.02 $27.10 $27.10 $81.04 $16.94 $16.94 $16.94 $137.00 $102.75 $16.94 $16.94 $16.94 $94.68 $94.68 $108.50 $16.94 $109.60 $27.95 $23.83 $16.94 $79.46 $137.00 $24.56 $16.94 $18.72 $16.94 N/A N/A 30200898 EAP CPT® 83789 MASS SPECTROMETRY QUANT BOTH IP/OP $118.00 $87.50 $6.66 $118.00 $118.00 $118.00 $118.00 $118.00 $24.11 $24.11 $12.06 $118.00 $24.11 $9.12 $9.12 $9.47 $6.66 $8.87 $38.58 $38.58 $118.00 $24.11 $24.11 $24.11 $118.00 $88.50 $24.11 $24.11 $24.11 $33.56 $33.56 $93.46 $24.11 $94.40 $118.00 $118.00 $24.11 $68.44 $118.00 $34.96 $24.11 $118.00 $24.11 N/A N/A 30200900 EAP CPT® 82154 ANDROSTANEDIOL GLUCURONIDE BOTH IP/OP $437.00 $323.50 $14.42 $437.00 $437.00 $437.00 $437.00 $437.00 $28.83 $28.83 $14.42 $437.00 $28.83 $43.78 $43.78 $45.47 $31.96 $42.60 $46.13 $46.13 $437.00 $28.83 $28.83 $28.83 $437.00 $327.75 $28.83 $28.83 $28.83 $161.16 $161.16 $346.10 $28.83 $349.60 $437.00 $437.00 $28.83 $253.46 $437.00 $41.80 $28.83 $437.00 $28.83 N/A N/A 30200908 EAP CPT® 82010 ACETONE ASSAY BOTH IP/OP $285.00 $211.00 $4.09 $285.00 $16.04 $16.04 $16.04 $16.04 $8.17 $8.17 $4.09 $4.09 $8.17 $12.41 $12.41 $12.88 $9.06 $12.08 $13.07 $13.07 $168.58 $8.17 $8.17 $8.17 $285.00 $213.75 $8.17 $8.17 $8.17 $45.68 $45.68 $225.72 $8.17 $228.00 $13.48 $11.50 $8.17 $165.30 $285.00 $11.85 $8.17 $9.03 $8.17 N/A N/A 30200910 EAP CPT® 82010 ACETONE ASSAY BOTH IP/OP $153.00 $113.50 $4.09 $153.00 $16.04 $16.04 $16.04 $16.04 $8.17 $8.17 $4.09 $4.09 $8.17 $12.41 $12.41 $12.88 $9.06 $12.08 $13.07 $13.07 $90.50 $8.17 $8.17 $8.17 $153.00 $114.75 $8.17 $8.17 $8.17 $45.68 $45.68 $121.18 $8.17 $122.40 $13.48 $11.50 $8.17 $88.74 $153.00 $11.85 $8.17 $9.03 $8.17 N/A N/A 30200912 EAP CPT® 87252 VIRUS INOCULATION TISSUE BOTH IP/OP $488.00 $361.50 $13.04 $488.00 $488.00 $488.00 $488.00 $488.00 $26.07 $26.07 $13.04 $488.00 $26.07 $33.57 $33.57 $34.86 $24.51 $32.66 $41.71 $41.71 $488.00 $26.07 $26.07 $26.07 $488.00 $366.00 $26.07 $26.07 $26.07 $123.56 $123.56 $386.50 $26.07 $390.40 $488.00 $488.00 $26.07 $283.04 $488.00 $37.80 $26.07 $488.00 $26.07 N/A N/A 30200913 EAP CPT® 87253 VIRUS INOCULATE TISSUE ADDL BOTH IP/OP $488.00 $361.50 $10.10 $488.00 $488.00 $488.00 $488.00 $488.00 $20.20 $20.20 $10.10 $488.00 $20.20 $24.73 $24.73 $25.68 $18.05 $24.06 $32.32 $32.32 $488.00 $20.20 $20.20 $20.20 $488.00 $366.00 $20.20 $20.20 $20.20 $91.04 $91.04 $386.50 $20.20 $390.40 $488.00 $488.00 $20.20 $283.04 $488.00 $29.29 $20.20 $488.00 $20.20 N/A N/A 30200915 EAP CPT® 82017 ACYLCARNITIES QUANT BOTH IP/OP $247.00 $183.00 $8.44 $247.00 $247.00 $247.00 $247.00 $247.00 $16.87 $16.87 $8.44 $247.00 $16.87 $25.62 $25.62 $26.60 $18.70 $24.92 $26.99 $26.99 $247.00 $16.87 $16.87 $16.87 $247.00 $185.25 $16.87 $16.87 $16.87 $94.28 $94.28 $195.62 $16.87 $197.60 $247.00 $247.00 $16.87 $143.26 $247.00 $24.46 $16.87 $247.00 $16.87 N/A N/A 30200919 EAP CPT® 84311 SPECTROPHOTOMETRY BOTH IP/OP $239.00 $177.00 $4.05 $239.00 $239.00 $239.00 $239.00 $239.00 $8.10 $8.10 $4.05 $239.00 $8.10 $10.61 $10.61 $11.02 $7.74 $10.32 $12.96 $12.96 $239.00 $8.10 $8.10 $8.10 $239.00 $179.25 $8.10 $8.10 $8.10 $39.08 $39.08 $189.29 $8.10 $191.20 $239.00 $239.00 $8.10 $138.62 $239.00 $11.75 $8.10 $239.00 $8.10 N/A N/A 30200921 EAP CPT® 84311 SPECTROPHOTOMETRY BOTH IP/OP $239.00 $177.00 $4.05 $239.00 $239.00 $239.00 $239.00 $239.00 $8.10 $8.10 $4.05 $239.00 $8.10 $10.61 $10.61 $11.02 $7.74 $10.32 $12.96 $12.96 $239.00 $8.10 $8.10 $8.10 $239.00 $179.25 $8.10 $8.10 $8.10 $39.08 $39.08 $189.29 $8.10 $191.20 $239.00 $239.00 $8.10 $138.62 $239.00 $11.75 $8.10 $239.00 $8.10 N/A N/A 30200923 EAP CPT® 87260 ADENOVIRUS AG IF BOTH IP/OP $128.00 $95.00 $7.22 $128.00 $128.00 $128.00 $128.00 $128.00 $14.43 $14.43 $7.22 $128.00 $14.43 $18.22 $18.22 $18.92 $13.30 $17.71 $23.09 $23.09 $128.00 $14.43 $14.43 $14.43 $128.00 $96.00 $14.43 $14.43 $14.43 $67.04 $67.04 $101.38 $14.43 $102.40 $128.00 $128.00 $14.43 $74.24 $128.00 $20.92 $14.43 $128.00 $14.43 N/A N/A 30200925 EAP CPT® 87798 DETECT AGENT NOS DNA AMP BOTH IP/OP $464.00 $343.50 $17.55 $464.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $274.46 $35.09 $35.09 $35.09 $464.00 $348.00 $35.09 $35.09 $35.09 $109.64 $109.64 $367.49 $35.09 $371.20 $57.90 $27.60 $35.09 $269.12 $464.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30200927 EAP CPT® 86316 IMMUNOASSAY TUMOR OTHER BOTH IP/OP $178.00 $132.00 $10.41 $178.00 $40.84 $40.84 $40.84 $40.84 $20.81 $20.81 $10.41 $10.41 $20.81 $31.60 $31.60 $32.81 $23.06 $30.73 $33.30 $33.30 $105.29 $20.81 $20.81 $20.81 $178.00 $133.50 $20.81 $20.81 $20.81 $116.28 $116.28 $140.98 $20.81 $142.40 $34.34 $29.27 $20.81 $103.24 $178.00 $30.17 $20.81 $22.99 $20.81 N/A N/A 30200929 EAP CPT® 82088 ASSAY OF ALDOSTERONE BOTH IP/OP $297.00 $220.00 $20.38 $297.00 $79.97 $79.97 $79.97 $79.97 $40.75 $40.75 $20.38 $20.38 $40.75 $61.88 $61.88 $64.26 $45.17 $60.21 $65.20 $65.20 $175.68 $40.75 $40.75 $40.75 $297.00 $222.75 $40.75 $40.75 $40.75 $227.76 $227.76 $235.22 $40.75 $237.60 $67.24 $57.34 $40.75 $172.26 $297.00 $59.09 $40.75 $45.04 $40.75 N/A N/A 30200937 EAP CPT® 82103 ALPHA-1-ANTITRYPSIN TOTAL BOTH IP/OP $137.00 $101.50 $6.72 $137.00 $26.38 $26.38 $26.38 $26.38 $13.44 $13.44 $6.72 $6.72 $13.44 $20.39 $20.39 $21.18 $14.89 $19.85 $21.50 $21.50 $81.04 $13.44 $13.44 $13.44 $137.00 $102.75 $13.44 $13.44 $13.44 $75.08 $75.08 $108.50 $13.44 $109.60 $22.18 $18.90 $13.44 $79.46 $137.00 $19.49 $13.44 $14.85 $13.44 N/A N/A 30200939 EAP CPT® 86316 IMMUNOASSAY TUMOR OTHER BOTH IP/OP $177.00 $131.00 $10.41 $177.00 $40.84 $40.84 $40.84 $40.84 $20.81 $20.81 $10.41 $10.41 $20.81 $31.60 $31.60 $32.81 $23.06 $30.73 $33.30 $33.30 $104.70 $20.81 $20.81 $20.81 $177.00 $132.75 $20.81 $20.81 $20.81 $116.28 $116.28 $140.18 $20.81 $141.60 $34.34 $29.27 $20.81 $102.66 $177.00 $30.17 $20.81 $22.99 $20.81 N/A N/A 30200941 EAP CPT® 86147 CARDIOLIPIN ANTIBODY BOTH IP/OP $53.00 $39.50 $12.73 $53.00 $49.95 $49.95 $49.95 $49.95 $25.45 $25.45 $12.73 $12.73 $25.45 $38.63 $38.63 $40.11 $28.20 $37.58 $40.72 $40.72 $31.35 $25.45 $25.45 $25.45 $53.00 $39.75 $25.45 $25.45 $25.45 $53.00 $53.00 $41.98 $25.45 $42.40 $41.99 $35.79 $25.45 $30.74 $53.00 $36.90 $25.45 $28.11 $25.45 N/A N/A 30200943 EAP CPT® 83520 IMMUNOASSAY QUANT NOS NONAB BOTH IP/OP $293.00 $217.00 $7.77 $293.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $173.31 $17.27 $17.27 $17.27 $293.00 $219.75 $17.27 $17.27 $17.27 $72.36 $72.36 $232.06 $17.27 $234.40 $28.50 $18.21 $17.27 $169.94 $293.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30200945 EAP CPT® 86146 GLYCOPROTEIN ANTIBODY BOTH IP/OP $107.00 $79.50 $12.73 $107.00 $49.95 $49.95 $49.95 $49.95 $25.45 $25.45 $12.73 $12.73 $25.45 $38.63 $38.63 $40.11 $28.20 $37.58 $40.72 $40.72 $63.29 $25.45 $25.45 $25.45 $107.00 $80.25 $25.45 $25.45 $25.45 $107.00 $107.00 $84.74 $25.45 $85.60 $41.99 $35.79 $25.45 $62.06 $107.00 $36.90 $25.45 $28.11 $25.45 N/A N/A 30200946 EAP CPT® 86147 CARDIOLIPIN ANTIBODY BOTH IP/OP $147.00 $109.00 $12.73 $147.00 $49.95 $49.95 $49.95 $49.95 $25.45 $25.45 $12.73 $12.73 $25.45 $38.63 $38.63 $40.11 $28.20 $37.58 $40.72 $40.72 $86.95 $25.45 $25.45 $25.45 $147.00 $110.25 $25.45 $25.45 $25.45 $142.16 $142.16 $116.42 $25.45 $117.60 $41.99 $35.79 $25.45 $85.26 $147.00 $36.90 $25.45 $28.11 $25.45 N/A N/A 30200947 EAP CPT® 86148 PHOSPHOLIPID ANTIBODY BOTH IP/OP $83.00 $61.50 $8.04 $83.00 $83.00 $83.00 $83.00 $83.00 $16.07 $16.07 $8.04 $83.00 $16.07 $24.39 $24.39 $25.33 $17.80 $23.73 $25.71 $25.71 $83.00 $16.07 $16.07 $16.07 $83.00 $62.25 $16.07 $16.07 $16.07 $83.00 $83.00 $65.74 $16.07 $66.40 $83.00 $83.00 $16.07 $48.14 $83.00 $23.30 $16.07 $83.00 $16.07 N/A N/A 30200949 EAP CPT® 85300 "ANTITHROMBIN III TEST,ACTIVITY" BOTH IP/OP $588.00 $435.50 $5.93 $588.00 $23.27 $23.27 $23.27 $23.27 $11.85 $11.85 $5.93 $5.93 $11.85 $17.99 $17.99 $18.68 $13.13 $17.50 $18.96 $18.96 $347.80 $11.85 $11.85 $11.85 $588.00 $441.00 $11.85 $11.85 $11.85 $66.20 $66.20 $465.70 $11.85 $470.40 $19.55 $16.67 $11.85 $341.04 $588.00 $17.18 $11.85 $13.09 $11.85 N/A N/A 30200950 EAP CPT® 85301 "ANTITHROMBIN III TEST,ANTIGEN ASSAY" BOTH IP/OP $588.00 $435.50 $5.40 $588.00 $21.21 $21.21 $21.21 $21.21 $10.81 $10.81 $5.41 $5.40 $10.81 $16.42 $16.42 $17.05 $11.99 $15.98 $17.30 $17.30 $347.80 $10.81 $10.81 $10.81 $588.00 $441.00 $10.81 $10.81 $10.81 $60.44 $60.44 $465.70 $10.81 $470.40 $17.84 $15.22 $10.81 $341.04 $588.00 $15.67 $10.81 $11.96 $10.81 N/A N/A 30200952 EAP CPT® 82172 ASSAY OF APOLIPOPROTEIN BOTH IP/OP $41.00 $30.50 $9.49 $41.00 $30.42 $30.42 $30.42 $30.42 $21.09 $21.09 $10.55 $9.49 $21.09 $23.52 $23.52 $24.43 $17.17 $22.90 $33.74 $33.74 $24.25 $21.09 $21.09 $21.09 $41.00 $30.75 $21.09 $21.09 $21.09 $41.00 $41.00 $32.47 $21.09 $32.80 $34.80 $21.81 $21.09 $23.78 $41.00 $30.58 $21.09 $17.13 $21.09 N/A N/A 30200954 EAP CPT® 86651 "ANTIBODY ENCEPHALITIS, CALIFORNIA (LA CROSSE)" BOTH IP/OP $25.00 $18.50 $6.60 $25.00 $25.00 $25.00 $25.00 $25.00 $13.19 $13.19 $6.60 $25.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $25.00 $13.19 $13.19 $13.19 $25.00 $18.75 $13.19 $13.19 $13.19 $25.00 $25.00 $19.80 $13.19 $20.00 $25.00 $25.00 $13.19 $14.50 $25.00 $19.13 $13.19 $25.00 $13.19 N/A N/A 30200955 EAP CPT® 86652 "ANTIBODY ENCEPHALITIS, EASTERN EQUINE" BOTH IP/OP $25.00 $18.50 $6.60 $25.00 $25.00 $25.00 $25.00 $25.00 $13.19 $13.19 $6.60 $25.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $25.00 $13.19 $13.19 $13.19 $25.00 $18.75 $13.19 $13.19 $13.19 $25.00 $25.00 $19.80 $13.19 $20.00 $25.00 $25.00 $13.19 $14.50 $25.00 $19.13 $13.19 $25.00 $13.19 N/A N/A 30200956 EAP CPT® 86653 "ANTIBODY ENCEPHALITIS, ST. LOUIS" BOTH IP/OP $25.00 $18.50 $6.60 $25.00 $25.00 $25.00 $25.00 $25.00 $13.19 $13.19 $6.60 $25.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $25.00 $13.19 $13.19 $13.19 $25.00 $18.75 $13.19 $13.19 $13.19 $25.00 $25.00 $19.80 $13.19 $20.00 $25.00 $25.00 $13.19 $14.50 $25.00 $19.13 $13.19 $25.00 $13.19 N/A N/A 30200957 EAP CPT® 86654 "ANTIBODY ENCEPHALITIS, WESTERN EQUINE" BOTH IP/OP $25.00 $18.50 $6.60 $25.00 $25.00 $25.00 $25.00 $25.00 $13.19 $13.19 $6.60 $25.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $25.00 $13.19 $13.19 $13.19 $25.00 $18.75 $13.19 $13.19 $13.19 $25.00 $25.00 $19.80 $13.19 $20.00 $25.00 $25.00 $13.19 $14.50 $25.00 $19.13 $13.19 $25.00 $13.19 N/A N/A 30200959 EAP CPT® 82175 ASSAY OF ARSENIC BOTH IP/OP $117.00 $87.00 $9.49 $117.00 $37.22 $37.22 $37.22 $37.22 $18.97 $18.97 $9.49 $9.49 $18.97 $28.81 $28.81 $29.92 $21.03 $28.02 $30.35 $30.35 $69.21 $18.97 $18.97 $18.97 $117.00 $87.75 $18.97 $18.97 $18.97 $106.04 $106.04 $92.66 $18.97 $93.60 $31.30 $26.69 $18.97 $67.86 $117.00 $27.51 $18.97 $20.96 $18.97 N/A N/A 30200961 EAP CPT® 84311 SPECTROPHOTOMETRY BOTH IP/OP $286.00 $212.00 $4.05 $286.00 $286.00 $286.00 $286.00 $286.00 $8.10 $8.10 $4.05 $286.00 $8.10 $10.61 $10.61 $11.02 $7.74 $10.32 $12.96 $12.96 $286.00 $8.10 $8.10 $8.10 $286.00 $214.50 $8.10 $8.10 $8.10 $39.08 $39.08 $226.51 $8.10 $228.80 $286.00 $286.00 $8.10 $165.88 $286.00 $11.75 $8.10 $286.00 $8.10 N/A N/A 30200963 EAP CPT® 86003 ALLERGEN SPECIFIC IGE BOTH IP/OP $124.00 $92.00 $2.61 $124.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $73.35 $5.22 $5.22 $5.22 $124.00 $93.00 $5.22 $5.22 $5.22 $29.20 $29.20 $98.21 $5.22 $99.20 $8.61 $7.35 $5.22 $71.92 $124.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30200965 EAP CPT® 87305 ASPERGILLUS AG EIA BOTH IP/OP $139.00 $103.00 $5.99 $139.00 $139.00 $139.00 $139.00 $139.00 $11.98 $11.98 $5.99 $139.00 $11.98 $18.22 $18.22 $18.92 $13.30 $17.71 $19.17 $19.17 $139.00 $11.98 $11.98 $11.98 $139.00 $104.25 $11.98 $11.98 $11.98 $67.04 $67.04 $110.09 $11.98 $111.20 $139.00 $139.00 $11.98 $80.62 $139.00 $17.37 $11.98 $139.00 $11.98 N/A N/A 30200967 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $280.00 $207.50 $8.39 $280.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $165.62 $18.64 $18.64 $18.64 $280.00 $210.00 $18.64 $18.64 $18.64 $67.28 $67.28 $221.76 $18.64 $224.00 $30.76 $16.94 $18.64 $162.40 $280.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30200969 EAP CPT® 86337 INSULIN ANTIBODIES BOTH IP/OP $411.00 $304.50 $10.71 $411.00 $42.02 $42.02 $42.02 $42.02 $21.41 $21.41 $10.71 $10.71 $21.41 $32.52 $32.52 $33.77 $23.74 $31.64 $34.26 $34.26 $243.11 $21.41 $21.41 $21.41 $411.00 $308.25 $21.41 $21.41 $21.41 $119.68 $119.68 $325.51 $21.41 $328.80 $35.33 $30.13 $21.41 $238.38 $411.00 $31.04 $21.41 $23.67 $21.41 N/A N/A 30200976 EAP CPT® 86753 PROTOZOA ANTIBODY NOS BOTH IP/OP $54.00 $40.00 $6.20 $54.00 $54.00 $54.00 $54.00 $54.00 $12.39 $12.39 $6.20 $54.00 $12.39 $18.81 $18.81 $19.54 $13.73 $18.31 $19.82 $19.82 $54.00 $12.39 $12.39 $12.39 $54.00 $40.50 $12.39 $12.39 $12.39 $54.00 $54.00 $42.77 $12.39 $43.20 $54.00 $54.00 $12.39 $31.32 $54.00 $17.97 $12.39 $54.00 $12.39 N/A N/A 30200978 EAP CPT® 87798 DETECT AGENT NOS DNA AMP BOTH IP/OP $526.00 $389.50 $17.55 $526.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $311.13 $35.09 $35.09 $35.09 $526.00 $394.50 $35.09 $35.09 $35.09 $109.64 $109.64 $416.59 $35.09 $420.80 $57.90 $27.60 $35.09 $305.08 $526.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30200980 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $301.00 $223.00 $8.39 $301.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $178.04 $18.64 $18.64 $18.64 $301.00 $225.75 $18.64 $18.64 $18.64 $67.28 $67.28 $238.39 $18.64 $240.80 $30.76 $16.94 $18.64 $174.58 $301.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30200982 EAP CPT® 87471 BARTONELLA DNA AMP PROBE BOTH IP/OP $441.00 $326.50 $17.55 $441.00 $441.00 $441.00 $441.00 $441.00 $35.09 $35.09 $17.55 $441.00 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $441.00 $35.09 $35.09 $35.09 $441.00 $330.75 $35.09 $35.09 $35.09 $109.64 $109.64 $349.27 $35.09 $352.80 $441.00 $441.00 $35.09 $255.78 $441.00 $50.88 $35.09 $441.00 $35.09 N/A N/A 30200997 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $189.00 $140.00 $8.39 $189.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $111.79 $18.64 $18.64 $18.64 $189.00 $141.75 $18.64 $18.64 $18.64 $67.28 $67.28 $149.69 $18.64 $151.20 $30.76 $16.94 $18.64 $109.62 $189.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30200999 EAP CPT® 86146 GLYCOPROTEIN ANTIBODY BOTH IP/OP $93.00 $69.00 $12.73 $93.00 $49.95 $49.95 $49.95 $49.95 $25.45 $25.45 $12.73 $12.73 $25.45 $38.63 $38.63 $40.11 $28.20 $37.58 $40.72 $40.72 $55.01 $25.45 $25.45 $25.45 $93.00 $69.75 $25.45 $25.45 $25.45 $93.00 $93.00 $73.66 $25.45 $74.40 $41.99 $35.79 $25.45 $53.94 $93.00 $36.90 $25.45 $28.11 $25.45 N/A N/A 30201001 EAP CPT® 82143 AMNIOTIC FLUID SCAN BOTH IP/OP $50.00 $37.00 $4.68 $50.00 $50.00 $50.00 $50.00 $50.00 $9.35 $9.35 $4.68 $50.00 $9.35 $10.43 $10.43 $10.83 $7.61 $10.16 $14.96 $14.96 $50.00 $9.35 $9.35 $9.35 $50.00 $37.50 $9.35 $9.35 $9.35 $38.44 $38.44 $39.60 $9.35 $40.00 $50.00 $50.00 $9.35 $29.00 $50.00 $13.56 $9.35 $50.00 $9.35 N/A N/A 30201003 EAP CPT® 87799 DETECT AGENT NOS DNA QUANT BOTH IP/OP "$1,125.00" $832.50 $21.42 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $42.84 $42.84 $21.42 "$1,125.00" $42.84 $65.04 $65.04 $67.54 $47.48 $234.46 $68.54 $68.54 "$1,125.00" $42.84 $42.84 $42.84 "$1,125.00" $843.75 $42.84 $42.84 $42.84 $239.40 $239.40 $891.00 $42.84 $900.00 "$1,125.00" "$1,125.00" $42.84 $652.50 "$1,125.00" $62.12 $42.84 "$1,125.00" $42.84 N/A N/A 30201005 EAP CPT® 86615 BORDETELLA ANTIBODY BOTH IP/OP $76.00 $56.50 $6.60 $76.00 $76.00 $76.00 $76.00 $76.00 $13.19 $13.19 $6.60 $76.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $76.00 $13.19 $13.19 $13.19 $76.00 $57.00 $13.19 $13.19 $13.19 $73.72 $73.72 $60.19 $13.19 $60.80 $76.00 $76.00 $13.19 $44.08 $76.00 $19.13 $13.19 $76.00 $13.19 N/A N/A 30201007 EAP CPT® 82523 COLLAGEN CROSSLINKS BOTH IP/OP $180.00 $133.50 $9.34 $180.00 $180.00 $180.00 $180.00 $180.00 $18.68 $18.68 $9.34 $180.00 $18.68 $28.38 $28.38 $29.47 $20.72 $27.60 $29.89 $29.89 $180.00 $18.68 $18.68 $18.68 $180.00 $135.00 $18.68 $18.68 $18.68 $104.44 $104.44 $142.56 $18.68 $144.00 $180.00 $180.00 $18.68 $104.40 $180.00 $27.09 $18.68 $180.00 $18.68 N/A N/A 30201009 EAP CPT® 83520 IMMUNOASSAY QUANT NOS NONAB BOTH IP/OP $186.00 $138.00 $7.77 $186.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $110.02 $17.27 $17.27 $17.27 $186.00 $139.50 $17.27 $17.27 $17.27 $72.36 $72.36 $147.31 $17.27 $148.80 $28.50 $18.21 $17.27 $107.88 $186.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30201011 EAP CPT® 86160 COMPLEMENT ANTIGEN BOTH IP/OP $224.00 $166.00 $6.00 $224.00 $23.54 $23.54 $23.54 $23.54 $12.00 $12.00 $6.00 $6.00 $12.00 $18.23 $18.23 $18.93 $13.31 $17.73 $19.20 $19.20 $132.50 $12.00 $12.00 $12.00 $224.00 $168.00 $12.00 $12.00 $12.00 $67.12 $67.12 $177.41 $12.00 $179.20 $19.80 $16.89 $12.00 $129.92 $224.00 $17.40 $12.00 $13.27 $12.00 N/A N/A 30201013 EAP CPT® 86329 IMMUNODIFFUSION BOTH IP/OP $122.00 $90.50 $7.02 $122.00 $27.56 $27.56 $27.56 $27.56 $14.05 $14.05 $7.03 $7.02 $14.05 $21.33 $21.33 $22.15 $15.57 $20.75 $22.48 $22.48 $72.16 $14.05 $14.05 $14.05 $122.00 $91.50 $14.05 $14.05 $14.05 $78.48 $78.48 $96.62 $14.05 $97.60 $23.18 $19.76 $14.05 $70.76 $122.00 $20.37 $14.05 $15.52 $14.05 N/A N/A 30201015 EAP CPT® 86301 IMMUNOASSAY TUMOR CA 19-9 BOTH IP/OP $91.00 $67.50 $10.41 $91.00 $40.84 $40.84 $40.84 $40.84 $20.81 $20.81 $10.41 $10.41 $20.81 $31.60 $31.60 $32.81 $23.06 $30.73 $33.30 $33.30 $53.83 $20.81 $20.81 $20.81 $91.00 $68.25 $20.81 $20.81 $20.81 $91.00 $91.00 $72.07 $20.81 $72.80 $34.34 $29.27 $20.81 $52.78 $91.00 $30.17 $20.81 $22.99 $20.81 N/A N/A 30201017 EAP CPT® 86403 PARTICLE AGGLUTINATION TEST BOTH IP/OP $216.00 $160.00 $5.19 $216.00 $20.00 $20.00 $20.00 $20.00 $11.54 $11.54 $5.77 $5.19 $11.54 $15.48 $15.48 $16.07 $11.30 $11.75 $18.46 $18.46 $127.76 $11.54 $11.54 $11.54 $216.00 $162.00 $11.54 $11.54 $11.54 $56.96 $56.96 $171.07 $11.54 $172.80 $19.04 $11.19 $11.54 $125.28 $216.00 $16.73 $11.54 $8.79 $11.54 N/A N/A 30201019 EAP CPT® 80157 ASSAY OF CARBAMAZEPINE FREE BOTH IP/OP $155.00 $115.00 $6.63 $155.00 $155.00 $155.00 $155.00 $155.00 $13.25 $13.25 $6.63 $155.00 $13.25 $20.13 $20.13 $20.91 $14.70 $14.69 $21.20 $21.20 $155.00 $13.25 $13.25 $13.25 $155.00 $116.25 $13.25 $13.25 $13.25 $74.08 $74.08 $122.76 $13.25 $124.00 $155.00 $155.00 $13.25 $89.90 $155.00 $19.21 $13.25 $155.00 $13.25 N/A N/A 30201021 EAP CPT® 82375 ASSAY CARBOXYHB QUANT BOTH IP/OP $60.00 $44.50 $3.19 $60.00 $60.00 $60.00 $60.00 $60.00 $12.32 $12.32 $6.16 $60.00 $12.32 $4.37 $4.37 $4.54 $3.19 $4.25 $19.71 $19.71 $60.00 $12.32 $12.32 $12.32 $60.00 $45.00 $12.32 $12.32 $12.32 $16.08 $16.08 $47.52 $12.32 $48.00 $60.00 $60.00 $12.32 $34.80 $60.00 $17.86 $12.32 $60.00 $12.32 N/A N/A 30201023 EAP CPT® 83516 IMMUNOASSAY NONANTIBODY BOTH IP/OP $172.00 $127.50 $5.76 $172.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $101.74 $11.53 $11.53 $11.53 $172.00 $129.00 $11.53 $11.53 $11.53 $59.76 $59.76 $136.22 $11.53 $137.60 $19.02 $15.05 $11.53 $99.76 $172.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30201025 EAP CPT® 86147 CARIOLIPIN ANTIBODY BOTH IP/OP $53.00 $39.50 $12.73 $53.00 $49.95 $49.95 $49.95 $49.95 $25.45 $25.45 $12.73 $12.73 $25.45 $38.63 $38.63 $40.11 $28.20 $37.58 $40.72 $40.72 $31.35 $25.45 $25.45 $25.45 $53.00 $39.75 $25.45 $25.45 $25.45 $53.00 $53.00 $41.98 $25.45 $42.40 $41.99 $35.79 $25.45 $30.74 $53.00 $36.90 $25.45 $28.11 $25.45 N/A N/A 30201027 EAP CPT® 82384 ASSAY THREE CATECHOLAMINES BOTH IP/OP $86.00 $64.00 $12.63 $86.00 $49.55 $49.55 $49.55 $49.55 $25.25 $25.25 $12.63 $12.63 $25.25 $38.34 $38.34 $39.82 $27.99 $37.30 $40.40 $40.40 $50.87 $25.25 $25.25 $25.25 $86.00 $64.50 $25.25 $25.25 $25.25 $86.00 $86.00 $68.11 $25.25 $68.80 $41.66 $35.52 $25.25 $49.88 $86.00 $36.61 $25.25 $27.90 $25.25 N/A N/A 30201028 EAP CPT® 82570 ASSAY OF URINE CREATININE BOTH IP/OP $34.00 $25.50 $2.59 $34.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $20.11 $5.18 $5.18 $5.18 $34.00 $25.50 $5.18 $5.18 $5.18 $28.92 $28.92 $26.93 $5.18 $27.20 $8.55 $7.28 $5.18 $19.72 $34.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30201030 EAP CPT® 88184 FLOWCYTOMETRY/TC 1 MARKER BOTH IP/OP $500.00 $370.00 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $295.75 $286.49 $75.09 $286.49 $300.82 $375.00 $286.49 $286.49 $286.49 $267.48 $267.48 $396.00 $286.49 $400.00 $325.00 $51.58 $286.49 $290.00 $300.82 $414.48 $286.49 $40.52 $286.49 N/A N/A 30201031 EAP CPT® 88185 FLOWCYTOMETRY/TC ADD-ON BOTH IP/OP $48.00 $36.00 $11.19 $50.81 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $48.00 $11.19 $48.00 $48.93 $48.93 $50.81 $35.72 $26.63 $48.00 $48.00 $28.39 $48.00 $24.01 $48.00 $48.00 $36.00 $48.00 $48.00 $48.00 $48.00 $48.00 $38.02 $48.00 $38.40 $31.20 $25.36 $48.00 $27.84 $48.00 $48.00 $48.00 $19.92 $48.00 N/A N/A 30201032 EAP CPT® 88187 FLOWCYTOMETRY/READ 2-8 BOTH IP/OP $180.00 $133.50 $18.24 $180.00 $180.00 $180.00 $180.00 $180.00 $35.84 $35.84 $18.24 $180.00 $35.84 $133.60 $133.60 $138.74 $93.78 $70.22 $57.34 $56.40 $180.00 $35.84 $35.25 $35.84 $180.00 $135.00 $35.84 $35.84 $35.84 $180.00 $180.00 $142.56 $35.84 $144.00 $117.00 $180.00 $35.84 $104.40 $180.00 $39.31 $35.84 $180.00 $35.84 N/A N/A 30201034 EAP CPT® 82378 CARCINOEMBRYINIC ANTIGEN BOTH IP/OP $58.00 $43.00 $9.48 $58.00 $37.22 $37.22 $37.22 $37.22 $18.96 $18.96 $9.48 $9.48 $18.96 $28.81 $28.81 $29.92 $21.03 $28.02 $30.34 $30.34 $34.31 $18.96 $18.96 $18.96 $58.00 $43.50 $18.96 $18.96 $18.96 $58.00 $58.00 $45.94 $18.96 $46.40 $31.28 $26.69 $18.96 $33.64 $58.00 $27.49 $18.96 $20.96 $18.96 N/A N/A 30201036 EAP CPT® 82378 CARCINOEMBRYINIC ANTIGEN BOTH IP/OP $58.00 $43.00 $9.48 $58.00 $37.22 $37.22 $37.22 $37.22 $18.96 $18.96 $9.48 $9.48 $18.96 $28.81 $28.81 $29.92 $21.03 $28.02 $30.34 $30.34 $34.31 $18.96 $18.96 $18.96 $58.00 $43.50 $18.96 $18.96 $18.96 $58.00 $58.00 $45.94 $18.96 $46.40 $31.28 $26.69 $18.96 $33.64 $58.00 $27.49 $18.96 $20.96 $18.96 N/A N/A 30201038 EAP CPT® 86631 CHLAMYDIA ANTIBODY BOTH IP/OP $87.00 $64.50 $5.91 $87.00 $23.22 $23.22 $23.22 $23.22 $11.82 $11.82 $5.91 $5.91 $11.82 $17.96 $17.96 $18.65 $13.11 $17.47 $18.91 $18.91 $51.46 $11.82 $11.82 $11.82 $87.00 $65.25 $11.82 $11.82 $11.82 $66.08 $66.08 $68.90 $11.82 $69.60 $19.50 $16.64 $11.82 $50.46 $87.00 $17.14 $11.82 $13.07 $11.82 N/A N/A 30201039 EAP CPT® 86632 CHLAMYDIA IGM ANTIBODY BOTH IP/OP $82.00 $61.00 $6.34 $82.00 $82.00 $82.00 $82.00 $82.00 $12.68 $12.68 $6.34 $82.00 $12.68 $19.27 $19.27 $20.01 $14.07 $18.76 $20.29 $20.29 $82.00 $12.68 $12.68 $12.68 $82.00 $61.50 $12.68 $12.68 $12.68 $70.96 $70.96 $64.94 $12.68 $65.60 $82.00 $82.00 $12.68 $47.56 $82.00 $18.39 $12.68 $82.00 $12.68 N/A N/A 30201041 EAP CPT® 82480 ASSAY SERUM CHOLINESTERASE BOTH IP/OP $58.00 $43.00 $3.94 $58.00 $58.00 $58.00 $58.00 $58.00 $7.87 $7.87 $3.94 $58.00 $7.87 $11.97 $11.97 $12.43 $8.74 $11.64 $12.59 $12.59 $58.00 $7.87 $7.87 $7.87 $58.00 $43.50 $7.87 $7.87 $7.87 $44.04 $44.04 $45.94 $7.87 $46.40 $58.00 $58.00 $7.87 $33.64 $58.00 $11.41 $7.87 $58.00 $7.87 N/A N/A 30201043 EAP CPT® 82495 ASSAY OF CHROMIUM BOTH IP/OP $97.00 $72.00 $10.14 $97.00 $97.00 $97.00 $97.00 $97.00 $20.28 $20.28 $10.14 $97.00 $20.28 $30.79 $30.79 $31.98 $22.48 $29.97 $32.45 $32.45 $97.00 $20.28 $20.28 $20.28 $97.00 $72.75 $20.28 $20.28 $20.28 $97.00 $97.00 $76.82 $20.28 $77.60 $97.00 $97.00 $20.28 $56.26 $97.00 $29.41 $20.28 $97.00 $20.28 N/A N/A 30201045 EAP CPT® 86316 IMMUNOASSAY TUMOR OTHER BOTH IP/OP $293.00 $217.00 $10.41 $293.00 $40.84 $40.84 $40.84 $40.84 $20.81 $20.81 $10.41 $10.41 $20.81 $31.60 $31.60 $32.81 $23.06 $30.73 $33.30 $33.30 $173.31 $20.81 $20.81 $20.81 $293.00 $219.75 $20.81 $20.81 $20.81 $116.28 $116.28 $232.06 $20.81 $234.40 $34.34 $29.27 $20.81 $169.94 $293.00 $30.17 $20.81 $22.99 $20.81 N/A N/A 30201049 EAP CPT® 86157 COLD AGGLUTININ TITER BOTH IP/OP $24.00 $18.00 $4.03 $24.00 $24.00 $24.00 $24.00 $24.00 $8.06 $8.06 $4.03 $24.00 $8.06 $12.24 $12.24 $12.71 $8.94 $11.91 $12.90 $12.90 $24.00 $8.06 $8.06 $8.06 $24.00 $18.00 $8.06 $8.06 $8.06 $24.00 $24.00 $19.01 $8.06 $19.20 $24.00 $24.00 $8.06 $13.92 $24.00 $11.69 $8.06 $24.00 $8.06 N/A N/A 30201051 EAP CPT® 82523 COLLAGEN CROSSLINKS BOTH IP/OP $99.00 $73.50 $9.34 $99.00 $99.00 $99.00 $99.00 $99.00 $18.68 $18.68 $9.34 $99.00 $18.68 $28.38 $28.38 $29.47 $20.72 $27.60 $29.89 $29.89 $99.00 $18.68 $18.68 $18.68 $99.00 $74.25 $18.68 $18.68 $18.68 $99.00 $99.00 $78.41 $18.68 $79.20 $99.00 $99.00 $18.68 $57.42 $99.00 $27.09 $18.68 $99.00 $18.68 N/A N/A 30201053 EAP CPT® 86160 COMPLEMENT ANTIGEN BOTH IP/OP $224.00 $166.00 $6.00 $224.00 $23.54 $23.54 $23.54 $23.54 $12.00 $12.00 $6.00 $6.00 $12.00 $18.23 $18.23 $18.93 $13.31 $17.73 $19.20 $19.20 $132.50 $12.00 $12.00 $12.00 $224.00 $168.00 $12.00 $12.00 $12.00 $67.12 $67.12 $177.41 $12.00 $179.20 $19.80 $16.89 $12.00 $129.92 $224.00 $17.40 $12.00 $13.27 $12.00 N/A N/A 30201055 EAP CPT® 86160 COMPLEMENT ANTIGEN BOTH IP/OP $200.00 $148.00 $6.00 $200.00 $23.54 $23.54 $23.54 $23.54 $12.00 $12.00 $6.00 $6.00 $12.00 $18.23 $18.23 $18.93 $13.31 $17.73 $19.20 $19.20 $118.30 $12.00 $12.00 $12.00 $200.00 $150.00 $12.00 $12.00 $12.00 $67.12 $67.12 $158.40 $12.00 $160.00 $19.80 $16.89 $12.00 $116.00 $200.00 $17.40 $12.00 $13.27 $12.00 N/A N/A 30201057 EAP CPT® 86160 COMPLEMENT ANTIGEN BOTH IP/OP $230.00 $170.50 $6.00 $230.00 $23.54 $23.54 $23.54 $23.54 $12.00 $12.00 $6.00 $6.00 $12.00 $18.23 $18.23 $18.93 $13.31 $17.73 $19.20 $19.20 $136.05 $12.00 $12.00 $12.00 $230.00 $172.50 $12.00 $12.00 $12.00 $67.12 $67.12 $182.16 $12.00 $184.00 $19.80 $16.89 $12.00 $133.40 $230.00 $17.40 $12.00 $13.27 $12.00 N/A N/A 30201059 EAP CPT® 86160 COMPLEMENT ANTIGEN BOTH IP/OP $230.00 $170.50 $6.00 $230.00 $23.54 $23.54 $23.54 $23.54 $12.00 $12.00 $6.00 $6.00 $12.00 $18.23 $18.23 $18.93 $13.31 $17.73 $19.20 $19.20 $136.05 $12.00 $12.00 $12.00 $230.00 $172.50 $12.00 $12.00 $12.00 $67.12 $67.12 $182.16 $12.00 $184.00 $19.80 $16.89 $12.00 $133.40 $230.00 $17.40 $12.00 $13.27 $12.00 N/A N/A 30201061 EAP CPT® 86160 COMPLEMENT ANTIGEN BOTH IP/OP $224.00 $166.00 $6.00 $224.00 $23.54 $23.54 $23.54 $23.54 $12.00 $12.00 $6.00 $6.00 $12.00 $18.23 $18.23 $18.93 $13.31 $17.73 $19.20 $19.20 $132.50 $12.00 $12.00 $12.00 $224.00 $168.00 $12.00 $12.00 $12.00 $67.12 $67.12 $177.41 $12.00 $179.20 $19.80 $16.89 $12.00 $129.92 $224.00 $17.40 $12.00 $13.27 $12.00 N/A N/A 30201063 EAP CPT® 83519 RIA NONANTIBODY BOTH IP/OP $686.00 $508.00 $8.28 $686.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $405.77 $18.40 $18.40 $18.40 $686.00 $514.50 $18.40 $18.40 $18.40 $75.52 $75.52 $543.31 $18.40 $548.80 $30.36 $19.01 $18.40 $397.88 $686.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30201065 EAP CPT® 82530 CORTISOL FREE BOTH IP/OP $180.00 $133.50 $8.36 $180.00 $32.78 $32.78 $32.78 $32.78 $16.71 $16.71 $8.36 $8.36 $16.71 $25.39 $25.39 $26.36 $18.53 $24.70 $26.74 $26.74 $106.47 $16.71 $16.71 $16.71 $180.00 $135.00 $16.71 $16.71 $16.71 $93.40 $93.40 $142.56 $16.71 $144.00 $27.57 $23.52 $16.71 $104.40 $180.00 $24.23 $16.71 $18.47 $16.71 N/A N/A 30201067 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $150.00 $111.00 $8.39 $150.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $88.73 $18.64 $18.64 $18.64 $150.00 $112.50 $18.64 $18.64 $18.64 $67.28 $67.28 $118.80 $18.64 $120.00 $30.76 $16.94 $18.64 $87.00 $150.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201069 EAP CPT® 82552 ASSAY OF CPK IN BLOOD BOTH IP/OP $61.00 $45.50 $6.70 $61.00 $61.00 $61.00 $61.00 $61.00 $13.39 $13.39 $6.70 $61.00 $13.39 $20.34 $20.34 $21.12 $14.85 $19.78 $21.42 $21.42 $61.00 $13.39 $13.39 $13.39 $61.00 $45.75 $13.39 $13.39 $13.39 $61.00 $61.00 $48.31 $13.39 $48.80 $61.00 $61.00 $13.39 $35.38 $61.00 $19.42 $13.39 $61.00 $13.39 N/A N/A 30201071 EAP CPT® 86343 LEUKOCYTE HISTAMINE RELEASE BOTH IP/OP $386.00 $286.00 $6.23 $386.00 $24.45 $24.45 $24.45 $24.45 $12.46 $12.46 $6.23 $6.23 $12.46 $18.93 $18.93 $19.66 $13.82 $18.41 $19.94 $19.94 $228.32 $12.46 $12.46 $12.46 $386.00 $289.50 $12.46 $12.46 $12.46 $69.64 $69.64 $305.71 $12.46 $308.80 $20.56 $17.53 $12.46 $223.88 $386.00 $18.07 $12.46 $13.77 $12.46 N/A N/A 30201073 EAP CPT® 84443 ASSAY THYROID STIM HORMONE BOTH IP/OP $146.00 $108.50 $8.40 $146.00 $32.98 $32.98 $32.98 $32.98 $16.80 $16.80 $8.40 $8.40 $16.80 $25.51 $25.51 $26.49 $18.62 $24.81 $26.88 $26.88 $86.36 $16.80 $16.80 $16.80 $146.00 $109.50 $16.80 $16.80 $16.80 $93.88 $93.88 $115.63 $16.80 $116.80 $27.72 $23.63 $16.80 $84.68 $146.00 $24.36 $16.80 $18.56 $16.80 N/A N/A 30201074 EAP CPT® 86343 LEUKOCYTE HISTAMINE RELEASE BOTH IP/OP $204.00 $151.00 $6.23 $204.00 $24.45 $24.45 $24.45 $24.45 $12.46 $12.46 $6.23 $6.23 $12.46 $18.93 $18.93 $19.66 $13.82 $18.41 $19.94 $19.94 $120.67 $12.46 $12.46 $12.46 $204.00 $153.00 $12.46 $12.46 $12.46 $69.64 $69.64 $161.57 $12.46 $163.20 $20.56 $17.53 $12.46 $118.32 $204.00 $18.07 $12.46 $13.77 $12.46 N/A N/A 30201075 EAP CPT® 86376 MICROSOMAL ANTIBODY BOTH IP/OP $108.00 $80.00 $7.28 $108.00 $28.56 $28.56 $28.56 $28.56 $14.55 $14.55 $7.28 $7.28 $14.55 $22.10 $22.10 $22.95 $16.13 $21.49 $23.28 $23.28 $63.88 $14.55 $14.55 $14.55 $108.00 $81.00 $14.55 $14.55 $14.55 $81.32 $81.32 $85.54 $14.55 $86.40 $24.01 $20.47 $14.55 $62.64 $108.00 $21.10 $14.55 $16.08 $14.55 N/A N/A 30201076 EAP CPT® 86800 THYROGLOBULIN ANTIBODY BOTH IP/OP $272.00 $201.50 $7.95 $272.00 $31.22 $31.22 $31.22 $31.22 $15.91 $15.91 $7.96 $7.95 $15.91 $24.15 $24.15 $25.08 $17.63 $23.50 $25.46 $25.46 $160.89 $15.91 $15.91 $15.91 $272.00 $204.00 $15.91 $15.91 $15.91 $88.88 $88.88 $215.42 $15.91 $217.60 $26.25 $22.38 $15.91 $157.76 $272.00 $23.07 $15.91 $17.58 $15.91 N/A N/A 30201078 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $227.00 $168.00 $8.39 $227.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $134.27 $18.64 $18.64 $18.64 $227.00 $170.25 $18.64 $18.64 $18.64 $67.28 $67.28 $179.78 $18.64 $181.60 $30.76 $16.94 $18.64 $131.66 $227.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201080 EAP CPT® 86682 HELMINTH ANTIBODY BOTH IP/OP $179.00 $132.50 $6.50 $179.00 $25.53 $25.53 $25.53 $25.53 $13.01 $13.01 $6.51 $6.50 $13.01 $19.75 $19.75 $20.51 $14.42 $19.20 $20.82 $20.82 $105.88 $13.01 $13.01 $13.01 $179.00 $134.25 $13.01 $13.01 $13.01 $72.68 $72.68 $141.77 $13.01 $143.20 $21.47 $18.29 $13.01 $103.82 $179.00 $18.86 $13.01 $14.37 $13.01 N/A N/A 30201082 EAP CPT® 82135 ASSAY AMINOLEVULINIC ACID BOTH IP/OP $164.00 $121.50 $8.23 $164.00 $164.00 $164.00 $164.00 $164.00 $16.45 $16.45 $8.23 $164.00 $16.45 $25.00 $25.00 $25.96 $18.25 $24.32 $26.32 $26.32 $164.00 $16.45 $16.45 $16.45 $164.00 $123.00 $16.45 $16.45 $16.45 $92.00 $92.00 $129.89 $16.45 $131.20 $164.00 $164.00 $16.45 $95.12 $164.00 $23.85 $16.45 $164.00 $16.45 N/A N/A 30201084 EAP CPT® 82135 ASSAY AMINOLEVULINIC ACID BOTH IP/OP $164.00 $121.50 $8.23 $164.00 $164.00 $164.00 $164.00 $164.00 $16.45 $16.45 $8.23 $164.00 $16.45 $25.00 $25.00 $25.96 $18.25 $24.32 $26.32 $26.32 $164.00 $16.45 $16.45 $16.45 $164.00 $123.00 $16.45 $16.45 $16.45 $92.00 $92.00 $129.89 $16.45 $131.20 $164.00 $164.00 $16.45 $95.12 $164.00 $23.85 $16.45 $164.00 $16.45 N/A N/A 30201086 EAP CPT® 86790 VIRUS ANTIBODY NOS BOTH IP/OP $267.00 $198.00 $6.44 $267.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $157.93 $12.88 $12.88 $12.88 $267.00 $200.25 $12.88 $12.88 $12.88 $72.00 $72.00 $211.46 $12.88 $213.60 $21.25 $18.12 $12.88 $154.86 $267.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30201088 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $201.00 $149.00 $8.39 $201.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $118.89 $18.64 $18.64 $18.64 $201.00 $150.75 $18.64 $18.64 $18.64 $67.28 $67.28 $159.19 $18.64 $160.80 $30.76 $16.94 $18.64 $116.58 $201.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201090 EAP CPT® 82533 TOTAL CORTISOL BOTH IP/OP $367.00 $272.00 $8.15 $367.00 $32.00 $32.00 $32.00 $32.00 $16.30 $16.30 $8.15 $8.15 $16.30 $24.76 $24.76 $25.71 $18.08 $24.09 $26.08 $26.08 $217.08 $16.30 $16.30 $16.30 $367.00 $275.25 $16.30 $16.30 $16.30 $91.12 $91.12 $290.66 $16.30 $293.60 $26.90 $22.94 $16.30 $212.86 $367.00 $23.64 $16.30 $18.02 $16.30 N/A N/A 30201092 EAP CPT® 86648 DIPTHERIA ANTIBODY BOTH IP/OP $97.00 $72.00 $7.61 $97.00 $97.00 $97.00 $97.00 $97.00 $15.21 $15.21 $7.61 $97.00 $15.21 $23.10 $23.10 $23.99 $16.86 $22.47 $24.34 $24.34 $97.00 $15.21 $15.21 $15.21 $97.00 $72.75 $15.21 $15.21 $15.21 $85.00 $85.00 $76.82 $15.21 $77.60 $97.00 $97.00 $15.21 $56.26 $97.00 $22.05 $15.21 $97.00 $15.21 N/A N/A 30201093 EAP CPT® 86774 TETANUS ANTIBODY BOTH IP/OP $87.00 $64.50 $7.40 $87.00 $87.00 $87.00 $87.00 $87.00 $14.80 $14.80 $7.40 $87.00 $14.80 $22.47 $22.47 $23.34 $16.41 $21.86 $23.68 $23.68 $87.00 $14.80 $14.80 $14.80 $87.00 $65.25 $14.80 $14.80 $14.80 $82.72 $82.72 $68.90 $14.80 $69.60 $87.00 $87.00 $14.80 $50.46 $87.00 $21.46 $14.80 $87.00 $14.80 N/A N/A 30201105 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $282.00 $209.00 $8.39 $282.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $166.80 $18.64 $18.64 $18.64 $282.00 $211.50 $18.64 $18.64 $18.64 $67.28 $67.28 $223.34 $18.64 $225.60 $30.76 $16.94 $18.64 $163.56 $282.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201107 EAP CPT® 82438 ASSAY OTHER FLUID CHLORIDES BOTH IP/OP $110.00 $81.50 $2.50 $110.00 $110.00 $110.00 $110.00 $110.00 $5.00 $5.00 $2.50 $110.00 $5.00 $7.43 $7.43 $7.71 $5.42 $7.22 $8.00 $8.00 $110.00 $5.00 $5.00 $5.00 $110.00 $82.50 $5.00 $5.00 $5.00 $27.32 $27.32 $87.12 $5.00 $88.00 $110.00 $110.00 $5.00 $63.80 $110.00 $7.25 $5.00 $110.00 $5.00 N/A N/A 30201108 EAP CPT® 84302 ASSAY OF SWEAT SODIUM BOTH IP/OP $114.00 $84.50 $2.43 $114.00 $114.00 $114.00 $114.00 $114.00 $4.86 $4.86 $2.43 $114.00 $4.86 $5.25 $5.25 $5.45 $3.83 $5.11 $7.78 $7.78 $114.00 $4.86 $4.86 $4.86 $114.00 $85.50 $4.86 $4.86 $4.86 $19.32 $19.32 $90.29 $4.86 $91.20 $114.00 $114.00 $4.86 $66.12 $114.00 $7.05 $4.86 $114.00 $4.86 N/A N/A 30201109 EAP CPT® 84311 SPECTROPHOTOMETRY BOTH IP/OP $72.00 $53.50 $4.05 $72.00 $72.00 $72.00 $72.00 $72.00 $8.10 $8.10 $4.05 $72.00 $8.10 $10.61 $10.61 $11.02 $7.74 $10.32 $12.96 $12.96 $72.00 $8.10 $8.10 $8.10 $72.00 $54.00 $8.10 $8.10 $8.10 $39.08 $39.08 $57.02 $8.10 $57.60 $72.00 $72.00 $8.10 $41.76 $72.00 $11.75 $8.10 $72.00 $8.10 N/A N/A 30201111 EAP CPT® 86255 FLUORESCENT ANTIBODY SCREEN BOTH IP/OP $124.00 $92.00 $6.03 $124.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $73.35 $12.05 $12.05 $12.05 $124.00 $93.00 $12.05 $12.05 $12.05 $67.36 $67.36 $98.21 $12.05 $99.20 $19.88 $16.96 $12.05 $71.92 $124.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201113 EAP CPT® 87337 ENTAMOEB HIST GROUP AG EIA BOTH IP/OP $89.00 $66.00 $5.99 $89.00 $23.52 $23.52 $23.52 $23.52 $11.98 $11.98 $5.99 $5.99 $11.98 $18.22 $18.22 $18.92 $13.30 $17.71 $19.17 $19.17 $52.64 $11.98 $11.98 $11.98 $89.00 $66.75 $11.98 $11.98 $11.98 $67.04 $67.04 $70.49 $11.98 $71.20 $19.77 $16.87 $11.98 $51.62 $89.00 $17.37 $11.98 $13.25 $11.98 N/A N/A 30201115 EAP CPT® 87798 DETECT AGENT NOS DNA AMP BOTH IP/OP $311.00 $230.50 $17.55 $311.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $183.96 $35.09 $35.09 $35.09 $311.00 $233.25 $35.09 $35.09 $35.09 $109.64 $109.64 $246.31 $35.09 $248.80 $57.90 $27.60 $35.09 $180.38 $311.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30201117 EAP CPT® 87799 DETECT AGENT NOS DNA QUANT BOTH IP/OP $779.00 $576.50 $21.42 $779.00 $779.00 $779.00 $779.00 $779.00 $42.84 $42.84 $21.42 $779.00 $42.84 $65.04 $65.04 $67.54 $47.48 $162.35 $68.54 $68.54 $779.00 $42.84 $42.84 $42.84 $779.00 $584.25 $42.84 $42.84 $42.84 $239.40 $239.40 $616.97 $42.84 $623.20 $779.00 $779.00 $42.84 $451.82 $779.00 $62.12 $42.84 $779.00 $42.84 N/A N/A 30201119 EAP CPT® 84202 ASSAY RBC PROTOPORPHYRIN BOTH IP/OP $24.00 $18.00 $7.18 $24.00 $24.00 $24.00 $24.00 $24.00 $14.35 $14.35 $7.18 $24.00 $14.35 $21.79 $21.79 $22.63 $15.91 $21.20 $22.96 $22.96 $24.00 $14.35 $14.35 $14.35 $24.00 $18.00 $14.35 $14.35 $14.35 $24.00 $24.00 $19.01 $14.35 $19.20 $24.00 $24.00 $14.35 $13.92 $24.00 $20.81 $14.35 $24.00 $14.35 N/A N/A 30201121 EAP CPT® 82672 ASSAY OF ESTROGEN BOTH IP/OP $131.00 $97.00 $10.85 $131.00 $131.00 $131.00 $131.00 $131.00 $21.70 $21.70 $10.85 $131.00 $21.70 $25.29 $25.29 $26.27 $18.46 $24.60 $34.72 $34.72 $131.00 $21.70 $21.70 $21.70 $131.00 $98.25 $21.70 $21.70 $21.70 $93.08 $93.08 $103.75 $21.70 $104.80 $131.00 $131.00 $21.70 $75.98 $131.00 $31.47 $21.70 $131.00 $21.70 N/A N/A 30201129 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $178.00 $132.00 $10.71 $178.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $105.29 $21.42 $21.42 $21.42 $178.00 $133.50 $21.42 $21.42 $21.42 $119.72 $119.72 $140.98 $21.42 $142.40 $35.34 $30.14 $21.42 $103.24 $178.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30201130 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $235.00 $174.00 $23.04 $235.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $139.00 $51.19 $51.19 $51.19 $235.00 $176.25 $51.19 $51.19 $51.19 $224.44 $224.44 $186.12 $51.19 $188.00 $84.46 $56.50 $51.19 $136.30 $235.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30201133 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $230.00 $170.50 $10.71 $230.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $136.05 $21.42 $21.42 $21.42 $230.00 $172.50 $21.42 $21.42 $21.42 $119.72 $119.72 $182.16 $21.42 $184.00 $35.34 $30.14 $21.42 $133.40 $230.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30201134 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $293.00 $217.00 $23.04 $293.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $173.31 $51.19 $51.19 $51.19 $293.00 $219.75 $51.19 $51.19 $51.19 $224.44 $224.44 $232.06 $51.19 $234.40 $84.46 $56.50 $51.19 $169.94 $293.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30201137 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $218.00 $161.50 $10.71 $218.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $128.95 $21.42 $21.42 $21.42 $218.00 $163.50 $21.42 $21.42 $21.42 $119.72 $119.72 $172.66 $21.42 $174.40 $35.34 $30.14 $21.42 $126.44 $218.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30201138 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $282.00 $209.00 $23.04 $282.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $166.80 $51.19 $51.19 $51.19 $282.00 $211.50 $51.19 $51.19 $51.19 $224.44 $224.44 $223.34 $51.19 $225.60 $84.46 $56.50 $51.19 $163.56 $282.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30201147 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $279.00 $206.50 $8.39 $279.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $165.03 $18.64 $18.64 $18.64 $279.00 $209.25 $18.64 $18.64 $18.64 $67.28 $67.28 $220.97 $18.64 $223.20 $30.76 $16.94 $18.64 $161.82 $279.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201151 EAP CPT® 83789 MASS SPECTROMETRY QUANT BOTH IP/OP $104.00 $77.00 $6.66 $104.00 $104.00 $104.00 $104.00 $104.00 $24.11 $24.11 $12.06 $104.00 $24.11 $9.12 $9.12 $9.47 $6.66 $8.87 $38.58 $38.58 $104.00 $24.11 $24.11 $24.11 $104.00 $78.00 $24.11 $24.11 $24.11 $33.56 $33.56 $82.37 $24.11 $83.20 $104.00 $104.00 $24.11 $60.32 $104.00 $34.96 $24.11 $104.00 $24.11 N/A N/A 30201153 EAP CPT® 86001 ALLERGEN SPECIFIC IGG BOTH IP/OP $196.00 $145.50 $3.91 $196.00 $196.00 $196.00 $196.00 $196.00 $7.82 $7.82 $3.91 $196.00 $7.82 $7.92 $7.92 $8.23 $5.79 $7.72 $12.51 $12.51 $196.00 $7.82 $7.82 $7.82 $196.00 $147.00 $7.82 $7.82 $7.82 $29.20 $29.20 $155.23 $7.82 $156.80 $196.00 $196.00 $7.82 $113.68 $196.00 $11.34 $7.82 $196.00 $7.82 N/A N/A 30201155 EAP CPT® 82679 ASSAY OF ESTRONE BOTH IP/OP $35.00 $26.00 $12.48 $41.17 $35.00 $35.00 $35.00 $35.00 $24.95 $24.95 $12.48 $12.48 $24.95 $37.91 $37.91 $39.37 $27.67 $35.00 $39.92 $39.92 $20.70 $24.95 $24.95 $24.95 $35.00 $26.25 $24.95 $24.95 $24.95 $35.00 $35.00 $27.72 $24.95 $28.00 $41.17 $35.00 $24.95 $20.30 $35.00 $35.00 $24.95 $27.59 $24.95 N/A N/A 30201156 EAP CPT® 82681 "ESTRADIOL; FREE, DIRECT" BOTH IP/OP $198.00 $147.00 $13.97 $198.00 $198.00 $198.00 $198.00 $198.00 $27.94 $27.94 $13.97 $198.00 $27.94 $146.96 $146.96 $152.62 $103.16 $26.26 $44.70 $44.70 $198.00 $27.94 $27.94 $27.94 $198.00 $148.50 $27.94 $27.94 $27.94 $99.00 $99.00 $156.82 $27.94 $158.40 $198.00 $198.00 $27.94 $114.84 $198.00 $40.51 $27.94 $198.00 $27.94 N/A N/A 30201157 EAP CPT® 82677 ASSAY OF ESTRIOL BOTH IP/OP $35.00 $26.00 $12.09 $39.90 $35.00 $35.00 $35.00 $35.00 $24.18 $24.18 $12.09 $12.09 $24.18 $36.72 $36.72 $38.13 $26.81 $35.00 $38.69 $38.69 $20.70 $24.18 $24.18 $24.18 $35.00 $26.25 $24.18 $24.18 $24.18 $35.00 $35.00 $27.72 $24.18 $28.00 $39.90 $34.02 $24.18 $20.30 $35.00 $35.00 $24.18 $26.72 $24.18 N/A N/A 30201159 EAP CPT® 83883 ASSAY NEPHELOMETRY NOT SPEC BOTH IP/OP $213.00 $158.00 $6.80 $213.00 $26.68 $26.68 $26.68 $26.68 $13.60 $13.60 $6.80 $6.80 $13.60 $20.64 $20.64 $21.44 $15.07 $20.09 $21.76 $21.76 $125.99 $13.60 $13.60 $13.60 $213.00 $159.75 $13.60 $13.60 $13.60 $76.00 $76.00 $168.70 $13.60 $170.40 $22.44 $19.13 $13.60 $123.54 $213.00 $19.72 $13.60 $15.03 $13.60 N/A N/A 30201165 EAP CPT® 83727 ASSAY OF IRH HORMONE BOTH IP/OP "$1,260.00" $932.50 $8.60 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $17.19 $17.19 $8.60 "$1,260.00" $17.19 $26.10 $26.10 $27.11 $19.06 $25.40 $27.50 $27.50 "$1,260.00" $17.19 $17.19 $17.19 "$1,260.00" $945.00 $17.19 $17.19 $17.19 $96.08 $96.08 $997.92 $17.19 "$1,008.00" "$1,260.00" "$1,260.00" $17.19 $730.80 "$1,260.00" $24.93 $17.19 "$1,260.00" $17.19 N/A N/A 30201167 EAP CPT® 87338 HPYLORI STOOL EIA BOTH IP/OP $175.00 $129.50 $7.19 $175.00 $175.00 $175.00 $175.00 $175.00 $14.38 $14.38 $7.19 $175.00 $14.38 $21.84 $21.84 $22.68 $15.94 $21.25 $23.01 $23.01 $175.00 $14.38 $14.38 $14.38 $175.00 $131.25 $14.38 $14.38 $14.38 $80.40 $80.40 $138.60 $14.38 $140.00 $175.00 $175.00 $14.38 $101.50 $175.00 $20.85 $14.38 $175.00 $14.38 N/A N/A 30201169 EAP CPT® 86684 HEMOPHILUS INFLUENZA BOTH IP/OP $198.00 $147.00 $7.92 $198.00 $198.00 $198.00 $198.00 $198.00 $15.84 $15.84 $7.92 $198.00 $15.84 $24.06 $24.06 $24.98 $17.56 $23.42 $25.34 $25.34 $198.00 $15.84 $15.84 $15.84 $198.00 $148.50 $15.84 $15.84 $15.84 $88.56 $88.56 $156.82 $15.84 $158.40 $198.00 $198.00 $15.84 $114.84 $198.00 $22.97 $15.84 $198.00 $15.84 N/A N/A 30201171 EAP CPT® 84702 CHORIONIC GONADOTROPIN TEST BOTH IP/OP $162.00 $120.00 $7.09 $162.00 $12.60 $12.60 $12.60 $12.60 $15.05 $15.05 $7.53 $7.53 $15.05 $9.74 $9.74 $10.12 $7.11 $9.48 $24.08 $24.08 $95.82 $15.05 $15.05 $15.05 $162.00 $121.50 $15.05 $15.05 $15.05 $35.88 $35.88 $128.30 $15.05 $129.60 $24.83 $9.03 $15.05 $93.96 $162.00 $21.82 $15.05 $7.09 $15.05 N/A N/A 30201173 EAP CPT® 82175 ASSAY OF ARSENIC BOTH IP/OP $43.00 $32.00 $9.49 $43.00 $37.22 $37.22 $37.22 $37.22 $18.97 $18.97 $9.49 $9.49 $18.97 $28.81 $28.81 $29.92 $21.03 $28.02 $30.35 $30.35 $25.43 $18.97 $18.97 $18.97 $43.00 $32.25 $18.97 $18.97 $18.97 $43.00 $43.00 $34.06 $18.97 $34.40 $31.30 $26.69 $18.97 $24.94 $43.00 $27.51 $18.97 $20.96 $18.97 N/A N/A 30201174 EAP CPT® 83655 ASSAY OF LEAD BOTH IP/OP $54.00 $40.00 $6.05 $54.00 $23.77 $23.77 $23.77 $23.77 $12.11 $12.11 $6.06 $6.05 $12.11 $18.38 $18.38 $19.08 $13.41 $11.75 $19.38 $19.38 $31.94 $12.11 $12.11 $12.11 $54.00 $40.50 $12.11 $12.11 $12.11 $54.00 $54.00 $42.77 $12.11 $43.20 $19.98 $11.19 $12.11 $31.32 $54.00 $17.56 $12.11 $8.79 $12.11 N/A N/A 30201175 EAP CPT® 83825 ASSAY OF MERCURY BOTH IP/OP $38.00 $28.50 $8.13 $38.00 $31.90 $31.90 $31.90 $31.90 $16.26 $16.26 $8.13 $8.13 $16.26 $24.69 $24.69 $25.64 $18.02 $24.02 $26.02 $26.02 $22.48 $16.26 $16.26 $16.26 $38.00 $28.50 $16.26 $16.26 $16.26 $38.00 $38.00 $30.10 $16.26 $30.40 $26.83 $22.88 $16.26 $22.04 $38.00 $23.58 $16.26 $17.97 $16.26 N/A N/A 30201177 EAP CPT® 82175 ASSAY OF ARSENIC BOTH IP/OP $69.00 $51.50 $9.49 $69.00 $37.22 $37.22 $37.22 $37.22 $18.97 $18.97 $9.49 $9.49 $18.97 $28.81 $28.81 $29.92 $21.03 $28.02 $30.35 $30.35 $40.81 $18.97 $18.97 $18.97 $69.00 $51.75 $18.97 $18.97 $18.97 $69.00 $69.00 $54.65 $18.97 $55.20 $31.30 $26.69 $18.97 $40.02 $69.00 $27.51 $18.97 $20.96 $18.97 N/A N/A 30201178 EAP CPT® 82300 ASSAY OF CADMIUM BOTH IP/OP $75.00 $55.50 $11.57 $75.00 $45.43 $45.43 $45.43 $45.43 $23.64 $23.64 $11.82 $11.57 $23.64 $35.14 $35.14 $36.49 $25.65 $34.19 $37.82 $37.82 $44.36 $23.64 $23.64 $23.64 $75.00 $56.25 $23.64 $23.64 $23.64 $75.00 $75.00 $59.40 $23.64 $60.00 $39.01 $32.56 $23.64 $43.50 $75.00 $34.28 $23.64 $25.58 $23.64 N/A N/A 30201179 EAP CPT® 82570 ASSAY OF URINE CREATININE BOTH IP/OP $91.00 $67.50 $2.59 $91.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $53.83 $5.18 $5.18 $5.18 $91.00 $68.25 $5.18 $5.18 $5.18 $28.92 $28.92 $72.07 $5.18 $72.80 $8.55 $7.28 $5.18 $52.78 $91.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30201180 EAP CPT® 83655 ASSAY OF LEAD BOTH IP/OP $76.00 $56.50 $6.05 $76.00 $23.77 $23.77 $23.77 $23.77 $12.11 $12.11 $6.06 $6.05 $12.11 $18.38 $18.38 $19.08 $13.41 $11.75 $19.38 $19.38 $44.95 $12.11 $12.11 $12.11 $76.00 $57.00 $12.11 $12.11 $12.11 $67.64 $67.64 $60.19 $12.11 $60.80 $19.98 $11.19 $12.11 $44.08 $76.00 $17.56 $12.11 $8.79 $12.11 N/A N/A 30201181 EAP CPT® 83825 ASSAY OF MERCURY BOTH IP/OP $62.00 $46.00 $8.13 $62.00 $31.90 $31.90 $31.90 $31.90 $16.26 $16.26 $8.13 $8.13 $16.26 $24.69 $24.69 $25.64 $18.02 $24.02 $26.02 $26.02 $36.67 $16.26 $16.26 $16.26 $62.00 $46.50 $16.26 $16.26 $16.26 $62.00 $62.00 $49.10 $16.26 $49.60 $26.83 $22.88 $16.26 $35.96 $62.00 $23.58 $16.26 $17.97 $16.26 N/A N/A 30201183 EAP CPT® 86804 HEP C AB TEST CONFIRM BOTH IP/OP $396.00 $293.50 $7.75 $396.00 $396.00 $396.00 $396.00 $396.00 $15.49 $15.49 $7.75 $396.00 $15.49 $23.51 $23.51 $24.42 $17.17 $22.88 $24.78 $24.78 $396.00 $15.49 $15.49 $15.49 $396.00 $297.00 $15.49 $15.49 $15.49 $86.56 $86.56 $313.63 $15.49 $316.80 $396.00 $396.00 $15.49 $229.68 $396.00 $22.46 $15.49 $396.00 $15.49 N/A N/A 30201185 EAP CPT® 87299 ANTIBODY DETECTION NOS IF BOTH IP/OP $88.00 $65.50 $8.05 $88.00 $88.00 $88.00 $88.00 $88.00 $16.10 $16.10 $8.05 $88.00 $16.10 $18.22 $18.22 $18.92 $13.30 $17.71 $25.76 $25.76 $88.00 $16.10 $16.10 $16.10 $88.00 $66.00 $16.10 $16.10 $16.10 $67.04 $67.04 $69.70 $16.10 $70.40 $88.00 $88.00 $16.10 $51.04 $88.00 $23.35 $16.10 $88.00 $16.10 N/A N/A 30201187 EAP CPT® 86970 RBC PRETREATMENT BOTH IP/OP $510.00 $377.50 $12.11 $408.00 $41.11 $41.11 $41.11 $41.11 $33.30 $33.30 $33.15 $106.30 $33.30 $16.59 $16.59 $17.23 $12.11 $106.29 $53.27 $48.99 $301.67 $33.30 $298.00 $33.30 $34.96 $382.50 $33.30 $33.30 $33.30 $74.44 $74.44 $403.92 $33.30 $408.00 $331.50 $101.22 $33.30 $295.80 $34.96 $48.17 $33.30 $106.28 $33.30 N/A N/A 30201189 EAP CPT® 87798 DETECT AGENT NOS DNA AMP BOTH IP/OP $436.00 $323.00 $17.55 $436.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $257.89 $35.09 $35.09 $35.09 $436.00 $327.00 $35.09 $35.09 $35.09 $109.64 $109.64 $345.31 $35.09 $348.80 $57.90 $27.60 $35.09 $252.88 $436.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30201191 EAP CPT® 86698 HISTOPLASMA BOTH IP/OP $72.00 $53.50 $6.90 $72.00 $72.00 $72.00 $72.00 $72.00 $13.79 $13.79 $6.90 $72.00 $13.79 $18.98 $18.98 $19.71 $13.86 $18.46 $22.06 $22.06 $72.00 $13.79 $13.79 $13.79 $72.00 $54.00 $13.79 $13.79 $13.79 $69.84 $69.84 $57.02 $13.79 $57.60 $72.00 $72.00 $13.79 $41.76 $72.00 $20.00 $13.79 $72.00 $13.79 N/A N/A 30201193 EAP CPT® 86689 HTLV/HIV CONFIRMATORY TEST BOTH IP/OP $143.00 $106.00 $9.68 $143.00 $143.00 $143.00 $143.00 $143.00 $19.35 $19.35 $9.68 $143.00 $19.35 $29.39 $29.39 $30.52 $21.45 $24.81 $30.96 $30.96 $143.00 $19.35 $19.35 $19.35 $143.00 $107.25 $19.35 $19.35 $19.35 $108.20 $108.20 $113.26 $19.35 $114.40 $143.00 $143.00 $19.35 $82.94 $143.00 $28.06 $19.35 $143.00 $19.35 N/A N/A 30201195 EAP CPT® 86702 HIV-2 BOTH IP/OP $135.00 $100.00 $6.76 $135.00 $26.53 $26.53 $26.53 $26.53 $13.52 $13.52 $6.76 $6.76 $13.52 $20.53 $20.53 $21.32 $14.99 $17.33 $21.63 $21.63 $79.85 $13.52 $13.52 $13.52 $135.00 $101.25 $13.52 $13.52 $13.52 $75.52 $75.52 $106.92 $13.52 $108.00 $22.31 $16.50 $13.52 $78.30 $135.00 $19.60 $13.52 $12.96 $13.52 N/A N/A 30201202 EAP CPT® 83090 ASSAY OF HOMOCYSTINE BOTH IP/OP $231.00 $171.00 $8.96 $231.00 $231.00 $231.00 $231.00 $231.00 $17.92 $17.92 $8.96 $231.00 $17.92 $25.62 $25.62 $26.60 $18.70 $24.92 $28.67 $28.67 $231.00 $17.92 $17.92 $17.92 $231.00 $173.25 $17.92 $17.92 $17.92 $94.28 $94.28 $182.95 $17.92 $184.80 $231.00 $231.00 $17.92 $133.98 $231.00 $25.98 $17.92 $231.00 $17.92 N/A N/A 30201204 EAP CPT® 82570 ASSAY OF URINE CREATININE BOTH IP/OP $54.00 $40.00 $2.59 $54.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $31.94 $5.18 $5.18 $5.18 $54.00 $40.50 $5.18 $5.18 $5.18 $28.92 $28.92 $42.77 $5.18 $43.20 $8.55 $7.28 $5.18 $31.32 $54.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30201205 EAP CPT® 82150 ASSAY OF AMYLASE BOTH IP/OP $101.00 $75.00 $3.24 $101.00 $12.73 $12.73 $12.73 $12.73 $6.48 $6.48 $3.24 $3.24 $6.48 $9.84 $9.84 $10.22 $7.18 $9.58 $10.37 $10.37 $59.74 $6.48 $6.48 $6.48 $101.00 $75.75 $6.48 $6.48 $6.48 $36.24 $36.24 $79.99 $6.48 $80.80 $10.69 $9.12 $6.48 $58.58 $101.00 $9.40 $6.48 $7.16 $6.48 N/A N/A 30201207 EAP CPT® 87529 DETECTION HERPES SIMPLEX VIRUS (HSV-1 OR HSV-2) AMPLIFIED PROBE TQ BOTH IP/OP $188.00 $139.50 $17.55 $188.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $111.20 $35.09 $35.09 $35.09 $188.00 $141.00 $35.09 $35.09 $35.09 $109.64 $109.64 $148.90 $35.09 $150.40 $57.90 $27.60 $35.09 $109.04 $188.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30201209 EAP CPT® 87530 HSV DNA QUANT BOTH IP/OP $248.00 $184.00 $21.42 $248.00 $248.00 $248.00 $248.00 $248.00 $42.84 $42.84 $21.42 $248.00 $42.84 $65.04 $65.04 $67.54 $47.48 $51.69 $68.54 $68.54 $248.00 $42.84 $42.84 $42.84 $248.00 $186.00 $42.84 $42.84 $42.84 $239.40 $239.40 $196.42 $42.84 $198.40 $248.00 $248.00 $42.84 $143.84 $248.00 $62.12 $42.84 $248.00 $42.84 N/A N/A 30201211 EAP CPT® 87532 DETECTION HERPES VIRUS-6 (HHV-6) AMPLIFIED PROBE TQ BOTH IP/OP $343.00 $254.00 $17.55 $343.00 $343.00 $343.00 $343.00 $343.00 $35.09 $35.09 $17.55 $343.00 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $343.00 $35.09 $35.09 $35.09 $343.00 $257.25 $35.09 $35.09 $35.09 $109.64 $109.64 $271.66 $35.09 $274.40 $343.00 $343.00 $35.09 $198.94 $343.00 $50.88 $35.09 $343.00 $35.09 N/A N/A 30201213 EAP CPT® 83632 PLACENTAL LACTOGEN BOTH IP/OP $484.00 $358.50 $10.11 $484.00 $484.00 $484.00 $484.00 $484.00 $20.22 $20.22 $10.11 $484.00 $20.22 $30.69 $30.69 $31.87 $22.40 $29.86 $32.35 $32.35 $484.00 $20.22 $20.22 $20.22 $484.00 $363.00 $20.22 $20.22 $20.22 $112.96 $112.96 $383.33 $20.22 $387.20 $484.00 $484.00 $20.22 $280.72 $484.00 $29.32 $20.22 $484.00 $20.22 N/A N/A 30201220 EAP CPT® 86331 IMMUNODIFFUSION OUCHTERLONY BOTH IP/OP $19.00 $14.50 $5.99 $19.17 $19.00 $19.00 $19.00 $19.00 $11.98 $11.98 $5.99 $19.00 $11.98 $18.20 $18.20 $18.90 $13.29 $17.71 $19.17 $19.17 $19.00 $11.98 $11.98 $11.98 $19.00 $14.25 $11.98 $11.98 $11.98 $19.00 $19.00 $15.05 $11.98 $15.20 $19.00 $19.00 $11.98 $11.02 $19.00 $17.37 $11.98 $19.00 $11.98 N/A N/A 30201221 EAP CPT® 86606 ASPERGILLUS ANTIBODY BOTH IP/OP $27.00 $20.00 $7.53 $27.00 $27.00 $27.00 $27.00 $27.00 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $15.97 $15.05 $15.05 $15.05 $27.00 $20.25 $15.05 $15.05 $15.05 $27.00 $27.00 $21.38 $15.05 $21.60 $24.83 $21.18 $15.05 $15.66 $27.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30201222 EAP CPT® 86744 NOCARDIA ANTIBODY BOTH IP/OP $24.00 $18.00 $8.00 $25.58 $24.00 $24.00 $24.00 $24.00 $15.99 $15.99 $8.00 $24.00 $15.99 $20.02 $20.02 $20.79 $14.61 $19.49 $25.58 $25.58 $24.00 $15.99 $15.99 $15.99 $24.00 $18.00 $15.99 $15.99 $15.99 $24.00 $24.00 $19.01 $15.99 $19.20 $24.00 $24.00 $15.99 $13.92 $24.00 $23.19 $15.99 $24.00 $15.99 N/A N/A 30201224 EAP CPT® 86341 ISLET CELL ANTIBODY BOTH IP/OP $195.00 $144.50 $10.61 $195.00 $38.83 $38.83 $38.83 $38.83 $23.57 $23.57 $11.79 $10.61 $23.57 $30.05 $30.05 $31.20 $21.93 $29.24 $37.71 $37.71 $115.34 $23.57 $23.57 $23.57 $195.00 $146.25 $23.57 $23.57 $23.57 $110.60 $110.60 $154.44 $23.57 $156.00 $38.89 $27.85 $23.57 $113.10 $195.00 $34.18 $23.57 $21.88 $23.57 N/A N/A 30201226 EAP CPT® 82784 ASSAY IGA/IGD/IGG/IGM EACH BOTH IP/OP $34.00 $25.50 $4.65 $34.00 $18.25 $18.25 $18.25 $18.25 $9.30 $9.30 $4.65 $4.65 $9.30 $14.12 $14.12 $14.67 $10.31 $13.73 $14.88 $14.88 $20.11 $9.30 $9.30 $9.30 $34.00 $25.50 $9.30 $9.30 $9.30 $34.00 $34.00 $26.93 $9.30 $27.20 $15.35 $13.08 $9.30 $19.72 $34.00 $13.49 $9.30 $10.27 $9.30 N/A N/A 30201227 EAP CPT® 82787 IGG 1 2 3 OR 4 EACH BOTH IP/OP $28.00 $21.00 $4.01 $28.00 $15.74 $15.74 $15.74 $15.74 $8.02 $8.02 $4.01 $4.01 $8.02 $12.18 $12.18 $12.65 $8.89 $11.84 $12.83 $12.83 $16.56 $8.02 $8.02 $8.02 $28.00 $21.00 $8.02 $8.02 $8.02 $28.00 $28.00 $22.18 $8.02 $22.40 $13.23 $11.28 $8.02 $16.24 $28.00 $11.63 $8.02 $8.86 $8.02 N/A N/A 30201229 EAP CPT® 86336 INHIBIN A BOTH IP/OP $128.00 $95.00 $7.79 $128.00 $25.43 $25.43 $25.43 $25.43 $15.59 $15.59 $7.80 $7.79 $15.59 $19.66 $19.66 $20.41 $14.35 $19.12 $24.94 $24.94 $75.71 $15.59 $15.59 $15.59 $128.00 $96.00 $15.59 $15.59 $15.59 $72.36 $72.36 $101.38 $15.59 $102.40 $25.72 $18.21 $15.59 $74.24 $128.00 $22.61 $15.59 $14.30 $15.59 N/A N/A 30201231 EAP CPT® 83520 IMMUNOASSAY QUANT NOS NONAB BOTH IP/OP $383.00 $283.50 $7.77 $383.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $226.54 $17.27 $17.27 $17.27 $383.00 $287.25 $17.27 $17.27 $17.27 $72.36 $72.36 $303.34 $17.27 $306.40 $28.50 $18.21 $17.27 $222.14 $383.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30201233 EAP CPT® 83789 MASS SPECTROMETRY QUANT BOTH IP/OP $116.00 $86.00 $6.66 $116.00 $116.00 $116.00 $116.00 $116.00 $24.11 $24.11 $12.06 $116.00 $24.11 $9.12 $9.12 $9.47 $6.66 $8.87 $38.58 $38.58 $116.00 $24.11 $24.11 $24.11 $116.00 $87.00 $24.11 $24.11 $24.11 $33.56 $33.56 $91.87 $24.11 $92.80 $116.00 $116.00 $24.11 $67.28 $116.00 $34.96 $24.11 $116.00 $24.11 N/A N/A 30201235 EAP CPT® 86886 COOMBS TEST INDIRECT TITER BOTH IP/OP $163.00 $121.00 $2.59 $234.73 $9.11 $9.11 $9.11 $9.11 $146.71 $146.71 $146.06 $2.59 $146.71 $7.06 $7.06 $7.33 $5.15 $6.87 $234.73 $226.86 $96.41 $146.71 $5.18 $146.71 $154.04 $122.25 $146.71 $146.71 $146.71 $26.00 $26.00 $129.10 $146.71 $130.40 $8.55 $6.54 $146.71 $94.54 $154.04 $163.00 $146.71 $5.14 $146.71 N/A N/A 30201236 EAP CPT® 86900 "BLOOD TYPING, SEROLOGIC, ABO" BOTH IP/OP $312.00 $231.00 $1.49 $249.60 $5.87 $5.87 $5.87 $5.87 $110.92 $110.92 $110.43 $1.49 $110.92 $4.52 $4.52 $4.70 $3.30 $4.41 $177.47 $167.51 $184.55 $110.92 $2.99 $110.92 $116.46 $234.00 $110.92 $110.92 $110.92 $16.68 $16.68 $247.10 $110.92 $249.60 $202.80 $4.20 $110.92 $180.96 $116.46 $160.47 $110.92 $3.30 $110.92 N/A N/A 30201238 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $209.00 $155.00 $8.39 $209.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $123.62 $18.64 $18.64 $18.64 $209.00 $156.75 $18.64 $18.64 $18.64 $67.28 $67.28 $165.53 $18.64 $167.20 $30.76 $16.94 $18.64 $121.22 $209.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201248 EAP CPT® 83630 LACTOFERRIN FECAL (QUAL) BOTH IP/OP $164.00 $121.50 $9.85 $164.00 $164.00 $164.00 $164.00 $164.00 $19.70 $19.70 $9.85 $164.00 $19.70 $29.81 $29.81 $30.95 $21.76 $15.80 $31.52 $31.52 $164.00 $19.70 $19.70 $19.70 $164.00 $123.00 $19.70 $19.70 $19.70 $109.68 $109.68 $129.89 $19.70 $131.20 $164.00 $164.00 $19.70 $95.12 $164.00 $28.57 $19.70 $164.00 $19.70 N/A N/A 30201250 EAP CPT® 87278 LEGION PNEUMOPHILIA AG IF BOTH IP/OP $148.00 $110.00 $7.80 $148.00 $148.00 $148.00 $148.00 $148.00 $15.60 $15.60 $7.80 $148.00 $15.60 $18.22 $18.22 $18.92 $13.30 $17.71 $24.96 $24.96 $148.00 $15.60 $15.60 $15.60 $148.00 $111.00 $15.60 $15.60 $15.60 $67.04 $67.04 $117.22 $15.60 $118.40 $148.00 $148.00 $15.60 $85.84 $148.00 $22.62 $15.60 $148.00 $15.60 N/A N/A 30201252 EAP CPT® 86717 LEISHMANIA ANTIBODY BOTH IP/OP $149.00 $110.50 $6.13 $149.00 $149.00 $149.00 $149.00 $149.00 $12.25 $12.25 $6.13 $149.00 $12.25 $18.61 $18.61 $19.32 $13.58 $18.10 $19.60 $19.60 $149.00 $12.25 $12.25 $12.25 $149.00 $111.75 $12.25 $12.25 $12.25 $68.48 $68.48 $118.01 $12.25 $119.20 $149.00 $149.00 $12.25 $86.42 $149.00 $17.76 $12.25 $149.00 $12.25 N/A N/A 30201254 EAP CPT® 83690 ASSAY OF LIPASE BOTH IP/OP $83.00 $61.50 $3.44 $83.00 $13.53 $13.53 $13.53 $13.53 $6.89 $6.89 $3.45 $3.44 $6.89 $10.46 $10.46 $10.86 $7.64 $10.17 $11.02 $11.02 $49.09 $6.89 $6.89 $6.89 $83.00 $62.25 $6.89 $6.89 $6.89 $38.48 $38.48 $65.74 $6.89 $66.40 $11.37 $9.69 $6.89 $48.14 $83.00 $9.99 $6.89 $7.61 $6.89 N/A N/A 30201256 EAP CPT® 83695 ASSAY OF LIPOPROTEIN(A) BOTH IP/OP $109.00 $81.00 $6.48 $109.00 $25.40 $25.40 $25.40 $25.40 $14.32 $14.32 $7.16 $6.48 $14.32 $19.67 $19.67 $20.42 $14.36 $19.12 $22.91 $22.91 $64.47 $14.32 $14.32 $14.32 $109.00 $81.75 $14.32 $14.32 $14.32 $72.36 $72.36 $86.33 $14.32 $87.20 $23.63 $18.21 $14.32 $63.22 $109.00 $20.76 $14.32 $14.30 $14.32 N/A N/A 30201258 EAP CPT® 82465 ASSAY BLD/SERUM CHOLESTEROL BOTH IP/OP $9.00 $7.00 $2.18 $9.00 $8.53 $8.53 $8.53 $8.53 $4.35 $4.35 $2.18 $2.18 $4.35 $6.61 $6.61 $6.87 $4.83 $6.43 $6.96 $6.96 $5.32 $4.35 $4.35 $4.35 $9.00 $6.75 $4.35 $4.35 $4.35 $9.00 $9.00 $7.13 $4.35 $7.20 $7.18 $6.12 $4.35 $5.22 $9.00 $6.31 $4.35 $4.81 $4.35 N/A N/A 30201259 EAP CPT® 82664 ELECTROPHORETIC TEST BOTH IP/OP $176.00 $130.50 $30.75 $176.00 $176.00 $176.00 $176.00 $176.00 $61.50 $61.50 $30.75 $176.00 $61.50 $52.17 $52.17 $54.17 $38.08 $50.75 $98.40 $98.40 $176.00 $61.50 $61.50 $61.50 $176.00 $132.00 $61.50 $61.50 $61.50 $176.00 $176.00 $139.39 $61.50 $140.80 $176.00 $176.00 $61.50 $102.08 $176.00 $89.18 $61.50 $176.00 $61.50 N/A N/A 30201260 EAP CPT® 84478 ASSAY OF TRIGLYCERIDES BOTH IP/OP $16.00 $12.00 $2.87 $16.00 $11.27 $11.27 $11.27 $11.27 $5.74 $5.74 $2.87 $2.87 $5.74 $8.74 $8.74 $9.07 $6.38 $7.46 $9.18 $9.18 $9.46 $5.74 $5.74 $5.74 $16.00 $12.00 $5.74 $5.74 $5.74 $16.00 $16.00 $12.67 $5.74 $12.80 $9.47 $7.10 $5.74 $9.28 $16.00 $8.32 $5.74 $5.58 $5.74 N/A N/A 30201261 EAP CPT® 84999 CLINICAL CHEMISTRY TEST BOTH IP/OP $23.00 $17.50 $4.56 $23.00 $23.00 $23.00 $23.00 $23.00 $23.00 $23.00 $23.00 $4.79 $23.00 $17.07 $17.07 $17.73 $11.98 $4.79 $23.00 $9.20 $13.60 $23.00 $23.00 $23.00 $23.00 $17.25 $23.00 $23.00 $23.00 $23.00 $23.00 $18.22 $23.00 $18.40 $14.95 $4.56 $23.00 $13.34 $23.00 $13.80 $23.00 $4.79 $23.00 N/A N/A 30201263 EAP CPT® 86609 BACTERIUM ANTIBODY BOTH IP/OP $175.00 $129.50 $6.44 $175.00 $175.00 $175.00 $175.00 $175.00 $12.88 $12.88 $6.44 $175.00 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $175.00 $12.88 $12.88 $12.88 $175.00 $131.25 $12.88 $12.88 $12.88 $72.00 $72.00 $138.60 $12.88 $140.00 $175.00 $175.00 $12.88 $101.50 $175.00 $18.68 $12.88 $175.00 $12.88 N/A N/A 30201265 EAP CPT® 86376 MICROSOMAL ANTIBODY BOTH IP/OP $205.00 $152.00 $7.28 $205.00 $28.56 $28.56 $28.56 $28.56 $14.55 $14.55 $7.28 $7.28 $14.55 $22.10 $22.10 $22.95 $16.13 $21.49 $23.28 $23.28 $121.26 $14.55 $14.55 $14.55 $205.00 $153.75 $14.55 $14.55 $14.55 $81.32 $81.32 $162.36 $14.55 $164.00 $24.01 $20.47 $14.55 $118.90 $205.00 $21.10 $14.55 $16.08 $14.55 N/A N/A 30201267 EAP CPT® 83516 IMMUNOASSAY NONANTIBODY BOTH IP/OP $107.00 $79.50 $5.76 $107.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $63.29 $11.53 $11.53 $11.53 $107.00 $80.25 $11.53 $11.53 $11.53 $59.76 $59.76 $84.74 $11.53 $85.60 $19.02 $15.05 $11.53 $62.06 $107.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30201268 EAP CPT® 83520 IMMUNOASSAY QUANT NOS NONAB BOTH IP/OP $118.00 $87.50 $7.77 $118.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $69.80 $17.27 $17.27 $17.27 $118.00 $88.50 $17.27 $17.27 $17.27 $72.36 $72.36 $93.46 $17.27 $94.40 $28.50 $18.21 $17.27 $68.44 $118.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30201269 EAP CPT® 86038 ANTINUCLEAR ANTIBODIES BOTH IP/OP $72.00 $53.50 $6.04 $72.00 $23.72 $23.72 $23.72 $23.72 $12.09 $12.09 $6.05 $6.04 $12.09 $18.36 $18.36 $19.06 $13.40 $17.86 $19.34 $19.34 $42.59 $12.09 $12.09 $12.09 $72.00 $54.00 $12.09 $12.09 $12.09 $67.56 $67.56 $57.02 $12.09 $57.60 $19.95 $17.01 $12.09 $41.76 $72.00 $17.53 $12.09 $13.36 $12.09 N/A N/A 30201270 EAP CPT® 84160 ASSAY OF PROTEIN ANY SOURCE BOTH IP/OP $129.00 $95.50 $2.81 $129.00 $129.00 $129.00 $129.00 $129.00 $5.61 $5.61 $2.81 $129.00 $5.61 $7.86 $7.86 $8.16 $5.74 $7.64 $8.98 $8.98 $129.00 $5.61 $5.61 $5.61 $129.00 $96.75 $5.61 $5.61 $5.61 $28.92 $28.92 $102.17 $5.61 $103.20 $129.00 $129.00 $5.61 $74.82 $129.00 $8.13 $5.61 $129.00 $5.61 N/A N/A 30201271 EAP CPT® 86235 NUCLEAR ANTIGEN ANTIBODY BOTH IP/OP $76.00 $56.50 $8.97 $76.00 $35.19 $35.19 $35.19 $35.19 $17.93 $17.93 $8.97 $8.97 $17.93 $27.23 $27.23 $28.27 $19.88 $26.49 $28.69 $28.69 $44.95 $17.93 $17.93 $17.93 $76.00 $57.00 $17.93 $17.93 $17.93 $76.00 $76.00 $60.19 $17.93 $60.80 $29.58 $25.23 $17.93 $44.08 $76.00 $26.00 $17.93 $19.82 $17.93 N/A N/A 30201272 EAP CPT® 86255 FLUORESCENT ANTIBODY SCREEN BOTH IP/OP $61.00 $45.50 $6.03 $61.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $36.08 $12.05 $12.05 $12.05 $61.00 $45.75 $12.05 $12.05 $12.05 $61.00 $61.00 $48.31 $12.05 $48.80 $19.88 $16.96 $12.05 $35.38 $61.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201273 EAP CPT® 86376 MICROSOMAL ANTIBODY BOTH IP/OP $57.00 $42.50 $7.28 $57.00 $28.56 $28.56 $28.56 $28.56 $14.55 $14.55 $7.28 $7.28 $14.55 $22.10 $22.10 $22.95 $16.13 $21.49 $23.28 $23.28 $33.72 $14.55 $14.55 $14.55 $57.00 $42.75 $14.55 $14.55 $14.55 $57.00 $57.00 $45.14 $14.55 $45.60 $24.01 $20.47 $14.55 $33.06 $57.00 $21.10 $14.55 $16.08 $14.55 N/A N/A 30201274 EAP CPT® 86431 RHEUMATOID FACTOR QUANT BOTH IP/OP $97.00 $72.00 $2.84 $97.00 $11.12 $11.12 $11.12 $11.12 $5.67 $5.67 $2.84 $2.84 $5.67 $8.62 $8.62 $8.95 $6.29 $8.39 $9.07 $9.07 $57.38 $5.67 $5.67 $5.67 $97.00 $72.75 $5.67 $5.67 $5.67 $31.72 $31.72 $76.82 $5.67 $77.60 $9.36 $7.99 $5.67 $56.26 $97.00 $8.22 $5.67 $6.28 $5.67 N/A N/A 30201276 EAP CPT® 86618 LYME DISEASE ANTIBODY BOTH IP/OP $69.00 $51.50 $8.51 $69.00 $33.43 $33.43 $33.43 $33.43 $17.03 $17.03 $8.52 $8.51 $17.03 $25.86 $25.86 $26.86 $18.88 $25.16 $27.25 $27.25 $40.81 $17.03 $17.03 $17.03 $69.00 $51.75 $17.03 $17.03 $17.03 $69.00 $69.00 $54.65 $17.03 $55.20 $28.10 $23.96 $17.03 $40.02 $69.00 $24.69 $17.03 $18.82 $17.03 N/A N/A 30201278 EAP CPT® 87476 LYME DIS DNA AMP PROBE BOTH IP/OP $387.00 $286.50 $17.55 $387.00 $387.00 $387.00 $387.00 $387.00 $35.09 $35.09 $17.55 $387.00 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $387.00 $35.09 $35.09 $35.09 $387.00 $290.25 $35.09 $35.09 $35.09 $109.64 $109.64 $306.50 $35.09 $309.60 $387.00 $387.00 $35.09 $224.46 $387.00 $50.88 $35.09 $387.00 $35.09 N/A N/A 30201280 EAP CPT® 87476 LYME DIS DNA AMP PROBE BOTH IP/OP $387.00 $286.50 $17.55 $387.00 $387.00 $387.00 $387.00 $387.00 $35.09 $35.09 $17.55 $387.00 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $387.00 $35.09 $35.09 $35.09 $387.00 $290.25 $35.09 $35.09 $35.09 $109.64 $109.64 $306.50 $35.09 $309.60 $387.00 $387.00 $35.09 $224.46 $387.00 $50.88 $35.09 $387.00 $35.09 N/A N/A 30201282 EAP CPT® 86355 B CELLS TOTAL COUNT BOTH IP/OP $111.00 $82.50 $18.86 $111.00 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $65.66 $37.73 $37.73 $37.73 $111.00 $83.25 $37.73 $37.73 $37.73 $111.00 $111.00 $87.91 $37.73 $88.80 $62.25 $33.14 $37.73 $64.38 $111.00 $54.71 $37.73 $26.03 $37.73 N/A N/A 30201283 EAP CPT® 86357 NK CELLS TOTAL COUNT BOTH IP/OP $111.00 $82.50 $18.87 $111.00 $111.00 $111.00 $111.00 $111.00 $37.73 $37.73 $18.87 $111.00 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $111.00 $37.73 $37.73 $37.73 $111.00 $83.25 $37.73 $37.73 $37.73 $111.00 $111.00 $87.91 $37.73 $88.80 $111.00 $111.00 $37.73 $64.38 $111.00 $54.71 $37.73 $111.00 $37.73 N/A N/A 30201284 EAP CPT® 86359 T CELLS TOTAL COUNT BOTH IP/OP $111.00 $82.50 $18.86 $111.00 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $65.66 $37.73 $37.73 $37.73 $111.00 $83.25 $37.73 $37.73 $37.73 $111.00 $111.00 $87.91 $37.73 $88.80 $62.25 $33.14 $37.73 $64.38 $111.00 $54.71 $37.73 $26.03 $37.73 N/A N/A 30201285 EAP CPT® 86360 T CELL ABSOLUTE COUNT/RATIO BOTH IP/OP $152.00 $112.50 $23.49 $152.00 $92.22 $92.22 $92.22 $92.22 $46.98 $46.98 $23.49 $23.49 $46.98 $71.34 $71.34 $74.09 $52.08 $69.42 $75.17 $75.17 $89.91 $46.98 $46.98 $46.98 $152.00 $114.00 $46.98 $46.98 $46.98 $152.00 $152.00 $120.38 $46.98 $121.60 $77.52 $66.11 $46.98 $88.16 $152.00 $68.12 $46.98 $51.93 $46.98 N/A N/A 30201286 EAP Custom 30201286 MAC SENSITIVITY BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 $150.00 $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A 30201287 EAP CPT® 87190 MICROBE SUSCEPT MYCOBACTERI BOTH IP/OP $35.00 $26.00 $3.66 $35.00 $35.00 $35.00 $35.00 $35.00 $7.31 $7.31 $3.66 $35.00 $7.31 $8.58 $8.58 $8.91 $6.26 $8.35 $11.70 $11.70 $35.00 $7.31 $7.31 $7.31 $35.00 $26.25 $7.31 $7.31 $7.31 $31.60 $31.60 $27.72 $7.31 $28.00 $35.00 $35.00 $7.31 $20.30 $35.00 $10.60 $7.31 $35.00 $7.31 N/A N/A 30201289 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $266.00 $197.00 $10.71 $266.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $157.34 $21.42 $21.42 $21.42 $266.00 $199.50 $21.42 $21.42 $21.42 $119.72 $119.72 $210.67 $21.42 $212.80 $35.34 $30.14 $21.42 $154.28 $266.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30201290 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $325.00 $240.50 $23.04 $325.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $192.24 $51.19 $51.19 $51.19 $325.00 $243.75 $51.19 $51.19 $51.19 $224.44 $224.44 $257.40 $51.19 $260.00 $84.46 $56.50 $51.19 $188.50 $325.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30201295 EAP CPT® 83825 ASSAY OF MERCURY BOTH IP/OP $50.00 $37.00 $8.13 $50.00 $31.90 $31.90 $31.90 $31.90 $16.26 $16.26 $8.13 $8.13 $16.26 $24.69 $24.69 $25.64 $18.02 $24.02 $26.02 $26.02 $29.58 $16.26 $16.26 $16.26 $50.00 $37.50 $16.26 $16.26 $16.26 $50.00 $50.00 $39.60 $16.26 $40.00 $26.83 $22.88 $16.26 $29.00 $50.00 $23.58 $16.26 $17.97 $16.26 N/A N/A 30201297 EAP CPT® 83825 ASSAY OF MERCURY BOTH IP/OP $75.00 $55.50 $8.13 $75.00 $31.90 $31.90 $31.90 $31.90 $16.26 $16.26 $8.13 $8.13 $16.26 $24.69 $24.69 $25.64 $18.02 $24.02 $26.02 $26.02 $44.36 $16.26 $16.26 $16.26 $75.00 $56.25 $16.26 $16.26 $16.26 $75.00 $75.00 $59.40 $16.26 $60.00 $26.83 $22.88 $16.26 $43.50 $75.00 $23.58 $16.26 $17.97 $16.26 N/A N/A 30201299 EAP CPT® 83835 ASSAY OF METANEPHRINES BOTH IP/OP $230.00 $170.50 $8.47 $230.00 $33.26 $33.26 $33.26 $33.26 $16.94 $16.94 $8.47 $8.47 $16.94 $25.73 $25.73 $26.72 $18.78 $25.02 $27.10 $27.10 $136.05 $16.94 $16.94 $16.94 $230.00 $172.50 $16.94 $16.94 $16.94 $94.68 $94.68 $182.16 $16.94 $184.00 $27.95 $23.83 $16.94 $133.40 $230.00 $24.56 $16.94 $18.72 $16.94 N/A N/A 30201300 EAP CPT® 82570 ASSAY OF URINE CREATININE BOTH IP/OP $52.00 $38.50 $2.59 $52.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $30.76 $5.18 $5.18 $5.18 $52.00 $39.00 $5.18 $5.18 $5.18 $28.92 $28.92 $41.18 $5.18 $41.60 $8.55 $7.28 $5.18 $30.16 $52.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30201302 EAP CPT® 83835 ASSAY OF METANEPHRINES BOTH IP/OP $573.00 $424.50 $8.47 $573.00 $33.26 $33.26 $33.26 $33.26 $16.94 $16.94 $8.47 $8.47 $16.94 $25.73 $25.73 $26.72 $18.78 $25.02 $27.10 $27.10 $338.93 $16.94 $16.94 $16.94 $573.00 $429.75 $16.94 $16.94 $16.94 $94.68 $94.68 $453.82 $16.94 $458.40 $27.95 $23.83 $16.94 $332.34 $573.00 $24.56 $16.94 $18.72 $16.94 N/A N/A 30201304 EAP CPT® 80358 ASSAY OF METHADONE BOTH IP/OP $187.00 $138.50 $0.03 $187.00 $0.03 $0.03 $0.03 $0.03 $187.00 $187.00 $12.01 $10.03 $187.00 $138.79 $138.79 $144.14 $97.43 $24.12 $187.00 $74.80 $110.61 $187.00 $187.00 $187.00 $187.00 $140.25 $187.00 $187.00 $187.00 $93.50 $93.50 $148.10 $187.00 $149.60 $121.55 $22.97 $187.00 $108.46 $187.00 $112.20 $187.00 $18.04 $187.00 N/A N/A 30201306 EAP CPT® 82542 COLUMN CHROMOTOGRAPHY QUANT BOTH IP/OP $288.00 $213.50 $6.64 $288.00 $35.44 $35.44 $35.44 $35.44 $24.09 $24.09 $12.05 $10.84 $24.09 $9.12 $9.12 $9.47 $6.66 $8.87 $38.54 $38.54 $170.35 $24.09 $24.09 $24.09 $288.00 $216.00 $24.09 $24.09 $24.09 $33.56 $33.56 $228.10 $24.09 $230.40 $39.75 $8.45 $24.09 $167.04 $288.00 $34.93 $24.09 $6.64 $24.09 N/A N/A 30201310 EAP CPT® 83921 ORGANIC ACID SINGLE QUANT BOTH IP/OP $289.00 $214.00 $9.54 $289.00 $32.28 $32.28 $32.28 $32.28 $21.21 $21.21 $10.61 $9.54 $21.21 $25.00 $25.00 $25.96 $18.25 $24.32 $33.94 $33.94 $170.94 $21.21 $21.21 $21.21 $289.00 $216.75 $21.21 $21.21 $21.21 $92.00 $92.00 $228.89 $21.21 $231.20 $35.00 $23.16 $21.21 $167.62 $289.00 $30.75 $21.21 $18.19 $21.21 N/A N/A 30201312 EAP CPT® 83519 RIA NONANTIBODY BOTH IP/OP "$1,254.00" $928.00 $8.28 "$1,254.00" $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $741.74 $18.40 $18.40 $18.40 "$1,254.00" $940.50 $18.40 $18.40 $18.40 $75.52 $75.52 $993.17 $18.40 "$1,003.20" $30.36 $19.01 $18.40 $727.32 "$1,254.00" $26.68 $18.40 $14.93 $18.40 N/A N/A 30201314 EAP CPT® 87190 MICROBE SUSCEPT MYCOBACTERI BOTH IP/OP $41.00 $30.50 $3.66 $41.00 $41.00 $41.00 $41.00 $41.00 $7.31 $7.31 $3.66 $41.00 $7.31 $8.58 $8.58 $8.91 $6.26 $8.35 $11.70 $11.70 $41.00 $7.31 $7.31 $7.31 $41.00 $30.75 $7.31 $7.31 $7.31 $31.60 $31.60 $32.47 $7.31 $32.80 $41.00 $41.00 $7.31 $23.78 $41.00 $10.60 $7.31 $41.00 $7.31 N/A N/A 30201316 EAP CPT® 87581 M.PNEUMON DNA PROBE BOTH IP/OP $505.00 $374.00 $17.55 $505.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $298.71 $35.09 $35.09 $35.09 $505.00 $378.75 $35.09 $35.09 $35.09 $109.64 $109.64 $399.96 $35.09 $404.00 $57.90 $27.60 $35.09 $292.90 $505.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30201318 EAP CPT® 83873 ASSAY OF CSF PROTEIN BOTH IP/OP $54.00 $40.00 $8.60 $54.00 $54.00 $54.00 $54.00 $54.00 $17.20 $17.20 $8.60 $54.00 $17.20 $26.12 $26.12 $27.13 $19.07 $25.42 $27.52 $27.52 $54.00 $17.20 $17.20 $17.20 $54.00 $40.50 $17.20 $17.20 $17.20 $54.00 $54.00 $42.77 $17.20 $43.20 $54.00 $54.00 $17.20 $31.32 $54.00 $24.94 $17.20 $54.00 $17.20 N/A N/A 30201320 EAP CPT® 83874 ASSAY OF MYOGLOBIN BOTH IP/OP $54.00 $40.00 $6.46 $54.00 $25.35 $25.35 $25.35 $25.35 $12.92 $12.92 $6.46 $6.46 $12.92 $19.61 $19.61 $20.37 $14.32 $19.08 $20.67 $20.67 $31.94 $12.92 $12.92 $12.92 $54.00 $40.50 $12.92 $12.92 $12.92 $54.00 $54.00 $42.77 $12.92 $43.20 $21.32 $18.17 $12.92 $31.32 $54.00 $18.73 $12.92 $14.27 $12.92 N/A N/A 30201322 EAP CPT® 86255 FLUORESCENT ANTIBODY SCREEN BOTH IP/OP $367.00 $272.00 $6.03 $367.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $217.08 $12.05 $12.05 $12.05 $367.00 $275.25 $12.05 $12.05 $12.05 $67.36 $67.36 $290.66 $12.05 $293.60 $19.88 $16.96 $12.05 $212.86 $367.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201324 EAP CPT® 80323 ASSAY OF NICOTINE BOTH IP/OP $212.00 $157.00 $0.03 $212.00 $0.03 $0.03 $0.03 $0.03 $212.00 $212.00 $12.01 $18.43 $212.00 $157.35 $157.35 $163.41 $110.45 $44.34 $212.00 $84.80 $125.40 $212.00 $212.00 $212.00 $212.00 $159.00 $212.00 $212.00 $212.00 $106.00 $106.00 $167.90 $212.00 $169.60 $137.80 $42.23 $212.00 $122.96 $212.00 $127.20 $212.00 $33.17 $212.00 N/A N/A 30201326 EAP CPT® 84999 CLINICAL CHEMISTRY TEST BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $92.03 $92.03 $95.58 $64.60 $25.84 $124.00 $49.60 $73.35 $124.00 $124.00 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $124.00 $124.00 $98.21 $124.00 $99.20 $80.60 $24.61 $124.00 $71.92 $124.00 $74.40 $124.00 $25.84 $124.00 N/A N/A 30201328 EAP CPT® 83945 ASSAY OF OXALATE BOTH IP/OP $48.00 $36.00 $7.23 $48.00 $48.00 $48.00 $48.00 $48.00 $14.45 $14.45 $7.23 $48.00 $14.45 $19.55 $19.55 $20.30 $14.27 $19.02 $23.12 $23.12 $48.00 $14.45 $14.45 $14.45 $48.00 $36.00 $14.45 $14.45 $14.45 $48.00 $48.00 $38.02 $14.45 $38.40 $48.00 $48.00 $14.45 $27.84 $48.00 $20.95 $14.45 $48.00 $14.45 N/A N/A 30201330 EAP CPT® 87279 PARAINFLUENZA AG IF BOTH IP/OP $42.00 $31.50 $8.22 $42.00 $42.00 $42.00 $42.00 $42.00 $16.43 $16.43 $8.22 $42.00 $16.43 $18.22 $18.22 $18.92 $13.30 $17.71 $26.29 $26.29 $42.00 $16.43 $16.43 $16.43 $42.00 $31.50 $16.43 $16.43 $16.43 $42.00 $42.00 $33.26 $16.43 $33.60 $42.00 $42.00 $16.43 $24.36 $42.00 $23.82 $16.43 $42.00 $16.43 N/A N/A 30201335 EAP CPT® 86255 FLUORESCENT ANTIBODY SCREEN BOTH IP/OP $171.00 $127.00 $6.03 $171.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $101.15 $12.05 $12.05 $12.05 $171.00 $128.25 $12.05 $12.05 $12.05 $67.36 $67.36 $135.43 $12.05 $136.80 $19.88 $16.96 $12.05 $99.18 $171.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201336 EAP CPT® 86255 FLUORESCENT ANTIBODY SCREEN BOTH IP/OP $133.00 $98.50 $6.03 $133.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $78.67 $12.05 $12.05 $12.05 $133.00 $99.75 $12.05 $12.05 $12.05 $67.36 $67.36 $105.34 $12.05 $106.40 $19.88 $16.96 $12.05 $77.14 $133.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201338 EAP CPT® 87799 DETECT AGENT NOS DNA QUANT BOTH IP/OP $634.00 $469.50 $21.42 $634.00 $634.00 $634.00 $634.00 $634.00 $42.84 $42.84 $21.42 $634.00 $42.84 $65.04 $65.04 $67.54 $47.48 $132.13 $68.54 $68.54 $634.00 $42.84 $42.84 $42.84 $634.00 $475.50 $42.84 $42.84 $42.84 $239.40 $239.40 $502.13 $42.84 $507.20 $634.00 $634.00 $42.84 $367.72 $634.00 $62.12 $42.84 $634.00 $42.84 N/A N/A 30201340 EAP CPT® 82657 ENZYME CELL ACTIVITY BOTH IP/OP $228.00 $169.00 $6.64 $228.00 $11.80 $11.80 $11.80 $11.80 $22.17 $22.17 $11.09 $9.98 $22.17 $9.12 $9.12 $9.47 $6.66 $8.87 $35.47 $35.47 $134.86 $22.17 $22.17 $22.17 $228.00 $171.00 $22.17 $22.17 $22.17 $33.56 $33.56 $180.58 $22.17 $182.40 $36.58 $8.45 $22.17 $132.24 $228.00 $32.15 $22.17 $6.64 $22.17 N/A N/A 30201342 EAP CPT® 83992 ASSAY FOR PHENCYCLIDINE BOTH IP/OP $254.00 $188.00 $16.29 $254.00 $254.00 $254.00 $254.00 $254.00 $254.00 $254.00 $20.72 $254.00 $254.00 $22.32 $22.32 $23.18 $16.29 $21.72 $254.00 $98.00 $254.00 $254.00 $245.00 $254.00 $254.00 $190.50 $254.00 $254.00 $254.00 $82.16 $82.16 $201.17 $254.00 $203.20 $165.10 $254.00 $254.00 $147.32 $254.00 $152.40 $254.00 $254.00 $254.00 N/A N/A 30201344 EAP CPT® 82570 ASSAY OF URINE CREATININE BOTH IP/OP $84.00 $62.50 $2.59 $84.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $49.69 $5.18 $5.18 $5.18 $84.00 $63.00 $5.18 $5.18 $5.18 $28.92 $28.92 $66.53 $5.18 $67.20 $8.55 $7.28 $5.18 $48.72 $84.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30201345 EAP CPT® 84600 ASSAY OF VOLATILES BOTH IP/OP $101.00 $75.00 $8.56 $101.00 $101.00 $101.00 $101.00 $101.00 $17.11 $17.11 $8.56 $101.00 $17.11 $24.41 $24.41 $25.35 $17.82 $23.74 $27.38 $27.38 $101.00 $17.11 $17.11 $17.11 $101.00 $75.75 $17.11 $17.11 $17.11 $89.80 $89.80 $79.99 $17.11 $80.80 $101.00 $101.00 $17.11 $58.58 $101.00 $24.81 $17.11 $101.00 $17.11 N/A N/A 30201354 EAP CPT® 84110 ASSAY OF PORPHOBILINOGEN BOTH IP/OP $54.00 $40.00 $4.22 $54.00 $54.00 $54.00 $54.00 $54.00 $8.44 $8.44 $4.22 $54.00 $8.44 $12.83 $12.83 $13.33 $9.37 $12.47 $13.50 $13.50 $54.00 $8.44 $8.44 $8.44 $54.00 $40.50 $8.44 $8.44 $8.44 $47.20 $47.20 $42.77 $8.44 $43.20 $54.00 $54.00 $8.44 $31.32 $54.00 $12.24 $8.44 $54.00 $8.44 N/A N/A 30201358 EAP CPT® 84120 ASSAY OF URINE PORPHYRINS BOTH IP/OP $55.00 $41.00 $7.36 $55.00 $55.00 $55.00 $55.00 $55.00 $14.71 $14.71 $7.36 $55.00 $14.71 $22.33 $22.33 $23.19 $16.30 $21.74 $23.54 $23.54 $55.00 $14.71 $14.71 $14.71 $55.00 $41.25 $14.71 $14.71 $14.71 $55.00 $55.00 $43.56 $14.71 $44.00 $55.00 $55.00 $14.71 $31.90 $55.00 $21.33 $14.71 $55.00 $14.71 N/A N/A 30201362 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $414.00 $306.50 $8.39 $414.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $244.88 $18.64 $18.64 $18.64 $414.00 $310.50 $18.64 $18.64 $18.64 $67.28 $67.28 $327.89 $18.64 $331.20 $30.76 $16.94 $18.64 $240.12 $414.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201363 EAP CPT® 84206 PROINSULIN SO BOTH IP/OP $488.00 $361.50 $13.35 $488.00 $488.00 $488.00 $488.00 $488.00 $26.69 $26.69 $13.35 $488.00 $26.69 $27.05 $27.05 $28.09 $19.75 $26.31 $42.70 $42.70 $488.00 $26.69 $26.69 $26.69 $488.00 $366.00 $26.69 $26.69 $26.69 $99.56 $99.56 $386.50 $26.69 $390.40 $488.00 $488.00 $26.69 $283.04 $488.00 $38.70 $26.69 $488.00 $26.69 N/A N/A 30201364 EAP CPT® 84206 ASSAY OF PROINSULIN BOTH IP/OP $644.00 $477.00 $13.35 $644.00 $644.00 $644.00 $644.00 $644.00 $26.69 $26.69 $13.35 $644.00 $26.69 $27.05 $27.05 $28.09 $19.75 $26.31 $42.70 $42.70 $644.00 $26.69 $26.69 $26.69 $644.00 $483.00 $26.69 $26.69 $26.69 $99.56 $99.56 $510.05 $26.69 $515.20 $644.00 $644.00 $26.69 $373.52 $644.00 $38.70 $26.69 $644.00 $26.69 N/A N/A 30201368 EAP CPT® 85303 "BLOOD CLOT INHIBITOR TEST;PROTEIN C,ACTIVITY" BOTH IP/OP $428.00 $317.00 $6.92 $428.00 $27.16 $27.16 $27.16 $27.16 $13.84 $13.84 $6.92 $6.92 $13.84 $21.00 $21.00 $21.81 $15.33 $20.43 $22.14 $22.14 $253.16 $13.84 $13.84 $13.84 $428.00 $321.00 $13.84 $13.84 $13.84 $77.28 $77.28 $338.98 $13.84 $342.40 $22.84 $19.46 $13.84 $248.24 $428.00 $20.07 $13.84 $15.29 $13.84 N/A N/A 30201369 EAP CPT® 85306 "BLOOD CLOT INHIBITOR TEST;PROTEIN S,FREE" BOTH IP/OP $513.00 $380.00 $7.66 $513.00 $513.00 $513.00 $513.00 $513.00 $15.32 $15.32 $7.66 $513.00 $15.32 $23.26 $23.26 $24.16 $16.98 $22.64 $24.51 $24.51 $513.00 $15.32 $15.32 $15.32 $513.00 $384.75 $15.32 $15.32 $15.32 $85.64 $85.64 $406.30 $15.32 $410.40 $513.00 $513.00 $15.32 $297.54 $513.00 $22.21 $15.32 $513.00 $15.32 N/A N/A 30201371 EAP CPT® 85305 "BLOOD CLOT INHIBITOR ASSAY;PROTEIN S,TOTAL" BOTH IP/OP $493.00 $365.00 $5.81 $493.00 $493.00 $493.00 $493.00 $493.00 $11.61 $11.61 $5.81 $493.00 $11.61 $17.61 $17.61 $18.28 $12.85 $17.13 $18.58 $18.58 $493.00 $11.61 $11.61 $11.61 $493.00 $369.75 $11.61 $11.61 $11.61 $64.80 $64.80 $390.46 $11.61 $394.40 $493.00 $493.00 $11.61 $285.94 $493.00 $16.83 $11.61 $493.00 $11.61 N/A N/A 30201374 EAP CPT® 84154 ASSAY OF PSA FREE BOTH IP/OP $42.00 $31.50 $9.20 $42.00 $42.00 $42.00 $42.00 $42.00 $18.39 $18.39 $9.20 $42.00 $18.39 $27.92 $27.92 $29.00 $20.38 $27.17 $29.42 $29.42 $42.00 $18.39 $18.39 $18.39 $42.00 $31.50 $18.39 $18.39 $18.39 $42.00 $42.00 $33.26 $18.39 $33.60 $42.00 $42.00 $18.39 $24.36 $42.00 $26.67 $18.39 $42.00 $18.39 N/A N/A 30201376 EAP CPT® 83970 ASSAY OF PARATHORMONE BOTH IP/OP $177.00 $131.00 $20.64 $177.00 $81.00 $81.00 $81.00 $81.00 $41.28 $41.28 $20.64 $20.64 $41.28 $62.68 $62.68 $65.09 $45.76 $60.97 $66.05 $66.05 $104.70 $41.28 $41.28 $41.28 $177.00 $132.75 $41.28 $41.28 $41.28 $177.00 $177.00 $140.18 $41.28 $141.60 $68.11 $58.07 $41.28 $102.66 $177.00 $59.86 $41.28 $45.61 $41.28 N/A N/A 30201378 EAP CPT® 83519 RIA NONANTIBODY BOTH IP/OP $483.00 $357.50 $8.28 $483.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $285.69 $18.40 $18.40 $18.40 $483.00 $362.25 $18.40 $18.40 $18.40 $75.52 $75.52 $382.54 $18.40 $386.40 $30.36 $19.01 $18.40 $280.14 $483.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30201380 EAP CPT® 84220 ASSAY OF PYRUVATE KINASE BOTH IP/OP $232.00 $172.00 $4.72 $232.00 $232.00 $232.00 $232.00 $232.00 $9.44 $9.44 $4.72 $232.00 $9.44 $14.32 $14.32 $14.87 $10.45 $13.93 $15.10 $15.10 $232.00 $9.44 $9.44 $9.44 $232.00 $174.00 $9.44 $9.44 $9.44 $52.72 $52.72 $183.74 $9.44 $185.60 $232.00 $232.00 $9.44 $134.56 $232.00 $13.69 $9.44 $232.00 $9.44 N/A N/A 30201382 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $255.00 $189.00 $8.39 $255.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $150.83 $18.64 $18.64 $18.64 $255.00 $191.25 $18.64 $18.64 $18.64 $67.28 $67.28 $201.96 $18.64 $204.00 $30.76 $16.94 $18.64 $147.90 $255.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201384 EAP CPT® 86317 IMMUNOASSAY INFECTIOUS AGENT BOTH IP/OP $143.00 $106.00 $7.49 $143.00 $23.57 $23.57 $23.57 $23.57 $14.99 $14.99 $7.50 $7.49 $14.99 $18.22 $18.22 $18.92 $13.30 $17.72 $23.98 $23.98 $84.58 $14.99 $14.99 $14.99 $143.00 $107.25 $14.99 $14.99 $14.99 $67.08 $67.08 $113.26 $14.99 $114.40 $24.73 $16.88 $14.99 $82.94 $143.00 $21.74 $14.99 $13.26 $14.99 N/A N/A 30201386 EAP CPT® 80195 ASSAY OF SIROLIMUS BOTH IP/OP $279.00 $206.50 $6.87 $279.00 $279.00 $279.00 $279.00 $279.00 $13.73 $13.73 $6.87 $279.00 $13.73 $20.84 $20.84 $21.64 $15.21 $20.27 $21.97 $21.97 $279.00 $13.73 $13.73 $13.73 $279.00 $209.25 $13.73 $13.73 $13.73 $76.68 $76.68 $220.97 $13.73 $223.20 $279.00 $279.00 $13.73 $161.82 $279.00 $19.91 $13.73 $279.00 $13.73 N/A N/A 30201388 EAP CPT® 87299 ANTIBODY DETECTION NOS IF BOTH IP/OP $91.00 $67.50 $8.05 $91.00 $91.00 $91.00 $91.00 $91.00 $16.10 $16.10 $8.05 $91.00 $16.10 $18.22 $18.22 $18.92 $13.30 $17.71 $25.76 $25.76 $91.00 $16.10 $16.10 $16.10 $91.00 $68.25 $16.10 $16.10 $16.10 $67.04 $67.04 $72.07 $16.10 $72.80 $91.00 $91.00 $16.10 $52.78 $91.00 $23.35 $16.10 $91.00 $16.10 N/A N/A 30201390 EAP CPT® 86003 ALLERGEN SPECIFIC IGE BOTH IP/OP $96.00 $71.50 $2.61 $96.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $56.78 $5.22 $5.22 $5.22 $96.00 $72.00 $5.22 $5.22 $5.22 $29.20 $29.20 $76.03 $5.22 $76.80 $62.40 $7.35 $5.22 $55.68 $96.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30201392 EAP CPT® 86003 ALLERGEN SPECIFIC IGE BOTH IP/OP $104.00 $77.00 $2.61 $104.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $61.52 $5.22 $5.22 $5.22 $104.00 $78.00 $5.22 $5.22 $5.22 $29.20 $29.20 $82.37 $5.22 $83.20 $8.61 $7.35 $5.22 $60.32 $104.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30201478 EAP CPT® 82480 ASSAY SERUM CHOLINESTERASE BOTH IP/OP $42.00 $31.50 $3.94 $42.00 $42.00 $42.00 $42.00 $42.00 $7.87 $7.87 $3.94 $42.00 $7.87 $11.97 $11.97 $12.43 $8.74 $11.64 $12.59 $12.59 $42.00 $7.87 $7.87 $7.87 $42.00 $31.50 $7.87 $7.87 $7.87 $42.00 $42.00 $33.26 $7.87 $33.60 $42.00 $42.00 $7.87 $24.36 $42.00 $11.41 $7.87 $42.00 $7.87 N/A N/A 30201479 EAP CPT® 82482 ASSAY RBC CHOLINESTERASE BOTH IP/OP $42.00 $31.50 $4.91 $42.00 $42.00 $42.00 $42.00 $42.00 $9.81 $9.81 $4.91 $42.00 $9.81 $11.67 $11.67 $12.12 $8.52 $11.36 $15.70 $15.70 $42.00 $9.81 $9.81 $9.81 $42.00 $31.50 $9.81 $9.81 $9.81 $42.00 $42.00 $33.26 $9.81 $33.60 $42.00 $42.00 $9.81 $24.36 $42.00 $14.22 $9.81 $42.00 $9.81 N/A N/A 30201481 EAP CPT® 85635 REPTILASE TEST BOTH IP/OP $178.00 $132.00 $4.93 $178.00 $178.00 $178.00 $178.00 $178.00 $9.85 $9.85 $4.93 $178.00 $9.85 $14.96 $14.96 $15.53 $10.92 $14.54 $15.76 $15.76 $178.00 $9.85 $9.85 $9.85 $178.00 $133.50 $9.85 $9.85 $9.85 $55.04 $55.04 $140.98 $9.85 $142.40 $178.00 $178.00 $9.85 $103.24 $178.00 $14.28 $9.85 $178.00 $9.85 N/A N/A 30201483 EAP CPT® 87798 DETECT AGENT NOS DNA AMP BOTH IP/OP $309.00 $229.00 $17.55 $309.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $182.77 $35.09 $35.09 $35.09 $309.00 $231.75 $35.09 $35.09 $35.09 $109.64 $109.64 $244.73 $35.09 $247.20 $57.90 $27.60 $35.09 $179.22 $309.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30201485 EAP CPT® 84482 T3 REVERSE BOTH IP/OP $129.00 $95.50 $7.88 $129.00 $129.00 $129.00 $129.00 $129.00 $15.76 $15.76 $7.88 $129.00 $15.76 $23.93 $23.93 $24.85 $17.47 $23.28 $25.22 $25.22 $129.00 $15.76 $15.76 $15.76 $129.00 $96.75 $15.76 $15.76 $15.76 $88.08 $88.08 $102.17 $15.76 $103.20 $129.00 $129.00 $15.76 $74.82 $129.00 $22.85 $15.76 $129.00 $15.76 N/A N/A 30201486 EAP CPT® 83516 RIBOSOMAL P ANTIBODY (SO) BOTH IP/OP $142.00 $105.50 $5.76 $142.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $83.99 $11.53 $11.53 $11.53 $142.00 $106.50 $11.53 $11.53 $11.53 $59.76 $59.76 $112.46 $11.53 $113.60 $19.02 $15.05 $11.53 $82.36 $142.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30201487 EAP CPT® 83516 IMMUNOASSAY NONANTIBODY BOTH IP/OP $199.00 $147.50 $5.76 $199.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $117.71 $11.53 $11.53 $11.53 $199.00 $149.25 $11.53 $11.53 $11.53 $59.76 $59.76 $157.61 $11.53 $159.20 $19.02 $15.05 $11.53 $115.42 $199.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30201489 EAP CPT® 86757 RICKETTSIA ANTIBODY BOTH IP/OP $78.00 $58.00 $9.68 $78.00 $78.00 $78.00 $78.00 $78.00 $19.35 $19.35 $9.68 $78.00 $19.35 $29.39 $29.39 $30.52 $21.45 $28.60 $30.96 $30.96 $78.00 $19.35 $19.35 $19.35 $78.00 $58.50 $19.35 $19.35 $19.35 $78.00 $78.00 $61.78 $19.35 $62.40 $78.00 $78.00 $19.35 $45.24 $78.00 $28.06 $19.35 $78.00 $19.35 N/A N/A 30201493 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $171.00 $127.00 $8.39 $171.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $101.15 $18.64 $18.64 $18.64 $171.00 $128.25 $18.64 $18.64 $18.64 $67.28 $67.28 $135.43 $18.64 $136.80 $30.76 $16.94 $18.64 $99.18 $171.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201495 EAP CPT® 83520 IMMUNOASSAY QUANT NOS NONAB BOTH IP/OP $211.00 $156.50 $7.77 $211.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $124.81 $17.27 $17.27 $17.27 $211.00 $158.25 $17.27 $17.27 $17.27 $72.36 $72.36 $167.11 $17.27 $168.80 $28.50 $18.21 $17.27 $122.38 $211.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30201497 EAP CPT® 86671 FUNGUS ANTIBODY BOTH IP/OP $99.00 $73.50 $6.13 $99.00 $99.00 $99.00 $99.00 $99.00 $12.25 $12.25 $6.13 $99.00 $12.25 $18.62 $18.62 $19.33 $13.59 $18.11 $19.60 $19.60 $99.00 $12.25 $12.25 $12.25 $99.00 $74.25 $12.25 $12.25 $12.25 $68.52 $68.52 $78.41 $12.25 $79.20 $99.00 $99.00 $12.25 $57.42 $99.00 $17.76 $12.25 $99.00 $12.25 N/A N/A 30201499 EAP CPT® 86671 FUNGUS ANTIBODY BOTH IP/OP $47.00 $35.00 $6.13 $47.00 $47.00 $47.00 $47.00 $47.00 $12.25 $12.25 $6.13 $47.00 $12.25 $18.62 $18.62 $19.33 $13.59 $18.11 $19.60 $19.60 $47.00 $12.25 $12.25 $12.25 $47.00 $35.25 $12.25 $12.25 $12.25 $47.00 $47.00 $37.22 $12.25 $37.60 $47.00 $47.00 $12.25 $27.26 $47.00 $17.76 $12.25 $47.00 $12.25 N/A N/A 30201501 EAP CPT® 86682 HELMINTH ANTIBODY BOTH IP/OP $192.00 $142.50 $6.50 $192.00 $25.53 $25.53 $25.53 $25.53 $13.01 $13.01 $6.51 $6.50 $13.01 $19.75 $19.75 $20.51 $14.42 $19.20 $20.82 $20.82 $113.57 $13.01 $13.01 $13.01 $192.00 $144.00 $13.01 $13.01 $13.01 $72.68 $72.68 $152.06 $13.01 $153.60 $21.47 $18.29 $13.01 $111.36 $192.00 $18.86 $13.01 $14.37 $13.01 N/A N/A 30201503 EAP CPT® 84255 ASSAY OF SELENIUM BOTH IP/OP $98.00 $73.00 $12.77 $98.00 $98.00 $98.00 $98.00 $98.00 $25.53 $25.53 $12.77 $98.00 $25.53 $38.76 $38.76 $40.25 $28.30 $37.71 $40.85 $40.85 $98.00 $25.53 $25.53 $25.53 $98.00 $73.50 $25.53 $25.53 $25.53 $98.00 $98.00 $77.62 $25.53 $78.40 $98.00 $98.00 $25.53 $56.84 $98.00 $37.02 $25.53 $98.00 $25.53 N/A N/A 30201505 EAP CPT® 82570 ASSAY OF URINE CREATININE BOTH IP/OP $72.00 $53.50 $2.59 $72.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $42.59 $5.18 $5.18 $5.18 $72.00 $54.00 $5.18 $5.18 $5.18 $28.92 $28.92 $57.02 $5.18 $57.60 $8.55 $7.28 $5.18 $41.76 $72.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30201506 EAP CPT® 84255 ASSAY OF SELENIUM BOTH IP/OP $71.00 $53.00 $12.77 $71.00 $71.00 $71.00 $71.00 $71.00 $25.53 $25.53 $12.77 $71.00 $25.53 $38.76 $38.76 $40.25 $28.30 $37.71 $40.85 $40.85 $71.00 $25.53 $25.53 $25.53 $71.00 $53.25 $25.53 $25.53 $25.53 $71.00 $71.00 $56.23 $25.53 $56.80 $71.00 $71.00 $25.53 $41.18 $71.00 $37.02 $25.53 $71.00 $25.53 N/A N/A 30201508 EAP CPT® 84270 ASSAY OF SEX HORMONE GLOBUL BOTH IP/OP $42.00 $31.50 $10.87 $42.00 $42.00 $42.00 $42.00 $42.00 $21.73 $21.73 $10.87 $42.00 $21.73 $33.00 $33.00 $34.27 $24.09 $32.10 $34.77 $34.77 $42.00 $21.73 $21.73 $21.73 $42.00 $31.50 $21.73 $21.73 $21.73 $42.00 $42.00 $33.26 $21.73 $33.60 $42.00 $42.00 $21.73 $24.36 $42.00 $31.51 $21.73 $42.00 $21.73 N/A N/A 30201510 EAP CPT® 86609 BACTERIUM ANTIBODY BOTH IP/OP $24.00 $18.00 $6.44 $24.00 $24.00 $24.00 $24.00 $24.00 $12.88 $12.88 $6.44 $24.00 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $24.00 $12.88 $12.88 $12.88 $24.00 $18.00 $12.88 $12.88 $12.88 $24.00 $24.00 $19.01 $12.88 $19.20 $24.00 $24.00 $12.88 $13.92 $24.00 $18.68 $12.88 $24.00 $12.88 N/A N/A 30201512 EAP CPT® 86403 PARTICLE AGGLUTINATION TEST BOTH IP/OP $203.00 $150.50 $5.19 $203.00 $20.00 $20.00 $20.00 $20.00 $11.54 $11.54 $5.77 $5.19 $11.54 $15.48 $15.48 $16.07 $11.30 $11.75 $18.46 $18.46 $120.07 $11.54 $11.54 $11.54 $203.00 $152.25 $11.54 $11.54 $11.54 $56.96 $56.96 $160.78 $11.54 $162.40 $19.04 $11.19 $11.54 $117.74 $203.00 $16.73 $11.54 $8.79 $11.54 N/A N/A 30201514 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $198.00 $147.00 $8.39 $198.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $117.12 $18.64 $18.64 $18.64 $198.00 $148.50 $18.64 $18.64 $18.64 $67.28 $67.28 $156.82 $18.64 $158.40 $30.76 $16.94 $18.64 $114.84 $198.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201516 EAP CPT® 87186 MICROBE SUSCEPTIBLE MIC BOTH IP/OP $323.00 $239.50 $4.32 $323.00 $16.97 $16.97 $16.97 $16.97 $8.65 $8.65 $4.33 $4.32 $8.65 $13.12 $13.12 $13.63 $9.58 $12.77 $13.84 $13.84 $191.05 $8.65 $8.65 $8.65 $323.00 $242.25 $8.65 $8.65 $8.65 $48.32 $48.32 $255.82 $8.65 $258.40 $14.27 $12.16 $8.65 $187.34 $323.00 $12.54 $8.65 $9.55 $8.65 N/A N/A 30201522 EAP CPT® 86780 TREPONEMA PALLIDUM BOTH IP/OP $93.00 $69.00 $6.62 $93.00 $25.98 $25.98 $25.98 $25.98 $13.24 $13.24 $6.62 $6.62 $13.24 $19.73 $19.73 $20.49 $14.40 $19.38 $21.18 $21.18 $55.01 $13.24 $13.24 $13.24 $93.00 $69.75 $13.24 $13.24 $13.24 $46.50 $46.50 $73.66 $13.24 $74.40 $21.85 $18.46 $13.24 $53.94 $93.00 $19.20 $13.24 $19.38 $13.24 N/A N/A 30201524 EAP CPT® 84482 T3 REVERSE BOTH IP/OP $150.00 $111.00 $7.88 $150.00 $150.00 $150.00 $150.00 $150.00 $15.76 $15.76 $7.88 $150.00 $15.76 $23.93 $23.93 $24.85 $17.47 $23.28 $25.22 $25.22 $150.00 $15.76 $15.76 $15.76 $150.00 $112.50 $15.76 $15.76 $15.76 $88.08 $88.08 $118.80 $15.76 $120.00 $150.00 $150.00 $15.76 $87.00 $150.00 $22.85 $15.76 $150.00 $15.76 N/A N/A 30201531 EAP CPT® 82040 ASSAY OF SERUM ALBUMIN BOTH IP/OP $8.00 $6.00 $2.48 $8.17 $5.65 $5.65 $5.65 $5.65 $4.95 $4.95 $2.48 $2.48 $4.95 $4.37 $4.37 $4.54 $3.19 $4.25 $7.92 $7.92 $4.73 $4.95 $4.95 $4.95 $8.00 $6.00 $4.95 $4.95 $4.95 $8.00 $8.00 $6.34 $4.95 $6.40 $8.17 $4.05 $4.95 $4.64 $8.00 $7.18 $4.95 $3.18 $4.95 N/A N/A 30201532 EAP CPT® 84270 ASSAY OF SEX HORMONE GLOBUL BOTH IP/OP $38.00 $28.50 $10.87 $38.00 $38.00 $38.00 $38.00 $38.00 $21.73 $21.73 $10.87 $38.00 $21.73 $33.00 $33.00 $34.27 $24.09 $32.10 $34.77 $34.77 $38.00 $21.73 $21.73 $21.73 $38.00 $28.50 $21.73 $21.73 $21.73 $38.00 $38.00 $30.10 $21.73 $30.40 $38.00 $38.00 $21.73 $22.04 $38.00 $31.51 $21.73 $38.00 $21.73 N/A N/A 30201533 EAP CPT® 84403 ASSAY OF TOTAL TESTOSTERONE BOTH IP/OP $52.00 $38.50 $12.91 $52.00 $50.65 $50.65 $50.65 $50.65 $25.81 $25.81 $12.91 $12.91 $25.81 $39.21 $39.21 $40.72 $28.62 $38.15 $41.30 $41.30 $30.76 $25.81 $25.81 $25.81 $52.00 $39.00 $25.81 $25.81 $25.81 $52.00 $52.00 $41.18 $25.81 $41.60 $42.59 $36.33 $25.81 $30.16 $52.00 $37.42 $25.81 $28.54 $25.81 N/A N/A 30201535 EAP CPT® 84402 ASSAY OF TESTOSTERONE BOTH IP/OP $50.00 $37.00 $12.74 $50.00 $50.00 $50.00 $50.00 $50.00 $25.47 $25.47 $12.74 $12.74 $25.47 $38.67 $38.67 $40.15 $28.23 $37.60 $40.75 $40.75 $29.58 $25.47 $25.47 $25.47 $50.00 $37.50 $25.47 $25.47 $25.47 $50.00 $50.00 $39.60 $25.47 $40.00 $42.03 $35.81 $25.47 $29.00 $50.00 $36.93 $25.47 $28.13 $25.47 N/A N/A 30201536 EAP CPT® 84403 ASSAY OF TOTAL TESTOSTERONE BOTH IP/OP $50.00 $37.00 $12.91 $50.00 $50.00 $50.00 $50.00 $50.00 $25.81 $25.81 $12.91 $12.91 $25.81 $39.21 $39.21 $40.72 $28.62 $38.15 $41.30 $41.30 $29.58 $25.81 $25.81 $25.81 $50.00 $37.50 $25.81 $25.81 $25.81 $50.00 $50.00 $39.60 $25.81 $40.00 $42.59 $36.33 $25.81 $29.00 $50.00 $37.42 $25.81 $28.54 $25.81 N/A N/A 30201538 EAP CPT® 84402 ASSAY OF TESTOSTERONE BOTH IP/OP $50.00 $37.00 $12.74 $50.00 $50.00 $50.00 $50.00 $50.00 $25.47 $25.47 $12.74 $12.74 $25.47 $38.67 $38.67 $40.15 $28.23 $37.60 $40.75 $40.75 $29.58 $25.47 $25.47 $25.47 $50.00 $37.50 $25.47 $25.47 $25.47 $50.00 $50.00 $39.60 $25.47 $40.00 $42.03 $35.81 $25.47 $29.00 $50.00 $36.93 $25.47 $28.13 $25.47 N/A N/A 30201540 EAP CPT® 86744 NOCARDIA ANTIBODY BOTH IP/OP $93.00 $69.00 $8.00 $93.00 $93.00 $93.00 $93.00 $93.00 $15.99 $15.99 $8.00 $93.00 $15.99 $20.02 $20.02 $20.79 $14.61 $19.49 $25.58 $25.58 $93.00 $15.99 $15.99 $15.99 $93.00 $69.75 $15.99 $15.99 $15.99 $73.72 $73.72 $73.66 $15.99 $74.40 $93.00 $93.00 $15.99 $53.94 $93.00 $23.19 $15.99 $93.00 $15.99 N/A N/A 30201542 EAP CPT® 83018 QUANTITATIVE SCREEN METALS BOTH IP/OP $259.00 $192.00 $10.98 $259.00 $43.10 $43.10 $43.10 $43.10 $21.96 $21.96 $10.98 $10.98 $21.96 $33.34 $33.34 $34.62 $24.34 $32.43 $35.14 $35.14 $153.20 $21.96 $21.96 $21.96 $259.00 $194.25 $21.96 $21.96 $21.96 $122.72 $122.72 $205.13 $21.96 $207.20 $36.23 $30.89 $21.96 $150.22 $259.00 $31.84 $21.96 $24.26 $21.96 N/A N/A 30201544 EAP CPT® 82570 ASSAY OF URINE CREATININE BOTH IP/OP $101.00 $75.00 $2.59 $101.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $59.74 $5.18 $5.18 $5.18 $101.00 $75.75 $5.18 $5.18 $5.18 $28.92 $28.92 $79.99 $5.18 $80.80 $8.55 $7.28 $5.18 $58.58 $101.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30201545 EAP CPT® 84430 ASSAY OF THIOCYANATE BOTH IP/OP $133.00 $98.50 $5.82 $133.00 $133.00 $133.00 $133.00 $133.00 $11.63 $11.63 $5.82 $133.00 $11.63 $8.76 $8.76 $9.09 $6.39 $8.52 $18.61 $18.61 $133.00 $11.63 $11.63 $11.63 $133.00 $99.75 $11.63 $11.63 $11.63 $32.24 $32.24 $105.34 $11.63 $106.40 $133.00 $133.00 $11.63 $77.14 $133.00 $16.86 $11.63 $133.00 $11.63 N/A N/A 30201546 EAP CPT® 84445 THYROID STIMULATING IMMUNOGLOBULIN SO BOTH IP/OP $135.00 $100.00 $9.36 $135.00 $16.62 $16.62 $16.62 $16.62 $50.86 $50.86 $25.43 $25.43 $50.86 $12.85 $12.85 $13.35 $9.38 $12.52 $81.38 $81.38 $79.85 $50.86 $50.86 $50.86 $135.00 $101.25 $50.86 $50.86 $50.86 $47.32 $47.32 $106.92 $50.86 $108.00 $83.92 $11.92 $50.86 $78.30 $135.00 $73.75 $50.86 $9.36 $50.86 N/A N/A 30201547 EAP CPT® 84445 ASSAY OF TSI BOTH IP/OP $172.00 $127.50 $9.36 $172.00 $16.62 $16.62 $16.62 $16.62 $50.86 $50.86 $25.43 $25.43 $50.86 $12.85 $12.85 $13.35 $9.38 $12.52 $81.38 $81.38 $101.74 $50.86 $50.86 $50.86 $172.00 $129.00 $50.86 $50.86 $50.86 $47.32 $47.32 $136.22 $50.86 $137.60 $83.92 $11.92 $50.86 $99.76 $172.00 $73.75 $50.86 $9.36 $50.86 N/A N/A 30201549 EAP CPT® 83519 RIA NONANTIBODY BOTH IP/OP $416.00 $308.00 $8.28 $416.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $246.06 $18.40 $18.40 $18.40 $416.00 $312.00 $18.40 $18.40 $18.40 $75.52 $75.52 $329.47 $18.40 $332.80 $30.36 $19.01 $18.40 $241.28 $416.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30201551 EAP CPT® 86682 HELMINTH ANTIBODY BOTH IP/OP $69.00 $51.50 $6.50 $69.00 $25.53 $25.53 $25.53 $25.53 $13.01 $13.01 $6.51 $6.50 $13.01 $19.75 $19.75 $20.51 $14.42 $19.20 $20.82 $20.82 $40.81 $13.01 $13.01 $13.01 $69.00 $51.75 $13.01 $13.01 $13.01 $69.00 $69.00 $54.65 $13.01 $55.20 $21.47 $18.29 $13.01 $40.02 $69.00 $18.86 $13.01 $14.37 $13.01 N/A N/A 30201553 EAP CPT® 87798 DETECT AGENT NOS DNA AMP BOTH IP/OP $442.00 $327.50 $17.55 $442.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $261.44 $35.09 $35.09 $35.09 $442.00 $331.50 $35.09 $35.09 $35.09 $109.64 $109.64 $350.06 $35.09 $353.60 $57.90 $27.60 $35.09 $256.36 $442.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30201555 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $242.00 $179.50 $8.39 $242.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $143.14 $18.64 $18.64 $18.64 $242.00 $181.50 $18.64 $18.64 $18.64 $67.28 $67.28 $191.66 $18.64 $193.60 $30.76 $16.94 $18.64 $140.36 $242.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201559 EAP CPT® 86753 PROROZOA ANTIBODY NOS BOTH IP/OP $39.00 $29.00 $6.20 $39.00 $39.00 $39.00 $39.00 $39.00 $12.39 $12.39 $6.20 $39.00 $12.39 $18.81 $18.81 $19.54 $13.73 $18.31 $19.82 $19.82 $39.00 $12.39 $12.39 $12.39 $39.00 $29.25 $12.39 $12.39 $12.39 $39.00 $39.00 $30.89 $12.39 $31.20 $39.00 $39.00 $12.39 $22.62 $39.00 $17.97 $12.39 $39.00 $12.39 N/A N/A 30201561 EAP CPT® 83520 IMMUNOASSAY QUANT NOS NONAB BOTH IP/OP $211.00 $156.50 $7.77 $211.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $124.81 $17.27 $17.27 $17.27 $211.00 $158.25 $17.27 $17.27 $17.27 $72.36 $72.36 $167.11 $17.27 $168.80 $28.50 $18.21 $17.27 $122.38 $211.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30201563 EAP CPT® 87799 DETECT AGENT NOS DNA QUANT BOTH IP/OP $968.00 $716.50 $21.42 $968.00 $968.00 $968.00 $968.00 $968.00 $42.84 $42.84 $21.42 $968.00 $42.84 $65.04 $65.04 $67.54 $47.48 $201.74 $68.54 $68.54 $968.00 $42.84 $42.84 $42.84 $968.00 $726.00 $42.84 $42.84 $42.84 $239.40 $239.40 $766.66 $42.84 $774.40 $968.00 $968.00 $42.84 $561.44 $968.00 $62.12 $42.84 $968.00 $42.84 N/A N/A 30201565 EAP CPT® 84425 ASSAY OF VITAMIN B-1 BOTH IP/OP $102.00 $75.50 $10.62 $102.00 $41.67 $41.67 $41.67 $41.67 $21.23 $21.23 $10.62 $10.62 $21.23 $32.25 $32.25 $33.49 $23.54 $31.36 $33.97 $33.97 $60.33 $21.23 $21.23 $21.23 $102.00 $76.50 $21.23 $21.23 $21.23 $102.00 $102.00 $80.78 $21.23 $81.60 $35.03 $29.87 $21.23 $59.16 $102.00 $30.78 $21.23 $23.46 $21.23 N/A N/A 30201566 EAP CPT® 84425 VITAMIN B1 PLASMA (THIAMINE) SO BOTH IP/OP $65.00 $48.50 $10.62 $65.00 $41.67 $41.67 $41.67 $41.67 $21.23 $21.23 $10.62 $10.62 $21.23 $32.25 $32.25 $33.49 $23.54 $31.36 $33.97 $33.97 $38.45 $21.23 $21.23 $21.23 $65.00 $48.75 $21.23 $21.23 $21.23 $65.00 $65.00 $51.48 $21.23 $52.00 $35.03 $29.87 $21.23 $37.70 $65.00 $30.78 $21.23 $23.46 $21.23 N/A N/A 30201567 EAP CPT® 84425 ASSAY OF VITAMIN B-1 BOTH IP/OP $157.00 $116.50 $10.62 $157.00 $41.67 $41.67 $41.67 $41.67 $21.23 $21.23 $10.62 $10.62 $21.23 $32.25 $32.25 $33.49 $23.54 $31.36 $33.97 $33.97 $92.87 $21.23 $21.23 $21.23 $157.00 $117.75 $21.23 $21.23 $21.23 $118.68 $118.68 $124.34 $21.23 $125.60 $35.03 $29.87 $21.23 $91.06 $157.00 $30.78 $21.23 $23.46 $21.23 N/A N/A 30201569 EAP CPT® 84597 ASSAY OF VITAMIN K BOTH IP/OP $566.00 $419.00 $6.86 $566.00 $566.00 $566.00 $566.00 $566.00 $13.72 $13.72 $6.86 $566.00 $13.72 $20.81 $20.81 $21.61 $15.19 $20.25 $21.95 $21.95 $566.00 $13.72 $13.72 $13.72 $566.00 $424.50 $13.72 $13.72 $13.72 $76.60 $76.60 $448.27 $13.72 $452.80 $566.00 $566.00 $13.72 $328.28 $566.00 $19.89 $13.72 $566.00 $13.72 N/A N/A 30201571 EAP CPT® 84591 ASSAY OF NOS VITAMIN BOTH IP/OP $121.00 $90.00 $8.53 $121.00 $121.00 $121.00 $121.00 $121.00 $17.06 $17.06 $8.53 $121.00 $17.06 $17.61 $17.61 $18.28 $12.85 $17.13 $27.30 $27.30 $121.00 $17.06 $17.06 $17.06 $121.00 $90.75 $17.06 $17.06 $17.06 $64.80 $64.80 $95.83 $17.06 $96.80 $121.00 $121.00 $17.06 $70.18 $121.00 $24.74 $17.06 $121.00 $17.06 N/A N/A 30201573 EAP CPT® 84207 ASSAY OF VTAMIN B-6 BOTH IP/OP $452.00 $334.50 $14.05 $452.00 $452.00 $452.00 $452.00 $452.00 $28.10 $28.10 $14.05 $452.00 $28.10 $42.66 $42.66 $44.30 $31.14 $41.51 $44.96 $44.96 $452.00 $28.10 $28.10 $28.10 $452.00 $339.00 $28.10 $28.10 $28.10 $157.00 $157.00 $357.98 $28.10 $361.60 $452.00 $452.00 $28.10 $262.16 $452.00 $40.75 $28.10 $452.00 $28.10 N/A N/A 30201575 EAP CPT® 82570 ASSAY OF URINE CREATININE BOTH IP/OP $24.00 $18.00 $2.59 $24.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $14.20 $5.18 $5.18 $5.18 $24.00 $18.00 $5.18 $5.18 $5.18 $24.00 $24.00 $19.01 $5.18 $19.20 $8.55 $7.28 $5.18 $13.92 $24.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30201576 EAP CPT® 84585 ASSAY OF URINE VMA BOTH IP/OP $30.00 $22.50 $7.75 $30.00 $30.00 $30.00 $30.00 $30.00 $15.50 $15.50 $7.75 $30.00 $15.50 $23.55 $23.55 $24.45 $17.19 $22.90 $24.80 $24.80 $30.00 $15.50 $15.50 $15.50 $30.00 $22.50 $15.50 $15.50 $15.50 $30.00 $30.00 $23.76 $15.50 $24.00 $30.00 $30.00 $15.50 $17.40 $30.00 $22.48 $15.50 $30.00 $15.50 N/A N/A 30201578 EAP CPT® 85247 BLOOD CLOT FACTOR VIII TEST BOTH IP/OP $323.00 $239.50 $11.47 $323.00 $323.00 $323.00 $323.00 $323.00 $22.94 $22.94 $11.47 $323.00 $22.94 $34.85 $34.85 $36.19 $25.44 $33.89 $36.70 $36.70 $323.00 $22.94 $22.94 $22.94 $323.00 $242.25 $22.94 $22.94 $22.94 $128.24 $128.24 $255.82 $22.94 $258.40 $323.00 $323.00 $22.94 $187.34 $323.00 $33.26 $22.94 $323.00 $22.94 N/A N/A 30201580 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $402.00 $297.50 $8.39 $402.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $237.78 $18.64 $18.64 $18.64 $402.00 $301.50 $18.64 $18.64 $18.64 $67.28 $67.28 $318.38 $18.64 $321.60 $30.76 $16.94 $18.64 $233.16 $402.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201581 EAP CPT® 86788 WEST NILE AB CSF SO BOTH IP/OP $193.00 $143.00 $8.43 $193.00 $193.00 $193.00 $193.00 $193.00 $16.85 $16.85 $8.43 $193.00 $16.85 $25.58 $25.58 $26.57 $18.68 $24.90 $26.96 $26.96 $193.00 $16.85 $16.85 $16.85 $193.00 $144.75 $16.85 $16.85 $16.85 $94.16 $94.16 $152.86 $16.85 $154.40 $193.00 $193.00 $16.85 $111.94 $193.00 $24.43 $16.85 $193.00 $16.85 N/A N/A 30201582 EAP CPT® 86788 WEST NILE VIRUS AG IGM BOTH IP/OP $300.00 $222.00 $8.43 $300.00 $300.00 $300.00 $300.00 $300.00 $16.85 $16.85 $8.43 $300.00 $16.85 $25.58 $25.58 $26.57 $18.68 $24.90 $26.96 $26.96 $300.00 $16.85 $16.85 $16.85 $300.00 $225.00 $16.85 $16.85 $16.85 $94.16 $94.16 $237.60 $16.85 $240.00 $300.00 $300.00 $16.85 $174.00 $300.00 $24.43 $16.85 $300.00 $16.85 N/A N/A 30201583 EAP CPT® 86789 WEST NILE VIRUS ANTIBODY BOTH IP/OP $300.00 $222.00 $7.20 $300.00 $300.00 $300.00 $300.00 $300.00 $14.39 $14.39 $7.20 $300.00 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $300.00 $14.39 $14.39 $14.39 $300.00 $225.00 $14.39 $14.39 $14.39 $65.04 $65.04 $237.60 $14.39 $240.00 $300.00 $300.00 $14.39 $174.00 $300.00 $20.87 $14.39 $300.00 $14.39 N/A N/A 30201584 EAP CPT® 86788 WEST NILE AB SERUM SO BOTH IP/OP $162.00 $120.00 $8.43 $162.00 $162.00 $162.00 $162.00 $162.00 $16.85 $16.85 $8.43 $162.00 $16.85 $25.58 $25.58 $26.57 $18.68 $24.90 $26.96 $26.96 $162.00 $16.85 $16.85 $16.85 $162.00 $121.50 $16.85 $16.85 $16.85 $94.16 $94.16 $128.30 $16.85 $129.60 $162.00 $162.00 $16.85 $93.96 $162.00 $24.43 $16.85 $162.00 $16.85 N/A N/A 30201585 EAP CPT® 86788 WEST NILE VIRUS AG IGM BOTH IP/OP $120.00 $89.00 $8.43 $120.00 $120.00 $120.00 $120.00 $120.00 $16.85 $16.85 $8.43 $120.00 $16.85 $25.58 $25.58 $26.57 $18.68 $24.90 $26.96 $26.96 $120.00 $16.85 $16.85 $16.85 $120.00 $90.00 $16.85 $16.85 $16.85 $94.16 $94.16 $95.04 $16.85 $96.00 $120.00 $120.00 $16.85 $69.60 $120.00 $24.43 $16.85 $120.00 $16.85 N/A N/A 30201586 EAP CPT® 86789 WEST NILE VIRUS ANTIBODY BOTH IP/OP $120.00 $89.00 $7.20 $120.00 $120.00 $120.00 $120.00 $120.00 $14.39 $14.39 $7.20 $120.00 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $120.00 $14.39 $14.39 $14.39 $120.00 $90.00 $14.39 $14.39 $14.39 $65.04 $65.04 $95.04 $14.39 $96.00 $120.00 $120.00 $14.39 $69.60 $120.00 $20.87 $14.39 $120.00 $14.39 N/A N/A 30201588 EAP CPT® 84311 SPECTROPHOTOMETRY BOTH IP/OP $239.00 $177.00 $4.05 $239.00 $239.00 $239.00 $239.00 $239.00 $8.10 $8.10 $4.05 $239.00 $8.10 $10.61 $10.61 $11.02 $7.74 $10.32 $12.96 $12.96 $239.00 $8.10 $8.10 $8.10 $239.00 $179.25 $8.10 $8.10 $8.10 $39.08 $39.08 $189.29 $8.10 $191.20 $239.00 $239.00 $8.10 $138.62 $239.00 $11.75 $8.10 $239.00 $8.10 N/A N/A 30201590 EAP CPT® 82570 ASSAY OF URINE CREATININE BOTH IP/OP $68.00 $50.50 $2.59 $68.00 $10.17 $10.17 $10.17 $10.17 $5.18 $5.18 $2.59 $2.59 $5.18 $7.86 $7.86 $8.16 $5.74 $7.64 $8.29 $8.29 $40.22 $5.18 $5.18 $5.18 $68.00 $51.00 $5.18 $5.18 $5.18 $28.92 $28.92 $53.86 $5.18 $54.40 $8.55 $7.28 $5.18 $39.44 $68.00 $7.51 $5.18 $5.72 $5.18 N/A N/A 30201591 EAP CPT® 83497 ASSAY OF 5-HIAA BOTH IP/OP $147.00 $109.00 $6.45 $147.00 $25.30 $25.30 $25.30 $25.30 $12.90 $12.90 $6.45 $6.45 $12.90 $19.58 $19.58 $20.34 $14.30 $19.05 $20.64 $20.64 $86.95 $12.90 $12.90 $12.90 $147.00 $110.25 $12.90 $12.90 $12.90 $72.04 $72.04 $116.42 $12.90 $117.60 $21.29 $18.14 $12.90 $85.26 $147.00 $18.71 $12.90 $14.25 $12.90 N/A N/A 30201593 EAP CPT® 83516 IMMUNOASSAY NONANTIBODY BOTH IP/OP $288.00 $213.50 $5.76 $288.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $170.35 $11.53 $11.53 $11.53 $288.00 $216.00 $11.53 $11.53 $11.53 $59.76 $59.76 $228.10 $11.53 $230.40 $19.02 $15.05 $11.53 $167.04 $288.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30201601 EAP CPT® 88360 TUMOR IMMUNOHISTOCHEM/MANUAL BOTH IP/OP $310.00 $229.50 $49.88 $248.00 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $183.37 $146.71 $78.13 $146.71 $154.04 $232.50 $146.71 $146.71 $146.71 $242.68 $242.68 $245.52 $146.71 $248.00 $201.50 $109.25 $146.71 $179.80 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 30201612 EAP CPT® 88381 MICRODISSECTION MANUAL BOTH IP/OP $29.00 $21.50 $14.50 $180.28 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $70.38 $29.00 $161.51 $161.51 $167.72 $117.90 $29.00 $29.00 $29.00 $17.15 $29.00 $180.28 $29.00 $29.00 $21.75 $29.00 $29.00 $29.00 $14.50 $14.50 $22.97 $29.00 $23.20 $18.85 $29.00 $29.00 $16.82 $29.00 $29.00 $29.00 $147.56 $29.00 N/A N/A 30201614 EAP CPT® 83516 IMMUNOASSAY NONANTIBODY BOTH IP/OP $272.00 $201.50 $5.76 $272.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $160.89 $11.53 $11.53 $11.53 $272.00 $204.00 $11.53 $11.53 $11.53 $59.76 $59.76 $215.42 $11.53 $217.60 $19.02 $15.05 $11.53 $157.76 $272.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30201616 EAP CPT® 83516 IMMUNOASSAY NONANTIBODY BOTH IP/OP $408.00 $302.00 $5.76 $408.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $241.33 $11.53 $11.53 $11.53 $408.00 $306.00 $11.53 $11.53 $11.53 $59.76 $59.76 $323.14 $11.53 $326.40 $19.02 $15.05 $11.53 $236.64 $408.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30201618 EAP CPT® 87538 HIV-2 DNA AMP PROBE BOTH IP/OP $521.00 $386.00 $17.55 $521.00 $521.00 $521.00 $521.00 $521.00 $35.09 $35.09 $17.55 $521.00 $35.09 $29.79 $29.79 $30.93 $21.74 $108.58 $56.14 $56.14 $521.00 $35.09 $35.09 $35.09 $521.00 $390.75 $35.09 $35.09 $35.09 $109.64 $109.64 $412.63 $35.09 $416.80 $521.00 $521.00 $35.09 $302.18 $521.00 $50.88 $35.09 $521.00 $35.09 N/A N/A 30201620 EAP CPT® 84432 ASSAY OF THYROGLOBULIN BOTH IP/OP $213.00 $158.00 $8.03 $213.00 $31.53 $31.53 $31.53 $31.53 $16.06 $16.06 $8.03 $8.03 $16.06 $24.39 $24.39 $25.33 $17.80 $23.73 $25.70 $25.70 $125.99 $16.06 $16.06 $16.06 $213.00 $159.75 $16.06 $16.06 $16.06 $89.76 $89.76 $168.70 $16.06 $170.40 $26.50 $22.60 $16.06 $123.54 $213.00 $23.29 $16.06 $17.75 $16.06 N/A N/A 30201628 EAP CPT® 86317 IMMUNOASSAY INFECTIOUS AGENT BOTH IP/OP $36.00 $27.00 $7.49 $36.00 $23.57 $23.57 $23.57 $23.57 $14.99 $14.99 $7.50 $7.49 $14.99 $18.22 $18.22 $18.92 $13.30 $17.72 $23.98 $23.98 $21.29 $14.99 $14.99 $14.99 $36.00 $27.00 $14.99 $14.99 $14.99 $36.00 $36.00 $28.51 $14.99 $28.80 $24.73 $16.88 $14.99 $20.88 $36.00 $21.74 $14.99 $13.26 $14.99 N/A N/A 30201630 EAP CPT® 86382 NEUTRALIZATION TEST VIRAL BOTH IP/OP $46.00 $34.50 $8.46 $46.00 $46.00 $46.00 $46.00 $46.00 $16.91 $16.91 $8.46 $46.00 $16.91 $25.68 $25.68 $26.67 $18.74 $24.98 $27.06 $27.06 $46.00 $16.91 $16.91 $16.91 $46.00 $34.50 $16.91 $16.91 $16.91 $46.00 $46.00 $36.43 $16.91 $36.80 $46.00 $46.00 $16.91 $26.68 $46.00 $24.52 $16.91 $46.00 $16.91 N/A N/A 30201632 EAP CPT® 83088 ASSAY OF HISTAMINE BOTH IP/OP $76.00 $56.50 $14.77 $76.00 $76.00 $76.00 $76.00 $76.00 $29.53 $29.53 $14.77 $76.00 $29.53 $44.84 $44.84 $46.57 $32.74 $43.62 $47.25 $47.25 $76.00 $29.53 $29.53 $29.53 $76.00 $57.00 $29.53 $29.53 $29.53 $76.00 $76.00 $60.19 $29.53 $60.80 $76.00 $76.00 $29.53 $44.08 $76.00 $42.82 $29.53 $76.00 $29.53 N/A N/A 30201634 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $69.00 $51.50 $10.71 $69.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $40.81 $21.42 $21.42 $21.42 $69.00 $51.75 $21.42 $21.42 $21.42 $69.00 $69.00 $54.65 $21.42 $55.20 $35.34 $30.14 $21.42 $40.02 $69.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30201635 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $137.00 $101.50 $23.04 $137.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $81.04 $51.19 $51.19 $51.19 $137.00 $102.75 $51.19 $51.19 $51.19 $137.00 $137.00 $108.50 $51.19 $109.60 $84.46 $56.50 $51.19 $79.46 $137.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30201638 EAP CPT® 88272 CYTOGENETICS 3-5 BOTH IP/OP $508.00 $376.00 $18.32 $508.00 $52.56 $52.56 $52.56 $52.56 $40.70 $40.70 $20.35 $18.32 $40.70 $40.65 $40.65 $42.22 $29.68 $39.55 $65.12 $65.12 $300.48 $40.70 $40.70 $40.70 $508.00 $381.00 $40.70 $40.70 $40.70 $149.64 $149.64 $402.34 $40.70 $406.40 $67.16 $37.67 $40.70 $294.64 $508.00 $59.02 $40.70 $29.59 $40.70 N/A N/A 30201640 EAP CPT® 86787 VARICELLA-ZOSTER ANTIBODY BOTH IP/OP $183.00 $135.50 $6.44 $183.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $108.24 $12.88 $12.88 $12.88 $183.00 $137.25 $12.88 $12.88 $12.88 $72.00 $72.00 $144.94 $12.88 $146.40 $21.25 $18.12 $12.88 $106.14 $183.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30201642 EAP CPT® 88360 TUMOR IMMUNOHISTOCHE/MANUAL BOTH IP/OP $297.00 $220.00 $49.88 $242.68 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $175.68 $146.71 $78.13 $146.71 $154.04 $222.75 $146.71 $146.71 $146.71 $242.68 $242.68 $235.22 $146.71 $237.60 $193.05 $109.25 $146.71 $172.26 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 30201650 EAP CPT® 86694 HERPES SIMPLEX TEST BOTH IP/OP $145.00 $107.50 $7.20 $145.00 $22.84 $22.84 $22.84 $22.84 $14.39 $14.39 $7.20 $7.20 $14.39 $17.67 $17.67 $18.35 $12.90 $17.19 $23.02 $23.02 $85.77 $14.39 $14.39 $14.39 $145.00 $108.75 $14.39 $14.39 $14.39 $65.04 $65.04 $114.84 $14.39 $116.00 $23.74 $16.37 $14.39 $84.10 $145.00 $20.87 $14.39 $12.86 $14.39 N/A N/A 30201652 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $62.00 $46.00 $10.71 $62.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $36.67 $21.42 $21.42 $21.42 $62.00 $46.50 $21.42 $21.42 $21.42 $62.00 $62.00 $49.10 $21.42 $49.60 $35.34 $30.14 $21.42 $35.96 $62.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30201653 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $151.00 $112.00 $23.04 $151.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $89.32 $51.19 $51.19 $51.19 $151.00 $113.25 $51.19 $51.19 $51.19 $151.00 $151.00 $119.59 $51.19 $120.80 $84.46 $56.50 $51.19 $87.58 $151.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30201656 EAP CPT® 86382 NEUTRALIZATION TEST VIRAL BOTH IP/OP $47.00 $35.00 $8.46 $47.00 $47.00 $47.00 $47.00 $47.00 $16.91 $16.91 $8.46 $47.00 $16.91 $25.68 $25.68 $26.67 $18.74 $24.98 $27.06 $27.06 $47.00 $16.91 $16.91 $16.91 $47.00 $35.25 $16.91 $16.91 $16.91 $47.00 $47.00 $37.22 $16.91 $37.60 $47.00 $47.00 $16.91 $27.26 $47.00 $24.52 $16.91 $47.00 $16.91 N/A N/A 30201658 EAP CPT® 86317 IMMUNOASSAY INFECTIOUS AGENT BOTH IP/OP $33.00 $24.50 $7.49 $33.00 $23.57 $23.57 $23.57 $23.57 $14.99 $14.99 $7.50 $7.49 $14.99 $18.22 $18.22 $18.92 $13.30 $17.72 $23.98 $23.98 $19.52 $14.99 $14.99 $14.99 $33.00 $24.75 $14.99 $14.99 $14.99 $33.00 $33.00 $26.14 $14.99 $26.40 $24.73 $16.88 $14.99 $19.14 $33.00 $21.74 $14.99 $13.26 $14.99 N/A N/A 30201660 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $77.00 $57.00 $10.71 $77.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $45.55 $21.42 $21.42 $21.42 $77.00 $57.75 $21.42 $21.42 $21.42 $77.00 $77.00 $60.98 $21.42 $61.60 $35.34 $30.14 $21.42 $44.66 $77.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30201661 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $117.00 $87.00 $23.04 $117.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $69.21 $51.19 $51.19 $51.19 $117.00 $87.75 $51.19 $51.19 $51.19 $117.00 $117.00 $92.66 $51.19 $93.60 $84.46 $56.50 $51.19 $67.86 $117.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30201664 EAP CPT® 83516 IMMUNOASSAY NONANTIBODY BOTH IP/OP $256.00 $189.50 $5.76 $256.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $151.42 $11.53 $11.53 $11.53 $256.00 $192.00 $11.53 $11.53 $11.53 $59.76 $59.76 $202.75 $11.53 $204.80 $19.02 $15.05 $11.53 $148.48 $256.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30201665 EAP CPT® 82784 ASSAY IGA/IGD/IGG/IGM EACH BOTH IP/OP $28.00 $21.00 $4.65 $28.00 $18.25 $18.25 $18.25 $18.25 $9.30 $9.30 $4.65 $4.65 $9.30 $14.12 $14.12 $14.67 $10.31 $13.73 $14.88 $14.88 $16.56 $9.30 $9.30 $9.30 $28.00 $21.00 $9.30 $9.30 $9.30 $28.00 $28.00 $22.18 $9.30 $22.40 $15.35 $13.08 $9.30 $16.24 $28.00 $13.49 $9.30 $10.27 $9.30 N/A N/A 30201667 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $85.00 $63.00 $10.71 $85.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $50.28 $21.42 $21.42 $21.42 $85.00 $63.75 $21.42 $21.42 $21.42 $85.00 $85.00 $67.32 $21.42 $68.00 $35.34 $30.14 $21.42 $49.30 $85.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30201668 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $139.00 $103.00 $23.04 $139.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $82.22 $51.19 $51.19 $51.19 $139.00 $104.25 $51.19 $51.19 $51.19 $139.00 $139.00 $110.09 $51.19 $111.20 $84.46 $56.50 $51.19 $80.62 $139.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30201671 EAP CPT® 86817 HLA TYPING DR/DQ BOTH IP/OP "$1,108.00" $820.00 $53.07 "$1,108.00" "$1,108.00" "$1,108.00" "$1,108.00" "$1,108.00" $106.14 $106.14 $53.07 "$1,108.00" $106.14 $97.76 $97.76 $101.52 $71.36 $95.11 $169.82 $169.82 "$1,108.00" $106.14 $106.14 $106.14 "$1,108.00" $831.00 $106.14 $106.14 $106.14 $359.80 $359.80 $877.54 $106.14 $886.40 "$1,108.00" "$1,108.00" $106.14 $642.64 "$1,108.00" $153.90 $106.14 "$1,108.00" $106.14 N/A N/A 30201672 EAP CPT® 86813 HLA TYPING A B OR C BOTH IP/OP "$1,254.00" $928.00 $29.00 "$1,254.00" "$1,254.00" "$1,254.00" "$1,254.00" "$1,254.00" $58.00 $58.00 $29.00 "$1,254.00" $58.00 $88.05 $88.05 $91.43 $64.27 $85.66 $92.80 $92.80 "$1,254.00" $58.00 $58.00 $58.00 "$1,254.00" $940.50 $58.00 $58.00 $58.00 $324.08 $324.08 $993.17 $58.00 "$1,003.20" "$1,254.00" "$1,254.00" $58.00 $727.32 "$1,254.00" $84.10 $58.00 "$1,254.00" $58.00 N/A N/A 30201673 EAP CPT® 86808 CYTOTOXIC ANTIBODY SCREENING BOTH IP/OP $349.00 $258.50 $14.84 $349.00 $349.00 $349.00 $349.00 $349.00 $29.68 $29.68 $14.84 $349.00 $29.68 $45.06 $45.06 $46.80 $32.90 $43.84 $47.49 $47.49 $349.00 $29.68 $29.68 $29.68 $349.00 $261.75 $29.68 $29.68 $29.68 $165.88 $165.88 $276.41 $29.68 $279.20 $349.00 $349.00 $29.68 $202.42 $349.00 $43.04 $29.68 $349.00 $29.68 N/A N/A 30201687 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $102.00 $75.50 $10.71 $102.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $60.33 $21.42 $21.42 $21.42 $102.00 $76.50 $21.42 $21.42 $21.42 $102.00 $102.00 $80.78 $21.42 $81.60 $35.34 $30.14 $21.42 $59.16 $102.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30201688 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $176.00 $130.50 $23.04 $176.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $104.10 $51.19 $51.19 $51.19 $176.00 $132.00 $51.19 $51.19 $51.19 $176.00 $176.00 $139.39 $51.19 $140.80 $84.46 $56.50 $51.19 $102.08 $176.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30201691 EAP CPT® 86255 FLUORESCENT ANTIBODY SCREEN BOTH IP/OP $659.00 $488.00 $6.03 $659.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $389.80 $12.05 $12.05 $12.05 $659.00 $494.25 $12.05 $12.05 $12.05 $67.36 $67.36 $521.93 $12.05 $527.20 $19.88 $16.96 $12.05 $382.22 $659.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201693 EAP CPT® 83519 RIA NONANTIBODY BOTH IP/OP "$1,170.00" $866.00 $8.28 "$1,170.00" $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $692.06 $18.40 $18.40 $18.40 "$1,170.00" $877.50 $18.40 $18.40 $18.40 $75.52 $75.52 $926.64 $18.40 $936.00 $30.36 $19.01 $18.40 $678.60 "$1,170.00" $26.68 $18.40 $14.93 $18.40 N/A N/A 30201706 EAP CPT® 83520 IMMUNOASSAY QUANT NOS NONAB BOTH IP/OP $182.00 $135.00 $7.77 $182.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $107.65 $17.27 $17.27 $17.27 $182.00 $136.50 $17.27 $17.27 $17.27 $72.36 $72.36 $144.14 $17.27 $145.60 $28.50 $18.21 $17.27 $105.56 $182.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30201707 EAP CPT® 86021 WBC ANTIBODY IDENTIFICATION BOTH IP/OP $92.00 $68.50 $7.53 $92.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $54.42 $15.05 $15.05 $15.05 $92.00 $69.00 $15.05 $15.05 $15.05 $84.12 $84.12 $72.86 $15.05 $73.60 $24.83 $21.18 $15.05 $53.36 $92.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30201708 EAP CPT® 86255 FLUORESCENT ANTIBODY SCREEN BOTH IP/OP $83.00 $61.50 $6.03 $83.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $49.09 $12.05 $12.05 $12.05 $83.00 $62.25 $12.05 $12.05 $12.05 $67.36 $67.36 $65.74 $12.05 $66.40 $19.88 $16.96 $12.05 $48.14 $83.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201709 EAP CPT® 86609 BACTERIUM ANTIBODY BOTH IP/OP $84.00 $62.50 $6.44 $84.00 $84.00 $84.00 $84.00 $84.00 $12.88 $12.88 $6.44 $84.00 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $84.00 $12.88 $12.88 $12.88 $84.00 $63.00 $12.88 $12.88 $12.88 $72.00 $72.00 $66.53 $12.88 $67.20 $84.00 $84.00 $12.88 $48.72 $84.00 $18.68 $12.88 $84.00 $12.88 N/A N/A 30201710 EAP CPT® 86671 FUNGUS ANTIBODY BOTH IP/OP $83.00 $61.50 $6.13 $83.00 $83.00 $83.00 $83.00 $83.00 $12.25 $12.25 $6.13 $83.00 $12.25 $18.62 $18.62 $19.33 $13.59 $18.11 $19.60 $19.60 $83.00 $12.25 $12.25 $12.25 $83.00 $62.25 $12.25 $12.25 $12.25 $68.52 $68.52 $65.74 $12.25 $66.40 $83.00 $83.00 $12.25 $48.14 $83.00 $17.76 $12.25 $83.00 $12.25 N/A N/A 30201711 EAP CPT® 86689 HIV-2 WB BOTH IP/OP $213.00 $158.00 $9.68 $213.00 $213.00 $213.00 $213.00 $213.00 $19.35 $19.35 $9.68 $213.00 $19.35 $29.39 $29.39 $30.52 $21.45 $24.81 $30.96 $30.96 $213.00 $19.35 $19.35 $19.35 $213.00 $159.75 $19.35 $19.35 $19.35 $108.20 $108.20 $168.70 $19.35 $170.40 $213.00 $213.00 $19.35 $123.54 $213.00 $28.06 $19.35 $213.00 $19.35 N/A N/A 30201712 EAP CPT® 86038 ANTINUCLEAR ANTIBODIES BOTH IP/OP $24.00 $18.00 $6.04 $24.00 $23.72 $23.72 $23.72 $23.72 $12.09 $12.09 $6.05 $6.04 $12.09 $18.36 $18.36 $19.06 $13.40 $17.86 $19.34 $19.34 $14.20 $12.09 $12.09 $12.09 $24.00 $18.00 $12.09 $12.09 $12.09 $24.00 $24.00 $19.01 $12.09 $19.20 $19.95 $17.01 $12.09 $13.92 $24.00 $17.53 $12.09 $13.36 $12.09 N/A N/A 30201713 EAP CPT® 86376 MICROSOMAL ANTIBODY BOTH IP/OP $49.00 $36.50 $7.28 $49.00 $28.56 $28.56 $28.56 $28.56 $14.55 $14.55 $7.28 $7.28 $14.55 $22.10 $22.10 $22.95 $16.13 $21.49 $23.28 $23.28 $28.98 $14.55 $14.55 $14.55 $49.00 $36.75 $14.55 $14.55 $14.55 $49.00 $49.00 $38.81 $14.55 $39.20 $24.01 $20.47 $14.55 $28.42 $49.00 $21.10 $14.55 $16.08 $14.55 N/A N/A 30201714 EAP CPT® 86658 ENTEROVIRUS ANTIBODY BOTH IP/OP $27.00 $20.00 $6.52 $27.00 $27.00 $27.00 $27.00 $27.00 $13.03 $13.03 $6.52 $27.00 $13.03 $19.79 $19.79 $20.55 $14.45 $19.25 $20.85 $20.85 $27.00 $13.03 $13.03 $13.03 $27.00 $20.25 $13.03 $13.03 $13.03 $27.00 $27.00 $21.38 $13.03 $21.60 $27.00 $27.00 $13.03 $15.66 $27.00 $18.89 $13.03 $27.00 $13.03 N/A N/A 30201715 EAP CPT® 86652 "ANTIBODY ENCEPHALITIS, EASTERN EQUINE" BOTH IP/OP $19.00 $14.50 $6.60 $21.10 $19.00 $19.00 $19.00 $19.00 $13.19 $13.19 $6.60 $19.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.00 $21.10 $21.10 $19.00 $13.19 $13.19 $13.19 $19.00 $14.25 $13.19 $13.19 $13.19 $19.00 $19.00 $15.05 $13.19 $15.20 $19.00 $19.00 $13.19 $11.02 $19.00 $19.00 $13.19 $19.00 $13.19 N/A N/A 30201718 EAP CPT® 86765 RUBEOLA ANTIBODY BOTH IP/OP $31.00 $23.00 $6.44 $31.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $18.34 $12.88 $12.88 $12.88 $31.00 $23.25 $12.88 $12.88 $12.88 $31.00 $31.00 $24.55 $12.88 $24.80 $21.25 $18.12 $12.88 $17.98 $31.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30201719 EAP CPT® 86653 ENCEPHALITIS ANTIBODY BOTH IP/OP $19.00 $14.50 $6.60 $21.10 $19.00 $19.00 $19.00 $19.00 $13.19 $13.19 $6.60 $19.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.00 $21.10 $21.10 $19.00 $13.19 $13.19 $13.19 $19.00 $14.25 $13.19 $13.19 $13.19 $19.00 $19.00 $15.05 $13.19 $15.20 $19.00 $19.00 $13.19 $11.02 $19.00 $19.00 $13.19 $19.00 $13.19 N/A N/A 30201720 EAP CPT® 86787 VARICELLA-ZOSTER ANTIBODY BOTH IP/OP $29.00 $21.50 $6.44 $29.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $17.15 $12.88 $12.88 $12.88 $29.00 $21.75 $12.88 $12.88 $12.88 $29.00 $29.00 $22.97 $12.88 $23.20 $21.25 $18.12 $12.88 $16.82 $29.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30201721 EAP CPT® 86654 ENCEPHALITIS ANTIBODY BOTH IP/OP $19.00 $14.50 $6.60 $21.10 $19.00 $19.00 $19.00 $19.00 $13.19 $13.19 $6.60 $19.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.00 $21.10 $21.10 $19.00 $13.19 $13.19 $13.19 $19.00 $14.25 $13.19 $13.19 $13.19 $19.00 $19.00 $15.05 $13.19 $15.20 $19.00 $19.00 $13.19 $11.02 $19.00 $19.00 $13.19 $19.00 $13.19 N/A N/A 30201722 EAP CPT® 86645 CMV ANTIBODY IGM BOTH IP/OP $35.00 $26.00 $8.42 $35.00 $33.06 $33.06 $33.06 $33.06 $16.85 $16.85 $8.43 $8.42 $16.85 $25.58 $25.58 $26.57 $18.68 $24.90 $26.96 $26.96 $20.70 $16.85 $16.85 $16.85 $35.00 $26.25 $16.85 $16.85 $16.85 $35.00 $35.00 $27.72 $16.85 $28.00 $27.80 $23.71 $16.85 $20.30 $35.00 $24.43 $16.85 $18.62 $16.85 N/A N/A 30201724 EAP CPT® 86403 PARTICLE AGGLUTINATION TEST BOTH IP/OP $90.00 $67.00 $5.19 $90.00 $20.00 $20.00 $20.00 $20.00 $11.54 $11.54 $5.77 $5.19 $11.54 $15.48 $15.48 $16.07 $11.30 $11.75 $18.46 $18.46 $53.24 $11.54 $11.54 $11.54 $90.00 $67.50 $11.54 $11.54 $11.54 $56.96 $56.96 $71.28 $11.54 $72.00 $19.04 $11.19 $11.54 $52.20 $90.00 $16.73 $11.54 $8.79 $11.54 N/A N/A 30201725 EAP CPT® 86406 PARTICLE AGGLUTINATION TEST BOTH IP/OP $136.00 $101.00 $5.32 $136.00 $20.88 $20.88 $20.88 $20.88 $10.64 $10.64 $5.32 $5.32 $10.64 $16.15 $16.15 $16.77 $11.79 $15.72 $17.02 $17.02 $80.44 $10.64 $10.64 $10.64 $136.00 $102.00 $10.64 $10.64 $10.64 $59.48 $59.48 $107.71 $10.64 $108.80 $17.56 $14.97 $10.64 $78.88 $136.00 $15.43 $10.64 $11.76 $10.64 N/A N/A 30201726 EAP CPT® 86403 PARTICLE AGGLUTINATION TEST BOTH IP/OP $99.00 $73.50 $5.19 $99.00 $20.00 $20.00 $20.00 $20.00 $11.54 $11.54 $5.77 $5.19 $11.54 $15.48 $15.48 $16.07 $11.30 $11.75 $18.46 $18.46 $58.56 $11.54 $11.54 $11.54 $99.00 $74.25 $11.54 $11.54 $11.54 $56.96 $56.96 $78.41 $11.54 $79.20 $19.04 $11.19 $11.54 $57.42 $99.00 $16.73 $11.54 $8.79 $11.54 N/A N/A 30201727 EAP CPT® 88342 IMMUNOHISTOCHEMISTRY BOTH IP/OP $275.00 $203.50 $43.77 $234.73 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $162.66 $146.71 $66.63 $146.71 $154.04 $206.25 $146.71 $146.71 $146.71 $212.92 $212.92 $217.80 $146.71 $220.00 $178.75 $80.08 $146.71 $159.50 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 30201728 EAP CPT® 88360 TUMOR IMMUNOHISTOCHEM/MANUAL BOTH IP/OP $638.00 $472.50 $49.88 $510.40 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $377.38 $146.71 $78.13 $146.71 $154.04 $478.50 $146.71 $146.71 $146.71 $242.68 $242.68 $505.30 $146.71 $510.40 $414.70 $109.25 $146.71 $370.04 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 30201729 EAP CPT® 86256 FLUORESCENT ANTIBODY TITER BOTH IP/OP $131.00 $97.00 $6.03 $131.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $77.49 $12.05 $12.05 $12.05 $131.00 $98.25 $12.05 $12.05 $12.05 $67.36 $67.36 $103.75 $12.05 $104.80 $19.88 $16.96 $12.05 $75.98 $131.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201730 EAP CPT® 88368 INSITU HYBRIDIZATION MANUAL BOTH IP/OP $454.00 $336.00 $58.22 $467.58 $169.58 $169.58 $169.58 $169.58 $286.49 $286.49 $285.22 $58.22 $286.49 $151.36 $151.36 $157.18 $110.49 $199.20 $458.39 $467.58 $268.54 $286.49 $102.49 $286.49 $300.82 $340.50 $286.49 $286.49 $286.49 $415.48 $415.48 $359.57 $286.49 $363.20 $295.10 $189.71 $286.49 $263.32 $300.82 $414.48 $286.49 $149.02 $286.49 N/A N/A 30201731 EAP CPT® 88342 IMMUNOHISTOCHEMISTRY BOTH IP/OP $556.00 $411.50 $43.77 $444.80 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $328.87 $146.71 $66.63 $146.71 $154.04 $417.00 $146.71 $146.71 $146.71 $212.92 $212.92 $440.35 $146.71 $444.80 $361.40 $80.08 $146.71 $322.48 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 30201735 EAP CPT® 86022 NAIT PLATELET AB (SO) BOTH IP/OP $361.00 $267.50 $9.19 $361.00 $361.00 $361.00 $361.00 $361.00 $18.37 $18.37 $9.19 $361.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $361.00 $18.37 $18.37 $18.37 $361.00 $270.75 $18.37 $18.37 $18.37 $102.64 $102.64 $285.91 $18.37 $288.80 $361.00 $361.00 $18.37 $209.38 $361.00 $26.64 $18.37 $361.00 $18.37 N/A N/A 30201736 EAP CPT® 86255 FLUORESCENT ANTIBODY SCREEN BOTH IP/OP $27.00 $20.00 $6.03 $27.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $15.97 $12.05 $12.05 $12.05 $27.00 $20.25 $12.05 $12.05 $12.05 $27.00 $27.00 $21.38 $12.05 $21.60 $19.88 $16.96 $12.05 $15.66 $27.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201737 EAP CPT® 86727 LYMPH CHORIOMENINGITIS AB BOTH IP/OP $19.00 $14.50 $6.44 $20.59 $19.00 $19.00 $19.00 $19.00 $12.87 $12.87 $6.44 $19.00 $12.87 $19.54 $19.54 $20.29 $14.27 $19.00 $20.59 $20.59 $19.00 $12.87 $12.87 $12.87 $19.00 $14.25 $12.87 $12.87 $12.87 $19.00 $19.00 $15.05 $12.87 $15.20 $19.00 $19.00 $12.87 $11.02 $19.00 $18.66 $12.87 $19.00 $12.87 N/A N/A 30201738 EAP CPT® 84181 WESTERN BLOT TEST BOTH IP/OP $316.00 $234.00 $8.52 $316.00 $316.00 $316.00 $316.00 $316.00 $17.03 $17.03 $8.52 $316.00 $17.03 $25.86 $25.86 $26.86 $18.88 $25.16 $27.25 $27.25 $316.00 $17.03 $17.03 $17.03 $316.00 $237.00 $17.03 $17.03 $17.03 $95.20 $95.20 $250.27 $17.03 $252.80 $316.00 $316.00 $17.03 $183.28 $316.00 $24.69 $17.03 $316.00 $17.03 N/A N/A 30201750 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $337.00 $249.50 $8.39 $337.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $199.34 $18.64 $18.64 $18.64 $337.00 $252.75 $18.64 $18.64 $18.64 $67.28 $67.28 $266.90 $18.64 $269.60 $30.76 $16.94 $18.64 $195.46 $337.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201754 EAP CPT® 82985 GLYCATED PROTEIN BOTH IP/OP $148.00 $110.00 $7.54 $148.00 $29.59 $29.59 $29.59 $29.59 $16.76 $16.76 $8.38 $7.54 $16.76 $22.89 $22.89 $23.77 $16.71 $22.26 $26.82 $26.82 $87.54 $16.76 $16.76 $16.76 $148.00 $111.00 $16.76 $16.76 $16.76 $84.24 $84.24 $117.22 $16.76 $118.40 $27.65 $21.20 $16.76 $85.84 $148.00 $24.30 $16.76 $16.65 $16.76 N/A N/A 30201758 EAP CPT® 83519 RIA NONANTIBODY BOTH IP/OP $82.00 $61.00 $8.28 $82.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $48.50 $18.40 $18.40 $18.40 $82.00 $61.50 $18.40 $18.40 $18.40 $75.52 $75.52 $64.94 $18.40 $65.60 $30.36 $19.01 $18.40 $47.56 $82.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30201759 EAP CPT® 86255 FLUORESCENT ANTIBODY SCREEN BOTH IP/OP $35.00 $26.00 $6.03 $35.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $20.70 $12.05 $12.05 $12.05 $35.00 $26.25 $12.05 $12.05 $12.05 $35.00 $35.00 $27.72 $12.05 $28.00 $19.88 $16.96 $12.05 $20.30 $35.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201760 EAP CPT® 86256 FLUORESCENT ANTIBODY TITER BOTH IP/OP $35.00 $26.00 $6.03 $35.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $20.70 $12.05 $12.05 $12.05 $35.00 $26.25 $12.05 $12.05 $12.05 $35.00 $35.00 $27.72 $12.05 $28.00 $19.88 $16.96 $12.05 $20.30 $35.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201761 EAP CPT® 86003 ALLERGEN SPECIFIC IGE BOTH IP/OP $104.00 $77.00 $2.61 $104.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $61.52 $5.22 $5.22 $5.22 $104.00 $78.00 $5.22 $5.22 $5.22 $29.20 $29.20 $82.37 $5.22 $83.20 $8.61 $7.35 $5.22 $60.32 $104.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30201762 EAP CPT® 83519 RIA NONANTIBODY BOTH IP/OP $359.00 $266.00 $8.28 $359.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $212.35 $18.40 $18.40 $18.40 $359.00 $269.25 $18.40 $18.40 $18.40 $75.52 $75.52 $284.33 $18.40 $287.20 $30.36 $19.01 $18.40 $208.22 $359.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30201766 EAP CPT® 87186 MICROBE SUSCEPTIBLE MIC BOTH IP/OP $271.00 $201.00 $4.32 $271.00 $16.97 $16.97 $16.97 $16.97 $8.65 $8.65 $4.33 $4.32 $8.65 $13.12 $13.12 $13.63 $9.58 $12.77 $13.84 $13.84 $160.30 $8.65 $8.65 $8.65 $271.00 $203.25 $8.65 $8.65 $8.65 $48.32 $48.32 $214.63 $8.65 $216.80 $14.27 $12.16 $8.65 $157.18 $271.00 $12.54 $8.65 $9.55 $8.65 N/A N/A 30201767 EAP CPT® 83520 IMMUNOASSAY QUANT NOS NONAB BOTH IP/OP $504.00 $373.00 $7.77 $504.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $298.12 $17.27 $17.27 $17.27 $504.00 $378.00 $17.27 $17.27 $17.27 $72.36 $72.36 $399.17 $17.27 $403.20 $28.50 $18.21 $17.27 $292.32 $504.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30201768 EAP CPT® 82107 ALPHA-FETOPROTEIN 13 BOTH IP/OP $276.00 $204.50 $32.21 $276.00 $276.00 $276.00 $276.00 $276.00 $64.41 $64.41 $32.21 $276.00 $64.41 $97.80 $97.80 $101.56 $71.39 $95.14 $103.06 $103.06 $276.00 $64.41 $64.41 $64.41 $276.00 $207.00 $64.41 $64.41 $64.41 $276.00 $276.00 $218.59 $64.41 $220.80 $276.00 $276.00 $64.41 $160.08 $276.00 $93.39 $64.41 $276.00 $64.41 N/A N/A 30201769 EAP CPT® 87496 DETECTION CYTOMEGALOVIRUS (CMV) AMPLIFIED PROBE TQ BOTH IP/OP $212.00 $157.00 $17.55 $212.00 $212.00 $212.00 $212.00 $212.00 $35.09 $35.09 $17.55 $212.00 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $212.00 $35.09 $35.09 $35.09 $212.00 $159.00 $35.09 $35.09 $35.09 $109.64 $109.64 $167.90 $35.09 $169.60 $212.00 $212.00 $35.09 $122.96 $212.00 $50.88 $35.09 $212.00 $35.09 N/A N/A 30201770 EAP CPT® 82374 ASSAY BLOOD CARBON DIOXIDE BOTH IP/OP $91.00 $67.50 $2.44 $91.00 $91.00 $91.00 $91.00 $91.00 $4.88 $4.88 $2.44 $91.00 $4.88 $7.43 $7.43 $7.71 $5.42 $7.22 $7.81 $7.81 $91.00 $4.88 $4.88 $4.88 $91.00 $68.25 $4.88 $4.88 $4.88 $27.32 $27.32 $72.07 $4.88 $72.80 $91.00 $91.00 $4.88 $52.78 $91.00 $7.08 $4.88 $91.00 $4.88 N/A N/A 30201771 EAP CPT® 86255 FLUORESCENT ANTIBODY SCREEN BOTH IP/OP $55.00 $41.00 $6.03 $55.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $32.53 $12.05 $12.05 $12.05 $55.00 $41.25 $12.05 $12.05 $12.05 $55.00 $55.00 $43.56 $12.05 $44.00 $19.88 $16.96 $12.05 $31.90 $55.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201772 EAP CPT® 86256 FLUORESCENT ANTIBODY TITER BOTH IP/OP $55.00 $41.00 $6.03 $55.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $32.53 $12.05 $12.05 $12.05 $55.00 $41.25 $12.05 $12.05 $12.05 $55.00 $55.00 $43.56 $12.05 $44.00 $19.88 $16.96 $12.05 $31.90 $55.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201773 EAP CPT® 82310 ASSAY OF CALCIUM BOTH IP/OP $35.00 $26.00 $2.58 $35.00 $10.14 $10.14 $10.14 $10.14 $5.16 $5.16 $2.58 $2.58 $5.16 $7.83 $7.83 $8.13 $5.72 $7.46 $8.26 $8.26 $20.70 $5.16 $5.16 $5.16 $35.00 $26.25 $5.16 $5.16 $5.16 $28.80 $28.80 $27.72 $5.16 $28.00 $8.51 $7.10 $5.16 $20.30 $35.00 $7.48 $5.16 $5.58 $5.16 N/A N/A 30201774 EAP CPT® 83970 ASSAY OF PARATHORMONE BOTH IP/OP $71.00 $53.00 $20.64 $71.00 $71.00 $71.00 $71.00 $71.00 $41.28 $41.28 $20.64 $20.64 $41.28 $62.68 $62.68 $65.09 $45.76 $60.97 $66.05 $66.05 $42.00 $41.28 $41.28 $41.28 $71.00 $53.25 $41.28 $41.28 $41.28 $71.00 $71.00 $56.23 $41.28 $56.80 $68.11 $58.07 $41.28 $41.18 $71.00 $59.86 $41.28 $45.61 $41.28 N/A N/A 30201786 EAP CPT® 84146 ASSAY OF PROLACTIN BOTH IP/OP $73.00 $54.50 $9.69 $73.00 $38.03 $38.03 $38.03 $38.03 $19.38 $19.38 $9.69 $9.69 $19.38 $29.43 $29.43 $30.56 $21.49 $28.63 $31.01 $31.01 $43.18 $19.38 $19.38 $19.38 $73.00 $54.75 $19.38 $19.38 $19.38 $73.00 $73.00 $57.82 $19.38 $58.40 $31.98 $27.27 $19.38 $42.34 $73.00 $28.10 $19.38 $21.42 $19.38 N/A N/A 30201789 EAP CPT® 83520 IMMUNOASSAY QUANT NOS NONAB BOTH IP/OP $346.00 $256.50 $7.77 $346.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $204.66 $17.27 $17.27 $17.27 $346.00 $259.50 $17.27 $17.27 $17.27 $72.36 $72.36 $274.03 $17.27 $276.80 $28.50 $18.21 $17.27 $200.68 $346.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30201790 EAP CPT® 87798 DETECT AGENT NOS DNA AMP BOTH IP/OP $262.00 $194.00 $17.55 $262.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $154.97 $35.09 $35.09 $35.09 $262.00 $196.50 $35.09 $35.09 $35.09 $109.64 $109.64 $207.50 $35.09 $209.60 $57.90 $27.60 $35.09 $151.96 $262.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30201793 EAP CPT® 86698 HISTOPLASMA BOTH IP/OP $26.00 $19.50 $6.90 $26.00 $26.00 $26.00 $26.00 $26.00 $13.79 $13.79 $6.90 $26.00 $13.79 $18.98 $18.98 $19.71 $13.86 $18.46 $22.06 $22.06 $26.00 $13.79 $13.79 $13.79 $26.00 $19.50 $13.79 $13.79 $13.79 $26.00 $26.00 $20.59 $13.79 $20.80 $26.00 $26.00 $13.79 $15.08 $26.00 $20.00 $13.79 $26.00 $13.79 N/A N/A 30201797 EAP CPT® 86611 BARTONELLA ANTIBODY BOTH IP/OP $78.00 $58.00 $5.09 $78.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $46.14 $10.18 $10.18 $10.18 $78.00 $58.50 $10.18 $10.18 $10.18 $56.88 $56.88 $61.78 $10.18 $62.40 $16.80 $14.32 $10.18 $45.24 $78.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30201798 EAP CPT® 86768 SALMONELLA ANTIBODY BOTH IP/OP $47.00 $35.00 $6.60 $47.00 $47.00 $47.00 $47.00 $47.00 $13.19 $13.19 $6.60 $47.00 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $47.00 $13.19 $13.19 $13.19 $47.00 $35.25 $13.19 $13.19 $13.19 $47.00 $47.00 $37.22 $13.19 $37.60 $47.00 $47.00 $13.19 $27.26 $47.00 $19.13 $13.19 $47.00 $13.19 N/A N/A 30201801 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $212.00 $157.00 $8.39 $212.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $125.40 $18.64 $18.64 $18.64 $212.00 $159.00 $18.64 $18.64 $18.64 $67.28 $67.28 $167.90 $18.64 $169.60 $30.76 $16.94 $18.64 $122.96 $212.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201802 EAP CPT® 87798 DETECT AGENT NOS DNA AMP BOTH IP/OP $438.00 $324.50 $17.55 $438.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $259.08 $35.09 $35.09 $35.09 $438.00 $328.50 $35.09 $35.09 $35.09 $109.64 $109.64 $346.90 $35.09 $350.40 $57.90 $27.60 $35.09 $254.04 $438.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30201816 EAP CPT® 83519 RIA NONANTIBODY BOTH IP/OP $496.00 $367.50 $8.28 $496.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $293.38 $18.40 $18.40 $18.40 $496.00 $372.00 $18.40 $18.40 $18.40 $75.52 $75.52 $392.83 $18.40 $396.80 $30.36 $19.01 $18.40 $287.68 $496.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30201817 EAP CPT® 80299 QUANTITATIVE ASSAY DRUG BOTH IP/OP $369.00 $273.50 $8.39 $369.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $218.26 $18.64 $18.64 $18.64 $369.00 $276.75 $18.64 $18.64 $18.64 $67.28 $67.28 $292.25 $18.64 $295.20 $30.76 $16.94 $18.64 $214.02 $369.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30201818 EAP CPT® 87906 GENOTYPE DNA HIV REVERSE T BOTH IP/OP $679.00 $502.50 $43.14 $679.00 $85.59 $85.59 $85.59 $85.59 $128.73 $128.73 $64.37 $64.36 $128.73 $63.81 $63.81 $66.27 $46.58 $57.67 $205.97 $205.97 $401.63 $128.73 $128.73 $128.73 $679.00 $509.25 $128.73 $128.73 $128.73 $339.50 $339.50 $537.77 $128.73 $543.20 $212.40 $54.92 $128.73 $393.82 $679.00 $186.66 $128.73 $43.14 $128.73 N/A N/A 30201819 EAP CPT® 86727 LYMPH CHORIOMENINGITIS AB BOTH IP/OP $96.00 $71.50 $6.44 $96.00 $96.00 $96.00 $96.00 $96.00 $12.87 $12.87 $6.44 $96.00 $12.87 $19.54 $19.54 $20.29 $14.27 $19.01 $20.59 $20.59 $96.00 $12.87 $12.87 $12.87 $96.00 $72.00 $12.87 $12.87 $12.87 $71.92 $71.92 $76.03 $12.87 $76.80 $96.00 $96.00 $12.87 $55.68 $96.00 $18.66 $12.87 $96.00 $12.87 N/A N/A 30201820 EAP CPT® 87906 GENOTYPE DNA HIV REVERSE T BOTH IP/OP "$1,376.00" "$1,018.50" $43.14 "$1,376.00" $85.59 $85.59 $85.59 $85.59 $128.73 $128.73 $64.37 $64.36 $128.73 $63.81 $63.81 $66.27 $46.58 $57.67 $205.97 $205.97 $813.90 $128.73 $128.73 $128.73 "$1,376.00" "$1,032.00" $128.73 $128.73 $128.73 $688.00 $688.00 "$1,089.79" $128.73 "$1,100.80" $212.40 $54.92 $128.73 $798.08 "$1,376.00" $186.66 $128.73 $43.14 $128.73 N/A N/A 30201821 EAP CPT® 88365 EBV ISH W/INTERP (SO) BOTH IP/OP $574.00 $425.00 $74.59 $574.00 $574.00 $574.00 $574.00 $574.00 $138.77 $138.77 $92.77 $574.00 $138.77 $102.18 $102.18 $106.11 $74.59 $103.59 $222.03 $223.50 $574.00 $138.77 $139.69 $138.77 $574.00 $430.50 $138.77 $138.77 $138.77 $313.80 $313.80 $454.61 $138.77 $459.20 $373.10 $574.00 $138.77 $332.92 $574.00 $137.95 $138.77 $574.00 $138.77 N/A N/A 30201822 EAP CPT® 88365 EBV ISH W/O INTERP (SO) BOTH IP/OP $574.00 $425.00 $74.59 $574.00 $574.00 $574.00 $574.00 $574.00 $138.77 $138.77 $92.77 $574.00 $138.77 $102.18 $102.18 $106.11 $74.59 $103.59 $222.03 $223.50 $574.00 $138.77 $139.69 $138.77 $574.00 $430.50 $138.77 $138.77 $138.77 $313.80 $313.80 $454.61 $138.77 $459.20 $373.10 $574.00 $138.77 $332.92 $574.00 $137.95 $138.77 $574.00 $138.77 N/A N/A 30201823 EAP CPT® 88275 FISH BURKITT NHL T(8;14)(SO) BOTH IP/OP $620.00 $459.00 $23.04 $620.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $366.73 $51.19 $51.19 $51.19 $620.00 $465.00 $51.19 $51.19 $51.19 $224.44 $224.44 $491.04 $51.19 $496.00 $84.46 $56.50 $51.19 $359.60 $620.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30201824 EAP CPT® 88271 FISH BURKITT DNA PROBE (SO) BOTH IP/OP $404.00 $299.00 $10.71 $404.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $238.97 $21.42 $21.42 $21.42 $404.00 $303.00 $21.42 $21.42 $21.42 $119.72 $119.72 $319.97 $21.42 $323.20 $35.34 $30.14 $21.42 $234.32 $404.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30201825 EAP CPT® 87902 HCV RNA GENOTYPE 1 NS5B (SO) BOTH IP/OP "$1,200.00" $888.00 $96.38 "$1,200.00" $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $132.42 $132.42 $137.52 $96.67 $128.84 $411.92 $411.92 $709.80 $257.45 $257.45 $257.45 "$1,200.00" $900.00 $257.45 $257.45 $257.45 $487.40 $487.40 $950.40 $257.45 $960.00 $424.79 $122.70 $257.45 $696.00 "$1,200.00" $373.30 $257.45 $96.38 $257.45 N/A N/A 30201834 EAP CPT® 82656 PANCREATIC ELASTASE FECAL BOTH IP/OP $273.00 $202.50 $5.76 $273.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $56.90 $18.45 $18.45 $161.48 $11.53 $11.53 $11.53 $273.00 $204.75 $11.53 $11.53 $11.53 $59.76 $59.76 $216.22 $11.53 $218.40 $19.02 $54.18 $11.53 $158.34 $273.00 $16.72 $11.53 $56.89 $11.53 N/A N/A 30201835 EAP CPT® 87798 DETECT AGENT NOS DNA AMP BOTH IP/OP $252.00 $186.50 $17.55 $252.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $149.06 $35.09 $35.09 $35.09 $252.00 $189.00 $35.09 $35.09 $35.09 $109.64 $109.64 $199.58 $35.09 $201.60 $57.90 $27.60 $35.09 $146.16 $252.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30201836 EAP CPT® 86356 MONONUCLEAR CELL ANTIGEN BOTH IP/OP $146.00 $108.50 $13.39 $146.00 $146.00 $146.00 $146.00 $146.00 $26.78 $26.78 $13.39 $146.00 $26.78 $39.63 $39.63 $41.16 $28.93 $38.57 $42.85 $42.85 $146.00 $26.78 $26.78 $26.78 $146.00 $109.50 $26.78 $26.78 $26.78 $73.00 $73.00 $115.63 $26.78 $116.80 $146.00 $146.00 $26.78 $84.68 $146.00 $38.83 $26.78 $146.00 $26.78 N/A N/A 30201837 EAP CPT® 86355 CELLS TOTAL COUNT BOTH IP/OP $49.00 $36.50 $18.86 $62.25 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $28.98 $37.73 $37.73 $37.73 $49.00 $36.75 $37.73 $37.73 $37.73 $49.00 $49.00 $38.81 $37.73 $39.20 $62.25 $33.14 $37.73 $28.42 $49.00 $49.00 $37.73 $26.03 $37.73 N/A N/A 30201838 EAP CPT® 86359 CELLS TOTAL COUNT BOTH IP/OP $49.00 $36.50 $18.86 $62.25 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $28.98 $37.73 $37.73 $37.73 $49.00 $36.75 $37.73 $37.73 $37.73 $49.00 $49.00 $38.81 $37.73 $39.20 $62.25 $33.14 $37.73 $28.42 $49.00 $49.00 $37.73 $26.03 $37.73 N/A N/A 30201839 EAP CPT® 88365 INSTITU HYBRIDIZATION (FISH) BOTH IP/OP $262.00 $194.00 $74.59 $262.00 $262.00 $262.00 $262.00 $262.00 $138.77 $138.77 $92.77 $262.00 $138.77 $102.18 $102.18 $106.11 $74.59 $103.59 $222.03 $223.50 $262.00 $138.77 $139.69 $138.77 $262.00 $196.50 $138.77 $138.77 $138.77 $262.00 $262.00 $207.50 $138.77 $209.60 $170.30 $262.00 $138.77 $151.96 $262.00 $137.95 $138.77 $262.00 $138.77 N/A N/A 30201840 EAP CPT® 86808 CYTOTOXIC ANTIBODY SCREENING BOTH IP/OP $325.00 $240.50 $14.84 $325.00 $325.00 $325.00 $325.00 $325.00 $29.68 $29.68 $14.84 $325.00 $29.68 $45.06 $45.06 $46.80 $32.90 $43.84 $47.49 $47.49 $325.00 $29.68 $29.68 $29.68 $325.00 $243.75 $29.68 $29.68 $29.68 $165.88 $165.88 $257.40 $29.68 $260.00 $325.00 $325.00 $29.68 $188.50 $325.00 $43.04 $29.68 $325.00 $29.68 N/A N/A 30201841 EAP CPT® 86816 HLA TYPING DR/DQ BOTH IP/OP $344.00 $255.00 $15.09 $344.00 $344.00 $344.00 $344.00 $344.00 $30.17 $30.17 $15.09 $344.00 $30.17 $42.30 $42.30 $43.92 $30.88 $41.15 $48.27 $48.27 $344.00 $30.17 $30.17 $30.17 $344.00 $258.00 $30.17 $30.17 $30.17 $155.68 $155.68 $272.45 $30.17 $275.20 $344.00 $344.00 $30.17 $199.52 $344.00 $43.75 $30.17 $344.00 $30.17 N/A N/A 30201842 EAP CPT® 86255 FLUORESCENT ANTIBODY SCREEN BOTH IP/OP $25.00 $18.50 $6.03 $25.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $14.79 $12.05 $12.05 $12.05 $25.00 $18.75 $12.05 $12.05 $12.05 $25.00 $25.00 $19.80 $12.05 $20.00 $19.88 $16.96 $12.05 $14.50 $25.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201843 EAP CPT® 86256 FLUORESCENT ANTIBODY TITER BOTH IP/OP $25.00 $18.50 $6.03 $25.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $14.79 $12.05 $12.05 $12.05 $25.00 $18.75 $12.05 $12.05 $12.05 $25.00 $25.00 $19.80 $12.05 $20.00 $19.88 $16.96 $12.05 $14.50 $25.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201844 EAP CPT® 86003 ALLERGEN SPECIFIC IGE BOTH IP/OP $407.00 $301.50 $2.61 $407.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $240.74 $5.22 $5.22 $5.22 $407.00 $305.25 $5.22 $5.22 $5.22 $29.20 $29.20 $322.34 $5.22 $325.60 $8.61 $7.35 $5.22 $236.06 $407.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30201845 EAP CPT® 86317 "IMMUNOASSAY FOR INFECTIOUS AGENT,AB,QUANT" BOTH IP/OP $31.00 $23.00 $7.49 $31.00 $23.57 $23.57 $23.57 $23.57 $14.99 $14.99 $7.50 $7.49 $14.99 $18.22 $18.22 $18.92 $13.30 $17.72 $23.98 $23.98 $18.34 $14.99 $14.99 $14.99 $31.00 $23.25 $14.99 $14.99 $14.99 $31.00 $31.00 $24.55 $14.99 $24.80 $24.73 $16.88 $14.99 $17.98 $31.00 $21.74 $14.99 $13.26 $14.99 N/A N/A 30201846 EAP CPT® 86001 ALLERGEN SPECIFIC IGG QUANT BOTH IP/OP $140.00 $104.00 $3.91 $140.00 $140.00 $140.00 $140.00 $140.00 $7.82 $7.82 $3.91 $140.00 $7.82 $7.92 $7.92 $8.23 $5.79 $7.72 $12.51 $12.51 $140.00 $7.82 $7.82 $7.82 $140.00 $105.00 $7.82 $7.82 $7.82 $29.20 $29.20 $110.88 $7.82 $112.00 $140.00 $140.00 $7.82 $81.20 $140.00 $11.34 $7.82 $140.00 $7.82 N/A N/A 30201847 EAP CPT® 86003 ALLERGEN SPECIFIC IGE BOTH IP/OP $140.00 $104.00 $2.61 $140.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $82.81 $5.22 $5.22 $5.22 $140.00 $105.00 $5.22 $5.22 $5.22 $29.20 $29.20 $110.88 $5.22 $112.00 $8.61 $7.35 $5.22 $81.20 $140.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30201848 EAP CPT® 86147 ANTI-CARDIOLIPIN IGG BOTH IP/OP $581.00 $430.00 $12.73 $581.00 $49.95 $49.95 $49.95 $49.95 $25.45 $25.45 $12.73 $12.73 $25.45 $38.63 $38.63 $40.11 $28.20 $37.58 $40.72 $40.72 $343.66 $25.45 $25.45 $25.45 $581.00 $435.75 $25.45 $25.45 $25.45 $142.16 $142.16 $460.15 $25.45 $464.80 $41.99 $35.79 $25.45 $336.98 $581.00 $36.90 $25.45 $28.11 $25.45 N/A N/A 30201849 EAP CPT® 86147 ANTI-CARDIOLIPIN IGM BOTH IP/OP $581.00 $430.00 $12.73 $581.00 $49.95 $49.95 $49.95 $49.95 $25.45 $25.45 $12.73 $12.73 $25.45 $38.63 $38.63 $40.11 $28.20 $37.58 $40.72 $40.72 $343.66 $25.45 $25.45 $25.45 $581.00 $435.75 $25.45 $25.45 $25.45 $142.16 $142.16 $460.15 $25.45 $464.80 $41.99 $35.79 $25.45 $336.98 $581.00 $36.90 $25.45 $28.11 $25.45 N/A N/A 30201850 EAP CPT® 86757 RMSF IGM TITER BOTH IP/OP $131.00 $97.00 $9.68 $131.00 $131.00 $131.00 $131.00 $131.00 $19.35 $19.35 $9.68 $131.00 $19.35 $29.39 $29.39 $30.52 $21.45 $28.60 $30.96 $30.96 $131.00 $19.35 $19.35 $19.35 $131.00 $98.25 $19.35 $19.35 $19.35 $108.20 $108.20 $103.75 $19.35 $104.80 $131.00 $131.00 $19.35 $75.98 $131.00 $28.06 $19.35 $131.00 $19.35 N/A N/A 30201856 EAP CPT® 81342 T-CELL REARRANGEMENT- PCR (RQD) BOTH IP/OP $667.00 $494.00 $100.75 $667.00 $667.00 $667.00 $667.00 $667.00 $201.50 $201.50 $100.75 $667.00 $201.50 $285.90 $285.90 $296.89 $208.70 $192.65 $322.40 $322.40 $667.00 $201.50 $201.50 $201.50 $667.00 $500.25 $201.50 $201.50 $201.50 $333.50 $333.50 $528.26 $201.50 $533.60 $667.00 $667.00 $201.50 $386.86 $667.00 $292.18 $201.50 $667.00 $201.50 N/A N/A 30201865 EAP Custom 30201865 BCR/ABL T(9;22) FISH (GEN) BOTH IP/OP $663.00 $491.00 $118.01 $663.00 $663.00 $663.00 $663.00 $663.00 $663.00 $663.00 $118.01 $663.00 $663.00 $492.08 $492.08 $511.04 $345.42 $138.18 $663.00 $265.20 $663.00 $663.00 $663.00 $663.00 $663.00 $497.25 $663.00 $663.00 $663.00 $331.50 $331.50 $525.10 $663.00 $530.40 $430.95 $663.00 $663.00 $384.54 $663.00 $397.80 $663.00 $663.00 $663.00 N/A N/A 30201869 EAP CPT® 81275 KRAS GENE MUTATION DETECTION (RQD) BOTH IP/OP $952.00 $704.50 $86.96 $952.00 $284.08 $284.08 $284.08 $284.08 $193.25 $193.25 $96.63 $86.96 $193.25 $205.38 $205.38 $213.28 $149.93 $220.85 $309.20 $309.20 $563.11 $193.25 $193.25 $193.25 $952.00 $714.00 $193.25 $193.25 $193.25 $476.00 $476.00 $753.98 $193.25 $761.60 $318.86 $210.33 $193.25 $552.16 $952.00 $280.21 $193.25 $165.21 $193.25 N/A N/A 30201879 EAP CPT® 87906 "INTEGRASE, QUEST" BOTH IP/OP $793.00 $587.00 $43.14 $793.00 $85.59 $85.59 $85.59 $85.59 $128.73 $128.73 $64.37 $64.36 $128.73 $63.81 $63.81 $66.27 $46.58 $57.67 $205.97 $205.97 $469.06 $128.73 $128.73 $128.73 $793.00 $594.75 $128.73 $128.73 $128.73 $396.50 $396.50 $628.06 $128.73 $634.40 $212.40 $54.92 $128.73 $459.94 $793.00 $186.66 $128.73 $43.14 $128.73 N/A N/A 30201900 EAP CPT® 87999 "TROFILE, DNA MONOGRAM -QUEST" BOTH IP/OP "$3,182.00" "$2,355.00" $240.40 "$3,182.00" "$3,182.00" "$3,182.00" "$3,182.00" "$3,182.00" "$3,182.00" "$3,182.00" "$3,182.00" "$3,182.00" "$3,182.00" "$2,361.68" "$2,361.68" "$2,452.69" "$1,657.82" $663.16 "$3,182.00" $240.40 "$3,182.00" "$3,182.00" $601.00 "$3,182.00" "$3,182.00" "$2,386.50" "$3,182.00" "$3,182.00" "$3,182.00" "$3,182.00" "$3,182.00" "$2,520.14" "$3,182.00" "$2,545.60" "$2,068.30" "$3,182.00" "$3,182.00" "$1,845.56" "$3,182.00" "$1,909.20" "$3,182.00" "$3,182.00" "$3,182.00" N/A N/A 30201914 EAP CPT® 81342 T-CELL REARRANGEMENT-PCR QD BOTH IP/OP $667.00 $494.00 $100.75 $667.00 $667.00 $667.00 $667.00 $667.00 $201.50 $201.50 $100.75 $667.00 $201.50 $285.90 $285.90 $296.89 $208.70 $192.65 $322.40 $322.40 $667.00 $201.50 $201.50 $201.50 $667.00 $500.25 $201.50 $201.50 $201.50 $333.50 $333.50 $528.26 $201.50 $533.60 $667.00 $667.00 $201.50 $386.86 $667.00 $292.18 $201.50 $667.00 $201.50 N/A N/A 30201926 EAP CPT® 81275 KRAS GENE MUTATION DETECT(RQD) BOTH IP/OP $823.00 $609.50 $86.96 $823.00 $284.08 $284.08 $284.08 $284.08 $193.25 $193.25 $96.63 $86.96 $193.25 $205.38 $205.38 $213.28 $149.93 $220.85 $309.20 $309.20 $486.80 $193.25 $193.25 $193.25 $823.00 $617.25 $193.25 $193.25 $193.25 $411.50 $411.50 $651.82 $193.25 $658.40 $318.86 $210.33 $193.25 $477.34 $823.00 $280.21 $193.25 $165.21 $193.25 N/A N/A 30201933 EAP CPT® 81270 JAK2 V617F MUTATION QUANT (SO) BOTH IP/OP $981.00 $726.00 $45.83 $981.00 $179.89 $179.89 $179.89 $179.89 $91.66 $91.66 $45.83 $45.83 $91.66 $130.06 $130.06 $135.06 $94.94 $84.58 $146.66 $146.66 $580.26 $91.66 $91.66 $91.66 $981.00 $735.75 $91.66 $91.66 $91.66 $490.50 $490.50 $776.95 $91.66 $784.80 $151.24 $80.55 $91.66 $568.98 $981.00 $132.91 $91.66 $63.27 $91.66 N/A N/A 30201934 EAP CPT® 87906 "INTEGRASE, QUEST" BOTH IP/OP $649.00 $480.50 $43.14 $649.00 $85.59 $85.59 $85.59 $85.59 $128.73 $128.73 $64.37 $64.36 $128.73 $63.81 $63.81 $66.27 $46.58 $57.67 $205.97 $205.97 $383.88 $128.73 $128.73 $128.73 $649.00 $486.75 $128.73 $128.73 $128.73 $324.50 $324.50 $514.01 $128.73 $519.20 $212.40 $54.92 $128.73 $376.42 $649.00 $186.66 $128.73 $43.14 $128.73 N/A N/A 30201936 EAP CPT® 81402 MPL ANAL MUTATION ANAL (RQD) BOTH IP/OP "$1,430.00" "$1,058.50" $75.17 "$1,430.00" "$1,430.00" "$1,430.00" "$1,430.00" "$1,430.00" $150.33 $150.33 $75.17 "$1,430.00" $150.33 "$1,061.35" "$1,061.35" "$1,102.24" $745.03 $192.65 $240.53 $240.53 "$1,430.00" $150.33 $150.33 $150.33 "$1,430.00" "$1,072.50" $150.33 $150.33 $150.33 $715.00 $715.00 "$1,132.56" $150.33 "$1,144.00" "$1,430.00" "$1,430.00" $150.33 $829.40 "$1,430.00" $217.98 $150.33 "$1,430.00" $150.33 N/A N/A 30201955 EAP CPT® 87999 "TROFILE, DNA MONOGRAM -QUEST" BOTH IP/OP "$3,030.00" "$2,242.50" $240.40 "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" "$2,248.87" "$2,248.87" "$2,335.52" "$1,578.63" $631.49 "$3,030.00" $240.40 "$3,030.00" "$3,030.00" $601.00 "$3,030.00" "$3,030.00" "$2,272.50" "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" "$2,399.76" "$3,030.00" "$2,424.00" "$1,969.50" "$3,030.00" "$3,030.00" "$1,757.40" "$3,030.00" "$1,818.00" "$3,030.00" "$3,030.00" "$3,030.00" N/A N/A 30201958 EAP CPT® 86703 FOCUS HIV 1/2 AB SCRN BOTH IP/OP $265.00 $196.50 $6.85 $265.00 $26.91 $26.91 $26.91 $26.91 $18.29 $18.29 $9.15 $6.85 $18.29 $20.82 $20.82 $21.62 $15.20 $17.58 $29.26 $29.26 $156.75 $18.29 $18.29 $18.29 $265.00 $198.75 $18.29 $18.29 $18.29 $76.68 $76.68 $209.88 $18.29 $212.00 $30.18 $16.74 $18.29 $153.70 $265.00 $19.88 $13.71 $13.15 $18.29 N/A N/A 30201959 EAP CPT® 86689 FOCUS HIV WB BOTH IP/OP $388.00 $287.50 $9.68 $388.00 $388.00 $388.00 $388.00 $388.00 $19.35 $19.35 $9.68 $388.00 $19.35 $29.39 $29.39 $30.52 $21.45 $24.81 $30.96 $30.96 $388.00 $19.35 $19.35 $19.35 $388.00 $291.00 $19.35 $19.35 $19.35 $108.20 $108.20 $307.30 $19.35 $310.40 $388.00 $388.00 $19.35 $225.04 $388.00 $28.06 $19.35 $388.00 $19.35 N/A N/A 30201960 EAP CPT® 86360 FOCUS LYMPHOCYTE SUBSETS BOTH IP/OP $495.00 $366.50 $23.49 $495.00 $92.22 $92.22 $92.22 $92.22 $46.98 $46.98 $23.49 $23.49 $46.98 $71.34 $71.34 $74.09 $52.08 $69.42 $75.17 $75.17 $292.79 $46.98 $46.98 $46.98 $495.00 $371.25 $46.98 $46.98 $46.98 $262.60 $262.60 $392.04 $46.98 $396.00 $77.52 $66.11 $46.98 $287.10 $495.00 $68.12 $46.98 $51.93 $46.98 N/A N/A 30201961 EAP CPT® 86317 STREP PNEUMONIAE IGG AB PANEL (SO) BOTH IP/OP $308.00 $228.00 $7.49 $308.00 $23.57 $23.57 $23.57 $23.57 $14.99 $14.99 $7.50 $7.49 $14.99 $18.22 $18.22 $18.92 $13.30 $17.72 $23.98 $23.98 $182.18 $14.99 $14.99 $14.99 $308.00 $231.00 $14.99 $14.99 $14.99 $67.08 $67.08 $243.94 $14.99 $246.40 $24.73 $16.88 $14.99 $178.64 $308.00 $21.74 $14.99 $13.26 $14.99 N/A N/A 30201965 EAP CPT® 81291 MTHFR MUTATION ANALYSIS (SO) BOTH IP/OP $331.00 $245.00 $32.67 $331.00 $331.00 $331.00 $331.00 $331.00 $65.34 $65.34 $32.67 $331.00 $65.34 $61.93 $61.93 $64.31 $45.21 $46.99 $104.54 $104.54 $331.00 $65.34 $65.34 $65.34 $331.00 $248.25 $65.34 $65.34 $65.34 $165.50 $165.50 $262.15 $65.34 $264.80 $331.00 $331.00 $65.34 $191.98 $331.00 $94.74 $65.34 $331.00 $65.34 N/A N/A 30201966 EAP CPT® 81241 FACTOR V LEIDEN MUTATION BOTH IP/OP $331.00 $245.00 $33.02 $331.00 $119.93 $119.93 $119.93 $119.93 $73.37 $73.37 $36.69 $33.02 $73.37 $86.70 $86.70 $90.04 $63.29 $46.99 $117.39 $117.39 $195.79 $73.37 $73.37 $73.37 $331.00 $248.25 $73.37 $73.37 $73.37 $165.50 $165.50 $262.15 $73.37 $264.80 $121.06 $44.75 $73.37 $191.98 $331.00 $106.39 $73.37 $35.15 $73.37 N/A N/A 30201967 EAP CPT® 81240 FACTOR II (PT) GENE MUTATION BOTH IP/OP $331.00 $245.00 $29.56 $331.00 $96.58 $96.58 $96.58 $96.58 $65.69 $65.69 $32.85 $29.56 $65.69 $69.82 $69.82 $72.50 $50.96 $46.99 $105.10 $105.10 $195.79 $65.69 $65.69 $65.69 $331.00 $248.25 $65.69 $65.69 $65.69 $165.50 $165.50 $262.15 $65.69 $264.80 $108.39 $44.75 $65.69 $191.98 $331.00 $95.25 $65.69 $35.15 $65.69 N/A N/A 30201968 EAP CPT® 81220 CYSTIC FIB 97 MUTATION RQD BOTH IP/OP "$1,038.00" $768.50 $250.47 "$1,038.00" $750.49 $750.49 $750.49 $750.49 $556.60 $556.60 $278.30 $250.47 $556.60 $770.40 $770.40 $800.09 $540.80 "$1,038.00" $890.56 $890.56 $613.98 $556.60 $556.60 $556.60 "$1,038.00" $778.50 $556.60 $556.60 $556.60 $519.00 $519.00 $822.10 $556.60 $830.40 $918.39 "$1,038.00" $556.60 $602.04 "$1,038.00" $807.07 $556.60 $843.67 $556.60 N/A N/A 30201974 EAP CPT® 81406 MEN2 (RET) DNA SEQ(ATHENA) BOTH IP/OP "$5,489.00" "$4,062.00" $141.44 "$5,489.00" "$5,489.00" "$5,489.00" "$5,489.00" "$5,489.00" $282.88 $282.88 $141.44 "$5,489.00" $282.88 "$4,073.94" "$4,073.94" "$4,230.92" "$2,060.15" $610.87 $452.61 $452.61 "$5,489.00" $282.88 $282.88 $282.88 "$5,489.00" "$4,116.75" $282.88 $282.88 $282.88 "$2,744.50" "$2,744.50" "$4,347.29" $282.88 "$4,391.20" "$5,489.00" "$5,489.00" $282.88 "$3,183.62" "$5,489.00" $410.18 $282.88 "$5,489.00" $282.88 N/A N/A 30201975 EAP CPT® 81401 HUNTINGTON'S DNA (SO) BOTH IP/OP "$1,288.00" $953.50 $61.65 "$1,288.00" $61.75 $61.75 $61.75 $61.75 $137.00 $137.00 $68.50 $61.65 $137.00 $955.95 $955.95 $992.79 $671.05 $131.58 $219.20 $219.20 $761.85 $137.00 $137.00 $137.00 "$1,288.00" $966.00 $137.00 $137.00 $137.00 $644.00 $644.00 "$1,020.10" $137.00 "$1,030.40" $226.05 $125.31 $137.00 $747.04 "$1,288.00" $198.65 $137.00 $98.43 $137.00 N/A N/A 30201977 EAP CPT® 81256 HERED HEMOCHROM DNA ANAL RQD BOTH IP/OP $575.00 $425.50 $32.68 $575.00 $575.00 $575.00 $575.00 $575.00 $65.36 $65.36 $32.68 $575.00 $65.36 $92.74 $92.74 $96.30 $67.70 $46.99 $104.58 $104.58 $575.00 $65.36 $65.36 $65.36 $575.00 $431.25 $65.36 $65.36 $65.36 $287.50 $287.50 $455.40 $65.36 $460.00 $575.00 $575.00 $65.36 $333.50 $575.00 $94.77 $65.36 $575.00 $65.36 N/A N/A 30201980 EAP CPT® 86003 ALLERGEN SPECIFIC IGE (SO) BOTH IP/OP $40.00 $30.00 $2.61 $40.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $23.66 $5.22 $5.22 $5.22 $40.00 $30.00 $5.22 $5.22 $5.22 $29.20 $29.20 $31.68 $5.22 $32.00 $8.61 $7.35 $5.22 $23.20 $40.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30201983 EAP CPT® 86003 ALLERGEN SPECIFIC (FOOD) IGE (SO) BOTH IP/OP $40.00 $30.00 $2.61 $40.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $23.66 $5.22 $5.22 $5.22 $40.00 $30.00 $5.22 $5.22 $5.22 $29.20 $29.20 $31.68 $5.22 $32.00 $8.61 $7.35 $5.22 $23.20 $40.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30201984 EAP CPT® 86003 ALLERGEN SPECIFIC (ENVIRO) IGE (SO) BOTH IP/OP $40.00 $30.00 $2.61 $40.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $23.66 $5.22 $5.22 $5.22 $40.00 $30.00 $5.22 $5.22 $5.22 $29.20 $29.20 $31.68 $5.22 $32.00 $8.61 $7.35 $5.22 $23.20 $40.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30201985 EAP CPT® 80074 ACUTE HEPATITIS PANEL BOTH IP/OP $890.00 $659.00 $23.82 $890.00 $890.00 $890.00 $890.00 $890.00 $47.63 $47.63 $23.82 $890.00 $47.63 $72.32 $72.32 $75.10 $52.79 $70.35 $76.21 $76.21 $890.00 $47.63 $47.63 $47.63 $890.00 $667.50 $47.63 $47.63 $47.63 $266.16 $266.16 $704.88 $47.63 $712.00 $890.00 $890.00 $47.63 $516.20 $890.00 $69.06 $47.63 $890.00 $47.63 N/A N/A 30201986 EAP CPT® 86790 "HANTAVIRUS ANTIBODY (IGG, IGM) (SO)" BOTH IP/OP $280.00 $207.50 $6.44 $280.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $165.62 $12.88 $12.88 $12.88 $280.00 $210.00 $12.88 $12.88 $12.88 $72.00 $72.00 $221.76 $12.88 $224.00 $21.25 $18.12 $12.88 $162.40 $280.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30201987 EAP CPT® 86332 IMMUNE COMPLEX DETECTION BY C1Q BINDING (SO) BOTH IP/OP $34.00 $25.50 $12.19 $40.21 $34.00 $34.00 $34.00 $34.00 $24.37 $24.37 $12.19 $12.19 $24.37 $37.01 $37.01 $38.44 $27.02 $34.00 $38.99 $38.99 $20.11 $24.37 $24.37 $24.37 $34.00 $25.50 $24.37 $24.37 $24.37 $34.00 $34.00 $26.93 $24.37 $27.20 $40.21 $34.00 $24.37 $19.72 $34.00 $34.00 $24.37 $26.93 $24.37 N/A N/A 30201988 EAP CPT® 86255 AMPA -RECEPTOR ANTIBODY (SO) MAYO BOTH IP/OP $379.00 $280.50 $6.03 $379.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $224.18 $12.05 $12.05 $12.05 $379.00 $284.25 $12.05 $12.05 $12.05 $67.36 $67.36 $300.17 $12.05 $303.20 $19.88 $16.96 $12.05 $219.82 $379.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201989 EAP CPT® 86255 "NMDA -RECEPTOR ANTIBODY, SERUM (MML)" BOTH IP/OP $358.00 $265.00 $6.03 $358.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $211.76 $12.05 $12.05 $12.05 $358.00 $268.50 $12.05 $12.05 $12.05 $67.36 $67.36 $283.54 $12.05 $286.40 $19.88 $16.96 $12.05 $207.64 $358.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30201990 EAP CPT® 86790 "CHIKUNGUNYA ANTIBODIES (IGG, IGM) (SO)" BOTH IP/OP $380.00 $281.50 $6.44 $380.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $224.77 $12.88 $12.88 $12.88 $380.00 $285.00 $12.88 $12.88 $12.88 $72.00 $72.00 $300.96 $12.88 $304.00 $21.25 $18.12 $12.88 $220.40 $380.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30201991 EAP CPT® 86790 "CHIKUNGUNYA ANTIBODIES (IGG, TITRATION) (SO)" BOTH IP/OP $380.00 $281.50 $6.44 $380.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $224.77 $12.88 $12.88 $12.88 $380.00 $285.00 $12.88 $12.88 $12.88 $72.00 $72.00 $300.96 $12.88 $304.00 $21.25 $18.12 $12.88 $220.40 $380.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30201992 EAP CPT® 86790 CHIKUNGUNYA ANTIBODIES (IGM TITRATION) (SO) BOTH IP/OP $380.00 $281.50 $6.44 $380.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $224.77 $12.88 $12.88 $12.88 $380.00 $285.00 $12.88 $12.88 $12.88 $72.00 $72.00 $300.96 $12.88 $304.00 $21.25 $18.12 $12.88 $220.40 $380.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30201993 EAP CPT® 86357 NATURAL KILLER CELLS (SO) BOTH IP/OP $83.00 $61.50 $18.87 $83.00 $83.00 $83.00 $83.00 $83.00 $37.73 $37.73 $18.87 $83.00 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $83.00 $37.73 $37.73 $37.73 $83.00 $62.25 $37.73 $37.73 $37.73 $83.00 $83.00 $65.74 $37.73 $66.40 $83.00 $83.00 $37.73 $48.14 $83.00 $54.71 $37.73 $83.00 $37.73 N/A N/A 30201994 EAP CPT® 83516 MYOSITIS ANTIBODY PANEL (MML) BOTH IP/OP $707.00 $523.50 $5.76 $707.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $418.19 $11.53 $11.53 $11.53 $707.00 $530.25 $11.53 $11.53 $11.53 $59.76 $59.76 $559.94 $11.53 $565.60 $19.02 $15.05 $11.53 $410.06 $707.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30201995 EAP CPT® 82017 "ACYLCARNITINE,PLASMA(SO)" BOTH IP/OP $117.00 $87.00 $8.44 $117.00 $117.00 $117.00 $117.00 $117.00 $16.87 $16.87 $8.44 $117.00 $16.87 $25.62 $25.62 $26.60 $18.70 $24.92 $26.99 $26.99 $117.00 $16.87 $16.87 $16.87 $117.00 $87.75 $16.87 $16.87 $16.87 $94.28 $94.28 $92.66 $16.87 $93.60 $117.00 $117.00 $16.87 $67.86 $117.00 $24.46 $16.87 $117.00 $16.87 N/A N/A 30201996 EAP CPT® 87305 "ASPERGILLUS ANTIGEN, EIA, SERUM(SO)" BOTH IP/OP $114.00 $84.50 $5.99 $114.00 $114.00 $114.00 $114.00 $114.00 $11.98 $11.98 $5.99 $114.00 $11.98 $18.22 $18.22 $18.92 $13.30 $17.71 $19.17 $19.17 $114.00 $11.98 $11.98 $11.98 $114.00 $85.50 $11.98 $11.98 $11.98 $67.04 $67.04 $90.29 $11.98 $91.20 $114.00 $114.00 $11.98 $66.12 $114.00 $17.37 $11.98 $114.00 $11.98 N/A N/A 30201997 EAP CPT® 87254 "VIRAL RESPIRATORY,RAPID CULTURE WITH REFLEX(SO)" BOTH IP/OP $425.00 $314.50 $7.22 $425.00 $425.00 $425.00 $425.00 $425.00 $19.56 $19.56 $9.78 $425.00 $19.56 $29.69 $29.69 $30.83 $21.67 $7.22 $31.30 $31.30 $425.00 $19.56 $19.56 $19.56 $425.00 $318.75 $19.56 $19.56 $19.56 $109.28 $109.28 $336.60 $19.56 $340.00 $425.00 $425.00 $19.56 $246.50 $425.00 $28.36 $19.56 $425.00 $19.56 N/A N/A 30201998 EAP CPT® 82397 ANTI-MULLERIAN HORMONE ASSESSR™(SO) BOTH IP/OP $296.00 $219.50 $7.06 $296.00 $27.71 $27.71 $27.71 $27.71 $14.12 $14.12 $7.06 $7.06 $14.12 $21.46 $21.46 $22.28 $15.66 $20.87 $22.59 $22.59 $175.08 $14.12 $14.12 $14.12 $296.00 $222.00 $14.12 $14.12 $14.12 $78.96 $78.96 $234.43 $14.12 $236.80 $23.30 $19.88 $14.12 $171.68 $296.00 $20.47 $14.12 $15.62 $14.12 N/A N/A 30201999 EAP CPT® 87906 HIV-1 INTEGRASE GENOTYPE(SO) BOTH IP/OP $225.00 $166.50 $43.14 $225.00 $85.59 $85.59 $85.59 $85.59 $128.73 $128.73 $64.37 $64.36 $128.73 $63.81 $63.81 $66.27 $46.58 $57.67 $205.97 $205.97 $133.09 $128.73 $128.73 $128.73 $225.00 $168.75 $128.73 $128.73 $128.73 $112.50 $112.50 $178.20 $128.73 $180.00 $212.40 $54.92 $128.73 $130.50 $225.00 $186.66 $128.73 $43.14 $128.73 N/A N/A 30202000 EAP CPT® 87798 "HPV 8 DNA,QUAL(SO)" BOTH IP/OP $418.00 $309.50 $17.55 $418.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $247.25 $35.09 $35.09 $35.09 $418.00 $313.50 $35.09 $35.09 $35.09 $109.64 $109.64 $331.06 $35.09 $334.40 $57.90 $27.60 $35.09 $242.44 $418.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30202001 EAP CPT® 86316 "CHROMGRANIN A,ECL" BOTH IP/OP $221.00 $164.00 $10.41 $221.00 $40.84 $40.84 $40.84 $40.84 $20.81 $20.81 $10.41 $10.41 $20.81 $31.60 $31.60 $32.81 $23.06 $30.73 $33.30 $33.30 $130.72 $20.81 $20.81 $20.81 $221.00 $165.75 $20.81 $20.81 $20.81 $116.28 $116.28 $175.03 $20.81 $176.80 $34.34 $29.27 $20.81 $128.18 $221.00 $30.17 $20.81 $22.99 $20.81 N/A N/A 30202002 EAP CPT® 83516 EUROMYELITIS OPTICA(SO) BOTH IP/OP "$1,413.00" "$1,046.00" $5.76 "$1,413.00" $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $835.79 $11.53 $11.53 $11.53 "$1,413.00" "$1,059.75" $11.53 $11.53 $11.53 $59.76 $59.76 "$1,119.10" $11.53 "$1,130.40" $19.02 $15.05 $11.53 $819.54 "$1,413.00" $16.72 $11.53 $11.82 $11.53 N/A N/A 30202003 EAP CPT® 86336 INHIBIN A(SO) BOTH IP/OP $89.00 $66.00 $7.79 $89.00 $25.43 $25.43 $25.43 $25.43 $15.59 $15.59 $7.80 $7.79 $15.59 $19.66 $19.66 $20.41 $14.35 $19.12 $24.94 $24.94 $52.64 $15.59 $15.59 $15.59 $89.00 $66.75 $15.59 $15.59 $15.59 $72.36 $72.36 $70.49 $15.59 $71.20 $25.72 $18.21 $15.59 $51.62 $89.00 $22.61 $15.59 $14.30 $15.59 N/A N/A 30202004 EAP CPT® 82397 INHIBIN B(SO) BOTH IP/OP $427.00 $316.00 $7.06 $427.00 $27.71 $27.71 $27.71 $27.71 $14.12 $14.12 $7.06 $7.06 $14.12 $21.46 $21.46 $22.28 $15.66 $20.87 $22.59 $22.59 $252.57 $14.12 $14.12 $14.12 $427.00 $320.25 $14.12 $14.12 $14.12 $78.96 $78.96 $338.18 $14.12 $341.60 $23.30 $19.88 $14.12 $247.66 $427.00 $20.47 $14.12 $15.62 $14.12 N/A N/A 30202005 EAP CPT® 88271 "FISH, MYELOMA CHROM CEP 9,11,15 DNA PROBE (SO)" BOTH IP/OP $638.00 $472.50 $10.71 $638.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $377.38 $21.42 $21.42 $21.42 $638.00 $478.50 $21.42 $21.42 $21.42 $119.72 $119.72 $505.30 $21.42 $510.40 $35.34 $30.14 $21.42 $370.04 $638.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 30202006 EAP CPT® 88275 "FISH, MYELOMA CHROM CEP 9,11,15 HYBRIDIZATION(SO)" BOTH IP/OP $354.00 $262.00 $23.04 $354.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $209.39 $51.19 $51.19 $51.19 $354.00 $265.50 $51.19 $51.19 $51.19 $224.44 $224.44 $280.37 $51.19 $283.20 $84.46 $56.50 $51.19 $205.32 $354.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30202007 EAP CPT® 88271 "FISH, MYELOMA 17P-,REA14Q32 (SO) DNA PROBE (SO)" BOTH IP/OP "$4,290.00" "$3,175.00" $10.71 "$4,290.00" $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 "$2,537.54" $21.42 $21.42 $21.42 "$4,290.00" "$3,217.50" $21.42 $21.42 $21.42 $119.72 $119.72 "$3,397.68" $21.42 "$3,432.00" $35.34 $30.14 $21.42 "$2,488.20" "$4,290.00" $31.06 $21.42 $23.67 $21.42 N/A N/A 30202008 EAP CPT® 88275 "FISH, MYELOMA 17P-,REA14Q32(SO) HYBRIDIZATION(SO)" BOTH IP/OP $601.00 $445.00 $23.04 $601.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $355.49 $51.19 $51.19 $51.19 $601.00 $450.75 $51.19 $51.19 $51.19 $224.44 $224.44 $475.99 $51.19 $480.80 $84.46 $56.50 $51.19 $348.58 $601.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 30202009 EAP CPT® 88271 "FISH, MYELOMA IGH PANEL(SO) DNA PROBE (SO)" BOTH IP/OP "$2,092.00" "$1,548.50" $10.71 "$2,092.00" $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 "$1,237.42" $21.42 $21.42 $21.42 "$2,092.00" "$1,569.00" $21.42 $21.42 $21.42 $119.72 $119.72 "$1,656.86" $21.42 "$1,673.60" $35.34 $30.14 $21.42 "$1,213.36" "$2,092.00" $31.06 $21.42 $23.67 $21.42 N/A N/A 30202010 EAP CPT® 88275 "FISH, MYELOMA IGH PANEL(SO) HYBRIDIZATION(SO)" BOTH IP/OP "$1,046.00" $774.50 $23.04 "$1,046.00" $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $618.71 $51.19 $51.19 $51.19 "$1,046.00" $784.50 $51.19 $51.19 $51.19 $224.44 $224.44 $828.43 $51.19 $836.80 $84.46 $56.50 $51.19 $606.68 "$1,046.00" $74.23 $51.19 $44.38 $51.19 N/A N/A 30202011 EAP CPT® 81596 "LIVER FIBROSIS, FIBRO TEST-ACTITEST PANEL (SO)" BOTH IP/OP "$1,021.00" $756.00 $36.10 "$1,021.00" "$1,021.00" "$1,021.00" "$1,021.00" "$1,021.00" $72.19 $72.19 $36.10 "$1,021.00" $72.19 $75.08 $75.08 $77.97 $54.81 $67.84 $115.50 $115.50 "$1,021.00" $72.19 $72.19 $72.19 "$1,021.00" $765.75 $72.19 $72.19 $72.19 $510.50 $510.50 $808.63 $72.19 $816.80 "$1,021.00" "$1,021.00" $72.19 $592.18 "$1,021.00" $104.68 $72.19 "$1,021.00" $72.19 N/A N/A 30202012 EAP CPT® 87535 "HIV-1, RNA QUALITATIVE TMA(SO)" BOTH IP/OP $347.00 $257.00 $17.55 $347.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $205.25 $35.09 $35.09 $35.09 $347.00 $260.25 $35.09 $35.09 $35.09 $109.64 $109.64 $274.82 $35.09 $277.60 $57.90 $27.60 $35.09 $201.26 $347.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30202013 EAP CPT® 87140 "VIRAL ID, RESPIRATORY(SO)" BOTH IP/OP $349.00 $258.50 $2.79 $349.00 $349.00 $349.00 $349.00 $349.00 $5.57 $5.57 $2.79 $349.00 $5.57 $8.47 $8.47 $8.79 $6.18 $8.23 $8.91 $8.91 $349.00 $5.57 $5.57 $5.57 $349.00 $261.75 $5.57 $5.57 $5.57 $31.16 $31.16 $276.41 $5.57 $279.20 $349.00 $349.00 $5.57 $202.42 $349.00 $8.08 $5.57 $349.00 $5.57 N/A N/A 30202015 EAP CPT® 81420 QNATAL ADVANCED(SO) BOTH IP/OP "$2,554.00" "$1,890.00" $341.57 "$2,554.00" "$1,147.90" "$1,147.90" "$1,147.90" "$1,147.90" $759.05 $759.05 $379.53 $341.57 $759.05 "$1,895.58" "$1,895.58" "$1,968.62" "$1,330.63" $754.02 "$1,214.48" "$1,214.48" "$1,510.69" $759.05 $759.05 $759.05 "$2,554.00" "$1,915.50" $759.05 $759.05 $759.05 "$1,277.00" "$1,277.00" "$2,022.77" $759.05 "$2,043.20" "$1,252.43" $718.11 $759.05 "$1,481.32" "$2,554.00" "$1,100.62" $759.05 $564.08 $759.05 N/A N/A 30202016 EAP CPT® 83835 "METANEPHRINES,FRAC,UR(SO)" BOTH IP/OP $81.00 $60.00 $8.47 $81.00 $33.26 $33.26 $33.26 $33.26 $16.94 $16.94 $8.47 $8.47 $16.94 $25.73 $25.73 $26.72 $18.78 $25.02 $27.10 $27.10 $47.91 $16.94 $16.94 $16.94 $81.00 $60.75 $16.94 $16.94 $16.94 $81.00 $81.00 $64.15 $16.94 $64.80 $27.95 $23.83 $16.94 $46.98 $81.00 $24.56 $16.94 $18.72 $16.94 N/A N/A 30202017 EAP CPT® 87305 "ASPERGILLUS ANTIGEN,EIA(SO)" BOTH IP/OP $103.00 $76.50 $5.99 $103.00 $103.00 $103.00 $103.00 $103.00 $11.98 $11.98 $5.99 $103.00 $11.98 $18.22 $18.22 $18.92 $13.30 $17.71 $19.17 $19.17 $103.00 $11.98 $11.98 $11.98 $103.00 $77.25 $11.98 $11.98 $11.98 $67.04 $67.04 $81.58 $11.98 $82.40 $103.00 $103.00 $11.98 $59.74 $103.00 $17.37 $11.98 $103.00 $11.98 N/A N/A 30202018 EAP CPT® 86701 HIV-1 CONFIRMATION BOTH IP/OP $197.00 $146.00 $4.44 $197.00 $17.44 $17.44 $17.44 $17.44 $8.89 $8.89 $4.45 $4.44 $8.89 $13.48 $13.48 $14.00 $9.84 $11.39 $14.22 $14.22 $116.53 $8.89 $8.89 $8.89 $197.00 $147.75 $8.89 $8.89 $8.89 $49.64 $49.64 $156.02 $8.89 $157.60 $14.67 $10.85 $8.89 $114.26 $197.00 $12.89 $8.89 $8.52 $8.89 N/A N/A 30202019 EAP CPT® 86702 HIV-2 CONFIRMATION BOTH IP/OP $238.00 $176.50 $6.76 $238.00 $26.53 $26.53 $26.53 $26.53 $13.52 $13.52 $6.76 $6.76 $13.52 $20.53 $20.53 $21.32 $14.99 $17.33 $21.63 $21.63 $140.78 $13.52 $13.52 $13.52 $238.00 $178.50 $13.52 $13.52 $13.52 $75.52 $75.52 $188.50 $13.52 $190.40 $22.31 $16.50 $13.52 $138.04 $238.00 $19.60 $13.52 $12.96 $13.52 N/A N/A 30202020 EAP CPT® 86666 ANAPLASMA PHAGGOCYTOPILIUM AB (SO) BOTH IP/OP $398.00 $295.00 $5.09 $398.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $235.42 $10.18 $10.18 $10.18 $398.00 $298.50 $10.18 $10.18 $10.18 $56.88 $56.88 $315.22 $10.18 $318.40 $16.80 $14.32 $10.18 $230.84 $398.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30202021 EAP CPT® 87798 "PNEUMOCYSTTIS JIROVECII, QUAL RT PCR (SO)" BOTH IP/OP $448.00 $332.00 $17.55 $448.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $264.99 $35.09 $35.09 $35.09 $448.00 $336.00 $35.09 $35.09 $35.09 $109.64 $109.64 $354.82 $35.09 $358.40 $57.90 $27.60 $35.09 $259.84 $448.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30202022 EAP CPT® 86790 CHIKUNGUNYA AB REFLEX TO TITER (SO) BOTH IP/OP $219.00 $162.50 $6.44 $219.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $129.54 $12.88 $12.88 $12.88 $219.00 $164.25 $12.88 $12.88 $12.88 $72.00 $72.00 $173.45 $12.88 $175.20 $21.25 $18.12 $12.88 $127.02 $219.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30202024 EAP CPT® 81255 TAY-SACHS DISEASE MUTATION ANAL (SO) BOTH IP/OP $304.00 $225.00 $25.73 $304.00 $304.00 $304.00 $304.00 $304.00 $51.45 $51.45 $25.73 $304.00 $51.45 $225.63 $225.63 $234.32 $158.38 $115.59 $82.32 $82.32 $304.00 $51.45 $51.45 $51.45 $304.00 $228.00 $51.45 $51.45 $51.45 $152.00 $152.00 $240.77 $51.45 $243.20 $304.00 $304.00 $51.45 $176.32 $304.00 $74.60 $51.45 $304.00 $51.45 N/A N/A 30202025 EAP CPT® 86738 MYCOPLASMA PNEUMONIAE AB CF CSF (SO) BOTH IP/OP $117.00 $87.00 $6.62 $117.00 $117.00 $117.00 $117.00 $117.00 $13.24 $13.24 $6.62 $117.00 $13.24 $20.11 $20.11 $20.89 $14.68 $19.57 $21.18 $21.18 $117.00 $13.24 $13.24 $13.24 $117.00 $87.75 $13.24 $13.24 $13.24 $74.04 $74.04 $92.66 $13.24 $93.60 $117.00 $117.00 $13.24 $67.86 $117.00 $19.20 $13.24 $117.00 $13.24 N/A N/A 30202026 EAP CPT® 87902 HEPATITIS C VIRAL RNA NS3 GENOTYPE(SO) BOTH IP/OP $339.00 $251.00 $96.38 $424.79 $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $132.42 $132.42 $137.52 $96.67 $128.84 $411.92 $411.92 $200.52 $257.45 $257.45 $257.45 $339.00 $254.25 $257.45 $257.45 $257.45 $339.00 $339.00 $268.49 $257.45 $271.20 $424.79 $122.70 $257.45 $196.62 $339.00 $339.00 $257.45 $96.38 $257.45 N/A N/A 30202027 EAP CPT® 87902 "HEPATITIS C VIRAL RNA, (SO)" BOTH IP/OP $671.00 $497.00 $96.38 $671.00 $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $132.42 $132.42 $137.52 $96.67 $128.84 $411.92 $411.92 $396.90 $257.45 $257.45 $257.45 $671.00 $503.25 $257.45 $257.45 $257.45 $487.40 $487.40 $531.43 $257.45 $536.80 $424.79 $122.70 $257.45 $389.18 $671.00 $373.30 $257.45 $96.38 $257.45 N/A N/A 30202030 EAP CPT® 83516 RNA POLYMERASE III ANTIBODY BOTH IP/OP $152.00 $112.50 $5.76 $152.00 $20.96 $20.96 $20.96 $20.96 $11.53 $11.53 $5.77 $5.76 $11.53 $16.23 $16.23 $16.86 $11.85 $15.80 $18.45 $18.45 $89.91 $11.53 $11.53 $11.53 $152.00 $114.00 $11.53 $11.53 $11.53 $59.76 $59.76 $120.38 $11.53 $121.60 $19.02 $15.05 $11.53 $88.16 $152.00 $16.72 $11.53 $11.82 $11.53 N/A N/A 30202031 EAP CPT® 86341 ISLET CELL AB (SO) BOTH IP/OP $163.00 $121.00 $10.61 $163.00 $38.83 $38.83 $38.83 $38.83 $23.57 $23.57 $11.79 $10.61 $23.57 $30.05 $30.05 $31.20 $21.93 $29.24 $37.71 $37.71 $96.41 $23.57 $23.57 $23.57 $163.00 $122.25 $23.57 $23.57 $23.57 $110.60 $110.60 $129.10 $23.57 $130.40 $38.89 $27.85 $23.57 $94.54 $163.00 $34.18 $23.57 $21.88 $23.57 N/A N/A 30202032 EAP CPT® 86341 ISLET CELL AB (SO) BOTH IP/OP $176.00 $130.50 $10.61 $176.00 $38.83 $38.83 $38.83 $38.83 $23.57 $23.57 $11.79 $10.61 $23.57 $30.05 $30.05 $31.20 $21.93 $29.24 $37.71 $37.71 $104.10 $23.57 $23.57 $23.57 $176.00 $132.00 $23.57 $23.57 $23.57 $110.60 $110.60 $139.39 $23.57 $140.80 $38.89 $27.85 $23.57 $102.08 $176.00 $34.18 $23.57 $21.88 $23.57 N/A N/A 30202034 EAP CPT® 86596 VOLTAGE-GTD CA CHNL AB (SO) BOTH IP/OP $215.00 $159.50 $12.94 $215.00 $215.00 $215.00 $215.00 $215.00 $18.40 $18.40 $38.27 $44.81 $18.40 $159.57 $159.57 $165.72 $112.02 $17.29 $29.44 $29.44 $127.17 $18.40 $18.40 $18.40 $215.00 $161.25 $18.40 $18.40 $18.40 $107.50 $107.50 $170.28 $18.40 $172.00 $139.75 $16.47 $18.40 $124.70 $215.00 $129.00 $18.40 $12.94 $18.40 N/A N/A 30202035 EAP CPT® 86596 VOLTAGE-GTD CA CHNL AB (SO) BOTH IP/OP $299.00 $221.50 $12.94 $299.00 $299.00 $299.00 $299.00 $299.00 $18.40 $18.40 $53.22 $62.32 $18.40 $221.92 $221.92 $230.47 $155.78 $17.29 $29.44 $29.44 $176.86 $18.40 $18.40 $18.40 $299.00 $224.25 $18.40 $18.40 $18.40 $149.50 $149.50 $236.81 $18.40 $239.20 $194.35 $16.47 $18.40 $173.42 $299.00 $179.40 $18.40 $12.94 $18.40 N/A N/A 30202036 EAP CPT® 86596 VOLTAGE-GTD CA CHNL AB (SO) BOTH IP/OP $353.00 $261.50 $12.94 $353.00 $353.00 $353.00 $353.00 $353.00 $18.40 $18.40 $62.83 $73.57 $18.40 $262.00 $262.00 $272.09 $183.91 $17.29 $29.44 $29.44 $208.80 $18.40 $18.40 $18.40 $353.00 $264.75 $18.40 $18.40 $18.40 $176.50 $176.50 $279.58 $18.40 $282.40 $229.45 $16.47 $18.40 $204.74 $353.00 $211.80 $18.40 $12.94 $18.40 N/A N/A 30202040 EAP CPT® 86703 RAPID HIV-1/HIV-2 (1 RESULT) AB BOTH IP/OP $69.00 $51.50 $6.85 $69.00 $26.91 $26.91 $26.91 $26.91 $13.71 $13.71 $6.86 $6.85 $13.71 $20.82 $20.82 $21.62 $15.20 $17.58 $21.94 $21.94 $40.81 $13.71 $13.71 $13.71 $69.00 $51.75 $13.71 $13.71 $13.71 $69.00 $69.00 $54.65 $13.71 $55.20 $22.62 $16.74 $13.71 $40.02 $69.00 $19.88 $13.71 $13.15 $13.71 N/A N/A 30202041 EAP CPT® 86502 AQUAPORIN-4 ANTB CBA (SO) BOTH IP/OP "$2,533.00" "$1,874.50" $450.87 "$2,533.00" "$2,533.00" "$2,533.00" "$2,533.00" "$2,533.00" "$2,533.00" "$2,533.00" $450.87 "$2,533.00" "$2,533.00" "$1,879.99" "$1,879.99" "$1,952.44" "$1,319.69" $527.91 "$2,533.00" "$1,013.20" "$2,533.00" "$2,533.00" "$2,533.00" "$2,533.00" "$2,533.00" "$1,899.75" "$2,533.00" "$2,533.00" "$2,533.00" "$1,266.50" "$1,266.50" "$2,006.14" "$2,533.00" "$2,026.40" "$1,646.45" "$2,533.00" "$2,533.00" "$1,469.14" "$2,533.00" "$1,519.80" "$2,533.00" "$2,533.00" "$2,533.00" N/A N/A 30250310 EAP CPT® 86256 MITOCHONDRIAL AB TITER BOTH IP/OP $70.00 $52.00 $6.03 $70.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $41.41 $12.05 $12.05 $12.05 $70.00 $52.50 $12.05 $12.05 $12.05 $67.36 $67.36 $55.44 $12.05 $56.00 $19.88 $16.96 $12.05 $40.60 $70.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30250311 EAP CPT® 83519 ALP SUB PIT GLYCOPROTEIN HORM BOTH IP/OP $850.00 $629.00 $8.28 $850.00 $26.51 $26.51 $26.51 $26.51 $18.40 $18.40 $9.20 $8.28 $18.40 $20.52 $20.52 $21.31 $14.98 $19.96 $29.44 $29.44 $502.78 $18.40 $18.40 $18.40 $850.00 $637.50 $18.40 $18.40 $18.40 $75.52 $75.52 $673.20 $18.40 $680.00 $30.36 $19.01 $18.40 $493.00 $850.00 $26.68 $18.40 $14.93 $18.40 N/A N/A 30250312 EAP CPT® 87624 MRNA BOTH IP/OP $101.00 $75.00 $16.04 $101.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $27.77 $27.77 $28.84 $20.27 $21.44 $56.14 $56.14 $59.74 $35.09 $35.09 $35.09 $101.00 $75.75 $35.09 $35.09 $35.09 $50.50 $50.50 $79.99 $35.09 $80.80 $57.90 $20.42 $35.09 $58.58 $101.00 $50.88 $35.09 $16.04 $35.09 N/A N/A 30250313 EAP CPT® 86021 C-ANCA TITER BOTH IP/OP $34.00 $25.50 $7.53 $34.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $20.11 $15.05 $15.05 $15.05 $34.00 $25.50 $15.05 $15.05 $15.05 $34.00 $34.00 $26.93 $15.05 $27.20 $24.83 $21.18 $15.05 $19.72 $34.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30250314 EAP CPT® 86021 P-ANCA TITER BOTH IP/OP $34.00 $25.50 $7.53 $34.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $20.11 $15.05 $15.05 $15.05 $34.00 $25.50 $15.05 $15.05 $15.05 $34.00 $34.00 $26.93 $15.05 $27.20 $24.83 $21.18 $15.05 $19.72 $34.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30250315 EAP CPT® 86021 ATYPICAL P-ANCA TITER BOTH IP/OP $80.00 $59.50 $7.53 $80.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $47.32 $15.05 $15.05 $15.05 $80.00 $60.00 $15.05 $15.05 $15.05 $80.00 $80.00 $63.36 $15.05 $64.00 $24.83 $21.18 $15.05 $46.40 $80.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30250316 EAP CPT® 86638 Q FEVER IGG PHASE I TITER BOTH IP/OP $43.00 $32.00 $6.06 $43.00 $43.00 $43.00 $43.00 $43.00 $12.12 $12.12 $6.06 $43.00 $12.12 $18.41 $18.41 $19.12 $13.44 $17.91 $19.39 $19.39 $43.00 $12.12 $12.12 $12.12 $43.00 $32.25 $12.12 $12.12 $12.12 $43.00 $43.00 $34.06 $12.12 $34.40 $43.00 $43.00 $12.12 $24.94 $43.00 $17.57 $12.12 $43.00 $12.12 N/A N/A 30250317 EAP CPT® 86638 Q FEVER IGG PHASE II TITER BOTH IP/OP $43.00 $32.00 $6.06 $43.00 $43.00 $43.00 $43.00 $43.00 $12.12 $12.12 $6.06 $43.00 $12.12 $18.41 $18.41 $19.12 $13.44 $17.91 $19.39 $19.39 $43.00 $12.12 $12.12 $12.12 $43.00 $32.25 $12.12 $12.12 $12.12 $43.00 $43.00 $34.06 $12.12 $34.40 $43.00 $43.00 $12.12 $24.94 $43.00 $17.57 $12.12 $43.00 $12.12 N/A N/A 30250318 EAP CPT® 86638 Q FEVER IGM PHASE I TITER BOTH IP/OP $43.00 $32.00 $6.06 $43.00 $43.00 $43.00 $43.00 $43.00 $12.12 $12.12 $6.06 $43.00 $12.12 $18.41 $18.41 $19.12 $13.44 $17.91 $19.39 $19.39 $43.00 $12.12 $12.12 $12.12 $43.00 $32.25 $12.12 $12.12 $12.12 $43.00 $43.00 $34.06 $12.12 $34.40 $43.00 $43.00 $12.12 $24.94 $43.00 $17.57 $12.12 $43.00 $12.12 N/A N/A 30250320 EAP CPT® 86611 B.HENSELAE IGG TITER BOTH IP/OP $50.00 $37.00 $5.09 $50.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $29.58 $10.18 $10.18 $10.18 $50.00 $37.50 $10.18 $10.18 $10.18 $50.00 $50.00 $39.60 $10.18 $40.00 $16.80 $14.32 $10.18 $29.00 $50.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30250321 EAP CPT® 86611 B.HENSELAE IGM TITER BOTH IP/OP $50.00 $37.00 $5.09 $50.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $29.58 $10.18 $10.18 $10.18 $50.00 $37.50 $10.18 $10.18 $10.18 $50.00 $50.00 $39.60 $10.18 $40.00 $16.80 $14.32 $10.18 $29.00 $50.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30250322 EAP CPT® 86611 B.QUINTANA IGG TITER BOTH IP/OP $50.00 $37.00 $5.09 $50.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $29.58 $10.18 $10.18 $10.18 $50.00 $37.50 $10.18 $10.18 $10.18 $50.00 $50.00 $39.60 $10.18 $40.00 $16.80 $14.32 $10.18 $29.00 $50.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30250323 EAP CPT® 86611 B.QUINTANA IGM TITER BOTH IP/OP $50.00 $37.00 $5.09 $50.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $29.58 $10.18 $10.18 $10.18 $50.00 $37.50 $10.18 $10.18 $10.18 $50.00 $50.00 $39.60 $10.18 $40.00 $16.80 $14.32 $10.18 $29.00 $50.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30250325 EAP CPT® 86003 ALLERGEN SPECIFIC IGE TILAPIA (SO) BOTH IP/OP $200.00 $148.00 $2.61 $200.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $118.30 $5.22 $5.22 $5.22 $200.00 $150.00 $5.22 $5.22 $5.22 $29.20 $29.20 $158.40 $5.22 $160.00 $8.61 $7.35 $5.22 $116.00 $200.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30250326 EAP CPT® 86003 ALLERGEN SPECIFIC IGE TROUT (SO) BOTH IP/OP $136.00 $101.00 $2.61 $136.00 $10.24 $10.24 $10.24 $10.24 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $80.44 $5.22 $5.22 $5.22 $136.00 $102.00 $5.22 $5.22 $5.22 $29.20 $29.20 $107.71 $5.22 $108.80 $8.61 $7.35 $5.22 $78.88 $136.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30250327 EAP CPT® 86790 HEPATITIS A IGG BOTH IP/OP $328.00 $243.00 $6.44 $328.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $194.01 $12.88 $12.88 $12.88 $328.00 $246.00 $12.88 $12.88 $12.88 $72.00 $72.00 $259.78 $12.88 $262.40 $21.25 $18.12 $12.88 $190.24 $328.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30250328 EAP CPT® 87389 HIV-1 AG WITH HIV-1/2 AB BOTH IP/OP $306.00 $226.50 $12.04 $306.00 $47.26 $47.26 $47.26 $47.26 $24.08 $24.08 $12.04 $12.04 $24.08 $35.48 $35.48 $36.85 $25.90 $32.07 $38.53 $38.53 $181.00 $24.08 $24.08 $24.08 $306.00 $229.50 $24.08 $24.08 $24.08 $153.00 $153.00 $242.35 $24.08 $244.80 $39.73 $30.54 $24.08 $177.48 $306.00 $34.92 $24.08 $23.99 $24.08 N/A N/A 30250329 EAP CPT® 86255 "DS-DNA AN, CRITHIDIA TITER" BOTH IP/OP $150.00 $111.00 $6.03 $150.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $88.73 $12.05 $12.05 $12.05 $150.00 $112.50 $12.05 $12.05 $12.05 $67.36 $67.36 $118.80 $12.05 $120.00 $19.88 $16.96 $12.05 $87.00 $150.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30250340 EAP CPT® 86361 ABSOLUTE CD4 COUNT BOTH IP/OP $117.00 $87.00 $13.39 $117.00 $51.25 $51.25 $51.25 $51.25 $26.78 $26.78 $13.39 $13.39 $26.78 $39.63 $39.63 $41.16 $28.93 $38.56 $42.85 $42.85 $69.21 $26.78 $26.78 $26.78 $117.00 $87.75 $26.78 $26.78 $26.78 $117.00 $117.00 $92.66 $26.78 $93.60 $44.19 $36.72 $26.78 $67.86 $117.00 $38.83 $26.78 $28.84 $26.78 N/A N/A 30250342 EAP CPT® 86038 ANA IFA W/REFLEX (SO) BOTH IP/OP $219.00 $162.50 $6.04 $219.00 $23.72 $23.72 $23.72 $23.72 $12.09 $12.09 $6.05 $6.04 $12.09 $18.36 $18.36 $19.06 $13.40 $17.86 $19.34 $19.34 $129.54 $12.09 $12.09 $12.09 $219.00 $164.25 $12.09 $12.09 $12.09 $67.56 $67.56 $173.45 $12.09 $175.20 $19.95 $17.01 $12.09 $127.02 $219.00 $17.53 $12.09 $13.36 $12.09 N/A N/A 30250380 EAP CPT® 86790 CHIKUNGUNYA IGG TITER(SO) BOTH IP/OP $210.00 $155.50 $6.44 $210.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $124.22 $12.88 $12.88 $12.88 $210.00 $157.50 $12.88 $12.88 $12.88 $72.00 $72.00 $166.32 $12.88 $168.00 $21.25 $18.12 $12.88 $121.80 $210.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30250381 EAP CPT® 86790 CHIKUNGUNYA IGM TITER(SO) BOTH IP/OP $192.00 $142.50 $6.44 $192.00 $25.28 $25.28 $25.28 $25.28 $12.88 $12.88 $6.44 $6.44 $12.88 $19.56 $19.56 $20.31 $14.28 $19.03 $20.61 $20.61 $113.57 $12.88 $12.88 $12.88 $192.00 $144.00 $12.88 $12.88 $12.88 $72.00 $72.00 $152.06 $12.88 $153.60 $21.25 $18.12 $12.88 $111.36 $192.00 $18.68 $12.88 $14.23 $12.88 N/A N/A 30250382 EAP CPT® 86039 "ANA SCREEN IFA, W/TITER AND PATTERN" BOTH IP/OP $142.00 $105.50 $5.58 $142.00 $142.00 $142.00 $142.00 $142.00 $11.16 $11.16 $5.58 $142.00 $11.16 $16.95 $16.95 $17.60 $12.37 $16.50 $17.86 $17.86 $142.00 $11.16 $11.16 $11.16 $142.00 $106.50 $11.16 $11.16 $11.16 $62.40 $62.40 $112.46 $11.16 $113.60 $142.00 $142.00 $11.16 $82.36 $142.00 $16.18 $11.16 $142.00 $11.16 N/A N/A 30250383 EAP CPT® 86713 "LEGIONELLA PNEUMOPHILA AB (IGG), IFA (SO)" BOTH IP/OP $104.00 $77.00 $7.65 $104.00 $104.00 $104.00 $104.00 $104.00 $15.30 $15.30 $7.65 $104.00 $15.30 $23.24 $23.24 $24.14 $16.97 $22.62 $24.48 $24.48 $104.00 $15.30 $15.30 $15.30 $104.00 $78.00 $15.30 $15.30 $15.30 $85.56 $85.56 $82.37 $15.30 $83.20 $104.00 $104.00 $15.30 $60.32 $104.00 $22.19 $15.30 $104.00 $15.30 N/A N/A 30250384 EAP CPT® 86255 COPEPTIN (SO) BOTH IP/OP $43.00 $32.00 $6.03 $43.00 $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $25.43 $12.05 $12.05 $12.05 $43.00 $32.25 $12.05 $12.05 $12.05 $43.00 $43.00 $34.06 $12.05 $34.40 $19.88 $16.96 $12.05 $24.94 $43.00 $17.47 $12.05 $13.32 $12.05 N/A N/A 30250388 EAP CPT® 86052 AQUAPORIN-4 ANTB CBA (SO) BOTH IP/OP $108.00 $80.00 $11.33 $108.00 $108.00 $108.00 $108.00 $108.00 $12.05 $12.05 $19.22 $108.00 $12.05 $80.16 $80.16 $83.25 $56.27 $11.33 $19.28 $19.28 $108.00 $12.05 $12.05 $12.05 $108.00 $81.00 $12.05 $12.05 $12.05 $54.00 $54.00 $85.54 $12.05 $86.40 $70.20 $108.00 $12.05 $62.64 $108.00 $64.80 $12.05 $108.00 $12.05 N/A N/A 30250389 EAP CPT® 86052 AQUAPORIN-4 ANTB CBA (SO) BOTH IP/OP "$2,533.00" "$1,874.50" $11.33 "$2,533.00" "$2,533.00" "$2,533.00" "$2,533.00" "$2,533.00" $12.05 $12.05 $450.87 "$2,533.00" $12.05 "$1,879.99" "$1,879.99" "$1,952.44" "$1,319.69" $11.33 $19.28 $19.28 "$2,533.00" $12.05 $12.05 $12.05 "$2,533.00" "$1,899.75" $12.05 $12.05 $12.05 "$1,266.50" "$1,266.50" "$2,006.14" $12.05 "$2,026.40" "$1,646.45" "$2,533.00" $12.05 "$1,469.14" "$2,533.00" "$1,519.80" $12.05 "$2,533.00" $12.05 N/A N/A 30250390 EAP CPT® 86695 HSV 1 IGG (SO) BOTH IP/OP $59.00 $44.00 $6.59 $59.00 $25.88 $25.88 $25.88 $25.88 $13.19 $13.19 $6.60 $6.59 $13.19 $20.02 $20.02 $20.79 $14.61 $19.49 $21.10 $21.10 $34.90 $13.19 $13.19 $13.19 $59.00 $44.25 $13.19 $13.19 $13.19 $59.00 $59.00 $46.73 $13.19 $47.20 $21.76 $18.56 $13.19 $34.22 $59.00 $19.13 $13.19 $14.58 $13.19 N/A N/A 30250391 EAP CPT® 86696 HSV 2 IGG (SO) BOTH IP/OP $59.00 $44.00 $9.68 $59.00 $37.98 $37.98 $37.98 $37.98 $19.35 $19.35 $9.68 $9.68 $19.35 $29.39 $29.39 $30.52 $21.45 $28.60 $30.96 $30.96 $34.90 $19.35 $19.35 $19.35 $59.00 $44.25 $19.35 $19.35 $19.35 $59.00 $59.00 $46.73 $19.35 $47.20 $31.93 $27.24 $19.35 $34.22 $59.00 $28.06 $19.35 $21.40 $19.35 N/A N/A 30250392 EAP CPT® 86696 HSV 2 IGG INHIBITION (SO) BOTH IP/OP $400.00 $296.00 $9.68 $400.00 $37.98 $37.98 $37.98 $37.98 $19.35 $19.35 $9.68 $9.68 $19.35 $29.39 $29.39 $30.52 $21.45 $28.60 $30.96 $30.96 $236.60 $19.35 $19.35 $19.35 $400.00 $300.00 $19.35 $19.35 $19.35 $108.20 $108.20 $316.80 $19.35 $320.00 $31.93 $27.24 $19.35 $232.00 $400.00 $28.06 $19.35 $21.40 $19.35 N/A N/A 30250393 EAP CPT® 86052 AQUAPORIN-4 ANTB CBA (SO) BOTH IP/OP $163.00 $121.00 $11.33 $163.00 $163.00 $163.00 $163.00 $163.00 $12.05 $12.05 $29.01 $163.00 $12.05 $120.98 $120.98 $125.64 $84.92 $11.33 $19.28 $19.28 $163.00 $12.05 $12.05 $12.05 $163.00 $122.25 $12.05 $12.05 $12.05 $81.50 $81.50 $129.10 $12.05 $130.40 $105.95 $163.00 $12.05 $94.54 $163.00 $97.80 $12.05 $163.00 $12.05 N/A N/A 30250394 EAP CPT® 86052 AQUAPORIN-4 ANTB CBA (SO) BOTH IP/OP $176.00 $130.50 $11.33 $176.00 $176.00 $176.00 $176.00 $176.00 $12.05 $12.05 $31.33 $176.00 $12.05 $130.63 $130.63 $135.66 $91.70 $11.33 $19.28 $19.28 $176.00 $12.05 $12.05 $12.05 $176.00 $132.00 $12.05 $12.05 $12.05 $88.00 $88.00 $139.39 $12.05 $140.80 $114.40 $176.00 $12.05 $102.08 $176.00 $105.60 $12.05 $176.00 $12.05 N/A N/A 30250395 EAP CPT® 86235 MYOSITIS SPECIFIC 11 AB NUCLEAR AG (SO) BOTH IP/OP $107.00 $79.50 $8.97 $107.00 $35.19 $35.19 $35.19 $35.19 $17.93 $17.93 $8.97 $8.97 $17.93 $27.23 $27.23 $28.27 $19.88 $26.49 $28.69 $28.69 $63.29 $17.93 $17.93 $17.93 $107.00 $80.25 $17.93 $17.93 $17.93 $100.24 $100.24 $84.74 $17.93 $85.60 $29.58 $25.23 $17.93 $62.06 $107.00 $26.00 $17.93 $19.82 $17.93 N/A N/A 30250396 EAP CPT® 88365 KAPPA/LAMBDA ISH BOTH IP/OP $251.00 $186.00 $74.59 $251.00 $251.00 $251.00 $251.00 $251.00 $138.77 $138.77 $92.77 $251.00 $138.77 $102.18 $102.18 $106.11 $74.59 $103.59 $222.03 $223.50 $251.00 $138.77 $139.69 $138.77 $251.00 $188.25 $138.77 $138.77 $138.77 $251.00 $251.00 $198.79 $138.77 $200.80 $163.15 $251.00 $138.77 $145.58 $251.00 $137.95 $138.77 $251.00 $138.77 N/A N/A 30250397 EAP CPT® 88366 KAPPA/LAMBDA ISH BOTH IP/OP $251.00 $186.00 $52.31 $363.50 $251.00 $251.00 $251.00 $251.00 $227.19 $227.19 $146.41 $251.00 $227.19 $155.94 $155.94 $161.94 $113.83 $52.31 $363.50 $352.29 $251.00 $227.19 $220.18 $227.19 $251.00 $188.25 $227.19 $227.19 $227.19 $125.50 $125.50 $198.79 $227.19 $200.80 $163.15 $251.00 $227.19 $145.58 $251.00 $216.10 $227.19 $251.00 $227.19 N/A N/A 30250399 EAP CPT® 86255 FLUORESCENT AB SCREEN (SO) BOTH IP/OP "$2,043.00" "$1,512.00" $6.03 "$2,043.00" $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 "$1,208.43" $12.05 $12.05 $12.05 "$2,043.00" "$1,532.25" $12.05 $12.05 $12.05 $67.36 $67.36 "$1,618.06" $12.05 "$1,634.40" $19.88 $16.96 $12.05 "$1,184.94" "$2,043.00" $17.47 $12.05 $13.32 $12.05 N/A N/A 30250400 EAP CPT® 86328 IA INFECTIOUS AG AB SARS-COV2 COVID 19 BOTH IP/OP $151.00 $112.00 $22.62 $151.00 $113.53 $113.53 $113.53 $113.53 $45.28 $45.28 $22.62 $57.41 $45.28 $101.02 $101.02 $105.06 $101.02 $60.28 $72.45 $72.45 $89.32 $45.28 $45.28 $45.28 $53.88 $113.25 $45.28 $45.28 $45.28 $75.50 $75.50 $119.59 $45.28 $120.80 $151.00 $57.41 $45.28 $87.58 $53.88 $151.00 $45.28 $57.41 $45.28 N/A N/A 30250401 EAP CPT® 86769 SARS-COV-2 COVID-19 ANTIBODY BOTH IP/OP $55.00 $41.00 $21.07 $67.41 $55.00 $55.00 $55.00 $55.00 $42.13 $42.13 $21.07 $57.41 $42.13 $55.00 $55.00 $55.00 $55.00 $55.00 $67.41 $67.41 $55.00 $42.13 $42.13 $42.13 $53.88 $41.25 $42.13 $42.13 $42.13 $27.50 $27.50 $43.56 $42.13 $44.00 $59.15 $55.00 $42.13 $31.90 $53.88 $55.00 $42.13 $55.00 $42.13 N/A N/A 30250402 EAP CPT® 86316 "CHROMOGRANIN A, REBASELINE (SO)" BOTH IP/OP $99.00 $73.50 $10.41 $99.00 $40.84 $40.84 $40.84 $40.84 $20.81 $20.81 $10.41 $10.41 $20.81 $31.60 $31.60 $32.81 $23.06 $30.73 $33.30 $33.30 $58.56 $20.81 $20.81 $20.81 $99.00 $74.25 $20.81 $20.81 $20.81 $99.00 $99.00 $78.41 $20.81 $79.20 $34.34 $29.27 $20.81 $57.42 $99.00 $30.17 $20.81 $22.99 $20.81 N/A N/A 30250403 EAP CPT® 86255 FLUORESCENT AB SCREEN (SO) BOTH IP/OP "$1,648.00" "$1,220.00" $6.03 "$1,648.00" $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $974.79 $12.05 $12.05 $12.05 "$1,648.00" "$1,236.00" $12.05 $12.05 $12.05 $67.36 $67.36 "$1,305.22" $12.05 "$1,318.40" $19.88 $16.96 $12.05 $955.84 "$1,648.00" $17.47 $12.05 $13.32 $12.05 N/A N/A 30250404 EAP CPT® 86255 FLUORESCENT AB SCREEN (SO) BOTH IP/OP "$1,493.00" "$1,105.00" $6.03 "$1,493.00" $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 $883.11 $12.05 $12.05 $12.05 "$1,493.00" "$1,119.75" $12.05 $12.05 $12.05 $67.36 $67.36 "$1,182.46" $12.05 "$1,194.40" $19.88 $16.96 $12.05 $865.94 "$1,493.00" $17.47 $12.05 $13.32 $12.05 N/A N/A 30250405 EAP CPT® 86255 FLUORESCENT AB SCREEN (SO) BOTH IP/OP "$3,099.00" "$2,293.50" $6.03 "$3,099.00" $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 "$1,833.06" $12.05 $12.05 $12.05 "$3,099.00" "$2,324.25" $12.05 $12.05 $12.05 $67.36 $67.36 "$2,454.41" $12.05 "$2,479.20" $19.88 $16.96 $12.05 "$1,797.42" "$3,099.00" $17.47 $12.05 $13.32 $12.05 N/A N/A 30250406 EAP CPT® 86255 FLUORESCENT AB SCREEN (SO) BOTH IP/OP "$3,352.00" "$2,480.50" $6.03 "$3,352.00" $23.64 $23.64 $23.64 $23.64 $12.05 $12.05 $6.03 $6.03 $12.05 $18.30 $18.30 $19.01 $13.36 $17.81 $19.28 $19.28 "$1,982.71" $12.05 $12.05 $12.05 "$3,352.00" "$2,514.00" $12.05 $12.05 $12.05 $67.36 $67.36 "$2,654.78" $12.05 "$2,681.60" $19.88 $16.96 $12.05 "$1,944.16" "$3,352.00" $17.47 $12.05 $13.32 $12.05 N/A N/A 30250407 EAP CPT® 86341 ISLET CELL AB (SO) BOTH IP/OP $325.00 $240.50 $10.61 $325.00 $38.83 $38.83 $38.83 $38.83 $23.57 $23.57 $11.79 $10.61 $23.57 $30.05 $30.05 $31.20 $21.93 $29.24 $37.71 $37.71 $192.24 $23.57 $23.57 $23.57 $325.00 $243.75 $23.57 $23.57 $23.57 $110.60 $110.60 $257.40 $23.57 $260.00 $38.89 $27.85 $23.57 $188.50 $325.00 $34.18 $23.57 $21.88 $23.57 N/A N/A 30250408 EAP CPT® 86341 ISLET CELL AB (SO) BOTH IP/OP $108.00 $80.00 $10.61 $108.00 $38.83 $38.83 $38.83 $38.83 $23.57 $23.57 $11.79 $10.61 $23.57 $30.05 $30.05 $31.20 $21.93 $29.24 $37.71 $37.71 $63.88 $23.57 $23.57 $23.57 $108.00 $81.00 $23.57 $23.57 $23.57 $108.00 $108.00 $85.54 $23.57 $86.40 $38.89 $27.85 $23.57 $62.64 $108.00 $34.18 $23.57 $21.88 $23.57 N/A N/A 30250409 EAP CPT® 86341 ISLET CELL AB (SO) BOTH IP/OP $165.00 $122.50 $10.61 $165.00 $38.83 $38.83 $38.83 $38.83 $23.57 $23.57 $11.79 $10.61 $23.57 $30.05 $30.05 $31.20 $21.93 $29.24 $37.71 $37.71 $97.60 $23.57 $23.57 $23.57 $165.00 $123.75 $23.57 $23.57 $23.57 $110.60 $110.60 $130.68 $23.57 $132.00 $38.89 $27.85 $23.57 $95.70 $165.00 $34.18 $23.57 $21.88 $23.57 N/A N/A 30250410 EAP CPT® 86003 PEANUT (F13) IGE (SO) BOTH IP/OP $10.00 $7.50 $2.61 $10.00 $10.00 $10.00 $10.00 $10.00 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $5.92 $5.22 $5.22 $5.22 $10.00 $7.50 $5.22 $5.22 $5.22 $10.00 $10.00 $7.92 $5.22 $8.00 $8.61 $7.35 $5.22 $5.80 $10.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30250411 EAP CPT® 86008 PEANUT PANEL - ARACHIS HYPOGAEA RECOMBINANT (RARA H) 1 AB IGE (SO) BOTH IP/OP $20.00 $15.00 $8.97 $28.69 $20.00 $20.00 $20.00 $20.00 $17.93 $17.93 $8.97 $20.00 $17.93 $23.03 $23.03 $23.91 $16.81 $20.00 $28.69 $28.69 $20.00 $17.93 $17.93 $17.93 $20.00 $15.00 $17.93 $17.93 $17.93 $10.00 $10.00 $15.84 $17.93 $16.00 $20.00 $20.00 $17.93 $11.60 $20.00 $20.00 $17.93 $20.00 $17.93 N/A N/A 30250412 EAP CPT® 86008 PEANUT PANEL - ARACHIS HYPOGAEA RECOMBINANT (RARA H) 2 AB IGE (SO) BOTH IP/OP $20.00 $15.00 $8.97 $28.69 $20.00 $20.00 $20.00 $20.00 $17.93 $17.93 $8.97 $20.00 $17.93 $23.03 $23.03 $23.91 $16.81 $20.00 $28.69 $28.69 $20.00 $17.93 $17.93 $17.93 $20.00 $15.00 $17.93 $17.93 $17.93 $10.00 $10.00 $15.84 $17.93 $16.00 $20.00 $20.00 $17.93 $11.60 $20.00 $20.00 $17.93 $20.00 $17.93 N/A N/A 30250413 EAP CPT® 86008 PEANUT PANEL - ARACHIS HYPOGAEA RECOMBINANT (RARA H) 3 AB IGE (SO) BOTH IP/OP $20.00 $15.00 $8.97 $28.69 $20.00 $20.00 $20.00 $20.00 $17.93 $17.93 $8.97 $20.00 $17.93 $23.03 $23.03 $23.91 $16.81 $20.00 $28.69 $28.69 $20.00 $17.93 $17.93 $17.93 $20.00 $15.00 $17.93 $17.93 $17.93 $10.00 $10.00 $15.84 $17.93 $16.00 $20.00 $20.00 $17.93 $11.60 $20.00 $20.00 $17.93 $20.00 $17.93 N/A N/A 30250414 EAP CPT® 86008 PEANUT PANEL - ARACHIS HYPOGAEA RECOMBINANT (RARA H) 8 AB IGE (SO) BOTH IP/OP $20.00 $15.00 $8.97 $28.69 $20.00 $20.00 $20.00 $20.00 $17.93 $17.93 $8.97 $20.00 $17.93 $23.03 $23.03 $23.91 $16.81 $20.00 $28.69 $28.69 $20.00 $17.93 $17.93 $17.93 $20.00 $15.00 $17.93 $17.93 $17.93 $10.00 $10.00 $15.84 $17.93 $16.00 $20.00 $20.00 $17.93 $11.60 $20.00 $20.00 $17.93 $20.00 $17.93 N/A N/A 30250415 EAP CPT® 86008 PEANUT PANEL - ARACHIS HYPOGAEA RECOMBINANT (RARA H) 9 AB IGE (SO) BOTH IP/OP $20.00 $15.00 $8.97 $28.69 $20.00 $20.00 $20.00 $20.00 $17.93 $17.93 $8.97 $20.00 $17.93 $23.03 $23.03 $23.91 $16.81 $20.00 $28.69 $28.69 $20.00 $17.93 $17.93 $17.93 $20.00 $15.00 $17.93 $17.93 $17.93 $10.00 $10.00 $15.84 $17.93 $16.00 $20.00 $20.00 $17.93 $11.60 $20.00 $20.00 $17.93 $20.00 $17.93 N/A N/A 30250416 EAP CPT® 86003 "PEANUT, TOTAL WITH REFLEX TO PEANUT COMPONENT PANEL (SO)" BOTH IP/OP $10.00 $7.50 $2.61 $10.00 $10.00 $10.00 $10.00 $10.00 $5.22 $5.22 $2.61 $2.61 $5.22 $7.92 $7.92 $8.23 $5.79 $7.72 $8.35 $8.35 $5.92 $5.22 $5.22 $5.22 $10.00 $7.50 $5.22 $5.22 $5.22 $10.00 $10.00 $7.92 $5.22 $8.00 $8.61 $7.35 $5.22 $5.80 $10.00 $7.57 $5.22 $5.77 $5.22 N/A N/A 30500001 EAP CPT® 85002 "BLEEDING TIME, TEMP" BOTH IP/OP $109.00 $81.00 $2.41 $109.00 $109.00 $109.00 $109.00 $109.00 $4.82 $4.82 $2.41 $109.00 $4.82 $6.83 $6.83 $7.10 $4.99 $6.65 $7.71 $7.71 $109.00 $4.82 $4.82 $4.82 $109.00 $81.75 $4.82 $4.82 $4.82 $25.16 $25.16 $86.33 $4.82 $87.20 $109.00 $109.00 $4.82 $63.22 $109.00 $6.99 $4.82 $109.00 $4.82 N/A N/A 30500002 EAP CPT® 85007 MISC. SMEAR BOTH IP/OP $102.00 $75.50 $1.72 $102.00 $6.73 $6.73 $6.73 $6.73 $3.80 $3.80 $1.90 $1.72 $3.80 $5.22 $5.22 $5.42 $3.81 $5.08 $6.08 $6.08 $60.33 $3.80 $3.80 $3.80 $102.00 $76.50 $3.80 $3.80 $3.80 $19.24 $19.24 $80.78 $3.80 $81.60 $6.27 $4.84 $3.80 $59.16 $102.00 $5.51 $3.80 $3.80 $3.80 N/A N/A 30500003 EAP CPT® 85576 BLD PLAT AGG - TEG BOTH IP/OP $442.00 $327.50 $11.21 $442.00 $42.17 $42.17 $42.17 $42.17 $24.91 $24.91 $12.46 $11.21 $24.91 $32.62 $32.62 $33.88 $23.82 $31.73 $39.86 $39.86 $261.44 $24.91 $24.91 $24.91 $442.00 $331.50 $24.91 $24.91 $24.91 $120.04 $120.04 $350.06 $24.91 $353.60 $41.10 $30.22 $24.91 $256.36 $442.00 $36.12 $24.91 $23.74 $24.91 N/A N/A 30500004 EAP CPT® 85384 FIBRINOGEN ACT - TEG BOTH IP/OP $207.00 $153.50 $4.37 $207.00 $16.67 $16.67 $16.67 $16.67 $9.72 $9.72 $4.86 $4.37 $9.72 $12.90 $12.90 $13.39 $9.41 $12.55 $15.55 $15.55 $122.44 $9.72 $9.72 $9.72 $207.00 $155.25 $9.72 $9.72 $9.72 $47.48 $47.48 $163.94 $9.72 $165.60 $16.04 $11.95 $9.72 $120.06 $207.00 $14.09 $9.72 $9.39 $9.72 N/A N/A 30500005 EAP CPT® 85008 RBC MORPHOLOGY EXAM BOTH IP/OP $83.00 $61.50 $1.72 $83.00 $6.73 $6.73 $6.73 $6.73 $3.43 $3.43 $1.72 $1.72 $3.43 $5.22 $5.22 $5.42 $3.81 $5.08 $5.49 $5.49 $49.09 $3.43 $3.43 $3.43 $83.00 $62.25 $3.43 $3.43 $3.43 $19.24 $19.24 $65.74 $3.43 $66.40 $5.66 $4.84 $3.43 $48.14 $83.00 $4.97 $3.43 $3.80 $3.43 N/A N/A 30500006 EAP CPT® 85008 "RBC, SCHISTOCYTE CNT" BOTH IP/OP $91.00 $67.50 $1.72 $91.00 $6.73 $6.73 $6.73 $6.73 $3.43 $3.43 $1.72 $1.72 $3.43 $5.22 $5.22 $5.42 $3.81 $5.08 $5.49 $5.49 $53.83 $3.43 $3.43 $3.43 $91.00 $68.25 $3.43 $3.43 $3.43 $19.24 $19.24 $72.07 $3.43 $72.80 $5.66 $4.84 $3.43 $52.78 $91.00 $4.97 $3.43 $3.80 $3.43 N/A N/A 30500007 EAP CPT® 85013 HEMATOCRIT COUNT BOTH IP/OP $51.00 $38.00 $2.63 $51.00 $51.00 $51.00 $51.00 $51.00 $7.00 $7.00 $3.50 $51.00 $7.00 $3.60 $3.60 $3.74 $2.63 $3.50 $11.20 $11.20 $51.00 $7.00 $7.00 $7.00 $51.00 $38.25 $7.00 $7.00 $7.00 $13.24 $13.24 $40.39 $7.00 $40.80 $51.00 $51.00 $7.00 $29.58 $51.00 $10.15 $7.00 $51.00 $7.00 N/A N/A 30500008 EAP CPT® 85013 "HEMATOCRIT, FLD - SPUN" BOTH IP/OP $51.00 $38.00 $2.63 $51.00 $51.00 $51.00 $51.00 $51.00 $7.00 $7.00 $3.50 $51.00 $7.00 $3.60 $3.60 $3.74 $2.63 $3.50 $11.20 $11.20 $51.00 $7.00 $7.00 $7.00 $51.00 $38.25 $7.00 $7.00 $7.00 $13.24 $13.24 $40.39 $7.00 $40.80 $51.00 $51.00 $7.00 $29.58 $51.00 $10.15 $7.00 $51.00 $7.00 N/A N/A 30500009 EAP CPT® 85347 "COAG TIME, ACTIVATED-TEG" BOTH IP/OP $293.00 $217.00 $2.13 $293.00 $8.36 $8.36 $8.36 $8.36 $4.28 $4.28 $2.14 $2.13 $4.28 $6.47 $6.47 $6.72 $4.72 $6.30 $6.85 $6.85 $173.31 $4.28 $4.28 $4.28 $293.00 $219.75 $4.28 $4.28 $4.28 $23.80 $23.80 $232.06 $4.28 $234.40 $7.06 $6.00 $4.28 $169.94 $293.00 $6.21 $4.28 $4.71 $4.28 N/A N/A 30500010 EAP CPT® 85013 "HEMATOCRIT, SPUN CAP" BOTH IP/OP $51.00 $38.00 $2.63 $51.00 $51.00 $51.00 $51.00 $51.00 $7.00 $7.00 $3.50 $51.00 $7.00 $3.60 $3.60 $3.74 $2.63 $3.50 $11.20 $11.20 $51.00 $7.00 $7.00 $7.00 $51.00 $38.25 $7.00 $7.00 $7.00 $13.24 $13.24 $40.39 $7.00 $40.80 $51.00 $51.00 $7.00 $29.58 $51.00 $10.15 $7.00 $51.00 $7.00 N/A N/A 30500011 EAP CPT® 85013 "HEMATOCRIT,CSF-SPUN" BOTH IP/OP $51.00 $38.00 $2.63 $51.00 $51.00 $51.00 $51.00 $51.00 $7.00 $7.00 $3.50 $51.00 $7.00 $3.60 $3.60 $3.74 $2.63 $3.50 $11.20 $11.20 $51.00 $7.00 $7.00 $7.00 $51.00 $38.25 $7.00 $7.00 $7.00 $13.24 $13.24 $40.39 $7.00 $40.80 $51.00 $51.00 $7.00 $29.58 $51.00 $10.15 $7.00 $51.00 $7.00 N/A N/A 30500012 EAP CPT® 85014 HEMATOCRIT BOTH IP/OP $58.00 $43.00 $1.19 $58.00 $58.00 $58.00 $58.00 $58.00 $2.37 $2.37 $1.19 $58.00 $2.37 $3.60 $3.60 $3.74 $2.63 $3.50 $3.79 $3.79 $58.00 $2.37 $2.37 $2.37 $58.00 $43.50 $2.37 $2.37 $2.37 $13.24 $13.24 $45.94 $2.37 $46.40 $58.00 $58.00 $2.37 $33.64 $58.00 $3.44 $2.37 $58.00 $2.37 N/A N/A 30500013 EAP CPT® 85390 FIBRINOLYSINS SCRN -TEG BOTH IP/OP $134.00 $99.50 $5.72 $134.00 $134.00 $134.00 $134.00 $134.00 $15.48 $15.48 $7.74 $134.00 $15.48 $7.84 $7.84 $8.14 $5.72 $7.63 $24.77 $24.77 $134.00 $15.48 $15.48 $15.48 $134.00 $100.50 $15.48 $15.48 $15.48 $28.88 $28.88 $106.13 $15.48 $107.20 $134.00 $134.00 $15.48 $77.72 $134.00 $22.45 $15.48 $134.00 $15.48 N/A N/A 30500015 EAP CPT® 85018 "HEMOGLOBIN, MICRO(METER)" BOTH IP/OP $51.00 $38.00 $1.18 $51.00 $4.64 $4.64 $4.64 $4.64 $2.37 $2.37 $1.19 $1.18 $2.37 $3.60 $3.60 $3.74 $2.63 $3.50 $3.79 $3.79 $30.17 $2.37 $2.37 $2.37 $51.00 $38.25 $2.37 $2.37 $2.37 $13.24 $13.24 $40.39 $2.37 $40.80 $3.91 $3.33 $2.37 $29.58 $51.00 $3.44 $2.37 $2.62 $2.37 N/A N/A 30500016 EAP CPT® 86022 PLATELET ANTIBODY SCREEN INDIRECT (SO) BOTH IP/OP $362.00 $268.00 $9.19 $362.00 $362.00 $362.00 $362.00 $362.00 $18.37 $18.37 $9.19 $362.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $362.00 $18.37 $18.37 $18.37 $362.00 $271.50 $18.37 $18.37 $18.37 $102.64 $102.64 $286.70 $18.37 $289.60 $362.00 $362.00 $18.37 $209.96 $362.00 $26.64 $18.37 $362.00 $18.37 N/A N/A 30500017 EAP CPT® 85018 HGB & HCT BOTH IP/OP $51.00 $38.00 $1.18 $51.00 $4.64 $4.64 $4.64 $4.64 $2.37 $2.37 $1.19 $1.18 $2.37 $3.60 $3.60 $3.74 $2.63 $3.50 $3.79 $3.79 $30.17 $2.37 $2.37 $2.37 $51.00 $38.25 $2.37 $2.37 $2.37 $13.24 $13.24 $40.39 $2.37 $40.80 $3.91 $3.33 $2.37 $29.58 $51.00 $3.44 $2.37 $2.62 $2.37 N/A N/A 30500018 EAP CPT® 85018 "HGB, VENOUS (METER)" BOTH IP/OP $51.00 $38.00 $1.18 $51.00 $4.64 $4.64 $4.64 $4.64 $2.37 $2.37 $1.19 $1.18 $2.37 $3.60 $3.60 $3.74 $2.63 $3.50 $3.79 $3.79 $30.17 $2.37 $2.37 $2.37 $51.00 $38.25 $2.37 $2.37 $2.37 $13.24 $13.24 $40.39 $2.37 $40.80 $3.91 $3.33 $2.37 $29.58 $51.00 $3.44 $2.37 $2.62 $2.37 N/A N/A 30500021 EAP CPT® 85025 "CBC, PLAT & DIFF" BOTH IP/OP $212.00 $157.00 $3.88 $212.00 $15.26 $15.26 $15.26 $15.26 $7.77 $7.77 $3.89 $3.88 $7.77 $9.97 $9.97 $10.36 $7.28 $11.48 $12.43 $12.43 $125.40 $7.77 $7.77 $7.77 $212.00 $159.00 $7.77 $7.77 $7.77 $43.44 $43.44 $167.90 $7.77 $169.60 $12.82 $10.93 $7.77 $122.96 $212.00 $11.27 $7.77 $8.59 $7.77 N/A N/A 30500022 EAP CPT® 85027 CBC & PLAT BOTH IP/OP $175.00 $129.50 $3.23 $175.00 $12.70 $12.70 $12.70 $12.70 $6.47 $6.47 $3.24 $3.23 $6.47 $9.83 $9.83 $10.21 $7.17 $9.57 $10.35 $10.35 $103.51 $6.47 $6.47 $6.47 $175.00 $131.25 $6.47 $6.47 $6.47 $36.16 $36.16 $138.60 $6.47 $140.00 $10.68 $9.11 $6.47 $101.50 $175.00 $9.38 $6.47 $7.16 $6.47 N/A N/A 30500024 EAP CPT® 85046 "RETICULOCYTES, AUTOMATED" BOTH IP/OP $154.00 $114.00 $2.79 $154.00 $10.92 $10.92 $10.92 $10.92 $5.57 $5.57 $2.79 $2.79 $5.57 $8.48 $8.48 $8.80 $6.19 $8.24 $8.91 $8.91 $91.09 $5.57 $5.57 $5.57 $154.00 $115.50 $5.57 $5.57 $5.57 $31.20 $31.20 $121.97 $5.57 $123.20 $9.19 $7.85 $5.57 $89.32 $154.00 $8.08 $5.57 $6.17 $5.57 N/A N/A 30500026 EAP CPT® 85048 "EOSINOPHIL COUNT, WB" BOTH IP/OP $68.00 $50.50 $1.27 $68.00 $68.00 $68.00 $68.00 $68.00 $2.54 $2.54 $1.27 $68.00 $2.54 $3.86 $3.86 $4.01 $2.82 $3.76 $4.06 $4.06 $68.00 $2.54 $2.54 $2.54 $68.00 $51.00 $2.54 $2.54 $2.54 $14.20 $14.20 $53.86 $2.54 $54.40 $68.00 $68.00 $2.54 $39.44 $68.00 $3.68 $2.54 $68.00 $2.54 N/A N/A 30500027 EAP CPT® 85049 PLATELET COUNT (WB) BOTH IP/OP $127.00 $94.00 $2.24 $127.00 $8.79 $8.79 $8.79 $8.79 $4.48 $4.48 $2.24 $2.24 $4.48 $6.79 $6.79 $7.05 $4.96 $6.62 $7.17 $7.17 $75.12 $4.48 $4.48 $4.48 $127.00 $95.25 $4.48 $4.48 $4.48 $25.00 $25.00 $100.58 $4.48 $101.60 $7.39 $6.30 $4.48 $73.66 $127.00 $6.50 $4.48 $4.95 $4.48 N/A N/A 30500028 EAP CPT® 85097 BONE MARROW EXAM BOTH IP/OP $773.00 $572.50 $24.50 $773.00 $773.00 $773.00 $773.00 $773.00 $48.25 $48.25 $24.50 $773.00 $48.25 $48.62 $48.62 $50.49 $35.49 $75.35 $77.20 $76.43 $773.00 $48.25 $47.77 $48.25 $773.00 $579.75 $48.25 $48.25 $48.25 $426.96 $426.96 $612.22 $48.25 $618.40 $502.45 $773.00 $48.25 $448.34 $773.00 $51.21 $48.25 $773.00 $48.25 N/A N/A 30500029 EAP CPT® 85210 FACTOR II ASSAY BOTH IP/OP $424.00 $314.00 $6.49 $424.00 $424.00 $424.00 $424.00 $424.00 $12.98 $12.98 $6.49 $424.00 $12.98 $19.72 $19.72 $20.48 $14.39 $19.18 $20.77 $20.77 $424.00 $12.98 $12.98 $12.98 $424.00 $318.00 $12.98 $12.98 $12.98 $72.56 $72.56 $335.81 $12.98 $339.20 $424.00 $424.00 $12.98 $245.92 $424.00 $18.82 $12.98 $424.00 $12.98 N/A N/A 30500030 EAP CPT® 85220 FACTOR V ASSAY BOTH IP/OP $568.00 $420.50 $8.83 $568.00 $568.00 $568.00 $568.00 $568.00 $17.65 $17.65 $8.83 $568.00 $17.65 $26.80 $26.80 $27.83 $19.56 $26.07 $28.24 $28.24 $568.00 $17.65 $17.65 $17.65 $568.00 $426.00 $17.65 $17.65 $17.65 $98.64 $98.64 $449.86 $17.65 $454.40 $568.00 $568.00 $17.65 $329.44 $568.00 $25.59 $17.65 $568.00 $17.65 N/A N/A 30500031 EAP CPT® 85230 FACTOR VII ASSAY BOTH IP/OP $584.00 $432.50 $8.95 $584.00 $35.14 $35.14 $35.14 $35.14 $17.90 $17.90 $8.95 $8.95 $17.90 $27.19 $27.19 $28.23 $19.85 $26.46 $28.64 $28.64 $345.44 $17.90 $17.90 $17.90 $584.00 $438.00 $17.90 $17.90 $17.90 $100.08 $100.08 $462.53 $17.90 $467.20 $29.54 $25.20 $17.90 $338.72 $584.00 $25.96 $17.90 $19.79 $17.90 N/A N/A 30500032 EAP CPT® 85240 FACTOR VIII ASSAY BOTH IP/OP $584.00 $432.50 $8.95 $584.00 $35.14 $35.14 $35.14 $35.14 $17.90 $17.90 $8.95 $8.95 $17.90 $27.19 $27.19 $28.23 $19.85 $26.46 $28.64 $28.64 $345.44 $17.90 $17.90 $17.90 $584.00 $438.00 $17.90 $17.90 $17.90 $100.08 $100.08 $462.53 $17.90 $467.20 $29.54 $25.20 $17.90 $338.72 $584.00 $25.96 $17.90 $19.79 $17.90 N/A N/A 30500033 EAP CPT® 85245 VW FACTOR ACTIVITY BOTH IP/OP $680.00 $503.50 $11.47 $680.00 $45.03 $45.03 $45.03 $45.03 $22.94 $22.94 $11.47 $11.47 $22.94 $34.85 $34.85 $36.19 $25.44 $33.89 $36.70 $36.70 $402.22 $22.94 $22.94 $22.94 $680.00 $510.00 $22.94 $22.94 $22.94 $128.24 $128.24 $538.56 $22.94 $544.00 $37.85 $32.28 $22.94 $394.40 $680.00 $33.26 $22.94 $25.36 $22.94 N/A N/A 30500034 EAP CPT® 85245 RISTOCETIN COFACTOR BOTH IP/OP $738.00 $546.50 $11.47 $738.00 $45.03 $45.03 $45.03 $45.03 $22.94 $22.94 $11.47 $11.47 $22.94 $34.85 $34.85 $36.19 $25.44 $33.89 $36.70 $36.70 $436.53 $22.94 $22.94 $22.94 $738.00 $553.50 $22.94 $22.94 $22.94 $128.24 $128.24 $584.50 $22.94 $590.40 $37.85 $32.28 $22.94 $428.04 $738.00 $33.26 $22.94 $25.36 $22.94 N/A N/A 30500035 EAP CPT® 85246 VON WILLEBRAND AG BOTH IP/OP $738.00 $546.50 $11.47 $738.00 $45.03 $45.03 $45.03 $45.03 $22.94 $22.94 $11.47 $11.47 $22.94 $34.85 $34.85 $36.19 $25.44 $33.89 $36.70 $36.70 $436.53 $22.94 $22.94 $22.94 $738.00 $553.50 $22.94 $22.94 $22.94 $128.24 $128.24 $584.50 $22.94 $590.40 $37.85 $32.28 $22.94 $428.04 $738.00 $33.26 $22.94 $25.36 $22.94 N/A N/A 30500036 EAP CPT® 85250 FACTOR IX ASSAY BOTH IP/OP $613.00 $454.00 $9.52 $613.00 $613.00 $613.00 $613.00 $613.00 $19.04 $19.04 $9.52 $613.00 $19.04 $28.90 $28.90 $30.01 $21.10 $28.12 $30.46 $30.46 $613.00 $19.04 $19.04 $19.04 $613.00 $459.75 $19.04 $19.04 $19.04 $106.40 $106.40 $485.50 $19.04 $490.40 $613.00 $613.00 $19.04 $355.54 $613.00 $27.61 $19.04 $613.00 $19.04 N/A N/A 30500037 EAP CPT® 85260 FACTOR X ASSAY BOTH IP/OP $584.00 $432.50 $8.95 $584.00 $35.14 $35.14 $35.14 $35.14 $17.90 $17.90 $8.95 $8.95 $17.90 $27.19 $27.19 $28.23 $19.85 $26.46 $28.64 $28.64 $345.44 $17.90 $17.90 $17.90 $584.00 $438.00 $17.90 $17.90 $17.90 $100.08 $100.08 $462.53 $17.90 $467.20 $29.54 $25.20 $17.90 $338.72 $584.00 $25.96 $17.90 $19.79 $17.90 N/A N/A 30500038 EAP CPT® 85270 FACTOR XI ASSAY BOTH IP/OP $584.00 $432.50 $8.95 $584.00 $584.00 $584.00 $584.00 $584.00 $17.90 $17.90 $8.95 $584.00 $17.90 $27.19 $27.19 $28.23 $19.85 $26.46 $28.64 $28.64 $584.00 $17.90 $17.90 $17.90 $584.00 $438.00 $17.90 $17.90 $17.90 $100.08 $100.08 $462.53 $17.90 $467.20 $584.00 $584.00 $17.90 $338.72 $584.00 $25.96 $17.90 $584.00 $17.90 N/A N/A 30500039 EAP CPT® 85280 FACTOR XII ASSAY BOTH IP/OP $621.00 $460.00 $9.68 $621.00 $621.00 $621.00 $621.00 $621.00 $19.35 $19.35 $9.68 $621.00 $19.35 $29.38 $29.38 $30.51 $21.45 $28.59 $30.96 $30.96 $621.00 $19.35 $19.35 $19.35 $621.00 $465.75 $19.35 $19.35 $19.35 $108.16 $108.16 $491.83 $19.35 $496.80 $621.00 $621.00 $19.35 $360.18 $621.00 $28.06 $19.35 $621.00 $19.35 N/A N/A 30500040 EAP CPT® 85291 FACTOR XIII SCREEN BOTH IP/OP $680.00 $503.50 $4.56 $680.00 $680.00 $680.00 $680.00 $680.00 $9.11 $9.11 $4.56 $680.00 $9.11 $13.50 $13.50 $14.02 $9.85 $13.14 $14.58 $14.58 $680.00 $9.11 $9.11 $9.11 $680.00 $510.00 $9.11 $9.11 $9.11 $49.68 $49.68 $538.56 $9.11 $544.00 $680.00 $680.00 $9.11 $394.40 $680.00 $13.21 $9.11 $680.00 $9.11 N/A N/A 30500041 EAP CPT® 85300 PROTEIN S ACTIVITY BOTH IP/OP $493.00 $365.00 $5.93 $493.00 $23.27 $23.27 $23.27 $23.27 $11.85 $11.85 $5.93 $5.93 $11.85 $17.99 $17.99 $18.68 $13.13 $17.50 $18.96 $18.96 $291.61 $11.85 $11.85 $11.85 $493.00 $369.75 $11.85 $11.85 $11.85 $66.20 $66.20 $390.46 $11.85 $394.40 $19.55 $16.67 $11.85 $285.94 $493.00 $17.18 $11.85 $13.09 $11.85 N/A N/A 30500042 EAP CPT® 85300 FACTOR AT-III ASSAY BOTH IP/OP $493.00 $365.00 $5.93 $493.00 $23.27 $23.27 $23.27 $23.27 $11.85 $11.85 $5.93 $5.93 $11.85 $17.99 $17.99 $18.68 $13.13 $17.50 $18.96 $18.96 $291.61 $11.85 $11.85 $11.85 $493.00 $369.75 $11.85 $11.85 $11.85 $66.20 $66.20 $390.46 $11.85 $394.40 $19.55 $16.67 $11.85 $285.94 $493.00 $17.18 $11.85 $13.09 $11.85 N/A N/A 30500043 EAP CPT® 85301 AT-III ANTIGEN BOTH IP/OP $971.00 $719.00 $5.40 $971.00 $21.21 $21.21 $21.21 $21.21 $10.81 $10.81 $5.41 $5.40 $10.81 $16.42 $16.42 $17.05 $11.99 $15.98 $17.30 $17.30 $574.35 $10.81 $10.81 $10.81 $971.00 $728.25 $10.81 $10.81 $10.81 $60.44 $60.44 $769.03 $10.81 $776.80 $17.84 $15.22 $10.81 $563.18 $971.00 $15.67 $10.81 $11.96 $10.81 N/A N/A 30500044 EAP CPT® 85303 PROTEIN C ACTIVITY BOTH IP/OP $466.00 $345.00 $6.92 $466.00 $27.16 $27.16 $27.16 $27.16 $13.84 $13.84 $6.92 $6.92 $13.84 $21.00 $21.00 $21.81 $15.33 $20.43 $22.14 $22.14 $275.64 $13.84 $13.84 $13.84 $466.00 $349.50 $13.84 $13.84 $13.84 $77.28 $77.28 $369.07 $13.84 $372.80 $22.84 $19.46 $13.84 $270.28 $466.00 $20.07 $13.84 $15.29 $13.84 N/A N/A 30500045 EAP CPT® 85307 ACT PROT-C RESIST (FV-LEIDEN) BOTH IP/OP $264.00 $195.50 $7.66 $264.00 $264.00 $264.00 $264.00 $264.00 $15.32 $15.32 $7.66 $264.00 $15.32 $23.26 $23.26 $24.16 $16.98 $22.64 $24.51 $24.51 $264.00 $15.32 $15.32 $15.32 $264.00 $198.00 $15.32 $15.32 $15.32 $85.64 $85.64 $209.09 $15.32 $211.20 $264.00 $264.00 $15.32 $153.12 $264.00 $22.21 $15.32 $264.00 $15.32 N/A N/A 30500046 EAP CPT® 85379 D-DIMER BOTH IP/OP $335.00 $248.00 $5.09 $335.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $198.15 $10.18 $10.18 $10.18 $335.00 $251.25 $10.18 $10.18 $10.18 $56.88 $56.88 $265.32 $10.18 $268.00 $16.80 $14.32 $10.18 $194.30 $335.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30500047 EAP CPT® 85384 FIBRINOGEN QUANT. BOTH IP/OP $299.00 $221.50 $4.37 $299.00 $16.67 $16.67 $16.67 $16.67 $9.72 $9.72 $4.86 $4.37 $9.72 $12.90 $12.90 $13.39 $9.41 $12.55 $15.55 $15.55 $176.86 $9.72 $9.72 $9.72 $299.00 $224.25 $9.72 $9.72 $9.72 $47.48 $47.48 $236.81 $9.72 $239.20 $16.04 $11.95 $9.72 $173.42 $299.00 $14.09 $9.72 $9.39 $9.72 N/A N/A 30500048 EAP CPT® 85410 ALPHA-2-ANTIPLASMIN BOTH IP/OP $183.00 $135.50 $3.86 $183.00 $183.00 $183.00 $183.00 $183.00 $7.71 $7.71 $3.86 $183.00 $7.71 $11.71 $11.71 $12.16 $8.55 $11.38 $12.34 $12.34 $183.00 $7.71 $7.71 $7.71 $183.00 $137.25 $7.71 $7.71 $7.71 $43.08 $43.08 $144.94 $7.71 $146.40 $183.00 $183.00 $7.71 $106.14 $183.00 $11.18 $7.71 $183.00 $7.71 N/A N/A 30500049 EAP CPT® 85420 PLASMINOGEN ACTIV. BOTH IP/OP $145.00 $107.50 $3.27 $145.00 $145.00 $145.00 $145.00 $145.00 $6.53 $6.53 $3.27 $145.00 $6.53 $9.93 $9.93 $10.31 $7.25 $9.66 $10.45 $10.45 $145.00 $6.53 $6.53 $6.53 $145.00 $108.75 $6.53 $6.53 $6.53 $36.52 $36.52 $114.84 $6.53 $116.00 $145.00 $145.00 $6.53 $84.10 $145.00 $9.47 $6.53 $145.00 $6.53 N/A N/A 30500050 EAP CPT® 85441 HEINZ BODY DIRECT BOTH IP/OP $57.00 $42.50 $2.10 $57.00 $57.00 $57.00 $57.00 $57.00 $4.20 $4.20 $2.10 $57.00 $4.20 $6.39 $6.39 $6.63 $4.66 $6.22 $6.72 $6.72 $57.00 $4.20 $4.20 $4.20 $57.00 $42.75 $4.20 $4.20 $4.20 $23.52 $23.52 $45.14 $4.20 $45.60 $57.00 $57.00 $4.20 $33.06 $57.00 $6.09 $4.20 $57.00 $4.20 N/A N/A 30500051 EAP CPT® 85445 HEINZ BODY INDUCED BOTH IP/OP $83.00 $61.50 $3.41 $83.00 $83.00 $83.00 $83.00 $83.00 $6.82 $6.82 $3.41 $83.00 $6.82 $10.35 $10.35 $10.75 $7.55 $10.07 $10.91 $10.91 $83.00 $6.82 $6.82 $6.82 $83.00 $62.25 $6.82 $6.82 $6.82 $38.08 $38.08 $65.74 $6.82 $66.40 $83.00 $83.00 $6.82 $48.14 $83.00 $9.89 $6.82 $83.00 $6.82 N/A N/A 30500052 EAP CPT® 85460 K-B HGB FETAL SCREEN ** BOTH IP/OP $51.00 $38.00 $2.67 $51.00 $4.74 $4.74 $4.74 $4.74 $7.73 $7.73 $3.87 $3.87 $7.73 $3.67 $3.67 $3.81 $2.68 $3.57 $12.37 $12.37 $30.17 $7.73 $7.73 $7.73 $51.00 $38.25 $7.73 $7.73 $7.73 $13.52 $13.52 $40.39 $7.73 $40.80 $12.75 $3.40 $7.73 $29.58 $51.00 $11.21 $7.73 $2.67 $7.73 N/A N/A 30500053 EAP CPT® 85475 "HEMOLYSIS,ACID-HAM'S" BOTH IP/OP $59.00 $44.00 $4.44 $59.00 $59.00 $59.00 $59.00 $59.00 $8.87 $8.87 $4.44 $59.00 $8.87 $7.91 $7.91 $8.22 $5.78 $7.70 $14.19 $14.19 $59.00 $8.87 $8.87 $8.87 $59.00 $44.25 $8.87 $8.87 $8.87 $29.12 $29.12 $46.73 $8.87 $47.20 $59.00 $59.00 $8.87 $34.22 $59.00 $12.86 $8.87 $59.00 $8.87 N/A N/A 30500054 EAP CPT® 85475 "HEMOLYSIS, SUCROSE" BOTH IP/OP $59.00 $44.00 $4.44 $59.00 $59.00 $59.00 $59.00 $59.00 $8.87 $8.87 $4.44 $59.00 $8.87 $7.91 $7.91 $8.22 $5.78 $7.70 $14.19 $14.19 $59.00 $8.87 $8.87 $8.87 $59.00 $44.25 $8.87 $8.87 $8.87 $29.12 $29.12 $46.73 $8.87 $47.20 $59.00 $59.00 $8.87 $34.22 $59.00 $12.86 $8.87 $59.00 $8.87 N/A N/A 30500055 EAP CPT® 85520 HEPARIN ASSAY BOTH IP/OP $400.00 $296.00 $6.55 $400.00 $25.70 $25.70 $25.70 $25.70 $13.09 $13.09 $6.55 $6.55 $13.09 $19.87 $19.87 $20.64 $14.51 $19.34 $20.94 $20.94 $236.60 $13.09 $13.09 $13.09 $400.00 $300.00 $13.09 $13.09 $13.09 $73.16 $73.16 $316.80 $13.09 $320.00 $21.60 $18.42 $13.09 $232.00 $400.00 $18.98 $13.09 $14.47 $13.09 N/A N/A 30500056 EAP CPT® 85536 IRON STORES-BM BOTH IP/OP $186.00 $138.00 $3.44 $186.00 $186.00 $186.00 $186.00 $186.00 $6.88 $6.88 $3.44 $186.00 $6.88 $9.83 $9.83 $10.21 $7.17 $9.57 $11.01 $11.01 $186.00 $6.88 $6.88 $6.88 $186.00 $139.50 $6.88 $6.88 $6.88 $36.16 $36.16 $147.31 $6.88 $148.80 $186.00 $186.00 $6.88 $107.88 $186.00 $9.98 $6.88 $186.00 $6.88 N/A N/A 30500057 EAP CPT® 85540 WBC LAP STAIN BOTH IP/OP $154.00 $114.00 $4.30 $154.00 $154.00 $154.00 $154.00 $154.00 $8.60 $8.60 $4.30 $154.00 $8.60 $9.17 $9.17 $9.53 $6.70 $8.93 $13.76 $13.76 $154.00 $8.60 $8.60 $8.60 $154.00 $115.50 $8.60 $8.60 $8.60 $33.76 $33.76 $121.97 $8.60 $123.20 $154.00 $154.00 $8.60 $89.32 $154.00 $12.47 $8.60 $154.00 $8.60 N/A N/A 30500058 EAP CPT® 85549 LYSOZYME BOTH IP/OP $180.00 $133.50 $9.37 $180.00 $36.80 $36.80 $36.80 $36.80 $18.75 $18.75 $9.38 $9.37 $18.75 $28.49 $28.49 $29.58 $20.79 $27.71 $30.00 $30.00 $106.47 $18.75 $18.75 $18.75 $180.00 $135.00 $18.75 $18.75 $18.75 $104.84 $104.84 $142.56 $18.75 $144.00 $30.94 $26.39 $18.75 $104.40 $180.00 $27.19 $18.75 $20.73 $18.75 N/A N/A 30500059 EAP CPT® 85576 "PLT AGG, THROMBIN" BOTH IP/OP $465.00 $344.50 $11.21 $465.00 $42.17 $42.17 $42.17 $42.17 $24.91 $24.91 $12.46 $11.21 $24.91 $32.62 $32.62 $33.88 $23.82 $31.73 $39.86 $39.86 $275.05 $24.91 $24.91 $24.91 $465.00 $348.75 $24.91 $24.91 $24.91 $120.04 $120.04 $368.28 $24.91 $372.00 $41.10 $30.22 $24.91 $269.70 $465.00 $36.12 $24.91 $23.74 $24.91 N/A N/A 30500060 EAP CPT® 85576 "PLT AGG, ADP" BOTH IP/OP $465.00 $344.50 $11.21 $465.00 $42.17 $42.17 $42.17 $42.17 $24.91 $24.91 $12.46 $11.21 $24.91 $32.62 $32.62 $33.88 $23.82 $31.73 $39.86 $39.86 $275.05 $24.91 $24.91 $24.91 $465.00 $348.75 $24.91 $24.91 $24.91 $120.04 $120.04 $368.28 $24.91 $372.00 $41.10 $30.22 $24.91 $269.70 $465.00 $36.12 $24.91 $23.74 $24.91 N/A N/A 30500061 EAP CPT® 85576 "PLT AGG, COLLAGEN" BOTH IP/OP $465.00 $344.50 $11.21 $465.00 $42.17 $42.17 $42.17 $42.17 $24.91 $24.91 $12.46 $11.21 $24.91 $32.62 $32.62 $33.88 $23.82 $31.73 $39.86 $39.86 $275.05 $24.91 $24.91 $24.91 $465.00 $348.75 $24.91 $24.91 $24.91 $120.04 $120.04 $368.28 $24.91 $372.00 $41.10 $30.22 $24.91 $269.70 $465.00 $36.12 $24.91 $23.74 $24.91 N/A N/A 30500062 EAP CPT® 85576 "PLT AGG, RISTOCETIN" BOTH IP/OP $465.00 $344.50 $11.21 $465.00 $42.17 $42.17 $42.17 $42.17 $24.91 $24.91 $12.46 $11.21 $24.91 $32.62 $32.62 $33.88 $23.82 $31.73 $39.86 $39.86 $275.05 $24.91 $24.91 $24.91 $465.00 $348.75 $24.91 $24.91 $24.91 $120.04 $120.04 $368.28 $24.91 $372.00 $41.10 $30.22 $24.91 $269.70 $465.00 $36.12 $24.91 $23.74 $24.91 N/A N/A 30500063 EAP CPT® 85576 "PLT AGG, ARACDNC ACID" BOTH IP/OP $465.00 $344.50 $11.21 $465.00 $42.17 $42.17 $42.17 $42.17 $24.91 $24.91 $12.46 $11.21 $24.91 $32.62 $32.62 $33.88 $23.82 $31.73 $39.86 $39.86 $275.05 $24.91 $24.91 $24.91 $465.00 $348.75 $24.91 $24.91 $24.91 $120.04 $120.04 $368.28 $24.91 $372.00 $41.10 $30.22 $24.91 $269.70 $465.00 $36.12 $24.91 $23.74 $24.91 N/A N/A 30500064 EAP CPT® 85576 PFA-COLLAGEN/EPI BOTH IP/OP $676.00 $500.50 $11.21 $676.00 $42.17 $42.17 $42.17 $42.17 $24.91 $24.91 $12.46 $11.21 $24.91 $32.62 $32.62 $33.88 $23.82 $31.73 $39.86 $39.86 $399.85 $24.91 $24.91 $24.91 $676.00 $507.00 $24.91 $24.91 $24.91 $120.04 $120.04 $535.39 $24.91 $540.80 $41.10 $30.22 $24.91 $392.08 $676.00 $36.12 $24.91 $23.74 $24.91 N/A N/A 30500065 EAP CPT® 85576 PFA-COLLAGEN/ADP BOTH IP/OP $676.00 $500.50 $11.21 $676.00 $42.17 $42.17 $42.17 $42.17 $24.91 $24.91 $12.46 $11.21 $24.91 $32.62 $32.62 $33.88 $23.82 $31.73 $39.86 $39.86 $399.85 $24.91 $24.91 $24.91 $676.00 $507.00 $24.91 $24.91 $24.91 $120.04 $120.04 $535.39 $24.91 $540.80 $41.10 $30.22 $24.91 $392.08 $676.00 $36.12 $24.91 $23.74 $24.91 N/A N/A 30500066 EAP CPT® 86022 PLATELET AGG-HEPRIN BOTH IP/OP $536.00 $397.00 $9.19 $536.00 $536.00 $536.00 $536.00 $536.00 $18.37 $18.37 $9.19 $536.00 $18.37 $27.89 $27.89 $28.97 $20.36 $27.12 $29.39 $29.39 $536.00 $18.37 $18.37 $18.37 $536.00 $402.00 $18.37 $18.37 $18.37 $102.64 $102.64 $424.51 $18.37 $428.80 $536.00 $536.00 $18.37 $310.88 $536.00 $26.64 $18.37 $536.00 $18.37 N/A N/A 30500067 EAP CPT® 85597 PLAT NEUTRALIZATION BOTH IP/OP $420.00 $311.00 $8.99 $420.00 $420.00 $420.00 $420.00 $420.00 $17.98 $17.98 $8.99 $420.00 $17.98 $27.30 $27.30 $28.35 $19.93 $26.57 $28.77 $28.77 $420.00 $17.98 $17.98 $17.98 $420.00 $315.00 $17.98 $17.98 $17.98 $100.48 $100.48 $332.64 $17.98 $336.00 $420.00 $420.00 $17.98 $243.60 $420.00 $26.07 $17.98 $420.00 $17.98 N/A N/A 30500068 EAP CPT® 85610 PT(PROTHROMBIN TIME) BOTH IP/OP $159.00 $118.00 $1.97 $159.00 $7.71 $7.71 $7.71 $7.71 $4.29 $4.29 $2.15 $1.97 $4.29 $5.97 $5.97 $6.20 $4.36 $5.81 $6.86 $6.86 $94.05 $4.29 $4.29 $4.29 $159.00 $119.25 $4.29 $4.29 $4.29 $21.96 $21.96 $125.93 $4.29 $127.20 $7.08 $5.53 $4.29 $92.22 $159.00 $6.22 $4.29 $4.34 $4.29 N/A N/A 30500069 EAP CPT® 85610 "PT,COUMADIN THERAPY" BOTH IP/OP $159.00 $118.00 $1.97 $159.00 $7.71 $7.71 $7.71 $7.71 $4.29 $4.29 $2.15 $1.97 $4.29 $5.97 $5.97 $6.20 $4.36 $5.81 $6.86 $6.86 $94.05 $4.29 $4.29 $4.29 $159.00 $119.25 $4.29 $4.29 $4.29 $21.96 $21.96 $125.93 $4.29 $127.20 $7.08 $5.53 $4.29 $92.22 $159.00 $6.22 $4.29 $4.34 $4.29 N/A N/A 30500070 EAP CPT® 85610 "PT, COUMATRAK" BOTH IP/OP $146.00 $108.50 $1.97 $146.00 $7.71 $7.71 $7.71 $7.71 $4.29 $4.29 $2.15 $1.97 $4.29 $5.97 $5.97 $6.20 $4.36 $5.81 $6.86 $6.86 $86.36 $4.29 $4.29 $4.29 $146.00 $109.50 $4.29 $4.29 $4.29 $21.96 $21.96 $115.63 $4.29 $116.80 $7.08 $5.53 $4.29 $84.68 $146.00 $6.22 $4.29 $4.34 $4.29 N/A N/A 30500071 EAP CPT® 85611 PT+NORMAL PLASMA BOTH IP/OP $145.00 $107.50 $1.97 $145.00 $145.00 $145.00 $145.00 $145.00 $3.94 $3.94 $1.97 $145.00 $3.94 $5.98 $5.98 $6.21 $4.37 $5.83 $6.30 $6.30 $145.00 $3.94 $3.94 $3.94 $145.00 $108.75 $3.94 $3.94 $3.94 $22.04 $22.04 $114.84 $3.94 $116.00 $145.00 $145.00 $3.94 $84.10 $145.00 $5.71 $3.94 $145.00 $3.94 N/A N/A 30500072 EAP CPT® 85611 "PT, HEPZYME-TREATED" BOTH IP/OP $133.00 $98.50 $1.97 $133.00 $133.00 $133.00 $133.00 $133.00 $3.94 $3.94 $1.97 $133.00 $3.94 $5.98 $5.98 $6.21 $4.37 $5.83 $6.30 $6.30 $133.00 $3.94 $3.94 $3.94 $133.00 $99.75 $3.94 $3.94 $3.94 $22.04 $22.04 $105.34 $3.94 $106.40 $133.00 $133.00 $3.94 $77.14 $133.00 $5.71 $3.94 $133.00 $3.94 N/A N/A 30500073 EAP CPT® 85613 DILUTE RUSSELL'S VIPER VENOM BOTH IP/OP $302.00 $223.50 $4.79 $302.00 $18.80 $18.80 $18.80 $18.80 $9.58 $9.58 $4.79 $4.79 $9.58 $14.53 $14.53 $15.09 $10.61 $14.13 $15.33 $15.33 $178.63 $9.58 $9.58 $9.58 $302.00 $226.50 $9.58 $9.58 $9.58 $53.48 $53.48 $239.18 $9.58 $241.60 $15.81 $13.46 $9.58 $175.16 $302.00 $13.89 $9.58 $10.57 $9.58 N/A N/A 30500074 EAP CPT® 85651 SED RATE WESTERGREN BOTH IP/OP $99.00 $73.50 $2.14 $99.00 $99.00 $99.00 $99.00 $99.00 $4.27 $4.27 $2.14 $99.00 $4.27 $5.39 $5.39 $5.59 $3.93 $5.24 $6.83 $6.83 $99.00 $4.27 $4.27 $4.27 $99.00 $74.25 $4.27 $4.27 $4.27 $19.84 $19.84 $78.41 $4.27 $79.20 $99.00 $99.00 $4.27 $57.42 $99.00 $6.19 $4.27 $99.00 $4.27 N/A N/A 30500075 EAP CPT® 85660 DONOR HGB S-ARC BOTH IP/OP $166.00 $123.00 $2.75 $166.00 $10.82 $10.82 $10.82 $10.82 $5.51 $5.51 $2.76 $2.75 $5.51 $8.38 $8.38 $8.70 $6.12 $8.15 $8.82 $8.82 $98.19 $5.51 $5.51 $5.51 $166.00 $124.50 $5.51 $5.51 $5.51 $30.84 $30.84 $131.47 $5.51 $132.80 $9.09 $7.76 $5.51 $96.28 $166.00 $7.99 $5.51 $6.10 $5.51 N/A N/A 30500076 EAP CPT® 85660 DONOR HGB S-GMH BOTH IP/OP $166.00 $123.00 $2.75 $166.00 $10.82 $10.82 $10.82 $10.82 $5.51 $5.51 $2.76 $2.75 $5.51 $8.38 $8.38 $8.70 $6.12 $8.15 $8.82 $8.82 $98.19 $5.51 $5.51 $5.51 $166.00 $124.50 $5.51 $5.51 $5.51 $30.84 $30.84 $131.47 $5.51 $132.80 $9.09 $7.76 $5.51 $96.28 $166.00 $7.99 $5.51 $6.10 $5.51 N/A N/A 30500077 EAP CPT® 85660 SICKLEDEX BOTH IP/OP $201.00 $149.00 $2.75 $201.00 $10.82 $10.82 $10.82 $10.82 $5.51 $5.51 $2.76 $2.75 $5.51 $8.38 $8.38 $8.70 $6.12 $8.15 $8.82 $8.82 $118.89 $5.51 $5.51 $5.51 $201.00 $150.75 $5.51 $5.51 $5.51 $30.84 $30.84 $159.19 $5.51 $160.80 $9.09 $7.76 $5.51 $116.58 $201.00 $7.99 $5.51 $6.10 $5.51 N/A N/A 30500078 EAP CPT® 85670 THROMBIN TIME BOTH IP/OP $145.00 $107.50 $2.89 $145.00 $145.00 $145.00 $145.00 $145.00 $5.77 $5.77 $2.89 $145.00 $5.77 $8.78 $8.78 $9.12 $6.41 $8.53 $9.23 $9.23 $145.00 $5.77 $5.77 $5.77 $145.00 $108.75 $5.77 $5.77 $5.77 $32.28 $32.28 $114.84 $5.77 $116.00 $145.00 $145.00 $5.77 $84.10 $145.00 $8.37 $5.77 $145.00 $5.77 N/A N/A 30500079 EAP CPT® 85730 "APPT, HEPZYME-TREATED" BOTH IP/OP $216.00 $160.00 $3.00 $216.00 $11.80 $11.80 $11.80 $11.80 $6.01 $6.01 $3.01 $3.00 $6.01 $9.11 $9.11 $9.46 $6.65 $8.86 $9.62 $9.62 $127.76 $6.01 $6.01 $6.01 $216.00 $162.00 $6.01 $6.01 $6.01 $33.52 $33.52 $171.07 $6.01 $172.80 $9.92 $8.44 $6.01 $125.28 $216.00 $8.71 $6.01 $6.63 $6.01 N/A N/A 30500080 EAP CPT® 85730 APTT BOTH IP/OP $216.00 $160.00 $3.00 $216.00 $11.80 $11.80 $11.80 $11.80 $6.01 $6.01 $3.01 $3.00 $6.01 $9.11 $9.11 $9.46 $6.65 $8.86 $9.62 $9.62 $127.76 $6.01 $6.01 $6.01 $216.00 $162.00 $6.01 $6.01 $6.01 $33.52 $33.52 $171.07 $6.01 $172.80 $9.92 $8.44 $6.01 $125.28 $216.00 $8.71 $6.01 $6.63 $6.01 N/A N/A 30500082 EAP CPT® 85730 APTT HEPARIN THERAPY BOTH IP/OP $187.00 $138.50 $3.00 $187.00 $11.80 $11.80 $11.80 $11.80 $6.01 $6.01 $3.01 $3.00 $6.01 $9.11 $9.11 $9.46 $6.65 $8.86 $9.62 $9.62 $110.61 $6.01 $6.01 $6.01 $187.00 $140.25 $6.01 $6.01 $6.01 $33.52 $33.52 $148.10 $6.01 $149.60 $9.92 $8.44 $6.01 $108.46 $187.00 $8.71 $6.01 $6.63 $6.01 N/A N/A 30500083 EAP CPT® 85730 PTT-SALINE BOTH IP/OP $187.00 $138.50 $3.00 $187.00 $11.80 $11.80 $11.80 $11.80 $6.01 $6.01 $3.01 $3.00 $6.01 $9.11 $9.11 $9.46 $6.65 $8.86 $9.62 $9.62 $110.61 $6.01 $6.01 $6.01 $187.00 $140.25 $6.01 $6.01 $6.01 $33.52 $33.52 $148.10 $6.01 $149.60 $9.92 $8.44 $6.01 $108.46 $187.00 $8.71 $6.01 $6.63 $6.01 N/A N/A 30500084 EAP CPT® 85732 APTT + APC BOTH IP/OP $225.00 $166.50 $3.24 $225.00 $225.00 $225.00 $225.00 $225.00 $6.47 $6.47 $3.24 $225.00 $6.47 $9.83 $9.83 $10.21 $7.17 $9.57 $10.35 $10.35 $225.00 $6.47 $6.47 $6.47 $225.00 $168.75 $6.47 $6.47 $6.47 $36.16 $36.16 $178.20 $6.47 $180.00 $225.00 $225.00 $6.47 $130.50 $225.00 $9.38 $6.47 $225.00 $6.47 N/A N/A 30500085 EAP CPT® 85732 FACTOR DEF SCRN-COAG BOTH IP/OP $225.00 $166.50 $3.24 $225.00 $225.00 $225.00 $225.00 $225.00 $6.47 $6.47 $3.24 $225.00 $6.47 $9.83 $9.83 $10.21 $7.17 $9.57 $10.35 $10.35 $225.00 $6.47 $6.47 $6.47 $225.00 $168.75 $6.47 $6.47 $6.47 $36.16 $36.16 $178.20 $6.47 $180.00 $225.00 $225.00 $6.47 $130.50 $225.00 $9.38 $6.47 $225.00 $6.47 N/A N/A 30500086 EAP CPT® 85732 FACTOR INHIB SCREEN BOTH IP/OP $196.00 $145.50 $3.24 $196.00 $196.00 $196.00 $196.00 $196.00 $6.47 $6.47 $3.24 $196.00 $6.47 $9.83 $9.83 $10.21 $7.17 $9.57 $10.35 $10.35 $196.00 $6.47 $6.47 $6.47 $196.00 $147.00 $6.47 $6.47 $6.47 $36.16 $36.16 $155.23 $6.47 $156.80 $196.00 $196.00 $6.47 $113.68 $196.00 $9.38 $6.47 $196.00 $6.47 N/A N/A 30500087 EAP CPT® 85810 "VISCOSITY, SERUM" BOTH IP/OP $243.00 $180.00 $5.84 $243.00 $22.92 $22.92 $22.92 $22.92 $11.67 $11.67 $5.84 $5.84 $11.67 $17.73 $17.73 $18.41 $12.94 $17.26 $18.67 $18.67 $143.73 $11.67 $11.67 $11.67 $243.00 $182.25 $11.67 $11.67 $11.67 $65.28 $65.28 $192.46 $11.67 $194.40 $19.26 $16.44 $11.67 $140.94 $243.00 $16.92 $11.67 $12.91 $11.67 N/A N/A 30500088 EAP CPT® 86078 TRANSFUSION REACTION BOTH IP/OP $470.00 $348.00 $25.20 $470.00 $470.00 $470.00 $470.00 $470.00 $49.64 $49.64 $25.20 $470.00 $49.64 $48.69 $48.69 $50.57 $35.55 $52.87 $79.42 $78.06 $470.00 $49.64 $48.79 $49.64 $470.00 $352.50 $49.64 $49.64 $49.64 $207.24 $207.24 $372.24 $49.64 $376.00 $305.50 $470.00 $49.64 $272.60 $470.00 $52.65 $49.64 $470.00 $49.64 N/A N/A 30500090 EAP CPT® 85048 "EOSINOPHIL COUNT, WB" BOTH IP/OP $68.00 $50.50 $1.27 $68.00 $68.00 $68.00 $68.00 $68.00 $2.54 $2.54 $1.27 $68.00 $2.54 $3.86 $3.86 $4.01 $2.82 $3.76 $4.06 $4.06 $68.00 $2.54 $2.54 $2.54 $68.00 $51.00 $2.54 $2.54 $2.54 $14.20 $14.20 $53.86 $2.54 $54.40 $68.00 $68.00 $2.54 $39.44 $68.00 $3.68 $2.54 $68.00 $2.54 N/A N/A 30500091 EAP CPT® 85652 "SED RATE, CAPILLARY PHOTOMETRY" BOTH IP/OP $105.00 $78.00 $1.35 $105.00 $5.30 $5.30 $5.30 $5.30 $2.70 $2.70 $1.35 $1.35 $2.70 $4.10 $4.10 $4.26 $2.99 $3.98 $4.32 $4.32 $62.11 $2.70 $2.70 $2.70 $105.00 $78.75 $2.70 $2.70 $2.70 $15.08 $15.08 $83.16 $2.70 $84.00 $4.46 $3.79 $2.70 $60.90 $105.00 $3.92 $2.70 $2.98 $2.70 N/A N/A 30500092 EAP CPT® 85415 PLASMINOGEN ACT INHIB (SO) BOTH IP/OP $268.00 $198.50 $8.60 $268.00 $268.00 $268.00 $268.00 $268.00 $17.19 $17.19 $8.60 $268.00 $17.19 $26.10 $26.10 $27.11 $19.06 $25.40 $27.50 $27.50 $268.00 $17.19 $17.19 $17.19 $268.00 $201.00 $17.19 $17.19 $17.19 $96.08 $96.08 $212.26 $17.19 $214.40 $268.00 $268.00 $17.19 $155.44 $268.00 $24.93 $17.19 $268.00 $17.19 N/A N/A 30500102 EAP CPT® 85008 RBC MORPHOLOGY EXAM BOTH IP/OP $91.00 $67.50 $1.72 $91.00 $6.73 $6.73 $6.73 $6.73 $3.43 $3.43 $1.72 $1.72 $3.43 $5.22 $5.22 $5.42 $3.81 $5.08 $5.49 $5.49 $53.83 $3.43 $3.43 $3.43 $91.00 $68.25 $3.43 $3.43 $3.43 $19.24 $19.24 $72.07 $3.43 $72.80 $5.66 $4.84 $3.43 $52.78 $91.00 $4.97 $3.43 $3.80 $3.43 N/A N/A 30500103 EAP CPT® 85013 "HEMATOCRIT, SPUN CAP" BOTH IP/OP $51.00 $38.00 $2.63 $51.00 $51.00 $51.00 $51.00 $51.00 $7.00 $7.00 $3.50 $51.00 $7.00 $3.60 $3.60 $3.74 $2.63 $3.50 $11.20 $11.20 $51.00 $7.00 $7.00 $7.00 $51.00 $38.25 $7.00 $7.00 $7.00 $13.24 $13.24 $40.39 $7.00 $40.80 $51.00 $51.00 $7.00 $29.58 $51.00 $10.15 $7.00 $51.00 $7.00 N/A N/A 30500104 EAP CPT® 85018 HGB & HCT BOTH IP/OP $51.00 $38.00 $1.18 $51.00 $4.64 $4.64 $4.64 $4.64 $2.37 $2.37 $1.19 $1.18 $2.37 $3.60 $3.60 $3.74 $2.63 $3.50 $3.79 $3.79 $30.17 $2.37 $2.37 $2.37 $51.00 $38.25 $2.37 $2.37 $2.37 $13.24 $13.24 $40.39 $2.37 $40.80 $3.91 $3.33 $2.37 $29.58 $51.00 $3.44 $2.37 $2.62 $2.37 N/A N/A 30500105 EAP CPT® 85025 "CBC, PLAT & DIFF" BOTH IP/OP $244.00 $181.00 $3.88 $244.00 $15.26 $15.26 $15.26 $15.26 $7.77 $7.77 $3.89 $3.88 $7.77 $9.97 $9.97 $10.36 $7.28 $11.48 $12.43 $12.43 $144.33 $7.77 $7.77 $7.77 $244.00 $183.00 $7.77 $7.77 $7.77 $43.44 $43.44 $193.25 $7.77 $195.20 $12.82 $10.93 $7.77 $141.52 $244.00 $11.27 $7.77 $8.59 $7.77 N/A N/A 30500106 EAP CPT® 85027 CBC & PLAT BOTH IP/OP $175.00 $129.50 $3.23 $175.00 $12.70 $12.70 $12.70 $12.70 $6.47 $6.47 $3.24 $3.23 $6.47 $9.83 $9.83 $10.21 $7.17 $9.57 $10.35 $10.35 $103.51 $6.47 $6.47 $6.47 $175.00 $131.25 $6.47 $6.47 $6.47 $36.16 $36.16 $138.60 $6.47 $140.00 $10.68 $9.11 $6.47 $101.50 $175.00 $9.38 $6.47 $7.16 $6.47 N/A N/A 30500108 EAP CPT® 85008 RBC MORPHOLOGY BOTH IP/OP $91.00 $67.50 $1.72 $91.00 $6.73 $6.73 $6.73 $6.73 $3.43 $3.43 $1.72 $1.72 $3.43 $5.22 $5.22 $5.42 $3.81 $5.08 $5.49 $5.49 $53.83 $3.43 $3.43 $3.43 $91.00 $68.25 $3.43 $3.43 $3.43 $19.24 $19.24 $72.07 $3.43 $72.80 $5.66 $4.84 $3.43 $52.78 $91.00 $4.97 $3.43 $3.80 $3.43 N/A N/A 30500109 EAP CPT® 85013 "HEMATOCRIT, SPUN" BOTH IP/OP $51.00 $38.00 $2.63 $51.00 $51.00 $51.00 $51.00 $51.00 $7.00 $7.00 $3.50 $51.00 $7.00 $3.60 $3.60 $3.74 $2.63 $3.50 $11.20 $11.20 $51.00 $7.00 $7.00 $7.00 $51.00 $38.25 $7.00 $7.00 $7.00 $13.24 $13.24 $40.39 $7.00 $40.80 $51.00 $51.00 $7.00 $29.58 $51.00 $10.15 $7.00 $51.00 $7.00 N/A N/A 30500110 EAP CPT® 85660 SICKLEDEX BOTH IP/OP $166.00 $123.00 $2.75 $166.00 $10.82 $10.82 $10.82 $10.82 $5.51 $5.51 $2.76 $2.75 $5.51 $8.38 $8.38 $8.70 $6.12 $8.15 $8.82 $8.82 $98.19 $5.51 $5.51 $5.51 $166.00 $124.50 $5.51 $5.51 $5.51 $30.84 $30.84 $131.47 $5.51 $132.80 $9.09 $7.76 $5.51 $96.28 $166.00 $7.99 $5.51 $6.10 $5.51 N/A N/A 30500112 EAP CPT® 85025 "CBC, PLAT & DIFF, IDP" BOTH IP/OP $244.00 $181.00 $3.88 $244.00 $15.26 $15.26 $15.26 $15.26 $7.77 $7.77 $3.89 $3.88 $7.77 $9.97 $9.97 $10.36 $7.28 $11.48 $12.43 $12.43 $144.33 $7.77 $7.77 $7.77 $244.00 $183.00 $7.77 $7.77 $7.77 $43.44 $43.44 $193.25 $7.77 $195.20 $12.82 $10.93 $7.77 $141.52 $244.00 $11.27 $7.77 $8.59 $7.77 N/A N/A 30500113 EAP CPT® 86146 BETA-2 GLYCOPROTEIN ANTIBODIES BOTH IP/OP $327.00 $242.00 $12.73 $327.00 $49.95 $49.95 $49.95 $49.95 $25.45 $25.45 $12.73 $12.73 $25.45 $38.63 $38.63 $40.11 $28.20 $37.58 $40.72 $40.72 $193.42 $25.45 $25.45 $25.45 $327.00 $245.25 $25.45 $25.45 $25.45 $142.16 $142.16 $258.98 $25.45 $261.60 $41.99 $35.79 $25.45 $189.66 $327.00 $36.90 $25.45 $28.11 $25.45 N/A N/A 30500114 EAP CPT® 85397 VON WILLEBRAN PROTEASE ACT Q BOTH IP/OP $471.00 $349.00 $13.89 $471.00 $45.03 $45.03 $45.03 $45.03 $30.86 $30.86 $15.43 $13.89 $30.86 $34.85 $34.85 $36.19 $25.44 $31.50 $49.38 $49.38 $278.60 $30.86 $30.86 $30.86 $471.00 $353.25 $30.86 $30.86 $30.86 $235.50 $235.50 $373.03 $30.86 $376.80 $50.92 $30.00 $30.86 $273.18 $471.00 $44.75 $30.86 $23.57 $30.86 N/A N/A 30500115 EAP CPT® 85730 SILICA CLOTTING TIME BOTH IP/OP $187.00 $138.50 $3.00 $187.00 $11.80 $11.80 $11.80 $11.80 $6.01 $6.01 $3.01 $3.00 $6.01 $9.11 $9.11 $9.46 $6.65 $8.86 $9.62 $9.62 $110.61 $6.01 $6.01 $6.01 $187.00 $140.25 $6.01 $6.01 $6.01 $33.52 $33.52 $148.10 $6.01 $149.60 $9.92 $8.44 $6.01 $108.46 $187.00 $8.71 $6.01 $6.63 $6.01 N/A N/A 30500117 EAP CPT® 83520 THROMBIN ANTI THRMBON COMPLEX (E) BOTH IP/OP $286.00 $212.00 $7.77 $286.00 $25.40 $25.40 $25.40 $25.40 $17.27 $17.27 $8.64 $7.77 $17.27 $19.67 $19.67 $20.42 $14.36 $19.12 $27.63 $27.63 $169.17 $17.27 $17.27 $17.27 $286.00 $214.50 $17.27 $17.27 $17.27 $72.36 $72.36 $226.51 $17.27 $228.80 $28.50 $18.21 $17.27 $165.88 $286.00 $25.04 $17.27 $14.30 $17.27 N/A N/A 30500118 EAP HCPCS 85999 "EOSINOPHIL SMEAR, URINE" BOTH IP/OP $63.00 $47.00 $13.13 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $25.20 $63.00 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $63.00 $63.00 $49.90 $63.00 $50.40 $40.95 $63.00 $63.00 $36.54 $63.00 $37.80 $63.00 $63.00 $63.00 N/A N/A 30500119 EAP CPT® 85999 "ESOINOPHIL SMEAR, URINE" BOTH IP/OP $63.00 $47.00 $13.13 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $25.20 $63.00 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $63.00 $63.00 $49.90 $63.00 $50.40 $40.95 $63.00 $63.00 $36.54 $63.00 $37.80 $63.00 $63.00 $63.00 N/A N/A 30500121 EAP CPT® 85362 FIBRIN MONOMER (SO) BOTH IP/OP $320.00 $237.00 $3.44 $320.00 $13.53 $13.53 $13.53 $13.53 $6.89 $6.89 $3.45 $3.44 $6.89 $10.46 $10.46 $10.86 $7.64 $10.17 $11.02 $11.02 $189.28 $6.89 $6.89 $6.89 $320.00 $240.00 $6.89 $6.89 $6.89 $38.48 $38.48 $253.44 $6.89 $256.00 $11.37 $9.69 $6.89 $185.60 $320.00 $9.99 $6.89 $7.61 $6.89 N/A N/A 30500122 EAP CPT® 85307 ACTIVATED PROTEIN C RESISTANCE (SO) BOTH IP/OP $125.00 $92.50 $7.66 $125.00 $125.00 $125.00 $125.00 $125.00 $15.32 $15.32 $7.66 $125.00 $15.32 $23.26 $23.26 $24.16 $16.98 $22.64 $24.51 $24.51 $125.00 $15.32 $15.32 $15.32 $125.00 $93.75 $15.32 $15.32 $15.32 $85.64 $85.64 $99.00 $15.32 $100.00 $125.00 $125.00 $15.32 $72.50 $125.00 $22.21 $15.32 $125.00 $15.32 N/A N/A 30500123 EAP CPT® 86355 LYMPHOCYTE SUBSET BAL - B CELLS TOTAL (SO) BOTH IP/OP $113.00 $84.00 $18.86 $113.00 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $66.84 $37.73 $37.73 $37.73 $113.00 $84.75 $37.73 $37.73 $37.73 $113.00 $113.00 $89.50 $37.73 $90.40 $62.25 $33.14 $37.73 $65.54 $113.00 $54.71 $37.73 $26.03 $37.73 N/A N/A 30500124 EAP CPT® 86359 LYMPHOCYTE SUBSET BAL - T CELLS TOTAL (SO) BOTH IP/OP $113.00 $84.00 $18.86 $113.00 $46.23 $46.23 $46.23 $46.23 $37.73 $37.73 $18.87 $18.86 $37.73 $35.77 $35.77 $37.14 $26.11 $34.80 $60.37 $60.37 $66.84 $37.73 $37.73 $37.73 $113.00 $84.75 $37.73 $37.73 $37.73 $113.00 $113.00 $89.50 $37.73 $90.40 $62.25 $33.14 $37.73 $65.54 $113.00 $54.71 $37.73 $26.03 $37.73 N/A N/A 30500125 EAP CPT® 86360 LYMPHOCYTE SUBSET BAL - ABSOLUTE CD4/CD8 WITH RATIO (SO) BOTH IP/OP $113.00 $84.00 $23.49 $113.00 $92.22 $92.22 $92.22 $92.22 $46.98 $46.98 $23.49 $23.49 $46.98 $71.34 $71.34 $74.09 $52.08 $69.42 $75.17 $75.17 $66.84 $46.98 $46.98 $46.98 $113.00 $84.75 $46.98 $46.98 $46.98 $113.00 $113.00 $89.50 $46.98 $90.40 $77.52 $66.11 $46.98 $65.54 $113.00 $68.12 $46.98 $51.93 $46.98 N/A N/A 30500126 EAP CPT® 85460 HEMOGLOBIN FETAL STAIN FAMILY MEMBER BOTH IP/OP $51.00 $38.00 $2.67 $51.00 $4.74 $4.74 $4.74 $4.74 $7.73 $7.73 $3.87 $3.87 $7.73 $3.67 $3.67 $3.81 $2.68 $3.57 $12.37 $12.37 $30.17 $7.73 $7.73 $7.73 $51.00 $38.25 $7.73 $7.73 $7.73 $13.52 $13.52 $40.39 $7.73 $40.80 $12.75 $3.40 $7.73 $29.58 $51.00 $11.21 $7.73 $2.67 $7.73 N/A N/A 30500130 EAP CPT® 80299 APIXABAN QUANTITATIVE ASSAY BOTH IP/OP $155.00 $115.00 $8.39 $155.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $91.68 $18.64 $18.64 $18.64 $155.00 $116.25 $18.64 $18.64 $18.64 $67.28 $67.28 $122.76 $18.64 $124.00 $30.76 $16.94 $18.64 $89.90 $155.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30500131 EAP CPT® 80299 RIVAROXABAN QUANTITATIVE ASSAY BOTH IP/OP $155.00 $115.00 $8.39 $155.00 $26.66 $26.66 $26.66 $26.66 $18.64 $18.64 $9.32 $8.39 $18.64 $18.28 $18.28 $18.99 $13.35 $17.79 $29.82 $29.82 $91.68 $18.64 $18.64 $18.64 $155.00 $116.25 $18.64 $18.64 $18.64 $67.28 $67.28 $122.76 $18.64 $124.00 $30.76 $16.94 $18.64 $89.90 $155.00 $27.03 $18.64 $13.31 $18.64 N/A N/A 30500135 EAP CPT® 85520 ANTI-XA DS BOTH IP/OP $515.00 $381.50 $6.55 $515.00 $25.70 $25.70 $25.70 $25.70 $13.09 $13.09 $6.55 $6.55 $13.09 $19.87 $19.87 $20.64 $14.51 $19.34 $20.94 $20.94 $304.62 $13.09 $13.09 $13.09 $515.00 $386.25 $13.09 $13.09 $13.09 $73.16 $73.16 $407.88 $13.09 $412.00 $21.60 $18.42 $13.09 $298.70 $515.00 $18.98 $13.09 $14.47 $13.09 N/A N/A 30500136 EAP CPT® 85520 DOAC-STOP ANTI-XA BOTH IP/OP "$1,020.00" $755.00 $6.55 "$1,020.00" $25.70 $25.70 $25.70 $25.70 $13.09 $13.09 $6.55 $6.55 $13.09 $19.87 $19.87 $20.64 $14.51 $19.34 $20.94 $20.94 $603.33 $13.09 $13.09 $13.09 "$1,020.00" $765.00 $13.09 $13.09 $13.09 $73.16 $73.16 $807.84 $13.09 $816.00 $21.60 $18.42 $13.09 $591.60 "$1,020.00" $18.98 $13.09 $14.47 $13.09 N/A N/A 30600001 EAP CPT® 87040 BLOOD CULT. ROUTINE BOTH IP/OP $476.00 $352.50 $5.16 $476.00 $20.26 $20.26 $20.26 $20.26 $10.32 $10.32 $5.16 $5.16 $10.32 $15.67 $15.67 $16.28 $11.44 $15.25 $16.51 $16.51 $281.55 $10.32 $10.32 $10.32 $476.00 $357.00 $10.32 $10.32 $10.32 $57.68 $57.68 $376.99 $10.32 $380.80 $17.03 $14.52 $10.32 $276.08 $476.00 $14.96 $10.32 $11.41 $10.32 N/A N/A 30600002 EAP CPT® 87045 STOOL CULTURE BOTH IP/OP $206.00 $152.50 $4.72 $206.00 $18.52 $18.52 $18.52 $18.52 $9.44 $9.44 $4.72 $4.72 $9.44 $14.32 $14.32 $14.87 $10.45 $42.93 $15.10 $15.10 $121.85 $9.44 $9.44 $9.44 $206.00 $154.50 $9.44 $9.44 $9.44 $52.72 $52.72 $163.15 $9.44 $164.80 $15.58 $40.89 $9.44 $119.48 $206.00 $13.69 $9.44 $42.93 $9.44 N/A N/A 30600003 EAP CPT® 87070 BONE MARROW CULTURE BOTH IP/OP $371.00 $275.00 $4.31 $371.00 $16.92 $16.92 $16.92 $16.92 $8.62 $8.62 $4.31 $4.31 $8.62 $13.07 $13.07 $13.58 $9.54 $12.73 $13.79 $13.79 $219.45 $8.62 $8.62 $8.62 $371.00 $278.25 $8.62 $8.62 $8.62 $48.12 $48.12 $293.83 $8.62 $296.80 $14.22 $12.12 $8.62 $215.18 $371.00 $12.50 $8.62 $9.52 $8.62 N/A N/A 30600004 EAP CPT® 87070 CSF CULTURE BOTH IP/OP $371.00 $275.00 $4.31 $371.00 $16.92 $16.92 $16.92 $16.92 $8.62 $8.62 $4.31 $4.31 $8.62 $13.07 $13.07 $13.58 $9.54 $12.73 $13.79 $13.79 $219.45 $8.62 $8.62 $8.62 $371.00 $278.25 $8.62 $8.62 $8.62 $48.12 $48.12 $293.83 $8.62 $296.80 $14.22 $12.12 $8.62 $215.18 $371.00 $12.50 $8.62 $9.52 $8.62 N/A N/A 30600005 EAP CPT® 87070 EXUDATE CULTURE BOTH IP/OP $371.00 $275.00 $4.31 $371.00 $16.92 $16.92 $16.92 $16.92 $8.62 $8.62 $4.31 $4.31 $8.62 $13.07 $13.07 $13.58 $9.54 $12.73 $13.79 $13.79 $219.45 $8.62 $8.62 $8.62 $371.00 $278.25 $8.62 $8.62 $8.62 $48.12 $48.12 $293.83 $8.62 $296.80 $14.22 $12.12 $8.62 $215.18 $371.00 $12.50 $8.62 $9.52 $8.62 N/A N/A 30600006 EAP CPT® 87070 FLUID/TISSUE CULT. BOTH IP/OP $371.00 $275.00 $4.31 $371.00 $16.92 $16.92 $16.92 $16.92 $8.62 $8.62 $4.31 $4.31 $8.62 $13.07 $13.07 $13.58 $9.54 $12.73 $13.79 $13.79 $219.45 $8.62 $8.62 $8.62 $371.00 $278.25 $8.62 $8.62 $8.62 $48.12 $48.12 $293.83 $8.62 $296.80 $14.22 $12.12 $8.62 $215.18 $371.00 $12.50 $8.62 $9.52 $8.62 N/A N/A 30600007 EAP CPT® 87070 GENITAL CULTURE BOTH IP/OP $371.00 $275.00 $4.31 $371.00 $16.92 $16.92 $16.92 $16.92 $8.62 $8.62 $4.31 $4.31 $8.62 $13.07 $13.07 $13.58 $9.54 $12.73 $13.79 $13.79 $219.45 $8.62 $8.62 $8.62 $371.00 $278.25 $8.62 $8.62 $8.62 $48.12 $48.12 $293.83 $8.62 $296.80 $14.22 $12.12 $8.62 $215.18 $371.00 $12.50 $8.62 $9.52 $8.62 N/A N/A 30600008 EAP CPT® 87070 "MISC CULT,REFERRAL" BOTH IP/OP $338.00 $250.50 $4.31 $338.00 $16.92 $16.92 $16.92 $16.92 $8.62 $8.62 $4.31 $4.31 $8.62 $13.07 $13.07 $13.58 $9.54 $12.73 $13.79 $13.79 $199.93 $8.62 $8.62 $8.62 $338.00 $253.50 $8.62 $8.62 $8.62 $48.12 $48.12 $267.70 $8.62 $270.40 $14.22 $12.12 $8.62 $196.04 $338.00 $12.50 $8.62 $9.52 $8.62 N/A N/A 30600009 EAP CPT® 87070 MISC. CULTURE BOTH IP/OP $371.00 $275.00 $4.31 $371.00 $16.92 $16.92 $16.92 $16.92 $8.62 $8.62 $4.31 $4.31 $8.62 $13.07 $13.07 $13.58 $9.54 $12.73 $13.79 $13.79 $219.45 $8.62 $8.62 $8.62 $371.00 $278.25 $8.62 $8.62 $8.62 $48.12 $48.12 $293.83 $8.62 $296.80 $14.22 $12.12 $8.62 $215.18 $371.00 $12.50 $8.62 $9.52 $8.62 N/A N/A 30600010 EAP CPT® 87070 SPUTUM CULTURE BOTH IP/OP $371.00 $275.00 $4.31 $371.00 $16.92 $16.92 $16.92 $16.92 $8.62 $8.62 $4.31 $4.31 $8.62 $13.07 $13.07 $13.58 $9.54 $12.73 $13.79 $13.79 $219.45 $8.62 $8.62 $8.62 $371.00 $278.25 $8.62 $8.62 $8.62 $48.12 $48.12 $293.83 $8.62 $296.80 $14.22 $12.12 $8.62 $215.18 $371.00 $12.50 $8.62 $9.52 $8.62 N/A N/A 30600011 EAP CPT® 87081 THROAT CULTURE BOTH IP/OP $305.00 $226.00 $3.31 $305.00 $13.00 $13.00 $13.00 $13.00 $6.63 $6.63 $3.32 $3.31 $6.63 $10.08 $10.08 $10.47 $7.36 $9.79 $10.61 $10.61 $180.41 $6.63 $6.63 $6.63 $305.00 $228.75 $6.63 $6.63 $6.63 $37.04 $37.04 $241.56 $6.63 $244.00 $10.94 $9.32 $6.63 $176.90 $305.00 $9.61 $6.63 $7.32 $6.63 N/A N/A 30600012 EAP CPT® 87075 ANAEROBE CULTURE BOTH IP/OP $318.00 $235.50 $4.73 $318.00 $18.57 $18.57 $18.57 $18.57 $9.47 $9.47 $4.74 $4.73 $9.47 $14.36 $14.36 $14.91 $10.48 $13.98 $15.15 $15.15 $188.10 $9.47 $9.47 $9.47 $318.00 $238.50 $9.47 $9.47 $9.47 $52.88 $52.88 $251.86 $9.47 $254.40 $15.63 $13.31 $9.47 $184.44 $318.00 $13.73 $9.47 $10.46 $9.47 N/A N/A 30600013 EAP CPT® 87899 "MALARIA RAPID ANTIGEN TEST,EVD" BOTH IP/OP $359.00 $266.00 $8.04 $359.00 $359.00 $359.00 $359.00 $359.00 $16.07 $16.07 $8.04 $359.00 $16.07 $18.22 $18.22 $18.92 $13.30 $17.71 $25.71 $25.71 $359.00 $16.07 $16.07 $16.07 $359.00 $269.25 $16.07 $16.07 $16.07 $67.04 $67.04 $284.33 $16.07 $287.20 $359.00 $359.00 $16.07 $208.22 $359.00 $23.30 $16.07 $359.00 $16.07 N/A N/A 30600014 EAP CPT® 87076 CULTURE I.D.-AEROBE BIOCHEM BOTH IP/OP $229.00 $169.50 $4.04 $229.00 $229.00 $229.00 $229.00 $229.00 $8.08 $8.08 $4.04 $229.00 $8.08 $12.27 $12.27 $12.74 $8.96 $11.94 $12.93 $12.93 $229.00 $8.08 $8.08 $8.08 $229.00 $171.75 $8.08 $8.08 $8.08 $45.16 $45.16 $181.37 $8.08 $183.20 $229.00 $229.00 $8.08 $132.82 $229.00 $11.72 $8.08 $229.00 $8.08 N/A N/A 30600015 EAP CPT® 87801 "EBOLA- AMPLIFIED PROBE TECHNIQUE, EVD" BOTH IP/OP $475.00 $351.50 $35.10 $475.00 $475.00 $475.00 $475.00 $475.00 $70.20 $70.20 $35.10 $475.00 $70.20 $90.13 $90.13 $93.59 $65.79 $57.96 $112.32 $112.32 $475.00 $70.20 $70.20 $70.20 $475.00 $356.25 $70.20 $70.20 $70.20 $219.28 $219.28 $376.20 $70.20 $380.00 $475.00 $475.00 $70.20 $275.50 $475.00 $101.79 $70.20 $475.00 $70.20 N/A N/A 30600016 EAP CPT® 87081 "GC CULT,VAG/CERVIX" BOTH IP/OP $305.00 $226.00 $3.31 $305.00 $13.00 $13.00 $13.00 $13.00 $6.63 $6.63 $3.32 $3.31 $6.63 $10.08 $10.08 $10.47 $7.36 $9.79 $10.61 $10.61 $180.41 $6.63 $6.63 $6.63 $305.00 $228.75 $6.63 $6.63 $6.63 $37.04 $37.04 $241.56 $6.63 $244.00 $10.94 $9.32 $6.63 $176.90 $305.00 $9.61 $6.63 $7.32 $6.63 N/A N/A 30600017 EAP CPT® 87081 "GC CULT,URETHRAL" BOTH IP/OP $305.00 $226.00 $3.31 $305.00 $13.00 $13.00 $13.00 $13.00 $6.63 $6.63 $3.32 $3.31 $6.63 $10.08 $10.08 $10.47 $7.36 $9.79 $10.61 $10.61 $180.41 $6.63 $6.63 $6.63 $305.00 $228.75 $6.63 $6.63 $6.63 $37.04 $37.04 $241.56 $6.63 $244.00 $10.94 $9.32 $6.63 $176.90 $305.00 $9.61 $6.63 $7.32 $6.63 N/A N/A 30600018 EAP CPT® 87081 "GC CULT,ANAL" BOTH IP/OP $305.00 $226.00 $3.31 $305.00 $13.00 $13.00 $13.00 $13.00 $6.63 $6.63 $3.32 $3.31 $6.63 $10.08 $10.08 $10.47 $7.36 $9.79 $10.61 $10.61 $180.41 $6.63 $6.63 $6.63 $305.00 $228.75 $6.63 $6.63 $6.63 $37.04 $37.04 $241.56 $6.63 $244.00 $10.94 $9.32 $6.63 $176.90 $305.00 $9.61 $6.63 $7.32 $6.63 N/A N/A 30600019 EAP CPT® 87081 "GC CULT,THROAT" BOTH IP/OP $305.00 $226.00 $3.31 $305.00 $13.00 $13.00 $13.00 $13.00 $6.63 $6.63 $3.32 $3.31 $6.63 $10.08 $10.08 $10.47 $7.36 $9.79 $10.61 $10.61 $180.41 $6.63 $6.63 $6.63 $305.00 $228.75 $6.63 $6.63 $6.63 $37.04 $37.04 $241.56 $6.63 $244.00 $10.94 $9.32 $6.63 $176.90 $305.00 $9.61 $6.63 $7.32 $6.63 N/A N/A 30600020 EAP CPT® 87081 GC CULTURE EYE BOTH IP/OP $305.00 $226.00 $3.31 $305.00 $13.00 $13.00 $13.00 $13.00 $6.63 $6.63 $3.32 $3.31 $6.63 $10.08 $10.08 $10.47 $7.36 $9.79 $10.61 $10.61 $180.41 $6.63 $6.63 $6.63 $305.00 $228.75 $6.63 $6.63 $6.63 $37.04 $37.04 $241.56 $6.63 $244.00 $10.94 $9.32 $6.63 $176.90 $305.00 $9.61 $6.63 $7.32 $6.63 N/A N/A 30600021 EAP CPT® 87086 URINE CULTURE BOTH IP/OP $299.00 $221.50 $4.04 $299.00 $15.84 $15.84 $15.84 $15.84 $8.07 $8.07 $4.04 $4.04 $8.07 $12.26 $12.26 $12.73 $8.95 $11.93 $12.91 $12.91 $176.86 $8.07 $8.07 $8.07 $299.00 $224.25 $8.07 $8.07 $8.07 $45.12 $45.12 $236.81 $8.07 $239.20 $13.32 $11.36 $8.07 $173.42 $299.00 $11.70 $8.07 $8.92 $8.07 N/A N/A 30600022 EAP CPT® 87088 URINE CULTURE-PRESUMP. ID BOTH IP/OP $302.00 $223.50 $4.05 $302.00 $302.00 $302.00 $302.00 $302.00 $8.09 $8.09 $4.05 $302.00 $8.09 $12.29 $12.29 $12.77 $8.97 $11.96 $12.94 $12.94 $302.00 $8.09 $8.09 $8.09 $302.00 $226.50 $8.09 $8.09 $8.09 $45.24 $45.24 $239.18 $8.09 $241.60 $302.00 $302.00 $8.09 $175.16 $302.00 $11.73 $8.09 $302.00 $8.09 N/A N/A 30600023 EAP CPT® 87101 FUNGUS CULT. DERM. BOTH IP/OP $218.00 $161.50 $3.85 $218.00 $15.11 $15.11 $15.11 $15.11 $7.71 $7.71 $3.86 $3.85 $7.71 $11.71 $11.71 $12.16 $8.55 $11.38 $12.34 $12.34 $128.95 $7.71 $7.71 $7.71 $218.00 $163.50 $7.71 $7.71 $7.71 $43.08 $43.08 $172.66 $7.71 $174.40 $12.72 $10.84 $7.71 $126.44 $218.00 $11.18 $7.71 $8.51 $7.71 N/A N/A 30600024 EAP CPT® 87102 "FUNGUS CULTURE,MISC." BOTH IP/OP $231.00 $171.00 $4.20 $231.00 $16.49 $16.49 $16.49 $16.49 $8.41 $8.41 $4.21 $4.20 $8.41 $12.75 $12.75 $13.24 $9.31 $12.42 $13.46 $13.46 $136.64 $8.41 $8.41 $8.41 $231.00 $173.25 $8.41 $8.41 $8.41 $46.96 $46.96 $182.95 $8.41 $184.80 $13.88 $11.83 $8.41 $133.98 $231.00 $12.19 $8.41 $9.29 $8.41 N/A N/A 30600025 EAP CPT® 87103 FUNGUS CULT. BLOOD BOTH IP/OP $251.00 $186.00 $10.00 $251.00 $251.00 $251.00 $251.00 $251.00 $20.46 $20.46 $10.23 $251.00 $20.46 $13.70 $13.70 $14.22 $10.00 $13.32 $32.74 $32.74 $251.00 $20.46 $20.46 $20.46 $251.00 $188.25 $20.46 $20.46 $20.46 $50.40 $50.40 $198.79 $20.46 $200.80 $251.00 $251.00 $20.46 $145.58 $251.00 $29.67 $20.46 $251.00 $20.46 N/A N/A 30600026 EAP CPT® 87106 CULTURE I.D.-YEAST BIOCHEM BOTH IP/OP $261.00 $193.50 $5.16 $261.00 $261.00 $261.00 $261.00 $261.00 $10.32 $10.32 $5.16 $261.00 $10.32 $15.67 $15.67 $16.28 $11.44 $15.25 $16.51 $16.51 $261.00 $10.32 $10.32 $10.32 $261.00 $195.75 $10.32 $10.32 $10.32 $57.68 $57.68 $206.71 $10.32 $208.80 $261.00 $261.00 $10.32 $151.38 $261.00 $14.96 $10.32 $261.00 $10.32 N/A N/A 30600027 EAP CPT® 87107 CULTURE I.D.- MOLD BIOCHEM BOTH IP/OP $261.00 $193.50 $5.16 $261.00 $261.00 $261.00 $261.00 $261.00 $10.32 $10.32 $5.16 $261.00 $10.32 $15.67 $15.67 $16.28 $11.44 $15.25 $16.51 $16.51 $261.00 $10.32 $10.32 $10.32 $261.00 $195.75 $10.32 $10.32 $10.32 $57.68 $57.68 $206.71 $10.32 $208.80 $261.00 $261.00 $10.32 $151.38 $261.00 $14.96 $10.32 $261.00 $10.32 N/A N/A 30600028 EAP CPT® 87110 "CHLAM CULT,REFERRAL" BOTH IP/OP $141.00 $104.50 $9.80 $141.00 $141.00 $141.00 $141.00 $141.00 $19.60 $19.60 $9.80 $141.00 $19.60 $29.74 $29.74 $30.89 $21.71 $28.94 $31.36 $31.36 $141.00 $19.60 $19.60 $19.60 $141.00 $105.75 $19.60 $19.60 $19.60 $109.48 $109.48 $111.67 $19.60 $112.80 $141.00 $141.00 $19.60 $81.78 $141.00 $28.42 $19.60 $141.00 $19.60 N/A N/A 30600029 EAP CPT® 87116 AFB CULTURE-MISC BOTH IP/OP $270.00 $200.00 $5.40 $270.00 $14.28 $14.28 $14.28 $14.28 $10.80 $10.80 $5.40 $5.40 $10.80 $11.02 $11.02 $11.45 $8.05 $56.27 $17.28 $17.28 $159.71 $10.80 $10.80 $10.80 $270.00 $202.50 $10.80 $10.80 $10.80 $40.56 $40.56 $213.84 $10.80 $216.00 $17.82 $53.59 $10.80 $156.60 $270.00 $15.66 $10.80 $56.27 $10.80 N/A N/A 30600030 EAP CPT® 87116 "AFB CULTURE, BLOOD" BOTH IP/OP $270.00 $200.00 $5.40 $270.00 $14.28 $14.28 $14.28 $14.28 $10.80 $10.80 $5.40 $5.40 $10.80 $11.02 $11.02 $11.45 $8.05 $56.27 $17.28 $17.28 $159.71 $10.80 $10.80 $10.80 $270.00 $202.50 $10.80 $10.80 $10.80 $40.56 $40.56 $213.84 $10.80 $216.00 $17.82 $53.59 $10.80 $156.60 $270.00 $15.66 $10.80 $56.27 $10.80 N/A N/A 30600031 EAP CPT® 87147 CULTURE I.D.-IMMUNOLOGIC BOTH IP/OP $105.00 $78.00 $2.59 $105.00 $105.00 $105.00 $105.00 $105.00 $5.18 $5.18 $2.59 $105.00 $5.18 $6.77 $6.77 $7.03 $4.94 $6.59 $8.29 $8.29 $105.00 $5.18 $5.18 $5.18 $105.00 $78.75 $5.18 $5.18 $5.18 $24.92 $24.92 $83.16 $5.18 $84.00 $105.00 $105.00 $5.18 $60.90 $105.00 $7.51 $5.18 $105.00 $5.18 N/A N/A 30600032 EAP CPT® 87149 CULTURE I.D.-PROBE BIOCHEM BOTH IP/OP $468.00 $346.50 $10.03 $468.00 $38.70 $38.70 $38.70 $38.70 $20.05 $20.05 $10.03 $10.03 $20.05 $29.94 $29.94 $31.09 $21.86 $29.14 $32.08 $32.08 $276.82 $20.05 $20.05 $20.05 $468.00 $351.00 $20.05 $20.05 $20.05 $110.20 $110.20 $370.66 $20.05 $374.40 $33.08 $27.75 $20.05 $271.44 $468.00 $29.07 $20.05 $21.80 $20.05 N/A N/A 30600033 EAP CPT® 87172 PINWORM EXAM BOTH IP/OP $134.00 $99.50 $2.14 $134.00 $134.00 $134.00 $134.00 $134.00 $4.27 $4.27 $2.14 $134.00 $4.27 $6.48 $6.48 $6.73 $4.73 $6.30 $6.83 $6.83 $134.00 $4.27 $4.27 $4.27 $134.00 $100.50 $4.27 $4.27 $4.27 $23.84 $23.84 $106.13 $4.27 $107.20 $134.00 $134.00 $4.27 $77.72 $134.00 $6.19 $4.27 $134.00 $4.27 N/A N/A 30600034 EAP CPT® 87177 "OVA & PARASITES, URN" BOTH IP/OP $251.00 $186.00 $4.45 $251.00 $17.47 $17.47 $17.47 $17.47 $8.90 $8.90 $4.45 $4.45 $8.90 $13.51 $13.51 $14.03 $9.86 $13.15 $14.24 $14.24 $148.47 $8.90 $8.90 $8.90 $251.00 $188.25 $8.90 $8.90 $8.90 $49.72 $49.72 $198.79 $8.90 $200.80 $14.69 $12.52 $8.90 $145.58 $251.00 $12.91 $8.90 $9.83 $8.90 N/A N/A 30600035 EAP CPT® 87177 "O&P,ETHYLACETATE" BOTH IP/OP $229.00 $169.50 $4.45 $229.00 $17.47 $17.47 $17.47 $17.47 $8.90 $8.90 $4.45 $4.45 $8.90 $13.51 $13.51 $14.03 $9.86 $13.15 $14.24 $14.24 $135.45 $8.90 $8.90 $8.90 $229.00 $171.75 $8.90 $8.90 $8.90 $49.72 $49.72 $181.37 $8.90 $183.20 $14.69 $12.52 $8.90 $132.82 $229.00 $12.91 $8.90 $9.83 $8.90 N/A N/A 30600036 EAP CPT® 87186 SENS.SPECIAL PANEL BOTH IP/OP $235.00 $174.00 $4.32 $235.00 $16.97 $16.97 $16.97 $16.97 $8.65 $8.65 $4.33 $4.32 $8.65 $13.12 $13.12 $13.63 $9.58 $12.77 $13.84 $13.84 $139.00 $8.65 $8.65 $8.65 $235.00 $176.25 $8.65 $8.65 $8.65 $48.32 $48.32 $186.12 $8.65 $188.00 $14.27 $12.16 $8.65 $136.30 $235.00 $12.54 $8.65 $9.55 $8.65 N/A N/A 30600037 EAP CPT® 87186 SENS.GRAM POS COCCI BOTH IP/OP $214.00 $158.50 $4.32 $214.00 $16.97 $16.97 $16.97 $16.97 $8.65 $8.65 $4.33 $4.32 $8.65 $13.12 $13.12 $13.63 $9.58 $12.77 $13.84 $13.84 $126.58 $8.65 $8.65 $8.65 $214.00 $160.50 $8.65 $8.65 $8.65 $48.32 $48.32 $169.49 $8.65 $171.20 $14.27 $12.16 $8.65 $124.12 $214.00 $12.54 $8.65 $9.55 $8.65 N/A N/A 30600038 EAP CPT® 87205 GRAM STAIN BOTH IP/OP $61.00 $45.50 $2.14 $61.00 $4.59 $4.59 $4.59 $4.59 $4.27 $4.27 $2.14 $2.14 $4.27 $3.57 $3.57 $3.70 $2.60 $3.47 $6.83 $6.83 $36.08 $4.27 $4.27 $4.27 $61.00 $45.75 $4.27 $4.27 $4.27 $13.12 $13.12 $48.31 $4.27 $48.80 $7.05 $3.30 $4.27 $35.38 $61.00 $6.19 $4.27 $2.59 $4.27 N/A N/A 30600039 EAP CPT® 87502 INFLUENZA VIRUS -A/B AMPLIFIED PROBE BOTH IP/OP $272.00 $201.50 $47.90 $272.00 $272.00 $272.00 $272.00 $272.00 $95.80 $95.80 $47.90 $272.00 $95.80 $75.96 $75.96 $78.88 $55.45 $68.64 $153.28 $153.28 $272.00 $95.80 $95.80 $95.80 $272.00 $204.00 $95.80 $95.80 $95.80 $136.00 $136.00 $215.42 $95.80 $217.60 $272.00 $272.00 $95.80 $157.76 $272.00 $138.91 $95.80 $272.00 $95.80 N/A N/A 30600040 EAP CPT® 87150 GROUP B STREP - AMPLIFIED PROBE BOTH IP/OP $384.00 $284.50 $17.55 $384.00 $384.00 $384.00 $384.00 $384.00 $35.09 $35.09 $17.55 $384.00 $35.09 $29.22 $29.22 $30.35 $21.33 $80.03 $56.14 $56.14 $384.00 $35.09 $35.09 $35.09 $384.00 $288.00 $35.09 $35.09 $35.09 $192.00 $192.00 $304.13 $35.09 $307.20 $384.00 $384.00 $35.09 $222.72 $384.00 $50.88 $35.09 $384.00 $35.09 N/A N/A 30600041 EAP CPT® 87503 INFLUENZA VIRUS (H1N1) (AMPLIFIED PROBE) BOTH IP/OP $271.00 $201.00 $8.31 $271.00 $271.00 $271.00 $271.00 $271.00 $29.22 $29.22 $14.61 $271.00 $29.22 $11.39 $11.39 $11.83 $8.31 $10.29 $46.75 $46.75 $271.00 $29.22 $29.22 $29.22 $271.00 $203.25 $29.22 $29.22 $29.22 $135.50 $135.50 $214.63 $29.22 $216.80 $271.00 $271.00 $29.22 $157.18 $271.00 $42.37 $29.22 $271.00 $29.22 N/A N/A 30600042 EAP CPT® 87206 PAS/KOH PREP BOTH IP/OP $158.00 $117.00 $2.70 $158.00 $10.57 $10.57 $10.57 $10.57 $5.39 $5.39 $2.70 $2.70 $5.39 $8.15 $8.15 $8.47 $5.95 $7.93 $8.62 $8.62 $93.46 $5.39 $5.39 $5.39 $158.00 $118.50 $5.39 $5.39 $5.39 $30.00 $30.00 $125.14 $5.39 $126.40 $8.89 $7.55 $5.39 $91.64 $158.00 $7.82 $5.39 $5.93 $5.39 N/A N/A 30600044 EAP CPT® 87328 CRYPTOSPORIDIUM SCRN. BOTH IP/OP $195.00 $144.50 $6.22 $195.00 $23.52 $23.52 $23.52 $23.52 $13.82 $13.82 $6.91 $6.22 $13.82 $18.22 $18.22 $18.92 $13.30 $17.71 $22.11 $22.11 $115.34 $13.82 $13.82 $13.82 $195.00 $146.25 $13.82 $13.82 $13.82 $67.04 $67.04 $154.44 $13.82 $156.00 $22.80 $16.87 $13.82 $113.10 $195.00 $20.04 $13.82 $13.25 $13.82 N/A N/A 30600045 EAP CPT® 87207 MALARIA/PARASITE SMR BOTH IP/OP $229.00 $169.50 $3.00 $229.00 $229.00 $229.00 $229.00 $229.00 $5.99 $5.99 $3.00 $229.00 $5.99 $9.10 $9.10 $9.45 $6.64 $8.84 $9.58 $9.58 $229.00 $5.99 $5.99 $5.99 $229.00 $171.75 $5.99 $5.99 $5.99 $33.48 $33.48 $181.37 $5.99 $183.20 $229.00 $229.00 $5.99 $132.82 $229.00 $8.69 $5.99 $229.00 $5.99 N/A N/A 30600046 EAP CPT® 87207 RBC INCLUSION BODY BOTH IP/OP $216.00 $160.00 $3.00 $216.00 $216.00 $216.00 $216.00 $216.00 $5.99 $5.99 $3.00 $216.00 $5.99 $9.10 $9.10 $9.45 $6.64 $8.84 $9.58 $9.58 $216.00 $5.99 $5.99 $5.99 $216.00 $162.00 $5.99 $5.99 $5.99 $33.48 $33.48 $171.07 $5.99 $172.80 $216.00 $216.00 $5.99 $125.28 $216.00 $8.69 $5.99 $216.00 $5.99 N/A N/A 30600047 EAP CPT® 87209 MICROSPORIDIUM BOTH IP/OP $391.00 $289.50 $8.99 $391.00 $35.29 $35.29 $35.29 $35.29 $17.98 $17.98 $8.99 $8.99 $17.98 $27.29 $27.29 $28.34 $19.92 $26.54 $28.77 $28.77 $231.28 $17.98 $17.98 $17.98 $391.00 $293.25 $17.98 $17.98 $17.98 $100.44 $100.44 $309.67 $17.98 $312.80 $29.67 $25.28 $17.98 $226.78 $391.00 $26.07 $17.98 $19.86 $17.98 N/A N/A 30600048 EAP CPT® 87209 "O&P,PVA/TRICHROME" BOTH IP/OP $367.00 $272.00 $8.99 $367.00 $35.29 $35.29 $35.29 $35.29 $17.98 $17.98 $8.99 $8.99 $17.98 $27.29 $27.29 $28.34 $19.92 $26.54 $28.77 $28.77 $217.08 $17.98 $17.98 $17.98 $367.00 $275.25 $17.98 $17.98 $17.98 $100.44 $100.44 $290.66 $17.98 $293.60 $29.67 $25.28 $17.98 $212.86 $367.00 $26.07 $17.98 $19.86 $17.98 N/A N/A 30600049 EAP CPT® 87799 EB VIRUS DNA QUANT PCR (SO) BOTH IP/OP $796.00 $589.50 $21.42 $796.00 $796.00 $796.00 $796.00 $796.00 $42.84 $42.84 $21.42 $796.00 $42.84 $65.04 $65.04 $67.54 $47.48 $165.90 $68.54 $68.54 $796.00 $42.84 $42.84 $42.84 $796.00 $597.00 $42.84 $42.84 $42.84 $239.40 $239.40 $630.43 $42.84 $636.80 $796.00 $796.00 $42.84 $461.68 $796.00 $62.12 $42.84 $796.00 $42.84 N/A N/A 30600050 EAP CPT® 87252 CMV CULTURE INOC TISSUE (SO) BOTH IP/OP $390.00 $289.00 $13.04 $390.00 $390.00 $390.00 $390.00 $390.00 $26.07 $26.07 $13.04 $390.00 $26.07 $33.57 $33.57 $34.86 $24.51 $32.66 $41.71 $41.71 $390.00 $26.07 $26.07 $26.07 $390.00 $292.50 $26.07 $26.07 $26.07 $123.56 $123.56 $308.88 $26.07 $312.00 $390.00 $390.00 $26.07 $226.20 $390.00 $37.80 $26.07 $390.00 $26.07 N/A N/A 30600051 EAP CPT® 87254 CMV CULTURE INOC SHELL (SO) BOTH IP/OP $240.00 $178.00 $7.22 $240.00 $240.00 $240.00 $240.00 $240.00 $19.56 $19.56 $9.78 $240.00 $19.56 $29.69 $29.69 $30.83 $21.67 $7.22 $31.30 $31.30 $240.00 $19.56 $19.56 $19.56 $240.00 $180.00 $19.56 $19.56 $19.56 $109.28 $109.28 $190.08 $19.56 $192.00 $240.00 $240.00 $19.56 $139.20 $240.00 $28.36 $19.56 $240.00 $19.56 N/A N/A 30600052 EAP CPT® 87210 "O & P DIRECT, SMEAR" BOTH IP/OP $216.00 $160.00 $2.62 $216.00 $8.38 $8.38 $8.38 $8.38 $5.82 $5.82 $2.91 $2.62 $5.82 $6.48 $6.48 $6.73 $4.73 $6.30 $9.31 $9.31 $127.76 $5.82 $5.82 $5.82 $216.00 $162.00 $5.82 $5.82 $5.82 $23.84 $23.84 $171.07 $5.82 $172.80 $9.60 $6.00 $5.82 $125.28 $216.00 $8.44 $5.82 $4.71 $5.82 N/A N/A 30600053 EAP CPT® 87220 KOH LEVEL BOTH IP/OP $198.00 $147.00 $2.14 $198.00 $8.38 $8.38 $8.38 $8.38 $4.27 $4.27 $2.14 $2.14 $4.27 $6.48 $6.48 $6.73 $4.73 $6.30 $6.83 $6.83 $117.12 $4.27 $4.27 $4.27 $198.00 $148.50 $4.27 $4.27 $4.27 $23.84 $23.84 $156.82 $4.27 $158.40 $7.05 $6.00 $4.27 $114.84 $198.00 $6.19 $4.27 $4.71 $4.27 N/A N/A 30600055 EAP CPT® 87252 "VIRAL CULT,REFERRAL" BOTH IP/OP $238.00 $176.50 $13.04 $238.00 $238.00 $238.00 $238.00 $238.00 $26.07 $26.07 $13.04 $238.00 $26.07 $33.57 $33.57 $34.86 $24.51 $32.66 $41.71 $41.71 $238.00 $26.07 $26.07 $26.07 $238.00 $178.50 $26.07 $26.07 $26.07 $123.56 $123.56 $188.50 $26.07 $190.40 $238.00 $238.00 $26.07 $138.04 $238.00 $37.80 $26.07 $238.00 $26.07 N/A N/A 30600056 EAP CPT® 87320 CHLAMYDIA SCREEN BOTH IP/OP $718.00 $531.50 $6.75 $718.00 $23.52 $23.52 $23.52 $23.52 $15.00 $15.00 $7.50 $6.75 $15.00 $18.22 $18.22 $18.92 $13.30 $17.71 $24.00 $24.00 $424.70 $15.00 $15.00 $15.00 $718.00 $538.50 $15.00 $15.00 $15.00 $67.04 $67.04 $568.66 $15.00 $574.40 $24.75 $16.87 $15.00 $416.44 $718.00 $21.75 $15.00 $13.25 $15.00 N/A N/A 30600057 EAP CPT® 87324 "C.DIFF. ASSAY,STOOL" BOTH IP/OP $195.00 $144.50 $5.99 $195.00 $23.52 $23.52 $23.52 $23.52 $11.98 $11.98 $5.99 $5.99 $11.98 $18.22 $18.22 $18.92 $13.30 $17.71 $19.17 $19.17 $115.34 $11.98 $11.98 $11.98 $195.00 $146.25 $11.98 $11.98 $11.98 $67.04 $67.04 $154.44 $11.98 $156.00 $19.77 $16.87 $11.98 $113.10 $195.00 $17.37 $11.98 $13.25 $11.98 N/A N/A 30600059 EAP CPT® 87329 EIA GIARDIA SCREEN BOTH IP/OP $195.00 $144.50 $5.99 $195.00 $23.52 $23.52 $23.52 $23.52 $11.98 $11.98 $5.99 $5.99 $11.98 $18.22 $18.22 $18.92 $13.30 $17.71 $19.17 $19.17 $115.34 $11.98 $11.98 $11.98 $195.00 $146.25 $11.98 $11.98 $11.98 $67.04 $67.04 $154.44 $11.98 $156.00 $19.77 $16.87 $11.98 $113.10 $195.00 $17.37 $11.98 $13.25 $11.98 N/A N/A 30600060 EAP CPT® 87337 H.PYLORI AG -STOOL BOTH IP/OP $334.00 $247.50 $5.99 $334.00 $23.52 $23.52 $23.52 $23.52 $11.98 $11.98 $5.99 $5.99 $11.98 $18.22 $18.22 $18.92 $13.30 $17.71 $19.17 $19.17 $197.56 $11.98 $11.98 $11.98 $334.00 $250.50 $11.98 $11.98 $11.98 $67.04 $67.04 $264.53 $11.98 $267.20 $19.77 $16.87 $11.98 $193.72 $334.00 $17.37 $11.98 $13.25 $11.98 N/A N/A 30600061 EAP CPT® 87340 HBV SURFACE AG BOTH IP/OP $255.00 $189.00 $5.17 $255.00 $20.28 $20.28 $20.28 $20.28 $10.33 $10.33 $5.17 $5.17 $10.33 $15.68 $15.68 $16.29 $11.45 $15.26 $16.53 $16.53 $150.83 $10.33 $10.33 $10.33 $255.00 $191.25 $10.33 $10.33 $10.33 $20.68 $20.68 $201.96 $10.33 $204.00 $17.04 $14.53 $10.33 $147.90 $255.00 $14.98 $10.33 $11.41 $10.33 N/A N/A 30600062 EAP CPT® 87340 HBV SURF AG-OB BOTH IP/OP $246.00 $182.50 $5.17 $246.00 $20.28 $20.28 $20.28 $20.28 $10.33 $10.33 $5.17 $5.17 $10.33 $15.68 $15.68 $16.29 $11.45 $15.26 $16.53 $16.53 $145.51 $10.33 $10.33 $10.33 $246.00 $184.50 $10.33 $10.33 $10.33 $20.68 $20.68 $194.83 $10.33 $196.80 $17.04 $14.53 $10.33 $142.68 $246.00 $14.98 $10.33 $11.41 $10.33 N/A N/A 30600063 EAP CPT® 87350 HBV E AG BOTH IP/OP $87.00 $64.50 $5.76 $87.00 $22.62 $22.62 $22.62 $22.62 $11.53 $11.53 $5.77 $5.76 $11.53 $17.50 $17.50 $18.18 $12.78 $17.02 $18.45 $18.45 $51.46 $11.53 $11.53 $11.53 $87.00 $65.25 $11.53 $11.53 $11.53 $64.40 $64.40 $68.90 $11.53 $69.60 $19.02 $16.21 $11.53 $50.46 $87.00 $16.72 $11.53 $12.73 $11.53 N/A N/A 30600064 EAP CPT® 87385 HISTOPLASMA AG BOTH IP/OP $318.00 $235.50 $5.99 $318.00 $23.52 $23.52 $23.52 $23.52 $13.25 $13.25 $6.63 $5.99 $13.25 $18.22 $18.22 $18.92 $13.30 $17.71 $21.20 $21.20 $188.10 $13.25 $13.25 $13.25 $318.00 $238.50 $13.25 $13.25 $13.25 $67.04 $67.04 $251.86 $13.25 $254.40 $21.86 $16.87 $13.25 $184.44 $318.00 $19.21 $13.25 $13.25 $13.25 N/A N/A 30600065 EAP CPT® 87390 HIV-AG-P24 BOTH IP/OP $225.00 $166.50 $12.03 $225.00 $225.00 $225.00 $225.00 $225.00 $24.06 $24.06 $12.03 $225.00 $24.06 $26.79 $26.79 $27.82 $19.56 $22.62 $38.50 $38.50 $225.00 $24.06 $24.06 $24.06 $225.00 $168.75 $24.06 $24.06 $24.06 $98.60 $98.60 $178.20 $24.06 $180.00 $225.00 $225.00 $24.06 $130.50 $225.00 $34.89 $24.06 $225.00 $24.06 N/A N/A 30600066 EAP CPT® 87425 "ROTAVIRUS AG, STOOL" BOTH IP/OP $223.00 $165.50 $5.99 $223.00 $23.52 $23.52 $23.52 $23.52 $11.98 $11.98 $5.99 $5.99 $11.98 $18.22 $18.22 $18.92 $13.30 $17.71 $19.17 $19.17 $131.90 $11.98 $11.98 $11.98 $223.00 $167.25 $11.98 $11.98 $11.98 $67.04 $67.04 $176.62 $11.98 $178.40 $19.77 $16.87 $11.98 $129.34 $223.00 $17.37 $11.98 $13.25 $11.98 N/A N/A 30600068 EAP CPT® 87430 STREP A AG-THROAT BOTH IP/OP $162.00 $120.00 $7.56 $162.00 $23.52 $23.52 $23.52 $23.52 $16.81 $16.81 $8.41 $7.56 $16.81 $18.22 $18.22 $18.92 $13.30 $17.71 $26.90 $26.90 $95.82 $16.81 $16.81 $16.81 $162.00 $121.50 $16.81 $16.81 $16.81 $67.04 $67.04 $128.30 $16.81 $129.60 $27.74 $16.87 $16.81 $93.96 $162.00 $24.37 $16.81 $13.25 $16.81 N/A N/A 30600070 EAP CPT® 87278 "L. PNEUMO-1 AG, URINE" BOTH IP/OP $271.00 $201.00 $7.80 $271.00 $271.00 $271.00 $271.00 $271.00 $15.60 $15.60 $7.80 $271.00 $15.60 $18.22 $18.22 $18.92 $13.30 $17.71 $24.96 $24.96 $271.00 $15.60 $15.60 $15.60 $271.00 $203.25 $15.60 $15.60 $15.60 $67.04 $67.04 $214.63 $15.60 $216.80 $271.00 $271.00 $15.60 $157.18 $271.00 $22.62 $15.60 $271.00 $15.60 N/A N/A 30600071 EAP CPT® 87491 CHLAMYDIA DETECTION BOTH IP/OP $374.00 $277.00 $17.55 $374.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $221.22 $35.09 $35.09 $35.09 $374.00 $280.50 $35.09 $35.09 $35.09 $70.20 $70.20 $296.21 $35.09 $299.20 $57.90 $27.60 $35.09 $216.92 $374.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30600072 EAP CPT® 87496 CMV DNA-PCR FLUIDS BOTH IP/OP $905.00 $670.00 $17.55 $905.00 $905.00 $905.00 $905.00 $905.00 $35.09 $35.09 $17.55 $905.00 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $905.00 $35.09 $35.09 $35.09 $905.00 $678.75 $35.09 $35.09 $35.09 $109.64 $109.64 $716.76 $35.09 $724.00 $905.00 $905.00 $35.09 $524.90 $905.00 $50.88 $35.09 $905.00 $35.09 N/A N/A 30600073 EAP CPT® 87516 HBV DNA-PCR BOTH IP/OP $319.00 $236.50 $17.55 $319.00 $319.00 $319.00 $319.00 $319.00 $35.09 $35.09 $17.55 $319.00 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $319.00 $35.09 $35.09 $35.09 $319.00 $239.25 $35.09 $35.09 $35.09 $109.64 $109.64 $252.65 $35.09 $255.20 $319.00 $319.00 $35.09 $185.02 $319.00 $50.88 $35.09 $319.00 $35.09 N/A N/A 30600074 EAP CPT® 87177 COCCIDIA SMEAR BOTH IP/OP $229.00 $169.50 $4.45 $229.00 $17.47 $17.47 $17.47 $17.47 $8.90 $8.90 $4.45 $4.45 $8.90 $13.51 $13.51 $14.03 $9.86 $13.15 $14.24 $14.24 $135.45 $8.90 $8.90 $8.90 $229.00 $171.75 $8.90 $8.90 $8.90 $49.72 $49.72 $181.37 $8.90 $183.20 $14.69 $12.52 $8.90 $132.82 $229.00 $12.91 $8.90 $9.83 $8.90 N/A N/A 30600075 EAP CPT® 87521 HCV RNA-PCR BOTH IP/OP $706.00 $522.50 $17.55 $706.00 $706.00 $706.00 $706.00 $706.00 $35.09 $35.09 $17.55 $706.00 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $706.00 $35.09 $35.09 $35.09 $706.00 $529.50 $35.09 $35.09 $35.09 $109.64 $109.64 $559.15 $35.09 $564.80 $706.00 $706.00 $35.09 $409.48 $706.00 $50.88 $35.09 $706.00 $35.09 N/A N/A 30600076 EAP CPT® 87522 "HCV RNA-PCR, QUANT" BOTH IP/OP "$1,023.00" $757.50 $21.42 "$1,023.00" $84.06 $84.06 $84.06 $84.06 $42.84 $42.84 $21.42 $21.42 $42.84 $65.04 $65.04 $67.54 $47.48 $63.28 $68.54 $68.54 $605.10 $42.84 $42.84 $42.84 "$1,023.00" $767.25 $42.84 $42.84 $42.84 $239.40 $239.40 $810.22 $42.84 $818.40 $70.69 $60.27 $42.84 $593.34 "$1,023.00" $62.12 $42.84 $47.34 $42.84 N/A N/A 30600077 EAP CPT® 87529 HSV DNA-PCR BOTH IP/OP $901.00 $667.00 $17.55 $901.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $532.94 $35.09 $35.09 $35.09 $901.00 $675.75 $35.09 $35.09 $35.09 $109.64 $109.64 $713.59 $35.09 $720.80 $57.90 $27.60 $35.09 $522.58 $901.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30600078 EAP CPT® 87535 HIV-1 DNA-PCR BOTH IP/OP $675.00 $499.50 $17.55 $675.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $399.26 $35.09 $35.09 $35.09 $675.00 $506.25 $35.09 $35.09 $35.09 $109.64 $109.64 $534.60 $35.09 $540.00 $57.90 $27.60 $35.09 $391.50 $675.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30600079 EAP CPT® 87536 "HIV-1 RNA B DNA, QUANT" BOTH IP/OP $742.00 $549.50 $42.55 $742.00 $101.83 $101.83 $101.83 $101.83 $85.10 $85.10 $42.55 $42.55 $85.10 $78.80 $78.80 $81.83 $57.52 $66.37 $136.16 $136.16 $438.89 $85.10 $85.10 $85.10 $742.00 $556.50 $85.10 $85.10 $85.10 $290.04 $290.04 $587.66 $85.10 $593.60 $140.42 $63.21 $85.10 $430.36 $742.00 $123.40 $85.10 $49.65 $85.10 N/A N/A 30600080 EAP CPT® 87556 DIRECT M. TB TEST BOTH IP/OP $317.00 $235.00 $18.76 $317.00 $38.50 $38.50 $38.50 $38.50 $41.68 $41.68 $20.84 $18.76 $41.68 $29.79 $29.79 $30.93 $21.74 $66.07 $66.69 $66.69 $187.51 $41.68 $41.68 $41.68 $317.00 $237.75 $41.68 $41.68 $41.68 $109.64 $109.64 $251.06 $41.68 $253.60 $68.77 $62.92 $41.68 $183.86 $317.00 $60.44 $41.68 $66.06 $41.68 N/A N/A 30600081 EAP CPT® 87591 GC DETECTION BOTH IP/OP $374.00 $277.00 $17.55 $374.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $25.16 $56.14 $56.14 $221.22 $35.09 $35.09 $35.09 $374.00 $280.50 $35.09 $35.09 $35.09 $70.20 $70.20 $296.21 $35.09 $299.20 $57.90 $23.96 $35.09 $216.92 $374.00 $50.88 $35.09 $18.82 $35.09 N/A N/A 30600082 EAP CPT® 87798 "ENTEROVIRUS PCR, CSF" BOTH IP/OP $807.00 $597.50 $17.55 $807.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $477.34 $35.09 $35.09 $35.09 $807.00 $605.25 $35.09 $35.09 $35.09 $109.64 $109.64 $639.14 $35.09 $645.60 $57.90 $27.60 $35.09 $468.06 $807.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30600083 EAP CPT® 87798 THYROID PEROX AB; TPO BOTH IP/OP $964.00 $713.50 $17.55 $964.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $570.21 $35.09 $35.09 $35.09 $964.00 $723.00 $35.09 $35.09 $35.09 $109.64 $109.64 $763.49 $35.09 $771.20 $57.90 $27.60 $35.09 $559.12 $964.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30600084 EAP CPT® 87798 "JCV DNA-PCR,CSF" BOTH IP/OP $900.00 $666.00 $17.55 $900.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $532.35 $35.09 $35.09 $35.09 $900.00 $675.00 $35.09 $35.09 $35.09 $109.64 $109.64 $712.80 $35.09 $720.00 $57.90 $27.60 $35.09 $522.00 $900.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30600085 EAP CPT® 87798 "VZV DNA-PCR,CSF" BOTH IP/OP $900.00 $666.00 $17.55 $900.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $532.35 $35.09 $35.09 $35.09 $900.00 $675.00 $35.09 $35.09 $35.09 $109.64 $109.64 $712.80 $35.09 $720.00 $57.90 $27.60 $35.09 $522.00 $900.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30600086 EAP CPT® 87804 INFLUENZA-A AG BOTH IP/OP $359.00 $266.00 $7.45 $359.00 $23.52 $23.52 $23.52 $23.52 $16.55 $16.55 $8.28 $7.45 $16.55 $18.22 $18.22 $18.92 $13.30 $17.71 $26.48 $26.48 $212.35 $16.55 $16.55 $16.55 $359.00 $269.25 $16.55 $16.55 $16.55 $67.04 $67.04 $284.33 $16.55 $287.20 $27.31 $16.87 $16.55 $208.22 $359.00 $24.00 $16.55 $13.25 $16.55 N/A N/A 30600087 EAP CPT® 87804 INFLUENZA-B AG BOTH IP/OP $359.00 $266.00 $7.45 $359.00 $23.52 $23.52 $23.52 $23.52 $16.55 $16.55 $8.28 $7.45 $16.55 $18.22 $18.22 $18.92 $13.30 $17.71 $26.48 $26.48 $212.35 $16.55 $16.55 $16.55 $359.00 $269.25 $16.55 $16.55 $16.55 $67.04 $67.04 $284.33 $16.55 $287.20 $27.31 $16.87 $16.55 $208.22 $359.00 $24.00 $16.55 $13.25 $16.55 N/A N/A 30600088 EAP CPT® 87807 RSV ASSAY BOTH IP/OP $656.00 $485.50 $5.99 $656.00 $23.52 $23.52 $23.52 $23.52 $13.10 $13.10 $6.55 $5.99 $13.10 $18.22 $18.22 $18.92 $13.30 $17.71 $20.96 $20.96 $388.02 $13.10 $13.10 $13.10 $656.00 $492.00 $13.10 $13.10 $13.10 $67.04 $67.04 $519.55 $13.10 $524.80 $21.62 $16.87 $13.10 $380.48 $656.00 $19.00 $13.10 $13.25 $13.10 N/A N/A 30600089 EAP CPT® 87901 HIV GENOTYPING BOTH IP/OP "$1,830.00" "$1,354.50" $96.38 "$1,830.00" $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $132.42 $132.42 $137.52 $96.67 $128.84 $411.92 $411.92 "$1,082.45" $257.45 $257.45 $257.45 "$1,830.00" "$1,372.50" $257.45 $257.45 $257.45 $487.40 $487.40 "$1,449.36" $257.45 "$1,464.00" $424.79 $122.70 $257.45 "$1,061.40" "$1,830.00" $373.30 $257.45 $96.38 $257.45 N/A N/A 30600090 EAP CPT® 87902 HCV GENOTYPING BOTH IP/OP "$1,980.00" "$1,465.50" $96.38 "$1,980.00" $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $132.42 $132.42 $137.52 $96.67 $128.84 $411.92 $411.92 "$1,171.17" $257.45 $257.45 $257.45 "$1,980.00" "$1,485.00" $257.45 $257.45 $257.45 $487.40 $487.40 "$1,568.16" $257.45 "$1,584.00" $424.79 $122.70 $257.45 "$1,148.40" "$1,980.00" $373.30 $257.45 $96.38 $257.45 N/A N/A 30600093 EAP CPT® 87254 "CYTOMEGALOVIRUS, RAPID CULTURE - QUEST (SO)" BOTH IP/OP $171.00 $127.00 $7.22 $171.00 $171.00 $171.00 $171.00 $171.00 $19.56 $19.56 $9.78 $171.00 $19.56 $29.69 $29.69 $30.83 $21.67 $7.22 $31.30 $31.30 $171.00 $19.56 $19.56 $19.56 $171.00 $128.25 $19.56 $19.56 $19.56 $109.28 $109.28 $135.43 $19.56 $136.80 $171.00 $171.00 $19.56 $99.18 $171.00 $28.36 $19.56 $171.00 $19.56 N/A N/A 30600094 EAP CPT® 86757 RICHETTSIA ANTIBODY IGM BOTH IP/OP $48.00 $36.00 $9.68 $48.00 $48.00 $48.00 $48.00 $48.00 $19.35 $19.35 $9.68 $48.00 $19.35 $29.39 $29.39 $30.52 $21.45 $28.60 $30.96 $30.96 $48.00 $19.35 $19.35 $19.35 $48.00 $36.00 $19.35 $19.35 $19.35 $48.00 $48.00 $38.02 $19.35 $38.40 $48.00 $48.00 $19.35 $27.84 $48.00 $28.06 $19.35 $48.00 $19.35 N/A N/A 30600095 EAP CPT® 87798 "PARVOVIRUS B19 PCR, QUAL" BOTH IP/OP $311.00 $230.50 $17.55 $311.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $183.96 $35.09 $35.09 $35.09 $311.00 $233.25 $35.09 $35.09 $35.09 $109.64 $109.64 $246.31 $35.09 $248.80 $57.90 $27.60 $35.09 $180.38 $311.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30600096 EAP CPT® 87517 "HBV DNA-PCR,QUANT" BOTH IP/OP $355.00 $263.00 $21.42 $355.00 $84.06 $84.06 $84.06 $84.06 $42.84 $42.84 $21.42 $21.42 $42.84 $65.04 $65.04 $67.54 $47.48 $63.28 $68.54 $68.54 $209.98 $42.84 $42.84 $42.84 $355.00 $266.25 $42.84 $42.84 $42.84 $239.40 $239.40 $281.16 $42.84 $284.00 $70.69 $60.27 $42.84 $205.90 $355.00 $62.12 $42.84 $47.34 $42.84 N/A N/A 30600100 EAP CPT® 87046 "E.COLI O157, CULTURE(SO)" BOTH IP/OP $63.00 $47.00 $2.61 $63.00 $18.52 $18.52 $18.52 $18.52 $9.44 $9.44 $4.72 $4.72 $9.44 $14.32 $14.32 $14.87 $10.45 $3.49 $15.10 $15.10 $37.26 $9.44 $9.44 $9.44 $63.00 $47.25 $9.44 $9.44 $9.44 $52.72 $52.72 $49.90 $9.44 $50.40 $15.58 $3.32 $9.44 $36.54 $63.00 $13.69 $9.44 $2.61 $9.44 N/A N/A 30600101 EAP CPT® 87496 "CYTOMEGALOVIRUS DNA, QUALITATIVE REAL-TIME PCR, SALIVA (SO)" BOTH IP/OP $70.00 $52.00 $17.55 $70.00 $70.00 $70.00 $70.00 $70.00 $35.09 $35.09 $17.55 $70.00 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $70.00 $35.09 $35.09 $35.09 $70.00 $52.50 $35.09 $35.09 $35.09 $70.00 $70.00 $55.44 $35.09 $56.00 $70.00 $70.00 $35.09 $40.60 $70.00 $50.88 $35.09 $70.00 $35.09 N/A N/A 30600105 EAP CPT® 87497 "CMV,DNA,PCR, QUANT" BOTH IP/OP $659.00 $488.00 $21.42 $659.00 $84.06 $84.06 $84.06 $84.06 $42.84 $42.84 $21.42 $21.42 $42.84 $65.04 $65.04 $67.54 $47.48 $63.28 $68.54 $68.54 $389.80 $42.84 $42.84 $42.84 $659.00 $494.25 $42.84 $42.84 $42.84 $239.40 $239.40 $521.93 $42.84 $527.20 $70.69 $60.27 $42.84 $382.22 $659.00 $62.12 $42.84 $47.34 $42.84 N/A N/A 30600106 EAP CPT® 87252 CMV INOC TISSUE (SO) BOTH IP/OP $390.00 $289.00 $13.04 $390.00 $390.00 $390.00 $390.00 $390.00 $26.07 $26.07 $13.04 $390.00 $26.07 $33.57 $33.57 $34.86 $24.51 $32.66 $41.71 $41.71 $390.00 $26.07 $26.07 $26.07 $390.00 $292.50 $26.07 $26.07 $26.07 $123.56 $123.56 $308.88 $26.07 $312.00 $390.00 $390.00 $26.07 $226.20 $390.00 $37.80 $26.07 $390.00 $26.07 N/A N/A 30600107 EAP CPT® 87254 CMV INOC SHELL VIA (SO) BOTH IP/OP $240.00 $178.00 $7.22 $240.00 $240.00 $240.00 $240.00 $240.00 $19.56 $19.56 $9.78 $240.00 $19.56 $29.69 $29.69 $30.83 $21.67 $7.22 $31.30 $31.30 $240.00 $19.56 $19.56 $19.56 $240.00 $180.00 $19.56 $19.56 $19.56 $109.28 $109.28 $190.08 $19.56 $192.00 $240.00 $240.00 $19.56 $139.20 $240.00 $28.36 $19.56 $240.00 $19.56 N/A N/A 30600108 EAP CPT® 87902 HEP C DNA GENO QUANT (SO) BOTH IP/OP "$1,193.00" $883.00 $96.38 "$1,193.00" $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $132.42 $132.42 $137.52 $96.67 $128.84 $411.92 $411.92 $705.66 $257.45 $257.45 $257.45 "$1,193.00" $894.75 $257.45 $257.45 $257.45 $487.40 $487.40 $944.86 $257.45 $954.40 $424.79 $122.70 $257.45 $691.94 "$1,193.00" $373.30 $257.45 $96.38 $257.45 N/A N/A 30600109 EAP CPT® 87799 EBV DNA DETECT NOS (SO) BOTH IP/OP $688.00 $509.50 $21.42 $688.00 $688.00 $688.00 $688.00 $688.00 $42.84 $42.84 $21.42 $688.00 $42.84 $65.04 $65.04 $67.54 $47.48 $143.39 $68.54 $68.54 $688.00 $42.84 $42.84 $42.84 $688.00 $516.00 $42.84 $42.84 $42.84 $239.40 $239.40 $544.90 $42.84 $550.40 $688.00 $688.00 $42.84 $399.04 $688.00 $62.12 $42.84 $688.00 $42.84 N/A N/A 30600200 EAP CPT® 87205 GRAM STAIN BOTH IP/OP $65.00 $48.50 $2.14 $65.00 $4.59 $4.59 $4.59 $4.59 $4.27 $4.27 $2.14 $2.14 $4.27 $3.57 $3.57 $3.70 $2.60 $3.47 $6.83 $6.83 $38.45 $4.27 $4.27 $4.27 $65.00 $48.75 $4.27 $4.27 $4.27 $13.12 $13.12 $51.48 $4.27 $52.00 $7.05 $3.30 $4.27 $37.70 $65.00 $6.19 $4.27 $2.59 $4.27 N/A N/A 30600201 EAP CPT® 87205 SEZARY CELL PREP BOTH IP/OP $61.00 $45.50 $2.14 $61.00 $4.59 $4.59 $4.59 $4.59 $4.27 $4.27 $2.14 $2.14 $4.27 $3.57 $3.57 $3.70 $2.60 $3.47 $6.83 $6.83 $36.08 $4.27 $4.27 $4.27 $61.00 $45.75 $4.27 $4.27 $4.27 $13.12 $13.12 $48.31 $4.27 $48.80 $7.05 $3.30 $4.27 $35.38 $61.00 $6.19 $4.27 $2.59 $4.27 N/A N/A 30600202 EAP CPT® 87206 PAS/KOH PREP BOTH IP/OP $158.00 $117.00 $2.70 $158.00 $10.57 $10.57 $10.57 $10.57 $5.39 $5.39 $2.70 $2.70 $5.39 $8.15 $8.15 $8.47 $5.95 $7.93 $8.62 $8.62 $93.46 $5.39 $5.39 $5.39 $158.00 $118.50 $5.39 $5.39 $5.39 $30.00 $30.00 $125.14 $5.39 $126.40 $8.89 $7.55 $5.39 $91.64 $158.00 $7.82 $5.39 $5.93 $5.39 N/A N/A 30600203 EAP CPT® 87206 AFB STAIN BOTH IP/OP $158.00 $117.00 $2.70 $158.00 $10.57 $10.57 $10.57 $10.57 $5.39 $5.39 $2.70 $2.70 $5.39 $8.15 $8.15 $8.47 $5.95 $7.93 $8.62 $8.62 $93.46 $5.39 $5.39 $5.39 $158.00 $118.50 $5.39 $5.39 $5.39 $30.00 $30.00 $125.14 $5.39 $126.40 $8.89 $7.55 $5.39 $91.64 $158.00 $7.82 $5.39 $5.93 $5.39 N/A N/A 30600204 EAP CPT® 87210 "O & P DIRECT, SMEAR" BOTH IP/OP $210.00 $155.50 $2.62 $210.00 $8.38 $8.38 $8.38 $8.38 $5.82 $5.82 $2.91 $2.62 $5.82 $6.48 $6.48 $6.73 $4.73 $6.30 $9.31 $9.31 $124.22 $5.82 $5.82 $5.82 $210.00 $157.50 $5.82 $5.82 $5.82 $23.84 $23.84 $166.32 $5.82 $168.00 $9.60 $6.00 $5.82 $121.80 $210.00 $8.44 $5.82 $4.71 $5.82 N/A N/A 30600205 EAP CPT® 87210 INDIA INK PREP BOTH IP/OP $216.00 $160.00 $2.62 $216.00 $8.38 $8.38 $8.38 $8.38 $5.82 $5.82 $2.91 $2.62 $5.82 $6.48 $6.48 $6.73 $4.73 $6.30 $9.31 $9.31 $127.76 $5.82 $5.82 $5.82 $216.00 $162.00 $5.82 $5.82 $5.82 $23.84 $23.84 $171.07 $5.82 $172.80 $9.60 $6.00 $5.82 $125.28 $216.00 $8.44 $5.82 $4.71 $5.82 N/A N/A 30600206 EAP CPT® 87210 VAGINAL WET PREP BOTH IP/OP $216.00 $160.00 $2.62 $216.00 $8.38 $8.38 $8.38 $8.38 $5.82 $5.82 $2.91 $2.62 $5.82 $6.48 $6.48 $6.73 $4.73 $6.30 $9.31 $9.31 $127.76 $5.82 $5.82 $5.82 $216.00 $162.00 $5.82 $5.82 $5.82 $23.84 $23.84 $171.07 $5.82 $172.80 $9.60 $6.00 $5.82 $125.28 $216.00 $8.44 $5.82 $4.71 $5.82 N/A N/A 30600207 EAP CPT® 87430 STREP A AG-THROAT BOTH IP/OP $169.00 $125.50 $7.56 $169.00 $23.52 $23.52 $23.52 $23.52 $16.81 $16.81 $8.41 $7.56 $16.81 $18.22 $18.22 $18.92 $13.30 $17.71 $26.90 $26.90 $99.96 $16.81 $16.81 $16.81 $169.00 $126.75 $16.81 $16.81 $16.81 $67.04 $67.04 $133.85 $16.81 $135.20 $27.74 $16.87 $16.81 $98.02 $169.00 $24.37 $16.81 $13.25 $16.81 N/A N/A 30600208 EAP CPT® 87205 GRAM STAIN FOR GC BOTH IP/OP $65.00 $48.50 $2.14 $65.00 $4.59 $4.59 $4.59 $4.59 $4.27 $4.27 $2.14 $2.14 $4.27 $3.57 $3.57 $3.70 $2.60 $3.47 $6.83 $6.83 $38.45 $4.27 $4.27 $4.27 $65.00 $48.75 $4.27 $4.27 $4.27 $13.12 $13.12 $51.48 $4.27 $52.00 $7.05 $3.30 $4.27 $37.70 $65.00 $6.19 $4.27 $2.59 $4.27 N/A N/A 30600209 EAP CPT® 87206 KOH PREP BOTH IP/OP $158.00 $117.00 $2.70 $158.00 $10.57 $10.57 $10.57 $10.57 $5.39 $5.39 $2.70 $2.70 $5.39 $8.15 $8.15 $8.47 $5.95 $7.93 $8.62 $8.62 $93.46 $5.39 $5.39 $5.39 $158.00 $118.50 $5.39 $5.39 $5.39 $30.00 $30.00 $125.14 $5.39 $126.40 $8.89 $7.55 $5.39 $91.64 $158.00 $7.82 $5.39 $5.93 $5.39 N/A N/A 30600210 EAP CPT® 87210 VAGINAL WET PREP BOTH IP/OP $216.00 $160.00 $2.62 $216.00 $8.38 $8.38 $8.38 $8.38 $5.82 $5.82 $2.91 $2.62 $5.82 $6.48 $6.48 $6.73 $4.73 $6.30 $9.31 $9.31 $127.76 $5.82 $5.82 $5.82 $216.00 $162.00 $5.82 $5.82 $5.82 $23.84 $23.84 $171.07 $5.82 $172.80 $9.60 $6.00 $5.82 $125.28 $216.00 $8.44 $5.82 $4.71 $5.82 N/A N/A 30600211 EAP CPT® 87430 RAPID STREP BOTH IP/OP $162.00 $120.00 $7.56 $162.00 $23.52 $23.52 $23.52 $23.52 $16.81 $16.81 $8.41 $7.56 $16.81 $18.22 $18.22 $18.92 $13.30 $17.71 $26.90 $26.90 $95.82 $16.81 $16.81 $16.81 $162.00 $121.50 $16.81 $16.81 $16.81 $67.04 $67.04 $128.30 $16.81 $129.60 $27.74 $16.87 $16.81 $93.96 $162.00 $24.37 $16.81 $13.25 $16.81 N/A N/A 30600212 EAP CPT® 87205 GRAM STAIN BOTH IP/OP $61.00 $45.50 $2.14 $61.00 $4.59 $4.59 $4.59 $4.59 $4.27 $4.27 $2.14 $2.14 $4.27 $3.57 $3.57 $3.70 $2.60 $3.47 $6.83 $6.83 $36.08 $4.27 $4.27 $4.27 $61.00 $45.75 $4.27 $4.27 $4.27 $13.12 $13.12 $48.31 $4.27 $48.80 $7.05 $3.30 $4.27 $35.38 $61.00 $6.19 $4.27 $2.59 $4.27 N/A N/A 30600213 EAP CPT® 87188 MICROBE SUSCEPT MACROBROTH BOTH IP/OP $41.00 $30.50 $3.32 $41.00 $41.00 $41.00 $41.00 $41.00 $6.64 $6.64 $3.32 $41.00 $6.64 $10.08 $10.08 $10.47 $7.36 $9.80 $10.62 $10.62 $41.00 $6.64 $6.64 $6.64 $41.00 $30.75 $6.64 $6.64 $6.64 $37.08 $37.08 $32.47 $6.64 $32.80 $41.00 $41.00 $6.64 $23.78 $41.00 $9.63 $6.64 $41.00 $6.64 N/A N/A 30600215 EAP CPT® 87290 VARICELLA ZOSTER AG IF BOTH IP/OP $66.00 $49.00 $6.71 $66.00 $66.00 $66.00 $66.00 $66.00 $13.42 $13.42 $6.71 $66.00 $13.42 $18.22 $18.22 $18.92 $13.30 $17.71 $21.47 $21.47 $66.00 $13.42 $13.42 $13.42 $66.00 $49.50 $13.42 $13.42 $13.42 $66.00 $66.00 $52.27 $13.42 $52.80 $66.00 $66.00 $13.42 $38.28 $66.00 $19.46 $13.42 $66.00 $13.42 N/A N/A 30600216 EAP CPT® 87299 ANTIBODY DETECTION NOS IF BOTH IP/OP $83.00 $61.50 $8.05 $83.00 $83.00 $83.00 $83.00 $83.00 $16.10 $16.10 $8.05 $83.00 $16.10 $18.22 $18.22 $18.92 $13.30 $17.71 $25.76 $25.76 $83.00 $16.10 $16.10 $16.10 $83.00 $62.25 $16.10 $16.10 $16.10 $67.04 $67.04 $65.74 $16.10 $66.40 $83.00 $83.00 $16.10 $48.14 $83.00 $23.35 $16.10 $83.00 $16.10 N/A N/A 30600218 EAP CPT® 87015 PNEUMOCYCSTIS CARNI DFA-CONCEN BOTH IP/OP $91.00 $67.50 $3.34 $91.00 $13.10 $13.10 $13.10 $13.10 $6.68 $6.68 $3.34 $3.34 $6.68 $10.14 $10.14 $10.53 $7.40 $9.87 $10.69 $10.69 $53.83 $6.68 $6.68 $6.68 $91.00 $68.25 $6.68 $6.68 $6.68 $37.32 $37.32 $72.07 $6.68 $72.80 $11.02 $9.40 $6.68 $52.78 $91.00 $9.69 $6.68 $7.38 $6.68 N/A N/A 30600219 EAP CPT® 87281 PNEUMOCYCSTIS CARNI DFA-ID (Q) BOTH IP/OP $110.00 $81.50 $5.99 $110.00 $110.00 $110.00 $110.00 $110.00 $11.98 $11.98 $5.99 $110.00 $11.98 $18.22 $18.22 $18.92 $13.30 $17.71 $19.17 $19.17 $110.00 $11.98 $11.98 $11.98 $110.00 $82.50 $11.98 $11.98 $11.98 $67.04 $67.04 $87.12 $11.98 $88.00 $110.00 $110.00 $11.98 $63.80 $110.00 $17.37 $11.98 $110.00 $11.98 N/A N/A 30600220 EAP CPT® 87799 "TOXOPLASMA GONDII DNA , QUANT PCR (SO)" BOTH IP/OP $846.00 $626.50 $21.42 $846.00 $846.00 $846.00 $846.00 $846.00 $42.84 $42.84 $21.42 $846.00 $42.84 $65.04 $65.04 $67.54 $47.48 $176.32 $68.54 $68.54 $846.00 $42.84 $42.84 $42.84 $846.00 $634.50 $42.84 $42.84 $42.84 $239.40 $239.40 $670.03 $42.84 $676.80 $846.00 $846.00 $42.84 $490.68 $846.00 $62.12 $42.84 $846.00 $42.84 N/A N/A 30600221 EAP CPT® 87798 BORDETELLA PERTUSSIS/PARAPERTUSSIS QUAL/PCR(SO) BOTH IP/OP $547.00 $405.00 $17.55 $547.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $323.55 $35.09 $35.09 $35.09 $547.00 $410.25 $35.09 $35.09 $35.09 $109.64 $109.64 $433.22 $35.09 $437.60 $57.90 $27.60 $35.09 $317.26 $547.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30600222 EAP CPT® 87912 HEPATITIS B VIRUS DRUG RESISTANCE GENOTYPE BCP/PRECORE (SO) BOTH IP/OP $590.00 $437.00 $84.28 $590.00 $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $373.52 $373.52 $387.88 $272.66 $112.65 $411.92 $411.92 $348.99 $257.45 $257.45 $257.45 $590.00 $442.50 $257.45 $257.45 $257.45 $295.00 $295.00 $467.28 $257.45 $472.00 $424.79 $107.29 $257.45 $342.20 $590.00 $373.30 $257.45 $84.28 $257.45 N/A N/A 30600223 EAP CPT® 87902 "HEPATITIS C VIRAL GENOTYPE , LIPA (SO)" BOTH IP/OP $339.00 $251.00 $96.38 $424.79 $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $132.42 $132.42 $137.52 $96.67 $128.84 $411.92 $411.92 $200.52 $257.45 $257.45 $257.45 $339.00 $254.25 $257.45 $257.45 $257.45 $339.00 $339.00 $268.49 $257.45 $271.20 $424.79 $122.70 $257.45 $196.62 $339.00 $339.00 $257.45 $96.38 $257.45 N/A N/A 30600224 EAP CPT® 87661 "TRICHOMONAS VAGINALIS RNA, QUAL" BOTH IP/OP $253.00 $187.50 $17.55 $253.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $27.84 $27.84 $28.91 $20.32 $25.16 $56.14 $56.14 $149.65 $35.09 $35.09 $35.09 $253.00 $189.75 $35.09 $35.09 $35.09 $70.20 $70.20 $200.38 $35.09 $202.40 $57.90 $23.96 $35.09 $146.74 $253.00 $50.88 $35.09 $18.82 $35.09 N/A N/A 30600225 EAP CPT® 87493 "CLOSTRIDIUM DIFFICILE TOXIN, GENE ,PCR" BOTH IP/OP $288.00 $213.50 $17.55 $288.00 $38.50 $38.50 $38.50 $38.50 $37.27 $37.27 $18.64 $17.55 $37.27 $29.22 $29.22 $30.35 $21.33 $60.02 $59.63 $59.63 $170.35 $37.27 $37.27 $37.27 $288.00 $216.00 $37.27 $37.27 $37.27 $144.00 $144.00 $228.10 $37.27 $230.40 $61.50 $57.16 $37.27 $167.04 $288.00 $54.04 $37.27 $60.02 $37.27 N/A N/A 30600227 EAP CPT® 87632 RESPIRATORY PCR PANEL IV (SO) BOTH IP/OP "$3,460.00" "$2,560.50" $109.03 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $218.06 $218.06 $109.03 "$3,460.00" $218.06 $309.59 $309.59 $321.49 $226.00 $127.33 $348.90 $348.90 "$3,460.00" $218.06 $218.06 $218.06 "$3,460.00" "$2,595.00" $218.06 $218.06 $218.06 "$1,730.00" "$1,730.00" "$2,740.32" $218.06 "$2,768.00" "$3,460.00" "$3,460.00" $218.06 "$2,006.80" "$3,460.00" $316.19 $218.06 "$3,460.00" $218.06 N/A N/A 30600228 EAP CPT® 87530 HERPES SIM PCR QUANT (SO) BOTH IP/OP $331.00 $245.00 $21.42 $331.00 $331.00 $331.00 $331.00 $331.00 $42.84 $42.84 $21.42 $331.00 $42.84 $65.04 $65.04 $67.54 $47.48 $68.98 $68.54 $68.54 $331.00 $42.84 $42.84 $42.84 $331.00 $248.25 $42.84 $42.84 $42.84 $239.40 $239.40 $262.15 $42.84 $264.80 $331.00 $331.00 $42.84 $191.98 $331.00 $62.12 $42.84 $331.00 $42.84 N/A N/A 30630620 EAP CPT® 87798 JC POLYOMA QUANT AMP (SO) BOTH IP/OP $326.00 $241.50 $17.55 $326.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $192.83 $35.09 $35.09 $35.09 $326.00 $244.50 $35.09 $35.09 $35.09 $109.64 $109.64 $258.19 $35.09 $260.80 $57.90 $27.60 $35.09 $189.08 $326.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30630621 EAP CPT® 87799 JC POLYOMA QUANT PCR (SO) BOTH IP/OP $589.00 $436.00 $21.42 $589.00 $589.00 $589.00 $589.00 $589.00 $42.84 $42.84 $21.42 $589.00 $42.84 $65.04 $65.04 $67.54 $47.48 $122.75 $68.54 $68.54 $589.00 $42.84 $42.84 $42.84 $589.00 $441.75 $42.84 $42.84 $42.84 $239.40 $239.40 $466.49 $42.84 $471.20 $589.00 $589.00 $42.84 $341.62 $589.00 $62.12 $42.84 $589.00 $42.84 N/A N/A 30630622 EAP CPT® 87798 ASPERGILLUS DNA QUAL PCR (SO) BOTH IP/OP $326.00 $241.50 $17.55 $326.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $192.83 $35.09 $35.09 $35.09 $326.00 $244.50 $35.09 $35.09 $35.09 $109.64 $109.64 $258.19 $35.09 $260.80 $57.90 $27.60 $35.09 $189.08 $326.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30630623 EAP CPT® 87081 BRUCELLA SCREEN (SO) BOTH IP/OP $143.00 $106.00 $3.31 $143.00 $13.00 $13.00 $13.00 $13.00 $6.63 $6.63 $3.32 $3.31 $6.63 $10.08 $10.08 $10.47 $7.36 $9.79 $10.61 $10.61 $84.58 $6.63 $6.63 $6.63 $143.00 $107.25 $6.63 $6.63 $6.63 $37.04 $37.04 $113.26 $6.63 $114.40 $10.94 $9.32 $6.63 $82.94 $143.00 $9.61 $6.63 $7.32 $6.63 N/A N/A 30630624 EAP CPT® 87799 HERPES VIRUS 8 DNA PCR (SO) BOTH IP/OP $509.00 $377.00 $21.42 $509.00 $509.00 $509.00 $509.00 $509.00 $42.84 $42.84 $21.42 $509.00 $42.84 $65.04 $65.04 $67.54 $47.48 $106.08 $68.54 $68.54 $509.00 $42.84 $42.84 $42.84 $509.00 $381.75 $42.84 $42.84 $42.84 $239.40 $239.40 $403.13 $42.84 $407.20 $509.00 $509.00 $42.84 $295.22 $509.00 $62.12 $42.84 $509.00 $42.84 N/A N/A 30650009 EAP CPT® 87070 SPUTUM CULTURE BOTH IP/OP $371.00 $275.00 $4.31 $371.00 $16.92 $16.92 $16.92 $16.92 $8.62 $8.62 $4.31 $4.31 $8.62 $13.07 $13.07 $13.58 $9.54 $12.73 $13.79 $13.79 $219.45 $8.62 $8.62 $8.62 $371.00 $278.25 $8.62 $8.62 $8.62 $48.12 $48.12 $293.83 $8.62 $296.80 $14.22 $12.12 $8.62 $215.18 $371.00 $12.50 $8.62 $9.52 $8.62 N/A N/A 30650014 EAP CPT® 87077 CULTURE I.D.-AEROBE BIOCHEM BOTH IP/OP $261.00 $193.50 $4.04 $261.00 $15.86 $15.86 $15.86 $15.86 $8.08 $8.08 $4.04 $4.04 $8.08 $12.27 $12.27 $12.74 $8.96 $11.94 $12.93 $12.93 $154.38 $8.08 $8.08 $8.08 $261.00 $195.75 $8.08 $8.08 $8.08 $45.16 $45.16 $206.71 $8.08 $208.80 $13.33 $11.37 $8.08 $151.38 $261.00 $11.72 $8.08 $8.93 $8.08 N/A N/A 30650094 EAP CPT® 86757 RICHETTSIA ANTIBODY IGG BOTH IP/OP $48.00 $36.00 $9.68 $48.00 $48.00 $48.00 $48.00 $48.00 $19.35 $19.35 $9.68 $48.00 $19.35 $29.39 $29.39 $30.52 $21.45 $28.60 $30.96 $30.96 $48.00 $19.35 $19.35 $19.35 $48.00 $36.00 $19.35 $19.35 $19.35 $48.00 $48.00 $38.02 $19.35 $38.40 $48.00 $48.00 $19.35 $27.84 $48.00 $28.06 $19.35 $48.00 $19.35 N/A N/A 30650206 EAP CPT® 87210 TRICHOMONAS PREP BOTH IP/OP $204.00 $151.00 $2.62 $204.00 $8.38 $8.38 $8.38 $8.38 $5.82 $5.82 $2.91 $2.62 $5.82 $6.48 $6.48 $6.73 $4.73 $6.30 $9.31 $9.31 $120.67 $5.82 $5.82 $5.82 $204.00 $153.00 $5.82 $5.82 $5.82 $23.84 $23.84 $161.57 $5.82 $163.20 $9.60 $6.00 $5.82 $118.32 $204.00 $8.44 $5.82 $4.71 $5.82 N/A N/A 30650311 EAP CPT® 87530 HSV DNA QUANT BOTH IP/OP $445.00 $329.50 $21.42 $445.00 $445.00 $445.00 $445.00 $445.00 $42.84 $42.84 $21.42 $445.00 $42.84 $65.04 $65.04 $67.54 $47.48 $92.74 $68.54 $68.54 $445.00 $42.84 $42.84 $42.84 $445.00 $333.75 $42.84 $42.84 $42.84 $239.40 $239.40 $352.44 $42.84 $356.00 $445.00 $445.00 $42.84 $258.10 $445.00 $62.12 $42.84 $445.00 $42.84 N/A N/A 30650312 EAP CPT® 87798 "T.PALLIDUM PCR QL,CSF Q" BOTH IP/OP $401.00 $297.00 $17.55 $401.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $237.19 $35.09 $35.09 $35.09 $401.00 $300.75 $35.09 $35.09 $35.09 $109.64 $109.64 $317.59 $35.09 $320.80 $57.90 $27.60 $35.09 $232.58 $401.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30650313 EAP CPT® 87624 PAPILLOMAVIRUS HUMAN BOTH IP/OP $90.00 $67.00 $16.04 $90.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $27.77 $27.77 $28.84 $20.27 $21.44 $56.14 $56.14 $53.24 $35.09 $35.09 $35.09 $90.00 $67.50 $35.09 $35.09 $35.09 $45.00 $45.00 $71.28 $35.09 $72.00 $57.90 $20.42 $35.09 $52.20 $90.00 $50.88 $35.09 $16.04 $35.09 N/A N/A 30650315 EAP CPT® 87798 EHRLICHIA CHAFF PCR (SO) BOTH IP/OP $373.00 $276.50 $17.55 $373.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $220.63 $35.09 $35.09 $35.09 $373.00 $279.75 $35.09 $35.09 $35.09 $109.64 $109.64 $295.42 $35.09 $298.40 $57.90 $27.60 $35.09 $216.34 $373.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30650316 EAP CPT® 87529 HSV PCR QUAL AMINO (SO) BOTH IP/OP $340.00 $252.00 $17.55 $340.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $201.11 $35.09 $35.09 $35.09 $340.00 $255.00 $35.09 $35.09 $35.09 $109.64 $109.64 $269.28 $35.09 $272.00 $57.90 $27.60 $35.09 $197.20 $340.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30650317 EAP CPT® 87900 HCV NS3/4 PHENO (SO) BOTH IP/OP "$1,201.00" $889.00 $65.18 "$1,201.00" "$1,201.00" "$1,201.00" "$1,201.00" "$1,201.00" $130.35 $130.35 $65.18 "$1,201.00" $130.35 $167.86 $167.86 $174.31 $122.53 $163.30 $208.56 $208.56 "$1,201.00" $130.35 $130.35 $130.35 "$1,201.00" $900.75 $130.35 $130.35 $130.35 $617.80 $617.80 $951.19 $130.35 $960.80 "$1,201.00" "$1,201.00" $130.35 $696.58 "$1,201.00" $189.01 $130.35 "$1,201.00" $130.35 N/A N/A 30650318 EAP CPT® 87902 HCV NS3/4 GENO (SO) BOTH IP/OP "$1,193.00" $883.00 $96.38 "$1,193.00" $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $132.42 $132.42 $137.52 $96.67 $128.84 $411.92 $411.92 $705.66 $257.45 $257.45 $257.45 "$1,193.00" $894.75 $257.45 $257.45 $257.45 $487.40 $487.40 $944.86 $257.45 $954.40 $424.79 $122.70 $257.45 $691.94 "$1,193.00" $373.30 $257.45 $96.38 $257.45 N/A N/A 30650319 EAP CPT® 87798 JC POLY QUAL PCR (SO) BOTH IP/OP $445.00 $329.50 $17.55 $445.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $263.22 $35.09 $35.09 $35.09 $445.00 $333.75 $35.09 $35.09 $35.09 $109.64 $109.64 $352.44 $35.09 $356.00 $57.90 $27.60 $35.09 $258.10 $445.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30650320 EAP CPT® 87906 HIV CORECEPTOR TROPISM ULTRA (SO) BOTH IP/OP $973.00 $720.50 $43.14 $973.00 $85.59 $85.59 $85.59 $85.59 $128.73 $128.73 $64.37 $64.36 $128.73 $63.81 $63.81 $66.27 $46.58 $57.67 $205.97 $205.97 $575.53 $128.73 $128.73 $128.73 $973.00 $729.75 $128.73 $128.73 $128.73 $486.50 $486.50 $770.62 $128.73 $778.40 $212.40 $54.92 $128.73 $564.34 $973.00 $186.66 $128.73 $43.14 $128.73 N/A N/A 30650321 EAP CPT® 87902 HCV RNA NS5A DRUG (SO) BOTH IP/OP "$1,270.00" $940.00 $96.38 "$1,270.00" $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $132.42 $132.42 $137.52 $96.67 $128.84 $411.92 $411.92 $751.21 $257.45 $257.45 $257.45 "$1,270.00" $952.50 $257.45 $257.45 $257.45 $487.40 $487.40 "$1,005.84" $257.45 "$1,016.00" $424.79 $122.70 $257.45 $736.60 "$1,270.00" $373.30 $257.45 $96.38 $257.45 N/A N/A 30650322 EAP CPT® 87902 HCV RNA NS5B RESIST (SO) BOTH IP/OP "$1,193.00" $883.00 $96.38 "$1,193.00" $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $132.42 $132.42 $137.52 $96.67 $128.84 $411.92 $411.92 $705.66 $257.45 $257.45 $257.45 "$1,193.00" $894.75 $257.45 $257.45 $257.45 $487.40 $487.40 $944.86 $257.45 $954.40 $424.79 $122.70 $257.45 $691.94 "$1,193.00" $373.30 $257.45 $96.38 $257.45 N/A N/A 30650323 EAP CPT® 87632 RESP VIRUS PCR IV (6-11) (SO) BOTH IP/OP "$3,561.00" "$2,635.50" $109.03 "$3,561.00" "$3,561.00" "$3,561.00" "$3,561.00" "$3,561.00" $218.06 $218.06 $109.03 "$3,561.00" $218.06 $309.59 $309.59 $321.49 $226.00 $127.33 $348.90 $348.90 "$3,561.00" $218.06 $218.06 $218.06 "$3,561.00" "$2,670.75" $218.06 $218.06 $218.06 "$1,780.50" "$1,780.50" "$2,820.31" $218.06 "$2,848.80" "$3,561.00" "$3,561.00" $218.06 "$2,065.38" "$3,561.00" $316.19 $218.06 "$3,561.00" $218.06 N/A N/A 30650324 EAP CPT® 87530 HSV DNA PCR QUANT (SO) BOTH IP/OP $327.00 $242.00 $21.42 $327.00 $327.00 $327.00 $327.00 $327.00 $42.84 $42.84 $21.42 $327.00 $42.84 $65.04 $65.04 $67.54 $47.48 $68.15 $68.54 $68.54 $327.00 $42.84 $42.84 $42.84 $327.00 $245.25 $42.84 $42.84 $42.84 $239.40 $239.40 $258.98 $42.84 $261.60 $327.00 $327.00 $42.84 $189.66 $327.00 $62.12 $42.84 $327.00 $42.84 N/A N/A 30650325 EAP CPT® 87902 HCV NS5A DRUG RESIST (SO) BOTH IP/OP $747.00 $553.00 $96.38 $747.00 $171.16 $171.16 $171.16 $171.16 $257.45 $257.45 $128.73 $128.72 $257.45 $132.42 $132.42 $137.52 $96.67 $128.84 $411.92 $411.92 $441.85 $257.45 $257.45 $257.45 $747.00 $560.25 $257.45 $257.45 $257.45 $487.40 $487.40 $591.62 $257.45 $597.60 $424.79 $122.70 $257.45 $433.26 $747.00 $373.30 $257.45 $96.38 $257.45 N/A N/A 30650326 EAP CPT® 87625 HPV GENOTYPING BOTH IP/OP $245.00 $181.50 $20.27 $245.00 $245.00 $245.00 $245.00 $245.00 $40.55 $40.55 $20.28 $245.00 $40.55 $27.77 $27.77 $28.84 $20.27 $21.44 $64.88 $64.88 $245.00 $40.55 $40.55 $40.55 $245.00 $183.75 $40.55 $40.55 $40.55 $122.50 $122.50 $194.04 $40.55 $196.00 $245.00 $245.00 $40.55 $142.10 $245.00 $58.80 $40.55 $245.00 $40.55 N/A N/A 30650330 EAP CPT® 87015 CYCLOSPORA & ISOSPORA CONCENTRATION (SO) BOTH IP/OP $77.00 $57.00 $3.34 $77.00 $13.10 $13.10 $13.10 $13.10 $6.68 $6.68 $3.34 $3.34 $6.68 $10.14 $10.14 $10.53 $7.40 $9.87 $10.69 $10.69 $45.55 $6.68 $6.68 $6.68 $77.00 $57.75 $6.68 $6.68 $6.68 $37.32 $37.32 $60.98 $6.68 $61.60 $11.02 $9.40 $6.68 $44.66 $77.00 $9.69 $6.68 $7.38 $6.68 N/A N/A 30650331 EAP CPT® 87207 CYCLOSPORA & ISOSPORA STAIN (SO) BOTH IP/OP $72.00 $53.50 $3.00 $72.00 $72.00 $72.00 $72.00 $72.00 $5.99 $5.99 $3.00 $72.00 $5.99 $9.10 $9.10 $9.45 $6.64 $8.84 $9.58 $9.58 $72.00 $5.99 $5.99 $5.99 $72.00 $54.00 $5.99 $5.99 $5.99 $33.48 $33.48 $57.02 $5.99 $57.60 $72.00 $72.00 $5.99 $41.76 $72.00 $8.69 $5.99 $72.00 $5.99 N/A N/A 30650340 EAP CPT® 87635 COVID-19 LAB TEST NON-CDC BOTH IP/OP $242.00 $179.50 $51.31 $242.00 $128.79 $128.79 $128.79 $128.79 $75.00 $75.00 $75.00 $57.41 $75.00 $114.60 $114.60 $114.60 $114.60 $60.28 $120.00 $120.00 $143.14 $75.00 $75.00 $75.00 $78.75 $181.50 $75.00 $75.00 $75.00 $205.32 $205.32 $191.66 $75.00 $193.60 $123.75 $57.41 $75.00 $140.36 $78.75 $242.00 $51.31 $57.41 $75.00 N/A N/A 30650350 EAP CPT® 87633 RESPIRATORY VIRUS PANEL 12-25 TARGETS BOTH IP/OP "$1,033.00" $764.50 $170.41 "$1,033.00" $346.05 $346.05 $346.05 $346.05 $416.78 $416.78 $208.39 $208.39 $416.78 $535.13 $535.13 $555.71 $390.64 $227.79 $666.85 $666.85 $611.02 $416.78 $416.78 $416.78 "$1,033.00" $774.75 $416.78 $416.78 $416.78 $516.50 $516.50 $818.14 $416.78 $826.40 $687.69 $216.94 $416.78 $599.14 "$1,033.00" $604.33 $416.78 $170.41 $416.78 N/A N/A 30650351 EAP CPT® 87798 BORDETELLA PERTUSSIS BOTH IP/OP $87.00 $64.50 $17.55 $87.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $51.46 $35.09 $35.09 $35.09 $87.00 $65.25 $35.09 $35.09 $35.09 $87.00 $87.00 $68.90 $35.09 $69.60 $57.90 $27.60 $35.09 $50.46 $87.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30650352 EAP CPT® 87486 CHLAMYDOPHILA/CHLAMYDIA PNEUMONIAE BOTH IP/OP $97.00 $72.00 $17.55 $97.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $57.38 $35.09 $35.09 $35.09 $97.00 $72.75 $35.09 $35.09 $35.09 $97.00 $97.00 $76.82 $35.09 $77.60 $57.90 $27.60 $35.09 $56.26 $97.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30650353 EAP CPT® 87581 MYCOPLASMA PNEUMONIAE BOTH IP/OP $91.00 $67.50 $17.55 $91.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $53.83 $35.09 $35.09 $35.09 $91.00 $68.25 $35.09 $35.09 $35.09 $91.00 $91.00 $72.07 $35.09 $72.80 $57.90 $27.60 $35.09 $52.78 $91.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30650354 EAP CPT® 87798 BORDETELLA PARAPERTUSSIS BOTH IP/OP $87.00 $64.50 $17.55 $87.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $51.46 $35.09 $35.09 $35.09 $87.00 $65.25 $35.09 $35.09 $35.09 $87.00 $87.00 $68.90 $35.09 $69.60 $57.90 $27.60 $35.09 $50.46 $87.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30650355 EAP CPT® 87498 DETECTION ENTEROVIRUS (EV) AMPLIFIED PROBE TQ BOTH IP/OP $91.00 $67.50 $17.55 $91.00 $91.00 $91.00 $91.00 $91.00 $35.09 $35.09 $17.55 $91.00 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $91.00 $35.09 $35.09 $35.09 $91.00 $68.25 $35.09 $35.09 $35.09 $91.00 $91.00 $72.07 $35.09 $72.80 $91.00 $91.00 $35.09 $52.78 $91.00 $50.88 $35.09 $91.00 $35.09 N/A N/A 30650356 EAP CPT® 87798 DETECTION HUMAN PARECHOVIRUS (HPEV) AMPLIFIED PROBE TQ BOTH IP/OP $87.00 $64.50 $17.55 $87.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $51.46 $35.09 $35.09 $35.09 $87.00 $65.25 $35.09 $35.09 $35.09 $87.00 $87.00 $68.90 $35.09 $69.60 $57.90 $27.60 $35.09 $50.46 $87.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30650357 EAP CPT® 87798 DETECTION VARICELLA ZOSTER (VZV) AMPLIFIED PROBE TQ BOTH IP/OP $87.00 $64.50 $17.55 $87.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $51.46 $35.09 $35.09 $35.09 $87.00 $65.25 $35.09 $35.09 $35.09 $87.00 $87.00 $68.90 $35.09 $69.60 $57.90 $27.60 $35.09 $50.46 $87.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30650360 EAP CPT® 87483 BIOFIRE® FILMARRAY® MENINGITIS/ENCEPHALITIS (ME) PANEL BOTH IP/OP "$1,032.00" $764.00 $170.05 "$1,032.00" $346.05 $346.05 $346.05 $346.05 $416.78 $416.78 $208.39 $208.39 $416.78 $251.56 $251.56 $261.23 $183.63 $227.31 $666.85 $666.85 $610.43 $416.78 $416.78 $416.78 "$1,032.00" $774.00 $416.78 $416.78 $416.78 $516.00 $516.00 $817.34 $416.78 $825.60 $687.69 $216.49 $416.78 $598.56 "$1,032.00" $604.33 $416.78 $170.05 $416.78 N/A N/A 30650371 EAP CPT® 87426 SARSCOV CORONAVIRUS AG IA BOTH IP/OP $89.00 $66.00 $22.62 $107.87 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $22.62 $40.48 $89.00 $89.00 $89.00 $89.00 $89.00 $42.51 $89.00 $89.00 $52.64 $89.00 $89.00 $89.00 $37.99 $66.75 $89.00 $89.00 $89.00 $44.50 $44.50 $70.49 $89.00 $71.20 $107.87 $40.48 $89.00 $51.62 $37.99 $89.00 $89.00 $40.48 $89.00 N/A N/A 30650372 EAP CPT® 87807 "RESPIRATORY SYNCYTIAL VIRUS (RSV), IMMUNOASSAY (SO)" BOTH IP/OP $121.00 $90.00 $5.99 $121.00 $23.52 $23.52 $23.52 $23.52 $13.10 $13.10 $6.55 $5.99 $13.10 $18.22 $18.22 $18.92 $13.30 $17.71 $20.96 $20.96 $71.57 $13.10 $13.10 $13.10 $121.00 $90.75 $13.10 $13.10 $13.10 $67.04 $67.04 $95.83 $13.10 $96.80 $21.62 $16.87 $13.10 $70.18 $121.00 $19.00 $13.10 $13.25 $13.10 N/A N/A 30650373 EAP CPT® 87637 IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ BOTH IP/OP $357.00 $264.50 $71.32 $368.11 $357.00 $357.00 $357.00 $357.00 $142.63 $142.63 $71.32 $159.57 $142.63 $258.38 $258.38 $368.11 $258.38 $167.57 $228.21 $228.21 $211.17 $142.63 $142.63 $142.63 $149.76 $267.75 $142.63 $142.63 $142.63 $178.50 $178.50 $282.74 $142.63 $285.60 $245.95 $159.57 $142.63 $207.06 $149.76 $357.00 $142.63 $159.57 $142.63 N/A N/A 30650374 EAP CPT® 87634 IADNA DNA/RNA RSV AMPLIFIED PROBE TECHNIQUE BOTH IP/OP $260.00 $192.50 $35.10 $260.00 $260.00 $260.00 $260.00 $260.00 $70.20 $70.20 $35.10 $260.00 $70.20 $90.13 $90.13 $93.59 $65.79 $81.45 $112.32 $112.32 $260.00 $70.20 $70.20 $70.20 $260.00 $195.00 $70.20 $70.20 $70.20 $130.00 $130.00 $205.92 $70.20 $208.00 $260.00 $260.00 $70.20 $150.80 $260.00 $101.79 $70.20 $260.00 $70.20 N/A N/A 30650380 EAP CPT® 87150 EPLEX BLOOD CULTURE ID (GRAM-NEG) EA ISOLATE BOTH IP/OP $44.00 $33.00 $9.17 $56.14 $44.00 $44.00 $44.00 $44.00 $35.09 $35.09 $17.55 $44.00 $35.09 $29.22 $29.22 $30.35 $21.33 $9.17 $56.14 $56.14 $44.00 $35.09 $35.09 $35.09 $44.00 $33.00 $35.09 $35.09 $35.09 $22.00 $22.00 $34.85 $35.09 $35.20 $44.00 $44.00 $35.09 $25.52 $44.00 $44.00 $35.09 $44.00 $35.09 N/A N/A 30650381 EAP CPT® 87150 EPLEX BLOOD CULTURE ID (GRAM-POS) EA ISOLATE BOTH IP/OP $39.00 $29.00 $8.13 $56.14 $39.00 $39.00 $39.00 $39.00 $35.09 $35.09 $17.55 $39.00 $35.09 $29.22 $29.22 $30.35 $21.33 $8.13 $56.14 $56.14 $39.00 $35.09 $35.09 $35.09 $39.00 $29.25 $35.09 $35.09 $35.09 $19.50 $19.50 $30.89 $35.09 $31.20 $39.00 $39.00 $35.09 $22.62 $39.00 $39.00 $35.09 $39.00 $35.09 N/A N/A 30650382 EAP CPT® 87150 EPLEX BLOOD CULTURE ID (FUNGAL-PATHOGEN) EA ISOLATE BOTH IP/OP $70.00 $52.00 $14.59 $70.00 $70.00 $70.00 $70.00 $70.00 $35.09 $35.09 $17.55 $70.00 $35.09 $29.22 $29.22 $30.35 $21.33 $14.59 $56.14 $56.14 $70.00 $35.09 $35.09 $35.09 $70.00 $52.50 $35.09 $35.09 $35.09 $35.00 $35.00 $55.44 $35.09 $56.00 $70.00 $70.00 $35.09 $40.60 $70.00 $50.88 $35.09 $70.00 $35.09 N/A N/A 30650383 EAP CPT® 87798 "MONKEYPOX VIRUS DNA, QUALITATIVE REAL-TIME PCR PART 1 (SO-QUEST)" BOTH IP/OP $125.00 $92.50 $17.55 $125.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $73.94 $35.09 $35.09 $35.09 $125.00 $93.75 $35.09 $35.09 $35.09 $109.64 $109.64 $99.00 $35.09 $100.00 $57.90 $27.60 $35.09 $72.50 $125.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30650384 EAP CPT® 87798 "MONKEYPOX VIRUS DNA, QUALITATIVE REAL-TIME PCR PART 2 (SO-QUEST)" BOTH IP/OP $125.00 $92.50 $17.55 $125.00 $38.50 $38.50 $38.50 $38.50 $35.09 $35.09 $17.55 $17.55 $35.09 $29.79 $29.79 $30.93 $21.74 $28.98 $56.14 $56.14 $73.94 $35.09 $35.09 $35.09 $125.00 $93.75 $35.09 $35.09 $35.09 $109.64 $109.64 $99.00 $35.09 $100.00 $57.90 $27.60 $35.09 $72.50 $125.00 $50.88 $35.09 $21.68 $35.09 N/A N/A 30700001 EAP CPT® 81000 "PH, URINE-DIPSTICK" BOTH IP/OP $103.00 $76.50 $1.81 $103.00 $6.22 $6.22 $6.22 $6.22 $4.02 $4.02 $2.01 $1.81 $4.02 $4.82 $4.82 $5.00 $3.52 $4.68 $6.43 $6.43 $60.92 $4.02 $4.02 $4.02 $103.00 $77.25 $4.02 $4.02 $4.02 $17.72 $17.72 $81.58 $4.02 $82.40 $6.63 $4.46 $4.02 $59.74 $103.00 $5.83 $4.02 $3.50 $4.02 N/A N/A 30700002 EAP CPT® 85025 "CBC, PLAT, WBCDIFF, EVD" BOTH IP/OP $212.00 $157.00 $3.88 $212.00 $15.26 $15.26 $15.26 $15.26 $7.77 $7.77 $3.89 $3.88 $7.77 $9.97 $9.97 $10.36 $7.28 $11.48 $12.43 $12.43 $125.40 $7.77 $7.77 $7.77 $212.00 $159.00 $7.77 $7.77 $7.77 $43.44 $43.44 $167.90 $7.77 $169.60 $12.82 $10.93 $7.77 $122.96 $212.00 $11.27 $7.77 $8.59 $7.77 N/A N/A 30700004 EAP CPT® 81002 URINE DIP STICK BOTH IP/OP $103.00 $76.50 $1.74 $103.00 $103.00 $103.00 $103.00 $103.00 $3.48 $3.48 $1.74 $103.00 $3.48 $3.89 $3.89 $4.04 $2.84 $3.77 $5.57 $5.57 $103.00 $3.48 $3.48 $3.48 $103.00 $77.25 $3.48 $3.48 $3.48 $14.28 $14.28 $81.58 $3.48 $82.40 $103.00 $103.00 $3.48 $59.74 $103.00 $5.05 $3.48 $103.00 $3.48 N/A N/A 30700007 EAP CPT® 81001 URINALYSIS COMPLETE BOTH IP/OP $192.00 $142.50 $1.58 $192.00 $6.22 $6.22 $6.22 $6.22 $3.17 $3.17 $1.59 $1.58 $3.17 $4.82 $4.82 $5.00 $3.52 $4.68 $5.07 $5.07 $113.57 $3.17 $3.17 $3.17 $192.00 $144.00 $3.17 $3.17 $3.17 $6.36 $6.36 $152.06 $3.17 $153.60 $5.23 $4.46 $3.17 $111.36 $192.00 $4.60 $3.17 $3.50 $3.17 N/A N/A 30700019 EAP CPT® 81003 URINALYSIS BOTH IP/OP $157.00 $116.50 $1.12 $157.00 $4.42 $4.42 $4.42 $4.42 $2.25 $2.25 $1.13 $1.12 $2.25 $3.41 $3.41 $3.54 $2.49 $3.33 $3.60 $3.60 $92.87 $2.25 $2.25 $2.25 $157.00 $117.75 $2.25 $2.25 $2.25 $12.56 $12.56 $124.34 $2.25 $125.60 $3.71 $3.17 $2.25 $91.06 $157.00 $3.26 $2.25 $2.49 $2.25 N/A N/A 30700027 EAP CPT® 81005 "PH, URINE(QUANT)" BOTH IP/OP $108.00 $80.00 $1.08 $108.00 $4.24 $4.24 $4.24 $4.24 $2.17 $2.17 $1.09 $1.08 $2.17 $3.29 $3.29 $3.41 $2.40 $3.20 $3.47 $3.47 $63.88 $2.17 $2.17 $2.17 $108.00 $81.00 $2.17 $2.17 $2.17 $12.12 $12.12 $85.54 $2.17 $86.40 $3.58 $3.05 $2.17 $62.64 $108.00 $3.15 $2.17 $2.40 $2.17 N/A N/A 30700035 EAP CPT® 81015 URINALYSIS-MICRO ONLY BOTH IP/OP $180.00 $133.50 $1.53 $180.00 $180.00 $180.00 $180.00 $180.00 $3.05 $3.05 $1.53 $180.00 $3.05 $4.61 $4.61 $4.78 $3.36 $4.48 $4.88 $4.88 $180.00 $3.05 $3.05 $3.05 $180.00 $135.00 $3.05 $3.05 $3.05 $16.96 $16.96 $142.56 $3.05 $144.00 $180.00 $180.00 $3.05 $104.40 $180.00 $4.42 $3.05 $180.00 $3.05 N/A N/A 30700041 EAP CPT® 81025 PREGNANCY TEST-URINE BOTH IP/OP $33.00 $24.50 $3.87 $33.00 $12.40 $12.40 $12.40 $12.40 $8.61 $8.61 $4.31 $3.87 $8.61 $9.61 $9.61 $9.98 $7.01 $9.36 $13.78 $13.78 $19.52 $8.61 $8.61 $8.61 $33.00 $24.75 $8.61 $8.61 $8.61 $33.00 $33.00 $26.14 $8.61 $26.40 $14.21 $8.91 $8.61 $19.14 $33.00 $12.48 $8.61 $7.00 $8.61 N/A N/A 30700042 EAP CPT® 81050 "URINE, TIMED COLLECT" BOTH IP/OP $129.00 $95.50 $1.64 $129.00 $5.90 $5.90 $5.90 $5.90 $3.64 $3.64 $1.82 $1.64 $3.64 $4.54 $4.54 $4.72 $3.32 $4.43 $5.82 $5.82 $76.30 $3.64 $3.64 $3.64 $129.00 $96.75 $3.64 $3.64 $3.64 $16.76 $16.76 $102.17 $3.64 $103.20 $6.01 $4.22 $3.64 $74.82 $129.00 $5.28 $3.64 $3.31 $3.64 N/A N/A 30700050 EAP CPT® 81003 URINALYSIS-BIOCHEM BOTH IP/OP $157.00 $116.50 $1.12 $157.00 $4.42 $4.42 $4.42 $4.42 $2.25 $2.25 $1.13 $1.12 $2.25 $3.41 $3.41 $3.54 $2.49 $3.33 $3.60 $3.60 $92.87 $2.25 $2.25 $2.25 $157.00 $117.75 $2.25 $2.25 $2.25 $12.56 $12.56 $124.34 $2.25 $125.60 $3.71 $3.17 $2.25 $91.06 $157.00 $3.26 $2.25 $2.49 $2.25 N/A N/A 30700080 EAP CPT® 81000 "PH, URINE-DIPSTICK" BOTH IP/OP $119.00 $88.50 $1.81 $119.00 $6.22 $6.22 $6.22 $6.22 $4.02 $4.02 $2.01 $1.81 $4.02 $4.82 $4.82 $5.00 $3.52 $4.68 $6.43 $6.43 $70.39 $4.02 $4.02 $4.02 $119.00 $89.25 $4.02 $4.02 $4.02 $17.72 $17.72 $94.25 $4.02 $95.20 $6.63 $4.46 $4.02 $69.02 $119.00 $5.83 $4.02 $3.50 $4.02 N/A N/A 30700081 EAP CPT® 81001 URINALYSIS WITH MICROSCOPY BOTH IP/OP $222.00 $164.50 $1.58 $222.00 $6.22 $6.22 $6.22 $6.22 $3.17 $3.17 $1.59 $1.58 $3.17 $4.82 $4.82 $5.00 $3.52 $4.68 $5.07 $5.07 $131.31 $3.17 $3.17 $3.17 $222.00 $166.50 $3.17 $3.17 $3.17 $6.36 $6.36 $175.82 $3.17 $177.60 $5.23 $4.46 $3.17 $128.76 $222.00 $4.60 $3.17 $3.50 $3.17 N/A N/A 30700082 EAP CPT® 81003 URINALYSIS BOTH IP/OP $182.00 $135.00 $1.12 $182.00 $4.42 $4.42 $4.42 $4.42 $2.25 $2.25 $1.13 $1.12 $2.25 $3.41 $3.41 $3.54 $2.49 $3.33 $3.60 $3.60 $107.65 $2.25 $2.25 $2.25 $182.00 $136.50 $2.25 $2.25 $2.25 $12.56 $12.56 $144.14 $2.25 $145.60 $3.71 $3.17 $2.25 $105.56 $182.00 $3.26 $2.25 $2.49 $2.25 N/A N/A 30700083 EAP CPT® 81003 "URINALYSIS, TOP" BOTH IP/OP $182.00 $135.00 $1.12 $182.00 $4.42 $4.42 $4.42 $4.42 $2.25 $2.25 $1.13 $1.12 $2.25 $3.41 $3.41 $3.54 $2.49 $3.33 $3.60 $3.60 $107.65 $2.25 $2.25 $2.25 $182.00 $136.50 $2.25 $2.25 $2.25 $12.56 $12.56 $144.14 $2.25 $145.60 $3.71 $3.17 $2.25 $105.56 $182.00 $3.26 $2.25 $2.49 $2.25 N/A N/A 30700084 EAP CPT® 81025 PREGNANCY TEST-URINE BOTH IP/OP $38.00 $28.50 $3.87 $38.00 $12.40 $12.40 $12.40 $12.40 $8.61 $8.61 $4.31 $3.87 $8.61 $9.61 $9.61 $9.98 $7.01 $9.36 $13.78 $13.78 $22.48 $8.61 $8.61 $8.61 $38.00 $28.50 $8.61 $8.61 $8.61 $35.36 $35.36 $30.10 $8.61 $30.40 $14.21 $8.91 $8.61 $22.04 $38.00 $12.48 $8.61 $7.00 $8.61 N/A N/A 30700085 EAP CPT® 81025 "PREG TEST,URINE" BOTH IP/OP $38.00 $28.50 $3.87 $38.00 $12.40 $12.40 $12.40 $12.40 $8.61 $8.61 $4.31 $3.87 $8.61 $9.61 $9.61 $9.98 $7.01 $9.36 $13.78 $13.78 $22.48 $8.61 $8.61 $8.61 $38.00 $28.50 $8.61 $8.61 $8.61 $35.36 $35.36 $30.10 $8.61 $30.40 $14.21 $8.91 $8.61 $22.04 $38.00 $12.48 $8.61 $7.00 $8.61 N/A N/A 30700086 EAP CPT® 81050 "URINE, TIMED COLLECT" BOTH IP/OP $117.00 $87.00 $1.64 $117.00 $5.90 $5.90 $5.90 $5.90 $3.64 $3.64 $1.82 $1.64 $3.64 $4.54 $4.54 $4.72 $3.32 $4.43 $5.82 $5.82 $69.21 $3.64 $3.64 $3.64 $117.00 $87.75 $3.64 $3.64 $3.64 $16.76 $16.76 $92.66 $3.64 $93.60 $6.01 $4.22 $3.64 $67.86 $117.00 $5.28 $3.64 $3.31 $3.64 N/A N/A 30700090 EAP CPT® 81000 "UROBILINOGEN, QUALITATIV" BOTH IP/OP $103.00 $76.50 $1.81 $103.00 $6.22 $6.22 $6.22 $6.22 $4.02 $4.02 $2.01 $1.81 $4.02 $4.82 $4.82 $5.00 $3.52 $4.68 $6.43 $6.43 $60.92 $4.02 $4.02 $4.02 $103.00 $77.25 $4.02 $4.02 $4.02 $17.72 $17.72 $81.58 $4.02 $82.40 $6.63 $4.46 $4.02 $59.74 $103.00 $5.83 $4.02 $3.50 $4.02 N/A N/A 30700091 EAP CPT® 81001 URINALYSIS COMP BOTH IP/OP $192.00 $142.50 $1.58 $192.00 $6.22 $6.22 $6.22 $6.22 $3.17 $3.17 $1.59 $1.58 $3.17 $4.82 $4.82 $5.00 $3.52 $4.68 $5.07 $5.07 $113.57 $3.17 $3.17 $3.17 $192.00 $144.00 $3.17 $3.17 $3.17 $6.36 $6.36 $152.06 $3.17 $153.60 $5.23 $4.46 $3.17 $111.36 $192.00 $4.60 $3.17 $3.50 $3.17 N/A N/A 30700092 EAP CPT® 81003 URINALYSIS-BIOCHEM BOTH IP/OP $157.00 $116.50 $1.12 $157.00 $4.42 $4.42 $4.42 $4.42 $2.25 $2.25 $1.13 $1.12 $2.25 $3.41 $3.41 $3.54 $2.49 $3.33 $3.60 $3.60 $92.87 $2.25 $2.25 $2.25 $157.00 $117.75 $2.25 $2.25 $2.25 $12.56 $12.56 $124.34 $2.25 $125.60 $3.71 $3.17 $2.25 $91.06 $157.00 $3.26 $2.25 $2.49 $2.25 N/A N/A 30700093 EAP CPT® 81025 URINE PREGNANCY TEST BOTH IP/OP $33.00 $24.50 $3.87 $33.00 $12.40 $12.40 $12.40 $12.40 $8.61 $8.61 $4.31 $3.87 $8.61 $9.61 $9.61 $9.98 $7.01 $9.36 $13.78 $13.78 $19.52 $8.61 $8.61 $8.61 $33.00 $24.75 $8.61 $8.61 $8.61 $33.00 $33.00 $26.14 $8.61 $26.40 $14.21 $8.91 $8.61 $19.14 $33.00 $12.48 $8.61 $7.00 $8.61 N/A N/A 30700094 EAP CPT® 81000 "SUGAR, CLINITEST" BOTH IP/OP $103.00 $76.50 $1.81 $103.00 $6.22 $6.22 $6.22 $6.22 $4.02 $4.02 $2.01 $1.81 $4.02 $4.82 $4.82 $5.00 $3.52 $4.68 $6.43 $6.43 $60.92 $4.02 $4.02 $4.02 $103.00 $77.25 $4.02 $4.02 $4.02 $17.72 $17.72 $81.58 $4.02 $82.40 $6.63 $4.46 $4.02 $59.74 $103.00 $5.83 $4.02 $3.50 $4.02 N/A N/A 30700095 EAP CPT® 81000 "BILE, URINE" BOTH IP/OP $103.00 $76.50 $1.81 $103.00 $6.22 $6.22 $6.22 $6.22 $4.02 $4.02 $2.01 $1.81 $4.02 $4.82 $4.82 $5.00 $3.52 $4.68 $6.43 $6.43 $60.92 $4.02 $4.02 $4.02 $103.00 $77.25 $4.02 $4.02 $4.02 $17.72 $17.72 $81.58 $4.02 $82.40 $6.63 $4.46 $4.02 $59.74 $103.00 $5.83 $4.02 $3.50 $4.02 N/A N/A 30700096 EAP CPT® 81000 SPECIFIC GRAVITY BOTH IP/OP $119.00 $88.50 $1.81 $119.00 $6.22 $6.22 $6.22 $6.22 $4.02 $4.02 $2.01 $1.81 $4.02 $4.82 $4.82 $5.00 $3.52 $4.68 $6.43 $6.43 $70.39 $4.02 $4.02 $4.02 $119.00 $89.25 $4.02 $4.02 $4.02 $17.72 $17.72 $94.25 $4.02 $95.20 $6.63 $4.46 $4.02 $69.02 $119.00 $5.83 $4.02 $3.50 $4.02 N/A N/A 30700097 EAP CPT® 81000 "UROBILINOGEN, QUALITATIV" BOTH IP/OP $103.00 $76.50 $1.81 $103.00 $6.22 $6.22 $6.22 $6.22 $4.02 $4.02 $2.01 $1.81 $4.02 $4.82 $4.82 $5.00 $3.52 $4.68 $6.43 $6.43 $60.92 $4.02 $4.02 $4.02 $103.00 $77.25 $4.02 $4.02 $4.02 $17.72 $17.72 $81.58 $4.02 $82.40 $6.63 $4.46 $4.02 $59.74 $103.00 $5.83 $4.02 $3.50 $4.02 N/A N/A 30750027 EAP CPT® 81005 "CLINITEST, STOOL" BOTH IP/OP $124.00 $92.00 $1.08 $124.00 $4.24 $4.24 $4.24 $4.24 $2.17 $2.17 $1.09 $1.08 $2.17 $3.29 $3.29 $3.41 $2.40 $3.20 $3.47 $3.47 $73.35 $2.17 $2.17 $2.17 $124.00 $93.00 $2.17 $2.17 $2.17 $12.12 $12.12 $98.21 $2.17 $99.20 $3.58 $3.05 $2.17 $71.92 $124.00 $3.15 $2.17 $2.40 $2.17 N/A N/A 30750028 EAP CPT® 81005 "SPEC.GRAVITY,REFRAC" BOTH IP/OP $108.00 $80.00 $1.08 $108.00 $4.24 $4.24 $4.24 $4.24 $2.17 $2.17 $1.09 $1.08 $2.17 $3.29 $3.29 $3.41 $2.40 $3.20 $3.47 $3.47 $63.88 $2.17 $2.17 $2.17 $108.00 $81.00 $2.17 $2.17 $2.17 $12.12 $12.12 $85.54 $2.17 $86.40 $3.58 $3.05 $2.17 $62.64 $108.00 $3.15 $2.17 $2.40 $2.17 N/A N/A 30750029 EAP CPT® 81005 "CLINITEST,URINE" BOTH IP/OP $108.00 $80.00 $1.08 $108.00 $4.24 $4.24 $4.24 $4.24 $2.17 $2.17 $1.09 $1.08 $2.17 $3.29 $3.29 $3.41 $2.40 $3.20 $3.47 $3.47 $63.88 $2.17 $2.17 $2.17 $108.00 $81.00 $2.17 $2.17 $2.17 $12.12 $12.12 $85.54 $2.17 $86.40 $3.58 $3.05 $2.17 $62.64 $108.00 $3.15 $2.17 $2.40 $2.17 N/A N/A 30750030 EAP CPT® 81005 "PROTEIN, UR-QUAL" BOTH IP/OP $108.00 $80.00 $1.08 $108.00 $4.24 $4.24 $4.24 $4.24 $2.17 $2.17 $1.09 $1.08 $2.17 $3.29 $3.29 $3.41 $2.40 $3.20 $3.47 $3.47 $63.88 $2.17 $2.17 $2.17 $108.00 $81.00 $2.17 $2.17 $2.17 $12.12 $12.12 $85.54 $2.17 $86.40 $3.58 $3.05 $2.17 $62.64 $108.00 $3.15 $2.17 $2.40 $2.17 N/A N/A 30750031 EAP CPT® 81005 "GLUCOSE, UR-QUAL" BOTH IP/OP $108.00 $80.00 $1.08 $108.00 $4.24 $4.24 $4.24 $4.24 $2.17 $2.17 $1.09 $1.08 $2.17 $3.29 $3.29 $3.41 $2.40 $3.20 $3.47 $3.47 $63.88 $2.17 $2.17 $2.17 $108.00 $81.00 $2.17 $2.17 $2.17 $12.12 $12.12 $85.54 $2.17 $86.40 $3.58 $3.05 $2.17 $62.64 $108.00 $3.15 $2.17 $2.40 $2.17 N/A N/A 30750032 EAP CPT® 81005 "KETONES,UR" BOTH IP/OP $108.00 $80.00 $1.08 $108.00 $4.24 $4.24 $4.24 $4.24 $2.17 $2.17 $1.09 $1.08 $2.17 $3.29 $3.29 $3.41 $2.40 $3.20 $3.47 $3.47 $63.88 $2.17 $2.17 $2.17 $108.00 $81.00 $2.17 $2.17 $2.17 $12.12 $12.12 $85.54 $2.17 $86.40 $3.58 $3.05 $2.17 $62.64 $108.00 $3.15 $2.17 $2.40 $2.17 N/A N/A 30750033 EAP CPT® 81005 "UROBILINOGEN,UR-QL" BOTH IP/OP $108.00 $80.00 $1.08 $108.00 $4.24 $4.24 $4.24 $4.24 $2.17 $2.17 $1.09 $1.08 $2.17 $3.29 $3.29 $3.41 $2.40 $3.20 $3.47 $3.47 $63.88 $2.17 $2.17 $2.17 $108.00 $81.00 $2.17 $2.17 $2.17 $12.12 $12.12 $85.54 $2.17 $86.40 $3.58 $3.05 $2.17 $62.64 $108.00 $3.15 $2.17 $2.40 $2.17 N/A N/A 30750034 EAP CPT® 81005 "GLUCOSE, UR-QUAL" BOTH IP/OP $108.00 $80.00 $1.08 $108.00 $4.24 $4.24 $4.24 $4.24 $2.17 $2.17 $1.09 $1.08 $2.17 $3.29 $3.29 $3.41 $2.40 $3.20 $3.47 $3.47 $63.88 $2.17 $2.17 $2.17 $108.00 $81.00 $2.17 $2.17 $2.17 $12.12 $12.12 $85.54 $2.17 $86.40 $3.58 $3.05 $2.17 $62.64 $108.00 $3.15 $2.17 $2.40 $2.17 N/A N/A 30750035 EAP CPT® 81005 "PROTEIN, UR-QUAL" BOTH IP/OP $108.00 $80.00 $1.08 $108.00 $4.24 $4.24 $4.24 $4.24 $2.17 $2.17 $1.09 $1.08 $2.17 $3.29 $3.29 $3.41 $2.40 $3.20 $3.47 $3.47 $63.88 $2.17 $2.17 $2.17 $108.00 $81.00 $2.17 $2.17 $2.17 $12.12 $12.12 $85.54 $2.17 $86.40 $3.58 $3.05 $2.17 $62.64 $108.00 $3.15 $2.17 $2.40 $2.17 N/A N/A 30750036 EAP CPT® 81005 "GLUCOSE, UR-QUAL" BOTH IP/OP $108.00 $80.00 $1.08 $108.00 $4.24 $4.24 $4.24 $4.24 $2.17 $2.17 $1.09 $1.08 $2.17 $3.29 $3.29 $3.41 $2.40 $3.20 $3.47 $3.47 $63.88 $2.17 $2.17 $2.17 $108.00 $81.00 $2.17 $2.17 $2.17 $12.12 $12.12 $85.54 $2.17 $86.40 $3.58 $3.05 $2.17 $62.64 $108.00 $3.15 $2.17 $2.40 $2.17 N/A N/A 30750037 EAP CPT® 81005 "KETONES,UR" BOTH IP/OP $108.00 $80.00 $1.08 $108.00 $4.24 $4.24 $4.24 $4.24 $2.17 $2.17 $1.09 $1.08 $2.17 $3.29 $3.29 $3.41 $2.40 $3.20 $3.47 $3.47 $63.88 $2.17 $2.17 $2.17 $108.00 $81.00 $2.17 $2.17 $2.17 $12.12 $12.12 $85.54 $2.17 $86.40 $3.58 $3.05 $2.17 $62.64 $108.00 $3.15 $2.17 $2.40 $2.17 N/A N/A 30750080 EAP CPT® 81000 "PH, URINE-DIPSTICK" BOTH IP/OP $103.00 $76.50 $1.81 $103.00 $6.22 $6.22 $6.22 $6.22 $4.02 $4.02 $2.01 $1.81 $4.02 $4.82 $4.82 $5.00 $3.52 $4.68 $6.43 $6.43 $60.92 $4.02 $4.02 $4.02 $103.00 $77.25 $4.02 $4.02 $4.02 $17.72 $17.72 $81.58 $4.02 $82.40 $6.63 $4.46 $4.02 $59.74 $103.00 $5.83 $4.02 $3.50 $4.02 N/A N/A 30900004 EAP CPT® 89060 "CRYSTALS,FLUID" BOTH IP/OP $165.00 $122.50 $3.58 $165.00 $14.03 $14.03 $14.03 $14.03 $7.33 $7.33 $3.67 $3.58 $7.33 $10.86 $10.86 $11.28 $7.93 $10.56 $11.73 $11.73 $97.60 $7.33 $7.33 $7.33 $165.00 $123.75 $7.33 $7.33 $7.33 $39.96 $39.96 $130.68 $7.33 $132.00 $107.25 $10.06 $7.33 $95.70 $165.00 $10.63 $7.33 $7.90 $7.33 N/A N/A 30900005 EAP CPT® 89190 NASAL SMEAR FOR EOS BOTH IP/OP $129.00 $95.50 $2.90 $129.00 $129.00 $129.00 $129.00 $129.00 $5.79 $5.79 $2.90 $129.00 $5.79 $7.21 $7.21 $7.48 $5.26 $7.02 $9.26 $9.26 $129.00 $5.79 $5.79 $5.79 $129.00 $96.75 $5.79 $5.79 $5.79 $26.56 $26.56 $102.17 $5.79 $103.20 $83.85 $129.00 $5.79 $74.82 $129.00 $8.40 $5.79 $129.00 $5.79 N/A N/A 30900006 EAP CPT® 89320 SEMEN EXAMINATION BOTH IP/OP $75.00 $55.50 $6.16 $75.00 $75.00 $75.00 $75.00 $75.00 $12.31 $12.31 $6.16 $75.00 $12.31 $8.76 $8.76 $9.09 $6.39 $8.52 $19.70 $19.70 $75.00 $12.31 $12.31 $12.31 $75.00 $56.25 $12.31 $12.31 $12.31 $32.24 $32.24 $59.40 $12.31 $60.00 $48.75 $75.00 $12.31 $43.50 $75.00 $17.85 $12.31 $75.00 $12.31 N/A N/A 30900009 EAP CPT® 81511 MSS SEQUENTIAL SCREEN-2 (SO) BOTH IP/OP $504.00 $373.00 $69.08 $504.00 $439.25 $439.25 $439.25 $439.25 $153.50 $153.50 $76.75 $69.08 $153.50 $374.07 $374.07 $388.48 $262.58 $144.26 $245.60 $245.60 $298.12 $153.50 $153.50 $153.50 $504.00 $378.00 $153.50 $153.50 $153.50 $252.00 $252.00 $399.17 $153.50 $403.20 $253.28 $137.39 $153.50 $292.32 $504.00 $222.58 $153.50 $107.92 $153.50 N/A N/A 30900011 EAP CPT® 84163 PREGNANCY ASSOCIATED PLASMA PROTEIN (SO) BOTH IP/OP $180.00 $133.50 $7.09 $180.00 $12.60 $12.60 $12.60 $12.60 $15.05 $15.05 $7.53 $7.53 $15.05 $9.74 $9.74 $10.12 $7.11 $9.48 $24.08 $24.08 $106.47 $15.05 $15.05 $15.05 $180.00 $135.00 $15.05 $15.05 $15.05 $35.88 $35.88 $142.56 $15.05 $144.00 $24.83 $9.03 $15.05 $104.40 $180.00 $21.82 $15.05 $7.09 $15.05 N/A N/A 30900012 EAP CPT® 84702 "HCG,QUANTITATIVE" BOTH IP/OP $31.00 $23.00 $7.09 $31.00 $12.60 $12.60 $12.60 $12.60 $15.05 $15.05 $7.53 $7.53 $15.05 $9.74 $9.74 $10.12 $7.11 $9.48 $24.08 $24.08 $18.34 $15.05 $15.05 $15.05 $31.00 $23.25 $15.05 $15.05 $15.05 $31.00 $31.00 $24.55 $15.05 $24.80 $24.83 $9.03 $15.05 $17.98 $31.00 $21.82 $15.05 $7.09 $15.05 N/A N/A 30900013 EAP CPT® 86021 C-ANCA TITER (SO) BOTH IP/OP $34.00 $25.50 $7.53 $34.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $20.11 $15.05 $15.05 $15.05 $34.00 $25.50 $15.05 $15.05 $15.05 $34.00 $34.00 $26.93 $15.05 $27.20 $24.83 $21.18 $15.05 $19.72 $34.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30900014 EAP CPT® 86021 P-ANCA TITER (SO) BOTH IP/OP $34.00 $25.50 $7.53 $34.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $20.11 $15.05 $15.05 $15.05 $34.00 $25.50 $15.05 $15.05 $15.05 $34.00 $34.00 $26.93 $15.05 $27.20 $24.83 $21.18 $15.05 $19.72 $34.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30900015 EAP CPT® 86021 ATYPICAL P-ANCA TITER (SO) BOTH IP/OP $80.00 $59.50 $7.53 $80.00 $29.54 $29.54 $29.54 $29.54 $15.05 $15.05 $7.53 $7.53 $15.05 $22.86 $22.86 $23.74 $16.69 $22.24 $24.08 $24.08 $47.32 $15.05 $15.05 $15.05 $80.00 $60.00 $15.05 $15.05 $15.05 $80.00 $80.00 $63.36 $15.05 $64.00 $24.83 $21.18 $15.05 $46.40 $80.00 $21.82 $15.05 $16.64 $15.05 N/A N/A 30900020 EAP CPT® 86638 Q FEVER IGG PHASE I TITER (SO) BOTH IP/OP $43.00 $32.00 $6.06 $43.00 $43.00 $43.00 $43.00 $43.00 $12.12 $12.12 $6.06 $43.00 $12.12 $18.41 $18.41 $19.12 $13.44 $17.91 $19.39 $19.39 $43.00 $12.12 $12.12 $12.12 $43.00 $32.25 $12.12 $12.12 $12.12 $43.00 $43.00 $34.06 $12.12 $34.40 $43.00 $43.00 $12.12 $24.94 $43.00 $17.57 $12.12 $43.00 $12.12 N/A N/A 30900021 EAP CPT® 86638 Q FEVER IGG PHASE II TITER (SO) BOTH IP/OP $43.00 $32.00 $6.06 $43.00 $43.00 $43.00 $43.00 $43.00 $12.12 $12.12 $6.06 $43.00 $12.12 $18.41 $18.41 $19.12 $13.44 $17.91 $19.39 $19.39 $43.00 $12.12 $12.12 $12.12 $43.00 $32.25 $12.12 $12.12 $12.12 $43.00 $43.00 $34.06 $12.12 $34.40 $43.00 $43.00 $12.12 $24.94 $43.00 $17.57 $12.12 $43.00 $12.12 N/A N/A 30900022 EAP CPT® 86638 Q FEVER IGG PHASE I TITER (SO) BOTH IP/OP $43.00 $32.00 $6.06 $43.00 $43.00 $43.00 $43.00 $43.00 $12.12 $12.12 $6.06 $43.00 $12.12 $18.41 $18.41 $19.12 $13.44 $17.91 $19.39 $19.39 $43.00 $12.12 $12.12 $12.12 $43.00 $32.25 $12.12 $12.12 $12.12 $43.00 $43.00 $34.06 $12.12 $34.40 $43.00 $43.00 $12.12 $24.94 $43.00 $17.57 $12.12 $43.00 $12.12 N/A N/A 30900023 EAP CPT® 86638 Q FEVER IGG PHASE II (SO) BOTH IP/OP $43.00 $32.00 $6.06 $43.00 $43.00 $43.00 $43.00 $43.00 $12.12 $12.12 $6.06 $43.00 $12.12 $18.41 $18.41 $19.12 $13.44 $17.91 $19.39 $19.39 $43.00 $12.12 $12.12 $12.12 $43.00 $32.25 $12.12 $12.12 $12.12 $43.00 $43.00 $34.06 $12.12 $34.40 $43.00 $43.00 $12.12 $24.94 $43.00 $17.57 $12.12 $43.00 $12.12 N/A N/A 30900024 EAP CPT® 86611 B.HENSELAE IGG TITER (SO) BOTH IP/OP $64.00 $47.50 $5.09 $64.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $37.86 $10.18 $10.18 $10.18 $64.00 $48.00 $10.18 $10.18 $10.18 $56.88 $56.88 $50.69 $10.18 $51.20 $16.80 $14.32 $10.18 $37.12 $64.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30900025 EAP CPT® 86611 B.HENSELAE IGM TITER (SO) BOTH IP/OP $64.00 $47.50 $5.09 $64.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $37.86 $10.18 $10.18 $10.18 $64.00 $48.00 $10.18 $10.18 $10.18 $56.88 $56.88 $50.69 $10.18 $51.20 $16.80 $14.32 $10.18 $37.12 $64.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30900026 EAP CPT® 86611 B.QUINTANA IGG TITER (SO) BOTH IP/OP $64.00 $47.50 $5.09 $64.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $37.86 $10.18 $10.18 $10.18 $64.00 $48.00 $10.18 $10.18 $10.18 $56.88 $56.88 $50.69 $10.18 $51.20 $16.80 $14.32 $10.18 $37.12 $64.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 30900027 EAP CPT® 86611 B.QUINTANA IGM TITER (SO) BOTH IP/OP $50.00 $37.00 $5.09 $50.00 $19.98 $19.98 $19.98 $19.98 $10.18 $10.18 $5.09 $5.09 $10.18 $15.44 $15.44 $16.04 $11.27 $15.04 $16.29 $16.29 $29.58 $10.18 $10.18 $10.18 $50.00 $37.50 $10.18 $10.18 $10.18 $50.00 $50.00 $39.60 $10.18 $40.00 $16.80 $14.32 $10.18 $29.00 $50.00 $14.76 $10.18 $11.25 $10.18 N/A N/A 31000001 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $384.00 $284.50 $10.71 $384.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $227.14 $21.42 $21.42 $21.42 $384.00 $288.00 $21.42 $21.42 $21.42 $119.72 $119.72 $304.13 $21.42 $307.20 $35.34 $30.14 $21.42 $222.72 $384.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000002 EAP CPT® 88305 LEVEL IV SURGICAL PATH EXAM BOTH IP/OP $771.00 $571.00 $31.63 $616.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $456.05 $48.88 $35.18 $48.88 $51.32 $578.25 $48.88 $48.88 $48.88 $281.96 $281.96 $610.63 $48.88 $616.80 $501.15 $73.71 $48.88 $447.18 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31000004 EAP CPT® 88331 PATH CONSULT INRAOP 1 BLOC BOTH IP/OP $160.00 $118.50 $22.30 $234.73 $141.31 $141.31 $141.31 $141.31 $146.71 $146.71 $146.06 $44.60 $146.71 $30.54 $30.54 $31.72 $22.30 $87.82 $234.73 $226.86 $94.64 $146.71 $41.60 $146.71 $154.04 $120.00 $146.71 $146.71 $146.71 $114.92 $114.92 $126.72 $146.71 $128.00 $104.00 $83.64 $146.71 $92.80 $154.04 $160.00 $146.71 $65.70 $146.71 N/A N/A 31000006 EAP CPT® 81314 PDGFRA MUTATION ANALYSIS (QUEST) BOTH IP/OP "$1,002.00" $741.50 $164.76 "$1,002.00" "$1,002.00" "$1,002.00" "$1,002.00" "$1,002.00" $329.51 $329.51 $164.76 "$1,002.00" $329.51 $342.69 $342.69 $355.87 $250.16 $309.68 $527.22 $527.22 "$1,002.00" $329.51 $329.51 $329.51 "$1,002.00" $751.50 $329.51 $329.51 $329.51 $501.00 $501.00 $793.58 $329.51 $801.60 "$1,002.00" "$1,002.00" $329.51 $581.16 "$1,002.00" $477.79 $329.51 "$1,002.00" $329.51 N/A N/A 31000007 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $447.00 $331.00 $23.04 $447.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $264.40 $51.19 $51.19 $51.19 $447.00 $335.25 $51.19 $51.19 $51.19 $224.44 $224.44 $354.02 $51.19 $357.60 $84.46 $56.50 $51.19 $259.26 $447.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31000010 EAP CPT® 88120 "CYTOPATH IN SITU HYBRIDIZATION,URINARY TRACT SPEC W/MORS" BOTH IP/OP $930.00 $688.50 $146.06 $917.93 $917.93 $917.93 $917.93 $917.93 $146.71 $146.71 $146.06 $273.92 $146.71 $422.54 $422.54 $438.79 $308.45 $324.87 $234.73 $226.86 $550.10 $146.71 $545.53 $146.71 $154.04 $697.50 $146.71 $146.71 $146.71 $465.00 $465.00 $736.56 $146.71 $744.00 $604.50 $309.40 $146.71 $539.40 $154.04 $212.25 $146.71 $243.03 $146.71 N/A N/A 31000011 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $62.00 $46.00 $10.71 $62.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $36.67 $21.42 $21.42 $21.42 $62.00 $46.50 $21.42 $21.42 $21.42 $62.00 $62.00 $49.10 $21.42 $49.60 $35.34 $30.14 $21.42 $35.96 $62.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000013 EAP CPT® 88230 TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS;LYMPHOCYTE BOTH IP/OP $347.00 $257.00 $58.25 $347.00 $228.64 $228.64 $228.64 $228.64 $116.49 $116.49 $58.25 $58.25 $116.49 $176.90 $176.90 $183.71 $129.14 $172.08 $186.38 $186.38 $205.25 $116.49 $116.49 $116.49 $347.00 $260.25 $116.49 $116.49 $116.49 $347.00 $347.00 $274.82 $116.49 $277.60 $192.21 $163.89 $116.49 $201.26 $347.00 $168.91 $116.49 $128.74 $116.49 N/A N/A 31000015 EAP CPT® 88271 CYTOGENETICS DNA PROBE BOTH IP/OP $287.00 $212.50 $10.71 $287.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $169.76 $21.42 $21.42 $21.42 $287.00 $215.25 $21.42 $21.42 $21.42 $119.72 $119.72 $227.30 $21.42 $229.60 $35.34 $30.14 $21.42 $166.46 $287.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000016 EAP CPT® 88275 CYTOGENETICS 100-300 BOTH IP/OP $349.00 $258.50 $23.04 $349.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $206.43 $51.19 $51.19 $51.19 $349.00 $261.75 $51.19 $51.19 $51.19 $224.44 $224.44 $276.41 $51.19 $279.20 $84.46 $56.50 $51.19 $202.42 $349.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31000018 EAP CPT® 88360 ER/PR HER2 W/REFLEX TO HER2 FISH (SO) BOTH IP/OP $731.00 $541.00 $49.88 $584.80 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $432.39 $146.71 $78.13 $146.71 $154.04 $548.25 $146.71 $146.71 $146.71 $242.68 $242.68 $578.95 $146.71 $584.80 $475.15 $109.25 $146.71 $423.98 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 31000019 EAP CPT® 88368 "FISH, HER-2/NEU (SO)" BOTH IP/OP $741.00 $548.50 $58.22 $592.80 $169.58 $169.58 $169.58 $169.58 $286.49 $286.49 $285.22 $58.22 $286.49 $151.36 $151.36 $157.18 $110.49 $199.20 $458.39 $467.58 $438.30 $286.49 $102.49 $286.49 $300.82 $555.75 $286.49 $286.49 $286.49 $415.48 $415.48 $586.87 $286.49 $592.80 $481.65 $189.71 $286.49 $429.78 $300.82 $414.48 $286.49 $149.02 $286.49 N/A N/A 31000020 EAP CPT® 88271 MOLECULAR CYTOGENETICS: DNA PROBE (FISH) (SO) PDGFRB BOTH IP/OP $511.00 $378.50 $10.71 $511.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $302.26 $21.42 $21.42 $21.42 $511.00 $383.25 $21.42 $21.42 $21.42 $119.72 $119.72 $404.71 $21.42 $408.80 $35.34 $30.14 $21.42 $296.38 $511.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000021 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION(100-300) CELLS (SO) PDGFRB BOTH IP/OP $256.00 $189.50 $23.04 $256.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $151.42 $51.19 $51.19 $51.19 $256.00 $192.00 $51.19 $51.19 $51.19 $224.44 $224.44 $202.75 $51.19 $204.80 $84.46 $56.50 $51.19 $148.48 $256.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31000022 EAP CPT® 88342 "LYNCH SYNDROME TUMOR PANEL, IHC (SO)" BOTH IP/OP $700.00 $518.00 $43.77 $560.00 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $414.05 $146.71 $66.63 $146.71 $154.04 $525.00 $146.71 $146.71 $146.71 $212.92 $212.92 $554.40 $146.71 $560.00 $455.00 $80.08 $146.71 $406.00 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31000025 EAP CPT® 88368 "FISH, MDM2 GENE AMPHLIFICATION (ARUP)" BOTH IP/OP "$1,325.00" $980.50 $58.22 "$1,060.00" $169.58 $169.58 $169.58 $169.58 $286.49 $286.49 $285.22 $58.22 $286.49 $151.36 $151.36 $157.18 $110.49 $199.20 $458.39 $467.58 $783.74 $286.49 $102.49 $286.49 $300.82 $993.75 $286.49 $286.49 $286.49 $415.48 $415.48 "$1,049.40" $286.49 "$1,060.00" $861.25 $189.71 $286.49 $768.50 $300.82 $414.48 $286.49 $149.02 $286.49 N/A N/A 31000026 EAP CPT® 88271 MOLECULAR CYTOGENETICS: DNA PROBE (FISH) (SO) MN BOTH IP/OP $300.00 $222.00 $10.71 $300.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $177.45 $21.42 $21.42 $21.42 $300.00 $225.00 $21.42 $21.42 $21.42 $119.72 $119.72 $237.60 $21.42 $240.00 $35.34 $30.14 $21.42 $174.00 $300.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000027 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION(100-300) CELLS (SO) MN BOTH IP/OP $128.00 $95.00 $23.04 $128.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $75.71 $51.19 $51.19 $51.19 $128.00 $96.00 $51.19 $51.19 $51.19 $128.00 $128.00 $101.38 $51.19 $102.40 $84.46 $56.50 $51.19 $74.24 $128.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31000028 EAP CPT® 88271 "FISH, HES/LEUKEMIA, 4Q12 REA(FIP1L-PDGFRA" BOTH IP/OP $665.00 $492.50 $10.71 $665.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $393.35 $21.42 $21.42 $21.42 $665.00 $498.75 $21.42 $21.42 $21.42 $119.72 $119.72 $526.68 $21.42 $532.00 $35.34 $30.14 $21.42 $385.70 $665.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000029 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION(100-300) CELLS (SO) HES BOTH IP/OP $221.00 $164.00 $23.04 $221.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $130.72 $51.19 $51.19 $51.19 $221.00 $165.75 $51.19 $51.19 $51.19 $221.00 $221.00 $175.03 $51.19 $176.80 $84.46 $56.50 $51.19 $128.18 $221.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31000030 EAP CPT® 88271 MOLECULAR CYTOGENETICS: DNA PROBE (FISH) (SO) FG BOTH IP/OP $499.00 $369.50 $10.71 $499.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $295.16 $21.42 $21.42 $21.42 $499.00 $374.25 $21.42 $21.42 $21.42 $119.72 $119.72 $395.21 $21.42 $399.20 $35.34 $30.14 $21.42 $289.42 $499.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000031 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION(100-300) CELLS (SO) FG BOTH IP/OP $248.00 $184.00 $23.04 $248.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $146.69 $51.19 $51.19 $51.19 $248.00 $186.00 $51.19 $51.19 $51.19 $224.44 $224.44 $196.42 $51.19 $198.40 $84.46 $56.50 $51.19 $143.84 $248.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31000032 EAP CPT® 88271 MOLECULAR CYTOGENETICS: DNA PROBE (FISH) (SO) NE BOTH IP/OP $714.00 $528.50 $10.71 $714.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $422.33 $21.42 $21.42 $21.42 $714.00 $535.50 $21.42 $21.42 $21.42 $119.72 $119.72 $565.49 $21.42 $571.20 $35.34 $30.14 $21.42 $414.12 $714.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000033 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION(100-300) CELLS (SO) NE BOTH IP/OP $142.00 $105.50 $23.04 $142.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $83.99 $51.19 $51.19 $51.19 $142.00 $106.50 $51.19 $51.19 $51.19 $142.00 $142.00 $112.46 $51.19 $113.60 $84.46 $56.50 $51.19 $82.36 $142.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31000034 EAP CPT® 88271 MOLECULAR CYTOGENETICS: DNA PROBE (FISH) (SO) ETO BOTH IP/OP $563.00 $417.00 $10.71 $563.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $333.01 $21.42 $21.42 $21.42 $563.00 $422.25 $21.42 $21.42 $21.42 $119.72 $119.72 $445.90 $21.42 $450.40 $35.34 $30.14 $21.42 $326.54 $563.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000035 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION(100-300) CELLS (SO) ETO BOTH IP/OP $282.00 $209.00 $23.04 $282.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $166.80 $51.19 $51.19 $51.19 $282.00 $211.50 $51.19 $51.19 $51.19 $224.44 $224.44 $223.34 $51.19 $225.60 $84.46 $56.50 $51.19 $163.56 $282.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31000036 EAP CPT® 88271 MOLECULAR CYTOGENETICS: DNA PROBE (FISH) (SO) MLL BOTH IP/OP $511.00 $378.50 $10.71 $511.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $302.26 $21.42 $21.42 $21.42 $511.00 $383.25 $21.42 $21.42 $21.42 $119.72 $119.72 $404.71 $21.42 $408.80 $35.34 $30.14 $21.42 $296.38 $511.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000037 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION(100-300) CELLS (SO) MLL BOTH IP/OP $256.00 $189.50 $23.04 $256.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $151.42 $51.19 $51.19 $51.19 $256.00 $192.00 $51.19 $51.19 $51.19 $224.44 $224.44 $202.75 $51.19 $204.80 $84.46 $56.50 $51.19 $148.48 $256.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31000038 EAP CPT® 88184 FLOW CYTOMETRY; FIRST MARKER (SO) PCN BOTH IP/OP $303.00 $224.50 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $179.22 $286.49 $75.09 $286.49 $300.82 $227.25 $286.49 $286.49 $286.49 $267.48 $267.48 $239.98 $286.49 $242.40 $196.95 $51.58 $286.49 $175.74 $300.82 $303.00 $286.49 $40.52 $286.49 N/A N/A 31000039 EAP CPT® 88185 FLOW CYTOMETRY;EACH ADD MARKER (SO) PCN BOTH IP/OP $233.00 $172.50 $11.19 $233.00 $53.97 $53.97 $53.97 $53.97 $233.00 $233.00 $233.00 $11.19 $233.00 $48.93 $48.93 $50.81 $35.72 $26.63 $233.00 $203.00 $137.82 $233.00 $24.01 $233.00 $233.00 $174.75 $233.00 $233.00 $233.00 $143.44 $143.44 $184.54 $233.00 $186.40 $151.45 $25.36 $233.00 $135.14 $233.00 $233.00 $233.00 $19.92 $233.00 N/A N/A 31000042 EAP CPT® 81200 CANAVAN DISEASE MUTATION ANALYSIS (SO) BOTH IP/OP $568.00 $420.50 $23.63 $568.00 $568.00 $568.00 $568.00 $568.00 $47.25 $47.25 $23.63 $568.00 $47.25 $421.57 $421.57 $437.81 $295.93 $115.59 $75.60 $75.60 $568.00 $47.25 $47.25 $47.25 $568.00 $426.00 $47.25 $47.25 $47.25 $284.00 $284.00 $449.86 $47.25 $454.40 $568.00 $568.00 $47.25 $329.44 $568.00 $68.51 $47.25 $568.00 $47.25 N/A N/A 31000043 EAP CPT® 88235 TISSUE CULTURE FOR AM-FLD OR CV-CELLS (SO) SC BOTH IP/OP $236.00 $175.00 $75.15 $240.48 $236.00 $236.00 $236.00 $236.00 $150.30 $150.30 $75.15 $236.00 $150.30 $223.60 $223.60 $232.20 $163.23 $217.53 $240.48 $240.48 $236.00 $150.30 $150.30 $150.30 $236.00 $177.00 $150.30 $150.30 $150.30 $236.00 $236.00 $186.91 $150.30 $188.80 $236.00 $236.00 $150.30 $136.88 $236.00 $217.94 $150.30 $236.00 $150.30 N/A N/A 31000045 EAP CPT® 88271 MOLECULAR CYTOGENETICS: DNA PROBE (FISH) (SO) DUP BOTH IP/OP $350.00 $259.00 $10.71 $350.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $207.03 $21.42 $21.42 $21.42 $350.00 $262.50 $21.42 $21.42 $21.42 $119.72 $119.72 $277.20 $21.42 $280.00 $35.34 $30.14 $21.42 $203.00 $350.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000046 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION(100-300) CELLS (SO) DUP BOTH IP/OP $350.00 $259.00 $23.04 $350.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $207.03 $51.19 $51.19 $51.19 $350.00 $262.50 $51.19 $51.19 $51.19 $224.44 $224.44 $277.20 $51.19 $280.00 $84.46 $56.50 $51.19 $203.00 $350.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31000051 EAP CPT® 88271 MOLECULAR CYTOGENETICS: DNA PROBE (FISH) (SO) MM BOTH IP/OP $499.00 $369.50 $10.71 $499.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $295.16 $21.42 $21.42 $21.42 $499.00 $374.25 $21.42 $21.42 $21.42 $119.72 $119.72 $395.21 $21.42 $399.20 $35.34 $30.14 $21.42 $289.42 $499.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000052 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION(100-300) CELLS (SO) MM BOTH IP/OP $248.00 $184.00 $23.04 $248.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $146.69 $51.19 $51.19 $51.19 $248.00 $186.00 $51.19 $51.19 $51.19 $224.44 $224.44 $196.42 $51.19 $198.40 $84.46 $56.50 $51.19 $143.84 $248.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31000055 EAP CPT® 81401 "EML4 ALK GENE FUSION, PCR (SO)" BOTH IP/OP "$1,030.00" $762.50 $61.65 "$1,030.00" $61.75 $61.75 $61.75 $61.75 $137.00 $137.00 $68.50 $61.65 $137.00 $764.47 $764.47 $793.92 $536.63 $131.58 $219.20 $219.20 $609.25 $137.00 $137.00 $137.00 "$1,030.00" $772.50 $137.00 $137.00 $137.00 $515.00 $515.00 $815.76 $137.00 $824.00 $226.05 $125.31 $137.00 $597.40 "$1,030.00" $198.65 $137.00 $98.43 $137.00 N/A N/A 31000060 EAP CPT® 88271 MOLECULAR CYTOGENETICS: DNA PROBE (FISH) (SO)RARA BOTH IP/OP $751.00 $556.00 $10.71 $751.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $444.22 $21.42 $21.42 $21.42 $751.00 $563.25 $21.42 $21.42 $21.42 $119.72 $119.72 $594.79 $21.42 $600.80 $35.34 $30.14 $21.42 $435.58 $751.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000061 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION(100-300) CELLS (SO) RARA BOTH IP/OP $374.00 $277.00 $23.04 $374.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $221.22 $51.19 $51.19 $51.19 $374.00 $280.50 $51.19 $51.19 $51.19 $224.44 $224.44 $296.21 $51.19 $299.20 $84.46 $56.50 $51.19 $216.92 $374.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31000062 EAP CPT® 88271 MOLECULAR CYTOGENETICS: DNA PROBE (FISH) (SO) ROS1 BOTH IP/OP $687.00 $508.50 $10.71 $687.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $406.36 $21.42 $21.42 $21.42 $687.00 $515.25 $21.42 $21.42 $21.42 $119.72 $119.72 $544.10 $21.42 $549.60 $35.34 $30.14 $21.42 $398.46 $687.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000063 EAP CPT® 88274 INTERPHASE IN SITU HYBRIDIZATION (25-99 CELLS (SO) ROS1 BOTH IP/OP $344.00 $255.00 $19.07 $344.00 $68.32 $68.32 $68.32 $68.32 $42.38 $42.38 $21.19 $19.07 $42.38 $52.85 $52.85 $54.89 $38.58 $51.42 $67.81 $67.81 $203.48 $42.38 $42.38 $42.38 $344.00 $258.00 $42.38 $42.38 $42.38 $194.52 $194.52 $272.45 $42.38 $275.20 $69.93 $48.97 $42.38 $199.52 $344.00 $61.45 $42.38 $38.47 $42.38 N/A N/A 31000066 EAP CPT® 88274 FANCONI ANEMIA TISSUE CX (SO) BOTH IP/OP $384.00 $284.50 $19.07 $384.00 $68.32 $68.32 $68.32 $68.32 $42.38 $42.38 $21.19 $19.07 $42.38 $52.85 $52.85 $54.89 $38.58 $51.42 $67.81 $67.81 $227.14 $42.38 $42.38 $42.38 $384.00 $288.00 $42.38 $42.38 $42.38 $194.52 $194.52 $304.13 $42.38 $307.20 $69.93 $48.97 $42.38 $222.72 $384.00 $61.45 $42.38 $38.47 $42.38 N/A N/A 31000067 EAP CPT® 88271 FANCONI ANEMIA CHROM ANAL (SO) BOTH IP/OP $241.00 $178.50 $10.71 $241.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $142.55 $21.42 $21.42 $21.42 $241.00 $180.75 $21.42 $21.42 $21.42 $119.72 $119.72 $190.87 $21.42 $192.80 $35.34 $30.14 $21.42 $139.78 $241.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000068 EAP CPT® 88271 FISH SRY/X CENTROMERE DNA (SO) BOTH IP/OP $241.00 $178.50 $10.71 $241.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $142.55 $21.42 $21.42 $21.42 $241.00 $180.75 $21.42 $21.42 $21.42 $119.72 $119.72 $190.87 $21.42 $192.80 $35.34 $30.14 $21.42 $139.78 $241.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000069 EAP CPT® 88273 FISH SRY/X CENTROMERE ISH (SO) BOTH IP/OP $392.00 $290.50 $17.41 $392.00 $392.00 $392.00 $392.00 $392.00 $34.81 $34.81 $17.41 $392.00 $34.81 $48.79 $48.79 $50.66 $35.61 $47.46 $55.70 $55.70 $392.00 $34.81 $34.81 $34.81 $392.00 $294.00 $34.81 $34.81 $34.81 $179.56 $179.56 $310.46 $34.81 $313.60 $392.00 $392.00 $34.81 $227.36 $392.00 $50.47 $34.81 $392.00 $34.81 N/A N/A 31000070 EAP CPT® 88291 FISH SRY/X CENTRO INTERP (SO) BOTH IP/OP $222.00 $164.50 $16.84 $222.00 $222.00 $222.00 $222.00 $222.00 $33.41 $33.41 $16.84 $222.00 $33.41 $164.77 $164.77 $171.12 $115.66 $29.83 $53.46 $52.02 $222.00 $33.41 $32.51 $33.41 $222.00 $166.50 $33.41 $33.41 $33.41 $107.92 $107.92 $175.82 $33.41 $177.60 $144.30 $222.00 $33.41 $128.76 $222.00 $34.61 $33.41 $222.00 $33.41 N/A N/A 31000071 EAP CPT® 88274 FISH CONCEPTION PROD ISH (SO) BOTH IP/OP $387.00 $286.50 $19.07 $387.00 $68.32 $68.32 $68.32 $68.32 $42.38 $42.38 $21.19 $19.07 $42.38 $52.85 $52.85 $54.89 $38.58 $51.42 $67.81 $67.81 $228.91 $42.38 $42.38 $42.38 $387.00 $290.25 $42.38 $42.38 $42.38 $194.52 $194.52 $306.50 $42.38 $309.60 $69.93 $48.97 $42.38 $224.46 $387.00 $61.45 $42.38 $38.47 $42.38 N/A N/A 31000072 EAP CPT® 88271 FISH CONCEPTION PROD DNA (SO) BOTH IP/OP $243.00 $180.00 $10.71 $243.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $143.73 $21.42 $21.42 $21.42 $243.00 $182.25 $21.42 $21.42 $21.42 $119.72 $119.72 $192.46 $21.42 $194.40 $35.34 $30.14 $21.42 $140.94 $243.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31000073 EAP CPT® 81301 COLONSEQ PANEL - PART 1 - QUEST SO BOTH IP/OP $918.00 $679.50 $174.28 $918.00 $918.00 $918.00 $918.00 $918.00 $348.56 $348.56 $174.28 $918.00 $348.56 $410.84 $410.84 $426.64 $299.91 $220.85 $557.70 $557.70 $918.00 $348.56 $348.56 $348.56 $918.00 $688.50 $348.56 $348.56 $348.56 $459.00 $459.00 $727.06 $348.56 $734.40 $918.00 $918.00 $348.56 $532.44 $918.00 $505.41 $348.56 $918.00 $348.56 N/A N/A 31000074 EAP CPT® 81445 COLONSEQ PANEL - PART 2 - QUEST SO BOTH IP/OP $918.00 $679.50 $191.32 $956.66 $918.00 $918.00 $918.00 $918.00 $597.91 $597.91 $298.96 $918.00 $597.91 $681.34 $681.34 $707.59 $478.28 $191.32 $956.66 $956.66 $918.00 $597.91 $597.91 $597.91 $918.00 $688.50 $597.91 $597.91 $597.91 $459.00 $459.00 $727.06 $597.91 $734.40 $918.00 $918.00 $597.91 $532.44 $918.00 $866.97 $597.91 $918.00 $597.91 N/A N/A 31000099 EAP CPT® 81275 COLORECTAL CAN. MUT. PANEL KRA SO BOTH IP/OP "$1,636.00" "$1,211.00" $86.96 "$1,636.00" $284.08 $284.08 $284.08 $284.08 $193.25 $193.25 $96.63 $86.96 $193.25 $205.38 $205.38 $213.28 $149.93 $220.85 $309.20 $309.20 $967.69 $193.25 $193.25 $193.25 "$1,636.00" "$1,227.00" $193.25 $193.25 $193.25 $818.00 $818.00 "$1,295.71" $193.25 "$1,308.80" $318.86 $210.33 $193.25 $948.88 "$1,636.00" $280.21 $193.25 $165.21 $193.25 N/A N/A 31000100 EAP CPT® 81210 COLORECTAL CAN. MUT. PANEL BRA SO BOTH IP/OP "$1,636.00" "$1,211.00" $78.93 "$1,636.00" $257.85 $257.85 $257.85 $257.85 $175.40 $175.40 $87.70 $78.93 $175.40 $186.42 $186.42 $193.59 $136.08 $115.59 $280.64 $280.64 $967.69 $175.40 $175.40 $175.40 "$1,636.00" "$1,227.00" $175.40 $175.40 $175.40 $818.00 $818.00 "$1,295.71" $175.40 "$1,308.80" $289.41 $110.09 $175.40 $948.88 "$1,636.00" $254.33 $175.40 $86.48 $175.40 N/A N/A 31000101 EAP CPT® 88304 SEMINAL VESICLE BOTH IP/OP $299.00 $221.50 $18.49 $239.20 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $176.86 $48.88 $31.80 $48.88 $51.32 $224.25 $48.88 $48.88 $48.88 $216.24 $216.24 $236.81 $48.88 $239.20 $194.35 $33.77 $48.88 $173.42 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31000102 EAP CPT® 81382 HLA II TYPING 1 (SO) BOTH IP/OP $935.00 $692.00 $61.84 $935.00 $935.00 $935.00 $935.00 $935.00 $123.68 $123.68 $61.84 $935.00 $123.68 $175.48 $175.48 $182.23 $128.10 $192.65 $197.89 $197.89 $935.00 $123.68 $123.68 $123.68 $935.00 $701.25 $123.68 $123.68 $123.68 $467.50 $467.50 $740.52 $123.68 $748.00 $935.00 $935.00 $123.68 $542.30 $935.00 $179.34 $123.68 $935.00 $123.68 N/A N/A 31000103 EAP CPT® 81379 HLA I TYPING COMP (SO) BOTH IP/OP "$2,608.00" "$1,930.00" $167.69 "$2,608.00" "$2,608.00" "$2,608.00" "$2,608.00" "$2,608.00" $335.38 $335.38 $167.69 "$2,608.00" $335.38 $475.84 $475.84 $494.14 $347.36 $192.65 $536.61 $536.61 "$2,608.00" $335.38 $335.38 $335.38 "$2,608.00" "$1,956.00" $335.38 $335.38 $335.38 "$1,304.00" "$1,304.00" "$2,065.54" $335.38 "$2,086.40" "$2,608.00" "$2,608.00" $335.38 "$1,512.64" "$2,608.00" $486.30 $335.38 "$2,608.00" $335.38 N/A N/A 31000118 EAP CPT® 81331 CONGEN HYOPTONIA UBE3A (SO) BOTH IP/OP $519.00 $384.50 $25.54 $519.00 $519.00 $519.00 $519.00 $519.00 $51.07 $51.07 $25.54 $519.00 $51.07 $385.20 $385.20 $400.05 $270.40 $46.99 $81.71 $81.71 $519.00 $51.07 $51.07 $51.07 $519.00 $389.25 $51.07 $51.07 $51.07 $259.50 $259.50 $411.05 $51.07 $415.20 $519.00 $519.00 $51.07 $301.02 $519.00 $74.05 $51.07 $519.00 $51.07 N/A N/A 31000119 EAP CPT® 81400 CONGEN HYPOTONIA L1 (SO) BOTH IP/OP $744.00 $551.00 $31.98 $744.00 $744.00 $744.00 $744.00 $744.00 $63.96 $63.96 $31.98 $744.00 $63.96 $552.20 $552.20 $573.48 $387.62 $115.59 $102.34 $102.34 $744.00 $63.96 $63.96 $63.96 $744.00 $558.00 $63.96 $63.96 $63.96 $372.00 $372.00 $589.25 $63.96 $595.20 $744.00 $744.00 $63.96 $431.52 $744.00 $92.74 $63.96 $744.00 $63.96 N/A N/A 31000120 EAP CPT® 81404 CONGEN HYPOTONIA L5 (SO) BOTH IP/OP "$1,519.00" "$1,124.50" $123.67 "$1,519.00" $439.25 $439.25 $439.25 $439.25 $274.83 $274.83 $137.42 $123.67 $274.83 "$1,127.40" "$1,127.40" "$1,170.85" $791.40 $286.64 $439.73 $439.73 $898.49 $274.83 $274.83 $274.83 "$1,519.00" "$1,139.25" $274.83 $274.83 $274.83 $759.50 $759.50 "$1,203.05" $274.83 "$1,215.20" $453.47 $272.99 $274.83 $881.02 "$1,519.00" $398.50 $274.83 $214.43 $274.83 N/A N/A 31000121 EAP CPT® 88365 INSITU HYBRID FISH (SO) BOTH IP/OP $579.00 $428.50 $74.59 $579.00 $579.00 $579.00 $579.00 $579.00 $138.77 $138.77 $92.77 $579.00 $138.77 $102.18 $102.18 $106.11 $74.59 $103.59 $222.03 $223.50 $579.00 $138.77 $139.69 $138.77 $579.00 $434.25 $138.77 $138.77 $138.77 $313.80 $313.80 $458.57 $138.77 $463.20 $376.35 $579.00 $138.77 $335.82 $579.00 $137.95 $138.77 $579.00 $138.77 N/A N/A 31000122 EAP CPT® 88381 MGMT MICRODISSECTION PCR (SO) BOTH IP/OP $506.00 $374.50 $70.38 $506.00 $176.28 $176.28 $176.28 $176.28 $506.00 $506.00 $506.00 $70.38 $506.00 $161.51 $161.51 $167.72 $117.90 $197.25 $506.00 $506.00 $299.30 $506.00 $180.28 $506.00 $506.00 $379.50 $506.00 $506.00 $506.00 $253.00 $253.00 $400.75 $506.00 $404.80 $328.90 $187.86 $506.00 $293.48 $506.00 $506.00 $506.00 $147.56 $506.00 N/A N/A 31000123 EAP CPT® 81287 MGMT GENE ANALYSIS (SO) BOTH IP/OP $591.00 $437.50 $62.32 $591.00 $591.00 $591.00 $591.00 $591.00 $124.64 $124.64 $62.32 $591.00 $124.64 $438.64 $438.64 $455.54 $307.91 $123.17 $199.42 $199.42 $591.00 $124.64 $124.64 $124.64 $591.00 $443.25 $124.64 $124.64 $124.64 $295.50 $295.50 $468.07 $124.64 $472.80 $591.00 $591.00 $124.64 $342.78 $591.00 $180.73 $124.64 $591.00 $124.64 N/A N/A 31000124 EAP CPT® 81479 CALR MUTATION ANALYSIS (SO) BOTH IP/OP $954.00 $706.00 $198.84 $954.00 $954.00 $954.00 $954.00 $954.00 $954.00 $954.00 $954.00 $198.84 $954.00 $708.06 $708.06 $735.34 $497.03 $954.00 $954.00 $381.60 $564.29 $954.00 $954.00 $954.00 $954.00 $715.50 $954.00 $954.00 $954.00 $477.00 $477.00 $755.57 $954.00 $763.20 $620.10 $954.00 $954.00 $553.32 $954.00 $572.40 $954.00 $782.22 $954.00 N/A N/A 31000126 EAP CPT® 81406 CADASIL BOTH IP/OP "$4,379.00" "$3,240.50" $141.44 "$4,379.00" "$4,379.00" "$4,379.00" "$4,379.00" "$4,379.00" $282.88 $282.88 $141.44 "$4,379.00" $282.88 "$3,250.09" "$3,250.09" "$3,375.33" "$2,060.15" $610.87 $452.61 $452.61 "$4,379.00" $282.88 $282.88 $282.88 "$4,379.00" "$3,284.25" $282.88 $282.88 $282.88 "$2,189.50" "$2,189.50" "$3,468.17" $282.88 "$3,503.20" "$4,379.00" "$4,379.00" $282.88 "$2,539.82" "$4,379.00" $410.18 $282.88 "$4,379.00" $282.88 N/A N/A 31000135 EAP CPT® 81218 AML PROGNOSTIC CEBPA (SO) BOTH IP/OP $529.00 $391.50 $120.95 $529.00 $529.00 $529.00 $529.00 $529.00 $241.90 $241.90 $120.95 $529.00 $241.90 $342.69 $342.69 $355.87 $250.16 $309.68 $387.04 $387.04 $529.00 $241.90 $241.90 $241.90 $529.00 $396.75 $241.90 $241.90 $241.90 $264.50 $264.50 $418.97 $241.90 $423.20 $529.00 $529.00 $241.90 $306.82 $529.00 $350.76 $241.90 $529.00 $241.90 N/A N/A 31000136 EAP CPT® 81245 AML PROGNOSTIC FLT3 (SO) BOTH IP/OP $381.00 $282.00 $82.76 $381.00 $381.00 $381.00 $381.00 $381.00 $165.51 $165.51 $82.76 $381.00 $165.51 $172.56 $172.56 $179.19 $125.96 $115.59 $264.82 $264.82 $381.00 $165.51 $165.51 $165.51 $381.00 $285.75 $165.51 $165.51 $165.51 $190.50 $190.50 $301.75 $165.51 $304.80 $381.00 $381.00 $165.51 $220.98 $381.00 $239.99 $165.51 $381.00 $165.51 N/A N/A 31000137 EAP CPT® 81246 AML PROGNOSTIC FLT3 ANAL (SO) BOTH IP/OP $275.00 $203.50 $41.50 $275.00 $275.00 $275.00 $275.00 $275.00 $83.00 $83.00 $41.50 $275.00 $83.00 $204.11 $204.11 $211.97 $143.28 $57.31 $132.80 $132.80 $275.00 $83.00 $83.00 $83.00 $275.00 $206.25 $83.00 $83.00 $83.00 $137.50 $137.50 $217.80 $83.00 $220.00 $275.00 $275.00 $83.00 $159.50 $275.00 $120.35 $83.00 $275.00 $83.00 N/A N/A 31000138 EAP CPT® 81310 AML PROGNOSTIC NPM1 (SO) BOTH IP/OP $708.00 $524.00 $46.99 $708.00 $708.00 $708.00 $708.00 $708.00 $246.52 $246.52 $123.26 $708.00 $246.52 $257.03 $257.03 $266.91 $187.63 $46.99 $394.43 $394.43 $708.00 $246.52 $246.52 $246.52 $708.00 $531.00 $246.52 $246.52 $246.52 $354.00 $354.00 $560.74 $246.52 $566.40 $708.00 $708.00 $246.52 $410.64 $708.00 $357.45 $246.52 $708.00 $246.52 N/A N/A 31000139 EAP CPT® 81450 MYELOID NEO MUTATION (SO) BOTH IP/OP "$2,350.00" "$1,739.00" $379.77 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $759.53 $759.53 $379.77 "$2,350.00" $759.53 "$1,744.17" "$1,744.17" "$1,811.38" "$1,224.35" $489.77 "$1,215.25" "$1,215.25" "$2,350.00" $759.53 $759.53 $759.53 "$2,350.00" "$1,762.50" $759.53 $759.53 $759.53 "$1,175.00" "$1,175.00" "$1,861.20" $759.53 "$1,880.00" "$2,350.00" "$2,350.00" $759.53 "$1,363.00" "$2,350.00" "$1,101.32" $759.53 "$2,350.00" $759.53 N/A N/A 31000145 EAP CPT® 81275 "KRAS GENE ANALYSIS; VARIANTS IN EXON 2 (EG, CODONS 12 & 13)" BOTH IP/OP $463.00 $343.00 $86.96 $463.00 $284.08 $284.08 $284.08 $284.08 $193.25 $193.25 $96.63 $86.96 $193.25 $205.38 $205.38 $213.28 $149.93 $220.85 $309.20 $309.20 $273.86 $193.25 $193.25 $193.25 $463.00 $347.25 $193.25 $193.25 $193.25 $231.50 $231.50 $366.70 $193.25 $370.40 $318.86 $210.33 $193.25 $268.54 $463.00 $280.21 $193.25 $165.21 $193.25 N/A N/A 31000146 EAP CPT® 81276 "KRAS GENE ANALYSIS; ADD'L VARIANT(S) (EG, CODON 61, CODON 146)" BOTH IP/OP $463.00 $343.00 $96.63 $463.00 $463.00 $463.00 $463.00 $463.00 $193.25 $193.25 $96.63 $463.00 $193.25 $205.08 $205.08 $212.97 $149.70 $185.31 $309.20 $309.20 $463.00 $193.25 $193.25 $193.25 $463.00 $347.25 $193.25 $193.25 $193.25 $231.50 $231.50 $366.70 $193.25 $370.40 $463.00 $463.00 $193.25 $268.54 $463.00 $280.21 $193.25 $463.00 $193.25 N/A N/A 31000147 EAP CPT® 81210 THYROSEQ - BRAF ANALYSIS (SO) BOTH IP/OP $305.00 $226.00 $78.93 $305.00 $257.85 $257.85 $257.85 $257.85 $175.40 $175.40 $87.70 $78.93 $175.40 $186.42 $186.42 $193.59 $136.08 $115.59 $280.64 $280.64 $180.41 $175.40 $175.40 $175.40 $305.00 $228.75 $175.40 $175.40 $175.40 $152.50 $152.50 $241.56 $175.40 $244.00 $289.41 $110.09 $175.40 $176.90 $305.00 $254.33 $175.40 $86.48 $175.40 N/A N/A 31000148 EAP CPT® 81275 THYROSEQ - KRAS ANALYSIS (SO) BOTH IP/OP $335.00 $248.00 $86.96 $335.00 $284.08 $284.08 $284.08 $284.08 $193.25 $193.25 $96.63 $86.96 $193.25 $205.38 $205.38 $213.28 $149.93 $220.85 $309.20 $309.20 $198.15 $193.25 $193.25 $193.25 $335.00 $251.25 $193.25 $193.25 $193.25 $167.50 $167.50 $265.32 $193.25 $268.00 $318.86 $210.33 $193.25 $194.30 $335.00 $280.21 $193.25 $165.21 $193.25 N/A N/A 31000149 EAP CPT® 81322 THYROSEQ - PTEN ANALYSIS (SO) BOTH IP/OP $91.00 $67.50 $21.40 $91.00 $84.01 $84.01 $84.01 $84.01 $46.60 $46.60 $23.30 $21.40 $46.60 $60.74 $60.74 $63.07 $44.34 $91.00 $74.56 $74.56 $53.83 $46.60 $46.60 $46.60 $91.00 $68.25 $46.60 $46.60 $46.60 $45.50 $45.50 $72.07 $46.60 $72.80 $76.89 $91.00 $46.60 $52.78 $91.00 $67.57 $46.60 $86.48 $46.60 N/A N/A 31000150 EAP CPT® 81401 THRYOSEQ - MOPATH LEVEL 2 (SO) BOTH IP/OP $238.00 $176.50 $61.65 $238.00 $61.75 $61.75 $61.75 $61.75 $137.00 $137.00 $68.50 $61.65 $137.00 $176.64 $176.64 $183.45 $124.00 $131.58 $219.20 $219.20 $140.78 $137.00 $137.00 $137.00 $238.00 $178.50 $137.00 $137.00 $137.00 $119.00 $119.00 $188.50 $137.00 $190.40 $226.05 $125.31 $137.00 $138.04 $238.00 $198.65 $137.00 $98.43 $137.00 N/A N/A 31000151 EAP CPT® 81403 THRYOSEQ - MOPATH LEVEL 4 (SO) BOTH IP/OP $322.00 $238.50 $83.34 $322.00 $251.00 $251.00 $251.00 $251.00 $185.20 $185.20 $92.60 $83.34 $185.20 $238.99 $238.99 $248.20 $167.76 $220.85 $296.32 $296.32 $190.46 $185.20 $185.20 $185.20 $322.00 $241.50 $185.20 $185.20 $185.20 $161.00 $161.00 $255.02 $185.20 $257.60 $305.58 $210.33 $185.20 $186.76 $322.00 $268.54 $185.20 $165.21 $185.20 N/A N/A 31000152 EAP CPT® 81404 THRYOSEQ - MOPATH LEVEL 5 (SO) BOTH IP/OP $477.00 $353.00 $123.67 $477.00 $439.25 $439.25 $439.25 $439.25 $274.83 $274.83 $137.42 $123.67 $274.83 $354.03 $354.03 $367.67 $248.52 $286.64 $439.73 $439.73 $282.15 $274.83 $274.83 $274.83 $477.00 $357.75 $274.83 $274.83 $274.83 $238.50 $238.50 $377.78 $274.83 $381.60 $453.47 $272.99 $274.83 $276.66 $477.00 $398.50 $274.83 $214.43 $274.83 N/A N/A 31000153 EAP CPT® 81405 THRYOSEQ - MOPATH LEVEL 6 (SO) BOTH IP/OP $523.00 $387.50 $135.61 $523.00 $439.25 $439.25 $439.25 $439.25 $301.35 $301.35 $150.68 $135.61 $301.35 $388.17 $388.17 $403.13 $272.48 $422.91 $482.16 $482.16 $309.35 $301.35 $301.35 $301.35 $523.00 $392.25 $301.35 $301.35 $301.35 $261.50 $261.50 $414.22 $301.35 $418.40 $497.23 $402.77 $301.35 $303.34 $523.00 $436.96 $301.35 $316.38 $301.35 N/A N/A 31000154 EAP CPT® 81479 THRYOSEQ - UNLISTED MOPATH (SO) BOTH IP/OP $2.00 $1.50 $0.42 $782.22 $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $0.42 $2.00 $1.48 $1.48 $1.54 $1.04 $2.00 $2.00 $0.80 $1.18 $2.00 $2.00 $2.00 $2.00 $1.50 $2.00 $2.00 $2.00 $1.00 $1.00 $1.58 $2.00 $1.60 $1.30 $2.00 $2.00 $1.16 $2.00 $1.20 $2.00 $782.22 $2.00 N/A N/A 31000155 EAP CPT® 81219 JAK2 R/X CALR (SO) BOTH IP/OP $436.00 $323.00 $60.81 $436.00 $238.70 $238.70 $238.70 $238.70 $121.63 $121.63 $60.82 $60.81 $121.63 $172.31 $172.31 $178.93 $125.78 $155.70 $194.61 $194.61 $257.89 $121.63 $121.63 $121.63 $436.00 $327.00 $121.63 $121.63 $121.63 $218.00 $218.00 $345.31 $121.63 $348.80 $200.69 $148.29 $121.63 $252.88 $436.00 $176.36 $121.63 $116.48 $121.63 N/A N/A 31000156 EAP CPT® 81270 JAK2 V617F (SO) BOTH IP/OP $436.00 $323.00 $45.83 $436.00 $179.89 $179.89 $179.89 $179.89 $91.66 $91.66 $45.83 $45.83 $91.66 $130.06 $130.06 $135.06 $94.94 $84.58 $146.66 $146.66 $257.89 $91.66 $91.66 $91.66 $436.00 $327.00 $91.66 $91.66 $91.66 $218.00 $218.00 $345.31 $91.66 $348.80 $151.24 $80.55 $91.66 $252.88 $436.00 $132.91 $91.66 $63.27 $91.66 N/A N/A 31000157 EAP CPT® 81479 JAK2 R/X-CSF3R (SO) BOTH IP/OP $436.00 $323.00 $90.87 $782.22 $436.00 $436.00 $436.00 $436.00 $436.00 $436.00 $436.00 $90.87 $436.00 $323.60 $323.60 $336.07 $227.16 $436.00 $436.00 $174.40 $257.89 $436.00 $436.00 $436.00 $436.00 $327.00 $436.00 $436.00 $436.00 $218.00 $218.00 $345.31 $436.00 $348.80 $283.40 $436.00 $436.00 $252.88 $436.00 $261.60 $436.00 $782.22 $436.00 N/A N/A 31000158 EAP CPT® 81279 "JAK2-EXONS-12,13 SEQ (SO)" BOTH IP/OP $436.00 $323.00 $90.87 $436.00 $264.96 $264.96 $264.96 $264.96 $185.20 $185.20 $92.60 $90.87 $185.20 $323.60 $323.60 $336.07 $227.16 $174.05 $296.32 $296.32 $257.89 $185.20 $185.20 $185.20 $436.00 $327.00 $185.20 $185.20 $185.20 $218.00 $218.00 $345.31 $185.20 $348.80 $305.58 $165.76 $185.20 $252.88 $436.00 $268.54 $185.20 $130.20 $185.20 N/A N/A 31000159 EAP CPT® 81403 JAK2 R/X-EXON12 (SO) BOTH IP/OP $431.00 $319.00 $83.34 $431.00 $251.00 $251.00 $251.00 $251.00 $185.20 $185.20 $92.60 $83.34 $185.20 $319.89 $319.89 $332.21 $224.55 $220.85 $296.32 $296.32 $254.94 $185.20 $185.20 $185.20 $431.00 $323.25 $185.20 $185.20 $185.20 $215.50 $215.50 $341.35 $185.20 $344.80 $305.58 $210.33 $185.20 $249.98 $431.00 $268.54 $185.20 $165.21 $185.20 N/A N/A 31000160 EAP CPT® 81311 NRAS GENE ANALYSIS VARIANTS EXON 2&3 (SO) BOTH IP/OP $463.00 $343.00 $147.90 $473.26 $463.00 $463.00 $463.00 $463.00 $295.79 $295.79 $147.90 $463.00 $295.79 $307.62 $307.62 $319.45 $224.56 $277.98 $473.26 $473.26 $463.00 $295.79 $295.79 $295.79 $463.00 $347.25 $295.79 $295.79 $295.79 $231.50 $231.50 $366.70 $295.79 $370.40 $463.00 $463.00 $295.79 $268.54 $463.00 $428.90 $295.79 $463.00 $295.79 N/A N/A 31000161 EAP CPT® 81403 HRAS GENE ANALYSIS (SO) BOTH IP/OP $463.00 $343.00 $83.34 $463.00 $251.00 $251.00 $251.00 $251.00 $185.20 $185.20 $92.60 $83.34 $185.20 $343.64 $343.64 $356.88 $241.22 $220.85 $296.32 $296.32 $273.86 $185.20 $185.20 $185.20 $463.00 $347.25 $185.20 $185.20 $185.20 $231.50 $231.50 $366.70 $185.20 $370.40 $305.58 $210.33 $185.20 $268.54 $463.00 $268.54 $185.20 $165.21 $185.20 N/A N/A 31000162 EAP CPT® 81450 "LEUKOVANTAGE, MYLOPROLIFERATIVE NEOPLASM (SO)" BOTH IP/OP "$4,269.00" "$3,159.50" $379.77 "$4,269.00" "$4,269.00" "$4,269.00" "$4,269.00" "$4,269.00" $759.53 $759.53 $379.77 "$4,269.00" $759.53 "$3,168.45" "$3,168.45" "$3,290.55" "$2,060.15" $889.71 "$1,215.25" "$1,215.25" "$4,269.00" $759.53 $759.53 $759.53 "$4,269.00" "$3,201.75" $759.53 $759.53 $759.53 "$2,134.50" "$2,134.50" "$3,381.05" $759.53 "$3,415.20" "$4,269.00" "$4,269.00" $759.53 "$2,476.02" "$4,269.00" "$1,101.32" $759.53 "$4,269.00" $759.53 N/A N/A 31000163 EAP CPT® 81450 LEUKOVANTAGE ACUTE MYELOID LEUKEMIA (SO) BOTH IP/OP "$4,500.00" "$3,330.00" $379.77 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $759.53 $759.53 $379.77 "$4,500.00" $759.53 "$3,339.90" "$3,339.90" "$3,468.60" "$2,060.15" $937.85 "$1,215.25" "$1,215.25" "$4,500.00" $759.53 $759.53 $759.53 "$4,500.00" "$3,375.00" $759.53 $759.53 $759.53 "$2,250.00" "$2,250.00" "$3,564.00" $759.53 "$3,600.00" "$4,500.00" "$4,500.00" $759.53 "$2,610.00" "$4,500.00" "$1,101.32" $759.53 "$4,500.00" $759.53 N/A N/A 31000164 EAP CPT® 81450 LEUKOVANTAGE MYELODYSPLASTIC SYNDROME (SO) BOTH IP/OP "$4,425.00" "$3,274.50" $379.77 "$4,425.00" "$4,425.00" "$4,425.00" "$4,425.00" "$4,425.00" $759.53 $759.53 $379.77 "$4,425.00" $759.53 "$3,284.24" "$3,284.24" "$3,410.79" "$2,060.15" $922.22 "$1,215.25" "$1,215.25" "$4,425.00" $759.53 $759.53 $759.53 "$4,425.00" "$3,318.75" $759.53 $759.53 $759.53 "$2,212.50" "$2,212.50" "$3,504.60" $759.53 "$3,540.00" "$4,425.00" "$4,425.00" $759.53 "$2,566.50" "$4,425.00" "$1,101.32" $759.53 "$4,425.00" $759.53 N/A N/A 31000165 EAP CPT® 81270 JAK2 V617F MUTATION ANALYSIS (SO) BOTH IP/OP $520.00 $385.00 $45.83 $520.00 $179.89 $179.89 $179.89 $179.89 $91.66 $91.66 $45.83 $45.83 $91.66 $130.06 $130.06 $135.06 $94.94 $84.58 $146.66 $146.66 $307.58 $91.66 $91.66 $91.66 $520.00 $390.00 $91.66 $91.66 $91.66 $260.00 $260.00 $411.84 $91.66 $416.00 $151.24 $80.55 $91.66 $301.60 $520.00 $132.91 $91.66 $63.27 $91.66 N/A N/A 31000170 EAP CPT® 88360 "PD-L1 LUNG (PEMBROLIZUMAB), IHC (SO)" BOTH IP/OP $855.00 $633.00 $49.88 $684.00 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $505.73 $146.71 $78.13 $146.71 $154.04 $641.25 $146.71 $146.71 $146.71 $242.68 $242.68 $677.16 $146.71 $684.00 $555.75 $109.25 $146.71 $495.90 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 31000171 EAP CPT® 88360 "PD-L1 LUNG (NIVOLUMAB), IHC (SO)" BOTH IP/OP $855.00 $633.00 $49.88 $684.00 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $505.73 $146.71 $78.13 $146.71 $154.04 $641.25 $146.71 $146.71 $146.71 $242.68 $242.68 $677.16 $146.71 $684.00 $555.75 $109.25 $146.71 $495.90 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 31000172 EAP CPT® 88360 "PD-L1 LUNG (ATEZOLIZUMAB), IHC (SO)" BOTH IP/OP $855.00 $633.00 $49.88 $684.00 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $505.73 $146.71 $78.13 $146.71 $154.04 $641.25 $146.71 $146.71 $146.71 $242.68 $242.68 $677.16 $146.71 $684.00 $555.75 $109.25 $146.71 $495.90 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 31000173 EAP CPT® 88360 "PD-L1 BLADDER (ATEZOLIZUMAB), IHC (SO)" BOTH IP/OP $855.00 $633.00 $49.88 $684.00 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $505.73 $146.71 $78.13 $146.71 $154.04 $641.25 $146.71 $146.71 $146.71 $242.68 $242.68 $677.16 $146.71 $684.00 $555.75 $109.25 $146.71 $495.90 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 31000174 EAP CPT® 88360 "PD-L1 NON-LUNG (PEMBROLIZUMAB), IHC (SO)" BOTH IP/OP $944.00 $699.00 $49.88 $755.20 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $558.38 $146.71 $78.13 $146.71 $154.04 $708.00 $146.71 $146.71 $146.71 $242.68 $242.68 $747.65 $146.71 $755.20 $613.60 $109.25 $146.71 $547.52 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 31000175 EAP CPT® 88184 "PD-L1 MONOCYTE EXPRESSION, SLE FLARE, 1ST MARKER (SO)" BOTH IP/OP $323.00 $239.50 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $191.05 $286.49 $75.09 $286.49 $300.82 $242.25 $286.49 $286.49 $286.49 $267.48 $267.48 $255.82 $286.49 $258.40 $209.95 $51.58 $286.49 $187.34 $300.82 $323.00 $286.49 $40.52 $286.49 N/A N/A 31000176 EAP CPT® 88185 "PD-L1 MONOCYTE EXPRESSION, SLE FLARE, ADDL MARKER (SO)" BOTH IP/OP $323.00 $239.50 $11.19 $323.00 $53.97 $53.97 $53.97 $53.97 $323.00 $323.00 $323.00 $11.19 $323.00 $48.93 $48.93 $50.81 $35.72 $26.63 $35.36 $203.00 $191.05 $323.00 $24.01 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $143.44 $143.44 $255.82 $323.00 $258.40 $209.95 $25.36 $323.00 $187.34 $323.00 $323.00 $323.00 $19.92 $323.00 N/A N/A 31000180 EAP HCPCS 0225U NFCT DS DNA&RNA 21 TARGETS SARS-COV-2 AMP PROBE BOTH IP/OP $466.00 $345.00 $97.12 $666.85 $466.00 $466.00 $466.00 $466.00 $416.78 $416.78 $416.78 $466.00 $416.78 $345.87 $345.87 $359.19 $242.79 $97.12 $666.85 $666.85 $466.00 $416.78 $416.78 $416.78 $466.00 $349.50 $416.78 $416.78 $416.78 $233.00 $233.00 $369.07 $416.78 $372.80 $466.00 $466.00 $416.78 $270.28 $466.00 $466.00 $416.78 $466.00 $416.78 N/A N/A 31000185 EAP CPT® 81225 CYP2C19 GENOTYPE BOTH IP/OP $744.00 $551.00 $145.68 $744.00 $744.00 $744.00 $744.00 $744.00 $291.36 $291.36 $145.68 $744.00 $291.36 $303.47 $303.47 $315.14 $221.53 $286.64 $466.18 $466.18 $744.00 $291.36 $291.36 $291.36 $744.00 $558.00 $291.36 $291.36 $291.36 $372.00 $372.00 $589.25 $291.36 $595.20 $744.00 $744.00 $291.36 $431.52 $744.00 $422.47 $291.36 $744.00 $291.36 N/A N/A 31000193 EAP CPT® 81309 PIK3CA MUTATION ANALYSIS (SO) BOTH IP/OP $625.00 $462.50 $137.42 $625.00 $625.00 $625.00 $625.00 $625.00 $274.83 $274.83 $137.42 $625.00 $274.83 $285.82 $285.82 $296.82 $208.65 $258.28 $439.73 $439.73 $625.00 $274.83 $274.83 $274.83 $625.00 $468.75 $274.83 $274.83 $274.83 $312.50 $312.50 $495.00 $274.83 $500.00 $625.00 $625.00 $274.83 $362.50 $625.00 $398.50 $274.83 $625.00 $274.83 N/A N/A 31000195 EAP CPT® 81450 LEUKOVANTAGE MYELOID (SO) BOTH IP/OP "$3,644.00" "$2,697.00" $379.77 "$3,644.00" "$3,644.00" "$3,644.00" "$3,644.00" "$3,644.00" $759.53 $759.53 $379.77 "$3,644.00" $759.53 "$2,704.58" "$2,704.58" "$2,808.80" "$1,898.52" $759.45 "$1,215.25" "$1,215.25" "$3,644.00" $759.53 $759.53 $759.53 "$3,644.00" "$2,733.00" $759.53 $759.53 $759.53 "$1,822.00" "$1,822.00" "$2,886.05" $759.53 "$2,915.20" "$3,644.00" "$3,644.00" $759.53 "$2,113.52" "$3,644.00" "$1,101.32" $759.53 "$3,644.00" $759.53 N/A N/A 31000445 EAP CPT® 81445 SOLID TUMOR CORE PANEL - 1 OF 3 (SO) BOTH IP/OP "$2,333.00" "$1,726.50" $298.96 "$2,333.00" "$2,333.00" "$2,333.00" "$2,333.00" "$2,333.00" $597.91 $597.91 $298.96 "$2,333.00" $597.91 "$1,731.55" "$1,731.55" "$1,798.28" "$1,215.49" $486.22 $956.66 $956.66 "$2,333.00" $597.91 $597.91 $597.91 "$2,333.00" "$1,749.75" $597.91 $597.91 $597.91 "$1,166.50" "$1,166.50" "$1,847.74" $597.91 "$1,866.40" "$2,333.00" "$2,333.00" $597.91 "$1,353.14" "$2,333.00" $866.97 $597.91 "$2,333.00" $597.91 N/A N/A 31000447 EAP CPT® 81479 SOLID TUMOR CORE PANEL - 3 OF 3 (SO) BOTH IP/OP "$2,333.00" "$1,726.50" $486.26 "$2,333.00" "$2,333.00" "$2,333.00" "$2,333.00" "$2,333.00" "$2,333.00" "$2,333.00" "$2,333.00" $486.26 "$2,333.00" "$1,731.55" "$1,731.55" "$1,798.28" "$1,215.49" "$1,045.61" "$2,333.00" $933.20 "$1,379.97" "$2,333.00" "$2,333.00" "$2,333.00" "$2,333.00" "$1,749.75" "$2,333.00" "$2,333.00" "$2,333.00" "$1,166.50" "$1,166.50" "$1,847.74" "$2,333.00" "$1,866.40" "$1,516.45" $995.82 "$2,333.00" "$1,353.14" "$2,333.00" "$1,399.80" "$2,333.00" $782.22 "$2,333.00" N/A N/A 31000450 EAP CPT® 81381 HLA-B*58:01 TYPING (SO) BOTH IP/OP $792.00 $586.50 $35.15 $792.00 $185.61 $185.61 $185.61 $185.61 $169.90 $169.90 $84.95 $76.46 $169.90 $134.19 $134.19 $139.35 $97.96 $46.99 $271.84 $271.84 $468.47 $169.90 $169.90 $169.90 $792.00 $594.00 $169.90 $169.90 $169.90 $396.00 $396.00 $627.26 $169.90 $633.60 $280.34 $44.75 $169.90 $459.36 $792.00 $246.36 $169.90 $35.15 $169.90 N/A N/A 31000451 EAP CPT® 81305 MYD88 MUTATION ANALYSIS (SO) BOTH IP/OP $957.00 $708.50 $87.70 $957.00 $957.00 $957.00 $957.00 $957.00 $175.40 $175.40 $87.70 $957.00 $175.40 $182.42 $182.42 $189.43 $133.16 $164.84 $280.64 $280.64 $957.00 $175.40 $175.40 $175.40 $957.00 $717.75 $175.40 $175.40 $175.40 $478.50 $478.50 $757.94 $175.40 $765.60 $957.00 $957.00 $175.40 $555.06 $957.00 $254.33 $175.40 $957.00 $175.40 N/A N/A 31000452 EAP CPT® 81288 MLH1 METHYLATION (SO) BOTH IP/OP $813.00 $602.00 $86.54 $813.00 $229.99 $229.99 $229.99 $229.99 $192.32 $192.32 $96.16 $86.54 $192.32 $603.41 $603.41 $626.66 $423.57 $169.44 $307.71 $307.71 $480.89 $192.32 $192.32 $192.32 $813.00 $609.75 $192.32 $192.32 $192.32 $406.50 $406.50 $643.90 $192.32 $650.40 $317.33 $161.36 $192.32 $471.54 $813.00 $278.86 $192.32 $169.43 $192.32 N/A N/A 31000453 EAP CPT® 81352 TP53 GENE TRGT SEQUENCE ALYS (SO) BOTH IP/OP "$2,625.00" "$1,942.50" $164.76 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $329.51 $329.51 $164.76 "$2,625.00" $329.51 "$1,948.28" "$1,948.28" "$2,023.35" "$1,367.63" $309.68 $527.22 $527.22 "$2,625.00" $329.51 $329.51 $329.51 "$2,625.00" "$1,968.75" $329.51 $329.51 $329.51 "$1,312.50" "$1,312.50" "$2,079.00" $329.51 "$2,100.00" "$2,625.00" "$2,625.00" $329.51 "$1,522.50" "$2,625.00" $477.79 $329.51 "$2,625.00" $329.51 N/A N/A 31000455 EAP CPT® 81229 "CHROMOSOMAL MICROARRAY, POC, CLARISURE® OLIGO-SNP (SO)" BOTH IP/OP "$2,222.50" "$1,645.00" $522.00 "$2,222.50" $768.06 $768.06 $768.06 $768.06 "$1,160.00" "$1,160.00" $580.00 $522.00 "$1,160.00" "$1,649.54" "$1,649.54" "$1,713.10" "$1,157.92" "$2,222.50" "$1,856.00" "$1,856.00" "$1,314.61" "$1,160.00" "$1,160.00" "$1,160.00" "$2,222.50" "$1,666.88" "$1,160.00" "$1,160.00" "$1,160.00" "$1,111.25" "$1,111.25" "$1,760.22" "$1,160.00" "$1,778.00" "$1,914.00" "$2,222.50" "$1,160.00" "$1,289.05" "$2,222.50" "$1,682.00" "$1,160.00" "$2,038.86" "$1,160.00" N/A N/A 31100001 EAP CPT® 88289 ADD HIGH RESO BOTH IP/OP $460.00 $340.50 $17.22 $460.00 $460.00 $460.00 $460.00 $460.00 $34.43 $34.43 $17.22 $460.00 $34.43 $52.29 $52.29 $54.30 $38.17 $50.86 $55.09 $55.09 $460.00 $34.43 $34.43 $34.43 $460.00 $345.00 $34.43 $34.43 $34.43 $192.44 $192.44 $364.32 $34.43 $368.00 $460.00 $460.00 $34.43 $266.80 $460.00 $49.92 $34.43 $460.00 $34.43 N/A N/A 31100002 EAP CPT® 88283 ADDITION BAND CHARGE BOTH IP/OP $455.00 $337.00 $34.30 $455.00 $455.00 $455.00 $455.00 $455.00 $68.60 $68.60 $34.30 $455.00 $68.60 $54.14 $54.14 $56.22 $39.52 $94.83 $109.76 $109.76 $455.00 $68.60 $68.60 $68.60 $455.00 $341.25 $68.60 $68.60 $68.60 $199.28 $199.28 $360.36 $68.60 $364.00 $455.00 $455.00 $68.60 $263.90 $455.00 $99.47 $68.60 $455.00 $68.60 N/A N/A 31100003 EAP CPT® 88285 ADDITION CELL CHARGE BOTH IP/OP $244.00 $181.00 $13.46 $244.00 $244.00 $244.00 $244.00 $244.00 $26.91 $26.91 $13.46 $244.00 $26.91 $28.85 $28.85 $29.96 $21.06 $28.07 $43.06 $43.06 $244.00 $26.91 $26.91 $26.91 $244.00 $183.00 $26.91 $26.91 $26.91 $106.16 $106.16 $193.25 $26.91 $195.20 $244.00 $244.00 $26.91 $141.52 $244.00 $39.02 $26.91 $244.00 $26.91 N/A N/A 31100004 EAP CPT® 88280 ADDITION KARYO CHARGE BOTH IP/OP $297.00 $220.00 $15.06 $297.00 $49.25 $49.25 $49.25 $49.25 $33.47 $33.47 $16.74 $15.06 $33.47 $38.11 $38.11 $39.57 $27.82 $37.08 $53.55 $53.55 $175.68 $33.47 $33.47 $33.47 $297.00 $222.75 $33.47 $33.47 $33.47 $140.28 $140.28 $235.22 $33.47 $237.60 $55.23 $35.31 $33.47 $172.26 $297.00 $48.53 $33.47 $27.74 $33.47 N/A N/A 31100005 EAP CPT® 88267 CA - 15 CELLS CHARGE BOTH IP/OP "$2,037.00" "$1,507.50" $89.89 "$2,037.00" $352.83 $352.83 $352.83 $352.83 $188.57 $188.57 $94.29 $89.89 $188.57 $272.97 $272.97 $283.47 $199.26 $265.55 $301.71 $301.71 "$1,204.89" $188.57 $188.57 $188.57 "$2,037.00" "$1,527.75" $188.57 $188.57 $188.57 "$1,004.68" "$1,004.68" "$1,613.30" $188.57 "$1,629.60" $311.14 $252.90 $188.57 "$1,181.46" "$2,037.00" $273.43 $188.57 $198.65 $188.57 N/A N/A 31100006 EAP CPT® 88248 CA - FRAGILE X CHARGE BOTH IP/OP "$2,617.00" "$1,937.00" $86.59 "$2,617.00" $339.85 $339.85 $339.85 $339.85 $173.17 $173.17 $86.59 $86.59 $173.17 $262.95 $262.95 $273.07 $191.95 $255.81 $277.07 $277.07 "$1,547.96" $173.17 $173.17 $173.17 "$2,617.00" "$1,962.75" $173.17 $173.17 $173.17 $967.84 $967.84 "$2,072.66" $173.17 "$2,093.60" $285.73 $243.63 $173.17 "$1,517.86" "$2,617.00" $251.10 $173.17 $191.37 $173.17 N/A N/A 31100007 EAP CPT® 88264 CELL ANALYSIS CHRG BOTH IP/OP "$1,265.00" $936.50 $65.07 "$1,265.00" $244.62 $244.62 $244.62 $244.62 $144.61 $144.61 $72.31 $65.07 $144.61 $189.26 $189.26 $196.54 $138.16 $184.12 $231.38 $231.38 $748.25 $144.61 $144.61 $144.61 "$1,265.00" $948.75 $144.61 $144.61 $144.61 $696.56 $696.56 "$1,001.88" $144.61 "$1,012.00" $238.61 $175.35 $144.61 $733.70 "$1,265.00" $209.68 $144.61 $137.74 $144.61 N/A N/A 31100008 EAP CPT® 88262 CELL CNT/KARYO TYP BOTH IP/OP "$1,886.00" "$1,396.00" $62.32 "$1,886.00" $244.62 $244.62 $244.62 $244.62 $125.49 $125.49 $62.75 $62.32 $125.49 $189.26 $189.26 $196.54 $138.16 $184.12 $200.78 $200.78 "$1,115.57" $125.49 $125.49 $125.49 "$1,886.00" "$1,414.50" $125.49 $125.49 $125.49 $696.56 $696.56 "$1,493.71" $125.49 "$1,508.80" $207.06 $175.35 $125.49 "$1,093.88" "$1,886.00" $181.96 $125.49 $137.74 $125.49 N/A N/A 31100009 EAP CPT® 88164 "CYTOLOGY, FEMALE GEN" BOTH IP/OP $64.00 $47.50 $7.58 $64.00 $64.00 $64.00 $64.00 $64.00 $15.92 $15.92 $7.58 $64.00 $15.92 $16.04 $16.04 $16.65 $11.71 $15.60 $25.47 $25.47 $64.00 $15.92 $15.92 $15.92 $64.00 $48.00 $15.92 $15.92 $15.92 $59.04 $59.04 $50.69 $15.92 $51.20 $64.00 $64.00 $15.92 $37.12 $64.00 $21.97 $15.92 $64.00 $15.92 N/A N/A 31100010 EAP CPT® 88142 "CYTOLOGY, GYN LBP" BOTH IP/OP $288.00 $213.50 $10.13 $288.00 $39.76 $39.76 $39.76 $39.76 $20.26 $20.26 $10.13 $10.13 $20.26 $30.76 $30.76 $31.95 $22.46 $29.94 $32.42 $32.42 $170.35 $20.26 $20.26 $20.26 $288.00 $216.00 $20.26 $20.26 $20.26 $40.52 $40.52 $228.10 $20.26 $230.40 $33.43 $28.51 $20.26 $167.04 $288.00 $29.38 $20.26 $22.39 $20.26 N/A N/A 31100011 EAP CPT® 88104 "CYTOLOGY,PULMONARY" BOTH IP/OP $353.00 $261.50 $25.45 $282.40 $107.93 $107.93 $107.93 $107.93 $33.30 $33.30 $33.15 $32.11 $33.30 $34.86 $34.86 $36.20 $25.45 $50.14 $53.27 $48.99 $208.80 $33.30 $42.96 $33.30 $34.96 $264.75 $33.30 $33.30 $33.30 $120.32 $120.32 $279.58 $33.30 $282.40 $229.45 $47.75 $33.30 $204.74 $34.96 $48.17 $33.30 $37.51 $33.30 N/A N/A 31100017 EAP CPT® 88172 CYTOPATHOLOGY EVAL OF FINA BOTH IP/OP $176.00 $130.50 $17.12 $234.73 $83.26 $83.26 $83.26 $83.26 $146.71 $146.71 $146.06 $25.95 $146.71 $23.45 $23.45 $24.35 $17.12 $66.47 $234.73 $226.86 $104.10 $146.71 $20.97 $146.71 $154.04 $132.00 $146.71 $146.71 $146.71 $88.88 $88.88 $139.39 $146.71 $140.80 $114.40 $63.30 $146.71 $102.08 $154.04 $176.00 $146.71 $49.72 $146.71 N/A N/A 31100018 EAP CPT® 88184 CYTOPLASMIC CHARGE BOTH IP/OP $421.00 $312.00 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $249.02 $286.49 $75.09 $286.49 $300.82 $315.75 $286.49 $286.49 $286.49 $267.48 $267.48 $333.43 $286.49 $336.80 $273.65 $51.58 $286.49 $244.18 $300.82 $414.48 $286.49 $40.52 $286.49 N/A N/A 31100019 EAP CPT® 88172 FINE NEEDLE ASPIRATION BOTH IP/OP $176.00 $130.50 $17.12 $234.73 $83.26 $83.26 $83.26 $83.26 $146.71 $146.71 $146.06 $25.95 $146.71 $23.45 $23.45 $24.35 $17.12 $66.47 $234.73 $226.86 $104.10 $146.71 $20.97 $146.71 $154.04 $132.00 $146.71 $146.71 $146.71 $88.88 $88.88 $139.39 $146.71 $140.80 $114.40 $63.30 $146.71 $102.08 $154.04 $176.00 $146.71 $49.72 $146.71 N/A N/A 31100020 EAP CPT® 88185 FLOW CYTOMETRY - ADDT'L MARKER BOTH IP/OP $169.00 $125.50 $11.19 $169.00 $53.97 $53.97 $53.97 $53.97 $169.00 $169.00 $169.00 $11.19 $169.00 $48.93 $48.93 $50.81 $35.72 $26.63 $169.00 $169.00 $99.96 $169.00 $24.01 $169.00 $169.00 $126.75 $169.00 $169.00 $169.00 $143.44 $143.44 $133.85 $169.00 $135.20 $109.85 $25.36 $169.00 $98.02 $169.00 $169.00 $169.00 $19.92 $169.00 N/A N/A 31100021 EAP CPT® 88188 "FLOW CYTOMETRY, INTERP." BOTH IP/OP $305.00 $226.00 $31.30 $305.00 $305.00 $305.00 $305.00 $305.00 $62.68 $62.68 $31.30 $305.00 $62.68 $226.37 $226.37 $235.09 $158.91 $87.63 $100.29 $98.67 $305.00 $62.68 $61.67 $62.68 $305.00 $228.75 $62.68 $62.68 $62.68 $305.00 $305.00 $241.56 $62.68 $244.00 $198.25 $305.00 $62.68 $176.90 $305.00 $65.99 $62.68 $305.00 $62.68 N/A N/A 31100022 EAP CPT® 88161 "FNA-BREAST,CYTO" BOTH IP/OP $207.00 $153.50 $22.39 $165.60 $95.08 $95.08 $95.08 $95.08 $24.30 $24.30 $24.19 $30.33 $24.30 $30.67 $30.67 $31.85 $22.39 $40.98 $38.88 $36.00 $122.44 $24.30 $52.43 $24.30 $25.52 $155.25 $24.30 $24.30 $24.30 $133.56 $133.56 $163.94 $24.30 $165.60 $134.55 $39.03 $24.30 $120.06 $25.52 $35.16 $24.30 $30.66 $24.30 N/A N/A 31100023 EAP CPT® 88104 "FNA-CELL BLK,,MISC" BOTH IP/OP $353.00 $261.50 $25.45 $282.40 $107.93 $107.93 $107.93 $107.93 $33.30 $33.30 $33.15 $32.11 $33.30 $34.86 $34.86 $36.20 $25.45 $50.14 $53.27 $48.99 $208.80 $33.30 $42.96 $33.30 $34.96 $264.75 $33.30 $33.30 $33.30 $120.32 $120.32 $279.58 $33.30 $282.40 $229.45 $47.75 $33.30 $204.74 $34.96 $48.17 $33.30 $37.51 $33.30 N/A N/A 31100024 EAP CPT® 88104 "FNA-CELL BLK,BREAST" BOTH IP/OP $353.00 $261.50 $25.45 $282.40 $107.93 $107.93 $107.93 $107.93 $33.30 $33.30 $33.15 $32.11 $33.30 $34.86 $34.86 $36.20 $25.45 $50.14 $53.27 $48.99 $208.80 $33.30 $42.96 $33.30 $34.96 $264.75 $33.30 $33.30 $33.30 $120.32 $120.32 $279.58 $33.30 $282.40 $229.45 $47.75 $33.30 $204.74 $34.96 $48.17 $33.30 $37.51 $33.30 N/A N/A 31100025 EAP CPT® 88161 "FNA-MISC,CYTO" BOTH IP/OP $205.00 $152.00 $22.39 $164.00 $95.08 $95.08 $95.08 $95.08 $24.30 $24.30 $24.19 $30.33 $24.30 $30.67 $30.67 $31.85 $22.39 $40.98 $38.88 $36.00 $121.26 $24.30 $52.43 $24.30 $25.52 $153.75 $24.30 $24.30 $24.30 $133.56 $133.56 $162.36 $24.30 $164.00 $133.25 $39.03 $24.30 $118.90 $25.52 $35.16 $24.30 $30.66 $24.30 N/A N/A 31100026 EAP CPT® 88104 "FNA-PULMONARY,CYTO" BOTH IP/OP $353.00 $261.50 $25.45 $282.40 $107.93 $107.93 $107.93 $107.93 $33.30 $33.30 $33.15 $32.11 $33.30 $34.86 $34.86 $36.20 $25.45 $50.14 $53.27 $48.99 $208.80 $33.30 $42.96 $33.30 $34.96 $264.75 $33.30 $33.30 $33.30 $120.32 $120.32 $279.58 $33.30 $282.40 $229.45 $47.75 $33.30 $204.74 $34.96 $48.17 $33.30 $37.51 $33.30 N/A N/A 31100027 EAP CPT® 88184 HAIRY CELL LEUKEMIA BOTH IP/OP $424.00 $314.00 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $250.80 $286.49 $75.09 $286.49 $300.82 $318.00 $286.49 $286.49 $286.49 $267.48 $267.48 $335.81 $286.49 $339.20 $275.60 $51.58 $286.49 $245.92 $300.82 $414.48 $286.49 $40.52 $286.49 N/A N/A 31100029 EAP CPT® 88280 KARYO TYPING CHARGE BOTH IP/OP $300.00 $222.00 $15.06 $300.00 $49.25 $49.25 $49.25 $49.25 $33.47 $33.47 $16.74 $15.06 $33.47 $38.11 $38.11 $39.57 $27.82 $37.08 $53.55 $53.55 $177.45 $33.47 $33.47 $33.47 $300.00 $225.00 $33.47 $33.47 $33.47 $140.28 $140.28 $237.60 $33.47 $240.00 $55.23 $35.31 $33.47 $174.00 $300.00 $48.53 $33.47 $27.74 $33.47 N/A N/A 31100030 EAP CPT® 88184 LYMPHOMA PROF-BASIC BOTH IP/OP $424.00 $314.00 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $250.80 $286.49 $75.09 $286.49 $300.82 $318.00 $286.49 $286.49 $286.49 $267.48 $267.48 $335.81 $286.49 $339.20 $275.60 $51.58 $286.49 $245.92 $300.82 $414.48 $286.49 $40.52 $286.49 N/A N/A 31100031 EAP CPT® 88184 NUCLEAR CHARGE BOTH IP/OP $424.00 $314.00 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $250.80 $286.49 $75.09 $286.49 $300.82 $318.00 $286.49 $286.49 $286.49 $267.48 $267.48 $335.81 $286.49 $339.20 $275.60 $51.58 $286.49 $245.92 $300.82 $414.48 $286.49 $40.52 $286.49 N/A N/A 31100033 EAP CPT® 88130 SEX CHROMATIN:BUCCAL BOTH IP/OP $166.00 $123.00 $8.99 $166.00 $166.00 $166.00 $166.00 $166.00 $17.98 $17.98 $8.99 $166.00 $17.98 $22.85 $22.85 $23.73 $16.68 $22.23 $28.77 $28.77 $166.00 $17.98 $17.98 $17.98 $166.00 $124.50 $17.98 $17.98 $17.98 $84.08 $84.08 $131.47 $17.98 $132.80 $166.00 $166.00 $17.98 $96.28 $166.00 $26.07 $17.98 $166.00 $17.98 N/A N/A 31100034 EAP CPT® 88235 "TIS CULT, AMINO CHARG" BOTH IP/OP "$2,229.00" "$1,649.50" $75.15 "$2,229.00" "$2,229.00" "$2,229.00" "$2,229.00" "$2,229.00" $150.30 $150.30 $75.15 "$2,229.00" $150.30 $223.60 $223.60 $232.20 $163.23 $217.53 $240.48 $240.48 "$2,229.00" $150.30 $150.30 $150.30 "$2,229.00" "$1,671.75" $150.30 $150.30 $150.30 $822.96 $822.96 "$1,765.37" $150.30 "$1,783.20" "$2,229.00" "$2,229.00" $150.30 "$1,292.82" "$2,229.00" $217.94 $150.30 "$2,229.00" $150.30 N/A N/A 31100035 EAP CPT® 88230 "TIS CULT, LYMPH CHARGE" BOTH IP/OP "$1,765.00" "$1,306.50" $58.25 "$1,765.00" $228.64 $228.64 $228.64 $228.64 $116.49 $116.49 $58.25 $58.25 $116.49 $176.90 $176.90 $183.71 $129.14 $172.08 $186.38 $186.38 "$1,044.00" $116.49 $116.49 $116.49 "$1,765.00" "$1,323.75" $116.49 $116.49 $116.49 $651.08 $651.08 "$1,397.88" $116.49 "$1,412.00" $192.21 $163.89 $116.49 "$1,023.70" "$1,765.00" $168.91 $116.49 $128.74 $116.49 N/A N/A 31100036 EAP CPT® 88239 "TIS CULT, OTHER CHARGE" BOTH IP/OP "$2,232.00" "$1,652.00" $73.76 "$2,232.00" $289.53 $289.53 $289.53 $289.53 $147.52 $147.52 $73.76 $73.76 $147.52 $224.01 $224.01 $232.62 $163.52 $217.93 $236.03 $236.03 "$1,320.23" $147.52 $147.52 $147.52 "$2,232.00" "$1,674.00" $147.52 $147.52 $147.52 $824.48 $824.48 "$1,767.74" $147.52 "$1,785.60" $243.41 $207.55 $147.52 "$1,294.56" "$2,232.00" $213.90 $147.52 $163.03 $147.52 N/A N/A 31100037 EAP CPT® 88237 "TISSUE CULTURE, CHRG" BOTH IP/OP $655.00 $485.00 $64.69 $655.00 $173.27 $173.27 $173.27 $173.27 $143.75 $143.75 $71.88 $64.69 $143.75 $134.06 $134.06 $139.21 $97.86 $130.42 $230.00 $230.00 $387.43 $143.75 $143.75 $143.75 $655.00 $491.25 $143.75 $143.75 $143.75 $493.40 $493.40 $518.76 $143.75 $524.00 $237.19 $124.21 $143.75 $379.90 $655.00 $208.44 $143.75 $97.57 $143.75 N/A N/A 31100038 EAP CPT® 88184 PLASMA CELL NEO FLOW TC/MARKER 1 (SO) BOTH IP/OP $500.00 $370.00 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $295.75 $286.49 $75.09 $286.49 $300.82 $375.00 $286.49 $286.49 $286.49 $267.48 $267.48 $396.00 $286.49 $400.00 $325.00 $51.58 $286.49 $290.00 $300.82 $414.48 $286.49 $40.52 $286.49 N/A N/A 31100039 EAP CPT® 88185 PLASMA CELL NEO FLOW TC/ADD ON (SO) BOTH IP/OP $90.00 $67.00 $11.19 $90.00 $53.97 $53.97 $53.97 $53.97 $90.00 $90.00 $90.00 $11.19 $90.00 $48.93 $48.93 $50.81 $35.72 $26.63 $90.00 $90.00 $53.24 $90.00 $24.01 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $90.00 $90.00 $71.28 $90.00 $72.00 $58.50 $25.36 $90.00 $52.20 $90.00 $90.00 $90.00 $19.92 $90.00 N/A N/A 31100040 EAP CPT® 88187 PLASMA CELL NEO FLOW READ 2 - 8(SO) BOTH IP/OP $90.00 $67.00 $18.24 $90.00 $90.00 $90.00 $90.00 $90.00 $35.84 $35.84 $18.24 $90.00 $35.84 $66.80 $66.80 $69.37 $46.89 $70.22 $57.34 $56.40 $90.00 $35.84 $35.25 $35.84 $90.00 $67.50 $35.84 $35.84 $35.84 $90.00 $90.00 $71.28 $35.84 $72.00 $58.50 $90.00 $35.84 $52.20 $90.00 $39.31 $35.84 $90.00 $35.84 N/A N/A 31100042 EAP CPT® 88271 FISH AML M3 RARA DNA (SO) BOTH IP/OP $407.00 $301.50 $10.71 $407.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $240.74 $21.42 $21.42 $21.42 $407.00 $305.25 $21.42 $21.42 $21.42 $119.72 $119.72 $322.34 $21.42 $325.60 $35.34 $30.14 $21.42 $236.06 $407.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31100043 EAP CPT® 88275 FISH AML M3 RARA 100-300 (SO) BOTH IP/OP $615.00 $455.50 $23.04 $615.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $363.77 $51.19 $51.19 $51.19 $615.00 $461.25 $51.19 $51.19 $51.19 $224.44 $224.44 $487.08 $51.19 $492.00 $84.46 $56.50 $51.19 $356.70 $615.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31100044 EAP CPT® 88364 "FISH, OLIGODEN 1P/19Q (SO)" BOTH IP/OP $566.00 $419.00 $72.08 $566.00 $566.00 $566.00 $566.00 $566.00 $105.65 $105.65 $72.08 $566.00 $105.65 $101.50 $101.50 $105.41 $74.10 $97.04 $169.04 $166.67 $566.00 $105.65 $104.17 $105.65 $566.00 $424.50 $105.65 $105.65 $105.65 $283.00 $283.00 $448.27 $105.65 $452.80 $367.90 $566.00 $105.65 $328.28 $566.00 $104.09 $105.65 $566.00 $105.65 N/A N/A 31100046 EAP CPT® 88299 FSHD CYTOGENETIC STUDY (SO) BOTH IP/OP "$2,331.00" "$1,725.00" $485.81 "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$1,730.07" "$1,730.07" "$1,796.73" "$1,214.45" $485.81 "$2,331.00" $932.40 "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$1,748.25" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$1,846.15" "$2,331.00" "$1,864.80" "$1,515.15" "$2,331.00" "$2,331.00" "$1,351.98" "$2,331.00" "$1,398.60" "$2,331.00" "$2,331.00" "$2,331.00" N/A N/A 31100047 EAP CPT® 88275 FISH HES 4QREA 100-300 (SO) BOTH IP/OP $389.00 $288.00 $23.04 $389.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $230.09 $51.19 $51.19 $51.19 $389.00 $291.75 $51.19 $51.19 $51.19 $224.44 $224.44 $308.09 $51.19 $311.20 $84.46 $56.50 $51.19 $225.62 $389.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31100048 EAP CPT® 88271 FISH HES 4QREA LEUK DNA (SO) BOTH IP/OP $389.00 $288.00 $10.71 $389.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $230.09 $21.42 $21.42 $21.42 $389.00 $291.75 $21.42 $21.42 $21.42 $119.72 $119.72 $308.09 $21.42 $311.20 $35.34 $30.14 $21.42 $225.62 $389.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31100049 EAP CPT® 88271 FISH FGFR1 8P11-12 DNA(SO) BOTH IP/OP $225.00 $166.50 $10.71 $225.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $133.09 $21.42 $21.42 $21.42 $225.00 $168.75 $21.42 $21.42 $21.42 $119.72 $119.72 $178.20 $21.42 $180.00 $35.34 $30.14 $21.42 $130.50 $225.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31100050 EAP CPT® 88275 FISH FGFR1 8P11-12 DNA(SO) BOTH IP/OP $225.00 $166.50 $23.04 $225.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $133.09 $51.19 $51.19 $51.19 $225.00 $168.75 $51.19 $51.19 $51.19 $224.44 $224.44 $178.20 $51.19 $180.00 $84.46 $56.50 $51.19 $130.50 $225.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31100051 EAP CPT® 88271 FISH NEONATAL SCREEN DNA (SO) BOTH IP/OP $126.00 $93.50 $10.71 $126.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $74.53 $21.42 $21.42 $21.42 $126.00 $94.50 $21.42 $21.42 $21.42 $119.72 $119.72 $99.79 $21.42 $100.80 $35.34 $30.14 $21.42 $73.08 $126.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31100052 EAP CPT® 88275 FISH NEONATAL SCREEN (SO) BOTH IP/OP $126.00 $93.50 $23.04 $126.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $74.53 $51.19 $51.19 $51.19 $126.00 $94.50 $51.19 $51.19 $51.19 $126.00 $126.00 $99.79 $51.19 $100.80 $84.46 $56.50 $51.19 $73.08 $126.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31100053 EAP CPT® 88275 FISH FGFR1 8P11-12 100-300 (SO) BOTH IP/OP $615.00 $455.50 $23.04 $615.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $363.77 $51.19 $51.19 $51.19 $615.00 $461.25 $51.19 $51.19 $51.19 $224.44 $224.44 $487.08 $51.19 $492.00 $84.46 $56.50 $51.19 $356.70 $615.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31100095 EAP CPT® 88143 CYTOPATAH C/V THIN LAYER REDO BOTH IP/OP $109.00 $81.00 $11.52 $109.00 $109.00 $109.00 $109.00 $109.00 $23.04 $23.04 $11.52 $109.00 $23.04 $30.76 $30.76 $31.95 $22.46 $29.94 $36.86 $36.86 $109.00 $23.04 $23.04 $23.04 $109.00 $81.75 $23.04 $23.04 $23.04 $109.00 $109.00 $86.33 $23.04 $87.20 $109.00 $109.00 $23.04 $63.22 $109.00 $33.41 $23.04 $109.00 $23.04 N/A N/A 31100096 EAP CPT® 88173 CYTOPATH EVAL FNA REPORT BOTH IP/OP $405.00 $300.00 $48.77 $405.00 $405.00 $405.00 $405.00 $405.00 $88.98 $88.98 $78.13 $405.00 $88.98 $66.81 $66.81 $69.38 $48.77 $107.58 $142.37 $150.46 $405.00 $88.98 $94.04 $88.98 $405.00 $303.75 $88.98 $88.98 $88.98 $274.12 $274.12 $320.76 $88.98 $324.00 $263.25 $405.00 $88.98 $234.90 $405.00 $83.20 $88.98 $405.00 $88.98 N/A N/A 31100097 EAP CPT® 88174 CYTOPATH C/V AUTO IN FLUID BOTH IP/OP $94.00 $70.00 $12.69 $94.00 $94.00 $94.00 $94.00 $94.00 $25.37 $25.37 $12.69 $94.00 $25.37 $32.44 $32.44 $33.69 $23.68 $31.56 $40.59 $40.59 $94.00 $25.37 $25.37 $25.37 $94.00 $70.50 $25.37 $25.37 $25.37 $94.00 $94.00 $74.45 $25.37 $75.20 $94.00 $94.00 $25.37 $54.52 $94.00 $36.79 $25.37 $94.00 $25.37 N/A N/A 31100098 EAP CPT® 88175 CYTOPATH C/V AUTO FLUID REDO BOTH IP/OP $116.00 $86.00 $13.31 $116.00 $116.00 $116.00 $116.00 $116.00 $26.61 $26.61 $13.31 $116.00 $26.61 $40.19 $40.19 $41.73 $29.34 $39.09 $42.58 $42.58 $116.00 $26.61 $26.61 $26.61 $116.00 $87.00 $26.61 $26.61 $26.61 $116.00 $116.00 $91.87 $26.61 $92.80 $116.00 $116.00 $26.61 $67.28 $116.00 $38.58 $26.61 $116.00 $26.61 N/A N/A 31100110 EAP Custom 31100110 "FISH, B-CELL CLL PANEL (SO)" BOTH IP/OP $369.00 $273.50 $65.68 $369.00 $369.00 $369.00 $369.00 $369.00 $369.00 $369.00 $65.68 $369.00 $369.00 $273.87 $273.87 $284.43 $192.25 $76.90 $369.00 $147.60 $369.00 $369.00 $369.00 $369.00 $369.00 $276.75 $369.00 $369.00 $369.00 $184.50 $184.50 $292.25 $369.00 $295.20 $239.85 $369.00 $369.00 $214.02 $369.00 $221.40 $369.00 $369.00 $369.00 N/A N/A 31100111 EAP CPT® 88271 MOLECULAR CYTOGEN; DNA PROBE (SO) BOTH IP/OP $369.00 $273.50 $10.71 $369.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $218.26 $21.42 $21.42 $21.42 $369.00 $276.75 $21.42 $21.42 $21.42 $119.72 $119.72 $292.25 $21.42 $295.20 $35.34 $30.14 $21.42 $214.02 $369.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31100112 EAP CPT® 88275 INTERPHASE IN SITU HYBIRD (SO) BOTH IP/OP $369.00 $273.50 $23.04 $369.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $218.26 $51.19 $51.19 $51.19 $369.00 $276.75 $51.19 $51.19 $51.19 $224.44 $224.44 $292.25 $51.19 $295.20 $84.46 $56.50 $51.19 $214.02 $369.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31100114 EAP CPT® 88271 MOLECULAR CYTOGENTICS; DNA PROBE (SO) BOTH IP/OP $367.00 $272.00 $10.71 $367.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $217.08 $21.42 $21.42 $21.42 $367.00 $275.25 $21.42 $21.42 $21.42 $119.72 $119.72 $290.66 $21.42 $293.60 $35.34 $30.14 $21.42 $212.86 $367.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31100116 EAP CPT® 88237 TISSUE CULTURE FOR NEOPLASTIC DISORDER (SO) BOTH IP/OP $340.00 $252.00 $64.69 $340.00 $173.27 $173.27 $173.27 $173.27 $143.75 $143.75 $71.88 $64.69 $143.75 $134.06 $134.06 $139.21 $97.86 $130.42 $230.00 $230.00 $201.11 $143.75 $143.75 $143.75 $340.00 $255.00 $143.75 $143.75 $143.75 $340.00 $340.00 $269.28 $143.75 $272.00 $237.19 $124.21 $143.75 $197.20 $340.00 $208.44 $143.75 $97.57 $143.75 N/A N/A 31100117 EAP CPT® 88264 CHROMOSOME ANALYSIS 20-25 CELLS (SO) BOTH IP/OP $366.00 $271.00 $65.07 $366.00 $244.62 $244.62 $244.62 $244.62 $144.61 $144.61 $72.31 $65.07 $144.61 $189.26 $189.26 $196.54 $138.16 $184.12 $231.38 $231.38 $216.49 $144.61 $144.61 $144.61 $366.00 $274.50 $144.61 $144.61 $144.61 $366.00 $366.00 $289.87 $144.61 $292.80 $238.61 $175.35 $144.61 $212.28 $366.00 $209.68 $144.61 $137.74 $144.61 N/A N/A 31100118 EAP CPT® 88120 "BLADDER CANCER,FISH (SO)" BOTH IP/OP $488.00 $361.50 $146.06 $545.53 $488.00 $488.00 $488.00 $488.00 $146.71 $146.71 $146.06 $273.92 $146.71 $422.54 $422.54 $438.79 $308.45 $324.87 $234.73 $226.86 $288.65 $146.71 $545.53 $146.71 $154.04 $366.00 $146.71 $146.71 $146.71 $244.00 $244.00 $386.50 $146.71 $390.40 $317.20 $309.40 $146.71 $283.04 $154.04 $212.25 $146.71 $243.03 $146.71 N/A N/A 31100120 EAP CPT® 88271 MOLECULAR CYTOGEN; DNA PROBE (SO) BOTH IP/OP $369.00 $273.50 $10.71 $369.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $218.26 $21.42 $21.42 $21.42 $369.00 $276.75 $21.42 $21.42 $21.42 $119.72 $119.72 $292.25 $21.42 $295.20 $35.34 $30.14 $21.42 $214.02 $369.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31100121 EAP CPT® 88275 INTERPHASE INSITU HYBIRD (SO) BOTH IP/OP $369.00 $273.50 $23.04 $369.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $218.26 $51.19 $51.19 $51.19 $369.00 $276.75 $51.19 $51.19 $51.19 $224.44 $224.44 $292.25 $51.19 $295.20 $84.46 $56.50 $51.19 $214.02 $369.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31100122 EAP CPT® 88275 INTERPHASE IN SITU HYBIRDIZATION (SO) BOTH IP/OP $367.00 $272.00 $23.04 $367.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $217.08 $51.19 $51.19 $51.19 $367.00 $275.25 $51.19 $51.19 $51.19 $224.44 $224.44 $290.66 $51.19 $293.60 $84.46 $56.50 $51.19 $212.86 $367.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31100123 EAP CPT® 88271 MOLECULAR CYTOGENETICS;DNA PROBE (FISH) (SO) BOTH IP/OP $325.00 $240.50 $10.71 $325.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $192.24 $21.42 $21.42 $21.42 $325.00 $243.75 $21.42 $21.42 $21.42 $119.72 $119.72 $257.40 $21.42 $260.00 $35.34 $30.14 $21.42 $188.50 $325.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31100124 EAP CPT® 88275 INTERPHASE IN SITU HYBIRDIZATION (SO) BOTH IP/OP $325.00 $240.50 $23.04 $325.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $192.24 $51.19 $51.19 $51.19 $325.00 $243.75 $51.19 $51.19 $51.19 $224.44 $224.44 $257.40 $51.19 $260.00 $84.46 $56.50 $51.19 $188.50 $325.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31100126 EAP CPT® 88184 "PNH FLOW CYTOMETRY, 1ST MRK (SO)" BOTH IP/OP $93.00 $69.00 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $55.01 $286.49 $75.09 $286.49 $300.82 $69.75 $286.49 $286.49 $286.49 $93.00 $93.00 $73.66 $286.49 $74.40 $60.45 $51.58 $286.49 $53.94 $300.82 $93.00 $286.49 $40.52 $286.49 N/A N/A 31100127 EAP CPT® 88185 "PNH FLOW CYTOMETRY, EA ADDL MRK (SO)" BOTH IP/OP $93.00 $69.00 $11.19 $93.00 $53.97 $53.97 $53.97 $53.97 $93.00 $93.00 $93.00 $11.19 $93.00 $48.93 $48.93 $50.81 $35.72 $26.63 $93.00 $93.00 $55.01 $93.00 $24.01 $93.00 $93.00 $69.75 $93.00 $93.00 $93.00 $93.00 $93.00 $73.66 $93.00 $74.40 $60.45 $25.36 $93.00 $53.94 $93.00 $93.00 $93.00 $19.92 $93.00 N/A N/A 31100130 EAP CPT® 88184 FLOW CYTOMETRY; FIRST MARKER (SO) BOTH IP/OP $303.00 $224.50 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $179.22 $286.49 $75.09 $286.49 $300.82 $227.25 $286.49 $286.49 $286.49 $267.48 $267.48 $239.98 $286.49 $242.40 $196.95 $51.58 $286.49 $175.74 $300.82 $303.00 $286.49 $40.52 $286.49 N/A N/A 31100132 EAP CPT® 88185 FLOW CYTOMETRY;16 OR MORE MARKERS (SO) BOTH IP/OP $133.00 $98.50 $11.19 $133.00 $53.97 $53.97 $53.97 $53.97 $133.00 $133.00 $133.00 $11.19 $133.00 $48.93 $48.93 $50.81 $35.72 $26.63 $133.00 $133.00 $78.67 $133.00 $24.01 $133.00 $133.00 $99.75 $133.00 $133.00 $133.00 $133.00 $133.00 $105.34 $133.00 $106.40 $86.45 $25.36 $133.00 $77.14 $133.00 $133.00 $133.00 $19.92 $133.00 N/A N/A 31100134 EAP CPT® 88271 MOLECULAR CYTOGEN DNA PROBE (SO) BOTH IP/OP $345.00 $255.50 $10.71 $345.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $204.07 $21.42 $21.42 $21.42 $345.00 $258.75 $21.42 $21.42 $21.42 $119.72 $119.72 $273.24 $21.42 $276.00 $35.34 $30.14 $21.42 $200.10 $345.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31100135 EAP CPT® 88275 INTERPHASE IN SITU HYBRID (SO) BOTH IP/OP $343.00 $254.00 $23.04 $343.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $202.88 $51.19 $51.19 $51.19 $343.00 $257.25 $51.19 $51.19 $51.19 $224.44 $224.44 $271.66 $51.19 $274.40 $84.46 $56.50 $51.19 $198.94 $343.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31100137 EAP CPT® 88184 FLOW CYTOMETRY; FIRST MARKER (SO) BOTH IP/OP $303.00 $224.50 $30.49 $467.58 $88.40 $88.40 $88.40 $88.40 $286.49 $286.49 $285.22 $30.49 $286.49 $82.40 $82.40 $85.57 $60.15 $54.16 $458.39 $467.58 $179.22 $286.49 $75.09 $286.49 $300.82 $227.25 $286.49 $286.49 $286.49 $267.48 $267.48 $239.98 $286.49 $242.40 $196.95 $51.58 $286.49 $175.74 $300.82 $303.00 $286.49 $40.52 $286.49 N/A N/A 31100141 EAP CPT® 88112 ENRICHED PREP SUREPATH BOTH IP/OP $545.00 $403.50 $30.81 $436.00 $98.67 $98.67 $98.67 $98.67 $48.88 $48.88 $48.66 $30.81 $48.88 $47.03 $47.03 $48.84 $34.33 $124.75 $78.21 $72.33 $322.37 $48.88 $40.25 $48.88 $51.32 $408.75 $48.88 $48.88 $48.88 $232.76 $232.76 $431.64 $48.88 $436.00 $354.25 $118.81 $48.88 $316.10 $51.32 $70.72 $48.88 $93.33 $48.88 N/A N/A 31100142 EAP CPT® 80356 6-MAM OPIATES (SO) BOTH IP/OP $166.00 $123.00 $12.00 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $166.00 $12.01 $166.00 $166.00 $123.21 $123.21 $127.95 $86.49 $34.60 $166.00 $12.00 $166.00 $166.00 $30.00 $166.00 $166.00 $124.50 $166.00 $166.00 $166.00 $83.00 $83.00 $131.47 $166.00 $132.80 $107.90 $166.00 $166.00 $96.28 $166.00 $99.60 $166.00 $166.00 $166.00 N/A N/A 31100143 EAP CPT® 88275 MOLEC CYTG INTERPHASE ISH ANALYZE 100-300 CLL (SO) BOTH IP/OP $375.00 $277.50 $23.04 $375.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $221.81 $51.19 $51.19 $51.19 $375.00 $281.25 $51.19 $51.19 $51.19 $224.44 $224.44 $297.00 $51.19 $300.00 $84.46 $56.50 $51.19 $217.50 $375.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31100144 EAP CPT® 88271 "FISH, LOCUS-SPECIFIC PROBE (X1) (SO)" BOTH IP/OP $375.00 $277.50 $10.71 $375.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $221.81 $21.42 $21.42 $21.42 $375.00 $281.25 $21.42 $21.42 $21.42 $119.72 $119.72 $297.00 $21.42 $300.00 $35.34 $30.14 $21.42 $217.50 $375.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31150011 EAP CPT® 88104 "CYTOLOGY, URINARY" BOTH IP/OP $353.00 $261.50 $25.45 $282.40 $107.93 $107.93 $107.93 $107.93 $33.30 $33.30 $33.15 $32.11 $33.30 $34.86 $34.86 $36.20 $25.45 $50.14 $53.27 $48.99 $208.80 $33.30 $42.96 $33.30 $34.96 $264.75 $33.30 $33.30 $33.30 $120.32 $120.32 $279.58 $33.30 $282.40 $229.45 $47.75 $33.30 $204.74 $34.96 $48.17 $33.30 $37.51 $33.30 N/A N/A 31150012 EAP CPT® 88104 "CYTOLOGY,FLUID" BOTH IP/OP $349.00 $258.50 $25.45 $279.20 $107.93 $107.93 $107.93 $107.93 $33.30 $33.30 $33.15 $32.11 $33.30 $34.86 $34.86 $36.20 $25.45 $50.14 $53.27 $48.99 $206.43 $33.30 $42.96 $33.30 $34.96 $261.75 $33.30 $33.30 $33.30 $120.32 $120.32 $276.41 $33.30 $279.20 $226.85 $47.75 $33.30 $202.42 $34.96 $48.17 $33.30 $37.51 $33.30 N/A N/A 31150013 EAP CPT® 88104 "CYTOLOGY,BREAST" BOTH IP/OP $349.00 $258.50 $25.45 $279.20 $107.93 $107.93 $107.93 $107.93 $33.30 $33.30 $33.15 $32.11 $33.30 $34.86 $34.86 $36.20 $25.45 $50.14 $53.27 $48.99 $206.43 $33.30 $42.96 $33.30 $34.96 $261.75 $33.30 $33.30 $33.30 $120.32 $120.32 $276.41 $33.30 $279.20 $226.85 $47.75 $33.30 $202.42 $34.96 $48.17 $33.30 $37.51 $33.30 N/A N/A 31150014 EAP CPT® 88104 "CYTOLOGY,CNS" BOTH IP/OP $353.00 $261.50 $25.45 $282.40 $107.93 $107.93 $107.93 $107.93 $33.30 $33.30 $33.15 $32.11 $33.30 $34.86 $34.86 $36.20 $25.45 $50.14 $53.27 $48.99 $208.80 $33.30 $42.96 $33.30 $34.96 $264.75 $33.30 $33.30 $33.30 $120.32 $120.32 $279.58 $33.30 $282.40 $229.45 $47.75 $33.30 $204.74 $34.96 $48.17 $33.30 $37.51 $33.30 N/A N/A 31150015 EAP CPT® 88104 "CYTOLOGY,MISC" BOTH IP/OP $353.00 $261.50 $25.45 $282.40 $107.93 $107.93 $107.93 $107.93 $33.30 $33.30 $33.15 $32.11 $33.30 $34.86 $34.86 $36.20 $25.45 $50.14 $53.27 $48.99 $208.80 $33.30 $42.96 $33.30 $34.96 $264.75 $33.30 $33.30 $33.30 $120.32 $120.32 $279.58 $33.30 $282.40 $229.45 $47.75 $33.30 $204.74 $34.96 $48.17 $33.30 $37.51 $33.30 N/A N/A 31200001 EAP CPT® 88300 TOOTH BOTH IP/OP $291.00 $215.50 $7.30 $232.80 $23.64 $23.64 $23.64 $23.64 $24.30 $24.30 $24.19 $7.30 $24.30 $19.71 $19.71 $20.47 $14.39 $16.80 $38.88 $36.00 $172.13 $24.30 $11.84 $24.30 $25.52 $218.25 $24.30 $24.30 $24.30 $77.52 $77.52 $230.47 $24.30 $232.80 $189.15 $16.00 $24.30 $168.78 $25.52 $35.16 $24.30 $12.57 $24.30 N/A N/A 31200002 EAP CPT® 88300 FOREIGN BODY BOTH IP/OP $291.00 $215.50 $7.30 $232.80 $23.64 $23.64 $23.64 $23.64 $24.30 $24.30 $24.19 $7.30 $24.30 $19.71 $19.71 $20.47 $14.39 $16.80 $38.88 $36.00 $172.13 $24.30 $11.84 $24.30 $25.52 $218.25 $24.30 $24.30 $24.30 $77.52 $77.52 $230.47 $24.30 $232.80 $189.15 $16.00 $24.30 $168.78 $25.52 $35.16 $24.30 $12.57 $24.30 N/A N/A 31200004 EAP CPT® 88300 INTRAUTERINE DEVICE BOTH IP/OP $291.00 $215.50 $7.30 $232.80 $23.64 $23.64 $23.64 $23.64 $24.30 $24.30 $24.19 $7.30 $24.30 $19.71 $19.71 $20.47 $14.39 $16.80 $38.88 $36.00 $172.13 $24.30 $11.84 $24.30 $25.52 $218.25 $24.30 $24.30 $24.30 $77.52 $77.52 $230.47 $24.30 $232.80 $189.15 $16.00 $24.30 $168.78 $25.52 $35.16 $24.30 $12.57 $24.30 N/A N/A 31200005 EAP CPT® 88302 "APPENDIX,INCIDENTIAL" BOTH IP/OP $393.00 $291.00 $14.11 $314.40 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $232.46 $24.30 $26.39 $24.30 $25.52 $294.75 $24.30 $24.30 $24.30 $174.88 $174.88 $311.26 $24.30 $314.40 $255.45 $39.23 $24.30 $227.94 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200006 EAP CPT® 88302 "FORESKIN, NEWBORN" BOTH IP/OP $389.00 $288.00 $14.11 $311.20 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $230.09 $24.30 $26.39 $24.30 $25.52 $291.75 $24.30 $24.30 $24.30 $174.88 $174.88 $308.09 $24.30 $311.20 $252.85 $39.23 $24.30 $225.62 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200007 EAP CPT® 88302 "TESTIS,CASTRATION" BOTH IP/OP $393.00 $291.00 $14.11 $314.40 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $232.46 $24.30 $26.39 $24.30 $25.52 $294.75 $24.30 $24.30 $24.30 $174.88 $174.88 $311.26 $24.30 $314.40 $255.45 $39.23 $24.30 $227.94 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200008 EAP CPT® 88302 NERVE BOTH IP/OP $389.00 $288.00 $14.11 $311.20 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $230.09 $24.30 $26.39 $24.30 $25.52 $291.75 $24.30 $24.30 $24.30 $174.88 $174.88 $308.09 $24.30 $311.20 $252.85 $39.23 $24.30 $225.62 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200009 EAP CPT® 88302 SKIN PLASTIC REPAIR BOTH IP/OP $393.00 $291.00 $14.11 $314.40 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $232.46 $24.30 $26.39 $24.30 $25.52 $294.75 $24.30 $24.30 $24.30 $174.88 $174.88 $311.26 $24.30 $314.40 $255.45 $39.23 $24.30 $227.94 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200010 EAP CPT® 88302 "AMPUT,DIGIT-TRAUMAT." BOTH IP/OP $393.00 $291.00 $14.11 $314.40 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $232.46 $24.30 $26.39 $24.30 $25.52 $294.75 $24.30 $24.30 $24.30 $174.88 $174.88 $311.26 $24.30 $314.40 $255.45 $39.23 $24.30 $227.94 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200011 EAP CPT® 88302 HERNIA SAC BOTH IP/OP $393.00 $291.00 $14.11 $314.40 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $232.46 $24.30 $26.39 $24.30 $25.52 $294.75 $24.30 $24.30 $24.30 $174.88 $174.88 $311.26 $24.30 $314.40 $255.45 $39.23 $24.30 $227.94 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200012 EAP CPT® 88302 HYDROCELE BOTH IP/OP $393.00 $291.00 $14.11 $314.40 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $232.46 $24.30 $26.39 $24.30 $25.52 $294.75 $24.30 $24.30 $24.30 $174.88 $174.88 $311.26 $24.30 $314.40 $255.45 $39.23 $24.30 $227.94 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200013 EAP CPT® 88302 "VAS DEFERENS, STERIL." BOTH IP/OP $393.00 $291.00 $14.11 $314.40 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $232.46 $24.30 $26.39 $24.30 $25.52 $294.75 $24.30 $24.30 $24.30 $174.88 $174.88 $311.26 $24.30 $314.40 $255.45 $39.23 $24.30 $227.94 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200014 EAP CPT® 88302 VAGINAL MUCOSA BOTH IP/OP $393.00 $291.00 $14.11 $314.40 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $232.46 $24.30 $26.39 $24.30 $25.52 $294.75 $24.30 $24.30 $24.30 $174.88 $174.88 $311.26 $24.30 $314.40 $255.45 $39.23 $24.30 $227.94 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200015 EAP CPT® 88304 NASAL POLYP BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200016 EAP CPT® 88304 COLOSTOMY STOMA BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200017 EAP CPT® 88304 "FORESKIN,NON-NEWBORN" BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200018 EAP CPT® 88304 "BONE/FRAG,NON-PATHOLOGIC" BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200019 EAP CPT® 88304 CARTILAGE SHAVINGS BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200020 EAP CPT® 88304 CARPAL TUNNEL TISSUE BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200021 EAP CPT® 88304 DUPUYTREN'S CONTRAC. BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200022 EAP CPT® 88304 "FEMORAL HEAD,N-FRACT" BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200023 EAP CPT® 88304 "CYST,MISC" BOTH IP/OP $495.00 $366.50 $18.49 $396.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $292.79 $48.88 $31.80 $48.88 $51.32 $371.25 $48.88 $48.88 $48.88 $216.24 $216.24 $392.04 $48.88 $396.00 $321.75 $33.77 $48.88 $287.10 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200024 EAP CPT® 88304 "CYST,SYNOVIAL" BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200025 EAP CPT® 88304 "CYST,GANGLION" BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200026 EAP CPT® 88304 FISSURE / FISTULA BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200027 EAP CPT® 88304 INTERVERTEBRAL DISC BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200028 EAP CPT® 88304 "JOINT, LOOSE BODY" BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200029 EAP CPT® 88304 TENDON SHEATH BOTH IP/OP $495.00 $366.50 $18.49 $396.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $292.79 $48.88 $31.80 $48.88 $51.32 $371.25 $48.88 $48.88 $48.88 $216.24 $216.24 $392.04 $48.88 $396.00 $321.75 $33.77 $48.88 $287.10 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200030 EAP CPT® 88304 "CYST,DENTAL" BOTH IP/OP $495.00 $366.50 $18.49 $396.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $292.79 $48.88 $31.80 $48.88 $51.32 $371.25 $48.88 $48.88 $48.88 $216.24 $216.24 $392.04 $48.88 $396.00 $321.75 $33.77 $48.88 $287.10 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200031 EAP CPT® 88304 "NEUROMA,TRAUMATIC" BOTH IP/OP $495.00 $366.50 $18.49 $396.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $292.79 $48.88 $31.80 $48.88 $51.32 $371.25 $48.88 $48.88 $48.88 $216.24 $216.24 $392.04 $48.88 $396.00 $321.75 $33.77 $48.88 $287.10 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200032 EAP CPT® 88304 "SKIN BIOPSY,PUNCH" BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200033 EAP CPT® 88304 "SKIN EXCISION,DEBRID" BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200034 EAP CPT® 88304 "CYST,PILONIDAL" BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200035 EAP CPT® 88304 "SOFT TISSUE,DEBRID" BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200036 EAP CPT® 88304 "SOFT TISSUE,LIPOMA" BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200037 EAP CPT® 88304 ANEURYSM BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200038 EAP CPT® 88304 "VEIN, VARICOSITY" BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200039 EAP CPT® 88304 EMBOLIS/THROMBUS BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200040 EAP CPT® 88304 HEMATOMA BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200041 EAP CPT® 88304 HEMORRHOIDS BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200042 EAP CPT® 88304 "ARTERY/VEIN, PLAQUE" BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200043 EAP CPT® 88304 CHOLESTEATOMA BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200044 EAP CPT® 88304 CONJUNCTIVA BIOPSY BOTH IP/OP $495.00 $366.50 $18.49 $396.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $292.79 $48.88 $31.80 $48.88 $51.32 $371.25 $48.88 $48.88 $48.88 $216.24 $216.24 $392.04 $48.88 $396.00 $321.75 $33.77 $48.88 $287.10 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200045 EAP CPT® 88304 CORNEA BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200046 EAP CPT® 88304 SALIVARY MUCOCELE BOTH IP/OP $495.00 $366.50 $18.49 $396.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $292.79 $48.88 $31.80 $48.88 $51.32 $371.25 $48.88 $48.88 $48.88 $216.24 $216.24 $392.04 $48.88 $396.00 $321.75 $33.77 $48.88 $287.10 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200047 EAP CPT® 88304 TONSIL/ADENOIDS BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200048 EAP CPT® 88304 GALL BLAD./BILE DUCT BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200049 EAP CPT® 88304 SPERMATOCELE BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200050 EAP CPT® 88304 VARICOCELE BOTH IP/OP $495.00 $366.50 $18.49 $396.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $292.79 $48.88 $31.80 $48.88 $51.32 $371.25 $48.88 $48.88 $48.88 $216.24 $216.24 $392.04 $48.88 $396.00 $321.75 $33.77 $48.88 $287.10 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200051 EAP CPT® 88304 VAS DEFERENS BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200052 EAP CPT® 88304 "CYST,BARTHOLIN" BOTH IP/OP $500.00 $370.00 $18.49 $400.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $295.75 $48.88 $31.80 $48.88 $51.32 $375.00 $48.88 $48.88 $48.88 $216.24 $216.24 $396.00 $48.88 $400.00 $325.00 $33.77 $48.88 $290.00 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200053 EAP CPT® 88304 "CYST,HYDAT-MORGAGNI" BOTH IP/OP $495.00 $366.50 $18.49 $396.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $292.79 $48.88 $31.80 $48.88 $51.32 $371.25 $48.88 $48.88 $48.88 $216.24 $216.24 $392.04 $48.88 $396.00 $321.75 $33.77 $48.88 $287.10 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200054 EAP CPT® 88305 "BREAST BX,CORE IMG" BOTH IP/OP $617.00 $457.00 $31.63 $493.60 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $364.96 $48.88 $35.18 $48.88 $51.32 $462.75 $48.88 $48.88 $48.88 $281.96 $281.96 $488.66 $48.88 $493.60 $401.05 $73.71 $48.88 $357.86 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200055 EAP CPT® 88305 BRONCHUS BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200056 EAP CPT® 88305 "TRACHEA, BIOPSY" BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200057 EAP CPT® 88305 "LARYNX, BIOPSY" BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200058 EAP CPT® 88305 NASOPHARYNX BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200059 EAP CPT® 88305 NASAL MUCOSA BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200060 EAP CPT® 88305 STOMACH POLYP BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200061 EAP CPT® 88305 DUODENUM BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200062 EAP CPT® 88305 COLORECTAL POLYP BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200063 EAP CPT® 88305 PERITONEUM BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200064 EAP CPT® 88305 UR BLADDER BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200065 EAP CPT® 88305 PROSTATE CHIPS BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200066 EAP CPT® 88305 CELL BLOCK BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200067 EAP CPT® 88305 "FEMORAL HEAD, FRACT." BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200068 EAP CPT® 88305 SYNOVIUM BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200069 EAP CPT® 88305 MENINGES RESECTION BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200070 EAP CPT® 88305 "SKIN BIOPSY,SHAVE" BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200071 EAP CPT® 88305 "SKIN EXCISION,OTHER" BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200072 EAP CPT® 88305 "SOFT TISSUE,OTHER" BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200073 EAP CPT® 88305 BREAST BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200074 EAP CPT® 88305 "BREAST,REDUCTION" BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200075 EAP CPT® 88305 ARTERY/VEIN BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200076 EAP CPT® 88305 LYMPH NODE BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200077 EAP CPT® 88305 BONE MARROW BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200078 EAP CPT® 88305 SPLEEN BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200079 EAP CPT® 88305 "AMPUT,EXTRM-TRAUMAT." BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200080 EAP CPT® 88305 JOINT RESECTION BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200081 EAP CPT® 88305 MUSCLE BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200082 EAP CPT® 88305 "AMPUT,DIGIT-NONTRAUM" BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200083 EAP CPT® 88305 HEART VALVE BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200084 EAP CPT® 88305 "LIP, WEDGE BIOPSY" BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200085 EAP CPT® 88305 TONGUE BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200086 EAP CPT® 88305 TONSIL BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200087 EAP CPT® 88305 ORAL/GINGIVA BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200088 EAP CPT® 88305 SALIVARY GLAND BX BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200089 EAP CPT® 88305 PARATHYROID GLAND BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200090 EAP CPT® 88305 PITUITARY TUMOR BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200091 EAP CPT® 88305 NERVE BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200092 EAP CPT® 88305 PLEURAL BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200093 EAP CPT® 88305 PERICARDIUM BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200094 EAP CPT® 88305 THYROGLOSSAL DUCT BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200095 EAP CPT® 88305 ESOPHAGUS BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200096 EAP CPT® 88305 STOMACH BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200097 EAP CPT® 88305 SM.INTESTINE BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200098 EAP CPT® 88305 COLON BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200099 EAP CPT® 88305 OMENTUM BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200100 EAP CPT® 88305 KIDNEY BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200101 EAP CPT® 88305 URETER BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200102 EAP CPT® 88305 URETHRA BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200103 EAP CPT® 88305 PROSTATE BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200104 EAP CPT® 88305 ENDOCERVICAL SCRAPE BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200105 EAP CPT® 88305 ENDOMETRIAL SCRAPE BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200106 EAP CPT® 88305 CERVICAL BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200107 EAP CPT® 88305 "VAGINA, BIOPSY" BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200108 EAP CPT® 88305 VULVA / LABIA BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200109 EAP CPT® 88305 OVARY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200110 EAP CPT® 88305 ENDOMETRIAL POLYP BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200111 EAP CPT® 88305 "UTERUS, PROLAPSE" BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200112 EAP CPT® 88305 FALLOPIAN TUBE BIOPSY BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200113 EAP CPT® 88305 "FALLOP. TUBE,ECTOPIC" BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200114 EAP CPT® 88305 "OVARY,WEDGE BIOPSY" BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200115 EAP CPT® 88305 "POC, SPONTANEOUS" BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200116 EAP CPT® 88305 "PLACENTA, N-3RD TRIM." BOTH IP/OP $624.00 $462.00 $31.63 $499.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $369.10 $48.88 $35.18 $48.88 $51.32 $468.00 $48.88 $48.88 $48.88 $281.96 $281.96 $494.21 $48.88 $499.20 $405.60 $73.71 $48.88 $361.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200117 EAP CPT® 88307 STOMACH RESECTION BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200118 EAP CPT® 88307 "COLON, SEG RESECTION" BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200119 EAP CPT® 88307 "PANCREAS, BIOPSY" BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200120 EAP CPT® 88307 LIVER RESECTION BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200121 EAP CPT® 88307 URETER RESECTION BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200122 EAP CPT® 88307 TESTIS BIOPSY BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200123 EAP CPT® 88307 PROSTATE RESECTION BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200124 EAP CPT® 88307 BONE BIOPSY BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200125 EAP CPT® 88307 "TUMOR,DENTAL" BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200126 EAP CPT® 88307 "MENINGES,TUMOR" BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200127 EAP CPT® 88307 "BREAST,SIMPLE MAST." BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200128 EAP CPT® 88307 LYMPH NODE RESECTN BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200129 EAP CPT® 88307 LIVER BIOPSY BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200130 EAP CPT® 88307 "AMPUT,EXTRM-NON TRAUM" BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200131 EAP CPT® 88307 "BONE/FRAG,PATHOLOGIC" BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200132 EAP CPT® 88307 "MEDIASTINUM,MASS" BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200133 EAP CPT® 88307 "SOFT TISSUE,BX/EXCIS" BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200134 EAP CPT® 88307 "EYE, ENUCLEATION" BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200135 EAP CPT® 88307 THYROID RESECTION BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200136 EAP CPT® 88307 ADRENAL RESECTION BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200137 EAP CPT® 88307 BRAIN BIOPSY BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200138 EAP CPT® 88307 "LUNG, WEDGE BIOPSY" BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200139 EAP CPT® 88307 MYOCARDIUM BIOPSY BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200140 EAP CPT® 88307 THYMUS TUMOR BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200141 EAP CPT® 88307 SMALL INTES. RESECTN BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200142 EAP CPT® 88307 NEPHRECTOMY BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200143 EAP CPT® 88307 TESTIS RESECTION BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200144 EAP CPT® 88307 UTERUS BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200145 EAP CPT® 88307 CERVICAL CONE BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200146 EAP CPT® 88307 "PLACENTA, THIRD TRIM." BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200147 EAP CPT® 88307 "OVARY,TUMOR" BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200148 EAP CPT® 88309 SMALL INTES. TUMOR BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200149 EAP CPT® 88309 "COLON, SEG RESEC,TUMOR" BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200150 EAP CPT® 88309 UR BLADDER RESECTION BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200151 EAP CPT® 88309 "TESTIS RESECT,TUMOR" BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200152 EAP CPT® 88309 BONE RESECTION BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200153 EAP CPT® 88309 "SOFT TISSUE,TUMOR" BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200154 EAP CPT® 88309 "BREAST,MAST.W/NODES" BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200155 EAP CPT® 88309 "LARYNX, RESECTN/NODE" BOTH IP/OP "$1,051.00" $778.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $621.67 $644.63 $298.65 $644.63 $676.87 $788.25 $644.63 $644.63 $644.63 $656.96 $656.96 $832.39 $644.63 $840.80 $683.15 $210.09 $644.63 $609.58 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200156 EAP CPT® 88309 "TONGUE, RESECTN,TUMOR" BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200157 EAP CPT® 88309 "TONSIL RESECTN,TUMOR" BOTH IP/OP "$1,051.00" $778.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $621.67 $644.63 $298.65 $644.63 $676.87 $788.25 $644.63 $644.63 $644.63 $656.96 $656.96 $832.39 $644.63 $840.80 $683.15 $210.09 $644.63 $609.58 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200158 EAP CPT® 88309 LUNG RESECTION BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200159 EAP CPT® 88309 ESOPHAGUS RESECTION BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200160 EAP CPT® 88309 "COLON, TOTAL RESECTN" BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200161 EAP CPT® 88309 PANCREAS BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200162 EAP CPT® 88309 "PROSTATE,RESECTN RAD" BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200163 EAP CPT® 88309 "UTERUS, TUMOR" BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200164 EAP CPT® 88309 "FETUS, W/DISSECTION" BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200165 EAP CPT® 88309 VULVA RESECTION BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200166 EAP CPT® 88312 STAIN GRP I - ACID FAST BACT BOTH IP/OP $419.00 $310.50 $38.13 $335.20 $142.87 $142.87 $142.87 $142.87 $48.88 $48.88 $48.66 $45.90 $48.88 $75.24 $75.24 $78.14 $54.93 $50.97 $78.21 $72.33 $247.84 $48.88 $87.26 $48.88 $51.32 $314.25 $48.88 $48.88 $48.88 $257.76 $257.76 $331.85 $48.88 $335.20 $272.35 $48.54 $48.88 $243.02 $51.32 $70.72 $48.88 $38.13 $48.88 N/A N/A 31200167 EAP CPT® 88312 STAIN GRP I - BIELSCHOWSKY BOTH IP/OP $415.00 $307.50 $38.13 $332.00 $142.87 $142.87 $142.87 $142.87 $48.88 $48.88 $48.66 $45.90 $48.88 $75.24 $75.24 $78.14 $54.93 $50.97 $78.21 $72.33 $245.47 $48.88 $87.26 $48.88 $51.32 $311.25 $48.88 $48.88 $48.88 $257.76 $257.76 $328.68 $48.88 $332.00 $269.75 $48.54 $48.88 $240.70 $51.32 $70.72 $48.88 $38.13 $48.88 N/A N/A 31200168 EAP CPT® 88312 STAIN GRP I - C E VIOLET BOTH IP/OP $415.00 $307.50 $38.13 $332.00 $142.87 $142.87 $142.87 $142.87 $48.88 $48.88 $48.66 $45.90 $48.88 $75.24 $75.24 $78.14 $54.93 $50.97 $78.21 $72.33 $245.47 $48.88 $87.26 $48.88 $51.32 $311.25 $48.88 $48.88 $48.88 $257.76 $257.76 $328.68 $48.88 $332.00 $269.75 $48.54 $48.88 $240.70 $51.32 $70.72 $48.88 $38.13 $48.88 N/A N/A 31200169 EAP CPT® 88312 STAIN GRP I - FITE STAIN BOTH IP/OP $419.00 $310.50 $38.13 $335.20 $142.87 $142.87 $142.87 $142.87 $48.88 $48.88 $48.66 $45.90 $48.88 $75.24 $75.24 $78.14 $54.93 $50.97 $78.21 $72.33 $247.84 $48.88 $87.26 $48.88 $51.32 $314.25 $48.88 $48.88 $48.88 $257.76 $257.76 $331.85 $48.88 $335.20 $272.35 $48.54 $48.88 $243.02 $51.32 $70.72 $48.88 $38.13 $48.88 N/A N/A 31200170 EAP CPT® 88312 STAIN GRP I - GRAM STAIN BOTH IP/OP $419.00 $310.50 $38.13 $335.20 $142.87 $142.87 $142.87 $142.87 $48.88 $48.88 $48.66 $45.90 $48.88 $75.24 $75.24 $78.14 $54.93 $50.97 $78.21 $72.33 $247.84 $48.88 $87.26 $48.88 $51.32 $314.25 $48.88 $48.88 $48.88 $257.76 $257.76 $331.85 $48.88 $335.20 $272.35 $48.54 $48.88 $243.02 $51.32 $70.72 $48.88 $38.13 $48.88 N/A N/A 31200171 EAP CPT® 88312 STAIN GRP I - GR METH SILVER BOTH IP/OP $419.00 $310.50 $38.13 $335.20 $142.87 $142.87 $142.87 $142.87 $48.88 $48.88 $48.66 $45.90 $48.88 $75.24 $75.24 $78.14 $54.93 $50.97 $78.21 $72.33 $247.84 $48.88 $87.26 $48.88 $51.32 $314.25 $48.88 $48.88 $48.88 $257.76 $257.76 $331.85 $48.88 $335.20 $272.35 $48.54 $48.88 $243.02 $51.32 $70.72 $48.88 $38.13 $48.88 N/A N/A 31200172 EAP CPT® 88312 SPECAL STAIN GROUP I BOTH IP/OP $415.00 $307.50 $38.13 $332.00 $142.87 $142.87 $142.87 $142.87 $48.88 $48.88 $48.66 $45.90 $48.88 $75.24 $75.24 $78.14 $54.93 $50.97 $78.21 $72.33 $245.47 $48.88 $87.26 $48.88 $51.32 $311.25 $48.88 $48.88 $48.88 $257.76 $257.76 $328.68 $48.88 $332.00 $269.75 $48.54 $48.88 $240.70 $51.32 $70.72 $48.88 $38.13 $48.88 N/A N/A 31200173 EAP CPT® 88312 STAIN GRP I - RETICUL STAIN BOTH IP/OP $419.00 $310.50 $38.13 $335.20 $142.87 $142.87 $142.87 $142.87 $48.88 $48.88 $48.66 $45.90 $48.88 $75.24 $75.24 $78.14 $54.93 $50.97 $78.21 $72.33 $247.84 $48.88 $87.26 $48.88 $51.32 $314.25 $48.88 $48.88 $48.88 $257.76 $257.76 $331.85 $48.88 $335.20 $272.35 $48.54 $48.88 $243.02 $51.32 $70.72 $48.88 $38.13 $48.88 N/A N/A 31200174 EAP CPT® 88312 STAIN GRP I - STEINER-SPIRO BOTH IP/OP $415.00 $307.50 $38.13 $332.00 $142.87 $142.87 $142.87 $142.87 $48.88 $48.88 $48.66 $45.90 $48.88 $75.24 $75.24 $78.14 $54.93 $50.97 $78.21 $72.33 $245.47 $48.88 $87.26 $48.88 $51.32 $311.25 $48.88 $48.88 $48.88 $257.76 $257.76 $328.68 $48.88 $332.00 $269.75 $48.54 $48.88 $240.70 $51.32 $70.72 $48.88 $38.13 $48.88 N/A N/A 31200175 EAP CPT® 88313 STAIN GRP II - ALCIAN BLUE BOTH IP/OP $363.00 $269.00 $33.15 $290.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $214.71 $33.30 $70.69 $33.30 $34.96 $272.25 $33.30 $33.30 $33.30 $221.40 $221.40 $287.50 $33.30 $290.40 $235.95 $50.25 $33.30 $210.54 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200176 EAP CPT® 88313 STAIN GRP II - COLLO IRON BOTH IP/OP $366.00 $271.00 $33.15 $292.80 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $216.49 $33.30 $70.69 $33.30 $34.96 $274.50 $33.30 $33.30 $33.30 $221.40 $221.40 $289.87 $33.30 $292.80 $237.90 $50.25 $33.30 $212.28 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200177 EAP CPT® 88313 STAIN GRP II - COLLO IRON W HY BOTH IP/OP $363.00 $269.00 $33.15 $290.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $214.71 $33.30 $70.69 $33.30 $34.96 $272.25 $33.30 $33.30 $33.30 $221.40 $221.40 $287.50 $33.30 $290.40 $235.95 $50.25 $33.30 $210.54 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200178 EAP CPT® 88313 STAIN GRP II - DIFF QUCK BOTH IP/OP $366.00 $271.00 $33.15 $292.80 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $216.49 $33.30 $70.69 $33.30 $34.96 $274.50 $33.30 $33.30 $33.30 $221.40 $221.40 $289.87 $33.30 $292.80 $237.90 $50.25 $33.30 $212.28 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200179 EAP CPT® 88313 STAIN GRP II - CONGO RED BOTH IP/OP $366.00 $271.00 $33.15 $292.80 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $216.49 $33.30 $70.69 $33.30 $34.96 $274.50 $33.30 $33.30 $33.30 $221.40 $221.40 $289.87 $33.30 $292.80 $237.90 $50.25 $33.30 $212.28 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200180 EAP CPT® 88313 STAIN GRP II - CRYSTAL VIOLET BOTH IP/OP $366.00 $271.00 $33.15 $292.80 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $216.49 $33.30 $70.69 $33.30 $34.96 $274.50 $33.30 $33.30 $33.30 $221.40 $221.40 $289.87 $33.30 $292.80 $237.90 $50.25 $33.30 $212.28 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200181 EAP CPT® 88313 STAIN GRP II - ELASTIC BOTH IP/OP $366.00 $271.00 $33.15 $292.80 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $216.49 $33.30 $70.69 $33.30 $34.96 $274.50 $33.30 $33.30 $33.30 $221.40 $221.40 $289.87 $33.30 $292.80 $237.90 $50.25 $33.30 $212.28 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200182 EAP CPT® 88313 STAIN GRP II - GIEMSA BOTH IP/OP $366.00 $271.00 $33.15 $292.80 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $216.49 $33.30 $70.69 $33.30 $34.96 $274.50 $33.30 $33.30 $33.30 $221.40 $221.40 $289.87 $33.30 $292.80 $237.90 $50.25 $33.30 $212.28 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200183 EAP CPT® 88313 STAIN GRP II - IRON BOTH IP/OP $366.00 $271.00 $33.15 $292.80 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $216.49 $33.30 $70.69 $33.30 $34.96 $274.50 $33.30 $33.30 $33.30 $221.40 $221.40 $289.87 $33.30 $292.80 $237.90 $50.25 $33.30 $212.28 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200184 EAP CPT® 88313 STAIN GRP II - LUXOL BLUE BOTH IP/OP $363.00 $269.00 $33.15 $290.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $214.71 $33.30 $70.69 $33.30 $34.96 $272.25 $33.30 $33.30 $33.30 $221.40 $221.40 $287.50 $33.30 $290.40 $235.95 $50.25 $33.30 $210.54 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200185 EAP CPT® 88313 STAIN GRP II - MASSON TRI BOTH IP/OP $366.00 $271.00 $33.15 $292.80 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $216.49 $33.30 $70.69 $33.30 $34.96 $274.50 $33.30 $33.30 $33.30 $221.40 $221.40 $289.87 $33.30 $292.80 $237.90 $50.25 $33.30 $212.28 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200186 EAP CPT® 88313 STAIN GRP II - MUCICARMINE BOTH IP/OP $366.00 $271.00 $33.15 $292.80 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $216.49 $33.30 $70.69 $33.30 $34.96 $274.50 $33.30 $33.30 $33.30 $221.40 $221.40 $289.87 $33.30 $292.80 $237.90 $50.25 $33.30 $212.28 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200187 EAP CPT® 88313 STAIN GRP II - OIL RED O BOTH IP/OP $363.00 $269.00 $33.15 $290.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $214.71 $33.30 $70.69 $33.30 $34.96 $272.25 $33.30 $33.30 $33.30 $221.40 $221.40 $287.50 $33.30 $290.40 $235.95 $50.25 $33.30 $210.54 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200188 EAP CPT® 88313 STAIN GRP II - PAS BOTH IP/OP $366.00 $271.00 $33.15 $292.80 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $216.49 $33.30 $70.69 $33.30 $34.96 $274.50 $33.30 $33.30 $33.30 $221.40 $221.40 $289.87 $33.30 $292.80 $237.90 $50.25 $33.30 $212.28 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200189 EAP CPT® 88313 STAIN GRP II - PAS ALC BLUE BOTH IP/OP $366.00 $271.00 $33.15 $292.80 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $216.49 $33.30 $70.69 $33.30 $34.96 $274.50 $33.30 $33.30 $33.30 $221.40 $221.40 $289.87 $33.30 $292.80 $237.90 $50.25 $33.30 $212.28 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200190 EAP CPT® 88313 STAIN GRP II - PAS W / WO DIAD BOTH IP/OP $366.00 $271.00 $33.15 $292.80 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $216.49 $33.30 $70.69 $33.30 $34.96 $274.50 $33.30 $33.30 $33.30 $221.40 $221.40 $289.87 $33.30 $292.80 $237.90 $50.25 $33.30 $212.28 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200191 EAP CPT® 88313 STAIN GRP II - SUDAN BLK B BOTH IP/OP $363.00 $269.00 $33.15 $290.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $214.71 $33.30 $70.69 $33.30 $34.96 $272.25 $33.30 $33.30 $33.30 $221.40 $221.40 $287.50 $33.30 $290.40 $235.95 $50.25 $33.30 $210.54 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200192 EAP CPT® 88313 STAIN GRP II - TOLU BLUE BOTH IP/OP $363.00 $269.00 $33.15 $290.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $214.71 $33.30 $70.69 $33.30 $34.96 $272.25 $33.30 $33.30 $33.30 $221.40 $221.40 $287.50 $33.30 $290.40 $235.95 $50.25 $33.30 $210.54 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200193 EAP CPT® 88313 STAIN GRP II - SUDAN BLACK BOTH IP/OP $363.00 $269.00 $33.15 $290.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $214.71 $33.30 $70.69 $33.30 $34.96 $272.25 $33.30 $33.30 $33.30 $221.40 $221.40 $287.50 $33.30 $290.40 $235.95 $50.25 $33.30 $210.54 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200194 EAP CPT® 88313 STAIN GRP II - NASD CL-AC-EST BOTH IP/OP $363.00 $269.00 $33.15 $290.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $214.71 $33.30 $70.69 $33.30 $34.96 $272.25 $33.30 $33.30 $33.30 $221.40 $221.40 $287.50 $33.30 $290.40 $235.95 $50.25 $33.30 $210.54 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200195 EAP CPT® 88313 STAIN GRP II - NAFL INHI NASD BOTH IP/OP $363.00 $269.00 $33.15 $290.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $214.71 $33.30 $70.69 $33.30 $34.96 $272.25 $33.30 $33.30 $33.30 $221.40 $221.40 $287.50 $33.30 $290.40 $235.95 $50.25 $33.30 $210.54 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200196 EAP CPT® 88313 STAIN GRP II - PAS BOTH IP/OP $363.00 $269.00 $33.15 $290.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $214.71 $33.30 $70.69 $33.30 $34.96 $272.25 $33.30 $33.30 $33.30 $221.40 $221.40 $287.50 $33.30 $290.40 $235.95 $50.25 $33.30 $210.54 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200197 EAP CPT® 88313 STAIN GRP II - NAPHTH ESTER BOTH IP/OP $363.00 $269.00 $33.15 $290.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $214.71 $33.30 $70.69 $33.30 $34.96 $272.25 $33.30 $33.30 $33.30 $221.40 $221.40 $287.50 $33.30 $290.40 $235.95 $50.25 $33.30 $210.54 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200198 EAP CPT® 88313 STAIN GRP II - T RESIST AP BOTH IP/OP $363.00 $269.00 $33.15 $290.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $214.71 $33.30 $70.69 $33.30 $34.96 $272.25 $33.30 $33.30 $33.30 $221.40 $221.40 $287.50 $33.30 $290.40 $235.95 $50.25 $33.30 $210.54 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200199 EAP CPT® 88313 STAIN GRP II - FONTANA MASSON BOTH IP/OP $518.00 $383.50 $33.15 $414.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $306.40 $33.30 $70.69 $33.30 $34.96 $388.50 $33.30 $33.30 $33.30 $221.40 $221.40 $410.26 $33.30 $414.40 $336.70 $50.25 $33.30 $300.44 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200200 EAP CPT® 88313 STAIN GRP II - BILE STAIN BOTH IP/OP $513.00 $380.00 $33.15 $410.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $303.44 $33.30 $70.69 $33.30 $34.96 $384.75 $33.30 $33.30 $33.30 $221.40 $221.40 $406.30 $33.30 $410.40 $333.45 $50.25 $33.30 $297.54 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200201 EAP CPT® 88313 STAIN GRP II - CALCIUM STAIN BOTH IP/OP $518.00 $383.50 $33.15 $414.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $306.40 $33.30 $70.69 $33.30 $34.96 $388.50 $33.30 $33.30 $33.30 $221.40 $221.40 $410.26 $33.30 $414.40 $336.70 $50.25 $33.30 $300.44 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200202 EAP CPT® 88313 STAIN GRP II - MELANIN (BLEACH) BOTH IP/OP $513.00 $380.00 $33.15 $410.40 $101.25 $101.25 $101.25 $101.25 $33.30 $33.30 $33.15 $33.25 $33.30 $63.07 $63.07 $65.49 $46.04 $52.76 $53.27 $48.99 $303.44 $33.30 $70.69 $33.30 $34.96 $384.75 $33.30 $33.30 $33.30 $221.40 $221.40 $406.30 $33.30 $410.40 $333.45 $50.25 $33.30 $297.54 $34.96 $48.17 $33.30 $39.47 $33.30 N/A N/A 31200203 EAP CPT® 88342 A-1 ANTITRYPSIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200204 EAP CPT® 88342 "ACTIN,MUSCLE SPEC." BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200205 EAP CPT® 88342 ALPHA-FETOPROTEIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200206 EAP CPT® 88342 B72.3-BREAST BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200207 EAP CPT® 88342 CA 125-OVARIAN CA BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200208 EAP CPT® 88342 CA-19-9-CARBOHYDRAT BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200209 EAP CPT® 88342 CALCITONIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200210 EAP CPT® 88342 CEA-P BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200211 EAP CPT® 88342 CHROMOGRANIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200212 EAP CPT® 88342 CYTOKERATIN-AE1/AE3 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200213 EAP CPT® 88342 CYTOKERATIN-CAM5.2 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200214 EAP CPT® 88342 CYTOMEGALOVIRUS BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200215 EAP CPT® 88342 DESMIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200216 EAP CPT® 88342 EMA BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200217 EAP CPT® 88342 FACTOR VIII BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200219 EAP CPT® 88342 *STAIN: ONCOPROTEIN (BCL2) BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200220 EAP CPT® 88342 *STAIN: CD30/BER H2 (KI-1) BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200221 EAP CPT® 88342 *STAIN: B-1 GLYCO BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200222 EAP CPT® 88342 *STAIN: CALPONIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200223 EAP CPT® 88342 *STAIN: CALRETININ BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200224 EAP CPT® 88342 *STAIN: A-1 ANTICHYMOTRYPS BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200225 EAP CPT® 88342 *STAIN: CYTOKERATIN 20 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200226 EAP CPT® 88342 *STAIN: CD10 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200227 EAP CPT® 88342 *STAIN: CD138 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200228 EAP CPT® 88342 *STAIN: CD23 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200229 EAP CPT® 88342 *STAIN: CD3 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200230 EAP CPT® 88342 *STAIN: CD31 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200231 EAP CPT® 88342 *STAIN: CD34 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200232 EAP CPT® 88342 *STAIN: CD43 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200233 EAP CPT® 88342 *STAIN: CD5 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200234 EAP CPT® 88342 *STAIN: CD79 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200235 EAP CPT® 88360 *STAIN: KI-67 (MIB-1) BOTH IP/OP $642.00 $475.50 $49.88 $513.60 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $379.74 $146.71 $78.13 $146.71 $154.04 $481.50 $146.71 $146.71 $146.71 $242.68 $242.68 $508.46 $146.71 $513.60 $417.30 $109.25 $146.71 $372.36 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 31200236 EAP CPT® 88342 *STAIN: CYTOKERATIN 7 BOTH IP/OP $544.00 $403.00 $43.77 $435.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $321.78 $146.71 $66.63 $146.71 $154.04 $408.00 $146.71 $146.71 $146.71 $212.92 $212.92 $430.85 $146.71 $435.20 $353.60 $80.08 $146.71 $315.52 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200237 EAP CPT® 88342 *STAIN: HEPATOCYTE BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200238 EAP CPT® 88342 *STAIN: HI MOL WT KERATIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200239 EAP CPT® 88342 *STAIN: INHIBIN ALPHA BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200240 EAP CPT® 88342 *STAIN: MYELOPEROXIDASE BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200241 EAP CPT® 88342 *STAIN: P16 BOTH IP/OP $544.00 $403.00 $43.77 $435.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $321.78 $146.71 $66.63 $146.71 $154.04 $408.00 $146.71 $146.71 $146.71 $212.92 $212.92 $430.85 $146.71 $435.20 $353.60 $80.08 $146.71 $315.52 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200242 EAP CPT® 88342 *STAIN: P53 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200243 EAP CPT® 88342 *STAIN: TDT BOTH IP/OP $544.00 $403.00 $43.77 $435.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $321.78 $146.71 $66.63 $146.71 $154.04 $408.00 $146.71 $146.71 $146.71 $212.92 $212.92 $430.85 $146.71 $435.20 $353.60 $80.08 $146.71 $315.52 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200244 EAP CPT® 88342 *STAIN: TTF-1 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200245 EAP CPT® 88342 *STAIN: VILLIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200246 EAP CPT® 88342 IMMUNOPEROXIDASE BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200247 EAP CPT® 88360 ESTROGEN RECEPTOR BOTH IP/OP $620.00 $459.00 $49.88 $496.00 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $366.73 $146.71 $78.13 $146.71 $154.04 $465.00 $146.71 $146.71 $146.71 $242.68 $242.68 $491.04 $146.71 $496.00 $403.00 $109.25 $146.71 $359.60 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 31200248 EAP CPT® 88360 PROGESTERONE RECEP. BOTH IP/OP $620.00 $459.00 $49.88 $496.00 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $366.73 $146.71 $78.13 $146.71 $154.04 $465.00 $146.71 $146.71 $146.71 $242.68 $242.68 $491.04 $146.71 $496.00 $403.00 $109.25 $146.71 $359.60 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 31200249 EAP CPT® 88342 GLIAL FIBRILLARY AP BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200250 EAP CPT® 88342 GLUCAGON BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200251 EAP CPT® 88342 HEPATITIS B CORE BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200252 EAP CPT® 88342 HEPATITIS B SURFACE BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200253 EAP CPT® 88342 HERPES SIMPLEX PROB BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200254 EAP CPT® 88342 HUMAN CHORIONIC GON BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200255 EAP CPT® 88342 HUMAN GROWTH HORMON BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200256 EAP CPT® 88342 INSULIN BOTH IP/OP $544.00 $403.00 $43.77 $435.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $321.78 $146.71 $66.63 $146.71 $154.04 $408.00 $146.71 $146.71 $146.71 $212.92 $212.92 $430.85 $146.71 $435.20 $353.60 $80.08 $146.71 $315.52 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200257 EAP CPT® 88342 KAPPA BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200258 EAP CPT® 88342 L-26 B CELL MARKER BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200259 EAP CPT® 88342 LAMBDA BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200260 EAP CPT® 88342 LEU M1 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200261 EAP CPT® 88342 LEUKOCYTE COMMON AG BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200262 EAP CPT® 88342 LEUTEINIZING HORMON BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200263 EAP CPT® 88342 MACROPHAGE-HAM-56 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200264 EAP CPT® 88342 MELANOMA-HMB-45 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200265 EAP CPT® 88342 NEURON SPEC ENOLASE BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200266 EAP CPT® 88342 PLACENTAL ALK PHOS BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200267 EAP CPT® 88342 PLACENTAL LACTOGEN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200268 EAP CPT® 88342 PROLACTIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200269 EAP CPT® 88342 PROSTATE ACID PHOS BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200270 EAP CPT® 88342 PROSTATE SPEC AG BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200271 EAP CPT® 88342 S-100 NEURAL AG BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200272 EAP CPT® 88342 SEROTONIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200273 EAP CPT® 88342 SYNATOPHYSIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200274 EAP CPT® 88342 THYROGLOBULIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200275 EAP CPT® 88342 UCHL-1 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200276 EAP CPT® 88342 VIMENTIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200277 EAP CPT® 88342 EM:KAPPA BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200278 EAP CPT® 88342 EM:LAMBDA BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200279 EAP CPT® 88346 EM:IGG BOTH IP/OP $764.00 $565.50 $43.49 $611.20 $137.20 $137.20 $137.20 $137.20 $286.49 $286.49 $285.22 $50.44 $286.49 $59.58 $59.58 $61.87 $43.49 $83.33 $458.39 $467.58 $451.91 $286.49 $118.04 $286.49 $300.82 $573.00 $286.49 $286.49 $286.49 $224.48 $224.48 $605.09 $286.49 $611.20 $496.60 $79.36 $286.49 $443.12 $300.82 $414.48 $286.49 $62.34 $286.49 N/A N/A 31200280 EAP CPT® 88346 EM:IGA BOTH IP/OP $764.00 $565.50 $43.49 $611.20 $137.20 $137.20 $137.20 $137.20 $286.49 $286.49 $285.22 $50.44 $286.49 $59.58 $59.58 $61.87 $43.49 $83.33 $458.39 $467.58 $451.91 $286.49 $118.04 $286.49 $300.82 $573.00 $286.49 $286.49 $286.49 $224.48 $224.48 $605.09 $286.49 $611.20 $496.60 $79.36 $286.49 $443.12 $300.82 $414.48 $286.49 $62.34 $286.49 N/A N/A 31200281 EAP CPT® 88346 EM:IGM BOTH IP/OP $764.00 $565.50 $43.49 $611.20 $137.20 $137.20 $137.20 $137.20 $286.49 $286.49 $285.22 $50.44 $286.49 $59.58 $59.58 $61.87 $43.49 $83.33 $458.39 $467.58 $451.91 $286.49 $118.04 $286.49 $300.82 $573.00 $286.49 $286.49 $286.49 $224.48 $224.48 $605.09 $286.49 $611.20 $496.60 $79.36 $286.49 $443.12 $300.82 $414.48 $286.49 $62.34 $286.49 N/A N/A 31200282 EAP CPT® 88346 EM:C3 BOTH IP/OP $764.00 $565.50 $43.49 $611.20 $137.20 $137.20 $137.20 $137.20 $286.49 $286.49 $285.22 $50.44 $286.49 $59.58 $59.58 $61.87 $43.49 $83.33 $458.39 $467.58 $451.91 $286.49 $118.04 $286.49 $300.82 $573.00 $286.49 $286.49 $286.49 $224.48 $224.48 $605.09 $286.49 $611.20 $496.60 $79.36 $286.49 $443.12 $300.82 $414.48 $286.49 $62.34 $286.49 N/A N/A 31200283 EAP CPT® 88346 EM:C4 BOTH IP/OP $764.00 $565.50 $43.49 $611.20 $137.20 $137.20 $137.20 $137.20 $286.49 $286.49 $285.22 $50.44 $286.49 $59.58 $59.58 $61.87 $43.49 $83.33 $458.39 $467.58 $451.91 $286.49 $118.04 $286.49 $300.82 $573.00 $286.49 $286.49 $286.49 $224.48 $224.48 $605.09 $286.49 $611.20 $496.60 $79.36 $286.49 $443.12 $300.82 $414.48 $286.49 $62.34 $286.49 N/A N/A 31200284 EAP CPT® 88346 EM:C1Q BOTH IP/OP $764.00 $565.50 $43.49 $611.20 $137.20 $137.20 $137.20 $137.20 $286.49 $286.49 $285.22 $50.44 $286.49 $59.58 $59.58 $61.87 $43.49 $83.33 $458.39 $467.58 $451.91 $286.49 $118.04 $286.49 $300.82 $573.00 $286.49 $286.49 $286.49 $224.48 $224.48 $605.09 $286.49 $611.20 $496.60 $79.36 $286.49 $443.12 $300.82 $414.48 $286.49 $62.34 $286.49 N/A N/A 31200285 EAP CPT® 88346 EM:FIBROGEN BOTH IP/OP $764.00 $565.50 $43.49 $611.20 $137.20 $137.20 $137.20 $137.20 $286.49 $286.49 $285.22 $50.44 $286.49 $59.58 $59.58 $61.87 $43.49 $83.33 $458.39 $467.58 $451.91 $286.49 $118.04 $286.49 $300.82 $573.00 $286.49 $286.49 $286.49 $224.48 $224.48 $605.09 $286.49 $611.20 $496.60 $79.36 $286.49 $443.12 $300.82 $414.48 $286.49 $62.34 $286.49 N/A N/A 31200286 EAP CPT® 88346 "IMMUNOF,DIR CHARGE" BOTH IP/OP $794.00 $588.00 $43.49 $635.20 $137.20 $137.20 $137.20 $137.20 $286.49 $286.49 $285.22 $50.44 $286.49 $59.58 $59.58 $61.87 $43.49 $83.33 $458.39 $467.58 $469.65 $286.49 $118.04 $286.49 $300.82 $595.50 $286.49 $286.49 $286.49 $224.48 $224.48 $628.85 $286.49 $635.20 $516.10 $79.36 $286.49 $460.52 $300.82 $414.48 $286.49 $62.34 $286.49 N/A N/A 31200287 EAP CPT® 88346 "IMMUNOF, IND CHARGE" BOTH IP/OP $537.00 $397.50 $43.49 $467.58 $137.20 $137.20 $137.20 $137.20 $286.49 $286.49 $285.22 $50.44 $286.49 $59.58 $59.58 $61.87 $43.49 $83.33 $458.39 $467.58 $317.64 $286.49 $118.04 $286.49 $300.82 $402.75 $286.49 $286.49 $286.49 $224.48 $224.48 $425.30 $286.49 $429.60 $349.05 $79.36 $286.49 $311.46 $300.82 $414.48 $286.49 $62.34 $286.49 N/A N/A 31200288 EAP CPT® 88360 *STAIN: HER2NEU BOTH IP/OP $642.00 $475.50 $49.88 $513.60 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $379.74 $146.71 $78.13 $146.71 $154.04 $481.50 $146.71 $146.71 $146.71 $242.68 $242.68 $508.46 $146.71 $513.60 $417.30 $109.25 $146.71 $372.36 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 31200290 EAP CPT® 88342 *STAIN: BER EP4 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200291 EAP CPT® 88342 *STAIN: CD117 (C-KIT) BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200292 EAP CPT® 88342 *STAIN: CDX2 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200293 EAP CPT® 88342 *STAIN: CEA (MONOCLONAL) BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200294 EAP CPT® 88342 *STAIN: CYCLIN D1 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200295 EAP CPT® 88342 *STAIN: CYTOKERATIN 19 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200296 EAP CPT® 88342 *STAIN: CYTOKERATIN 5 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200297 EAP CPT® 88342 *STAIN: CYTOKERATIN 5/6 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200298 EAP CPT® 88342 *STAIN: CYTOKERATIN 6 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200299 EAP CPT® 88342 *STAIN: E-CADHERIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200300 EAP CPT® 88342 *STAIN: EGFR BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200301 EAP CPT® 88342 *STAIN: GALECTIN-3 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200302 EAP CPT® 88342 *STAIN: GCDFP-15 BOTH IP/OP $544.00 $403.00 $43.77 $435.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $321.78 $146.71 $66.63 $146.71 $154.04 $408.00 $146.71 $146.71 $146.71 $212.92 $212.92 $430.85 $146.71 $435.20 $353.60 $80.08 $146.71 $315.52 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200303 EAP CPT® 88342 *STAIN: HBME-1 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200304 EAP CPT® 88342 *STAIN: HELICOBACTER PYLORI BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200305 EAP CPT® 88342 *STAIN: HHV-8 (HUMAN HERPES-8) BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200306 EAP CPT® 88342 *STAIN: MELAN A (MART-1) BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200307 EAP CPT® 88342 *STAIN: P10 BOTH IP/OP $544.00 $403.00 $43.77 $435.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $321.78 $146.71 $66.63 $146.71 $154.04 $408.00 $146.71 $146.71 $146.71 $212.92 $212.92 $430.85 $146.71 $435.20 $353.60 $80.08 $146.71 $315.52 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200308 EAP CPT® 88342 *STAIN: P63 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200309 EAP CPT® 88342 *STAIN: TREPONEMA BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200310 EAP CPT® 88342 *STAIN: WT-1 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200311 EAP CPT® 88342 *STAIN:PIN COCKTAIL(P63=P504S) BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200312 EAP CPT® 88342 *STAIN:SMA(SMOOTH MUSCLE ACTIN BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200313 EAP CPT® 88342 STAIN: CD56 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200314 EAP CPT® 88342 STAIN: CD99 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200315 EAP CPT® 88342 STAIN: GLYPICAN-3 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200316 EAP CPT® 88342 STAIN: MOC-1 BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200317 EAP CPT® 88342 IMMUNOHISTO CHEMISTRY BOTH IP/OP $278.00 $206.00 $43.77 $234.73 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $164.44 $146.71 $66.63 $146.71 $154.04 $208.50 $146.71 $146.71 $146.71 $212.92 $212.92 $220.18 $146.71 $222.40 $180.70 $80.08 $146.71 $161.24 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200320 EAP CPT® 88342 IHC MARKER (STAIN ONLY) (SO) BOTH IP/OP $333.00 $246.50 $43.77 $266.40 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $196.97 $146.71 $66.63 $146.71 $154.04 $249.75 $146.71 $146.71 $146.71 $212.92 $212.92 $263.74 $146.71 $266.40 $216.45 $80.08 $146.71 $193.14 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200321 EAP CPT® 88361 INSCAPE ER/PR/HER QUANT-IHC (SO) BOTH IP/OP $736.00 $545.00 $61.99 $736.00 $736.00 $736.00 $736.00 $736.00 $78.37 $78.37 $61.99 $736.00 $78.37 $96.90 $96.90 $100.62 $70.73 $143.65 $125.39 $121.76 $736.00 $78.37 $76.10 $78.37 $736.00 $552.00 $78.37 $78.37 $78.37 $425.20 $425.20 $582.91 $78.37 $588.80 $478.40 $736.00 $78.37 $426.88 $736.00 $82.48 $78.37 $736.00 $78.37 N/A N/A 31200322 EAP CPT® 88361 INSCAPE ER/PR QUANT -IHC (SO) BOTH IP/OP $510.00 $377.50 $61.99 $510.00 $510.00 $510.00 $510.00 $510.00 $78.37 $78.37 $61.99 $510.00 $78.37 $96.90 $96.90 $100.62 $70.73 $143.65 $125.39 $121.76 $510.00 $78.37 $76.10 $78.37 $510.00 $382.50 $78.37 $78.37 $78.37 $425.20 $425.20 $403.92 $78.37 $408.00 $331.50 $510.00 $78.37 $295.80 $510.00 $82.48 $78.37 $510.00 $78.37 N/A N/A 31200323 EAP CPT® 88342 ERCC1 IHC WITH INTERP (SO) BOTH IP/OP $278.00 $206.00 $43.77 $234.73 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $164.44 $146.71 $66.63 $146.71 $154.04 $208.50 $146.71 $146.71 $146.71 $212.92 $212.92 $220.18 $146.71 $222.40 $180.70 $80.08 $146.71 $161.24 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200330 EAP CPT® 88305 ACCESSORT DIGIT DIAGNOSTIC BOTH IP/OP $367.00 $272.00 $31.63 $293.60 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $217.08 $48.88 $35.18 $48.88 $51.32 $275.25 $48.88 $48.88 $48.88 $281.96 $281.96 $290.66 $48.88 $293.60 $238.55 $73.71 $48.88 $212.86 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200331 EAP CPT® 88305 ACROMIOCLAVICULAR JOINT BOTH IP/OP $367.00 $272.00 $31.63 $293.60 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $217.08 $48.88 $35.18 $48.88 $51.32 $275.25 $48.88 $48.88 $48.88 $281.96 $281.96 $290.66 $48.88 $293.60 $238.55 $73.71 $48.88 $212.86 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200332 EAP CPT® 88304 ADHESIONS PELVIC BOTH IP/OP $371.00 $275.00 $18.49 $296.80 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $219.45 $48.88 $31.80 $48.88 $51.32 $278.25 $48.88 $48.88 $48.88 $216.24 $216.24 $293.83 $48.88 $296.80 $241.15 $33.77 $48.88 $215.18 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200333 EAP CPT® 88304 ADIPOSE TISSUE (FAT/FATTY TISSUE) BOTH IP/OP $367.00 $272.00 $18.49 $293.60 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $217.08 $48.88 $31.80 $48.88 $51.32 $275.25 $48.88 $48.88 $48.88 $216.24 $216.24 $290.66 $48.88 $293.60 $238.55 $33.77 $48.88 $212.86 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200334 EAP CPT® 88305 AMPULLA OF VATER BOTH IP/OP $371.00 $275.00 $31.63 $296.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $219.45 $48.88 $35.18 $48.88 $51.32 $278.25 $48.88 $48.88 $48.88 $281.96 $281.96 $293.83 $48.88 $296.80 $241.15 $73.71 $48.88 $215.18 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200335 EAP CPT® 88307 AMPUTATION-EXTREMITY NON-TRAUMATIC BOTH IP/OP $371.00 $275.00 $98.83 $467.58 $371.00 $371.00 $371.00 $371.00 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $219.45 $286.49 $211.40 $286.49 $300.82 $278.25 $286.49 $286.49 $286.49 $371.00 $371.00 $293.83 $286.49 $296.80 $241.15 $149.14 $286.49 $215.18 $300.82 $371.00 $286.49 $117.15 $286.49 N/A N/A 31200336 EAP CPT® 88307 ARACHNOID MATER-TUMOR RESECTION BOTH IP/OP $367.00 $272.00 $98.83 $467.58 $367.00 $367.00 $367.00 $367.00 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $217.08 $286.49 $211.40 $286.49 $300.82 $275.25 $286.49 $286.49 $286.49 $367.00 $367.00 $290.66 $286.49 $293.60 $238.55 $149.14 $286.49 $212.86 $300.82 $367.00 $286.49 $117.15 $286.49 N/A N/A 31200337 EAP CPT® 88305 ARTERIOVENOUS MALFORMATION (AVM) BOTH IP/OP $474.00 $351.00 $31.63 $379.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $280.37 $48.88 $35.18 $48.88 $51.32 $355.50 $48.88 $48.88 $48.88 $281.96 $281.96 $375.41 $48.88 $379.20 $308.10 $73.71 $48.88 $274.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200338 EAP CPT® 88307 ARTERIOVENOUS MALFORMATION (AVM) COMPLEX BOTH IP/OP $474.00 $351.00 $98.83 $474.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $280.37 $286.49 $211.40 $286.49 $300.82 $355.50 $286.49 $286.49 $286.49 $474.00 $474.00 $375.41 $286.49 $379.20 $308.10 $149.14 $286.49 $274.92 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200339 EAP CPT® 88307 AXILLARY TAIL/AXILLA - LYMPH NODES RESECTION BOTH IP/OP $474.00 $351.00 $98.83 $474.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $280.37 $286.49 $211.40 $286.49 $300.82 $355.50 $286.49 $286.49 $286.49 $474.00 $474.00 $375.41 $286.49 $379.20 $308.10 $149.14 $286.49 $274.92 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200340 EAP CPT® 88305 BONE MARROW PARTICLE CLOT BOTH IP/OP $474.00 $351.00 $31.63 $379.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $280.37 $48.88 $35.18 $48.88 $51.32 $355.50 $48.88 $48.88 $48.88 $281.96 $281.96 $375.41 $48.88 $379.20 $308.10 $73.71 $48.88 $274.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200341 EAP CPT® 88305 BREAST EXCISION OF DISCRETE LESION BOTH IP/OP $474.00 $351.00 $31.63 $379.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $280.37 $48.88 $35.18 $48.88 $51.32 $355.50 $48.88 $48.88 $48.88 $281.96 $281.96 $375.41 $48.88 $379.20 $308.10 $73.71 $48.88 $274.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200342 EAP CPT® 88305 BREAST NEEDLE CORE TISSUE BIOPSY BOTH IP/OP $474.00 $351.00 $31.63 $379.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $280.37 $48.88 $35.18 $48.88 $51.32 $355.50 $48.88 $48.88 $48.88 $281.96 $281.96 $375.41 $48.88 $379.20 $308.10 $73.71 $48.88 $274.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200343 EAP CPT® 88305 BREAST INCISIONAL BIOPSY BOTH IP/OP $474.00 $351.00 $31.63 $379.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $280.37 $48.88 $35.18 $48.88 $51.32 $355.50 $48.88 $48.88 $48.88 $281.96 $281.96 $375.41 $48.88 $379.20 $308.10 $73.71 $48.88 $274.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200344 EAP CPT® 88307 BREAST QUADRANTECTOMY/PARTIAL MASTECTOMY/SEGMENTECTOMY BOTH IP/OP $474.00 $351.00 $98.83 $474.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $280.37 $286.49 $211.40 $286.49 $300.82 $355.50 $286.49 $286.49 $286.49 $474.00 $474.00 $375.41 $286.49 $379.20 $308.10 $149.14 $286.49 $274.92 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200345 EAP CPT® 88307 CERVIX AMPUTATION WITHOUT UTERUS BOTH IP/OP $474.00 $351.00 $98.83 $474.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $280.37 $286.49 $211.40 $286.49 $300.82 $355.50 $286.49 $286.49 $286.49 $474.00 $474.00 $375.41 $286.49 $379.20 $308.10 $149.14 $286.49 $274.92 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200346 EAP CPT® 88305 "COLON ""DONUT""" BOTH IP/OP $474.00 $351.00 $31.63 $379.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $280.37 $48.88 $35.18 $48.88 $51.32 $355.50 $48.88 $48.88 $48.88 $281.96 $281.96 $375.41 $48.88 $379.20 $308.10 $73.71 $48.88 $274.92 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200347 EAP CPT® 88304 COLON DONUT BOTH IP/OP $474.00 $351.00 $18.49 $379.20 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $280.37 $48.88 $31.80 $48.88 $51.32 $355.50 $48.88 $48.88 $48.88 $216.24 $216.24 $375.41 $48.88 $379.20 $308.10 $33.77 $48.88 $274.92 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200348 EAP CPT® 88307 CYST - BONE BOTH IP/OP $469.00 $347.50 $98.83 $469.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $277.41 $286.49 $211.40 $286.49 $300.82 $351.75 $286.49 $286.49 $286.49 $469.00 $469.00 $371.45 $286.49 $375.20 $304.85 $149.14 $286.49 $272.02 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200349 EAP CPT® 88305 CYST - CERVIX BOTH IP/OP $469.00 $347.50 $31.63 $375.20 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $277.41 $48.88 $35.18 $48.88 $51.32 $351.75 $48.88 $48.88 $48.88 $281.96 $281.96 $371.45 $48.88 $375.20 $304.85 $73.71 $48.88 $272.02 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200350 EAP CPT® 88307 CYST - DERMOID OF SOFT TISSUE/OVARY (EG TERATOMA) BOTH IP/OP $474.00 $351.00 $98.83 $474.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $280.37 $286.49 $211.40 $286.49 $300.82 $355.50 $286.49 $286.49 $286.49 $474.00 $474.00 $375.41 $286.49 $379.20 $308.10 $149.14 $286.49 $274.92 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200351 EAP CPT® 88304 CYST - DERMOID SKIN BOTH IP/OP $469.00 $347.50 $18.49 $375.20 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $277.41 $48.88 $31.80 $48.88 $51.32 $351.75 $48.88 $48.88 $48.88 $216.24 $216.24 $371.45 $48.88 $375.20 $304.85 $33.77 $48.88 $272.02 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200352 EAP CPT® 88304 CYST - EPIDERMOID BOTH IP/OP $591.00 $437.50 $18.49 $472.80 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $349.58 $48.88 $31.80 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $216.24 $216.24 $468.07 $48.88 $472.80 $384.15 $33.77 $48.88 $342.78 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200353 EAP CPT® 88305 CYST - OVARIAN NON-NEOPLASTIC BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200354 EAP CPT® 88307 CYST NOS NEOPLASTIC BOTH IP/OP $591.00 $437.50 $98.83 $480.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $349.58 $286.49 $211.40 $286.49 $300.82 $443.25 $286.49 $286.49 $286.49 $480.00 $480.00 $468.07 $286.49 $472.80 $384.15 $149.14 $286.49 $342.78 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200355 EAP CPT® 88305 CYST NOS NONNEOPLASTIC BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200356 EAP CPT® 88302 CYSTOCELE BOTH IP/OP $585.00 $433.00 $14.11 $468.00 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $346.03 $24.30 $26.39 $24.30 $25.52 $438.75 $24.30 $24.30 $24.30 $174.88 $174.88 $463.32 $24.30 $468.00 $380.25 $39.23 $24.30 $339.30 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200357 EAP CPT® 88309 DIAPHRAGM - RESECTION FOR TUMOR BOTH IP/OP $585.00 $433.00 $135.48 "$1,120.24" $585.00 $585.00 $585.00 $585.00 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $346.03 $644.63 $298.65 $644.63 $676.87 $438.75 $644.63 $644.63 $644.63 $585.00 $585.00 $463.32 $644.63 $468.00 $380.25 $210.09 $644.63 $339.30 $676.87 $585.00 $644.63 $165.03 $644.63 N/A N/A 31200358 EAP CPT® 88307 DIAPHRAGM - RESECTION OTHER THAN FOR TUMOR BOTH IP/OP $585.00 $433.00 $98.83 $480.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $346.03 $286.49 $211.40 $286.49 $300.82 $438.75 $286.49 $286.49 $286.49 $480.00 $480.00 $463.32 $286.49 $468.00 $380.25 $149.14 $286.49 $339.30 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200359 EAP CPT® 88307 DURA MATER - TUMOR RESECTION BOTH IP/OP $591.00 $437.50 $98.83 $480.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $349.58 $286.49 $211.40 $286.49 $300.82 $443.25 $286.49 $286.49 $286.49 $480.00 $480.00 $468.07 $286.49 $472.80 $384.15 $149.14 $286.49 $342.78 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200360 EAP CPT® 88305 ENDOMETRIAL POLYP BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200361 EAP CPT® 88309 ENDOSCOPIC MUCOSAL RESECTION (EMR) BOTH IP/OP $591.00 $437.50 $135.48 "$1,120.24" $591.00 $591.00 $591.00 $591.00 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $349.58 $644.63 $298.65 $644.63 $676.87 $443.25 $644.63 $644.63 $644.63 $591.00 $591.00 $468.07 $644.63 $472.80 $384.15 $210.09 $644.63 $342.78 $676.87 $591.00 $644.63 $165.03 $644.63 N/A N/A 31200362 EAP CPT® 88305 EPIGLOTTIS BIOPSY/SIMPLE EXCISION BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200363 EAP CPT® 88305 ESOPHAGEAL POLYP BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200364 EAP CPT® 88304 FAT/FATTY TISSUE NOS BOTH IP/OP $585.00 $433.00 $18.49 $468.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $346.03 $48.88 $31.80 $48.88 $51.32 $438.75 $48.88 $48.88 $48.88 $216.24 $216.24 $463.32 $48.88 $468.00 $380.25 $33.77 $48.88 $339.30 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200365 EAP CPT® 88305 GASTRIC POLYP BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200366 EAP CPT® 88305 MUCOSA BIOPSY - GINGIVA BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200367 EAP CPT® 88305 MUCOSA BIOPSY - NASAL BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200368 EAP CPT® 88305 MUCOSA BIOPSY - NOS BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200369 EAP CPT® 88304 NASAL SEPTUM BOTH IP/OP $591.00 $437.50 $18.49 $472.80 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $349.58 $48.88 $31.80 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $216.24 $216.24 $468.07 $48.88 $472.80 $384.15 $33.77 $48.88 $342.78 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200370 EAP CPT® 88307 OMENTUM RESECTION BOTH IP/OP $591.00 $437.50 $98.83 $480.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $349.58 $286.49 $211.40 $286.49 $300.82 $443.25 $286.49 $286.49 $286.49 $480.00 $480.00 $468.07 $286.49 $472.80 $384.15 $149.14 $286.49 $342.78 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200371 EAP CPT® 88309 OMENTUM RESECTION - FOR TUMOR BOTH IP/OP $591.00 $437.50 $135.48 "$1,120.24" $591.00 $591.00 $591.00 $591.00 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $349.58 $644.63 $298.65 $644.63 $676.87 $443.25 $644.63 $644.63 $644.63 $591.00 $591.00 $468.07 $644.63 $472.80 $384.15 $210.09 $644.63 $342.78 $676.87 $591.00 $644.63 $165.03 $644.63 N/A N/A 31200372 EAP CPT® 88305 ORAL CYST BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200373 EAP CPT® 88305 PANNICULUS BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200374 EAP CPT® 88305 PENIS BIOPSY BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200375 EAP CPT® 88309 PENIS RESECTION FOR TUMOR BOTH IP/OP $591.00 $437.50 $135.48 "$1,120.24" $591.00 $591.00 $591.00 $591.00 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $349.58 $644.63 $298.65 $644.63 $676.87 $443.25 $644.63 $644.63 $644.63 $591.00 $591.00 $468.07 $644.63 $472.80 $384.15 $210.09 $644.63 $342.78 $676.87 $591.00 $644.63 $165.03 $644.63 N/A N/A 31200376 EAP CPT® 88305 PERICARDIIUM BIOPSY OR TISSUE BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200377 EAP CPT® 88309 PERICARDIUM RESECTION - FOR TUMOR BOTH IP/OP $585.00 $433.00 $135.48 "$1,120.24" $585.00 $585.00 $585.00 $585.00 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $346.03 $644.63 $298.65 $644.63 $676.87 $438.75 $644.63 $644.63 $644.63 $585.00 $585.00 $463.32 $644.63 $468.00 $380.25 $210.09 $644.63 $339.30 $676.87 $585.00 $644.63 $165.03 $644.63 N/A N/A 31200378 EAP CPT® 88309 PERITONEUM RESECTION - FOR TUMOR BOTH IP/OP $591.00 $437.50 $135.48 "$1,120.24" $591.00 $591.00 $591.00 $591.00 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $349.58 $644.63 $298.65 $644.63 $676.87 $443.25 $644.63 $644.63 $644.63 $591.00 $591.00 $468.07 $644.63 $472.80 $384.15 $210.09 $644.63 $342.78 $676.87 $591.00 $644.63 $165.03 $644.63 N/A N/A 31200379 EAP CPT® 88305 PIA MATER - OTHER THAN TUMOR RESECTION BOTH IP/OP $585.00 $433.00 $31.63 $468.00 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $346.03 $48.88 $35.18 $48.88 $51.32 $438.75 $48.88 $48.88 $48.88 $281.96 $281.96 $463.32 $48.88 $468.00 $380.25 $73.71 $48.88 $339.30 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200380 EAP CPT® 88307 PIA MATER - TUMOR RESECTION BOTH IP/OP $585.00 $433.00 $98.83 $480.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $346.03 $286.49 $211.40 $286.49 $300.82 $438.75 $286.49 $286.49 $286.49 $480.00 $480.00 $463.32 $286.49 $468.00 $380.25 $149.14 $286.49 $339.30 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200381 EAP CPT® 88307 PLEURA RESECTION BOTH IP/OP $591.00 $437.50 $98.83 $480.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $349.58 $286.49 $211.40 $286.49 $300.82 $443.25 $286.49 $286.49 $286.49 $480.00 $480.00 $468.07 $286.49 $472.80 $384.15 $149.14 $286.49 $342.78 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200382 EAP CPT® 88305 RETROPERITONEAL BIOPSY BOTH IP/OP $585.00 $433.00 $31.63 $468.00 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $346.03 $48.88 $35.18 $48.88 $51.32 $438.75 $48.88 $48.88 $48.88 $281.96 $281.96 $463.32 $48.88 $468.00 $380.25 $73.71 $48.88 $339.30 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200383 EAP CPT® 88304 SCAR - SOFT TISSUE BOTH IP/OP $591.00 $437.50 $18.49 $472.80 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $349.58 $48.88 $31.80 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $216.24 $216.24 $468.07 $48.88 $472.80 $384.15 $33.77 $48.88 $342.78 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200384 EAP CPT® 88305 SKIN WART (EG VERRUCA VULGARIS) BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200385 EAP CPT® 88305 SPINAL CORD BIOPSY BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200386 EAP CPT® 88307 SPINAL CORD TUMOR EXCISION BOTH IP/OP $591.00 $437.50 $98.83 $480.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $349.58 $286.49 $211.40 $286.49 $300.82 $443.25 $286.49 $286.49 $286.49 $480.00 $480.00 $468.07 $286.49 $472.80 $384.15 $149.14 $286.49 $342.78 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200387 EAP CPT® 88304 STOMA (ANY SITE) BOTH IP/OP $591.00 $437.50 $18.49 $472.80 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $349.58 $48.88 $31.80 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $216.24 $216.24 $468.07 $48.88 $472.80 $384.15 $33.77 $48.88 $342.78 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200388 EAP CPT® 88305 STOMACH POLYP BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200389 EAP CPT® 88302 SUPERNUMERARY DIGIT BOTH IP/OP $591.00 $437.50 $14.11 $472.80 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $349.58 $24.30 $26.39 $24.30 $25.52 $443.25 $24.30 $24.30 $24.30 $174.88 $174.88 $468.07 $24.30 $472.80 $384.15 $39.23 $24.30 $342.78 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200390 EAP CPT® 88305 SUPERNUMERARY DIGIT DIAGNOSTIC BOTH IP/OP $585.00 $433.00 $31.63 $468.00 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $346.03 $48.88 $35.18 $48.88 $51.32 $438.75 $48.88 $48.88 $48.88 $281.96 $281.96 $463.32 $48.88 $468.00 $380.25 $73.71 $48.88 $339.30 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200391 EAP CPT® 88307 SURGICAL MARGIN COMPLICATED EXAM BOTH IP/OP $591.00 $437.50 $98.83 $480.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $349.58 $286.49 $211.40 $286.49 $300.82 $443.25 $286.49 $286.49 $286.49 $480.00 $480.00 $468.07 $286.49 $472.80 $384.15 $149.14 $286.49 $342.78 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200392 EAP CPT® 88302 THYMUS INCIDENTIAL BOTH IP/OP $591.00 $437.50 $14.11 $472.80 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $349.58 $24.30 $26.39 $24.30 $25.52 $443.25 $24.30 $24.30 $24.30 $174.88 $174.88 $468.07 $24.30 $472.80 $384.15 $39.23 $24.30 $342.78 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200393 EAP CPT® 88302 UVULA - INCIDENTAL BOTH IP/OP $585.00 $433.00 $14.11 $468.00 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $346.03 $24.30 $26.39 $24.30 $25.52 $438.75 $24.30 $24.30 $24.30 $174.88 $174.88 $463.32 $24.30 $468.00 $380.25 $39.23 $24.30 $339.30 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200394 EAP CPT® 88305 VOCAL CORD BIOPSY BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200395 EAP CPT® 88307 VOCAL CORD RESECTION BOTH IP/OP $591.00 $437.50 $98.83 $480.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $349.58 $286.49 $211.40 $286.49 $300.82 $443.25 $286.49 $286.49 $286.49 $480.00 $480.00 $468.07 $286.49 $472.80 $384.15 $149.14 $286.49 $342.78 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200396 EAP CPT® 88307 BONE CYST BOTH IP/OP $591.00 $437.50 $98.83 $480.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $349.58 $286.49 $211.40 $286.49 $300.82 $443.25 $286.49 $286.49 $286.49 $480.00 $480.00 $468.07 $286.49 $472.80 $384.15 $149.14 $286.49 $342.78 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200397 EAP CPT® 88305 BREAST BIOPSY WITHOUT MARGIN EXAM BOTH IP/OP $591.00 $437.50 $31.63 $472.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $349.58 $48.88 $35.18 $48.88 $51.32 $443.25 $48.88 $48.88 $48.88 $281.96 $281.96 $468.07 $48.88 $472.80 $384.15 $73.71 $48.88 $342.78 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200398 EAP CPT® 88307 CYST - OVARIAN NEOPLASTIC BOTH IP/OP $591.00 $437.50 $98.83 $480.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $349.58 $286.49 $211.40 $286.49 $300.82 $443.25 $286.49 $286.49 $286.49 $480.00 $480.00 $468.07 $286.49 $472.80 $384.15 $149.14 $286.49 $342.78 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200399 EAP CPT® 88305 CYST - SINSUS BOTH IP/OP $737.00 $545.50 $31.63 $589.60 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $435.94 $48.88 $35.18 $48.88 $51.32 $552.75 $48.88 $48.88 $48.88 $281.96 $281.96 $583.70 $48.88 $589.60 $479.05 $73.71 $48.88 $427.46 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200400 EAP CPT® 88305 DIAPHRAGM BIOPSY OR TISSUE BOTH IP/OP $737.00 $545.50 $31.63 $589.60 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $435.94 $48.88 $35.18 $48.88 $51.32 $552.75 $48.88 $48.88 $48.88 $281.96 $281.96 $583.70 $48.88 $589.60 $479.05 $73.71 $48.88 $427.46 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200401 EAP CPT® 88304 DIVERTICULUM - BLADDER/URETHRA BOTH IP/OP $745.00 $551.50 $18.49 $596.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $440.67 $48.88 $31.80 $48.88 $51.32 $558.75 $48.88 $48.88 $48.88 $216.24 $216.24 $590.04 $48.88 $596.00 $484.25 $33.77 $48.88 $432.10 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200402 EAP CPT® 88305 DURA MATER BOTH IP/OP $745.00 $551.50 $31.63 $596.00 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $440.67 $48.88 $35.18 $48.88 $51.32 $558.75 $48.88 $48.88 $48.88 $281.96 $281.96 $590.04 $48.88 $596.00 $484.25 $73.71 $48.88 $432.10 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200403 EAP CPT® 88302 ENTEROCELE BOTH IP/OP $737.00 $545.50 $14.11 $589.60 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $435.94 $24.30 $26.39 $24.30 $25.52 $552.75 $24.30 $24.30 $24.30 $174.88 $174.88 $583.70 $24.30 $589.60 $479.05 $39.23 $24.30 $427.46 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200404 EAP CPT® 88305 ETHMOID TISSUE BOTH IP/OP $737.00 $545.50 $31.63 $589.60 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $435.94 $48.88 $35.18 $48.88 $51.32 $552.75 $48.88 $48.88 $48.88 $281.96 $281.96 $583.70 $48.88 $589.60 $479.05 $73.71 $48.88 $427.46 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200405 EAP CPT® 88305 FAT PAD BIOPSY BOTH IP/OP $745.00 $551.50 $31.63 $596.00 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $440.67 $48.88 $35.18 $48.88 $51.32 $558.75 $48.88 $48.88 $48.88 $281.96 $281.96 $590.04 $48.88 $596.00 $484.25 $73.71 $48.88 $432.10 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200406 EAP CPT® 88305 LEEP BIOPSY BOTH IP/OP $745.00 $551.50 $31.63 $596.00 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $440.67 $48.88 $35.18 $48.88 $51.32 $558.75 $48.88 $48.88 $48.88 $281.96 $281.96 $590.04 $48.88 $596.00 $484.25 $73.71 $48.88 $432.10 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200407 EAP CPT® 88304 LIGAMENT BOTH IP/OP $745.00 $551.50 $18.49 $596.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $440.67 $48.88 $31.80 $48.88 $51.32 $558.75 $48.88 $48.88 $48.88 $216.24 $216.24 $590.04 $48.88 $596.00 $484.25 $33.77 $48.88 $432.10 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200408 EAP CPT® 88307 LYMPH NODE FOR LYMPHOMA WORKUP BOTH IP/OP $745.00 $551.50 $98.83 $596.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $440.67 $286.49 $211.40 $286.49 $300.82 $558.75 $286.49 $286.49 $286.49 $480.00 $480.00 $590.04 $286.49 $596.00 $484.25 $149.14 $286.49 $432.10 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200409 EAP CPT® 88304 MENINGEMATOMA/MENINGHEMATOMA BOTH IP/OP $737.00 $545.50 $18.49 $589.60 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $435.94 $48.88 $31.80 $48.88 $51.32 $552.75 $48.88 $48.88 $48.88 $216.24 $216.24 $583.70 $48.88 $589.60 $479.05 $33.77 $48.88 $427.46 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200410 EAP CPT® 88305 MUCOSA BIOPSY - ORAL BOTH IP/OP $745.00 $551.50 $31.63 $596.00 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $440.67 $48.88 $35.18 $48.88 $51.32 $558.75 $48.88 $48.88 $48.88 $281.96 $281.96 $590.04 $48.88 $596.00 $484.25 $73.71 $48.88 $432.10 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200411 EAP CPT® 88304 NAIL NAIL BED OR SCRAPPING FOR FUNGUS BOTH IP/OP $745.00 $551.50 $18.49 $596.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $440.67 $48.88 $31.80 $48.88 $51.32 $558.75 $48.88 $48.88 $48.88 $216.24 $216.24 $590.04 $48.88 $596.00 $484.25 $33.77 $48.88 $432.10 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200412 EAP CPT® 88307 NERVE TUMOR BOTH IP/OP $745.00 $551.50 $98.83 $596.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $440.67 $286.49 $211.40 $286.49 $300.82 $558.75 $286.49 $286.49 $286.49 $480.00 $480.00 $590.04 $286.49 $596.00 $484.25 $149.14 $286.49 $432.10 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200413 EAP CPT® 88305 NEUROFIBROMA/NEUROMA BOTH IP/OP $737.00 $545.50 $31.63 $589.60 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $435.94 $48.88 $35.18 $48.88 $51.32 $552.75 $48.88 $48.88 $48.88 $281.96 $281.96 $583.70 $48.88 $589.60 $479.05 $73.71 $48.88 $427.46 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200414 EAP CPT® 88305 OSTEOCHONDROMA (EXOSTOSIS) BOTH IP/OP $737.00 $545.50 $31.63 $589.60 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $435.94 $48.88 $35.18 $48.88 $51.32 $552.75 $48.88 $48.88 $48.88 $281.96 $281.96 $583.70 $48.88 $589.60 $479.05 $73.71 $48.88 $427.46 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200415 EAP CPT® 88307 PERICARDIUM RESECTION BOTH IP/OP $737.00 $545.50 $98.83 $589.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $435.94 $286.49 $211.40 $286.49 $300.82 $552.75 $286.49 $286.49 $286.49 $480.00 $480.00 $583.70 $286.49 $589.60 $479.05 $149.14 $286.49 $427.46 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200416 EAP CPT® 88307 PERITONEUM RESECTION BOTH IP/OP $737.00 $545.50 $98.83 $589.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $435.94 $286.49 $211.40 $286.49 $300.82 $552.75 $286.49 $286.49 $286.49 $480.00 $480.00 $583.70 $286.49 $589.60 $479.05 $149.14 $286.49 $427.46 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200417 EAP CPT® 88309 PLEURA RESECTION - FOR TUMOR BOTH IP/OP $745.00 $551.50 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $440.67 $644.63 $298.65 $644.63 $676.87 $558.75 $644.63 $644.63 $644.63 $656.96 $656.96 $590.04 $644.63 $596.00 $484.25 $210.09 $644.63 $432.10 $676.87 $745.00 $644.63 $165.03 $644.63 N/A N/A 31200418 EAP CPT® 88307 RETROPERITONEAL MASS BOTH IP/OP $737.00 $545.50 $98.83 $589.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $435.94 $286.49 $211.40 $286.49 $300.82 $552.75 $286.49 $286.49 $286.49 $480.00 $480.00 $583.70 $286.49 $589.60 $479.05 $149.14 $286.49 $427.46 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200419 EAP CPT® 88305 RIB MARROW SQUEEZE BOTH IP/OP $737.00 $545.50 $31.63 $589.60 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $435.94 $48.88 $35.18 $48.88 $51.32 $552.75 $48.88 $48.88 $48.88 $281.96 $281.96 $583.70 $48.88 $589.60 $479.05 $73.71 $48.88 $427.46 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200420 EAP CPT® 88305 SCAR - KELOID BOTH IP/OP $745.00 $551.50 $31.63 $596.00 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $440.67 $48.88 $35.18 $48.88 $51.32 $558.75 $48.88 $48.88 $48.88 $281.96 $281.96 $590.04 $48.88 $596.00 $484.25 $73.71 $48.88 $432.10 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200421 EAP CPT® 88304 SCAR - SKIN (SIMPLE/CICATRIX) BOTH IP/OP $745.00 $551.50 $18.49 $596.00 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $440.67 $48.88 $31.80 $48.88 $51.32 $558.75 $48.88 $48.88 $48.88 $216.24 $216.24 $590.04 $48.88 $596.00 $484.25 $33.77 $48.88 $432.10 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200422 EAP CPT® 88305 SCAR - SKIN (TUMOR EXCISION/RE-EXCISION BOTH IP/OP $745.00 $551.50 $31.63 $596.00 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $440.67 $48.88 $35.18 $48.88 $51.32 $558.75 $48.88 $48.88 $48.88 $281.96 $281.96 $590.04 $48.88 $596.00 $484.25 $73.71 $48.88 $432.10 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200423 EAP CPT® 88302 SINUS CONTENTS BOTH IP/OP "$1,012.00" $749.00 $14.11 $809.60 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $598.60 $24.30 $26.39 $24.30 $25.52 $759.00 $24.30 $24.30 $24.30 $174.88 $174.88 $801.50 $24.30 $809.60 $657.80 $39.23 $24.30 $586.96 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200424 EAP CPT® 88305 SINUS MUCOSA STRIPPING BOTH IP/OP "$1,001.00" $741.00 $31.63 $800.80 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $592.09 $48.88 $35.18 $48.88 $51.32 $750.75 $48.88 $48.88 $48.88 $281.96 $281.96 $792.79 $48.88 $800.80 $650.65 $73.71 $48.88 $580.58 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200425 EAP CPT® 88305 SURGICAL MARGIN UNCOMPLICATED EXAM BOTH IP/OP "$1,012.00" $749.00 $31.63 $809.60 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $598.60 $48.88 $35.18 $48.88 $51.32 $759.00 $48.88 $48.88 $48.88 $281.96 $281.96 $801.50 $48.88 $809.60 $657.80 $73.71 $48.88 $586.96 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200426 EAP CPT® 88305 THYROID BIOPSY BOTH IP/OP "$1,012.00" $749.00 $31.63 $809.60 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $598.60 $48.88 $35.18 $48.88 $51.32 $759.00 $48.88 $48.88 $48.88 $281.96 $281.96 $801.50 $48.88 $809.60 $657.80 $73.71 $48.88 $586.96 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200427 EAP CPT® 88304 TURBINATES (NASAL CONCHAE) BOTH IP/OP "$1,012.00" $749.00 $18.49 $809.60 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $598.60 $48.88 $31.80 $48.88 $51.32 $759.00 $48.88 $48.88 $48.88 $216.24 $216.24 $801.50 $48.88 $809.60 $657.80 $33.77 $48.88 $586.96 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200428 EAP CPT® 88302 UVULA SIMPLE EXCISION BOTH IP/OP "$1,012.00" $749.00 $14.11 $809.60 $44.73 $44.73 $44.73 $44.73 $24.30 $24.30 $24.19 $14.11 $24.30 $43.98 $43.98 $45.67 $32.11 $41.19 $38.88 $36.00 $598.60 $24.30 $26.39 $24.30 $25.52 $759.00 $24.30 $24.30 $24.30 $174.88 $174.88 $801.50 $24.30 $809.60 $657.80 $39.23 $24.30 $586.96 $25.52 $35.16 $24.30 $30.82 $24.30 N/A N/A 31200429 EAP CPT® 88305 VEIN BIOPSY/SEGMENT BOTH IP/OP "$1,012.00" $749.00 $31.63 $809.60 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $598.60 $48.88 $35.18 $48.88 $51.32 $759.00 $48.88 $48.88 $48.88 $281.96 $281.96 $801.50 $48.88 $809.60 $657.80 $73.71 $48.88 $586.96 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200450 EAP CPT® 88342 "P40 PROTEIN, IHC" BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200455 EAP CPT® 88309 "TERATOMA , EXTENSIVE RESECTION" BOTH IP/OP "$1,001.00" $741.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $592.09 $644.63 $298.65 $644.63 $676.87 $750.75 $644.63 $644.63 $644.63 $656.96 $656.96 $792.79 $644.63 $800.80 $650.65 $210.09 $644.63 $580.58 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200456 EAP CPT® 88342 "NAPSIN-A,IHC" BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200457 EAP CPT® 88304 "APPENDIX, NON-INCIDENTAL" BOTH IP/OP $474.00 $351.00 $18.49 $379.20 $59.61 $59.61 $59.61 $59.61 $48.88 $48.88 $48.66 $18.49 $48.88 $53.11 $53.11 $55.16 $38.77 $35.46 $78.21 $72.33 $280.37 $48.88 $31.80 $48.88 $51.32 $355.50 $48.88 $48.88 $48.88 $216.24 $216.24 $375.41 $48.88 $379.20 $308.10 $33.77 $48.88 $274.92 $51.32 $70.72 $48.88 $26.53 $48.88 N/A N/A 31200458 EAP CPT® 88307 SENTINEL LYMPH NODE(S) BOTH IP/OP $745.00 $551.50 $98.83 $596.00 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $440.67 $286.49 $211.40 $286.49 $300.82 $558.75 $286.49 $286.49 $286.49 $480.00 $480.00 $590.04 $286.49 $596.00 $484.25 $149.14 $286.49 $432.10 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200459 EAP CPT® 88305 NEEDLE CORE BIOPSY BOTH IP/OP $745.00 $551.50 $31.63 $596.00 $99.70 $99.70 $99.70 $99.70 $48.88 $48.88 $48.66 $31.63 $48.88 $70.10 $70.10 $72.79 $51.17 $77.40 $78.21 $72.33 $440.67 $48.88 $35.18 $48.88 $51.32 $558.75 $48.88 $48.88 $48.88 $281.96 $281.96 $590.04 $48.88 $596.00 $484.25 $73.71 $48.88 $432.10 $51.32 $70.72 $48.88 $57.90 $48.88 N/A N/A 31200460 EAP CPT® 88300 "TISSUE, GROSS ONLY" BOTH IP/OP $266.00 $197.00 $7.30 $212.80 $23.64 $23.64 $23.64 $23.64 $24.30 $24.30 $24.19 $7.30 $24.30 $19.71 $19.71 $20.47 $14.39 $16.80 $38.88 $36.00 $157.34 $24.30 $11.84 $24.30 $25.52 $199.50 $24.30 $24.30 $24.30 $77.52 $77.52 $210.67 $24.30 $212.80 $172.90 $16.00 $24.30 $154.28 $25.52 $35.16 $24.30 $12.57 $24.30 N/A N/A 31200461 EAP CPT® 88329 INTRA-OPERATIVE PATHOLOGY CONSULT BOTH IP/OP $298.00 $221.00 $17.89 $298.00 $298.00 $298.00 $298.00 $298.00 $35.49 $35.49 $17.89 $298.00 $35.49 $34.74 $34.74 $36.07 $25.36 $43.31 $56.78 $56.38 $298.00 $35.49 $35.24 $35.49 $298.00 $223.50 $35.49 $35.49 $35.49 $203.88 $203.88 $236.02 $35.49 $238.40 $193.70 $298.00 $35.49 $172.84 $298.00 $37.86 $35.49 $298.00 $35.49 N/A N/A 31200462 EAP CPT® 88331 FIRST TISSUE BLOCK W FS (SINGLE SPEC) BOTH IP/OP $581.00 $430.00 $22.30 $464.80 $141.31 $141.31 $141.31 $141.31 $146.71 $146.71 $146.06 $44.60 $146.71 $30.54 $30.54 $31.72 $22.30 $87.82 $234.73 $226.86 $343.66 $146.71 $41.60 $146.71 $154.04 $435.75 $146.71 $146.71 $146.71 $114.92 $114.92 $460.15 $146.71 $464.80 $377.65 $83.64 $146.71 $336.98 $154.04 $212.25 $146.71 $65.70 $146.71 N/A N/A 31200463 EAP CPT® 88332 EACH ADD TISSUE BLOCK W FROZEN SECTION(S) BOTH IP/OP $280.00 $207.50 $7.96 $280.00 $76.56 $76.56 $76.56 $76.56 $280.00 $280.00 $280.00 $24.49 $280.00 $10.90 $10.90 $11.32 $7.96 $44.09 $280.00 $280.00 $165.62 $280.00 $25.03 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $40.92 $40.92 $221.76 $280.00 $224.00 $182.00 $41.99 $280.00 $162.40 $280.00 $280.00 $280.00 $32.98 $280.00 N/A N/A 31200464 EAP CPT® 88360 ER/PR QUANTITIATIVE IHC BOTH IP/OP "$1,001.00" $741.00 $49.88 $800.80 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $592.09 $146.71 $78.13 $146.71 $154.04 $750.75 $146.71 $146.71 $146.71 $242.68 $242.68 $792.79 $146.71 $800.80 $650.65 $109.25 $146.71 $580.58 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 31200466 EAP CPT® 88342 "HUMAN HERPESVIRUS , TYPE 8(HHV-8)" BOTH IP/OP $510.00 $377.50 $43.77 $408.00 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $301.67 $146.71 $66.63 $146.71 $154.04 $382.50 $146.71 $146.71 $146.71 $212.92 $212.92 $403.92 $146.71 $408.00 $331.50 $80.08 $146.71 $295.80 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200467 EAP CPT® 88342 "NEURON SPECIFIC ENOLASE (NSE), IHC" BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200468 EAP CPT® 88342 "CD20, L26, IHC" BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200469 EAP CPT® 88307 SALIVARY GLAND BOTH IP/OP $774.00 $573.00 $98.83 $619.20 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $457.82 $286.49 $211.40 $286.49 $300.82 $580.50 $286.49 $286.49 $286.49 $480.00 $480.00 $613.01 $286.49 $619.20 $503.10 $149.14 $286.49 $448.92 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200470 EAP CPT® 88307 "URINARY BLADDER, TUR" BOTH IP/OP $782.00 $579.00 $98.83 $625.60 $386.46 $386.46 $386.46 $386.46 $286.49 $286.49 $285.22 $123.09 $286.49 $135.39 $135.39 $140.59 $98.83 $156.60 $458.39 $467.58 $462.55 $286.49 $211.40 $286.49 $300.82 $586.50 $286.49 $286.49 $286.49 $480.00 $480.00 $619.34 $286.49 $625.60 $508.30 $149.14 $286.49 $453.56 $300.82 $414.48 $286.49 $117.15 $286.49 N/A N/A 31200471 EAP CPT® 88333 INTRAOPERATIVE CYTOLOGIC EXAMINATION (TOUCH PREP) INITIAL SITE BOTH IP/OP $654.00 $484.00 $23.96 "$1,120.24" $136.69 $136.69 $136.69 $136.69 $644.63 $644.63 $641.78 $41.03 $644.63 $32.82 $32.82 $34.08 $23.96 $88.68 "$1,031.41" "$1,120.24" $386.84 $644.63 $32.47 $644.63 $676.87 $490.50 $644.63 $644.63 $644.63 $114.92 $114.92 $517.97 $644.63 $523.20 $425.10 $84.46 $644.63 $379.32 $676.87 $654.00 $644.63 $66.34 $644.63 N/A N/A 31200472 EAP CPT® 88334 INTRAOPERATIVE CYTOLOGIC EXAMINATION (TOUCH PREP) ADD SITE BOTH IP/OP $280.00 $207.50 $14.61 $280.00 $280.00 $280.00 $280.00 $280.00 $19.34 $19.34 $28.56 $280.00 $19.34 $20.02 $20.02 $20.79 $14.61 $46.34 $30.94 $31.39 $280.00 $19.34 $19.62 $19.34 $280.00 $210.00 $19.34 $19.34 $19.34 $69.04 $69.04 $221.76 $19.34 $224.00 $182.00 $280.00 $19.34 $162.40 $280.00 $18.01 $19.34 $280.00 $19.34 N/A N/A 31200473 EAP CPT® 88341 IHC STAIN - ADDITIONAL BOTH IP/OP $766.00 $567.00 $42.49 $766.00 $132.08 $132.08 $132.08 $132.08 $766.00 $766.00 $766.00 $42.49 $766.00 $70.50 $70.50 $73.21 $51.47 $67.41 $766.00 $766.00 $453.09 $766.00 $59.18 $766.00 $766.00 $574.50 $61.48 $766.00 $766.00 $383.00 $383.00 $606.67 $766.00 $612.80 $497.90 $64.20 $766.00 $444.28 $766.00 $766.00 $766.00 $50.43 $766.00 N/A N/A 31200474 EAP CPT® 88341 *STAIN: MELAN A (MART-1) BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200475 EAP CPT® 88341 *STAIN: P10 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200476 EAP CPT® 88341 *STAIN: P63 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200477 EAP CPT® 88341 *STAIN: TREPONEMA BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200478 EAP CPT® 88341 *STAIN: WT-1 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200479 EAP CPT® 88341 *STAIN: PIN COCKTAIL(P63=P504S) BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200480 EAP CPT® 88341 *STAIN: SMA(SMOOTH MUSCLE ACTIN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200481 EAP CPT® 88341 STAIN: CD56 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200482 EAP CPT® 88341 STAIN: CD99 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $61.48 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200483 EAP CPT® 88341 STAIN: GLYPICAN-3 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $61.48 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200484 EAP CPT® 88341 STAIN: MOC-1 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200485 EAP CPT® 88341 IMMUNOHISTO CHEMISTRY BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200486 EAP CPT® 88341 IHC MARKER (STAIN ONLY) (SO) BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $61.48 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200487 EAP CPT® 88341 ERCC1 IHC WITH INTERP (SO) BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200488 EAP CPT® 88341 "P40 PROTEIN, IHC" BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200489 EAP CPT® 88341 "NAPSIN-A,IHC" BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200490 EAP CPT® 88341 "NEURON SPECIFIC ENOLASE (NSE), IHC" BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200491 EAP CPT® 88341 "CD20, L26, IHC" BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200492 EAP CPT® 88341 PLACENTAL LACTOGEN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200493 EAP CPT® 88341 PROLACTIN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200494 EAP CPT® 88341 PROSTATE ACID PHOS BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200495 EAP CPT® 88341 PROSTATE SPEC AG BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200496 EAP CPT® 88341 S-100 NEURAL AG BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200497 EAP CPT® 88341 SEROTONIN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200498 EAP CPT® 88341 SYNATOPHYSIN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200499 EAP CPT® 88341 THYROGLOBULIN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200500 EAP CPT® 88341 UCHL-1 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200501 EAP CPT® 88341 VIMENTIN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200502 EAP CPT® 88341 EM:KAPPA BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200503 EAP CPT® 88341 EM:LAMBDA BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200504 EAP CPT® 88341 *STAIN: BER EP4 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200505 EAP CPT® 88341 *STAIN: CD117 (C-KIT) BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200506 EAP CPT® 88341 *STAIN: CDX2 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200507 EAP CPT® 88341 *STAIN: CDX2 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200508 EAP CPT® 88341 *STAIN: CEA (MONOCLONAL) BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200509 EAP CPT® 88341 *STAIN: CYCLIN D1 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200510 EAP CPT® 88341 *STAIN: CYCLIN D1 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200511 EAP CPT® 88341 *STAIN: CYTOKERATIN 19 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200512 EAP CPT® 88341 *STAIN: CYTOKERATIN 5 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200513 EAP CPT® 88341 *STAIN: CYTOKERATIN 5/6 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200514 EAP CPT® 88341 *STAIN: CYTOKERATIN 6 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200515 EAP CPT® 88341 *STAIN: E-CADHERIN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200516 EAP CPT® 88341 *STAIN: EGFR BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200517 EAP CPT® 88341 *STAIN: GALECTIN-3 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200518 EAP CPT® 88341 *STAIN: GCDFP-15 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200519 EAP CPT® 88341 *STAIN: HBME-1 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200520 EAP CPT® 88341 *STAIN: HELICOBACTER PYLORI BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200521 EAP CPT® 88341 *STAIN: HHV-8 (HUMAN HERPES-8) BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200522 EAP CPT® 88341 *STAIN: CD79 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200523 EAP CPT® 88341 *STAIN: CYTOKERATIN 7 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200524 EAP CPT® 88341 *STAIN: HEPATOCYTE BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200525 EAP CPT® 88341 *STAIN: HI MOL WT KERATIN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200526 EAP CPT® 88341 *STAIN: INHIBIN ALPHA BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200527 EAP CPT® 88341 *STAIN: MYELOPEROXIDASE BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200528 EAP CPT® 88341 *STAIN: P16 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200529 EAP CPT® 88341 *STAIN: P53 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200530 EAP CPT® 88341 *STAIN: TDT BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200531 EAP CPT® 88341 *STAIN: TTF-1 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200532 EAP CPT® 88341 *STAIN: VILLIN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200533 EAP CPT® 88341 IMMUNOPEROXIDASE BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200534 EAP CPT® 88341 GLIAL FIBRILLARY AP BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200535 EAP CPT® 88341 GLUCAGON BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200536 EAP CPT® 88341 HEPATITIS B CORE BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200537 EAP CPT® 88341 HEPATITIS B SURFACE BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200538 EAP CPT® 88341 HERPES SIMPLEX PROB BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200539 EAP CPT® 88341 HUMAN CHORIONIC GON BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200540 EAP CPT® 88341 HUMAN GROWTH HORMON BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200541 EAP CPT® 88341 INSULIN BOTH IP/OP $766.00 $567.00 $42.49 $766.00 $132.08 $132.08 $132.08 $132.08 $766.00 $766.00 $766.00 $42.49 $766.00 $70.50 $70.50 $73.21 $51.47 $67.41 $766.00 $599.00 $453.09 $766.00 $59.18 $766.00 $766.00 $574.50 $766.00 $766.00 $766.00 $383.00 $383.00 $606.67 $766.00 $612.80 $497.90 $64.20 $766.00 $444.28 $766.00 $766.00 $766.00 $50.43 $766.00 N/A N/A 31200542 EAP CPT® 88341 KAPPA BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200543 EAP CPT® 88341 L-26 B CELL MARKER BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200544 EAP CPT® 88341 LAMBDA BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200545 EAP CPT® 88341 LEU M1 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200546 EAP CPT® 88341 LEUKOCYTE COMMON AG BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200547 EAP CPT® 88341 LEUTEINIZING HORMON BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200548 EAP CPT® 88341 MACROPHAGE-HAM-56 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200549 EAP CPT® 88341 MELANOMA-HMB-45 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200550 EAP CPT® 88341 NEURON SPEC ENOLASE BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200551 EAP CPT® 88341 PLACENTAL ALK PHOS BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200552 EAP CPT® 88341 A-1 ANTITRYPSIN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200553 EAP CPT® 88341 "ACTIN,MUSCLE SPEC." BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200554 EAP CPT® 88341 ALPHA-FETOPROTEIN BOTH IP/OP $586.00 $434.00 $42.49 $586.00 $132.08 $132.08 $132.08 $132.08 $586.00 $586.00 $586.00 $42.49 $586.00 $70.50 $70.50 $73.21 $51.47 $67.41 $586.00 $586.00 $346.62 $586.00 $59.18 $586.00 $586.00 $439.50 $586.00 $586.00 $586.00 $293.00 $293.00 $464.11 $586.00 $468.80 $380.90 $64.20 $586.00 $339.88 $586.00 $586.00 $586.00 $50.43 $586.00 N/A N/A 31200555 EAP CPT® 88341 B72.3-BREAST BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200556 EAP CPT® 88341 CA 125-OVARIAN CA BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200557 EAP CPT® 88341 CA-19-9-CARBOHYDRAT BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200558 EAP CPT® 88341 CALCITONIN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200559 EAP CPT® 88341 CEA-P BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200560 EAP CPT® 88341 CHROMOGRANIN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200561 EAP CPT® 88341 CYTOKERATIN-AE1/AE3 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200562 EAP CPT® 88341 CYTOKERATIN-CAM5.2 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200563 EAP CPT® 88341 CYTOMEGALOVIRUS BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200564 EAP CPT® 88341 DESMIN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200565 EAP CPT® 88341 EMA BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200566 EAP CPT® 88341 FACTOR VIII BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200567 EAP CPT® 88341 *STAIN:ONCOPROTEIN (BCL2) BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200568 EAP CPT® 88341 *STAIN: CD30/BER H2 (KI-1) BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200569 EAP CPT® 88341 *STAIN: B-1 GLYCO BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200570 EAP CPT® 88341 *STAIN: CALPONIN BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200571 EAP CPT® 88341 *STAIN: CALRETININ BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200572 EAP CPT® 88341 *STAIN: A-1 ANTICHYMOTRYPS BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200573 EAP CPT® 88341 *STAIN: CYTOKERATIN 20 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200574 EAP CPT® 88341 *STAIN: CD10 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200575 EAP CPT® 88341 *STAIN: CD138 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200576 EAP CPT® 88341 *STAIN: CD23 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200577 EAP CPT® 88341 *STAIN: CD3 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $61.48 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200578 EAP CPT® 88341 *STAIN: CD31 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $61.48 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200579 EAP CPT® 88341 *STAIN: CD34 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $61.48 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200580 EAP CPT® 88341 *STAIN: CD43 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $61.48 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200581 EAP CPT® 88341 *STAIN: CD5 BOTH IP/OP $773.00 $572.50 $42.49 $773.00 $132.08 $132.08 $132.08 $132.08 $773.00 $773.00 $773.00 $42.49 $773.00 $70.50 $70.50 $73.21 $51.47 $67.41 $773.00 $599.00 $457.23 $773.00 $59.18 $773.00 $773.00 $579.75 $773.00 $773.00 $773.00 $386.50 $386.50 $612.22 $773.00 $618.40 $502.45 $64.20 $773.00 $448.34 $773.00 $773.00 $773.00 $50.43 $773.00 N/A N/A 31200582 EAP CPT® 88342 STAIN:CD45(LCA) BOTH IP/OP $549.00 $406.50 $43.77 $439.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $324.73 $146.71 $66.63 $146.71 $154.04 $411.75 $146.71 $146.71 $146.71 $212.92 $212.92 $434.81 $146.71 $439.20 $356.85 $80.08 $146.71 $318.42 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200583 EAP CPT® 88342 STAIN:CD15 BOTH IP/OP $369.00 $273.50 $43.77 $295.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $218.26 $146.71 $66.63 $146.71 $154.04 $276.75 $146.71 $146.71 $146.71 $212.92 $212.92 $292.25 $146.71 $295.20 $239.85 $80.08 $146.71 $214.02 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31200584 EAP CPT® 88360 ER/PR PARAFFIN (SO) BOTH IP/OP $526.00 $389.50 $49.88 $420.80 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $311.13 $146.71 $78.13 $146.71 $154.04 $394.50 $146.71 $146.71 $146.71 $242.68 $242.68 $416.59 $146.71 $420.80 $341.90 $109.25 $146.71 $305.08 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 31200585 EAP CPT® 88360 HER2 IHC W/INTERPRET (SO) BOTH IP/OP $430.00 $318.50 $49.88 $344.00 $203.51 $203.51 $203.51 $203.51 $146.71 $146.71 $146.06 $58.38 $146.71 $68.33 $68.33 $70.96 $49.88 $114.71 $234.73 $226.86 $254.35 $146.71 $78.13 $146.71 $154.04 $322.50 $146.71 $146.71 $146.71 $242.68 $242.68 $340.56 $146.71 $344.00 $279.50 $109.25 $146.71 $249.40 $154.04 $212.25 $146.71 $85.82 $146.71 N/A N/A 31200586 EAP CPT® 88309 SURG PATH FETUS AND PLACENTA BOTH IP/OP "$1,062.00" $786.00 $135.48 "$1,120.24" $592.54 $592.54 $592.54 $592.54 $644.63 $644.63 $641.78 $186.99 $644.63 $185.59 $185.59 $192.73 $135.48 $220.59 "$1,031.41" "$1,120.24" $628.17 $644.63 $298.65 $644.63 $676.87 $796.50 $644.63 $644.63 $644.63 $656.96 $656.96 $841.10 $644.63 $849.60 $690.30 $210.09 $644.63 $615.96 $676.87 $932.62 $644.63 $165.03 $644.63 N/A N/A 31200600 EAP CPT® 88342 IHC STAIN - FIRST BOTH IP/OP $544.00 $403.00 $43.77 $435.20 $155.22 $155.22 $155.22 $155.22 $146.71 $146.71 $146.06 $48.82 $146.71 $59.96 $59.96 $62.26 $43.77 $84.08 $234.73 $226.86 $321.78 $146.71 $66.63 $146.71 $154.04 $408.00 $146.71 $146.71 $146.71 $212.92 $212.92 $430.85 $146.71 $435.20 $353.60 $80.08 $146.71 $315.52 $154.04 $212.25 $146.71 $62.90 $146.71 N/A N/A 31900001 EAP CPT® 88348 EM PROCESSING ONLY BOTH IP/OP "$3,624.00" "$2,682.00" $215.81 "$3,624.00" "$3,624.00" "$3,624.00" "$3,624.00" "$3,624.00" $384.83 $384.83 $215.81 "$3,624.00" $384.83 $572.71 $572.71 $594.73 $418.07 $328.30 $615.73 $641.84 "$3,624.00" $384.83 $401.15 $384.83 "$3,624.00" "$2,718.00" $384.83 $384.83 $384.83 "$1,812.76" "$1,812.76" "$2,870.21" $384.83 "$2,899.20" "$2,355.60" "$3,624.00" $384.83 "$2,101.92" "$3,624.00" $313.71 $384.83 "$3,624.00" $384.83 N/A N/A 31900002 EAP CPT® 88348 EM: NON KIDNEY BOTH IP/OP "$3,624.00" "$2,682.00" $215.81 "$3,624.00" "$3,624.00" "$3,624.00" "$3,624.00" "$3,624.00" $384.83 $384.83 $215.81 "$3,624.00" $384.83 $572.71 $572.71 $594.73 $418.07 $328.30 $615.73 $641.84 "$3,624.00" $384.83 $401.15 $384.83 "$3,624.00" "$2,718.00" $384.83 $384.83 $384.83 "$1,812.76" "$1,812.76" "$2,870.21" $384.83 "$2,899.20" "$2,355.60" "$3,624.00" $384.83 "$2,101.92" "$3,624.00" $313.71 $384.83 "$3,624.00" $384.83 N/A N/A 31900003 EAP CPT® 88348 EM:KIDNEY BOTH IP/OP "$3,624.00" "$2,682.00" $215.81 "$3,624.00" "$3,624.00" "$3,624.00" "$3,624.00" "$3,624.00" $384.83 $384.83 $215.81 "$3,624.00" $384.83 $572.71 $572.71 $594.73 $418.07 $328.30 $615.73 $641.84 "$3,624.00" $384.83 $401.15 $384.83 "$3,624.00" "$2,718.00" $384.83 $384.83 $384.83 "$1,812.76" "$1,812.76" "$2,870.21" $384.83 "$2,899.20" "$2,355.60" "$3,624.00" $384.83 "$2,101.92" "$3,624.00" $313.71 $384.83 "$3,624.00" $384.83 N/A N/A 31900004 EAP CPT® 81229 CHROMOSOMAL MICROARRAY POSTNATAL (SO) BOTH IP/OP "$1,401.00" "$1,037.00" $522.00 "$2,038.86" $768.06 $768.06 $768.06 $768.06 "$1,160.00" "$1,160.00" $580.00 $522.00 "$1,160.00" "$1,039.82" "$1,039.82" "$1,079.89" $729.92 "$1,401.00" "$1,856.00" "$1,856.00" $828.69 "$1,160.00" "$1,160.00" "$1,160.00" "$1,401.00" "$1,050.75" "$1,160.00" "$1,160.00" "$1,160.00" $700.50 $700.50 "$1,109.59" "$1,160.00" "$1,120.80" "$1,914.00" "$1,401.00" "$1,160.00" $812.58 "$1,401.00" "$1,401.00" "$1,160.00" "$2,038.86" "$1,160.00" N/A N/A 31900005 EAP CPT® 81263 CLL-IGVH MUTATION STATUS (SO) BOTH IP/OP "$1,310.00" $969.50 $86.48 "$1,310.00" $578.00 $578.00 $578.00 $578.00 $294.52 $294.52 $147.26 $147.26 $294.52 $417.86 $417.86 $433.93 $305.04 $115.59 $471.23 $471.23 $774.87 $294.52 $294.52 $294.52 "$1,310.00" $982.50 $294.52 $294.52 $294.52 $655.00 $655.00 "$1,037.52" $294.52 "$1,048.00" $485.96 $110.09 $294.52 $759.80 "$1,310.00" $427.05 $294.52 $86.48 $294.52 N/A N/A 31900007 EAP CPT® 81301 MICROSATELITE INSTABILITY (MSI) (SO) BOTH IP/OP "$1,565.00" "$1,158.50" $174.28 "$1,565.00" "$1,565.00" "$1,565.00" "$1,565.00" "$1,565.00" $348.56 $348.56 $174.28 "$1,565.00" $348.56 $410.84 $410.84 $426.64 $299.91 $220.85 $557.70 $557.70 "$1,565.00" $348.56 $348.56 $348.56 "$1,565.00" "$1,173.75" $348.56 $348.56 $348.56 $782.50 $782.50 "$1,239.48" $348.56 "$1,252.00" "$1,565.00" "$1,565.00" $348.56 $907.70 "$1,565.00" $505.41 $348.56 "$1,565.00" $348.56 N/A N/A 31900008 EAP CPT® 81329 SPINAL MUSCULAR ATROPHY SCREEN (SO) BOTH IP/OP "$1,664.00" "$1,231.50" $61.65 "$1,664.00" $196.01 $196.01 $196.01 $196.01 $137.00 $137.00 $68.50 $61.65 $137.00 $142.48 $142.48 $147.96 $104.01 $128.75 $219.20 $219.20 $984.26 $137.00 $137.00 $137.00 "$1,664.00" "$1,248.00" $137.00 $137.00 $137.00 $832.00 $832.00 "$1,317.89" $137.00 "$1,331.20" $226.05 $122.62 $137.00 $965.12 "$1,664.00" $198.65 $137.00 $96.32 $137.00 N/A N/A 31900009 EAP CPT® 81206 P210 BCR-ABL1 (SO) BOTH IP/OP $630.00 $466.50 $81.98 $630.00 $321.78 $321.78 $321.78 $321.78 $163.96 $163.96 $81.98 $81.98 $163.96 $232.64 $232.64 $241.59 $169.82 $115.59 $262.34 $262.34 $372.65 $163.96 $163.96 $163.96 $630.00 $472.50 $163.96 $163.96 $163.96 $315.00 $315.00 $498.96 $163.96 $504.00 $270.53 $110.09 $163.96 $365.40 $630.00 $237.74 $163.96 $86.48 $163.96 N/A N/A 31900011 EAP CPT® 81235 EGFR MUTATION ANALYSIS (SO) BOTH IP/OP "$1,354.00" "$1,002.00" $86.48 "$1,354.00" $474.74 $474.74 $474.74 $474.74 $324.58 $324.58 $162.29 $146.06 $324.58 $343.21 $343.21 $356.41 $250.54 $115.59 $519.33 $519.33 $800.89 $324.58 $324.58 $324.58 "$1,354.00" "$1,015.50" $324.58 $324.58 $324.58 $677.00 $677.00 "$1,072.37" $324.58 "$1,083.20" $535.56 $110.09 $324.58 $785.32 "$1,354.00" $470.64 $324.58 $86.48 $324.58 N/A N/A 31900014 EAP CPT® 81207 P190 BCR-ABL1 (SO) BOTH IP/OP $556.00 $411.50 $72.42 $556.00 $284.26 $284.26 $284.26 $284.26 $144.84 $144.84 $72.42 $72.42 $144.84 $205.49 $205.49 $213.40 $150.01 $115.59 $231.74 $231.74 $328.87 $144.84 $144.84 $144.84 $556.00 $417.00 $144.84 $144.84 $144.84 $278.00 $278.00 $440.35 $144.84 $444.80 $238.99 $110.09 $144.84 $322.48 $556.00 $210.02 $144.84 $86.48 $144.84 N/A N/A 31900015 EAP CPT® 88271 "FISH DNA PROBE, EACH (SO)" BOTH IP/OP $555.00 $411.00 $10.71 $555.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $328.28 $21.42 $21.42 $21.42 $555.00 $416.25 $21.42 $21.42 $21.42 $119.72 $119.72 $439.56 $21.42 $444.00 $35.34 $30.14 $21.42 $321.90 $555.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31900016 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION (SO) BOTH IP/OP $555.00 $411.00 $23.04 $555.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $328.28 $51.19 $51.19 $51.19 $555.00 $416.25 $51.19 $51.19 $51.19 $224.44 $224.44 $439.56 $51.19 $444.00 $84.46 $56.50 $51.19 $321.90 $555.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31900017 EAP CPT® 88271 "FISH DNA PROBE, EACH (SO)" BOTH IP/OP $555.00 $411.00 $10.71 $555.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $328.28 $21.42 $21.42 $21.42 $555.00 $416.25 $21.42 $21.42 $21.42 $119.72 $119.72 $439.56 $21.42 $444.00 $35.34 $30.14 $21.42 $321.90 $555.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31900018 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION (SO) BOTH IP/OP $555.00 $411.00 $23.04 $555.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $328.28 $51.19 $51.19 $51.19 $555.00 $416.25 $51.19 $51.19 $51.19 $224.44 $224.44 $439.56 $51.19 $444.00 $84.46 $56.50 $51.19 $321.90 $555.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31900019 EAP CPT® 88271 "FISH DNA PROBE, EACH (SO)" BOTH IP/OP $411.00 $304.50 $10.71 $411.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $243.11 $21.42 $21.42 $21.42 $411.00 $308.25 $21.42 $21.42 $21.42 $119.72 $119.72 $325.51 $21.42 $328.80 $35.34 $30.14 $21.42 $238.38 $411.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31900020 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION (SO) BOTH IP/OP $411.00 $304.50 $23.04 $411.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $243.11 $51.19 $51.19 $51.19 $411.00 $308.25 $51.19 $51.19 $51.19 $224.44 $224.44 $325.51 $51.19 $328.80 $84.46 $56.50 $51.19 $238.38 $411.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31900021 EAP CPT® 88271 "FISH DNA PROBE, EACH (SO)" BOTH IP/OP $411.00 $304.50 $10.71 $411.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $243.11 $21.42 $21.42 $21.42 $411.00 $308.25 $21.42 $21.42 $21.42 $119.72 $119.72 $325.51 $21.42 $328.80 $35.34 $30.14 $21.42 $238.38 $411.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31900022 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION (SO) BOTH IP/OP $411.00 $304.50 $23.04 $411.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $243.11 $51.19 $51.19 $51.19 $411.00 $308.25 $51.19 $51.19 $51.19 $224.44 $224.44 $325.51 $51.19 $328.80 $84.46 $56.50 $51.19 $238.38 $411.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31900023 EAP CPT® 88271 "FISH DNA PROBE, EACH (SO)" BOTH IP/OP "$1,105.00" $818.00 $10.71 "$1,105.00" $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $653.61 $21.42 $21.42 $21.42 "$1,105.00" $828.75 $21.42 $21.42 $21.42 $119.72 $119.72 $875.16 $21.42 $884.00 $35.34 $30.14 $21.42 $640.90 "$1,105.00" $31.06 $21.42 $23.67 $21.42 N/A N/A 31900024 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION (SO) BOTH IP/OP "$1,105.00" $818.00 $23.04 "$1,105.00" $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $653.61 $51.19 $51.19 $51.19 "$1,105.00" $828.75 $51.19 $51.19 $51.19 $224.44 $224.44 $875.16 $51.19 $884.00 $84.46 $56.50 $51.19 $640.90 "$1,105.00" $74.23 $51.19 $44.38 $51.19 N/A N/A 31900025 EAP CPT® 88271 "FISH, DNA PROBE EACH (SO)" BOTH IP/OP $555.00 $411.00 $10.71 $555.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $328.28 $21.42 $21.42 $21.42 $555.00 $416.25 $21.42 $21.42 $21.42 $119.72 $119.72 $439.56 $21.42 $444.00 $35.34 $30.14 $21.42 $321.90 $555.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31900026 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION (SO) BOTH IP/OP $555.00 $411.00 $23.04 $555.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $328.28 $51.19 $51.19 $51.19 $555.00 $416.25 $51.19 $51.19 $51.19 $224.44 $224.44 $439.56 $51.19 $444.00 $84.46 $56.50 $51.19 $321.90 $555.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31900027 EAP CPT® 88271 "FISH, DNA PROBE EACH (SO)" BOTH IP/OP $690.00 $511.00 $10.71 $690.00 $42.04 $42.04 $42.04 $42.04 $21.42 $21.42 $10.71 $10.71 $21.42 $32.52 $32.52 $33.77 $23.74 $31.65 $34.27 $34.27 $408.14 $21.42 $21.42 $21.42 $690.00 $517.50 $21.42 $21.42 $21.42 $119.72 $119.72 $546.48 $21.42 $552.00 $35.34 $30.14 $21.42 $400.20 $690.00 $31.06 $21.42 $23.67 $21.42 N/A N/A 31900028 EAP CPT® 88275 INTERPHASE IN SITU HYBRIDIZATION (SO) BOTH IP/OP $690.00 $511.00 $23.04 $690.00 $78.81 $78.81 $78.81 $78.81 $51.19 $51.19 $25.60 $23.04 $51.19 $60.99 $60.99 $63.33 $44.52 $59.33 $81.90 $81.90 $408.14 $51.19 $51.19 $51.19 $690.00 $517.50 $51.19 $51.19 $51.19 $224.44 $224.44 $546.48 $51.19 $552.00 $84.46 $56.50 $51.19 $400.20 $690.00 $74.23 $51.19 $44.38 $51.19 N/A N/A 31900030 EAP CPT® 81404 PANCREATITIS PRESS (SO) BOTH IP/OP "$1,757.00" "$1,300.50" $123.67 "$1,757.00" $439.25 $439.25 $439.25 $439.25 $274.83 $274.83 $137.42 $123.67 $274.83 "$1,304.05" "$1,304.05" "$1,354.30" $915.40 $286.64 $439.73 $439.73 "$1,039.27" $274.83 $274.83 $274.83 "$1,757.00" "$1,317.75" $274.83 $274.83 $274.83 $878.50 $878.50 "$1,391.54" $274.83 "$1,405.60" $453.47 $272.99 $274.83 "$1,019.06" "$1,757.00" $398.50 $274.83 $214.43 $274.83 N/A N/A 31900031 EAP CPT® 81404 PANCREATITIS SPINK-1 (SO) BOTH IP/OP "$1,757.00" "$1,300.50" $123.67 "$1,757.00" $439.25 $439.25 $439.25 $439.25 $274.83 $274.83 $137.42 $123.67 $274.83 "$1,304.05" "$1,304.05" "$1,354.30" $915.40 $286.64 $439.73 $439.73 "$1,039.27" $274.83 $274.83 $274.83 "$1,757.00" "$1,317.75" $274.83 $274.83 $274.83 $878.50 $878.50 "$1,391.54" $274.83 "$1,405.60" $453.47 $272.99 $274.83 "$1,019.06" "$1,757.00" $398.50 $274.83 $214.43 $274.83 N/A N/A 31900032 EAP CPT® 81479 PANCREATITIS CTRC (SO) BOTH IP/OP $906.00 $670.50 $188.83 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $188.83 $906.00 $672.43 $672.43 $698.34 $472.03 $906.00 $906.00 $362.40 $535.90 $906.00 $906.00 $906.00 $906.00 $679.50 $906.00 $906.00 $906.00 $453.00 $453.00 $717.55 $906.00 $724.80 $588.90 $906.00 $906.00 $525.48 $906.00 $543.60 $906.00 $782.22 $906.00 N/A N/A 32000001 EAP CPT® 77085 "DUAL-ENERGY X-RAY ABSORPTIOMETRY(DXA),BONE DENSITY STUDY" BOTH IP/OP $668.00 $494.50 $37.27 $668.00 $668.00 $668.00 $668.00 $668.00 $37.27 $37.27 $45.25 $668.00 $37.27 $102.50 $102.50 $106.44 $74.83 $139.22 $59.63 $60.61 $668.00 $37.27 $37.88 $37.27 $668.00 $501.00 $37.27 $37.27 $37.27 $320.64 $320.64 $529.06 $37.27 $534.40 $668.00 $668.00 $37.27 $387.44 $668.00 $38.90 $37.27 $668.00 $37.27 N/A N/A 32000003 EAP CPT® 70015 CISTERNOGRAPHY BOTH IP/OP "$1,032.00" $764.00 $104.81 "$1,032.00" "$1,032.00" "$1,032.00" "$1,032.00" "$1,032.00" $118.43 $118.43 $147.01 "$1,032.00" $118.43 $200.20 $200.20 $207.90 $146.14 $215.08 $189.49 $182.37 "$1,032.00" $118.43 $113.98 $118.43 "$1,032.00" $774.00 $118.43 $118.43 $118.43 $495.36 $495.36 $817.34 $118.43 $825.60 "$1,032.00" "$1,032.00" $118.43 $598.56 "$1,032.00" $104.81 $118.43 "$1,032.00" $118.43 N/A N/A 32000005 EAP CPT® 70100 MANDIBLE 1-3 VIEW RDG BOTH IP/OP $259.00 $192.00 $27.73 $259.00 $259.00 $259.00 $259.00 $259.00 $30.71 $30.71 $33.11 $259.00 $30.71 $52.31 $52.31 $54.32 $38.19 $53.98 $49.14 $48.70 $259.00 $30.71 $30.44 $30.71 $259.00 $194.25 $30.71 $30.71 $30.71 $124.32 $124.32 $205.13 $30.71 $207.20 $259.00 $259.00 $30.71 $150.22 $259.00 $27.73 $30.71 $259.00 $30.71 N/A N/A 32000007 EAP CPT® 70110 MANDIBLE COMPL 4+ VIEW RDG BOTH IP/OP $303.00 $224.50 $32.13 $242.40 $82.00 $82.00 $82.00 $82.00 $107.09 $107.09 $106.62 $63.15 $107.09 $65.61 $65.61 $68.14 $47.90 $63.15 $171.35 $154.19 $179.22 $107.09 $32.13 $107.09 $112.45 $227.25 $107.09 $107.09 $107.09 $145.44 $145.44 $239.98 $107.09 $242.40 $176.70 $60.14 $107.09 $175.74 $112.45 $154.94 $107.09 $63.15 $107.09 N/A N/A 32000013 EAP CPT® 70160 NASAL BONES COMPL 3+VIEW RDG BOTH IP/OP $455.00 $337.00 $27.73 $455.00 $455.00 $455.00 $455.00 $455.00 $30.71 $30.71 $32.81 $455.00 $30.71 $56.86 $56.86 $59.04 $41.50 $94.83 $49.14 $48.70 $455.00 $30.71 $30.44 $30.71 $455.00 $341.25 $30.71 $30.71 $30.71 $218.40 $218.40 $360.36 $30.71 $364.00 $455.00 $455.00 $30.71 $263.90 $455.00 $27.73 $30.71 $455.00 $30.71 N/A N/A 32000020 EAP CPT® 70250 SKULL 1-3VIEW W/WO STEREO RDG BOTH IP/OP $799.00 $591.50 $25.57 $799.00 $799.00 $799.00 $799.00 $799.00 $27.94 $27.94 $30.74 $799.00 $27.94 $59.27 $59.27 $61.55 $43.27 $166.52 $44.70 $44.38 $799.00 $27.94 $27.74 $27.94 $799.00 $599.25 $27.94 $27.94 $27.94 $383.52 $383.52 $632.81 $27.94 $639.20 $799.00 $799.00 $27.94 $463.42 $799.00 $25.57 $27.94 $799.00 $27.94 N/A N/A 32000022 EAP CPT® 70300 PERIAPICAL X-RAY BOTH IP/OP $307.00 $227.50 $7.91 $307.00 $307.00 $307.00 $307.00 $307.00 $7.91 $7.91 $11.20 $307.00 $7.91 $21.47 $21.47 $22.29 $15.67 $63.98 $12.66 $12.99 $307.00 $7.91 $8.12 $7.91 $307.00 $230.25 $7.91 $7.91 $7.91 $147.36 $147.36 $243.14 $7.91 $245.60 $307.00 $307.00 $7.91 $178.06 $307.00 $8.28 $7.91 $307.00 $7.91 N/A N/A 32000023 EAP CPT® 70320 X-RAY COMPLETE BOTH IP/OP $430.00 $318.50 $42.62 $430.00 $430.00 $430.00 $430.00 $430.00 $45.21 $45.21 $48.80 $430.00 $45.21 $89.04 $89.04 $92.47 $65.00 $89.62 $72.34 $68.19 $430.00 $45.21 $42.62 $45.21 $430.00 $322.50 $45.21 $45.21 $45.21 $206.40 $206.40 $340.56 $45.21 $344.00 $430.00 $430.00 $45.21 $249.40 $430.00 $44.30 $45.21 $430.00 $45.21 N/A N/A 32000024 EAP CPT® 70355 X-RAY PANOREX BOTH IP/OP $572.00 $423.50 $8.46 $457.60 $45.23 $45.23 $45.23 $45.23 $79.57 $79.57 $79.21 $119.22 $79.57 $31.14 $31.14 $32.34 $22.73 $119.21 $127.31 $125.33 $338.34 $79.57 $8.46 $79.57 $83.54 $429.00 $79.57 $79.57 $79.57 $274.56 $274.56 $453.02 $79.57 $457.60 $131.28 $113.53 $79.57 $331.76 $83.54 $115.11 $79.57 $119.20 $79.57 N/A N/A 32000026 EAP CPT® 70328 TMJ UNILAT OPEN & CLOSED RDG BOTH IP/OP $252.00 $186.50 $24.49 $252.00 $252.00 $252.00 $252.00 $252.00 $26.91 $26.91 $29.85 $252.00 $26.91 $50.51 $50.51 $52.46 $36.87 $52.52 $43.06 $42.22 $252.00 $26.91 $26.39 $26.91 $252.00 $189.00 $26.91 $26.91 $26.91 $120.96 $120.96 $199.58 $26.91 $201.60 $252.00 $252.00 $26.91 $146.16 $252.00 $24.49 $26.91 $252.00 $26.91 N/A N/A 32000028 EAP CPT® 70330 TMJ BILAT OPEN & CLOSED RDG BOTH IP/OP $660.00 $488.50 $42.28 $528.00 $104.24 $104.24 $104.24 $104.24 $79.57 $79.57 $79.21 $137.56 $79.57 $85.43 $85.43 $88.71 $62.36 $137.55 $127.31 $125.33 $390.39 $79.57 $42.28 $79.57 $83.54 $495.00 $79.57 $79.57 $79.57 $316.80 $316.80 $522.72 $79.57 $528.00 $131.28 $130.99 $79.57 $382.80 $83.54 $115.11 $79.57 $137.54 $79.57 N/A N/A 32000031 EAP CPT® 70360 NECK SOFT TISSUE RDG BOTH IP/OP $746.00 $552.50 $23.34 $596.80 $60.57 $60.57 $60.57 $60.57 $79.57 $79.57 $79.21 $155.49 $79.57 $45.06 $45.06 $46.80 $32.90 $155.47 $127.31 $125.33 $441.26 $79.57 $23.34 $79.57 $83.54 $559.50 $79.57 $79.57 $79.57 $358.08 $358.08 $590.83 $79.57 $596.80 $131.28 $148.06 $79.57 $432.68 $83.54 $115.11 $79.57 $155.47 $79.57 N/A N/A 32000033 EAP CPT® 70370 PHARYN/LARYNX FLUO &/MAGN RDG BOTH IP/OP "$1,216.00" $900.00 $74.56 "$1,216.00" "$1,216.00" "$1,216.00" "$1,216.00" "$1,216.00" $91.49 $91.49 $83.70 "$1,216.00" $91.49 $143.21 $143.21 $148.72 $104.54 $253.43 $146.38 $141.78 "$1,216.00" $91.49 $88.61 $91.49 "$1,216.00" $912.00 $91.49 $91.49 $91.49 $583.68 $583.68 $963.07 $91.49 $972.80 "$1,216.00" "$1,216.00" $91.49 $705.28 "$1,216.00" $74.56 $91.49 "$1,216.00" $91.49 N/A N/A 32000035 EAP CPT® 70390 SIALOGRAPHY S&I RDG BOTH IP/OP "$2,072.00" "$1,533.50" $94.36 "$2,072.00" "$2,072.00" "$2,072.00" "$2,072.00" "$2,072.00" $106.00 $106.00 $103.83 "$2,072.00" $106.00 $197.01 $197.01 $204.58 $143.81 $431.83 $169.60 $162.88 "$2,072.00" $106.00 $101.80 $106.00 "$2,072.00" "$1,554.00" $106.00 $106.00 $106.00 $994.56 $994.56 "$1,641.02" $106.00 "$1,657.60" "$2,072.00" "$2,072.00" $106.00 "$1,201.76" "$2,072.00" $94.36 $106.00 "$2,072.00" $106.00 N/A N/A 32000051 EAP CPT® 71046 EMPLOYEE HEALTH 2 VIEW CHEST BOTH IP/OP $653.00 $483.50 $23.68 $522.40 $66.04 $66.04 $66.04 $66.04 $79.57 $79.57 $79.21 $136.10 $79.57 $49.06 $49.06 $50.94 $35.81 $136.09 $127.31 $125.33 $386.25 $79.57 $23.68 $79.57 $83.54 $489.75 $79.57 $79.57 $79.57 $313.44 $313.44 $517.18 $79.57 $522.40 $131.28 $129.60 $79.57 $378.74 $83.54 $115.11 $79.57 $136.09 $79.57 N/A N/A 32000058 EAP CPT® 71110 RIBS BILAT X-RAY 3VIEW RDG BOTH IP/OP $750.00 $555.00 $30.78 $600.00 $81.25 $81.25 $81.25 $81.25 $107.09 $107.09 $106.62 $156.32 $107.09 $67.28 $67.28 $69.87 $49.11 $156.31 $171.35 $154.19 $443.63 $107.09 $30.78 $107.09 $112.45 $562.50 $107.09 $107.09 $107.09 $360.00 $360.00 $594.00 $107.09 $600.00 $176.70 $148.86 $107.09 $435.00 $112.45 $154.94 $107.09 $156.30 $107.09 N/A N/A 32000060 EAP CPT® 71111 RIBS BILAT X-RAY 4+VIEW RDG BOTH IP/OP "$1,290.00" $955.00 $37.88 "$1,032.00" $104.24 $104.24 $104.24 $104.24 $107.09 $107.09 $106.62 $268.87 $107.09 $88.90 $88.90 $92.32 $64.90 $268.85 $171.35 $154.19 $763.04 $107.09 $37.88 $107.09 $112.45 $967.50 $107.09 $107.09 $107.09 $619.20 $619.20 "$1,021.68" $107.09 "$1,032.00" $176.70 $256.03 $107.09 $748.20 $112.45 $154.94 $107.09 $268.84 $107.09 N/A N/A 32000062 EAP CPT® 71120 STERNUM X-RAY 2+VIEW RDG BOTH IP/OP $508.00 $376.00 $24.69 $406.40 $63.63 $63.63 $63.63 $63.63 $79.57 $79.57 $79.21 $105.88 $79.57 $55.63 $55.63 $57.77 $40.61 $105.87 $127.31 $125.33 $300.48 $79.57 $24.69 $79.57 $83.54 $381.00 $79.57 $79.57 $79.57 $243.84 $243.84 $402.34 $79.57 $406.40 $131.28 $100.83 $79.57 $294.64 $83.54 $115.11 $79.57 $105.87 $79.57 N/A N/A 32000064 EAP CPT® 71130 STERNOCLAVICU JNTS 3+VIEW RDG BOTH IP/OP $371.00 $275.00 $31.46 $296.80 $77.41 $77.41 $77.41 $77.41 $79.57 $79.57 $79.21 $77.33 $79.57 $64.71 $64.71 $67.20 $47.24 $77.32 $127.31 $125.33 $219.45 $79.57 $31.46 $79.57 $83.54 $278.25 $79.57 $79.57 $79.57 $178.08 $178.08 $293.83 $79.57 $296.80 $131.28 $73.63 $79.57 $215.18 $83.54 $115.11 $79.57 $77.32 $79.57 N/A N/A 32000065 EAP CPT® 73020 SHOULDER 1 VIEW RDG BOTH IP/OP "$1,417.00" "$1,049.00" $14.55 "$1,133.60" $49.82 $49.82 $49.82 $49.82 $79.57 $79.57 $79.21 $295.34 $79.57 $38.71 $38.71 $40.20 $28.26 $295.32 $127.31 $125.33 $838.16 $79.57 $14.55 $79.57 $83.54 "$1,062.75" $79.57 $79.57 $79.57 $680.16 $680.16 "$1,122.26" $79.57 "$1,133.60" $131.28 $281.24 $79.57 $821.86 $83.54 $115.11 $79.57 $295.30 $79.57 N/A N/A 32000071 EAP CPT® 72020 CERVICAL SPINE 1 VIEW RDG BOTH IP/OP "$1,075.00" $795.50 $17.25 $860.00 $47.54 $47.54 $47.54 $47.54 $79.57 $79.57 $79.21 $224.06 $79.57 $38.71 $38.71 $40.20 $28.26 $224.04 $127.31 $125.33 $635.86 $79.57 $17.25 $79.57 $83.54 $806.25 $79.57 $79.57 $79.57 $516.00 $516.00 $851.40 $79.57 $860.00 $131.28 $213.36 $79.57 $623.50 $83.54 $115.11 $79.57 $224.03 $79.57 N/A N/A 32000073 EAP CPT® 72020 X-RAY EXAM SPINE 1 VIEW BOTH IP/OP "$1,075.00" $795.50 $17.25 $860.00 $47.54 $47.54 $47.54 $47.54 $79.57 $79.57 $79.21 $224.06 $79.57 $38.71 $38.71 $40.20 $28.26 $224.04 $127.31 $125.33 $635.86 $79.57 $17.25 $79.57 $83.54 $806.25 $79.57 $79.57 $79.57 $516.00 $516.00 $851.40 $79.57 $860.00 $131.28 $213.36 $79.57 $623.50 $83.54 $115.11 $79.57 $224.03 $79.57 N/A N/A 32000075 EAP CPT® 72020 THORACIC SPINE 1 VIEW RDG BOTH IP/OP "$1,075.00" $795.50 $17.25 $860.00 $47.54 $47.54 $47.54 $47.54 $79.57 $79.57 $79.21 $224.06 $79.57 $38.71 $38.71 $40.20 $28.26 $224.04 $127.31 $125.33 $635.86 $79.57 $17.25 $79.57 $83.54 $806.25 $79.57 $79.57 $79.57 $516.00 $516.00 $851.40 $79.57 $860.00 $131.28 $213.36 $79.57 $623.50 $83.54 $115.11 $79.57 $224.03 $79.57 N/A N/A 32000078 EAP CPT® 72040 RAD EXAM SPINE 2 OR 3 VIEWS BOTH IP/OP "$1,040.00" $770.00 $29.43 $832.00 $71.28 $71.28 $71.28 $71.28 $79.57 $79.57 $79.21 $216.76 $79.57 $62.89 $62.89 $65.31 $45.91 $216.75 $127.31 $125.33 $615.16 $79.57 $29.43 $79.57 $83.54 $780.00 $79.57 $79.57 $79.57 $499.20 $499.20 $823.68 $79.57 $832.00 $131.28 $206.41 $79.57 $603.20 $83.54 $115.11 $79.57 $216.74 $79.57 N/A N/A 32000080 EAP CPT® 72050 CERVICAL SPINE 4+VIEW RDG BOTH IP/OP "$1,826.00" "$1,351.50" $40.93 "$1,460.80" $98.12 $98.12 $98.12 $98.12 $107.09 $107.09 $106.62 $380.58 $107.09 $89.81 $89.81 $93.27 $65.56 $380.56 $171.35 $154.19 "$1,080.08" $107.09 $40.93 $107.09 $112.45 "$1,369.50" $107.09 $107.09 $107.09 $876.48 $876.48 "$1,446.19" $107.09 "$1,460.80" $176.70 $362.42 $107.09 "$1,059.08" $112.45 $154.94 $107.09 $380.54 $107.09 N/A N/A 32000081 EAP CPT® 72052 CERVICAL SPINE COMPLETE W/ FLEX/EXT RDG BOTH IP/OP "$1,837.00" "$1,359.50" $48.71 "$1,469.60" $121.11 $121.11 $121.11 $121.11 $107.09 $107.09 $106.62 $382.88 $107.09 $115.22 $115.22 $119.65 $84.11 $382.85 $171.35 $154.19 "$1,086.59" $107.09 $48.71 $107.09 $112.45 "$1,377.75" $107.09 $107.09 $107.09 $881.76 $881.76 "$1,454.90" $107.09 "$1,469.60" $176.70 $364.60 $107.09 "$1,065.46" $112.45 $154.94 $107.09 $382.83 $107.09 N/A N/A 32000084 EAP CPT® 72070 THORACIC SPINE 2 VIEW RDG BOTH IP/OP "$1,158.00" $857.00 $23.68 $926.40 $73.59 $73.59 $73.59 $73.59 $107.09 $107.09 $106.62 $241.36 $107.09 $55.63 $55.63 $57.77 $40.61 $241.34 $171.35 $154.19 $684.96 $107.09 $23.68 $107.09 $112.45 $868.50 $107.09 $107.09 $107.09 $555.84 $555.84 $917.14 $107.09 $926.40 $176.70 $229.83 $107.09 $671.64 $112.45 $154.94 $107.09 $241.33 $107.09 N/A N/A 32000088 EAP CPT® 72080 THORACOLUMBAR 2VIEW RDG BOTH IP/OP "$1,173.00" $868.50 $25.03 $938.40 $65.91 $65.91 $65.91 $65.91 $79.57 $79.57 $79.21 $244.48 $79.57 $59.27 $59.27 $61.55 $43.27 $244.47 $127.31 $125.33 $693.83 $79.57 $25.03 $79.57 $83.54 $879.75 $79.57 $79.57 $79.57 $563.04 $563.04 $929.02 $79.57 $938.40 $131.28 $232.81 $79.57 $680.34 $83.54 $115.11 $79.57 $244.45 $79.57 N/A N/A 32000092 EAP CPT® 72100 LUMBOSACRAL SPINE 2-3VIEW RDG BOTH IP/OP "$1,018.00" $753.50 $29.77 $814.40 $75.88 $75.88 $75.88 $75.88 $107.09 $107.09 $106.62 $212.18 $107.09 $67.44 $67.44 $70.04 $49.23 $212.16 $171.35 $154.19 $602.15 $107.09 $29.77 $107.09 $112.45 $763.50 $107.09 $107.09 $107.09 $488.64 $488.64 $806.26 $107.09 $814.40 $176.70 $202.05 $107.09 $590.44 $112.45 $154.94 $107.09 $212.15 $107.09 N/A N/A 32000095 EAP CPT® 72110 LUMBOSACRAL SPINE 4+VIEW RDG BOTH IP/OP "$1,784.00" "$1,320.50" $39.57 "$1,427.20" $105.77 $105.77 $105.77 $105.77 $107.09 $107.09 $106.62 $371.83 $107.09 $94.35 $94.35 $97.98 $68.87 $371.81 $171.35 $154.19 "$1,055.24" $107.09 $39.57 $107.09 $112.45 "$1,338.00" $107.09 $107.09 $107.09 $856.32 $856.32 "$1,412.93" $107.09 "$1,427.20" $176.70 $354.08 $107.09 "$1,034.72" $112.45 $154.94 $107.09 $371.79 $107.09 N/A N/A 32000097 EAP CPT® 72114 LUMBOSAC COM + BENDING 6 VIEWS BOTH IP/OP "$1,524.00" "$1,128.00" $48.03 "$1,219.20" $134.13 $134.13 $134.13 $134.13 $107.09 $107.09 $106.62 $317.64 $107.09 $127.92 $127.92 $132.84 $93.38 $317.62 $171.35 $154.19 $901.45 $107.09 $48.03 $107.09 $112.45 "$1,143.00" $107.09 $107.09 $107.09 $731.52 $731.52 "$1,207.01" $107.09 "$1,219.20" $176.70 $302.48 $107.09 $883.92 $112.45 $154.94 $107.09 $317.60 $107.09 N/A N/A 32000099 EAP CPT® 72120 LUMBOSAC BENDING 2 OR 3 VIEWS BOTH IP/OP $763.00 $565.00 $28.45 $763.00 $763.00 $763.00 $763.00 $763.00 $31.05 $31.05 $35.18 $763.00 $31.05 $91.62 $91.62 $95.15 $66.88 $159.02 $49.68 $48.70 $763.00 $31.05 $30.44 $31.05 $763.00 $572.25 $31.05 $31.05 $31.05 $366.24 $366.24 $604.30 $31.05 $610.40 $763.00 $763.00 $31.05 $442.54 $763.00 $28.45 $31.05 $763.00 $31.05 N/A N/A 32000109 EAP CPT® 72170 PELVIS X-RAY 1-2 VIEW RDG BOTH IP/OP $796.00 $589.50 $19.96 $636.80 $69.00 $69.00 $69.00 $69.00 $107.09 $107.09 $106.62 $165.91 $107.09 $42.34 $42.34 $43.97 $30.91 $165.90 $171.35 $154.19 $470.83 $107.09 $19.96 $107.09 $112.45 $597.00 $107.09 $107.09 $107.09 $382.08 $382.08 $630.43 $107.09 $636.80 $176.70 $157.99 $107.09 $461.68 $112.45 $154.94 $107.09 $165.89 $107.09 N/A N/A 32000111 EAP CPT® 72190 PELVIS X-RAY COMPL 3+VIEW RDG BOTH IP/OP $805.00 $596.00 $30.78 $644.00 $82.03 $82.03 $82.03 $82.03 $107.09 $107.09 $106.62 $167.78 $107.09 $70.16 $70.16 $72.86 $51.22 $167.77 $171.35 $154.19 $476.16 $107.09 $30.78 $107.09 $112.45 $603.75 $107.09 $107.09 $107.09 $386.40 $386.40 $637.56 $107.09 $644.00 $176.70 $159.77 $107.09 $466.90 $112.45 $154.94 $107.09 $167.76 $107.09 N/A N/A 32000117 EAP CPT® 72200 SACROILIAC JNT 1-2 VIEW RDG BOTH IP/OP $300.00 $222.00 $25.37 $300.00 $61.32 $61.32 $61.32 $61.32 $107.09 $107.09 $106.62 $300.00 $107.09 $300.00 $300.00 $300.00 $300.00 $300.00 $171.35 $154.19 $300.00 $107.09 $25.37 $107.09 $112.45 $225.00 $107.09 $107.09 $107.09 $144.00 $144.00 $300.00 $107.09 $300.00 $195.00 $300.00 $107.09 $174.00 $112.45 $154.94 $107.09 $300.00 $107.09 N/A N/A 32000119 EAP CPT® 72202 SACROILIAC JNT 3+VIEW RDG BOTH IP/OP $317.00 $235.00 $29.09 $253.60 $71.28 $71.28 $71.28 $71.28 $107.09 $107.09 $106.62 $66.07 $107.09 $61.97 $61.97 $64.36 $45.24 $66.07 $171.35 $154.19 $187.51 $107.09 $29.09 $107.09 $112.45 $237.75 $107.09 $107.09 $107.09 $152.16 $152.16 $251.06 $107.09 $253.60 $176.70 $62.92 $107.09 $183.86 $112.45 $154.94 $107.09 $66.06 $107.09 N/A N/A 32000122 EAP CPT® 72220 X-RAY EXAM SACRUM TAILBONE 2+ VIEW BOTH IP/OP $655.00 $485.00 $24.69 $524.00 $60.57 $60.57 $60.57 $60.57 $79.57 $79.57 $79.21 $136.52 $79.57 $51.11 $51.11 $53.07 $37.31 $136.51 $127.31 $125.33 $387.43 $79.57 $24.69 $79.57 $83.54 $491.25 $79.57 $79.57 $79.57 $314.40 $314.40 $518.76 $79.57 $524.00 $131.28 $130.00 $79.57 $379.90 $83.54 $115.11 $79.57 $136.50 $79.57 N/A N/A 32000123 EAP CPT® 72240 MYELOGRAPHY CERVICAL S&I RDG BOTH IP/OP "$1,372.00" "$1,015.50" $72.04 "$1,161.19" $213.07 $213.07 $213.07 $213.07 $703.75 $703.75 $700.64 $285.96 $703.75 $278.28 $278.28 $288.99 $203.14 $285.94 "$1,126.00" "$1,068.65" $811.54 $703.75 $72.04 $703.75 $738.94 "$1,029.00" $703.75 $703.75 $703.75 $658.56 $658.56 "$1,086.62" $703.75 "$1,097.60" "$1,161.19" $272.31 $703.75 $795.76 $738.94 "$1,018.15" $703.75 $285.92 $703.75 N/A N/A 32000124 EAP CPT® 72255 MYELOGRAPHY THORACIC S&I RDG BOTH IP/OP "$1,317.00" $975.00 $66.27 "$1,317.00" "$1,317.00" "$1,317.00" "$1,317.00" "$1,317.00" $75.95 $75.95 $101.87 "$1,317.00" $75.95 $247.00 $247.00 $256.50 $180.31 $274.48 $121.52 $120.14 "$1,317.00" $75.95 $75.09 $75.95 "$1,317.00" $987.75 $75.95 $75.95 $75.95 $632.16 $632.16 "$1,043.06" $75.95 "$1,053.60" "$1,317.00" "$1,317.00" $75.95 $763.86 "$1,317.00" $66.27 $75.95 "$1,317.00" $75.95 N/A N/A 32000125 EAP CPT® 72265 MYELOGRAPHY LUMBAR S&I RDG BOTH IP/OP "$1,372.00" "$1,015.50" $62.67 "$1,372.00" "$1,372.00" "$1,372.00" "$1,372.00" "$1,372.00" $72.84 $72.84 $93.74 "$1,372.00" $72.84 $260.59 $260.59 $270.62 $190.23 $285.94 $116.54 $114.19 "$1,372.00" $72.84 $71.37 $72.84 "$1,372.00" "$1,029.00" $72.84 $72.84 $72.84 $658.56 $658.56 "$1,086.62" $72.84 "$1,097.60" "$1,372.00" "$1,372.00" $72.84 $795.76 "$1,372.00" $62.67 $72.84 "$1,372.00" $72.84 N/A N/A 32000126 EAP CPT® 72270 MYELOGRAPHY COMPLETE S&I RDG BOTH IP/OP "$1,265.00" $936.50 $75.28 "$1,265.00" "$1,265.00" "$1,265.00" "$1,265.00" "$1,265.00" $104.96 $104.96 $128.35 "$1,265.00" $104.96 $401.35 $401.35 $416.78 $292.98 $263.64 $167.94 $161.26 "$1,265.00" $104.96 $100.79 $104.96 "$1,265.00" $948.75 $104.96 $104.96 $104.96 $607.20 $607.20 "$1,001.88" $104.96 "$1,012.00" "$1,265.00" "$1,265.00" $104.96 $733.70 "$1,265.00" $75.28 $104.96 "$1,265.00" $104.96 N/A N/A 32000127 EAP CPT® 72285 DISKOGRAPHY CERVICL/THORAC SPN BOTH IP/OP "$3,367.00" "$2,492.00" $63.75 "$3,367.00" "$3,367.00" "$3,367.00" "$3,367.00" "$3,367.00" $73.88 $73.88 $108.83 "$3,367.00" $73.88 $300.81 $300.81 $312.38 $219.59 $701.72 $118.21 $119.60 "$3,367.00" $73.88 $74.75 $73.88 "$3,367.00" "$2,525.25" $73.88 $73.88 $73.88 "$1,616.16" "$1,616.16" "$2,666.66" $73.88 "$2,693.60" "$3,367.00" "$3,367.00" $73.88 "$1,952.86" "$3,367.00" $63.75 $73.88 "$3,367.00" $73.88 N/A N/A 32000128 EAP CPT® 72295 DISKOGRAPHY LUMBAR SPN BOTH IP/OP "$3,838.00" "$2,840.50" $65.19 "$3,838.00" "$3,838.00" "$3,838.00" "$3,838.00" "$3,838.00" $74.91 $74.91 $97.27 "$3,838.00" $74.91 $290.41 $290.41 $301.58 $212.00 $799.88 $119.86 $116.35 "$3,838.00" $74.91 $72.72 $74.91 "$3,838.00" "$2,878.50" $74.91 $74.91 $74.91 "$1,842.24" "$1,842.24" "$3,039.70" $74.91 "$3,070.40" "$3,838.00" "$3,838.00" $74.91 "$2,226.04" "$3,838.00" $65.19 $74.91 "$3,838.00" $74.91 N/A N/A 32000129 EAP CPT® 73000 CLAVICLE COMPLETE RDG BOTH IP/OP $754.00 $558.00 $24.69 $603.20 $59.79 $59.79 $59.79 $59.79 $79.57 $79.57 $79.21 $157.15 $79.57 $46.88 $46.88 $48.69 $34.22 $157.14 $127.31 $125.33 $445.99 $79.57 $24.69 $79.57 $83.54 $565.50 $79.57 $79.57 $79.57 $361.92 $361.92 $597.17 $79.57 $603.20 $131.28 $149.65 $79.57 $437.32 $83.54 $115.11 $79.57 $157.13 $79.57 N/A N/A 32000131 EAP CPT® 73000 X-RAY EXAM COLLAR BONE BOTH IP/OP $922.00 $682.50 $24.69 $737.60 $59.79 $59.79 $59.79 $59.79 $79.57 $79.57 $79.21 $192.17 $79.57 $46.88 $46.88 $48.69 $34.22 $192.15 $127.31 $125.33 $545.36 $79.57 $24.69 $79.57 $83.54 $691.50 $79.57 $79.57 $79.57 $442.56 $442.56 $730.22 $79.57 $737.60 $131.28 $182.99 $79.57 $534.76 $83.54 $115.11 $79.57 $192.14 $79.57 N/A N/A 32000133 EAP CPT® 73000 CLAVICLE COMPLETE RT RDG BOTH IP/OP $922.00 $682.50 $24.69 $737.60 $59.79 $59.79 $59.79 $59.79 $79.57 $79.57 $79.21 $192.17 $79.57 $46.88 $46.88 $48.69 $34.22 $192.15 $127.31 $125.33 $545.36 $79.57 $24.69 $79.57 $83.54 $691.50 $79.57 $79.57 $79.57 $442.56 $442.56 $730.22 $79.57 $737.60 $131.28 $182.99 $79.57 $534.76 $83.54 $115.11 $79.57 $192.14 $79.57 N/A N/A 32000135 EAP CPT® 73000 X-RAY EXAM COLLAR BONE BILAT BOTH IP/OP "$1,513.00" "$1,120.00" $24.69 "$1,210.40" $59.79 $59.79 $59.79 $59.79 $79.57 $79.57 $79.21 $315.35 $79.57 $46.88 $46.88 $48.69 $34.22 $315.33 $127.31 $125.33 $894.94 $79.57 $24.69 $79.57 $83.54 "$1,134.75" $79.57 $79.57 $79.57 $726.24 $726.24 "$1,198.30" $79.57 "$1,210.40" $131.28 $300.29 $79.57 $877.54 $83.54 $115.11 $79.57 $315.31 $79.57 N/A N/A 32000137 EAP CPT® 73010 SCAPULA COMPLETE RDG BOTH IP/OP $648.00 $480.00 $15.22 $518.40 $65.16 $65.16 $65.16 $65.16 $107.09 $107.09 $106.62 $135.06 $107.09 $47.79 $47.79 $49.63 $34.88 $135.05 $171.35 $154.19 $383.29 $107.09 $15.22 $107.09 $112.45 $486.00 $107.09 $107.09 $107.09 $311.04 $311.04 $513.22 $107.09 $518.40 $176.70 $128.61 $107.09 $375.84 $112.45 $154.94 $107.09 $135.04 $107.09 N/A N/A 32000139 EAP CPT® 73010 X-RAY EXAM SHOULDER BLADE BOTH IP/OP $711.00 $526.50 $15.22 $568.80 $65.16 $65.16 $65.16 $65.16 $107.09 $107.09 $106.62 $148.19 $107.09 $47.79 $47.79 $49.63 $34.88 $148.18 $171.35 $154.19 $420.56 $107.09 $15.22 $107.09 $112.45 $533.25 $107.09 $107.09 $107.09 $341.28 $341.28 $563.11 $107.09 $568.80 $176.70 $141.12 $107.09 $412.38 $112.45 $154.94 $107.09 $148.17 $107.09 N/A N/A 32000141 EAP CPT® 73010 SCAPULA COMPLETE RT RDG BOTH IP/OP $711.00 $526.50 $15.22 $568.80 $65.16 $65.16 $65.16 $65.16 $107.09 $107.09 $106.62 $148.19 $107.09 $47.79 $47.79 $49.63 $34.88 $148.18 $171.35 $154.19 $420.56 $107.09 $15.22 $107.09 $112.45 $533.25 $107.09 $107.09 $107.09 $341.28 $341.28 $563.11 $107.09 $568.80 $176.70 $141.12 $107.09 $412.38 $112.45 $154.94 $107.09 $148.17 $107.09 N/A N/A 32000143 EAP CPT® 73010 X-RAY EXAM SHOULDER BLADE BILAT BOTH IP/OP "$1,291.00" $955.50 $15.22 "$1,032.80" $65.16 $65.16 $65.16 $65.16 $107.09 $107.09 $106.62 $269.08 $107.09 $47.79 $47.79 $49.63 $34.88 $269.06 $171.35 $154.19 $763.63 $107.09 $15.22 $107.09 $112.45 $968.25 $107.09 $107.09 $107.09 $619.68 $619.68 "$1,022.47" $107.09 "$1,032.80" $176.70 $256.23 $107.09 $748.78 $112.45 $154.94 $107.09 $269.04 $107.09 N/A N/A 32000153 EAP CPT® 73030 SHOULDER 2+VIEWS RDG BOTH IP/OP "$1,291.00" $955.50 $26.05 "$1,032.80" $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $269.08 $79.57 $50.19 $50.19 $52.12 $36.64 $269.06 $127.31 $125.33 $763.63 $79.57 $26.05 $79.57 $83.54 $968.25 $79.57 $79.57 $79.57 $619.68 $619.68 "$1,022.47" $79.57 "$1,032.80" $131.28 $256.23 $79.57 $748.78 $83.54 $115.11 $79.57 $269.04 $79.57 N/A N/A 32000154 EAP CPT® 73030 SHOULDER COMPL 2+VIEW EXR BOTH IP/OP "$1,291.00" $955.50 $26.05 "$1,032.80" $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $269.08 $79.57 $50.19 $50.19 $52.12 $36.64 $269.06 $127.31 $125.33 $763.63 $79.57 $26.05 $79.57 $83.54 $968.25 $79.57 $79.57 $79.57 $619.68 $619.68 "$1,022.47" $79.57 "$1,032.80" $131.28 $256.23 $79.57 $748.78 $83.54 $115.11 $79.57 $269.04 $79.57 N/A N/A 32000156 EAP CPT® 73030 X-RAY EXAM SHOULDER 2+ VIEW BOTH IP/OP "$1,417.00" "$1,049.00" $26.05 "$1,133.60" $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $295.34 $79.57 $50.19 $50.19 $52.12 $36.64 $295.32 $127.31 $125.33 $838.16 $79.57 $26.05 $79.57 $83.54 "$1,062.75" $79.57 $79.57 $79.57 $680.16 $680.16 "$1,122.26" $79.57 "$1,133.60" $131.28 $281.24 $79.57 $821.86 $83.54 $115.11 $79.57 $295.30 $79.57 N/A N/A 32000158 EAP CPT® 73030 SHOULDER COMPL 2+VIEWS RT RDG BOTH IP/OP "$1,417.00" "$1,049.00" $26.05 "$1,133.60" $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $295.34 $79.57 $50.19 $50.19 $52.12 $36.64 $295.32 $127.31 $125.33 $838.16 $79.57 $26.05 $79.57 $83.54 "$1,062.75" $79.57 $79.57 $79.57 $680.16 $680.16 "$1,122.26" $79.57 "$1,133.60" $131.28 $281.24 $79.57 $821.86 $83.54 $115.11 $79.57 $295.30 $79.57 N/A N/A 32000161 EAP CPT® 73030 X-RAY EXAM SHOULDER 2+ VIEW BILAT BOTH IP/OP "$1,430.00" "$1,058.50" $26.05 "$1,144.00" $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $298.05 $79.57 $50.19 $50.19 $52.12 $36.64 $298.03 $127.31 $125.33 $845.85 $79.57 $26.05 $79.57 $83.54 "$1,072.50" $79.57 $79.57 $79.57 $686.40 $686.40 "$1,132.56" $79.57 "$1,144.00" $131.28 $283.82 $79.57 $829.40 $83.54 $115.11 $79.57 $298.01 $79.57 N/A N/A 32000163 EAP CPT® 73040 X-RAY SHOULDER W/CONTRAST BOTH IP/OP "$1,335.00" $988.00 $106.88 "$1,068.00" $216.14 $216.14 $216.14 $216.14 $362.23 $362.23 $360.63 $278.25 $362.23 $195.02 $195.02 $202.52 $142.36 $278.23 $579.58 $531.51 $789.65 $362.23 $106.88 $362.23 $380.35 "$1,001.25" $362.23 $362.23 $362.23 $640.80 $640.80 "$1,057.32" $362.23 "$1,068.00" $597.69 $264.96 $362.23 $774.30 $380.35 $524.06 $362.23 $278.21 $362.23 N/A N/A 32000164 EAP CPT® 73040 SHOULDER ARTHROGRAPHY LT RDG BOTH IP/OP "$1,335.00" $988.00 $106.88 "$1,068.00" $216.14 $216.14 $216.14 $216.14 $362.23 $362.23 $360.63 $278.25 $362.23 $195.02 $195.02 $202.52 $142.36 $278.23 $579.58 $531.51 $789.65 $362.23 $106.88 $362.23 $380.35 "$1,001.25" $362.23 $362.23 $362.23 $640.80 $640.80 "$1,057.32" $362.23 "$1,068.00" $597.69 $264.96 $362.23 $774.30 $380.35 $524.06 $362.23 $278.21 $362.23 N/A N/A 32000165 EAP CPT® 73040 X-RAY SHOULDER W/CONTRAST BILAT BOTH IP/OP "$2,432.00" "$1,800.00" $106.88 "$1,945.60" $216.14 $216.14 $216.14 $216.14 $362.23 $362.23 $360.63 $506.89 $362.23 $195.02 $195.02 $202.52 $142.36 $506.86 $579.58 $531.51 "$1,438.53" $362.23 $106.88 $362.23 $380.35 "$1,824.00" $362.23 $362.23 $362.23 "$1,167.36" "$1,167.36" "$1,926.14" $362.23 "$1,945.60" $597.69 $482.69 $362.23 "$1,410.56" $380.35 $524.06 $362.23 $506.83 $362.23 N/A N/A 32000167 EAP CPT® 73050 ACROMICLAVICULAR JNTS BI DRG BOTH IP/OP $864.00 $639.50 $19.96 $864.00 $864.00 $864.00 $864.00 $864.00 $20.00 $20.00 $24.52 $864.00 $20.00 $61.97 $61.97 $64.36 $45.24 $180.07 $32.00 $31.94 $864.00 $20.00 $19.96 $20.00 $864.00 $648.00 $20.00 $20.00 $20.00 $414.72 $414.72 $684.29 $20.00 $691.20 $864.00 $864.00 $20.00 $501.12 $864.00 $21.97 $20.00 $864.00 $20.00 N/A N/A 32000169 EAP CPT® 73060 X-RAY EXAM HUMERUS 2+ VIEW BILAT BOTH IP/OP "$2,462.00" "$1,822.00" $24.69 "$1,969.60" $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $513.14 $79.57 $50.19 $50.19 $52.12 $36.64 $513.11 $127.31 $125.33 "$1,456.27" $79.57 $24.69 $79.57 $83.54 "$1,846.50" $79.57 $79.57 $79.57 "$1,181.76" "$1,181.76" "$1,949.90" $79.57 "$1,969.60" $131.28 $488.65 $79.57 "$1,427.96" $83.54 $115.11 $79.57 $513.08 $79.57 N/A N/A 32000171 EAP CPT® 73060 HUMERUS 2+VIEW RDG BOTH IP/OP "$1,122.00" $830.50 $24.69 $897.60 $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $233.85 $79.57 $50.19 $50.19 $52.12 $36.64 $233.84 $127.31 $125.33 $663.66 $79.57 $24.69 $79.57 $83.54 $841.50 $79.57 $79.57 $79.57 $538.56 $538.56 $888.62 $79.57 $897.60 $131.28 $222.69 $79.57 $650.76 $83.54 $115.11 $79.57 $233.82 $79.57 N/A N/A 32000173 EAP CPT® 73060 X-RAY EXAM HUMERUS 2+ VIEW BOTH IP/OP "$1,233.00" $912.50 $24.69 $986.40 $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $256.99 $79.57 $50.19 $50.19 $52.12 $36.64 $256.97 $127.31 $125.33 $729.32 $79.57 $24.69 $79.57 $83.54 $924.75 $79.57 $79.57 $79.57 $591.84 $591.84 $976.54 $79.57 $986.40 $131.28 $244.72 $79.57 $715.14 $83.54 $115.11 $79.57 $256.96 $79.57 N/A N/A 32000175 EAP CPT® 73060 HUMERUS 2+VIEW RT RDG BOTH IP/OP "$1,233.00" $912.50 $24.69 $986.40 $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $256.99 $79.57 $50.19 $50.19 $52.12 $36.64 $256.97 $127.31 $125.33 $729.32 $79.57 $24.69 $79.57 $83.54 $924.75 $79.57 $79.57 $79.57 $591.84 $591.84 $976.54 $79.57 $986.40 $131.28 $244.72 $79.57 $715.14 $83.54 $115.11 $79.57 $256.96 $79.57 N/A N/A 32000177 EAP CPT® 73070 ELBOW 2 VIEW RDG BOTH IP/OP $647.00 $479.00 $21.65 $517.60 $59.04 $59.04 $59.04 $59.04 $79.57 $79.57 $79.21 $134.85 $79.57 $46.88 $46.88 $48.69 $34.22 $134.84 $127.31 $125.33 $382.70 $79.57 $21.65 $79.57 $83.54 $485.25 $79.57 $79.57 $79.57 $310.56 $310.56 $512.42 $79.57 $517.60 $131.28 $128.41 $79.57 $375.26 $83.54 $115.11 $79.57 $134.83 $79.57 N/A N/A 32000179 EAP CPT® 73070 X-RAY EXAM ELBOW 2+ VIEW BOTH IP/OP $798.00 $591.00 $21.65 $638.40 $59.04 $59.04 $59.04 $59.04 $79.57 $79.57 $79.21 $166.32 $79.57 $46.88 $46.88 $48.69 $34.22 $166.31 $127.31 $125.33 $472.02 $79.57 $21.65 $79.57 $83.54 $598.50 $79.57 $79.57 $79.57 $383.04 $383.04 $632.02 $79.57 $638.40 $131.28 $158.38 $79.57 $462.84 $83.54 $115.11 $79.57 $166.30 $79.57 N/A N/A 32000181 EAP CPT® 73070 ELBOW 2 VIEW RT RDG BOTH IP/OP $798.00 $591.00 $21.65 $638.40 $59.04 $59.04 $59.04 $59.04 $79.57 $79.57 $79.21 $166.32 $79.57 $46.88 $46.88 $48.69 $34.22 $166.31 $127.31 $125.33 $472.02 $79.57 $21.65 $79.57 $83.54 $598.50 $79.57 $79.57 $79.57 $383.04 $383.04 $632.02 $79.57 $638.40 $131.28 $158.38 $79.57 $462.84 $83.54 $115.11 $79.57 $166.30 $79.57 N/A N/A 32000183 EAP CPT® 73070 X-RAY EXAM ELBOW 2+ VIEW BILAT BOTH IP/OP "$1,598.00" "$1,183.00" $21.65 "$1,278.40" $59.04 $59.04 $59.04 $59.04 $79.57 $79.57 $79.21 $333.06 $79.57 $46.88 $46.88 $48.69 $34.22 $333.04 $127.31 $125.33 $945.22 $79.57 $21.65 $79.57 $83.54 "$1,198.50" $79.57 $79.57 $79.57 $767.04 $767.04 "$1,265.62" $79.57 "$1,278.40" $131.28 $317.16 $79.57 $926.84 $83.54 $115.11 $79.57 $333.02 $79.57 N/A N/A 32000185 EAP CPT® 73080 ELBOW 3+VIEW NWR BOTH IP/OP $689.00 $510.00 $24.69 $551.20 $67.47 $67.47 $67.47 $67.47 $79.57 $79.57 $79.21 $143.60 $79.57 $62.89 $62.89 $65.31 $45.91 $143.60 $127.31 $125.33 $407.54 $79.57 $24.69 $79.57 $83.54 $516.75 $79.57 $79.57 $79.57 $330.72 $330.72 $545.69 $79.57 $551.20 $131.28 $136.75 $79.57 $399.62 $83.54 $115.11 $79.57 $143.59 $79.57 N/A N/A 32000186 EAP CPT® 73080 ELBOW COMPL 3+VIEW RDG BOTH IP/OP $689.00 $510.00 $24.69 $551.20 $67.47 $67.47 $67.47 $67.47 $79.57 $79.57 $79.21 $143.60 $79.57 $62.89 $62.89 $65.31 $45.91 $143.60 $127.31 $125.33 $407.54 $79.57 $24.69 $79.57 $83.54 $516.75 $79.57 $79.57 $79.57 $330.72 $330.72 $545.69 $79.57 $551.20 $131.28 $136.75 $79.57 $399.62 $83.54 $115.11 $79.57 $143.59 $79.57 N/A N/A 32000188 EAP CPT® 73080 X-RAY EXAM ELBOW 3+ VIEW BOTH IP/OP $850.00 $629.00 $24.69 $680.00 $67.47 $67.47 $67.47 $67.47 $79.57 $79.57 $79.21 $177.16 $79.57 $62.89 $62.89 $65.31 $45.91 $177.15 $127.31 $125.33 $502.78 $79.57 $24.69 $79.57 $83.54 $637.50 $79.57 $79.57 $79.57 $408.00 $408.00 $673.20 $79.57 $680.00 $131.28 $168.70 $79.57 $493.00 $83.54 $115.11 $79.57 $177.14 $79.57 N/A N/A 32000190 EAP CPT® 73080 ELBOW COMPL 3+VIEW RT RDG BOTH IP/OP $850.00 $629.00 $24.69 $680.00 $67.47 $67.47 $67.47 $67.47 $79.57 $79.57 $79.21 $177.16 $79.57 $62.89 $62.89 $65.31 $45.91 $177.15 $127.31 $125.33 $502.78 $79.57 $24.69 $79.57 $83.54 $637.50 $79.57 $79.57 $79.57 $408.00 $408.00 $673.20 $79.57 $680.00 $131.28 $168.70 $79.57 $493.00 $83.54 $115.11 $79.57 $177.14 $79.57 N/A N/A 32000192 EAP CPT® 73080 X-RAY EXAM ELBOW 3+ VIEW BILAT BOTH IP/OP "$1,376.00" "$1,018.50" $24.69 "$1,100.80" $67.47 $67.47 $67.47 $67.47 $79.57 $79.57 $79.21 $286.79 $79.57 $62.89 $62.89 $65.31 $45.91 $286.77 $127.31 $125.33 $813.90 $79.57 $24.69 $79.57 $83.54 "$1,032.00" $79.57 $79.57 $79.57 $660.48 $660.48 "$1,089.79" $79.57 "$1,100.80" $131.28 $273.10 $79.57 $798.08 $83.54 $115.11 $79.57 $286.76 $79.57 N/A N/A 32000195 EAP CPT® 73085 X-RAY ELBOW W/CONTRAST BOTH IP/OP "$2,432.00" "$1,800.00" $84.64 "$2,432.00" "$2,432.00" "$2,432.00" "$2,432.00" "$2,432.00" $89.42 $89.42 $101.72 "$2,432.00" $89.42 $170.52 $170.52 $177.08 $124.48 $506.86 $143.07 $138.00 "$2,432.00" $89.42 $86.25 $89.42 "$2,432.00" "$1,824.00" $89.42 $89.42 $89.42 "$1,167.36" "$1,167.36" "$1,926.14" $89.42 "$1,945.60" "$2,432.00" "$2,432.00" $89.42 "$1,410.56" "$2,432.00" $84.64 $89.42 "$2,432.00" $89.42 N/A N/A 32000196 EAP CPT® 73085 ELBOW ARTHROGRAPHY LT RDG BOTH IP/OP "$2,432.00" "$1,800.00" $84.64 "$2,432.00" "$2,432.00" "$2,432.00" "$2,432.00" "$2,432.00" $89.42 $89.42 $101.72 "$2,432.00" $89.42 $170.52 $170.52 $177.08 $124.48 $506.86 $143.07 $138.00 "$2,432.00" $89.42 $86.25 $89.42 "$2,432.00" "$1,824.00" $89.42 $89.42 $89.42 "$1,167.36" "$1,167.36" "$1,926.14" $89.42 "$1,945.60" "$2,432.00" "$2,432.00" $89.42 "$1,410.56" "$2,432.00" $84.64 $89.42 "$2,432.00" $89.42 N/A N/A 32000197 EAP CPT® 73085 X-RAY ELBOW W/CONTRAST BILAT BOTH IP/OP "$4,867.00" "$3,602.00" $84.64 "$4,867.00" "$4,867.00" "$4,867.00" "$4,867.00" "$4,867.00" $89.42 $89.42 $101.72 "$4,867.00" $89.42 $170.52 $170.52 $177.08 $124.48 "$1,014.34" $143.07 $138.00 "$4,867.00" $89.42 $86.25 $89.42 "$4,867.00" "$3,650.25" $89.42 $89.42 $89.42 "$2,336.16" "$2,336.16" "$3,854.66" $89.42 "$3,893.60" "$4,867.00" "$4,867.00" $89.42 "$2,822.86" "$4,867.00" $84.64 $89.42 "$4,867.00" $89.42 N/A N/A 32000198 EAP CPT® 73090 FOREARM X-RAY 2 VIEW RDG BOTH IP/OP $739.00 $547.00 $21.99 $591.20 $55.97 $55.97 $55.97 $55.97 $79.57 $79.57 $79.21 $154.03 $79.57 $46.88 $46.88 $48.69 $34.22 $154.02 $127.31 $125.33 $437.12 $79.57 $21.99 $79.57 $83.54 $554.25 $79.57 $79.57 $79.57 $354.72 $354.72 $585.29 $79.57 $591.20 $131.28 $146.67 $79.57 $428.62 $83.54 $115.11 $79.57 $154.01 $79.57 N/A N/A 32000200 EAP CPT® 73090 X-RAY EXAM FOREARM 2+ VIEW BOTH IP/OP $859.00 $636.00 $21.99 $687.20 $55.97 $55.97 $55.97 $55.97 $79.57 $79.57 $79.21 $179.04 $79.57 $46.88 $46.88 $48.69 $34.22 $179.03 $127.31 $125.33 $508.10 $79.57 $21.99 $79.57 $83.54 $644.25 $79.57 $79.57 $79.57 $412.32 $412.32 $680.33 $79.57 $687.20 $131.28 $170.49 $79.57 $498.22 $83.54 $115.11 $79.57 $179.02 $79.57 N/A N/A 32000202 EAP CPT® 73090 FOREARM X-RAY 2 VIEW RT RDG BOTH IP/OP $859.00 $636.00 $21.99 $687.20 $55.97 $55.97 $55.97 $55.97 $79.57 $79.57 $79.21 $179.04 $79.57 $46.88 $46.88 $48.69 $34.22 $179.03 $127.31 $125.33 $508.10 $79.57 $21.99 $79.57 $83.54 $644.25 $79.57 $79.57 $79.57 $412.32 $412.32 $680.33 $79.57 $687.20 $131.28 $170.49 $79.57 $498.22 $83.54 $115.11 $79.57 $179.02 $79.57 N/A N/A 32000205 EAP CPT® 73090 X-RAY EXAM FOREARM 2+ VIEW BILAT BOTH IP/OP "$1,721.00" "$1,274.00" $21.99 "$1,376.80" $55.97 $55.97 $55.97 $55.97 $79.57 $79.57 $79.21 $358.70 $79.57 $46.88 $46.88 $48.69 $34.22 $358.68 $127.31 $125.33 "$1,017.97" $79.57 $21.99 $79.57 $83.54 "$1,290.75" $79.57 $79.57 $79.57 $826.08 $826.08 "$1,363.03" $79.57 "$1,376.80" $131.28 $341.58 $79.57 $998.18 $83.54 $115.11 $79.57 $358.66 $79.57 N/A N/A 32000206 EAP CPT® 73092 UPP EXT INFANT 2+VIEW RDG BOTH IP/OP $495.00 $366.50 $22.33 $495.00 $495.00 $495.00 $495.00 $495.00 $24.83 $24.83 $27.19 $495.00 $24.83 $48.68 $48.68 $50.55 $35.54 $103.16 $39.73 $38.98 $495.00 $24.83 $24.36 $24.83 $495.00 $371.25 $24.83 $24.83 $24.83 $237.60 $237.60 $392.04 $24.83 $396.00 $495.00 $495.00 $24.83 $287.10 $495.00 $22.33 $24.83 $495.00 $24.83 N/A N/A 32000207 EAP CPT® 73092 X-RAY UPPER EXT INFANT 2+ VIEW BILAT BOTH IP/OP $984.00 $728.50 $22.33 $984.00 $984.00 $984.00 $984.00 $984.00 $24.83 $24.83 $27.19 $984.00 $24.83 $48.68 $48.68 $50.55 $35.54 $205.08 $39.73 $38.98 $984.00 $24.83 $24.36 $24.83 $984.00 $738.00 $24.83 $24.83 $24.83 $472.32 $472.32 $779.33 $24.83 $787.20 $984.00 $984.00 $24.83 $570.72 $984.00 $22.33 $24.83 $984.00 $24.83 N/A N/A 32000210 EAP CPT® 73092 X-RAY UPPER EXT INFANT 2+ VIEW BOTH IP/OP $575.00 $425.50 $22.33 $575.00 $575.00 $575.00 $575.00 $575.00 $24.83 $24.83 $27.19 $575.00 $24.83 $48.68 $48.68 $50.55 $35.54 $119.84 $39.73 $38.98 $575.00 $24.83 $24.36 $24.83 $575.00 $431.25 $24.83 $24.83 $24.83 $276.00 $276.00 $455.40 $24.83 $460.00 $575.00 $575.00 $24.83 $333.50 $575.00 $22.33 $24.83 $575.00 $24.83 N/A N/A 32000212 EAP CPT® 73092 UPP EXT INFANT 2+VIEW RT RDG BOTH IP/OP $575.00 $425.50 $22.33 $575.00 $575.00 $575.00 $575.00 $575.00 $24.83 $24.83 $27.19 $575.00 $24.83 $48.68 $48.68 $50.55 $35.54 $119.84 $39.73 $38.98 $575.00 $24.83 $24.36 $24.83 $575.00 $431.25 $24.83 $24.83 $24.83 $276.00 $276.00 $455.40 $24.83 $460.00 $575.00 $575.00 $24.83 $333.50 $575.00 $22.33 $24.83 $575.00 $24.83 N/A N/A 32000214 EAP CPT® 73100 WRIST 2 VIEW RDG BOTH IP/OP $628.00 $465.00 $26.39 $502.40 $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $130.89 $79.57 $48.68 $48.68 $50.55 $35.54 $130.88 $127.31 $125.33 $371.46 $79.57 $26.39 $79.57 $83.54 $471.00 $79.57 $79.57 $79.57 $301.44 $301.44 $497.38 $79.57 $502.40 $131.28 $124.64 $79.57 $364.24 $83.54 $115.11 $79.57 $130.88 $79.57 N/A N/A 32000216 EAP CPT® 73100 WRIST 2 VIEW LT RDG BOTH IP/OP $725.00 $536.50 $26.39 $580.00 $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $151.11 $79.57 $48.68 $48.68 $50.55 $35.54 $151.10 $127.31 $125.33 $428.84 $79.57 $26.39 $79.57 $83.54 $543.75 $79.57 $79.57 $79.57 $348.00 $348.00 $574.20 $79.57 $580.00 $131.28 $143.89 $79.57 $420.50 $83.54 $115.11 $79.57 $151.09 $79.57 N/A N/A 32000218 EAP CPT® 73100 X-RAY EXAM WRIST 2+ VIEW BOTH IP/OP $725.00 $536.50 $26.39 $580.00 $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $151.11 $79.57 $48.68 $48.68 $50.55 $35.54 $151.10 $127.31 $125.33 $428.84 $79.57 $26.39 $79.57 $83.54 $543.75 $79.57 $79.57 $79.57 $348.00 $348.00 $574.20 $79.57 $580.00 $131.28 $143.89 $79.57 $420.50 $83.54 $115.11 $79.57 $151.09 $79.57 N/A N/A 32000220 EAP CPT® 73100 X-RAY EXAM WRIST 2+ VIEW BILAT BOTH IP/OP "$1,252.00" $926.50 $26.39 "$1,001.60" $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $260.95 $79.57 $48.68 $48.68 $50.55 $35.54 $260.93 $127.31 $125.33 $740.56 $79.57 $26.39 $79.57 $83.54 $939.00 $79.57 $79.57 $79.57 $600.96 $600.96 $991.58 $79.57 "$1,001.60" $131.28 $248.49 $79.57 $726.16 $83.54 $115.11 $79.57 $260.92 $79.57 N/A N/A 32000223 EAP CPT® 73110 WRIST 3+VIEW RDG BOTH IP/OP $675.00 $499.50 $33.15 $540.00 $76.66 $76.66 $76.66 $76.66 $79.57 $79.57 $79.21 $140.69 $79.57 $61.39 $61.39 $63.75 $44.82 $140.68 $127.31 $125.33 $399.26 $79.57 $33.15 $79.57 $83.54 $506.25 $79.57 $79.57 $79.57 $324.00 $324.00 $534.60 $79.57 $540.00 $131.28 $133.97 $79.57 $391.50 $83.54 $115.11 $79.57 $140.67 $79.57 N/A N/A 32000225 EAP CPT® 73110 X-RAY EXAM WRIST 3+ VIEW BOTH IP/OP $780.00 $577.50 $33.15 $624.00 $76.66 $76.66 $76.66 $76.66 $79.57 $79.57 $79.21 $162.57 $79.57 $61.39 $61.39 $63.75 $44.82 $162.56 $127.31 $125.33 $461.37 $79.57 $33.15 $79.57 $83.54 $585.00 $79.57 $79.57 $79.57 $374.40 $374.40 $617.76 $79.57 $624.00 $131.28 $154.81 $79.57 $452.40 $83.54 $115.11 $79.57 $162.55 $79.57 N/A N/A 32000227 EAP CPT® 73110 WRIST 3+VIEW RT RDG BOTH IP/OP $780.00 $577.50 $33.15 $624.00 $76.66 $76.66 $76.66 $76.66 $79.57 $79.57 $79.21 $162.57 $79.57 $61.39 $61.39 $63.75 $44.82 $162.56 $127.31 $125.33 $461.37 $79.57 $33.15 $79.57 $83.54 $585.00 $79.57 $79.57 $79.57 $374.40 $374.40 $617.76 $79.57 $624.00 $131.28 $154.81 $79.57 $452.40 $83.54 $115.11 $79.57 $162.55 $79.57 N/A N/A 32000229 EAP CPT® 73110 X-RAY EXAM WRIST 3+ VIEW BILAT BOTH IP/OP "$1,561.00" "$1,155.50" $33.15 "$1,248.80" $76.66 $76.66 $76.66 $76.66 $79.57 $79.57 $79.21 $325.35 $79.57 $61.39 $61.39 $63.75 $44.82 $325.33 $127.31 $125.33 $923.33 $79.57 $33.15 $79.57 $83.54 "$1,170.75" $79.57 $79.57 $79.57 $749.28 $749.28 "$1,236.31" $79.57 "$1,248.80" $131.28 $309.82 $79.57 $905.38 $83.54 $115.11 $79.57 $325.31 $79.57 N/A N/A 32000231 EAP CPT® 73115 X-RAY WRIST W/CONTRAST BILAT BOTH IP/OP "$4,442.00" "$3,287.50" $99.41 "$4,442.00" "$4,442.00" "$4,442.00" "$4,442.00" "$4,442.00" $114.63 $114.63 $118.59 "$4,442.00" $114.63 $183.57 $183.57 $190.63 $134.00 $925.76 $183.41 $176.96 "$4,442.00" $114.63 $110.60 $114.63 "$4,442.00" "$3,331.50" $114.63 $114.63 $114.63 "$2,132.16" "$2,132.16" "$3,518.06" $114.63 "$3,553.60" "$4,442.00" "$4,442.00" $114.63 "$2,576.36" "$4,442.00" $99.41 $114.63 "$4,442.00" $114.63 N/A N/A 32000232 EAP CPT® 73115 X-RAY WRIST W/CONTRAST BOTH IP/OP "$2,563.00" "$1,897.00" $99.41 "$2,563.00" "$2,563.00" "$2,563.00" "$2,563.00" "$2,563.00" $114.63 $114.63 $118.59 "$2,563.00" $114.63 $183.57 $183.57 $190.63 $134.00 $534.16 $183.41 $176.96 "$2,563.00" $114.63 $110.60 $114.63 "$2,563.00" "$1,922.25" $114.63 $114.63 $114.63 "$1,230.24" "$1,230.24" "$2,029.90" $114.63 "$2,050.40" "$2,563.00" "$2,563.00" $114.63 "$1,486.54" "$2,563.00" $99.41 $114.63 "$2,563.00" $114.63 N/A N/A 32000233 EAP CPT® 73120 HAND 2 VIEW RDG BOTH IP/OP $646.00 $478.50 $23.68 $516.80 $56.73 $56.73 $56.73 $56.73 $107.09 $107.09 $106.62 $134.64 $107.09 $45.96 $45.96 $47.73 $33.55 $134.63 $171.35 $154.19 $382.11 $107.09 $23.68 $107.09 $112.45 $484.50 $107.09 $107.09 $107.09 $310.08 $310.08 $511.63 $107.09 $516.80 $176.70 $128.21 $107.09 $374.68 $112.45 $154.94 $107.09 $134.63 $107.09 N/A N/A 32000235 EAP CPT® 73120 HAND 2 VIEW LT RDG BOTH IP/OP $743.00 $550.00 $23.68 $594.40 $56.73 $56.73 $56.73 $56.73 $107.09 $107.09 $106.62 $154.86 $107.09 $45.96 $45.96 $47.73 $33.55 $154.85 $171.35 $154.19 $439.48 $107.09 $23.68 $107.09 $112.45 $557.25 $107.09 $107.09 $107.09 $356.64 $356.64 $588.46 $107.09 $594.40 $176.70 $147.47 $107.09 $430.94 $112.45 $154.94 $107.09 $154.84 $107.09 N/A N/A 32000237 EAP CPT® 73120 X-RAY EXAM HAND 2+ VIEW BOTH IP/OP $743.00 $550.00 $23.68 $594.40 $56.73 $56.73 $56.73 $56.73 $107.09 $107.09 $106.62 $154.86 $107.09 $45.96 $45.96 $47.73 $33.55 $154.85 $171.35 $154.19 $439.48 $107.09 $23.68 $107.09 $112.45 $557.25 $107.09 $107.09 $107.09 $356.64 $356.64 $588.46 $107.09 $594.40 $176.70 $147.47 $107.09 $430.94 $112.45 $154.94 $107.09 $154.84 $107.09 N/A N/A 32000239 EAP CPT® 73130 HAND 3+VIEW RDG BOTH IP/OP $698.00 $517.00 $29.09 $558.40 $66.69 $66.69 $66.69 $66.69 $79.57 $79.57 $79.21 $145.48 $79.57 $54.14 $54.14 $56.22 $39.52 $145.47 $127.31 $125.33 $412.87 $79.57 $29.09 $79.57 $83.54 $523.50 $79.57 $79.57 $79.57 $335.04 $335.04 $552.82 $79.57 $558.40 $131.28 $138.54 $79.57 $404.84 $83.54 $115.11 $79.57 $145.46 $79.57 N/A N/A 32000241 EAP CPT® 73130 HAND 3+VIEW LT RDG BOTH IP/OP $802.00 $593.50 $29.09 $641.60 $66.69 $66.69 $66.69 $66.69 $79.57 $79.57 $79.21 $167.16 $79.57 $54.14 $54.14 $56.22 $39.52 $167.15 $127.31 $125.33 $474.38 $79.57 $29.09 $79.57 $83.54 $601.50 $79.57 $79.57 $79.57 $384.96 $384.96 $635.18 $79.57 $641.60 $131.28 $159.18 $79.57 $465.16 $83.54 $115.11 $79.57 $167.14 $79.57 N/A N/A 32000243 EAP CPT® 73130 X-RAY EXAM HAND 3+ VIEW BOTH IP/OP $802.00 $593.50 $29.09 $641.60 $66.69 $66.69 $66.69 $66.69 $79.57 $79.57 $79.21 $167.16 $79.57 $54.14 $54.14 $56.22 $39.52 $167.15 $127.31 $125.33 $474.38 $79.57 $29.09 $79.57 $83.54 $601.50 $79.57 $79.57 $79.57 $384.96 $384.96 $635.18 $79.57 $641.60 $131.28 $159.18 $79.57 $465.16 $83.54 $115.11 $79.57 $167.14 $79.57 N/A N/A 32000244 EAP CPT® 73120 X-RAY EXAM HAND 2+ VIEW BILAT BOTH IP/OP "$1,485.00" "$1,099.00" $23.68 "$1,188.00" $56.73 $56.73 $56.73 $56.73 $107.09 $107.09 $106.62 $309.51 $107.09 $45.96 $45.96 $47.73 $33.55 $309.49 $171.35 $154.19 $878.38 $107.09 $23.68 $107.09 $112.45 "$1,113.75" $107.09 $107.09 $107.09 $712.80 $712.80 "$1,176.12" $107.09 "$1,188.00" $176.70 $294.74 $107.09 $861.30 $112.45 $154.94 $107.09 $309.47 $107.09 N/A N/A 32000246 EAP CPT® 73130 X-RAY EXAM HAND 3+ VIEW BILAT BOTH IP/OP "$1,609.00" "$1,191.00" $29.09 "$1,287.20" $66.69 $66.69 $66.69 $66.69 $79.57 $79.57 $79.21 $335.36 $79.57 $54.14 $54.14 $56.22 $39.52 $335.33 $127.31 $125.33 $951.72 $79.57 $29.09 $79.57 $83.54 "$1,206.75" $79.57 $79.57 $79.57 $772.32 $772.32 "$1,274.33" $79.57 "$1,287.20" $131.28 $319.35 $79.57 $933.22 $83.54 $115.11 $79.57 $335.32 $79.57 N/A N/A 32000248 EAP CPT® 73140 FINGER 3 VIEWS BOTH IP/OP $609.00 $451.00 $31.80 $487.20 $68.22 $68.22 $68.22 $68.22 $79.57 $79.57 $79.21 $126.93 $79.57 $53.24 $53.24 $55.29 $38.86 $126.92 $127.31 $125.33 $360.22 $79.57 $31.80 $79.57 $83.54 $456.75 $79.57 $79.57 $79.57 $292.32 $292.32 $482.33 $79.57 $487.20 $131.28 $120.87 $79.57 $353.22 $83.54 $115.11 $79.57 $126.92 $79.57 N/A N/A 32000249 EAP CPT® 73140 FINGER X-RAY BOTH IP/OP $609.00 $451.00 $31.80 $487.20 $68.22 $68.22 $68.22 $68.22 $79.57 $79.57 $79.21 $126.93 $79.57 $53.24 $53.24 $55.29 $38.86 $126.92 $127.31 $125.33 $360.22 $79.57 $31.80 $79.57 $83.54 $456.75 $79.57 $79.57 $79.57 $292.32 $292.32 $482.33 $79.57 $487.20 $131.28 $120.87 $79.57 $353.22 $83.54 $115.11 $79.57 $126.92 $79.57 N/A N/A 32000250 EAP CPT® 73140 FINGER(S) 2+VIEW RDG BOTH IP/OP $609.00 $451.00 $31.80 $487.20 $68.22 $68.22 $68.22 $68.22 $79.57 $79.57 $79.21 $126.93 $79.57 $53.24 $53.24 $55.29 $38.86 $126.92 $127.31 $125.33 $360.22 $79.57 $31.80 $79.57 $83.54 $456.75 $79.57 $79.57 $79.57 $292.32 $292.32 $482.33 $79.57 $487.20 $131.28 $120.87 $79.57 $353.22 $83.54 $115.11 $79.57 $126.92 $79.57 N/A N/A 32000252 EAP CPT® 73140 X-RAY EXAM FINGER(S) 2+ VIEW BILAT BOTH IP/OP "$1,218.00" $901.50 $31.80 $974.40 $68.22 $68.22 $68.22 $68.22 $79.57 $79.57 $79.21 $253.86 $79.57 $53.24 $53.24 $55.29 $38.86 $253.84 $127.31 $125.33 $720.45 $79.57 $31.80 $79.57 $83.54 $913.50 $79.57 $79.57 $79.57 $584.64 $584.64 $964.66 $79.57 $974.40 $131.28 $241.74 $79.57 $706.44 $83.54 $115.11 $79.57 $253.83 $79.57 N/A N/A 32000254 EAP CPT® 73140 FINGER(S) 2+VIEW LT RDG BOTH IP/OP $718.00 $531.50 $31.80 $574.40 $68.22 $68.22 $68.22 $68.22 $79.57 $79.57 $79.21 $149.65 $79.57 $53.24 $53.24 $55.29 $38.86 $149.64 $127.31 $125.33 $424.70 $79.57 $31.80 $79.57 $83.54 $538.50 $79.57 $79.57 $79.57 $344.64 $344.64 $568.66 $79.57 $574.40 $131.28 $142.51 $79.57 $416.44 $83.54 $115.11 $79.57 $149.63 $79.57 N/A N/A 32000256 EAP CPT® 73140 X-RAY EXAM FINGER(S) 2+ VIEW BOTH IP/OP $718.00 $531.50 $31.80 $574.40 $68.22 $68.22 $68.22 $68.22 $79.57 $79.57 $79.21 $149.65 $79.57 $53.24 $53.24 $55.29 $38.86 $149.64 $127.31 $125.33 $424.70 $79.57 $31.80 $79.57 $83.54 $538.50 $79.57 $79.57 $79.57 $344.64 $344.64 $568.66 $79.57 $574.40 $131.28 $142.51 $79.57 $416.44 $83.54 $115.11 $79.57 $149.63 $79.57 N/A N/A 32000258 EAP CPT® 36299 INJECT VASCULAR UNLSTD PROC BOTH IP/OP "$4,131.00" "$3,057.00" $860.95 "$4,131.00" "$4,131.00" "$4,131.00" "$4,131.00" "$4,131.00" "$4,131.00" "$4,131.00" "$4,131.00" "$4,131.00" "$4,131.00" "$4,131.00" "$4,131.00" "$4,131.00" "$4,131.00" $860.95 "$4,131.00" "$1,652.40" "$4,131.00" "$4,131.00" "$4,131.00" "$4,131.00" "$4,131.00" "$3,098.25" "$4,131.00" "$4,131.00" "$4,131.00" "$2,762.00" "$2,065.50" "$3,271.75" "$4,131.00" "$3,304.80" "$1,750.00" "$4,131.00" "$4,131.00" "$2,395.98" "$4,131.00" "$2,478.60" "$4,131.00" "$4,131.00" "$4,131.00" N/A N/A 32000285 EAP CPT® 73525 X-RAY HIP W/CONTRAST BOTH IP/OP "$1,275.00" $943.50 $94.73 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $110.83 $110.83 $116.49 "$1,275.00" $110.83 $168.72 $168.72 $175.21 $123.16 $265.72 $177.33 $167.76 "$1,275.00" $110.83 $104.85 $110.83 "$1,275.00" $956.25 $110.83 $110.83 $110.83 $612.00 $612.00 "$1,009.80" $110.83 "$1,020.00" "$1,275.00" "$1,275.00" $110.83 $739.50 "$1,275.00" $94.73 $110.83 "$1,275.00" $110.83 N/A N/A 32000286 EAP CPT® 73525 HIP ARTHROGRAPHY LT RDG BOTH IP/OP "$1,275.00" $943.50 $94.73 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $110.83 $110.83 $116.49 "$1,275.00" $110.83 $168.72 $168.72 $175.21 $123.16 $265.72 $177.33 $167.76 "$1,275.00" $110.83 $104.85 $110.83 "$1,275.00" $956.25 $110.83 $110.83 $110.83 $612.00 $612.00 "$1,009.80" $110.83 "$1,020.00" "$1,275.00" "$1,275.00" $110.83 $739.50 "$1,275.00" $94.73 $110.83 "$1,275.00" $110.83 N/A N/A 32000287 EAP CPT® 73525 X-RAY HIP W/CONTRAST BILAT BOTH IP/OP "$1,891.00" "$1,399.50" $94.73 "$1,891.00" "$1,891.00" "$1,891.00" "$1,891.00" "$1,891.00" $110.83 $110.83 $116.49 "$1,891.00" $110.83 $168.72 $168.72 $175.21 $123.16 $394.11 $177.33 $167.76 "$1,891.00" $110.83 $104.85 $110.83 "$1,891.00" "$1,418.25" $110.83 $110.83 $110.83 $907.68 $907.68 "$1,497.67" $110.83 "$1,512.80" "$1,891.00" "$1,891.00" $110.83 "$1,096.78" "$1,891.00" $94.73 $110.83 "$1,891.00" $110.83 N/A N/A 32000303 EAP CPT® 73560 KNEE 1-2 VIEW RDG BOTH IP/OP $694.00 $514.00 $26.72 $555.20 $66.69 $66.69 $66.69 $66.69 $79.57 $79.57 $79.21 $144.65 $79.57 $47.79 $47.79 $49.63 $34.88 $144.64 $127.31 $125.33 $410.50 $79.57 $26.72 $79.57 $83.54 $520.50 $79.57 $79.57 $79.57 $333.12 $333.12 $549.65 $79.57 $555.20 $131.28 $137.74 $79.57 $402.52 $83.54 $115.11 $79.57 $144.63 $79.57 N/A N/A 32000305 EAP CPT® 73560 X-RAY EXAM KNEE 1 OR 2 VIEWS BOTH IP/OP $835.00 $618.00 $26.72 $668.00 $66.69 $66.69 $66.69 $66.69 $79.57 $79.57 $79.21 $174.03 $79.57 $47.79 $47.79 $49.63 $34.88 $174.02 $127.31 $125.33 $493.90 $79.57 $26.72 $79.57 $83.54 $626.25 $79.57 $79.57 $79.57 $400.80 $400.80 $661.32 $79.57 $668.00 $131.28 $165.73 $79.57 $484.30 $83.54 $115.11 $79.57 $174.01 $79.57 N/A N/A 32000307 EAP CPT® 73560 KNEE 1-2 VIEW RT RDG BOTH IP/OP $835.00 $618.00 $26.72 $668.00 $66.69 $66.69 $66.69 $66.69 $79.57 $79.57 $79.21 $174.03 $79.57 $47.79 $47.79 $49.63 $34.88 $174.02 $127.31 $125.33 $493.90 $79.57 $26.72 $79.57 $83.54 $626.25 $79.57 $79.57 $79.57 $400.80 $400.80 $661.32 $79.57 $668.00 $131.28 $165.73 $79.57 $484.30 $83.54 $115.11 $79.57 $174.01 $79.57 N/A N/A 32000309 EAP CPT® 73560 X-RAY EXAM KNEE 1 OR 2 VIEWS BILAT BOTH IP/OP "$1,666.00" "$1,233.00" $26.72 "$1,332.80" $66.69 $66.69 $66.69 $66.69 $79.57 $79.57 $79.21 $347.24 $79.57 $47.79 $47.79 $49.63 $34.88 $347.21 $127.31 $125.33 $985.44 $79.57 $26.72 $79.57 $83.54 "$1,249.50" $79.57 $79.57 $79.57 $799.68 $799.68 "$1,319.47" $79.57 "$1,332.80" $131.28 $330.66 $79.57 $966.28 $83.54 $115.11 $79.57 $347.19 $79.57 N/A N/A 32000311 EAP CPT® 73562 KNEE 3 VIEW RDG BOTH IP/OP $749.00 $554.50 $32.13 $599.20 $77.41 $77.41 $77.41 $77.41 $79.57 $79.57 $79.21 $156.11 $79.57 $60.18 $60.18 $62.50 $43.93 $156.10 $127.31 $125.33 $443.03 $79.57 $32.13 $79.57 $83.54 $561.75 $79.57 $79.57 $79.57 $359.52 $359.52 $593.21 $79.57 $599.20 $131.28 $148.66 $79.57 $434.42 $83.54 $115.11 $79.57 $156.09 $79.57 N/A N/A 32000313 EAP CPT® 73562 KNEE 3 VIEW LT RDG BOTH IP/OP $901.00 $667.00 $32.13 $720.80 $77.41 $77.41 $77.41 $77.41 $79.57 $79.57 $79.21 $187.79 $79.57 $60.18 $60.18 $62.50 $43.93 $187.78 $127.31 $125.33 $532.94 $79.57 $32.13 $79.57 $83.54 $675.75 $79.57 $79.57 $79.57 $432.48 $432.48 $713.59 $79.57 $720.80 $131.28 $178.83 $79.57 $522.58 $83.54 $115.11 $79.57 $187.77 $79.57 N/A N/A 32000315 EAP CPT® 73562 X-RAY EXAM KNEE 3 VIEW BOTH IP/OP $901.00 $667.00 $32.13 $720.80 $77.41 $77.41 $77.41 $77.41 $79.57 $79.57 $79.21 $187.79 $79.57 $60.18 $60.18 $62.50 $43.93 $187.78 $127.31 $125.33 $532.94 $79.57 $32.13 $79.57 $83.54 $675.75 $79.57 $79.57 $79.57 $432.48 $432.48 $713.59 $79.57 $720.80 $131.28 $178.83 $79.57 $522.58 $83.54 $115.11 $79.57 $187.77 $79.57 N/A N/A 32000317 EAP CPT® 73562 X-RAY EXAM KNEE 3 VIEW BILAT BOTH IP/OP "$1,495.00" "$1,106.50" $32.13 "$1,196.00" $77.41 $77.41 $77.41 $77.41 $79.57 $79.57 $79.21 $311.60 $79.57 $60.18 $60.18 $62.50 $43.93 $311.57 $127.31 $125.33 $884.29 $79.57 $32.13 $79.57 $83.54 "$1,121.25" $79.57 $79.57 $79.57 $717.60 $717.60 "$1,184.04" $79.57 "$1,196.00" $131.28 $296.72 $79.57 $867.10 $83.54 $115.11 $79.57 $311.56 $79.57 N/A N/A 32000319 EAP CPT® 73564 KNEE 4+VIEW EXR BOTH IP/OP $699.00 $517.50 $36.19 $559.20 $85.84 $85.84 $85.84 $85.84 $107.09 $107.09 $106.62 $145.69 $107.09 $69.25 $69.25 $71.92 $50.55 $145.68 $171.35 $154.19 $413.46 $107.09 $36.19 $107.09 $112.45 $524.25 $107.09 $107.09 $107.09 $335.52 $335.52 $553.61 $107.09 $559.20 $176.70 $138.73 $107.09 $405.42 $112.45 $154.94 $107.09 $145.67 $107.09 N/A N/A 32000320 EAP CPT® 73564 X-RAY EXAM KNEE 4+ VIEW BOTH IP/OP $841.00 $622.50 $36.19 $672.80 $85.84 $85.84 $85.84 $85.84 $107.09 $107.09 $106.62 $175.29 $107.09 $69.25 $69.25 $71.92 $50.55 $175.27 $171.35 $154.19 $497.45 $107.09 $36.19 $107.09 $112.45 $630.75 $107.09 $107.09 $107.09 $403.68 $403.68 $666.07 $107.09 $672.80 $176.70 $166.92 $107.09 $487.78 $112.45 $154.94 $107.09 $175.26 $107.09 N/A N/A 32000322 EAP CPT® 73564 KNEE 4+VIEW RT RDG BOTH IP/OP $841.00 $622.50 $36.19 $672.80 $85.84 $85.84 $85.84 $85.84 $107.09 $107.09 $106.62 $175.29 $107.09 $69.25 $69.25 $71.92 $50.55 $175.27 $171.35 $154.19 $497.45 $107.09 $36.19 $107.09 $112.45 $630.75 $107.09 $107.09 $107.09 $403.68 $403.68 $666.07 $107.09 $672.80 $176.70 $166.92 $107.09 $487.78 $112.45 $154.94 $107.09 $175.26 $107.09 N/A N/A 32000324 EAP CPT® 73564 X-RAY EXAM KNEE 4+ VIEW BILAT BOTH IP/OP "$1,395.00" "$1,032.50" $36.19 "$1,116.00" $85.84 $85.84 $85.84 $85.84 $107.09 $107.09 $106.62 $290.75 $107.09 $69.25 $69.25 $71.92 $50.55 $290.73 $171.35 $154.19 $825.14 $107.09 $36.19 $107.09 $112.45 "$1,046.25" $107.09 $107.09 $107.09 $669.60 $669.60 "$1,104.84" $107.09 "$1,116.00" $176.70 $276.87 $107.09 $809.10 $112.45 $154.94 $107.09 $290.72 $107.09 N/A N/A 32000327 EAP CPT® 73565 KNEES BOTH STANDING AP RDG BOTH IP/OP $826.00 $611.50 $30.25 $826.00 $826.00 $826.00 $826.00 $826.00 $33.12 $33.12 $35.18 $826.00 $33.12 $51.41 $51.41 $53.38 $37.53 $172.15 $52.99 $51.41 $826.00 $33.12 $32.13 $33.12 $826.00 $619.50 $33.12 $33.12 $33.12 $396.48 $396.48 $654.19 $33.12 $660.80 $826.00 $826.00 $33.12 $479.08 $826.00 $30.25 $33.12 $826.00 $33.12 N/A N/A 32000329 EAP CPT® 73580 X-RAY KNEE JOINT W/CONTRAST BOTH IP/OP "$2,466.00" "$1,825.00" $99.44 "$2,466.00" "$2,466.00" "$2,466.00" "$2,466.00" "$2,466.00" $125.34 $125.34 $126.55 "$2,466.00" $125.34 $227.38 $227.38 $236.12 $165.98 $513.94 $200.54 $159.10 "$2,466.00" $125.34 $99.44 $125.34 "$2,466.00" "$1,849.50" $125.34 $125.34 $125.34 "$1,183.68" "$1,183.68" "$1,953.07" $125.34 "$1,972.80" "$2,466.00" "$2,466.00" $125.34 "$1,430.28" "$2,466.00" $108.77 $125.34 "$2,466.00" $125.34 N/A N/A 32000330 EAP CPT® 73580 KNEE ARTHROGRAPHY LT RDG BOTH IP/OP "$2,466.00" "$1,825.00" $99.44 "$2,466.00" "$2,466.00" "$2,466.00" "$2,466.00" "$2,466.00" $125.34 $125.34 $126.55 "$2,466.00" $125.34 $227.38 $227.38 $236.12 $165.98 $513.94 $200.54 $159.10 "$2,466.00" $125.34 $99.44 $125.34 "$2,466.00" "$1,849.50" $125.34 $125.34 $125.34 "$1,183.68" "$1,183.68" "$1,953.07" $125.34 "$1,972.80" "$2,466.00" "$2,466.00" $125.34 "$1,430.28" "$2,466.00" $108.77 $125.34 "$2,466.00" $125.34 N/A N/A 32000331 EAP CPT® 73580 X-RAY KNEE JOINT W/CONTRAST BILAT BOTH IP/OP "$2,466.00" "$1,825.00" $99.44 "$2,466.00" "$2,466.00" "$2,466.00" "$2,466.00" "$2,466.00" $125.34 $125.34 $126.55 "$2,466.00" $125.34 $227.38 $227.38 $236.12 $165.98 $513.94 $200.54 $159.10 "$2,466.00" $125.34 $99.44 $125.34 "$2,466.00" "$1,849.50" $125.34 $125.34 $125.34 "$1,183.68" "$1,183.68" "$1,953.07" $125.34 "$1,972.80" "$2,466.00" "$2,466.00" $125.34 "$1,430.28" "$2,466.00" $108.77 $125.34 "$2,466.00" $125.34 N/A N/A 32000332 EAP CPT® 73590 TIBIA&FIBULA 2 VIEW RDG BOTH IP/OP $879.00 $650.50 $24.36 $703.20 $62.10 $62.10 $62.10 $62.10 $79.57 $79.57 $79.21 $183.21 $79.57 $45.06 $45.06 $46.80 $32.90 $183.19 $127.31 $125.33 $519.93 $79.57 $24.36 $79.57 $83.54 $659.25 $79.57 $79.57 $79.57 $421.92 $421.92 $696.17 $79.57 $703.20 $131.28 $174.46 $79.57 $509.82 $83.54 $115.11 $79.57 $183.18 $79.57 N/A N/A 32000334 EAP CPT® 73590 X-RAY EXAM TIBULA AND FIBULA 2+ VIEW BOTH IP/OP $879.00 $650.50 $24.36 $703.20 $62.10 $62.10 $62.10 $62.10 $79.57 $79.57 $79.21 $183.21 $79.57 $45.06 $45.06 $46.80 $32.90 $183.19 $127.31 $125.33 $519.93 $79.57 $24.36 $79.57 $83.54 $659.25 $79.57 $79.57 $79.57 $421.92 $421.92 $696.17 $79.57 $703.20 $131.28 $174.46 $79.57 $509.82 $83.54 $115.11 $79.57 $183.18 $79.57 N/A N/A 32000336 EAP CPT® 73590 X-RAY EXAM TIBULA AND FIBULA 2+ VIEW BILAT BOTH IP/OP $879.00 $650.50 $24.36 $703.20 $62.10 $62.10 $62.10 $62.10 $79.57 $79.57 $79.21 $183.21 $79.57 $45.06 $45.06 $46.80 $32.90 $183.19 $127.31 $125.33 $519.93 $79.57 $24.36 $79.57 $83.54 $659.25 $79.57 $79.57 $79.57 $421.92 $421.92 $696.17 $79.57 $703.20 $131.28 $174.46 $79.57 $509.82 $83.54 $115.11 $79.57 $183.18 $79.57 N/A N/A 32000338 EAP CPT® 73590 TIBIA&FIBULA 2VW ECH BILAT RDG BOTH IP/OP $790.00 $585.00 $24.36 $632.00 $62.10 $62.10 $62.10 $62.10 $79.57 $79.57 $79.21 $164.66 $79.57 $45.06 $45.06 $46.80 $32.90 $164.64 $127.31 $125.33 $467.29 $79.57 $24.36 $79.57 $83.54 $592.50 $79.57 $79.57 $79.57 $379.20 $379.20 $625.68 $79.57 $632.00 $131.28 $156.80 $79.57 $458.20 $83.54 $115.11 $79.57 $164.64 $79.57 N/A N/A 32000339 EAP CPT® 73592 X-RAY EXAM LOWER EXT INFANT 2+ VIEW BOTH IP/OP $372.00 $275.50 $22.33 $372.00 $372.00 $372.00 $372.00 $372.00 $24.83 $24.83 $27.19 $372.00 $24.83 $48.68 $48.68 $50.55 $35.54 $77.53 $39.73 $38.98 $372.00 $24.83 $24.36 $24.83 $372.00 $279.00 $24.83 $24.83 $24.83 $178.56 $178.56 $294.62 $24.83 $297.60 $372.00 $372.00 $24.83 $215.76 $372.00 $22.33 $24.83 $372.00 $24.83 N/A N/A 32000340 EAP CPT® 73592 LOW EXT INFANT 2+VIEW BI RDG BOTH IP/OP $372.00 $275.50 $22.33 $372.00 $372.00 $372.00 $372.00 $372.00 $24.83 $24.83 $27.19 $372.00 $24.83 $48.68 $48.68 $50.55 $35.54 $77.53 $39.73 $38.98 $372.00 $24.83 $24.36 $24.83 $372.00 $279.00 $24.83 $24.83 $24.83 $178.56 $178.56 $294.62 $24.83 $297.60 $372.00 $372.00 $24.83 $215.76 $372.00 $22.33 $24.83 $372.00 $24.83 N/A N/A 32000343 EAP CPT® 73592 LOW EXT INFANT 2+VIEW LT RDG BOTH IP/OP $372.00 $275.50 $22.33 $372.00 $372.00 $372.00 $372.00 $372.00 $24.83 $24.83 $27.19 $372.00 $24.83 $48.68 $48.68 $50.55 $35.54 $77.53 $39.73 $38.98 $372.00 $24.83 $24.36 $24.83 $372.00 $279.00 $24.83 $24.83 $24.83 $178.56 $178.56 $294.62 $24.83 $297.60 $372.00 $372.00 $24.83 $215.76 $372.00 $22.33 $24.83 $372.00 $24.83 N/A N/A 32000345 EAP CPT® 73592 LOW EXT INFANT 2+VIEW RT RDG BOTH IP/OP $372.00 $275.50 $22.33 $372.00 $372.00 $372.00 $372.00 $372.00 $24.83 $24.83 $27.19 $372.00 $24.83 $48.68 $48.68 $50.55 $35.54 $77.53 $39.73 $38.98 $372.00 $24.83 $24.36 $24.83 $372.00 $279.00 $24.83 $24.83 $24.83 $178.56 $178.56 $294.62 $24.83 $297.60 $372.00 $372.00 $24.83 $215.76 $372.00 $22.33 $24.83 $372.00 $24.83 N/A N/A 32000347 EAP CPT® 73600 ANKLE 2 VIEW RDG BOTH IP/OP $734.00 $543.50 $25.03 $587.20 $64.38 $64.38 $64.38 $64.38 $79.57 $79.57 $79.21 $152.98 $79.57 $45.96 $45.96 $47.73 $33.55 $152.97 $127.31 $125.33 $434.16 $79.57 $25.03 $79.57 $83.54 $550.50 $79.57 $79.57 $79.57 $352.32 $352.32 $581.33 $79.57 $587.20 $131.28 $145.68 $79.57 $425.72 $83.54 $115.11 $79.57 $152.97 $79.57 N/A N/A 32000349 EAP CPT® 73600 ANKLE 2 VIEW LT RDG BOTH IP/OP $980.00 $725.50 $25.03 $784.00 $64.38 $64.38 $64.38 $64.38 $79.57 $79.57 $79.21 $204.26 $79.57 $45.96 $45.96 $47.73 $33.55 $204.24 $127.31 $125.33 $579.67 $79.57 $25.03 $79.57 $83.54 $735.00 $79.57 $79.57 $79.57 $470.40 $470.40 $776.16 $79.57 $784.00 $131.28 $194.51 $79.57 $568.40 $83.54 $115.11 $79.57 $204.23 $79.57 N/A N/A 32000351 EAP CPT® 73600 X-RAY EXAM ANKLE 2+ VIEW BOTH IP/OP $980.00 $725.50 $25.03 $784.00 $64.38 $64.38 $64.38 $64.38 $79.57 $79.57 $79.21 $204.26 $79.57 $45.96 $45.96 $47.73 $33.55 $204.24 $127.31 $125.33 $579.67 $79.57 $25.03 $79.57 $83.54 $735.00 $79.57 $79.57 $79.57 $470.40 $470.40 $776.16 $79.57 $784.00 $131.28 $194.51 $79.57 $568.40 $83.54 $115.11 $79.57 $204.23 $79.57 N/A N/A 32000353 EAP CPT® 73600 X-RAY EXAM ANKLE 2+ VIEW BILAT BOTH IP/OP "$1,958.00" "$1,449.00" $25.03 "$1,566.40" $64.38 $64.38 $64.38 $64.38 $79.57 $79.57 $79.21 $408.10 $79.57 $45.96 $45.96 $47.73 $33.55 $408.07 $127.31 $125.33 "$1,158.16" $79.57 $25.03 $79.57 $83.54 "$1,468.50" $79.57 $79.57 $79.57 $939.84 $939.84 "$1,550.74" $79.57 "$1,566.40" $131.28 $388.61 $79.57 "$1,135.64" $83.54 $115.11 $79.57 $408.05 $79.57 N/A N/A 32000357 EAP CPT® 73610 ANKLE 3+VIEW LT RDG BOTH IP/OP "$1,060.00" $784.50 $29.09 $848.00 $68.22 $68.22 $68.22 $68.22 $79.57 $79.57 $79.21 $220.93 $79.57 $54.14 $54.14 $56.22 $39.52 $220.92 $127.31 $125.33 $626.99 $79.57 $29.09 $79.57 $83.54 $795.00 $79.57 $79.57 $79.57 $508.80 $508.80 $839.52 $79.57 $848.00 $131.28 $210.38 $79.57 $614.80 $83.54 $115.11 $79.57 $220.90 $79.57 N/A N/A 32000359 EAP CPT® 73610 X-RAY EXAM ANKLE 3+ VIEW BOTH IP/OP "$1,060.00" $784.50 $29.09 $848.00 $68.22 $68.22 $68.22 $68.22 $79.57 $79.57 $79.21 $220.93 $79.57 $54.14 $54.14 $56.22 $39.52 $220.92 $127.31 $125.33 $626.99 $79.57 $29.09 $79.57 $83.54 $795.00 $79.57 $79.57 $79.57 $508.80 $508.80 $839.52 $79.57 $848.00 $131.28 $210.38 $79.57 $614.80 $83.54 $115.11 $79.57 $220.90 $79.57 N/A N/A 32000362 EAP CPT® 73615 X-RAY ANKLE W/CONTRAST BOTH IP/OP "$2,593.00" "$1,919.00" $100.13 "$2,593.00" "$2,593.00" "$2,593.00" "$2,593.00" "$2,593.00" $110.49 $110.49 $118.86 "$2,593.00" $110.49 $175.98 $175.98 $182.75 $128.46 $540.41 $176.78 $167.22 "$2,593.00" $110.49 $104.51 $110.49 "$2,593.00" "$1,944.75" $110.49 $110.49 $110.49 "$1,244.64" "$1,244.64" "$2,053.66" $110.49 "$2,074.40" "$2,593.00" "$2,593.00" $110.49 "$1,503.94" "$2,593.00" $100.13 $110.49 "$2,593.00" $110.49 N/A N/A 32000363 EAP CPT® 73615 ANKLE ARTHROGRAPHY RT RDG BOTH IP/OP "$2,593.00" "$1,919.00" $100.13 "$2,593.00" "$2,593.00" "$2,593.00" "$2,593.00" "$2,593.00" $110.49 $110.49 $118.86 "$2,593.00" $110.49 $175.98 $175.98 $182.75 $128.46 $540.41 $176.78 $167.22 "$2,593.00" $110.49 $104.51 $110.49 "$2,593.00" "$1,944.75" $110.49 $110.49 $110.49 "$1,244.64" "$1,244.64" "$2,053.66" $110.49 "$2,074.40" "$2,593.00" "$2,593.00" $110.49 "$1,503.94" "$2,593.00" $100.13 $110.49 "$2,593.00" $110.49 N/A N/A 32000364 EAP CPT® 73610 X-RAY EXAM ANKLE 3+ VIEW BILAT BOTH IP/OP "$2,115.00" "$1,565.50" $29.09 "$1,692.00" $68.22 $68.22 $68.22 $68.22 $79.57 $79.57 $79.21 $440.82 $79.57 $54.14 $54.14 $56.22 $39.52 $440.79 $127.31 $125.33 "$1,251.02" $79.57 $29.09 $79.57 $83.54 "$1,586.25" $79.57 $79.57 $79.57 "$1,015.20" "$1,015.20" "$1,675.08" $79.57 "$1,692.00" $131.28 $419.77 $79.57 "$1,226.70" $83.54 $115.11 $79.57 $440.77 $79.57 N/A N/A 32000366 EAP CPT® 73615 X-RAY ANKLE W/CONTRAST BILAT BOTH IP/OP "$5,189.00" "$3,840.00" $100.13 "$5,189.00" "$5,189.00" "$5,189.00" "$5,189.00" "$5,189.00" $110.49 $110.49 $118.86 "$5,189.00" $110.49 $175.98 $175.98 $182.75 $128.46 "$1,081.44" $176.78 $167.22 "$5,189.00" $110.49 $104.51 $110.49 "$5,189.00" "$3,891.75" $110.49 $110.49 $110.49 "$2,490.72" "$2,490.72" "$4,109.69" $110.49 "$4,151.20" "$5,189.00" "$5,189.00" $110.49 "$3,009.62" "$5,189.00" $100.13 $110.49 "$5,189.00" $110.49 N/A N/A 32000367 EAP CPT® 73620 FEET 2 VIEW EACH BILAT RDG BOTH IP/OP "$1,600.00" "$1,184.00" $21.31 "$1,280.00" $55.97 $55.97 $55.97 $55.97 $79.57 $79.57 $79.21 $333.48 $79.57 $44.15 $44.15 $45.85 $32.23 $333.46 $127.31 $125.33 $946.40 $79.57 $21.31 $79.57 $83.54 "$1,200.00" $79.57 $79.57 $79.57 $768.00 $768.00 "$1,267.20" $79.57 "$1,280.00" $131.28 $317.56 $79.57 $928.00 $83.54 $115.11 $79.57 $333.44 $79.57 N/A N/A 32000369 EAP CPT® 73620 FOOT 2 VIEW LT RDG BOTH IP/OP $801.00 $593.00 $21.31 $640.80 $55.97 $55.97 $55.97 $55.97 $79.57 $79.57 $79.21 $166.95 $79.57 $44.15 $44.15 $45.85 $32.23 $166.94 $127.31 $125.33 $473.79 $79.57 $21.31 $79.57 $83.54 $600.75 $79.57 $79.57 $79.57 $384.48 $384.48 $634.39 $79.57 $640.80 $131.28 $158.98 $79.57 $464.58 $83.54 $115.11 $79.57 $166.93 $79.57 N/A N/A 32000371 EAP CPT® 73620 X-RAY EXAM FOOT 2+ VIEW BOTH IP/OP $801.00 $593.00 $21.31 $640.80 $55.97 $55.97 $55.97 $55.97 $79.57 $79.57 $79.21 $166.95 $79.57 $44.15 $44.15 $45.85 $32.23 $166.94 $127.31 $125.33 $473.79 $79.57 $21.31 $79.57 $83.54 $600.75 $79.57 $79.57 $79.57 $384.48 $384.48 $634.39 $79.57 $640.80 $131.28 $158.98 $79.57 $464.58 $83.54 $115.11 $79.57 $166.93 $79.57 N/A N/A 32000373 EAP CPT® 73620 FOOT 2 VIEWS RDG BOTH IP/OP $669.00 $495.50 $21.31 $535.20 $55.97 $55.97 $55.97 $55.97 $79.57 $79.57 $79.21 $139.44 $79.57 $44.15 $44.15 $45.85 $32.23 $139.43 $127.31 $125.33 $395.71 $79.57 $21.31 $79.57 $83.54 $501.75 $79.57 $79.57 $79.57 $321.12 $321.12 $529.85 $79.57 $535.20 $131.28 $132.78 $79.57 $388.02 $83.54 $115.11 $79.57 $139.42 $79.57 N/A N/A 32000375 EAP CPT® 73630 X-RAY EXAM FOOT 3+ VIEW BILAT BOTH IP/OP "$1,730.00" "$1,280.50" $26.72 "$1,384.00" $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $360.58 $79.57 $53.24 $53.24 $55.29 $38.86 $360.55 $127.31 $125.33 "$1,023.30" $79.57 $26.72 $79.57 $83.54 "$1,297.50" $79.57 $79.57 $79.57 $830.40 $830.40 "$1,370.16" $79.57 "$1,384.00" $131.28 $343.36 $79.57 "$1,003.40" $83.54 $115.11 $79.57 $360.53 $79.57 N/A N/A 32000377 EAP CPT® 73630 X-RAY EXAM FOOT 3+ VIEW BOTH IP/OP $863.00 $639.00 $26.72 $690.40 $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $179.87 $79.57 $53.24 $53.24 $55.29 $38.86 $179.86 $127.31 $125.33 $510.46 $79.57 $26.72 $79.57 $83.54 $647.25 $79.57 $79.57 $79.57 $414.24 $414.24 $683.50 $79.57 $690.40 $131.28 $171.28 $79.57 $500.54 $83.54 $115.11 $79.57 $179.85 $79.57 N/A N/A 32000379 EAP CPT® 73630 FOOT 3+VIEW LT RDG BOTH IP/OP $863.00 $639.00 $26.72 $690.40 $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $179.87 $79.57 $53.24 $53.24 $55.29 $38.86 $179.86 $127.31 $125.33 $510.46 $79.57 $26.72 $79.57 $83.54 $647.25 $79.57 $79.57 $79.57 $414.24 $414.24 $683.50 $79.57 $690.40 $131.28 $171.28 $79.57 $500.54 $83.54 $115.11 $79.57 $179.85 $79.57 N/A N/A 32000381 EAP CPT® 73630 FOOT 3+VIEW RT RDG BOTH IP/OP $720.00 $533.00 $26.72 $576.00 $62.85 $62.85 $62.85 $62.85 $79.57 $79.57 $79.21 $150.07 $79.57 $53.24 $53.24 $55.29 $38.86 $150.06 $127.31 $125.33 $425.88 $79.57 $26.72 $79.57 $83.54 $540.00 $79.57 $79.57 $79.57 $345.60 $345.60 $570.24 $79.57 $576.00 $131.28 $142.90 $79.57 $417.60 $83.54 $115.11 $79.57 $150.05 $79.57 N/A N/A 32000383 EAP CPT® 73650 X-RAY EXAM CALCANEUS 2+ VIEW BILAT BOTH IP/OP "$1,538.00" "$1,138.50" $21.31 "$1,230.40" $58.26 $58.26 $58.26 $58.26 $79.57 $79.57 $79.21 $320.56 $79.57 $45.06 $45.06 $46.80 $32.90 $320.54 $127.31 $125.33 $909.73 $79.57 $21.31 $79.57 $83.54 "$1,153.50" $79.57 $79.57 $79.57 $738.24 $738.24 "$1,218.10" $79.57 "$1,230.40" $131.28 $305.25 $79.57 $892.04 $83.54 $115.11 $79.57 $320.52 $79.57 N/A N/A 32000385 EAP CPT® 73650 CALCANEUS 2+VIEW RDG BOTH IP/OP $638.00 $472.50 $21.31 $510.40 $58.26 $58.26 $58.26 $58.26 $79.57 $79.57 $79.21 $132.98 $79.57 $45.06 $45.06 $46.80 $32.90 $132.97 $127.31 $125.33 $377.38 $79.57 $21.31 $79.57 $83.54 $478.50 $79.57 $79.57 $79.57 $306.24 $306.24 $505.30 $79.57 $510.40 $131.28 $126.63 $79.57 $370.04 $83.54 $115.11 $79.57 $132.96 $79.57 N/A N/A 32000387 EAP CPT® 73650 CALCANEUS 2+VIEW LT RDG BOTH IP/OP $770.00 $570.00 $21.31 $616.00 $58.26 $58.26 $58.26 $58.26 $79.57 $79.57 $79.21 $160.49 $79.57 $45.06 $45.06 $46.80 $32.90 $160.48 $127.31 $125.33 $455.46 $79.57 $21.31 $79.57 $83.54 $577.50 $79.57 $79.57 $79.57 $369.60 $369.60 $609.84 $79.57 $616.00 $131.28 $152.83 $79.57 $446.60 $83.54 $115.11 $79.57 $160.47 $79.57 N/A N/A 32000389 EAP CPT® 73650 X-RAY EXAM CALCANEUS 2+ VIEW BOTH IP/OP $770.00 $570.00 $21.31 $616.00 $58.26 $58.26 $58.26 $58.26 $79.57 $79.57 $79.21 $160.49 $79.57 $45.06 $45.06 $46.80 $32.90 $160.48 $127.31 $125.33 $455.46 $79.57 $21.31 $79.57 $83.54 $577.50 $79.57 $79.57 $79.57 $369.60 $369.60 $609.84 $79.57 $616.00 $131.28 $152.83 $79.57 $446.60 $83.54 $115.11 $79.57 $160.47 $79.57 N/A N/A 32000391 EAP CPT® 73660 TOE X-RAY BOTH IP/OP $863.00 $639.00 $23.34 $690.40 $60.57 $60.57 $60.57 $60.57 $79.57 $79.57 $79.21 $179.87 $79.57 $50.51 $50.51 $52.46 $36.87 $179.86 $127.31 $125.33 $510.46 $79.57 $23.34 $79.57 $83.54 $647.25 $79.57 $79.57 $79.57 $414.24 $414.24 $683.50 $79.57 $690.40 $131.28 $171.28 $79.57 $500.54 $83.54 $115.11 $79.57 $179.85 $79.57 N/A N/A 32000392 EAP CPT® 73660 X-RAY EXAM TOE(S) 2+ VIEW BILAT BOTH IP/OP "$1,733.00" "$1,282.50" $23.34 "$1,386.40" $60.57 $60.57 $60.57 $60.57 $79.57 $79.57 $79.21 $361.20 $79.57 $50.51 $50.51 $52.46 $36.87 $361.18 $127.31 $125.33 "$1,025.07" $79.57 $23.34 $79.57 $83.54 "$1,299.75" $79.57 $79.57 $79.57 $831.84 $831.84 "$1,372.54" $79.57 "$1,386.40" $131.28 $343.96 $79.57 "$1,005.14" $83.54 $115.11 $79.57 $361.16 $79.57 N/A N/A 32000394 EAP CPT® 73660 TOE(S) X-RAY 2+VIEW RDG BOTH IP/OP $863.00 $639.00 $23.34 $690.40 $60.57 $60.57 $60.57 $60.57 $79.57 $79.57 $79.21 $179.87 $79.57 $50.51 $50.51 $52.46 $36.87 $179.86 $127.31 $125.33 $510.46 $79.57 $23.34 $79.57 $83.54 $647.25 $79.57 $79.57 $79.57 $414.24 $414.24 $683.50 $79.57 $690.40 $131.28 $171.28 $79.57 $500.54 $83.54 $115.11 $79.57 $179.85 $79.57 N/A N/A 32000396 EAP CPT® 73660 TOE(S) X-RAY 2+VIEW LT RDG BOTH IP/OP $878.00 $650.00 $23.34 $702.40 $60.57 $60.57 $60.57 $60.57 $79.57 $79.57 $79.21 $183.00 $79.57 $50.51 $50.51 $52.46 $36.87 $182.98 $127.31 $125.33 $519.34 $79.57 $23.34 $79.57 $83.54 $658.50 $79.57 $79.57 $79.57 $421.44 $421.44 $695.38 $79.57 $702.40 $131.28 $174.26 $79.57 $509.24 $83.54 $115.11 $79.57 $182.98 $79.57 N/A N/A 32000398 EAP CPT® 73660 X-RAY EXAM TOE(S) 2+ VIEW BOTH IP/OP $878.00 $650.00 $23.34 $702.40 $60.57 $60.57 $60.57 $60.57 $79.57 $79.57 $79.21 $183.00 $79.57 $50.51 $50.51 $52.46 $36.87 $182.98 $127.31 $125.33 $519.34 $79.57 $23.34 $79.57 $83.54 $658.50 $79.57 $79.57 $79.57 $421.44 $421.44 $695.38 $79.57 $702.40 $131.28 $174.26 $79.57 $509.24 $83.54 $115.11 $79.57 $182.98 $79.57 N/A N/A 32000412 EAP CPT® 74018 "KUB-KIDNEY,URETER,BLADDER RDG" BOTH IP/OP $797.00 $590.00 $21.65 $637.60 $59.14 $59.14 $59.14 $59.14 $79.57 $79.57 $79.21 $166.11 $79.57 $45.51 $45.51 $47.26 $33.22 $166.10 $127.31 $125.33 $471.43 $79.57 $21.65 $79.57 $83.54 $597.75 $79.57 $79.57 $79.57 $382.56 $382.56 $631.22 $79.57 $637.60 $131.28 $158.18 $79.57 $462.26 $83.54 $115.11 $79.57 $166.09 $79.57 N/A N/A 32000417 EAP CPT® 74019 ABDOMEN AP OBLIQ&CONE RDG BOTH IP/OP $704.00 $521.00 $26.39 $563.20 $72.16 $72.16 $72.16 $72.16 $107.09 $107.09 $106.62 $146.73 $107.09 $54.42 $54.42 $56.52 $39.73 $146.72 $171.35 $154.19 $416.42 $107.09 $26.39 $107.09 $112.45 $528.00 $107.09 $107.09 $107.09 $337.92 $337.92 $557.57 $107.09 $563.20 $176.70 $139.73 $107.09 $408.32 $112.45 $154.94 $107.09 $146.71 $107.09 N/A N/A 32000419 EAP CPT® 74019 X-RAY EXAM ABDOMEN 2 VIEWS BOTH IP/OP $813.00 $602.00 $26.39 $650.40 $72.16 $72.16 $72.16 $72.16 $107.09 $107.09 $106.62 $169.45 $107.09 $54.42 $54.42 $56.52 $39.73 $169.44 $171.35 $154.19 $480.89 $107.09 $26.39 $107.09 $112.45 $609.75 $107.09 $107.09 $107.09 $390.24 $390.24 $643.90 $107.09 $650.40 $176.70 $161.36 $107.09 $471.54 $112.45 $154.94 $107.09 $169.43 $107.09 N/A N/A 32000421 EAP CPT® 74022 XR 2 VW ABD W/ SINGLE VIEW CHEST BOTH IP/OP "$1,195.00" $884.50 $35.18 $956.00 $96.58 $96.58 $96.58 $96.58 $107.09 $107.09 $106.62 $249.07 $107.09 $79.08 $79.08 $82.12 $57.73 $249.05 $171.35 $154.19 $706.84 $107.09 $35.18 $107.09 $112.45 $896.25 $107.09 $107.09 $107.09 $573.60 $573.60 $946.44 $107.09 $956.00 $176.70 $237.18 $107.09 $693.10 $112.45 $154.94 $107.09 $249.04 $107.09 N/A N/A 32000430 EAP CPT® 74210 XR PHARYNX/CERV ESOPH SINGLE CONTRAST BOTH IP/OP $630.00 $466.50 $65.55 $630.00 $630.00 $630.00 $630.00 $630.00 $73.88 $73.88 $86.03 $630.00 $73.88 $142.45 $142.45 $147.93 $103.99 $131.30 $118.21 $112.56 $630.00 $73.88 $70.35 $73.88 $630.00 $472.50 $73.88 $73.88 $73.88 $302.40 $302.40 $498.96 $73.88 $504.00 $630.00 $630.00 $73.88 $365.40 $630.00 $65.55 $73.88 $630.00 $73.88 N/A N/A 32000432 EAP CPT® 74220 X-RAY EXAM ESOPHAGUS SGL CONTRAST BOTH IP/OP "$1,176.00" $870.50 $72.04 $940.80 $190.86 $190.86 $190.86 $190.86 $175.71 $175.71 $174.93 $245.11 $175.71 $156.06 $156.06 $162.06 $113.92 $245.09 $281.13 $260.16 $695.60 $175.71 $72.04 $175.71 $184.49 $882.00 $175.71 $175.71 $175.71 $564.48 $564.48 $931.39 $175.71 $940.80 $289.92 $233.41 $175.71 $682.08 $184.49 $254.21 $175.71 $245.08 $175.71 N/A N/A 32000434 EAP CPT® 74230 X-RAY EXAM SWALLOW FUNCTION SGL CONTRAST BOTH IP/OP $978.00 $724.00 $103.49 $978.00 $978.00 $978.00 $978.00 $978.00 $108.41 $108.41 $115.63 $978.00 $108.41 $153.16 $153.16 $159.05 $111.81 $203.83 $173.46 $165.58 $978.00 $108.41 $103.49 $108.41 $978.00 $733.50 $108.41 $108.41 $108.41 $469.44 $469.44 $774.58 $108.41 $782.40 $978.00 $978.00 $108.41 $567.24 $978.00 $104.09 $108.41 $978.00 $108.41 N/A N/A 32000435 EAP CPT® 74230 BARIUM SWALLOW BOTH IP/OP $988.00 $731.50 $103.49 $988.00 $988.00 $988.00 $988.00 $988.00 $108.41 $108.41 $115.63 $988.00 $108.41 $153.16 $153.16 $159.05 $111.81 $205.91 $173.46 $165.58 $988.00 $108.41 $103.49 $108.41 $988.00 $741.00 $108.41 $108.41 $108.41 $474.24 $474.24 $782.50 $108.41 $790.40 $988.00 $988.00 $108.41 $573.04 $988.00 $104.09 $108.41 $988.00 $108.41 N/A N/A 32000436 EAP CPT® 74235 ESOPHAGEAL FB REMOVAL S&I SPV BOTH IP/OP "$1,329.00" $983.50 $217.79 "$5,322.00" "$1,329.00" "$1,329.00" "$1,329.00" "$1,329.00" "$1,329.00" "$1,329.00" $236.56 "$1,329.00" "$1,329.00" $298.34 $298.34 $309.82 $217.79 $276.98 "$1,329.00" "$2,128.80" "$1,329.00" "$1,329.00" "$5,322.00" "$1,329.00" "$1,329.00" $996.75 "$1,329.00" "$1,329.00" "$1,329.00" $637.92 $637.92 "$1,052.57" "$1,329.00" "$1,063.20" "$1,329.00" "$1,329.00" "$1,329.00" $770.82 "$1,329.00" "$1,329.00" "$1,329.00" "$1,329.00" "$1,329.00" N/A N/A 32000437 EAP CPT® 74235 FB REMOVAL ESOPHAGEAL S&I EXR BOTH IP/OP "$1,342.00" $993.50 $217.79 "$5,322.00" "$1,342.00" "$1,342.00" "$1,342.00" "$1,342.00" "$1,342.00" "$1,342.00" $238.88 "$1,342.00" "$1,342.00" $298.34 $298.34 $309.82 $217.79 $279.69 "$1,342.00" "$2,128.80" "$1,342.00" "$1,342.00" "$5,322.00" "$1,342.00" "$1,342.00" "$1,006.50" "$1,342.00" "$1,342.00" "$1,342.00" $644.16 $644.16 "$1,062.86" "$1,342.00" "$1,073.60" "$1,342.00" "$1,342.00" "$1,342.00" $778.36 "$1,342.00" "$1,342.00" "$1,342.00" "$1,342.00" "$1,342.00" N/A N/A 32000439 EAP CPT® 74235 REM. F.B. ESOPH XRAY SUPER/INT BOTH IP/OP "$1,329.00" $983.50 $217.79 "$5,322.00" "$1,329.00" "$1,329.00" "$1,329.00" "$1,329.00" "$1,329.00" "$1,329.00" $236.56 "$1,329.00" "$1,329.00" $298.34 $298.34 $309.82 $217.79 $276.98 "$1,329.00" "$2,128.80" "$1,329.00" "$1,329.00" "$5,322.00" "$1,329.00" "$1,329.00" $996.75 "$1,329.00" "$1,329.00" "$1,329.00" $637.92 $637.92 "$1,052.57" "$1,329.00" "$1,063.20" "$1,329.00" "$1,329.00" "$1,329.00" $770.82 "$1,329.00" "$1,329.00" "$1,329.00" "$1,329.00" "$1,329.00" N/A N/A 32000441 EAP CPT® 74240 UGI W/O KUB RDG BOTH IP/OP "$1,446.00" "$1,070.50" $87.94 "$1,156.80" $243.75 $243.75 $243.75 $243.75 $175.71 $175.71 $174.93 $301.38 $175.71 $177.54 $177.54 $184.37 $129.60 $301.36 $281.13 $260.16 $855.31 $175.71 $87.94 $175.71 $184.49 "$1,084.50" $175.71 $175.71 $175.71 $694.08 $694.08 "$1,145.23" $175.71 "$1,156.80" $289.92 $286.99 $175.71 $838.68 $184.49 $254.21 $175.71 $301.35 $175.71 N/A N/A 32000448 EAP CPT® 74246 X-RAY UGI W/ AIR CON W/O KUB BOTH IP/OP "$1,369.00" "$1,013.50" $100.79 "$1,095.20" $274.39 $274.39 $274.39 $274.39 $175.71 $175.71 $174.93 $285.33 $175.71 $216.23 $216.23 $224.54 $157.84 $285.31 $281.13 $260.16 $809.76 $175.71 $100.79 $175.71 $184.49 "$1,026.75" $175.71 $175.71 $175.71 $657.12 $657.12 "$1,084.25" $175.71 "$1,095.20" $289.92 $271.71 $175.71 $794.02 $184.49 $254.21 $175.71 $285.30 $175.71 N/A N/A 32000449 EAP CPT® 74246 UGI W/AIR CONTRAST BOTH IP/OP "$1,369.00" "$1,013.50" $100.79 "$1,095.20" $274.39 $274.39 $274.39 $274.39 $175.71 $175.71 $174.93 $285.33 $175.71 $216.23 $216.23 $224.54 $157.84 $285.31 $281.13 $260.16 $809.76 $175.71 $100.79 $175.71 $184.49 "$1,026.75" $175.71 $175.71 $175.71 $657.12 $657.12 "$1,084.25" $175.71 "$1,095.20" $289.92 $271.71 $175.71 $794.02 $184.49 $254.21 $175.71 $285.30 $175.71 N/A N/A 32000457 EAP CPT® 74250 XR SMALL BOWEL SINGLE CONTRAST BOTH IP/OP $656.00 $485.50 $81.04 $656.00 $656.00 $656.00 $656.00 $656.00 $90.45 $90.45 $108.84 $656.00 $90.45 $190.37 $190.37 $197.69 $138.97 $136.72 $144.72 $139.62 $656.00 $90.45 $87.26 $90.45 $656.00 $492.00 $90.45 $90.45 $90.45 $314.88 $314.88 $519.55 $90.45 $524.80 $656.00 $656.00 $90.45 $380.48 $656.00 $81.04 $90.45 $656.00 $90.45 N/A N/A 32000462 EAP CPT® 74270 XR COLON SINGLE CONTRAST BOTH IP/OP "$1,428.00" "$1,057.00" $108.57 "$1,142.40" $316.56 $316.56 $316.56 $316.56 $175.71 $175.71 $174.93 $297.63 $175.71 $270.52 $270.52 $280.93 $197.48 $297.61 $281.13 $260.16 $844.66 $175.71 $108.57 $175.71 $184.49 "$1,071.00" $175.71 $175.71 $175.71 $685.44 $685.44 "$1,130.98" $175.71 "$1,142.40" $289.92 $283.42 $175.71 $828.24 $184.49 $254.21 $175.71 $297.60 $175.71 N/A N/A 32000463 EAP CPT® 74270 X-RAY EXAM BARIUM ENEMA SGL CONTRAST BOTH IP/OP "$1,716.00" "$1,270.00" $108.57 "$1,372.80" $316.56 $316.56 $316.56 $316.56 $175.71 $175.71 $174.93 $357.66 $175.71 $270.52 $270.52 $280.93 $197.48 $357.63 $281.13 $260.16 "$1,015.01" $175.71 $108.57 $175.71 $184.49 "$1,287.00" $175.71 $175.71 $175.71 $823.68 $823.68 "$1,359.07" $175.71 "$1,372.80" $289.92 $340.58 $175.71 $995.28 $184.49 $254.21 $175.71 $357.61 $175.71 N/A N/A 32000465 EAP CPT® 74280 XR COLON DOUBLE CONTRAST BOTH IP/OP "$2,694.00" "$1,994.00" $167.42 "$2,155.20" $349.52 $349.52 $349.52 $349.52 $175.71 $175.71 $174.93 $561.50 $175.71 $370.04 $370.04 $384.27 $270.13 $561.46 $281.13 $260.16 "$1,593.50" $175.71 $167.42 $175.71 $184.49 "$2,020.50" $175.71 $175.71 $175.71 "$1,293.12" "$1,293.12" "$2,133.65" $175.71 "$2,155.20" $289.92 $534.69 $175.71 "$1,562.52" $184.49 $254.21 $175.71 $561.43 $175.71 N/A N/A 32000467 EAP CPT® 74283 THERAPEUTIC ENEMA CON/AIR RDG BOTH IP/OP "$1,218.00" $901.50 $146.23 "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" $167.47 $167.47 $228.65 "$1,218.00" $167.47 $256.43 $256.43 $266.30 $187.19 $253.84 $267.95 $256.50 "$1,218.00" $167.47 $160.31 $167.47 "$1,218.00" $913.50 $167.47 $167.47 $167.47 $584.64 $584.64 $964.66 $167.47 $974.40 "$1,218.00" "$1,218.00" $167.47 $706.44 "$1,218.00" $146.23 $167.47 "$1,218.00" $167.47 N/A N/A 32000468 EAP CPT® 74290 CHOLECYSTOGRAPHY W/DYE RDG BOTH IP/OP "$1,066.00" $789.00 $66.99 "$1,066.00" "$1,066.00" "$1,066.00" "$1,066.00" "$1,066.00" $75.95 $75.95 $76.03 "$1,066.00" $75.95 $119.00 $119.00 $123.57 $86.87 $222.17 $121.52 $116.90 "$1,066.00" $75.95 $73.06 $75.95 "$1,066.00" $799.50 $75.95 $75.95 $75.95 $511.68 $511.68 $844.27 $75.95 $852.80 "$1,066.00" "$1,066.00" $75.95 $618.28 "$1,066.00" $66.99 $75.95 "$1,066.00" $75.95 N/A N/A 32000470 EAP CPT® 74300 X-RAY BILE DUCTS/PANCREAS BOTH IP/OP "$1,122.00" $830.50 $64.83 "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" $199.72 "$1,122.00" "$1,122.00" $88.82 $88.82 $92.23 $64.83 $233.84 "$1,122.00" $448.80 "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" $841.50 "$1,122.00" "$1,122.00" "$1,122.00" $538.56 $538.56 $888.62 "$1,122.00" $897.60 "$1,122.00" "$1,122.00" "$1,122.00" $650.76 "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" N/A N/A 32000471 EAP CPT® 74300 XRAY BILE DUCTS/PANCREAS BOTH IP/OP "$1,122.00" $830.50 $64.83 "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" $199.72 "$1,122.00" "$1,122.00" $88.82 $88.82 $92.23 $64.83 $233.84 "$1,122.00" $448.80 "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" $841.50 "$1,122.00" "$1,122.00" "$1,122.00" $538.56 $538.56 $888.62 "$1,122.00" $897.60 "$1,122.00" "$1,122.00" "$1,122.00" $650.76 "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" N/A N/A 32000477 EAP CPT® 74328 RADIOLOGICAL;BILIARY DUCTAL BOTH IP/OP $934.00 $691.50 $166.25 $934.00 $934.00 $934.00 $934.00 $934.00 $934.00 $934.00 $166.25 $934.00 $934.00 $344.53 $344.53 $357.78 $251.50 $194.66 $934.00 $373.60 $934.00 $934.00 $934.00 $934.00 $934.00 $700.50 $934.00 $934.00 $934.00 $448.32 $448.32 $739.73 $934.00 $747.20 $934.00 $934.00 $934.00 $541.72 $934.00 $934.00 $934.00 $934.00 $934.00 N/A N/A 32000478 EAP CPT® 74329 RADIOLOGICAL;PANCREATIC DUCTAL BOTH IP/OP $934.00 $691.50 $127.03 $934.00 $934.00 $934.00 $934.00 $934.00 $934.00 $934.00 $166.25 $934.00 $934.00 $174.01 $174.01 $180.71 $127.03 $194.66 $934.00 $373.60 $934.00 $934.00 $934.00 $934.00 $934.00 $700.50 $934.00 $934.00 $934.00 $448.32 $448.32 $739.73 $934.00 $747.20 $934.00 $934.00 $934.00 $541.72 $934.00 $934.00 $934.00 $934.00 $934.00 N/A N/A 32000479 EAP CPT® 74330 RADIOLOGICAL;BILIARY & PANCREA BOTH IP/OP $934.00 $691.50 $166.25 $934.00 $934.00 $934.00 $934.00 $934.00 $934.00 $934.00 $166.25 $934.00 $934.00 $344.53 $344.53 $357.78 $251.50 $194.66 $934.00 $373.60 $934.00 $934.00 $934.00 $934.00 $934.00 $700.50 $934.00 $934.00 $934.00 $448.32 $448.32 $739.73 $934.00 $747.20 $934.00 $934.00 $934.00 $541.72 $934.00 $934.00 $934.00 $934.00 $934.00 N/A N/A 32000481 EAP CPT® 74340 X-RAY GUIDE FOR GI TUBE BOTH IP/OP $456.00 $337.50 $81.17 "$1,377.00" $456.00 $456.00 $456.00 $456.00 $456.00 $456.00 $81.17 $456.00 $456.00 $286.63 $286.63 $297.66 $209.24 $95.04 $456.00 $550.80 $456.00 $456.00 "$1,377.00" $456.00 $456.00 $342.00 $456.00 $456.00 $456.00 $218.88 $218.88 $361.15 $456.00 $364.80 $456.00 $456.00 $456.00 $264.48 $456.00 $456.00 $456.00 $456.00 $456.00 N/A N/A 32000482 EAP CPT® 74340 X-RAY GUIDE FOR GI TUBE BOTH IP/OP $461.00 $341.50 $82.06 "$1,377.00" $461.00 $461.00 $461.00 $461.00 $461.00 $461.00 $82.06 $461.00 $461.00 $286.63 $286.63 $297.66 $209.24 $96.08 $461.00 $550.80 $461.00 $461.00 "$1,377.00" $461.00 $461.00 $345.75 $461.00 $461.00 $461.00 $221.28 $221.28 $365.11 $461.00 $368.80 $461.00 $461.00 $461.00 $267.38 $461.00 $461.00 $461.00 $461.00 $461.00 N/A N/A 32000484 EAP CPT® 74355 PL ENTEROCLYSIS TUBE PERC SPV BOTH IP/OP $844.00 $625.00 $150.23 $844.00 $844.00 $844.00 $844.00 $844.00 $844.00 $844.00 $150.23 $844.00 $844.00 $286.63 $286.63 $297.66 $209.24 $175.90 $844.00 $337.60 $844.00 $844.00 $844.00 $844.00 $844.00 $633.00 $844.00 $844.00 $844.00 $405.12 $405.12 $668.45 $844.00 $675.20 $844.00 $844.00 $844.00 $489.52 $844.00 $844.00 $844.00 $844.00 $844.00 N/A N/A 32000485 EAP CPT® 74360 X-RAY GUIDE GI DILATION BOTH IP/OP $976.00 $722.50 $193.71 $976.00 $255.39 $255.39 $255.39 $255.39 $976.00 $976.00 $976.00 $203.42 $976.00 $344.53 $344.53 $357.78 $251.50 $203.41 $976.00 $976.00 $577.30 $976.00 $976.00 $976.00 $976.00 $732.00 $976.00 $976.00 $976.00 $468.48 $468.48 $772.99 $976.00 $780.80 $976.00 $193.71 $976.00 $566.08 $976.00 $976.00 $976.00 $203.40 $976.00 N/A N/A 32000486 EAP CPT® 74360 INTRALUMINAL DILAT STRICTU SPV BOTH IP/OP $976.00 $722.50 $193.71 $976.00 $255.39 $255.39 $255.39 $255.39 $976.00 $976.00 $976.00 $203.42 $976.00 $344.53 $344.53 $357.78 $251.50 $203.41 $976.00 $976.00 $577.30 $976.00 $976.00 $976.00 $976.00 $732.00 $976.00 $976.00 $976.00 $468.48 $468.48 $772.99 $976.00 $780.80 $976.00 $193.71 $976.00 $566.08 $976.00 $976.00 $976.00 $203.40 $976.00 N/A N/A 32000487 EAP CPT® 74363 BILIARY STRICTURE SPV BOTH IP/OP "$2,534.00" "$1,875.50" $159.73 "$2,534.00" "$2,534.00" "$2,534.00" "$2,534.00" "$2,534.00" "$2,534.00" "$2,534.00" $451.05 "$2,534.00" "$2,534.00" $218.82 $218.82 $227.23 $159.73 $528.11 "$2,534.00" "$1,013.60" "$2,534.00" "$2,534.00" "$2,534.00" "$2,534.00" "$2,534.00" "$1,900.50" "$2,534.00" "$2,534.00" "$2,534.00" "$1,216.32" "$1,216.32" "$2,006.93" "$2,534.00" "$2,027.20" "$2,534.00" "$2,534.00" "$2,534.00" "$1,469.72" "$2,534.00" "$2,534.00" "$2,534.00" "$2,534.00" "$2,534.00" N/A N/A 32000488 EAP CPT® 74400 X-RAY URINARY TRACT HYPERTENSIVE W/CONTRAST BOTH IP/OP $888.00 $657.50 $104.81 $888.00 $888.00 $888.00 $888.00 $888.00 $119.12 $119.12 $117.75 $888.00 $119.12 $208.81 $208.81 $216.84 $152.43 $185.07 $190.59 $184.00 $888.00 $119.12 $115.00 $119.12 $888.00 $666.00 $119.12 $119.12 $119.12 $426.24 $426.24 $703.30 $119.12 $710.40 $888.00 $888.00 $119.12 $515.04 $888.00 $104.81 $119.12 $888.00 $119.12 N/A N/A 32000490 EAP CPT® 74400 UROGRAPHY W/WO KUB/TOMOG RDG BOTH IP/OP $888.00 $657.50 $104.81 $888.00 $888.00 $888.00 $888.00 $888.00 $119.12 $119.12 $117.75 $888.00 $119.12 $208.81 $208.81 $216.84 $152.43 $185.07 $190.59 $184.00 $888.00 $119.12 $115.00 $119.12 $888.00 $666.00 $119.12 $119.12 $119.12 $426.24 $426.24 $703.30 $119.12 $710.40 $888.00 $888.00 $119.12 $515.04 $888.00 $104.81 $119.12 $888.00 $119.12 N/A N/A 32000493 EAP CPT® 74410 UROGRAPHY DRIP INFUSION RDG BOTH IP/OP $868.00 $642.50 $107.33 $868.00 $868.00 $868.00 $868.00 $868.00 $123.96 $123.96 $121.60 $868.00 $123.96 $222.40 $222.40 $230.96 $162.35 $180.90 $198.34 $193.20 $868.00 $123.96 $120.75 $123.96 $868.00 $651.00 $123.96 $123.96 $123.96 $416.64 $416.64 $687.46 $123.96 $694.40 $868.00 $868.00 $123.96 $503.44 $868.00 $107.33 $123.96 $868.00 $123.96 N/A N/A 32000495 EAP CPT® 74415 UROGRAPHY WITH NEPHRO EXR BOTH IP/OP $868.00 $642.50 $129.30 $868.00 $868.00 $868.00 $868.00 $868.00 $139.50 $139.50 $138.18 $868.00 $139.50 $264.92 $264.92 $275.11 $193.39 $180.90 $223.20 $215.38 $868.00 $139.50 $134.61 $139.50 $868.00 $651.00 $139.50 $139.50 $139.50 $416.64 $416.64 $687.46 $139.50 $694.40 $868.00 $868.00 $139.50 $503.44 $868.00 $129.30 $139.50 $868.00 $139.50 N/A N/A 32000496 EAP CPT® 74420 X-RAY URINARY TRACT RETROGRADE W/CONTRAST BOTH IP/OP $888.00 $657.50 $48.98 $888.00 $888.00 $888.00 $888.00 $888.00 $54.19 $54.19 $66.25 $888.00 $54.19 $286.63 $286.63 $297.66 $209.24 $185.07 $86.70 $86.05 $888.00 $54.19 $53.78 $54.19 $888.00 $666.00 $54.19 $54.19 $54.19 $426.24 $426.24 $703.30 $54.19 $710.40 $888.00 $888.00 $54.19 $515.04 $888.00 $48.98 $54.19 $888.00 $54.19 N/A N/A 32000497 EAP CPT® 74420 UROGRA RETRO W/WO KUB RDG BOTH IP/OP $888.00 $657.50 $48.98 $888.00 $888.00 $888.00 $888.00 $888.00 $54.19 $54.19 $66.25 $888.00 $54.19 $286.63 $286.63 $297.66 $209.24 $185.07 $86.70 $86.05 $888.00 $54.19 $53.78 $54.19 $888.00 $666.00 $54.19 $54.19 $54.19 $426.24 $426.24 $703.30 $54.19 $710.40 $888.00 $888.00 $54.19 $515.04 $888.00 $48.98 $54.19 $888.00 $54.19 N/A N/A 32000500 EAP CPT® 74425 NEPHROSTOGRAM BOTH IP/OP "$1,039.00" $769.00 $104.24 "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" $119.47 $119.47 $120.42 "$1,039.00" $119.47 $142.79 $142.79 $148.28 $104.24 $216.54 $191.15 $184.53 "$1,039.00" $119.47 $115.33 $119.47 "$1,039.00" $779.25 $119.47 $119.47 $119.47 $498.72 $498.72 $822.89 $119.47 $831.20 "$1,039.00" "$1,039.00" $119.47 $602.62 "$1,039.00" $106.25 $119.47 "$1,039.00" $119.47 N/A N/A 32000501 EAP CPT® 74425 LOOPOGRAM/POUCHOGRAM BOTH IP/OP "$1,039.00" $769.00 $104.24 "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" $119.47 $119.47 $120.42 "$1,039.00" $119.47 $142.79 $142.79 $148.28 $104.24 $216.54 $191.15 $184.53 "$1,039.00" $119.47 $115.33 $119.47 "$1,039.00" $779.25 $119.47 $119.47 $119.47 $498.72 $498.72 $822.89 $119.47 $831.20 "$1,039.00" "$1,039.00" $119.47 $602.62 "$1,039.00" $106.25 $119.47 "$1,039.00" $119.47 N/A N/A 32000502 EAP CPT® 74425 X-RAY URINARY TRACT ANTEGRADE W/CONTRAST BOTH IP/OP "$1,039.00" $769.00 $104.24 "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" $119.47 $119.47 $120.42 "$1,039.00" $119.47 $142.79 $142.79 $148.28 $104.24 $216.54 $191.15 $184.53 "$1,039.00" $119.47 $115.33 $119.47 "$1,039.00" $779.25 $119.47 $119.47 $119.47 $498.72 $498.72 $822.89 $119.47 $831.20 "$1,039.00" "$1,039.00" $119.47 $602.62 "$1,039.00" $106.25 $119.47 "$1,039.00" $119.47 N/A N/A 32000503 EAP CPT® 74430 CYSTOGRAPHY 3+ VIEW BOTH IP/OP "$1,235.00" $914.00 $26.72 $988.00 $82.03 $82.03 $82.03 $82.03 $362.23 $362.23 $360.63 $257.40 $362.23 $152.43 $152.43 $158.30 $111.27 $257.39 $579.58 $531.51 $730.50 $362.23 $26.72 $362.23 $380.35 $926.25 $362.23 $362.23 $362.23 $592.80 $592.80 $978.12 $362.23 $988.00 $597.69 $245.12 $362.23 $716.30 $380.35 $524.06 $362.23 $257.37 $362.23 N/A N/A 32000504 EAP CPT® 74430 CONTRAST XRAY BLADDER BOTH IP/OP "$1,247.00" $923.00 $26.72 $997.60 $82.03 $82.03 $82.03 $82.03 $362.23 $362.23 $360.63 $259.91 $362.23 $152.43 $152.43 $158.30 $111.27 $259.89 $579.58 $531.51 $737.60 $362.23 $26.72 $362.23 $380.35 $935.25 $362.23 $362.23 $362.23 $598.56 $598.56 $987.62 $362.23 $997.60 $597.69 $247.50 $362.23 $723.26 $380.35 $524.06 $362.23 $259.87 $362.23 N/A N/A 32000505 EAP CPT® 74440 VASOGRAPHY VESICU'GRAPHY SPV BOTH IP/OP "$1,078.00" $798.00 $74.56 "$1,078.00" "$1,078.00" "$1,078.00" "$1,078.00" "$1,078.00" $84.24 $84.24 $85.51 "$1,078.00" $84.24 $159.69 $159.69 $165.83 $116.57 $224.67 $134.78 $129.87 "$1,078.00" $84.24 $81.17 $84.24 "$1,078.00" $808.50 $84.24 $84.24 $84.24 $517.44 $517.44 $853.78 $84.24 $862.40 "$1,078.00" "$1,078.00" $84.24 $625.24 "$1,078.00" $74.56 $84.24 "$1,078.00" $84.24 N/A N/A 32000506 EAP CPT® 74445 CORPORA CAVERNO'GRAM S&I SPV BOTH IP/OP "$1,078.00" $798.00 $89.87 "$1,078.00" "$1,078.00" "$1,078.00" "$1,078.00" "$1,078.00" "$1,078.00" "$1,078.00" $191.88 "$1,078.00" "$1,078.00" $123.12 $123.12 $127.85 $89.87 $224.67 "$1,078.00" $129.20 "$1,078.00" "$1,078.00" $323.00 "$1,078.00" "$1,078.00" $808.50 "$1,078.00" "$1,078.00" "$1,078.00" $517.44 $517.44 $853.78 "$1,078.00" $862.40 "$1,078.00" "$1,078.00" "$1,078.00" $625.24 "$1,078.00" "$1,078.00" "$1,078.00" "$1,078.00" "$1,078.00" N/A N/A 32000508 EAP CPT® 74450 RETRO URETHROCYSTOGRAPHY BOTH IP/OP "$2,861.00" "$2,117.50" $116.31 "$2,288.80" $492.86 $492.86 $492.86 $492.86 $226.34 $226.34 $225.34 $596.30 $226.34 $159.33 $159.33 $165.46 $116.31 $596.26 $362.15 $336.89 "$1,692.28" $226.34 $915.00 $226.34 $237.66 "$2,145.75" $226.34 $226.34 $226.34 "$1,373.28" "$1,373.28" "$2,265.91" $226.34 "$2,288.80" $373.47 $567.84 $226.34 "$1,659.38" $237.66 $327.46 $226.34 $596.23 $226.34 N/A N/A 32000509 EAP CPT® 74450 X-RAY URETHRA/BLADDER RETROGRADE BOTH IP/OP "$2,861.00" "$2,117.50" $116.31 "$2,288.80" $492.86 $492.86 $492.86 $492.86 $226.34 $226.34 $225.34 $596.30 $226.34 $159.33 $159.33 $165.46 $116.31 $596.26 $362.15 $336.89 "$1,692.28" $226.34 $915.00 $226.34 $237.66 "$2,145.75" $226.34 $226.34 $226.34 "$1,373.28" "$1,373.28" "$2,265.91" $226.34 "$2,288.80" $373.47 $567.84 $226.34 "$1,659.38" $237.66 $327.46 $226.34 $596.23 $226.34 N/A N/A 32000514 EAP CPT® 74485 NEPHRSTOMY/URETERAL DILAT SPV BOTH IP/OP "$2,682.00" "$1,985.00" $73.83 "$2,682.00" "$2,682.00" "$2,682.00" "$2,682.00" "$2,682.00" $84.58 $84.58 $103.27 "$2,682.00" $84.58 $224.19 $224.19 $232.82 $163.66 $558.96 $135.33 $130.96 "$2,682.00" $84.58 $81.85 $84.58 "$2,682.00" "$2,011.50" $84.58 $84.58 $84.58 "$1,287.36" "$1,287.36" "$2,124.14" $84.58 "$2,145.60" "$2,682.00" "$2,682.00" $84.58 "$1,555.56" "$2,682.00" $73.83 $84.58 "$2,682.00" $84.58 N/A N/A 32000516 EAP CPT® 74740 HYSTEROSALPINGOGRAPHY RDG BOTH IP/OP $957.00 $708.50 $79.14 $765.60 $161.72 $161.72 $161.72 $161.72 $226.34 $226.34 $225.34 $199.46 $226.34 $144.10 $144.10 $149.64 $105.19 $199.45 $362.15 $336.89 $566.07 $226.34 $79.14 $226.34 $237.66 $717.75 $226.34 $226.34 $226.34 $459.36 $459.36 $757.94 $226.34 $765.60 $373.47 $189.94 $226.34 $555.06 $237.66 $327.46 $226.34 $199.44 $226.34 N/A N/A 32000517 EAP CPT® 74742 TRANSCERVIC CATH FALLOPIAN SPV BOTH IP/OP $623.00 $461.50 $109.24 $623.00 $190.94 $190.94 $190.94 $190.94 $623.00 $623.00 $623.00 $129.85 $623.00 $149.65 $149.65 $155.40 $109.24 $129.84 $623.00 $623.00 $368.50 $623.00 $623.00 $623.00 $623.00 $467.25 $623.00 $623.00 $623.00 $299.04 $299.04 $493.42 $623.00 $498.40 $623.00 $123.65 $623.00 $361.34 $623.00 $623.00 $623.00 $129.83 $623.00 N/A N/A 32000548 EAP CPT® 75726 ANGIO HEPATIC SPV BOTH IP/OP "$8,089.00" "$5,986.00" $78.81 "$7,739.87" $323.46 $323.46 $323.46 $323.46 "$4,690.83" "$4,690.83" "$4,670.08" "$1,685.95" "$4,690.83" $560.51 $560.51 $582.07 $409.17 "$1,685.84" "$7,505.33" "$7,414.92" "$4,784.64" "$4,690.83" $78.81 "$4,690.83" "$4,925.37" "$6,066.75" "$4,690.83" "$4,690.83" "$4,690.83" "$3,882.72" "$3,882.72" "$6,406.49" "$4,690.83" "$6,471.20" "$7,739.87" "$1,605.46" "$4,690.83" "$4,691.62" "$4,925.37" "$6,786.45" "$4,690.83" "$1,685.75" "$4,690.83" N/A N/A 32000555 EAP CPT® 75746 ANGIO PULMONARY NONSELE SPV BOTH IP/OP "$2,391.00" "$1,769.50" $83.51 "$2,391.00" "$2,391.00" "$2,391.00" "$2,391.00" "$2,391.00" $83.51 $83.51 $120.61 "$2,391.00" $83.51 $545.99 $545.99 $566.99 $398.57 $498.31 $133.62 $133.68 "$2,391.00" $83.51 $83.55 $83.51 "$2,391.00" "$1,793.25" $83.51 $83.51 $83.51 "$1,147.68" "$1,147.68" "$1,893.67" $83.51 "$1,912.80" "$2,391.00" "$2,391.00" $83.51 "$1,386.78" "$2,391.00" $90.04 $83.51 "$2,391.00" $83.51 N/A N/A 32000556 EAP CPT® 75756 "ARTERY XRAY, CHEST" BOTH IP/OP "$3,613.00" "$2,674.00" $107.00 "$3,613.00" "$3,613.00" "$3,613.00" "$3,613.00" "$3,613.00" $107.00 $107.00 $139.42 "$3,613.00" $107.00 $577.75 $577.75 $599.97 $421.75 $752.99 $171.20 $173.73 "$3,613.00" $107.00 $108.58 $107.00 "$3,613.00" "$2,709.75" $107.00 $107.00 $107.00 "$1,734.24" "$1,734.24" "$2,861.50" $107.00 "$2,890.40" "$3,613.00" "$3,613.00" $107.00 "$2,095.54" "$3,613.00" $109.13 $107.00 "$3,613.00" $107.00 N/A N/A 32000560 EAP CPT® 75809 X-RAY NONVASCULAR SHUNT BOTH IP/OP $853.00 $631.50 $60.20 $682.40 $213.85 $213.85 $213.85 $213.85 $107.09 $107.09 $106.62 $177.79 $107.09 $156.21 $156.21 $162.22 $114.03 $177.77 $171.35 $154.19 $504.55 $107.09 $60.20 $107.09 $112.45 $639.75 $107.09 $107.09 $107.09 $409.44 $409.44 $675.58 $107.09 $682.40 $176.70 $169.30 $107.09 $494.74 $112.45 $154.94 $107.09 $177.77 $107.09 N/A N/A 32000561 EAP CPT® 75810 SPLENOPORTOGRAPHY SPV BOTH IP/OP "$11,121.00" "$8,230.00" "$1,004.01" "$11,121.00" "$11,121.00" "$11,121.00" "$11,121.00" "$11,121.00" "$11,121.00" "$11,121.00" "$1,979.54" "$11,121.00" "$11,121.00" "$1,375.38" "$1,375.38" "$1,428.28" "$1,004.01" "$2,317.74" "$11,121.00" "$2,837.20" "$11,121.00" "$11,121.00" "$7,093.00" "$11,121.00" "$11,121.00" "$8,340.75" "$11,121.00" "$11,121.00" "$11,121.00" "$5,338.08" "$5,338.08" "$8,807.83" "$11,121.00" "$8,896.80" "$11,121.00" "$11,121.00" "$11,121.00" "$6,450.18" "$11,121.00" "$11,121.00" "$11,121.00" "$11,121.00" "$11,121.00" N/A N/A 32000562 EAP CPT® 75820 EXTREMITY UNI VENOGRAM SPV BOTH IP/OP "$1,483.00" "$1,097.50" $61.22 "$2,282.37" $249.90 $249.90 $249.90 $249.90 "$1,383.25" "$1,383.25" "$1,377.13" $309.09 "$1,383.25" $205.08 $205.08 $212.97 $149.70 $309.07 "$2,213.20" "$2,146.46" "$1,483.00" "$1,383.25" $61.22 "$1,383.25" "$1,452.41" "$1,112.25" "$1,383.25" "$1,383.25" "$1,383.25" $711.84 $711.84 "$1,174.54" "$1,383.25" "$1,186.40" "$2,282.37" $294.34 "$1,383.25" $860.14 "$1,452.41" "$1,483.00" "$1,383.25" $309.06 "$1,383.25" N/A N/A 32000563 EAP CPT® 75822 EXTREMITY BI VENOGRAM SPV BOTH IP/OP "$1,616.00" "$1,196.00" $66.29 "$1,616.00" "$1,616.00" "$1,616.00" "$1,616.00" "$1,616.00" $68.01 $68.01 $121.94 "$1,616.00" $68.01 $227.43 $227.43 $236.17 $166.02 $336.79 $108.82 $106.06 "$1,616.00" $68.01 $66.29 $68.01 "$1,616.00" "$1,212.00" $68.01 $68.01 $68.01 $775.68 $775.68 "$1,279.87" $68.01 "$1,292.80" "$1,616.00" "$1,616.00" $68.01 $937.28 "$1,616.00" $75.28 $68.01 "$1,616.00" $68.01 N/A N/A 32000564 EAP CPT® 75825 INFERIOR VENO CAVAGRAM SPV BOTH IP/OP "$8,524.00" "$6,308.00" $62.57 "$8,524.00" "$8,524.00" "$8,524.00" "$8,524.00" "$8,524.00" $63.86 $63.86 $104.73 "$8,524.00" $63.86 $506.96 $506.96 $526.46 $370.08 "$1,776.50" $102.18 $100.11 "$8,524.00" $63.86 $62.57 $63.86 "$8,524.00" "$6,393.00" $63.86 $63.86 $63.86 "$4,091.52" "$4,091.52" "$6,751.01" $63.86 "$6,819.20" "$8,524.00" "$8,524.00" $63.86 "$4,943.92" "$8,524.00" $71.31 $63.86 "$8,524.00" $63.86 N/A N/A 32000565 EAP CPT® 75827 SUPERIOR VENO CAVAGRAM SPV BOTH IP/OP "$2,543.00" "$1,882.00" $67.31 "$2,282.37" $299.77 $299.77 $299.77 $299.77 "$1,383.25" "$1,383.25" "$1,377.13" $530.02 "$1,383.25" $508.79 $508.79 $528.36 $371.41 $529.99 "$2,213.20" "$2,146.46" "$1,504.18" "$1,383.25" $67.31 "$1,383.25" "$1,452.41" "$1,907.25" "$1,383.25" "$1,383.25" "$1,383.25" "$1,220.64" "$1,220.64" "$2,014.06" "$1,383.25" "$2,034.40" "$2,282.37" $504.72 "$1,383.25" "$1,474.94" "$1,452.41" "$2,001.22" "$1,383.25" $529.96 "$1,383.25" N/A N/A 32000566 EAP CPT® 75831 RENAL VENOGRAPH UNI SELEC SPV BOTH IP/OP "$7,721.00" "$5,714.00" $70.02 "$6,176.80" $303.56 $303.56 $303.56 $303.56 "$2,815.92" "$2,815.92" "$2,803.47" "$1,609.25" "$2,815.92" $514.24 $514.24 $534.02 $375.39 "$1,609.14" "$4,505.48" "$4,297.64" "$4,566.97" "$2,815.92" $70.02 "$2,815.92" "$2,956.72" "$5,790.75" "$2,815.92" "$2,815.92" "$2,815.92" "$3,706.08" "$3,706.08" "$6,115.03" "$2,815.92" "$6,176.80" "$4,646.27" "$1,532.43" "$2,815.92" "$4,478.18" "$2,956.72" "$4,073.93" "$2,815.92" "$1,609.06" "$2,815.92" N/A N/A 32000567 EAP CPT® 75833 RENAL VENOGRAM BI SELECT SPV BOTH IP/OP "$8,009.00" "$5,927.00" $79.15 "$8,009.00" "$8,009.00" "$8,009.00" "$8,009.00" "$8,009.00" $80.75 $80.75 $130.98 "$8,009.00" $80.75 $546.89 $546.89 $567.93 $399.23 "$1,669.16" $129.20 $126.64 "$8,009.00" $80.75 $79.15 $80.75 "$8,009.00" "$6,006.75" $80.75 $80.75 $80.75 "$3,844.32" "$3,844.32" "$6,343.13" $80.75 "$6,407.20" "$8,009.00" "$8,009.00" $80.75 "$4,645.22" "$8,009.00" $86.08 $80.75 "$8,009.00" $80.75 N/A N/A 32000568 EAP CPT® 75840 ADRENAL VENO UNILAT SEL SPV BOTH IP/OP "$5,361.00" "$3,967.50" $76.44 "$5,361.00" "$5,361.00" "$5,361.00" "$5,361.00" "$5,361.00" $77.33 $77.33 $117.12 "$5,361.00" $77.33 $510.59 $510.59 $530.23 $372.72 "$1,117.29" $123.73 $122.30 "$5,361.00" $77.33 $76.44 $77.33 "$5,361.00" "$4,020.75" $77.33 $77.33 $77.33 "$2,573.28" "$2,573.28" "$4,245.91" $77.33 "$4,288.80" "$5,361.00" "$5,361.00" $77.33 "$3,109.38" "$5,361.00" $84.64 $77.33 "$5,361.00" $77.33 N/A N/A 32000569 EAP CPT® 75842 ADRENAL VENOGRPHY BI SELCT SPV BOTH IP/OP "$5,630.00" "$4,166.50" $89.63 "$5,630.00" "$5,630.00" "$5,630.00" "$5,630.00" "$5,630.00" $90.08 $90.08 $142.24 "$5,630.00" $90.08 $548.70 $548.70 $569.81 $400.55 "$1,173.35" $144.13 $143.41 "$5,630.00" $90.08 $89.63 $90.08 "$5,630.00" "$4,222.50" $90.08 $90.08 $90.08 "$2,702.40" "$2,702.40" "$4,458.96" $90.08 "$4,504.00" "$5,630.00" "$5,630.00" $90.08 "$3,265.40" "$5,630.00" $97.61 $90.08 "$5,630.00" $90.08 N/A N/A 32000570 EAP CPT® 75860 SINUS/JUGULAR VENOGRAM SPN BOTH IP/OP "$3,267.00" "$2,418.00" $74.08 "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" $75.26 $75.26 $115.52 "$3,267.00" $75.26 $524.20 $524.20 $544.36 $382.66 $680.88 $120.42 $118.53 "$3,267.00" $75.26 $74.08 $75.26 "$3,267.00" "$2,450.25" $75.26 $75.26 $75.26 "$1,568.16" "$1,568.16" "$2,587.46" $75.26 "$2,613.60" "$3,267.00" "$3,267.00" $75.26 "$1,894.86" "$3,267.00" $82.84 $75.26 "$3,267.00" $75.26 N/A N/A 32000571 EAP CPT® 75870 SUPER SAGG SINUS VENOGRAM SPN BOTH IP/OP "$2,716.00" "$2,010.00" $99.78 "$2,716.00" "$2,716.00" "$2,716.00" "$2,716.00" "$2,716.00" $106.00 $106.00 $149.26 "$2,716.00" $106.00 $522.39 $522.39 $542.48 $381.34 $566.04 $169.60 $159.65 "$2,716.00" $106.00 $99.78 $106.00 "$2,716.00" "$2,037.00" $106.00 $106.00 $106.00 "$1,303.68" "$1,303.68" "$2,151.07" $106.00 "$2,172.80" "$2,716.00" "$2,716.00" $106.00 "$1,575.28" "$2,716.00" $121.02 $106.00 "$2,716.00" $106.00 N/A N/A 32000572 EAP CPT® 75872 EPIDURAL VENOGRAM SPN BOTH IP/OP "$1,855.00" "$1,373.00" $76.44 "$1,855.00" "$1,855.00" "$1,855.00" "$1,855.00" "$1,855.00" $77.33 $77.33 $117.12 "$1,855.00" $77.33 $574.13 $574.13 $596.21 $419.11 $386.60 $123.73 $122.30 "$1,855.00" $77.33 $76.44 $77.33 "$1,855.00" "$1,391.25" $77.33 $77.33 $77.33 $890.40 $890.40 "$1,469.16" $77.33 "$1,484.00" "$1,855.00" "$1,855.00" $77.33 "$1,075.90" "$1,855.00" $84.64 $77.33 "$1,855.00" $77.33 N/A N/A 32000573 EAP CPT® 75880 ORBITAL VENOGRAM SPN BOTH IP/OP "$1,855.00" "$1,373.00" $76.11 "$1,855.00" "$1,855.00" "$1,855.00" "$1,855.00" "$1,855.00" $76.98 $76.98 $98.77 "$1,855.00" $76.98 $211.42 $211.42 $219.55 $154.34 $386.60 $123.17 $121.78 "$1,855.00" $76.98 $76.11 $76.98 "$1,855.00" "$1,391.25" $76.98 $76.98 $76.98 $890.40 $890.40 "$1,469.16" $76.98 "$1,484.00" "$1,855.00" "$1,855.00" $76.98 "$1,075.90" "$1,855.00" $84.64 $76.98 "$1,855.00" $76.98 N/A N/A 32000574 EAP CPT® 75885 TRANS-HEP PORT W/HEMODYNAM SPV BOTH IP/OP "$7,625.00" "$5,642.50" $73.40 "$7,625.00" "$7,625.00" "$7,625.00" "$7,625.00" "$7,625.00" $73.88 $73.88 $123.53 "$7,625.00" $73.88 $516.04 $516.04 $535.89 $376.70 "$1,589.13" $118.21 $117.44 "$7,625.00" $73.88 $73.40 $73.88 "$7,625.00" "$5,718.75" $73.88 $73.88 $73.88 "$3,660.00" "$3,660.00" "$6,039.00" $73.88 "$6,100.00" "$7,625.00" "$7,625.00" $73.88 "$4,422.50" "$7,625.00" $82.12 $73.88 "$7,625.00" $73.88 N/A N/A 32000575 EAP CPT® 75887 TRANS-HEP PORT W/O HEMODYN SPV BOTH IP/OP "$4,003.00" "$2,962.50" $74.41 "$4,003.00" "$4,003.00" "$4,003.00" "$4,003.00" "$4,003.00" $75.26 $75.26 $124.72 "$4,003.00" $75.26 $521.49 $521.49 $541.54 $380.68 $834.27 $120.42 $119.06 "$4,003.00" $75.26 $74.41 $75.26 "$4,003.00" "$3,002.25" $75.26 $75.26 $75.26 "$1,921.44" "$1,921.44" "$3,170.38" $75.26 "$3,202.40" "$4,003.00" "$4,003.00" $75.26 "$2,321.74" "$4,003.00" $82.48 $75.26 "$4,003.00" $75.26 N/A N/A 32000576 EAP CPT® 75889 HEPATIC WEDGE VENO W/EVAL SPV BOTH IP/OP "$7,625.00" "$5,642.50" $73.74 "$7,625.00" "$7,625.00" "$7,625.00" "$7,625.00" "$7,625.00" $74.57 $74.57 $111.79 "$7,625.00" $74.57 $515.13 $515.13 $534.95 $376.04 "$1,589.13" $119.31 $117.98 "$7,625.00" $74.57 $73.74 $74.57 "$7,625.00" "$5,718.75" $74.57 $74.57 $74.57 "$3,660.00" "$3,660.00" "$6,039.00" $74.57 "$6,100.00" "$7,625.00" "$7,625.00" $74.57 "$4,422.50" "$7,625.00" $82.12 $74.57 "$7,625.00" $74.57 N/A N/A 32000577 EAP CPT® 75891 HEPATIC WEDG VENO W/O EVAL SPV BOTH IP/OP "$8,009.00" "$5,927.00" $74.08 "$8,009.00" "$8,009.00" "$8,009.00" "$8,009.00" "$8,009.00" $74.91 $74.91 $112.97 "$8,009.00" $74.91 $515.13 $515.13 $534.95 $376.04 "$1,669.16" $119.86 $118.53 "$8,009.00" $74.91 $74.08 $74.91 "$8,009.00" "$6,006.75" $74.91 $74.91 $74.91 "$3,844.32" "$3,844.32" "$6,343.13" $74.91 "$6,407.20" "$8,009.00" "$8,009.00" $74.91 "$4,645.22" "$8,009.00" $83.20 $74.91 "$8,009.00" $74.91 N/A N/A 32000578 EAP CPT® 75893 VENOUS SAMPLING W/WO ANGI SPV BOTH IP/OP "$5,000.00" "$3,700.00" $80.16 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $80.78 $80.78 $95.80 "$5,000.00" $80.78 $514.24 $514.24 $534.02 $375.39 "$1,042.06" $129.25 $128.26 "$5,000.00" $80.78 $80.16 $80.78 "$5,000.00" "$3,750.00" $80.78 $80.78 $80.78 "$2,400.00" "$2,400.00" "$3,960.00" $80.78 "$4,000.00" "$5,000.00" "$5,000.00" $80.78 "$2,900.00" "$5,000.00" $89.32 $80.78 "$5,000.00" $80.78 N/A N/A 32000579 EAP CPT® 75894 X-RAY TRANSCATH THERAPY EMBOLIZATION BOTH IP/OP "$11,713.00" "$8,668.00" "$1,923.97" "$12,035.00" "$11,713.00" "$11,713.00" "$11,713.00" "$11,713.00" "$11,713.00" "$11,713.00" "$2,084.91" "$11,713.00" "$11,713.00" "$2,635.61" "$2,635.61" "$2,736.98" "$1,923.97" "$2,441.12" "$11,713.00" "$4,814.00" "$11,713.00" "$11,713.00" "$12,035.00" "$11,713.00" "$11,713.00" "$8,784.75" "$11,713.00" "$11,713.00" "$11,713.00" "$5,622.24" "$5,622.24" "$9,276.70" "$11,713.00" "$9,370.40" "$11,713.00" "$11,713.00" "$11,713.00" "$6,793.54" "$11,713.00" "$11,713.00" "$11,713.00" "$11,713.00" "$11,713.00" N/A N/A 32000580 EAP CPT® 75894 "TRANSCATH EMBOLIZATION, S&I" BOTH IP/OP "$10,671.00" "$7,897.00" "$1,899.44" "$12,035.00" "$10,671.00" "$10,671.00" "$10,671.00" "$10,671.00" "$10,671.00" "$10,671.00" "$1,899.44" "$10,671.00" "$10,671.00" "$2,635.61" "$2,635.61" "$2,736.98" "$1,923.97" "$2,223.95" "$10,671.00" "$4,814.00" "$10,671.00" "$10,671.00" "$12,035.00" "$10,671.00" "$10,671.00" "$8,003.25" "$10,671.00" "$10,671.00" "$10,671.00" "$5,122.08" "$5,122.08" "$8,451.43" "$10,671.00" "$8,536.80" "$10,671.00" "$10,671.00" "$10,671.00" "$6,189.18" "$10,671.00" "$10,671.00" "$10,671.00" "$10,671.00" "$10,671.00" N/A N/A 32000585 EAP CPT® 75901 REMOVE CVA DEVICE OBSTRUCT BOTH IP/OP $585.00 $433.00 $121.92 $585.00 $585.00 $585.00 $585.00 $585.00 $224.43 $224.43 $206.17 $585.00 $224.43 $361.60 $361.60 $375.51 $263.96 $121.92 $359.09 $339.30 $585.00 $224.43 $212.06 $224.43 $585.00 $438.75 $224.43 $224.43 $224.43 $280.80 $280.80 $463.32 $224.43 $468.00 $585.00 $585.00 $224.43 $339.30 $585.00 $197.37 $224.43 $585.00 $224.43 N/A N/A 32000592 EAP CPT® 75956 ENDOVASC THOR AO REPR BOTH IP/OP "$2,118.00" "$1,567.50" $377.00 "$2,118.00" "$2,118.00" "$2,118.00" "$2,118.00" "$2,118.00" "$2,118.00" "$2,118.00" $377.00 "$2,118.00" "$2,118.00" "$1,571.98" "$1,571.98" "$1,632.55" "$1,103.48" $441.41 "$2,118.00" $847.20 "$2,118.00" "$2,118.00" "$2,118.00" "$2,118.00" "$2,118.00" "$1,588.50" "$2,118.00" "$2,118.00" "$2,118.00" "$1,016.64" "$1,016.64" "$1,677.46" "$2,118.00" "$1,694.40" "$2,118.00" "$2,118.00" "$2,118.00" "$1,228.44" "$2,118.00" "$2,118.00" "$2,118.00" "$2,118.00" "$2,118.00" N/A N/A 32000593 EAP CPT® 75957 ENDOVASC THOR AOR REPR BOTH IP/OP "$2,287.00" "$1,692.50" $407.09 "$2,287.00" "$2,287.00" "$2,287.00" "$2,287.00" "$2,287.00" "$2,287.00" "$2,287.00" $407.09 "$2,287.00" "$2,287.00" "$1,697.41" "$1,697.41" "$1,762.82" "$1,191.53" $476.64 "$2,287.00" $914.80 "$2,287.00" "$2,287.00" "$2,287.00" "$2,287.00" "$2,287.00" "$1,715.25" "$2,287.00" "$2,287.00" "$2,287.00" "$1,097.76" "$1,097.76" "$1,811.30" "$2,287.00" "$1,829.60" "$2,287.00" "$2,287.00" "$2,287.00" "$1,326.46" "$2,287.00" "$2,287.00" "$2,287.00" "$2,287.00" "$2,287.00" N/A N/A 32000594 EAP CPT® 75958 PLACE PROX EXT THOR AO BOTH IP/OP "$1,761.00" "$1,303.50" $313.46 "$1,761.00" "$1,761.00" "$1,761.00" "$1,761.00" "$1,761.00" "$1,761.00" "$1,761.00" $313.46 "$1,761.00" "$1,761.00" "$1,307.01" "$1,307.01" "$1,357.38" $917.48 $367.01 "$1,761.00" $494.00 "$1,761.00" "$1,761.00" "$1,235.00" "$1,761.00" "$1,761.00" "$1,320.75" "$1,761.00" "$1,761.00" "$1,761.00" $845.28 $845.28 "$1,394.71" "$1,761.00" "$1,408.80" "$1,761.00" "$1,761.00" "$1,761.00" "$1,021.38" "$1,761.00" "$1,761.00" "$1,761.00" "$1,761.00" "$1,761.00" N/A N/A 32000595 EAP CPT® 75959 PLACE DIST EXT THOR AO BOTH IP/OP "$1,693.00" "$1,253.00" $301.35 "$1,693.00" "$1,693.00" "$1,693.00" "$1,693.00" "$1,693.00" "$1,693.00" "$1,693.00" $301.35 "$1,693.00" "$1,693.00" "$1,256.54" "$1,256.54" "$1,304.96" $882.05 $352.84 "$1,693.00" $433.20 "$1,693.00" "$1,693.00" "$1,083.00" "$1,693.00" "$1,693.00" "$1,269.75" "$1,693.00" "$1,693.00" "$1,693.00" $812.64 $812.64 "$1,340.86" "$1,693.00" "$1,354.40" "$1,693.00" "$1,693.00" "$1,693.00" $981.94 "$1,693.00" "$1,693.00" "$1,693.00" "$1,693.00" "$1,693.00" N/A N/A 32000607 EAP CPT® 75984 X-RAY CONTROL CATHETER CHANGE BOTH IP/OP "$2,247.00" "$1,663.00" $59.87 "$2,247.00" "$2,247.00" "$2,247.00" "$2,247.00" "$2,247.00" $62.13 $62.13 $90.19 "$2,247.00" $62.13 $191.56 $191.56 $198.93 $139.84 $468.30 $99.41 $95.79 "$2,247.00" $62.13 $59.87 $62.13 "$2,247.00" "$1,685.25" $62.13 $62.13 $62.13 "$1,078.56" "$1,078.56" "$1,779.62" $62.13 "$1,797.60" "$2,247.00" "$2,247.00" $62.13 "$1,303.26" "$2,247.00" $64.83 $62.13 "$2,247.00" $62.13 N/A N/A 32000608 EAP CPT® 75989 US DRAIN PERCUT S&I BOTH IP/OP "$3,905.00" "$2,890.00" $58.85 "$3,905.00" "$3,905.00" "$3,905.00" "$3,905.00" "$3,905.00" $61.44 $61.44 $102.88 "$3,905.00" $61.44 $785.72 $785.72 $815.94 $573.57 $813.84 $98.30 $94.16 "$3,905.00" $61.44 $58.85 $61.44 "$3,905.00" "$2,928.75" $61.44 $61.44 $61.44 "$1,874.40" "$1,874.40" "$3,092.76" $61.44 "$3,124.00" "$3,905.00" "$3,905.00" $61.44 "$2,264.90" "$3,905.00" $63.75 $61.44 "$3,905.00" $61.44 N/A N/A 32000609 EAP CPT® 75989 ABSCESS DRAINAGE UNDER X-RAY BOTH IP/OP "$4,282.00" "$3,169.00" $58.85 "$4,282.00" "$4,282.00" "$4,282.00" "$4,282.00" "$4,282.00" $61.44 $61.44 $102.88 "$4,282.00" $61.44 $785.72 $785.72 $815.94 $573.57 $892.42 $98.30 $94.16 "$4,282.00" $61.44 $58.85 $61.44 "$4,282.00" "$3,211.50" $61.44 $61.44 $61.44 "$2,055.36" "$2,055.36" "$3,391.34" $61.44 "$3,425.60" "$4,282.00" "$4,282.00" $61.44 "$2,483.56" "$4,282.00" $63.75 $61.44 "$4,282.00" $61.44 N/A N/A 32000612 EAP CPT® 76000 FLUOROSCOPY <1 HR PHYS/QHP BOTH IP/OP "$1,426.00" "$1,055.50" $28.41 "$1,140.80" $102.73 $102.73 $102.73 $102.73 $226.34 $226.34 $225.34 $297.21 $226.34 $216.68 $216.68 $225.02 $158.18 $297.19 $362.15 $336.89 $843.48 $226.34 $28.41 $226.34 $237.66 "$1,069.50" $226.34 $226.34 $226.34 $684.48 $684.48 "$1,129.39" $226.34 "$1,140.80" $373.47 $283.03 $226.34 $827.08 $237.66 $327.46 $226.34 $297.18 $226.34 N/A N/A 32000619 EAP CPT® 76010 NOSE TO RECTUM FBODY CHILD RDG BOTH IP/OP $370.00 $274.00 $19.81 $370.00 $370.00 $370.00 $370.00 $370.00 $21.73 $21.73 $25.71 $370.00 $21.73 $45.96 $45.96 $47.73 $33.55 $77.11 $34.77 $34.64 $370.00 $21.73 $21.65 $21.73 $370.00 $277.50 $21.73 $21.73 $21.73 $177.60 $177.60 $293.04 $21.73 $296.00 $370.00 $370.00 $21.73 $214.60 $370.00 $19.81 $21.73 $370.00 $21.73 N/A N/A 32000621 EAP CPT® 76080 X-RAY EXAM FISTULA BOTH IP/OP $865.00 $640.50 $35.85 $784.25 $119.58 $119.58 $119.58 $119.58 $475.30 $475.30 $473.20 $180.29 $475.30 $88.90 $88.90 $92.32 $64.90 $180.28 $760.48 $725.84 $511.65 $475.30 $35.85 $475.30 $499.07 $648.75 $475.30 $475.30 $475.30 $415.20 $415.20 $685.08 $475.30 $692.00 $784.25 $171.68 $475.30 $501.70 $499.07 $687.64 $475.30 $180.27 $475.30 N/A N/A 32000624 EAP CPT® 76098 X-RAY EXAM SURGICAL SPECIMEN BOTH IP/OP "$1,550.00" "$1,147.00" $20.98 "$1,240.00" $36.04 $36.04 $36.04 $36.04 $475.30 $475.30 $473.20 $323.06 $475.30 $28.74 $28.74 $29.84 $20.98 $323.04 $760.48 $725.84 $916.83 $475.30 $27.40 $475.30 $499.07 "$1,162.50" $475.30 $475.30 $475.30 $744.00 $744.00 "$1,227.60" $475.30 "$1,240.00" $784.25 $307.64 $475.30 $899.00 $499.07 $687.64 $475.30 $323.02 $475.30 N/A N/A 32000625 EAP CPT® 76098 RAD EXAM SURGICAL SPECMEN CBC BOTH IP/OP "$1,409.00" "$1,043.00" $20.98 "$1,127.20" $36.04 $36.04 $36.04 $36.04 $475.30 $475.30 $473.20 $293.67 $475.30 $28.74 $28.74 $29.84 $20.98 $293.65 $760.48 $725.84 $833.42 $475.30 $27.40 $475.30 $499.07 "$1,056.75" $475.30 $475.30 $475.30 $676.32 $676.32 "$1,115.93" $475.30 "$1,127.20" $784.25 $279.65 $475.30 $817.22 $499.07 $687.64 $475.30 $293.64 $475.30 N/A N/A 32000733 EAP CPT® 77001 FLUORO GUIDE CV ACCESS DEV SPV BOTH IP/OP "$1,059.00" $784.00 $84.22 "$1,059.00" $182.43 $182.43 $182.43 $182.43 "$1,059.00" "$1,059.00" $88.98 $220.72 "$1,059.00" $211.68 $211.68 $219.82 $154.53 $220.71 "$1,059.00" "$1,059.00" $626.40 "$1,059.00" $84.22 "$1,059.00" "$1,059.00" $794.25 "$1,059.00" "$1,059.00" "$1,059.00" $508.32 $508.32 $838.73 "$1,059.00" $847.20 "$1,059.00" $210.19 "$1,059.00" $614.22 "$1,059.00" "$1,059.00" "$1,059.00" $220.70 "$1,059.00" N/A N/A 32000734 EAP CPT® 77002 FLUORO GUIDE NEEDLE PLACEMENT BOTH IP/OP $717.00 $531.00 $80.02 "$1,513.00" $201.60 $201.60 $201.60 $201.60 $717.00 $717.00 $717.00 $149.44 $717.00 $109.62 $109.62 $113.83 $80.02 $149.43 $717.00 "$1,513.00" $424.11 $717.00 $91.32 $717.00 $717.00 $537.75 $717.00 $717.00 $717.00 $344.16 $344.16 $567.86 $717.00 $573.60 $717.00 $142.31 $717.00 $415.86 $717.00 $717.00 $717.00 $149.42 $717.00 N/A N/A 32000738 EAP CPT® 77003 FLUOROSCOPY FOR SPINE PROCEDUR BOTH IP/OP $924.00 $684.00 $56.16 $924.00 $203.89 $203.89 $203.89 $203.89 $924.00 $924.00 $924.00 $192.58 $924.00 $76.94 $76.94 $79.90 $56.16 $192.57 $924.00 $863.00 $546.55 $924.00 $78.81 $924.00 $924.00 $693.00 $924.00 $924.00 $924.00 $443.52 $443.52 $731.81 $924.00 $739.20 $924.00 $183.39 $924.00 $535.92 $924.00 $924.00 $924.00 $192.56 $924.00 N/A N/A 32000739 EAP CPT® 77003 FLUOROGUIDE FOR SPINE INJECT BOTH IP/OP $924.00 $684.00 $56.16 $924.00 $203.89 $203.89 $203.89 $203.89 $924.00 $924.00 $924.00 $192.58 $924.00 $76.94 $76.94 $79.90 $56.16 $192.57 $924.00 $863.00 $546.55 $924.00 $78.81 $924.00 $924.00 $693.00 $924.00 $924.00 $924.00 $443.52 $443.52 $731.81 $924.00 $739.20 $924.00 $183.39 $924.00 $535.92 $924.00 $924.00 $924.00 $192.56 $924.00 N/A N/A 32000751 EAP CPT® 77053 GALACTOGRAM SINGLE DUCT BIC BOTH IP/OP "$1,073.00" $794.50 $36.87 "$1,073.00" "$1,073.00" "$1,073.00" "$1,073.00" "$1,073.00" $37.27 $37.27 $47.89 "$1,073.00" $37.27 $144.79 $144.79 $150.36 $105.69 $223.63 $59.63 $58.99 "$1,073.00" $37.27 $36.87 $37.27 "$1,073.00" $804.75 $37.27 $37.27 $37.27 $515.04 $515.04 $849.82 $37.27 $858.40 "$1,073.00" "$1,073.00" $37.27 $622.34 "$1,073.00" $39.26 $37.27 "$1,073.00" $37.27 N/A N/A 32000752 EAP CPT® 77054 GALACTOGRAM MULTI DUCT BIC BOTH IP/OP "$1,248.00" $924.00 $48.71 "$1,248.00" "$1,248.00" "$1,248.00" "$1,248.00" "$1,248.00" $49.01 $49.01 $62.10 "$1,248.00" $49.01 $199.37 $199.37 $207.04 $145.54 $260.10 $78.42 $77.94 "$1,248.00" $49.01 $48.71 $49.01 "$1,248.00" $936.00 $49.01 $49.01 $49.01 $599.04 $599.04 $988.42 $49.01 $998.40 "$1,248.00" "$1,248.00" $49.01 $723.84 "$1,248.00" $51.50 $49.01 "$1,248.00" $49.01 N/A N/A 32000764 EAP CPT® 77072 BONE AGE STUDIES X-RAY RDG BOTH IP/OP $510.00 $377.50 $17.25 $408.00 $49.82 $49.82 $49.82 $49.82 $107.09 $107.09 $106.62 $106.30 $107.09 $34.16 $34.16 $35.48 $24.94 $106.29 $171.35 $154.19 $301.67 $107.09 $17.25 $107.09 $112.45 $382.50 $107.09 $107.09 $107.09 $244.80 $244.80 $403.92 $107.09 $408.00 $176.70 $101.22 $107.09 $295.80 $112.45 $154.94 $107.09 $106.28 $107.09 N/A N/A 32000766 EAP CPT® 77073 BONE LENGTH STUDIES RDG BOTH IP/OP $629.00 $465.50 $32.47 $503.20 $77.43 $77.43 $77.43 $77.43 $107.09 $107.09 $106.62 $131.10 $107.09 $59.12 $59.12 $61.40 $43.16 $131.09 $171.35 $154.19 $372.05 $107.09 $32.47 $107.09 $112.45 $471.75 $107.09 $107.09 $107.09 $301.92 $301.92 $498.17 $107.09 $503.20 $176.70 $124.84 $107.09 $364.82 $112.45 $154.94 $107.09 $131.08 $107.09 N/A N/A 32000768 EAP CPT® 77074 BONE SURVEY OSSEOUS LIMIT RDG BOTH IP/OP $430.00 $318.50 $41.42 $430.00 $430.00 $430.00 $430.00 $430.00 $45.90 $45.90 $56.18 $430.00 $45.90 $113.40 $113.40 $117.76 $82.78 $89.62 $73.44 $71.98 $430.00 $45.90 $44.99 $45.90 $430.00 $322.50 $45.90 $45.90 $45.90 $206.40 $206.40 $340.56 $45.90 $344.00 $430.00 $430.00 $45.90 $249.40 $430.00 $41.42 $45.90 $430.00 $45.90 N/A N/A 32000770 EAP CPT® 77075 BONE SURVEY OSSEOUS COMPL RDG BOTH IP/OP $453.00 $335.50 $74.75 $362.40 $188.55 $188.55 $188.55 $188.55 $107.09 $107.09 $106.62 $94.42 $107.09 $179.33 $179.33 $186.22 $130.91 $94.41 $171.35 $154.19 $267.95 $107.09 $74.75 $107.09 $112.45 $339.75 $107.09 $107.09 $107.09 $217.44 $217.44 $358.78 $107.09 $362.40 $176.70 $89.91 $107.09 $262.74 $112.45 $154.94 $107.09 $94.41 $107.09 N/A N/A 32000772 EAP CPT® 77076 BONE SURVEY OSSEOUS INFANT RDG BOTH IP/OP $290.00 $215.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $76.29 $76.29 $91.96 $290.00 $76.29 $145.33 $145.33 $150.92 $106.09 $60.44 $122.06 $120.69 $290.00 $76.29 $75.43 $76.29 $290.00 $217.50 $76.29 $76.29 $76.29 $139.20 $139.20 $229.68 $76.29 $232.00 $290.00 $290.00 $76.29 $168.20 $290.00 $68.79 $76.29 $290.00 $76.29 N/A N/A 32000773 EAP CPT® 77080 BONE DENSITY SCAN AXIAL BOTH IP/OP $866.00 $641.00 $29.09 $692.80 $88.90 $88.90 $88.90 $88.90 $107.09 $107.09 $106.62 $180.50 $107.09 $152.48 $152.48 $158.35 $111.31 $180.48 $171.35 $154.19 $512.24 $107.09 $29.09 $107.09 $112.45 $649.50 $107.09 $107.09 $107.09 $415.68 $415.68 $685.87 $107.09 $692.80 $176.70 $171.88 $107.09 $502.28 $112.45 $154.94 $107.09 $180.47 $107.09 N/A N/A 32000774 EAP CPT® 77081 BONE DENSISTY SCAN PERIPH NUC BOTH IP/OP $162.00 $120.00 $21.99 $131.28 $60.57 $60.57 $60.57 $60.57 $79.57 $79.57 $79.21 $33.76 $79.57 $48.21 $48.21 $50.07 $35.20 $33.76 $127.31 $125.33 $95.82 $79.57 $21.99 $79.57 $83.54 $121.50 $79.57 $79.57 $79.57 $77.76 $77.76 $128.30 $79.57 $129.60 $131.28 $32.15 $79.57 $93.96 $83.54 $115.11 $79.57 $33.76 $79.57 N/A N/A 32000784 EAP CPT® 75860 SINUS/JUGULAR VENOGRAM NIR BOTH IP/OP "$3,145.00" "$2,327.50" $74.08 "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" $75.26 $75.26 $115.52 "$3,145.00" $75.26 $524.20 $524.20 $544.36 $382.66 $655.45 $120.42 $118.53 "$3,145.00" $75.26 $74.08 $75.26 "$3,145.00" "$2,358.75" $75.26 $75.26 $75.26 "$1,509.60" "$1,509.60" "$2,490.84" $75.26 "$2,516.00" "$3,145.00" "$3,145.00" $75.26 "$1,824.10" "$3,145.00" $82.84 $75.26 "$3,145.00" $75.26 N/A N/A 32000785 EAP CPT® 75870 SUPER SAGG SINUS VENOGRAM NIR BOTH IP/OP "$2,716.00" "$2,010.00" $99.78 "$2,716.00" "$2,716.00" "$2,716.00" "$2,716.00" "$2,716.00" $106.00 $106.00 $149.26 "$2,716.00" $106.00 $522.39 $522.39 $542.48 $381.34 $566.04 $169.60 $159.65 "$2,716.00" $106.00 $99.78 $106.00 "$2,716.00" "$2,037.00" $106.00 $106.00 $106.00 "$1,303.68" "$1,303.68" "$2,151.07" $106.00 "$2,172.80" "$2,716.00" "$2,716.00" $106.00 "$1,575.28" "$2,716.00" $121.02 $106.00 "$2,716.00" $106.00 N/A N/A 32000786 EAP CPT® 75872 EPIDURAL VENOGRAM NIR BOTH IP/OP "$1,855.00" "$1,373.00" $76.44 "$1,855.00" "$1,855.00" "$1,855.00" "$1,855.00" "$1,855.00" $77.33 $77.33 $117.12 "$1,855.00" $77.33 $574.13 $574.13 $596.21 $419.11 $386.60 $123.73 $122.30 "$1,855.00" $77.33 $76.44 $77.33 "$1,855.00" "$1,391.25" $77.33 $77.33 $77.33 $890.40 $890.40 "$1,469.16" $77.33 "$1,484.00" "$1,855.00" "$1,855.00" $77.33 "$1,075.90" "$1,855.00" $84.64 $77.33 "$1,855.00" $77.33 N/A N/A 32000787 EAP CPT® 75894 TRANSCATH EMBOLIZATION NIR BOTH IP/OP "$10,671.00" "$7,897.00" "$1,899.44" "$12,035.00" "$10,671.00" "$10,671.00" "$10,671.00" "$10,671.00" "$10,671.00" "$10,671.00" "$1,899.44" "$10,671.00" "$10,671.00" "$2,635.61" "$2,635.61" "$2,736.98" "$1,923.97" "$2,223.95" "$10,671.00" "$4,814.00" "$10,671.00" "$10,671.00" "$12,035.00" "$10,671.00" "$10,671.00" "$8,003.25" "$10,671.00" "$10,671.00" "$10,671.00" "$5,122.08" "$5,122.08" "$8,451.43" "$10,671.00" "$8,536.80" "$10,671.00" "$10,671.00" "$10,671.00" "$6,189.18" "$10,671.00" "$10,671.00" "$10,671.00" "$10,671.00" "$10,671.00" N/A N/A 32000796 EAP CPT® 74263 "CT COLONOGRAPHY, SCREEN" BOTH IP/OP "$1,621.00" "$1,200.00" $337.83 "$1,621.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,621.00" "$1,621.00" $656.92 "$1,621.00" "$1,621.00" "$1,621.00" "$1,621.00" "$1,621.00" "$1,621.00" $337.83 "$1,621.00" $520.80 "$1,106.00" "$1,621.00" "$1,302.00" "$1,621.00" "$1,621.00" "$1,215.75" "$1,621.00" "$1,621.00" "$1,621.00" $778.08 $778.08 "$1,283.83" "$1,621.00" "$1,296.80" $540.00 "$1,621.00" "$1,621.00" $940.18 "$1,621.00" $972.60 "$1,621.00" "$1,621.00" "$1,621.00" N/A N/A 32000797 EAP CPT® 74261 "CT COLONOGRAPHY, W/O DYE" BOTH IP/OP "$1,621.00" "$1,200.00" $326.72 "$1,621.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $340.47 $340.47 $407.67 "$1,621.00" $340.47 "$1,621.00" "$1,621.00" "$1,621.00" "$1,621.00" $337.83 $544.75 $522.75 "$1,106.00" $340.47 $326.72 $340.47 "$1,621.00" "$1,215.75" $340.47 $340.47 $340.47 $778.08 $778.08 "$1,283.83" $340.47 "$1,296.80" $540.00 "$1,621.00" $340.47 $940.18 "$1,621.00" $361.61 $340.47 "$1,621.00" $340.47 N/A N/A 32000798 EAP CPT® 74262 "CT COLONOGRAPHY, W/DYE" BOTH IP/OP "$1,621.00" "$1,200.00" $337.83 "$1,621.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $395.32 $395.32 $459.47 "$1,621.00" $395.32 "$1,621.00" "$1,621.00" "$1,621.00" "$1,621.00" $337.83 $632.51 $604.46 "$1,106.00" $395.32 $377.79 $395.32 "$1,621.00" "$1,215.75" $395.32 $395.32 $395.32 $778.08 $778.08 "$1,283.83" $395.32 "$1,296.80" $540.00 "$1,621.00" $395.32 $940.18 "$1,621.00" $416.72 $395.32 "$1,621.00" $395.32 N/A N/A 32000801 EAP CPT® 72072 THROACIC SPINE 4 VIEW RDG BOTH IP/OP "$1,196.00" $885.50 $27.01 "$1,196.00" "$1,196.00" "$1,196.00" "$1,196.00" "$1,196.00" $29.32 $29.32 $33.70 "$1,196.00" $29.32 $67.28 $67.28 $69.87 $49.11 $249.26 $46.91 $46.54 "$1,196.00" $29.32 $29.09 $29.32 "$1,196.00" $897.00 $29.32 $29.32 $29.32 $574.08 $574.08 $947.23 $29.32 $956.80 "$1,196.00" "$1,196.00" $29.32 $693.68 "$1,196.00" $27.01 $29.32 "$1,196.00" $29.32 N/A N/A 32000802 EAP CPT® 77071 MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS BOTH IP/OP $433.00 $320.50 $55.53 $346.40 $105.04 $105.04 $105.04 $105.04 $79.57 $79.57 $79.21 $90.25 $79.57 $321.37 $321.37 $333.76 $225.59 $90.24 $127.31 $125.33 $256.12 $79.57 $55.53 $79.57 $83.54 $324.75 $79.57 $79.57 $79.57 $207.84 $207.84 $342.94 $79.57 $346.40 $131.28 $85.94 $79.57 $251.14 $83.54 $115.11 $79.57 $90.24 $79.57 N/A N/A 32000810 EAP CPT® 74190 "PERITONEOGRAM, RADIOLOGICAL SUPERVISION AND INTERPRETATION" BOTH IP/OP $911.00 $674.50 $104.24 $911.00 $911.00 $911.00 $911.00 $911.00 $911.00 $911.00 $162.16 $911.00 $911.00 $142.79 $142.79 $148.28 $104.24 $189.86 $911.00 $364.40 $911.00 $911.00 $911.00 $911.00 $911.00 $683.25 $911.00 $911.00 $911.00 $437.28 $437.28 $721.51 $911.00 $728.80 $911.00 $911.00 $911.00 $528.38 $911.00 $911.00 $911.00 $911.00 $911.00 N/A N/A 32000812 EAP CPT® 74450 "URETHROCYSTOGRAPHY, RETROGRADE, RADIOLOGICAL SUPERVISION" BOTH IP/OP "$2,150.00" "$1,591.00" $116.31 "$1,720.00" $492.86 $492.86 $492.86 $492.86 $226.34 $226.34 $225.34 $448.11 $226.34 $159.33 $159.33 $165.46 $116.31 $448.08 $362.15 $336.89 "$1,271.73" $226.34 $915.00 $226.34 $237.66 "$1,612.50" $226.34 $226.34 $226.34 "$1,032.00" "$1,032.00" "$1,702.80" $226.34 "$1,720.00" $373.47 $426.72 $226.34 "$1,247.00" $237.66 $327.46 $226.34 $448.06 $226.34 N/A N/A 32000813 EAP CPT® 74455 X-RAY URETHRA/BLADDER VOIDING BOTH IP/OP "$2,191.00" "$1,621.50" $90.98 "$1,752.80" $177.06 $177.06 $177.06 $177.06 $226.34 $226.34 $225.34 $456.66 $226.34 $181.73 $181.73 $188.72 $132.66 $456.63 $362.15 $336.89 "$1,295.98" $226.34 $90.98 $226.34 $237.66 "$1,643.25" $226.34 $226.34 $226.34 "$1,051.68" "$1,051.68" "$1,735.27" $226.34 "$1,752.80" $373.47 $434.86 $226.34 "$1,270.78" $237.66 $327.46 $226.34 $456.60 $226.34 N/A N/A 32000814 EAP CPT® 74470 "RADIOLOGIC EXAMINATION, RENAL CYST STUDY" BOTH IP/OP $927.00 $686.00 $99.67 $927.00 $927.00 $927.00 $927.00 $927.00 $927.00 $927.00 $165.01 $927.00 $927.00 $136.54 $136.54 $141.79 $99.67 $193.20 $927.00 $370.80 $927.00 $927.00 $927.00 $927.00 $927.00 $695.25 $927.00 $927.00 $927.00 $444.96 $444.96 $734.18 $927.00 $741.60 $927.00 $927.00 $927.00 $537.66 $927.00 $927.00 $927.00 $927.00 $927.00 N/A N/A 32000815 EAP CPT® 75733 "ADRENAL, BILATERAL" BOTH IP/OP "$4,426.00" "$3,275.50" $110.28 "$4,426.00" "$4,426.00" "$4,426.00" "$4,426.00" "$4,426.00" $110.39 $110.39 $149.63 "$4,426.00" $110.39 $647.63 $647.63 $672.54 $472.76 $922.43 $176.62 $176.45 "$4,426.00" $110.39 $110.28 $110.39 "$4,426.00" "$3,319.50" $110.39 $110.39 $110.39 "$2,124.48" "$2,124.48" "$3,505.39" $110.39 "$3,540.80" "$4,426.00" "$4,426.00" $110.39 "$2,567.08" "$4,426.00" $113.81 $110.39 "$4,426.00" $110.39 N/A N/A 32000820 EAP CPT® 75809 SHUNTOGRAM FOR INVESTIGATION BOTH IP/OP $862.00 $638.00 $60.20 $689.60 $213.85 $213.85 $213.85 $213.85 $107.09 $107.09 $106.62 $179.66 $107.09 $156.21 $156.21 $162.22 $114.03 $179.65 $171.35 $154.19 $509.87 $107.09 $60.20 $107.09 $112.45 $646.50 $107.09 $107.09 $107.09 $413.76 $413.76 $682.70 $107.09 $689.60 $176.70 $171.09 $107.09 $499.96 $112.45 $154.94 $107.09 $179.64 $107.09 N/A N/A 32000821 EAP CPT® 75902 MECHANICAL REMOVAL OF INTRALUMINAL (INTRACATHETER) FROME BOTH IP/OP "$1,027.00" $760.00 $66.99 "$1,027.00" "$1,027.00" "$1,027.00" "$1,027.00" "$1,027.00" $78.02 $78.02 $79.80 "$1,027.00" $78.02 $192.80 $192.80 $200.21 $140.74 $214.04 $124.83 $117.42 "$1,027.00" $78.02 $73.39 $78.02 "$1,027.00" $770.25 $78.02 $78.02 $78.02 $492.96 $492.96 $813.38 $78.02 $821.60 "$1,027.00" "$1,027.00" $78.02 $595.66 "$1,027.00" $66.99 $78.02 "$1,027.00" $78.02 N/A N/A 32000822 EAP CPT® 75970 "TRANSCATHETER BIOPSY, RADIOLOGICAL SUPERVISION AND INTERPRETATION" BOTH IP/OP "$3,027.00" "$2,240.00" $600.78 "$3,027.00" $971.75 $971.75 $971.75 $971.75 "$3,027.00" "$3,027.00" "$3,027.00" $630.90 "$3,027.00" "$1,259.39" "$1,259.39" "$1,307.83" $919.34 $630.86 "$3,027.00" "$3,027.00" "$1,790.47" "$3,027.00" "$3,027.00" "$3,027.00" "$3,027.00" "$2,270.25" "$3,027.00" "$3,027.00" "$3,027.00" "$1,452.96" "$1,452.96" "$2,397.38" "$3,027.00" "$2,421.60" "$3,027.00" $600.78 "$3,027.00" "$1,755.66" "$3,027.00" "$3,027.00" "$3,027.00" $630.83 "$3,027.00" N/A N/A 32000823 EAP CPT® 75984 CHANGE OF PERCUTANEOUS TUBE OR DRAINAGE CATHETER WITH CONTRAST BOTH IP/OP "$2,247.00" "$1,663.00" $59.87 "$2,247.00" "$2,247.00" "$2,247.00" "$2,247.00" "$2,247.00" $62.13 $62.13 $90.19 "$2,247.00" $62.13 $191.56 $191.56 $198.93 $139.84 $468.30 $99.41 $95.79 "$2,247.00" $62.13 $59.87 $62.13 "$2,247.00" "$1,685.25" $62.13 $62.13 $62.13 "$1,078.56" "$1,078.56" "$1,779.62" $62.13 "$1,797.60" "$2,247.00" "$2,247.00" $62.13 "$1,303.26" "$2,247.00" $64.83 $62.13 "$2,247.00" $62.13 N/A N/A 32000824 EAP CPT® 75989 RADIOLOGICAL GUIDANCE FOR PERCUTANEOUS DRAINAGE BOTH IP/OP "$4,282.00" "$3,169.00" $58.85 "$4,282.00" "$4,282.00" "$4,282.00" "$4,282.00" "$4,282.00" $61.44 $61.44 $102.88 "$4,282.00" $61.44 $785.72 $785.72 $815.94 $573.57 $892.42 $98.30 $94.16 "$4,282.00" $61.44 $58.85 $61.44 "$4,282.00" "$3,211.50" $61.44 $61.44 $61.44 "$2,055.36" "$2,055.36" "$3,391.34" $61.44 "$3,425.60" "$4,282.00" "$4,282.00" $61.44 "$2,483.56" "$4,282.00" $63.75 $61.44 "$4,282.00" $61.44 N/A N/A 32000825 EAP CPT® 76080 "ABSCESS, FISTULA, SINUS TRACT STUDY" BOTH IP/OP $865.00 $640.50 $35.85 $784.25 $119.58 $119.58 $119.58 $119.58 $475.30 $475.30 $473.20 $180.29 $475.30 $88.90 $88.90 $92.32 $64.90 $180.28 $760.48 $725.84 $511.65 $475.30 $35.85 $475.30 $499.07 $648.75 $475.30 $475.30 $475.30 $415.20 $415.20 $685.08 $475.30 $692.00 $784.25 $171.68 $475.30 $501.70 $499.07 $687.64 $475.30 $180.27 $475.30 N/A N/A 32000826 EAP CPT® 76940 US GUIDE TISSUE ABLATION BOTH IP/OP "$1,128.00" $835.00 $135.01 "$1,443.00" "$1,128.00" "$1,128.00" "$1,128.00" "$1,128.00" "$1,128.00" "$1,128.00" $200.78 "$1,128.00" "$1,128.00" $184.95 $184.95 $192.07 $135.01 $235.09 "$1,128.00" $577.20 "$1,128.00" "$1,128.00" "$1,443.00" "$1,128.00" "$1,128.00" $846.00 "$1,128.00" "$1,128.00" "$1,128.00" $541.44 $541.44 $893.38 "$1,128.00" $902.40 "$1,128.00" "$1,128.00" "$1,128.00" $654.24 "$1,128.00" "$1,128.00" "$1,128.00" "$1,128.00" "$1,128.00" N/A N/A 32000828 EAP CPT® 0075T "INTRAVASCULAR STENT, PERC, INITIAL VESSEL" BOTH IP/OP "$14,320.00" "$10,597.00" "$1,248.19" "$14,320.00" "$14,320.00" "$14,320.00" "$14,320.00" "$14,320.00" "$14,320.00" "$14,320.00" "$1,248.19" "$14,320.00" "$14,320.00" "$14,320.00" "$14,320.00" "$14,320.00" "$14,320.00" "$2,984.45" "$14,320.00" "$5,728.00" "$14,320.00" "$14,320.00" "$14,320.00" "$14,320.00" "$14,320.00" "$10,740.00" "$14,320.00" "$14,320.00" "$14,320.00" "$7,160.00" "$7,160.00" "$11,341.44" "$14,320.00" "$11,456.00" "$9,308.00" "$14,320.00" "$14,320.00" "$8,305.60" "$14,320.00" "$8,592.00" "$14,320.00" "$14,320.00" "$14,320.00" N/A N/A 32000829 EAP CPT® 0076T "INTRAVASCULAR STENT, PERC, EA ADD'L VESSEL" BOTH IP/OP "$11,316.00" "$8,374.00" $624.11 "$11,316.00" "$11,316.00" "$11,316.00" "$11,316.00" "$11,316.00" "$11,316.00" "$11,316.00" $624.11 "$11,316.00" "$11,316.00" "$11,316.00" "$11,316.00" "$11,316.00" "$11,316.00" "$2,358.38" "$11,316.00" "$4,526.40" "$11,316.00" "$11,316.00" "$11,316.00" "$11,316.00" "$11,316.00" "$8,487.00" "$11,316.00" "$11,316.00" "$11,316.00" "$5,658.00" "$5,658.00" "$8,962.27" "$11,316.00" "$9,052.80" "$11,316.00" "$11,316.00" "$11,316.00" "$6,563.28" "$11,316.00" "$6,789.60" "$11,316.00" "$11,316.00" "$11,316.00" N/A N/A 32000840 EAP CPT® 76496 FLUROSCOPY PROCEDURE BOTH IP/OP $528.00 $391.00 $30.38 $528.00 $528.00 $528.00 $528.00 $528.00 $528.00 $528.00 $30.38 $528.00 $528.00 $210.43 $210.43 $218.53 $153.61 $110.04 $528.00 $189.20 $528.00 $528.00 $473.00 $528.00 $528.00 $396.00 $528.00 $528.00 $528.00 $253.44 $253.44 $418.18 $528.00 $422.40 $528.00 $528.00 $528.00 $306.24 $528.00 $316.80 $528.00 $528.00 $528.00 N/A N/A 32000843 EAP CPT® 49422 REMOVAL OF TUNNELED INTRAPERITONEAL CATHETER BOTH IP/OP "$3,643.00" "$2,696.00" $222.34 "$3,643.00" "$3,643.00" "$3,643.00" "$3,643.00" "$3,643.00" $224.13 $224.13 $224.69 "$3,643.00" $224.13 "$3,643.00" "$3,643.00" "$3,643.00" "$3,643.00" $759.24 $358.61 $355.74 "$3,643.00" $224.13 $222.34 $224.13 "$3,643.00" "$2,732.25" $224.13 $224.13 $224.13 "$2,762.00" "$1,821.50" "$2,885.26" $224.13 "$2,914.40" "$3,250.00" "$3,643.00" $224.13 "$2,112.94" "$3,643.00" $232.90 $224.13 "$3,643.00" $224.13 N/A N/A 32000853 EAP CPT® 72082 XR T-L SPINE 2 OR 3 VIEWS BOTH IP/OP $645.00 $477.50 $51.86 $645.00 $645.00 $645.00 $645.00 $645.00 $56.95 $56.95 $60.35 $645.00 $56.95 $115.22 $115.22 $119.65 $84.11 $134.43 $91.12 $89.84 $645.00 $56.95 $56.15 $56.95 $645.00 $483.75 $56.95 $56.95 $56.95 $309.60 $309.60 $510.84 $56.95 $516.00 $645.00 $645.00 $56.95 $374.10 $645.00 $51.86 $56.95 $645.00 $56.95 N/A N/A 32000854 EAP CPT® 72081 XR T-L SPINE INCL SKULL 1 VIEW BOTH IP/OP $424.00 $314.00 $30.78 $339.20 $84.34 $84.34 $84.34 $84.34 $79.57 $79.57 $79.21 $88.37 $79.57 $63.38 $63.38 $65.82 $46.27 $88.37 $127.31 $125.33 $250.80 $79.57 $30.78 $79.57 $83.54 $318.00 $79.57 $79.57 $79.57 $203.52 $203.52 $335.81 $79.57 $339.20 $131.28 $84.15 $79.57 $245.92 $83.54 $115.11 $79.57 $88.36 $79.57 N/A N/A 32000855 EAP CPT® 72083 XR T-L SPINE 4 OR 5 VIEWS BOTH IP/OP "$1,228.00" $909.00 $60.87 "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" $63.52 $63.52 $68.34 "$1,228.00" $63.52 $125.05 $125.05 $129.86 $91.29 $255.93 $101.63 $100.66 "$1,228.00" $63.52 $62.91 $63.52 "$1,228.00" $921.00 $63.52 $63.52 $63.52 $589.44 $589.44 $972.58 $63.52 $982.40 "$1,228.00" "$1,228.00" $63.52 $712.24 "$1,228.00" $60.87 $63.52 "$1,228.00" $63.52 N/A N/A 32000856 EAP CPT® 72084 XR T-L SPINE INCL SKLL 6+ VIEW BOTH IP/OP "$1,228.00" $909.00 $73.11 "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" $81.13 $81.13 $84.30 "$1,228.00" $81.13 $150.07 $150.07 $155.84 $109.55 $255.93 $129.81 $128.80 "$1,228.00" $81.13 $80.50 $81.13 "$1,228.00" $921.00 $81.13 $81.13 $81.13 $589.44 $589.44 $972.58 $81.13 $982.40 "$1,228.00" "$1,228.00" $81.13 $712.24 "$1,228.00" $73.11 $81.13 "$1,228.00" $81.13 N/A N/A 32000857 EAP CPT® 73501 XR HIP UNILAT W/PELVIS 1 VIEW BOTH IP/OP $378.00 $280.00 $24.36 $302.40 $64.38 $64.38 $64.38 $64.38 $79.57 $79.57 $79.21 $78.78 $79.57 $50.89 $50.89 $52.84 $37.15 $78.78 $127.31 $125.33 $223.59 $79.57 $24.36 $79.57 $83.54 $283.50 $79.57 $79.57 $79.57 $181.44 $181.44 $299.38 $79.57 $302.40 $131.28 $75.02 $79.57 $219.24 $83.54 $115.11 $79.57 $78.78 $79.57 N/A N/A 32000858 EAP CPT® 73502 XR HIP UNILAT W/PELVIS 2-3 VW BOTH IP/OP $378.00 $280.00 $36.87 $302.40 $89.68 $89.68 $89.68 $89.68 $79.57 $79.57 $79.21 $78.78 $79.57 $75.00 $75.00 $77.89 $54.75 $78.78 $127.31 $125.33 $223.59 $79.57 $36.87 $79.57 $83.54 $283.50 $79.57 $79.57 $79.57 $181.44 $181.44 $299.38 $79.57 $302.40 $131.28 $75.02 $79.57 $219.24 $83.54 $115.11 $79.57 $78.78 $79.57 N/A N/A 32000859 EAP CPT® 73503 XR HIP UNILAT W/PELVIS 4+ VW BOTH IP/OP $627.00 $464.00 $47.02 $501.60 $111.92 $111.92 $111.92 $111.92 $107.09 $107.09 $106.62 $130.68 $107.09 $92.89 $92.89 $96.47 $67.81 $130.67 $171.35 $154.19 $370.87 $107.09 $47.02 $107.09 $112.45 $470.25 $107.09 $107.09 $107.09 $300.96 $300.96 $496.58 $107.09 $501.60 $176.70 $124.44 $107.09 $363.66 $112.45 $154.94 $107.09 $130.67 $107.09 N/A N/A 32000860 EAP CPT® 73521 XR HIP BILAT W/PELVIS 2 VIEWS BOTH IP/OP $627.00 $464.00 $31.12 $501.60 $85.84 $85.84 $85.84 $85.84 $107.09 $107.09 $106.62 $130.68 $107.09 $70.54 $70.54 $73.26 $51.50 $130.67 $171.35 $154.19 $370.87 $107.09 $31.12 $107.09 $112.45 $470.25 $107.09 $107.09 $107.09 $300.96 $300.96 $496.58 $107.09 $501.60 $176.70 $124.44 $107.09 $363.66 $112.45 $154.94 $107.09 $130.67 $107.09 N/A N/A 32000861 EAP CPT® 73522 XR HIP BILAT W/PELVIS 3-4 VIEW BOTH IP/OP $627.00 $464.00 $40.25 $501.60 $105.77 $105.77 $105.77 $105.77 $107.09 $107.09 $106.62 $130.68 $107.09 $83.92 $83.92 $87.15 $61.26 $130.67 $171.35 $154.19 $370.87 $107.09 $40.25 $107.09 $112.45 $470.25 $107.09 $107.09 $107.09 $300.96 $300.96 $496.58 $107.09 $501.60 $176.70 $124.44 $107.09 $363.66 $112.45 $154.94 $107.09 $130.67 $107.09 N/A N/A 32000862 EAP CPT® 73523 XR HIP BILAT W/PELVIS 5+ VIEWS BOTH IP/OP "$1,194.00" $884.00 $47.69 $955.20 $122.64 $122.64 $122.64 $122.64 $107.09 $107.09 $106.62 $248.86 $107.09 $100.92 $100.92 $104.80 $73.67 $248.84 $171.35 $154.19 $706.25 $107.09 $47.69 $107.09 $112.45 $895.50 $107.09 $107.09 $107.09 $573.12 $573.12 $945.65 $107.09 $955.20 $176.70 $236.98 $107.09 $692.52 $112.45 $154.94 $107.09 $248.83 $107.09 N/A N/A 32000863 EAP CPT® 73551 XR FEMUR 1 VIEW BOTH IP/OP $361.00 $267.50 $21.65 $288.80 $60.57 $60.57 $60.57 $60.57 $79.57 $79.57 $79.21 $75.24 $79.57 $48.20 $48.20 $50.06 $35.19 $75.24 $127.31 $125.33 $213.53 $79.57 $21.65 $79.57 $83.54 $270.75 $79.57 $79.57 $79.57 $173.28 $173.28 $285.91 $79.57 $288.80 $131.28 $71.65 $79.57 $209.38 $83.54 $115.11 $79.57 $75.23 $79.57 N/A N/A 32000864 EAP CPT® 73552 XR FEMUR MIN 2 VIEWS BOTH IP/OP $361.00 $267.50 $27.40 $288.80 $70.53 $70.53 $70.53 $70.53 $79.57 $79.57 $79.21 $75.24 $79.57 $57.14 $57.14 $59.34 $41.71 $75.24 $127.31 $125.33 $213.53 $79.57 $27.40 $79.57 $83.54 $270.75 $79.57 $79.57 $79.57 $173.28 $173.28 $285.91 $79.57 $288.80 $131.28 $71.65 $79.57 $209.38 $83.54 $115.11 $79.57 $75.23 $79.57 N/A N/A 32000865 EAP CPT® 76499 RADIOGRAPHIC PROCEDURE BOTH IP/OP $150.00 $111.00 $29.77 "$1,120.00" $150.00 $150.00 $150.00 $150.00 $79.57 $79.57 $79.21 $31.26 $79.57 $111.33 $111.33 $115.62 $78.15 $31.26 $127.31 $125.33 $88.73 $79.57 "$1,120.00" $79.57 $83.54 $112.50 $79.57 $79.57 $79.57 $72.00 $72.00 $118.80 $79.57 $120.00 $131.28 $29.77 $79.57 $87.00 $83.54 $115.11 $79.57 $31.26 $79.57 N/A N/A 32000866 EAP CPT® 77077 JOINT SURVEY SINGLE VIEW BOTH IP/OP $275.00 $203.50 $28.81 $275.00 $275.00 $275.00 $275.00 $275.00 $31.40 $31.40 $40.49 $275.00 $31.40 $66.21 $66.21 $68.75 $48.33 $57.31 $50.24 $49.79 $275.00 $31.40 $31.12 $31.40 $275.00 $206.25 $31.40 $31.40 $31.40 $132.00 $132.00 $217.80 $31.40 $220.00 $275.00 $275.00 $31.40 $159.50 $275.00 $28.81 $31.40 $275.00 $31.40 N/A N/A 32000868 EAP CPT® 75807 LYMPH VESSEL X-RAY TRUNK BOTH IP/OP "$3,673.00" "$2,718.50" $456.12 "$3,673.00" "$3,673.00" "$3,673.00" "$3,673.00" "$3,673.00" "$3,673.00" "$3,673.00" $653.79 "$3,673.00" "$3,673.00" $624.83 $624.83 $648.86 $456.12 $765.49 "$3,673.00" "$1,469.20" "$3,673.00" "$3,673.00" "$3,673.00" "$3,673.00" "$3,673.00" "$2,754.75" "$3,673.00" "$3,673.00" "$3,673.00" "$1,763.04" "$1,763.04" "$2,909.02" "$3,673.00" "$2,938.40" "$3,673.00" "$3,673.00" "$3,673.00" "$2,130.34" "$3,673.00" "$3,673.00" "$3,673.00" "$3,673.00" "$3,673.00" N/A N/A 32000869 EAP CPT® 74248 XR SMALL BOWEL FOLLOW-THROUGH ADD ON BOTH IP/OP "$2,246.00" "$1,662.50" $47.90 "$2,246.00" $178.34 $178.34 $178.34 $178.34 "$2,246.00" "$2,246.00" "$2,246.00" $468.12 "$2,246.00" $110.26 $110.26 $114.50 $80.49 $468.09 "$2,246.00" "$1,656.00" "$1,328.51" "$2,246.00" $51.41 "$2,246.00" "$2,246.00" "$1,684.50" "$2,246.00" "$2,246.00" "$2,246.00" "$1,078.08" "$1,078.08" "$1,778.83" "$2,246.00" "$1,796.80" "$2,246.00" $445.77 "$2,246.00" "$1,302.68" "$2,246.00" $47.90 "$2,246.00" $468.07 "$2,246.00" N/A N/A 32000875 EAP CPT® 73552 "BILATERAL X-RAY OF FEMUR, MINIMUM 2 VIEWS" BOTH IP/OP $542.00 $401.50 $27.40 $433.60 $70.53 $70.53 $70.53 $70.53 $79.57 $79.57 $79.21 $112.97 $79.57 $57.14 $57.14 $59.34 $41.71 $112.96 $127.31 $125.33 $320.59 $79.57 $27.40 $79.57 $83.54 $406.50 $79.57 $79.57 $79.57 $260.16 $260.16 $429.26 $79.57 $433.60 $131.28 $107.57 $79.57 $314.36 $83.54 $115.11 $79.57 $112.95 $79.57 N/A N/A 32200006 EAP CPT® 73040 SHOULDER ARTHROGRAPHY RDG BOTH IP/OP "$1,216.00" $900.00 $106.88 $972.80 $216.14 $216.14 $216.14 $216.14 $362.23 $362.23 $360.63 $253.44 $362.23 $902.52 $902.52 $937.29 $633.54 $253.43 $579.58 $531.51 $719.26 $362.23 $106.88 $362.23 $380.35 $912.00 $362.23 $362.23 $362.23 $583.68 $583.68 $963.07 $362.23 $972.80 $597.69 $241.35 $362.23 $705.28 $380.35 $524.06 $362.23 $253.41 $362.23 N/A N/A 32300001 EAP CPT® 75605 THORACIC ARCH ANGIO SPN BOTH IP/OP "$5,612.00" "$4,153.00" $69.00 "$7,739.87" $298.97 $298.97 $298.97 $298.97 "$4,690.83" "$4,690.83" "$4,670.08" "$1,169.68" "$4,690.83" "$4,165.23" "$4,165.23" "$4,325.73" "$2,060.15" "$1,169.60" "$7,505.33" "$7,414.92" "$3,319.50" "$4,690.83" $69.00 "$4,690.83" "$4,925.37" "$4,209.00" "$4,690.83" "$4,690.83" "$4,690.83" "$2,693.76" "$2,693.76" "$4,444.70" "$4,690.83" "$4,489.60" "$7,739.87" "$1,113.84" "$4,690.83" "$3,254.96" "$4,925.37" "$5,612.00" "$4,690.83" "$1,169.54" "$4,690.83" N/A N/A 32300002 EAP CPT® 75625 AORTOGRAM ABD CATHETER SPV BOTH IP/OP "$5,567.00" "$4,120.00" $60.88 "$4,646.27" $297.46 $297.46 $297.46 $297.46 "$2,815.92" "$2,815.92" "$2,803.47" "$1,160.30" "$2,815.92" "$4,131.83" "$4,131.83" "$4,291.04" "$2,060.15" "$1,160.22" "$4,505.48" "$4,297.64" "$3,292.88" "$2,815.92" $60.88 "$2,815.92" "$2,956.72" "$4,175.25" "$2,815.92" "$2,815.92" "$2,815.92" "$2,672.16" "$2,672.16" "$4,409.06" "$2,815.92" "$4,453.60" "$4,646.27" "$1,104.91" "$2,815.92" "$3,228.86" "$2,956.72" "$4,073.93" "$2,815.92" "$1,160.16" "$2,815.92" N/A N/A 32300003 EAP CPT® 75630 AORTOGRAPHY BILAT LOWER BOTH IP/OP "$6,875.00" "$5,087.50" $65.28 "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" $67.31 $67.31 $142.77 "$6,875.00" $67.31 "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" $107.70 $104.45 "$6,875.00" $67.31 $65.28 $67.31 "$6,875.00" "$5,156.25" $67.31 $67.31 $67.31 "$3,300.00" "$3,300.00" "$5,445.00" $67.31 "$5,500.00" "$6,875.00" "$6,875.00" $67.31 "$3,987.50" "$6,875.00" $73.47 $67.31 "$6,875.00" $67.31 N/A N/A 32300013 EAP CPT® 75705 ANGIO SPINAL SELECTIVE BOTH IP/OP "$9,855.00" "$7,293.00" $133.59 "$9,855.00" "$9,855.00" "$9,855.00" "$9,855.00" "$9,855.00" $133.59 $133.59 $215.12 "$9,855.00" $133.59 "$4,181.12" "$4,181.12" "$7,596.23" "$2,060.15" "$2,053.89" $213.74 $216.48 "$9,855.00" $133.59 $135.30 $133.59 "$9,855.00" "$7,391.25" $133.59 $133.59 $133.59 "$4,730.40" "$4,730.40" "$7,805.16" $133.59 "$7,884.00" "$9,855.00" "$9,855.00" $133.59 "$5,715.90" "$9,855.00" $136.14 $133.59 "$9,855.00" $133.59 N/A N/A 32300014 EAP CPT® 75710 ANGIO EXTREMITY UNILAT SPV BOTH IP/OP "$8,204.00" "$6,071.00" $70.02 "$6,563.20" $351.12 $351.12 $351.12 $351.12 "$2,815.92" "$2,815.92" "$2,803.47" "$1,709.92" "$2,815.92" "$4,181.12" "$4,181.12" "$6,323.64" "$2,060.15" "$1,709.80" "$4,505.48" "$4,297.64" "$4,852.67" "$2,815.92" $70.02 "$2,815.92" "$2,956.72" "$6,153.00" "$2,815.92" "$2,815.92" "$2,815.92" "$3,937.92" "$3,937.92" "$6,497.57" "$2,815.92" "$6,563.20" "$4,646.27" "$1,628.29" "$2,815.92" "$4,758.32" "$2,956.72" "$4,073.93" "$2,815.92" "$1,709.71" "$2,815.92" N/A N/A 32300015 EAP CPT® 75716 ANGIO EXT BILAT BOTH IP/OP "$8,615.00" "$6,375.50" $72.72 "$6,892.00" $404.01 $404.01 $404.01 $404.01 "$2,815.92" "$2,815.92" "$2,803.47" "$1,795.58" "$2,815.92" "$4,181.12" "$4,181.12" "$6,640.44" "$2,060.15" "$1,795.46" "$4,505.48" "$4,297.64" "$5,095.77" "$2,815.92" $72.72 "$2,815.92" "$2,956.72" "$6,461.25" "$2,815.92" "$2,815.92" "$2,815.92" "$4,135.20" "$4,135.20" "$6,823.08" "$2,815.92" "$6,892.00" "$4,646.27" "$1,709.86" "$2,815.92" "$4,996.70" "$2,956.72" "$4,073.93" "$2,815.92" "$1,795.37" "$2,815.92" N/A N/A 32300018 EAP CPT® 75726 ANGIO VISCERAL BOTH IP/OP "$8,089.00" "$5,986.00" $78.81 "$7,739.87" $323.46 $323.46 $323.46 $323.46 "$4,690.83" "$4,690.83" "$4,670.08" "$1,685.95" "$4,690.83" "$4,181.12" "$4,181.12" "$6,235.00" "$2,060.15" "$1,685.84" "$7,505.33" "$7,414.92" "$4,784.64" "$4,690.83" $78.81 "$4,690.83" "$4,925.37" "$6,066.75" "$4,690.83" "$4,690.83" "$4,690.83" "$3,882.72" "$3,882.72" "$6,406.49" "$4,690.83" "$6,471.20" "$7,739.87" "$1,605.46" "$4,690.83" "$4,691.62" "$4,925.37" "$6,786.45" "$4,690.83" "$1,685.75" "$4,690.83" N/A N/A 32300019 EAP CPT® 75731 ANGIO ADRENAL UNILAT SPV BOTH IP/OP "$4,162.00" "$3,080.00" $100.09 "$4,162.00" "$4,162.00" "$4,162.00" "$4,162.00" "$4,162.00" $100.09 $100.09 $136.03 "$4,162.00" $100.09 "$3,089.04" "$3,089.04" "$3,208.07" "$2,060.15" $867.41 $160.14 $160.75 "$4,162.00" $100.09 $100.47 $100.09 "$4,162.00" "$3,121.50" $100.09 $100.09 $100.09 "$1,997.76" "$1,997.76" "$3,296.30" $100.09 "$3,329.60" "$4,162.00" "$4,162.00" $100.09 "$2,413.96" "$4,162.00" $107.33 $100.09 "$4,162.00" $100.09 N/A N/A 32300021 EAP CPT® 75736 ANGIO PELVIC SELECTIVE SPV BOTH IP/OP "$8,804.00" "$6,515.00" $91.80 "$8,804.00" "$8,804.00" "$8,804.00" "$8,804.00" "$8,804.00" $91.80 $91.80 $126.15 "$8,804.00" $91.80 "$4,181.12" "$4,181.12" "$6,786.12" "$2,060.15" "$1,834.85" $146.88 $147.76 "$8,804.00" $91.80 $92.35 $91.80 "$8,804.00" "$6,603.00" $91.80 $91.80 $91.80 "$4,225.92" "$4,225.92" "$6,972.77" $91.80 "$7,043.20" "$8,804.00" "$8,804.00" $91.80 "$5,106.32" "$8,804.00" $97.61 $91.80 "$8,804.00" $91.80 N/A N/A 32300022 EAP CPT® 75741 ANGIO PULMONARY UNILAT SPV BOTH IP/OP "$5,405.00" "$4,000.00" $72.05 "$4,646.27" $326.50 $326.50 $326.50 $326.50 "$2,815.92" "$2,815.92" "$2,803.47" "$1,126.54" "$2,815.92" "$4,011.59" "$4,011.59" "$4,166.17" "$2,060.15" "$1,126.46" "$4,505.48" "$4,297.64" "$3,197.06" "$2,815.92" $72.05 "$2,815.92" "$2,956.72" "$4,053.75" "$2,815.92" "$2,815.92" "$2,815.92" "$2,594.40" "$2,594.40" "$4,280.76" "$2,815.92" "$4,324.00" "$4,646.27" "$1,072.76" "$2,815.92" "$3,134.90" "$2,956.72" "$4,073.93" "$2,815.92" "$1,126.40" "$2,815.92" N/A N/A 32300023 EAP CPT® 75743 ANGIO PULMONARY BILATERAL SPV BOTH IP/OP "$5,466.00" "$4,045.00" $73.40 "$5,466.00" "$5,466.00" "$5,466.00" "$5,466.00" "$5,466.00" $74.53 $74.53 $133.85 "$5,466.00" $74.53 "$4,056.87" "$4,056.87" "$4,213.19" "$2,060.15" "$1,139.17" $119.25 $117.44 "$5,466.00" $74.53 $73.40 $74.53 "$5,466.00" "$4,099.50" $74.53 $74.53 $74.53 "$2,623.68" "$2,623.68" "$4,329.07" $74.53 "$4,372.80" "$5,466.00" "$5,466.00" $74.53 "$3,170.28" "$5,466.00" $81.76 $74.53 "$5,466.00" $74.53 N/A N/A 32300024 EAP CPT® 75774 ANGIO SELECTIVE ADD'L VESS SPV BOTH IP/OP "$3,796.00" "$2,809.50" $52.09 "$3,884.00" $187.02 $187.02 $187.02 $187.02 "$3,796.00" "$3,796.00" "$3,796.00" $791.18 "$3,796.00" "$2,817.39" "$2,817.39" "$2,925.96" "$1,977.72" $791.13 "$3,796.00" "$3,884.00" "$2,245.33" "$3,796.00" $52.09 "$3,796.00" "$3,796.00" "$2,847.00" "$3,796.00" "$3,796.00" "$3,796.00" "$1,822.08" "$1,822.08" "$3,006.43" "$3,796.00" "$3,036.80" "$3,796.00" $753.41 "$3,796.00" "$2,201.68" "$3,796.00" "$3,796.00" "$3,796.00" $791.09 "$3,796.00" N/A N/A 32300026 EAP CPT® 75898 ANGIO W/EXIST CATH FU STDY SPV BOTH IP/OP "$2,784.00" "$2,060.50" $495.55 "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" $495.55 "$2,784.00" "$2,784.00" "$2,066.28" "$2,066.28" "$2,145.91" "$1,450.46" $580.22 "$2,784.00" $887.60 "$2,784.00" "$2,784.00" "$2,219.00" "$2,784.00" "$2,784.00" "$2,088.00" "$2,784.00" "$2,784.00" "$2,784.00" "$1,336.32" "$1,336.32" "$2,204.93" "$2,784.00" "$2,227.20" "$2,784.00" "$2,784.00" "$2,784.00" "$1,614.72" "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" N/A N/A 32300066 EAP CPT® 75705 ANGIO SPINAL SELECTIVE NIR BOTH IP/OP "$9,955.00" "$7,367.00" $133.59 "$9,955.00" "$9,955.00" "$9,955.00" "$9,955.00" "$9,955.00" $133.59 $133.59 $215.12 "$9,955.00" $133.59 "$4,181.12" "$4,181.12" "$7,673.31" "$2,060.15" "$2,074.73" $213.74 $216.48 "$9,955.00" $133.59 $135.30 $133.59 "$9,955.00" "$7,466.25" $133.59 $133.59 $133.59 "$4,778.40" "$4,778.40" "$7,884.36" $133.59 "$7,964.00" "$9,955.00" "$9,955.00" $133.59 "$5,773.90" "$9,955.00" $136.14 $133.59 "$9,955.00" $133.59 N/A N/A 32300072 EAP CPT® 37197 "TRANSCATHETER RETRIEVAL,PERCUTANEOUS OF INTRAVAS FB INCI" BOTH IP/OP "$34,751.00" "$25,716.00" $296.58 "$34,751.00" "$34,751.00" "$34,751.00" "$34,751.00" "$34,751.00" $298.49 $298.49 $301.03 "$34,751.00" $298.49 "$34,751.00" "$34,751.00" "$34,751.00" "$34,751.00" "$7,242.49" $477.58 $474.53 "$34,751.00" $298.49 $296.58 $298.49 "$34,751.00" "$26,063.25" $298.49 $298.49 $298.49 "$3,500.00" "$17,375.50" "$27,522.79" $298.49 "$27,800.80" "$3,725.00" "$34,751.00" $298.49 "$20,155.58" "$34,751.00" $315.16 $298.49 "$34,751.00" $298.49 N/A N/A 32400001 EAP CPT® 71045 CHEST X-RAY BOTH IP/OP $623.00 $461.50 $17.59 $498.40 $43.07 $43.07 $43.07 $43.07 $79.57 $79.57 $79.21 $129.85 $79.57 $26.80 $26.80 $27.83 $19.56 $129.84 $127.31 $125.33 $368.50 $79.57 $17.59 $79.57 $83.54 $467.25 $79.57 $79.57 $79.57 $299.04 $299.04 $493.42 $79.57 $498.40 $131.28 $123.65 $79.57 $361.34 $83.54 $115.11 $79.57 $129.83 $79.57 N/A N/A 32400002 EAP CPT® 71045 X-RAY EXAM CHEST 1 VIEW BOTH IP/OP $697.00 $516.00 $17.59 $557.60 $43.07 $43.07 $43.07 $43.07 $79.57 $79.57 $79.21 $145.27 $79.57 $26.80 $26.80 $27.83 $19.56 $145.26 $127.31 $125.33 $412.28 $79.57 $17.59 $79.57 $83.54 $522.75 $79.57 $79.57 $79.57 $334.56 $334.56 $552.02 $79.57 $557.60 $131.28 $138.34 $79.57 $404.26 $83.54 $115.11 $79.57 $145.25 $79.57 N/A N/A 32400003 EAP CPT® 71045 LINE PLACEMENT-CHEST BOTH IP/OP $623.00 $461.50 $17.59 $498.40 $43.07 $43.07 $43.07 $43.07 $79.57 $79.57 $79.21 $129.85 $79.57 $26.80 $26.80 $27.83 $19.56 $129.84 $127.31 $125.33 $368.50 $79.57 $17.59 $79.57 $83.54 $467.25 $79.57 $79.57 $79.57 $299.04 $299.04 $493.42 $79.57 $498.40 $131.28 $123.65 $79.57 $361.34 $83.54 $115.11 $79.57 $129.83 $79.57 N/A N/A 32400006 EAP CPT® 71046 X-RAY EXAM CHEST 2 VIEW BOTH IP/OP $730.00 $540.50 $23.68 $584.00 $66.04 $66.04 $66.04 $66.04 $79.57 $79.57 $79.21 $152.15 $79.57 $49.06 $49.06 $50.94 $35.81 $152.14 $127.31 $125.33 $431.80 $79.57 $23.68 $79.57 $83.54 $547.50 $79.57 $79.57 $79.57 $350.40 $350.40 $578.16 $79.57 $584.00 $131.28 $144.89 $79.57 $423.40 $83.54 $115.11 $79.57 $152.13 $79.57 N/A N/A 32400008 EAP CPT® 71047 CHEST 2VIEW W/APICAL LORDO RDG BOTH IP/OP $752.00 $556.50 $29.77 $601.60 $84.44 $84.44 $84.44 $84.44 $79.57 $79.57 $79.21 $156.74 $79.57 $62.44 $62.44 $64.84 $45.58 $156.73 $127.31 $125.33 $444.81 $79.57 $29.77 $79.57 $83.54 $564.00 $79.57 $79.57 $79.57 $360.96 $360.96 $595.58 $79.57 $601.60 $131.28 $149.25 $79.57 $436.16 $83.54 $115.11 $79.57 $156.72 $79.57 N/A N/A 32400010 EAP CPT® 71048 CHEST X-RAY 4+VIEW RDG BOTH IP/OP $809.00 $599.00 $32.13 $647.20 $90.56 $90.56 $90.56 $90.56 $107.09 $107.09 $106.62 $168.62 $107.09 $64.20 $64.20 $66.67 $46.86 $168.60 $171.35 $154.19 $478.52 $107.09 $32.13 $107.09 $112.45 $606.75 $107.09 $107.09 $107.09 $388.32 $388.32 $640.73 $107.09 $647.20 $176.70 $160.57 $107.09 $469.22 $112.45 $154.94 $107.09 $168.60 $107.09 N/A N/A 32400012 EAP CPT® 71046 CHEST X-RAY 3VW DECUBITUS RDG BOTH IP/OP $771.00 $571.00 $23.68 $616.80 $66.04 $66.04 $66.04 $66.04 $79.57 $79.57 $79.21 $160.70 $79.57 $49.06 $49.06 $50.94 $35.81 $160.68 $127.31 $125.33 $456.05 $79.57 $23.68 $79.57 $83.54 $578.25 $79.57 $79.57 $79.57 $370.08 $370.08 $610.63 $79.57 $616.80 $131.28 $153.02 $79.57 $447.18 $83.54 $115.11 $79.57 $160.68 $79.57 N/A N/A 33100001 EAP CPT® 96411 IV CHEMO PUSH-EA ADDTL MED BOTH IP/OP $478.00 $354.00 $55.84 $382.40 $174.62 $174.62 $174.62 $174.62 $60.99 $60.99 $60.72 $99.63 $60.99 $354.77 $354.77 $368.44 $249.04 $99.62 $97.58 $97.33 $282.74 $60.99 $55.84 $60.99 $64.04 $358.50 $60.99 $60.99 $60.99 $239.00 $239.00 $378.58 $60.99 $382.40 $310.70 $94.87 $60.99 $277.24 $64.04 $88.23 $60.99 $99.62 $60.99 N/A N/A 33100002 EAP CPT® 96409 IV CHEMO PUSH-1ST MED INITL1VS BOTH IP/OP $830.00 $614.50 $101.85 $664.00 $310.54 $310.54 $310.54 $310.54 $201.23 $201.23 $200.34 $172.99 $201.23 $616.03 $616.03 $639.76 $432.43 $172.98 $321.97 $298.01 $490.95 $201.23 $101.85 $201.23 $211.29 $622.50 $201.23 $201.23 $201.23 $415.00 $415.00 $657.36 $201.23 $664.00 $539.50 $164.73 $201.23 $481.40 $211.29 $291.13 $201.23 $172.97 $201.23 N/A N/A 33100004 EAP CPT® 96411 IV CHEMO PUSH1ST MED DUR INFUS BOTH IP/OP $478.00 $354.00 $55.84 $382.40 $174.62 $174.62 $174.62 $174.62 $60.99 $60.99 $60.72 $99.63 $60.99 $354.77 $354.77 $368.44 $249.04 $99.62 $97.58 $97.33 $282.74 $60.99 $55.84 $60.99 $64.04 $358.50 $60.99 $60.99 $60.99 $239.00 $239.00 $378.58 $60.99 $382.40 $310.70 $94.87 $60.99 $277.24 $64.04 $88.23 $60.99 $99.62 $60.99 N/A N/A 33100006 EAP CPT® 96411 IV CHEMO PUSH-1 MED DUR INFUS BOTH IP/OP $357.00 $264.50 $55.84 $285.60 $174.62 $174.62 $174.62 $174.62 $60.99 $60.99 $60.72 $74.41 $60.99 $264.97 $264.97 $275.18 $186.00 $74.40 $97.58 $97.33 $211.17 $60.99 $55.84 $60.99 $64.04 $267.75 $60.99 $60.99 $60.99 $178.50 $178.50 $282.74 $60.99 $285.60 $232.05 $70.86 $60.99 $207.06 $64.04 $88.23 $60.99 $74.40 $60.99 N/A N/A 33100007 EAP CPT® 96401 INJECT CHEMO-IM/SQ NON HORMONA BOTH IP/OP $496.00 $367.50 $60.72 $396.80 $208.36 $208.36 $208.36 $208.36 $60.99 $60.99 $60.72 $103.38 $60.99 $368.13 $368.13 $382.32 $258.42 $103.37 $97.58 $97.33 $293.38 $60.99 $73.43 $60.99 $64.04 $372.00 $60.99 $60.99 $60.99 $248.00 $248.00 $392.83 $60.99 $396.80 $322.40 $98.44 $60.99 $287.68 $64.04 $88.23 $60.99 $103.37 $60.99 N/A N/A 33100008 EAP CPT® 96402 INJECT CHEMO-IM/SQ HORMONAL BOTH IP/OP $619.00 $458.50 $34.18 $495.20 $91.26 $91.26 $91.26 $91.26 $60.99 $60.99 $60.72 $129.02 $60.99 $459.42 $459.42 $477.13 $322.50 $129.01 $97.58 $97.33 $366.14 $60.99 $34.18 $60.99 $64.04 $464.25 $60.99 $60.99 $60.99 $309.50 $309.50 $490.25 $60.99 $495.20 $402.35 $122.86 $60.99 $359.02 $64.04 $88.23 $60.99 $129.00 $60.99 N/A N/A 33300001 EAP CPT® 77280 SIMULATION-SIMPLE BOTH IP/OP "$1,882.00" "$1,393.00" $124.26 "$1,505.60" $595.52 $595.52 $595.52 $595.52 $124.82 $124.82 $124.26 $392.26 $124.82 $371.97 $371.97 $386.27 $271.53 $392.23 $199.71 $192.42 "$1,113.20" $124.82 $234.71 $124.82 $131.06 "$1,411.50" $124.82 $124.82 $124.82 $903.36 $903.36 "$1,490.54" $124.82 "$1,505.60" $205.95 $373.53 $124.82 "$1,091.56" $131.06 $180.58 $124.82 $392.21 $124.82 N/A N/A 33300002 EAP CPT® 77285 SIMULATION-INTERMEDIAT BOTH IP/OP "$2,531.00" "$1,873.00" $333.11 "$2,531.00" "$2,531.00" "$2,531.00" "$2,531.00" "$2,531.00" $397.11 $397.11 $406.89 "$2,531.00" $397.11 $661.39 $661.39 $686.83 $482.81 $527.49 $635.38 $623.38 "$2,531.00" $397.11 $389.61 $397.11 "$2,531.00" "$1,898.25" $397.11 $397.11 $397.11 "$1,214.88" "$1,214.88" "$2,004.55" $397.11 "$2,024.80" "$2,531.00" "$2,531.00" $333.11 "$1,467.98" "$2,531.00" $414.20 $397.11 "$2,531.00" $397.11 N/A N/A 33300003 EAP CPT® 77290 SIMULATION-COMPLEX BOTH IP/OP "$3,403.00" "$2,518.50" $331.64 "$2,722.40" "$1,122.05" "$1,122.05" "$1,122.05" "$1,122.05" $333.11 $333.11 $331.64 $709.27 $333.11 "$1,034.52" "$1,034.52" "$1,074.31" $755.19 $709.22 $532.97 $517.51 "$2,012.87" $333.11 $375.07 $333.11 $349.76 "$2,552.25" $333.11 $333.11 $333.11 "$1,633.44" "$1,633.44" "$2,695.18" $333.11 "$2,722.40" $549.63 $675.41 $333.11 "$1,973.74" $349.76 $481.92 $333.11 $709.19 $333.11 N/A N/A 33300004 EAP CPT® 77295 3D RADIOTHERAPY PLAN W/ VOL HISTO BOTH IP/OP "$12,364.00" "$9,149.50" $256.73 "$9,891.20" "$1,066.83" "$1,066.83" "$1,066.83" "$1,066.83" "$1,242.16" "$1,242.16" "$1,236.66" "$2,576.97" "$1,242.16" "$1,140.85" "$1,140.85" "$1,184.73" $832.81 "$2,576.79" "$1,987.45" "$1,934.13" "$7,313.31" "$1,242.16" $256.73 "$1,242.16" "$1,304.27" "$9,273.00" "$1,242.16" "$1,242.16" "$1,242.16" "$5,934.72" "$5,934.72" "$9,792.29" "$1,242.16" "$9,891.20" "$2,049.56" "$2,453.94" "$1,242.16" "$7,171.12" "$1,304.27" "$1,797.09" "$1,242.16" "$2,576.66" "$1,242.16" N/A N/A 33300007 EAP CPT® 77300 CENTRAL AXIS CALCULATION BOTH IP/OP $916.00 $678.00 $33.49 $732.80 $144.85 $144.85 $144.85 $144.85 $124.82 $124.82 $124.26 $190.92 $124.82 $100.51 $100.51 $104.37 $73.37 $190.90 $199.71 $192.42 $541.81 $124.82 $33.49 $124.82 $131.06 $687.00 $124.82 $124.82 $124.82 $439.68 $439.68 $725.47 $124.82 $732.80 $205.95 $181.80 $124.82 $531.28 $131.06 $180.58 $124.82 $190.89 $124.82 N/A N/A 33300008 EAP CPT® 77301 IMRT BOTH IP/OP "$7,048.00" "$5,216.00" "$1,236.66" "$5,638.40" "$4,249.25" "$4,249.25" "$4,249.25" "$4,249.25" "$1,242.16" "$1,242.16" "$1,236.66" "$1,468.98" "$1,242.16" "$4,395.44" "$4,395.44" "$4,564.49" "$3,208.63" "$1,468.88" "$1,987.45" "$1,934.13" "$4,168.89" "$1,242.16" "$1,435.82" "$1,242.16" "$1,304.27" "$5,286.00" "$1,242.16" "$1,242.16" "$1,242.16" "$3,383.04" "$3,383.04" "$5,582.02" "$1,242.16" "$5,638.40" "$2,049.56" "$1,398.85" "$1,242.16" "$4,087.84" "$1,304.27" "$1,797.09" "$1,242.16" "$1,468.80" "$1,242.16" N/A N/A 33300012 EAP CPT® 77321 TELETHER PLAN SPECIAL BOTH IP/OP "$1,950.00" "$1,443.00" $44.31 "$1,560.00" $202.33 $202.33 $202.33 $202.33 $333.11 $333.11 $331.64 $406.43 $333.11 $187.24 $187.24 $194.44 $136.68 $406.40 $532.97 $517.51 "$1,153.43" $333.11 $44.31 $333.11 $349.76 "$1,462.50" $333.11 $333.11 $333.11 $936.00 $936.00 "$1,544.40" $333.11 "$1,560.00" $549.63 $387.03 $333.11 "$1,131.00" $349.76 $481.92 $333.11 $406.38 $333.11 N/A N/A 33300014 EAP CPT® 77331 TLD/MICRODOSIMETRY BOTH IP/OP $889.00 $658.00 $18.96 $711.20 $139.48 $139.48 $139.48 $139.48 $124.82 $124.82 $124.26 $185.29 $124.82 $46.88 $46.88 $48.69 $34.22 $185.28 $199.71 $192.42 $525.84 $124.82 $19.28 $124.82 $131.06 $666.75 $124.82 $124.82 $124.82 $426.72 $426.72 $704.09 $124.82 $711.20 $205.95 $176.44 $18.96 $515.62 $131.06 $180.58 $124.82 $185.27 $124.82 N/A N/A 33300015 EAP CPT® 77332 RADIATION TREATMENT AID(S) SIMPLE BOTH IP/OP "$1,023.00" $757.50 $14.55 $818.40 $146.38 $146.38 $146.38 $146.38 $124.82 $124.82 $124.26 $213.22 $124.82 $126.87 $126.87 $131.75 $92.61 $213.20 $199.71 $192.42 $605.10 $124.82 $14.55 $124.82 $131.06 $767.25 $124.82 $124.82 $124.82 $491.04 $491.04 $810.22 $124.82 $818.40 $205.95 $203.04 $124.82 $593.34 $131.06 $180.58 $124.82 $213.19 $124.82 N/A N/A 33300016 EAP CPT® 77332 BOLUS SIMPLE BOTH IP/OP $765.00 $566.50 $14.55 $612.00 $146.38 $146.38 $146.38 $146.38 $124.82 $124.82 $124.26 $159.45 $124.82 $126.87 $126.87 $131.75 $92.61 $159.43 $199.71 $192.42 $452.50 $124.82 $14.55 $124.82 $131.06 $573.75 $124.82 $124.82 $124.82 $367.20 $367.20 $605.88 $124.82 $612.00 $205.95 $151.83 $124.82 $443.70 $131.06 $180.58 $124.82 $159.43 $124.82 N/A N/A 33300018 EAP CPT® 77333 BOLUS INTER. BOTH IP/OP "$1,056.00" $781.50 $49.08 $844.80 $209.99 $209.99 $209.99 $209.99 $124.82 $124.82 $124.26 $220.10 $124.82 $67.24 $67.24 $69.82 $49.08 $220.08 $199.71 $192.42 $624.62 $124.82 $99.44 $124.82 $131.06 $792.00 $124.82 $124.82 $124.82 $506.88 $506.88 $836.35 $124.82 $844.80 $205.95 $209.59 $124.82 $612.48 $131.06 $180.58 $124.82 $220.07 $124.82 N/A N/A 33300019 EAP CPT® 77334 RADIATION TREATMENT AID(S) COMPLEX BOTH IP/OP "$1,488.00" "$1,101.50" $65.62 "$1,190.40" $284.33 $284.33 $284.33 $284.33 $333.11 $333.11 $331.64 $310.14 $333.11 $240.51 $240.51 $249.76 $175.57 $310.12 $532.97 $517.51 $880.15 $333.11 $65.62 $333.11 $349.76 "$1,116.00" $333.11 $333.11 $333.11 $714.24 $714.24 "$1,178.50" $333.11 "$1,190.40" $549.63 $295.33 $333.11 $863.04 $349.76 $481.92 $333.11 $310.10 $333.11 N/A N/A 33300020 EAP CPT® 77334 COMPENSATOR FILTER BOTH IP/OP "$1,113.00" $824.00 $65.62 $890.40 $284.33 $284.33 $284.33 $284.33 $333.11 $333.11 $331.64 $231.98 $333.11 $240.51 $240.51 $249.76 $175.57 $231.96 $532.97 $517.51 $658.34 $333.11 $65.62 $333.11 $349.76 $834.75 $333.11 $333.11 $333.11 $534.24 $534.24 $881.50 $333.11 $890.40 $549.63 $220.90 $333.11 $645.54 $349.76 $481.92 $333.11 $231.95 $333.11 N/A N/A 33300021 EAP CPT® 77334 POSITIONING MOLD BOTH IP/OP "$1,113.00" $824.00 $65.62 $890.40 $284.33 $284.33 $284.33 $284.33 $333.11 $333.11 $331.64 $231.98 $333.11 $240.51 $240.51 $249.76 $175.57 $231.96 $532.97 $517.51 $658.34 $333.11 $65.62 $333.11 $349.76 $834.75 $333.11 $333.11 $333.11 $534.24 $534.24 $881.50 $333.11 $890.40 $549.63 $220.90 $333.11 $645.54 $349.76 $481.92 $333.11 $231.95 $333.11 N/A N/A 33300022 EAP CPT® 77336 CONTINUING PHYSICS/WK BOTH IP/OP $962.00 $712.00 $87.30 $769.60 $172.54 $172.54 $172.54 $172.54 $124.82 $124.82 $124.26 $200.50 $124.82 $155.36 $155.36 $161.33 $113.41 $200.49 $199.71 $192.42 $569.02 $124.82 $87.30 $124.82 $131.06 $721.50 $124.82 $124.82 $124.82 $461.76 $461.76 $761.90 $124.82 $769.60 $205.95 $190.93 $124.82 $557.96 $131.06 $180.58 $124.82 $200.48 $124.82 N/A N/A 33300023 EAP CPT® 77370 SPEC MEDICAL PHYSICS CONSULT BOTH IP/OP "$1,142.00" $845.50 $124.26 $913.60 $265.33 $265.33 $265.33 $265.33 $124.82 $124.82 $124.26 $238.02 $124.82 $293.91 $293.91 $305.22 $214.55 $238.01 $199.71 $192.42 $675.49 $124.82 $140.44 $124.82 $131.06 $856.50 $124.82 $124.82 $124.82 $548.16 $548.16 $904.46 $124.82 $913.60 $205.95 $226.66 $124.82 $662.36 $131.06 $180.58 $124.82 $237.99 $124.82 N/A N/A 33300024 EAP CPT® 77401 "RAD DELIVERY, SUPERF &/OR ORTHOVOLT, PER DAY" BOTH IP/OP $899.00 $665.50 $24.85 $899.00 $899.00 $899.00 $899.00 $899.00 $42.10 $42.10 $37.27 $899.00 $42.10 $79.93 $79.93 $83.01 $58.35 $187.36 $67.36 $66.56 $899.00 $42.10 $41.60 $42.10 $899.00 $674.25 $42.10 $42.10 $42.10 $431.52 $431.52 $712.01 $42.10 $719.20 $899.00 $899.00 $42.10 $521.42 $899.00 $24.85 $42.10 $899.00 $42.10 N/A N/A 33300026 EAP CPT® 77306 TELETHER PLAN SIMPLE BOTH IP/OP "$1,192.00" $882.50 $75.09 $953.60 $324.97 $324.97 $324.97 $324.97 $333.11 $333.11 $331.64 $248.44 $333.11 $182.75 $182.75 $189.78 $133.41 $248.43 $532.97 $517.51 $705.07 $333.11 $75.09 $333.11 $349.76 $894.00 $333.11 $333.11 $333.11 $572.16 $572.16 $944.06 $333.11 $953.60 $549.63 $236.58 $333.11 $691.36 $349.76 $481.92 $333.11 $248.41 $333.11 N/A N/A 33300028 EAP CPT® 77307 TELETHER PLAN COMPLEX BOTH IP/OP "$1,998.00" "$1,479.00" $135.64 "$1,598.40" $628.43 $628.43 $628.43 $628.43 $333.11 $333.11 $331.64 $416.43 $333.11 $335.12 $335.12 $348.01 $244.63 $416.41 $532.97 $517.51 "$1,181.82" $333.11 $135.64 $333.11 $349.76 "$1,498.50" $333.11 $333.11 $333.11 $959.04 $959.04 "$1,582.42" $333.11 "$1,598.40" $549.63 $396.55 $333.11 "$1,158.84" $349.76 $481.92 $333.11 $416.38 $333.11 N/A N/A 33300030 EAP CPT® 77318 BRACHYTHER PLAN COMPLEX BOTH IP/OP "$2,101.00" "$1,555.00" $260.04 "$2,101.00" "$2,101.00" "$2,101.00" "$2,101.00" "$2,101.00" $306.74 $306.74 $375.02 "$2,101.00" $306.74 $504.45 $504.45 $523.85 $368.25 $437.87 $490.78 $493.02 "$2,101.00" $306.74 $308.14 $306.74 "$2,101.00" "$1,575.75" $306.74 $306.74 $306.74 "$1,008.48" "$1,008.48" "$1,663.99" $306.74 "$1,680.80" "$2,101.00" "$2,101.00" $306.74 "$1,218.58" "$2,101.00" $260.04 $306.74 "$2,101.00" $306.74 N/A N/A 33300031 EAP CPT® 77407 "RAD TX DEL >= 1 MEV, INTERMED" BOTH IP/OP "$1,214.00" $898.50 $168.99 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $168.99 "$1,214.00" "$1,214.00" $531.75 $531.75 $552.20 $388.17 $253.01 "$1,214.00" $321.60 "$1,214.00" "$1,214.00" $804.00 "$1,214.00" "$1,214.00" $910.50 "$1,214.00" "$1,214.00" "$1,214.00" $582.72 $582.72 $961.49 "$1,214.00" $971.20 "$1,214.00" "$1,214.00" "$1,214.00" $704.12 "$1,214.00" $728.40 "$1,214.00" "$1,214.00" "$1,214.00" N/A N/A 33300033 EAP CPT® 77412 "RAD TX DEL >= 1 MEV, COMPLEX" BOTH IP/OP "$1,771.00" "$1,311.00" $236.72 "$1,887.00" $585.58 $585.58 $585.58 $585.58 $237.78 $237.78 $236.72 $369.12 $237.78 $515.25 $515.25 $535.06 $376.13 $369.10 $380.44 $379.32 "$1,047.55" $237.78 "$1,887.00" $237.78 $249.66 "$1,328.25" $237.78 $237.78 $237.78 $850.08 $850.08 "$1,402.63" $237.78 "$1,416.80" $392.33 $351.50 $237.78 "$1,027.18" $249.66 $344.00 $237.78 $369.08 $237.78 N/A N/A 33300035 EAP CPT® 77385 IMRT TX DELIVERY SIMPLE BOTH IP/OP "$4,467.00" "$3,306.00" $531.35 "$6,102.00" $744.99 $744.99 $744.99 $744.99 $533.71 $533.71 $531.35 $931.03 $533.71 "$3,315.41" "$3,315.41" "$3,443.16" "$2,060.15" $930.97 $853.93 $825.88 "$2,642.23" $533.71 "$6,102.00" $533.71 $560.39 "$3,350.25" $533.71 $533.71 $533.71 "$2,144.16" "$2,144.16" "$3,537.86" $533.71 "$3,573.60" $880.62 $886.59 $533.71 "$2,590.86" $560.39 $772.14 $533.71 $930.92 $533.71 N/A N/A 33300037 EAP CPT® 77386 IMRT TX DELIVERY COMPLEX BOTH IP/OP "$4,467.00" "$3,306.00" $531.35 "$6,514.00" $747.33 $747.33 $747.33 $747.33 $533.71 $533.71 $531.35 $931.03 $533.71 "$3,315.41" "$3,315.41" "$3,443.16" "$2,060.15" $930.97 $853.93 $825.88 "$2,642.23" $533.71 "$6,514.00" $533.71 $560.39 "$3,350.25" $533.71 $533.71 $533.71 "$2,144.16" "$2,144.16" "$3,537.86" $533.71 "$3,573.60" $880.62 $886.59 $533.71 "$2,590.86" $560.39 $772.14 $533.71 $930.92 $533.71 N/A N/A 33300040 EAP CPT® 77387 GUIDANCE FOR RADIATION TX DLVR BOTH IP/OP "$1,005.00" $744.00 $69.56 "$3,306.00" $139.48 $139.48 $139.48 $139.48 "$1,005.00" "$1,005.00" "$1,005.00" $209.47 "$1,005.00" $95.28 $95.28 $98.95 $69.56 $209.45 "$1,005.00" "$3,306.00" $594.46 "$1,005.00" "$3,306.00" "$1,005.00" "$1,005.00" $753.75 "$1,005.00" "$1,005.00" "$1,005.00" $482.40 $482.40 $795.96 "$1,005.00" $804.00 "$1,005.00" $199.47 "$1,005.00" $582.90 "$1,005.00" "$1,005.00" "$1,005.00" $209.44 "$1,005.00" N/A N/A 33300047 EAP CPT® 77417 PORT IMAGE(S) BOTH IP/OP $631.00 $467.00 $13.87 $796.00 $23.77 $23.77 $23.77 $23.77 $631.00 $631.00 $631.00 $131.52 $631.00 $40.22 $40.22 $41.76 $29.36 $131.51 $631.00 $796.00 $373.24 $631.00 $13.87 $631.00 $631.00 $473.25 $631.00 $631.00 $631.00 $302.88 $302.88 $499.75 $631.00 $504.80 $631.00 $125.24 $631.00 $365.98 $631.00 $631.00 $631.00 $131.50 $631.00 N/A N/A 33300049 EAP CPT® 77402 "RAD TX DEL >= 1 MEV, SIMPLE" BOTH IP/OP "$1,202.00" $889.50 $117.83 "$1,202.00" "$1,202.00" "$1,202.00" "$1,202.00" "$1,202.00" "$1,202.00" "$1,202.00" $122.81 "$1,202.00" "$1,202.00" $339.51 $339.51 $352.57 $247.84 $250.51 "$1,202.00" $454.40 "$1,202.00" "$1,202.00" "$1,136.00" "$1,202.00" "$1,202.00" $901.50 "$1,202.00" "$1,202.00" "$1,202.00" $576.96 $576.96 $951.98 "$1,202.00" $961.60 "$1,202.00" "$1,202.00" $117.83 $697.16 "$1,202.00" $721.20 "$1,202.00" "$1,202.00" "$1,202.00" N/A N/A 33300050 EAP CPT® 77470 SPECIAL TREATMENT BOTH IP/OP "$6,620.00" "$4,899.00" $32.82 "$5,296.00" $313.45 $313.45 $313.45 $313.45 $533.71 $533.71 $531.35 "$1,379.77" $533.71 $379.95 $379.95 $394.57 $277.36 "$1,379.68" $853.93 $825.88 "$3,915.73" $533.71 $32.82 $533.71 $560.39 "$4,965.00" $533.71 $533.71 $533.71 "$3,177.60" "$3,177.60" "$5,243.04" $533.71 "$5,296.00" $880.62 "$1,313.90" $533.71 "$3,839.60" $560.39 $772.14 $533.71 "$1,379.61" $533.71 N/A N/A 33300052 EAP CPT® 77763 INTRACAVITARY COMPLEX BOTH IP/OP "$2,833.00" "$2,096.50" $301.82 "$2,833.00" "$2,833.00" "$2,833.00" "$2,833.00" "$2,833.00" $315.31 $315.31 $652.88 "$2,833.00" $315.31 $617.13 $617.13 $640.86 $450.50 $590.43 $504.50 $519.58 "$2,833.00" $315.31 $324.74 $315.31 "$2,833.00" "$2,124.75" $315.31 $315.31 $315.31 "$1,359.84" "$1,359.84" "$2,243.74" $315.31 "$2,266.40" "$2,833.00" "$2,833.00" $315.31 "$1,643.14" "$2,833.00" $301.82 $315.31 "$2,833.00" $315.31 N/A N/A 33300053 EAP CPT® 77338 IMRT TREATMENT DEVICE BOTH IP/OP "$1,470.00" "$1,088.00" $242.20 "$1,176.00" "$1,103.65" "$1,103.65" "$1,103.65" "$1,103.65" $333.11 $333.11 $331.64 $306.38 $333.11 $646.24 $646.24 $671.09 $471.75 $306.36 $532.97 $517.51 $869.51 $333.11 $242.20 $333.11 $349.76 "$1,102.50" $333.11 $333.11 $333.11 $705.60 $705.60 "$1,164.24" $333.11 "$1,176.00" $549.63 $291.76 $333.11 $852.60 $349.76 $481.92 $333.11 $306.35 $333.11 N/A N/A 33300055 EAP CPT® 77372 CRANIAL ONLY X 1 BOTH IP/OP "$10,692.00" "$7,912.50" $978.85 "$12,623.10" "$2,334.02" "$2,334.02" "$2,334.02" "$2,334.02" "$7,650.36" "$7,650.36" "$7,616.52" "$2,228.48" "$7,650.36" "$2,033.64" "$2,033.64" "$2,111.85" "$1,484.54" "$2,228.33" "$12,240.58" "$11,094.88" "$6,324.32" "$7,650.36" $978.85 "$7,650.36" "$8,032.88" "$8,019.00" "$7,650.36" "$7,650.36" "$7,650.36" "$5,132.16" "$5,132.16" "$8,468.06" "$7,650.36" "$8,553.60" "$12,623.10" "$2,122.09" "$7,650.36" "$6,201.36" "$8,032.88" "$10,692.00" "$7,650.36" "$2,228.21" "$7,650.36" N/A N/A 33300057 EAP CPT® 77373 ROBT LIN-RADSURG FRACT 1-5 BOTH IP/OP "$7,072.00" "$5,233.50" "$1,017.09" "$5,657.60" "$2,962.55" "$2,962.55" "$2,962.55" "$2,962.55" "$1,706.03" "$1,706.03" "$1,698.48" "$1,473.98" "$1,706.03" "$3,765.33" "$3,765.33" "$3,910.15" "$2,748.66" "$1,473.88" "$2,729.64" "$2,549.83" "$4,183.09" "$1,706.03" "$1,017.09" "$1,706.03" "$1,791.33" "$5,304.00" "$1,706.03" "$1,706.03" "$1,706.03" "$3,394.56" "$3,394.56" "$5,601.02" "$1,706.03" "$5,657.60" "$2,814.94" "$1,403.62" "$1,706.03" "$4,101.76" "$1,791.33" "$2,468.19" "$1,706.03" "$1,473.80" "$1,706.03" N/A N/A 33300067 EAP CPT® 77014 CBCT INFUSION RADIOACTIVE MAT BOTH IP/OP "$1,462.00" "$1,082.00" $77.11 "$2,159.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,462.00" "$1,462.00" "$1,462.00" $304.72 "$1,462.00" $785.72 $785.72 $815.94 $573.57 $304.70 "$1,462.00" "$2,159.00" $864.77 "$1,462.00" $77.11 "$1,462.00" "$1,462.00" "$1,096.50" "$1,462.00" "$1,462.00" "$1,462.00" $701.76 $701.76 "$1,157.90" "$1,462.00" "$1,169.60" "$1,462.00" $290.17 "$1,462.00" $847.96 "$1,462.00" "$1,462.00" "$1,462.00" $304.68 "$1,462.00" N/A N/A 33300073 EAP CPT® 57156 INS VAG BRACHYTX DEVICE BOTH IP/OP "$1,386.00" "$1,026.00" $152.84 "$1,386.00" "$1,386.00" "$1,386.00" "$1,386.00" "$1,386.00" $277.43 $277.43 $276.20 $288.88 $277.43 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $288.86 $443.89 $421.19 "$1,386.00" $277.43 $152.84 $277.43 $291.30 "$1,039.50" $277.43 $277.43 $277.43 "$1,386.00" $693.00 "$1,097.71" $277.43 "$1,108.80" "$1,386.00" $275.09 $277.43 $803.88 $291.30 $401.37 $277.43 $288.84 $277.43 N/A N/A 33300088 EAP CPT® 77293 RESP MOTION MGMT SIM BOTH IP/OP "$1,270.00" $940.00 $252.06 "$1,270.00" "$1,013.99" "$1,013.99" "$1,013.99" "$1,013.99" "$1,270.00" "$1,270.00" "$1,270.00" $264.70 "$1,270.00" $823.32 $823.32 $854.98 $601.01 $264.68 "$1,270.00" "$1,270.00" $751.21 "$1,270.00" $312.52 "$1,270.00" "$1,270.00" $952.50 "$1,270.00" "$1,270.00" "$1,270.00" $609.60 $609.60 "$1,005.84" "$1,270.00" "$1,016.00" "$1,270.00" $252.06 "$1,270.00" $736.60 "$1,270.00" "$1,270.00" "$1,270.00" $264.67 "$1,270.00" N/A N/A 33300090 EAP CPT® 77768 HDR RDNCL SKN SURF BRCHYTX LES >2CM OR MLT LES BOTH IP/OP $595.00 $440.50 $124.00 $731.86 $595.00 $595.00 $595.00 $595.00 $292.65 $292.65 $315.63 $595.00 $292.65 $704.76 $704.76 $731.86 $514.47 $124.00 $468.24 $469.76 $595.00 $292.65 $293.60 $292.65 $595.00 $446.25 $292.65 $292.65 $292.65 $285.60 $285.60 $471.24 $292.65 $476.00 $595.00 $595.00 $292.65 $345.10 $595.00 $289.94 $292.65 $595.00 $292.65 N/A N/A 33300091 EAP CPT® 77767 HDR RDNCL SKN SURF BRACHYTX LES UP TO 2 CM BOTH IP/OP $595.00 $440.50 $124.00 $595.00 $595.00 $595.00 $595.00 $595.00 $196.04 $196.04 $213.55 $595.00 $196.04 $428.76 $428.76 $445.25 $312.99 $124.00 $313.66 $313.89 $595.00 $196.04 $196.18 $196.04 $595.00 $446.25 $196.04 $196.04 $196.04 $285.60 $285.60 $471.24 $196.04 $476.00 $595.00 $595.00 $196.04 $345.10 $595.00 $186.93 $196.04 $595.00 $196.04 N/A N/A 33300092 EAP CPT® 77435 STEREOTACTIC BODY RADIATION MANAGEMENT BOTH IP/OP "$3,000.00" "$2,220.00" $547.09 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $645.49 $645.49 $547.09 "$3,000.00" $645.49 "$2,226.60" "$2,226.60" "$2,312.40" "$1,563.00" $625.23 "$1,032.78" "$1,035.15" "$3,000.00" $645.49 $646.97 $645.49 "$3,000.00" "$2,250.00" $645.49 $645.49 $645.49 "$1,440.00" "$1,440.00" "$2,376.00" $645.49 "$2,400.00" "$3,000.00" "$3,000.00" $645.49 "$1,740.00" "$3,000.00" $662.08 $645.49 "$3,000.00" $645.49 N/A N/A 33500001 EAP CPT® 96450 IV CHEMO INTO CNS W/SPINAL PUN BOTH IP/OP "$1,346.00" $996.50 $76.96 "$1,076.80" $508.85 $508.85 $508.85 $508.85 $313.64 $313.64 $312.26 $280.54 $313.64 $999.00 $999.00 "$1,037.50" $701.27 $280.52 $501.83 $479.85 $796.16 $313.64 $76.96 $313.64 $329.33 "$1,009.50" $313.64 $313.64 $313.64 $673.00 $673.00 "$1,066.03" $313.64 "$1,076.80" $874.90 $267.15 $313.64 $780.68 $329.33 $453.76 $313.64 $280.51 $313.64 N/A N/A 33500002 EAP CPT® 96413 "CHEMO TX ADMN IV NFS TQ UP 1 HR, SNG OR 1ST SBST/DRUG" BOTH IP/OP "$1,213.00" $898.00 $131.96 $970.40 $385.94 $385.94 $385.94 $385.94 $313.64 $313.64 $312.26 $252.82 $313.64 $900.29 $900.29 $934.98 $631.97 $252.80 $501.83 $479.85 $717.49 $313.64 $131.96 $313.64 $329.33 $909.75 $313.64 $313.64 $313.64 $606.50 $606.50 $960.70 $313.64 $970.40 $788.45 $240.75 $313.64 $703.54 $329.33 $453.76 $313.64 $252.79 $313.64 N/A N/A 33500003 EAP CPT® 96416 IV CHEMO INF PROLONGED GTR8HRS BOTH IP/OP "$1,346.00" $996.50 $267.15 "$1,244.00" $389.90 $389.90 $389.90 $389.90 $313.64 $313.64 $312.26 $280.54 $313.64 $999.00 $999.00 "$1,037.50" $701.27 $280.52 $501.83 $479.85 $796.16 $313.64 "$1,244.00" $313.64 $329.33 "$1,009.50" $313.64 $313.64 $313.64 $673.00 $673.00 "$1,066.03" $313.64 "$1,076.80" $874.90 $267.15 $313.64 $780.68 $329.33 $453.76 $313.64 $280.51 $313.64 N/A N/A 33500004 EAP CPT® 96415 IV CHEMO INF MED EA ADDTL HR BOTH IP/OP $337.00 $249.50 $28.43 $269.60 $79.37 $79.37 $79.37 $79.37 $60.99 $60.99 $60.72 $70.24 $60.99 $250.12 $250.12 $259.76 $175.58 $70.23 $97.58 $97.33 $199.34 $60.99 $28.43 $60.99 $64.04 $252.75 $60.99 $60.99 $60.99 $168.50 $168.50 $266.90 $60.99 $269.60 $219.05 $66.89 $60.99 $195.46 $64.04 $88.23 $60.99 $70.23 $60.99 N/A N/A 33500005 EAP CPT® 96417 IV CHEMO INF EA NEW MED 16-90 BOTH IP/OP $529.00 $391.50 $60.72 $423.20 $182.55 $182.55 $182.55 $182.55 $60.99 $60.99 $60.72 $110.26 $60.99 $392.62 $392.62 $407.75 $275.61 $110.25 $97.58 $97.33 $312.90 $60.99 $64.97 $60.99 $64.04 $396.75 $60.99 $60.99 $60.99 $264.50 $264.50 $418.97 $60.99 $423.20 $343.85 $104.99 $60.99 $306.82 $64.04 $88.23 $60.99 $110.24 $60.99 N/A N/A 33500007 EAP CPT® 96416 IV CHEM INF PROLONG GTR 8HR PU BOTH IP/OP "$1,346.00" $996.50 $267.15 "$1,244.00" $389.90 $389.90 $389.90 $389.90 $313.64 $313.64 $312.26 $280.54 $313.64 $999.00 $999.00 "$1,037.50" $701.27 $280.52 $501.83 $479.85 $796.16 $313.64 "$1,244.00" $313.64 $329.33 "$1,009.50" $313.64 $313.64 $313.64 $673.00 $673.00 "$1,066.03" $313.64 "$1,076.80" $874.90 $267.15 $313.64 $780.68 $329.33 $453.76 $313.64 $280.51 $313.64 N/A N/A 34000004 EAP CPT® 79440 NUCLEARRX INTRA-ARTICULAR NUC BOTH IP/OP "$1,139.00" $843.00 $40.26 "$1,139.00" "$1,139.00" "$1,139.00" "$1,139.00" "$1,139.00" $41.72 $41.72 $105.09 "$1,139.00" $41.72 $149.33 $149.33 $155.08 $109.01 $237.38 $66.75 $64.42 "$1,139.00" $41.72 $40.26 $41.72 "$1,139.00" $854.25 $41.72 $41.72 $41.72 $546.72 $546.72 $902.09 $41.72 $911.20 "$1,139.00" "$1,139.00" $41.72 $660.62 "$1,139.00" $40.34 $41.72 "$1,139.00" $41.72 N/A N/A 34000005 EAP CPT® 78265 NM GASTRIC EMPTYING IMG STD BOTH IP/OP $832.00 $616.00 $165.13 $948.99 $817.83 $817.83 $817.83 $817.83 $370.81 $370.81 $369.17 $173.41 $370.81 $913.84 $913.84 $948.99 $667.09 $173.40 $593.29 $560.74 $492.13 $370.81 $323.35 $370.81 $389.35 $624.00 $370.81 $370.81 $370.81 $399.36 $399.36 $658.94 $370.81 $665.60 $611.83 $165.13 $370.81 $482.56 $389.35 $536.46 $370.81 $173.39 $370.81 N/A N/A 34100005 EAP CPT® 78018 THYROID CA/METS IMAGE WHOL NUC BOTH IP/OP "$1,629.00" "$1,205.50" $255.02 "$1,303.20" $702.10 $702.10 $702.10 $702.10 $481.37 $481.37 $479.24 $339.52 $481.37 $662.46 $662.46 $687.94 $483.59 $339.50 $770.19 $727.82 $963.55 $481.37 $255.02 $481.37 $505.44 "$1,221.75" $481.37 $481.37 $481.37 $781.92 $781.92 "$1,290.17" $481.37 "$1,303.20" $794.26 $323.32 $481.37 $944.82 $505.44 $696.42 $481.37 $339.48 $481.37 N/A N/A 34100006 EAP CPT® 78020 THYROID CARCINOMA METATASES UP BOTH IP/OP "$1,082.00" $801.00 $53.11 "$1,082.00" "$1,082.00" "$1,082.00" "$1,082.00" "$1,082.00" $54.16 $54.16 $71.26 "$1,082.00" $54.16 $149.33 $149.33 $155.08 $109.01 $225.50 $86.66 $84.98 "$1,082.00" $54.16 $53.11 $54.16 "$1,082.00" $811.50 $54.16 $54.16 $54.16 $519.36 $519.36 $856.94 $54.16 $865.60 "$1,082.00" "$1,082.00" $54.16 $627.56 "$1,082.00" $56.91 $54.16 "$1,082.00" $54.16 N/A N/A 34100007 EAP CPT® 78070 PARATHYROID SCAN NUC BOTH IP/OP "$1,933.00" "$1,430.50" $234.57 "$1,546.40" $672.96 $672.96 $672.96 $672.96 $370.81 $370.81 $369.17 $402.89 $370.81 $321.33 $321.33 $333.69 $234.57 $402.86 $593.29 $560.74 "$1,143.37" $370.81 $239.47 $370.81 $389.35 "$1,449.75" $370.81 $370.81 $370.81 $927.84 $927.84 "$1,530.94" $370.81 "$1,546.40" $611.83 $383.65 $370.81 "$1,121.14" $389.35 $536.46 $370.81 $402.84 $370.81 N/A N/A 34100008 EAP CPT® 78075 ADRENAL SCAN CORTX&/MEDU NUC BOTH IP/OP "$12,239.00" "$9,057.00" $384.91 "$12,239.00" "$12,239.00" "$12,239.00" "$12,239.00" "$12,239.00" $398.67 $398.67 $389.62 "$12,239.00" $398.67 $908.41 $908.41 $943.35 $663.13 "$2,550.74" $637.87 $615.86 "$12,239.00" $398.67 $384.91 $398.67 "$12,239.00" "$9,179.25" $398.67 $398.67 $398.67 "$5,874.72" "$5,874.72" "$9,693.29" $398.67 "$9,791.20" "$12,239.00" "$12,239.00" $398.67 "$7,098.62" "$12,239.00" $423.92 $398.67 "$12,239.00" $398.67 N/A N/A 34100009 EAP CPT® 78102 BONE MARROW LIMITED NUC BOTH IP/OP "$1,469.00" "$1,087.50" $139.36 "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" $143.20 $143.20 $149.64 "$1,469.00" $143.20 $325.73 $325.73 $338.26 $237.78 $306.16 $229.12 $222.98 "$1,469.00" $143.20 $139.36 $143.20 "$1,469.00" "$1,101.75" $143.20 $143.20 $143.20 $705.12 $705.12 "$1,163.45" $143.20 "$1,175.20" "$1,469.00" "$1,469.00" $143.20 $852.02 "$1,469.00" $148.39 $143.20 "$1,469.00" $143.20 N/A N/A 34100010 EAP CPT® 78104 BONE MARROW WHOLE BODY NUC BOTH IP/OP "$1,469.00" "$1,087.50" $200.24 "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" $206.75 $206.75 $216.50 "$1,469.00" $206.75 $507.48 $507.48 $527.00 $370.45 $306.16 $330.80 $320.38 "$1,469.00" $206.75 $200.24 $206.75 "$1,469.00" "$1,101.75" $206.75 $206.75 $206.75 $705.12 $705.12 "$1,163.45" $206.75 "$1,175.20" "$1,469.00" "$1,469.00" $206.75 $852.02 "$1,469.00" $217.54 $206.75 "$1,469.00" $206.75 N/A N/A 34100011 EAP CPT® 78140 RBC LABELED SEQ LIVER NUC BOTH IP/OP "$1,312.00" $971.00 $85.93 "$1,312.00" "$1,312.00" "$1,312.00" "$1,312.00" "$1,312.00" $88.28 $88.28 $97.28 "$1,312.00" $88.28 $288.89 $288.89 $300.00 $210.89 $273.44 $141.25 $137.49 "$1,312.00" $88.28 $85.93 $88.28 "$1,312.00" $984.00 $88.28 $88.28 $88.28 $629.76 $629.76 "$1,039.10" $88.28 "$1,049.60" "$1,312.00" "$1,312.00" $88.28 $760.96 "$1,312.00" $88.60 $88.28 "$1,312.00" $88.28 N/A N/A 34100012 EAP CPT® 78185 SPLEEN SCAN W/ W/O FLOW NUC BOTH IP/OP "$1,410.00" "$1,043.50" $144.10 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $152.18 $152.18 $149.36 "$1,410.00" $152.18 $408.17 $408.17 $423.87 $297.96 $293.86 $243.49 $230.56 "$1,410.00" $152.18 $144.10 $152.18 "$1,410.00" "$1,057.50" $152.18 $152.18 $152.18 $676.80 $676.80 "$1,116.72" $152.18 "$1,128.00" "$1,410.00" "$1,410.00" $152.18 $817.80 "$1,410.00" $158.47 $152.18 "$1,410.00" $152.18 N/A N/A 34100013 EAP CPT® 78195 LYMPHOSCINTIGRAPHY NUC BOTH IP/OP "$1,629.00" "$1,205.50" $278.02 "$1,303.20" $798.68 $798.68 $798.68 $798.68 $481.37 $481.37 $479.24 $339.52 $481.37 $667.18 $667.18 $692.84 $487.04 $339.50 $770.19 $727.82 $963.55 $481.37 $278.02 $481.37 $505.44 "$1,221.75" $481.37 $481.37 $481.37 $781.92 $781.92 "$1,290.17" $481.37 "$1,303.20" $794.26 $323.32 $481.37 $944.82 $505.44 $696.42 $481.37 $339.48 $481.37 N/A N/A 34100015 EAP CPT® 78215 LIVER & SPLEEN IMAGING STATIC BOTH IP/OP "$1,454.00" "$1,076.00" $163.71 "$1,454.00" "$1,454.00" "$1,454.00" "$1,454.00" "$1,454.00" $168.76 $168.76 $170.36 "$1,454.00" $168.76 $390.75 $390.75 $405.78 $285.24 $303.03 $270.02 $261.94 "$1,454.00" $168.76 $163.71 $168.76 "$1,454.00" "$1,090.50" $168.76 $168.76 $168.76 $697.92 $697.92 "$1,151.57" $168.76 "$1,163.20" "$1,454.00" "$1,454.00" $168.76 $843.32 "$1,454.00" $176.84 $168.76 "$1,454.00" $168.76 N/A N/A 34100016 EAP CPT® 78216 LIVER/SPLEEN W/VASCU FLOW NUC BOTH IP/OP "$1,469.00" "$1,087.50" $103.51 "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" $104.52 $104.52 $112.35 "$1,469.00" $104.52 $271.22 $271.22 $281.65 $197.99 $306.16 $167.23 $165.62 "$1,469.00" $104.52 $103.51 $104.52 "$1,469.00" "$1,101.75" $104.52 $104.52 $104.52 $705.12 $705.12 "$1,163.45" $104.52 "$1,175.20" "$1,469.00" "$1,469.00" $104.52 $852.02 "$1,469.00" $105.17 $104.52 "$1,469.00" $104.52 N/A N/A 34100019 EAP CPT® 78262 GI REFLUX NUC BOTH IP/OP "$2,128.00" "$1,575.00" $200.57 "$2,128.00" "$2,128.00" "$2,128.00" "$2,128.00" "$2,128.00" $206.75 $206.75 $210.86 "$2,128.00" $206.75 $500.19 $500.19 $519.43 $365.13 $443.50 $330.80 $320.91 "$2,128.00" $206.75 $200.57 $206.75 "$2,128.00" "$1,596.00" $206.75 $206.75 $206.75 "$1,021.44" "$1,021.44" "$1,685.38" $206.75 "$1,702.40" "$2,128.00" "$2,128.00" $206.75 "$1,234.24" "$2,128.00" $212.86 $206.75 "$2,128.00" $206.75 N/A N/A 34100020 EAP CPT® 78264 GASTRIC EMPTYING NUC BOTH IP/OP "$3,115.00" "$2,305.50" $274.64 "$2,492.00" $754.23 $754.23 $754.23 $754.23 $370.81 $370.81 $369.17 $649.24 $370.81 $574.62 $574.62 $596.72 $419.47 $649.20 $593.29 $560.74 "$1,842.52" $370.81 $274.64 $370.81 $389.35 "$2,336.25" $370.81 $370.81 $370.81 "$1,495.20" "$1,495.20" "$2,467.08" $370.81 "$2,492.00" $611.83 $618.25 $370.81 "$1,806.70" $389.35 $536.46 $370.81 $649.17 $370.81 N/A N/A 34100021 EAP CPT® 78278 ACUTE GI BLEEDING IMAGING NUC BOTH IP/OP "$2,498.00" "$1,849.00" $282.42 "$2,498.00" "$2,498.00" "$2,498.00" "$2,498.00" "$2,498.00" $293.06 $293.06 $302.91 "$2,498.00" $293.06 $685.78 $685.78 $712.15 $500.61 $520.61 $468.90 $451.87 "$2,498.00" $293.06 $282.42 $293.06 "$2,498.00" "$1,873.50" $293.06 $293.06 $293.06 "$1,199.04" "$1,199.04" "$1,978.42" $293.06 "$1,998.40" "$2,498.00" "$2,498.00" $293.06 "$1,448.84" "$2,498.00" $309.03 $293.06 "$2,498.00" $293.06 N/A N/A 34100022 EAP CPT® 78290 BOWEL IMAGING MECKLES SCAN NUC BOTH IP/OP "$2,402.00" "$1,777.50" $279.37 "$2,402.00" "$2,402.00" "$2,402.00" "$2,402.00" "$2,402.00" $289.60 $289.60 $287.50 "$2,402.00" $289.60 $638.22 $638.22 $662.76 $465.89 $500.60 $463.36 $446.99 "$2,402.00" $289.60 $279.37 $289.60 "$2,402.00" "$1,801.50" $289.60 $289.60 $289.60 "$1,152.96" "$1,152.96" "$1,902.38" $289.60 "$1,921.60" "$2,402.00" "$2,402.00" $289.60 "$1,393.16" "$2,402.00" $306.14 $289.60 "$2,402.00" $289.60 N/A N/A 34100023 EAP CPT® 78291 SHUNT PATENCY LEVEEN/DENV NUC BOTH IP/OP "$2,255.00" "$1,669.00" $207.00 "$2,255.00" "$2,255.00" "$2,255.00" "$2,255.00" "$2,255.00" $213.65 $213.65 $217.98 "$2,255.00" $213.65 $478.47 $478.47 $496.88 $349.28 $469.97 $341.84 $331.20 "$2,255.00" $213.65 $207.00 $213.65 "$2,255.00" "$1,691.25" $213.65 $213.65 $213.65 "$1,082.40" "$1,082.40" "$1,785.96" $213.65 "$1,804.00" "$2,255.00" "$2,255.00" $213.65 "$1,307.90" "$2,255.00" $218.98 $213.65 "$2,255.00" $213.65 N/A N/A 34100024 EAP CPT® 78300 BONE IMAGING LIMITED NUC BOTH IP/OP "$1,481.00" "$1,096.00" $185.02 "$1,481.00" "$1,481.00" "$1,481.00" "$1,481.00" "$1,481.00" $192.93 $192.93 $199.91 "$1,481.00" $192.93 $336.30 $336.30 $349.24 $245.50 $308.66 $308.69 $296.03 "$1,481.00" $192.93 $185.02 $192.93 "$1,481.00" "$1,110.75" $192.93 $192.93 $192.93 $710.88 $710.88 "$1,172.95" $192.93 "$1,184.80" "$1,481.00" "$1,481.00" $192.93 $858.98 "$1,481.00" $204.58 $192.93 "$1,481.00" $192.93 N/A N/A 34100025 EAP CPT® 78306 NM BONE IMAGING WHOLE BODY BOTH IP/OP "$2,737.00" "$2,025.50" $238.79 "$2,189.60" $563.34 $563.34 $563.34 $563.34 $370.81 $370.81 $369.17 $570.46 $370.81 $502.02 $502.02 $521.33 $366.47 $570.42 $593.29 $560.74 "$1,618.94" $370.81 $238.79 $370.81 $389.35 "$2,052.75" $370.81 $370.81 $370.81 "$1,313.76" "$1,313.76" "$2,167.70" $370.81 "$2,189.60" $611.83 $543.23 $370.81 "$1,587.46" $389.35 $536.46 $370.81 $570.39 $370.81 N/A N/A 34100026 EAP CPT® 78315 NM BONE IMAGING 3 PHASE STUDY BOTH IP/OP "$2,737.00" "$2,025.50" $279.03 "$2,737.00" "$2,737.00" "$2,737.00" "$2,737.00" "$2,737.00" $289.60 $289.60 $301.14 "$2,737.00" $289.60 $683.05 $683.05 $709.32 $498.62 $570.42 $463.36 $446.45 "$2,737.00" $289.60 $279.03 $289.60 "$2,737.00" "$2,052.75" $289.60 $289.60 $289.60 "$1,313.76" "$1,313.76" "$2,167.70" $289.60 "$2,189.60" "$2,737.00" "$2,737.00" $289.60 "$1,587.46" "$2,737.00" $305.42 $289.60 "$2,737.00" $289.60 N/A N/A 34100028 EAP CPT® 78445 CERETEC VASCULAR FLOW IMAGING BOTH IP/OP "$1,584.00" "$1,172.50" $174.87 "$1,584.00" "$1,584.00" "$1,584.00" "$1,584.00" "$1,584.00" $180.84 $180.84 $178.29 "$1,584.00" $180.84 $342.22 $342.22 $355.38 $249.82 $330.12 $289.34 $279.79 "$1,584.00" $180.84 $174.87 $180.84 "$1,584.00" "$1,188.00" $180.84 $180.84 $180.84 $760.32 $760.32 "$1,254.53" $180.84 "$1,267.20" "$1,584.00" "$1,584.00" $180.84 $918.72 "$1,584.00" $175.76 $180.84 "$1,584.00" $180.84 N/A N/A 34100029 EAP CPT® 78453 CARDIAC SCAN THALLIUM (PLANAR) BOTH IP/OP "$5,102.00" "$3,775.50" $229.66 "$5,102.00" "$5,102.00" "$5,102.00" "$5,102.00" "$5,102.00" $240.94 $240.94 $260.31 "$5,102.00" $240.94 $568.46 $568.46 $590.33 $414.97 "$1,063.31" $385.50 $367.46 "$5,102.00" $240.94 $229.66 $240.94 "$5,102.00" "$3,826.50" $240.94 $240.94 $240.94 "$2,448.96" "$2,448.96" "$4,040.78" $240.94 "$4,081.60" "$5,102.00" "$5,102.00" $240.94 "$2,959.16" "$5,102.00" $261.12 $240.94 "$5,102.00" $240.94 N/A N/A 34100030 EAP CPT® 78451 CARDIAC PERFUSION SINGLE NUC BOTH IP/OP "$6,945.00" "$5,139.50" $255.70 "$5,556.00" $760.33 $760.33 $760.33 $760.33 "$1,285.45" "$1,285.45" "$1,279.77" "$1,447.51" "$1,285.45" $634.33 $634.33 $658.72 $463.05 "$1,447.41" "$2,056.72" "$1,914.80" "$4,107.97" "$1,285.45" $255.70 "$1,285.45" "$1,349.73" "$5,208.75" "$1,285.45" "$1,285.45" "$1,285.45" "$3,333.60" "$3,333.60" "$5,500.44" "$1,285.45" "$5,556.00" "$2,121.00" "$1,378.41" "$1,285.45" "$4,028.10" "$1,349.73" "$1,859.73" "$1,285.45" "$1,447.34" "$1,285.45" N/A N/A 34100031 EAP CPT® 78452 CARDIAC SCAN BOTH IP/OP "$9,411.00" "$6,964.50" $367.66 "$7,528.80" "$1,056.18" "$1,056.18" "$1,056.18" "$1,056.18" "$1,285.45" "$1,285.45" "$1,279.77" "$1,961.49" "$1,285.45" $928.32 $928.32 $964.03 $677.67 "$1,961.36" "$2,056.72" "$1,914.80" "$5,566.61" "$1,285.45" $367.66 "$1,285.45" "$1,349.73" "$7,058.25" "$1,285.45" "$1,285.45" "$1,285.45" "$4,517.28" "$4,517.28" "$7,453.51" "$1,285.45" "$7,528.80" "$2,121.00" "$1,867.85" "$1,285.45" "$5,458.38" "$1,349.73" "$1,859.73" "$1,285.45" "$1,961.25" "$1,285.45" N/A N/A 34100032 EAP CPT® 78472 CARDIAC SCAN GATED NUC BOTH IP/OP "$3,623.00" "$2,681.50" $169.80 "$2,898.40" $512.01 $512.01 $512.01 $512.01 $370.81 $370.81 $369.17 $755.12 $370.81 $519.79 $519.79 $539.78 $379.44 $755.07 $593.29 $560.74 "$2,143.00" $370.81 $169.80 $370.81 $389.35 "$2,717.25" $370.81 $370.81 $370.81 "$1,739.04" "$1,739.04" "$2,869.42" $370.81 "$2,898.40" $611.83 $719.07 $370.81 "$2,101.34" $389.35 $536.46 $370.81 $755.03 $370.81 N/A N/A 34100034 EAP CPT® 78580 PULM (LUNG) PERFUSION IMAG BOTH IP/OP "$2,905.00" "$2,150.00" $189.07 "$2,324.00" $535.78 $535.78 $535.78 $535.78 $370.81 $370.81 $369.17 $605.47 $370.81 $418.26 $418.26 $434.34 $305.32 $605.43 $593.29 $560.74 "$1,718.31" $370.81 $189.07 $370.81 $389.35 "$2,178.75" $370.81 $370.81 $370.81 "$1,394.40" "$1,394.40" "$2,300.76" $370.81 "$2,324.00" $611.83 $576.57 $370.81 "$1,684.90" $389.35 $536.46 $370.81 $605.40 $370.81 N/A N/A 34100038 EAP CPT® 78606 BRAIN SCAN W/VASCULAR FLO NUC BOTH IP/OP "$2,511.00" "$1,858.50" $278.36 "$2,511.00" "$2,511.00" "$2,511.00" "$2,511.00" "$2,511.00" $289.60 $289.60 $288.68 "$2,511.00" $289.60 $660.09 $660.09 $685.48 $481.86 $523.32 $463.36 $445.38 "$2,511.00" $289.60 $278.36 $289.60 "$2,511.00" "$1,883.25" $289.60 $289.60 $289.60 "$1,205.28" "$1,205.28" "$1,988.71" $289.60 "$2,008.80" "$2,511.00" "$2,511.00" $289.60 "$1,456.38" "$2,511.00" $308.31 $289.60 "$2,511.00" $289.60 N/A N/A 34100040 EAP CPT® 78630 CISTERNOGRAPHY NUC BOTH IP/OP "$1,521.00" "$1,126.00" $285.80 "$1,521.00" "$1,521.00" "$1,521.00" "$1,521.00" "$1,521.00" $297.55 $297.55 $293.72 "$1,521.00" $297.55 $700.89 $700.89 $727.84 $511.64 $316.99 $476.08 $457.28 "$1,521.00" $297.55 $285.80 $297.55 "$1,521.00" "$1,140.75" $297.55 $297.55 $297.55 $730.08 $730.08 "$1,204.63" $297.55 "$1,216.80" "$1,521.00" "$1,521.00" $297.55 $882.18 "$1,521.00" $313.71 $297.55 "$1,521.00" $297.55 N/A N/A 34100041 EAP CPT® 78701 KIDNEY IMAG W/VASCUL FLO NUC BOTH IP/OP "$4,099.00" "$3,033.50" $190.43 "$4,099.00" "$4,099.00" "$4,099.00" "$4,099.00" "$4,099.00" $192.93 $192.93 $191.67 "$4,099.00" $192.93 $443.66 $443.66 $460.73 $323.87 $854.28 $308.69 $304.69 "$4,099.00" $192.93 $190.43 $192.93 "$4,099.00" "$3,074.25" $192.93 $192.93 $192.93 "$1,967.52" "$1,967.52" "$3,246.41" $192.93 "$3,279.20" "$4,099.00" "$4,099.00" $192.93 "$2,377.42" "$4,099.00" $200.61 $192.93 "$4,099.00" $192.93 N/A N/A 34100042 EAP CPT® 78707 KID.IMG.MOR.W/VAS.SINGLEW/O PH BOTH IP/OP "$3,679.00" "$2,722.50" $176.90 "$2,943.20" $521.20 $521.20 $521.20 $521.20 $481.37 $481.37 $479.24 $766.80 $481.37 $466.46 $466.46 $484.40 $340.51 $766.74 $770.19 $727.82 "$2,176.13" $481.37 $176.90 $481.37 $505.44 "$2,759.25" $481.37 $481.37 $481.37 "$1,765.92" "$1,765.92" "$2,913.77" $481.37 "$2,943.20" $794.26 $730.19 $481.37 "$2,133.82" $505.44 $696.42 $481.37 $766.70 $481.37 N/A N/A 34100043 EAP CPT® 78708 KID.IMG.MOR.W/VAS.SINGLEW/PHAR BOTH IP/OP "$3,968.00" "$2,936.50" $120.08 "$3,174.40" $393.22 $393.22 $393.22 $393.22 $481.37 $481.37 $479.24 $827.03 $481.37 $324.90 $324.90 $337.39 $237.17 $826.97 $770.19 $727.82 "$2,347.07" $481.37 $120.08 $481.37 $505.44 "$2,976.00" $481.37 $481.37 $481.37 "$1,904.64" "$1,904.64" "$3,142.66" $481.37 "$3,174.40" $794.26 $787.55 $481.37 "$2,301.44" $505.44 $696.42 $481.37 $826.93 $481.37 N/A N/A 34100044 EAP CPT® 78709 KID.IMG.MOR.W/VAS.MULTI W&W/O BOTH IP/OP "$3,969.00" "$2,937.50" $284.12 "$3,175.20" $817.06 $817.06 $817.06 $817.06 $481.37 $481.37 $479.24 $827.24 $481.37 $686.09 $686.09 $712.48 $500.84 $827.18 $770.19 $727.82 "$2,347.66" $481.37 $284.12 $481.37 $505.44 "$2,976.75" $481.37 $481.37 $481.37 "$1,905.12" "$1,905.12" "$3,143.45" $481.37 "$3,175.20" $794.26 $787.75 $481.37 "$2,302.02" $505.44 $696.42 $481.37 $827.14 $481.37 N/A N/A 34100045 EAP CPT® 78740 VOIDING CYSTOGRAM NUC BOTH IP/OP "$3,569.00" "$2,641.50" $180.28 "$3,569.00" "$3,569.00" "$3,569.00" "$3,569.00" "$3,569.00" $186.71 $186.71 $191.97 "$3,569.00" $186.71 $428.28 $428.28 $444.75 $312.64 $743.82 $298.74 $288.45 "$3,569.00" $186.71 $180.28 $186.71 "$3,569.00" "$2,676.75" $186.71 $186.71 $186.71 "$1,713.12" "$1,713.12" "$2,826.65" $186.71 "$2,855.20" "$3,569.00" "$3,569.00" $186.71 "$2,070.02" "$3,569.00" $195.93 $186.71 "$3,569.00" $186.71 N/A N/A 34100046 EAP CPT® 78800 NM RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING BOTH IP/OP "$1,356.00" "$1,003.50" $208.01 "$1,084.80" $431.57 $431.57 $431.57 $431.57 $370.81 $370.81 $369.17 $282.62 $370.81 $367.43 $367.43 $381.56 $268.22 $282.61 $593.29 $560.74 $802.07 $370.81 $208.01 $370.81 $389.35 "$1,017.00" $370.81 $370.81 $370.81 $650.88 $650.88 "$1,073.95" $370.81 "$1,084.80" $611.83 $269.13 $370.81 $786.48 $389.35 $536.46 $370.81 $282.59 $370.81 N/A N/A 34100047 EAP CPT® 78801 NM RP LOCLZJ TUM PLNR 2+ AREAS OR 2+ DAYS BOTH IP/OP "$1,295.00" $958.50 $224.59 "$1,295.00" "$1,295.00" "$1,295.00" "$1,295.00" "$1,295.00" $234.72 $234.72 $245.77 "$1,295.00" $234.72 $502.02 $502.02 $521.33 $366.47 $269.89 $375.55 $359.34 "$1,295.00" $234.72 $224.59 $234.72 "$1,295.00" $971.25 $234.72 $234.72 $234.72 $621.60 $621.60 "$1,025.64" $234.72 "$1,036.00" "$1,295.00" "$1,295.00" $234.72 $751.10 "$1,295.00" $255.72 $234.72 "$1,295.00" $234.72 N/A N/A 34100048 EAP CPT® 78802 TUMOR SINGLE DAY BOTH IP/OP "$1,371.00" "$1,015.00" $255.02 "$1,371.00" "$1,371.00" "$1,371.00" "$1,371.00" "$1,371.00" $265.46 $265.46 $272.44 "$1,371.00" $265.46 $680.45 $680.45 $706.62 $496.72 $285.73 $424.74 $408.03 "$1,371.00" $265.46 $255.02 $265.46 "$1,371.00" "$1,028.25" $265.46 $265.46 $265.46 $658.08 $658.08 "$1,085.83" $265.46 "$1,096.80" "$1,371.00" "$1,371.00" $265.46 $795.18 "$1,371.00" $282.37 $265.46 "$1,371.00" $265.46 N/A N/A 34100049 EAP CPT® 78803 NM TUMOR LOCALALIZATION SPECT BOTH IP/OP "$4,783.00" "$3,539.50" $309.47 "$3,826.40" $765.70 $765.70 $765.70 $765.70 "$1,285.45" "$1,285.45" "$1,279.77" $996.90 "$1,285.45" $731.39 $731.39 $759.52 $533.91 $996.83 "$2,056.72" "$1,914.80" "$2,829.14" "$1,285.45" $309.47 "$1,285.45" "$1,349.73" "$3,587.25" "$1,285.45" "$1,285.45" "$1,285.45" "$2,295.84" "$2,295.84" "$3,788.14" "$1,285.45" "$3,826.40" "$2,121.00" $949.31 "$1,285.45" "$2,774.14" "$1,349.73" "$1,859.73" "$1,285.45" $996.78 "$1,285.45" N/A N/A 34100057 EAP CPT® 78451 MYOCARDIAL EJECTION FRACTION BOTH IP/OP "$6,142.00" "$4,545.50" $255.70 "$4,913.60" $760.33 $760.33 $760.33 $760.33 "$1,285.45" "$1,285.45" "$1,279.77" "$1,280.15" "$1,285.45" $634.33 $634.33 $658.72 $463.05 "$1,280.06" "$2,056.72" "$1,914.80" "$3,632.99" "$1,285.45" $255.70 "$1,285.45" "$1,349.73" "$4,606.50" "$1,285.45" "$1,285.45" "$1,285.45" "$2,948.16" "$2,948.16" "$4,864.46" "$1,285.45" "$4,913.60" "$2,121.00" "$1,219.03" "$1,285.45" "$3,562.36" "$1,349.73" "$1,859.73" "$1,285.45" "$1,279.99" "$1,285.45" N/A N/A 34100060 EAP CPT® 78804 TUMOR IMAGING WHOLE BODY NUC BOTH IP/OP "$2,500.00" "$1,850.00" $521.03 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $590.64 $590.64 $574.53 "$2,500.00" $590.64 "$1,253.14" "$1,253.14" "$1,301.34" $914.78 $521.03 $945.02 $901.02 "$2,500.00" $590.64 $563.14 $590.64 "$2,500.00" "$1,875.00" $590.64 $590.64 $590.64 "$1,200.00" "$1,200.00" "$1,980.00" $590.64 "$2,000.00" "$2,500.00" "$2,500.00" $590.64 "$1,450.00" "$2,500.00" $629.22 $590.64 "$2,500.00" $590.64 N/A N/A 34100062 EAP CPT® 78226 HEPATOBILIARY IMAG W GLBLDR BOTH IP/OP "$2,589.00" "$1,916.00" $271.93 "$2,071.20" $741.96 $741.96 $741.96 $741.96 $370.81 $370.81 $369.17 $539.61 $370.81 $738.89 $738.89 $767.31 $539.38 $539.58 $593.29 $560.74 "$1,531.39" $370.81 $271.93 $370.81 $389.35 "$1,941.75" $370.81 $370.81 $370.81 "$1,242.72" "$1,242.72" "$2,050.49" $370.81 "$2,071.20" $611.83 $513.85 $370.81 "$1,501.62" $389.35 $536.46 $370.81 $539.55 $370.81 N/A N/A 34100063 EAP CPT® 78227 HEPATOBIL IMAG PHARMA W GLBLDR BOTH IP/OP "$2,615.00" "$1,935.50" $370.03 "$2,615.00" "$2,615.00" "$2,615.00" "$2,615.00" "$2,615.00" $384.51 $384.51 $383.42 "$2,615.00" $384.51 "$1,026.06" "$1,026.06" "$1,065.53" $749.02 $544.99 $615.22 $592.05 "$2,615.00" $384.51 $370.03 $384.51 "$2,615.00" "$1,961.25" $384.51 $384.51 $384.51 "$1,255.20" "$1,255.20" "$2,071.08" $384.51 "$2,092.00" "$2,615.00" "$2,615.00" $384.51 "$1,516.70" "$2,615.00" $410.59 $384.51 "$2,615.00" $384.51 N/A N/A 34100064 EAP CPT® 78579 PULMONARY VENTILATION IMAGING BOTH IP/OP "$1,086.00" $804.00 $155.59 "$1,086.00" "$1,086.00" "$1,086.00" "$1,086.00" "$1,086.00" $159.78 $159.78 $162.66 "$1,086.00" $159.78 $381.40 $381.40 $396.07 $278.42 $226.33 $255.65 $248.94 "$1,086.00" $159.78 $155.59 $159.78 "$1,086.00" $814.50 $159.78 $159.78 $159.78 $521.28 $521.28 $860.11 $159.78 $868.80 "$1,086.00" "$1,086.00" $159.78 $629.88 "$1,086.00" $168.56 $159.78 "$1,086.00" $159.78 N/A N/A 34100065 EAP CPT® 78582 PULMON VENT IMAG W PERFUS BOTH IP/OP "$1,696.00" "$1,255.50" $263.48 "$1,356.80" $750.39 $750.39 $750.39 $750.39 $481.37 $481.37 $479.24 $353.49 $481.37 $684.86 $684.86 $711.20 $499.94 $353.47 $770.19 $727.82 "$1,003.18" $481.37 $263.48 $481.37 $505.44 "$1,272.00" $481.37 $481.37 $481.37 $814.08 $814.08 "$1,343.23" $481.37 "$1,356.80" $794.26 $336.61 $481.37 $983.68 $505.44 $696.42 $481.37 $353.45 $481.37 N/A N/A 34100066 EAP CPT® 78598 QUANT DIFF PULM PERFU + VENT BOTH IP/OP "$1,700.00" "$1,258.00" $246.23 "$1,700.00" "$1,700.00" "$1,700.00" "$1,700.00" "$1,700.00" $256.83 $256.83 $264.45 "$1,700.00" $256.83 $662.58 $662.58 $688.07 $483.68 $354.30 $410.93 $393.97 "$1,700.00" $256.83 $246.23 $256.83 "$1,700.00" "$1,275.00" $256.83 $256.83 $256.83 $816.00 $816.00 "$1,346.40" $256.83 "$1,360.00" "$1,700.00" "$1,700.00" $256.83 $986.00 "$1,700.00" $271.57 $256.83 "$1,700.00" $256.83 N/A N/A 34100067 EAP CPT® 78597 QUANT DIFF PULM PERFUSION BOTH IP/OP "$1,086.00" $804.00 $156.27 "$1,086.00" "$1,086.00" "$1,086.00" "$1,086.00" "$1,086.00" $162.88 $162.88 $175.94 "$1,086.00" $162.88 $408.86 $408.86 $424.58 $298.46 $226.33 $260.61 $250.03 "$1,086.00" $162.88 $156.27 $162.88 "$1,086.00" $814.50 $162.88 $162.88 $162.88 $521.28 $521.28 $860.11 $162.88 $868.80 "$1,086.00" "$1,086.00" $162.88 $629.88 "$1,086.00" $170.72 $162.88 "$1,086.00" $162.88 N/A N/A 34100070 EAP CPT® 78645 SHUNT EVALUATION BOTH IP/OP $922.00 $682.50 $192.15 $922.00 $922.00 $922.00 $922.00 $922.00 $288.91 $288.91 $281.63 $922.00 $288.91 $652.41 $652.41 $677.51 $476.26 $192.15 $462.26 $444.83 $922.00 $288.91 $278.02 $288.91 $922.00 $691.50 $288.91 $288.91 $288.91 $442.56 $442.56 $730.22 $288.91 $737.60 $922.00 $922.00 $288.91 $534.76 $922.00 $306.14 $288.91 $922.00 $288.91 N/A N/A 34100072 EAP CPT® 78012 THYROID UPTAKE SING/MULTI INC SUPRES DISCH BOTH IP/OP "$4,484.00" "$3,318.50" $70.91 "$4,484.00" "$4,484.00" "$4,484.00" "$4,484.00" "$4,484.00" $73.43 $73.43 $70.91 "$4,484.00" $73.43 $185.90 $185.90 $193.05 $135.71 $934.51 $117.49 $116.91 "$4,484.00" $73.43 $73.07 $73.43 "$4,484.00" "$3,363.00" $73.43 $73.43 $73.43 "$2,152.32" "$2,152.32" "$3,551.33" $73.43 "$3,587.20" "$4,484.00" "$4,484.00" $73.43 "$2,600.72" "$4,484.00" $74.19 $73.43 "$4,484.00" $73.43 N/A N/A 34100073 EAP CPT® 78013 THYROID IMAGING BOTH IP/OP "$2,280.00" "$1,687.50" $163.03 "$2,280.00" "$2,280.00" "$2,280.00" "$2,280.00" "$2,280.00" $172.21 $172.21 $170.08 "$2,280.00" $172.21 $484.05 $484.05 $502.66 $353.35 $475.18 $275.54 $260.85 "$2,280.00" $172.21 $163.03 $172.21 "$2,280.00" "$1,710.00" $172.21 $172.21 $172.21 "$1,094.40" "$1,094.40" "$1,805.76" $172.21 "$1,824.00" "$2,280.00" "$2,280.00" $172.21 "$1,322.40" "$2,280.00" $179.36 $172.21 "$2,280.00" $172.21 N/A N/A 34100074 EAP CPT® 78014 THYROID IMAGING W/MULTI DETERM INC SUPRS/DC BOTH IP/OP "$5,018.00" "$3,713.50" $201.93 "$4,014.40" $541.91 $541.91 $541.91 $541.91 $370.81 $370.81 $369.17 "$1,045.88" $370.81 $550.89 $550.89 $572.08 $402.14 "$1,045.81" $593.29 $560.74 "$2,968.15" $370.81 $201.93 $370.81 $389.35 "$3,763.50" $370.81 $370.81 $370.81 "$2,408.64" "$2,408.64" "$3,974.26" $370.81 "$4,014.40" $611.83 $995.95 $370.81 "$2,910.44" $389.35 $536.46 $370.81 "$1,045.75" $370.81 N/A N/A 34100075 EAP CPT® 78071 PARATHYRD PLANAR W/WO SUBTRJ BOTH IP/OP "$1,132.00" $838.00 $235.92 "$1,132.00" "$1,132.00" "$1,132.00" "$1,132.00" "$1,132.00" $285.11 $285.11 $306.45 "$1,132.00" $285.11 $768.59 $768.59 $798.15 $561.06 $235.92 $456.18 $439.42 "$1,132.00" $285.11 $274.64 $285.11 "$1,132.00" $849.00 $285.11 $285.11 $285.11 $543.36 $543.36 $896.54 $285.11 $905.60 "$1,132.00" "$1,132.00" $285.11 $656.56 "$1,132.00" $304.70 $285.11 "$1,132.00" $285.11 N/A N/A 34100076 EAP CPT® 78072 PARATHYRD PLANAR W/SPECT&CT BOTH IP/OP "$3,095.00" "$2,290.50" $338.90 "$2,476.00" $690.25 $690.25 $690.25 $690.25 $481.37 $481.37 $479.24 $645.08 $481.37 $785.72 $785.72 $815.94 $573.57 $645.03 $770.19 $727.82 "$1,830.69" $481.37 $338.90 $481.37 $505.44 "$2,321.25" $481.37 $481.37 $481.37 "$1,485.60" "$1,485.60" "$2,451.24" $481.37 "$2,476.00" $794.26 $614.28 $481.37 "$1,795.10" $505.44 $696.42 $481.37 $645.00 $481.37 N/A N/A 34100077 EAP CPT® 78831 RP LOCLZJ TUM SPECT 2 AREA/SEP ACQUISJ IMG BOTH IP/OP "$2,001.00" "$1,481.00" #N/A #N/A "$2,001.00" "$2,001.00" "$2,001.00" "$2,001.00" $604.80 $604.80 $617.44 "$2,001.00" $604.80 "$1,480.71" "$1,480.71" "$1,537.66" "$1,080.91" $417.03 $967.68 #N/A "$2,001.00" $604.80 #N/A $604.80 "$2,001.00" "$1,500.75" $604.80 $604.80 $604.80 $960.48 $960.48 "$1,584.79" $604.80 "$1,600.80" "$2,001.00" "$2,001.00" $604.80 "$1,160.58" "$2,001.00" $643.26 $604.80 "$2,001.00" $604.80 N/A N/A 34100080 EAP CPT® 78830 NM RP LOCLZJ TUM SPECT W/CT 1 BOTH IP/OP "$3,129.00" "$2,315.50" $385.24 "$3,129.00" "$3,129.00" "$3,129.00" "$3,129.00" "$3,129.00" $404.27 $404.27 $427.82 "$3,129.00" $404.27 $997.36 $997.36 "$1,035.72" $728.06 $652.12 $646.83 $616.38 "$3,129.00" $404.27 $385.24 $404.27 "$3,129.00" "$2,346.75" $404.27 $404.27 $404.27 "$1,501.92" "$1,501.92" "$2,478.17" $404.27 "$2,503.20" "$3,129.00" "$3,129.00" $404.27 "$1,814.82" "$3,129.00" $433.29 $404.27 "$3,129.00" $404.27 N/A N/A 34100081 EAP CPT® 78832 RP LOCLZJ TUM SPECT CT 2AREA/SEP ACQUISJ IMG BOTH IP/OP "$3,547.00" "$2,625.00" #N/A #N/A "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" $799.21 $799.21 $804.42 "$3,547.00" $799.21 "$1,954.92" "$1,954.92" "$2,030.11" "$1,427.07" $739.23 "$1,278.74" #N/A "$3,547.00" $799.21 #N/A $799.21 "$3,547.00" "$2,660.25" $799.21 $799.21 $799.21 "$1,702.56" "$1,702.56" "$2,809.22" $799.21 "$2,837.60" "$3,547.00" "$3,547.00" $799.21 "$2,057.26" "$3,547.00" $849.28 $799.21 "$3,547.00" $799.21 N/A N/A 34200013 EAP CPT® 79005 INIT HYPERTHYROID THERAPY NUC BOTH IP/OP "$2,958.00" "$2,189.00" $51.76 "$2,366.40" $298.89 $298.89 $298.89 $298.89 $248.90 $248.90 $247.80 $616.52 $248.90 $155.69 $155.69 $161.68 $113.65 $616.48 $398.24 $360.27 "$1,749.66" $248.90 $51.76 $248.90 $261.34 "$2,218.50" $248.90 $248.90 $248.90 "$1,419.84" "$1,419.84" "$2,342.74" $248.90 "$2,366.40" $410.68 $587.09 $248.90 "$1,715.64" $261.34 $360.10 $248.90 $616.45 $248.90 N/A N/A 34200014 EAP CPT® 77316 BRACHYTHER PLAN SIMPLE BOTH IP/OP $904.00 $669.00 $172.84 $723.20 $410.06 $410.06 $410.06 $410.06 $333.11 $333.11 $331.64 $188.42 $333.11 $285.20 $285.20 $296.17 $208.19 $188.40 $532.97 $517.51 $534.72 $333.11 $172.84 $333.11 $349.76 $678.00 $333.11 $333.11 $333.11 $433.92 $433.92 $715.97 $333.11 $723.20 $549.63 $179.42 $333.11 $524.32 $349.76 $481.92 $333.11 $188.39 $333.11 N/A N/A 34200015 EAP CPT® 77317 BRACHYTHER PLAN INTER BOTH IP/OP "$1,196.00" $885.50 $227.98 $956.80 $534.20 $534.20 $534.20 $534.20 $333.11 $333.11 $331.64 $249.28 $333.11 $371.63 $371.63 $385.93 $271.29 $249.26 $532.97 $517.51 $707.43 $333.11 $227.98 $333.11 $349.76 $897.00 $333.11 $333.11 $333.11 $574.08 $574.08 $947.23 $333.11 $956.80 $549.63 $237.38 $333.11 $693.68 $349.76 $481.92 $333.11 $249.25 $333.11 N/A N/A 34200016 EAP CPT® 79445 NUCLEAR RX INTRA-ARTERIAL BOTH IP/OP "$1,324.00" $980.00 $191.86 "$1,324.00" $456.92 $456.92 $456.92 $456.92 $248.90 $248.90 $247.80 $275.95 $248.90 $262.82 $262.82 $272.93 $191.86 $275.94 $398.24 $360.27 $783.15 $248.90 "$1,324.00" $248.90 $261.34 $993.00 $248.90 $248.90 $248.90 $635.52 $635.52 "$1,048.61" $248.90 "$1,059.20" $410.68 $262.78 $248.90 $767.92 $261.34 $360.10 $248.90 $275.92 $248.90 N/A N/A 34200017 EAP CPT® 77770 HDR BRACHYTX 1 CHANNEL BOTH IP/OP "$4,521.00" "$3,346.00" $246.91 "$3,616.80" $697.45 $697.45 $697.45 $697.45 $697.81 $697.81 $694.72 $942.29 $697.81 $554.68 $554.68 $576.02 $404.91 $942.23 "$1,116.50" "$1,041.20" "$2,674.17" $697.81 $246.91 $697.81 $732.70 "$3,390.75" $697.81 $697.81 $697.81 "$2,170.08" "$2,170.08" "$3,580.63" $697.81 "$3,616.80" "$1,151.39" $897.31 $697.81 "$2,622.18" $732.70 "$1,009.55" $697.81 $942.18 $697.81 N/A N/A 34200018 EAP CPT® 77771 HDR BRACHYTX 2-12 CHANNEL BOTH IP/OP "$5,523.00" "$4,087.50" $406.57 "$4,418.40" "$1,299.10" "$1,299.10" "$1,299.10" "$1,299.10" $697.81 $697.81 $694.72 "$1,151.13" $697.81 "$1,010.25" "$1,010.25" "$1,049.10" $737.47 "$1,151.05" "$1,116.50" "$1,041.20" "$3,266.85" $697.81 $406.57 $697.81 $732.70 "$4,142.25" $697.81 $697.81 $697.81 "$2,651.04" "$2,651.04" "$4,374.22" $697.81 "$4,418.40" "$1,151.39" "$1,096.18" $697.81 "$3,203.34" $732.70 "$1,009.55" $697.81 "$1,150.99" $697.81 N/A N/A 34200019 EAP CPT® 77772 HDR BRACHYTX OVER 12 CHAN BOTH IP/OP "$6,877.00" "$5,089.00" $614.65 "$6,877.00" "$6,877.00" "$6,877.00" "$6,877.00" "$6,877.00" $614.65 $614.65 $781.08 "$6,877.00" $614.65 "$1,594.37" "$1,594.37" "$1,655.69" "$1,163.88" "$1,433.24" $983.44 $994.72 "$6,877.00" $614.65 $621.70 $614.65 "$6,877.00" "$5,157.75" $614.65 $614.65 $614.65 "$3,300.96" "$3,300.96" "$5,446.58" $614.65 "$5,501.60" "$6,877.00" "$6,877.00" $614.65 "$3,988.66" "$6,877.00" $630.30 $614.65 "$6,877.00" $614.65 N/A N/A 34200020 EAP CPT® 79101 NM RADIOPHARM THERAPY IV ADMIN BOTH IP/OP $622.00 $460.50 $54.12 $497.60 $313.42 $313.42 $313.42 $313.42 $248.90 $248.90 $247.80 $129.64 $248.90 $169.30 $169.30 $175.81 $123.59 $129.63 $398.24 $360.27 $367.91 $248.90 $54.12 $248.90 $261.34 $466.50 $248.90 $248.90 $248.90 $298.56 $298.56 $492.62 $248.90 $497.60 $410.68 $123.45 $248.90 $360.76 $261.34 $360.10 $248.90 $129.62 $248.90 N/A N/A 34300001 EAP HCPCS A9500 "TC-99M SESTAMBI/CARDIOLITE, DX PER STUDY" BOTH IP/OP $516.00 $382.00 $102.41 $516.00 $516.00 $516.00 $516.00 $516.00 $516.00 $516.00 $516.00 $107.55 $516.00 $516.00 $516.00 $397.73 $268.84 $107.54 $516.00 $516.00 $305.21 $516.00 $516.00 $516.00 $516.00 $387.00 $516.00 $516.00 $516.00 $258.00 $258.00 $408.67 $516.00 $412.80 $335.40 $102.41 $516.00 $299.28 $516.00 $516.00 $516.00 $107.53 $516.00 N/A N/A 34300002 EAP HCPCS A9502 "TC-99M TETROFOSMIN MYOVIEW, DX PER STUDY" BOTH IP/OP $812.00 $601.00 $155.45 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $155.45 $812.00 $812.00 $812.00 $625.89 $423.05 $169.23 $812.00 $812.00 $480.30 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $161.16 $812.00 $470.96 $812.00 $812.00 $812.00 $169.22 $812.00 N/A N/A 34300003 EAP HCPCS A9503 "TC-99M MDP, DX UP TO 30 MCI" BOTH IP/OP $312.00 $231.00 $61.92 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $65.03 $312.00 $312.00 $312.00 $240.49 $162.55 $65.02 $312.00 $312.00 $184.55 $312.00 $312.00 $312.00 $312.00 $234.00 $312.00 $312.00 $312.00 $156.00 $156.00 $247.10 $312.00 $249.60 $202.80 $61.92 $312.00 $180.96 $312.00 $312.00 $312.00 $65.02 $312.00 N/A N/A 34300004 EAP HCPCS A9505 "TI-201 THALLOUS CHLORIDE, DX PER MCI" BOTH IP/OP $131.00 $97.00 $26.33 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $26.33 $131.00 $131.00 $131.00 $131.00 $100.97 $68.25 $27.30 $131.00 $52.40 $131.00 $131.00 $131.00 $131.00 $131.00 $98.25 $131.00 $131.00 $131.00 $65.50 $65.50 $103.75 $131.00 $104.80 $85.15 $131.00 $131.00 $75.98 $131.00 $78.60 $131.00 $131.00 $131.00 N/A N/A 34300005 EAP HCPCS A9516 "I-123, DX CAPSULE PER 100 UCI (MAX 999 UCI)" BOTH IP/OP "$2,008.00" "$1,486.00" $398.54 "$2,008.00" "$2,008.00" "$2,008.00" "$2,008.00" "$2,008.00" "$2,008.00" "$2,008.00" "$2,008.00" $418.52 "$2,008.00" "$2,008.00" "$2,008.00" "$1,547.77" "$1,046.17" $418.49 "$2,008.00" "$2,008.00" "$1,187.73" "$2,008.00" "$2,008.00" "$2,008.00" "$2,008.00" "$1,506.00" "$2,008.00" "$2,008.00" "$2,008.00" "$1,004.00" "$1,004.00" "$1,590.34" "$2,008.00" "$1,606.40" "$1,305.20" $398.54 "$2,008.00" "$1,164.64" "$2,008.00" "$2,008.00" "$2,008.00" $418.47 "$2,008.00" N/A N/A 34300006 EAP HCPCS A9521 99MTC CERETEC-LABLD - WBC BOTH IP/OP "$1,888.00" "$1,397.50" $393.48 "$1,888.00" "$1,888.00" "$1,888.00" "$1,888.00" "$1,888.00" "$1,888.00" "$1,888.00" "$1,307.10" "$1,888.00" "$1,888.00" "$1,888.00" "$1,888.00" "$1,455.27" $983.65 $393.48 "$1,888.00" $755.20 "$1,888.00" "$1,888.00" "$1,888.00" "$1,888.00" "$1,888.00" "$1,416.00" "$1,888.00" "$1,888.00" "$1,888.00" $944.00 $944.00 "$1,495.30" "$1,888.00" "$1,510.40" "$1,227.20" "$1,888.00" "$1,888.00" "$1,095.04" "$1,888.00" "$1,132.80" "$1,888.00" "$1,888.00" "$1,888.00" N/A N/A 34300007 EAP HCPCS A9537 "TC-99M MEBROFENIN, DX UP TO 15 MCI" BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $258.22 $174.54 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $217.75 $66.49 $335.00 $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A 34300008 EAP HCPCS A9539 "TC-99M PENTETATE (DTPA), DX UP TO 25 MCI" BOTH IP/OP $409.00 $303.00 $81.18 $409.00 $409.00 $409.00 $409.00 $409.00 $409.00 $409.00 $409.00 $85.25 $409.00 $409.00 $409.00 $315.26 $213.09 $85.24 $409.00 $409.00 $241.92 $409.00 $409.00 $409.00 $409.00 $306.75 $409.00 $409.00 $409.00 $204.50 $204.50 $323.93 $409.00 $327.20 $265.85 $81.18 $409.00 $237.22 $409.00 $409.00 $409.00 $85.24 $409.00 N/A N/A 34300009 EAP HCPCS A9540 "TC-99M MAAUC, DX UP TO 10 MCI" BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 34300010 EAP HCPCS A9541 "TC-99M SULFUR COLLOID, DX UP TO 20 MCI" BOTH IP/OP $523.00 $387.50 $103.80 $523.00 $523.00 $523.00 $523.00 $523.00 $523.00 $523.00 $523.00 $109.01 $523.00 $523.00 $523.00 $403.13 $272.48 $109.00 $523.00 $523.00 $309.35 $523.00 $523.00 $523.00 $523.00 $392.25 $523.00 $523.00 $523.00 $261.50 $261.50 $414.22 $523.00 $418.40 $339.95 $103.80 $523.00 $303.34 $523.00 $523.00 $523.00 $108.99 $523.00 N/A N/A 34300011 EAP HCPCS A9521 TC-99M EXAMETAZIME (CERETEC) UP TO 25 MCI BOTH IP/OP "$4,651.00" "$3,442.00" $969.32 "$4,651.00" "$4,651.00" "$4,651.00" "$4,651.00" "$4,651.00" "$4,651.00" "$4,651.00" "$1,307.10" "$4,651.00" "$4,651.00" "$4,651.00" "$4,651.00" "$3,584.99" "$2,060.15" $969.32 "$4,651.00" "$1,860.40" "$4,651.00" "$4,651.00" "$4,651.00" "$4,651.00" "$4,651.00" "$3,488.25" "$4,651.00" "$4,651.00" "$4,651.00" "$2,325.50" "$2,325.50" "$3,683.59" "$4,651.00" "$3,720.80" "$3,023.15" "$4,651.00" "$4,651.00" "$2,697.58" "$4,651.00" "$2,790.60" "$4,651.00" "$4,651.00" "$4,651.00" N/A N/A 34300016 EAP HCPCS A9582 "I-123 MIBG, DX UP TO 15 MCI" BOTH IP/OP "$10,753.00" "$7,957.50" "$2,060.15" "$10,753.00" "$10,753.00" "$10,753.00" "$10,753.00" "$10,753.00" "$10,753.00" "$10,753.00" "$4,251.01" "$10,753.00" "$10,753.00" "$4,181.12" "$4,181.12" "$8,288.41" "$2,060.15" "$2,241.04" "$10,753.00" "$4,301.20" "$10,753.00" "$10,753.00" "$10,753.00" "$10,753.00" "$10,753.00" "$8,064.75" "$10,753.00" "$10,753.00" "$10,753.00" "$5,376.50" "$5,376.50" "$8,516.38" "$10,753.00" "$8,602.40" "$6,989.45" "$10,753.00" "$10,753.00" "$6,236.74" "$10,753.00" "$6,451.80" "$10,753.00" "$10,753.00" "$10,753.00" N/A N/A 34300020 EAP HCPCS A9572 "IN-111 PENTETREOTIDE, DX UP TO 6 MCI" BOTH IP/OP "$12,489.00" "$9,242.00" "$2,060.15" "$12,489.00" "$12,489.00" "$12,489.00" "$12,489.00" "$12,489.00" "$12,489.00" "$12,489.00" "$4,684.43" "$12,489.00" "$12,489.00" "$12,489.00" "$12,489.00" "$9,626.52" "$2,060.15" "$2,602.84" "$12,489.00" "$4,995.60" "$12,489.00" "$12,489.00" "$12,489.00" "$12,489.00" "$12,489.00" "$9,366.75" "$12,489.00" "$12,489.00" "$12,489.00" "$6,244.50" "$6,244.50" "$9,891.29" "$12,489.00" "$9,991.20" "$8,117.85" "$12,489.00" "$12,489.00" "$7,243.62" "$12,489.00" "$7,493.40" "$12,489.00" "$12,489.00" "$12,489.00" N/A N/A 34300021 EAP HCPCS A9512 "TC-99M PERTECHNETATE, DX PER MCI" BOTH IP/OP $227.00 $168.00 $3.80 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $3.80 $227.00 $227.00 $227.00 $227.00 $174.97 $118.27 $47.31 $227.00 $90.80 $227.00 $227.00 $227.00 $227.00 $227.00 $170.25 $227.00 $227.00 $227.00 $113.50 $113.50 $179.78 $227.00 $181.60 $147.55 $227.00 $227.00 $131.66 $227.00 $136.20 $227.00 $227.00 $227.00 N/A N/A 34300024 EAP HCPCS A9520 "TC-99M TILMANOCEPT (LYMPHOSEEK), DX UP TO 0.5 MCI" BOTH IP/OP "$1,571.00" "$1,163.00" $311.80 "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" $327.44 "$1,571.00" "$1,571.00" "$1,571.00" "$1,210.93" $818.49 $327.41 "$1,571.00" "$1,571.00" $929.25 "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,178.25" "$1,571.00" "$1,571.00" "$1,571.00" $785.50 $785.50 "$1,244.23" "$1,571.00" "$1,256.80" "$1,021.15" $311.80 "$1,571.00" $911.18 "$1,571.00" "$1,571.00" "$1,571.00" $327.40 "$1,571.00" N/A N/A 34300025 EAP HCPCS A9580 "F-18 SODIUM FLUORIDE, DX UP TO 30 MCI" BOTH IP/OP $312.00 $231.00 $61.92 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $65.03 $312.00 $312.00 $312.00 $240.49 $162.55 $65.02 $312.00 $312.00 $184.55 $312.00 $312.00 $312.00 $312.00 $234.00 $312.00 $312.00 $312.00 $156.00 $156.00 $247.10 $312.00 $249.60 $202.80 $61.92 $312.00 $180.96 $312.00 $312.00 $312.00 $65.02 $312.00 N/A N/A 34300026 EAP HCPCS A9587 "GALLIUM GA-68, DOTATATE, DIAGNOSTIC" BOTH IP/OP "$8,000.00" "$5,920.00" $62.22 "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" $62.22 "$8,000.00" "$8,000.00" "$4,181.12" "$4,181.12" "$6,166.40" "$2,060.15" "$1,667.29" "$8,000.00" "$3,200.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$6,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$4,000.00" "$4,000.00" "$6,336.00" "$8,000.00" "$6,400.00" "$5,200.00" "$8,000.00" "$8,000.00" "$4,640.00" "$8,000.00" "$4,800.00" "$8,000.00" "$8,000.00" "$8,000.00" N/A N/A 34300027 EAP HCPCS A9588 "F-18 FLUCICLOVINE, DX PER MCI" BOTH IP/OP "$11,015.00" "$8,151.50" "$2,060.15" "$11,015.00" "$5,981.15" "$5,981.15" "$5,981.15" "$5,981.15" "$11,015.00" "$11,015.00" "$11,015.00" "$2,295.80" "$11,015.00" "$4,181.12" "$4,181.12" "$8,490.36" "$2,060.15" "$2,295.65" "$11,015.00" "$11,015.00" "$3,094.73" "$11,015.00" "$11,015.00" "$11,015.00" "$11,015.00" "$8,261.25" "$11,015.00" "$11,015.00" "$11,015.00" "$5,507.50" "$5,507.50" "$8,723.88" "$11,015.00" "$8,812.00" "$7,159.75" "$2,186.20" "$11,015.00" "$6,388.70" "$11,015.00" "$11,015.00" "$11,015.00" "$2,295.53" "$11,015.00" N/A N/A 34300028 EAP HCPCS A9584 "I-123 IOFLUPANE DX, UP TO 5 MCI" BOTH IP/OP "$6,000.00" "$4,440.00" "$1,250.47" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$2,369.28" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$4,624.80" "$2,060.15" "$1,250.47" "$6,000.00" "$2,400.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$4,500.00" "$6,000.00" "$6,000.00" "$6,000.00" "$3,000.00" "$3,000.00" "$4,752.00" "$6,000.00" "$4,800.00" "$3,900.00" "$6,000.00" "$6,000.00" "$3,480.00" "$6,000.00" "$3,600.00" "$6,000.00" "$6,000.00" "$6,000.00" N/A N/A 34300029 EAP HCPCS A9587 "GA-68 GALLIUM DOTATATE DX, PER 0.1 MCI" BOTH IP/OP $167.00 $124.00 $34.80 $167.00 $167.00 $167.00 $167.00 $167.00 $167.00 $167.00 $62.22 $167.00 $167.00 $123.95 $123.95 $128.72 $87.01 $34.80 $167.00 $66.80 $167.00 $167.00 $167.00 $167.00 $167.00 $125.25 $167.00 $167.00 $167.00 $83.50 $83.50 $132.26 $167.00 $133.60 $108.55 $167.00 $167.00 $96.86 $167.00 $100.20 $167.00 $167.00 $167.00 N/A N/A 34300030 EAP HCPCS A9538 TC-99M PYROPHOSPHATE UP TO 25 MCI BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" $924.96 $625.20 $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $780.00 $238.17 "$1,200.00" $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 34300031 EAP HCPCS A9592 "CU-64 COPPER DOTATATE, DX PER MCI" BOTH IP/OP "$9,250.00" "$6,845.00" $918.52 "$9,250.00" "$5,022.75" "$5,022.75" "$5,022.75" "$5,022.75" $918.52 $918.52 $918.52 "$1,927.93" $918.52 "$4,181.12" "$4,181.12" "$7,129.90" "$2,060.15" "$1,927.80" "$1,469.64" "$9,250.00" "$3,094.73" $918.52 "$9,250.00" $918.52 $964.45 "$6,937.50" $918.52 $918.52 $918.52 "$4,625.00" "$4,625.00" "$7,326.00" $918.52 "$7,400.00" "$6,012.50" "$1,835.89" $918.52 "$5,365.00" $964.45 "$1,331.86" $918.52 "$1,927.70" $918.52 N/A N/A 34300045 EAP HCPCS A9528 "I-131 SODIUM IODIDE CAP(S) DX, PER MCI" BOTH IP/OP $350.00 $259.00 $72.94 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $76.26 $350.00 $350.00 $350.00 $350.00 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 $350.00 $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A 34300046 EAP HCPCS A9529 "I-131 IODIDE SOL, DX EACH ADDL MCI (ADD ON TO 34300045)" BOTH IP/OP $26.00 $19.50 $5.42 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $20.04 $13.55 $5.42 $26.00 $10.40 $26.00 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $16.90 $26.00 $26.00 $15.08 $26.00 $15.60 $26.00 $26.00 $26.00 N/A N/A 34300047 EAP HCPCS A9531 "I-131 SODIUM IODIDE DX, PER UCI (UP TO 100 UCI)" BOTH IP/OP $236.00 $175.00 $3.27 $236.00 $236.00 $236.00 $236.00 $236.00 $236.00 $236.00 $3.27 $236.00 $236.00 $236.00 $236.00 $181.91 $122.96 $49.18 $236.00 $94.40 $236.00 $236.00 $236.00 $236.00 $236.00 $177.00 $236.00 $236.00 $236.00 $118.00 $118.00 $186.91 $236.00 $188.80 $153.40 $236.00 $236.00 $136.88 $236.00 $141.60 $236.00 $236.00 $236.00 N/A N/A 34300052 EAP HCPCS A9547 IN-111 OXYQUINOLINE DX PER 0.5 MCI BOTH IP/OP "$7,234.00" "$5,353.50" "$1,507.65" "$7,234.00" "$7,234.00" "$7,234.00" "$7,234.00" "$7,234.00" "$7,234.00" "$7,234.00" "$1,528.85" "$7,234.00" "$7,234.00" "$7,234.00" "$7,234.00" "$5,575.97" "$2,060.15" "$1,507.65" "$7,234.00" "$2,893.60" "$7,234.00" "$7,234.00" "$7,234.00" "$7,234.00" "$7,234.00" "$5,425.50" "$7,234.00" "$7,234.00" "$7,234.00" "$3,617.00" "$3,617.00" "$5,729.33" "$7,234.00" "$5,787.20" "$4,702.10" "$7,234.00" "$7,234.00" "$4,195.72" "$7,234.00" "$4,340.40" "$7,234.00" "$7,234.00" "$7,234.00" N/A N/A 34300055 EAP HCPCS A9554 "I-125 IOTHALAMATE, DX UP TO 10 UCI" BOTH IP/OP "$5,000.00" "$3,700.00" $25.20 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $25.20 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,854.00" "$2,060.15" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$3,250.00" "$5,000.00" "$5,000.00" "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 34300056 EAP HCPCS A9555 RB-82 RUBIDIUM DX UP TO 60 MCI BOTH IP/OP $300.00 $222.00 $62.52 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $218.91 $300.00 $300.00 $300.00 $300.00 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 $300.00 $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 34300057 EAP HCPCS A9557 TC-99M BICISATE DX UP TO 25 MCI BOTH IP/OP "$4,038.00" "$2,988.50" $267.91 "$4,038.00" "$4,038.00" "$4,038.00" "$4,038.00" "$4,038.00" "$4,038.00" "$4,038.00" $267.91 "$4,038.00" "$4,038.00" "$4,038.00" "$4,038.00" "$3,112.49" "$2,060.15" $841.56 "$4,038.00" "$1,615.20" "$4,038.00" "$4,038.00" "$4,038.00" "$4,038.00" "$4,038.00" "$3,028.50" "$4,038.00" "$4,038.00" "$4,038.00" "$2,019.00" "$2,019.00" "$3,198.10" "$4,038.00" "$3,230.40" "$2,624.70" "$4,038.00" "$4,038.00" "$2,342.04" "$4,038.00" "$2,422.80" "$4,038.00" "$4,038.00" "$4,038.00" N/A N/A 34300058 EAP HCPCS A9558 XE-133 XENON DX PER 10 MCI BOTH IP/OP $327.00 $242.00 $68.15 $327.00 $327.00 $327.00 $327.00 $327.00 $327.00 $327.00 $188.99 $327.00 $327.00 $327.00 $327.00 $252.05 $170.37 $68.15 $327.00 $130.80 $327.00 $327.00 $327.00 $327.00 $327.00 $245.25 $327.00 $327.00 $327.00 $163.50 $163.50 $258.98 $327.00 $261.60 $212.55 $327.00 $327.00 $189.66 $327.00 $196.20 $327.00 $327.00 $327.00 N/A N/A 34300060 EAP HCPCS A9561 TC-99M OXIDRONATE DX UP TO 30 MCI BOTH IP/OP $113.00 $84.00 $23.55 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $36.04 $113.00 $113.00 $113.00 $113.00 $87.10 $58.87 $23.55 $113.00 $45.20 $113.00 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $73.45 $113.00 $113.00 $65.54 $113.00 $67.80 $113.00 $113.00 $113.00 N/A N/A 34300062 EAP HCPCS A9567 TC-99M AEROSOL DX UP TO 75 MCI BOTH IP/OP $367.00 $272.00 $16.45 $367.00 $367.00 $367.00 $367.00 $367.00 $367.00 $367.00 $16.45 $367.00 $367.00 $367.00 $367.00 $282.88 $191.21 $76.49 $367.00 $146.80 $367.00 $367.00 $367.00 $367.00 $367.00 $275.25 $367.00 $367.00 $367.00 $183.50 $183.50 $290.66 $367.00 $293.60 $238.55 $367.00 $367.00 $212.86 $367.00 $220.20 $367.00 $367.00 $367.00 N/A N/A 34300064 EAP HCPCS A9569 TC-99M AUTO WBC DX PER STUDY BOTH IP/OP "$5,981.00" "$4,426.00" "$1,246.51" "$5,981.00" "$5,981.00" "$5,981.00" "$5,981.00" "$5,981.00" "$5,981.00" "$5,981.00" "$1,307.10" "$5,981.00" "$5,981.00" "$5,981.00" "$5,981.00" "$4,610.15" "$2,060.15" "$1,246.51" "$5,981.00" "$2,392.40" "$5,981.00" "$5,981.00" "$5,981.00" "$5,981.00" "$5,981.00" "$4,485.75" "$5,981.00" "$5,981.00" "$5,981.00" "$2,990.50" "$2,990.50" "$4,736.95" "$5,981.00" "$4,784.80" "$3,887.65" "$5,981.00" "$5,981.00" "$3,468.98" "$5,981.00" "$3,588.60" "$5,981.00" "$5,981.00" "$5,981.00" N/A N/A 34300065 EAP HCPCS A9570 IN-111 INDIUM AUTO WBC DX PER STUDY BOTH IP/OP "$7,590.00" "$5,617.00" "$1,581.84" "$7,590.00" "$7,590.00" "$7,590.00" "$7,590.00" "$7,590.00" "$7,590.00" "$7,590.00" "$2,574.90" "$7,590.00" "$7,590.00" "$7,590.00" "$7,590.00" "$5,850.37" "$2,060.15" "$1,581.84" "$7,590.00" "$3,036.00" "$7,590.00" "$7,590.00" "$7,590.00" "$7,590.00" "$7,590.00" "$5,692.50" "$7,590.00" "$7,590.00" "$7,590.00" "$3,795.00" "$3,795.00" "$6,011.28" "$7,590.00" "$6,072.00" "$4,933.50" "$7,590.00" "$7,590.00" "$4,402.20" "$7,590.00" "$4,554.00" "$7,590.00" "$7,590.00" "$7,590.00" N/A N/A 34300066 EAP HCPCS A9571 IN-111 INDIUM AUTO PLATELET DX PER STUDY BOTH IP/OP "$7,263.00" "$5,375.00" "$1,513.69" "$7,263.00" "$7,263.00" "$7,263.00" "$7,263.00" "$7,263.00" "$7,263.00" "$7,263.00" "$2,574.90" "$7,263.00" "$7,263.00" "$7,263.00" "$7,263.00" "$5,598.32" "$2,060.15" "$1,513.69" "$7,263.00" "$2,905.20" "$7,263.00" "$7,263.00" "$7,263.00" "$7,263.00" "$7,263.00" "$5,447.25" "$7,263.00" "$7,263.00" "$7,263.00" "$3,631.50" "$3,631.50" "$5,752.30" "$7,263.00" "$5,810.40" "$4,720.95" "$7,263.00" "$7,263.00" "$4,212.54" "$7,263.00" "$4,357.80" "$7,263.00" "$7,263.00" "$7,263.00" N/A N/A 34400001 EAP HCPCS A9527 I-125 SODIUM IOTHALAMATE THERAPEUTIC PER UCI BOTH IP/OP $207.00 $153.50 $40.37 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $58.54 $40.37 $43.14 $207.00 N/A N/A 34400013 EAP HCPCS A9606 RA-223 RADIUM DICHLORIDE THER PER UCI BOTH IP/OP $356.00 $263.50 $70.66 $391.00 $193.31 $193.31 $193.31 $193.31 $148.93 $148.93 $148.93 $74.20 $148.93 $264.22 $264.22 $274.40 $185.48 $74.19 $238.28 $391.00 $210.57 $148.93 $356.00 $148.93 $156.37 $267.00 $148.93 $148.93 $148.93 $178.00 $178.00 $281.95 $148.93 $284.80 $231.40 $70.66 $148.93 $206.48 $156.37 $215.94 $148.93 $162.25 $148.93 N/A N/A 35000001 EAP CPT® 73200 CT UPPER EXT W/O DYE BILAT BOTH IP/OP "$7,981.00" "$5,906.00" $106.62 "$6,384.80" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 "$1,663.44" $107.09 $785.72 $785.72 $815.94 $573.58 "$1,663.33" $171.35 $154.19 "$1,106.00" $107.09 $122.77 $107.09 $112.45 "$5,985.75" $107.09 $107.09 $107.09 "$2,172.00" "$1,846.00" "$6,320.95" $107.09 "$6,384.80" $540.00 "$1,584.03" $107.09 "$4,628.98" $112.45 $154.94 $107.09 "$1,663.24" $107.09 N/A N/A 35000002 EAP CPT® 73201 CT UPPER EXT W/DYE BILAT BOTH IP/OP "$8,891.00" "$6,579.50" $156.93 "$7,112.80" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $362.23 $362.23 $360.63 "$1,853.11" $362.23 $785.72 $785.72 $815.94 $573.58 "$1,852.98" $579.58 $531.51 "$1,106.00" $362.23 $156.93 $362.23 $380.35 "$6,668.25" $362.23 $362.23 $362.23 "$1,025.00" $871.00 "$7,041.67" $362.23 "$7,112.80" $540.00 "$1,764.64" $362.23 "$5,156.78" $380.35 $524.06 $362.23 "$1,852.88" $362.23 N/A N/A 35000003 EAP CPT® 73202 CT UPPER EXT W/O&W/DYE BILAT BOTH IP/OP "$9,863.00" "$7,299.00" $205.30 "$9,863.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $213.03 $213.03 $239.34 "$9,863.00" $213.03 "$9,863.00" "$9,863.00" "$9,863.00" "$9,863.00" "$2,055.56" $340.85 $328.48 "$1,106.00" $213.03 $205.30 $213.03 "$9,863.00" "$7,397.25" $213.03 $213.03 $213.03 "$1,221.00" "$1,038.00" "$7,811.50" $213.03 "$7,890.40" $540.00 "$9,863.00" $213.03 "$5,720.54" "$9,863.00" $219.34 $213.03 "$9,863.00" $213.03 N/A N/A 35000007 EAP CPT® 73702 CT LOWER EXT W/O&W/DYE BOTH IP/OP "$6,038.00" "$4,468.50" $147.46 "$6,038.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $150.52 $150.52 $182.24 "$6,038.00" $150.52 "$6,038.00" "$6,038.00" "$6,038.00" "$6,038.00" "$1,258.39" $240.83 $235.94 "$1,106.00" $150.52 $147.46 $150.52 "$6,038.00" "$4,528.50" $150.52 $150.52 $150.52 "$1,221.00" "$1,038.00" "$4,782.10" $150.52 "$4,830.40" $540.00 "$6,038.00" $150.52 "$3,502.04" "$6,038.00" $174.32 $150.52 "$6,038.00" $150.52 N/A N/A 35000009 EAP CPT® 75635 CT ANGIO ABDOMINAL ARTERIES BOTH IP/OP "$6,653.00" "$4,923.50" $174.93 "$5,322.40" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,386.65" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,386.56" $281.13 $260.16 "$1,106.00" $175.71 $317.93 $175.71 $184.49 "$4,989.75" $175.71 $175.71 $175.71 "$1,386.00" "$1,178.00" "$5,269.18" $175.71 "$5,322.40" $540.00 "$1,320.45" $175.71 "$3,858.74" $184.49 $254.21 $175.71 "$1,386.49" $175.71 N/A N/A 35000010 EAP CPT® 76376 3D RENDER W/O INTRP POSTPROCES BOTH IP/OP "$2,200.00" "$1,628.00" $14.89 "$2,200.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" $785.72 $785.72 $815.94 $573.58 $458.50 "$2,200.00" "$2,200.00" "$1,106.00" "$2,200.00" $14.89 "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,056.00" "$1,056.00" "$1,742.40" "$2,200.00" "$1,760.00" $540.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 35000011 EAP CPT® 76377 3D RENDER W/INTRP POSTPROCES BOTH IP/OP "$4,133.00" "$3,058.50" $38.90 "$4,133.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$4,133.00" "$4,133.00" "$4,133.00" $861.42 "$4,133.00" $785.72 $785.72 $815.94 $573.58 $861.36 "$4,133.00" "$3,306.00" "$1,106.00" "$4,133.00" $38.90 "$4,133.00" "$4,133.00" "$3,099.75" "$4,133.00" "$4,133.00" "$4,133.00" "$1,983.84" "$1,983.84" "$3,273.34" "$4,133.00" "$3,306.40" $540.00 $820.30 "$4,133.00" "$2,397.14" "$4,133.00" "$4,133.00" "$4,133.00" $861.32 "$4,133.00" N/A N/A 35000013 EAP CPT® 77011 CT GUIDED STEREOTAT LOC NCT BOTH IP/OP "$1,725.00" "$1,276.50" $165.38 "$1,725.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $170.93 $170.93 $204.03 "$1,725.00" $170.93 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 $273.49 $264.61 "$1,106.00" $170.93 $165.38 $170.93 "$1,725.00" "$1,293.75" $170.93 $170.93 $170.93 $828.00 $828.00 "$1,366.20" $170.93 "$1,380.00" $540.00 "$1,725.00" $170.93 "$1,000.50" "$1,725.00" $171.44 $170.93 "$1,725.00" $170.93 N/A N/A 35000014 EAP CPT® 77012 CT GUIDANCE NEEDLE PLACEMENT BOTH IP/OP "$2,365.00" "$1,750.50" $73.06 "$4,567.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$2,365.00" "$2,365.00" "$2,365.00" $492.93 "$2,365.00" $785.72 $785.72 $815.94 $573.58 $492.89 "$2,365.00" "$4,567.00" "$1,106.00" "$2,365.00" $73.06 "$2,365.00" "$2,365.00" "$1,773.75" "$2,365.00" "$2,365.00" "$2,365.00" "$1,135.20" "$1,135.20" "$1,873.08" "$2,365.00" "$1,892.00" $540.00 $469.39 "$2,365.00" "$1,371.70" "$2,365.00" "$2,365.00" "$2,365.00" $492.87 "$2,365.00" N/A N/A 35000015 EAP CPT® 77013 "CT, VISCERAL TISSUE ABLATION" BOTH IP/OP "$2,734.00" "$2,023.50" $540.00 "$2,734.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$2,734.00" "$2,734.00" "$2,734.00" $569.83 "$2,734.00" $785.72 $785.72 $815.94 $573.58 $569.80 "$2,734.00" "$2,734.00" "$1,106.00" "$2,734.00" "$2,734.00" "$2,734.00" "$2,734.00" "$2,050.50" "$2,734.00" "$2,734.00" "$2,734.00" "$1,312.32" "$1,312.32" "$2,165.33" "$2,734.00" "$2,187.20" $540.00 $542.63 "$2,734.00" "$1,585.72" "$2,734.00" "$2,734.00" "$2,734.00" $569.77 "$2,734.00" N/A N/A 35000020 EAP CPT® 76497 UNLISTED CT PROCEDURE BOTH IP/OP $700.00 $518.00 $93.76 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $93.76 $700.00 $700.00 $700.00 $700.00 $700.00 $700.00 $145.89 $700.00 $280.00 $700.00 $700.00 $700.00 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $336.00 $336.00 $554.40 $700.00 $560.00 $540.00 $700.00 $700.00 $406.00 $700.00 $420.00 $700.00 $700.00 $700.00 N/A N/A 35000104 EAP CPT® 73206 UPP EXT CTA W&WO DYE RT ECT BOTH IP/OP "$3,509.00" "$2,597.00" $174.93 "$2,807.20" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 $731.36 $175.71 $785.72 $785.72 $815.94 $573.58 $731.31 $281.13 $260.16 "$1,106.00" $175.71 $227.97 $175.71 $184.49 "$2,631.75" $175.71 $175.71 $175.71 "$1,386.00" "$1,178.00" "$2,779.13" $175.71 "$2,807.20" $540.00 $696.45 $175.71 "$2,035.22" $184.49 $254.21 $175.71 $731.28 $175.71 N/A N/A 35000108 EAP CPT® 20982 ABLATION BONE TUMOR PERC W/IMG BOTH IP/OP "$13,275.00" "$9,823.50" $365.91 "$13,275.00" "$13,275.00" "$13,275.00" "$13,275.00" "$13,275.00" $365.91 $365.91 $368.66 "$13,275.00" $365.91 "$13,275.00" "$13,275.00" "$13,275.00" "$13,275.00" "$2,766.66" $585.46 $587.82 "$13,275.00" $365.91 $367.39 $365.91 "$13,275.00" "$9,956.25" $365.91 $365.91 $365.91 "$6,679.00" "$6,637.50" "$10,513.80" $365.91 "$10,620.00" "$4,334.00" "$13,275.00" $365.91 "$7,699.50" "$13,275.00" $380.79 $365.91 "$13,275.00" $365.91 N/A N/A 35000202 EAP CPT® 73201 UPP EXT CT W/DYE LT/RT ECT BOTH IP/OP "$4,446.00" "$3,290.50" $156.93 "$3,556.80" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $362.23 $362.23 $360.63 $926.66 $362.23 $785.72 $785.72 $815.94 $573.58 $926.60 $579.58 $531.51 "$1,106.00" $362.23 $156.93 $362.23 $380.35 "$3,334.50" $362.23 $362.23 $362.23 "$1,025.00" $871.00 "$3,521.23" $362.23 "$3,556.80" $540.00 $882.42 $362.23 "$2,578.68" $380.35 $524.06 $362.23 $926.55 $362.23 N/A N/A 35000303 EAP CPT® 73202 UPP EXT CT W&WO DYE LT/RT ECT BOTH IP/OP "$4,933.00" "$3,650.50" $205.30 "$4,933.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $213.03 $213.03 $239.34 "$4,933.00" $213.03 "$4,933.00" "$4,933.00" "$4,933.00" "$4,933.00" "$1,028.09" $340.85 $328.48 "$1,106.00" $213.03 $205.30 $213.03 "$4,933.00" "$3,699.75" $213.03 $213.03 $213.03 "$1,221.00" "$1,038.00" "$3,906.94" $213.03 "$3,946.40" $540.00 "$4,933.00" $213.03 "$2,861.14" "$4,933.00" $219.34 $213.03 "$4,933.00" $213.03 N/A N/A 35000305 EAP CPT® 75571 CT HRT W/O DYE W/CA TEST BOTH IP/OP $125.00 $92.50 $24.81 $127.31 $125.00 $125.00 $125.00 $125.00 $79.57 $79.57 $79.21 $26.05 $79.57 $125.00 $125.00 $125.00 $125.00 $26.05 $127.31 $125.33 $125.00 $79.57 $76.44 $79.57 $83.54 $93.75 $79.57 $79.57 $79.57 $60.00 $60.00 $99.00 $79.57 $100.00 $125.00 $24.81 $79.57 $72.50 $83.54 $115.11 $79.57 $26.05 $79.57 N/A N/A 35000306 EAP CPT® 75572 CT HRT W/3D IMAGE BOTH IP/OP "$1,534.00" "$1,135.50" $154.92 "$1,534.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $158.39 $158.39 $235.50 "$1,534.00" $158.39 "$1,534.00" "$1,534.00" "$1,534.00" "$1,534.00" $319.70 $253.42 $247.87 "$1,106.00" $158.39 $154.92 $158.39 "$1,534.00" "$1,150.50" $158.39 $158.39 $158.39 $736.32 $736.32 "$1,214.93" $158.39 "$1,227.20" $540.00 "$1,534.00" $158.39 $889.72 "$1,534.00" $163.88 $158.39 "$1,534.00" $158.39 N/A N/A 35000307 EAP CPT® 75573 "CT HRT W/3D IMAGE, CONGEN" BOTH IP/OP "$1,268.00" $938.50 $195.50 "$1,268.00" "$1,268.00" "$1,268.00" "$1,268.00" "$1,268.00" $202.95 $202.95 $320.30 "$1,268.00" $202.95 "$1,268.00" "$1,268.00" "$1,268.00" "$1,268.00" $264.27 $324.72 $312.80 "$1,106.00" $202.95 $195.50 $202.95 "$1,268.00" $951.00 $202.95 $202.95 $202.95 $608.64 $608.64 "$1,004.26" $202.95 "$1,014.40" $540.00 "$1,268.00" $202.95 $735.44 "$1,268.00" $210.34 $202.95 "$1,268.00" $202.95 N/A N/A 35000308 EAP CPT® 75574 CT ANGIO HRT W/3D IMAGE BOTH IP/OP "$2,297.00" "$1,700.00" $174.93 "$1,837.60" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 $478.75 $175.71 $785.72 $785.72 $815.94 $573.58 $478.72 $281.13 $260.16 "$1,106.00" $175.71 $222.22 $175.71 $184.49 "$1,722.75" $175.71 $175.71 $175.71 "$1,102.56" "$1,102.56" "$1,819.22" $175.71 "$1,837.60" $540.00 $455.90 $175.71 "$1,332.26" $184.49 $254.21 $175.71 $478.69 $175.71 N/A N/A 35000309 EAP CPT® 75571 CT HEART W/O DYE;QUAL CALC OCT BOTH IP/OP $125.00 $92.50 $24.81 $127.31 $125.00 $125.00 $125.00 $125.00 $79.57 $79.57 $79.21 $26.05 $79.57 $125.00 $125.00 $125.00 $125.00 $26.05 $127.31 $125.33 $125.00 $79.57 $76.44 $79.57 $83.54 $93.75 $79.57 $79.57 $79.57 $60.00 $60.00 $99.00 $79.57 $100.00 $125.00 $24.81 $79.57 $72.50 $83.54 $115.11 $79.57 $26.05 $79.57 N/A N/A 35000311 EAP CPT® 73700 LOW EXT CT W/O DYE BILAT ECT BOTH IP/OP "$6,983.00" "$5,167.50" $88.27 "$5,586.40" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 "$1,455.43" $107.09 $785.72 $785.72 $815.94 $573.58 "$1,455.33" $171.35 $154.19 "$1,106.00" $107.09 $88.27 $107.09 $112.45 "$5,237.25" $107.09 $107.09 $107.09 $749.00 $637.00 "$5,530.54" $107.09 "$5,586.40" $540.00 "$1,385.95" $107.09 "$4,050.14" $112.45 $154.94 $107.09 "$1,455.26" $107.09 N/A N/A 35000312 EAP CPT® 73701 LOW EXT CT W/DYE BILAT ECT BOTH IP/OP "$9,578.00" "$7,088.00" $119.73 "$7,662.40" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,996.29" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,996.16" $281.13 $260.16 "$1,106.00" $175.71 $119.73 $175.71 $184.49 "$7,183.50" $175.71 $175.71 $175.71 "$4,597.44" "$4,597.44" "$7,585.78" $175.71 "$7,662.40" $540.00 "$1,900.99" $175.71 "$5,555.24" $184.49 $254.21 $175.71 "$1,996.06" $175.71 N/A N/A 35000313 EAP CPT® 73702 LOW EXT CT W&WO DYE BILAT ECT BOTH IP/OP "$11,163.00" "$8,261.00" $147.46 "$11,163.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $150.52 $150.52 $182.24 "$11,163.00" $150.52 "$11,163.00" "$11,163.00" "$11,163.00" "$11,163.00" "$2,326.49" $240.83 $235.94 "$1,106.00" $150.52 $147.46 $150.52 "$11,163.00" "$8,372.25" $150.52 $150.52 $150.52 "$1,221.00" "$1,038.00" "$8,841.10" $150.52 "$8,930.40" $540.00 "$11,163.00" $150.52 "$6,474.54" "$11,163.00" $174.32 $150.52 "$11,163.00" $150.52 N/A N/A 35000314 EAP CPT® 73706 LOW EXT CTA W&WO DYE BILAT ECT BOTH IP/OP "$12,088.00" "$8,945.50" $174.93 "$9,670.40" $690.25 $690.25 $690.25 $690.25 $175.71 $175.71 $174.93 "$2,519.44" $175.71 $785.72 $785.72 $815.94 $573.58 "$2,519.27" $281.13 $260.16 "$1,106.00" $175.71 $250.96 $175.71 $184.49 "$9,066.00" $175.71 $175.71 $175.71 "$1,386.00" "$1,178.00" "$9,573.70" $175.71 "$9,670.40" $540.00 "$2,399.17" $175.71 "$7,011.04" $184.49 $254.21 $175.71 "$2,519.14" $175.71 N/A N/A 35000315 EAP CPT® 73206 CT ANGIO UPPER EXTM W/O&W/DYE BILAT BOTH IP/OP "$7,023.00" "$5,197.50" $174.93 "$5,618.40" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,463.77" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,463.67" $281.13 $260.16 "$1,106.00" $175.71 $227.97 $175.71 $184.49 "$5,267.25" $175.71 $175.71 $175.71 "$1,386.00" "$1,178.00" "$5,562.22" $175.71 "$5,618.40" $540.00 "$1,393.89" $175.71 "$4,073.34" $184.49 $254.21 $175.71 "$1,463.59" $175.71 N/A N/A 35000352 EAP CPT® 74176 "CT, ABD AND PELVIS W/O CONTRAST" BOTH IP/OP "$7,437.00" "$5,503.50" $108.57 "$5,949.60" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $226.34 $226.34 $225.34 "$1,550.06" $226.34 $785.72 $785.72 $815.94 $573.58 "$1,549.95" $362.15 $336.89 "$1,106.00" $226.34 $108.57 $226.34 $237.66 "$5,577.75" $226.34 $226.34 $226.34 "$3,569.76" "$3,569.76" "$5,890.10" $226.34 "$5,949.60" $540.00 "$1,476.06" $226.34 "$4,313.46" $237.66 $327.46 $226.34 "$1,549.87" $226.34 N/A N/A 35000353 EAP CPT® 74177 "CT, ABD AND PELVIS W/CONTRAST" BOTH IP/OP "$10,201.00" "$7,549.00" $234.72 "$8,160.80" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $362.23 $362.23 $360.63 "$2,126.14" $362.23 $785.72 $785.72 $815.94 $573.58 "$2,126.00" $579.58 $531.51 "$1,106.00" $362.23 $234.72 $362.23 $380.35 "$7,650.75" $362.23 $362.23 $362.23 "$4,896.48" "$4,896.48" "$8,079.19" $362.23 "$8,160.80" $540.00 "$2,024.64" $362.23 "$5,916.58" $380.35 $524.06 $362.23 "$2,125.89" $362.23 N/A N/A 35000354 EAP CPT® 37220 ILIAC REVASC BOTH IP/OP "$11,190.00" "$8,281.00" $395.24 "$11,190.00" "$11,190.00" "$11,190.00" "$11,190.00" "$11,190.00" $398.84 $398.84 $400.54 "$11,190.00" $398.84 "$11,190.00" "$11,190.00" "$11,190.00" "$11,190.00" "$2,332.12" $638.14 $632.38 "$11,190.00" $398.84 $395.24 $398.84 "$11,190.00" "$8,392.50" $398.84 $398.84 $398.84 "$6,095.00" "$5,595.00" "$8,862.48" $398.84 "$8,952.00" "$4,334.00" "$11,190.00" $398.84 "$6,490.20" "$11,190.00" $420.41 $398.84 "$11,190.00" $398.84 N/A N/A 35000355 EAP CPT® 37221 ILIAC REVASC W/STENT BOTH IP/OP "$32,950.00" "$24,383.00" $486.60 "$32,950.00" "$32,950.00" "$32,950.00" "$32,950.00" "$32,950.00" $491.54 $491.54 $494.14 "$32,950.00" $491.54 "$32,950.00" "$32,950.00" "$32,950.00" "$32,950.00" "$6,867.14" $786.46 $778.56 "$32,950.00" $491.54 $486.60 $491.54 "$32,950.00" "$24,712.50" $491.54 $491.54 $491.54 "$7,479.00" "$16,475.00" "$26,096.40" $491.54 "$26,360.00" "$5,164.00" "$32,950.00" $491.54 "$19,111.00" "$32,950.00" $518.84 $491.54 "$32,950.00" $491.54 N/A N/A 35000356 EAP CPT® 37222 ILIAC REVASC ADD-ON BOTH IP/OP "$27,325.00" "$20,220.50" $183.03 "$27,325.00" "$27,325.00" "$27,325.00" "$27,325.00" "$27,325.00" $185.03 $185.03 $184.95 "$27,325.00" $185.03 "$27,325.00" "$27,325.00" "$27,325.00" "$27,325.00" "$5,694.83" $296.05 $292.85 "$27,325.00" $185.03 $183.03 $185.03 "$27,325.00" "$20,493.75" $185.03 $185.03 $185.03 "$13,662.50" "$13,662.50" "$21,641.40" $185.03 "$21,860.00" "$4,334.00" "$27,325.00" $185.03 "$15,848.50" "$27,325.00" $195.43 $185.03 "$27,325.00" $185.03 N/A N/A 35000357 EAP CPT® 37223 ILIAC REVASC W/STENT ADD-ON BOTH IP/OP "$32,950.00" "$24,383.00" $208.86 "$32,950.00" "$32,950.00" "$32,950.00" "$32,950.00" "$32,950.00" $211.58 $211.58 $212.77 "$32,950.00" $211.58 "$32,950.00" "$32,950.00" "$32,950.00" "$32,950.00" "$6,867.14" $338.53 $334.18 "$32,950.00" $211.58 $208.86 $211.58 "$32,950.00" "$24,712.50" $211.58 $211.58 $211.58 "$16,475.00" "$16,475.00" "$26,096.40" $211.58 "$26,360.00" "$4,334.00" "$32,950.00" $211.58 "$19,111.00" "$32,950.00" $223.19 $211.58 "$32,950.00" $211.58 N/A N/A 35000358 EAP CPT® 37224 FEM/POPL REVAS W/TLA BOTH IP/OP "$21,928.00" "$16,227.00" $438.72 "$17,542.40" "$3,558.00" "$3,558.00" "$3,558.00" "$3,558.00" "$4,875.41" "$4,875.41" "$4,853.85" "$4,570.34" "$4,875.41" "$3,116.95" "$3,116.95" "$3,236.84" "$2,187.86" "$4,570.04" "$7,800.66" "$7,524.05" "$4,877.00" "$4,875.41" $438.72 "$4,875.41" "$5,119.18" "$16,446.00" "$4,875.41" "$4,875.41" "$4,875.41" "$6,095.00" "$5,161.00" "$17,366.98" "$4,875.41" "$17,542.40" "$4,334.00" "$4,352.16" "$4,875.41" "$12,718.24" "$5,119.18" "$7,053.49" "$4,875.41" "$4,569.80" "$4,875.41" N/A N/A 35000359 EAP CPT® 37225 FEM/POPL REVAS W/ATHER BOTH IP/OP "$46,544.00" "$34,443.00" $590.09 "$46,544.00" "$46,544.00" "$46,544.00" "$46,544.00" "$46,544.00" $597.57 $597.57 $602.63 "$46,544.00" $597.57 "$46,544.00" "$46,544.00" "$46,544.00" "$46,544.00" "$9,700.28" $956.11 $944.14 "$46,544.00" $597.57 $590.09 $597.57 "$46,544.00" "$34,908.00" $597.57 $597.57 $597.57 "$7,479.00" "$23,272.00" "$36,862.85" $597.57 "$37,235.20" "$5,164.00" "$46,544.00" $597.57 "$26,995.52" "$46,544.00" $632.41 $597.57 "$46,544.00" $597.57 N/A N/A 35000360 EAP CPT® 37226 FEM/POPL REVASC W/STENT BOTH IP/OP "$46,544.00" "$34,443.00" $512.42 "$37,235.20" "$3,558.00" "$3,558.00" "$3,558.00" "$3,558.00" "$9,880.57" "$9,880.57" "$9,836.87" "$9,417.94" "$9,880.57" "$3,769.39" "$3,769.39" "$3,914.36" "$2,645.82" "$9,700.28" "$15,808.91" "$15,314.28" "$4,877.00" "$9,880.57" $512.42 "$9,880.57" "$10,374.60" "$34,908.00" "$9,880.57" "$9,880.57" "$9,880.57" "$7,479.00" "$6,357.00" "$36,862.85" "$9,880.57" "$37,235.20" "$5,164.00" "$7,712.84" "$9,880.57" "$26,995.52" "$10,374.60" "$14,294.69" "$9,880.57" "$8,098.48" "$9,880.57" N/A N/A 35000361 EAP CPT® 37227 FEM/POPL REVASC STNT & ATHER BOTH IP/OP "$80,612.00" "$59,653.00" $707.94 "$80,612.00" "$80,612.00" "$80,612.00" "$80,612.00" "$80,612.00" $715.87 $715.87 $721.96 "$80,612.00" $715.87 "$80,612.00" "$80,612.00" "$80,612.00" "$80,612.00" "$16,800.43" "$1,145.39" "$1,132.70" "$80,612.00" $715.87 $707.94 $715.87 "$80,612.00" "$60,459.00" $715.87 $715.87 $715.87 "$7,479.00" "$40,306.00" "$63,844.70" $715.87 "$64,489.60" "$5,343.00" "$80,612.00" $715.87 "$46,754.96" "$80,612.00" $760.78 $715.87 "$80,612.00" $715.87 N/A N/A 35000362 EAP CPT® 37228 TIB/PER REVASC W/TLA BOTH IP/OP "$21,928.00" "$16,227.00" $534.47 "$17,542.40" "$3,558.00" "$3,558.00" "$3,558.00" "$3,558.00" "$9,880.57" "$9,880.57" "$9,836.87" "$4,570.34" "$9,880.57" "$3,769.39" "$3,769.39" "$3,914.36" "$2,645.82" "$4,570.04" "$15,808.91" "$15,314.28" "$4,877.00" "$9,880.57" $534.47 "$9,880.57" "$10,374.60" "$16,446.00" "$9,880.57" "$9,880.57" "$9,880.57" "$7,479.00" "$6,357.00" "$17,366.98" "$9,880.57" "$17,542.40" "$4,334.00" "$4,352.16" "$9,880.57" "$12,718.24" "$10,374.60" "$14,294.69" "$9,880.57" "$4,569.80" "$9,880.57" N/A N/A 35000363 EAP CPT® 37229 TIB/PER REVASC W/ATHER BOTH IP/OP "$41,457.00" "$30,678.50" $684.76 "$41,457.00" "$41,457.00" "$41,457.00" "$41,457.00" "$41,457.00" $693.13 $693.13 $698.31 "$41,457.00" $693.13 "$41,457.00" "$41,457.00" "$41,457.00" "$41,457.00" "$8,640.09" "$1,109.01" "$1,095.62" "$41,457.00" $693.13 $684.76 $693.13 "$41,457.00" "$31,092.75" $693.13 $693.13 $693.13 "$7,479.00" "$20,728.50" "$32,833.94" $693.13 "$33,165.60" "$5,164.00" "$41,457.00" $693.13 "$24,045.06" "$41,457.00" $737.35 $693.13 "$41,457.00" $693.13 N/A N/A 35000364 EAP CPT® 37230 TIB/PER REVASC W/STENT BOTH IP/OP "$46,544.00" "$34,443.00" $683.82 "$37,235.20" "$3,558.00" "$3,558.00" "$3,558.00" "$3,558.00" "$15,798.05" "$15,798.05" "$15,728.18" "$9,417.94" "$15,798.05" "$4,607.43" "$4,607.43" "$4,784.64" "$3,234.06" "$9,700.28" "$25,276.88" "$24,781.43" "$4,877.00" "$15,798.05" $683.82 "$15,798.05" "$16,587.95" "$34,908.00" "$15,798.05" "$15,798.05" "$15,798.05" "$7,479.00" "$6,357.00" "$36,862.85" "$15,798.05" "$37,235.20" "$5,164.00" "$7,712.84" "$15,798.05" "$26,995.52" "$16,587.95" "$22,855.80" "$15,798.05" "$8,098.48" "$15,798.05" N/A N/A 35000365 EAP CPT® 37231 TIB/PER REVASC STENT & ATHER BOTH IP/OP "$62,684.00" "$46,386.50" $724.32 "$62,684.00" "$62,684.00" "$62,684.00" "$62,684.00" "$62,684.00" $733.99 $733.99 $750.88 "$62,684.00" $733.99 "$62,684.00" "$62,684.00" "$62,684.00" "$62,684.00" "$13,064.04" "$1,174.38" "$1,158.91" "$62,684.00" $733.99 $724.32 $733.99 "$62,684.00" "$47,013.00" $733.99 $733.99 $733.99 "$7,479.00" "$31,342.00" "$49,645.73" $733.99 "$50,147.20" "$5,343.00" "$62,684.00" $733.99 "$36,356.72" "$62,684.00" $794.67 $733.99 "$62,684.00" $733.99 N/A N/A 35000366 EAP CPT® 37232 TIB/PER REVASC ADD-ON BOTH IP/OP "$19,531.00" "$14,453.00" $196.23 "$19,531.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$19,531.00" "$19,531.00" "$19,531.00" "$4,070.75" "$19,531.00" "$19,531.00" "$19,531.00" "$19,531.00" "$19,531.00" "$4,070.48" "$19,531.00" "$11,405.00" "$3,094.73" "$19,531.00" $196.23 "$19,531.00" "$19,531.00" "$14,648.25" "$19,531.00" "$19,531.00" "$19,531.00" "$9,765.50" "$5,151.00" "$15,468.55" "$19,531.00" "$15,624.80" "$4,334.00" "$3,876.42" "$19,531.00" "$11,327.98" "$19,531.00" "$19,531.00" "$19,531.00" "$4,070.26" "$19,531.00" N/A N/A 35000367 EAP CPT® 37233 TIBPER REVASC W/ATHER ADD-ON BOTH IP/OP "$41,457.00" "$30,678.50" $318.08 "$41,457.00" "$41,457.00" "$41,457.00" "$41,457.00" "$41,457.00" $322.50 $322.50 $325.49 "$41,457.00" $322.50 "$41,457.00" "$41,457.00" "$41,457.00" "$41,457.00" "$8,640.09" $516.00 $508.93 "$41,457.00" $322.50 $318.08 $322.50 "$41,457.00" "$31,092.75" $322.50 $322.50 $322.50 "$20,728.50" "$20,728.50" "$32,833.94" $322.50 "$33,165.60" "$5,164.00" "$41,457.00" $322.50 "$24,045.06" "$41,457.00" $341.82 $322.50 "$41,457.00" $322.50 N/A N/A 35000368 EAP CPT® 37234 REVSC OPN/PRQ TIB/PERO STENT BOTH IP/OP "$19,531.00" "$14,453.00" $277.03 "$19,531.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$19,531.00" "$19,531.00" "$19,531.00" "$4,070.75" "$19,531.00" "$19,531.00" "$19,531.00" "$19,531.00" "$19,531.00" "$4,070.48" "$19,531.00" "$13,426.00" "$3,094.73" "$19,531.00" $277.03 "$19,531.00" "$19,531.00" "$14,648.25" "$19,531.00" "$19,531.00" "$19,531.00" "$9,765.50" "$5,151.00" "$15,468.55" "$19,531.00" "$15,624.80" "$4,334.00" "$3,876.42" "$19,531.00" "$11,327.98" "$19,531.00" "$19,531.00" "$19,531.00" "$4,070.26" "$19,531.00" N/A N/A 35000369 EAP CPT® 37235 TIB/PER REVASC STNT & ATHER BOTH IP/OP "$19,531.00" "$14,453.00" $365.75 "$19,531.00" "$19,531.00" "$19,531.00" "$19,531.00" "$19,531.00" $382.56 $382.56 $394.96 "$19,531.00" $382.56 "$19,531.00" "$19,531.00" "$19,531.00" "$19,531.00" "$4,070.48" $612.10 $585.20 "$19,531.00" $382.56 $365.75 $382.56 "$19,531.00" "$14,648.25" $382.56 $382.56 $382.56 "$9,765.50" "$9,765.50" "$15,468.55" $382.56 "$15,624.80" "$4,334.00" "$19,531.00" $382.56 "$11,327.98" "$19,531.00" $421.85 $382.56 "$19,531.00" $382.56 N/A N/A 35000381 EAP CPT® 74178 "CT, ABD AND PELVIS W&W/O CONTRAST" BOTH IP/OP "$11,888.00" "$8,797.50" $264.82 "$9,510.40" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $362.23 $362.23 $360.63 "$2,477.76" $362.23 $785.72 $785.72 $815.94 $573.58 "$2,477.59" $579.58 $531.51 "$1,106.00" $362.23 $264.82 $362.23 $380.35 "$8,916.00" $362.23 $362.23 $362.23 "$5,706.24" "$5,706.24" "$9,415.30" $362.23 "$9,510.40" $540.00 "$2,359.47" $362.23 "$6,895.04" $380.35 $524.06 $362.23 "$2,477.46" $362.23 N/A N/A 35100001 EAP CPT® 70450 HEAD/BRAIN CT W/O DYE ECT BOTH IP/OP "$4,085.00" "$3,023.00" $70.69 "$3,268.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 $851.42 $107.09 $785.72 $785.72 $815.94 $573.58 $851.36 $171.35 $154.19 "$1,106.00" $107.09 $70.69 $107.09 $112.45 "$3,063.75" $107.09 $107.09 $107.09 $749.00 $637.00 "$3,235.32" $107.09 "$3,268.00" $540.00 $810.77 $107.09 "$2,369.30" $112.45 $154.94 $107.09 $851.31 $107.09 N/A N/A 35100002 EAP CPT® 70460 HEAD/BRAIN CT W/ DYE ECT BOTH IP/OP "$5,603.00" "$4,146.50" $101.13 "$5,603.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $103.92 $103.92 $138.43 "$5,603.00" $103.92 "$5,603.00" "$5,603.00" "$5,603.00" "$5,603.00" "$1,167.73" $166.27 $161.81 "$1,106.00" $103.92 $101.13 $103.92 "$5,603.00" "$4,202.25" $103.92 $103.92 $103.92 "$1,025.00" $871.00 "$4,437.58" $103.92 "$4,482.40" $540.00 "$5,603.00" $103.92 "$3,249.74" "$5,603.00" $107.69 $103.92 "$5,603.00" $103.92 N/A N/A 35100003 EAP CPT® 70470 HEAD/BRAIN CT W&WO DYE ECT BOTH IP/OP "$6,525.00" "$4,828.50" $121.76 "$5,220.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,359.97" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,359.88" $281.13 $260.16 "$1,106.00" $175.71 $121.76 $175.71 $184.49 "$4,893.75" $175.71 $175.71 $175.71 "$1,221.00" "$1,038.00" "$5,167.80" $175.71 "$5,220.00" $540.00 "$1,295.05" $175.71 "$3,784.50" $184.49 $254.21 $175.71 "$1,359.81" $175.71 N/A N/A 35100004 EAP CPT® 70480 ORBIT/SELLA/EAR W/O DYE ECT BOTH IP/OP "$4,725.00" "$3,496.50" $104.85 "$3,780.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 $984.81 $107.09 $785.72 $785.72 $815.94 $573.58 $984.74 $171.35 $154.19 "$1,106.00" $107.09 $104.85 $107.09 $112.45 "$3,543.75" $107.09 $107.09 $107.09 $749.00 $637.00 "$3,742.20" $107.09 "$3,780.00" $540.00 $937.79 $107.09 "$2,740.50" $112.45 $154.94 $107.09 $984.69 $107.09 N/A N/A 35100005 EAP CPT® 70481 ORBIT/SELLA/EAR W/DYE ECT BOTH IP/OP "$6,480.00" "$4,795.50" $135.97 "$5,184.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,350.59" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,350.50" $281.13 $260.16 "$1,106.00" $175.71 $135.97 $175.71 $184.49 "$4,860.00" $175.71 $175.71 $175.71 "$1,025.00" $871.00 "$5,132.16" $175.71 "$5,184.00" $540.00 "$1,286.12" $175.71 "$3,758.40" $184.49 $254.21 $175.71 "$1,350.43" $175.71 N/A N/A 35100006 EAP CPT® 70482 ORB/SELLA/EAR W&WO DYE ECT BOTH IP/OP "$7,547.00" "$5,585.00" $161.33 "$7,547.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $166.40 $166.40 $199.97 "$7,547.00" $166.40 "$7,547.00" "$7,547.00" "$7,547.00" "$7,547.00" "$1,572.88" $266.24 $258.13 "$1,106.00" $166.40 $161.33 $166.40 "$7,547.00" "$5,660.25" $166.40 $166.40 $166.40 "$1,221.00" "$1,038.00" "$5,977.22" $166.40 "$6,037.60" $540.00 "$7,547.00" $166.40 "$4,377.26" "$7,547.00" $186.57 $166.40 "$7,547.00" $166.40 N/A N/A 35100007 EAP CPT® 70486 MAXILLOFAC CT W/O DYE ECT BOTH IP/OP "$4,725.00" "$3,496.50" $93.69 "$3,780.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 $984.81 $107.09 $785.72 $785.72 $815.94 $573.58 $984.74 $171.35 $154.19 "$1,106.00" $107.09 $93.69 $107.09 $112.45 "$3,543.75" $107.09 $107.09 $107.09 $749.00 $637.00 "$3,742.20" $107.09 "$3,780.00" $540.00 $937.79 $107.09 "$2,740.50" $112.45 $154.94 $107.09 $984.69 $107.09 N/A N/A 35100008 EAP CPT® 70487 MAXILLOFAC CT W/DYE ECT BOTH IP/OP "$6,480.00" "$4,795.50" $105.52 "$5,184.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,350.59" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,350.50" $281.13 $260.16 "$1,106.00" $175.71 $105.52 $175.71 $184.49 "$4,860.00" $175.71 $175.71 $175.71 "$1,025.00" $871.00 "$5,132.16" $175.71 "$5,184.00" $540.00 "$1,286.12" $175.71 "$3,758.40" $184.49 $254.21 $175.71 "$1,350.43" $175.71 N/A N/A 35100009 EAP CPT® 70488 MAXILLOFAC CT W&WO DYE ECT BOTH IP/OP "$7,547.00" "$5,585.00" $133.60 "$7,547.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $137.42 $137.42 $174.25 "$7,547.00" $137.42 "$7,547.00" "$7,547.00" "$7,547.00" "$7,547.00" "$1,572.88" $219.87 $213.76 "$1,106.00" $137.42 $133.60 $137.42 "$7,547.00" "$5,660.25" $137.42 $137.42 $137.42 "$1,221.00" "$1,038.00" "$5,977.22" $137.42 "$6,037.60" $540.00 "$7,547.00" $137.42 "$4,377.26" "$7,547.00" $141.55 $137.42 "$7,547.00" $137.42 N/A N/A 35100010 EAP CPT® 70490 SOFT TISS NECK CT W/O DYE ECT BOTH IP/OP "$3,955.00" "$2,927.00" $96.05 "$3,164.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 $824.32 $107.09 $785.72 $785.72 $815.94 $573.58 $824.27 $171.35 $154.19 "$1,106.00" $107.09 $96.05 $107.09 $112.45 "$2,966.25" $107.09 $107.09 $107.09 $749.00 $637.00 "$3,132.36" $107.09 "$3,164.00" $540.00 $784.97 $107.09 "$2,293.90" $112.45 $154.94 $107.09 $824.22 $107.09 N/A N/A 35100011 EAP CPT® 70491 SOFT TISS NECK CT W/DYE ECT BOTH IP/OP "$5,424.00" "$4,014.00" $127.85 "$4,339.20" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,130.50" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,130.42" $281.13 $260.16 "$1,106.00" $175.71 $127.85 $175.71 $184.49 "$4,068.00" $175.71 $175.71 $175.71 "$1,025.00" $871.00 "$4,295.81" $175.71 "$4,339.20" $540.00 "$1,076.53" $175.71 "$3,145.92" $184.49 $254.21 $175.71 "$1,130.36" $175.71 N/A N/A 35100012 EAP CPT® 70492 SOFT TISS NECK CT W&WO DYE ECT BOTH IP/OP "$6,319.00" "$4,676.50" $156.26 "$5,055.20" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,317.04" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,316.95" $281.13 $260.16 "$1,106.00" $175.71 $156.26 $175.71 $184.49 "$4,739.25" $175.71 $175.71 $175.71 "$1,221.00" "$1,038.00" "$5,004.65" $175.71 "$5,055.20" $540.00 "$1,254.16" $175.71 "$3,665.02" $184.49 $254.21 $175.71 "$1,316.88" $175.71 N/A N/A 35100013 EAP CPT® 70496 HEAD CTA W & W/O DYE ECT BOTH IP/OP "$6,849.00" "$5,068.50" $174.93 "$5,479.20" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,427.50" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,427.41" $281.13 $260.16 "$1,106.00" $175.71 $206.66 $175.71 $184.49 "$5,136.75" $175.71 $175.71 $175.71 "$1,386.00" "$1,178.00" "$5,424.41" $175.71 "$5,479.20" $540.00 "$1,359.36" $175.71 "$3,972.42" $184.49 $254.21 $175.71 "$1,427.33" $175.71 N/A N/A 35100014 EAP CPT® 70498 NECK CTA W & W/O DYE ECT BOTH IP/OP "$6,849.00" "$5,068.50" $174.93 "$5,479.20" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,427.50" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,427.41" $281.13 $260.16 "$1,106.00" $175.71 $206.32 $175.71 $184.49 "$5,136.75" $175.71 $175.71 $175.71 "$1,386.00" "$1,178.00" "$5,424.41" $175.71 "$5,479.20" $540.00 "$1,359.36" $175.71 "$3,972.42" $184.49 $254.21 $175.71 "$1,427.33" $175.71 N/A N/A 35100015 EAP CPT® 0042T "BRAIN PERFUSION W/CONT CT, ECT" BOTH IP/OP "$6,102.00" "$4,515.50" $540.00 "$6,102.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$6,102.00" "$6,102.00" "$6,102.00" "$1,271.81" "$6,102.00" $785.72 $785.72 $815.94 $573.58 "$1,271.72" "$6,102.00" "$6,102.00" "$1,106.00" "$6,102.00" "$6,102.00" "$6,102.00" "$6,102.00" "$4,576.50" "$6,102.00" "$6,102.00" "$6,102.00" "$3,051.00" "$3,051.00" "$4,832.78" "$6,102.00" "$4,881.60" $540.00 "$1,211.09" "$6,102.00" "$3,539.16" "$6,102.00" "$6,102.00" "$6,102.00" "$1,271.66" "$6,102.00" N/A N/A 35200001 EAP CPT® 71250 THORAX CT W/O DYE BCT BOTH IP/OP "$3,675.00" "$2,719.50" $87.94 "$2,940.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 $765.96 $107.09 $785.72 $785.72 $815.94 $573.58 $765.91 $171.35 $154.19 "$1,106.00" $107.09 $87.94 $107.09 $112.45 "$2,756.25" $107.09 $107.09 $107.09 "$1,764.00" "$1,764.00" "$2,910.60" $107.09 "$2,940.00" $540.00 $729.40 $107.09 "$2,131.50" $112.45 $154.94 $107.09 $765.87 $107.09 N/A N/A 35200002 EAP CPT® 71260 THORAX CT W/DYE BCT BOTH IP/OP "$5,044.00" "$3,733.00" $119.39 "$4,035.20" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,051.30" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,051.23" $281.13 $260.16 "$1,106.00" $175.71 $119.39 $175.71 $184.49 "$3,783.00" $175.71 $175.71 $175.71 "$2,421.12" "$2,421.12" "$3,994.85" $175.71 "$4,035.20" $540.00 "$1,001.11" $175.71 "$2,925.52" $184.49 $254.21 $175.71 "$1,051.17" $175.71 N/A N/A 35200003 EAP CPT® 71270 THORAX CT W&WO DYE BCT BOTH IP/OP "$5,874.00" "$4,347.00" $147.13 "$5,874.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $151.21 $151.21 $185.50 "$5,874.00" $151.21 "$5,874.00" "$5,874.00" "$5,874.00" "$5,874.00" "$1,224.21" $241.94 $235.41 "$1,106.00" $151.21 $147.13 $151.21 "$5,874.00" "$4,405.50" $151.21 $151.21 $151.21 "$2,819.52" "$2,819.52" "$4,652.21" $151.21 "$4,699.20" $540.00 "$5,874.00" $151.21 "$3,406.92" "$5,874.00" $164.96 $151.21 "$5,874.00" $151.21 N/A N/A 35200004 EAP CPT® 71275 THORAX CTA W&WO DYE BCT BOTH IP/OP "$6,367.00" "$4,712.00" $174.93 "$5,093.60" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,327.04" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,326.95" $281.13 $260.16 "$1,106.00" $175.71 $209.03 $175.71 $184.49 "$4,775.25" $175.71 $175.71 $175.71 "$3,056.16" "$3,056.16" "$5,042.66" $175.71 "$5,093.60" $540.00 "$1,263.69" $175.71 "$3,692.86" $184.49 $254.21 $175.71 "$1,326.88" $175.71 N/A N/A 35200005 EAP CPT® 72125 CERVICAL SPINE CT W/O DYE ECT BOTH IP/OP "$7,128.00" "$5,275.00" $88.61 "$5,702.40" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 "$1,485.65" $107.09 $785.72 $785.72 $815.94 $573.58 "$1,485.55" $171.35 $154.19 "$1,106.00" $107.09 $88.61 $107.09 $112.45 "$5,346.00" $107.09 $107.09 $107.09 $749.00 $637.00 "$5,645.38" $107.09 "$5,702.40" $540.00 "$1,414.73" $107.09 "$4,134.24" $112.45 $154.94 $107.09 "$1,485.48" $107.09 N/A N/A 35200006 EAP CPT® 72126 CERVICAL SPINE CT W/DYE ECT BOTH IP/OP "$9,771.00" "$7,231.00" $119.06 "$7,816.80" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $362.23 $362.23 $360.63 "$2,036.52" $362.23 $785.72 $785.72 $815.94 $573.58 "$2,036.38" $579.58 $531.51 "$1,106.00" $362.23 $119.06 $362.23 $380.35 "$7,328.25" $362.23 $362.23 $362.23 "$1,025.00" $871.00 "$7,738.63" $362.23 "$7,816.80" $540.00 "$1,939.30" $362.23 "$5,667.18" $380.35 $524.06 $362.23 "$2,036.28" $362.23 N/A N/A 35200007 EAP CPT® 72127 CERVICAL SPINE CT W&WO DYE ECT BOTH IP/OP "$10,974.00" "$8,121.00" $147.13 "$10,974.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $151.21 $151.21 $185.50 "$10,974.00" $151.21 "$10,974.00" "$10,974.00" "$10,974.00" "$10,974.00" "$2,287.10" $241.94 $235.41 "$1,106.00" $151.21 $147.13 $151.21 "$10,974.00" "$8,230.50" $151.21 $151.21 $151.21 "$1,221.00" "$1,038.00" "$8,691.41" $151.21 "$8,779.20" $540.00 "$10,974.00" $151.21 "$6,364.92" "$10,974.00" $168.56 $151.21 "$10,974.00" $151.21 N/A N/A 35200008 EAP CPT® 72128 THORACIC SPINE CT W/O DYE ECT BOTH IP/OP "$4,233.00" "$3,132.50" $88.61 "$3,386.40" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 $882.26 $107.09 $785.72 $785.72 $815.94 $573.58 $882.20 $171.35 $154.19 "$1,106.00" $107.09 $88.61 $107.09 $112.45 "$3,174.75" $107.09 $107.09 $107.09 $749.00 $637.00 "$3,352.54" $107.09 "$3,386.40" $540.00 $840.14 $107.09 "$2,455.14" $112.45 $154.94 $107.09 $882.16 $107.09 N/A N/A 35200009 EAP CPT® 72129 THORACIC SPINE CT W/DYE ECT BOTH IP/OP "$5,804.00" "$4,295.00" $120.07 "$5,804.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $122.92 $122.92 $158.86 "$5,804.00" $122.92 "$5,804.00" "$5,804.00" "$5,804.00" "$5,804.00" "$1,209.62" $196.67 $192.11 "$1,106.00" $122.92 $120.07 $122.92 "$5,804.00" "$4,353.00" $122.92 $122.92 $122.92 "$1,025.00" $871.00 "$4,596.77" $122.92 "$4,643.20" $540.00 "$5,804.00" $122.92 "$3,366.32" "$5,804.00" $137.23 $122.92 "$5,804.00" $122.92 N/A N/A 35200010 EAP CPT® 72130 THORACIC SPINE CT W&WO DYE ECT BOTH IP/OP "$6,518.00" "$4,823.50" $148.82 "$6,518.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $152.24 $152.24 $186.39 "$6,518.00" $152.24 "$6,518.00" "$6,518.00" "$6,518.00" "$6,518.00" "$1,358.42" $243.58 $238.11 "$1,106.00" $152.24 $148.82 $152.24 "$6,518.00" "$4,888.50" $152.24 $152.24 $152.24 "$1,221.00" "$1,038.00" "$5,162.26" $152.24 "$5,214.40" $540.00 "$6,518.00" $152.24 "$3,780.44" "$6,518.00" $168.92 $152.24 "$6,518.00" $152.24 N/A N/A 35200011 EAP CPT® 72131 LUMBAR SPINE CT W/O DYE ECT BOTH IP/OP "$3,544.00" "$2,623.00" $87.94 "$2,835.20" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 $738.66 $107.09 $785.72 $785.72 $815.94 $573.58 $738.61 $171.35 $154.19 "$1,106.00" $107.09 $87.94 $107.09 $112.45 "$2,658.00" $107.09 $107.09 $107.09 $749.00 $637.00 "$2,806.85" $107.09 "$2,835.20" $540.00 $703.40 $107.09 "$2,055.52" $112.45 $154.94 $107.09 $738.57 $107.09 N/A N/A 35200012 EAP CPT® 72132 LUMBAR SPINE CT W/DYE ECT BOTH IP/OP "$4,861.00" "$3,597.50" $119.39 "$4,861.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $121.88 $121.88 $157.97 "$4,861.00" $121.88 "$4,861.00" "$4,861.00" "$4,861.00" "$4,861.00" "$1,013.09" $195.01 $191.02 "$1,106.00" $121.88 $119.39 $121.88 "$4,861.00" "$3,645.75" $121.88 $121.88 $121.88 "$1,025.00" $871.00 "$3,849.91" $121.88 "$3,888.80" $540.00 "$4,861.00" $121.88 "$2,819.38" "$4,861.00" $136.15 $121.88 "$4,861.00" $121.88 N/A N/A 35200013 EAP CPT® 72133 LUMBAR SPINE CT W&WO DYE ECT BOTH IP/OP "$5,459.00" "$4,040.00" $147.46 "$5,459.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $150.86 $150.86 $185.50 "$5,459.00" $150.86 "$5,459.00" "$5,459.00" "$5,459.00" "$5,459.00" "$1,137.72" $241.38 $235.94 "$1,106.00" $150.86 $147.46 $150.86 "$5,459.00" "$4,094.25" $150.86 $150.86 $150.86 "$1,221.00" "$1,038.00" "$4,323.53" $150.86 "$4,367.20" $540.00 "$5,459.00" $150.86 "$3,166.22" "$5,459.00" $167.84 $150.86 "$5,459.00" $150.86 N/A N/A 35200014 EAP CPT® 72191 PELVIS CTA W&WO DYE BCT BOTH IP/OP "$6,137.00" "$4,541.50" $235.55 "$6,137.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $243.42 $243.42 $284.25 "$6,137.00" $243.42 "$6,137.00" "$6,137.00" "$6,137.00" "$6,137.00" "$1,279.02" $389.47 $377.73 "$1,106.00" $243.42 $236.08 $243.42 "$6,137.00" "$4,602.75" $243.42 $243.42 $243.42 "$1,386.00" "$1,178.00" "$4,860.50" $243.42 "$4,909.60" $540.00 "$6,137.00" $243.42 "$3,559.46" "$6,137.00" $235.55 $243.42 "$6,137.00" $243.42 N/A N/A 35200015 EAP CPT® 72192 CT PELVIS W/O DYE BOTH IP/OP "$4,157.00" "$3,076.50" $87.60 "$3,325.60" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 $866.42 $107.09 $785.72 $785.72 $815.94 $573.58 $866.36 $171.35 $154.19 "$1,106.00" $107.09 $87.60 $107.09 $112.45 "$3,117.75" $107.09 $107.09 $107.09 $749.00 $637.00 "$3,292.34" $107.09 "$3,325.60" $540.00 $825.06 $107.09 "$2,411.06" $112.45 $154.94 $107.09 $866.32 $107.09 N/A N/A 35200017 EAP CPT® 72193 PELVIS CT W/DYE BCT BOTH IP/OP "$5,705.00" "$4,222.00" $174.93 "$4,564.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,189.06" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,188.98" $281.13 $260.16 "$1,106.00" $175.71 $187.71 $175.71 $184.49 "$4,278.75" $175.71 $175.71 $175.71 "$1,025.00" $871.00 "$4,518.36" $175.71 "$4,564.00" $540.00 "$1,132.30" $175.71 "$3,308.90" $184.49 $254.21 $175.71 "$1,188.92" $175.71 N/A N/A 35200018 EAP CPT® 72194 PELVIS CT W&WO DYE BCT BOTH IP/OP "$6,641.00" "$4,914.50" $174.93 "$5,312.80" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,384.15" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,384.06" $281.13 $260.16 "$1,106.00" $175.71 $210.03 $175.71 $184.49 "$4,980.75" $175.71 $175.71 $175.71 "$1,221.00" "$1,038.00" "$5,259.67" $175.71 "$5,312.80" $540.00 "$1,318.07" $175.71 "$3,851.78" $184.49 $254.21 $175.71 "$1,383.98" $175.71 N/A N/A 35200019 EAP CPT® 73200 UPP EXT CT W/O DYE BILAT BCT BOTH IP/OP "$7,981.00" "$5,906.00" $106.62 "$6,384.80" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 "$1,663.44" $107.09 $785.72 $785.72 $815.94 $573.58 "$1,663.33" $171.35 $154.19 "$1,106.00" $107.09 $122.77 $107.09 $112.45 "$5,985.75" $107.09 $107.09 $107.09 "$2,172.00" "$1,846.00" "$6,320.95" $107.09 "$6,384.80" $540.00 "$1,584.03" $107.09 "$4,628.98" $112.45 $154.94 $107.09 "$1,663.24" $107.09 N/A N/A 35200020 EAP CPT® 73200 CT UPPER EXT W/O DYE BOTH IP/OP "$4,400.00" "$3,256.00" $106.62 "$3,520.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 $917.07 $107.09 $785.72 $785.72 $815.94 $573.58 $917.01 $171.35 $154.19 "$1,106.00" $107.09 $122.77 $107.09 $112.45 "$3,300.00" $107.09 $107.09 $107.09 "$2,172.00" "$1,846.00" "$3,484.80" $107.09 "$3,520.00" $540.00 $873.29 $107.09 "$2,552.00" $112.45 $154.94 $107.09 $916.96 $107.09 N/A N/A 35200022 EAP CPT® 73201 UPP EXT CT W/DYE BILAT BCT BOTH IP/OP "$8,891.00" "$6,579.50" $156.93 "$7,112.80" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $362.23 $362.23 $360.63 "$1,853.11" $362.23 $785.72 $785.72 $815.94 $573.58 "$1,852.98" $579.58 $531.51 "$1,106.00" $362.23 $156.93 $362.23 $380.35 "$6,668.25" $362.23 $362.23 $362.23 "$1,025.00" $871.00 "$7,041.67" $362.23 "$7,112.80" $540.00 "$1,764.64" $362.23 "$5,156.78" $380.35 $524.06 $362.23 "$1,852.88" $362.23 N/A N/A 35200023 EAP CPT® 73201 CT UPPER EXT W/DYE BOTH IP/OP "$4,904.00" "$3,629.00" $156.93 "$3,923.20" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $362.23 $362.23 $360.63 "$1,022.12" $362.23 $785.72 $785.72 $815.94 $573.58 "$1,022.05" $579.58 $531.51 "$1,106.00" $362.23 $156.93 $362.23 $380.35 "$3,678.00" $362.23 $362.23 $362.23 "$1,025.00" $871.00 "$3,883.97" $362.23 "$3,923.20" $540.00 $973.32 $362.23 "$2,844.32" $380.35 $524.06 $362.23 "$1,021.99" $362.23 N/A N/A 35200025 EAP CPT® 73202 UPP EXT CT W&WO DYE BILAT BCT BOTH IP/OP "$9,863.00" "$7,299.00" $205.30 "$9,863.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $213.03 $213.03 $239.34 "$9,863.00" $213.03 "$9,863.00" "$9,863.00" "$9,863.00" "$9,863.00" "$2,055.56" $340.85 $328.48 "$1,106.00" $213.03 $205.30 $213.03 "$9,863.00" "$7,397.25" $213.03 $213.03 $213.03 "$1,221.00" "$1,038.00" "$7,811.50" $213.03 "$7,890.40" $540.00 "$9,863.00" $213.03 "$5,720.54" "$9,863.00" $219.34 $213.03 "$9,863.00" $213.03 N/A N/A 35200026 EAP CPT® 73202 UPP EXT CT W&WO DYE LT BCT BOTH IP/OP "$4,933.00" "$3,650.50" $205.30 "$4,933.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $213.03 $213.03 $239.34 "$4,933.00" $213.03 "$4,933.00" "$4,933.00" "$4,933.00" "$4,933.00" "$1,028.09" $340.85 $328.48 "$1,106.00" $213.03 $205.30 $213.03 "$4,933.00" "$3,699.75" $213.03 $213.03 $213.03 "$1,221.00" "$1,038.00" "$3,906.94" $213.03 "$3,946.40" $540.00 "$4,933.00" $213.03 "$2,861.14" "$4,933.00" $219.34 $213.03 "$4,933.00" $213.03 N/A N/A 35200027 EAP CPT® 73202 CT UPPER EXT W/O&W/DYE BOTH IP/OP "$5,441.00" "$4,026.50" $205.30 "$5,441.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $213.03 $213.03 $239.34 "$5,441.00" $213.03 "$5,441.00" "$5,441.00" "$5,441.00" "$5,441.00" "$1,133.96" $340.85 $328.48 "$1,106.00" $213.03 $205.30 $213.03 "$5,441.00" "$4,080.75" $213.03 $213.03 $213.03 "$1,221.00" "$1,038.00" "$4,309.27" $213.03 "$4,352.80" $540.00 "$5,441.00" $213.03 "$3,155.78" "$5,441.00" $219.34 $213.03 "$5,441.00" $213.03 N/A N/A 35200028 EAP CPT® 73206 UPP EXT CTA W&WO DYE BILAT BCT BOTH IP/OP "$7,023.00" "$5,197.50" $174.93 "$5,618.40" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,463.77" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,463.67" $281.13 $260.16 "$1,106.00" $175.71 $227.97 $175.71 $184.49 "$5,267.25" $175.71 $175.71 $175.71 "$1,386.00" "$1,178.00" "$5,562.22" $175.71 "$5,618.40" $540.00 "$1,393.89" $175.71 "$4,073.34" $184.49 $254.21 $175.71 "$1,463.59" $175.71 N/A N/A 35200029 EAP CPT® 73206 CT ANGIO UPPER EXTM W/O&W/DYE BOTH IP/OP "$3,870.00" "$2,864.00" $174.93 "$3,096.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 $806.60 $175.71 $785.72 $785.72 $815.94 $573.58 $806.55 $281.13 $260.16 "$1,106.00" $175.71 $227.97 $175.71 $184.49 "$2,902.50" $175.71 $175.71 $175.71 "$1,386.00" "$1,178.00" "$3,065.04" $175.71 "$3,096.00" $540.00 $768.10 $175.71 "$2,244.60" $184.49 $254.21 $175.71 $806.51 $175.71 N/A N/A 35200031 EAP CPT® 73700 CT LOWER EXT W/O DYE BILAT BOTH IP/OP "$6,983.00" "$5,167.50" $88.27 "$5,586.40" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 "$1,455.43" $107.09 $785.72 $785.72 $815.94 $573.58 "$1,455.33" $171.35 $154.19 "$1,106.00" $107.09 $88.27 $107.09 $112.45 "$5,237.25" $107.09 $107.09 $107.09 $749.00 $637.00 "$5,530.54" $107.09 "$5,586.40" $540.00 "$1,385.95" $107.09 "$4,050.14" $112.45 $154.94 $107.09 "$1,455.26" $107.09 N/A N/A 35200032 EAP CPT® 73700 CT LOWER EXT W/O DYE BOTH IP/OP "$3,776.00" "$2,794.50" $88.27 "$3,020.80" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 $787.01 $107.09 $785.72 $785.72 $815.94 $573.58 $786.96 $171.35 $154.19 "$1,106.00" $107.09 $88.27 $107.09 $112.45 "$2,832.00" $107.09 $107.09 $107.09 $749.00 $637.00 "$2,990.59" $107.09 "$3,020.80" $540.00 $749.44 $107.09 "$2,190.08" $112.45 $154.94 $107.09 $786.92 $107.09 N/A N/A 35200034 EAP CPT® 73701 CT LOWER EXT W/DYE BILAT BOTH IP/OP "$9,578.00" "$7,088.00" $119.73 "$7,662.40" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,996.29" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,996.16" $281.13 $260.16 "$1,106.00" $175.71 $119.73 $175.71 $184.49 "$7,183.50" $175.71 $175.71 $175.71 "$4,597.44" "$4,597.44" "$7,585.78" $175.71 "$7,662.40" $540.00 "$1,900.99" $175.71 "$5,555.24" $184.49 $254.21 $175.71 "$1,996.06" $175.71 N/A N/A 35200035 EAP CPT® 73701 CT LOWER EXT W/DYE BOTH IP/OP "$5,185.00" "$3,837.00" $119.73 "$4,148.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,080.68" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,080.61" $281.13 $260.16 "$1,106.00" $175.71 $119.73 $175.71 $184.49 "$3,888.75" $175.71 $175.71 $175.71 "$2,488.80" "$2,488.80" "$4,106.52" $175.71 "$4,148.00" $540.00 "$1,029.09" $175.71 "$3,007.30" $184.49 $254.21 $175.71 "$1,080.55" $175.71 N/A N/A 35200037 EAP CPT® 73702 CT LOWER EXT W/O&W/DYE BILAT BOTH IP/OP "$11,163.00" "$8,261.00" $147.46 "$11,163.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $150.52 $150.52 $182.24 "$11,163.00" $150.52 "$11,163.00" "$11,163.00" "$11,163.00" "$11,163.00" "$2,326.49" $240.83 $235.94 "$1,106.00" $150.52 $147.46 $150.52 "$11,163.00" "$8,372.25" $150.52 $150.52 $150.52 "$1,221.00" "$1,038.00" "$8,841.10" $150.52 "$8,930.40" $540.00 "$11,163.00" $150.52 "$6,474.54" "$11,163.00" $174.32 $150.52 "$11,163.00" $150.52 N/A N/A 35200039 EAP CPT® 73702 LOW EXT CT W&WO DYE RT BCT BOTH IP/OP "$6,038.00" "$4,468.50" $147.46 "$6,038.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $150.52 $150.52 $182.24 "$6,038.00" $150.52 "$6,038.00" "$6,038.00" "$6,038.00" "$6,038.00" "$1,258.39" $240.83 $235.94 "$1,106.00" $150.52 $147.46 $150.52 "$6,038.00" "$4,528.50" $150.52 $150.52 $150.52 "$1,221.00" "$1,038.00" "$4,782.10" $150.52 "$4,830.40" $540.00 "$6,038.00" $150.52 "$3,502.04" "$6,038.00" $174.32 $150.52 "$6,038.00" $150.52 N/A N/A 35200041 EAP CPT® 73706 CT ANGIO LOWER EXT W/O&W/DYE BOTH IP/OP "$6,541.00" "$4,840.50" $174.93 "$5,232.80" $690.25 $690.25 $690.25 $690.25 $175.71 $175.71 $174.93 "$1,363.31" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,363.22" $281.13 $260.16 "$1,106.00" $175.71 $250.96 $175.71 $184.49 "$4,905.75" $175.71 $175.71 $175.71 "$1,386.00" "$1,178.00" "$5,180.47" $175.71 "$5,232.80" $540.00 "$1,298.22" $175.71 "$3,793.78" $184.49 $254.21 $175.71 "$1,363.14" $175.71 N/A N/A 35200043 EAP CPT® 74150 CT ABDOMEN W/O DYE BOTH IP/OP "$3,994.00" "$2,956.00" $86.58 "$3,195.20" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 $832.45 $107.09 $785.72 $785.72 $815.94 $573.58 $832.39 $171.35 $154.19 "$1,106.00" $107.09 $86.58 $107.09 $112.45 "$2,995.50" $107.09 $107.09 $107.09 $749.00 $637.00 "$3,163.25" $107.09 "$3,195.20" $540.00 $792.71 $107.09 "$2,316.52" $112.45 $154.94 $107.09 $832.35 $107.09 N/A N/A 35200044 EAP CPT® 74150 ABDOMEN CT W/O DYE LIMITED BCT BOTH IP/OP "$3,661.00" "$2,709.50" $86.58 "$2,928.80" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 $763.04 $107.09 $785.72 $785.72 $815.94 $573.58 $762.99 $171.35 $154.19 "$1,106.00" $107.09 $86.58 $107.09 $112.45 "$2,745.75" $107.09 $107.09 $107.09 $749.00 $637.00 "$2,899.51" $107.09 "$2,928.80" $540.00 $726.62 $107.09 "$2,123.38" $112.45 $154.94 $107.09 $762.95 $107.09 N/A N/A 35200045 EAP CPT® 74150 "STONE PROTOCOL, BCT" BOTH IP/OP "$3,661.00" "$2,709.50" $86.58 "$2,928.80" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $107.09 $107.09 $106.62 $763.04 $107.09 $785.72 $785.72 $815.94 $573.58 $762.99 $171.35 $154.19 "$1,106.00" $107.09 $86.58 $107.09 $112.45 "$2,745.75" $107.09 $107.09 $107.09 $749.00 $637.00 "$2,899.51" $107.09 "$2,928.80" $540.00 $726.62 $107.09 "$2,123.38" $112.45 $154.94 $107.09 $762.95 $107.09 N/A N/A 35200046 EAP CPT® 74160 CT ABDOMEN W/DYE BOTH IP/OP "$5,483.00" "$4,057.50" $174.93 "$4,386.40" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,142.79" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,142.72" $281.13 $260.16 "$1,106.00" $175.71 $186.70 $175.71 $184.49 "$4,112.25" $175.71 $175.71 $175.71 "$1,025.00" $871.00 "$4,342.54" $175.71 "$4,386.40" $540.00 "$1,088.24" $175.71 "$3,180.14" $184.49 $254.21 $175.71 "$1,142.66" $175.71 N/A N/A 35200047 EAP CPT® 74160 ABDOMEN CT W/DYE LIMITED BCT BOTH IP/OP "$5,025.00" "$3,718.50" $174.93 "$4,020.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,047.34" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,047.27" $281.13 $260.16 "$1,106.00" $175.71 $186.70 $175.71 $184.49 "$3,768.75" $175.71 $175.71 $175.71 "$1,025.00" $871.00 "$3,979.80" $175.71 "$4,020.00" $540.00 $997.34 $175.71 "$2,914.50" $184.49 $254.21 $175.71 "$1,047.21" $175.71 N/A N/A 35200048 EAP CPT® 74170 ABDOMEN CT W&WO DYE BCT BOTH IP/OP "$6,385.00" "$4,725.00" $174.93 "$5,108.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,330.79" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,330.70" $281.13 $260.16 "$1,106.00" $175.71 $211.05 $175.71 $184.49 "$4,788.75" $175.71 $175.71 $175.71 "$1,221.00" "$1,038.00" "$5,056.92" $175.71 "$5,108.00" $540.00 "$1,267.26" $175.71 "$3,703.30" $184.49 $254.21 $175.71 "$1,330.63" $175.71 N/A N/A 35200049 EAP CPT® 74175 ABDOMEN CTA W&WO DYE BCT BOTH IP/OP "$6,919.00" "$5,120.50" $174.93 "$5,535.20" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,442.09" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,442.00" $281.13 $260.16 "$1,106.00" $175.71 $236.76 $175.71 $184.49 "$5,189.25" $175.71 $175.71 $175.71 "$1,386.00" "$1,178.00" "$5,479.85" $175.71 "$5,535.20" $540.00 "$1,373.25" $175.71 "$4,013.02" $184.49 $254.21 $175.71 "$1,441.92" $175.71 N/A N/A 35200058 EAP CPT® 75635 ABD AORTA&ILLIOFEMOR CTA BCT BOTH IP/OP "$6,097.00" "$4,512.00" $174.93 "$4,877.60" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $175.71 $175.71 $174.93 "$1,270.77" $175.71 $785.72 $785.72 $815.94 $573.58 "$1,270.68" $281.13 $260.16 "$1,106.00" $175.71 $317.93 $175.71 $184.49 "$4,572.75" $175.71 $175.71 $175.71 "$1,386.00" "$1,178.00" "$4,828.82" $175.71 "$4,877.60" $540.00 "$1,210.10" $175.71 "$3,536.26" $184.49 $254.21 $175.71 "$1,270.61" $175.71 N/A N/A 35200059 EAP CPT® 76380 FOLLOW UP STUDY CT LIMITED BCT BOTH IP/OP "$1,494.00" "$1,106.00" $79.21 "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $79.57 $79.57 $79.21 $311.39 $79.57 $785.72 $785.72 $815.94 $573.58 $311.37 $127.31 $125.33 "$1,106.00" $79.57 $92.33 $79.57 $83.54 "$1,120.50" $79.57 $79.57 $79.57 $717.12 $717.12 "$1,183.25" $79.57 "$1,195.20" $540.00 $296.52 $79.57 $866.52 $83.54 $115.11 $79.57 $311.35 $79.57 N/A N/A 35200060 EAP CPT® 74174 "CTA, ABDOMEN AND PELVIS, W DYE" BOTH IP/OP "$8,464.00" "$6,263.50" $296.62 "$6,771.20" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" $362.23 $362.23 $360.63 "$1,764.11" $362.23 $785.72 $785.72 $815.94 $573.58 "$1,763.99" $579.58 $531.51 "$1,106.00" $362.23 $296.62 $362.23 $380.35 "$6,348.00" $362.23 $362.23 $362.23 "$4,062.72" "$4,062.72" "$6,703.49" $362.23 "$6,771.20" $540.00 "$1,679.89" $362.23 "$4,909.12" $380.35 $524.06 $362.23 "$1,763.90" $362.23 N/A N/A 35200063 EAP HCPCS 71271 LOW DOSE CT THORAX LUNG CA SCR BOTH IP/OP $632.00 $468.00 $92.67 $632.00 $632.00 $632.00 $632.00 $632.00 $107.09 $107.09 $106.62 $131.72 $107.09 $632.00 $632.00 $632.00 $573.58 $131.72 $171.35 $154.19 $632.00 $107.09 $92.67 $107.09 $112.45 $474.00 $107.09 $107.09 $107.09 $303.36 $303.36 $500.54 $107.09 $505.60 $540.00 $125.44 $107.09 $366.56 $112.45 $154.94 $107.09 $131.71 $107.09 N/A N/A 36000003 EAP CPT® 58611 LIGATE OVIDUCT(S) ADD-ON BOTH IP/OP $499.00 $369.50 $76.68 $499.00 $499.00 $499.00 $499.00 $499.00 $76.68 $76.68 $77.35 $499.00 $76.68 $499.00 $499.00 $499.00 $499.00 $104.00 $122.69 $122.69 $499.00 $76.68 $76.68 $76.68 $499.00 $374.25 $76.68 $76.68 $76.68 $499.00 $249.50 $395.21 $76.68 $399.20 $324.35 $499.00 $76.68 $289.42 $499.00 $80.77 $76.68 $499.00 $76.68 N/A N/A 36000027 EAP CPT® 19499 BREAST SURGERY PROCEDURE CBC BOTH IP/OP "$6,169.00" "$4,565.50" "$1,285.69" "$6,169.00" "$6,169.00" "$6,169.00" "$6,169.00" "$6,169.00" "$6,169.00" "$6,169.00" "$6,169.00" "$6,169.00" "$6,169.00" "$6,169.00" "$6,169.00" "$6,169.00" "$6,169.00" "$1,285.69" "$6,169.00" "$2,467.60" "$6,169.00" "$6,169.00" "$6,169.00" "$6,169.00" "$6,169.00" "$4,626.75" "$6,169.00" "$6,169.00" "$6,169.00" "$2,762.00" "$3,084.50" "$4,885.85" "$6,169.00" "$4,935.20" "$3,250.00" "$6,169.00" "$6,169.00" "$3,578.02" "$6,169.00" "$3,701.40" "$6,169.00" "$6,169.00" "$6,169.00" N/A N/A 36000028 EAP Custom 36000028 L&D LEVEL 1 1ST 30 MIN BOTH IP/OP "$1,771.00" "$1,311.00" $315.24 "$1,913.00" "$1,771.00" "$1,771.00" "$1,771.00" "$1,771.00" "$1,771.00" "$1,771.00" $315.24 "$1,771.00" "$1,771.00" "$1,771.00" "$1,771.00" "$1,771.00" "$1,771.00" $369.10 "$1,771.00" $765.20 "$1,771.00" "$1,771.00" "$1,913.00" "$1,771.00" "$1,771.00" "$1,328.25" "$1,771.00" "$1,771.00" "$1,771.00" $885.50 $885.50 "$1,402.63" "$1,771.00" "$1,416.80" "$1,151.15" "$1,771.00" "$1,771.00" "$1,027.18" "$1,771.00" "$1,062.60" "$1,771.00" "$1,771.00" "$1,771.00" N/A N/A 36000029 EAP Custom 36000029 L&D LEVEL 2 1ST 30 MIN BOTH IP/OP "$2,152.00" "$1,592.50" $383.06 "$2,324.00" "$2,152.00" "$2,152.00" "$2,152.00" "$2,152.00" "$2,152.00" "$2,152.00" $383.06 "$2,152.00" "$2,152.00" "$2,152.00" "$2,152.00" "$2,152.00" "$2,152.00" $448.50 "$2,152.00" $929.60 "$2,152.00" "$2,152.00" "$2,324.00" "$2,152.00" "$2,152.00" "$1,614.00" "$2,152.00" "$2,152.00" "$2,152.00" "$1,076.00" "$1,076.00" "$1,704.38" "$2,152.00" "$1,721.60" "$1,398.80" "$2,152.00" "$2,152.00" "$1,248.16" "$2,152.00" "$1,291.20" "$2,152.00" "$2,152.00" "$2,152.00" N/A N/A 36000038 EAP Custom 36000038 L&D LEVEL 3 1ST 30 MIN BOTH IP/OP "$2,404.00" "$1,779.00" $427.91 "$2,596.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" $427.91 "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" $501.02 "$2,404.00" "$1,038.40" "$2,404.00" "$2,404.00" "$2,596.00" "$2,404.00" "$2,404.00" "$1,803.00" "$2,404.00" "$2,404.00" "$2,404.00" "$1,202.00" "$1,202.00" "$1,903.97" "$2,404.00" "$1,923.20" "$1,562.60" "$2,404.00" "$2,404.00" "$1,394.32" "$2,404.00" "$1,442.40" "$2,404.00" "$2,404.00" "$2,404.00" N/A N/A 36000039 EAP Custom 36000039 L&D LEVEL 4 1ST 30 MIN BOTH IP/OP "$2,657.00" "$1,966.50" $472.95 "$2,870.00" "$2,657.00" "$2,657.00" "$2,657.00" "$2,657.00" "$2,657.00" "$2,657.00" $472.95 "$2,657.00" "$2,657.00" "$2,657.00" "$2,657.00" "$2,657.00" "$2,657.00" $553.75 "$2,657.00" "$1,148.00" "$2,657.00" "$2,657.00" "$2,870.00" "$2,657.00" "$2,657.00" "$1,992.75" "$2,657.00" "$2,657.00" "$2,657.00" "$1,328.50" "$1,328.50" "$2,104.34" "$2,657.00" "$2,125.60" "$1,727.05" "$2,657.00" "$2,657.00" "$1,541.06" "$2,657.00" "$1,594.20" "$2,657.00" "$2,657.00" "$2,657.00" N/A N/A 36000040 EAP Custom 36000040 L&D LEVEL 5 1ST 30 MIN BOTH IP/OP "$1,957.00" "$1,448.50" $348.35 "$2,114.00" "$1,957.00" "$1,957.00" "$1,957.00" "$1,957.00" "$1,957.00" "$1,957.00" $348.35 "$1,957.00" "$1,957.00" "$1,957.00" "$1,957.00" "$1,957.00" "$1,957.00" $407.86 "$1,957.00" $845.60 "$1,957.00" "$1,957.00" "$2,114.00" "$1,957.00" "$1,957.00" "$1,467.75" "$1,957.00" "$1,957.00" "$1,957.00" $978.50 $978.50 "$1,549.94" "$1,957.00" "$1,565.60" "$1,272.05" "$1,957.00" "$1,957.00" "$1,135.06" "$1,957.00" "$1,174.20" "$1,957.00" "$1,957.00" "$1,957.00" N/A N/A 36000042 EAP Custom 36000042 L&D LEVEL 6 1ST 30 MIN BOTH IP/OP "$3,163.00" "$2,341.00" $563.01 "$3,416.00" "$3,163.00" "$3,163.00" "$3,163.00" "$3,163.00" "$3,163.00" "$3,163.00" $563.01 "$3,163.00" "$3,163.00" "$3,163.00" "$3,163.00" "$3,163.00" "$3,163.00" $659.20 "$3,163.00" "$1,366.40" "$3,163.00" "$3,163.00" "$3,416.00" "$3,163.00" "$3,163.00" "$2,372.25" "$3,163.00" "$3,163.00" "$3,163.00" "$1,581.50" "$1,581.50" "$2,505.10" "$3,163.00" "$2,530.40" "$2,055.95" "$3,163.00" "$3,163.00" "$1,834.54" "$3,163.00" "$1,897.80" "$3,163.00" "$3,163.00" "$3,163.00" N/A N/A 36000043 EAP Custom 36000043 L&D LEVEL 1 ADD 15 MIN BOTH IP/OP $797.00 $590.00 $141.87 $861.00 $797.00 $797.00 $797.00 $797.00 $797.00 $797.00 $141.87 $797.00 $797.00 $797.00 $797.00 $797.00 $797.00 $166.10 $797.00 $344.40 $797.00 $797.00 $861.00 $797.00 $797.00 $597.75 $797.00 $797.00 $797.00 $398.50 $398.50 $631.22 $797.00 $637.60 $518.05 $797.00 $797.00 $462.26 $797.00 $478.20 $797.00 $797.00 $797.00 N/A N/A 36000044 EAP Custom 36000044 L&D LEVEL 2 ADD 15 MIN BOTH IP/OP $969.00 $717.50 $172.48 "$1,047.00" $969.00 $969.00 $969.00 $969.00 $969.00 $969.00 $172.48 $969.00 $969.00 $969.00 $969.00 $969.00 $969.00 $201.95 $969.00 $418.80 $969.00 $969.00 "$1,047.00" $969.00 $969.00 $726.75 $969.00 $969.00 $969.00 $484.50 $484.50 $767.45 $969.00 $775.20 $629.85 $969.00 $969.00 $562.02 $969.00 $581.40 $969.00 $969.00 $969.00 N/A N/A 36000045 EAP Custom 36000045 L&D LEVEL 3 ADD 15 MIN BOTH IP/OP "$1,081.00" $800.00 $192.42 "$1,168.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" $192.42 "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" $225.29 "$1,081.00" $467.20 "$1,081.00" "$1,081.00" "$1,168.00" "$1,081.00" "$1,081.00" $810.75 "$1,081.00" "$1,081.00" "$1,081.00" $540.50 $540.50 $856.15 "$1,081.00" $864.80 $702.65 "$1,081.00" "$1,081.00" $626.98 "$1,081.00" $648.60 "$1,081.00" "$1,081.00" "$1,081.00" N/A N/A 36000046 EAP Custom 36000046 L&D LEVEL 4 ADD 15 MIN BOTH IP/OP "$1,195.00" $884.50 $212.71 "$1,291.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $516.40 "$1,195.00" "$1,195.00" "$1,291.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $776.75 "$1,195.00" "$1,195.00" $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 36000047 EAP Custom 36000047 L&D LEVEL 5 ADD 15 MIN BOTH IP/OP $881.00 $652.00 $156.82 $952.00 $881.00 $881.00 $881.00 $881.00 $881.00 $881.00 $156.82 $881.00 $881.00 $881.00 $881.00 $881.00 $881.00 $183.61 $881.00 $380.80 $881.00 $881.00 $952.00 $881.00 $881.00 $660.75 $881.00 $881.00 $881.00 $440.50 $440.50 $697.75 $881.00 $704.80 $572.65 $881.00 $881.00 $510.98 $881.00 $528.60 $881.00 $881.00 $881.00 N/A N/A 36000048 EAP Custom 36000048 L&D LEVEL 6 ADD 15 MIN BOTH IP/OP "$1,422.00" "$1,052.50" $253.12 "$1,536.00" "$1,422.00" "$1,422.00" "$1,422.00" "$1,422.00" "$1,422.00" "$1,422.00" $253.12 "$1,422.00" "$1,422.00" "$1,422.00" "$1,422.00" "$1,422.00" "$1,422.00" $296.36 "$1,422.00" $614.40 "$1,422.00" "$1,422.00" "$1,536.00" "$1,422.00" "$1,422.00" "$1,066.50" "$1,422.00" "$1,422.00" "$1,422.00" $711.00 $711.00 "$1,126.22" "$1,422.00" "$1,137.60" $924.30 "$1,422.00" "$1,422.00" $824.76 "$1,422.00" $853.20 "$1,422.00" "$1,422.00" "$1,422.00" N/A N/A 36000110 EAP Custom 36000110 PERFUSIONIST BOTH IP/OP "$3,589.00" "$2,656.00" $638.84 "$3,589.00" "$3,589.00" "$3,589.00" "$3,589.00" "$3,589.00" "$3,589.00" "$3,589.00" $638.84 "$3,589.00" "$3,589.00" "$3,589.00" "$3,589.00" "$3,589.00" "$3,589.00" $747.99 "$3,589.00" "$1,435.60" "$3,589.00" "$3,589.00" "$3,589.00" "$3,589.00" "$3,589.00" "$2,691.75" "$3,589.00" "$3,589.00" "$3,589.00" "$1,794.50" "$1,794.50" "$2,842.49" "$3,589.00" "$2,871.20" "$2,332.85" "$3,589.00" "$3,589.00" "$2,081.62" "$3,589.00" "$2,153.40" "$3,589.00" "$3,589.00" "$3,589.00" N/A N/A 36000116 EAP CPT® 36680 PLACEMENT OF A NEEDLE FOR INTRAOSSEOUS INFUSION BOTH IP/OP $684.00 $506.50 $59.46 $684.00 $684.00 $684.00 $684.00 $684.00 $59.46 $59.46 $59.61 $684.00 $59.46 $684.00 $684.00 $684.00 $684.00 $142.55 $95.14 $95.58 $684.00 $59.46 $59.74 $59.46 $684.00 $513.00 $59.46 $59.46 $59.46 $684.00 $342.00 $541.73 $59.46 $547.20 $684.00 $684.00 $59.46 $396.72 $684.00 $62.74 $59.46 $684.00 $59.46 N/A N/A 36000117 EAP Custom 36000117 LEVEL 1 1ST 30 MIN BOTH IP/OP "$11,028.00" "$8,161.00" "$1,962.98" "$11,910.00" "$11,028.00" "$11,028.00" "$11,028.00" "$11,028.00" "$11,028.00" "$11,028.00" "$1,962.98" "$11,028.00" "$11,028.00" "$11,028.00" "$11,028.00" "$11,028.00" "$11,028.00" "$2,298.36" "$11,028.00" "$4,764.00" "$11,028.00" "$11,028.00" "$11,910.00" "$11,028.00" "$11,028.00" "$8,271.00" "$11,028.00" "$11,028.00" "$11,028.00" "$5,514.00" "$5,514.00" "$8,734.18" "$11,028.00" "$8,822.40" "$7,168.20" "$11,028.00" "$11,028.00" "$6,396.24" "$11,028.00" "$6,616.80" "$11,028.00" "$11,028.00" "$11,028.00" N/A N/A 36000118 EAP Custom 36000118 LEVEL 2 1ST 30 MIN BOTH IP/OP "$13,392.00" "$9,910.50" "$2,383.78" "$14,463.00" "$13,392.00" "$13,392.00" "$13,392.00" "$13,392.00" "$13,392.00" "$13,392.00" "$2,383.78" "$13,392.00" "$13,392.00" "$13,392.00" "$13,392.00" "$13,392.00" "$13,392.00" "$2,791.04" "$13,392.00" "$5,785.20" "$13,392.00" "$13,392.00" "$14,463.00" "$13,392.00" "$13,392.00" "$10,044.00" "$13,392.00" "$13,392.00" "$13,392.00" "$6,696.00" "$6,696.00" "$10,606.46" "$13,392.00" "$10,713.60" "$8,704.80" "$13,392.00" "$13,392.00" "$7,767.36" "$13,392.00" "$8,035.20" "$13,392.00" "$13,392.00" "$13,392.00" N/A N/A 36000119 EAP Custom 36000119 LEVEL 3 1ST 30 MIN BOTH IP/OP "$14,968.00" "$11,076.50" "$2,664.30" "$16,165.00" "$14,968.00" "$14,968.00" "$14,968.00" "$14,968.00" "$14,968.00" "$14,968.00" "$2,664.30" "$14,968.00" "$14,968.00" "$14,968.00" "$14,968.00" "$14,968.00" "$14,968.00" "$3,119.50" "$14,968.00" "$6,466.00" "$14,968.00" "$14,968.00" "$16,165.00" "$14,968.00" "$14,968.00" "$11,226.00" "$14,968.00" "$14,968.00" "$14,968.00" "$7,484.00" "$7,484.00" "$11,854.66" "$14,968.00" "$11,974.40" "$9,729.20" "$14,968.00" "$14,968.00" "$8,681.44" "$14,968.00" "$8,980.80" "$14,968.00" "$14,968.00" "$14,968.00" N/A N/A 36000120 EAP Custom 36000120 LEVEL 4 1ST 30 MIN BOTH IP/OP "$16,545.00" "$12,243.50" "$2,945.01" "$17,869.00" "$16,545.00" "$16,545.00" "$16,545.00" "$16,545.00" "$16,545.00" "$16,545.00" "$2,945.01" "$16,545.00" "$16,545.00" "$16,545.00" "$16,545.00" "$16,545.00" "$16,545.00" "$3,448.16" "$16,545.00" "$7,147.60" "$16,545.00" "$16,545.00" "$17,869.00" "$16,545.00" "$16,545.00" "$12,408.75" "$16,545.00" "$16,545.00" "$16,545.00" "$8,272.50" "$8,272.50" "$13,103.64" "$16,545.00" "$13,236.00" "$10,754.25" "$16,545.00" "$16,545.00" "$9,596.10" "$16,545.00" "$9,927.00" "$16,545.00" "$16,545.00" "$16,545.00" N/A N/A 36000121 EAP Custom 36000121 LEVEL 5 1ST 30 MIN BOTH IP/OP "$18,117.00" "$13,407.00" "$3,224.83" "$19,566.00" "$18,117.00" "$18,117.00" "$18,117.00" "$18,117.00" "$18,117.00" "$18,117.00" "$3,224.83" "$18,117.00" "$18,117.00" "$18,117.00" "$18,117.00" "$18,117.00" "$18,117.00" "$3,775.78" "$18,117.00" "$7,826.40" "$18,117.00" "$18,117.00" "$19,566.00" "$18,117.00" "$18,117.00" "$13,587.75" "$18,117.00" "$18,117.00" "$18,117.00" "$9,058.50" "$9,058.50" "$14,348.66" "$18,117.00" "$14,493.60" "$11,776.05" "$18,117.00" "$18,117.00" "$10,507.86" "$18,117.00" "$10,870.20" "$18,117.00" "$18,117.00" "$18,117.00" N/A N/A 36000122 EAP Custom 36000122 LEVEL 6 1ST 30 MIN BOTH IP/OP "$19,694.00" "$14,574.00" "$3,505.53" "$21,270.00" "$19,694.00" "$19,694.00" "$19,694.00" "$19,694.00" "$19,694.00" "$19,694.00" "$3,505.53" "$19,694.00" "$19,694.00" "$19,694.00" "$19,694.00" "$19,694.00" "$19,694.00" "$4,104.45" "$19,694.00" "$8,508.00" "$19,694.00" "$19,694.00" "$21,270.00" "$19,694.00" "$19,694.00" "$14,770.50" "$19,694.00" "$19,694.00" "$19,694.00" "$9,847.00" "$9,847.00" "$15,597.65" "$19,694.00" "$15,755.20" "$12,801.10" "$19,694.00" "$19,694.00" "$11,422.52" "$19,694.00" "$11,816.40" "$19,694.00" "$19,694.00" "$19,694.00" N/A N/A 36000123 EAP Custom 36000123 LEVEL 1 ADD 15 MIN BOTH IP/OP "$4,964.00" "$3,673.50" $883.59 "$5,361.00" "$4,964.00" "$4,964.00" "$4,964.00" "$4,964.00" "$4,964.00" "$4,964.00" $883.59 "$4,964.00" "$4,964.00" "$4,964.00" "$4,964.00" "$4,964.00" "$4,964.00" "$1,034.55" "$4,964.00" "$2,144.40" "$4,964.00" "$4,964.00" "$5,361.00" "$4,964.00" "$4,964.00" "$3,723.00" "$4,964.00" "$4,964.00" "$4,964.00" "$2,482.00" "$2,482.00" "$3,931.49" "$4,964.00" "$3,971.20" "$3,226.60" "$4,964.00" "$4,964.00" "$2,879.12" "$4,964.00" "$2,978.40" "$4,964.00" "$4,964.00" "$4,964.00" N/A N/A 36000124 EAP Custom 36000124 LEVEL 2 ADD 15 MIN BOTH IP/OP "$6,030.00" "$4,462.50" "$1,073.34" "$6,512.00" "$6,030.00" "$6,030.00" "$6,030.00" "$6,030.00" "$6,030.00" "$6,030.00" "$1,073.34" "$6,030.00" "$6,030.00" "$6,030.00" "$6,030.00" "$6,030.00" "$6,030.00" "$1,256.72" "$6,030.00" "$2,604.80" "$6,030.00" "$6,030.00" "$6,512.00" "$6,030.00" "$6,030.00" "$4,522.50" "$6,030.00" "$6,030.00" "$6,030.00" "$3,015.00" "$3,015.00" "$4,775.76" "$6,030.00" "$4,824.00" "$3,919.50" "$6,030.00" "$6,030.00" "$3,497.40" "$6,030.00" "$3,618.00" "$6,030.00" "$6,030.00" "$6,030.00" N/A N/A 36000125 EAP Custom 36000125 LEVEL 3 ADD 15 MIN BOTH IP/OP "$6,740.00" "$4,988.00" "$1,199.72" "$7,279.00" "$6,740.00" "$6,740.00" "$6,740.00" "$6,740.00" "$6,740.00" "$6,740.00" "$1,199.72" "$6,740.00" "$6,740.00" "$6,740.00" "$6,740.00" "$6,740.00" "$6,740.00" "$1,404.69" "$6,740.00" "$2,911.60" "$6,740.00" "$6,740.00" "$7,279.00" "$6,740.00" "$6,740.00" "$5,055.00" "$6,740.00" "$6,740.00" "$6,740.00" "$3,370.00" "$3,370.00" "$5,338.08" "$6,740.00" "$5,392.00" "$4,381.00" "$6,740.00" "$6,740.00" "$3,909.20" "$6,740.00" "$4,044.00" "$6,740.00" "$6,740.00" "$6,740.00" N/A N/A 36000126 EAP Custom 36000126 LEVEL 4 ADD 15 MIN BOTH IP/OP "$7,445.00" "$5,509.50" "$1,325.21" "$8,041.00" "$7,445.00" "$7,445.00" "$7,445.00" "$7,445.00" "$7,445.00" "$7,445.00" "$1,325.21" "$7,445.00" "$7,445.00" "$7,445.00" "$7,445.00" "$7,445.00" "$7,445.00" "$1,551.62" "$7,445.00" "$3,216.40" "$7,445.00" "$7,445.00" "$8,041.00" "$7,445.00" "$7,445.00" "$5,583.75" "$7,445.00" "$7,445.00" "$7,445.00" "$3,722.50" "$3,722.50" "$5,896.44" "$7,445.00" "$5,956.00" "$4,839.25" "$7,445.00" "$7,445.00" "$4,318.10" "$7,445.00" "$4,467.00" "$7,445.00" "$7,445.00" "$7,445.00" N/A N/A 36000127 EAP Custom 36000127 LEVEL 5 ADD 15 MIN BOTH IP/OP "$7,979.00" "$5,904.50" "$1,420.26" "$8,617.00" "$7,979.00" "$7,979.00" "$7,979.00" "$7,979.00" "$7,979.00" "$7,979.00" "$1,420.26" "$7,979.00" "$7,979.00" "$7,979.00" "$7,979.00" "$7,979.00" "$7,979.00" "$1,662.91" "$7,979.00" "$3,446.80" "$7,979.00" "$7,979.00" "$8,617.00" "$7,979.00" "$7,979.00" "$5,984.25" "$7,979.00" "$7,979.00" "$7,979.00" "$3,989.50" "$3,989.50" "$6,319.37" "$7,979.00" "$6,383.20" "$5,186.35" "$7,979.00" "$7,979.00" "$4,627.82" "$7,979.00" "$4,787.40" "$7,979.00" "$7,979.00" "$7,979.00" N/A N/A 36000128 EAP Custom 36000128 LEVEL 6 ADD 15 MIN BOTH IP/OP "$8,864.00" "$6,559.50" "$1,577.79" "$9,573.00" "$8,864.00" "$8,864.00" "$8,864.00" "$8,864.00" "$8,864.00" "$8,864.00" "$1,577.79" "$8,864.00" "$8,864.00" "$8,864.00" "$8,864.00" "$8,864.00" "$8,864.00" "$1,847.36" "$8,864.00" "$3,829.20" "$8,864.00" "$8,864.00" "$9,573.00" "$8,864.00" "$8,864.00" "$6,648.00" "$8,864.00" "$8,864.00" "$8,864.00" "$4,432.00" "$4,432.00" "$7,020.29" "$8,864.00" "$7,091.20" "$5,761.60" "$8,864.00" "$8,864.00" "$5,141.12" "$8,864.00" "$5,318.40" "$8,864.00" "$8,864.00" "$8,864.00" N/A N/A 36100001 EAP CPT® 10021 FNA BX W/O IMG GDN 1ST LES BOTH IP/OP "$1,308.00" $968.00 $55.28 "$1,308.00" "$1,308.00" "$1,308.00" "$1,308.00" "$1,308.00" $340.00 $340.00 $338.49 $272.62 $340.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $272.60 $543.99 $538.21 $113.00 $340.00 $55.28 $340.00 $357.00 $981.00 $340.00 $340.00 $340.00 "$1,308.00" $654.00 "$1,035.94" $340.00 "$1,046.40" "$1,308.00" $259.61 $340.00 $758.64 $357.00 $491.89 $340.00 $272.59 $340.00 N/A N/A 36100002 EAP CPT® 69100 BIOPSY OF EXTERNAL EAR BOTH IP/OP "$2,056.00" "$1,521.50" $47.12 "$2,056.00" "$1,116.41" "$1,116.41" "$1,116.41" "$1,116.41" $208.11 $208.11 $207.19 $428.52 $208.11 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $428.49 $332.98 $299.82 "$1,871.00" $208.11 $47.12 $208.11 $218.52 "$1,542.00" $208.11 $208.11 $208.11 "$2,056.00" "$1,028.00" "$1,628.35" $208.11 "$1,644.80" "$1,750.00" $408.06 $208.11 "$1,192.48" $218.52 $301.08 $208.11 $428.47 $208.11 N/A N/A 36100003 EAP CPT® 22510 PERCUT VERTEBROPLASTY THOR BOTH IP/OP "$7,794.00" "$5,768.00" $434.19 "$7,794.00" "$7,794.00" "$7,794.00" "$7,794.00" "$7,794.00" $434.19 $434.19 $435.45 "$7,794.00" $434.19 "$7,794.00" "$7,794.00" "$7,794.00" "$7,794.00" "$1,624.36" $694.70 $695.65 "$7,794.00" $434.19 $434.78 $434.19 "$7,794.00" "$5,845.50" $434.19 $434.19 $434.19 "$7,479.00" "$3,897.00" "$6,172.85" $434.19 "$6,235.20" "$3,725.00" "$7,794.00" $434.19 "$4,520.52" "$7,794.00" $450.72 $434.19 "$7,794.00" $434.19 N/A N/A 36100005 EAP CPT® 22511 PERCUT VERTEBROPLASTY LUMB BOTH IP/OP "$7,794.00" "$5,768.00" $407.97 "$7,794.00" "$7,794.00" "$7,794.00" "$7,794.00" "$7,794.00" $409.07 $409.07 $409.45 "$7,794.00" $409.07 "$7,794.00" "$7,794.00" "$7,794.00" "$7,794.00" "$1,624.36" $654.51 $652.75 "$7,794.00" $409.07 $407.97 $409.07 "$7,794.00" "$5,845.50" $409.07 $409.07 $409.07 "$7,479.00" "$3,897.00" "$6,172.85" $409.07 "$6,235.20" "$3,725.00" "$7,794.00" $409.07 "$4,520.52" "$7,794.00" $422.59 $409.07 "$7,794.00" $409.07 N/A N/A 36100006 EAP CPT® 22512 PERCUT VERTEBROPLASTY ADD'L BOTH IP/OP "$7,794.00" "$5,768.00" $207.32 "$7,794.00" "$7,794.00" "$7,794.00" "$7,794.00" "$7,794.00" $207.49 $207.49 $208.26 "$7,794.00" $207.49 "$7,794.00" "$7,794.00" "$7,794.00" "$7,794.00" "$1,624.36" $331.98 $331.71 "$7,794.00" $207.49 $207.32 $207.49 "$7,794.00" "$5,845.50" $207.49 $207.49 $207.49 "$7,479.00" "$3,897.00" "$6,172.85" $207.49 "$6,235.20" "$1,750.00" "$7,794.00" $207.49 "$4,520.52" "$7,794.00" $214.91 $207.49 "$7,794.00" $207.49 N/A N/A 36100007 EAP CPT® 22513 "PERCUT KYPHOPLASTY, THOR" BOTH IP/OP "$21,530.00" "$15,932.50" $513.93 "$21,530.00" "$21,530.00" "$21,530.00" "$21,530.00" "$21,530.00" $513.96 $513.96 $517.59 "$21,530.00" $513.96 "$21,530.00" "$21,530.00" "$21,530.00" "$21,530.00" "$4,487.09" $822.34 $822.29 "$21,530.00" $513.96 $513.93 $513.96 "$21,530.00" "$16,147.50" $513.96 $513.96 $513.96 "$7,479.00" "$10,765.00" "$17,051.76" $513.96 "$17,224.00" "$4,334.00" "$21,530.00" $513.96 "$12,487.40" "$21,530.00" $534.66 $513.96 "$21,530.00" $513.96 N/A N/A 36100008 EAP CPT® 10040 ACNE SURGERY BOTH IP/OP $568.00 $420.50 $52.20 $568.00 $308.42 $308.42 $308.42 $308.42 $176.64 $176.64 $175.86 $118.39 $176.64 $568.00 $568.00 $568.00 $568.00 $118.38 $282.63 $260.52 $113.00 $176.64 $52.20 $176.64 $185.48 $426.00 $176.64 $176.64 $176.64 $568.00 $284.00 $449.86 $176.64 $454.40 $568.00 $112.73 $176.64 $329.44 $185.48 $255.56 $176.64 $118.37 $176.64 N/A N/A 36100009 EAP CPT® 10060 I&D ABSCESS SIMPLE/SINGLE BOTH IP/OP "$1,334.00" $987.50 $106.35 "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" $176.64 $176.64 $175.86 $278.04 $176.64 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $278.02 $282.63 $260.52 $113.00 $176.64 $106.35 $176.64 $185.48 "$1,000.50" $176.64 $176.64 $176.64 "$1,334.00" $667.00 "$1,056.53" $176.64 "$1,067.20" "$1,334.00" $264.77 $176.64 $773.72 $185.48 $255.56 $176.64 $278.01 $176.64 N/A N/A 36100010 EAP CPT® 99291 HYPOTHERMIA (CRITICAL CARE) 1ST 30-74 MIN BOTH IP/OP "$4,975.00" "$3,681.50" $213.96 "$4,975.00" "$4,975.00" "$4,975.00" "$4,975.00" "$4,975.00" $217.60 $217.60 $219.40 "$4,975.00" $217.60 "$4,975.00" "$4,975.00" "$4,975.00" "$4,975.00" "$1,036.84" $348.16 $342.34 "$4,975.00" $217.60 $213.96 $217.60 "$4,975.00" "$3,731.25" $217.60 $217.60 $217.60 "$2,487.50" "$2,487.50" "$3,940.20" $217.60 "$3,980.00" "$3,233.75" "$4,975.00" $217.60 "$2,885.50" "$4,975.00" $226.49 $217.60 "$4,975.00" $217.60 N/A N/A 36100012 EAP CPT® 99292 HYPOTHERMIA (CRITICAL CARE) ADDL 30 MIN BOTH IP/OP "$1,110.00" $821.50 $107.49 "$1,110.00" "$1,110.00" "$1,110.00" "$1,110.00" "$1,110.00" $109.30 $109.30 $110.21 "$1,110.00" $109.30 "$1,110.00" "$1,110.00" "$1,110.00" "$1,110.00" $231.34 $174.88 $171.98 "$1,110.00" $109.30 $107.49 $109.30 "$1,110.00" $832.50 $109.30 $109.30 $109.30 $555.00 $555.00 $879.12 $109.30 $888.00 "$1,110.00" "$1,110.00" $109.30 $643.80 "$1,110.00" $113.96 $109.30 "$1,110.00" $109.30 N/A N/A 36100013 EAP CPT® 22514 "PERCUT KYPHOPLASTY, LUMB" BOTH IP/OP "$21,530.00" "$15,932.50" $478.42 "$21,530.00" "$21,530.00" "$21,530.00" "$21,530.00" "$21,530.00" $478.42 $478.42 $483.36 "$21,530.00" $478.42 "$21,530.00" "$21,530.00" "$21,530.00" "$21,530.00" "$4,487.09" $765.47 $766.90 "$21,530.00" $478.42 $479.31 $478.42 "$21,530.00" "$16,147.50" $478.42 $478.42 $478.42 "$7,479.00" "$10,765.00" "$17,051.76" $478.42 "$17,224.00" "$4,334.00" "$21,530.00" $478.42 "$12,487.40" "$21,530.00" $498.60 $478.42 "$21,530.00" $478.42 N/A N/A 36100014 EAP CPT® 22515 "PERCUT KYPHOPLASTY, ADD-ON" BOTH IP/OP "$21,530.00" "$15,932.50" $219.23 "$21,530.00" "$21,530.00" "$21,530.00" "$21,530.00" "$21,530.00" $219.50 $219.50 $221.42 "$21,530.00" $219.50 "$21,530.00" "$21,530.00" "$21,530.00" "$21,530.00" "$4,487.09" $351.20 $350.77 "$21,530.00" $219.50 $219.23 $219.50 "$21,530.00" "$16,147.50" $219.50 $219.50 $219.50 "$10,765.00" "$10,765.00" "$17,051.76" $219.50 "$17,224.00" "$1,750.00" "$21,530.00" $219.50 "$12,487.40" "$21,530.00" $230.39 $219.50 "$21,530.00" $219.50 N/A N/A 36100016 EAP CPT® 62302 MYELOGRAPHY VIA LUMBAR INJECTION;CERVICAL;INCLUDING S&I BOTH IP/OP $764.00 $565.50 $119.33 $764.00 $764.00 $764.00 $764.00 $764.00 $120.04 $120.04 $121.04 $764.00 $120.04 $764.00 $764.00 $764.00 $764.00 $159.23 $192.06 $190.93 $764.00 $120.04 $119.33 $120.04 $764.00 $573.00 $120.04 $120.04 $120.04 $382.00 $382.00 $605.09 $120.04 $611.20 $764.00 $764.00 $120.04 $443.12 $764.00 $126.21 $120.04 $764.00 $120.04 N/A N/A 36100017 EAP CPT® 62303 MYELOGRAPHY VIA LUMBAR INJECTION;THORACIC;INCLUDING S&I BOTH IP/OP $804.00 $595.00 $119.33 $804.00 $804.00 $804.00 $804.00 $804.00 $120.39 $120.39 $121.04 $804.00 $120.39 $804.00 $804.00 $804.00 $804.00 $167.56 $192.62 $190.93 $804.00 $120.39 $119.33 $120.39 $804.00 $603.00 $120.39 $120.39 $120.39 $402.00 $402.00 $636.77 $120.39 $643.20 $804.00 $804.00 $120.39 $466.32 $804.00 $126.21 $120.39 $804.00 $120.39 N/A N/A 36100018 EAP CPT® 62304 MYELOGRAPHY VIA LUMBAR INJECTION;LUMBOSACRAL;INCLUDING S&I BOTH IP/OP "$1,729.00" "$1,279.50" $117.64 "$1,729.00" "$1,729.00" "$1,729.00" "$1,729.00" "$1,729.00" $118.31 $118.31 $119.29 "$1,729.00" $118.31 "$1,729.00" "$1,729.00" "$1,729.00" "$1,729.00" $360.34 $189.30 $188.22 "$1,729.00" $118.31 $117.64 $118.31 "$1,729.00" "$1,296.75" $118.31 $118.31 $118.31 $864.50 $864.50 "$1,369.37" $118.31 "$1,383.20" "$1,729.00" "$1,729.00" $118.31 "$1,002.82" "$1,729.00" $124.41 $118.31 "$1,729.00" $118.31 N/A N/A 36100019 EAP CPT® 62305 MYELOGRAPHY VIA LUMBAR INJECTION' 2OR MORE REGIONS;INCLUDING S&I BOTH IP/OP "$3,914.00" "$2,896.50" $122.38 "$3,914.00" "$3,914.00" "$3,914.00" "$3,914.00" "$3,914.00" $123.47 $123.47 $124.18 "$3,914.00" $123.47 "$3,914.00" "$3,914.00" "$3,914.00" "$3,914.00" $815.72 $197.55 $195.81 "$3,914.00" $123.47 $122.38 $123.47 "$3,914.00" "$2,935.50" $123.47 $123.47 $123.47 "$1,957.00" "$1,957.00" "$3,099.89" $123.47 "$3,131.20" "$2,150.00" "$3,914.00" $123.47 "$2,270.12" "$3,914.00" $129.46 $123.47 "$3,914.00" $123.47 N/A N/A 36100020 EAP CPT® 10061 I&D ABSCESS COMPLEX/MULTIPLE BOTH IP/OP "$1,394.00" "$1,032.00" $185.34 "$1,394.00" "$1,394.00" "$1,394.00" "$1,394.00" "$1,394.00" $340.00 $340.00 $338.49 $290.54 $340.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $290.52 $543.99 $538.21 "$1,394.00" $340.00 $185.34 $340.00 $357.00 "$1,045.50" $340.00 $340.00 $340.00 "$1,394.00" $697.00 "$1,104.05" $340.00 "$1,115.20" "$1,394.00" $276.67 $340.00 $808.52 $357.00 $491.89 $340.00 $290.51 $340.00 N/A N/A 36100022 EAP CPT® 20604 DRAIN /INJECT-FINGER/TOE WITH US GUIDANCE BOTH IP/OP $935.00 $692.00 $46.12 $935.00 $935.00 $935.00 $935.00 $935.00 $257.00 $257.00 $255.86 $194.88 $257.00 $935.00 $935.00 $935.00 $882.37 $194.86 $411.20 $392.25 $113.00 $257.00 $46.12 $257.00 $269.85 $701.25 $257.00 $257.00 $257.00 $935.00 $467.50 $740.52 $257.00 $748.00 $935.00 $185.57 $257.00 $542.30 $269.85 $371.81 $257.00 $194.85 $257.00 N/A N/A 36100023 EAP CPT® 20606 DRAIN/INJECT-WRIST ELBOW ANKLE WITH US GUIDANCE BOTH IP/OP $935.00 $692.00 $52.22 $999.41 $935.00 $935.00 $935.00 $935.00 $624.63 $624.63 $621.87 $194.88 $624.63 $935.00 $935.00 $935.00 $882.37 $194.86 $999.41 $929.56 $113.00 $624.63 $52.22 $624.63 $655.86 $701.25 $624.63 $624.63 $624.63 $935.00 $467.50 $740.52 $624.63 $748.00 $935.00 $185.57 $624.63 $542.30 $655.86 $903.68 $624.63 $194.85 $624.63 N/A N/A 36100024 EAP CPT® 20611 DRAIN/INJECT-SHOULDER HIP KNEE WITH US GUIDANCE BOTH IP/OP "$2,198.00" "$1,627.00" $60.38 "$2,198.00" "$2,198.00" "$2,198.00" "$2,198.00" "$2,198.00" $257.00 $257.00 $255.86 $458.12 $257.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $458.09 $411.20 $392.25 $113.00 $257.00 $60.38 $257.00 $269.85 "$1,648.50" $257.00 $257.00 $257.00 "$2,198.00" "$1,099.00" "$1,740.82" $257.00 "$1,758.40" "$1,750.00" $436.25 $257.00 "$1,274.84" $269.85 $371.81 $257.00 $458.06 $257.00 N/A N/A 36100025 EAP CPT® 20983 ABLATION THERAPY BONE TUMOR(S) PERQ BOTH IP/OP "$6,719.00" "$4,972.50" $339.55 "$6,719.00" "$6,719.00" "$6,719.00" "$6,719.00" "$6,719.00" $339.55 $339.55 $344.71 "$6,719.00" $339.55 "$6,719.00" "$6,719.00" "$6,719.00" "$6,719.00" "$1,400.31" $543.28 $545.30 "$6,719.00" $339.55 $340.81 $339.55 "$6,719.00" "$5,039.25" $339.55 $339.55 $339.55 "$6,679.00" "$3,359.50" "$5,321.45" $339.55 "$5,375.20" "$4,334.00" "$6,719.00" $339.55 "$3,897.02" "$6,719.00" $360.99 $339.55 "$6,719.00" $339.55 N/A N/A 36100026 EAP CPT® 64566 PERCUTANEOUS TIBIAL NERVE STIMULATION BOTH IP/OP $617.00 $457.00 $30.19 $617.00 $617.00 $617.00 $617.00 $617.00 $257.00 $257.00 $255.86 $128.60 $257.00 $617.00 $617.00 $617.00 $617.00 $128.59 $411.20 $392.25 $617.00 $257.00 $30.19 $257.00 $269.85 $462.75 $257.00 $257.00 $257.00 $617.00 $308.50 $488.66 $257.00 $493.60 $617.00 $122.46 $257.00 $357.86 $269.85 $371.81 $257.00 $128.58 $257.00 N/A N/A 36100027 EAP CPT® 46607 ANOSCOPY HRA W/BIOPSY BOTH IP/OP "$3,451.00" "$2,554.00" $124.79 "$3,451.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,020.04" "$1,020.04" "$1,015.53" $719.27 "$1,020.04" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $719.23 "$1,632.07" "$1,562.27" "$3,451.00" "$1,020.04" $124.79 "$1,020.04" "$1,071.05" "$2,588.25" "$1,020.04" "$1,020.04" "$1,020.04" "$2,762.00" "$1,725.50" "$2,733.19" "$1,020.04" "$2,760.80" "$2,500.00" $684.94 "$1,020.04" "$2,001.58" "$1,071.05" "$1,475.75" "$1,020.04" $719.19 "$1,020.04" N/A N/A 36100028 EAP CPT® 10080 DRAINAGE OF PILONIDAL CYST BOTH IP/OP $712.00 $527.00 $105.72 $712.00 $712.00 $712.00 $712.00 $712.00 $106.15 $106.15 $106.02 $712.00 $106.15 $712.00 $712.00 $712.00 $712.00 $148.39 $169.84 $169.15 $712.00 $106.15 $105.72 $106.15 $712.00 $534.00 $106.15 $106.15 $106.15 $712.00 $356.00 $563.90 $106.15 $569.60 $712.00 $712.00 $106.15 $412.96 $712.00 $106.33 $106.15 $712.00 $106.15 N/A N/A 36100030 EAP CPT® 10120 REMOVE FB SUBQ SIMPLE BOTH IP/OP $768.00 $568.50 $104.69 $768.00 $768.00 $768.00 $768.00 $768.00 $104.69 $104.69 $105.49 $768.00 $104.69 $768.00 $768.00 $768.00 $768.00 $160.06 $167.50 $170.21 $768.00 $104.69 $106.38 $104.69 $768.00 $576.00 $104.69 $104.69 $104.69 $768.00 $384.00 $608.26 $104.69 $614.40 $768.00 $768.00 $104.69 $445.44 $768.00 $105.97 $104.69 $768.00 $104.69 N/A N/A 36100034 EAP CPT® 10121 "REMOVAL OF FB, SC TISSUE COMPL" BOTH IP/OP "$7,169.00" "$5,305.50" $185.41 "$7,169.00" "$7,169.00" "$7,169.00" "$7,169.00" "$7,169.00" $185.77 $185.77 $186.96 "$7,169.00" $185.77 "$7,169.00" "$7,169.00" "$7,169.00" "$7,169.00" "$1,494.10" $297.23 $296.66 "$7,169.00" $185.77 $185.41 $185.77 "$7,169.00" "$5,376.75" $185.77 $185.77 $185.77 "$2,851.00" "$3,584.50" "$5,677.85" $185.77 "$5,735.20" "$2,500.00" "$7,169.00" $185.77 "$4,158.02" "$7,169.00" $192.14 $185.77 "$7,169.00" $185.77 N/A N/A 36100035 EAP CPT® 10140 DRAINAGE OF HEMATOMA/FLUID BOTH IP/OP "$6,515.00" "$4,821.50" $113.00 "$5,212.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,384.05" "$1,384.05" "$1,377.93" "$1,357.89" "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,357.80" "$2,214.48" "$2,163.34" $113.00 "$1,384.05" $118.94 "$1,384.05" "$1,453.25" "$4,886.25" "$1,384.05" "$1,384.05" "$1,384.05" "$2,762.00" "$2,348.00" "$5,159.88" "$1,384.05" "$5,212.00" "$2,500.00" "$1,293.06" "$1,384.05" "$3,778.70" "$1,453.25" "$2,002.37" "$1,384.05" "$1,357.73" "$1,384.05" N/A N/A 36100036 EAP CPT® 52204 CYSTOSCOPY W/DIOPSY (S) BOTH IP/OP "$13,064.00" "$9,667.50" $139.69 "$13,064.00" "$13,064.00" "$13,064.00" "$13,064.00" "$13,064.00" $140.77 $140.77 $141.62 "$13,064.00" $140.77 "$13,064.00" "$13,064.00" "$13,064.00" "$13,064.00" "$2,722.68" $225.23 $223.50 "$13,064.00" $140.77 $139.69 $140.77 "$13,064.00" "$9,798.00" $140.77 $140.77 $140.77 "$2,851.00" "$6,532.00" "$10,346.69" $140.77 "$10,451.20" "$3,250.00" "$13,064.00" $140.77 "$7,577.12" "$13,064.00" $146.76 $140.77 "$13,064.00" $140.77 N/A N/A 36100037 EAP CPT® 52354 CYSTOURETERO W/DIOPSY BOTH IP/OP "$6,056.00" "$4,481.50" $412.03 "$6,056.00" "$6,056.00" "$6,056.00" "$6,056.00" "$6,056.00" $414.67 $414.67 $418.17 "$6,056.00" $414.67 "$6,056.00" "$6,056.00" "$6,056.00" "$6,056.00" "$1,262.14" $663.47 $659.25 "$6,056.00" $414.67 $412.03 $414.67 "$6,056.00" "$4,542.00" $414.67 $414.67 $414.67 "$4,417.00" "$3,028.00" "$4,796.35" $414.67 "$4,844.80" "$3,250.00" "$6,056.00" $414.67 "$3,512.48" "$6,056.00" $433.80 $414.67 "$6,056.00" $414.67 N/A N/A 36100041 EAP CPT® 10160 PUNC ASP ABSCESS/CYST/HEMATOMA BOTH IP/OP $645.00 $477.50 $97.59 $645.00 $645.00 $645.00 $645.00 $645.00 $340.00 $340.00 $338.49 $134.43 $340.00 $645.00 $645.00 $645.00 $645.00 $134.43 $543.99 $538.21 $113.00 $340.00 $97.59 $340.00 $357.00 $483.75 $340.00 $340.00 $340.00 $645.00 $322.50 $510.84 $340.00 $516.00 $645.00 $128.02 $340.00 $374.10 $357.00 $491.89 $340.00 $134.42 $340.00 N/A N/A 36100042 EAP CPT® 31600 "TRACHEOSTOMY, PLANNED" BOTH IP/OP "$4,986.00" "$3,690.00" $307.43 "$4,986.00" "$4,986.00" "$4,986.00" "$4,986.00" "$4,986.00" $308.49 $308.49 $309.37 "$4,986.00" $308.49 "$4,986.00" "$4,986.00" "$4,986.00" "$4,986.00" "$1,039.14" $493.58 $491.89 "$4,986.00" $308.49 $307.43 $308.49 "$4,986.00" "$3,739.50" $308.49 $308.49 $308.49 "$2,851.00" "$2,493.00" "$3,948.91" $308.49 "$3,988.80" "$3,250.00" "$4,986.00" $308.49 "$2,891.88" "$4,986.00" $320.52 $308.49 "$4,986.00" $308.49 N/A N/A 36100044 EAP CPT® 36473 ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN BOTH IP/OP "$8,848.00" "$6,548.00" $113.00 "$7,078.40" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$2,815.92" "$2,815.92" "$2,803.47" "$1,844.14" "$2,815.92" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$1,844.02" "$4,505.48" "$4,297.64" $113.00 "$2,815.92" $179.58 "$2,815.92" "$2,956.72" "$6,636.00" "$2,815.92" "$2,815.92" "$2,815.92" "$3,500.00" "$2,975.00" "$7,007.62" "$2,815.92" "$7,078.40" "$3,725.00" "$1,756.11" "$2,815.92" "$5,131.84" "$2,956.72" "$4,073.93" "$2,815.92" "$1,843.92" "$2,815.92" N/A N/A 36100045 EAP CPT® 36474 ENDOVEN ABLTJ INCMPTNT VEIN MCHN SBSQ VEINS-ADD ON BOTH IP/OP "$2,213.00" "$1,638.00" $89.16 "$2,213.00" "$2,213.00" "$2,213.00" "$2,213.00" "$2,213.00" $89.16 $89.16 $90.24 "$2,213.00" $89.16 "$2,213.00" "$2,213.00" "$2,213.00" "$2,213.00" $461.21 $142.66 $142.83 "$2,213.00" $89.16 $89.27 $89.16 "$2,213.00" "$1,659.75" $89.16 $89.16 $89.16 "$1,106.50" "$1,106.50" "$1,752.70" $89.16 "$1,770.40" "$1,750.00" "$2,213.00" $89.16 "$1,283.54" "$2,213.00" $93.75 $89.16 "$2,213.00" $89.16 N/A N/A 36100046 EAP CPT® 64611 CHEMODENERV PAROTID/SUBM SALIVARY GLANDS BILATERAL BOTH IP/OP $469.00 $347.50 $97.74 $469.00 $469.00 $469.00 $469.00 $469.00 $112.49 $112.49 $109.98 $469.00 $112.49 $469.00 $469.00 $469.00 $469.00 $97.74 $179.98 $180.67 $469.00 $112.49 $112.92 $112.49 $469.00 $351.75 $112.49 $112.49 $112.49 $469.00 $234.50 $371.45 $112.49 $375.20 $469.00 $469.00 $112.49 $272.02 $469.00 $108.82 $112.49 $469.00 $112.49 N/A N/A 36100049 EAP CPT® 10180 I&D COMPLEX POST OP WOUND INF BOTH IP/OP "$6,264.00" "$4,635.50" $181.06 "$5,011.20" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,332.34" "$2,332.34" "$2,322.02" "$1,305.57" "$2,332.34" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$1,305.49" "$3,731.74" "$3,726.76" "$2,836.00" "$2,332.34" $181.06 "$2,332.34" "$2,448.96" "$4,698.00" "$2,332.34" "$2,332.34" "$2,332.34" "$2,851.00" "$2,423.00" "$4,961.09" "$2,332.34" "$5,011.20" "$3,250.00" "$1,243.25" "$2,332.34" "$3,633.12" "$2,448.96" "$3,374.31" "$2,332.34" "$1,305.42" "$2,332.34" N/A N/A 36100050 EAP CPT® 52315 CYSTOSCOPY AND TREATMENT BOTH IP/OP "$8,062.00" "$5,966.00" $272.31 "$8,062.00" "$8,062.00" "$8,062.00" "$8,062.00" "$8,062.00" $272.91 $272.91 $275.52 "$8,062.00" $272.91 "$8,062.00" "$8,062.00" "$8,062.00" "$8,062.00" "$1,680.21" $436.66 $435.70 "$8,062.00" $272.91 $272.31 $272.91 "$8,062.00" "$6,046.50" $272.91 $272.91 $272.91 "$2,851.00" "$4,031.00" "$6,385.10" $272.91 "$6,449.60" "$3,250.00" "$8,062.00" $272.91 "$4,675.96" "$8,062.00" $285.23 $272.91 "$8,062.00" $272.91 N/A N/A 36100051 EAP CPT® 11000 DEBRIDEMENT OF SKIN BOTH IP/OP "$3,090.00" "$2,287.00" $27.12 "$3,090.00" "$3,090.00" "$3,090.00" "$3,090.00" "$3,090.00" $27.85 $27.85 $28.08 "$3,090.00" $27.85 "$3,090.00" "$3,090.00" "$3,090.00" "$3,090.00" $643.99 $44.56 $43.39 "$3,090.00" $27.85 $27.12 $27.85 "$3,090.00" "$2,317.50" $27.85 $27.85 $27.85 "$2,762.00" "$1,545.00" "$2,447.28" $27.85 "$2,472.00" "$1,750.00" "$3,090.00" $27.85 "$1,792.20" "$3,090.00" $29.57 $27.85 "$3,090.00" $27.85 N/A N/A 36100054 EAP CPT® 27685 REVISION OF LOWER LEG TENDON BOTH IP/OP "$6,964.00" "$5,153.50" $472.32 "$6,964.00" "$6,964.00" "$6,964.00" "$6,964.00" "$6,964.00" $472.32 $472.32 $472.50 "$6,964.00" $472.32 "$6,964.00" "$6,964.00" "$6,964.00" "$6,964.00" "$1,451.37" $755.71 $758.08 "$6,964.00" $472.32 $473.80 $472.32 "$6,964.00" "$5,223.00" $472.32 $472.32 $472.32 "$3,500.00" "$3,482.00" "$5,515.49" $472.32 "$5,571.20" "$3,725.00" "$6,964.00" $472.32 "$4,039.12" "$6,964.00" $481.61 $472.32 "$6,964.00" $472.32 N/A N/A 36100057 EAP CPT® 11001 "DEBRIDE, EACH ADD 10% OF BODY" BOTH IP/OP "$1,665.00" "$1,232.50" $14.40 "$1,665.00" "$1,665.00" "$1,665.00" "$1,665.00" "$1,665.00" $14.40 $14.40 $14.52 "$1,665.00" $14.40 "$1,665.00" "$1,665.00" "$1,665.00" "$1,665.00" $347.00 $23.04 $23.89 "$1,665.00" $14.40 $14.93 $14.40 "$1,665.00" "$1,248.75" $14.40 $14.40 $14.40 "$1,665.00" $832.50 "$1,318.68" $14.40 "$1,332.00" "$1,665.00" "$1,665.00" $14.40 $965.70 "$1,665.00" $14.79 $14.40 "$1,665.00" $14.40 N/A N/A 36100058 EAP CPT® 97597 DEBRIDE FIRST 20 SQ CM BOTH IP/OP $740.00 $548.00 $35.60 $740.00 $740.00 $740.00 $740.00 $740.00 $176.64 $176.64 $175.86 $154.23 $176.64 $740.00 $740.00 $740.00 $740.00 $154.22 $282.63 $260.52 $437.71 $176.64 $35.60 $176.64 $185.48 $555.00 $176.64 $176.64 $176.64 $740.00 $370.00 $586.08 $176.64 $592.00 $481.00 $146.87 $176.64 $429.20 $185.48 $255.56 $176.64 $154.22 $176.64 N/A N/A 36100060 EAP CPT® 49418 INSERTION OF TUNNELED INTRAPERITONEAL CATHETER BOTH IP/OP "$8,783.00" "$6,499.50" $199.73 "$8,783.00" "$8,783.00" "$8,783.00" "$8,783.00" "$8,783.00" $201.01 $201.01 $202.71 "$8,783.00" $201.01 "$8,783.00" "$8,783.00" "$8,783.00" "$8,783.00" "$1,830.47" $321.62 $319.57 "$8,783.00" $201.01 $199.73 $201.01 "$8,783.00" "$6,587.25" $201.01 $201.01 $201.01 "$3,500.00" "$4,391.50" "$6,956.14" $201.01 "$7,026.40" "$3,725.00" "$8,783.00" $201.01 "$5,094.14" "$8,783.00" $212.04 $201.01 "$8,783.00" $201.01 N/A N/A 36100063 EAP CPT® 11042 DEBRIDE SKIN & SUBCUTANEOUS BOTH IP/OP "$2,172.00" "$1,607.50" $60.00 "$2,172.00" "$2,172.00" "$2,172.00" "$2,172.00" "$2,172.00" $340.00 $340.00 $338.49 $452.70 $340.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $452.67 $543.99 $538.21 "$2,172.00" $340.00 $60.00 $340.00 $357.00 "$1,629.00" $340.00 $340.00 $340.00 "$2,172.00" "$1,086.00" "$1,720.22" $340.00 "$1,737.60" "$1,750.00" $431.09 $340.00 "$1,259.76" $357.00 $491.89 $340.00 $452.64 $340.00 N/A N/A 36100065 EAP CPT® 11043 DEBRIDEMENT SKIN/SQ/MUSCLE BOTH IP/OP "$4,347.00" "$3,217.00" $154.31 "$3,477.60" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" $515.18 $515.18 $512.91 $906.02 $515.18 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $905.96 $824.30 $838.11 "$2,836.00" $515.18 $154.31 $515.18 $540.94 "$3,260.25" $515.18 $515.18 $515.18 "$2,851.00" "$2,423.00" "$3,442.82" $515.18 "$3,477.60" "$1,750.00" $862.77 $515.18 "$2,521.26" $540.94 $745.34 $515.18 $905.91 $515.18 N/A N/A 36100067 EAP CPT® 11044 "DEBRIDEMENT, BONE" BOTH IP/OP "$5,344.00" "$3,955.00" $226.25 "$4,275.20" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,384.05" "$1,384.05" "$1,377.93" "$1,113.82" "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,113.75" "$2,214.48" "$2,163.34" "$2,836.00" "$1,384.05" $226.25 "$1,384.05" "$1,453.25" "$4,008.00" "$1,384.05" "$1,384.05" "$1,384.05" "$2,851.00" "$2,423.00" "$4,232.45" "$1,384.05" "$4,275.20" "$2,150.00" "$1,060.65" "$1,384.05" "$3,099.52" "$1,453.25" "$2,002.37" "$1,384.05" "$1,113.69" "$1,384.05" N/A N/A 36100070 EAP CPT® 11055 "PARE WART/CALLUS/HYPERKARATOTIC LESION, SINGLE" BOTH IP/OP $365.00 $270.50 $15.94 $365.00 $365.00 $365.00 $365.00 $365.00 $176.64 $176.64 $175.86 $76.08 $176.64 $365.00 $365.00 $365.00 $365.00 $76.07 $282.63 $260.52 $113.00 $176.64 $15.94 $176.64 $185.48 $273.75 $176.64 $176.64 $176.64 $365.00 $182.50 $289.08 $176.64 $292.00 $365.00 $72.44 $176.64 $211.70 $185.48 $255.56 $176.64 $76.07 $176.64 N/A N/A 36100073 EAP CPT® 11056 "PARE WART/CALLUS, 2-4 LESIONS" BOTH IP/OP $365.00 $270.50 $22.04 $365.00 $365.00 $365.00 $365.00 $365.00 $176.64 $176.64 $175.86 $76.08 $176.64 $365.00 $365.00 $365.00 $365.00 $76.07 $282.63 $260.52 $113.00 $176.64 $22.04 $176.64 $185.48 $273.75 $176.64 $176.64 $176.64 $365.00 $182.50 $289.08 $176.64 $292.00 $365.00 $72.44 $176.64 $211.70 $185.48 $255.56 $176.64 $76.07 $176.64 N/A N/A 36100074 EAP CPT® 11057 "PARE WART/CALLUS, >4 LESIONS" BOTH IP/OP $927.00 $686.00 $28.48 $927.00 $927.00 $927.00 $927.00 $927.00 $176.64 $176.64 $175.86 $193.21 $176.64 $927.00 $927.00 $927.00 $882.37 $193.20 $282.63 $260.52 $113.00 $176.64 $28.48 $176.64 $185.48 $695.25 $176.64 $176.64 $176.64 $927.00 $463.50 $734.18 $176.64 $741.60 $927.00 $183.99 $176.64 $537.66 $185.48 $255.56 $176.64 $193.19 $176.64 N/A N/A 36100078 EAP CPT® 11200 REMOVAL OF SKIN TAGS (1-15) BOTH IP/OP $712.00 $527.00 $77.22 $712.00 $712.00 $712.00 $712.00 $712.00 $176.64 $176.64 $175.86 $148.40 $176.64 $712.00 $712.00 $712.00 $712.00 $148.39 $282.63 $260.52 $113.00 $176.64 $77.22 $176.64 $185.48 $534.00 $176.64 $176.64 $176.64 $712.00 $356.00 $563.90 $176.64 $569.60 $712.00 $141.31 $176.64 $412.96 $185.48 $255.56 $176.64 $148.38 $176.64 N/A N/A 36100081 EAP CPT® 11201 REMOVAL OF SKIN TAGS;EA ADD 10 BOTH IP/OP "$1,016.00" $752.00 $16.47 "$1,016.00" "$1,016.00" "$1,016.00" "$1,016.00" "$1,016.00" $16.47 $16.47 $16.60 "$1,016.00" $16.47 "$1,016.00" "$1,016.00" "$1,016.00" "$1,016.00" $211.75 $26.35 $26.59 "$1,016.00" $16.47 $16.62 $16.47 "$1,016.00" $762.00 $16.47 $16.47 $16.47 "$1,016.00" $508.00 $804.67 $16.47 $812.80 "$1,016.00" "$1,016.00" $16.47 $589.28 "$1,016.00" $16.95 $16.47 "$1,016.00" $16.47 N/A N/A 36100082 EAP CPT® 11300 SHAVE LES TRUNK ARM LEG <0.5CM BOTH IP/OP $365.00 $270.50 $34.00 $365.00 $365.00 $365.00 $365.00 $365.00 $34.35 $34.35 $34.00 $365.00 $34.35 $365.00 $365.00 $365.00 $365.00 $76.07 $54.96 $54.78 $365.00 $34.35 $34.24 $34.35 $365.00 $273.75 $34.35 $34.35 $34.35 $365.00 $182.50 $289.08 $34.35 $292.00 $365.00 $365.00 $34.35 $211.70 $365.00 $35.70 $34.35 $365.00 $34.35 N/A N/A 36100083 EAP CPT® 11301 SHAVE TRUNK ARM LEG 0.6-1.0CM BOTH IP/OP $365.00 $270.50 $51.23 $365.00 $365.00 $365.00 $365.00 $365.00 $51.23 $51.23 $51.65 $365.00 $51.23 $365.00 $365.00 $365.00 $365.00 $76.07 $81.97 $82.45 $365.00 $51.23 $51.53 $51.23 $365.00 $273.75 $51.23 $51.23 $51.23 $365.00 $182.50 $289.08 $51.23 $292.00 $365.00 $365.00 $51.23 $211.70 $365.00 $54.08 $51.23 $365.00 $51.23 N/A N/A 36100084 EAP CPT® 11302 SHAVE TRUNK ARM LEG 1.1-2.0CM BOTH IP/OP $752.00 $556.50 $60.00 $752.00 $752.00 $752.00 $752.00 $752.00 $60.15 $60.15 $60.65 $752.00 $60.15 $752.00 $752.00 $752.00 $752.00 $156.73 $96.24 $96.00 $752.00 $60.15 $60.00 $60.15 $752.00 $564.00 $60.15 $60.15 $60.15 $752.00 $376.00 $595.58 $60.15 $601.60 $752.00 $752.00 $60.15 $436.16 $752.00 $63.46 $60.15 $752.00 $60.15 N/A N/A 36100085 EAP CPT® 11303 SHAVE TRUNK ARM LEG >2.0CM BOTH IP/OP "$1,136.00" $841.00 $70.84 "$1,136.00" "$1,136.00" "$1,136.00" "$1,136.00" "$1,136.00" $70.84 $70.84 $71.75 "$1,136.00" $70.84 "$1,136.00" "$1,136.00" "$1,136.00" "$1,136.00" $236.75 $113.34 $113.90 "$1,136.00" $70.84 $71.19 $70.84 "$1,136.00" $852.00 $70.84 $70.84 $70.84 "$1,136.00" $568.00 $899.71 $70.84 $908.80 "$1,136.00" "$1,136.00" $70.84 $658.88 "$1,136.00" $74.64 $70.84 "$1,136.00" $70.84 N/A N/A 36100086 EAP CPT® 11305 SHAVE SKIN LESION 0.5 CM/< BOTH IP/OP $752.00 $556.50 $37.64 $752.00 $408.34 $408.34 $408.34 $408.34 $176.64 $176.64 $175.86 $156.74 $176.64 $752.00 $752.00 $752.00 $752.00 $156.73 $282.63 $260.52 $113.00 $176.64 $37.64 $176.64 $185.48 $564.00 $176.64 $176.64 $176.64 $752.00 $376.00 $595.58 $176.64 $601.60 $752.00 $149.25 $176.64 $436.16 $185.48 $255.56 $176.64 $156.72 $176.64 N/A N/A 36100088 EAP CPT® 11306 SHAVE SCALP/NECK/HND/FT 0.6-1. BOTH IP/OP $752.00 $556.50 $49.50 $752.00 $408.34 $408.34 $408.34 $408.34 $176.64 $176.64 $175.86 $156.74 $176.64 $752.00 $752.00 $752.00 $752.00 $156.73 $282.63 $260.52 $113.00 $176.64 $49.50 $176.64 $185.48 $564.00 $176.64 $176.64 $176.64 $752.00 $376.00 $595.58 $176.64 $601.60 $752.00 $149.25 $176.64 $436.16 $185.48 $255.56 $176.64 $156.72 $176.64 N/A N/A 36100090 EAP CPT® 11308 SHAVE SCALP/NECK/HND/FEET >2.0 BOTH IP/OP $721.00 $534.00 $70.18 $721.00 $721.00 $721.00 $721.00 $721.00 $71.20 $71.20 $72.80 $721.00 $71.20 $721.00 $721.00 $721.00 $721.00 $150.26 $113.92 $112.29 $721.00 $71.20 $70.18 $71.20 $721.00 $540.75 $71.20 $71.20 $71.20 $721.00 $360.50 $571.03 $71.20 $576.80 $721.00 $721.00 $71.20 $418.18 $721.00 $76.09 $71.20 $721.00 $71.20 N/A N/A 36100091 EAP CPT® 11310 SHAVING FAC EAR NOS LIP <.5CM BOTH IP/OP $720.00 $533.00 $45.70 $720.00 $720.00 $720.00 $720.00 $720.00 $45.70 $45.70 $46.08 $720.00 $45.70 $720.00 $720.00 $720.00 $720.00 $150.06 $73.12 $73.78 $720.00 $45.70 $46.11 $45.70 $720.00 $540.00 $45.70 $45.70 $45.70 $720.00 $360.00 $570.24 $45.70 $576.00 $720.00 $720.00 $45.70 $417.60 $720.00 $48.31 $45.70 $720.00 $45.70 N/A N/A 36100092 EAP CPT® 27570 MANIPULATION KNEE JOINT UNDER GENERAL ANES BOTH IP/OP "$4,221.00" "$3,124.00" $154.32 "$4,221.00" "$4,221.00" "$4,221.00" "$4,221.00" "$4,221.00" $155.72 $155.72 $154.32 "$4,221.00" $155.72 "$4,221.00" "$4,221.00" "$4,221.00" "$4,221.00" $879.70 $249.15 $251.07 "$4,221.00" $155.72 $156.92 $155.72 "$4,221.00" "$3,165.75" $155.72 $155.72 $155.72 "$2,762.00" "$2,110.50" "$3,343.03" $155.72 "$3,376.80" "$2,500.00" "$4,221.00" $155.72 "$2,448.18" "$4,221.00" $156.42 $155.72 "$4,221.00" $155.72 N/A N/A 36100094 EAP CPT® 11311 SHAV FAC/EAR/EYE/NOS/LIP 0.6-1 BOTH IP/OP $752.00 $556.50 $63.05 $752.00 $408.34 $408.34 $408.34 $408.34 $176.64 $176.64 $175.86 $156.74 $176.64 $752.00 $752.00 $752.00 $752.00 $156.73 $282.63 $260.52 $113.00 $176.64 $63.05 $176.64 $185.48 $564.00 $176.64 $176.64 $176.64 $752.00 $376.00 $595.58 $176.64 $601.60 $752.00 $149.25 $176.64 $436.16 $185.48 $255.56 $176.64 $156.72 $176.64 N/A N/A 36100098 EAP CPT® 11313 SHAV FACE/EAR/EYE/NOSE/LIP >2. BOTH IP/OP "$1,483.00" "$1,097.50" $95.94 "$1,483.00" $805.27 $805.27 $805.27 $805.27 $340.00 $340.00 $338.49 $309.09 $340.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $309.07 $543.99 $538.21 $113.00 $340.00 $95.94 $340.00 $357.00 "$1,112.25" $340.00 $340.00 $340.00 "$1,483.00" $741.50 "$1,174.54" $340.00 "$1,186.40" "$1,483.00" $294.34 $340.00 $860.14 $357.00 $491.89 $340.00 $309.06 $340.00 N/A N/A 36100099 EAP CPT® 11400 EXC BENIGN LESION T/A/L 0.5 CM/< BOTH IP/OP "$2,074.00" "$1,535.00" $85.02 "$2,074.00" "$2,074.00" "$2,074.00" "$2,074.00" "$2,074.00" $612.13 $612.13 $609.42 $432.27 $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $432.24 $979.40 $936.25 "$1,871.00" $612.13 $85.02 $612.13 $642.73 "$1,555.50" $612.13 $612.13 $612.13 "$2,074.00" "$1,037.00" "$1,642.61" $612.13 "$1,659.20" "$2,074.00" $411.64 $612.13 "$1,202.92" $642.73 $885.59 $612.13 $432.22 $612.13 N/A N/A 36100100 EAP CPT® 64999 QUADRATUS LUMBORUM-ANES BOTH IP/OP "$4,470.00" "$3,308.00" $255.86 "$4,470.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $257.00 $257.00 $255.86 $931.66 $257.00 "$4,470.00" "$4,470.00" "$4,470.00" "$4,470.00" $931.60 $411.20 $392.25 "$4,470.00" $257.00 "$2,607.00" $257.00 $269.85 "$3,352.50" $257.00 $257.00 $257.00 "$2,762.00" "$2,348.00" "$3,540.24" $257.00 "$3,576.00" "$1,750.00" $887.18 $257.00 "$2,592.60" $269.85 $371.81 $257.00 $931.55 $257.00 N/A N/A 36100101 EAP CPT® 11401 EXC BENIGN LESION T/A/L 0.6-1.0 CM BOTH IP/OP "$2,327.00" "$1,722.00" $107.40 "$2,327.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $340.00 $340.00 $338.49 $485.00 $340.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $484.97 $543.99 $538.21 "$1,871.00" $340.00 $107.40 $340.00 $357.00 "$1,745.25" $340.00 $340.00 $340.00 "$2,327.00" "$1,163.50" "$1,842.98" $340.00 "$1,861.60" "$2,150.00" $461.85 $340.00 "$1,349.66" $357.00 $491.89 $340.00 $484.95 $340.00 N/A N/A 36100103 EAP CPT® 11402 EXC BENIGN LESION T/A/L 1.1-2.0 CM BOTH IP/OP "$2,327.00" "$1,722.00" $116.89 "$2,327.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $612.13 $612.13 $609.42 $485.00 $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $484.97 $979.40 $936.25 "$1,871.00" $612.13 $116.89 $612.13 $642.73 "$1,745.25" $612.13 $612.13 $612.13 "$2,327.00" "$1,163.50" "$1,842.98" $612.13 "$1,861.60" "$2,150.00" $461.85 $612.13 "$1,349.66" $642.73 $885.59 $612.13 $484.95 $612.13 N/A N/A 36100105 EAP CPT® 11403 EXC BENIGN LESION T/A/L 2.1-3.0 CM BOTH IP/OP "$6,030.00" "$4,462.50" $150.79 "$4,824.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $612.13 $612.13 $609.42 "$1,256.80" $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 "$1,256.72" $979.40 $936.25 "$1,871.00" $612.13 $150.79 $612.13 $642.73 "$4,522.50" $612.13 $612.13 $612.13 "$2,762.00" "$2,348.00" "$4,775.76" $612.13 "$4,824.00" "$2,150.00" "$1,196.80" $612.13 "$3,497.40" $642.73 $885.59 $612.13 "$1,256.65" $612.13 N/A N/A 36100107 EAP CPT® 11404 EXC BENIGN LESION T/A/L 3.1-4.0 CM BOTH IP/OP "$10,505.00" "$7,774.00" $166.41 "$8,404.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,384.05" "$1,384.05" "$1,377.93" "$2,189.50" "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$2,189.36" "$2,214.48" "$2,163.34" "$1,871.00" "$1,384.05" $166.41 "$1,384.05" "$1,453.25" "$7,878.75" "$1,384.05" "$1,384.05" "$1,384.05" "$2,762.00" "$2,348.00" "$8,319.96" "$1,384.05" "$8,404.00" "$2,500.00" "$2,084.98" "$1,384.05" "$6,092.90" "$1,453.25" "$2,002.37" "$1,384.05" "$2,189.24" "$1,384.05" N/A N/A 36100109 EAP CPT® 11406 "EXC, BENIGN,>4.0 CM, T/A/L" BOTH IP/OP "$11,772.00" "$8,711.50" $250.56 "$9,417.60" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,384.05" "$1,384.05" "$1,377.93" "$2,453.58" "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$2,453.41" "$2,214.48" "$2,163.34" "$2,836.00" "$1,384.05" $250.56 "$1,384.05" "$1,453.25" "$8,829.00" "$1,384.05" "$1,384.05" "$1,384.05" "$2,851.00" "$2,423.00" "$9,323.42" "$1,384.05" "$9,417.60" "$2,500.00" "$2,336.45" "$1,384.05" "$6,827.76" "$1,453.25" "$2,002.37" "$1,384.05" "$2,453.28" "$1,384.05" N/A N/A 36100110 EAP CPT® 64505 N BLOCK SPENOPALATINE GANGL BOTH IP/OP "$2,665.00" "$1,972.50" $105.49 "$2,665.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $257.00 $257.00 $255.86 $555.45 $257.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $555.42 $411.20 $392.25 "$1,871.00" $257.00 $105.49 $257.00 $269.85 "$1,998.75" $257.00 $257.00 $257.00 "$2,665.00" "$1,332.50" "$2,110.68" $257.00 "$2,132.00" "$1,750.00" $528.94 $257.00 "$1,545.70" $269.85 $371.81 $257.00 $555.39 $257.00 N/A N/A 36100111 EAP CPT® 11420 EXC BENIGN SCALP GENIT HAND FT BOTH IP/OP "$6,030.00" "$4,462.50" $82.94 "$6,030.00" "$6,030.00" "$6,030.00" "$6,030.00" "$6,030.00" $82.98 $82.98 $82.94 "$6,030.00" $82.98 "$6,030.00" "$6,030.00" "$6,030.00" "$6,030.00" "$1,256.72" $132.77 $132.78 "$6,030.00" $82.98 $82.99 $82.98 "$6,030.00" "$4,522.50" $82.98 $82.98 $82.98 "$2,762.00" "$3,015.00" "$4,775.76" $82.98 "$4,824.00" "$2,150.00" "$6,030.00" "$1,384.05" "$3,497.40" "$6,030.00" $84.35 $82.98 "$6,030.00" $82.98 N/A N/A 36100112 EAP CPT® 30140 RESECT INFERIOR TURBINATE SUBMUCOUS BILATERAL BOTH IP/OP "$5,043.00" "$3,732.00" $180.38 "$4,305.68" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,691.05" "$2,691.05" "$2,679.15" "$1,051.09" "$2,691.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,051.02" "$4,305.68" "$4,104.40" "$2,836.00" "$2,691.05" $180.38 "$2,691.05" "$2,825.60" "$3,782.25" "$2,691.05" "$2,691.05" "$2,691.05" "$2,851.00" "$2,423.00" "$3,994.06" "$2,691.05" "$4,034.40" "$3,250.00" "$1,000.91" "$2,691.05" "$2,924.94" "$2,825.60" "$3,893.27" "$2,691.05" "$1,050.96" "$2,691.05" N/A N/A 36100115 EAP CPT® 11421 EXC BENIGN SCALP GENIT HND FT BOTH IP/OP "$6,030.00" "$4,462.50" $110.80 "$4,824.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" $612.13 $612.13 $609.42 "$1,256.80" $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 "$1,256.72" $979.40 $936.25 "$1,871.00" $612.13 $110.80 $612.13 $642.73 "$4,522.50" $612.13 $612.13 $612.13 "$2,762.00" "$2,348.00" "$4,775.76" $612.13 "$4,824.00" "$2,150.00" "$1,196.80" $612.13 "$3,497.40" $642.73 $885.59 $612.13 "$1,256.65" $612.13 N/A N/A 36100118 EAP CPT® 11422 EXC BEN SCAL GENT HD FT NECK BOTH IP/OP "$5,541.00" "$4,100.50" $137.22 "$4,432.80" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,384.05" "$1,384.05" "$1,377.93" "$1,154.88" "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,154.81" "$2,214.48" "$2,163.34" "$1,871.00" "$1,384.05" $137.22 "$1,384.05" "$1,453.25" "$4,155.75" "$1,384.05" "$1,384.05" "$1,384.05" "$2,762.00" "$2,348.00" "$4,388.47" "$1,384.05" "$4,432.80" "$2,150.00" "$1,099.75" "$1,384.05" "$3,213.78" "$1,453.25" "$2,002.37" "$1,384.05" "$1,154.74" "$1,384.05" N/A N/A 36100120 EAP CPT® 11423 EXC BENG SCP GENT HD FT NK BOTH IP/OP "$6,030.00" "$4,462.50" $157.90 "$4,824.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,384.05" "$1,384.05" "$1,377.93" "$1,256.80" "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,256.72" "$2,214.48" "$2,163.34" "$1,871.00" "$1,384.05" $157.90 "$1,384.05" "$1,453.25" "$4,522.50" "$1,384.05" "$1,384.05" "$1,384.05" "$2,762.00" "$2,348.00" "$4,775.76" "$1,384.05" "$4,824.00" "$2,500.00" "$1,196.80" "$1,384.05" "$3,497.40" "$1,453.25" "$2,002.37" "$1,384.05" "$1,256.65" "$1,384.05" N/A N/A 36100121 EAP CPT® 31295 SINUS ENDO W/BALLOON DIL BOTH IP/OP "$6,390.00" "$4,729.00" $158.12 "$6,390.00" "$6,390.00" "$6,390.00" "$6,390.00" "$6,390.00" $159.17 $159.17 $158.12 "$6,390.00" $159.17 "$6,390.00" "$6,390.00" "$6,390.00" "$6,390.00" "$1,331.75" $254.67 $254.43 "$6,390.00" $159.17 $159.02 $159.17 "$6,390.00" "$4,792.50" $159.17 $159.17 $159.17 "$4,780.00" "$3,195.00" "$5,060.88" $159.17 "$5,112.00" "$3,725.00" "$6,390.00" $159.17 "$3,706.20" "$6,390.00" $162.97 $159.17 "$6,390.00" $159.17 N/A N/A 36100122 EAP CPT® 11424 "EXC BENG SC, GENIT HD FT NECK" BOTH IP/OP "$4,851.00" "$3,590.00" $180.30 "$3,880.80" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,384.05" "$1,384.05" "$1,377.93" "$1,011.07" "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,011.00" "$2,214.48" "$2,163.34" "$2,836.00" "$1,384.05" $180.30 "$1,384.05" "$1,453.25" "$3,638.25" "$1,384.05" "$1,384.05" "$1,384.05" "$2,851.00" "$2,423.00" "$3,841.99" "$1,384.05" "$3,880.80" "$2,500.00" $962.80 "$1,384.05" "$2,813.58" "$1,453.25" "$2,002.37" "$1,384.05" "$1,010.95" "$1,384.05" N/A N/A 36100123 EAP CPT® 31513 INJECTION INTO VOCAL CORD BOTH IP/OP "$6,225.00" "$4,606.50" $131.13 "$6,225.00" "$6,225.00" "$6,225.00" "$6,225.00" "$6,225.00" $131.13 $131.13 $131.14 "$6,225.00" $131.13 "$6,225.00" "$6,225.00" "$6,225.00" "$6,225.00" "$1,297.36" $209.81 $211.01 "$6,225.00" $131.13 $131.88 $131.13 "$6,225.00" "$4,668.75" $131.13 $131.13 $131.13 "$2,851.00" "$3,112.50" "$4,930.20" $131.13 "$4,980.00" "$2,150.00" "$6,225.00" $131.13 "$3,610.50" "$6,225.00" $134.12 $131.13 "$6,225.00" $131.13 N/A N/A 36100124 EAP CPT® 11426 "EXC,BENIGN,>4.0 CM,SCLP/H/F" BOTH IP/OP "$6,408.00" "$4,742.00" $272.58 "$5,126.40" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,332.34" "$2,332.34" "$2,322.02" "$1,335.59" "$2,332.34" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$1,335.50" "$3,731.74" "$3,726.76" "$2,836.00" "$2,332.34" $272.58 "$2,332.34" "$2,448.96" "$4,806.00" "$2,332.34" "$2,332.34" "$2,332.34" "$2,851.00" "$2,423.00" "$5,075.14" "$2,332.34" "$5,126.40" "$3,250.00" "$1,271.83" "$2,332.34" "$3,716.64" "$2,448.96" "$3,374.31" "$2,332.34" "$1,335.43" "$2,332.34" N/A N/A 36100126 EAP CPT® 11440 EXC BENIGN FACE EAR NOSE MUC BOTH IP/OP "$1,776.00" "$1,314.50" $107.35 "$1,776.00" "$1,776.00" "$1,776.00" "$1,776.00" "$1,776.00" $612.13 $612.13 $609.42 $370.16 $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $370.14 $979.40 $936.25 "$1,776.00" $612.13 $107.35 $612.13 $642.73 "$1,332.00" $612.13 $612.13 $612.13 "$1,776.00" $888.00 "$1,406.59" $612.13 "$1,420.80" "$1,776.00" $352.49 $612.13 "$1,030.08" $642.73 $885.59 $612.13 $370.12 $612.13 N/A N/A 36100130 EAP CPT® 11441 EXC BENIGN FACE EAR NOSE MUC BOTH IP/OP "$3,293.00" "$2,437.00" $134.48 "$2,762.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" $612.13 $612.13 $609.42 $686.34 $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $686.30 $979.40 $936.25 "$1,871.00" $612.13 $134.48 $612.13 $642.73 "$2,469.75" $612.13 $612.13 $612.13 "$2,762.00" "$1,646.50" "$2,608.06" $612.13 "$2,634.40" "$2,150.00" $653.58 $612.13 "$1,909.94" $642.73 $885.59 $612.13 $686.26 $612.13 N/A N/A 36100132 EAP CPT® 11442 "EXC, BENG FC, ER,NOS,MUC 1.1-2" BOTH IP/OP "$3,246.00" "$2,402.50" $148.39 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $612.13 $612.13 $609.42 $676.55 $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $676.50 $979.40 $936.25 "$1,871.00" $612.13 $148.39 $612.13 $642.73 "$2,434.50" $612.13 $612.13 $612.13 "$2,762.00" "$1,623.00" "$2,570.83" $612.13 "$2,596.80" "$2,150.00" $644.25 $612.13 "$1,882.68" $642.73 $885.59 $612.13 $676.47 $612.13 N/A N/A 36100135 EAP CPT® 11443 EXC BENIGN LESION F/E/E/N/L/M 2.1-3.0CM BOTH IP/OP "$6,030.00" "$4,462.50" $180.61 "$4,824.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,384.05" "$1,384.05" "$1,377.93" "$1,256.80" "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,256.72" "$2,214.48" "$2,163.34" "$1,871.00" "$1,384.05" $180.61 "$1,384.05" "$1,453.25" "$4,522.50" "$1,384.05" "$1,384.05" "$1,384.05" "$2,762.00" "$2,348.00" "$4,775.76" "$1,384.05" "$4,824.00" "$2,150.00" "$1,196.80" "$1,384.05" "$3,497.40" "$1,453.25" "$2,002.37" "$1,384.05" "$1,256.65" "$1,384.05" N/A N/A 36100138 EAP CPT® 11444 EXC BENIGN LESION F/E/E/N/L/M 3.1-4.0CM BOTH IP/OP "$2,484.00" "$1,838.50" $227.75 "$2,484.00" "$2,484.00" "$2,484.00" "$2,484.00" "$2,484.00" $227.80 $227.80 $227.88 "$2,484.00" $227.80 "$2,484.00" "$2,484.00" "$2,484.00" "$2,484.00" $517.69 $364.48 $364.40 "$2,484.00" $227.80 $227.75 $227.80 "$2,484.00" "$1,863.00" $227.80 $227.80 $227.80 "$2,484.00" "$1,242.00" "$1,967.33" $227.80 "$1,987.20" "$2,150.00" "$2,484.00" $227.80 "$1,440.72" "$2,484.00" $233.95 $227.80 "$2,484.00" $227.80 N/A N/A 36100141 EAP CPT® 11446 "EXC BENIGN,>4.0 CM,F/E/MEM" BOTH IP/OP "$15,310.00" "$11,329.50" $318.96 "$12,248.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,332.34" "$2,332.34" "$2,322.02" "$3,190.99" "$2,332.34" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$3,190.77" "$3,731.74" "$3,726.76" "$2,836.00" "$2,332.34" $318.96 "$2,332.34" "$2,448.96" "$11,482.50" "$2,332.34" "$2,332.34" "$2,332.34" "$2,851.00" "$2,423.00" "$12,125.52" "$2,332.34" "$12,248.00" "$3,250.00" "$3,038.65" "$2,332.34" "$8,879.80" "$2,448.96" "$3,374.31" "$2,332.34" "$3,190.60" "$2,332.34" N/A N/A 36100142 EAP CPT® 11601 "EXC.MALIG,TR/A/L,0.6-1.0CM" BOTH IP/OP "$2,235.00" "$1,654.00" $149.22 "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" $149.22 $149.22 $149.41 "$2,235.00" $149.22 "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" $465.80 $238.75 $239.10 "$2,235.00" $149.22 $149.44 $149.22 "$2,235.00" "$1,676.25" $149.22 $149.22 $149.22 "$2,235.00" "$1,117.50" "$1,770.12" $149.22 "$1,788.00" "$2,150.00" "$2,235.00" $149.22 "$1,296.30" "$2,235.00" $152.85 $149.22 "$2,235.00" $149.22 N/A N/A 36100143 EAP CPT® 11602 "EXC.MALIG,TR/A/L,1.1-2.0CM" BOTH IP/OP "$2,327.00" "$1,722.00" $162.30 "$2,327.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $340.00 $340.00 $338.49 $485.00 $340.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $484.97 $543.99 $538.21 "$1,871.00" $340.00 $162.30 $340.00 $357.00 "$1,745.25" $340.00 $340.00 $340.00 "$2,327.00" "$1,163.50" "$1,842.98" $340.00 "$1,861.60" "$2,150.00" $461.85 $340.00 "$1,349.66" $357.00 $491.89 $340.00 $484.95 $340.00 N/A N/A 36100144 EAP CPT® 11603 "EXC.MALIG TR/A/L,2.1-3.0CM" BOTH IP/OP "$5,176.00" "$3,830.50" $194.53 "$4,140.80" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $612.13 $612.13 $609.42 "$1,078.81" $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 "$1,078.74" $979.40 $936.25 "$1,871.00" $612.13 $194.53 $612.13 $642.73 "$3,882.00" $612.13 $612.13 $612.13 "$2,762.00" "$2,348.00" "$4,099.39" $612.13 "$4,140.80" "$2,150.00" "$1,027.31" $612.13 "$3,002.08" $642.73 $885.59 $612.13 "$1,078.68" $612.13 N/A N/A 36100145 EAP CPT® 11604 EXC MALIGN TR ARM LEG 3.1-4.0 BOTH IP/OP "$5,176.00" "$3,830.50" $214.21 "$4,140.80" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" $612.13 $612.13 $609.42 "$1,078.81" $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 "$1,078.74" $979.40 $936.25 "$2,836.00" $612.13 $214.21 $612.13 $642.73 "$3,882.00" $612.13 $612.13 $612.13 "$2,851.00" "$2,423.00" "$4,099.39" $612.13 "$4,140.80" "$2,150.00" "$1,027.31" $612.13 "$3,002.08" $642.73 $885.59 $612.13 "$1,078.68" $612.13 N/A N/A 36100146 EAP CPT® 11606 "EXC MALIG>4.0 CM,TRNK/A/L" BOTH IP/OP "$10,505.00" "$7,774.00" $318.41 "$10,505.00" "$10,505.00" "$10,505.00" "$10,505.00" "$10,505.00" $319.50 $319.50 $319.21 "$10,505.00" $319.50 "$10,505.00" "$10,505.00" "$10,505.00" "$10,505.00" "$2,189.36" $511.20 $509.46 "$10,505.00" $319.50 $318.41 $319.50 "$10,505.00" "$7,878.75" $319.50 $319.50 $319.50 "$2,851.00" "$5,252.50" "$8,319.96" $319.50 "$8,404.00" "$2,500.00" "$10,505.00" $319.50 "$6,092.90" "$10,505.00" $329.86 $319.50 "$10,505.00" $319.50 N/A N/A 36100147 EAP CPT® 11621 "EXC MALIGN SCAP GENT HD,FT NK" BOTH IP/OP "$3,293.00" "$2,437.00" $149.76 "$3,293.00" "$3,293.00" "$3,293.00" "$3,293.00" "$3,293.00" $149.91 $149.91 $149.76 "$3,293.00" $149.91 "$3,293.00" "$3,293.00" "$3,293.00" "$3,293.00" $686.30 $239.86 $240.74 "$3,293.00" $149.91 $150.46 $149.91 "$3,293.00" "$2,469.75" $149.91 $149.91 $149.91 "$2,762.00" "$1,646.50" "$2,608.06" $149.91 "$2,634.40" "$2,150.00" "$3,293.00" $149.91 "$1,909.94" "$3,293.00" $153.93 $149.91 "$3,293.00" $149.91 N/A N/A 36100148 EAP CPT® 11622 EXC MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM BOTH IP/OP "$6,030.00" "$4,462.50" $170.10 "$4,824.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $612.13 $612.13 $609.42 "$1,256.80" $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 "$1,256.72" $979.40 $936.25 "$1,871.00" $612.13 $170.10 $612.13 $642.73 "$4,522.50" $612.13 $612.13 $612.13 "$2,762.00" "$2,348.00" "$4,775.76" $612.13 "$4,824.00" "$2,150.00" "$1,196.80" $612.13 "$3,497.40" $642.73 $885.59 $612.13 "$1,256.65" $612.13 N/A N/A 36100150 EAP CPT® 11623 EXC MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM BOTH IP/OP "$11,307.00" "$8,367.50" $113.00 "$9,045.60" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,384.05" "$1,384.05" "$1,377.93" "$2,356.66" "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$2,356.50" "$2,214.48" "$2,163.34" $113.00 "$1,384.05" $210.81 "$1,384.05" "$1,453.25" "$8,480.25" "$1,384.05" "$1,384.05" "$1,384.05" "$2,762.00" "$2,348.00" "$8,955.14" "$1,384.05" "$9,045.60" "$2,150.00" "$2,244.16" "$1,384.05" "$6,558.06" "$1,453.25" "$2,002.37" "$1,384.05" "$2,356.38" "$1,384.05" N/A N/A 36100152 EAP CPT® 11624 EXC MALIGN SCP GENT HD FT NK BOTH IP/OP "$10,091.00" "$7,467.50" $238.96 "$10,091.00" "$10,091.00" "$10,091.00" "$10,091.00" "$10,091.00" $239.00 $239.00 $238.96 "$10,091.00" $239.00 "$10,091.00" "$10,091.00" "$10,091.00" "$10,091.00" "$2,103.08" $382.40 $382.91 "$10,091.00" $239.00 $239.32 $239.00 "$10,091.00" "$7,568.25" $239.00 $239.00 $239.00 "$2,851.00" "$5,045.50" "$7,992.07" $239.00 "$8,072.80" "$2,500.00" "$10,091.00" $239.00 "$5,852.78" "$10,091.00" $246.95 $239.00 "$10,091.00" $239.00 N/A N/A 36100153 EAP CPT® 11626 "EXCIS MALIG,>4.0 CM,SCP/H/FT" BOTH IP/OP "$13,133.00" "$9,718.50" $293.65 "$13,133.00" "$13,133.00" "$13,133.00" "$13,133.00" "$13,133.00" $294.52 $294.52 $294.59 "$13,133.00" $294.52 "$13,133.00" "$13,133.00" "$13,133.00" "$13,133.00" "$2,737.06" $471.23 $469.84 "$13,133.00" $294.52 $293.65 $294.52 "$13,133.00" "$9,849.75" $294.52 $294.52 $294.52 "$2,851.00" "$6,566.50" "$10,401.34" $294.52 "$10,506.40" "$3,250.00" "$13,133.00" $294.52 "$7,617.14" "$13,133.00" $304.27 $294.52 "$13,133.00" $294.52 N/A N/A 36100154 EAP CPT® 11640 EXC MALIGNANT LESION F/E/E/N/L 0.5 CM/< BOTH IP/OP "$3,168.00" "$2,344.50" $127.22 "$3,168.00" "$3,168.00" "$3,168.00" "$3,168.00" "$3,168.00" $127.22 $127.22 $127.23 "$3,168.00" $127.22 "$3,168.00" "$3,168.00" "$3,168.00" "$3,168.00" $660.25 $203.55 $203.84 "$3,168.00" $127.22 $127.40 $127.22 "$3,168.00" "$2,376.00" $127.22 $127.22 $127.22 "$2,762.00" "$1,584.00" "$2,509.06" $127.22 "$2,534.40" "$2,150.00" "$3,168.00" $127.22 "$1,837.44" "$3,168.00" $129.41 $127.22 "$3,168.00" $127.22 N/A N/A 36100156 EAP CPT® 11641 EXC MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM BOTH IP/OP "$3,044.00" "$2,253.00" $155.79 "$3,044.00" "$3,044.00" "$3,044.00" "$3,044.00" "$3,044.00" $155.79 $155.79 $156.00 "$3,044.00" $155.79 "$3,044.00" "$3,044.00" "$3,044.00" "$3,044.00" $634.40 $249.26 $250.50 "$3,044.00" $155.79 $156.56 $155.79 "$3,044.00" "$2,283.00" $155.79 $155.79 $155.79 "$2,762.00" "$1,522.00" "$2,410.85" $155.79 "$2,435.20" "$2,150.00" "$3,044.00" $155.79 "$1,765.52" "$3,044.00" $160.41 $155.79 "$3,044.00" $155.79 N/A N/A 36100159 EAP CPT® 11642 EXC MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM BOTH IP/OP "$6,030.00" "$4,462.50" $182.53 "$6,030.00" "$6,030.00" "$6,030.00" "$6,030.00" "$6,030.00" $182.53 $182.53 $182.68 "$6,030.00" $182.53 "$6,030.00" "$6,030.00" "$6,030.00" "$6,030.00" "$1,256.72" $292.05 $292.24 "$6,030.00" $182.53 $182.65 $182.53 "$6,030.00" "$4,522.50" $182.53 $182.53 $182.53 "$2,762.00" "$3,015.00" "$4,775.76" $182.53 "$4,824.00" "$2,150.00" "$6,030.00" $182.53 "$3,497.40" "$6,030.00" $188.18 $182.53 "$6,030.00" $182.53 N/A N/A 36100161 EAP CPT® 11643 EXC MALIGN FC EAR NOSE MUS MEM BOTH IP/OP "$5,789.00" "$4,284.00" $228.16 "$5,789.00" "$5,789.00" "$5,789.00" "$5,789.00" "$5,789.00" $228.16 $228.16 $228.98 "$5,789.00" $228.16 "$5,789.00" "$5,789.00" "$5,789.00" "$5,789.00" "$1,206.49" $365.06 $365.50 "$5,789.00" $228.16 $228.44 $228.16 "$5,789.00" "$4,341.75" $228.16 $228.16 $228.16 "$2,762.00" "$2,894.50" "$4,584.89" $228.16 "$4,631.20" "$2,150.00" "$5,789.00" $228.16 "$3,357.62" "$5,789.00" $236.13 $228.16 "$5,789.00" $228.16 N/A N/A 36100162 EAP CPT® 11644 EXC MALIGN FC EAR NOSE MUC MEM BOTH IP/OP "$10,091.00" "$7,467.50" $283.39 "$8,072.80" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,384.05" "$1,384.05" "$1,377.93" "$2,103.22" "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$2,103.08" "$2,214.48" "$2,163.34" "$2,836.00" "$1,384.05" $283.39 "$1,384.05" "$1,453.25" "$7,568.25" "$1,384.05" "$1,384.05" "$1,384.05" "$2,851.00" "$2,423.00" "$7,992.07" "$1,384.05" "$8,072.80" "$2,500.00" "$2,002.81" "$1,384.05" "$5,852.78" "$1,453.25" "$2,002.37" "$1,384.05" "$2,102.96" "$1,384.05" N/A N/A 36100163 EAP CPT® 11646 "EXC,MALIG,>4.0 CM,F/E/MEM" BOTH IP/OP "$13,656.00" "$10,105.50" $392.30 "$13,656.00" "$13,656.00" "$13,656.00" "$13,656.00" "$13,656.00" $393.14 $393.14 $394.37 "$13,656.00" $393.14 "$13,656.00" "$13,656.00" "$13,656.00" "$13,656.00" "$2,846.06" $629.02 $627.68 "$13,656.00" $393.14 $392.30 $393.14 "$13,656.00" "$10,242.00" $393.14 $393.14 $393.14 "$2,851.00" "$6,828.00" "$10,815.55" $393.14 "$10,924.80" "$3,250.00" "$13,656.00" $393.14 "$7,920.48" "$13,656.00" $406.66 $393.14 "$13,656.00" $393.14 N/A N/A 36100165 EAP CPT® 11719 TRIM OF NONDYSTROPHIC NAIL(S) ANY BOTH IP/OP $285.00 $211.00 $7.46 $285.00 $285.00 $285.00 $285.00 $285.00 $7.58 $7.58 $7.64 $285.00 $7.58 $285.00 $285.00 $285.00 $285.00 $59.40 $12.13 $11.94 $285.00 $7.58 $7.46 $7.58 $285.00 $213.75 $7.58 $7.58 $7.58 $285.00 $142.50 $225.72 $7.58 $228.00 $285.00 $285.00 $7.58 $165.30 $285.00 $7.94 $7.58 $285.00 $7.58 N/A N/A 36100166 EAP CPT® 11720 DEBRIDEMENT NAIL(S) 1-5 BOTH IP/OP $199.00 $147.50 $14.59 $199.00 $199.00 $199.00 $199.00 $199.00 $54.76 $54.76 $54.51 $41.48 $54.76 $199.00 $199.00 $199.00 $199.00 $41.47 $87.61 $82.92 $113.00 $54.76 $14.59 $54.76 $57.49 $149.25 $54.76 $54.76 $54.76 $199.00 $99.50 $157.61 $54.76 $159.20 $199.00 $39.50 $54.76 $115.42 $57.49 $79.22 $54.76 $41.47 $54.76 N/A N/A 36100169 EAP CPT® 11721 DEBRIDEMENT NAIL ANY METHOD 6/> BOTH IP/OP $199.00 $147.50 $23.73 $199.00 $199.00 $199.00 $199.00 $199.00 $54.76 $54.76 $54.51 $41.48 $54.76 $199.00 $199.00 $199.00 $199.00 $41.47 $87.61 $82.92 $113.00 $54.76 $23.73 $54.76 $57.49 $149.25 $54.76 $54.76 $54.76 $199.00 $99.50 $157.61 $54.76 $159.20 $199.00 $39.50 $54.76 $115.42 $57.49 $79.22 $54.76 $41.47 $54.76 N/A N/A 36100173 EAP CPT® 11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1ST BOTH IP/OP $427.00 $316.00 $53.91 $427.00 $427.00 $427.00 $427.00 $427.00 $176.64 $176.64 $175.86 $89.00 $176.64 $427.00 $427.00 $427.00 $427.00 $88.99 $282.63 $260.52 $113.00 $176.64 $53.91 $176.64 $185.48 $320.25 $176.64 $176.64 $176.64 $427.00 $213.50 $338.18 $176.64 $341.60 $427.00 $84.75 $176.64 $247.66 $185.48 $255.56 $176.64 $88.99 $176.64 N/A N/A 36100176 EAP CPT® 11732 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE EA ADDL BOTH IP/OP $207.00 $153.50 $17.30 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $43.14 $207.00 $207.00 $207.00 $207.00 $207.00 $43.14 $207.00 $207.00 $122.44 $207.00 $17.30 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $207.00 $103.50 $163.94 $207.00 $165.60 $207.00 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 36100178 EAP CPT® 11740 I&D SUBUNGUAL HEMATOMA BOTH IP/OP $248.00 $184.00 $31.58 $248.00 $248.00 $248.00 $248.00 $248.00 $31.67 $31.67 $31.58 $248.00 $31.67 $248.00 $248.00 $248.00 $248.00 $51.69 $50.67 $51.49 $248.00 $31.67 $32.18 $31.67 $248.00 $186.00 $31.67 $31.67 $31.67 $248.00 $124.00 $196.42 $31.67 $198.40 $248.00 $248.00 $31.67 $143.84 $248.00 $32.44 $31.67 $248.00 $31.67 N/A N/A 36100180 EAP CPT® 11750 EXCISION NAIL MATRIX PERMANENT REMOVAL BOTH IP/OP "$1,397.00" "$1,034.00" $101.30 "$1,397.00" "$1,397.00" "$1,397.00" "$1,397.00" "$1,397.00" $340.00 $340.00 $338.49 $291.17 $340.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $291.15 $543.99 $538.21 "$1,397.00" $340.00 $101.30 $340.00 $357.00 "$1,047.75" $340.00 $340.00 $340.00 "$1,397.00" $698.50 "$1,106.42" $340.00 "$1,117.60" "$1,397.00" $277.27 $340.00 $810.26 $357.00 $491.89 $340.00 $291.13 $340.00 N/A N/A 36100183 EAP CPT® 11765 WEDGE EXCISION SKIN NAIL FOLD BOTH IP/OP $554.00 $410.00 $92.81 $554.00 $554.00 $554.00 $554.00 $554.00 $340.00 $340.00 $338.49 $115.47 $340.00 $554.00 $554.00 $554.00 $554.00 $115.46 $543.99 $538.21 $113.00 $340.00 $92.81 $340.00 $357.00 $415.50 $340.00 $340.00 $340.00 $554.00 $277.00 $438.77 $340.00 $443.20 $554.00 $109.96 $340.00 $321.32 $357.00 $491.89 $340.00 $115.45 $340.00 N/A N/A 36100186 EAP CPT® 11900 INTRALESIONAL INJ UP TO 7 LES BOTH IP/OP $338.00 $250.50 $30.17 $338.00 $338.00 $338.00 $338.00 $338.00 $176.64 $176.64 $175.86 $70.45 $176.64 $338.00 $338.00 $338.00 $338.00 $70.44 $282.63 $260.52 $113.00 $176.64 $30.17 $176.64 $185.48 $253.50 $176.64 $176.64 $176.64 $338.00 $169.00 $267.70 $176.64 $270.40 $338.00 $67.08 $176.64 $196.04 $185.48 $255.56 $176.64 $70.44 $176.64 N/A N/A 36100188 EAP CPT® 11901 INJECTION INTRALESIONAL >7 LESIONS BOTH IP/OP $276.00 $204.50 $45.76 $282.63 $276.00 $276.00 $276.00 $276.00 $176.64 $176.64 $175.86 $57.53 $176.64 $276.00 $276.00 $276.00 $276.00 $57.52 $282.63 $260.52 $113.00 $176.64 $45.76 $176.64 $185.48 $207.00 $176.64 $176.64 $176.64 $276.00 $138.00 $218.59 $176.64 $220.80 $276.00 $54.78 $176.64 $160.08 $185.48 $255.56 $176.64 $57.52 $176.64 N/A N/A 36100190 EAP CPT® 11952 SALINE INJECTION < 10.0CC BOTH IP/OP $556.00 $411.50 $103.11 $556.00 $556.00 $556.00 $556.00 $556.00 $103.76 $103.76 $104.30 $556.00 $103.76 $556.00 $556.00 $556.00 $556.00 $115.88 $166.02 $164.98 $556.00 $103.76 $103.11 $103.76 $556.00 $417.00 $103.76 $103.76 $103.76 $556.00 $278.00 $440.35 $103.76 $444.80 $556.00 $556.00 $103.76 $322.48 $556.00 $109.23 $103.76 $556.00 $103.76 N/A N/A 36100191 EAP CPT® 11954 SALINE INJECTION > 10.0CC BOTH IP/OP $562.00 $416.00 $112.95 $562.00 $562.00 $562.00 $562.00 $562.00 $113.34 $113.34 $114.31 $562.00 $113.34 $562.00 $562.00 $562.00 $562.00 $117.13 $181.34 $180.72 $562.00 $113.34 $112.95 $113.34 $562.00 $421.50 $113.34 $113.34 $113.34 $562.00 $281.00 $445.10 $113.34 $449.60 $562.00 $562.00 $113.34 $325.96 $562.00 $118.61 $113.34 $562.00 $113.34 N/A N/A 36100192 EAP CPT® 11960 INSERT TISSUE EXPANDER(S) BOTH IP/OP "$5,416.00" "$4,008.00" "$1,013.13" "$5,416.00" "$5,416.00" "$5,416.00" "$5,416.00" "$5,416.00" "$1,030.96" "$1,030.96" "$1,037.07" "$5,416.00" "$1,030.96" "$5,416.00" "$5,416.00" "$5,416.00" "$5,416.00" "$1,128.75" "$1,649.54" "$1,646.53" "$5,416.00" "$1,030.96" "$1,029.08" "$1,030.96" "$5,416.00" "$4,062.00" "$1,030.96" "$1,030.96" "$1,030.96" "$2,851.00" "$2,708.00" "$4,289.47" "$1,030.96" "$4,332.80" "$3,725.00" "$5,416.00" "$1,030.96" "$3,141.28" "$5,416.00" "$1,013.13" "$1,030.96" "$5,416.00" "$1,030.96" N/A N/A 36100193 EAP CPT® 11981 "INSERT,IMPLANT CONTRACEPTIVE" BOTH IP/OP $286.00 $212.00 $56.76 $286.00 $286.00 $286.00 $286.00 $286.00 $110.92 $110.92 $110.43 $59.61 $110.92 $286.00 $286.00 $286.00 $286.00 $59.61 $177.47 $167.51 $113.00 $110.92 $63.10 $110.92 $116.46 $214.50 $110.92 $110.92 $110.92 $286.00 $143.00 $226.51 $110.92 $228.80 $286.00 $56.76 $110.92 $165.88 $116.46 $160.47 $110.92 $59.60 $110.92 N/A N/A 36100200 EAP CPT® 12002 LAC REPR FCE EAR LP 2.6-5.0 BOTH IP/OP $867.00 $642.00 $59.29 $867.00 $867.00 $867.00 $867.00 $867.00 $59.46 $59.46 $59.29 $867.00 $59.46 $867.00 $867.00 $867.00 $867.00 $180.69 $95.14 $95.04 $867.00 $59.46 $59.40 $59.46 $867.00 $650.25 $59.46 $59.46 $59.46 $867.00 $433.50 $686.66 $59.46 $693.60 $867.00 $867.00 $59.46 $502.86 $867.00 $62.38 $59.46 $867.00 $59.46 N/A N/A 36100201 EAP CPT® 12002 LAC REPR SCLP NCK HND FT 2.6-7 BOTH IP/OP $938.00 $694.50 $59.29 $938.00 $938.00 $938.00 $938.00 $938.00 $59.46 $59.46 $59.29 $938.00 $59.46 $938.00 $938.00 $938.00 $938.00 $195.49 $95.14 $95.04 $938.00 $59.46 $59.40 $59.46 $938.00 $703.50 $59.46 $59.46 $59.46 $938.00 $469.00 $742.90 $59.46 $750.40 $938.00 $938.00 $59.46 $544.04 $938.00 $62.38 $59.46 $938.00 $59.46 N/A N/A 36100206 EAP CPT® 20552 BILAT INJECT TRIGGER POINT 1-2 MUSC BOTH IP/OP $961.00 $711.50 $37.29 $961.00 $961.00 $961.00 $961.00 $961.00 $257.00 $257.00 $255.86 $200.30 $257.00 $961.00 $961.00 $961.00 $882.37 $200.28 $411.20 $392.25 $961.00 $257.00 $37.29 $257.00 $269.85 $720.75 $257.00 $257.00 $257.00 $961.00 $480.50 $761.11 $257.00 $768.80 $961.00 $190.73 $257.00 $557.38 $269.85 $371.81 $257.00 $200.27 $257.00 N/A N/A 36100208 EAP CPT® 16036 ESCHAROTOMY EACH ADDL INCISION BOTH IP/OP "$1,260.00" $932.50 $79.07 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $79.07 $79.07 $79.35 "$1,260.00" $79.07 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 $126.51 $133.04 "$1,260.00" $79.07 $83.15 $79.07 "$1,260.00" $945.00 $79.07 $79.07 $79.07 "$1,260.00" $630.00 $997.92 $79.07 "$1,008.00" "$1,260.00" "$1,260.00" $79.07 $730.80 "$1,260.00" $85.45 $79.07 "$1,260.00" $79.07 N/A N/A 36100209 EAP CPT® 16035 ESCHAROTOMY FIRST INCISION BOTH IP/OP $770.00 $570.00 $160.48 $770.00 $770.00 $770.00 $770.00 $770.00 $193.57 $193.57 $195.52 $770.00 $193.57 $770.00 $770.00 $770.00 $770.00 $160.48 $309.71 $312.61 $770.00 $193.57 $195.38 $193.57 $770.00 $577.50 $193.57 $193.57 $193.57 $770.00 $385.00 $609.84 $193.57 $616.00 $770.00 $770.00 $193.57 $446.60 $770.00 $205.89 $193.57 $770.00 $193.57 N/A N/A 36100214 EAP CPT® 12015 SMPL RPR SPRFSL FACE 7.6-12.5C BOTH IP/OP "$1,035.00" $766.00 $95.06 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $95.23 $95.23 $95.70 "$1,035.00" $95.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 $152.37 $152.10 "$1,035.00" $95.23 $95.06 $95.23 "$1,035.00" $776.25 $95.23 $95.23 $95.23 "$1,035.00" $517.50 $819.72 $95.23 $828.00 "$1,035.00" "$1,035.00" $95.23 $600.30 "$1,035.00" $100.24 $95.23 "$1,035.00" $95.23 N/A N/A 36100215 EAP CPT® 12016 SMPL RPR SPRFSL FACE 12.6-20CM BOTH IP/OP $957.00 $708.50 $129.01 $957.00 $957.00 $957.00 $957.00 $957.00 $130.08 $130.08 $130.15 $957.00 $130.08 $957.00 $957.00 $957.00 $957.00 $199.45 $208.13 $206.42 $957.00 $130.08 $129.01 $130.08 $957.00 $717.75 $130.08 $130.08 $130.08 $957.00 $478.50 $757.94 $130.08 $765.60 $957.00 $957.00 $130.08 $555.06 $957.00 $135.94 $130.08 $957.00 $130.08 N/A N/A 36100216 EAP CPT® 12017 SMPL RPR SPRFSL FACE 20.1-30.0 BOTH IP/OP "$1,559.00" "$1,154.00" $153.83 "$1,559.00" "$1,559.00" "$1,559.00" "$1,559.00" "$1,559.00" $153.83 $153.83 $154.48 "$1,559.00" $153.83 "$1,559.00" "$1,559.00" "$1,559.00" "$1,559.00" $324.91 $246.13 $248.27 "$1,559.00" $153.83 $155.17 $153.83 "$1,559.00" "$1,169.25" $153.83 $153.83 $153.83 "$1,559.00" $779.50 "$1,234.73" $153.83 "$1,247.20" "$1,559.00" "$1,559.00" $153.83 $904.22 "$1,559.00" $161.54 $153.83 "$1,559.00" $153.83 N/A N/A 36100217 EAP CPT® 12020 WOUND DEHISCENCE SIMPLE CLOSUR BOTH IP/OP "$2,965.00" "$2,194.50" $190.51 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $515.18 $515.18 $512.91 $617.98 $515.18 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $617.94 $824.30 $838.11 "$1,871.00" $515.18 $190.51 $515.18 $540.94 "$2,223.75" $515.18 $515.18 $515.18 "$2,762.00" "$1,482.50" "$2,348.28" $515.18 "$2,372.00" "$2,150.00" $588.48 $515.18 "$1,719.70" $540.94 $745.34 $515.18 $617.91 $515.18 N/A N/A 36100219 EAP CPT® 12021 PACKING OF WOUND DEHISIENCE BOTH IP/OP "$3,923.00" "$2,903.50" $142.69 "$3,138.40" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $340.00 $340.00 $338.49 $817.65 $340.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $817.60 $543.99 $538.21 "$1,871.00" $340.00 $142.69 $340.00 $357.00 "$2,942.25" $340.00 $340.00 $340.00 "$2,762.00" "$1,961.50" "$3,107.02" $340.00 "$3,138.40" "$1,750.00" $778.62 $340.00 "$2,275.34" $357.00 $491.89 $340.00 $817.55 $340.00 N/A N/A 36100230 EAP CPT® 12054 INT REP FCE EAR LP 7.6-12.5 CM BOTH IP/OP $957.00 $708.50 $199.45 $957.00 $957.00 $957.00 $957.00 $957.00 $219.80 $219.80 $219.95 $957.00 $219.80 $957.00 $957.00 $957.00 $957.00 $199.45 $351.68 $354.80 $957.00 $219.80 $221.75 $219.80 $957.00 $717.75 $219.80 $219.80 $219.80 $957.00 $478.50 $757.94 $219.80 $765.60 $957.00 $957.00 $219.80 $555.06 $957.00 $228.92 $219.80 $957.00 $219.80 N/A N/A 36100231 EAP CPT® 12055 REP INT FCE EAR LP 12.6-20.0CM BOTH IP/OP $957.00 $708.50 $199.45 $957.00 $957.00 $957.00 $957.00 $957.00 $300.63 $300.63 $301.38 $957.00 $300.63 $957.00 $957.00 $957.00 $957.00 $199.45 $481.01 $485.04 $957.00 $300.63 $303.15 $300.63 $957.00 $717.75 $300.63 $300.63 $300.63 $957.00 $478.50 $757.94 $300.63 $765.60 $957.00 $957.00 $300.63 $555.06 $957.00 $312.18 $300.63 $957.00 $300.63 N/A N/A 36100232 EAP CPT® 12056 REP INT FCE EAR LP 20.1-30.0CM BOTH IP/OP "$1,559.00" "$1,154.00" $324.91 "$1,559.00" "$1,559.00" "$1,559.00" "$1,559.00" "$1,559.00" $388.20 $388.20 $389.75 "$1,559.00" $388.20 "$1,559.00" "$1,559.00" "$1,559.00" "$1,559.00" $324.91 $621.12 $622.16 "$1,559.00" $388.20 $388.85 $388.20 "$1,559.00" "$1,169.25" $388.20 $388.20 $388.20 "$1,559.00" $779.50 "$1,234.73" $388.20 "$1,247.20" "$1,559.00" "$1,559.00" $388.20 $904.22 "$1,559.00" $400.11 $388.20 "$1,559.00" $388.20 N/A N/A 36100233 EAP CPT® 12057 LAC REP INTER OVER 30.0CM BOTH IP/OP "$4,870.00" "$3,604.00" $423.06 "$4,870.00" "$4,870.00" "$4,870.00" "$4,870.00" "$4,870.00" $423.06 $423.06 $426.98 "$4,870.00" $423.06 "$4,870.00" "$4,870.00" "$4,870.00" "$4,870.00" "$1,014.96" $676.90 $678.10 "$4,870.00" $423.06 $423.81 $423.06 "$4,870.00" "$3,652.50" $423.06 $423.06 $423.06 "$2,851.00" "$2,435.00" "$3,857.04" $423.06 "$3,896.00" "$1,750.00" "$4,870.00" $423.06 "$2,824.60" "$4,870.00" $442.65 $423.06 "$4,870.00" $423.06 N/A N/A 36100234 EAP CPT® 13100 "REPR COMPLEX,1.1 TO 2.5 CM" BOTH IP/OP "$2,495.00" "$1,846.50" $201.11 "$2,495.00" "$2,495.00" "$2,495.00" "$2,495.00" "$2,495.00" $201.11 $201.11 $202.74 "$2,495.00" $201.11 "$2,495.00" "$2,495.00" "$2,495.00" "$2,495.00" $519.99 $321.78 $322.64 "$2,495.00" $201.11 $201.65 $201.11 "$2,495.00" "$1,871.25" $201.11 $201.11 $201.11 "$2,495.00" "$1,247.50" "$1,976.04" $201.11 "$1,996.00" "$2,150.00" "$2,495.00" $201.11 "$1,447.10" "$2,495.00" $209.45 $201.11 "$2,495.00" $201.11 N/A N/A 36100235 EAP CPT® 13101 REPR COMPLEX TRK 2.6-7.5CM BOTH IP/OP "$2,602.00" "$1,925.50" $248.72 "$2,602.00" "$2,602.00" "$2,602.00" "$2,602.00" "$2,602.00" $249.33 $249.33 $252.13 "$2,602.00" $249.33 "$2,602.00" "$2,602.00" "$2,602.00" "$2,602.00" $542.29 $398.93 $397.95 "$2,602.00" $249.33 $248.72 $249.33 "$2,602.00" "$1,951.50" $249.33 $249.33 $249.33 "$2,602.00" "$1,301.00" "$2,060.78" $249.33 "$2,081.60" "$2,150.00" "$2,602.00" $249.33 "$1,509.16" "$2,602.00" $257.39 $249.33 "$2,602.00" $249.33 N/A N/A 36100236 EAP CPT® 13120 REPR COMP SCALP ARMS LGS 1.1 BOTH IP/OP "$1,319.00" $976.50 $233.48 "$1,319.00" "$1,319.00" "$1,319.00" "$1,319.00" "$1,319.00" $234.50 $234.50 $236.51 "$1,319.00" $234.50 "$1,319.00" "$1,319.00" "$1,319.00" "$1,319.00" $274.89 $375.20 $373.57 "$1,319.00" $234.50 $233.48 $234.50 "$1,319.00" $989.25 $234.50 $234.50 $234.50 "$1,319.00" $659.50 "$1,044.65" $234.50 "$1,055.20" "$1,319.00" "$1,319.00" $234.50 $765.02 "$1,319.00" $240.80 $234.50 "$1,319.00" $234.50 N/A N/A 36100241 EAP CPT® 13151 REPR COMP EYE NOSE EARS LIPS BOTH IP/OP "$2,307.00" "$1,707.50" $279.39 "$2,307.00" "$2,307.00" "$2,307.00" "$2,307.00" "$2,307.00" $279.39 $279.39 $281.05 "$2,307.00" $279.39 "$2,307.00" "$2,307.00" "$2,307.00" "$2,307.00" $480.80 $447.02 $447.41 "$2,307.00" $279.39 $279.63 $279.39 "$2,307.00" "$1,730.25" $279.39 $279.39 $279.39 "$2,307.00" "$1,153.50" "$1,827.14" $279.39 "$1,845.60" "$2,150.00" "$2,307.00" $279.39 "$1,338.06" "$2,307.00" $291.66 $279.39 "$2,307.00" $279.39 N/A N/A 36100242 EAP CPT® 13151 RPR COMPLX EYELID ETC.1.1-2.5C BOTH IP/OP "$2,307.00" "$1,707.50" $279.39 "$2,307.00" "$2,307.00" "$2,307.00" "$2,307.00" "$2,307.00" $279.39 $279.39 $281.05 "$2,307.00" $279.39 "$2,307.00" "$2,307.00" "$2,307.00" "$2,307.00" $480.80 $447.02 $447.41 "$2,307.00" $279.39 $279.63 $279.39 "$2,307.00" "$1,730.25" $279.39 $279.39 $279.39 "$2,307.00" "$1,153.50" "$1,827.14" $279.39 "$1,845.60" "$2,150.00" "$2,307.00" $279.39 "$1,338.06" "$2,307.00" $291.66 $279.39 "$2,307.00" $279.39 N/A N/A 36100244 EAP CPT® 14000 "TISS TRAN,TRNK,<10 SQ CM" BOTH IP/OP "$8,323.00" "$6,159.50" $504.09 "$8,323.00" "$8,323.00" "$8,323.00" "$8,323.00" "$8,323.00" $506.66 $506.66 $504.09 "$8,323.00" $506.66 "$8,323.00" "$8,323.00" "$8,323.00" "$8,323.00" "$1,734.60" $810.66 $814.51 "$8,323.00" $506.66 $509.07 $506.66 "$8,323.00" "$6,242.25" $506.66 $506.66 $506.66 "$2,851.00" "$4,161.50" "$6,591.82" $506.66 "$6,658.40" "$2,500.00" "$8,323.00" $506.66 "$4,827.34" "$8,323.00" $515.43 $506.66 "$8,323.00" $506.66 N/A N/A 36100245 EAP CPT® 14020 "TISS TRANS,S/A/L/<10 SQ CM" BOTH IP/OP "$8,323.00" "$6,159.50" $566.68 "$8,323.00" "$8,323.00" "$8,323.00" "$8,323.00" "$8,323.00" $568.11 $568.11 $566.68 "$8,323.00" $568.11 "$8,323.00" "$8,323.00" "$8,323.00" "$8,323.00" "$1,734.60" $908.98 $913.55 "$8,323.00" $568.11 $570.97 $568.11 "$8,323.00" "$6,242.25" $568.11 $568.11 $568.11 "$3,500.00" "$4,161.50" "$6,591.82" $568.11 "$6,658.40" "$2,500.00" "$8,323.00" $568.11 "$4,827.34" "$8,323.00" $578.53 $568.11 "$8,323.00" $568.11 N/A N/A 36100246 EAP CPT® 14040 TISS XFR HEAD MOUTH CHK HND <1 BOTH IP/OP "$8,323.00" "$6,159.50" $625.37 "$8,323.00" "$8,323.00" "$8,323.00" "$8,323.00" "$8,323.00" $625.37 $625.37 $625.78 "$8,323.00" $625.37 "$8,323.00" "$8,323.00" "$8,323.00" "$8,323.00" "$1,734.60" "$1,000.59" "$1,005.23" "$8,323.00" $625.37 $628.27 $625.37 "$8,323.00" "$6,242.25" $625.37 $625.37 $625.37 "$2,851.00" "$4,161.50" "$6,591.82" $625.37 "$6,658.40" "$2,500.00" "$8,323.00" $625.37 "$4,827.34" "$8,323.00" $642.74 $625.37 "$8,323.00" $625.37 N/A N/A 36100247 EAP CPT® 14060 TISS TRANS E/N/E/L <10 SQ CM BOTH IP/OP "$9,690.00" "$7,171.00" $665.84 "$9,690.00" "$9,690.00" "$9,690.00" "$9,690.00" "$9,690.00" $666.77 $666.77 $665.84 "$9,690.00" $666.77 "$9,690.00" "$9,690.00" "$9,690.00" "$9,690.00" "$2,019.50" "$1,066.83" "$1,071.87" "$9,690.00" $666.77 $669.92 $666.77 "$9,690.00" "$7,267.50" $666.77 $666.77 $666.77 "$3,500.00" "$4,845.00" "$7,674.48" $666.77 "$7,752.00" "$2,500.00" "$9,690.00" $666.77 "$5,620.20" "$9,690.00" $684.92 $666.77 "$9,690.00" $666.77 N/A N/A 36100248 EAP CPT® 15788 CHEM PEEL FACE EPIDERMAL BOTH IP/OP $529.00 $391.50 $110.25 $529.00 $529.00 $529.00 $529.00 $529.00 $215.91 $215.91 $223.31 $529.00 $215.91 $529.00 $529.00 $529.00 $529.00 $110.25 $345.46 $348.40 $529.00 $215.91 $217.75 $215.91 $529.00 $396.75 $215.91 $215.91 $215.91 $529.00 $264.50 $418.97 $215.91 $423.20 $529.00 $529.00 $215.91 $306.82 $529.00 $236.05 $215.91 $529.00 $215.91 N/A N/A 36100249 EAP CPT® 15820 BLEPHAROPLASTY LOWER EYELID BOTH IP/OP "$14,915.00" "$11,037.50" $517.81 "$14,915.00" "$14,915.00" "$14,915.00" "$14,915.00" "$14,915.00" $518.69 $518.69 $519.19 "$14,915.00" $518.69 "$14,915.00" "$14,915.00" "$14,915.00" "$14,915.00" "$3,108.45" $829.90 $828.50 "$14,915.00" $518.69 $517.81 $518.69 "$14,915.00" "$11,186.25" $518.69 $518.69 $518.69 "$3,500.00" "$7,457.50" "$11,812.68" $518.69 "$11,932.00" "$2,500.00" "$14,915.00" $518.69 "$8,650.70" "$14,915.00" $523.03 $518.69 "$14,915.00" $518.69 N/A N/A 36100250 EAP CPT® 15822 BLEPHAROPLASTY UPPER EYELID BOTH IP/OP "$14,915.00" "$11,037.50" $402.25 "$14,915.00" "$14,915.00" "$14,915.00" "$14,915.00" "$14,915.00" $404.72 $404.72 $402.25 "$14,915.00" $404.72 "$14,915.00" "$14,915.00" "$14,915.00" "$14,915.00" "$3,108.45" $647.55 $644.38 "$14,915.00" $404.72 $402.74 $404.72 "$14,915.00" "$11,186.25" $404.72 $404.72 $404.72 "$3,500.00" "$7,457.50" "$11,812.68" $404.72 "$11,932.00" "$2,500.00" "$14,915.00" $404.72 "$8,650.70" "$14,915.00" $404.41 $404.72 "$14,915.00" $404.72 N/A N/A 36100251 EAP CPT® 16000 INITIAL TX FIRST DEGREE BURN BOTH IP/OP "$1,690.00" "$1,251.00" $45.26 "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" $45.26 $45.26 $45.60 "$1,690.00" $45.26 "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" $352.21 $72.42 $73.82 "$1,690.00" $45.26 $46.14 $45.26 "$1,690.00" "$1,267.50" $45.26 $45.26 $45.26 "$1,690.00" $845.00 "$1,338.48" $45.26 "$1,352.00" "$1,690.00" "$1,690.00" $176.64 $980.20 "$1,690.00" $47.96 $45.26 "$1,690.00" $45.26 N/A N/A 36100253 EAP CPT® 16000 "INITAL TREATMENT, 1% BURN" BOTH IP/OP "$1,690.00" "$1,251.00" $45.26 "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" $45.26 $45.26 $45.60 "$1,690.00" $45.26 "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" $352.21 $72.42 $73.82 "$1,690.00" $45.26 $46.14 $45.26 "$1,690.00" "$1,267.50" $45.26 $45.26 $45.26 "$1,690.00" $845.00 "$1,338.48" $45.26 "$1,352.00" "$1,690.00" "$1,690.00" $176.64 $980.20 "$1,690.00" $47.96 $45.26 "$1,690.00" $45.26 N/A N/A 36100254 EAP CPT® 16020 PART THICK BURN DRESS/DEBRD;SM BOTH IP/OP "$1,690.00" "$1,251.00" $55.92 "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" $176.64 $176.64 $175.86 $352.24 $176.64 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $352.21 $282.63 $260.52 "$1,690.00" $176.64 $55.92 $176.64 $185.48 "$1,267.50" $176.64 $176.64 $176.64 "$1,690.00" $845.00 "$1,338.48" $176.64 "$1,352.00" "$1,690.00" $335.42 $176.64 $980.20 $185.48 $255.56 $176.64 $352.20 $176.64 N/A N/A 36100255 EAP CPT® 16025 PART THICK BURN DRESS/DEBRD;MD (TBSA 5%-10%) BOTH IP/OP "$3,421.00" "$2,532.00" $111.21 "$2,836.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" $176.64 $176.64 $175.86 $713.02 $176.64 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $712.97 $282.63 $260.52 "$2,836.00" $176.64 $111.21 $176.64 $185.48 "$2,565.75" $176.64 $176.64 $176.64 "$2,762.00" "$1,710.50" "$2,709.43" $176.64 "$2,736.80" "$1,750.00" $678.98 $176.64 "$1,984.18" $185.48 $255.56 $176.64 $712.94 $176.64 N/A N/A 36100256 EAP CPT® 16030 PART THICK BURN DRESS/DEBRD;LG (TBSA >10%) BOTH IP/OP "$4,574.00" "$3,385.00" $132.62 "$3,659.20" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" $340.00 $340.00 $338.49 $953.34 $340.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $953.27 $543.99 $538.21 "$2,836.00" $340.00 $132.62 $340.00 $357.00 "$3,430.50" $340.00 $340.00 $340.00 "$2,762.00" "$2,348.00" "$3,622.61" $340.00 "$3,659.20" "$1,750.00" $907.82 $340.00 "$2,652.92" $357.00 $491.89 $340.00 $953.22 $340.00 N/A N/A 36100257 EAP CPT® 17000 "DEST, PREMALIGNANT LESION 1ST" BOTH IP/OP $389.00 $288.00 $55.20 $389.00 $389.00 $389.00 $389.00 $389.00 $176.64 $176.64 $175.86 $81.08 $176.64 $389.00 $389.00 $389.00 $389.00 $81.07 $282.63 $260.52 $113.00 $176.64 $55.20 $176.64 $185.48 $291.75 $176.64 $176.64 $176.64 $389.00 $194.50 $308.09 $176.64 $311.20 $389.00 $77.21 $176.64 $225.62 $185.48 $255.56 $176.64 $81.07 $176.64 N/A N/A 36100259 EAP CPT® 17003 "DEST, PREMALIGNANT LESION 2-14" BOTH IP/OP $389.00 $288.00 $2.03 $389.00 $389.00 $389.00 $389.00 $389.00 $389.00 $389.00 $389.00 $81.08 $389.00 $389.00 $389.00 $389.00 $389.00 $81.07 $389.00 $389.00 $230.09 $389.00 $2.03 $389.00 $389.00 $291.75 $389.00 $389.00 $389.00 $389.00 $194.50 $308.09 $389.00 $311.20 $389.00 $77.21 $389.00 $225.62 $389.00 $389.00 $389.00 $81.07 $389.00 N/A N/A 36100260 EAP CPT® 17004 "LES DEST, BENIGN PREMAL > 15" BOTH IP/OP $807.00 $597.50 $99.96 $807.00 $807.00 $807.00 $807.00 $807.00 $340.00 $340.00 $338.49 $168.20 $340.00 $807.00 $807.00 $807.00 $807.00 $168.19 $543.99 $538.21 $807.00 $340.00 $99.96 $340.00 $357.00 $605.25 $340.00 $340.00 $340.00 $807.00 $403.50 $639.14 $340.00 $645.60 $807.00 $160.17 $340.00 $468.06 $357.00 $491.89 $340.00 $168.18 $340.00 N/A N/A 36100262 EAP CPT® 17110 "DEST FLAT WARTS MOLLU,MILLA" BOTH IP/OP $365.00 $270.50 $67.73 $365.00 $365.00 $365.00 $365.00 $365.00 $176.64 $176.64 $175.86 $76.08 $176.64 $365.00 $365.00 $365.00 $365.00 $76.07 $282.63 $260.52 $113.00 $176.64 $67.73 $176.64 $185.48 $273.75 $176.64 $176.64 $176.64 $365.00 $182.50 $289.08 $176.64 $292.00 $365.00 $72.44 $176.64 $211.70 $185.48 $255.56 $176.64 $76.07 $176.64 N/A N/A 36100266 EAP CPT® 17111 "DEST. FLAT WARTS, >15 LESIONS" BOTH IP/OP $807.00 $597.50 $82.98 $807.00 $807.00 $807.00 $807.00 $807.00 $176.64 $176.64 $175.86 $168.20 $176.64 $807.00 $807.00 $807.00 $807.00 $168.19 $282.63 $260.52 $113.00 $176.64 $82.98 $176.64 $185.48 $605.25 $176.64 $176.64 $176.64 $807.00 $403.50 $639.14 $176.64 $645.60 $807.00 $160.17 $176.64 $468.06 $185.48 $255.56 $176.64 $168.18 $176.64 N/A N/A 36100269 EAP CPT® 17250 CHEMICAL CAUTERY TISSUE BOTH IP/OP $753.00 $557.50 $37.62 $753.00 $753.00 $753.00 $753.00 $753.00 $176.64 $176.64 $175.86 $156.94 $176.64 $753.00 $753.00 $753.00 $753.00 $156.93 $282.63 $260.52 $113.00 $176.64 $37.62 $176.64 $185.48 $564.75 $176.64 $176.64 $176.64 $753.00 $376.50 $596.38 $176.64 $602.40 $753.00 $149.45 $176.64 $436.74 $185.48 $255.56 $176.64 $156.93 $176.64 N/A N/A 36100270 EAP CPT® 36410 MID LINE INSERTION BOTH IP/OP "$6,447.00" "$4,771.00" $9.16 "$6,447.00" "$6,447.00" "$6,447.00" "$6,447.00" "$6,447.00" $9.27 $9.27 $9.35 "$6,447.00" $9.27 "$6,447.00" "$6,447.00" "$6,447.00" "$6,447.00" "$1,343.63" $14.83 $14.66 "$6,447.00" $9.27 $9.16 $9.27 "$6,447.00" "$4,835.25" $9.27 $9.27 $9.27 "$2,762.00" "$3,223.50" "$5,106.02" $9.27 "$5,157.60" "$4,190.55" "$6,447.00" $9.27 "$3,739.26" "$6,447.00" $9.74 $9.27 "$6,447.00" $9.27 N/A N/A 36100272 EAP CPT® 17260 LESION DSTR MALIG TRNK ARM <.5 BOTH IP/OP $670.00 $496.00 $70.81 $670.00 $670.00 $670.00 $670.00 $670.00 $70.92 $70.92 $70.81 $670.00 $70.92 $670.00 $670.00 $670.00 $670.00 $139.64 $113.47 $113.84 $670.00 $70.92 $71.15 $70.92 $670.00 $502.50 $70.92 $70.92 $70.92 $670.00 $335.00 $530.64 $70.92 $536.00 $670.00 $670.00 $70.92 $388.60 $670.00 $72.10 $70.92 $670.00 $70.92 N/A N/A 36100273 EAP CPT® 17261 LES DSTR MALIG TRNK ARM 0.6-1. BOTH IP/OP $753.00 $557.50 $87.07 $753.00 $753.00 $753.00 $753.00 $753.00 $176.64 $176.64 $175.86 $156.94 $176.64 $753.00 $753.00 $753.00 $753.00 $156.93 $282.63 $260.52 $113.00 $176.64 $87.07 $176.64 $185.48 $564.75 $176.64 $176.64 $176.64 $753.00 $376.50 $596.38 $176.64 $602.40 $753.00 $149.45 $176.64 $436.74 $185.48 $255.56 $176.64 $156.93 $176.64 N/A N/A 36100274 EAP CPT® 17262 LES DSTR MALIG TRNK ARM 1.1-2. BOTH IP/OP $753.00 $557.50 $111.15 $753.00 $753.00 $753.00 $753.00 $753.00 $176.64 $176.64 $175.86 $156.94 $176.64 $753.00 $753.00 $753.00 $753.00 $156.93 $282.63 $260.52 $113.00 $176.64 $111.15 $176.64 $185.48 $564.75 $176.64 $176.64 $176.64 $753.00 $376.50 $596.38 $176.64 $602.40 $753.00 $149.45 $176.64 $436.74 $185.48 $255.56 $176.64 $156.93 $176.64 N/A N/A 36100275 EAP CPT® 17263 LES DSTR MALIG TRNK ARM 2.1-3. BOTH IP/OP $646.00 $478.50 $122.12 $646.00 $646.00 $646.00 $646.00 $646.00 $122.12 $122.12 $122.50 $646.00 $122.12 $646.00 $646.00 $646.00 $646.00 $134.63 $195.39 $196.27 $646.00 $122.12 $122.67 $122.12 $646.00 $484.50 $122.12 $122.12 $122.12 $646.00 $323.00 $511.63 $122.12 $516.80 $646.00 $646.00 $122.12 $374.68 $646.00 $127.98 $122.12 $646.00 $122.12 N/A N/A 36100276 EAP CPT® 17264 LES DSTR MALIG TRNK ARM 3.1-4. BOTH IP/OP $645.00 $477.50 $130.38 $645.00 $645.00 $645.00 $645.00 $645.00 $130.38 $130.38 $131.15 $645.00 $130.38 $645.00 $645.00 $645.00 $645.00 $134.43 $208.61 $209.28 $645.00 $130.38 $130.80 $130.38 $645.00 $483.75 $130.38 $130.38 $130.38 $645.00 $322.50 $510.84 $130.38 $516.00 $645.00 $645.00 $130.38 $374.10 $645.00 $136.64 $130.38 $645.00 $130.38 N/A N/A 36100277 EAP CPT® 17266 LES DSTR MALIG TRNK ARM >4.0 BOTH IP/OP "$1,428.00" "$1,057.00" $153.07 "$1,428.00" "$1,428.00" "$1,428.00" "$1,428.00" "$1,428.00" $153.07 $153.07 $154.03 "$1,428.00" $153.07 "$1,428.00" "$1,428.00" "$1,428.00" "$1,428.00" $297.61 $244.91 $246.70 "$1,428.00" $153.07 $154.19 $153.07 "$1,428.00" "$1,071.00" $153.07 $153.07 $153.07 "$1,428.00" $714.00 "$1,130.98" $153.07 "$1,142.40" "$1,428.00" "$1,428.00" $153.07 $828.24 "$1,428.00" $161.15 $153.07 "$1,428.00" $153.07 N/A N/A 36100278 EAP CPT® 17271 LES DSTR MALIG SCLP NCK 0.6-1. BOTH IP/OP $946.00 $700.50 $104.30 $946.00 $946.00 $946.00 $946.00 $946.00 $104.30 $104.30 $105.48 $946.00 $104.30 $946.00 $946.00 $946.00 $946.00 $197.16 $166.88 $169.70 $946.00 $104.30 $106.06 $104.30 $946.00 $709.50 $104.30 $104.30 $104.30 $946.00 $473.00 $749.23 $104.30 $756.80 $946.00 $946.00 $104.30 $548.68 $946.00 $108.87 $104.30 $946.00 $104.30 N/A N/A 36100279 EAP CPT® 17272 LES DSTR MALIG SCLP NCK 1.1-2. BOTH IP/OP $646.00 $478.50 $121.08 $646.00 $646.00 $646.00 $646.00 $646.00 $121.08 $121.08 $121.45 $646.00 $121.08 $646.00 $646.00 $646.00 $646.00 $134.63 $193.73 $194.64 $646.00 $121.08 $121.65 $121.08 $646.00 $484.50 $121.08 $121.08 $121.08 $646.00 $323.00 $511.63 $121.08 $516.80 $646.00 $646.00 $121.08 $374.68 $646.00 $126.90 $121.08 $646.00 $121.08 N/A N/A 36100280 EAP CPT® 17273 LES DSTR MALIG SCLP NCK 2.1-3. BOTH IP/OP $974.00 $721.00 $136.92 $974.00 $974.00 $974.00 $974.00 $974.00 $136.92 $136.92 $138.05 $974.00 $136.92 $974.00 $974.00 $974.00 $974.00 $202.99 $219.07 $220.13 $974.00 $136.92 $137.58 $136.92 $974.00 $730.50 $136.92 $136.92 $136.92 $974.00 $487.00 $771.41 $136.92 $779.20 $974.00 $974.00 $136.92 $564.92 $974.00 $143.85 $136.92 $974.00 $136.92 N/A N/A 36100281 EAP CPT® 17274 LES DSTR MALIG SCLP NCK 3.1-4. BOTH IP/OP "$1,430.00" "$1,058.50" $167.22 "$1,430.00" "$1,430.00" "$1,430.00" "$1,430.00" "$1,430.00" $167.22 $167.22 $168.26 "$1,430.00" $167.22 "$1,430.00" "$1,430.00" "$1,430.00" "$1,430.00" $298.03 $267.55 $269.49 "$1,430.00" $167.22 $168.43 $167.22 "$1,430.00" "$1,072.50" $167.22 $167.22 $167.22 "$1,430.00" $715.00 "$1,132.56" $167.22 "$1,144.00" "$1,430.00" "$1,430.00" $167.22 $829.40 "$1,430.00" $175.94 $167.22 "$1,430.00" $167.22 N/A N/A 36100282 EAP CPT® 17280 LESION DSTR MALIG FACE EAR <.5 BOTH IP/OP $646.00 $478.50 $86.07 $646.00 $646.00 $646.00 $646.00 $646.00 $86.07 $86.07 $87.07 $646.00 $86.07 $646.00 $646.00 $646.00 $646.00 $134.63 $137.71 $138.77 $646.00 $86.07 $86.73 $86.07 $646.00 $484.50 $86.07 $86.07 $86.07 $646.00 $323.00 $511.63 $86.07 $516.80 $646.00 $646.00 $86.07 $374.68 $646.00 $89.40 $86.07 $646.00 $86.07 N/A N/A 36100283 EAP CPT® 17281 LES DSTR MALIG FACE EAR 0.6-1. BOTH IP/OP "$1,726.00" "$1,277.50" $113.00 "$1,726.00" "$1,726.00" "$1,726.00" "$1,726.00" "$1,726.00" $340.00 $340.00 $338.49 $359.74 $340.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $359.72 $543.99 $538.21 $113.00 $340.00 $118.94 $340.00 $357.00 "$1,294.50" $340.00 $340.00 $340.00 "$1,726.00" $863.00 "$1,366.99" $340.00 "$1,380.80" "$1,726.00" $342.57 $340.00 "$1,001.08" $357.00 $491.89 $340.00 $359.70 $340.00 N/A N/A 36100284 EAP CPT® 17282 LES DSTR MALIG FACE EAR 1.1-2. BOTH IP/OP $974.00 $721.00 $136.23 $974.00 $974.00 $974.00 $974.00 $974.00 $136.23 $136.23 $137.36 $974.00 $136.23 $974.00 $974.00 $974.00 $974.00 $202.99 $217.97 $219.58 $974.00 $136.23 $137.24 $136.23 $974.00 $730.50 $136.23 $136.23 $136.23 $974.00 $487.00 $771.41 $136.23 $779.20 $974.00 $974.00 $136.23 $564.92 $974.00 $143.12 $136.23 $974.00 $136.23 N/A N/A 36100289 EAP CPT® 19001 EACH ADDITIONA CYST-BREAST BOTH IP/OP $921.00 $682.00 $20.68 $921.00 $921.00 $921.00 $921.00 $921.00 $21.28 $21.28 $21.46 $921.00 $21.28 $921.00 $921.00 $921.00 $921.00 $191.95 $34.05 $33.09 $921.00 $21.28 $20.68 $21.28 $921.00 $690.75 $21.28 $21.28 $21.28 $921.00 $460.50 $729.43 $21.28 $736.80 $921.00 $921.00 $21.28 $534.18 $921.00 $22.72 $21.28 $921.00 $21.28 N/A N/A 36100298 EAP CPT® 19000 PUNCT ASPIR CYST BREAST BIC BOTH IP/OP "$1,130.00" $836.50 $42.74 "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" $612.13 $612.13 $609.42 $235.52 $612.13 "$1,130.00" "$1,130.00" "$1,130.00" $882.37 $235.50 $979.40 $936.25 "$1,130.00" $612.13 $42.74 $612.13 $642.73 $847.50 $612.13 $612.13 $612.13 "$1,130.00" $565.00 $894.96 $612.13 $904.00 "$1,130.00" $224.28 $612.13 $655.40 $642.73 $885.59 $612.13 $235.49 $612.13 N/A N/A 36100299 EAP CPT® 54065 DESTRUCTION PENIS LESION(S) BOTH IP/OP "$7,192.00" "$5,322.50" $172.81 "$5,753.60" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,684.82" "$1,684.82" "$1,677.37" "$1,498.99" "$1,684.82" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,498.89" "$2,695.71" "$2,489.83" "$1,871.00" "$1,684.82" $172.81 "$1,684.82" "$1,769.06" "$5,394.00" "$1,684.82" "$1,684.82" "$1,684.82" "$2,762.00" "$2,348.00" "$5,696.06" "$1,684.82" "$5,753.60" "$2,500.00" "$1,427.43" "$1,684.82" "$4,171.36" "$1,769.06" "$2,437.51" "$1,684.82" "$1,498.81" "$1,684.82" N/A N/A 36100300 EAP CPT® 19001 PUNC ASPIR EA ADD'L CYST BREAS BOTH IP/OP $921.00 $682.00 $20.68 $921.00 $921.00 $921.00 $921.00 $921.00 $21.28 $21.28 $21.46 $921.00 $21.28 $921.00 $921.00 $921.00 $921.00 $191.95 $34.05 $33.09 $921.00 $21.28 $20.68 $21.28 $921.00 $690.75 $21.28 $21.28 $21.28 $921.00 $460.50 $729.43 $21.28 $736.80 $921.00 $921.00 $21.28 $534.18 $921.00 $22.72 $21.28 $921.00 $21.28 N/A N/A 36100301 EAP CPT® 19001 PUNCT ASPIR EA ADDT CYST BIC BOTH IP/OP "$1,130.00" $836.50 $20.68 "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" $21.28 $21.28 $21.46 "$1,130.00" $21.28 "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" $235.50 $34.05 $33.09 "$1,130.00" $21.28 $20.68 $21.28 "$1,130.00" $847.50 $21.28 $21.28 $21.28 "$1,130.00" $565.00 $894.96 $21.28 $904.00 "$1,130.00" "$1,130.00" $21.28 $655.40 "$1,130.00" $22.72 $21.28 "$1,130.00" $21.28 N/A N/A 36100303 EAP CPT® 19020 INCISION OF BREAST LESION RT BOTH IP/OP "$7,031.00" "$5,203.00" $317.47 "$7,031.00" "$7,031.00" "$7,031.00" "$7,031.00" "$7,031.00" $318.91 $318.91 $317.47 "$7,031.00" $318.91 "$7,031.00" "$7,031.00" "$7,031.00" "$7,031.00" "$1,465.34" $510.26 $511.01 "$7,031.00" $318.91 $319.38 $318.91 "$7,031.00" "$5,273.25" $318.91 $318.91 $318.91 "$2,851.00" "$3,515.50" "$5,568.55" $318.91 "$5,624.80" "$3,250.00" "$7,031.00" $318.91 "$4,077.98" "$7,031.00" $321.85 $318.91 "$7,031.00" $318.91 N/A N/A 36100304 EAP CPT® 19030 GALACTOGRAM INJECTION BIC BOTH IP/OP $764.00 $565.50 $75.70 $764.00 $764.00 $764.00 $764.00 $764.00 $75.70 $75.70 $76.64 $764.00 $75.70 $764.00 $764.00 $764.00 $764.00 $159.23 $121.12 $122.62 $764.00 $75.70 $76.64 $75.70 $764.00 $573.00 $75.70 $75.70 $75.70 $764.00 $382.00 $605.09 $75.70 $611.20 $764.00 $764.00 $75.70 $443.12 $764.00 $80.06 $75.70 $764.00 $75.70 N/A N/A 36100306 EAP CPT® 19100 BREAST BX NEEDLE W/0 IMAGING BOTH IP/OP "$1,927.00" "$1,426.00" $69.60 "$2,214.48" "$1,927.00" "$1,927.00" "$1,927.00" "$1,927.00" "$1,384.05" "$1,384.05" "$1,377.93" $401.63 "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $401.61 "$2,214.48" "$2,163.34" "$1,871.00" "$1,384.05" $69.60 "$1,384.05" "$1,453.25" "$1,445.25" "$1,384.05" "$1,384.05" "$1,384.05" "$1,927.00" $963.50 "$1,526.18" "$1,384.05" "$1,541.60" "$1,927.00" $382.46 "$1,384.05" "$1,117.66" "$1,453.25" "$1,927.00" "$1,384.05" $401.59 "$1,384.05" N/A N/A 36100307 EAP CPT® 19100 "BREAST BX, NEEDLE" BOTH IP/OP "$1,571.00" "$1,163.00" $69.60 "$2,214.48" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,384.05" "$1,384.05" "$1,377.93" $327.44 "$1,384.05" "$1,541.95" "$1,541.95" "$1,571.00" "$1,082.33" $327.41 "$2,214.48" "$2,163.34" "$1,571.00" "$1,384.05" $69.60 "$1,384.05" "$1,453.25" "$1,178.25" "$1,384.05" "$1,384.05" "$1,384.05" "$1,571.00" $785.50 "$1,244.23" "$1,384.05" "$1,256.80" "$1,571.00" $311.80 "$1,384.05" $911.18 "$1,453.25" "$1,571.00" "$1,384.05" $327.40 "$1,384.05" N/A N/A 36100318 EAP CPT® 19296 PLACE PO BREAST CATH FOR RAD BOTH IP/OP "$17,549.00" "$12,986.50" $212.15 "$17,549.00" "$17,549.00" "$17,549.00" "$17,549.00" "$17,549.00" $212.52 $212.52 $212.36 "$17,549.00" $212.52 "$17,549.00" "$17,549.00" "$17,549.00" "$17,549.00" "$3,657.40" $340.03 $339.44 "$17,549.00" $212.52 $212.15 $212.52 "$17,549.00" "$13,161.75" $212.52 $212.52 $212.52 "$7,479.00" "$8,774.50" "$13,898.81" $212.52 "$14,039.20" "$4,334.00" "$17,549.00" $212.52 "$10,178.42" "$17,549.00" $220.27 $212.52 "$17,549.00" $212.52 N/A N/A 36100319 EAP CPT® 19297 BR CATH FOR RAD CONCUR W/PT MA BOTH IP/OP "$17,549.00" "$12,986.50" $95.07 "$17,549.00" "$17,549.00" "$17,549.00" "$17,549.00" "$17,549.00" $95.11 $95.11 $96.21 "$17,549.00" $95.11 "$17,549.00" "$17,549.00" "$17,549.00" "$17,549.00" "$3,657.40" $152.18 $152.11 "$17,549.00" $95.11 $95.07 $95.11 "$17,549.00" "$13,161.75" $95.11 $95.11 $95.11 "$7,479.00" "$8,774.50" "$13,898.81" $95.11 "$14,039.20" "$4,334.00" "$17,549.00" $95.11 "$10,178.42" "$17,549.00" $99.86 $95.11 "$17,549.00" $95.11 N/A N/A 36100320 EAP CPT® 19357 BREAST RECONST TISS EXPANDER BOTH IP/OP "$11,975.00" "$8,861.50" "$1,176.90" "$11,975.00" "$11,975.00" "$11,975.00" "$11,975.00" "$11,975.00" "$1,177.16" "$1,177.16" "$1,183.17" "$11,975.00" "$1,177.16" "$11,975.00" "$11,975.00" "$11,975.00" "$11,975.00" "$2,495.72" "$1,883.46" "$1,883.04" "$11,975.00" "$1,177.16" "$1,176.90" "$1,177.16" "$11,975.00" "$8,981.25" "$1,177.16" "$1,177.16" "$1,177.16" "$4,780.00" "$5,987.50" "$9,484.20" "$1,177.16" "$9,580.00" "$4,334.00" "$11,975.00" "$1,177.16" "$6,945.50" "$11,975.00" "$1,563.18" "$1,177.16" "$11,975.00" "$1,177.16" N/A N/A 36100321 EAP CPT® 19499 DUCT LAV ASPIRATION BOTH IP/OP "$6,124.00" "$4,532.00" "$1,276.31" "$6,169.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$1,276.31" "$6,124.00" "$2,467.60" "$6,124.00" "$6,124.00" "$6,169.00" "$6,124.00" "$6,124.00" "$4,593.00" "$6,124.00" "$6,124.00" "$6,124.00" "$2,762.00" "$3,062.00" "$4,850.21" "$6,124.00" "$4,899.20" "$3,250.00" "$6,124.00" "$6,124.00" "$3,551.92" "$6,124.00" "$3,674.40" "$6,124.00" "$6,124.00" "$6,124.00" N/A N/A 36100323 EAP CPT® 20206 BX MUSCLE NEEDLE PERCUT BCT BOTH IP/OP "$1,504.00" "$1,113.00" $57.28 "$1,504.00" "$1,504.00" "$1,504.00" "$1,504.00" "$1,504.00" $57.45 $57.45 $57.58 "$1,504.00" $57.45 "$1,504.00" "$1,504.00" "$1,504.00" "$1,504.00" $313.45 $91.92 $91.65 "$1,504.00" $57.45 $57.28 $57.45 "$1,504.00" "$1,128.00" $57.45 $57.45 $57.45 "$1,504.00" $752.00 "$1,191.17" $57.45 "$1,203.20" "$1,504.00" "$1,504.00" $57.45 $872.32 "$1,504.00" $60.21 $57.45 "$1,504.00" $57.45 N/A N/A 36100326 EAP CPT® 20220 BX BONE TROCAR/NDLE SUPF BCT BOTH IP/OP "$2,018.00" "$1,493.50" $87.81 "$2,214.48" "$2,018.00" "$2,018.00" "$2,018.00" "$2,018.00" "$1,384.05" "$1,384.05" "$1,377.93" $420.60 "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $420.57 "$2,214.48" "$2,163.34" "$1,871.00" "$1,384.05" $87.81 "$1,384.05" "$1,453.25" "$1,513.50" "$1,384.05" "$1,384.05" "$1,384.05" "$2,018.00" "$1,009.00" "$1,598.26" "$1,384.05" "$1,614.40" "$2,018.00" $400.52 "$1,384.05" "$1,170.44" "$1,453.25" "$2,002.37" "$1,384.05" $420.55 "$1,384.05" N/A N/A 36100328 EAP CPT® 20225 BX BONE TROCAR/NDLE DEEP BCT BOTH IP/OP "$3,057.00" "$2,262.50" $129.17 "$2,851.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,384.05" "$1,384.05" "$1,377.93" $637.16 "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $637.11 "$2,214.48" "$2,163.34" "$2,836.00" "$1,384.05" $129.17 "$1,384.05" "$1,453.25" "$2,292.75" "$1,384.05" "$1,384.05" "$1,384.05" "$2,851.00" "$1,528.50" "$2,421.14" "$1,384.05" "$2,445.60" "$2,500.00" $606.74 "$1,384.05" "$1,773.06" "$1,453.25" "$2,002.37" "$1,384.05" $637.08 "$1,384.05" N/A N/A 36100329 EAP CPT® 20501 INJECT SINUS TRACT DIAGNOSTIC BOTH IP/OP "$1,226.00" $907.50 $36.62 "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" $255.53 "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" $255.51 "$1,226.00" "$1,068.00" $725.18 "$1,226.00" $36.62 "$1,226.00" "$1,226.00" $919.50 "$1,226.00" "$1,226.00" "$1,226.00" "$1,226.00" $613.00 $970.99 "$1,226.00" $980.80 "$1,226.00" $243.33 "$1,226.00" $711.08 "$1,226.00" "$1,226.00" "$1,226.00" $255.50 "$1,226.00" N/A N/A 36100330 EAP CPT® 20520 REMOVE FOREIGN BODY (SIMPLE) BOTH IP/OP "$1,594.00" "$1,180.00" $149.10 "$2,214.48" "$1,594.00" "$1,594.00" "$1,594.00" "$1,594.00" "$1,384.05" "$1,384.05" "$1,377.93" $332.23 "$1,384.05" "$1,541.95" "$1,541.95" "$1,594.00" "$1,082.33" $332.21 "$2,214.48" "$2,163.34" "$1,594.00" "$1,384.05" $149.10 "$1,384.05" "$1,453.25" "$1,195.50" "$1,384.05" "$1,384.05" "$1,384.05" "$1,594.00" $797.00 "$1,262.45" "$1,384.05" "$1,275.20" "$1,594.00" $316.37 $149.49 $924.52 "$1,453.25" "$1,594.00" "$1,384.05" $332.19 "$1,384.05" N/A N/A 36100331 EAP CPT® 20525 REMOVE FOREIGN BODY (COMPL.) BOTH IP/OP "$2,653.00" "$1,963.50" $250.28 "$2,653.00" "$2,653.00" "$2,653.00" "$2,653.00" "$2,653.00" $250.28 $250.28 $251.00 "$2,653.00" $250.28 "$2,653.00" "$2,653.00" "$2,653.00" "$2,653.00" $552.91 $400.45 $400.90 "$2,653.00" $250.28 $250.56 $250.28 "$2,653.00" "$1,989.75" $250.28 $250.28 $250.28 "$2,653.00" "$1,326.50" "$2,101.18" $250.28 "$2,122.40" "$2,653.00" "$2,653.00" $250.28 "$1,538.74" "$2,653.00" $256.29 $250.28 "$2,653.00" $250.28 N/A N/A 36100332 EAP CPT® 20526 CARPAL TUNNEL INJECTION BOTH IP/OP $903.00 $668.50 $57.67 $903.00 $903.00 $903.00 $903.00 $903.00 $257.00 $257.00 $255.86 $188.21 $257.00 $903.00 $903.00 $903.00 $882.37 $188.20 $411.20 $392.25 $903.00 $257.00 $57.67 $257.00 $269.85 $677.25 $257.00 $257.00 $257.00 $903.00 $451.50 $715.18 $257.00 $722.40 $903.00 $179.22 $257.00 $523.74 $269.85 $371.81 $257.00 $188.19 $257.00 N/A N/A 36100333 EAP CPT® 20550 INJECT TENDON SHEATH LIGAMENT BOTH IP/OP $719.00 $532.50 $39.34 $719.00 $719.00 $719.00 $719.00 $719.00 $257.00 $257.00 $255.86 $149.86 $257.00 $719.00 $719.00 $719.00 $719.00 $149.85 $411.20 $392.25 $719.00 $257.00 $39.34 $257.00 $269.85 $539.25 $257.00 $257.00 $257.00 $719.00 $359.50 $569.45 $257.00 $575.20 $719.00 $142.70 $257.00 $417.02 $269.85 $371.81 $257.00 $149.84 $257.00 N/A N/A 36100336 EAP CPT® 20551 INJ TENDON ORIGIN/INSERTION BOTH IP/OP $903.00 $668.50 $39.34 $903.00 $903.00 $903.00 $903.00 $903.00 $39.48 $39.48 $39.80 $903.00 $39.48 $903.00 $903.00 $903.00 $903.00 $188.20 $63.17 $62.94 $903.00 $39.48 $39.34 $39.48 $903.00 $677.25 $39.48 $39.48 $39.48 $903.00 $451.50 $715.18 $39.48 $722.40 $903.00 $903.00 $39.48 $523.74 $903.00 $41.47 $39.48 $903.00 $39.48 N/A N/A 36100337 EAP CPT® 20552 INJECT TRIGGER POINT 1-2 MUSC BOTH IP/OP $640.00 $474.00 $37.29 $640.00 $640.00 $640.00 $640.00 $640.00 $257.00 $257.00 $255.86 $133.39 $257.00 $640.00 $640.00 $640.00 $640.00 $133.38 $411.20 $392.25 $640.00 $257.00 $37.29 $257.00 $269.85 $480.00 $257.00 $257.00 $257.00 $640.00 $320.00 $506.88 $257.00 $512.00 $640.00 $127.02 $257.00 $371.20 $269.85 $371.81 $257.00 $133.38 $257.00 N/A N/A 36100338 EAP CPT® 20553 TRIGGER POINT INJECTIONS: THREE OR MORE MUSCLES BOTH IP/OP $903.00 $668.50 $42.72 $903.00 $903.00 $903.00 $903.00 $903.00 $257.00 $257.00 $255.86 $188.21 $257.00 $903.00 $903.00 $903.00 $882.37 $188.20 $411.20 $392.25 $903.00 $257.00 $42.72 $257.00 $269.85 $677.25 $257.00 $257.00 $257.00 $903.00 $451.50 $715.18 $257.00 $722.40 $903.00 $179.22 $257.00 $523.74 $269.85 $371.81 $257.00 $188.19 $257.00 N/A N/A 36100339 EAP CPT® 20600 DRAIN/INJECT-FINGER/TOE WO US GUIDANCE BOTH IP/OP $935.00 $692.00 $35.60 $935.00 $935.00 $935.00 $935.00 $935.00 $257.00 $257.00 $255.86 $194.88 $257.00 $935.00 $935.00 $935.00 $882.37 $194.86 $411.20 $392.25 $935.00 $257.00 $35.60 $257.00 $269.85 $701.25 $257.00 $257.00 $257.00 $935.00 $467.50 $740.52 $257.00 $748.00 $935.00 $185.57 $257.00 $542.30 $269.85 $371.81 $257.00 $194.85 $257.00 N/A N/A 36100340 EAP CPT® 50561 KINDEY ENDOSCOPY & TREATMENT BOTH IP/OP "$6,215.00" "$4,599.50" $389.99 "$6,215.00" "$6,215.00" "$6,215.00" "$6,215.00" "$6,215.00" $392.35 $392.35 $395.36 "$6,215.00" $392.35 "$6,215.00" "$6,215.00" "$6,215.00" "$6,215.00" "$1,295.27" $627.76 $623.98 "$6,215.00" $392.35 $389.99 $392.35 "$6,215.00" "$4,661.25" $392.35 $392.35 $392.35 "$2,762.00" "$3,107.50" "$4,922.28" $392.35 "$4,972.00" "$3,250.00" "$6,215.00" $392.35 "$3,604.70" "$6,215.00" $409.64 $392.35 "$6,215.00" $392.35 N/A N/A 36100345 EAP CPT® 20605 DRAIN/INJECT-WRIST ELBOW ANKLE WO US GUIDANCE BOTH IP/OP $935.00 $692.00 $37.31 $935.00 $935.00 $935.00 $935.00 $935.00 $257.00 $257.00 $255.86 $194.88 $257.00 $935.00 $935.00 $935.00 $882.37 $194.86 $411.20 $392.25 $935.00 $257.00 $37.31 $257.00 $269.85 $701.25 $257.00 $257.00 $257.00 $935.00 $467.50 $740.52 $257.00 $748.00 $935.00 $185.57 $257.00 $542.30 $269.85 $371.81 $257.00 $194.85 $257.00 N/A N/A 36100348 EAP CPT® 20610 DRAIN/INJECT-SHOULDER HIP KNEE WO US GUIDANCE BOTH IP/OP "$2,198.00" "$1,627.00" $45.44 "$2,198.00" "$2,198.00" "$2,198.00" "$2,198.00" "$2,198.00" $257.00 $257.00 $255.86 $458.12 $257.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $458.09 $411.20 $392.25 "$1,871.00" $257.00 $45.44 $257.00 $269.85 "$1,648.50" $257.00 $257.00 $257.00 "$2,198.00" "$1,099.00" "$1,740.82" $257.00 "$1,758.40" "$1,750.00" $436.25 $257.00 "$1,274.84" $269.85 $371.81 $257.00 $458.06 $257.00 N/A N/A 36100349 EAP CPT® 41009 DRAINAGE OF MOUTH LESION BOTH IP/OP "$6,979.00" "$5,164.50" $285.99 "$6,979.00" "$6,979.00" "$6,979.00" "$6,979.00" "$6,979.00" $285.99 $285.99 $286.69 "$6,979.00" $285.99 "$6,979.00" "$6,979.00" "$6,979.00" "$6,979.00" "$1,454.50" $457.58 $460.75 "$6,979.00" $285.99 $287.97 $285.99 "$6,979.00" "$5,234.25" $285.99 $285.99 $285.99 "$2,762.00" "$3,489.50" "$5,527.37" $285.99 "$5,583.20" "$1,750.00" "$6,979.00" $285.99 "$4,047.82" "$6,979.00" $295.22 $285.99 "$6,979.00" $285.99 N/A N/A 36100354 EAP CPT® 20612 "ASPIRATION/INJ.,GANGION CYST" BOTH IP/OP "$1,050.00" $777.00 $41.37 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $257.00 $257.00 $255.86 $218.85 $257.00 "$1,050.00" "$1,050.00" "$1,050.00" $882.37 $218.83 $411.20 $392.25 "$1,050.00" $257.00 $41.37 $257.00 $269.85 $787.50 $257.00 $257.00 $257.00 "$1,050.00" $525.00 $831.60 $257.00 $840.00 "$1,050.00" $208.40 $257.00 $609.00 $269.85 $371.81 $257.00 $218.82 $257.00 N/A N/A 36100355 EAP CPT® 20670 ARCH BAR REMOVAL BOTH IP/OP "$7,188.00" "$5,319.50" #N/A #N/A "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,384.05" "$1,384.05" "$1,377.93" "$1,498.16" "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,498.06" "$2,214.48" "$2,163.34" "$1,871.00" "$1,384.05" $146.72 "$1,384.05" "$1,453.25" "$5,391.00" "$1,384.05" "$1,384.05" "$1,384.05" "$2,762.00" "$2,348.00" "$5,692.90" "$1,384.05" "$5,750.40" "$2,500.00" "$1,426.64" #N/A "$4,169.04" "$1,453.25" "$2,002.37" "$1,384.05" "$1,497.98" "$1,384.05" N/A N/A 36100356 EAP CPT® 20670 REMOVAL IMPLANT; SUPERFICIAL BOTH IP/OP "$7,188.00" "$5,319.50" $146.72 "$5,750.40" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,384.05" "$1,384.05" "$1,377.93" "$1,498.16" "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,498.06" "$2,214.48" "$2,163.34" "$1,871.00" "$1,384.05" $146.72 "$1,384.05" "$1,453.25" "$5,391.00" "$1,384.05" "$1,384.05" "$1,384.05" "$2,762.00" "$2,348.00" "$5,692.90" "$1,384.05" "$5,750.40" "$2,500.00" "$1,426.64" "$1,384.05" "$4,169.04" "$1,453.25" "$2,002.37" "$1,384.05" "$1,497.98" "$1,384.05" N/A N/A 36100357 EAP CPT® 21025 "SEQUESTRECTOMY, MANDIBLE" BOTH IP/OP "$12,260.00" "$9,072.50" $667.21 "$9,808.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$5,002.91" "$5,002.91" "$4,980.79" "$2,555.29" "$5,002.91" "$2,192.53" "$2,192.53" "$2,276.86" "$1,538.39" "$2,555.12" "$8,004.66" "$7,703.33" "$2,836.00" "$5,002.91" $667.21 "$5,002.91" "$5,253.06" "$9,195.00" "$5,002.91" "$5,002.91" "$5,002.91" "$2,851.00" "$2,423.00" "$9,709.92" "$5,002.91" "$9,808.00" "$4,334.00" "$2,433.30" "$5,002.91" "$7,110.80" "$5,253.06" "$7,237.96" "$5,002.91" "$2,554.98" "$5,002.91" N/A N/A 36100358 EAP CPT® 21026 "SEQUESTRECTOMY, MAXILLA" BOTH IP/OP "$8,448.00" "$6,252.00" $432.28 "$8,448.00" "$8,448.00" "$8,448.00" "$8,448.00" "$8,448.00" $433.39 $433.39 $440.88 "$8,448.00" $433.39 "$8,448.00" "$8,448.00" "$8,448.00" "$8,448.00" "$1,760.66" $693.42 $691.65 "$8,448.00" $433.39 $432.28 $433.39 "$8,448.00" "$6,336.00" $433.39 $433.39 $433.39 "$2,851.00" "$4,224.00" "$6,690.82" $433.39 "$6,758.40" "$3,250.00" "$8,448.00" $433.39 "$4,899.84" "$8,448.00" $467.88 $433.39 "$8,448.00" $433.39 N/A N/A 36100359 EAP CPT® 21031 EXCISION OF TORUS MANDIBULARIS BOTH IP/OP "$3,080.00" "$2,279.50" $275.38 "$4,305.68" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,691.05" "$2,691.05" "$2,679.15" $641.95 "$2,691.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $641.91 "$4,305.68" "$4,104.40" "$3,080.00" "$2,691.05" $275.38 "$2,691.05" "$2,825.60" "$2,310.00" "$2,691.05" "$2,691.05" "$2,691.05" "$2,851.00" "$1,540.00" "$2,439.36" "$2,691.05" "$2,464.00" "$3,080.00" $611.30 "$2,691.05" "$1,786.40" "$2,825.60" "$3,080.00" "$2,691.05" $641.87 "$2,691.05" N/A N/A 36100360 EAP CPT® 21032 EXCISION OF MAXILLARY TORUS BOTH IP/OP "$4,910.00" "$3,633.50" $262.87 "$4,877.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,691.05" "$2,691.05" "$2,679.15" "$1,023.37" "$2,691.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,023.30" "$4,305.68" "$4,104.40" "$4,877.00" "$2,691.05" $262.87 "$2,691.05" "$2,825.60" "$3,682.50" "$2,691.05" "$2,691.05" "$2,691.05" "$2,851.00" "$2,423.00" "$3,888.72" "$2,691.05" "$3,928.00" "$3,250.00" $974.51 "$2,691.05" "$2,847.80" "$2,825.60" "$3,893.27" "$2,691.05" "$1,023.24" "$2,691.05" N/A N/A 36100361 EAP CPT® 21208 "OSTEOPLASTY, FACIAL BONES" BOTH IP/OP "$7,747.00" "$5,733.00" $742.43 "$7,747.00" "$7,747.00" "$7,747.00" "$7,747.00" "$7,747.00" $745.48 $745.48 $757.99 "$7,747.00" $745.48 "$7,747.00" "$7,747.00" "$7,747.00" "$7,747.00" "$1,614.56" "$1,192.77" "$1,187.89" "$7,747.00" $745.48 $742.43 $745.48 "$7,747.00" "$5,810.25" $745.48 $745.48 $745.48 "$6,095.00" "$3,873.50" "$6,135.62" $745.48 "$6,197.60" "$4,334.00" "$7,747.00" $745.48 "$4,493.26" "$7,747.00" $783.41 $745.48 "$7,747.00" $745.48 N/A N/A 36100362 EAP CPT® 21320 CLOSED NASAL BONE W/STABILIZA BOTH IP/OP "$4,482.00" "$3,317.00" $95.96 "$4,482.00" "$4,482.00" "$4,482.00" "$4,482.00" "$4,482.00" $96.38 $96.38 $135.44 "$4,482.00" $96.38 "$4,482.00" "$4,482.00" "$4,482.00" "$4,482.00" $934.10 $154.21 $153.54 "$4,482.00" $96.38 $95.96 $96.38 "$4,482.00" "$3,361.50" $96.38 $96.38 $96.38 "$2,851.00" "$2,241.00" "$3,549.74" $96.38 "$3,585.60" "$2,500.00" "$4,482.00" $96.38 "$2,599.56" "$4,482.00" $137.70 $96.38 "$4,482.00" $96.38 N/A N/A 36100364 EAP CPT® 21440 REDUCE ALVEOLAR RIDGE FRACTURE BOTH IP/OP "$2,518.00" "$1,863.50" $520.67 "$2,518.00" "$2,518.00" "$2,518.00" "$2,518.00" "$2,518.00" $574.36 $574.36 $556.65 "$2,518.00" $574.36 "$2,518.00" "$2,518.00" "$2,518.00" "$2,518.00" $524.78 $918.98 $900.61 "$2,518.00" $574.36 $562.88 $574.36 "$2,518.00" "$1,888.50" $574.36 $574.36 $574.36 "$2,518.00" "$1,259.00" "$1,994.26" $574.36 "$2,014.40" "$2,518.00" "$2,518.00" $574.36 "$1,460.44" "$2,518.00" $520.67 $574.36 "$2,518.00" $574.36 N/A N/A 36100365 EAP CPT® 21453 REDUCE MANDIBULAR INTERDENTAL BOTH IP/OP "$7,522.00" "$5,566.50" $883.57 "$7,522.00" "$7,522.00" "$7,522.00" "$7,522.00" "$7,522.00" $968.50 $968.50 $954.09 "$7,522.00" $968.50 "$7,522.00" "$7,522.00" "$7,522.00" "$7,522.00" "$1,567.67" "$1,549.60" "$1,518.86" "$7,522.00" $968.50 $949.29 $968.50 "$7,522.00" "$5,641.50" $968.50 $968.50 $968.50 "$3,500.00" "$3,761.00" "$5,957.42" $968.50 "$6,017.60" "$4,334.00" "$7,522.00" $968.50 "$4,362.76" "$7,522.00" $883.57 $968.50 "$7,522.00" $968.50 N/A N/A 36100366 EAP CPT® 21480 "REDUCE TMJ DISLOCA, IX OR SUB" BOTH IP/OP $257.00 $190.50 $31.11 $257.00 $257.00 $257.00 $257.00 $257.00 $31.11 $31.11 $32.00 $257.00 $31.11 $257.00 $257.00 $257.00 $257.00 $53.56 $49.78 $50.51 $257.00 $31.11 $31.57 $31.11 $257.00 $192.75 $31.11 $31.11 $31.11 $257.00 $128.50 $203.54 $31.11 $205.60 $257.00 $257.00 $31.11 $149.06 $257.00 $33.17 $31.11 $257.00 $31.11 N/A N/A 36100368 EAP CPT® 21550 BIOPSY NECK BOTH IP/OP "$4,410.00" "$3,263.50" $158.26 "$3,528.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,384.05" "$1,384.05" "$1,377.93" $919.15 "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $919.09 "$2,214.48" "$2,163.34" "$1,871.00" "$1,384.05" $158.26 "$1,384.05" "$1,453.25" "$3,307.50" "$1,384.05" "$1,384.05" "$1,384.05" "$2,762.00" "$2,348.00" "$3,492.72" "$1,384.05" "$3,528.00" "$2,500.00" $875.27 "$1,384.05" "$2,557.80" "$1,453.25" "$2,002.37" "$1,384.05" $919.04 "$1,384.05" N/A N/A 36100376 EAP CPT® 23350 INJECTION SHOULDER ARTHROGRAPH BOTH IP/OP "$1,471.00" "$1,089.00" $50.18 "$1,471.00" "$1,471.00" "$1,471.00" "$1,471.00" "$1,471.00" "$1,471.00" "$1,471.00" "$1,471.00" $306.59 "$1,471.00" "$1,471.00" "$1,471.00" "$1,471.00" "$1,471.00" $306.57 "$1,471.00" $952.00 $870.10 "$1,471.00" $50.18 "$1,471.00" "$1,471.00" "$1,103.25" "$1,471.00" "$1,471.00" "$1,471.00" "$1,471.00" $735.50 "$1,165.03" "$1,471.00" "$1,176.80" "$1,471.00" $291.96 "$1,471.00" $853.18 "$1,471.00" "$1,471.00" "$1,471.00" $306.56 "$1,471.00" N/A N/A 36100379 EAP CPT® 24220 INJECTION ELBOW ARTHROGRAPHY BOTH IP/OP "$2,130.00" "$1,576.50" $66.70 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $66.70 $66.70 $68.23 "$2,130.00" $66.70 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 $106.72 $106.88 "$2,130.00" $66.70 $66.80 $66.70 "$2,130.00" "$1,597.50" $66.70 $66.70 $66.70 "$2,130.00" "$1,065.00" "$1,686.96" $66.70 "$1,704.00" "$1,750.00" "$2,130.00" $66.70 "$1,235.40" "$2,130.00" $70.32 $66.70 "$2,130.00" $66.70 N/A N/A 36100380 EAP CPT® 25246 INJECTION WRIST ARTHROGRAPHY BOTH IP/OP "$1,633.00" "$1,208.50" $72.90 "$1,633.00" "$1,633.00" "$1,633.00" "$1,633.00" "$1,633.00" $73.27 $73.27 $74.86 "$1,633.00" $73.27 "$1,633.00" "$1,633.00" "$1,633.00" "$1,633.00" $340.34 $117.23 $116.64 "$1,633.00" $73.27 $72.90 $73.27 "$1,633.00" "$1,224.75" $73.27 $73.27 $73.27 "$1,633.00" $816.50 "$1,293.34" $73.27 "$1,306.40" "$1,633.00" "$1,633.00" $73.27 $947.14 "$1,633.00" $77.17 $73.27 "$1,633.00" $73.27 N/A N/A 36100382 EAP CPT® 26010 I&D ABSCESS FINGER SIMPLE BOTH IP/OP "$1,407.00" "$1,041.50" $142.73 "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" $143.60 $143.60 $142.73 "$1,407.00" $143.60 "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" $293.23 $229.76 $230.42 "$1,407.00" $143.60 $144.01 $143.60 "$1,407.00" "$1,055.25" $143.60 $143.60 $143.60 "$1,407.00" $703.50 "$1,114.34" $143.60 "$1,125.60" "$1,407.00" "$1,407.00" $143.60 $816.06 "$1,407.00" $143.08 $143.60 "$1,407.00" $143.60 N/A N/A 36100383 EAP CPT® 26011 ABSCESS FINGER COMPLICATED BOTH IP/OP "$4,878.00" "$3,610.00" $189.15 "$4,878.00" "$4,878.00" "$4,878.00" "$4,878.00" "$4,878.00" $189.15 $189.15 $189.64 "$4,878.00" $189.15 "$4,878.00" "$4,878.00" "$4,878.00" "$4,878.00" "$1,016.63" $302.64 $303.66 "$4,878.00" $189.15 $189.79 $189.15 "$4,878.00" "$3,658.50" $189.15 $189.15 $189.15 "$2,762.00" "$2,439.00" "$3,863.38" $189.15 "$3,902.40" "$2,500.00" "$4,878.00" $189.15 "$2,829.24" "$4,878.00" $191.74 $189.15 "$4,878.00" $189.15 N/A N/A 36100384 EAP CPT® 26035 "DECOMPRESSION FINGERS, HAND" BOTH IP/OP "$3,306.00" "$2,446.50" $689.01 "$3,306.00" "$3,306.00" "$3,306.00" "$3,306.00" "$3,306.00" $877.70 $877.70 $878.90 "$3,306.00" $877.70 "$3,306.00" "$3,306.00" "$3,306.00" "$3,306.00" $689.01 "$1,404.32" "$1,407.65" "$3,306.00" $877.70 $879.78 $877.70 "$3,306.00" "$2,479.50" $877.70 $877.70 $877.70 "$2,762.00" "$1,653.00" "$2,618.35" $877.70 "$2,644.80" "$2,500.00" "$3,306.00" $877.70 "$1,917.48" "$3,306.00" $892.09 $877.70 "$3,306.00" $877.70 N/A N/A 36100386 EAP CPT® 27093 INJECTION HIP ARTHRO W/O ANES BOTH IP/OP "$1,657.00" "$1,226.50" $68.85 "$1,657.00" "$1,657.00" "$1,657.00" "$1,657.00" "$1,657.00" "$1,657.00" "$1,657.00" "$1,657.00" $345.36 "$1,657.00" "$1,657.00" "$1,657.00" "$1,657.00" "$1,657.00" $345.34 "$1,657.00" "$1,140.00" $980.12 "$1,657.00" $68.85 "$1,657.00" "$1,657.00" "$1,242.75" "$1,657.00" "$1,657.00" "$1,657.00" "$1,657.00" $828.50 "$1,312.34" "$1,657.00" "$1,325.60" "$1,657.00" $328.87 "$1,657.00" $961.06 "$1,657.00" "$1,657.00" "$1,657.00" $345.32 "$1,657.00" N/A N/A 36100388 EAP CPT® 27095 INJECTION HIP ARTHRO W ANES BOTH IP/OP "$2,101.00" "$1,555.00" $82.42 "$2,101.00" "$2,101.00" "$2,101.00" "$2,101.00" "$2,101.00" $83.59 $83.59 $84.00 "$2,101.00" $83.59 "$2,101.00" "$2,101.00" "$2,101.00" "$2,101.00" $437.87 $133.74 $131.87 "$2,101.00" $83.59 $82.42 $83.59 "$2,101.00" "$1,575.75" $83.59 $83.59 $83.59 "$2,101.00" "$1,050.50" "$1,663.99" $83.59 "$1,680.80" "$1,750.00" "$2,101.00" $83.59 "$1,218.58" "$2,101.00" $87.61 $83.59 "$2,101.00" $83.59 N/A N/A 36100389 EAP CPT® 27096 SACROILIAC JT INJ WITH ARTHROGRAPHY BOTH IP/OP "$2,110.00" "$1,561.50" $82.95 "$2,110.00" "$2,110.00" "$2,110.00" "$2,110.00" "$2,110.00" $624.63 $624.63 $621.87 $439.78 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $439.75 $999.41 $929.56 $113.00 $624.63 "$2,110.00" $624.63 $655.86 "$1,582.50" $624.63 $624.63 $624.63 "$2,110.00" "$1,055.00" "$1,671.12" $624.63 "$1,688.00" "$2,110.00" $418.78 $624.63 "$1,223.80" $655.86 $86.18 $82.95 $439.72 $624.63 N/A N/A 36100391 EAP CPT® 27630 "EXCISION, LES ANKLE/LOWER LEG" BOTH IP/OP "$7,251.00" "$5,366.00" $361.60 "$7,251.00" "$7,251.00" "$7,251.00" "$7,251.00" "$7,251.00" $365.44 $365.44 $367.14 "$7,251.00" $365.44 "$7,251.00" "$7,251.00" "$7,251.00" "$7,251.00" "$1,511.19" $584.70 $578.56 "$7,251.00" $365.44 $361.60 $365.44 "$7,251.00" "$5,438.25" $365.44 $365.44 $365.44 "$3,500.00" "$3,625.50" "$5,742.79" $365.44 "$5,800.80" "$3,250.00" "$7,251.00" $365.44 "$4,205.58" "$7,251.00" $373.45 $365.44 "$7,251.00" $365.44 N/A N/A 36100392 EAP CPT® 27648 INJECTION ANKLE ARTHROGRAPHY BOTH IP/OP "$1,873.00" "$1,386.50" $51.21 "$1,873.00" "$1,873.00" "$1,873.00" "$1,873.00" "$1,873.00" "$1,873.00" "$1,873.00" "$1,873.00" $390.38 "$1,873.00" "$1,873.00" "$1,873.00" "$1,873.00" "$1,873.00" $390.35 "$1,873.00" $990.00 "$1,107.88" "$1,873.00" $51.21 "$1,873.00" "$1,873.00" "$1,404.75" "$1,873.00" "$1,873.00" "$1,873.00" "$1,873.00" $936.50 "$1,483.42" "$1,873.00" "$1,498.40" "$1,750.00" $371.74 "$1,873.00" "$1,086.34" "$1,873.00" "$1,873.00" "$1,873.00" $390.33 "$1,873.00" N/A N/A 36100393 EAP CPT® 28080 "EXCISION,LES. INTERDIGITAL LEG" BOTH IP/OP "$4,873.00" "$3,606.50" $377.61 "$4,873.00" "$4,873.00" "$4,873.00" "$4,873.00" "$4,873.00" $380.90 $380.90 $377.61 "$4,873.00" $380.90 "$4,873.00" "$4,873.00" "$4,873.00" "$4,873.00" "$1,015.59" $609.44 $611.39 "$4,873.00" $380.90 $382.12 $380.90 "$4,873.00" "$3,654.75" $380.90 $380.90 $380.90 "$3,500.00" "$2,436.50" "$3,859.42" $380.90 "$3,898.40" "$3,250.00" "$4,873.00" $380.90 "$2,826.34" "$4,873.00" $382.82 $380.90 "$4,873.00" $380.90 N/A N/A 36100394 EAP CPT® 28090 "EXCISION, CYST FOOT" BOTH IP/OP "$4,873.00" "$3,606.50" $310.51 "$4,873.00" "$4,873.00" "$4,873.00" "$4,873.00" "$4,873.00" $310.66 $310.66 $310.51 "$4,873.00" $310.66 "$4,873.00" "$4,873.00" "$4,873.00" "$4,873.00" "$1,015.59" $497.06 $498.77 "$4,873.00" $310.66 $311.73 $310.66 "$4,873.00" "$3,654.75" $310.66 $310.66 $310.66 "$3,500.00" "$2,436.50" "$3,859.42" $310.66 "$3,898.40" "$3,250.00" "$4,873.00" $310.66 "$2,826.34" "$4,873.00" $318.33 $310.66 "$4,873.00" $310.66 N/A N/A 36100395 EAP CPT® 28092 "EXCISION, LESION, TOE(S) EACH" BOTH IP/OP "$4,873.00" "$3,606.50" $271.75 "$4,873.00" "$4,873.00" "$4,873.00" "$4,873.00" "$4,873.00" $272.18 $272.18 $271.75 "$4,873.00" $272.18 "$4,873.00" "$4,873.00" "$4,873.00" "$4,873.00" "$1,015.59" $435.49 $438.53 "$4,873.00" $272.18 $274.08 $272.18 "$4,873.00" "$3,654.75" $272.18 $272.18 $272.18 "$3,500.00" "$2,436.50" "$3,859.42" $272.18 "$3,898.40" "$3,250.00" "$4,873.00" $272.18 "$2,826.34" "$4,873.00" $279.38 $272.18 "$4,873.00" $272.18 N/A N/A 36100397 EAP CPT® 28192 "REMOVAL FB, FOOT DEEP" BOTH IP/OP "$5,468.00" "$4,046.50" $312.75 "$5,468.00" "$5,468.00" "$5,468.00" "$5,468.00" "$5,468.00" $313.88 $313.88 $315.40 "$5,468.00" $313.88 "$5,468.00" "$5,468.00" "$5,468.00" "$5,468.00" "$1,139.59" $502.21 $500.40 "$5,468.00" $313.88 $312.75 $313.88 "$5,468.00" "$4,101.00" $313.88 $313.88 $313.88 "$2,851.00" "$2,734.00" "$4,330.66" $313.88 "$4,374.40" "$2,500.00" "$5,468.00" $313.88 "$3,171.44" "$5,468.00" $324.83 $313.88 "$5,468.00" $313.88 N/A N/A 36100398 EAP CPT® 28193 "REMOVAL FB, FOOT, COMPLICATED" BOTH IP/OP "$5,468.00" "$4,046.50" $369.00 "$5,468.00" "$5,468.00" "$5,468.00" "$5,468.00" "$5,468.00" $369.99 $369.99 $372.01 "$5,468.00" $369.99 "$5,468.00" "$5,468.00" "$5,468.00" "$5,468.00" "$1,139.59" $591.98 $590.40 "$5,468.00" $369.99 $369.00 $369.99 "$5,468.00" "$4,101.00" $369.99 $369.99 $369.99 "$4,417.00" "$2,734.00" "$4,330.66" $369.99 "$4,374.40" "$2,150.00" "$5,468.00" $369.99 "$3,171.44" "$5,468.00" $383.25 $369.99 "$5,468.00" $369.99 N/A N/A 36100404 EAP CPT® 29515 "SPLINT APPLICATION, ANKLE" BOTH IP/OP $794.00 $588.00 $49.83 $794.00 $431.14 $431.14 $431.14 $431.14 $138.97 $138.97 $138.36 $165.49 $138.97 $794.00 $794.00 $794.00 $794.00 $165.48 $222.36 $210.28 $113.00 $138.97 $49.83 $138.97 $145.92 $595.50 $138.97 $138.97 $138.97 $794.00 $397.00 $628.85 $138.97 $635.20 $794.00 $157.59 $138.97 $460.52 $145.92 $201.06 $138.97 $165.47 $138.97 N/A N/A 36100405 EAP CPT® 29530 "WRAPPING, KNEE" BOTH IP/OP $681.00 $504.00 $18.27 $681.00 $681.00 $681.00 $681.00 $681.00 $18.27 $18.27 $18.42 $681.00 $18.27 $681.00 $681.00 $681.00 $681.00 $141.93 $29.23 $29.28 $681.00 $18.27 $18.30 $18.27 $681.00 $510.75 $18.27 $18.27 $18.27 $681.00 $340.50 $539.35 $18.27 $544.80 $442.65 $681.00 $18.27 $394.98 $681.00 $19.48 $18.27 $681.00 $18.27 N/A N/A 36100407 EAP CPT® 29540 STRAPPING OF ANKLE AND/OR FT BOTH IP/OP $366.00 $271.00 $17.64 $366.00 $198.74 $198.74 $198.74 $198.74 $138.97 $138.97 $138.36 $76.28 $138.97 $366.00 $366.00 $366.00 $366.00 $76.28 $222.36 $210.28 $216.49 $138.97 $17.64 $138.97 $145.92 $274.50 $138.97 $138.97 $138.97 $366.00 $183.00 $289.87 $138.97 $292.80 $237.90 $72.64 $138.97 $212.28 $145.92 $201.06 $138.97 $76.27 $138.97 N/A N/A 36100408 EAP CPT® 29550 "SPLINTING, TOES" BOTH IP/OP $751.00 $556.00 $11.19 $751.00 $407.79 $407.79 $407.79 $407.79 $54.76 $54.76 $54.51 $156.53 $54.76 $751.00 $751.00 $751.00 $751.00 $156.52 $87.61 $82.92 $113.00 $54.76 $11.19 $54.76 $57.49 $563.25 $54.76 $54.76 $54.76 $751.00 $375.50 $594.79 $54.76 $600.80 $751.00 $149.05 $54.76 $435.58 $57.49 $79.22 $54.76 $156.51 $54.76 N/A N/A 36100409 EAP CPT® 29580 UNNA BOOT BOTH IP/OP $828.00 $613.00 $26.46 $828.00 $449.60 $449.60 $449.60 $449.60 $138.97 $138.97 $138.36 $172.58 $138.97 $828.00 $828.00 $828.00 $828.00 $172.56 $222.36 $210.28 $489.76 $138.97 $26.46 $138.97 $145.92 $621.00 $138.97 $138.97 $138.97 $828.00 $414.00 $655.78 $138.97 $662.40 $538.20 $164.34 $138.97 $480.24 $145.92 $201.06 $138.97 $172.56 $138.97 N/A N/A 36100411 EAP CPT® 30100 "BIOPSY, INTRANASAL" BOTH IP/OP "$1,837.00" "$1,359.50" $67.54 "$1,837.00" "$1,837.00" "$1,837.00" "$1,837.00" "$1,837.00" $68.06 $68.06 $67.54 "$1,837.00" $68.06 "$1,837.00" "$1,837.00" "$1,837.00" "$1,837.00" $382.85 $108.90 $109.52 "$1,837.00" $68.06 $68.45 $68.06 "$1,837.00" "$1,377.75" $68.06 $68.06 $68.06 "$1,837.00" $918.50 "$1,454.90" $68.06 "$1,469.60" "$1,837.00" "$1,837.00" $68.06 "$1,065.46" "$1,837.00" $68.85 $68.06 "$1,837.00" $68.06 N/A N/A 36100412 EAP CPT® 30300 REMOVE FB INTRANASAL BOTH IP/OP $272.00 $201.50 $56.69 $272.00 $272.00 $272.00 $272.00 $272.00 $127.41 $127.41 $122.86 $272.00 $127.41 $272.00 $272.00 $272.00 $272.00 $56.69 $203.86 $203.20 $272.00 $127.41 $127.00 $127.41 $272.00 $204.00 $127.41 $127.41 $127.41 $272.00 $136.00 $215.42 $127.41 $217.60 $272.00 $272.00 $127.41 $157.76 $272.00 $116.41 $127.41 $272.00 $127.41 N/A N/A 36100418 EAP CPT® 30905 CONTROL NASAL HEMORRHAGE WITH NASAL PACKS AND/OR CAUTERY BOTH IP/OP $518.00 $383.50 $106.44 $518.00 $518.00 $518.00 $518.00 $518.00 $106.44 $106.44 $106.63 $518.00 $106.44 $518.00 $518.00 $518.00 $518.00 $107.96 $170.30 $171.55 $518.00 $106.44 $107.22 $106.44 $518.00 $388.50 $106.44 $106.44 $106.44 $518.00 $259.00 $410.26 $106.44 $414.40 $518.00 $518.00 $106.44 $300.44 $518.00 $110.69 $106.44 $518.00 $106.44 N/A N/A 36100420 EAP CPT® 31000 MAXILLARY SINUS IRRIGATION BOTH IP/OP $605.00 $448.00 $108.21 $605.00 $605.00 $605.00 $605.00 $605.00 $111.05 $111.05 $108.21 $605.00 $111.05 $605.00 $605.00 $605.00 $605.00 $126.09 $177.68 $179.95 $605.00 $111.05 $112.47 $111.05 $605.00 $453.75 $111.05 $111.05 $111.05 $605.00 $302.50 $479.16 $111.05 $484.00 $605.00 $605.00 $111.05 $350.90 $605.00 $108.85 $111.05 $605.00 $111.05 N/A N/A 36100422 EAP CPT® 31231 NASAL ENDOSCOPY DX UNI/BILAT BOTH IP/OP $887.00 $656.50 $65.45 $887.00 $887.00 $887.00 $887.00 $887.00 $161.93 $161.93 $161.21 $184.87 $161.93 $887.00 $887.00 $887.00 $882.37 $184.86 $259.08 $257.88 $113.00 $161.93 $65.45 $161.93 $170.02 $665.25 $161.93 $161.93 $161.93 $887.00 $443.50 $702.50 $161.93 $709.60 $887.00 $176.05 $161.93 $514.46 $170.02 $234.27 $161.93 $184.85 $161.93 N/A N/A 36100423 EAP CPT® 31500 ENDOTRACHEAL INTUBATION BOTH IP/OP "$2,893.00" "$2,141.00" $141.49 "$2,893.00" "$2,893.00" "$2,893.00" "$2,893.00" "$2,893.00" $142.17 $142.17 $143.32 "$2,893.00" $142.17 "$2,893.00" "$2,893.00" "$2,893.00" "$2,893.00" $602.93 $227.47 $226.38 "$2,893.00" $142.17 $141.49 $142.17 "$2,893.00" "$2,169.75" $142.17 $142.17 $142.17 "$2,762.00" "$1,446.50" "$2,291.26" $142.17 "$2,314.40" "$1,750.00" "$2,893.00" $142.17 "$1,677.94" "$2,893.00" $149.30 $142.17 "$2,893.00" $142.17 N/A N/A 36100428 EAP CPT® 31502 ET/TRACH CHANGE BOTH IP/OP "$1,571.00" "$1,163.00" $35.28 "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" $208.11 $208.11 $207.19 $327.44 $208.11 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $327.41 $332.98 $299.82 "$1,571.00" $208.11 $35.28 $208.11 $218.52 "$1,178.25" $208.11 $208.11 $208.11 "$1,571.00" $785.50 "$1,244.23" $208.11 "$1,256.80" "$1,571.00" $311.80 $208.11 $911.18 $218.52 $301.08 $208.11 $327.40 $208.11 N/A N/A 36100429 EAP CPT® 31502 TRACH SET CHANGE BOTH IP/OP "$1,379.00" "$1,020.50" $35.28 "$1,379.00" "$1,379.00" "$1,379.00" "$1,379.00" "$1,379.00" $208.11 $208.11 $207.19 $287.42 $208.11 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $287.40 $332.98 $299.82 "$1,379.00" $208.11 $35.28 $208.11 $218.52 "$1,034.25" $208.11 $208.11 $208.11 "$1,379.00" $689.50 "$1,092.17" $208.11 "$1,103.20" "$1,379.00" $273.70 $208.11 $799.82 $218.52 $301.08 $208.11 $287.38 $208.11 N/A N/A 36100432 EAP CPT® 31505 "LARYNGOSCOPY, INDIRECT, DX" BOTH IP/OP $372.00 $275.50 $48.85 $372.00 $372.00 $372.00 $372.00 $372.00 $49.48 $49.48 $48.85 $372.00 $49.48 $372.00 $372.00 $372.00 $372.00 $77.53 $79.17 $79.68 $372.00 $49.48 $49.80 $49.48 $372.00 $279.00 $49.48 $49.48 $49.48 $372.00 $186.00 $294.62 $49.48 $297.60 $372.00 $372.00 $49.48 $215.76 $372.00 $50.10 $49.48 $372.00 $49.48 N/A N/A 36100434 EAP CPT® 31510 "LARYNGOSCOPY, INDIR, W BX" BOTH IP/OP "$4,546.00" "$3,364.50" $120.81 "$4,546.00" "$4,546.00" "$4,546.00" "$4,546.00" "$4,546.00" $120.89 $120.89 $120.81 "$4,546.00" $120.89 "$4,546.00" "$4,546.00" "$4,546.00" "$4,546.00" $947.44 $193.42 $195.81 "$4,546.00" $120.89 $122.38 $120.89 "$4,546.00" "$3,409.50" $120.89 $120.89 $120.89 "$2,851.00" "$2,273.00" "$3,600.43" $120.89 "$3,636.80" "$2,500.00" "$4,546.00" $120.89 "$2,636.68" "$4,546.00" $124.38 $120.89 "$4,546.00" $120.89 N/A N/A 36100435 EAP CPT® 31528 LARYNGOSCOPY AND DILATION BOTH IP/OP "$9,657.00" "$7,146.50" $143.60 "$9,657.00" "$9,657.00" "$9,657.00" "$9,657.00" "$9,657.00" $144.15 $144.15 $143.60 "$9,657.00" $144.15 "$9,657.00" "$9,657.00" "$9,657.00" "$9,657.00" "$2,012.63" $230.64 $232.74 "$9,657.00" $144.15 $145.46 $144.15 "$9,657.00" "$7,242.75" $144.15 $144.15 $144.15 "$2,851.00" "$4,828.50" "$7,648.34" $144.15 "$7,725.60" "$3,250.00" "$9,657.00" $144.15 "$5,601.06" "$9,657.00" $147.46 $144.15 "$9,657.00" $144.15 N/A N/A 36100437 EAP CPT® 31575 "LARYNGOSCOPY, FIBEROPTIC, DX" BOTH IP/OP $745.00 $551.50 $68.80 $745.00 $745.00 $745.00 $745.00 $745.00 $161.93 $161.93 $161.21 $155.28 $161.93 $745.00 $745.00 $745.00 $745.00 $155.27 $259.08 $257.88 $113.00 $161.93 $68.80 $161.93 $170.02 $558.75 $161.93 $161.93 $161.93 $745.00 $372.50 $590.04 $161.93 $596.00 $745.00 $147.86 $161.93 $432.10 $170.02 $234.27 $161.93 $155.26 $161.93 N/A N/A 36100438 EAP CPT® 31605 TRACHEOSTOMY-CRICO BOTH IP/OP "$1,598.00" "$1,183.00" $333.04 "$1,598.00" "$1,598.00" "$1,598.00" "$1,598.00" "$1,598.00" $335.37 $335.37 $335.15 "$1,598.00" $335.37 "$1,598.00" "$1,598.00" "$1,598.00" "$1,598.00" $333.04 $536.59 $534.94 "$1,598.00" $335.37 $334.34 $335.37 "$1,598.00" "$1,198.50" $335.37 $335.37 $335.37 "$1,598.00" $799.00 "$1,265.62" $335.37 "$1,278.40" "$1,598.00" "$1,598.00" $335.37 $926.84 "$1,598.00" $349.75 $335.37 "$1,598.00" $335.37 N/A N/A 36100442 EAP CPT® 31612 TRACH PUNC PERCUT ASPIR BOTH IP/OP "$10,209.00" "$7,555.00" $48.37 "$10,209.00" "$10,209.00" "$10,209.00" "$10,209.00" "$10,209.00" $48.37 $48.37 $48.71 "$10,209.00" $48.37 "$10,209.00" "$10,209.00" "$10,209.00" "$10,209.00" "$2,127.67" $77.39 $78.72 "$10,209.00" $48.37 $49.20 $48.37 "$10,209.00" "$7,656.75" $48.37 $48.37 $48.37 "$2,762.00" "$5,104.50" "$8,085.53" $48.37 "$8,167.20" "$3,250.00" "$10,209.00" $48.37 "$5,921.22" "$10,209.00" $49.40 $48.37 "$10,209.00" $48.37 N/A N/A 36100444 EAP CPT® 31615 TRACHEOBRONCHOSCOPY BOTH IP/OP "$3,046.00" "$2,254.50" $115.94 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $444.88 $444.88 $442.92 $634.86 $444.88 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $634.82 $711.81 $659.03 "$1,871.00" $444.88 $115.94 $444.88 $467.13 "$2,284.50" $444.88 $444.88 $444.88 "$2,762.00" "$1,523.00" "$2,412.43" $444.88 "$2,436.80" "$2,150.00" $604.55 $444.88 "$1,766.68" $467.13 $643.63 $444.88 $634.79 $444.88 N/A N/A 36100446 EAP CPT® 31622 BRONCHOSCOPY W OR W/O WASHING BOTH IP/OP "$4,212.00" "$3,117.00" $130.55 "$4,212.00" "$4,212.00" "$4,212.00" "$4,212.00" "$4,212.00" $132.23 $132.23 $132.66 "$4,212.00" $132.23 "$4,212.00" "$4,212.00" "$4,212.00" "$4,212.00" $877.83 $211.57 $208.88 "$4,212.00" $132.23 $130.55 $132.23 "$4,212.00" "$3,159.00" $132.23 $132.23 $132.23 "$2,762.00" "$2,106.00" "$3,335.90" $132.23 "$3,369.60" "$2,500.00" "$4,212.00" $132.23 "$2,442.96" "$4,212.00" $136.67 $132.23 "$4,212.00" $132.23 N/A N/A 36100448 EAP CPT® 31623 BRONCHOSCOPY W/BRUSHING BOTH IP/OP "$3,942.00" "$2,917.50" $130.18 "$3,153.60" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,471.71" "$1,471.71" "$1,465.20" $821.61 "$1,471.71" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $821.56 "$2,354.73" "$2,306.17" "$2,836.00" "$1,471.71" $130.18 "$1,471.71" "$1,545.29" "$2,956.50" "$1,471.71" "$1,471.71" "$1,471.71" "$2,851.00" "$1,971.00" "$3,122.06" "$1,471.71" "$3,153.60" "$2,500.00" $782.39 "$1,471.71" "$2,286.36" "$1,545.29" "$2,129.19" "$1,471.71" $821.51 "$1,471.71" N/A N/A 36100449 EAP CPT® 31624 BRONCHOSCOPY W/BAL BOTH IP/OP "$3,942.00" "$2,917.50" $132.56 "$3,153.60" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,471.71" "$1,471.71" "$1,465.20" $821.61 "$1,471.71" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $821.56 "$2,354.73" "$2,306.17" "$2,836.00" "$1,471.71" $132.56 "$1,471.71" "$1,545.29" "$2,956.50" "$1,471.71" "$1,471.71" "$1,471.71" "$2,851.00" "$1,971.00" "$3,122.06" "$1,471.71" "$3,153.60" "$2,500.00" $782.39 "$1,471.71" "$2,286.36" "$1,545.29" "$2,129.19" "$1,471.71" $821.51 "$1,471.71" N/A N/A 36100450 EAP CPT® 31625 BRONCH DX /ENDOBRONCHIAL BX SINGLE/MULTIPLE LOBE BOTH IP/OP "$3,942.00" "$2,917.50" $153.93 "$3,153.60" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,471.71" "$1,471.71" "$1,465.20" $821.61 "$1,471.71" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $821.56 "$2,354.73" "$2,306.17" "$2,836.00" "$1,471.71" $153.93 "$1,471.71" "$1,545.29" "$2,956.50" "$1,471.71" "$1,471.71" "$1,471.71" "$2,851.00" "$1,971.00" "$3,122.06" "$1,471.71" "$3,153.60" "$2,500.00" $782.39 "$1,471.71" "$2,286.36" "$1,545.29" "$2,129.19" "$1,471.71" $821.51 "$1,471.71" N/A N/A 36100452 EAP CPT® 31628 TRANSBRONCH BX W&W/O FLUO BOTH IP/OP "$3,582.00" "$2,651.00" $173.58 "$4,875.25" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$3,047.03" "$3,047.03" "$3,033.56" $746.58 "$3,047.03" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" $746.53 "$4,875.25" "$4,809.32" "$2,836.00" "$3,047.03" $173.58 "$3,047.03" "$3,199.39" "$2,686.50" "$3,047.03" "$3,047.03" "$3,047.03" "$2,851.00" "$1,791.00" "$2,836.94" "$3,047.03" "$2,865.60" "$2,500.00" $710.94 "$3,047.03" "$2,077.56" "$3,199.39" "$3,582.00" "$3,047.03" $746.49 "$3,047.03" N/A N/A 36100453 EAP CPT® 31629 BRON W/TRANS NEEDL ASPIR BOTH IP/OP "$4,091.00" "$3,027.50" $184.11 "$4,875.25" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$3,047.03" "$3,047.03" "$3,033.56" $852.67 "$3,047.03" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" $852.61 "$4,875.25" "$4,809.32" "$2,836.00" "$3,047.03" $184.11 "$3,047.03" "$3,199.39" "$3,068.25" "$3,047.03" "$3,047.03" "$3,047.03" "$2,851.00" "$2,045.50" "$3,240.07" "$3,047.03" "$3,272.80" "$3,725.00" $811.96 "$3,047.03" "$2,372.78" "$3,199.39" "$4,091.00" "$3,047.03" $852.56 "$3,047.03" N/A N/A 36100454 EAP CPT® 31630 BRONCHOSCOPY DILATE/FX REPR BOTH IP/OP "$10,854.00" "$8,032.00" $196.69 "$10,854.00" "$10,854.00" "$10,854.00" "$10,854.00" "$10,854.00" $198.83 $198.83 $200.10 "$10,854.00" $198.83 "$10,854.00" "$10,854.00" "$10,854.00" "$10,854.00" "$2,262.09" $318.13 $314.70 "$10,854.00" $198.83 $196.69 $198.83 "$10,854.00" "$8,140.50" $198.83 $198.83 $198.83 "$2,851.00" "$5,427.00" "$8,596.37" $198.83 "$8,683.20" "$3,725.00" "$10,854.00" $198.83 "$6,295.32" "$10,854.00" $206.26 $198.83 "$10,854.00" $198.83 N/A N/A 36100455 EAP CPT® 31631 TRACHEAL BRONCIAL W&W/O STENT BOTH IP/OP "$9,733.00" "$7,202.50" $224.51 "$9,733.00" "$9,733.00" "$9,733.00" "$9,733.00" "$9,733.00" $226.90 $226.90 $229.10 "$9,733.00" $226.90 "$9,733.00" "$9,733.00" "$9,733.00" "$9,733.00" "$2,028.46" $363.04 $359.22 "$9,733.00" $226.90 $224.51 $226.90 "$9,733.00" "$7,299.75" $226.90 $226.90 $226.90 "$2,851.00" "$4,866.50" "$7,708.54" $226.90 "$7,786.40" "$3,725.00" "$9,733.00" $226.90 "$5,645.14" "$9,733.00" $236.55 $226.90 "$9,733.00" $226.90 N/A N/A 36100456 EAP CPT® 31635 "BRONCH TX, FB REMOVAL" BOTH IP/OP "$10,854.00" "$8,032.00" $172.93 "$8,683.20" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,471.71" "$1,471.71" "$1,465.20" "$2,262.24" "$1,471.71" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$2,262.09" "$2,354.73" "$2,306.17" "$2,836.00" "$1,471.71" $172.93 "$1,471.71" "$1,545.29" "$8,140.50" "$1,471.71" "$1,471.71" "$1,471.71" "$2,851.00" "$2,423.00" "$8,596.37" "$1,471.71" "$8,683.20" "$2,500.00" "$2,154.25" "$1,471.71" "$6,295.32" "$1,545.29" "$2,129.19" "$1,471.71" "$2,261.97" "$1,471.71" N/A N/A 36100457 EAP CPT® 31635 BRONCHOSCOPY W/FB REMOVAL BOTH IP/OP "$10,854.00" "$8,032.00" $172.93 "$10,854.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,471.71" "$1,471.71" "$1,465.20" "$2,262.24" "$1,471.71" "$1,541.95" "$1,541.95" "$1,601.25" "$10,854.00" "$2,262.09" "$2,354.73" "$2,306.17" "$2,836.00" "$1,471.71" $172.93 "$1,471.71" "$1,545.29" "$8,140.50" "$1,471.71" "$1,471.71" "$1,471.71" "$2,851.00" "$2,423.00" "$8,596.37" "$1,471.71" "$8,683.20" "$2,500.00" "$2,154.25" "$1,471.71" "$6,295.32" "$1,545.29" "$2,129.19" "$1,471.71" "$2,261.97" "$1,471.71" N/A N/A 36100458 EAP CPT® 31640 BRONCHOSCOPY W/ TUMOR BOTH IP/OP "$12,526.00" "$9,269.50" $245.84 "$10,020.80" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$3,047.03" "$3,047.03" "$3,033.56" "$2,610.73" "$3,047.03" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$2,610.56" "$4,875.25" "$4,809.32" "$2,836.00" "$3,047.03" $245.84 "$3,047.03" "$3,199.39" "$9,394.50" "$3,047.03" "$3,047.03" "$3,047.03" "$2,851.00" "$2,423.00" "$9,920.59" "$3,047.03" "$10,020.80" "$3,725.00" "$2,486.10" "$3,047.03" "$7,265.08" "$3,199.39" "$4,408.29" "$3,047.03" "$2,610.42" "$3,047.03" N/A N/A 36100459 EAP CPT® 31643 BRONCHOSCOPY INTRACAV RAD ADDL BOTH IP/OP "$10,051.00" "$7,438.00" $167.47 "$10,051.00" "$10,051.00" "$10,051.00" "$10,051.00" "$10,051.00" $176.13 $176.13 $175.60 "$10,051.00" $176.13 "$10,051.00" "$10,051.00" "$10,051.00" "$10,051.00" "$2,094.74" $281.81 $267.95 "$10,051.00" $176.13 $167.47 $176.13 "$10,051.00" "$7,538.25" $176.13 $176.13 $176.13 "$2,851.00" "$5,025.50" "$7,960.39" $176.13 "$8,040.80" "$2,500.00" "$10,051.00" $176.13 "$5,829.58" "$10,051.00" $181.76 $176.13 "$10,051.00" $176.13 N/A N/A 36100461 EAP CPT® 31645 "BRONCHOSCOPY, CLEAR AIRWAYS" BOTH IP/OP "$12,162.00" "$9,000.00" $145.11 "$9,729.60" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,471.71" "$1,471.71" "$1,465.20" "$2,534.86" "$1,471.71" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$2,534.69" "$2,354.73" "$2,306.17" "$1,871.00" "$1,471.71" $145.11 "$1,471.71" "$1,545.29" "$9,121.50" "$1,471.71" "$1,471.71" "$1,471.71" "$2,762.00" "$2,348.00" "$9,632.30" "$1,471.71" "$9,729.60" "$2,500.00" "$2,413.85" "$1,471.71" "$7,053.96" "$1,545.29" "$2,129.19" "$1,471.71" "$2,534.56" "$1,471.71" N/A N/A 36100462 EAP CPT® 31646 BRON W/ASP TRACHBRON SUB BOTH IP/OP "$11,900.00" "$8,806.00" $140.02 "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" $142.36 $142.36 $142.85 "$11,900.00" $142.36 "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.09" $227.78 $224.03 "$11,900.00" $142.36 $140.02 $142.36 "$11,900.00" "$8,925.00" $142.36 $142.36 $142.36 "$2,762.00" "$5,950.00" "$9,424.80" $142.36 "$9,520.00" "$2,500.00" "$11,900.00" $142.36 "$6,902.00" "$11,900.00" $147.13 $142.36 "$11,900.00" $142.36 N/A N/A 36100463 EAP CPT® 31646 "BRONCHOSCOPY, RECLEAR AIRWAY" BOTH IP/OP "$12,162.00" "$9,000.00" $140.02 "$12,162.00" "$12,162.00" "$12,162.00" "$12,162.00" "$12,162.00" $142.36 $142.36 $142.85 "$12,162.00" $142.36 "$12,162.00" "$12,162.00" "$12,162.00" "$12,162.00" "$2,534.69" $227.78 $224.03 "$12,162.00" $142.36 $140.02 $142.36 "$12,162.00" "$9,121.50" $142.36 $142.36 $142.36 "$2,762.00" "$6,081.00" "$9,632.30" $142.36 "$9,729.60" "$2,500.00" "$12,162.00" $142.36 "$7,053.96" "$12,162.00" $147.13 $142.36 "$12,162.00" $142.36 N/A N/A 36100467 EAP CPT® 31720 NASOTREACHEAL SUCTION BOTH IP/OP $256.00 $189.50 $48.48 $256.00 $256.00 $256.00 $256.00 $256.00 $59.84 $59.84 $55.15 $256.00 $59.84 $256.00 $256.00 $256.00 $256.00 $53.35 $95.74 $77.57 $256.00 $59.84 $48.48 $59.84 $256.00 $192.00 $59.84 $59.84 $59.84 $256.00 $128.00 $202.75 $59.84 $204.80 $256.00 $256.00 $59.84 $148.48 $256.00 $57.34 $59.84 $256.00 $59.84 N/A N/A 36100468 EAP CPT® 31720 SUCTIONING NASOTRACHEAL BOTH IP/OP $250.00 $185.00 $48.48 $250.00 $250.00 $250.00 $250.00 $250.00 $59.84 $59.84 $55.15 $250.00 $59.84 $250.00 $250.00 $250.00 $250.00 $52.10 $95.74 $77.57 $250.00 $59.84 $48.48 $59.84 $250.00 $187.50 $59.84 $59.84 $59.84 $250.00 $125.00 $198.00 $59.84 $200.00 $250.00 $250.00 $59.84 $145.00 $250.00 $57.34 $59.84 $250.00 $59.84 N/A N/A 36100469 EAP CPT® 31899 BRONCHI MEDICATION INJECTION BOTH IP/OP "$4,452.00" "$3,294.50" $137.20 "$4,452.00" "$4,452.00" "$4,452.00" "$4,452.00" "$4,452.00" "$4,452.00" "$4,452.00" "$4,452.00" "$4,452.00" "$4,452.00" "$4,452.00" "$4,452.00" "$4,452.00" "$4,452.00" $927.85 "$4,452.00" $137.20 "$4,452.00" "$4,452.00" $343.00 "$4,452.00" "$4,452.00" "$3,339.00" "$4,452.00" "$4,452.00" "$4,452.00" "$2,762.00" "$2,226.00" "$3,525.98" "$4,452.00" "$3,561.60" "$2,500.00" "$4,452.00" "$4,452.00" "$2,582.16" "$4,452.00" "$2,671.20" "$4,452.00" "$4,452.00" "$4,452.00" N/A N/A 36100471 EAP CPT® 32400 PLEURAL BIOPSY BOTH IP/OP "$4,104.00" "$3,037.00" $84.10 "$4,104.00" "$4,104.00" "$4,104.00" "$4,104.00" "$4,104.00" $85.22 $85.22 $85.30 "$4,104.00" $85.22 "$4,104.00" "$4,104.00" "$4,104.00" "$4,104.00" $855.32 $136.35 $134.56 "$4,104.00" $85.22 $84.10 $85.22 "$4,104.00" "$3,078.00" $85.22 $85.22 $85.22 "$2,762.00" "$2,052.00" "$3,250.37" $85.22 "$3,283.20" "$2,500.00" "$4,104.00" $85.22 "$2,380.32" "$4,104.00" $89.44 $85.22 "$4,104.00" $85.22 N/A N/A 36100480 EAP CPT® 32550 INSERT INDWELLING CATH BOTH IP/OP "$20,731.00" "$15,341.00" $203.51 "$20,731.00" "$20,731.00" "$20,731.00" "$20,731.00" "$20,731.00" $205.39 $205.39 $207.13 "$20,731.00" $205.39 "$20,731.00" "$20,731.00" "$20,731.00" "$20,731.00" "$4,320.57" $328.62 $325.62 "$20,731.00" $205.39 $203.51 $205.39 "$20,731.00" "$15,548.25" $205.39 $205.39 $205.39 "$3,500.00" "$10,365.50" "$16,418.95" $205.39 "$16,584.80" "$3,725.00" "$20,731.00" $205.39 "$12,023.98" "$20,731.00" $215.27 $205.39 "$20,731.00" $205.39 N/A N/A 36100481 EAP CPT® 32550 INSERT/INDWELLING TUN PLEURAL BOTH IP/OP "$16,257.00" "$12,030.50" $203.51 "$16,257.00" "$16,257.00" "$16,257.00" "$16,257.00" "$16,257.00" $205.39 $205.39 $207.13 "$16,257.00" $205.39 "$16,257.00" "$16,257.00" "$16,257.00" "$16,257.00" "$3,388.14" $328.62 $325.62 "$16,257.00" $205.39 $203.51 $205.39 "$16,257.00" "$12,192.75" $205.39 $205.39 $205.39 "$3,500.00" "$8,128.50" "$12,875.54" $205.39 "$13,005.60" "$3,725.00" "$16,257.00" $205.39 "$9,429.06" "$16,257.00" $215.27 $205.39 "$16,257.00" $205.39 N/A N/A 36100482 EAP CPT® 32551 CHEST TUBE INSERTION BOTH IP/OP "$2,893.00" "$2,141.00" $155.42 "$2,893.00" "$2,893.00" "$2,893.00" "$2,893.00" "$2,893.00" $157.64 $157.64 $157.65 "$2,893.00" $157.64 "$2,893.00" "$2,893.00" "$2,893.00" "$2,893.00" $602.93 $252.22 $248.67 "$2,893.00" $157.64 $155.42 $157.64 "$2,893.00" "$2,169.75" $157.64 $157.64 $157.64 "$2,762.00" "$1,446.50" "$2,291.26" $157.64 "$2,314.40" "$2,150.00" "$2,893.00" $157.64 "$1,677.94" "$2,893.00" $164.42 $157.64 "$2,893.00" $157.64 N/A N/A 36100485 EAP CPT® 32560 CHEMICAL PLEURODESIS BOTH IP/OP "$2,169.00" "$1,605.50" $75.66 "$2,169.00" "$2,169.00" "$2,169.00" "$2,169.00" "$2,169.00" $77.38 $77.38 $77.71 "$2,169.00" $77.38 "$2,169.00" "$2,169.00" "$2,169.00" "$2,169.00" $452.04 $123.81 $121.06 "$2,169.00" $77.38 $75.66 $77.38 "$2,169.00" "$1,626.75" $77.38 $77.38 $77.38 "$2,169.00" "$1,084.50" "$1,717.85" $77.38 "$1,735.20" "$2,150.00" "$2,169.00" $77.38 "$1,258.02" "$2,169.00" $81.13 $77.38 "$2,169.00" $77.38 N/A N/A 36100486 EAP CPT® 32999 REMOVAL OF PLEURAL CATHETER BOTH IP/OP "$1,359.00" "$1,006.00" $283.23 "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" $283.23 "$1,359.00" $543.60 "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,019.25" "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" $679.50 "$1,076.33" "$1,359.00" "$1,087.20" "$1,359.00" "$1,359.00" "$1,359.00" $788.22 "$1,359.00" $815.40 "$1,359.00" "$1,359.00" "$1,359.00" N/A N/A 36100489 EAP CPT® 33207 INSRT NEW/REPL PCMKR/LD-VENT BOTH IP/OP "$31,143.00" "$23,046.00" $479.79 "$31,143.00" "$31,143.00" "$31,143.00" "$31,143.00" "$31,143.00" $484.07 $484.07 $485.85 "$31,143.00" $484.07 "$31,143.00" "$31,143.00" "$31,143.00" "$31,143.00" "$6,490.54" $774.51 $767.66 "$31,143.00" $484.07 $479.79 $484.07 "$31,143.00" "$23,357.25" $484.07 $484.07 $484.07 "$7,479.00" "$15,571.50" "$24,665.26" $484.07 "$24,914.40" "$5,164.00" "$31,143.00" $484.07 "$18,062.94" "$31,143.00" $501.80 $484.07 "$31,143.00" $484.07 N/A N/A 36100490 EAP CPT® 33208 INSRT NEW/REPL PCMKR/LD- A / V BOTH IP/OP "$13,386.00" "$9,906.00" $519.85 "$13,386.00" "$13,386.00" "$13,386.00" "$13,386.00" "$13,386.00" $525.05 $525.05 $527.47 "$13,386.00" $525.05 "$13,386.00" "$13,386.00" "$13,386.00" "$13,386.00" "$2,789.79" $840.08 $831.76 "$13,386.00" $525.05 $519.85 $525.05 "$13,386.00" "$10,039.50" $525.05 $525.05 $525.05 "$7,479.00" "$6,693.00" "$10,601.71" $525.05 "$10,708.80" "$5,343.00" "$13,386.00" $525.05 "$7,763.88" "$13,386.00" $545.42 $525.05 "$13,386.00" $525.05 N/A N/A 36100491 EAP CPT® 33210 TEMP PACEMAKER WIRE BOTH IP/OP "$25,023.00" "$18,517.50" $160.90 "$25,023.00" "$25,023.00" "$25,023.00" "$25,023.00" "$25,023.00" $162.53 $162.53 $163.56 "$25,023.00" $162.53 "$25,023.00" "$25,023.00" "$25,023.00" "$25,023.00" "$5,215.07" $260.05 $257.44 "$25,023.00" $162.53 $160.90 $162.53 "$25,023.00" "$18,767.25" $162.53 $162.53 $162.53 "$4,417.00" "$12,511.50" "$19,818.22" $162.53 "$20,018.40" "$4,334.00" "$25,023.00" $162.53 "$14,513.34" "$25,023.00" $170.90 $162.53 "$25,023.00" $162.53 N/A N/A 36100492 EAP CPT® 33212 INSRT PCMKR W EXIST SNGL LD BOTH IP/OP "$19,776.00" "$14,634.50" $322.65 "$15,820.80" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$8,025.41" "$8,025.41" "$7,989.91" "$4,121.81" "$8,025.41" "$3,769.39" "$3,769.39" "$3,914.36" "$2,645.82" "$4,121.54" "$12,840.65" "$11,776.10" "$3,856.00" "$8,025.41" $322.65 "$8,025.41" "$8,426.68" "$14,832.00" "$8,025.41" "$8,025.41" "$8,025.41" "$3,500.00" "$2,975.00" "$15,662.59" "$8,025.41" "$15,820.80" "$5,164.00" "$3,925.04" "$8,025.41" "$11,470.08" "$8,426.68" "$11,610.74" "$8,025.41" "$4,121.32" "$8,025.41" N/A N/A 36100493 EAP CPT® 33213 INSRT PCMKR W EXIST DUAL LDS BOTH IP/OP "$22,852.00" "$16,910.50" $337.58 "$18,281.60" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$10,228.10" "$10,228.10" "$10,182.87" "$4,762.93" "$10,228.10" "$3,769.39" "$3,769.39" "$3,914.36" "$2,645.82" "$4,762.61" "$16,364.97" "$14,900.90" "$3,856.00" "$10,228.10" $337.58 "$10,228.10" "$10,739.51" "$17,139.00" "$10,228.10" "$10,228.10" "$10,228.10" "$3,500.00" "$2,975.00" "$18,098.78" "$10,228.10" "$18,281.60" "$5,164.00" "$4,535.55" "$10,228.10" "$13,254.16" "$10,739.51" "$14,797.49" "$10,228.10" "$4,762.36" "$10,228.10" N/A N/A 36100494 EAP CPT® 33214 UPGRADE PACEMAKER SYSTEM BOTH IP/OP "$11,993.00" "$8,875.00" $481.42 "$11,993.00" "$11,993.00" "$11,993.00" "$11,993.00" "$11,993.00" $485.01 $485.01 $486.76 "$11,993.00" $485.01 "$11,993.00" "$11,993.00" "$11,993.00" "$11,993.00" "$2,499.47" $776.02 $770.27 "$11,993.00" $485.01 $481.42 $485.01 "$11,993.00" "$8,994.75" $485.01 $485.01 $485.01 "$7,479.00" "$5,996.50" "$9,498.46" $485.01 "$9,594.40" "$5,343.00" "$11,993.00" $485.01 "$6,955.94" "$11,993.00" $500.71 $485.01 "$11,993.00" $485.01 N/A N/A 36100495 EAP CPT® 33215 REPOSITION ICD LEAD BOTH IP/OP "$14,372.00" "$10,635.50" $311.47 "$14,372.00" "$14,372.00" "$14,372.00" "$14,372.00" "$14,372.00" $313.40 $313.40 $313.98 "$14,372.00" $313.40 "$14,372.00" "$14,372.00" "$14,372.00" "$14,372.00" "$2,995.28" $501.44 $498.35 "$14,372.00" $313.40 $311.47 $313.40 "$14,372.00" "$10,779.00" $313.40 $313.40 $313.40 "$2,762.00" "$7,186.00" "$11,382.62" $313.40 "$11,497.60" "$3,250.00" "$14,372.00" $313.40 "$8,335.76" "$14,372.00" $324.79 $313.40 "$14,372.00" $313.40 N/A N/A 36100496 EAP CPT® 33216 INSRT SNGL ICD LEAD TRANSVENO BOTH IP/OP "$15,719.00" "$11,632.50" $374.17 "$15,719.00" "$15,719.00" "$15,719.00" "$15,719.00" "$15,719.00" $377.14 $377.14 $377.96 "$15,719.00" $377.14 "$15,719.00" "$15,719.00" "$15,719.00" "$15,719.00" "$3,276.01" $603.42 $598.67 "$15,719.00" $377.14 $374.17 $377.14 "$15,719.00" "$11,789.25" $377.14 $377.14 $377.14 "$7,479.00" "$7,859.50" "$12,449.45" $377.14 "$12,575.20" "$4,334.00" "$15,719.00" $377.14 "$9,117.02" "$15,719.00" $388.94 $377.14 "$15,719.00" $377.14 N/A N/A 36100497 EAP CPT® 33217 INSRT DUAL ICD LEAD TRANSVENO BOTH IP/OP "$30,222.00" "$22,364.50" $370.44 "$30,222.00" "$30,222.00" "$30,222.00" "$30,222.00" "$30,222.00" $373.71 $373.71 $374.12 "$30,222.00" $373.71 "$30,222.00" "$30,222.00" "$30,222.00" "$30,222.00" "$6,298.60" $597.94 $592.70 "$30,222.00" $373.71 $370.44 $373.71 "$30,222.00" "$22,666.50" $373.71 $373.71 $373.71 "$7,479.00" "$15,111.00" "$23,935.82" $373.71 "$24,177.60" "$4,334.00" "$30,222.00" $373.71 "$17,528.76" "$30,222.00" $383.18 $373.71 "$30,222.00" $373.71 N/A N/A 36100498 EAP CPT® 33218 REPAIR SNGL LEAD PCMKR / ICD BOTH IP/OP "$26,919.00" "$19,920.50" $392.47 "$26,919.00" "$26,919.00" "$26,919.00" "$26,919.00" "$26,919.00" $394.63 $394.63 $394.87 "$26,919.00" $394.63 "$26,919.00" "$26,919.00" "$26,919.00" "$26,919.00" "$5,610.22" $631.41 $627.95 "$26,919.00" $394.63 $392.47 $394.63 "$26,919.00" "$20,189.25" $394.63 $394.63 $394.63 "$4,780.00" "$13,459.50" "$21,319.85" $394.63 "$21,535.20" "$3,725.00" "$26,919.00" $394.63 "$15,613.02" "$26,919.00" $403.72 $394.63 "$26,919.00" $394.63 N/A N/A 36100499 EAP CPT® 33220 REPAIR DUAL LEADS PCMKR / ICD BOTH IP/OP "$14,001.00" "$10,361.00" $377.95 "$14,001.00" "$14,001.00" "$14,001.00" "$14,001.00" "$14,001.00" $382.04 $382.04 $381.51 "$14,001.00" $382.04 "$14,001.00" "$14,001.00" "$14,001.00" "$14,001.00" "$2,917.96" $611.26 $604.72 "$14,001.00" $382.04 $377.95 $382.04 "$14,001.00" "$10,500.75" $382.04 $382.04 $382.04 "$4,780.00" "$7,000.50" "$11,088.79" $382.04 "$11,200.80" "$3,725.00" "$14,001.00" $382.04 "$8,120.58" "$14,001.00" $393.28 $382.04 "$14,001.00" $382.04 N/A N/A 36100500 EAP CPT® 33223 RELOCATION SKIN PKT CARDIOVERT-DEFIB BOTH IP/OP "$6,168.00" "$4,564.50" $411.50 "$6,168.00" "$6,168.00" "$6,168.00" "$6,168.00" "$6,168.00" $415.38 $415.38 $417.11 "$6,168.00" $415.38 "$6,168.00" "$6,168.00" "$6,168.00" "$6,168.00" "$1,285.48" $664.61 $658.40 "$6,168.00" $415.38 $411.50 $415.38 "$6,168.00" "$4,626.00" $415.38 $415.38 $415.38 "$2,851.00" "$3,084.00" "$4,885.06" $415.38 "$4,934.40" "$2,500.00" "$6,168.00" $415.38 "$3,577.44" "$6,168.00" $428.24 $415.38 "$6,168.00" $415.38 N/A N/A 36100501 EAP CPT® 33224 INSERT LEAD TO PREV PCMKR / ICD BOTH IP/OP "$13,464.00" "$9,963.50" $512.85 "$16,364.97" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$10,228.10" "$10,228.10" "$10,182.87" "$2,806.23" "$10,228.10" "$3,769.39" "$3,769.39" "$3,914.36" "$2,645.82" "$2,806.05" "$16,364.97" "$14,900.90" "$4,877.00" "$10,228.10" $512.85 "$10,228.10" "$10,739.51" "$10,098.00" "$10,228.10" "$10,228.10" "$10,228.10" "$7,479.00" "$6,357.00" "$10,663.49" "$10,228.10" "$10,771.20" "$5,343.00" "$2,672.27" "$10,228.10" "$7,809.12" "$10,739.51" "$13,464.00" "$10,228.10" "$2,805.90" "$10,228.10" N/A N/A 36100502 EAP CPT® 33225 L VENTR PACING LEAD ADD +POCK BOTH IP/OP "$50,601.00" "$37,445.00" $463.67 "$50,601.00" "$3,558.00" "$3,558.00" "$3,558.00" "$3,558.00" "$50,601.00" "$50,601.00" "$50,601.00" "$9,417.94" "$50,601.00" "$50,601.00" "$50,601.00" "$50,601.00" "$50,601.00" "$10,545.81" "$50,601.00" "$50,601.00" "$4,877.00" "$50,601.00" $463.67 "$50,601.00" "$50,601.00" "$37,950.75" "$50,601.00" "$50,601.00" "$50,601.00" "$25,300.50" "$5,151.00" "$40,075.99" "$50,601.00" "$40,480.80" "$5,343.00" "$7,712.84" "$50,601.00" "$29,348.58" "$50,601.00" "$50,601.00" "$50,601.00" "$8,098.48" "$50,601.00" N/A N/A 36100504 EAP CPT® 33233 REMOVE PCMKR ONLY BOTH IP/OP "$12,134.00" "$8,979.50" $235.35 "$12,134.00" "$12,134.00" "$12,134.00" "$12,134.00" "$12,134.00" $237.18 $237.18 $236.78 "$12,134.00" $237.18 "$12,134.00" "$12,134.00" "$12,134.00" "$12,134.00" "$2,528.86" $379.49 $376.56 "$12,134.00" $237.18 $235.35 $237.18 "$12,134.00" "$9,100.50" $237.18 $237.18 $237.18 "$7,479.00" "$6,067.00" "$9,610.13" $237.18 "$9,707.20" "$3,725.00" "$12,134.00" $237.18 "$7,037.72" "$12,134.00" $240.77 $237.18 "$12,134.00" $237.18 N/A N/A 36100505 EAP CPT® 33234 REMOVE PCMKR ELECTRODE BOTH IP/OP "$7,315.00" "$5,413.50" $486.18 "$7,315.00" "$7,315.00" "$7,315.00" "$7,315.00" "$7,315.00" $491.13 $491.13 $493.56 "$7,315.00" $491.13 "$7,315.00" "$7,315.00" "$7,315.00" "$7,315.00" "$1,524.53" $785.81 $777.89 "$7,315.00" $491.13 $486.18 $491.13 "$7,315.00" "$5,486.25" $491.13 $491.13 $491.13 "$2,762.00" "$3,657.50" "$5,793.48" $491.13 "$5,852.00" "$3,725.00" "$7,315.00" $491.13 "$4,242.70" "$7,315.00" $507.92 $491.13 "$7,315.00" $491.13 N/A N/A 36100506 EAP CPT® 33241 REMOVE ICD GENERATOR ONLY BOTH IP/OP "$6,919.00" "$5,120.50" $216.04 "$5,535.20" "$3,558.00" "$3,558.00" "$3,558.00" "$3,558.00" "$3,387.26" "$3,387.26" "$3,372.28" "$1,442.09" "$3,387.26" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$1,442.00" "$5,419.62" "$4,834.25" "$4,877.00" "$3,387.26" $216.04 "$3,387.26" "$3,556.62" "$5,189.25" "$3,387.26" "$3,387.26" "$3,387.26" "$2,762.00" "$2,348.00" "$5,479.85" "$3,387.26" "$5,535.20" "$3,725.00" "$1,373.25" "$3,387.26" "$4,013.02" "$3,556.62" "$4,900.51" "$3,387.26" "$1,441.92" "$3,387.26" N/A N/A 36100507 EAP CPT® 33244 TRANSVENOUS REMOVAL ICD LEAD BOTH IP/OP "$11,879.00" "$8,790.50" $868.26 "$9,503.20" "$3,558.00" "$3,558.00" "$3,558.00" "$3,558.00" "$3,387.26" "$3,387.26" "$3,372.28" "$2,475.88" "$3,387.26" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$2,475.71" "$5,419.62" "$4,834.25" "$4,877.00" "$3,387.26" $868.26 "$3,387.26" "$3,556.62" "$8,909.25" "$3,387.26" "$3,387.26" "$3,387.26" "$2,851.00" "$2,423.00" "$9,408.17" "$3,387.26" "$9,503.20" "$3,725.00" "$2,357.68" "$3,387.26" "$6,889.82" "$3,556.62" "$4,900.51" "$3,387.26" "$2,475.58" "$3,387.26" N/A N/A 36100508 EAP CPT® 33249 INSRT/REPL SGL/DUAL ICD LD/GEN BOTH IP/OP "$40,394.00" "$29,892.00" $916.15 "$51,697.85" "$5,422.00" "$5,422.00" "$5,422.00" "$5,422.00" "$32,311.16" "$32,311.16" "$32,168.25" "$8,419.12" "$32,311.16" "$4,607.43" "$4,607.43" "$4,784.64" "$3,234.06" "$8,418.55" "$51,697.85" "$46,275.21" "$4,877.00" "$32,311.16" $916.15 "$32,311.16" "$33,926.72" "$30,295.50" "$32,311.16" "$32,311.16" "$32,311.16" "$7,479.00" "$6,357.00" "$31,992.05" "$32,311.16" "$32,315.20" "$5,410.00" "$7,712.84" "$32,311.16" "$23,428.52" "$33,926.72" "$40,394.00" "$32,311.16" "$8,098.48" "$32,311.16" N/A N/A 36100518 EAP CPT® 33968 REMOVE INTRA-AORTIC BALLOON BOTH IP/OP "$1,998.00" "$1,479.00" $33.15 "$1,998.00" "$1,998.00" "$1,998.00" "$1,998.00" "$1,998.00" $33.15 $33.15 $34.06 "$1,998.00" $33.15 "$1,998.00" "$1,998.00" "$1,998.00" "$1,998.00" $416.41 $53.04 $53.78 "$1,998.00" $33.15 $33.61 $33.15 "$1,998.00" "$1,498.50" $33.15 $33.15 $33.15 "$1,998.00" $999.00 "$1,582.42" $33.15 "$1,598.40" "$1,998.00" "$1,998.00" $33.15 "$1,158.84" "$1,998.00" $35.33 $33.15 "$1,998.00" $33.15 N/A N/A 36100519 EAP CPT® 34201 EMB. OR THROMB; FEMOROPOP BOTH IP/OP "$13,033.00" "$9,644.50" "$1,013.03" "$13,033.00" "$13,033.00" "$13,033.00" "$13,033.00" "$13,033.00" "$1,021.75" "$1,021.75" "$1,023.84" "$13,033.00" "$1,021.75" "$13,033.00" "$13,033.00" "$13,033.00" "$13,033.00" "$2,716.22" "$1,634.80" "$1,620.85" "$13,033.00" "$1,021.75" "$1,013.03" "$1,021.75" "$13,033.00" "$9,774.75" "$1,021.75" "$1,021.75" "$1,021.75" "$4,780.00" "$6,516.50" "$10,322.14" "$1,021.75" "$10,426.40" "$4,334.00" "$13,033.00" "$1,021.75" "$7,559.14" "$13,033.00" "$1,075.11" "$1,021.75" "$13,033.00" "$1,021.75" N/A N/A 36100520 EAP CPT® 34203 EMB. OR THROMB;POPLITEAL-TIBIO BOTH IP/OP "$13,033.00" "$9,644.50" $940.31 "$13,033.00" "$13,033.00" "$13,033.00" "$13,033.00" "$13,033.00" $948.30 $948.30 $948.68 "$13,033.00" $948.30 "$13,033.00" "$13,033.00" "$13,033.00" "$13,033.00" "$2,716.22" "$1,517.28" "$1,504.50" "$13,033.00" $948.30 $940.31 $948.30 "$13,033.00" "$9,774.75" $948.30 $948.30 $948.30 "$4,780.00" "$6,516.50" "$10,322.14" $948.30 "$10,426.40" "$4,334.00" "$13,033.00" $948.30 "$7,559.14" "$13,033.00" $995.78 $948.30 "$13,033.00" $948.30 N/A N/A 36100535 EAP CPT® 35286 REPAIR BLOOD VESSEL WITH GRAFT OTHER THAN VEIN LOWER EXTEREMITY BOTH IP/OP "$13,185.00" "$9,757.00" $923.57 "$13,185.00" "$13,185.00" "$13,185.00" "$13,185.00" "$13,185.00" $933.78 $933.78 $935.99 "$13,185.00" $933.78 "$13,185.00" "$13,185.00" "$13,185.00" "$13,185.00" "$2,747.90" "$1,494.05" "$1,477.71" "$13,185.00" $933.78 $923.57 $933.78 "$13,185.00" "$9,888.75" $933.78 $933.78 $933.78 "$2,762.00" "$6,592.50" "$10,442.52" $933.78 "$10,548.00" "$3,725.00" "$13,185.00" $933.78 "$7,647.30" "$13,185.00" $979.18 $933.78 "$13,185.00" $933.78 N/A N/A 36100536 EAP CPT® 35355 "THROMB., ILIOFEMORAL" BOTH IP/OP "$6,828.00" "$5,053.00" "$1,019.19" "$6,828.00" "$6,828.00" "$6,828.00" "$6,828.00" "$6,828.00" "$1,027.66" "$1,027.66" "$1,030.76" "$6,828.00" "$1,027.66" "$6,828.00" "$6,828.00" "$6,828.00" "$6,828.00" "$1,423.03" "$1,644.26" "$1,630.70" "$6,828.00" "$1,027.66" "$1,019.19" "$1,027.66" "$6,828.00" "$5,121.00" "$1,027.66" "$1,027.66" "$1,027.66" "$2,762.00" "$3,414.00" "$5,407.78" "$1,027.66" "$5,462.40" "$4,438.20" "$6,828.00" "$1,027.66" "$3,960.24" "$6,828.00" "$1,081.25" "$1,027.66" "$6,828.00" "$1,027.66" N/A N/A 36100537 EAP CPT® 35371 "THROMB., COMMON FEMORAL" BOTH IP/OP "$5,569.00" "$4,121.50" $808.54 "$5,569.00" "$5,569.00" "$5,569.00" "$5,569.00" "$5,569.00" $814.86 $814.86 $817.48 "$5,569.00" $814.86 "$5,569.00" "$5,569.00" "$5,569.00" "$5,569.00" "$1,160.64" "$1,303.78" "$1,293.66" "$5,569.00" $814.86 $808.54 $814.86 "$5,569.00" "$4,176.75" $814.86 $814.86 $814.86 "$2,762.00" "$2,784.50" "$4,410.65" $814.86 "$4,455.20" "$3,619.85" "$5,569.00" $814.86 "$3,230.02" "$5,569.00" $856.26 $814.86 "$5,569.00" $814.86 N/A N/A 36100538 EAP CPT® 35372 "THROMB., DEEP FEMORAL" BOTH IP/OP "$6,697.00" "$4,956.00" $967.52 "$6,697.00" "$6,697.00" "$6,697.00" "$6,697.00" "$6,697.00" $972.70 $972.70 $976.41 "$6,697.00" $972.70 "$6,697.00" "$6,697.00" "$6,697.00" "$6,697.00" "$1,395.73" "$1,556.32" "$1,548.03" "$6,697.00" $972.70 $967.52 $972.70 "$6,697.00" "$5,022.75" $972.70 $972.70 $972.70 "$2,762.00" "$3,348.50" "$5,304.02" $972.70 "$5,357.60" "$4,353.05" "$6,697.00" $972.70 "$3,884.26" "$6,697.00" "$1,025.72" $972.70 "$6,697.00" $972.70 N/A N/A 36100557 EAP CPT® 36005 INJECTION CONTRAST VENOGRAPHY BOTH IP/OP "$3,362.00" "$2,488.00" $47.62 "$3,362.00" "$3,362.00" "$3,362.00" "$3,362.00" "$3,362.00" $47.62 $47.62 $48.33 "$3,362.00" $47.62 "$3,362.00" "$3,362.00" "$3,362.00" "$3,362.00" $700.68 $76.19 $76.56 "$3,362.00" $47.62 $47.85 $47.62 "$3,362.00" "$2,521.50" $47.62 $47.62 $47.62 "$2,762.00" "$1,681.00" "$2,662.70" $47.62 "$2,689.60" "$1,750.00" "$3,362.00" $47.62 "$1,949.96" "$3,362.00" $49.76 $47.62 "$3,362.00" $47.62 N/A N/A 36100558 EAP CPT® 36010 "INTRO CATH, SUP/INF VENA CAVA" BOTH IP/OP "$7,585.00" "$5,613.00" $107.25 "$7,585.00" "$7,585.00" "$7,585.00" "$7,585.00" "$7,585.00" $108.71 $108.71 $109.96 "$7,585.00" $108.71 "$7,585.00" "$7,585.00" "$7,585.00" "$7,585.00" "$1,580.80" $173.94 $171.60 "$7,585.00" $108.71 $107.25 $108.71 "$7,585.00" "$5,688.75" $108.71 $108.71 $108.71 "$2,762.00" "$3,792.50" "$6,007.32" $108.71 "$6,068.00" "$1,750.00" "$7,585.00" $108.71 "$4,399.30" "$7,585.00" $115.03 $108.71 "$7,585.00" $108.71 N/A N/A 36100559 EAP CPT® 36011 SELECT CATH VENOUS 1ST ORDER BOTH IP/OP "$2,771.00" "$2,051.00" $154.74 "$2,771.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,771.00" "$2,771.00" "$2,771.00" $577.55 "$2,771.00" "$2,771.00" "$2,771.00" "$2,771.00" "$2,771.00" $577.51 "$2,771.00" "$2,771.00" "$1,639.05" "$2,771.00" $154.74 "$2,771.00" "$2,771.00" "$2,078.25" "$2,771.00" "$2,771.00" "$2,771.00" "$2,771.00" "$1,385.50" "$2,194.63" "$2,771.00" "$2,216.80" "$1,750.00" $549.97 "$2,771.00" "$1,607.18" "$2,771.00" "$2,771.00" "$2,771.00" $577.48 "$2,771.00" N/A N/A 36100560 EAP CPT® 36012 SELECT CATH VENOUS 2ND ORDER BOTH IP/OP "$16,258.00" "$12,031.00" $171.02 "$16,258.00" "$16,258.00" "$16,258.00" "$16,258.00" "$16,258.00" $173.15 $173.15 $173.92 "$16,258.00" $173.15 "$16,258.00" "$16,258.00" "$16,258.00" "$16,258.00" "$3,388.35" $277.04 $273.63 "$16,258.00" $173.15 $171.02 $173.15 "$16,258.00" "$12,193.50" $173.15 $173.15 $173.15 "$2,762.00" "$8,129.00" "$12,876.34" $173.15 "$13,006.40" "$1,750.00" "$16,258.00" $173.15 "$9,429.64" "$16,258.00" $181.74 $173.15 "$16,258.00" $173.15 N/A N/A 36100561 EAP CPT® 36013 INTRO CATH RT HEART/MAIN PULM BOTH IP/OP "$12,826.00" "$9,491.50" $123.82 "$12,826.00" "$12,826.00" "$12,826.00" "$12,826.00" "$12,826.00" $124.12 $124.12 $123.83 "$12,826.00" $124.12 "$12,826.00" "$12,826.00" "$12,826.00" "$12,826.00" "$2,673.08" $198.59 $198.11 "$12,826.00" $124.12 $123.82 $124.12 "$12,826.00" "$9,619.50" $124.12 $124.12 $124.12 "$2,762.00" "$6,413.00" "$10,158.19" $124.12 "$10,260.80" "$1,750.00" "$12,826.00" $124.12 "$7,439.08" "$12,826.00" $127.30 $124.12 "$12,826.00" $124.12 N/A N/A 36100562 EAP CPT® 36014 SELECT CATH LT/RT PULM ARTERY BOTH IP/OP "$14,945.00" "$11,059.50" $149.97 "$14,945.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$14,945.00" "$14,945.00" "$14,945.00" "$3,114.91" "$14,945.00" "$14,945.00" "$14,945.00" "$14,945.00" "$14,945.00" "$3,114.70" "$14,945.00" "$2,722.00" "$3,094.73" "$14,945.00" $149.97 "$14,945.00" "$14,945.00" "$11,208.75" "$14,945.00" "$14,945.00" "$14,945.00" "$2,762.00" "$2,348.00" "$11,836.44" "$14,945.00" "$11,956.00" "$1,750.00" "$2,966.21" "$14,945.00" "$8,668.10" "$14,945.00" "$14,945.00" "$14,945.00" "$3,114.54" "$14,945.00" N/A N/A 36100563 EAP CPT® 36015 SELECT CATH SEGMENTAL PULM ART BOTH IP/OP "$2,294.00" "$1,698.00" $168.92 "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" $170.25 $170.25 $171.69 "$2,294.00" $170.25 "$2,294.00" "$2,294.00" "$2,294.00" "$2,294.00" $478.09 $272.40 $270.27 "$2,294.00" $170.25 $168.92 $170.25 "$2,294.00" "$1,720.50" $170.25 $170.25 $170.25 "$2,294.00" "$1,147.00" "$1,816.85" $170.25 "$1,835.20" "$1,750.00" "$2,294.00" $170.25 "$1,330.52" "$2,294.00" $180.31 $170.25 "$2,294.00" $170.25 N/A N/A 36100565 EAP CPT® 36140 INTRO NEEDLE EXTREMITY ARTERY BOTH IP/OP "$5,160.00" "$3,818.50" $88.26 "$5,160.00" "$5,160.00" "$5,160.00" "$5,160.00" "$5,160.00" $89.12 $89.12 $89.83 "$5,160.00" $89.12 "$5,160.00" "$5,160.00" "$5,160.00" "$5,160.00" "$1,075.40" $142.59 $141.22 "$5,160.00" $89.12 $88.26 $89.12 "$5,160.00" "$3,870.00" $89.12 $89.12 $89.12 "$2,762.00" "$2,580.00" "$4,086.72" $89.12 "$4,128.00" "$1,750.00" "$5,160.00" "$5,160.00" "$2,992.80" "$5,160.00" $93.75 $89.12 "$5,160.00" $89.12 N/A N/A 36100567 EAP CPT® 36160 INTRO NEEDLE AORTIC/TRANSLUMBA BOTH IP/OP "$7,974.00" "$5,901.00" $122.13 "$7,974.00" "$7,974.00" "$7,974.00" "$7,974.00" "$7,974.00" $124.09 $124.09 $123.79 "$7,974.00" $124.09 "$7,974.00" "$7,974.00" "$7,974.00" "$7,974.00" "$1,661.87" $198.54 $195.41 "$7,974.00" $124.09 $122.13 $124.09 "$7,974.00" "$5,980.50" $124.09 $124.09 $124.09 "$2,762.00" "$3,987.00" "$6,315.41" $124.09 "$6,379.20" "$1,750.00" "$7,974.00" $124.09 "$4,624.92" "$7,974.00" $130.18 $124.09 "$7,974.00" $124.09 N/A N/A 36100568 EAP CPT® 36200 INTRO CATHETER AORTA BOTH IP/OP "$8,501.00" "$6,291.00" $137.52 "$8,501.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$8,501.00" "$8,501.00" "$8,501.00" "$1,771.82" "$8,501.00" "$8,501.00" "$8,501.00" "$8,501.00" "$8,501.00" "$1,771.70" "$8,501.00" "$2,182.00" "$3,094.73" "$8,501.00" $137.52 "$8,501.00" "$8,501.00" "$6,375.75" "$8,501.00" "$8,501.00" "$8,501.00" "$2,762.00" "$2,348.00" "$6,732.79" "$8,501.00" "$6,800.80" "$1,750.00" "$1,687.24" "$8,501.00" "$4,930.58" "$8,501.00" "$8,501.00" "$8,501.00" "$1,771.61" "$8,501.00" N/A N/A 36100569 EAP CPT® 36215 SELCT ART 1ST ORD THOR/BRACH BOTH IP/OP "$3,917.00" "$2,899.00" $210.32 "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" $212.56 $212.56 $212.68 "$3,917.00" $212.56 "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" $816.35 $340.10 $336.51 "$3,917.00" $212.56 $210.32 $212.56 "$3,917.00" "$2,937.75" $212.56 $212.56 $212.56 "$2,762.00" "$1,958.50" "$3,102.26" $212.56 "$3,133.60" "$1,750.00" "$3,917.00" $212.56 "$2,271.86" "$3,917.00" $221.05 $212.56 "$3,917.00" $212.56 N/A N/A 36100570 EAP CPT® 36216 SELCT ART 2ND ORD THOR/BRACH BOTH IP/OP "$3,917.00" "$2,899.00" $268.15 "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" $269.33 $269.33 $271.66 "$3,917.00" $269.33 "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" $816.35 $430.93 $429.04 "$3,917.00" $269.33 $268.15 $269.33 "$3,917.00" "$2,937.75" $269.33 $269.33 $269.33 "$2,762.00" "$1,958.50" "$3,102.26" $269.33 "$3,133.60" "$1,750.00" "$3,917.00" $269.33 "$2,271.86" "$3,917.00" $284.85 $269.33 "$3,917.00" $269.33 N/A N/A 36100571 EAP CPT® 36217 SELCT ART 3RD ORD THOR/BRACH BOTH IP/OP "$3,917.00" "$2,899.00" $327.96 "$3,917.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$3,917.00" "$3,917.00" "$3,917.00" $816.40 "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" $816.35 "$3,917.00" "$3,917.00" "$2,316.91" "$3,917.00" $327.96 "$3,917.00" "$3,917.00" "$2,937.75" "$3,917.00" "$3,917.00" "$3,917.00" "$2,762.00" "$1,958.50" "$3,102.26" "$3,917.00" "$3,133.60" "$1,750.00" $777.43 "$3,917.00" "$2,271.86" "$3,917.00" "$3,917.00" "$3,917.00" $816.30 "$3,917.00" N/A N/A 36100572 EAP CPT® 36218 SELCT ART ADD'L 2ND/3RD TH/BR BOTH IP/OP "$1,886.00" "$1,396.00" $50.42 "$1,886.00" "$1,886.00" "$1,886.00" "$1,886.00" "$1,886.00" $51.29 $51.29 $50.42 "$1,886.00" $51.29 "$1,886.00" "$1,886.00" "$1,886.00" "$1,886.00" $393.06 $82.06 $82.54 "$1,886.00" $51.29 $51.59 $51.29 "$1,886.00" "$1,414.50" $51.29 $51.29 $51.29 "$1,886.00" $943.00 "$1,493.71" $51.29 "$1,508.80" "$1,750.00" "$1,886.00" $51.29 "$1,093.88" "$1,886.00" $54.09 $51.29 "$1,886.00" $51.29 N/A N/A 36100573 EAP Custom 36100573 SELCT ART 1ST ORD ABD/PELV BOTH IP/OP "$3,581.00" "$2,650.00" $637.42 "$3,581.00" "$3,581.00" "$3,581.00" "$3,581.00" "$3,581.00" "$3,581.00" "$3,581.00" $637.42 "$3,581.00" "$3,581.00" "$3,581.00" "$3,581.00" "$3,581.00" "$3,581.00" $746.32 "$3,581.00" "$1,432.40" "$3,581.00" "$3,581.00" "$3,581.00" "$3,581.00" "$3,581.00" "$2,685.75" "$3,581.00" "$3,581.00" "$3,581.00" "$1,790.50" "$1,790.50" "$2,836.15" "$3,581.00" "$2,864.80" "$2,327.65" "$3,581.00" "$3,581.00" "$2,076.98" "$3,581.00" "$2,148.60" "$3,581.00" "$3,581.00" "$3,581.00" N/A N/A 36100574 EAP CPT® 36245 SELCT ART 1ST ORD ABD/PELV/LE BOTH IP/OP "$3,917.00" "$2,899.00" $233.14 "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" $234.68 $234.68 $236.02 "$3,917.00" $234.68 "$3,917.00" "$3,917.00" "$3,917.00" "$3,917.00" $816.35 $375.49 $373.02 "$3,917.00" $234.68 $233.14 $234.68 "$3,917.00" "$2,937.75" $234.68 $234.68 $234.68 "$2,762.00" "$1,958.50" "$3,102.26" $234.68 "$3,133.60" "$1,750.00" "$3,917.00" $234.68 "$2,271.86" "$3,917.00" $248.44 $234.68 "$3,917.00" $234.68 N/A N/A 36100575 EAP CPT® 36246 SELCT ART 2ND ORD ABD/PELV/LE BOTH IP/OP "$4,056.00" "$3,001.50" $248.83 "$4,056.00" "$4,056.00" "$4,056.00" "$4,056.00" "$4,056.00" $251.60 $251.60 $253.40 "$4,056.00" $251.60 "$4,056.00" "$4,056.00" "$4,056.00" "$4,056.00" $845.32 $402.56 $398.13 "$4,056.00" $251.60 $248.83 $251.60 "$4,056.00" "$3,042.00" $251.60 $251.60 $251.60 "$2,762.00" "$2,028.00" "$3,212.35" $251.60 "$3,244.80" "$1,750.00" "$4,056.00" $251.60 "$2,352.48" "$4,056.00" $265.02 $251.60 "$4,056.00" $251.60 N/A N/A 36100576 EAP CPT® 36247 SELCT ART 3RD ORD ABD/PELV/LE BOTH IP/OP "$4,335.00" "$3,208.00" $295.26 "$4,550.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$4,335.00" "$4,335.00" "$4,335.00" $903.52 "$4,335.00" "$4,335.00" "$4,335.00" "$4,335.00" "$4,335.00" $903.46 "$4,335.00" "$4,550.00" "$2,564.15" "$4,335.00" $295.26 "$4,335.00" "$4,335.00" "$3,251.25" "$4,335.00" "$4,335.00" "$4,335.00" "$2,762.00" "$2,348.00" "$3,433.32" "$4,335.00" "$3,468.00" "$1,750.00" $860.39 "$4,335.00" "$2,514.30" "$4,335.00" "$4,335.00" "$4,335.00" $903.41 "$4,335.00" N/A N/A 36100577 EAP CPT® 36248 "SELCT ART, ADDT'L, ABD/PELV/LE" BOTH IP/OP "$4,056.00" "$3,001.50" $47.83 "$4,056.00" "$4,056.00" "$4,056.00" "$4,056.00" "$4,056.00" $48.06 $48.06 $49.09 "$4,056.00" $48.06 "$4,056.00" "$4,056.00" "$4,056.00" "$4,056.00" $845.32 $76.90 $76.53 "$4,056.00" $48.06 $47.83 $48.06 "$4,056.00" "$3,042.00" $48.06 $48.06 $48.06 "$2,762.00" "$2,028.00" "$3,212.35" $48.06 "$3,244.80" "$1,750.00" "$4,056.00" $48.06 "$2,352.48" "$4,056.00" $50.85 $48.06 "$4,056.00" $48.06 N/A N/A 36100582 EAP CPT® 36406 "PHELB, MICRO-10BOPC" BOTH IP/OP $89.00 $66.00 $8.69 $89.00 $89.00 $89.00 $89.00 $89.00 $8.96 $8.96 $8.69 $89.00 $8.96 $89.00 $89.00 $89.00 $89.00 $18.55 $14.34 $14.10 $89.00 $8.96 $8.81 $8.96 $89.00 $66.75 $8.96 $8.96 $8.96 $89.00 $44.50 $70.49 $8.96 $71.20 $57.85 $89.00 $8.96 $51.62 $89.00 $9.02 $8.96 $89.00 $8.96 N/A N/A 36100583 EAP CPT® 36406 "PHELB,MICRO-WARD 12 MIDNIGHT" BOTH IP/OP $89.00 $66.00 $8.69 $89.00 $89.00 $89.00 $89.00 $89.00 $8.96 $8.96 $8.69 $89.00 $8.96 $89.00 $89.00 $89.00 $89.00 $18.55 $14.34 $14.10 $89.00 $8.96 $8.81 $8.96 $89.00 $66.75 $8.96 $8.96 $8.96 $89.00 $44.50 $70.49 $8.96 $71.20 $57.85 $89.00 $8.96 $51.62 $89.00 $9.02 $8.96 $89.00 $8.96 N/A N/A 36100584 EAP CPT® 36406 "PHLEB,CAP-WARD 12N" BOTH IP/OP $89.00 $66.00 $8.69 $89.00 $89.00 $89.00 $89.00 $89.00 $8.96 $8.96 $8.69 $89.00 $8.96 $89.00 $89.00 $89.00 $89.00 $18.55 $14.34 $14.10 $89.00 $8.96 $8.81 $8.96 $89.00 $66.75 $8.96 $8.96 $8.96 $89.00 $44.50 $70.49 $8.96 $71.20 $57.85 $89.00 $8.96 $51.62 $89.00 $9.02 $8.96 $89.00 $8.96 N/A N/A 36100585 EAP CPT® 36406 "PHLEB,CAP-WARD 6PM" BOTH IP/OP $89.00 $66.00 $8.69 $89.00 $89.00 $89.00 $89.00 $89.00 $8.96 $8.96 $8.69 $89.00 $8.96 $89.00 $89.00 $89.00 $89.00 $18.55 $14.34 $14.10 $89.00 $8.96 $8.81 $8.96 $89.00 $66.75 $8.96 $8.96 $8.96 $89.00 $44.50 $70.49 $8.96 $71.20 $57.85 $89.00 $8.96 $51.62 $89.00 $9.02 $8.96 $89.00 $8.96 N/A N/A 36100586 EAP CPT® 36406 "PHLEB,CAP-WARD 7AM" BOTH IP/OP $89.00 $66.00 $8.69 $89.00 $89.00 $89.00 $89.00 $89.00 $8.96 $8.96 $8.69 $89.00 $8.96 $89.00 $89.00 $89.00 $89.00 $18.55 $14.34 $14.10 $89.00 $8.96 $8.81 $8.96 $89.00 $66.75 $8.96 $8.96 $8.96 $89.00 $44.50 $70.49 $8.96 $71.20 $57.85 $89.00 $8.96 $51.62 $89.00 $9.02 $8.96 $89.00 $8.96 N/A N/A 36100587 EAP CPT® 36406 "PHLEB,NURSERY 1PM" BOTH IP/OP $89.00 $66.00 $8.69 $89.00 $89.00 $89.00 $89.00 $89.00 $8.96 $8.96 $8.69 $89.00 $8.96 $89.00 $89.00 $89.00 $89.00 $18.55 $14.34 $14.10 $89.00 $8.96 $8.81 $8.96 $89.00 $66.75 $8.96 $8.96 $8.96 $89.00 $44.50 $70.49 $8.96 $71.20 $57.85 $89.00 $8.96 $51.62 $89.00 $9.02 $8.96 $89.00 $8.96 N/A N/A 36100592 EAP CPT® 36468 "INJECTION(S), SPIDER VEIN" BOTH IP/OP $447.00 $331.00 $93.16 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $93.16 $447.00 $178.80 $447.00 $447.00 $447.00 $447.00 $447.00 $335.25 $447.00 $447.00 $447.00 $447.00 $223.50 $354.02 $447.00 $357.60 $447.00 $447.00 $447.00 $259.26 $447.00 $268.20 $447.00 $447.00 $447.00 N/A N/A 36100594 EAP CPT® 36470 INJECTION THERAPY OF VEIN BOTH IP/OP $717.00 $531.00 $37.93 $717.00 $717.00 $717.00 $717.00 $717.00 $37.93 $37.93 $38.56 $717.00 $37.93 $717.00 $717.00 $717.00 $717.00 $149.43 $60.69 $61.94 $717.00 $37.93 $38.71 $37.93 $717.00 $537.75 $37.93 $37.93 $37.93 $717.00 $358.50 $567.86 $37.93 $573.60 $717.00 $717.00 $37.93 $415.86 $717.00 $39.66 $37.93 $717.00 $37.93 N/A N/A 36100596 EAP CPT® 36475 "ENDOVENOUS RF, 1ST VEIN" BOTH IP/OP "$14,476.00" "$10,712.50" $275.99 "$14,476.00" "$14,476.00" "$14,476.00" "$14,476.00" "$14,476.00" $277.54 $277.54 $279.88 "$14,476.00" $277.54 "$14,476.00" "$14,476.00" "$14,476.00" "$14,476.00" "$3,016.96" $444.06 $441.58 "$14,476.00" $277.54 $275.99 $277.54 "$14,476.00" "$10,857.00" $277.54 $277.54 $277.54 "$7,479.00" "$7,238.00" "$11,464.99" $277.54 "$11,580.80" "$3,725.00" "$14,476.00" $277.54 "$8,396.08" "$14,476.00" $291.69 $277.54 "$14,476.00" $277.54 N/A N/A 36100597 EAP CPT® 36476 "ENDOVENOUS RF, VEIN ADD ON" BOTH IP/OP "$14,476.00" "$10,712.50" $133.09 "$14,476.00" "$14,476.00" "$14,476.00" "$14,476.00" "$14,476.00" $134.40 $134.40 $134.57 "$14,476.00" $134.40 "$14,476.00" "$14,476.00" "$14,476.00" "$14,476.00" "$3,016.96" $215.04 $212.94 "$14,476.00" $134.40 $133.09 $134.40 "$14,476.00" "$10,857.00" $134.40 $134.40 $134.40 "$7,479.00" "$7,238.00" "$11,464.99" $134.40 "$11,580.80" "$1,750.00" "$14,476.00" $134.40 "$8,396.08" "$14,476.00" $141.34 $134.40 "$14,476.00" $134.40 N/A N/A 36100598 EAP CPT® 36478 "ENDOVENOUS LASER, 1ST VEIN" BOTH IP/OP "$14,476.00" "$10,712.50" $275.62 "$11,580.80" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$2,815.92" "$2,815.92" "$2,803.47" "$3,017.16" "$2,815.92" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$3,016.96" "$4,505.48" "$4,297.64" "$9,641.00" "$2,815.92" $275.62 "$2,815.92" "$2,956.72" "$10,857.00" "$2,815.92" "$2,815.92" "$2,815.92" "$7,479.00" "$6,357.00" "$11,464.99" "$2,815.92" "$11,580.80" "$3,725.00" "$2,873.12" "$2,815.92" "$8,396.08" "$2,956.72" "$4,073.93" "$2,815.92" "$3,016.80" "$2,815.92" N/A N/A 36100599 EAP CPT® 36479 ENDOVENOUS LASER VEIN ADD-ON BOTH IP/OP "$14,476.00" "$10,712.50" $134.43 "$14,476.00" "$14,476.00" "$14,476.00" "$14,476.00" "$14,476.00" $135.85 $135.85 $136.03 "$14,476.00" $135.85 "$14,476.00" "$14,476.00" "$14,476.00" "$14,476.00" "$3,016.96" $217.36 $215.09 "$14,476.00" $135.85 $134.43 $135.85 "$14,476.00" "$10,857.00" $135.85 $135.85 $135.85 "$7,479.00" "$7,238.00" "$11,464.99" $135.85 "$11,580.80" "$1,750.00" "$14,476.00" $135.85 "$8,396.08" "$14,476.00" $142.78 $135.85 "$14,476.00" $135.85 N/A N/A 36100600 EAP CPT® 36481 PERCUT PORTAL VEIN CATH BOTH IP/OP "$6,954.00" "$5,146.00" $322.34 "$6,954.00" "$6,954.00" "$6,954.00" "$6,954.00" "$6,954.00" $322.34 $322.34 $328.02 "$6,954.00" $322.34 "$6,954.00" "$6,954.00" "$6,954.00" "$6,954.00" "$1,449.29" $515.74 $517.10 "$6,954.00" $322.34 $323.19 $322.34 "$6,954.00" "$5,215.50" $322.34 $322.34 $322.34 "$2,762.00" "$3,477.00" "$5,507.57" $322.34 "$5,563.20" "$1,750.00" "$6,954.00" $322.34 "$4,033.32" "$6,954.00" $344.76 $322.34 "$6,954.00" $322.34 N/A N/A 36100601 EAP CPT® 36500 VENOUS CATH SELCT ORG BLD SAMP BOTH IP/OP "$3,040.00" "$2,250.00" $180.22 "$3,040.00" "$3,040.00" "$3,040.00" "$3,040.00" "$3,040.00" $181.55 $181.55 $183.12 "$3,040.00" $181.55 "$3,040.00" "$3,040.00" "$3,040.00" "$3,040.00" $633.57 $290.48 $288.35 "$3,040.00" $181.55 $180.22 $181.55 "$3,040.00" "$2,280.00" $181.55 $181.55 $181.55 "$2,762.00" "$1,520.00" "$2,407.68" $181.55 "$2,432.00" "$1,750.00" "$3,040.00" $181.55 "$1,763.20" "$3,040.00" $190.74 $181.55 "$3,040.00" $181.55 N/A N/A 36100602 EAP CPT® 36555 INS NON-TUN CVC <5 SPV BOTH IP/OP "$6,197.00" "$4,586.00" $84.44 "$6,197.00" "$6,197.00" "$6,197.00" "$6,197.00" "$6,197.00" $85.23 $85.23 $84.96 "$6,197.00" $85.23 "$6,197.00" "$6,197.00" "$6,197.00" "$6,197.00" "$1,291.52" $136.37 $135.10 "$6,197.00" $85.23 $84.44 $85.23 "$6,197.00" "$4,647.75" $85.23 $85.23 $85.23 "$2,762.00" "$3,098.50" "$4,908.02" $85.23 "$4,957.60" "$2,500.00" "$6,197.00" $85.23 "$3,594.26" "$6,197.00" $88.01 $85.23 "$6,197.00" $85.23 N/A N/A 36100603 EAP CPT® 36556 CENTRAL LINE PLACEMENT BOTH IP/OP "$6,532.00" "$4,834.00" $84.12 "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" $84.71 $84.71 $85.10 "$6,532.00" $84.71 "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$1,361.34" $135.54 $134.59 "$6,532.00" $84.71 $84.12 $84.71 "$6,532.00" "$4,899.00" $84.71 $84.71 $84.71 "$2,762.00" "$3,266.00" "$5,173.34" $84.71 "$5,225.60" "$2,500.00" "$6,532.00" $84.71 "$3,788.56" "$6,532.00" $88.71 $84.71 "$6,532.00" $84.71 N/A N/A 36100607 EAP CPT® 36557 INS TUN CVC W/O PORT <5 SPV BOTH IP/OP "$7,565.00" "$5,598.50" $323.03 "$7,565.00" "$7,565.00" "$7,565.00" "$7,565.00" "$7,565.00" $325.44 $325.44 $324.79 "$7,565.00" $325.44 "$7,565.00" "$7,565.00" "$7,565.00" "$7,565.00" "$1,576.63" $520.70 $516.85 "$7,565.00" $325.44 $323.03 $325.44 "$7,565.00" "$5,673.75" $325.44 $325.44 $325.44 "$2,851.00" "$3,782.50" "$5,991.48" $325.44 "$6,052.00" "$3,725.00" "$7,565.00" $325.44 "$4,387.70" "$7,565.00" $333.43 $325.44 "$7,565.00" $325.44 N/A N/A 36100608 EAP CPT® 36558 INS TUN CVC W/O PORT >5 SPV BOTH IP/OP "$11,867.00" "$8,782.00" $259.43 "$9,493.60" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,815.92" "$2,815.92" "$2,803.47" "$2,473.38" "$2,815.92" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$2,473.21" "$4,505.48" "$4,297.64" "$2,836.00" "$2,815.92" $259.43 "$2,815.92" "$2,956.72" "$8,900.25" "$2,815.92" "$2,815.92" "$2,815.92" "$2,851.00" "$2,423.00" "$9,398.66" "$2,815.92" "$9,493.60" "$3,725.00" "$2,355.30" "$2,815.92" "$6,882.86" "$2,956.72" "$4,073.93" "$2,815.92" "$2,473.08" "$2,815.92" N/A N/A 36100609 EAP CPT® 36560 INS TUN CVC W/PORT <5 SPV BOTH IP/OP "$16,153.00" "$11,953.50" $387.56 "$16,153.00" "$16,153.00" "$16,153.00" "$16,153.00" "$16,153.00" $388.85 $388.85 $388.41 "$16,153.00" $388.85 "$16,153.00" "$16,153.00" "$16,153.00" "$16,153.00" "$3,366.46" $622.16 $620.10 "$16,153.00" $388.85 $387.56 $388.85 "$16,153.00" "$12,114.75" $388.85 $388.85 $388.85 "$3,500.00" "$8,076.50" "$12,793.18" $388.85 "$12,922.40" "$3,725.00" "$16,153.00" $388.85 "$9,368.74" "$16,153.00" $399.40 $388.85 "$16,153.00" $388.85 N/A N/A 36100610 EAP CPT® 36561 INS TUN CVC W/PORT >5 SPV BOTH IP/OP "$23,715.00" "$17,549.50" $332.73 "$18,972.00" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$2,815.92" "$2,815.92" "$2,803.47" "$4,942.80" "$2,815.92" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$4,942.47" "$4,505.48" "$4,297.64" "$3,856.00" "$2,815.92" $332.73 "$2,815.92" "$2,956.72" "$17,786.25" "$2,815.92" "$2,815.92" "$2,815.92" "$3,500.00" "$2,975.00" "$18,782.28" "$2,815.92" "$18,972.00" "$3,725.00" "$4,706.83" "$2,815.92" "$13,754.70" "$2,956.72" "$4,073.93" "$2,815.92" "$4,942.21" "$2,815.92" N/A N/A 36100611 EAP CPT® 36563 INS TUN CVC W/PUMP SPV BOTH IP/OP "$34,457.00" "$25,498.50" $366.11 "$34,457.00" "$34,457.00" "$34,457.00" "$34,457.00" "$34,457.00" $368.86 $368.86 $369.26 "$34,457.00" $368.86 "$34,457.00" "$34,457.00" "$34,457.00" "$34,457.00" "$7,181.22" $590.18 $585.78 "$34,457.00" $368.86 $366.11 $368.86 "$34,457.00" "$25,842.75" $368.86 $368.86 $368.86 "$3,500.00" "$17,228.50" "$27,289.94" $368.86 "$27,565.60" "$3,725.00" "$34,457.00" $368.86 "$19,985.06" "$34,457.00" $382.12 $368.86 "$34,457.00" $368.86 N/A N/A 36100612 EAP CPT® 36565 INSERT TUNNELED CV CATH BOTH IP/OP "$22,459.00" "$16,620.00" $336.31 "$22,459.00" "$22,459.00" "$22,459.00" "$22,459.00" "$22,459.00" $338.88 $338.88 $338.62 "$22,459.00" $338.88 "$22,459.00" "$22,459.00" "$22,459.00" "$22,459.00" "$4,680.70" $542.21 $538.10 "$22,459.00" $338.88 $336.31 $338.88 "$22,459.00" "$16,844.25" $338.88 $338.88 $338.88 "$3,500.00" "$11,229.50" "$17,787.53" $338.88 "$17,967.20" "$3,725.00" "$22,459.00" $338.88 "$13,026.22" "$22,459.00" $350.06 $338.88 "$22,459.00" $338.88 N/A N/A 36100613 EAP CPT® 36566 INSERT TUNNELED CV CATH W/PORT BOTH IP/OP "$9,620.00" "$7,119.00" $357.57 "$9,620.00" "$9,620.00" "$9,620.00" "$9,620.00" "$9,620.00" $361.93 $361.93 $362.46 "$9,620.00" $361.93 "$9,620.00" "$9,620.00" "$9,620.00" "$9,620.00" "$2,004.91" $579.09 $572.11 "$9,620.00" $361.93 $357.57 $361.93 "$9,620.00" "$7,215.00" $361.93 $361.93 $361.93 "$3,500.00" "$4,810.00" "$7,619.04" $361.93 "$7,696.00" "$3,725.00" "$9,620.00" $361.93 "$5,579.60" "$9,620.00" $376.75 $361.93 "$9,620.00" $361.93 N/A N/A 36100616 EAP CPT® 36568 INSERTION OF PICC CATHETER BOTH IP/OP "$7,593.00" "$5,619.00" $91.68 "$7,593.00" "$7,593.00" "$7,593.00" "$7,593.00" "$7,593.00" $91.68 $91.68 $92.09 "$7,593.00" $91.68 "$7,593.00" "$7,593.00" "$7,593.00" "$7,593.00" "$1,582.46" $146.69 $147.12 "$7,593.00" $91.68 $91.95 $91.68 "$7,593.00" "$5,694.75" $91.68 $91.68 $91.68 "$2,762.00" "$3,796.50" "$6,013.66" $91.68 "$6,074.40" "$2,500.00" "$7,593.00" $91.68 "$4,403.94" "$7,593.00" $96.66 $91.68 "$7,593.00" $91.68 N/A N/A 36100619 EAP CPT® 36569 INSERT PICC WO PORT/PUMP >5 BOTH IP/OP "$6,447.00" "$4,771.00" $93.29 "$6,447.00" "$6,447.00" "$6,447.00" "$6,447.00" "$6,447.00" $93.98 $93.98 $94.16 "$6,447.00" $93.98 "$6,447.00" "$6,447.00" "$6,447.00" "$6,447.00" "$1,343.63" $150.37 $149.26 "$6,447.00" $93.98 $93.29 $93.98 "$6,447.00" "$4,835.25" $93.98 $93.98 $93.98 "$2,762.00" "$3,223.50" "$5,106.02" $93.98 "$5,157.60" "$2,500.00" "$6,447.00" "$1,383.25" "$3,739.26" "$6,447.00" $98.45 $93.98 "$6,447.00" $93.98 N/A N/A 36100620 EAP CPT® 36570 INS PERH CVC W/PORT <5SPV BOTH IP/OP "$14,840.00" "$10,982.00" $335.60 "$14,840.00" "$14,840.00" "$14,840.00" "$14,840.00" "$14,840.00" $337.38 $337.38 $336.83 "$14,840.00" $337.38 "$14,840.00" "$14,840.00" "$14,840.00" "$14,840.00" "$3,092.82" $539.81 $536.96 "$14,840.00" $337.38 $335.60 $337.38 "$14,840.00" "$11,130.00" $337.38 $337.38 $337.38 "$3,500.00" "$7,420.00" "$11,753.28" $337.38 "$11,872.00" "$3,725.00" "$14,840.00" $337.38 "$8,607.20" "$14,840.00" $346.41 $337.38 "$14,840.00" $337.38 N/A N/A 36100621 EAP CPT® 36571 INS PERH CVC W/ PORT >5 SPV BOTH IP/OP "$10,048.00" "$7,436.00" $313.46 "$8,038.40" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$2,815.92" "$2,815.92" "$2,803.47" "$2,094.25" "$2,815.92" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$2,094.11" "$4,505.48" "$4,297.64" "$3,856.00" "$2,815.92" $313.46 "$2,815.92" "$2,956.72" "$7,536.00" "$2,815.92" "$2,815.92" "$2,815.92" "$3,500.00" "$2,975.00" "$7,958.02" "$2,815.92" "$8,038.40" "$3,725.00" "$1,994.28" "$2,815.92" "$5,827.84" "$2,956.72" "$4,073.93" "$2,815.92" "$2,094.00" "$2,815.92" N/A N/A 36100622 EAP CPT® 36575 REPAIR CV CATH WO PORT/PUMP BOTH IP/OP "$4,589.00" "$3,396.00" $33.23 "$4,589.00" "$4,589.00" "$4,589.00" "$4,589.00" "$4,589.00" $33.98 $33.98 $34.57 "$4,589.00" $33.98 "$4,589.00" "$4,589.00" "$4,589.00" "$4,589.00" $956.40 $54.37 $53.17 "$4,589.00" $33.98 $33.23 $33.98 "$4,589.00" "$3,441.75" $33.98 $33.98 $33.98 "$2,851.00" "$2,294.50" "$3,634.49" $33.98 "$3,671.20" "$2,150.00" "$4,589.00" $33.98 "$2,661.62" "$4,589.00" $36.42 $33.98 "$4,589.00" $33.98 N/A N/A 36100623 EAP CPT® 36575 REPAIR TUN/N-TUN CVC WO PT SPV BOTH IP/OP "$4,589.00" "$3,396.00" $33.23 "$4,589.00" "$4,589.00" "$4,589.00" "$4,589.00" "$4,589.00" $33.98 $33.98 $34.57 "$4,589.00" $33.98 "$4,589.00" "$4,589.00" "$4,589.00" "$4,589.00" $956.40 $54.37 $53.17 "$4,589.00" $33.98 $33.23 $33.98 "$4,589.00" "$3,441.75" $33.98 $33.98 $33.98 "$2,851.00" "$2,294.50" "$3,634.49" $33.98 "$3,671.20" "$2,150.00" "$4,589.00" $33.98 "$2,661.62" "$4,589.00" $36.42 $33.98 "$4,589.00" $33.98 N/A N/A 36100624 EAP CPT® 36576 REPAIR CVC W/PORT/PUMP SPV BOTH IP/OP "$4,589.00" "$3,396.00" $183.84 "$4,589.00" "$4,589.00" "$4,589.00" "$4,589.00" "$4,589.00" $186.23 $186.23 $186.14 "$4,589.00" $186.23 "$4,589.00" "$4,589.00" "$4,589.00" "$4,589.00" $956.40 $297.97 $294.14 "$4,589.00" $186.23 $183.84 $186.23 "$4,589.00" "$3,441.75" $186.23 $186.23 $186.23 "$2,851.00" "$2,294.50" "$3,634.49" $186.23 "$3,671.20" "$2,500.00" "$4,589.00" $186.23 "$2,661.62" "$4,589.00" $192.87 $186.23 "$4,589.00" $186.23 N/A N/A 36100626 EAP CPT® 36578 REPLCE CAT CVC W/PORT/PUMP SPV BOTH IP/OP "$12,764.00" "$9,445.50" $204.21 "$12,764.00" "$12,764.00" "$12,764.00" "$12,764.00" "$12,764.00" $204.77 $204.77 $204.45 "$12,764.00" $204.77 "$12,764.00" "$12,764.00" "$12,764.00" "$12,764.00" "$2,660.16" $327.63 $326.74 "$12,764.00" $204.77 $204.21 $204.77 "$12,764.00" "$9,573.00" $204.77 $204.77 $204.77 "$2,851.00" "$6,382.00" "$10,109.09" $204.77 "$10,211.20" "$3,725.00" "$12,764.00" $204.77 "$7,403.12" "$12,764.00" $212.34 $204.77 "$12,764.00" $204.77 N/A N/A 36100627 EAP CPT® 36580 REPLACE CV CATH NON-TUN WO POR BOTH IP/OP "$6,828.00" "$5,053.00" $65.47 "$6,828.00" "$6,828.00" "$6,828.00" "$6,828.00" "$6,828.00" $65.85 $65.85 $66.11 "$6,828.00" $65.85 "$6,828.00" "$6,828.00" "$6,828.00" "$6,828.00" "$1,423.03" $105.36 $104.75 "$6,828.00" $65.85 $65.47 $65.85 "$6,828.00" "$5,121.00" $65.85 $65.85 $65.85 "$2,762.00" "$3,414.00" "$5,407.78" $65.85 "$5,462.40" "$2,500.00" "$6,828.00" $65.85 "$3,960.24" "$6,828.00" $68.88 $65.85 "$6,828.00" $65.85 N/A N/A 36100628 EAP CPT® 36580 REPLCE NON-TUN CVC WO PORT SPV BOTH IP/OP "$8,234.00" "$6,093.50" $65.47 "$8,234.00" "$8,234.00" "$8,234.00" "$8,234.00" "$8,234.00" $65.85 $65.85 $66.11 "$8,234.00" $65.85 "$8,234.00" "$8,234.00" "$8,234.00" "$8,234.00" "$1,716.06" $105.36 $104.75 "$8,234.00" $65.85 $65.47 $65.85 "$8,234.00" "$6,175.50" $65.85 $65.85 $65.85 "$2,762.00" "$4,117.00" "$6,521.33" $65.85 "$6,587.20" "$2,500.00" "$8,234.00" $65.85 "$4,775.72" "$8,234.00" $68.88 $65.85 "$8,234.00" $65.85 N/A N/A 36100629 EAP CPT® 36581 REPLCE TUN CVC W/O PORT SPV BOTH IP/OP "$5,567.00" "$4,120.00" $182.42 "$4,505.48" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,815.92" "$2,815.92" "$2,803.47" "$1,160.30" "$2,815.92" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$1,160.22" "$4,505.48" "$4,297.64" "$2,836.00" "$2,815.92" $182.42 "$2,815.92" "$2,956.72" "$4,175.25" "$2,815.92" "$2,815.92" "$2,815.92" "$2,851.00" "$2,423.00" "$4,409.06" "$2,815.92" "$4,453.60" "$3,725.00" "$1,104.91" "$2,815.92" "$3,228.86" "$2,956.72" "$4,073.93" "$2,815.92" "$1,160.16" "$2,815.92" N/A N/A 36100630 EAP CPT® 36582 REPLCE TUN CVC W/ PORT SPV BOTH IP/OP "$22,026.00" "$16,299.50" $287.30 "$22,026.00" "$22,026.00" "$22,026.00" "$22,026.00" "$22,026.00" $290.08 $290.08 $290.90 "$22,026.00" $290.08 "$22,026.00" "$22,026.00" "$22,026.00" "$22,026.00" "$4,590.46" $464.13 $459.68 "$22,026.00" $290.08 $287.30 $290.08 "$22,026.00" "$16,519.50" $290.08 $290.08 $290.08 "$3,500.00" "$11,013.00" "$17,444.59" $290.08 "$17,620.80" "$3,725.00" "$22,026.00" $290.08 "$12,775.08" "$22,026.00" $302.85 $290.08 "$22,026.00" $290.08 N/A N/A 36100631 EAP CPT® 36583 REPLCE TUN CVC W/PUMP SPV BOTH IP/OP "$34,457.00" "$25,498.50" $331.53 "$34,457.00" "$34,457.00" "$34,457.00" "$34,457.00" "$34,457.00" $333.96 $333.96 $333.69 "$34,457.00" $333.96 "$34,457.00" "$34,457.00" "$34,457.00" "$34,457.00" "$7,181.22" $534.34 $530.45 "$34,457.00" $333.96 $331.53 $333.96 "$34,457.00" "$25,842.75" $333.96 $333.96 $333.96 "$3,500.00" "$17,228.50" "$27,289.94" $333.96 "$27,565.60" "$3,725.00" "$34,457.00" $333.96 "$19,985.06" "$34,457.00" $342.80 $333.96 "$34,457.00" $333.96 N/A N/A 36100632 EAP CPT® 36584 REPLACE PICC WO PORT/PUMP BOTH IP/OP "$8,528.00" "$6,311.00" $58.32 "$8,528.00" "$8,528.00" "$8,528.00" "$8,528.00" "$8,528.00" $58.78 $58.78 $60.25 "$8,528.00" $58.78 "$8,528.00" "$8,528.00" "$8,528.00" "$8,528.00" "$1,777.33" $94.05 $93.31 "$8,528.00" $58.78 $58.32 $58.78 "$8,528.00" "$6,396.00" $58.78 $58.78 $58.78 "$2,762.00" "$4,264.00" "$6,754.18" $58.78 "$6,822.40" "$2,500.00" "$8,528.00" $58.78 "$4,946.24" "$8,528.00" $62.39 $58.78 "$8,528.00" $58.78 N/A N/A 36100634 EAP CPT® 36584 REPLCE COMP PICC W/O PORT SPV BOTH IP/OP "$10,284.00" "$7,610.50" $58.32 "$10,284.00" "$10,284.00" "$10,284.00" "$10,284.00" "$10,284.00" $58.78 $58.78 $60.25 "$10,284.00" $58.78 "$10,284.00" "$10,284.00" "$10,284.00" "$10,284.00" "$2,143.30" $94.05 $93.31 "$10,284.00" $58.78 $58.32 $58.78 "$10,284.00" "$7,713.00" $58.78 $58.78 $58.78 "$2,762.00" "$5,142.00" "$8,144.93" $58.78 "$8,227.20" "$2,500.00" "$10,284.00" $58.78 "$5,964.72" "$10,284.00" $62.39 $58.78 "$10,284.00" $58.78 N/A N/A 36100635 EAP CPT® 36585 REPLCE COMP PICC W/PORT SPV BOTH IP/OP "$17,895.00" "$13,242.50" $281.83 "$14,316.00" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$2,815.92" "$2,815.92" "$2,803.47" "$3,729.77" "$2,815.92" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$3,729.51" "$4,505.48" "$4,297.64" "$3,856.00" "$2,815.92" $281.83 "$2,815.92" "$2,956.72" "$13,421.25" "$2,815.92" "$2,815.92" "$2,815.92" "$3,500.00" "$2,975.00" "$14,172.84" "$2,815.92" "$14,316.00" "$3,725.00" "$3,551.71" "$2,815.92" "$10,379.10" "$2,956.72" "$4,073.93" "$2,815.92" "$3,729.32" "$2,815.92" N/A N/A 36100636 EAP CPT® 36589 REMOVAL TUN CVC W/O PORT SPV BOTH IP/OP "$4,906.00" "$3,630.50" $136.99 "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" $138.27 $138.27 $139.41 "$4,906.00" $138.27 "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$1,022.46" $221.23 $219.18 "$4,906.00" $138.27 $136.99 $138.27 "$4,906.00" "$3,679.50" $138.27 $138.27 $138.27 "$2,762.00" "$2,453.00" "$3,885.55" $138.27 "$3,924.80" "$2,150.00" "$4,906.00" $531.70 "$2,845.48" "$4,906.00" $143.13 $138.27 "$4,906.00" $138.27 N/A N/A 36100638 EAP CPT® 36590 REMOVAL TUN CVC W/PORT SPV BOTH IP/OP "$4,906.00" "$3,630.50" $190.60 "$3,924.80" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,383.25" "$1,383.25" "$1,377.13" "$1,022.53" "$1,383.25" "$1,257.08" "$1,257.08" "$1,305.43" $882.37 "$1,022.46" "$2,213.20" "$2,146.46" "$1,871.00" "$1,383.25" $190.60 "$1,383.25" "$1,452.41" "$3,679.50" "$1,383.25" "$1,383.25" "$1,383.25" "$2,762.00" "$2,348.00" "$3,885.55" "$1,383.25" "$3,924.80" "$2,500.00" $973.72 "$1,383.25" "$2,845.48" "$1,452.41" "$2,001.22" "$1,383.25" "$1,022.41" "$1,383.25" N/A N/A 36100639 EAP CPT® 36590 REMOVE CV CATH BOTH IP/OP "$4,068.00" "$3,010.50" $190.60 "$3,254.40" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,383.25" "$1,383.25" "$1,377.13" $847.87 "$1,383.25" "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $847.82 "$2,213.20" "$2,146.46" "$1,871.00" "$1,383.25" $190.60 "$1,383.25" "$1,452.41" "$3,051.00" "$1,383.25" "$1,383.25" "$1,383.25" "$2,762.00" "$2,348.00" "$3,221.86" "$1,383.25" "$3,254.40" "$2,500.00" $807.40 "$1,383.25" "$2,359.44" "$1,452.41" "$2,001.22" "$1,383.25" $847.77 "$1,383.25" N/A N/A 36100640 EAP CPT® 36591 BLOOD DRAW CENTRAL LINE BOTH IP/OP $311.00 $230.50 $27.06 $311.00 $168.87 $168.87 $168.87 $168.87 $110.92 $110.92 $110.43 $64.82 $110.92 $311.00 $311.00 $311.00 $311.00 $64.82 $177.47 $167.51 $113.00 $110.92 $27.06 $110.92 $116.46 $233.25 $110.92 $110.92 $110.92 $311.00 $155.50 $246.31 $110.92 $248.80 $311.00 $61.73 $110.92 $180.38 $116.46 $160.47 $110.92 $64.81 $110.92 N/A N/A 36100642 EAP CPT® 36593 DECLOT VASCULAR ACCESS DEVICE BOTH IP/OP "$2,043.00" "$1,512.00" $33.49 "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" $313.64 $313.64 $312.26 $425.81 $313.64 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $425.78 $501.83 $479.85 $113.00 $313.64 $33.49 $313.64 $329.33 "$1,532.25" $313.64 $313.64 $313.64 "$2,043.00" "$1,021.50" "$1,618.06" $313.64 "$1,634.40" "$1,750.00" $405.48 $313.64 "$1,184.94" $329.33 $453.76 $313.64 $425.76 $313.64 N/A N/A 36100645 EAP CPT® 36595 MECH REMOVAL OBSTR CVC SPV BOTH IP/OP "$16,371.00" "$12,115.00" $179.40 "$16,371.00" "$16,371.00" "$16,371.00" "$16,371.00" "$16,371.00" $181.65 $181.65 $183.53 "$16,371.00" $181.65 "$16,371.00" "$16,371.00" "$16,371.00" "$16,371.00" "$3,411.90" $290.64 $287.04 "$16,371.00" $181.65 $179.40 $181.65 "$16,371.00" "$12,278.25" $181.65 $181.65 $181.65 "$3,500.00" "$8,185.50" "$12,965.83" $181.65 "$13,096.80" "$3,725.00" "$16,371.00" $181.65 "$9,495.18" "$16,371.00" $190.04 $181.65 "$16,371.00" $181.65 N/A N/A 36100646 EAP CPT® 36596 MECH REMOVAL CATH OBST CVC SPV BOTH IP/OP "$5,648.00" "$4,180.00" $43.95 "$5,648.00" "$5,648.00" "$5,648.00" "$5,648.00" "$5,648.00" $44.28 $44.28 $43.95 "$5,648.00" $44.28 "$5,648.00" "$5,648.00" "$5,648.00" "$5,648.00" "$1,177.11" $70.85 $70.53 "$5,648.00" $44.28 $44.08 $44.28 "$5,648.00" "$4,236.00" $44.28 $44.28 $44.28 "$2,762.00" "$2,824.00" "$4,473.22" $44.28 "$4,518.40" "$2,500.00" "$5,648.00" $44.28 "$3,275.84" "$5,648.00" $45.43 $44.28 "$5,648.00" $44.28 N/A N/A 36100647 EAP CPT® 36597 REPOSIT CVC W/ FLUORO GUID SPV BOTH IP/OP "$8,057.00" "$5,962.50" $59.79 "$8,057.00" "$8,057.00" "$8,057.00" "$8,057.00" "$8,057.00" $59.79 $59.79 $60.91 "$8,057.00" $59.79 "$8,057.00" "$8,057.00" "$8,057.00" "$8,057.00" "$1,679.17" $95.66 $97.15 "$8,057.00" $59.79 $60.72 $59.79 "$8,057.00" "$6,042.75" $59.79 $59.79 $59.79 "$2,762.00" "$4,028.50" "$6,381.14" $59.79 "$6,445.60" "$2,500.00" "$8,057.00" $59.79 "$4,673.06" "$8,057.00" $63.11 $59.79 "$8,057.00" $59.79 N/A N/A 36100648 EAP CPT® 36598 "INJ W/FLURO, EVAL CV DEVICE" BOTH IP/OP "$1,173.00" $868.50 $35.60 "$1,173.00" "$1,173.00" "$1,173.00" "$1,173.00" "$1,173.00" $201.23 $201.23 $200.34 $244.48 $201.23 "$1,173.00" "$1,173.00" "$1,173.00" $882.37 $244.47 $321.97 $298.01 "$1,173.00" $201.23 $35.60 $201.23 $211.29 $879.75 $201.23 $201.23 $201.23 "$1,173.00" $586.50 $929.02 $201.23 $938.40 "$1,173.00" $232.81 $201.23 $680.34 $211.29 $291.13 $201.23 $244.45 $201.23 N/A N/A 36100649 EAP CPT® 36600 ARTERIAL PUNCTURE BOTH IP/OP $302.00 $223.50 $14.91 $302.00 $163.99 $163.99 $163.99 $163.99 $110.92 $110.92 $110.43 $62.94 $110.92 $302.00 $302.00 $302.00 $302.00 $62.94 $177.47 $167.51 $113.00 $110.92 $14.91 $110.92 $116.46 $226.50 $110.92 $110.92 $110.92 $302.00 $151.00 $239.18 $110.92 $241.60 $302.00 $59.94 $110.92 $175.16 $116.46 $160.47 $110.92 $62.94 $110.92 N/A N/A 36100650 EAP CPT® 20610 BILATERAL DRAIN/INJECT-SHOULDER HIP KNEE WO US GUIDANCE BOTH IP/OP "$4,395.00" "$3,252.50" $45.44 "$3,516.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $257.00 $257.00 $255.86 $916.03 $257.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $915.97 $411.20 $392.25 "$1,871.00" $257.00 $45.44 $257.00 $269.85 "$3,296.25" $257.00 $257.00 $257.00 "$2,762.00" "$2,348.00" "$3,480.84" $257.00 "$3,516.00" "$1,750.00" $872.30 $257.00 "$2,549.10" $269.85 $371.81 $257.00 $915.92 $257.00 N/A N/A 36100652 EAP CPT® 36620 ARTERIAL LINE INSERT BOTH IP/OP "$1,575.00" "$1,165.50" $44.43 "$2,277.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$2,277.00" $931.61 "$1,575.00" $44.43 "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 "$1,247.40" "$1,575.00" "$1,260.00" "$1,575.00" $312.60 "$1,575.00" $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 36100655 EAP CPT® 36860 CANNULA DECLOT W/O BALLOON BOTH IP/OP "$9,536.00" "$7,057.00" $111.04 "$9,536.00" "$9,536.00" "$9,536.00" "$9,536.00" "$9,536.00" $111.42 $111.42 $111.39 "$9,536.00" $111.42 "$9,536.00" "$9,536.00" "$9,536.00" "$9,536.00" "$1,987.41" $178.27 $177.66 "$9,536.00" $111.42 $111.04 $111.42 "$9,536.00" "$7,152.00" $111.42 $111.42 $111.42 "$2,851.00" "$4,768.00" "$7,552.51" $111.42 "$7,628.80" "$1,750.00" "$9,536.00" $111.42 "$5,530.88" "$9,536.00" $116.45 $111.42 "$9,536.00" $111.42 N/A N/A 36100657 EAP CPT® 37182 INSERT HEPATIC SHUNT (TIPS) BOTH IP/OP "$15,415.00" "$11,407.50" $805.40 "$15,415.00" "$15,415.00" "$15,415.00" "$15,415.00" "$15,415.00" $810.55 $810.55 $817.08 "$15,415.00" $810.55 "$15,415.00" "$15,415.00" "$15,415.00" "$15,415.00" "$3,212.66" "$1,296.88" "$1,288.64" "$15,415.00" $810.55 $805.40 $810.55 "$15,415.00" "$11,561.25" $810.55 $810.55 $810.55 "$7,707.50" "$7,707.50" "$12,208.68" $810.55 "$12,332.00" "$10,019.75" "$15,415.00" $810.55 "$8,940.70" "$15,415.00" $856.17 $810.55 "$15,415.00" $810.55 N/A N/A 36100658 EAP CPT® 37183 REMOVE HEPATIC SHUNT (TIPS) BOTH IP/OP "$61,100.00" "$45,214.00" $369.98 "$48,880.00" "$5,681.00" "$5,681.00" "$5,681.00" "$5,681.00" "$4,875.41" "$4,875.41" "$4,853.85" "$9,417.94" "$4,875.41" "$3,116.95" "$3,116.95" "$3,236.84" "$2,187.86" "$12,733.91" "$7,800.66" "$7,524.05" "$4,877.00" "$4,875.41" $369.98 "$4,875.41" "$5,119.18" "$45,825.00" "$4,875.41" "$4,875.41" "$4,875.41" "$6,095.00" "$5,161.00" "$48,391.20" "$4,875.41" "$48,880.00" "$5,164.00" "$7,712.84" "$4,875.41" "$35,438.00" "$5,119.18" "$7,053.49" "$4,875.41" "$8,098.48" "$4,875.41" N/A N/A 36100659 EAP CPT® 37184 PRIM ART MECH THROMBECTOMY BOTH IP/OP "$39,064.00" "$28,907.50" $425.97 "$31,251.20" "$5,681.00" "$5,681.00" "$5,681.00" "$5,681.00" "$9,880.57" "$9,880.57" "$9,836.87" "$8,141.91" "$9,880.57" "$3,116.95" "$3,116.95" "$3,236.84" "$2,187.86" "$8,141.37" "$15,808.91" "$15,314.28" "$9,641.00" "$9,880.57" $425.97 "$9,880.57" "$10,374.60" "$29,298.00" "$9,880.57" "$9,880.57" "$9,880.57" "$4,780.00" "$4,063.00" "$30,938.69" "$9,880.57" "$31,251.20" "$4,334.00" "$7,712.84" "$9,880.57" "$22,657.12" "$10,374.60" "$14,294.69" "$9,880.57" "$8,098.48" "$9,880.57" N/A N/A 36100660 EAP CPT® 37185 PRIM ART M-THROMBECT ADD-ON BOTH IP/OP "$36,020.00" "$26,655.00" $161.26 "$36,020.00" "$36,020.00" "$36,020.00" "$36,020.00" "$36,020.00" $161.79 $161.79 $163.16 "$36,020.00" $161.79 "$36,020.00" "$36,020.00" "$36,020.00" "$36,020.00" "$7,506.96" $258.86 $258.02 "$36,020.00" $161.79 $161.26 $161.79 "$36,020.00" "$27,015.00" $161.79 $161.79 $161.79 "$18,010.00" "$18,010.00" "$28,527.84" $161.79 "$28,816.00" "$1,750.00" "$36,020.00" $161.79 "$20,891.60" "$36,020.00" $171.99 $161.79 "$36,020.00" $161.79 N/A N/A 36100661 EAP CPT® 37186 SEC ART THROMBECT ADD-ON BOTH IP/OP "$31,656.00" "$23,425.50" $240.02 "$31,656.00" "$31,656.00" "$31,656.00" "$31,656.00" "$31,656.00" $242.71 $242.71 $244.51 "$31,656.00" $242.71 "$31,656.00" "$31,656.00" "$31,656.00" "$31,656.00" "$6,597.46" $388.34 $384.03 "$31,656.00" $242.71 $240.02 $242.71 "$31,656.00" "$23,742.00" $242.71 $242.71 $242.71 "$15,828.00" "$15,828.00" "$25,071.55" $242.71 "$25,324.80" "$1,750.00" "$31,656.00" $242.71 "$18,360.48" "$31,656.00" $255.65 $242.71 "$31,656.00" $242.71 N/A N/A 36100662 EAP CPT® 37187 VENOUS MECH THROMBECTOMY BOTH IP/OP "$19,167.00" "$14,184.00" $387.82 "$19,167.00" "$19,167.00" "$19,167.00" "$19,167.00" "$19,167.00" $391.39 $391.39 $393.38 "$19,167.00" $391.39 "$19,167.00" "$19,167.00" "$19,167.00" "$19,167.00" "$3,994.61" $626.22 $620.51 "$19,167.00" $391.39 $387.82 $391.39 "$19,167.00" "$14,375.25" $391.39 $391.39 $391.39 "$4,780.00" "$9,583.50" "$15,180.26" $391.39 "$15,333.60" "$4,334.00" "$19,167.00" $391.39 "$11,116.86" "$19,167.00" $411.44 $391.39 "$19,167.00" $391.39 N/A N/A 36100663 EAP CPT® 37188 VENOUS M-THROMBECTOMY ADD-ON BOTH IP/OP "$15,850.00" "$11,729.00" $276.95 "$15,850.00" "$15,850.00" "$15,850.00" "$15,850.00" "$15,850.00" $276.95 $276.95 $278.30 "$15,850.00" $276.95 "$15,850.00" "$15,850.00" "$15,850.00" "$15,850.00" "$3,303.31" $443.12 $444.11 "$15,850.00" $276.95 $277.57 $276.95 "$15,850.00" "$11,887.50" $276.95 $276.95 $276.95 "$4,780.00" "$7,925.00" "$12,553.20" $276.95 "$12,680.00" "$4,334.00" "$15,850.00" $276.95 "$9,193.00" "$15,850.00" $292.07 $276.95 "$15,850.00" $276.95 N/A N/A 36100664 EAP CPT® 37195 "THROMBOLYTIC THERAPY, STROKE" BOTH IP/OP "$14,728.00" "$10,899.00" $309.38 "$14,728.00" "$14,728.00" "$14,728.00" "$14,728.00" "$14,728.00" "$14,728.00" "$14,728.00" $309.38 "$14,728.00" "$14,728.00" "$14,728.00" "$14,728.00" "$14,728.00" "$14,728.00" "$3,069.48" "$14,728.00" $563.20 "$14,728.00" "$14,728.00" "$1,408.00" "$14,728.00" "$14,728.00" "$11,046.00" "$14,728.00" "$14,728.00" "$14,728.00" "$2,762.00" "$7,364.00" "$11,664.58" "$14,728.00" "$11,782.40" "$1,750.00" "$14,728.00" "$14,728.00" "$8,542.24" "$14,728.00" "$8,836.80" "$14,728.00" "$14,728.00" "$14,728.00" N/A N/A 36100665 EAP CPT® 37200 TRANSCATHETER BIOPSY BOTH IP/OP "$17,005.00" "$12,584.00" $211.96 "$13,604.00" "$3,558.00" "$3,558.00" "$3,558.00" "$3,558.00" "$4,690.83" "$4,690.83" "$4,670.08" "$3,544.27" "$4,690.83" "$2,192.53" "$2,192.53" "$2,276.86" "$1,538.39" "$3,544.03" "$7,505.33" "$7,414.92" "$1,871.00" "$4,690.83" $211.96 "$4,690.83" "$4,925.37" "$12,753.75" "$4,690.83" "$4,690.83" "$4,690.83" "$2,762.00" "$2,348.00" "$13,467.96" "$4,690.83" "$13,604.00" "$3,725.00" "$3,375.07" "$4,690.83" "$9,862.90" "$4,925.37" "$6,786.45" "$4,690.83" "$3,543.84" "$4,690.83" N/A N/A 36100681 EAP CPT® 37215 "TRANSCATH STENT, CCA W/EPS" BOTH IP/OP "$18,633.00" "$13,788.50" $985.01 "$18,633.00" "$18,633.00" "$18,633.00" "$18,633.00" "$18,633.00" $993.57 $993.57 $999.68 "$18,633.00" $993.57 "$18,633.00" "$18,633.00" "$18,633.00" "$18,633.00" "$3,883.32" "$1,589.71" "$1,576.02" "$18,633.00" $993.57 $985.01 $993.57 "$18,633.00" "$13,974.75" $993.57 $993.57 $993.57 "$9,316.50" "$9,316.50" "$14,757.34" $993.57 "$14,906.40" "$12,111.45" "$18,633.00" $993.57 "$10,807.14" "$18,633.00" "$1,046.93" $993.57 "$18,633.00" $993.57 N/A N/A 36100682 EAP CPT® 37216 "TRANSCATH STENT, CCA W/O EPS" BOTH IP/OP "$21,388.00" "$15,827.50" $988.62 "$21,388.00" "$21,388.00" "$21,388.00" "$21,388.00" "$21,388.00" "$21,388.00" "$21,388.00" $988.62 "$21,388.00" "$21,388.00" "$21,388.00" "$21,388.00" "$21,388.00" "$21,388.00" "$4,457.49" "$21,388.00" "$4,650.80" "$21,388.00" "$21,388.00" "$11,627.00" "$21,388.00" "$21,388.00" "$16,041.00" "$21,388.00" "$21,388.00" "$21,388.00" "$10,694.00" "$10,694.00" "$16,939.30" "$21,388.00" "$17,110.40" "$13,902.20" "$21,388.00" "$21,388.00" "$12,405.04" "$21,388.00" "$12,832.80" "$21,388.00" "$21,388.00" "$21,388.00" N/A N/A 36100685 EAP CPT® 37609 TEMPORAL ARTERY BIOPSY BOTH IP/OP "$10,925.00" "$8,084.50" $206.90 "$10,925.00" "$10,925.00" "$10,925.00" "$10,925.00" "$10,925.00" $207.08 $207.08 $207.43 "$10,925.00" $207.08 "$10,925.00" "$10,925.00" "$10,925.00" "$10,925.00" "$2,276.89" $331.33 $331.04 "$10,925.00" $207.08 $206.90 $207.08 "$10,925.00" "$8,193.75" $207.08 $207.08 $207.08 "$2,851.00" "$5,462.50" "$8,652.60" $207.08 "$8,740.00" "$2,500.00" "$10,925.00" $207.08 "$6,336.50" "$10,925.00" $214.12 $207.08 "$10,925.00" $207.08 N/A N/A 36100687 EAP CPT® 37765 PHLEB VEINS-EXTREM-UP TO 20 BOTH IP/OP "$17,595.00" "$13,020.50" $270.17 "$17,595.00" "$17,595.00" "$17,595.00" "$17,595.00" "$17,595.00" $272.18 $272.18 $272.41 "$17,595.00" $272.18 "$17,595.00" "$17,595.00" "$17,595.00" "$17,595.00" "$3,666.99" $435.49 $432.27 "$17,595.00" $272.18 $270.17 $272.18 "$17,595.00" "$13,196.25" $272.18 $272.18 $272.18 "$2,851.00" "$8,797.50" "$13,935.24" $272.18 "$14,076.00" "$3,725.00" "$17,595.00" $272.18 "$10,205.10" "$17,595.00" $284.09 $272.18 "$17,595.00" $272.18 N/A N/A 36100688 EAP CPT® 37766 PHLEB VEINS-EXTREM-20+ BOTH IP/OP "$17,362.00" "$12,848.00" $330.59 "$17,362.00" "$17,362.00" "$17,362.00" "$17,362.00" "$17,362.00" $333.20 $333.20 $333.06 "$17,362.00" $333.20 "$17,362.00" "$17,362.00" "$17,362.00" "$17,362.00" "$3,618.43" $533.12 $528.94 "$17,362.00" $333.20 $330.59 $333.20 "$17,362.00" "$13,021.50" $333.20 $333.20 $333.20 "$2,851.00" "$8,681.00" "$13,750.70" $333.20 "$13,889.60" "$3,725.00" "$17,362.00" $333.20 "$10,069.96" "$17,362.00" $347.91 $333.20 "$17,362.00" $333.20 N/A N/A 36100689 EAP CPT® 37799 VASCULAR SURGERY PROCEDURE BOTH IP/OP "$11,080.00" "$8,199.50" "$1,750.00" "$11,080.00" "$11,080.00" "$11,080.00" "$11,080.00" "$11,080.00" "$11,080.00" "$11,080.00" "$11,080.00" "$11,080.00" "$11,080.00" "$11,080.00" "$11,080.00" "$11,080.00" "$11,080.00" "$2,309.19" "$11,080.00" "$4,432.00" "$11,080.00" "$11,080.00" "$11,080.00" "$11,080.00" "$11,080.00" "$8,310.00" "$11,080.00" "$11,080.00" "$11,080.00" "$2,762.00" "$5,540.00" "$8,775.36" "$11,080.00" "$8,864.00" "$1,750.00" "$11,080.00" "$11,080.00" "$6,426.40" "$11,080.00" "$6,648.00" "$11,080.00" "$11,080.00" "$11,080.00" N/A N/A 36100690 EAP CPT® 38200 SPLENOPORTOGRAPHY INJ BOTH IP/OP "$1,250.00" $925.00 $129.85 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $131.40 $131.40 $132.17 "$1,250.00" $131.40 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 $210.24 $207.76 "$1,250.00" $131.40 $129.85 $131.40 "$1,250.00" $937.50 $131.40 $131.40 $131.40 "$1,250.00" $625.00 $990.00 $131.40 "$1,000.00" "$1,250.00" "$1,250.00" $131.40 $725.00 "$1,250.00" $138.84 $131.40 "$1,250.00" $131.40 N/A N/A 36100691 EAP CPT® 38220 DIAGNOSTIC BONE MARROW; ASPIRATION(S) BOTH IP/OP "$1,504.00" "$1,113.00" $67.78 "$1,504.00" "$1,504.00" "$1,504.00" "$1,504.00" "$1,504.00" $68.52 $68.52 $70.22 "$1,504.00" $68.52 "$1,504.00" "$1,504.00" "$1,504.00" "$1,504.00" $313.45 $109.63 $108.45 "$1,504.00" $68.52 $67.78 $68.52 "$1,504.00" "$1,128.00" $68.52 $68.52 $68.52 "$1,504.00" $752.00 "$1,191.17" $68.52 "$1,203.20" "$1,504.00" "$1,504.00" $68.52 $872.32 "$1,504.00" $72.47 $68.52 "$1,504.00" $68.52 N/A N/A 36100693 EAP CPT® 38221 DIAGNOSTIC BONE MARROW; BIOPSY(IES) BOTH IP/OP "$1,527.00" "$1,130.00" $70.15 "$1,527.00" "$1,527.00" "$1,527.00" "$1,527.00" "$1,527.00" $71.29 $71.29 $70.49 "$1,527.00" $71.29 "$1,527.00" "$1,527.00" "$1,527.00" "$1,527.00" $318.24 $114.06 $112.24 "$1,527.00" $71.29 $70.15 $71.29 "$1,527.00" "$1,145.25" $71.29 $71.29 $71.29 "$1,527.00" $763.50 "$1,209.38" $71.29 "$1,221.60" "$1,527.00" "$1,527.00" "$1,384.05" $885.66 "$1,527.00" $72.12 $71.29 "$1,527.00" $71.29 N/A N/A 36100695 EAP CPT® 38505 BX LYMPH NODE(S) NDL BCT BOTH IP/OP "$1,805.00" "$1,336.00" $86.11 "$2,214.48" "$1,805.00" "$1,805.00" "$1,805.00" "$1,805.00" "$1,384.05" "$1,384.05" "$1,377.93" $376.21 "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $376.18 "$2,214.48" "$2,163.34" "$1,805.00" "$1,384.05" $86.11 "$1,384.05" "$1,453.25" "$1,353.75" "$1,384.05" "$1,384.05" "$1,384.05" "$1,805.00" $902.50 "$1,429.56" "$1,384.05" "$1,444.00" "$1,805.00" $358.25 "$1,384.05" "$1,046.90" "$1,453.25" "$1,805.00" "$1,384.05" $376.16 "$1,384.05" N/A N/A 36100696 EAP CPT® 38525 "BX, OPEN DEEP AX NODE" BOTH IP/OP "$5,701.00" "$4,219.00" $447.79 "$5,701.00" "$5,701.00" "$5,701.00" "$5,701.00" "$5,701.00" $449.43 $449.43 $447.79 "$5,701.00" $449.43 "$5,701.00" "$5,701.00" "$5,701.00" "$5,701.00" "$1,188.15" $719.09 $717.58 "$5,701.00" $449.43 $448.49 $449.43 "$5,701.00" "$4,275.75" $449.43 $449.43 $449.43 "$2,851.00" "$2,850.50" "$4,515.19" $449.43 "$4,560.80" "$3,250.00" "$5,701.00" $449.43 "$3,306.58" "$5,701.00" $457.78 $449.43 "$5,701.00" $449.43 N/A N/A 36100697 EAP CPT® 38790 INJ LYMPHANGIOGRAPHY BOTH IP/OP "$4,411.00" "$3,264.50" $81.64 "$4,411.00" "$4,411.00" "$4,411.00" "$4,411.00" "$4,411.00" $81.64 $81.64 $82.28 "$4,411.00" $81.64 "$4,411.00" "$4,411.00" "$4,411.00" "$4,411.00" $919.30 $130.62 $131.82 "$4,411.00" $81.64 $82.39 $81.64 "$4,411.00" "$3,308.25" $81.64 $81.64 $81.64 "$2,205.50" "$2,205.50" "$3,493.51" $81.64 "$3,528.80" "$1,750.00" "$4,411.00" $81.64 "$2,558.38" "$4,411.00" $85.08 $81.64 "$4,411.00" $81.64 N/A N/A 36100698 EAP CPT® 38792 IDENTIFY SENTINEL NODE BOTH IP/OP $485.00 $359.00 $32.56 $593.29 $485.00 $485.00 $485.00 $485.00 $370.81 $370.81 $369.17 $101.09 $370.81 $485.00 $485.00 $485.00 $485.00 $101.08 $593.29 $560.74 $485.00 $370.81 $32.56 $370.81 $389.35 $363.75 $370.81 $370.81 $370.81 $485.00 $242.50 $384.12 $370.81 $388.00 $485.00 $96.26 $370.81 $281.30 $389.35 $485.00 $370.81 $101.07 $370.81 N/A N/A 36100699 EAP CPT® 40490 BIOPSY OF LIP BOTH IP/OP $578.00 $428.00 $69.49 $578.00 $313.85 $313.85 $313.85 $313.85 $208.11 $208.11 $207.19 $120.47 $208.11 $578.00 $578.00 $578.00 $578.00 $120.46 $332.98 $299.82 $113.00 $208.11 $69.49 $208.11 $218.52 $433.50 $208.11 $208.11 $208.11 $578.00 $289.00 $457.78 $208.11 $462.40 $578.00 $114.72 $208.11 $335.24 $218.52 $301.08 $208.11 $120.46 $208.11 N/A N/A 36100701 EAP CPT® 40800 I&D ABSCESS INTRA-ORAL SIMPLE BOTH IP/OP $698.00 $517.00 $119.88 $698.00 $698.00 $698.00 $698.00 $698.00 $120.57 $120.57 $123.28 $698.00 $120.57 $698.00 $698.00 $698.00 $698.00 $145.47 $192.91 $191.81 $698.00 $120.57 $119.88 $120.57 $698.00 $523.50 $120.57 $120.57 $120.57 $698.00 $349.00 $552.82 $120.57 $558.40 $698.00 $698.00 $612.13 $404.84 $698.00 $128.30 $120.57 $698.00 $120.57 N/A N/A 36100702 EAP CPT® 40801 I&D ABSCESS INTRA-ORAL COMPLEX BOTH IP/OP "$1,566.00" "$1,159.00" $199.34 "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" $199.34 $199.34 $203.08 "$1,566.00" $199.34 "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" $326.37 $318.94 $319.25 "$1,566.00" $199.34 $199.53 $199.34 "$1,566.00" "$1,174.50" $199.34 $199.34 $199.34 "$1,566.00" $783.00 "$1,240.27" $199.34 "$1,252.80" "$1,566.00" "$1,566.00" $199.34 $908.28 "$1,566.00" $214.83 $199.34 "$1,566.00" $199.34 N/A N/A 36100703 EAP CPT® 40808 BIOPSY VESTIBULE OF MOUTH BOTH IP/OP $874.00 $647.00 $89.77 $874.00 $874.00 $874.00 $874.00 $874.00 $444.88 $444.88 $442.92 $182.16 $444.88 $874.00 $874.00 $874.00 $874.00 $182.15 $711.81 $659.03 $113.00 $444.88 $89.77 $444.88 $467.13 $655.50 $444.88 $444.88 $444.88 $874.00 $437.00 $692.21 $444.88 $699.20 $874.00 $173.47 $444.88 $506.92 $467.13 $643.63 $444.88 $182.14 $444.88 N/A N/A 36100705 EAP CPT® 40812 EXC/LES/MOUTH W/SIMPLE REPAIR BOTH IP/OP "$6,659.00" "$4,928.00" $186.33 "$6,659.00" "$6,659.00" "$6,659.00" "$6,659.00" "$6,659.00" $188.27 $188.27 $189.83 "$6,659.00" $188.27 "$6,659.00" "$6,659.00" "$6,659.00" "$6,659.00" "$1,387.81" $301.23 $298.13 "$6,659.00" $188.27 $186.33 $188.27 "$6,659.00" "$4,994.25" $188.27 $188.27 $188.27 "$2,762.00" "$3,329.50" "$5,273.93" $188.27 "$5,327.20" "$2,500.00" "$6,659.00" $188.27 "$3,862.22" "$6,659.00" $196.45 $188.27 "$6,659.00" $188.27 N/A N/A 36100706 EAP CPT® 40814 EXC/LES/MOUTH W/COMPLEX REPAIR BOTH IP/OP "$5,169.00" "$3,825.50" $287.94 "$5,169.00" "$5,169.00" "$5,169.00" "$5,169.00" "$5,169.00" $288.11 $288.11 $292.28 "$5,169.00" $288.11 "$5,169.00" "$5,169.00" "$5,169.00" "$5,169.00" "$1,077.28" $460.98 $460.70 "$5,169.00" $288.11 $287.94 $288.11 "$5,169.00" "$3,876.75" $288.11 $288.11 $288.11 "$2,851.00" "$2,584.50" "$4,093.85" $288.11 "$4,135.20" "$3,359.85" "$5,169.00" $288.11 "$2,998.02" "$5,169.00" $303.13 $288.11 "$5,169.00" $288.11 N/A N/A 36100707 EAP CPT® 40819 EXC FRENUM LIBIAL BUCCAL BOTH IP/OP "$2,245.00" "$1,661.50" $200.86 "$2,245.00" "$2,245.00" "$2,245.00" "$2,245.00" "$2,245.00" $201.15 $201.15 $205.29 "$2,245.00" $201.15 "$2,245.00" "$2,245.00" "$2,245.00" "$2,245.00" $467.88 $321.84 $321.38 "$2,245.00" $201.15 $200.86 $201.15 "$2,245.00" "$1,683.75" $201.15 $201.15 $201.15 "$2,245.00" "$1,122.50" "$1,778.04" $201.15 "$1,796.00" "$2,245.00" "$2,245.00" $201.15 "$1,302.10" "$2,245.00" $218.79 $201.15 "$2,245.00" $201.15 N/A N/A 36100708 EAP CPT® 40820 DEST/LES VESTIBULE MOUTH BOTH IP/OP "$5,179.00" "$3,832.50" $168.60 "$5,179.00" "$5,179.00" "$5,179.00" "$5,179.00" "$5,179.00" $172.39 $172.39 $174.45 "$5,179.00" $172.39 "$5,179.00" "$5,179.00" "$5,179.00" "$5,179.00" "$1,079.36" $275.82 $269.76 "$5,179.00" $172.39 $168.60 $172.39 "$5,179.00" "$3,884.25" $172.39 $172.39 $172.39 "$2,762.00" "$2,589.50" "$4,101.77" $172.39 "$4,143.20" "$2,500.00" "$5,179.00" $172.39 "$3,003.82" "$5,179.00" $172.25 $172.39 "$5,179.00" $172.39 N/A N/A 36100709 EAP CPT® 41015 I&D EXTRAORAL SUBLINGUAL BOTH IP/OP $945.00 $699.50 $196.95 $945.00 $945.00 $945.00 $945.00 $945.00 $302.38 $302.38 $307.70 $945.00 $302.38 $945.00 $945.00 $945.00 $945.00 $196.95 $483.81 $482.40 $945.00 $302.38 $301.50 $302.38 $945.00 $708.75 $302.38 $302.38 $302.38 $945.00 $472.50 $748.44 $302.38 $756.00 $945.00 $945.00 $302.38 $548.10 $945.00 $321.54 $302.38 $945.00 $302.38 N/A N/A 36100710 EAP CPT® 41016 "I&D,FLOOR OF MOUTH-SUBMENTAL" BOTH IP/OP "$5,296.00" "$3,919.50" $349.57 "$5,296.00" "$5,296.00" "$5,296.00" "$5,296.00" "$5,296.00" $353.24 $353.24 $355.76 "$5,296.00" $353.24 "$5,296.00" "$5,296.00" "$5,296.00" "$5,296.00" "$1,103.74" $565.18 $559.31 "$5,296.00" $353.24 $349.57 $353.24 "$5,296.00" "$3,972.00" $353.24 $353.24 $353.24 "$2,762.00" "$2,648.00" "$4,194.43" $353.24 "$4,236.80" "$3,250.00" "$5,296.00" $353.24 "$3,071.68" "$5,296.00" $357.56 $353.24 "$5,296.00" $353.24 N/A N/A 36100711 EAP CPT® 41017 "I&D,FLOOR/MOUTH-SUBMANDIBULAR" BOTH IP/OP "$2,620.00" "$1,939.00" $347.75 "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" $347.75 $347.75 $352.34 "$2,620.00" $347.75 "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" $546.04 $556.40 $557.15 "$2,620.00" $347.75 $348.22 $347.75 "$2,620.00" "$1,965.00" $347.75 $347.75 $347.75 "$2,620.00" "$1,310.00" "$2,075.04" $347.75 "$2,096.00" "$2,500.00" "$2,620.00" $347.75 "$1,519.60" "$2,620.00" $355.40 $347.75 "$2,620.00" $347.75 N/A N/A 36100712 EAP CPT® 41018 "I&D,FLOOR OF MOUTH-MASTICATOR" BOTH IP/OP "$2,215.00" "$1,639.50" $404.35 "$2,215.00" "$2,215.00" "$2,215.00" "$2,215.00" "$2,215.00" $404.35 $404.35 $406.79 "$2,215.00" $404.35 "$2,215.00" "$2,215.00" "$2,215.00" "$2,215.00" $461.63 $646.96 $648.29 "$2,215.00" $404.35 $405.18 $404.35 "$2,215.00" "$1,661.25" $404.35 $404.35 $404.35 "$2,215.00" "$1,107.50" "$1,754.28" $404.35 "$1,772.00" "$2,150.00" "$2,215.00" $404.35 "$1,284.70" "$2,215.00" $413.10 $404.35 "$2,215.00" $404.35 N/A N/A 36100713 EAP CPT® 41100 BIOPSY ANTERIOR 2/3 OF TONGUE BOTH IP/OP $991.00 $733.50 $109.11 $991.00 $991.00 $991.00 $991.00 $991.00 $444.88 $444.88 $442.92 $206.55 $444.88 $991.00 $991.00 $991.00 $882.37 $206.54 $711.81 $659.03 $991.00 $444.88 $109.11 $444.88 $467.13 $743.25 $444.88 $444.88 $444.88 $991.00 $495.50 $784.87 $444.88 $792.80 $991.00 $196.69 $444.88 $574.78 $467.13 $643.63 $444.88 $206.52 $444.88 N/A N/A 36100715 EAP CPT® 41105 BIOPSY POSTERIOR 1/3 TONGUE BOTH IP/OP "$2,240.00" "$1,658.00" $111.82 "$4,305.68" "$2,240.00" "$2,240.00" "$2,240.00" "$2,240.00" "$2,691.05" "$2,691.05" "$2,679.15" $466.87 "$2,691.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $466.84 "$4,305.68" "$4,104.40" "$2,240.00" "$2,691.05" $111.82 "$2,691.05" "$2,825.60" "$1,680.00" "$2,691.05" "$2,691.05" "$2,691.05" "$2,240.00" "$1,120.00" "$1,774.08" "$2,691.05" "$1,792.00" "$2,240.00" $444.58 "$2,691.05" "$1,299.20" "$2,825.60" "$2,240.00" "$2,691.05" $466.82 "$2,691.05" N/A N/A 36100717 EAP CPT® 41108 "BIOPSY, FLOOR OF MOUTH" BOTH IP/OP "$1,504.00" "$1,113.00" $93.18 "$2,214.48" "$1,504.00" "$1,504.00" "$1,504.00" "$1,504.00" "$1,384.05" "$1,384.05" "$1,377.93" $313.47 "$1,384.05" "$1,504.00" "$1,504.00" "$1,504.00" "$1,082.33" $313.45 "$2,214.48" "$2,163.34" "$1,504.00" "$1,384.05" $93.18 "$1,384.05" "$1,453.25" "$1,128.00" "$1,384.05" "$1,384.05" "$1,384.05" "$1,504.00" $752.00 "$1,191.17" "$1,384.05" "$1,203.20" "$1,504.00" $298.51 "$1,384.05" $872.32 "$1,453.25" "$1,504.00" "$1,384.05" $313.43 "$1,384.05" N/A N/A 36100718 EAP CPT® 41116 EXC LESION FLOOR OF MOUTH BOTH IP/OP "$4,520.00" "$3,345.00" $218.20 "$4,520.00" "$4,520.00" "$4,520.00" "$4,520.00" "$4,520.00" $218.79 $218.79 $218.20 "$4,520.00" $218.79 "$4,520.00" "$4,520.00" "$4,520.00" "$4,520.00" $942.02 $350.06 $351.25 "$4,520.00" $218.79 $219.53 $218.79 "$4,520.00" "$3,390.00" $218.79 $218.79 $218.79 "$2,762.00" "$2,260.00" "$3,579.84" $218.79 "$3,616.00" "$3,250.00" "$4,520.00" $218.79 "$2,621.60" "$4,520.00" $222.75 $218.79 "$4,520.00" $218.79 N/A N/A 36100719 EAP CPT® 41822 EXCISION OF FIBROUS TUBEROSITY BOTH IP/OP "$4,451.00" "$3,294.00" $202.13 "$4,451.00" "$4,451.00" "$4,451.00" "$4,451.00" "$4,451.00" $202.91 $202.91 $202.13 "$4,451.00" $202.91 "$4,451.00" "$4,451.00" "$4,451.00" "$4,451.00" $927.64 $324.66 $326.98 "$4,451.00" $202.91 $204.36 $202.91 "$4,451.00" "$3,338.25" $202.91 $202.91 $202.91 "$2,762.00" "$2,225.50" "$3,525.19" $202.91 "$3,560.80" "$2,150.00" "$4,451.00" $202.91 "$2,581.58" "$4,451.00" $205.80 $202.91 "$4,451.00" $202.91 N/A N/A 36100720 EAP CPT® 41823 EXCISION OF OSSEOUSTUBEROSITY BOTH IP/OP "$4,910.00" "$3,633.50" $366.88 "$4,910.00" "$4,910.00" "$4,910.00" "$4,910.00" "$4,910.00" $369.67 $369.67 $366.88 "$4,910.00" $369.67 "$4,910.00" "$4,910.00" "$4,910.00" "$4,910.00" "$1,023.30" $591.47 $595.20 "$4,910.00" $369.67 $372.00 $369.67 "$4,910.00" "$3,682.50" $369.67 $369.67 $369.67 "$2,851.00" "$2,455.00" "$3,888.72" $369.67 "$3,928.00" "$3,250.00" "$4,910.00" $369.67 "$2,847.80" "$4,910.00" $370.12 $369.67 "$4,910.00" $369.67 N/A N/A 36100721 EAP CPT® 41826 EXC W/SIMPLE REPAIR DENTOALVEO BOTH IP/OP "$3,486.00" "$2,580.00" $199.85 "$3,486.00" "$3,486.00" "$3,486.00" "$3,486.00" "$3,486.00" $201.77 $201.77 $207.66 "$3,486.00" $201.77 "$3,486.00" "$3,486.00" "$3,486.00" "$3,486.00" $726.52 $322.83 $319.76 "$3,486.00" $201.77 $199.85 $201.77 "$3,486.00" "$2,614.50" $201.77 $201.77 $201.77 "$2,762.00" "$1,743.00" "$2,760.91" $201.77 "$2,788.80" "$2,265.90" "$3,486.00" $201.77 "$2,021.88" "$3,486.00" $211.94 $201.77 "$3,486.00" $201.77 N/A N/A 36100722 EAP CPT® 41850 "DESTRUCT LESION, DENTOALVEOLAR" BOTH IP/OP "$5,372.00" "$3,975.50" $126.08 "$5,372.00" "$5,372.00" "$5,372.00" "$5,372.00" "$5,372.00" "$5,372.00" "$5,372.00" $126.08 "$5,372.00" "$5,372.00" "$5,372.00" "$5,372.00" "$5,372.00" "$5,372.00" "$1,119.58" "$5,372.00" "$2,148.80" "$5,372.00" "$5,372.00" "$5,372.00" "$5,372.00" "$5,372.00" "$4,029.00" "$5,372.00" "$5,372.00" "$5,372.00" "$2,762.00" "$2,686.00" "$4,254.62" "$5,372.00" "$4,297.60" "$3,491.80" "$5,372.00" "$5,372.00" "$3,115.76" "$5,372.00" "$3,223.20" "$5,372.00" "$5,372.00" "$5,372.00" N/A N/A 36100723 EAP CPT® 41874 "ALVEOLOPLASTY, EACH QUADRANT" BOTH IP/OP "$3,051.00" "$2,258.00" $244.60 "$4,305.68" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,691.05" "$2,691.05" "$2,679.15" $635.90 "$2,691.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $635.86 "$4,305.68" "$4,104.40" "$3,051.00" "$2,691.05" $244.60 "$2,691.05" "$2,825.60" "$2,288.25" "$2,691.05" "$2,691.05" "$2,691.05" "$3,051.00" "$1,525.50" "$2,416.39" "$2,691.05" "$2,440.80" "$2,500.00" $605.55 "$2,691.05" "$1,769.58" "$2,825.60" "$3,051.00" "$2,691.05" $635.83 "$2,691.05" N/A N/A 36100724 EAP CPT® 41899 COMPLETELY BONY BOTH IP/OP "$1,862.00" "$1,378.00" $207.19 "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" $208.11 $208.11 $207.19 $388.09 $208.11 "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" $388.06 $332.98 $299.82 "$1,862.00" $208.11 "$1,862.00" $208.11 $218.52 "$1,396.50" $208.11 $208.11 $208.11 "$1,862.00" $931.00 "$1,474.70" $208.11 "$1,489.60" "$1,750.00" $369.56 $208.11 "$1,079.96" $218.52 $301.08 $208.11 $388.04 $208.11 N/A N/A 36100725 EAP CPT® 42100 "BIOPSY PALATE, UVULA" BOTH IP/OP "$1,837.00" "$1,359.50" $109.26 "$1,837.00" "$1,837.00" "$1,837.00" "$1,837.00" "$1,837.00" $111.06 $111.06 $109.26 "$1,837.00" $111.06 "$1,837.00" "$1,837.00" "$1,837.00" "$1,837.00" $382.85 $177.70 $178.90 "$1,837.00" $111.06 $111.81 $111.06 "$1,837.00" "$1,377.75" $111.06 $111.06 $111.06 "$1,837.00" $918.50 "$1,454.90" $111.06 "$1,469.60" "$1,837.00" "$1,837.00" $111.06 "$1,065.46" "$1,837.00" $111.02 $111.06 "$1,837.00" $111.06 N/A N/A 36100727 EAP CPT® 42104 "EXC PALATE, UVULA,W/O CLOSURE" BOTH IP/OP "$3,431.00" "$2,539.00" $136.28 "$3,431.00" "$3,431.00" "$3,431.00" "$3,431.00" "$3,431.00" $136.51 $136.51 $136.28 "$3,431.00" $136.51 "$3,431.00" "$3,431.00" "$3,431.00" "$3,431.00" $715.06 $218.42 $219.01 "$3,431.00" $136.51 $136.88 $136.51 "$3,431.00" "$2,573.25" $136.51 $136.51 $136.51 "$2,762.00" "$1,715.50" "$2,717.35" $136.51 "$2,744.80" "$2,500.00" "$3,431.00" $136.51 "$1,989.98" "$3,431.00" $140.57 $136.51 "$3,431.00" $136.51 N/A N/A 36100728 EAP CPT® 42140 UVULECTOMY BOTH IP/OP "$3,002.00" "$2,221.50" $159.90 "$3,002.00" "$3,002.00" "$3,002.00" "$3,002.00" "$3,002.00" $163.39 $163.39 $159.90 "$3,002.00" $163.39 "$3,002.00" "$3,002.00" "$3,002.00" "$3,002.00" $625.65 $261.42 $264.50 "$3,002.00" $163.39 $165.31 $163.39 "$3,002.00" "$2,251.50" $163.39 $163.39 $163.39 "$2,851.00" "$1,501.00" "$2,377.58" $163.39 "$2,401.60" "$2,500.00" "$3,002.00" $163.39 "$1,741.16" "$3,002.00" $160.74 $163.39 "$3,002.00" $163.39 N/A N/A 36100729 EAP CPT® 42160 "DEST LESION, PALATE OR UVULA" BOTH IP/OP "$7,516.00" "$5,562.00" $145.70 "$6,012.80" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,691.05" "$2,691.05" "$2,679.15" "$1,566.52" "$2,691.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,566.42" "$4,305.68" "$4,104.40" "$1,871.00" "$2,691.05" $145.70 "$2,691.05" "$2,825.60" "$5,637.00" "$2,691.05" "$2,691.05" "$2,691.05" "$2,762.00" "$2,348.00" "$5,952.67" "$2,691.05" "$6,012.80" "$2,500.00" "$1,491.74" "$2,691.05" "$4,359.28" "$2,825.60" "$3,893.27" "$2,691.05" "$1,566.33" "$2,691.05" N/A N/A 36100730 EAP CPT® 42400 "BIOPSY OF SALIVARY GLAND,NEEDL" BOTH IP/OP "$4,676.00" "$3,460.50" $53.20 "$4,676.00" "$4,676.00" "$4,676.00" "$4,676.00" "$4,676.00" $53.29 $53.29 $53.39 "$4,676.00" $53.29 "$4,676.00" "$4,676.00" "$4,676.00" "$4,676.00" $974.53 $85.26 $85.12 "$4,676.00" $53.29 $53.20 $53.29 "$4,676.00" "$3,507.00" $53.29 $53.29 $53.29 "$2,762.00" "$2,338.00" "$3,703.39" $53.29 "$3,740.80" "$2,150.00" "$4,676.00" $53.29 "$2,712.08" "$4,676.00" $55.52 $53.29 "$4,676.00" $53.29 N/A N/A 36100732 EAP CPT® 42700 I&D PERITONSILLAR ABSCESS BOTH IP/OP $436.00 $323.00 $90.87 $436.00 $436.00 $436.00 $436.00 $436.00 $137.45 $137.45 $136.50 $436.00 $137.45 $436.00 $436.00 $436.00 $436.00 $90.87 $219.92 $221.74 $436.00 $137.45 $138.59 $137.45 $436.00 $327.00 $137.45 $137.45 $137.45 $436.00 $218.00 $345.31 $137.45 $348.80 $436.00 $436.00 $137.45 $252.88 $436.00 $139.13 $137.45 $436.00 $137.45 N/A N/A 36100733 EAP CPT® 42405 BIOPSY OF SALIVARY GLAND BOTH IP/OP "$9,563.00" "$7,077.00" $228.24 "$9,563.00" "$9,563.00" "$9,563.00" "$9,563.00" "$9,563.00" $229.85 $229.85 $228.24 "$9,563.00" $229.85 "$9,563.00" "$9,563.00" "$9,563.00" "$9,563.00" "$1,993.03" $367.76 $369.31 "$9,563.00" $229.85 $230.82 $229.85 "$9,563.00" "$7,172.25" $229.85 $229.85 $229.85 "$2,851.00" "$4,781.50" "$7,573.90" $229.85 "$7,650.40" "$3,250.00" "$9,563.00" $229.85 "$5,546.54" "$9,563.00" $233.60 $229.85 "$9,563.00" $229.85 N/A N/A 36100738 EAP CPT® 43246 G-TUBE INSERTION BOTH IP/OP "$5,939.00" "$4,395.00" $199.77 "$5,939.00" "$5,939.00" "$5,939.00" "$5,939.00" "$5,939.00" $201.29 $201.29 $201.66 "$5,939.00" $201.29 "$5,939.00" "$5,939.00" "$5,939.00" "$5,939.00" "$1,237.75" $322.06 $319.63 "$5,939.00" $201.29 $199.77 $201.29 "$5,939.00" "$4,454.25" $201.29 $201.29 $201.29 "$2,851.00" "$2,969.50" "$4,703.69" $201.29 "$4,751.20" "$2,500.00" "$5,939.00" $201.29 "$3,444.62" "$5,939.00" $209.12 $201.29 "$5,939.00" $201.29 N/A N/A 36100740 EAP CPT® 43450 DIL ESO/UNGUIDE BOUGIE 1>1 PAS BOTH IP/OP "$2,096.00" "$1,551.50" $79.76 "$2,096.00" "$2,096.00" "$2,096.00" "$2,096.00" "$2,096.00" $79.76 $79.76 $80.04 "$2,096.00" $79.76 "$2,096.00" "$2,096.00" "$2,096.00" "$2,096.00" $436.83 $127.62 $128.00 "$2,096.00" $79.76 $80.00 $79.76 "$2,096.00" "$1,572.00" $79.76 $79.76 $79.76 "$2,096.00" "$1,048.00" "$1,660.03" $79.76 "$1,676.80" "$2,096.00" "$2,096.00" $79.76 "$1,215.68" "$2,096.00" $81.84 $79.76 "$2,096.00" $79.76 N/A N/A 36100742 EAP CPT® 43752 NASO GASTRIC TUBE PLACE BOTH IP/OP "$2,134.00" "$1,579.50" $40.36 "$2,134.00" "$2,134.00" "$2,134.00" "$2,134.00" "$2,134.00" $266.97 $266.97 $265.79 $444.78 $266.97 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $444.75 $427.15 $544.70 $113.00 $266.97 $40.36 $266.97 $280.32 "$1,600.50" $266.97 $266.97 $266.97 "$2,134.00" "$1,067.00" "$1,690.13" $266.97 "$1,707.20" "$1,750.00" $423.55 $266.97 "$1,237.72" $280.32 $386.24 $266.97 $444.73 $266.97 N/A N/A 36100747 EAP CPT® 43761 REPOSITION GASTROSTOMY TUBE BOTH IP/OP "$5,739.00" "$4,247.00" $104.78 "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" $104.78 $104.78 $105.02 "$5,739.00" $104.78 "$5,739.00" "$5,739.00" "$5,739.00" "$5,739.00" "$1,196.07" $167.65 $167.76 "$5,739.00" $104.78 $104.85 $104.78 "$5,739.00" "$4,304.25" $104.78 $104.78 $104.78 "$2,762.00" "$2,869.50" "$4,545.29" $104.78 "$4,591.20" "$2,500.00" "$5,739.00" $104.78 "$3,328.62" "$5,739.00" $108.54 $104.78 "$5,739.00" $104.78 N/A N/A 36100748 EAP CPT® 44015 JEJUNOSTOMY INTRA-OP ENT ALIME BOTH IP/OP "$6,352.00" "$4,700.50" $142.95 "$6,352.00" "$6,352.00" "$6,352.00" "$6,352.00" "$6,352.00" $143.15 $143.15 $143.68 "$6,352.00" $143.15 "$6,352.00" "$6,352.00" "$6,352.00" "$6,352.00" "$1,323.83" $229.04 $228.72 "$6,352.00" $143.15 $142.95 $143.15 "$6,352.00" "$4,764.00" $143.15 $143.15 $143.15 "$2,762.00" "$3,176.00" "$5,030.78" $143.15 "$5,081.60" "$4,128.80" "$6,352.00" $143.15 "$3,684.16" "$6,352.00" $149.62 $143.15 "$6,352.00" $143.15 N/A N/A 36100749 EAP CPT® 44373 PEG CONVERSION TO PEJ BOTH IP/OP "$4,055.00" "$3,001.00" $190.56 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $192.62 $192.62 $193.49 "$4,055.00" $192.62 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 $308.19 $304.90 "$4,055.00" $192.62 $190.56 $192.62 "$4,055.00" "$3,041.25" $192.62 $192.62 $192.62 "$2,851.00" "$2,027.50" "$3,211.56" $192.62 "$3,244.00" "$2,500.00" "$4,055.00" $192.62 "$2,351.90" "$4,055.00" $200.11 $192.62 "$4,055.00" $192.62 N/A N/A 36100751 EAP CPT® 44500 INTRO OF LONG GI TUBE BOTH IP/OP "$1,291.00" $955.50 $19.33 "$1,291.00" "$1,291.00" "$1,291.00" "$1,291.00" "$1,291.00" $19.58 $19.58 $19.75 "$1,291.00" $19.58 "$1,291.00" "$1,291.00" "$1,291.00" "$1,291.00" $269.06 $31.33 $30.93 "$1,291.00" $19.58 $19.33 $19.58 "$1,291.00" $968.25 $19.58 $19.58 $19.58 "$1,291.00" $645.50 "$1,022.47" $19.58 "$1,032.80" "$1,291.00" "$1,291.00" $19.58 $748.78 "$1,291.00" $20.20 $19.58 "$1,291.00" $19.58 N/A N/A 36100754 EAP CPT® 45000 DRAIN PELVIC ABSCESS US BOTH IP/OP "$6,884.00" "$5,094.50" $433.17 "$6,884.00" "$6,884.00" "$6,884.00" "$6,884.00" "$6,884.00" $436.60 $436.60 $433.17 "$6,884.00" $436.60 "$6,884.00" "$6,884.00" "$6,884.00" "$6,884.00" "$1,434.70" $698.56 $696.62 "$6,884.00" $436.60 $435.39 $436.60 "$6,884.00" "$5,163.00" $436.60 $436.60 $436.60 "$2,762.00" "$3,442.00" "$5,452.13" $436.60 "$5,507.20" "$3,250.00" "$6,884.00" $436.60 "$3,992.72" "$6,884.00" $445.19 $436.60 "$6,884.00" $436.60 N/A N/A 36100757 EAP CPT® 46040 PERIRECTAL ABSCESS BOTH IP/OP "$2,951.00" "$2,184.00" $433.27 "$2,951.00" "$2,951.00" "$2,951.00" "$2,951.00" "$2,951.00" $436.25 $436.25 $433.73 "$2,951.00" $436.25 "$2,951.00" "$2,951.00" "$2,951.00" "$2,951.00" $615.02 $698.00 $693.23 "$2,951.00" $436.25 $433.27 $436.25 "$2,951.00" "$2,213.25" $436.25 $436.25 $436.25 "$2,951.00" "$1,475.50" "$2,337.19" $436.25 "$2,360.80" "$2,500.00" "$2,951.00" $436.25 "$1,711.58" "$2,951.00" $438.28 $436.25 "$2,951.00" $436.25 N/A N/A 36100758 EAP CPT® 46600 "ANOSCOPY, DIAGNOSTIC, INC SPEC COLLECT" BOTH IP/OP $561.00 $415.50 $41.70 $561.00 $561.00 $561.00 $561.00 $561.00 $110.92 $110.92 $110.43 $116.93 $110.92 $561.00 $561.00 $561.00 $561.00 $116.92 $177.47 $167.51 $113.00 $110.92 $41.70 $110.92 $116.46 $420.75 $110.92 $110.92 $110.92 $561.00 $280.50 $444.31 $110.92 $448.80 $561.00 $111.34 $110.92 $325.38 $116.46 $160.47 $110.92 $116.91 $110.92 N/A N/A 36100759 EAP CPT® 46606 ANOSCOPY AND BIOPSY BOTH IP/OP "$2,211.00" "$1,636.50" $75.62 "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,020.04" "$1,020.04" "$1,015.53" $460.83 "$1,020.04" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $460.80 "$1,632.07" "$1,562.27" "$2,211.00" "$1,020.04" $75.62 "$1,020.04" "$1,071.05" "$1,658.25" "$1,020.04" "$1,020.04" "$1,020.04" "$2,211.00" "$1,105.50" "$1,751.11" "$1,020.04" "$1,768.80" "$2,211.00" $438.83 "$1,020.04" "$1,282.38" "$1,071.05" "$1,475.75" "$1,020.04" $460.77 "$1,020.04" N/A N/A 36100760 EAP CPT® 46900 DESTR CONDYLOMA ANAL - CHEMIC BOTH IP/OP $945.00 $699.50 $137.56 $945.00 $945.00 $945.00 $945.00 $945.00 $138.50 $138.50 $137.56 $945.00 $138.50 $945.00 $945.00 $945.00 $945.00 $196.95 $221.60 $222.32 $945.00 $138.50 $138.95 $138.50 $945.00 $708.75 $138.50 $138.50 $138.50 $945.00 $472.50 $748.44 $138.50 $756.00 $945.00 $945.00 $138.50 $548.10 $945.00 $141.31 $138.50 $945.00 $138.50 N/A N/A 36100763 EAP CPT® 46916 ANAL CRYO SURGERY BOTH IP/OP $429.00 $317.50 $85.15 $429.00 $429.00 $429.00 $429.00 $429.00 $176.64 $176.64 $175.86 $89.41 $176.64 $429.00 $429.00 $429.00 $429.00 $89.41 $282.63 $260.52 $113.00 $176.64 $142.97 $176.64 $185.48 $321.75 $176.64 $176.64 $176.64 $429.00 $214.50 $339.77 $176.64 $343.20 $429.00 $85.15 $176.64 $248.82 $185.48 $255.56 $176.64 $89.40 $176.64 N/A N/A 36100764 EAP CPT® 47000 "LIVER BIOPSY, NEEDLE, PERCUT" BOTH IP/OP "$2,078.00" "$1,538.00" $87.81 "$2,214.48" "$2,078.00" "$2,078.00" "$2,078.00" "$2,078.00" "$1,384.05" "$1,384.05" "$1,377.93" $433.11 "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $433.08 "$2,214.48" "$2,163.34" "$1,871.00" "$1,384.05" $87.81 "$1,384.05" "$1,453.25" "$1,558.50" "$1,384.05" "$1,384.05" "$1,384.05" "$2,078.00" "$1,039.00" "$1,645.78" "$1,384.05" "$1,662.40" "$2,078.00" $412.43 "$1,384.05" "$1,205.24" "$1,453.25" "$2,002.37" "$1,384.05" $433.06 "$1,384.05" N/A N/A 36100769 EAP CPT® 47001 BX LIVER ADDTL PROC PERCUT BCT BOTH IP/OP "$2,720.00" "$2,013.00" $104.23 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $104.35 $104.35 $104.87 "$2,720.00" $104.35 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 $166.96 $166.77 "$2,720.00" $104.35 $104.23 $104.35 "$2,720.00" "$2,040.00" $104.35 $104.35 $104.35 "$2,720.00" "$1,360.00" "$2,154.24" $104.35 "$2,176.00" "$1,750.00" "$2,720.00" $104.35 "$1,577.60" "$2,720.00" $109.60 $104.35 "$2,720.00" $104.35 N/A N/A 36100770 EAP CPT® 47015 EXPLORATORY LAPAROTOMY BOTH IP/OP "$4,765.00" "$3,526.50" $993.08 "$4,765.00" "$4,765.00" "$4,765.00" "$4,765.00" "$4,765.00" "$1,191.08" "$1,191.08" "$1,191.67" "$4,765.00" "$1,191.08" "$4,765.00" "$4,765.00" "$4,765.00" "$4,765.00" $993.08 "$1,905.73" "$1,892.29" "$4,765.00" "$1,191.08" "$1,182.68" "$1,191.08" "$4,765.00" "$3,573.75" "$1,191.08" "$1,191.08" "$1,191.08" "$2,762.00" "$2,382.50" "$3,773.88" "$1,191.08" "$3,812.00" "$2,500.00" "$4,765.00" "$1,191.08" "$2,763.70" "$4,765.00" "$1,224.52" "$1,191.08" "$4,765.00" "$1,191.08" N/A N/A 36100771 EAP CPT® 47380 "ABLATION, OPEN LIVER TUMOR, RF" BOTH IP/OP "$6,657.00" "$4,926.50" "$1,387.39" "$6,657.00" "$6,657.00" "$6,657.00" "$6,657.00" "$6,657.00" "$1,470.39" "$1,470.39" "$1,468.66" "$6,657.00" "$1,470.39" "$6,657.00" "$6,657.00" "$6,657.00" "$6,657.00" "$1,387.39" "$2,352.62" "$2,342.16" "$6,657.00" "$1,470.39" "$1,463.85" "$1,470.39" "$6,657.00" "$4,992.75" "$1,470.39" "$1,470.39" "$1,470.39" "$2,762.00" "$3,328.50" "$5,272.34" "$1,470.39" "$5,325.60" "$4,327.05" "$6,657.00" "$1,470.39" "$3,861.06" "$6,657.00" "$1,518.07" "$1,470.39" "$6,657.00" "$1,470.39" N/A N/A 36100773 EAP CPT® 47382 "ABLATION, LIVER TUMOR; RF" BOTH IP/OP "$8,888.00" "$6,577.50" $732.12 "$7,963.70" "$3,558.00" "$3,558.00" "$3,558.00" "$3,558.00" "$4,977.31" "$4,977.31" "$4,955.30" "$1,852.48" "$4,977.31" "$2,571.13" "$2,571.13" "$2,670.02" "$1,804.74" "$1,852.36" "$7,963.70" "$7,519.36" "$4,877.00" "$4,977.31" $732.12 "$4,977.31" "$5,226.18" "$6,666.00" "$4,977.31" "$4,977.31" "$4,977.31" "$6,679.00" "$5,151.00" "$7,039.30" "$4,977.31" "$7,110.40" "$4,334.00" "$1,764.05" "$4,977.31" "$5,155.04" "$5,226.18" "$7,200.92" "$4,977.31" "$1,852.26" "$4,977.31" N/A N/A 36100774 EAP CPT® 47490 DRAIN CHOLECYSTOSTOMY S&I BCT BOTH IP/OP "$5,844.00" "$4,325.00" $333.05 "$5,844.00" "$5,844.00" "$5,844.00" "$5,844.00" "$5,844.00" $335.70 $335.70 $337.79 "$5,844.00" $335.70 "$5,844.00" "$5,844.00" "$5,844.00" "$5,844.00" "$1,217.95" $537.12 $532.88 "$5,844.00" $335.70 $333.05 $335.70 "$5,844.00" "$4,383.00" $335.70 $335.70 $335.70 "$2,762.00" "$2,922.00" "$4,628.45" $335.70 "$4,675.20" "$3,250.00" "$5,844.00" $335.70 "$3,389.52" "$5,844.00" $345.72 $335.70 "$5,844.00" $335.70 N/A N/A 36100781 EAP CPT® 47555 DILAT BIL STRICT W/O STENT SPV BOTH IP/OP "$4,136.00" "$3,061.00" $327.85 "$4,136.00" "$4,136.00" "$4,136.00" "$4,136.00" "$4,136.00" $327.85 $327.85 $329.27 "$4,136.00" $327.85 "$4,136.00" "$4,136.00" "$4,136.00" "$4,136.00" $861.99 $524.56 $527.12 "$4,136.00" $327.85 $329.45 $327.85 "$4,136.00" "$3,102.00" $327.85 $327.85 $327.85 "$3,500.00" "$2,068.00" "$3,275.71" $327.85 "$3,308.80" "$3,250.00" "$4,136.00" $327.85 "$2,398.88" "$4,136.00" $344.82 $327.85 "$4,136.00" $327.85 N/A N/A 36100783 EAP CPT® 47556 BILIARY DIL STRICT W/STENT BOTH IP/OP "$8,728.00" "$6,459.00" $371.73 "$8,728.00" "$8,728.00" "$8,728.00" "$8,728.00" "$8,728.00" $371.73 $371.73 $372.89 "$8,728.00" $371.73 "$8,728.00" "$8,728.00" "$8,728.00" "$8,728.00" "$1,819.01" $594.77 $597.15 "$8,728.00" $371.73 $373.22 $371.73 "$8,728.00" "$6,546.00" $371.73 $371.73 $371.73 "$7,479.00" "$4,364.00" "$6,912.58" $371.73 "$6,982.40" "$4,334.00" "$8,728.00" $371.73 "$5,062.24" "$8,728.00" $390.63 $371.73 "$8,728.00" $371.73 N/A N/A 36100786 EAP CPT® 48000 PANCREATITIS PLACE DRAIN BCT BOTH IP/OP "$9,260.00" "$6,852.50" "$1,905.34" "$9,260.00" "$9,260.00" "$9,260.00" "$9,260.00" "$9,260.00" "$1,917.25" "$1,917.25" "$1,918.01" "$9,260.00" "$1,917.25" "$9,260.00" "$9,260.00" "$9,260.00" "$9,260.00" "$1,929.89" "$3,067.60" "$3,048.54" "$9,260.00" "$1,917.25" "$1,905.34" "$1,917.25" "$9,260.00" "$6,945.00" "$1,917.25" "$1,917.25" "$1,917.25" "$2,851.00" "$4,630.00" "$7,333.92" "$1,917.25" "$7,408.00" "$6,019.00" "$9,260.00" "$1,917.25" "$5,370.80" "$9,260.00" "$1,983.78" "$1,917.25" "$9,260.00" "$1,917.25" N/A N/A 36100787 EAP CPT® 48102 BX PANCREAS PERCUT NDL BCT BOTH IP/OP "$2,114.00" "$1,564.50" $234.63 "$2,114.00" "$2,114.00" "$2,114.00" "$2,114.00" "$2,114.00" $235.57 $235.57 $238.19 "$2,114.00" $235.57 "$2,114.00" "$2,114.00" "$2,114.00" "$2,114.00" $440.58 $376.91 $375.41 "$2,114.00" $235.57 $234.63 $235.57 "$2,114.00" "$1,585.50" $235.57 $235.57 $235.57 "$2,114.00" "$1,057.00" "$1,674.29" $235.57 "$1,691.20" "$2,114.00" "$2,114.00" $235.57 "$1,226.12" "$2,114.00" $249.55 $235.57 "$2,114.00" $235.57 N/A N/A 36100800 EAP CPT® 37211 THROMBOLYTIC ART THERAPY W/S/I ANY METH INIT DAY BOTH IP/OP "$25,698.00" "$19,017.00" $381.50 "$25,698.00" "$25,698.00" "$25,698.00" "$25,698.00" "$25,698.00" $384.52 $384.52 $386.45 "$25,698.00" $384.52 "$25,698.00" "$25,698.00" "$25,698.00" "$25,698.00" "$5,355.75" $615.23 $610.40 "$25,698.00" $384.52 $381.50 $384.52 "$25,698.00" "$19,273.50" $384.52 $384.52 $384.52 "$2,762.00" "$12,849.00" "$20,352.82" $384.52 "$20,558.40" "$2,500.00" "$25,698.00" $384.52 "$14,904.84" "$25,698.00" $404.58 $384.52 "$25,698.00" $384.52 N/A N/A 36100802 EAP CPT® 37212 THROMBOLYTIC VENOUS THERAPY W S/I ANY METH INIT DAY BOTH IP/OP "$25,698.00" "$19,017.00" $333.60 "$25,698.00" "$25,698.00" "$25,698.00" "$25,698.00" "$25,698.00" $335.67 $335.67 $338.14 "$25,698.00" $335.67 "$25,698.00" "$25,698.00" "$25,698.00" "$25,698.00" "$5,355.75" $537.07 $533.76 "$25,698.00" $335.67 $333.60 $335.67 "$25,698.00" "$19,273.50" $335.67 $335.67 $335.67 "$2,762.00" "$12,849.00" "$20,352.82" $335.67 "$20,558.40" "$2,500.00" "$25,698.00" $335.67 "$14,904.84" "$25,698.00" $353.75 $335.67 "$25,698.00" $335.67 N/A N/A 36100806 EAP CPT® 49180 BX RETROPERITONE MASS PERC BCT BOTH IP/OP "$3,117.00" "$2,307.00" $83.08 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,384.05" "$1,384.05" "$1,377.93" $649.66 "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $649.62 "$2,214.48" "$2,163.34" "$1,871.00" "$1,384.05" $83.08 "$1,384.05" "$1,453.25" "$2,337.75" "$1,384.05" "$1,384.05" "$1,384.05" "$2,762.00" "$1,558.50" "$2,468.66" "$1,384.05" "$2,493.60" "$2,500.00" $618.65 "$1,384.05" "$1,807.86" "$1,453.25" "$2,002.37" "$1,384.05" $649.58 "$1,384.05" N/A N/A 36100807 EAP CPT® 49419 INSERT. OF INTRPERITONEAL CATH BOTH IP/OP "$11,483.00" "$8,497.50" $424.13 "$11,483.00" "$11,483.00" "$11,483.00" "$11,483.00" "$11,483.00" $432.11 $432.11 $435.73 "$11,483.00" $432.11 "$11,483.00" "$11,483.00" "$11,483.00" "$11,483.00" "$2,393.18" $691.38 $678.61 "$11,483.00" $432.11 $424.13 $432.11 "$11,483.00" "$8,612.25" $432.11 $432.11 $432.11 "$2,762.00" "$5,741.50" "$9,094.54" $432.11 "$9,186.40" "$3,725.00" "$11,483.00" $432.11 "$6,660.14" "$11,483.00" $451.36 $432.11 "$11,483.00" $432.11 N/A N/A 36100808 EAP CPT® 49421 PERITONEAL DIALYSIS CAT.PLACEM BOTH IP/OP "$11,842.00" "$8,763.50" $227.47 "$11,842.00" "$11,842.00" "$11,842.00" "$11,842.00" "$11,842.00" $229.16 $229.16 $230.46 "$11,842.00" $229.16 "$11,842.00" "$11,842.00" "$11,842.00" "$11,842.00" "$2,468.00" $366.66 $363.95 "$11,842.00" $229.16 $227.47 $229.16 "$11,842.00" "$8,881.50" $229.16 $229.16 $229.16 "$2,762.00" "$5,921.00" "$9,378.86" $229.16 "$9,473.60" "$3,725.00" "$11,842.00" $229.16 "$6,868.36" "$11,842.00" $239.75 $229.16 "$11,842.00" $229.16 N/A N/A 36100809 EAP CPT® 49423 CATHETER EXCH RAD GUIDE BCT BOTH IP/OP "$3,484.00" "$2,578.50" $69.82 "$3,484.00" "$3,484.00" "$3,484.00" "$3,484.00" "$3,484.00" $69.82 $69.82 $71.06 "$3,484.00" $69.82 "$3,484.00" "$3,484.00" "$3,484.00" "$3,484.00" $726.10 $111.71 $112.88 "$3,484.00" $69.82 $70.55 $69.82 "$3,484.00" "$2,613.00" $69.82 $69.82 $69.82 "$3,484.00" "$1,742.00" "$2,759.33" $69.82 "$2,787.20" "$2,500.00" "$3,484.00" $69.82 "$2,020.72" "$3,484.00" $73.93 $69.82 "$3,484.00" $69.82 N/A N/A 36100810 EAP CPT® 37213 THROM ART/VEN THERAPY W S/I INC F/U CATH SUBSQ DAY BOTH IP/OP "$43,713.00" "$32,348.00" $228.07 "$43,713.00" "$43,713.00" "$43,713.00" "$43,713.00" "$43,713.00" $230.92 $230.92 $232.61 "$43,713.00" $230.92 "$43,713.00" "$43,713.00" "$43,713.00" "$43,713.00" "$9,110.27" $369.47 $364.91 "$43,713.00" $230.92 $228.07 $230.92 "$43,713.00" "$32,784.75" $230.92 $230.92 $230.92 "$3,500.00" "$21,856.50" "$34,620.70" $230.92 "$34,970.40" "$3,725.00" "$43,713.00" $230.92 "$25,353.54" "$43,713.00" $243.77 $230.92 "$43,713.00" $230.92 N/A N/A 36100811 EAP CPT® 49424 INJ DYE VIA PREVIOUS DRN BCT BOTH IP/OP "$3,484.00" "$2,578.50" $37.30 "$3,484.00" "$3,484.00" "$3,484.00" "$3,484.00" "$3,484.00" $37.78 $37.78 $37.47 "$3,484.00" $37.78 "$3,484.00" "$3,484.00" "$3,484.00" "$3,484.00" $726.10 $60.45 $59.68 "$3,484.00" $37.78 $37.30 $37.78 "$3,484.00" "$2,613.00" $37.78 $37.78 $37.78 "$2,762.00" "$1,742.00" "$2,759.33" $37.78 "$2,787.20" "$1,750.00" "$3,484.00" $37.78 "$2,020.72" "$3,484.00" $40.03 $37.78 "$3,484.00" $37.78 N/A N/A 36100812 EAP CPT® 49427 "INJECTION, ABDOMINAL SHUNT" BOTH IP/OP $373.00 $276.50 $38.77 $373.00 $373.00 $373.00 $373.00 $373.00 $38.80 $38.80 $38.77 $373.00 $38.80 $373.00 $373.00 $373.00 $373.00 $77.74 $62.08 $62.43 $373.00 $38.80 $39.02 $38.80 $373.00 $279.75 $38.80 $38.80 $38.80 $373.00 $186.50 $295.42 $38.80 $298.40 $373.00 $373.00 $38.80 $216.34 $373.00 $40.76 $38.80 $373.00 $38.80 N/A N/A 36100813 EAP CPT® 49440 GASTROSTOMY TUBE PLACE S&I SPV BOTH IP/OP "$5,144.00" "$3,807.00" $201.74 "$4,115.20" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,597.70" "$1,597.70" "$1,590.63" "$1,072.14" "$1,597.70" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,072.07" "$2,556.32" "$2,512.52" "$1,871.00" "$1,597.70" $201.74 "$1,597.70" "$1,677.58" "$3,858.00" "$1,597.70" "$1,597.70" "$1,597.70" "$2,762.00" "$2,348.00" "$4,074.05" "$1,597.70" "$4,115.20" "$2,500.00" "$1,020.96" "$1,597.70" "$2,983.52" "$1,677.58" "$2,311.47" "$1,597.70" "$1,072.01" "$1,597.70" N/A N/A 36100814 EAP CPT® 49446 G TUBE CHECK BOTH IP/OP "$6,735.00" "$4,984.00" $145.14 "$6,735.00" "$6,735.00" "$6,735.00" "$6,735.00" "$6,735.00" $146.08 $146.08 $147.36 "$6,735.00" $146.08 "$6,735.00" "$6,735.00" "$6,735.00" "$6,735.00" "$1,403.65" $233.73 $232.22 "$6,735.00" $146.08 $145.14 $146.08 "$6,735.00" "$5,051.25" $146.08 $146.08 $146.08 "$2,762.00" "$3,367.50" "$5,334.12" $146.08 "$5,388.00" "$2,500.00" "$6,735.00" $146.08 "$3,906.30" "$6,735.00" $155.08 $146.08 "$6,735.00" $146.08 N/A N/A 36100815 EAP CPT® 49450 REPLACE G/C TUBE PERC BOTH IP/OP "$3,451.00" "$2,554.00" $66.14 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $795.95 $795.95 $792.43 $719.27 $795.95 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $719.23 "$1,273.51" "$1,190.93" "$1,871.00" $795.95 $66.14 $795.95 $835.74 "$2,588.25" $795.95 $795.95 $795.95 "$2,762.00" "$1,725.50" "$2,733.19" $795.95 "$2,760.80" "$2,150.00" $684.94 $795.95 "$2,001.58" $835.74 "$1,151.53" $795.95 $719.19 $795.95 N/A N/A 36100816 EAP CPT® 49452 REPLACE G-J TUBE PERC BOTH IP/OP "$3,451.00" "$2,554.00" $135.65 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $795.95 $795.95 $792.43 $719.27 $795.95 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $719.23 "$1,273.51" "$1,190.93" "$1,871.00" $795.95 $135.65 $795.95 $835.74 "$2,588.25" $795.95 $795.95 $795.95 "$2,762.00" "$1,725.50" "$2,733.19" $795.95 "$2,760.80" "$2,150.00" $684.94 $795.95 "$2,001.58" $835.74 "$1,151.53" $795.95 $719.19 $795.95 N/A N/A 36100818 EAP CPT® 50200 BX RENAL PERCUT TROCAR/NDL BCT BOTH IP/OP "$2,343.00" "$1,734.00" $125.77 "$2,343.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,384.05" "$1,384.05" "$1,377.93" $488.34 "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $488.31 "$2,214.48" "$2,163.34" "$1,871.00" "$1,384.05" $125.77 "$1,384.05" "$1,453.25" "$1,757.25" "$1,384.05" "$1,384.05" "$1,384.05" "$2,343.00" "$1,171.50" "$1,855.66" "$1,384.05" "$1,874.40" "$2,343.00" $465.03 "$1,384.05" "$1,358.94" "$1,453.25" "$2,002.37" "$1,384.05" $488.28 "$1,384.05" N/A N/A 36100821 EAP CPT® 50382 "CHANGE URTER STENT, PERCUT" BOTH IP/OP "$7,354.00" "$5,442.00" $249.60 "$7,354.00" "$7,354.00" "$7,354.00" "$7,354.00" "$7,354.00" $251.55 $251.55 $255.09 "$7,354.00" $251.55 "$7,354.00" "$7,354.00" "$7,354.00" "$7,354.00" "$1,532.65" $402.48 $399.36 "$7,354.00" $251.55 $249.60 $251.55 "$7,354.00" "$5,515.50" $251.55 $251.55 $251.55 "$2,851.00" "$3,677.00" "$5,824.37" $251.55 "$5,883.20" "$3,250.00" "$7,354.00" $251.55 "$4,265.32" "$7,354.00" $267.95 $251.55 "$7,354.00" $251.55 N/A N/A 36100822 EAP CPT® 50384 "REMOVE URTER STENT, PERCUT" BOTH IP/OP "$6,508.00" "$4,816.00" $225.19 "$6,508.00" "$6,508.00" "$6,508.00" "$6,508.00" "$6,508.00" $225.46 $225.46 $229.42 "$6,508.00" $225.46 "$6,508.00" "$6,508.00" "$6,508.00" "$6,508.00" "$1,356.34" $360.74 $360.30 "$6,508.00" $225.46 $225.19 $225.46 "$6,508.00" "$4,881.00" $225.46 $225.46 $225.46 "$2,762.00" "$3,254.00" "$5,154.34" $225.46 "$5,206.40" "$2,500.00" "$6,508.00" $225.46 "$3,774.64" "$6,508.00" $239.83 $225.46 "$6,508.00" $225.46 N/A N/A 36100823 EAP CPT® 50387 CHANGE EXT/INT URETER STENT BOTH IP/OP "$2,713.00" "$2,008.00" $82.41 "$2,818.05" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,761.28" "$1,761.28" "$1,753.49" $565.46 "$1,761.28" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $565.42 "$2,818.05" "$2,675.95" "$2,713.00" "$1,761.28" $82.41 "$1,761.28" "$1,849.35" "$2,034.75" "$1,761.28" "$1,761.28" "$1,761.28" "$2,713.00" "$1,356.50" "$2,148.70" "$1,761.28" "$2,170.40" "$2,500.00" $538.46 "$1,761.28" "$1,573.54" "$1,849.35" "$2,548.13" "$1,761.28" $565.39 "$1,761.28" N/A N/A 36100824 EAP CPT® 50389 REMOVE RENAL TUBE WITH FLURO BOTH IP/OP $987.00 $730.50 $52.90 $987.00 $987.00 $987.00 $987.00 $987.00 $52.94 $52.94 $53.72 $987.00 $52.94 $987.00 $987.00 $987.00 $987.00 $205.70 $84.70 $84.64 $987.00 $52.94 $52.90 $52.94 $987.00 $740.25 $52.94 $52.94 $52.94 $987.00 $493.50 $781.70 $52.94 $789.60 $987.00 $987.00 $52.94 $572.46 $987.00 $55.90 $52.94 $987.00 $52.94 N/A N/A 36100825 EAP CPT® 50390 ASPIR/INJECT RENAL CYST/PELVIS BOTH IP/OP "$4,429.00" "$3,277.50" $93.93 "$4,429.00" "$4,429.00" "$4,429.00" "$4,429.00" "$4,429.00" $95.19 $95.19 $95.69 "$4,429.00" $95.19 "$4,429.00" "$4,429.00" "$4,429.00" "$4,429.00" $923.05 $152.30 $150.29 "$4,429.00" $95.19 $93.93 $95.19 "$4,429.00" "$3,321.75" $95.19 $95.19 $95.19 "$2,762.00" "$2,214.50" "$3,507.77" $95.19 "$3,543.20" "$2,500.00" "$4,429.00" $95.19 "$2,568.82" "$4,429.00" $99.90 $95.19 "$4,429.00" $95.19 N/A N/A 36100831 EAP CPT® 50592 "ABLATION, RENAL TUMOR, RF" BOTH IP/OP "$16,043.00" "$11,872.00" $340.39 "$12,834.40" "$3,558.00" "$3,558.00" "$3,558.00" "$3,558.00" "$4,977.31" "$4,977.31" "$4,955.30" "$3,343.76" "$4,977.31" "$2,571.13" "$2,571.13" "$2,670.02" "$1,804.74" "$3,343.54" "$7,963.70" "$7,519.36" "$1,871.00" "$4,977.31" $340.39 "$4,977.31" "$5,226.18" "$12,032.25" "$4,977.31" "$4,977.31" "$4,977.31" "$6,679.00" "$5,677.00" "$12,706.06" "$4,977.31" "$12,834.40" "$4,334.00" "$3,184.13" "$4,977.31" "$9,304.94" "$5,226.18" "$7,200.92" "$4,977.31" "$3,343.36" "$4,977.31" N/A N/A 36100832 EAP CPT® 50684 INJECTION FOR URETER XRAY BOTH IP/OP $774.00 $573.00 $50.18 $774.00 $774.00 $774.00 $774.00 $774.00 $50.18 $50.18 $50.60 $774.00 $50.18 $774.00 $774.00 $774.00 $774.00 $161.31 $80.29 $81.34 $774.00 $50.18 $50.84 $50.18 $774.00 $580.50 $50.18 $50.18 $50.18 $387.00 $387.00 $613.01 $50.18 $619.20 $774.00 $774.00 $50.18 $448.92 $774.00 $52.27 $50.18 $774.00 $50.18 N/A N/A 36100833 EAP CPT® 50688 CHANGE OF URETER TUBE/STENT BOTH IP/OP "$2,286.00" "$1,692.00" $77.09 "$2,286.00" "$2,286.00" "$2,286.00" "$2,286.00" "$2,286.00" $77.09 $77.09 $77.38 "$2,286.00" $77.09 "$2,286.00" "$2,286.00" "$2,286.00" "$2,286.00" $476.43 $123.34 $123.62 "$2,286.00" $77.09 $77.26 $77.09 "$2,286.00" "$1,714.50" $77.09 $77.09 $77.09 "$2,286.00" "$1,143.00" "$1,810.51" $77.09 "$1,828.80" "$2,286.00" "$2,286.00" $77.09 "$1,325.88" "$2,286.00" $80.76 $77.09 "$2,286.00" $77.09 N/A N/A 36100834 EAP CPT® 50690 INJECT FOR URETER X-RAY BOTH IP/OP $829.00 $613.50 $69.49 $829.00 $829.00 $829.00 $829.00 $829.00 $69.49 $69.49 $69.72 $829.00 $69.49 $829.00 $829.00 $829.00 $829.00 $172.77 $111.18 $111.71 $829.00 $69.49 $69.82 $69.49 $829.00 $621.75 $69.49 $69.49 $69.49 $414.50 $414.50 $656.57 $69.49 $663.20 $829.00 $829.00 $69.49 $480.82 $829.00 $72.83 $69.49 $829.00 $69.49 N/A N/A 36100835 EAP CPT® 51080 DRN PERIVESIC/PREVESIC ABS BCT BOTH IP/OP "$3,734.00" "$2,763.50" $410.83 "$3,734.00" "$3,734.00" "$3,734.00" "$3,734.00" "$3,734.00" $411.65 $411.65 $413.42 "$3,734.00" $411.65 "$3,734.00" "$3,734.00" "$3,734.00" "$3,734.00" $778.21 $658.64 $657.33 "$3,734.00" $411.65 $410.83 $411.65 "$3,734.00" "$2,800.50" $411.65 $411.65 $411.65 "$2,762.00" "$1,867.00" "$2,957.33" $411.65 "$2,987.20" "$3,250.00" "$3,734.00" $411.65 "$2,165.72" "$3,734.00" $425.07 $411.65 "$3,734.00" $411.65 N/A N/A 36100836 EAP CPT® 51100 DRAIN BLADDER BY NEEDLE BOTH IP/OP $647.00 $479.00 $38.73 $647.00 $647.00 $647.00 $647.00 $647.00 $38.79 $38.79 $38.73 $647.00 $38.79 $647.00 $647.00 $647.00 $647.00 $134.84 $62.06 $62.42 $647.00 $38.79 $39.01 $38.79 $647.00 $485.25 $38.79 $38.79 $38.79 $647.00 $323.50 $512.42 $38.79 $517.60 $647.00 $647.00 $38.79 $375.26 $647.00 $40.39 $38.79 $647.00 $38.79 N/A N/A 36100839 EAP CPT® 51102 BLADDER TAP-SUPRAPUB W CATH IN BOTH IP/OP "$5,564.00" "$4,117.50" $143.08 "$5,564.00" "$5,564.00" "$5,564.00" "$5,564.00" "$5,564.00" $144.64 $144.64 $145.88 "$5,564.00" $144.64 "$5,564.00" "$5,564.00" "$5,564.00" "$5,564.00" "$1,159.60" $231.42 $228.93 "$5,564.00" $144.64 $143.08 $144.64 "$5,564.00" "$4,173.00" $144.64 $144.64 $144.64 "$2,762.00" "$2,782.00" "$4,406.69" $144.64 "$4,451.20" "$3,250.00" "$5,564.00" $144.64 "$3,227.12" "$5,564.00" $151.45 $144.64 "$5,564.00" $144.64 N/A N/A 36100840 EAP CPT® 51102 DRAIN BL W/CATH INSERTION BOTH IP/OP "$5,564.00" "$4,117.50" $143.08 "$5,564.00" "$5,564.00" "$5,564.00" "$5,564.00" "$5,564.00" $144.64 $144.64 $145.88 "$5,564.00" $144.64 "$5,564.00" "$5,564.00" "$5,564.00" "$5,564.00" "$1,159.60" $231.42 $228.93 "$5,564.00" $144.64 $143.08 $144.64 "$5,564.00" "$4,173.00" $144.64 $144.64 $144.64 "$2,762.00" "$2,782.00" "$4,406.69" $144.64 "$4,451.20" "$3,250.00" "$5,564.00" $144.64 "$3,227.12" "$5,564.00" $151.45 $144.64 "$5,564.00" $144.64 N/A N/A 36100841 EAP CPT® 51102 DRAINAGE OF BLADDER BOTH IP/OP "$5,564.00" "$4,117.50" $143.08 "$5,564.00" "$5,564.00" "$5,564.00" "$5,564.00" "$5,564.00" $144.64 $144.64 $145.88 "$5,564.00" $144.64 "$5,564.00" "$5,564.00" "$5,564.00" "$5,564.00" "$1,159.60" $231.42 $228.93 "$5,564.00" $144.64 $143.08 $144.64 "$5,564.00" "$4,173.00" $144.64 $144.64 $144.64 "$2,762.00" "$2,782.00" "$4,406.69" $144.64 "$4,451.20" "$3,250.00" "$5,564.00" $144.64 "$3,227.12" "$5,564.00" $151.45 $144.64 "$5,564.00" $144.64 N/A N/A 36100842 EAP CPT® 51600 INJECT CYSTOGRAPHY/VOIDING BOTH IP/OP "$1,275.00" $943.50 $43.75 "$1,275.00" $692.33 $692.33 $692.33 $692.33 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" $43.75 "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" "$1,275.00" $253.06 "$1,275.00" $739.50 "$1,275.00" "$1,275.00" "$1,275.00" $265.71 "$1,275.00" N/A N/A 36100844 EAP CPT® 51610 INJECT CYSTOGRAPHY/VOID RETRO BOTH IP/OP "$2,406.00" "$1,780.50" $64.06 "$2,406.00" "$1,306.46" "$1,306.46" "$1,306.46" "$1,306.46" "$2,406.00" "$2,406.00" "$2,406.00" $501.47 "$2,406.00" "$2,406.00" "$2,406.00" "$2,406.00" "$2,406.00" $501.44 "$2,406.00" "$1,022.00" "$1,423.15" "$2,406.00" $64.06 "$2,406.00" "$2,406.00" "$1,804.50" "$2,406.00" "$2,406.00" "$2,406.00" "$1,203.00" "$1,203.00" "$1,905.55" "$2,406.00" "$1,924.80" "$1,750.00" $477.53 "$2,406.00" "$1,395.48" "$2,406.00" "$2,406.00" "$2,406.00" $501.41 "$2,406.00" N/A N/A 36100846 EAP CPT® 51700 BLADDER IRRIGATION &/OR INSTIL BOTH IP/OP $504.00 $373.00 $30.19 $504.00 $504.00 $504.00 $504.00 $504.00 $261.76 $261.76 $260.60 $105.05 $261.76 $504.00 $504.00 $504.00 $504.00 $105.04 $418.81 $309.98 $113.00 $261.76 $30.19 $261.76 $274.85 $378.00 $261.76 $261.76 $261.76 $504.00 $252.00 $399.17 $261.76 $403.20 $504.00 $100.03 $261.76 $292.32 $274.85 $378.70 $261.76 $105.03 $261.76 N/A N/A 36100848 EAP CPT® 51701 INSERT STRAIGHT CATH IN & OUT BOTH IP/OP $865.00 $640.50 $25.44 $865.00 $865.00 $865.00 $865.00 $865.00 $110.92 $110.92 $110.43 $180.29 $110.92 $865.00 $865.00 $865.00 $865.00 $180.28 $177.47 $167.51 $113.00 $110.92 $25.44 $110.92 $116.46 $648.75 $110.92 $110.92 $110.92 $865.00 $432.50 $685.08 $110.92 $692.00 $865.00 $171.68 $110.92 $501.70 $116.46 $160.47 $110.92 $180.27 $110.92 N/A N/A 36100849 EAP CPT® 51702 CATH INSERT INDWELLING BOTH IP/OP "$1,070.00" $792.00 $25.10 "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" $110.92 $110.92 $110.43 $223.01 $110.92 "$1,070.00" "$1,070.00" "$1,070.00" $882.37 $223.00 $177.47 $167.51 $113.00 $110.92 $25.10 $110.92 $116.46 $802.50 $110.92 $110.92 $110.92 "$1,070.00" $535.00 $847.44 $110.92 $856.00 "$1,070.00" $212.37 $110.92 $620.60 $116.46 $160.47 $110.92 $222.99 $110.92 N/A N/A 36100851 EAP CPT® 51703 INSERT COMPLICATED CATH BOTH IP/OP "$1,809.00" "$1,339.00" $76.30 "$1,809.00" "$1,809.00" "$1,809.00" "$1,809.00" "$1,809.00" $137.34 $137.34 $136.73 $377.04 $137.34 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $377.02 $219.74 $209.80 "$1,809.00" $137.34 $76.30 $137.34 $144.20 "$1,356.75" $137.34 $137.34 $137.34 "$1,809.00" $904.50 "$1,432.73" $137.34 "$1,447.20" "$1,750.00" $359.04 $137.34 "$1,049.22" $144.20 $198.69 $137.34 $377.00 $137.34 N/A N/A 36100852 EAP CPT® 51705 CHANGE CYSTO TUBE SIMPLE BOTH IP/OP $626.00 $463.50 $51.51 $626.00 $626.00 $626.00 $626.00 $626.00 $51.51 $51.51 $51.94 $626.00 $51.51 $626.00 $626.00 $626.00 $626.00 $130.47 $82.42 $82.45 $626.00 $51.51 $51.53 $51.51 $626.00 $469.50 $51.51 $51.51 $51.51 $626.00 $313.00 $495.79 $51.51 $500.80 $626.00 $626.00 $51.51 $363.08 $626.00 $54.08 $51.51 $626.00 $51.51 N/A N/A 36100853 EAP CPT® 51710 CHANGE CYSTO TUBE COMPLICATED BOTH IP/OP "$3,957.00" "$2,928.50" $80.02 "$3,165.60" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $565.91 $565.91 $563.41 $824.74 $565.91 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $824.68 $905.46 $902.15 "$1,871.00" $565.91 $80.02 $565.91 $594.21 "$2,967.75" $565.91 $565.91 $565.91 "$2,762.00" "$1,978.50" "$3,133.94" $565.91 "$3,165.60" "$2,150.00" $785.37 $565.91 "$2,295.06" $594.21 $818.74 $565.91 $824.64 $565.91 N/A N/A 36100854 EAP CPT® 51720 INSTILL BLADDER ANTICANCER AGE BOTH IP/OP "$1,029.00" $761.50 $43.75 "$1,029.00" "$1,029.00" "$1,029.00" "$1,029.00" "$1,029.00" $261.76 $261.76 $260.60 $214.47 $261.76 "$1,029.00" "$1,029.00" "$1,029.00" $882.37 $214.45 $418.81 $902.15 "$1,029.00" $261.76 $43.75 $261.76 $274.85 $771.75 $261.76 $261.76 $261.76 "$1,029.00" $514.50 $814.97 $261.76 $823.20 "$1,029.00" $204.23 $261.76 $596.82 $274.85 $378.70 $261.76 $214.44 $261.76 N/A N/A 36100855 EAP CPT® 51726 CYSTOMETROGRAM BOTH IP/OP "$1,648.00" "$1,220.00" $208.90 "$1,648.00" "$1,648.00" "$1,648.00" "$1,648.00" "$1,648.00" $229.95 $229.95 $313.67 "$1,648.00" $229.95 "$1,648.00" "$1,648.00" "$1,648.00" "$1,648.00" $343.46 $367.92 $354.45 "$1,648.00" $229.95 $221.53 $229.95 "$1,648.00" "$1,236.00" $229.95 $229.95 $229.95 "$1,648.00" $824.00 "$1,305.22" $229.95 "$1,318.40" "$1,648.00" "$1,648.00" $229.95 $955.84 "$1,648.00" $208.90 $229.95 "$1,648.00" $229.95 N/A N/A 36100858 EAP CPT® 51798 RESIDUAL URINE BY ULTRASOUND BOTH IP/OP $205.00 $152.00 $10.41 $205.00 $205.00 $205.00 $205.00 $205.00 $10.67 $10.67 $10.41 $205.00 $10.67 $205.00 $205.00 $205.00 $205.00 $42.72 $17.07 $17.33 $205.00 $10.67 $10.83 $10.67 $205.00 $153.75 $10.67 $10.67 $10.67 $205.00 $102.50 $162.36 $10.67 $164.00 $205.00 $205.00 $10.67 $118.90 $205.00 $10.44 $10.67 $205.00 $10.67 N/A N/A 36100860 EAP CPT® 52000 CYSTOURETHROSCOPY BOTH IP/OP "$3,069.00" "$2,271.50" $80.03 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $565.91 $565.91 $563.41 $639.66 $565.91 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $639.61 $905.46 $902.15 "$1,871.00" $565.91 $80.03 $565.91 $594.21 "$2,301.75" $565.91 $565.91 $565.91 "$2,762.00" "$1,534.50" "$2,430.65" $565.91 "$2,455.20" "$2,150.00" $609.12 $565.91 "$1,780.02" $594.21 $818.74 $565.91 $639.58 $565.91 N/A N/A 36100861 EAP CPT® 52005 CYSTOURETHRO W URETERAL CATH BOTH IP/OP "$5,902.00" "$4,367.50" $131.21 "$5,902.00" "$5,902.00" "$5,902.00" "$5,902.00" "$5,902.00" $132.22 $132.22 $133.00 "$5,902.00" $132.22 "$5,902.00" "$5,902.00" "$5,902.00" "$5,902.00" "$1,230.04" $211.55 $209.94 "$5,902.00" $132.22 $131.21 $132.22 "$5,902.00" "$4,426.50" $132.22 $132.22 $132.22 "$2,851.00" "$2,951.00" "$4,674.38" $132.22 "$4,721.60" "$3,250.00" "$5,902.00" $132.22 "$3,423.16" "$5,902.00" $137.38 $132.22 "$5,902.00" $132.22 N/A N/A 36100862 EAP CPT® 52281 PERC DILATE URETER W BALLOON BOTH IP/OP "$6,114.00" "$4,524.50" $150.89 "$6,114.00" "$6,114.00" "$6,114.00" "$6,114.00" "$6,114.00" $151.42 $151.42 $152.36 "$6,114.00" $151.42 "$6,114.00" "$6,114.00" "$6,114.00" "$6,114.00" "$1,274.22" $242.27 $241.42 "$6,114.00" $151.42 $150.89 $151.42 "$6,114.00" "$4,585.50" $151.42 $151.42 $151.42 "$2,851.00" "$3,057.00" "$4,842.29" $151.42 "$4,891.20" "$2,500.00" "$6,114.00" $151.42 "$3,546.12" "$6,114.00" $157.57 $151.42 "$6,114.00" $151.42 N/A N/A 36100863 EAP CPT® 52310 CYSTO W STENT REMOVAL BOTH IP/OP "$5,725.00" "$4,236.50" $150.22 "$4,580.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,761.28" "$1,761.28" "$1,753.49" "$1,193.23" "$1,761.28" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,193.15" "$2,818.05" "$2,675.95" "$2,836.00" "$1,761.28" $150.22 "$1,761.28" "$1,849.35" "$4,293.75" "$1,761.28" "$1,761.28" "$1,761.28" "$2,851.00" "$2,423.00" "$4,534.20" "$1,761.28" "$4,580.00" "$2,500.00" "$1,136.27" "$1,761.28" "$3,320.50" "$1,849.35" "$2,548.13" "$1,761.28" "$1,193.09" "$1,761.28" N/A N/A 36100864 EAP CPT® 52332 CYSTO W URETER STENT PLCMNT BOTH IP/OP "$10,798.00" "$7,991.00" $154.28 "$10,798.00" "$10,798.00" "$10,798.00" "$10,798.00" "$10,798.00" $154.85 $154.85 $155.82 "$10,798.00" $154.85 "$10,798.00" "$10,798.00" "$10,798.00" "$10,798.00" "$2,250.42" $247.76 $246.85 "$10,798.00" $154.85 $154.28 $154.85 "$10,798.00" "$8,098.50" $154.85 $154.85 $154.85 "$2,851.00" "$5,399.00" "$8,552.02" $154.85 "$8,638.40" "$3,250.00" "$10,798.00" $154.85 "$6,262.84" "$10,798.00" $160.82 $154.85 "$10,798.00" $154.85 N/A N/A 36100865 EAP CPT® 53600 DILATE URETHRA STRICTURE MALE INITIAL BOTH IP/OP $687.00 $508.50 $63.18 $687.00 $687.00 $687.00 $687.00 $687.00 $63.18 $63.18 $64.05 $687.00 $63.18 $687.00 $687.00 $687.00 $687.00 $143.18 $101.09 $102.56 $687.00 $63.18 $64.10 $63.18 $687.00 $515.25 $63.18 $63.18 $63.18 $687.00 $343.50 $544.10 $63.18 $549.60 $687.00 $687.00 $63.18 $398.46 $687.00 $65.99 $63.18 $687.00 $63.18 N/A N/A 36100866 EAP CPT® 53601 DILATE STRICTURE MALE SUBSEQ BOTH IP/OP $314.00 $232.50 $52.90 $314.00 $314.00 $314.00 $314.00 $314.00 $52.90 $52.90 $53.97 $314.00 $52.90 $314.00 $314.00 $314.00 $314.00 $65.44 $84.64 $85.18 $314.00 $52.90 $53.24 $52.90 $314.00 $235.50 $52.90 $52.90 $52.90 $314.00 $157.00 $248.69 $52.90 $251.20 $314.00 $314.00 $52.90 $182.12 $314.00 $55.53 $52.90 $314.00 $52.90 N/A N/A 36100867 EAP CPT® 53620 DILATE STRICT MALE FILIFORM IX BOTH IP/OP "$4,447.00" "$3,291.00" $86.47 "$4,447.00" "$4,447.00" "$4,447.00" "$4,447.00" "$4,447.00" $87.19 $87.19 $87.59 "$4,447.00" $87.19 "$4,447.00" "$4,447.00" "$4,447.00" "$4,447.00" $926.80 $139.50 $138.35 "$4,447.00" $87.19 $86.47 $87.19 "$4,447.00" "$3,335.25" $87.19 $87.19 $87.19 "$2,762.00" "$2,223.50" "$3,522.02" $87.19 "$3,557.60" "$2,150.00" "$4,447.00" $87.19 "$2,579.26" "$4,447.00" $90.51 $87.19 "$4,447.00" $87.19 N/A N/A 36100868 EAP CPT® 53621 DILATE STRICT MALE FILIFORM SU BOTH IP/OP $804.00 $595.00 $71.55 $804.00 $804.00 $804.00 $804.00 $804.00 $72.07 $72.07 $72.03 $804.00 $72.07 $804.00 $804.00 $804.00 $804.00 $167.56 $115.31 $114.48 $804.00 $72.07 $71.55 $72.07 $804.00 $603.00 $72.07 $72.07 $72.07 $804.00 $402.00 $636.77 $72.07 $643.20 $804.00 $804.00 $72.07 $466.32 $804.00 $74.64 $72.07 $804.00 $72.07 N/A N/A 36100869 EAP CPT® 53660 DILATE URETHRA STRICT FEMALE I BOTH IP/OP $286.00 $212.00 $41.55 $286.00 $286.00 $286.00 $286.00 $286.00 $41.55 $41.55 $41.89 $286.00 $41.55 $286.00 $286.00 $286.00 $286.00 $59.61 $66.48 $66.74 $286.00 $41.55 $41.71 $41.55 $286.00 $214.50 $41.55 $41.55 $41.55 $286.00 $143.00 $226.51 $41.55 $228.80 $286.00 $286.00 $41.55 $165.88 $286.00 $43.27 $41.55 $286.00 $41.55 N/A N/A 36100870 EAP CPT® 53661 DILATE URETHRA STRICT FEMALE S BOTH IP/OP $286.00 $212.00 $40.17 $286.00 $286.00 $286.00 $286.00 $286.00 $40.17 $40.17 $40.50 $286.00 $40.17 $286.00 $286.00 $286.00 $286.00 $59.61 $64.27 $65.10 $286.00 $40.17 $40.69 $40.17 $286.00 $214.50 $40.17 $40.17 $40.17 $286.00 $143.00 $226.51 $40.17 $228.80 $286.00 $286.00 $40.17 $165.88 $286.00 $42.19 $40.17 $286.00 $40.17 N/A N/A 36100871 EAP CPT® 54001 DORSAL SLIT EXC NEWBORN BOTH IP/OP "$6,461.00" "$4,781.50" $141.01 "$5,168.80" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,761.28" "$1,761.28" "$1,753.49" "$1,346.63" "$1,761.28" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,346.54" "$2,818.05" "$2,675.95" "$2,836.00" "$1,761.28" $141.01 "$1,761.28" "$1,849.35" "$4,845.75" "$1,761.28" "$1,761.28" "$1,761.28" "$2,851.00" "$2,423.00" "$5,117.11" "$1,761.28" "$5,168.80" "$3,250.00" "$1,282.35" "$1,761.28" "$3,747.38" "$1,849.35" "$2,548.13" "$1,761.28" "$1,346.47" "$1,761.28" N/A N/A 36100872 EAP CPT® 54015 "INCISE AND DRAIN PENIS, DEEP" BOTH IP/OP "$4,851.00" "$3,590.00" $305.13 "$4,851.00" "$4,851.00" "$4,851.00" "$4,851.00" "$4,851.00" $306.36 $306.36 $308.58 "$4,851.00" $306.36 "$4,851.00" "$4,851.00" "$4,851.00" "$4,851.00" "$1,011.00" $490.18 $488.21 "$4,851.00" $306.36 $305.13 $306.36 "$4,851.00" "$3,638.25" $306.36 $306.36 $306.36 "$4,417.00" "$2,425.50" "$3,841.99" $306.36 "$3,880.80" "$3,250.00" "$4,851.00" $306.36 "$2,813.58" "$4,851.00" $318.38 $306.36 "$4,851.00" $306.36 N/A N/A 36100873 EAP CPT® 54050 "LES, DEST, CHEM PENIS, SIMPLE" BOTH IP/OP $755.00 $559.00 $105.73 $755.00 $755.00 $755.00 $755.00 $755.00 $105.73 $105.73 $106.54 $755.00 $105.73 $755.00 $755.00 $755.00 $755.00 $157.35 $169.17 $172.93 $755.00 $105.73 $108.08 $105.73 $755.00 $566.25 $105.73 $105.73 $105.73 $755.00 $377.50 $597.96 $105.73 $604.00 $755.00 $755.00 $105.73 $437.90 $755.00 $107.78 $105.73 $755.00 $105.73 N/A N/A 36100875 EAP CPT® 54056 CRYOSURG PENIS LESION(S) SIMPL BOTH IP/OP $304.00 $225.00 $60.34 $304.00 $165.07 $165.07 $165.07 $165.07 $176.64 $176.64 $175.86 $63.36 $176.64 $304.00 $304.00 $304.00 $304.00 $63.36 $282.63 $260.52 $113.00 $176.64 $112.45 $176.64 $185.48 $228.00 $176.64 $176.64 $176.64 $304.00 $152.00 $240.77 $176.64 $243.20 $304.00 $60.34 $176.64 $176.32 $185.48 $255.56 $176.64 $63.35 $176.64 N/A N/A 36100876 EAP CPT® 54100 BIOPSY OF PENIS BOTH IP/OP "$6,079.00" "$4,498.50" $120.71 "$6,079.00" "$6,079.00" "$6,079.00" "$6,079.00" "$6,079.00" $120.71 $120.71 $122.09 "$6,079.00" $120.71 "$6,079.00" "$6,079.00" "$6,079.00" "$6,079.00" "$1,266.93" $193.14 $194.11 "$6,079.00" $120.71 $121.32 $120.71 "$6,079.00" "$4,559.25" $120.71 $120.71 $120.71 "$2,762.00" "$3,039.50" "$4,814.57" $120.71 "$4,863.20" "$2,500.00" "$6,079.00" $120.71 "$3,525.82" "$6,079.00" $126.18 $120.71 "$6,079.00" $120.71 N/A N/A 36100877 EAP CPT® 54150 CIRCUMCISION BOTH IP/OP "$2,277.00" "$1,685.00" $96.67 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $97.40 $97.40 $98.21 "$2,277.00" $97.40 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 $155.84 $154.67 "$2,277.00" $97.40 $96.67 $97.40 "$2,277.00" "$1,707.75" $97.40 $97.40 $97.40 "$2,277.00" "$1,138.50" "$1,803.38" $97.40 "$1,821.60" "$2,277.00" "$2,277.00" $97.40 "$1,320.66" "$2,277.00" $102.41 $97.40 "$2,277.00" $97.40 N/A N/A 36100878 EAP CPT® 54200 TREATMENT OF PENIS LESION BOTH IP/OP $590.00 $437.00 $86.36 $590.00 $590.00 $590.00 $590.00 $590.00 $86.37 $86.37 $86.36 $590.00 $86.37 $590.00 $590.00 $590.00 $590.00 $122.96 $138.19 $139.33 $590.00 $86.37 $87.08 $86.37 $590.00 $442.50 $86.37 $86.37 $86.37 $590.00 $295.00 $467.28 $86.37 $472.00 $590.00 $590.00 $86.37 $342.20 $590.00 $86.87 $86.37 $590.00 $86.37 N/A N/A 36100879 EAP CPT® 54230 INJECT CORPORA CAVERNOSOGRAPHY BOTH IP/OP "$1,666.00" "$1,233.00" $79.67 "$1,666.00" "$1,666.00" "$1,666.00" "$1,666.00" "$1,666.00" $79.67 $79.67 $79.70 "$1,666.00" $79.67 "$1,666.00" "$1,666.00" "$1,666.00" "$1,666.00" $347.21 $127.47 $127.47 "$1,666.00" $79.67 $79.67 $79.67 "$1,666.00" "$1,249.50" $79.67 $79.67 $79.67 "$1,666.00" $833.00 "$1,319.47" $79.67 "$1,332.80" "$1,666.00" "$1,666.00" $79.67 $966.28 "$1,666.00" $82.21 $79.67 "$1,666.00" $79.67 N/A N/A 36100880 EAP CPT® 54450 PARAPHIMOSIS REDUCTION BOTH IP/OP $618.00 $457.50 $56.98 $618.00 $618.00 $618.00 $618.00 $618.00 $261.76 $261.76 $260.60 $128.81 $261.76 $618.00 $618.00 $618.00 $618.00 $128.80 $418.81 $309.98 $618.00 $261.76 $56.98 $261.76 $274.85 $463.50 $261.76 $261.76 $261.76 $618.00 $309.00 $489.46 $261.76 $494.40 $618.00 $122.66 $261.76 $358.44 $274.85 $378.70 $261.76 $128.79 $261.76 N/A N/A 36100881 EAP CPT® 54700 "INCISE AND DRAIN, TESTES" BOTH IP/OP "$3,277.00" "$2,425.00" $213.57 "$3,250.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,761.28" "$1,761.28" "$1,753.49" $683.01 "$1,761.28" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $682.96 "$2,818.05" "$2,675.95" "$2,836.00" "$1,761.28" $213.57 "$1,761.28" "$1,849.35" "$2,457.75" "$1,761.28" "$1,761.28" "$1,761.28" "$2,851.00" "$1,638.50" "$2,595.38" "$1,761.28" "$2,621.60" "$3,250.00" $650.40 "$1,761.28" "$1,900.66" "$1,849.35" "$2,548.13" "$1,761.28" $682.93 "$1,761.28" N/A N/A 36100882 EAP CPT® 54860 REMOVAL OF EPIDIDYMIS BOTH IP/OP "$7,853.00" "$5,811.50" $421.01 "$7,853.00" "$7,853.00" "$7,853.00" "$7,853.00" "$7,853.00" $422.55 $422.55 $424.13 "$7,853.00" $422.55 "$7,853.00" "$7,853.00" "$7,853.00" "$7,853.00" "$1,636.65" $676.08 $673.62 "$7,853.00" $422.55 $421.01 $422.55 "$7,853.00" "$5,889.75" $422.55 $422.55 $422.55 "$3,500.00" "$3,926.50" "$6,219.58" $422.55 "$6,282.40" "$3,250.00" "$7,853.00" $422.55 "$4,554.74" "$7,853.00" $435.17 $422.55 "$7,853.00" $422.55 N/A N/A 36100883 EAP CPT® 55000 ASPIRATION OF HYDROCELE BOTH IP/OP $988.00 $731.50 $84.42 $988.00 $536.48 $536.48 $536.48 $536.48 $612.13 $612.13 $609.42 $205.92 $612.13 $988.00 $988.00 $988.00 $882.37 $205.91 $979.40 $936.25 $113.00 $612.13 $84.42 $612.13 $642.73 $741.00 $612.13 $612.13 $612.13 $988.00 $494.00 $782.50 $612.13 $790.40 $988.00 $196.09 $612.13 $573.04 $642.73 $885.59 $612.13 $205.90 $612.13 N/A N/A 36100884 EAP CPT® 55250 REMOVAL OF SPERM DUCT(S) BOTH IP/OP "$2,475.00" "$1,831.50" $230.33 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $230.33 $230.33 $230.88 "$2,475.00" $230.33 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 $368.53 $368.70 "$2,475.00" $230.33 $230.44 $230.33 "$2,475.00" "$1,856.25" $230.33 $230.33 $230.33 "$2,475.00" "$1,237.50" "$1,960.20" $230.33 "$1,980.00" "$2,475.00" "$2,475.00" $230.33 "$1,435.50" "$2,475.00" $236.13 $230.33 "$2,475.00" $230.33 N/A N/A 36100885 EAP CPT® 55700 BIOPSY PROSTATE NEEDLE/PUNCH BOTH IP/OP "$4,505.00" "$3,334.00" $129.20 "$3,604.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,761.28" "$1,761.28" "$1,753.49" $938.95 "$1,761.28" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $938.89 "$2,818.05" "$2,675.95" "$2,836.00" "$1,761.28" $129.20 "$1,761.28" "$1,849.35" "$3,378.75" "$1,761.28" "$1,761.28" "$1,761.28" "$2,851.00" "$2,423.00" "$3,567.96" "$1,761.28" "$3,604.00" "$2,500.00" $894.13 "$1,761.28" "$2,612.90" "$1,849.35" "$2,548.13" "$1,761.28" $938.84 "$1,761.28" N/A N/A 36100887 EAP CPT® 56405 I AND D VULVA PERINEAL ABSCES BOTH IP/OP $291.00 $215.50 $60.65 $291.00 $291.00 $291.00 $291.00 $291.00 $130.53 $130.53 $127.09 $291.00 $130.53 $291.00 $291.00 $291.00 $291.00 $60.65 $208.85 $207.65 $291.00 $130.53 $129.78 $130.53 $291.00 $218.25 $130.53 $130.53 $130.53 $291.00 $145.50 $230.47 $130.53 $232.80 $291.00 $291.00 $130.53 $168.78 $291.00 $123.63 $130.53 $291.00 $130.53 N/A N/A 36100888 EAP CPT® 0440T ABLTJ PERC UXTR/PERPH NRV BOTH IP/OP "$4,318.00" "$3,195.50" $202.73 "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" $202.73 "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" $899.92 "$4,318.00" "$1,727.20" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$3,238.50" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$2,159.00" "$3,419.86" "$4,318.00" "$3,454.40" "$2,806.70" "$4,318.00" "$4,318.00" "$2,504.44" "$4,318.00" "$2,590.80" "$4,318.00" "$4,318.00" "$4,318.00" N/A N/A 36100889 EAP CPT® 0442T ABLTJ PERC PLEX/TRNCL NRV BOTH IP/OP "$14,024.00" "$10,378.00" $171.66 "$14,024.00" "$14,024.00" "$14,024.00" "$14,024.00" "$14,024.00" "$14,024.00" "$14,024.00" $171.66 "$14,024.00" "$14,024.00" "$14,024.00" "$14,024.00" "$14,024.00" "$14,024.00" "$2,922.76" "$14,024.00" "$5,609.60" "$14,024.00" "$14,024.00" "$14,024.00" "$14,024.00" "$14,024.00" "$10,518.00" "$14,024.00" "$14,024.00" "$14,024.00" "$6,095.00" "$7,012.00" "$11,107.01" "$14,024.00" "$11,219.20" "$9,115.60" "$14,024.00" "$14,024.00" "$8,133.92" "$14,024.00" "$8,414.40" "$14,024.00" "$14,024.00" "$14,024.00" N/A N/A 36100890 EAP CPT® 0600T IRE ABLTJ 1+TUM ORGAN PERQ BOTH IP/OP "$21,903.00" "$16,208.50" "$1,834.05" "$21,903.00" "$21,903.00" "$21,903.00" "$21,903.00" "$21,903.00" "$21,903.00" "$21,903.00" "$1,834.05" "$21,903.00" "$21,903.00" "$21,903.00" "$21,903.00" "$21,903.00" "$21,903.00" "$4,564.83" "$21,903.00" "$8,761.20" "$21,903.00" "$21,903.00" "$21,903.00" "$21,903.00" "$21,903.00" "$16,427.25" "$21,903.00" "$21,903.00" "$21,903.00" "$6,095.00" "$10,951.50" "$17,347.18" "$21,903.00" "$17,522.40" "$14,236.95" "$21,903.00" "$21,903.00" "$12,703.74" "$21,903.00" "$13,141.80" "$21,903.00" "$21,903.00" "$21,903.00" N/A N/A 36100891 EAP CPT® 32994 ABLATE PULM TUMOR PERQ CRYBL BOTH IP/OP "$12,443.00" "$9,208.00" $434.06 "$9,954.40" "$3,558.00" "$3,558.00" "$3,558.00" "$3,558.00" "$4,977.31" "$4,977.31" "$4,955.30" "$2,593.43" "$4,977.31" "$2,571.13" "$2,571.13" "$2,670.02" "$1,804.74" "$2,593.26" "$7,963.70" "$7,519.36" "$4,877.00" "$4,977.31" $434.06 "$4,977.31" "$5,226.18" "$9,332.25" "$4,977.31" "$4,977.31" "$4,977.31" "$6,095.00" "$5,161.00" "$9,854.86" "$4,977.31" "$9,954.40" "$8,087.95" "$2,469.62" "$4,977.31" "$7,216.94" "$5,226.18" "$7,200.92" "$4,977.31" "$2,593.12" "$4,977.31" N/A N/A 36100892 EAP CPT® 47383 PERQ ABLTJ LVR CRYOABLATION BOTH IP/OP "$12,443.00" "$9,208.00" $445.83 "$12,443.00" "$12,443.00" "$12,443.00" "$12,443.00" "$12,443.00" $445.83 $445.83 $447.66 "$12,443.00" $445.83 "$12,443.00" "$12,443.00" "$12,443.00" "$12,443.00" "$2,593.26" $713.33 $715.04 "$12,443.00" $445.83 $446.90 $445.83 "$12,443.00" "$9,332.25" $445.83 $445.83 $445.83 "$6,679.00" "$6,221.50" "$9,854.86" $445.83 "$9,954.40" "$4,334.00" "$12,443.00" $445.83 "$7,216.94" "$12,443.00" $475.29 $445.83 "$12,443.00" $445.83 N/A N/A 36100893 EAP CPT® 0620T EVASC VEN ARTLZ TIBL/PRNL VN BOTH IP/OP "$39,495.00" "$29,226.50" "$8,231.19" "$39,495.00" "$39,495.00" "$39,495.00" "$39,495.00" "$39,495.00" "$39,495.00" "$39,495.00" "$9,920.13" "$39,495.00" "$39,495.00" "$39,495.00" "$39,495.00" "$39,495.00" "$39,495.00" "$8,231.19" "$39,495.00" "$15,798.00" "$39,495.00" "$39,495.00" "$39,495.00" "$39,495.00" "$39,495.00" "$29,621.25" "$39,495.00" "$39,495.00" "$39,495.00" "$19,747.50" "$19,747.50" "$31,280.04" "$39,495.00" "$31,596.00" "$25,671.75" "$39,495.00" "$39,495.00" "$22,907.10" "$39,495.00" "$23,697.00" "$39,495.00" "$39,495.00" "$39,495.00" N/A N/A 36100898 EAP CPT® 56420 BARTHOLIN GLAND ABSCESS BOTH IP/OP $665.00 $492.50 $113.55 $665.00 $665.00 $665.00 $665.00 $665.00 $167.58 $167.58 $166.84 $138.60 $167.58 $665.00 $665.00 $665.00 $665.00 $138.59 $268.13 $256.98 $665.00 $167.58 $113.55 $167.58 $175.96 $498.75 $167.58 $167.58 $167.58 $665.00 $332.50 $526.68 $167.58 $532.00 $665.00 $131.99 $167.58 $385.70 $175.96 $242.45 $167.58 $138.59 $167.58 N/A N/A 36100902 EAP CPT® 37214 CESS THERAPY CATH REMOVALW/ VESS CLOSE BOTH IP/OP "$7,726.00" "$5,717.50" $120.83 "$7,726.00" "$7,726.00" "$7,726.00" "$7,726.00" "$7,726.00" $121.10 $121.10 $122.80 "$7,726.00" $121.10 "$7,726.00" "$7,726.00" "$7,726.00" "$7,726.00" "$1,610.18" $193.76 $193.33 "$7,726.00" $121.10 $120.83 $121.10 "$7,726.00" "$5,794.50" $121.10 $121.10 $121.10 "$3,500.00" "$3,863.00" "$6,118.99" $121.10 "$6,180.80" "$3,725.00" "$7,726.00" $121.10 "$4,481.08" "$7,726.00" $128.73 $121.10 "$7,726.00" $121.10 N/A N/A 36100903 EAP CPT® 56501 "CRYOSURGERY, VULVAR" BOTH IP/OP "$6,455.00" "$4,777.00" $129.76 "$6,455.00" "$6,455.00" "$6,455.00" "$6,455.00" "$6,455.00" $136.44 $136.44 $132.38 "$6,455.00" $136.44 "$6,455.00" "$6,455.00" "$6,455.00" "$6,455.00" "$1,345.29" $218.30 $218.48 "$6,455.00" $136.44 $136.55 $136.44 "$6,455.00" "$4,841.25" $136.44 $136.44 $136.44 "$2,762.00" "$3,227.50" "$5,112.36" $136.44 "$5,164.00" "$2,500.00" "$6,455.00" $136.44 "$3,743.90" "$6,455.00" $129.76 $136.44 "$6,455.00" $136.44 N/A N/A 36100904 EAP CPT® 56501 DESTROY LESION(S) VULVA SIMPLE BOTH IP/OP "$6,455.00" "$4,777.00" $129.76 "$6,455.00" "$6,455.00" "$6,455.00" "$6,455.00" "$6,455.00" $136.44 $136.44 $132.38 "$6,455.00" $136.44 "$6,455.00" "$6,455.00" "$6,455.00" "$6,455.00" "$1,345.29" $218.30 $218.48 "$6,455.00" $136.44 $136.55 $136.44 "$6,455.00" "$4,841.25" $136.44 $136.44 $136.44 "$2,762.00" "$3,227.50" "$5,112.36" $136.44 "$5,164.00" "$2,500.00" "$6,455.00" $136.44 "$3,743.90" "$6,455.00" $129.76 $136.44 "$6,455.00" $136.44 N/A N/A 36100906 EAP CPT® 56515 DESTROY LESION(S) VULVA EXTENS BOTH IP/OP "$4,384.00" "$3,244.50" $214.58 "$4,384.00" "$4,384.00" "$4,384.00" "$4,384.00" "$4,384.00" $217.55 $217.55 $214.58 "$4,384.00" $217.55 "$4,384.00" "$4,384.00" "$4,384.00" "$4,384.00" $913.67 $348.08 $347.14 "$4,384.00" $217.55 $216.96 $217.55 "$4,384.00" "$3,288.00" $217.55 $217.55 $217.55 "$3,500.00" "$2,192.00" "$3,472.13" $217.55 "$3,507.20" "$2,500.00" "$4,384.00" $217.55 "$2,542.72" "$4,384.00" $215.21 $217.55 "$4,384.00" $217.55 N/A N/A 36100909 EAP CPT® 56605 "VULVAR BIOPSY, ONE LESION" BOTH IP/OP $641.00 $474.50 $60.04 "$1,014.87" $641.00 $641.00 $641.00 $641.00 $623.62 $623.62 $620.86 $133.60 $623.62 $641.00 $641.00 $641.00 $641.00 $133.59 $997.79 "$1,014.87" $641.00 $623.62 $60.04 $623.62 $654.80 $480.75 $623.62 $623.62 $623.62 $641.00 $320.50 $507.67 $623.62 $512.80 $641.00 $127.22 $623.62 $371.78 $654.80 $641.00 $623.62 $133.58 $623.62 N/A N/A 36100914 EAP CPT® 56606 "VULVAR BX, EACH ADDL LESION" BOTH IP/OP $557.00 $412.50 $29.86 $557.00 $557.00 $557.00 $557.00 $557.00 $557.00 $557.00 $557.00 $116.09 $557.00 $557.00 $557.00 $557.00 $557.00 $116.08 $557.00 $557.00 $329.47 $557.00 $29.86 $557.00 $557.00 $417.75 $557.00 $557.00 $557.00 $557.00 $278.50 $441.14 $557.00 $445.60 $557.00 $110.55 $557.00 $323.06 $557.00 $557.00 $557.00 $116.08 $557.00 N/A N/A 36100920 EAP CPT® 56820 "COLPOSCOPY, VULVA" BOTH IP/OP $501.00 $371.00 $85.48 $501.00 $501.00 $501.00 $501.00 $501.00 $167.58 $167.58 $166.84 $104.42 $167.58 $501.00 $501.00 $501.00 $501.00 $104.41 $268.13 $256.98 $113.00 $167.58 $85.48 $167.58 $175.96 $375.75 $167.58 $167.58 $167.58 $501.00 $250.50 $396.79 $167.58 $400.80 $501.00 $99.44 $167.58 $290.58 $175.96 $242.45 $167.58 $104.41 $167.58 N/A N/A 36100921 EAP CPT® 56821 "COLPOSCOPY, VULVA + VULVA BX" BOTH IP/OP "$1,623.00" "$1,201.50" $114.66 "$1,623.00" "$1,623.00" "$1,623.00" "$1,623.00" "$1,623.00" $277.43 $277.43 $276.20 $338.27 $277.43 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $338.25 $443.89 $421.19 "$1,623.00" $277.43 $114.66 $277.43 $291.30 "$1,217.25" $277.43 $277.43 $277.43 "$1,623.00" $811.50 "$1,285.42" $277.43 "$1,298.40" "$1,623.00" $322.12 $277.43 $941.34 $291.30 $401.37 $277.43 $338.23 $277.43 N/A N/A 36100923 EAP CPT® 57020 COLPOCENTESIS BOTH IP/OP "$3,281.00" "$2,428.00" $80.41 "$6,940.13" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$4,337.58" "$4,337.58" "$4,318.40" $683.84 "$4,337.58" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $683.80 "$6,940.13" "$6,686.89" "$2,836.00" "$4,337.58" $80.41 "$4,337.58" "$4,554.46" "$2,460.75" "$4,337.58" "$4,337.58" "$4,337.58" "$2,851.00" "$1,640.50" "$2,598.55" "$4,337.58" "$2,624.80" "$3,250.00" $651.20 "$4,337.58" "$1,902.98" "$4,554.46" "$3,281.00" "$4,337.58" $683.76 "$4,337.58" N/A N/A 36100925 EAP CPT® 57061 DESTROY VAGINAL LESION(S) SIMP BOTH IP/OP "$4,198.00" "$3,107.00" $111.37 "$4,198.00" "$4,198.00" "$4,198.00" "$4,198.00" "$4,198.00" $117.87 $117.87 $114.67 "$4,198.00" $117.87 "$4,198.00" "$4,198.00" "$4,198.00" "$4,198.00" $874.91 $188.59 $188.66 "$4,198.00" $117.87 $117.91 $117.87 "$4,198.00" "$3,148.50" $117.87 $117.87 $117.87 "$2,851.00" "$2,099.00" "$3,324.82" $117.87 "$3,358.40" "$3,250.00" "$4,198.00" $117.87 "$2,434.84" "$4,198.00" $111.37 $117.87 "$4,198.00" $117.87 N/A N/A 36100926 EAP CPT® 57065 DESTROY VAGINAL LESION(S) EXTE BOTH IP/OP "$4,256.00" "$3,149.50" $187.45 "$4,256.00" "$4,256.00" "$4,256.00" "$4,256.00" "$4,256.00" $190.15 $190.15 $188.21 "$4,256.00" $190.15 "$4,256.00" "$4,256.00" "$4,256.00" "$4,256.00" $887.00 $304.24 $303.73 "$4,256.00" $190.15 $189.83 $190.15 "$4,256.00" "$3,192.00" $190.15 $190.15 $190.15 "$2,762.00" "$2,128.00" "$3,370.75" $190.15 "$3,404.80" "$3,250.00" "$4,256.00" $190.15 "$2,468.48" "$4,256.00" $187.45 $190.15 "$4,256.00" $190.15 N/A N/A 36100929 EAP CPT® 57100 VAGINAL BIOPSY SIMPLE BOTH IP/OP "$3,448.00" "$2,552.00" $65.81 "$3,448.00" "$3,448.00" "$3,448.00" "$3,448.00" "$3,448.00" $66.43 $66.43 $66.67 "$3,448.00" $66.43 "$3,448.00" "$3,448.00" "$3,448.00" "$3,448.00" $718.60 $106.29 $105.30 "$3,448.00" $66.43 $65.81 $66.43 "$3,448.00" "$2,586.00" $66.43 $66.43 $66.43 "$3,448.00" "$1,724.00" "$2,730.82" $66.43 "$2,758.40" "$2,150.00" "$3,448.00" $623.62 "$1,999.84" "$3,448.00" $68.51 $66.43 "$3,448.00" $66.43 N/A N/A 36100930 EAP CPT® 27096 BIL SACROILIAC JT INJ WITH ARTHROGRAPHY BOTH IP/OP "$3,165.00" "$2,342.50" $82.95 "$3,165.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$3,165.00" "$3,165.00" "$3,165.00" $659.67 "$3,165.00" "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $659.62 "$3,165.00" "$3,165.00" $113.00 "$3,165.00" "$3,165.00" "$3,165.00" "$3,165.00" "$2,373.75" "$3,165.00" "$3,165.00" "$3,165.00" "$2,762.00" "$1,582.50" "$2,506.68" "$3,165.00" "$2,532.00" "$1,750.00" $628.17 "$3,165.00" "$1,835.70" "$3,165.00" $86.18 $82.95 $659.59 "$3,165.00" N/A N/A 36100933 EAP CPT® 57150 VAGINAL IRRIGATION BOTH IP/OP $472.00 $349.50 $26.12 $472.00 $472.00 $472.00 $472.00 $472.00 $26.68 $26.68 $26.90 $472.00 $26.68 $472.00 $472.00 $472.00 $472.00 $98.37 $42.69 $41.79 $472.00 $26.68 $26.12 $26.68 $472.00 $354.00 $26.68 $26.68 $26.68 $472.00 $236.00 $373.82 $26.68 $377.60 $472.00 $472.00 $26.68 $273.76 $472.00 $28.12 $26.68 $472.00 $26.68 N/A N/A 36100934 EAP CPT® 57155 INSERTION OF T&O BOTH IP/OP "$4,229.00" "$3,129.50" $286.05 "$6,940.13" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$4,337.58" "$4,337.58" "$4,318.40" $881.43 "$4,337.58" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $881.37 "$6,940.13" "$6,686.89" "$2,836.00" "$4,337.58" $286.05 "$4,337.58" "$4,554.46" "$3,171.75" "$4,337.58" "$4,337.58" "$4,337.58" "$2,851.00" "$2,423.00" "$3,349.37" "$4,337.58" "$3,383.20" "$2,150.00" $839.35 "$4,337.58" "$2,452.82" "$4,554.46" "$4,229.00" "$4,337.58" $881.32 "$4,337.58" N/A N/A 36100935 EAP CPT® 57160 PESSARY INSERTION BOTH IP/OP $335.00 $248.00 $46.48 $335.00 $181.91 $181.91 $181.91 $181.91 $167.58 $167.58 $166.84 $69.82 $167.58 $335.00 $335.00 $335.00 $335.00 $69.82 $268.13 $256.98 $113.00 $167.58 $46.48 $167.58 $175.96 $251.25 $167.58 $167.58 $167.58 $335.00 $167.50 $265.32 $167.58 $268.00 $335.00 $66.49 $167.58 $194.30 $175.96 $242.45 $167.58 $69.81 $167.58 N/A N/A 36100936 EAP CPT® 57170 DIAPHRAGM CERVICAL CAP FITTIN BOTH IP/OP $500.00 $370.00 $47.96 $500.00 $500.00 $500.00 $500.00 $500.00 $47.96 $47.96 $48.67 $500.00 $47.96 $500.00 $500.00 $500.00 $500.00 $104.21 $76.74 $77.65 $500.00 $47.96 $48.53 $47.96 $500.00 $375.00 $47.96 $47.96 $47.96 $500.00 $250.00 $396.00 $47.96 $400.00 $500.00 $500.00 $47.96 $290.00 $500.00 $49.76 $47.96 $500.00 $47.96 N/A N/A 36100938 EAP CPT® 57170 DIAPHRAGM FITTING BOTH IP/OP $500.00 $370.00 $47.96 $500.00 $500.00 $500.00 $500.00 $500.00 $47.96 $47.96 $48.67 $500.00 $47.96 $500.00 $500.00 $500.00 $500.00 $104.21 $76.74 $77.65 $500.00 $47.96 $48.53 $47.96 $500.00 $375.00 $47.96 $47.96 $47.96 $500.00 $250.00 $396.00 $47.96 $400.00 $500.00 $500.00 $47.96 $290.00 $500.00 $49.76 $47.96 $500.00 $47.96 N/A N/A 36100939 EAP CPT® 57210 COLPOPERINEORRHAPHY BOTH IP/OP "$10,423.00" "$7,713.50" $399.06 "$10,423.00" "$10,423.00" "$10,423.00" "$10,423.00" "$10,423.00" $404.56 $404.56 $399.66 "$10,423.00" $404.56 "$10,423.00" "$10,423.00" "$10,423.00" "$10,423.00" "$2,172.27" $647.30 $641.65 "$10,423.00" $404.56 $401.03 $404.56 "$10,423.00" "$7,817.25" $404.56 $404.56 $404.56 "$2,851.00" "$5,211.50" "$8,255.02" $404.56 "$8,338.40" "$3,250.00" "$10,423.00" $404.56 "$6,045.34" "$10,423.00" $399.06 $404.56 "$10,423.00" $404.56 N/A N/A 36100940 EAP CPT® 57420 COLPOSCOPY OF VAGINA BOTH IP/OP "$1,237.00" $915.50 $90.22 "$1,237.00" "$1,237.00" "$1,237.00" "$1,237.00" "$1,237.00" $277.43 $277.43 $276.20 $257.82 $277.43 "$1,237.00" "$1,237.00" "$1,237.00" $882.37 $257.80 $443.89 $421.19 "$1,237.00" $277.43 $90.22 $277.43 $291.30 $927.75 $277.43 $277.43 $277.43 "$1,237.00" $618.50 $979.70 $277.43 $989.60 "$1,237.00" $245.51 $277.43 $717.46 $291.30 $401.37 $277.43 $257.79 $277.43 N/A N/A 36100941 EAP CPT® 57420 "COLPOSCOPY, VAGINA WITH CERVIX" BOTH IP/OP "$1,237.00" $915.50 $90.22 "$1,237.00" "$1,237.00" "$1,237.00" "$1,237.00" "$1,237.00" $277.43 $277.43 $276.20 $257.82 $277.43 "$1,237.00" "$1,237.00" "$1,237.00" $882.37 $257.80 $443.89 $421.19 "$1,237.00" $277.43 $90.22 $277.43 $291.30 $927.75 $277.43 $277.43 $277.43 "$1,237.00" $618.50 $979.70 $277.43 $989.60 "$1,237.00" $245.51 $277.43 $717.46 $291.30 $401.37 $277.43 $257.79 $277.43 N/A N/A 36100942 EAP CPT® 57421 COLPOSCOPY BX OF VAGINA+CERVIX BOTH IP/OP "$1,039.00" $769.00 $122.46 "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" $623.62 $623.62 $620.86 $216.55 $623.62 "$1,039.00" "$1,039.00" "$1,039.00" $882.37 $216.54 $997.79 "$1,014.87" "$1,039.00" $623.62 $122.46 $623.62 $654.80 $779.25 $623.62 $623.62 $623.62 "$1,039.00" $519.50 $822.89 $623.62 $831.20 "$1,039.00" $206.22 $623.62 $602.62 $654.80 $902.22 $623.62 $216.53 $623.62 N/A N/A 36100943 EAP CPT® 57421 COLPOSCOPY OF VAGINA W/BX BOTH IP/OP "$1,039.00" $769.00 $122.46 "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" $623.62 $623.62 $620.86 $216.55 $623.62 "$1,039.00" "$1,039.00" "$1,039.00" $882.37 $216.54 $997.79 "$1,014.87" "$1,039.00" $623.62 $122.46 $623.62 $654.80 $779.25 $623.62 $623.62 $623.62 "$1,039.00" $519.50 $822.89 $623.62 $831.20 "$1,039.00" $206.22 $623.62 $602.62 $654.80 $902.22 $623.62 $216.53 $623.62 N/A N/A 36100944 EAP CPT® 57421 "COLPOSCOPY, VAGINA W/ BX" BOTH IP/OP "$1,039.00" $769.00 $122.46 "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" "$1,039.00" $623.62 $623.62 $620.86 $216.55 $623.62 "$1,039.00" "$1,039.00" "$1,039.00" $882.37 $216.54 $997.79 "$1,014.87" "$1,039.00" $623.62 $122.46 $623.62 $654.80 $779.25 $623.62 $623.62 $623.62 "$1,039.00" $519.50 $822.89 $623.62 $831.20 "$1,039.00" $206.22 $623.62 $602.62 $654.80 $902.22 $623.62 $216.53 $623.62 N/A N/A 36100945 EAP CPT® 57452 COLPOSCOPY WITHOUT BIOPSY BOTH IP/OP $556.00 $411.50 $91.90 $556.00 $556.00 $556.00 $556.00 $556.00 $167.58 $167.58 $166.84 $115.88 $167.58 $556.00 $556.00 $556.00 $556.00 $115.88 $268.13 $256.98 $556.00 $167.58 $91.90 $167.58 $175.96 $417.00 $167.58 $167.58 $167.58 $556.00 $278.00 $440.35 $167.58 $444.80 $556.00 $110.35 $167.58 $322.48 $175.96 $242.45 $167.58 $115.87 $167.58 N/A N/A 36100951 EAP CPT® 57454 COLPOSCOPY W/BX & ECC BOTH IP/OP "$1,185.00" $877.00 $134.31 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $277.43 $277.43 $276.20 $246.98 $277.43 "$1,185.00" "$1,185.00" "$1,185.00" $882.37 $246.97 $443.89 $421.19 "$1,185.00" $277.43 $134.31 $277.43 $291.30 $888.75 $277.43 $277.43 $277.43 "$1,185.00" $592.50 $938.52 $277.43 $948.00 "$1,185.00" $235.19 $277.43 $687.30 $291.30 $401.37 $277.43 $246.95 $277.43 N/A N/A 36100956 EAP CPT® 57455 COLPOSCOPY + CX BX BOTH IP/OP "$1,218.00" $901.50 $109.56 "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" $277.43 $277.43 $276.20 $253.86 $277.43 "$1,218.00" "$1,218.00" "$1,218.00" $882.37 $253.84 $443.89 $421.19 "$1,218.00" $277.43 $109.56 $277.43 $291.30 $913.50 $277.43 $277.43 $277.43 "$1,218.00" $609.00 $964.66 $277.43 $974.40 "$1,218.00" $241.74 $277.43 $706.44 $291.30 $401.37 $277.43 $253.83 $277.43 N/A N/A 36100957 EAP CPT® 64999 "UNLISTED PROCEDURE, NERVOUS SYSTEM" BOTH IP/OP $643.00 $476.00 $127.62 $643.00 $643.00 $643.00 $643.00 $643.00 $257.00 $257.00 $255.86 $134.02 $257.00 $643.00 $643.00 $643.00 $643.00 $134.01 $411.20 $392.25 $643.00 $257.00 $643.00 $257.00 $269.85 $482.25 $257.00 $257.00 $257.00 $643.00 $321.50 $509.26 $257.00 $514.40 $643.00 $127.62 $257.00 $372.94 $269.85 $371.81 $257.00 $134.00 $257.00 N/A N/A 36100960 EAP CPT® 57456 COLPOSCOPY + ECC BOTH IP/OP "$1,218.00" $901.50 $102.10 "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" $277.43 $277.43 $276.20 $253.86 $277.43 "$1,218.00" "$1,218.00" "$1,218.00" $882.37 $253.84 $443.89 $421.19 "$1,218.00" $277.43 $102.10 $277.43 $291.30 $913.50 $277.43 $277.43 $277.43 "$1,218.00" $609.00 $964.66 $277.43 $974.40 "$1,218.00" $241.74 $277.43 $706.44 $291.30 $401.37 $277.43 $253.83 $277.43 N/A N/A 36100961 EAP CPT® 57460 COLPOSCOPY W/LEEP BX BOTH IP/OP "$4,730.00" "$3,500.50" $161.11 "$4,730.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,580.85" "$2,580.85" "$2,569.43" $985.85 "$2,580.85" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $985.78 "$4,129.35" "$4,079.03" "$4,730.00" "$2,580.85" $161.11 "$2,580.85" "$2,709.89" "$3,547.50" "$2,580.85" "$2,580.85" "$2,580.85" "$2,762.00" "$2,348.00" "$3,746.16" "$2,580.85" "$3,784.00" "$3,250.00" $938.79 "$2,580.85" "$2,743.40" "$2,709.89" "$3,733.83" "$2,580.85" $985.73 "$2,580.85" N/A N/A 36100963 EAP CPT® 57461 COLPOSCOPY W/LEEP CONE BOTH IP/OP "$8,498.00" "$6,289.00" $185.23 "$6,798.40" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$2,580.85" "$2,580.85" "$2,569.43" "$1,771.20" "$2,580.85" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,771.08" "$4,129.35" "$4,079.03" "$2,836.00" "$2,580.85" $185.23 "$2,580.85" "$2,709.89" "$6,373.50" "$2,580.85" "$2,580.85" "$2,580.85" "$2,762.00" "$2,348.00" "$6,730.42" "$2,580.85" "$6,798.40" "$3,250.00" "$1,686.64" "$2,580.85" "$4,928.84" "$2,709.89" "$3,733.83" "$2,580.85" "$1,770.98" "$2,580.85" N/A N/A 36100964 EAP CPT® 57500 CERVICAL BIOPSY BOTH IP/OP "$3,362.00" "$2,488.00" $75.61 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $623.62 $623.62 $620.86 $700.72 $623.62 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $700.68 $997.79 "$1,014.87" "$1,871.00" $623.62 $75.61 $623.62 $654.80 "$2,521.50" $623.62 $623.62 $623.62 "$2,762.00" "$1,681.00" "$2,662.70" $623.62 "$2,689.60" "$2,150.00" $667.27 $623.62 "$1,949.96" $654.80 $902.22 $623.62 $700.64 $623.62 N/A N/A 36100967 EAP CPT® 57511 "CRYOSURGERY, CERVIX" BOTH IP/OP $785.00 $581.00 $146.35 $785.00 $785.00 $785.00 $785.00 $785.00 $151.06 $151.06 $147.81 $785.00 $151.06 $785.00 $785.00 $785.00 $785.00 $163.60 $241.70 $240.22 $785.00 $151.06 $150.14 $151.06 $785.00 $588.75 $151.06 $151.06 $151.06 $785.00 $392.50 $621.72 $151.06 $628.00 $785.00 $785.00 $151.06 $455.30 $785.00 $146.35 $151.06 $785.00 $151.06 N/A N/A 36100968 EAP CPT® 57522 LEEP + ECC + CONE BOTH IP/OP "$8,652.00" "$6,402.50" $260.00 "$6,921.60" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,580.85" "$2,580.85" "$2,569.43" "$1,803.29" "$2,580.85" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,803.17" "$4,129.35" "$4,079.03" "$2,836.00" "$2,580.85" $260.00 "$2,580.85" "$2,709.89" "$6,489.00" "$2,580.85" "$2,580.85" "$2,580.85" "$2,851.00" "$2,423.00" "$6,852.38" "$2,580.85" "$6,921.60" "$3,250.00" "$1,717.21" "$2,580.85" "$5,018.16" "$2,709.89" "$3,733.83" "$2,580.85" "$1,803.08" "$2,580.85" N/A N/A 36100969 EAP CPT® 57720 REVISION OF CERVIX BOTH IP/OP "$6,223.00" "$4,605.50" $336.32 "$6,223.00" "$6,223.00" "$6,223.00" "$6,223.00" "$6,223.00" $344.25 $344.25 $339.16 "$6,223.00" $344.25 "$6,223.00" "$6,223.00" "$6,223.00" "$6,223.00" "$1,296.94" $550.80 $547.22 "$6,223.00" $344.25 $342.01 $344.25 "$6,223.00" "$4,667.25" $344.25 $344.25 $344.25 "$3,500.00" "$3,111.50" "$4,928.62" $344.25 "$4,978.40" "$3,250.00" "$6,223.00" $344.25 "$3,609.34" "$6,223.00" $336.32 $344.25 "$6,223.00" $344.25 N/A N/A 36100970 EAP CPT® 58100 ENDOMETRIAL BIOPSY BOTH IP/OP $343.00 $254.00 $63.78 $343.00 $343.00 $343.00 $343.00 $343.00 $167.58 $167.58 $166.84 $71.49 $167.58 $343.00 $343.00 $343.00 $343.00 $71.48 $268.13 $256.98 $113.00 $167.58 $63.78 $167.58 $175.96 $257.25 $167.58 $167.58 $167.58 $343.00 $171.50 $271.66 $167.58 $274.40 $343.00 $68.08 $167.58 $198.94 $175.96 $242.45 $167.58 $71.48 $167.58 N/A N/A 36100971 EAP CPT® 0237T "ATHERECTOMY, BRANCHIOCEPHALIC ARTERY" BOTH IP/OP "$12,918.00" "$9,559.50" "$2,692.25" "$12,918.00" "$12,918.00" "$12,918.00" "$12,918.00" "$12,918.00" "$12,918.00" "$12,918.00" "$4,320.91" "$12,918.00" "$12,918.00" "$12,918.00" "$12,918.00" "$12,918.00" "$12,918.00" "$2,692.25" "$12,918.00" "$5,167.20" "$12,918.00" "$12,918.00" "$12,918.00" "$12,918.00" "$12,918.00" "$9,688.50" "$12,918.00" "$12,918.00" "$12,918.00" "$7,479.00" "$6,459.00" "$10,231.06" "$12,918.00" "$10,334.40" "$5,164.00" "$12,918.00" "$12,918.00" "$7,492.44" "$12,918.00" "$7,750.80" "$12,918.00" "$12,918.00" "$12,918.00" N/A N/A 36100972 EAP CPT® 0236T "ATHERECTOMY, AORTA" BOTH IP/OP "$24,595.00" "$18,200.50" "$4,451.14" "$24,595.00" "$24,595.00" "$24,595.00" "$24,595.00" "$24,595.00" "$24,595.00" "$24,595.00" "$4,451.14" "$24,595.00" "$24,595.00" "$24,595.00" "$24,595.00" "$24,595.00" "$24,595.00" "$5,125.87" "$24,595.00" "$7,149.60" "$24,595.00" "$24,595.00" "$17,874.00" "$24,595.00" "$24,595.00" "$18,446.25" "$24,595.00" "$24,595.00" "$24,595.00" "$7,479.00" "$12,297.50" "$19,479.24" "$24,595.00" "$19,676.00" "$5,164.00" "$24,595.00" "$24,595.00" "$14,265.10" "$24,595.00" "$14,757.00" "$24,595.00" "$24,595.00" "$24,595.00" N/A N/A 36100973 EAP CPT® 0234T "ATHERECTOMY, RENAL ARTERY" BOTH IP/OP "$24,595.00" "$18,200.50" "$2,138.35" "$24,595.00" "$24,595.00" "$24,595.00" "$24,595.00" "$24,595.00" "$24,595.00" "$24,595.00" "$2,138.35" "$24,595.00" "$24,595.00" "$24,595.00" "$24,595.00" "$24,595.00" "$24,595.00" "$5,125.87" "$24,595.00" "$7,149.60" "$24,595.00" "$24,595.00" "$17,874.00" "$24,595.00" "$24,595.00" "$18,446.25" "$24,595.00" "$24,595.00" "$24,595.00" "$7,479.00" "$12,297.50" "$19,479.24" "$24,595.00" "$19,676.00" "$5,164.00" "$24,595.00" "$24,595.00" "$14,265.10" "$24,595.00" "$14,757.00" "$24,595.00" "$24,595.00" "$24,595.00" N/A N/A 36100974 EAP CPT® 58110 ENDOMETRIAL BX IN CONJ W/COLP BOTH IP/OP $238.00 $176.50 $40.37 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $49.61 $238.00 $238.00 $238.00 $238.00 $238.00 $49.60 $238.00 $238.00 $140.78 $238.00 $40.37 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $238.00 $47.24 $238.00 $138.04 $238.00 $238.00 $238.00 $49.60 $238.00 N/A N/A 36100975 EAP CPT® 0238T "ATHERECTOMY, LILAC ARTERY" BOTH IP/OP "$18,351.00" "$13,580.00" "$3,824.55" "$18,351.00" "$18,351.00" "$18,351.00" "$18,351.00" "$18,351.00" "$18,351.00" "$18,351.00" "$6,782.56" "$18,351.00" "$18,351.00" "$18,351.00" "$18,351.00" "$18,351.00" "$18,351.00" "$3,824.55" "$18,351.00" "$7,340.40" "$18,351.00" "$18,351.00" "$18,351.00" "$18,351.00" "$18,351.00" "$13,763.25" "$18,351.00" "$18,351.00" "$18,351.00" "$7,479.00" "$9,175.50" "$14,533.99" "$18,351.00" "$14,680.80" "$5,164.00" "$18,351.00" "$18,351.00" "$10,643.58" "$18,351.00" "$11,010.60" "$18,351.00" "$18,351.00" "$18,351.00" N/A N/A 36100976 EAP CPT® 58120 DILATION & CURETTAGE DX&/THER NONOBSTETRIC BOTH IP/OP "$7,782.00" "$5,759.00" $235.84 "$7,782.00" "$7,782.00" "$7,782.00" "$7,782.00" "$7,782.00" $239.02 $239.02 $235.84 "$7,782.00" $239.02 "$7,782.00" "$7,782.00" "$7,782.00" "$7,782.00" "$1,621.85" $382.43 $380.29 "$7,782.00" $239.02 $237.68 $239.02 "$7,782.00" "$5,836.50" $239.02 $239.02 $239.02 "$2,851.00" "$3,891.00" "$6,163.34" $239.02 "$6,225.60" "$3,250.00" "$7,782.00" $239.02 "$4,513.56" "$7,782.00" $236.49 $239.02 "$7,782.00" $239.02 N/A N/A 36100977 EAP CPT® 0441T ABLTJ PERC CRYOABLTJ IMG GDN LXTR/PERPH NERVE BOTH IP/OP "$4,318.00" "$3,195.50" $202.73 "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" $202.73 "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" $899.92 "$4,318.00" "$1,727.20" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$3,238.50" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$2,159.00" "$3,419.86" "$4,318.00" "$3,454.40" "$4,318.00" "$4,318.00" "$4,318.00" "$2,504.44" "$4,318.00" "$2,590.80" "$4,318.00" "$4,318.00" "$4,318.00" N/A N/A 36100978 EAP CPT® 58300 INSERTION IUD BOTH IP/OP $676.00 $500.50 $51.66 "$1,381.00" $676.00 $676.00 $676.00 $676.00 $676.00 $676.00 $51.66 $140.90 $676.00 $676.00 $676.00 $676.00 $676.00 $140.89 $676.00 $552.40 $113.00 $676.00 "$1,381.00" $676.00 $676.00 $507.00 $676.00 $676.00 $676.00 $676.00 $338.00 $535.39 $676.00 $540.80 $676.00 $134.17 $676.00 $392.08 $676.00 $405.60 $676.00 $140.88 $676.00 N/A N/A 36100980 EAP CPT® 37197 RETRIEVE FB PERCUT INTRAVASCUL W/ S AND I BOTH IP/OP "$28,818.00" "$21,325.50" $296.58 "$28,818.00" "$28,818.00" "$28,818.00" "$28,818.00" "$28,818.00" $298.49 $298.49 $301.03 "$28,818.00" $298.49 "$28,818.00" "$28,818.00" "$28,818.00" "$28,818.00" "$6,005.99" $477.58 $474.53 "$28,818.00" $298.49 $296.58 $298.49 "$28,818.00" "$21,613.50" $298.49 $298.49 $298.49 "$3,500.00" "$14,409.00" "$22,823.86" $298.49 "$23,054.40" "$3,725.00" "$28,818.00" $298.49 "$16,714.44" "$28,818.00" $315.16 $298.49 "$28,818.00" $298.49 N/A N/A 36100981 EAP CPT® 36221 NON SEL CATH PLAC AORT W ANGIO INC S/I BOTH IP/OP "$67,249.00" "$49,764.50" $197.61 "$67,249.00" "$67,249.00" "$67,249.00" "$67,249.00" "$67,249.00" $201.14 $201.14 $200.89 "$67,249.00" $201.14 "$67,249.00" "$67,249.00" "$67,249.00" "$67,249.00" "$14,015.43" $321.82 $316.18 "$67,249.00" $201.14 $197.61 $201.14 "$67,249.00" "$50,436.75" $201.14 $201.14 $201.14 "$3,500.00" "$33,624.50" "$53,261.21" $201.14 "$53,799.20" "$3,725.00" "$67,249.00" $201.14 "$39,004.42" "$67,249.00" $210.21 $201.14 "$67,249.00" $201.14 N/A N/A 36100982 EAP CPT® 36222 SEL CATH PLAC EXT CAROTID ANGIO W S&I BOTH IP/OP "$19,446.00" "$14,390.50" $283.52 "$15,556.80" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,815.92" "$2,815.92" "$2,803.47" "$4,053.03" "$2,815.92" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$4,052.76" "$4,505.48" "$4,297.64" "$4,877.00" "$2,815.92" $283.52 "$2,815.92" "$2,956.72" "$14,584.50" "$2,815.92" "$2,815.92" "$2,815.92" "$3,500.00" "$2,975.00" "$15,401.23" "$2,815.92" "$15,556.80" "$3,725.00" "$3,859.54" "$2,815.92" "$11,278.68" "$2,956.72" "$4,073.93" "$2,815.92" "$4,052.55" "$2,815.92" N/A N/A 36100983 EAP CPT® 58301 "IUD, REMOVAL" BOTH IP/OP $281.00 $208.00 $55.77 $443.89 $281.00 $281.00 $281.00 $281.00 $277.43 $277.43 $276.20 $58.57 $277.43 $281.00 $281.00 $281.00 $281.00 $58.56 $443.89 $421.19 $281.00 $277.43 $66.83 $277.43 $291.30 $210.75 $277.43 $277.43 $277.43 $281.00 $140.50 $222.55 $277.43 $224.80 $281.00 $55.77 $277.43 $162.98 $291.30 $281.00 $277.43 $58.56 $277.43 N/A N/A 36100984 EAP CPT® 36223 SEL CATH PLAC COMMON/INOM INTRACRANIAL CAROTID BOTH IP/OP "$18,704.00" "$13,841.00" $326.68 "$14,963.20" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$4,690.83" "$4,690.83" "$4,670.08" "$3,898.38" "$4,690.83" "$2,192.53" "$2,192.53" "$2,276.86" "$1,538.39" "$3,898.12" "$7,505.33" "$7,414.92" "$4,877.00" "$4,690.83" $326.68 "$4,690.83" "$4,925.37" "$14,028.00" "$4,690.83" "$4,690.83" "$4,690.83" "$3,500.00" "$2,975.00" "$14,813.57" "$4,690.83" "$14,963.20" "$3,725.00" "$3,712.28" "$4,690.83" "$10,848.32" "$4,925.37" "$6,786.45" "$4,690.83" "$3,897.91" "$4,690.83" N/A N/A 36100985 EAP CPT® 36224 SEL CATH PLAC INTERNAL INTRACRANIAL CAROTID UNILATERAL BOTH IP/OP "$21,402.00" "$15,837.50" $367.81 "$17,121.60" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$4,690.83" "$4,690.83" "$4,670.08" "$4,460.71" "$4,690.83" "$2,192.53" "$2,192.53" "$2,276.86" "$1,538.39" "$4,460.41" "$7,505.33" "$7,414.92" "$4,877.00" "$4,690.83" $367.81 "$4,690.83" "$4,925.37" "$16,051.50" "$4,690.83" "$4,690.83" "$4,690.83" "$6,095.00" "$5,161.00" "$16,950.38" "$4,690.83" "$17,121.60" "$4,334.00" "$4,247.76" "$4,690.83" "$12,413.16" "$4,925.37" "$6,786.45" "$4,690.83" "$4,460.18" "$4,690.83" N/A N/A 36100986 EAP CPT® 36225 "SEL CATH PLAC SUB CLAV,/INNOM UNI W/ANGIO AND S/I" BOTH IP/OP "$18,704.00" "$13,841.00" $319.29 "$18,704.00" "$18,704.00" "$18,704.00" "$18,704.00" "$18,704.00" $319.92 $319.92 $319.29 "$18,704.00" $319.92 "$18,704.00" "$18,704.00" "$18,704.00" "$18,704.00" "$3,898.12" $511.87 $517.81 "$18,704.00" $319.92 $323.63 $319.92 "$18,704.00" "$14,028.00" $319.92 $319.92 $319.92 "$3,500.00" "$9,352.00" "$14,813.57" $319.92 "$14,963.20" "$3,725.00" "$18,704.00" $319.92 "$10,848.32" "$18,704.00" $329.88 $319.92 "$18,704.00" $319.92 N/A N/A 36100987 EAP CPT® 36226 "SEL CATH PLAC SUB CLAV,/VERT W/ANGIO AND S/I" BOTH IP/OP "$60,254.00" "$44,588.00" $365.42 "$48,203.20" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$4,690.83" "$4,690.83" "$4,670.08" "$9,417.94" "$4,690.83" "$2,192.53" "$2,192.53" "$2,276.86" "$1,538.39" "$12,557.60" "$7,505.33" "$7,414.92" "$4,877.00" "$4,690.83" $365.42 "$4,690.83" "$4,925.37" "$45,190.50" "$4,690.83" "$4,690.83" "$4,690.83" "$6,095.00" "$5,161.00" "$47,721.17" "$4,690.83" "$48,203.20" "$4,334.00" "$7,712.84" "$4,690.83" "$34,947.32" "$4,925.37" "$6,786.45" "$4,690.83" "$8,098.48" "$4,690.83" N/A N/A 36100988 EAP CPT® 36227 SEL CATH PLAC EXT CAROTID ANGIO W S&I BOTH IP/OP "$18,704.00" "$13,841.00" $120.22 "$20,658.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$18,704.00" "$18,704.00" "$18,704.00" "$3,898.38" "$18,704.00" "$18,704.00" "$18,704.00" "$18,704.00" "$18,704.00" "$3,898.12" "$18,704.00" "$20,658.00" "$4,877.00" "$18,704.00" $120.22 "$18,704.00" "$18,704.00" "$14,028.00" "$18,704.00" "$18,704.00" "$18,704.00" "$9,352.00" "$5,151.00" "$14,813.57" "$18,704.00" "$14,963.20" "$1,750.00" "$3,712.28" "$18,704.00" "$10,848.32" "$18,704.00" "$18,704.00" "$18,704.00" "$3,897.91" "$18,704.00" N/A N/A 36100989 EAP CPT® 58340 INJECT HYSTEROSALPINGOGRAPHY BOTH IP/OP "$1,109.00" $821.00 $57.98 "$1,233.00" "$1,109.00" "$1,109.00" "$1,109.00" "$1,109.00" "$1,109.00" "$1,109.00" "$1,109.00" $231.14 "$1,109.00" "$1,109.00" "$1,109.00" "$1,109.00" "$1,109.00" $231.13 "$1,109.00" "$1,233.00" $655.97 "$1,109.00" $57.98 "$1,109.00" "$1,109.00" $831.75 "$1,109.00" "$1,109.00" "$1,109.00" "$1,109.00" $554.50 $878.33 "$1,109.00" $887.20 "$1,109.00" $220.11 "$1,109.00" $643.22 "$1,109.00" "$1,109.00" "$1,109.00" $231.12 "$1,109.00" N/A N/A 36100990 EAP CPT® 58345 TRANSCERVICAL INTRO OF CATHETE BOTH IP/OP "$6,236.00" "$4,615.00" $294.69 "$4,988.80" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,580.85" "$2,580.85" "$2,569.43" "$1,299.74" "$2,580.85" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,299.65" "$4,129.35" "$4,079.03" "$4,877.00" "$2,580.85" $294.69 "$2,580.85" "$2,709.89" "$4,677.00" "$2,580.85" "$2,580.85" "$2,580.85" "$2,762.00" "$2,348.00" "$4,938.91" "$2,580.85" "$4,988.80" "$3,250.00" "$1,237.69" "$2,580.85" "$3,616.88" "$2,709.89" "$3,733.83" "$2,580.85" "$1,299.58" "$2,580.85" N/A N/A 36100991 EAP CPT® 58558 "HYSTEROSCOPY, BIOPSY" BOTH IP/OP "$5,957.00" "$4,408.50" $232.96 "$5,957.00" "$5,957.00" "$5,957.00" "$5,957.00" "$5,957.00" $232.96 $232.96 $234.26 "$5,957.00" $232.96 "$5,957.00" "$5,957.00" "$5,957.00" "$5,957.00" "$1,241.50" $372.74 $373.95 "$5,957.00" $232.96 $233.72 $232.96 "$5,957.00" "$4,467.75" $232.96 $232.96 $232.96 "$3,500.00" "$2,978.50" "$4,717.94" $232.96 "$4,765.60" "$3,250.00" "$5,957.00" $232.96 "$3,455.06" "$5,957.00" $243.01 $232.96 "$5,957.00" $232.96 N/A N/A 36100993 EAP CPT® 59000 AMNIOCENTESIS US BOTH IP/OP "$1,106.00" $818.50 $81.49 "$1,106.00" "$1,106.00" "$1,106.00" "$1,106.00" "$1,106.00" $623.62 $623.62 $620.86 $230.52 $623.62 "$1,106.00" "$1,106.00" "$1,106.00" $882.37 $230.50 $997.79 "$1,014.87" $654.20 $623.62 $81.49 $623.62 $654.80 $829.50 $623.62 $623.62 $623.62 "$1,106.00" $553.00 $875.95 $623.62 $884.80 "$1,106.00" $219.51 $623.62 $641.48 $654.80 $902.22 $623.62 $230.49 $623.62 N/A N/A 36100999 EAP CPT® 59200 INSERT CERVICAL DILATOR BOTH IP/OP $760.00 $562.50 $44.58 $760.00 $760.00 $760.00 $760.00 $760.00 $44.58 $44.58 $44.98 $760.00 $44.58 $760.00 $760.00 $760.00 $760.00 $158.39 $71.33 $71.73 $760.00 $44.58 $44.83 $44.58 $760.00 $570.00 $44.58 $44.58 $44.58 $760.00 $380.00 $601.92 $44.58 $608.00 $760.00 $760.00 $44.58 $440.80 $760.00 $46.86 $44.58 $760.00 $44.58 N/A N/A 36101000 EAP CPT® 59300 EPISITOMY/VAGINAL REPAIR BOTH IP/OP "$6,453.00" "$4,775.50" $147.50 "$6,453.00" "$6,453.00" "$6,453.00" "$6,453.00" "$6,453.00" $147.50 $147.50 $148.09 "$6,453.00" $147.50 "$6,453.00" "$6,453.00" "$6,453.00" "$6,453.00" "$1,344.88" $236.00 $239.60 "$6,453.00" $147.50 $149.75 $147.50 "$6,453.00" "$4,839.75" $147.50 $147.50 $147.50 "$2,851.00" "$3,226.50" "$5,110.78" $147.50 "$5,162.40" "$3,250.00" "$6,453.00" "$2,580.85" "$3,742.74" "$6,453.00" $153.56 $147.50 "$6,453.00" $147.50 N/A N/A 36101001 EAP CPT® 59414 DELIVERY OF PLACENTA BOTH IP/OP "$6,078.00" "$4,498.00" $90.55 "$6,078.00" "$6,078.00" "$6,078.00" "$6,078.00" "$6,078.00" $90.55 $90.55 $91.96 "$6,078.00" $90.55 "$6,078.00" "$6,078.00" "$6,078.00" "$6,078.00" "$1,266.72" $144.88 $147.28 "$6,078.00" $90.55 $92.05 $90.55 "$6,078.00" "$4,558.50" $90.55 $90.55 $90.55 "$2,762.00" "$3,039.00" "$4,813.78" $90.55 "$4,862.40" "$3,250.00" "$6,078.00" $90.55 "$3,525.24" "$6,078.00" $95.89 $90.55 "$6,078.00" $90.55 N/A N/A 36101002 EAP CPT® 59525 REMOVE UTERUS AFTER CESAREAN BOTH IP/OP "$7,130.00" "$5,276.50" $483.70 "$7,130.00" "$7,130.00" "$7,130.00" "$7,130.00" "$7,130.00" $483.70 $483.70 $485.60 "$7,130.00" $483.70 "$7,130.00" "$7,130.00" "$7,130.00" "$7,130.00" "$1,485.97" $773.92 $780.99 "$7,130.00" $483.70 $488.12 $483.70 "$7,130.00" "$5,347.50" $483.70 $483.70 $483.70 "$2,762.00" "$3,565.00" "$5,646.96" $483.70 "$5,704.00" "$4,634.50" "$7,130.00" $483.70 "$4,135.40" "$7,130.00" $508.29 $483.70 "$7,130.00" $483.70 N/A N/A 36101003 EAP CPT® 59812 TRTMT OF SPONTANEOUS ABORTION BOTH IP/OP "$3,629.00" "$2,685.50" $314.60 "$4,129.35" "$3,629.00" "$3,629.00" "$3,629.00" "$3,629.00" "$2,580.85" "$2,580.85" "$2,569.43" $756.37 "$2,580.85" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $756.32 "$4,129.35" "$4,079.03" "$3,629.00" "$2,580.85" $314.60 "$2,580.85" "$2,709.89" "$2,721.75" "$2,580.85" "$2,580.85" "$2,580.85" "$3,629.00" "$1,814.50" "$2,874.17" "$2,580.85" "$2,903.20" "$3,250.00" $720.27 "$2,580.85" "$2,104.82" "$2,709.89" "$3,629.00" "$2,580.85" $756.28 "$2,580.85" N/A N/A 36101004 EAP CPT® 59820 TRMT OF MISSED ABORT.-1ST TRIM BOTH IP/OP "$3,769.00" "$2,789.50" $387.67 "$3,769.00" "$3,769.00" "$3,769.00" "$3,769.00" "$3,769.00" $393.02 $393.02 $387.67 "$3,769.00" $393.02 "$3,769.00" "$3,769.00" "$3,769.00" "$3,769.00" $785.50 $628.83 $633.41 "$3,769.00" $393.02 $395.88 $393.02 "$3,769.00" "$2,826.75" $393.02 $393.02 $393.02 "$3,769.00" "$1,884.50" "$2,985.05" $393.02 "$3,015.20" "$3,250.00" "$3,769.00" "$2,580.85" "$2,186.02" "$3,769.00" $387.80 $393.02 "$3,769.00" $393.02 N/A N/A 36101005 EAP CPT® 59840 IND/ABORTION/DILATION&CURETTAG BOTH IP/OP "$3,706.00" "$2,742.50" $227.68 "$4,129.35" "$3,706.00" "$3,706.00" "$3,706.00" "$3,706.00" "$2,580.85" "$2,580.85" "$2,569.43" $772.42 "$2,580.85" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $772.37 "$4,129.35" "$4,079.03" "$3,706.00" "$2,580.85" $227.68 "$2,580.85" "$2,709.89" "$2,779.50" "$2,580.85" "$2,580.85" "$2,580.85" "$3,706.00" "$1,853.00" "$2,935.15" "$2,580.85" "$2,964.80" "$3,250.00" $735.55 "$2,580.85" "$2,149.48" "$2,709.89" "$3,706.00" "$2,580.85" $772.33 "$2,580.85" N/A N/A 36101007 EAP CPT® 59855 ABORTION BY VAG. SUP. INSERT BOTH IP/OP "$1,807.00" "$1,337.50" $376.60 "$1,807.00" "$1,807.00" "$1,807.00" "$1,807.00" "$1,807.00" $431.35 $431.35 $430.22 "$1,807.00" $431.35 "$1,807.00" "$1,807.00" "$1,807.00" "$1,807.00" $376.60 $690.16 $697.36 "$1,807.00" $431.35 $435.85 $431.35 "$1,807.00" "$1,355.25" $431.35 $431.35 $431.35 "$1,807.00" $903.50 "$1,431.14" $431.35 "$1,445.60" "$1,174.55" "$1,807.00" $431.35 "$1,048.06" "$1,807.00" $440.83 $431.35 "$1,807.00" $431.35 N/A N/A 36101008 EAP CPT® 59855 INDUCED ABORTION AFTER 16 WKS BOTH IP/OP "$1,825.00" "$1,350.50" $380.35 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $431.35 $431.35 $430.22 "$1,825.00" $431.35 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 $690.16 $697.36 "$1,825.00" $431.35 $435.85 $431.35 "$1,825.00" "$1,368.75" $431.35 $431.35 $431.35 "$1,825.00" $912.50 "$1,445.40" $431.35 "$1,460.00" "$1,186.25" "$1,825.00" $431.35 "$1,058.50" "$1,825.00" $440.83 $431.35 "$1,825.00" $431.35 N/A N/A 36101009 EAP CPT® 59871 REMOVAL CERALAGE SUTURE BOTH IP/OP "$3,549.00" "$2,626.50" $132.89 "$3,549.00" "$3,549.00" "$3,549.00" "$3,549.00" "$3,549.00" $132.89 $132.89 $133.68 "$3,549.00" $132.89 "$3,549.00" "$3,549.00" "$3,549.00" "$3,549.00" $739.65 $212.62 $216.22 "$3,549.00" $132.89 $135.14 $132.89 "$3,549.00" "$2,661.75" $132.89 $132.89 $132.89 "$3,549.00" "$1,774.50" "$2,810.81" $132.89 "$2,839.20" "$3,250.00" "$3,549.00" $132.89 "$2,058.42" "$3,549.00" $138.78 $132.89 "$3,549.00" $132.89 N/A N/A 36101010 EAP CPT® 59871 REMOVE CERCLAGE SUTURE BOTH IP/OP "$3,549.00" "$2,626.50" $132.89 "$3,549.00" "$3,549.00" "$3,549.00" "$3,549.00" "$3,549.00" $132.89 $132.89 $133.68 "$3,549.00" $132.89 "$3,549.00" "$3,549.00" "$3,549.00" "$3,549.00" $739.65 $212.62 $216.22 "$3,549.00" $132.89 $135.14 $132.89 "$3,549.00" "$2,661.75" $132.89 $132.89 $132.89 "$3,549.00" "$1,774.50" "$2,810.81" $132.89 "$2,839.20" "$3,250.00" "$3,549.00" $132.89 "$2,058.42" "$3,549.00" $138.78 $132.89 "$3,549.00" $132.89 N/A N/A 36101011 EAP CPT® 60100 BX THYROID PERC NEEDLE BCT BOTH IP/OP $760.00 $562.50 $77.32 $979.40 $760.00 $760.00 $760.00 $760.00 $612.13 $612.13 $609.42 $158.40 $612.13 $760.00 $760.00 $760.00 $760.00 $158.39 $979.40 $936.25 $760.00 $612.13 $77.32 $612.13 $642.73 $570.00 $612.13 $612.13 $612.13 $760.00 $380.00 $601.92 $612.13 $608.00 $760.00 $150.84 $612.13 $440.80 $642.73 $760.00 $612.13 $158.38 $612.13 N/A N/A 36101012 EAP CPT® 60100 BX THYROID US BOTH IP/OP $762.00 $564.00 $77.32 $979.40 $762.00 $762.00 $762.00 $762.00 $612.13 $612.13 $609.42 $158.82 $612.13 $762.00 $762.00 $762.00 $762.00 $158.81 $979.40 $936.25 $762.00 $612.13 $77.32 $612.13 $642.73 $571.50 $612.13 $612.13 $612.13 $762.00 $381.00 $603.50 $612.13 $609.60 $762.00 $151.24 $612.13 $441.96 $642.73 $762.00 $612.13 $158.80 $612.13 N/A N/A 36101015 EAP CPT® 61070 PUNCT SHUNT TUBE/RESERVO BCT BOTH IP/OP "$2,212.00" "$1,637.00" $56.68 "$2,212.00" "$2,212.00" "$2,212.00" "$2,212.00" "$2,212.00" $57.19 $57.19 $56.68 "$2,212.00" $57.19 "$2,212.00" "$2,212.00" "$2,212.00" "$2,212.00" $461.01 $91.50 $91.17 "$2,212.00" $57.19 $56.98 $57.19 "$2,212.00" "$1,659.00" $57.19 $57.19 $57.19 "$2,212.00" "$1,106.00" "$1,751.90" $57.19 "$1,769.60" "$2,150.00" "$2,212.00" $57.19 "$1,282.96" "$2,212.00" $58.76 $57.19 "$2,212.00" $57.19 N/A N/A 36101016 EAP CPT® 61624 EMBOLIZA INTRACRAN/SP CORD SPN BOTH IP/OP "$12,218.00" "$9,041.50" "$1,155.52" "$12,218.00" "$12,218.00" "$12,218.00" "$12,218.00" "$12,218.00" "$1,155.52" "$1,155.52" "$1,155.82" "$12,218.00" "$1,155.52" "$12,218.00" "$12,218.00" "$12,218.00" "$12,218.00" "$2,546.37" "$1,848.83" "$1,877.63" "$12,218.00" "$1,155.52" "$1,173.52" "$1,155.52" "$12,218.00" "$9,163.50" "$1,155.52" "$1,155.52" "$1,155.52" "$2,762.00" "$6,109.00" "$9,676.66" "$1,155.52" "$9,774.40" "$7,941.70" "$12,218.00" "$1,155.52" "$7,086.44" "$12,218.00" "$1,201.90" "$1,155.52" "$12,218.00" "$1,155.52" N/A N/A 36101019 EAP CPT® 61626 EMBOLIZATION EXTRACRANIAL BOTH IP/OP "$27,904.00" "$20,649.00" $891.13 "$27,904.00" "$27,904.00" "$27,904.00" "$27,904.00" "$27,904.00" $895.39 $895.39 $891.13 "$27,904.00" $895.39 "$27,904.00" "$27,904.00" "$27,904.00" "$27,904.00" "$5,815.50" "$1,432.62" "$1,446.46" "$27,904.00" $895.39 $904.04 $895.39 "$27,904.00" "$20,928.00" $895.39 $895.39 $895.39 "$7,479.00" "$13,952.00" "$22,099.97" $895.39 "$22,323.20" "$5,164.00" "$27,904.00" $895.39 "$16,184.32" "$27,904.00" $923.39 $895.39 "$27,904.00" $895.39 N/A N/A 36101020 EAP CPT® 61630 INTRACRANIAL ANGIOPLASTY BOTH IP/OP "$20,055.00" "$14,841.00" "$1,371.82" "$20,055.00" "$20,055.00" "$20,055.00" "$20,055.00" "$20,055.00" "$1,371.82" "$1,371.82" "$1,380.77" "$20,055.00" "$1,371.82" "$20,055.00" "$20,055.00" "$20,055.00" "$20,055.00" "$4,179.68" "$2,194.91" "$2,218.64" "$20,055.00" "$1,371.82" "$1,386.65" "$1,371.82" "$20,055.00" "$15,041.25" "$1,371.82" "$1,371.82" "$1,371.82" "$10,027.50" "$10,027.50" "$15,883.56" "$1,371.82" "$16,044.00" "$13,035.75" "$20,055.00" "$1,371.82" "$11,631.90" "$20,055.00" "$1,424.57" "$1,371.82" "$20,055.00" "$1,371.82" N/A N/A 36101021 EAP CPT® 61635 INTRACRAN ANGIOPLASTY W/STENT BOTH IP/OP "$31,953.00" "$23,645.50" "$1,461.74" "$31,953.00" "$31,953.00" "$31,953.00" "$31,953.00" "$31,953.00" "$1,462.22" "$1,462.22" "$1,461.74" "$31,953.00" "$1,462.22" "$31,953.00" "$31,953.00" "$31,953.00" "$31,953.00" "$6,659.36" "$2,339.55" "$2,395.68" "$31,953.00" "$1,462.22" "$1,497.30" "$1,462.22" "$31,953.00" "$23,964.75" "$1,462.22" "$1,462.22" "$1,462.22" "$15,976.50" "$15,976.50" "$25,306.78" "$1,462.22" "$25,562.40" "$20,769.45" "$31,953.00" "$1,462.22" "$18,532.74" "$31,953.00" "$1,514.43" "$1,462.22" "$31,953.00" "$1,462.22" N/A N/A 36101022 EAP CPT® 61640 "DILATE IC VASOSPASM, INIT" BOTH IP/OP "$30,077.00" "$22,257.00" $483.19 "$30,077.00" "$30,077.00" "$30,077.00" "$30,077.00" "$30,077.00" "$30,077.00" "$30,077.00" $483.19 "$30,077.00" "$30,077.00" "$30,077.00" "$30,077.00" "$30,077.00" "$30,077.00" "$6,268.38" "$30,077.00" "$3,746.80" "$30,077.00" "$30,077.00" "$9,367.00" "$30,077.00" "$30,077.00" "$22,557.75" "$30,077.00" "$30,077.00" "$30,077.00" "$15,038.50" "$15,038.50" "$23,820.98" "$30,077.00" "$24,061.60" "$19,550.05" "$30,077.00" "$30,077.00" "$17,444.66" "$30,077.00" "$18,046.20" "$30,077.00" "$30,077.00" "$30,077.00" N/A N/A 36101023 EAP CPT® 61642 DILATE IC VASOSPASM ADD-ON BOTH IP/OP "$26,318.00" "$19,475.50" $339.40 "$26,318.00" "$26,318.00" "$26,318.00" "$26,318.00" "$26,318.00" "$26,318.00" "$26,318.00" $339.40 "$26,318.00" "$26,318.00" "$26,318.00" "$26,318.00" "$26,318.00" "$26,318.00" "$5,484.96" "$26,318.00" "$3,211.20" "$26,318.00" "$26,318.00" "$8,028.00" "$26,318.00" "$26,318.00" "$19,738.50" "$26,318.00" "$26,318.00" "$26,318.00" "$13,159.00" "$13,159.00" "$20,843.86" "$26,318.00" "$21,054.40" "$17,106.70" "$26,318.00" "$26,318.00" "$15,264.44" "$26,318.00" "$15,790.80" "$26,318.00" "$26,318.00" "$26,318.00" N/A N/A 36101024 EAP CPT® 61710 EMBLZ CAROTID CAVERN FISTULA BOTH IP/OP "$13,680.00" "$10,123.50" "$2,164.20" "$13,680.00" "$13,680.00" "$13,680.00" "$13,680.00" "$13,680.00" "$2,164.20" "$2,164.20" "$2,166.68" "$13,680.00" "$2,164.20" "$13,680.00" "$13,680.00" "$13,680.00" "$13,680.00" "$2,851.06" "$3,462.72" "$3,518.37" "$13,680.00" "$2,164.20" "$2,198.98" "$2,164.20" "$13,680.00" "$10,260.00" "$2,164.20" "$2,164.20" "$2,164.20" "$4,780.00" "$6,840.00" "$10,834.56" "$2,164.20" "$10,944.00" "$8,892.00" "$13,680.00" "$2,164.20" "$7,934.40" "$13,680.00" "$2,237.74" "$2,164.20" "$13,680.00" "$2,164.20" N/A N/A 36101025 EAP CPT® 62268 SPINAL CORD CYST PERC ASPI BCT BOTH IP/OP "$3,101.00" "$2,295.00" $256.31 "$3,101.00" "$3,101.00" "$3,101.00" "$3,101.00" "$3,101.00" $257.73 $257.73 $261.47 "$3,101.00" $257.73 "$3,101.00" "$3,101.00" "$3,101.00" "$3,101.00" $646.28 $412.37 $410.10 "$3,101.00" $257.73 $256.31 $257.73 "$3,101.00" "$2,325.75" $257.73 $257.73 $257.73 "$2,762.00" "$1,550.50" "$2,455.99" $257.73 "$2,480.80" "$2,150.00" "$3,101.00" $257.73 "$1,798.58" "$3,101.00" $268.27 $257.73 "$3,101.00" $257.73 N/A N/A 36101026 EAP CPT® 62269 BX SPINAL CORD PERC NEEDLE BCT BOTH IP/OP "$3,394.00" "$2,512.00" $260.68 "$3,394.00" "$3,394.00" "$3,394.00" "$3,394.00" "$3,394.00" $261.84 $261.84 $264.33 "$3,394.00" $261.84 "$3,394.00" "$3,394.00" "$3,394.00" "$3,394.00" $707.35 $418.94 $417.09 "$3,394.00" $261.84 $260.68 $261.84 "$3,394.00" "$2,545.50" $261.84 $261.84 $261.84 "$2,762.00" "$1,697.00" "$2,688.05" $261.84 "$2,715.20" "$2,500.00" "$3,394.00" $261.84 "$1,968.52" "$3,394.00" $275.87 $261.84 "$3,394.00" $261.84 N/A N/A 36101027 EAP CPT® 62270 DX LUMBAR PUNCTURE W/O IMAGING BOTH IP/OP $835.00 $618.00 $63.13 $999.41 $835.00 $835.00 $835.00 $835.00 $624.63 $624.63 $621.87 $174.03 $624.63 $835.00 $835.00 $835.00 $835.00 $174.02 $999.41 $929.56 $835.00 $624.63 $63.13 $624.63 $655.86 $626.25 $624.63 $624.63 $624.63 $835.00 $417.50 $661.32 $624.63 $668.00 $835.00 $165.73 $624.63 $484.30 $655.86 $835.00 $624.63 $174.01 $624.63 N/A N/A 36101032 EAP CPT® 62272 THERAPEUTIC LUMBAR PUNCTURE W/O IMAGING BOTH IP/OP $923.00 $683.50 $88.49 $923.00 $923.00 $923.00 $923.00 $923.00 $89.67 $89.67 $88.49 $923.00 $89.67 $923.00 $923.00 $923.00 $923.00 $192.36 $143.47 $146.69 $923.00 $89.67 $91.68 $89.67 $923.00 $692.25 $89.67 $89.67 $89.67 $923.00 $461.50 $731.02 $89.67 $738.40 $923.00 $923.00 $89.67 $535.34 $923.00 $91.58 $89.67 $923.00 $89.67 N/A N/A 36101033 EAP CPT® 55876 PLACEMENT OF PROSTATE FIDUCIAL MARKERS BOTH IP/OP "$3,543.00" "$2,622.00" $101.69 "$2,834.40" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,242.16" "$1,242.16" "$1,236.66" $738.45 "$1,242.16" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $738.40 "$1,987.45" "$1,934.13" "$1,871.00" "$1,242.16" $101.69 "$1,242.16" "$1,304.27" "$2,657.25" "$1,242.16" "$1,242.16" "$1,242.16" "$2,762.00" "$1,771.50" "$2,806.06" "$1,242.16" "$2,834.40" "$2,500.00" $703.20 "$1,242.16" "$2,054.94" "$1,304.27" "$1,797.09" "$1,242.16" $738.36 "$1,242.16" N/A N/A 36101039 EAP CPT® 62273 INJECTION EPIDURAL BLOOD PATCH BOTH IP/OP "$1,679.00" "$1,242.50" $113.24 "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" $113.78 $113.78 $114.06 "$1,679.00" $113.78 "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" $349.92 $182.05 $181.18 "$1,679.00" $113.78 $113.24 $113.78 "$1,679.00" "$1,259.25" $113.78 $113.78 $113.78 "$1,679.00" $839.50 "$1,329.77" $113.78 "$1,343.20" "$1,679.00" "$1,679.00" $624.63 $973.82 "$1,679.00" $117.56 $113.78 "$1,679.00" $113.78 N/A N/A 36101040 EAP CPT® 62280 INJECT SUBARACHNOID NEUROLYTIC BOTH IP/OP "$1,845.00" "$1,365.50" $159.29 "$1,845.00" "$1,845.00" "$1,845.00" "$1,845.00" "$1,845.00" $159.87 $159.87 $171.52 "$1,845.00" $159.87 "$1,845.00" "$1,845.00" "$1,845.00" "$1,845.00" $384.52 $255.79 $254.86 "$1,845.00" $159.87 $159.29 $159.87 "$1,845.00" "$1,383.75" $159.87 $159.87 $159.87 "$1,845.00" $922.50 "$1,461.24" $159.87 "$1,476.00" "$1,845.00" "$1,845.00" $159.87 "$1,070.10" "$1,845.00" $176.64 $159.87 "$1,845.00" $159.87 N/A N/A 36101041 EAP CPT® 62282 EPIDUR LUMBAR SACRAL NEUROLYTI BOTH IP/OP "$1,751.00" "$1,296.00" $141.98 "$1,751.00" "$1,751.00" "$1,751.00" "$1,751.00" "$1,751.00" $144.57 $144.57 $147.12 "$1,751.00" $144.57 "$1,751.00" "$1,751.00" "$1,751.00" "$1,751.00" $364.93 $231.31 $227.17 "$1,751.00" $144.57 $141.98 $144.57 "$1,751.00" "$1,313.25" $144.57 $144.57 $144.57 "$1,751.00" $875.50 "$1,386.79" $144.57 "$1,400.80" "$1,751.00" "$1,751.00" $144.57 "$1,015.58" "$1,751.00" $148.90 $144.57 "$1,751.00" $144.57 N/A N/A 36101042 EAP CPT® 62284 INJECTION MYELO/CT SPINAL BOTH IP/OP "$1,572.00" "$1,163.50" $84.42 "$1,572.00" "$1,572.00" "$1,572.00" "$1,572.00" "$1,572.00" "$1,572.00" "$1,572.00" "$1,572.00" $327.64 "$1,572.00" "$1,572.00" "$1,572.00" "$1,572.00" "$1,572.00" $327.62 "$1,572.00" "$1,572.00" $929.84 "$1,572.00" $84.42 "$1,572.00" "$1,572.00" "$1,179.00" "$1,572.00" "$1,572.00" "$1,572.00" "$1,572.00" $786.00 "$1,245.02" "$1,572.00" "$1,257.60" "$1,572.00" $312.00 "$1,572.00" $911.76 "$1,572.00" "$1,572.00" "$1,572.00" $327.60 "$1,572.00" N/A N/A 36101043 EAP CPT® 62287 ASPIR PERC DISKECTOMY BOTH IP/OP "$6,339.00" "$4,691.00" $568.99 "$6,339.00" "$6,339.00" "$6,339.00" "$6,339.00" "$6,339.00" $583.28 $583.28 $587.38 "$6,339.00" $583.28 "$6,339.00" "$6,339.00" "$6,339.00" "$6,339.00" "$1,321.12" $933.25 $910.38 "$6,339.00" $583.28 $568.99 $583.28 "$6,339.00" "$4,754.25" $583.28 $583.28 $583.28 "$6,339.00" "$3,169.50" "$5,020.49" $583.28 "$5,071.20" "$3,725.00" "$6,339.00" $583.28 "$3,676.62" "$6,339.00" $604.22 $583.28 "$6,339.00" $583.28 N/A N/A 36101044 EAP CPT® 62290 INJECT DISKOGRAPHY EA LEV LUMB BOTH IP/OP "$2,963.00" "$2,193.00" $157.63 "$2,963.00" "$2,963.00" "$2,963.00" "$2,963.00" "$2,963.00" $161.31 $161.31 $165.78 "$2,963.00" $161.31 "$2,963.00" "$2,963.00" "$2,963.00" "$2,963.00" $617.52 $258.10 $252.21 "$2,963.00" $161.31 $157.63 $161.31 "$2,963.00" "$2,222.25" $161.31 $161.31 $161.31 "$2,851.00" "$1,481.50" "$2,346.70" $161.31 "$2,370.40" "$1,750.00" "$2,963.00" $161.31 "$1,718.54" "$2,963.00" $172.72 $161.31 "$2,963.00" $161.31 N/A N/A 36101045 EAP CPT® 62291 INJECT DISKOGRAPHY EA LEV CERV BOTH IP/OP "$2,594.00" "$1,920.00" $146.11 "$2,594.00" "$2,594.00" "$2,594.00" "$2,594.00" "$2,594.00" $149.28 $149.28 $157.10 "$2,594.00" $149.28 "$2,594.00" "$2,594.00" "$2,594.00" "$2,594.00" $540.62 $238.85 $233.78 "$2,594.00" $149.28 $146.11 $149.28 "$2,594.00" "$1,945.50" $149.28 $149.28 $149.28 "$2,594.00" "$1,297.00" "$2,054.45" $149.28 "$2,075.20" "$1,750.00" "$2,594.00" $149.28 "$1,504.52" "$2,594.00" $164.79 $149.28 "$2,594.00" $149.28 N/A N/A 36101048 EAP CPT® 63650 IMPLANT NEUROELECTRODES BOTH IP/OP "$16,380.00" "$12,121.50" $415.93 "$16,380.00" "$16,380.00" "$16,380.00" "$16,380.00" "$16,380.00" $418.24 $418.24 $421.11 "$16,380.00" $418.24 "$16,380.00" "$16,380.00" "$16,380.00" "$16,380.00" "$3,413.77" $669.18 $665.49 "$16,380.00" $418.24 $415.93 $418.24 "$16,380.00" "$12,285.00" $418.24 $418.24 $418.24 "$2,851.00" "$8,190.00" "$12,972.96" $418.24 "$13,104.00" "$4,334.00" "$16,380.00" $418.24 "$9,500.40" "$16,380.00" $430.15 $418.24 "$16,380.00" $418.24 N/A N/A 36101049 EAP CPT® 64408 INJ ANES/STRD CRANIAL/VAGUS NERVE BOTH IP/OP "$1,831.00" "$1,355.00" $44.30 "$1,831.00" "$1,831.00" "$1,831.00" "$1,831.00" "$1,831.00" $45.28 $45.28 $44.30 "$1,831.00" $45.28 "$1,831.00" "$1,831.00" "$1,831.00" "$1,831.00" $381.60 $72.45 $72.70 "$1,831.00" $45.28 $45.44 $45.28 "$1,831.00" "$1,373.25" $45.28 $45.28 $45.28 "$1,831.00" $915.50 "$1,450.15" $45.28 "$1,464.80" "$1,750.00" "$1,831.00" $45.28 "$1,061.98" "$1,831.00" $45.07 $45.28 "$1,831.00" $45.28 N/A N/A 36101051 EAP CPT® 64425 INJ ANES/STRD ILIOINGUINAL/ILIOHYPOGASTRIC NERVE BOTH IP/OP "$3,566.00" "$2,639.00" $54.92 "$2,852.80" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $624.63 $624.63 $621.87 $743.24 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $743.19 $999.41 $929.56 "$1,871.00" $624.63 $54.92 $624.63 $655.86 "$2,674.50" $624.63 $624.63 $624.63 "$2,762.00" "$1,783.00" "$2,824.27" $624.63 "$2,852.80" "$2,150.00" $707.76 $624.63 "$2,068.28" $655.86 $903.68 $624.63 $743.15 $624.63 N/A N/A 36101052 EAP CPT® 64450 INJ ANES/STRD OTHER PERIPHERAL NERVE BOTH IP/OP "$2,850.00" "$2,109.00" $42.04 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $624.63 $624.63 $621.87 $594.01 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $593.97 $999.41 $929.56 "$1,871.00" $624.63 $42.04 $624.63 $655.86 "$2,137.50" $624.63 $624.63 $624.63 "$2,762.00" "$1,425.00" "$2,257.20" $624.63 "$2,280.00" "$2,150.00" $565.65 $624.63 "$1,653.00" $655.86 $903.68 $624.63 $593.94 $624.63 N/A N/A 36101059 EAP CPT® 64483 INJECT ANEST TXFORAMEN L/S SNG BOTH IP/OP "$1,767.00" "$1,308.00" $110.83 "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" $809.76 $809.76 $806.18 $368.29 $809.76 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $368.26 "$1,295.61" "$1,229.40" "$1,767.00" $809.76 $110.83 $809.76 $850.25 "$1,325.25" $809.76 $809.76 $809.76 "$1,767.00" $883.50 "$1,399.46" $809.76 "$1,413.60" "$1,767.00" $350.71 $809.76 "$1,024.86" $850.25 "$1,171.52" $809.76 $368.24 $809.76 N/A N/A 36101061 EAP CPT® 64484 TRANSFOR INJ LUM/SAC ADDT SPN BOTH IP/OP "$1,767.00" "$1,308.00" $51.53 "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" $368.29 "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" $368.26 "$1,767.00" "$1,767.00" "$1,045.18" "$1,767.00" $51.53 "$1,767.00" "$1,767.00" "$1,325.25" "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" $883.50 "$1,399.46" "$1,767.00" "$1,413.60" "$1,750.00" $350.71 "$1,767.00" "$1,024.86" "$1,767.00" "$1,767.00" "$1,767.00" $368.24 "$1,767.00" N/A N/A 36101062 EAP CPT® 64520 INJECT ANEST LUMBAR THORACIC BOTH IP/OP "$5,436.00" "$4,023.00" $84.38 "$5,436.00" "$5,436.00" "$5,436.00" "$5,436.00" "$5,436.00" $85.01 $85.01 $85.30 "$5,436.00" $85.01 "$5,436.00" "$5,436.00" "$5,436.00" "$5,436.00" "$1,132.92" $136.02 $135.01 "$5,436.00" $85.01 $84.38 $85.01 "$5,436.00" "$4,077.00" $85.01 $85.01 $85.01 "$2,762.00" "$2,718.00" "$4,305.31" $85.01 "$4,348.80" "$2,150.00" "$5,436.00" $85.01 "$3,152.88" "$5,436.00" $85.81 $85.01 "$5,436.00" $85.01 N/A N/A 36101064 EAP CPT® 64530 "N BLOCK INJ, CELIAC PELUS" BOTH IP/OP "$8,849.00" "$6,548.50" $94.91 "$8,849.00" "$8,849.00" "$8,849.00" "$8,849.00" "$8,849.00" $94.98 $94.98 $95.38 "$8,849.00" $94.98 "$8,849.00" "$8,849.00" "$8,849.00" "$8,849.00" "$1,844.23" $151.97 $151.86 "$8,849.00" $94.98 $94.91 $94.98 "$8,849.00" "$6,636.75" $94.98 $94.98 $94.98 "$2,762.00" "$4,424.50" "$7,008.41" $94.98 "$7,079.20" "$2,150.00" "$8,849.00" $94.98 "$5,132.42" "$8,849.00" $95.91 $94.98 "$8,849.00" $94.98 N/A N/A 36101065 EAP CPT® 64612 CHEMODENERVE MUS INV FAC NERVE BOTH IP/OP $728.00 $539.00 $119.99 $728.00 $728.00 $728.00 $728.00 $728.00 $257.00 $257.00 $255.86 $151.73 $257.00 $728.00 $728.00 $728.00 $728.00 $151.72 $411.20 $392.25 $728.00 $257.00 $119.99 $257.00 $269.85 $546.00 $257.00 $257.00 $257.00 $728.00 $364.00 $576.58 $257.00 $582.40 $728.00 $144.49 $257.00 $422.24 $269.85 $371.81 $257.00 $151.72 $257.00 N/A N/A 36101067 EAP CPT® 61055 CISTERNAL/LATERAL C1-C2 PUNCTURE W/INJECTION BOTH IP/OP $643.00 $476.00 $118.26 $643.00 $643.00 $643.00 $643.00 $643.00 $118.26 $118.26 $120.91 $643.00 $118.26 $643.00 $643.00 $643.00 $643.00 $134.01 $189.22 $190.50 $643.00 $118.26 $119.06 $118.26 $643.00 $482.25 $118.26 $118.26 $118.26 $643.00 $321.50 $509.26 $118.26 $514.40 $643.00 $643.00 $118.26 $372.94 $643.00 $128.34 $118.26 $643.00 $118.26 N/A N/A 36101070 EAP CPT® 64640 DESTR PERIPHERAL NERVE BOTH IP/OP "$2,488.00" "$1,841.50" $118.62 "$2,488.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $809.76 $809.76 $806.18 $518.56 $809.76 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $518.53 "$1,295.61" "$1,229.40" "$1,871.00" $809.76 $118.62 $809.76 $850.25 "$1,866.00" $809.76 $809.76 $809.76 "$2,488.00" "$1,244.00" "$1,970.50" $809.76 "$1,990.40" "$2,150.00" $493.81 $809.76 "$1,443.04" $850.25 "$1,171.52" $809.76 $518.50 $809.76 N/A N/A 36101072 EAP CPT® 64680 DESTR NEUROLYITC CELIAC PLEXUS BOTH IP/OP "$4,672.00" "$3,457.50" $162.33 "$4,672.00" "$4,672.00" "$4,672.00" "$4,672.00" "$4,672.00" $162.39 $162.39 $163.38 "$4,672.00" $162.39 "$4,672.00" "$4,672.00" "$4,672.00" "$4,672.00" $973.70 $259.82 $259.73 "$4,672.00" $162.39 $162.33 $162.39 "$4,672.00" "$3,504.00" $162.39 $162.39 $162.39 "$2,851.00" "$2,336.00" "$3,700.22" $162.39 "$3,737.60" "$3,250.00" "$4,672.00" $162.39 "$2,709.76" "$4,672.00" $168.02 $162.39 "$4,672.00" $162.39 N/A N/A 36101075 EAP CPT® 65205 "FB REMOVAL, EYE" BOTH IP/OP $378.00 $280.00 $29.14 $378.00 $378.00 $378.00 $378.00 $378.00 $29.26 $29.26 $29.50 $378.00 $29.26 $378.00 $378.00 $378.00 $378.00 $78.78 $46.82 $46.62 $378.00 $29.26 $29.14 $29.26 $378.00 $283.50 $29.26 $29.26 $29.26 $378.00 $189.00 $299.38 $29.26 $302.40 $378.00 $378.00 $29.26 $219.24 $378.00 $29.93 $29.26 $378.00 $29.26 N/A N/A 36101076 EAP CPT® 65205 REMOVE FB EYE CONJ SUPERFICIAL BOTH IP/OP $313.00 $232.00 $29.14 $313.00 $313.00 $313.00 $313.00 $313.00 $29.26 $29.26 $29.50 $313.00 $29.26 $313.00 $313.00 $313.00 $313.00 $65.23 $46.82 $46.62 $313.00 $29.26 $29.14 $29.26 $313.00 $234.75 $29.26 $29.26 $29.26 $313.00 $156.50 $247.90 $29.26 $250.40 $313.00 $313.00 $29.26 $181.54 $313.00 $29.93 $29.26 $313.00 $29.26 N/A N/A 36101077 EAP CPT® 65222 REMOVE FB EYE CORNEAL W/SL BOTH IP/OP $800.00 $592.00 $49.80 $800.00 $800.00 $800.00 $800.00 $800.00 $50.32 $50.32 $51.08 $800.00 $50.32 $800.00 $800.00 $800.00 $800.00 $166.73 $80.51 $79.68 $800.00 $50.32 $49.80 $50.32 $800.00 $600.00 $50.32 $50.32 $50.32 $800.00 $400.00 $633.60 $50.32 $640.00 $800.00 $800.00 $50.32 $464.00 $800.00 $52.64 $50.32 $800.00 $50.32 N/A N/A 36101078 EAP CPT® 65270 REPAIR LACERATION CONJUNCTIVA BOTH IP/OP "$4,186.00" "$3,098.00" $140.25 "$4,186.00" "$4,186.00" "$4,186.00" "$4,186.00" "$4,186.00" $140.25 $140.25 $141.72 "$4,186.00" $140.25 "$4,186.00" "$4,186.00" "$4,186.00" "$4,186.00" $872.41 $224.40 $226.02 "$4,186.00" $140.25 $141.26 $140.25 "$4,186.00" "$3,139.50" $140.25 $140.25 $140.25 "$2,851.00" "$2,093.00" "$3,315.31" $140.25 "$3,348.80" "$3,250.00" "$4,186.00" $140.25 "$2,427.88" "$4,186.00" $143.84 $140.25 "$4,186.00" $140.25 N/A N/A 36101079 EAP CPT® 65275 RPR LACER CORNEA NON-PERFOR BOTH IP/OP "$8,972.00" "$6,639.50" $459.32 "$8,972.00" "$8,972.00" "$8,972.00" "$8,972.00" "$8,972.00" $461.26 $461.26 $463.44 "$8,972.00" $461.26 "$8,972.00" "$8,972.00" "$8,972.00" "$8,972.00" "$1,869.86" $738.02 $734.91 "$8,972.00" $461.26 $459.32 $461.26 "$8,972.00" "$6,729.00" $461.26 $461.26 $461.26 "$4,417.00" "$4,486.00" "$7,105.82" $461.26 "$7,177.60" "$3,725.00" "$8,972.00" $461.26 "$5,203.76" "$8,972.00" $472.61 $461.26 "$8,972.00" $461.26 N/A N/A 36101080 EAP CPT® 65286 CORNEA SCLERA WOUND TISSUE GLU BOTH IP/OP "$3,275.00" "$2,423.50" $493.85 "$3,268.36" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,042.73" "$2,042.73" "$2,033.69" $682.59 "$2,042.73" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $682.55 "$3,268.36" "$3,115.33" "$1,871.00" "$2,042.73" $493.85 "$2,042.73" "$2,144.86" "$2,456.25" "$2,042.73" "$2,042.73" "$2,042.73" "$2,762.00" "$1,637.50" "$2,593.80" "$2,042.73" "$2,620.00" "$2,500.00" $650.01 "$2,042.73" "$1,899.50" "$2,144.86" "$2,955.31" "$2,042.73" $682.51 "$2,042.73" N/A N/A 36101081 EAP CPT® 65290 REPAIR WOUND EXTRAOCULAR MUSCL BOTH IP/OP "$4,425.00" "$3,274.50" $488.42 "$4,425.00" "$4,425.00" "$4,425.00" "$4,425.00" "$4,425.00" $489.25 $489.25 $492.33 "$4,425.00" $489.25 "$4,425.00" "$4,425.00" "$4,425.00" "$4,425.00" $922.22 $782.80 $781.47 "$4,425.00" $489.25 $488.42 $489.25 "$4,425.00" "$3,318.75" $489.25 $489.25 $489.25 "$3,500.00" "$2,212.50" "$3,504.60" $489.25 "$3,540.00" "$3,250.00" "$4,425.00" $489.25 "$2,566.50" "$4,425.00" $501.08 $489.25 "$4,425.00" $489.25 N/A N/A 36101082 EAP CPT® 65400 EXCISE LESN CORNEA NOT PTERYGM BOTH IP/OP "$5,997.00" "$4,438.00" $601.16 "$4,797.60" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $796.59 $796.59 $793.07 "$1,249.92" $796.59 "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,249.84" "$1,274.55" "$1,258.92" "$1,871.00" $796.59 $601.16 $796.59 $836.42 "$4,497.75" $796.59 $796.59 $796.59 "$2,762.00" "$2,348.00" "$4,749.62" $796.59 "$4,797.60" "$2,150.00" "$1,190.25" $796.59 "$3,478.26" $836.42 "$1,152.47" $796.59 "$1,249.77" $796.59 N/A N/A 36101084 EAP CPT® 65420 EXCISE PTERYGIUM W/O GRAFT BOTH IP/OP "$2,706.00" "$2,002.50" $378.41 "$2,706.00" "$2,706.00" "$2,706.00" "$2,706.00" "$2,706.00" $378.41 $378.41 $380.19 "$2,706.00" $378.41 "$2,706.00" "$2,706.00" "$2,706.00" "$2,706.00" $563.96 $605.46 $606.30 "$2,706.00" $378.41 $378.94 $378.41 "$2,706.00" "$2,029.50" $378.41 $378.41 $378.41 "$2,706.00" "$1,353.00" "$2,143.15" $378.41 "$2,164.80" "$2,706.00" "$2,706.00" $378.41 "$1,569.48" "$2,706.00" $384.24 $378.41 "$2,706.00" $378.41 N/A N/A 36101085 EAP CPT® 65430 SCRAPING CORNEA DIAGNOSTIC BOTH IP/OP $525.00 $388.50 $100.61 $525.00 $525.00 $525.00 $525.00 $525.00 $100.94 $100.94 $101.77 $525.00 $100.94 $525.00 $525.00 $525.00 $525.00 $109.42 $161.50 $160.98 $525.00 $100.94 $100.61 $100.94 $525.00 $393.75 $100.94 $100.94 $100.94 $525.00 $262.50 $415.80 $100.94 $420.00 $525.00 $525.00 $100.94 $304.50 $525.00 $104.55 $100.94 $525.00 $100.94 N/A N/A 36101086 EAP CPT® 65772 RELAX CORNEA INCISION ASTIGMAT BOTH IP/OP "$4,930.00" "$3,648.50" $403.17 "$4,930.00" "$4,930.00" "$4,930.00" "$4,930.00" "$4,930.00" $403.17 $403.17 $405.15 "$4,930.00" $403.17 "$4,930.00" "$4,930.00" "$4,930.00" "$4,930.00" "$1,027.47" $645.07 $645.39 "$4,930.00" $403.17 $403.37 $403.17 "$4,930.00" "$3,697.50" $403.17 $403.17 $403.17 "$4,417.00" "$2,465.00" "$3,904.56" $403.17 "$3,944.00" "$2,150.00" "$4,930.00" $403.17 "$2,859.40" "$4,930.00" $412.74 $403.17 "$4,930.00" $403.17 N/A N/A 36101087 EAP CPT® 65800 PARACENTESIS ANT CHAMB EYE WDX BOTH IP/OP "$4,672.00" "$3,457.50" $88.45 "$3,737.60" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,042.73" "$2,042.73" "$2,033.69" $973.76 "$2,042.73" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $973.70 "$3,268.36" "$3,115.33" "$1,871.00" "$2,042.73" $88.45 "$2,042.73" "$2,144.86" "$3,504.00" "$2,042.73" "$2,042.73" "$2,042.73" "$2,762.00" "$2,348.00" "$3,700.22" "$2,042.73" "$3,737.60" "$1,750.00" $927.28 "$2,042.73" "$2,709.76" "$2,144.86" "$2,955.31" "$2,042.73" $973.64 "$2,042.73" N/A N/A 36101089 EAP CPT® 65815 EYE PARACENTESIS ANT BLOOD REM BOTH IP/OP "$7,374.00" "$5,457.00" $474.49 "$7,374.00" "$7,374.00" "$7,374.00" "$7,374.00" "$7,374.00" $474.56 $474.56 $477.76 "$7,374.00" $474.56 "$7,374.00" "$7,374.00" "$7,374.00" "$7,374.00" "$1,536.82" $759.30 $759.18 "$7,374.00" $474.56 $474.49 $474.56 "$7,374.00" "$5,530.50" $474.56 $474.56 $474.56 "$2,851.00" "$3,687.00" "$5,840.21" $474.56 "$5,899.20" "$3,250.00" "$7,374.00" $474.56 "$4,276.92" "$7,374.00" $485.92 $474.56 "$7,374.00" $474.56 N/A N/A 36101090 EAP CPT® 65855 TRABECULOPLASTY BY LASER BOTH IP/OP "$2,930.00" "$2,168.50" $204.61 "$2,762.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" $495.04 $495.04 $492.86 $610.69 $495.04 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $610.64 $792.07 $765.72 "$1,871.00" $495.04 $204.61 $495.04 $519.80 "$2,197.50" $495.04 $495.04 $495.04 "$2,762.00" "$1,465.00" "$2,320.56" $495.04 "$2,344.00" "$2,150.00" $581.53 $495.04 "$1,699.40" $519.80 $716.21 $495.04 $610.61 $495.04 N/A N/A 36101091 EAP CPT® 65860 INCISE INNER EYE ADHESIONS BOTH IP/OP "$1,369.00" "$1,013.50" $246.95 "$1,369.00" "$1,369.00" "$1,369.00" "$1,369.00" "$1,369.00" $247.00 $247.00 $248.73 "$1,369.00" $247.00 "$1,369.00" "$1,369.00" "$1,369.00" "$1,369.00" $285.31 $395.20 $395.12 "$1,369.00" $247.00 $246.95 $247.00 "$1,369.00" "$1,026.75" $247.00 $247.00 $247.00 "$1,369.00" $684.50 "$1,084.25" $247.00 "$1,095.20" "$1,369.00" "$1,369.00" $247.00 $794.02 "$1,369.00" $256.32 $247.00 "$1,369.00" $247.00 N/A N/A 36101092 EAP CPT® 66250 REPAIR OPERATIVE WOUND ANT EYE BOTH IP/OP "$3,567.00" "$2,640.00" $554.10 "$3,567.00" "$3,567.00" "$3,567.00" "$3,567.00" "$3,567.00" $554.72 $554.72 $557.67 "$3,567.00" $554.72 "$3,567.00" "$3,567.00" "$3,567.00" "$3,567.00" $743.40 $887.55 $886.56 "$3,567.00" $554.72 $554.10 $554.72 "$3,567.00" "$2,675.25" $554.72 $554.72 $554.72 "$2,851.00" "$1,783.50" "$2,825.06" $554.72 "$2,853.60" "$3,250.00" "$3,567.00" $554.72 "$2,068.86" "$3,567.00" $567.39 $554.72 "$3,567.00" $554.72 N/A N/A 36101093 EAP CPT® 66710 DESTRUCTION CILIARY BODY BOTH IP/OP "$4,407.00" "$3,261.50" $389.50 "$3,525.60" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,968.41" "$1,968.41" "$1,959.70" $918.53 "$1,968.41" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $918.47 "$3,149.46" "$3,050.10" "$2,836.00" "$1,968.41" $389.50 "$1,968.41" "$2,066.83" "$3,305.25" "$1,968.41" "$1,968.41" "$1,968.41" "$2,851.00" "$2,423.00" "$3,490.34" "$1,968.41" "$3,525.60" "$3,250.00" $874.68 "$1,968.41" "$2,556.06" "$2,066.83" "$2,847.79" "$1,968.41" $918.42 "$1,968.41" N/A N/A 36101094 EAP CPT® 66710 TRANSSCLERAL CYCLOPHOTOCOAGULA BOTH IP/OP "$4,407.00" "$3,261.50" $389.50 "$3,525.60" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,968.41" "$1,968.41" "$1,959.70" $918.53 "$1,968.41" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $918.47 "$3,149.46" "$3,050.10" "$2,836.00" "$1,968.41" $389.50 "$1,968.41" "$2,066.83" "$3,305.25" "$1,968.41" "$1,968.41" "$1,968.41" "$2,851.00" "$2,423.00" "$3,490.34" "$1,968.41" "$3,525.60" "$3,250.00" $874.68 "$1,968.41" "$2,556.06" "$2,066.83" "$2,847.79" "$1,968.41" $918.42 "$1,968.41" N/A N/A 36101095 EAP CPT® 66720 DESTROY CILIARY BODY CRYOTHER BOTH IP/OP "$2,644.00" "$1,957.00" $408.73 "$2,644.00" "$2,644.00" "$2,644.00" "$2,644.00" "$2,644.00" $408.73 $408.73 $410.41 "$2,644.00" $408.73 "$2,644.00" "$2,644.00" "$2,644.00" "$2,644.00" $551.04 $653.97 $655.07 "$2,644.00" $408.73 $409.42 $408.73 "$2,644.00" "$1,983.00" $408.73 $408.73 $408.73 "$2,644.00" "$1,322.00" "$2,094.05" $408.73 "$2,115.20" "$2,644.00" "$2,644.00" $408.73 "$1,533.52" "$2,644.00" $415.60 $408.73 "$2,644.00" $408.73 N/A N/A 36101096 EAP CPT® 66761 IRIDOTOMY LASER SURGERY BOTH IP/OP "$7,642.00" "$5,655.50" $235.39 "$6,113.60" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $495.04 $495.04 $492.86 "$1,592.78" $495.04 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 "$1,592.68" $792.07 $765.72 "$1,871.00" $495.04 $235.39 $495.04 $519.80 "$5,731.50" $495.04 $495.04 $495.04 "$2,762.00" "$2,348.00" "$6,052.46" $495.04 "$6,113.60" "$2,150.00" "$1,516.75" $495.04 "$4,432.36" $519.80 $716.21 $495.04 "$1,592.59" $495.04 N/A N/A 36101097 EAP CPT® 66762 IRIDOPLASTY PHOTOCOAGULATION BOTH IP/OP "$1,046.00" $774.50 $218.00 "$1,046.00" "$1,046.00" "$1,046.00" "$1,046.00" "$1,046.00" $423.15 $423.15 $425.93 "$1,046.00" $423.15 "$1,046.00" "$1,046.00" "$1,046.00" "$1,046.00" $218.00 $677.04 $676.83 "$1,046.00" $423.15 $423.02 $423.15 "$1,046.00" $784.50 $423.15 $423.15 $423.15 "$1,046.00" $523.00 $828.43 $423.15 $836.80 "$1,046.00" "$1,046.00" $423.15 $606.68 "$1,046.00" $432.93 $423.15 "$1,046.00" $423.15 N/A N/A 36101098 EAP CPT® 66821 YAG LASER CAPSULOTOMY BOTH IP/OP "$2,125.00" "$1,572.50" $311.18 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $495.04 $495.04 $492.86 $442.90 $495.04 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $442.87 $792.07 $765.72 "$2,125.00" $495.04 $311.18 $495.04 $519.80 "$1,593.75" $495.04 $495.04 $495.04 "$2,125.00" "$1,062.50" "$1,683.00" $495.04 "$1,700.00" "$2,125.00" $421.76 $495.04 "$1,232.50" $519.80 $716.21 $495.04 $442.85 $495.04 N/A N/A 36101099 EAP CPT® 67015 POSTERIOR SCLEROTOMY BOTH IP/OP "$15,938.00" "$11,794.50" $603.77 "$15,938.00" "$15,938.00" "$15,938.00" "$15,938.00" "$15,938.00" $607.90 $607.90 $605.03 "$15,938.00" $607.90 "$15,938.00" "$15,938.00" "$15,938.00" "$15,938.00" "$3,321.65" $972.64 $968.27 "$15,938.00" $607.90 $605.17 $607.90 "$15,938.00" "$11,953.50" $607.90 $607.90 $607.90 "$2,762.00" "$7,969.00" "$12,622.90" $607.90 "$12,750.40" "$3,250.00" "$15,938.00" $607.90 "$9,244.04" "$15,938.00" $603.77 $607.90 "$15,938.00" $607.90 N/A N/A 36101100 EAP CPT® 67025 INJECT VITREOUS PARS PLA/LIMBL BOTH IP/OP "$8,619.00" "$6,378.50" $628.15 "$8,619.00" "$8,619.00" "$8,619.00" "$8,619.00" "$8,619.00" $628.15 $628.15 $633.01 "$8,619.00" $628.15 "$8,619.00" "$8,619.00" "$8,619.00" "$8,619.00" "$1,796.29" "$1,005.04" "$1,006.35" "$8,619.00" $628.15 $628.97 $628.15 "$8,619.00" "$6,464.25" $628.15 $628.15 $628.15 "$2,762.00" "$4,309.50" "$6,826.25" $628.15 "$6,895.20" "$3,250.00" "$8,619.00" $628.15 "$4,999.02" "$8,619.00" $643.81 $628.15 "$8,619.00" $628.15 N/A N/A 36101101 EAP CPT® 67028 INJECTION INTRAVITREAL DRUG BOTH IP/OP "$2,178.00" "$1,612.00" $91.14 "$2,178.00" "$2,178.00" "$2,178.00" "$2,178.00" "$2,178.00" $313.64 $313.64 $312.26 $453.95 $313.64 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $453.92 $501.83 $479.85 "$1,871.00" $313.64 $91.14 $313.64 $329.33 "$1,633.50" $313.64 $313.64 $313.64 "$2,178.00" "$1,089.00" "$1,724.98" $313.64 "$1,742.40" "$1,750.00" $432.28 $313.64 "$1,263.24" $329.33 $453.76 $313.64 $453.90 $313.64 N/A N/A 36101102 EAP CPT® 67031 "SEVER VITREOUS, LASER" BOTH IP/OP "$2,310.00" "$1,709.50" $352.91 "$2,310.00" "$2,310.00" "$2,310.00" "$2,310.00" "$2,310.00" $353.55 $353.55 $356.52 "$2,310.00" $353.55 "$2,310.00" "$2,310.00" "$2,310.00" "$2,310.00" $481.43 $565.68 $564.66 "$2,310.00" $353.55 $352.91 $353.55 "$2,310.00" "$1,732.50" $353.55 $353.55 $353.55 "$2,310.00" "$1,155.00" "$1,829.52" $353.55 "$1,848.00" "$2,150.00" "$2,310.00" $353.55 "$1,339.80" "$2,310.00" $362.63 $353.55 "$2,310.00" $353.55 N/A N/A 36101103 EAP CPT® 67101 RETINAL DETACH RPR CRYO/DIATH BOTH IP/OP "$7,769.00" "$5,749.50" $283.81 "$6,215.20" "$3,558.00" "$3,558.00" "$3,558.00" "$3,558.00" "$2,042.73" "$2,042.73" "$2,033.69" "$1,619.25" "$2,042.73" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,619.15" "$3,268.36" "$3,115.33" "$1,871.00" "$2,042.73" $283.81 "$2,042.73" "$2,144.86" "$5,826.75" "$2,042.73" "$2,042.73" "$2,042.73" "$2,762.00" "$2,348.00" "$6,153.05" "$2,042.73" "$6,215.20" "$3,250.00" "$1,541.95" "$2,042.73" "$4,506.02" "$2,144.86" "$2,955.31" "$2,042.73" "$1,619.06" "$2,042.73" N/A N/A 36101104 EAP CPT® 67105 REPAIR RETINAL DETACH LASER BOTH IP/OP "$1,373.00" "$1,016.50" $273.65 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" $273.65 $273.65 $275.57 "$1,373.00" $273.65 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" $286.15 $437.84 $438.38 "$1,373.00" $273.65 $273.99 $273.65 "$1,373.00" "$1,029.75" $273.65 $273.65 $273.65 "$1,373.00" $686.50 "$1,087.42" $273.65 "$1,098.40" "$1,373.00" "$1,373.00" $273.65 $796.34 "$1,373.00" $280.08 $273.65 "$1,373.00" $273.65 N/A N/A 36101105 EAP CPT® 67141 CRYOTHERAPY RETINAL TEAR BOTH IP/OP "$1,917.00" "$1,419.00" $215.72 "$1,917.00" "$1,917.00" "$1,917.00" "$1,917.00" "$1,917.00" $216.07 $216.07 $486.83 "$1,917.00" $216.07 "$1,917.00" "$1,917.00" "$1,917.00" "$1,917.00" $399.52 $345.71 $345.15 "$1,917.00" $216.07 $215.72 $216.07 "$1,917.00" "$1,437.75" $216.07 $216.07 $216.07 "$1,917.00" $958.50 "$1,518.26" $216.07 "$1,533.60" "$1,750.00" "$1,917.00" $216.07 "$1,111.86" "$1,917.00" $495.65 $216.07 "$1,917.00" $216.07 N/A N/A 36101106 EAP CPT® 67145 PHOTOCOAGULATION RETINAL TEAR BOTH IP/OP "$1,043.00" $772.00 $207.01 "$1,043.00" "$1,043.00" "$1,043.00" "$1,043.00" "$1,043.00" $495.04 $495.04 $492.86 $217.39 $495.04 "$1,043.00" "$1,043.00" "$1,043.00" $882.37 $217.37 $792.07 $765.72 "$1,043.00" $495.04 $215.72 $495.04 $519.80 $782.25 $495.04 $495.04 $495.04 "$1,043.00" $521.50 $826.06 $495.04 $834.40 "$1,043.00" $207.01 $495.04 $604.94 $519.80 $716.21 $495.04 $217.36 $495.04 N/A N/A 36101107 EAP CPT® 67208 DESTROY LESION RETINA CRYO/DIA BOTH IP/OP "$4,906.00" "$3,630.50" $573.77 "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" $575.35 $575.35 $578.76 "$4,906.00" $575.35 "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$1,022.46" $920.56 $918.03 "$4,906.00" $575.35 $573.77 $575.35 "$4,906.00" "$3,679.50" $575.35 $575.35 $575.35 "$2,762.00" "$2,453.00" "$3,885.55" $575.35 "$3,924.80" "$1,750.00" "$4,906.00" $575.35 "$2,845.48" "$4,906.00" $587.96 $575.35 "$4,906.00" $575.35 N/A N/A 36101108 EAP CPT® 67210 DESTROY LESION RETINA PHOTOCOA BOTH IP/OP "$1,009.00" $747.00 $200.26 "$1,009.00" "$1,009.00" "$1,009.00" "$1,009.00" "$1,009.00" $495.04 $495.04 $492.86 $210.30 $495.04 "$1,009.00" "$1,009.00" "$1,009.00" $882.37 $210.29 $792.07 $765.72 "$1,009.00" $495.04 $496.53 $495.04 $519.80 $756.75 $495.04 $495.04 $495.04 "$1,009.00" $504.50 $799.13 $495.04 $807.20 "$1,009.00" $200.26 $495.04 $585.22 $519.80 $716.21 $495.04 $210.28 $495.04 N/A N/A 36101109 EAP CPT® 67220 DESTR CHOROID LESION PHOPTOCOA BOTH IP/OP "$1,514.00" "$1,120.50" $315.53 "$1,514.00" "$1,514.00" "$1,514.00" "$1,514.00" "$1,514.00" $496.49 $496.49 $499.31 "$1,514.00" $496.49 "$1,514.00" "$1,514.00" "$1,514.00" "$1,514.00" $315.53 $794.38 $793.89 "$1,514.00" $496.49 $496.18 $496.49 "$1,514.00" "$1,135.50" $496.49 $496.49 $496.49 "$1,514.00" $757.00 "$1,199.09" $496.49 "$1,211.20" "$1,514.00" "$1,514.00" $496.49 $878.12 "$1,514.00" $508.99 $496.49 "$1,514.00" $496.49 N/A N/A 36101110 EAP CPT® 67227 DESTROY RETINOPATHY CRYO/DIATH BOTH IP/OP "$4,468.00" "$3,306.50" $252.59 "$4,468.00" "$4,468.00" "$4,468.00" "$4,468.00" "$4,468.00" $252.59 $252.59 $254.65 "$4,468.00" $252.59 "$4,468.00" "$4,468.00" "$4,468.00" "$4,468.00" $931.18 $404.14 $404.85 "$4,468.00" $252.59 $253.03 $252.59 "$4,468.00" "$3,351.00" $252.59 $252.59 $252.59 "$2,762.00" "$2,234.00" "$3,538.66" $252.59 "$3,574.40" "$3,725.00" "$4,468.00" $252.59 "$2,591.44" "$4,468.00" $261.00 $252.59 "$4,468.00" $252.59 N/A N/A 36101111 EAP CPT® 67228 TX EXTENSIVE RETINOPATHY PHOTOCOAGULATION BOTH IP/OP "$7,387.00" "$5,466.50" $301.84 "$5,909.60" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $495.04 $495.04 $492.86 "$1,539.64" $495.04 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 "$1,539.53" $792.07 $765.72 "$1,871.00" $495.04 $301.84 $495.04 $519.80 "$5,540.25" $495.04 $495.04 $495.04 "$2,762.00" "$2,348.00" "$5,850.50" $495.04 "$5,909.60" "$2,150.00" "$1,466.13" $495.04 "$4,284.46" $519.80 $716.21 $495.04 "$1,539.45" $495.04 N/A N/A 36101112 EAP CPT® 67335 PLACE ADJUST SUTURE STRABISMUS BOTH IP/OP "$6,484.00" "$4,798.50" $145.81 "$6,484.00" "$6,484.00" "$6,484.00" "$6,484.00" "$6,484.00" $187.29 $187.29 $145.81 "$6,484.00" $187.29 "$6,484.00" "$6,484.00" "$6,484.00" "$6,484.00" "$1,351.34" $299.66 $298.21 "$6,484.00" $187.29 $186.38 $187.29 "$6,484.00" "$4,863.00" $187.29 $187.29 $187.29 "$4,417.00" "$3,242.00" "$5,135.33" $187.29 "$5,187.20" "$1,750.00" "$6,484.00" $187.29 "$3,760.72" "$6,484.00" $150.36 $187.29 "$6,484.00" $187.29 N/A N/A 36101113 EAP CPT® 67345 CHEMODENERV EXTRAOCULAR MUSCLE BOTH IP/OP $846.00 $626.50 $167.91 $846.00 $846.00 $846.00 $846.00 $846.00 $257.32 $257.32 $256.18 $176.33 $257.32 $846.00 $846.00 $846.00 $846.00 $176.32 $411.71 $381.89 $846.00 $257.32 $215.55 $257.32 $270.18 $634.50 $257.32 $257.32 $257.32 $846.00 $423.00 $670.03 $257.32 $676.80 $846.00 $167.91 $257.32 $490.68 $270.18 $372.27 $257.32 $176.31 $257.32 N/A N/A 36101114 EAP CPT® 67415 FNA ORBITAL CONTENTS BOTH IP/OP "$11,904.00" "$8,809.00" $101.96 "$11,904.00" "$11,904.00" "$11,904.00" "$11,904.00" "$11,904.00" $101.96 $101.96 $103.44 "$11,904.00" $101.96 "$11,904.00" "$11,904.00" "$11,904.00" "$11,904.00" "$2,480.92" $163.14 $163.20 "$11,904.00" $101.96 $102.00 $101.96 "$11,904.00" "$8,928.00" $101.96 $101.96 $101.96 "$2,762.00" "$5,952.00" "$9,427.97" $101.96 "$9,523.20" "$3,250.00" "$11,904.00" $101.96 "$6,904.32" "$11,904.00" $106.73 $101.96 "$11,904.00" $101.96 N/A N/A 36101115 EAP CPT® 67500 INJECT MEDICATION RETROBULBAR BOTH IP/OP $703.00 $520.50 $62.12 $703.00 $703.00 $703.00 $703.00 $703.00 $62.65 $62.65 $62.12 $703.00 $62.65 $703.00 $703.00 $703.00 $703.00 $146.51 $100.24 $101.95 $703.00 $62.65 $63.72 $62.65 $703.00 $527.25 $62.65 $62.65 $62.65 $703.00 $351.50 $556.78 $62.65 $562.40 $703.00 $703.00 $62.65 $407.74 $703.00 $62.75 $62.65 $703.00 $62.65 N/A N/A 36101116 EAP CPT® 67505 INJECT ALCOHOL RETROBULBAR BOTH IP/OP $843.00 $624.00 $71.39 $843.00 $843.00 $843.00 $843.00 $843.00 $71.97 $71.97 $72.57 $843.00 $71.97 $843.00 $843.00 $843.00 $843.00 $175.69 $115.15 $115.49 $843.00 $71.97 $72.18 $71.97 $843.00 $632.25 $71.97 $71.97 $71.97 $843.00 $421.50 $667.66 $71.97 $674.40 $843.00 $843.00 $71.97 $488.94 $843.00 $71.39 $71.97 $843.00 $71.97 N/A N/A 36101117 EAP CPT® 67515 INJECT MEDICATION TENON'S CAPS BOTH IP/OP "$2,002.00" "$1,481.50" $47.10 "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" $47.14 $47.14 $47.25 "$2,002.00" $47.14 "$2,002.00" "$2,002.00" "$2,002.00" "$2,002.00" $417.24 $75.42 $75.36 "$2,002.00" $47.14 $47.10 $47.14 "$2,002.00" "$1,501.50" $47.14 $47.14 $47.14 "$2,002.00" "$1,001.00" "$1,585.58" $47.14 "$1,601.60" "$1,750.00" "$2,002.00" $47.14 "$1,161.16" "$2,002.00" $60.20 $47.14 "$2,002.00" $47.14 N/A N/A 36101118 EAP CPT® 67700 BLEPHAROTOMY EYELID BOTH IP/OP "$1,339.00" $991.00 $115.78 "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" $115.78 $115.78 $116.40 "$1,339.00" $115.78 "$1,339.00" "$1,339.00" "$1,339.00" "$1,339.00" $279.06 $185.25 $185.86 "$1,339.00" $115.78 $116.16 $115.78 "$1,339.00" "$1,004.25" $115.78 $115.78 $115.78 "$1,339.00" $669.50 "$1,060.49" $115.78 "$1,071.20" "$1,339.00" "$1,339.00" $115.78 $776.62 "$1,339.00" $118.23 $115.78 "$1,339.00" $115.78 N/A N/A 36101119 EAP CPT® 67710 SEVERING OF TARSORRHAPHY BOTH IP/OP "$2,216.00" "$1,640.00" $97.52 "$2,216.00" "$2,216.00" "$2,216.00" "$2,216.00" "$2,216.00" $97.52 $97.52 $98.33 "$2,216.00" $97.52 "$2,216.00" "$2,216.00" "$2,216.00" "$2,216.00" $461.84 $156.03 $157.14 "$2,216.00" $97.52 $98.21 $97.52 "$2,216.00" "$1,662.00" $97.52 $97.52 $97.52 "$2,216.00" "$1,108.00" "$1,755.07" $97.52 "$1,772.80" "$2,150.00" "$2,216.00" $97.52 "$1,285.28" "$2,216.00" $99.12 $97.52 "$2,216.00" $97.52 N/A N/A 36101120 EAP CPT® 67715 CANTHOTOMY BOTH IP/OP "$9,511.00" "$7,038.50" $107.98 "$9,511.00" "$9,511.00" "$9,511.00" "$9,511.00" "$9,511.00" $107.98 $107.98 $108.25 "$9,511.00" $107.98 "$9,511.00" "$9,511.00" "$9,511.00" "$9,511.00" "$1,982.20" $172.77 $174.02 "$9,511.00" $107.98 $108.76 $107.98 "$9,511.00" "$7,133.25" $107.98 $107.98 $107.98 "$2,762.00" "$4,755.50" "$7,532.71" $107.98 "$7,608.80" "$3,250.00" "$9,511.00" $107.98 "$5,516.38" "$9,511.00" $109.22 $107.98 "$9,511.00" $107.98 N/A N/A 36101121 EAP CPT® 67800 EXCISE CHALAZION SINGLE BOTH IP/OP "$1,334.00" $987.50 $101.96 "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" $257.32 $257.32 $256.18 $278.04 $257.32 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $278.02 $411.71 $381.89 "$1,334.00" $257.32 $101.96 $257.32 $270.18 "$1,000.50" $257.32 $257.32 $257.32 "$1,334.00" $667.00 "$1,056.53" $257.32 "$1,067.20" "$1,334.00" $264.77 $257.32 $773.72 $270.18 $372.27 $257.32 $278.01 $257.32 N/A N/A 36101122 EAP CPT® 67801 EXCISE CHALAZION MULTIPLE BOTH IP/OP "$2,208.00" "$1,634.00" $131.79 "$2,208.00" "$2,208.00" "$2,208.00" "$2,208.00" "$2,208.00" $796.59 $796.59 $793.07 $460.20 $796.59 "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $460.17 "$1,274.55" "$1,258.92" "$1,871.00" $796.59 $131.79 $796.59 $836.42 "$1,656.00" $796.59 $796.59 $796.59 "$2,208.00" "$1,104.00" "$1,748.74" $796.59 "$1,766.40" "$2,150.00" $438.23 $796.59 "$1,280.64" $836.42 "$1,152.47" $796.59 $460.15 $796.59 N/A N/A 36101123 EAP CPT® 67805 "EXCISE CHALAZION,MULT,DIFF LID" BOTH IP/OP "$1,668.00" "$1,234.50" $163.27 "$1,668.00" "$1,668.00" "$1,668.00" "$1,668.00" "$1,668.00" $257.32 $257.32 $256.18 $347.65 $257.32 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $347.63 $411.71 $381.89 "$1,668.00" $257.32 $163.27 $257.32 $270.18 "$1,251.00" $257.32 $257.32 $257.32 "$1,668.00" $834.00 "$1,321.06" $257.32 "$1,334.40" "$1,668.00" $331.06 $257.32 $967.44 $270.18 $372.27 $257.32 $347.61 $257.32 N/A N/A 36101124 EAP CPT® 67810 BIOPSY OF EYELID BOTH IP/OP "$1,150.00" $851.00 $68.11 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $68.11 $68.11 $69.02 "$1,150.00" $68.11 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 $108.98 $108.99 "$1,150.00" $68.11 $68.12 $68.11 "$1,150.00" $862.50 $68.11 $68.11 $68.11 "$1,150.00" $575.00 $910.80 $68.11 $920.00 "$1,150.00" "$1,150.00" $68.11 $667.00 "$1,150.00" $72.11 $68.11 "$1,150.00" $68.11 N/A N/A 36101125 EAP CPT® 67825 CORRECT TRICHIASIS ELECTROSURG BOTH IP/OP "$1,150.00" $851.00 $121.31 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $121.31 $121.31 $121.97 "$1,150.00" $121.31 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 $194.10 $194.53 "$1,150.00" $121.31 $121.58 $121.31 "$1,150.00" $862.50 $121.31 $121.31 $121.31 "$1,150.00" $575.00 $910.80 $121.31 $920.00 "$1,150.00" "$1,150.00" $121.31 $667.00 "$1,150.00" $123.64 $121.31 "$1,150.00" $121.31 N/A N/A 36101126 EAP CPT® 67840 EXCISE LESION EYELID SMPL CLOS BOTH IP/OP "$2,572.00" "$1,903.50" $157.17 "$2,572.00" "$2,572.00" "$2,572.00" "$2,572.00" "$2,572.00" $796.59 $796.59 $793.07 $536.07 $796.59 "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $536.03 "$1,274.55" "$1,258.92" "$1,871.00" $796.59 $157.17 $796.59 $836.42 "$1,929.00" $796.59 $796.59 $796.59 "$2,572.00" "$1,286.00" "$2,037.02" $796.59 "$2,057.60" "$2,150.00" $510.48 $796.59 "$1,491.76" $836.42 "$1,152.47" $796.59 $536.00 $796.59 N/A N/A 36101127 EAP CPT® 67875 TEMPORARY TARSORRAPHY BOTH IP/OP "$3,736.00" "$2,765.00" $94.86 "$2,988.80" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $796.59 $796.59 $793.07 $778.68 $796.59 "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $778.62 "$1,274.55" "$1,258.92" "$1,871.00" $796.59 $94.86 $796.59 $836.42 "$2,802.00" $796.59 $796.59 $796.59 "$2,762.00" "$1,868.00" "$2,958.91" $796.59 "$2,988.80" "$2,150.00" $741.50 $796.59 "$2,166.88" $836.42 "$1,152.47" $796.59 $778.58 $796.59 N/A N/A 36101128 EAP CPT® 67880 CONSTRUCT INTEMAR ADHES ETC. BOTH IP/OP "$7,543.00" "$5,582.00" $366.59 "$7,543.00" "$7,543.00" "$7,543.00" "$7,543.00" "$7,543.00" $366.59 $366.59 $368.62 "$7,543.00" $366.59 "$7,543.00" "$7,543.00" "$7,543.00" "$7,543.00" "$1,572.04" $586.54 $586.88 "$7,543.00" $366.59 $366.80 $366.59 "$7,543.00" "$5,657.25" $366.59 $366.59 $366.59 "$3,500.00" "$3,771.50" "$5,974.06" $366.59 "$6,034.40" "$3,250.00" "$7,543.00" $366.59 "$4,374.94" "$7,543.00" $374.53 $366.59 "$7,543.00" $366.59 N/A N/A 36101129 EAP CPT® 67909 REDUCE PTOSIS OVERCORRECTION BOTH IP/OP "$9,164.00" "$6,781.50" $437.29 "$9,164.00" "$9,164.00" "$9,164.00" "$9,164.00" "$9,164.00" $437.38 $437.38 $439.33 "$9,164.00" $437.38 "$9,164.00" "$9,164.00" "$9,164.00" "$9,164.00" "$1,909.88" $699.81 $699.66 "$9,164.00" $437.38 $437.29 $437.38 "$9,164.00" "$6,873.00" $437.38 $437.38 $437.38 "$4,417.00" "$4,582.00" "$7,257.89" $437.38 "$7,331.20" "$3,250.00" "$9,164.00" $437.38 "$5,315.12" "$9,164.00" $447.34 $437.38 "$9,164.00" $437.38 N/A N/A 36101130 EAP CPT® 67914 REPAIR ECTROPION BY SUTURE BOTH IP/OP "$5,265.00" "$3,896.50" $326.97 "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" $326.97 $326.97 $328.36 "$5,265.00" $326.97 "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$1,097.28" $523.15 $523.97 "$5,265.00" $326.97 $327.48 $326.97 "$5,265.00" "$3,948.75" $326.97 $326.97 $326.97 "$3,500.00" "$2,632.50" "$4,169.88" $326.97 "$4,212.00" "$3,250.00" "$5,265.00" $326.97 "$3,053.70" "$5,265.00" $333.05 $326.97 "$5,265.00" $326.97 N/A N/A 36101131 EAP CPT® 67916 "RPR ECTROPION, BLEPHAR TARSAL" BOTH IP/OP "$9,164.00" "$6,781.50" $427.78 "$9,164.00" "$9,164.00" "$9,164.00" "$9,164.00" "$9,164.00" $427.90 $427.90 $430.37 "$9,164.00" $427.90 "$9,164.00" "$9,164.00" "$9,164.00" "$9,164.00" "$1,909.88" $684.64 $684.45 "$9,164.00" $427.90 $427.78 $427.90 "$9,164.00" "$6,873.00" $427.90 $427.90 $427.90 "$4,417.00" "$4,582.00" "$7,257.89" $427.90 "$7,331.20" "$3,250.00" "$9,164.00" $427.90 "$5,315.12" "$9,164.00" $437.98 $427.90 "$9,164.00" $427.90 N/A N/A 36101132 EAP CPT® 67921 REPAIR ENTROPION BY SUTURE BOTH IP/OP "$5,284.00" "$3,910.50" $309.91 "$5,284.00" "$5,284.00" "$5,284.00" "$5,284.00" "$5,284.00" $309.91 $309.91 $312.10 "$5,284.00" $309.91 "$5,284.00" "$5,284.00" "$5,284.00" "$5,284.00" "$1,101.24" $495.86 $497.92 "$5,284.00" $309.91 $311.20 $309.91 "$5,284.00" "$3,963.00" $309.91 $309.91 $309.91 "$3,500.00" "$2,642.00" "$4,184.93" $309.91 "$4,227.20" "$3,250.00" "$5,284.00" $309.91 "$3,064.72" "$5,284.00" $315.74 $309.91 "$5,284.00" $309.91 N/A N/A 36101133 EAP CPT® 67923 "RPR ENTROPION, BLEPHAR TARSAL" BOTH IP/OP "$9,164.00" "$6,781.50" $427.62 "$9,164.00" "$9,164.00" "$9,164.00" "$9,164.00" "$9,164.00" $427.62 $427.62 $430.43 "$9,164.00" $427.62 "$9,164.00" "$9,164.00" "$9,164.00" "$9,164.00" "$1,909.88" $684.19 $684.99 "$9,164.00" $427.62 $428.12 $427.62 "$9,164.00" "$6,873.00" $427.62 $427.62 $427.62 "$4,417.00" "$4,582.00" "$7,257.89" $427.62 "$7,331.20" "$3,250.00" "$9,164.00" $427.62 "$5,315.12" "$9,164.00" $438.70 $427.62 "$9,164.00" $427.62 N/A N/A 36101134 EAP CPT® 67924 "RPR ENTROPION, BLEPHAR EXTNSV" BOTH IP/OP "$9,164.00" "$6,781.50" $454.08 "$9,164.00" "$9,164.00" "$9,164.00" "$9,164.00" "$9,164.00" $454.08 $454.08 $456.83 "$9,164.00" $454.08 "$9,164.00" "$9,164.00" "$9,164.00" "$9,164.00" "$1,909.88" $726.53 $726.74 "$9,164.00" $454.08 $454.21 $454.08 "$9,164.00" "$6,873.00" $454.08 $454.08 $454.08 "$4,417.00" "$4,582.00" "$7,257.89" $454.08 "$7,331.20" "$3,250.00" "$9,164.00" $454.08 "$5,315.12" "$9,164.00" $466.10 $454.08 "$9,164.00" $454.08 N/A N/A 36101135 EAP CPT® 67930 SUTURE WOUND EYELID PARTIAL TH BOTH IP/OP "$5,476.00" "$4,052.50" $234.80 "$5,476.00" "$5,476.00" "$5,476.00" "$5,476.00" "$5,476.00" $235.20 $235.20 $237.53 "$5,476.00" $235.20 "$5,476.00" "$5,476.00" "$5,476.00" "$5,476.00" "$1,141.26" $376.32 $375.68 "$5,476.00" $235.20 $234.80 $235.20 "$5,476.00" "$4,107.00" $235.20 $235.20 $235.20 "$2,762.00" "$2,738.00" "$4,336.99" $235.20 "$4,380.80" "$3,250.00" "$5,476.00" $235.20 "$3,176.08" "$5,476.00" $244.44 $235.20 "$5,476.00" $235.20 N/A N/A 36101136 EAP CPT® 67935 SUTURE WOUND EYELID FULL THICK BOTH IP/OP "$10,632.00" "$7,868.00" $437.38 "$10,632.00" "$10,632.00" "$10,632.00" "$10,632.00" "$10,632.00" $438.93 $438.93 $441.28 "$10,632.00" $438.93 "$10,632.00" "$10,632.00" "$10,632.00" "$10,632.00" "$2,215.83" $702.29 $699.81 "$10,632.00" $438.93 $437.38 $438.93 "$10,632.00" "$7,974.00" $438.93 $438.93 $438.93 "$2,851.00" "$5,316.00" "$8,420.54" $438.93 "$8,505.60" "$3,250.00" "$10,632.00" $438.93 "$6,166.56" "$10,632.00" $451.36 $438.93 "$10,632.00" $438.93 N/A N/A 36101138 EAP CPT® 67938 REMOVE FOREIGN BODY EYELID BOTH IP/OP "$1,204.00" $891.00 $117.23 "$1,204.00" "$1,204.00" "$1,204.00" "$1,204.00" "$1,204.00" $117.23 $117.23 $117.50 "$1,204.00" $117.23 "$1,204.00" "$1,204.00" "$1,204.00" "$1,204.00" $250.93 $187.57 $189.09 "$1,204.00" $117.23 $118.18 $117.23 "$1,204.00" $903.00 $117.23 $117.23 $117.23 "$1,204.00" $602.00 $953.57 $117.23 $963.20 "$1,204.00" "$1,204.00" $117.23 $698.32 "$1,204.00" $118.23 $117.23 "$1,204.00" $117.23 N/A N/A 36101139 EAP CPT® 67950 CANTHOPLASTY BOTH IP/OP "$9,333.00" "$6,906.50" $461.01 "$9,333.00" "$9,333.00" "$9,333.00" "$9,333.00" "$9,333.00" $461.11 $461.11 $463.60 "$9,333.00" $461.11 "$9,333.00" "$9,333.00" "$9,333.00" "$9,333.00" "$1,945.10" $737.78 $737.62 "$9,333.00" $461.11 $461.01 $461.11 "$9,333.00" "$6,999.75" $461.11 $461.11 $461.11 "$2,851.00" "$4,666.50" "$7,391.74" $461.11 "$7,466.40" "$3,250.00" "$9,333.00" $461.11 "$5,413.14" "$9,333.00" $472.22 $461.11 "$9,333.00" $461.11 N/A N/A 36101140 EAP CPT® 68020 I & D CONJUNCTIVA CYST BOTH IP/OP "$3,391.00" "$2,509.50" $110.07 "$3,391.00" "$3,391.00" "$3,391.00" "$3,391.00" "$3,391.00" $110.29 $110.29 $111.21 "$3,391.00" $110.29 "$3,391.00" "$3,391.00" "$3,391.00" "$3,391.00" $706.72 $176.46 $176.11 "$3,391.00" $110.29 $110.07 $110.29 "$3,391.00" "$2,543.25" $110.29 $110.29 $110.29 "$2,762.00" "$1,695.50" "$2,685.67" $110.29 "$2,712.80" "$2,150.00" "$3,391.00" $110.29 "$1,966.78" "$3,391.00" $112.11 $110.29 "$3,391.00" $110.29 N/A N/A 36101141 EAP CPT® 68100 BIOPSY OF CONJUNCTIVA BOTH IP/OP "$2,389.00" "$1,768.00" $94.71 "$2,389.00" "$2,389.00" "$2,389.00" "$2,389.00" "$2,389.00" $94.71 $94.71 $95.50 "$2,389.00" $94.71 "$2,389.00" "$2,389.00" "$2,389.00" "$2,389.00" $497.89 $151.54 $151.76 "$2,389.00" $94.71 $94.85 $94.71 "$2,389.00" "$1,791.75" $94.71 $94.71 $94.71 "$2,389.00" "$1,194.50" "$1,892.09" $94.71 "$1,911.20" "$2,150.00" "$2,389.00" $94.71 "$1,385.62" "$2,389.00" $98.06 $94.71 "$2,389.00" $94.71 N/A N/A 36101142 EAP CPT® 68110 EXCISE LESION CONJUNCTIVA <1 C BOTH IP/OP "$4,701.00" "$3,479.00" $147.66 "$3,760.80" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,968.41" "$1,968.41" "$1,959.70" $979.81 "$1,968.41" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $979.74 "$3,149.46" "$3,050.10" "$1,871.00" "$1,968.41" $147.66 "$1,968.41" "$2,066.83" "$3,525.75" "$1,968.41" "$1,968.41" "$1,968.41" "$2,762.00" "$2,348.00" "$3,723.19" "$1,968.41" "$3,760.80" "$3,250.00" $933.03 "$1,968.41" "$2,726.58" "$2,066.83" "$2,847.79" "$1,968.41" $979.69 "$1,968.41" N/A N/A 36101143 EAP CPT® 68110 INCISION CONJUNCTIVAL LESION BOTH IP/OP "$4,701.00" "$3,479.00" $147.66 "$3,760.80" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,968.41" "$1,968.41" "$1,959.70" $979.81 "$1,968.41" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $979.74 "$3,149.46" "$3,050.10" "$1,871.00" "$1,968.41" $147.66 "$1,968.41" "$2,066.83" "$3,525.75" "$1,968.41" "$1,968.41" "$1,968.41" "$2,762.00" "$2,348.00" "$3,723.19" "$1,968.41" "$3,760.80" "$3,250.00" $933.03 "$1,968.41" "$2,726.58" "$2,066.83" "$2,847.79" "$1,968.41" $979.69 "$1,968.41" N/A N/A 36101144 EAP CPT® 68115 EXCISE LESION CONJUNCTIVA >1 C BOTH IP/OP "$5,345.00" "$3,955.50" #N/A #N/A "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,968.41" "$1,968.41" "$1,959.70" "$1,114.03" "$1,968.41" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,113.96" "$3,149.46" "$3,050.10" "$2,836.00" "$1,968.41" $182.23 "$1,968.41" "$2,066.83" "$4,008.75" "$1,968.41" "$1,968.41" "$1,968.41" "$2,851.00" "$2,423.00" "$4,233.24" "$1,968.41" "$4,276.00" "$3,250.00" "$1,060.85" #N/A "$3,100.10" "$2,066.83" "$2,847.79" "$1,968.41" "$1,113.90" "$1,968.41" N/A N/A 36101145 EAP CPT® 68200 INJECTION SUBCONJUNCTIVA BOTH IP/OP $264.00 $195.50 $33.88 $264.00 $264.00 $264.00 $264.00 $264.00 $34.10 $34.10 $34.38 $264.00 $34.10 $264.00 $264.00 $264.00 $264.00 $55.02 $54.56 $54.21 $264.00 $34.10 $33.88 $34.10 $264.00 $198.00 $34.10 $34.10 $34.10 $264.00 $132.00 $209.09 $34.10 $211.20 $264.00 $264.00 $34.10 $153.12 $264.00 $35.69 $34.10 $264.00 $34.10 N/A N/A 36101146 EAP CPT® 68400 I & D LACRIMAL GLAND BOTH IP/OP $850.00 $629.00 $129.59 $850.00 $850.00 $850.00 $850.00 $850.00 $129.59 $129.59 $130.95 $850.00 $129.59 $850.00 $850.00 $850.00 $850.00 $177.15 $207.34 $209.20 $850.00 $129.59 $130.75 $129.59 $850.00 $637.50 $129.59 $129.59 $129.59 $850.00 $425.00 $673.20 $129.59 $680.00 $850.00 $850.00 $129.59 $493.00 $850.00 $133.74 $129.59 $850.00 $129.59 N/A N/A 36101147 EAP CPT® 68420 I & D LACRIMAL SAC BOTH IP/OP "$3,029.00" "$2,241.50" $165.65 "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" $165.98 $165.98 $166.69 "$3,029.00" $165.98 "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" $631.28 $265.57 $265.04 "$3,029.00" $165.98 $165.65 $165.98 "$3,029.00" "$2,271.75" $165.98 $165.98 $165.98 "$2,762.00" "$1,514.50" "$2,398.97" $165.98 "$2,423.20" "$2,150.00" "$3,029.00" $165.98 "$1,756.82" "$3,029.00" $171.24 $165.98 "$3,029.00" $165.98 N/A N/A 36101148 EAP CPT® 68440 SNIP INCISION LACRIMAL PUNCTUM BOTH IP/OP $661.00 $489.50 $99.59 $661.00 $661.00 $661.00 $661.00 $661.00 $99.59 $99.59 $100.07 $661.00 $99.59 $661.00 $661.00 $661.00 $661.00 $137.76 $159.34 $159.81 $661.00 $99.59 $99.88 $99.59 $661.00 $495.75 $99.59 $99.59 $99.59 $661.00 $330.50 $523.51 $99.59 $528.80 $661.00 $661.00 $99.59 $383.38 $661.00 $100.91 $99.59 $661.00 $99.59 N/A N/A 36101150 EAP CPT® 68705 CORRECT EVERTED PUNCTUM CAUTER BOTH IP/OP $661.00 $489.50 $137.76 $661.00 $661.00 $661.00 $661.00 $661.00 $164.99 $164.99 $165.38 $661.00 $164.99 $661.00 $661.00 $661.00 $661.00 $137.76 $263.98 $264.46 $661.00 $164.99 $165.29 $164.99 $661.00 $495.75 $164.99 $164.99 $164.99 $661.00 $330.50 $523.51 $164.99 $528.80 $661.00 $661.00 $164.99 $383.38 $661.00 $168.70 $164.99 $661.00 $164.99 N/A N/A 36101151 EAP CPT® 68760 CLOSE LACRI PUNCT LASER LIGATE BOTH IP/OP $623.00 $461.50 $129.84 $623.00 $623.00 $623.00 $623.00 $623.00 $144.44 $144.44 $145.92 $623.00 $144.44 $623.00 $623.00 $623.00 $623.00 $129.84 $231.10 $232.46 $623.00 $144.44 $145.29 $144.44 $623.00 $467.25 $144.44 $144.44 $144.44 $623.00 $311.50 $493.42 $144.44 $498.40 $623.00 $623.00 $144.44 $361.34 $623.00 $148.15 $144.44 $623.00 $144.44 N/A N/A 36101152 EAP CPT® 68761 CLOSE TEAR DUCT OPENING BOTH IP/OP $584.00 $432.50 $117.16 $584.00 $584.00 $584.00 $584.00 $584.00 $117.58 $117.58 $118.20 $584.00 $117.58 $584.00 $584.00 $584.00 $584.00 $121.71 $188.13 $187.46 $584.00 $117.58 $117.16 $117.58 $584.00 $438.00 $117.58 $117.58 $117.58 $584.00 $292.00 $462.53 $117.58 $467.20 $584.00 $584.00 $117.58 $338.72 $584.00 $119.67 $117.58 $584.00 $117.58 N/A N/A 36101153 EAP CPT® 68770 CLOSURE LACRIMAL FISTULA BOTH IP/OP "$5,253.00" "$3,887.50" $624.59 "$5,253.00" "$5,253.00" "$5,253.00" "$5,253.00" "$5,253.00" $624.65 $624.65 $628.47 "$5,253.00" $624.65 "$5,253.00" "$5,253.00" "$5,253.00" "$5,253.00" "$1,094.78" $999.44 $999.34 "$5,253.00" $624.65 $624.59 $624.65 "$5,253.00" "$3,939.75" $624.65 $624.65 $624.65 "$4,417.00" "$2,626.50" "$4,160.38" $624.65 "$4,202.40" "$2,150.00" "$5,253.00" $624.65 "$3,046.74" "$5,253.00" $640.22 $624.65 "$5,253.00" $624.65 N/A N/A 36101154 EAP CPT® 68801 DILATE LACRIMAL PUNCTUM BOTH IP/OP $523.00 $387.50 $78.29 $523.00 $523.00 $523.00 $523.00 $523.00 $78.29 $78.29 $78.59 $523.00 $78.29 $523.00 $523.00 $523.00 $523.00 $109.00 $125.26 $126.21 $523.00 $78.29 $78.88 $78.29 $523.00 $392.25 $78.29 $78.29 $78.29 $523.00 $261.50 $414.22 $78.29 $418.40 $523.00 $523.00 $78.29 $303.34 $523.00 $78.57 $78.29 $523.00 $78.29 N/A N/A 36101155 EAP CPT® 68810 PROBE NASOLACRIMAL DUCT BOTH IP/OP $670.00 $496.00 $126.84 $670.00 $670.00 $670.00 $670.00 $670.00 $126.84 $126.84 $128.18 $670.00 $126.84 $670.00 $670.00 $670.00 $670.00 $139.64 $202.94 $204.29 $670.00 $126.84 $127.68 $126.84 $670.00 $502.50 $126.84 $126.84 $126.84 $670.00 $335.00 $530.64 $126.84 $536.00 $670.00 $670.00 $126.84 $388.60 $670.00 $129.77 $126.84 $670.00 $126.84 N/A N/A 36101156 EAP CPT® 68815 PROBE NASOLACRIMAL DUCT W TUBE BOTH IP/OP "$5,253.00" "$3,887.50" $221.20 "$5,253.00" "$5,253.00" "$5,253.00" "$5,253.00" "$5,253.00" $221.20 $221.20 $222.37 "$5,253.00" $221.20 "$5,253.00" "$5,253.00" "$5,253.00" "$5,253.00" "$1,094.78" $353.92 $354.40 "$5,253.00" $221.20 $221.50 $221.20 "$5,253.00" "$3,939.75" $221.20 $221.20 $221.20 "$2,851.00" "$2,626.50" "$4,160.38" $221.20 "$4,202.40" "$3,250.00" "$5,253.00" $221.20 "$3,046.74" "$5,253.00" $226.01 $221.20 "$5,253.00" $221.20 N/A N/A 36101157 EAP CPT® 68840 PROBE LACRIMAL CANALICULI BOTH IP/OP $670.00 $496.00 $116.50 $670.00 $670.00 $670.00 $670.00 $670.00 $116.50 $116.50 $117.12 $670.00 $116.50 $670.00 $670.00 $670.00 $670.00 $139.64 $186.40 $187.46 $670.00 $116.50 $117.16 $116.50 $670.00 $502.50 $116.50 $116.50 $116.50 $670.00 $335.00 $530.64 $116.50 $536.00 $670.00 $670.00 $116.50 $388.60 $670.00 $117.86 $116.50 $670.00 $116.50 N/A N/A 36101158 EAP CPT® 69105 BIOPSY EXTERNAL EAR CANAL BOTH IP/OP "$3,660.00" "$2,708.50" $63.01 "$3,660.00" "$3,660.00" "$3,660.00" "$3,660.00" "$3,660.00" $63.25 $63.25 $63.01 "$3,660.00" $63.25 "$3,660.00" "$3,660.00" "$3,660.00" "$3,660.00" $762.78 $101.20 $103.02 "$3,660.00" $63.25 $64.39 $63.25 "$3,660.00" "$2,745.00" $63.25 $63.25 $63.25 "$2,762.00" "$1,830.00" "$2,898.72" $63.25 "$2,928.00" "$2,500.00" "$3,660.00" $63.25 "$2,122.80" "$3,660.00" $64.16 $63.25 "$3,660.00" $63.25 N/A N/A 36101160 EAP CPT® 69145 EXCISION AURAL MASS BOTH IP/OP "$14,091.00" "$10,427.50" $263.53 "$11,272.80" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,332.34" "$2,332.34" "$2,322.02" "$2,936.92" "$2,332.34" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$2,936.72" "$3,731.74" "$3,726.76" "$2,836.00" "$2,332.34" $263.53 "$2,332.34" "$2,448.96" "$10,568.25" "$2,332.34" "$2,332.34" "$2,332.34" "$2,851.00" "$2,423.00" "$11,160.07" "$2,332.34" "$11,272.80" "$2,500.00" "$2,796.71" "$2,332.34" "$8,172.78" "$2,448.96" "$3,374.31" "$2,332.34" "$2,936.56" "$2,332.34" N/A N/A 36101162 EAP CPT® 69200 REMOVE FB EAR W/O ANES BOTH IP/OP $408.00 $302.00 $47.40 $408.00 $408.00 $408.00 $408.00 $408.00 $47.70 $47.70 $47.40 $408.00 $47.70 $408.00 $408.00 $408.00 $408.00 $85.03 $76.32 $76.48 $408.00 $47.70 $47.80 $47.70 $408.00 $306.00 $47.70 $47.70 $47.70 $408.00 $204.00 $323.14 $47.70 $326.40 $408.00 $408.00 $47.70 $236.64 $408.00 $48.67 $47.70 $408.00 $47.70 N/A N/A 36101165 EAP CPT® 69220 "DEBRIDEMENT,EAR WASH PLACEMENT" BOTH IP/OP $326.00 $241.50 $51.16 $326.00 $326.00 $326.00 $326.00 $326.00 $51.16 $51.16 $51.52 $326.00 $51.16 $326.00 $326.00 $326.00 $326.00 $67.94 $81.86 $82.99 $326.00 $51.16 $51.87 $51.16 $326.00 $244.50 $51.16 $51.16 $51.16 $326.00 $163.00 $258.19 $51.16 $260.80 $326.00 $326.00 $51.16 $189.08 $326.00 $52.64 $51.16 $326.00 $51.16 N/A N/A 36101171 EAP CPT® 69420 "MYRINGOTOMY W ASPIR, E TUBE IN" BOTH IP/OP "$1,533.00" "$1,134.50" $122.64 "$1,533.00" "$1,533.00" "$1,533.00" "$1,533.00" "$1,533.00" $208.11 $208.11 $207.19 $319.52 $208.11 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $319.49 $332.98 $299.82 "$1,533.00" $208.11 $122.64 $208.11 $218.52 "$1,149.75" $208.11 $208.11 $208.11 "$1,533.00" $766.50 "$1,214.14" $208.11 "$1,226.40" "$1,533.00" $304.26 $208.11 $889.14 $218.52 $301.08 $208.11 $319.48 $208.11 N/A N/A 36101173 EAP CPT® 69424 REMOVE VENTILATING TUBE W ANES BOTH IP/OP "$10,633.00" "$7,868.50" $60.86 "$10,633.00" "$10,633.00" "$10,633.00" "$10,633.00" "$10,633.00" $60.86 $60.86 $60.99 "$10,633.00" $60.86 "$10,633.00" "$10,633.00" "$10,633.00" "$10,633.00" "$2,216.03" $97.38 $97.58 "$10,633.00" $60.86 $60.99 $60.86 "$10,633.00" "$7,974.75" $60.86 $60.86 $60.86 "$2,762.00" "$5,316.50" "$8,421.34" $60.86 "$8,506.40" "$2,500.00" "$10,633.00" $60.86 "$6,167.14" "$10,633.00" $62.36 $60.86 "$10,633.00" $60.86 N/A N/A 36101176 EAP CPT® 69433 TYMPANOSTOMY LOCAL ANES BOTH IP/OP "$1,455.00" "$1,077.00" $134.84 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" $444.88 $444.88 $442.92 $303.26 $444.88 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $303.24 $711.81 $659.03 "$1,455.00" $444.88 $134.84 $444.88 $467.13 "$1,091.25" $444.88 $444.88 $444.88 "$1,455.00" $727.50 "$1,152.36" $444.88 "$1,164.00" "$1,455.00" $288.78 $444.88 $843.90 $467.13 $643.63 $444.88 $303.22 $444.88 N/A N/A 36101177 EAP CPT® 69540 EXCISION OF AURAL POLYP BOTH IP/OP "$2,303.00" "$1,704.50" $129.02 "$2,303.00" "$2,303.00" "$2,303.00" "$2,303.00" "$2,303.00" $133.13 $133.13 $130.12 "$2,303.00" $133.13 "$2,303.00" "$2,303.00" "$2,303.00" "$2,303.00" $479.97 $213.01 $213.52 "$2,303.00" $133.13 $133.45 $133.13 "$2,303.00" "$1,727.25" $133.13 $133.13 $133.13 "$2,303.00" "$1,151.50" "$1,823.98" $133.13 "$1,842.40" "$2,303.00" "$2,303.00" $133.13 "$1,335.74" "$2,303.00" $129.02 $133.13 "$2,303.00" $133.13 N/A N/A 36101179 EAP CPT® 69610 TYMPANIC MEMBRANE REPAIR BOTH IP/OP "$3,245.00" "$2,401.50" $289.72 "$3,245.00" "$3,245.00" "$3,245.00" "$3,245.00" "$3,245.00" $291.45 $291.45 $289.72 "$3,245.00" $291.45 "$3,245.00" "$3,245.00" "$3,245.00" "$3,245.00" $676.29 $466.32 $468.10 "$3,245.00" $291.45 $292.56 $291.45 "$3,245.00" "$2,433.75" $291.45 $291.45 $291.45 "$2,762.00" "$1,622.50" "$2,570.04" $291.45 "$2,596.00" "$3,245.00" "$3,245.00" $291.45 "$1,882.10" "$3,245.00" $297.06 $291.45 "$3,245.00" $291.45 N/A N/A 36101181 EAP CPT® 92977 THROMBOLYTIC BY IV FOR AMI BOTH IP/OP "$3,599.00" "$2,663.50" $52.48 "$3,599.00" "$3,599.00" "$3,599.00" "$3,599.00" "$3,599.00" $52.48 $52.48 $54.59 "$3,599.00" $52.48 "$3,599.00" "$3,599.00" "$3,599.00" "$3,599.00" $750.07 $83.97 $85.62 "$3,599.00" $52.48 $53.51 $52.48 "$3,599.00" "$2,699.25" $52.48 $52.48 $52.48 "$1,799.50" "$1,799.50" "$2,850.41" $52.48 "$2,879.20" "$1,750.00" "$3,599.00" $52.48 "$2,087.42" "$3,599.00" $54.38 $52.48 "$3,599.00" $52.48 N/A N/A 36101183 EAP CPT® 92978 IVUS INITIAL VESSEL BOTH IP/OP "$8,205.00" "$6,072.00" "$1,628.49" "$8,205.00" "$4,455.32" "$4,455.32" "$4,455.32" "$4,455.32" "$8,205.00" "$8,205.00" "$8,205.00" "$1,710.13" "$8,205.00" "$8,205.00" "$8,205.00" "$8,205.00" "$8,205.00" "$1,710.01" "$8,205.00" "$8,205.00" "$3,094.73" "$8,205.00" "$8,205.00" "$8,205.00" "$8,205.00" "$6,153.75" "$8,205.00" "$8,205.00" "$8,205.00" "$4,102.50" "$4,102.50" "$6,498.36" "$8,205.00" "$6,564.00" "$1,750.00" "$1,628.49" "$8,205.00" "$4,758.90" "$8,205.00" "$8,205.00" "$8,205.00" "$1,709.92" "$8,205.00" N/A N/A 36101184 EAP CPT® 92979 IVUS - ADDIT VESSEL BOTH IP/OP "$8,818.00" "$6,525.50" "$1,750.00" "$8,818.00" "$4,788.17" "$4,788.17" "$4,788.17" "$4,788.17" "$8,818.00" "$8,818.00" "$8,818.00" "$1,837.89" "$8,818.00" "$4,181.12" "$4,181.12" "$6,796.91" "$2,060.15" "$1,837.77" "$8,818.00" "$8,818.00" "$5,215.85" "$8,818.00" "$8,818.00" "$8,818.00" "$8,818.00" "$6,613.50" "$8,818.00" "$8,818.00" "$8,818.00" "$4,409.00" "$4,409.00" "$6,983.86" "$8,818.00" "$7,054.40" "$1,750.00" "$1,750.15" "$8,818.00" "$5,114.44" "$8,818.00" "$8,818.00" "$8,818.00" "$1,837.67" "$8,818.00" N/A N/A 36101185 EAP CPT® 27096 INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMAGE BOTH IP/OP "$2,110.00" "$1,561.50" $82.95 "$2,110.00" "$2,110.00" "$2,110.00" "$2,110.00" "$2,110.00" $624.63 $624.63 $621.87 $439.78 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $439.75 $999.41 $929.56 $113.00 $624.63 "$2,110.00" $624.63 $655.86 "$1,582.50" $624.63 $624.63 $624.63 "$2,110.00" "$1,055.00" "$1,671.12" $624.63 "$1,688.00" "$2,110.00" $418.78 $624.63 "$1,223.80" $655.86 $86.18 $82.95 $439.72 $624.63 N/A N/A 36101186 EAP CPT® 27096 BIL INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMAGE BOTH IP/OP "$3,165.00" "$2,342.50" $82.95 "$3,165.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $624.63 $624.63 $621.87 $659.67 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $659.62 $999.41 $929.56 $113.00 $624.63 "$3,165.00" $624.63 $655.86 "$2,373.75" $624.63 $624.63 $624.63 "$2,762.00" "$1,582.50" "$2,506.68" $624.63 "$2,532.00" "$2,150.00" $628.17 $624.63 "$1,835.70" $655.86 $86.18 $82.95 $659.59 $624.63 N/A N/A 36101187 EAP HCPCS G0269 CLOSURE DEVICE PLACEMENT BOTH IP/OP "$2,840.00" "$2,102.00" $563.67 "$2,840.00" "$1,542.12" "$1,542.12" "$1,542.12" "$1,542.12" "$2,840.00" "$2,840.00" "$2,840.00" $591.93 "$2,840.00" "$2,840.00" "$2,840.00" "$2,840.00" "$2,840.00" $591.89 "$2,840.00" "$2,653.00" "$1,679.86" "$2,840.00" "$2,653.00" "$2,840.00" "$2,840.00" "$2,130.00" "$2,840.00" "$2,840.00" "$2,840.00" "$1,420.00" "$1,420.00" "$2,249.28" "$2,840.00" "$2,272.00" "$1,750.00" $563.67 "$2,840.00" "$1,647.20" "$2,840.00" "$2,840.00" "$2,840.00" $591.86 "$2,840.00" N/A N/A 36101192 EAP CPT® 41899 PARTIALLY BONY BOTH IP/OP "$1,862.00" "$1,378.00" $207.19 "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" $208.11 $208.11 $207.19 $388.09 $208.11 "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" $388.06 $332.98 $299.82 "$1,862.00" $208.11 "$1,862.00" $208.11 $218.52 "$1,396.50" $208.11 $208.11 $208.11 "$1,862.00" $931.00 "$1,474.70" $208.11 "$1,489.60" "$1,750.00" $369.56 $208.11 "$1,079.96" $218.52 $301.08 $208.11 $388.04 $208.11 N/A N/A 36101193 EAP CPT® 41899 SOFT TISSUE BOTH IP/OP "$1,862.00" "$1,378.00" $207.19 "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" $208.11 $208.11 $207.19 $388.09 $208.11 "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" $388.06 $332.98 $299.82 "$1,862.00" $208.11 "$1,862.00" $208.11 $218.52 "$1,396.50" $208.11 $208.11 $208.11 "$1,862.00" $931.00 "$1,474.70" $208.11 "$1,489.60" "$1,750.00" $369.56 $208.11 "$1,079.96" $218.52 $301.08 $208.11 $388.04 $208.11 N/A N/A 36101198 EAP CPT® 62320 NJX INTERLAMINAR CRV/THRC BOTH IP/OP "$1,385.00" "$1,025.00" $101.06 "$1,385.00" "$1,385.00" "$1,385.00" "$1,385.00" "$1,385.00" $624.63 $624.63 $621.87 $288.67 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $288.65 $999.41 $929.56 "$1,385.00" $624.63 $101.06 $624.63 $655.86 "$1,038.75" $624.63 $624.63 $624.63 "$1,385.00" $692.50 "$1,096.92" $624.63 "$1,108.00" "$1,385.00" $274.89 $624.63 $803.30 $655.86 $903.68 $624.63 $288.63 $624.63 N/A N/A 36101199 EAP CPT® 62322 NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN BOTH IP/OP "$1,385.00" "$1,025.00" $80.71 "$1,385.00" "$1,385.00" "$1,385.00" "$1,385.00" "$1,385.00" $81.69 $81.69 $82.08 "$1,385.00" $81.69 "$1,385.00" "$1,385.00" "$1,385.00" "$1,385.00" $288.65 $130.70 $129.14 "$1,385.00" $81.69 $80.71 $81.69 "$1,385.00" "$1,038.75" $81.69 $81.69 $81.69 "$1,385.00" $692.50 "$1,096.92" $81.69 "$1,108.00" "$1,385.00" "$1,385.00" $81.69 $803.30 "$1,385.00" $87.62 $81.69 "$1,385.00" $81.69 N/A N/A 36101202 EAP CPT® 15792 TCA PEEL BOTH IP/OP "$1,056.00" $781.50 $209.78 "$1,056.00" "$1,056.00" "$1,056.00" "$1,056.00" "$1,056.00" $209.78 $209.78 $221.96 "$1,056.00" $209.78 "$1,056.00" "$1,056.00" "$1,056.00" "$1,056.00" $220.08 $335.65 $338.06 "$1,056.00" $209.78 $211.29 $209.78 "$1,056.00" $792.00 $209.78 $209.78 $209.78 "$1,056.00" $528.00 $836.35 $209.78 $844.80 "$1,056.00" "$1,056.00" $209.78 $612.48 "$1,056.00" $238.19 $209.78 "$1,056.00" $209.78 N/A N/A 36101208 EAP CPT® 36600 ARTERIAL PUNCTURE BOTH IP/OP $227.00 $168.00 $14.91 $227.00 $123.26 $123.26 $123.26 $123.26 $110.92 $110.92 $110.43 $47.31 $110.92 $227.00 $227.00 $227.00 $227.00 $47.31 $177.47 $167.51 $113.00 $110.92 $14.91 $110.92 $116.46 $170.25 $110.92 $110.92 $110.92 $227.00 $113.50 $179.78 $110.92 $181.60 $227.00 $45.05 $110.92 $131.66 $116.46 $160.47 $110.92 $47.31 $110.92 N/A N/A 36101209 EAP CPT® 46611 HR ANOSCOPY W/ BX BOTH IP/OP "$2,999.00" "$2,219.50" $80.69 "$2,999.00" "$2,999.00" "$2,999.00" "$2,999.00" "$2,999.00" $81.29 $81.29 $80.95 "$2,999.00" $81.29 "$2,999.00" "$2,999.00" "$2,999.00" "$2,999.00" $625.02 $130.06 $129.10 "$2,999.00" $81.29 $80.69 $81.29 "$2,999.00" "$2,249.25" $81.29 $81.29 $81.29 "$2,762.00" "$1,499.50" "$2,375.21" $81.29 "$2,399.20" "$2,500.00" "$2,999.00" $81.29 "$1,739.42" "$2,999.00" $83.28 $81.29 "$2,999.00" $81.29 N/A N/A 36101210 EAP CPT® 46614 HR ANO/W CONTROL OF BLEEDING BOTH IP/OP "$1,516.00" "$1,122.00" $63.85 "$1,516.00" "$1,516.00" "$1,516.00" "$1,516.00" "$1,516.00" $63.85 $63.85 $64.35 "$1,516.00" $63.85 "$1,516.00" "$1,516.00" "$1,516.00" "$1,516.00" $315.95 $102.16 $104.16 "$1,516.00" $63.85 $65.10 $63.85 "$1,516.00" "$1,137.00" $63.85 $63.85 $63.85 "$1,516.00" $758.00 "$1,200.67" $63.85 "$1,212.80" "$1,516.00" "$1,516.00" $63.85 $879.28 "$1,516.00" $66.69 $63.85 "$1,516.00" $63.85 N/A N/A 36101211 EAP CPT® 46615 HR ANO W/ABLATION OF TUMOR BOTH IP/OP "$6,197.00" "$4,586.00" $90.52 "$6,197.00" "$6,197.00" "$6,197.00" "$6,197.00" "$6,197.00" $92.36 $92.36 $92.11 "$6,197.00" $92.36 "$6,197.00" "$6,197.00" "$6,197.00" "$6,197.00" "$1,291.52" $147.78 $144.83 "$6,197.00" $92.36 $90.52 $92.36 "$6,197.00" "$4,647.75" $92.36 $92.36 $92.36 "$2,851.00" "$3,098.50" "$4,908.02" $92.36 "$4,957.60" "$3,250.00" "$6,197.00" $92.36 "$3,594.26" "$6,197.00" $95.18 $92.36 "$6,197.00" $92.36 N/A N/A 36101212 EAP CPT® 51727 CYSTOMETROGRAM W/URETHRAL PRES BOTH IP/OP $790.00 $585.00 $113.00 $905.46 $790.00 $790.00 $790.00 $790.00 $565.91 $565.91 $563.41 $164.66 $565.91 $790.00 $790.00 $790.00 $790.00 $164.64 $905.46 $902.15 $113.00 $565.91 $265.83 $565.91 $594.21 $592.50 $565.91 $565.91 $565.91 $790.00 $395.00 $625.68 $565.91 $632.00 $790.00 $156.80 $565.91 $458.20 $594.21 $790.00 $565.91 $164.64 $565.91 N/A N/A 36101213 EAP CPT® 51728 CYSTOMETROGRAM W/VOIDING PRESS BOTH IP/OP $791.00 $585.50 $164.85 $791.00 $791.00 $791.00 $791.00 $791.00 $278.30 $278.30 $380.84 $791.00 $278.30 $791.00 $791.00 $791.00 $791.00 $164.85 $445.28 $427.50 $791.00 $278.30 $267.19 $278.30 $791.00 $593.25 $278.30 $278.30 $278.30 $791.00 $395.50 $626.47 $278.30 $632.80 $791.00 $791.00 $278.30 $458.78 $791.00 $251.40 $278.30 $791.00 $278.30 N/A N/A 36101214 EAP CPT® 51729 CYSTOMETROGRAM W/VP&UP BOTH IP/OP $791.00 $585.50 $113.00 $905.46 $791.00 $791.00 $791.00 $791.00 $565.91 $565.91 $563.41 $164.86 $565.91 $791.00 $791.00 $791.00 $791.00 $164.85 $905.46 $902.15 $113.00 $565.91 $266.85 $565.91 $594.21 $593.25 $565.91 $565.91 $565.91 $791.00 $395.50 $626.47 $565.91 $632.80 $791.00 $156.99 $565.91 $458.78 $594.21 $791.00 $565.91 $164.84 $565.91 N/A N/A 36101216 EAP CPT® 49429 REMOVAL OF PERITONEAL-VENOUS SHUNT BOTH IP/OP "$9,158.00" "$6,777.00" $465.65 "$9,158.00" "$9,158.00" "$9,158.00" "$9,158.00" "$9,158.00" $466.59 $466.59 $467.45 "$9,158.00" $466.59 "$9,158.00" "$9,158.00" "$9,158.00" "$9,158.00" "$1,908.63" $746.54 $745.04 "$9,158.00" $466.59 $465.65 $466.59 "$9,158.00" "$6,868.50" $466.59 $466.59 $466.59 "$2,762.00" "$4,579.00" "$7,253.14" $466.59 "$7,326.40" "$3,250.00" "$9,158.00" $466.59 "$5,311.64" "$9,158.00" $481.60 $466.59 "$9,158.00" $466.59 N/A N/A 36101217 EAP CPT® 21040 EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT BOTH IP/OP "$4,993.00" "$3,695.00" $367.91 "$4,305.68" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,691.05" "$2,691.05" "$2,679.15" "$1,040.67" "$2,691.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,040.60" "$4,305.68" "$4,104.40" "$2,836.00" "$2,691.05" $367.91 "$2,691.05" "$2,825.60" "$3,744.75" "$2,691.05" "$2,691.05" "$2,691.05" "$2,851.00" "$2,423.00" "$3,954.46" "$2,691.05" "$3,994.40" "$3,250.00" $990.99 "$2,691.05" "$2,895.94" "$2,825.60" "$3,893.27" "$2,691.05" "$1,040.54" "$2,691.05" N/A N/A 36101219 EAP CPT® 57800 INSERT SMIT SLEEVE BOTH IP/OP "$5,262.00" "$3,894.00" $48.01 "$5,262.00" "$5,262.00" "$5,262.00" "$5,262.00" "$5,262.00" $48.01 $48.01 $48.73 "$5,262.00" $48.01 "$5,262.00" "$5,262.00" "$5,262.00" "$5,262.00" "$1,096.66" $76.82 $77.04 "$5,262.00" $48.01 $48.15 $48.01 "$5,262.00" "$3,946.50" $48.01 $48.01 $48.01 "$2,762.00" "$2,631.00" "$4,167.50" $48.01 "$4,209.60" "$3,725.00" "$5,262.00" $48.01 "$3,051.96" "$5,262.00" $50.11 $48.01 "$5,262.00" $48.01 N/A N/A 36101225 EAP CPT® 64415 INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN BOTH IP/OP "$2,280.00" "$1,687.50" #N/A #N/A "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $809.76 $809.76 $806.18 $475.21 $809.76 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $475.18 "$1,295.61" #N/A "$1,871.00" $809.76 #N/A $809.76 $850.25 "$1,710.00" $809.76 $809.76 $809.76 "$2,280.00" "$1,140.00" "$1,805.76" $809.76 "$1,824.00" "$2,150.00" $452.52 $809.76 "$1,322.40" $850.25 "$1,171.52" $809.76 $475.15 $809.76 N/A N/A 36101226 EAP CPT® 64417 INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN BOTH IP/OP "$1,969.00" "$1,457.50" #N/A #N/A "$1,969.00" "$1,969.00" "$1,969.00" "$1,969.00" $809.76 $809.76 $806.18 $410.39 $809.76 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $410.36 "$1,295.61" #N/A "$1,871.00" $809.76 #N/A $809.76 $850.25 "$1,476.75" $809.76 $809.76 $809.76 "$1,969.00" $984.50 "$1,559.45" $809.76 "$1,575.20" "$1,969.00" $390.80 $809.76 "$1,142.02" $850.25 "$1,171.52" $809.76 $410.34 $809.76 N/A N/A 36101227 EAP CPT® 64420 INJ ANES/STRD INTERCOSTAL NERVE 1ST LEVEL BOTH IP/OP "$1,959.00" "$1,450.00" $58.64 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $59.47 $59.47 $59.96 "$1,959.00" $59.47 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 $95.15 $93.82 "$1,959.00" $59.47 $58.64 $59.47 "$1,959.00" "$1,469.25" $59.47 $59.47 $59.47 "$1,959.00" $979.50 "$1,551.53" $59.47 "$1,567.20" "$1,959.00" "$1,959.00" $59.47 "$1,136.22" "$1,959.00" $62.02 $59.47 "$1,959.00" $59.47 N/A N/A 36101228 EAP CPT® 64421 INJ ANES/STRD INTERCOSTAL NERVE ADDL LEVEL BOTH IP/OP "$3,789.00" "$2,804.00" $24.41 "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" $25.08 $25.08 $25.29 "$3,789.00" $25.08 "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" $789.67 $40.13 $39.06 "$3,789.00" $25.08 $24.41 $25.08 "$3,789.00" "$2,841.75" $25.08 $25.08 $25.08 "$2,762.00" "$1,894.50" "$3,000.89" $25.08 "$3,031.20" "$2,150.00" "$3,789.00" $25.08 "$2,197.62" "$3,789.00" $26.33 $25.08 "$3,789.00" $25.08 N/A N/A 36101229 EAP CPT® 64445 INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN BOTH IP/OP "$3,789.00" "$2,804.00" $73.59 "$3,031.20" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $624.63 $624.63 $621.87 $789.72 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $789.67 $999.41 $929.56 "$1,871.00" $624.63 $73.59 $624.63 $655.86 "$2,841.75" $624.63 $624.63 $624.63 "$2,762.00" "$1,894.50" "$3,000.89" $624.63 "$3,031.20" "$2,150.00" $752.02 $624.63 "$2,197.62" $655.86 $903.68 $624.63 $789.63 $624.63 N/A N/A 36101230 EAP CPT® 64447 INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN BOTH IP/OP "$2,384.00" "$1,764.50" #N/A #N/A "$1,294.51" "$1,294.51" "$1,294.51" "$1,294.51" $624.63 $624.63 $621.87 $496.89 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $496.85 $999.41 #N/A "$1,871.00" $624.63 #N/A $624.63 $655.86 "$1,788.00" $624.63 $624.63 $624.63 "$2,384.00" "$1,192.00" "$1,888.13" $624.63 "$1,907.20" "$2,150.00" $473.16 $624.63 "$1,382.72" $655.86 $903.68 $624.63 $496.83 $624.63 N/A N/A 36101231 EAP CPT® 64490 BILAT_INJ PARAVERT F JNT C/T 1 LEV BOTH IP/OP "$5,684.00" "$4,206.50" $105.07 "$4,547.20" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $809.76 $809.76 $806.18 "$1,184.69" $809.76 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 "$1,184.61" "$1,295.61" "$1,229.40" "$1,871.00" $809.76 $105.07 $809.76 $850.25 "$4,263.00" $809.76 $809.76 $809.76 "$2,762.00" "$2,348.00" "$4,501.73" $809.76 "$4,547.20" "$2,150.00" "$1,128.13" $809.76 "$3,296.72" $850.25 "$1,171.52" $809.76 "$1,184.55" $809.76 N/A N/A 36101232 EAP CPT® 64491 BILAT_INJ PARAVERT F JNT C/T 2 LEV BOTH IP/OP "$2,740.00" "$2,028.00" $59.34 "$2,740.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,740.00" "$2,740.00" "$2,740.00" $571.08 "$2,740.00" "$2,740.00" "$2,740.00" "$2,740.00" "$2,740.00" $571.05 "$2,740.00" "$2,060.00" "$1,620.71" "$2,740.00" $59.34 "$2,740.00" "$2,740.00" "$2,055.00" "$2,740.00" "$2,740.00" "$2,740.00" "$1,370.00" "$1,370.00" "$2,170.08" "$2,740.00" "$2,192.00" "$1,750.00" $543.82 "$2,740.00" "$1,589.20" "$2,740.00" "$2,740.00" "$2,740.00" $571.02 "$2,740.00" N/A N/A 36101233 EAP CPT® 64492 BILAT_INJ PARAVERT F JNT C/T 3 LEV BOTH IP/OP "$2,441.00" "$1,806.50" $60.35 "$2,441.00" "$2,441.00" "$2,441.00" "$2,441.00" "$2,441.00" $60.51 $60.51 $61.99 "$2,441.00" $60.51 "$2,441.00" "$2,441.00" "$2,441.00" "$2,441.00" $508.73 $96.82 $96.56 "$2,441.00" $60.51 $60.35 $60.51 "$2,441.00" "$1,830.75" $60.51 $60.51 $60.51 "$1,220.50" "$1,220.50" "$1,933.27" $60.51 "$1,952.80" "$1,750.00" "$2,441.00" $60.51 "$1,415.78" "$2,441.00" $63.11 $60.51 "$2,441.00" $60.51 N/A N/A 36101234 EAP CPT® 64493 BILAT_INJ PARAVERT F JNT L/S 1 LEV BOTH IP/OP "$5,684.00" "$4,206.50" $90.50 "$4,547.20" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $809.76 $809.76 $806.18 "$1,184.69" $809.76 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 "$1,184.61" "$1,295.61" "$1,229.40" "$1,871.00" $809.76 $90.50 $809.76 $850.25 "$4,263.00" $809.76 $809.76 $809.76 "$2,762.00" "$2,348.00" "$4,501.73" $809.76 "$4,547.20" "$2,150.00" "$1,128.13" $809.76 "$3,296.72" $850.25 "$1,171.52" $809.76 "$1,184.55" $809.76 N/A N/A 36101235 EAP CPT® 64494 BILAT_INJ PARAVERT F JNT L/S 2 LEV BOTH IP/OP "$2,583.00" "$1,911.50" $51.20 "$2,583.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,583.00" "$2,583.00" "$2,583.00" $538.36 "$2,583.00" "$2,583.00" "$2,583.00" "$2,583.00" "$2,583.00" $538.33 "$2,583.00" "$2,060.00" "$1,527.84" "$2,583.00" $51.20 "$2,583.00" "$2,583.00" "$1,937.25" "$2,583.00" "$2,583.00" "$2,583.00" "$1,291.50" "$1,291.50" "$2,045.74" "$2,583.00" "$2,066.40" "$1,750.00" $512.66 "$2,583.00" "$1,498.14" "$2,583.00" "$2,583.00" "$2,583.00" $538.30 "$2,583.00" N/A N/A 36101236 EAP CPT® 64495 BILAT_INJ PARAVERT F JNT L/S 3 LEV BOTH IP/OP "$2,478.00" "$1,834.00" $51.87 "$2,478.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,478.00" "$2,478.00" "$2,478.00" $516.48 "$2,478.00" "$2,478.00" "$2,478.00" "$2,478.00" "$2,478.00" $516.44 "$2,478.00" "$2,060.00" "$1,465.74" "$2,478.00" $51.87 "$2,478.00" "$2,478.00" "$1,858.50" "$2,478.00" "$2,478.00" "$2,478.00" "$1,239.00" "$1,239.00" "$1,962.58" "$2,478.00" "$1,982.40" "$1,750.00" $491.82 "$2,478.00" "$1,437.24" "$2,478.00" "$2,478.00" "$2,478.00" $516.42 "$2,478.00" N/A N/A 36101252 EAP CPT® 19126 EXCISION ADDL BREAST LESION BOTH IP/OP $508.00 $376.00 $105.87 $508.00 $508.00 $508.00 $508.00 $508.00 $162.57 $162.57 $162.94 $508.00 $162.57 $508.00 $508.00 $508.00 $508.00 $105.87 $260.11 $258.05 $508.00 $162.57 $161.28 $162.57 $508.00 $381.00 $162.57 $162.57 $162.57 $508.00 $254.00 $402.34 $162.57 $406.40 $508.00 $508.00 $162.57 $294.64 $508.00 $168.72 $162.57 $508.00 $162.57 N/A N/A 36101253 EAP CPT® 57520 CONIZATION OF CERVIX BOTH IP/OP "$2,862.00" "$2,118.00" $296.67 "$2,862.00" "$2,862.00" "$2,862.00" "$2,862.00" "$2,862.00" $302.75 $302.75 $298.71 "$2,862.00" $302.75 "$2,862.00" "$2,862.00" "$2,862.00" "$2,862.00" $596.47 $484.40 $483.78 "$2,862.00" $302.75 $302.36 $302.75 "$2,862.00" "$2,146.50" $302.75 $302.75 $302.75 "$2,851.00" "$1,431.00" "$2,266.70" $302.75 "$2,289.60" "$2,862.00" "$2,862.00" $302.75 "$1,659.96" "$2,862.00" $296.67 $302.75 "$2,862.00" $302.75 N/A N/A 36101264 EAP CPT® 69210 REMOVAL IMPACTED CERUMEN INSTRUMENT UNILAT BOTH IP/OP $408.00 $302.00 $32.89 $408.00 $408.00 $408.00 $408.00 $408.00 $54.76 $54.76 $54.51 $85.04 $54.76 $408.00 $408.00 $408.00 $408.00 $85.03 $87.61 $82.92 $113.00 $54.76 $32.89 $54.76 $57.49 $306.00 $54.76 $54.76 $54.76 $408.00 $204.00 $323.14 $54.76 $326.40 $408.00 $80.98 $54.76 $236.64 $57.49 $79.22 $54.76 $85.03 $54.76 N/A N/A 36101266 EAP CPT® 36569 PICC W/O PORT BOTH IP/OP "$4,743.00" "$3,510.00" $93.29 "$4,743.00" "$4,743.00" "$4,743.00" "$4,743.00" "$4,743.00" $93.98 $93.98 $94.16 "$4,743.00" $93.98 "$4,743.00" "$4,743.00" "$4,743.00" "$4,743.00" $988.49 $150.37 $149.26 "$4,743.00" $93.98 $93.29 $93.98 "$4,743.00" "$3,557.25" $93.98 $93.98 $93.98 "$2,762.00" "$2,371.50" "$3,756.46" $93.98 "$3,794.40" "$2,500.00" "$4,743.00" "$1,383.25" "$2,750.94" "$4,743.00" $98.45 $93.98 "$4,743.00" $93.98 N/A N/A 36101267 EAP CPT® 67820 REVISED EYE LASHES BOTH IP/OP $316.00 $234.00 $22.02 $316.00 $171.59 $171.59 $171.59 $171.59 $110.92 $110.92 $110.43 $65.86 $110.92 $316.00 $316.00 $316.00 $316.00 $65.86 $177.47 $167.51 $113.00 $110.92 $22.02 $110.92 $116.46 $237.00 $110.92 $110.92 $110.92 $316.00 $158.00 $250.27 $110.92 $252.80 $316.00 $62.72 $110.92 $183.28 $116.46 $160.47 $110.92 $65.85 $110.92 N/A N/A 36101270 EAP CPT® 19000 DRAIN BREAST CYST BOTH IP/OP $921.00 $682.00 $42.74 $979.40 $921.00 $921.00 $921.00 $921.00 $612.13 $612.13 $609.42 $191.96 $612.13 $921.00 $921.00 $921.00 $882.37 $191.95 $979.40 $936.25 $921.00 $612.13 $42.74 $612.13 $642.73 $690.75 $612.13 $612.13 $612.13 $921.00 $460.50 $729.43 $612.13 $736.80 $921.00 $182.80 $612.13 $534.18 $642.73 $885.59 $612.13 $191.94 $612.13 N/A N/A 36101274 EAP CPT® 31535 LARYNGOSCOPY W/BIOPSY BOTH IP/OP "$9,759.00" "$7,222.00" $188.88 "$9,759.00" "$9,759.00" "$9,759.00" "$9,759.00" "$9,759.00" $189.43 $189.43 $188.88 "$9,759.00" $189.43 "$9,759.00" "$9,759.00" "$9,759.00" "$9,759.00" "$2,033.88" $303.09 $303.79 "$9,759.00" $189.43 $189.87 $189.43 "$9,759.00" "$7,319.25" $189.43 $189.43 $189.43 "$2,851.00" "$4,879.50" "$7,729.13" $189.43 "$7,807.20" "$3,250.00" "$9,759.00" $189.43 "$5,660.22" "$9,759.00" $194.33 $189.43 "$9,759.00" $189.43 N/A N/A 36101275 EAP CPT® 31577 "REMOVAL FOREIGN BODY, LARYNX" BOTH IP/OP "$1,746.00" "$1,292.50" $133.52 "$1,746.00" "$1,746.00" "$1,746.00" "$1,746.00" "$1,746.00" $136.25 $136.25 $133.52 "$1,746.00" $136.25 "$1,746.00" "$1,746.00" "$1,746.00" "$1,746.00" $363.89 $218.00 $216.48 "$1,746.00" $136.25 $135.30 $136.25 "$1,746.00" "$1,309.50" $136.25 $136.25 $136.25 "$1,746.00" $873.00 "$1,382.83" $136.25 "$1,396.80" "$1,746.00" "$1,746.00" $136.25 "$1,012.68" "$1,746.00" $137.72 $136.25 "$1,746.00" $136.25 N/A N/A 36101281 EAP CPT® 49411 INS MARK ABD/PEL FOR RT PERQ BOTH IP/OP "$2,721.00" "$2,014.00" $183.32 "$2,721.00" "$2,721.00" "$2,721.00" "$2,721.00" "$2,721.00" $183.32 $183.32 $184.53 "$2,721.00" $183.32 "$2,721.00" "$2,721.00" "$2,721.00" "$2,721.00" $567.09 $293.31 $294.54 "$2,721.00" $183.32 $184.09 $183.32 "$2,721.00" "$2,040.75" $183.32 $183.32 $183.32 "$2,721.00" "$1,360.50" "$2,155.03" $183.32 "$2,176.80" "$2,500.00" "$2,721.00" $183.32 "$1,578.18" "$2,721.00" $192.21 $183.32 "$2,721.00" $183.32 N/A N/A 36101284 EAP CPT® 54161 CIRCUM 28 DAYS OR OLDER BOTH IP/OP "$4,264.00" "$3,155.50" $197.97 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $198.55 $198.55 $199.19 "$4,264.00" $198.55 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 $317.68 $316.75 "$4,264.00" $198.55 $197.97 $198.55 "$4,264.00" "$3,198.00" $198.55 $198.55 $198.55 "$2,851.00" "$2,132.00" "$3,377.09" $198.55 "$3,411.20" "$3,250.00" "$4,264.00" $198.55 "$2,473.12" "$4,264.00" $204.79 $198.55 "$4,264.00" $198.55 N/A N/A 36101285 EAP CPT® 58999 FEMALE GENITAL SYSTEM PROCEDUR BOTH IP/OP $263.00 $195.00 $54.81 $263.00 $263.00 $263.00 $263.00 $263.00 $263.00 $263.00 $263.00 $263.00 $263.00 $263.00 $263.00 $263.00 $263.00 $54.81 $263.00 $105.20 $263.00 $263.00 $263.00 $263.00 $263.00 $197.25 $263.00 $263.00 $263.00 $263.00 $131.50 $208.30 $263.00 $210.40 $263.00 $263.00 $263.00 $152.54 $263.00 $157.80 $263.00 $263.00 $263.00 N/A N/A 36101286 EAP CPT® 59412 ANTEPARTUM MANIPULATION BOTH IP/OP "$4,901.00" "$3,627.00" $104.25 "$4,129.35" "$2,661.24" "$2,661.24" "$2,661.24" "$2,661.24" "$2,580.85" "$2,580.85" "$2,569.43" "$1,021.49" "$2,580.85" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,021.42" "$4,129.35" "$4,079.03" "$1,871.00" "$2,580.85" $104.25 "$2,580.85" "$2,709.89" "$3,675.75" "$2,580.85" "$2,580.85" "$2,580.85" "$2,762.00" "$2,348.00" "$3,881.59" "$2,580.85" "$3,920.80" "$3,250.00" $972.73 "$2,580.85" "$2,842.58" "$2,709.89" "$3,733.83" "$2,580.85" "$1,021.37" "$2,580.85" N/A N/A 36101287 EAP CPT® 59870 EVACUATE MOLE OF UTERUS BOTH IP/OP "$4,868.00" "$3,602.50" $530.16 "$4,868.00" "$4,868.00" "$4,868.00" "$4,868.00" "$4,868.00" $548.69 $548.69 $537.00 "$4,868.00" $548.69 "$4,868.00" "$4,868.00" "$4,868.00" "$4,868.00" "$1,014.54" $877.90 $881.94 "$4,868.00" $548.69 $551.21 $548.69 "$4,868.00" "$3,651.00" $548.69 $548.69 $548.69 "$4,780.00" "$2,434.00" "$3,855.46" $548.69 "$3,894.40" "$3,250.00" "$4,868.00" $548.69 "$2,823.44" "$4,868.00" $530.16 $548.69 "$4,868.00" $548.69 N/A N/A 36101288 EAP CPT® 60300 ASPIR/INJ THYROID CYST BOTH IP/OP "$1,745.00" "$1,291.50" $48.49 "$1,745.00" "$1,745.00" "$1,745.00" "$1,745.00" "$1,745.00" $49.13 $49.13 $49.54 "$1,745.00" $49.13 "$1,745.00" "$1,745.00" "$1,745.00" "$1,745.00" $363.68 $78.61 $77.58 "$1,745.00" $49.13 $48.49 $49.13 "$1,745.00" "$1,308.75" $49.13 $49.13 $49.13 "$1,745.00" $872.50 "$1,382.04" $49.13 "$1,396.00" "$1,745.00" "$1,745.00" $49.13 "$1,012.10" "$1,745.00" $51.21 $49.13 "$1,745.00" $49.13 N/A N/A 36101290 EAP CPT® 61623 ENDOVASC TEMPRY VESEL OCL NIR BOTH IP/OP "$17,372.00" "$12,855.50" $582.80 "$15,808.91" "$4,551.00" "$4,551.00" "$4,551.00" "$4,551.00" "$9,880.57" "$9,880.57" "$9,836.87" "$3,620.76" "$9,880.57" "$3,769.39" "$3,769.39" "$3,914.36" "$2,645.82" "$3,620.52" "$15,808.91" "$15,314.28" "$4,877.00" "$9,880.57" $582.80 "$9,880.57" "$10,374.60" "$13,029.00" "$9,880.57" "$9,880.57" "$9,880.57" "$7,479.00" "$6,357.00" "$13,758.62" "$9,880.57" "$13,897.60" "$5,164.00" "$3,447.91" "$9,880.57" "$10,075.76" "$10,374.60" "$14,294.69" "$9,880.57" "$3,620.32" "$9,880.57" N/A N/A 36101292 EAP CPT® 61641 DILATE IC VASOSPASM ADD-ON BOTH IP/OP "$13,302.00" "$9,843.50" $169.70 "$13,302.00" "$13,302.00" "$13,302.00" "$13,302.00" "$13,302.00" "$13,302.00" "$13,302.00" $169.70 "$13,302.00" "$13,302.00" "$13,302.00" "$13,302.00" "$13,302.00" "$13,302.00" "$2,772.28" "$13,302.00" "$2,457.20" "$13,302.00" "$13,302.00" "$6,143.00" "$13,302.00" "$13,302.00" "$9,976.50" "$13,302.00" "$13,302.00" "$13,302.00" "$6,651.00" "$6,651.00" "$10,535.18" "$13,302.00" "$10,641.60" "$8,646.30" "$13,302.00" "$13,302.00" "$7,715.16" "$13,302.00" "$7,981.20" "$13,302.00" "$13,302.00" "$13,302.00" N/A N/A 36101295 EAP CPT® 65210 REMOVE FOREIGN BODY FROM EYE BOTH IP/OP $605.00 $448.00 $35.91 $605.00 $605.00 $605.00 $605.00 $605.00 $36.18 $36.18 $36.82 $605.00 $36.18 $605.00 $605.00 $605.00 $605.00 $126.09 $57.89 $57.46 $605.00 $36.18 $35.91 $36.18 $605.00 $453.75 $36.18 $36.18 $36.18 $605.00 $302.50 $479.16 $36.18 $484.00 $605.00 $605.00 $36.18 $350.90 $605.00 $37.50 $36.18 $605.00 $36.18 N/A N/A 36101298 EAP CPT® 74220 "CONTRAST X-RAY, ESOPHAGUS,SPV" BOTH IP/OP "$1,126.00" $833.50 $72.04 "$1,126.00" $190.86 $190.86 $190.86 $190.86 $175.71 $175.71 $174.93 $234.69 $175.71 "$1,126.00" "$1,126.00" "$1,126.00" "$1,126.00" $234.67 $281.13 $260.16 $666.03 $175.71 $72.04 $175.71 $184.49 $844.50 $175.71 $175.71 $175.71 $540.48 $540.48 $891.79 $175.71 $900.80 $731.90 $223.48 $175.71 $653.08 $184.49 $254.21 $175.71 $234.66 $175.71 N/A N/A 36101302 EAP CPT® 92953 TEMP TRANSCUT PACING BOTH IP/OP "$2,499.00" "$1,849.50" $1.00 "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" $1.00 $1.00 $1.01 "$2,499.00" $1.00 "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" $520.82 $1.60 $1.63 "$2,499.00" $1.00 $1.02 $1.00 "$2,499.00" "$1,874.25" $1.00 $1.00 $1.00 "$1,249.50" "$1,249.50" "$1,979.21" $1.00 "$1,999.20" "$2,150.00" "$2,499.00" $1.00 "$1,449.42" "$2,499.00" $1.08 $1.00 "$2,499.00" $1.00 N/A N/A 36101310 EAP CPT® 31641 BRONCHOSCOPY TREAT BLOCKAGE BOTH IP/OP "$9,910.00" "$7,333.50" $251.94 "$7,928.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$3,047.03" "$3,047.03" "$3,033.56" "$2,065.49" "$3,047.03" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$2,065.35" "$4,875.25" "$4,809.32" "$2,836.00" "$3,047.03" $251.94 "$3,047.03" "$3,199.39" "$7,432.50" "$3,047.03" "$3,047.03" "$3,047.03" "$2,851.00" "$2,423.00" "$7,848.72" "$3,047.03" "$7,928.00" "$3,725.00" "$1,966.89" "$3,047.03" "$5,747.80" "$3,199.39" "$4,408.29" "$3,047.03" "$2,065.24" "$3,047.03" N/A N/A 36101314 EAP CPT® 64449 INJ ANES/STRD LUMBAR PLEXUS BY CONT INFUSION BOTH IP/OP "$3,355.00" "$2,483.00" $61.90 "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" $61.90 $61.90 $63.04 "$3,355.00" $61.90 "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" $699.22 $99.04 $99.28 "$3,355.00" $61.90 $62.05 $61.90 "$3,355.00" "$2,516.25" $61.90 $61.90 $61.90 "$2,762.00" "$1,677.50" "$2,657.16" $61.90 "$2,684.00" "$2,150.00" "$3,355.00" $61.90 "$1,945.90" "$3,355.00" $64.55 $61.90 "$3,355.00" $61.90 N/A N/A 36101315 EAP CPT® 64486 TAP BLOCK UNIL BY INJECTION BOTH IP/OP "$1,767.00" "$1,308.00" $55.28 "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" $368.29 "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" $368.26 "$1,767.00" "$1,767.00" "$1,045.18" "$1,767.00" $55.28 "$1,767.00" "$1,767.00" "$1,325.25" "$1,767.00" "$1,767.00" "$1,767.00" $883.50 $883.50 "$1,399.46" "$1,767.00" "$1,413.60" "$1,750.00" $350.71 "$1,767.00" "$1,024.86" "$1,767.00" "$1,767.00" "$1,767.00" $368.24 "$1,767.00" N/A N/A 36101316 EAP CPT® 64487 TAP BLOCK UNI BY INFUSION BOTH IP/OP "$1,557.00" "$1,152.50" $63.42 "$1,557.00" "$1,557.00" "$1,557.00" "$1,557.00" "$1,557.00" $63.98 $63.98 $65.14 "$1,557.00" $63.98 "$1,557.00" "$1,557.00" "$1,557.00" "$1,557.00" $324.50 $102.37 $101.47 "$1,557.00" $63.98 $63.42 $63.98 "$1,557.00" "$1,167.75" $63.98 $63.98 $63.98 $778.50 $778.50 "$1,233.14" $63.98 "$1,245.60" "$1,557.00" "$1,557.00" $63.98 $903.06 "$1,557.00" $66.73 $63.98 "$1,557.00" $63.98 N/A N/A 36101317 EAP CPT® 64488 TAP BLOCK BI INJECTION BOTH IP/OP "$1,767.00" "$1,308.00" $68.50 "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" $69.14 $69.14 $70.03 "$1,767.00" $69.14 "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" $368.26 $110.62 $109.60 "$1,767.00" $69.14 $68.50 $69.14 "$1,767.00" "$1,325.25" $69.14 $69.14 $69.14 $883.50 $883.50 "$1,399.46" $69.14 "$1,413.60" "$1,750.00" "$1,767.00" $69.14 "$1,024.86" "$1,767.00" $72.14 $69.14 "$1,767.00" $69.14 N/A N/A 36101318 EAP CPT® 64489 TAP BLOCK BI BY INFUSION BOTH IP/OP "$1,557.00" "$1,152.50" $77.72 "$1,557.00" "$1,557.00" "$1,557.00" "$1,557.00" "$1,557.00" $77.72 $77.72 $78.68 "$1,557.00" $77.72 "$1,557.00" "$1,557.00" "$1,557.00" "$1,557.00" $324.50 $124.35 $125.36 "$1,557.00" $77.72 $78.35 $77.72 "$1,557.00" "$1,167.75" $77.72 $77.72 $77.72 $778.50 $778.50 "$1,233.14" $77.72 "$1,245.60" "$1,557.00" "$1,557.00" $77.72 $903.06 "$1,557.00" $81.16 $77.72 "$1,557.00" $77.72 N/A N/A 36101350 EAP CPT® 31525 "DX LARYNGOSCOPY, EXCEPT NB" BOTH IP/OP "$6,130.00" "$4,536.50" $159.51 "$6,130.00" "$6,130.00" "$6,130.00" "$6,130.00" "$6,130.00" $160.89 $160.89 $159.51 "$6,130.00" $160.89 "$6,130.00" "$6,130.00" "$6,130.00" "$6,130.00" "$1,277.56" $257.42 $257.14 "$6,130.00" $160.89 $160.71 $160.89 "$6,130.00" "$4,597.50" $160.89 $160.89 $160.89 "$2,762.00" "$3,065.00" "$4,854.96" $160.89 "$4,904.00" "$2,500.00" "$6,130.00" $160.89 "$3,555.40" "$6,130.00" $164.40 $160.89 "$6,130.00" $160.89 N/A N/A 36101351 EAP CPT® 49451 "REPLACE DUOD/JEJ TUBE PERC,SPV" BOTH IP/OP "$2,862.00" "$2,118.00" $87.83 "$2,862.00" "$2,862.00" "$2,862.00" "$2,862.00" "$2,862.00" $88.96 $88.96 $89.07 "$2,862.00" $88.96 "$2,862.00" "$2,862.00" "$2,862.00" "$2,862.00" $596.47 $142.34 $140.53 "$2,862.00" $88.96 $87.83 $88.96 "$2,862.00" "$2,146.50" $88.96 $88.96 $88.96 "$2,762.00" "$1,431.00" "$2,266.70" $88.96 "$2,289.60" "$2,150.00" "$2,862.00" $88.96 "$1,659.96" "$2,862.00" $94.13 $88.96 "$2,862.00" $88.96 N/A N/A 36101355 EAP CPT® 69000 DRAIN EXTERNAL EAR LESION BOTH IP/OP $694.00 $514.00 $123.70 $694.00 $694.00 $694.00 $694.00 $694.00 $126.11 $126.11 $123.70 $694.00 $126.11 $694.00 $694.00 $694.00 $694.00 $144.64 $201.78 $203.30 $694.00 $126.11 $127.06 $126.11 $694.00 $520.50 $126.11 $126.11 $126.11 $694.00 $347.00 $549.65 $126.11 $555.20 $694.00 $694.00 $126.11 $402.52 $694.00 $125.07 $126.11 $694.00 $126.11 N/A N/A 36101370 EAP CPT® 92511 NASOPHARYNGOSCOPY W/ENDOSCOPE BOTH IP/OP $606.00 $448.50 $37.94 $606.00 $606.00 $606.00 $606.00 $606.00 $161.93 $161.93 $161.21 $126.31 $161.93 $606.00 $606.00 $606.00 $606.00 $126.30 $259.08 $257.88 $358.45 $161.93 $37.94 $161.93 $170.02 $454.50 $161.93 $161.93 $161.93 $606.00 $303.00 $479.95 $161.93 $484.80 $393.90 $120.28 $161.93 $351.48 $170.02 $234.27 $161.93 $126.29 $161.93 N/A N/A 36101390 EAP CPT® 49180 ABLATION ABD STANDA BOTH IP/OP "$2,498.00" "$1,849.00" $83.08 "$2,498.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,384.05" "$1,384.05" "$1,377.93" $520.65 "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $520.61 "$2,214.48" "$2,163.34" "$1,871.00" "$1,384.05" $83.08 "$1,384.05" "$1,453.25" "$1,873.50" "$1,384.05" "$1,384.05" "$1,384.05" "$2,498.00" "$1,249.00" "$1,978.42" "$1,384.05" "$1,998.40" "$2,498.00" $495.79 "$1,384.05" "$1,448.84" "$1,453.25" "$2,002.37" "$1,384.05" $520.58 "$1,384.05" N/A N/A 36101401 EAP CPT® 31651 BRONCHIAL VALVE REMOV ADDL BOTH IP/OP $947.00 $701.00 $75.97 $947.00 $947.00 $947.00 $947.00 $947.00 $76.33 $76.33 $76.93 $947.00 $76.33 $947.00 $947.00 $947.00 $947.00 $197.37 $122.13 $121.55 $947.00 $76.33 $75.97 $76.33 $947.00 $710.25 $76.33 $76.33 $76.33 $473.50 $473.50 $750.02 $76.33 $757.60 $947.00 $947.00 $76.33 $549.26 $947.00 $76.82 $76.33 $947.00 $76.33 N/A N/A 36101402 EAP CPT® 32556 INSERT CATH PLEURA W/O IMAGE BOTH IP/OP "$3,737.00" "$2,765.50" $123.82 "$3,737.00" "$3,737.00" "$3,737.00" "$3,737.00" "$3,737.00" $124.50 $124.50 $124.55 "$3,737.00" $124.50 "$3,737.00" "$3,737.00" "$3,737.00" "$3,737.00" $778.83 $199.20 $198.11 "$3,737.00" $124.50 $123.82 $124.50 "$3,737.00" "$2,802.75" $124.50 $124.50 $124.50 "$2,762.00" "$1,868.50" "$2,959.70" $124.50 "$2,989.60" "$2,150.00" "$3,737.00" $124.50 "$2,167.46" "$3,737.00" $128.38 $124.50 "$3,737.00" $124.50 N/A N/A 36101403 EAP CPT® 32557 INSERT CATH PLEURA W/ IMAGE BOTH IP/OP "$2,776.00" "$2,054.50" $148.52 "$2,776.00" "$2,776.00" "$2,776.00" "$2,776.00" "$2,776.00" $149.92 $149.92 $151.19 "$2,776.00" $149.92 "$2,776.00" "$2,776.00" "$2,776.00" "$2,776.00" $578.55 $239.87 $237.63 "$2,776.00" $149.92 $148.52 $149.92 "$2,776.00" "$2,082.00" $149.92 $149.92 $149.92 "$2,762.00" "$1,388.00" "$2,198.59" $149.92 "$2,220.80" "$2,150.00" "$2,776.00" $149.92 "$1,610.08" "$2,776.00" $158.68 $149.92 "$2,776.00" $149.92 N/A N/A 36101404 EAP CPT® 31626 NAVIGATION BRONCHOSCOPY W/MARKERS BOTH IP/OP "$5,560.00" "$4,114.50" $194.32 "$9,165.40" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$5,728.37" "$5,728.37" "$5,703.04" "$1,158.84" "$5,728.37" "$3,116.95" "$3,116.95" "$3,236.84" "$2,187.86" "$1,158.77" "$9,165.40" "$8,925.84" "$3,856.00" "$5,728.37" $194.32 "$5,728.37" "$6,014.79" "$4,170.00" "$5,728.37" "$5,728.37" "$5,728.37" "$3,500.00" "$2,975.00" "$4,403.52" "$5,728.37" "$4,448.00" "$3,725.00" "$1,103.52" "$5,728.37" "$3,224.80" "$6,014.79" "$5,560.00" "$5,728.37" "$1,158.70" "$5,728.37" N/A N/A 36101405 EAP CPT® 61650 ENDOVASC INTRACRAN ADM RX 1ST BOTH IP/OP "$10,002.00" "$7,401.50" $572.64 "$10,002.00" "$10,002.00" "$10,002.00" "$10,002.00" "$10,002.00" $575.29 $575.29 $572.64 "$10,002.00" $575.29 "$10,002.00" "$10,002.00" "$10,002.00" "$10,002.00" "$2,084.53" $920.46 $925.46 "$10,002.00" $575.29 $578.41 $575.29 "$10,002.00" "$7,501.50" $575.29 $575.29 $575.29 "$5,001.00" "$5,001.00" "$7,921.58" $575.29 "$8,001.60" "$6,501.30" "$10,002.00" $575.29 "$5,801.16" "$10,002.00" $595.18 $575.29 "$10,002.00" $575.29 N/A N/A 36101406 EAP CPT® 61651 ENDOVASC INTRACRAN ADM RX ADD BOTH IP/OP "$9,649.00" "$7,140.50" $242.55 "$9,649.00" "$9,649.00" "$9,649.00" "$9,649.00" "$9,649.00" $242.55 $242.55 $245.51 "$9,649.00" $242.55 "$9,649.00" "$9,649.00" "$9,649.00" "$9,649.00" "$2,010.96" $388.08 $398.38 "$9,649.00" $242.55 $248.99 $242.55 "$9,649.00" "$7,236.75" $242.55 $242.55 $242.55 "$4,824.50" "$4,824.50" "$7,642.01" $242.55 "$7,719.20" "$6,271.85" "$9,649.00" $242.55 "$5,596.42" "$9,649.00" $254.87 $242.55 "$9,649.00" $242.55 N/A N/A 36101407 EAP CPT® 37252 US VASCULAR NON-CORONARY INIT BOTH IP/OP "$15,412.00" "$11,405.00" $88.27 "$15,412.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$15,412.00" "$15,412.00" "$15,412.00" "$3,212.25" "$15,412.00" "$15,412.00" "$15,412.00" "$15,412.00" "$15,412.00" "$3,212.03" "$15,412.00" "$4,368.00" "$3,094.73" "$15,412.00" $88.27 "$15,412.00" "$15,412.00" "$11,559.00" "$15,412.00" "$15,412.00" "$15,412.00" "$4,780.00" "$4,063.00" "$12,206.30" "$15,412.00" "$12,329.60" "$1,750.00" "$3,058.90" "$15,412.00" "$8,938.96" "$15,412.00" "$15,412.00" "$15,412.00" "$3,211.86" "$15,412.00" N/A N/A 36101408 EAP CPT® 37253 US VASCULAR NON-CORON ADD EA BOTH IP/OP "$11,429.00" "$8,457.50" $69.92 "$11,429.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$11,429.00" "$11,429.00" "$11,429.00" "$2,382.09" "$11,429.00" "$11,429.00" "$11,429.00" "$11,429.00" "$11,429.00" "$2,381.93" "$11,429.00" "$3,689.00" "$3,094.73" "$11,429.00" $69.92 "$11,429.00" "$11,429.00" "$8,571.75" "$11,429.00" "$11,429.00" "$11,429.00" "$4,780.00" "$4,063.00" "$9,051.77" "$11,429.00" "$9,143.20" "$1,750.00" "$2,268.37" "$11,429.00" "$6,628.82" "$11,429.00" "$11,429.00" "$11,429.00" "$2,381.80" "$11,429.00" N/A N/A 36101409 EAP CPT® 47532 XR CHOLANGIOGRAM TRANSHEPATIC BOTH IP/OP "$3,224.00" "$2,386.00" $208.21 "$3,224.00" "$3,224.00" "$3,224.00" "$3,224.00" "$3,224.00" $210.33 $210.33 $213.43 "$3,224.00" $210.33 "$3,224.00" "$3,224.00" "$3,224.00" "$3,224.00" $671.92 $336.53 $333.14 "$3,224.00" $210.33 $208.21 $210.33 "$3,224.00" "$2,418.00" $210.33 $210.33 $210.33 "$3,224.00" "$1,612.00" "$2,553.41" $210.33 "$2,579.20" "$3,224.00" "$3,224.00" $210.33 "$1,869.92" "$3,224.00" $222.15 $210.33 "$3,224.00" $210.33 N/A N/A 36101410 EAP CPT® 47531 XR CHOLANGIOGRAM THRU CATH BOTH IP/OP "$3,224.00" "$2,386.00" $69.49 "$5,109.79" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$3,129.64" "$3,129.64" "$3,115.80" $671.96 "$3,129.64" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" $671.92 "$5,007.43" "$5,109.79" "$1,871.00" "$3,129.64" $69.49 "$3,129.64" "$3,286.13" "$2,418.00" "$3,129.64" "$3,129.64" "$3,129.64" "$2,762.00" "$1,612.00" "$2,553.41" "$3,129.64" "$2,579.20" "$1,750.00" $639.88 "$3,129.64" "$1,869.92" "$3,286.13" "$3,224.00" "$3,129.64" $671.88 "$3,129.64" N/A N/A 36101411 EAP CPT® 47533 PL BIL DRN CATH PERC EXT RAD BOTH IP/OP "$5,443.00" "$4,028.00" $261.11 "$5,443.00" "$5,443.00" "$5,443.00" "$5,443.00" "$5,443.00" $263.30 $263.30 $265.20 "$5,443.00" $263.30 "$5,443.00" "$5,443.00" "$5,443.00" "$5,443.00" "$1,134.38" $421.28 $417.78 "$5,443.00" $263.30 $261.11 $263.30 "$5,443.00" "$4,082.25" $263.30 $263.30 $263.30 "$2,762.00" "$2,721.50" "$4,310.86" $263.30 "$4,354.40" "$3,725.00" "$5,443.00" $263.30 "$3,156.94" "$5,443.00" $278.41 $263.30 "$5,443.00" $263.30 N/A N/A 36101412 EAP CPT® 47534 PL BIL DRN CATH PERC INT/EXT R BOTH IP/OP "$6,143.00" "$4,546.00" $364.87 "$6,143.00" "$6,143.00" "$6,143.00" "$6,143.00" "$6,143.00" $366.82 $366.82 $369.96 "$6,143.00" $366.82 "$6,143.00" "$6,143.00" "$6,143.00" "$6,143.00" "$1,280.27" $586.91 $583.79 "$6,143.00" $366.82 $364.87 $366.82 "$6,143.00" "$4,607.25" $366.82 $366.82 $366.82 "$2,762.00" "$3,071.50" "$4,865.26" $366.82 "$4,914.40" "$3,725.00" "$6,143.00" $366.82 "$3,562.94" "$6,143.00" $388.41 $366.82 "$6,143.00" $366.82 N/A N/A 36101413 EAP CPT® 47535 CONV EXT BIL DRN CATH TO INT/E BOTH IP/OP "$5,443.00" "$4,028.00" $193.62 "$5,443.00" "$5,443.00" "$5,443.00" "$5,443.00" "$5,443.00" $194.61 $194.61 $195.56 "$5,443.00" $194.61 "$5,443.00" "$5,443.00" "$5,443.00" "$5,443.00" "$1,134.38" $311.38 $309.79 "$5,443.00" $194.61 $193.62 $194.61 "$5,443.00" "$4,082.25" $194.61 $194.61 $194.61 "$2,762.00" "$2,721.50" "$4,310.86" $194.61 "$4,354.40" "$3,725.00" "$5,443.00" $194.61 "$3,156.94" "$5,443.00" $204.84 $194.61 "$5,443.00" $194.61 N/A N/A 36101414 EAP CPT® 47536 EXCH BIL DRN CATH PERC RAD BOTH IP/OP "$6,143.00" "$4,546.00" $129.86 "$6,143.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$3,129.64" "$3,129.64" "$3,115.80" "$1,280.35" "$3,129.64" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$1,280.27" "$5,007.43" "$5,109.79" "$6,143.00" "$3,129.64" $129.86 "$3,129.64" "$3,286.13" "$4,607.25" "$3,129.64" "$3,129.64" "$3,129.64" "$2,762.00" "$2,348.00" "$4,865.26" "$3,129.64" "$4,914.40" "$3,725.00" "$1,219.23" "$3,129.64" "$3,562.94" "$3,286.13" "$4,527.81" "$3,129.64" "$1,280.20" "$3,129.64" N/A N/A 36101415 EAP CPT® 47537 RMVL BIL DRN CATH PERC FLUOR G BOTH IP/OP "$1,195.00" $884.50 $95.61 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $95.90 $95.90 $96.06 "$1,195.00" $95.90 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 $153.44 $152.98 "$1,195.00" $95.90 $95.61 $95.90 "$1,195.00" $896.25 $95.90 $95.90 $95.90 "$1,195.00" $597.50 $946.44 $95.90 $956.00 "$1,195.00" "$1,195.00" $95.90 $693.10 "$1,195.00" $100.61 $95.90 "$1,195.00" $95.90 N/A N/A 36101416 EAP CPT® 47538 PLMT STENT BILE DUCT PERC RAD EXIS ACCS BOTH IP/OP "$10,193.00" "$7,543.00" $231.26 "$10,193.00" "$10,193.00" "$10,193.00" "$10,193.00" "$10,193.00" $232.78 $232.78 $235.72 "$10,193.00" $232.78 "$10,193.00" "$10,193.00" "$10,193.00" "$10,193.00" "$2,124.33" $372.45 $370.02 "$10,193.00" $232.78 $231.26 $232.78 "$10,193.00" "$7,644.75" $232.78 $232.78 $232.78 "$3,500.00" "$5,096.50" "$8,072.86" $232.78 "$8,154.40" "$4,334.00" "$10,193.00" $232.78 "$5,911.94" "$10,193.00" $247.75 $232.78 "$10,193.00" $232.78 N/A N/A 36101417 EAP CPT® 47539 PLMT STENT BILE DUCT PERC RAD NEW ACCS W/O CATH BOTH IP/OP "$10,193.00" "$7,543.00" $419.50 "$10,193.00" "$10,193.00" "$10,193.00" "$10,193.00" "$10,193.00" $419.50 $419.50 $419.98 "$10,193.00" $419.50 "$10,193.00" "$10,193.00" "$10,193.00" "$10,193.00" "$2,124.33" $671.20 $671.22 "$10,193.00" $419.50 $419.51 $419.50 "$10,193.00" "$7,644.75" $419.50 $419.50 $419.50 "$3,500.00" "$5,096.50" "$8,072.86" $419.50 "$8,154.40" "$4,334.00" "$10,193.00" $419.50 "$5,911.94" "$10,193.00" $444.31 $419.50 "$10,193.00" $419.50 N/A N/A 36101418 EAP CPT® 47540 PLMT STENT BILE DUCT PERC RAD NEW ACCS W/ CATH BOTH IP/OP "$10,296.00" "$7,619.50" $433.04 "$10,296.00" "$10,296.00" "$10,296.00" "$10,296.00" "$10,296.00" $436.51 $436.51 $439.22 "$10,296.00" $436.51 "$10,296.00" "$10,296.00" "$10,296.00" "$10,296.00" "$2,145.80" $698.42 $692.86 "$10,296.00" $436.51 $433.04 $436.51 "$10,296.00" "$7,722.00" $436.51 $436.51 $436.51 "$3,500.00" "$5,148.00" "$8,154.43" $436.51 "$8,236.80" "$4,334.00" "$10,296.00" $436.51 "$5,971.68" "$10,296.00" $461.62 $436.51 "$10,296.00" $436.51 N/A N/A 36101419 EAP CPT® 47541 PLACE ACCESS BILIARY SM BOWEL BOTH IP/OP "$5,443.00" "$4,028.00" $331.98 "$5,443.00" "$5,443.00" "$5,443.00" "$5,443.00" "$5,443.00" $331.98 $331.98 $333.02 "$5,443.00" $331.98 "$5,443.00" "$5,443.00" "$5,443.00" "$5,443.00" "$1,134.38" $531.17 $531.18 "$5,443.00" $331.98 $331.99 $331.98 "$5,443.00" "$4,082.25" $331.98 $331.98 $331.98 "$2,762.00" "$2,721.50" "$4,310.86" $331.98 "$4,354.40" "$3,725.00" "$5,443.00" $331.98 "$3,156.94" "$5,443.00" $347.65 $331.98 "$5,443.00" $331.98 N/A N/A 36101420 EAP CPT® 47542 DILATION BILIARY DUCT/AMPULLA BOTH IP/OP "$5,389.00" "$3,988.00" $134.29 "$5,389.00" "$5,389.00" "$5,389.00" "$5,389.00" "$5,389.00" $134.42 $134.42 $135.89 "$5,389.00" $134.42 "$5,389.00" "$5,389.00" "$5,389.00" "$5,389.00" "$1,123.13" $215.07 $214.86 "$5,389.00" $134.42 $134.29 $134.42 "$5,389.00" "$4,041.75" $134.42 $134.42 $134.42 "$2,694.50" "$2,694.50" "$4,268.09" $134.42 "$4,311.20" "$1,750.00" "$5,389.00" $134.42 "$3,125.62" "$5,389.00" $142.82 $134.42 "$5,389.00" $134.42 N/A N/A 36101421 EAP CPT® 47543 ENDOLUMIN BX BILIARY TREE PERQ BOTH IP/OP "$5,389.00" "$3,988.00" $141.75 "$5,389.00" "$5,389.00" "$5,389.00" "$5,389.00" "$5,389.00" $142.03 $142.03 $143.87 "$5,389.00" $142.03 "$5,389.00" "$5,389.00" "$5,389.00" "$5,389.00" "$1,123.13" $227.25 $226.80 "$5,389.00" $142.03 $141.75 $142.03 "$5,389.00" "$4,041.75" $142.03 $142.03 $142.03 "$2,694.50" "$2,694.50" "$4,268.09" $142.03 "$4,311.20" "$1,750.00" "$5,389.00" $142.03 "$3,125.62" "$5,389.00" $151.83 $142.03 "$5,389.00" $142.03 N/A N/A 36101422 EAP CPT® 47544 EXTRACT STONE DUCT BILIARY BOTH IP/OP "$2,246.00" "$1,662.50" $154.31 "$2,246.00" "$2,246.00" "$2,246.00" "$2,246.00" "$2,246.00" $154.64 $154.64 $156.30 "$2,246.00" $154.64 "$2,246.00" "$2,246.00" "$2,246.00" "$2,246.00" $468.09 $247.42 $246.90 "$2,246.00" $154.64 $154.31 $154.64 "$2,246.00" "$1,684.50" $154.64 $154.64 $154.64 "$2,246.00" "$1,123.00" "$1,778.83" $154.64 "$1,796.80" "$1,750.00" "$2,246.00" $154.64 "$1,302.68" "$2,246.00" $164.10 $154.64 "$2,246.00" $154.64 N/A N/A 36101423 EAP CPT® 49185 SCLEROTX FLUID COLLECTION PERQ BOTH IP/OP "$2,939.00" "$2,175.00" $118.00 "$2,939.00" "$2,939.00" "$2,939.00" "$2,939.00" "$2,939.00" $118.57 $118.57 $119.23 "$2,939.00" $118.57 "$2,939.00" "$2,939.00" "$2,939.00" "$2,939.00" $612.52 $189.71 $188.80 "$2,939.00" $118.57 $118.00 $118.57 "$2,939.00" "$2,204.25" $118.57 $118.57 $118.57 "$1,469.50" "$1,469.50" "$2,327.69" $118.57 "$2,351.20" "$2,500.00" "$2,939.00" $118.57 "$1,704.62" "$2,939.00" $125.13 $118.57 "$2,939.00" $118.57 N/A N/A 36101424 EAP CPT® 50432 PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I BOTH IP/OP "$6,538.00" "$4,838.50" $202.76 "$6,538.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,761.28" "$1,761.28" "$1,753.49" "$1,362.68" "$1,761.28" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,362.59" "$2,818.05" "$2,675.95" "$6,538.00" "$1,761.28" $202.76 "$1,761.28" "$1,849.35" "$4,903.50" "$1,761.28" "$1,761.28" "$1,761.28" "$2,762.00" "$2,348.00" "$5,178.10" "$1,761.28" "$5,230.40" "$3,250.00" "$1,297.63" "$1,761.28" "$3,792.04" "$1,849.35" "$2,548.13" "$1,761.28" "$1,362.52" "$1,761.28" N/A N/A 36101425 EAP CPT® 50693 PLMT URETERAL STENT PRQ NEPH/URETEROGRAM PRE-EXIST BOTH IP/OP "$5,609.00" "$4,151.00" $201.05 "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" $201.87 $201.87 $203.92 "$5,609.00" $201.87 "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" "$1,168.98" $322.99 $321.68 "$5,609.00" $201.87 $201.05 $201.87 "$5,609.00" "$4,206.75" $201.87 $201.87 $201.87 "$2,762.00" "$2,804.50" "$4,442.33" $201.87 "$4,487.20" "$3,725.00" "$5,609.00" $201.87 "$3,253.22" "$5,609.00" $213.48 $201.87 "$5,609.00" $201.87 N/A N/A 36101426 EAP CPT® 50694 PLMT URETERAL STENT PRQ NEPH/URETEROGRAM NEW ACCES BOTH IP/OP "$5,609.00" "$4,151.00" $263.44 "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" $263.80 $263.80 $266.68 "$5,609.00" $263.80 "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" "$1,168.98" $422.08 $421.50 "$5,609.00" $263.80 $263.44 $263.80 "$5,609.00" "$4,206.75" $263.80 $263.80 $263.80 "$2,762.00" "$2,804.50" "$4,442.33" $263.80 "$4,487.20" "$3,725.00" "$5,609.00" $263.80 "$3,253.22" "$5,609.00" $280.56 $263.80 "$5,609.00" $263.80 N/A N/A 36101427 EAP CPT® 50695 PLMT URETERAL STENT PRQ NEP/URT NEW ACCES SEP CATH BOTH IP/OP "$5,609.00" "$4,151.00" $337.36 "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" $339.74 $339.74 $343.64 "$5,609.00" $339.74 "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" "$1,168.98" $543.58 $539.78 "$5,609.00" $339.74 $337.36 $339.74 "$5,609.00" "$4,206.75" $339.74 $339.74 $339.74 "$2,762.00" "$2,804.50" "$4,442.33" $339.74 "$4,487.20" "$3,725.00" "$5,609.00" $339.74 "$3,253.22" "$5,609.00" $359.54 $339.74 "$5,609.00" $339.74 N/A N/A 36101428 EAP CPT® 50430 INJ ANTEGRADE NEPH/URET COMP BOTH IP/OP "$1,379.00" "$1,020.50" $152.23 "$1,379.00" "$1,379.00" "$1,379.00" "$1,379.00" "$1,379.00" $565.91 $565.91 $563.41 $287.42 $565.91 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $287.40 $905.46 $902.15 "$1,379.00" $565.91 $152.23 $565.91 $594.21 "$1,034.25" $565.91 $565.91 $565.91 "$1,379.00" $689.50 "$1,092.17" $565.91 "$1,103.20" "$1,379.00" $273.70 $565.91 $799.82 $594.21 $818.74 $565.91 $287.38 $565.91 N/A N/A 36101429 EAP CPT® 50431 INJ ANTEGRADE NEPH/URET COMP BOTH IP/OP "$1,379.00" "$1,020.50" $65.41 "$1,379.00" "$1,379.00" "$1,379.00" "$1,379.00" "$1,379.00" $565.91 $565.91 $563.41 $287.42 $565.91 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $287.40 $905.46 $902.15 "$1,379.00" $565.91 $65.41 $565.91 $594.21 "$1,034.25" $565.91 $565.91 $565.91 "$1,379.00" $689.50 "$1,092.17" $565.91 "$1,103.20" "$1,379.00" $273.70 $565.91 $799.82 $594.21 $818.74 $565.91 $287.38 $565.91 N/A N/A 36101430 EAP CPT® 50433 PLACE NEPHROURETERAL CATH PRQ BOTH IP/OP "$3,960.00" "$2,930.50" $251.59 "$4,838.98" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$3,024.36" "$3,024.36" "$3,010.98" $825.36 "$3,024.36" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $825.31 "$4,838.98" "$4,623.90" "$3,960.00" "$3,024.36" $251.59 "$3,024.36" "$3,175.58" "$2,970.00" "$3,024.36" "$3,024.36" "$3,024.36" "$2,762.00" "$1,980.00" "$3,136.32" "$3,024.36" "$3,168.00" "$3,250.00" $785.96 "$3,024.36" "$2,296.80" "$3,175.58" "$3,960.00" "$3,024.36" $825.26 "$3,024.36" N/A N/A 36101431 EAP CPT® 50434 CONVERT NEPHROSTOMY CATH BOTH IP/OP "$2,023.00" "$1,497.50" $188.85 "$2,818.05" "$2,023.00" "$2,023.00" "$2,023.00" "$2,023.00" "$1,761.28" "$1,761.28" "$1,753.49" $421.64 "$1,761.28" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $421.62 "$2,818.05" "$2,675.95" "$2,023.00" "$1,761.28" $188.85 "$1,761.28" "$1,849.35" "$1,517.25" "$1,761.28" "$1,761.28" "$1,761.28" "$2,023.00" "$1,011.50" "$1,602.22" "$1,761.28" "$1,618.40" "$2,023.00" $401.51 "$1,761.28" "$1,173.34" "$1,849.35" "$2,023.00" "$1,761.28" $421.59 "$1,761.28" N/A N/A 36101432 EAP CPT® 50435 CHG TUBE NEPHRO/PYELO BOTH IP/OP "$2,275.00" "$1,683.50" $98.99 "$2,818.05" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,761.28" "$1,761.28" "$1,753.49" $474.17 "$1,761.28" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $474.14 "$2,818.05" "$2,675.95" "$2,275.00" "$1,761.28" $98.99 "$1,761.28" "$1,849.35" "$1,706.25" "$1,761.28" "$1,761.28" "$1,761.28" "$2,275.00" "$1,137.50" "$1,801.80" "$1,761.28" "$1,820.00" "$2,150.00" $451.53 "$1,761.28" "$1,319.50" "$1,849.35" "$2,275.00" "$1,761.28" $474.11 "$1,761.28" N/A N/A 36101433 EAP CPT® 50606 ENDOLUMINAL BX URETER RENAL BOTH IP/OP "$5,609.00" "$4,151.00" $137.33 "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" $137.33 $137.33 $150.47 "$5,609.00" $137.33 "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" "$1,168.98" $219.73 $220.40 "$5,609.00" $137.33 $137.75 $137.33 "$5,609.00" "$4,206.75" $137.33 $137.33 $137.33 "$2,804.50" "$2,804.50" "$4,442.33" $137.33 "$4,487.20" "$1,750.00" "$5,609.00" $137.33 "$3,253.22" "$5,609.00" $159.04 $137.33 "$5,609.00" $137.33 N/A N/A 36101437 EAP CPT® 50705 URETERAL EMBOLIZATION/OCCUSION BOTH IP/OP "$5,609.00" "$4,151.00" $174.77 "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" $174.77 $174.77 $176.19 "$5,609.00" $174.77 "$5,609.00" "$5,609.00" "$5,609.00" "$5,609.00" "$1,168.98" $279.63 $281.74 "$5,609.00" $174.77 $176.09 $174.77 "$5,609.00" "$4,206.75" $174.77 $174.77 $174.77 "$2,804.50" "$2,804.50" "$4,442.33" $174.77 "$4,487.20" "$1,750.00" "$5,609.00" $174.77 "$3,253.22" "$5,609.00" $184.31 $174.77 "$5,609.00" $174.77 N/A N/A 36101438 EAP CPT® 50706 BALL DILAT URETERAL STRICTURE BOTH IP/OP "$5,900.00" "$4,366.00" $178.38 "$5,900.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$5,900.00" "$5,900.00" "$5,900.00" "$1,229.71" "$5,900.00" "$5,900.00" "$5,900.00" "$5,900.00" "$5,900.00" "$1,229.62" "$5,900.00" "$3,163.00" "$3,094.73" "$5,900.00" $178.38 "$5,900.00" "$5,900.00" "$4,425.00" "$5,900.00" "$5,900.00" "$5,900.00" "$2,950.00" "$2,950.00" "$4,672.80" "$5,900.00" "$4,720.00" "$1,750.00" "$1,171.00" "$5,900.00" "$3,422.00" "$5,900.00" "$5,900.00" "$5,900.00" "$1,229.56" "$5,900.00" N/A N/A 36101439 EAP CPT® 61645 PERQ ARTERIAL TRANSLUM THROMEC BOTH IP/OP "$25,070.00" "$18,552.00" $840.93 "$25,070.00" "$25,070.00" "$25,070.00" "$25,070.00" "$25,070.00" $840.93 $840.93 $841.88 "$25,070.00" $840.93 "$25,070.00" "$25,070.00" "$25,070.00" "$25,070.00" "$5,224.86" "$1,345.49" "$1,358.85" "$25,070.00" $840.93 $849.28 $840.93 "$25,070.00" "$18,802.50" $840.93 $840.93 $840.93 "$12,535.00" "$12,535.00" "$19,855.44" $840.93 "$20,056.00" "$16,295.50" "$25,070.00" $840.93 "$14,540.60" "$25,070.00" $872.10 $840.93 "$25,070.00" $840.93 N/A N/A 36101440 EAP CPT® 62321 INJ OF SUB SPINAL CANAL UPPER/MID BACK; W/IMAGE BOTH IP/OP "$1,385.00" "$1,025.00" $106.78 "$1,385.00" "$1,385.00" "$1,385.00" "$1,385.00" "$1,385.00" $624.63 $624.63 $621.87 $288.67 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $288.65 $999.41 $929.56 "$1,385.00" $624.63 $106.78 $624.63 $655.86 "$1,038.75" $624.63 $624.63 $624.63 "$1,385.00" $692.50 "$1,096.92" $624.63 "$1,108.00" "$1,385.00" $274.89 $624.63 $803.30 $655.86 $903.68 $624.63 $288.63 $624.63 N/A N/A 36101441 EAP CPT® 62323 INJ OF SUB SPINAL CANAL LOWER BACK/SACRUM; W/IMAGE BOTH IP/OP "$1,385.00" "$1,025.00" $98.98 "$1,385.00" "$1,385.00" "$1,385.00" "$1,385.00" "$1,385.00" $624.63 $624.63 $621.87 $288.67 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $288.65 $999.41 $929.56 "$1,385.00" $624.63 $98.98 $624.63 $655.86 "$1,038.75" $624.63 $624.63 $624.63 "$1,385.00" $692.50 "$1,096.92" $624.63 "$1,108.00" "$1,385.00" $274.89 $624.63 $803.30 $655.86 $903.68 $624.63 $288.63 $624.63 N/A N/A 36101445 EAP CPT® 31573 LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI BOTH IP/OP "$3,859.00" "$2,856.00" $150.20 "$3,859.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,471.71" "$1,471.71" "$1,465.20" $804.31 "$1,471.71" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $804.26 "$2,354.73" "$2,306.17" "$3,859.00" "$1,471.71" $150.20 "$1,471.71" "$1,545.29" "$2,894.25" "$1,471.71" "$1,471.71" "$1,471.71" "$2,762.00" "$1,929.50" "$3,056.33" "$1,471.71" "$3,087.20" "$2,500.00" $765.92 "$1,471.71" "$2,238.22" "$1,545.29" "$2,129.19" "$1,471.71" $804.22 "$1,471.71" N/A N/A 36101501 EAP CPT® 30020 DRAINAGE OF NOSE LESION BOTH IP/OP "$2,343.00" "$1,734.00" $121.30 "$2,343.00" "$2,343.00" "$2,343.00" "$2,343.00" "$2,343.00" $123.72 $123.72 $121.30 "$2,343.00" $123.72 "$2,343.00" "$2,343.00" "$2,343.00" "$2,343.00" $488.31 $197.95 $199.50 "$2,343.00" $123.72 $124.69 $123.72 "$2,343.00" "$1,757.25" $123.72 $123.72 $123.72 "$2,343.00" "$1,171.50" "$1,855.66" $123.72 "$1,874.40" "$1,750.00" "$2,343.00" $123.72 "$1,358.94" "$2,343.00" $122.55 $123.72 "$2,343.00" $123.72 N/A N/A 36101502 EAP CPT® 31654 BRONCHOSCOPY RIGID/FLEX EBUS INTERVEN PERI LESION BOTH IP/OP "$22,686.00" "$16,788.00" $65.78 "$22,686.00" "$22,686.00" "$22,686.00" "$22,686.00" "$22,686.00" $67.09 $67.09 $67.64 "$22,686.00" $67.09 "$22,686.00" "$22,686.00" "$22,686.00" "$22,686.00" "$4,728.01" $107.34 $105.25 "$22,686.00" $67.09 $65.78 $67.09 "$22,686.00" "$17,014.50" $67.09 $67.09 $67.09 "$11,343.00" "$11,343.00" "$17,967.31" $67.09 "$18,148.80" "$1,750.00" "$22,686.00" $67.09 "$13,157.88" "$22,686.00" $69.97 $67.09 "$22,686.00" $67.09 N/A N/A 36101503 EAP CPT® 31652 BRONCHOSCOPY RIGID/FLEX EBUS SAMPLING 1 OR 2 NODE BOTH IP/OP "$5,306.00" "$3,926.50" $218.02 "$5,306.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$3,047.03" "$3,047.03" "$3,033.56" "$1,105.90" "$3,047.03" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$1,105.83" "$4,875.25" "$4,809.32" "$5,306.00" "$3,047.03" $218.02 "$3,047.03" "$3,199.39" "$3,979.50" "$3,047.03" "$3,047.03" "$3,047.03" "$2,762.00" "$2,348.00" "$4,202.35" "$3,047.03" "$4,244.80" "$3,250.00" "$1,053.11" "$3,047.03" "$3,077.48" "$3,199.39" "$4,408.29" "$3,047.03" "$1,105.77" "$3,047.03" N/A N/A 36101504 EAP CPT® 31653 BRONCHOSCOPY RIGID/FLEX EBUS SAMPLING 3/> NODE BOTH IP/OP "$4,682.00" "$3,465.00" $241.76 "$4,875.25" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$3,047.03" "$3,047.03" "$3,033.56" $975.85 "$3,047.03" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" $975.78 "$4,875.25" "$4,809.32" "$4,682.00" "$3,047.03" $241.76 "$3,047.03" "$3,199.39" "$3,511.50" "$3,047.03" "$3,047.03" "$3,047.03" "$2,762.00" "$2,348.00" "$3,708.14" "$3,047.03" "$3,745.60" "$3,250.00" $929.26 "$3,047.03" "$2,715.56" "$3,199.39" "$4,408.29" "$3,047.03" $975.73 "$3,047.03" N/A N/A 36101520 EAP CPT® 42330 REMOVAL OF SALIVARY STONE BOTH IP/OP "$6,425.00" "$4,754.50" $165.98 "$6,425.00" "$6,425.00" "$6,425.00" "$6,425.00" "$6,425.00" $167.69 $167.69 $165.98 "$6,425.00" $167.69 "$6,425.00" "$6,425.00" "$6,425.00" "$6,425.00" "$1,339.04" $268.30 $269.47 "$6,425.00" $167.69 $168.42 $167.69 "$6,425.00" "$4,818.75" $167.69 $167.69 $167.69 "$2,762.00" "$3,212.50" "$5,088.60" $167.69 "$5,140.00" "$2,500.00" "$6,425.00" $167.69 "$3,726.50" "$6,425.00" $169.06 $167.69 "$6,425.00" $167.69 N/A N/A 36101961 EAP CPT® 57460 COLPOSCOPY W/LEEP BX BOTH IP/OP "$4,743.00" "$3,510.00" $161.11 "$4,743.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,580.85" "$2,580.85" "$2,569.43" $988.56 "$2,580.85" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $988.49 "$4,129.35" "$4,079.03" "$4,743.00" "$2,580.85" $161.11 "$2,580.85" "$2,709.89" "$3,557.25" "$2,580.85" "$2,580.85" "$2,580.85" "$2,762.00" "$2,348.00" "$3,756.46" "$2,580.85" "$3,794.40" "$3,250.00" $941.37 "$2,580.85" "$2,750.94" "$2,709.89" "$3,733.83" "$2,580.85" $988.44 "$2,580.85" N/A N/A 36101985 EAP CPT® 46999 ANUS SURGERY PROCEDURE BOTH IP/OP "$1,251.00" $926.00 $260.72 "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" $260.72 "$1,251.00" $500.40 "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" $938.25 "$1,251.00" "$1,251.00" "$1,251.00" "$1,251.00" $625.50 $990.79 "$1,251.00" "$1,000.80" "$1,251.00" "$1,251.00" "$1,251.00" $725.58 "$1,251.00" $750.60 "$1,251.00" "$1,251.00" "$1,251.00" N/A N/A 36101987 EAP CPT® 57456 COLPOSCOPY + ECC BOTH IP/OP "$1,218.00" $901.50 $102.10 "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" $277.43 $277.43 $276.20 $253.86 $277.43 "$1,218.00" "$1,218.00" "$1,218.00" $882.37 $253.84 $443.89 $421.19 "$1,218.00" $277.43 $102.10 $277.43 $291.30 $913.50 $277.43 $277.43 $277.43 "$1,218.00" $609.00 $964.66 $277.43 $974.40 "$1,218.00" $241.74 $277.43 $706.44 $291.30 $401.37 $277.43 $253.83 $277.43 N/A N/A 36101989 EAP CPT® 23931 DRAINAGE OF ARM BURSA BOTH IP/OP "$7,496.00" "$5,547.50" $161.11 "$7,496.00" "$7,496.00" "$7,496.00" "$7,496.00" "$7,496.00" $163.42 $163.42 $163.03 "$7,496.00" $163.42 "$7,496.00" "$7,496.00" "$7,496.00" "$7,496.00" "$1,562.25" $261.47 $263.52 "$7,496.00" $163.42 $164.70 $163.42 "$7,496.00" "$5,622.00" $163.42 $163.42 $163.42 "$2,851.00" "$3,748.00" "$5,936.83" $163.42 "$5,996.80" "$2,500.00" "$7,496.00" $163.42 "$4,347.68" "$7,496.00" $161.11 $163.42 "$7,496.00" $163.42 N/A N/A 36101990 EAP CPT® 91111 ESOPHAGEAL CAPSULE ENDOSCOPY BOTH IP/OP "$3,592.00" "$2,658.50" $748.61 "$3,592.00" "$3,592.00" "$3,592.00" "$3,592.00" "$3,592.00" $923.49 $923.49 $967.65 "$3,592.00" $923.49 "$3,592.00" "$3,592.00" "$3,592.00" "$3,592.00" $748.61 "$1,477.58" "$1,377.68" "$3,592.00" $923.49 $861.05 $923.49 "$3,592.00" "$2,694.00" $923.49 $923.49 $923.49 "$1,796.00" "$1,796.00" "$2,844.86" $923.49 "$2,873.60" "$2,500.00" "$3,592.00" $923.49 "$2,083.36" "$3,592.00" $828.40 $923.49 "$3,592.00" $923.49 N/A N/A 36101991 EAP CPT® 91110 GI TRACT CAPSULE ENDOSCOPY BOTH IP/OP "$4,034.00" "$2,985.50" $643.93 "$4,034.00" "$2,190.46" "$2,190.46" "$2,190.46" "$2,190.46" $795.95 $795.95 $792.43 $840.79 $795.95 "$4,034.00" "$4,034.00" "$4,034.00" "$4,034.00" $840.73 "$1,273.51" "$1,190.93" "$2,386.11" $795.95 $643.93 $795.95 $835.74 "$3,025.50" $795.95 $795.95 $795.95 "$2,017.00" "$2,017.00" "$3,194.93" $795.95 "$3,227.20" "$2,500.00" $800.65 $795.95 "$2,339.72" $835.74 "$1,151.53" $795.95 $840.69 $795.95 N/A N/A 36101992 EAP CPT® 56405 "I & D, VULVA, PERINEUM" BOTH IP/OP $294.00 $218.00 $61.27 $294.00 $294.00 $294.00 $294.00 $294.00 $130.53 $130.53 $127.09 $294.00 $130.53 $294.00 $294.00 $294.00 $294.00 $61.27 $208.85 $207.65 $294.00 $130.53 $129.78 $130.53 $294.00 $220.50 $130.53 $130.53 $130.53 $294.00 $147.00 $232.85 $130.53 $235.20 $294.00 $294.00 $130.53 $170.52 $294.00 $123.63 $130.53 $294.00 $130.53 N/A N/A 36101994 EAP CPT® 64425 INJECT ANEST ILIOIN BOTH IP/OP "$3,143.00" "$2,326.00" $54.92 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $624.63 $624.63 $621.87 $655.08 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $655.04 $999.41 $929.56 "$1,871.00" $624.63 $54.92 $624.63 $655.86 "$2,357.25" $624.63 $624.63 $624.63 "$2,762.00" "$1,571.50" "$2,489.26" $624.63 "$2,514.40" "$2,150.00" $623.81 $624.63 "$1,822.94" $655.86 $903.68 $624.63 $655.00 $624.63 N/A N/A 36101995 EAP CPT® 41899 REM IMP TOOTH W MUCOPER FIP BOTH IP/OP "$1,862.00" "$1,378.00" $207.19 "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" $208.11 $208.11 $207.19 $388.09 $208.11 "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" $388.06 $332.98 $299.82 "$1,862.00" $208.11 "$1,862.00" $208.11 $218.52 "$1,396.50" $208.11 $208.11 $208.11 "$1,862.00" $931.00 "$1,474.70" $208.11 "$1,489.60" "$1,750.00" $369.56 $208.11 "$1,079.96" $218.52 $301.08 $208.11 $388.04 $208.11 N/A N/A 36101998 EAP CPT® 36228 SEL CATH PLC INTRACRN BRNCH IC/VERT ART W/ANGIO BOTH IP/OP "$73,169.00" "$54,145.50" $243.05 "$73,169.00" "$73,169.00" "$73,169.00" "$73,169.00" "$73,169.00" $243.05 $243.05 $243.17 "$73,169.00" $243.05 "$73,169.00" "$73,169.00" "$73,169.00" "$73,169.00" "$15,249.22" $388.88 $394.56 "$73,169.00" $243.05 $246.60 $243.05 "$73,169.00" "$54,876.75" $243.05 $243.05 $243.05 "$36,584.50" "$36,584.50" "$57,949.85" $243.05 "$58,535.20" "$1,750.00" "$73,169.00" $243.05 "$42,438.02" "$73,169.00" $251.63 $243.05 "$73,169.00" $243.05 N/A N/A 36102050 EAP CPT® 26010 ABSCESS FINGER SIMPLE BOTH IP/OP "$1,407.00" "$1,041.50" $142.73 "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" $143.60 $143.60 $142.73 "$1,407.00" $143.60 "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" $293.23 $229.76 $230.42 "$1,407.00" $143.60 $144.01 $143.60 "$1,407.00" "$1,055.25" $143.60 $143.60 $143.60 "$1,407.00" $703.50 "$1,114.34" $143.60 "$1,125.60" "$1,407.00" "$1,407.00" $143.60 $816.06 "$1,407.00" $143.08 $143.60 "$1,407.00" $143.60 N/A N/A 36102063 EAP CPT® 38505 BX LYMPH NODE NDL BIC BOTH IP/OP "$1,805.00" "$1,336.00" $86.11 "$2,214.48" "$1,805.00" "$1,805.00" "$1,805.00" "$1,805.00" "$1,384.05" "$1,384.05" "$1,377.93" $376.21 "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $376.18 "$2,214.48" "$2,163.34" "$1,805.00" "$1,384.05" $86.11 "$1,384.05" "$1,453.25" "$1,353.75" "$1,384.05" "$1,384.05" "$1,384.05" "$1,805.00" $902.50 "$1,429.56" "$1,384.05" "$1,444.00" "$1,805.00" $358.25 "$1,384.05" "$1,046.90" "$1,453.25" "$1,805.00" "$1,384.05" $376.16 "$1,384.05" N/A N/A 36102064 EAP CPT® 45005 DRAINAGE OF RECTAL ABSCESS ULT BOTH IP/OP "$5,625.00" "$4,162.50" $166.93 "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" $172.20 $172.20 $166.93 "$5,625.00" $172.20 "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" $275.52 $271.81 "$5,625.00" $172.20 $169.88 $172.20 "$5,625.00" "$4,218.75" $172.20 $172.20 $172.20 "$2,851.00" "$2,812.50" "$4,455.00" $172.20 "$4,500.00" "$2,500.00" "$5,625.00" $172.20 "$3,262.50" "$5,625.00" $169.04 $172.20 "$5,625.00" $172.20 N/A N/A 36102066 EAP CPT® 49060 DRAIN OPEN RETROP ABSCESS ULT BOTH IP/OP "$5,398.00" "$3,995.00" "$1,107.60" "$5,398.00" "$5,398.00" "$5,398.00" "$5,398.00" "$5,398.00" "$1,116.70" "$1,116.70" "$1,115.62" "$5,398.00" "$1,116.70" "$5,398.00" "$5,398.00" "$5,398.00" "$5,398.00" "$1,125.00" "$1,786.72" "$1,772.16" "$5,398.00" "$1,116.70" "$1,107.60" "$1,116.70" "$5,398.00" "$4,048.50" "$1,116.70" "$1,116.70" "$1,116.70" "$2,762.00" "$2,699.00" "$4,275.22" "$1,116.70" "$4,318.40" "$3,508.70" "$5,398.00" "$1,116.70" "$3,130.84" "$5,398.00" "$1,154.32" "$1,116.70" "$5,398.00" "$1,116.70" N/A N/A 36102068 EAP CPT® 52341 CYSTO W/URETER STRICTURE TX BOTH IP/OP "$9,570.00" "$7,082.00" $281.46 "$9,570.00" "$9,570.00" "$9,570.00" "$9,570.00" "$9,570.00" $282.18 $282.18 $284.55 "$9,570.00" $282.18 "$9,570.00" "$9,570.00" "$9,570.00" "$9,570.00" "$1,994.49" $451.49 $450.34 "$9,570.00" $282.18 $281.46 $282.18 "$9,570.00" "$7,177.50" $282.18 $282.18 $282.18 "$3,500.00" "$4,785.00" "$7,579.44" $282.18 "$7,656.00" "$3,250.00" "$9,570.00" $282.18 "$5,550.60" "$9,570.00" $295.32 $282.18 "$9,570.00" $282.18 N/A N/A 36102082 EAP CPT® 57505 ECC CERVICAL SCRAPE BOTH IP/OP "$2,043.00" "$1,512.00" $111.46 "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" $623.62 $623.62 $620.86 $425.81 $623.62 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $425.78 $997.79 "$1,014.87" "$1,871.00" $623.62 $111.46 $623.62 $654.80 "$1,532.25" $623.62 $623.62 $623.62 "$2,043.00" "$1,021.50" "$1,618.06" $623.62 "$1,634.40" "$2,043.00" $405.48 $623.62 "$1,184.94" $654.80 $902.22 $623.62 $425.76 $623.62 N/A N/A 36102090 EAP CPT® 49421 PERM PERITONEAL CATH INSERT BOTH IP/OP "$11,842.00" "$8,763.50" $227.47 "$11,842.00" "$11,842.00" "$11,842.00" "$11,842.00" "$11,842.00" $229.16 $229.16 $230.46 "$11,842.00" $229.16 "$11,842.00" "$11,842.00" "$11,842.00" "$11,842.00" "$2,468.00" $366.66 $363.95 "$11,842.00" $229.16 $227.47 $229.16 "$11,842.00" "$8,881.50" $229.16 $229.16 $229.16 "$2,762.00" "$5,921.00" "$9,378.86" $229.16 "$9,473.60" "$3,725.00" "$11,842.00" $229.16 "$6,868.36" "$11,842.00" $239.75 $229.16 "$11,842.00" $229.16 N/A N/A 36102091 EAP CPT® 49402 TECHOFF CATH. REMOVAL BOTH IP/OP "$5,016.00" "$3,712.00" $866.06 "$5,016.00" "$5,016.00" "$5,016.00" "$5,016.00" "$5,016.00" $868.73 $868.73 $869.99 "$5,016.00" $868.73 "$5,016.00" "$5,016.00" "$5,016.00" "$5,016.00" "$1,045.39" "$1,389.97" "$1,385.70" "$5,016.00" $868.73 $866.06 $868.73 "$5,016.00" "$3,762.00" $868.73 $868.73 $868.73 "$2,851.00" "$2,508.00" "$3,972.67" $868.73 "$4,012.80" "$3,725.00" "$5,016.00" $868.73 "$2,909.28" "$5,016.00" $898.70 $868.73 "$5,016.00" $868.73 N/A N/A 36102095 EAP CPT® 19120 "EXCISION OF CYST,FIBRO ADRENOMA" BOTH IP/OP "$5,508.00" "$4,076.00" $424.12 "$5,508.00" "$5,508.00" "$5,508.00" "$5,508.00" "$5,508.00" $425.05 $425.05 $424.12 "$5,508.00" $425.05 "$5,508.00" "$5,508.00" "$5,508.00" "$5,508.00" "$1,147.93" $680.08 $680.61 "$5,508.00" $425.05 $425.38 $425.05 "$5,508.00" "$4,131.00" $425.05 $425.05 $425.05 "$3,500.00" "$2,754.00" "$4,362.34" $425.05 "$4,406.40" "$3,250.00" "$5,508.00" $425.05 "$3,194.64" "$5,508.00" $432.54 $425.05 "$5,508.00" $425.05 N/A N/A 36102100 EAP CPT® 64400 "INJ ANES/STRD TRIGEMINAL NERVE, EACH BRANCH" BOTH IP/OP "$1,227.00" $908.00 $50.62 "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" $50.86 $50.86 $50.62 "$1,227.00" $50.86 "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" $255.72 $81.38 $81.44 "$1,227.00" $50.86 $50.90 $50.86 "$1,227.00" $920.25 $50.86 $50.86 $50.86 "$1,227.00" $613.50 $971.78 $50.86 $981.60 "$1,227.00" "$1,227.00" $50.86 $711.66 "$1,227.00" $51.91 $50.86 "$1,227.00" $50.86 N/A N/A 36102101 EAP CPT® 64455 N BLOCK INJ PLANTAR DIGIT BOTH IP/OP "$1,081.00" $800.00 $33.57 "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" $257.00 $257.00 $255.86 $225.31 $257.00 "$1,081.00" "$1,081.00" "$1,081.00" $882.37 $225.29 $411.20 $392.25 $113.00 $257.00 $33.57 $257.00 $269.85 $810.75 $257.00 $257.00 $257.00 "$1,081.00" $540.50 $856.15 $257.00 $864.80 "$1,081.00" $214.55 $257.00 $626.98 $269.85 $371.81 $257.00 $225.28 $257.00 N/A N/A 36102150 EAP CPT® 19101 "BREAST BIOPSY, OPEN, INCISIONAL" BOTH IP/OP "$3,347.00" "$2,477.00" $227.62 "$3,347.00" "$3,347.00" "$3,347.00" "$3,347.00" "$3,347.00" $228.43 $228.43 $227.63 "$3,347.00" $228.43 "$3,347.00" "$3,347.00" "$3,347.00" "$3,347.00" $697.55 $365.49 $364.19 "$3,347.00" $228.43 $227.62 $228.43 "$3,347.00" "$2,510.25" $228.43 $228.43 $228.43 "$2,851.00" "$1,673.50" "$2,650.82" $228.43 "$2,677.60" "$3,250.00" "$3,347.00" $228.43 "$1,941.26" "$3,347.00" $232.49 $228.43 "$3,347.00" $228.43 N/A N/A 36102151 EAP CPT® 19125 EXCISION BREAST LESION BOTH IP/OP "$3,037.00" "$2,247.50" $469.45 "$3,037.00" "$3,037.00" "$3,037.00" "$3,037.00" "$3,037.00" $471.33 $471.33 $469.45 "$3,037.00" $471.33 "$3,037.00" "$3,037.00" "$3,037.00" "$3,037.00" $632.94 $754.13 $752.86 "$3,037.00" $471.33 $470.54 $471.33 "$3,037.00" "$2,277.75" $471.33 $471.33 $471.33 "$3,037.00" "$1,518.50" "$2,405.30" $471.33 "$2,429.60" "$3,037.00" "$3,037.00" $471.33 "$1,761.46" "$3,037.00" $480.48 $471.33 "$3,037.00" $471.33 N/A N/A 36102152 EAP CPT® 66020 INJECTION TREATMENT OF EYE BOTH IP/OP "$4,930.00" "$3,648.50" $130.27 "$4,930.00" "$4,930.00" "$4,930.00" "$4,930.00" "$4,930.00" $130.27 $130.27 $131.32 "$4,930.00" $130.27 "$4,930.00" "$4,930.00" "$4,930.00" "$4,930.00" "$1,027.47" $208.43 $209.17 "$4,930.00" $130.27 $130.73 $130.27 "$4,930.00" "$3,697.50" $130.27 $130.27 $130.27 "$2,762.00" "$2,465.00" "$3,904.56" $130.27 "$3,944.00" "$2,500.00" "$4,930.00" $130.27 "$2,859.40" "$4,930.00" $133.37 $130.27 "$4,930.00" $130.27 N/A N/A 36102153 EAP CPT® 68530 CLEARANCE OF TEAR DUCT BOTH IP/OP $579.00 $428.50 $120.67 $579.00 $579.00 $579.00 $579.00 $579.00 $251.81 $251.81 $253.58 $579.00 $251.81 $579.00 $579.00 $579.00 $579.00 $120.67 $402.90 $403.81 $579.00 $251.81 $252.38 $251.81 $579.00 $434.25 $251.81 $251.81 $251.81 $579.00 $289.50 $458.57 $251.81 $463.20 $579.00 $579.00 $251.81 $335.82 $579.00 $260.65 $251.81 $579.00 $251.81 N/A N/A 36102155 EAP CPT® 11600 EXC TR-EMT MLG+MARG 0.5 20SQ CM BOTH IP/OP "$2,528.00" "$1,871.00" $25.45 "$2,528.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,528.00" "$2,528.00" "$2,528.00" $526.90 "$2,528.00" "$2,528.00" "$2,528.00" "$2,528.00" "$2,528.00" $526.86 "$2,528.00" "$1,267.00" "$1,495.31" "$2,528.00" $25.45 "$2,528.00" "$2,528.00" "$1,896.00" "$2,528.00" "$2,528.00" "$2,528.00" "$1,264.00" "$1,264.00" "$2,002.18" "$2,528.00" "$2,022.40" "$1,750.00" $501.74 "$2,528.00" "$1,466.24" "$2,528.00" "$2,528.00" "$2,528.00" $526.84 "$2,528.00" N/A N/A 36102331 EAP CPT® 11046 EXCL DEBRIDE- MUSCLE > 20SQ CM BOTH IP/OP "$2,528.00" "$1,871.00" $54.97 "$2,528.00" "$2,528.00" "$2,528.00" "$2,528.00" "$2,528.00" $55.72 $55.72 $56.18 "$2,528.00" $55.72 "$2,528.00" "$2,528.00" "$2,528.00" "$2,528.00" $526.86 $89.15 $87.95 "$2,528.00" $55.72 $54.97 $55.72 "$2,528.00" "$1,896.00" $55.72 $55.72 $55.72 "$1,264.00" "$1,264.00" "$2,002.18" $55.72 "$2,022.40" "$1,750.00" "$2,528.00" $55.72 "$1,466.24" "$2,528.00" $58.41 $55.72 "$2,528.00" $55.72 N/A N/A 36102332 EAP CPT® 11047 EXCL DEBRIDE-BONE > 20 SQ CM BOTH IP/OP "$6,167.00" "$4,564.00" $97.40 "$6,167.00" "$6,167.00" "$6,167.00" "$6,167.00" "$6,167.00" $97.45 $97.45 $98.26 "$6,167.00" $97.45 "$6,167.00" "$6,167.00" "$6,167.00" "$6,167.00" "$1,285.27" $155.92 $155.84 "$6,167.00" $97.45 $97.40 $97.45 "$6,167.00" "$4,625.25" $97.45 $97.45 $97.45 "$3,083.50" "$3,083.50" "$4,884.26" $97.45 "$4,933.60" "$1,750.00" "$6,167.00" $97.45 "$3,576.86" "$6,167.00" $103.11 $97.45 "$6,167.00" $97.45 N/A N/A 36102333 EAP CPT® 11755 BIOPSY OF NAIL UNIT BOTH IP/OP $978.00 $724.00 $60.68 $979.40 $978.00 $978.00 $978.00 $978.00 $612.13 $612.13 $609.42 $203.84 $612.13 $978.00 $978.00 $978.00 $882.37 $203.83 $979.40 $936.25 $978.00 $612.13 $60.68 $612.13 $642.73 $733.50 $612.13 $612.13 $612.13 $978.00 $489.00 $774.58 $612.13 $782.40 $978.00 $194.11 $60.89 $567.24 $642.73 $885.59 $612.13 $203.82 $612.13 N/A N/A 36102334 EAP CPT® 15004 "SITE PREP-100 SQ CM (HANDS, FEET)" BOTH IP/OP "$2,328.00" "$1,723.00" $261.45 "$2,328.00" "$2,328.00" "$2,328.00" "$2,328.00" "$2,328.00" $263.10 $263.10 $264.97 "$2,328.00" $263.10 "$2,328.00" "$2,328.00" "$2,328.00" "$2,328.00" $485.18 $420.96 $418.32 "$2,328.00" $263.10 $261.45 $263.10 "$2,328.00" "$1,746.00" $263.10 $263.10 $263.10 "$2,328.00" "$1,164.00" "$1,843.78" $263.10 "$1,862.40" "$2,150.00" "$2,328.00" $263.10 "$1,350.24" "$2,328.00" $275.82 $263.10 "$2,328.00" $263.10 N/A N/A 36102342 EAP CPT® 97602 REM/DEBRIDE DEVITALIZED TISSUE W/O ANES BOTH IP/OP $386.00 $286.00 $76.61 $386.00 $209.60 $209.60 $209.60 $209.60 $176.64 $176.64 $175.86 $80.45 $176.64 $386.00 $386.00 $386.00 $386.00 $80.45 $282.63 $260.52 $228.32 $176.64 $309.00 $176.64 $185.48 $289.50 $176.64 $176.64 $176.64 $193.00 $193.00 $305.71 $176.64 $308.80 $250.90 $76.61 $176.64 $223.88 $185.48 $255.56 $176.64 $80.44 $176.64 N/A N/A 36102343 EAP CPT® 10036 PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE; EACH BOTH IP/OP "$1,630.00" "$1,206.50" $42.73 "$1,630.00" "$1,630.00" "$1,630.00" "$1,630.00" "$1,630.00" $42.90 $42.90 $43.26 "$1,630.00" $42.90 "$1,630.00" "$1,630.00" "$1,630.00" "$1,630.00" $339.71 $68.64 $68.37 "$1,630.00" $42.90 $42.73 $42.90 "$1,630.00" "$1,222.50" $42.90 $42.90 $42.90 $815.00 $815.00 "$1,290.96" $42.90 "$1,304.00" "$1,630.00" "$1,630.00" $42.90 $945.40 "$1,630.00" $45.08 $42.90 "$1,630.00" $42.90 N/A N/A 36102345 EAP CPT® 41820 EXC. GUM EACH QUAD(GINGIVECTOMY) BOTH IP/OP "$2,596.00" "$1,921.50" $252.15 "$2,596.00" "$2,596.00" "$2,596.00" "$2,596.00" "$2,596.00" "$2,596.00" "$2,596.00" $252.15 "$2,596.00" "$2,596.00" "$2,596.00" "$2,596.00" "$2,596.00" "$2,596.00" $541.03 "$2,596.00" "$1,038.40" "$2,596.00" "$2,596.00" "$2,596.00" "$2,596.00" "$2,596.00" "$1,947.00" "$2,596.00" "$2,596.00" "$2,596.00" "$2,596.00" "$1,298.00" "$2,056.03" "$2,596.00" "$2,076.80" "$2,596.00" "$2,596.00" "$2,596.00" "$1,505.68" "$2,596.00" "$1,557.60" "$2,596.00" "$2,596.00" "$2,596.00" N/A N/A 36102346 EAP CPT® 30580 "REPAIR UPPER JAW FISTULA," BOTH IP/OP "$9,049.00" "$6,696.50" $466.25 "$9,049.00" "$9,049.00" "$9,049.00" "$9,049.00" "$9,049.00" $467.65 $467.65 $469.86 "$9,049.00" $467.65 "$9,049.00" "$9,049.00" "$9,049.00" "$9,049.00" "$1,885.91" $748.24 $746.00 "$9,049.00" $467.65 $466.25 $467.65 "$9,049.00" "$6,786.75" $467.65 $467.65 $467.65 "$4,417.00" "$4,524.50" "$7,166.81" $467.65 "$7,239.20" "$4,334.00" "$9,049.00" $467.65 "$5,248.42" "$9,049.00" $491.37 $467.65 "$9,049.00" $467.65 N/A N/A 36102360 EAP CPT® 55100 DRAINAGE OF SCROTUM ABCESS BOTH IP/OP "$2,572.00" "$1,903.50" $168.80 "$2,572.00" "$2,572.00" "$2,572.00" "$2,572.00" "$2,572.00" $168.95 $168.95 $168.99 "$2,572.00" $168.95 "$2,572.00" "$2,572.00" "$2,572.00" "$2,572.00" $536.03 $270.32 $270.08 "$2,572.00" $168.95 $168.80 $168.95 "$2,572.00" "$1,929.00" $168.95 $168.95 $168.95 "$2,572.00" "$1,286.00" "$2,037.02" $168.95 "$2,057.60" "$2,500.00" "$2,572.00" $168.95 "$1,491.76" "$2,572.00" $173.04 $168.95 "$2,572.00" $168.95 N/A N/A 36102362 EAP CPT® 19081 BREAST BX W/ PLCE LOCAL DEV AND IMAGING OF SPEC 1ST LESE BOTH IP/OP "$6,618.00" "$4,897.50" $163.44 "$5,294.40" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,384.05" "$1,384.05" "$1,377.93" "$1,379.36" "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,379.26" "$2,214.48" "$2,163.34" "$3,856.00" "$1,384.05" $163.44 "$1,384.05" "$1,453.25" "$4,963.50" "$1,384.05" "$1,384.05" "$1,384.05" "$2,762.00" "$2,348.00" "$5,241.46" "$1,384.05" "$5,294.40" "$2,500.00" "$1,313.51" "$1,384.05" "$3,838.44" "$1,453.25" "$2,002.37" "$1,384.05" "$1,379.19" "$1,384.05" N/A N/A 36102363 EAP CPT® 19082 BREAST BX W/ PLCE LOCAL DEV AND IMAGING OF SPEC EA ADD'E BOTH IP/OP "$4,964.00" "$3,673.50" $82.40 "$4,964.00" "$4,964.00" "$4,964.00" "$4,964.00" "$4,964.00" $83.14 $83.14 $83.51 "$4,964.00" $83.14 "$4,964.00" "$4,964.00" "$4,964.00" "$4,964.00" "$1,034.55" $133.02 $131.84 "$4,964.00" $83.14 $82.40 $83.14 "$4,964.00" "$3,723.00" $83.14 $83.14 $83.14 "$2,482.00" "$2,482.00" "$3,931.49" $83.14 "$3,971.20" "$1,750.00" "$4,964.00" $83.14 "$2,879.12" "$4,964.00" $87.27 $83.14 "$4,964.00" $83.14 N/A N/A 36102364 EAP CPT® 19083 BREAST BX W/ PLCE LOCAL DEV AND IMAGING OF SPEC 1ST LESE BOTH IP/OP "$7,720.00" "$5,713.00" $153.60 "$6,176.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,384.05" "$1,384.05" "$1,377.93" "$1,609.04" "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,608.93" "$2,214.48" "$2,163.34" "$3,856.00" "$1,384.05" $153.60 "$1,384.05" "$1,453.25" "$5,790.00" "$1,384.05" "$1,384.05" "$1,384.05" "$2,762.00" "$2,348.00" "$6,114.24" "$1,384.05" "$6,176.00" "$2,500.00" "$1,532.23" "$1,384.05" "$4,477.60" "$1,453.25" "$2,002.37" "$1,384.05" "$1,608.85" "$1,384.05" N/A N/A 36102365 EAP CPT® 19084 BREAST BX W/ PLCE LOCAL DEV AND IMAGING OF SPEC EA ADD'E BOTH IP/OP "$5,433.00" "$4,020.50" $77.66 "$5,433.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$5,433.00" "$5,433.00" "$5,433.00" "$1,132.37" "$5,433.00" "$5,433.00" "$5,433.00" "$5,433.00" "$5,433.00" "$1,132.30" "$5,433.00" "$1,940.00" "$3,094.73" "$5,433.00" $77.66 "$5,433.00" "$5,433.00" "$4,074.75" "$5,433.00" "$5,433.00" "$5,433.00" "$2,716.50" "$2,716.50" "$4,302.94" "$5,433.00" "$4,346.40" "$1,750.00" "$1,078.31" "$5,433.00" "$3,151.14" "$5,433.00" "$5,433.00" "$5,433.00" "$1,132.24" "$5,433.00" N/A N/A 36102366 EAP CPT® 19085 BREAST BX W/ PLCE LOCAL DEV AND IMAGING OF SPEC 1ST LESE BOTH IP/OP "$7,925.00" "$5,864.50" $178.66 "$7,925.00" "$7,925.00" "$7,925.00" "$7,925.00" "$7,925.00" $180.91 $180.91 $182.44 "$7,925.00" $180.91 "$7,925.00" "$7,925.00" "$7,925.00" "$7,925.00" "$1,651.66" $289.46 $285.86 "$7,925.00" $180.91 $178.66 $180.91 "$7,925.00" "$5,943.75" $180.91 $180.91 $180.91 "$2,762.00" "$3,962.50" "$6,276.60" $180.91 "$6,340.00" "$2,500.00" "$7,925.00" $180.91 "$4,596.50" "$7,925.00" $190.41 $180.91 "$7,925.00" $180.91 N/A N/A 36102367 EAP CPT® 19086 BREAST BX W/ PLCE LOCAL DEV AND IMAGING OF SPEC EA ADD'L LESION INC MRI GUIDE BOTH IP/OP "$4,847.00" "$3,587.00" $89.85 "$4,847.00" "$4,847.00" "$4,847.00" "$4,847.00" "$4,847.00" $90.16 $90.16 $91.22 "$4,847.00" $90.16 "$4,847.00" "$4,847.00" "$4,847.00" "$4,847.00" "$1,010.17" $144.26 $143.76 "$4,847.00" $90.16 $89.85 $90.16 "$4,847.00" "$3,635.25" $90.16 $90.16 $90.16 "$2,423.50" "$2,423.50" "$3,838.82" $90.16 "$3,877.60" "$1,750.00" "$4,847.00" $90.16 "$2,811.26" "$4,847.00" $94.85 $90.16 "$4,847.00" $90.16 N/A N/A 36102368 EAP CPT® 19281 PLCE BREAST LOCAL DEV PERCUT 1ST LESION INC MAMMO GUIDE BOTH IP/OP "$2,033.00" "$1,504.50" $98.66 "$2,163.34" "$2,033.00" "$2,033.00" "$2,033.00" "$2,033.00" $612.13 $612.13 $609.42 $423.73 $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $423.70 $979.40 "$2,163.34" "$1,871.00" $612.13 $98.66 $612.13 $642.73 "$1,524.75" $612.13 $612.13 $612.13 "$2,033.00" "$1,016.50" "$1,610.14" $612.13 "$1,626.40" "$1,750.00" $403.50 $612.13 "$1,179.14" $642.73 $885.59 $612.13 $423.68 $612.13 N/A N/A 36102369 EAP CPT® 19282 PLCE BREAST LOCAL DEV PERCUT EA ADD'L LESION INC MAMMO GUIDE BOTH IP/OP "$1,526.00" "$1,129.50" $49.84 "$1,526.00" "$1,526.00" "$1,526.00" "$1,526.00" "$1,526.00" "$1,526.00" "$1,526.00" "$1,526.00" $318.06 "$1,526.00" "$1,526.00" "$1,526.00" "$1,526.00" "$1,526.00" $318.04 "$1,526.00" $922.00 $902.63 "$1,526.00" $49.84 "$1,526.00" "$1,526.00" "$1,144.50" "$1,526.00" "$1,526.00" "$1,526.00" $763.00 $763.00 "$1,208.59" "$1,526.00" "$1,220.80" "$1,526.00" $302.87 "$1,526.00" $885.08 "$1,526.00" "$1,526.00" "$1,526.00" $318.02 "$1,526.00" N/A N/A 36102370 EAP CPT® 19283 PLCE BREAST LOCAL DEV PERCUT 1ST LESION INC STEREO GUIDE BOTH IP/OP "$3,496.00" "$2,587.50" $99.35 "$3,496.00" "$3,496.00" "$3,496.00" "$3,496.00" "$3,496.00" $100.34 $100.34 $101.17 "$3,496.00" $100.34 "$3,496.00" "$3,496.00" "$3,496.00" "$3,496.00" $728.60 $160.54 $158.96 "$3,496.00" $100.34 $99.35 $100.34 "$3,496.00" "$2,622.00" $100.34 $100.34 $100.34 "$2,762.00" "$1,748.00" "$2,768.83" $100.34 "$2,796.80" "$1,750.00" "$3,496.00" $100.34 "$2,027.68" "$3,496.00" $105.66 $100.34 "$3,496.00" $100.34 N/A N/A 36102371 EAP CPT® 19284 PLCE BREAST LOCAL DEV PERCUT EA ADD'L LESION INC STEREO GUIDE BOTH IP/OP "$2,623.00" "$1,941.50" $49.85 "$2,623.00" "$2,623.00" "$2,623.00" "$2,623.00" "$2,623.00" $50.48 $50.48 $51.53 "$2,623.00" $50.48 "$2,623.00" "$2,623.00" "$2,623.00" "$2,623.00" $546.66 $80.77 $79.76 "$2,623.00" $50.48 $49.85 $50.48 "$2,623.00" "$1,967.25" $50.48 $50.48 $50.48 "$1,311.50" "$1,311.50" "$2,077.42" $50.48 "$2,098.40" "$1,750.00" "$2,623.00" $50.48 "$1,521.34" "$2,623.00" $53.73 $50.48 "$2,623.00" $50.48 N/A N/A 36102372 EAP CPT® 19285 PLCE BREAST LOCAL DEV PERCUT 1ST LESION INC ULTRSND GUIDE BOTH IP/OP "$1,641.00" "$1,214.50" $84.77 "$1,641.00" "$1,641.00" "$1,641.00" "$1,641.00" "$1,641.00" $612.13 $612.13 $609.42 $342.03 $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $342.00 $979.40 $936.25 "$1,641.00" $612.13 $84.77 $612.13 $642.73 "$1,230.75" $612.13 $612.13 $612.13 "$1,641.00" $820.50 "$1,299.67" $612.13 "$1,312.80" "$1,641.00" $325.70 $612.13 $951.78 $642.73 $885.59 $612.13 $341.98 $612.13 N/A N/A 36102373 EAP CPT® 19286 PLCE BREAST LOCAL DEV PERCUT EA ADD'L LESION INC ULTRSND GUIDE BOTH IP/OP "$1,231.00" $911.00 $42.73 "$1,231.00" "$1,231.00" "$1,231.00" "$1,231.00" "$1,231.00" $42.94 $42.94 $43.29 "$1,231.00" $42.94 "$1,231.00" "$1,231.00" "$1,231.00" "$1,231.00" $256.55 $68.70 $68.37 "$1,231.00" $42.94 $42.73 $42.94 "$1,231.00" $923.25 $42.94 $42.94 $42.94 $615.50 $615.50 $974.95 $42.94 $984.80 "$1,231.00" "$1,231.00" "$1,231.00" $713.98 "$1,231.00" $45.44 $42.94 "$1,231.00" $42.94 N/A N/A 36102374 EAP CPT® 19287 PLCE BREAST LOCAL DEV PERCUT 1ST LESION INC STEREO GUIDE BOTH IP/OP "$5,193.00" "$3,843.00" $125.44 "$5,193.00" "$5,193.00" "$5,193.00" "$5,193.00" "$5,193.00" $126.59 $126.59 $127.64 "$5,193.00" $126.59 "$5,193.00" "$5,193.00" "$5,193.00" "$5,193.00" "$1,082.28" $202.54 $200.70 "$5,193.00" $126.59 $125.44 $126.59 "$5,193.00" "$3,894.75" $126.59 $126.59 $126.59 "$2,762.00" "$2,596.50" "$4,112.86" $126.59 "$4,154.40" "$1,750.00" "$5,193.00" $126.59 "$3,011.94" "$5,193.00" $134.15 $126.59 "$5,193.00" $126.59 N/A N/A 36102375 EAP CPT® 19288 PLCE BREAST LOCAL DEV PERCUT EA ADD'L LESION INC MRI GUIDE BOTH IP/OP "$3,894.00" "$2,882.00" $63.06 "$3,894.00" "$3,894.00" "$3,894.00" "$3,894.00" "$3,894.00" $63.62 $63.62 $64.15 "$3,894.00" $63.62 "$3,894.00" "$3,894.00" "$3,894.00" "$3,894.00" $811.55 $101.79 $100.90 "$3,894.00" $63.62 $63.06 $63.62 "$3,894.00" "$2,920.50" $63.62 $63.62 $63.62 "$1,947.00" "$1,947.00" "$3,084.05" $63.62 "$3,115.20" "$1,750.00" "$3,894.00" $63.62 "$2,258.52" "$3,894.00" $67.44 $63.62 "$3,894.00" $63.62 N/A N/A 36102376 EAP CPT® 10030 PERQ IMAGE-GUIDED CATHETER FLUID COLLECTION BOTH IP/OP "$1,213.00" $898.00 $113.00 "$1,213.00" "$1,213.00" "$1,213.00" "$1,213.00" "$1,213.00" $612.13 $612.13 $609.42 $252.82 $612.13 "$1,213.00" "$1,213.00" "$1,213.00" $882.37 $252.80 $979.40 $936.25 $113.00 $612.13 $134.96 $612.13 $642.73 $909.75 $612.13 $612.13 $612.13 "$1,213.00" $606.50 $960.70 $612.13 $970.40 "$1,213.00" $240.75 $612.13 $703.54 $642.73 $885.59 $612.13 $252.79 $612.13 N/A N/A 36102380 EAP CPT® 67028 INJECTION INTRAVITREAL DRUG-BOTH EYES BOTH IP/OP "$3,267.00" "$2,418.00" $91.14 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $313.64 $313.64 $312.26 $680.92 $313.64 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $680.88 $501.83 $479.85 "$1,871.00" $313.64 $91.14 $313.64 $329.33 "$2,450.25" $313.64 $313.64 $313.64 "$2,762.00" "$1,633.50" "$2,587.46" $313.64 "$2,613.60" "$1,750.00" $648.42 $313.64 "$1,894.86" $329.33 $453.76 $313.64 $680.84 $313.64 N/A N/A 36103335 EAP CPT® 57135 REMOVE VAGINA LESION BOTH IP/OP "$3,669.00" "$2,715.50" $188.90 "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" $191.88 $191.88 $189.61 "$3,669.00" $191.88 "$3,669.00" "$3,669.00" "$3,669.00" "$3,669.00" $764.66 $307.01 $306.99 "$3,669.00" $191.88 $191.87 $191.88 "$3,669.00" "$2,751.75" $191.88 $191.88 $191.88 "$2,851.00" "$1,834.50" "$2,905.85" $191.88 "$2,935.20" "$3,250.00" "$3,669.00" $191.88 "$2,128.02" "$3,669.00" $188.90 $191.88 "$3,669.00" $191.88 N/A N/A 36103340 EAP CPT® 64642 CHEMODENERV 1 EXTERMITY 1-4 BOTH IP/OP "$3,119.00" "$2,308.50" $107.21 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $624.63 $624.63 $621.87 $650.08 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $650.03 $999.41 $929.56 $113.00 $624.63 $107.21 $624.63 $655.86 "$2,339.25" $624.63 $624.63 $624.63 "$2,762.00" "$1,559.50" "$2,470.25" $624.63 "$2,495.20" "$2,150.00" $619.04 $624.63 "$1,809.02" $655.86 $903.68 $624.63 $650.00 $624.63 N/A N/A 36103341 EAP CPT® 64643 CHEMODENERV 1 EXTERM 1-4 EA BOTH IP/OP "$2,339.00" "$1,731.00" $70.92 "$2,339.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,339.00" "$2,339.00" "$2,339.00" $487.51 "$2,339.00" "$2,339.00" "$2,339.00" "$2,339.00" "$2,339.00" $487.47 "$2,339.00" $967.00 "$1,383.52" "$2,339.00" $70.92 "$2,339.00" "$2,339.00" "$1,754.25" "$2,339.00" "$2,339.00" "$2,339.00" "$1,169.50" "$1,169.50" "$1,852.49" "$2,339.00" "$1,871.20" "$1,750.00" $464.23 "$2,339.00" "$1,356.62" "$2,339.00" "$2,339.00" "$2,339.00" $487.45 "$2,339.00" N/A N/A 36103342 EAP CPT® 64644 CHEMODENERV 1 EXTERM --5/>MUS BOTH IP/OP "$3,701.00" "$2,739.00" $113.00 "$2,960.80" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $624.63 $624.63 $621.87 $771.38 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $771.33 $999.41 $929.56 $113.00 $624.63 $117.05 $624.63 $655.86 "$2,775.75" $624.63 $624.63 $624.63 "$2,762.00" "$1,850.50" "$2,931.19" $624.63 "$2,960.80" "$2,150.00" $734.56 $624.63 "$2,146.58" $655.86 $903.68 $624.63 $771.29 $624.63 N/A N/A 36103343 EAP CPT® 64645 CHEMODENERV 1 EXTERM --5/> EA BOTH IP/OP "$2,775.00" "$2,053.50" $82.48 "$2,775.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,775.00" "$2,775.00" "$2,775.00" $578.38 "$2,775.00" "$2,775.00" "$2,775.00" "$2,775.00" "$2,775.00" $578.34 "$2,775.00" $967.00 "$1,641.41" "$2,775.00" $82.48 "$2,775.00" "$2,775.00" "$2,081.25" "$2,775.00" "$2,775.00" "$2,775.00" "$1,387.50" "$1,387.50" "$2,197.80" "$2,775.00" "$2,220.00" "$1,750.00" $550.77 "$2,775.00" "$1,609.50" "$2,775.00" "$2,775.00" "$2,775.00" $578.31 "$2,775.00" N/A N/A 36103344 EAP CPT® 64646 CHEMODENERV TRUNK MUSC 1-5 BOTH IP/OP "$3,119.00" "$2,308.50" $113.00 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $624.63 $624.63 $621.87 $650.08 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $650.03 $999.41 $929.56 $113.00 $624.63 $117.10 $624.63 $655.86 "$2,339.25" $624.63 $624.63 $624.63 "$2,762.00" "$1,559.50" "$2,470.25" $624.63 "$2,495.20" "$2,150.00" $619.04 $624.63 "$1,809.02" $655.86 $903.68 $624.63 $650.00 $624.63 N/A N/A 36103345 EAP CPT® 64647 CHEMODENERV TRUNK MUSC 6/> BOTH IP/OP "$3,721.00" "$2,754.00" $113.00 "$2,976.80" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $624.63 $624.63 $621.87 $775.55 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $775.50 $999.41 $929.56 $113.00 $624.63 $135.10 $624.63 $655.86 "$2,790.75" $624.63 $624.63 $624.63 "$2,762.00" "$1,860.50" "$2,947.03" $624.63 "$2,976.80" "$2,150.00" $738.53 $624.63 "$2,158.18" $655.86 $903.68 $624.63 $775.46 $624.63 N/A N/A 36103352 EAP CPT® 37239 OPEN/PEQ PLACE STENT EA ADD BOTH IP/OP "$20,475.00" "$15,151.50" $148.35 "$20,475.00" "$20,475.00" "$20,475.00" "$20,475.00" "$20,475.00" $150.18 $150.18 $152.09 "$20,475.00" $150.18 "$20,475.00" "$20,475.00" "$20,475.00" "$20,475.00" "$4,267.22" $240.29 $237.36 "$20,475.00" $150.18 $148.35 $150.18 "$20,475.00" "$15,356.25" $150.18 $150.18 $150.18 "$10,237.50" "$10,237.50" "$16,216.20" $150.18 "$16,380.00" "$4,334.00" "$20,475.00" $150.18 "$11,875.50" "$20,475.00" $159.73 $150.18 "$20,475.00" $150.18 N/A N/A 36103353 EAP CPT® 37238 OPEN/PERO PLACE STENT SAME BOTH IP/OP "$45,270.00" "$33,500.00" $302.10 "$45,270.00" "$45,270.00" "$45,270.00" "$45,270.00" "$45,270.00" $304.99 $304.99 $307.56 "$45,270.00" $304.99 "$45,270.00" "$45,270.00" "$45,270.00" "$45,270.00" "$9,434.77" $487.98 $483.36 "$45,270.00" $304.99 $302.10 $304.99 "$45,270.00" "$33,952.50" $304.99 $304.99 $304.99 "$7,479.00" "$22,635.00" "$35,853.84" $304.99 "$36,216.00" "$5,164.00" "$45,270.00" $304.99 "$26,256.60" "$45,270.00" $320.19 $304.99 "$45,270.00" $304.99 N/A N/A 36103354 EAP CPT® 37236 OPEN/PERQ PLACE STENT 1ST BOTH IP/OP "$45,270.00" "$33,500.00" $436.66 "$45,270.00" "$45,270.00" "$45,270.00" "$45,270.00" "$45,270.00" $440.05 $440.05 $443.20 "$45,270.00" $440.05 "$45,270.00" "$45,270.00" "$45,270.00" "$45,270.00" "$9,434.77" $704.08 $698.66 "$45,270.00" $440.05 $436.66 $440.05 "$45,270.00" "$33,952.50" $440.05 $440.05 $440.05 "$7,479.00" "$22,635.00" "$35,853.84" $440.05 "$36,216.00" "$5,164.00" "$45,270.00" $440.05 "$26,256.60" "$45,270.00" $466.21 $440.05 "$45,270.00" $440.05 N/A N/A 36103355 EAP CPT® 37237 OPEN/PERQ PLACE STENT EA ADD BOTH IP/OP "$18,237.00" "$13,495.50" $207.48 "$18,237.00" "$18,237.00" "$18,237.00" "$18,237.00" "$18,237.00" $210.30 $210.30 $210.81 "$18,237.00" $210.30 "$18,237.00" "$18,237.00" "$18,237.00" "$18,237.00" "$3,800.79" $336.48 $331.97 "$18,237.00" $210.30 $207.48 $210.30 "$18,237.00" "$13,677.75" $210.30 $210.30 $210.30 "$9,118.50" "$9,118.50" "$14,443.70" $210.30 "$14,589.60" "$4,334.00" "$18,237.00" $210.30 "$10,577.46" "$18,237.00" $222.83 $210.30 "$18,237.00" $210.30 N/A N/A 36103358 EAP CPT® 37242 VASC EMBOLIZE/OCCLUDE ARTERY BOTH IP/OP "$21,962.00" "$16,252.00" $470.66 "$21,962.00" "$21,962.00" "$21,962.00" "$21,962.00" "$21,962.00" $472.26 $472.26 $476.27 "$21,962.00" $472.26 "$21,962.00" "$21,962.00" "$21,962.00" "$21,962.00" "$4,577.12" $755.62 $753.06 "$21,962.00" $472.26 $470.66 $472.26 "$21,962.00" "$16,471.50" $472.26 $472.26 $472.26 "$7,479.00" "$10,981.00" "$17,393.90" $472.26 "$17,569.60" "$5,164.00" "$21,962.00" $472.26 "$12,737.96" "$21,962.00" $499.45 $472.26 "$21,962.00" $472.26 N/A N/A 36103359 EAP CPT® 37244 VASC EMBOLIZE/OCCLUDE BLEED BOTH IP/OP "$21,962.00" "$16,252.00" $653.52 "$21,962.00" "$21,962.00" "$21,962.00" "$21,962.00" "$21,962.00" $657.32 $657.32 $663.69 "$21,962.00" $657.32 "$21,962.00" "$21,962.00" "$21,962.00" "$21,962.00" "$4,577.12" "$1,051.71" "$1,045.63" "$21,962.00" $657.32 $653.52 $657.32 "$21,962.00" "$16,471.50" $657.32 $657.32 $657.32 "$7,479.00" "$10,981.00" "$17,393.90" $657.32 "$17,569.60" "$5,164.00" "$21,962.00" $657.32 "$12,737.96" "$21,962.00" $696.04 $657.32 "$21,962.00" $657.32 N/A N/A 36103361 EAP CPT® 37241 VASC EMBOLIZE/OCCLUDE VENOUS BOTH IP/OP "$21,962.00" "$16,252.00" $424.47 "$21,962.00" "$21,962.00" "$21,962.00" "$21,962.00" "$21,962.00" $428.47 $428.47 $433.38 "$21,962.00" $428.47 "$21,962.00" "$21,962.00" "$21,962.00" "$21,962.00" "$4,577.12" $685.55 $679.15 "$21,962.00" $428.47 $424.47 $428.47 "$21,962.00" "$16,471.50" $428.47 $428.47 $428.47 "$7,479.00" "$10,981.00" "$17,393.90" $428.47 "$17,569.60" "$14,275.30" "$21,962.00" $428.47 "$12,737.96" "$21,962.00" $457.96 $428.47 "$21,962.00" $428.47 N/A N/A 36103374 EAP CPT® 64616 CHEMODENERV MUSC NECK DYSTON BOTH IP/OP $632.00 $468.00 $110.33 $632.00 $632.00 $632.00 $632.00 $632.00 $257.00 $257.00 $255.86 $131.72 $257.00 $632.00 $632.00 $632.00 $632.00 $131.72 $411.20 $392.25 $113.00 $257.00 $110.33 $257.00 $269.85 $474.00 $257.00 $257.00 $257.00 $632.00 $316.00 $500.54 $257.00 $505.60 $632.00 $125.44 $257.00 $366.56 $269.85 $371.81 $257.00 $131.71 $257.00 N/A N/A 36103376 EAP CPT® 37243 VASC EMBOLIZE/OCCLUDE ORGAN BOTH IP/OP "$23,963.00" "$17,733.00" $553.12 "$19,170.40" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$9,880.57" "$9,880.57" "$9,836.87" "$4,994.49" "$9,880.57" "$3,769.39" "$3,769.39" "$3,914.36" "$2,645.82" "$4,994.15" "$15,808.91" "$15,314.28" "$4,877.00" "$9,880.57" $553.12 "$9,880.57" "$10,374.60" "$17,972.25" "$9,880.57" "$9,880.57" "$9,880.57" "$7,479.00" "$6,357.00" "$18,978.70" "$9,880.57" "$19,170.40" "$5,164.00" "$4,756.06" "$9,880.57" "$13,898.54" "$10,374.60" "$14,294.69" "$9,880.57" "$4,993.89" "$9,880.57" N/A N/A 36103378 EAP CPT® 34841 "ENDOVAS RP VIS A DEP VISCL AORT END, S/I,ANGIO ONE" BOTH IP/OP "$19,007.00" "$14,065.50" "$1,373.60" "$19,007.00" "$19,007.00" "$19,007.00" "$19,007.00" "$19,007.00" "$19,007.00" "$19,007.00" "$1,373.60" "$19,007.00" "$19,007.00" "$19,007.00" "$19,007.00" "$19,007.00" "$19,007.00" "$3,961.27" "$19,007.00" "$2,430.40" "$19,007.00" "$19,007.00" "$6,076.00" "$19,007.00" "$19,007.00" "$14,255.25" "$19,007.00" "$19,007.00" "$19,007.00" "$9,503.50" "$9,503.50" "$15,053.54" "$19,007.00" "$15,205.60" "$12,354.55" "$19,007.00" "$19,007.00" "$11,024.06" "$19,007.00" "$11,404.20" "$19,007.00" "$19,007.00" "$19,007.00" N/A N/A 36103379 EAP CPT® 34842 ENDOVAS RP VIS A DEP VISCL AORT END S/I ANGIO TWO BOTH IP/OP "$20,567.00" "$15,220.00" "$1,662.20" "$20,567.00" "$20,567.00" "$20,567.00" "$20,567.00" "$20,567.00" "$20,567.00" "$20,567.00" "$1,662.20" "$20,567.00" "$20,567.00" "$20,567.00" "$20,567.00" "$20,567.00" "$20,567.00" "$4,286.39" "$20,567.00" "$2,430.40" "$20,567.00" "$20,567.00" "$6,076.00" "$20,567.00" "$20,567.00" "$15,425.25" "$20,567.00" "$20,567.00" "$20,567.00" "$10,283.50" "$10,283.50" "$16,289.06" "$20,567.00" "$16,453.60" "$13,368.55" "$20,567.00" "$20,567.00" "$11,928.86" "$20,567.00" "$12,340.20" "$20,567.00" "$20,567.00" "$20,567.00" N/A N/A 36103380 EAP CPT® 34843 ENDOVAS RP VIS A DEP VISCL AORT END S/I ANGIO THREE BOTH IP/OP "$22,120.00" "$16,369.00" "$1,626.23" "$22,120.00" "$22,120.00" "$22,120.00" "$22,120.00" "$22,120.00" "$22,120.00" "$22,120.00" "$1,626.23" "$22,120.00" "$22,120.00" "$22,120.00" "$22,120.00" "$22,120.00" "$22,120.00" "$4,610.05" "$22,120.00" "$2,430.40" "$22,120.00" "$22,120.00" "$6,076.00" "$22,120.00" "$22,120.00" "$16,590.00" "$22,120.00" "$22,120.00" "$22,120.00" "$11,060.00" "$11,060.00" "$17,519.04" "$22,120.00" "$17,696.00" "$14,378.00" "$22,120.00" "$22,120.00" "$12,829.60" "$22,120.00" "$13,272.00" "$22,120.00" "$22,120.00" "$22,120.00" N/A N/A 36103381 EAP CPT® 34844 ENDOVAS RP VIS A DEP VISCL AORT END S/I ANGIO FOUR OR > BOTH IP/OP "$23,672.00" "$17,517.50" "$1,680.40" "$23,672.00" "$23,672.00" "$23,672.00" "$23,672.00" "$23,672.00" "$23,672.00" "$23,672.00" "$1,680.40" "$23,672.00" "$23,672.00" "$23,672.00" "$23,672.00" "$23,672.00" "$23,672.00" "$4,933.51" "$23,672.00" "$2,430.40" "$23,672.00" "$23,672.00" "$6,076.00" "$23,672.00" "$23,672.00" "$17,754.00" "$23,672.00" "$23,672.00" "$23,672.00" "$11,836.00" "$11,836.00" "$18,748.22" "$23,672.00" "$18,937.60" "$15,386.80" "$23,672.00" "$23,672.00" "$13,729.76" "$23,672.00" "$14,203.20" "$23,672.00" "$23,672.00" "$23,672.00" N/A N/A 36103382 EAP CPT® 34845 ENDOVAS RP VIS A DEP VISCL AORT END W/ UNIBDY OR MOD INFRENL END S/I ANGIO ONE BOTH IP/OP "$23,049.00" "$17,056.50" "$1,490.78" "$23,049.00" "$23,049.00" "$23,049.00" "$23,049.00" "$23,049.00" "$23,049.00" "$23,049.00" "$1,490.78" "$23,049.00" "$23,049.00" "$23,049.00" "$23,049.00" "$23,049.00" "$23,049.00" "$4,803.67" "$23,049.00" "$2,430.40" "$23,049.00" "$23,049.00" "$6,076.00" "$23,049.00" "$23,049.00" "$17,286.75" "$23,049.00" "$23,049.00" "$23,049.00" "$11,524.50" "$11,524.50" "$18,254.81" "$23,049.00" "$18,439.20" "$14,981.85" "$23,049.00" "$23,049.00" "$13,368.42" "$23,049.00" "$13,829.40" "$23,049.00" "$23,049.00" "$23,049.00" N/A N/A 36103383 EAP CPT® 34846 ENDOVAS RP VIS A DEP VISCL AORT END W/ UNIBDY OR MOD INFRENL END S/I ANGIO TWO BOTH IP/OP "$24,602.00" "$18,205.50" "$1,779.40" "$24,602.00" "$24,602.00" "$24,602.00" "$24,602.00" "$24,602.00" "$24,602.00" "$24,602.00" "$1,779.40" "$24,602.00" "$24,602.00" "$24,602.00" "$24,602.00" "$24,602.00" "$24,602.00" "$5,127.33" "$24,602.00" "$2,430.40" "$24,602.00" "$24,602.00" "$6,076.00" "$24,602.00" "$24,602.00" "$18,451.50" "$24,602.00" "$24,602.00" "$24,602.00" "$12,301.00" "$12,301.00" "$19,484.78" "$24,602.00" "$19,681.60" "$15,991.30" "$24,602.00" "$24,602.00" "$14,269.16" "$24,602.00" "$14,761.20" "$24,602.00" "$24,602.00" "$24,602.00" N/A N/A 36103384 EAP CPT® 34847 ENDOVAS RP VIS A DEP VISCL AORT END W/ UNIBDY OR MOD INFRENL END S/I ANGIO THREE BOTH IP/OP "$26,154.00" "$19,354.00" "$1,743.43" "$26,154.00" "$26,154.00" "$26,154.00" "$26,154.00" "$26,154.00" "$26,154.00" "$26,154.00" "$1,743.43" "$26,154.00" "$26,154.00" "$26,154.00" "$26,154.00" "$26,154.00" "$26,154.00" "$5,450.78" "$26,154.00" "$2,430.40" "$26,154.00" "$26,154.00" "$6,076.00" "$26,154.00" "$26,154.00" "$19,615.50" "$26,154.00" "$26,154.00" "$26,154.00" "$13,077.00" "$13,077.00" "$20,713.97" "$26,154.00" "$20,923.20" "$17,000.10" "$26,154.00" "$26,154.00" "$15,169.32" "$26,154.00" "$15,692.40" "$26,154.00" "$26,154.00" "$26,154.00" N/A N/A 36103385 EAP CPT® 34848 ENDOVAS RP VIS A DEP VISCL AORT END W/ UNIBDY OR MOD INFRENL END S/I ANGIO FOUR OR > BOTH IP/OP "$27,705.00" "$20,502.00" "$1,797.59" "$27,705.00" "$27,705.00" "$27,705.00" "$27,705.00" "$27,705.00" "$27,705.00" "$27,705.00" "$1,797.59" "$27,705.00" "$27,705.00" "$27,705.00" "$27,705.00" "$27,705.00" "$27,705.00" "$5,774.03" "$27,705.00" "$11,082.00" "$27,705.00" "$27,705.00" "$27,705.00" "$27,705.00" "$27,705.00" "$20,778.75" "$27,705.00" "$27,705.00" "$27,705.00" "$13,852.50" "$13,852.50" "$21,942.36" "$27,705.00" "$22,164.00" "$18,008.25" "$27,705.00" "$27,705.00" "$16,068.90" "$27,705.00" "$16,623.00" "$27,705.00" "$27,705.00" "$27,705.00" N/A N/A 36103388 EAP CPT® 20694 "REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIX SYSTEM" BOTH IP/OP "$5,413.00" "$4,006.00" $345.38 "$5,413.00" "$5,413.00" "$5,413.00" "$5,413.00" "$5,413.00" $345.58 $345.58 $345.38 "$5,413.00" $345.58 "$5,413.00" "$5,413.00" "$5,413.00" "$5,413.00" "$1,128.13" $552.93 $556.94 "$5,413.00" $345.58 $348.09 $345.58 "$5,413.00" "$4,059.75" $345.58 $345.58 $345.58 "$2,762.00" "$2,706.50" "$4,287.10" $345.58 "$4,330.40" "$3,250.00" "$5,413.00" $345.58 "$3,139.54" "$5,413.00" $350.34 $345.58 "$5,413.00" $345.58 N/A N/A 36103390 EAP CPT® 64617 "CHEMODENERVATION OF MUSCLE(S); LARYNX, UNILATERAL, PERCD" BOTH IP/OP $850.00 $629.00 $109.53 $929.56 $850.00 $850.00 $850.00 $850.00 $257.00 $257.00 $255.86 $177.16 $257.00 $850.00 $850.00 $850.00 $850.00 $177.15 $411.20 $929.56 $113.00 $257.00 $109.53 $257.00 $269.85 $637.50 $257.00 $257.00 $257.00 $850.00 $425.00 $673.20 $257.00 $680.00 $850.00 $168.70 $257.00 $493.00 $269.85 $371.81 $257.00 $177.14 $257.00 N/A N/A 36103391 EAP CPT® 66183 "INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, H" BOTH IP/OP "$6,247.00" "$4,623.00" "$1,025.56" "$6,247.00" "$6,247.00" "$6,247.00" "$6,247.00" "$6,247.00" "$1,027.18" "$1,027.18" "$1,034.02" "$6,247.00" "$1,027.18" "$6,247.00" "$6,247.00" "$6,247.00" "$6,247.00" "$1,301.94" "$1,643.49" "$1,640.90" "$6,247.00" "$1,027.18" "$1,025.56" "$1,027.18" "$6,247.00" "$4,685.25" "$1,027.18" "$1,027.18" "$1,027.18" "$4,780.00" "$3,123.50" "$4,947.62" "$1,027.18" "$4,997.60" "$4,334.00" "$6,247.00" "$1,027.18" "$3,623.26" "$6,247.00" "$1,049.71" "$1,027.18" "$6,247.00" "$1,027.18" N/A N/A 36103392 EAP CPT® 49406 "IMG-GDE FLUID COLLECT DRAIN / CATH (EG, ABCSS, HEMA, SEU" BOTH IP/OP "$6,571.00" "$4,863.00" $192.60 "$6,571.00" "$6,571.00" "$6,571.00" "$6,571.00" "$6,571.00" $194.27 $194.27 $196.26 "$6,571.00" $194.27 "$6,571.00" "$6,571.00" "$6,571.00" "$6,571.00" "$1,369.47" $310.83 $308.16 "$6,571.00" $194.27 $192.60 $194.27 "$6,571.00" "$4,928.25" $194.27 $194.27 $194.27 "$2,762.00" "$3,285.50" "$5,204.23" $194.27 "$5,256.80" "$2,500.00" "$6,571.00" $194.27 "$3,811.18" "$6,571.00" $205.56 $194.27 "$6,571.00" $194.27 N/A N/A 36103394 EAP CPT® 52356 "CYSTO, W/ URETER AND/OR PYELO; W/ LITHO INC INST OF IND" BOTH IP/OP "$8,403.00" "$6,218.50" $410.67 "$8,403.00" "$8,403.00" "$8,403.00" "$8,403.00" "$8,403.00" $413.29 $413.29 $416.78 "$8,403.00" $413.29 "$8,403.00" "$8,403.00" "$8,403.00" "$8,403.00" "$1,751.28" $661.26 $657.07 "$8,403.00" $413.29 $410.67 $413.29 "$8,403.00" "$6,302.25" $413.29 $413.29 $413.29 "$4,780.00" "$4,201.50" "$6,655.18" $413.29 "$6,722.40" "$4,334.00" "$8,403.00" $413.29 "$4,873.74" "$8,403.00" $432.00 $413.29 "$8,403.00" $413.29 N/A N/A 36103395 EAP CPT® 49405 "IMG-GDE FLUID COLLECT DRAIN / CATH (EG, ABCSS, HEMA, SEU" BOTH IP/OP "$6,571.00" "$4,863.00" $192.60 "$6,571.00" "$6,571.00" "$6,571.00" "$6,571.00" "$6,571.00" $194.62 $194.62 $196.26 "$6,571.00" $194.62 "$6,571.00" "$6,571.00" "$6,571.00" "$6,571.00" "$1,369.47" $311.39 $308.16 "$6,571.00" $194.62 $192.60 $194.62 "$6,571.00" "$4,928.25" $194.62 $194.62 $194.62 "$2,762.00" "$3,285.50" "$5,204.23" $194.62 "$5,256.80" "$2,500.00" "$6,571.00" $194.62 "$3,811.18" "$6,571.00" $205.92 $194.62 "$6,571.00" $194.62 N/A N/A 36103396 EAP CPT® 23333 REMOVAL FOREIGN BODY SHOULDER DEEP SUB FAC/INTRA MUSC BOTH IP/OP "$2,755.00" "$2,039.00" $481.90 "$2,755.00" "$2,755.00" "$2,755.00" "$2,755.00" "$2,755.00" $483.01 $483.01 $484.36 "$2,755.00" $483.01 "$2,755.00" "$2,755.00" "$2,755.00" "$2,755.00" $574.17 $772.82 $776.14 "$2,755.00" $483.01 $485.09 $483.01 "$2,755.00" "$2,066.25" $483.01 $483.01 $483.01 "$2,755.00" "$1,377.50" "$2,181.96" $483.01 "$2,204.00" "$2,150.00" "$2,755.00" $483.01 "$1,597.90" "$2,755.00" $481.90 $483.01 "$2,755.00" $483.01 N/A N/A 36103397 EAP CPT® 31633 TRANBRONCHIAL NEEDLE ASPIRATION BIOSPY EA ADDTL LOBE BOTH IP/OP "$2,726.00" "$2,017.50" $62.05 "$2,726.00" "$2,726.00" "$2,726.00" "$2,726.00" "$2,726.00" $63.28 $63.28 $64.15 "$2,726.00" $63.28 "$2,726.00" "$2,726.00" "$2,726.00" "$2,726.00" $568.13 $101.25 $99.28 "$2,726.00" $63.28 $62.05 $63.28 "$2,726.00" "$2,044.50" $63.28 $63.28 $63.28 "$1,363.00" "$1,363.00" "$2,158.99" $63.28 "$2,180.80" "$1,750.00" "$2,726.00" $63.28 "$1,581.08" "$2,726.00" $65.64 $63.28 "$2,726.00" $63.28 N/A N/A 36103398 EAP CPT® 31627 "BRONCH WITH COMPUTER-ASSISTED, IMAGE-GUIDED NAVIGATION" BOTH IP/OP "$3,577.00" "$2,647.00" $94.95 "$3,577.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$3,577.00" "$3,577.00" "$3,577.00" $745.54 "$3,577.00" "$3,577.00" "$3,577.00" "$3,577.00" "$3,577.00" $745.49 "$3,577.00" "$3,577.00" "$2,115.80" "$3,577.00" $94.95 "$3,577.00" "$3,577.00" "$2,682.75" "$3,577.00" "$3,577.00" "$3,577.00" "$1,788.50" "$1,788.50" "$2,832.98" "$3,577.00" "$2,861.60" "$1,750.00" $709.95 "$3,577.00" "$2,074.66" "$3,577.00" "$3,577.00" "$3,577.00" $745.45 "$3,577.00" N/A N/A 36103399 EAP HCPCS 64650 CHEMODENERV ECCRINE GLANDS BOTH IP/OP $527.00 $390.00 $41.04 $527.00 $527.00 $527.00 $527.00 $527.00 $257.00 $257.00 $255.86 $109.84 $257.00 $527.00 $527.00 $527.00 $527.00 $109.83 $411.20 $392.25 $527.00 $257.00 $41.04 $257.00 $269.85 $395.25 $257.00 $257.00 $257.00 $527.00 $263.50 $417.38 $257.00 $421.60 $527.00 $104.60 $257.00 $305.66 $269.85 $371.81 $257.00 $109.83 $257.00 N/A N/A 36103400 EAP HCPCS 64653 "CHEMODENERV ECCRINE OTHER SCALP,FACE,NECK" BOTH IP/OP $561.00 $415.50 $52.09 $561.00 $561.00 $561.00 $561.00 $561.00 $52.63 $52.63 $52.09 $561.00 $52.63 $561.00 $561.00 $561.00 $561.00 $116.92 $84.21 $83.60 $561.00 $52.63 $52.25 $52.63 $561.00 $420.75 $52.63 $52.63 $52.63 $561.00 $280.50 $444.31 $52.63 $448.80 $561.00 $561.00 $52.63 $325.38 $561.00 $55.16 $52.63 $561.00 $52.63 N/A N/A 36103401 EAP HCPCS 46221 LIGATION OF HEMORRHOID(S) BOTH IP/OP "$2,229.00" "$1,649.50" $195.51 "$2,229.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $780.62 $780.62 $777.17 $464.58 $780.62 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $464.55 "$1,249.00" "$1,198.91" "$1,871.00" $780.62 $195.51 $780.62 $819.65 "$1,671.75" $780.62 $780.62 $780.62 "$2,229.00" "$1,114.50" "$1,765.37" $780.62 "$1,783.20" "$2,150.00" $442.40 $780.62 "$1,292.82" $819.65 "$1,129.36" $780.62 $464.52 $780.62 N/A N/A 36103402 EAP CPT® 64450 ADDUCTOR CANAL BOTH IP/OP "$2,850.00" "$2,109.00" $42.04 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $624.63 $624.63 $621.87 $594.01 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $593.97 $999.41 $929.56 "$1,871.00" $624.63 $42.04 $624.63 $655.86 "$2,137.50" $624.63 $624.63 $624.63 "$2,762.00" "$1,425.00" "$2,257.20" $624.63 "$2,280.00" "$2,150.00" $565.65 $624.63 "$1,653.00" $655.86 $903.68 $624.63 $593.94 $624.63 N/A N/A 36103404 EAP CPT® 24200 REMOVE FB ARM SUPERFICIAL BOTH IP/OP "$4,943.00" "$3,658.00" $142.02 "$4,943.00" "$4,943.00" "$4,943.00" "$4,943.00" "$4,943.00" $144.14 $144.14 $143.97 "$4,943.00" $144.14 "$4,943.00" "$4,943.00" "$4,943.00" "$4,943.00" "$1,030.18" $230.62 $227.23 "$4,943.00" $144.14 $142.02 $144.14 "$4,943.00" "$3,707.25" $144.14 $144.14 $144.14 "$2,762.00" "$2,471.50" "$3,914.86" $144.14 "$3,954.40" "$2,150.00" "$4,943.00" $144.14 "$2,866.94" "$4,943.00" $145.98 $144.14 "$4,943.00" $144.14 N/A N/A 36103405 EAP CPT® 49425 INSERT ABDOMEN - VENOUS DRAIN BOTH IP/OP "$24,132.00" "$17,858.00" $708.41 "$24,132.00" "$24,132.00" "$24,132.00" "$24,132.00" "$24,132.00" $708.41 $708.41 $716.21 "$24,132.00" $708.41 "$24,132.00" "$24,132.00" "$24,132.00" "$24,132.00" "$5,029.37" "$1,133.46" "$1,269.97" "$24,132.00" $708.41 $793.73 $708.41 "$24,132.00" "$18,099.00" $708.41 $708.41 $708.41 "$12,066.00" "$12,066.00" "$19,112.54" $708.41 "$19,305.60" "$2,500.00" "$24,132.00" $708.41 "$13,996.56" "$24,132.00" $747.73 $708.41 "$24,132.00" $708.41 N/A N/A 36103406 EAP CPT® 54220 TREATMENT OF PENIS LESION BOTH IP/OP "$1,092.00" $808.50 $133.64 "$1,092.00" "$1,092.00" "$1,092.00" "$1,092.00" "$1,092.00" $133.66 $133.66 $134.45 "$1,092.00" $133.66 "$1,092.00" "$1,092.00" "$1,092.00" "$1,092.00" $227.58 $213.86 $213.82 "$1,092.00" $133.66 $133.64 $133.66 "$1,092.00" $819.00 $133.66 $133.66 $133.66 "$1,092.00" $546.00 $864.86 $133.66 $873.60 "$1,092.00" "$1,092.00" $133.66 $633.36 "$1,092.00" $139.18 $133.66 "$1,092.00" $133.66 N/A N/A 36103407 EAP CPT® 17106 DESTRUCTION OF SKIN LESIONS BOTH IP/OP "$1,627.00" "$1,204.00" $278.16 "$1,627.00" "$1,627.00" "$1,627.00" "$1,627.00" "$1,627.00" $340.00 $340.00 $338.49 $339.11 $340.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $339.08 $543.99 $538.21 "$1,627.00" $340.00 $278.16 $340.00 $357.00 "$1,220.25" $340.00 $340.00 $340.00 "$1,627.00" $813.50 "$1,288.58" $340.00 "$1,301.60" "$1,627.00" $322.92 $340.00 $943.66 $357.00 $491.89 $340.00 $339.07 $340.00 N/A N/A 36103410 EAP CPT® 54205 INJECTION FOR PEYRONIE DISEASE; W/SURG EXP PLAQUE BOTH IP/OP "$9,133.00" "$6,758.50" $533.57 "$9,133.00" "$9,133.00" "$9,133.00" "$9,133.00" "$9,133.00" $535.95 $535.95 $538.40 "$9,133.00" $535.95 "$9,133.00" "$9,133.00" "$9,133.00" "$9,133.00" "$1,903.42" $857.52 $853.71 "$9,133.00" $535.95 $533.57 $535.95 "$9,133.00" "$6,849.75" $535.95 $535.95 $535.95 "$4,417.00" "$4,566.50" "$7,233.34" $535.95 "$7,306.40" "$3,725.00" "$9,133.00" $535.95 "$5,297.14" "$9,133.00" $553.80 $535.95 "$9,133.00" $535.95 N/A N/A 36103411 EAP CPT® 55874 TPRNL PLMT BIODEGRADABLE MATRL PERIPROSTATIC BOTH IP/OP "$6,075.00" "$4,495.50" $163.74 "$6,943.83" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$4,339.89" "$4,339.89" "$4,320.70" "$1,266.18" "$4,339.89" "$2,192.53" "$2,192.53" "$2,276.86" "$1,538.39" "$1,266.10" "$6,943.83" "$6,783.64" "$6,075.00" "$4,339.89" $163.74 "$4,339.89" "$4,556.89" "$4,556.25" "$4,339.89" "$4,339.89" "$4,339.89" "$6,075.00" "$3,037.50" "$4,811.40" "$4,339.89" "$4,860.00" "$3,948.75" "$1,205.74" "$4,339.89" "$3,523.50" "$4,556.89" "$6,075.00" "$4,339.89" "$1,266.03" "$4,339.89" N/A N/A 36191374 EAP CPT® 64615 "DESTROY MUCLES FACIAL, TRIGEMINAL, CERVICAL, SPINAL" BOTH IP/OP $533.00 $394.50 $105.79 $533.00 $533.00 $533.00 $533.00 $533.00 $257.00 $257.00 $255.86 $111.09 $257.00 $533.00 $533.00 $533.00 $533.00 $111.08 $411.20 $392.25 $113.00 $257.00 $124.98 $257.00 $269.85 $399.75 $257.00 $257.00 $257.00 $533.00 $266.50 $422.14 $257.00 $426.40 $533.00 $105.79 $257.00 $309.14 $269.85 $371.81 $257.00 $111.08 $257.00 N/A N/A 36191375 EAP CPT® 58145 MYOMECTOMY VAG METHOD BOTH IP/OP "$5,267.00" "$3,898.00" $579.14 "$5,267.00" "$5,267.00" "$5,267.00" "$5,267.00" "$5,267.00" $582.37 $582.37 $579.92 "$5,267.00" $582.37 "$5,267.00" "$5,267.00" "$5,267.00" "$5,267.00" "$1,097.70" $931.79 $926.62 "$5,267.00" $582.37 $579.14 $582.37 "$5,267.00" "$3,950.25" $582.37 $582.37 $582.37 "$4,780.00" "$2,633.50" "$4,171.46" $582.37 "$4,213.60" "$3,250.00" "$5,267.00" $582.37 "$3,054.86" "$5,267.00" $585.47 $582.37 "$5,267.00" $582.37 N/A N/A 36191376 EAP CPT® 11982 REMOVE DRUG IMPLANT CONTRACEPTIVE BOTH IP/OP $501.00 $371.00 $74.65 $544.70 $501.00 $501.00 $501.00 $501.00 $266.97 $266.97 $265.79 $104.42 $266.97 $501.00 $501.00 $501.00 $501.00 $104.41 $427.15 $544.70 $113.00 $266.97 $74.65 $266.97 $280.32 $375.75 $266.97 $266.97 $266.97 $501.00 $250.50 $396.79 $266.97 $400.80 $501.00 $99.44 $266.97 $290.58 $280.32 $386.24 $266.97 $104.41 $266.97 N/A N/A 36191377 EAP CPT® 11983 REMOVE WITH REINSERTION OF DRUG IMPLANT BOTH IP/OP $502.00 $371.50 $99.63 $544.70 $502.00 $502.00 $502.00 $502.00 $266.97 $266.97 $265.79 $104.63 $266.97 $502.00 $502.00 $502.00 $502.00 $104.62 $427.15 $544.70 $113.00 $266.97 $104.50 $266.97 $280.32 $376.50 $266.97 $266.97 $266.97 $502.00 $251.00 $397.58 $266.97 $401.60 $502.00 $99.63 $266.97 $291.16 $280.32 $386.24 $266.97 $104.62 $266.97 N/A N/A 36191378 EAP CPT® 64435 INJ ANES/STRD PARACERVICAL NERVE BOTH IP/OP "$1,923.00" "$1,423.50" $43.56 "$1,923.00" "$1,923.00" "$1,923.00" "$1,923.00" "$1,923.00" $43.56 $43.56 $44.20 "$1,923.00" $43.56 "$1,923.00" "$1,923.00" "$1,923.00" "$1,923.00" $400.77 $69.70 $70.00 "$1,923.00" $43.56 $43.75 $43.56 "$1,923.00" "$1,442.25" $43.56 $43.56 $43.56 "$1,923.00" $961.50 "$1,523.02" $43.56 "$1,538.40" "$1,923.00" "$1,923.00" $43.56 "$1,115.34" "$1,923.00" $45.43 $43.56 "$1,923.00" $43.56 N/A N/A 36191381 EAP CPT® 31632 TRANSBRONCHIAL BX W/ADDL LOBE BOTH IP/OP "$2,153.00" "$1,593.50" $48.83 "$2,153.00" "$2,153.00" "$2,153.00" "$2,153.00" "$2,153.00" "$2,153.00" "$2,153.00" "$2,153.00" $448.74 "$2,153.00" "$2,153.00" "$2,153.00" "$2,153.00" "$2,153.00" $448.71 "$2,153.00" "$2,153.00" "$2,153.00" "$2,153.00" $48.83 "$2,153.00" "$2,153.00" "$1,614.75" "$2,153.00" "$2,153.00" "$2,153.00" "$1,076.50" "$1,076.50" "$1,705.18" "$2,153.00" "$1,722.40" "$1,750.00" $427.32 "$2,153.00" "$1,248.74" "$2,153.00" "$2,153.00" "$2,153.00" $448.69 "$2,153.00" N/A N/A 36191382 EAP CPT® 31633 TRANSBRONCHIAL NEEDLE BX W/ADDL LOBE BOTH IP/OP "$2,667.00" "$1,974.00" $62.05 "$2,667.00" "$2,667.00" "$2,667.00" "$2,667.00" "$2,667.00" $63.28 $63.28 $64.15 "$2,667.00" $63.28 "$2,667.00" "$2,667.00" "$2,667.00" "$2,667.00" $555.83 $101.25 $99.28 "$2,667.00" $63.28 $62.05 $63.28 "$2,667.00" "$2,000.25" $63.28 $63.28 $63.28 "$1,333.50" "$1,333.50" "$2,112.26" $63.28 "$2,133.60" "$1,750.00" "$2,667.00" $63.28 "$1,546.86" "$2,667.00" $65.64 $63.28 "$2,667.00" $63.28 N/A N/A 36191383 EAP CPT® 20950 COMPARTMENT PRESSURE MEASUREMENT BOTH IP/OP $664.00 $491.50 $88.49 $664.00 $664.00 $664.00 $664.00 $664.00 $88.76 $88.76 $88.86 $664.00 $88.76 $664.00 $664.00 $664.00 $664.00 $138.38 $142.02 $141.58 $664.00 $88.76 $88.49 $88.76 $664.00 $498.00 $88.76 $88.76 $88.76 $664.00 $332.00 $525.89 $88.76 $531.20 $664.00 $664.00 $88.76 $385.12 $664.00 $92.28 $88.76 $664.00 $88.76 N/A N/A 36191384 EAP CPT® 23405 "TENOTOMY, SHOULDER AREA; SINGLE TENDON" BOTH IP/OP "$5,610.00" "$4,151.50" $630.22 "$5,610.00" "$5,610.00" "$5,610.00" "$5,610.00" "$5,610.00" $632.35 $632.35 $633.19 "$5,610.00" $632.35 "$5,610.00" "$5,610.00" "$5,610.00" "$5,610.00" "$1,169.19" "$1,011.76" "$1,008.35" "$5,610.00" $632.35 $630.22 $632.35 "$5,610.00" "$4,207.50" $632.35 $632.35 $632.35 "$2,851.00" "$2,805.00" "$4,443.12" $632.35 "$4,488.00" "$3,725.00" "$5,610.00" $632.35 "$3,253.80" "$5,610.00" $644.50 $632.35 "$5,610.00" $632.35 N/A N/A 36191385 EAP CPT® 59151 TREAT ECTOPIC PREGNANCY BOTH IP/OP "$13,348.00" "$9,878.00" $781.52 "$13,348.00" "$13,348.00" "$13,348.00" "$13,348.00" "$13,348.00" $787.39 $787.39 $781.52 "$13,348.00" $787.39 "$13,348.00" "$13,348.00" "$13,348.00" "$13,348.00" "$2,781.87" "$1,259.82" "$1,269.38" "$13,348.00" $787.39 $793.36 $787.39 "$13,348.00" "$10,011.00" $787.39 $787.39 $787.39 "$6,679.00" "$6,674.00" "$10,571.62" $787.39 "$10,678.40" "$4,334.00" "$13,348.00" $787.39 "$7,741.84" "$13,348.00" $802.02 $787.39 "$13,348.00" $787.39 N/A N/A 36191386 EAP CPT® 24357 "TENOTOMY, ELBOW, LATERAL OR MEDIA; PERCUTANEOUS" BOTH IP/OP "$2,899.00" "$2,145.50" $427.84 "$2,899.00" "$2,899.00" "$2,899.00" "$2,899.00" "$2,899.00" $429.71 $429.71 $427.84 "$2,899.00" $429.71 "$2,899.00" "$2,899.00" "$2,899.00" "$2,899.00" $604.18 $687.54 $684.67 "$2,899.00" $429.71 $427.92 $429.71 "$2,899.00" "$2,174.25" $429.71 $429.71 $429.71 "$2,899.00" "$1,449.50" "$2,296.01" $429.71 "$2,319.20" "$2,899.00" "$2,899.00" $429.71 "$1,681.42" "$2,899.00" $431.83 $429.71 "$2,899.00" $429.71 N/A N/A 36191387 EAP CPT® 26055 TENDON SHEATH INCISION BOTH IP/OP "$2,440.00" "$1,806.00" $246.90 "$2,440.00" "$2,440.00" "$2,440.00" "$2,440.00" "$2,440.00" "$1,370.10" "$1,370.10" "$1,364.04" "$2,440.00" "$1,370.10" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$2,440.00" "$2,192.17" "$2,069.52" "$2,440.00" "$1,370.10" $300.20 "$1,370.10" "$1,438.61" "$1,830.00" "$1,370.10" "$1,370.10" "$1,370.10" "$2,440.00" "$2,440.00" "$2,440.00" "$1,370.10" "$2,440.00" "$2,440.00" $246.90 "$1,370.10" "$1,415.20" "$1,438.61" "$1,982.20" "$1,370.10" "$2,440.00" "$1,370.10" N/A N/A 36191389 EAP CPT® 64491 INJ PARAVERT F JNT C/T 2 LEV BOTH IP/OP "$1,819.00" "$1,346.50" $59.34 "$1,819.00" "$1,819.00" "$1,819.00" "$1,819.00" "$1,819.00" "$1,819.00" "$1,819.00" "$1,819.00" $379.13 "$1,819.00" "$1,819.00" "$1,819.00" "$1,819.00" "$1,819.00" $379.10 "$1,819.00" "$1,819.00" "$1,075.94" "$1,819.00" $59.34 "$1,819.00" "$1,819.00" "$1,364.25" "$1,819.00" "$1,819.00" "$1,819.00" $909.50 $909.50 "$1,440.65" "$1,819.00" "$1,455.20" "$1,750.00" $361.03 "$1,819.00" "$1,055.02" "$1,819.00" "$1,819.00" "$1,819.00" $379.08 "$1,819.00" N/A N/A 36191391 EAP CPT® 27000 "TENOTOMY, ADDUCTOR OF HIP, PERCUTANEOUS" BOTH IP/OP "$1,575.00" "$1,165.50" $328.25 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $411.35 $411.35 $416.46 "$1,575.00" $411.35 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 $658.16 $641.34 "$1,575.00" $411.35 $400.84 $411.35 "$1,575.00" "$1,181.25" $411.35 $411.35 $411.35 "$1,575.00" $787.50 "$1,247.40" $411.35 "$1,260.00" "$1,575.00" "$1,575.00" $411.35 $913.50 "$1,575.00" $419.97 $411.35 "$1,575.00" $411.35 N/A N/A 36191392 EAP CPT® 27005 "TENOTOMY, HIP FLEXOR(S), OPEN" BOTH IP/OP "$1,961.00" "$1,451.50" $408.69 "$1,961.00" "$1,961.00" "$1,961.00" "$1,961.00" "$1,961.00" $737.39 $737.39 $733.74 "$1,961.00" $737.39 "$1,961.00" "$1,961.00" "$1,961.00" "$1,961.00" $408.69 "$1,179.82" "$1,169.62" "$1,961.00" $737.39 $731.01 $737.39 "$1,961.00" "$1,470.75" $737.39 $737.39 $737.39 "$1,961.00" $980.50 "$1,553.11" $737.39 "$1,568.80" "$1,274.65" "$1,961.00" $737.39 "$1,137.38" "$1,961.00" $752.27 $737.39 "$1,961.00" $737.39 N/A N/A 36191393 EAP CPT® 27006 "TENOTOMY, ABDUCTORS AND/OR EXTENSOR(S) OF HIP,OPEN" BOTH IP/OP "$2,650.00" "$1,961.00" $552.29 "$2,650.00" "$2,650.00" "$2,650.00" "$2,650.00" "$2,650.00" $730.75 $730.75 $734.63 "$2,650.00" $730.75 "$2,650.00" "$2,650.00" "$2,650.00" "$2,650.00" $552.29 "$1,169.20" "$1,161.15" "$2,650.00" $730.75 $725.72 $730.75 "$2,650.00" "$1,987.50" $730.75 $730.75 $730.75 "$2,650.00" "$1,325.00" "$2,098.80" $730.75 "$2,120.00" "$2,650.00" "$2,650.00" $730.75 "$1,537.00" "$2,650.00" $746.17 $730.75 "$2,650.00" $730.75 N/A N/A 36191394 EAP CPT® 27306 "TENOTOMY, PERCUTANEOUS, OR HAMSTRING, SINGLE TENDON" BOTH IP/OP "$5,757.00" "$4,260.50" $342.53 "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" $346.34 $346.34 $342.56 "$5,757.00" $346.34 "$5,757.00" "$5,757.00" "$5,757.00" "$5,757.00" "$1,199.82" $554.14 $548.05 "$5,757.00" $346.34 $342.53 $346.34 "$5,757.00" "$4,317.75" $346.34 $346.34 $346.34 "$3,500.00" "$2,878.50" "$4,559.54" $346.34 "$4,605.60" "$3,250.00" "$5,757.00" $346.34 "$3,339.06" "$5,757.00" $355.80 $346.34 "$5,757.00" $346.34 N/A N/A 36191395 EAP CPT® 27307 "TENOTOMY, PERCUTANEOUS, ADDUCTOR OR HAMSTRING; MULTIPLE TENDONS" BOTH IP/OP "$8,511.00" "$6,298.50" $417.46 "$8,511.00" "$8,511.00" "$8,511.00" "$8,511.00" "$8,511.00" $427.25 $427.25 $491.99 "$8,511.00" $427.25 "$8,511.00" "$8,511.00" "$8,511.00" "$8,511.00" "$1,773.79" $683.60 $667.94 "$8,511.00" $427.25 $417.46 $427.25 "$8,511.00" "$6,383.25" $427.25 $427.25 $427.25 "$3,500.00" "$4,255.50" "$6,740.71" $427.25 "$6,808.80" "$3,725.00" "$8,511.00" $427.25 "$4,936.38" "$8,511.00" $498.83 $427.25 "$8,511.00" $427.25 N/A N/A 36191396 EAP CPT® 27605 "TENOTOMY, PERCUTANEOUS, ACHILLES TENDON ; LOCAL ANESTHESIA" BOTH IP/OP "$1,485.00" "$1,099.00" $185.02 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $185.13 $185.13 $187.02 "$1,485.00" $185.13 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 $296.21 $296.03 "$1,485.00" $185.13 $185.02 $185.13 "$1,485.00" "$1,113.75" $185.13 $185.13 $185.13 "$1,485.00" $742.50 "$1,176.12" $185.13 "$1,188.00" "$1,485.00" "$1,485.00" $185.13 $861.30 "$1,485.00" $192.52 $185.13 "$1,485.00" $185.13 N/A N/A 36191397 EAP CPT® 28008 "FASCIOTOMY, FOOT AND/OR TOE" BOTH IP/OP "$2,912.00" "$2,155.00" $297.50 "$2,912.00" "$2,912.00" "$2,912.00" "$2,912.00" "$2,912.00" $297.73 $297.73 $299.44 "$2,912.00" $297.73 "$2,912.00" "$2,912.00" "$2,912.00" "$2,912.00" $606.89 $476.37 $476.00 "$2,912.00" $297.73 $297.50 $297.73 "$2,912.00" "$2,184.00" $297.73 $297.73 $297.73 "$2,912.00" "$1,456.00" "$2,306.30" $297.73 "$2,329.60" "$2,912.00" "$2,912.00" $297.73 "$1,688.96" "$2,912.00" $306.09 $297.73 "$2,912.00" $297.73 N/A N/A 36191398 EAP CPT® 28899 "UNLISTED PROCEDURE, FOOT OR TOES" BOTH IP/OP "$2,668.00" "$1,974.50" $234.80 "$2,668.00" "$2,668.00" "$2,668.00" "$2,668.00" "$2,668.00" "$2,668.00" "$2,668.00" "$2,668.00" "$2,668.00" "$2,668.00" "$2,668.00" "$2,668.00" "$2,668.00" "$2,668.00" $556.04 "$2,668.00" $234.80 "$2,668.00" "$2,668.00" $587.00 "$2,668.00" "$2,668.00" "$2,001.00" "$2,668.00" "$2,668.00" "$2,668.00" "$2,668.00" "$1,334.00" "$2,113.06" "$2,668.00" "$2,134.40" "$1,750.00" "$2,668.00" "$2,668.00" "$1,547.44" "$2,668.00" "$1,600.80" "$2,668.00" "$2,668.00" "$2,668.00" N/A N/A 36191399 EAP CPT® 64430 INJ ANES/STRD PUDENDAL NERVE BOTH IP/OP $995.00 $736.50 $54.93 "$1,295.61" $995.00 $995.00 $995.00 $995.00 $809.76 $809.76 $806.18 $207.38 $809.76 $995.00 $995.00 $995.00 $882.37 $207.37 "$1,295.61" "$1,229.40" $995.00 $809.76 $54.93 $809.76 $850.25 $746.25 $809.76 $809.76 $809.76 $995.00 $497.50 $788.04 $809.76 $796.00 $995.00 $197.48 $809.76 $577.10 $850.25 $995.00 $809.76 $207.36 $809.76 N/A N/A 36191400 EAP CPT® 12037 INTMD WND REPAIR S/TR/EXT BOTH IP/OP "$2,035.00" "$1,506.00" $330.36 "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" $331.28 $331.28 $332.35 "$2,035.00" $331.28 "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" $424.12 $530.05 $528.58 "$2,035.00" $331.28 $330.36 $331.28 "$2,035.00" "$1,526.25" $331.28 $331.28 $331.28 "$2,035.00" "$1,017.50" "$1,611.72" $331.28 "$1,628.00" "$2,035.00" "$2,035.00" $331.28 "$1,180.30" "$2,035.00" $343.53 $331.28 "$2,035.00" $331.28 N/A N/A 36191401 EAP CPT® 26070 "ARTHROTOMY W/EXPL,DRAIN,RMVL OF LOOSE/FB CARPOMETACARPAL JNT" BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$2,192.17" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,370.10" "$1,370.10" "$1,364.04" $312.64 "$1,370.10" "$1,500.00" "$1,500.00" "$1,500.00" "$1,082.33" $312.62 "$2,192.17" "$2,069.52" "$1,500.00" "$1,370.10" $332.77 "$1,370.10" "$1,438.61" "$1,125.00" "$1,370.10" "$1,370.10" "$1,370.10" "$1,500.00" $750.00 "$1,188.00" "$1,370.10" "$1,200.00" "$1,500.00" $297.71 "$1,370.10" $870.00 "$1,438.61" "$1,500.00" "$1,370.10" $312.60 "$1,370.10" N/A N/A 36191402 EAP CPT® 26075 "ARTHROTOMY W/EXPL,DRAIN,RMVL OF LOOSE/FB METACARPOPHALANGEAL JNT EA" BOTH IP/OP "$2,700.00" "$1,998.00" $345.83 "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" $346.37 $346.37 $345.83 "$2,700.00" $346.37 "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" $562.71 $554.19 $559.01 "$2,700.00" $346.37 $349.38 $346.37 "$2,700.00" "$2,025.00" $346.37 $346.37 $346.37 "$2,700.00" "$1,350.00" "$2,138.40" $346.37 "$2,160.00" "$2,500.00" "$2,700.00" $346.37 "$1,566.00" "$2,700.00" $347.44 $346.37 "$2,700.00" $346.37 N/A N/A 36191403 EAP CPT® 26080 "ARTHROTOMY W/EXPL,DRAIN,RMVL OF LOOSE/FB INTERPHALANGEAL JNT EA" BOTH IP/OP "$2,575.00" "$1,905.50" $407.24 "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" $408.91 $408.91 $407.24 "$2,575.00" $408.91 "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" $536.66 $654.26 $657.10 "$2,575.00" $408.91 $410.69 $408.91 "$2,575.00" "$1,931.25" $408.91 $408.91 $408.91 "$2,575.00" "$1,287.50" "$2,039.40" $408.91 "$2,060.00" "$2,500.00" "$2,575.00" $408.91 "$1,493.50" "$2,575.00" $407.62 $408.91 "$2,575.00" $408.91 N/A N/A 36191404 EAP Custom 26320 REMOVAL OF IMPLANT FROM FINGER OR HAND BOTH IP/OP "$1,581.00" "$1,170.00" $329.50 "$1,581.00" "$1,581.00" "$1,581.00" "$1,581.00" "$1,581.00" $359.07 $359.07 $358.28 "$1,581.00" $359.07 "$1,581.00" "$1,581.00" "$1,581.00" "$1,581.00" $329.50 $574.51 $576.38 "$1,581.00" $359.07 $360.24 $359.07 "$1,581.00" "$1,185.75" $359.07 $359.07 $359.07 "$1,581.00" $790.50 "$1,252.15" $359.07 "$1,264.80" "$1,581.00" "$1,581.00" $359.07 $916.98 "$1,581.00" $360.78 $359.07 "$1,581.00" $359.07 N/A N/A 36191405 EAP CPT® 26641 "CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION,THUMB,W/MANIPULATION" BOTH IP/OP "$1,104.00" $817.00 $230.09 "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" $395.01 $395.01 $391.48 "$1,104.00" $395.01 "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" $230.09 $632.02 $634.90 "$1,104.00" $395.01 $396.81 $395.01 "$1,104.00" $828.00 $395.01 $395.01 $395.01 "$1,104.00" $552.00 $874.37 $395.01 $883.20 "$1,104.00" "$1,104.00" $395.01 $640.32 "$1,104.00" $359.33 $395.01 "$1,104.00" $395.01 N/A N/A 36191406 EAP CPT® 26607 "CLSD TX OF METACARPAL FX, W/ MANIP,W/EXTERNAL FIX EA BONE" BOTH IP/OP "$3,176.00" "$2,350.50" $503.48 "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" $526.91 $526.91 $518.08 "$3,176.00" $526.91 "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" $661.91 $843.06 $840.40 "$3,176.00" $526.91 $525.25 $526.91 "$3,176.00" "$2,382.00" $526.91 $526.91 $526.91 "$2,851.00" "$1,588.00" "$2,515.39" $526.91 "$2,540.80" "$2,500.00" "$3,176.00" $526.91 "$1,842.08" "$3,176.00" $503.48 $526.91 "$3,176.00" $526.91 N/A N/A 36191407 EAP CPT® 26645 "CLSD TX OF CARPOMETACARPAL FX DISLOC, THUMB W/MANIP" BOTH IP/OP "$1,500.00" "$1,110.00" $312.62 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $407.87 $407.87 $406.44 "$1,500.00" $407.87 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 $652.59 $656.13 "$1,500.00" $407.87 $410.08 $407.87 "$1,500.00" "$1,125.00" $407.87 $407.87 $407.87 "$1,500.00" $750.00 "$1,188.00" $407.87 "$1,200.00" "$1,500.00" "$1,500.00" $407.87 $870.00 "$1,500.00" $407.98 $407.87 "$1,500.00" $407.87 N/A N/A 36191408 EAP CPT® 26650 PERC SKEL FIX OF CARPOMETACARPAL FX DISLOC THUMB W/ MANIP BOTH IP/OP "$5,811.00" "$4,300.50" $494.76 "$5,811.00" "$5,811.00" "$5,811.00" "$5,811.00" "$5,811.00" $494.76 $494.76 $495.10 "$5,811.00" $494.76 "$5,811.00" "$5,811.00" "$5,811.00" "$5,811.00" "$1,211.08" $791.62 $795.89 "$5,811.00" $494.76 $497.43 $494.76 "$5,811.00" "$4,358.25" $494.76 $494.76 $494.76 "$2,851.00" "$2,905.50" "$4,602.31" $494.76 "$4,648.80" "$3,250.00" "$5,811.00" $494.76 "$3,370.38" "$5,811.00" $496.27 $494.76 "$5,811.00" $494.76 N/A N/A 36191409 EAP CPT® 26670 "CLSD TX OF CARPOMETACARPAL DISLOC NOT THUMB, W/MANIP EA JNT,W/O ANEST" BOTH IP/OP "$1,035.00" $766.00 $215.71 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $322.75 $322.75 $320.30 "$1,035.00" $322.75 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 $516.40 $519.54 "$1,035.00" $322.75 $324.71 $322.75 "$1,035.00" $776.25 $322.75 $322.75 $322.75 "$1,035.00" $517.50 $819.72 $322.75 $828.00 "$1,035.00" "$1,035.00" $322.75 $600.30 "$1,035.00" $319.70 $322.75 "$1,035.00" $322.75 N/A N/A 36191450 EAP CPT® 69209 REMOVE CERUMEN IMPACTED IRRIG/LAVAGE UNILAT BOTH IP/OP $274.00 $203.00 $15.56 $274.00 $274.00 $274.00 $274.00 $274.00 $54.76 $54.76 $54.51 $57.11 $54.76 $274.00 $274.00 $274.00 $274.00 $57.10 $87.61 $82.92 $113.00 $54.76 $15.56 $54.76 $57.49 $205.50 $54.76 $54.76 $54.76 $274.00 $137.00 $217.01 $54.76 $219.20 $274.00 $54.38 $54.76 $158.92 $57.49 $79.22 $54.76 $57.10 $54.76 N/A N/A 36191451 EAP CPT® 66761 IRIDOTOMY LASER SURGERY-BOTH EYES BOTH IP/OP "$11,463.00" "$8,483.00" $235.39 "$9,170.40" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $495.04 $495.04 $492.86 "$2,389.18" $495.04 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 "$2,389.02" $792.07 $765.72 "$1,871.00" $495.04 $235.39 $495.04 $519.80 "$8,597.25" $495.04 $495.04 $495.04 "$2,762.00" "$2,348.00" "$9,078.70" $495.04 "$9,170.40" "$2,150.00" "$2,275.12" $495.04 "$6,648.54" $519.80 $716.21 $495.04 "$2,388.89" $495.04 N/A N/A 36191452 EAP CPT® 64405 INJ ANES/STRD GREATER OCCIPITAL NERVE BOTH IP/OP "$3,313.00" "$2,452.00" $53.29 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $257.00 $257.00 $255.86 $690.51 $257.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $690.47 $411.20 $392.25 "$1,871.00" $257.00 $53.29 $257.00 $269.85 "$2,484.75" $257.00 $257.00 $257.00 "$2,762.00" "$1,656.50" "$2,623.90" $257.00 "$2,650.40" "$2,150.00" $657.55 $257.00 "$1,921.54" $269.85 $371.81 $257.00 $690.43 $257.00 N/A N/A 36191453 EAP CPT® 64510 INJECT STELLATE GANGLION BOTH IP/OP "$1,767.00" "$1,308.00" $76.92 "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" "$1,767.00" $809.76 $809.76 $806.18 $368.29 $809.76 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $368.26 "$1,295.61" "$1,229.40" "$1,767.00" $809.76 $76.92 $809.76 $850.25 "$1,325.25" $809.76 $809.76 $809.76 "$1,767.00" $883.50 "$1,399.46" $809.76 "$1,413.60" "$1,767.00" $350.71 $809.76 "$1,024.86" $850.25 "$1,171.52" $809.76 $368.24 $809.76 N/A N/A 36191454 EAP CPT® 64620 DESTROY INTERCOSTAL NEUROLYTIC BOTH IP/OP "$6,513.00" "$4,820.00" $178.29 "$6,513.00" "$6,513.00" "$6,513.00" "$6,513.00" "$6,513.00" $178.72 $178.72 $178.91 "$6,513.00" $178.72 "$6,513.00" "$6,513.00" "$6,513.00" "$6,513.00" "$1,357.38" $285.95 $285.26 "$6,513.00" $178.72 $178.29 $178.72 "$6,513.00" "$4,884.75" $178.72 $178.72 $178.72 "$2,762.00" "$3,256.50" "$5,158.30" $178.72 "$5,210.40" "$3,250.00" "$6,513.00" $809.76 "$3,777.54" "$6,513.00" $181.36 $178.72 "$6,513.00" $178.72 N/A N/A 36191455 EAP CPT® 64494 INJ PARAVERT F JNT L/S 2 LEV BOTH IP/OP "$1,721.00" "$1,274.00" $51.20 "$1,721.00" "$1,721.00" "$1,721.00" "$1,721.00" "$1,721.00" "$1,721.00" "$1,721.00" "$1,721.00" $358.70 "$1,721.00" "$1,721.00" "$1,721.00" "$1,721.00" "$1,721.00" $358.68 "$1,721.00" "$1,721.00" "$1,017.97" "$1,721.00" $51.20 "$1,721.00" "$1,721.00" "$1,290.75" "$1,721.00" "$1,721.00" "$1,721.00" $860.50 $860.50 "$1,363.03" "$1,721.00" "$1,376.80" "$1,721.00" $341.58 "$1,721.00" $998.18 "$1,721.00" "$1,721.00" "$1,721.00" $358.66 "$1,721.00" N/A N/A 36191456 EAP CPT® 64495 INJ PARAVERT F JNT L/S 3 LEV BOTH IP/OP "$1,652.00" "$1,222.50" $51.87 "$1,652.00" "$1,652.00" "$1,652.00" "$1,652.00" "$1,652.00" "$1,652.00" "$1,652.00" "$1,652.00" $344.32 "$1,652.00" "$1,652.00" "$1,652.00" "$1,652.00" "$1,652.00" $344.29 "$1,652.00" "$1,652.00" $977.16 "$1,652.00" $51.87 "$1,652.00" "$1,652.00" "$1,239.00" "$1,652.00" "$1,652.00" "$1,652.00" $826.00 $826.00 "$1,308.38" "$1,652.00" "$1,321.60" "$1,652.00" $327.88 "$1,652.00" $958.16 "$1,652.00" "$1,652.00" "$1,652.00" $344.28 "$1,652.00" N/A N/A 36191457 EAP CPT® 64492 INJ PARAVERT F JNT C/T 3 LEV BOTH IP/OP "$1,627.00" "$1,204.00" $60.35 "$1,627.00" "$1,627.00" "$1,627.00" "$1,627.00" "$1,627.00" $60.51 $60.51 $61.99 "$1,627.00" $60.51 "$1,627.00" "$1,627.00" "$1,627.00" "$1,627.00" $339.08 $96.82 $96.56 "$1,627.00" $60.51 $60.35 $60.51 "$1,627.00" "$1,220.25" $60.51 $60.51 $60.51 $813.50 $813.50 "$1,288.58" $60.51 "$1,301.60" "$1,627.00" "$1,627.00" $60.51 $943.66 "$1,627.00" $63.11 $60.51 "$1,627.00" $60.51 N/A N/A 36191458 EAP CPT® 64493 INJ PARAVERT F JNT L/S 1 LEV BOTH IP/OP "$3,789.00" "$2,804.00" $90.50 "$3,031.20" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $809.76 $809.76 $806.18 $789.72 $809.76 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $789.67 "$1,295.61" "$1,229.40" "$1,871.00" $809.76 $90.50 $809.76 $850.25 "$2,841.75" $809.76 $809.76 $809.76 "$2,762.00" "$1,894.50" "$3,000.89" $809.76 "$3,031.20" "$2,150.00" $752.02 $809.76 "$2,197.62" $850.25 "$1,171.52" $809.76 $789.63 $809.76 N/A N/A 36191459 EAP CPT® 64490 INJ PARAVERT F JNT C/T 1 LEV BOTH IP/OP "$3,789.00" "$2,804.00" $105.07 "$3,031.20" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $809.76 $809.76 $806.18 $789.72 $809.76 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $789.67 "$1,295.61" "$1,229.40" "$1,871.00" $809.76 $105.07 $809.76 $850.25 "$2,841.75" $809.76 $809.76 $809.76 "$2,762.00" "$1,894.50" "$3,000.89" $809.76 "$3,031.20" "$2,150.00" $752.02 $809.76 "$2,197.62" $850.25 "$1,171.52" $809.76 $789.63 $809.76 N/A N/A 36191460 EAP CPT® 64517 NBLOCK INJ HYPOGAS PLXS BOTH IP/OP "$3,493.00" "$2,585.00" $126.41 "$2,851.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" $809.76 $809.76 $806.18 $728.03 $809.76 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $727.98 "$1,295.61" "$1,229.40" "$2,836.00" $809.76 $126.41 $809.76 $850.25 "$2,619.75" $809.76 $809.76 $809.76 "$2,851.00" "$1,746.50" "$2,766.46" $809.76 "$2,794.40" "$2,150.00" $693.27 $809.76 "$2,025.94" $850.25 "$1,171.52" $809.76 $727.94 $809.76 N/A N/A 36191461 EAP CPT® 64418 INJ ANES/STRD SUPRASCAPULAR BOTH IP/OP "$3,173.00" "$2,348.50" $55.95 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $624.63 $624.63 $621.87 $661.33 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $661.29 $999.41 $929.56 "$1,871.00" $624.63 $55.95 $624.63 $655.86 "$2,379.75" $624.63 $624.63 $624.63 "$2,762.00" "$1,586.50" "$2,513.02" $624.63 "$2,538.40" "$2,150.00" $629.76 $624.63 "$1,840.34" $655.86 $903.68 $624.63 $661.25 $624.63 N/A N/A 36191462 EAP CPT® 38222 BONE MARROW BIOPSY(IES) & ASPIRATION(S) BOTH IP/OP "$2,325.00" "$1,720.50" $75.59 "$3,731.74" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,332.34" "$2,332.34" "$2,322.02" $484.59 "$2,332.34" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $484.56 "$3,731.74" "$3,726.76" "$1,871.00" "$2,332.34" $75.59 "$2,332.34" "$2,448.96" "$1,743.75" "$2,332.34" "$2,332.34" "$2,332.34" "$2,325.00" "$1,162.50" "$1,841.40" "$2,332.34" "$1,860.00" "$1,511.25" $461.45 "$2,332.34" "$1,348.50" "$2,448.96" "$2,325.00" "$2,332.34" $484.53 "$2,332.34" N/A N/A 36191464 EAP CPT® 65855 "ARGON TRABECULOPLASTY, BOTH EYES" BOTH IP/OP "$4,121.00" "$3,050.00" $204.61 "$3,296.80" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" $495.04 $495.04 $492.86 $858.92 $495.04 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $858.86 $792.07 $765.72 "$1,871.00" $495.04 $204.61 $495.04 $519.80 "$3,090.75" $495.04 $495.04 $495.04 "$2,762.00" "$2,348.00" "$3,263.83" $495.04 "$3,296.80" "$2,150.00" $817.92 $495.04 "$2,390.18" $519.80 $716.21 $495.04 $858.82 $495.04 N/A N/A 36191465 EAP CPT® 67040 "PAN RETINAL PHOTOCOAGULATION, BOTH EYES" BOTH IP/OP "$15,964.00" "$11,813.50" "$1,029.44" "$15,964.00" "$15,964.00" "$15,964.00" "$15,964.00" "$15,964.00" "$1,031.08" "$1,031.08" "$1,038.97" "$15,964.00" "$1,031.08" "$15,964.00" "$15,964.00" "$15,964.00" "$15,964.00" "$3,327.07" "$1,649.73" "$1,647.10" "$15,964.00" "$1,031.08" "$1,029.44" "$1,031.08" "$15,964.00" "$11,973.00" "$1,031.08" "$1,031.08" "$1,031.08" "$6,095.00" "$7,982.00" "$12,643.49" "$1,031.08" "$12,771.20" "$4,334.00" "$15,964.00" "$1,031.08" "$9,259.12" "$15,964.00" "$1,061.32" "$1,031.08" "$15,964.00" "$1,031.08" N/A N/A 36191466 EAP CPT® 66821 "YAG CAPSULOTOMY, BOTH EYES" BOTH IP/OP "$3,181.00" "$2,354.00" $311.18 "$2,851.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" $495.04 $495.04 $492.86 $663.00 $495.04 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $662.96 $792.07 $765.72 "$2,836.00" $495.04 $311.18 $495.04 $519.80 "$2,385.75" $495.04 $495.04 $495.04 "$2,851.00" "$1,590.50" "$2,519.35" $495.04 "$2,544.80" "$2,150.00" $631.35 $495.04 "$1,844.98" $519.80 $716.21 $495.04 $662.92 $495.04 N/A N/A 36191467 EAP CPT® 65865 "ARGON LASER GONIOPLASTY, ONE EYE" BOTH IP/OP "$4,345.00" "$3,215.50" $477.85 "$4,345.00" "$4,345.00" "$4,345.00" "$4,345.00" "$4,345.00" $478.72 $478.72 $480.57 "$4,345.00" $478.72 "$4,345.00" "$4,345.00" "$4,345.00" "$4,345.00" $905.55 $765.95 $764.56 "$4,345.00" $478.72 $477.85 $478.72 "$4,345.00" "$3,258.75" $478.72 $478.72 $478.72 "$2,762.00" "$2,172.50" "$3,441.24" $478.72 "$3,476.00" "$3,250.00" "$4,345.00" $478.72 "$2,520.10" "$4,345.00" $484.82 $478.72 "$4,345.00" $478.72 N/A N/A 36191468 EAP CPT® 46230 "EXCISION OF MULTIPLE EXTERNAL PAPILLAE OR TAGS, ANUS" BOTH IP/OP "$4,962.00" "$3,672.00" $175.30 "$4,962.00" "$4,962.00" "$4,962.00" "$4,962.00" "$4,962.00" $175.30 $175.30 $175.64 "$4,962.00" $175.30 "$4,962.00" "$4,962.00" "$4,962.00" "$4,962.00" "$1,034.14" $280.48 $281.01 "$4,962.00" $175.30 $175.63 $175.30 "$4,962.00" "$3,721.50" $175.30 $175.30 $175.30 "$2,762.00" "$2,481.00" "$3,929.90" $175.30 "$3,969.60" "$2,500.00" "$4,962.00" $175.30 "$2,877.96" "$4,962.00" $180.24 $175.30 "$4,962.00" $175.30 N/A N/A 36191469 EAP CPT® 31574 LARYNGOSCOPY W/ INJ AUGMENTATION UNILATERAL BOTH IP/OP "$3,605.00" "$2,668.00" $148.79 "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" $149.30 $149.30 $148.79 "$3,605.00" $149.30 "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" $751.32 $238.88 $240.86 "$3,605.00" $149.30 $150.54 $149.30 "$3,605.00" "$2,703.75" $149.30 $149.30 $149.30 "$2,762.00" "$1,802.50" "$2,855.16" $149.30 "$2,884.00" "$2,500.00" "$3,605.00" $149.30 "$2,090.90" "$3,605.00" $152.15 $149.30 "$3,605.00" $149.30 N/A N/A 36191470 EAP CPT® 31574 LARYNGOSCOPY W/ INJ AUGMENTATION BILATERAL BOTH IP/OP "$4,748.00" "$3,514.00" $148.79 "$4,748.00" "$4,748.00" "$4,748.00" "$4,748.00" "$4,748.00" $149.30 $149.30 $148.79 "$4,748.00" $149.30 "$4,748.00" "$4,748.00" "$4,748.00" "$4,748.00" $989.54 $238.88 $240.86 "$4,748.00" $149.30 $150.54 $149.30 "$4,748.00" "$3,561.00" $149.30 $149.30 $149.30 "$2,762.00" "$2,374.00" "$3,760.42" $149.30 "$3,798.40" "$2,500.00" "$4,748.00" $149.30 "$2,753.84" "$4,748.00" $152.15 $149.30 "$4,748.00" $149.30 N/A N/A 36191471 EAP CPT® 62355 REMOVE SPINAL CANAL CATHETER BOTH IP/OP "$7,880.00" "$5,831.50" $276.45 "$7,880.00" "$7,880.00" "$7,880.00" "$7,880.00" "$7,880.00" $276.45 $276.45 $277.04 "$7,880.00" $276.45 "$7,880.00" "$7,880.00" "$7,880.00" "$7,880.00" "$1,642.28" $442.32 $448.14 "$7,880.00" $276.45 $280.09 $276.45 "$7,880.00" "$5,910.00" $276.45 $276.45 $276.45 "$2,851.00" "$3,940.00" "$6,240.96" $276.45 "$6,304.00" "$3,250.00" "$7,880.00" $276.45 "$4,570.40" "$7,880.00" $280.78 $276.45 "$7,880.00" $276.45 N/A N/A 36191472 EAP CPT® 64561 IMPLANT NEUROELECTRODES SACRAL NERVE BOTH IP/OP "$11,177.00" "$8,271.00" $304.51 "$11,177.00" "$11,177.00" "$11,177.00" "$11,177.00" "$11,177.00" $305.76 $305.76 $307.00 "$11,177.00" $305.76 "$11,177.00" "$11,177.00" "$11,177.00" "$11,177.00" "$2,329.41" $489.22 $487.22 "$11,177.00" $305.76 $304.51 $305.76 "$11,177.00" "$8,382.75" $305.76 $305.76 $305.76 "$3,500.00" "$5,588.50" "$8,852.18" $305.76 "$8,941.60" "$4,334.00" "$11,177.00" $305.76 "$6,482.66" "$11,177.00" $316.22 $305.76 "$11,177.00" $305.76 N/A N/A 36191473 EAP CPT® 64461 PVB THORACIC SINGLE INJ SITE BOTH IP/OP "$4,312.00" "$3,191.00" $77.98 "$4,312.00" "$4,312.00" "$4,312.00" "$4,312.00" "$4,312.00" $79.00 $79.00 $77.98 "$4,312.00" $79.00 "$4,312.00" "$4,312.00" "$4,312.00" "$4,312.00" $898.67 $126.40 $125.36 "$4,312.00" $79.00 $78.35 $79.00 "$4,312.00" "$3,234.00" $79.00 $79.00 $79.00 "$2,762.00" "$2,156.00" "$3,415.10" $79.00 "$3,449.60" "$2,150.00" "$4,312.00" $79.00 "$2,500.96" "$4,312.00" $80.08 $79.00 "$4,312.00" $79.00 N/A N/A 36191474 EAP CPT® 64462 PVB THORACIC 2ND+ INJ SITE BOTH IP/OP "$2,500.00" "$1,850.00" $48.84 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $49.17 $49.17 $49.58 "$2,500.00" $49.17 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 $78.67 $78.14 "$2,500.00" $49.17 $48.84 $49.17 "$2,500.00" "$1,875.00" $49.17 $49.17 $49.17 "$1,250.00" "$1,250.00" "$1,980.00" $49.17 "$2,000.00" "$1,750.00" "$2,500.00" $49.17 "$1,450.00" "$2,500.00" $51.22 $49.17 "$2,500.00" $49.17 N/A N/A 36191475 EAP CPT® 55920 PLACE NEEDLES PELVIC FOR RT BOTH IP/OP "$10,000.00" "$7,400.00" $460.57 "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" $460.57 $460.57 $460.80 "$10,000.00" $460.57 "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" $736.91 $741.25 "$10,000.00" $460.57 $463.28 $460.57 "$10,000.00" "$7,500.00" $460.57 $460.57 $460.57 "$3,500.00" "$5,000.00" "$7,920.00" $460.57 "$8,000.00" "$3,725.00" "$10,000.00" $460.57 "$5,800.00" "$10,000.00" $472.02 $460.57 "$10,000.00" $460.57 N/A N/A 36191476 EAP CPT® 36660 INSERTION CATHETER ARTERY BOTH IP/OP $212.00 $157.00 $44.18 $212.00 $212.00 $212.00 $212.00 $212.00 $69.22 $69.22 $69.10 $212.00 $69.22 $212.00 $212.00 $212.00 $212.00 $44.18 $110.75 $109.01 $212.00 $69.22 $68.13 $69.22 $212.00 $159.00 $69.22 $69.22 $69.22 $212.00 $106.00 $167.90 $69.22 $169.60 $137.80 $212.00 $69.22 $122.96 $212.00 $71.05 $69.22 $212.00 $69.22 N/A N/A 36191477 EAP CPT® 46910 DESTRUCTION ANAL LESION(S) BOTH IP/OP "$5,868.00" "$4,342.50" $136.27 "$4,877.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,684.82" "$1,684.82" "$1,677.37" "$1,223.04" "$1,684.82" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,222.96" "$2,695.71" "$2,489.83" "$4,877.00" "$1,684.82" $136.27 "$1,684.82" "$1,769.06" "$4,401.00" "$1,684.82" "$1,684.82" "$1,684.82" "$2,762.00" "$2,348.00" "$4,647.46" "$1,684.82" "$4,694.40" "$2,500.00" "$1,164.65" "$1,684.82" "$3,403.44" "$1,769.06" "$2,437.51" "$1,684.82" "$1,222.89" "$1,684.82" N/A N/A 36191478 EAP CPT® 66500 IRIDOTOMY BY STAB INCISION; EXCEPT TRANSFIXION BOTH IP/OP "$4,000.00" "$2,960.00" $380.60 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $400.30 $400.30 $393.20 "$4,000.00" $400.30 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 $640.48 $635.42 "$4,000.00" $400.30 $397.14 $400.30 "$4,000.00" "$3,000.00" $400.30 $400.30 $400.30 "$2,762.00" "$2,000.00" "$3,168.00" $400.30 "$3,200.00" "$1,750.00" "$4,000.00" $400.30 "$2,320.00" "$4,000.00" $380.60 $400.30 "$4,000.00" $400.30 N/A N/A 36191479 EAP CPT® 65435 CURETTE/TREAT CORNEA BOTH IP/OP "$2,421.00" "$1,792.00" $68.76 "$2,421.00" "$2,421.00" "$2,421.00" "$2,421.00" "$2,421.00" $68.88 $68.88 $68.82 "$2,421.00" $68.88 "$2,421.00" "$2,421.00" "$2,421.00" "$2,421.00" $504.56 $110.21 $110.02 "$2,421.00" $68.88 $68.76 $68.88 "$2,421.00" "$1,815.75" $68.88 $68.88 $68.88 "$2,421.00" "$1,210.50" "$1,917.43" $68.88 "$1,936.80" "$2,150.00" "$2,421.00" $68.88 "$1,404.18" "$2,421.00" $71.38 $68.88 "$2,421.00" $68.88 N/A N/A 36191480 EAP CPT® 65810 PARACENTESIS ANT CHAM W/ RMVL VITREOUS W/WO AIR INJ BOTH IP/OP "$6,052.00" "$4,478.50" $462.30 "$6,052.00" "$6,052.00" "$6,052.00" "$6,052.00" "$6,052.00" $462.49 $462.49 $465.60 "$6,052.00" $462.49 "$6,052.00" "$6,052.00" "$6,052.00" "$6,052.00" "$1,261.30" $739.98 $739.68 "$6,052.00" $462.49 $462.30 $462.49 "$6,052.00" "$4,539.00" $462.49 $462.49 $462.49 "$3,500.00" "$3,026.00" "$4,793.18" $462.49 "$4,841.60" "$3,250.00" "$6,052.00" $462.49 "$3,510.16" "$6,052.00" $473.66 $462.49 "$6,052.00" $462.49 N/A N/A 36191481 EAP CPT® 27369 NJX PX CNTRST KNE ARTHG CNTRST ENHNCD CT/MRI KNE BOTH IP/OP "$1,323.00" $979.50 $40.14 "$1,323.00" "$1,323.00" "$1,323.00" "$1,323.00" "$1,323.00" $40.14 $40.14 $40.47 "$1,323.00" $40.14 "$1,323.00" "$1,323.00" "$1,323.00" "$1,323.00" $275.73 $64.22 $65.12 "$1,323.00" $40.14 $40.70 $40.14 "$1,323.00" $992.25 $40.14 $40.14 $40.14 $661.50 $661.50 "$1,047.82" $40.14 "$1,058.40" $859.95 "$1,323.00" $40.14 $767.34 "$1,323.00" $42.55 $40.14 "$1,323.00" $40.14 N/A N/A 36191482 EAP CPT® 33285 INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG BOTH IP/OP "$12,848.00" "$9,508.00" $87.91 "$12,840.65" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$8,025.41" "$8,025.41" "$7,989.91" "$2,677.84" "$8,025.41" "$3,769.39" "$3,769.39" "$3,914.36" "$2,645.82" "$2,677.66" "$12,840.65" "$11,776.10" "$4,877.00" "$8,025.41" $87.91 "$8,025.41" "$8,426.68" "$9,636.00" "$8,025.41" "$8,025.41" "$8,025.41" "$7,479.00" "$6,357.00" "$10,175.62" "$8,025.41" "$10,278.40" "$8,351.20" "$2,550.01" "$8,025.41" "$7,451.84" "$8,426.68" "$11,610.74" "$8,025.41" "$2,677.52" "$8,025.41" N/A N/A 36191483 EAP CPT® 33286 REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR BOTH IP/OP "$13,427.00" "$9,936.00" $86.55 "$10,741.60" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $612.13 $612.13 $609.42 "$2,798.52" $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 "$2,798.33" $979.40 $936.25 "$2,836.00" $612.13 $86.55 $612.13 $642.73 "$10,070.25" $612.13 $612.13 $612.13 "$2,762.00" "$2,348.00" "$10,634.18" $612.13 "$10,741.60" "$8,727.55" "$2,664.92" $612.13 "$7,787.66" $642.73 $885.59 $612.13 "$2,798.19" $612.13 N/A N/A 36191484 EAP CPT® 10005 FNA BX W/ US GUIDE 1ST LESION BOTH IP/OP "$1,535.00" "$1,136.00" $73.93 "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" $612.13 $612.13 $609.42 $319.93 $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $319.91 $979.40 $936.25 "$1,535.00" $612.13 $73.93 $612.13 $642.73 "$1,151.25" $612.13 $612.13 $612.13 "$1,535.00" $767.50 "$1,215.72" $612.13 "$1,228.00" $997.75 $304.66 $612.13 $890.30 $642.73 $885.59 $612.13 $319.89 $612.13 N/A N/A 36191485 EAP CPT® 10006 FNA BX W/ US GUIDE EA ADDTL BOTH IP/OP $524.00 $388.00 $50.18 $524.00 $524.00 $524.00 $524.00 $524.00 $524.00 $524.00 $524.00 $109.21 $524.00 $524.00 $524.00 $524.00 $524.00 $109.21 $524.00 $524.00 $309.95 $524.00 $50.18 $524.00 $524.00 $393.00 $524.00 $524.00 $524.00 $262.00 $262.00 $415.01 $524.00 $419.20 $340.60 $104.00 $524.00 $303.92 $524.00 $524.00 $524.00 $109.20 $524.00 N/A N/A 36191486 EAP CPT® 10007 FNA BX W/ FLUORO GUIDE 1ST LESION BOTH IP/OP "$1,535.00" "$1,136.00" $88.85 "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" $91.69 $91.69 $92.48 "$1,535.00" $91.69 "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" $319.91 $146.70 $142.16 "$1,535.00" $91.69 $88.85 $91.69 "$1,535.00" "$1,151.25" $91.69 $91.69 $91.69 "$1,535.00" $767.50 "$1,215.72" $91.69 "$1,228.00" $997.75 "$1,535.00" $91.69 $890.30 "$1,535.00" $97.00 $91.69 "$1,535.00" $91.69 N/A N/A 36191487 EAP CPT® 10008 FNA BX W/ FLUORO GUIDE EA ADDTL BOTH IP/OP $524.00 $388.00 $52.60 $524.00 $524.00 $524.00 $524.00 $524.00 $57.75 $57.75 $58.92 $524.00 $57.75 $524.00 $524.00 $524.00 $524.00 $109.21 $92.40 $84.16 $524.00 $57.75 $52.60 $57.75 $524.00 $393.00 $57.75 $57.75 $57.75 $262.00 $262.00 $415.01 $57.75 $419.20 $340.60 $524.00 $57.75 $303.92 $524.00 $63.47 $57.75 $524.00 $57.75 N/A N/A 36191488 EAP CPT® 10009 FNA BX W/ CT GUIDE 1ST LESION BOTH IP/OP "$1,535.00" "$1,136.00" $109.19 "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" $612.13 $612.13 $609.42 $319.93 $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $319.91 $979.40 $936.25 "$1,535.00" $612.13 $109.19 $612.13 $642.73 "$1,151.25" $612.13 $612.13 $612.13 "$1,535.00" $767.50 "$1,215.72" $612.13 "$1,228.00" $997.75 $304.66 $612.13 $890.30 $642.73 $885.59 $612.13 $319.89 $612.13 N/A N/A 36191489 EAP CPT® 10010 FNA BX W/ CT GUIDE EA ADDTL BOTH IP/OP $524.00 $388.00 $71.92 $524.00 $524.00 $524.00 $524.00 $524.00 $80.13 $80.13 $81.81 $524.00 $80.13 $524.00 $524.00 $524.00 $524.00 $109.21 $128.21 $115.07 $524.00 $80.13 $71.92 $80.13 $524.00 $393.00 $80.13 $80.13 $80.13 $262.00 $262.00 $415.01 $80.13 $419.20 $340.60 $524.00 $80.13 $303.92 $524.00 $85.83 $80.13 $524.00 $80.13 N/A N/A 36191490 EAP CPT® 10011 FNA BX W/ MR GUIDE 1ST LESION BOTH IP/OP "$1,535.00" "$1,136.00" $319.91 "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" $325.01 "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" $319.91 "$1,535.00" $614.00 "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" "$1,151.25" "$1,535.00" "$1,535.00" "$1,535.00" "$1,535.00" $767.50 "$1,215.72" "$1,535.00" "$1,228.00" $997.75 "$1,535.00" "$1,535.00" $890.30 "$1,535.00" $921.00 "$1,535.00" "$1,535.00" "$1,535.00" N/A N/A 36191491 EAP CPT® 10012 FNA BX W/ MR GUIDE EA ADDTL BOTH IP/OP $524.00 $388.00 $109.21 $524.00 $524.00 $524.00 $524.00 $524.00 $524.00 $524.00 $184.11 $524.00 $524.00 $524.00 $524.00 $524.00 $524.00 $109.21 $524.00 $209.60 $524.00 $524.00 $524.00 $524.00 $524.00 $393.00 $524.00 $524.00 $524.00 $262.00 $262.00 $415.01 $524.00 $419.20 $340.60 $524.00 $524.00 $303.92 $524.00 $314.40 $524.00 $524.00 $524.00 N/A N/A 36191492 EAP CPT® 11102 TANGENTIAL (SHAVE) BX SKIN; 1ST LESION BOTH IP/OP $313.00 $232.00 $37.97 $313.00 $313.00 $313.00 $313.00 $313.00 $176.64 $176.64 $175.86 $65.24 $176.64 $313.00 $313.00 $313.00 $313.00 $65.23 $282.63 $260.52 $113.00 $176.64 $37.97 $176.64 $185.48 $234.75 $176.64 $176.64 $176.64 $313.00 $156.50 $247.90 $176.64 $250.40 $203.45 $62.12 $176.64 $181.54 $185.48 $255.56 $176.64 $65.23 $176.64 N/A N/A 36191493 EAP CPT® 11104 PUNCH BX SKIN; 1ST LESION BOTH IP/OP $313.00 $232.00 $47.13 $543.99 $313.00 $313.00 $313.00 $313.00 $340.00 $340.00 $338.49 $65.24 $340.00 $313.00 $313.00 $313.00 $313.00 $65.23 $543.99 $538.21 $113.00 $340.00 $47.13 $340.00 $357.00 $234.75 $340.00 $340.00 $340.00 $313.00 $156.50 $247.90 $340.00 $250.40 $203.45 $62.12 $340.00 $181.54 $357.00 $313.00 $340.00 $65.23 $340.00 N/A N/A 36191494 EAP CPT® 11106 INCISIONAL (WEDGE) BX SKIN; 1ST LESION BOTH IP/OP $375.00 $277.50 $56.62 $375.00 $375.00 $375.00 $375.00 $375.00 $57.04 $57.04 $58.21 $375.00 $57.04 $375.00 $375.00 $375.00 $375.00 $78.15 $91.26 $90.59 $375.00 $57.04 $56.62 $57.04 $375.00 $281.25 $57.04 $57.04 $57.04 $375.00 $187.50 $297.00 $57.04 $300.00 $243.75 $375.00 $57.04 $217.50 $375.00 $60.94 $57.04 $375.00 $57.04 N/A N/A 36191495 EAP CPT® 11103 TANGENTIAL (SHAVE) BX SKIN; EA ADDTL BOTH IP/OP $300.00 $222.00 $21.69 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $300.00 $177.45 $300.00 $21.69 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $59.54 $300.00 $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 36191496 EAP CPT® 11105 PUNCH BX SKIN; EA ADDTL BOTH IP/OP $300.00 $222.00 $25.77 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $300.00 $177.45 $300.00 $25.77 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $59.54 $300.00 $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 36191497 EAP CPT® 11107 INCISIONAL (WEDGE) BX SKIN; EA ADDTL BOTH IP/OP $300.00 $222.00 $30.85 $300.00 $300.00 $300.00 $300.00 $300.00 $31.24 $31.24 $31.21 $300.00 $31.24 $300.00 $300.00 $300.00 $300.00 $62.52 $49.98 $49.36 $300.00 $31.24 $30.85 $31.24 $300.00 $225.00 $31.24 $31.24 $31.24 $150.00 $150.00 $237.60 $31.24 $240.00 $195.00 $300.00 $31.24 $174.00 $300.00 $32.81 $31.24 $300.00 $31.24 N/A N/A 36191498 EAP CPT® 43762 PERQ REPLACEMENT GTUBE NOT REQ REV GASTRO TRACT BOTH IP/OP "$1,668.00" "$1,234.50" $36.99 "$1,668.00" "$1,668.00" "$1,668.00" "$1,668.00" "$1,668.00" $37.31 $37.31 $38.28 "$1,668.00" $37.31 "$1,668.00" "$1,668.00" "$1,668.00" "$1,668.00" $347.63 $59.70 $59.18 "$1,668.00" $37.31 $36.99 $37.31 "$1,668.00" "$1,251.00" $37.31 $37.31 $37.31 "$1,668.00" $834.00 "$1,321.06" $37.31 "$1,334.40" "$1,084.20" "$1,668.00" $37.31 $967.44 "$1,668.00" $39.66 $37.31 "$1,668.00" $37.31 N/A N/A 36191499 EAP CPT® 43763 PERQ REPLACEMENT GTUBE REQUIRING REV GASTRO TRACT BOTH IP/OP "$1,668.00" "$1,234.50" $85.29 "$1,668.00" "$1,668.00" "$1,668.00" "$1,668.00" "$1,668.00" $85.63 $85.63 $85.29 "$1,668.00" $85.63 "$1,668.00" "$1,668.00" "$1,668.00" "$1,668.00" $347.63 $137.01 $140.56 "$1,668.00" $85.63 $87.85 $85.63 "$1,668.00" "$1,251.00" $85.63 $85.63 $85.63 "$1,668.00" $834.00 "$1,321.06" $85.63 "$1,334.40" "$1,084.20" "$1,668.00" $85.63 $967.44 "$1,668.00" $87.97 $85.63 "$1,668.00" $85.63 N/A N/A 36191500 EAP CPT® 50436 PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG BOTH IP/OP "$9,134.00" "$6,759.50" $147.82 "$9,134.00" "$9,134.00" "$9,134.00" "$9,134.00" "$9,134.00" $149.90 $149.90 $151.14 "$9,134.00" $149.90 "$9,134.00" "$9,134.00" "$9,134.00" "$9,134.00" "$1,903.63" $239.84 $236.51 "$9,134.00" $149.90 $147.82 $149.90 "$9,134.00" "$6,850.50" $149.90 $149.90 $149.90 "$2,762.00" "$4,567.00" "$7,234.13" $149.90 "$7,307.20" "$5,937.10" "$9,134.00" $149.90 "$5,297.72" "$9,134.00" $156.86 $149.90 "$9,134.00" $149.90 N/A N/A 36191501 EAP CPT® 50437 PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS BOTH IP/OP "$9,134.00" "$6,759.50" $246.48 "$9,134.00" "$9,134.00" "$9,134.00" "$9,134.00" "$9,134.00" $247.60 $247.60 $250.64 "$9,134.00" $247.60 "$9,134.00" "$9,134.00" "$9,134.00" "$9,134.00" "$1,903.63" $396.16 $394.37 "$9,134.00" $247.60 $246.48 $247.60 "$9,134.00" "$6,850.50" $247.60 $247.60 $247.60 "$4,780.00" "$4,567.00" "$7,234.13" $247.60 "$7,307.20" "$5,937.10" "$9,134.00" $247.60 "$5,297.72" "$9,134.00" $262.88 $247.60 "$9,134.00" $247.60 N/A N/A 36191502 EAP CPT® 65436 CURETTAGE/TREATMENT CORNEA BOTH IP/OP "$4,500.00" "$3,330.00" $367.99 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $367.99 $367.99 $370.02 "$4,500.00" $367.99 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 $588.78 $589.07 "$4,500.00" $367.99 $368.17 $367.99 "$4,500.00" "$3,375.00" $367.99 $367.99 $367.99 "$2,762.00" "$2,250.00" "$3,564.00" $367.99 "$3,600.00" "$3,250.00" "$4,500.00" $367.99 "$2,610.00" "$4,500.00" $377.06 $367.99 "$4,500.00" $367.99 N/A N/A 36191503 EAP CPT® 10004 FNA BX W/O IMG GDN EA ADDL BOTH IP/OP $524.00 $388.00 $42.73 $524.00 $524.00 $524.00 $524.00 $524.00 $43.21 $43.21 $43.22 $524.00 $43.21 $524.00 $524.00 $524.00 $524.00 $109.21 $69.14 $68.37 $524.00 $43.21 $42.73 $43.21 $524.00 $393.00 $43.21 $43.21 $43.21 $262.00 $262.00 $415.01 $43.21 $419.20 $340.60 $524.00 $43.21 $303.92 $524.00 $45.07 $43.21 $524.00 $43.21 N/A N/A 36191504 EAP CPT® 27369 CT/MR CONTRAST ENHANCED ARTHRG KNEE INJ PX BILATERAL BOTH IP/OP "$1,984.00" "$1,468.50" $40.14 "$1,984.00" "$1,984.00" "$1,984.00" "$1,984.00" "$1,984.00" $40.14 $40.14 $40.47 "$1,984.00" $40.14 "$1,984.00" "$1,984.00" "$1,984.00" "$1,984.00" $413.49 $64.22 $65.12 "$1,984.00" $40.14 $40.70 $40.14 "$1,984.00" "$1,488.00" $40.14 $40.14 $40.14 $992.00 $992.00 "$1,571.33" $40.14 "$1,587.20" "$1,289.60" "$1,984.00" $40.14 "$1,150.72" "$1,984.00" $42.55 $40.14 "$1,984.00" $40.14 N/A N/A 36191505 EAP CPT® 64635 BILATERAL DESTR LUMB/SAC FACET JNT; SINGLE BOTH IP/OP "$4,252.00" "$3,146.50" $191.83 "$4,252.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,727.24" "$1,727.24" "$1,719.60" $886.22 "$1,727.24" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $886.16 "$2,763.59" "$2,593.22" "$4,252.00" "$1,727.24" $191.83 "$1,727.24" "$1,813.61" "$3,189.00" "$1,727.24" "$1,727.24" "$1,727.24" "$2,762.00" "$2,348.00" "$3,367.58" "$1,727.24" "$3,401.60" "$3,250.00" $843.92 "$1,727.24" "$2,466.16" "$1,813.61" "$2,498.89" "$1,727.24" $886.12 "$1,727.24" N/A N/A 36191507 EAP CPT® 69209 REMOVE IMPACTED EAR WAX IRRIG/LAVAGE BIL BOTH IP/OP $410.00 $303.50 $15.56 $410.00 $410.00 $410.00 $410.00 $410.00 $54.76 $54.76 $54.51 $85.45 $54.76 $410.00 $410.00 $410.00 $410.00 $85.45 $87.61 $82.92 $113.00 $54.76 $15.56 $54.76 $57.49 $307.50 $54.76 $54.76 $54.76 $410.00 $205.00 $324.72 $54.76 $328.00 $410.00 $81.37 $54.76 $237.80 $57.49 $79.22 $54.76 $85.44 $54.76 N/A N/A 36191508 EAP CPT® 36573 INS PICC W/ IMAGING 5 YR+ BOTH IP/OP "$5,719.00" "$4,232.50" $83.76 "$5,719.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,383.25" "$1,383.25" "$1,377.13" "$1,191.98" "$1,383.25" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,191.90" "$2,213.20" "$2,146.46" "$5,719.00" "$1,383.25" $83.76 "$1,383.25" "$1,452.41" "$4,289.25" "$1,383.25" "$1,383.25" "$1,383.25" "$2,762.00" "$2,348.00" "$4,529.45" "$1,383.25" "$4,575.20" "$3,717.35" "$1,135.08" "$1,383.25" "$3,317.02" "$1,452.41" "$2,001.22" "$1,383.25" "$1,191.84" "$1,383.25" N/A N/A 36191509 EAP CPT® 27266 CLSD TX POST HIP ARTHROPLASTY DISLOC BOTH IP/OP "$4,283.00" "$3,169.50" $597.62 "$4,283.00" "$4,283.00" "$4,283.00" "$4,283.00" "$4,283.00" $598.38 $598.38 $597.62 "$4,283.00" $598.38 "$4,283.00" "$4,283.00" "$4,283.00" "$4,283.00" $892.62 $957.41 $958.50 "$4,283.00" $598.38 $599.06 $598.38 "$4,283.00" "$3,212.25" $598.38 $598.38 $598.38 "$2,851.00" "$2,141.50" "$3,392.14" $598.38 "$3,426.40" "$2,500.00" "$4,283.00" $598.38 "$2,484.14" "$4,283.00" $605.55 $598.38 "$4,283.00" $598.38 N/A N/A 36191510 EAP CPT® 15793 CHEMICAL PEEL (TCA) NONFACIAL BOTH IP/OP "$1,268.00" $938.50 $264.27 "$1,268.00" "$1,268.00" "$1,268.00" "$1,268.00" "$1,268.00" $357.14 $357.14 $355.29 "$1,268.00" $357.14 "$1,268.00" "$1,268.00" "$1,268.00" "$1,268.00" $264.27 $571.42 $572.86 "$1,268.00" $357.14 $358.04 $357.14 "$1,268.00" $951.00 $357.14 $357.14 $357.14 "$1,268.00" $634.00 "$1,004.26" $357.14 "$1,014.40" "$1,268.00" "$1,268.00" $357.14 $735.44 "$1,268.00" $362.58 $357.14 "$1,268.00" $357.14 N/A N/A 36191511 EAP CPT® 46922 SIMPLE EXCISION OF ANAL LESION(S) BOTH IP/OP "$7,021.00" "$5,196.00" $138.66 "$7,021.00" "$7,021.00" "$7,021.00" "$7,021.00" "$7,021.00" $139.59 $139.59 $138.66 "$7,021.00" $139.59 "$7,021.00" "$7,021.00" "$7,021.00" "$7,021.00" "$1,463.25" $223.34 $224.03 "$7,021.00" $139.59 $140.02 $139.59 "$7,021.00" "$5,265.75" $139.59 $139.59 $139.59 "$2,762.00" "$3,510.50" "$5,560.63" $139.59 "$5,616.80" "$3,250.00" "$7,021.00" "$2,403.12" "$4,072.18" "$7,021.00" $141.66 $139.59 "$7,021.00" $139.59 N/A N/A 36191512 EAP CPT® 20526 BILATERAL CARPAL TUNNEL INJ BOTH IP/OP "$1,355.00" "$1,003.00" $57.67 "$1,355.00" "$1,355.00" "$1,355.00" "$1,355.00" "$1,355.00" $257.00 $257.00 $255.86 $282.42 $257.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $282.40 $411.20 $392.25 "$1,355.00" $257.00 $57.67 $257.00 $269.85 "$1,016.25" $257.00 $257.00 $257.00 "$1,355.00" $677.50 "$1,073.16" $257.00 "$1,084.00" "$1,355.00" $268.93 $257.00 $785.90 $269.85 $371.81 $257.00 $282.38 $257.00 N/A N/A 36191513 EAP CPT® 64483 BIL INJECT TXFORAMEN EPI L/S SNGL BOTH IP/OP "$2,651.00" "$1,962.00" $110.83 "$2,651.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $809.76 $809.76 $806.18 $552.53 $809.76 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $552.50 "$1,295.61" "$1,229.40" "$1,871.00" $809.76 $110.83 $809.76 $850.25 "$1,988.25" $809.76 $809.76 $809.76 "$2,651.00" "$1,325.50" "$2,099.59" $809.76 "$2,120.80" "$2,150.00" $526.16 $809.76 "$1,537.58" $850.25 "$1,171.52" $809.76 $552.47 $809.76 N/A N/A 36191514 EAP CPT® 67110 REPAIR RETINAL DETACHMENT INJ PX BOTH IP/OP "$7,476.00" "$5,532.50" $810.14 "$7,476.00" "$7,476.00" "$7,476.00" "$7,476.00" "$7,476.00" $810.14 $810.14 $815.21 "$7,476.00" $810.14 "$7,476.00" "$7,476.00" "$7,476.00" "$7,476.00" "$1,558.08" "$1,296.22" "$1,296.22" "$7,476.00" $810.14 $810.14 $810.14 "$7,476.00" "$5,607.00" $810.14 $810.14 $810.14 "$2,762.00" "$3,738.00" "$5,920.99" $810.14 "$5,980.80" "$3,250.00" "$7,476.00" $810.14 "$4,336.08" "$7,476.00" $828.72 $810.14 "$7,476.00" $810.14 N/A N/A 36191515 EAP CPT® 11450 REMOVAL SWEAT GLAND LESION BOTH IP/OP "$8,560.00" "$6,334.50" $266.15 "$6,848.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,332.34" "$2,332.34" "$2,322.02" "$1,784.12" "$2,332.34" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$1,784.00" "$3,731.74" "$3,726.76" "$2,836.00" "$2,332.34" $266.15 "$2,332.34" "$2,448.96" "$6,420.00" "$2,332.34" "$2,332.34" "$2,332.34" "$2,851.00" "$2,423.00" "$6,779.52" "$2,332.34" "$6,848.00" "$3,250.00" "$1,698.95" "$2,332.34" "$4,964.80" "$2,448.96" "$3,374.31" "$2,332.34" "$1,783.90" "$2,332.34" N/A N/A 36191516 EAP CPT® 69210 BIL REMOVAL IMPACTED CERUMEN INSTRUMENT BOTH IP/OP $613.00 $454.00 $32.89 $613.00 $613.00 $613.00 $613.00 $613.00 $54.76 $54.76 $54.51 $127.76 $54.76 $613.00 $613.00 $613.00 $613.00 $127.76 $87.61 $82.92 $113.00 $54.76 $32.89 $54.76 $57.49 $459.75 $54.76 $54.76 $54.76 $613.00 $306.50 $485.50 $54.76 $490.40 $613.00 $121.67 $54.76 $355.54 $57.49 $79.22 $54.76 $127.75 $54.76 N/A N/A 36191517 EAP CPT® 45100 BIOPSY OF RECTUM BOTH IP/OP "$5,621.00" "$4,160.00" $306.39 "$5,621.00" "$5,621.00" "$5,621.00" "$5,621.00" "$5,621.00" $307.64 $307.64 $306.39 "$5,621.00" $307.64 "$5,621.00" "$5,621.00" "$5,621.00" "$5,621.00" "$1,171.48" $492.22 $492.50 "$5,621.00" $307.64 $307.81 $307.64 "$5,621.00" "$4,215.75" $307.64 $307.64 $307.64 "$2,762.00" "$2,810.50" "$4,451.83" $307.64 "$4,496.80" "$2,500.00" "$5,621.00" $307.64 "$3,260.18" "$5,621.00" $311.79 $307.64 "$5,621.00" $307.64 N/A N/A 36191518 EAP CPT® 11462 EXCISION HIDRADENITIS INGUINAL SIMPLE/INTERM BOTH IP/OP "$7,409.00" "$5,483.00" $249.19 "$7,409.00" "$7,409.00" "$7,409.00" "$7,409.00" "$7,409.00" $253.29 $253.29 $249.19 "$7,409.00" $253.29 "$7,409.00" "$7,409.00" "$7,409.00" "$7,409.00" "$1,544.12" $405.26 $403.55 "$7,409.00" $253.29 $252.22 $253.29 "$7,409.00" "$5,556.75" $253.29 $253.29 $253.29 "$2,851.00" "$3,704.50" "$5,867.93" $253.29 "$5,927.20" "$3,250.00" "$7,409.00" $253.29 "$4,297.22" "$7,409.00" $252.65 $253.29 "$7,409.00" $253.29 N/A N/A 36191519 EAP CPT® 20611 BILATERAL DRAIN/INJECT-SHOULDER HIP KNEE WITH US GUIDANCE BOTH IP/OP "$4,395.00" "$3,252.50" $60.38 "$3,516.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $257.00 $257.00 $255.86 $916.03 $257.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $915.97 $411.20 $392.25 $113.00 $257.00 $60.38 $257.00 $269.85 "$3,296.25" $257.00 $257.00 $257.00 "$2,762.00" "$2,348.00" "$3,480.84" $257.00 "$3,516.00" "$1,750.00" $872.30 $257.00 "$2,549.10" $269.85 $371.81 $257.00 $915.92 $257.00 N/A N/A 36191520 EAP CPT® 55899 GENITAL SURGERY PROCEDURE UNLISTED BOTH IP/OP "$5,214.00" "$3,858.50" "$1,086.65" "$5,214.00" "$5,214.00" "$5,214.00" "$5,214.00" "$5,214.00" "$5,214.00" "$5,214.00" "$5,214.00" "$5,214.00" "$5,214.00" "$5,214.00" "$5,214.00" "$5,214.00" "$5,214.00" "$1,086.65" "$5,214.00" "$2,085.60" "$5,214.00" "$5,214.00" "$5,214.00" "$5,214.00" "$5,214.00" "$3,910.50" "$5,214.00" "$5,214.00" "$5,214.00" "$2,762.00" "$2,607.00" "$4,129.49" "$5,214.00" "$4,171.20" "$1,750.00" "$5,214.00" "$5,214.00" "$3,024.12" "$5,214.00" "$3,128.40" "$5,214.00" "$5,214.00" "$5,214.00" N/A N/A 36191521 EAP CPT® 53020 INCISION OF URETHRA BOTH IP/OP "$6,761.00" "$5,003.50" $96.30 "$6,761.00" "$6,761.00" "$6,761.00" "$6,761.00" "$6,761.00" $96.49 $96.49 $97.29 "$6,761.00" $96.49 "$6,761.00" "$6,761.00" "$6,761.00" "$6,761.00" "$1,409.07" $154.38 $154.08 "$6,761.00" $96.49 $96.30 $96.49 "$6,761.00" "$5,070.75" $96.49 $96.49 $96.49 "$2,762.00" "$3,380.50" "$5,354.71" $96.49 "$5,408.80" "$3,250.00" "$6,761.00" $96.49 "$3,921.38" "$6,761.00" $100.96 $96.49 "$6,761.00" $96.49 N/A N/A 36191522 EAP CPT® 31636 BRONCHOSCOPY INITIAL BRONCH STENT BOTH IP/OP "$9,005.00" "$6,664.00" $213.96 "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" $218.21 $218.21 $220.65 "$9,005.00" $218.21 "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.74" $349.14 $342.34 "$9,005.00" $218.21 $213.96 $218.21 "$9,005.00" "$6,753.75" $218.21 $218.21 $218.21 "$2,851.00" "$4,502.50" "$7,131.96" $218.21 "$7,204.00" "$3,725.00" "$9,005.00" $218.21 "$5,222.90" "$9,005.00" $228.27 $218.21 "$9,005.00" $218.21 N/A N/A 36191523 EAP CPT® 31637 BRONCHOSCOPY ADDL BRONCH STENT BOTH IP/OP "$4,558.00" "$3,373.00" $76.30 "$4,558.00" "$4,558.00" "$4,558.00" "$4,558.00" "$4,558.00" $77.36 $77.36 $77.97 "$4,558.00" $77.36 "$4,558.00" "$4,558.00" "$4,558.00" "$4,558.00" $949.94 $123.78 $122.08 "$4,558.00" $77.36 $76.30 $77.36 "$4,558.00" "$3,418.50" $77.36 $77.36 $77.36 "$2,762.00" "$2,279.00" "$3,609.94" $77.36 "$3,646.40" "$1,750.00" "$4,558.00" $77.36 "$2,643.64" "$4,558.00" $80.06 $77.36 "$4,558.00" $77.36 N/A N/A 36191524 EAP CPT® 31638 BRONCHOSCOPY STENT REVISION INCL DILATION BOTH IP/OP "$8,711.00" "$6,446.50" $244.48 "$8,711.00" "$8,711.00" "$8,711.00" "$8,711.00" "$8,711.00" $248.00 $248.00 $250.44 "$8,711.00" $248.00 "$8,711.00" "$8,711.00" "$8,711.00" "$8,711.00" "$1,815.47" $396.80 $391.17 "$8,711.00" $248.00 $244.48 $248.00 "$8,711.00" "$6,533.25" $248.00 $248.00 $248.00 "$2,851.00" "$4,355.50" "$6,899.11" $248.00 "$6,968.80" "$3,725.00" "$8,711.00" $248.00 "$5,052.38" "$8,711.00" $258.56 $248.00 "$8,711.00" $248.00 N/A N/A 36191525 EAP CPT® 64788 REMOVE NF OR NL; CUTANEOUS NERVE BOTH IP/OP "$7,647.00" "$5,659.00" $410.66 "$7,647.00" "$7,647.00" "$7,647.00" "$7,647.00" "$7,647.00" $412.64 $412.64 $410.66 "$7,647.00" $412.64 "$7,647.00" "$7,647.00" "$7,647.00" "$7,647.00" "$1,593.72" $660.22 $660.67 "$7,647.00" $412.64 $412.92 $412.64 "$7,647.00" "$5,735.25" $412.64 $412.64 $412.64 "$3,500.00" "$3,823.50" "$6,056.42" $412.64 "$6,117.60" "$3,250.00" "$7,647.00" $412.64 "$4,435.26" "$7,647.00" $418.10 $412.64 "$7,647.00" $412.64 N/A N/A 36191526 EAP CPT® 64999 UNLISTED NEURO PX BOTH IP/OP "$5,528.00" "$4,091.00" $255.86 "$5,528.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $257.00 $257.00 $255.86 "$1,152.17" $257.00 "$5,528.00" "$5,528.00" "$5,528.00" "$5,528.00" "$1,152.10" $411.20 $392.25 "$4,877.00" $257.00 "$2,607.00" $257.00 $269.85 "$4,146.00" $257.00 $257.00 $257.00 "$2,762.00" "$2,348.00" "$4,378.18" $257.00 "$4,422.40" "$1,750.00" "$1,097.17" $257.00 "$3,206.24" $269.85 $371.81 $257.00 "$1,152.04" $257.00 N/A N/A 36191527 EAP CPT® 49999 UNLISTED ABDOMINAL PX BOTH IP/OP "$8,000.00" "$5,920.00" "$1,667.29" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$1,667.29" "$8,000.00" "$2,633.60" "$8,000.00" "$8,000.00" "$6,584.00" "$8,000.00" "$8,000.00" "$6,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$2,762.00" "$4,000.00" "$6,336.00" "$8,000.00" "$6,400.00" "$3,725.00" "$8,000.00" "$8,000.00" "$4,640.00" "$8,000.00" "$4,800.00" "$8,000.00" "$8,000.00" "$8,000.00" N/A N/A 36191528 EAP CPT® 67911 BIL CORRECTION OF LID RETRACTION BOTH IP/OP "$6,479.00" "$4,794.50" $556.52 "$6,479.00" "$6,479.00" "$6,479.00" "$6,479.00" "$6,479.00" $557.03 $557.03 $560.98 "$6,479.00" $557.03 "$6,479.00" "$6,479.00" "$6,479.00" "$6,479.00" "$1,350.29" $891.25 $890.43 "$6,479.00" $557.03 $556.52 $557.03 "$6,479.00" "$4,859.25" $557.03 $557.03 $557.03 "$3,500.00" "$3,239.50" "$5,131.37" $557.03 "$5,183.20" "$3,250.00" "$6,479.00" $557.03 "$3,757.82" "$6,479.00" $571.74 $557.03 "$6,479.00" $557.03 N/A N/A 36191529 EAP CPT® 38794 ACCESS THORACIC LYMPH DUCT BOTH IP/OP "$2,000.00" "$1,480.00" $280.99 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $295.72 $295.72 $295.80 "$2,000.00" $295.72 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 $473.15 $449.58 "$2,000.00" $295.72 $280.99 $295.72 "$2,000.00" "$1,500.00" $295.72 $295.72 $295.72 "$2,000.00" "$1,000.00" "$1,584.00" $295.72 "$1,600.00" "$1,750.00" "$2,000.00" $295.72 "$1,160.00" "$2,000.00" $307.18 $295.72 "$2,000.00" $295.72 N/A N/A 36191530 EAP CPT® 67025 BIL INJ SUBSTITUTE PARS PLANA/LIMBL W/WO ASP SPX BOTH IP/OP "$13,059.00" "$9,664.00" $628.15 "$13,059.00" "$13,059.00" "$13,059.00" "$13,059.00" "$13,059.00" $628.15 $628.15 $633.01 "$13,059.00" $628.15 "$13,059.00" "$13,059.00" "$13,059.00" "$13,059.00" "$2,721.64" "$1,005.04" "$1,006.35" "$13,059.00" $628.15 $628.97 $628.15 "$13,059.00" "$9,794.25" $628.15 $628.15 $628.15 "$2,762.00" "$6,529.50" "$10,342.73" $628.15 "$10,447.20" "$3,250.00" "$13,059.00" $628.15 "$7,574.22" "$13,059.00" $643.81 $628.15 "$13,059.00" $628.15 N/A N/A 36191531 EAP CPT® 67505 BIL RETROBULBAR INJECTION ALCOHOL BOTH IP/OP "$1,265.00" $936.50 $71.39 "$1,265.00" "$1,265.00" "$1,265.00" "$1,265.00" "$1,265.00" $71.97 $71.97 $72.57 "$1,265.00" $71.97 "$1,265.00" "$1,265.00" "$1,265.00" "$1,265.00" $263.64 $115.15 $115.49 "$1,265.00" $71.97 $72.18 $71.97 "$1,265.00" $948.75 $71.97 $71.97 $71.97 "$1,265.00" $632.50 "$1,001.88" $71.97 "$1,012.00" "$1,265.00" "$1,265.00" $71.97 $733.70 "$1,265.00" $71.39 $71.97 "$1,265.00" $71.97 N/A N/A 36191532 EAP CPT® 68200 BIL SUBCONJUNCTIVAL INJECTION BOTH IP/OP $393.00 $291.00 $33.88 $393.00 $393.00 $393.00 $393.00 $393.00 $34.10 $34.10 $34.38 $393.00 $34.10 $393.00 $393.00 $393.00 $393.00 $81.91 $54.56 $54.21 $393.00 $34.10 $33.88 $34.10 $393.00 $294.75 $34.10 $34.10 $34.10 $393.00 $196.50 $311.26 $34.10 $314.40 $393.00 $393.00 $34.10 $227.94 $393.00 $35.69 $34.10 $393.00 $34.10 N/A N/A 36191533 EAP CPT® 67515 BIL INJECTION MEDICATION/OTHER SUBST TENON CAPSULE BOTH IP/OP "$2,730.00" "$2,020.50" $47.10 "$2,730.00" "$2,730.00" "$2,730.00" "$2,730.00" "$2,730.00" $47.14 $47.14 $47.25 "$2,730.00" $47.14 "$2,730.00" "$2,730.00" "$2,730.00" "$2,730.00" $568.96 $75.42 $75.36 "$2,730.00" $47.14 $47.10 $47.14 "$2,730.00" "$2,047.50" $47.14 $47.14 $47.14 "$2,730.00" "$1,365.00" "$2,162.16" $47.14 "$2,184.00" "$1,750.00" "$2,730.00" $47.14 "$1,583.40" "$2,730.00" $60.20 $47.14 "$2,730.00" $47.14 N/A N/A 36191534 EAP CPT® 36831 THRMBC OPN ARVEN FSTL W/O REVJ DIAL GRF BOTH IP/OP "$14,743.00" "$10,910.00" $612.81 "$14,743.00" "$14,743.00" "$14,743.00" "$14,743.00" "$14,743.00" $616.37 $616.37 $617.22 "$14,743.00" $616.37 "$14,743.00" "$14,743.00" "$14,743.00" "$14,743.00" "$3,072.60" $986.19 $980.50 "$14,743.00" $616.37 $612.81 $616.37 "$14,743.00" "$11,057.25" $616.37 $616.37 $616.37 "$7,479.00" "$7,371.50" "$11,676.46" $616.37 "$11,794.40" "$4,334.00" "$14,743.00" $616.37 "$8,550.94" "$14,743.00" $645.32 $616.37 "$14,743.00" $616.37 N/A N/A 36191535 EAP CPT® 33016 PERICARDIOCENTESIS W/IMAGING BOTH IP/OP "$1,395.00" "$1,032.50" $232.87 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $235.49 $235.49 $237.16 "$1,395.00" $235.49 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $290.73 $376.78 $372.59 "$1,395.00" $235.49 $232.87 $235.49 "$1,395.00" "$1,046.25" $235.49 $235.49 $235.49 "$1,395.00" $697.50 "$1,104.84" $235.49 "$1,116.00" $906.75 "$1,395.00" $235.49 $809.10 "$1,395.00" $246.97 $235.49 "$1,395.00" $235.49 N/A N/A 36191536 EAP CPT® 33017 PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY BOTH IP/OP $405.00 $300.00 $84.41 $405.00 $405.00 $405.00 $405.00 $405.00 $246.46 $246.46 $245.94 $405.00 $246.46 $405.00 $405.00 $405.00 $405.00 $84.41 $394.34 $391.06 $405.00 $246.46 $244.41 $246.46 $405.00 $303.75 $246.46 $246.46 $246.46 $202.50 $202.50 $320.76 $246.46 $324.00 $263.25 $405.00 $246.46 $234.90 $405.00 $255.99 $246.46 $405.00 $246.46 N/A N/A 36191537 EAP CPT® 33018 PERQ PRCRD DRG 0-5YR/ANY AGE W/CGEN CAR ANOMALY BOTH IP/OP $405.00 $300.00 $84.41 $465.34 $405.00 $405.00 $405.00 $405.00 $290.84 $290.84 $279.55 $405.00 $290.84 $405.00 $405.00 $405.00 $405.00 $84.41 $465.34 $459.01 $405.00 $290.84 $286.88 $290.84 $405.00 $303.75 $290.84 $290.84 $290.84 $202.50 $202.50 $320.76 $290.84 $324.00 $263.25 $405.00 $290.84 $234.90 $405.00 $291.70 $290.84 $405.00 $290.84 N/A N/A 36191540 EAP CPT® 62328 DX LUMBAR PUNCTURE W/FL OR CT GUIDANCE BOTH IP/OP "$1,571.00" "$1,163.00" $86.47 "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" $624.63 $624.63 $621.87 $327.44 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $327.41 $999.41 $929.56 "$1,571.00" $624.63 $86.47 $624.63 $655.86 "$1,178.25" $624.63 $624.63 $624.63 "$1,571.00" $785.50 "$1,244.23" $624.63 "$1,256.80" "$1,021.15" $311.80 $624.63 $911.18 $655.86 $903.68 $624.63 $327.40 $624.63 N/A N/A 36191541 EAP CPT® 62329 THERAPEUTIC LUMBAR PUNCTURE W/FL OR CT GUIDANCE BOTH IP/OP "$1,571.00" "$1,163.00" $108.93 "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" $111.71 $111.71 $113.27 "$1,571.00" $111.71 "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" $327.41 $178.74 $174.29 "$1,571.00" $111.71 $108.93 $111.71 "$1,571.00" "$1,178.25" $111.71 $111.71 $111.71 "$1,571.00" $785.50 "$1,244.23" $111.71 "$1,256.80" "$1,021.15" "$1,571.00" $111.71 $911.18 "$1,571.00" $117.53 $111.71 "$1,571.00" $111.71 N/A N/A 36191550 EAP CPT® 64451 INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG BOTH IP/OP "$1,547.00" "$1,145.00" $81.69 "$1,547.00" "$1,547.00" "$1,547.00" "$1,547.00" "$1,547.00" $624.63 $624.63 $621.87 $322.43 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $322.41 $999.41 $929.56 "$1,547.00" $624.63 $81.69 $624.63 $655.86 "$1,160.25" $624.63 $624.63 $624.63 "$1,547.00" $773.50 "$1,225.22" $624.63 "$1,237.60" "$1,005.55" $307.04 $624.63 $897.26 $655.86 $903.68 $624.63 $322.39 $624.63 N/A N/A 36191551 EAP CPT® 64454 INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG BOTH IP/OP "$1,547.00" "$1,145.00" $82.03 "$1,547.00" "$1,547.00" "$1,547.00" "$1,547.00" "$1,547.00" $624.63 $624.63 $621.87 $322.43 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $322.41 $999.41 $929.56 "$1,547.00" $624.63 $82.03 $624.63 $655.86 "$1,160.25" $624.63 $624.63 $624.63 "$1,547.00" $773.50 "$1,225.22" $624.63 "$1,237.60" "$1,005.55" $307.04 $624.63 $897.26 $655.86 $903.68 $624.63 $322.39 $624.63 N/A N/A 36191552 EAP CPT® 64624 DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG BOTH IP/OP "$4,084.00" "$3,022.50" $146.07 "$3,267.20" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,727.24" "$1,727.24" "$1,719.60" $851.21 "$1,727.24" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $851.15 "$2,763.59" "$2,593.22" "$1,871.00" "$1,727.24" $146.07 "$1,727.24" "$1,813.61" "$3,063.00" "$1,727.24" "$1,727.24" "$1,727.24" "$2,762.00" "$2,348.00" "$3,234.53" "$1,727.24" "$3,267.20" "$2,654.60" $810.57 "$1,727.24" "$2,368.72" "$1,813.61" "$2,498.89" "$1,727.24" $851.11 "$1,727.24" N/A N/A 36191553 EAP CPT® 64625 RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN BOTH IP/OP "$4,084.00" "$3,022.50" $194.87 "$4,084.00" "$3,558.00" "$3,558.00" "$3,558.00" "$3,558.00" "$1,727.24" "$1,727.24" "$1,719.60" $851.21 "$1,727.24" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $851.15 "$2,763.59" "$2,593.22" "$4,084.00" "$1,727.24" $194.87 "$1,727.24" "$1,813.61" "$3,063.00" "$1,727.24" "$1,727.24" "$1,727.24" "$2,762.00" "$2,348.00" "$3,234.53" "$1,727.24" "$3,267.20" "$2,654.60" $810.57 "$1,727.24" "$2,368.72" "$1,813.61" "$2,498.89" "$1,727.24" $851.11 "$1,727.24" N/A N/A 36191555 EAP CPT® 64405 BIL GREATER OCCIPITAL NERVE INJ BOTH IP/OP "$4,971.00" "$3,679.00" $53.29 "$3,976.80" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $257.00 $257.00 $255.86 "$1,036.08" $257.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 "$1,036.01" $411.20 $392.25 "$1,871.00" $257.00 $53.29 $257.00 $269.85 "$3,728.25" $257.00 $257.00 $257.00 "$2,762.00" "$2,348.00" "$3,937.03" $257.00 "$3,976.80" "$2,150.00" $986.62 $257.00 "$2,883.18" $269.85 $371.81 $257.00 "$1,035.96" $257.00 N/A N/A 36191556 EAP CPT® 52224 CYSTOURETHROSCOPY W/ FULGURATION <.5CM LESN BOTH IP/OP "$3,924.00" "$2,904.00" $201.12 "$3,924.00" "$3,924.00" "$3,924.00" "$3,924.00" "$3,924.00" $202.77 $202.77 $204.23 "$3,924.00" $202.77 "$3,924.00" "$3,924.00" "$3,924.00" "$3,924.00" $817.80 $324.43 $321.79 "$3,924.00" $202.77 $201.12 $202.77 "$3,924.00" "$2,943.00" $202.77 $202.77 $202.77 "$2,851.00" "$1,962.00" "$3,107.81" $202.77 "$3,139.20" "$3,250.00" "$3,924.00" $202.77 "$2,275.92" "$3,924.00" $212.40 $202.77 "$3,924.00" $202.77 N/A N/A 36191560 EAP CPT® 41008 I&D SUBMANDIBULAR ABSCESS BOTH IP/OP "$4,919.00" "$3,640.50" $258.31 "$4,919.00" "$4,919.00" "$4,919.00" "$4,919.00" "$4,919.00" $258.31 $258.31 $261.21 "$4,919.00" $258.31 "$4,919.00" "$4,919.00" "$4,919.00" "$4,919.00" "$1,025.17" $413.30 $415.79 "$4,919.00" $258.31 $259.87 $258.31 "$4,919.00" "$3,689.25" $258.31 $258.31 $258.31 "$2,762.00" "$2,459.50" "$3,895.85" $258.31 "$3,935.20" "$2,500.00" "$4,919.00" $258.31 "$2,853.02" "$4,919.00" $268.55 $258.31 "$4,919.00" $258.31 N/A N/A 36191561 EAP CPT® 42000 "I&D ABSCESS PLATE, UVULA" BOTH IP/OP $283.00 $209.50 $58.98 $283.00 $283.00 $283.00 $283.00 $283.00 $109.30 $109.30 $106.79 $283.00 $109.30 $283.00 $283.00 $283.00 $283.00 $58.98 $174.88 $177.26 $283.00 $109.30 $110.79 $109.30 $283.00 $212.25 $109.30 $109.30 $109.30 $283.00 $141.50 $224.14 $109.30 $226.40 $283.00 $283.00 $109.30 $164.14 $283.00 $107.41 $109.30 $283.00 $109.30 N/A N/A 36191562 EAP CPT® 46050 I&D ABSCESS PERIANAL SUPERFICIAL BOTH IP/OP "$3,991.00" "$2,953.50" $102.00 "$3,991.00" "$3,991.00" "$3,991.00" "$3,991.00" "$3,991.00" $102.23 $102.23 $102.00 "$3,991.00" $102.23 "$3,991.00" "$3,991.00" "$3,991.00" "$3,991.00" $831.77 $163.57 $164.88 "$3,991.00" $102.23 $103.05 $102.23 "$3,991.00" "$2,993.25" $102.23 $102.23 $102.23 "$2,762.00" "$1,995.50" "$3,160.87" $102.23 "$3,192.80" "$2,150.00" "$3,991.00" $102.23 "$2,314.78" "$3,991.00" $102.72 $102.23 "$3,991.00" $102.23 N/A N/A 36191563 EAP CPT® 31233 "NASAL/SINUS ENDOSCOPY, DX" BOTH IP/OP $661.00 $489.50 $134.98 $661.00 $661.00 $661.00 $661.00 $661.00 $135.91 $135.91 $134.98 $661.00 $135.91 $661.00 $661.00 $661.00 $661.00 $137.76 $217.46 $218.05 $661.00 $135.91 $136.28 $135.91 $661.00 $495.75 $135.91 $135.91 $135.91 $661.00 $330.50 $523.51 $135.91 $528.80 $661.00 $661.00 $135.91 $383.38 $661.00 $138.44 $135.91 $661.00 $135.91 N/A N/A 36191564 EAP CPT® 45385 COLONOSCOPY W/LESION REMOVAL BOTH IP/OP "$3,182.00" "$2,355.00" $252.60 "$3,182.00" "$3,182.00" "$3,182.00" "$3,182.00" "$3,182.00" $255.86 $255.86 $255.99 "$3,182.00" $255.86 "$3,182.00" "$3,182.00" "$3,182.00" "$3,182.00" $663.16 $409.38 $404.16 "$3,182.00" $255.86 $252.60 $255.86 "$3,182.00" "$2,386.50" $255.86 $255.86 $255.86 "$2,851.00" "$1,591.00" "$2,520.14" $255.86 "$2,545.60" "$2,500.00" "$3,182.00" $255.86 "$1,845.56" "$3,182.00" $265.02 $255.86 "$3,182.00" $255.86 N/A N/A 36191565 EAP CPT® 43235 "UPPER GI ENDOSCOPY, DIAGNOSTIC" BOTH IP/OP "$4,485.00" "$3,319.00" $122.05 "$4,485.00" "$4,485.00" "$4,485.00" "$4,485.00" "$4,485.00" $123.32 $123.32 $123.65 "$4,485.00" $123.32 "$4,485.00" "$4,485.00" "$4,485.00" "$4,485.00" $934.72 $197.31 $195.28 "$4,485.00" $123.32 $122.05 $123.32 "$4,485.00" "$3,363.75" $123.32 $123.32 $123.32 "$2,762.00" "$2,242.50" "$3,552.12" $123.32 "$3,588.00" "$2,500.00" "$4,485.00" $123.32 "$2,601.30" "$4,485.00" $127.63 $123.32 "$4,485.00" $123.32 N/A N/A 36191566 EAP CPT® 31515 LARYNGOSCOPY FOR ASPIRATION BOTH IP/OP "$7,668.00" "$5,674.50" $111.09 "$7,668.00" "$7,668.00" "$7,668.00" "$7,668.00" "$7,668.00" $112.25 $112.25 $111.09 "$7,668.00" $112.25 "$7,668.00" "$7,668.00" "$7,668.00" "$7,668.00" "$1,598.10" $179.60 $180.08 "$7,668.00" $112.25 $112.55 $112.25 "$7,668.00" "$5,751.00" $112.25 $112.25 $112.25 "$2,762.00" "$3,834.00" "$6,073.06" $112.25 "$6,134.40" "$2,500.00" "$7,668.00" $112.25 "$4,447.44" "$7,668.00" $113.21 $112.25 "$7,668.00" $112.25 N/A N/A 36191567 EAP CPT® 45305 PROCTOSIGMOIDOSCOPY W/BX SINGLE/MULTIPLE BOTH IP/OP "$5,063.00" "$3,747.00" $73.24 "$5,063.00" "$5,063.00" "$5,063.00" "$5,063.00" "$5,063.00" $73.34 $73.34 $73.60 "$5,063.00" $73.34 "$5,063.00" "$5,063.00" "$5,063.00" "$5,063.00" "$1,055.18" $117.34 $117.18 "$5,063.00" $73.34 $73.24 $73.34 "$5,063.00" "$3,797.25" $73.34 $73.34 $73.34 "$2,762.00" "$2,531.50" "$4,009.90" $73.34 "$4,050.40" "$2,500.00" "$5,063.00" $73.34 "$2,936.54" "$5,063.00" $75.71 $73.34 "$5,063.00" $73.34 N/A N/A 36191568 EAP CPT® 45300 PROCTOSIGMOIDOSCOPY DX BOTH IP/OP "$2,337.00" "$1,729.50" $48.05 "$2,337.00" "$2,337.00" "$2,337.00" "$2,337.00" "$2,337.00" $48.05 $48.05 $48.73 "$2,337.00" $48.05 "$2,337.00" "$2,337.00" "$2,337.00" "$2,337.00" $487.06 $76.88 $77.58 "$2,337.00" $48.05 $48.49 $48.05 "$2,337.00" "$1,752.75" $48.05 $48.05 $48.05 "$2,337.00" "$1,168.50" "$1,850.90" $48.05 "$1,869.60" "$2,150.00" "$2,337.00" $48.05 "$1,355.46" "$2,337.00" $49.75 $48.05 "$2,337.00" $48.05 N/A N/A 36191573 EAP CPT® 43247 UGI ENDO-REMOVE FB BOTH IP/OP "$4,228.00" "$3,129.00" $175.98 "$4,228.00" "$4,228.00" "$4,228.00" "$4,228.00" "$4,228.00" $177.85 $177.85 $178.34 "$4,228.00" $177.85 "$4,228.00" "$4,228.00" "$4,228.00" "$4,228.00" $881.16 $284.56 $281.57 "$4,228.00" $177.85 $175.98 $177.85 "$4,228.00" "$3,171.00" $177.85 $177.85 $177.85 "$2,851.00" "$2,114.00" "$3,348.58" $177.85 "$3,382.40" "$2,500.00" "$4,228.00" $177.85 "$2,452.24" "$4,228.00" $184.25 $177.85 "$4,228.00" $177.85 N/A N/A 36191580 EAP CPT® 42300 I&D PAROTID ABSCESS; SIMPLE BOTH IP/OP "$4,525.00" "$3,348.50" $156.31 "$4,525.00" "$4,525.00" "$4,525.00" "$4,525.00" "$4,525.00" $157.78 $157.78 $156.31 "$4,525.00" $157.78 "$4,525.00" "$4,525.00" "$4,525.00" "$4,525.00" $943.06 $252.45 $255.36 "$4,525.00" $157.78 $159.60 $157.78 "$4,525.00" "$3,393.75" $157.78 $157.78 $157.78 "$2,762.00" "$2,262.50" "$3,583.80" $157.78 "$3,620.00" "$2,150.00" "$4,525.00" $157.78 "$2,624.50" "$4,525.00" $158.24 $157.78 "$4,525.00" $157.78 N/A N/A 36191585 EAP CPT® 26740 CLSD TX ARTCLR FX MTCRPHLNGL/IPHAL JT W/O MANIP BOTH IP/OP $795.00 $588.50 $165.69 $795.00 $795.00 $795.00 $795.00 $795.00 $227.85 $227.85 $225.98 $795.00 $227.85 $795.00 $795.00 $795.00 $795.00 $165.69 $364.56 $368.54 $795.00 $227.85 $230.34 $227.85 $795.00 $596.25 $227.85 $227.85 $227.85 $795.00 $397.50 $629.64 $227.85 $636.00 $795.00 $795.00 $227.85 $461.10 $795.00 $225.23 $227.85 $795.00 $227.85 N/A N/A 36191586 EAP CPT® 10081 I&D PILONIDAL CYST COMPLEX BOTH IP/OP "$3,502.00" "$2,591.50" $172.92 "$3,502.00" "$3,502.00" "$3,502.00" "$3,502.00" "$3,502.00" $173.25 $173.25 $175.04 "$3,502.00" $173.25 "$3,502.00" "$3,502.00" "$3,502.00" "$3,502.00" $729.86 $277.20 $276.67 "$3,502.00" $173.25 $172.92 $173.25 "$3,502.00" "$2,626.50" $173.25 $173.25 $173.25 "$2,762.00" "$1,751.00" "$2,773.58" $173.25 "$2,801.60" "$2,500.00" "$3,502.00" $173.25 "$2,031.16" "$3,502.00" $177.72 $173.25 "$3,502.00" $173.25 N/A N/A 36191590 EAP CPT® 32408 CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG BOTH IP/OP "$2,607.00" "$1,929.50" $151.57 "$2,214.48" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,384.05" "$1,384.05" "$1,377.93" $543.36 "$1,384.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $543.33 "$2,214.48" "$2,163.34" "$1,542.04" "$1,384.05" $151.57 "$1,384.05" "$1,453.25" "$1,955.25" "$1,384.05" "$1,384.05" "$1,384.05" "$1,303.50" "$1,303.50" "$2,064.74" "$1,384.05" "$2,085.60" "$1,694.55" $517.42 "$1,384.05" "$1,512.06" "$1,453.25" "$2,002.37" "$1,384.05" $543.30 "$1,384.05" N/A N/A 36191600 EAP CPT® 62252 CSF SHUNT REPROGRAMMING BOTH IP/OP $829.00 $613.50 $38.90 $829.00 $450.15 $450.15 $450.15 $450.15 $268.59 $268.59 $267.40 $172.78 $268.59 $829.00 $829.00 $829.00 $829.00 $172.77 $429.74 $399.12 $829.00 $268.59 $38.90 $268.59 $282.02 $621.75 $268.59 $268.59 $268.59 $829.00 $414.50 $656.57 $268.59 $663.20 $829.00 $164.54 $268.59 $480.82 $282.02 $388.58 $268.59 $172.76 $268.59 N/A N/A 36191601 EAP CPT® 52234 CYSTOURETHROSCOPY WITH FULGURATION SMALL BLADDER TUMOR(S) BOTH IP/OP "$9,308.00" "$6,888.00" $243.47 "$9,308.00" "$9,308.00" "$9,308.00" "$9,308.00" "$9,308.00" $244.75 $244.75 $246.18 "$9,308.00" $244.75 "$9,308.00" "$9,308.00" "$9,308.00" "$9,308.00" "$1,939.89" $391.60 $389.55 "$9,308.00" $244.75 $243.47 $244.75 "$9,308.00" "$6,981.00" $244.75 $244.75 $244.75 "$2,851.00" "$4,654.00" "$7,371.94" $244.75 "$7,446.40" "$3,250.00" "$9,308.00" $244.75 "$5,398.64" "$9,308.00" $255.30 $244.75 "$9,308.00" $244.75 N/A N/A 36191602 EAP CPT® 36821 AV ANASTOMOSIS OPEN/DIRECT ANY SITE BOTH IP/OP "$19,504.00" "$14,433.00" $657.30 "$19,504.00" "$19,504.00" "$19,504.00" "$19,504.00" "$19,504.00" $663.70 $663.70 $665.35 "$19,504.00" $663.70 "$19,504.00" "$19,504.00" "$19,504.00" "$19,504.00" "$4,064.85" "$1,061.92" "$1,051.68" "$19,504.00" $663.70 $657.30 $663.70 "$19,504.00" "$14,628.00" $663.70 $663.70 $663.70 "$3,500.00" "$9,752.00" "$15,447.17" $663.70 "$15,603.20" "$4,334.00" "$19,504.00" "$2,815.92" "$11,312.32" "$19,504.00" $696.15 $663.70 "$19,504.00" $663.70 N/A N/A 36191605 EAP CPT® 29581 BILATERAL MULTLAY COMPRS LWR LEG APPLICATION BOTH IP/OP $681.00 $504.00 $26.76 $681.00 $369.78 $369.78 $369.78 $369.78 $138.97 $138.97 $138.36 $141.94 $138.97 $681.00 $681.00 $681.00 $681.00 $141.93 $222.36 $210.28 $402.81 $138.97 $26.76 $138.97 $145.92 $510.75 $138.97 $138.97 $138.97 $681.00 $340.50 $539.35 $138.97 $544.80 $442.65 $135.16 $138.97 $394.98 $145.92 $201.06 $138.97 $141.92 $138.97 N/A N/A 36191606 EAP CPT® 29580 BILATERAL APPLICATION OF UNNA BOOT BOTH IP/OP "$1,243.00" $920.00 $26.46 "$1,243.00" $674.95 $674.95 $674.95 $674.95 $138.97 $138.97 $138.36 $259.07 $138.97 "$1,243.00" "$1,243.00" "$1,243.00" $882.37 $259.05 $222.36 $210.28 $735.23 $138.97 $26.46 $138.97 $145.92 $932.25 $138.97 $138.97 $138.97 "$1,243.00" $621.50 $984.46 $138.97 $994.40 $807.95 $246.70 $138.97 $720.94 $145.92 $201.06 $138.97 $259.04 $138.97 N/A N/A 36191610 EAP CPT® 11451 EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR BOTH IP/OP "$8,549.00" "$6,326.50" $333.65 "$8,549.00" "$8,549.00" "$8,549.00" "$8,549.00" "$8,549.00" $335.37 $335.37 $333.65 "$8,549.00" $335.37 "$8,549.00" "$8,549.00" "$8,549.00" "$8,549.00" "$1,781.71" $536.59 $539.81 "$8,549.00" $335.37 $337.38 $335.37 "$8,549.00" "$6,411.75" $335.37 $335.37 $335.37 "$2,851.00" "$4,274.50" "$6,770.81" $335.37 "$6,839.20" "$3,250.00" "$8,549.00" $335.37 "$4,958.42" "$8,549.00" $339.18 $335.37 "$8,549.00" $335.37 N/A N/A 36191611 EAP CPT® 11463 EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR BOTH IP/OP "$8,549.00" "$6,326.50" $335.11 "$8,549.00" "$8,549.00" "$8,549.00" "$8,549.00" "$8,549.00" $338.79 $338.79 $335.11 "$8,549.00" $338.79 "$8,549.00" "$8,549.00" "$8,549.00" "$8,549.00" "$1,781.71" $542.06 $543.02 "$8,549.00" $338.79 $339.39 $338.79 "$8,549.00" "$6,411.75" $338.79 $338.79 $338.79 "$2,851.00" "$4,274.50" "$6,770.81" $338.79 "$6,839.20" "$3,250.00" "$8,549.00" $338.79 "$4,958.42" "$8,549.00" $342.06 $338.79 "$8,549.00" $338.79 N/A N/A 36191612 EAP CPT® 11470 EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR BOTH IP/OP "$8,549.00" "$6,326.50" $292.23 "$6,839.20" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,332.34" "$2,332.34" "$2,322.02" "$1,781.83" "$2,332.34" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$1,781.71" "$3,731.74" "$3,726.76" "$2,836.00" "$2,332.34" $292.23 "$2,332.34" "$2,448.96" "$6,411.75" "$2,332.34" "$2,332.34" "$2,332.34" "$2,851.00" "$2,423.00" "$6,770.81" "$2,332.34" "$6,839.20" "$3,250.00" "$1,696.76" "$2,332.34" "$4,958.42" "$2,448.96" "$3,374.31" "$2,332.34" "$1,781.61" "$2,332.34" N/A N/A 36191613 EAP CPT® 11471 EXCISION H/P/P/U COMPLEX REPAIR BOTH IP/OP "$8,549.00" "$6,326.50" $354.20 "$8,549.00" "$8,549.00" "$8,549.00" "$8,549.00" "$8,549.00" $357.31 $357.31 $354.20 "$8,549.00" $357.31 "$8,549.00" "$8,549.00" "$8,549.00" "$8,549.00" "$1,781.71" $571.70 $568.50 "$8,549.00" $357.31 $355.31 $357.31 "$8,549.00" "$6,411.75" $357.31 $357.31 $357.31 "$2,851.00" "$4,274.50" "$6,770.81" $357.31 "$6,839.20" "$3,250.00" "$8,549.00" $357.31 "$4,958.42" "$8,549.00" $361.18 $357.31 "$8,549.00" $357.31 N/A N/A 36191615 EAP CPT® 47564 LAPAROSCOPIC CHOLECYSTECTOMY BOTH IP/OP "$12,125.00" "$8,972.50" "$1,134.51" "$12,125.00" "$12,125.00" "$12,125.00" "$12,125.00" "$12,125.00" "$1,138.92" "$1,138.92" "$1,139.26" "$12,125.00" "$1,138.92" "$12,125.00" "$12,125.00" "$12,125.00" "$12,125.00" "$2,526.98" "$1,822.27" "$1,815.22" "$12,125.00" "$1,138.92" "$1,134.51" "$1,138.92" "$12,125.00" "$9,093.75" "$1,138.92" "$1,138.92" "$1,138.92" "$6,679.00" "$6,062.50" "$9,603.00" "$1,138.92" "$9,700.00" "$4,334.00" "$12,125.00" "$1,138.92" "$7,032.50" "$12,125.00" "$1,170.84" "$1,138.92" "$12,125.00" "$1,138.92" N/A N/A 36191616 EAP CPT® 37607 LIGATION OF ARTERIOVENOUS FISTULA BOTH IP/OP "$13,515.00" "$10,001.50" $373.66 "$13,515.00" "$13,515.00" "$13,515.00" "$13,515.00" "$13,515.00" $376.22 $376.22 $377.00 "$13,515.00" $376.22 "$13,515.00" "$13,515.00" "$13,515.00" "$13,515.00" "$2,816.67" $601.95 $597.86 "$13,515.00" $376.22 $373.66 $376.22 "$13,515.00" "$10,136.25" $376.22 $376.22 $376.22 "$3,500.00" "$6,757.50" "$10,703.88" $376.22 "$10,812.00" "$3,725.00" "$13,515.00" $376.22 "$7,838.70" "$13,515.00" $391.50 $376.22 "$13,515.00" $376.22 N/A N/A 36191617 EAP CPT® 36836 PERQ AV FISTULA CREATION UXTR SINGLE ACCESS BOTH IP/OP "$31,908.00" "$23,612.00" $351.45 "$31,908.00" "$31,908.00" "$31,908.00" "$31,908.00" "$31,908.00" "$31,908.00" "$31,908.00" "$5,679.62" "$31,908.00" "$31,908.00" "$31,908.00" "$31,908.00" "$31,908.00" "$31,908.00" "$6,649.98" "$31,908.00" $562.32 "$31,908.00" "$31,908.00" $351.45 "$31,908.00" "$31,908.00" "$23,931.00" "$31,908.00" "$31,908.00" "$31,908.00" "$15,954.00" "$15,954.00" "$25,271.14" "$31,908.00" "$25,526.40" "$20,740.20" "$31,908.00" "$31,908.00" "$18,506.64" "$31,908.00" "$19,144.80" "$31,908.00" "$31,908.00" "$31,908.00" N/A N/A 36191619 EAP CPT® 64704 REVISION HAND/FOOT NERVE BOTH IP/OP "$4,318.00" "$3,195.50" $329.03 "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" $329.37 $329.37 $329.38 "$4,318.00" $329.37 "$4,318.00" "$4,318.00" "$4,318.00" "$4,318.00" $899.92 $526.99 $526.45 "$4,318.00" $329.37 $329.03 $329.37 "$4,318.00" "$3,238.50" $329.37 $329.37 $329.37 "$2,762.00" "$2,159.00" "$3,419.86" $329.37 "$3,454.40" "$3,250.00" "$4,318.00" $329.37 "$2,504.44" "$4,318.00" $333.82 $329.37 "$4,318.00" $329.37 N/A N/A 36191620 EAP CPT® 57545 REMOVAL OF REMAINING CERVIX WITH REPAIR OF PELVIC FLOOR THROUGH ABDOMEN BOTH IP/OP "$6,453.00" "$4,775.50" $849.55 "$6,453.00" "$6,453.00" "$6,453.00" "$6,453.00" "$6,453.00" $852.40 $852.40 $850.36 "$6,453.00" $852.40 "$6,453.00" "$6,453.00" "$6,453.00" "$6,453.00" "$1,344.88" "$1,363.84" "$1,359.28" "$6,453.00" $852.40 $849.55 $852.40 "$6,453.00" "$4,839.75" $852.40 $852.40 $852.40 "$2,762.00" "$3,226.50" "$5,110.78" $852.40 "$5,162.40" "$4,194.45" "$6,453.00" $852.40 "$3,742.74" "$6,453.00" $868.16 $852.40 "$6,453.00" $852.40 N/A N/A 36191621 EAP CPT® 0402T COLLAGEN CROSS-LINKING OF CORNEA BOTH IP/OP "$4,921.00" "$3,642.00" "$1,025.59" "$4,921.00" "$4,921.00" "$4,921.00" "$4,921.00" "$4,921.00" "$4,921.00" "$4,921.00" "$4,921.00" "$4,921.00" "$4,921.00" "$4,921.00" "$4,921.00" "$4,921.00" "$4,921.00" "$1,025.59" "$4,921.00" "$1,968.40" "$4,921.00" "$4,921.00" "$4,921.00" "$4,921.00" "$4,921.00" "$3,690.75" "$4,921.00" "$4,921.00" "$4,921.00" "$2,762.00" "$2,460.50" "$3,897.43" "$4,921.00" "$3,936.80" "$2,150.00" "$4,921.00" "$4,921.00" "$2,854.18" "$4,921.00" "$2,952.60" "$4,921.00" "$4,921.00" "$4,921.00" N/A N/A 37000023 EAP Custom 37000023 LEVEL 1 1ST 30 MIN BOTH IP/OP "$1,003.00" $742.50 $178.53 "$1,083.00" "$1,003.00" "$1,003.00" "$1,003.00" "$1,003.00" "$1,003.00" "$1,003.00" $178.53 "$1,003.00" "$1,003.00" $744.43 $744.43 $773.11 $522.56 $209.04 "$1,003.00" $433.20 "$1,003.00" "$1,003.00" "$1,083.00" "$1,003.00" "$1,003.00" $752.25 "$1,003.00" "$1,003.00" "$1,003.00" $501.50 $501.50 $794.38 "$1,003.00" $802.40 $651.95 "$1,003.00" "$1,003.00" $581.74 "$1,003.00" $601.80 "$1,003.00" "$1,003.00" "$1,003.00" N/A N/A 37000024 EAP Custom 37000024 LEVEL 2 1ST 30 MIN BOTH IP/OP "$1,766.00" "$1,307.00" $314.35 "$1,907.00" "$1,766.00" "$1,766.00" "$1,766.00" "$1,766.00" "$1,766.00" "$1,766.00" $314.35 "$1,766.00" "$1,766.00" "$1,310.73" "$1,310.73" "$1,361.23" $920.09 $368.05 "$1,766.00" $762.80 "$1,766.00" "$1,766.00" "$1,907.00" "$1,766.00" "$1,766.00" "$1,324.50" "$1,766.00" "$1,766.00" "$1,766.00" $883.00 $883.00 "$1,398.67" "$1,766.00" "$1,412.80" "$1,147.90" "$1,766.00" "$1,766.00" "$1,024.28" "$1,766.00" "$1,059.60" "$1,766.00" "$1,766.00" "$1,766.00" N/A N/A 37000025 EAP Custom 37000025 LEVEL 3 1ST 30 MIN BOTH IP/OP "$2,608.00" "$1,930.00" $464.22 "$2,817.00" "$2,608.00" "$2,608.00" "$2,608.00" "$2,608.00" "$2,608.00" "$2,608.00" $464.22 "$2,608.00" "$2,608.00" "$1,935.66" "$1,935.66" "$2,010.25" "$1,358.77" $543.54 "$2,608.00" "$1,126.80" "$2,608.00" "$2,608.00" "$2,817.00" "$2,608.00" "$2,608.00" "$1,956.00" "$2,608.00" "$2,608.00" "$2,608.00" "$1,304.00" "$1,304.00" "$2,065.54" "$2,608.00" "$2,086.40" "$1,695.20" "$2,608.00" "$2,608.00" "$1,512.64" "$2,608.00" "$1,564.80" "$2,608.00" "$2,608.00" "$2,608.00" N/A N/A 37000026 EAP Custom 37000026 LEVEL 4 1ST 30 MIN BOTH IP/OP "$3,052.00" "$2,258.50" $543.26 "$3,296.00" "$3,052.00" "$3,052.00" "$3,052.00" "$3,052.00" "$3,052.00" "$3,052.00" $543.26 "$3,052.00" "$3,052.00" "$2,265.19" "$2,265.19" "$2,352.48" "$1,590.09" $636.07 "$3,052.00" "$1,318.40" "$3,052.00" "$3,052.00" "$3,296.00" "$3,052.00" "$3,052.00" "$2,289.00" "$3,052.00" "$3,052.00" "$3,052.00" "$1,526.00" "$1,526.00" "$2,417.18" "$3,052.00" "$2,441.60" "$1,983.80" "$3,052.00" "$3,052.00" "$1,770.16" "$3,052.00" "$1,831.20" "$3,052.00" "$3,052.00" "$3,052.00" N/A N/A 37000027 EAP Custom 37000027 LEVEL 5 1ST 30 MIN BOTH IP/OP "$3,572.00" "$2,643.50" $635.82 "$3,858.00" "$3,572.00" "$3,572.00" "$3,572.00" "$3,572.00" "$3,572.00" "$3,572.00" $635.82 "$3,572.00" "$3,572.00" "$2,651.14" "$2,651.14" "$2,753.30" "$1,861.01" $744.44 "$3,572.00" "$1,543.20" "$3,572.00" "$3,572.00" "$3,858.00" "$3,572.00" "$3,572.00" "$2,679.00" "$3,572.00" "$3,572.00" "$3,572.00" "$1,786.00" "$1,786.00" "$2,829.02" "$3,572.00" "$2,857.60" "$2,321.80" "$3,572.00" "$3,572.00" "$2,071.76" "$3,572.00" "$2,143.20" "$3,572.00" "$3,572.00" "$3,572.00" N/A N/A 37000028 EAP Custom 37000028 LEVEL 1 ADD 15 MIN BOTH IP/OP $408.00 $302.00 $72.62 $441.00 $408.00 $408.00 $408.00 $408.00 $408.00 $408.00 $72.62 $408.00 $408.00 $302.82 $302.82 $314.49 $212.57 $85.03 $408.00 $176.40 $408.00 $408.00 $441.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $265.20 $408.00 $408.00 $236.64 $408.00 $244.80 $408.00 $408.00 $408.00 N/A N/A 37000029 EAP Custom 37000029 LEVEL 2 ADD 15 MIN BOTH IP/OP $667.00 $494.00 $118.73 $720.00 $667.00 $667.00 $667.00 $667.00 $667.00 $667.00 $118.73 $667.00 $667.00 $495.05 $495.05 $514.12 $347.51 $139.01 $667.00 $288.00 $667.00 $667.00 $720.00 $667.00 $667.00 $500.25 $667.00 $667.00 $667.00 $333.50 $333.50 $528.26 $667.00 $533.60 $433.55 $667.00 $667.00 $386.86 $667.00 $400.20 $667.00 $667.00 $667.00 N/A N/A 37000030 EAP Custom 37000030 LEVEL 3 ADD 15 MIN BOTH IP/OP "$1,085.00" $803.00 $193.13 "$1,172.00" "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" $193.13 "$1,085.00" "$1,085.00" $805.29 $805.29 $836.32 $565.29 $226.13 "$1,085.00" $468.80 "$1,085.00" "$1,085.00" "$1,172.00" "$1,085.00" "$1,085.00" $813.75 "$1,085.00" "$1,085.00" "$1,085.00" $542.50 $542.50 $859.32 "$1,085.00" $868.00 $705.25 "$1,085.00" "$1,085.00" $629.30 "$1,085.00" $651.00 "$1,085.00" "$1,085.00" "$1,085.00" N/A N/A 37000031 EAP Custom 37000031 LEVEL 4 ADD 15 MIN BOTH IP/OP "$1,203.00" $890.50 $214.13 "$1,299.00" "$1,203.00" "$1,203.00" "$1,203.00" "$1,203.00" "$1,203.00" "$1,203.00" $214.13 "$1,203.00" "$1,203.00" $892.87 $892.87 $927.27 $626.76 $250.72 "$1,203.00" $519.60 "$1,203.00" "$1,203.00" "$1,299.00" "$1,203.00" "$1,203.00" $902.25 "$1,203.00" "$1,203.00" "$1,203.00" $601.50 $601.50 $952.78 "$1,203.00" $962.40 $781.95 "$1,203.00" "$1,203.00" $697.74 "$1,203.00" $721.80 "$1,203.00" "$1,203.00" "$1,203.00" N/A N/A 37000032 EAP Custom 37000032 LEVEL 5 ADD 15 MIN BOTH IP/OP "$1,376.00" "$1,018.50" $244.93 "$1,486.00" "$1,376.00" "$1,376.00" "$1,376.00" "$1,376.00" "$1,376.00" "$1,376.00" $244.93 "$1,376.00" "$1,376.00" "$1,021.27" "$1,021.27" "$1,060.62" $716.90 $286.77 "$1,376.00" $594.40 "$1,376.00" "$1,376.00" "$1,486.00" "$1,376.00" "$1,376.00" "$1,032.00" "$1,376.00" "$1,376.00" "$1,376.00" $688.00 $688.00 "$1,089.79" "$1,376.00" "$1,100.80" $894.40 "$1,376.00" "$1,376.00" $798.08 "$1,376.00" $825.60 "$1,376.00" "$1,376.00" "$1,376.00" N/A N/A 37000033 EAP CPT® 99151 MOD SED SAME PHYS/QHP INITIAL 15 MINS; <5 YRS BOTH IP/OP $504.00 $373.00 $24.16 $504.00 $504.00 $504.00 $504.00 $504.00 $25.12 $25.12 $25.29 $504.00 $25.12 $374.07 $374.07 $388.48 $262.58 $105.04 $40.19 $39.06 $504.00 $25.12 $24.41 $25.12 $504.00 $378.00 $25.12 $25.12 $25.12 $252.00 $252.00 $399.17 $25.12 $403.20 $327.60 $504.00 $25.12 $292.32 $504.00 $24.16 $25.12 $504.00 $25.12 N/A N/A 37000034 EAP CPT® 99152 MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS BOTH IP/OP $504.00 $373.00 $12.55 "$1,159.00" $273.67 $273.67 $273.67 $273.67 $504.00 $504.00 $504.00 $105.05 $12.67 $374.07 $374.07 $388.48 $262.58 $105.04 $504.00 "$1,159.00" $298.12 $504.00 $12.55 $504.00 $504.00 $378.00 $504.00 $504.00 $504.00 $252.00 $252.00 $399.17 $504.00 $403.20 $327.60 $100.03 $504.00 $292.32 $504.00 $504.00 $504.00 $105.03 $504.00 N/A N/A 37000035 EAP CPT® 99153 MOD SED SAME PHYS/QHP EACH ADDL 15 MINS BOTH IP/OP $138.00 $102.50 $10.99 $578.00 $74.93 $74.93 $74.93 $74.93 $138.00 $138.00 $138.00 $28.76 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $578.00 $81.63 $138.00 $11.17 $138.00 $138.00 $103.50 $10.99 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $27.39 $138.00 $80.04 $138.00 $138.00 $138.00 $28.76 $138.00 N/A N/A 37000036 EAP CPT® 99155 MOD SED OTHER PHYS/QHP INITIAL 15 MINS; <5 YRS BOTH IP/OP $504.00 $373.00 $82.77 $504.00 $504.00 $504.00 $504.00 $504.00 $83.37 $83.37 $84.06 $504.00 $83.37 $374.07 $374.07 $388.48 $262.58 $105.04 $133.39 $132.43 $504.00 $83.37 $82.77 $83.37 $504.00 $378.00 $83.37 $83.37 $83.37 $252.00 $252.00 $399.17 $83.37 $403.20 $327.60 $504.00 $83.37 $292.32 $504.00 $87.64 $83.37 $504.00 $83.37 N/A N/A 37000037 EAP CPT® 99156 MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS BOTH IP/OP $504.00 $373.00 $75.98 $504.00 $273.67 $273.67 $273.67 $273.67 $504.00 $504.00 $504.00 $105.05 $504.00 $374.07 $374.07 $388.48 $262.58 $105.04 $504.00 $504.00 $298.12 $504.00 $75.98 $504.00 $504.00 $378.00 $504.00 $504.00 $504.00 $252.00 $252.00 $399.17 $504.00 $403.20 $327.60 $100.03 $504.00 $292.32 $504.00 $504.00 $504.00 $105.03 $504.00 N/A N/A 37000038 EAP CPT® 99157 MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS BOTH IP/OP $138.00 $102.50 $27.39 $138.00 $74.93 $74.93 $74.93 $74.93 $138.00 $138.00 $138.00 $28.76 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $138.00 $81.63 $138.00 $62.04 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $27.39 $138.00 $80.04 $138.00 $138.00 $138.00 $28.76 $138.00 N/A N/A 37000123 EAP Custom 37000123 EPIDURAL FEE BOTH IP/OP "$2,316.00" "$1,714.00" $412.25 "$2,501.00" "$2,316.00" "$2,316.00" "$2,316.00" "$2,316.00" "$2,316.00" "$2,316.00" $412.25 "$2,316.00" "$2,316.00" "$1,718.94" "$1,718.94" "$1,785.17" "$1,206.64" $482.68 "$2,316.00" "$1,000.40" "$2,316.00" "$2,316.00" "$2,501.00" "$2,316.00" "$2,316.00" "$1,737.00" "$2,316.00" "$2,316.00" "$2,316.00" "$1,158.00" "$1,158.00" "$1,834.27" "$2,316.00" "$1,852.80" "$1,505.40" "$2,316.00" "$2,316.00" "$1,343.28" "$2,316.00" "$1,389.60" "$2,316.00" "$2,316.00" "$2,316.00" N/A N/A 37000124 EAP EA ADD’L 60-90 MIN BOTH IP/OP $520.00 $385.00 $92.56 $562.00 $520.00 $520.00 $520.00 $520.00 $520.00 $520.00 $92.56 $520.00 $520.00 $385.94 $385.94 $400.82 $270.92 $108.37 $520.00 $224.80 $520.00 $520.00 $562.00 $520.00 $520.00 $390.00 $520.00 $520.00 $520.00 $260.00 $260.00 $411.84 $520.00 $416.00 $338.00 $520.00 $520.00 $301.60 $520.00 $312.00 $520.00 $520.00 $520.00 N/A N/A 39000001 EAP HCPCS P9010 WHOLE BLOOD UNIT BOTH IP/OP "$2,098.00" "$1,553.00" $22.29 "$2,098.00" "$2,098.00" "$2,098.00" "$2,098.00" "$2,098.00" "$2,098.00" "$2,098.00" $22.29 "$2,098.00" "$2,098.00" "$1,557.14" "$1,557.14" "$1,617.14" "$1,093.06" $437.25 "$2,098.00" $839.20 "$2,098.00" "$2,098.00" "$2,098.00" "$2,098.00" "$2,098.00" "$1,573.50" "$2,098.00" "$2,098.00" "$2,098.00" "$1,049.00" "$1,049.00" "$1,661.62" "$2,098.00" "$1,678.40" "$1,363.70" "$2,098.00" "$2,098.00" "$1,216.84" "$2,098.00" "$1,258.80" "$2,098.00" "$2,098.00" "$2,098.00" N/A N/A 39000002 EAP HCPCS P9012 POOLED CRYO BOTH IP/OP $904.00 $669.00 $188.40 $904.00 $904.00 $904.00 $904.00 $904.00 $904.00 $904.00 $904.00 $904.00 $904.00 $670.95 $670.95 $696.80 $470.98 $188.40 $904.00 $361.60 $904.00 $904.00 $904.00 $904.00 $904.00 $678.00 $904.00 $904.00 $904.00 $452.00 $452.00 $715.97 $904.00 $723.20 $587.60 $904.00 $904.00 $524.32 $904.00 $542.40 $904.00 $904.00 $904.00 N/A N/A 39000003 EAP HCPCS P9016 RBC LEUKORED UNIT BOTH IP/OP "$1,327.00" $982.00 $192.39 "$1,559.00" $720.56 $720.56 $720.56 $720.56 $192.39 $192.39 $192.39 $276.58 $192.39 $984.90 $984.90 "$1,022.85" $691.37 $276.56 $307.82 $272.97 $784.92 $192.39 "$1,559.00" $192.39 $202.01 $995.25 $192.39 $192.39 $192.39 $663.50 $663.50 "$1,050.98" $192.39 "$1,061.60" $862.55 $263.38 $192.39 $769.66 $202.01 $278.97 $192.39 $276.55 $192.39 N/A N/A 39000004 EAP HCPCS P9017 FRESH FROZEN PLASMA UNIT BOTH IP/OP $629.00 $465.50 $131.09 $629.00 $629.00 $629.00 $629.00 $629.00 $629.00 $629.00 $629.00 $629.00 $629.00 $466.84 $466.84 $484.83 $327.71 $131.09 $629.00 $251.60 $629.00 $629.00 $629.00 $629.00 $629.00 $471.75 $629.00 $629.00 $629.00 $314.50 $314.50 $498.17 $629.00 $503.20 $408.85 $629.00 $629.00 $364.82 $629.00 $377.40 $629.00 $629.00 $629.00 N/A N/A 39000012 EAP HCPCS P9035 PLATELET PHERESIS LEUKORED UNIT BOTH IP/OP "$4,769.00" "$3,529.50" $993.91 "$4,769.00" "$4,769.00" "$4,769.00" "$4,769.00" "$4,769.00" "$4,769.00" "$4,769.00" "$4,769.00" "$4,769.00" "$4,769.00" "$3,539.55" "$3,539.55" "$3,675.95" "$2,060.15" $993.91 "$4,769.00" "$1,907.60" "$4,769.00" "$4,769.00" "$4,769.00" "$4,769.00" "$4,769.00" "$3,576.75" "$4,769.00" "$4,769.00" "$4,769.00" "$2,384.50" "$2,384.50" "$3,777.05" "$4,769.00" "$3,815.20" "$3,099.85" "$4,769.00" "$4,769.00" "$2,766.02" "$4,769.00" "$2,861.40" "$4,769.00" "$4,769.00" "$4,769.00" N/A N/A 39000013 EAP HCPCS P9037 PLATELET PHERESIS LEUKORED IRR UNIT BOTH IP/OP "$5,621.00" "$4,160.00" "$1,171.48" "$5,621.00" "$5,621.00" "$5,621.00" "$5,621.00" "$5,621.00" "$5,621.00" "$5,621.00" "$5,621.00" "$5,621.00" "$5,621.00" "$4,171.91" "$4,171.91" "$4,332.67" "$2,060.15" "$1,171.48" "$5,621.00" "$2,248.40" "$5,621.00" "$5,621.00" "$5,621.00" "$5,621.00" "$5,621.00" "$4,215.75" "$5,621.00" "$5,621.00" "$5,621.00" "$2,810.50" "$2,810.50" "$4,451.83" "$5,621.00" "$4,496.80" "$3,653.65" "$5,621.00" "$5,621.00" "$3,260.18" "$5,621.00" "$3,372.60" "$5,621.00" "$5,621.00" "$5,621.00" N/A N/A 39000016 EAP HCPCS P9040 RBC LEUKORED IRR UNIT BOTH IP/OP "$2,277.00" "$1,685.00" $266.03 "$2,277.00" "$1,236.41" "$1,236.41" "$1,236.41" "$1,236.41" $266.03 $266.03 $266.03 $474.58 $266.03 "$1,689.99" "$1,689.99" "$1,755.11" "$1,186.32" $474.55 $425.65 $373.82 "$1,346.85" $266.03 "$2,277.00" $266.03 $279.33 "$1,707.75" $266.03 $266.03 $266.03 "$1,138.50" "$1,138.50" "$1,803.38" $266.03 "$1,821.60" "$1,480.05" $451.93 $266.03 "$1,320.66" $279.33 $385.74 $266.03 $474.53 $266.03 N/A N/A 39000017 EAP HCPCS P9044 FFP-CRYO POOR PLASMA BOTH IP/OP $337.00 $249.50 $70.23 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $250.12 $250.12 $259.76 $175.58 $70.23 $337.00 $134.80 $337.00 $337.00 $337.00 $337.00 $337.00 $252.75 $337.00 $337.00 $337.00 $168.50 $168.50 $266.90 $337.00 $269.60 $219.05 $337.00 $337.00 $195.46 $337.00 $202.20 $337.00 $337.00 $337.00 N/A N/A 39000021 EAP HCPCS P9054 BLOOD LEUKORED DEGLYC WASHED UNIT BOTH IP/OP "$2,064.00" "$1,527.50" $430.16 "$2,064.00" "$2,064.00" "$2,064.00" "$2,064.00" "$2,064.00" "$2,064.00" "$2,064.00" "$2,064.00" "$2,064.00" "$2,064.00" "$1,531.90" "$1,531.90" "$1,590.93" "$1,075.34" $430.16 "$2,064.00" $825.60 "$2,064.00" "$2,064.00" "$2,064.00" "$2,064.00" "$2,064.00" "$1,548.00" "$2,064.00" "$2,064.00" "$2,064.00" "$1,032.00" "$1,032.00" "$1,634.69" "$2,064.00" "$1,651.20" "$1,341.60" "$2,064.00" "$2,064.00" "$1,197.12" "$2,064.00" "$1,238.40" "$2,064.00" "$2,064.00" "$2,064.00" N/A N/A 39000024 EAP HCPCS P9057 BLOOD LEUKORED DEGLYC WASHED IRR UNIT BOTH IP/OP "$2,718.00" "$2,011.50" $566.46 "$2,718.00" "$2,718.00" "$2,718.00" "$2,718.00" "$2,718.00" "$2,718.00" "$2,718.00" "$2,718.00" "$2,718.00" "$2,718.00" "$2,017.30" "$2,017.30" "$2,095.03" "$1,416.08" $566.46 "$2,718.00" "$1,078.80" "$2,718.00" "$2,718.00" "$2,697.00" "$2,718.00" "$2,718.00" "$2,038.50" "$2,718.00" "$2,718.00" "$2,718.00" "$1,359.00" "$1,359.00" "$2,152.66" "$2,718.00" "$2,174.40" "$1,766.70" "$2,718.00" "$2,718.00" "$1,576.44" "$2,718.00" "$1,630.80" "$2,718.00" "$2,718.00" "$2,718.00" N/A N/A 39000026 EAP HCPCS P9059 FFP-FROZEN 24 HOUR BOTH IP/OP $776.00 $574.50 $161.73 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $575.95 $575.95 $598.14 $404.30 $161.73 $776.00 $254.40 $776.00 $776.00 $636.00 $776.00 $776.00 $582.00 $776.00 $776.00 $776.00 $388.00 $388.00 $614.59 $776.00 $620.80 $504.40 $776.00 $776.00 $450.08 $776.00 $465.60 $776.00 $776.00 $776.00 N/A N/A 39000040 EAP HCPCS P9016 RBC-WBC REDUCED BOTH IP/OP "$1,209.00" $895.00 $192.39 "$1,559.00" $656.49 $656.49 $656.49 $656.49 $192.39 $192.39 $192.39 $251.99 $192.39 $897.32 $897.32 $931.90 $629.89 $251.97 $307.82 $272.97 $715.12 $192.39 "$1,559.00" $192.39 $202.01 $906.75 $192.39 $192.39 $192.39 $604.50 $604.50 $957.53 $192.39 $967.20 $785.85 $239.96 $192.39 $701.22 $202.01 $278.97 $192.39 $251.96 $192.39 N/A N/A 39000052 EAP CPT® 86891 NON CARDIAC CELL SAVER BOTH IP/OP "$1,970.00" "$1,458.00" $72.43 "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" $72.43 "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" $410.57 "$1,970.00" $788.00 "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" "$1,477.50" "$1,970.00" "$1,970.00" "$1,970.00" $469.68 $469.68 "$1,560.24" "$1,970.00" "$1,576.00" "$1,280.50" "$1,970.00" "$1,970.00" "$1,142.60" "$1,970.00" "$1,182.00" "$1,970.00" "$1,970.00" "$1,970.00" N/A N/A 39000060 EAP HCPCS P9011 RBC LEUKORED ALIQUOT BOTH IP/OP $396.00 $293.50 $78.60 $587.00 $215.03 $215.03 $215.03 $215.03 $150.69 $150.69 $150.69 $82.54 $150.69 $293.91 $293.91 $305.24 $206.32 $82.53 $241.10 $200.60 $234.23 $150.69 $587.00 $150.69 $158.22 $297.00 $150.69 $150.69 $150.69 $198.00 $198.00 $313.63 $150.69 $316.80 $257.40 $78.60 $150.69 $229.68 $158.22 $218.50 $150.69 $82.53 $150.69 N/A N/A 39000061 EAP HCPCS P9011 RBC LEUKORED IRR ALIQUOT BOTH IP/OP $396.00 $293.50 $78.60 $587.00 $215.03 $215.03 $215.03 $215.03 $150.69 $150.69 $150.69 $82.54 $150.69 $293.91 $293.91 $305.24 $206.32 $82.53 $241.10 $200.60 $234.23 $150.69 $587.00 $150.69 $158.22 $297.00 $150.69 $150.69 $150.69 $198.00 $198.00 $313.63 $150.69 $316.80 $257.40 $78.60 $150.69 $229.68 $158.22 $218.50 $150.69 $82.53 $150.69 N/A N/A 39000062 EAP HCPCS P9011 "PLATELET PHERESIS, LR ALIQUOT" BOTH IP/OP $800.00 $592.00 $150.69 $640.00 $434.40 $434.40 $434.40 $434.40 $150.69 $150.69 $150.69 $166.74 $150.69 $593.76 $593.76 $616.64 $416.80 $166.73 $241.10 $200.60 $473.20 $150.69 $587.00 $150.69 $158.22 $600.00 $150.69 $150.69 $150.69 $400.00 $400.00 $633.60 $150.69 $640.00 $520.00 $158.78 $150.69 $464.00 $158.22 $218.50 $150.69 $166.72 $150.69 N/A N/A 39000063 EAP HCPCS P9011 PLATELET PHERESIS LR IRR ALIQUOT BOTH IP/OP $882.00 $653.00 $150.69 $705.60 $478.93 $478.93 $478.93 $478.93 $150.69 $150.69 $150.69 $183.83 $150.69 $654.62 $654.62 $679.85 $459.52 $183.82 $241.10 $200.60 $521.70 $150.69 $587.00 $150.69 $158.22 $661.50 $150.69 $150.69 $150.69 $441.00 $441.00 $698.54 $150.69 $705.60 $573.30 $175.05 $150.69 $511.56 $158.22 $218.50 $150.69 $183.81 $150.69 N/A N/A 39000064 EAP HCPCS P9012 SINGLE CRYO BOTH IP/OP $396.00 $293.50 $82.53 $904.00 $396.00 $396.00 $396.00 $396.00 $396.00 $396.00 $396.00 $396.00 $396.00 $293.91 $293.91 $305.24 $206.32 $82.53 $396.00 $361.60 $396.00 $396.00 $904.00 $396.00 $396.00 $297.00 $396.00 $396.00 $396.00 $198.00 $198.00 $313.63 $396.00 $316.80 $257.40 $396.00 $396.00 $229.68 $396.00 $237.60 $396.00 $396.00 $396.00 N/A N/A 39000065 EAP HCPCS P9011 THAWED FFP ALIQUOT BOTH IP/OP $396.00 $293.50 $78.60 $587.00 $215.03 $215.03 $215.03 $215.03 $150.69 $150.69 $150.69 $82.54 $150.69 $293.91 $293.91 $305.24 $206.32 $82.53 $241.10 $200.60 $234.23 $150.69 $587.00 $150.69 $158.22 $297.00 $150.69 $150.69 $150.69 $198.00 $198.00 $313.63 $150.69 $316.80 $257.40 $78.60 $150.69 $229.68 $158.22 $218.50 $150.69 $82.53 $150.69 N/A N/A 39000066 EAP HCPCS P9073 "PLATELETS, PHERESIS, PATHOGEN REDUCED, EA UNIT" BOTH IP/OP "$1,725.00" "$1,276.50" $342.37 "$2,162.00" $936.68 $936.68 $936.68 $936.68 $596.13 $596.13 $596.13 $359.53 $596.13 "$1,280.30" "$1,280.30" "$1,329.63" $898.73 $359.51 $953.81 $833.69 "$1,020.34" $596.13 "$2,162.00" $596.13 $625.94 "$1,293.75" $596.13 $596.13 $596.13 $862.50 $862.50 "$1,366.20" $596.13 "$1,380.00" "$1,121.25" $342.37 $596.13 "$1,000.50" $625.94 $864.39 $596.13 $359.49 $596.13 N/A N/A 39100001 EAP CPT® 36430 "TRANSFUSION, BLOOD" BOTH IP/OP "$3,057.00" "$2,262.50" $39.58 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $390.44 $390.44 $388.71 $637.16 $390.44 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $637.11 $624.70 $588.25 "$1,808.22" $390.44 $39.58 $390.44 $409.96 "$2,292.75" $390.44 $390.44 $390.44 "$2,762.00" "$1,528.50" "$2,421.14" $390.44 "$2,445.60" "$1,750.00" $606.74 $390.44 "$1,773.06" $409.96 $564.86 $390.44 $637.08 $390.44 N/A N/A 40000002 EAP CPT® 76376 3D RENDERING W/O POSTPROCE NIR BOTH IP/OP "$3,154.00" "$2,334.00" $14.89 "$3,154.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$3,154.00" "$3,154.00" "$3,154.00" $657.37 "$3,154.00" "$2,340.90" "$2,340.90" "$2,431.10" "$1,643.23" $657.33 "$3,154.00" "$2,200.00" "$1,865.59" "$3,154.00" $14.89 "$3,154.00" "$3,154.00" "$2,365.50" "$3,154.00" "$3,154.00" "$3,154.00" "$1,513.92" "$1,513.92" "$2,497.97" "$3,154.00" "$2,523.20" "$3,154.00" $625.99 "$3,154.00" "$1,829.32" "$3,154.00" "$3,154.00" "$3,154.00" $657.29 "$3,154.00" N/A N/A 40000003 EAP CPT® 76377 3D RENDERING W/POSTPROCESS NIR BOTH IP/OP "$3,154.00" "$2,334.00" $38.90 "$3,306.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$3,154.00" "$3,154.00" "$3,154.00" $657.37 "$3,154.00" "$2,340.90" "$2,340.90" "$2,431.10" "$1,643.23" $657.33 "$3,154.00" "$3,306.00" "$1,865.59" "$3,154.00" $38.90 "$3,154.00" "$3,154.00" "$2,365.50" "$3,154.00" "$3,154.00" "$3,154.00" "$1,513.92" "$1,513.92" "$2,497.97" "$3,154.00" "$2,523.20" "$3,154.00" $625.99 "$3,154.00" "$1,829.32" "$3,154.00" "$3,154.00" "$3,154.00" $657.29 "$3,154.00" N/A N/A 40100003 EAP CPT® 77061 DX DIGITAL BREAST TOMOSYNTHESIS; UNILATERAL BOTH IP/OP $156.00 $115.50 $24.18 $310.17 $156.00 $156.00 $156.00 $156.00 $24.18 $24.18 $55.28 $32.51 $24.18 $298.68 $298.68 $310.17 $218.03 $32.51 $38.69 $38.96 $92.27 $24.18 $24.35 $24.18 $156.00 $117.00 $24.18 $24.18 $24.18 $74.88 $74.88 $123.55 $24.18 $124.80 $156.00 $30.96 $24.18 $90.48 $156.00 $93.60 $156.00 $32.51 $24.18 N/A N/A 40100008 EAP CPT® 77062 DX DIGITAL BREAST TOMOSYNTHESIS; BILATERAL BOTH IP/OP $275.00 $203.50 $24.18 $275.00 $275.00 $275.00 $275.00 $275.00 $24.18 $24.18 $55.28 $57.32 $24.18 $234.47 $234.47 $243.49 $171.16 $57.31 $38.69 $38.96 $162.66 $24.18 $24.35 $24.18 $275.00 $206.25 $24.18 $24.18 $24.18 $132.00 $132.00 $217.80 $24.18 $220.00 $275.00 $54.58 $24.18 $159.50 $275.00 $165.00 $275.00 $57.31 $24.18 N/A N/A 40100012 EAP CPT® 77065 DX MAMMO INCL CAD UNI BOTH IP/OP $337.00 $249.50 $66.89 $337.00 $288.20 $288.20 $288.20 $288.20 $90.45 $90.45 $111.20 $70.24 $90.45 $236.28 $236.28 $245.37 $172.48 $70.23 $144.72 $141.78 $199.34 $90.45 $88.61 $90.45 $337.00 $252.75 $90.45 $90.45 $90.45 $161.76 $161.76 $266.90 $90.45 $269.60 $337.00 $66.89 $90.45 $195.46 $337.00 $94.36 $90.45 $70.23 $90.45 N/A N/A 40100013 EAP CPT® 77066 DX MAMMO INCL CAD BI BOTH IP/OP $416.00 $308.00 $82.57 $416.00 $365.61 $365.61 $365.61 $365.61 $115.32 $115.32 $140.79 $86.70 $115.32 $302.23 $302.23 $313.86 $220.63 $86.70 $184.51 $180.74 $246.06 $115.32 $112.96 $115.32 $416.00 $312.00 $115.32 $115.32 $115.32 $199.68 $199.68 $329.47 $115.32 $332.80 $416.00 $82.57 $115.32 $241.28 $416.00 $120.30 $115.32 $86.69 $115.32 N/A N/A 40200001 EAP CPT® 76506 ULTRASOUND CRANIAL BOTH IP/OP $621.00 $460.00 $84.28 $621.00 $621.00 $621.00 $621.00 $621.00 $88.38 $88.38 $101.69 $621.00 $88.38 $205.65 $205.65 $213.56 $150.12 $129.42 $141.41 $135.82 $621.00 $88.38 $84.89 $88.38 $621.00 $465.75 $88.38 $88.38 $88.38 $298.08 $298.08 $491.83 $88.38 $496.80 $183.00 $621.00 $88.38 $360.18 $621.00 $84.28 $88.38 $621.00 $88.38 N/A N/A 40200002 EAP CPT® 76641 ULTRASOUND BREAST COMPLETE BOTH IP/OP "$1,344.00" $995.00 $70.01 "$1,344.00" "$1,344.00" "$1,344.00" "$1,344.00" "$1,344.00" $71.46 $71.46 $92.26 "$1,344.00" $71.46 $179.16 $179.16 $186.05 $130.79 $280.10 $114.34 $112.02 "$1,344.00" $71.46 $70.01 $71.46 "$1,344.00" "$1,008.00" $71.46 $71.46 $71.46 $645.12 $645.12 "$1,064.45" $71.46 "$1,075.20" $183.00 "$1,344.00" $71.46 $779.52 "$1,344.00" $71.67 $71.46 "$1,344.00" $71.46 N/A N/A 40200003 EAP CPT® 76506 ECHO EXAM HEAD BOTH IP/OP $615.00 $455.50 $84.28 $615.00 $615.00 $615.00 $615.00 $615.00 $88.38 $88.38 $101.69 $615.00 $88.38 $205.65 $205.65 $213.56 $150.12 $128.17 $141.41 $135.82 $615.00 $88.38 $84.89 $88.38 $615.00 $461.25 $88.38 $88.38 $88.38 $295.20 $295.20 $487.08 $88.38 $492.00 $183.00 $615.00 $88.38 $356.70 $615.00 $84.28 $88.38 $615.00 $88.38 N/A N/A 40200005 EAP CPT® 76512 "OPHTH US, B W/NON-QUANT A" BOTH IP/OP $759.00 $562.00 $17.93 $607.20 $200.75 $200.75 $200.75 $200.75 $107.09 $107.09 $106.62 $158.19 $107.09 $104.58 $104.58 $108.60 $76.34 $158.18 $171.35 $154.19 $448.95 $107.09 $17.93 $107.09 $112.45 $569.25 $107.09 $107.09 $107.09 $364.32 $364.32 $601.13 $107.09 $607.20 $183.00 $150.64 $107.09 $440.22 $112.45 $154.94 $107.09 $158.18 $107.09 N/A N/A 40200006 EAP CPT® 76514 "ECHO EXAM OF EYE, THICKNESS" BOTH IP/OP $287.00 $212.50 $3.73 $229.60 $32.96 $32.96 $32.96 $32.96 $24.30 $24.30 $24.19 $59.82 $24.30 $8.91 $8.91 $9.26 $6.51 $59.81 $38.88 $36.00 $169.76 $24.30 $3.73 $24.30 $25.52 $215.25 $24.30 $24.30 $24.30 $137.76 $137.76 $227.30 $24.30 $229.60 $183.00 $56.96 $24.30 $166.46 $25.52 $35.16 $24.30 $59.81 $24.30 N/A N/A 40200007 EAP CPT® 76519 ULTRASONOGRAPHY BOTH IP/OP $759.00 $562.00 $36.02 $759.00 $759.00 $759.00 $759.00 $759.00 $37.96 $37.96 $57.99 $759.00 $37.96 $108.71 $108.71 $112.89 $79.36 $158.18 $60.74 $60.61 $759.00 $37.96 $37.88 $37.96 $759.00 $569.25 $37.96 $37.96 $37.96 $364.32 $364.32 $601.13 $37.96 $607.20 $183.00 $759.00 $37.96 $440.22 $759.00 $36.02 $37.96 $759.00 $37.96 N/A N/A 40200008 EAP CPT® 76642 ULTRASOUND BREAST LIMITED BOTH IP/OP "$1,265.00" $936.50 $53.78 "$1,012.00" $192.39 $192.39 $192.39 $192.39 $79.57 $79.57 $79.21 $263.66 $79.57 $137.30 $137.30 $142.58 $100.23 $263.64 $127.31 $125.33 $748.25 $79.57 $53.78 $79.57 $83.54 $948.75 $79.57 $79.57 $79.57 $607.20 $607.20 "$1,001.88" $79.57 "$1,012.00" $183.00 $251.07 $79.57 $733.70 $83.54 $115.11 $79.57 $263.63 $79.57 N/A N/A 40200009 EAP CPT® 76536 SOFT TISS/HEAD&NECK W/REALTIME BOTH IP/OP "$1,100.00" $814.00 $85.91 $880.00 $253.71 $253.71 $253.71 $253.71 $107.09 $107.09 $106.62 $229.27 $107.09 $204.76 $204.76 $212.63 $149.47 $229.25 $171.35 $154.19 $650.65 $107.09 $85.91 $107.09 $112.45 $825.00 $107.09 $107.09 $107.09 $528.00 $528.00 $871.20 $107.09 $880.00 $183.00 $218.32 $107.09 $638.00 $112.45 $154.94 $107.09 $229.24 $107.09 N/A N/A 40200011 EAP CPT® 76536 US EXAM HEAD AND NECK BOTH IP/OP "$1,100.00" $814.00 $85.91 $880.00 $253.71 $253.71 $253.71 $253.71 $107.09 $107.09 $106.62 $229.27 $107.09 $204.76 $204.76 $212.63 $149.47 $229.25 $171.35 $154.19 $650.65 $107.09 $85.91 $107.09 $112.45 $825.00 $107.09 $107.09 $107.09 $528.00 $528.00 $871.20 $107.09 $880.00 $183.00 $218.32 $107.09 $638.00 $112.45 $154.94 $107.09 $229.24 $107.09 N/A N/A 40200012 EAP CPT® 76604 "ULTRASOUND EXAM, CHEST" BOTH IP/OP "$1,206.00" $892.50 $29.77 $964.80 $192.39 $192.39 $192.39 $192.39 $107.09 $107.09 $106.62 $251.36 $107.09 $145.00 $145.00 $150.57 $105.85 $251.34 $171.35 $154.19 $713.35 $107.09 $29.77 $107.09 $112.45 $904.50 $107.09 $107.09 $107.09 $578.88 $578.88 $955.15 $107.09 $964.80 $183.00 $239.36 $107.09 $699.48 $112.45 $154.94 $107.09 $251.33 $107.09 N/A N/A 40200014 EAP CPT® 76604 US EXAM CHEST BOTH IP/OP "$1,206.00" $892.50 $29.77 $964.80 $192.39 $192.39 $192.39 $192.39 $107.09 $107.09 $106.62 $251.36 $107.09 $145.00 $145.00 $150.57 $105.85 $251.34 $171.35 $154.19 $713.35 $107.09 $29.77 $107.09 $112.45 $904.50 $107.09 $107.09 $107.09 $578.88 $578.88 $955.15 $107.09 $964.80 $183.00 $239.36 $107.09 $699.48 $112.45 $154.94 $107.09 $251.33 $107.09 N/A N/A 40200018 EAP CPT® 76700 "US ABD, RT W/IMAGE" BOTH IP/OP "$1,489.00" "$1,102.00" $80.16 "$1,191.20" $266.71 $266.71 $266.71 $266.71 $107.09 $107.09 $106.62 $310.34 $107.09 $236.95 $236.95 $246.07 $172.97 $310.32 $171.35 $154.19 $880.74 $107.09 $80.16 $107.09 $112.45 "$1,116.75" $107.09 $107.09 $107.09 $714.72 $714.72 "$1,179.29" $107.09 "$1,191.20" $183.00 $295.53 $107.09 $863.62 $112.45 $154.94 $107.09 $310.31 $107.09 N/A N/A 40200020 EAP CPT® 76705 BLADDER ULTRASOUND BOTH IP/OP "$1,412.00" "$1,045.00" $61.22 "$1,129.60" $199.27 $199.27 $199.27 $199.27 $107.09 $107.09 $106.62 $294.30 $107.09 $182.05 $182.05 $189.05 $132.90 $294.28 $171.35 $154.19 $835.20 $107.09 $61.22 $107.09 $112.45 "$1,059.00" $107.09 $107.09 $107.09 $677.76 $677.76 "$1,118.30" $107.09 "$1,129.60" $183.00 $280.25 $107.09 $818.96 $112.45 $154.94 $107.09 $294.26 $107.09 N/A N/A 40200021 EAP CPT® 76705 ECHO EXAM ABDOMEN BOTH IP/OP "$1,415.00" "$1,047.50" $61.22 "$1,132.00" $199.27 $199.27 $199.27 $199.27 $107.09 $107.09 $106.62 $294.92 $107.09 $182.05 $182.05 $189.05 $132.90 $294.90 $171.35 $154.19 $836.97 $107.09 $61.22 $107.09 $112.45 "$1,061.25" $107.09 $107.09 $107.09 $679.20 $679.20 "$1,120.68" $107.09 "$1,132.00" $183.00 $280.84 $107.09 $820.70 $112.45 $154.94 $107.09 $294.89 $107.09 N/A N/A 40200022 EAP CPT® 76641 ULTRASOUND BREAST RT COMPLETE BOTH IP/OP "$1,168.00" $864.50 $70.01 "$1,168.00" "$1,168.00" "$1,168.00" "$1,168.00" "$1,168.00" $71.46 $71.46 $92.26 "$1,168.00" $71.46 $179.16 $179.16 $186.05 $130.79 $243.42 $114.34 $112.02 "$1,168.00" $71.46 $70.01 $71.46 "$1,168.00" $876.00 $71.46 $71.46 $71.46 $560.64 $560.64 $925.06 $71.46 $934.40 $183.00 "$1,168.00" $71.46 $677.44 "$1,168.00" $71.67 $71.46 "$1,168.00" $71.46 N/A N/A 40200023 EAP CPT® 76770 "US RETROPERIT, RT W/IMAGE; COMPLETE" BOTH IP/OP "$1,417.00" "$1,049.00" $75.42 "$1,133.60" $246.81 $246.81 $246.81 $246.81 $107.09 $107.09 $106.62 $295.34 $107.09 $231.49 $231.49 $240.40 $168.99 $295.32 $171.35 $154.19 $838.16 $107.09 $75.42 $107.09 $112.45 "$1,062.75" $107.09 $107.09 $107.09 $680.16 $680.16 "$1,122.26" $107.09 "$1,133.60" $183.00 $281.24 $107.09 $821.86 $112.45 $154.94 $107.09 $295.30 $107.09 N/A N/A 40200025 EAP CPT® 76775 "US RETROPER, RT W/IMAGE LTD" BOTH IP/OP "$1,302.00" $963.50 $32.13 "$1,041.60" $127.23 $127.23 $127.23 $127.23 $107.09 $107.09 $106.62 $271.37 $107.09 $202.02 $202.02 $209.79 $147.47 $271.35 $171.35 $154.19 $770.13 $107.09 $32.13 $107.09 $112.45 $976.50 $107.09 $107.09 $107.09 $624.96 $624.96 "$1,031.18" $107.09 "$1,041.60" $183.00 $258.41 $107.09 $755.16 $112.45 $154.94 $107.09 $271.34 $107.09 N/A N/A 40200027 EAP CPT® 76800 US SPINE BOTH IP/OP "$1,019.00" $754.50 $85.72 "$1,019.00" "$1,019.00" "$1,019.00" "$1,019.00" "$1,019.00" $90.80 $90.80 $123.91 "$1,019.00" $90.80 $170.28 $170.28 $176.83 $124.30 $212.37 $145.28 $156.93 "$1,019.00" $90.80 $98.08 $90.80 "$1,019.00" $764.25 $90.80 $90.80 $90.80 $489.12 $489.12 $807.05 $90.80 $815.20 $183.00 "$1,019.00" $90.80 $591.02 "$1,019.00" $85.72 $90.80 "$1,019.00" $90.80 N/A N/A 40200028 EAP CPT® 76642 ULTRASOUND BREAST RT LIMITED BOTH IP/OP "$1,082.00" $801.00 $53.78 $865.60 $192.39 $192.39 $192.39 $192.39 $79.57 $79.57 $79.21 $225.52 $79.57 $137.30 $137.30 $142.58 $100.23 $225.50 $127.31 $125.33 $640.00 $79.57 $53.78 $79.57 $83.54 $811.50 $79.57 $79.57 $79.57 $519.36 $519.36 $856.94 $79.57 $865.60 $183.00 $214.75 $79.57 $627.56 $83.54 $115.11 $79.57 $225.49 $79.57 N/A N/A 40200029 EAP CPT® 76641 ULTRASOUND BREAST RT COMPLETE BOTH IP/OP "$1,168.00" $864.50 $70.01 "$1,168.00" "$1,168.00" "$1,168.00" "$1,168.00" "$1,168.00" $71.46 $71.46 $92.26 "$1,168.00" $71.46 $179.16 $179.16 $186.05 $130.79 $243.42 $114.34 $112.02 "$1,168.00" $71.46 $70.01 $71.46 "$1,168.00" $876.00 $71.46 $71.46 $71.46 $560.64 $560.64 $925.06 $71.46 $934.40 $183.00 "$1,168.00" $71.46 $677.44 "$1,168.00" $71.67 $71.46 "$1,168.00" $71.46 N/A N/A 40200030 EAP CPT® 76642 ULTRASOUND BREAST RT LIMITED BOTH IP/OP $941.00 $696.50 $53.78 $752.80 $192.39 $192.39 $192.39 $192.39 $79.57 $79.57 $79.21 $196.13 $79.57 $137.30 $137.30 $142.58 $100.23 $196.11 $127.31 $125.33 $556.60 $79.57 $53.78 $79.57 $83.54 $705.75 $79.57 $79.57 $79.57 $451.68 $451.68 $745.27 $79.57 $752.80 $183.00 $186.76 $79.57 $545.78 $83.54 $115.11 $79.57 $196.10 $79.57 N/A N/A 40200031 EAP CPT® 76941 CORDOCENTESIS US GUIDANCE BOTH IP/OP $813.00 $602.00 $107.87 $813.00 $813.00 $813.00 $813.00 $813.00 $813.00 $813.00 $144.71 $813.00 $813.00 $147.76 $147.76 $153.45 $107.87 $169.44 $813.00 $325.20 $813.00 $813.00 $813.00 $813.00 $813.00 $609.75 $813.00 $813.00 $813.00 $390.24 $390.24 $643.90 $813.00 $650.40 $183.00 $813.00 $813.00 $471.54 $813.00 $813.00 $813.00 $813.00 $813.00 N/A N/A 40200034 EAP CPT® 76801 "OB US <14 WKS, SINGLE FETUS" BOTH IP/OP $554.00 $410.00 $72.38 $443.20 $269.80 $269.80 $269.80 $269.80 $107.09 $107.09 $106.62 $115.47 $107.09 $201.38 $201.38 $209.12 $147.00 $115.46 $171.35 $154.19 $327.69 $107.09 $72.38 $107.09 $112.45 $415.50 $107.09 $107.09 $107.09 $265.92 $265.92 $438.77 $107.09 $443.20 $183.00 $109.96 $107.09 $321.32 $112.45 $154.94 $107.09 $115.45 $107.09 N/A N/A 40200035 EAP CPT® 76885 US INFANT HIPS DYNAMIC BOTH IP/OP "$1,786.00" "$1,322.00" $103.84 "$1,786.00" "$1,786.00" "$1,786.00" "$1,786.00" "$1,786.00" $106.65 $106.65 $124.22 "$1,786.00" $106.65 $244.37 $244.37 $253.77 $178.39 $372.22 $170.64 $166.14 "$1,786.00" $106.65 $103.84 $106.65 "$1,786.00" "$1,339.50" $106.65 $106.65 $106.65 $857.28 $857.28 "$1,414.51" $106.65 "$1,428.80" $183.00 "$1,786.00" $106.65 "$1,035.88" "$1,786.00" $108.05 $106.65 "$1,786.00" $106.65 N/A N/A 40200036 EAP CPT® 76870 US SCROTUM BOTH IP/OP "$1,540.00" "$1,140.00" $72.04 "$1,232.00" $148.69 $148.69 $148.69 $148.69 $107.09 $107.09 $106.62 $320.97 $107.09 $215.32 $215.32 $223.60 $157.18 $320.95 $171.35 $154.19 $910.91 $107.09 $72.04 $107.09 $112.45 "$1,155.00" $107.09 $107.09 $107.09 $739.20 $739.20 "$1,219.68" $107.09 "$1,232.00" $183.00 $305.65 $107.09 $893.20 $112.45 $154.94 $107.09 $320.94 $107.09 N/A N/A 40200037 EAP CPT® 76872 "ULTRASOUND,TRANSRECTAL" BOTH IP/OP $615.00 $455.50 $106.62 $492.00 $206.92 $206.92 $206.92 $206.92 $107.09 $107.09 $106.62 $128.18 $107.09 $263.43 $263.43 $273.56 $192.30 $128.17 $171.35 $154.19 $363.77 $107.09 $171.81 $107.09 $112.45 $461.25 $107.09 $107.09 $107.09 $295.20 $295.20 $487.08 $107.09 $492.00 $183.00 $122.06 $107.09 $356.70 $112.45 $154.94 $107.09 $128.17 $107.09 N/A N/A 40200038 EAP CPT® 76881 "US EXTREMITY, NON-VASC RT W/IM COM" BOTH IP/OP "$1,000.00" $740.00 $11.17 $800.00 $257.53 $257.53 $257.53 $257.53 $107.09 $107.09 $106.62 $208.43 $107.09 $215.36 $215.36 $223.65 $157.21 $208.41 $171.35 $154.19 $591.50 $107.09 $11.17 $107.09 $112.45 $750.00 $107.09 $107.09 $107.09 $480.00 $480.00 $792.00 $107.09 $800.00 $183.00 $198.48 $107.09 $580.00 $112.45 $154.94 $107.09 $208.40 $107.09 N/A N/A 40200039 EAP CPT® 76805 OB US >/= 14 WKS SNGL FETUS BOTH IP/OP $679.00 $502.50 $90.31 $543.20 $311.19 $311.19 $311.19 $311.19 $107.09 $107.09 $106.62 $141.52 $107.09 $239.50 $239.50 $248.71 $174.83 $141.51 $171.35 $154.19 $401.63 $107.09 $90.31 $107.09 $112.45 $509.25 $107.09 $107.09 $107.09 $325.92 $325.92 $537.77 $107.09 $543.20 $183.00 $134.76 $107.09 $393.82 $112.45 $154.94 $107.09 $141.50 $107.09 N/A N/A 40200040 EAP CPT® 76886 US INFANT HIPS STATIC BOTH IP/OP "$1,725.00" "$1,276.50" $72.72 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $74.22 $74.22 $91.06 "$1,725.00" $74.22 $172.09 $172.09 $178.71 $125.62 $359.51 $118.75 $116.35 "$1,725.00" $74.22 $72.72 $74.22 "$1,725.00" "$1,293.75" $74.22 $74.22 $74.22 $828.00 $828.00 "$1,366.20" $74.22 "$1,380.00" $183.00 "$1,725.00" $74.22 "$1,000.50" "$1,725.00" $75.28 $74.22 "$1,725.00" $74.22 N/A N/A 40200042 EAP CPT® 76937 US GUIDANCE FOR VASCULAR ACESS BOTH IP/OP "$1,573.00" "$1,164.50" $25.70 "$1,573.00" $68.22 $68.22 $68.22 $68.22 "$1,573.00" "$1,573.00" "$1,573.00" $327.85 "$1,573.00" $51.04 $51.04 $53.01 $37.26 $327.83 "$1,573.00" "$1,259.00" $930.43 "$1,573.00" $25.70 "$1,573.00" "$1,573.00" "$1,179.75" "$1,573.00" "$1,573.00" "$1,573.00" $755.04 $755.04 "$1,245.82" "$1,573.00" "$1,258.40" $183.00 $312.20 "$1,573.00" $912.34 "$1,573.00" "$1,573.00" "$1,573.00" $327.81 "$1,573.00" N/A N/A 40200043 EAP CPT® 76940 ULT GUIDE FOR MON. PAR.TIS.ABL BOTH IP/OP $912.00 $675.00 $135.01 "$1,443.00" $912.00 $912.00 $912.00 $912.00 $912.00 $912.00 $162.34 $912.00 $912.00 $184.95 $184.95 $192.07 $135.01 $190.07 $912.00 $577.20 $912.00 $912.00 "$1,443.00" $912.00 $912.00 $684.00 $912.00 $912.00 $912.00 $437.76 $437.76 $722.30 $912.00 $729.60 $183.00 $912.00 $912.00 $528.96 $912.00 $912.00 $912.00 $912.00 $912.00 N/A N/A 40200044 EAP CPT® 76810 OB US >= 14 WKS ADDL FETUS BOTH IP/OP $666.00 $493.00 $42.28 $742.00 $203.89 $203.89 $203.89 $203.89 $666.00 $666.00 $666.00 $138.81 $666.00 $129.92 $129.92 $134.91 $94.84 $138.80 $666.00 $742.00 $393.94 $666.00 $42.28 $666.00 $666.00 $499.50 $666.00 $666.00 $666.00 $319.68 $319.68 $527.47 $666.00 $532.80 $183.00 $132.18 $666.00 $386.28 $666.00 $666.00 $666.00 $138.79 $666.00 N/A N/A 40200045 EAP CPT® 76942 NEEDLE PLACEMENT US GUIDE BIC BOTH IP/OP "$1,083.00" $801.50 $28.41 "$1,212.00" $131.05 $131.05 $131.05 $131.05 "$1,083.00" "$1,083.00" "$1,083.00" $225.72 "$1,083.00" $375.04 $375.04 $389.47 $273.78 $225.71 "$1,083.00" "$1,212.00" $640.59 "$1,083.00" $28.41 "$1,083.00" "$1,083.00" $812.25 "$1,083.00" "$1,083.00" "$1,083.00" $519.84 $519.84 $857.74 "$1,083.00" $866.40 $183.00 $214.95 "$1,083.00" $628.14 "$1,083.00" "$1,083.00" "$1,083.00" $225.70 "$1,083.00" N/A N/A 40200047 EAP CPT® 76946 ECHO GUIDE AMNIOCENTESIS BOTH IP/OP $770.00 $570.00 $14.89 $770.00 $71.31 $71.31 $71.31 $71.31 $770.00 $770.00 $770.00 $160.49 $770.00 $64.66 $64.66 $67.14 $47.20 $160.48 $770.00 $770.00 $455.46 $770.00 $14.89 $770.00 $770.00 $577.50 $770.00 $770.00 $770.00 $369.60 $369.60 $609.84 $770.00 $616.00 $183.00 $152.83 $770.00 $446.60 $770.00 $770.00 $770.00 $160.47 $770.00 N/A N/A 40200048 EAP CPT® 76810 OB US >/= 14 WKS ADDITIONAL FETUS BOTH IP/OP $667.00 $494.00 $42.28 $742.00 $203.89 $203.89 $203.89 $203.89 $667.00 $667.00 $667.00 $139.02 $667.00 $129.92 $129.92 $134.91 $94.84 $139.01 $667.00 $742.00 $394.53 $667.00 $42.28 $667.00 $667.00 $500.25 $667.00 $667.00 $667.00 $320.16 $320.16 $528.26 $667.00 $533.60 $183.00 $132.38 $667.00 $386.86 $667.00 $667.00 $667.00 $139.00 $667.00 N/A N/A 40200049 EAP CPT® 76998 US GUIDANCE INTRAOPERATIVE BOTH IP/OP $864.00 $639.50 $153.79 $864.00 $864.00 $864.00 $864.00 $864.00 $864.00 $864.00 $153.79 $864.00 $864.00 $286.63 $286.63 $297.66 $209.24 $180.07 $864.00 $345.60 $864.00 $864.00 $864.00 $864.00 $864.00 $648.00 $864.00 $864.00 $864.00 $414.72 $414.72 $684.29 $864.00 $691.20 $183.00 $864.00 $864.00 $501.12 $864.00 $864.00 $864.00 $864.00 $864.00 N/A N/A 40200052 EAP CPT® 76811 US PREG UTERUS 1ST GEST BOTH IP/OP "$1,414.00" "$1,046.50" $87.62 "$1,131.20" $401.68 $401.68 $401.68 $401.68 $226.34 $226.34 $225.34 $294.71 $226.34 $279.03 $279.03 $289.76 $203.69 $294.69 $362.15 $336.89 $836.38 $226.34 $87.62 $226.34 $237.66 "$1,060.50" $226.34 $226.34 $226.34 $678.72 $678.72 "$1,119.89" $226.34 "$1,131.20" $183.00 $280.64 $226.34 $820.12 $237.66 $327.46 $226.34 $294.68 $226.34 N/A N/A 40200054 EAP CPT® 76813 "OB US NUCHAL MEAS, 1 GEST" BOTH IP/OP $927.00 $686.00 $62.23 $741.60 $267.52 $267.52 $267.52 $267.52 $107.09 $107.09 $106.62 $193.21 $107.09 $174.75 $174.75 $181.47 $127.57 $193.20 $171.35 $154.19 $548.32 $107.09 $62.23 $107.09 $112.45 $695.25 $107.09 $107.09 $107.09 $444.96 $444.96 $734.18 $107.09 $741.60 $183.00 $183.99 $107.09 $537.66 $112.45 $154.94 $107.09 $193.19 $107.09 N/A N/A 40200055 EAP CPT® 76814 "OB US NUCHAL MEAS, ADD-ON" BOTH IP/OP $555.00 $411.00 $28.75 $555.00 $555.00 $555.00 $555.00 $555.00 $29.32 $29.32 $67.70 $555.00 $29.32 $86.72 $86.72 $90.05 $63.30 $115.67 $46.91 $46.00 $555.00 $29.32 $28.75 $29.32 $555.00 $416.25 $29.32 $29.32 $29.32 $266.40 $266.40 $439.56 $29.32 $444.00 $183.00 $555.00 $29.32 $321.90 $555.00 $29.53 $29.32 $555.00 $29.32 N/A N/A 40200056 EAP CPT® 76815 "OB US, LIMITED, FETUS(S)" BOTH IP/OP $554.00 $410.00 $51.41 $443.20 $185.49 $185.49 $185.49 $185.49 $107.09 $107.09 $106.62 $115.47 $107.09 $144.86 $144.86 $150.43 $105.75 $115.46 $171.35 $154.19 $327.69 $107.09 $51.41 $107.09 $112.45 $415.50 $107.09 $107.09 $107.09 $265.92 $265.92 $438.77 $107.09 $443.20 $183.00 $109.96 $107.09 $321.32 $112.45 $154.94 $107.09 $115.45 $107.09 N/A N/A 40200062 EAP CPT® 76816 US PREG UTERUS F/U BOTH IP/OP $554.00 $410.00 $70.69 $443.20 $253.71 $253.71 $253.71 $253.71 $107.09 $107.09 $106.62 $115.47 $107.09 $171.46 $171.46 $178.06 $125.17 $115.46 $171.35 $154.19 $327.69 $107.09 $70.69 $107.09 $112.45 $415.50 $107.09 $107.09 $107.09 $265.92 $265.92 $438.77 $107.09 $443.20 $183.00 $109.96 $107.09 $321.32 $112.45 $154.94 $107.09 $115.45 $107.09 N/A N/A 40200064 EAP CPT® 76817 TRANSVAGINAL U/S PREGNANT BOTH IP/OP $593.00 $439.00 $58.18 $474.40 $213.07 $213.07 $213.07 $213.07 $107.09 $107.09 $106.62 $123.60 $107.09 $158.78 $158.78 $164.88 $115.91 $123.59 $171.35 $154.19 $350.76 $107.09 $58.18 $107.09 $112.45 $444.75 $107.09 $107.09 $107.09 $284.64 $284.64 $469.66 $107.09 $474.40 $183.00 $117.70 $107.09 $343.94 $112.45 $154.94 $107.09 $123.58 $107.09 N/A N/A 40200065 EAP CPT® 76882 "ULTRASOUND, EXTREMITY, NONVASCULAR, LIMITED" BOTH IP/OP $649.00 $480.50 $9.48 $649.00 $78.19 $78.19 $78.19 $78.19 $107.09 $107.09 $106.62 $10.15 $107.09 $649.00 $649.00 $649.00 $649.00 $649.00 $171.35 $154.19 $649.00 $107.09 $9.48 $107.09 $112.45 $486.75 $107.09 $107.09 $107.09 $311.52 $311.52 $649.00 $107.09 $649.00 $421.85 $649.00 $107.09 $376.42 $112.45 $154.94 $107.09 $649.00 $107.09 N/A N/A 40200067 EAP CPT® 76818 BIOPHYSICAL PROFILE W/NST BOTH IP/OP "$1,430.00" "$1,058.50" $67.65 "$1,144.00" $270.60 $270.60 $270.60 $270.60 $107.09 $107.09 $106.62 $298.05 $107.09 $170.84 $170.84 $177.41 $124.71 $298.03 $171.35 $154.19 $845.85 $107.09 $67.65 $107.09 $112.45 "$1,072.50" $107.09 $107.09 $107.09 $686.40 $686.40 "$1,132.56" $107.09 "$1,144.00" $183.00 $283.82 $107.09 $829.40 $112.45 $154.94 $107.09 $298.01 $107.09 N/A N/A 40200069 EAP CPT® 76819 BIOPHYSICAL PROFILE W/O NST BOTH IP/OP "$1,063.00" $787.00 $48.71 $850.40 $197.76 $197.76 $197.76 $197.76 $107.09 $107.09 $106.62 $221.56 $107.09 $137.27 $137.27 $142.55 $100.21 $221.54 $171.35 $154.19 $628.76 $107.09 $48.71 $107.09 $112.45 $797.25 $107.09 $107.09 $107.09 $510.24 $510.24 $841.90 $107.09 $850.40 $183.00 $210.98 $107.09 $616.54 $112.45 $154.94 $107.09 $221.53 $107.09 N/A N/A 40200071 EAP CPT® 76820 FETAL DOPP VELOCIMETRY UMB ART BOTH IP/OP "$1,583.00" "$1,171.50" $21.65 "$1,266.40" $105.80 $105.80 $105.80 $105.80 $107.09 $107.09 $106.62 $329.94 $107.09 $73.41 $73.41 $76.24 $53.59 $329.91 $171.35 $154.19 $936.34 $107.09 $21.65 $107.09 $112.45 "$1,187.25" $107.09 $107.09 $107.09 $759.84 $759.84 "$1,253.74" $107.09 "$1,266.40" $183.00 $314.19 $107.09 $918.14 $112.45 $154.94 $107.09 $329.90 $107.09 N/A N/A 40200072 EAP CPT® 76821 FETAL DOPP VELOCIMETRY MID CER BOTH IP/OP "$1,583.00" "$1,171.50" $56.48 "$1,266.40" $203.91 $203.91 $203.91 $203.91 $107.09 $107.09 $106.62 $329.94 $107.09 $156.00 $156.00 $162.00 $113.88 $329.91 $171.35 $154.19 $936.34 $107.09 $56.48 $107.09 $112.45 "$1,187.25" $107.09 $107.09 $107.09 $759.84 $759.84 "$1,253.74" $107.09 "$1,266.40" $183.00 $314.19 $107.09 $918.14 $112.45 $154.94 $107.09 $329.90 $107.09 N/A N/A 40200073 EAP CPT® 76825 FETAL ECHO (2D) BOTH IP/OP "$2,946.00" "$2,180.50" $183.00 "$2,356.80" $607.80 $607.80 $607.80 $607.80 $475.30 $475.30 $473.20 $614.02 $475.30 $311.37 $311.37 $323.34 $227.29 $613.98 $760.48 $725.84 "$1,742.56" $475.30 $187.05 $475.30 $499.07 "$2,209.50" $475.30 $475.30 $475.30 "$1,414.08" "$1,414.08" "$2,333.23" $475.30 "$2,356.80" $183.00 $584.71 $475.30 "$1,708.68" $499.07 $687.64 $475.30 $613.95 $475.30 N/A N/A 40200074 EAP CPT® 76826 "FETAL ECHO, F/U, REPEAT" BOTH IP/OP "$1,629.00" "$1,205.50" $120.07 "$1,629.00" "$1,629.00" "$1,629.00" "$1,629.00" "$1,629.00" $123.92 $123.92 $143.15 "$1,629.00" $123.92 $184.35 $184.35 $191.44 $134.57 $339.50 $198.27 $192.11 "$1,629.00" $123.92 $120.07 $123.92 "$1,629.00" "$1,221.75" $123.92 $123.92 $123.92 $781.92 $781.92 "$1,290.17" $123.92 "$1,303.20" $183.00 "$1,629.00" $123.92 $944.82 "$1,629.00" $123.18 $123.92 "$1,629.00" $123.92 N/A N/A 40200075 EAP CPT® 76827 FETAL DOPPLER ECHO BOTH IP/OP "$2,946.00" "$2,180.50" $42.96 "$2,946.00" "$2,946.00" "$2,946.00" "$2,946.00" "$2,946.00" $44.87 $44.87 $63.59 "$2,946.00" $44.87 $107.91 $107.91 $112.06 $78.77 $613.98 $71.79 $68.74 "$2,946.00" $44.87 $42.96 $44.87 "$2,946.00" "$2,209.50" $44.87 $44.87 $44.87 "$1,414.08" "$1,414.08" "$2,333.23" $44.87 "$2,356.80" $183.00 "$2,946.00" $44.87 "$1,708.68" "$2,946.00" $45.38 $44.87 "$2,946.00" $44.87 N/A N/A 40200077 EAP CPT® 76828 "FETAL DOPP ECHO,REPEAT" BOTH IP/OP "$1,148.00" $850.00 $23.34 "$1,148.00" "$1,148.00" "$1,148.00" "$1,148.00" "$1,148.00" $23.80 $23.80 $44.65 "$1,148.00" $23.80 $63.18 $63.18 $65.61 $46.12 $239.26 $38.08 $37.34 "$1,148.00" $23.80 $23.34 $23.80 "$1,148.00" $861.00 $23.80 $23.80 $23.80 $551.04 $551.04 $909.22 $23.80 $918.40 $183.00 "$1,148.00" $23.80 $665.84 "$1,148.00" $24.49 $23.80 "$1,148.00" $23.80 N/A N/A 40200078 EAP CPT® 76812 OB US DETAILED ADDL FETUS BOTH IP/OP $289.00 $214.00 $57.36 $839.00 $289.00 $289.00 $289.00 $289.00 $289.00 $289.00 $289.00 $60.23 $289.00 $289.00 $289.00 $289.00 $289.00 $60.23 $289.00 $839.00 $170.94 $289.00 $109.59 $289.00 $289.00 $216.75 $289.00 $289.00 $289.00 $138.72 $138.72 $228.89 $289.00 $231.20 $187.85 $57.36 $289.00 $167.62 $289.00 $289.00 $289.00 $60.23 $289.00 N/A N/A 40200079 EAP CPT® 76830 US TRANSVAGINAL BOTH IP/OP "$1,612.00" "$1,193.00" $88.61 "$1,289.60" $266.74 $266.74 $266.74 $266.74 $107.09 $107.09 $106.62 $335.98 $107.09 $211.68 $211.68 $219.82 $154.53 $335.96 $171.35 $154.19 $953.50 $107.09 $88.61 $107.09 $112.45 "$1,209.00" $107.09 $107.09 $107.09 $773.76 $773.76 "$1,276.70" $107.09 "$1,289.60" $183.00 $319.94 $107.09 $934.96 $112.45 $154.94 $107.09 $335.94 $107.09 N/A N/A 40200083 EAP CPT® 76831 US HYSTEROSONO W/WO DOPPLER BOTH IP/OP "$2,535.00" "$1,876.00" $83.88 "$2,028.00" $261.37 $261.37 $261.37 $261.37 $226.34 $226.34 $225.34 $528.36 $226.34 $209.87 $209.87 $217.94 $153.20 $528.32 $362.15 $336.89 "$1,499.45" $226.34 $83.88 $226.34 $237.66 "$1,901.25" $226.34 $226.34 $226.34 "$1,216.80" "$1,216.80" "$2,007.72" $226.34 "$2,028.00" $183.00 $503.13 $226.34 "$1,470.30" $237.66 $327.46 $226.34 $528.29 $226.34 N/A N/A 40200085 EAP CPT® 76856 US PELVIS(NON-OB)COMP W/RT IMG BOTH IP/OP "$1,593.00" "$1,179.00" $74.41 "$1,274.40" $240.66 $240.66 $240.66 $240.66 $107.09 $107.09 $106.62 $332.02 $107.09 $212.59 $212.59 $220.76 $155.19 $332.00 $171.35 $154.19 $942.26 $107.09 $74.41 $107.09 $112.45 "$1,194.75" $107.09 $107.09 $107.09 $764.64 $764.64 "$1,261.66" $107.09 "$1,274.40" $183.00 $316.17 $107.09 $923.94 $112.45 $154.94 $107.09 $331.98 $107.09 N/A N/A 40200087 EAP CPT® 76857 US PELVIS LTD/FU NON-OB BOTH IP/OP "$1,018.00" $753.50 $25.71 $814.40 $105.02 $105.02 $105.02 $105.02 $107.09 $107.09 $106.62 $212.18 $107.09 $200.51 $200.51 $208.22 $146.37 $212.16 $171.35 $154.19 $602.15 $107.09 $25.71 $107.09 $112.45 $763.50 $107.09 $107.09 $107.09 $488.64 $488.64 $806.26 $107.09 $814.40 $183.00 $202.05 $107.09 $590.44 $112.45 $154.94 $107.09 $212.15 $107.09 N/A N/A 40200092 EAP CPT® 76516 ECHO EXAM OF EYE BOTH IP/OP $249.00 $184.50 $24.69 $199.20 $170.13 $170.13 $170.13 $170.13 $107.09 $107.09 $106.62 $51.90 $107.09 $97.82 $97.82 $101.58 $71.41 $51.89 $171.35 $154.19 $147.28 $107.09 $24.69 $107.09 $112.45 $186.75 $107.09 $107.09 $107.09 $119.52 $119.52 $197.21 $107.09 $199.20 $183.00 $49.42 $107.09 $144.42 $112.45 $154.94 $107.09 $51.89 $107.09 N/A N/A 40200097 EAP CPT® 76510 OPTH US B & QUANT A BOTH IP/OP $636.00 $471.00 $30.78 $636.00 $636.00 $636.00 $636.00 $636.00 $31.40 $31.40 $63.03 $636.00 $31.40 $168.59 $168.59 $175.08 $123.07 $132.55 $50.24 $49.25 $636.00 $31.40 $30.78 $31.40 $636.00 $477.00 $31.40 $31.40 $31.40 $305.28 $305.28 $503.71 $31.40 $508.80 $183.00 $636.00 $31.40 $368.88 $636.00 $43.94 $31.40 $636.00 $31.40 N/A N/A 40200125 EAP CPT® 76802 US PREG UTERUS EA ADDL GEST BOTH IP/OP $487.00 $360.50 $21.64 $487.00 $141.04 $141.04 $141.04 $141.04 $487.00 $487.00 $487.00 $101.50 $487.00 $80.66 $80.66 $83.76 $58.88 $101.50 $487.00 $487.00 $288.06 $487.00 $21.64 $487.00 $487.00 $365.25 $487.00 $487.00 $487.00 $233.76 $233.76 $385.70 $487.00 $389.60 $183.00 $96.66 $487.00 $282.46 $487.00 $487.00 $487.00 $101.49 $487.00 N/A N/A 40200126 EAP CPT® 93990 DUPLEX SCAN OF HEMODIALYSIS ACCESS BOTH IP/OP "$1,058.00" $783.00 $106.62 $846.40 $285.81 $285.81 $285.81 $285.81 $107.09 $107.09 $106.62 $220.51 $107.09 $450.12 $450.12 $467.43 $328.59 $220.50 $171.35 $154.19 $625.81 $107.09 $125.14 $107.09 $112.45 $793.50 $107.09 $107.09 $107.09 $529.00 $529.00 $837.94 $107.09 $846.40 $687.70 $209.99 $107.09 $613.64 $112.45 $154.94 $107.09 $220.49 $107.09 N/A N/A 40200127 EAP CPT® 76529 OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION BOTH IP/OP $220.00 $163.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $55.57 $55.57 $75.16 $220.00 $55.57 $95.85 $95.85 $99.53 $69.97 $45.85 $88.91 $87.66 $220.00 $55.57 $54.79 $55.57 $220.00 $165.00 $55.57 $55.57 $55.57 $105.60 $105.60 $174.24 $55.57 $176.00 $183.00 $220.00 $55.57 $127.60 $220.00 $51.14 $55.57 $220.00 $55.57 N/A N/A 40200132 EAP CPT® 76706 US ABDL AORTA SCREEN AAA BOTH IP/OP $380.00 $281.50 $75.42 $304.00 $203.89 $203.89 $203.89 $203.89 $107.09 $107.09 $106.62 $79.20 $107.09 $166.71 $166.71 $173.12 $121.70 $79.20 $171.35 $154.19 $224.77 $107.09 $82.19 $107.09 $112.45 $285.00 $107.09 $107.09 $107.09 $182.40 $182.40 $300.96 $107.09 $304.00 $183.00 $75.42 $107.09 $220.40 $112.45 $154.94 $107.09 $79.19 $107.09 N/A N/A 40200133 EAP CPT® 76516 ECHO EXAM EYE BOTH IP/OP $374.00 $277.00 $24.69 $299.20 $170.13 $170.13 $170.13 $170.13 $107.09 $107.09 $106.62 $77.95 $107.09 $97.82 $97.82 $101.58 $71.41 $77.95 $171.35 $154.19 $221.22 $107.09 $24.69 $107.09 $112.45 $280.50 $107.09 $107.09 $107.09 $179.52 $179.52 $296.21 $107.09 $299.20 $183.00 $74.23 $107.09 $216.92 $112.45 $154.94 $107.09 $77.94 $107.09 N/A N/A 40200134 EAP CPT® 76513 ECHO EXAM EYE WATER BATH BOTH IP/OP $539.00 $399.00 $43.63 $431.20 $206.15 $206.15 $206.15 $206.15 $107.09 $107.09 $106.62 $112.34 $107.09 $125.46 $125.46 $130.28 $91.58 $112.33 $171.35 $154.19 $318.82 $107.09 $43.63 $107.09 $112.45 $404.25 $107.09 $107.09 $107.09 $258.72 $258.72 $426.89 $107.09 $431.20 $183.00 $106.98 $107.09 $312.62 $112.45 $154.94 $107.09 $112.33 $107.09 N/A N/A 40200135 EAP CPT® 76513 "B-SCAN US, HIGH RESOLUTION BOTH EYES" BOTH IP/OP $808.00 $598.00 $43.63 $646.40 $206.15 $206.15 $206.15 $206.15 $107.09 $107.09 $106.62 $168.41 $107.09 $125.46 $125.46 $130.28 $91.58 $168.40 $171.35 $154.19 $477.93 $107.09 $43.63 $107.09 $112.45 $606.00 $107.09 $107.09 $107.09 $387.84 $387.84 $639.94 $107.09 $646.40 $183.00 $160.37 $107.09 $468.64 $112.45 $154.94 $107.09 $168.39 $107.09 N/A N/A 40300003 EAP CPT® 77063 BREAST TOMOSYNTHESIS BILAT BOTH IP/OP $149.00 $110.50 $24.18 $149.00 $120.33 $120.33 $120.33 $120.33 $24.18 $24.18 $46.99 $31.06 $24.18 $64.15 $64.15 $66.61 $46.83 $31.05 $38.69 $38.96 $88.13 $24.18 $24.35 $24.18 $149.00 $111.75 $24.18 $24.18 $24.18 $71.52 $71.52 $118.01 $24.18 $119.20 $149.00 $29.57 $24.18 $86.42 $149.00 $25.21 $24.18 $31.05 $24.18 N/A N/A 40300004 EAP CPT® 77063 "SCR DIGITAL BREAST TOMOSYNTHESIS, UNI" BOTH IP/OP $149.00 $110.50 $24.18 $149.00 $120.33 $120.33 $120.33 $120.33 $24.18 $24.18 $46.99 $31.06 $24.18 $64.15 $64.15 $66.61 $46.83 $31.05 $38.69 $38.96 $88.13 $24.18 $24.35 $24.18 $149.00 $111.75 $24.18 $24.18 $24.18 $71.52 $71.52 $118.01 $24.18 $119.20 $149.00 $29.57 $24.18 $86.42 $149.00 $25.21 $24.18 $31.05 $24.18 N/A N/A 40300010 EAP CPT® 77067 SCR MAMMO BI INCL CAD BOTH IP/OP $366.00 $271.00 $72.64 $366.00 $295.08 $295.08 $295.08 $295.08 $95.29 $95.29 $113.86 $76.28 $95.29 $249.62 $249.62 $259.22 $182.22 $76.28 $152.46 $149.90 $216.49 $95.29 $93.69 $95.29 $366.00 $274.50 $95.29 $95.29 $95.29 $175.68 $175.68 $289.87 $95.29 $292.80 $366.00 $72.64 $95.29 $212.28 $366.00 $99.77 $95.29 $76.27 $95.29 N/A N/A 40300011 EAP CPT® 77067 SCR MAMMO UNILATERAL INCL CAD BOTH IP/OP $366.00 $271.00 $72.64 $366.00 $295.08 $295.08 $295.08 $295.08 $95.29 $95.29 $113.86 $76.28 $95.29 $249.62 $249.62 $259.22 $182.22 $76.28 $152.46 $149.90 $216.49 $95.29 $93.69 $95.29 $366.00 $274.50 $95.29 $95.29 $95.29 $175.68 $175.68 $289.87 $95.29 $292.80 $366.00 $72.64 $95.29 $212.28 $366.00 $99.77 $95.29 $76.27 $95.29 N/A N/A 40400005 EAP CPT® 78814 PET IMG RESTG THYROID CA PET BOTH IP/OP "$10,583.00" "$7,831.50" "$1,572.39" "$10,583.00" "$10,583.00" "$10,583.00" "$10,583.00" "$10,583.00" "$10,583.00" "$10,583.00" "$1,883.77" "$10,583.00" "$10,583.00" "$2,153.99" "$2,153.99" "$2,236.83" "$1,572.39" "$2,205.61" "$10,583.00" "$3,529.60" "$3,731.00" "$10,583.00" "$8,824.00" "$10,583.00" "$10,583.00" "$7,937.25" "$10,583.00" "$10,583.00" "$10,583.00" "$5,079.84" "$5,079.84" "$8,381.74" "$10,583.00" "$8,466.40" "$2,400.00" "$10,583.00" "$10,583.00" "$6,138.14" "$10,583.00" "$10,583.00" "$10,583.00" "$10,583.00" "$10,583.00" N/A N/A 40400008 EAP CPT® 78815 PET/CT SKULL BASE MID-THIGH BOTH IP/OP "$10,477.00" "$7,753.00" "$1,449.43" "$10,477.00" "$3,765.00" "$3,765.00" "$3,765.00" "$3,765.00" "$1,455.87" "$1,455.87" "$1,449.43" "$2,183.67" "$1,455.87" "$2,380.34" "$2,380.34" "$2,471.89" "$1,737.63" "$2,183.52" "$2,329.40" "$2,148.62" "$3,731.00" "$1,455.87" "$10,477.00" "$1,455.87" "$1,528.67" "$7,857.75" "$1,455.87" "$1,455.87" "$1,455.87" "$5,028.96" "$5,028.96" "$8,297.78" "$1,455.87" "$8,381.60" "$2,400.00" "$2,079.42" "$1,455.87" "$6,076.66" "$1,528.67" "$2,106.28" "$1,455.87" "$2,183.41" "$1,455.87" N/A N/A 40400030 EAP CPT® 78431 MYOCRD IMG PET PRFUJ MLT STD RST&STRS CNCRNT CT BOTH IP/OP "$5,419.00" "$4,010.50" $964.58 "$5,419.00" "$5,419.00" "$5,419.00" "$5,419.00" "$5,419.00" "$5,419.00" "$5,419.00" $964.58 "$5,419.00" "$5,419.00" "$4,021.98" "$4,021.98" "$4,176.97" "$2,060.15" "$1,129.38" "$5,419.00" "$2,167.60" "$3,731.00" "$5,419.00" "$5,419.00" "$5,419.00" "$5,419.00" "$4,064.25" "$5,419.00" "$5,419.00" "$5,419.00" "$2,601.12" "$2,601.12" "$4,291.85" "$5,419.00" "$4,335.20" "$2,400.00" "$5,419.00" "$5,419.00" "$3,143.02" "$5,419.00" "$5,419.00" "$5,419.00" "$5,419.00" "$5,419.00" N/A N/A 40400031 EAP CPT® 78430 MYOCRD IMG PET PRFUJ 1STD REST/STRESS CNCRNT CT BOTH IP/OP "$3,640.00" "$2,694.00" $647.92 "$3,640.00" "$3,640.00" "$3,640.00" "$3,640.00" "$3,640.00" "$3,640.00" "$3,640.00" $647.92 "$3,640.00" "$3,640.00" "$2,701.61" "$2,701.61" "$2,805.71" "$1,896.44" $758.62 "$3,640.00" "$1,456.00" "$3,640.00" "$3,640.00" "$3,640.00" "$3,640.00" "$3,640.00" "$2,730.00" "$3,640.00" "$3,640.00" "$3,640.00" "$1,747.20" "$1,747.20" "$2,882.88" "$3,640.00" "$2,912.00" "$2,400.00" "$3,640.00" "$3,640.00" "$2,111.20" "$3,640.00" "$3,640.00" "$3,640.00" "$3,640.00" "$3,640.00" N/A N/A 40400032 EAP CPT® 78434 AQMBF PET REST AND PHARMACOLOGIC STRESS (ADD-ON) BOTH IP/OP "$2,500.00" "$1,850.00" $445.00 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $445.00 "$2,500.00" "$2,500.00" "$1,855.50" "$1,855.50" "$1,927.00" "$1,302.50" $521.03 "$2,500.00" "$1,000.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,200.00" "$1,200.00" "$1,980.00" "$2,500.00" "$2,000.00" "$2,400.00" "$2,500.00" "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 40400055 EAP CPT® 78816 PET/CT WHOLE BODY BOTH IP/OP "$10,477.00" "$7,753.00" "$1,449.43" "$10,477.00" "$3,765.00" "$3,765.00" "$3,765.00" "$3,765.00" "$1,455.87" "$1,455.87" "$1,449.43" "$2,183.67" "$1,455.87" "$2,441.96" "$2,441.96" "$2,535.88" "$1,782.61" "$2,183.52" "$2,329.40" "$2,148.62" "$3,731.00" "$1,455.87" "$10,477.00" "$1,455.87" "$1,528.67" "$7,857.75" "$1,455.87" "$1,455.87" "$1,455.87" "$5,028.96" "$5,028.96" "$8,297.78" "$1,455.87" "$8,381.60" "$2,400.00" "$2,079.42" "$1,455.87" "$6,076.66" "$1,528.67" "$2,106.28" "$1,455.87" "$2,183.41" "$1,455.87" N/A N/A 40400056 EAP CPT® 78608 "BRAIN IMAGING, POSITRON EMISSION TOMO (PET); METABOLIC EVAL" BOTH IP/OP "$6,836.00" "$5,059.00" $434.22 "$6,836.00" "$6,836.00" "$6,836.00" "$6,836.00" "$6,836.00" "$6,836.00" "$6,836.00" "$1,216.81" "$6,836.00" "$6,836.00" $594.83 $594.83 $617.71 $434.22 "$1,424.70" "$6,836.00" "$2,734.40" "$3,731.00" "$6,836.00" "$6,836.00" "$6,836.00" "$6,836.00" "$5,127.00" "$6,836.00" "$6,836.00" "$6,836.00" "$3,281.28" "$3,281.28" "$5,414.11" "$6,836.00" "$5,468.80" "$2,400.00" "$6,836.00" "$6,836.00" "$3,964.88" "$6,836.00" "$6,836.00" "$6,836.00" "$6,836.00" "$6,836.00" N/A N/A 40400057 EAP CPT® 78459 "MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), METABOLIC EVAL" BOTH IP/OP "$5,940.00" "$4,396.00" $350.21 "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$1,057.32" "$5,940.00" "$5,940.00" $479.75 $479.75 $498.20 $350.21 "$1,237.96" "$5,940.00" "$2,376.00" "$3,731.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$4,455.00" "$5,940.00" "$5,940.00" "$5,940.00" "$2,851.20" "$2,851.20" "$4,704.48" "$5,940.00" "$4,752.00" "$2,400.00" "$5,940.00" "$5,940.00" "$3,445.20" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" N/A N/A 40400058 EAP CPT® 78429 PET/CT CARDIAC METABOLIC EVAL BOTH IP/OP "$5,940.00" "$4,396.00" "$1,178.94" "$4,817.00" "$3,765.00" "$3,765.00" "$3,765.00" "$3,765.00" "$1,455.87" "$1,455.87" "$1,449.43" "$1,238.04" "$1,455.87" "$4,181.12" "$4,181.12" "$4,578.55" "$2,060.15" "$1,237.96" "$2,329.40" "$2,148.62" "$3,731.00" "$1,455.87" "$4,817.00" "$1,455.87" "$1,528.67" "$4,455.00" "$1,455.87" "$1,455.87" "$1,455.87" "$2,851.20" "$2,851.20" "$4,704.48" "$1,455.87" "$4,752.00" "$2,400.00" "$1,178.94" "$1,455.87" "$3,445.20" "$1,528.67" "$2,106.28" "$1,455.87" "$1,237.90" "$1,455.87" N/A N/A 40400060 EAP CPT® 78811 PET IMAGING LIMITED AREA CHEST/HEAD/NECK BOTH IP/OP "$3,129.00" "$2,315.50" $556.96 "$3,129.00" "$3,129.00" "$3,129.00" "$3,129.00" "$3,129.00" "$3,129.00" "$3,129.00" $556.96 "$3,129.00" "$3,129.00" "$1,529.16" "$1,529.16" "$1,587.98" "$1,116.28" $652.12 "$3,129.00" "$1,251.60" "$3,129.00" "$3,129.00" "$3,129.00" "$3,129.00" "$3,129.00" "$2,346.75" "$3,129.00" "$3,129.00" "$3,129.00" "$1,501.92" "$1,501.92" "$2,478.17" "$3,129.00" "$2,503.20" "$2,400.00" "$3,129.00" "$3,129.00" "$1,814.82" "$3,129.00" "$3,129.00" "$3,129.00" "$3,129.00" "$3,129.00" N/A N/A 40400061 EAP CPT® 78812 PET IMAGING SKULL BASE TO MID-THIGH BOTH IP/OP "$3,547.00" "$2,625.00" $631.37 "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" $631.37 "$3,547.00" "$3,547.00" "$1,899.49" "$1,899.49" "$1,972.54" "$1,386.61" $739.23 "$3,547.00" "$1,418.80" "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" "$2,660.25" "$3,547.00" "$3,547.00" "$3,547.00" "$1,702.56" "$1,702.56" "$2,809.22" "$3,547.00" "$2,837.60" "$2,400.00" "$3,547.00" "$3,547.00" "$2,057.26" "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" N/A N/A 40400062 EAP CPT® 78813 PET IMAGING WHOLE BODY BOTH IP/OP "$3,547.00" "$2,625.00" $631.37 "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" $631.37 "$3,547.00" "$3,547.00" "$1,968.81" "$1,968.81" "$2,044.54" "$1,437.22" $739.23 "$3,547.00" "$1,418.80" "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" "$2,660.25" "$3,547.00" "$3,547.00" "$3,547.00" "$1,702.56" "$1,702.56" "$2,809.22" "$3,547.00" "$2,837.60" "$2,400.00" "$3,547.00" "$3,547.00" "$2,057.26" "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" "$3,547.00" N/A N/A 41000001 EAP CPT® 94002 VENTILATION ASSIST/MGT INITIAL BOTH IP/OP "$6,841.00" "$5,062.50" $91.55 "$5,472.80" "$3,714.66" "$3,714.66" "$3,714.66" "$3,714.66" $479.21 $479.21 $477.09 "$1,425.84" $479.21 "$4,181.12" "$4,181.12" "$5,273.04" "$2,060.15" "$1,425.74" $766.74 $803.16 "$4,046.45" $479.21 $91.55 $479.21 $503.17 "$5,130.75" $479.21 $479.21 $479.21 "$3,420.50" "$3,420.50" "$5,418.07" $479.21 "$5,472.80" "$4,446.65" "$1,357.77" $479.21 "$3,967.78" $503.17 $693.30 $479.21 "$1,425.66" $479.21 N/A N/A 41000009 EAP CPT® 94003 "MECH VENT, EA SUBSEQ DAY" BOTH IP/OP "$6,231.00" "$4,611.00" $64.08 "$6,231.00" "$6,231.00" "$6,231.00" "$6,231.00" "$6,231.00" $65.36 $65.36 $65.90 "$6,231.00" $65.36 "$4,181.12" "$4,181.12" "$4,802.85" "$2,060.15" "$1,298.61" $104.58 $102.53 "$6,231.00" $65.36 $64.08 $65.36 "$6,231.00" "$4,673.25" $65.36 $65.36 $65.36 "$3,115.50" "$3,115.50" "$4,934.95" $65.36 "$4,984.80" "$4,050.15" "$6,231.00" $65.36 "$3,613.98" "$6,231.00" $68.52 $65.36 "$6,231.00" $65.36 N/A N/A 41000017 EAP CPT® 94640 AEROSAL RX SUB ADMIN (O2) BOTH IP/OP $535.00 $396.00 $9.14 $428.00 $290.51 $290.51 $290.51 $290.51 $184.90 $184.90 $184.08 $111.51 $184.90 $397.08 $397.08 $412.38 $278.74 $111.50 $295.84 $276.26 $316.45 $184.90 $9.14 $184.90 $194.14 $401.25 $184.90 $184.90 $184.90 $267.50 $267.50 $423.72 $184.90 $428.00 $347.75 $106.18 $184.90 $310.30 $194.14 $267.50 $184.90 $111.49 $184.90 N/A N/A 41000020 EAP Custom 94640 AEROSOL CONTINUOUS SUBSEQUENT BOTH IP/OP $494.00 $366.00 $87.93 $580.00 $268.24 $268.24 $268.24 $268.24 $494.00 $494.00 $87.93 $102.96 $494.00 $366.65 $366.65 $380.78 $257.37 $102.96 $494.00 $232.00 $292.20 $494.00 $580.00 $494.00 $494.00 $370.50 $494.00 $494.00 $494.00 $247.00 $247.00 $391.25 $494.00 $395.20 $321.10 $98.05 $494.00 $286.52 $494.00 $296.40 $494.00 $102.95 $494.00 N/A N/A 41000021 EAP CPT® 94640 AEROSOL TREATMENT INITIAL BOTH IP/OP $535.00 $396.00 $9.14 $428.00 $290.51 $290.51 $290.51 $290.51 $184.90 $184.90 $184.08 $111.51 $184.90 $397.08 $397.08 $412.38 $278.74 $111.50 $295.84 $276.26 $316.45 $184.90 $9.14 $184.90 $194.14 $401.25 $184.90 $184.90 $184.90 $267.50 $267.50 $423.72 $184.90 $428.00 $347.75 $106.18 $184.90 $310.30 $194.14 $267.50 $184.90 $111.49 $184.90 N/A N/A 41000022 EAP CPT® 94640 AERSOL TREATMENT SUBSEQUENT BOTH IP/OP $535.00 $396.00 $9.14 $428.00 $290.51 $290.51 $290.51 $290.51 $184.90 $184.90 $184.08 $111.51 $184.90 $397.08 $397.08 $412.38 $278.74 $111.50 $295.84 $276.26 $316.45 $184.90 $9.14 $184.90 $194.14 $401.25 $184.90 $184.90 $184.90 $267.50 $267.50 $423.72 $184.90 $428.00 $347.75 $106.18 $184.90 $310.30 $194.14 $267.50 $184.90 $111.49 $184.90 N/A N/A 41000027 EAP CPT® 94640 DELIVERY ASSIST BOTH IP/OP $535.00 $396.00 $9.14 $428.00 $290.51 $290.51 $290.51 $290.51 $184.90 $184.90 $184.08 $111.51 $184.90 $397.08 $397.08 $412.38 $278.74 $111.50 $295.84 $276.26 $316.45 $184.90 $9.14 $184.90 $194.14 $401.25 $184.90 $184.90 $184.90 $267.50 $267.50 $423.72 $184.90 $428.00 $347.75 $106.18 $184.90 $310.30 $194.14 $267.50 $184.90 $111.49 $184.90 N/A N/A 41000028 EAP CPT® 94640 HIGH HUMIDITY AEROSOL INITIAL BOTH IP/OP $414.00 $306.50 $9.14 $331.20 $224.80 $224.80 $224.80 $224.80 $184.90 $184.90 $184.08 $86.29 $184.90 $307.27 $307.27 $319.11 $215.69 $86.28 $295.84 $276.26 $244.88 $184.90 $9.14 $184.90 $194.14 $310.50 $184.90 $184.90 $184.90 $207.00 $207.00 $327.89 $184.90 $331.20 $269.10 $82.17 $184.90 $240.12 $194.14 $267.50 $184.90 $86.28 $184.90 N/A N/A 41000029 EAP CPT® 94640 HIGH HUMIDITY AEROSOL SUBSEQ BOTH IP/OP $414.00 $306.50 $9.14 $331.20 $224.80 $224.80 $224.80 $224.80 $184.90 $184.90 $184.08 $86.29 $184.90 $307.27 $307.27 $319.11 $215.69 $86.28 $295.84 $276.26 $244.88 $184.90 $9.14 $184.90 $194.14 $310.50 $184.90 $184.90 $184.90 $207.00 $207.00 $327.89 $184.90 $331.20 $269.10 $82.17 $184.90 $240.12 $194.14 $267.50 $184.90 $86.28 $184.90 N/A N/A 41000031 EAP CPT® 94640 INCENTIVE SPIROMETER SUBSEQUEN BOTH IP/OP $535.00 $396.00 $9.14 $428.00 $290.51 $290.51 $290.51 $290.51 $184.90 $184.90 $184.08 $111.51 $184.90 $397.08 $397.08 $412.38 $278.74 $111.50 $295.84 $276.26 $316.45 $184.90 $9.14 $184.90 $194.14 $401.25 $184.90 $184.90 $184.90 $267.50 $267.50 $423.72 $184.90 $428.00 $347.75 $106.18 $184.90 $310.30 $194.14 $267.50 $184.90 $111.49 $184.90 N/A N/A 41000034 EAP CPT® 94640 INITIAL INHALATION TX AIRWAY OBS BOTH IP/OP $535.00 $396.00 $9.14 $428.00 $290.51 $290.51 $290.51 $290.51 $184.90 $184.90 $184.08 $111.51 $184.90 $397.08 $397.08 $412.38 $278.74 $111.50 $295.84 $276.26 $316.45 $184.90 $9.14 $184.90 $194.14 $401.25 $184.90 $184.90 $184.90 $267.50 $267.50 $423.72 $184.90 $428.00 $347.75 $106.18 $184.90 $310.30 $194.14 $267.50 $184.90 $111.49 $184.90 N/A N/A 41000040 EAP CPT® 94640 "MDI, INITIAL RX" BOTH IP/OP $535.00 $396.00 $9.14 $428.00 $290.51 $290.51 $290.51 $290.51 $184.90 $184.90 $184.08 $111.51 $184.90 $397.08 $397.08 $412.38 $278.74 $111.50 $295.84 $276.26 $316.45 $184.90 $9.14 $184.90 $194.14 $401.25 $184.90 $184.90 $184.90 $267.50 $267.50 $423.72 $184.90 $428.00 $347.75 $106.18 $184.90 $310.30 $194.14 $267.50 $184.90 $111.49 $184.90 N/A N/A 41000041 EAP CPT® 94640 "MDI, SUBSEQUENT RX" BOTH IP/OP $535.00 $396.00 $9.14 $428.00 $290.51 $290.51 $290.51 $290.51 $184.90 $184.90 $184.08 $111.51 $184.90 $397.08 $397.08 $412.38 $278.74 $111.50 $295.84 $276.26 $316.45 $184.90 $9.14 $184.90 $194.14 $401.25 $184.90 $184.90 $184.90 $267.50 $267.50 $423.72 $184.90 $428.00 $347.75 $106.18 $184.90 $310.30 $194.14 $267.50 $184.90 $111.49 $184.90 N/A N/A 41000042 EAP CPT® 94640 MICRO NEB SUBSEQUENT BOTH IP/OP $535.00 $396.00 $9.14 $428.00 $290.51 $290.51 $290.51 $290.51 $184.90 $184.90 $184.08 $111.51 $184.90 $397.08 $397.08 $412.38 $278.74 $111.50 $295.84 $276.26 $316.45 $184.90 $9.14 $184.90 $194.14 $401.25 $184.90 $184.90 $184.90 $267.50 $267.50 $423.72 $184.90 $428.00 $347.75 $106.18 $184.90 $310.30 $194.14 $267.50 $184.90 $111.49 $184.90 N/A N/A 41000043 EAP CPT® 94640 "MICRO NEB, SETUP" BOTH IP/OP $535.00 $396.00 $9.14 $428.00 $290.51 $290.51 $290.51 $290.51 $184.90 $184.90 $184.08 $111.51 $184.90 $397.08 $397.08 $412.38 $278.74 $111.50 $295.84 $276.26 $316.45 $184.90 $9.14 $184.90 $194.14 $401.25 $184.90 $184.90 $184.90 $267.50 $267.50 $423.72 $184.90 $428.00 $347.75 $106.18 $184.90 $310.30 $194.14 $267.50 $184.90 $111.49 $184.90 N/A N/A 41000045 EAP CPT® 94640 NEO MICRO SUBSQUENT BOTH IP/OP $535.00 $396.00 $9.14 $428.00 $290.51 $290.51 $290.51 $290.51 $184.90 $184.90 $184.08 $111.51 $184.90 $397.08 $397.08 $412.38 $278.74 $111.50 $295.84 $276.26 $316.45 $184.90 $9.14 $184.90 $194.14 $401.25 $184.90 $184.90 $184.90 $267.50 $267.50 $423.72 $184.90 $428.00 $347.75 $106.18 $184.90 $310.30 $194.14 $267.50 $184.90 $111.49 $184.90 N/A N/A 41000050 EAP CPT® 94640 SPUTUM INDUCTION INITIAL BOTH IP/OP $535.00 $396.00 $9.14 $428.00 $290.51 $290.51 $290.51 $290.51 $184.90 $184.90 $184.08 $111.51 $184.90 $397.08 $397.08 $412.38 $278.74 $111.50 $295.84 $276.26 $316.45 $184.90 $9.14 $184.90 $194.14 $401.25 $184.90 $184.90 $184.90 $267.50 $267.50 $423.72 $184.90 $428.00 $347.75 $106.18 $184.90 $310.30 $194.14 $267.50 $184.90 $111.49 $184.90 N/A N/A 41000055 EAP CPT® 94644 "MICRO NEBULIZER, CONT; INITIAL" BOTH IP/OP $983.00 $727.50 $60.20 $786.40 $533.77 $533.77 $533.77 $533.77 $110.92 $110.92 $110.43 $204.88 $110.92 $729.58 $729.58 $757.70 $512.14 $204.87 $177.47 $167.51 $581.44 $110.92 $60.20 $110.92 $116.46 $737.25 $110.92 $110.92 $110.92 $491.50 $491.50 $778.54 $110.92 $786.40 $638.95 $195.10 $110.92 $570.14 $116.46 $160.47 $110.92 $204.86 $110.92 N/A N/A 41000059 EAP CPT® 94645 REPEAT NEB TREATMENT BOTH IP/OP $524.00 $388.00 $15.90 $524.00 $524.00 $524.00 $524.00 $524.00 $16.20 $16.20 $16.68 $524.00 $16.20 $388.91 $388.91 $403.90 $273.00 $109.21 $25.92 $25.44 $524.00 $16.20 $15.90 $16.20 $524.00 $393.00 $16.20 $16.20 $16.20 $262.00 $262.00 $415.01 $16.20 $419.20 $340.60 $524.00 $16.20 $303.92 $524.00 $16.93 $16.20 $524.00 $16.20 N/A N/A 41000062 EAP CPT® 94660 SLEEP APNEA/BIPAP BOTH IP/OP "$2,079.00" "$1,538.50" $36.95 "$2,079.00" "$2,079.00" "$2,079.00" "$2,079.00" "$2,079.00" $38.16 $38.16 $37.85 "$2,079.00" $38.16 "$1,543.03" "$1,543.03" "$1,602.49" "$1,083.16" $433.29 $61.06 $59.12 "$2,079.00" $38.16 $36.95 $38.16 "$2,079.00" "$1,559.25" $38.16 $38.16 $38.16 "$1,039.50" "$1,039.50" "$1,646.57" $38.16 "$1,663.20" "$1,351.35" "$2,079.00" $38.16 "$1,205.82" "$2,079.00" $39.31 $38.16 "$2,079.00" $38.16 N/A N/A 41000063 EAP CPT® 94660 NEO CPAP BOTH IP/OP "$2,079.00" "$1,538.50" $36.95 "$2,079.00" "$2,079.00" "$2,079.00" "$2,079.00" "$2,079.00" $38.16 $38.16 $37.85 "$2,079.00" $38.16 "$1,543.03" "$1,543.03" "$1,602.49" "$1,083.16" $433.29 $61.06 $59.12 "$2,079.00" $38.16 $36.95 $38.16 "$2,079.00" "$1,559.25" $38.16 $38.16 $38.16 "$1,039.50" "$1,039.50" "$1,646.57" $38.16 "$1,663.20" "$1,351.35" "$2,079.00" $38.16 "$1,205.82" "$2,079.00" $39.31 $38.16 "$2,079.00" $38.16 N/A N/A 41000064 EAP CPT® 94660 CPAP PRESCRIPTION BOTH IP/OP "$2,001.00" "$1,481.00" $36.95 "$2,001.00" "$2,001.00" "$2,001.00" "$2,001.00" "$2,001.00" $38.16 $38.16 $37.85 "$2,001.00" $38.16 "$1,485.14" "$1,485.14" "$1,542.37" "$1,042.52" $417.03 $61.06 $59.12 "$2,001.00" $38.16 $36.95 $38.16 "$2,001.00" "$1,500.75" $38.16 $38.16 $38.16 "$1,000.50" "$1,000.50" "$1,584.79" $38.16 "$1,600.80" "$1,300.65" "$2,001.00" $38.16 "$1,160.58" "$2,001.00" $39.31 $38.16 "$2,001.00" $38.16 N/A N/A 41000065 EAP CPT® 94664 PATIENT ASSESSMENT/EDUCATION BOTH IP/OP $290.00 $215.00 $17.25 $295.84 $157.47 $157.47 $157.47 $157.47 $184.90 $184.90 $184.08 $60.44 $184.90 $215.24 $215.24 $223.53 $151.09 $60.44 $295.84 $276.26 $171.54 $184.90 $17.25 $184.90 $194.14 $217.50 $184.90 $184.90 $184.90 $145.00 $145.00 $229.68 $184.90 $232.00 $188.50 $57.56 $184.90 $168.20 $194.14 $267.50 $184.90 $60.44 $184.90 N/A N/A 41000067 EAP CPT® 94667 "CHEST PT, INITAL RX" BOTH IP/OP $501.00 $371.00 $21.56 $501.00 $501.00 $501.00 $501.00 $501.00 $23.07 $23.07 $21.56 $501.00 $23.07 $371.84 $371.84 $386.17 $261.02 $104.41 $36.91 $37.90 $501.00 $23.07 $23.69 $23.07 $501.00 $375.75 $23.07 $23.07 $23.07 $250.50 $250.50 $396.79 $23.07 $400.80 $325.65 $501.00 $23.07 $290.58 $501.00 $25.21 $23.07 $501.00 $23.07 N/A N/A 41000069 EAP CPT® 94667 CPT/VEST BOTH IP/OP $501.00 $371.00 $21.56 $501.00 $501.00 $501.00 $501.00 $501.00 $23.07 $23.07 $21.56 $501.00 $23.07 $371.84 $371.84 $386.17 $261.02 $104.41 $36.91 $37.90 $501.00 $23.07 $23.69 $23.07 $501.00 $375.75 $23.07 $23.07 $23.07 $250.50 $250.50 $396.79 $23.07 $400.80 $325.65 $501.00 $23.07 $290.58 $501.00 $25.21 $23.07 $501.00 $23.07 N/A N/A 41000070 EAP CPT® 94667 INITIAL CHEST THERAPY BOTH IP/OP $465.00 $344.50 $21.56 $465.00 $465.00 $465.00 $465.00 $465.00 $23.07 $23.07 $21.56 $465.00 $23.07 $345.12 $345.12 $358.42 $242.27 $96.91 $36.91 $37.90 $465.00 $23.07 $23.69 $23.07 $465.00 $348.75 $23.07 $23.07 $23.07 $232.50 $232.50 $368.28 $23.07 $372.00 $302.25 $465.00 $23.07 $269.70 $465.00 $25.21 $23.07 $465.00 $23.07 N/A N/A 41000072 EAP CPT® 94667 PEP/ACPELLA THERAPY BOTH IP/OP $465.00 $344.50 $21.56 $465.00 $465.00 $465.00 $465.00 $465.00 $23.07 $23.07 $21.56 $465.00 $23.07 $345.12 $345.12 $358.42 $242.27 $96.91 $36.91 $37.90 $465.00 $23.07 $23.69 $23.07 $465.00 $348.75 $23.07 $23.07 $23.07 $232.50 $232.50 $368.28 $23.07 $372.00 $302.25 $465.00 $23.07 $269.70 $465.00 $25.21 $23.07 $465.00 $23.07 N/A N/A 41000073 EAP CPT® 94667 SIPAP SETUP BOTH IP/OP $501.00 $371.00 $21.56 $501.00 $501.00 $501.00 $501.00 $501.00 $23.07 $23.07 $21.56 $501.00 $23.07 $371.84 $371.84 $386.17 $261.02 $104.41 $36.91 $37.90 $501.00 $23.07 $23.69 $23.07 $501.00 $375.75 $23.07 $23.07 $23.07 $250.50 $250.50 $396.79 $23.07 $400.80 $325.65 $501.00 $23.07 $290.58 $501.00 $25.21 $23.07 $501.00 $23.07 N/A N/A 41000074 EAP CPT® 94668 "CHEST PT, SUBSEQUENT RX" BOTH IP/OP $373.00 $276.50 $29.17 $373.00 $373.00 $373.00 $373.00 $373.00 $35.85 $35.85 $33.36 $373.00 $35.85 $276.84 $276.84 $287.51 $194.33 $77.74 $57.36 $59.01 $373.00 $35.85 $36.88 $35.85 $373.00 $279.75 $35.85 $35.85 $35.85 $186.50 $186.50 $295.42 $35.85 $298.40 $242.45 $373.00 $35.85 $216.34 $373.00 $29.17 $35.85 $373.00 $35.85 N/A N/A 41000076 EAP CPT® 94668 CPT/VEST SUB BOTH IP/OP $283.00 $209.50 $29.17 $283.00 $283.00 $283.00 $283.00 $283.00 $35.85 $35.85 $33.36 $283.00 $35.85 $210.04 $210.04 $218.14 $147.44 $58.98 $57.36 $59.01 $283.00 $35.85 $36.88 $35.85 $283.00 $212.25 $35.85 $35.85 $35.85 $141.50 $141.50 $224.14 $35.85 $226.40 $183.95 $283.00 $35.85 $164.14 $283.00 $29.17 $35.85 $283.00 $35.85 N/A N/A 41000077 EAP CPT® 94668 SIPAP EA SHIFT BOTH IP/OP $373.00 $276.50 $29.17 $373.00 $373.00 $373.00 $373.00 $373.00 $35.85 $35.85 $33.36 $373.00 $35.85 $276.84 $276.84 $287.51 $194.33 $77.74 $57.36 $59.01 $373.00 $35.85 $36.88 $35.85 $373.00 $279.75 $35.85 $35.85 $35.85 $186.50 $186.50 $295.42 $35.85 $298.40 $242.45 $373.00 $35.85 $216.34 $373.00 $29.17 $35.85 $373.00 $35.85 N/A N/A 41000078 EAP CPT® 94668 SUBSEQUENT CHEST THERAPY BOTH IP/OP $373.00 $276.50 $29.17 $373.00 $373.00 $373.00 $373.00 $373.00 $35.85 $35.85 $33.36 $373.00 $35.85 $276.84 $276.84 $287.51 $194.33 $77.74 $57.36 $59.01 $373.00 $35.85 $36.88 $35.85 $373.00 $279.75 $35.85 $35.85 $35.85 $186.50 $186.50 $295.42 $35.85 $298.40 $242.45 $373.00 $35.85 $216.34 $373.00 $29.17 $35.85 $373.00 $35.85 N/A N/A 41000080 EAP CPT® 94003 "MECH VENT, EA SUBSEQ DAY" BOTH IP/OP "$5,771.00" "$4,271.00" $64.08 "$5,771.00" "$5,771.00" "$5,771.00" "$5,771.00" "$5,771.00" $65.36 $65.36 $65.90 "$5,771.00" $65.36 "$4,181.12" "$4,181.12" "$4,448.29" "$2,060.15" "$1,202.74" $104.58 $102.53 "$5,771.00" $65.36 $64.08 $65.36 "$5,771.00" "$4,328.25" $65.36 $65.36 $65.36 "$2,885.50" "$2,885.50" "$4,570.63" $65.36 "$4,616.80" "$3,751.15" "$5,771.00" $65.36 "$3,347.18" "$5,771.00" $68.52 $65.36 "$5,771.00" $65.36 N/A N/A 41000081 EAP CPT® 94664 ASTHMA TEACHING-NEBULIZER &MDI BOTH IP/OP $290.00 $215.00 $17.25 $295.84 $157.47 $157.47 $157.47 $157.47 $184.90 $184.90 $184.08 $60.44 $184.90 $215.24 $215.24 $223.53 $151.09 $60.44 $295.84 $276.26 $171.54 $184.90 $17.25 $184.90 $194.14 $217.50 $184.90 $184.90 $184.90 $145.00 $145.00 $229.68 $184.90 $232.00 $188.50 $57.56 $184.90 $168.20 $194.14 $267.50 $184.90 $60.44 $184.90 N/A N/A 41000090 EAP CPT® 94003 "MECH VENT, EA SUBSEQ DAY" BOTH IP/OP "$5,771.00" "$4,271.00" $64.08 "$5,771.00" "$5,771.00" "$5,771.00" "$5,771.00" "$5,771.00" $65.36 $65.36 $65.90 "$5,771.00" $65.36 "$4,181.12" "$4,181.12" "$4,448.29" "$2,060.15" "$1,202.74" $104.58 $102.53 "$5,771.00" $65.36 $64.08 $65.36 "$5,771.00" "$4,328.25" $65.36 $65.36 $65.36 "$2,885.50" "$2,885.50" "$4,570.63" $65.36 "$4,616.80" "$3,751.15" "$5,771.00" $65.36 "$3,347.18" "$5,771.00" $68.52 $65.36 "$5,771.00" $65.36 N/A N/A 41000110 EAP CPT® 94002 SPEC VENT INITIAL BOTH IP/OP "$6,841.00" "$5,062.50" $91.55 "$5,472.80" "$3,714.66" "$3,714.66" "$3,714.66" "$3,714.66" $479.21 $479.21 $477.09 "$1,425.84" $479.21 "$4,181.12" "$4,181.12" "$5,273.04" "$2,060.15" "$1,425.74" $766.74 $803.16 "$4,046.45" $479.21 $91.55 $479.21 $503.17 "$5,130.75" $479.21 $479.21 $479.21 "$3,420.50" "$3,420.50" "$5,418.07" $479.21 "$5,472.80" "$4,446.65" "$1,357.77" $479.21 "$3,967.78" $503.17 $693.30 $479.21 "$1,425.66" $479.21 N/A N/A 41000111 EAP CPT® 94002 NEO MECH VENT INITIAL BOTH IP/OP "$6,841.00" "$5,062.50" $91.55 "$5,472.80" "$3,714.66" "$3,714.66" "$3,714.66" "$3,714.66" $479.21 $479.21 $477.09 "$1,425.84" $479.21 "$4,181.12" "$4,181.12" "$5,273.04" "$2,060.15" "$1,425.74" $766.74 $803.16 "$4,046.45" $479.21 $91.55 $479.21 $503.17 "$5,130.75" $479.21 $479.21 $479.21 "$3,420.50" "$3,420.50" "$5,418.07" $479.21 "$5,472.80" "$4,446.65" "$1,357.77" $479.21 "$3,967.78" $503.17 $693.30 $479.21 "$1,425.66" $479.21 N/A N/A 41000112 EAP CPT® 94002 MECH VENT INITIAL BOTH IP/OP "$6,841.00" "$5,062.50" $91.55 "$5,472.80" "$3,714.66" "$3,714.66" "$3,714.66" "$3,714.66" $479.21 $479.21 $477.09 "$1,425.84" $479.21 "$4,181.12" "$4,181.12" "$5,273.04" "$2,060.15" "$1,425.74" $766.74 $803.16 "$4,046.45" $479.21 $91.55 $479.21 $503.17 "$5,130.75" $479.21 $479.21 $479.21 "$3,420.50" "$3,420.50" "$5,418.07" $479.21 "$5,472.80" "$4,446.65" "$1,357.77" $479.21 "$3,967.78" $503.17 $693.30 $479.21 "$1,425.66" $479.21 N/A N/A 41000119 EAP CPT® 94003 "SPEC VENT, EA SUBSEQ DAY" BOTH IP/OP "$6,231.00" "$4,611.00" $64.08 "$6,231.00" "$6,231.00" "$6,231.00" "$6,231.00" "$6,231.00" $65.36 $65.36 $65.90 "$6,231.00" $65.36 "$4,181.12" "$4,181.12" "$4,802.85" "$2,060.15" "$1,298.61" $104.58 $102.53 "$6,231.00" $65.36 $64.08 $65.36 "$6,231.00" "$4,673.25" $65.36 $65.36 $65.36 "$3,115.50" "$3,115.50" "$4,934.95" $65.36 "$4,984.80" "$4,050.15" "$6,231.00" $65.36 "$3,613.98" "$6,231.00" $68.52 $65.36 "$6,231.00" $65.36 N/A N/A 41000120 EAP CPT® 94003 NEO MECH VENT SUBSEQ BOTH IP/OP "$6,231.00" "$4,611.00" $64.08 "$6,231.00" "$6,231.00" "$6,231.00" "$6,231.00" "$6,231.00" $65.36 $65.36 $65.90 "$6,231.00" $65.36 "$4,181.12" "$4,181.12" "$4,802.85" "$2,060.15" "$1,298.61" $104.58 $102.53 "$6,231.00" $65.36 $64.08 $65.36 "$6,231.00" "$4,673.25" $65.36 $65.36 $65.36 "$3,115.50" "$3,115.50" "$4,934.95" $65.36 "$4,984.80" "$4,050.15" "$6,231.00" $65.36 "$3,613.98" "$6,231.00" $68.52 $65.36 "$6,231.00" $65.36 N/A N/A 41000121 EAP CPT® 94640 "NEO MICRO NEB, SETUP" BOTH IP/OP $535.00 $396.00 $9.14 $428.00 $290.51 $290.51 $290.51 $290.51 $184.90 $184.90 $184.08 $111.51 $184.90 $397.08 $397.08 $412.38 $278.74 $111.50 $295.84 $276.26 $316.45 $184.90 $9.14 $184.90 $194.14 $401.25 $184.90 $184.90 $184.90 $267.50 $267.50 $423.72 $184.90 $428.00 $347.75 $106.18 $184.90 $310.30 $194.14 $267.50 $184.90 $111.49 $184.90 N/A N/A 41000150 EAP CPT® 94640 SPUTUM INDUCTION SUBSEQ BOTH IP/OP $535.00 $396.00 $9.14 $428.00 $290.51 $290.51 $290.51 $290.51 $184.90 $184.90 $184.08 $111.51 $184.90 $397.08 $397.08 $412.38 $278.74 $111.50 $295.84 $276.26 $316.45 $184.90 $9.14 $184.90 $194.14 $401.25 $184.90 $184.90 $184.90 $267.50 $267.50 $423.72 $184.90 $428.00 $347.75 $106.18 $184.90 $310.30 $194.14 $267.50 $184.90 $111.49 $184.90 N/A N/A 41000190 EAP CPT® 94003 NEO VENTILATION SUBSEQ BOTH IP/OP "$6,231.00" "$4,611.00" $64.08 "$6,231.00" "$6,231.00" "$6,231.00" "$6,231.00" "$6,231.00" $65.36 $65.36 $65.90 "$6,231.00" $65.36 "$4,181.12" "$4,181.12" "$4,802.85" "$2,060.15" "$1,298.61" $104.58 $102.53 "$6,231.00" $65.36 $64.08 $65.36 "$6,231.00" "$4,673.25" $65.36 $65.36 $65.36 "$3,115.50" "$3,115.50" "$4,934.95" $65.36 "$4,984.80" "$4,050.15" "$6,231.00" $65.36 "$3,613.98" "$6,231.00" $68.52 $65.36 "$6,231.00" $65.36 N/A N/A 41000191 EAP CPT® 94669 CHEST VEST MECHANICAL OSCILLAT BOTH IP/OP "$1,866.00" "$1,381.00" $18.93 "$1,866.00" "$1,866.00" "$1,866.00" "$1,866.00" "$1,866.00" $18.93 $18.93 $23.27 "$1,866.00" $18.93 "$1,384.95" "$1,384.95" "$1,438.31" $972.19 $388.89 $30.29 $31.41 "$1,866.00" $18.93 $19.63 $18.93 "$1,866.00" "$1,399.50" $18.93 $18.93 $18.93 $933.00 $933.00 "$1,477.87" $18.93 "$1,492.80" "$1,212.90" "$1,866.00" $18.93 "$1,082.28" "$1,866.00" $29.89 $18.93 "$1,866.00" $18.93 N/A N/A 41200001 EAP CPT® 94642 AEROSOL INHAL. OF PENTAMIDINE BOTH IP/OP $353.00 $261.50 $27.43 $353.00 $353.00 $353.00 $353.00 $353.00 $353.00 $353.00 $27.43 $353.00 $353.00 $262.00 $262.00 $272.09 $183.91 $73.57 $353.00 $141.20 $353.00 $353.00 $353.00 $353.00 $353.00 $264.75 $353.00 $353.00 $353.00 $176.50 $176.50 $279.58 $353.00 $282.40 $229.45 $353.00 $353.00 $204.74 $353.00 $211.80 $353.00 $353.00 $353.00 N/A N/A 42000002 EAP CPT® 92526 PEDIATRIC FEEDING BOTH IP/OP $792.00 $586.50 $86.62 $792.00 $430.06 $430.06 $430.06 $430.06 $86.62 $86.62 $140.98 $165.07 $86.62 $444.74 $444.74 $461.84 $312.17 $165.06 $138.59 $160.00 $468.47 $86.62 $792.00 $86.62 $90.95 $594.00 $86.62 $86.62 $86.62 $396.00 $396.00 $627.26 $86.62 $633.60 $138.59 $157.19 $86.62 $459.36 $90.95 $125.60 $86.62 $625.00 $86.62 N/A N/A 42000006 EAP CPT® 97012 "TRACTION, MECHANICAL" BOTH IP/OP $206.00 $152.50 $36.67 $625.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $36.67 $206.00 $206.00 $444.74 $444.74 $461.84 $312.17 $42.93 $206.00 $160.00 $206.00 $206.00 $200.00 $206.00 $206.00 $154.50 $206.00 $206.00 $206.00 $103.00 $103.00 $163.15 $206.00 $164.80 $206.00 $206.00 $206.00 $119.48 $206.00 $206.00 $206.00 $625.00 $206.00 N/A N/A 42000007 EAP CPT® 97014 ELECTRICAL STIM UNSUPERVISED BOTH IP/OP $291.00 $215.50 $51.80 $625.00 $291.00 $291.00 $291.00 $291.00 $291.00 $291.00 $51.80 $291.00 $291.00 $444.74 $444.74 $461.84 $312.17 $60.65 $291.00 $160.00 $291.00 $291.00 $181.00 $291.00 $291.00 $218.25 $291.00 $291.00 $291.00 $145.50 $145.50 $230.47 $291.00 $232.80 $291.00 $291.00 $291.00 $168.78 $291.00 $174.60 $291.00 $625.00 $291.00 N/A N/A 42000009 EAP CPT® 97018 PARAFFIN BATH BOTH IP/OP $278.00 $206.00 $5.84 $625.00 $17.75 $17.75 $17.75 $17.75 $5.84 $5.84 $49.48 $57.94 $5.84 $444.74 $444.74 $461.84 $312.17 $57.94 $9.34 $160.00 $164.44 $5.84 $223.00 $5.84 $6.13 $208.50 $5.84 $5.84 $5.84 $139.00 $139.00 $220.18 $5.84 $222.40 $9.34 $55.18 $5.84 $161.24 $6.13 $8.47 $5.84 $625.00 $5.84 N/A N/A 42000010 EAP CPT® 97022 WHIRLPOOL BOTH IP/OP $328.00 $243.00 $17.59 $625.00 $38.35 $38.35 $38.35 $38.35 $17.59 $17.59 $58.38 $68.36 $17.59 $444.74 $444.74 $461.84 $312.17 $68.36 $28.14 $160.00 $194.01 $17.59 $328.00 $17.59 $18.47 $246.00 $17.59 $17.59 $17.59 $164.00 $164.00 $259.78 $17.59 $262.40 $28.14 $65.10 $17.59 $190.24 $18.47 $25.51 $17.59 $625.00 $17.59 N/A N/A 42000011 EAP CPT® 97032 ELEC STIM CONS ATTEN EA 15 MIN BOTH IP/OP $301.00 $223.00 $14.84 $625.00 $30.92 $30.92 $30.92 $30.92 $14.84 $14.84 $53.58 $62.74 $14.84 $444.74 $444.74 $461.84 $312.17 $62.73 $23.74 $160.00 $178.04 $14.84 $301.00 $14.84 $15.58 $225.75 $14.84 $14.84 $14.84 $150.50 $150.50 $238.39 $14.84 $240.80 $23.74 $59.74 $14.84 $174.58 $15.58 $21.52 $14.84 $625.00 $14.84 N/A N/A 42000012 EAP CPT® 97035 ULTRASOUND EA 15 MIN BOTH IP/OP $162.00 $120.00 $14.49 $625.00 $20.61 $20.61 $20.61 $20.61 $14.49 $14.49 $28.84 $33.76 $14.49 $444.74 $444.74 $461.84 $312.17 $33.76 $23.18 $160.00 $95.82 $14.49 $162.00 $14.49 $15.21 $121.50 $14.49 $14.49 $14.49 $81.00 $81.00 $128.30 $14.49 $129.60 $23.18 $32.15 $14.49 $93.96 $15.21 $21.01 $14.49 $625.00 $14.49 N/A N/A 42000013 EAP CPT® 97036 HUBBARD TANK EA 15 MIN BOTH IP/OP $200.00 $148.00 $35.60 $625.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $444.74 $444.74 $461.84 $312.17 $41.68 $200.00 $160.00 $200.00 $200.00 $168.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $200.00 $200.00 $200.00 $116.00 $200.00 $200.00 $200.00 $625.00 $200.00 N/A N/A 42000015 EAP CPT® 97110 EXERCISE EACH 15 MINUTES BOTH IP/OP $351.00 $260.00 $30.01 $625.00 $52.66 $52.66 $52.66 $52.66 $30.01 $30.01 $62.48 $73.16 $30.01 $444.74 $444.74 $461.84 $312.17 $73.15 $48.02 $160.00 $207.62 $30.01 $351.00 $30.01 $31.51 $263.25 $30.01 $30.01 $30.01 $175.50 $175.50 $277.99 $30.01 $280.80 $48.02 $69.66 $30.01 $203.58 $31.51 $43.51 $30.01 $625.00 $30.01 N/A N/A 42000016 EAP CPT® 97112 NEURO-MUSC RE-ED EA 15 MIN BOTH IP/OP $332.00 $246.00 $34.85 $625.00 $54.97 $54.97 $54.97 $54.97 $34.85 $34.85 $59.10 $69.20 $34.85 $444.74 $444.74 $461.84 $312.17 $69.19 $55.76 $160.00 $196.38 $34.85 $332.00 $34.85 $36.59 $249.00 $34.85 $34.85 $34.85 $166.00 $166.00 $262.94 $34.85 $265.60 $55.76 $65.89 $34.85 $192.56 $36.59 $50.53 $34.85 $625.00 $34.85 N/A N/A 42000017 EAP CPT® 97116 GAIT TRAINING EA 15 MIN BOTH IP/OP $332.00 $246.00 $30.01 $625.00 $45.78 $45.78 $45.78 $45.78 $30.01 $30.01 $59.10 $69.20 $30.01 $444.74 $444.74 $461.84 $312.17 $69.19 $48.02 $160.00 $196.38 $30.01 $332.00 $30.01 $31.51 $249.00 $30.01 $30.01 $30.01 $166.00 $166.00 $262.94 $30.01 $265.60 $48.02 $65.89 $30.01 $192.56 $31.51 $43.51 $30.01 $625.00 $30.01 N/A N/A 42000018 EAP CPT® 97139 TILT TABLE - EACH 15 MIN BOTH IP/OP $198.00 $147.00 $35.24 $625.00 $37.42 $37.42 $37.42 $37.42 $198.00 $198.00 $35.24 $41.27 $198.00 $444.74 $444.74 $461.84 $312.17 $41.27 $198.00 $160.00 $117.12 $198.00 $191.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $198.00 $39.30 $198.00 $114.84 $198.00 $118.80 $198.00 $625.00 $198.00 N/A N/A 42000019 EAP CPT® 97140 JOINT MOBILIZATION EA 15 MIN BOTH IP/OP $468.00 $346.50 $27.59 $625.00 $48.64 $48.64 $48.64 $48.64 $27.59 $27.59 $83.30 $97.54 $27.59 $444.74 $444.74 $461.84 $312.17 $97.54 $44.14 $160.00 $276.82 $27.59 $468.00 $27.59 $28.97 $351.00 $27.59 $27.59 $27.59 $234.00 $234.00 $370.66 $27.59 $374.40 $44.14 $92.89 $27.59 $271.44 $28.97 $40.01 $27.59 $625.00 $27.59 N/A N/A 42000020 EAP CPT® 97150 GROUP ACTIVITY/EXERCISE BOTH IP/OP $143.00 $106.00 $17.95 $625.00 $28.04 $28.04 $28.04 $28.04 $17.95 $17.95 $25.45 $29.80 $17.95 $444.74 $444.74 $461.84 $312.17 $29.80 $28.72 $160.00 $84.58 $17.95 $143.00 $17.95 $18.85 $107.25 $17.95 $17.95 $17.95 $71.50 $71.50 $113.26 $17.95 $114.40 $28.72 $28.38 $17.95 $82.94 $18.85 $26.03 $17.95 $625.00 $17.95 N/A N/A 42000021 EAP CPT® 97530 FUNCTIONAL ACTIVITIES EA 15 MI BOTH IP/OP $331.00 $245.00 $37.96 $625.00 $56.68 $56.68 $56.68 $56.68 $37.96 $37.96 $58.92 $68.99 $37.96 $444.74 $444.74 $461.84 $312.17 $68.98 $60.74 $160.00 $195.79 $37.96 $331.00 $37.96 $39.86 $248.25 $37.96 $37.96 $37.96 $165.50 $165.50 $262.15 $37.96 $264.80 $60.74 $65.70 $37.96 $191.98 $39.86 $55.04 $37.96 $625.00 $37.96 N/A N/A 42000023 EAP CPT® 97542 W/C MANAGEMENT TRAINING EA 15M BOTH IP/OP $290.00 $215.00 $32.43 $625.00 $49.80 $49.80 $49.80 $49.80 $32.43 $32.43 $51.62 $60.44 $32.43 $444.74 $444.74 $461.84 $312.17 $60.44 $51.89 $160.00 $171.54 $32.43 $290.00 $32.43 $34.05 $217.50 $32.43 $32.43 $32.43 $145.00 $145.00 $229.68 $32.43 $232.00 $51.89 $57.56 $32.43 $168.20 $34.05 $47.02 $32.43 $625.00 $32.43 N/A N/A 42000026 EAP CPT® 97760 ORTHOTIC FIT/TRAIN INIT EA 15 BOTH IP/OP $344.00 $255.00 $49.70 $625.00 $186.79 $186.79 $186.79 $186.79 $49.70 $49.70 $61.23 $71.70 $49.70 $444.74 $444.74 $461.84 $312.17 $71.69 $79.52 $160.00 $203.48 $49.70 $276.00 $49.70 $52.19 $258.00 $49.70 $49.70 $49.70 $172.00 $172.00 $272.45 $49.70 $275.20 $79.52 $68.28 $49.70 $199.52 $52.19 $72.07 $49.70 $625.00 $49.70 N/A N/A 42000027 EAP CPT® 97761 PROSTHETIC TRAINING EA 15 MIN BOTH IP/OP $164.00 $121.50 $29.19 $625.00 $89.05 $89.05 $89.05 $89.05 $42.45 $42.45 $29.19 $34.18 $42.45 $444.74 $444.74 $461.84 $312.17 $34.18 $67.92 $160.00 $97.01 $42.45 $164.00 $42.45 $44.57 $123.00 $42.45 $42.45 $42.45 $82.00 $82.00 $129.89 $42.45 $131.20 $67.92 $32.55 $42.45 $95.12 $44.57 $61.55 $42.45 $625.00 $42.45 N/A N/A 42000028 EAP CPT® 97763 ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN BOTH IP/OP $344.00 $255.00 $55.23 $625.00 $186.79 $186.79 $186.79 $186.79 $55.23 $55.23 $61.23 $71.70 $55.23 $444.74 $444.74 $461.84 $312.17 $71.69 $88.37 $160.00 $203.48 $55.23 $344.00 $55.23 $57.99 $258.00 $55.23 $55.23 $55.23 $172.00 $172.00 $272.45 $55.23 $275.20 $88.37 $68.28 $55.23 $199.52 $57.99 $80.08 $55.23 $625.00 $55.23 N/A N/A 42000034 EAP CPT® 97545 WORK HARDENING-PT BOTH IP/OP $207.00 $153.50 $36.85 $625.00 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $36.85 $207.00 $207.00 $444.74 $444.74 $461.84 $312.17 $43.14 $207.00 $160.00 $207.00 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $207.00 $207.00 $207.00 $120.06 $207.00 $124.20 $207.00 $625.00 $207.00 N/A N/A 42000045 EAP CPT® 97139 SCAR MANAGEMENT EA 15 MIN BOTH IP/OP $198.00 $147.00 $35.24 $625.00 $37.42 $37.42 $37.42 $37.42 $198.00 $198.00 $35.24 $41.27 $198.00 $444.74 $444.74 $461.84 $312.17 $41.27 $198.00 $160.00 $117.12 $198.00 $191.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $198.00 $39.30 $198.00 $114.84 $198.00 $118.80 $198.00 $625.00 $198.00 N/A N/A 42000050 EAP CPT® 97546 WORK HARDENING ADD-ON BOTH IP/OP $102.00 $75.50 $18.16 $625.00 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $18.16 $102.00 $102.00 $444.74 $444.74 $461.84 $312.17 $21.26 $102.00 $160.00 $102.00 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $102.00 $102.00 $102.00 $59.16 $102.00 $61.20 $102.00 $625.00 $102.00 N/A N/A 42000068 EAP CPT® 29584 APPLY MULTLAY COMPRS ARM/HAND-LT BOTH IP/OP $427.00 $316.00 $15.88 $625.00 $427.00 $427.00 $427.00 $427.00 $15.88 $15.88 $76.01 $427.00 $15.88 $427.00 $427.00 $427.00 $427.00 $88.99 $25.41 $160.00 $427.00 $15.88 $15.92 $15.88 $427.00 $320.25 $15.88 $15.88 $15.88 $427.00 $213.50 $338.18 $15.88 $341.60 $427.00 $427.00 $15.88 $247.66 $427.00 $16.95 $15.88 $625.00 $15.88 N/A N/A 42000088 EAP CPT® 97022 FLUIDIOTHERAPY-GP BOTH IP/OP $328.00 $243.00 $17.59 $625.00 $38.35 $38.35 $38.35 $38.35 $17.59 $17.59 $58.38 $68.36 $17.59 $444.74 $444.74 $461.84 $312.17 $68.36 $28.14 $160.00 $194.01 $17.59 $328.00 $17.59 $18.47 $246.00 $17.59 $17.59 $17.59 $164.00 $164.00 $259.78 $17.59 $262.40 $28.14 $65.10 $17.59 $190.24 $18.47 $25.51 $17.59 $625.00 $17.59 N/A N/A 42000093 EAP CPT® 29584 APPLY MULTLAY COMPRS ARM/HAND-RT BOTH IP/OP $427.00 $316.00 $15.88 $625.00 $427.00 $427.00 $427.00 $427.00 $15.88 $15.88 $76.01 $427.00 $15.88 $427.00 $427.00 $427.00 $427.00 $88.99 $25.41 $160.00 $427.00 $15.88 $15.92 $15.88 $427.00 $320.25 $15.88 $15.88 $15.88 $427.00 $213.50 $338.18 $15.88 $341.60 $427.00 $427.00 $15.88 $247.66 $427.00 $16.95 $15.88 $625.00 $15.88 N/A N/A 42000103 EAP HCPCS G8981 BODY POS CURRENT STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000104 EAP HCPCS G8982 BODY POS GOAL STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000105 EAP HCPCS G8983 BODY POS D/C STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000106 EAP HCPCS G8984 CARRY CURRENT STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000107 EAP HCPCS G8985 CARRY GOAL STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000108 EAP HCPCS G8986 CARRY D/C STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000109 EAP HCPCS G8987 SELF-CARE CURRENT STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000110 EAP HCPCS G8988 SELF-CARE GOAL STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000111 EAP HCPCS G8989 SELF-CARE D/C STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000112 EAP HCPCS G8990 OTHER PT/OT CURRENT STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000113 EAP HCPCS G8991 OTHER PT/OT GOAL STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000114 EAP HCPCS G8992 OTHER PT/OT D/C STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000115 EAP HCPCS G8993 SUB PT/OT CURRENT STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000116 EAP HCPCS G8994 SUB PT/OT GOAL STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000117 EAP HCPCS G8995 SUB PT/OT D/C STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 42000125 EAP CPT® 97597 DEBRIDEMENT FIRST 20 SQ CM OR LESS BOTH IP/OP $740.00 $548.00 $35.60 $740.00 $740.00 $740.00 $740.00 $740.00 $176.64 $176.64 $131.72 $154.23 $176.64 $740.00 $740.00 $740.00 $740.00 $154.22 $282.63 $160.00 $437.71 $176.64 $35.60 $176.64 $185.48 $555.00 $176.64 $176.64 $176.64 $740.00 $370.00 $586.08 $176.64 $592.00 $291.46 $146.87 $176.64 $429.20 $185.48 $255.56 $176.64 $625.00 $176.64 N/A N/A 42000126 EAP CPT® 97610 PT LOW FREQUENCY NON CONTRAST/THERMAL PER DAY BOTH IP/OP $514.00 $380.50 $17.96 $625.00 $514.00 $514.00 $514.00 $514.00 $18.30 $18.30 $91.49 $514.00 $18.30 $444.74 $444.74 $461.84 $312.17 $107.12 $29.28 $160.00 $514.00 $18.30 $17.96 $18.30 $514.00 $385.50 $18.30 $18.30 $18.30 $257.00 $257.00 $407.09 $18.30 $411.20 $514.00 $514.00 $18.30 $298.12 $514.00 $19.12 $18.30 $625.00 $18.30 N/A N/A 42000226 EAP CPT® 97598 DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM BOTH IP/OP $616.00 $456.00 $24.76 $625.00 $616.00 $616.00 $616.00 $616.00 $616.00 $616.00 $109.65 $128.39 $616.00 $444.74 $444.74 $461.84 $312.17 $128.38 $616.00 $160.00 $364.36 $616.00 $24.76 $616.00 $616.00 $462.00 $616.00 $616.00 $616.00 $308.00 $308.00 $487.87 $616.00 $492.80 $616.00 $122.26 $616.00 $357.28 $616.00 $616.00 $616.00 $625.00 $616.00 N/A N/A 42000227 EAP CPT® 97014 PT ELECTRIC STIM THER UNSUPERVISED WOUND BOTH IP/OP $291.00 $215.50 $51.80 $625.00 $291.00 $291.00 $291.00 $291.00 $291.00 $291.00 $51.80 $291.00 $291.00 $444.74 $444.74 $461.84 $312.17 $60.65 $291.00 $160.00 $291.00 $291.00 $181.00 $291.00 $291.00 $218.25 $291.00 $291.00 $291.00 $145.50 $145.50 $230.47 $291.00 $232.80 $291.00 $291.00 $291.00 $168.78 $291.00 $174.60 $291.00 $625.00 $291.00 N/A N/A 42000228 EAP CPT® 97014 PT ELECTRIC STIM THER UNSUPERVISED NON-WOUND BOTH IP/OP $301.00 $223.00 $53.58 $625.00 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $53.58 $301.00 $301.00 $444.74 $444.74 $461.84 $312.17 $62.73 $301.00 $160.00 $301.00 $301.00 $181.00 $301.00 $301.00 $225.75 $301.00 $301.00 $301.00 $150.50 $150.50 $238.39 $301.00 $240.80 $301.00 $301.00 $301.00 $174.58 $301.00 $180.60 $301.00 $625.00 $301.00 N/A N/A 42400010 EAP CPT® 97161 PT EVAL LOW COMPLEX BOTH IP/OP $726.00 $537.50 $102.11 $726.00 $131.70 $131.70 $131.70 $131.70 $102.11 $102.11 $129.23 $151.32 $102.11 $444.74 $444.74 $461.84 $312.17 $151.31 $163.38 $160.00 $429.43 $102.11 $726.00 $102.11 $107.22 $544.50 $102.11 $102.11 $102.11 $363.00 $363.00 $574.99 $102.11 $580.80 $163.38 $144.09 $102.11 $421.08 $107.22 $148.06 $102.11 $625.00 $102.11 N/A N/A 42400011 EAP CPT® 97162 PT EVAL MOD COMPLEX BOTH IP/OP $743.00 $550.00 $102.11 $743.00 $131.70 $131.70 $131.70 $131.70 $102.11 $102.11 $132.25 $154.86 $102.11 $444.74 $444.74 $461.84 $312.17 $154.85 $163.38 $160.00 $439.48 $102.11 $743.00 $102.11 $107.22 $557.25 $102.11 $102.11 $102.11 $371.50 $371.50 $588.46 $102.11 $594.40 $163.38 $147.47 $102.11 $430.94 $107.22 $148.06 $102.11 $625.00 $102.11 N/A N/A 42400012 EAP CPT® 97163 PT EVAL HIGH COMPLEX BOTH IP/OP $759.00 $562.00 $102.11 $759.00 $131.70 $131.70 $131.70 $131.70 $102.11 $102.11 $135.10 $158.19 $102.11 $444.74 $444.74 $461.84 $312.17 $158.18 $163.38 $160.00 $448.95 $102.11 $759.00 $102.11 $107.22 $569.25 $102.11 $102.11 $102.11 $379.50 $379.50 $601.13 $102.11 $607.20 $163.38 $150.64 $102.11 $440.22 $107.22 $148.06 $102.11 $625.00 $102.11 N/A N/A 42400013 EAP CPT® 97164 PT RE-EVAL BOTH IP/OP $528.00 $391.00 $70.39 $625.00 $88.78 $88.78 $88.78 $88.78 $70.39 $70.39 $93.98 $110.05 $70.39 $444.74 $444.74 $461.84 $312.17 $110.04 $112.62 $160.00 $312.31 $70.39 $528.00 $70.39 $73.91 $396.00 $70.39 $70.39 $70.39 $264.00 $264.00 $418.18 $70.39 $422.40 $112.62 $104.79 $70.39 $306.24 $73.91 $102.07 $70.39 $625.00 $70.39 N/A N/A 43000002 EAP CPT® 92526 DYSPHAGIA TREATMENT BOTH IP/OP $728.00 $539.00 $86.62 $792.00 $395.30 $395.30 $395.30 $395.30 $86.62 $86.62 $87.06 $151.73 $86.62 $444.74 $444.74 $461.84 $312.17 $151.72 $138.59 $160.00 $430.61 $86.62 $792.00 $86.62 $90.95 $546.00 $86.62 $86.62 $86.62 $364.00 $364.00 $576.58 $86.62 $582.40 $138.59 $144.49 $86.62 $422.24 $90.95 $125.60 $86.62 $625.00 $86.62 N/A N/A 43000005 EAP CPT® 95851 RANGE OF MOTION MEASUREMENT BOTH IP/OP $36.00 $27.00 $6.11 $625.00 $36.00 $36.00 $36.00 $36.00 $7.92 $7.92 $6.11 $36.00 $7.92 $444.74 $444.74 $461.84 $312.17 $7.50 $12.67 $160.00 $36.00 $7.92 $7.80 $7.92 $36.00 $27.00 $7.92 $7.92 $7.92 $18.00 $18.00 $28.51 $7.92 $28.80 $23.40 $36.00 $7.92 $20.88 $36.00 $8.29 $7.92 $625.00 $7.92 N/A N/A 43000008 EAP CPT® 97014 ELECTRICAL STIM UNSUPERVISED BOTH IP/OP $291.00 $215.50 $60.65 $625.00 $291.00 $291.00 $291.00 $291.00 $291.00 $291.00 $291.00 $291.00 $291.00 $444.74 $444.74 $461.84 $312.17 $60.65 $291.00 $160.00 $291.00 $291.00 $181.00 $291.00 $291.00 $218.25 $291.00 $291.00 $291.00 $145.50 $145.50 $230.47 $291.00 $232.80 $291.00 $291.00 $291.00 $168.78 $291.00 $174.60 $291.00 $625.00 $291.00 N/A N/A 43000010 EAP CPT® 97018 PARAFFIN BATH BOTH IP/OP $278.00 $206.00 $5.84 $625.00 $17.75 $17.75 $17.75 $17.75 $5.84 $5.84 $11.16 $57.94 $5.84 $444.74 $444.74 $461.84 $312.17 $57.94 $9.34 $160.00 $164.44 $5.84 $223.00 $5.84 $6.13 $208.50 $5.84 $5.84 $5.84 $139.00 $139.00 $220.18 $5.84 $222.40 $9.34 $55.18 $5.84 $161.24 $6.13 $8.47 $5.84 $625.00 $5.84 N/A N/A 43000011 EAP CPT® 97022 WHIRLPOOL BOTH IP/OP $328.00 $243.00 $17.59 $625.00 $38.35 $38.35 $38.35 $38.35 $17.59 $17.59 $23.78 $68.36 $17.59 $444.74 $444.74 $461.84 $312.17 $68.36 $28.14 $160.00 $194.01 $17.59 $328.00 $17.59 $18.47 $246.00 $17.59 $17.59 $17.59 $164.00 $164.00 $259.78 $17.59 $262.40 $28.14 $65.10 $17.59 $190.24 $18.47 $25.51 $17.59 $625.00 $17.59 N/A N/A 43000012 EAP CPT® 97032 ELEC STIM CONS ATTEN EA 15 MIN BOTH IP/OP $301.00 $223.00 $14.84 $625.00 $30.92 $30.92 $30.92 $30.92 $14.84 $14.84 $19.43 $62.74 $14.84 $444.74 $444.74 $461.84 $312.17 $62.73 $23.74 $160.00 $178.04 $14.84 $301.00 $14.84 $15.58 $225.75 $14.84 $14.84 $14.84 $150.50 $150.50 $238.39 $14.84 $240.80 $23.74 $59.74 $14.84 $174.58 $15.58 $21.52 $14.84 $625.00 $14.84 N/A N/A 43000013 EAP CPT® 97035 ULTRASOUND HEAT EA 15 MIN BOTH IP/OP $162.00 $120.00 $12.94 $625.00 $20.61 $20.61 $20.61 $20.61 $14.49 $14.49 $12.94 $33.76 $14.49 $444.74 $444.74 $461.84 $312.17 $33.76 $23.18 $160.00 $95.82 $14.49 $162.00 $14.49 $15.21 $121.50 $14.49 $14.49 $14.49 $81.00 $81.00 $128.30 $14.49 $129.60 $23.18 $32.15 $14.49 $93.96 $15.21 $21.01 $14.49 $625.00 $14.49 N/A N/A 43000014 EAP CPT® 97022 FLUIDIOTHERAPY BOTH IP/OP $328.00 $243.00 $17.59 $625.00 $38.35 $38.35 $38.35 $38.35 $17.59 $17.59 $23.78 $68.36 $17.59 $444.74 $444.74 $461.84 $312.17 $68.36 $28.14 $160.00 $194.01 $17.59 $328.00 $17.59 $18.47 $246.00 $17.59 $17.59 $17.59 $164.00 $164.00 $259.78 $17.59 $262.40 $28.14 $65.10 $17.59 $190.24 $18.47 $25.51 $17.59 $625.00 $17.59 N/A N/A 43000015 EAP CPT® 97110 THERAPEUTIC EXERCISE EA 15MIN BOTH IP/OP $351.00 $260.00 $30.01 $625.00 $52.66 $52.66 $52.66 $52.66 $30.01 $30.01 $32.74 $73.16 $30.01 $444.74 $444.74 $461.84 $312.17 $73.15 $48.02 $160.00 $207.62 $30.01 $351.00 $30.01 $31.51 $263.25 $30.01 $30.01 $30.01 $175.50 $175.50 $277.99 $30.01 $280.80 $48.02 $69.66 $30.01 $203.58 $31.51 $43.51 $30.01 $625.00 $30.01 N/A N/A 43000016 EAP CPT® 97112 NEUROMUSCULAR RE-ED EA. 15 MIN BOTH IP/OP $332.00 $246.00 $33.84 $625.00 $54.97 $54.97 $54.97 $54.97 $34.85 $34.85 $33.84 $69.20 $34.85 $444.74 $444.74 $461.84 $312.17 $69.19 $55.76 $160.00 $196.38 $34.85 $332.00 $34.85 $36.59 $249.00 $34.85 $34.85 $34.85 $166.00 $166.00 $262.94 $34.85 $265.60 $55.76 $65.89 $34.85 $192.56 $36.59 $50.53 $34.85 $625.00 $34.85 N/A N/A 43000018 EAP CPT® 97139 SCAR MANAGEMENT EA 15 MIN BOTH IP/OP $198.00 $147.00 $14.44 $625.00 $37.42 $37.42 $37.42 $37.42 $198.00 $198.00 $14.44 $41.27 $198.00 $444.74 $444.74 $461.84 $312.17 $41.27 $198.00 $160.00 $117.12 $198.00 $191.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $128.70 $39.30 $198.00 $114.84 $198.00 $118.80 $198.00 $625.00 $198.00 N/A N/A 43000019 EAP CPT® 97140 JOINT MOBILIZATION EA 15 MIN BOTH IP/OP $468.00 $346.50 $27.59 $625.00 $48.64 $48.64 $48.64 $48.64 $27.59 $27.59 $30.24 $97.54 $27.59 $444.74 $444.74 $461.84 $312.17 $97.54 $44.14 $160.00 $276.82 $27.59 $468.00 $27.59 $28.97 $351.00 $27.59 $27.59 $27.59 $234.00 $234.00 $370.66 $27.59 $374.40 $44.14 $92.89 $27.59 $271.44 $28.97 $40.01 $27.59 $625.00 $27.59 N/A N/A 43000020 EAP CPT® 97150 GROUP ACTIVITY/EXERCISE BOTH IP/OP $143.00 $106.00 $17.62 $625.00 $28.04 $28.04 $28.04 $28.04 $17.95 $17.95 $17.62 $29.80 $17.95 $444.74 $444.74 $461.84 $312.17 $29.80 $28.72 $160.00 $84.58 $17.95 $143.00 $17.95 $18.85 $107.25 $17.95 $17.95 $17.95 $71.50 $71.50 $113.26 $17.95 $114.40 $28.72 $28.38 $17.95 $82.94 $18.85 $26.03 $17.95 $625.00 $17.95 N/A N/A 43000021 EAP CPT® 97530 ACTIV.TO INCREASE FUNC.EA 15MI BOTH IP/OP $331.00 $245.00 $35.29 $625.00 $56.68 $56.68 $56.68 $56.68 $37.96 $37.96 $35.29 $68.99 $37.96 $444.74 $444.74 $461.84 $312.17 $68.98 $60.74 $160.00 $195.79 $37.96 $331.00 $37.96 $39.86 $248.25 $37.96 $37.96 $37.96 $165.50 $165.50 $262.15 $37.96 $264.80 $60.74 $65.70 $37.96 $191.98 $39.86 $55.04 $37.96 $625.00 $37.96 N/A N/A 43000023 EAP CPT® 97533 SENSORY INTEGRAT TECH EA 15MIN BOTH IP/OP $191.00 $141.50 $29.51 $625.00 $47.51 $47.51 $47.51 $47.51 $65.93 $65.93 $29.51 $39.81 $65.93 $444.74 $444.74 $461.84 $312.17 $39.81 $105.49 $160.00 $112.98 $65.93 $164.00 $65.93 $69.23 $143.25 $65.93 $65.93 $65.93 $95.50 $95.50 $151.27 $65.93 $152.80 $105.49 $37.91 $65.93 $110.78 $69.23 $95.60 $65.93 $625.00 $65.93 N/A N/A 43000024 EAP CPT® 97535 ADL TRAINING EACH 15 MINS BOTH IP/OP $278.00 $206.00 $33.47 $625.00 $56.68 $56.68 $56.68 $56.68 $33.47 $33.47 $35.29 $57.94 $33.47 $444.74 $444.74 $461.84 $312.17 $57.94 $53.55 $160.00 $164.44 $33.47 $223.00 $33.47 $35.14 $208.50 $33.47 $33.47 $33.47 $139.00 $139.00 $220.18 $33.47 $222.40 $53.55 $55.18 $33.47 $161.24 $35.14 $48.53 $33.47 $625.00 $33.47 N/A N/A 43000028 EAP CPT® 97760 "SPLINT/ORT-FAB,FIT/TRA/Q 15MIN" BOTH IP/OP $344.00 $255.00 $38.52 $625.00 $186.79 $186.79 $186.79 $186.79 $49.70 $49.70 $38.52 $71.70 $49.70 $444.74 $444.74 $461.84 $312.17 $71.69 $79.52 $160.00 $203.48 $49.70 $276.00 $49.70 $52.19 $258.00 $49.70 $49.70 $49.70 $172.00 $172.00 $272.45 $49.70 $275.20 $79.52 $68.28 $49.70 $199.52 $52.19 $72.07 $49.70 $625.00 $49.70 N/A N/A 43000029 EAP CPT® 97761 PROSTH/TRAINING EA 15 MIN BOTH IP/OP $164.00 $121.50 $32.55 $625.00 $89.05 $89.05 $89.05 $89.05 $42.45 $42.45 $33.46 $34.18 $42.45 $444.74 $444.74 $461.84 $312.17 $34.18 $67.92 $160.00 $97.01 $42.45 $164.00 $42.45 $44.57 $123.00 $42.45 $42.45 $42.45 $82.00 $82.00 $129.89 $42.45 $131.20 $67.92 $32.55 $42.45 $95.12 $44.57 $61.55 $42.45 $625.00 $42.45 N/A N/A 43000030 EAP CPT® 97763 ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN BOTH IP/OP $344.00 $255.00 $55.23 $625.00 $186.79 $186.79 $186.79 $186.79 $55.23 $55.23 $344.00 $71.70 $55.23 $444.74 $444.74 $461.84 $312.17 $71.69 $88.37 $160.00 $203.48 $55.23 $344.00 $55.23 $57.99 $258.00 $55.23 $55.23 $55.23 $172.00 $172.00 $272.45 $55.23 $275.20 $88.37 $68.28 $55.23 $199.52 $57.99 $80.08 $55.23 $625.00 $55.23 N/A N/A 43000044 EAP CPT® 97545 WORK HARDENING-OT BOTH IP/OP $207.00 $153.50 $43.14 $625.00 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $169.10 $207.00 $207.00 $444.74 $444.74 $461.84 $312.17 $43.14 $207.00 $160.00 $207.00 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $207.00 $207.00 $120.06 $207.00 $124.20 $207.00 $625.00 $207.00 N/A N/A 43000060 EAP CPT® 97546 WORK HARDENING ADD-ON-OT BOTH IP/OP $102.00 $75.50 $21.26 $625.00 $102.00 $102.00 $102.00 $102.00 $102.00 $102.00 $67.37 $102.00 $102.00 $444.74 $444.74 $461.84 $312.17 $21.26 $102.00 $160.00 $102.00 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $102.00 $102.00 $59.16 $102.00 $61.20 $102.00 $625.00 $102.00 N/A N/A 43000065 EAP CPT® 29584 APPLY MULTLAY COMPRS ARM/HAND-LT BOTH IP/OP $508.00 $376.00 $15.88 $625.00 $508.00 $508.00 $508.00 $508.00 $15.88 $15.88 $16.01 $508.00 $15.88 $508.00 $508.00 $508.00 $508.00 $105.87 $25.41 $160.00 $508.00 $15.88 $15.92 $15.88 $508.00 $381.00 $15.88 $15.88 $15.88 $508.00 $254.00 $402.34 $15.88 $406.40 $330.20 $508.00 $15.88 $294.64 $508.00 $16.95 $15.88 $625.00 $15.88 N/A N/A 43000080 EAP CPT® 97129 OCC THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES BOTH IP/OP $379.00 $280.50 $18.64 $625.00 $39.08 $39.08 $39.08 $39.08 $23.11 $23.11 $18.64 $78.99 $23.11 $444.74 $444.74 $461.84 $312.17 $78.99 $36.98 $160.00 $224.18 $23.11 $22.36 $23.11 $379.00 $284.25 $23.11 $23.11 $23.11 $189.50 $189.50 $300.17 $23.11 $303.20 $246.35 $75.22 $23.11 $219.82 $379.00 $24.17 $23.11 $625.00 $23.11 N/A N/A 43000081 EAP CPT® 97130 OCC THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES BOTH IP/OP $379.00 $280.50 $17.80 $625.00 $37.35 $37.35 $37.35 $37.35 $22.07 $22.07 $17.80 $78.99 $22.07 $444.74 $444.74 $461.84 $312.17 $78.99 $35.31 $160.00 $224.18 $22.07 $21.68 $22.07 $379.00 $284.25 $22.07 $22.07 $22.07 $189.50 $189.50 $300.17 $22.07 $303.20 $246.35 $75.22 $22.07 $219.82 $379.00 $23.44 $22.07 $625.00 $22.07 N/A N/A 43000093 EAP CPT® 29584 APPLY MULTLAY COMPRS ARM/HAND-RT BOTH IP/OP $508.00 $376.00 $15.88 $625.00 $508.00 $508.00 $508.00 $508.00 $15.88 $15.88 $16.01 $508.00 $15.88 $508.00 $508.00 $508.00 $508.00 $105.87 $25.41 $160.00 $508.00 $15.88 $15.92 $15.88 $508.00 $381.00 $15.88 $15.88 $15.88 $508.00 $254.00 $402.34 $15.88 $406.40 $330.20 $508.00 $15.88 $294.64 $508.00 $16.95 $15.88 $625.00 $15.88 N/A N/A 43000100 EAP HCPCS G8978 MOBILITY CURRENT STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 43000101 EAP HCPCS G8979 MOBILITY GOAL STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 43000102 EAP HCPCS G8980 MOBILITY D/C STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 43000103 EAP HCPCS G8981 BODY POS CURRENT STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 43000104 EAP HCPCS G8982 BODY POS GOAL STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 43000106 EAP HCPCS G8984 CARRY CURRENT STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 43000107 EAP HCPCS G8985 CARRY GOAL STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 43000108 EAP HCPCS G8986 CARRY D/C STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 43000112 EAP HCPCS G8990 OTHER PT/OT CURRENT STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 43000113 EAP HCPCS G8991 OTHER PT/OT GOAL STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 43000114 EAP HCPCS G8992 OTHER PT/OT D/C STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 43000115 EAP HCPCS G8993 SUB PT/OT CURRENT STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 43000116 EAP HCPCS G8994 SUB PT/OT GOAL STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 43000117 EAP HCPCS G8995 SUB PT/OT D/C STATUS BOTH IP/OP $0.01 $0.50 $0.01 $625.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $444.74 $444.74 $461.84 $312.17 $0.01 $0.01 $160.00 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $625.00 $0.01 N/A N/A 43000118 EAP CPT® 97014 OT ELECTRIC STIM THER UNSUPERVISED WOUND BOTH IP/OP $291.00 $215.50 $13.56 $625.00 $291.00 $291.00 $291.00 $291.00 $291.00 $291.00 $13.56 $291.00 $291.00 $444.74 $444.74 $461.84 $312.17 $60.65 $291.00 $160.00 $291.00 $291.00 $181.00 $291.00 $291.00 $218.25 $291.00 $291.00 $291.00 $145.50 $145.50 $230.47 $291.00 $232.80 $189.15 $291.00 $291.00 $168.78 $291.00 $174.60 $291.00 $625.00 $291.00 N/A N/A 43000119 EAP CPT® 97014 OT ELECTRIC STIM THER UNSUPERVISED NON-WOUND BOTH IP/OP $301.00 $223.00 $62.73 $625.00 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $301.00 $444.74 $444.74 $461.84 $312.17 $62.73 $301.00 $160.00 $301.00 $301.00 $181.00 $301.00 $301.00 $225.75 $301.00 $301.00 $301.00 $150.50 $150.50 $238.39 $301.00 $240.80 $301.00 $301.00 $301.00 $174.58 $301.00 $180.60 $301.00 $625.00 $301.00 N/A N/A 43400001 EAP CPT® 92610 NICU/PED/SWALLOWING EVALUATION BOTH IP/OP "$1,185.00" $877.00 $56.49 "$1,185.00" $643.46 $643.46 $643.46 $643.46 $71.01 $71.01 $56.49 $246.98 $71.01 $444.74 $444.74 $461.84 $312.17 $246.97 $113.62 $160.00 $700.93 $71.01 $70.46 $71.01 "$1,185.00" $888.75 $71.01 $71.01 $71.01 $592.50 $592.50 $938.52 $71.01 $948.00 $770.25 $235.19 $71.01 $687.30 "$1,185.00" $74.65 $71.01 $625.00 $71.01 N/A N/A 43400060 EAP CPT® 97165 OT EVAL LOW COMPLEX BOTH IP/OP $726.00 $537.50 $102.80 $726.00 $150.02 $150.02 $150.02 $150.02 $102.80 $102.80 $726.00 $151.32 $102.80 $444.74 $444.74 $461.84 $312.17 $151.31 $164.48 $160.00 $429.43 $102.80 $726.00 $102.80 $107.94 $544.50 $102.80 $102.80 $102.80 $363.00 $363.00 $574.99 $102.80 $580.80 $164.48 $144.09 $102.80 $421.08 $107.94 $149.06 $102.80 $625.00 $102.80 N/A N/A 43400061 EAP CPT® 97166 OT EVAL MOD COMPLEX BOTH IP/OP $743.00 $550.00 $102.80 $743.00 $150.02 $150.02 $150.02 $150.02 $102.80 $102.80 $743.00 $154.86 $102.80 $444.74 $444.74 $461.84 $312.17 $154.85 $164.48 $160.00 $439.48 $102.80 $743.00 $102.80 $107.94 $557.25 $102.80 $102.80 $102.80 $371.50 $371.50 $588.46 $102.80 $594.40 $164.48 $147.47 $102.80 $430.94 $107.94 $149.06 $102.80 $625.00 $102.80 N/A N/A 43400062 EAP CPT® 97167 OT EVAL HIGH COMPLEX BOTH IP/OP $759.00 $562.00 $102.80 $759.00 $150.02 $150.02 $150.02 $150.02 $102.80 $102.80 $759.00 $158.19 $102.80 $444.74 $444.74 $461.84 $312.17 $158.18 $164.48 $160.00 $448.95 $102.80 $759.00 $102.80 $107.94 $569.25 $102.80 $102.80 $102.80 $379.50 $379.50 $601.13 $102.80 $607.20 $164.48 $150.64 $102.80 $440.22 $107.94 $149.06 $102.80 $625.00 $102.80 N/A N/A 43400063 EAP CPT® 97168 OT RE-EVAL BOTH IP/OP $528.00 $391.00 $110.04 $625.00 $528.00 $528.00 $528.00 $528.00 $528.00 $528.00 $528.00 $528.00 $528.00 $444.74 $444.74 $461.84 $312.17 $110.04 $528.00 $160.00 $528.00 $528.00 $528.00 $528.00 $528.00 $396.00 $528.00 $528.00 $528.00 $264.00 $264.00 $418.18 $528.00 $422.40 $528.00 $528.00 $528.00 $306.24 $528.00 $528.00 $528.00 $625.00 $528.00 N/A N/A 44000001 EAP CPT® 92507 INDIVIDUAL SPEECH THERAPY BOTH IP/OP $629.00 $465.50 $77.98 $629.00 $140.71 $140.71 $140.71 $140.71 $77.98 $77.98 $80.21 $131.10 $77.98 $444.74 $444.74 $461.84 $312.17 $131.09 $124.77 $160.00 $372.05 $77.98 $629.00 $77.98 $81.88 $471.75 $77.98 $77.98 $77.98 $314.50 $314.50 $498.17 $77.98 $503.20 $124.77 $124.84 $77.98 $364.82 $81.88 $113.07 $77.98 $131.08 $77.98 N/A N/A 44000004 EAP CPT® 92526 TREATMET OF SWALLOW & ORAL FUN BOTH IP/OP $792.00 $586.50 $86.62 $792.00 $430.06 $430.06 $430.06 $430.06 $86.62 $86.62 $87.06 $165.07 $86.62 $444.74 $444.74 $461.84 $312.17 $165.06 $138.59 $160.00 $468.47 $86.62 $792.00 $86.62 $90.95 $594.00 $86.62 $86.62 $86.62 $396.00 $396.00 $627.26 $86.62 $633.60 $138.59 $157.19 $86.62 $459.36 $90.95 $125.60 $86.62 $165.05 $86.62 N/A N/A 44000007 EAP CPT® 92609 THER SER/SPEECH-GENERATING DEV BOTH IP/OP $509.00 $377.00 $106.08 $509.00 $509.00 $509.00 $509.00 $509.00 $509.00 $509.00 $509.00 $509.00 $509.00 $444.74 $444.74 $461.84 $312.17 $106.08 $509.00 $160.00 $509.00 $509.00 $375.00 $509.00 $509.00 $381.75 $509.00 $509.00 $509.00 $254.50 $254.50 $403.13 $509.00 $407.20 $509.00 $509.00 $509.00 $295.22 $509.00 $509.00 $509.00 $509.00 $509.00 N/A N/A 44000044 EAP CPT® 92524 BEHAVIORAL AND QUALITATIVE ANALYSIS OF VOICE AND RESONAE BOTH IP/OP $920.00 $681.00 $91.21 $920.00 $158.41 $158.41 $158.41 $158.41 $111.74 $111.74 $91.21 $191.75 $111.74 $444.74 $444.74 $461.84 $312.17 $191.74 $178.78 $160.00 $544.18 $111.74 $920.00 $111.74 $117.33 $690.00 $111.74 $111.74 $111.74 $460.00 $460.00 $728.64 $111.74 $736.00 $178.78 $182.60 $111.74 $533.60 $117.33 $162.02 $111.74 $191.73 $111.74 N/A N/A 44000050 EAP CPT® 97129 SPEECH THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES BOTH IP/OP $379.00 $280.50 $18.64 $461.84 $39.08 $39.08 $39.08 $39.08 $23.11 $23.11 $18.64 $78.99 $23.11 $444.74 $444.74 $461.84 $312.17 $78.99 $36.98 $160.00 $224.18 $23.11 $22.36 $23.11 $379.00 $284.25 $23.11 $23.11 $23.11 $189.50 $189.50 $300.17 $23.11 $303.20 $246.35 $75.22 $23.11 $219.82 $379.00 $24.17 $23.11 $78.98 $23.11 N/A N/A 44000051 EAP CPT® 97130 SPEECH THER IVNTJ COG FUNCJ CNTCT EA ADDL 15 MINUTES BOTH IP/OP $379.00 $280.50 $17.80 $461.84 $37.35 $37.35 $37.35 $37.35 $22.07 $22.07 $17.80 $78.99 $22.07 $444.74 $444.74 $461.84 $312.17 $78.99 $35.31 $160.00 $224.18 $22.07 $21.68 $22.07 $379.00 $284.25 $22.07 $22.07 $22.07 $189.50 $189.50 $300.17 $22.07 $303.20 $246.35 $75.22 $22.07 $219.82 $379.00 $23.44 $22.07 $78.98 $22.07 N/A N/A 44300005 EAP CPT® 92508 GROUP SPEECH THER EACH 15MIN BOTH IP/OP $188.00 $139.50 $39.18 $461.84 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $444.74 $444.74 $461.84 $312.17 $39.18 $188.00 $160.00 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $188.00 $188.00 $188.00 $109.04 $188.00 $188.00 $188.00 $188.00 $188.00 N/A N/A 44400003 EAP CPT® 92597 EVALUATION FOR VOICE PROSTHESI BOTH IP/OP "$1,176.00" $870.50 $72.95 "$1,176.00" $638.57 $638.57 $638.57 $638.57 $73.42 $73.42 $72.95 $245.11 $73.42 $444.74 $444.74 $461.84 $312.17 $245.09 $117.47 $160.00 $695.60 $73.42 "$1,176.00" $73.42 $77.09 $882.00 $73.42 $73.42 $73.42 $588.00 $588.00 $931.39 $73.42 $940.80 $117.47 $233.41 $73.42 $682.08 $77.09 $106.46 $73.42 $245.08 $73.42 N/A N/A 44400005 EAP CPT® 92607 EVAL SPEECH DEVICE FIRST HOUR BOTH IP/OP $553.00 $409.50 $115.25 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $553.00 $444.74 $444.74 $461.84 $312.17 $115.25 $553.00 $160.00 $553.00 $553.00 $553.00 $553.00 $553.00 $414.75 $553.00 $553.00 $553.00 $276.50 $276.50 $437.98 $553.00 $442.40 $553.00 $553.00 $553.00 $320.74 $553.00 $553.00 $553.00 $553.00 $553.00 N/A N/A 44400007 EAP CPT® 92608 EVAL/SPEECH DVC (ADD'L 30 MIN) BOTH IP/OP $200.00 $148.00 $40.89 $461.84 $200.00 $200.00 $200.00 $200.00 $50.00 $50.00 $40.89 $200.00 $50.00 $444.74 $444.74 $461.84 $312.17 $41.68 $80.00 $160.00 $200.00 $50.00 $49.10 $50.00 $200.00 $150.00 $50.00 $50.00 $50.00 $100.00 $100.00 $158.40 $50.00 $160.00 $130.00 $200.00 $50.00 $116.00 $200.00 $52.99 $50.00 $200.00 $50.00 N/A N/A 44400009 EAP CPT® 92610 EVAL.OF SWALLOW & ORAL FUNC. BOTH IP/OP "$1,288.00" $953.50 $56.49 "$1,288.00" $699.38 $699.38 $699.38 $699.38 $71.01 $71.01 $56.49 $268.45 $71.01 $444.74 $444.74 $461.84 $312.17 $268.43 $113.62 $160.00 $761.85 $71.01 $70.46 $71.01 "$1,288.00" $966.00 $71.01 $71.01 $71.01 $644.00 $644.00 "$1,020.10" $71.01 "$1,030.40" $837.20 $255.64 $71.01 $747.04 "$1,288.00" $74.65 $71.01 $268.42 $71.01 N/A N/A 44400012 EAP CPT® 92611 MOTION FLUO EVAL OF SWALLOWING BOTH IP/OP "$1,288.00" $953.50 $74.78 "$1,288.00" $699.38 $699.38 $699.38 $699.38 $93.40 $93.40 $74.78 $268.45 $93.40 $444.74 $444.74 $461.84 $312.17 $268.43 $149.44 $160.00 $761.85 $93.40 $92.47 $93.40 "$1,288.00" $966.00 $93.40 $93.40 $93.40 $644.00 $644.00 "$1,020.10" $93.40 "$1,030.40" $837.20 $255.64 $93.40 $747.04 "$1,288.00" $94.46 $93.40 $268.42 $93.40 N/A N/A 44400014 EAP CPT® 92612 FLEX FIB ENDO EVAL/SWALLOWING BOTH IP/OP "$2,142.00" "$1,585.50" $53.40 "$2,142.00" "$2,142.00" "$2,142.00" "$2,142.00" "$2,142.00" $67.52 $67.52 $53.40 "$2,142.00" $67.52 $444.74 $444.74 $461.84 $312.17 $446.42 $108.03 $160.00 "$2,142.00" $67.52 $66.75 $67.52 "$2,142.00" "$1,606.50" $67.52 $67.52 $67.52 "$1,071.00" "$1,071.00" "$1,696.46" $67.52 "$1,713.60" "$1,392.30" "$2,142.00" $67.52 "$1,242.36" "$2,142.00" $70.32 $67.52 "$2,142.00" $67.52 N/A N/A 44400017 EAP CPT® 96105 ASSESSMENT OF APHASIA BOTH IP/OP $607.00 $449.50 $80.90 $607.00 $607.00 $607.00 $607.00 $607.00 $99.61 $99.61 $80.90 $607.00 $99.61 $444.74 $444.74 $461.84 $312.17 $126.51 $159.38 $160.00 $607.00 $99.61 $98.26 $99.61 $607.00 $455.25 $99.61 $99.61 $99.61 $303.50 $303.50 $480.74 $99.61 $485.60 $394.55 $607.00 $99.61 $352.06 $607.00 $105.65 $99.61 $607.00 $99.61 N/A N/A 44400020 EAP CPT® 92540 "OBSERVATION, TESTING, AND RECORDING OF ABNORMAL EYE MOVEMENT" BOTH IP/OP $911.00 $674.50 $32.13 $728.80 $494.67 $494.67 $494.67 $494.67 $137.34 $137.34 $136.73 $189.88 $137.34 $676.14 $676.14 $702.20 $474.63 $189.86 $219.74 $209.80 $538.86 $137.34 $32.13 $137.34 $144.20 $683.25 $137.34 $137.34 $137.34 $455.50 $455.50 $721.51 $137.34 $728.80 $592.15 $180.81 $137.34 $528.38 $144.20 $198.69 $137.34 $189.85 $137.34 N/A N/A 44400030 EAP CPT® 92570 ACOUSTIC IMMITTANCE TESTING BOTH IP/OP $273.00 $202.50 $29.13 $461.84 $273.00 $273.00 $273.00 $273.00 $29.96 $29.96 $30.20 $273.00 $29.96 $444.74 $444.74 $461.84 $312.17 $56.90 $47.94 $160.00 $273.00 $29.96 $29.13 $29.96 $273.00 $204.75 $29.96 $29.96 $29.96 $136.50 $136.50 $216.22 $29.96 $218.40 $177.45 $273.00 $29.96 $158.34 $273.00 $30.65 $29.96 $273.00 $29.96 N/A N/A 44400031 EAP CPT® 92550 TYMPANOMETRY AND REFLEX THRESH BOTH IP/OP $156.00 $115.50 $22.35 $461.84 $84.71 $84.71 $84.71 $84.71 $137.34 $137.34 $136.73 $32.51 $137.34 $444.74 $444.74 $461.84 $312.17 $32.51 $219.74 $160.00 $92.27 $137.34 $22.35 $137.34 $144.20 $117.00 $137.34 $137.34 $137.34 $78.00 $78.00 $123.55 $137.34 $124.80 $101.40 $30.96 $137.34 $90.48 $144.20 $156.00 $137.34 $32.51 $137.34 N/A N/A 44400033 EAP CPT® 92618 EX FOR NON-SPEECH DEV RX ADD BOTH IP/OP $150.00 $111.00 $26.37 $461.84 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.37 $150.00 $150.00 $444.74 $444.74 $461.84 $312.17 $31.26 $150.00 $160.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 $150.00 $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A 44400034 EAP CPT® 92522 "EVAL OF ONLY SPEECH SND PROD (MOTOR SPEECH, ARTIC, ETC)" BOTH IP/OP $772.00 $571.50 $93.49 $617.60 $164.08 $164.08 $164.08 $164.08 $113.47 $113.47 $93.49 $160.90 $113.47 $444.74 $444.74 $461.84 $312.17 $160.89 $181.55 $160.00 $456.64 $113.47 $596.00 $113.47 $119.14 $579.00 $113.47 $113.47 $113.47 $386.00 $386.00 $611.42 $113.47 $617.60 $181.55 $153.22 $113.47 $447.76 $119.14 $164.53 $113.47 $160.88 $113.47 N/A N/A 44400035 EAP CPT® 92521 "EVALUATION OF SPEECH FLUENCY (EG, STUTTERING, CLUTTERIN)" BOTH IP/OP $811.00 $600.50 $160.00 $811.00 $811.00 $811.00 $811.00 $811.00 $811.00 $811.00 $811.00 $811.00 $811.00 $444.74 $444.74 $461.84 $312.17 $169.02 $811.00 $160.00 $811.00 $811.00 $596.00 $811.00 $811.00 $608.25 $811.00 $811.00 $811.00 $405.50 $405.50 $642.31 $811.00 $648.80 $811.00 $811.00 $811.00 $470.38 $811.00 $811.00 $811.00 $811.00 $811.00 N/A N/A 44400036 EAP CPT® 92523 "EVAL OF SPEECH, LANGUAGE & COGNITION-COMMUNICATION" BOTH IP/OP "$1,188.00" $879.50 $160.00 "$1,188.00" $350.25 $350.25 $350.25 $350.25 $230.93 $230.93 $190.53 $247.61 $230.93 $444.74 $444.74 $461.84 $312.17 $247.59 $369.49 $160.00 $702.70 $230.93 "$1,188.00" $230.93 $242.48 $891.00 $230.93 $230.93 $230.93 $594.00 $594.00 $940.90 $230.93 $950.40 $369.49 $235.79 $230.93 $689.04 $242.48 $334.85 $230.93 $247.58 $230.93 N/A N/A 44400056 EAP CPT® 92523 "EVAL OF SPEECH, LANGUAGE & COGNITION-COMM" BOTH IP/OP "$1,188.00" $879.50 $160.00 "$1,188.00" $350.25 $350.25 $350.25 $350.25 $230.93 $230.93 $190.53 $247.61 $230.93 $444.74 $444.74 $461.84 $312.17 $247.59 $369.49 $160.00 $702.70 $230.93 "$1,188.00" $230.93 $242.48 $891.00 $230.93 $230.93 $230.93 $594.00 $594.00 $940.90 $230.93 $950.40 $369.49 $235.79 $230.93 $689.04 $242.48 $334.85 $230.93 $247.58 $230.93 N/A N/A 45000003 EAP CPT® 52310 CYSTOSCOPY AND TREATAMENT BOTH IP/OP "$5,725.00" "$4,236.50" $150.22 "$4,580.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,761.28" "$1,761.28" "$1,753.49" "$1,193.23" "$1,761.28" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,193.15" "$2,818.05" "$2,675.95" "$2,836.00" "$1,761.28" $150.22 "$1,761.28" "$1,849.35" "$4,293.75" "$1,761.28" "$1,761.28" "$1,761.28" "$2,851.00" "$2,423.00" "$4,534.20" "$1,761.28" "$4,580.00" "$2,500.00" "$1,136.27" "$1,761.28" "$3,320.50" "$1,849.35" "$2,548.13" "$1,761.28" "$1,193.09" "$1,761.28" N/A N/A 45000005 EAP CPT® 45300 PROCTOSIGMIDOSCOPY DX BOTH IP/OP "$2,361.00" "$1,747.50" $48.05 "$2,361.00" "$2,361.00" "$2,361.00" "$2,361.00" "$2,361.00" $48.05 $48.05 $48.73 "$2,361.00" $48.05 "$2,361.00" "$2,361.00" "$2,361.00" "$2,361.00" $492.06 $76.88 $77.58 "$2,361.00" $48.05 $48.49 $48.05 "$2,361.00" "$1,770.75" $48.05 $48.05 $48.05 "$2,361.00" "$1,180.50" "$1,869.91" $48.05 "$1,888.80" "$2,150.00" "$2,361.00" $48.05 "$1,369.38" "$2,361.00" $49.75 $48.05 "$2,361.00" $48.05 N/A N/A 45000006 EAP CPT® 24675 CLOSED TRATMENT OF PROXIMAL ULNA/W MANIPULATION BOTH IP/OP "$1,594.00" "$1,180.00" $332.21 "$1,594.00" "$1,594.00" "$1,594.00" "$1,594.00" "$1,594.00" $433.98 $433.98 $426.98 "$1,594.00" $433.98 "$1,594.00" "$1,594.00" "$1,594.00" "$1,594.00" $332.21 $694.37 $692.99 "$1,594.00" $433.98 $433.12 $433.98 "$1,594.00" "$1,195.50" $433.98 $433.98 $433.98 "$1,594.00" $797.00 "$1,262.45" $433.98 "$1,275.20" "$1,594.00" "$1,594.00" $433.98 $924.52 "$1,594.00" $432.13 $433.98 "$1,594.00" $433.98 N/A N/A 45000009 EAP CPT® 29126 APPLYFORE ARM SPLINT BOTH IP/OP $732.00 $542.00 $48.82 $732.00 $732.00 $732.00 $732.00 $732.00 $49.46 $49.46 $48.82 $732.00 $49.46 $732.00 $732.00 $732.00 $732.00 $152.56 $79.14 $79.71 $732.00 $49.46 $49.82 $49.46 $732.00 $549.00 $49.46 $49.46 $49.46 $732.00 $366.00 $579.74 $49.46 $585.60 $732.00 $732.00 $49.46 $424.56 $732.00 $50.47 $49.46 $732.00 $49.46 N/A N/A 45000018 EAP CPT® 11760 REPAIR OF NAIL BED BOTH IP/OP $752.00 $556.50 $111.49 $752.00 $752.00 $752.00 $752.00 $752.00 $112.40 $112.40 $115.04 $752.00 $112.40 $752.00 $752.00 $752.00 $752.00 $156.73 $179.84 $178.38 $752.00 $112.40 $111.49 $112.40 $752.00 $564.00 $112.40 $112.40 $112.40 $752.00 $376.00 $595.58 $112.40 $601.60 $752.00 $752.00 $112.40 $436.16 $752.00 $118.60 $112.40 $752.00 $112.40 N/A N/A 45000020 EAP CPT® 12001 LAC REPR SCLP NCK HND FT <2.6C BOTH IP/OP $751.00 $556.00 $44.84 $751.00 $751.00 $751.00 $751.00 $751.00 $45.44 $45.44 $44.84 $751.00 $45.44 $751.00 $751.00 $751.00 $751.00 $156.52 $72.70 $72.77 $751.00 $45.44 $45.48 $45.44 $751.00 $563.25 $45.44 $45.44 $45.44 $751.00 $375.50 $594.79 $45.44 $600.80 $751.00 $751.00 $45.44 $435.58 $751.00 $46.87 $45.44 $751.00 $45.44 N/A N/A 45000021 EAP CPT® 27550 "TREAT KNEE DISLOCATION,W/O ANESTHESIA" BOTH IP/OP $902.00 $667.50 $187.99 $902.00 $902.00 $902.00 $902.00 $902.00 $486.81 $486.81 $498.67 $902.00 $486.81 $902.00 $902.00 $902.00 $902.00 $187.99 $778.90 $782.10 $902.00 $486.81 $488.81 $486.81 $902.00 $676.50 $486.81 $486.81 $486.81 $902.00 $451.00 $714.38 $486.81 $721.60 $902.00 $902.00 $486.81 $523.16 $902.00 $503.15 $486.81 $902.00 $486.81 N/A N/A 45000022 EAP CPT® 12002 LAC REPR SCLP NCK HND FT 2.6-7 BOTH IP/OP $938.00 $694.50 $59.29 $938.00 $938.00 $938.00 $938.00 $938.00 $59.46 $59.46 $59.29 $938.00 $59.46 $938.00 $938.00 $938.00 $938.00 $195.49 $95.14 $95.04 $938.00 $59.46 $59.40 $59.46 $938.00 $703.50 $59.46 $59.46 $59.46 $938.00 $469.00 $742.90 $59.46 $750.40 $938.00 $938.00 $59.46 $544.04 $938.00 $62.38 $59.46 $938.00 $59.46 N/A N/A 45000023 EAP CPT® 12004 REP SC/NK/AX/GEN/TK 7.6-12.5CM BOTH IP/OP "$1,035.00" $766.00 $73.48 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $73.48 $73.48 $73.77 "$1,035.00" $73.48 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 $117.57 $117.84 "$1,035.00" $73.48 $73.65 $73.48 "$1,035.00" $776.25 $73.48 $73.48 $73.48 "$1,035.00" $517.50 $819.72 $73.48 $828.00 "$1,035.00" "$1,035.00" $73.48 $600.30 "$1,035.00" $77.52 $73.48 "$1,035.00" $73.48 N/A N/A 45000025 EAP CPT® 12005 REP SC/NK/AX/GEN/ 12.6-20.0 CM BOTH IP/OP $970.00 $718.00 $95.39 $970.00 $970.00 $970.00 $970.00 $970.00 $95.92 $95.92 $96.74 $970.00 $95.92 $970.00 $970.00 $970.00 $970.00 $202.16 $153.47 $152.62 $970.00 $95.92 $95.39 $95.92 $970.00 $727.50 $95.92 $95.92 $95.92 $970.00 $485.00 $768.24 $95.92 $776.00 $970.00 $970.00 $95.92 $562.60 $970.00 $100.96 $95.92 $970.00 $95.92 N/A N/A 45000027 EAP CPT® 12006 REP SC/NK/AX/GEN/ 20.1-30.0 CM BOTH IP/OP $465.00 $344.50 $96.91 $465.00 $465.00 $465.00 $465.00 $465.00 $117.79 $117.79 $118.13 $465.00 $117.79 $465.00 $465.00 $465.00 $465.00 $96.91 $188.46 $187.94 $465.00 $117.79 $117.46 $117.79 $465.00 $348.75 $117.79 $117.79 $117.79 $465.00 $232.50 $368.28 $117.79 $372.00 $465.00 $465.00 $117.79 $269.70 $465.00 $123.68 $117.79 $465.00 $117.79 N/A N/A 45000029 EAP CPT® 12007 REP SC/NK/AX/GEN/TK > 30.0 CM BOTH IP/OP $970.00 $718.00 $145.96 $970.00 $970.00 $970.00 $970.00 $970.00 $146.89 $146.89 $147.69 $970.00 $146.89 $970.00 $970.00 $970.00 $970.00 $202.16 $235.02 $233.54 $970.00 $146.89 $145.96 $146.89 $970.00 $727.50 $146.89 $146.89 $146.89 $970.00 $485.00 $768.24 $146.89 $776.00 $970.00 $970.00 $146.89 $562.60 $970.00 $152.52 $146.89 $970.00 $146.89 N/A N/A 45000030 EAP CPT® 12011 LAC REP.FAC/EAR/LID/NOSE<2.5CM BOTH IP/OP $778.00 $576.00 $55.66 $778.00 $778.00 $778.00 $778.00 $778.00 $55.69 $55.69 $56.15 $778.00 $55.69 $778.00 $778.00 $778.00 $778.00 $162.14 $89.10 $89.06 $778.00 $55.69 $55.66 $55.69 $778.00 $583.50 $55.69 $55.69 $55.69 $778.00 $389.00 $616.18 $55.69 $622.40 $778.00 $778.00 $55.69 $451.24 $778.00 $58.77 $55.69 $778.00 $55.69 N/A N/A 45000031 EAP CPT® 12013 LAC REPR FCE EAR EYE LP 2.6-5. BOTH IP/OP $954.00 $706.00 $58.71 $954.00 $954.00 $954.00 $954.00 $954.00 $58.71 $58.71 $58.88 $954.00 $58.71 $954.00 $954.00 $954.00 $954.00 $198.82 $93.94 $94.53 $954.00 $58.71 $59.08 $58.71 $954.00 $715.50 $58.71 $58.71 $58.71 $954.00 $477.00 $755.57 $58.71 $763.20 $954.00 $954.00 $58.71 $553.32 $954.00 $62.02 $58.71 $954.00 $58.71 N/A N/A 45000032 EAP CPT® 12014 LAC REPR FCE EAR EYE LP 5.1-7. BOTH IP/OP "$1,035.00" $766.00 $75.37 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $75.43 $75.43 $75.74 "$1,035.00" $75.43 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 $120.69 $120.59 "$1,035.00" $75.43 $75.37 $75.43 "$1,035.00" $776.25 $75.43 $75.43 $75.43 "$1,035.00" $517.50 $819.72 $75.43 $828.00 "$1,035.00" "$1,035.00" $75.43 $600.30 "$1,035.00" $79.33 $75.43 "$1,035.00" $75.43 N/A N/A 45000034 EAP CPT® 12015 LAC REP FCE EAR EYE LP 7.6-12. BOTH IP/OP "$1,035.00" $766.00 $95.06 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $95.23 $95.23 $95.70 "$1,035.00" $95.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 $152.37 $152.10 "$1,035.00" $95.23 $95.06 $95.23 "$1,035.00" $776.25 $95.23 $95.23 $95.23 "$1,035.00" $517.50 $819.72 $95.23 $828.00 "$1,035.00" "$1,035.00" $95.23 $600.30 "$1,035.00" $100.24 $95.23 "$1,035.00" $95.23 N/A N/A 45000035 EAP CPT® 27510 "TREATMENT OF THIGH FRACTURE,W MANIPULATION" BOTH IP/OP "$1,589.00" "$1,176.00" $331.17 "$1,589.00" "$1,589.00" "$1,589.00" "$1,589.00" "$1,589.00" $692.54 $692.54 $695.38 "$1,589.00" $692.54 "$1,589.00" "$1,589.00" "$1,589.00" "$1,589.00" $331.17 "$1,108.06" "$1,116.59" "$1,589.00" $692.54 $697.87 $692.54 "$1,589.00" "$1,191.75" $692.54 $692.54 $692.54 "$1,589.00" $794.50 "$1,258.49" $692.54 "$1,271.20" "$1,589.00" "$1,589.00" $692.54 $921.62 "$1,589.00" $707.95 $692.54 "$1,589.00" $692.54 N/A N/A 45000036 EAP CPT® 12016 LAC REP FCE EAR EYE LP12.6-20. BOTH IP/OP "$1,035.00" $766.00 $129.01 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $130.08 $130.08 $130.15 "$1,035.00" $130.08 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 $208.13 $206.42 "$1,035.00" $130.08 $129.01 $130.08 "$1,035.00" $776.25 $130.08 $130.08 $130.08 "$1,035.00" $517.50 $819.72 $130.08 $828.00 "$1,035.00" "$1,035.00" $130.08 $600.30 "$1,035.00" $135.94 $130.08 "$1,035.00" $130.08 N/A N/A 45000038 EAP CPT® 12017 RP SI FA EAR NOS LIP 20.1-30.0 BOTH IP/OP "$1,686.00" "$1,248.00" $153.83 "$1,686.00" "$1,686.00" "$1,686.00" "$1,686.00" "$1,686.00" $153.83 $153.83 $154.48 "$1,686.00" $153.83 "$1,686.00" "$1,686.00" "$1,686.00" "$1,686.00" $351.38 $246.13 $248.27 "$1,686.00" $153.83 $155.17 $153.83 "$1,686.00" "$1,264.50" $153.83 $153.83 $153.83 "$1,686.00" $843.00 "$1,335.31" $153.83 "$1,348.80" "$1,686.00" "$1,686.00" $153.83 $977.88 "$1,686.00" $161.54 $153.83 "$1,686.00" $153.83 N/A N/A 45000041 EAP CPT® 12031 INT REP SCLP TRNK EXTRM <2.5CM BOTH IP/OP "$1,035.00" $766.00 $113.00 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $340.00 $340.00 $338.49 $215.72 $340.00 "$1,035.00" "$1,035.00" "$1,035.00" $882.37 $215.71 $543.99 $538.21 $113.00 $340.00 $152.81 $340.00 $357.00 $776.25 $340.00 $340.00 $340.00 "$1,035.00" $517.50 $819.72 $340.00 $828.00 "$1,035.00" $205.42 $340.00 $600.30 $357.00 $491.89 $340.00 $215.69 $340.00 N/A N/A 45000042 EAP CPT® 12032 INT REP SCLP TRK EXT 2.6-7.5CM BOTH IP/OP "$1,035.00" $766.00 $113.00 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $340.00 $340.00 $338.49 $215.72 $340.00 "$1,035.00" "$1,035.00" "$1,035.00" $882.37 $215.71 $543.99 $538.21 $113.00 $340.00 $191.09 $340.00 $357.00 $776.25 $340.00 $340.00 $340.00 "$1,035.00" $517.50 $819.72 $340.00 $828.00 "$1,035.00" $205.42 $340.00 $600.30 $357.00 $491.89 $340.00 $215.69 $340.00 N/A N/A 45000043 EAP CPT® 12034 INT REP SCLP TRK EXT7.6-12.5CM BOTH IP/OP $496.00 $367.50 $103.37 $496.00 $496.00 $496.00 $496.00 $496.00 $206.13 $206.13 $207.11 $496.00 $206.13 $496.00 $496.00 $496.00 $496.00 $103.37 $329.81 $330.78 $496.00 $206.13 $206.74 $206.13 $496.00 $372.00 $206.13 $206.13 $206.13 $496.00 $248.00 $392.83 $206.13 $396.80 $496.00 $496.00 $340.00 $287.68 $496.00 $213.05 $206.13 $496.00 $206.13 N/A N/A 45000044 EAP CPT® 12035 INT REP SCLP TRK EXTRM12.6-20. BOTH IP/OP $970.00 $718.00 $202.16 $970.00 $970.00 $970.00 $970.00 $970.00 $243.03 $243.03 $244.00 $970.00 $243.03 $970.00 $970.00 $970.00 $970.00 $202.16 $388.85 $389.52 $970.00 $243.03 $243.45 $243.03 $970.00 $727.50 $243.03 $243.03 $243.03 $970.00 $485.00 $768.24 $243.03 $776.00 $970.00 $970.00 $243.03 $562.60 $970.00 $250.17 $243.03 $970.00 $243.03 N/A N/A 45000045 EAP CPT® 28455 TREATMENT OF TARSAL BONE FRACTURE BOTH IP/OP "$6,532.00" "$4,834.00" $263.32 "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" $265.24 $265.24 $263.32 "$6,532.00" $265.24 "$6,532.00" "$6,532.00" "$6,532.00" "$6,532.00" "$1,361.34" $424.38 $429.28 "$6,532.00" $265.24 $268.30 $265.24 "$6,532.00" "$4,899.00" $265.24 $265.24 $265.24 "$2,762.00" "$3,266.00" "$5,173.34" $265.24 "$5,225.60" "$1,750.00" "$6,532.00" $265.24 "$3,788.56" "$6,532.00" $266.74 $265.24 "$6,532.00" $265.24 N/A N/A 45000046 EAP CPT® 12036 INT REP S/TR/EXT/20.1-30.0CM BOTH IP/OP $894.00 $662.00 $186.32 $894.00 $894.00 $894.00 $894.00 $894.00 $286.13 $286.13 $286.23 $894.00 $286.13 $894.00 $894.00 $894.00 $894.00 $186.32 $457.81 $454.74 $894.00 $286.13 $284.21 $286.13 $894.00 $670.50 $286.13 $286.13 $286.13 $894.00 $447.00 $708.05 $286.13 $715.20 $894.00 $894.00 $286.13 $518.52 $894.00 $293.79 $286.13 $894.00 $286.13 N/A N/A 45000047 EAP CPT® 56440 MARSUPIALIZATION OF BARTHOLIN CYST BOTH IP/OP "$7,879.00" "$5,830.50" $184.12 "$6,303.20" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,580.85" "$2,580.85" "$2,569.43" "$1,642.18" "$2,580.85" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,642.07" "$4,129.35" "$4,079.03" "$2,836.00" "$2,580.85" $184.12 "$2,580.85" "$2,709.89" "$5,909.25" "$2,580.85" "$2,580.85" "$2,580.85" "$2,851.00" "$2,423.00" "$6,240.17" "$2,580.85" "$6,303.20" "$3,250.00" "$1,563.78" "$2,580.85" "$4,569.82" "$2,709.89" "$3,733.83" "$2,580.85" "$1,641.98" "$2,580.85" N/A N/A 45000048 EAP CPT® 12037 INTMD WND REPAIR S/TR/EXT BOTH IP/OP "$1,882.00" "$1,393.00" $330.36 "$1,882.00" "$1,882.00" "$1,882.00" "$1,882.00" "$1,882.00" $331.28 $331.28 $332.35 "$1,882.00" $331.28 "$1,882.00" "$1,882.00" "$1,882.00" "$1,882.00" $392.23 $530.05 $528.58 "$1,882.00" $331.28 $330.36 $331.28 "$1,882.00" "$1,411.50" $331.28 $331.28 $331.28 "$1,882.00" $941.00 "$1,490.54" $331.28 "$1,505.60" "$1,882.00" "$1,882.00" $331.28 "$1,091.56" "$1,882.00" $343.53 $331.28 "$1,882.00" $331.28 N/A N/A 45000049 EAP CPT® 12041 INT REPR N-HF/GENIT <2.6CM BOTH IP/OP "$1,035.00" $766.00 $113.00 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $340.00 $340.00 $338.49 $215.72 $340.00 "$1,035.00" "$1,035.00" "$1,035.00" $882.37 $215.71 $543.99 $538.21 $113.00 $340.00 $146.06 $340.00 $357.00 $776.25 $340.00 $340.00 $340.00 "$1,035.00" $517.50 $819.72 $340.00 $828.00 "$1,035.00" $205.42 $340.00 $600.30 $357.00 $491.89 $340.00 $215.69 $340.00 N/A N/A 45000051 EAP CPT® 12042 INT REPR NCK HND FT 2.6-7.5 CM BOTH IP/OP $615.00 $455.50 $113.00 $615.00 $615.00 $615.00 $615.00 $615.00 $340.00 $340.00 $338.49 $128.18 $340.00 $615.00 $615.00 $615.00 $615.00 $128.17 $543.99 $538.21 $113.00 $340.00 $196.53 $340.00 $357.00 $461.25 $340.00 $340.00 $340.00 $615.00 $307.50 $487.08 $340.00 $492.00 $615.00 $122.06 $340.00 $356.70 $357.00 $491.89 $340.00 $128.17 $340.00 N/A N/A 45000052 EAP CPT® 12044 INT REPR NCK HND FT 7.6-12.5CM BOTH IP/OP "$1,012.00" $749.00 $210.91 "$1,012.00" "$1,012.00" "$1,012.00" "$1,012.00" "$1,012.00" $214.33 $214.33 $215.00 "$1,012.00" $214.33 "$1,012.00" "$1,012.00" "$1,012.00" "$1,012.00" $210.91 $342.93 $344.38 "$1,012.00" $214.33 $215.24 $214.33 "$1,012.00" $759.00 $214.33 $214.33 $214.33 "$1,012.00" $506.00 $801.50 $214.33 $809.60 "$1,012.00" "$1,012.00" $214.33 $586.96 "$1,012.00" $222.06 $214.33 "$1,012.00" $214.33 N/A N/A 45000053 EAP CPT® 12045 INT REP NCK HND FT 12.6-20.0CM BOTH IP/OP "$2,196.00" "$1,625.50" $272.22 "$2,196.00" "$2,196.00" "$2,196.00" "$2,196.00" "$2,196.00" $273.75 $273.75 $272.22 "$2,196.00" $273.75 "$2,196.00" "$2,196.00" "$2,196.00" "$2,196.00" $457.67 $438.00 $444.22 "$2,196.00" $273.75 $277.64 $273.75 "$2,196.00" "$1,647.00" $273.75 $273.75 $273.75 "$2,196.00" "$1,098.00" "$1,739.23" $273.75 "$1,756.80" "$1,750.00" "$2,196.00" $273.75 "$1,273.68" "$2,196.00" $279.72 $273.75 "$2,196.00" $273.75 N/A N/A 45000054 EAP CPT® 12046 INT REP NCK HND FT 20.1-30.0CM BOTH IP/OP "$1,314.00" $972.50 $273.85 "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" $323.47 $323.47 $321.79 "$1,314.00" $323.47 "$1,314.00" "$1,314.00" "$1,314.00" "$1,314.00" $273.85 $517.55 $515.04 "$1,314.00" $323.47 $321.90 $323.47 "$1,314.00" $985.50 $323.47 $323.47 $323.47 "$1,314.00" $657.00 "$1,040.69" $323.47 "$1,051.20" "$1,314.00" "$1,314.00" $323.47 $762.12 "$1,314.00" $327.27 $323.47 "$1,314.00" $323.47 N/A N/A 45000055 EAP CPT® 12051 INT REPR FCE EAR EYE LP<2.5CM BOTH IP/OP "$1,035.00" $766.00 $169.83 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $169.83 $169.83 $169.88 "$1,035.00" $169.83 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 $271.73 $273.26 "$1,035.00" $169.83 $170.79 $169.83 "$1,035.00" $776.25 $169.83 $169.83 $169.83 "$1,035.00" $517.50 $819.72 $169.83 $828.00 "$1,035.00" "$1,035.00" $169.83 $600.30 "$1,035.00" $174.83 $169.83 "$1,035.00" $169.83 N/A N/A 45000056 EAP CPT® 12052 INT REPR F/E/L/MM 2.6-5.0CM BOTH IP/OP "$1,035.00" $766.00 $199.75 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $199.75 $199.75 $200.71 "$1,035.00" $199.75 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 $319.60 $321.54 "$1,035.00" $199.75 $200.96 $199.75 "$1,035.00" $776.25 $199.75 $199.75 $199.75 "$1,035.00" $517.50 $819.72 $199.75 $828.00 "$1,035.00" "$1,035.00" $199.75 $600.30 "$1,035.00" $206.92 $199.75 "$1,035.00" $199.75 N/A N/A 45000057 EAP CPT® 12053 INT WND REPR FACE/MM 5.1-7.5CM BOTH IP/OP "$1,718.00" "$1,271.50" $113.00 "$1,718.00" "$1,718.00" "$1,718.00" "$1,718.00" "$1,718.00" $340.00 $340.00 $338.49 $358.07 $340.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $358.05 $543.99 $538.21 $113.00 $340.00 $216.91 $340.00 $357.00 "$1,288.50" $340.00 $340.00 $340.00 "$1,718.00" $859.00 "$1,360.66" $340.00 "$1,374.40" "$1,718.00" $340.98 $340.00 $996.44 $357.00 $491.89 $340.00 $358.03 $340.00 N/A N/A 45000058 EAP CPT® 12054 INT REP FCE EAR LP 7.6-12.5 CM BOTH IP/OP "$1,035.00" $766.00 $215.71 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $219.80 $219.80 $219.95 "$1,035.00" $219.80 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 $351.68 $354.80 "$1,035.00" $219.80 $221.75 $219.80 "$1,035.00" $776.25 $219.80 $219.80 $219.80 "$1,035.00" $517.50 $819.72 $219.80 $828.00 "$1,035.00" "$1,035.00" $219.80 $600.30 "$1,035.00" $228.92 $219.80 "$1,035.00" $219.80 N/A N/A 45000059 EAP CPT® 12055 REP INT FCE EAR LP 12.6-20.0CM BOTH IP/OP "$1,035.00" $766.00 $215.71 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $300.63 $300.63 $301.38 "$1,035.00" $300.63 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 $481.01 $485.04 "$1,035.00" $300.63 $303.15 $300.63 "$1,035.00" $776.25 $300.63 $300.63 $300.63 "$1,035.00" $517.50 $819.72 $300.63 $828.00 "$1,035.00" "$1,035.00" $300.63 $600.30 "$1,035.00" $312.18 $300.63 "$1,035.00" $300.63 N/A N/A 45000060 EAP CPT® 16000 INIT TRMNT BURN 1ST DEGREE BOTH IP/OP "$1,690.00" "$1,251.00" $45.26 "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" $45.26 $45.26 $45.60 "$1,690.00" $45.26 "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" $352.21 $72.42 $73.82 "$1,690.00" $45.26 $46.14 $45.26 "$1,690.00" "$1,267.50" $45.26 $45.26 $45.26 "$1,690.00" $845.00 "$1,338.48" $45.26 "$1,352.00" "$1,690.00" "$1,690.00" $176.64 $980.20 "$1,690.00" $47.96 $45.26 "$1,690.00" $45.26 N/A N/A 45000063 EAP CPT® 19020 INCISION OF BREAST LESION BOTH IP/OP "$7,031.00" "$5,203.00" $317.47 "$7,031.00" "$7,031.00" "$7,031.00" "$7,031.00" "$7,031.00" $318.91 $318.91 $317.47 "$7,031.00" $318.91 "$7,031.00" "$7,031.00" "$7,031.00" "$7,031.00" "$1,465.34" $510.26 $511.01 "$7,031.00" $318.91 $319.38 $318.91 "$7,031.00" "$5,273.25" $318.91 $318.91 $318.91 "$2,851.00" "$3,515.50" "$5,568.55" $318.91 "$5,624.80" "$3,250.00" "$7,031.00" $318.91 "$4,077.98" "$7,031.00" $321.85 $318.91 "$7,031.00" $318.91 N/A N/A 45000067 EAP CPT® 24565 TREAT HUMERUS FRACTURE BOTH IP/OP "$1,500.00" "$1,110.00" $312.62 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $508.75 $508.75 $506.79 "$1,500.00" $508.75 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 $814.00 $819.94 "$1,500.00" $508.75 $512.46 $508.75 "$1,500.00" "$1,125.00" $508.75 $508.75 $508.75 "$1,500.00" $750.00 "$1,188.00" $508.75 "$1,200.00" "$1,500.00" "$1,500.00" $508.75 $870.00 "$1,500.00" $509.98 $508.75 "$1,500.00" $508.75 N/A N/A 45000069 EAP CPT® 25535 CLSD FRACTURE ULNA W MANIP BOTH IP/OP $662.00 $490.00 $137.97 $758.59 $662.00 $662.00 $662.00 $662.00 $471.18 $471.18 $470.24 $662.00 $471.18 $662.00 $662.00 $662.00 $662.00 $137.97 $753.89 $758.59 $662.00 $471.18 $474.12 $471.18 $662.00 $496.50 $471.18 $471.18 $471.18 $662.00 $331.00 $524.30 $471.18 $529.60 $662.00 $662.00 $471.18 $383.96 $662.00 $469.98 $471.18 $662.00 $471.18 N/A N/A 45000070 EAP CPT® 25600 TREAT FRACTURE RADIUS/ULNA BOTH IP/OP "$1,250.00" $925.00 $260.51 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $335.14 $335.14 $330.70 "$1,250.00" $335.14 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 $536.22 $541.39 "$1,250.00" $335.14 $338.37 $335.14 "$1,250.00" $937.50 $335.14 $335.14 $335.14 "$1,250.00" $625.00 $990.00 $335.14 "$1,000.00" "$1,250.00" "$1,250.00" $335.14 $725.00 "$1,250.00" $326.48 $335.14 "$1,250.00" $335.14 N/A N/A 45000072 EAP CPT® 27760 CLSD TX MEDIAL MALLEOLUS FX BOTH IP/OP $680.00 $503.50 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $317.49 $317.49 $315.63 $680.00 $317.49 $680.00 $680.00 $680.00 $680.00 $141.72 $507.98 $510.06 $680.00 $317.49 $318.79 $317.49 $680.00 $510.00 $317.49 $317.49 $317.49 $680.00 $340.00 $538.56 $317.49 $544.00 $680.00 $680.00 $317.49 $394.40 $680.00 $317.50 $317.49 $680.00 $317.49 N/A N/A 45000073 EAP CPT® 27780 CLSD FRACTURE FIBULA W/O MANIP BOTH IP/OP "$1,057.00" $782.50 $220.29 "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" $295.05 $295.05 $292.37 "$1,057.00" $295.05 "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" $220.29 $472.08 $475.39 "$1,057.00" $295.05 $297.12 $295.05 "$1,057.00" $792.75 $295.05 $295.05 $295.05 "$1,057.00" $528.50 $837.14 $295.05 $845.60 "$1,057.00" "$1,057.00" $295.05 $613.06 "$1,057.00" $291.19 $295.05 "$1,057.00" $295.05 N/A N/A 45000075 EAP CPT® 27786 CLSD TX DISTAL FIBULAR FX BOTH IP/OP "$1,204.00" $891.00 $250.93 "$1,204.00" "$1,204.00" "$1,204.00" "$1,204.00" "$1,204.00" $298.17 $298.17 $296.21 "$1,204.00" $298.17 "$1,204.00" "$1,204.00" "$1,204.00" "$1,204.00" $250.93 $477.07 $478.66 "$1,204.00" $298.17 $299.16 $298.17 "$1,204.00" $903.00 $298.17 $298.17 $298.17 "$1,204.00" $602.00 $953.57 $298.17 $963.20 "$1,204.00" "$1,204.00" $298.17 $698.32 "$1,204.00" $297.32 $298.17 "$1,204.00" $298.17 N/A N/A 45000077 EAP CPT® 28400 CLSD TX CALCANEAL FX W/O MANIP BOTH IP/OP $811.00 $600.50 $169.02 $811.00 $811.00 $811.00 $811.00 $811.00 $235.53 $235.53 $233.41 $811.00 $235.53 $811.00 $811.00 $811.00 $811.00 $169.02 $376.85 $379.92 $811.00 $235.53 $237.45 $235.53 $811.00 $608.25 $235.53 $235.53 $235.53 $811.00 $405.50 $642.31 $235.53 $648.80 $811.00 $811.00 $235.53 $470.38 $811.00 $236.05 $235.53 $811.00 $235.53 N/A N/A 45000078 EAP CPT® 28430 TREATMENT OF ANKLE FRACTURE BOTH IP/OP $820.00 $607.00 $170.90 $820.00 $820.00 $820.00 $820.00 $820.00 $216.60 $216.60 $215.64 $820.00 $216.60 $820.00 $820.00 $820.00 $820.00 $170.90 $346.56 $348.51 $820.00 $216.60 $217.82 $216.60 $820.00 $615.00 $216.60 $216.60 $216.60 $820.00 $410.00 $649.44 $216.60 $656.00 $820.00 $820.00 $216.60 $475.60 $820.00 $217.32 $216.60 $820.00 $216.60 N/A N/A 45000079 EAP CPT® 28515 CLSD FRACTURE TOE W MANIP BOTH IP/OP $547.00 $405.00 $114.00 $547.00 $547.00 $547.00 $547.00 $547.00 $145.27 $145.27 $143.75 $547.00 $145.27 $547.00 $547.00 $547.00 $547.00 $114.00 $232.43 $235.18 $547.00 $145.27 $146.99 $145.27 $547.00 $410.25 $145.27 $145.27 $145.27 $547.00 $273.50 $433.22 $145.27 $437.60 $547.00 $547.00 $145.27 $317.26 $547.00 $147.05 $145.27 $547.00 $145.27 N/A N/A 45000080 EAP CPT® 28540 TREAT FOOT DISLOCATION BOTH IP/OP $398.00 $295.00 $82.95 $398.00 $398.00 $398.00 $398.00 $398.00 $178.44 $178.44 $176.85 $398.00 $178.44 $398.00 $398.00 $398.00 $398.00 $82.95 $285.50 $286.66 $398.00 $178.44 $179.16 $178.44 $398.00 $298.50 $178.44 $178.44 $178.44 $398.00 $199.00 $315.22 $178.44 $318.40 $398.00 $398.00 $178.44 $230.84 $398.00 $180.59 $178.44 $398.00 $178.44 N/A N/A 45000081 EAP CPT® 28630 CLOSED TX METATARSOPHAL JT DIS BOTH IP/OP $547.00 $405.00 $111.78 $547.00 $547.00 $547.00 $547.00 $547.00 $111.90 $111.90 $111.78 $547.00 $111.90 $547.00 $547.00 $547.00 $547.00 $114.00 $179.04 $180.10 $547.00 $111.90 $112.56 $111.90 $547.00 $410.25 $111.90 $111.90 $111.90 $547.00 $273.50 $433.22 $111.90 $437.60 $547.00 $547.00 $111.90 $317.26 $547.00 $115.36 $111.90 $547.00 $111.90 N/A N/A 45000083 EAP CPT® 29240 STRAPPING OF SHOULDER BOTH IP/OP $727.00 $538.00 $18.30 $727.00 $727.00 $727.00 $727.00 $727.00 $18.61 $18.61 $18.77 $727.00 $18.61 $727.00 $727.00 $727.00 $727.00 $151.51 $29.78 $29.28 $727.00 $18.61 $18.30 $18.61 $727.00 $545.25 $18.61 $18.61 $18.61 $727.00 $363.50 $575.78 $18.61 $581.60 $472.55 $727.00 $18.61 $421.66 $727.00 $19.48 $18.61 $727.00 $18.61 N/A N/A 45000084 EAP CPT® 29240 APPLY SHOULDER IMMOBILIZER BOTH IP/OP $727.00 $538.00 $18.30 $727.00 $727.00 $727.00 $727.00 $727.00 $18.61 $18.61 $18.77 $727.00 $18.61 $727.00 $727.00 $727.00 $727.00 $151.51 $29.78 $29.28 $727.00 $18.61 $18.30 $18.61 $727.00 $545.25 $18.61 $18.61 $18.61 $727.00 $363.50 $575.78 $18.61 $581.60 $472.55 $727.00 $18.61 $421.66 $727.00 $19.48 $18.61 $727.00 $18.61 N/A N/A 45000088 EAP CPT® 41250 REPAIR TONGUE LACERATION BOTH IP/OP $794.00 $588.00 $155.04 $794.00 $794.00 $794.00 $794.00 $794.00 $155.04 $155.04 $156.71 $794.00 $155.04 $794.00 $794.00 $794.00 $794.00 $165.48 $248.06 $250.03 $794.00 $155.04 $156.27 $155.04 $794.00 $595.50 $155.04 $155.04 $155.04 $794.00 $397.00 $628.85 $155.04 $635.20 $794.00 $794.00 $155.04 $460.52 $794.00 $159.67 $155.04 $794.00 $155.04 N/A N/A 45000089 EAP CPT® 41800 DRAINAGE OF GUM LESION BOTH IP/OP $634.00 $469.50 $110.92 $634.00 $634.00 $634.00 $634.00 $634.00 $156.24 $156.24 $160.32 $634.00 $156.24 $634.00 $634.00 $634.00 $634.00 $132.13 $249.98 $250.35 $634.00 $156.24 $156.47 $156.24 $634.00 $475.50 $156.24 $156.24 $156.24 $634.00 $317.00 $502.13 $156.24 $507.20 $634.00 $634.00 $110.92 $367.72 $634.00 $157.47 $156.24 $634.00 $156.24 N/A N/A 45000090 EAP CPT® 42700 I&D PERITONSILLAR ABSCESS BOTH IP/OP $436.00 $323.00 $90.87 $436.00 $436.00 $436.00 $436.00 $436.00 $137.45 $137.45 $136.50 $436.00 $137.45 $436.00 $436.00 $436.00 $436.00 $90.87 $219.92 $221.74 $436.00 $137.45 $138.59 $137.45 $436.00 $327.00 $137.45 $137.45 $137.45 $436.00 $218.00 $345.31 $137.45 $348.80 $436.00 $436.00 $137.45 $252.88 $436.00 $139.13 $137.45 $436.00 $137.45 N/A N/A 45000093 EAP CPT® 46050 I & D PERIANAL ABCESS BOTH IP/OP "$4,031.00" "$2,983.00" $102.00 "$4,031.00" "$4,031.00" "$4,031.00" "$4,031.00" "$4,031.00" $102.23 $102.23 $102.00 "$4,031.00" $102.23 "$4,031.00" "$4,031.00" "$4,031.00" "$4,031.00" $840.10 $163.57 $164.88 "$4,031.00" $102.23 $103.05 $102.23 "$4,031.00" "$3,023.25" $102.23 $102.23 $102.23 "$2,762.00" "$2,015.50" "$3,192.55" $102.23 "$3,224.80" "$2,150.00" "$4,031.00" $102.23 "$2,337.98" "$4,031.00" $102.72 $102.23 "$4,031.00" $102.23 N/A N/A 45000094 EAP CPT® 56420 I & D BARTHOLIN ABSCESS BOTH IP/OP $665.00 $492.50 $113.55 $665.00 $665.00 $665.00 $665.00 $665.00 $167.58 $167.58 $166.84 $138.60 $167.58 $665.00 $665.00 $665.00 $665.00 $138.59 $268.13 $256.98 $665.00 $167.58 $113.55 $167.58 $175.96 $498.75 $167.58 $167.58 $167.58 $665.00 $332.50 $526.68 $167.58 $532.00 $665.00 $131.99 $167.58 $385.70 $175.96 $242.45 $167.58 $138.59 $167.58 N/A N/A 45000096 EAP CPT® 69000 DRAIN EXTERNAL EAR LESION BOTH IP/OP $694.00 $514.00 $123.70 $694.00 $694.00 $694.00 $694.00 $694.00 $126.11 $126.11 $123.70 $694.00 $126.11 $694.00 $694.00 $694.00 $694.00 $144.64 $201.78 $203.30 $694.00 $126.11 $127.06 $126.11 $694.00 $520.50 $126.11 $126.11 $126.11 $694.00 $347.00 $549.65 $126.11 $555.20 $694.00 $694.00 $126.11 $402.52 $694.00 $125.07 $126.11 $694.00 $126.11 N/A N/A 45000112 EAP CPT® 12056 REP INT FCE EAR LP 20.1-30.0CM BOTH IP/OP "$1,559.00" "$1,154.00" $324.91 "$1,559.00" "$1,559.00" "$1,559.00" "$1,559.00" "$1,559.00" $388.20 $388.20 $389.75 "$1,559.00" $388.20 "$1,559.00" "$1,559.00" "$1,559.00" "$1,559.00" $324.91 $621.12 $622.16 "$1,559.00" $388.20 $388.85 $388.20 "$1,559.00" "$1,169.25" $388.20 $388.20 $388.20 "$1,559.00" $779.50 "$1,234.73" $388.20 "$1,247.20" "$1,559.00" "$1,559.00" $388.20 $904.22 "$1,559.00" $400.11 $388.20 "$1,559.00" $388.20 N/A N/A 45000113 EAP CPT® 13120 CMPLX RPR SCLP ARM LGS 1.1-2.5 BOTH IP/OP "$1,427.00" "$1,056.00" $233.48 "$1,427.00" "$1,427.00" "$1,427.00" "$1,427.00" "$1,427.00" $234.50 $234.50 $236.51 "$1,427.00" $234.50 "$1,427.00" "$1,427.00" "$1,427.00" "$1,427.00" $297.40 $375.20 $373.57 "$1,427.00" $234.50 $233.48 $234.50 "$1,427.00" "$1,070.25" $234.50 $234.50 $234.50 "$1,427.00" $713.50 "$1,130.18" $234.50 "$1,141.60" "$1,427.00" "$1,427.00" $234.50 $827.66 "$1,427.00" $240.80 $234.50 "$1,427.00" $234.50 N/A N/A 45000114 EAP CPT® 13121 REPR COMP SCALP ARMS LGS 2.5-7 BOTH IP/OP "$1,539.00" "$1,139.00" $257.94 "$1,539.00" "$1,539.00" "$1,539.00" "$1,539.00" "$1,539.00" $257.94 $257.94 $260.39 "$1,539.00" $257.94 "$1,539.00" "$1,539.00" "$1,539.00" "$1,539.00" $320.74 $412.70 $413.18 "$1,539.00" $257.94 $258.24 $257.94 "$1,539.00" "$1,154.25" $257.94 $257.94 $257.94 "$1,539.00" $769.50 "$1,218.89" $257.94 "$1,231.20" "$1,539.00" "$1,539.00" $257.94 $892.62 "$1,539.00" $270.39 $257.94 "$1,539.00" $257.94 N/A N/A 45000115 EAP CPT® 13122 CMPLX RPR SCLP ARM LGS EA ADD BOTH IP/OP "$1,378.00" "$1,020.00" $82.68 "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" $82.68 $82.68 $83.72 "$1,378.00" $82.68 "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" $287.19 $132.29 $132.94 "$1,378.00" $82.68 $83.09 $82.68 "$1,378.00" "$1,033.50" $82.68 $82.68 $82.68 "$1,378.00" $689.00 "$1,091.38" $82.68 "$1,102.40" "$1,378.00" "$1,378.00" $82.68 $799.24 "$1,378.00" $87.25 $82.68 "$1,378.00" $82.68 N/A N/A 45000116 EAP CPT® 13131 "REPR COMPLEX MOUTH NECK HDS,FT" BOTH IP/OP "$1,427.00" "$1,056.00" $242.67 "$1,427.00" "$1,427.00" "$1,427.00" "$1,427.00" "$1,427.00" $340.00 $340.00 $338.49 $297.42 $340.00 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $297.40 $543.99 $538.21 "$1,427.00" $340.00 $242.67 $340.00 $357.00 "$1,070.25" $340.00 $340.00 $340.00 "$1,427.00" $713.50 "$1,130.18" $340.00 "$1,141.60" "$1,427.00" $283.22 $340.00 $827.66 $357.00 $491.89 $340.00 $297.39 $340.00 N/A N/A 45000117 EAP CPT® 13132 "REPR COMP MOUTH,NECK,HDS,FT2.6" BOTH IP/OP "$1,427.00" "$1,056.00" $297.40 "$1,427.00" "$1,427.00" "$1,427.00" "$1,427.00" "$1,427.00" $303.60 $303.60 $304.82 "$1,427.00" $303.60 "$1,427.00" "$1,427.00" "$1,427.00" "$1,427.00" $297.40 $485.76 $486.43 "$1,427.00" $303.60 $304.02 $303.60 "$1,427.00" "$1,070.25" $303.60 $303.60 $303.60 "$1,427.00" $713.50 "$1,130.18" $303.60 "$1,141.60" "$1,427.00" "$1,427.00" $303.60 $827.66 "$1,427.00" $317.62 $303.60 "$1,427.00" $303.60 N/A N/A 45000118 EAP CPT® 13133 REPAIR WOUND/LESION ADD-ON BOTH IP/OP "$1,336.00" $989.00 $125.11 "$1,336.00" "$1,336.00" "$1,336.00" "$1,336.00" "$1,336.00" $125.40 $125.40 $127.10 "$1,336.00" $125.40 "$1,336.00" "$1,336.00" "$1,336.00" "$1,336.00" $278.44 $200.64 $200.18 "$1,336.00" $125.40 $125.11 $125.40 "$1,336.00" "$1,002.00" $125.40 $125.40 $125.40 "$1,336.00" $668.00 "$1,058.11" $125.40 "$1,068.80" "$1,336.00" "$1,336.00" $125.40 $774.88 "$1,336.00" $133.04 $125.40 "$1,336.00" $125.40 N/A N/A 45000120 EAP CPT® 13151 CMPLX RPR EYE NOSE EAR 1.1-2.5 BOTH IP/OP "$2,495.00" "$1,846.50" $279.39 "$2,495.00" "$2,495.00" "$2,495.00" "$2,495.00" "$2,495.00" $279.39 $279.39 $281.05 "$2,495.00" $279.39 "$2,495.00" "$2,495.00" "$2,495.00" "$2,495.00" $519.99 $447.02 $447.41 "$2,495.00" $279.39 $279.63 $279.39 "$2,495.00" "$1,871.25" $279.39 $279.39 $279.39 "$2,495.00" "$1,247.50" "$1,976.04" $279.39 "$1,996.00" "$2,150.00" "$2,495.00" $279.39 "$1,447.10" "$2,495.00" $291.66 $279.39 "$2,495.00" $279.39 N/A N/A 45000121 EAP CPT® 13152 "REPR COMP EYEL, NOSE,EARS LIPS" BOTH IP/OP "$2,703.00" "$2,000.50" $336.50 "$2,703.00" "$2,703.00" "$2,703.00" "$2,703.00" "$2,703.00" $336.50 $336.50 $338.94 "$2,703.00" $336.50 "$2,703.00" "$2,703.00" "$2,703.00" "$2,703.00" $563.33 $538.40 $539.07 "$2,703.00" $336.50 $336.92 $336.50 "$2,703.00" "$2,027.25" $336.50 $336.50 $336.50 "$2,703.00" "$1,351.50" "$2,140.78" $336.50 "$2,162.40" "$2,150.00" "$2,703.00" $336.50 "$1,567.74" "$2,703.00" $351.15 $336.50 "$2,703.00" $336.50 N/A N/A 45000122 EAP CPT® 13153 CMPLX RPR EYE NOSE EAR ADD-ON BOTH IP/OP "$1,378.00" "$1,020.00" $137.21 "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" $137.21 $137.21 $138.34 "$1,378.00" $137.21 "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" $287.19 $219.54 $219.76 "$1,378.00" $137.21 $137.35 $137.21 "$1,378.00" "$1,033.50" $137.21 $137.21 $137.21 "$1,378.00" $689.00 "$1,091.38" $137.21 "$1,102.40" "$1,378.00" "$1,378.00" $137.21 $799.24 "$1,378.00" $144.94 $137.21 "$1,378.00" $137.21 N/A N/A 45000123 EAP CPT® 13160 SECOND CLOSR SURG WOUND; COMP BOTH IP/OP "$10,207.00" "$7,553.50" $805.28 "$10,207.00" "$10,207.00" "$10,207.00" "$10,207.00" "$10,207.00" $807.73 $807.73 $808.92 "$10,207.00" $807.73 "$10,207.00" "$10,207.00" "$10,207.00" "$10,207.00" "$2,127.25" "$1,292.37" "$1,288.45" "$10,207.00" $807.73 $805.28 $807.73 "$10,207.00" "$7,655.25" $807.73 $807.73 $807.73 "$2,851.00" "$5,103.50" "$8,083.94" $807.73 "$8,165.60" "$2,500.00" "$10,207.00" $807.73 "$5,920.06" "$10,207.00" $828.76 $807.73 "$10,207.00" $807.73 N/A N/A 45000125 EAP CPT® 26675 TREAT HAND DISLOCATION BOTH IP/OP "$3,905.00" "$2,890.00" $433.49 "$3,905.00" "$3,905.00" "$3,905.00" "$3,905.00" "$3,905.00" $435.36 $435.36 $433.49 "$3,905.00" $435.36 "$3,905.00" "$3,905.00" "$3,905.00" "$3,905.00" $813.84 $696.58 $701.12 "$3,905.00" $435.36 $438.20 $435.36 "$3,905.00" "$2,928.75" $435.36 $435.36 $435.36 "$2,851.00" "$1,952.50" "$3,092.76" $435.36 "$3,124.00" "$1,750.00" "$3,905.00" $435.36 "$2,264.90" "$3,905.00" $435.37 $435.36 "$3,905.00" $435.36 N/A N/A 45000128 EAP CPT® 20102 "EXPLORE WOUND, ABDOMEN" BOTH IP/OP "$4,018.00" "$2,973.50" $257.17 "$4,018.00" "$4,018.00" "$4,018.00" "$4,018.00" "$4,018.00" $260.04 $260.04 $259.20 "$4,018.00" $260.04 "$4,018.00" "$4,018.00" "$4,018.00" "$4,018.00" $837.40 $416.06 $411.47 "$4,018.00" $260.04 $257.17 $260.04 "$4,018.00" "$3,013.50" $260.04 $260.04 $260.04 "$2,762.00" "$2,009.00" "$3,182.26" $260.04 "$3,214.40" "$2,500.00" "$4,018.00" $260.04 "$2,330.44" "$4,018.00" $267.83 $260.04 "$4,018.00" $260.04 N/A N/A 45000129 EAP CPT® 20103 "EXPLORE WOUND, EXTREMITY" BOTH IP/OP "$3,502.00" "$2,591.50" $349.30 "$3,502.00" "$3,502.00" "$3,502.00" "$3,502.00" "$3,502.00" $349.43 $349.43 $350.68 "$3,502.00" $349.43 "$3,502.00" "$3,502.00" "$3,502.00" "$3,502.00" $729.86 $559.09 $558.88 "$3,502.00" $349.43 $349.30 $349.43 "$3,502.00" "$2,626.50" $349.43 $349.43 $349.43 "$2,762.00" "$1,751.00" "$2,773.58" $349.43 "$2,801.60" "$2,500.00" "$3,502.00" $349.43 "$2,031.16" "$3,502.00" $360.85 $349.43 "$3,502.00" $349.43 N/A N/A 45000134 EAP CPT® 20822 "REPLANTATION DIGIT, COMPLETE" BOTH IP/OP "$9,548.00" "$7,066.00" "$1,793.78" "$9,548.00" "$9,548.00" "$9,548.00" "$9,548.00" "$9,548.00" "$1,794.73" "$1,794.73" "$1,801.18" "$9,548.00" "$1,794.73" "$9,548.00" "$9,548.00" "$9,548.00" "$9,548.00" "$1,989.91" "$2,871.57" "$2,870.05" "$9,548.00" "$1,794.73" "$1,793.78" "$1,794.73" "$9,548.00" "$7,161.00" "$1,794.73" "$1,794.73" "$1,794.73" "$2,851.00" "$4,774.00" "$7,562.02" "$1,794.73" "$7,638.40" "$3,725.00" "$9,548.00" "$1,794.73" "$5,537.84" "$9,548.00" "$1,847.08" "$1,794.73" "$9,548.00" "$1,794.73" N/A N/A 45000135 EAP CPT® 21110 INTERDENTAL FIXATION BOTH IP/OP "$1,478.00" "$1,094.00" $308.03 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $746.66 $746.66 $741.11 "$1,478.00" $746.66 "$1,478.00" "$1,478.00" "$1,478.00" "$1,478.00" $308.03 "$1,194.66" "$1,166.22" "$1,478.00" $746.66 $728.89 $746.66 "$1,478.00" "$1,108.50" $746.66 $746.66 $746.66 "$1,478.00" $739.00 "$1,170.58" $746.66 "$1,182.40" "$1,478.00" "$1,478.00" $746.66 $857.24 "$1,478.00" $708.86 $746.66 "$1,478.00" $746.66 N/A N/A 45000138 EAP CPT® 21315 TREATMENT OF NOSE FRACTURE BOTH IP/OP "$4,285.00" "$3,171.00" $59.71 "$4,285.00" "$4,285.00" "$4,285.00" "$4,285.00" "$4,285.00" $59.71 $59.71 $155.95 "$4,285.00" $59.71 "$4,285.00" "$4,285.00" "$4,285.00" "$4,285.00" $893.04 $95.54 $97.66 "$4,285.00" $59.71 $61.04 $59.71 "$4,285.00" "$3,213.75" $59.71 $59.71 $59.71 "$2,851.00" "$2,142.50" "$3,393.72" $59.71 "$3,428.00" "$2,500.00" "$4,285.00" $59.71 "$2,485.30" "$4,285.00" $155.35 $59.71 "$4,285.00" $59.71 N/A N/A 45000140 EAP CPT® 21421 MAXILLARY FRACTURE BOTH IP/OP "$9,532.00" "$7,054.00" $552.34 "$9,532.00" "$9,532.00" "$9,532.00" "$9,532.00" "$9,532.00" $558.50 $558.50 $574.38 "$9,532.00" $558.50 "$9,532.00" "$9,532.00" "$9,532.00" "$9,532.00" "$1,986.57" $893.60 $883.74 "$9,532.00" $558.50 $552.34 $558.50 "$9,532.00" "$7,149.00" $558.50 $558.50 $558.50 "$4,417.00" "$4,766.00" "$7,549.34" $558.50 "$7,625.60" "$3,250.00" "$9,532.00" $558.50 "$5,528.56" "$9,532.00" $582.80 $558.50 "$9,532.00" $558.50 N/A N/A 45000141 EAP CPT® 21450 MANDIBULAR FX WO MANIP BOTH IP/OP $810.00 $599.50 $168.81 $810.00 $810.00 $810.00 $810.00 $810.00 $499.97 $499.97 $500.32 $810.00 $499.97 $810.00 $810.00 $810.00 $810.00 $168.81 $799.95 $783.18 $810.00 $499.97 $489.49 $499.97 $810.00 $607.50 $499.97 $499.97 $499.97 $810.00 $405.00 $641.52 $499.97 $648.00 $810.00 $810.00 $499.97 $469.80 $810.00 $482.88 $499.97 $810.00 $499.97 N/A N/A 45000142 EAP CPT® 21480 RESET DISLOCATED JAW BOTH IP/OP $254.00 $188.00 $31.11 $254.00 $254.00 $254.00 $254.00 $254.00 $31.11 $31.11 $32.00 $254.00 $31.11 $254.00 $254.00 $254.00 $254.00 $52.94 $49.78 $50.51 $254.00 $31.11 $31.57 $31.11 $254.00 $190.50 $31.11 $31.11 $31.11 $254.00 $127.00 $201.17 $31.11 $203.20 $254.00 $254.00 $31.11 $147.32 $254.00 $33.17 $31.11 $254.00 $31.11 N/A N/A 45000148 EAP CPT® 23500 CLAVICULAR FX WO MANIP BOTH IP/OP "$1,101.00" $815.00 $229.46 "$1,101.00" "$1,101.00" "$1,101.00" "$1,101.00" "$1,101.00" $234.67 $234.67 $233.10 "$1,101.00" $234.67 "$1,101.00" "$1,101.00" "$1,101.00" "$1,101.00" $229.46 $375.47 $382.16 "$1,101.00" $234.67 $238.85 $234.67 "$1,101.00" $825.75 $234.67 $234.67 $234.67 "$1,101.00" $550.50 $871.99 $234.67 $880.80 "$1,101.00" "$1,101.00" $234.67 $638.58 "$1,101.00" $232.44 $234.67 "$1,101.00" $234.67 N/A N/A 45000150 EAP CPT® 23540 CLSD TX ACROMIOCLAVICULAR DISLOCATION BOTH IP/OP $815.00 $603.50 $169.85 $815.00 $815.00 $815.00 $815.00 $815.00 $243.16 $243.16 $239.98 $815.00 $243.16 $815.00 $815.00 $815.00 $815.00 $169.85 $389.06 $395.71 $815.00 $243.16 $247.32 $243.16 $815.00 $611.25 $243.16 $243.16 $243.16 $815.00 $407.50 $645.48 $243.16 $652.00 $815.00 $815.00 $243.16 $472.70 $815.00 $239.29 $243.16 $815.00 $243.16 N/A N/A 45000154 EAP CPT® 23605 CLSD TXT PROXIMAL HUMERUS W/MANIPU BOTH IP/OP "$6,187.00" "$4,578.50" $439.61 "$6,187.00" "$6,187.00" "$6,187.00" "$6,187.00" "$6,187.00" $439.80 $439.80 $439.61 "$6,187.00" $439.80 "$6,187.00" "$6,187.00" "$6,187.00" "$6,187.00" "$1,289.44" $703.68 $708.77 "$6,187.00" $439.80 $442.98 $439.80 "$6,187.00" "$4,640.25" $439.80 $439.80 $439.80 "$2,851.00" "$3,093.50" "$4,900.10" $439.80 "$4,949.60" "$3,250.00" "$6,187.00" $439.80 "$3,588.46" "$6,187.00" $441.87 $439.80 "$6,187.00" $439.80 N/A N/A 45000156 EAP CPT® 23615 TREAT HUMERUS FRACTURE BOTH IP/OP "$36,769.00" "$27,209.50" $899.69 "$36,769.00" "$36,769.00" "$36,769.00" "$36,769.00" "$36,769.00" $899.69 $899.69 $901.84 "$36,769.00" $899.69 "$36,769.00" "$36,769.00" "$36,769.00" "$36,769.00" "$7,663.06" "$1,439.50" "$1,441.42" "$36,769.00" $899.69 $900.89 $899.69 "$36,769.00" "$27,576.75" $899.69 $899.69 $899.69 "$4,417.00" "$18,384.50" "$29,121.05" $899.69 "$29,415.20" "$4,334.00" "$36,769.00" $899.69 "$21,326.02" "$36,769.00" $919.16 $899.69 "$36,769.00" $899.69 N/A N/A 45000158 EAP CPT® 23650 SHOULDER DISLOCA W MANIP BOTH IP/OP "$1,131.00" $837.00 $235.71 "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" $304.90 $304.90 $300.91 "$1,131.00" $304.90 "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" $235.71 $487.84 $499.46 "$1,131.00" $304.90 $312.16 $304.90 "$1,131.00" $848.25 $304.90 $304.90 $304.90 "$1,131.00" $565.50 $895.75 $304.90 $904.80 "$1,131.00" "$1,131.00" $304.90 $655.98 "$1,131.00" $301.31 $304.90 "$1,131.00" $304.90 N/A N/A 45000160 EAP CPT® 23655 SHOULDER DISLOCA W HUMERAL BOTH IP/OP "$5,598.00" "$4,143.00" $418.64 "$5,598.00" "$5,598.00" "$5,598.00" "$5,598.00" "$5,598.00" $421.01 $421.01 $418.64 "$5,598.00" $421.01 "$5,598.00" "$5,598.00" "$5,598.00" "$5,598.00" "$1,166.68" $673.62 $674.02 "$5,598.00" $421.01 $421.26 $421.01 "$5,598.00" "$4,198.50" $421.01 $421.01 $421.01 "$2,762.00" "$2,799.00" "$4,433.62" $421.01 "$4,478.40" "$2,500.00" "$5,598.00" $421.01 "$3,246.84" "$5,598.00" $419.52 $421.01 "$5,598.00" $421.01 N/A N/A 45000162 EAP CPT® 23675 SHOULDER DISLOCA W NECK FX BOTH IP/OP "$1,594.00" "$1,180.00" $332.21 "$1,594.00" "$1,594.00" "$1,594.00" "$1,594.00" "$1,594.00" $514.42 $514.42 $512.23 "$1,594.00" $514.42 "$1,594.00" "$1,594.00" "$1,594.00" "$1,594.00" $332.21 $823.07 $825.97 "$1,594.00" $514.42 $516.23 $514.42 "$1,594.00" "$1,195.50" $514.42 $514.42 $514.42 "$1,594.00" $797.00 "$1,262.45" $514.42 "$1,275.20" "$1,594.00" "$1,594.00" $514.42 $924.52 "$1,594.00" $521.17 $514.42 "$1,594.00" $514.42 N/A N/A 45000163 EAP CPT® 24201 REMOVAL OF ARM FOREIGN BODY BOTH IP/OP "$9,773.00" "$7,232.50" $372.10 "$9,773.00" "$9,773.00" "$9,773.00" "$9,773.00" "$9,773.00" $374.15 $374.15 $372.10 "$9,773.00" $374.15 "$9,773.00" "$9,773.00" "$9,773.00" "$9,773.00" "$2,036.80" $598.64 $601.55 "$9,773.00" $374.15 $375.97 $374.15 "$9,773.00" "$7,329.75" $374.15 $374.15 $374.15 "$2,851.00" "$4,886.50" "$7,740.22" $374.15 "$7,818.40" "$2,500.00" "$9,773.00" $374.15 "$5,668.34" "$9,773.00" $376.65 $374.15 "$9,773.00" $374.15 N/A N/A 45000164 EAP CPT® 24341 REPAIR TENDON/MUSCLE UPPER ARM BOTH IP/OP "$17,367.00" "$12,852.00" $759.67 "$17,367.00" "$17,367.00" "$17,367.00" "$17,367.00" "$17,367.00" $759.67 $759.67 $761.57 "$17,367.00" $759.67 "$17,367.00" "$17,367.00" "$17,367.00" "$17,367.00" "$3,619.47" "$1,215.47" "$1,224.08" "$17,367.00" $759.67 $765.05 $759.67 "$17,367.00" "$13,025.25" $759.67 $759.67 $759.67 "$3,500.00" "$8,683.50" "$13,754.66" $759.67 "$13,893.60" "$4,334.00" "$17,367.00" $759.67 "$10,072.86" "$17,367.00" $773.85 $759.67 "$17,367.00" $759.67 N/A N/A 45000168 EAP CPT® 24505 CLSD TXT HUMERAL SHAFT W/MANIPULATION BOTH IP/OP "$1,594.00" "$1,180.00" $332.21 "$1,594.00" "$1,594.00" "$1,594.00" "$1,594.00" "$1,594.00" $466.15 $466.15 $464.20 "$1,594.00" $466.15 "$1,594.00" "$1,594.00" "$1,594.00" "$1,594.00" $332.21 $745.84 $749.97 "$1,594.00" $466.15 $468.73 $466.15 "$1,594.00" "$1,195.50" $466.15 $466.15 $466.15 "$1,594.00" $797.00 "$1,262.45" $466.15 "$1,275.20" "$1,594.00" "$1,594.00" $466.15 $924.52 "$1,594.00" $466.38 $466.15 "$1,594.00" $466.15 N/A N/A 45000174 EAP CPT® 24577 TREAT HUMERUS FRACTURE BOTH IP/OP "$2,383.00" "$1,763.50" $496.64 "$2,383.00" "$2,383.00" "$2,383.00" "$2,383.00" "$2,383.00" $522.73 $522.73 $520.57 "$2,383.00" $522.73 "$2,383.00" "$2,383.00" "$2,383.00" "$2,383.00" $496.64 $836.37 $840.54 "$2,383.00" $522.73 $525.34 $522.73 "$2,383.00" "$1,787.25" $522.73 $522.73 $522.73 "$2,383.00" "$1,191.50" "$1,887.34" $522.73 "$1,906.40" "$1,750.00" "$2,383.00" $522.73 "$1,382.14" "$2,383.00" $524.04 $522.73 "$2,383.00" $522.73 N/A N/A 45000175 EAP CPT® 24600 ELBOW DISLOCA WO ANES BOTH IP/OP $879.00 $650.50 $183.19 $879.00 $879.00 $879.00 $879.00 $879.00 $349.65 $349.65 $346.07 $879.00 $349.65 $879.00 $879.00 $879.00 $879.00 $183.19 $559.44 $570.05 $879.00 $349.65 $356.28 $349.65 $879.00 $659.25 $349.65 $349.65 $349.65 $879.00 $439.50 $696.17 $349.65 $703.20 $879.00 $879.00 $349.65 $509.82 $879.00 $349.98 $349.65 $879.00 $349.65 N/A N/A 45000176 EAP CPT® 24605 TREAT ELBOW DISLOCATION BOTH IP/OP "$9,171.00" "$6,787.00" $490.23 "$9,171.00" "$9,171.00" "$9,171.00" "$9,171.00" "$9,171.00" $491.66 $491.66 $490.23 "$9,171.00" $491.66 "$9,171.00" "$9,171.00" "$9,171.00" "$9,171.00" "$1,911.34" $786.66 $789.57 "$9,171.00" $491.66 $493.48 $491.66 "$9,171.00" "$6,878.25" $491.66 $491.66 $491.66 "$2,851.00" "$4,585.50" "$7,263.43" $491.66 "$7,336.80" "$2,500.00" "$9,171.00" $491.66 "$5,319.18" "$9,171.00" $491.61 $491.66 "$9,171.00" $491.66 N/A N/A 45000177 EAP CPT® 24620 TREAT ELBOW FRACTURE BOTH IP/OP "$8,190.00" "$6,061.00" $575.59 "$8,190.00" "$8,190.00" "$8,190.00" "$8,190.00" "$8,190.00" $578.36 $578.36 $575.59 "$8,190.00" $578.36 "$8,190.00" "$8,190.00" "$8,190.00" "$8,190.00" "$1,706.89" $925.38 $968.08 "$8,190.00" $578.36 $605.05 $578.36 "$8,190.00" "$6,142.50" $578.36 $578.36 $578.36 "$2,851.00" "$4,095.00" "$6,486.48" $578.36 "$6,552.00" "$2,500.00" "$8,190.00" $578.36 "$4,750.20" "$8,190.00" $576.34 $578.36 "$8,190.00" $578.36 N/A N/A 45000179 EAP CPT® 24650 RADIAL HD/NECK FX WO MANIP BOTH IP/OP "$1,128.00" $835.00 $235.09 "$1,128.00" "$1,128.00" "$1,128.00" "$1,128.00" "$1,128.00" $253.30 $253.30 $252.23 "$1,128.00" $253.30 "$1,128.00" "$1,128.00" "$1,128.00" "$1,128.00" $235.09 $405.28 $410.85 "$1,128.00" $253.30 $256.78 $253.30 "$1,128.00" $846.00 $253.30 $253.30 $253.30 "$1,128.00" $564.00 $893.38 $253.30 $902.40 "$1,128.00" "$1,128.00" $253.30 $654.24 "$1,128.00" $250.82 $253.30 "$1,128.00" $253.30 N/A N/A 45000181 EAP CPT® 24655 CLSD TXT RADIAL HD/NECK FX W/OUT M BOTH IP/OP "$2,532.00" "$1,874.00" $411.74 "$2,532.00" "$2,532.00" "$2,532.00" "$2,532.00" "$2,532.00" $416.23 $416.23 $411.74 "$2,532.00" $416.23 "$2,532.00" "$2,532.00" "$2,532.00" "$2,532.00" $527.70 $665.97 $671.82 "$2,532.00" $416.23 $419.89 $416.23 "$2,532.00" "$1,899.00" $416.23 $416.23 $416.23 "$2,532.00" "$1,266.00" "$2,005.34" $416.23 "$2,025.60" "$1,750.00" "$2,532.00" $416.23 "$1,468.56" "$2,532.00" $413.75 $416.23 "$2,532.00" $416.23 N/A N/A 45000184 EAP CPT® 25500 RADIAL SHAFT FX WO MANIP BOTH IP/OP "$1,047.00" $775.00 $218.21 "$1,047.00" "$1,047.00" "$1,047.00" "$1,047.00" "$1,047.00" $265.87 $265.87 $263.61 "$1,047.00" $265.87 "$1,047.00" "$1,047.00" "$1,047.00" "$1,047.00" $218.21 $425.39 $430.40 "$1,047.00" $265.87 $269.00 $265.87 "$1,047.00" $785.25 $265.87 $265.87 $265.87 "$1,047.00" $523.50 $829.22 $265.87 $837.60 "$1,047.00" "$1,047.00" $265.87 $607.26 "$1,047.00" $261.28 $265.87 "$1,047.00" $265.87 N/A N/A 45000186 EAP CPT® 25505 CLSD TXT RADIAL SHAFT FX W/MANIPUL BOTH IP/OP "$2,452.00" "$1,814.50" $470.60 "$2,452.00" "$2,452.00" "$2,452.00" "$2,452.00" "$2,452.00" $472.41 $472.41 $470.60 "$2,452.00" $472.41 "$2,452.00" "$2,452.00" "$2,452.00" "$2,452.00" $511.02 $755.86 $765.14 "$2,452.00" $472.41 $478.21 $472.41 "$2,452.00" "$1,839.00" $472.41 $472.41 $472.41 "$2,452.00" "$1,226.00" "$1,941.98" $472.41 "$1,961.60" "$2,150.00" "$2,452.00" $472.41 "$1,422.16" "$2,452.00" $476.11 $472.41 "$2,452.00" $472.41 N/A N/A 45000189 EAP CPT® 25520 TREAT FRACTURE OF RADIUS BOTH IP/OP "$2,483.00" "$1,837.50" $517.48 "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" $560.11 $560.11 $558.24 "$2,483.00" $560.11 "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" $517.48 $896.18 $900.75 "$2,483.00" $560.11 $562.97 $560.11 "$2,483.00" "$1,862.25" $560.11 $560.11 $560.11 "$2,483.00" "$1,241.50" "$1,966.54" $560.11 "$1,986.40" "$1,750.00" "$2,483.00" $560.11 "$1,440.14" "$2,483.00" $561.17 $560.11 "$2,483.00" $560.11 N/A N/A 45000190 EAP CPT® 25530 CLSD TX ULNAR SHAFT FX W/O MANIP BOTH IP/OP "$1,274.00" $943.00 $247.93 "$1,274.00" "$1,274.00" "$1,274.00" "$1,274.00" "$1,274.00" $250.22 $250.22 $249.47 "$1,274.00" $250.22 "$1,274.00" "$1,274.00" "$1,274.00" "$1,274.00" $265.52 $400.35 $405.95 "$1,274.00" $250.22 $253.72 $250.22 "$1,274.00" $955.50 $250.22 $250.22 $250.22 "$1,274.00" $637.00 "$1,009.01" $250.22 "$1,019.20" "$1,274.00" "$1,274.00" $250.22 $738.92 "$1,274.00" $247.93 $250.22 "$1,274.00" $250.22 N/A N/A 45000192 EAP CPT® 25560 RADIAL/ULNER FX WO MANIP BOTH IP/OP $891.00 $659.50 $185.69 $891.00 $891.00 $891.00 $891.00 $891.00 $267.56 $267.56 $265.00 $891.00 $267.56 $891.00 $891.00 $891.00 $891.00 $185.69 $428.10 $433.12 $891.00 $267.56 $270.70 $267.56 $891.00 $668.25 $267.56 $267.56 $267.56 $891.00 $445.50 $705.67 $267.56 $712.80 $891.00 $891.00 $267.56 $516.78 $891.00 $263.44 $267.56 $891.00 $267.56 N/A N/A 45000194 EAP CPT® 25565 TREAT FRACTURE RADIUS & ULNA BOTH IP/OP "$2,483.00" "$1,837.50" $476.50 "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" $479.67 $479.67 $476.50 "$2,483.00" $479.67 "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" $517.48 $767.47 $773.95 "$2,483.00" $479.67 $483.72 $479.67 "$2,483.00" "$1,862.25" $479.67 $479.67 $479.67 "$2,483.00" "$1,241.50" "$1,966.54" $479.67 "$1,986.40" "$1,750.00" "$2,483.00" $479.67 "$1,440.14" "$2,483.00" $482.25 $479.67 "$2,483.00" $479.67 N/A N/A 45000196 EAP CPT® 25605 TREAT FRACTURE RADIUS/ULNA BOTH IP/OP "$2,483.00" "$1,837.50" $517.48 "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" $526.10 $526.10 $524.64 "$2,483.00" $526.10 "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" $517.48 $841.76 $847.65 "$2,483.00" $526.10 $529.78 $526.10 "$2,483.00" "$1,862.25" $526.10 $526.10 $526.10 "$2,483.00" "$1,241.50" "$1,966.54" $526.10 "$1,986.40" "$2,150.00" "$2,483.00" $526.10 "$1,440.14" "$2,483.00" $530.90 $526.10 "$2,483.00" $526.10 N/A N/A 45000200 EAP CPT® 25635 TREAT WRIST BONE FRACTURE BOTH IP/OP "$2,483.00" "$1,837.50" $433.56 "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" $436.54 $436.54 $434.30 "$2,483.00" $436.54 "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" $517.48 $698.46 $702.13 "$2,483.00" $436.54 $438.83 $436.54 "$2,483.00" "$1,862.25" $436.54 $436.54 $436.54 "$2,483.00" "$1,241.50" "$1,966.54" $436.54 "$1,986.40" "$1,750.00" "$2,483.00" $436.54 "$1,440.14" "$2,483.00" $433.56 $436.54 "$2,483.00" $436.54 N/A N/A 45000203 EAP CPT® 25650 TREAT WRIST BONE FRACTURE BOTH IP/OP $992.00 $734.50 $206.74 $992.00 $992.00 $992.00 $992.00 $992.00 $315.98 $315.98 $314.04 $992.00 $315.98 $992.00 $992.00 $992.00 $992.00 $206.74 $505.57 $512.86 $992.00 $315.98 $320.54 $315.98 $992.00 $744.00 $315.98 $315.98 $315.98 $992.00 $496.00 $785.66 $315.98 $793.60 $992.00 $992.00 $315.98 $575.36 $992.00 $313.54 $315.98 $992.00 $315.98 N/A N/A 45000205 EAP CPT® 25675 CLSD TX RADIOULNAR (WRIST) DISLOCATION BOTH IP/OP $509.00 $377.00 $106.08 $684.91 $509.00 $509.00 $509.00 $509.00 $418.81 $418.81 $413.33 $509.00 $418.81 $509.00 $509.00 $509.00 $509.00 $106.08 $670.10 $684.91 $509.00 $418.81 $428.07 $418.81 $509.00 $381.75 $418.81 $418.81 $418.81 $509.00 $254.50 $403.13 $418.81 $407.20 $509.00 $509.00 $418.81 $295.22 $509.00 $415.93 $418.81 $509.00 $418.81 N/A N/A 45000206 EAP CPT® 25680 TRANS-SCAPOPERILUNAR FX DISLOC BOTH IP/OP "$1,085.00" $803.00 $226.13 "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" $545.03 $545.03 $542.02 "$1,085.00" $545.03 "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" $226.13 $872.05 $876.34 "$1,085.00" $545.03 $547.71 $545.03 "$1,085.00" $813.75 $545.03 $545.03 $545.03 "$1,085.00" $542.50 $859.32 $545.03 $868.00 "$1,085.00" "$1,085.00" $545.03 $629.30 "$1,085.00" $544.58 $545.03 "$1,085.00" $545.03 N/A N/A 45000207 EAP CPT® 25690 TREAT WRIST DISLOCATION BOTH IP/OP "$8,034.00" "$5,945.50" $502.96 "$8,034.00" "$8,034.00" "$8,034.00" "$8,034.00" "$8,034.00" $505.63 $505.63 $502.96 "$8,034.00" $505.63 "$8,034.00" "$8,034.00" "$8,034.00" "$8,034.00" "$1,674.37" $809.01 $812.86 "$8,034.00" $505.63 $508.04 $505.63 "$8,034.00" "$6,025.50" $505.63 $505.63 $505.63 "$2,762.00" "$4,017.00" "$6,362.93" $505.63 "$6,427.20" "$2,500.00" "$8,034.00" $505.63 "$4,659.72" "$8,034.00" $504.57 $505.63 "$8,034.00" $505.63 N/A N/A 45000209 EAP CPT® 26410 REPAIR HAND TENDON BOTH IP/OP "$3,718.00" "$2,751.50" $596.73 "$3,718.00" "$3,718.00" "$3,718.00" "$3,718.00" "$3,718.00" $629.43 $629.43 $622.59 "$3,718.00" $629.43 "$3,718.00" "$3,718.00" "$3,718.00" "$3,718.00" $774.87 "$1,007.09" $994.86 "$3,718.00" $629.43 $621.79 $629.43 "$3,718.00" "$2,788.50" $629.43 $629.43 $629.43 "$3,500.00" "$1,859.00" "$2,944.66" $629.43 "$2,974.40" "$2,500.00" "$3,718.00" $629.43 "$2,156.44" "$3,718.00" $596.73 $629.43 "$3,718.00" $629.43 N/A N/A 45000210 EAP CPT® 26418 REPAIR FINGER TENDON BOTH IP/OP "$4,565.00" "$3,378.50" $613.64 "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" $652.71 $652.71 $642.62 "$4,565.00" $652.71 "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" $951.40 "$1,044.34" "$1,032.10" "$4,565.00" $652.71 $645.06 $652.71 "$4,565.00" "$3,423.75" $652.71 $652.71 $652.71 "$4,417.00" "$2,282.50" "$3,615.48" $652.71 "$3,652.00" "$2,500.00" "$4,565.00" $652.71 "$2,647.70" "$4,565.00" $613.64 $652.71 "$4,565.00" $652.71 N/A N/A 45000211 EAP CPT® 26600 CLSD TX METACARPAL FX SINGLE W/O MANIP BOTH IP/OP "$1,078.00" $798.00 $224.67 "$1,078.00" "$1,078.00" "$1,078.00" "$1,078.00" "$1,078.00" $296.26 $296.26 $292.86 "$1,078.00" $296.26 "$1,078.00" "$1,078.00" "$1,078.00" "$1,078.00" $224.67 $474.02 $479.10 "$1,078.00" $296.26 $299.44 $296.26 "$1,078.00" $808.50 $296.26 $296.26 $296.26 "$1,078.00" $539.00 $853.78 $296.26 $862.40 "$1,078.00" "$1,078.00" $296.26 $625.24 "$1,078.00" $290.45 $296.26 "$1,078.00" $296.26 N/A N/A 45000213 EAP CPT® 26605 TREAT METACARPAL FRACTURE BOTH IP/OP $647.00 $479.00 $134.84 $647.00 $647.00 $647.00 $647.00 $647.00 $308.40 $308.40 $305.10 $647.00 $308.40 $647.00 $647.00 $647.00 $647.00 $134.84 $493.44 $497.09 $647.00 $308.40 $310.68 $308.40 $647.00 $485.25 $308.40 $308.40 $308.40 $647.00 $323.50 $512.42 $308.40 $517.60 $647.00 $647.00 $308.40 $375.26 $647.00 $304.53 $308.40 $647.00 $308.40 N/A N/A 45000216 EAP CPT® 26645 TREAT THUMB FRACTURE BOTH IP/OP "$1,593.00" "$1,179.00" $332.00 "$1,593.00" "$1,593.00" "$1,593.00" "$1,593.00" "$1,593.00" $407.87 $407.87 $406.44 "$1,593.00" $407.87 "$1,593.00" "$1,593.00" "$1,593.00" "$1,593.00" $332.00 $652.59 $656.13 "$1,593.00" $407.87 $410.08 $407.87 "$1,593.00" "$1,194.75" $407.87 $407.87 $407.87 "$1,593.00" $796.50 "$1,261.66" $407.87 "$1,274.40" "$1,593.00" "$1,593.00" $407.87 $923.94 "$1,593.00" $407.98 $407.87 "$1,593.00" $407.87 N/A N/A 45000217 EAP CPT® 26670 TREAT HAND DISLOCATION BOTH IP/OP "$1,099.00" $813.50 $229.04 "$1,099.00" "$1,099.00" "$1,099.00" "$1,099.00" "$1,099.00" $322.75 $322.75 $320.30 "$1,099.00" $322.75 "$1,099.00" "$1,099.00" "$1,099.00" "$1,099.00" $229.04 $516.40 $519.54 "$1,099.00" $322.75 $324.71 $322.75 "$1,099.00" $824.25 $322.75 $322.75 $322.75 "$1,099.00" $549.50 $870.41 $322.75 $879.20 "$1,099.00" "$1,099.00" $322.75 $637.42 "$1,099.00" $319.70 $322.75 "$1,099.00" $322.75 N/A N/A 45000218 EAP CPT® 26700 "METACARPOPHLANGEAL DISLOC,SING" BOTH IP/OP $735.00 $544.00 $153.18 $735.00 $735.00 $735.00 $735.00 $735.00 $321.40 $321.40 $317.52 $735.00 $321.40 $735.00 $735.00 $735.00 $735.00 $153.18 $514.24 $522.78 $735.00 $321.40 $326.74 $321.40 $735.00 $551.25 $321.40 $321.40 $321.40 $735.00 $367.50 $582.12 $321.40 $588.00 $735.00 $735.00 $321.40 $426.30 $735.00 $319.34 $321.40 $735.00 $321.40 N/A N/A 45000219 EAP CPT® 26705 TREAT KNUCKLE DISLOCATION BOTH IP/OP "$1,593.00" "$1,179.00" $332.00 "$1,593.00" "$1,593.00" "$1,593.00" "$1,593.00" "$1,593.00" $396.98 $396.98 $395.40 "$1,593.00" $396.98 "$1,593.00" "$1,593.00" "$1,593.00" "$1,593.00" $332.00 $635.17 $659.33 "$1,593.00" $396.98 $412.08 $396.98 "$1,593.00" "$1,194.75" $396.98 $396.98 $396.98 "$1,593.00" $796.50 "$1,261.66" $396.98 "$1,274.40" "$1,593.00" "$1,593.00" $396.98 $923.94 "$1,593.00" $397.17 $396.98 "$1,593.00" $396.98 N/A N/A 45000220 EAP CPT® 26720 "PHALANGEAL SHAFT FX, WO MANIP" BOTH IP/OP $678.00 $502.00 $141.30 $678.00 $678.00 $678.00 $678.00 $678.00 $194.50 $194.50 $192.31 $678.00 $194.50 $678.00 $678.00 $678.00 $678.00 $141.30 $311.20 $315.98 $678.00 $194.50 $197.49 $194.50 $678.00 $508.50 $194.50 $194.50 $194.50 $678.00 $339.00 $536.98 $194.50 $542.40 $678.00 $678.00 $194.50 $393.24 $678.00 $191.72 $194.50 $678.00 $194.50 N/A N/A 45000223 EAP CPT® 26725 CLOSD FRACTURE FINGER W MANIP BOTH IP/OP "$1,116.00" $826.00 $232.59 "$1,116.00" "$1,116.00" "$1,116.00" "$1,116.00" "$1,116.00" $314.42 $314.42 $312.25 "$1,116.00" $314.42 "$1,116.00" "$1,116.00" "$1,116.00" "$1,116.00" $232.59 $503.07 $508.05 "$1,116.00" $314.42 $317.53 $314.42 "$1,116.00" $837.00 $314.42 $314.42 $314.42 "$1,116.00" $558.00 $883.87 $314.42 $892.80 "$1,116.00" "$1,116.00" $314.42 $647.28 "$1,116.00" $314.64 $314.42 "$1,116.00" $314.42 N/A N/A 45000224 EAP CPT® 26746 "TREAT FINGER FRACTURE, EACH" BOTH IP/OP "$7,420.00" "$5,491.00" $757.68 "$7,420.00" "$7,420.00" "$7,420.00" "$7,420.00" "$7,420.00" $757.68 $757.68 $758.93 "$7,420.00" $757.68 "$7,420.00" "$7,420.00" "$7,420.00" "$7,420.00" "$1,546.41" "$1,212.29" "$1,215.46" "$7,420.00" $757.68 $759.66 $757.68 "$7,420.00" "$5,565.00" $757.68 $757.68 $757.68 "$4,780.00" "$3,710.00" "$5,876.64" $757.68 "$5,936.00" "$3,250.00" "$7,420.00" $757.68 "$4,303.60" "$7,420.00" $770.63 $757.68 "$7,420.00" $757.68 N/A N/A 45000227 EAP CPT® 26755 "TREAT FINGER FRACTURE, EACH" BOTH IP/OP $649.00 $480.50 $135.26 $649.00 $649.00 $649.00 $649.00 $649.00 $283.76 $283.76 $283.01 $649.00 $283.76 $649.00 $649.00 $649.00 $649.00 $135.26 $454.02 $459.30 $649.00 $283.76 $287.06 $283.76 $649.00 $486.75 $283.76 $283.76 $283.76 $649.00 $324.50 $514.01 $283.76 $519.20 $649.00 $649.00 $283.76 $376.42 $649.00 $283.65 $283.76 $649.00 $283.76 N/A N/A 45000229 EAP CPT® 26756 "PIN FINGER FRACTURE, EACH" BOTH IP/OP "$6,983.00" "$5,167.50" $435.01 "$6,983.00" "$6,983.00" "$6,983.00" "$6,983.00" "$6,983.00" $437.14 $437.14 $435.01 "$6,983.00" $437.14 "$6,983.00" "$6,983.00" "$6,983.00" "$6,983.00" "$1,455.33" $699.42 $702.61 "$6,983.00" $437.14 $439.13 $437.14 "$6,983.00" "$5,237.25" $437.14 $437.14 $437.14 "$2,851.00" "$3,491.50" "$5,530.54" $437.14 "$5,586.40" "$3,250.00" "$6,983.00" $437.14 "$4,050.14" "$6,983.00" $436.80 $437.14 "$6,983.00" $437.14 N/A N/A 45000230 EAP CPT® 26765 "TREAT FINGER FRACTURE, EACH" BOTH IP/OP "$7,322.00" "$5,418.50" $513.78 "$7,322.00" "$7,322.00" "$7,322.00" "$7,322.00" "$7,322.00" $514.22 $514.22 $513.78 "$7,322.00" $514.22 "$7,322.00" "$7,322.00" "$7,322.00" "$7,322.00" "$1,525.99" $822.75 $828.53 "$7,322.00" $514.22 $517.83 $514.22 "$7,322.00" "$5,491.50" $514.22 $514.22 $514.22 "$4,417.00" "$3,661.00" "$5,799.02" $514.22 "$5,857.60" "$3,250.00" "$7,322.00" $514.22 "$4,246.76" "$7,322.00" $519.72 $514.22 "$7,322.00" $514.22 N/A N/A 45000231 EAP CPT® 26770 INTERPHALAN JT DISLOCA W MANIP BOTH IP/OP $650.00 $481.00 $135.47 $650.00 $650.00 $650.00 $650.00 $650.00 $268.31 $268.31 $266.01 $650.00 $268.31 $650.00 $650.00 $650.00 $650.00 $135.47 $429.30 $437.60 $650.00 $268.31 $273.50 $268.31 $650.00 $487.50 $268.31 $268.31 $268.31 $650.00 $325.00 $514.80 $268.31 $520.00 $650.00 $650.00 $268.31 $377.00 $650.00 $267.07 $268.31 $650.00 $268.31 N/A N/A 45000233 EAP CPT® 26775 TREAT FINGER DISLOCATION BOTH IP/OP "$4,733.00" "$3,502.50" $358.97 "$4,733.00" "$4,733.00" "$4,733.00" "$4,733.00" "$4,733.00" $363.99 $363.99 $361.15 "$4,733.00" $363.99 "$4,733.00" "$4,733.00" "$4,733.00" "$4,733.00" $986.41 $582.38 $591.49 "$4,733.00" $363.99 $369.68 $363.99 "$4,733.00" "$3,549.75" $363.99 $363.99 $363.99 "$2,762.00" "$2,366.50" "$3,748.54" $363.99 "$3,786.40" "$1,750.00" "$4,733.00" $363.99 "$2,745.14" "$4,733.00" $358.97 $363.99 "$4,733.00" $363.99 N/A N/A 45000235 EAP CPT® 26785 DISLOCATION OF FINGER BOTH IP/OP "$16,294.00" "$12,058.00" $559.03 "$16,294.00" "$16,294.00" "$16,294.00" "$16,294.00" "$16,294.00" $559.03 $559.03 $559.62 "$16,294.00" $559.03 "$16,294.00" "$16,294.00" "$16,294.00" "$16,294.00" "$3,395.85" $894.45 $901.79 "$16,294.00" $559.03 $563.62 $559.03 "$16,294.00" "$12,220.50" $559.03 $559.03 $559.03 "$2,851.00" "$8,147.00" "$12,904.85" $559.03 "$13,035.20" "$3,250.00" "$16,294.00" $559.03 "$9,450.52" "$16,294.00" $566.22 $559.03 "$16,294.00" $559.03 N/A N/A 45000236 EAP CPT® 26951 AMPUTATION OF FINGER/THUMB BOTH IP/OP "$7,787.00" "$5,762.50" $690.09 "$7,787.00" "$7,787.00" "$7,787.00" "$7,787.00" "$7,787.00" $727.76 $727.76 $716.83 "$7,787.00" $727.76 "$7,787.00" "$7,787.00" "$7,787.00" "$7,787.00" "$1,622.90" "$1,164.42" "$1,155.95" "$7,787.00" $727.76 $722.47 $727.76 "$7,787.00" "$5,840.25" $727.76 $727.76 $727.76 "$2,851.00" "$3,893.50" "$6,167.30" $727.76 "$6,229.60" "$2,500.00" "$7,787.00" $727.76 "$4,516.46" "$7,787.00" $690.09 $727.76 "$7,787.00" $727.76 N/A N/A 45000238 EAP CPT® 27230 CLSD TX FEMORAL FX PROX END NCK W/O MANIP BOTH IP/OP $612.00 $453.00 $127.55 $787.44 $612.00 $612.00 $612.00 $612.00 $489.75 $489.75 $488.69 $612.00 $489.75 $612.00 $612.00 $612.00 $612.00 $127.55 $783.60 $787.44 $612.00 $489.75 $492.15 $489.75 $612.00 $459.00 $489.75 $489.75 $489.75 $612.00 $306.00 $484.70 $489.75 $489.60 $612.00 $612.00 $489.75 $354.96 $612.00 $493.06 $489.75 $612.00 $489.75 N/A N/A 45000239 EAP CPT® 27232 TREAT THIGH FRACTURE BOTH IP/OP "$3,641.00" "$2,694.50" $739.83 "$3,641.00" "$3,641.00" "$3,641.00" "$3,641.00" "$3,641.00" $750.96 $750.96 $754.79 "$3,641.00" $750.96 "$3,641.00" "$3,641.00" "$3,641.00" "$3,641.00" $758.82 "$1,201.54" "$1,183.73" "$3,641.00" $750.96 $739.83 $750.96 "$3,641.00" "$2,730.75" $750.96 $750.96 $750.96 "$2,762.00" "$1,820.50" "$2,883.67" $750.96 "$2,912.80" "$2,366.65" "$3,641.00" $750.96 "$2,111.78" "$3,641.00" $779.37 $750.96 "$3,641.00" $750.96 N/A N/A 45000240 EAP CPT® 27246 TROCHANTERIC FX WO MANIP BOTH IP/OP $612.00 $453.00 $127.55 $638.35 $612.00 $612.00 $612.00 $612.00 $396.39 $396.39 $395.95 $612.00 $396.39 $612.00 $612.00 $612.00 $612.00 $127.55 $634.22 $638.35 $612.00 $396.39 $398.97 $396.39 $612.00 $459.00 $396.39 $396.39 $396.39 $612.00 $306.00 $484.70 $396.39 $489.60 $612.00 $612.00 $396.39 $354.96 $612.00 $400.80 $396.39 $612.00 $396.39 N/A N/A 45000241 EAP CPT® 27250 HIP DISLOCA WO ANES BOTH IP/OP $572.00 $423.50 $119.21 $572.00 $572.00 $572.00 $572.00 $572.00 $181.81 $181.81 $182.37 $572.00 $181.81 $572.00 $572.00 $572.00 $572.00 $119.21 $290.90 $291.74 $572.00 $181.81 $182.34 $181.81 $572.00 $429.00 $181.81 $181.81 $181.81 $572.00 $286.00 $453.02 $181.81 $457.60 $572.00 $572.00 $181.81 $331.76 $572.00 $192.19 $181.81 $572.00 $181.81 N/A N/A 45000244 EAP CPT® 27256 TREAT HIP DISLOCATION BOTH IP/OP $941.00 $696.50 $196.11 $941.00 $941.00 $941.00 $941.00 $941.00 $241.55 $241.55 $240.51 $941.00 $241.55 $941.00 $941.00 $941.00 $941.00 $196.11 $386.48 $392.03 $941.00 $241.55 $245.02 $241.55 $941.00 $705.75 $241.55 $241.55 $241.55 $941.00 $470.50 $745.27 $241.55 $752.80 $941.00 $941.00 $241.55 $545.78 $941.00 $248.77 $241.55 $941.00 $241.55 N/A N/A 45000245 EAP CPT® 69020 ER DRAIN ABSC EXT AUDITORY CAN BOTH IP/OP $600.00 $444.00 $125.05 $600.00 $600.00 $600.00 $600.00 $600.00 $146.86 $146.86 $144.98 $600.00 $146.86 $600.00 $600.00 $600.00 $600.00 $125.05 $234.98 $235.76 $600.00 $146.86 $147.35 $146.86 $600.00 $450.00 $146.86 $146.86 $146.86 $600.00 $300.00 $475.20 $146.86 $480.00 $600.00 $600.00 $146.86 $348.00 $600.00 $144.52 $146.86 $600.00 $146.86 N/A N/A 45000246 EAP CPT® 27500 FEMORAL SHAFT FX WO MANIP BOTH IP/OP "$1,560.00" "$1,154.50" $325.12 "$1,560.00" "$1,560.00" "$1,560.00" "$1,560.00" "$1,560.00" $491.91 $491.91 $492.57 "$1,560.00" $491.91 "$1,560.00" "$1,560.00" "$1,560.00" "$1,560.00" $325.12 $787.06 $793.02 "$1,560.00" $491.91 $495.64 $491.91 "$1,560.00" "$1,170.00" $491.91 $491.91 $491.91 "$1,560.00" $780.00 "$1,235.52" $491.91 "$1,248.00" "$1,560.00" "$1,560.00" $491.91 $904.80 "$1,560.00" $499.21 $491.91 "$1,560.00" $491.91 N/A N/A 45000248 EAP CPT® 27508 CLSD TX FEMUR DISTAL END MEDIAL/LATERAL CONDYLE FX W/O MANIP BOTH IP/OP "$1,091.00" $807.50 $227.38 "$1,091.00" "$1,091.00" "$1,091.00" "$1,091.00" "$1,091.00" $512.00 $512.00 $510.46 "$1,091.00" $512.00 "$1,091.00" "$1,091.00" "$1,091.00" "$1,091.00" $227.38 $819.20 $821.63 "$1,091.00" $512.00 $513.52 $512.00 "$1,091.00" $818.25 $512.00 $512.00 $512.00 "$1,091.00" $545.50 $864.07 $512.00 $872.80 "$1,091.00" "$1,091.00" $512.00 $632.78 "$1,091.00" $515.41 $512.00 "$1,091.00" $512.00 N/A N/A 45000250 EAP CPT® 27520 PATELLAR FX WO MANIP BOTH IP/OP "$1,494.00" "$1,106.00" $307.77 "$1,494.00" "$1,494.00" "$1,494.00" "$1,494.00" "$1,494.00" $311.16 $311.16 $308.55 "$1,494.00" $311.16 "$1,494.00" "$1,494.00" "$1,494.00" "$1,494.00" $311.37 $497.86 $502.51 "$1,494.00" $311.16 $314.07 $311.16 "$1,494.00" "$1,120.50" $311.16 $311.16 $311.16 "$1,494.00" $747.00 "$1,183.25" $311.16 "$1,195.20" "$1,494.00" "$1,494.00" $311.16 $866.52 "$1,494.00" $307.77 $311.16 "$1,494.00" $311.16 N/A N/A 45000252 EAP CPT® 27530 TIBIAL FX WO MANIP BOTH IP/OP "$1,494.00" "$1,106.00" $293.70 "$1,494.00" "$1,494.00" "$1,494.00" "$1,494.00" "$1,494.00" $299.59 $299.59 $295.90 "$1,494.00" $299.59 "$1,494.00" "$1,494.00" "$1,494.00" "$1,494.00" $311.37 $479.34 $482.37 "$1,494.00" $299.59 $301.48 $299.59 "$1,494.00" "$1,120.50" $299.59 $299.59 $299.59 "$1,494.00" $747.00 "$1,183.25" $299.59 "$1,195.20" "$1,494.00" "$1,494.00" $299.59 $866.52 "$1,494.00" $293.70 $299.59 "$1,494.00" $299.59 N/A N/A 45000254 EAP CPT® 27535 TREAT KNEE FRACTURE BOTH IP/OP "$5,367.00" "$3,972.00" $911.27 "$5,367.00" "$5,367.00" "$5,367.00" "$5,367.00" "$5,367.00" $911.80 $911.80 $915.44 "$5,367.00" $911.80 "$5,367.00" "$5,367.00" "$5,367.00" "$5,367.00" "$1,118.54" "$1,458.88" "$1,458.03" "$5,367.00" $911.80 $911.27 $911.80 "$5,367.00" "$4,025.25" $911.80 $911.80 $911.80 "$2,683.50" "$2,683.50" "$4,250.66" $911.80 "$4,293.60" "$3,250.00" "$5,367.00" $911.80 "$3,112.86" "$5,367.00" $935.79 $911.80 "$5,367.00" $911.80 N/A N/A 45000255 EAP CPT® 27560 TREAT KNEECAP DISLOCATION BOTH IP/OP "$1,047.00" $775.00 $218.21 "$1,047.00" "$1,047.00" "$1,047.00" "$1,047.00" "$1,047.00" $347.22 $347.22 $353.61 "$1,047.00" $347.22 "$1,047.00" "$1,047.00" "$1,047.00" "$1,047.00" $218.21 $555.55 $569.90 "$1,047.00" $347.22 $356.19 $347.22 "$1,047.00" $785.25 $347.22 $347.22 $347.22 "$1,047.00" $523.50 $829.22 $347.22 $837.60 "$1,047.00" "$1,047.00" $347.22 $607.26 "$1,047.00" $356.08 $347.22 "$1,047.00" $347.22 N/A N/A 45000259 EAP CPT® 27750 TIBIAL SHAFT FX WO MANIP BOTH IP/OP "$1,070.00" $792.00 $223.00 "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" $333.10 $333.10 $331.05 "$1,070.00" $333.10 "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" $223.00 $532.96 $537.78 "$1,070.00" $333.10 $336.11 $333.10 "$1,070.00" $802.50 $333.10 $333.10 $333.10 "$1,070.00" $535.00 $847.44 $333.10 $856.00 "$1,070.00" "$1,070.00" $333.10 $620.60 "$1,070.00" $330.84 $333.10 "$1,070.00" $333.10 N/A N/A 45000261 EAP CPT® 27752 TREATMENT OF TIBIA FRACTURE BOTH IP/OP "$7,594.00" "$5,620.00" $506.79 "$6,075.20" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$1,370.10" "$1,370.10" "$1,364.04" "$1,582.78" "$1,370.10" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,582.67" "$2,192.17" "$2,069.52" "$1,871.00" "$1,370.10" $506.79 "$1,370.10" "$1,438.61" "$5,695.50" "$1,370.10" "$1,370.10" "$1,370.10" "$2,762.00" "$2,348.00" "$6,014.45" "$1,370.10" "$6,075.20" "$2,500.00" "$1,507.22" "$1,370.10" "$4,404.52" "$1,438.61" "$1,982.20" "$1,370.10" "$1,582.59" "$1,370.10" N/A N/A 45000264 EAP CPT® 27762 TREATMENT OF ANKLE FRACTURE BOTH IP/OP "$7,594.00" "$5,620.00" $443.79 "$7,594.00" "$7,594.00" "$7,594.00" "$7,594.00" "$7,594.00" $449.96 $449.96 $443.79 "$7,594.00" $449.96 "$7,594.00" "$7,594.00" "$7,594.00" "$7,594.00" "$1,582.67" $719.94 $724.02 "$7,594.00" $449.96 $452.51 $449.96 "$7,594.00" "$5,695.50" $449.96 $449.96 $449.96 "$2,762.00" "$3,797.00" "$6,014.45" $449.96 "$6,075.20" "$2,500.00" "$7,594.00" $449.96 "$4,404.52" "$7,594.00" $450.18 $449.96 "$7,594.00" $449.96 N/A N/A 45000267 EAP CPT® 27788 TREATMENT OF ANKLE FRACTURE BOTH IP/OP "$1,028.00" $761.00 $214.25 "$1,028.00" "$1,028.00" "$1,028.00" "$1,028.00" "$1,028.00" $396.64 $396.64 $395.19 "$1,028.00" $396.64 "$1,028.00" "$1,028.00" "$1,028.00" "$1,028.00" $214.25 $634.62 $639.34 "$1,028.00" $396.64 $399.59 $396.64 "$1,028.00" $771.00 $396.64 $396.64 $396.64 "$1,028.00" $514.00 $814.18 $396.64 $822.40 "$1,028.00" "$1,028.00" $396.64 $596.24 "$1,028.00" $400.07 $396.64 "$1,028.00" $396.64 N/A N/A 45000270 EAP CPT® 27808 CLSD FRAC BIMALL ANKLE WO MANI BOTH IP/OP "$1,135.00" $840.00 $236.55 "$1,135.00" "$1,135.00" "$1,135.00" "$1,135.00" "$1,135.00" $316.44 $316.44 $314.22 "$1,135.00" $316.44 "$1,135.00" "$1,135.00" "$1,135.00" "$1,135.00" $236.55 $506.30 $509.52 "$1,135.00" $316.44 $318.45 $316.44 "$1,135.00" $851.25 $316.44 $316.44 $316.44 "$1,135.00" $567.50 $898.92 $316.44 $908.00 "$1,135.00" "$1,135.00" $316.44 $658.30 "$1,135.00" $313.53 $316.44 "$1,135.00" $316.44 N/A N/A 45000272 EAP CPT® 27810 CLOSED TX BIMAL ANKLE FX W/MAN BOTH IP/OP "$2,348.00" "$1,738.00" $435.77 "$2,348.00" "$2,348.00" "$2,348.00" "$2,348.00" "$2,348.00" $437.96 $437.96 $435.77 "$2,348.00" $437.96 "$2,348.00" "$2,348.00" "$2,348.00" "$2,348.00" $489.35 $700.74 $708.85 "$2,348.00" $437.96 $443.03 $437.96 "$2,348.00" "$1,761.00" $437.96 $437.96 $437.96 "$2,348.00" "$1,174.00" "$1,859.62" $437.96 "$1,878.40" "$2,150.00" "$2,348.00" $437.96 "$1,361.84" "$2,348.00" $439.72 $437.96 "$2,348.00" $437.96 N/A N/A 45000273 EAP CPT® 27816 CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION BOTH IP/OP $902.00 $667.50 $187.99 $902.00 $902.00 $902.00 $902.00 $902.00 $303.91 $303.91 $301.62 $902.00 $303.91 $902.00 $902.00 $902.00 $902.00 $187.99 $486.26 $488.98 $902.00 $303.91 $305.61 $303.91 $902.00 $676.50 $303.91 $303.91 $303.91 $902.00 $451.00 $714.38 $303.91 $721.60 $902.00 $902.00 $303.91 $523.16 $902.00 $301.29 $303.91 $902.00 $303.91 N/A N/A 45000275 EAP CPT® 27818 TRIMALLEOLAR ANKLE FX WITH MAN BOTH IP/OP "$2,348.00" "$1,738.00" $447.40 "$2,348.00" "$2,348.00" "$2,348.00" "$2,348.00" "$2,348.00" $449.53 $449.53 $447.40 "$2,348.00" $449.53 "$2,348.00" "$2,348.00" "$2,348.00" "$2,348.00" $489.35 $719.25 $728.43 "$2,348.00" $449.53 $455.27 $449.53 "$2,348.00" "$1,761.00" $449.53 $449.53 $449.53 "$2,348.00" "$1,174.00" "$1,859.62" $449.53 "$1,878.40" "$2,150.00" "$2,348.00" $449.53 "$1,361.84" "$2,348.00" $451.99 $449.53 "$2,348.00" $449.53 N/A N/A 45000277 EAP CPT® 27825 TREAT LOWER LEG FRACTURE BOTH IP/OP "$7,594.00" "$5,620.00" $503.14 "$7,594.00" "$7,594.00" "$7,594.00" "$7,594.00" "$7,594.00" $503.14 $503.14 $503.30 "$7,594.00" $503.14 "$7,594.00" "$7,594.00" "$7,594.00" "$7,594.00" "$1,582.67" $805.02 $812.03 "$7,594.00" $503.14 $507.52 $503.14 "$7,594.00" "$5,695.50" $503.14 $503.14 $503.14 "$2,851.00" "$3,797.00" "$6,014.45" $503.14 "$6,075.20" "$2,500.00" "$7,594.00" $503.14 "$4,404.52" "$7,594.00" $513.64 $503.14 "$7,594.00" $503.14 N/A N/A 45000278 EAP CPT® 27840 ANKLE DISLOCA WO ANES BOTH IP/OP "$2,348.00" "$1,738.00" $388.35 "$2,348.00" "$2,348.00" "$2,348.00" "$2,348.00" "$2,348.00" $393.03 $393.03 $388.35 "$2,348.00" $393.03 "$2,348.00" "$2,348.00" "$2,348.00" "$2,348.00" $489.35 $628.85 $641.04 "$2,348.00" $393.03 $400.65 $393.03 "$2,348.00" "$1,761.00" $393.03 $393.03 $393.03 "$2,348.00" "$1,174.00" "$1,859.62" $393.03 "$1,878.40" "$1,750.00" "$2,348.00" $393.03 "$1,361.84" "$2,348.00" $390.71 $393.03 "$2,348.00" $393.03 N/A N/A 45000283 EAP CPT® 28470 CLSD TX METATAR FX WO MANIP EA BOTH IP/OP $981.00 $726.00 $204.45 $981.00 $981.00 $981.00 $981.00 $981.00 $210.56 $210.56 $209.21 $981.00 $210.56 $981.00 $981.00 $981.00 $981.00 $204.45 $336.90 $337.60 $981.00 $210.56 $211.00 $210.56 $981.00 $735.75 $210.56 $210.56 $210.56 $981.00 $490.50 $776.95 $210.56 $784.80 $981.00 $981.00 $210.56 $568.98 $981.00 $210.83 $210.56 $981.00 $210.56 N/A N/A 45000285 EAP CPT® 28475 CLSD TX METATAR FX W/MANIP BOTH IP/OP $419.00 $310.50 $87.32 $419.00 $419.00 $419.00 $419.00 $419.00 $230.15 $230.15 $230.67 $419.00 $230.15 $419.00 $419.00 $419.00 $419.00 $87.32 $368.24 $372.96 $419.00 $230.15 $233.10 $230.15 $419.00 $314.25 $230.15 $230.15 $230.15 $419.00 $209.50 $331.85 $230.15 $335.20 $419.00 $419.00 $230.15 $243.02 $419.00 $235.02 $230.15 $419.00 $230.15 N/A N/A 45000286 EAP CPT® 28490 CLSD TX GREAT TOE PHLX/PHLG W/O MANIP BOTH IP/OP $898.00 $665.00 $86.92 $898.00 $898.00 $898.00 $898.00 $898.00 $202.75 $202.75 $201.85 $898.00 $202.75 $898.00 $898.00 $898.00 $882.37 $898.00 $324.39 $298.65 $113.00 $202.75 $128.70 $202.75 $212.88 $673.50 $202.75 $202.75 $202.75 $898.00 $898.00 $898.00 $202.75 $898.00 $898.00 $86.92 $202.75 $520.84 $212.88 $293.32 $202.75 $898.00 $202.75 N/A N/A 45000289 EAP CPT® 28510 CLSD FX TOE W/O MANIPULATION BOTH IP/OP $991.00 $733.50 $82.46 $991.00 $991.00 $991.00 $991.00 $991.00 $202.75 $202.75 $201.85 $991.00 $202.75 $991.00 $991.00 $991.00 $882.37 $991.00 $324.39 $298.65 $113.00 $202.75 $123.61 $202.75 $212.88 $743.25 $202.75 $202.75 $202.75 $991.00 $991.00 $991.00 $202.75 $991.00 $991.00 $82.46 $202.75 $574.78 $212.88 $293.32 $202.75 $991.00 $202.75 N/A N/A 45000291 EAP CPT® 28600 TREAT FOOT DISLOCATION BOTH IP/OP $832.00 $616.00 $173.40 $832.00 $832.00 $832.00 $832.00 $832.00 $188.59 $188.59 $188.73 $832.00 $188.59 $832.00 $832.00 $832.00 $832.00 $173.40 $301.74 $306.21 $832.00 $188.59 $191.38 $188.59 $832.00 $624.00 $188.59 $188.59 $188.59 $832.00 $416.00 $658.94 $188.59 $665.60 $832.00 $832.00 $188.59 $482.56 $832.00 $191.02 $188.59 $832.00 $188.59 N/A N/A 45000292 EAP CPT® 28660 TREAT TOE DISLOCATION BOTH IP/OP $232.00 $172.00 $48.35 $232.00 $232.00 $232.00 $232.00 $232.00 $94.32 $94.32 $93.74 $232.00 $94.32 $232.00 $232.00 $232.00 $232.00 $48.35 $150.91 $151.87 $232.00 $94.32 $94.92 $94.32 $232.00 $174.00 $94.32 $94.32 $94.32 $232.00 $116.00 $183.74 $94.32 $185.60 $232.00 $232.00 $94.32 $134.56 $232.00 $94.44 $94.32 $232.00 $94.32 N/A N/A 45000296 EAP CPT® 29130 APP'L FINGER SPLINT BOTH IP/OP $859.00 $636.00 $29.86 $859.00 $466.44 $466.44 $466.44 $466.44 $110.92 $110.92 $110.43 $179.04 $110.92 $859.00 $859.00 $859.00 $859.00 $179.03 $177.47 $167.51 $113.00 $110.92 $29.86 $110.92 $116.46 $644.25 $110.92 $110.92 $110.92 $859.00 $429.50 $680.33 $110.92 $687.20 $859.00 $170.49 $110.92 $498.22 $116.46 $160.47 $110.92 $179.02 $110.92 N/A N/A 45000298 EAP CPT® 29200 APPLY CLAVICLE STRAP BOTH IP/OP $579.00 $428.50 $18.64 $579.00 $579.00 $579.00 $579.00 $579.00 $18.96 $18.96 $18.77 $579.00 $18.96 $579.00 $579.00 $579.00 $579.00 $120.67 $30.34 $29.82 $579.00 $18.96 $18.64 $18.96 $579.00 $434.25 $18.96 $18.96 $18.96 $579.00 $289.50 $458.57 $18.96 $463.20 $579.00 $579.00 $18.96 $335.82 $579.00 $19.48 $18.96 $579.00 $18.96 N/A N/A 45000299 EAP CPT® 29280 STRAPPING HAND OR FINGER BOTH IP/OP $511.00 $378.50 $19.75 $511.00 $511.00 $511.00 $511.00 $511.00 $19.93 $19.93 $19.75 $511.00 $19.93 $511.00 $511.00 $511.00 $511.00 $106.50 $31.89 $32.00 $511.00 $19.93 $20.00 $19.93 $511.00 $383.25 $19.93 $19.93 $19.93 $511.00 $255.50 $404.71 $19.93 $408.80 $511.00 $511.00 $19.93 $296.38 $511.00 $21.63 $19.93 $511.00 $19.93 N/A N/A 45000300 EAP CPT® 29345 APPLY LONG LEG CAST BOTH IP/OP $705.00 $522.00 $100.07 $705.00 $705.00 $705.00 $705.00 $705.00 $100.07 $100.07 $100.58 $705.00 $100.07 $705.00 $705.00 $705.00 $705.00 $146.93 $160.11 $161.12 $705.00 $100.07 $100.70 $100.07 $705.00 $528.75 $100.07 $100.07 $100.07 $705.00 $352.50 $558.36 $100.07 $564.00 $705.00 $705.00 $100.07 $408.90 $705.00 $103.45 $100.07 $705.00 $100.07 N/A N/A 45000301 EAP CPT® 29358 LONG LEG APPLICATION BOTH IP/OP "$1,062.00" $786.00 $103.46 "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" $103.46 $103.46 $104.00 "$1,062.00" $103.46 "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" $221.33 $165.54 $166.56 "$1,062.00" $103.46 $104.10 $103.46 "$1,062.00" $796.50 $103.46 $103.46 $103.46 "$1,062.00" $531.00 $841.10 $103.46 $849.60 "$1,062.00" "$1,062.00" $103.46 $615.96 "$1,062.00" $106.69 $103.46 "$1,062.00" $103.46 N/A N/A 45000310 EAP CPT® 29530 APPLY KNEE IMMOBILIZER BOTH IP/OP $809.00 $599.00 $18.27 $809.00 $809.00 $809.00 $809.00 $809.00 $18.27 $18.27 $18.42 $809.00 $18.27 $809.00 $809.00 $809.00 $809.00 $168.60 $29.23 $29.28 $809.00 $18.27 $18.30 $18.27 $809.00 $606.75 $18.27 $18.27 $18.27 $809.00 $404.50 $640.73 $18.27 $647.20 $525.85 $809.00 $18.27 $469.22 $809.00 $19.48 $18.27 $809.00 $18.27 N/A N/A 45000315 EAP CPT® 30300 "REMOVE FB, INTRANASAL" BOTH IP/OP $269.00 $199.50 $56.06 $269.00 $269.00 $269.00 $269.00 $269.00 $127.41 $127.41 $122.86 $269.00 $127.41 $269.00 $269.00 $269.00 $269.00 $56.06 $203.86 $203.20 $269.00 $127.41 $127.00 $127.41 $269.00 $201.75 $127.41 $127.41 $127.41 $269.00 $134.50 $213.05 $127.41 $215.20 $269.00 $269.00 $127.41 $156.02 $269.00 $116.41 $127.41 $269.00 $127.41 N/A N/A 45000317 EAP CPT® 30901 CONTROL NASAL HEMORR ANT SIMPL BOTH IP/OP $345.00 $255.50 $56.63 $345.00 $345.00 $345.00 $345.00 $345.00 $57.13 $57.13 $56.63 $345.00 $57.13 $345.00 $345.00 $345.00 $345.00 $71.90 $91.41 $91.76 $345.00 $57.13 $57.35 $57.13 $345.00 $258.75 $57.13 $57.13 $57.13 $345.00 $172.50 $273.24 $57.13 $276.00 $345.00 $345.00 $57.13 $200.10 $345.00 $59.13 $57.13 $345.00 $57.13 N/A N/A 45000319 EAP CPT® 30903 CONTROL NASAL HEMORR ANT COMPL BOTH IP/OP $354.00 $262.00 $73.78 $354.00 $354.00 $354.00 $354.00 $354.00 $77.69 $77.69 $78.30 $354.00 $77.69 $354.00 $354.00 $354.00 $354.00 $73.78 $124.30 $125.42 $354.00 $77.69 $78.39 $77.69 $354.00 $265.50 $77.69 $77.69 $77.69 $354.00 $177.00 $280.37 $77.69 $283.20 $354.00 $354.00 $77.69 $205.32 $354.00 $82.21 $77.69 $354.00 $77.69 N/A N/A 45000320 EAP CPT® 30905 CONTROL NASAL HEMORR POST INIT BOTH IP/OP $518.00 $383.50 $106.44 $518.00 $518.00 $518.00 $518.00 $518.00 $106.44 $106.44 $106.63 $518.00 $106.44 $518.00 $518.00 $518.00 $518.00 $107.96 $170.30 $171.55 $518.00 $106.44 $107.22 $106.44 $518.00 $388.50 $106.44 $106.44 $106.44 $518.00 $259.00 $410.26 $106.44 $414.40 $518.00 $518.00 $106.44 $300.44 $518.00 $110.69 $106.44 $518.00 $106.44 N/A N/A 45000326 EAP CPT® 31515 LARYNGOSCOPY FOR ASPIRATION BOTH IP/OP "$6,731.00" "$4,981.00" $111.09 "$6,731.00" "$6,731.00" "$6,731.00" "$6,731.00" "$6,731.00" $112.25 $112.25 $111.09 "$6,731.00" $112.25 "$6,731.00" "$6,731.00" "$6,731.00" "$6,731.00" "$1,402.81" $179.60 $180.08 "$6,731.00" $112.25 $112.55 $112.25 "$6,731.00" "$5,048.25" $112.25 $112.25 $112.25 "$2,762.00" "$3,365.50" "$5,330.95" $112.25 "$5,384.80" "$2,500.00" "$6,731.00" $112.25 "$3,903.98" "$6,731.00" $113.21 $112.25 "$6,731.00" $112.25 N/A N/A 45000327 EAP CPT® 31525 "DX LARYNGOSCOPY, EXCEPT NB" BOTH IP/OP "$6,130.00" "$4,536.50" $159.51 "$6,130.00" "$6,130.00" "$6,130.00" "$6,130.00" "$6,130.00" $160.89 $160.89 $159.51 "$6,130.00" $160.89 "$6,130.00" "$6,130.00" "$6,130.00" "$6,130.00" "$1,277.56" $257.42 $257.14 "$6,130.00" $160.89 $160.71 $160.89 "$6,130.00" "$4,597.50" $160.89 $160.89 $160.89 "$2,762.00" "$3,065.00" "$4,854.96" $160.89 "$4,904.00" "$2,500.00" "$6,130.00" $160.89 "$3,555.40" "$6,130.00" $164.40 $160.89 "$6,130.00" $160.89 N/A N/A 45000330 EAP CPT® 31605 "TRACHEOSTOMY, CRICOTHYROID" BOTH IP/OP "$1,598.00" "$1,183.00" $333.04 "$1,598.00" "$1,598.00" "$1,598.00" "$1,598.00" "$1,598.00" $335.37 $335.37 $335.15 "$1,598.00" $335.37 "$1,598.00" "$1,598.00" "$1,598.00" "$1,598.00" $333.04 $536.59 $534.94 "$1,598.00" $335.37 $334.34 $335.37 "$1,598.00" "$1,198.50" $335.37 $335.37 $335.37 "$1,598.00" $799.00 "$1,265.62" $335.37 "$1,278.40" "$1,598.00" "$1,598.00" $335.37 $926.84 "$1,598.00" $349.75 $335.37 "$1,598.00" $335.37 N/A N/A 45000333 EAP CPT® 32160 THORACOTOMY W/CARDIAC MASSAGE BOTH IP/OP "$5,460.00" "$4,040.50" $800.54 "$5,460.00" "$5,460.00" "$5,460.00" "$5,460.00" "$5,460.00" $801.19 $801.19 $802.27 "$5,460.00" $801.19 "$5,460.00" "$5,460.00" "$5,460.00" "$5,460.00" "$1,137.92" "$1,281.90" "$1,280.86" "$5,460.00" $801.19 $800.54 $801.19 "$5,460.00" "$4,095.00" $801.19 $801.19 $801.19 "$2,762.00" "$2,730.00" "$4,324.32" $801.19 "$4,368.00" "$3,549.00" "$5,460.00" $801.19 "$3,166.80" "$5,460.00" $828.05 $801.19 "$5,460.00" $801.19 N/A N/A 45000337 EAP CPT® 35206 REPAIR BLOOD VESSEL LESION BOTH IP/OP "$8,232.00" "$6,092.00" $784.44 "$8,232.00" "$8,232.00" "$8,232.00" "$8,232.00" "$8,232.00" $786.74 $786.74 $786.38 "$8,232.00" $786.74 "$8,232.00" "$8,232.00" "$8,232.00" "$8,232.00" "$1,715.64" "$1,258.78" "$1,255.10" "$8,232.00" $786.74 $784.44 $786.74 "$8,232.00" "$6,174.00" $786.74 $786.74 $786.74 "$2,762.00" "$4,116.00" "$6,519.74" $786.74 "$6,585.60" "$3,725.00" "$8,232.00" $786.74 "$4,774.56" "$8,232.00" $817.65 $786.74 "$8,232.00" $786.74 N/A N/A 45000348 EAP CPT® 36593 DECLOT VASCULAR ACCESS DEVICE BOTH IP/OP "$1,299.00" $961.50 $33.49 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $313.64 $313.64 $312.26 $270.74 $313.64 "$1,257.08" "$1,257.08" "$1,299.00" $882.37 $270.73 $501.83 $479.85 $113.00 $313.64 $33.49 $313.64 $329.33 $974.25 $313.64 $313.64 $313.64 "$1,299.00" $649.50 "$1,028.81" $313.64 "$1,039.20" "$1,299.00" $257.82 $313.64 $753.42 $329.33 $453.76 $313.64 $270.71 $313.64 N/A N/A 45000356 EAP CPT® 41252 REPAIR TONGUE LACERATION 2.6CM BOTH IP/OP "$2,783.00" "$2,059.50" $211.33 "$2,783.00" "$2,783.00" "$2,783.00" "$2,783.00" "$2,783.00" $211.33 $211.33 $211.76 "$2,783.00" $211.33 "$2,783.00" "$2,783.00" "$2,783.00" "$2,783.00" $580.01 $338.13 $340.62 "$2,783.00" $211.33 $212.89 $211.33 "$2,783.00" "$2,087.25" $211.33 $211.33 $211.33 "$2,783.00" "$1,391.50" "$2,204.14" $211.33 "$2,226.40" "$2,150.00" "$2,783.00" $211.33 "$1,614.14" "$2,783.00" $216.65 $211.33 "$2,783.00" $211.33 N/A N/A 45000357 EAP CPT® 42000 "I&D ABSCESS PLATE, UVULA" BOTH IP/OP $283.00 $209.50 $58.98 $283.00 $283.00 $283.00 $283.00 $283.00 $109.30 $109.30 $106.79 $283.00 $109.30 $283.00 $283.00 $283.00 $283.00 $58.98 $174.88 $177.26 $283.00 $109.30 $110.79 $109.30 $283.00 $212.25 $109.30 $109.30 $109.30 $283.00 $141.50 $224.14 $109.30 $226.40 $283.00 $283.00 $109.30 $164.14 $283.00 $107.41 $109.30 $283.00 $109.30 N/A N/A 45000358 EAP CPT® 42809 REMOVE FB PHARYNX BOTH IP/OP $495.00 $366.50 $103.16 $495.00 $495.00 $495.00 $495.00 $495.00 $128.35 $128.35 $126.70 $495.00 $128.35 $495.00 $495.00 $495.00 $495.00 $103.16 $205.36 $205.57 $495.00 $128.35 $128.48 $128.35 $495.00 $371.25 $128.35 $128.35 $128.35 $495.00 $247.50 $392.04 $128.35 $396.00 $495.00 $495.00 $128.35 $287.10 $495.00 $128.34 $128.35 $495.00 $128.35 N/A N/A 45000360 EAP CPT® 43752 N/G TUBE PLACEMENT BOTH IP/OP "$2,134.00" "$1,579.50" $40.36 "$2,134.00" "$2,134.00" "$2,134.00" "$2,134.00" "$2,134.00" $266.97 $266.97 $265.79 $444.78 $266.97 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $444.75 $427.15 $544.70 $113.00 $266.97 $40.36 $266.97 $280.32 "$1,600.50" $266.97 $266.97 $266.97 "$2,134.00" "$1,067.00" "$1,690.13" $266.97 "$1,707.20" "$1,750.00" $423.55 $266.97 "$1,237.72" $280.32 $386.24 $266.97 $444.73 $266.97 N/A N/A 45000361 EAP CPT® 44500 INTRO OF LONG GI TUBE BOTH IP/OP "$1,291.00" $955.50 $19.33 "$1,291.00" "$1,291.00" "$1,291.00" "$1,291.00" "$1,291.00" $19.58 $19.58 $19.75 "$1,291.00" $19.58 "$1,291.00" "$1,291.00" "$1,291.00" "$1,291.00" $269.06 $31.33 $30.93 "$1,291.00" $19.58 $19.33 $19.58 "$1,291.00" $968.25 $19.58 $19.58 $19.58 "$1,291.00" $645.50 "$1,022.47" $19.58 "$1,032.80" "$1,291.00" "$1,291.00" $19.58 $748.78 "$1,291.00" $20.20 $19.58 "$1,291.00" $19.58 N/A N/A 45000362 EAP CPT® 45300 PROCTOSIGMOIDOSCOPY BOTH IP/OP "$2,361.00" "$1,747.50" $48.05 "$2,361.00" "$2,361.00" "$2,361.00" "$2,361.00" "$2,361.00" $48.05 $48.05 $48.73 "$2,361.00" $48.05 "$2,361.00" "$2,361.00" "$2,361.00" "$2,361.00" $492.06 $76.88 $77.58 "$2,361.00" $48.05 $48.49 $48.05 "$2,361.00" "$1,770.75" $48.05 $48.05 $48.05 "$2,361.00" "$1,180.50" "$1,869.91" $48.05 "$1,888.80" "$2,150.00" "$2,361.00" $48.05 "$1,369.38" "$2,361.00" $49.75 $48.05 "$2,361.00" $48.05 N/A N/A 45000363 EAP CPT® 45305 PROCTOSIGMOIDOSCOPY W/BX BOTH IP/OP "$5,114.00" "$3,784.50" $73.24 "$5,114.00" "$5,114.00" "$5,114.00" "$5,114.00" "$5,114.00" $73.34 $73.34 $73.60 "$5,114.00" $73.34 "$5,114.00" "$5,114.00" "$5,114.00" "$5,114.00" "$1,065.81" $117.34 $117.18 "$5,114.00" $73.34 $73.24 $73.34 "$5,114.00" "$3,835.50" $73.34 $73.34 $73.34 "$2,762.00" "$2,557.00" "$4,050.29" $73.34 "$4,091.20" "$2,500.00" "$5,114.00" $73.34 "$2,966.12" "$5,114.00" $75.71 $73.34 "$5,114.00" $73.34 N/A N/A 45000364 EAP CPT® 45385 LESION REMOVAL COLONOSCOPY BOTH IP/OP "$2,922.00" "$2,162.50" $252.60 "$2,922.00" "$2,922.00" "$2,922.00" "$2,922.00" "$2,922.00" $255.86 $255.86 $255.99 "$2,922.00" $255.86 "$2,922.00" "$2,922.00" "$2,922.00" "$2,922.00" $608.98 $409.38 $404.16 "$2,922.00" $255.86 $252.60 $255.86 "$2,922.00" "$2,191.50" $255.86 $255.86 $255.86 "$2,851.00" "$1,461.00" "$2,314.22" $255.86 "$2,337.60" "$2,500.00" "$2,922.00" $255.86 "$1,694.76" "$2,922.00" $265.02 $255.86 "$2,922.00" $255.86 N/A N/A 45000366 EAP CPT® 46040 INCISION OF RECTAL ABSCESS BOTH IP/OP "$2,951.00" "$2,184.00" $433.27 "$2,951.00" "$2,951.00" "$2,951.00" "$2,951.00" "$2,951.00" $436.25 $436.25 $433.73 "$2,951.00" $436.25 "$2,951.00" "$2,951.00" "$2,951.00" "$2,951.00" $615.02 $698.00 $693.23 "$2,951.00" $436.25 $433.27 $436.25 "$2,951.00" "$2,213.25" $436.25 $436.25 $436.25 "$2,951.00" "$1,475.50" "$2,337.19" $436.25 "$2,360.80" "$2,500.00" "$2,951.00" $436.25 "$1,711.58" "$2,951.00" $438.28 $436.25 "$2,951.00" $436.25 N/A N/A 45000367 EAP CPT® 46083 INCISE EXTERNAL HEMORRHOID BOTH IP/OP "$1,099.00" $813.50 $111.38 "$1,099.00" "$1,099.00" "$1,099.00" "$1,099.00" "$1,099.00" $112.16 $112.16 $111.38 "$1,099.00" $112.16 "$1,099.00" "$1,099.00" "$1,099.00" "$1,099.00" $229.04 $179.46 $178.45 "$1,099.00" $112.16 $111.53 $112.16 "$1,099.00" $824.25 $112.16 $112.16 $112.16 "$1,099.00" $549.50 $870.41 $112.16 $879.20 "$1,099.00" "$1,099.00" $112.16 $637.42 "$1,099.00" $112.82 $112.16 "$1,099.00" $112.16 N/A N/A 45000371 EAP CPT® 51701 "URINARY CATH, STRAIGHT" BOTH IP/OP $865.00 $640.50 $25.44 $865.00 $865.00 $865.00 $865.00 $865.00 $110.92 $110.92 $110.43 $180.29 $110.92 $865.00 $865.00 $865.00 $865.00 $180.28 $177.47 $167.51 $113.00 $110.92 $25.44 $110.92 $116.46 $648.75 $110.92 $110.92 $110.92 $865.00 $432.50 $685.08 $110.92 $692.00 $865.00 $171.68 $110.92 $501.70 $116.46 $160.47 $110.92 $180.27 $110.92 N/A N/A 45000372 EAP CPT® 51701 INSERT STRAIGHT CATH BOTH IP/OP $865.00 $640.50 $25.44 $865.00 $865.00 $865.00 $865.00 $865.00 $110.92 $110.92 $110.43 $180.29 $110.92 $865.00 $865.00 $865.00 $865.00 $180.28 $177.47 $167.51 $113.00 $110.92 $25.44 $110.92 $116.46 $648.75 $110.92 $110.92 $110.92 $865.00 $432.50 $685.08 $110.92 $692.00 $865.00 $171.68 $110.92 $501.70 $116.46 $160.47 $110.92 $180.27 $110.92 N/A N/A 45000374 EAP CPT® 51702 CATH INSERT INDWELLING BOTH IP/OP "$1,070.00" $792.00 $25.10 "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" $110.92 $110.92 $110.43 $223.01 $110.92 "$1,070.00" "$1,070.00" "$1,070.00" $882.37 $223.00 $177.47 $167.51 $113.00 $110.92 $25.10 $110.92 $116.46 $802.50 $110.92 $110.92 $110.92 "$1,070.00" $535.00 $847.44 $110.92 $856.00 "$1,070.00" $212.37 $110.92 $620.60 $116.46 $160.47 $110.92 $222.99 $110.92 N/A N/A 45000375 EAP CPT® 51703 "INSERT BLADDER CATH, COMPLEX" BOTH IP/OP "$1,809.00" "$1,339.00" $76.30 "$1,809.00" "$1,809.00" "$1,809.00" "$1,809.00" "$1,809.00" $137.34 $137.34 $136.73 $377.04 $137.34 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $377.02 $219.74 $209.80 "$1,809.00" $137.34 $76.30 $137.34 $144.20 "$1,356.75" $137.34 $137.34 $137.34 "$1,809.00" $904.50 "$1,432.73" $137.34 "$1,447.20" "$1,750.00" $359.04 $137.34 "$1,049.22" $144.20 $198.69 $137.34 $377.00 $137.34 N/A N/A 45000376 EAP CPT® 51705 CYSTOSTOMY TUBE BOTH IP/OP $626.00 $463.50 $51.51 $626.00 $626.00 $626.00 $626.00 $626.00 $51.51 $51.51 $51.94 $626.00 $51.51 $626.00 $626.00 $626.00 $626.00 $130.47 $82.42 $82.45 $626.00 $51.51 $51.53 $51.51 $626.00 $469.50 $51.51 $51.51 $51.51 $626.00 $313.00 $495.79 $51.51 $500.80 $626.00 $626.00 $51.51 $363.08 $626.00 $54.08 $51.51 $626.00 $51.51 N/A N/A 45000377 EAP CPT® 52000 CYSTOSCOPY BOTH IP/OP "$3,069.00" "$2,271.50" $80.03 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $565.91 $565.91 $563.41 $639.66 $565.91 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $639.61 $905.46 $902.15 "$1,871.00" $565.91 $80.03 $565.91 $594.21 "$2,301.75" $565.91 $565.91 $565.91 "$2,762.00" "$1,534.50" "$2,430.65" $565.91 "$2,455.20" "$2,150.00" $609.12 $565.91 "$1,780.02" $594.21 $818.74 $565.91 $639.58 $565.91 N/A N/A 45000378 EAP CPT® 54220 TREATMENT OF PENIS LESION BOTH IP/OP "$1,092.00" $808.50 $133.64 "$1,092.00" "$1,092.00" "$1,092.00" "$1,092.00" "$1,092.00" $133.66 $133.66 $134.45 "$1,092.00" $133.66 "$1,092.00" "$1,092.00" "$1,092.00" "$1,092.00" $227.58 $213.86 $213.82 "$1,092.00" $133.66 $133.64 $133.66 "$1,092.00" $819.00 $133.66 $133.66 $133.66 "$1,092.00" $546.00 $864.86 $133.66 $873.60 "$1,092.00" "$1,092.00" $133.66 $633.36 "$1,092.00" $139.18 $133.66 "$1,092.00" $133.66 N/A N/A 45000380 EAP CPT® 54700 I & D SCROTUM BOTH IP/OP "$3,277.00" "$2,425.00" $213.57 "$3,250.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,761.28" "$1,761.28" "$1,753.49" $683.01 "$1,761.28" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $682.96 "$2,818.05" "$2,675.95" "$2,836.00" "$1,761.28" $213.57 "$1,761.28" "$1,849.35" "$2,457.75" "$1,761.28" "$1,761.28" "$1,761.28" "$2,851.00" "$1,638.50" "$2,595.38" "$1,761.28" "$2,621.60" "$3,250.00" $650.40 "$1,761.28" "$1,900.66" "$1,849.35" "$2,548.13" "$1,761.28" $682.93 "$1,761.28" N/A N/A 45000381 EAP CPT® 55100 DRAINAGE OF SCROTUM ABSCESS BOTH IP/OP "$2,572.00" "$1,903.50" $168.80 "$2,572.00" "$2,572.00" "$2,572.00" "$2,572.00" "$2,572.00" $168.95 $168.95 $168.99 "$2,572.00" $168.95 "$2,572.00" "$2,572.00" "$2,572.00" "$2,572.00" $536.03 $270.32 $270.08 "$2,572.00" $168.95 $168.80 $168.95 "$2,572.00" "$1,929.00" $168.95 $168.95 $168.95 "$2,572.00" "$1,286.00" "$2,037.02" $168.95 "$2,057.60" "$2,500.00" "$2,572.00" $168.95 "$1,491.76" "$2,572.00" $173.04 $168.95 "$2,572.00" $168.95 N/A N/A 45000383 EAP CPT® 56405 I & D OF VULVA/PERINEUM BOTH IP/OP $291.00 $215.50 $60.65 $291.00 $291.00 $291.00 $291.00 $291.00 $130.53 $130.53 $127.09 $291.00 $130.53 $291.00 $291.00 $291.00 $291.00 $60.65 $208.85 $207.65 $291.00 $130.53 $129.78 $130.53 $291.00 $218.25 $130.53 $130.53 $130.53 $291.00 $145.50 $230.47 $130.53 $232.80 $291.00 $291.00 $130.53 $168.78 $291.00 $123.63 $130.53 $291.00 $130.53 N/A N/A 45000384 EAP CPT® 57180 VAG. EXAM WITH PACKING BOTH IP/OP $382.00 $283.00 $79.61 $382.00 $382.00 $382.00 $382.00 $382.00 $124.67 $124.67 $122.22 $382.00 $124.67 $382.00 $382.00 $382.00 $382.00 $79.61 $199.47 $198.48 $382.00 $124.67 $124.05 $124.67 $382.00 $286.50 $124.67 $124.67 $124.67 $382.00 $191.00 $302.54 $124.67 $305.60 $382.00 $382.00 $124.67 $221.56 $382.00 $119.68 $124.67 $382.00 $124.67 N/A N/A 45000385 EAP CPT® 57415 REMOVE VAGINAL FB W/ANESTHESIA BOTH IP/OP "$8,477.00" "$6,273.00" $176.28 "$8,477.00" "$8,477.00" "$8,477.00" "$8,477.00" "$8,477.00" $179.88 $179.88 $177.22 "$8,477.00" $179.88 "$8,477.00" "$8,477.00" "$8,477.00" "$8,477.00" "$1,766.70" $287.81 $285.81 "$8,477.00" $179.88 $178.63 $179.88 "$8,477.00" "$6,357.75" $179.88 $179.88 $179.88 "$2,851.00" "$4,238.50" "$6,713.78" $179.88 "$6,781.60" "$3,250.00" "$8,477.00" $179.88 "$4,916.66" "$8,477.00" $176.28 $179.88 "$8,477.00" $179.88 N/A N/A 45000391 EAP CPT® 62273 INJECTION EPIDURAL BLOOD PATCH BOTH IP/OP "$1,679.00" "$1,242.50" $113.24 "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" $113.78 $113.78 $114.06 "$1,679.00" $113.78 "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" $349.92 $182.05 $181.18 "$1,679.00" $113.78 $113.24 $113.78 "$1,679.00" "$1,259.25" $113.78 $113.78 $113.78 "$1,679.00" $839.50 "$1,329.77" $113.78 "$1,343.20" "$1,679.00" "$1,679.00" $624.63 $973.82 "$1,679.00" $117.56 $113.78 "$1,679.00" $113.78 N/A N/A 45000395 EAP CPT® 65205 REMOVE FB EYE CONJ SUPERFICIAL BOTH IP/OP $378.00 $280.00 $29.14 $378.00 $378.00 $378.00 $378.00 $378.00 $29.26 $29.26 $29.50 $378.00 $29.26 $378.00 $378.00 $378.00 $378.00 $78.78 $46.82 $46.62 $378.00 $29.26 $29.14 $29.26 $378.00 $283.50 $29.26 $29.26 $29.26 $378.00 $189.00 $299.38 $29.26 $302.40 $378.00 $378.00 $29.26 $219.24 $378.00 $29.93 $29.26 $378.00 $29.26 N/A N/A 45000398 EAP CPT® 65220 EYE EXAM W/O SLIT LAMP BOTH IP/OP "$1,563.00" "$1,157.00" $41.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $41.20 $41.20 $41.89 "$1,563.00" $41.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $325.75 $65.92 $66.74 "$1,563.00" $41.20 $41.71 $41.20 "$1,563.00" "$1,172.25" $41.20 $41.20 $41.20 "$1,563.00" $781.50 "$1,237.90" $41.20 "$1,250.40" "$1,563.00" "$1,563.00" $41.20 $906.54 "$1,563.00" $42.91 $41.20 "$1,563.00" $41.20 N/A N/A 45000399 EAP CPT® 65222 EYE EXAM SLIT LAMP BOTH IP/OP $800.00 $592.00 $49.80 $800.00 $800.00 $800.00 $800.00 $800.00 $50.32 $50.32 $51.08 $800.00 $50.32 $800.00 $800.00 $800.00 $800.00 $166.73 $80.51 $79.68 $800.00 $50.32 $49.80 $50.32 $800.00 $600.00 $50.32 $50.32 $50.32 $800.00 $400.00 $633.60 $50.32 $640.00 $800.00 $800.00 $50.32 $464.00 $800.00 $52.64 $50.32 $800.00 $50.32 N/A N/A 45000400 EAP CPT® 65800 PARACENTESIS ANT CHAMB EYE WDX BOTH IP/OP "$4,672.00" "$3,457.50" $88.45 "$3,737.60" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,042.73" "$2,042.73" "$2,033.69" $973.76 "$2,042.73" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $973.70 "$3,268.36" "$3,115.33" "$1,871.00" "$2,042.73" $88.45 "$2,042.73" "$2,144.86" "$3,504.00" "$2,042.73" "$2,042.73" "$2,042.73" "$2,762.00" "$2,348.00" "$3,700.22" "$2,042.73" "$3,737.60" "$1,750.00" $927.28 "$2,042.73" "$2,709.76" "$2,144.86" "$2,955.31" "$2,042.73" $973.64 "$2,042.73" N/A N/A 45000402 EAP CPT® 66999 IRRIGATION EYE BOTH IP/OP "$1,980.00" "$1,465.50" $412.65 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 "$1,568.16" "$1,980.00" "$1,584.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" "$1,980.00" "$1,980.00" N/A N/A 45000403 EAP CPT® 67228 DESTROY RETINOPATHY PHOTOCOAG BOTH IP/OP "$7,462.00" "$5,522.00" $301.84 "$5,969.60" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $495.04 $495.04 $492.86 "$1,555.27" $495.04 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 "$1,555.16" $792.07 $765.72 "$1,871.00" $495.04 $301.84 $495.04 $519.80 "$5,596.50" $495.04 $495.04 $495.04 "$2,762.00" "$2,348.00" "$5,909.90" $495.04 "$5,969.60" "$2,150.00" "$1,481.02" $495.04 "$4,327.96" $519.80 $716.21 $495.04 "$1,555.08" $495.04 N/A N/A 45000404 EAP CPT® 67700 DRAINAGE OF EYELID ABSCESS BOTH IP/OP "$1,334.00" $987.50 $115.78 "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" $115.78 $115.78 $116.40 "$1,334.00" $115.78 "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" $278.02 $185.25 $185.86 "$1,334.00" $115.78 $116.16 $115.78 "$1,334.00" "$1,000.50" $115.78 $115.78 $115.78 "$1,334.00" $667.00 "$1,056.53" $115.78 "$1,067.20" "$1,334.00" "$1,334.00" $115.78 $773.72 "$1,334.00" $118.23 $115.78 "$1,334.00" $115.78 N/A N/A 45000405 EAP CPT® 67715 INCISION OF EYE LID FOLD BOTH IP/OP "$9,511.00" "$7,038.50" $107.98 "$9,511.00" "$9,511.00" "$9,511.00" "$9,511.00" "$9,511.00" $107.98 $107.98 $108.25 "$9,511.00" $107.98 "$9,511.00" "$9,511.00" "$9,511.00" "$9,511.00" "$1,982.20" $172.77 $174.02 "$9,511.00" $107.98 $108.76 $107.98 "$9,511.00" "$7,133.25" $107.98 $107.98 $107.98 "$2,762.00" "$4,755.50" "$7,532.71" $107.98 "$7,608.80" "$3,250.00" "$9,511.00" $107.98 "$5,516.38" "$9,511.00" $109.22 $107.98 "$9,511.00" $107.98 N/A N/A 45000406 EAP CPT® 67840 EXCISE LESION EYELID SMPL CLOS BOTH IP/OP "$2,581.00" "$1,910.00" $157.17 "$2,581.00" "$2,581.00" "$2,581.00" "$2,581.00" "$2,581.00" $796.59 $796.59 $793.07 $537.94 $796.59 "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" $537.91 "$1,274.55" "$1,258.92" "$1,871.00" $796.59 $157.17 $796.59 $836.42 "$1,935.75" $796.59 $796.59 $796.59 "$2,581.00" "$1,290.50" "$2,044.15" $796.59 "$2,064.80" "$2,150.00" $512.26 $796.59 "$1,496.98" $836.42 "$1,152.47" $796.59 $537.88 $796.59 N/A N/A 45000407 EAP CPT® 69005 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA CMPLX BOTH IP/OP "$9,524.00" "$7,048.00" $160.02 "$9,524.00" "$9,524.00" "$9,524.00" "$9,524.00" "$9,524.00" $162.81 $162.81 $160.02 "$9,524.00" $162.81 "$9,524.00" "$9,524.00" "$9,524.00" "$9,524.00" "$1,984.91" $260.50 $260.80 "$9,524.00" $162.81 $163.00 $162.81 "$9,524.00" "$7,143.00" $162.81 $162.81 $162.81 "$2,762.00" "$4,762.00" "$7,543.01" $162.81 "$7,619.20" "$2,500.00" "$9,524.00" $162.81 "$5,523.92" "$9,524.00" $162.21 $162.81 "$9,524.00" $162.81 N/A N/A 45000412 EAP CPT® 90945 PERITONEAL DIALYSIS BOTH IP/OP "$1,724.00" "$1,276.00" $85.39 "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" $86.47 $86.47 $86.49 "$1,724.00" $86.47 "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" $359.30 $138.35 $136.62 "$1,724.00" $86.47 $85.39 $86.47 "$1,724.00" "$1,293.00" $86.47 $86.47 $86.47 $862.00 $862.00 "$1,365.41" $86.47 "$1,379.20" "$1,120.60" "$1,724.00" $86.47 $999.92 "$1,724.00" $87.99 $86.47 "$1,724.00" $86.47 N/A N/A 45000413 EAP CPT® 92511 NASOPHARYNGOSCOPY W/ENDOSCOPE BOTH IP/OP $606.00 $448.50 $37.94 $606.00 $606.00 $606.00 $606.00 $606.00 $161.93 $161.93 $161.21 $126.31 $161.93 $606.00 $606.00 $606.00 $606.00 $126.30 $259.08 $257.88 $358.45 $161.93 $37.94 $161.93 $170.02 $454.50 $161.93 $161.93 $161.93 $606.00 $303.00 $479.95 $161.93 $484.80 $393.90 $120.28 $161.93 $351.48 $170.02 $234.27 $161.93 $126.29 $161.93 N/A N/A 45000426 EAP CPT® 96373 INJECT-INTRA-ARTERIAL ONLY BOTH IP/OP $266.00 $197.00 $18.28 $266.00 $266.00 $266.00 $266.00 $266.00 $18.28 $18.28 $18.44 $266.00 $18.28 $266.00 $266.00 $266.00 $266.00 $55.44 $29.25 $29.25 $266.00 $18.28 $18.28 $18.28 $266.00 $199.50 $18.28 $18.28 $18.28 $133.00 $133.00 $210.67 $18.28 $212.80 $172.90 $266.00 $18.28 $154.28 $266.00 $18.74 $18.28 $266.00 $18.28 N/A N/A 45000443 EAP CPT® 99281 EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP BOTH IP/OP $564.00 $417.50 #N/A #N/A $564.00 $564.00 $564.00 $564.00 $21.97 $21.97 $22.16 $564.00 $21.97 $564.00 $564.00 $564.00 $564.00 $117.54 $35.15 #N/A $564.00 $21.97 #N/A $21.97 $564.00 $423.00 $21.97 $21.97 $21.97 $282.00 $282.00 $446.69 $21.97 $451.20 $564.00 $564.00 $21.97 $327.12 $564.00 $23.08 $21.97 $564.00 $21.97 N/A N/A 45000447 EAP CPT® 99282 EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM BOTH IP/OP "$1,060.00" $784.50 #N/A #N/A "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $42.56 $42.56 $42.92 "$1,060.00" $42.56 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $220.92 $68.10 #N/A "$1,060.00" $42.56 #N/A $42.56 "$1,060.00" $795.00 $42.56 $42.56 $42.56 $530.00 $530.00 $839.52 $42.56 $848.00 $992.00 "$1,060.00" $42.56 $614.80 "$1,060.00" $44.36 $42.56 "$1,060.00" $42.56 N/A N/A 45000451 EAP CPT® 99283 EMERGENCY DEPARTMENT VISIT LOW MDM BOTH IP/OP "$1,580.00" "$1,169.50" #N/A #N/A "$1,580.00" "$1,580.00" "$1,580.00" "$1,580.00" $72.40 $72.40 $72.37 "$1,580.00" $72.40 "$1,580.00" "$1,580.00" "$1,580.00" "$1,580.00" $329.29 $115.84 #N/A "$1,580.00" $72.40 #N/A $72.40 "$1,580.00" "$1,185.00" $72.40 $72.40 $72.40 $790.00 $790.00 "$1,251.36" $72.40 "$1,264.00" "$1,274.00" "$1,580.00" $72.40 $916.40 "$1,580.00" $66.37 $72.40 "$1,580.00" $72.40 N/A N/A 45000455 EAP CPT® 99284 EMERGENCY DEPARTMENT VISIT MODERATE MDM BOTH IP/OP "$3,050.00" "$2,257.00" #N/A #N/A "$2,444.00" "$2,444.00" "$2,444.00" "$2,444.00" $357.83 $357.83 $356.25 $635.70 $357.83 "$2,890.83" "$2,890.83" "$3,002.01" "$2,029.14" $635.65 $572.53 #N/A "$3,050.00" $357.83 #N/A $357.83 $375.72 "$2,287.50" $357.83 $357.83 $357.83 "$1,525.00" "$1,525.00" "$2,415.60" $357.83 "$2,440.00" "$2,164.00" $605.35 $357.83 "$1,769.00" $375.72 $517.69 $357.83 $635.62 $357.83 N/A N/A 45000459 EAP CPT® 99285 EMERGENCY DEPARTMENT VISIT HIGH MDM BOTH IP/OP "$3,503.00" "$2,592.50" #N/A #N/A "$3,343.00" "$3,343.00" "$3,343.00" "$3,343.00" $513.62 $513.62 $511.35 $730.11 $513.62 "$3,261.45" "$3,261.45" "$3,386.89" "$2,289.29" $730.06 $821.80 #N/A "$3,503.00" $513.62 #N/A $513.62 $539.31 "$2,627.25" $513.62 $513.62 $513.62 "$1,751.50" "$1,751.50" "$2,774.38" $513.62 "$2,802.40" "$2,932.00" $695.26 $513.62 "$2,031.74" $539.31 $743.09 $513.62 $730.03 $513.62 N/A N/A 45000462 EAP CPT® 99291 CRITICAL CARE 1ST HR BOTH IP/OP "$4,975.00" "$3,681.50" $213.96 "$4,975.00" "$4,975.00" "$4,975.00" "$4,975.00" "$4,975.00" $217.60 $217.60 $219.40 "$4,975.00" $217.60 "$4,975.00" "$4,975.00" "$4,975.00" "$4,975.00" "$1,036.84" $348.16 $342.34 "$4,975.00" $217.60 $213.96 $217.60 "$4,975.00" "$3,731.25" $217.60 $217.60 $217.60 "$2,487.50" "$2,487.50" "$3,940.20" $217.60 "$3,980.00" "$3,233.75" "$4,975.00" $217.60 "$2,885.50" "$4,975.00" $226.49 $217.60 "$4,975.00" $217.60 N/A N/A 45000464 EAP CPT® 99292 CRITICAL CARE ADD'L 0.5 HR BOTH IP/OP "$1,359.00" "$1,006.00" $107.49 "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" $109.30 $109.30 $110.21 "$1,359.00" $109.30 "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" $283.23 $174.88 $171.98 "$1,359.00" $109.30 $107.49 $109.30 "$1,359.00" "$1,019.25" $109.30 $109.30 $109.30 $679.50 $679.50 "$1,076.33" $109.30 "$1,087.20" "$1,359.00" "$1,359.00" $109.30 $788.22 "$1,359.00" $113.96 $109.30 "$1,359.00" $109.30 N/A N/A 45000468 EAP CPT® 99465 NEWBORN RESUSCITATION BOTH IP/OP "$1,530.00" "$1,132.50" $141.68 "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" $144.95 $144.95 $145.11 "$1,530.00" $144.95 "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" $318.87 $231.92 $226.69 "$1,530.00" $144.95 $141.68 $144.95 "$1,530.00" "$1,147.50" $144.95 $144.95 $144.95 $765.00 $765.00 "$1,211.76" $144.95 "$1,224.00" $994.50 "$1,530.00" $144.95 $887.40 "$1,530.00" $148.95 $144.95 "$1,530.00" $144.95 N/A N/A 45000471 EAP Custom 45000471 STRAPPING BOTH IP/OP $68.00 $50.50 $12.10 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $12.10 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $14.17 $68.00 $27.20 $68.00 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $68.00 $68.00 $39.44 $68.00 $40.80 $68.00 $68.00 $68.00 N/A N/A 45000473 EAP CPT® 29131 APPLICATION FINGER SPLINT DYNAMIC BOTH IP/OP $517.00 $383.00 $34.57 $517.00 $517.00 $517.00 $517.00 $517.00 $34.63 $34.63 $34.57 $517.00 $34.63 $517.00 $517.00 $517.00 $517.00 $107.75 $55.41 $56.43 $517.00 $34.63 $35.27 $34.63 $517.00 $387.75 $34.63 $34.63 $34.63 $517.00 $258.50 $409.46 $34.63 $413.60 $517.00 $517.00 $34.63 $299.86 $517.00 $35.33 $34.63 $517.00 $34.63 N/A N/A 45000476 EAP CPT® 40830 REPAIR MOUTH LACERATION BOTH IP/OP "$1,099.00" $813.50 $147.71 "$1,099.00" "$1,099.00" "$1,099.00" "$1,099.00" "$1,099.00" $150.93 $150.93 $168.35 "$1,099.00" $150.93 "$1,099.00" "$1,099.00" "$1,099.00" "$1,099.00" $229.04 $241.49 $236.34 "$1,099.00" $150.93 $147.71 $150.93 "$1,099.00" $824.25 $150.93 $150.93 $150.93 "$1,099.00" $549.50 $870.41 $150.93 $879.20 "$1,099.00" "$1,099.00" $150.93 $637.42 "$1,099.00" $174.43 $150.93 "$1,099.00" $150.93 N/A N/A 45000477 EAP CPT® 26775 TREAT FINGER DISLOCATION BOTH IP/OP "$5,029.00" "$3,721.50" $358.97 "$5,029.00" "$5,029.00" "$5,029.00" "$5,029.00" "$5,029.00" $363.99 $363.99 $361.15 "$5,029.00" $363.99 "$5,029.00" "$5,029.00" "$5,029.00" "$5,029.00" "$1,048.10" $582.38 $591.49 "$5,029.00" $363.99 $369.68 $363.99 "$5,029.00" "$3,771.75" $363.99 $363.99 $363.99 "$2,762.00" "$2,514.50" "$3,982.97" $363.99 "$4,023.20" "$1,750.00" "$5,029.00" $363.99 "$2,916.82" "$5,029.00" $358.97 $363.99 "$5,029.00" $363.99 N/A N/A 45000479 EAP CPT® 28665 TXT TOE DISLOCATION W/ANESTH BOTH IP/OP "$4,530.00" "$3,352.50" $126.05 "$4,530.00" "$4,530.00" "$4,530.00" "$4,530.00" "$4,530.00" $127.96 $127.96 $127.66 "$4,530.00" $127.96 "$4,530.00" "$4,530.00" "$4,530.00" "$4,530.00" $944.10 $204.74 $201.68 "$4,530.00" $127.96 $126.05 $127.96 "$4,530.00" "$3,397.50" $127.96 $127.96 $127.96 "$2,762.00" "$2,265.00" "$3,587.76" $127.96 "$3,624.00" "$1,750.00" "$4,530.00" $127.96 "$2,627.40" "$4,530.00" $134.11 $127.96 "$4,530.00" $127.96 N/A N/A 45000480 EAP CPT® 27784 TREATMENT OF FIBULA FRACTURE BOTH IP/OP "$16,355.00" "$12,103.00" $720.97 "$16,355.00" "$16,355.00" "$16,355.00" "$16,355.00" "$16,355.00" $721.69 $721.69 $720.97 "$16,355.00" $721.69 "$16,355.00" "$16,355.00" "$16,355.00" "$16,355.00" "$3,408.56" "$1,154.70" "$1,161.38" "$16,355.00" $721.69 $725.86 $721.69 "$16,355.00" "$12,266.25" $721.69 $721.69 $721.69 "$3,500.00" "$8,177.50" "$12,953.16" $721.69 "$13,084.00" "$4,334.00" "$16,355.00" $721.69 "$9,485.90" "$16,355.00" $739.29 $721.69 "$16,355.00" $721.69 N/A N/A 45000481 EAP CPT® 43235 "UPPER GI ENDOSCOPY, DIAGNOSIS" BOTH IP/OP "$4,485.00" "$3,319.00" $122.05 "$4,485.00" "$4,485.00" "$4,485.00" "$4,485.00" "$4,485.00" $123.32 $123.32 $123.65 "$4,485.00" $123.32 "$4,485.00" "$4,485.00" "$4,485.00" "$4,485.00" $934.72 $197.31 $195.28 "$4,485.00" $123.32 $122.05 $123.32 "$4,485.00" "$3,363.75" $123.32 $123.32 $123.32 "$2,762.00" "$2,242.50" "$3,552.12" $123.32 "$3,588.00" "$2,500.00" "$4,485.00" $123.32 "$2,601.30" "$4,485.00" $127.63 $123.32 "$4,485.00" $123.32 N/A N/A 45000491 EAP CPT® 12020 WOUND DEHISCENCE SIMPLE CLOSUR BOTH IP/OP "$2,965.00" "$2,194.50" $190.51 "$2,762.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $515.18 $515.18 $512.91 $617.98 $515.18 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $617.94 $824.30 $838.11 "$1,871.00" $515.18 $190.51 $515.18 $540.94 "$2,223.75" $515.18 $515.18 $515.18 "$2,762.00" "$1,482.50" "$2,348.28" $515.18 "$2,372.00" "$2,150.00" $588.48 $515.18 "$1,719.70" $540.94 $745.34 $515.18 $617.91 $515.18 N/A N/A 45000492 EAP CPT® 26011 ABSCESS FINGER COMPLICATED BOTH IP/OP "$4,878.00" "$3,610.00" $189.15 "$4,878.00" "$4,878.00" "$4,878.00" "$4,878.00" "$4,878.00" $189.15 $189.15 $189.64 "$4,878.00" $189.15 "$4,878.00" "$4,878.00" "$4,878.00" "$4,878.00" "$1,016.63" $302.64 $303.66 "$4,878.00" $189.15 $189.79 $189.15 "$4,878.00" "$3,658.50" $189.15 $189.15 $189.15 "$2,762.00" "$2,439.00" "$3,863.38" $189.15 "$3,902.40" "$2,500.00" "$4,878.00" $189.15 "$2,829.24" "$4,878.00" $191.74 $189.15 "$4,878.00" $189.15 N/A N/A 45000493 EAP CPT® 29260 "SPLINT APPLICATION, WRIST" BOTH IP/OP "$1,081.00" $800.00 $19.33 "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" $19.58 $19.58 $19.75 "$1,081.00" $19.58 "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" $225.29 $31.33 $30.93 "$1,081.00" $19.58 $19.33 $19.58 "$1,081.00" $810.75 $19.58 $19.58 $19.58 "$1,081.00" $540.50 $856.15 $19.58 $864.80 "$1,081.00" "$1,081.00" $19.58 $626.98 "$1,081.00" $20.20 $19.58 "$1,081.00" $19.58 N/A N/A 45000494 EAP CPT® 53600 DILATE URETHRA STRICT MALE INI BOTH IP/OP $687.00 $508.50 $63.18 $687.00 $687.00 $687.00 $687.00 $687.00 $63.18 $63.18 $64.05 $687.00 $63.18 $687.00 $687.00 $687.00 $687.00 $143.18 $101.09 $102.56 $687.00 $63.18 $64.10 $63.18 $687.00 $515.25 $63.18 $63.18 $63.18 $687.00 $343.50 $544.10 $63.18 $549.60 $687.00 $687.00 $63.18 $398.46 $687.00 $65.99 $63.18 $687.00 $63.18 N/A N/A 45000495 EAP CPT® 54001 DORSAL SLIT EXCEPT NEWBORN BOTH IP/OP "$6,453.00" "$4,775.50" $141.01 "$5,162.40" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,761.28" "$1,761.28" "$1,753.49" "$1,344.97" "$1,761.28" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,344.88" "$2,818.05" "$2,675.95" "$2,836.00" "$1,761.28" $141.01 "$1,761.28" "$1,849.35" "$4,839.75" "$1,761.28" "$1,761.28" "$1,761.28" "$2,851.00" "$2,423.00" "$5,110.78" "$1,761.28" "$5,162.40" "$3,250.00" "$1,280.76" "$1,761.28" "$3,742.74" "$1,849.35" "$2,548.13" "$1,761.28" "$1,344.81" "$1,761.28" N/A N/A 45000496 EAP CPT® 58301 REMOVAL IUD BOTH IP/OP $281.00 $208.00 $55.77 $443.89 $281.00 $281.00 $281.00 $281.00 $277.43 $277.43 $276.20 $58.57 $277.43 $281.00 $281.00 $281.00 $281.00 $58.56 $443.89 $421.19 $281.00 $277.43 $66.83 $277.43 $291.30 $210.75 $277.43 $277.43 $277.43 $281.00 $140.50 $222.55 $277.43 $224.80 $281.00 $55.77 $277.43 $162.98 $291.30 $281.00 $277.43 $58.56 $277.43 N/A N/A 45000499 EAP CPT® 69000 DRAIN EXTERNAL EAR LESION BOTH IP/OP $700.00 $518.00 $123.70 $700.00 $700.00 $700.00 $700.00 $700.00 $126.11 $126.11 $123.70 $700.00 $126.11 $700.00 $700.00 $700.00 $700.00 $145.89 $201.78 $203.30 $700.00 $126.11 $127.06 $126.11 $700.00 $525.00 $126.11 $126.11 $126.11 $700.00 $350.00 $554.40 $126.11 $560.00 $700.00 $700.00 $126.11 $406.00 $700.00 $125.07 $126.11 $700.00 $126.11 N/A N/A 45000501 EAP CPT® 28190 REMOVAL OF FOOT FOREIGN BODY BOTH IP/OP "$1,318.00" $975.50 $133.16 "$1,318.00" "$1,318.00" "$1,318.00" "$1,318.00" "$1,318.00" $612.13 $612.13 $609.42 $274.70 $612.13 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $274.69 $979.40 $936.25 "$1,318.00" $612.13 $133.16 $612.13 $642.73 $988.50 $612.13 $612.13 $612.13 "$1,318.00" $659.00 "$1,043.86" $612.13 "$1,054.40" "$1,318.00" $261.59 $612.13 $764.44 $642.73 $885.59 $612.13 $274.67 $612.13 N/A N/A 45000502 EAP CPT® 49451 REPLACE DUOD/JEJ TUBE PERC BOTH IP/OP "$2,862.00" "$2,118.00" $87.83 "$2,862.00" "$2,862.00" "$2,862.00" "$2,862.00" "$2,862.00" $88.96 $88.96 $89.07 "$2,862.00" $88.96 "$2,862.00" "$2,862.00" "$2,862.00" "$2,862.00" $596.47 $142.34 $140.53 "$2,862.00" $88.96 $87.83 $88.96 "$2,862.00" "$2,146.50" $88.96 $88.96 $88.96 "$2,762.00" "$1,431.00" "$2,266.70" $88.96 "$2,289.60" "$2,150.00" "$2,862.00" $88.96 "$1,659.96" "$2,862.00" $94.13 $88.96 "$2,862.00" $88.96 N/A N/A 45000505 EAP CPT® 25260 REPAIR FOREARM TENDON/MUSCLE BOTH IP/OP "$6,859.00" "$5,076.00" $647.32 "$6,859.00" "$6,859.00" "$6,859.00" "$6,859.00" "$6,859.00" $648.74 $648.74 $647.32 "$6,859.00" $648.74 "$6,859.00" "$6,859.00" "$6,859.00" "$6,859.00" "$1,429.49" "$1,037.98" "$1,043.46" "$6,859.00" $648.74 $652.16 $648.74 "$6,859.00" "$5,144.25" $648.74 $648.74 $648.74 "$4,417.00" "$3,429.50" "$5,432.33" $648.74 "$5,487.20" "$3,725.00" "$6,859.00" $648.74 "$3,978.22" "$6,859.00" $655.27 $648.74 "$6,859.00" $648.74 N/A N/A 45000506 EAP CPT® 42960 CONTROL THROAT BLEEDING BOTH IP/OP "$5,082.00" "$3,761.00" $163.35 "$5,082.00" "$5,082.00" "$5,082.00" "$5,082.00" "$5,082.00" $164.18 $164.18 $164.53 "$5,082.00" $164.18 "$5,082.00" "$5,082.00" "$5,082.00" "$5,082.00" "$1,059.14" $262.69 $261.36 "$5,082.00" $164.18 $163.35 $164.18 "$5,082.00" "$3,811.50" $164.18 $164.18 $164.18 "$2,762.00" "$2,541.00" "$4,024.94" $164.18 "$4,065.60" "$1,750.00" "$5,082.00" $164.18 "$2,947.56" "$5,082.00" $170.51 $164.18 "$5,082.00" $164.18 N/A N/A 45000508 EAP CPT® 25270 REPAIR FOREARM TENDON/MUSCLE BOTH IP/OP "$5,401.00" "$3,997.00" $505.73 "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" $505.73 $505.73 $505.84 "$5,401.00" $505.73 "$5,401.00" "$5,401.00" "$5,401.00" "$5,401.00" "$1,125.63" $809.17 $813.44 "$5,401.00" $505.73 $508.40 $505.73 "$5,401.00" "$4,050.75" $505.73 $505.73 $505.73 "$4,417.00" "$2,700.50" "$4,277.59" $505.73 "$4,320.80" "$3,725.00" "$5,401.00" $505.73 "$3,132.58" "$5,401.00" $511.45 $505.73 "$5,401.00" $505.73 N/A N/A 45000512 EAP CPT® 36425 VEIN ACCESS CUTDOWN > 1 YR BOTH IP/OP $399.00 $295.50 $39.68 $399.00 $399.00 $399.00 $399.00 $399.00 $40.48 $40.48 $40.82 $399.00 $40.48 $399.00 $399.00 $399.00 $399.00 $83.16 $64.77 $63.49 $399.00 $40.48 $39.68 $40.48 $399.00 $299.25 $40.48 $40.48 $40.48 $399.00 $199.50 $316.01 $40.48 $319.20 $399.00 $399.00 $40.48 $231.42 $399.00 $41.47 $40.48 $399.00 $40.48 N/A N/A 45000520 EAP Custom 45000520 SCREENED TO CLINIC BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 45000525 EAP CPT® 64420 INTERCOSTAL NERVE BLOCK BOTH IP/OP "$1,959.00" "$1,450.00" $58.64 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $59.47 $59.47 $59.96 "$1,959.00" $59.47 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 $95.15 $93.82 "$1,959.00" $59.47 $58.64 $59.47 "$1,959.00" "$1,469.25" $59.47 $59.47 $59.47 "$1,959.00" $979.50 "$1,551.53" $59.47 "$1,567.20" "$1,959.00" "$1,959.00" $59.47 "$1,136.22" "$1,959.00" $62.02 $59.47 "$1,959.00" $59.47 N/A N/A 45000526 EAP CPT® 64421 INTERCOSTAL NERVE BLOCK/MULTI BOTH IP/OP "$3,789.00" "$2,804.00" $24.41 "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" $25.08 $25.08 $25.29 "$3,789.00" $25.08 "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" $789.67 $40.13 $39.06 "$3,789.00" $25.08 $24.41 $25.08 "$3,789.00" "$2,841.75" $25.08 $25.08 $25.08 "$2,762.00" "$1,894.50" "$3,000.89" $25.08 "$3,031.20" "$2,150.00" "$3,789.00" $25.08 "$2,197.62" "$3,789.00" $26.33 $25.08 "$3,789.00" $25.08 N/A N/A 45000529 EAP CPT® 64400 TRIGEMINAL NERVE BLOCK BOTH IP/OP "$1,227.00" $908.00 $50.62 "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" $50.86 $50.86 $50.62 "$1,227.00" $50.86 "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" $255.72 $81.38 $81.44 "$1,227.00" $50.86 $50.90 $50.86 "$1,227.00" $920.25 $50.86 $50.86 $50.86 "$1,227.00" $613.50 $971.78 $50.86 $981.60 "$1,227.00" "$1,227.00" $50.86 $711.66 "$1,227.00" $51.91 $50.86 "$1,227.00" $50.86 N/A N/A 45000535 EAP CPT® 36569 INSERT PICC CATH BOTH IP/OP "$4,743.00" "$3,510.00" $93.29 "$4,743.00" "$4,743.00" "$4,743.00" "$4,743.00" "$4,743.00" $93.98 $93.98 $94.16 "$4,743.00" $93.98 "$4,743.00" "$4,743.00" "$4,743.00" "$4,743.00" $988.49 $150.37 $149.26 "$4,743.00" $93.98 $93.29 $93.98 "$4,743.00" "$3,557.25" $93.98 $93.98 $93.98 "$2,762.00" "$2,371.50" "$3,756.46" $93.98 "$3,794.40" "$2,500.00" "$4,743.00" "$1,383.25" "$2,750.94" "$4,743.00" $98.45 $93.98 "$4,743.00" $93.98 N/A N/A 45000536 EAP CPT® 54235 PENILE INJECTION BOTH IP/OP $898.00 $665.00 $74.25 $898.00 $487.61 $487.61 $487.61 $487.61 $261.76 $261.76 $260.60 $187.17 $261.76 $898.00 $898.00 $898.00 $882.37 $187.15 $418.81 $309.98 $113.00 $261.76 $74.25 $261.76 $274.85 $673.50 $261.76 $261.76 $261.76 $898.00 $449.00 $711.22 $261.76 $718.40 $898.00 $178.23 $261.76 $520.84 $274.85 $378.70 $261.76 $187.14 $261.76 N/A N/A 45000537 EAP CPT® 46320 REM. OF HEMORRHOID CLOT BOTH IP/OP "$6,695.00" "$4,954.50" $114.59 "$6,695.00" "$6,695.00" "$6,695.00" "$6,695.00" "$6,695.00" $115.25 $115.25 $114.81 "$6,695.00" $115.25 "$6,695.00" "$6,695.00" "$6,695.00" "$6,695.00" "$1,395.31" $184.40 $183.34 "$6,695.00" $115.25 $114.59 $115.25 "$6,695.00" "$5,021.25" $115.25 $115.25 $115.25 "$2,762.00" "$3,347.50" "$5,302.44" $115.25 "$5,356.00" "$2,500.00" "$6,695.00" $115.25 "$3,883.10" "$6,695.00" $116.07 $115.25 "$6,695.00" $115.25 N/A N/A 45000538 EAP CPT® 26735 OPEN TX OF PHALANGEAL SHAFT FX BOTH IP/OP "$8,714.00" "$6,448.50" $607.95 "$8,714.00" "$8,714.00" "$8,714.00" "$8,714.00" "$8,714.00" $607.95 $607.95 $608.91 "$8,714.00" $607.95 "$8,714.00" "$8,714.00" "$8,714.00" "$8,714.00" "$1,816.09" $972.72 $976.69 "$8,714.00" $607.95 $610.43 $607.95 "$8,714.00" "$6,535.50" $607.95 $607.95 $607.95 "$4,417.00" "$4,357.00" "$6,901.49" $607.95 "$6,971.20" "$3,250.00" "$8,714.00" $607.95 "$5,054.12" "$8,714.00" $616.70 $607.95 "$8,714.00" $607.95 N/A N/A 45000541 EAP CPT® 23665 TREAT DISLOCATION /FX BOTH IP/OP "$1,745.00" "$1,291.50" $363.68 "$1,745.00" "$1,745.00" "$1,745.00" "$1,745.00" "$1,745.00" $412.02 $412.02 $408.92 "$1,745.00" $412.02 "$1,745.00" "$1,745.00" "$1,745.00" "$1,745.00" $363.68 $659.23 $662.62 "$1,745.00" $412.02 $414.14 $412.02 "$1,745.00" "$1,308.75" $412.02 $412.02 $412.02 "$1,745.00" $872.50 "$1,382.04" $412.02 "$1,396.00" "$1,745.00" "$1,745.00" $412.02 "$1,012.10" "$1,745.00" $411.23 $412.02 "$1,745.00" $412.02 N/A N/A 45000542 EAP CPT® 40654 REPAIR LIP/COMPLEX BOTH IP/OP "$1,515.00" "$1,121.50" $315.74 "$1,515.00" "$1,515.00" "$1,515.00" "$1,515.00" "$1,515.00" $431.12 $431.12 $428.24 "$1,515.00" $431.12 "$1,515.00" "$1,515.00" "$1,515.00" "$1,515.00" $315.74 $689.79 $692.93 "$1,515.00" $431.12 $433.08 $431.12 "$1,515.00" "$1,136.25" $431.12 $431.12 $431.12 "$1,515.00" $757.50 "$1,199.88" $431.12 "$1,212.00" "$1,515.00" "$1,515.00" $431.12 $878.70 "$1,515.00" $438.31 $431.12 "$1,515.00" $431.12 N/A N/A 45000543 EAP CPT® 31530 LARYNGOSCOPY W/FB REM BOTH IP/OP "$7,908.00" "$5,852.00" $198.20 "$7,908.00" "$7,908.00" "$7,908.00" "$7,908.00" "$7,908.00" $200.27 $200.27 $198.20 "$7,908.00" $200.27 "$7,908.00" "$7,908.00" "$7,908.00" "$7,908.00" "$1,648.11" $320.43 $320.66 "$7,908.00" $200.27 $200.41 $200.27 "$7,908.00" "$5,931.00" $200.27 $200.27 $200.27 "$2,851.00" "$3,954.00" "$6,263.14" $200.27 "$6,326.40" "$2,500.00" "$7,908.00" $200.27 "$4,586.64" "$7,908.00" $205.51 $200.27 "$7,908.00" $200.27 N/A N/A 45000544 EAP CPT® 28435 TREATMENT OF ANKLE FX BOTH IP/OP "$1,516.00" "$1,122.00" $301.27 "$1,516.00" "$1,516.00" "$1,516.00" "$1,516.00" "$1,516.00" $337.02 $337.02 $301.27 "$1,516.00" $337.02 "$1,516.00" "$1,516.00" "$1,516.00" "$1,516.00" $315.95 $539.23 $543.82 "$1,516.00" $337.02 $339.89 $337.02 "$1,516.00" "$1,137.00" $337.02 $337.02 $337.02 "$1,516.00" $758.00 "$1,200.67" $337.02 "$1,212.80" "$1,516.00" "$1,516.00" $337.02 $879.28 "$1,516.00" $335.53 $337.02 "$1,516.00" $337.02 N/A N/A 45000545 EAP CPT® 23625 TREAT HUMERUS FX BOTH IP/OP "$7,014.00" "$5,190.50" $359.51 "$7,014.00" "$7,014.00" "$7,014.00" "$7,014.00" "$7,014.00" $363.30 $363.30 $359.51 "$7,014.00" $363.30 "$7,014.00" "$7,014.00" "$7,014.00" "$7,014.00" "$1,461.79" $581.28 $591.60 "$7,014.00" $363.30 $369.75 $363.30 "$7,014.00" "$5,260.50" $363.30 $363.30 $363.30 "$2,851.00" "$3,507.00" "$5,555.09" $363.30 "$5,611.20" "$2,500.00" "$7,014.00" $363.30 "$4,068.12" "$7,014.00" $364.38 $363.30 "$7,014.00" $363.30 N/A N/A 45000546 EAP CPT® 23545 TREAT CLAVICLE DISLOCATION BOTH IP/OP "$1,245.00" $921.50 $259.47 "$1,245.00" "$1,245.00" "$1,245.00" "$1,245.00" "$1,245.00" $325.96 $325.96 $320.72 "$1,245.00" $325.96 "$1,245.00" "$1,245.00" "$1,245.00" "$1,245.00" $259.47 $521.54 $538.40 "$1,245.00" $325.96 $336.50 $325.96 "$1,245.00" $933.75 $325.96 $325.96 $325.96 "$1,245.00" $622.50 $986.04 $325.96 $996.00 "$1,245.00" "$1,245.00" $325.96 $722.10 "$1,245.00" $321.47 $325.96 "$1,245.00" $325.96 N/A N/A 45000550 EAP CPT® 52332 CYSTO W URETER STENT PLCMNT BOTH IP/OP "$10,798.00" "$7,991.00" $154.28 "$10,798.00" "$10,798.00" "$10,798.00" "$10,798.00" "$10,798.00" $154.85 $154.85 $155.82 "$10,798.00" $154.85 "$10,798.00" "$10,798.00" "$10,798.00" "$10,798.00" "$2,250.42" $247.76 $246.85 "$10,798.00" $154.85 $154.28 $154.85 "$10,798.00" "$8,098.50" $154.85 $154.85 $154.85 "$2,851.00" "$5,399.00" "$8,552.02" $154.85 "$8,638.40" "$3,250.00" "$10,798.00" $154.85 "$6,262.84" "$10,798.00" $160.82 $154.85 "$10,798.00" $154.85 N/A N/A 45000560 EAP CPT® 24535 TREAT HUMERUS FX BOTH IP/OP "$1,745.00" "$1,291.50" $363.68 "$1,745.00" "$1,745.00" "$1,745.00" "$1,745.00" "$1,745.00" $584.01 $584.01 $586.13 "$1,745.00" $584.01 "$1,745.00" "$1,745.00" "$1,745.00" "$1,745.00" $363.68 $934.42 $942.03 "$1,745.00" $584.01 $588.77 $584.01 "$1,745.00" "$1,308.75" $584.01 $584.01 $584.01 "$1,745.00" $872.50 "$1,382.04" $584.01 "$1,396.00" "$1,745.00" "$1,745.00" $584.01 "$1,012.10" "$1,745.00" $588.94 $584.01 "$1,745.00" $584.01 N/A N/A 45000561 EAP CPT® 24640 TREAT ELBOW DIS/NURSEMAID BOTH IP/OP $615.00 $455.50 $80.93 $615.00 $615.00 $615.00 $615.00 $615.00 $81.99 $81.99 $80.93 $615.00 $81.99 $615.00 $615.00 $615.00 $615.00 $128.17 $131.18 $129.55 $615.00 $81.99 $80.97 $81.99 $615.00 $461.25 $81.99 $81.99 $81.99 $615.00 $307.50 $487.08 $81.99 $492.00 $615.00 $615.00 $81.99 $356.70 $615.00 $81.48 $81.99 $615.00 $81.99 N/A N/A 45000562 EAP CPT® 28405 TREAT HEEL FX BOTH IP/OP "$5,013.00" "$3,710.00" $359.75 "$5,013.00" "$5,013.00" "$5,013.00" "$5,013.00" "$5,013.00" $359.75 $359.75 $363.11 "$5,013.00" $359.75 "$5,013.00" "$5,013.00" "$5,013.00" "$5,013.00" "$1,044.76" $575.60 $670.80 "$5,013.00" $359.75 $419.25 $359.75 "$5,013.00" "$3,759.75" $359.75 $359.75 $359.75 "$2,851.00" "$2,506.50" "$3,970.30" $359.75 "$4,010.40" "$2,150.00" "$5,013.00" $359.75 "$2,907.54" "$5,013.00" $363.35 $359.75 "$5,013.00" $359.75 N/A N/A 45000563 EAP CPT® 40831 REPAIR MOUTH LACERATIONS BOTH IP/OP "$2,115.00" "$1,565.50" $203.94 "$2,115.00" "$2,115.00" "$2,115.00" "$2,115.00" "$2,115.00" $211.51 $211.51 $232.09 "$2,115.00" $211.51 "$2,115.00" "$2,115.00" "$2,115.00" "$2,115.00" $440.79 $338.42 $326.30 "$2,115.00" $211.51 $203.94 $211.51 "$2,115.00" "$1,586.25" $211.51 $211.51 $211.51 "$2,115.00" "$1,057.50" "$1,675.08" $211.51 "$1,692.00" "$2,115.00" "$2,115.00" $211.51 "$1,226.70" "$2,115.00" $239.31 $211.51 "$2,115.00" $211.51 N/A N/A 45000564 EAP CPT® 23675 TREAT DISLOCATION/FRACTURE BOTH IP/OP "$1,500.00" "$1,110.00" $312.62 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $514.42 $514.42 $512.23 "$1,500.00" $514.42 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 $823.07 $825.97 "$1,500.00" $514.42 $516.23 $514.42 "$1,500.00" "$1,125.00" $514.42 $514.42 $514.42 "$1,500.00" $750.00 "$1,188.00" $514.42 "$1,200.00" "$1,500.00" "$1,500.00" $514.42 $870.00 "$1,500.00" $521.17 $514.42 "$1,500.00" $514.42 N/A N/A 45000565 EAP CPT® 20101 EXPLORATION OF PENETRATING WOUND (CHEST) BOTH IP/OP "$2,635.00" "$1,950.00" $212.75 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $214.76 $214.76 $213.92 "$2,635.00" $214.76 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 $343.62 $340.40 "$2,635.00" $214.76 $212.75 $214.76 "$2,635.00" "$1,976.25" $214.76 $214.76 $214.76 "$2,635.00" "$1,317.50" "$2,086.92" $214.76 "$2,108.00" "$2,500.00" "$2,635.00" $214.76 "$1,528.30" "$2,635.00" $219.88 $214.76 "$2,635.00" $214.76 N/A N/A 45000571 EAP CPT® 90792 PSYCH DIAG EVAL W/MED SRVCS BOTH IP/OP $482.00 $357.00 $95.66 $482.00 $261.73 $261.73 $261.73 $261.73 $131.62 $131.62 $131.03 $100.46 $131.62 $482.00 $482.00 $482.00 $482.00 $100.45 $210.59 $210.20 $285.10 $131.62 $172.19 $131.62 $138.20 $361.50 $131.62 $131.62 $131.62 $241.00 $241.00 $381.74 $131.62 $385.60 $313.30 $95.66 $131.62 $279.56 $138.20 $190.41 $131.62 $482.00 $131.62 N/A N/A 45000572 EAP CPT® 90863 PHARMA MGMT INC PRESCPT/MED REVIEW W PSYTX (ADD-ON) BOTH IP/OP $331.00 $245.00 $24.63 $331.00 $331.00 $331.00 $331.00 $331.00 $331.00 $331.00 $24.63 $331.00 $331.00 $331.00 $331.00 $331.00 $331.00 $68.98 $331.00 $132.40 $331.00 $331.00 $331.00 $331.00 $331.00 $248.25 $331.00 $331.00 $331.00 $165.50 $165.50 $262.15 $331.00 $264.80 $215.15 $331.00 $331.00 $191.98 $331.00 $198.60 $331.00 $331.00 $331.00 N/A N/A 45000575 EAP CPT® 27781 TREATMENT FIBULA FRACTURE BOTH IP/OP "$6,599.00" "$4,883.50" $410.12 "$6,599.00" "$6,599.00" "$6,599.00" "$6,599.00" "$6,599.00" $413.81 $413.81 $410.12 "$6,599.00" $413.81 "$6,599.00" "$6,599.00" "$6,599.00" "$6,599.00" "$1,375.30" $662.10 $669.66 "$6,599.00" $413.81 $418.54 $413.81 "$6,599.00" "$4,949.25" $413.81 $413.81 $413.81 "$2,762.00" "$3,299.50" "$5,226.41" $413.81 "$5,279.20" "$2,150.00" "$6,599.00" $413.81 "$3,827.42" "$6,599.00" $413.39 $413.81 "$6,599.00" $413.81 N/A N/A 45000576 EAP CPT® 45900 REDUCTION OF RECTAL PROLAPSE BOTH IP/OP "$1,534.00" "$1,135.50" $216.43 "$1,534.00" "$1,534.00" "$1,534.00" "$1,534.00" "$1,534.00" $217.39 $217.39 $217.17 "$1,534.00" $217.39 "$1,534.00" "$1,534.00" "$1,534.00" "$1,534.00" $319.70 $347.82 $346.29 "$1,534.00" $217.39 $216.43 $217.39 "$1,534.00" "$1,150.50" $217.39 $217.39 $217.39 "$1,534.00" $767.00 "$1,214.93" $217.39 "$1,227.20" "$1,534.00" "$1,534.00" $217.39 $889.72 "$1,534.00" $221.31 $217.39 "$1,534.00" $217.39 N/A N/A 45000580 EAP Custom 45000580 I & D COMPLEX POST OP WOUND INF BOTH IP/OP "$6,628.00" "$4,905.00" "$1,179.78" "$6,628.00" "$6,628.00" "$6,628.00" "$6,628.00" "$6,628.00" "$6,628.00" "$6,628.00" "$1,179.78" "$6,628.00" "$6,628.00" "$6,628.00" "$6,628.00" "$6,628.00" "$6,628.00" "$1,381.35" "$6,628.00" "$2,651.20" "$6,628.00" "$6,628.00" "$6,628.00" "$6,628.00" "$6,628.00" "$4,971.00" "$6,628.00" "$6,628.00" "$6,628.00" "$3,314.00" "$3,314.00" "$5,249.38" "$6,628.00" "$5,302.40" "$4,308.20" "$6,628.00" "$6,628.00" "$3,844.24" "$6,628.00" "$3,976.80" "$6,628.00" "$6,628.00" "$6,628.00" N/A N/A 45000581 EAP CPT® 21451 CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION BOTH IP/OP "$5,346.00" "$3,956.50" $650.13 "$5,346.00" "$5,346.00" "$5,346.00" "$5,346.00" "$5,346.00" $666.71 $666.71 $667.78 "$5,346.00" $666.71 "$5,346.00" "$5,346.00" "$5,346.00" "$5,346.00" "$1,114.17" "$1,066.74" "$1,045.49" "$5,346.00" $666.71 $653.43 $666.71 "$5,346.00" "$4,009.50" $666.71 $666.71 $666.71 "$4,417.00" "$2,673.00" "$4,234.03" $666.71 "$4,276.80" "$2,500.00" "$5,346.00" $666.71 "$3,100.68" "$5,346.00" $650.13 $666.71 "$5,346.00" $666.71 N/A N/A 45000584 EAP Custom 45000584 I & D FLOOR MOUTH SUB MANDIBULAR BOTH IP/OP "$1,227.00" $908.00 $218.41 "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" $218.41 "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" $255.72 "$1,227.00" $490.80 "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" $920.25 "$1,227.00" "$1,227.00" "$1,227.00" $613.50 $613.50 $971.78 "$1,227.00" $981.60 $797.55 "$1,227.00" "$1,227.00" $711.66 "$1,227.00" $736.20 "$1,227.00" "$1,227.00" "$1,227.00" N/A N/A 45000585 EAP CPT® 13102 "REPAIR,COMPLEX,TRUNK,EACH ADDITIONAL 5CM OR LESS" BOTH IP/OP "$3,100.00" "$2,294.00" $71.90 "$3,100.00" "$3,100.00" "$3,100.00" "$3,100.00" "$3,100.00" $72.65 $72.65 $72.94 "$3,100.00" $72.65 "$3,100.00" "$3,100.00" "$3,100.00" "$3,100.00" $646.07 $116.24 $115.04 "$3,100.00" $72.65 $71.90 $72.65 "$3,100.00" "$2,325.00" $72.65 $72.65 $72.65 "$2,762.00" "$1,550.00" "$2,455.20" $72.65 "$2,480.00" "$1,750.00" "$3,100.00" $72.65 "$1,798.00" "$3,100.00" $75.71 $72.65 "$3,100.00" $72.65 N/A N/A 45000589 EAP CPT® 41016 "I&D MOUTH FLOOR LES, ABCESS,CYST, HEMAT" BOTH IP/OP "$5,296.00" "$3,919.50" $349.57 "$5,296.00" "$5,296.00" "$5,296.00" "$5,296.00" "$5,296.00" $353.24 $353.24 $355.76 "$5,296.00" $353.24 "$5,296.00" "$5,296.00" "$5,296.00" "$5,296.00" "$1,103.74" $565.18 $559.31 "$5,296.00" $353.24 $349.57 $353.24 "$5,296.00" "$3,972.00" $353.24 $353.24 $353.24 "$2,762.00" "$2,648.00" "$4,194.43" $353.24 "$4,236.80" "$3,250.00" "$5,296.00" $353.24 "$3,071.68" "$5,296.00" $357.56 $353.24 "$5,296.00" $353.24 N/A N/A 45000590 EAP CPT® 27265 TREAT HIP DISLOCATION BOTH IP/OP $891.00 $659.50 $185.69 $891.00 $891.00 $891.00 $891.00 $891.00 $421.00 $421.00 $415.56 $891.00 $421.00 $891.00 $891.00 $891.00 $891.00 $185.69 $673.60 $687.18 $891.00 $421.00 $429.49 $421.00 $891.00 $668.25 $421.00 $421.00 $421.00 $891.00 $445.50 $705.67 $421.00 $712.80 $891.00 $891.00 $421.00 $516.78 $891.00 $420.27 $421.00 $891.00 $421.00 N/A N/A 45000592 EAP CPT® 41016 "I&D,FLOOR OF MOUTH-SUBMENTAL" BOTH IP/OP "$5,549.00" "$4,106.50" $349.57 "$5,549.00" "$5,549.00" "$5,549.00" "$5,549.00" "$5,549.00" $353.24 $353.24 $355.76 "$5,549.00" $353.24 "$5,549.00" "$5,549.00" "$5,549.00" "$5,549.00" "$1,156.47" $565.18 $559.31 "$5,549.00" $353.24 $349.57 $353.24 "$5,549.00" "$4,161.75" $353.24 $353.24 $353.24 "$2,762.00" "$2,774.50" "$4,394.81" $353.24 "$4,439.20" "$3,250.00" "$5,549.00" $353.24 "$3,218.42" "$5,549.00" $357.56 $353.24 "$5,549.00" $353.24 N/A N/A 45000593 EAP CPT® 21320 CLOSED TX NOSE FX W/STABJ BOTH IP/OP "$4,437.00" "$3,283.50" $95.96 "$4,437.00" "$4,437.00" "$4,437.00" "$4,437.00" "$4,437.00" $96.38 $96.38 $135.44 "$4,437.00" $96.38 "$4,437.00" "$4,437.00" "$4,437.00" "$4,437.00" $924.72 $154.21 $153.54 "$4,437.00" $96.38 $95.96 $96.38 "$4,437.00" "$3,327.75" $96.38 $96.38 $96.38 "$2,851.00" "$2,218.50" "$3,514.10" $96.38 "$3,549.60" "$2,500.00" "$4,437.00" $96.38 "$2,573.46" "$4,437.00" $137.70 $96.38 "$4,437.00" $96.38 N/A N/A 45000594 EAP CPT® 21453 REDUCE MANDIBULAR INTERDENTAL BOTH IP/OP "$8,688.00" "$6,429.50" "$1,546.46" "$8,688.00" "$8,688.00" "$8,688.00" "$8,688.00" "$8,688.00" "$8,688.00" "$8,688.00" "$1,546.46" "$8,688.00" "$8,688.00" "$8,688.00" "$8,688.00" "$8,688.00" "$8,688.00" "$1,810.67" "$8,688.00" "$3,475.20" "$8,688.00" "$8,688.00" "$8,688.00" "$8,688.00" "$8,688.00" "$6,516.00" "$8,688.00" "$8,688.00" "$8,688.00" "$4,344.00" "$4,344.00" "$6,880.90" "$8,688.00" "$6,950.40" "$5,647.20" "$8,688.00" "$8,688.00" "$5,039.04" "$8,688.00" "$5,212.80" "$8,688.00" "$8,688.00" "$8,688.00" N/A N/A 45000595 EAP CPT® 11012 DEB SKIN BONE AT FX SITE BOTH IP/OP "$8,257.00" "$6,110.50" $418.88 "$8,257.00" "$8,257.00" "$8,257.00" "$8,257.00" "$8,257.00" $418.88 $418.88 $420.78 "$8,257.00" $418.88 "$8,257.00" "$8,257.00" "$8,257.00" "$8,257.00" "$1,720.85" $670.21 $670.29 "$8,257.00" $418.88 $418.93 $418.88 "$8,257.00" "$6,192.75" $418.88 $418.88 $418.88 "$2,851.00" "$4,128.50" "$6,539.54" $418.88 "$6,605.60" "$2,150.00" "$8,257.00" $418.88 "$4,789.06" "$8,257.00" $435.86 $418.88 "$8,257.00" $418.88 N/A N/A 45000598 EAP CPT® 25624 CLOSED TREATMENT OF CARPAL SCAPHOID FRACTURE WITH MANIPULATION BOTH IP/OP "$2,265.00" "$1,676.50" $455.18 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $459.21 $459.21 $455.84 "$2,265.00" $459.21 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 $734.74 $739.54 "$2,265.00" $459.21 $462.21 $459.21 "$2,265.00" "$1,698.75" $459.21 $459.21 $459.21 "$2,265.00" "$1,132.50" "$1,793.88" $459.21 "$1,812.00" "$2,150.00" "$2,265.00" $459.21 "$1,313.70" "$2,265.00" $455.18 $459.21 "$2,265.00" $459.21 N/A N/A 45000599 EAP CPT® 28825 "AMPUTATION TOE, INTERPHALANGEAL JOINT" BOTH IP/OP "$5,435.00" "$4,022.00" $173.28 "$5,435.00" "$5,435.00" "$5,435.00" "$5,435.00" "$5,435.00" $175.07 $175.07 $177.50 "$5,435.00" $175.07 "$5,435.00" "$5,435.00" "$5,435.00" "$5,435.00" "$1,132.71" $280.11 $277.25 "$5,435.00" $175.07 $173.28 $175.07 "$5,435.00" "$4,076.25" $175.07 $175.07 $175.07 "$2,851.00" "$2,717.50" "$4,304.52" $175.07 "$4,348.00" "$3,250.00" "$5,435.00" $175.07 "$3,152.30" "$5,435.00" $382.13 $175.07 "$5,435.00" $175.07 N/A N/A 45000600 EAP CPT® 28495 CLOSED FRACTURE TREATMENT OF GREAT TOE OR PHALANX BOTH IP/OP $588.00 $435.50 $122.55 $588.00 $588.00 $588.00 $588.00 $588.00 $151.77 $151.77 $150.00 $588.00 $151.77 $588.00 $588.00 $588.00 $588.00 $122.55 $242.83 $243.87 $588.00 $151.77 $152.42 $151.77 $588.00 $441.00 $151.77 $151.77 $151.77 $588.00 $294.00 $465.70 $151.77 $470.40 $588.00 $588.00 $151.77 $341.04 $588.00 $153.18 $151.77 $588.00 $151.77 N/A N/A 45000606 EAP CPT® 28505 "OPEN TX, INTERNAL FIXATION GRT TOE FX" BOTH IP/OP "$6,418.00" "$4,749.50" $501.92 "$6,418.00" "$6,418.00" "$6,418.00" "$6,418.00" "$6,418.00" $505.84 $505.84 $504.21 "$6,418.00" $505.84 "$6,418.00" "$6,418.00" "$6,418.00" "$6,418.00" "$1,337.58" $809.34 $803.07 "$6,418.00" $505.84 $501.92 $505.84 "$6,418.00" "$4,813.50" $505.84 $505.84 $505.84 "$3,500.00" "$3,209.00" "$5,083.06" $505.84 "$5,134.40" "$3,250.00" "$6,418.00" $505.84 "$3,722.44" "$6,418.00" $516.24 $505.84 "$6,418.00" $505.84 N/A N/A 45000607 EAP CPT® 40652 REPAIR LIP BOTH IP/OP "$2,180.00" "$1,613.50" $362.13 "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" $363.93 $363.93 $362.13 "$2,180.00" $363.93 "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" $454.34 $582.29 $588.32 "$2,180.00" $363.93 $367.70 $363.93 "$2,180.00" "$1,635.00" $363.93 $363.93 $363.93 "$2,180.00" "$1,090.00" "$1,726.56" $363.93 "$1,744.00" "$2,150.00" "$2,180.00" $363.93 "$1,264.40" "$2,180.00" $368.37 $363.93 "$2,180.00" $363.93 N/A N/A 45000608 EAP CPT® 26952 AMPUTATION OF FINGER/THUMB BOTH IP/OP "$6,468.00" "$4,786.50" "$1,151.30" "$6,468.00" "$6,468.00" "$6,468.00" "$6,468.00" "$6,468.00" "$6,468.00" "$6,468.00" "$1,151.30" "$6,468.00" "$6,468.00" "$6,468.00" "$6,468.00" "$6,468.00" "$6,468.00" "$1,348.00" "$6,468.00" "$2,587.20" "$6,468.00" "$6,468.00" "$6,468.00" "$6,468.00" "$6,468.00" "$4,851.00" "$6,468.00" "$6,468.00" "$6,468.00" "$3,234.00" "$3,234.00" "$5,122.66" "$6,468.00" "$5,174.40" "$4,204.20" "$6,468.00" "$6,468.00" "$3,751.44" "$6,468.00" "$3,880.80" "$6,468.00" "$6,468.00" "$6,468.00" N/A N/A 45000609 EAP CPT® 51102 DRAIN BL W/CATH INSERTION BOTH IP/OP "$5,564.00" "$4,117.50" $143.08 "$5,564.00" "$5,564.00" "$5,564.00" "$5,564.00" "$5,564.00" $144.64 $144.64 $145.88 "$5,564.00" $144.64 "$5,564.00" "$5,564.00" "$5,564.00" "$5,564.00" "$1,159.60" $231.42 $228.93 "$5,564.00" $144.64 $143.08 $144.64 "$5,564.00" "$4,173.00" $144.64 $144.64 $144.64 "$2,762.00" "$2,782.00" "$4,406.69" $144.64 "$4,451.20" "$3,250.00" "$5,564.00" $144.64 "$3,227.12" "$5,564.00" $151.45 $144.64 "$5,564.00" $144.64 N/A N/A 45000610 EAP CPT® 57200 REPAIR OF VAGINA BOTH IP/OP "$5,461.00" "$4,041.50" $330.55 "$5,461.00" "$5,461.00" "$5,461.00" "$5,461.00" "$5,461.00" $341.57 $341.57 $334.75 "$5,461.00" $341.57 "$5,461.00" "$5,461.00" "$5,461.00" "$5,461.00" "$1,138.13" $546.51 $541.22 "$5,461.00" $341.57 $338.26 $341.57 "$5,461.00" "$4,095.75" $341.57 $341.57 $341.57 "$2,762.00" "$2,730.50" "$4,325.11" $341.57 "$4,368.80" "$3,250.00" "$5,461.00" $341.57 "$3,167.38" "$5,461.00" $330.55 $341.57 "$5,461.00" $341.57 N/A N/A 45000611 EAP CPT® 27532 TX FX TIBIAL PROX W/ OR W/O MANIP W/TRACT CLOSED BOTH IP/OP "$5,978.00" "$4,424.00" $590.42 "$5,978.00" "$5,978.00" "$5,978.00" "$5,978.00" "$5,978.00" $593.35 $593.35 $590.42 "$5,978.00" $593.35 "$5,978.00" "$5,978.00" "$5,978.00" "$5,978.00" "$1,245.88" $949.36 $951.94 "$5,978.00" $593.35 $594.96 $593.35 "$5,978.00" "$4,483.50" $593.35 $593.35 $593.35 "$2,762.00" "$2,989.00" "$4,734.58" $593.35 "$4,782.40" "$2,500.00" "$5,978.00" $593.35 "$3,467.24" "$5,978.00" $599.41 $593.35 "$5,978.00" $593.35 N/A N/A 45000612 EAP Custom 45000612 LEVEL 3 PARTIAL TRAUMA ACTIVATION W/O PRENOTIFICAT BOTH IP/OP "$7,507.00" "$5,555.50" "$1,336.25" "$8,258.00" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$1,336.25" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$7,507.00" "$1,564.54" "$7,507.00" "$3,303.20" "$7,507.00" "$7,507.00" "$8,258.00" "$7,507.00" "$7,507.00" "$5,630.25" "$7,507.00" "$7,507.00" "$7,507.00" "$3,753.50" "$3,753.50" "$5,945.54" "$7,507.00" "$6,005.60" "$4,879.55" "$7,507.00" "$7,507.00" "$4,354.06" "$7,507.00" "$4,504.20" "$7,507.00" "$7,507.00" "$7,507.00" N/A N/A 45000613 EAP CPT® 41007 DRAINAGE OF MOUTH LESION BOTH IP/OP "$2,500.00" "$1,850.00" $221.76 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $221.76 $221.76 $224.33 "$2,500.00" $221.76 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 $354.82 $356.14 "$2,500.00" $221.76 $222.59 $221.76 "$2,500.00" "$1,875.00" $221.76 $221.76 $221.76 "$2,500.00" "$1,250.00" "$1,980.00" $221.76 "$2,000.00" "$2,500.00" "$2,500.00" $221.76 "$1,450.00" "$2,500.00" $239.37 $221.76 "$2,500.00" $221.76 N/A N/A 45000620 EAP CPT® 20650 INSERT AND REMOVE BONE PIN BOTH IP/OP "$6,356.00" "$4,703.50" $160.69 "$6,356.00" "$6,356.00" "$6,356.00" "$6,356.00" "$6,356.00" $163.45 $163.45 $160.69 "$6,356.00" $163.45 "$6,356.00" "$6,356.00" "$6,356.00" "$6,356.00" "$1,324.66" $261.52 $265.73 "$6,356.00" $163.45 $166.08 $163.45 "$6,356.00" "$4,767.00" $163.45 $163.45 $163.45 "$3,500.00" "$3,178.00" "$5,033.95" $163.45 "$5,084.80" "$3,725.00" "$6,356.00" $163.45 "$3,686.48" "$6,356.00" $163.66 $163.45 "$6,356.00" $163.45 N/A N/A 45000630 EAP CPT® 27768 CLSD TX POST ANKLE FX W/MANIP BOTH IP/OP "$3,336.00" "$2,469.00" $458.04 "$3,336.00" "$3,336.00" "$3,336.00" "$3,336.00" "$3,336.00" $459.74 $459.74 $458.04 "$3,336.00" $459.74 "$3,336.00" "$3,336.00" "$3,336.00" "$3,336.00" $695.26 $735.58 $740.72 "$3,336.00" $459.74 $462.95 $459.74 "$3,336.00" "$2,502.00" $459.74 $459.74 $459.74 "$2,762.00" "$1,668.00" "$2,642.11" $459.74 "$2,668.80" "$1,750.00" "$3,336.00" $459.74 "$1,934.88" "$3,336.00" $459.88 $459.74 "$3,336.00" $459.74 N/A N/A 45000634 EAP CPT® 61107 TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE BOTH IP/OP "$4,189.00" "$3,100.00" $312.73 "$4,189.00" "$4,189.00" "$4,189.00" "$4,189.00" "$4,189.00" $312.73 $312.73 $314.40 "$4,189.00" $312.73 "$4,189.00" "$4,189.00" "$4,189.00" "$4,189.00" $873.03 $500.37 $508.40 "$4,189.00" $312.73 $317.75 $312.73 "$4,189.00" "$3,141.75" $312.73 $312.73 $312.73 "$2,762.00" "$2,094.50" "$3,317.69" $312.73 "$3,351.20" "$2,722.85" "$4,189.00" $312.73 "$2,429.62" "$4,189.00" $327.27 $312.73 "$4,189.00" $312.73 N/A N/A 45000635 EAP CPT® 99281 COMPLETED MSE BOTH IP/OP $564.00 $417.50 $11.88 $564.00 $564.00 $564.00 $564.00 $564.00 $21.97 $21.97 $22.16 $564.00 $21.97 $564.00 $564.00 $564.00 $564.00 $117.54 $35.15 $19.01 $564.00 $21.97 $11.88 $21.97 $564.00 $423.00 $21.97 $21.97 $21.97 $282.00 $282.00 $446.69 $21.97 $451.20 $564.00 $564.00 $21.97 $327.12 $564.00 $23.08 $21.97 $564.00 $21.97 N/A N/A 46000001 EAP CPT® 94010 SPIRO LUNG VOL/PF BOTH IP/OP $685.00 $507.00 $18.94 $548.00 $371.96 $371.96 $371.96 $371.96 $137.34 $137.34 $136.73 $142.77 $137.34 $508.41 $508.41 $528.00 $356.89 $142.76 $219.74 $209.80 $405.18 $137.34 $18.94 $137.34 $144.20 $513.75 $137.34 $137.34 $137.34 $342.50 $342.50 $542.52 $137.34 $548.00 $445.25 $135.96 $137.34 $397.30 $144.20 $198.69 $137.34 $142.75 $137.34 N/A N/A 46000006 EAP CPT® 94060 BRONCHOSPASM EVAL PRE AND POST BOTH IP/OP $784.00 $580.50 $28.75 $627.20 $425.71 $425.71 $425.71 $425.71 $260.33 $260.33 $259.18 $163.41 $260.33 $581.88 $581.88 $604.31 $408.46 $163.39 $416.53 $404.03 $463.74 $260.33 $28.75 $260.33 $273.35 $588.00 $260.33 $260.33 $260.33 $392.00 $392.00 $620.93 $260.33 $627.20 $509.60 $155.60 $260.33 $454.72 $273.35 $376.64 $260.33 $163.39 $260.33 N/A N/A 46000007 EAP CPT® 94060 SPIROMETRY PRE & POST BOTH IP/OP $784.00 $580.50 $28.75 $627.20 $425.71 $425.71 $425.71 $425.71 $260.33 $260.33 $259.18 $163.41 $260.33 $581.88 $581.88 $604.31 $408.46 $163.39 $416.53 $404.03 $463.74 $260.33 $28.75 $260.33 $273.35 $588.00 $260.33 $260.33 $260.33 $392.00 $392.00 $620.93 $260.33 $627.20 $509.60 $155.60 $260.33 $454.72 $273.35 $376.64 $260.33 $163.39 $260.33 N/A N/A 46000010 EAP CPT® 94070 BRONCHOPROVOCATION BOTH IP/OP "$1,441.00" "$1,066.50" $34.16 "$1,152.80" $782.46 $782.46 $782.46 $782.46 $260.33 $260.33 $259.18 $300.34 $260.33 "$1,069.51" "$1,069.51" "$1,110.72" $750.76 $300.32 $416.53 $404.03 $852.35 $260.33 $34.16 $260.33 $273.35 "$1,080.75" $260.33 $260.33 $260.33 $720.50 $720.50 "$1,141.27" $260.33 "$1,152.80" $936.65 $286.00 $260.33 $835.78 $273.35 $376.64 $260.33 $300.30 $260.33 N/A N/A 46000012 EAP CPT® 94150 PEAK FLOW DETERMINATION BOTH IP/OP $267.00 $198.00 $25.36 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $267.00 $25.36 $267.00 $267.00 $198.17 $198.17 $205.80 $139.11 $55.65 $267.00 $106.80 $267.00 $267.00 $267.00 $267.00 $267.00 $200.25 $267.00 $267.00 $267.00 $133.50 $133.50 $211.46 $267.00 $213.60 $173.55 $267.00 $267.00 $154.86 $267.00 $160.20 $267.00 $267.00 $267.00 N/A N/A 46000015 EAP CPT® 94200 MAX VOLUME VENTILATION (MVV) BOTH IP/OP $109.00 $81.00 $12.18 $109.00 $109.00 $109.00 $109.00 $109.00 $12.40 $12.40 $18.05 $109.00 $12.40 $80.90 $80.90 $84.02 $56.79 $22.72 $19.84 $19.49 $109.00 $12.40 $12.18 $12.40 $109.00 $81.75 $12.40 $12.40 $12.40 $54.50 $54.50 $86.33 $12.40 $87.20 $70.85 $109.00 $54.76 $63.22 $109.00 $18.01 $12.40 $109.00 $12.40 N/A N/A 46000027 EAP CPT® 94375 "MAXFLW-VOL CURVES, I+R" BOTH IP/OP $266.00 $197.00 $24.36 $416.53 $144.44 $144.44 $144.44 $144.44 $260.33 $260.33 $259.18 $55.44 $260.33 $197.43 $197.43 $205.03 $138.59 $55.44 $416.53 $404.03 $157.34 $260.33 $24.36 $260.33 $273.35 $199.50 $260.33 $260.33 $260.33 $133.00 $133.00 $210.67 $260.33 $212.80 $172.90 $52.79 $260.33 $154.28 $273.35 $266.00 $260.33 $55.43 $260.33 N/A N/A 46000030 EAP CPT® 94450 HYPOXIC RESPONSE CURVE BOTH IP/OP $219.00 $162.50 $45.64 $219.00 $219.00 $219.00 $219.00 $219.00 $47.25 $47.25 $62.23 $219.00 $47.25 $162.54 $162.54 $168.81 $114.10 $45.64 $75.60 $101.20 $219.00 $47.25 $63.25 $47.25 $219.00 $164.25 $47.25 $47.25 $47.25 $109.50 $109.50 $173.45 $47.25 $175.20 $142.35 $219.00 $47.25 $127.02 $219.00 $48.26 $47.25 $219.00 $47.25 N/A N/A 46000031 EAP CPT® 94618 SIX MINUTE WALK(PULM STRESS SIMPLE) BOTH IP/OP $311.00 $230.50 $11.84 $248.80 $168.87 $168.87 $168.87 $168.87 $110.92 $110.92 $110.43 $64.82 $110.92 $230.82 $230.82 $239.72 $162.03 $64.82 $177.47 $167.51 $183.96 $110.92 $11.84 $110.92 $116.46 $233.25 $110.92 $110.92 $110.92 $155.50 $155.50 $246.31 $110.92 $248.80 $202.15 $61.73 $110.92 $180.38 $116.46 $160.47 $110.92 $64.81 $110.92 N/A N/A 46000033 EAP CPT® 94680 02 ANAL BOTH IP/OP $150.00 $111.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $40.72 $40.72 $53.93 $150.00 $40.72 $111.33 $111.33 $115.62 $78.15 $31.26 $65.15 $64.96 $150.00 $40.72 $40.60 $40.72 $150.00 $112.50 $40.72 $40.72 $40.72 $75.00 $75.00 $118.80 $40.72 $120.00 $97.50 $150.00 $40.72 $87.00 $150.00 $41.42 $40.72 $150.00 $40.72 N/A N/A 46000035 EAP CPT® 94681 ET/CO2 OXYGEN UPTAKE BOTH IP/OP "$1,529.00" "$1,131.50" $37.89 "$1,529.00" "$1,529.00" "$1,529.00" "$1,529.00" "$1,529.00" $39.34 $39.34 $51.84 "$1,529.00" $39.34 "$1,134.82" "$1,134.82" "$1,178.55" $796.61 $318.66 $62.94 $60.62 "$1,529.00" $39.34 $37.89 $39.34 "$1,529.00" "$1,146.75" $39.34 $39.34 $39.34 $764.50 $764.50 "$1,210.97" $39.34 "$1,223.20" $993.85 "$1,529.00" $39.34 $886.82 "$1,529.00" $43.22 $39.34 "$1,529.00" $39.34 N/A N/A 46000037 EAP CPT® 94681 MET CART V02 BOTH IP/OP "$1,529.00" "$1,131.50" $37.89 "$1,529.00" "$1,529.00" "$1,529.00" "$1,529.00" "$1,529.00" $39.34 $39.34 $51.84 "$1,529.00" $39.34 "$1,134.82" "$1,134.82" "$1,178.55" $796.61 $318.66 $62.94 $60.62 "$1,529.00" $39.34 $37.89 $39.34 "$1,529.00" "$1,146.75" $39.34 $39.34 $39.34 $764.50 $764.50 "$1,210.97" $39.34 "$1,223.20" $993.85 "$1,529.00" $39.34 $886.82 "$1,529.00" $43.22 $39.34 "$1,529.00" $39.34 N/A N/A 46000039 EAP CPT® 94681 O2 UPTAKE INCL CO2 OUTPUT BOTH IP/OP $279.00 $206.50 $37.89 $279.00 $279.00 $279.00 $279.00 $279.00 $39.34 $39.34 $51.84 $279.00 $39.34 $207.07 $207.07 $215.05 $145.36 $58.15 $62.94 $60.62 $279.00 $39.34 $37.89 $39.34 $279.00 $209.25 $39.34 $39.34 $39.34 $139.50 $139.50 $220.97 $39.34 $223.20 $181.35 $279.00 $39.34 $161.82 $279.00 $43.22 $39.34 $279.00 $39.34 N/A N/A 46000044 EAP CPT® 94760 NEO PULSE OXIMETRY SINGLE BOTH IP/OP $440.00 $326.00 $2.37 $440.00 $238.92 $238.92 $238.92 $238.92 $440.00 $440.00 $440.00 $91.71 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $440.00 $260.26 $440.00 $2.37 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $87.33 $440.00 $255.20 $440.00 $440.00 $440.00 $91.70 $440.00 N/A N/A 46000046 EAP CPT® 94760 PULSE OXIMETRY BOTH IP/OP $440.00 $326.00 $2.37 $440.00 $238.92 $238.92 $238.92 $238.92 $440.00 $440.00 $440.00 $91.71 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $440.00 $260.26 $440.00 $2.37 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $87.33 $440.00 $255.20 $440.00 $440.00 $440.00 $91.70 $440.00 N/A N/A 46000049 EAP CPT® 94761 ADULT PULSE OX MULTIPLE BOTH IP/OP $576.00 $426.50 $3.42 $576.00 $576.00 $576.00 $576.00 $576.00 $3.42 $3.42 $3.80 $576.00 $3.42 $427.51 $427.51 $443.98 $300.10 $120.04 $5.47 $5.97 $576.00 $3.42 $3.73 $3.42 $576.00 $432.00 $3.42 $3.42 $3.42 $288.00 $288.00 $456.19 $3.42 $460.80 $374.40 $576.00 $3.42 $334.08 $576.00 $3.96 $3.42 $576.00 $3.42 N/A N/A 46000050 EAP CPT® 94761 NEO PULSE OX MULTIPLE BOTH IP/OP $576.00 $426.50 $3.42 $576.00 $576.00 $576.00 $576.00 $576.00 $3.42 $3.42 $3.80 $576.00 $3.42 $427.51 $427.51 $443.98 $300.10 $120.04 $5.47 $5.97 $576.00 $3.42 $3.73 $3.42 $576.00 $432.00 $3.42 $3.42 $3.42 $288.00 $288.00 $456.19 $3.42 $460.80 $374.40 $576.00 $3.42 $334.08 $576.00 $3.96 $3.42 $576.00 $3.42 N/A N/A 46000051 EAP CPT® 94761 "OXIMETRY, MULTIPLE" BOTH IP/OP $576.00 $426.50 $3.42 $576.00 $576.00 $576.00 $576.00 $576.00 $3.42 $3.42 $3.80 $576.00 $3.42 $427.51 $427.51 $443.98 $300.10 $120.04 $5.47 $5.97 $576.00 $3.42 $3.73 $3.42 $576.00 $432.00 $3.42 $3.42 $3.42 $288.00 $288.00 $456.19 $3.42 $460.80 $374.40 $576.00 $3.42 $334.08 $576.00 $3.96 $3.42 $576.00 $3.42 N/A N/A 46000055 EAP CPT® 94762 OXIMETRY CONTINUOUS BOTH IP/OP $759.00 $562.00 $25.71 $607.20 $412.14 $412.14 $412.14 $412.14 $137.34 $137.34 $136.73 $158.19 $137.34 $563.33 $563.33 $585.04 $395.44 $158.18 $219.74 $209.80 $448.95 $137.34 $25.71 $137.34 $144.20 $569.25 $137.34 $137.34 $137.34 $379.50 $379.50 $601.13 $137.34 $607.20 $493.35 $150.64 $137.34 $440.22 $144.20 $198.69 $137.34 $158.18 $137.34 N/A N/A 46000056 EAP CPT® 94762 PULSE OX-OVERNIGHT BOTH IP/OP $674.00 $499.00 $25.71 $539.20 $365.98 $365.98 $365.98 $365.98 $137.34 $137.34 $136.73 $140.48 $137.34 $500.24 $500.24 $519.52 $351.15 $140.47 $219.74 $209.80 $398.67 $137.34 $25.71 $137.34 $144.20 $505.50 $137.34 $137.34 $137.34 $337.00 $337.00 $533.81 $137.34 $539.20 $438.10 $133.77 $137.34 $390.92 $144.20 $198.69 $137.34 $140.46 $137.34 N/A N/A 46000060 EAP CPT® 94799 BREATHING EXERCISE BOTH IP/OP "$1,459.00" "$1,080.00" $304.07 "$1,459.00" "$1,459.00" "$1,459.00" "$1,459.00" "$1,459.00" "$1,459.00" "$1,459.00" "$1,459.00" "$1,459.00" "$1,459.00" "$1,082.87" "$1,082.87" "$1,124.60" $760.14 $304.07 "$1,459.00" $532.80 "$1,459.00" "$1,459.00" "$1,332.00" "$1,459.00" "$1,459.00" "$1,094.25" "$1,459.00" "$1,459.00" "$1,459.00" $729.50 $729.50 "$1,155.53" "$1,459.00" "$1,167.20" $948.35 "$1,459.00" "$1,459.00" $846.22 "$1,459.00" $875.40 "$1,459.00" "$1,459.00" "$1,459.00" N/A N/A 46000061 EAP CPT® 94799 MINI BAL LAVAGE BOTH IP/OP "$1,459.00" "$1,080.00" $304.07 "$1,459.00" "$1,459.00" "$1,459.00" "$1,459.00" "$1,459.00" "$1,459.00" "$1,459.00" "$1,459.00" "$1,459.00" "$1,459.00" "$1,082.87" "$1,082.87" "$1,124.60" $760.14 $304.07 "$1,459.00" $532.80 "$1,459.00" "$1,459.00" "$1,332.00" "$1,459.00" "$1,459.00" "$1,094.25" "$1,459.00" "$1,459.00" "$1,459.00" $729.50 $729.50 "$1,155.53" "$1,459.00" "$1,167.20" $948.35 "$1,459.00" "$1,459.00" $846.22 "$1,459.00" $875.40 "$1,459.00" "$1,459.00" "$1,459.00" N/A N/A 46000066 EAP CPT® 94610 SURFACTANT ADMINISTRATION BOTH IP/OP $397.00 $294.00 $55.50 $397.00 $397.00 $397.00 $397.00 $397.00 $55.74 $55.74 $55.50 $397.00 $55.74 $294.65 $294.65 $306.01 $206.84 $82.74 $89.18 $90.03 $397.00 $55.74 $56.27 $55.74 $397.00 $297.75 $55.74 $55.74 $55.74 $198.50 $198.50 $314.42 $55.74 $317.60 $258.05 $397.00 $55.74 $230.26 $397.00 $57.34 $55.74 $397.00 $55.74 N/A N/A 46000070 EAP CPT® 94681 MET CART VCO2 BOTH IP/OP "$1,529.00" "$1,131.50" $37.89 "$1,529.00" "$1,529.00" "$1,529.00" "$1,529.00" "$1,529.00" $39.34 $39.34 $51.84 "$1,529.00" $39.34 "$1,134.82" "$1,134.82" "$1,178.55" $796.61 $318.66 $62.94 $60.62 "$1,529.00" $39.34 $37.89 $39.34 "$1,529.00" "$1,146.75" $39.34 $39.34 $39.34 $764.50 $764.50 "$1,210.97" $39.34 "$1,223.20" $993.85 "$1,529.00" $39.34 $886.82 "$1,529.00" $43.22 $39.34 "$1,529.00" $39.34 N/A N/A 46000071 EAP CPT® 94726 PLETHYSMO LUNG VOL / AIR RESIST BOTH IP/OP $314.00 $232.50 $42.96 $416.53 $170.50 $170.50 $170.50 $170.50 $260.33 $260.33 $259.18 $65.45 $260.33 $233.05 $233.05 $242.03 $163.59 $65.44 $416.53 $404.03 $185.73 $260.33 $42.96 $260.33 $273.35 $235.50 $260.33 $260.33 $260.33 $157.00 $157.00 $248.69 $260.33 $251.20 $204.10 $62.32 $260.33 $182.12 $273.35 $314.00 $260.33 $65.44 $260.33 N/A N/A 46000072 EAP CPT® 94728 PUL FUNC OSCILLOMETRY BOTH IP/OP $254.00 $188.00 $27.74 $254.00 $254.00 $254.00 $254.00 $254.00 $27.94 $27.94 $41.39 $254.00 $27.94 $188.52 $188.52 $195.78 $132.33 $52.94 $44.70 $44.38 $254.00 $27.94 $27.74 $27.94 $254.00 $190.50 $27.94 $27.94 $27.94 $127.00 $127.00 $201.17 $27.94 $203.20 $165.10 $254.00 $27.94 $147.32 $254.00 $28.45 $27.94 $254.00 $27.94 N/A N/A 46000075 EAP CPT® 94726 PULM FUNC TEST PLETHYSMOGR BOTH IP/OP "$1,167.00" $864.00 $42.96 $933.60 $633.68 $633.68 $633.68 $633.68 $260.33 $260.33 $259.18 $243.23 $260.33 $866.15 $866.15 $899.52 $608.01 $243.22 $416.53 $404.03 $690.28 $260.33 $42.96 $260.33 $273.35 $875.25 $260.33 $260.33 $260.33 $583.50 $583.50 $924.26 $260.33 $933.60 $758.55 $231.62 $260.33 $676.86 $273.35 $376.64 $260.33 $243.20 $260.33 N/A N/A 46000076 EAP CPT® 94727 PULM FUNC TEST BY GAS BOTH IP/OP $331.00 $245.00 $31.69 $331.00 $331.00 $331.00 $331.00 $331.00 $32.43 $32.43 $44.53 $331.00 $32.43 $245.67 $245.67 $255.13 $172.45 $68.98 $51.89 $51.41 $331.00 $32.43 $32.13 $32.43 $331.00 $248.25 $32.43 $32.43 $32.43 $165.50 $165.50 $262.15 $32.43 $264.80 $215.15 $331.00 $32.43 $191.98 $331.00 $31.69 $32.43 $331.00 $32.43 N/A N/A 46000077 EAP CPT® 94728 PULM FUNC TEST OSCILLOMETRY BOTH IP/OP $254.00 $188.00 $27.74 $254.00 $254.00 $254.00 $254.00 $254.00 $27.94 $27.94 $41.39 $254.00 $27.94 $188.52 $188.52 $195.78 $132.33 $52.94 $44.70 $44.38 $254.00 $27.94 $27.74 $27.94 $254.00 $190.50 $27.94 $27.94 $27.94 $127.00 $127.00 $201.17 $27.94 $203.20 $165.10 $254.00 $27.94 $147.32 $254.00 $28.45 $27.94 $254.00 $27.94 N/A N/A 46000078 EAP CPT® 94729 C02/MEMBRANE DIFFUSE CAPAC BOTH IP/OP $379.00 $280.50 $48.37 $969.00 $205.80 $205.80 $205.80 $205.80 $379.00 $379.00 $379.00 $78.99 $379.00 $281.29 $281.29 $292.13 $197.46 $78.99 $379.00 $969.00 $224.18 $379.00 $48.37 $379.00 $379.00 $284.25 $379.00 $379.00 $379.00 $189.50 $189.50 $300.17 $379.00 $303.20 $246.35 $75.22 $379.00 $219.82 $379.00 $379.00 $379.00 $78.98 $379.00 N/A N/A 46000082 EAP CPT® 32554 ASPIRATE PLEURA W/O IMAGING BOTH IP/OP "$2,630.00" "$1,946.50" $88.18 "$2,630.00" "$2,630.00" "$2,630.00" "$2,630.00" "$2,630.00" $89.96 $89.96 $90.39 "$2,630.00" $89.96 "$2,630.00" "$2,630.00" "$2,630.00" "$2,630.00" $548.12 $143.94 $141.09 "$2,630.00" $89.96 $88.18 $89.96 "$2,630.00" "$1,972.50" $89.96 $89.96 $89.96 "$2,630.00" "$1,315.00" "$2,082.96" $89.96 "$2,104.00" "$2,150.00" "$2,630.00" $89.96 "$1,525.40" "$2,630.00" $93.40 $89.96 "$2,630.00" $89.96 N/A N/A 46000083 EAP CPT® 32555 ASPIRATE PLEURA W/ IMAGING BOTH IP/OP "$3,657.00" "$2,706.50" $108.84 "$2,925.60" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $531.70 $531.70 $529.35 $762.21 $531.70 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $762.16 $850.72 $834.58 "$1,871.00" $531.70 $108.84 $531.70 $558.29 "$2,742.75" $531.70 $531.70 $531.70 "$2,762.00" "$1,828.50" "$2,896.34" $531.70 "$2,925.60" "$2,150.00" $725.82 $531.70 "$2,121.06" $558.29 $769.24 $531.70 $762.12 $531.70 N/A N/A 46000084 EAP CPT® 31647 BRONCHIAL VALVE INIT INSERT BOTH IP/OP "$5,261.00" "$3,893.50" $202.75 "$5,261.00" "$5,261.00" "$5,261.00" "$5,261.00" "$5,261.00" $207.28 $207.28 $209.69 "$5,261.00" $207.28 "$5,261.00" "$5,261.00" "$5,261.00" "$5,261.00" "$1,096.45" $331.65 $324.40 "$5,261.00" $207.28 $202.75 $207.28 "$5,261.00" "$3,945.75" $207.28 $207.28 $207.28 "$3,500.00" "$2,630.50" "$4,166.71" $207.28 "$4,208.80" "$3,725.00" "$5,261.00" $207.28 "$3,051.38" "$5,261.00" $218.89 $207.28 "$5,261.00" $207.28 N/A N/A 46000085 EAP CPT® 31648 BRONCHIAL VALVE ADDL INSERT BOTH IP/OP "$2,999.00" "$2,219.50" $194.28 "$2,999.00" "$2,999.00" "$2,999.00" "$2,999.00" "$2,999.00" $198.63 $198.63 $200.56 "$2,999.00" $198.63 "$2,999.00" "$2,999.00" "$2,999.00" "$2,999.00" $625.02 $317.81 $310.85 "$2,999.00" $198.63 $194.28 $198.63 "$2,999.00" "$2,249.25" $198.63 $198.63 $198.63 "$2,999.00" "$1,499.50" "$2,375.21" $198.63 "$2,399.20" "$2,999.00" "$2,999.00" $198.63 "$1,739.42" "$2,999.00" $208.07 $198.63 "$2,999.00" $198.63 N/A N/A 46000086 EAP CPT® 31649 BRONCHIAL VALVE REMOV INIT BOTH IP/OP "$1,485.00" "$1,099.00" $66.11 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $67.43 $67.43 $67.99 "$1,485.00" $67.43 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 $107.89 $105.78 "$1,485.00" $67.43 $66.11 $67.43 "$1,485.00" "$1,113.75" $67.43 $67.43 $67.43 "$1,485.00" $742.50 "$1,176.12" $67.43 "$1,188.00" "$1,485.00" "$1,485.00" $67.43 $861.30 "$1,485.00" $70.33 $67.43 "$1,485.00" $67.43 N/A N/A 46000087 EAP CPT® 31651 BRONCHIAL VALVE REMOV ADDL BOTH IP/OP $947.00 $701.00 $75.97 $947.00 $947.00 $947.00 $947.00 $947.00 $76.33 $76.33 $76.93 $947.00 $76.33 $702.86 $702.86 $729.95 $493.39 $197.37 $122.13 $121.55 $947.00 $76.33 $75.97 $76.33 $947.00 $710.25 $76.33 $76.33 $76.33 $473.50 $473.50 $750.02 $76.33 $757.60 $947.00 $947.00 $76.33 $549.26 $947.00 $76.82 $76.33 $947.00 $76.33 N/A N/A 46000088 EAP CPT® 32556 INSERT CATH PLEURA W/O IMAGE BOTH IP/OP "$2,930.00" "$2,168.50" $123.82 "$2,930.00" "$2,930.00" "$2,930.00" "$2,930.00" "$2,930.00" $124.50 $124.50 $124.55 "$2,930.00" $124.50 "$2,930.00" "$2,930.00" "$2,930.00" "$2,930.00" $610.64 $199.20 $198.11 "$2,930.00" $124.50 $123.82 $124.50 "$2,930.00" "$2,197.50" $124.50 $124.50 $124.50 "$2,762.00" "$1,465.00" "$2,320.56" $124.50 "$2,344.00" "$2,150.00" "$2,930.00" $124.50 "$1,699.40" "$2,930.00" $128.38 $124.50 "$2,930.00" $124.50 N/A N/A 46000090 EAP CPT® 94452 HIGH ALTITUDE SIMULATION TESTING(HAST) BOTH IP/OP $447.00 $331.00 $35.18 $447.00 $447.00 $447.00 $447.00 $447.00 $35.54 $35.54 $51.84 $447.00 $35.54 $331.76 $331.76 $344.55 $232.89 $93.16 $56.86 $56.29 $447.00 $35.54 $35.18 $35.54 $447.00 $335.25 $35.54 $35.54 $35.54 $223.50 $223.50 $354.02 $35.54 $357.60 $290.55 $447.00 $35.54 $259.26 $447.00 $38.54 $35.54 $447.00 $35.54 N/A N/A 46000091 EAP CPT® 94453 HIGH ALTITUDE SIMULATION TESTING(HAST) O2 TITRATION BOTH IP/OP $500.00 $370.00 $48.71 $400.00 $271.50 $271.50 $271.50 $271.50 $110.92 $110.92 $110.43 $104.21 $110.92 $371.10 $371.10 $385.40 $260.50 $104.21 $177.47 $167.51 $295.75 $110.92 $48.71 $110.92 $116.46 $375.00 $110.92 $110.92 $110.92 $250.00 $250.00 $396.00 $110.92 $400.00 $325.00 $99.24 $110.92 $290.00 $116.46 $160.47 $110.92 $104.20 $110.92 N/A N/A 47000001 EAP CPT® 92551 "IPV SCR, 2 EARS, PURE TONE,AIR" BOTH IP/OP $30.00 $22.50 $5.95 $150.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $11.81 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $60.00 $17.75 $30.00 $150.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $30.00 $30.00 $23.76 $30.00 $24.00 $19.50 $5.95 $30.00 $17.40 $30.00 $18.00 $30.00 $6.25 $30.00 N/A N/A 47000006 EAP CPT® 92592 "HEARING AID CHECK, MONAURAL" BOTH IP/OP $146.00 $108.50 $20.80 $146.00 $79.28 $79.28 $79.28 $79.28 $146.00 $146.00 $22.24 $30.43 $146.00 $108.36 $108.36 $112.54 $76.07 $30.43 $146.00 $20.80 $86.36 $146.00 $52.00 $146.00 $146.00 $109.50 $146.00 $146.00 $146.00 $80.04 $80.04 $115.63 $146.00 $116.80 $94.90 $28.98 $146.00 $84.68 $146.00 $87.60 $146.00 $30.43 $146.00 N/A N/A 47000007 EAP CPT® 92593 "HEARING AID CHECK, BINAURAL" BOTH IP/OP $288.00 $213.50 $37.15 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $37.15 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $115.20 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $128.12 $128.12 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $172.80 $288.00 $60.02 $288.00 N/A N/A 47000022 EAP CPT® 95992 CANALITH REPOSITIONING PROC BOTH IP/OP $102.00 $75.50 $21.26 $102.00 $102.00 $102.00 $102.00 $102.00 $36.88 $36.88 $29.75 $102.00 $36.88 $75.70 $75.70 $78.62 $53.14 $21.26 $59.01 $58.02 $102.00 $36.88 $36.26 $36.88 $102.00 $76.50 $36.88 $36.88 $36.88 $51.00 $51.00 $80.78 $36.88 $81.60 $66.30 $102.00 $36.88 $59.16 $102.00 $38.95 $36.88 $102.00 $36.88 N/A N/A 47000023 EAP CPT® 92626 EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR BOTH IP/OP $508.00 $376.00 $74.86 $508.00 $508.00 $508.00 $508.00 $508.00 $75.57 $75.57 $76.20 $508.00 $75.57 $377.04 $377.04 $391.57 $264.67 $105.87 $120.91 $119.78 $508.00 $75.57 $74.86 $75.57 $508.00 $381.00 $75.57 $75.57 $75.57 $357.60 $357.60 $402.34 $75.57 $406.40 $330.20 $508.00 $75.57 $294.64 $508.00 $78.26 $75.57 $508.00 $75.57 N/A N/A 47000024 EAP CPT® 92591 HEARING AID EXAMINATION & SELECTION BINAURAL BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $72.56 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $133.20 $204.07 $345.00 $333.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $249.84 $249.84 $273.24 $345.00 $276.00 $224.25 $68.47 $345.00 $200.10 $345.00 $207.00 $345.00 $71.90 $345.00 N/A N/A 47000025 EAP ELECTROACOUS EVAL HEARING AID BINAURAL BOTH IP/OP $224.00 $166.00 $39.87 $224.00 $224.00 $224.00 $224.00 $224.00 $224.00 $224.00 $39.87 $224.00 $224.00 $166.25 $166.25 $172.66 $116.70 $46.68 $224.00 $89.60 $224.00 $224.00 $224.00 $224.00 $224.00 $168.00 $224.00 $224.00 $224.00 $112.00 $112.00 $177.41 $224.00 $179.20 $145.60 $224.00 $224.00 $129.92 $224.00 $134.40 $224.00 $224.00 $224.00 N/A N/A 47100001 EAP CPT® 92511 "NASAL PHARYNGOSCOPY, SIMPLE" BOTH IP/OP $606.00 $448.50 $37.94 $606.00 $606.00 $606.00 $606.00 $606.00 $161.93 $161.93 $161.21 $126.31 $161.93 $449.77 $449.77 $467.10 $315.73 $126.30 $259.08 $257.88 $358.45 $161.93 $37.94 $161.93 $170.02 $454.50 $161.93 $161.93 $161.93 $606.00 $408.48 $479.95 $161.93 $484.80 $393.90 $120.28 $161.93 $351.48 $170.02 $234.27 $161.93 $126.29 $161.93 N/A N/A 47100002 EAP CPT® 92541 SPONTANEOUS NYSTAGMUS TEST BOTH IP/OP $647.00 $479.00 $4.40 $517.60 $351.32 $351.32 $351.32 $351.32 $110.92 $110.92 $110.43 $134.85 $110.92 $480.20 $480.20 $498.71 $337.09 $134.84 $177.47 $167.51 $382.70 $110.92 $4.40 $110.92 $116.46 $485.25 $110.92 $110.92 $110.92 $148.40 $148.40 $512.42 $110.92 $517.60 $420.55 $128.41 $110.92 $375.26 $116.46 $160.47 $110.92 $134.83 $110.92 N/A N/A 47100003 EAP CPT® 92542 POSITIONAL NYSTAGMUS TEST BOTH IP/OP $899.00 $665.50 $4.32 $899.00 $899.00 $899.00 $899.00 $899.00 $4.46 $4.46 $29.92 $899.00 $4.46 $667.24 $667.24 $692.95 $468.38 $187.36 $7.14 $7.04 $899.00 $4.46 $4.40 $4.46 $899.00 $674.25 $4.46 $4.46 $4.46 $171.56 $171.56 $712.01 $4.46 $719.20 $584.35 $899.00 $4.46 $521.42 $899.00 $4.32 $4.46 $899.00 $4.46 N/A N/A 47100005 EAP CPT® 92544 OPTOKINETIC NYSTAGMUS TEST BOTH IP/OP $654.00 $484.00 $3.24 $654.00 $654.00 $654.00 $654.00 $654.00 $3.77 $3.77 $18.41 $654.00 $3.77 $485.40 $485.40 $504.10 $340.73 $136.30 $6.03 $5.97 $654.00 $3.77 $3.73 $3.77 $654.00 $490.50 $3.77 $3.77 $3.77 $138.52 $138.52 $517.97 $3.77 $523.20 $425.10 $654.00 $3.77 $379.32 $654.00 $3.24 $3.77 $654.00 $3.77 N/A N/A 47100006 EAP CPT® 92545 OSCILLATING TRACKING TEST BOTH IP/OP $575.00 $425.50 $3.24 $575.00 $575.00 $575.00 $575.00 $575.00 $3.77 $3.77 $17.02 $575.00 $3.77 $426.77 $426.77 $443.21 $299.58 $119.84 $6.03 $5.97 $575.00 $3.77 $3.73 $3.77 $575.00 $431.25 $3.77 $3.77 $3.77 $126.92 $126.92 $455.40 $3.77 $460.00 $373.75 $575.00 $3.77 $333.50 $575.00 $3.24 $3.77 $575.00 $3.77 N/A N/A 47100007 EAP CPT® 92551 HEARING SCREENING BOTH IP/OP $164.00 $121.50 $11.81 $164.00 $89.05 $89.05 $89.05 $89.05 $164.00 $164.00 $11.81 $34.18 $164.00 $121.72 $121.72 $126.41 $85.44 $34.18 $164.00 $60.00 $97.01 $164.00 $150.00 $164.00 $164.00 $123.00 $164.00 $164.00 $164.00 $42.80 $42.80 $129.89 $164.00 $131.20 $106.60 $32.55 $164.00 $95.12 $164.00 $98.40 $164.00 $34.18 $164.00 N/A N/A 47100011 EAP CPT® 92552 AIR CONDUCTION (BOTH) BOTH IP/OP $276.00 $204.50 $35.85 $220.80 $149.87 $149.87 $149.87 $149.87 $110.92 $110.92 $110.43 $57.53 $110.92 $204.85 $204.85 $212.74 $143.80 $57.52 $177.47 $167.51 $163.25 $110.92 $35.85 $110.92 $116.46 $207.00 $110.92 $110.92 $110.92 $83.48 $83.48 $218.59 $110.92 $220.80 $179.40 $54.78 $110.92 $160.08 $116.46 $160.47 $110.92 $57.52 $110.92 N/A N/A 47100012 EAP CPT® 92552 AIR CONDUCTION (ONE) BOTH IP/OP $276.00 $204.50 $35.85 $220.80 $149.87 $149.87 $149.87 $149.87 $110.92 $110.92 $110.43 $57.53 $110.92 $204.85 $204.85 $212.74 $143.80 $57.52 $177.47 $167.51 $163.25 $110.92 $35.85 $110.92 $116.46 $207.00 $110.92 $110.92 $110.92 $83.48 $83.48 $218.59 $110.92 $220.80 $179.40 $54.78 $110.92 $160.08 $116.46 $160.47 $110.92 $57.52 $110.92 N/A N/A 47100013 EAP CPT® 92552 AUDIOMETRY BOTH IP/OP $273.00 $202.50 $35.85 $218.40 $148.24 $148.24 $148.24 $148.24 $110.92 $110.92 $110.43 $56.90 $110.92 $202.62 $202.62 $210.43 $142.23 $56.90 $177.47 $167.51 $161.48 $110.92 $35.85 $110.92 $116.46 $204.75 $110.92 $110.92 $110.92 $83.48 $83.48 $216.22 $110.92 $218.40 $177.45 $54.18 $110.92 $158.34 $116.46 $160.47 $110.92 $56.89 $110.92 N/A N/A 47100014 EAP CPT® 92552 AUDIOMETRY - AIR ONLY BOTH IP/OP $273.00 $202.50 $35.85 $218.40 $148.24 $148.24 $148.24 $148.24 $110.92 $110.92 $110.43 $56.90 $110.92 $202.62 $202.62 $210.43 $142.23 $56.90 $177.47 $167.51 $161.48 $110.92 $35.85 $110.92 $116.46 $204.75 $110.92 $110.92 $110.92 $83.48 $83.48 $216.22 $110.92 $218.40 $177.45 $54.18 $110.92 $158.34 $116.46 $160.47 $110.92 $56.89 $110.92 N/A N/A 47100015 EAP CPT® 92552 AUDIOMETRY-AIR CONDUCTION BOTH IP/OP $276.00 $204.50 $35.85 $220.80 $149.87 $149.87 $149.87 $149.87 $110.92 $110.92 $110.43 $57.53 $110.92 $204.85 $204.85 $212.74 $143.80 $57.52 $177.47 $167.51 $163.25 $110.92 $35.85 $110.92 $116.46 $207.00 $110.92 $110.92 $110.92 $83.48 $83.48 $218.59 $110.92 $220.80 $179.40 $54.78 $110.92 $160.08 $116.46 $160.47 $110.92 $57.52 $110.92 N/A N/A 47100018 EAP CPT® 92592 AIR AND BONE CONDUCTION (ONE) BOTH IP/OP $295.00 $218.50 $20.80 $295.00 $160.19 $160.19 $160.19 $160.19 $295.00 $295.00 $22.24 $61.49 $295.00 $218.95 $218.95 $227.39 $153.70 $61.48 $295.00 $20.80 $174.49 $295.00 $52.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $80.04 $80.04 $233.64 $295.00 $236.00 $191.75 $58.55 $295.00 $171.10 $295.00 $177.00 $295.00 $61.48 $295.00 N/A N/A 47100019 EAP CPT® 92553 AUDIOMETRY - AIR AND BONE BOTH IP/OP $616.00 $456.00 $43.97 $492.80 $334.49 $334.49 $334.49 $334.49 $137.34 $137.34 $136.73 $128.39 $137.34 $457.20 $457.20 $474.81 $320.94 $128.38 $219.74 $209.80 $364.36 $137.34 $43.97 $137.34 $144.20 $462.00 $137.34 $137.34 $137.34 $119.44 $119.44 $487.87 $137.34 $492.80 $400.40 $122.26 $137.34 $357.28 $144.20 $198.69 $137.34 $128.37 $137.34 N/A N/A 47100020 EAP CPT® 92555 SPEECH AUDIOMETRY THRESHOLD BOTH IP/OP $218.00 $161.50 $27.74 $174.40 $118.37 $118.37 $118.37 $118.37 $33.30 $33.30 $33.15 $45.44 $33.30 $161.80 $161.80 $168.03 $113.58 $45.43 $53.27 $48.99 $128.95 $33.30 $27.74 $33.30 $34.96 $163.50 $33.30 $33.30 $33.30 $68.60 $68.60 $172.66 $33.30 $174.40 $141.70 $43.27 $33.30 $126.44 $34.96 $48.17 $33.30 $45.43 $33.30 N/A N/A 47100023 EAP CPT® 92556 "SPEECH AUDIOMETRY, COMPLETE" BOTH IP/OP $160.00 $118.50 $33.35 $160.00 $160.00 $160.00 $160.00 $160.00 $40.72 $40.72 $39.67 $160.00 $40.72 $118.75 $118.75 $123.33 $83.36 $33.35 $65.15 $68.74 $160.00 $40.72 $42.96 $40.72 $160.00 $120.00 $40.72 $40.72 $40.72 $101.24 $101.24 $126.72 $40.72 $128.00 $104.00 $160.00 $40.72 $92.80 $160.00 $38.54 $40.72 $160.00 $40.72 N/A N/A 47100026 EAP CPT® 92557 AUDIOMETRIC BATTERY BOTH IP/OP $736.00 $545.00 $31.84 $588.80 $399.65 $399.65 $399.65 $399.65 $137.34 $137.34 $136.73 $153.40 $137.34 $546.26 $546.26 $567.31 $383.46 $153.39 $219.74 $209.80 $435.34 $137.34 $31.84 $137.34 $144.20 $552.00 $137.34 $137.34 $137.34 $217.40 $217.40 $582.91 $137.34 $588.80 $478.40 $146.08 $137.34 $426.88 $144.20 $198.69 $137.34 $153.38 $137.34 N/A N/A 47100029 EAP CPT® 92562 LOUDNESS BALANCE TEST BOTH IP/OP $227.00 $168.00 $45.02 $227.00 $227.00 $227.00 $227.00 $227.00 $46.94 $46.94 $46.98 $227.00 $46.94 $168.48 $168.48 $174.97 $118.27 $47.31 $75.10 $77.39 $227.00 $46.94 $48.37 $46.94 $227.00 $170.25 $46.94 $46.94 $46.94 $85.16 $85.16 $179.78 $46.94 $181.60 $147.55 $227.00 $46.94 $131.66 $227.00 $45.02 $46.94 $227.00 $46.94 N/A N/A 47100032 EAP CPT® 92565 "STENGER TEST, PURE TONE" BOTH IP/OP $278.00 $206.00 $15.85 $278.00 $278.00 $278.00 $278.00 $278.00 $19.31 $19.31 $17.73 $278.00 $19.31 $206.33 $206.33 $214.28 $144.84 $57.94 $30.90 $32.48 $278.00 $19.31 $20.30 $19.31 $278.00 $208.50 $19.31 $19.31 $19.31 $65.28 $65.28 $220.18 $19.31 $222.40 $180.70 $278.00 $19.31 $161.24 $278.00 $15.85 $19.31 $278.00 $19.31 N/A N/A 47100033 EAP CPT® 92567 TYMPANOMETRY BOTH IP/OP $158.00 $117.00 $10.84 $126.40 $85.79 $85.79 $85.79 $85.79 $33.30 $33.30 $33.15 $32.93 $33.30 $117.27 $117.27 $121.79 $82.32 $32.93 $53.27 $48.99 $93.46 $33.30 $10.84 $33.30 $34.96 $118.50 $33.30 $33.30 $33.30 $93.00 $93.00 $125.14 $33.30 $126.40 $102.70 $31.36 $33.30 $91.64 $34.96 $48.17 $33.30 $32.93 $33.30 N/A N/A 47100036 EAP CPT® 92568 ACOUSTIC REFLEX TESTING BOTH IP/OP $276.00 $204.50 $15.25 $276.00 $276.00 $276.00 $276.00 $276.00 $15.50 $15.50 $15.28 $276.00 $15.50 $204.85 $204.85 $212.74 $143.80 $57.52 $24.80 $24.40 $276.00 $15.50 $15.25 $15.50 $276.00 $207.00 $15.50 $15.50 $15.50 $58.68 $58.68 $218.59 $15.50 $220.80 $179.40 $276.00 $15.50 $160.08 $276.00 $15.87 $15.50 $276.00 $15.50 N/A N/A 47100038 EAP CPT® 92568 ACOUSTIC REFLEX TESTING (BT) BOTH IP/OP $276.00 $204.50 $15.25 $276.00 $276.00 $276.00 $276.00 $276.00 $15.50 $15.50 $15.28 $276.00 $15.50 $204.85 $204.85 $212.74 $143.80 $57.52 $24.80 $24.40 $276.00 $15.50 $15.25 $15.50 $276.00 $207.00 $15.50 $15.50 $15.50 $58.68 $58.68 $218.59 $15.50 $220.80 $179.40 $276.00 $15.50 $160.08 $276.00 $15.87 $15.50 $276.00 $15.50 N/A N/A 47100040 EAP CPT® 92568 ACOUSTIC REFLEX(ONE) BOTH IP/OP $276.00 $204.50 $15.25 $276.00 $276.00 $276.00 $276.00 $276.00 $15.50 $15.50 $15.28 $276.00 $15.50 $204.85 $204.85 $212.74 $143.80 $57.52 $24.80 $24.40 $276.00 $15.50 $15.25 $15.50 $276.00 $207.00 $15.50 $15.50 $15.50 $58.68 $58.68 $218.59 $15.50 $220.80 $179.40 $276.00 $15.50 $160.08 $276.00 $15.87 $15.50 $276.00 $15.50 N/A N/A 47100044 EAP CPT® 92570 "ACOUSTIC REFLEX TESTING, BOTH" BOTH IP/OP $273.00 $202.50 $29.13 $273.00 $273.00 $273.00 $273.00 $273.00 $29.96 $29.96 $30.20 $273.00 $29.96 $202.62 $202.62 $210.43 $142.23 $56.90 $47.94 $46.61 $273.00 $29.96 $29.13 $29.96 $273.00 $204.75 $29.96 $29.96 $29.96 $136.50 $136.50 $216.22 $29.96 $218.40 $177.45 $273.00 $29.96 $158.34 $273.00 $30.65 $29.96 $273.00 $29.96 N/A N/A 47100045 EAP CPT® 92570 "ACOUSTIC REFLEX TESTING, ONE" BOTH IP/OP $276.00 $204.50 $29.13 $276.00 $276.00 $276.00 $276.00 $276.00 $29.96 $29.96 $30.20 $276.00 $29.96 $204.85 $204.85 $212.74 $143.80 $57.52 $47.94 $46.61 $276.00 $29.96 $29.13 $29.96 $276.00 $207.00 $29.96 $29.96 $29.96 $138.00 $138.00 $218.59 $29.96 $220.80 $179.40 $276.00 $29.96 $160.08 $276.00 $30.65 $29.96 $276.00 $29.96 N/A N/A 47100049 EAP CPT® 92577 "STENGER TEST, SPEECH" BOTH IP/OP $495.00 $366.50 $14.05 $495.00 $495.00 $495.00 $495.00 $495.00 $18.96 $18.96 $15.29 $495.00 $18.96 $367.39 $367.39 $381.55 $257.90 $103.16 $30.34 $33.02 $495.00 $18.96 $20.64 $18.96 $495.00 $371.25 $18.96 $18.96 $18.96 $109.32 $109.32 $392.04 $18.96 $396.00 $321.75 $495.00 $18.96 $287.10 $495.00 $14.05 $18.96 $495.00 $18.96 N/A N/A 47100052 EAP CPT® 92579 VISUAL REINFORCEMENT AUDIOMETR BOTH IP/OP $329.00 $243.50 $37.26 $329.00 $329.00 $329.00 $329.00 $329.00 $38.25 $38.25 $38.57 $329.00 $38.25 $244.18 $244.18 $253.59 $171.41 $68.57 $61.20 $59.62 $329.00 $38.25 $37.26 $38.25 $329.00 $246.75 $38.25 $38.25 $38.25 $134.32 $134.32 $260.57 $38.25 $263.20 $213.85 $329.00 $38.25 $190.82 $329.00 $39.31 $38.25 $329.00 $38.25 N/A N/A 47100053 EAP CPT® 92582 CONDITIONING PLAY AUDIOMETRY BOTH IP/OP $414.00 $306.50 $74.55 $414.00 $414.00 $414.00 $414.00 $414.00 $78.68 $78.68 $76.20 $414.00 $78.68 $307.27 $307.27 $319.11 $215.69 $86.28 $125.89 $132.58 $414.00 $78.68 $82.86 $78.68 $414.00 $310.50 $78.68 $78.68 $78.68 $144.24 $144.24 $327.89 $78.68 $331.20 $269.10 $414.00 $78.68 $240.12 $414.00 $74.55 $78.68 $414.00 $78.68 N/A N/A 47100061 EAP CPT® 92587 EVOKE OTOACOUSTIC EMISSION LTD BOTH IP/OP $431.00 $319.00 $3.60 $431.00 $431.00 $431.00 $431.00 $431.00 $4.11 $4.11 $22.59 $431.00 $4.11 $319.89 $319.89 $332.21 $224.55 $89.83 $6.58 $6.50 $431.00 $4.11 $4.06 $4.11 $431.00 $323.25 $4.11 $4.11 $4.11 $202.76 $202.76 $341.35 $4.11 $344.80 $280.15 $431.00 $4.11 $249.98 $431.00 $3.60 $4.11 $431.00 $4.11 N/A N/A 47100064 EAP CPT® 92588 EVOKE OTOACOUSTIC DX/COMPRE BOTH IP/OP $442.00 $327.50 $5.42 $416.53 $240.01 $240.01 $240.01 $240.01 $260.33 $260.33 $259.18 $92.12 $260.33 $328.05 $328.05 $340.69 $230.28 $92.12 $416.53 $404.03 $261.44 $260.33 $5.42 $260.33 $273.35 $331.50 $260.33 $260.33 $260.33 $238.68 $238.68 $350.06 $260.33 $353.60 $287.30 $87.73 $260.33 $256.36 $273.35 $376.64 $260.33 $92.11 $260.33 N/A N/A 47100067 EAP CPT® 92590 HEARING AID EVAL 75 MIN BOTH IP/OP $288.00 $213.50 $28.80 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $288.00 $56.60 $288.00 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $28.80 $288.00 $288.00 $72.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $195.52 $195.52 $228.10 $288.00 $230.40 $187.20 $288.00 $288.00 $167.04 $288.00 $172.80 $288.00 $288.00 $288.00 N/A N/A 47100072 EAP CPT® 92594 ELECTROACOUSTIC EVAL MONAURAL BOTH IP/OP $158.00 $117.00 $20.80 $158.00 $85.79 $85.79 $85.79 $85.79 $158.00 $158.00 $21.19 $32.93 $158.00 $117.27 $117.27 $121.79 $82.32 $32.93 $158.00 $20.80 $93.46 $158.00 $52.00 $158.00 $158.00 $118.50 $158.00 $158.00 $158.00 $75.20 $75.20 $125.14 $158.00 $126.40 $102.70 $31.36 $158.00 $91.64 $158.00 $94.80 $158.00 $32.93 $158.00 N/A N/A 47100073 EAP CPT® 92596 EAR PROTECTOR ATTENUATION MEAS BOTH IP/OP $245.00 $181.50 $51.06 $245.00 $245.00 $245.00 $245.00 $245.00 $69.73 $69.73 $68.22 $245.00 $69.73 $181.84 $181.84 $188.85 $127.65 $51.06 $111.57 $118.51 $245.00 $69.73 $74.07 $69.73 $245.00 $183.75 $69.73 $69.73 $69.73 $121.12 $121.12 $194.04 $69.73 $196.00 $159.25 $245.00 $69.73 $142.10 $245.00 $66.27 $69.73 $245.00 $69.73 N/A N/A 47100086 EAP CPT® 92551 "HEARING TEST, DIAGNOSTIC" BOTH IP/OP $165.00 $122.50 $11.81 $165.00 $89.60 $89.60 $89.60 $89.60 $165.00 $165.00 $11.81 $34.39 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $60.00 $97.60 $165.00 $150.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $42.80 $42.80 $130.68 $165.00 $132.00 $107.25 $32.75 $165.00 $95.70 $165.00 $99.00 $165.00 $34.39 $165.00 N/A N/A 47100088 EAP CPT® 95885 NCS/EMG <=4 LIMB BOTH IP/OP $240.00 $178.00 $44.64 $564.00 $130.32 $130.32 $130.32 $130.32 $240.00 $240.00 $240.00 $50.02 $240.00 $178.13 $178.13 $184.99 $125.04 $50.02 $240.00 $564.00 $141.96 $240.00 $44.64 $240.00 $240.00 $180.00 $240.00 $240.00 $240.00 $120.00 $120.00 $190.08 $240.00 $192.00 $156.00 $47.63 $240.00 $139.20 $240.00 $240.00 $240.00 $50.02 $240.00 N/A N/A 47100089 EAP CPT® 95886 NCS/EMG 5+LIMB BOTH IP/OP $240.00 $178.00 $47.63 $714.00 $130.32 $130.32 $130.32 $130.32 $240.00 $240.00 $240.00 $50.02 $240.00 $178.13 $178.13 $184.99 $125.04 $50.02 $240.00 $714.00 $141.96 $240.00 $53.43 $240.00 $240.00 $180.00 $240.00 $240.00 $240.00 $120.00 $120.00 $190.08 $240.00 $192.00 $156.00 $47.63 $240.00 $139.20 $240.00 $240.00 $240.00 $50.02 $240.00 N/A N/A 47100098 EAP CPT® 95887 MUSCL TEST W/N TEST NON-EXTR BOTH IP/OP $127.00 $94.00 $26.47 $127.00 $127.00 $127.00 $127.00 $127.00 $50.77 $50.77 $90.11 $127.00 $50.77 $94.26 $94.26 $97.89 $66.17 $26.47 $81.23 $76.30 $127.00 $50.77 $47.69 $50.77 $127.00 $95.25 $50.77 $50.77 $50.77 $63.50 $63.50 $100.58 $50.77 $101.60 $82.55 $127.00 $50.77 $73.66 $127.00 $47.54 $50.77 $127.00 $50.77 N/A N/A 47100099 EAP CPT® 95938 SOMATOSENSORY TESTING BOTH IP/OP $556.00 $411.50 $115.88 $556.00 $556.00 $556.00 $556.00 $556.00 $326.24 $326.24 $368.23 $556.00 $326.24 $412.66 $412.66 $428.56 $289.68 $115.88 $521.98 $517.34 $556.00 $326.24 $323.34 $326.24 $556.00 $417.00 $326.24 $326.24 $326.24 $278.00 $278.00 $440.35 $326.24 $444.80 $361.40 $556.00 $326.24 $322.48 $556.00 $308.31 $326.24 $556.00 $326.24 N/A N/A 47100110 EAP CPT® 92547 VERTICAL ELECTRODES BOTH IP/OP $250.00 $185.00 $8.64 $250.00 $250.00 $250.00 $250.00 $250.00 $10.71 $10.71 $10.10 $250.00 $10.71 $185.55 $185.55 $192.70 $130.25 $52.10 $17.14 $17.31 $250.00 $10.71 $10.82 $10.71 $250.00 $187.50 $10.71 $10.71 $10.71 $23.52 $23.52 $198.00 $10.71 $200.00 $162.50 $250.00 $10.71 $145.00 $250.00 $8.64 $10.71 $250.00 $10.71 N/A N/A 47100132 EAP CPT® 92537 "CALORIC VSTBLAR TEST W/REC,BILAT" BOTH IP/OP "$1,168.00" $864.50 $9.81 $934.40 $634.22 $634.22 $634.22 $634.22 $137.34 $137.34 $136.73 $243.44 $137.34 $866.89 $866.89 $900.29 $608.53 $243.42 $219.74 $209.80 $690.87 $137.34 $9.81 $137.34 $144.20 $876.00 $137.34 $137.34 $137.34 $584.00 $584.00 $925.06 $137.34 $934.40 $759.20 $231.82 $137.34 $677.44 $144.20 $198.69 $137.34 $243.41 $137.34 N/A N/A 47100133 EAP CPT® 92538 "CALORIC VSTBLAR TEST W/REC,BILAT;MONOTHERMAL" BOTH IP/OP "$1,168.00" $864.50 $6.77 $934.40 $634.22 $634.22 $634.22 $634.22 $137.34 $137.34 $136.73 $243.44 $137.34 $866.89 $866.89 $900.29 $608.53 $243.42 $219.74 $209.80 $690.87 $137.34 $6.77 $137.34 $144.20 $876.00 $137.34 $137.34 $137.34 $584.00 $584.00 $925.06 $137.34 $934.40 $759.20 $231.82 $137.34 $677.44 $144.20 $198.69 $137.34 $243.41 $137.34 N/A N/A 47100135 EAP CPT® 92602 REPROGRAM COCHLEAR IMPLT <7 BOTH IP/OP $676.00 $500.50 $69.78 $676.00 $676.00 $676.00 $676.00 $676.00 $70.73 $70.73 $71.31 $676.00 $70.73 $501.73 $501.73 $521.06 $352.20 $140.89 $113.17 $111.65 $676.00 $70.73 $69.78 $70.73 $676.00 $507.00 $70.73 $70.73 $70.73 $443.40 $443.40 $535.39 $70.73 $540.80 $439.40 $676.00 $70.73 $392.08 $676.00 $73.21 $70.73 $676.00 $70.73 N/A N/A 47100137 EAP GLL FITTING VISIT BOTH IP/OP $215.00 $159.50 $38.27 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $38.27 $215.00 $215.00 $159.57 $159.57 $165.72 $112.02 $44.81 $215.00 $86.00 $215.00 $215.00 $215.00 $215.00 $215.00 $161.25 $215.00 $215.00 $215.00 $107.50 $107.50 $170.28 $215.00 $172.00 $139.75 $215.00 $215.00 $124.70 $215.00 $129.00 $215.00 $215.00 $215.00 N/A N/A 47100138 EAP GLL VISIT - POST 4TH VISIT BOTH IP/OP $25.00 $18.50 $4.45 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $4.45 $25.00 $25.00 $18.56 $18.56 $19.27 $13.03 $5.21 $25.00 $10.00 $25.00 $25.00 $25.00 $25.00 $25.00 $18.75 $25.00 $25.00 $25.00 $12.50 $12.50 $19.80 $25.00 $20.00 $16.25 $25.00 $25.00 $14.50 $25.00 $15.00 $25.00 $25.00 $25.00 N/A N/A 47100140 EAP CPT® 92653 AEP NEURODX INTERPRETATION AND REPORT BOTH IP/OP $362.00 $268.00 $75.44 $362.00 $362.00 $362.00 $362.00 $362.00 $87.57 $87.57 $87.32 $362.00 $87.57 $268.68 $268.68 $279.03 $188.60 $75.44 $140.11 $136.53 $362.00 $87.57 $85.33 $87.57 $362.00 $271.50 $87.57 $87.57 $87.57 $181.00 $181.00 $286.70 $87.57 $289.60 $235.30 $362.00 $87.57 $209.96 $362.00 $217.20 $87.57 $362.00 $87.57 N/A N/A 47100141 EAP CPT® 92652 AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R BOTH IP/OP $362.00 $268.00 $75.44 $362.00 $362.00 $362.00 $362.00 $362.00 $117.93 $117.93 $119.25 $362.00 $117.93 $268.68 $268.68 $279.03 $188.60 $75.44 $188.69 $183.14 $362.00 $117.93 $114.46 $117.93 $362.00 $271.50 $117.93 $117.93 $117.93 $181.00 $181.00 $286.70 $117.93 $289.60 $235.30 $362.00 $117.93 $209.96 $362.00 $217.20 $117.93 $362.00 $117.93 N/A N/A 47100142 EAP CPT® 92651 AEP HEARING STATUS DETER BROADBAND STIMULI I&R BOTH IP/OP $219.00 $162.50 $45.64 $219.00 $219.00 $219.00 $219.00 $219.00 $90.05 $90.05 $91.14 $219.00 $90.05 $162.54 $162.54 $168.81 $114.10 $45.64 $144.08 $137.06 $219.00 $90.05 $85.66 $90.05 $219.00 $164.25 $90.05 $90.05 $90.05 $109.50 $109.50 $173.45 $90.05 $175.20 $142.35 $219.00 $90.05 $127.02 $219.00 $131.40 $90.05 $219.00 $90.05 N/A N/A 47100143 EAP CPT® 92650 AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS BOTH IP/OP $436.00 $323.00 $28.86 $436.00 $436.00 $436.00 $436.00 $436.00 $436.00 $436.00 $28.86 $436.00 $436.00 $323.60 $323.60 $336.07 $227.16 $90.87 $436.00 $139.60 $436.00 $436.00 $349.00 $436.00 $436.00 $327.00 $436.00 $436.00 $436.00 $218.00 $218.00 $345.31 $436.00 $348.80 $283.40 $436.00 $436.00 $252.88 $436.00 $261.60 $436.00 $436.00 $436.00 N/A N/A 47200002 EAP CPT® 92603 COCHLEAR IMPLT EXAM 7 > YRS BOTH IP/OP $267.00 $198.00 $52.99 $267.00 $144.98 $144.98 $144.98 $144.98 $137.34 $137.34 $136.73 $55.65 $137.34 $198.17 $198.17 $205.80 $139.11 $55.65 $219.74 $209.80 $157.93 $137.34 $119.57 $137.34 $144.20 $200.25 $137.34 $137.34 $137.34 $267.00 $267.00 $211.46 $137.34 $213.60 $173.55 $52.99 $137.34 $154.86 $144.20 $198.69 $137.34 $55.64 $137.34 N/A N/A 47200003 EAP CPT® 92604 REPROGRAM CODHLEAR IMPLT 7 > YRS BOTH IP/OP $631.00 $467.00 $66.73 $504.80 $342.63 $342.63 $342.63 $342.63 $137.34 $137.34 $136.73 $131.52 $137.34 $468.33 $468.33 $486.37 $328.75 $131.51 $219.74 $209.80 $373.24 $137.34 $66.73 $137.34 $144.20 $473.25 $137.34 $137.34 $137.34 $264.76 $264.76 $499.75 $137.34 $504.80 $410.15 $125.24 $137.34 $365.98 $144.20 $198.69 $137.34 $131.50 $137.34 N/A N/A 47200010 EAP HCPCS C1887 MAXC CATHETER REPERFUSION 4MAX BOTH IP/OP "$4,108.00" "$3,040.00" $815.34 "$4,108.00" "$2,230.64" "$2,230.64" "$2,230.64" "$2,230.64" "$4,108.00" "$4,108.00" "$4,108.00" $856.21 "$4,108.00" "$3,048.96" "$3,048.96" "$3,166.45" "$2,060.15" $856.15 "$4,108.00" "$4,108.00" "$2,429.88" "$4,108.00" "$4,108.00" "$4,108.00" "$4,108.00" "$3,081.00" "$4,108.00" "$4,108.00" "$4,108.00" "$2,054.00" "$2,054.00" "$3,253.54" "$4,108.00" "$3,286.40" "$2,670.20" $815.34 "$4,108.00" "$2,382.64" "$4,108.00" "$4,108.00" "$4,108.00" $856.11 "$4,108.00" N/A N/A 47200011 EAP HCPCS C1757 PSC041 CATHETER THRMB 141CM 4.1FR .041IN REPERFUSION BOTH IP/OP "$3,813.00" "$2,822.00" $756.79 "$3,813.00" "$2,070.46" "$2,070.46" "$2,070.46" "$2,070.46" "$3,813.00" "$3,813.00" "$3,813.00" $794.72 "$3,813.00" "$2,830.01" "$2,830.01" "$2,939.06" "$1,986.57" $794.67 "$3,813.00" "$3,813.00" "$2,255.39" "$3,813.00" "$3,813.00" "$3,813.00" "$3,813.00" "$2,859.75" "$3,813.00" "$3,813.00" "$3,813.00" "$1,906.50" "$1,906.50" "$3,019.90" "$3,813.00" "$3,050.40" "$2,478.45" $756.79 "$3,813.00" "$2,211.54" "$3,813.00" "$3,813.00" "$3,813.00" $794.63 "$3,813.00" N/A N/A 47900003 EAP CPT® 92587 HEARING SCREENING (OAE) BOTH IP/OP $431.00 $319.00 $3.60 $431.00 $431.00 $431.00 $431.00 $431.00 $4.11 $4.11 $22.59 $431.00 $4.11 $319.89 $319.89 $332.21 $224.55 $89.83 $6.58 $6.50 $431.00 $4.11 $4.06 $4.11 $431.00 $323.25 $4.11 $4.11 $4.11 $202.76 $202.76 $341.35 $4.11 $344.80 $280.15 $431.00 $4.11 $249.98 $431.00 $3.60 $4.11 $431.00 $4.11 N/A N/A 48000001 EAP CPT® 33967 PERC INSERTION INTRAAORTIC BAL BOTH IP/OP "$5,482.00" "$4,057.00" $255.63 "$5,482.00" "$5,482.00" "$5,482.00" "$5,482.00" "$5,482.00" $258.89 $258.89 $260.72 "$5,482.00" $258.89 "$5,482.00" "$5,482.00" "$5,482.00" "$5,482.00" "$1,142.51" $414.22 $409.01 "$5,482.00" $258.89 $255.63 $258.89 "$5,482.00" "$4,111.50" $258.89 $258.89 $258.89 "$2,762.00" "$2,741.00" "$4,341.74" $258.89 "$4,385.60" "$5,343.00" "$5,482.00" $258.89 "$3,179.56" "$5,482.00" $270.76 $258.89 "$5,482.00" $258.89 N/A N/A 48000002 EAP CPT® 92950 CARDIO RES - CPR BOTH IP/OP "$2,336.00" "$1,729.00" $182.45 "$2,336.00" "$2,336.00" "$2,336.00" "$2,336.00" "$2,336.00" $185.13 $185.13 $186.00 "$2,336.00" $185.13 "$1,733.78" "$1,733.78" "$1,800.59" "$1,217.06" $486.85 $296.21 $291.92 "$2,336.00" $185.13 $182.45 $185.13 "$2,336.00" "$1,752.00" $185.13 $185.13 $185.13 "$1,168.00" "$1,168.00" "$1,850.11" $185.13 "$1,868.80" "$1,750.00" "$2,336.00" $185.13 "$1,354.88" "$2,336.00" $193.31 $185.13 "$2,336.00" $185.13 N/A N/A 48000003 EAP CPT® 92953 TEMP TRANSCUT PACING BOTH IP/OP "$2,474.00" "$1,831.00" $1.00 "$2,474.00" "$2,474.00" "$2,474.00" "$2,474.00" "$2,474.00" $1.00 $1.00 $1.01 "$2,474.00" $1.00 "$1,836.20" "$1,836.20" "$1,906.96" "$1,288.95" $515.61 $1.60 $1.63 "$2,474.00" $1.00 $1.02 $1.00 "$2,474.00" "$1,855.50" $1.00 $1.00 $1.00 "$1,237.00" "$1,237.00" "$1,959.41" $1.00 "$1,979.20" "$2,150.00" "$2,474.00" $1.00 "$1,434.92" "$2,474.00" $1.08 $1.00 "$2,474.00" $1.00 N/A N/A 48000004 EAP CPT® 92960 CARDIOVERSION BOTH IP/OP "$2,742.00" "$2,029.50" $108.12 "$2,193.60" "$1,488.91" "$1,488.91" "$1,488.91" "$1,488.91" $552.59 $552.59 $550.15 $571.50 $552.59 "$2,035.11" "$2,035.11" "$2,113.53" "$1,428.58" $571.46 $884.15 $848.49 "$1,621.89" $552.59 $108.12 $552.59 $580.22 "$2,056.50" $552.59 $552.59 $552.59 "$1,371.00" "$1,371.00" "$2,171.66" $552.59 "$2,193.60" "$2,150.00" $544.22 $552.59 "$1,590.36" $580.22 $799.46 $552.59 $571.43 $552.59 N/A N/A 48000005 EAP CPT® 92971 CIRCULATORY ASSIST - EXTERNAL BOTH IP/OP "$1,227.00" $908.00 $99.45 "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" "$1,227.00" $99.98 $99.98 $100.81 "$1,227.00" $99.98 $910.68 $910.68 $945.77 $639.27 $255.72 $159.97 $159.12 "$1,227.00" $99.98 $99.45 $99.98 "$1,227.00" $920.25 $99.98 $99.98 $99.98 $613.50 $613.50 $971.78 $99.98 $981.60 $797.55 "$1,227.00" $99.98 $711.66 "$1,227.00" $104.91 $99.98 "$1,227.00" $99.98 N/A N/A 48000011 EAP CPT® 92986 "PERC BALLOON VPLASTY, AORTIC" BOTH IP/OP "$20,704.00" "$15,321.00" "$1,312.03" "$20,704.00" "$20,704.00" "$20,704.00" "$20,704.00" "$20,704.00" "$1,325.82" "$1,325.82" "$1,324.93" "$20,704.00" "$1,325.82" "$20,704.00" "$20,704.00" "$20,704.00" "$20,704.00" "$4,314.94" "$2,121.31" "$2,099.25" "$20,704.00" "$1,325.82" "$1,312.03" "$1,325.82" "$20,704.00" "$15,528.00" "$1,325.82" "$1,325.82" "$1,325.82" "$2,762.00" "$10,352.00" "$16,397.57" "$1,325.82" "$16,563.20" "$4,334.00" "$20,704.00" "$1,325.82" "$12,008.32" "$20,704.00" "$1,376.42" "$1,325.82" "$20,704.00" "$1,325.82" N/A N/A 48000012 EAP CPT® 92987 "PERC BALLOON VPLASTY, MITRAL" BOTH IP/OP "$20,704.00" "$15,321.00" "$1,357.19" "$20,704.00" "$20,704.00" "$20,704.00" "$20,704.00" "$20,704.00" "$1,371.47" "$1,371.47" "$1,369.15" "$20,704.00" "$1,371.47" "$20,704.00" "$20,704.00" "$20,704.00" "$20,704.00" "$4,314.94" "$2,194.35" "$2,171.50" "$20,704.00" "$1,371.47" "$1,357.19" "$1,371.47" "$20,704.00" "$15,528.00" "$1,371.47" "$1,371.47" "$1,371.47" "$2,762.00" "$10,352.00" "$16,397.57" "$1,371.47" "$16,563.20" "$4,334.00" "$20,704.00" "$1,371.47" "$12,008.32" "$20,704.00" "$1,419.69" "$1,371.47" "$20,704.00" "$1,371.47" N/A N/A 48000013 EAP CPT® 92990 "PERC BALLOON VPLASTY, PULM" BOTH IP/OP "$20,704.00" "$15,321.00" "$1,083.61" "$20,704.00" "$20,704.00" "$20,704.00" "$20,704.00" "$20,704.00" "$1,092.59" "$1,092.59" "$1,092.64" "$20,704.00" "$1,092.59" "$20,704.00" "$20,704.00" "$20,704.00" "$20,704.00" "$4,314.94" "$1,748.14" "$1,733.78" "$20,704.00" "$1,092.59" "$1,083.61" "$1,092.59" "$20,704.00" "$15,528.00" "$1,092.59" "$1,092.59" "$1,092.59" "$2,762.00" "$10,352.00" "$16,397.57" "$1,092.59" "$16,563.20" "$4,334.00" "$20,704.00" "$1,092.59" "$12,008.32" "$20,704.00" "$1,134.13" "$1,092.59" "$20,704.00" "$1,092.59" N/A N/A 48000014 EAP CPT® 93282 SINGLE LEAD ICD PROGRAMMING / EVALUATION IN PERSON BOTH IP/OP $328.00 $243.00 $36.47 $262.40 $133.18 $133.18 $133.18 $133.18 $36.63 $36.63 $36.47 $68.36 $36.63 $243.44 $243.44 $252.82 $170.89 $68.36 $58.61 $50.50 $194.01 $36.63 $40.25 $36.63 $38.46 $246.00 $36.63 $36.63 $36.63 $164.00 $164.00 $259.78 $36.63 $262.40 $213.20 $65.10 $36.63 $190.24 $38.46 $52.99 $36.63 $68.36 $36.63 N/A N/A 48000015 EAP CPT® 93283 DUAL LEAD ICD PROGRAM/ EVAL IN PERSON BOTH IP/OP $328.00 $243.00 $36.47 $262.40 $171.86 $171.86 $171.86 $171.86 $36.63 $36.63 $36.47 $68.36 $36.63 $243.44 $243.44 $252.82 $170.89 $68.36 $58.61 $50.50 $194.01 $36.63 $43.97 $36.63 $38.46 $246.00 $36.63 $36.63 $36.63 $164.00 $164.00 $259.78 $36.63 $262.40 $213.20 $65.10 $36.63 $190.24 $38.46 $52.99 $36.63 $68.36 $36.63 N/A N/A 48000016 EAP CPT® 93285 SQ-CARDIAC RHYTHM MONITOR / LOOP RECORDER PROGRAM / EVAL IN PERSON BOTH IP/OP $204.00 $151.00 $36.19 $163.20 $88.55 $88.55 $88.55 $88.55 $36.63 $36.63 $36.47 $42.52 $36.63 $151.41 $151.41 $157.24 $106.28 $42.52 $58.61 $50.50 $120.67 $36.63 $36.19 $36.63 $38.46 $153.00 $36.63 $36.63 $36.63 $102.00 $102.00 $161.57 $36.63 $163.20 $132.60 $40.49 $36.63 $118.32 $38.46 $52.99 $36.63 $42.51 $36.63 N/A N/A 48000017 EAP CPT® 93289 PACEMAKER INTERROG / EVAL IN PERSON BOTH IP/OP $328.00 $243.00 $36.47 $262.40 $138.38 $138.38 $138.38 $138.38 $36.63 $36.63 $36.47 $68.36 $36.63 $243.44 $243.44 $252.82 $170.89 $68.36 $58.61 $50.50 $194.01 $36.63 $37.21 $36.63 $38.46 $246.00 $36.63 $36.63 $36.63 $164.00 $164.00 $259.78 $36.63 $262.40 $213.20 $65.10 $36.63 $190.24 $38.46 $52.99 $36.63 $68.36 $36.63 N/A N/A 48000019 EAP CPT® 93307 2D ECHO BOTH IP/OP "$3,555.00" "$2,631.00" $95.04 "$3,555.00" "$3,555.00" "$3,555.00" "$3,555.00" "$3,555.00" $98.71 $98.71 $146.47 "$3,555.00" $98.71 $316.71 $316.71 $328.89 $231.20 $740.90 $157.94 $152.06 "$3,555.00" $98.71 $95.04 $98.71 "$3,555.00" "$2,666.25" $98.71 $98.71 $98.71 "$1,777.50" "$1,777.50" "$2,815.56" $98.71 "$2,844.00" "$2,310.75" "$3,555.00" $98.71 "$2,061.90" "$3,555.00" $97.61 $98.71 "$3,555.00" $98.71 N/A N/A 48000020 EAP CPT® 93312 TRANSESOPHAGEAL ECHO BOTH IP/OP "$4,858.00" "$3,595.00" $133.26 "$3,886.40" $517.84 $517.84 $517.84 $517.84 $475.30 $475.30 $473.20 "$1,012.53" $475.30 $522.69 $522.69 $542.80 $381.56 "$1,012.46" $760.48 $725.84 "$2,873.51" $475.30 $133.26 $475.30 $499.07 "$3,643.50" $475.30 $475.30 $475.30 "$2,429.00" "$2,429.00" "$3,847.54" $475.30 "$3,886.40" "$3,157.70" $964.19 $475.30 "$2,817.64" $499.07 $687.64 $475.30 "$1,012.41" $475.30 N/A N/A 48000021 EAP CPT® 93320 ECHO DOPPLER COMPLETE BOTH IP/OP "$2,768.00" "$2,048.50" $33.49 "$3,041.00" $113.83 $113.83 $113.83 $113.83 "$2,768.00" "$2,768.00" "$2,768.00" $576.92 "$2,768.00" $143.29 $143.29 $148.80 $104.60 $576.88 "$2,768.00" "$3,041.00" "$1,637.27" "$2,768.00" $33.49 "$2,768.00" "$2,768.00" "$2,076.00" "$2,768.00" "$2,768.00" "$2,768.00" "$1,384.00" "$1,384.00" "$2,192.26" "$2,768.00" "$2,214.40" "$1,799.20" $549.38 "$2,768.00" "$1,605.44" "$2,768.00" "$2,768.00" "$2,768.00" $576.85 "$2,768.00" N/A N/A 48000022 EAP CPT® 93325 COLOR FLOW MAPPING BOTH IP/OP "$1,693.00" "$1,253.00" $20.63 "$3,041.00" $53.56 $53.56 $53.56 $53.56 "$1,693.00" "$1,693.00" "$1,693.00" $352.86 "$1,693.00" $122.81 $122.81 $127.54 $89.65 $352.84 "$1,693.00" "$3,041.00" "$1,001.41" "$1,693.00" $20.63 "$1,693.00" "$1,693.00" "$1,269.75" "$1,693.00" "$1,693.00" "$1,693.00" $846.50 $846.50 "$1,340.86" "$1,693.00" "$1,354.40" "$1,100.45" $336.02 "$1,693.00" $981.94 "$1,693.00" "$1,693.00" "$1,693.00" $352.82 "$1,693.00" N/A N/A 48000024 EAP CPT® 93503 INSERTION SWAN GANZ BOTH IP/OP "$8,527.00" "$6,310.00" $87.50 "$8,527.00" "$8,527.00" "$8,527.00" "$8,527.00" "$8,527.00" $88.63 $88.63 $88.38 "$8,527.00" $88.63 "$8,527.00" "$8,527.00" "$8,527.00" "$8,527.00" "$1,777.12" $141.81 $140.00 "$8,527.00" $88.63 $87.50 $88.63 "$8,527.00" "$6,395.25" $88.63 $88.63 $88.63 "$2,762.00" "$4,263.50" "$6,753.38" $88.63 "$6,821.60" "$3,250.00" "$8,527.00" $88.63 "$4,945.66" "$8,527.00" $91.98 $88.63 "$8,527.00" $88.63 N/A N/A 48000025 EAP CPT® 93580 PERC CLOSURE ATRIAL SEPTAL DEF BOTH IP/OP "$19,473.00" "$14,410.50" $964.07 "$19,473.00" "$19,473.00" "$19,473.00" "$19,473.00" "$19,473.00" $974.02 $974.02 $976.66 "$19,473.00" $974.02 "$19,473.00" "$19,473.00" "$19,473.00" "$19,473.00" "$4,058.39" "$1,558.43" "$1,542.51" "$19,473.00" $974.02 $964.07 $974.02 "$19,473.00" "$14,604.75" $974.02 $974.02 $974.02 "$7,479.00" "$9,736.50" "$15,422.62" $974.02 "$15,578.40" "$5,343.00" "$19,473.00" $974.02 "$11,294.34" "$19,473.00" "$1,019.60" $974.02 "$19,473.00" $974.02 N/A N/A 48000026 EAP CPT® 33222 RELOCATION SKIN PKT FOR PACEMAKER BOTH IP/OP "$27,668.00" "$20,474.50" $345.27 "$27,668.00" "$27,668.00" "$27,668.00" "$27,668.00" "$27,668.00" $347.65 $347.65 $347.75 "$27,668.00" $347.65 "$27,668.00" "$27,668.00" "$27,668.00" "$27,668.00" "$5,766.32" $556.24 $552.43 "$27,668.00" $347.65 $345.27 $347.65 "$27,668.00" "$20,751.00" $347.65 $347.65 $347.65 "$2,851.00" "$13,834.00" "$21,913.06" $347.65 "$22,134.40" "$2,500.00" "$27,668.00" $347.65 "$16,047.44" "$27,668.00" $354.68 $347.65 "$27,668.00" $347.65 N/A N/A 48000027 EAP CPT® 93640 EP EVAL ICD LEADS INIT IMPLANT BOTH IP/OP "$5,142.00" "$3,805.50" $915.28 "$5,142.00" "$5,142.00" "$5,142.00" "$5,142.00" "$5,142.00" "$5,142.00" "$5,142.00" $915.28 "$5,142.00" "$5,142.00" "$3,816.39" "$3,816.39" "$3,963.45" "$2,060.15" "$1,071.65" "$5,142.00" "$2,056.80" "$5,142.00" "$5,142.00" "$5,142.00" "$5,142.00" "$5,142.00" "$3,856.50" "$5,142.00" "$5,142.00" "$5,142.00" "$2,571.00" "$2,571.00" "$4,072.46" "$5,142.00" "$4,113.60" "$1,750.00" "$5,142.00" "$5,142.00" "$2,982.36" "$5,142.00" "$5,142.00" "$5,142.00" "$5,142.00" "$5,142.00" N/A N/A 48000028 EAP CPT® 93641 TEST ICD GEN INITIAL IMPLANT BOTH IP/OP "$5,361.00" "$3,967.50" "$1,064.02" "$8,403.00" "$5,361.00" "$5,361.00" "$5,361.00" "$5,361.00" "$5,361.00" "$5,361.00" "$5,361.00" "$1,117.37" "$5,361.00" "$3,978.93" "$3,978.93" "$4,132.26" "$2,060.15" "$1,117.29" "$5,361.00" "$8,403.00" "$3,094.73" "$5,361.00" "$8,403.00" "$5,361.00" "$5,361.00" "$4,020.75" "$5,361.00" "$5,361.00" "$5,361.00" "$2,680.50" "$2,680.50" "$4,245.91" "$5,361.00" "$4,288.80" "$1,750.00" "$1,064.02" "$5,361.00" "$3,109.38" "$5,361.00" "$5,361.00" "$5,361.00" "$1,117.23" "$5,361.00" N/A N/A 48000029 EAP CPT® 93642 EP EVAL ICD GEN & PROGRAMMING BOTH IP/OP "$5,562.00" "$4,116.00" $83.56 "$5,422.00" "$5,422.00" "$5,422.00" "$5,422.00" "$5,422.00" "$1,095.61" "$1,095.61" "$1,090.77" "$1,159.26" "$1,095.61" "$4,128.12" "$4,128.12" "$4,287.19" "$2,060.15" "$1,159.18" "$1,752.98" "$1,611.54" "$3,094.73" "$1,095.61" $83.56 "$1,095.61" "$1,150.39" "$4,171.50" "$1,095.61" "$1,095.61" "$1,095.61" "$2,781.00" "$2,781.00" "$4,405.10" "$1,095.61" "$4,449.60" "$2,500.00" "$1,103.92" "$1,095.61" "$3,225.96" "$1,150.39" "$1,585.08" "$1,095.61" "$1,159.12" "$1,095.61" N/A N/A 48000030 EAP CPT® 93660 TILT TABLE EVALUATION BOTH IP/OP "$1,423.00" "$1,053.50" $71.05 "$1,423.00" $772.69 $772.69 $772.69 $772.69 $480.16 $480.16 $478.04 $296.59 $480.16 "$1,056.15" "$1,056.15" "$1,096.85" $741.38 $296.57 $768.26 $697.42 $841.70 $480.16 $71.05 $480.16 $504.17 "$1,067.25" $480.16 $480.16 $480.16 $711.50 $711.50 "$1,127.02" $480.16 "$1,138.40" "$1,423.00" $282.43 $480.16 $825.34 $504.17 $694.68 $480.16 $296.55 $480.16 N/A N/A 48000040 EAP CPT® 93788 AMBULATORY BP ANALYSIS BOTH IP/OP $212.00 $157.00 $5.04 $212.00 $212.00 $212.00 $212.00 $212.00 $5.15 $5.15 $5.19 $212.00 $5.15 $157.35 $157.35 $163.41 $110.45 $44.18 $8.24 $8.67 $212.00 $5.15 $5.42 $5.15 $212.00 $159.00 $5.15 $5.15 $5.15 $106.00 $106.00 $167.90 $5.15 $169.60 $137.80 $212.00 $5.15 $122.96 $212.00 $5.04 $5.15 $212.00 $5.15 N/A N/A 48000045 EAP CPT® 93458 LT HEART CATH INCLUDING V GRAM BOTH IP/OP "$22,078.00" "$16,338.00" $764.34 "$17,662.40" "$9,802.00" "$9,802.00" "$9,802.00" "$9,802.00" "$2,852.42" "$2,852.42" "$2,839.80" "$4,601.61" "$2,852.42" "$5,559.30" "$5,559.30" "$5,773.12" "$1,876.38" "$4,601.30" "$4,563.87" "$4,268.05" "$13,059.14" "$2,852.42" $764.34 "$2,852.42" "$2,995.04" "$16,558.50" "$2,852.42" "$2,852.42" "$2,852.42" "$3,500.00" "$2,975.00" "$17,485.78" "$2,852.42" "$17,662.40" "$4,334.00" "$4,381.93" "$2,852.42" "$12,805.24" "$2,995.04" "$4,126.73" "$2,852.42" "$4,601.06" "$2,852.42" N/A N/A 48000046 EAP CPT® 93459 LHC W/ V GRAM AND GRAFTS BOTH IP/OP "$22,078.00" "$16,338.00" $805.26 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" $854.97 $854.97 "$1,222.85" "$22,078.00" $854.97 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$4,601.30" "$1,367.95" "$1,288.42" "$22,078.00" $854.97 $805.26 $854.97 "$22,078.00" "$16,558.50" $854.97 $854.97 $854.97 "$3,500.00" "$11,039.00" "$17,485.78" $854.97 "$17,662.40" "$4,334.00" "$22,078.00" "$2,852.42" "$12,805.24" "$22,078.00" $842.80 $854.97 "$22,078.00" $854.97 N/A N/A 48000047 EAP CPT® 93460 R&LHC W/V GRAM BOTH IP/OP "$22,078.00" "$16,338.00" $891.50 "$17,662.40" "$9,802.00" "$9,802.00" "$9,802.00" "$9,802.00" "$2,852.42" "$2,852.42" "$2,839.80" "$4,601.61" "$2,852.42" "$5,559.30" "$5,559.30" "$5,773.12" "$1,876.38" "$4,601.30" "$4,563.87" "$4,268.05" "$13,059.14" "$2,852.42" $891.50 "$2,852.42" "$2,995.04" "$16,558.50" "$2,852.42" "$2,852.42" "$2,852.42" "$3,500.00" "$2,975.00" "$17,485.78" "$2,852.42" "$17,662.40" "$4,334.00" "$4,381.93" "$2,852.42" "$12,805.24" "$2,995.04" "$4,126.73" "$2,852.42" "$4,601.06" "$2,852.42" N/A N/A 48000048 EAP CPT® 93461 R&LHC W/V GRAM AND GRAFTS BOTH IP/OP "$22,078.00" "$16,338.00" $982.49 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$1,043.13" "$1,043.13" "$1,504.49" "$22,078.00" "$1,043.13" "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$4,601.30" "$1,669.01" "$1,571.98" "$22,078.00" "$1,043.13" $982.49 "$1,043.13" "$22,078.00" "$16,558.50" "$1,043.13" "$1,043.13" "$1,043.13" "$3,500.00" "$11,039.00" "$17,485.78" "$1,043.13" "$17,662.40" "$4,334.00" "$22,078.00" "$1,043.13" "$12,805.24" "$22,078.00" "$1,044.50" "$1,043.13" "$22,078.00" "$1,043.13" N/A N/A 48000050 EAP CPT® 33235 REMOVAL PACEMAKER ELECTRODES BOTH IP/OP "$9,098.00" "$6,733.00" $639.87 "$9,098.00" "$9,098.00" "$9,098.00" "$9,098.00" "$9,098.00" $645.64 $645.64 $647.39 "$9,098.00" $645.64 "$9,098.00" "$9,098.00" "$9,098.00" "$9,098.00" "$1,896.12" "$1,033.02" "$1,023.79" "$9,098.00" $645.64 $639.87 $645.64 "$9,098.00" "$6,823.50" $645.64 $645.64 $645.64 "$2,762.00" "$4,549.00" "$7,205.62" $645.64 "$7,278.40" "$3,725.00" "$9,098.00" $645.64 "$5,276.84" "$9,098.00" $666.88 $645.64 "$9,098.00" $645.64 N/A N/A 48000053 EAP CPT® 94621 PULM EXER STRESS TEST; COMPLEX BOTH IP/OP "$1,097.00" $812.00 $86.94 "$1,097.00" "$1,097.00" "$1,097.00" "$1,097.00" "$1,097.00" $88.28 $88.28 $159.61 "$1,097.00" $88.28 $814.19 $814.19 $845.57 $571.54 $228.63 $141.25 $139.10 "$1,097.00" $88.28 $86.94 $88.28 "$1,097.00" $822.75 $88.28 $88.28 $88.28 $548.50 $548.50 $868.82 $88.28 $877.60 $713.05 "$1,097.00" $88.28 $636.26 "$1,097.00" $90.40 $88.28 "$1,097.00" $88.28 N/A N/A 48000054 EAP Custom 48000054 CPET PATIENT INTERFACE KIT BOTH IP/OP $424.00 $314.00 $75.47 $424.00 $424.00 $424.00 $424.00 $424.00 $424.00 $424.00 $75.47 $424.00 $424.00 $314.69 $314.69 $326.82 $220.90 $88.37 $424.00 $169.60 $424.00 $424.00 $424.00 $424.00 $424.00 $318.00 $424.00 $424.00 $424.00 $212.00 $212.00 $335.81 $424.00 $339.20 $275.60 $424.00 $424.00 $245.92 $424.00 $254.40 $424.00 $424.00 $424.00 N/A N/A 48000055 EAP Custom 48000055 ANALYZE/IND/TERM TACHYCARDIA BOTH IP/OP $238.00 $176.50 $42.36 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $42.36 $238.00 $238.00 $176.64 $176.64 $183.45 $124.00 $49.60 $238.00 $95.20 $238.00 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $154.70 $238.00 $238.00 $138.04 $238.00 $142.80 $238.00 $238.00 $238.00 N/A N/A 48000057 EAP CPT® 92920 PRQ CARDIAC ANGIOPLAST 1 ART BOTH IP/OP "$17,577.00" "$13,007.00" $522.47 "$17,577.00" "$17,577.00" "$17,577.00" "$17,577.00" "$17,577.00" $529.72 $529.72 $531.59 "$17,577.00" $529.72 "$17,577.00" "$17,577.00" "$17,577.00" "$17,577.00" "$3,663.24" $847.55 $835.95 "$17,577.00" $529.72 $522.47 $529.72 "$17,577.00" "$13,182.75" $529.72 $529.72 $529.72 "$6,095.00" "$8,788.50" "$13,920.98" $529.72 "$14,061.60" "$17,577.00" "$17,577.00" $529.72 "$10,194.66" "$17,577.00" $555.58 $529.72 "$17,577.00" $529.72 N/A N/A 48000058 EAP CPT® 92921 PRQ CARDIAC ANGIO ADDL ART BOTH IP/OP "$28,094.00" "$20,790.00" "$2,060.15" "$28,094.00" "$28,094.00" "$28,094.00" "$28,094.00" "$28,094.00" "$28,094.00" "$28,094.00" "$28,094.00" "$28,094.00" "$28,094.00" "$4,181.12" "$4,181.12" "$21,654.86" "$2,060.15" "$5,855.10" "$28,094.00" "$2,563.60" "$28,094.00" "$28,094.00" "$6,409.00" "$28,094.00" "$28,094.00" "$21,070.50" "$28,094.00" "$28,094.00" "$28,094.00" "$14,047.00" "$14,047.00" "$22,250.45" "$28,094.00" "$22,475.20" "$28,094.00" "$28,094.00" "$28,094.00" "$16,294.52" "$28,094.00" "$16,856.40" "$28,094.00" "$28,094.00" "$28,094.00" N/A N/A 48000059 EAP CPT® 92928 PRQ CARD STENT W/ANGIO 1 VSL BOTH IP/OP "$32,293.00" "$23,897.00" $582.57 "$25,834.40" "$17,535.10" "$17,535.10" "$17,535.10" "$17,535.10" "$9,880.57" "$9,880.57" "$9,836.87" "$6,730.67" "$9,880.57" "$3,769.39" "$3,769.39" "$3,914.36" "$2,645.82" "$6,730.22" "$15,808.91" "$15,314.28" "$19,101.31" "$9,880.57" $582.57 "$9,880.57" "$10,374.60" "$24,219.75" "$9,880.57" "$9,880.57" "$9,880.57" "$7,479.00" "$6,357.00" "$25,576.06" "$9,880.57" "$25,834.40" "$4,334.00" "$6,409.35" "$9,880.57" "$18,729.94" "$10,374.60" "$14,294.69" "$9,880.57" "$6,729.86" "$9,880.57" N/A N/A 48000060 EAP CPT® 92929 PRQ CARD STENT W/ANGIO ADDL BOTH IP/OP "$44,709.00" "$33,085.00" "$1,750.00" "$44,709.00" "$44,709.00" "$44,709.00" "$44,709.00" "$44,709.00" "$44,709.00" "$44,709.00" "$44,709.00" "$44,709.00" "$44,709.00" "$4,181.12" "$4,181.12" "$34,461.70" "$2,060.15" "$9,317.85" "$44,709.00" "$2,440.40" "$44,709.00" "$44,709.00" "$6,101.00" "$44,709.00" "$44,709.00" "$33,531.75" "$44,709.00" "$44,709.00" "$44,709.00" "$22,354.50" "$22,354.50" "$35,409.53" "$44,709.00" "$35,767.20" "$1,750.00" "$44,709.00" "$44,709.00" "$25,931.22" "$44,709.00" "$26,825.40" "$44,709.00" "$44,709.00" "$44,709.00" N/A N/A 48000061 EAP CPT® 92937 PRQ REVASC BYP GRAFT 1 VSL BOTH IP/OP "$14,275.00" "$10,563.50" $581.90 "$14,275.00" "$14,275.00" "$14,275.00" "$14,275.00" "$14,275.00" $588.70 $588.70 $590.74 "$14,275.00" $588.70 "$14,275.00" "$14,275.00" "$14,275.00" "$14,275.00" "$2,975.07" $941.92 $931.04 "$14,275.00" $588.70 $581.90 $588.70 "$14,275.00" "$10,706.25" $588.70 $588.70 $588.70 "$7,479.00" "$7,137.50" "$11,305.80" $588.70 "$11,420.00" "$4,334.00" "$14,275.00" $588.70 "$8,279.50" "$14,275.00" $617.23 $588.70 "$14,275.00" $588.70 N/A N/A 48000062 EAP CPT® 92938 PRQ REVASC BYP GRAFT ADDL BOTH IP/OP "$12,738.00" "$9,426.50" "$1,750.00" "$12,738.00" "$12,738.00" "$12,738.00" "$12,738.00" "$12,738.00" "$12,738.00" "$12,738.00" "$12,738.00" "$12,738.00" "$12,738.00" "$4,181.12" "$4,181.12" "$9,818.45" "$2,060.15" "$2,654.74" "$12,738.00" "$5,095.20" "$12,738.00" "$12,738.00" "$12,738.00" "$12,738.00" "$12,738.00" "$9,553.50" "$12,738.00" "$12,738.00" "$12,738.00" "$6,369.00" "$6,369.00" "$10,088.50" "$12,738.00" "$10,190.40" "$1,750.00" "$12,738.00" "$12,738.00" "$7,388.04" "$12,738.00" "$7,642.80" "$12,738.00" "$12,738.00" "$12,738.00" N/A N/A 48000063 EAP CPT® 92941 PRQ CARD REVASC MI 1 VSL BOTH IP/OP "$39,045.00" "$28,893.50" $662.35 "$39,045.00" "$39,045.00" "$39,045.00" "$39,045.00" "$39,045.00" "$39,045.00" "$39,045.00" "$39,045.00" "$39,045.00" "$39,045.00" "$39,045.00" "$39,045.00" "$39,045.00" "$39,045.00" "$8,137.41" "$39,045.00" "$13,780.80" "$39,045.00" "$39,045.00" "$34,452.00" "$39,045.00" "$39,045.00" "$29,283.75" "$39,045.00" "$39,045.00" "$39,045.00" "$19,522.50" "$19,522.50" "$30,923.64" "$39,045.00" "$31,236.00" "$5,164.00" "$39,045.00" "$39,045.00" "$22,646.10" "$39,045.00" $694.75 $662.35 "$39,045.00" "$39,045.00" N/A N/A 48000064 EAP CPT® 92943 PRQ CARD REVASC CHRONIC 1VSL BOTH IP/OP "$29,217.00" "$21,621.00" $662.32 "$29,217.00" "$29,217.00" "$29,217.00" "$29,217.00" "$29,217.00" "$29,217.00" "$29,217.00" "$29,217.00" "$29,217.00" "$29,217.00" "$29,217.00" "$29,217.00" "$29,217.00" "$29,217.00" "$6,089.14" "$29,217.00" "$11,686.80" "$29,217.00" "$29,217.00" "$29,217.00" "$29,217.00" "$29,217.00" "$21,912.75" "$29,217.00" "$29,217.00" "$29,217.00" "$7,479.00" "$14,608.50" "$23,139.86" "$29,217.00" "$23,373.60" "$5,164.00" "$29,217.00" "$29,217.00" "$16,945.86" "$29,217.00" $694.75 $662.32 "$29,217.00" "$29,217.00" N/A N/A 48000065 EAP CPT® 92944 PRQ CARD REVASC CHRONIC ADDL BOTH IP/OP "$20,209.00" "$14,955.00" "$1,750.00" "$20,209.00" "$20,209.00" "$20,209.00" "$20,209.00" "$20,209.00" "$20,209.00" "$20,209.00" "$20,209.00" "$20,209.00" "$20,209.00" "$4,181.12" "$4,181.12" "$15,577.10" "$2,060.15" "$4,211.78" "$20,209.00" "$8,083.60" "$20,209.00" "$20,209.00" "$20,209.00" "$20,209.00" "$20,209.00" "$15,156.75" "$20,209.00" "$20,209.00" "$20,209.00" "$10,104.50" "$10,104.50" "$16,005.53" "$20,209.00" "$16,167.20" "$1,750.00" "$20,209.00" "$20,209.00" "$11,721.22" "$20,209.00" "$12,125.40" "$20,209.00" "$20,209.00" "$20,209.00" N/A N/A 48000066 EAP CPT® 33223 RELOCATION SKIN PKT CARDIOVERT-DEFIB BOTH IP/OP "$5,494.00" "$4,066.00" $411.50 "$5,494.00" "$5,494.00" "$5,494.00" "$5,494.00" "$5,494.00" $415.38 $415.38 $417.11 "$5,494.00" $415.38 "$5,494.00" "$5,494.00" "$5,494.00" "$5,494.00" "$1,145.01" $664.61 $658.40 "$5,494.00" $415.38 $411.50 $415.38 "$5,494.00" "$4,120.50" $415.38 $415.38 $415.38 "$2,851.00" "$2,747.00" "$4,351.25" $415.38 "$4,395.20" "$2,500.00" "$5,494.00" $415.38 "$3,186.52" "$5,494.00" $428.24 $415.38 "$5,494.00" $415.38 N/A N/A 48000067 EAP CPT® 93261 S-ICD INTERROG / EVAL IN PERSON BOTH IP/OP $208.00 $154.00 $35.18 $166.40 $125.75 $125.75 $125.75 $125.75 $36.63 $36.63 $36.47 $43.35 $36.63 $154.38 $154.38 $160.33 $108.37 $43.35 $58.61 $50.50 $123.03 $36.63 $35.18 $36.63 $38.46 $156.00 $36.63 $36.63 $36.63 $104.00 $104.00 $164.74 $36.63 $166.40 $135.20 $41.28 $36.63 $120.64 $38.46 $52.99 $36.63 $43.35 $36.63 N/A N/A 48000070 EAP CPT® 92933 PRQ TRLUML CORONARY ANGIO/ATHE BOTH IP/OP "$20,912.00" "$15,475.00" $652.85 "$20,912.00" "$20,912.00" "$20,912.00" "$20,912.00" "$20,912.00" $660.97 $660.97 $663.96 "$20,912.00" $660.97 "$20,912.00" "$20,912.00" "$20,912.00" "$20,912.00" "$4,358.29" "$1,057.55" "$1,044.56" "$20,912.00" $660.97 $652.85 $660.97 "$20,912.00" "$15,684.00" $660.97 $660.97 $660.97 "$7,479.00" "$10,456.00" "$16,562.30" $660.97 "$16,729.60" "$4,334.00" "$20,912.00" $660.97 "$12,128.96" "$20,912.00" $693.67 $660.97 "$20,912.00" $660.97 N/A N/A 48000071 EAP CPT® 33999 INSERTION OF IMPELLA DEVICE - RP BOTH IP/OP "$13,372.00" "$9,895.50" "$2,060.15" "$13,372.00" "$13,372.00" "$13,372.00" "$13,372.00" "$13,372.00" "$13,372.00" "$13,372.00" "$13,372.00" "$13,372.00" "$13,372.00" "$4,181.12" "$4,181.12" "$10,307.14" "$2,060.15" "$2,786.87" "$13,372.00" "$5,348.80" "$13,372.00" "$13,372.00" "$13,372.00" "$13,372.00" "$13,372.00" "$10,029.00" "$13,372.00" "$13,372.00" "$13,372.00" "$2,762.00" "$6,686.00" "$10,590.62" "$13,372.00" "$10,697.60" "$2,150.00" "$13,372.00" "$13,372.00" "$7,755.76" "$13,372.00" "$8,023.20" "$13,372.00" "$13,372.00" "$13,372.00" N/A N/A 48000111 EAP CPT® 93298 S-ICD/LOOP RECORDER INTERROG / EVAL REMOTE UP TO 30 DAYS BOTH IP/OP $204.00 $151.00 $26.50 $204.00 $56.55 $56.55 $56.55 $56.55 $36.63 $36.63 $36.47 $42.52 $36.63 $151.41 $151.41 $157.24 $106.28 $42.52 $58.61 $50.50 $120.67 $36.63 $204.00 $36.63 $38.46 $153.00 $36.63 $36.63 $36.63 $102.00 $102.00 $161.57 $36.63 $163.20 $132.60 $40.49 $36.63 $118.32 $38.46 $28.13 $26.50 $42.51 $36.63 N/A N/A 48100001 EAP CPT® 33240 INSRT ICD PULSE GEN W SNGL LEAD BOTH IP/OP "$29,623.00" "$21,921.50" $367.45 "$29,623.00" "$29,623.00" "$29,623.00" "$29,623.00" "$29,623.00" $371.39 $371.39 $370.46 "$29,623.00" $371.39 "$29,623.00" "$29,623.00" "$29,623.00" "$29,623.00" "$6,173.76" $594.22 $587.92 "$29,623.00" $371.39 $367.45 $371.39 "$29,623.00" "$22,217.25" $371.39 $371.39 $371.39 "$7,479.00" "$14,811.50" "$23,461.42" $371.39 "$23,698.40" "$5,410.00" "$29,623.00" $371.39 "$17,181.34" "$29,623.00" $381.75 $371.39 "$29,623.00" $371.39 N/A N/A 48100004 EAP CPT® 92973 PERC CORONARY THROMBECTOMY BOTH IP/OP "$9,050.00" "$6,697.00" $173.82 "$9,050.00" "$9,050.00" "$9,050.00" "$9,050.00" "$9,050.00" $176.69 $176.69 $177.49 "$9,050.00" $176.69 "$4,181.12" "$4,181.12" "$6,975.74" "$2,060.15" "$1,886.12" $282.70 $278.11 "$9,050.00" $176.69 $173.82 $176.69 "$9,050.00" "$6,787.50" $176.69 $176.69 $176.69 "$4,525.00" "$4,525.00" "$7,167.60" $176.69 "$7,240.00" "$1,750.00" "$9,050.00" $176.69 "$5,249.00" "$9,050.00" $184.59 $176.69 "$9,050.00" $176.69 N/A N/A 48100006 EAP CPT® 93505 ENDOMYOCARDIAL BIOPSY BOTH IP/OP "$3,290.00" "$2,435.00" $430.53 "$4,505.48" "$3,290.00" "$3,290.00" "$3,290.00" "$3,290.00" "$2,815.92" "$2,815.92" "$2,803.47" $685.72 "$2,815.92" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" $685.67 "$4,505.48" "$4,297.64" "$1,946.04" "$2,815.92" $430.53 "$2,815.92" "$2,956.72" "$2,467.50" "$2,815.92" "$2,815.92" "$2,815.92" "$2,762.00" "$1,645.00" "$2,605.68" "$2,815.92" "$2,632.00" "$3,250.00" $652.98 "$2,815.92" "$1,908.20" "$2,956.72" "$3,290.00" "$2,815.92" $685.64 "$2,815.92" N/A N/A 48100022 EAP CPT® 93571 INTRAVASC CORNARY FLOW MEASURE BOTH IP/OP "$5,647.00" "$4,179.00" "$1,120.79" "$5,647.00" "$3,066.32" "$3,066.32" "$3,066.32" "$3,066.32" "$5,647.00" "$5,647.00" "$5,647.00" "$1,176.98" "$5,647.00" "$4,181.12" "$4,181.12" "$4,352.71" "$2,060.15" "$1,176.90" "$5,647.00" "$4,469.00" "$3,340.20" "$5,647.00" "$4,469.00" "$5,647.00" "$5,647.00" "$4,235.25" "$5,647.00" "$5,647.00" "$5,647.00" "$2,823.50" "$2,823.50" "$4,472.42" "$5,647.00" "$4,517.60" "$1,750.00" "$1,120.79" "$5,647.00" "$3,275.26" "$5,647.00" "$5,647.00" "$5,647.00" "$1,176.83" "$5,647.00" N/A N/A 48100023 EAP CPT® 93572 INTRAVASC COR. FLOW ADDIT VESS BOTH IP/OP "$5,581.00" "$4,130.00" $993.42 "$5,581.00" "$5,581.00" "$5,581.00" "$5,581.00" "$5,581.00" "$5,581.00" "$5,581.00" $993.42 "$5,581.00" "$5,581.00" "$4,142.22" "$4,142.22" "$4,301.83" "$2,060.15" "$1,163.14" "$5,581.00" "$1,550.00" "$5,581.00" "$5,581.00" "$3,875.00" "$5,581.00" "$5,581.00" "$4,185.75" "$5,581.00" "$5,581.00" "$5,581.00" "$2,790.50" "$2,790.50" "$4,420.15" "$5,581.00" "$4,464.80" "$1,750.00" "$5,581.00" "$5,581.00" "$3,236.98" "$5,581.00" "$5,581.00" "$5,581.00" "$5,581.00" "$5,581.00" N/A N/A 48100026 EAP CPT® 33270 INSERT SUBCUTANEOUS AICD BOTH IP/OP "$129,402.00" "$95,757.50" $563.92 "$103,521.60" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$32,311.16" "$32,311.16" "$32,168.25" "$9,417.94" "$32,311.16" "$4,607.43" "$4,607.43" "$4,784.64" "$3,234.06" "$26,968.80" "$51,697.85" "$46,275.21" "$4,877.00" "$32,311.16" $563.92 "$32,311.16" "$33,926.72" "$97,051.50" "$32,311.16" "$32,311.16" "$32,311.16" "$7,479.00" "$6,357.00" "$102,486.38" "$32,311.16" "$103,521.60" "$5,410.00" "$7,712.84" "$32,311.16" "$75,053.16" "$33,926.72" "$46,746.11" "$32,311.16" "$8,098.48" "$32,311.16" N/A N/A 48100029 EAP CPT® 93462 LEFT HEART CATH BY TRANSEPTAL PUNCTURE BOTH IP/OP "$12,155.00" "$8,995.00" $207.39 "$12,155.00" "$12,155.00" "$12,155.00" "$12,155.00" "$12,155.00" $210.52 $210.52 $211.73 "$12,155.00" $210.52 "$12,155.00" "$12,155.00" "$12,155.00" "$12,155.00" "$2,533.24" $336.83 $331.82 "$12,155.00" $210.52 $207.39 $210.52 "$12,155.00" "$9,116.25" $210.52 $210.52 $210.52 "$6,077.50" "$6,077.50" "$9,626.76" $210.52 "$9,724.00" "$1,750.00" "$12,155.00" $210.52 "$7,049.90" "$12,155.00" $219.92 $210.52 "$12,155.00" $210.52 N/A N/A 48100030 EAP CPT® 93451 RIGHT HEART CATH BOTH IP/OP "$22,078.00" "$16,338.00" $750.48 "$17,662.40" "$9,802.00" "$9,802.00" "$9,802.00" "$9,802.00" "$2,852.42" "$2,852.42" "$2,839.80" "$4,601.61" "$2,852.42" "$5,559.30" "$5,559.30" "$5,773.12" "$1,876.38" "$4,601.30" "$4,563.87" "$4,268.05" "$13,059.14" "$2,852.42" $750.48 "$2,852.42" "$2,995.04" "$16,558.50" "$2,852.42" "$2,852.42" "$2,852.42" "$3,500.00" "$2,975.00" "$17,485.78" "$2,852.42" "$17,662.40" "$4,334.00" "$4,381.93" "$2,852.42" "$12,805.24" "$2,995.04" "$4,126.73" "$2,852.42" "$4,601.06" "$2,852.42" N/A N/A 48100031 EAP CPT® 93452 LHC W/V GRAM BOTH IP/OP "$22,078.00" "$16,338.00" $681.15 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" $726.18 $726.18 $977.49 "$22,078.00" $726.18 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$4,601.30" "$1,161.89" "$1,089.84" "$22,078.00" $726.18 $681.15 $726.18 "$22,078.00" "$16,558.50" $726.18 $726.18 $726.18 "$3,500.00" "$11,039.00" "$17,485.78" $726.18 "$17,662.40" "$4,334.00" "$22,078.00" "$2,852.42" "$12,805.24" "$22,078.00" $686.49 $726.18 "$22,078.00" $726.18 N/A N/A 48100032 EAP CPT® 93453 R/LHC W/V GRAM (S&I) BOTH IP/OP "$22,078.00" "$16,338.00" $850.92 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" $905.40 $905.40 "$1,247.12" "$22,078.00" $905.40 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$4,601.30" "$1,448.64" "$1,361.47" "$22,078.00" $905.40 $850.92 $905.40 "$22,078.00" "$16,558.50" $905.40 $905.40 $905.40 "$3,500.00" "$11,039.00" "$17,485.78" $905.40 "$17,662.40" "$4,334.00" "$22,078.00" $905.40 "$12,805.24" "$22,078.00" $872.34 $905.40 "$22,078.00" $905.40 N/A N/A 48100033 EAP CPT® 93454 CORONARY ANGIO W/O LHC BOTH IP/OP "$22,078.00" "$16,338.00" $682.50 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" $725.49 $725.49 $979.10 "$22,078.00" $725.49 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$4,601.30" "$1,160.78" "$1,092.00" "$22,078.00" $725.49 $682.50 $725.49 "$22,078.00" "$16,558.50" $725.49 $725.49 $725.49 "$2,762.00" "$11,039.00" "$17,485.78" $725.49 "$17,662.40" "$4,334.00" "$22,078.00" $725.49 "$12,805.24" "$22,078.00" $685.77 $725.49 "$22,078.00" $725.49 N/A N/A 48100034 EAP CPT® 93455 CORONARY ANGIO W/O LHC W/GRAFT INJ BOTH IP/OP "$22,078.00" "$16,338.00" $748.11 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" $794.57 $794.57 "$1,099.50" "$22,078.00" $794.57 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$4,601.30" "$1,271.31" "$1,196.98" "$22,078.00" $794.57 $748.11 $794.57 "$22,078.00" "$16,558.50" $794.57 $794.57 $794.57 "$2,762.00" "$11,039.00" "$17,485.78" $794.57 "$17,662.40" "$4,334.00" "$22,078.00" $794.57 "$12,805.24" "$22,078.00" $772.21 $794.57 "$22,078.00" $794.57 N/A N/A 48100035 EAP CPT® 93456 RHC/CORONARY ANGIO W/O LHC BOTH IP/OP "$22,078.00" "$16,338.00" $835.36 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" $888.51 $888.51 "$1,226.98" "$22,078.00" $888.51 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$4,601.30" "$1,421.62" "$1,336.58" "$22,078.00" $888.51 $835.36 $888.51 "$22,078.00" "$16,558.50" $888.51 $888.51 $888.51 "$3,500.00" "$11,039.00" "$17,485.78" $888.51 "$17,662.40" "$4,334.00" "$22,078.00" $888.51 "$12,805.24" "$22,078.00" $859.01 $888.51 "$22,078.00" $888.51 N/A N/A 48100036 EAP CPT® 93457 RHC/CORONARY ANGIO W/O LHC W/GRAFT INJ BOTH IP/OP "$22,078.00" "$16,338.00" $899.96 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" $957.55 $957.55 "$1,345.95" "$22,078.00" $957.55 "$22,078.00" "$22,078.00" "$22,078.00" "$22,078.00" "$4,601.30" "$1,532.08" "$1,439.94" "$22,078.00" $957.55 $899.96 $957.55 "$22,078.00" "$16,558.50" $957.55 $957.55 $957.55 "$3,500.00" "$11,039.00" "$17,485.78" $957.55 "$17,662.40" "$4,334.00" "$22,078.00" $957.55 "$12,805.24" "$22,078.00" $944.37 $957.55 "$22,078.00" $957.55 N/A N/A 48100037 EAP CPT® 33991 INSERT VAD ART&VEIN ACCESS BOTH IP/OP "$31,345.00" "$23,195.50" $450.60 "$31,345.00" "$31,345.00" "$31,345.00" "$31,345.00" "$31,345.00" $473.79 $473.79 $474.50 "$31,345.00" $473.79 "$31,345.00" "$31,345.00" "$31,345.00" "$31,345.00" "$6,532.64" $758.06 $720.96 "$31,345.00" $473.79 $450.60 $473.79 "$31,345.00" "$23,508.75" $473.79 $473.79 $473.79 "$15,672.50" "$15,672.50" "$24,825.24" $473.79 "$25,076.00" "$20,374.25" "$31,345.00" $473.79 "$18,180.10" "$31,345.00" $651.85 $473.79 "$31,345.00" $473.79 N/A N/A 48100040 EAP CPT® 93567 INJ. SUPRAVALVULAR AORTOGRAPHY BOTH IP/OP $185.00 $137.00 $36.72 $185.00 $185.00 $185.00 $185.00 $185.00 $185.00 $185.00 $185.00 $38.56 $185.00 $185.00 $185.00 $185.00 $185.00 $38.56 $185.00 $185.00 $109.43 $185.00 $37.69 $185.00 $185.00 $138.75 $185.00 $185.00 $185.00 $92.50 $92.50 $146.52 $185.00 $148.00 $185.00 $36.72 $185.00 $107.30 $185.00 $185.00 $185.00 $38.55 $185.00 N/A N/A 48100042 EAP HCPCS G0278 ILIAC/FEM ANGIO W/CARDIAC CATH BOTH IP/OP "$2,706.00" "$2,002.50" $13.58 "$2,706.00" "$1,469.36" "$1,469.36" "$1,469.36" "$1,469.36" "$2,706.00" "$2,706.00" "$2,706.00" $564.00 "$2,706.00" "$2,008.39" "$2,008.39" "$2,085.78" "$1,409.83" $563.96 "$2,706.00" "$2,706.00" "$1,600.60" "$2,706.00" $13.58 "$2,706.00" "$2,706.00" "$2,029.50" "$2,706.00" "$2,706.00" "$2,706.00" "$1,353.00" "$1,353.00" "$2,143.15" "$2,706.00" "$2,164.80" "$1,758.90" $537.07 "$2,706.00" "$1,569.48" "$2,706.00" "$2,706.00" "$2,706.00" $563.93 "$2,706.00" N/A N/A 48100051 EAP CPT® 33229 REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEADS BOTH IP/OP "$43,902.00" "$32,487.50" $375.89 "$35,121.60" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$18,320.06" "$18,320.06" "$18,239.04" "$9,150.27" "$18,320.06" "$4,607.43" "$4,607.43" "$4,784.64" "$3,234.06" "$9,149.66" "$29,312.10" "$26,937.35" "$4,877.00" "$18,320.06" $375.89 "$18,320.06" "$19,236.07" "$32,926.50" "$18,320.06" "$18,320.06" "$18,320.06" "$7,479.00" "$6,357.00" "$34,770.38" "$18,320.06" "$35,121.60" "$5,164.00" "$7,712.84" "$18,320.06" "$25,463.16" "$19,236.07" "$26,504.52" "$18,320.06" "$8,098.48" "$18,320.06" N/A N/A 48100053 EAP CPT® 33230 INSRT ICD W EXIST DUAL LDS BOTH IP/OP "$77,559.00" "$57,394.00" $384.73 "$77,559.00" "$77,559.00" "$77,559.00" "$77,559.00" "$77,559.00" $389.27 $389.27 $389.43 "$77,559.00" $389.27 "$77,559.00" "$77,559.00" "$77,559.00" "$77,559.00" "$16,164.15" $622.83 $615.57 "$77,559.00" $389.27 $384.73 $389.27 "$77,559.00" "$58,169.25" $389.27 $389.27 $389.27 "$7,479.00" "$38,779.50" "$61,426.73" $389.27 "$62,047.20" "$5,410.00" "$77,559.00" $389.27 "$44,984.22" "$77,559.00" $399.78 $389.27 "$77,559.00" $389.27 N/A N/A 48100054 EAP CPT® 33231 INSRT ICD W EXIST MULTI LDS BOTH IP/OP "$77,559.00" "$57,394.00" $401.01 "$77,559.00" "$77,559.00" "$77,559.00" "$77,559.00" "$77,559.00" $404.36 $404.36 $407.02 "$77,559.00" $404.36 "$77,559.00" "$77,559.00" "$77,559.00" "$77,559.00" "$16,164.15" $646.98 $641.62 "$77,559.00" $404.36 $401.01 $404.36 "$77,559.00" "$58,169.25" $404.36 $404.36 $404.36 "$7,479.00" "$38,779.50" "$61,426.73" $404.36 "$62,047.20" "$5,410.00" "$77,559.00" $404.36 "$44,984.22" "$77,559.00" $420.32 $404.36 "$77,559.00" $404.36 N/A N/A 48100055 EAP CPT® 33262 REMOVE/REPL ICD W SNGL LD BOTH IP/OP "$87,076.00" "$64,436.50" $374.55 "$69,660.80" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$22,683.24" "$22,683.24" "$22,582.91" "$9,417.94" "$22,683.24" "$4,607.43" "$4,607.43" "$4,784.64" "$3,234.06" "$18,147.60" "$36,293.18" "$32,919.07" "$4,877.00" "$22,683.24" $374.55 "$22,683.24" "$23,817.40" "$65,307.00" "$22,683.24" "$22,683.24" "$22,683.24" "$7,479.00" "$6,357.00" "$68,964.19" "$22,683.24" "$69,660.80" "$5,410.00" "$7,712.84" "$22,683.24" "$50,504.08" "$23,817.40" "$32,816.93" "$22,683.24" "$8,098.48" "$22,683.24" N/A N/A 48100056 EAP CPT® 33263 REMOVE/REPL ICD W DUAL LDS BOTH IP/OP "$87,076.00" "$64,436.50" $388.80 "$87,076.00" "$87,076.00" "$87,076.00" "$87,076.00" "$87,076.00" $393.73 $393.73 $394.69 "$87,076.00" $393.73 "$87,076.00" "$87,076.00" "$87,076.00" "$87,076.00" "$18,147.60" $629.97 $622.08 "$87,076.00" $393.73 $388.80 $393.73 "$87,076.00" "$65,307.00" $393.73 $393.73 $393.73 "$7,479.00" "$43,538.00" "$68,964.19" $393.73 "$69,660.80" "$5,410.00" "$87,076.00" $393.73 "$50,504.08" "$87,076.00" $405.90 $393.73 "$87,076.00" $393.73 N/A N/A 48100057 EAP CPT® 33264 REMOVE/REPL ICD W MULTI LDS BOTH IP/OP "$87,076.00" "$64,436.50" $405.42 "$69,660.80" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$32,311.16" "$32,311.16" "$32,168.25" "$9,417.94" "$32,311.16" "$4,607.43" "$4,607.43" "$4,784.64" "$3,234.06" "$18,147.60" "$51,697.85" "$46,275.21" "$4,877.00" "$32,311.16" $405.42 "$32,311.16" "$33,926.72" "$65,307.00" "$32,311.16" "$32,311.16" "$32,311.16" "$7,479.00" "$6,357.00" "$68,964.19" "$32,311.16" "$69,660.80" "$5,410.00" "$7,712.84" "$32,311.16" "$50,504.08" "$33,926.72" "$46,746.11" "$32,311.16" "$8,098.48" "$32,311.16" N/A N/A 48100058 EAP CPT® 33221 INSRT PCMKR GEN ONLY EXIST MULTI BOTH IP/OP "$39,104.00" "$28,937.00" $360.95 "$39,104.00" "$39,104.00" "$39,104.00" "$39,104.00" "$39,104.00" $365.80 $365.80 $367.54 "$39,104.00" $365.80 "$39,104.00" "$39,104.00" "$39,104.00" "$39,104.00" "$8,149.70" $585.28 $577.52 "$39,104.00" $365.80 $360.95 $365.80 "$39,104.00" "$29,328.00" $365.80 $365.80 $365.80 "$7,479.00" "$19,552.00" "$30,970.37" $365.80 "$31,283.20" "$5,164.00" "$39,104.00" $365.80 "$22,680.32" "$39,104.00" $378.13 $365.80 "$39,104.00" $365.80 N/A N/A 48100059 EAP CPT® 33228 REMV & REPLC PM GEN DUAL LEAD BOTH IP/OP "$42,575.00" "$31,505.50" $355.54 "$34,060.00" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$10,228.10" "$10,228.10" "$10,182.87" "$8,873.69" "$10,228.10" "$3,769.39" "$3,769.39" "$3,914.36" "$2,645.82" "$8,873.10" "$16,364.97" "$14,900.90" "$4,877.00" "$10,228.10" $355.54 "$10,228.10" "$10,739.51" "$31,931.25" "$10,228.10" "$10,228.10" "$10,228.10" "$7,479.00" "$6,357.00" "$33,719.40" "$10,228.10" "$34,060.00" "$5,164.00" "$7,712.84" "$10,228.10" "$24,693.50" "$10,739.51" "$14,797.49" "$10,228.10" "$8,098.48" "$10,228.10" N/A N/A 48100060 EAP CPT® 93600 BUNDLE OF HILS RECORDING BOTH IP/OP "$5,320.00" "$3,937.00" $946.96 "$5,320.00" "$5,320.00" "$5,320.00" "$5,320.00" "$5,320.00" "$5,320.00" "$5,320.00" $946.96 "$5,320.00" "$5,320.00" "$3,948.50" "$3,948.50" "$4,100.66" "$2,060.15" "$1,108.75" "$5,320.00" "$2,128.00" "$5,320.00" "$5,320.00" "$5,320.00" "$5,320.00" "$5,320.00" "$3,990.00" "$5,320.00" "$5,320.00" "$5,320.00" "$2,660.00" "$2,660.00" "$4,213.44" "$5,320.00" "$4,256.00" "$2,500.00" "$5,320.00" "$5,320.00" "$3,085.60" "$5,320.00" "$5,320.00" "$5,320.00" "$5,320.00" "$5,320.00" N/A N/A 48100061 EAP CPT® 93602 INTRA-ATRIAL RECORDING BOTH IP/OP "$6,000.00" "$4,440.00" "$1,068.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,068.00" "$6,000.00" "$6,000.00" "$4,181.12" "$4,181.12" "$4,624.80" "$2,060.15" "$1,250.47" "$6,000.00" "$2,248.80" "$6,000.00" "$6,000.00" "$5,622.00" "$6,000.00" "$6,000.00" "$4,500.00" "$6,000.00" "$6,000.00" "$6,000.00" "$3,000.00" "$3,000.00" "$4,752.00" "$6,000.00" "$4,800.00" "$2,500.00" "$6,000.00" "$6,000.00" "$3,480.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" N/A N/A 48100062 EAP CPT® 93603 RIGHT VENTRICULAR RECORDING BOTH IP/OP "$9,546.00" "$7,064.50" $531.60 "$9,546.00" "$9,546.00" "$9,546.00" "$9,546.00" "$9,546.00" "$9,546.00" "$9,546.00" "$1,699.19" "$9,546.00" "$9,546.00" "$4,181.12" "$4,181.12" "$7,358.06" "$2,060.15" "$1,989.49" "$9,546.00" $531.60 "$9,546.00" "$9,546.00" "$1,329.00" "$9,546.00" "$9,546.00" "$7,159.50" "$9,546.00" "$9,546.00" "$9,546.00" "$4,773.00" "$4,773.00" "$7,560.43" "$9,546.00" "$7,636.80" "$2,500.00" "$9,546.00" "$9,546.00" "$5,536.68" "$9,546.00" "$9,546.00" "$9,546.00" "$9,546.00" "$9,546.00" N/A N/A 48100063 EAP CPT® 93610 INTRA-ATRIAL PACING BOTH IP/OP "$6,000.00" "$4,440.00" "$1,068.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,068.00" "$6,000.00" "$6,000.00" "$4,181.12" "$4,181.12" "$4,624.80" "$2,060.15" "$1,250.47" "$6,000.00" "$2,400.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$4,500.00" "$6,000.00" "$6,000.00" "$6,000.00" "$3,000.00" "$3,000.00" "$4,752.00" "$6,000.00" "$4,800.00" "$2,500.00" "$6,000.00" "$6,000.00" "$3,480.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" N/A N/A 48100064 EAP CPT® 93612 INTRA-VENTRICULAR PACING BOTH IP/OP "$6,000.00" "$4,440.00" "$1,068.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,068.00" "$6,000.00" "$6,000.00" "$4,181.12" "$4,181.12" "$4,624.80" "$2,060.15" "$1,250.47" "$6,000.00" "$2,400.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$4,500.00" "$6,000.00" "$6,000.00" "$6,000.00" "$3,000.00" "$3,000.00" "$4,752.00" "$6,000.00" "$4,800.00" "$2,500.00" "$6,000.00" "$6,000.00" "$3,480.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" N/A N/A 48100065 EAP CPT® 93618 INDUCTION OF ARRYTHMIA BY ELECTRIAL PACING BOTH IP/OP "$4,835.00" "$3,578.00" $860.63 "$4,835.00" "$4,835.00" "$4,835.00" "$4,835.00" "$4,835.00" "$4,835.00" "$4,835.00" $860.63 "$4,835.00" "$4,835.00" "$3,588.54" "$3,588.54" "$3,726.82" "$2,060.15" "$1,007.67" "$4,835.00" "$1,934.00" "$4,835.00" "$4,835.00" "$4,835.00" "$4,835.00" "$4,835.00" "$3,626.25" "$4,835.00" "$4,835.00" "$4,835.00" "$2,417.50" "$2,417.50" "$3,829.32" "$4,835.00" "$3,868.00" "$2,500.00" "$4,835.00" "$4,835.00" "$2,804.30" "$4,835.00" "$4,835.00" "$4,835.00" "$4,835.00" "$4,835.00" N/A N/A 48100066 EAP CPT® 93624 FOLLOW-UP EP STUDY W/PACING & RECORDING BOTH IP/OP "$10,198.00" "$7,547.00" "$1,815.24" "$10,198.00" "$10,198.00" "$10,198.00" "$10,198.00" "$10,198.00" "$10,198.00" "$10,198.00" "$1,815.24" "$10,198.00" "$10,198.00" "$4,181.12" "$4,181.12" "$7,860.62" "$2,060.15" "$2,125.38" "$10,198.00" "$3,812.40" "$10,198.00" "$10,198.00" "$9,531.00" "$10,198.00" "$10,198.00" "$7,648.50" "$10,198.00" "$10,198.00" "$10,198.00" "$5,099.00" "$5,099.00" "$8,076.82" "$10,198.00" "$8,158.40" "$4,334.00" "$10,198.00" "$10,198.00" "$5,914.84" "$10,198.00" "$10,198.00" "$10,198.00" "$10,198.00" "$10,198.00" N/A N/A 48100067 EAP CPT® 93619 COMPLETE EPS W/OINDUCTION OF ARRHYTHMIA BOTH IP/OP "$14,885.00" "$11,015.00" "$2,060.15" "$14,885.00" "$5,422.00" "$5,422.00" "$5,422.00" "$5,422.00" "$5,979.14" "$5,979.14" "$5,952.70" "$3,102.41" "$5,979.14" "$4,181.12" "$4,181.12" "$11,473.36" "$2,060.15" "$3,102.20" "$9,566.63" "$9,713.06" "$8,804.48" "$5,979.14" "$14,885.00" "$5,979.14" "$6,278.10" "$11,163.75" "$5,979.14" "$5,979.14" "$5,979.14" "$7,442.50" "$7,442.50" "$11,788.92" "$5,979.14" "$11,908.00" "$9,675.25" "$2,954.30" "$5,979.14" "$8,633.30" "$6,278.10" "$8,650.31" "$5,979.14" "$3,102.03" "$5,979.14" N/A N/A 48100068 EAP CPT® 93620 COMPLETE EPS WITH INDUCTION ARRHYTHMIA BOTH IP/OP "$16,933.00" "$12,530.50" "$2,060.15" "$18,889.00" "$5,422.00" "$5,422.00" "$5,422.00" "$5,422.00" "$5,979.14" "$5,979.14" "$5,952.70" "$3,529.26" "$5,979.14" "$4,181.12" "$4,181.12" "$13,051.96" "$2,060.15" "$3,529.02" "$9,566.63" "$9,713.06" "$10,015.87" "$5,979.14" "$18,889.00" "$5,979.14" "$6,278.10" "$12,699.75" "$5,979.14" "$5,979.14" "$5,979.14" "$8,466.50" "$8,466.50" "$13,410.94" "$5,979.14" "$13,546.40" "$4,334.00" "$3,360.78" "$5,979.14" "$9,821.14" "$6,278.10" "$8,650.31" "$5,979.14" "$3,528.84" "$5,979.14" N/A N/A 48100069 EAP CPT® 93621 LEFT ATRIAL OR CORONARY SINUS PACING & RECORDING BOTH IP/OP "$13,424.00" "$9,934.00" "$1,750.00" "$13,424.00" "$5,422.00" "$5,422.00" "$5,422.00" "$5,422.00" "$13,424.00" "$13,424.00" "$13,424.00" "$2,797.90" "$13,424.00" "$4,181.12" "$4,181.12" "$10,347.22" "$2,060.15" "$2,797.71" "$13,424.00" "$13,424.00" "$7,940.30" "$13,424.00" "$13,424.00" "$13,424.00" "$13,424.00" "$10,068.00" "$13,424.00" "$13,424.00" "$13,424.00" "$6,712.00" "$6,712.00" "$10,631.81" "$13,424.00" "$10,739.20" "$1,750.00" "$2,664.33" "$13,424.00" "$7,785.92" "$13,424.00" "$13,424.00" "$13,424.00" "$2,797.56" "$13,424.00" N/A N/A 48100070 EAP CPT® 93622 LEFT VENTRICULAR PACING & RECORDING BOTH IP/OP "$12,767.00" "$9,448.00" "$1,750.00" "$12,767.00" "$5,422.00" "$5,422.00" "$5,422.00" "$5,422.00" "$12,767.00" "$12,767.00" "$12,767.00" "$2,660.96" "$12,767.00" "$4,181.12" "$4,181.12" "$9,840.80" "$2,060.15" "$2,660.78" "$12,767.00" "$8,064.00" "$7,551.68" "$12,767.00" "$8,064.00" "$12,767.00" "$12,767.00" "$9,575.25" "$12,767.00" "$12,767.00" "$12,767.00" "$6,383.50" "$6,383.50" "$10,111.46" "$12,767.00" "$10,213.60" "$1,750.00" "$2,533.93" "$12,767.00" "$7,404.86" "$12,767.00" "$12,767.00" "$12,767.00" "$2,660.64" "$12,767.00" N/A N/A 48100071 EAP CPT® 93609 CATHETER MAPPING OF TACHYCARDIA BOTH IP/OP "$7,163.00" "$5,301.00" "$1,275.01" "$7,163.00" "$7,163.00" "$7,163.00" "$7,163.00" "$7,163.00" "$7,163.00" "$7,163.00" "$1,275.01" "$7,163.00" "$7,163.00" "$4,181.12" "$4,181.12" "$5,521.24" "$2,060.15" "$1,492.85" "$7,163.00" "$2,340.40" "$7,163.00" "$7,163.00" "$5,851.00" "$7,163.00" "$7,163.00" "$5,372.25" "$7,163.00" "$7,163.00" "$7,163.00" "$3,581.50" "$3,581.50" "$5,673.10" "$7,163.00" "$5,730.40" "$1,750.00" "$7,163.00" "$7,163.00" "$4,154.54" "$7,163.00" "$7,163.00" "$7,163.00" "$7,163.00" "$7,163.00" N/A N/A 48100072 EAP CPT® 93613 ELECTROPHYS MAP 3D BOTH IP/OP "$13,202.00" "$9,769.50" $291.90 "$13,202.00" "$7,168.69" "$7,168.69" "$7,168.69" "$7,168.69" "$13,202.00" "$13,202.00" "$13,202.00" "$2,751.63" "$13,202.00" "$4,181.12" "$4,181.12" "$10,176.10" "$2,060.15" "$2,751.44" "$13,202.00" "$13,202.00" "$7,808.98" "$13,202.00" $291.90 "$13,202.00" "$13,202.00" "$9,901.50" "$13,202.00" "$13,202.00" "$13,202.00" "$6,601.00" "$6,601.00" "$10,455.98" "$13,202.00" "$10,561.60" "$1,750.00" "$2,620.27" "$13,202.00" "$7,657.16" "$13,202.00" "$13,202.00" "$13,202.00" "$2,751.30" "$13,202.00" N/A N/A 48100073 EAP CPT® 93623 PROGRAM STIMULATION AND PACING AFTER DRUG INFUSION BOTH IP/OP "$7,519.00" "$5,564.50" "$1,492.33" "$7,519.00" "$4,082.82" "$4,082.82" "$4,082.82" "$4,082.82" "$7,519.00" "$7,519.00" "$7,519.00" "$1,567.15" "$7,519.00" "$4,181.12" "$4,181.12" "$5,795.65" "$2,060.15" "$1,567.04" "$7,519.00" "$7,519.00" "$4,447.49" "$7,519.00" "$7,519.00" "$7,519.00" "$7,519.00" "$5,639.25" "$7,519.00" "$7,519.00" "$7,519.00" "$3,759.50" "$3,759.50" "$5,955.05" "$7,519.00" "$6,015.20" "$1,750.00" "$1,492.33" "$7,519.00" "$4,361.02" "$7,519.00" "$7,519.00" "$7,519.00" "$1,566.96" "$7,519.00" N/A N/A 48100074 EAP CPT® 93650 AV NODE ABLATION BOTH IP/OP "$11,950.00" "$8,843.00" $583.78 "$11,950.00" "$11,950.00" "$11,950.00" "$11,950.00" "$11,950.00" $591.21 $591.21 $594.98 "$11,950.00" $591.21 "$11,950.00" "$11,950.00" "$11,950.00" "$11,950.00" "$2,490.51" $945.94 $934.05 "$11,950.00" $591.21 $583.78 $591.21 "$11,950.00" "$8,962.50" $591.21 $591.21 $591.21 "$5,975.00" "$5,975.00" "$9,464.40" $591.21 "$9,560.00" "$4,334.00" "$11,950.00" $591.21 "$6,931.00" "$11,950.00" $618.99 $591.21 "$11,950.00" $591.21 N/A N/A 48100077 EAP CPT® 93662 INTRACARDIAC ECHOCARDIOGRAPHY BOTH IP/OP "$5,649.00" "$4,180.50" "$1,005.52" "$5,649.00" "$5,649.00" "$5,649.00" "$5,649.00" "$5,649.00" "$5,649.00" "$5,649.00" "$1,005.52" "$5,649.00" "$5,649.00" "$4,181.12" "$4,181.12" "$4,354.25" "$2,060.15" "$1,177.31" "$5,649.00" "$2,259.60" "$5,649.00" "$5,649.00" "$5,649.00" "$5,649.00" "$5,649.00" "$4,236.75" "$5,649.00" "$5,649.00" "$5,649.00" "$2,824.50" "$2,824.50" "$4,474.01" "$5,649.00" "$4,519.20" "$1,750.00" "$5,649.00" "$5,649.00" "$3,276.42" "$5,649.00" "$5,649.00" "$5,649.00" "$5,649.00" "$5,649.00" N/A N/A 48100078 EAP CPT® 93631 HEART PACING MAPPING BOTH IP/OP "$5,080.00" "$3,759.50" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$3,770.38" "$3,770.38" "$3,915.66" "$2,060.15" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$1,750.00" "$5,080.00" "$5,080.00" "$2,946.40" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 48100079 EAP CPT® 37197 TRANS CATH RETRVAL FB INC S/I BOTH IP/OP "$28,818.00" "$21,325.50" $296.58 "$28,818.00" "$28,818.00" "$28,818.00" "$28,818.00" "$28,818.00" $298.49 $298.49 $301.03 "$28,818.00" $298.49 "$28,818.00" "$28,818.00" "$28,818.00" "$28,818.00" "$6,005.99" $477.58 $474.53 "$28,818.00" $298.49 $296.58 $298.49 "$28,818.00" "$21,613.50" $298.49 $298.49 $298.49 "$3,500.00" "$14,409.00" "$22,823.86" $298.49 "$23,054.40" "$3,725.00" "$28,818.00" $298.49 "$16,714.44" "$28,818.00" $315.16 $298.49 "$28,818.00" $298.49 N/A N/A 48100080 EAP CPT® 93653 "COMP EP EVAL INC ARRHYTH IND VENTRIC PAC, HIS REC, CATH ABLAT" BOTH IP/OP "$40,706.00" "$30,122.50" $838.39 "$33,875.50" "$5,422.00" "$5,422.00" "$5,422.00" "$5,422.00" "$21,108.21" "$21,108.21" "$21,014.85" "$8,484.15" "$21,108.21" "$4,607.43" "$4,607.43" "$4,784.64" "$3,234.06" "$8,483.58" "$33,773.14" "$33,875.50" "$24,077.60" "$21,108.21" $838.39 "$21,108.21" "$22,163.62" "$30,529.50" "$21,108.21" "$21,108.21" "$21,108.21" "$20,353.00" "$20,353.00" "$32,239.15" "$21,108.21" "$32,564.80" "$5,343.00" "$7,712.84" "$21,108.21" "$23,609.48" "$22,163.62" "$30,538.26" "$21,108.21" "$8,098.48" "$21,108.21" N/A N/A 48100081 EAP CPT® 93654 "COMP EP EVAL INC ARRHYTH IND VENTRIC PAC, HIS REC, CATH ABLAT W/TX VE" BOTH IP/OP "$40,706.00" "$30,122.50" "$1,010.48" "$33,875.50" "$5,422.00" "$5,422.00" "$5,422.00" "$5,422.00" "$21,108.21" "$21,108.21" "$21,014.85" "$8,484.15" "$21,108.21" "$4,607.43" "$4,607.43" "$4,784.64" "$3,234.06" "$8,483.58" "$33,773.14" "$33,875.50" "$24,077.60" "$21,108.21" "$1,010.48" "$21,108.21" "$22,163.62" "$30,529.50" "$21,108.21" "$21,108.21" "$21,108.21" "$20,353.00" "$20,353.00" "$32,239.15" "$21,108.21" "$32,564.80" "$26,458.90" "$7,712.84" "$21,108.21" "$23,609.48" "$22,163.62" "$30,538.26" "$21,108.21" "$8,098.48" "$21,108.21" N/A N/A 48100082 EAP CPT® 93655 ABLATAE ARRHYTHMIA - ADD ON BOTH IP/OP "$37,635.00" "$27,850.00" $307.51 "$37,635.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$37,635.00" "$37,635.00" "$37,635.00" "$7,844.07" "$37,635.00" "$4,181.12" "$4,181.12" "$29,009.06" "$2,060.15" "$7,843.55" "$37,635.00" "$16,397.00" "$22,261.10" "$37,635.00" $307.51 "$37,635.00" "$37,635.00" "$28,226.25" "$37,635.00" "$37,635.00" "$37,635.00" "$18,817.50" "$18,817.50" "$29,806.92" "$37,635.00" "$30,108.00" "$1,750.00" "$7,469.61" "$37,635.00" "$21,828.30" "$37,635.00" "$37,635.00" "$37,635.00" "$7,843.13" "$37,635.00" N/A N/A 48100083 EAP CPT® 93656 "COMP EP EVAL INC TRANS SEPT CATH, INSERT ELECT CATH, INDUCT ARRHYTH," BOTH IP/OP "$40,706.00" "$30,122.50" $950.74 "$40,706.00" "$40,706.00" "$40,706.00" "$40,706.00" "$40,706.00" "$1,121.36" "$1,121.36" "$1,129.78" "$40,706.00" "$1,121.36" "$40,706.00" "$40,706.00" "$40,706.00" "$40,706.00" "$8,483.58" "$1,794.18" "$1,521.18" "$40,706.00" "$1,121.36" $950.74 "$1,121.36" "$40,706.00" "$30,529.50" "$1,121.36" "$1,121.36" "$1,121.36" "$20,353.00" "$20,353.00" "$32,239.15" "$1,121.36" "$32,564.80" "$5,343.00" "$40,706.00" "$1,121.36" "$23,609.48" "$40,706.00" "$1,176.00" "$1,121.36" "$40,706.00" "$1,121.36" N/A N/A 48100084 EAP CPT® 93657 TX L/R ATRIAL FIB ADDL BOTH IP/OP "$40,706.00" "$30,122.50" $307.51 "$40,706.00" "$40,706.00" "$40,706.00" "$40,706.00" "$40,706.00" $311.88 $311.88 $427.90 "$40,706.00" $311.88 "$4,181.12" "$4,181.12" "$31,376.18" "$2,060.15" "$8,483.58" $499.01 $492.02 "$40,706.00" $311.88 $307.51 $311.88 "$40,706.00" "$30,529.50" $311.88 $311.88 $311.88 "$20,353.00" "$20,353.00" "$32,239.15" $311.88 "$32,564.80" "$1,750.00" "$40,706.00" $311.88 "$23,609.48" "$40,706.00" $446.32 $311.88 "$40,706.00" $311.88 N/A N/A 48100086 EAP CPT® 93463 MED ADMIN & HEMODYNAMIC MEASURMENT (W/NITRIC OXIDE) BOTH IP/OP "$3,396.00" "$2,513.50" $97.30 "$3,396.00" "$1,844.03" "$1,844.03" "$1,844.03" "$1,844.03" "$3,396.00" "$3,396.00" "$3,396.00" $707.81 "$3,396.00" "$3,396.00" "$3,396.00" "$3,396.00" "$1,876.38" $707.76 "$3,396.00" $640.00 "$2,008.73" "$3,396.00" $97.30 "$3,396.00" "$3,396.00" "$2,547.00" "$3,396.00" "$3,396.00" "$3,396.00" "$1,698.00" "$1,698.00" "$2,689.63" "$3,396.00" "$2,716.80" "$1,750.00" $674.02 "$3,396.00" "$1,969.68" "$3,396.00" "$3,396.00" "$3,396.00" $707.73 "$3,396.00" N/A N/A 48100090 EAP CPT® 93581 PERCUT TRANS CATH CLOSE CONGENT VENTRIC SEPT DEFECT W/ T BOTH IP/OP "$16,546.00" "$12,244.50" "$1,309.08" "$16,546.00" "$16,546.00" "$16,546.00" "$16,546.00" "$16,546.00" "$1,325.53" "$1,325.53" "$1,329.87" "$16,546.00" "$1,325.53" "$16,546.00" "$16,546.00" "$16,546.00" "$16,546.00" "$3,448.37" "$2,120.85" "$2,094.53" "$16,546.00" "$1,325.53" "$1,309.08" "$1,325.53" "$16,546.00" "$12,409.50" "$1,325.53" "$1,325.53" "$1,325.53" "$7,479.00" "$8,273.00" "$13,104.43" "$1,325.53" "$13,236.80" "$5,343.00" "$16,546.00" "$1,325.53" "$9,596.68" "$16,546.00" "$1,389.12" "$1,325.53" "$16,546.00" "$1,325.53" N/A N/A 48100091 EAP CPT® 93582 PERCUT TRANS CATH CLOSE PATENT DUCT ARTERIOSUS BOTH IP/OP "$18,778.00" "$13,896.00" $654.56 "$18,778.00" "$18,778.00" "$18,778.00" "$18,778.00" "$18,778.00" $663.20 $663.20 $665.22 "$18,778.00" $663.20 "$18,778.00" "$18,778.00" "$18,778.00" "$18,778.00" "$3,913.54" "$1,061.12" "$1,047.30" "$18,778.00" $663.20 $654.56 $663.20 "$18,778.00" "$14,083.50" $663.20 $663.20 $663.20 "$7,479.00" "$9,389.00" "$14,872.18" $663.20 "$15,022.40" "$5,343.00" "$18,778.00" $663.20 "$10,891.24" "$18,778.00" $695.46 $663.20 "$18,778.00" $663.20 N/A N/A 48100092 EAP CPT® 93583 PERCUT TRANS CATH SEPTAL REDUCT THERPY (ALCOHOL SEPT AB BOTH IP/OP "$27,795.00" "$20,568.50" $732.94 "$27,795.00" "$27,795.00" "$27,795.00" "$27,795.00" "$27,795.00" $740.82 $740.82 $744.50 "$27,795.00" $740.82 "$27,795.00" "$27,795.00" "$27,795.00" "$27,795.00" "$5,792.78" "$1,185.31" "$1,172.70" "$27,795.00" $740.82 $732.94 $740.82 "$27,795.00" "$20,846.25" $740.82 $740.82 $740.82 "$13,897.50" "$13,897.50" "$22,013.64" $740.82 "$22,236.00" "$18,066.75" "$27,795.00" $740.82 "$16,121.10" "$27,795.00" $777.31 $740.82 "$27,795.00" $740.82 N/A N/A 48100095 EAP CPT® 93566 INJECT R VENTR/ATRIAL ANGIO BOTH IP/OP "$3,057.00" "$2,262.50" $26.47 "$3,057.00" "$3,057.00" "$3,057.00" "$3,057.00" "$3,057.00" $46.10 $46.10 $45.50 "$3,057.00" $46.10 "$3,057.00" "$3,057.00" "$3,057.00" "$3,057.00" $637.11 $73.76 $42.35 "$3,057.00" $46.10 $26.47 $46.10 "$3,057.00" "$2,292.75" $46.10 $46.10 $46.10 "$1,528.50" "$1,528.50" "$2,421.14" $46.10 "$2,445.60" "$1,750.00" "$3,057.00" $46.10 "$1,773.06" "$3,057.00" $48.31 $46.10 "$3,057.00" $46.10 N/A N/A 48100097 EAP CPT® 92998 PULMONARY ARTERY PTA ADD'L VESSEL BOTH IP/OP "$13,019.00" "$9,634.50" $314.68 "$13,019.00" "$13,019.00" "$13,019.00" "$13,019.00" "$13,019.00" $317.41 $317.41 $316.89 "$13,019.00" $317.41 "$4,181.12" "$4,181.12" "$10,035.05" "$2,060.15" "$2,713.30" $507.86 $503.49 "$13,019.00" $317.41 $314.68 $317.41 "$13,019.00" "$9,764.25" $317.41 $317.41 $317.41 "$2,762.00" "$6,509.50" "$10,311.05" $317.41 "$10,415.20" "$4,334.00" "$13,019.00" $317.41 "$7,551.02" "$13,019.00" $337.82 $317.41 "$13,019.00" $317.41 N/A N/A 48100098 EAP CPT® 92924 CORONARY ATHERECTOMY BOTH IP/OP "$25,780.00" "$19,077.50" $624.33 "$25,780.00" "$25,780.00" "$25,780.00" "$25,780.00" "$25,780.00" $631.34 $631.34 $633.77 "$25,780.00" $631.34 "$25,780.00" "$25,780.00" "$25,780.00" "$25,780.00" "$5,372.84" "$1,010.14" $998.93 "$25,780.00" $631.34 $624.33 $631.34 "$25,780.00" "$19,335.00" $631.34 $631.34 $631.34 "$7,479.00" "$12,890.00" "$20,417.76" $631.34 "$20,624.00" "$5,164.00" "$25,780.00" $631.34 "$14,952.40" "$25,780.00" $662.30 $631.34 "$25,780.00" $631.34 N/A N/A 48100099 EAP CPT® 92925 ATHERECTOMY ADD'L VESSEL BOTH IP/OP "$22,259.00" "$16,472.00" "$2,060.15" "$22,259.00" "$22,259.00" "$22,259.00" "$22,259.00" "$22,259.00" "$22,259.00" "$22,259.00" "$22,259.00" "$22,259.00" "$22,259.00" "$4,181.12" "$4,181.12" "$17,157.24" "$2,060.15" "$4,639.02" "$22,259.00" "$3,605.20" "$22,259.00" "$22,259.00" "$9,013.00" "$22,259.00" "$22,259.00" "$16,694.25" "$22,259.00" "$22,259.00" "$22,259.00" "$11,129.50" "$11,129.50" "$17,629.13" "$22,259.00" "$17,807.20" "$5,164.00" "$22,259.00" "$22,259.00" "$12,910.22" "$22,259.00" "$13,355.40" "$22,259.00" "$22,259.00" "$22,259.00" N/A N/A 48100100 EAP CPT® 93568 INJ. PROC DURING CATH PULMONARY ANGIOGRAPHY BOTH IP/OP "$3,441.00" "$2,546.50" $46.85 "$3,441.00" "$3,441.00" "$3,441.00" "$3,441.00" "$3,441.00" $47.76 $47.76 $47.84 "$3,441.00" $47.76 "$3,441.00" "$3,441.00" "$3,441.00" "$3,441.00" $717.14 $76.42 $74.96 "$3,441.00" $47.76 $46.85 $47.76 "$3,441.00" "$2,580.75" $47.76 $47.76 $47.76 "$1,720.50" "$1,720.50" "$2,725.27" $47.76 "$2,752.80" "$1,750.00" "$3,441.00" $47.76 "$1,995.78" "$3,441.00" $49.39 $47.76 "$3,441.00" $47.76 N/A N/A 48100101 EAP CPT® 93566 INJECT PRO. DURING CATH/RV/RA./S&I BOTH IP/OP "$3,057.00" "$2,262.50" $26.47 "$3,057.00" "$3,057.00" "$3,057.00" "$3,057.00" "$3,057.00" $46.10 $46.10 $45.50 "$3,057.00" $46.10 "$3,057.00" "$3,057.00" "$3,057.00" "$3,057.00" $637.11 $73.76 $42.35 "$3,057.00" $46.10 $26.47 $46.10 "$3,057.00" "$2,292.75" $46.10 $46.10 $46.10 "$1,528.50" "$1,528.50" "$2,421.14" $46.10 "$2,445.60" "$1,750.00" "$3,057.00" $46.10 "$1,773.06" "$3,057.00" $48.31 $46.10 "$3,057.00" $46.10 N/A N/A 48100102 EAP CPT® 93565 INJ. PRO DURING CATH/LV/LA/S&I BOTH IP/OP "$2,659.00" "$1,968.00" $26.82 "$2,659.00" "$2,659.00" "$2,659.00" "$2,659.00" "$2,659.00" $46.38 $46.38 $44.87 "$2,659.00" $46.38 "$2,659.00" "$2,659.00" "$2,659.00" "$2,659.00" $554.16 $74.21 $42.91 "$2,659.00" $46.38 $26.82 $46.38 "$2,659.00" "$1,994.25" $46.38 $46.38 $46.38 "$1,329.50" "$1,329.50" "$2,105.93" $46.38 "$2,127.20" "$1,750.00" "$2,659.00" $46.38 "$1,542.22" "$2,659.00" $46.52 $46.38 "$2,659.00" $46.38 N/A N/A 48100103 EAP CPT® 33990 INSERT LEFT HEART VAD ARTERIAL BOTH IP/OP "$35,191.00" "$26,041.50" $357.84 "$35,191.00" "$35,191.00" "$35,191.00" "$35,191.00" "$35,191.00" $361.55 $361.55 $363.29 "$35,191.00" $361.55 "$35,191.00" "$35,191.00" "$35,191.00" "$35,191.00" "$7,334.19" $578.48 $572.54 "$35,191.00" $361.55 $357.84 $361.55 "$35,191.00" "$26,393.25" $361.55 $361.55 $361.55 "$17,595.50" "$17,595.50" "$27,871.27" $361.55 "$28,152.80" "$22,874.15" "$35,191.00" $361.55 "$20,410.78" "$35,191.00" $444.18 $361.55 "$35,191.00" $361.55 N/A N/A 48100104 EAP CPT® 33992 REMOVAL LEFT HEART VAD BOTH IP/OP "$12,888.00" "$9,537.50" $185.71 "$12,888.00" "$12,888.00" "$12,888.00" "$12,888.00" "$12,888.00" $188.88 $188.88 $188.87 "$12,888.00" $188.88 "$12,888.00" "$12,888.00" "$12,888.00" "$12,888.00" "$2,686.00" $302.21 $297.14 "$12,888.00" $188.88 $185.71 $188.88 "$12,888.00" "$9,666.00" $188.88 $188.88 $188.88 "$6,444.00" "$6,444.00" "$10,207.30" $188.88 "$10,310.40" "$8,377.20" "$12,888.00" $188.88 "$7,475.04" "$12,888.00" $208.39 $188.88 "$12,888.00" $188.88 N/A N/A 48100105 EAP CPT® 33993 RESPOSITIONING OF IMPELLA BOTH IP/OP "$17,220.00" "$12,743.00" $164.63 "$17,220.00" "$17,220.00" "$17,220.00" "$17,220.00" "$17,220.00" $166.26 $166.26 $166.31 "$17,220.00" $166.26 "$17,220.00" "$17,220.00" "$17,220.00" "$17,220.00" "$3,588.84" $266.02 $263.41 "$17,220.00" $166.26 $164.63 $166.26 "$17,220.00" "$12,915.00" $166.26 $166.26 $166.26 "$8,610.00" "$8,610.00" "$13,638.24" $166.26 "$13,776.00" "$11,193.00" "$17,220.00" $166.26 "$9,987.60" "$17,220.00" $181.72 $166.26 "$17,220.00" $166.26 N/A N/A 48100106 EAP CPT® 34812 OPEN OF FEMORAL ARTERY BOTH IP/OP "$8,696.00" "$6,435.50" $203.46 "$8,696.00" "$8,696.00" "$8,696.00" "$8,696.00" "$8,696.00" $205.29 $205.29 $206.36 "$8,696.00" $205.29 "$8,696.00" "$8,696.00" "$8,696.00" "$8,696.00" "$1,812.34" $328.46 $325.54 "$8,696.00" $205.29 $203.46 $205.29 "$8,696.00" "$6,522.00" $205.29 $205.29 $205.29 "$2,762.00" "$4,348.00" "$6,887.23" $205.29 "$6,956.80" "$5,652.40" "$8,696.00" $205.29 "$5,043.68" "$8,696.00" $216.69 $205.29 "$8,696.00" $205.29 N/A N/A 48100108 EAP HCPCS 93563 INJECT CONGENITAL CARD CATH BOTH IP/OP "$3,180.00" "$2,353.50" $51.58 "$3,180.00" "$3,180.00" "$3,180.00" "$3,180.00" "$3,180.00" $58.17 $58.17 $57.67 "$3,180.00" $58.17 "$3,180.00" "$3,180.00" "$3,180.00" "$3,180.00" $662.75 $93.07 $82.53 "$3,180.00" $58.17 $51.58 $58.17 "$3,180.00" "$2,385.00" $58.17 $58.17 $58.17 "$1,590.00" "$1,590.00" "$2,518.56" $58.17 "$2,544.00" "$1,750.00" "$3,180.00" $58.17 "$1,844.40" "$3,180.00" $60.22 $58.17 "$3,180.00" $58.17 N/A N/A 48100109 EAP CPT® 33947 ECMO/ECLS INITIATION ARTERY BOTH IP/OP "$4,152.00" "$3,072.50" $339.83 "$4,152.00" "$4,152.00" "$4,152.00" "$4,152.00" "$4,152.00" $342.62 $342.62 $345.46 "$4,152.00" $342.62 "$4,152.00" "$4,152.00" "$4,152.00" "$4,152.00" $865.32 $548.19 $543.73 "$4,152.00" $342.62 $339.83 $342.62 "$4,152.00" "$3,114.00" $342.62 $342.62 $342.62 "$2,762.00" "$2,076.00" "$3,288.38" $342.62 "$3,321.60" "$2,698.80" "$4,152.00" $342.62 "$2,408.16" "$4,152.00" $358.75 $342.62 "$4,152.00" $342.62 N/A N/A 48100110 EAP CPT® 33947 ECMO/ECLS INSJ PRPH CANNULA BOTH IP/OP "$6,244.00" "$4,621.00" $339.83 "$6,244.00" "$6,244.00" "$6,244.00" "$6,244.00" "$6,244.00" $342.62 $342.62 $345.46 "$6,244.00" $342.62 "$6,244.00" "$6,244.00" "$6,244.00" "$6,244.00" "$1,301.32" $548.19 $543.73 "$6,244.00" $342.62 $339.83 $342.62 "$6,244.00" "$4,683.00" $342.62 $342.62 $342.62 "$2,762.00" "$3,122.00" "$4,945.25" $342.62 "$4,995.20" "$4,058.60" "$6,244.00" $342.62 "$3,621.52" "$6,244.00" $358.75 $342.62 "$6,244.00" $342.62 N/A N/A 48100111 EAP CPT® 36901 INTRO CATH DIALYSIS CIRCUIT BOTH IP/OP "$3,666.00" "$2,713.00" $166.59 "$3,666.00" "$3,666.00" "$3,666.00" "$3,666.00" "$3,666.00" $168.18 $168.18 $168.95 "$3,666.00" $168.18 "$3,666.00" "$3,666.00" "$3,666.00" "$3,666.00" $764.03 $269.09 $266.54 "$3,666.00" $168.18 $166.59 $168.18 "$3,666.00" "$2,749.50" $168.18 $168.18 $168.18 "$2,762.00" "$1,833.00" "$2,903.47" $168.18 "$2,932.80" "$2,150.00" "$3,666.00" $168.18 "$2,126.28" "$3,666.00" $176.69 $168.18 "$3,666.00" $168.18 N/A N/A 48100112 EAP CPT® 36902 INTRO CATH DIALYSIS CIRCUIT; W ANGIO BOTH IP/OP "$18,144.00" "$13,427.00" $236.81 "$14,515.20" "$5,422.00" "$5,422.00" "$5,422.00" "$5,422.00" "$4,875.41" "$4,875.41" "$4,853.85" "$3,781.66" "$4,875.41" "$3,116.95" "$3,116.95" "$3,236.84" "$2,187.86" "$3,781.41" "$7,800.66" "$7,524.05" "$4,877.00" "$4,875.41" $236.81 "$4,875.41" "$5,119.18" "$13,608.00" "$4,875.41" "$4,875.41" "$4,875.41" "$6,095.00" "$5,161.00" "$14,370.05" "$4,875.41" "$14,515.20" "$5,164.00" "$3,601.13" "$4,875.41" "$10,523.52" "$5,119.18" "$7,053.49" "$4,875.41" "$3,781.21" "$4,875.41" N/A N/A 48100113 EAP CPT® 36903 INTRO CATH DIALYSIS CIRCUIT; W TRANS INTRA STENT BOTH IP/OP "$36,671.00" "$27,137.00" $311.15 "$36,671.00" "$36,671.00" "$36,671.00" "$36,671.00" "$36,671.00" $314.96 $314.96 $316.63 "$36,671.00" $314.96 "$36,671.00" "$36,671.00" "$36,671.00" "$36,671.00" "$7,642.64" $503.94 $497.84 "$36,671.00" $314.96 $311.15 $314.96 "$36,671.00" "$27,503.25" $314.96 $314.96 $314.96 "$7,479.00" "$18,335.50" "$29,043.43" $314.96 "$29,336.80" "$5,343.00" "$36,671.00" $314.96 "$21,269.18" "$36,671.00" $331.75 $314.96 "$36,671.00" $314.96 N/A N/A 48100114 EAP CPT® 36904 THRMBC/NFS DIALYSIS CIRCUIT BOTH IP/OP "$18,144.00" "$13,427.00" $364.05 "$18,144.00" "$18,144.00" "$18,144.00" "$18,144.00" "$18,144.00" $366.34 $366.34 $369.41 "$18,144.00" $366.34 "$18,144.00" "$18,144.00" "$18,144.00" "$18,144.00" "$3,781.41" $586.14 $582.48 "$18,144.00" $366.34 $364.05 $366.34 "$18,144.00" "$13,608.00" $366.34 $366.34 $366.34 "$6,095.00" "$9,072.00" "$14,370.05" $366.34 "$14,515.20" "$5,164.00" "$18,144.00" $366.34 "$10,523.52" "$18,144.00" $387.30 $366.34 "$18,144.00" $366.34 N/A N/A 48100115 EAP CPT® 36905 THRMBC/NFS DIALYSIS CIRCUIT; W ANGIO BOTH IP/OP "$36,671.00" "$27,137.00" $437.62 "$36,671.00" "$36,671.00" "$36,671.00" "$36,671.00" "$36,671.00" $442.94 $442.94 $445.70 "$36,671.00" $442.94 "$36,671.00" "$36,671.00" "$36,671.00" "$36,671.00" "$7,642.64" $708.70 $700.19 "$36,671.00" $442.94 $437.62 $442.94 "$36,671.00" "$27,503.25" $442.94 $442.94 $442.94 "$7,479.00" "$18,335.50" "$29,043.43" $442.94 "$29,336.80" "$5,343.00" "$36,671.00" $442.94 "$21,269.18" "$36,671.00" $464.47 $442.94 "$36,671.00" $442.94 N/A N/A 48100116 EAP CPT® 36906 THRMBC/NFS DIALYSIS CIRCUIT; W TRANS INTRA STENT BOTH IP/OP "$55,585.00" "$41,133.00" $504.50 "$55,585.00" "$55,585.00" "$55,585.00" "$55,585.00" "$55,585.00" $508.98 $508.98 $513.23 "$55,585.00" $508.98 "$55,585.00" "$55,585.00" "$55,585.00" "$55,585.00" "$11,584.53" $814.37 $807.20 "$55,585.00" $508.98 $504.50 $508.98 "$55,585.00" "$41,688.75" $508.98 $508.98 $508.98 "$7,479.00" "$27,792.50" "$44,023.32" $508.98 "$44,468.00" "$5,410.00" "$55,585.00" $508.98 "$32,239.30" "$55,585.00" $536.23 $508.98 "$55,585.00" $508.98 N/A N/A 48100117 EAP CPT® 36907 BALO ANGIOP CTR DIALYSIS SEG BOTH IP/OP "$3,666.00" "$2,713.00" $144.54 "$3,666.00" "$3,666.00" "$3,666.00" "$3,666.00" "$3,666.00" $145.62 $145.62 $147.15 "$3,666.00" $145.62 "$2,720.91" "$2,720.91" "$2,825.75" "$1,909.99" $764.03 $232.99 $231.26 "$3,666.00" $145.62 $144.54 $145.62 "$3,666.00" "$2,749.50" $145.62 $145.62 $145.62 "$1,833.00" "$1,833.00" "$2,903.47" $145.62 "$2,932.80" "$1,750.00" "$3,666.00" $145.62 "$2,126.28" "$3,666.00" $153.26 $145.62 "$3,666.00" $145.62 N/A N/A 48100118 EAP CPT® 37246 TRLUML BALO ANGIOP 1ST ART BOTH IP/OP "$15,477.00" "$11,453.00" $343.50 "$15,477.00" "$15,477.00" "$15,477.00" "$15,477.00" "$15,477.00" $346.31 $346.31 $347.54 "$15,477.00" $346.31 "$15,477.00" "$15,477.00" "$15,477.00" "$15,477.00" "$3,225.58" $554.10 $549.60 "$15,477.00" $346.31 $343.50 $346.31 "$15,477.00" "$11,607.75" $346.31 $346.31 $346.31 "$6,095.00" "$7,738.50" "$12,257.78" $346.31 "$12,381.60" "$5,164.00" "$15,477.00" $346.31 "$8,976.66" "$15,477.00" $364.92 $346.31 "$15,477.00" $346.31 N/A N/A 48100119 EAP CPT® 37247 TRLUML BALO ANGIOP ADDL ART BOTH IP/OP "$7,740.00" "$5,728.00" $169.17 "$7,740.00" "$7,740.00" "$7,740.00" "$7,740.00" "$7,740.00" $169.17 $169.17 $169.63 "$7,740.00" $169.17 "$4,181.12" "$4,181.12" "$5,965.99" "$2,060.15" "$1,613.10" $270.67 $272.18 "$7,740.00" $169.17 $170.11 $169.17 "$7,740.00" "$5,805.00" $169.17 $169.17 $169.17 "$3,870.00" "$3,870.00" "$6,130.08" $169.17 "$6,192.00" "$1,750.00" "$7,740.00" $169.17 "$4,489.20" "$7,740.00" $179.22 $169.17 "$7,740.00" $169.17 N/A N/A 48100120 EAP CPT® 37248 TRLUML BALO ANGIOP 1ST VEIN BOTH IP/OP "$15,477.00" "$11,453.00" $292.79 "$15,477.00" "$15,477.00" "$15,477.00" "$15,477.00" "$15,477.00" $296.36 $296.36 $297.56 "$15,477.00" $296.36 "$15,477.00" "$15,477.00" "$15,477.00" "$15,477.00" "$3,225.58" $474.18 $468.46 "$15,477.00" $296.36 $292.79 $296.36 "$15,477.00" "$11,607.75" $296.36 $296.36 $296.36 "$6,095.00" "$7,738.50" "$12,257.78" $296.36 "$12,381.60" "$5,164.00" "$15,477.00" $296.36 "$8,976.66" "$15,477.00" $311.56 $296.36 "$15,477.00" $296.36 N/A N/A 48100121 EAP CPT® 37249 TRLUML BALO ANGIOP ADDL VEIN BOTH IP/OP "$7,740.00" "$5,728.00" $143.57 "$7,740.00" "$7,740.00" "$7,740.00" "$7,740.00" "$7,740.00" $144.67 $144.67 $145.24 "$7,740.00" $144.67 "$4,181.12" "$4,181.12" "$5,965.99" "$2,060.15" "$1,613.10" $231.47 $229.71 "$7,740.00" $144.67 $143.57 $144.67 "$7,740.00" "$5,805.00" $144.67 $144.67 $144.67 "$3,870.00" "$3,870.00" "$6,130.08" $144.67 "$6,192.00" "$1,750.00" "$7,740.00" $144.67 "$4,489.20" "$7,740.00" $152.90 $144.67 "$7,740.00" $144.67 N/A N/A 48100122 EAP CPT® 36908 TCAT PLMT IV STENT CTR DIALYSIS SEG W/IMG S&I BOTH IP/OP "$3,261.00" "$2,413.50" $203.95 "$3,261.00" "$3,261.00" "$3,261.00" "$3,261.00" "$3,261.00" $206.37 $206.37 $207.83 "$3,261.00" $206.37 "$2,420.31" "$2,420.31" "$2,513.58" "$1,698.98" $679.63 $330.19 $326.32 "$3,261.00" $206.37 $203.95 $206.37 "$3,261.00" "$2,445.75" $206.37 $206.37 $206.37 "$1,630.50" "$1,630.50" "$2,582.71" $206.37 "$2,608.80" "$1,750.00" "$3,261.00" $206.37 "$1,891.38" "$3,261.00" $217.09 $206.37 "$3,261.00" $206.37 N/A N/A 48100123 EAP CPT® 36909 DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I BOTH IP/OP "$3,261.00" "$2,413.50" $198.86 "$3,261.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$3,261.00" "$3,261.00" "$3,261.00" $679.67 "$3,261.00" "$3,261.00" "$3,261.00" "$3,261.00" "$3,261.00" $679.63 "$3,261.00" "$3,261.00" "$1,928.88" "$3,261.00" $198.86 "$3,261.00" "$3,261.00" "$2,445.75" "$3,261.00" "$3,261.00" "$3,261.00" "$1,630.50" "$1,630.50" "$2,582.71" "$3,261.00" "$2,608.80" "$1,750.00" $647.23 "$3,261.00" "$1,891.38" "$3,261.00" "$3,261.00" "$3,261.00" $679.59 "$3,261.00" N/A N/A 48100125 EAP CPT® 62323 NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN BOTH IP/OP "$1,385.00" "$1,025.00" $98.98 "$1,385.00" "$1,385.00" "$1,385.00" "$1,385.00" "$1,385.00" $624.63 $624.63 $621.87 $288.67 $624.63 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $288.65 $999.41 $929.56 "$1,385.00" $624.63 $98.98 $624.63 $655.86 "$1,038.75" $624.63 $624.63 $624.63 "$1,385.00" $692.50 "$1,096.92" $624.63 "$1,108.00" "$1,385.00" $274.89 $624.63 $803.30 $655.86 $903.68 $624.63 $288.63 $624.63 N/A N/A 48100126 EAP HCPCS C9600 PERC DRUG-ELUTING COR STENT; SINGLE VESSEL BOTH IP/OP "$30,247.00" "$22,383.00" "$2,645.82" "$24,197.60" "$16,424.12" "$16,424.12" "$16,424.12" "$16,424.12" "$9,880.57" "$9,880.57" "$9,836.87" "$6,304.23" "$9,880.57" "$3,769.39" "$3,769.39" "$3,914.36" "$2,645.82" "$6,303.81" "$15,808.91" "$15,314.28" "$17,891.10" "$9,880.57" "$20,822.00" "$9,880.57" "$10,374.60" "$22,685.25" "$9,880.57" "$9,880.57" "$9,880.57" "$15,123.50" "$15,123.50" "$23,955.62" "$9,880.57" "$24,197.60" "$5,164.00" "$6,003.27" "$9,880.57" "$17,543.26" "$10,374.60" "$14,294.69" "$9,880.57" "$6,303.47" "$9,880.57" N/A N/A 48100127 EAP HCPCS C9601 PERC DRUG-ELUTING COR STENT; EA ADDL BRANCH BOTH IP/OP "$25,675.00" "$18,999.50" "$1,750.00" "$25,675.00" "$13,941.53" "$13,941.53" "$13,941.53" "$13,941.53" "$25,675.00" "$25,675.00" "$25,675.00" "$5,351.31" "$25,675.00" "$4,181.12" "$4,181.12" "$19,790.29" "$2,060.15" "$5,350.95" "$25,675.00" "$25,675.00" "$15,186.76" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$19,256.25" "$25,675.00" "$25,675.00" "$25,675.00" "$12,837.50" "$12,837.50" "$20,334.60" "$25,675.00" "$20,540.00" "$1,750.00" "$5,095.85" "$25,675.00" "$14,891.50" "$25,675.00" "$25,675.00" "$25,675.00" "$5,350.67" "$25,675.00" N/A N/A 48100128 EAP HCPCS C9602 PERC DRUG-ELUTING COR STENT & ATHERECT; SINGL VESS BOTH IP/OP "$25,675.00" "$18,999.50" "$5,164.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$5,350.95" "$25,675.00" "$9,441.60" "$25,675.00" "$25,675.00" "$23,604.00" "$25,675.00" "$25,675.00" "$19,256.25" "$25,675.00" "$25,675.00" "$25,675.00" "$12,837.50" "$12,837.50" "$20,334.60" "$25,675.00" "$20,540.00" "$5,164.00" "$25,675.00" "$25,675.00" "$14,891.50" "$25,675.00" "$15,405.00" "$25,675.00" "$25,675.00" "$25,675.00" N/A N/A 48100129 EAP HCPCS C9603 PERC DRUG-ELUTING COR STENT & ATHERECT; EA ADDL BR BOTH IP/OP "$28,009.00" "$20,727.00" "$1,750.00" "$28,009.00" "$28,009.00" "$28,009.00" "$28,009.00" "$28,009.00" "$28,009.00" "$28,009.00" "$28,009.00" "$28,009.00" "$28,009.00" "$4,181.12" "$4,181.12" "$21,589.34" "$2,060.15" "$5,837.38" "$28,009.00" "$7,004.80" "$28,009.00" "$28,009.00" "$17,512.00" "$28,009.00" "$28,009.00" "$21,006.75" "$28,009.00" "$28,009.00" "$28,009.00" "$14,004.50" "$14,004.50" "$22,183.13" "$28,009.00" "$22,407.20" "$1,750.00" "$28,009.00" "$28,009.00" "$16,245.22" "$28,009.00" "$16,805.40" "$28,009.00" "$28,009.00" "$28,009.00" N/A N/A 48100130 EAP HCPCS C9604 PERC DRUG-ELUTING COR REVASC OF OR THRO CABG;SING BOTH IP/OP "$26,434.00" "$19,561.50" "$5,164.00" "$26,434.00" "$26,434.00" "$26,434.00" "$26,434.00" "$26,434.00" "$26,434.00" "$26,434.00" "$26,434.00" "$26,434.00" "$26,434.00" "$26,434.00" "$26,434.00" "$26,434.00" "$26,434.00" "$5,509.14" "$26,434.00" "$9,807.20" "$26,434.00" "$26,434.00" "$24,518.00" "$26,434.00" "$26,434.00" "$19,825.50" "$26,434.00" "$26,434.00" "$26,434.00" "$13,217.00" "$13,217.00" "$20,935.73" "$26,434.00" "$21,147.20" "$5,164.00" "$26,434.00" "$26,434.00" "$15,331.72" "$26,434.00" "$15,860.40" "$26,434.00" "$26,434.00" "$26,434.00" N/A N/A 48100131 EAP HCPCS C9605 PERC DRUG-ELUTING COR REVASC OF OR THR CABG; EA AD BOTH IP/OP "$25,675.00" "$18,999.50" "$1,750.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$4,181.12" "$4,181.12" "$19,790.29" "$2,060.15" "$5,350.95" "$25,675.00" "$7,370.00" "$25,675.00" "$25,675.00" "$18,425.00" "$25,675.00" "$25,675.00" "$19,256.25" "$25,675.00" "$25,675.00" "$25,675.00" "$12,837.50" "$12,837.50" "$20,334.60" "$25,675.00" "$20,540.00" "$1,750.00" "$25,675.00" "$25,675.00" "$14,891.50" "$25,675.00" "$15,405.00" "$25,675.00" "$25,675.00" "$25,675.00" N/A N/A 48100132 EAP HCPCS C9606 PERC DRUG-ELUTING COR W/ AMI;SINGLE VES BOTH IP/OP "$28,038.00" "$20,748.50" "$5,164.00" "$34,452.00" "$28,038.00" "$28,038.00" "$28,038.00" "$28,038.00" "$28,038.00" "$28,038.00" "$28,038.00" "$28,038.00" "$28,038.00" "$28,038.00" "$28,038.00" "$28,038.00" "$28,038.00" "$5,843.43" "$28,038.00" "$13,780.80" "$28,038.00" "$28,038.00" "$34,452.00" "$28,038.00" "$28,038.00" "$21,028.50" "$28,038.00" "$28,038.00" "$28,038.00" "$14,019.00" "$14,019.00" "$22,206.10" "$28,038.00" "$22,430.40" "$5,164.00" "$28,038.00" "$28,038.00" "$16,262.04" "$28,038.00" "$16,822.80" "$28,038.00" "$28,038.00" "$28,038.00" N/A N/A 48100133 EAP HCPCS C9607 PERC DRUG-ELUTING COR REVASC CTO;SINGLE VESS BOTH IP/OP "$25,675.00" "$18,999.50" "$5,164.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$5,350.95" "$25,675.00" "$10,270.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$25,675.00" "$19,256.25" "$25,675.00" "$25,675.00" "$25,675.00" "$12,837.50" "$12,837.50" "$20,334.60" "$25,675.00" "$20,540.00" "$5,164.00" "$25,675.00" "$25,675.00" "$14,891.50" "$25,675.00" "$15,405.00" "$25,675.00" "$25,675.00" "$25,675.00" N/A N/A 48100134 EAP HCPCS C9608 PERC DRUG-ELUTING COR REVASC CTO; EA ADDL VESSEL BOTH IP/OP "$26,553.00" "$19,649.50" "$1,750.00" "$26,553.00" "$26,553.00" "$26,553.00" "$26,553.00" "$26,553.00" "$26,553.00" "$26,553.00" "$26,553.00" "$26,553.00" "$26,553.00" "$4,181.12" "$4,181.12" "$20,467.05" "$2,060.15" "$5,533.94" "$26,553.00" "$10,621.20" "$26,553.00" "$26,553.00" "$26,553.00" "$26,553.00" "$26,553.00" "$19,914.75" "$26,553.00" "$26,553.00" "$26,553.00" "$13,276.50" "$13,276.50" "$21,029.98" "$26,553.00" "$21,242.40" "$1,750.00" "$26,553.00" "$26,553.00" "$15,400.74" "$26,553.00" "$15,931.80" "$26,553.00" "$26,553.00" "$26,553.00" N/A N/A 48100140 EAP CPT® 33274 TRANSCATH INSJ/RPL PERM LEADLESS PM RV W/IMG BOTH IP/OP "$43,271.00" "$32,021.00" $481.14 "$43,271.00" "$43,271.00" "$43,271.00" "$43,271.00" "$43,271.00" $487.18 $487.18 $490.37 "$43,271.00" $487.18 "$43,271.00" "$43,271.00" "$43,271.00" "$43,271.00" "$9,018.15" $779.49 $769.82 "$43,271.00" $487.18 $481.14 $487.18 "$43,271.00" "$32,453.25" $487.18 $487.18 $487.18 "$7,479.00" "$21,635.50" "$34,270.63" $487.18 "$34,616.80" "$28,126.15" "$43,271.00" $487.18 "$25,097.18" "$43,271.00" $509.00 $487.18 "$43,271.00" $487.18 N/A N/A 48100145 EAP CPT® 33995 INSJ PERQ VAD W/RS&I R HEART VENOUS ACCESS ONLY BOTH IP/OP "$23,275.00" "$17,223.50" $352.98 "$23,275.00" "$23,275.00" "$23,275.00" "$23,275.00" "$23,275.00" $361.63 $361.63 $365.29 "$23,275.00" $361.63 "$23,275.00" "$23,275.00" "$23,275.00" "$23,275.00" "$4,850.77" $578.61 $564.77 "$23,275.00" $361.63 $352.98 $361.63 "$23,275.00" "$17,456.25" $361.63 $361.63 $361.63 "$11,637.50" "$11,637.50" "$18,433.80" $361.63 "$18,620.00" "$15,128.75" "$23,275.00" $361.63 "$13,499.50" "$23,275.00" "$13,965.00" $361.63 "$23,275.00" $361.63 N/A N/A 48100146 EAP CPT® 33997 REMOVAL PERQ R HEART VAD VENOUS CANNULA SEP INSJ BOTH IP/OP "$23,275.00" "$17,223.50" $156.85 "$23,275.00" "$23,275.00" "$23,275.00" "$23,275.00" "$23,275.00" $160.86 $160.86 $162.51 "$23,275.00" $160.86 "$23,275.00" "$23,275.00" "$23,275.00" "$23,275.00" "$4,850.77" $257.38 $250.96 "$23,275.00" $160.86 $156.85 $160.86 "$23,275.00" "$17,456.25" $160.86 $160.86 $160.86 "$11,637.50" "$11,637.50" "$18,433.80" $160.86 "$18,620.00" "$15,128.75" "$23,275.00" $160.86 "$13,499.50" "$23,275.00" "$13,965.00" $160.86 "$23,275.00" $160.86 N/A N/A 48100147 EAP CPT® 93593 RHC CHD W/IMG CATH TRGT ZONE NML NT CONNJ BOTH IP/OP "$7,131.00" "$5,277.00" "$1,269.32" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$1,269.32" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$1,486.18" "$7,131.00" "$2,852.40" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$5,348.25" "$7,131.00" "$7,131.00" "$7,131.00" "$3,565.50" "$3,565.50" "$5,647.75" "$7,131.00" "$5,704.80" "$4,635.15" "$7,131.00" "$7,131.00" "$4,135.98" "$7,131.00" "$4,278.60" "$7,131.00" "$7,131.00" "$7,131.00" N/A N/A 48100148 EAP CPT® 93594 RHC CHD W/IMG CATH TRGT ZONE ABNL NT CONNJ BOTH IP/OP "$7,131.00" "$5,277.00" "$1,269.32" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$1,269.32" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$1,486.18" "$7,131.00" "$2,852.40" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$5,348.25" "$7,131.00" "$7,131.00" "$7,131.00" "$3,565.50" "$3,565.50" "$5,647.75" "$7,131.00" "$5,704.80" "$4,635.15" "$7,131.00" "$7,131.00" "$4,135.98" "$7,131.00" "$4,278.60" "$7,131.00" "$7,131.00" "$7,131.00" N/A N/A 48100149 EAP CPT® 93595 LHC CHD W/IMG CATH TRGT ZONE NML/ABNL NT CNJ BOTH IP/OP "$7,131.00" "$5,277.00" "$1,269.32" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$1,269.32" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$1,486.18" "$7,131.00" "$2,852.40" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$5,348.25" "$7,131.00" "$7,131.00" "$7,131.00" "$3,565.50" "$3,565.50" "$5,647.75" "$7,131.00" "$5,704.80" "$4,635.15" "$7,131.00" "$7,131.00" "$4,135.98" "$7,131.00" "$4,278.60" "$7,131.00" "$7,131.00" "$7,131.00" N/A N/A 48100150 EAP CPT® 93596 LHC/RHC CHD W/IMG CATH TRGT ZONE NML NT CONNJ BOTH IP/OP "$7,131.00" "$5,277.00" "$1,269.32" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$1,269.32" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$1,486.18" "$7,131.00" "$2,852.40" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$5,348.25" "$7,131.00" "$7,131.00" "$7,131.00" "$3,565.50" "$3,565.50" "$5,647.75" "$7,131.00" "$5,704.80" "$4,635.15" "$7,131.00" "$7,131.00" "$4,135.98" "$7,131.00" "$4,278.60" "$7,131.00" "$7,131.00" "$7,131.00" N/A N/A 48100151 EAP CPT® 93597 LHC/RHC CHD W/IMG CATH TRGT ZONE ABNL NT CONNJ BOTH IP/OP "$7,131.00" "$5,277.00" "$1,269.32" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$1,269.32" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$1,486.18" "$7,131.00" "$2,852.40" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$7,131.00" "$5,348.25" "$7,131.00" "$7,131.00" "$7,131.00" "$3,565.50" "$3,565.50" "$5,647.75" "$7,131.00" "$5,704.80" "$4,635.15" "$7,131.00" "$7,131.00" "$4,135.98" "$7,131.00" "$4,278.60" "$7,131.00" "$7,131.00" "$7,131.00" N/A N/A 48100152 EAP CPT® 93598 CAR OUTP MEAS DURING HEART CATH EVAL CHD ADD-ON BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$1,484.40" "$1,484.40" "$1,541.60" "$1,042.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" "$1,300.00" "$2,000.00" "$2,000.00" "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 48200002 EAP CPT® 93017 CARDIAC STRESS TEST BOTH IP/OP "$3,585.00" "$2,653.00" $36.20 "$2,868.00" $82.60 $82.60 $82.60 $82.60 $260.33 $260.33 $259.18 $747.20 $260.33 "$2,660.79" "$2,660.79" "$2,763.32" "$1,867.79" $747.15 $416.53 $404.03 "$2,120.53" $260.33 $36.20 $260.33 $273.35 "$2,688.75" $260.33 $260.33 $260.33 "$1,792.50" "$1,792.50" "$2,839.32" $260.33 "$2,868.00" "$2,330.25" $711.53 $260.33 "$2,079.30" $273.35 $376.64 $260.33 $747.11 $260.33 N/A N/A 48300001 EAP CPT® 93306 "TTE, COMPLETE" BOTH IP/OP "$4,414.00" "$3,266.50" $130.23 "$3,531.20" $479.91 $479.91 $479.91 $479.91 $475.30 $475.30 $473.20 $919.99 $475.30 "$3,276.07" "$3,276.07" "$3,402.31" "$2,060.15" $919.93 $760.48 $725.84 "$2,610.88" $475.30 $130.23 $475.30 $499.07 "$3,310.50" $475.30 $475.30 $475.30 "$2,207.00" "$2,207.00" "$3,495.89" $475.30 "$3,531.20" "$2,869.10" $876.07 $475.30 "$2,560.12" $499.07 $687.64 $475.30 $919.88 $475.30 N/A N/A 48300003 EAP CPT® 93308 TTE. LIMITED BOTH IP/OP "$2,613.00" "$1,934.00" $74.75 "$2,090.40" $262.65 $262.65 $262.65 $262.65 $226.34 $226.34 $225.34 $544.61 $226.34 $205.76 $205.76 $213.68 $150.21 $544.58 $362.15 $336.89 "$1,545.59" $226.34 $74.75 $226.34 $237.66 "$1,959.75" $226.34 $226.34 $226.34 "$1,306.50" "$1,306.50" "$2,069.50" $226.34 "$2,090.40" "$1,698.45" $518.62 $226.34 "$1,515.54" $237.66 $327.46 $226.34 $544.55 $226.34 N/A N/A 48300004 EAP CPT® 93350 ECHO W/STRESS TEST BOTH IP/OP "$3,748.00" "$2,774.00" $119.39 "$2,998.40" $505.94 $505.94 $505.94 $505.94 $475.30 $475.30 $473.20 $781.18 $475.30 $328.30 $328.30 $340.92 $239.65 $781.12 $760.48 $725.84 "$2,216.94" $475.30 $119.39 $475.30 $499.07 "$2,811.00" $475.30 $475.30 $475.30 "$1,874.00" "$1,874.00" "$2,968.42" $475.30 "$2,998.40" "$2,436.20" $743.88 $475.30 "$2,173.84" $499.07 $687.64 $475.30 $781.08 $475.30 N/A N/A 48300005 EAP CPT® 93303 TRANSTHORACIC ECHO FOR CONGENITAL ANOMALIES BOTH IP/OP "$2,416.00" "$1,788.00" $162.02 "$2,416.00" "$2,416.00" "$2,416.00" "$2,416.00" "$2,416.00" $168.13 $168.13 $237.39 "$2,416.00" $168.13 $372.07 $372.07 $386.38 $271.61 $503.52 $269.01 $259.23 "$2,416.00" $168.13 $162.02 $168.13 "$2,416.00" "$1,812.00" $168.13 $168.13 $168.13 "$1,208.00" "$1,208.00" "$1,913.47" $168.13 "$1,932.80" "$1,570.40" "$2,416.00" $168.13 "$1,401.28" "$2,416.00" $171.80 $168.13 "$2,416.00" $168.13 N/A N/A 48300006 EAP CPT® 93304 TRANSTHORACIC ECHO FOLLOW-UP LIMITED STUDY BOTH IP/OP "$1,512.00" "$1,119.00" $121.42 "$1,512.00" "$1,512.00" "$1,512.00" "$1,512.00" "$1,512.00" $125.99 $125.99 $166.31 "$1,512.00" $125.99 $239.35 $239.35 $248.55 $174.72 $315.12 $201.58 $194.27 "$1,512.00" $125.99 $121.42 $125.99 "$1,512.00" "$1,134.00" $125.99 $125.99 $125.99 $756.00 $756.00 "$1,197.50" $125.99 "$1,209.60" $982.80 "$1,512.00" $125.99 $876.96 "$1,512.00" $125.34 $125.99 "$1,512.00" $125.99 N/A N/A 48300007 EAP HCPCS C8924 TTE 2D W OR W/O FOL W/CONTRAST; FOLLOW-UP OR LTD BOTH IP/OP "$2,899.00" "$2,145.50" $360.63 "$2,320.00" "$1,574.16" "$1,574.16" "$1,574.16" "$1,574.16" $362.23 $362.23 $360.63 $604.22 $362.23 "$2,151.64" "$2,151.64" "$2,234.55" "$1,510.38" $604.18 $579.58 $531.51 "$1,714.76" $362.23 "$2,320.00" $362.23 $380.35 "$2,174.25" $362.23 $362.23 $362.23 "$1,449.50" "$1,449.50" "$2,296.01" $362.23 "$2,319.20" "$1,884.35" $575.38 $362.23 "$1,681.42" $380.35 $524.06 $362.23 $604.15 $362.23 N/A N/A 48300008 EAP HCPCS C8929 TTE 2D W OR W/O FOL W/CONTRAST; DOPPLER BOTH IP/OP "$4,697.00" "$3,476.00" $700.64 "$4,459.00" "$2,550.47" "$2,550.47" "$2,550.47" "$2,550.47" $703.75 $703.75 $700.64 $978.97 $703.75 "$3,486.11" "$3,486.11" "$3,620.45" "$2,060.15" $978.91 "$1,126.00" "$1,068.65" "$2,778.28" $703.75 "$4,459.00" $703.75 $738.94 "$3,522.75" $703.75 $703.75 $703.75 "$2,348.50" "$2,348.50" "$3,720.02" $703.75 "$3,757.60" "$3,053.05" $932.24 $703.75 "$2,724.26" $738.94 "$1,018.15" $703.75 $978.85 $703.75 N/A N/A 48300009 EAP CPT® 93321 DOPPLER ECHO EXAM HEART (ADD-ON) BOTH IP/OP $670.00 $496.00 $18.26 $670.00 $670.00 $670.00 $670.00 $670.00 $19.00 $19.00 $27.14 $670.00 $19.00 $65.89 $65.89 $68.43 $48.10 $139.64 $30.40 $29.22 $670.00 $19.00 $18.26 $19.00 $670.00 $502.50 $19.00 $19.00 $19.00 $335.00 $335.00 $530.64 $19.00 $536.00 $435.50 $670.00 $19.00 $388.60 $670.00 $19.45 $19.00 $670.00 $19.00 N/A N/A 48300010 EAP CPT® 93356 MYOCRD STRAIN IMG SPCKL TRCK (ADD-ON) BOTH IP/OP "$1,000.00" $740.00 $11.53 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $12.04 $12.04 $12.14 "$1,000.00" $12.04 $742.20 $742.20 $770.80 $521.00 $208.41 $19.26 $18.45 "$1,000.00" $12.04 $11.53 $12.04 "$1,000.00" $750.00 $12.04 $12.04 $12.04 $500.00 $500.00 $792.00 $12.04 $800.00 $650.00 "$1,000.00" $12.04 $580.00 "$1,000.00" $12.26 $12.04 "$1,000.00" $12.04 N/A N/A 48300011 EAP CPT® 93319 3D ECHO IMG TEE/TTE CGEN CAR ANOMAL ADD-ON BOTH IP/OP "$2,000.00" "$1,480.00" $24.07 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $25.08 $25.08 $356.00 "$2,000.00" $25.08 "$1,484.40" "$1,484.40" "$1,541.60" "$1,042.00" $416.82 $40.13 $38.51 "$2,000.00" $25.08 $24.07 $25.08 "$2,000.00" "$1,500.00" $25.08 $25.08 $25.08 "$1,000.00" "$1,000.00" "$1,584.00" $25.08 "$1,600.00" "$1,300.00" "$2,000.00" $25.08 "$1,160.00" "$2,000.00" "$1,200.00" $25.08 "$2,000.00" $25.08 N/A N/A 49000001 EAP CPT® 59821 TRMT OF MISSED ABORT.-2ND TRIM BOTH IP/OP "$3,666.00" "$2,713.00" $380.46 "$3,666.00" "$3,666.00" "$3,666.00" "$3,666.00" "$3,666.00" $384.11 $384.11 $380.46 "$3,666.00" $384.11 "$3,666.00" "$3,666.00" "$3,666.00" "$3,666.00" $764.03 $614.58 $619.46 "$3,666.00" $384.11 $387.16 $384.11 "$3,666.00" "$2,749.50" $384.11 $384.11 $384.11 "$3,666.00" "$1,833.00" "$2,903.47" $384.11 "$2,932.80" "$3,250.00" "$3,666.00" $384.11 "$2,126.28" "$3,666.00" $384.21 $384.11 "$3,666.00" $384.11 N/A N/A 51000003 EAP CPT® 19499 "DUCT LAV EA BRST, SING DUCT" BOTH IP/OP "$6,124.00" "$4,532.00" "$1,276.31" "$6,169.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$6,124.00" "$1,276.31" "$6,124.00" "$2,467.60" "$6,124.00" "$6,124.00" "$6,169.00" "$6,124.00" "$6,124.00" "$4,593.00" "$6,124.00" "$6,124.00" "$6,124.00" "$2,762.00" "$3,062.00" "$4,850.21" "$6,124.00" "$4,899.20" "$3,250.00" "$6,124.00" "$6,124.00" "$3,551.92" "$6,124.00" "$3,674.40" "$6,124.00" "$6,124.00" "$6,124.00" N/A N/A 51000004 EAP CPT® 23500 SHOULDER-CLAVICULAR BOTH IP/OP "$1,037.00" $767.50 $216.12 "$1,037.00" "$1,037.00" "$1,037.00" "$1,037.00" "$1,037.00" $234.67 $234.67 $233.10 "$1,037.00" $234.67 "$1,037.00" "$1,037.00" "$1,037.00" "$1,037.00" $216.12 $375.47 $382.16 "$1,037.00" $234.67 $238.85 $234.67 "$1,037.00" $777.75 $234.67 $234.67 $234.67 "$1,037.00" $518.50 $821.30 $234.67 $829.60 "$1,037.00" "$1,037.00" $234.67 $601.46 "$1,037.00" $232.44 $234.67 "$1,037.00" $234.67 N/A N/A 51000005 EAP CPT® 23540 TREAT CLAVICLE DISLOCATION BOTH IP/OP $815.00 $603.50 $169.85 $815.00 $815.00 $815.00 $815.00 $815.00 $243.16 $243.16 $239.98 $815.00 $243.16 $815.00 $815.00 $815.00 $815.00 $169.85 $389.06 $395.71 $815.00 $243.16 $247.32 $243.16 $815.00 $611.25 $243.16 $243.16 $243.16 $815.00 $407.50 $645.48 $243.16 $652.00 $815.00 $815.00 $243.16 $472.70 $815.00 $239.29 $243.16 $815.00 $243.16 N/A N/A 51000006 EAP CPT® 23620 HUMERUS-PROXIMAL BOTH IP/OP "$1,035.00" $766.00 $201.85 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $202.75 $202.75 $201.85 $215.72 $202.75 "$1,035.00" "$1,035.00" "$1,035.00" $882.37 $215.71 $324.39 $298.65 "$1,035.00" $202.75 $271.71 $202.75 $212.88 $776.25 $202.75 $202.75 $202.75 "$1,035.00" $517.50 $819.72 $202.75 $828.00 "$1,035.00" $205.42 $202.75 $600.30 $212.88 $293.32 $202.75 $215.69 $202.75 N/A N/A 51000007 EAP CPT® 23675 HUMERUS-NECK BOTH IP/OP "$1,500.00" "$1,110.00" $312.62 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $514.42 $514.42 $512.23 "$1,500.00" $514.42 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 $823.07 $825.97 "$1,500.00" $514.42 $516.23 $514.42 "$1,500.00" "$1,125.00" $514.42 $514.42 $514.42 "$1,500.00" $750.00 "$1,188.00" $514.42 "$1,200.00" "$1,500.00" "$1,500.00" $514.42 $870.00 "$1,500.00" $521.17 $514.42 "$1,500.00" $514.42 N/A N/A 51000008 EAP CPT® 24500 CLSD TX HUMERAL SHAFT FX W/O MANIP BOTH IP/OP $689.00 $510.00 $143.60 $689.00 $689.00 $689.00 $689.00 $689.00 $345.15 $345.15 $341.46 $689.00 $345.15 $689.00 $689.00 $689.00 $689.00 $143.60 $552.24 $557.28 $689.00 $345.15 $348.30 $345.15 $689.00 $516.75 $345.15 $345.15 $345.15 $689.00 $344.50 $545.69 $345.15 $551.20 $689.00 $689.00 $345.15 $399.62 $689.00 $340.92 $345.15 $689.00 $345.15 N/A N/A 51000009 EAP CPT® 24530 HUMERUS-CONDYLE-SUPRA BOTH IP/OP "$1,035.00" $766.00 $215.71 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $362.59 $362.59 $359.74 "$1,035.00" $362.59 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 $580.14 $586.05 "$1,035.00" $362.59 $366.28 $362.59 "$1,035.00" $776.25 $362.59 $362.59 $362.59 "$1,035.00" $517.50 $819.72 $362.59 $828.00 "$1,035.00" "$1,035.00" $362.59 $600.30 "$1,035.00" $358.95 $362.59 "$1,035.00" $362.59 N/A N/A 51000010 EAP CPT® 24560 HUMERUS-DISTAL CLOSED BOTH IP/OP $978.00 $724.00 $203.83 $978.00 $978.00 $978.00 $978.00 $978.00 $304.94 $304.94 $304.02 $978.00 $304.94 $978.00 $978.00 $978.00 $978.00 $203.83 $487.90 $493.30 $978.00 $304.94 $308.31 $304.94 $978.00 $733.50 $304.94 $304.94 $304.94 $978.00 $489.00 $774.58 $304.94 $782.40 $978.00 $978.00 $304.94 $567.24 $978.00 $303.08 $304.94 $978.00 $304.94 N/A N/A 51000011 EAP CPT® 24576 HUMERUS-CONDYLE-MEDIAL BOTH IP/OP "$1,053.00" $779.50 $219.46 "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" $323.94 $323.94 $321.09 "$1,053.00" $323.94 "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" $219.46 $518.30 $523.07 "$1,053.00" $323.94 $326.92 $323.94 "$1,053.00" $789.75 $323.94 $323.94 $323.94 "$1,053.00" $526.50 $833.98 $323.94 $842.40 "$1,053.00" "$1,053.00" $323.94 $610.74 "$1,053.00" $320.01 $323.94 "$1,053.00" $323.94 N/A N/A 51000012 EAP CPT® 24650 ELBOW-RADIAL HEAD BOTH IP/OP "$1,062.00" $786.00 $221.33 "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" $253.30 $253.30 $252.23 "$1,062.00" $253.30 "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" $221.33 $405.28 $410.85 "$1,062.00" $253.30 $256.78 $253.30 "$1,062.00" $796.50 $253.30 $253.30 $253.30 "$1,062.00" $531.00 $841.10 $253.30 $849.60 "$1,062.00" "$1,062.00" $253.30 $615.96 "$1,062.00" $250.82 $253.30 "$1,062.00" $253.30 N/A N/A 51000013 EAP CPT® 24670 ELBOW-OLECRANON BOTH IP/OP $978.00 $724.00 $203.83 $978.00 $978.00 $978.00 $978.00 $978.00 $277.14 $277.14 $274.66 $978.00 $277.14 $978.00 $978.00 $978.00 $978.00 $203.83 $443.42 $447.76 $978.00 $277.14 $279.85 $277.14 $978.00 $733.50 $277.14 $277.14 $277.14 $978.00 $489.00 $774.58 $277.14 $782.40 $978.00 $978.00 $277.14 $567.24 $978.00 $274.61 $277.14 $978.00 $277.14 N/A N/A 51000015 EAP CPT® 25560 FOREARM-BOTH BONES BOTH IP/OP $891.00 $659.50 $185.69 $891.00 $891.00 $891.00 $891.00 $891.00 $267.56 $267.56 $265.00 $891.00 $267.56 $891.00 $891.00 $891.00 $891.00 $185.69 $428.10 $433.12 $891.00 $267.56 $270.70 $267.56 $891.00 $668.25 $267.56 $267.56 $267.56 $891.00 $445.50 $705.67 $267.56 $712.80 $891.00 $891.00 $267.56 $516.78 $891.00 $263.44 $267.56 $891.00 $267.56 N/A N/A 51000016 EAP CPT® 25600 WRIST-COLLES BOTH IP/OP "$1,165.00" $862.50 $242.80 "$1,165.00" "$1,165.00" "$1,165.00" "$1,165.00" "$1,165.00" $335.14 $335.14 $330.70 "$1,165.00" $335.14 "$1,165.00" "$1,165.00" "$1,165.00" "$1,165.00" $242.80 $536.22 $541.39 "$1,165.00" $335.14 $338.37 $335.14 "$1,165.00" $873.75 $335.14 $335.14 $335.14 "$1,165.00" $582.50 $922.68 $335.14 $932.00 "$1,165.00" "$1,165.00" $335.14 $675.70 "$1,165.00" $326.48 $335.14 "$1,165.00" $335.14 N/A N/A 51000017 EAP CPT® 25622 WRIST-SCAPHOID BOTH IP/OP "$1,077.00" $797.00 $224.46 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $293.73 $293.73 $291.04 "$1,077.00" $293.73 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $224.46 $469.97 $475.38 "$1,077.00" $293.73 $297.11 $293.73 "$1,077.00" $807.75 $293.73 $293.73 $293.73 "$1,077.00" $538.50 $852.98 $293.73 $861.60 "$1,077.00" "$1,077.00" $293.73 $624.66 "$1,077.00" $290.82 $293.73 "$1,077.00" $293.73 N/A N/A 51000018 EAP CPT® 25630 WRIST-CAPITATE BOTH IP/OP "$1,223.00" $905.50 $254.89 "$1,223.00" "$1,223.00" "$1,223.00" "$1,223.00" "$1,223.00" $293.65 $293.65 $292.28 "$1,223.00" $293.65 "$1,223.00" "$1,223.00" "$1,223.00" "$1,223.00" $254.89 $469.84 $475.46 "$1,223.00" $293.65 $297.16 $293.65 "$1,223.00" $917.25 $293.65 $293.65 $293.65 "$1,223.00" $611.50 $968.62 $293.65 $978.40 "$1,223.00" "$1,223.00" $293.65 $709.34 "$1,223.00" $293.00 $293.65 "$1,223.00" $293.65 N/A N/A 51000020 EAP CPT® 26750 HAND-PHALLAX BOTH IP/OP $974.00 $721.00 $192.80 $974.00 $974.00 $974.00 $974.00 $974.00 $194.84 $194.84 $192.98 $974.00 $194.84 $974.00 $974.00 $974.00 $974.00 $202.99 $311.74 $317.63 $974.00 $194.84 $198.52 $194.84 $974.00 $730.50 $194.84 $194.84 $194.84 $974.00 $487.00 $771.41 $194.84 $779.20 $974.00 $974.00 $194.84 $564.92 $974.00 $192.80 $194.84 $974.00 $194.84 N/A N/A 51000021 EAP CPT® 27750 TIBIA-PROXIMAL BOTH IP/OP "$1,070.00" $792.00 $223.00 "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" $333.10 $333.10 $331.05 "$1,070.00" $333.10 "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" $223.00 $532.96 $537.78 "$1,070.00" $333.10 $336.11 $333.10 "$1,070.00" $802.50 $333.10 $333.10 $333.10 "$1,070.00" $535.00 $847.44 $333.10 $856.00 "$1,070.00" "$1,070.00" $333.10 $620.60 "$1,070.00" $330.84 $333.10 "$1,070.00" $333.10 N/A N/A 51000022 EAP CPT® 27760 CLSD TX MEDIAL MALLEOLUS FX W/O MANIP BOTH IP/OP $752.00 $556.50 $156.73 $752.00 $752.00 $752.00 $752.00 $752.00 $317.49 $317.49 $315.63 $752.00 $317.49 $752.00 $752.00 $752.00 $752.00 $156.73 $507.98 $510.06 $752.00 $317.49 $318.79 $317.49 $752.00 $564.00 $317.49 $317.49 $317.49 $752.00 $376.00 $595.58 $317.49 $601.60 $752.00 $752.00 $317.49 $436.16 $752.00 $317.50 $317.49 $752.00 $317.49 N/A N/A 51000023 EAP CPT® 27780 CLSD TX PROX/SHAFT FIBULA FX W/O MANIP BOTH IP/OP "$1,057.00" $782.50 $220.29 "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" $295.05 $295.05 $292.37 "$1,057.00" $295.05 "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" $220.29 $472.08 $475.39 "$1,057.00" $295.05 $297.12 $295.05 "$1,057.00" $792.75 $295.05 $295.05 $295.05 "$1,057.00" $528.50 $837.14 $295.05 $845.60 "$1,057.00" "$1,057.00" $295.05 $613.06 "$1,057.00" $291.19 $295.05 "$1,057.00" $295.05 N/A N/A 51000024 EAP CPT® 27786 ANKLE-LATERAL MALLEOLUS BOTH IP/OP "$1,204.00" $891.00 $250.93 "$1,204.00" "$1,204.00" "$1,204.00" "$1,204.00" "$1,204.00" $298.17 $298.17 $296.21 "$1,204.00" $298.17 "$1,204.00" "$1,204.00" "$1,204.00" "$1,204.00" $250.93 $477.07 $478.66 "$1,204.00" $298.17 $299.16 $298.17 "$1,204.00" $903.00 $298.17 $298.17 $298.17 "$1,204.00" $602.00 $953.57 $298.17 $963.20 "$1,204.00" "$1,204.00" $298.17 $698.32 "$1,204.00" $297.32 $298.17 "$1,204.00" $298.17 N/A N/A 51000026 EAP CPT® 28470 FOOT-METATARSAL BOTH IP/OP $981.00 $726.00 $204.45 $981.00 $981.00 $981.00 $981.00 $981.00 $210.56 $210.56 $209.21 $981.00 $210.56 $981.00 $981.00 $981.00 $981.00 $204.45 $336.90 $337.60 $981.00 $210.56 $211.00 $210.56 $981.00 $735.75 $210.56 $210.56 $210.56 $981.00 $490.50 $776.95 $210.56 $784.80 $981.00 $981.00 $210.56 $568.98 $981.00 $210.83 $210.56 $981.00 $210.56 N/A N/A 51000027 EAP CPT® 28510 TREATMENT OF TOE FRACTURE BOTH IP/OP $981.00 $726.00 $82.46 $981.00 $981.00 $981.00 $981.00 $981.00 $202.75 $202.75 $201.85 $981.00 $202.75 $981.00 $981.00 $981.00 $882.37 $981.00 $324.39 $298.65 $113.00 $202.75 $123.61 $202.75 $212.88 $735.75 $202.75 $202.75 $202.75 $981.00 $981.00 $981.00 $202.75 $981.00 $981.00 $82.46 $202.75 $568.98 $212.88 $293.32 $202.75 $981.00 $202.75 N/A N/A 51000031 EAP CPT® 29505 LONG LEG SPLINT BOTH IP/OP "$1,372.00" "$1,015.50" $51.50 "$1,372.00" "$1,372.00" "$1,372.00" "$1,372.00" "$1,372.00" $51.50 $51.50 $52.20 "$1,372.00" $51.50 "$1,372.00" "$1,372.00" "$1,372.00" "$1,372.00" $285.94 $82.40 $84.06 "$1,372.00" $51.50 $52.54 $51.50 "$1,372.00" "$1,029.00" $51.50 $51.50 $51.50 "$1,372.00" $686.00 "$1,086.62" $51.50 "$1,097.60" "$1,372.00" "$1,372.00" $51.50 $795.76 "$1,372.00" $52.27 $51.50 "$1,372.00" $51.50 N/A N/A 51000032 EAP CPT® 29515 "SPLINT, SHORT LEG" BOTH IP/OP $943.00 $698.00 $49.83 $943.00 $512.05 $512.05 $512.05 $512.05 $138.97 $138.97 $138.36 $196.54 $138.97 $943.00 $943.00 $943.00 $882.37 $196.53 $222.36 $210.28 $113.00 $138.97 $49.83 $138.97 $145.92 $707.25 $138.97 $138.97 $138.97 $943.00 $471.50 $746.86 $138.97 $754.40 $943.00 $187.16 $138.97 $546.94 $145.92 $201.06 $138.97 $196.52 $138.97 N/A N/A 51000038 EAP CPT® 59070 AMNIO INFUSION (ADB) BOTH IP/OP $439.00 $325.00 $91.49 $500.45 $439.00 $439.00 $439.00 $439.00 $309.08 $309.08 $310.73 $439.00 $309.08 $439.00 $439.00 $439.00 $439.00 $91.49 $494.53 $500.45 $439.00 $309.08 $312.78 $309.08 $439.00 $329.25 $309.08 $309.08 $309.08 $439.00 $219.50 $347.69 $309.08 $351.20 $439.00 $439.00 $309.08 $254.62 $439.00 $324.07 $309.08 $439.00 $309.08 N/A N/A 51000039 EAP CPT® 59899 MATERNITY CARE PROCEDURE BOTH IP/OP $183.00 $135.50 $38.14 $514.63 $183.00 $183.00 $183.00 $183.00 $183.00 $183.00 $514.63 $183.00 $183.00 $183.00 $183.00 $183.00 $183.00 $38.14 $183.00 $73.20 $183.00 $183.00 $183.00 $183.00 $183.00 $137.25 $183.00 $183.00 $183.00 $183.00 $91.50 $144.94 $183.00 $146.40 $183.00 $183.00 $183.00 $106.14 $183.00 $109.80 $183.00 $183.00 $183.00 N/A N/A 51000041 EAP CPT® 92002 "OPHALMOL EXAM, INTER, NP" BOTH IP/OP $313.00 $232.00 $45.73 $323.29 $313.00 $313.00 $313.00 $313.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $65.23 $187.01 $174.36 $185.14 $116.88 $45.73 $116.88 $122.72 $234.75 $116.88 $116.88 $116.88 $156.50 $156.50 $247.90 $116.88 $250.40 $313.00 $62.12 $116.88 $181.54 $122.72 $169.10 $116.88 $65.23 $116.88 N/A N/A 51000042 EAP CPT® 92004 "OPTHALMOL EXAM, COMPRE, NP" BOTH IP/OP $411.00 $304.50 $67.13 $411.00 $411.00 $411.00 $411.00 $411.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $85.66 $187.01 $174.36 $243.11 $116.88 $93.83 $116.88 $122.72 $308.25 $116.88 $116.88 $116.88 $205.50 $205.50 $325.51 $116.88 $328.80 $411.00 $81.57 $116.88 $238.38 $122.72 $169.10 $116.88 $85.65 $116.88 N/A N/A 51000043 EAP CPT® 92012 "OPTHALMOL EXAM, INTER, EP" BOTH IP/OP $313.00 $232.00 $50.48 $323.29 $313.00 $313.00 $313.00 $313.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $65.23 $187.01 $174.36 $185.14 $116.88 $50.48 $116.88 $122.72 $234.75 $116.88 $116.88 $116.88 $156.50 $156.50 $247.90 $116.88 $250.40 $313.00 $62.12 $116.88 $181.54 $122.72 $169.10 $116.88 $65.23 $116.88 N/A N/A 51000044 EAP CPT® 92014 "OPTHALMOL EXAM, COMPRE, EP" BOTH IP/OP $380.00 $281.50 $67.13 $380.00 $380.00 $380.00 $380.00 $380.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $79.20 $187.01 $174.36 $224.77 $116.88 $75.88 $116.88 $122.72 $285.00 $116.88 $116.88 $116.88 $190.00 $190.00 $300.96 $116.88 $304.00 $380.00 $75.42 $116.88 $220.40 $122.72 $169.10 $116.88 $79.19 $116.88 N/A N/A 51000046 EAP CPT® 92020 GONIOSCOPY EXAM BOTH IP/OP $272.00 $201.50 $20.32 $323.29 $272.00 $272.00 $272.00 $272.00 $110.92 $110.92 $110.43 $67.13 $110.92 $311.31 $311.31 $323.29 $218.52 $56.69 $177.47 $167.51 $160.89 $110.92 $20.32 $110.92 $116.46 $204.00 $110.92 $110.92 $110.92 $136.00 $136.00 $215.42 $110.92 $217.60 $272.00 $53.99 $110.92 $157.76 $116.46 $160.47 $110.92 $56.68 $110.92 N/A N/A 51000050 EAP CPT® 96372 IM/SQ INJECTION BOTH IP/OP $260.00 $192.50 $14.22 $260.00 $141.18 $141.18 $141.18 $141.18 $60.99 $60.99 $60.72 $54.19 $60.99 $192.97 $192.97 $200.41 $135.46 $54.19 $97.58 $97.33 $153.79 $60.99 $14.22 $60.99 $64.04 $195.00 $60.99 $60.99 $60.99 $130.00 $130.00 $205.92 $60.99 $208.00 $169.00 $51.60 $60.99 $150.80 $64.04 $88.23 $60.99 $260.00 $60.99 N/A N/A 51000058 EAP CPT® 99202 VISIT LEVEL 2 - NP BOTH IP/OP $384.00 $284.50 $49.16 $384.00 $384.00 $384.00 $384.00 $384.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $80.03 $187.01 $174.36 $227.14 $116.88 $384.00 $116.88 $122.72 $288.00 $116.88 $116.88 $116.88 $192.00 $192.00 $304.13 $116.88 $307.20 $384.00 $108.54 $116.88 $222.72 $122.72 $169.10 $49.16 $99.97 $116.88 N/A N/A 51000059 EAP CPT® 99203 VISIT LEVEL 3 - NP BOTH IP/OP $449.00 $332.50 $67.13 $449.00 $449.00 $449.00 $449.00 $449.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $93.58 $187.01 $174.36 $265.58 $116.88 $449.00 $116.88 $122.72 $336.75 $116.88 $116.88 $116.88 $224.50 $224.50 $355.61 $116.88 $359.20 $449.00 $108.54 $116.88 $260.42 $122.72 $169.10 $83.83 $99.97 $116.88 N/A N/A 51000060 EAP CPT® 99204 VISIT LEVEL 4 - NP BOTH IP/OP $579.00 $428.50 $67.13 $579.00 $579.00 $579.00 $579.00 $579.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $120.67 $187.01 $174.36 $342.48 $116.88 $579.00 $116.88 $122.72 $434.25 $116.88 $116.88 $116.88 $289.50 $289.50 $458.57 $116.88 $463.20 $579.00 $108.54 $116.88 $335.82 $122.72 $169.10 $135.82 $99.97 $116.88 N/A N/A 51000061 EAP CPT® 99205 VISIT LEVEL 5-NP BOTH IP/OP $697.00 $516.00 $67.13 $697.00 $697.00 $697.00 $697.00 $697.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $145.26 $187.01 $174.36 $412.28 $116.88 $697.00 $116.88 $122.72 $522.75 $116.88 $116.88 $116.88 $348.50 $348.50 $552.02 $116.88 $557.60 $697.00 $108.54 $116.88 $404.26 $122.72 $169.10 $184.32 $99.97 $116.88 N/A N/A 51000062 EAP CPT® 99211 VISIT LEVEL 1 - EP BOTH IP/OP $325.00 $240.50 $8.96 $325.00 $325.00 $325.00 $325.00 $325.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $67.73 $187.01 $174.36 $192.24 $116.88 $325.00 $116.88 $122.72 $243.75 $116.88 $116.88 $116.88 $162.50 $162.50 $257.40 $116.88 $260.00 $325.00 $108.54 $116.88 $188.50 $122.72 $169.10 $8.96 $99.97 $116.88 N/A N/A 51000063 EAP CPT® 99212 VISIT LEVEL 2-EP BOTH IP/OP $348.00 $258.00 $36.43 $348.00 $348.00 $348.00 $348.00 $348.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $72.53 $187.01 $174.36 $205.84 $116.88 $348.00 $116.88 $122.72 $261.00 $116.88 $116.88 $116.88 $174.00 $174.00 $275.62 $116.88 $278.40 $348.00 $108.54 $116.88 $201.84 $122.72 $169.10 $36.43 $99.97 $116.88 N/A N/A 51000064 EAP CPT® 99213 VISIT LEVEL 3-EP BOTH IP/OP $434.00 $321.50 $67.11 $434.00 $434.00 $434.00 $434.00 $434.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $90.45 $187.01 $174.36 $256.71 $116.88 $434.00 $116.88 $122.72 $325.50 $116.88 $116.88 $116.88 $217.00 $217.00 $343.73 $116.88 $347.20 $434.00 $108.54 $116.88 $251.72 $122.72 $169.10 $67.11 $99.97 $116.88 N/A N/A 51000065 EAP CPT® 99214 VISIT LEVEL 4-EP BOTH IP/OP $526.00 $389.50 $67.13 $526.00 $526.00 $526.00 $526.00 $526.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $109.62 $187.01 $174.36 $311.13 $116.88 $526.00 $116.88 $122.72 $394.50 $116.88 $116.88 $116.88 $263.00 $263.00 $416.59 $116.88 $420.80 $526.00 $108.54 $116.88 $305.08 $122.72 $169.10 $98.52 $99.97 $116.88 N/A N/A 51000066 EAP CPT® 99215 VISIT LEVEL 5-EP BOTH IP/OP $576.00 $426.50 $67.13 $576.00 $576.00 $576.00 $576.00 $576.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $120.04 $187.01 $174.36 $340.70 $116.88 $576.00 $116.88 $122.72 $432.00 $116.88 $116.88 $116.88 $288.00 $288.00 $456.19 $116.88 $460.80 $576.00 $108.54 $116.88 $334.08 $122.72 $169.10 $146.29 $99.97 $116.88 N/A N/A 51000070 EAP CPT® 99244 OFFICE CONSULTATION LEVEL - 4 BOTH IP/OP $440.00 $326.00 $152.96 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $152.96 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 51000086 EAP HCPCS G0127 TRIM OF DYSTROPHIC NAIL(S) BOTH IP/OP $121.00 $90.00 $7.46 $121.00 $65.70 $65.70 $65.70 $65.70 $54.76 $54.76 $54.51 $25.22 $54.76 $121.00 $121.00 $121.00 $121.00 $25.22 $87.61 $82.92 $113.00 $54.76 $7.46 $54.76 $57.49 $90.75 $54.76 $54.76 $54.76 $121.00 $60.50 $95.83 $54.76 $96.80 $121.00 $24.02 $54.76 $70.18 $57.49 $79.22 $54.76 $25.22 $54.76 N/A N/A 51000087 EAP HCPCS G0402 NEW MEDICARE PHYS EXAM BOTH IP/OP $375.00 $277.50 $67.13 $375.00 $375.00 $375.00 $375.00 $375.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $78.15 $187.01 $174.36 $221.81 $116.88 $131.51 $116.88 $122.72 $281.25 $116.88 $116.88 $116.88 $187.50 $187.50 $297.00 $116.88 $300.00 $375.00 $74.43 $116.88 $217.50 $122.72 $169.10 $116.88 $78.15 $116.88 N/A N/A 51000158 EAP CPT® 99202 VISIT LEVEL BCCP 2 - NP BOTH IP/OP $384.00 $284.50 $49.16 $384.00 $384.00 $384.00 $384.00 $384.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $80.03 $187.01 $174.36 $227.14 $116.88 $384.00 $116.88 $122.72 $288.00 $116.88 $116.88 $116.88 $192.00 $192.00 $304.13 $116.88 $307.20 $384.00 $108.54 $116.88 $222.72 $122.72 $169.10 $49.16 $99.97 $116.88 N/A N/A 51000159 EAP CPT® 99203 VISIT LEVEL BCCP 3 - NP BOTH IP/OP $449.00 $332.50 $67.13 $449.00 $449.00 $449.00 $449.00 $449.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $93.58 $187.01 $174.36 $265.58 $116.88 $449.00 $116.88 $122.72 $336.75 $116.88 $116.88 $116.88 $224.50 $224.50 $355.61 $116.88 $359.20 $449.00 $108.54 $116.88 $260.42 $122.72 $169.10 $83.83 $99.97 $116.88 N/A N/A 51000161 EAP CPT® 99205 VISIT LEVEL BCCP 5-NP BOTH IP/OP $697.00 $516.00 $67.13 $697.00 $697.00 $697.00 $697.00 $697.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $145.26 $187.01 $174.36 $412.28 $116.88 $697.00 $116.88 $122.72 $522.75 $116.88 $116.88 $116.88 $348.50 $348.50 $552.02 $116.88 $557.60 $697.00 $108.54 $116.88 $404.26 $122.72 $169.10 $184.32 $99.97 $116.88 N/A N/A 51000163 EAP CPT® 99212 VISIT LEVEL BCCP 2 - EP BOTH IP/OP $340.00 $252.00 $36.43 $348.00 $340.00 $340.00 $340.00 $340.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $70.86 $187.01 $174.36 $201.11 $116.88 $348.00 $116.88 $122.72 $255.00 $116.88 $116.88 $116.88 $170.00 $170.00 $269.28 $116.88 $272.00 $340.00 $108.54 $116.88 $197.20 $122.72 $169.10 $36.43 $99.97 $116.88 N/A N/A 51000164 EAP CPT® 99213 VISIT LEVEL BCCP 3 - EP BOTH IP/OP $434.00 $321.50 $67.11 $434.00 $434.00 $434.00 $434.00 $434.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $90.45 $187.01 $174.36 $256.71 $116.88 $434.00 $116.88 $122.72 $325.50 $116.88 $116.88 $116.88 $217.00 $217.00 $343.73 $116.88 $347.20 $434.00 $108.54 $116.88 $251.72 $122.72 $169.10 $67.11 $99.97 $116.88 N/A N/A 51000166 EAP CPT® 99215 VISIT LEVEL BCCP 5-EP BOTH IP/OP $576.00 $426.50 $67.13 $576.00 $576.00 $576.00 $576.00 $576.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $120.04 $187.01 $174.36 $340.70 $116.88 $576.00 $116.88 $122.72 $432.00 $116.88 $116.88 $116.88 $288.00 $288.00 $456.19 $116.88 $460.80 $576.00 $108.54 $116.88 $334.08 $122.72 $169.10 $146.29 $99.97 $116.88 N/A N/A 51000190 EAP CPT® 92133 CMPTR OPHTH IMG OPTIC NERVE BOTH IP/OP $342.00 $253.50 $15.56 $342.00 $342.00 $342.00 $342.00 $342.00 $54.76 $54.76 $54.51 $67.13 $54.76 $311.31 $311.31 $323.29 $218.52 $71.28 $87.61 $82.92 $202.29 $54.76 $15.56 $54.76 $57.49 $256.50 $54.76 $54.76 $54.76 $171.00 $171.00 $270.86 $54.76 $273.60 $342.00 $67.88 $54.76 $198.36 $57.49 $79.22 $54.76 $71.27 $54.76 N/A N/A 51000191 EAP CPT® 92134 CPTR OPHTH DX IMG POST SEGMT BOTH IP/OP $342.00 $253.50 $15.90 $342.00 $342.00 $342.00 $342.00 $342.00 $54.76 $54.76 $54.51 $67.13 $54.76 $311.31 $311.31 $323.29 $218.52 $71.28 $87.61 $82.92 $202.29 $54.76 $15.90 $54.76 $57.49 $256.50 $54.76 $54.76 $54.76 $171.00 $171.00 $270.86 $54.76 $273.60 $342.00 $67.88 $54.76 $198.36 $57.49 $79.22 $54.76 $71.27 $54.76 N/A N/A 51000211 EAP CPT® 99497 ADVANCE CARE PLANNING FIRST 30 MINS BOTH IP/OP $173.00 $128.50 $34.34 $323.29 $173.00 $173.00 $173.00 $173.00 $73.60 $73.60 $73.28 $67.13 $73.60 $311.31 $311.31 $323.29 $218.52 $36.06 $117.77 $109.43 $102.33 $73.60 $75.58 $73.60 $77.28 $129.75 $73.60 $73.60 $73.60 $86.50 $86.50 $137.02 $73.60 $138.40 $173.00 $34.34 $73.60 $100.34 $77.28 $106.49 $73.60 $36.05 $73.60 N/A N/A 51000212 EAP CPT® 99498 ADVANCE CARE PLANNING EA ADDL 30 MINS (ADD-ON) BOTH IP/OP $158.00 $117.00 $31.36 $323.29 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $67.13 $158.00 $311.31 $311.31 $323.29 $218.52 $32.93 $158.00 $158.00 $93.46 $158.00 $71.51 $158.00 $158.00 $118.50 $158.00 $158.00 $158.00 $79.00 $79.00 $125.14 $158.00 $126.40 $158.00 $31.36 $158.00 $91.64 $158.00 $158.00 $158.00 $32.93 $158.00 N/A N/A 51000260 EAP CPT® 99204 VISIT LEVEL BCCP 4 - NP BOTH IP/OP $579.00 $428.50 $67.13 $579.00 $579.00 $579.00 $579.00 $579.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $120.67 $187.01 $174.36 $342.48 $116.88 $579.00 $116.88 $122.72 $434.25 $116.88 $116.88 $116.88 $289.50 $289.50 $458.57 $116.88 $463.20 $579.00 $108.54 $116.88 $335.82 $122.72 $169.10 $135.82 $99.97 $116.88 N/A N/A 51000265 EAP CPT® 99214 VISIT LEVEL BCCP 4-EP BOTH IP/OP $526.00 $389.50 $67.13 $526.00 $526.00 $526.00 $526.00 $526.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $109.62 $187.01 $174.36 $311.13 $116.88 $526.00 $116.88 $122.72 $394.50 $116.88 $116.88 $116.88 $263.00 $263.00 $416.59 $116.88 $420.80 $526.00 $108.54 $116.88 $305.08 $122.72 $169.10 $98.52 $99.97 $116.88 N/A N/A 51000313 EAP CPT® 99495 DISCHARGE PHONE CALL AND F/U APPT WITHIN 14 DAYS BOTH IP/OP $285.00 $211.00 #N/A #N/A $285.00 $285.00 $285.00 $285.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $59.40 $187.01 #N/A $168.58 $116.88 #N/A $116.88 $122.72 $213.75 $116.88 $116.88 $116.88 $142.50 $142.50 $225.72 $116.88 $228.00 $285.00 $56.57 $116.88 $165.30 $122.72 $169.10 $116.88 $59.39 $116.88 N/A N/A 51000314 EAP CPT® 99496 DISCHARGE PHONE CALL AND F/U APPT WITHIN 7 DAYS BOTH IP/OP $417.00 $309.00 #N/A #N/A $417.00 $417.00 $417.00 $417.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $86.91 $187.01 #N/A $246.66 $116.88 #N/A $116.88 $122.72 $312.75 $116.88 $116.88 $116.88 $208.50 $208.50 $330.26 $116.88 $333.60 $417.00 $82.76 $116.88 $241.86 $122.72 $169.10 $116.88 $86.90 $116.88 N/A N/A 51000315 EAP CPT® 99205 ISOLATION EVALUATION - NP BOTH IP/OP "$1,700.00" "$1,258.00" $67.13 "$1,700.00" "$1,700.00" "$1,700.00" "$1,700.00" "$1,700.00" $184.32 $184.32 "$1,700.00" $67.13 $184.32 $311.31 $311.31 $323.29 $218.52 $354.30 $294.91 $290.18 "$1,005.55" $184.32 $181.36 $184.32 "$1,700.00" "$1,275.00" $184.32 $184.32 $184.32 $850.00 $850.00 "$1,346.40" $184.32 "$1,360.00" "$1,700.00" $108.54 $184.32 $986.00 "$1,700.00" $169.10 $184.32 $99.97 $184.32 N/A N/A 51000316 EAP CPT® 99215 ISOLATION EVALUATION - EP BOTH IP/OP "$1,320.00" $977.00 $67.13 "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" $146.29 $146.29 "$1,320.00" $67.13 $146.29 $311.31 $311.31 $323.29 $218.52 $275.10 $234.06 $229.39 $780.78 $146.29 $143.37 $146.29 "$1,320.00" $990.00 $146.29 $146.29 $146.29 $660.00 $660.00 "$1,045.44" $146.29 "$1,056.00" "$1,320.00" $108.54 $146.29 $765.60 "$1,320.00" $169.10 $146.29 $99.97 $146.29 N/A N/A 51000320 EAP CPT® 97605 NEG PRESS WD TX - 50 SQ CM OR LESS BOTH IP/OP $317.00 $235.00 $24.73 $317.00 $172.13 $172.13 $172.13 $172.13 $176.64 $176.64 $175.86 $66.07 $176.64 $317.00 $317.00 $317.00 $317.00 $66.07 $282.63 $260.52 $187.51 $176.64 $24.73 $176.64 $185.48 $237.75 $176.64 $176.64 $176.64 $158.50 $158.50 $251.06 $176.64 $253.60 $206.05 $62.92 $176.64 $183.86 $185.48 $255.56 $176.64 $66.06 $176.64 N/A N/A 51000321 EAP CPT® 97606 NEG PRESS WD TX-> THAN 50 SQ CM BOTH IP/OP $524.00 $388.00 $26.76 $543.99 $284.53 $284.53 $284.53 $284.53 $340.00 $340.00 $338.49 $109.21 $340.00 $524.00 $524.00 $524.00 $524.00 $109.21 $543.99 $538.21 $309.95 $340.00 $26.76 $340.00 $357.00 $393.00 $340.00 $340.00 $340.00 $262.00 $262.00 $415.01 $340.00 $419.20 $340.60 $104.00 $340.00 $303.92 $357.00 $491.89 $340.00 $109.20 $340.00 N/A N/A 51000322 EAP CPT® G0438 "ANNUAL WELLNESS VISIT, INITIAL VISIT" BOTH IP/OP $409.00 $303.00 $67.13 $409.00 $409.00 $409.00 $409.00 $409.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $85.24 $187.01 $174.36 $241.92 $116.88 $409.00 $116.88 $122.72 $306.75 $116.88 $116.88 $116.88 $204.50 $204.50 $323.93 $116.88 $327.20 $409.00 $81.18 $116.88 $237.22 $122.72 $172.69 $168.86 $85.24 $116.88 N/A N/A 51000323 EAP CPT® G0439 "ANNUAL WELLNESS VISIT, SUBSEQ VISIT" BOTH IP/OP $291.00 $215.50 $57.76 $323.29 $291.00 $291.00 $291.00 $291.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $60.65 $187.01 $174.36 $172.13 $116.88 $291.00 $116.88 $122.72 $218.25 $116.88 $116.88 $116.88 $145.50 $145.50 $230.47 $116.88 $232.80 $291.00 $57.76 $116.88 $168.78 $122.72 $117.16 $132.05 $60.64 $116.88 N/A N/A 51000324 EAP CPT® 99487 COMPLEX CHRONIC CARE MGMT - 1ST HR PER MONTH BOTH IP/OP $175.00 $129.50 $34.73 $323.29 $175.00 $175.00 $175.00 $175.00 $131.62 $131.62 $131.03 $67.13 $131.62 $311.31 $311.31 $323.29 $218.52 $36.47 $210.59 $210.20 $103.51 $131.62 $90.83 $131.62 $138.20 $131.25 $131.62 $131.62 $131.62 $87.50 $87.50 $138.60 $131.62 $140.00 $175.00 $34.73 $131.62 $101.50 $138.20 $175.00 $131.62 $36.47 $131.62 N/A N/A 51000325 EAP CPT® 99490 CHRONIC CARE MGMT - 20 MIN. PER MONTH BOTH IP/OP $175.00 $129.50 $34.73 $323.29 $175.00 $175.00 $175.00 $175.00 $73.60 $73.60 $73.28 $67.13 $73.60 $311.31 $311.31 $323.29 $218.52 $36.47 $117.77 $109.43 $103.51 $73.60 $50.50 $73.60 $77.28 $131.25 $73.60 $73.60 $73.60 $87.50 $87.50 $138.60 $73.60 $140.00 $175.00 $34.73 $73.60 $101.50 $77.28 $106.49 $73.60 $36.47 $73.60 N/A N/A 51000326 EAP CPT® 99489 COMPLEX CHRONIC CARE MGMT – EA ADDL 30 MIN PER MONTH BOTH IP/OP $87.00 $64.50 $17.27 $323.29 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $87.00 $67.13 $87.00 $311.31 $311.31 $323.29 $218.52 $18.13 $87.00 $87.00 $51.46 $87.00 $50.16 $87.00 $87.00 $65.25 $87.00 $87.00 $87.00 $43.50 $43.50 $68.90 $87.00 $69.60 $87.00 $17.27 $87.00 $50.46 $87.00 $87.00 $87.00 $18.13 $87.00 N/A N/A 51000327 EAP CPT® 92230 EYE EXAM WITH PHOTOS BOTH IP/OP $712.00 $527.00 $34.56 $768.26 $712.00 $712.00 $712.00 $712.00 $480.16 $480.16 $478.04 $67.13 $480.16 $311.31 $311.31 $323.29 $218.52 $148.39 $768.26 $697.42 $421.15 $480.16 $34.56 $480.16 $504.17 $534.00 $480.16 $480.16 $480.16 $356.00 $356.00 $563.90 $480.16 $569.60 $712.00 $141.31 $480.16 $412.96 $504.17 $694.68 $480.16 $148.38 $480.16 N/A N/A 51000328 EAP CPT® 92326 REPLACEMENT OF CONTACT LENS BOTH IP/OP $150.00 $111.00 $31.26 $323.29 $150.00 $150.00 $150.00 $150.00 $40.03 $40.03 $150.00 $150.00 $40.03 $311.31 $311.31 $323.29 $218.52 $31.26 $64.05 $62.78 $150.00 $40.03 $39.24 $40.03 $150.00 $112.50 $40.03 $40.03 $40.03 $75.00 $75.00 $118.80 $40.03 $120.00 $150.00 $150.00 $40.03 $87.00 $150.00 $38.18 $40.03 $150.00 $40.03 N/A N/A 51000329 EAP CPT® 99439 CHRONIC CARE MGMT - ADDL 20 MIN. PER MONTH BOTH IP/OP $87.00 $64.50 $18.13 $323.29 $87.00 $87.00 $87.00 $87.00 $36.15 $36.15 $87.00 $87.00 $36.15 $311.31 $311.31 $323.29 $218.52 $18.13 $57.84 $55.86 $87.00 $36.15 $34.91 $36.15 $87.00 $65.25 $36.15 $36.15 $36.15 $43.50 $43.50 $68.90 $36.15 $69.60 $87.00 $87.00 $36.15 $50.46 $87.00 $52.20 $36.15 $87.00 $36.15 N/A N/A 51100021 EAP CPT® 64640 NJX ANES/STRD OTHER PERIPHERAL NERVE BOTH IP/OP "$2,488.00" "$1,841.50" $118.62 "$2,488.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $809.76 $809.76 $806.18 $518.56 $809.76 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $518.53 "$1,295.61" "$1,229.40" "$1,871.00" $809.76 $118.62 $809.76 $850.25 "$1,866.00" $809.76 $809.76 $809.76 "$2,488.00" "$1,244.00" "$1,970.50" $809.76 "$1,990.40" "$2,150.00" $493.81 $809.76 "$1,443.04" $850.25 "$1,171.52" $809.76 $518.50 $809.76 N/A N/A 60000610 EAP HCPCS C1757 CATHETER EMBL 80CM 7FR 14MM FGRTY ART SS SIL BLN BOTH IP/OP $130.00 $96.50 $25.80 $130.00 $70.59 $70.59 $70.59 $70.59 $130.00 $130.00 $130.00 $27.10 $130.00 $96.49 $96.49 $100.20 $67.73 $27.09 $130.00 $130.00 $76.90 $130.00 $130.00 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $65.00 $65.00 $102.96 $130.00 $104.00 $84.50 $25.80 $130.00 $75.40 $130.00 $130.00 $130.00 $27.09 $130.00 N/A N/A 61000001 EAP CPT® 70336 MRI TMJ MRI BOTH IP/OP "$4,123.00" "$3,051.50" $210.71 "$4,123.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $218.90 $218.90 $260.94 "$4,123.00" $218.90 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $859.28 $350.24 $337.14 "$1,758.00" $218.90 $210.71 $218.90 "$4,123.00" "$3,092.25" $218.90 $218.90 $218.90 "$1,379.00" "$1,172.00" "$3,265.42" $218.90 "$3,298.40" $800.00 "$4,123.00" $218.90 "$2,391.34" "$4,123.00" $236.99 $218.90 "$4,123.00" $218.90 N/A N/A 61000002 EAP CPT® 70540 MRI:ORBIT/FACE/NECKW/O CONTR. BOTH IP/OP "$5,561.00" "$4,115.50" $175.20 "$4,448.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 "$1,159.05" $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,158.97" $362.15 $336.89 "$1,758.00" $226.34 $175.20 $226.34 $237.66 "$4,170.75" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$4,404.31" $226.34 "$4,448.80" $800.00 "$1,103.72" $226.34 "$3,225.38" $237.66 $327.46 $226.34 "$1,158.91" $226.34 N/A N/A 61000003 EAP CPT® 70542 MRI ORBIT/FACE/NECK/W/DYE MRI BOTH IP/OP "$5,964.00" "$4,413.50" $206.99 "$4,771.20" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,243.05" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,242.96" $579.58 $531.51 "$1,758.00" $362.23 $206.99 $362.23 $380.35 "$4,473.00" $362.23 $362.23 $362.23 "$1,536.00" "$1,306.00" "$4,723.49" $362.23 "$4,771.20" $800.00 "$1,183.70" $362.23 "$3,459.12" $380.35 $524.06 $362.23 "$1,242.90" $362.23 N/A N/A 61000004 EAP CPT® 70543 MRI ORB/FACE/NECK W&WO DYE MRI BOTH IP/OP "$8,010.00" "$5,927.50" $256.71 "$6,408.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,669.48" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,669.37" $579.58 $531.51 "$1,758.00" $362.23 $256.71 $362.23 $380.35 "$6,007.50" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$6,343.92" $362.23 "$6,408.00" $800.00 "$1,589.78" $362.23 "$4,645.80" $380.35 $524.06 $362.23 "$1,669.28" $362.23 N/A N/A 61000005 EAP CPT® 70544 MRA HEAD W/O DYE BOTH IP/OP "$5,561.00" "$4,115.50" $169.79 "$4,448.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 "$1,159.05" $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,158.97" $362.15 $336.89 "$1,758.00" $226.34 $169.79 $226.34 $237.66 "$4,170.75" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$4,404.31" $226.34 "$4,448.80" $800.00 "$1,103.72" $226.34 "$3,225.38" $237.66 $327.46 $226.34 "$1,158.91" $226.34 N/A N/A 61000006 EAP CPT® 70545 MRA HEAD W/ DYE BOTH IP/OP "$5,964.00" "$4,413.50" $182.99 "$4,771.20" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,243.05" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,242.96" $579.58 $531.51 "$1,758.00" $362.23 $182.99 $362.23 $380.35 "$4,473.00" $362.23 $362.23 $362.23 "$1,536.00" "$1,306.00" "$4,723.49" $362.23 "$4,771.20" $800.00 "$1,183.70" $362.23 "$3,459.12" $380.35 $524.06 $362.23 "$1,242.90" $362.23 N/A N/A 61000007 EAP CPT® 70546 MRA HEAD W & W/O DYE BOTH IP/OP "$8,010.00" "$5,927.50" $277.34 "$6,408.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,669.48" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,669.37" $579.58 $531.51 "$1,758.00" $362.23 $277.34 $362.23 $380.35 "$6,007.50" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$6,343.92" $362.23 "$6,408.00" $800.00 "$1,589.78" $362.23 "$4,645.80" $380.35 $524.06 $362.23 "$1,669.28" $362.23 N/A N/A 61000008 EAP CPT® 70547 MRA NECK W/O DYE BOTH IP/OP "$5,561.00" "$4,115.50" $170.12 "$4,448.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 "$1,159.05" $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,158.97" $362.15 $336.89 "$1,758.00" $226.34 $170.12 $226.34 $237.66 "$4,170.75" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$4,404.31" $226.34 "$4,448.80" $800.00 "$1,103.72" $226.34 "$3,225.38" $237.66 $327.46 $226.34 "$1,158.91" $226.34 N/A N/A 61000009 EAP CPT® 70548 MRA NECK W/ DYE BOTH IP/OP "$6,193.00" "$4,583.00" $188.06 "$6,193.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $193.00 $193.00 $233.70 "$6,193.00" $193.00 "$6,193.00" "$6,193.00" "$6,193.00" "$6,193.00" "$1,290.69" $308.80 $300.90 "$1,758.00" $193.00 $188.06 $193.00 "$6,193.00" "$4,644.75" $193.00 $193.00 $193.00 "$1,536.00" "$1,306.00" "$4,904.86" $193.00 "$4,954.40" $800.00 "$6,193.00" $193.00 "$3,591.94" "$6,193.00" $202.06 $193.00 "$6,193.00" $193.00 N/A N/A 61000010 EAP CPT® 70549 MRA NECK W&WO DYE BOTH IP/OP "$8,010.00" "$5,927.50" $278.70 "$6,408.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,669.48" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,669.37" $579.58 $531.51 "$1,758.00" $362.23 $278.70 $362.23 $380.35 "$6,007.50" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$6,343.92" $362.23 "$6,408.00" $800.00 "$1,589.78" $362.23 "$4,645.80" $380.35 $524.06 $362.23 "$1,669.28" $362.23 N/A N/A 61000011 EAP CPT® 71550 MRI CHEST W/O DYE BOTH IP/OP "$4,941.00" "$3,656.50" $225.34 "$3,952.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 "$1,029.83" $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,029.76" $362.15 $336.89 "$1,758.00" $226.34 $289.52 $226.34 $237.66 "$3,705.75" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$3,913.27" $226.34 "$3,952.80" $800.00 $980.66 $226.34 "$2,865.78" $237.66 $327.46 $226.34 "$1,029.70" $226.34 N/A N/A 61000012 EAP CPT® 71551 MRI CHEST W/DYE BOTH IP/OP "$3,511.00" "$2,598.50" $314.55 "$3,511.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $327.28 $327.28 $369.74 "$3,511.00" $327.28 "$3,511.00" "$3,511.00" "$3,511.00" "$3,511.00" $731.73 $523.65 $503.28 "$1,758.00" $327.28 $314.55 $327.28 "$3,511.00" "$2,633.25" $327.28 $327.28 $327.28 "$1,536.00" "$1,306.00" "$2,780.71" $327.28 "$2,808.80" $800.00 "$3,511.00" $327.28 "$2,036.38" "$3,511.00" $355.13 $327.28 "$3,511.00" $327.28 N/A N/A 61000013 EAP CPT® 71552 MRI CHEST W&WO DYE BOTH IP/OP "$6,183.00" "$4,575.50" $393.68 "$6,183.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $410.17 $410.17 $468.60 "$6,183.00" $410.17 "$6,183.00" "$6,183.00" "$6,183.00" "$6,183.00" "$1,288.61" $656.27 $629.89 "$1,758.00" $410.17 $393.68 $410.17 "$6,183.00" "$4,637.25" $410.17 $410.17 $410.17 "$2,172.00" "$1,846.00" "$4,896.94" $410.17 "$4,946.40" $800.00 "$6,183.00" $410.17 "$3,586.14" "$6,183.00" $446.61 $410.17 "$6,183.00" $410.17 N/A N/A 61000014 EAP CPT® 71555 MRA CHEST W&WO DYE BOTH IP/OP "$5,145.00" "$3,807.50" $276.51 "$4,116.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,072.35" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,072.27" $579.58 $531.51 "$1,758.00" $362.23 "$2,331.00" $362.23 $380.35 "$3,858.75" $362.23 $362.23 $362.23 "$2,469.60" "$2,469.60" "$4,074.84" $362.23 "$4,116.00" $800.00 "$1,021.15" $362.23 "$2,984.10" $380.35 $297.86 $276.51 "$1,072.22" $362.23 N/A N/A 61000015 EAP CPT® 72159 MRA SPINAL CANAL W/WO DYE BOTH IP/OP "$8,413.00" "$6,226.00" $279.71 "$8,413.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $288.25 $288.25 $336.29 "$8,413.00" $288.25 "$8,413.00" "$8,413.00" "$8,413.00" "$8,413.00" "$1,753.36" $461.20 $447.54 "$1,758.00" $288.25 $279.71 $288.25 "$8,413.00" "$6,309.75" $288.25 $288.25 $288.25 "$4,038.24" "$4,038.24" "$6,663.10" $288.25 "$6,730.40" $800.00 "$8,413.00" $288.25 "$4,879.54" "$8,413.00" $311.91 $288.25 "$8,413.00" $288.25 N/A N/A 61000016 EAP CPT® 72198 MRA PELVIS W/WO DYE BOTH IP/OP "$6,417.00" "$4,749.00" $278.93 "$6,417.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" "$6,417.00" "$6,417.00" "$6,417.00" "$6,417.00" "$6,417.00" "$6,417.00" "$6,417.00" "$6,417.00" "$6,417.00" "$1,337.37" "$6,417.00" "$1,096.80" "$1,758.00" "$6,417.00" "$2,742.00" "$6,417.00" "$6,417.00" "$4,812.75" "$6,417.00" "$6,417.00" "$6,417.00" "$3,080.16" "$3,080.16" "$5,082.26" "$6,417.00" "$5,133.60" $800.00 "$6,417.00" "$6,417.00" "$3,721.86" "$6,417.00" $300.38 $278.93 "$6,417.00" "$6,417.00" N/A N/A 61000017 EAP CPT® 73218 MRI UPPER EXT W/O DYE BILAT BOTH IP/OP "$10,051.00" "$7,438.00" $225.34 "$8,040.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 "$2,094.88" $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$2,094.74" $362.15 $336.89 "$1,758.00" $226.34 $258.07 $226.34 $237.66 "$7,538.25" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$7,960.39" $226.34 "$8,040.80" $800.00 "$1,994.87" $226.34 "$5,829.58" $237.66 $327.46 $226.34 "$2,094.63" $226.34 N/A N/A 61000019 EAP CPT® 73218 MRI UPPER EXT W/O DYE BOTH IP/OP "$4,976.00" "$3,682.50" $225.34 "$3,980.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 "$1,037.12" $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,037.05" $362.15 $336.89 "$1,758.00" $226.34 $258.07 $226.34 $237.66 "$3,732.00" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$3,940.99" $226.34 "$3,980.80" $800.00 $987.61 $226.34 "$2,886.08" $237.66 $327.46 $226.34 "$1,037.00" $226.34 N/A N/A 61000020 EAP CPT® 73219 MRI UPPER EXT W/DYE BILAT BOTH IP/OP "$10,778.00" "$7,976.00" $275.31 "$10,778.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $283.83 $283.83 $327.76 "$10,778.00" $283.83 "$10,778.00" "$10,778.00" "$10,778.00" "$10,778.00" "$2,246.25" $454.13 $440.50 "$1,758.00" $283.83 $275.31 $283.83 "$10,778.00" "$8,083.50" $283.83 $283.83 $283.83 "$1,536.00" "$1,306.00" "$8,536.18" $283.83 "$8,622.40" $800.00 "$10,778.00" $283.83 "$6,251.24" "$10,778.00" $311.91 $283.83 "$10,778.00" $283.83 N/A N/A 61000021 EAP CPT® 73219 MRI UPPER EXT W/DYE BOTH IP/OP "$5,393.00" "$3,991.00" $275.31 "$5,393.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $283.83 $283.83 $327.76 "$5,393.00" $283.83 "$5,393.00" "$5,393.00" "$5,393.00" "$5,393.00" "$1,123.96" $454.13 $440.50 "$1,758.00" $283.83 $275.31 $283.83 "$5,393.00" "$4,044.75" $283.83 $283.83 $283.83 "$1,536.00" "$1,306.00" "$4,271.26" $283.83 "$4,314.40" $800.00 "$5,393.00" $283.83 "$3,127.94" "$5,393.00" $311.91 $283.83 "$5,393.00" $283.83 N/A N/A 61000022 EAP CPT® 73219 MRI UPP EXT NOT JT W/DYE R MRI BOTH IP/OP "$5,339.00" "$3,951.00" $275.31 "$5,339.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $283.83 $283.83 $327.76 "$5,339.00" $283.83 "$5,339.00" "$5,339.00" "$5,339.00" "$5,339.00" "$1,112.71" $454.13 $440.50 "$1,758.00" $283.83 $275.31 $283.83 "$5,339.00" "$4,004.25" $283.83 $283.83 $283.83 "$1,536.00" "$1,306.00" "$4,228.49" $283.83 "$4,271.20" $800.00 "$5,339.00" $283.83 "$3,096.62" "$5,339.00" $311.91 $283.83 "$5,339.00" $283.83 N/A N/A 61000023 EAP CPT® 73220 MRI UPPER EXT W/O&W/DYE BILAT BOTH IP/OP "$13,949.00" "$10,322.50" $333.15 "$11,159.20" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$2,907.32" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$2,907.13" $579.58 $531.51 "$1,758.00" $362.23 $333.15 $362.23 $380.35 "$10,461.75" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$11,047.61" $362.23 "$11,159.20" $800.00 "$2,768.53" $362.23 "$8,090.42" $380.35 $524.06 $362.23 "$2,906.97" $362.23 N/A N/A 61000024 EAP CPT® 73220 MRI UPPER EXT W/O&W/DYE BOTH IP/OP "$6,906.00" "$5,110.50" $333.15 "$5,524.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,439.38" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,439.29" $579.58 $531.51 "$1,758.00" $362.23 $333.15 $362.23 $380.35 "$5,179.50" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$5,469.55" $362.23 "$5,524.80" $800.00 "$1,370.67" $362.23 "$4,005.48" $380.35 $524.06 $362.23 "$1,439.21" $362.23 N/A N/A 61000026 EAP CPT® 73221 MRI JOINT UPPER EXT W/O DYE BILAT BOTH IP/OP "$10,051.00" "$7,438.00" $148.48 "$8,040.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 "$2,094.88" $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$2,094.74" $362.15 $336.89 "$1,758.00" $226.34 $148.48 $226.34 $237.66 "$7,538.25" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$7,960.39" $226.34 "$8,040.80" $800.00 "$1,994.87" $226.34 "$5,829.58" $237.66 $327.46 $226.34 "$2,094.63" $226.34 N/A N/A 61000028 EAP CPT® 73221 MRI JOINT UPPER EXT W/O DYE BOTH IP/OP "$4,976.00" "$3,682.50" $148.48 "$3,980.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 "$1,037.12" $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,037.05" $362.15 $336.89 "$1,758.00" $226.34 $148.48 $226.34 $237.66 "$3,732.00" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$3,940.99" $226.34 "$3,980.80" $800.00 $987.61 $226.34 "$2,886.08" $237.66 $327.46 $226.34 "$1,037.00" $226.34 N/A N/A 61000030 EAP CPT® 73222 MRI JOINT UPPER EXT W/DYE BILAT BOTH IP/OP "$11,196.00" "$8,285.50" $254.67 "$8,956.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $703.75 $703.75 $700.64 "$2,333.53" $703.75 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$2,333.37" "$1,126.00" "$1,068.65" "$1,758.00" $703.75 $254.67 $703.75 $738.94 "$8,397.00" $703.75 $703.75 $703.75 "$1,536.00" "$1,306.00" "$8,867.23" $703.75 "$8,956.80" $800.00 "$2,222.13" $703.75 "$6,493.68" $738.94 "$1,018.15" $703.75 "$2,333.25" $703.75 N/A N/A 61000031 EAP CPT® 73222 MRI UPP EXT JNT W/DYE LT MRI BOTH IP/OP "$5,541.00" "$4,100.50" $254.67 "$4,432.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $703.75 $703.75 $700.64 "$1,154.88" $703.75 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,154.81" "$1,126.00" "$1,068.65" "$1,758.00" $703.75 $254.67 $703.75 $738.94 "$4,155.75" $703.75 $703.75 $703.75 "$1,536.00" "$1,306.00" "$4,388.47" $703.75 "$4,432.80" $800.00 "$1,099.75" $703.75 "$3,213.78" $738.94 "$1,018.15" $703.75 "$1,154.74" $703.75 N/A N/A 61000032 EAP CPT® 73222 MRI JOINT UPPER EXT W/DYE BOTH IP/OP "$5,541.00" "$4,100.50" $254.67 "$4,432.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $703.75 $703.75 $700.64 "$1,154.88" $703.75 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,154.81" "$1,126.00" "$1,068.65" "$1,758.00" $703.75 $254.67 $703.75 $738.94 "$4,155.75" $703.75 $703.75 $703.75 "$1,536.00" "$1,306.00" "$4,388.47" $703.75 "$4,432.80" $800.00 "$1,099.75" $703.75 "$3,213.78" $738.94 "$1,018.15" $703.75 "$1,154.74" $703.75 N/A N/A 61000033 EAP CPT® 73223 MRI JOINT UPPER EXT W/O&W/DYE BILAT BOTH IP/OP "$13,949.00" "$10,322.50" $308.46 "$11,159.20" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$2,907.32" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$2,907.13" $579.58 $531.51 "$1,758.00" $362.23 $308.46 $362.23 $380.35 "$10,461.75" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$11,047.61" $362.23 "$11,159.20" $800.00 "$2,768.53" $362.23 "$8,090.42" $380.35 $524.06 $362.23 "$2,906.97" $362.23 N/A N/A 61000035 EAP CPT® 73223 MRI JOINT UPPER EXT W/O&W/DYE BOTH IP/OP "$6,906.00" "$5,110.50" $308.46 "$5,524.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,439.38" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,439.29" $579.58 $531.51 "$1,758.00" $362.23 $308.46 $362.23 $380.35 "$5,179.50" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$5,469.55" $362.23 "$5,524.80" $800.00 "$1,370.67" $362.23 "$4,005.48" $380.35 $524.06 $362.23 "$1,439.21" $362.23 N/A N/A 61000036 EAP CPT® 73225 MR ANGIO UPPER EXT W/O&W/DYE BILAT BOTH IP/OP "$27,844.00" "$20,605.00" $279.71 "$27,844.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $288.25 $288.25 $333.63 "$27,844.00" $288.25 "$27,844.00" "$27,844.00" "$27,844.00" "$27,844.00" "$5,803.00" $461.20 $447.54 "$1,758.00" $288.25 $279.71 $288.25 "$27,844.00" "$20,883.00" $288.25 $288.25 $288.25 "$13,365.12" "$13,365.12" "$22,052.45" $288.25 "$22,275.20" $800.00 "$27,844.00" $288.25 "$16,149.52" "$27,844.00" $311.91 $288.25 "$27,844.00" $288.25 N/A N/A 61000038 EAP CPT® 73225 MRA UPP EXT W/WO DYE RT BOTH IP/OP "$13,918.00" "$10,299.50" $279.71 "$13,918.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $288.25 $288.25 $333.63 "$13,918.00" $288.25 "$13,918.00" "$13,918.00" "$13,918.00" "$13,918.00" "$2,900.66" $461.20 $447.54 "$1,758.00" $288.25 $279.71 $288.25 "$13,918.00" "$10,438.50" $288.25 $288.25 $288.25 "$6,680.64" "$6,680.64" "$11,023.06" $288.25 "$11,134.40" $800.00 "$13,918.00" $288.25 "$8,072.44" "$13,918.00" $311.91 $288.25 "$13,918.00" $288.25 N/A N/A 61000040 EAP CPT® 73718 MRI LOWER EXT W/O DYE BILAT BOTH IP/OP "$11,745.00" "$8,691.50" $172.15 "$9,396.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 "$2,447.95" $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$2,447.79" $362.15 $336.89 "$1,758.00" $226.34 $172.15 $226.34 $237.66 "$8,808.75" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$9,302.04" $226.34 "$9,396.00" $800.00 "$2,331.09" $226.34 "$6,812.10" $237.66 $327.46 $226.34 "$2,447.66" $226.34 N/A N/A 61000042 EAP CPT® 73718 MRI LOWER EXT W/O DYE BOTH IP/OP "$4,266.00" "$3,157.00" $172.15 "$3,412.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 $889.14 $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 $889.08 $362.15 $336.89 "$1,758.00" $226.34 $172.15 $226.34 $237.66 "$3,199.50" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$3,378.67" $226.34 "$3,412.80" $800.00 $846.69 $226.34 "$2,474.28" $237.66 $327.46 $226.34 $889.03 $226.34 N/A N/A 61000043 EAP CPT® 73719 MRI LOWER EXT W/DYE BILAT BOTH IP/OP "$9,248.00" "$6,844.00" $200.56 "$9,248.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $207.50 $207.50 $256.42 "$9,248.00" $207.50 "$9,248.00" "$9,248.00" "$9,248.00" "$9,248.00" "$1,927.38" $332.00 $320.90 "$1,758.00" $207.50 $200.56 $207.50 "$9,248.00" "$6,936.00" $207.50 $207.50 $207.50 "$1,536.00" "$1,306.00" "$7,324.42" $207.50 "$7,398.40" $800.00 "$9,248.00" $207.50 "$5,363.84" "$9,248.00" $225.83 $207.50 "$9,248.00" $207.50 N/A N/A 61000044 EAP CPT® 73719 MRI LOWER EXT W/DYE BOTH IP/OP "$4,759.00" "$3,522.00" $200.56 "$4,759.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $207.50 $207.50 $256.42 "$4,759.00" $207.50 "$4,759.00" "$4,759.00" "$4,759.00" "$4,759.00" $991.83 $332.00 $320.90 "$1,758.00" $207.50 $200.56 $207.50 "$4,759.00" "$3,569.25" $207.50 $207.50 $207.50 "$1,536.00" "$1,306.00" "$3,769.13" $207.50 "$3,807.20" $800.00 "$4,759.00" $207.50 "$2,760.22" "$4,759.00" $225.83 $207.50 "$4,759.00" $207.50 N/A N/A 61000045 EAP CPT® 73719 MRI LOW EXT NT JT W/DYE R MRI BOTH IP/OP "$4,759.00" "$3,522.00" $200.56 "$4,759.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $207.50 $207.50 $256.42 "$4,759.00" $207.50 "$4,759.00" "$4,759.00" "$4,759.00" "$4,759.00" $991.83 $332.00 $320.90 "$1,758.00" $207.50 $200.56 $207.50 "$4,759.00" "$3,569.25" $207.50 $207.50 $207.50 "$1,536.00" "$1,306.00" "$3,769.13" $207.50 "$3,807.20" $800.00 "$4,759.00" $207.50 "$2,760.22" "$4,759.00" $225.83 $207.50 "$4,759.00" $207.50 N/A N/A 61000046 EAP CPT® 73720 MRI LOWER EXT W/O&W/DYE BILAT BOTH IP/OP "$11,957.00" "$8,848.50" $255.02 "$9,565.60" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$2,492.14" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$2,491.97" $579.58 $531.51 "$1,758.00" $362.23 $255.02 $362.23 $380.35 "$8,967.75" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$9,469.94" $362.23 "$9,565.60" $800.00 "$2,373.17" $362.23 "$6,935.06" $380.35 $524.06 $362.23 "$2,491.84" $362.23 N/A N/A 61000047 EAP CPT® 73720 MRI LOWER EXT W/O&W/DYE BOTH IP/OP "$6,146.00" "$4,548.50" $255.02 "$4,916.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,280.98" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,280.89" $579.58 $531.51 "$1,758.00" $362.23 $255.02 $362.23 $380.35 "$4,609.50" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$4,867.63" $362.23 "$4,916.80" $800.00 "$1,219.83" $362.23 "$3,564.68" $380.35 $524.06 $362.23 "$1,280.83" $362.23 N/A N/A 61000050 EAP CPT® 73721 MRI JOINT LOWER EXT W/O DYE BILAT BOTH IP/OP "$8,531.00" "$6,313.00" $148.48 "$6,824.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 "$1,778.07" $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,777.95" $362.15 $336.89 "$1,758.00" $226.34 $148.48 $226.34 $237.66 "$6,398.25" $226.34 $226.34 $226.34 "$4,094.88" "$4,094.88" "$6,756.55" $226.34 "$6,824.80" $800.00 "$1,693.19" $226.34 "$4,947.98" $237.66 $327.46 $226.34 "$1,777.86" $226.34 N/A N/A 61000051 EAP CPT® 73721 MRI JOINT LOWER EXT W/O DYE BOTH IP/OP "$4,266.00" "$3,157.00" $148.48 "$3,412.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 $889.14 $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 $889.08 $362.15 $336.89 "$1,758.00" $226.34 $148.48 $226.34 $237.66 "$3,199.50" $226.34 $226.34 $226.34 "$2,047.68" "$2,047.68" "$3,378.67" $226.34 "$3,412.80" $800.00 $846.69 $226.34 "$2,474.28" $237.66 $327.46 $226.34 $889.03 $226.34 N/A N/A 61000053 EAP CPT® 73722 MRI JOINT LOWER EXT W/DYE BILAT BOTH IP/OP "$8,903.00" "$6,588.50" $255.01 "$8,903.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $265.18 $265.18 $310.88 "$8,903.00" $265.18 "$8,903.00" "$8,903.00" "$8,903.00" "$8,903.00" "$1,855.48" $424.29 $408.02 "$1,758.00" $265.18 $255.01 $265.18 "$8,903.00" "$6,677.25" $265.18 $265.18 $265.18 "$1,536.00" "$1,306.00" "$7,051.18" $265.18 "$7,122.40" $800.00 "$8,903.00" $265.18 "$5,163.74" "$8,903.00" $287.78 $265.18 "$8,903.00" $265.18 N/A N/A 61000054 EAP CPT® 73722 MRI LOW EXT JNT W/DYE LT MRI BOTH IP/OP "$4,578.00" "$3,388.00" $255.01 "$4,578.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $265.18 $265.18 $310.88 "$4,578.00" $265.18 "$4,578.00" "$4,578.00" "$4,578.00" "$4,578.00" $954.11 $424.29 $408.02 "$1,758.00" $265.18 $255.01 $265.18 "$4,578.00" "$3,433.50" $265.18 $265.18 $265.18 "$1,536.00" "$1,306.00" "$3,625.78" $265.18 "$3,662.40" $800.00 "$4,578.00" $265.18 "$2,655.24" "$4,578.00" $287.78 $265.18 "$4,578.00" $265.18 N/A N/A 61000055 EAP CPT® 73722 MRI JOINT LOWER EXT W/DYE BOTH IP/OP "$4,578.00" "$3,388.00" $255.01 "$4,578.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $265.18 $265.18 $310.88 "$4,578.00" $265.18 "$4,578.00" "$4,578.00" "$4,578.00" "$4,578.00" $954.11 $424.29 $408.02 "$1,758.00" $265.18 $255.01 $265.18 "$4,578.00" "$3,433.50" $265.18 $265.18 $265.18 "$1,536.00" "$1,306.00" "$3,625.78" $265.18 "$3,662.40" $800.00 "$4,578.00" $265.18 "$2,655.24" "$4,578.00" $287.78 $265.18 "$4,578.00" $265.18 N/A N/A 61000056 EAP CPT® 73723 MRI JOINT LOWER EXT W/O&W/DYE BILAT BOTH IP/OP "$12,288.00" "$9,093.50" $307.44 "$9,830.40" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$2,561.13" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$2,560.95" $579.58 $531.51 "$1,758.00" $362.23 $307.44 $362.23 $380.35 "$9,216.00" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$9,732.10" $362.23 "$9,830.40" $800.00 "$2,438.86" $362.23 "$7,127.04" $380.35 $524.06 $362.23 "$2,560.82" $362.23 N/A N/A 61000057 EAP CPT® 73723 MRI JOINT LOWER EXT W/O&W/DYE BOTH IP/OP "$6,146.00" "$4,548.50" $307.44 "$4,916.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,280.98" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,280.89" $579.58 $531.51 "$1,758.00" $362.23 $307.44 $362.23 $380.35 "$4,609.50" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$4,867.63" $362.23 "$4,916.80" $800.00 "$1,219.83" $362.23 "$3,564.68" $380.35 $524.06 $362.23 "$1,280.83" $362.23 N/A N/A 61000059 EAP CPT® 74181 MRI ABDOMEN W/O DYE BOTH IP/OP "$5,552.00" "$4,108.50" $137.32 "$4,441.60" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 "$1,157.18" $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,157.10" $362.15 $336.89 "$1,758.00" $226.34 $137.32 $226.34 $237.66 "$4,164.00" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$4,397.18" $226.34 "$4,441.60" $800.00 "$1,101.93" $226.34 "$3,220.16" $237.66 $327.46 $226.34 "$1,157.04" $226.34 N/A N/A 61000060 EAP CPT® 74182 MRI ABDOMEN W/ DYE BOTH IP/OP "$5,491.00" "$4,063.50" $238.45 "$4,392.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,144.46" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,144.38" $579.58 $531.51 "$1,758.00" $362.23 $238.45 $362.23 $380.35 "$4,118.25" $362.23 $362.23 $362.23 "$1,536.00" "$1,306.00" "$4,348.87" $362.23 "$4,392.80" $800.00 "$1,089.83" $362.23 "$3,184.78" $380.35 $524.06 $362.23 "$1,144.32" $362.23 N/A N/A 61000062 EAP CPT® 74183 MRI ABDOMEN W&WO DYE BOTH IP/OP "$6,073.00" "$4,494.50" $254.01 "$4,858.40" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,265.77" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,265.68" $579.58 $531.51 "$1,758.00" $362.23 $254.01 $362.23 $380.35 "$4,554.75" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$4,809.82" $362.23 "$4,858.40" $800.00 "$1,205.34" $362.23 "$3,522.34" $380.35 $524.06 $362.23 "$1,265.61" $362.23 N/A N/A 61000063 EAP CPT® 74185 MRA ABDOMEN WO CONT BOTH IP/OP "$3,369.00" "$2,493.50" $279.62 "$3,369.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" "$3,369.00" $702.14 "$3,369.00" "$1,084.80" "$1,758.00" "$3,369.00" "$2,712.00" "$3,369.00" "$3,369.00" "$2,526.75" "$3,369.00" "$3,369.00" "$3,369.00" "$1,617.12" "$1,617.12" "$2,668.25" "$3,369.00" "$2,695.20" $800.00 "$3,369.00" "$3,369.00" "$1,954.02" "$3,369.00" $301.82 $279.62 "$3,369.00" "$3,369.00" N/A N/A 61000064 EAP CPT® 75557 MRI CARD MORPH W/O CONT BOTH IP/OP "$3,922.00" "$2,902.50" $182.98 "$3,922.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $191.99 $191.99 $271.59 "$3,922.00" $191.99 "$3,922.00" "$3,922.00" "$3,922.00" "$3,922.00" $817.39 $307.18 $292.77 "$1,758.00" $191.99 $182.98 $191.99 "$3,922.00" "$2,941.50" $191.99 $191.99 $191.99 "$1,882.56" "$1,882.56" "$3,106.22" $191.99 "$3,137.60" $800.00 "$3,922.00" $191.99 "$2,274.76" "$3,922.00" $206.38 $191.99 "$3,922.00" $191.99 N/A N/A 61000065 EAP CPT® 75559 MRI CARD MORPH W/O W/STRESS BOTH IP/OP "$3,112.00" "$2,303.00" $257.04 "$3,112.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $270.70 $270.70 $376.35 "$3,112.00" $270.70 "$3,112.00" "$3,112.00" "$3,112.00" "$3,112.00" $648.58 $433.12 $411.26 "$1,758.00" $270.70 $257.04 $270.70 "$3,112.00" "$2,334.00" $270.70 $270.70 $270.70 "$1,493.76" "$1,493.76" "$2,464.70" $270.70 "$2,489.60" $800.00 "$3,112.00" $270.70 "$1,804.96" "$3,112.00" $305.43 $270.70 "$3,112.00" $270.70 N/A N/A 61000066 EAP CPT® 75561 MRI CARD MORPH W&W/O BOTH IP/OP "$4,708.00" "$3,484.00" $262.11 "$3,766.40" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 $981.26 $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 $981.20 $579.58 $531.51 "$1,758.00" $362.23 $262.11 $362.23 $380.35 "$3,531.00" $362.23 $362.23 $362.23 "$2,259.84" "$2,259.84" "$3,728.74" $362.23 "$3,766.40" $800.00 $934.42 $362.23 "$2,730.64" $380.35 $524.06 $362.23 $981.15 $362.23 N/A N/A 61000067 EAP CPT® 75563 MRI CARD MORPH W&W/O W/STRESS BOTH IP/OP "$5,552.00" "$4,108.50" $308.12 "$5,552.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $325.62 $325.62 $422.20 "$5,552.00" $325.62 "$5,552.00" "$5,552.00" "$5,552.00" "$5,552.00" "$1,157.10" $520.99 $492.99 "$1,758.00" $325.62 $308.12 $325.62 "$5,552.00" "$4,164.00" $325.62 $325.62 $325.62 "$2,664.96" "$2,664.96" "$4,397.18" $325.62 "$4,441.60" $800.00 "$5,552.00" $325.62 "$3,220.16" "$5,552.00" $354.05 $325.62 "$5,552.00" $325.62 N/A N/A 61000068 EAP CPT® 76390 MRI SPECTROSCOPY BOTH IP/OP "$4,990.00" "$3,693.00" $364.26 "$4,990.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" "$4,990.00" "$4,990.00" $364.26 "$4,990.00" "$4,990.00" "$4,990.00" "$4,990.00" "$4,990.00" "$4,990.00" "$1,039.97" "$4,990.00" "$1,648.80" "$1,758.00" "$4,990.00" "$4,122.00" "$4,990.00" "$4,990.00" "$3,742.50" "$4,990.00" "$4,990.00" "$4,990.00" "$2,395.20" "$2,395.20" "$3,952.08" "$4,990.00" "$3,992.00" $800.00 "$4,990.00" "$4,990.00" "$2,894.20" "$4,990.00" "$2,994.00" "$4,990.00" "$4,990.00" "$4,990.00" N/A N/A 61000069 EAP HCPCS C8900 MRA ABDOMEN W DYE BOTH IP/OP "$4,319.00" "$3,196.50" $800.00 "$4,319.00" "$4,319.00" "$4,319.00" "$4,319.00" "$4,319.00" "$4,319.00" "$4,319.00" "$4,319.00" "$4,319.00" "$4,319.00" "$4,319.00" "$4,319.00" "$4,319.00" "$4,319.00" $900.13 "$4,319.00" "$1,727.60" "$1,758.00" "$4,319.00" "$4,319.00" "$4,319.00" "$4,319.00" "$3,239.25" "$4,319.00" "$4,319.00" "$4,319.00" "$2,159.50" "$2,159.50" "$3,420.65" "$4,319.00" "$3,455.20" $800.00 "$4,319.00" "$4,319.00" "$2,505.02" "$4,319.00" "$2,591.40" "$4,319.00" "$4,319.00" "$4,319.00" N/A N/A 61000070 EAP HCPCS C8901 MRA ABDOMEN W/O DYE BOTH IP/OP "$2,291.00" "$1,695.50" $477.47 "$2,291.00" "$2,291.00" "$2,291.00" "$2,291.00" "$2,291.00" "$2,291.00" "$2,291.00" "$2,291.00" "$2,291.00" "$2,291.00" "$2,291.00" "$2,291.00" "$2,291.00" "$2,291.00" $477.47 "$2,291.00" $916.40 "$1,758.00" "$2,291.00" "$2,291.00" "$2,291.00" "$2,291.00" "$1,718.25" "$2,291.00" "$2,291.00" "$2,291.00" "$1,145.50" "$1,145.50" "$1,814.47" "$2,291.00" "$1,832.80" $800.00 "$2,291.00" "$2,291.00" "$1,328.78" "$2,291.00" "$1,374.60" "$2,291.00" "$2,291.00" "$2,291.00" N/A N/A 61000071 EAP HCPCS C8909 MRA CHEST W DYE BOTH IP/OP "$4,649.00" "$3,440.50" $800.00 "$4,649.00" "$4,649.00" "$4,649.00" "$4,649.00" "$4,649.00" "$4,649.00" "$4,649.00" "$4,649.00" "$4,649.00" "$4,649.00" "$4,649.00" "$4,649.00" "$4,649.00" "$4,649.00" $968.90 "$4,649.00" "$1,089.20" "$1,758.00" "$4,649.00" "$2,723.00" "$4,649.00" "$4,649.00" "$3,486.75" "$4,649.00" "$4,649.00" "$4,649.00" "$2,324.50" "$2,324.50" "$3,682.01" "$4,649.00" "$3,719.20" $800.00 "$4,649.00" "$4,649.00" "$2,696.42" "$4,649.00" "$2,789.40" "$4,649.00" "$4,649.00" "$4,649.00" N/A N/A 61000072 EAP HCPCS C8910 MRA CHEST W/O DYE BOTH IP/OP "$5,409.00" "$4,003.00" $800.00 "$5,409.00" "$5,409.00" "$5,409.00" "$5,409.00" "$5,409.00" "$5,409.00" "$5,409.00" "$5,409.00" "$5,409.00" "$5,409.00" "$5,409.00" "$5,409.00" "$5,409.00" "$5,409.00" "$1,127.30" "$5,409.00" "$1,608.80" "$1,758.00" "$5,409.00" "$4,022.00" "$5,409.00" "$5,409.00" "$4,056.75" "$5,409.00" "$5,409.00" "$5,409.00" "$2,704.50" "$2,704.50" "$4,283.93" "$5,409.00" "$4,327.20" $800.00 "$5,409.00" "$5,409.00" "$3,137.22" "$5,409.00" "$3,245.40" "$5,409.00" "$5,409.00" "$5,409.00" N/A N/A 61000073 EAP HCPCS C8914 MRA LOW EXT W&WO DYE BI MRI BOTH IP/OP "$4,133.00" "$3,058.50" $800.00 "$5,796.00" "$4,133.00" "$4,133.00" "$4,133.00" "$4,133.00" "$4,133.00" "$4,133.00" "$4,133.00" "$4,133.00" "$4,133.00" "$4,133.00" "$4,133.00" "$4,133.00" "$4,133.00" $861.36 "$4,133.00" "$2,318.40" "$1,758.00" "$4,133.00" "$5,796.00" "$4,133.00" "$4,133.00" "$3,099.75" "$4,133.00" "$4,133.00" "$4,133.00" "$2,066.50" "$2,066.50" "$3,273.34" "$4,133.00" "$3,306.40" $800.00 "$4,133.00" "$4,133.00" "$2,397.14" "$4,133.00" "$2,479.80" "$4,133.00" "$4,133.00" "$4,133.00" N/A N/A 61000074 EAP HCPCS C8914 MRA LOW EXT W&WO DYE LT BOTH IP/OP "$2,898.00" "$2,145.00" $603.98 "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" $603.98 "$2,898.00" "$1,159.20" "$1,758.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,173.50" "$2,898.00" "$2,898.00" "$2,898.00" "$1,449.00" "$1,449.00" "$2,295.22" "$2,898.00" "$2,318.40" $800.00 "$2,898.00" "$2,898.00" "$1,680.84" "$2,898.00" "$1,738.80" "$2,898.00" "$2,898.00" "$2,898.00" N/A N/A 61000075 EAP HCPCS C8914 MRA LOW EXT W/WO DYE RT BOTH IP/OP "$2,898.00" "$2,145.00" $603.98 "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" $603.98 "$2,898.00" "$1,159.20" "$1,758.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,898.00" "$2,173.50" "$2,898.00" "$2,898.00" "$2,898.00" "$1,449.00" "$1,449.00" "$2,295.22" "$2,898.00" "$2,318.40" $800.00 "$2,898.00" "$2,898.00" "$1,680.84" "$2,898.00" "$1,738.80" "$2,898.00" "$2,898.00" "$2,898.00" N/A N/A 61000077 EAP HCPCS C8903 "MRI W/CONT, BRST, UNI, MRI" BOTH IP/OP "$1,389.00" "$1,028.00" $289.48 "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" $289.48 "$1,389.00" $555.60 "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,041.75" "$1,389.00" "$1,389.00" "$1,389.00" $694.50 $694.50 "$1,100.09" "$1,389.00" "$1,111.20" $800.00 "$1,389.00" "$1,389.00" $805.62 "$1,389.00" $833.40 "$1,389.00" "$1,389.00" "$1,389.00" N/A N/A 61000081 EAP HCPCS C8905 "MRI W/OFOL W/CON,BRST,UNI,MRI" BOTH IP/OP "$1,753.00" "$1,297.50" $365.34 "$1,753.00" "$1,753.00" "$1,753.00" "$1,753.00" "$1,753.00" "$1,753.00" "$1,753.00" "$1,753.00" "$1,753.00" "$1,753.00" "$1,753.00" "$1,753.00" "$1,753.00" "$1,753.00" $365.34 "$1,753.00" $701.20 "$1,753.00" "$1,753.00" "$1,753.00" "$1,753.00" "$1,753.00" "$1,314.75" "$1,753.00" "$1,753.00" "$1,753.00" $876.50 $876.50 "$1,388.38" "$1,753.00" "$1,402.40" $800.00 "$1,753.00" "$1,753.00" "$1,016.74" "$1,753.00" "$1,051.80" "$1,753.00" "$1,753.00" "$1,753.00" N/A N/A 61000082 EAP HCPCS C8906 "MRI W/CON, BRST, BI,MRI" BOTH IP/OP "$1,389.00" "$1,028.00" $289.48 "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" $289.48 "$1,389.00" $555.60 "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,041.75" "$1,389.00" "$1,389.00" "$1,389.00" $694.50 $694.50 "$1,100.09" "$1,389.00" "$1,111.20" $800.00 "$1,389.00" "$1,389.00" $805.62 "$1,389.00" $833.40 "$1,389.00" "$1,389.00" "$1,389.00" N/A N/A 61000087 EAP CPT® 77049 "MRI BREAST W/WO CONTRAST INCL CAD, BILATERAL" BOTH IP/OP "$4,339.00" "$3,211.00" $262.76 "$4,339.00" "$1,066.75" "$1,066.75" "$1,066.75" "$1,066.75" $362.23 $362.23 $360.63 $904.36 $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 $904.30 $579.58 $531.51 "$1,758.00" $362.23 "$4,339.00" $362.23 $380.35 "$3,254.25" $362.23 $362.23 $362.23 "$2,082.72" "$2,082.72" "$3,436.49" $362.23 "$3,471.20" $800.00 $861.18 $362.23 "$2,516.62" $380.35 $285.62 $262.76 $904.25 $362.23 N/A N/A 61000090 EAP CPT® 72220 CERVICAL SPINE FLEX EXT NIR BOTH IP/OP $488.00 $361.50 $24.69 $488.00 $60.57 $60.57 $60.57 $60.57 $79.57 $79.57 $79.21 $101.71 $79.57 $488.00 $488.00 $488.00 $488.00 $101.70 $127.31 $125.33 $488.00 $79.57 $24.69 $79.57 $83.54 $366.00 $79.57 $79.57 $79.57 $234.24 $234.24 $386.50 $79.57 $390.40 $488.00 $96.86 $79.57 $283.04 $83.54 $115.11 $79.57 $101.70 $79.57 N/A N/A 61000098 EAP CPT® 76376 3D RENDERING W/O POSTPROCE MRI BOTH IP/OP "$1,659.00" "$1,228.00" $14.89 "$2,200.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,338.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,171.15" "$1,171.15" "$1,216.20" $854.94 $345.75 "$1,659.00" "$2,200.00" "$1,659.00" "$1,659.00" $14.89 "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $796.32 $796.32 "$1,313.93" "$1,659.00" "$1,327.20" $800.00 $329.27 "$1,659.00" $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 61000110 EAP CPT® 77021 MRI GUIDANCE NEEDLE PLACEMENT BOTH IP/OP "$3,150.00" "$2,331.00" $364.25 "$3,150.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $371.90 $371.90 $399.79 "$3,150.00" $371.90 "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" $656.49 $595.04 $582.80 "$1,758.00" $371.90 $364.25 $371.90 "$3,150.00" "$2,362.50" $371.90 $371.90 $371.90 "$1,512.00" "$1,512.00" "$2,494.80" $371.90 "$2,520.00" $800.00 "$3,150.00" $371.90 "$1,827.00" "$3,150.00" $397.27 $371.90 "$3,150.00" $371.90 N/A N/A 61000116 EAP HCPCS C8932 "MRA, W/O DYE, SPINAL CANAL" BOTH IP/OP "$4,243.00" "$3,140.00" $800.00 "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" $884.29 "$4,243.00" "$1,697.20" "$1,758.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$3,182.25" "$4,243.00" "$4,243.00" "$4,243.00" "$2,121.50" "$2,121.50" "$3,360.46" "$4,243.00" "$3,394.40" $800.00 "$4,243.00" "$4,243.00" "$2,460.94" "$4,243.00" "$2,545.80" "$4,243.00" "$4,243.00" "$4,243.00" N/A N/A 61000117 EAP HCPCS C8933 "MRA, W/O&W/DYE, SPINAL CANAL" BOTH IP/OP "$3,605.00" "$2,668.00" $751.32 "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" $751.32 "$3,605.00" "$1,442.00" "$1,758.00" "$3,605.00" "$3,605.00" "$3,605.00" "$3,605.00" "$2,703.75" "$3,605.00" "$3,605.00" "$3,605.00" "$1,802.50" "$1,802.50" "$2,855.16" "$3,605.00" "$2,884.00" $800.00 "$3,605.00" "$3,605.00" "$2,090.90" "$3,605.00" "$2,163.00" "$3,605.00" "$3,605.00" "$3,605.00" N/A N/A 61000118 EAP HCPCS C8934 "MRA, W/DYE, UPPER EXTREMITY" BOTH IP/OP "$4,210.00" "$3,115.50" $800.00 "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" $877.41 "$4,210.00" "$1,096.80" "$1,758.00" "$4,210.00" "$2,742.00" "$4,210.00" "$4,210.00" "$3,157.50" "$4,210.00" "$4,210.00" "$4,210.00" "$2,105.00" "$2,105.00" "$3,334.32" "$4,210.00" "$3,368.00" $800.00 "$4,210.00" "$4,210.00" "$2,441.80" "$4,210.00" "$2,526.00" "$4,210.00" "$4,210.00" "$4,210.00" N/A N/A 61000119 EAP HCPCS C8935 "MRA, W/ODYE, UPPER EXTREMITY" BOTH IP/OP "$4,210.00" "$3,115.50" $800.00 "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" $877.41 "$4,210.00" $865.60 "$1,758.00" "$4,210.00" "$2,164.00" "$4,210.00" "$4,210.00" "$3,157.50" "$4,210.00" "$4,210.00" "$4,210.00" "$2,105.00" "$2,105.00" "$3,334.32" "$4,210.00" "$3,368.00" $800.00 "$4,210.00" "$4,210.00" "$2,441.80" "$4,210.00" "$2,526.00" "$4,210.00" "$4,210.00" "$4,210.00" N/A N/A 61000120 EAP HCPCS C8936 "MRA, W/O&W/DYE, UPPER EXTREMITY" BOTH IP/OP "$4,210.00" "$3,115.50" $800.00 "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" "$4,210.00" $877.41 "$4,210.00" "$1,388.40" "$1,758.00" "$4,210.00" "$3,471.00" "$4,210.00" "$4,210.00" "$3,157.50" "$4,210.00" "$4,210.00" "$4,210.00" "$2,105.00" "$2,105.00" "$3,334.32" "$4,210.00" "$3,368.00" $800.00 "$4,210.00" "$4,210.00" "$2,441.80" "$4,210.00" "$2,526.00" "$4,210.00" "$4,210.00" "$4,210.00" N/A N/A 61000122 EAP CPT® 77021 MRI GUIDANCE FOR NEEDLE PLACEMENT BOTH IP/OP "$3,150.00" "$2,331.00" $364.25 "$3,150.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $371.90 $371.90 $399.79 "$3,150.00" $371.90 "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" $656.49 $595.04 $582.80 "$1,758.00" $371.90 $364.25 $371.90 "$3,150.00" "$2,362.50" $371.90 $371.90 $371.90 "$1,512.00" "$1,512.00" "$2,494.80" $371.90 "$2,520.00" $800.00 "$3,150.00" $371.90 "$1,827.00" "$3,150.00" $397.27 $371.90 "$3,150.00" $371.90 N/A N/A 61000124 EAP CPT® 77048 MRI BREAST W AND/OR WO CONT INCL CAD UNI BOTH IP/OP $491.00 $363.50 $102.33 $491.00 $491.00 $491.00 $491.00 $491.00 $264.83 $264.83 $328.35 $491.00 $264.83 $491.00 $491.00 $491.00 $491.00 $102.33 $423.73 $409.66 $491.00 $264.83 $256.04 $264.83 $491.00 $368.25 $264.83 $264.83 $264.83 $235.68 $235.68 $388.87 $264.83 $392.80 $491.00 $491.00 $264.83 $284.78 $491.00 $286.70 $264.83 $491.00 $264.83 N/A N/A 61000125 EAP CPT® 77049 MRI BREAST W AND/OR WO CONT INCL CAD BIL BOTH IP/OP $491.00 $363.50 $97.45 $491.00 $491.00 $491.00 $491.00 $491.00 $262.76 $262.76 $335.44 $102.34 $262.76 $491.00 $491.00 $491.00 $491.00 $102.33 $420.42 $406.42 $491.00 $262.76 $254.01 $262.76 $491.00 $368.25 $262.76 $262.76 $262.76 $235.68 $235.68 $388.87 $262.76 $392.80 $491.00 $97.45 $262.76 $284.78 $491.00 $285.62 $262.76 $102.32 $262.76 N/A N/A 61000126 EAP CPT® 77047 MRI BREAST WITHOUT CONTRAST MATERIAL BILATERAL BOTH IP/OP "$2,874.00" "$2,127.00" $155.92 "$2,874.00" "$2,874.00" "$2,874.00" "$2,874.00" "$2,874.00" $160.19 $160.19 $211.81 "$2,874.00" $160.19 "$2,874.00" "$2,874.00" "$2,874.00" "$2,874.00" $598.97 $256.30 $249.47 "$1,758.00" $160.19 $155.92 $160.19 "$2,874.00" "$2,155.50" $160.19 $160.19 $160.19 "$1,379.52" "$1,379.52" "$2,276.21" $160.19 "$2,299.20" $800.00 "$2,874.00" $160.19 "$1,666.92" "$2,874.00" $173.24 $160.19 "$2,874.00" $160.19 N/A N/A 61000127 EAP CPT® 77046 MRI BREAST WO CONTRAST UNI BOTH IP/OP $554.00 $410.00 $115.46 $554.00 $554.00 $554.00 $554.00 $554.00 $160.88 $160.88 $206.17 $554.00 $160.88 $554.00 $554.00 $554.00 $554.00 $115.46 $257.41 $248.38 $554.00 $160.88 $155.24 $160.88 $554.00 $415.50 $160.88 $160.88 $160.88 $265.92 $265.92 $438.77 $160.88 $443.20 $554.00 $554.00 $160.88 $321.32 $554.00 $174.32 $160.88 $554.00 $160.88 N/A N/A 61000130 EAP CPT® 76498 MRI PELVIS TX PLAN W/O CONTRAST BOTH IP/OP "$2,500.00" "$1,850.00" $78.22 "$2,500.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" "$2,500.00" "$2,500.00" $78.22 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,758.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,200.00" "$1,200.00" "$1,980.00" "$2,500.00" "$2,000.00" $800.00 "$2,500.00" "$2,500.00" "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 61100001 EAP CPT® 70551 MRI BRAIN W/O DYE BOTH IP/OP "$5,561.00" "$4,115.50" $135.63 "$4,448.80" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 "$1,159.05" $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,158.97" $362.15 $336.89 "$1,758.00" $226.34 $135.63 $226.34 $237.66 "$4,170.75" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$4,404.31" $226.34 "$4,448.80" $800.00 "$1,103.72" $226.34 "$3,225.38" $237.66 $327.46 $226.34 "$1,158.91" $226.34 N/A N/A 61100003 EAP CPT® 70552 MRI BRAIN W/DYE BOTH IP/OP "$6,193.00" "$4,583.00" $200.57 "$4,954.40" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,290.78" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,290.69" $579.58 $531.51 "$1,758.00" $362.23 $200.57 $362.23 $380.35 "$4,644.75" $362.23 $362.23 $362.23 "$1,536.00" "$1,306.00" "$4,904.86" $362.23 "$4,954.40" $800.00 "$1,229.16" $362.23 "$3,591.94" $380.35 $524.06 $362.23 "$1,290.62" $362.23 N/A N/A 61100005 EAP CPT® 70553 MRI BRAIN W&WO DYE BOTH IP/OP "$8,010.00" "$5,927.50" $227.29 "$6,408.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,669.48" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,669.37" $579.58 $531.51 "$1,758.00" $362.23 $227.29 $362.23 $380.35 "$6,007.50" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$6,343.92" $362.23 "$6,408.00" $800.00 "$1,589.78" $362.23 "$4,645.80" $380.35 $524.06 $362.23 "$1,669.28" $362.23 N/A N/A 61200001 EAP CPT® 72141 MRI CERVICAL SPINE W/O DYE BOTH IP/OP "$5,640.00" "$4,174.00" $129.88 "$4,512.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 "$1,175.52" $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,175.44" $362.15 $336.89 "$1,758.00" $226.34 $129.88 $226.34 $237.66 "$4,230.00" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$4,466.88" $226.34 "$4,512.00" $800.00 "$1,119.40" $226.34 "$3,271.20" $237.66 $327.46 $226.34 "$1,175.38" $226.34 N/A N/A 61200004 EAP CPT® 72142 MRI CERVICAL SPINE W CONTRAST BOTH IP/OP "$6,282.00" "$4,649.00" $205.30 "$6,282.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $212.68 $212.68 $266.49 "$6,282.00" $212.68 "$6,282.00" "$6,282.00" "$6,282.00" "$6,282.00" "$1,309.24" $340.29 $328.48 "$1,758.00" $212.68 $205.30 $212.68 "$6,282.00" "$4,711.50" $212.68 $212.68 $212.68 "$1,536.00" "$1,306.00" "$4,975.34" $212.68 "$5,025.60" $800.00 "$6,282.00" $212.68 "$3,643.56" "$6,282.00" $228.35 $212.68 "$6,282.00" $212.68 N/A N/A 61200005 EAP CPT® 72146 MRI THORACIC SPINE W/O DYE BOTH IP/OP "$4,510.00" "$3,337.50" $129.88 "$3,608.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 $940.00 $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 $939.93 $362.15 $336.89 "$1,758.00" $226.34 $129.88 $226.34 $237.66 "$3,382.50" $226.34 $226.34 $226.34 "$2,164.80" "$2,164.80" "$3,571.92" $226.34 "$3,608.00" $800.00 $895.12 $226.34 "$2,615.80" $237.66 $327.46 $226.34 $939.88 $226.34 N/A N/A 61200006 EAP CPT® 72147 MRI THORACIC SPINE W/DYE BOTH IP/OP "$5,023.00" "$3,717.50" $203.27 "$5,023.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $209.92 $209.92 $264.72 "$5,023.00" $209.92 "$5,023.00" "$5,023.00" "$5,023.00" "$5,023.00" "$1,046.85" $335.87 $325.23 "$1,758.00" $209.92 $203.27 $209.92 "$5,023.00" "$3,767.25" $209.92 $209.92 $209.92 "$1,536.00" "$1,306.00" "$3,978.22" $209.92 "$4,018.40" $800.00 "$5,023.00" $209.92 "$2,913.34" "$5,023.00" $226.55 $209.92 "$5,023.00" $209.92 N/A N/A 61200007 EAP CPT® 72148 MRI LUMBAR SPINE W/O DYE BOTH IP/OP "$4,264.00" "$3,155.50" $130.56 "$3,411.20" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 $888.72 $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 $888.66 $362.15 $336.89 "$1,758.00" $226.34 $130.56 $226.34 $237.66 "$3,198.00" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$3,377.09" $226.34 "$3,411.20" $800.00 $846.30 $226.34 "$2,473.12" $237.66 $327.46 $226.34 $888.62 $226.34 N/A N/A 61200008 EAP CPT® 72149 MRI LUMBAR SPINE W/ DYE BOTH IP/OP "$4,587.00" "$3,394.50" $200.56 "$4,587.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $207.50 $207.50 $262.35 "$4,587.00" $207.50 "$4,587.00" "$4,587.00" "$4,587.00" "$4,587.00" $955.98 $332.00 $320.90 "$1,758.00" $207.50 $200.56 $207.50 "$4,587.00" "$3,440.25" $207.50 $207.50 $207.50 "$1,536.00" "$1,306.00" "$3,632.90" $207.50 "$3,669.60" $800.00 "$4,587.00" $207.50 "$2,660.46" "$4,587.00" $223.67 $207.50 "$4,587.00" $207.50 N/A N/A 61200009 EAP CPT® 72156 MRI CERVICAL SPINE W&WO DYE BOTH IP/OP "$8,124.00" "$6,012.00" $228.98 "$6,499.20" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,693.24" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,693.13" $579.58 $531.51 "$1,758.00" $362.23 $228.98 $362.23 $380.35 "$6,093.00" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$6,434.21" $362.23 "$6,499.20" $800.00 "$1,612.41" $362.23 "$4,711.92" $380.35 $524.06 $362.23 "$1,693.04" $362.23 N/A N/A 61200010 EAP CPT® 72157 MRI THORACIC SPINE W&WO DYE BOTH IP/OP "$6,499.00" "$4,809.50" $229.66 "$5,199.20" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,354.55" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,354.46" $579.58 $531.51 "$1,758.00" $362.23 $229.66 $362.23 $380.35 "$4,874.25" $362.23 $362.23 $362.23 "$3,119.52" "$3,119.52" "$5,147.21" $362.23 "$5,199.20" $800.00 "$1,289.89" $362.23 "$3,769.42" $380.35 $524.06 $362.23 "$1,354.39" $362.23 N/A N/A 61200011 EAP CPT® 72158 MRI LUMBAR SPINE W&WO DYE BOTH IP/OP "$6,144.00" "$4,547.00" $228.31 "$4,915.20" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,280.56" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,280.48" $579.58 $531.51 "$1,758.00" $362.23 $228.31 $362.23 $380.35 "$4,608.00" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$4,866.05" $362.23 "$4,915.20" $800.00 "$1,219.43" $362.23 "$3,563.52" $380.35 $524.06 $362.23 "$1,280.41" $362.23 N/A N/A 61200012 EAP CPT® 72195 MRI PELVIS W/O DYE BOTH IP/OP "$4,089.00" "$3,026.00" $172.49 "$3,271.20" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $226.34 $226.34 $225.34 $852.25 $226.34 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 $852.19 $362.15 $336.89 "$1,758.00" $226.34 $172.49 $226.34 $237.66 "$3,066.75" $226.34 $226.34 $226.34 "$1,379.00" "$1,172.00" "$3,238.49" $226.34 "$3,271.20" $800.00 $811.56 $226.34 "$2,371.62" $237.66 $327.46 $226.34 $852.15 $226.34 N/A N/A 61200013 EAP CPT® 72196 MRI PELVIS W/ DYE BOTH IP/OP "$4,633.00" "$3,428.50" $201.58 "$3,706.40" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 $965.63 $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 $965.57 $579.58 $531.51 "$1,758.00" $362.23 $201.58 $362.23 $380.35 "$3,474.75" $362.23 $362.23 $362.23 "$1,536.00" "$1,306.00" "$3,669.34" $362.23 "$3,706.40" $800.00 $919.53 $362.23 "$2,687.14" $380.35 $524.06 $362.23 $965.52 $362.23 N/A N/A 61200014 EAP CPT® 72197 MRI PELVIS W&WO DYE BOTH IP/OP "$5,028.00" "$3,721.00" $252.66 "$4,022.40" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $362.23 $362.23 $360.63 "$1,047.96" $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 "$1,047.89" $579.58 $531.51 "$1,758.00" $362.23 $252.66 $362.23 $380.35 "$3,771.00" $362.23 $362.23 $362.23 "$2,172.00" "$1,846.00" "$3,982.18" $362.23 "$4,022.40" $800.00 $997.93 $362.23 "$2,916.24" $380.35 $524.06 $362.23 "$1,047.84" $362.23 N/A N/A 61400000 EAP CPT® 75565 MR CARDIAC MRI FOR VELOCITY FLOW MAPPING BOTH IP/OP "$2,506.00" "$1,854.50" $36.19 "$2,506.00" "$1,962.00" "$1,962.00" "$1,962.00" "$1,962.00" $38.34 $38.34 $45.27 "$2,506.00" $38.34 "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" $522.28 $61.34 $57.90 "$1,758.00" $38.34 $36.19 $38.34 "$2,506.00" "$1,879.50" $38.34 $38.34 $38.34 "$1,202.88" "$1,202.88" "$1,984.75" $38.34 "$2,004.80" $800.00 "$2,506.00" $38.34 "$1,453.48" "$2,506.00" $40.70 $38.34 "$2,506.00" $38.34 N/A N/A 61800010 EAP HCPCS C8902 "MRA W/O FOL W/CONT, ABD, CBC" BOTH IP/OP "$1,744.00" "$1,291.00" $346.14 "$1,744.00" $946.99 $946.99 $946.99 $946.99 $362.23 $362.23 $360.63 $363.49 $362.23 "$1,171.15" "$1,171.15" "$1,216.20" $854.94 $363.47 $579.58 $531.51 "$1,744.00" $362.23 "$1,744.00" $362.23 $380.35 "$1,308.00" $362.23 $362.23 $362.23 $872.00 $872.00 "$1,381.25" $362.23 "$1,395.20" $800.00 $346.14 $362.23 "$1,011.52" $380.35 $524.06 $362.23 $363.45 $362.23 N/A N/A 62200001 EAP Custom 62200001 INTRO AORTIC BALLOONS BOTH IP/OP "$5,547.00" "$4,105.00" $987.37 "$5,547.00" "$5,547.00" "$5,547.00" "$5,547.00" "$5,547.00" "$5,547.00" "$5,547.00" $987.37 "$5,547.00" "$5,547.00" "$5,547.00" "$5,547.00" "$5,547.00" "$5,547.00" "$1,156.06" "$5,547.00" "$2,218.80" "$5,547.00" "$5,547.00" "$5,547.00" "$5,547.00" "$5,547.00" "$4,160.25" "$5,547.00" "$5,547.00" "$5,547.00" "$2,773.50" "$2,773.50" "$4,393.22" "$5,547.00" "$4,437.60" "$3,605.55" "$5,547.00" "$5,547.00" "$3,217.26" "$5,547.00" "$3,328.20" "$5,547.00" "$5,547.00" "$5,547.00" N/A N/A 62300002 EAP HCPCS A6234 HYDROCOLLOID DSG 16 SQ IN OR LESS BOTH IP/OP $43.00 $32.00 $2.92 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $2.92 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 $43.00 $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A 62300003 EAP HCPCS A6235 HYDROCOLLOID DSG MORE THAN 16SQ IN BOTH IP/OP $131.00 $97.00 $12.01 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $12.01 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $27.30 $131.00 $52.40 $131.00 $131.00 $131.00 $131.00 $131.00 $98.25 $131.00 $131.00 $131.00 $65.50 $65.50 $103.75 $131.00 $104.80 $85.15 $131.00 $131.00 $75.98 $131.00 $78.60 $131.00 $131.00 $131.00 N/A N/A 62300006 EAP HCPCS A6196 ALGINATE DRESSING <= 16 SQ IN BOTH IP/OP $44.00 $33.00 $3.48 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $3.48 $44.00 $44.00 $44.00 $44.00 $44.00 $44.00 $9.17 $44.00 $17.60 $44.00 $44.00 $44.00 $44.00 $44.00 $33.00 $44.00 $44.00 $44.00 $22.00 $22.00 $34.85 $44.00 $35.20 $28.60 $44.00 $44.00 $25.52 $44.00 $26.40 $44.00 $44.00 $44.00 N/A N/A 62400002 EAP Custom 62400002 TREVO RETRIEVER-IDE#G100056 BOTH IP/OP "$4,937.00" "$3,653.50" $878.79 "$4,937.00" "$4,937.00" "$4,937.00" "$4,937.00" "$4,937.00" "$4,937.00" "$4,937.00" $878.79 "$4,937.00" "$4,937.00" "$4,937.00" "$4,937.00" "$4,937.00" "$4,937.00" "$1,028.93" "$4,937.00" "$1,974.80" "$4,937.00" "$4,937.00" "$4,937.00" "$4,937.00" "$4,937.00" "$3,702.75" "$4,937.00" "$4,937.00" "$4,937.00" "$2,468.50" "$2,468.50" "$3,910.10" "$4,937.00" "$3,949.60" "$3,209.05" "$4,937.00" "$4,937.00" "$2,863.46" "$4,937.00" "$2,962.20" "$4,937.00" "$4,937.00" "$4,937.00" N/A N/A 62400003 EAP Custom 62400003 TREVO 18 MICROCATHETER-IDE#G100056 BOTH IP/OP $199.00 $147.50 $35.42 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $35.42 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $41.47 $199.00 $79.60 $199.00 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $199.00 $199.00 $115.42 $199.00 $119.40 $199.00 $199.00 $199.00 N/A N/A 63600011 EAP CPT® 90670 PNEUMONIA VACCINE PREVNAR BOTH IP/OP $30.00 $22.50 $4.26 $270.06 $13.50 $13.50 $13.50 $13.50 $7.80 $7.80 $241.38 $6.25 $7.80 $251.04 $251.04 $260.69 $241.38 $30.00 $30.00 $12.00 $17.75 $7.80 $7.80 $7.80 $30.00 $22.50 $7.80 $4.26 $7.80 $15.00 $15.00 $23.76 $7.80 $24.00 $13.50 $30.00 $7.80 $17.40 $30.00 $4.38 $7.80 $270.06 $7.80 N/A N/A 63600012 EAP CPT® 90732 PNEUMONIA VACCINE PNEUMOVAX BOTH IP/OP $30.00 $22.50 $4.26 $149.33 $13.50 $13.50 $13.50 $13.50 $7.80 $7.80 $125.92 $9.40 $7.80 $138.81 $138.81 $144.15 $133.47 $30.00 $30.00 $12.00 $17.75 $7.80 $7.80 $7.80 $30.00 $22.50 $7.80 $4.26 $7.80 $15.00 $15.00 $23.76 $7.80 $24.00 $13.50 $30.00 $7.80 $17.40 $30.00 $4.38 $7.80 $149.33 $7.80 N/A N/A 63600022 EAP CPT® 90651 GARDASIL-9 VACCINE BOTH IP/OP $493.00 $365.00 $102.75 $493.00 $221.85 $221.85 $221.85 $221.85 $493.00 $493.00 $243.34 $102.75 $493.00 $263.74 $263.74 $273.89 $253.60 $297.94 $493.00 $197.20 $291.61 $493.00 $493.00 $493.00 $493.00 $369.75 $493.00 $493.00 $493.00 $246.50 $246.50 $390.46 $493.00 $394.40 $221.85 $283.73 $493.00 $285.94 $493.00 $295.80 $493.00 $283.73 $493.00 N/A N/A 63600025 EAP HCPCS J2182 RX EAP NUCALA CHARGE BOTH IP/OP $80.00 $59.50 $28.29 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $28.29 $80.00 $80.00 $29.84 $29.84 $30.99 $28.69 $33.71 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $36.00 $80.00 $28.69 $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 63600101 EAP HCPCS A9562 "TC-99M MERTIATIDE, DX UP TO 15 MCI" BOTH IP/OP $784.00 $580.50 $155.60 $784.00 $784.00 $784.00 $784.00 $784.00 $784.00 $784.00 $784.00 $163.41 $784.00 $784.00 $784.00 $604.31 $408.46 $163.39 $784.00 $784.00 $463.74 $784.00 $784.00 $784.00 $784.00 $588.00 $784.00 $784.00 $784.00 $392.00 $392.00 $620.93 $784.00 $627.20 $509.60 $155.60 $784.00 $454.72 $784.00 $784.00 $784.00 $163.39 $784.00 N/A N/A 63600104 EAP HCPCS J7197 ANTI-THROMBIN III BOTH IP/OP $6.00 $4.50 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $3.20 $6.00 $6.00 $3.69 $3.69 $3.83 $3.55 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $2.70 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 63600112 EAP HCPCS J0881 DARBEPOETIN ALFA 1 BOTH IP/OP $16.00 $12.00 $3.09 $16.00 $7.20 $7.20 $7.20 $7.20 $3.09 $3.09 $3.09 $3.60 $3.09 $3.21 $3.21 $3.34 $3.09 $3.63 $3.09 $3.09 $9.46 $3.09 $16.00 $3.09 $3.25 $12.00 $3.09 $3.09 $3.09 $8.00 $8.00 $12.67 $3.09 $12.80 $7.20 $3.46 $3.09 $9.28 $3.25 $4.49 $3.09 $3.46 $3.09 N/A N/A 63600116 EAP HCPCS J7189 FACTOR 7A NOVOSEVEN BOTH IP/OP $5.00 $4.00 $1.04 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $5.00 $2.33 $5.00 $5.00 $2.40 $2.40 $2.49 $2.31 $1.04 $5.00 $2.00 $5.00 $5.00 $5.00 $5.00 $5.00 $3.75 $5.00 $5.00 $5.00 $2.50 $2.50 $3.96 $5.00 $4.00 $2.25 $5.00 $5.00 $2.90 $5.00 $3.00 $5.00 $5.00 $5.00 N/A N/A 63600119 EAP HCPCS A9552 "F-18 FDG, DX UP TO 45 MCI" BOTH IP/OP "$1,722.00" "$1,274.50" $341.77 "$1,722.00" "$1,722.00" "$1,722.00" "$1,722.00" "$1,722.00" "$1,722.00" "$1,722.00" "$1,722.00" $358.91 "$1,722.00" "$1,722.00" "$1,722.00" "$1,327.32" $897.16 $358.88 "$1,722.00" "$1,722.00" "$1,018.56" "$1,722.00" "$1,722.00" "$1,722.00" "$1,722.00" "$1,291.50" "$1,722.00" "$1,722.00" "$1,722.00" $861.00 $861.00 "$1,363.82" "$1,722.00" "$1,377.60" "$1,119.30" $341.77 "$1,722.00" $998.76 "$1,722.00" "$1,722.00" "$1,722.00" $358.86 "$1,722.00" N/A N/A 63600120 EAP HCPCS A9556 GA-67 GALLIUM CITRA BOTH IP/OP $169.00 $125.50 $35.22 $169.00 $169.00 $169.00 $169.00 $169.00 $169.00 $169.00 $108.14 $169.00 $169.00 $169.00 $169.00 $130.27 $88.05 $35.22 $169.00 $67.60 $169.00 $169.00 $169.00 $169.00 $169.00 $126.75 $169.00 $169.00 $169.00 $84.50 $84.50 $133.85 $169.00 $135.20 $109.85 $169.00 $169.00 $98.02 $169.00 $101.40 $169.00 $169.00 $169.00 N/A N/A 63600121 EAP HCPCS A9530 I-131 THERAPEUTIC PER MCI BOTH IP/OP $26.00 $19.50 $5.42 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $8.61 $26.00 $26.00 $19.30 $19.30 $20.04 $13.55 $5.42 $26.00 $10.40 $26.00 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $16.90 $26.00 $26.00 $15.08 $26.00 $15.60 $26.00 $26.00 $26.00 N/A N/A 63600122 EAP HCPCS A9517 I-131 CAPSULE THERAPEUTIC PER MCI BOTH IP/OP $350.00 $259.00 $20.12 $350.00 $190.05 $190.05 $190.05 $190.05 $20.12 $20.12 $20.12 $72.95 $20.12 $259.77 $259.77 $269.78 $182.35 $72.94 $32.19 $350.00 $207.03 $20.12 $350.00 $20.12 $21.13 $262.50 $20.12 $20.12 $20.12 $175.00 $175.00 $277.20 $20.12 $280.00 $227.50 $69.47 $20.12 $203.00 $21.13 $29.17 $20.12 $72.94 $20.12 N/A N/A 63600133 EAP HCPCS J1885 KETOROLAC 15MG INJ BOTH IP/OP $34.00 $25.50 $0.32 $34.00 $15.30 $15.30 $15.30 $15.30 $34.00 $34.00 $34.00 $0.32 $34.00 $0.57 $0.57 $0.59 $0.55 $0.65 $34.00 $34.00 $20.11 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $15.30 $0.62 $34.00 $19.72 $34.00 $34.00 $34.00 $0.62 $34.00 N/A N/A 63600134 EAP HCPCS J1885 KETOROLAC 30MG BOTH IP/OP $34.00 $25.50 $0.32 $34.00 $15.30 $15.30 $15.30 $15.30 $34.00 $34.00 $34.00 $0.32 $34.00 $0.57 $0.57 $0.59 $0.55 $0.65 $34.00 $34.00 $20.11 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $15.30 $0.62 $34.00 $19.72 $34.00 $34.00 $34.00 $0.62 $34.00 N/A N/A 63600138 EAP HCPCS J0561 PENICILLIN G BENZATHINE INJ BOTH IP/OP $30.00 $22.50 $6.25 $30.00 $13.50 $13.50 $13.50 $13.50 $15.04 $15.04 $15.04 $6.25 $15.04 $15.64 $15.64 $16.24 $15.04 $17.67 $15.04 $18.59 $17.75 $15.04 $30.00 $15.04 $15.80 $22.50 $15.04 $15.04 $15.04 $15.00 $15.00 $23.76 $15.04 $24.00 $13.50 $16.83 $15.04 $17.40 $15.80 $21.81 $15.04 $16.83 $15.04 N/A N/A 63600146 EAP HCPCS Q9967 LOCM 300-349MG/ML I BOTH IP/OP $2.00 $1.50 $0.12 $2.00 $0.90 $0.90 $0.90 $0.90 $2.00 $2.00 $2.00 $0.42 $2.00 $2.00 $2.00 $0.13 $0.12 $0.42 $2.00 $2.00 $1.18 $2.00 $2.00 $2.00 $2.00 $1.50 $2.00 $2.00 $2.00 $1.00 $1.00 $1.58 $2.00 $1.60 $0.90 $0.40 $2.00 $1.16 $2.00 $2.00 $2.00 $0.42 $2.00 N/A N/A 63600170 EAP HCPCS J0561 PENICILLIN G BENZ L BOTH IP/OP $158.00 $117.00 $15.04 $158.00 $71.10 $71.10 $71.10 $71.10 $15.04 $15.04 $15.04 $32.93 $15.04 $15.64 $15.64 $16.24 $15.04 $17.67 $15.04 $18.59 $93.46 $15.04 $158.00 $15.04 $15.80 $118.50 $15.04 $15.04 $15.04 $79.00 $79.00 $125.14 $15.04 $126.40 $71.10 $16.83 $15.04 $91.64 $15.80 $21.81 $15.04 $16.83 $15.04 N/A N/A 63600174 EAP HCPCS J0561 PENICILLIN G BENZ L BOTH IP/OP $159.00 $118.00 $15.04 $159.00 $71.55 $71.55 $71.55 $71.55 $15.04 $15.04 $15.04 $33.14 $15.04 $15.64 $15.64 $16.24 $15.04 $17.67 $15.04 $18.59 $94.05 $15.04 $159.00 $15.04 $15.80 $119.25 $15.04 $15.04 $15.04 $79.50 $79.50 $125.93 $15.04 $127.20 $71.55 $16.83 $15.04 $92.22 $15.80 $21.81 $15.04 $16.83 $15.04 N/A N/A 63600182 EAP HCPCS J2820 SARGRAMOSTIM 50MCG BOTH IP/OP $174.00 $129.00 $51.55 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $51.55 $174.00 $174.00 $55.70 $55.70 $57.84 $53.56 $62.92 $174.00 $69.60 $174.00 $174.00 $174.00 $174.00 $174.00 $130.50 $174.00 $174.00 $174.00 $87.00 $87.00 $137.81 $174.00 $139.20 $78.30 $174.00 $174.00 $100.92 $174.00 $104.40 $174.00 $174.00 $174.00 N/A N/A 63600183 EAP HCPCS A9560 "TC-99M LABELED RBC, DX UP TO 30 MCI" BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $371.00 $371.00 $371.00 $371.00 $371.00 $371.00 $371.00 $77.33 $371.00 $371.00 $371.00 $285.97 $193.29 $77.32 $371.00 $371.00 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $241.15 $73.63 $371.00 $215.18 $371.00 $371.00 $371.00 $77.32 $371.00 N/A N/A 63600192 EAP HCPCS J3420 VITAMIN B-12 1000MG BOTH IP/OP $32.00 $24.00 $0.31 $32.00 $14.40 $14.40 $14.40 $14.40 $32.00 $32.00 $32.00 $0.31 $32.00 $1.87 $1.87 $1.94 $1.80 $2.11 $32.00 $32.00 $18.93 $32.00 $32.00 $32.00 $32.00 $24.00 $32.00 $32.00 $32.00 $16.00 $16.00 $25.34 $32.00 $25.60 $14.40 $2.01 $32.00 $18.56 $32.00 $32.00 $32.00 $2.01 $32.00 N/A N/A 63600209 EAP HCPCS A9551 TC-99M DMSA NUC BOTH IP/OP "$1,886.00" "$1,396.00" $165.00 "$1,886.00" "$1,886.00" "$1,886.00" "$1,886.00" "$1,886.00" "$1,886.00" "$1,886.00" $165.00 "$1,886.00" "$1,886.00" "$1,886.00" "$1,886.00" "$1,453.73" $982.61 $393.06 "$1,886.00" $754.40 "$1,886.00" "$1,886.00" "$1,886.00" "$1,886.00" "$1,886.00" "$1,414.50" "$1,886.00" "$1,886.00" "$1,886.00" $943.00 $943.00 "$1,493.71" "$1,886.00" "$1,508.80" "$1,225.90" "$1,886.00" "$1,886.00" "$1,093.88" "$1,886.00" "$1,131.60" "$1,886.00" "$1,886.00" "$1,886.00" N/A N/A 63600210 EAP HCPCS A9600 SR-89 STRONTIUM CHLORIDE THERAPEUTIC PER MCI BOTH IP/OP "$3,784.00" "$2,800.50" $788.63 "$3,784.00" "$3,784.00" "$3,784.00" "$3,784.00" "$3,784.00" "$3,784.00" "$3,784.00" "$1,650.08" "$3,784.00" "$3,784.00" "$2,808.48" "$2,808.48" "$2,916.71" "$1,971.46" $788.63 "$3,784.00" "$1,513.60" "$3,784.00" "$3,784.00" "$3,784.00" "$3,784.00" "$3,784.00" "$2,838.00" "$3,784.00" "$3,784.00" "$3,784.00" "$1,892.00" "$1,892.00" "$2,996.93" "$3,784.00" "$3,027.20" "$2,459.60" "$3,784.00" "$3,784.00" "$2,194.72" "$3,784.00" "$2,270.40" "$3,784.00" "$3,784.00" "$3,784.00" N/A N/A 63600211 EAP HCPCS A9604 SM-153 SAMARIUM LEXIDRONAM THERAPEUTIC UP TO 150 MCI BOTH IP/OP "$48,815.00" "$36,123.50" "$2,060.15" "$48,815.00" "$48,815.00" "$48,815.00" "$48,815.00" "$48,815.00" "$48,815.00" "$48,815.00" "$11,723.68" "$48,815.00" "$48,815.00" "$4,181.12" "$4,181.12" "$37,626.60" "$2,060.15" "$10,173.58" "$48,815.00" "$19,526.00" "$48,815.00" "$48,815.00" "$48,815.00" "$48,815.00" "$48,815.00" "$36,611.25" "$48,815.00" "$48,815.00" "$48,815.00" "$24,407.50" "$24,407.50" "$38,661.48" "$48,815.00" "$39,052.00" "$31,729.75" "$48,815.00" "$48,815.00" "$28,312.70" "$48,815.00" "$29,289.00" "$48,815.00" "$48,815.00" "$48,815.00" N/A N/A 63600212 EAP HCPCS A9548 "IN-111 PENTETATE, DX PER 0.5 MCI" BOTH IP/OP "$7,022.00" "$5,196.50" $529.92 "$7,022.00" "$7,022.00" "$7,022.00" "$7,022.00" "$7,022.00" "$7,022.00" "$7,022.00" $529.92 "$7,022.00" "$7,022.00" "$7,022.00" "$7,022.00" "$5,412.56" "$2,060.15" "$1,463.46" "$7,022.00" "$2,808.80" "$7,022.00" "$7,022.00" "$7,022.00" "$7,022.00" "$7,022.00" "$5,266.50" "$7,022.00" "$7,022.00" "$7,022.00" "$3,511.00" "$3,511.00" "$5,561.42" "$7,022.00" "$5,617.60" "$4,564.30" "$7,022.00" "$7,022.00" "$4,072.76" "$7,022.00" "$4,213.20" "$7,022.00" "$7,022.00" "$7,022.00" N/A N/A 63600214 EAP HCPCS A9595 "PIFLUFOLASTAT F-18, DX, 1 MCI (PYLARIFY)" BOTH IP/OP "$1,354.00" "$1,002.00" $268.74 "$1,354.00" $735.22 $735.22 $735.22 $735.22 $541.78 $541.78 $541.78 $282.21 $541.78 "$1,004.94" "$1,004.94" "$1,043.66" $705.43 $282.19 $866.84 "$1,354.00" $800.89 $541.78 "$1,354.00" $541.78 $568.87 "$1,015.50" $541.78 $541.78 $541.78 $677.00 $677.00 "$1,072.37" $541.78 "$1,083.20" $880.10 $268.74 $541.78 $785.32 $568.87 $785.58 $541.78 $282.17 $541.78 N/A N/A 63600324 EAP CPT® 90632 HEP A VACCINE BOTH IP/OP $72.00 $53.50 $32.40 $72.43 $32.40 $32.40 $32.40 $32.40 $72.00 $72.00 $72.00 $56.67 $72.00 $67.33 $67.33 $69.92 $64.74 $72.00 $72.00 $72.00 $42.59 $72.00 $72.00 $72.00 $72.00 $54.00 $72.00 $72.00 $72.00 $36.00 $36.00 $57.02 $72.00 $57.60 $32.40 $72.00 $72.00 $41.76 $72.00 $72.00 $72.00 $72.43 $72.00 N/A N/A 63600325 EAP CPT® 90633 HEPA VACCINE PED/ADOL 2 DOSE IM BOTH IP/OP $72.00 $53.50 $9.40 $72.00 $32.40 $32.40 $32.40 $32.40 $72.00 $72.00 $72.00 $9.40 $72.00 $36.24 $36.24 $37.64 $34.85 $15.01 $72.00 $72.00 $42.59 $72.00 $72.00 $72.00 $72.00 $54.00 $72.00 $72.00 $72.00 $36.00 $36.00 $57.02 $72.00 $57.60 $32.40 $14.29 $72.00 $41.76 $72.00 $72.00 $72.00 $15.00 $72.00 N/A N/A 63600326 EAP CPT® 90636 HEP A/B TWINRX VACCINE BOTH IP/OP $98.00 $73.00 $44.10 $125.70 $44.10 $44.10 $44.10 $44.10 $98.00 $98.00 $98.00 $107.88 $98.00 $116.84 $116.84 $121.34 $112.35 $98.00 $98.00 $98.00 $57.97 $98.00 $98.00 $98.00 $98.00 $73.50 $98.00 $98.00 $98.00 $49.00 $49.00 $77.62 $98.00 $78.40 $44.10 $98.00 $98.00 $56.84 $98.00 $98.00 $98.00 $125.70 $98.00 N/A N/A 63600327 EAP CPT® 90647 PEDVAXHIB VACCINE BOTH IP/OP $38.00 $28.50 $7.54 $38.00 $17.10 $17.10 $17.10 $17.10 $38.00 $38.00 $38.00 $7.92 $38.00 $29.17 $29.17 $30.29 $28.05 $7.92 $38.00 $38.00 $22.48 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $17.10 $7.54 $38.00 $22.04 $38.00 $38.00 $38.00 $7.92 $38.00 N/A N/A 63600335 EAP CPT® 90675 RABIES VACCINE BOTH IP/OP "$1,011.00" $748.50 $327.53 "$1,011.00" "$1,011.00" "$1,011.00" "$1,011.00" "$1,011.00" "$1,011.00" "$1,011.00" $327.53 "$1,011.00" "$1,011.00" $355.63 $355.63 $369.31 $341.95 $401.74 "$1,011.00" $404.40 "$1,011.00" "$1,011.00" "$1,011.00" "$1,011.00" "$1,011.00" $758.25 "$1,011.00" "$1,011.00" "$1,011.00" $505.50 $505.50 $800.71 "$1,011.00" $808.80 $454.95 "$1,011.00" "$1,011.00" $586.38 "$1,011.00" $606.60 "$1,011.00" "$1,011.00" "$1,011.00" N/A N/A 63600336 EAP CPT® 90680 ROTAVIRUS 3 DOSE VACCINE BOTH IP/OP $108.00 $80.00 $21.44 $108.00 $48.60 $48.60 $48.60 $48.60 $108.00 $108.00 $108.00 $22.51 $108.00 $94.12 $94.12 $97.74 $90.50 $22.51 $108.00 $43.20 $63.88 $108.00 $108.00 $108.00 $108.00 $81.00 $108.00 $108.00 $108.00 $54.00 $54.00 $85.54 $108.00 $86.40 $48.60 $21.44 $108.00 $62.64 $108.00 $108.00 $108.00 $22.51 $108.00 N/A N/A 63600337 EAP CPT® 90698 PENTACEL VACCINE BOTH IP/OP $130.00 $96.50 $75.40 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $84.50 $130.00 $130.00 $75.40 $130.00 $130.00 $130.00 $130.00 $130.00 N/A N/A 63600338 EAP CPT® 90700 DTAP VACCINE BOTH IP/OP $38.00 $28.50 $7.54 $38.00 $17.10 $17.10 $17.10 $17.10 $38.00 $38.00 $38.00 $7.92 $38.00 $27.36 $27.36 $28.41 $26.31 $7.92 $38.00 $38.00 $22.48 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $17.10 $7.54 $38.00 $22.04 $38.00 $38.00 $38.00 $7.92 $38.00 N/A N/A 63600344 EAP CPT® 90707 MMR VACCINE BOTH IP/OP $83.00 $61.50 $11.75 $97.68 $37.35 $37.35 $37.35 $37.35 $83.00 $83.00 $83.00 $11.75 $83.00 $90.80 $90.80 $94.29 $87.31 $83.00 $83.00 $83.00 $49.09 $83.00 $83.00 $83.00 $83.00 $62.25 $83.00 $83.00 $83.00 $41.50 $41.50 $65.74 $83.00 $66.40 $37.35 $83.00 $83.00 $48.14 $83.00 $83.00 $83.00 $97.68 $83.00 N/A N/A 63600346 EAP CPT® 90710 MMRV VACCINE BOTH IP/OP $19.00 $14.50 $3.77 $270.02 $8.55 $8.55 $8.55 $8.55 $19.00 $19.00 $19.00 $3.96 $19.00 $260.02 $260.02 $270.02 $250.02 $3.96 $19.00 $160.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $8.55 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 63600348 EAP CPT® 90713 POLIO VACCINE BOTH IP/OP $32.00 $24.00 $9.40 $41.27 $14.40 $14.40 $14.40 $14.40 $32.00 $32.00 $32.00 $9.40 $32.00 $38.37 $38.37 $39.84 $36.89 $32.00 $32.00 $32.00 $18.93 $32.00 $32.00 $32.00 $32.00 $24.00 $32.00 $32.00 $32.00 $16.00 $16.00 $25.34 $32.00 $25.60 $14.40 $32.00 $32.00 $18.56 $32.00 $32.00 $32.00 $41.27 $32.00 N/A N/A 63600349 EAP CPT® 90714 TENIVAC VACCINE BOTH IP/OP $30.00 $22.50 $11.75 $30.99 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $30.00 $11.75 $30.00 $28.81 $28.81 $29.92 $27.70 $30.00 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $30.00 $30.00 $17.40 $30.00 $30.00 $30.00 $30.99 $30.00 N/A N/A 63600350 EAP CPT® 90715 TDAP VACCINE BOTH IP/OP $54.00 $40.00 $11.25 $54.00 $24.30 $24.30 $24.30 $24.30 $54.00 $54.00 $54.00 $11.25 $54.00 $37.61 $37.61 $39.05 $36.16 $42.48 $54.00 $54.00 $31.94 $54.00 $54.00 $54.00 $54.00 $40.50 $54.00 $54.00 $54.00 $27.00 $27.00 $42.77 $54.00 $43.20 $24.30 $40.46 $54.00 $31.32 $54.00 $54.00 $54.00 $40.46 $54.00 N/A N/A 63600351 EAP CPT® 90716 VARICELLA VACCINE BOTH IP/OP $414.00 $306.50 $9.40 $414.00 $186.30 $186.30 $186.30 $186.30 $414.00 $414.00 $144.82 $9.40 $414.00 $157.02 $157.02 $163.06 $150.98 $177.38 $414.00 $165.60 $244.88 $414.00 $414.00 $414.00 $414.00 $310.50 $414.00 $414.00 $414.00 $207.00 $207.00 $327.89 $414.00 $331.20 $186.30 $168.92 $414.00 $240.12 $414.00 $248.40 $414.00 $168.92 $414.00 N/A N/A 63600355 EAP CPT® 90723 DTAP HEPB VACCINE BOTH IP/OP $108.00 $80.00 $21.44 $108.00 $48.60 $48.60 $48.60 $48.60 $108.00 $108.00 $85.84 $22.51 $108.00 $93.65 $93.65 $97.25 $90.05 $22.51 $108.00 $43.20 $63.88 $108.00 $108.00 $108.00 $108.00 $81.00 $108.00 $108.00 $108.00 $54.00 $54.00 $85.54 $108.00 $86.40 $48.60 $21.44 $108.00 $62.64 $108.00 $64.80 $108.00 $22.51 $108.00 N/A N/A 63600360 EAP CPT® 90746 HEP B VACCINE ADULT 3 DOSE BOTH IP/OP $230.00 $170.50 $32.66 $230.00 $103.50 $103.50 $103.50 $103.50 $59.80 $59.80 $69.65 $70.16 $59.80 $73.20 $73.20 $76.01 $70.38 $82.69 $230.00 $92.00 $136.05 $59.80 $59.80 $59.80 $230.00 $172.50 $59.80 $32.66 $59.80 $115.00 $115.00 $182.16 $59.80 $184.00 $103.50 $78.74 $59.80 $133.40 $230.00 $138.00 $59.80 $78.74 $59.80 N/A N/A 63600374 EAP HCPCS J0561 PENICILLIN G BENZ LA 1.2 MU BOTH IP/OP $159.00 $118.00 $15.04 $159.00 $71.55 $71.55 $71.55 $71.55 $15.04 $15.04 $15.04 $33.14 $15.04 $15.64 $15.64 $16.24 $15.04 $17.67 $15.04 $18.59 $94.05 $15.04 $159.00 $15.04 $15.80 $119.25 $15.04 $15.04 $15.04 $79.50 $79.50 $125.93 $15.04 $127.20 $71.55 $16.83 $15.04 $92.22 $15.80 $21.81 $15.04 $16.83 $15.04 N/A N/A 63600380 EAP HCPCS J0131 "ACETAMINOPHEN, IV 1000MG/100 ML" BOTH IP/OP $58.00 $43.00 $0.23 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $0.23 $58.00 $58.00 $0.25 $0.25 $0.26 $0.24 $12.09 $58.00 $23.20 $58.00 $58.00 $58.00 $58.00 $58.00 $43.50 $58.00 $58.00 $58.00 $29.00 $29.00 $45.94 $58.00 $46.40 $26.10 $58.00 $58.00 $33.64 $58.00 $34.80 $58.00 $58.00 $58.00 N/A N/A 63600381 EAP HCPCS J0461 "ATROPINE 0.4MG/ML,20 ML" BOTH IP/OP $124.00 $92.00 $0.09 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $0.09 $0.09 $0.10 $0.09 $0.11 $124.00 $124.00 $73.35 $124.00 $124.00 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $0.10 $124.00 $71.92 $124.00 $124.00 $124.00 $0.10 $124.00 N/A N/A 63600382 EAP HCPCS J0690 "CEFAZOLIN SODIUM, 1 GM VIAL" BOTH IP/OP $16.00 $12.00 $0.69 $16.00 $7.20 $7.20 $7.20 $7.20 $16.00 $16.00 $16.00 $0.69 $16.00 $0.80 $0.80 $0.83 $0.77 $0.90 $16.00 $16.00 $9.46 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $7.20 $0.86 $16.00 $9.28 $16.00 $16.00 $16.00 $0.86 $16.00 N/A N/A 63600383 EAP HCPCS S0077 "CLINDAMYCIN PHOSPHATE, 300 MG" BOTH IP/OP $39.00 $29.00 $1.35 $39.00 $17.55 $17.55 $17.55 $17.55 $39.00 $39.00 $1.35 $3.54 $39.00 $2.19 $2.19 $2.28 $2.11 $1.66 $39.00 $15.60 $23.07 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $17.55 $1.58 $39.00 $22.62 $39.00 $23.40 $39.00 $1.58 $39.00 N/A N/A 63600384 EAP HCPCS J1100 "DEXAMETHASONE,4MG/ML 5ML" BOTH IP/OP $16.00 $12.00 $0.11 $16.00 $7.20 $7.20 $7.20 $7.20 $16.00 $16.00 $16.00 $0.11 $16.00 $0.12 $0.12 $0.13 $0.12 $0.14 $16.00 $16.00 $9.46 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $7.20 $0.13 $16.00 $9.28 $16.00 $16.00 $16.00 $0.13 $16.00 N/A N/A 63600385 EAP HCPCS J1200 DIPHENHYDRAMINE HCI UP TO 50 MG BOTH IP/OP $16.00 $12.00 $0.86 $16.00 $7.20 $7.20 $7.20 $7.20 $16.00 $16.00 $16.00 $0.86 $16.00 $1.10 $1.10 $1.14 $1.06 $1.25 $16.00 $16.00 $9.46 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $7.20 $1.19 $16.00 $9.28 $16.00 $16.00 $16.00 $1.19 $16.00 N/A N/A 63600386 EAP HCPCS J0171 "EPINEPHRINE1 MG/1 ML, 30 ML" BOTH IP/OP $27.00 $20.00 $0.72 $27.00 $12.15 $12.15 $12.15 $12.15 $27.00 $27.00 $27.00 $5.63 $27.00 $0.75 $0.75 $0.78 $0.72 $0.85 $27.00 $27.00 $15.97 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $12.15 $0.81 $27.00 $15.66 $27.00 $27.00 $27.00 $0.81 $27.00 N/A N/A 63600387 EAP HCPCS J1940 "FUROSEMIDE, UP TO 20 MG" BOTH IP/OP $16.00 $12.00 $0.25 $16.00 $7.20 $7.20 $7.20 $7.20 $16.00 $16.00 $16.00 $0.25 $16.00 $0.54 $0.54 $0.56 $0.52 $0.61 $16.00 $16.00 $9.46 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $7.20 $0.58 $16.00 $9.28 $16.00 $16.00 $16.00 $0.58 $16.00 N/A N/A 63600388 EAP HCPCS J1644 "HEPARIN SODIUM, PER 1000 UNITS/ML, 10 ML" BOTH IP/OP $16.00 $12.00 $0.24 $16.00 $7.20 $7.20 $7.20 $7.20 $16.00 $16.00 $0.25 $0.24 $16.00 $0.26 $0.26 $0.27 $0.25 $0.29 $16.00 $16.00 $9.46 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $7.20 $0.28 $16.00 $9.28 $16.00 $16.00 $16.00 $0.28 $16.00 N/A N/A 63600389 EAP HCPCS J0360 "HYDRALAZINE HCI, UP TO 20 MG" BOTH IP/OP $47.00 $35.00 $5.35 $47.00 $21.15 $21.15 $21.15 $21.15 $47.00 $47.00 $47.00 $5.77 $47.00 $5.56 $5.56 $5.78 $5.35 $6.29 $47.00 $47.00 $27.80 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $21.15 $5.99 $47.00 $27.26 $47.00 $47.00 $47.00 $5.99 $47.00 N/A N/A 63600390 EAP HCPCS J1720 "HYDROCORTISONE SOD SUCC UP, TO 100" BOTH IP/OP $19.00 $14.50 $3.96 $19.00 $8.55 $8.55 $8.55 $8.55 $19.00 $19.00 $19.00 $3.96 $19.00 $15.35 $15.35 $15.94 $14.76 $17.34 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $8.55 $16.51 $19.00 $11.02 $19.00 $19.00 $19.00 $16.51 $19.00 N/A N/A 63600391 EAP HCPCS J1885 KETOROLAC 60MG/2ML BOTH IP/OP $16.00 $12.00 $0.32 $16.00 $7.20 $7.20 $7.20 $7.20 $16.00 $16.00 $16.00 $0.32 $16.00 $0.57 $0.57 $0.59 $0.55 $0.65 $16.00 $16.00 $9.46 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $7.20 $0.62 $16.00 $9.28 $16.00 $16.00 $16.00 $0.62 $16.00 N/A N/A 63600392 EAP HCPCS J2405 "ONDANSETRON HCI, PER 1MG" BOTH IP/OP $16.00 $12.00 $0.08 $16.00 $7.20 $7.20 $7.20 $7.20 $16.00 $16.00 $16.00 $0.25 $16.00 $0.08 $0.08 $0.09 $0.08 $0.09 $16.00 $16.00 $9.46 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $7.20 $0.09 $16.00 $9.28 $16.00 $16.00 $16.00 $0.09 $16.00 N/A N/A 63600393 EAP HCPCS J2590 "OXYTOCIN, UP TO 10 UNITS" BOTH IP/OP $16.00 $12.00 $0.87 $16.00 $7.20 $7.20 $7.20 $7.20 $16.00 $16.00 $16.00 $1.47 $16.00 $0.90 $0.90 $0.94 $0.87 $3.33 $16.00 $16.00 $9.46 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $7.20 $3.18 $16.00 $9.28 $16.00 $16.00 $16.00 $16.00 $16.00 N/A N/A 63600394 EAP HCPCS J2370 "PHENYLEPHRINE 10MG/ML, 1ML" BOTH IP/OP $47.00 $35.00 $0.96 $47.00 $21.15 $21.15 $21.15 $21.15 $47.00 $47.00 $47.00 $0.96 $47.00 $3.49 $3.49 $3.63 $3.36 $3.95 $47.00 $47.00 $27.80 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $21.15 $3.76 $47.00 $27.26 $47.00 $47.00 $47.00 $3.76 $47.00 N/A N/A 63600395 EAP HCPCS J0330 "SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG/ML,10 ML" BOTH IP/OP $33.00 $24.50 $1.10 $33.00 $14.85 $14.85 $14.85 $14.85 $33.00 $33.00 $33.00 $6.88 $33.00 $1.14 $1.14 $1.19 $1.10 $6.88 $33.00 $33.00 $19.52 $33.00 $33.00 $33.00 $33.00 $24.75 $33.00 $33.00 $33.00 $16.50 $16.50 $26.14 $33.00 $26.40 $14.85 $6.55 $33.00 $19.14 $33.00 $33.00 $33.00 $6.88 $33.00 N/A N/A 63600396 EAP HCPCS J3370 VANCOMYCIN 1GM VIAL BOTH IP/OP $24.00 $18.00 $2.78 $24.00 $10.80 $10.80 $10.80 $10.80 $24.00 $24.00 $24.00 $3.62 $24.00 $2.89 $2.89 $3.00 $2.78 $3.27 $24.00 $24.00 $14.20 $24.00 $24.00 $24.00 $24.00 $18.00 $24.00 $24.00 $24.00 $12.00 $12.00 $19.01 $24.00 $19.20 $10.80 $3.11 $24.00 $13.92 $24.00 $24.00 $24.00 $3.11 $24.00 N/A N/A 63600402 EAP HCPCS J2791 "NJX, RHO(D) IMMUNE GLOBULIN (HUMAN), (RHOPHYLAC)" BOTH IP/OP $534.00 $395.50 $4.71 $534.00 $240.30 $240.30 $240.30 $240.30 $534.00 $534.00 $534.00 $111.30 $534.00 $4.90 $4.90 $5.09 $4.71 $5.53 $534.00 $534.00 $315.86 $534.00 $534.00 $534.00 $534.00 $400.50 $534.00 $534.00 $534.00 $267.00 $267.00 $422.93 $534.00 $427.20 $240.30 $5.27 $534.00 $309.72 $534.00 $534.00 $534.00 $5.27 $534.00 N/A N/A 63600404 EAP HCPCS J7194 FACTOR 9 BOTH IP/OP $2.00 $1.50 $0.42 $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $2.00 $1.54 $2.00 $2.00 $1.59 $1.59 $1.65 $1.53 $0.42 $2.00 $0.80 $2.00 $2.00 $2.00 $2.00 $2.00 $1.50 $2.00 $2.00 $2.00 $1.00 $1.00 $1.58 $2.00 $1.60 $0.90 $2.00 $2.00 $1.16 $2.00 $1.20 $2.00 $2.00 $2.00 N/A N/A 63600405 EAP HCPCS J2790 RH IMMUNE GLOBULIN- 300 MCG BOTH IP/OP $131.00 $97.00 $58.95 $131.00 $58.95 $58.95 $58.95 $58.95 $131.00 $131.00 $131.00 $101.36 $131.00 $82.15 $82.15 $85.31 $78.99 $92.80 $131.00 $131.00 $77.49 $131.00 $131.00 $131.00 $131.00 $98.25 $131.00 $131.00 $131.00 $65.50 $65.50 $103.75 $131.00 $104.80 $58.95 $88.37 $131.00 $75.98 $131.00 $131.00 $131.00 $88.37 $131.00 N/A N/A 63600460 EAP HCPCS J7189 NOVOSEVEN F7 1.0 BOTH IP/OP "$5,380.00" "$3,981.50" $2.31 "$5,380.00" "$5,380.00" "$5,380.00" "$5,380.00" "$5,380.00" "$5,380.00" "$5,380.00" $2.33 "$5,380.00" "$5,380.00" $2.40 $2.40 $2.49 $2.31 "$1,121.25" "$5,380.00" "$2,152.00" "$5,380.00" "$5,380.00" "$5,380.00" "$5,380.00" "$5,380.00" "$4,035.00" "$5,380.00" "$5,380.00" "$5,380.00" "$2,690.00" "$2,690.00" "$4,260.96" "$5,380.00" "$4,304.00" "$2,421.00" "$5,380.00" "$5,380.00" "$3,120.40" "$5,380.00" "$3,228.00" "$5,380.00" "$5,380.00" "$5,380.00" N/A N/A 63600461 EAP HCPCS J7189 NOVOSEVEN F7 2.0 BOTH IP/OP "$10,222.00" "$7,564.50" $2.31 "$10,222.00" "$10,222.00" "$10,222.00" "$10,222.00" "$10,222.00" "$10,222.00" "$10,222.00" $2.33 "$10,222.00" "$10,222.00" $2.40 $2.40 $2.49 $2.31 "$2,130.38" "$10,222.00" "$4,088.80" "$10,222.00" "$10,222.00" "$10,222.00" "$10,222.00" "$10,222.00" "$7,666.50" "$10,222.00" "$10,222.00" "$10,222.00" "$5,111.00" "$5,111.00" "$8,095.82" "$10,222.00" "$8,177.60" "$4,599.90" "$10,222.00" "$10,222.00" "$5,928.76" "$10,222.00" "$6,133.20" "$10,222.00" "$10,222.00" "$10,222.00" N/A N/A 63600462 EAP CPT® 90734 MENVEO VACCINE BOTH IP/OP $410.00 $303.50 $9.40 $410.00 $184.50 $184.50 $184.50 $184.50 $410.00 $410.00 $129.26 $9.40 $410.00 $140.16 $140.16 $145.55 $134.77 $158.33 $410.00 $164.00 $242.52 $410.00 $410.00 $410.00 $410.00 $307.50 $410.00 $410.00 $410.00 $205.00 $205.00 $324.72 $410.00 $328.00 $184.50 $150.78 $410.00 $237.80 $410.00 $246.00 $410.00 $150.78 $410.00 N/A N/A 63600467 EAP CPT® 90620 MENINGITIS VACCINE BOTH IP/OP $569.62 $422.00 $118.72 $569.62 $256.33 $256.33 $256.33 $256.33 $569.62 $569.62 $183.95 $118.72 $569.62 $199.42 $199.42 $207.09 $191.75 $225.28 $569.62 $227.85 $336.93 $569.62 $569.62 $569.62 $569.62 $427.22 $569.62 $569.62 $569.62 $284.81 $284.81 $451.14 $569.62 $455.70 $256.33 $214.53 $569.62 $330.38 $569.62 $341.77 $569.62 $214.53 $569.62 N/A N/A 63600526 EAP HCPCS C9250 KIT TISS CLSR 4ML ARTISS FRZN SLNT BOTH IP/OP $811.00 $600.50 $156.84 $811.00 $364.95 $364.95 $364.95 $364.95 $156.84 $156.84 $156.84 $169.03 $156.84 $811.00 $811.00 $811.00 $811.00 $169.02 $156.84 $180.54 $479.71 $156.84 $811.00 $156.84 $164.68 $608.25 $156.84 $156.84 $156.84 $405.50 $405.50 $642.31 $156.84 $648.80 $364.95 $160.96 $156.84 $470.38 $164.68 $227.42 $156.84 $169.01 $156.84 N/A N/A 63600527 EAP HCPCS C9250 KIT TISS CLSR 10ML ARTISS FRZN SLNT BOTH IP/OP "$1,814.00" "$1,342.50" $156.84 "$1,814.00" $816.30 $816.30 $816.30 $816.30 $156.84 $156.84 $156.84 $378.08 $156.84 "$1,814.00" "$1,814.00" "$1,814.00" "$1,814.00" $378.06 $156.84 $180.54 $894.30 $156.84 "$1,814.00" $156.84 $164.68 "$1,360.50" $156.84 $156.84 $156.84 $907.00 $907.00 "$1,436.69" $156.84 "$1,451.20" $816.30 $360.03 $156.84 "$1,052.12" $164.68 $227.42 $156.84 $378.04 $156.84 N/A N/A 63600528 EAP HCPCS C9250 KIT TISS CLSR 2ML ARTISS FRZN SLNT BOTH IP/OP $475.00 $351.50 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $156.84 $156.84 $156.84 $99.00 $156.84 $475.00 $475.00 $475.00 $475.00 $99.00 $156.84 $180.54 $280.96 $156.84 $475.00 $156.84 $164.68 $356.25 $156.84 $156.84 $156.84 $237.50 $237.50 $376.20 $156.84 $380.00 $213.75 $94.28 $156.84 $275.50 $164.68 $227.42 $156.84 $98.99 $156.84 N/A N/A 63603027 EAP HCPCS J1610 GLUCAGON 1 MG BOTH IP/OP $415.00 $307.50 $88.07 $415.00 $186.75 $186.75 $186.75 $186.75 $166.77 $166.77 $166.77 $88.07 $166.77 $173.44 $173.44 $180.11 $166.77 $195.93 $166.77 $190.26 $245.47 $166.77 $415.00 $166.77 $175.11 $311.25 $166.77 $166.77 $166.77 $207.50 $207.50 $328.68 $166.77 $332.00 $186.75 $186.58 $166.77 $240.70 $175.11 $241.82 $166.77 $186.58 $166.77 N/A N/A 63603031 EAP CPT® 90633 HEPA VACCINE PED/ADOL 2 DOSE IM BOTH IP/OP $72.00 $53.50 $9.40 $72.00 $32.40 $32.40 $32.40 $32.40 $72.00 $72.00 $72.00 $9.40 $72.00 $36.24 $36.24 $37.64 $34.85 $15.01 $72.00 $72.00 $42.59 $72.00 $72.00 $72.00 $72.00 $54.00 $72.00 $72.00 $72.00 $36.00 $36.00 $57.02 $72.00 $57.60 $32.40 $14.29 $72.00 $41.76 $72.00 $72.00 $72.00 $15.00 $72.00 N/A N/A 63603176 EAP HCPCS J2792 "RHO(D) IMMUNE GLOBULIN H, SD WINRHO" BOTH IP/OP $215.00 $159.50 $31.42 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $31.42 $215.00 $215.00 $32.78 $32.78 $34.04 $31.52 $37.03 $215.00 $86.00 $215.00 $215.00 $215.00 $215.00 $215.00 $161.25 $215.00 $215.00 $215.00 $107.50 $107.50 $170.28 $215.00 $172.00 $96.75 $215.00 $215.00 $124.70 $215.00 $129.00 $215.00 $215.00 $215.00 N/A N/A 63603287 EAP CPT® 90634 HEPA VACCINE PED/ADOL-3 DOSE-IM BOTH IP/OP $34.00 $25.50 $7.09 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $28.21 $34.00 $34.00 $34.00 $34.00 $34.00 $34.00 $7.09 $34.00 $13.60 $34.00 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $15.30 $34.00 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 63603296 EAP CPT® 90696 DTAP IPV VACCINE BOTH IP/OP $185.00 $137.00 $36.72 $185.00 $83.25 $83.25 $83.25 $83.25 $185.00 $185.00 $185.00 $38.56 $185.00 $57.87 $57.87 $60.09 $55.64 $38.56 $185.00 $185.00 $109.43 $185.00 $185.00 $185.00 $185.00 $138.75 $185.00 $185.00 $185.00 $92.50 $92.50 $146.52 $185.00 $148.00 $83.25 $36.72 $185.00 $107.30 $185.00 $185.00 $185.00 $38.55 $185.00 N/A N/A 63603300 EAP CPT® 90747 HEP B VACCINE IMMUNOSUPRESSED BOTH IP/OP $100.00 $74.00 $14.20 $152.02 $100.00 $100.00 $100.00 $100.00 $26.00 $26.00 $140.76 $100.00 $26.00 $146.39 $146.39 $152.02 $140.76 $100.00 $100.00 $40.00 $100.00 $26.00 $26.00 $26.00 $100.00 $75.00 $26.00 $14.20 $26.00 $50.00 $50.00 $79.20 $26.00 $80.00 $45.00 $100.00 $26.00 $58.00 $100.00 $60.00 $26.00 $100.00 $26.00 N/A N/A 63603301 EAP CPT® 90744 HEP B VACCINE PED/ADULT 3 DOSE BOTH IP/OP $100.00 $74.00 $14.20 $100.00 $45.00 $45.00 $45.00 $45.00 $26.00 $26.00 $28.22 $20.84 $26.00 $29.91 $29.91 $31.06 $28.76 $20.84 $100.00 $40.00 $59.15 $26.00 $26.00 $26.00 $100.00 $75.00 $26.00 $14.20 $26.00 $50.00 $50.00 $79.20 $26.00 $80.00 $45.00 $19.85 $26.00 $58.00 $100.00 $60.00 $26.00 $20.84 $26.00 N/A N/A 63604091 EAP HCPCS C9250 KIT TISS CLSR FRZN SLNT ARTISS 4ML BOTH IP/OP $836.00 $619.00 $156.84 $836.00 $376.20 $376.20 $376.20 $376.20 $156.84 $156.84 $156.84 $174.24 $156.84 $836.00 $836.00 $836.00 $836.00 $174.23 $156.84 $180.54 $494.49 $156.84 $836.00 $156.84 $164.68 $627.00 $156.84 $156.84 $156.84 $418.00 $418.00 $662.11 $156.84 $668.80 $376.20 $165.93 $156.84 $484.88 $164.68 $227.42 $156.84 $174.22 $156.84 N/A N/A 63604093 EAP CPT® 90648 HIBERIX VACCINE BOTH IP/OP $87.19 $65.00 $11.57 $87.19 $39.24 $39.24 $39.24 $39.24 $87.19 $87.19 $87.19 $18.17 $87.19 $12.03 $12.03 $12.50 $11.57 $18.17 $87.19 $87.19 $51.57 $87.19 $87.19 $87.19 $87.19 $65.39 $87.19 $87.19 $87.19 $43.60 $43.60 $69.05 $87.19 $69.75 $39.24 $17.31 $87.19 $50.57 $87.19 $87.19 $87.19 $18.17 $87.19 N/A N/A 63604113 EAP HCPCS J7298 MIRENA IUD 52 MG BOTH IP/OP "$2,345.14" "$1,735.50" $488.79 "$2,345.14" "$1,055.31" "$1,055.31" "$1,055.31" "$1,055.31" "$2,345.14" "$2,345.14" $959.31 $488.79 "$2,345.14" "$1,039.25" "$1,039.25" "$1,079.22" $999.28 "$1,174.00" "$2,345.14" $938.06 "$1,156.15" "$2,345.14" "$2,345.14" "$2,345.14" "$2,345.14" "$1,758.86" "$2,345.14" "$2,345.14" "$2,345.14" "$1,172.57" "$1,172.57" "$1,857.35" "$2,345.14" "$1,876.11" "$1,055.31" "$1,117.99" "$2,345.14" "$1,360.18" "$2,345.14" "$1,407.08" "$2,345.14" "$1,117.99" "$2,345.14" N/A N/A 63604115 EAP HCPCS J7304 CONTRACEPTIVE PATCH (WEEKLY) EA BOTH IP/OP $14.00 $10.50 $2.78 $18.48 $6.30 $6.30 $6.30 $6.30 $14.00 $14.00 $14.00 $18.48 $14.00 $14.00 $14.00 $14.00 $14.00 $2.92 $14.00 $5.60 $8.28 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $6.30 $2.78 $14.00 $8.12 $14.00 $8.40 $14.00 $14.00 $14.00 N/A N/A 63690324 EAP HCPCS J1050 DEPO PROVERA INJECT 1MG BOTH IP/OP $50.00 $37.00 $0.57 $50.00 $22.50 $22.50 $22.50 $22.50 $50.00 $50.00 $50.00 $10.42 $50.00 $0.59 $0.59 $0.62 $0.57 $0.67 $50.00 $50.00 $29.58 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $22.50 $0.64 $50.00 $29.00 $50.00 $50.00 $50.00 $0.64 $50.00 N/A N/A 63690325 EAP HCPCS J0696 CEFTRIAXONE PER 250 MG BOTH IP/OP $35.00 $26.00 $0.48 $35.00 $15.75 $15.75 $15.75 $15.75 $35.00 $35.00 $35.00 $1.41 $35.00 $0.50 $0.50 $0.52 $0.48 $0.56 $35.00 $35.00 $20.70 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $15.75 $0.54 $35.00 $20.30 $35.00 $35.00 $35.00 $0.54 $35.00 N/A N/A 63690332 EAP HCPCS J0694 CEFOXITIN 1GM VIAL BOTH IP/OP $25.00 $18.50 $4.68 $25.00 $11.25 $11.25 $11.25 $11.25 $25.00 $25.00 $25.00 $8.06 $25.00 $4.87 $4.87 $5.05 $4.68 $5.50 $25.00 $25.00 $14.79 $25.00 $25.00 $25.00 $25.00 $18.75 $25.00 $25.00 $25.00 $12.50 $12.50 $19.80 $25.00 $20.00 $11.25 $5.24 $25.00 $14.50 $25.00 $25.00 $25.00 $5.24 $25.00 N/A N/A 63690333 EAP HCPCS J1200 DIPHENHYDRAMINE 50 MG/ML BOTH IP/OP $16.00 $12.00 $0.86 $16.00 $7.20 $7.20 $7.20 $7.20 $16.00 $16.00 $16.00 $0.86 $16.00 $1.10 $1.10 $1.14 $1.06 $1.25 $16.00 $16.00 $9.46 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $7.20 $1.19 $16.00 $9.28 $16.00 $16.00 $16.00 $1.19 $16.00 N/A N/A 63690334 EAP HCPCS J0360 HYDRALAZINE 20MG/1ML BOTH IP/OP $47.00 $35.00 $5.35 $47.00 $21.15 $21.15 $21.15 $21.15 $47.00 $47.00 $47.00 $5.77 $47.00 $5.56 $5.56 $5.78 $5.35 $6.29 $47.00 $47.00 $27.80 $47.00 $47.00 $47.00 $47.00 $35.25 $47.00 $47.00 $47.00 $23.50 $23.50 $37.22 $47.00 $37.60 $21.15 $5.99 $47.00 $27.26 $47.00 $47.00 $47.00 $5.99 $47.00 N/A N/A 63690335 EAP HCPCS J1720 HYDROCORTISONE SOD SUCC 100MG VIAL BOTH IP/OP $19.00 $14.50 $3.96 $19.00 $8.55 $8.55 $8.55 $8.55 $19.00 $19.00 $19.00 $3.96 $19.00 $15.35 $15.35 $15.94 $14.76 $17.34 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $8.55 $16.51 $19.00 $11.02 $19.00 $19.00 $19.00 $16.51 $19.00 N/A N/A 63690336 EAP HCPCS J1885 KETOROLAC 60 MG/2ML BOTH IP/OP $16.00 $12.00 $0.32 $16.00 $7.20 $7.20 $7.20 $7.20 $16.00 $16.00 $16.00 $0.32 $16.00 $0.57 $0.57 $0.59 $0.55 $0.65 $16.00 $16.00 $9.46 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $7.20 $0.62 $16.00 $9.28 $16.00 $16.00 $16.00 $0.62 $16.00 N/A N/A 63690337 EAP HCPCS J2590 OXYTOCIN 10UNIT/1ML BOTH IP/OP $16.00 $12.00 $0.87 $16.00 $7.20 $7.20 $7.20 $7.20 $16.00 $16.00 $16.00 $1.47 $16.00 $0.90 $0.90 $0.94 $0.87 $3.33 $16.00 $16.00 $9.46 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $7.20 $3.18 $16.00 $9.28 $16.00 $16.00 $16.00 $16.00 $16.00 N/A N/A 63690341 EAP CPT® 90656 FLU VACCINE PF > 18 YRS 2018-2019 BOTH IP/OP $25.00 $18.50 $0.01 $25.00 $25.00 $25.00 $25.00 $25.00 $6.50 $6.50 $15.36 $25.00 $6.50 $0.01 $0.01 $0.01 $0.01 $5.21 $25.00 $10.00 $25.00 $6.50 $6.50 $6.50 $25.00 $18.75 $6.50 $3.55 $6.50 $12.50 $12.50 $19.80 $6.50 $20.00 $11.25 $25.00 $6.50 $14.50 $25.00 $3.65 $6.50 $25.00 $6.50 N/A N/A 63690342 EAP CPT® 90685 FLU VACCINE PF 6-35 MONTHS 2018-2019 BOTH IP/OP $25.00 $18.50 $3.55 $25.00 $11.25 $11.25 $11.25 $11.25 $6.50 $6.50 $21.64 $5.21 $6.50 $22.51 $22.51 $23.37 $21.64 $25.00 $25.00 $10.00 $14.79 $6.50 $6.50 $6.50 $25.00 $18.75 $6.50 $3.55 $6.50 $12.50 $12.50 $19.80 $6.50 $20.00 $11.25 $24.21 $6.50 $14.50 $25.00 $3.65 $6.50 $24.21 $6.50 N/A N/A 63690347 EAP CPT® 90688 FLU IIV4 VACCINE SPLT 0.5ML IM (2018-2019) BOTH IP/OP $25.00 $18.50 $3.55 $25.00 $11.25 $11.25 $11.25 $11.25 $6.50 $6.50 $19.91 $5.21 $6.50 $20.71 $20.71 $21.50 $19.91 $23.39 $25.00 $10.00 $14.79 $6.50 $6.50 $6.50 $25.00 $18.75 $6.50 $3.55 $6.50 $12.50 $12.50 $19.80 $6.50 $20.00 $11.25 $22.28 $6.50 $14.50 $25.00 $3.65 $6.50 $22.28 $6.50 N/A N/A 63690350 EAP CPT® 90685 FLU VACCINE PF 6M - 35M 2019-2020 BOTH IP/OP $25.00 $18.50 $3.55 $25.00 $11.25 $11.25 $11.25 $11.25 $6.50 $6.50 $21.64 $5.21 $6.50 $22.51 $22.51 $23.37 $21.64 $25.00 $25.00 $10.00 $14.79 $6.50 $6.50 $6.50 $25.00 $18.75 $6.50 $3.55 $6.50 $12.50 $12.50 $19.80 $6.50 $20.00 $11.25 $24.21 $6.50 $14.50 $25.00 $3.65 $6.50 $24.21 $6.50 N/A N/A 63690351 EAP CPT® 90686 FLU VACCINE PF 3 & UP 2019-2020 BOTH IP/OP $25.00 $18.50 $3.55 $25.00 $11.25 $11.25 $11.25 $11.25 $6.50 $6.50 $25.00 $5.21 $6.50 $21.35 $21.35 $22.17 $20.53 $24.12 $25.00 $10.00 $14.79 $6.50 $6.50 $6.50 $25.00 $18.75 $6.50 $3.55 $6.50 $12.50 $12.50 $19.80 $6.50 $20.00 $11.25 $22.97 $6.50 $14.50 $25.00 $3.65 $6.50 $22.97 $6.50 N/A N/A 63690354 EAP CPT® 90694 FLU VACCINE ADJUVANTED PF >= 65 YEARS (FOR AMB) BOTH IP/OP $161.00 $119.50 $33.56 $161.00 $72.45 $72.45 $72.45 $72.45 $161.00 $161.00 $66.43 $33.56 $161.00 $69.09 $69.09 $71.74 $66.43 $78.04 $161.00 $64.40 $95.23 $161.00 $161.00 $161.00 $161.00 $120.75 $161.00 $161.00 $161.00 $80.50 $80.50 $127.51 $161.00 $128.80 $72.45 $74.32 $161.00 $93.38 $161.00 $96.60 $161.00 $74.32 $161.00 N/A N/A 63690355 EAP CPT® 90674 2020-2021 FLU VACCINE BOTH IP/OP $25.00 $18.50 $3.55 $33.50 $11.25 $11.25 $11.25 $11.25 $6.50 $6.50 $25.00 $5.21 $6.50 $31.14 $31.14 $32.34 $29.94 $25.00 $25.00 $10.00 $14.79 $6.50 $6.50 $6.50 $25.00 $18.75 $6.50 $3.55 $6.50 $12.50 $12.50 $19.80 $6.50 $20.00 $11.25 $25.00 $6.50 $14.50 $25.00 $3.65 $6.50 $33.50 $6.50 N/A N/A 63690358 EAP CPT® 90686 2020-2021 FLU VACCINE BOTH IP/OP $25.00 $18.50 $3.55 $25.00 $11.25 $11.25 $11.25 $11.25 $6.50 $6.50 $25.00 $5.21 $6.50 $21.35 $21.35 $22.17 $20.53 $24.12 $25.00 $10.00 $14.79 $6.50 $6.50 $6.50 $25.00 $18.75 $6.50 $3.55 $6.50 $12.50 $12.50 $19.80 $6.50 $20.00 $11.25 $22.97 $6.50 $14.50 $25.00 $3.65 $6.50 $22.97 $6.50 N/A N/A 63690360 EAP CPT® 90681 ROTAVIRUS 2 DOSE VACCINE BOTH IP/OP $108.00 $80.00 $21.44 $137.19 $48.60 $48.60 $48.60 $48.60 $108.00 $108.00 $121.83 $22.51 $108.00 $132.11 $132.11 $137.19 $127.03 $22.51 $108.00 $43.20 $63.88 $108.00 $108.00 $108.00 $108.00 $81.00 $108.00 $108.00 $108.00 $54.00 $54.00 $85.54 $108.00 $86.40 $48.60 $21.44 $108.00 $62.64 $108.00 $64.80 $108.00 $22.51 $108.00 N/A N/A 63690370 EAP CPT® 90648 ACTHIB VACCINE BOTH IP/OP $71.00 $53.00 $11.57 $71.00 $31.95 $31.95 $31.95 $31.95 $71.00 $71.00 $71.00 $14.80 $71.00 $12.03 $12.03 $12.50 $11.57 $14.80 $71.00 $71.00 $42.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $31.95 $14.09 $71.00 $41.18 $71.00 $71.00 $71.00 $14.80 $71.00 N/A N/A 63690430 EAP HCPCS J0517 RX FASENRA 30MG/ML SOLUTION BOTH IP/OP $447.00 $331.00 $93.17 $447.00 $201.15 $201.15 $201.15 $201.15 $167.44 $167.44 $167.44 $93.17 $167.44 $174.14 $174.14 $180.84 $167.44 $196.72 $167.44 $167.12 $264.40 $167.44 $447.00 $167.44 $175.81 $335.25 $167.44 $167.44 $167.44 $223.50 $223.50 $354.02 $167.44 $357.60 $201.15 $187.33 $167.44 $259.26 $175.81 $242.79 $167.44 $187.33 $167.44 N/A N/A 63690431 EAP HCPCS J3590 RX DUPIXENT 200MG SOLUTION BOTH IP/OP "$4,200.00" "$3,108.00" $833.60 "$4,200.00" "$1,890.00" "$1,890.00" "$1,890.00" "$1,890.00" "$4,200.00" "$4,200.00" "$4,200.00" $875.39 "$4,200.00" "$4,200.00" "$4,200.00" "$4,200.00" "$4,200.00" $875.33 "$4,200.00" "$4,200.00" "$2,070.60" "$4,200.00" "$4,200.00" "$4,200.00" "$4,200.00" "$3,150.00" "$4,200.00" "$4,200.00" "$4,200.00" "$2,100.00" "$2,100.00" "$3,326.40" "$4,200.00" "$3,360.00" "$1,890.00" $833.60 "$4,200.00" "$2,436.00" "$4,200.00" "$4,200.00" "$4,200.00" $875.28 "$4,200.00" N/A N/A 63690434 EAP HCPCS J3590 RX DUPIXENT 300MG SOLUTION BOTH IP/OP "$4,200.00" "$3,108.00" $833.60 "$4,200.00" "$1,890.00" "$1,890.00" "$1,890.00" "$1,890.00" "$4,200.00" "$4,200.00" "$4,200.00" $875.39 "$4,200.00" "$4,200.00" "$4,200.00" "$4,200.00" "$4,200.00" $875.33 "$4,200.00" "$4,200.00" "$2,070.60" "$4,200.00" "$4,200.00" "$4,200.00" "$4,200.00" "$3,150.00" "$4,200.00" "$4,200.00" "$4,200.00" "$2,100.00" "$2,100.00" "$3,326.40" "$4,200.00" "$3,360.00" "$1,890.00" $833.60 "$4,200.00" "$2,436.00" "$4,200.00" "$4,200.00" "$4,200.00" $875.28 "$4,200.00" N/A N/A 63690436 EAP HCPCS J0741 RX CABOTEGRAVIR/RILPIVIRINE 400&600MG/2ML IM BOTH IP/OP $51.08 $38.00 $10.65 $51.08 $22.99 $22.99 $22.99 $22.99 $20.56 $20.56 $20.56 $10.65 $20.56 $21.38 $21.38 $22.20 $20.56 $24.15 $20.56 $21.56 $30.21 $20.56 $51.08 $20.56 $21.58 $38.31 $20.56 $20.56 $20.56 $25.54 $25.54 $40.46 $20.56 $40.86 $22.99 $23.00 $20.56 $29.63 $21.58 $29.81 $20.56 $23.00 $20.56 N/A N/A 63690437 EAP HCPCS J0741 RX CABOTEGRAVIR/RILPIVIRINE 600&900MG/2ML IM BOTH IP/OP $51.08 $38.00 $10.65 $51.08 $22.99 $22.99 $22.99 $22.99 $20.56 $20.56 $20.56 $10.65 $20.56 $21.38 $21.38 $22.20 $20.56 $24.15 $20.56 $21.56 $30.21 $20.56 $51.08 $20.56 $21.58 $38.31 $20.56 $20.56 $20.56 $25.54 $25.54 $40.46 $20.56 $40.86 $22.99 $23.00 $20.56 $29.63 $21.58 $29.81 $20.56 $23.00 $20.56 N/A N/A 63690440 EAP CPT® 90740 IMMUNIZATION-HEP B 3-DOSE IMMUNSUP IM BOTH IP/OP $638.00 $472.50 $90.60 $638.00 $287.10 $287.10 $287.10 $287.10 $165.88 $165.88 $140.76 $140.32 $165.88 $146.39 $146.39 $152.02 $140.76 $132.97 $638.00 $255.20 $377.38 $165.88 $165.88 $165.88 $638.00 $478.50 $165.88 $90.60 $165.88 $319.00 $319.00 $505.30 $165.88 $510.40 $287.10 $126.63 $165.88 $370.04 $638.00 $382.80 $165.88 $132.96 $165.88 N/A N/A 63690441 EAP CPT® 90744 IMMUNIZATION-HEP B 3-DOSE PED/ADOL IM BOTH IP/OP $110.00 $81.50 $15.62 $110.00 $49.50 $49.50 $49.50 $49.50 $28.60 $28.60 $28.22 $22.93 $28.60 $29.91 $29.91 $31.06 $28.76 $22.93 $110.00 $44.00 $65.07 $28.60 $28.60 $28.60 $110.00 $82.50 $28.60 $15.62 $28.60 $55.00 $55.00 $87.12 $28.60 $88.00 $49.50 $21.83 $28.60 $63.80 $110.00 $66.00 $28.60 $22.92 $28.60 N/A N/A 63690442 EAP CPT® 90746 IMMUNIZATION-HEP B 3-DOSE ADULT IM BOTH IP/OP $243.00 $180.00 $34.51 $243.00 $109.35 $109.35 $109.35 $109.35 $63.18 $63.18 $69.65 $70.16 $63.18 $73.20 $73.20 $76.01 $70.38 $82.69 $243.00 $97.20 $143.73 $63.18 $63.18 $63.18 $243.00 $182.25 $63.18 $34.51 $63.18 $121.50 $121.50 $192.46 $63.18 $194.40 $109.35 $78.74 $63.18 $140.94 $243.00 $145.80 $63.18 $78.74 $63.18 N/A N/A 63690445 EAP CPT® 90696 IMMUNIZATION-DTAP-IPV VACCINE 4-6 YRS IM (2022) BOTH IP/OP $236.00 $175.00 $46.84 $236.00 $106.20 $106.20 $106.20 $106.20 $236.00 $236.00 $236.00 $49.19 $236.00 $57.87 $57.87 $60.09 $55.64 $49.18 $236.00 $236.00 $139.59 $236.00 $236.00 $236.00 $236.00 $177.00 $236.00 $236.00 $236.00 $118.00 $118.00 $186.91 $236.00 $188.80 $106.20 $46.84 $236.00 $136.88 $236.00 $236.00 $236.00 $49.18 $236.00 N/A N/A 63690447 EAP CPT® 90697 DTAP- IPV- HIB- HEPB COMBINED VACCINE IM BOTH IP/OP $560.24 $415.00 $111.19 $560.24 $252.11 $252.11 $252.11 $252.11 $560.24 $560.24 $126.74 $116.77 $560.24 $138.08 $138.08 $143.39 $132.77 $116.76 $560.24 $224.10 $331.38 $560.24 $560.24 $560.24 $560.24 $420.18 $560.24 $560.24 $560.24 $280.12 $280.12 $443.71 $560.24 $448.19 $252.11 $111.19 $560.24 $324.94 $560.24 $336.14 $560.24 $116.75 $560.24 N/A N/A 63690450 EAP CPT® 90686 FLU (IIV4) PRSV FREE 0.5 ML 2021-2022 BOTH IP/OP $25.00 $18.50 $3.55 $25.00 $11.25 $11.25 $11.25 $11.25 $6.50 $6.50 $25.00 $5.21 $6.50 $21.35 $21.35 $22.17 $20.53 $24.12 $25.00 $10.00 $14.79 $6.50 $6.50 $6.50 $25.00 $18.75 $6.50 $3.55 $6.50 $12.50 $12.50 $19.80 $6.50 $20.00 $11.25 $22.97 $6.50 $14.50 $25.00 $3.65 $6.50 $22.97 $6.50 N/A N/A 63690460 EAP CPT® 90371 IMMUNIZATION-HEP B IG-IM BOTH IP/OP "$2,487.00" "$1,840.50" $130.31 "$2,487.00" "$2,487.00" "$2,487.00" "$2,487.00" "$2,487.00" "$2,487.00" "$2,487.00" $130.31 "$2,487.00" "$2,487.00" $141.01 $141.01 $146.44 $135.59 $159.30 "$2,487.00" $994.80 "$2,487.00" "$2,487.00" "$2,487.00" "$2,487.00" "$2,487.00" "$1,865.25" "$2,487.00" "$2,487.00" "$2,487.00" "$1,243.50" "$1,243.50" "$1,969.70" "$2,487.00" "$1,989.60" "$1,119.15" "$2,487.00" "$2,487.00" "$1,442.46" "$2,487.00" "$1,492.20" "$2,487.00" "$2,487.00" "$2,487.00" N/A N/A 63690461 EAP CPT® 90677 IMMUNIZATION- PNEUMONIA PREVNAR 20 VACCINE BOTH IP/OP $872.06 $645.50 $173.08 $872.06 $392.43 $392.43 $392.43 $392.43 $872.06 $872.06 $264.74 $181.76 $872.06 $275.33 $275.33 $285.92 $264.74 $181.75 $872.06 $348.82 $515.82 $872.06 $872.06 $872.06 $872.06 $654.05 $872.06 $872.06 $872.06 $436.03 $436.03 $690.67 $872.06 $697.65 $392.43 $173.08 $872.06 $505.79 $872.06 $523.24 $872.06 $181.74 $872.06 N/A N/A 63690462 EAP CPT® 90611 "JYNNEOS SMALLPOX AND MONKEYPOX VACCINE, LIVE" BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 63690463 EAP CPT® 90686 FLU (IIV4) PRSV FREE 0.5 ML 2022-2023 BOTH IP/OP $25.00 $18.50 $3.55 $25.00 $11.25 $11.25 $11.25 $11.25 $6.50 $6.50 $20.53 $5.21 $6.50 $21.35 $21.35 $22.17 $20.53 $24.12 $25.00 $10.00 $14.79 $6.50 $6.50 $6.50 $25.00 $18.75 $6.50 $3.55 $6.50 $12.50 $12.50 $19.80 $6.50 $20.00 $11.25 $22.97 $6.50 $14.50 $25.00 $3.65 $6.50 $22.97 $6.50 N/A N/A 63690900 EAP HCPCS M1145 "MFN DRUG ADD-ON, PER DOSE" BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 68000010 EAP Custom 68000010 LEVEL 2 PARTIAL TRAUMA ACTIVATION W/O PRENOTIFICAT BOTH IP/OP "$14,957.00" "$11,068.50" "$2,662.35" "$16,453.00" "$14,957.00" "$14,957.00" "$14,957.00" "$14,957.00" "$14,957.00" "$14,957.00" "$2,662.35" "$14,957.00" "$14,957.00" "$14,957.00" "$14,957.00" "$14,957.00" "$14,957.00" "$3,117.20" "$14,957.00" "$6,581.20" "$14,957.00" "$14,957.00" "$16,453.00" "$14,957.00" "$14,957.00" "$11,217.75" "$14,957.00" "$14,957.00" "$14,957.00" "$7,478.50" "$7,478.50" "$11,845.94" "$14,957.00" "$11,965.60" "$9,722.05" "$14,957.00" "$14,957.00" "$8,675.06" "$14,957.00" "$8,974.20" "$14,957.00" "$14,957.00" "$14,957.00" N/A N/A 68000065 EAP Custom 68000065 LEVEL 1 FULL TRAUMA ACTIVATION W/O PRENOTIFICATION BOTH IP/OP "$27,981.00" "$20,706.00" "$4,980.62" "$30,779.00" "$27,981.00" "$27,981.00" "$27,981.00" "$27,981.00" "$27,981.00" "$27,981.00" "$4,980.62" "$27,981.00" "$27,981.00" "$27,981.00" "$27,981.00" "$27,981.00" "$27,981.00" "$5,831.55" "$27,981.00" "$12,311.60" "$27,981.00" "$27,981.00" "$30,779.00" "$27,981.00" "$27,981.00" "$20,985.75" "$27,981.00" "$27,981.00" "$27,981.00" "$13,990.50" "$13,990.50" "$22,160.95" "$27,981.00" "$22,384.80" "$18,187.65" "$27,981.00" "$27,981.00" "$16,228.98" "$27,981.00" "$16,788.60" "$27,981.00" "$27,981.00" "$27,981.00" N/A N/A 68100003 EAP Custom 68100003 LEVEL 1 FULL TRAUMA ACTIVATION BOTH IP/OP "$27,981.00" "$20,706.00" "$3,121.76" "$30,779.00" "$5,362.00" "$5,362.00" "$5,362.00" "$5,362.00" "$27,981.00" "$27,981.00" "$4,980.62" "$27,981.00" "$27,981.00" "$4,447.44" "$4,447.44" "$4,618.49" "$3,121.76" "$5,831.55" "$27,981.00" "$12,311.60" "$5,671.00" "$27,981.00" "$30,779.00" "$27,981.00" "$27,981.00" "$20,985.75" "$27,981.00" "$27,981.00" "$27,981.00" "$13,990.50" "$13,990.50" "$22,160.95" "$27,981.00" "$22,384.80" "$18,187.65" "$27,981.00" "$27,981.00" "$16,228.98" "$27,981.00" "$16,788.60" "$27,981.00" "$27,981.00" "$27,981.00" N/A N/A 68100004 EAP Custom 68100004 LEVEL 2 PARTIAL TRAUMA ACTIVATION BOTH IP/OP "$14,957.00" "$11,068.50" "$2,662.35" "$16,453.00" "$5,362.00" "$5,362.00" "$5,362.00" "$5,362.00" "$14,957.00" "$14,957.00" "$2,662.35" "$14,957.00" "$14,957.00" "$4,447.44" "$4,447.44" "$4,618.49" "$3,121.76" "$3,117.20" "$14,957.00" "$6,581.20" "$5,671.00" "$14,957.00" "$16,453.00" "$14,957.00" "$14,957.00" "$11,217.75" "$14,957.00" "$14,957.00" "$14,957.00" "$7,478.50" "$7,478.50" "$11,845.94" "$14,957.00" "$11,965.60" "$9,722.05" "$14,957.00" "$14,957.00" "$8,675.06" "$14,957.00" "$8,974.20" "$14,957.00" "$14,957.00" "$14,957.00" N/A N/A 68100005 EAP Custom 68100005 LEVEL 3 PARTIAL TRAUMA ACTIVATION BOTH IP/OP "$7,507.00" "$5,555.50" "$1,336.25" "$8,258.00" "$5,362.00" "$5,362.00" "$5,362.00" "$5,362.00" "$7,507.00" "$7,507.00" "$1,336.25" "$7,507.00" "$7,507.00" "$4,447.44" "$4,447.44" "$4,618.49" "$3,121.76" "$1,564.54" "$7,507.00" "$3,303.20" "$5,671.00" "$7,507.00" "$8,258.00" "$7,507.00" "$7,507.00" "$5,630.25" "$7,507.00" "$7,507.00" "$7,507.00" "$3,753.50" "$3,753.50" "$5,945.54" "$7,507.00" "$6,005.60" "$4,879.55" "$7,507.00" "$7,507.00" "$4,354.06" "$7,507.00" "$4,504.20" "$7,507.00" "$7,507.00" "$7,507.00" N/A N/A 70000001 EAP CPT® 29035 "APPLY BODY CAST, SHLDR TO HIPS" BOTH IP/OP "$1,410.00" "$1,043.50" $143.63 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $143.63 $143.63 $144.16 "$1,410.00" $143.63 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 $229.81 $232.14 "$1,410.00" $143.63 $145.09 $143.63 "$1,410.00" "$1,057.50" $143.63 $143.63 $143.63 "$1,410.00" $705.00 "$1,116.72" $143.63 "$1,128.00" "$1,410.00" "$1,410.00" $143.63 $817.80 "$1,410.00" $147.05 $143.63 "$1,410.00" $143.63 N/A N/A 70000002 EAP CPT® 29040 APPLY BODY CAST RISSER/MINERVA BOTH IP/OP "$1,062.00" $786.00 $172.79 "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" $172.79 $172.79 $174.19 "$1,062.00" $172.79 "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" $221.33 $276.46 $279.34 "$1,062.00" $172.79 $174.59 $172.79 "$1,062.00" $796.50 $172.79 $172.79 $172.79 "$1,062.00" $531.00 $841.10 $172.79 $849.60 "$1,062.00" "$1,062.00" $172.79 $615.96 "$1,062.00" $178.41 $172.79 "$1,062.00" $172.79 N/A N/A 70000003 EAP CPT® 29065 APPLY LONG ARM CAST BOTH IP/OP "$1,466.00" "$1,085.00" $69.16 "$1,466.00" $796.04 $796.04 $796.04 $796.04 $237.30 $237.30 $236.25 $305.55 $237.30 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $305.53 $379.69 $346.11 $113.00 $237.30 $69.16 $237.30 $249.17 "$1,099.50" $237.30 $237.30 $237.30 "$1,466.00" $733.00 "$1,161.07" $237.30 "$1,172.80" "$1,466.00" $290.96 $237.30 $850.28 $249.17 $343.32 $237.30 $305.51 $237.30 N/A N/A 70000004 EAP CPT® 29075 APPLY SHORT ARM CAST BOTH IP/OP $943.00 $698.00 $63.74 $943.00 $512.05 $512.05 $512.05 $512.05 $237.30 $237.30 $236.25 $196.54 $237.30 $943.00 $943.00 $943.00 $882.37 $196.53 $379.69 $346.11 $113.00 $237.30 $63.74 $237.30 $249.17 $707.25 $237.30 $237.30 $237.30 $943.00 $471.50 $746.86 $237.30 $754.40 $943.00 $187.16 $237.30 $546.94 $249.17 $343.32 $237.30 $196.52 $237.30 N/A N/A 70000005 EAP CPT® 29105 APPLY LONG ARM SPLINT BOTH IP/OP $912.00 $675.00 $42.77 $912.00 $495.22 $495.22 $495.22 $495.22 $138.97 $138.97 $138.36 $190.08 $138.97 $912.00 $912.00 $912.00 $882.37 $190.07 $222.36 $210.28 $113.00 $138.97 $42.77 $138.97 $145.92 $684.00 $138.97 $138.97 $138.97 $912.00 $456.00 $722.30 $138.97 $729.60 $912.00 $181.01 $138.97 $528.96 $145.92 $201.06 $138.97 $190.06 $138.97 N/A N/A 70000006 EAP CPT® 29125 APPLY SHORT ARM SPLINT STATIC BOTH IP/OP "$1,011.00" $748.50 $41.02 "$1,011.00" $548.97 $548.97 $548.97 $548.97 $110.92 $110.92 $110.43 $210.72 $110.92 "$1,011.00" "$1,011.00" "$1,011.00" $882.37 $210.70 $177.47 $167.51 $113.00 $110.92 $41.02 $110.92 $116.46 $758.25 $110.92 $110.92 $110.92 "$1,011.00" $505.50 $800.71 $110.92 $808.80 "$1,011.00" $200.66 $110.92 $586.38 $116.46 $160.47 $110.92 $210.69 $110.92 N/A N/A 70000007 EAP CPT® 29305 "APPLY HIP SPICA CAST, ONE LEG" BOTH IP/OP $612.00 $453.00 $127.55 $612.00 $612.00 $612.00 $612.00 $612.00 $158.37 $158.37 $159.65 $612.00 $158.37 $612.00 $612.00 $612.00 $612.00 $127.55 $253.39 $256.03 $612.00 $158.37 $160.02 $158.37 $612.00 $459.00 $158.37 $158.37 $158.37 $612.00 $306.00 $484.70 $158.37 $489.60 $612.00 $612.00 $158.37 $354.96 $612.00 $163.28 $158.37 $612.00 $158.37 N/A N/A 70000008 EAP CPT® 29325 APPLY HIP SPICA CAST BOTH LEGS BOTH IP/OP "$1,104.00" $817.00 $177.53 "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" $177.53 $177.53 $178.34 "$1,104.00" $177.53 "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" $230.09 $284.05 $286.40 "$1,104.00" $177.53 $179.00 $177.53 "$1,104.00" $828.00 $177.53 $177.53 $177.53 "$1,104.00" $552.00 $874.37 $177.53 $883.20 "$1,104.00" "$1,104.00" $177.53 $640.32 "$1,104.00" $183.46 $177.53 "$1,104.00" $177.53 N/A N/A 70000009 EAP CPT® 29345 APPLY LONG LEG CAST BOTH IP/OP $838.00 $620.50 $100.07 $838.00 $838.00 $838.00 $838.00 $838.00 $100.07 $100.07 $100.58 $838.00 $100.07 $838.00 $838.00 $838.00 $838.00 $174.65 $160.11 $161.12 $838.00 $100.07 $100.70 $100.07 $838.00 $628.50 $100.07 $100.07 $100.07 $838.00 $419.00 $663.70 $100.07 $670.40 $838.00 $838.00 $100.07 $486.04 $838.00 $103.45 $100.07 $838.00 $100.07 N/A N/A 70000010 EAP CPT® 29358 APPLY LONG LEG CAST BRACE BOTH IP/OP "$1,062.00" $786.00 $103.46 "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" $103.46 $103.46 $104.00 "$1,062.00" $103.46 "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" $221.33 $165.54 $166.56 "$1,062.00" $103.46 $104.10 $103.46 "$1,062.00" $796.50 $103.46 $103.46 $103.46 "$1,062.00" $531.00 $841.10 $103.46 $849.60 "$1,062.00" "$1,062.00" $103.46 $615.96 "$1,062.00" $106.69 $103.46 "$1,062.00" $103.46 N/A N/A 70000011 EAP CPT® 29365 APPLY CYLINDER CAST BOTH IP/OP "$1,312.00" $971.00 $87.46 "$1,312.00" "$1,312.00" "$1,312.00" "$1,312.00" "$1,312.00" $87.72 $87.72 $87.46 "$1,312.00" $87.72 "$1,312.00" "$1,312.00" "$1,312.00" "$1,312.00" $273.44 $140.35 $141.04 "$1,312.00" $87.72 $88.15 $87.72 "$1,312.00" $984.00 $87.72 $87.72 $87.72 "$1,312.00" $656.00 "$1,039.10" $87.72 "$1,049.60" "$1,312.00" "$1,312.00" $87.72 $760.96 "$1,312.00" $90.11 $87.72 "$1,312.00" $87.72 N/A N/A 70000012 EAP CPT® 29405 APPLY SHORT LEG CAST BOTH IP/OP $943.00 $698.00 $58.97 $943.00 $512.05 $512.05 $512.05 $512.05 $237.30 $237.30 $236.25 $196.54 $237.30 $943.00 $943.00 $943.00 $882.37 $196.53 $379.69 $346.11 $113.00 $237.30 $58.97 $237.30 $249.17 $707.25 $237.30 $237.30 $237.30 $943.00 $471.50 $746.86 $237.30 $754.40 $943.00 $187.16 $237.30 $546.94 $249.17 $343.32 $237.30 $196.52 $237.30 N/A N/A 70000013 EAP CPT® 29425 APPLY SHORT LEG CAST WALKING BOTH IP/OP "$1,403.00" "$1,038.50" $54.30 "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" $54.30 $54.30 $55.10 "$1,403.00" $54.30 "$1,403.00" "$1,403.00" "$1,403.00" "$1,403.00" $292.40 $86.88 $87.30 "$1,403.00" $54.30 $54.56 $54.30 "$1,403.00" "$1,052.25" $54.30 $54.30 $54.30 "$1,403.00" $701.50 "$1,111.18" $54.30 "$1,122.40" "$1,403.00" "$1,403.00" $54.30 $813.74 "$1,403.00" $57.32 $54.30 "$1,403.00" $54.30 N/A N/A 70000014 EAP CPT® 29435 APPLY SHORT LEG CAST PTB BOTH IP/OP $794.00 $588.00 $80.25 $794.00 $794.00 $794.00 $794.00 $794.00 $80.25 $80.25 $81.92 $794.00 $80.25 $794.00 $794.00 $794.00 $794.00 $165.48 $128.40 $130.74 $794.00 $80.25 $81.71 $80.25 $794.00 $595.50 $80.25 $80.25 $80.25 $794.00 $397.00 $628.85 $80.25 $635.20 $794.00 $794.00 $80.25 $460.52 $794.00 $84.71 $80.25 $794.00 $80.25 N/A N/A 70000015 EAP CPT® 29445 APPL RIGID TOTAL CONTACT LEG CAST BOTH IP/OP "$1,935.00" "$1,432.00" $98.65 "$1,935.00" "$1,050.71" "$1,050.71" "$1,050.71" "$1,050.71" $237.30 $237.30 $236.25 $403.30 $237.30 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $403.28 $379.69 $346.11 $113.00 $237.30 $98.65 $237.30 $249.17 "$1,451.25" $237.30 $237.30 $237.30 "$1,935.00" $967.50 "$1,532.52" $237.30 "$1,548.00" "$1,750.00" $384.05 $237.30 "$1,122.30" $249.17 $343.32 $237.30 $403.25 $237.30 N/A N/A 70000016 EAP CPT® 29505 APPLY LONG LEG SPLINT BOTH IP/OP "$1,630.00" "$1,206.50" $51.50 "$1,630.00" "$1,630.00" "$1,630.00" "$1,630.00" "$1,630.00" $51.50 $51.50 $52.20 "$1,630.00" $51.50 "$1,630.00" "$1,630.00" "$1,630.00" "$1,630.00" $339.71 $82.40 $84.06 "$1,630.00" $51.50 $52.54 $51.50 "$1,630.00" "$1,222.50" $51.50 $51.50 $51.50 "$1,630.00" $815.00 "$1,290.96" $51.50 "$1,304.00" "$1,630.00" "$1,630.00" $51.50 $945.40 "$1,630.00" $52.27 $51.50 "$1,630.00" $51.50 N/A N/A 70000017 EAP CPT® 29515 APPLY SHORT LEG SPLINT BOTH IP/OP $943.00 $698.00 $49.83 $943.00 $512.05 $512.05 $512.05 $512.05 $138.97 $138.97 $138.36 $196.54 $138.97 $943.00 $943.00 $943.00 $882.37 $196.53 $222.36 $210.28 $113.00 $138.97 $49.83 $138.97 $145.92 $707.25 $138.97 $138.97 $138.97 $943.00 $471.50 $746.86 $138.97 $754.40 $943.00 $187.16 $138.97 $546.94 $145.92 $201.06 $138.97 $196.52 $138.97 N/A N/A 70000018 EAP CPT® 29705 REMOVAL FULL ARM/LEG CAST BOTH IP/OP $943.00 $698.00 $45.10 $943.00 $512.05 $512.05 $512.05 $512.05 $237.30 $237.30 $236.25 $196.54 $237.30 $943.00 $943.00 $943.00 $882.37 $196.53 $379.69 $346.11 $113.00 $237.30 $45.10 $237.30 $249.17 $707.25 $237.30 $237.30 $237.30 $943.00 $471.50 $746.86 $237.30 $754.40 $943.00 $187.16 $237.30 $546.94 $249.17 $343.32 $237.30 $196.52 $237.30 N/A N/A 70000019 EAP CPT® 29730 WINDOWING OF CAST BOTH IP/OP $612.00 $453.00 $44.55 $612.00 $612.00 $612.00 $612.00 $612.00 $44.56 $44.56 $44.55 $612.00 $44.56 $612.00 $612.00 $612.00 $612.00 $127.55 $71.30 $71.63 $612.00 $44.56 $44.77 $44.56 $612.00 $459.00 $44.56 $44.56 $44.56 $612.00 $306.00 $484.70 $44.56 $489.60 $612.00 $612.00 $44.56 $354.96 $612.00 $45.07 $44.56 $612.00 $44.56 N/A N/A 70000219 EAP HCPCS C1757 CATHETER THRMB 135CM 5FR UNFS FLW-THRU HUB INFUS BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 70000220 EAP HCPCS C1757 CATHETER THRMB 135CM 5FR UNFS FLW-THRU HUB INFUS BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 70000225 EAP HCPCS C1725 CATHETER ANGIO SOS O2 CURVE 5FR 80CM VSCR RADIOPQ BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 70000282 EAP Custom 70000282 NEEDLE BSCP 140CM 19GA 21GA 15MM STRL 3MM WANG RTRCT TRNBR BOTH IP/OP $133.00 $98.50 $23.67 $133.00 $133.00 $133.00 $133.00 $133.00 $133.00 $133.00 $23.67 $133.00 $133.00 $98.71 $98.71 $102.52 $69.29 $27.72 $133.00 $53.20 $133.00 $133.00 $133.00 $133.00 $133.00 $99.75 $133.00 $133.00 $133.00 $66.50 $66.50 $105.34 $133.00 $106.40 $86.45 $133.00 $133.00 $77.14 $133.00 $79.80 $133.00 $133.00 $133.00 N/A N/A 70000311 EAP HCPCS A4344 CATHETER URTH 16FR 30ML STRL LF BARD LBRSL 2W FL BLN SIL BOTH IP/OP $224.00 $166.00 $44.46 $224.00 $121.63 $121.63 $121.63 $121.63 $224.00 $224.00 $224.00 $46.69 $224.00 $166.25 $166.25 $172.66 $116.70 $46.68 $224.00 $224.00 $132.50 $224.00 $224.00 $224.00 $224.00 $168.00 $224.00 $224.00 $224.00 $112.00 $112.00 $177.41 $224.00 $179.20 $145.60 $44.46 $224.00 $129.92 $224.00 $224.00 $224.00 $46.68 $224.00 N/A N/A 70000562 EAP HCPCS C1884 COIL 500-710 MICRON (2VL/BX) BOTH IP/OP $734.00 $543.50 $145.68 $734.00 $330.30 $330.30 $330.30 $330.30 $734.00 $734.00 $734.00 $152.98 $734.00 $734.00 $734.00 $734.00 $734.00 $152.97 $734.00 $734.00 $434.16 $734.00 $734.00 $734.00 $734.00 $550.50 $734.00 $734.00 $734.00 $367.00 $367.00 $581.33 $734.00 $587.20 $330.30 $145.68 $734.00 $425.72 $734.00 $734.00 $734.00 $152.97 $734.00 N/A N/A 70000577 EAP HCPCS C1884 COIL 710-1000 MICRON (2VL/BX) BOTH IP/OP $734.00 $543.50 $145.68 $734.00 $330.30 $330.30 $330.30 $330.30 $734.00 $734.00 $734.00 $152.98 $734.00 $734.00 $734.00 $734.00 $734.00 $152.97 $734.00 $734.00 $434.16 $734.00 $734.00 $734.00 $734.00 $550.50 $734.00 $734.00 $734.00 $367.00 $367.00 $581.33 $734.00 $587.20 $330.30 $145.68 $734.00 $425.72 $734.00 $734.00 $734.00 $152.97 $734.00 N/A N/A 70000584 EAP HCPCS C1876 STENT ENDOPRSTH TRCHBR 90MM 16MM 9FR MTL WLSTNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 "$2,250.00" "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 70000587 EAP HCPCS C1769 GUIDEWIRE VASC 260CM .035IN FLXB FLPY TIP FLTWR BOTH IP/OP "$2,653.00" "$1,963.50" $526.55 "$2,653.00" "$1,440.58" "$1,440.58" "$1,440.58" "$1,440.58" "$2,653.00" "$2,653.00" "$2,653.00" $552.95 "$2,653.00" "$1,969.06" "$1,969.06" "$2,044.93" "$1,382.21" $552.91 "$2,653.00" "$2,653.00" "$1,569.25" "$2,653.00" "$2,653.00" "$2,653.00" "$2,653.00" "$1,989.75" "$2,653.00" "$2,653.00" "$2,653.00" "$1,326.50" "$1,326.50" "$2,101.18" "$2,653.00" "$2,122.40" "$1,724.45" $526.55 "$2,653.00" "$1,538.74" "$2,653.00" "$2,653.00" "$2,653.00" $552.89 "$2,653.00" N/A N/A 70000602 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN INTMD TIP RADIOPQ X BOTH IP/OP "$1,075.00" $795.50 $213.36 "$1,075.00" $583.73 $583.73 $583.73 $583.73 "$1,075.00" "$1,075.00" "$1,075.00" $224.06 "$1,075.00" $797.87 $797.87 $828.61 $560.08 $224.04 "$1,075.00" "$1,075.00" $635.86 "$1,075.00" "$1,075.00" "$1,075.00" "$1,075.00" $806.25 "$1,075.00" "$1,075.00" "$1,075.00" $537.50 $537.50 $851.40 "$1,075.00" $860.00 $698.75 $213.36 "$1,075.00" $623.50 "$1,075.00" "$1,075.00" "$1,075.00" $224.03 "$1,075.00" N/A N/A 70000603 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN FLPY INTMD TIP RADIOPQ BOTH IP/OP "$1,075.00" $795.50 $213.36 "$1,075.00" $583.73 $583.73 $583.73 $583.73 "$1,075.00" "$1,075.00" "$1,075.00" $224.06 "$1,075.00" $797.87 $797.87 $828.61 $560.08 $224.04 "$1,075.00" "$1,075.00" $635.86 "$1,075.00" "$1,075.00" "$1,075.00" "$1,075.00" $806.25 "$1,075.00" "$1,075.00" "$1,075.00" $537.50 $537.50 $851.40 "$1,075.00" $860.00 $698.75 $213.36 "$1,075.00" $623.50 "$1,075.00" "$1,075.00" "$1,075.00" $224.03 "$1,075.00" N/A N/A 70000626 EAP HCPCS C1769 GUIDEWIRE VASC 145CM .035IN FLXB FLPY TIP FLTWR BOTH IP/OP $331.00 $245.00 $65.70 $331.00 $179.73 $179.73 $179.73 $179.73 $331.00 $331.00 $331.00 $68.99 $331.00 $245.67 $245.67 $255.13 $172.45 $68.98 $331.00 $331.00 $195.79 $331.00 $331.00 $331.00 $331.00 $248.25 $331.00 $331.00 $331.00 $165.50 $165.50 $262.15 $331.00 $264.80 $215.15 $65.70 $331.00 $191.98 $331.00 $331.00 $331.00 $68.98 $331.00 N/A N/A 70000650 EAP HCPCS C2625 STENT URETERAL FLEXIMA LARGE REGULAR PIGTAIL CURVE L22 CM OD2.66 MM BOTH IP/OP $266.00 $197.00 $52.79 $266.00 $119.70 $119.70 $119.70 $119.70 $266.00 $266.00 $266.00 $55.44 $266.00 $266.00 $266.00 $266.00 $266.00 $55.44 $266.00 $266.00 $157.34 $266.00 $266.00 $266.00 $266.00 $199.50 $266.00 $266.00 $266.00 $133.00 $133.00 $210.67 $266.00 $212.80 $119.70 $52.79 $266.00 $154.28 $266.00 $266.00 $266.00 $55.43 $266.00 N/A N/A 70000820 EAP HCPCS C1773 SET RTRVL 80CM 6.3FR 11FR GNTH TLP COONS VC 3W BOTH IP/OP $625.00 $462.50 $124.05 $625.00 $339.38 $339.38 $339.38 $339.38 $625.00 $625.00 $625.00 $130.27 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $124.05 $625.00 $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A 70000823 EAP HCPCS C1769 GUIDEWIRE VASC 60CM .018IN FLPY SFTP ANG TPR 7CM BOTH IP/OP $98.00 $73.00 $19.45 $98.00 $53.21 $53.21 $53.21 $53.21 $98.00 $98.00 $98.00 $20.43 $98.00 $72.74 $72.74 $75.54 $51.06 $20.42 $98.00 $98.00 $57.97 $98.00 $98.00 $98.00 $98.00 $73.50 $98.00 $98.00 $98.00 $49.00 $49.00 $77.62 $98.00 $78.40 $63.70 $19.45 $98.00 $56.84 $98.00 $98.00 $98.00 $20.42 $98.00 N/A N/A 70000837 EAP HCPCS A4215 NEEDLE BIOP 20GA 15CM CHIBA STERILE DISPOSABLE ASPIRAT BOTH IP/OP $27.00 $20.00 $0.22 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $0.22 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 70000838 EAP HCPCS A4215 NEEDLE BIOP 20GA 20CM CHIBA STERILE DISPOSABLE ASPIRAT BOTH IP/OP $27.00 $20.00 $0.22 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $0.22 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 70000977 EAP HCPCS C1887 CATHETER GUID BLUE YLW 100CM 6FR CRDS VSBR AR2 BOTH IP/OP $93.00 $69.00 $18.46 $93.00 $50.50 $50.50 $50.50 $50.50 $93.00 $93.00 $93.00 $19.38 $93.00 $69.02 $69.02 $71.68 $48.45 $19.38 $93.00 $93.00 $55.01 $93.00 $93.00 $93.00 $93.00 $69.75 $93.00 $93.00 $93.00 $46.50 $46.50 $73.66 $93.00 $74.40 $60.45 $18.46 $93.00 $53.94 $93.00 $93.00 $93.00 $19.38 $93.00 N/A N/A 70000983 EAP HCPCS C1887 CATHETER GUID 100CM 6FR SHR NX ACT MP1 CURVE PERI BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $97.80 $163.00 $33.97 $163.00 N/A N/A 70000997 EAP HCPCS C1887 CATHETER GUID BLUE YLW 100CM 6FR CRDS VSBR JR4ST BOTH IP/OP $93.00 $69.00 $18.46 $93.00 $50.50 $50.50 $50.50 $50.50 $93.00 $93.00 $93.00 $19.38 $93.00 $69.02 $69.02 $71.68 $48.45 $19.38 $93.00 $93.00 $55.01 $93.00 $93.00 $93.00 $93.00 $69.75 $93.00 $93.00 $93.00 $46.50 $46.50 $73.66 $93.00 $74.40 $60.45 $18.46 $93.00 $53.94 $93.00 $55.80 $93.00 $19.38 $93.00 N/A N/A 70000998 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL AR1 CURVE CORON BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001000 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL STD JL3.5 CURVE BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001001 EAP HCPCS C1887 CATHETER GUID 7FR SHR NX BAL STD JR3.5 CURVE CORON BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001003 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL STD JL5 CURVE BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001005 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL STD JR5 CURVE BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001006 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL MP1 CURVE PERI BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001013 EAP HCPCS C1887 CATHETER GUID 7FR SHR NX BAL STD JR4 CURVE CORON BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001014 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL IMA CURVE PERI BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001028 EAP HCPCS C1887 CATHETER GUID 100CM 6FR SHR NX BAL AR1 CURVE CORON BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001029 EAP HCPCS C1887 CATHETER GUID 100CM 6FR SHR NX BAL STD JL4 CURVE BOTH IP/OP $118.00 $87.50 $23.42 $118.00 $64.07 $64.07 $64.07 $64.07 $118.00 $118.00 $118.00 $24.59 $118.00 $87.58 $87.58 $90.95 $61.48 $24.59 $118.00 $118.00 $69.80 $118.00 $118.00 $118.00 $118.00 $88.50 $118.00 $118.00 $118.00 $59.00 $59.00 $93.46 $118.00 $94.40 $76.70 $23.42 $118.00 $68.44 $118.00 $118.00 $118.00 $24.59 $118.00 N/A N/A 70001030 EAP HCPCS C1887 CATHETER GUID 100CM 6FR SHR NX BAL STD JR4 CURVE BOTH IP/OP $118.00 $87.50 $23.42 $118.00 $64.07 $64.07 $64.07 $64.07 $118.00 $118.00 $118.00 $24.59 $118.00 $87.58 $87.58 $90.95 $61.48 $24.59 $118.00 $118.00 $69.80 $118.00 $118.00 $118.00 $118.00 $88.50 $118.00 $118.00 $118.00 $59.00 $59.00 $93.46 $118.00 $94.40 $76.70 $23.42 $118.00 $68.44 $118.00 $118.00 $118.00 $24.59 $118.00 N/A N/A 70001041 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL STD JL4 CURVE BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001043 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL STD JR4 CURVE BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001045 EAP HCPCS C1887 CATHETER GUID 100CM 6FR SHR NX BAL AL1 CURVE CORON BOTH IP/OP $118.00 $87.50 $23.42 $118.00 $64.07 $64.07 $64.07 $64.07 $118.00 $118.00 $118.00 $24.59 $118.00 $87.58 $87.58 $90.95 $61.48 $24.59 $118.00 $118.00 $69.80 $118.00 $118.00 $118.00 $118.00 $88.50 $118.00 $118.00 $118.00 $59.00 $59.00 $93.46 $118.00 $94.40 $76.70 $23.42 $118.00 $68.44 $118.00 $70.80 $118.00 $24.59 $118.00 N/A N/A 70001047 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL AL1 CURVE CORON BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001048 EAP HCPCS C1887 CATHETER GUID 100CM 6FR SHR NX BAL STD JL4 CURVE BOTH IP/OP $118.00 $87.50 $23.42 $118.00 $64.07 $64.07 $64.07 $64.07 $118.00 $118.00 $118.00 $24.59 $118.00 $87.58 $87.58 $90.95 $61.48 $24.59 $118.00 $118.00 $69.80 $118.00 $118.00 $118.00 $118.00 $88.50 $118.00 $118.00 $118.00 $59.00 $59.00 $93.46 $118.00 $94.40 $76.70 $23.42 $118.00 $68.44 $118.00 $118.00 $118.00 $24.59 $118.00 N/A N/A 70001049 EAP HCPCS C1887 CATHETER GUID 100CM 6FR SHR NX BAL STD JR4 CURVE BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001050 EAP HCPCS C1887 CATHETER GUID BLUE YLW 100CM 6FR CRDS VSBR XB3 BOTH IP/OP $93.00 $69.00 $18.46 $93.00 $50.50 $50.50 $50.50 $50.50 $93.00 $93.00 $93.00 $19.38 $93.00 $69.02 $69.02 $71.68 $48.45 $19.38 $93.00 $93.00 $55.01 $93.00 $93.00 $93.00 $93.00 $69.75 $93.00 $93.00 $93.00 $46.50 $46.50 $73.66 $93.00 $74.40 $60.45 $18.46 $93.00 $53.94 $93.00 $93.00 $93.00 $19.38 $93.00 N/A N/A 70001051 EAP HCPCS C1887 CATHETER GUID BLUE YLW 100CM 6FR CRDS VSBR XB3.5 BOTH IP/OP $93.00 $69.00 $18.46 $93.00 $50.50 $50.50 $50.50 $50.50 $93.00 $93.00 $93.00 $19.38 $93.00 $69.02 $69.02 $71.68 $48.45 $19.38 $93.00 $93.00 $55.01 $93.00 $93.00 $93.00 $93.00 $69.75 $93.00 $93.00 $93.00 $46.50 $46.50 $73.66 $93.00 $74.40 $60.45 $18.46 $93.00 $53.94 $93.00 $55.80 $93.00 $19.38 $93.00 N/A N/A 70001054 EAP HCPCS C1887 CATHETER GUID 100CM 6FR SHR NX BAL AL2 CURVE CORON BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $97.80 $163.00 $33.97 $163.00 N/A N/A 70001055 EAP HCPCS C1887 CATHETER GUID 100CM 6FR SHR NX BAL STD JR3.5 CURVE BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001056 EAP HCPCS C1887 CATHETER GUID 100CM 6FR SHR NX BAL AL.75 CURVE BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $97.80 $163.00 $33.97 $163.00 N/A N/A 70001057 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL AL.75 CURVE BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 70001234 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN SFT RBN TIP KINK RST BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 70001408 EAP HCPCS C1757 SNARE VASC 120CM 9-15MM 6FR ENSNR STD 3 PREFRM BOTH IP/OP $828.00 $613.00 $164.34 $828.00 $449.60 $449.60 $449.60 $449.60 $828.00 $828.00 $828.00 $172.58 $828.00 $614.54 $614.54 $638.22 $431.39 $172.56 $828.00 $828.00 $489.76 $828.00 $828.00 $828.00 $828.00 $621.00 $828.00 $828.00 $828.00 $414.00 $414.00 $655.78 $828.00 $662.40 $538.20 $164.34 $828.00 $480.24 $828.00 $828.00 $828.00 $172.56 $828.00 N/A N/A 70001411 EAP Custom 70001411 KIT SYR 150ML LF MRK5 PRVS QKFL QKFL TUBE FASTURN STY BOTH IP/OP $575.00 $425.50 $102.35 $575.00 $575.00 $575.00 $575.00 $575.00 $575.00 $575.00 $102.35 $575.00 $575.00 $426.77 $426.77 $443.21 $299.58 $119.84 $575.00 $230.00 $575.00 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $373.75 $575.00 $575.00 $333.50 $575.00 $345.00 $575.00 $575.00 $575.00 N/A N/A 70001510 EAP HCPCS L0625 SUPPORT ORTHOPEDIC UNIVERSAL BINDER VELCRO CLOSURE YELLOW BOTH IP/OP $538.00 $398.50 $20.11 $538.00 $538.00 $538.00 $538.00 $538.00 $538.00 $538.00 $20.11 $538.00 $538.00 $399.30 $399.30 $414.69 $280.30 $112.13 $538.00 $215.20 $538.00 $538.00 $538.00 $538.00 $538.00 $403.50 $538.00 $538.00 $538.00 $269.00 $269.00 $426.10 $538.00 $430.40 $349.70 $538.00 $538.00 $312.04 $538.00 $322.80 $538.00 $538.00 $538.00 N/A N/A 71000014 EAP Custom 71000014 PHASE II RECOVERY < 6HRS BOTH IP/OP "$2,822.00" "$2,088.50" $502.32 "$3,047.00" "$2,822.00" "$2,822.00" "$2,822.00" "$2,822.00" "$2,822.00" "$2,822.00" $502.32 "$2,822.00" "$2,822.00" "$2,094.49" "$2,094.49" "$2,175.20" "$1,470.26" $588.14 "$2,822.00" "$1,218.80" "$2,822.00" "$2,822.00" "$3,047.00" "$2,822.00" "$2,822.00" "$2,116.50" "$2,822.00" "$2,822.00" "$2,822.00" "$1,411.00" "$1,411.00" "$2,235.02" "$2,822.00" "$2,257.60" "$1,834.30" "$2,822.00" "$2,822.00" "$1,636.76" "$2,822.00" "$1,693.20" "$2,822.00" "$2,822.00" "$2,822.00" N/A N/A 71000033 EAP Custom 71000033 PHASE II RECOVERY > 6HRS BOTH IP/OP "$4,229.00" "$3,129.50" $752.76 "$4,567.00" "$4,229.00" "$4,229.00" "$4,229.00" "$4,229.00" "$4,229.00" "$4,229.00" $752.76 "$4,229.00" "$4,229.00" "$3,138.76" "$3,138.76" "$3,259.71" "$2,060.15" $881.37 "$4,229.00" "$1,826.80" "$4,229.00" "$4,229.00" "$4,567.00" "$4,229.00" "$4,229.00" "$3,171.75" "$4,229.00" "$4,229.00" "$4,229.00" "$2,114.50" "$2,114.50" "$3,349.37" "$4,229.00" "$3,383.20" "$2,748.85" "$4,229.00" "$4,229.00" "$2,452.82" "$4,229.00" "$2,537.40" "$4,229.00" "$4,229.00" "$4,229.00" N/A N/A 71000040 EAP Custom 71000040 LEVEL 1 1ST 30 MIN BOTH IP/OP "$2,001.00" "$1,481.00" $356.18 "$2,161.00" "$2,001.00" "$2,001.00" "$2,001.00" "$2,001.00" "$2,001.00" "$2,001.00" $356.18 "$2,001.00" "$2,001.00" "$1,485.14" "$1,485.14" "$1,542.37" "$1,042.52" $417.03 "$2,001.00" $864.40 "$2,001.00" "$2,001.00" "$2,161.00" "$2,001.00" "$2,001.00" "$1,500.75" "$2,001.00" "$2,001.00" "$2,001.00" "$1,000.50" "$1,000.50" "$1,584.79" "$2,001.00" "$1,600.80" "$1,300.65" "$2,001.00" "$2,001.00" "$1,160.58" "$2,001.00" "$1,200.60" "$2,001.00" "$2,001.00" "$2,001.00" N/A N/A 71000041 EAP Custom 71000041 LEVEL 2 1ST 30 MIN BOTH IP/OP "$2,403.00" "$1,778.50" $427.73 "$2,595.00" "$2,403.00" "$2,403.00" "$2,403.00" "$2,403.00" "$2,403.00" "$2,403.00" $427.73 "$2,403.00" "$2,403.00" "$1,783.51" "$1,783.51" "$1,852.23" "$1,251.96" $500.81 "$2,403.00" "$1,038.00" "$2,403.00" "$2,403.00" "$2,595.00" "$2,403.00" "$2,403.00" "$1,802.25" "$2,403.00" "$2,403.00" "$2,403.00" "$1,201.50" "$1,201.50" "$1,903.18" "$2,403.00" "$1,922.40" "$1,561.95" "$2,403.00" "$2,403.00" "$1,393.74" "$2,403.00" "$1,441.80" "$2,403.00" "$2,403.00" "$2,403.00" N/A N/A 71000042 EAP Custom 71000042 LEVEL 3 1ST 30 MIN BOTH IP/OP "$3,201.00" "$2,369.00" $569.78 "$3,457.00" "$3,201.00" "$3,201.00" "$3,201.00" "$3,201.00" "$3,201.00" "$3,201.00" $569.78 "$3,201.00" "$3,201.00" "$2,375.78" "$2,375.78" "$2,467.33" "$1,667.72" $667.12 "$3,201.00" "$1,382.80" "$3,201.00" "$3,201.00" "$3,457.00" "$3,201.00" "$3,201.00" "$2,400.75" "$3,201.00" "$3,201.00" "$3,201.00" "$1,600.50" "$1,600.50" "$2,535.19" "$3,201.00" "$2,560.80" "$2,080.65" "$3,201.00" "$3,201.00" "$1,856.58" "$3,201.00" "$1,920.60" "$3,201.00" "$3,201.00" "$3,201.00" N/A N/A 71000043 EAP Custom 71000043 LEVEL 4 1ST 30 MIN BOTH IP/OP "$3,467.00" "$2,566.00" $617.13 "$3,744.00" "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" $617.13 "$3,467.00" "$3,467.00" "$2,573.21" "$2,573.21" "$2,672.36" "$1,806.31" $722.56 "$3,467.00" "$1,497.60" "$3,467.00" "$3,467.00" "$3,744.00" "$3,467.00" "$3,467.00" "$2,600.25" "$3,467.00" "$3,467.00" "$3,467.00" "$1,733.50" "$1,733.50" "$2,745.86" "$3,467.00" "$2,773.60" "$2,253.55" "$3,467.00" "$3,467.00" "$2,010.86" "$3,467.00" "$2,080.20" "$3,467.00" "$3,467.00" "$3,467.00" N/A N/A 71000044 EAP Custom 71000044 LEVEL 5 1ST 30 MIN BOTH IP/OP "$4,801.00" "$3,553.00" $854.58 "$5,185.00" "$4,801.00" "$4,801.00" "$4,801.00" "$4,801.00" "$4,801.00" "$4,801.00" $854.58 "$4,801.00" "$4,801.00" "$3,563.30" "$3,563.30" "$3,700.61" "$2,060.15" "$1,000.58" "$4,801.00" "$2,074.00" "$4,801.00" "$4,801.00" "$5,185.00" "$4,801.00" "$4,801.00" "$3,600.75" "$4,801.00" "$4,801.00" "$4,801.00" "$2,400.50" "$2,400.50" "$3,802.39" "$4,801.00" "$3,840.80" "$3,120.65" "$4,801.00" "$4,801.00" "$2,784.58" "$4,801.00" "$2,880.60" "$4,801.00" "$4,801.00" "$4,801.00" N/A N/A 71000045 EAP Custom 71000045 LEVEL 1 ADD 15 MIN BOTH IP/OP "$1,049.00" $776.50 $186.72 "$1,133.00" "$1,049.00" "$1,049.00" "$1,049.00" "$1,049.00" "$1,049.00" "$1,049.00" $186.72 "$1,049.00" "$1,049.00" $778.57 $778.57 $808.57 $546.53 $218.62 "$1,049.00" $453.20 "$1,049.00" "$1,049.00" "$1,133.00" "$1,049.00" "$1,049.00" $786.75 "$1,049.00" "$1,049.00" "$1,049.00" $524.50 $524.50 $830.81 "$1,049.00" $839.20 $681.85 "$1,049.00" "$1,049.00" $608.42 "$1,049.00" $629.40 "$1,049.00" "$1,049.00" "$1,049.00" N/A N/A 71000046 EAP Custom 71000046 LEVEL 2 ADD 15 MIN BOTH IP/OP "$1,261.00" $933.50 $224.46 "$1,361.00" "$1,261.00" "$1,261.00" "$1,261.00" "$1,261.00" "$1,261.00" "$1,261.00" $224.46 "$1,261.00" "$1,261.00" $935.91 $935.91 $971.98 $656.98 $262.81 "$1,261.00" $544.40 "$1,261.00" "$1,261.00" "$1,361.00" "$1,261.00" "$1,261.00" $945.75 "$1,261.00" "$1,261.00" "$1,261.00" $630.50 $630.50 $998.71 "$1,261.00" "$1,008.80" $819.65 "$1,261.00" "$1,261.00" $731.38 "$1,261.00" $756.60 "$1,261.00" "$1,261.00" "$1,261.00" N/A N/A 71000047 EAP Custom 71000047 LEVEL 3 ADD 15 MIN BOTH IP/OP "$1,678.00" "$1,242.00" $298.68 "$1,812.00" "$1,678.00" "$1,678.00" "$1,678.00" "$1,678.00" "$1,678.00" "$1,678.00" $298.68 "$1,678.00" "$1,678.00" "$1,245.41" "$1,245.41" "$1,293.40" $874.24 $349.71 "$1,678.00" $724.80 "$1,678.00" "$1,678.00" "$1,812.00" "$1,678.00" "$1,678.00" "$1,258.50" "$1,678.00" "$1,678.00" "$1,678.00" $839.00 $839.00 "$1,328.98" "$1,678.00" "$1,342.40" "$1,090.70" "$1,678.00" "$1,678.00" $973.24 "$1,678.00" "$1,006.80" "$1,678.00" "$1,678.00" "$1,678.00" N/A N/A 71000048 EAP Custom 71000048 LEVEL 4 ADD 15 MIN BOTH IP/OP "$1,823.00" "$1,349.50" $324.49 "$1,968.00" "$1,823.00" "$1,823.00" "$1,823.00" "$1,823.00" "$1,823.00" "$1,823.00" $324.49 "$1,823.00" "$1,823.00" "$1,353.03" "$1,353.03" "$1,405.17" $949.78 $379.93 "$1,823.00" $787.20 "$1,823.00" "$1,823.00" "$1,968.00" "$1,823.00" "$1,823.00" "$1,367.25" "$1,823.00" "$1,823.00" "$1,823.00" $911.50 $911.50 "$1,443.82" "$1,823.00" "$1,458.40" "$1,184.95" "$1,823.00" "$1,823.00" "$1,057.34" "$1,823.00" "$1,093.80" "$1,823.00" "$1,823.00" "$1,823.00" N/A N/A 71000049 EAP Custom 71000049 LEVEL 5 ADD 15 MIN BOTH IP/OP "$2,521.00" "$1,866.00" $448.74 "$2,722.00" "$2,521.00" "$2,521.00" "$2,521.00" "$2,521.00" "$2,521.00" "$2,521.00" $448.74 "$2,521.00" "$2,521.00" "$1,871.09" "$1,871.09" "$1,943.19" "$1,313.44" $525.40 "$2,521.00" "$1,088.80" "$2,521.00" "$2,521.00" "$2,722.00" "$2,521.00" "$2,521.00" "$1,890.75" "$2,521.00" "$2,521.00" "$2,521.00" "$1,260.50" "$1,260.50" "$1,996.63" "$2,521.00" "$2,016.80" "$1,638.65" "$2,521.00" "$2,521.00" "$1,462.18" "$2,521.00" "$1,512.60" "$2,521.00" "$2,521.00" "$2,521.00" N/A N/A 71000050 EAP GI PROCEDURE RECOVERY BOTH IP/OP $636.00 $471.00 $113.21 $686.00 $636.00 $636.00 $636.00 $636.00 $636.00 $636.00 $113.21 $636.00 $636.00 $472.04 $472.04 $490.23 $331.36 $132.55 $636.00 $274.40 $636.00 $636.00 $686.00 $636.00 $636.00 $477.00 $636.00 $636.00 $636.00 $318.00 $318.00 $503.71 $636.00 $508.80 $413.40 $636.00 $636.00 $368.88 $636.00 $381.60 $636.00 $636.00 $636.00 N/A N/A 71000051 EAP CARDIOLOGY RECOVERY BOTH IP/OP $636.00 $471.00 $113.21 $686.00 $636.00 $636.00 $636.00 $636.00 $636.00 $636.00 $113.21 $636.00 $636.00 $472.04 $472.04 $490.23 $331.36 $132.55 $636.00 $274.40 $636.00 $636.00 $686.00 $636.00 $636.00 $477.00 $636.00 $636.00 $636.00 $318.00 $318.00 $503.71 $636.00 $508.80 $413.40 $636.00 $636.00 $368.88 $636.00 $381.60 $636.00 $636.00 $636.00 N/A N/A 71000133 EAP Custom 71000133 PHASE II RECOVERY > 6HRS BOTH IP/OP "$3,435.00" "$2,542.00" $611.43 "$3,709.00" "$3,435.00" "$3,435.00" "$3,435.00" "$3,435.00" "$3,435.00" "$3,435.00" $611.43 "$3,435.00" "$3,435.00" "$2,549.46" "$2,549.46" "$2,647.70" "$1,789.64" $715.89 "$3,435.00" "$1,483.60" "$3,435.00" "$3,435.00" "$3,709.00" "$3,435.00" "$3,435.00" "$2,576.25" "$3,435.00" "$3,435.00" "$3,435.00" "$1,717.50" "$1,717.50" "$2,720.52" "$3,435.00" "$2,748.00" "$2,232.75" "$3,435.00" "$3,435.00" "$1,992.30" "$3,435.00" "$2,061.00" "$3,435.00" "$3,435.00" "$3,435.00" N/A N/A 71000134 EAP IR RECOVERY BOTH IP/OP $636.00 $471.00 $113.21 $686.00 $636.00 $636.00 $636.00 $636.00 $636.00 $636.00 $113.21 $636.00 $636.00 $472.04 $472.04 $490.23 $331.36 $132.55 $636.00 $274.40 $636.00 $636.00 $686.00 $636.00 $636.00 $477.00 $636.00 $636.00 $636.00 $318.00 $318.00 $503.71 $636.00 $508.80 $413.40 $636.00 $636.00 $368.88 $636.00 $381.60 $636.00 $636.00 $636.00 N/A N/A 71900020 EAP Custom 71900020 EXTENDED RECOVERY 1ST 30 MINS BOTH IP/OP "$1,308.00" $968.00 $232.82 "$1,412.00" "$1,308.00" "$1,308.00" "$1,308.00" "$1,308.00" "$1,308.00" "$1,308.00" $232.82 "$1,308.00" "$1,308.00" $970.80 $970.80 "$1,008.21" $681.47 $272.60 "$1,308.00" $564.80 "$1,308.00" "$1,308.00" "$1,412.00" "$1,308.00" "$1,308.00" $981.00 "$1,308.00" "$1,308.00" "$1,308.00" $654.00 $654.00 "$1,035.94" "$1,308.00" "$1,046.40" $850.20 "$1,308.00" "$1,308.00" $758.64 "$1,308.00" $784.80 "$1,308.00" "$1,308.00" "$1,308.00" N/A N/A 71900021 EAP Custom 71900021 EXTENDED RECOVERY EA ADDTL 15 MINS BOTH IP/OP $739.00 $547.00 $131.54 $798.00 $739.00 $739.00 $739.00 $739.00 $739.00 $739.00 $131.54 $739.00 $739.00 $548.49 $548.49 $569.62 $385.02 $154.02 $739.00 $319.20 $739.00 $739.00 $798.00 $739.00 $739.00 $554.25 $739.00 $739.00 $739.00 $369.50 $369.50 $585.29 $739.00 $591.20 $480.35 $739.00 $739.00 $428.62 $739.00 $443.40 $739.00 $739.00 $739.00 N/A N/A 72000001 EAP CPT® 59030 FETAL SCALP BLOOD BOTH IP/OP "$1,104.00" $817.00 $112.60 "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" $112.60 $112.60 $112.94 "$1,104.00" $112.60 "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" $230.09 $180.16 $182.06 "$1,104.00" $112.60 $113.79 $112.60 "$1,104.00" $828.00 $112.60 $112.60 $112.60 "$1,104.00" $552.00 $874.37 $112.60 $883.20 "$1,104.00" "$1,104.00" $112.60 $640.32 "$1,104.00" $118.24 $112.60 "$1,104.00" $112.60 N/A N/A 72000003 EAP CPT® 59160 D & C POSTPARTUM BOTH IP/OP "$5,311.00" "$3,930.50" $189.29 "$5,311.00" "$5,311.00" "$5,311.00" "$5,311.00" "$5,311.00" $192.10 $192.10 $189.29 "$5,311.00" $192.10 "$5,311.00" "$5,311.00" "$5,311.00" "$5,311.00" "$1,106.87" $307.36 $309.54 "$5,311.00" $192.10 $193.46 $192.10 "$5,311.00" "$3,983.25" $192.10 $192.10 $192.10 "$3,500.00" "$2,655.50" "$4,206.31" $192.10 "$4,248.80" "$3,250.00" "$5,311.00" $192.10 "$3,080.38" "$5,311.00" $190.68 $192.10 "$5,311.00" $192.10 N/A N/A 72000006 EAP CPT® 59612 VAGINAL DELIVERY AFTER PRIOR CESAREAN DELIVERY BOTH IP/OP "$8,307.00" "$6,147.50" $911.33 "$8,307.00" "$8,307.00" "$8,307.00" "$8,307.00" "$8,307.00" $911.33 $911.33 $916.56 "$8,307.00" $911.33 "$8,307.00" "$8,307.00" "$8,307.00" "$8,307.00" "$1,731.27" "$1,458.13" "$1,473.94" "$8,307.00" $911.33 $921.21 $911.33 "$8,307.00" "$6,230.25" $911.33 $911.33 $911.33 "$2,762.00" "$4,153.50" "$6,579.14" $911.33 "$6,645.60" "$3,250.00" "$8,307.00" $911.33 "$4,818.06" "$8,307.00" $958.54 $911.33 "$8,307.00" $911.33 N/A N/A 72200001 EAP CPT® 59409 VAGINAL DELIVERY ONLY COMPLICA BOTH IP/OP "$6,614.00" "$4,894.50" $808.42 "$5,291.20" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,580.85" "$2,580.85" "$2,569.43" "$1,378.52" "$2,580.85" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,378.43" "$4,129.35" "$4,079.03" "$4,877.00" "$2,580.85" $813.62 "$2,580.85" "$2,709.89" "$4,960.50" "$2,580.85" "$2,580.85" "$2,580.85" "$2,762.00" "$2,348.00" "$5,238.29" "$2,580.85" "$5,291.20" "$3,250.00" "$1,312.71" $808.42 "$3,836.12" "$2,709.89" "$3,733.83" "$2,580.85" "$1,378.36" "$2,580.85" N/A N/A 72200002 EAP CPT® 59409 VAGINAL DELIVERY ONLY UNCOMPL. BOTH IP/OP "$6,435.00" "$4,762.00" $808.42 "$5,148.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,580.85" "$2,580.85" "$2,569.43" "$1,341.21" "$2,580.85" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,341.12" "$4,129.35" "$4,079.03" "$4,877.00" "$2,580.85" $813.62 "$2,580.85" "$2,709.89" "$4,826.25" "$2,580.85" "$2,580.85" "$2,580.85" "$2,762.00" "$2,348.00" "$5,096.52" "$2,580.85" "$5,148.00" "$3,250.00" "$1,277.19" $808.42 "$3,732.30" "$2,709.89" "$3,733.83" "$2,580.85" "$1,341.05" "$2,580.85" N/A N/A 73000001 EAP CPT® 93005 EKG BOTH IP/OP $606.00 $448.50 $6.43 $484.80 $17.87 $17.87 $17.87 $17.87 $54.76 $54.76 $54.51 $126.31 $54.76 $449.77 $449.77 $467.10 $315.73 $126.30 $87.61 $82.92 $358.45 $54.76 $6.43 $54.76 $57.49 $454.50 $54.76 $54.76 $54.76 $303.00 $303.00 $479.95 $54.76 $484.80 $393.90 $120.28 $54.76 $351.48 $57.49 $79.22 $54.76 $126.29 $54.76 N/A N/A 73000007 EAP CPT® 93041 "RHYTHM ECG, TRACING" BOTH IP/OP $57.00 $42.50 $5.76 $57.00 $57.00 $57.00 $57.00 $57.00 $5.84 $5.84 $5.89 $57.00 $5.84 $42.31 $42.31 $43.94 $29.70 $11.88 $9.34 $9.74 $57.00 $5.84 $6.09 $5.84 $57.00 $42.75 $5.84 $5.84 $5.84 $28.50 $28.50 $45.14 $5.84 $45.60 $37.05 $57.00 $5.84 $33.06 $57.00 $5.76 $5.84 $57.00 $5.84 N/A N/A 73000010 EAP CPT® 93041 EKG RHYTHM STRIP 3 LEAD BOTH IP/OP $57.00 $42.50 $5.76 $57.00 $57.00 $57.00 $57.00 $57.00 $5.84 $5.84 $5.89 $57.00 $5.84 $42.31 $42.31 $43.94 $29.70 $11.88 $9.34 $9.74 $57.00 $5.84 $6.09 $5.84 $57.00 $42.75 $5.84 $5.84 $5.84 $28.50 $28.50 $45.14 $5.84 $45.60 $37.05 $57.00 $5.84 $33.06 $57.00 $5.76 $5.84 $57.00 $5.84 N/A N/A 73000011 EAP CPT® 93017 CARDIAC STRESS TEST BOTH IP/OP "$3,585.00" "$2,653.00" $36.20 "$2,868.00" $82.60 $82.60 $82.60 $82.60 $260.33 $260.33 $259.18 $747.20 $260.33 "$2,660.79" "$2,660.79" "$2,763.32" "$1,867.79" $747.15 $416.53 $404.03 "$2,120.53" $260.33 $36.20 $260.33 $273.35 "$2,688.75" $260.33 $260.33 $260.33 "$1,792.50" "$1,792.50" "$2,839.32" $260.33 "$2,868.00" "$2,330.25" $711.53 $260.33 "$2,079.30" $273.35 $376.64 $260.33 $747.11 $260.33 N/A N/A 73100001 EAP CPT® 93225 ECG MONIT/REPRT UP TO 48 HRS BOTH IP/OP "$1,032.00" $764.00 $18.61 $825.60 $55.82 $55.82 $55.82 $55.82 $110.92 $110.92 $110.43 $215.09 $110.92 $765.95 $765.95 $795.47 $537.67 $215.08 $177.47 $167.51 $610.43 $110.92 $18.61 $110.92 $116.46 $774.00 $110.92 $110.92 $110.92 $516.00 $516.00 $817.34 $110.92 $825.60 $670.80 $204.83 $110.92 $598.56 $116.46 $160.47 $110.92 $215.07 $110.92 N/A N/A 73100002 EAP CPT® 93226 ECG MONITORING ANALYSIS&REPORT BOTH IP/OP "$1,644.00" "$1,217.00" $36.53 "$1,644.00" "$1,644.00" "$1,644.00" "$1,644.00" "$1,644.00" $38.65 $38.65 $41.41 "$1,644.00" $38.65 "$1,220.18" "$1,220.18" "$1,267.20" $856.52 $342.63 $61.84 $58.45 "$1,644.00" $38.65 $36.53 $38.65 "$1,644.00" "$1,233.00" $38.65 $38.65 $38.65 $822.00 $822.00 "$1,302.05" $38.65 "$1,315.20" "$1,068.60" "$1,644.00" $38.65 $953.52 "$1,644.00" $36.74 $38.65 "$1,644.00" $38.65 N/A N/A 73100003 EAP CPT® 93270 CARDIAC EVENT RECORDING BOTH IP/OP $709.00 $525.00 $8.46 $567.20 $19.35 $19.35 $19.35 $19.35 $36.63 $36.63 $36.47 $147.77 $36.63 $526.22 $526.22 $546.50 $369.39 $147.76 $58.61 $50.50 $419.37 $36.63 $8.46 $36.63 $38.46 $531.75 $36.63 $36.63 $36.63 $354.50 $354.50 $561.53 $36.63 $567.20 $460.85 $140.72 $36.63 $411.22 $38.46 $52.99 $36.63 $147.76 $36.63 N/A N/A 73100004 EAP CPT® 93271 CARDIAC EVENT ANALYSIS BOTH IP/OP $716.00 $530.00 $147.80 $716.00 $716.00 $716.00 $716.00 $716.00 $155.38 $155.38 $167.12 $716.00 $155.38 $531.42 $531.42 $551.89 $373.04 $149.22 $248.61 $236.48 $716.00 $155.38 $147.80 $155.38 $716.00 $537.00 $155.38 $155.38 $155.38 $358.00 $358.00 $567.07 $155.38 $572.80 $465.40 $716.00 $155.38 $415.28 $716.00 $168.20 $155.38 $716.00 $155.38 N/A N/A 73100010 EAP CPT® 93242 EXTERNAL ECG REC>48HR<7D RECORDING BOTH IP/OP $80.00 $59.50 $12.18 $87.61 $31.68 $31.68 $31.68 $31.68 $54.76 $54.76 $54.51 $80.00 $54.76 $80.00 $80.00 $80.00 $80.00 $80.00 $87.61 $48.99 $80.00 $54.76 $12.18 $54.76 $57.49 $60.00 $54.76 $54.76 $54.76 $80.00 $80.00 $80.00 $54.76 $80.00 $52.00 $80.00 $54.76 $46.40 $57.49 $79.22 $54.76 $80.00 $54.76 N/A N/A 73100011 EAP CPT® 93243 EXTERNAL ECG REC>48HR<7D SCANNING ALYS W/REPORT BOTH IP/OP $132.00 $98.00 $27.51 $370.13 $132.00 $132.00 $132.00 $132.00 $132.00 $132.00 $57.30 $132.00 $132.00 $97.97 $97.97 $101.75 $68.77 $27.51 $132.00 $370.13 $132.00 $132.00 $231.33 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $85.80 $132.00 $132.00 $76.56 $132.00 $79.20 $132.00 $132.00 $132.00 N/A N/A 73100012 EAP CPT® 93246 EXTERNAL ECG REC>7D<15D RECORDING BOTH IP/OP $132.00 $98.00 $12.18 $132.00 $31.68 $31.68 $31.68 $31.68 $54.76 $54.76 $54.51 $132.00 $54.76 $132.00 $132.00 $132.00 $132.00 $132.00 $87.61 $82.92 $132.00 $54.76 $12.18 $54.76 $57.49 $99.00 $54.76 $54.76 $54.76 $132.00 $132.00 $132.00 $54.76 $132.00 $85.80 $132.00 $54.76 $76.56 $57.49 $79.22 $54.76 $132.00 $54.76 N/A N/A 73100013 EAP CPT® 93247 EXTERNAL ECG REC>7D<15D SCANNING ALYS W/REPORT BOTH IP/OP $266.00 $197.00 $55.44 $389.07 $266.00 $266.00 $266.00 $266.00 $266.00 $266.00 $59.04 $266.00 $266.00 $197.43 $197.43 $205.03 $138.59 $55.44 $266.00 $389.07 $266.00 $266.00 $243.17 $266.00 $266.00 $199.50 $266.00 $266.00 $266.00 $133.00 $133.00 $210.67 $266.00 $212.80 $172.90 $266.00 $266.00 $154.28 $266.00 $159.60 $266.00 $266.00 $266.00 N/A N/A 74000001 EAP CPT® 95812 EEG UP TO 1 HOUR BOTH IP/OP $835.00 $618.00 $174.02 $835.00 $835.00 $835.00 $835.00 $835.00 $297.58 $297.58 $352.54 $835.00 $297.58 $619.74 $619.74 $643.62 $435.04 $174.02 $476.13 $469.18 $835.00 $297.58 $293.24 $297.58 $835.00 $626.25 $297.58 $297.58 $297.58 $417.50 $417.50 $661.32 $297.58 $668.00 $542.75 $835.00 $297.58 $484.30 $835.00 $275.53 $297.58 $835.00 $297.58 N/A N/A 74000002 EAP CPT® 95813 EEG EXTENDED MONITORING 61-119 MINUTES BOTH IP/OP "$1,873.00" "$1,386.50" $259.18 "$1,498.40" "$1,017.04" "$1,017.04" "$1,017.04" "$1,017.04" $260.33 $260.33 $259.18 $390.38 $260.33 "$1,390.14" "$1,390.14" "$1,443.71" $975.83 $390.35 $416.53 $404.03 "$1,107.88" $260.33 $349.04 $260.33 $273.35 "$1,404.75" $260.33 $260.33 $260.33 $936.50 $936.50 "$1,483.42" $260.33 "$1,498.40" "$1,217.45" $371.74 $260.33 "$1,086.34" $273.35 $376.64 $260.33 $390.33 $260.33 N/A N/A 74000003 EAP CPT® 95816 "EEG, AWAKE AND DROWSY" BOTH IP/OP "$1,050.00" $777.00 $208.40 $840.00 $570.15 $570.15 $570.15 $570.15 $260.33 $260.33 $259.18 $218.85 $260.33 $779.31 $779.31 $809.34 $547.05 $218.83 $416.53 $404.03 $621.08 $260.33 $331.12 $260.33 $273.35 $787.50 $260.33 $260.33 $260.33 $525.00 $525.00 $831.60 $260.33 $840.00 $682.50 $208.40 $260.33 $609.00 $273.35 $376.64 $260.33 $218.82 $260.33 N/A N/A 74000004 EAP CPT® 95819 "EEG, W/AWAKE & ASLEEP RECORD" BOTH IP/OP "$1,794.00" "$1,328.00" $259.18 "$1,435.20" $974.14 $974.14 $974.14 $974.14 $260.33 $260.33 $259.18 $373.91 $260.33 "$1,331.51" "$1,331.51" "$1,382.82" $934.67 $373.89 $416.53 $404.03 "$1,061.15" $260.33 $393.01 $260.33 $273.35 "$1,345.50" $260.33 $260.33 $260.33 $897.00 $897.00 "$1,420.85" $260.33 "$1,435.20" "$1,166.10" $356.06 $260.33 "$1,040.52" $273.35 $376.64 $260.33 $373.87 $260.33 N/A N/A 74000005 EAP CPT® 95822 "EEG, SLEEP ONLY" BOTH IP/OP "$1,752.00" "$1,296.50" $340.00 "$1,752.00" "$1,752.00" "$1,752.00" "$1,752.00" "$1,752.00" $369.07 $369.07 $421.84 "$1,752.00" $369.07 "$1,300.33" "$1,300.33" "$1,350.44" $912.79 $365.14 $590.51 $582.82 "$1,752.00" $369.07 $364.26 $369.07 "$1,752.00" "$1,314.00" $369.07 $369.07 $369.07 $876.00 $876.00 "$1,387.58" $369.07 "$1,401.60" "$1,138.80" "$1,752.00" $369.07 "$1,016.16" "$1,752.00" $340.00 $369.07 "$1,752.00" $369.07 N/A N/A 74000011 EAP CPT® 95930 VEP BOTH IP/OP "$1,158.00" $857.00 $48.32 "$1,158.00" "$1,158.00" "$1,158.00" "$1,158.00" "$1,158.00" $48.32 $48.32 $68.56 "$1,158.00" $48.32 $859.47 $859.47 $892.59 $603.32 $241.34 $77.31 $77.94 "$1,158.00" $48.32 $48.71 $48.32 "$1,158.00" $868.50 $48.32 $48.32 $48.32 $579.00 $579.00 $917.14 $48.32 $926.40 $752.70 "$1,158.00" $48.32 $671.64 "$1,158.00" $48.62 $48.32 "$1,158.00" $48.32 N/A N/A 74000012 EAP CPT® 95938 SSEP 4 EXT BOTH IP/OP $768.00 $568.50 $160.06 $768.00 $768.00 $768.00 $768.00 $768.00 $326.24 $326.24 $368.23 $768.00 $326.24 $570.01 $570.01 $591.97 $400.13 $160.06 $521.98 $517.34 $768.00 $326.24 $323.34 $326.24 $768.00 $576.00 $326.24 $326.24 $326.24 $384.00 $384.00 $608.26 $326.24 $614.40 $499.20 $768.00 $326.24 $445.44 $768.00 $308.31 $326.24 $768.00 $326.24 N/A N/A 74000013 EAP CPT® 95929 CMEP LOWER LIMBS BOTH IP/OP $981.00 $726.00 $154.51 $981.00 $981.00 $981.00 $981.00 $981.00 $170.20 $170.20 $249.24 $981.00 $170.20 $728.10 $728.10 $756.15 $511.10 $204.45 $272.32 $262.46 $981.00 $170.20 $164.04 $170.20 $981.00 $735.75 $170.20 $170.20 $170.20 $490.50 $490.50 $776.95 $170.20 $784.80 $637.65 $981.00 $170.20 $568.98 $981.00 $154.51 $170.20 $981.00 $170.20 N/A N/A 74000014 EAP CPT® 95939 CMEP UPPER LIMBS BOTH IP/OP "$1,351.00" "$1,000.00" $281.56 "$1,351.00" "$1,351.00" "$1,351.00" "$1,351.00" "$1,351.00" $442.60 $442.60 $557.53 "$1,351.00" $442.60 "$1,002.71" "$1,002.71" "$1,041.35" $703.87 $281.56 $708.16 $695.90 "$1,351.00" $442.60 $434.94 $442.60 "$1,351.00" "$1,013.25" $442.60 $442.60 $442.60 $675.50 $675.50 "$1,069.99" $442.60 "$1,080.80" $878.15 "$1,351.00" $442.60 $783.58 "$1,351.00" $411.68 $442.60 "$1,351.00" $442.60 N/A N/A 74000015 EAP CPT® 95940 INTRAOPERATIVE MONITORING NEURO IN OR EA 15 MIN BOTH IP/OP "$4,241.00" "$3,138.50" $32.19 "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" $32.72 $32.72 $32.99 "$4,241.00" $32.72 "$3,147.67" "$3,147.67" "$3,268.96" "$2,060.15" $883.87 $52.35 $51.50 "$4,241.00" $32.72 $32.19 $32.72 "$4,241.00" "$3,180.75" $32.72 $32.72 $32.72 "$2,120.50" "$2,120.50" "$3,358.87" $32.72 "$3,392.80" "$2,756.65" "$4,241.00" $32.72 "$2,459.78" "$4,241.00" $33.90 $32.72 "$4,241.00" $32.72 N/A N/A 74000017 EAP CPT® 95961 FUNCTIONAL CORTICAL MAPPING BY INTRA OPERATIVE STIMULATION INITIAL HR BOTH IP/OP $905.00 $670.00 $150.19 $905.00 $905.00 $905.00 $905.00 $905.00 $169.17 $169.17 $321.40 $905.00 $169.17 $671.69 $671.69 $697.57 $471.51 $188.61 $270.67 $250.02 $905.00 $169.17 $156.26 $169.17 $905.00 $678.75 $169.17 $169.17 $169.17 $452.50 $452.50 $716.76 $169.17 $724.00 $588.25 $905.00 $169.17 $524.90 $905.00 $150.19 $169.17 $905.00 $169.17 N/A N/A 74000018 EAP CPT® 95962 FUNCTIONAL MONITOR BY STIMULATION EA ADD'L HOUR BOTH IP/OP $661.00 $489.50 $90.40 $661.00 $661.00 $661.00 $661.00 $661.00 $98.37 $98.37 $268.31 $661.00 $98.37 $490.59 $490.59 $509.50 $344.38 $137.76 $157.39 $164.51 $661.00 $98.37 $102.82 $98.37 $661.00 $495.75 $98.37 $98.37 $98.37 $330.50 $330.50 $523.51 $98.37 $528.80 $429.65 $661.00 $98.37 $383.38 $661.00 $90.40 $98.37 $661.00 $98.37 N/A N/A 74000020 EAP CPT® 95958 EEG MONITORING/FUNCTION TEST BOTH IP/OP "$1,943.00" "$1,438.00" $360.17 "$1,943.00" "$1,943.00" "$1,943.00" "$1,943.00" "$1,943.00" $414.18 $414.18 $609.78 "$1,943.00" $414.18 "$1,442.09" "$1,442.09" "$1,497.66" "$1,012.30" $404.94 $662.69 $728.96 "$1,943.00" $414.18 $455.60 $414.18 "$1,943.00" "$1,457.25" $414.18 $414.18 $414.18 $971.50 $971.50 "$1,538.86" $414.18 "$1,554.40" "$1,262.95" "$1,943.00" $414.18 "$1,126.94" "$1,943.00" $360.17 $414.18 "$1,943.00" $414.18 N/A N/A 74000021 EAP CPT® 95958 EEG HEMISPHERE FUNCTION (WADA) BOTH IP/OP "$1,943.00" "$1,438.00" $360.17 "$1,943.00" "$1,943.00" "$1,943.00" "$1,943.00" "$1,943.00" $414.18 $414.18 $609.78 "$1,943.00" $414.18 "$1,442.09" "$1,442.09" "$1,497.66" "$1,012.30" $404.94 $662.69 $728.96 "$1,943.00" $414.18 $455.60 $414.18 "$1,943.00" "$1,457.25" $414.18 $414.18 $414.18 $971.50 $971.50 "$1,538.86" $414.18 "$1,554.40" "$1,262.95" "$1,943.00" $414.18 "$1,126.94" "$1,943.00" $360.17 $414.18 "$1,943.00" $414.18 N/A N/A 74000030 EAP CPT® 95941 IONM REMOTE/NEARBY/>1 PATIENT IN OR PER HOUR BOTH IP/OP "$3,680.00" "$2,723.50" $354.80 "$3,680.00" "$3,680.00" "$3,680.00" "$3,680.00" "$3,680.00" "$3,680.00" "$3,680.00" "$3,680.00" "$3,680.00" "$3,680.00" "$2,731.30" "$2,731.30" "$2,836.54" "$1,917.28" $766.95 "$3,680.00" $354.80 "$3,680.00" "$3,680.00" $887.00 "$3,680.00" "$3,680.00" "$2,760.00" "$3,680.00" "$3,680.00" "$3,680.00" "$1,840.00" "$1,840.00" "$2,914.56" "$3,680.00" "$2,944.00" "$2,392.00" "$3,680.00" "$3,680.00" "$2,134.40" "$3,680.00" "$2,208.00" "$3,680.00" "$3,680.00" "$3,680.00" N/A N/A 74000050 EAP CPT® 95700 EEG CONT REC W/VIDEO BY TECH MIN 8 CHANNELS BOTH IP/OP "$4,241.00" "$3,138.50" $209.80 "$4,241.00" "$2,302.86" "$2,302.86" "$2,302.86" "$2,302.86" $260.33 $260.33 $259.18 $883.93 $260.33 "$3,147.67" "$3,147.67" "$3,268.96" "$2,060.15" $883.87 $416.53 $209.80 "$2,508.55" $260.33 "$4,241.00" $260.33 $273.35 "$3,180.75" $260.33 $260.33 $260.33 "$2,120.50" "$2,120.50" "$3,358.87" $260.33 "$3,392.80" "$2,756.65" $841.73 $260.33 "$2,459.78" $273.35 $376.64 $260.33 $883.82 $260.33 N/A N/A 74000052 EAP CPT® 95706 EEG W/O VIDEO (CERIBELL) 2-12 HR INTERMITTENT MNTR BOTH IP/OP "$4,241.00" "$3,138.50" $404.63 "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" $404.63 "$4,241.00" "$4,241.00" "$3,147.67" "$3,147.67" "$3,268.96" "$2,060.15" $883.87 "$4,241.00" $978.40 "$4,241.00" "$4,241.00" "$2,446.00" "$4,241.00" "$4,241.00" "$3,180.75" "$4,241.00" "$4,241.00" "$4,241.00" "$2,120.50" "$2,120.50" "$3,358.87" "$4,241.00" "$3,392.80" "$2,756.65" "$4,241.00" "$4,241.00" "$2,459.78" "$4,241.00" "$2,544.60" "$4,241.00" "$4,241.00" "$4,241.00" N/A N/A 74000054 EAP CPT® 95708 EEG W/O VID BY TECH EA INCR 12-26HR UNMONITORED BOTH IP/OP "$6,903.00" "$5,108.50" $478.04 "$6,903.00" "$3,748.33" "$3,748.33" "$3,748.33" "$3,748.33" $480.16 $480.16 $478.04 "$1,438.76" $480.16 "$4,181.12" "$4,181.12" "$5,320.83" "$2,060.15" "$1,438.66" $768.26 $697.42 "$3,094.73" $480.16 "$6,903.00" $480.16 $504.17 "$5,177.25" $480.16 $480.16 $480.16 "$3,451.50" "$3,451.50" "$5,467.18" $480.16 "$5,522.40" "$4,486.95" "$1,370.07" $480.16 "$4,003.74" $504.17 $694.68 $480.16 "$1,438.59" $480.16 N/A N/A 74000055 EAP CPT® 95709 EEG W/O VIDEO (CERIBELL) EA INCR 12-26 HR INTMT MNTR BOTH IP/OP "$10,349.00" "$7,658.50" $809.25 "$10,349.00" "$10,349.00" "$10,349.00" "$10,349.00" "$10,349.00" "$10,349.00" "$10,349.00" $809.25 "$10,349.00" "$10,349.00" "$4,181.12" "$4,181.12" "$7,977.01" "$2,060.15" "$2,156.85" "$10,349.00" "$2,799.20" "$10,349.00" "$10,349.00" "$6,998.00" "$10,349.00" "$10,349.00" "$7,761.75" "$10,349.00" "$10,349.00" "$10,349.00" "$5,174.50" "$5,174.50" "$8,196.41" "$10,349.00" "$8,279.20" "$6,726.85" "$10,349.00" "$10,349.00" "$6,002.42" "$10,349.00" "$6,209.40" "$10,349.00" "$10,349.00" "$10,349.00" N/A N/A 74000057 EAP CPT® 95711 VEEG BY TECH 2-12 HOURS UNMONITORED BOTH IP/OP "$4,241.00" "$3,138.50" $129.69 "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" $129.69 "$4,241.00" "$4,241.00" "$3,147.67" "$3,147.67" "$3,268.96" "$2,060.15" $883.87 "$4,241.00" $349.60 "$4,241.00" "$4,241.00" $874.00 "$4,241.00" "$4,241.00" "$3,180.75" "$4,241.00" "$4,241.00" "$4,241.00" "$2,120.50" "$2,120.50" "$3,358.87" "$4,241.00" "$3,392.80" "$2,756.65" "$4,241.00" "$4,241.00" "$2,459.78" "$4,241.00" "$2,544.60" "$4,241.00" "$4,241.00" "$4,241.00" N/A N/A 74000058 EAP CPT® 95712 VEEG BY TECH 2-12 HR INTERMITTENT MONITORING BOTH IP/OP "$4,241.00" "$3,138.50" $518.75 "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" $518.75 "$4,241.00" "$4,241.00" "$3,147.67" "$3,147.67" "$3,268.96" "$2,060.15" $883.87 "$4,241.00" "$1,696.40" "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" "$4,241.00" "$3,180.75" "$4,241.00" "$4,241.00" "$4,241.00" "$2,120.50" "$2,120.50" "$3,358.87" "$4,241.00" "$3,392.80" "$2,756.65" "$4,241.00" "$4,241.00" "$2,459.78" "$4,241.00" "$2,544.60" "$4,241.00" "$4,241.00" "$4,241.00" N/A N/A 74000060 EAP CPT® 95714 VEEG BY TECH EA INCR 12-26 HR UNMONITORED BOTH IP/OP "$6,903.00" "$5,108.50" $207.50 "$6,903.00" "$6,903.00" "$6,903.00" "$6,903.00" "$6,903.00" "$6,903.00" "$6,903.00" $207.50 "$6,903.00" "$6,903.00" "$4,181.12" "$4,181.12" "$5,320.83" "$2,060.15" "$1,438.66" "$6,903.00" "$2,761.20" "$6,903.00" "$6,903.00" "$6,903.00" "$6,903.00" "$6,903.00" "$5,177.25" "$6,903.00" "$6,903.00" "$6,903.00" "$3,451.50" "$3,451.50" "$5,467.18" "$6,903.00" "$5,522.40" "$4,486.95" "$6,903.00" "$6,903.00" "$4,003.74" "$6,903.00" "$4,141.80" "$6,903.00" "$6,903.00" "$6,903.00" N/A N/A 74000061 EAP CPT® 95715 VEEG BY TECH EA INCR 12-26 HR INTERMITTENT MNTR BOTH IP/OP "$10,349.00" "$7,658.50" $478.04 "$10,349.00" "$5,619.51" "$5,619.51" "$5,619.51" "$5,619.51" $480.16 $480.16 $478.04 "$2,156.99" $480.16 "$4,181.12" "$4,181.12" "$7,977.01" "$2,060.15" "$2,156.85" $768.26 $697.42 "$3,094.73" $480.16 "$10,349.00" $480.16 $504.17 "$7,761.75" $480.16 $480.16 $480.16 "$5,174.50" "$5,174.50" "$8,196.41" $480.16 "$8,279.20" "$6,726.85" "$2,054.02" $480.16 "$6,002.42" $504.17 $694.68 $480.16 "$2,156.73" $480.16 N/A N/A 74000065 EAP CPT® 95955 EEG DURING (CAROTID) SURGERY BOTH IP/OP "$1,096.00" $811.50 $142.05 "$1,096.00" "$1,096.00" "$1,096.00" "$1,096.00" "$1,096.00" $155.73 $155.73 $221.35 "$1,096.00" $155.73 $813.45 $813.45 $844.80 $571.02 $228.42 $249.17 $227.28 "$1,096.00" $155.73 $142.05 $155.73 "$1,096.00" $822.00 $155.73 $155.73 $155.73 $548.00 $548.00 $868.03 $155.73 $876.80 $712.40 "$1,096.00" $155.73 $635.68 "$1,096.00" $158.48 $155.73 "$1,096.00" $155.73 N/A N/A 75000046 EAP CPT® 44360 SB ENDOSCOP EXCLUDING ILEUM DX BOTH IP/OP "$3,384.00" "$2,504.50" $142.73 "$3,384.00" "$3,384.00" "$3,384.00" "$3,384.00" "$3,384.00" $144.00 $144.00 $144.53 "$3,384.00" $144.00 "$3,384.00" "$3,384.00" "$3,384.00" "$3,384.00" $705.26 $230.40 $228.37 "$3,384.00" $144.00 $142.73 $144.00 "$3,384.00" "$2,538.00" $144.00 $144.00 $144.00 "$2,851.00" "$1,692.00" "$2,680.13" $144.00 "$2,707.20" "$2,500.00" "$3,384.00" $144.00 "$1,962.72" "$3,384.00" $149.27 $144.00 "$3,384.00" $144.00 N/A N/A 75000047 EAP CPT® 44361 SB ENDO-BX SINGLE MULTIPLE BOTH IP/OP "$2,728.00" "$2,019.00" $157.30 "$2,728.00" "$2,728.00" "$2,728.00" "$2,728.00" "$2,728.00" $159.43 $159.43 $160.09 "$2,728.00" $159.43 "$2,728.00" "$2,728.00" "$2,728.00" "$2,728.00" $568.55 $255.09 $251.68 "$2,728.00" $159.43 $157.30 $159.43 "$2,728.00" "$2,046.00" $159.43 $159.43 $159.43 "$2,728.00" "$1,364.00" "$2,160.58" $159.43 "$2,182.40" "$2,500.00" "$2,728.00" $159.43 "$1,582.24" "$2,728.00" $164.78 $159.43 "$2,728.00" $159.43 N/A N/A 75000050 EAP CPT® 44366 SB ENDO-CTRL OF BLEED ANY METH BOTH IP/OP "$3,030.00" "$2,242.50" $238.34 "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" $240.25 $240.25 $241.54 "$3,030.00" $240.25 "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" $631.49 $384.40 $381.34 "$3,030.00" $240.25 $238.34 $240.25 "$3,030.00" "$2,272.50" $240.25 $240.25 $240.25 "$2,851.00" "$1,515.00" "$2,399.76" $240.25 "$2,424.00" "$2,500.00" "$3,030.00" $240.25 "$1,757.40" "$3,030.00" $249.88 $240.25 "$3,030.00" $240.25 N/A N/A 75000051 EAP CPT® 44369 "SB ENDO-ABLAT OF TUM,LES OTHER" BOTH IP/OP "$3,030.00" "$2,242.50" $243.77 "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" $246.41 $246.41 $247.44 "$3,030.00" $246.41 "$3,030.00" "$3,030.00" "$3,030.00" "$3,030.00" $631.49 $394.26 $390.03 "$3,030.00" $246.41 $243.77 $246.41 "$3,030.00" "$2,272.50" $246.41 $246.41 $246.41 "$2,851.00" "$1,515.00" "$2,399.76" $246.41 "$2,424.00" "$2,500.00" "$3,030.00" $246.41 "$1,757.40" "$3,030.00" $256.01 $246.41 "$3,030.00" $246.41 N/A N/A 75000076 EAP CPT® 45334 "SIGMOID, FLEX W CONTROL BLEEDI" BOTH IP/OP "$3,337.00" "$2,469.50" $117.30 "$3,337.00" "$3,337.00" "$3,337.00" "$3,337.00" "$3,337.00" $118.20 $118.20 $118.17 "$3,337.00" $118.20 "$3,337.00" "$3,337.00" "$3,337.00" "$3,337.00" $695.47 $189.12 $187.68 "$3,337.00" $118.20 $117.30 $118.20 "$3,337.00" "$2,502.75" $118.20 $118.20 $118.20 "$2,762.00" "$1,668.50" "$2,642.90" $118.20 "$2,669.60" "$2,500.00" "$3,337.00" $118.20 "$1,935.46" "$3,337.00" $121.87 $118.20 "$3,337.00" $118.20 N/A N/A 75000100 EAP HCPCS G0121 COLON CA SCRN NOT HI RSK IND BOTH IP/OP "$4,021.00" "$2,976.00" $184.12 "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" $185.74 $185.74 $187.24 "$4,021.00" $185.74 "$4,021.00" "$4,021.00" "$4,021.00" "$4,021.00" $838.02 $297.18 $294.59 "$4,021.00" $185.74 $184.12 $185.74 "$4,021.00" "$3,015.75" $185.74 $185.74 $185.74 "$2,851.00" "$2,010.50" "$3,184.63" $185.74 "$3,216.80" "$2,150.00" "$4,021.00" $185.74 "$2,332.18" "$4,021.00" $193.26 $185.74 "$4,021.00" $185.74 N/A N/A 75000101 EAP CPT® 45391 "COLONOSCOPY, ENDOSCOPIC ULTRASOUND EXAMINATION" BOTH IP/OP "$3,045.00" "$2,253.50" $256.32 "$3,045.00" "$3,045.00" "$3,045.00" "$3,045.00" "$3,045.00" $259.07 $259.07 $259.23 "$3,045.00" $259.07 "$3,045.00" "$3,045.00" "$3,045.00" "$3,045.00" $634.61 $414.51 $410.11 "$3,045.00" $259.07 $256.32 $259.07 "$3,045.00" "$2,283.75" $259.07 $259.07 $259.07 "$2,851.00" "$1,522.50" "$2,411.64" $259.07 "$2,436.00" "$2,500.00" "$3,045.00" $259.07 "$1,766.10" "$3,045.00" $267.91 $259.07 "$3,045.00" $259.07 N/A N/A 75000102 EAP CPT® 45341 SIGMOIDSCOPY W/ULTRASOUND BOTH IP/OP "$4,341.00" "$3,212.50" $123.06 "$4,341.00" "$4,341.00" "$4,341.00" "$4,341.00" "$4,341.00" $124.74 $124.74 $124.76 "$4,341.00" $124.74 "$4,341.00" "$4,341.00" "$4,341.00" "$4,341.00" $904.71 $199.58 $196.90 "$4,341.00" $124.74 $123.06 $124.74 "$4,341.00" "$3,255.75" $124.74 $124.74 $124.74 "$2,762.00" "$2,170.50" "$3,438.07" $124.74 "$3,472.80" "$2,500.00" "$4,341.00" $124.74 "$2,517.78" "$4,341.00" $128.72 $124.74 "$4,341.00" $124.74 N/A N/A 75000110 EAP CPT® 45335 SIGMOIDOSCOPY W/SUBMUC INJ BOTH IP/OP "$2,361.00" "$1,747.50" $66.34 "$2,361.00" "$2,361.00" "$2,361.00" "$2,361.00" "$2,361.00" $66.34 $66.34 $67.17 "$2,361.00" $66.34 "$2,361.00" "$2,361.00" "$2,361.00" "$2,361.00" $492.06 $106.14 $106.85 "$2,361.00" $66.34 $66.78 $66.34 "$2,361.00" "$1,770.75" $66.34 $66.34 $66.34 "$2,361.00" "$1,180.50" "$1,869.91" $66.34 "$1,888.80" "$2,150.00" "$2,361.00" $66.34 "$1,369.38" "$2,361.00" $68.86 $66.34 "$2,361.00" $66.34 N/A N/A 75000120 EAP CPT® 43238 UPPER GI ENDOSCOPY W/US FN BX BOTH IP/OP "$2,842.00" "$2,103.50" $230.54 "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" $233.02 $233.02 $234.22 "$2,842.00" $233.02 "$2,842.00" "$2,842.00" "$2,842.00" "$2,842.00" $592.30 $372.83 $368.86 "$2,842.00" $233.02 $230.54 $233.02 "$2,842.00" "$2,131.50" $233.02 $233.02 $233.02 "$2,842.00" "$1,421.00" "$2,250.86" $233.02 "$2,273.60" "$2,500.00" "$2,842.00" $233.02 "$1,648.36" "$2,842.00" $241.59 $233.02 "$2,842.00" $233.02 N/A N/A 75000125 EAP CPT® 43242 UPPER GI ENDOSCOPY W/US FN BX BOTH IP/OP "$5,337.00" "$3,949.50" $261.40 "$5,337.00" "$5,337.00" "$5,337.00" "$5,337.00" "$5,337.00" $264.23 $264.23 $264.42 "$5,337.00" $264.23 "$5,337.00" "$5,337.00" "$5,337.00" "$5,337.00" "$1,112.29" $422.77 $418.24 "$5,337.00" $264.23 $261.40 $264.23 "$5,337.00" "$4,002.75" $264.23 $264.23 $264.23 "$2,851.00" "$2,668.50" "$4,226.90" $264.23 "$4,269.60" "$2,500.00" "$5,337.00" $264.23 "$3,095.46" "$5,337.00" $273.32 $264.23 "$5,337.00" $264.23 N/A N/A 75000127 EAP CPT® 43242 TRANSENDOSCOPIC US W/ FN BX BOTH IP/OP "$4,893.00" "$3,621.00" $261.40 "$4,893.00" "$4,893.00" "$4,893.00" "$4,893.00" "$4,893.00" $264.23 $264.23 $264.42 "$4,893.00" $264.23 "$4,893.00" "$4,893.00" "$4,893.00" "$4,893.00" "$1,019.76" $422.77 $418.24 "$4,893.00" $264.23 $261.40 $264.23 "$4,893.00" "$3,669.75" $264.23 $264.23 $264.23 "$2,851.00" "$2,446.50" "$3,875.26" $264.23 "$3,914.40" "$2,500.00" "$4,893.00" $264.23 "$2,837.94" "$4,893.00" $273.32 $264.23 "$4,893.00" $264.23 N/A N/A 75000128 EAP CPT® 45327 PROCTOSIGMOIDOSCOPY W/STENT BOTH IP/OP "$11,233.00" "$8,312.50" $117.77 "$11,233.00" "$11,233.00" "$11,233.00" "$11,233.00" "$11,233.00" $118.10 $118.10 $118.07 "$11,233.00" $118.10 "$11,233.00" "$11,233.00" "$11,233.00" "$11,233.00" "$2,341.08" $188.96 $188.43 "$11,233.00" $118.10 $117.77 $118.10 "$11,233.00" "$8,424.75" $118.10 $118.10 $118.10 "$2,762.00" "$5,616.50" "$8,896.54" $118.10 "$8,986.40" "$3,725.00" "$11,233.00" $118.10 "$6,515.14" "$11,233.00" $122.92 $118.10 "$11,233.00" $118.10 N/A N/A 75000130 EAP CPT® 45335 SIGMOIDOSCOPY W/SUBMUC INJ BOTH IP/OP "$2,361.00" "$1,747.50" $66.34 "$2,361.00" "$2,361.00" "$2,361.00" "$2,361.00" "$2,361.00" $66.34 $66.34 $67.17 "$2,361.00" $66.34 "$2,361.00" "$2,361.00" "$2,361.00" "$2,361.00" $492.06 $106.14 $106.85 "$2,361.00" $66.34 $66.78 $66.34 "$2,361.00" "$1,770.75" $66.34 $66.34 $66.34 "$2,361.00" "$1,180.50" "$1,869.91" $66.34 "$1,888.80" "$2,150.00" "$2,361.00" $66.34 "$1,369.38" "$2,361.00" $68.86 $66.34 "$2,361.00" $66.34 N/A N/A 75000132 EAP CPT® 45340 SIG W/BALLOON DILATION BOTH IP/OP "$5,946.00" "$4,400.50" $78.26 "$5,946.00" "$5,946.00" "$5,946.00" "$5,946.00" "$5,946.00" $78.59 $78.59 $78.26 "$5,946.00" $78.59 "$5,946.00" "$5,946.00" "$5,946.00" "$5,946.00" "$1,239.21" $125.74 $125.31 "$5,946.00" $78.59 $78.32 $78.59 "$5,946.00" "$4,459.50" $78.59 $78.59 $78.59 "$2,762.00" "$2,973.00" "$4,709.23" $78.59 "$4,756.80" "$2,500.00" "$5,946.00" $78.59 "$3,448.68" "$5,946.00" $80.76 $78.59 "$5,946.00" $78.59 N/A N/A 75000136 EAP CPT® 91034 "ESOPH, GASTROESOPH REFLUX TEST W/REC, ANLYS,RPT" BOTH IP/OP "$2,483.00" "$1,837.50" $142.99 "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" $150.55 $150.55 $203.59 "$2,483.00" $150.55 "$2,483.00" "$2,483.00" "$2,483.00" "$2,483.00" $517.48 $240.88 $233.23 "$2,483.00" $150.55 $145.77 $150.55 "$2,483.00" "$1,862.25" $150.55 $150.55 $150.55 "$1,241.50" "$1,241.50" "$1,966.54" $150.55 "$1,986.40" "$1,750.00" "$2,483.00" $150.55 "$1,440.14" "$2,483.00" $142.99 $150.55 "$2,483.00" $150.55 N/A N/A 75000137 EAP CPT® 91038 "ESOPH GASTRO REFLUX TEST, PROLONGED 1-24 HRS." BOTH IP/OP "$2,693.00" "$1,993.00" $359.85 "$2,693.00" "$1,462.30" "$1,462.30" "$1,462.30" "$1,462.30" $480.16 $480.16 $478.04 $561.29 $480.16 "$2,693.00" "$2,693.00" "$2,693.00" "$2,693.00" $561.25 $768.26 $697.42 "$1,592.91" $480.16 $359.85 $480.16 $504.17 "$2,019.75" $480.16 $480.16 $480.16 "$1,346.50" "$1,346.50" "$2,132.86" $480.16 "$2,154.40" "$1,750.00" $534.49 $480.16 "$1,561.94" $504.17 $694.68 $480.16 $561.22 $480.16 N/A N/A 75000138 EAP CPT® 91010 ESOPHAGEAL MOTILITY STUDY W/ INTERP & REPORT BOTH IP/OP "$3,327.00" "$2,462.00" $160.32 "$3,327.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $480.16 $480.16 $478.04 $693.43 $480.16 "$3,327.00" "$3,327.00" "$3,327.00" "$3,327.00" $693.38 $768.26 $697.42 "$1,967.92" $480.16 $160.32 $480.16 $504.17 "$2,495.25" $480.16 $480.16 $480.16 "$1,663.50" "$1,663.50" "$2,634.98" $480.16 "$2,661.60" "$1,750.00" $660.33 $480.16 "$1,929.66" $504.17 $694.68 $480.16 $693.35 $480.16 N/A N/A 75000139 EAP CPT® 91037 "ESOPH GASTROESOPH REFLUX TEST FUNCT W/REC, ANLYS,RPT" BOTH IP/OP "$2,254.00" "$1,668.00" $118.14 "$2,254.00" "$2,254.00" "$2,254.00" "$2,254.00" "$2,254.00" $127.75 $127.75 $178.20 "$2,254.00" $127.75 "$2,254.00" "$2,254.00" "$2,254.00" "$2,254.00" $469.76 $204.40 $195.90 "$2,254.00" $127.75 $122.44 $127.75 "$2,254.00" "$1,690.50" $127.75 $127.75 $127.75 "$1,127.00" "$1,127.00" "$1,785.17" $127.75 "$1,803.20" "$1,750.00" "$2,254.00" $127.75 "$1,307.32" "$2,254.00" $118.14 $127.75 "$2,254.00" $127.75 N/A N/A 75000140 EAP CPT® 91120 RECTAL SENSATION TONE & COMPLY BALLOON DISTENTION BOTH IP/OP "$1,373.00" "$1,016.50" $259.18 "$1,373.00" $745.54 $745.54 $745.54 $745.54 $260.33 $260.33 $259.18 $286.17 $260.33 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" $286.15 $416.53 $404.03 $812.13 $260.33 $470.43 $260.33 $273.35 "$1,029.75" $260.33 $260.33 $260.33 $686.50 $686.50 "$1,087.42" $260.33 "$1,098.40" "$1,373.00" $272.51 $260.33 $796.34 $273.35 $376.64 $260.33 $286.13 $260.33 N/A N/A 75000141 EAP CPT® 91122 ANORECTAL MANOMETRY BOTH IP/OP "$1,373.00" "$1,016.50" $190.75 "$1,373.00" $745.54 $745.54 $745.54 $745.54 $261.76 $261.76 $260.60 $286.17 $261.76 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" $286.15 $418.81 $404.03 $812.13 $261.76 $190.75 $261.76 $274.85 "$1,029.75" $261.76 $261.76 $261.76 $686.50 $686.50 "$1,087.42" $261.76 "$1,098.40" "$1,373.00" $272.51 $261.76 $796.34 $274.85 $378.70 $261.76 $286.13 $261.76 N/A N/A 75000142 EAP CPT® 51784 "EMG ANAL OR URETHRAL SPHINCTER, OTHER THAN NEEDLE" BOTH IP/OP $210.00 $155.50 $27.74 $219.74 $114.03 $114.03 $114.03 $114.03 $137.34 $137.34 $136.73 $43.77 $137.34 $210.00 $210.00 $210.00 $210.00 $43.77 $219.74 $209.80 $113.00 $137.34 $27.74 $137.34 $144.20 $157.50 $137.34 $137.34 $137.34 $210.00 $105.00 $166.32 $137.34 $168.00 $210.00 $41.68 $137.34 $121.80 $144.20 $198.69 $137.34 $43.76 $137.34 N/A N/A 75000145 EAP CPT® 91035 G-ESOPH REFLX TST W/ELECTRODE BOTH IP/OP "$2,720.00" "$2,013.00" $387.91 "$2,720.00" "$1,476.96" "$1,476.96" "$1,476.96" "$1,476.96" $480.16 $480.16 $478.04 $566.92 $480.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 $768.26 $697.42 "$1,608.88" $480.16 $387.91 $480.16 $504.17 "$2,040.00" $480.16 $480.16 $480.16 "$1,360.00" "$1,360.00" "$2,154.24" $480.16 "$2,176.00" "$1,750.00" $539.85 $480.16 "$1,577.60" $504.17 $694.68 $480.16 $566.85 $480.16 N/A N/A 75000146 EAP CPT® 91022 DUODENAL MOTILITY STUDY BOTH IP/OP "$1,128.00" $835.00 $95.44 "$1,128.00" "$1,128.00" "$1,128.00" "$1,128.00" "$1,128.00" $104.58 $104.58 $178.90 "$1,128.00" $104.58 "$1,128.00" "$1,128.00" "$1,128.00" "$1,128.00" $235.09 $167.33 $162.90 "$1,128.00" $104.58 $101.81 $104.58 "$1,128.00" $846.00 $104.58 $104.58 $104.58 $564.00 $564.00 $893.38 $104.58 $902.40 "$1,128.00" "$1,128.00" $104.58 $654.24 "$1,128.00" $95.44 $104.58 "$1,128.00" $104.58 N/A N/A 75000147 EAP CPT® 91117 COLON MOTILITY 6HRS OR >INC PROVOC TEST W/ INTERP& REPOT BOTH IP/OP $865.00 $640.50 $135.55 $865.00 $865.00 $865.00 $865.00 $865.00 $137.42 $137.42 $137.58 $865.00 $137.42 $865.00 $865.00 $865.00 $865.00 $180.28 $219.87 $216.88 $865.00 $137.42 $135.55 $137.42 $865.00 $648.75 $137.42 $137.42 $137.42 $432.50 $432.50 $685.08 $137.42 $692.00 $865.00 $865.00 $137.42 $501.70 $865.00 $141.35 $137.42 $865.00 $137.42 N/A N/A 75000182 EAP CPT® 46601 HIGH-RESOLUTION ANOSCOPY (HRA) DIAGNOSTIC BOTH IP/OP $637.00 $471.50 $93.58 $637.00 $637.00 $637.00 $637.00 $637.00 $110.92 $110.92 $110.43 $132.77 $110.92 $637.00 $637.00 $637.00 $637.00 $132.76 $177.47 $167.51 $637.00 $110.92 $93.58 $110.92 $116.46 $477.75 $110.92 $110.92 $110.92 $637.00 $318.50 $504.50 $110.92 $509.60 $637.00 $126.43 $110.92 $369.46 $116.46 $160.47 $110.92 $132.75 $110.92 N/A N/A 75000200 EAP Custom 75000200 COLONSCOPY DX BOTH IP/OP "$3,855.00" "$2,853.00" $686.19 "$4,241.00" "$3,855.00" "$3,855.00" "$3,855.00" "$3,855.00" "$3,855.00" "$3,855.00" $686.19 "$3,855.00" "$3,855.00" "$3,855.00" "$3,855.00" "$3,855.00" "$3,855.00" $803.42 "$3,855.00" "$1,696.40" "$3,855.00" "$3,855.00" "$4,241.00" "$3,855.00" "$3,855.00" "$2,891.25" "$3,855.00" "$3,855.00" "$3,855.00" "$1,927.50" "$1,927.50" "$3,053.16" "$3,855.00" "$3,084.00" "$2,505.75" "$3,855.00" "$3,855.00" "$2,235.90" "$3,855.00" "$2,313.00" "$3,855.00" "$3,855.00" "$3,855.00" N/A N/A 75000201 EAP Custom 75000201 COLONSCOPY THERA 1 INTERVENTION BOTH IP/OP "$4,243.00" "$3,140.00" $755.25 "$4,667.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" $755.25 "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" "$4,243.00" $884.29 "$4,243.00" "$1,866.80" "$4,243.00" "$4,243.00" "$4,667.00" "$4,243.00" "$4,243.00" "$3,182.25" "$4,243.00" "$4,243.00" "$4,243.00" "$2,121.50" "$2,121.50" "$3,360.46" "$4,243.00" "$3,394.40" "$2,757.95" "$4,243.00" "$4,243.00" "$2,460.94" "$4,243.00" "$2,545.80" "$4,243.00" "$4,243.00" "$4,243.00" N/A N/A 75000202 EAP Custom 75000202 COLONSCOPY THERA 2 INTERVENTION BOTH IP/OP "$4,665.00" "$3,452.50" $830.37 "$5,132.00" "$4,665.00" "$4,665.00" "$4,665.00" "$4,665.00" "$4,665.00" "$4,665.00" $830.37 "$4,665.00" "$4,665.00" "$4,665.00" "$4,665.00" "$4,665.00" "$4,665.00" $972.24 "$4,665.00" "$2,052.80" "$4,665.00" "$4,665.00" "$5,132.00" "$4,665.00" "$4,665.00" "$3,498.75" "$4,665.00" "$4,665.00" "$4,665.00" "$2,332.50" "$2,332.50" "$3,694.68" "$4,665.00" "$3,732.00" "$3,032.25" "$4,665.00" "$4,665.00" "$2,705.70" "$4,665.00" "$2,799.00" "$4,665.00" "$4,665.00" "$4,665.00" N/A N/A 75000203 EAP Custom 75000203 COLONSCOPY THERA 3 INTERVENTION BOTH IP/OP "$5,132.00" "$3,798.00" $913.50 "$5,645.00" "$5,132.00" "$5,132.00" "$5,132.00" "$5,132.00" "$5,132.00" "$5,132.00" $913.50 "$5,132.00" "$5,132.00" "$5,132.00" "$5,132.00" "$5,132.00" "$5,132.00" "$1,069.57" "$5,132.00" "$2,258.00" "$5,132.00" "$5,132.00" "$5,645.00" "$5,132.00" "$5,132.00" "$3,849.00" "$5,132.00" "$5,132.00" "$5,132.00" "$2,566.00" "$2,566.00" "$4,064.54" "$5,132.00" "$4,105.60" "$3,335.80" "$5,132.00" "$5,132.00" "$2,976.56" "$5,132.00" "$3,079.20" "$5,132.00" "$5,132.00" "$5,132.00" N/A N/A 75000204 EAP Custom 75000204 EGD DX BOTH IP/OP "$3,286.00" "$2,432.00" $584.91 "$3,615.00" "$3,286.00" "$3,286.00" "$3,286.00" "$3,286.00" "$3,286.00" "$3,286.00" $584.91 "$3,286.00" "$3,286.00" "$3,286.00" "$3,286.00" "$3,286.00" "$3,286.00" $684.84 "$3,286.00" "$1,446.00" "$3,286.00" "$3,286.00" "$3,615.00" "$3,286.00" "$3,286.00" "$2,464.50" "$3,286.00" "$3,286.00" "$3,286.00" "$1,643.00" "$1,643.00" "$2,602.51" "$3,286.00" "$2,628.80" "$2,135.90" "$3,286.00" "$3,286.00" "$1,905.88" "$3,286.00" "$1,971.60" "$3,286.00" "$3,286.00" "$3,286.00" N/A N/A 75000205 EAP Custom 75000205 EGD THERA 1 INTERVENTION BOTH IP/OP "$3,615.00" "$2,675.50" $643.47 "$3,977.00" "$3,615.00" "$3,615.00" "$3,615.00" "$3,615.00" "$3,615.00" "$3,615.00" $643.47 "$3,615.00" "$3,615.00" "$3,615.00" "$3,615.00" "$3,615.00" "$3,615.00" $753.41 "$3,615.00" "$1,590.80" "$3,615.00" "$3,615.00" "$3,977.00" "$3,615.00" "$3,615.00" "$2,711.25" "$3,615.00" "$3,615.00" "$3,615.00" "$1,807.50" "$1,807.50" "$2,863.08" "$3,615.00" "$2,892.00" "$2,349.75" "$3,615.00" "$3,615.00" "$2,096.70" "$3,615.00" "$2,169.00" "$3,615.00" "$3,615.00" "$3,615.00" N/A N/A 75000206 EAP Custom 75000206 EGD THERA 2 INTERVENTION BOTH IP/OP "$3,977.00" "$2,943.00" $707.91 "$4,375.00" "$3,977.00" "$3,977.00" "$3,977.00" "$3,977.00" "$3,977.00" "$3,977.00" $707.91 "$3,977.00" "$3,977.00" "$3,977.00" "$3,977.00" "$3,977.00" "$3,977.00" $828.85 "$3,977.00" "$1,750.00" "$3,977.00" "$3,977.00" "$4,375.00" "$3,977.00" "$3,977.00" "$2,982.75" "$3,977.00" "$3,977.00" "$3,977.00" "$1,988.50" "$1,988.50" "$3,149.78" "$3,977.00" "$3,181.60" "$2,585.05" "$3,977.00" "$3,977.00" "$2,306.66" "$3,977.00" "$2,386.20" "$3,977.00" "$3,977.00" "$3,977.00" N/A N/A 75000207 EAP Custom 75000207 EGD THERA 3 INTERVENTION BOTH IP/OP "$4,374.00" "$3,237.00" $778.57 "$4,811.00" "$4,374.00" "$4,374.00" "$4,374.00" "$4,374.00" "$4,374.00" "$4,374.00" $778.57 "$4,374.00" "$4,374.00" "$4,374.00" "$4,374.00" "$4,374.00" "$4,374.00" $911.59 "$4,374.00" "$1,924.40" "$4,374.00" "$4,374.00" "$4,811.00" "$4,374.00" "$4,374.00" "$3,280.50" "$4,374.00" "$4,374.00" "$4,374.00" "$2,187.00" "$2,187.00" "$3,464.21" "$4,374.00" "$3,499.20" "$2,843.10" "$4,374.00" "$4,374.00" "$2,536.92" "$4,374.00" "$2,624.40" "$4,374.00" "$4,374.00" "$4,374.00" N/A N/A 75000208 EAP Custom 75000208 ERCP DX BOTH IP/OP "$6,193.00" "$4,583.00" "$1,102.35" "$6,812.00" "$6,193.00" "$6,193.00" "$6,193.00" "$6,193.00" "$6,193.00" "$6,193.00" "$1,102.35" "$6,193.00" "$6,193.00" "$6,193.00" "$6,193.00" "$6,193.00" "$6,193.00" "$1,290.69" "$6,193.00" "$2,724.80" "$6,193.00" "$6,193.00" "$6,812.00" "$6,193.00" "$6,193.00" "$4,644.75" "$6,193.00" "$6,193.00" "$6,193.00" "$3,096.50" "$3,096.50" "$4,904.86" "$6,193.00" "$4,954.40" "$4,025.45" "$6,193.00" "$6,193.00" "$3,591.94" "$6,193.00" "$3,715.80" "$6,193.00" "$6,193.00" "$6,193.00" N/A N/A 75000209 EAP Custom 75000209 ERCP THERA 1 INTERVENTION BOTH IP/OP "$6,810.00" "$5,039.50" "$1,212.18" "$7,491.00" "$6,810.00" "$6,810.00" "$6,810.00" "$6,810.00" "$6,810.00" "$6,810.00" "$1,212.18" "$6,810.00" "$6,810.00" "$6,810.00" "$6,810.00" "$6,810.00" "$6,810.00" "$1,419.28" "$6,810.00" "$2,996.40" "$6,810.00" "$6,810.00" "$7,491.00" "$6,810.00" "$6,810.00" "$5,107.50" "$6,810.00" "$6,810.00" "$6,810.00" "$3,405.00" "$3,405.00" "$5,393.52" "$6,810.00" "$5,448.00" "$4,426.50" "$6,810.00" "$6,810.00" "$3,949.80" "$6,810.00" "$4,086.00" "$6,810.00" "$6,810.00" "$6,810.00" N/A N/A 75000210 EAP Custom 75000210 ERCP THERA 2 INTERVENTION BOTH IP/OP "$7,493.00" "$5,545.00" "$1,333.75" "$8,242.00" "$7,493.00" "$7,493.00" "$7,493.00" "$7,493.00" "$7,493.00" "$7,493.00" "$1,333.75" "$7,493.00" "$7,493.00" "$7,493.00" "$7,493.00" "$7,493.00" "$7,493.00" "$1,561.62" "$7,493.00" "$3,296.80" "$7,493.00" "$7,493.00" "$8,242.00" "$7,493.00" "$7,493.00" "$5,619.75" "$7,493.00" "$7,493.00" "$7,493.00" "$3,746.50" "$3,746.50" "$5,934.46" "$7,493.00" "$5,994.40" "$4,870.45" "$7,493.00" "$7,493.00" "$4,345.94" "$7,493.00" "$4,495.80" "$7,493.00" "$7,493.00" "$7,493.00" N/A N/A 75000211 EAP Custom 75000211 ERCP THERA 3 INTERVENTION BOTH IP/OP "$8,242.00" "$6,099.50" "$1,467.08" "$8,242.00" "$8,242.00" "$8,242.00" "$8,242.00" "$8,242.00" "$8,242.00" "$8,242.00" "$1,467.08" "$8,242.00" "$8,242.00" "$8,242.00" "$8,242.00" "$8,242.00" "$8,242.00" "$1,717.72" "$8,242.00" "$3,296.80" "$8,242.00" "$8,242.00" "$8,242.00" "$8,242.00" "$8,242.00" "$6,181.50" "$8,242.00" "$8,242.00" "$8,242.00" "$4,121.00" "$4,121.00" "$6,527.66" "$8,242.00" "$6,593.60" "$5,357.30" "$8,242.00" "$8,242.00" "$4,780.36" "$8,242.00" "$4,945.20" "$8,242.00" "$8,242.00" "$8,242.00" N/A N/A 75000212 EAP Custom 75000212 SIGMOIDOSCOPY DX BOTH IP/OP "$3,919.00" "$2,900.50" $697.58 "$4,311.00" "$3,919.00" "$3,919.00" "$3,919.00" "$3,919.00" "$3,919.00" "$3,919.00" $697.58 "$3,919.00" "$3,919.00" "$3,919.00" "$3,919.00" "$3,919.00" "$3,919.00" $816.76 "$3,919.00" "$1,724.40" "$3,919.00" "$3,919.00" "$4,311.00" "$3,919.00" "$3,919.00" "$2,939.25" "$3,919.00" "$3,919.00" "$3,919.00" "$1,959.50" "$1,959.50" "$3,103.85" "$3,919.00" "$3,135.20" "$2,547.35" "$3,919.00" "$3,919.00" "$2,273.02" "$3,919.00" "$2,351.40" "$3,919.00" "$3,919.00" "$3,919.00" N/A N/A 75000213 EAP Custom 75000213 SIGMOIDOSCOPY THERA 1 INTERVENTION BOTH IP/OP "$4,311.00" "$3,190.50" $767.36 "$4,742.00" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" $767.36 "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" $898.46 "$4,311.00" "$1,896.80" "$4,311.00" "$4,311.00" "$4,742.00" "$4,311.00" "$4,311.00" "$3,233.25" "$4,311.00" "$4,311.00" "$4,311.00" "$2,155.50" "$2,155.50" "$3,414.31" "$4,311.00" "$3,448.80" "$2,802.15" "$4,311.00" "$4,311.00" "$2,500.38" "$4,311.00" "$2,586.60" "$4,311.00" "$4,311.00" "$4,311.00" N/A N/A 75000214 EAP Custom 75000214 SIGMOIDOSCOPY THERA 2 INTERVENTION BOTH IP/OP "$4,741.00" "$3,508.50" $843.90 "$5,215.00" "$4,741.00" "$4,741.00" "$4,741.00" "$4,741.00" "$4,741.00" "$4,741.00" $843.90 "$4,741.00" "$4,741.00" "$4,741.00" "$4,741.00" "$4,741.00" "$4,741.00" $988.08 "$4,741.00" "$2,086.00" "$4,741.00" "$4,741.00" "$5,215.00" "$4,741.00" "$4,741.00" "$3,555.75" "$4,741.00" "$4,741.00" "$4,741.00" "$2,370.50" "$2,370.50" "$3,754.87" "$4,741.00" "$3,792.80" "$3,081.65" "$4,741.00" "$4,741.00" "$2,749.78" "$4,741.00" "$2,844.60" "$4,741.00" "$4,741.00" "$4,741.00" N/A N/A 75000215 EAP Custom 75000215 SIGMOIDOSCOPY THERA 3 INTERVENTION BOTH IP/OP "$5,217.00" "$3,861.00" $928.63 "$5,739.00" "$5,217.00" "$5,217.00" "$5,217.00" "$5,217.00" "$5,217.00" "$5,217.00" $928.63 "$5,217.00" "$5,217.00" "$5,217.00" "$5,217.00" "$5,217.00" "$5,217.00" "$1,087.28" "$5,217.00" "$2,295.60" "$5,217.00" "$5,217.00" "$5,739.00" "$5,217.00" "$5,217.00" "$3,912.75" "$5,217.00" "$5,217.00" "$5,217.00" "$2,608.50" "$2,608.50" "$4,131.86" "$5,217.00" "$4,173.60" "$3,391.05" "$5,217.00" "$5,217.00" "$3,025.86" "$5,217.00" "$3,130.20" "$5,217.00" "$5,217.00" "$5,217.00" N/A N/A 75000216 EAP Custom 75000216 COLONSCOPY VIA STOMA DX BOTH IP/OP "$3,081.00" "$2,280.00" $548.42 "$3,389.00" "$3,081.00" "$3,081.00" "$3,081.00" "$3,081.00" "$3,081.00" "$3,081.00" $548.42 "$3,081.00" "$3,081.00" "$3,081.00" "$3,081.00" "$3,081.00" "$3,081.00" $642.11 "$3,081.00" "$1,355.60" "$3,081.00" "$3,081.00" "$3,389.00" "$3,081.00" "$3,081.00" "$2,310.75" "$3,081.00" "$3,081.00" "$3,081.00" "$1,540.50" "$1,540.50" "$2,440.15" "$3,081.00" "$2,464.80" "$2,002.65" "$3,081.00" "$3,081.00" "$1,786.98" "$3,081.00" "$1,848.60" "$3,081.00" "$3,081.00" "$3,081.00" N/A N/A 75000217 EAP Custom 75000217 COLONSCOPY VIA STOMA 1 INTERVENTION BOTH IP/OP "$3,389.00" "$2,508.00" $603.24 "$3,728.00" "$3,389.00" "$3,389.00" "$3,389.00" "$3,389.00" "$3,389.00" "$3,389.00" $603.24 "$3,389.00" "$3,389.00" "$3,389.00" "$3,389.00" "$3,389.00" "$3,389.00" $706.30 "$3,389.00" "$1,491.20" "$3,389.00" "$3,389.00" "$3,728.00" "$3,389.00" "$3,389.00" "$2,541.75" "$3,389.00" "$3,389.00" "$3,389.00" "$1,694.50" "$1,694.50" "$2,684.09" "$3,389.00" "$2,711.20" "$2,202.85" "$3,389.00" "$3,389.00" "$1,965.62" "$3,389.00" "$2,033.40" "$3,389.00" "$3,389.00" "$3,389.00" N/A N/A 75000218 EAP Custom 75000218 COLONSCOPY VIA STOMA 2 INTERVENTION BOTH IP/OP "$3,727.00" "$2,758.00" $663.41 "$4,100.00" "$3,727.00" "$3,727.00" "$3,727.00" "$3,727.00" "$3,727.00" "$3,727.00" $663.41 "$3,727.00" "$3,727.00" "$3,727.00" "$3,727.00" "$3,727.00" "$3,727.00" $776.75 "$3,727.00" "$1,640.00" "$3,727.00" "$3,727.00" "$4,100.00" "$3,727.00" "$3,727.00" "$2,795.25" "$3,727.00" "$3,727.00" "$3,727.00" "$1,863.50" "$1,863.50" "$2,951.78" "$3,727.00" "$2,981.60" "$2,422.55" "$3,727.00" "$3,727.00" "$2,161.66" "$3,727.00" "$2,236.20" "$3,727.00" "$3,727.00" "$3,727.00" N/A N/A 75000219 EAP Custom 75000219 COLONSCOPY VIA STOMA 3 INTERVENTION BOTH IP/OP "$4,101.00" "$3,035.00" $729.98 "$4,511.00" "$4,101.00" "$4,101.00" "$4,101.00" "$4,101.00" "$4,101.00" "$4,101.00" $729.98 "$4,101.00" "$4,101.00" "$4,101.00" "$4,101.00" "$4,101.00" "$4,101.00" $854.69 "$4,101.00" "$1,804.40" "$4,101.00" "$4,101.00" "$4,511.00" "$4,101.00" "$4,101.00" "$3,075.75" "$4,101.00" "$4,101.00" "$4,101.00" "$2,050.50" "$2,050.50" "$3,247.99" "$4,101.00" "$3,280.80" "$2,665.65" "$4,101.00" "$4,101.00" "$2,378.58" "$4,101.00" "$2,460.60" "$4,101.00" "$4,101.00" "$4,101.00" N/A N/A 75000220 EAP CPT® 91112 GI WIRELESS CAPSULE MEASURE BOTH IP/OP "$3,844.00" "$2,845.00" $801.13 "$3,844.00" "$3,844.00" "$3,844.00" "$3,844.00" "$3,844.00" "$1,683.30" "$1,683.30" "$1,713.57" "$3,844.00" "$1,683.30" "$3,844.00" "$3,844.00" "$3,844.00" "$3,844.00" $801.13 "$2,693.28" "$2,506.99" "$3,844.00" "$1,683.30" "$1,566.87" "$1,683.30" "$3,844.00" "$2,883.00" "$1,683.30" "$1,683.30" "$1,683.30" "$1,922.00" "$1,922.00" "$3,044.45" "$1,683.30" "$3,075.20" "$2,500.00" "$3,844.00" "$1,683.30" "$2,229.52" "$3,844.00" "$1,365.06" "$1,683.30" "$3,844.00" "$1,683.30" N/A N/A 75000221 EAP HCPCS 91299 PATENCY PILL PLACEMENT BOTH IP/OP "$1,081.00" $800.00 $195.20 "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" "$1,081.00" $225.29 "$1,081.00" $195.20 "$1,081.00" "$1,081.00" $488.00 "$1,081.00" "$1,081.00" $810.75 "$1,081.00" "$1,081.00" "$1,081.00" $540.50 $540.50 $856.15 "$1,081.00" $864.80 $702.65 "$1,081.00" "$1,081.00" $626.98 "$1,081.00" $648.60 "$1,081.00" "$1,081.00" "$1,081.00" N/A N/A 75000222 EAP EGD TRANSORAL BIOPSY SINGLE/MULTI-IP BEDSIDE BOTH IP/OP "$3,388.00" "$2,507.50" $603.06 "$3,388.00" "$3,388.00" "$3,388.00" "$3,388.00" "$3,388.00" "$3,388.00" "$3,388.00" $603.06 "$3,388.00" "$3,388.00" "$3,388.00" "$3,388.00" "$3,388.00" "$3,388.00" $706.10 "$3,388.00" "$1,355.20" "$3,388.00" "$3,388.00" "$3,388.00" "$3,388.00" "$3,388.00" "$2,541.00" "$3,388.00" "$3,388.00" "$3,388.00" "$1,694.00" "$1,694.00" "$2,683.30" "$3,388.00" "$2,710.40" "$2,202.20" "$3,388.00" "$3,388.00" "$1,965.04" "$3,388.00" "$2,032.80" "$3,388.00" "$3,388.00" "$3,388.00" N/A N/A 76100002 EAP CPT® 36511 LEUKOPHERESIS BOTH IP/OP "$6,450.00" "$4,773.00" $109.11 "$6,450.00" "$6,450.00" "$6,450.00" "$6,450.00" "$6,450.00" $109.92 $109.92 $111.11 "$6,450.00" $109.92 "$6,450.00" "$6,450.00" "$6,450.00" "$6,450.00" "$1,344.25" $175.87 $174.58 "$6,450.00" $109.92 $109.11 $109.92 "$6,450.00" "$4,837.50" $109.92 $109.92 $109.92 "$2,762.00" "$3,225.00" "$5,108.40" $109.92 "$5,160.00" "$2,500.00" "$6,450.00" $109.92 "$3,741.00" "$6,450.00" $113.59 $109.92 "$6,450.00" $109.92 N/A N/A 76100003 EAP CPT® 36512 THERAPEUTIC APHERESIS RED BLOOD CELLS BOTH IP/OP "$8,063.00" "$5,967.00" $106.06 "$6,450.40" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,341.70" "$1,341.70" "$1,335.77" "$1,680.53" "$1,341.70" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,680.42" "$2,146.72" "$1,961.79" "$4,877.00" "$1,341.70" $106.06 "$1,341.70" "$1,408.79" "$6,047.25" "$1,341.70" "$1,341.70" "$1,341.70" "$2,762.00" "$2,348.00" "$6,385.90" "$1,341.70" "$6,450.40" "$2,500.00" "$1,600.30" "$1,341.70" "$4,676.54" "$1,408.79" "$1,941.10" "$1,341.70" "$1,680.33" "$1,341.70" N/A N/A 76100004 EAP CPT® 36513 PLATELETPHERESIS BOTH IP/OP "$8,063.00" "$5,967.00" $105.77 "$8,063.00" "$8,063.00" "$8,063.00" "$8,063.00" "$8,063.00" $106.87 $106.87 $109.46 "$8,063.00" $106.87 "$8,063.00" "$8,063.00" "$8,063.00" "$8,063.00" "$1,680.42" $170.99 $169.23 "$8,063.00" $106.87 $105.77 $106.87 "$8,063.00" "$6,047.25" $106.87 $106.87 $106.87 "$2,762.00" "$4,031.50" "$6,385.90" $106.87 "$6,450.40" "$2,500.00" "$8,063.00" $106.87 "$4,676.54" "$8,063.00" $113.58 $106.87 "$8,063.00" $106.87 N/A N/A 76100005 EAP CPT® 36514 PLASMAPHERESIS BOTH IP/OP "$7,805.00" "$5,776.00" $92.87 "$7,805.00" "$7,805.00" "$7,805.00" "$7,805.00" "$7,805.00" $94.30 $94.30 $95.40 "$7,805.00" $94.30 "$7,805.00" "$7,805.00" "$7,805.00" "$7,805.00" "$1,626.65" $150.88 $148.59 "$7,805.00" $94.30 $92.87 $94.30 "$7,805.00" "$5,853.75" $94.30 $94.30 $94.30 "$2,762.00" "$3,902.50" "$6,181.56" $94.30 "$6,244.00" "$2,500.00" "$7,805.00" $94.30 "$4,526.90" "$7,805.00" $99.17 $94.30 "$7,805.00" $94.30 N/A N/A 76100006 EAP CPT® 51700 BLADDER IRRIG/INSTILL SIMPLE BOTH IP/OP $504.00 $373.00 $30.19 $504.00 $504.00 $504.00 $504.00 $504.00 $261.76 $261.76 $260.60 $105.05 $261.76 $504.00 $504.00 $504.00 $504.00 $105.04 $418.81 $309.98 $113.00 $261.76 $30.19 $261.76 $274.85 $378.00 $261.76 $261.76 $261.76 $504.00 $252.00 $399.17 $261.76 $403.20 $504.00 $100.03 $261.76 $292.32 $274.85 $378.70 $261.76 $105.03 $261.76 N/A N/A 76100007 EAP CPT® 51700 BADDER IRRIG/INSTILL SIMPLE BOTH IP/OP $504.00 $373.00 $30.19 $504.00 $504.00 $504.00 $504.00 $504.00 $261.76 $261.76 $260.60 $105.05 $261.76 $504.00 $504.00 $504.00 $504.00 $105.04 $418.81 $309.98 $113.00 $261.76 $30.19 $261.76 $274.85 $378.00 $261.76 $261.76 $261.76 $504.00 $252.00 $399.17 $261.76 $403.20 $504.00 $100.03 $261.76 $292.32 $274.85 $378.70 $261.76 $105.03 $261.76 N/A N/A 76100009 EAP CPT® 92136 IOL CALCULATIONS (OPHTHALMIC BIOMETRY) BOTH IP/OP $416.00 $308.00 $17.25 $416.00 $225.89 $225.89 $225.89 $225.89 $110.92 $110.92 $110.43 $86.70 $110.92 $416.00 $416.00 $416.00 $416.00 $86.70 $177.47 $167.51 $246.06 $110.92 $17.25 $110.92 $116.46 $312.00 $110.92 $110.92 $110.92 $208.00 $208.00 $329.47 $110.92 $332.80 $270.40 $82.57 $110.92 $241.28 $116.46 $160.47 $110.92 $86.69 $110.92 N/A N/A 76100011 EAP CPT® 51701 INSERT STRAIGHT CATH BOTH IP/OP $865.00 $640.50 $25.44 $865.00 $865.00 $865.00 $865.00 $865.00 $110.92 $110.92 $110.43 $180.29 $110.92 $865.00 $865.00 $865.00 $865.00 $180.28 $177.47 $167.51 $113.00 $110.92 $25.44 $110.92 $116.46 $648.75 $110.92 $110.92 $110.92 $865.00 $432.50 $685.08 $110.92 $692.00 $865.00 $171.68 $110.92 $501.70 $116.46 $160.47 $110.92 $180.27 $110.92 N/A N/A 76100013 EAP CPT® 51703 "URINARY CATH, INDWELLING" BOTH IP/OP "$1,809.00" "$1,339.00" $76.30 "$1,809.00" "$1,809.00" "$1,809.00" "$1,809.00" "$1,809.00" $137.34 $137.34 $136.73 $377.04 $137.34 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $377.02 $219.74 $209.80 "$1,809.00" $137.34 $76.30 $137.34 $144.20 "$1,356.75" $137.34 $137.34 $137.34 "$1,809.00" $904.50 "$1,432.73" $137.34 "$1,447.20" "$1,750.00" $359.04 $137.34 "$1,049.22" $144.20 $198.69 $137.34 $377.00 $137.34 N/A N/A 76100017 EAP CPT® 51703 "INSERT BLADDER CATH, COMPLEX" BOTH IP/OP "$1,808.00" "$1,338.00" $76.30 "$1,808.00" "$1,808.00" "$1,808.00" "$1,808.00" "$1,808.00" $137.34 $137.34 $136.73 $376.83 $137.34 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $376.81 $219.74 $209.80 "$1,808.00" $137.34 $76.30 $137.34 $144.20 "$1,356.00" $137.34 $137.34 $137.34 "$1,808.00" $904.00 "$1,431.94" $137.34 "$1,446.40" "$1,750.00" $358.84 $137.34 "$1,048.64" $144.20 $198.69 $137.34 $376.79 $137.34 N/A N/A 76100020 EAP CPT® 51701 BLADDER IRRIG/INSTILL SIMPLE BOTH IP/OP $864.00 $639.50 $25.44 $864.00 $864.00 $864.00 $864.00 $864.00 $110.92 $110.92 $110.43 $180.08 $110.92 $864.00 $864.00 $864.00 $864.00 $180.07 $177.47 $167.51 $113.00 $110.92 $25.44 $110.92 $116.46 $648.00 $110.92 $110.92 $110.92 $864.00 $432.00 $684.29 $110.92 $691.20 $864.00 $171.48 $110.92 $501.12 $116.46 $160.47 $110.92 $180.06 $110.92 N/A N/A 76100028 EAP CPT® 40810 EXC. LESION MUCOSA&SUB W/O REPAIR BOTH IP/OP "$5,204.00" "$3,851.00" $125.00 "$4,877.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,691.05" "$2,691.05" "$2,679.15" "$1,084.64" "$2,691.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,084.57" "$4,305.68" "$4,104.40" "$4,877.00" "$2,691.05" $125.00 "$2,691.05" "$2,825.60" "$3,903.00" "$2,691.05" "$2,691.05" "$2,691.05" "$2,762.00" "$2,348.00" "$4,121.57" "$2,691.05" "$4,163.20" "$2,500.00" "$1,032.86" "$2,691.05" "$3,018.32" "$2,825.60" "$3,893.27" "$2,691.05" "$1,084.51" "$2,691.05" N/A N/A 76100029 EAP CPT® 40804 "REM EMBEDDED FB, MOUTH SIMPLE" BOTH IP/OP $800.00 $592.00 $113.00 "$1,273.51" $434.40 $434.40 $434.40 $434.40 $795.95 $795.95 $792.43 $166.74 $795.95 $800.00 $800.00 $800.00 $800.00 $166.73 "$1,273.51" "$1,190.93" $113.00 $795.95 $114.50 $795.95 $835.74 $600.00 $795.95 $795.95 $795.95 $800.00 $400.00 $633.60 $795.95 $640.00 $800.00 $158.78 $795.95 $464.00 $835.74 $800.00 $795.95 $166.72 $795.95 N/A N/A 76100030 EAP CPT® 54520 ORCHIECTOMY SIMPLE BOTH IP/OP "$4,759.00" "$3,522.00" $329.84 "$4,759.00" "$4,759.00" "$4,759.00" "$4,759.00" "$4,759.00" $331.03 $331.03 $332.10 "$4,759.00" $331.03 "$4,759.00" "$4,759.00" "$4,759.00" "$4,759.00" $991.83 $529.65 $527.74 "$4,759.00" $331.03 $329.84 $331.03 "$4,759.00" "$3,569.25" $331.03 $331.03 $331.03 "$3,500.00" "$2,379.50" "$3,769.13" $331.03 "$3,807.20" "$3,725.00" "$4,759.00" $331.03 "$2,760.22" "$4,759.00" $338.90 $331.03 "$4,759.00" $331.03 N/A N/A 76100031 EAP CPT® 54535 ORCHIECTOMY RADICAL/TUMOR BOTH IP/OP "$7,279.00" "$5,386.50" $744.86 "$7,279.00" "$7,279.00" "$7,279.00" "$7,279.00" "$7,279.00" $747.74 $747.74 $751.98 "$7,279.00" $747.74 "$7,279.00" "$7,279.00" "$7,279.00" "$7,279.00" "$1,517.02" "$1,196.38" "$1,191.78" "$7,279.00" $747.74 $744.86 $747.74 "$7,279.00" "$5,459.25" $747.74 $747.74 $747.74 "$2,762.00" "$3,639.50" "$5,764.97" $747.74 "$5,823.20" "$3,725.00" "$7,279.00" $747.74 "$4,221.82" "$7,279.00" $774.86 $747.74 "$7,279.00" $747.74 N/A N/A 76100032 EAP CPT® 40799 LIP SURGERY PROCEDURE BOTH IP/OP $244.00 $181.00 $50.85 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $244.00 $50.85 $244.00 $97.60 $244.00 $244.00 $244.00 $244.00 $244.00 $183.00 $244.00 $244.00 $244.00 $244.00 $122.00 $193.25 $244.00 $195.20 $244.00 $244.00 $244.00 $141.52 $244.00 $146.40 $244.00 $244.00 $244.00 N/A N/A 76100034 EAP CPT® 53040 DRAINAGE OF URETHRA ABSCESS BOTH IP/OP "$6,748.00" "$4,994.00" $394.24 "$6,748.00" "$6,748.00" "$6,748.00" "$6,748.00" "$6,748.00" $394.78 $394.78 $396.76 "$6,748.00" $394.78 "$6,748.00" "$6,748.00" "$6,748.00" "$6,748.00" "$1,406.36" $631.65 $630.78 "$6,748.00" $394.78 $394.24 $394.78 "$6,748.00" "$5,061.00" $394.78 $394.78 $394.78 "$2,851.00" "$3,374.00" "$5,344.42" $394.78 "$5,398.40" "$3,250.00" "$6,748.00" $394.78 "$3,913.84" "$6,748.00" $408.14 $394.78 "$6,748.00" $394.78 N/A N/A 76100035 EAP CPT® 42106 EXC. LESION MOUTH ROOF(PALATE) BOTH IP/OP "$2,709.00" "$2,005.00" $164.66 "$2,709.00" "$2,709.00" "$2,709.00" "$2,709.00" "$2,709.00" $166.18 $166.18 $168.32 "$2,709.00" $166.18 "$2,709.00" "$2,709.00" "$2,709.00" "$2,709.00" $564.59 $265.89 $263.46 "$2,709.00" $166.18 $164.66 $166.18 "$2,709.00" "$2,031.75" $166.18 $166.18 $166.18 "$2,709.00" "$1,354.50" "$2,145.53" $166.18 "$2,167.20" "$2,500.00" "$2,709.00" $166.18 "$1,571.22" "$2,709.00" $175.18 $166.18 "$2,709.00" $166.18 N/A N/A 76100040 EAP CPT® 21497 INDENTAL WIRING BOTH IP/OP "$4,596.00" "$3,401.50" $590.99 "$4,596.00" "$4,596.00" "$4,596.00" "$4,596.00" "$4,596.00" $612.74 $612.74 $613.61 "$4,596.00" $612.74 "$4,596.00" "$4,596.00" "$4,596.00" "$4,596.00" $957.86 $980.38 $959.78 "$4,596.00" $612.74 $599.86 $612.74 "$4,596.00" "$3,447.00" $612.74 $612.74 $612.74 "$2,851.00" "$2,298.00" "$3,640.03" $612.74 "$3,676.80" "$2,150.00" "$4,596.00" $612.74 "$2,665.68" "$4,596.00" $590.99 $612.74 "$4,596.00" $612.74 N/A N/A 76100043 EAP CPT® 31820 CLOSURE OF WINDPIPE LESION BOTH IP/OP "$6,588.00" "$4,875.50" $338.27 "$5,270.40" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,691.05" "$2,691.05" "$2,679.15" "$1,373.10" "$2,691.05" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,373.01" "$4,305.68" "$4,104.40" "$1,871.00" "$2,691.05" $338.27 "$2,691.05" "$2,825.60" "$4,941.00" "$2,691.05" "$2,691.05" "$2,691.05" "$2,762.00" "$2,348.00" "$5,217.70" "$2,691.05" "$5,270.40" "$3,250.00" "$1,307.55" "$2,691.05" "$3,821.04" "$2,825.60" "$3,893.27" "$2,691.05" "$1,372.94" "$2,691.05" N/A N/A 76100044 EAP CPT® 40650 LIP REPAIR BOTH IP/OP "$1,705.00" "$1,262.00" $314.48 "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" $317.35 $317.35 $314.48 "$1,705.00" $317.35 "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" $355.34 $507.76 $512.48 "$1,705.00" $317.35 $320.30 $317.35 "$1,705.00" "$1,278.75" $317.35 $317.35 $317.35 "$1,705.00" $852.50 "$1,350.36" $317.35 "$1,364.00" "$1,705.00" "$1,705.00" $317.35 $988.90 "$1,705.00" $316.82 $317.35 "$1,705.00" $317.35 N/A N/A 76100045 EAP CPT® 41000 DRAINAGE OF MOUTH LESION BOTH IP/OP "$3,430.00" "$2,538.50" $107.07 "$3,430.00" "$3,430.00" "$3,430.00" "$3,430.00" "$3,430.00" $107.99 $107.99 $109.96 "$3,430.00" $107.99 "$3,430.00" "$3,430.00" "$3,430.00" "$3,430.00" $714.85 $172.78 $171.31 "$3,430.00" $107.99 $107.07 $107.99 "$3,430.00" "$2,572.50" $107.99 $107.99 $107.99 "$2,762.00" "$1,715.00" "$2,716.56" $107.99 "$2,744.00" "$2,150.00" "$3,430.00" $107.99 "$1,989.40" "$3,430.00" $112.82 $107.99 "$3,430.00" $107.99 N/A N/A 76100046 EAP CPT® 36511 LEUKOPHERESIS BOTH IP/OP "$7,776.00" "$5,754.50" $109.11 "$7,776.00" "$7,776.00" "$7,776.00" "$7,776.00" "$7,776.00" $109.92 $109.92 $111.11 "$7,776.00" $109.92 "$7,776.00" "$7,776.00" "$7,776.00" "$7,776.00" "$1,620.60" $175.87 $174.58 "$7,776.00" $109.92 $109.11 $109.92 "$7,776.00" "$5,832.00" $109.92 $109.92 $109.92 "$2,762.00" "$3,888.00" "$6,158.59" $109.92 "$6,220.80" "$2,500.00" "$7,776.00" $109.92 "$4,510.08" "$7,776.00" $113.59 $109.92 "$7,776.00" $109.92 N/A N/A 76100047 EAP CPT® 36513 PLATELETPHERESIS BOTH IP/OP "$8,063.00" "$5,967.00" $105.77 "$8,063.00" "$8,063.00" "$8,063.00" "$8,063.00" "$8,063.00" $106.87 $106.87 $109.46 "$8,063.00" $106.87 "$8,063.00" "$8,063.00" "$8,063.00" "$8,063.00" "$1,680.42" $170.99 $169.23 "$8,063.00" $106.87 $105.77 $106.87 "$8,063.00" "$6,047.25" $106.87 $106.87 $106.87 "$2,762.00" "$4,031.50" "$6,385.90" $106.87 "$6,450.40" "$2,500.00" "$8,063.00" $106.87 "$4,676.54" "$8,063.00" $113.58 $106.87 "$8,063.00" $106.87 N/A N/A 76100048 EAP CPT® 36514 PLASMAPHERESIS BOTH IP/OP "$9,881.00" "$7,312.00" $92.87 "$9,881.00" "$9,881.00" "$9,881.00" "$9,881.00" "$9,881.00" $94.30 $94.30 $95.40 "$9,881.00" $94.30 "$9,881.00" "$9,881.00" "$9,881.00" "$9,881.00" "$2,059.31" $150.88 $148.59 "$9,881.00" $94.30 $92.87 $94.30 "$9,881.00" "$7,410.75" $94.30 $94.30 $94.30 "$2,762.00" "$4,940.50" "$7,825.75" $94.30 "$7,904.80" "$2,500.00" "$9,881.00" $94.30 "$5,730.98" "$9,881.00" $99.17 $94.30 "$9,881.00" $94.30 N/A N/A 76100055 EAP CPT® 65778 COVER EYE W/ MEMBRANE BOTH IP/OP "$3,166.00" "$2,343.00" $52.51 "$3,166.00" "$3,166.00" "$3,166.00" "$3,166.00" "$3,166.00" $53.44 $53.44 $53.88 "$3,166.00" $53.44 "$3,166.00" "$3,166.00" "$3,166.00" "$3,166.00" $659.83 $85.50 $84.02 "$3,166.00" $53.44 $52.51 $53.44 "$3,166.00" "$2,374.50" $53.44 $53.44 $53.44 "$2,762.00" "$1,583.00" "$2,507.47" $53.44 "$2,532.80" "$2,150.00" "$3,166.00" $53.44 "$1,836.28" "$3,166.00" $55.90 $53.44 "$3,166.00" $53.44 N/A N/A 76100060 EAP CPT® 54235 PENILE INJECTION BOTH IP/OP $898.00 $665.00 $74.25 $898.00 $487.61 $487.61 $487.61 $487.61 $261.76 $261.76 $260.60 $187.17 $261.76 $898.00 $898.00 $898.00 $882.37 $187.15 $418.81 $309.98 $113.00 $261.76 $74.25 $261.76 $274.85 $673.50 $261.76 $261.76 $261.76 $898.00 $449.00 $711.22 $261.76 $718.40 $898.00 $178.23 $261.76 $520.84 $274.85 $378.70 $261.76 $187.14 $261.76 N/A N/A 76100061 EAP CPT® 20240 BONE BX EXC. BOTH IP/OP "$2,386.00" "$1,766.00" $140.37 "$3,731.74" "$2,386.00" "$2,386.00" "$2,386.00" "$2,386.00" "$2,332.34" "$2,332.34" "$2,322.02" $497.30 "$2,332.34" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" $497.27 "$3,731.74" "$3,726.76" "$2,386.00" "$2,332.34" $140.37 "$2,332.34" "$2,448.96" "$1,789.50" "$2,332.34" "$2,332.34" "$2,332.34" "$2,386.00" "$1,193.00" "$1,889.71" "$2,332.34" "$1,908.80" "$2,386.00" $473.56 "$2,332.34" "$1,383.88" "$2,448.96" "$2,386.00" "$2,332.34" $497.24 "$2,332.34" N/A N/A 76100062 EAP CPT® 21337 TREAT NASA SEPTAL FX BOTH IP/OP "$2,277.00" "$1,685.00" $300.90 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $305.23 $305.23 $300.90 "$2,277.00" $305.23 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 $488.37 $490.58 "$2,277.00" $305.23 $306.61 $305.23 "$2,277.00" "$1,707.75" $305.23 $305.23 $305.23 "$2,277.00" "$1,138.50" "$1,803.38" $305.23 "$1,821.60" "$2,277.00" "$2,277.00" $305.23 "$1,320.66" "$2,277.00" $303.12 $305.23 "$2,277.00" $305.23 N/A N/A 76100063 EAP CPT® 31579 DIRECT LARYNGOSCOPY BOTH IP/OP "$1,660.00" "$1,228.50" $119.10 "$1,660.00" "$1,660.00" "$1,660.00" "$1,660.00" "$1,660.00" $119.85 $119.85 $119.10 "$1,660.00" $119.85 "$1,660.00" "$1,660.00" "$1,660.00" "$1,660.00" $345.96 $191.76 $193.09 "$1,660.00" $119.85 $120.68 $119.85 "$1,660.00" "$1,245.00" $119.85 $119.85 $119.85 "$1,660.00" $830.00 "$1,314.72" $119.85 "$1,328.00" "$1,660.00" "$1,660.00" $119.85 $962.80 "$1,660.00" $122.94 $119.85 "$1,660.00" $119.85 N/A N/A 76100064 EAP CPT® 31237 NASAL/SINUS ENDOSCOPY BOTH IP/OP "$7,080.00" "$5,239.50" $161.38 "$5,664.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,471.71" "$1,471.71" "$1,465.20" "$1,475.65" "$1,471.71" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,475.55" "$2,354.73" "$2,306.17" "$2,836.00" "$1,471.71" $161.38 "$1,471.71" "$1,545.29" "$5,310.00" "$1,471.71" "$1,471.71" "$1,471.71" "$2,851.00" "$2,423.00" "$5,607.36" "$1,471.71" "$5,664.00" "$2,500.00" "$1,405.20" "$1,471.71" "$4,106.40" "$1,545.29" "$2,129.19" "$1,471.71" "$1,475.47" "$1,471.71" N/A N/A 76100070 EAP CPT® 20615 TREATMENT OF BONE CYST BOTH IP/OP $919.00 $680.50 $113.00 $979.40 $919.00 $919.00 $919.00 $919.00 $612.13 $612.13 $609.42 $191.54 $612.13 $919.00 $919.00 $919.00 $882.37 $191.53 $979.40 $936.25 $113.00 $612.13 $163.35 $612.13 $642.73 $689.25 $612.13 $612.13 $612.13 $919.00 $459.50 $727.85 $612.13 $735.20 $919.00 $182.40 $612.13 $533.02 $642.73 $885.59 $612.13 $191.52 $612.13 N/A N/A 76100071 EAP CPT® 41830 REMOVAL OF GUM TISSUE BOTH IP/OP "$3,478.00" "$2,574.00" $320.11 "$3,478.00" "$3,478.00" "$3,478.00" "$3,478.00" "$3,478.00" $320.11 $320.11 $323.11 "$3,478.00" $320.11 "$3,478.00" "$3,478.00" "$3,478.00" "$3,478.00" $724.85 $512.18 $512.35 "$3,478.00" $320.11 $320.22 $320.11 "$3,478.00" "$2,608.50" $320.11 $320.11 $320.11 "$2,762.00" "$1,739.00" "$2,754.58" $320.11 "$2,782.40" "$3,250.00" "$3,478.00" $320.11 "$2,017.24" "$3,478.00" $321.12 $320.11 "$3,478.00" $320.11 N/A N/A 76100073 EAP CPT® 42310 DRAINAGE OF SALIVARY GLAND BOTH IP/OP "$1,573.00" "$1,164.50" $135.78 "$1,573.00" "$1,573.00" "$1,573.00" "$1,573.00" "$1,573.00" $136.67 $136.67 $135.78 "$1,573.00" $136.67 "$1,573.00" "$1,573.00" "$1,573.00" "$1,573.00" $327.83 $218.67 $220.05 "$1,573.00" $136.67 $137.53 $136.67 "$1,573.00" "$1,179.75" $136.67 $136.67 $136.67 "$1,573.00" $786.50 "$1,245.82" $136.67 "$1,258.40" "$1,573.00" "$1,573.00" $136.67 $912.34 "$1,573.00" $137.33 $136.67 "$1,573.00" $136.67 N/A N/A 76100076 EAP CPT® 53852 PROSTATIC RF THERMOTX (TUNA) BOTH IP/OP "$15,721.00" "$11,634.00" $382.46 "$15,721.00" "$15,721.00" "$15,721.00" "$15,721.00" "$15,721.00" $382.46 $382.46 $382.60 "$15,721.00" $382.46 "$15,721.00" "$15,721.00" "$15,721.00" "$15,721.00" "$3,276.43" $611.94 $612.26 "$15,721.00" $382.46 $382.66 $382.46 "$15,721.00" "$11,790.75" $382.46 $382.46 $382.46 "$4,780.00" "$7,860.50" "$12,451.03" $382.46 "$12,576.80" "$4,334.00" "$15,721.00" $382.46 "$9,118.18" "$15,721.00" $390.09 $382.46 "$15,721.00" $382.46 N/A N/A 76100077 EAP CPT® 53850 PROSTATIC MICROWAVE THERMOTX (TUMT) BOTH IP/OP "$15,721.00" "$11,634.00" $356.75 "$15,721.00" "$15,721.00" "$15,721.00" "$15,721.00" "$15,721.00" $356.75 $356.75 $357.31 "$15,721.00" $356.75 "$15,721.00" "$15,721.00" "$15,721.00" "$15,721.00" "$3,276.43" $570.80 $571.01 "$15,721.00" $356.75 $356.88 $356.75 "$15,721.00" "$11,790.75" $356.75 $356.75 $356.75 "$2,762.00" "$7,860.50" "$12,451.03" $356.75 "$12,576.80" "$2,500.00" "$15,721.00" $356.75 "$9,118.18" "$15,721.00" $364.12 $356.75 "$15,721.00" $356.75 N/A N/A 76100078 EAP CPT® 31571 LARYNGOSCOPY W/VC INJ+SCOPE BOTH IP/OP "$12,143.00" "$8,986.00" $248.05 "$12,143.00" "$12,143.00" "$12,143.00" "$12,143.00" "$12,143.00" $249.77 $249.77 $248.05 "$12,143.00" $249.77 "$12,143.00" "$12,143.00" "$12,143.00" "$12,143.00" "$2,530.73" $399.63 $399.84 "$12,143.00" $249.77 $249.90 $249.77 "$12,143.00" "$9,107.25" $249.77 $249.77 $249.77 "$2,851.00" "$6,071.50" "$9,617.26" $249.77 "$9,714.40" "$3,250.00" "$12,143.00" $249.77 "$7,042.94" "$12,143.00" $255.99 $249.77 "$12,143.00" $249.77 N/A N/A 76100086 EAP CPT® 36512 THERAPETIC PHLEBOTOMY BOTH IP/OP "$8,063.00" "$5,967.00" $106.06 "$6,450.40" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,341.70" "$1,341.70" "$1,335.77" "$1,680.53" "$1,341.70" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,680.42" "$2,146.72" "$1,961.79" "$4,877.00" "$1,341.70" $106.06 "$1,341.70" "$1,408.79" "$6,047.25" "$1,341.70" "$1,341.70" "$1,341.70" "$2,762.00" "$2,348.00" "$6,385.90" "$1,341.70" "$6,450.40" "$2,500.00" "$1,600.30" "$1,341.70" "$4,676.54" "$1,408.79" "$1,941.10" "$1,341.70" "$1,680.33" "$1,341.70" N/A N/A 76100087 EAP CPT® 21299 CRANIO/MAXILLOFACIAL PROC. BOTH IP/OP $272.00 $201.50 $56.69 $272.00 $272.00 $272.00 $272.00 $272.00 $272.00 $272.00 $272.00 $272.00 $272.00 $272.00 $272.00 $272.00 $272.00 $56.69 $272.00 $108.80 $272.00 $272.00 $272.00 $272.00 $272.00 $204.00 $272.00 $272.00 $272.00 $272.00 $136.00 $215.42 $272.00 $217.60 $272.00 $272.00 $272.00 $157.76 $272.00 $163.20 $272.00 $272.00 $272.00 N/A N/A 76100088 EAP CPT® 20527 INJ DUPUYTREN CORD W ENZYME BOTH IP/OP $514.00 $380.50 $66.02 $514.00 $514.00 $514.00 $514.00 $514.00 $66.11 $66.11 $66.02 $514.00 $66.11 $514.00 $514.00 $514.00 $514.00 $107.12 $105.78 $106.35 $514.00 $66.11 $66.47 $66.11 $514.00 $385.50 $66.11 $66.11 $66.11 $514.00 $257.00 $407.09 $66.11 $411.20 $514.00 $514.00 $66.11 $298.12 $514.00 $68.49 $66.11 $514.00 $66.11 N/A N/A 76100089 EAP CPT® 20615 NASAL SURGERY PROC BOTH IP/OP $919.00 $680.50 $113.00 $979.40 $919.00 $919.00 $919.00 $919.00 $612.13 $612.13 $609.42 $191.54 $612.13 $919.00 $919.00 $919.00 $882.37 $191.53 $979.40 $936.25 $113.00 $612.13 $163.35 $612.13 $642.73 $689.25 $612.13 $612.13 $612.13 $919.00 $459.50 $727.85 $612.13 $735.20 $919.00 $182.40 $612.13 $533.02 $642.73 $885.59 $612.13 $191.52 $612.13 N/A N/A 76100090 EAP CPT® 15271 SKIN SUB GRAFT TRNK/ARM/LEG 25 BOTH IP/OP "$2,131.00" "$1,577.00" $83.77 "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" $84.35 $84.35 $84.70 "$2,131.00" $84.35 "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" $444.12 $134.96 $134.03 "$2,131.00" $84.35 $83.77 $84.35 "$2,131.00" "$1,598.25" $84.35 $84.35 $84.35 "$2,131.00" "$1,065.50" "$1,687.75" $84.35 "$1,704.80" "$2,131.00" "$2,131.00" $84.35 "$1,235.98" "$2,131.00" $88.33 $84.35 "$2,131.00" $84.35 N/A N/A 76100091 EAP CPT® 15272 SKIN SUB GRAFT T/A/L ADDL 25 BOTH IP/OP $622.00 $460.50 $16.62 $622.00 $622.00 $622.00 $622.00 $622.00 $17.75 $17.75 $17.27 $622.00 $17.75 $622.00 $622.00 $622.00 $622.00 $129.63 $28.40 $26.59 $622.00 $17.75 $16.62 $17.75 $622.00 $466.50 $17.75 $17.75 $17.75 $311.00 $311.00 $492.62 $17.75 $497.60 $622.00 $622.00 $17.75 $360.76 $622.00 $18.39 $17.75 $622.00 $17.75 N/A N/A 76100092 EAP CPT® 15273 SKIN SUB GRFT T/A/LG CHILD 100 BOTH IP/OP "$3,292.00" "$2,436.50" $196.79 "$3,292.00" "$3,292.00" "$3,292.00" "$3,292.00" "$3,292.00" $199.13 $199.13 $200.47 "$3,292.00" $199.13 "$3,292.00" "$3,292.00" "$3,292.00" "$3,292.00" $686.09 $318.61 $314.86 "$3,292.00" $199.13 $196.79 $199.13 "$3,292.00" "$2,469.00" $199.13 $199.13 $199.13 "$3,292.00" "$1,646.00" "$2,607.26" $199.13 "$2,633.60" "$3,292.00" "$3,292.00" $199.13 "$1,909.36" "$3,292.00" $209.83 $199.13 "$3,292.00" $199.13 N/A N/A 76100093 EAP CPT® 15274 SKIN SUB GRFT T/A/LG CH ADDL 100 BOTH IP/OP "$1,578.00" "$1,168.00" $45.14 "$1,578.00" "$1,578.00" "$1,578.00" "$1,578.00" "$1,578.00" $45.75 $45.75 $45.50 "$1,578.00" $45.75 "$1,578.00" "$1,578.00" "$1,578.00" "$1,578.00" $328.87 $73.20 $72.22 "$1,578.00" $45.75 $45.14 $45.75 "$1,578.00" "$1,183.50" $45.75 $45.75 $45.75 $789.00 $789.00 "$1,249.78" $45.75 "$1,262.40" "$1,578.00" "$1,578.00" $45.75 $915.24 "$1,578.00" $47.59 $45.75 "$1,578.00" $45.75 N/A N/A 76100094 EAP CPT® 15275 SKIN SUB GRFT FACE/NK/HF/G 25 BOTH IP/OP "$2,179.00" "$1,612.50" $94.11 "$2,179.00" "$2,179.00" "$2,179.00" "$2,179.00" "$2,179.00" "$2,179.00" "$2,179.00" "$2,179.00" "$2,179.00" "$2,179.00" "$2,179.00" "$2,179.00" "$2,179.00" "$2,179.00" $454.13 "$2,179.00" $871.60 "$2,179.00" "$2,179.00" "$2,179.00" "$2,179.00" "$2,179.00" "$1,634.25" "$2,179.00" "$2,179.00" "$2,179.00" "$2,179.00" "$1,089.50" "$1,725.77" "$2,179.00" "$1,743.20" "$2,150.00" "$2,179.00" "$2,179.00" "$1,263.82" "$2,179.00" $99.17 $94.11 "$2,179.00" "$2,179.00" N/A N/A 76100095 EAP CPT® 15276 SKIN SUB GRFT F/N/HF/G ADDL 25 BOTH IP/OP $583.00 $431.50 $25.10 $583.00 $583.00 $583.00 $583.00 $583.00 $25.68 $25.68 $25.26 $583.00 $25.68 $583.00 $583.00 $583.00 $583.00 $121.50 $41.09 $40.16 $583.00 $25.68 $25.10 $25.68 $583.00 $437.25 $25.68 $25.68 $25.68 $291.50 $291.50 $461.74 $25.68 $466.40 $583.00 $583.00 $25.68 $338.14 $583.00 $27.04 $25.68 $583.00 $25.68 N/A N/A 76100096 EAP CPT® 15277 SKIN SUB GRFT F/N/HF/G CHILD 100 BOTH IP/OP "$2,570.00" "$1,902.00" $225.61 "$2,570.00" "$2,570.00" "$2,570.00" "$2,570.00" "$2,570.00" $226.88 $226.88 $227.47 "$2,570.00" $226.88 "$2,570.00" "$2,570.00" "$2,570.00" "$2,570.00" $535.62 $363.01 $360.98 "$2,570.00" $226.88 $225.61 $226.88 "$2,570.00" "$1,927.50" $226.88 $226.88 $226.88 "$2,570.00" "$1,285.00" "$2,035.44" $226.88 "$2,056.00" "$2,500.00" "$2,570.00" $226.88 "$1,490.60" "$2,570.00" $237.95 $226.88 "$2,570.00" $226.88 N/A N/A 76100097 EAP CPT® 15278 SKIN SUB GRFT F/N/HF/G CH ADD 100 BOTH IP/OP "$1,684.00" "$1,246.50" $55.99 "$1,684.00" "$1,684.00" "$1,684.00" "$1,684.00" "$1,684.00" $57.10 $57.10 $57.22 "$1,684.00" $57.10 "$1,684.00" "$1,684.00" "$1,684.00" "$1,684.00" $350.96 $91.36 $89.58 "$1,684.00" $57.10 $55.99 $57.10 "$1,684.00" "$1,263.00" $57.10 $57.10 $57.10 $842.00 $842.00 "$1,333.73" $57.10 "$1,347.20" "$1,684.00" "$1,684.00" $57.10 $976.72 "$1,684.00" $60.21 $57.10 "$1,684.00" $57.10 N/A N/A 76100098 EAP CPT® 29581 APPLY MULTILAYER COMPRESSION BELOW KNEE W/ANKLE FOOT BOTH IP/OP $453.00 $335.50 $26.76 $453.00 $245.98 $245.98 $245.98 $245.98 $138.97 $138.97 $138.36 $94.42 $138.97 $453.00 $453.00 $453.00 $453.00 $94.41 $222.36 $210.28 $267.95 $138.97 $26.76 $138.97 $145.92 $339.75 $138.97 $138.97 $138.97 $453.00 $226.50 $358.78 $138.97 $362.40 $294.45 $89.91 $138.97 $262.74 $145.92 $201.06 $138.97 $94.41 $138.97 N/A N/A 76100102 EAP CPT® 29584 APPLY MULTLAY COMPRS ARM/HAND BOTH IP/OP $427.00 $316.00 $15.88 $427.00 $427.00 $427.00 $427.00 $427.00 $15.88 $15.88 $16.01 $427.00 $15.88 $427.00 $427.00 $427.00 $427.00 $88.99 $25.41 $25.47 $427.00 $15.88 $15.92 $15.88 $427.00 $320.25 $15.88 $15.88 $15.88 $427.00 $213.50 $338.18 $15.88 $341.60 $277.55 $427.00 $15.88 $247.66 $427.00 $16.95 $15.88 $427.00 $15.88 N/A N/A 76100103 EAP CPT® 46220 EXC. ANAL EXT. TAG/PAPILLA BOTH IP/OP "$4,310.00" "$3,189.50" $122.47 "$4,310.00" "$4,310.00" "$4,310.00" "$4,310.00" "$4,310.00" $123.16 $123.16 $122.47 "$4,310.00" $123.16 "$4,310.00" "$4,310.00" "$4,310.00" "$4,310.00" $898.25 $197.06 $197.42 "$4,310.00" $123.16 $123.39 $123.16 "$4,310.00" "$3,232.50" $123.16 $123.16 $123.16 "$2,762.00" "$2,155.00" "$3,413.52" $123.16 "$3,448.00" "$2,500.00" "$4,310.00" $123.16 "$2,499.80" "$4,310.00" $123.64 $123.16 "$4,310.00" $123.16 N/A N/A 76100104 EAP CPT® 17999 SKIN TISSUE PROCEDURE BOTH IP/OP $252.00 $186.50 $52.52 $252.00 $252.00 $252.00 $252.00 $252.00 $252.00 $252.00 $252.00 $252.00 $252.00 $252.00 $252.00 $252.00 $252.00 $52.52 $252.00 $100.80 $252.00 $252.00 $252.00 $252.00 $252.00 $189.00 $252.00 $252.00 $252.00 $252.00 $126.00 $199.58 $252.00 $201.60 $252.00 $252.00 $252.00 $146.16 $252.00 $151.20 $252.00 $252.00 $252.00 N/A N/A 76100105 EAP CPT® 31570 LARYNGOSCOPE W/VC INJ BOTH IP/OP "$8,010.00" "$5,927.50" $230.59 "$6,408.00" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$3,047.03" "$3,047.03" "$3,033.56" "$1,669.48" "$3,047.03" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$1,669.37" "$4,875.25" "$4,809.32" "$2,836.00" "$3,047.03" $230.59 "$3,047.03" "$3,199.39" "$6,007.50" "$3,047.03" "$3,047.03" "$3,047.03" "$2,851.00" "$2,423.00" "$6,343.92" "$3,047.03" "$6,408.00" "$2,500.00" "$1,589.78" "$3,047.03" "$4,645.80" "$3,199.39" "$4,408.29" "$3,047.03" "$1,669.28" "$3,047.03" N/A N/A 76100106 EAP CPT® 41899 BX OF GUM MASS BOTH IP/OP "$1,862.00" "$1,378.00" $207.19 "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" $208.11 $208.11 $207.19 $388.09 $208.11 "$1,862.00" "$1,862.00" "$1,862.00" "$1,862.00" $388.06 $332.98 $299.82 "$1,862.00" $208.11 "$1,862.00" $208.11 $218.52 "$1,396.50" $208.11 $208.11 $208.11 "$1,862.00" $931.00 "$1,474.70" $208.11 "$1,489.60" "$1,750.00" $369.56 $208.11 "$1,079.96" $218.52 $301.08 $208.11 $388.04 $208.11 N/A N/A 76100107 EAP CPT® 40899 VESTIBULE OF MOUTH (UNLISTED) BOTH IP/OP $262.00 $194.00 $54.60 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $54.60 $262.00 $104.80 $262.00 $262.00 $262.00 $262.00 $262.00 $196.50 $262.00 $262.00 $262.00 $262.00 $131.00 $207.50 $262.00 $209.60 $262.00 $262.00 $262.00 $151.96 $262.00 $157.20 $262.00 $262.00 $262.00 N/A N/A 76100110 EAP CPT® 49082 ABDOM PARACENTESIS W/O IMAG BOTH IP/OP "$1,861.00" "$1,377.50" $73.25 "$1,861.00" "$1,861.00" "$1,861.00" "$1,861.00" "$1,861.00" $74.07 $74.07 $73.70 "$1,861.00" $74.07 "$1,861.00" "$1,861.00" "$1,861.00" "$1,861.00" $387.85 $118.51 $117.20 "$1,861.00" $74.07 $73.25 $74.07 "$1,861.00" "$1,395.75" $74.07 $74.07 $74.07 "$1,861.00" $930.50 "$1,473.91" $74.07 "$1,488.80" "$1,861.00" "$1,861.00" $74.07 "$1,079.38" "$1,861.00" $77.15 $74.07 "$1,861.00" $74.07 N/A N/A 76100112 EAP CPT® 49083 ABDOM PARACENTESIS W IMAG BOTH IP/OP "$1,861.00" "$1,377.50" $105.77 "$1,861.00" "$1,861.00" "$1,861.00" "$1,861.00" "$1,861.00" $795.95 $795.95 $792.43 $387.88 $795.95 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $387.85 "$1,273.51" "$1,190.93" "$1,861.00" $795.95 $105.77 $795.95 $835.74 "$1,395.75" $795.95 $795.95 $795.95 "$1,861.00" $930.50 "$1,473.91" $795.95 "$1,488.80" "$1,861.00" $369.36 $795.95 "$1,079.38" $835.74 "$1,151.53" $795.95 $387.83 $795.95 N/A N/A 76100113 EAP CPT® 49084 PERITONEAL LAVAGE W IMAG BOTH IP/OP "$1,861.00" "$1,377.50" $107.91 "$1,861.00" "$1,861.00" "$1,861.00" "$1,861.00" "$1,861.00" $107.91 $107.91 $109.15 "$1,861.00" $107.91 "$1,861.00" "$1,861.00" "$1,861.00" "$1,861.00" $387.85 $172.66 $172.72 "$1,861.00" $107.91 $107.95 $107.91 "$1,861.00" "$1,395.75" $107.91 $107.91 $107.91 "$1,861.00" $930.50 "$1,473.91" $107.91 "$1,488.80" "$1,861.00" "$1,861.00" $107.91 "$1,079.38" "$1,861.00" $113.93 $107.91 "$1,861.00" $107.91 N/A N/A 76100114 EAP CPT® 20680 REMOVAL OF SUPPORT IMPLANT BOTH IP/OP "$5,413.00" "$4,006.00" $424.94 "$5,413.00" "$5,413.00" "$5,413.00" "$5,413.00" "$5,413.00" $424.94 $424.94 $426.79 "$5,413.00" $424.94 "$5,413.00" "$5,413.00" "$5,413.00" "$5,413.00" "$1,128.13" $679.90 $681.28 "$5,413.00" $424.94 $425.80 $424.94 "$5,413.00" "$4,059.75" $424.94 $424.94 $424.94 "$3,500.00" "$2,706.50" "$4,287.10" $424.94 "$4,330.40" "$3,250.00" "$5,413.00" $424.94 "$3,139.54" "$5,413.00" $437.25 $424.94 "$5,413.00" $424.94 N/A N/A 76100116 EAP CPT® 27825 TREAT LOWER LEG FRACTURE BOTH IP/OP "$6,872.00" "$5,085.50" $503.14 "$6,872.00" "$6,872.00" "$6,872.00" "$6,872.00" "$6,872.00" $503.14 $503.14 $503.30 "$6,872.00" $503.14 "$6,872.00" "$6,872.00" "$6,872.00" "$6,872.00" "$1,432.20" $805.02 $812.03 "$6,872.00" $503.14 $507.52 $503.14 "$6,872.00" "$5,154.00" $503.14 $503.14 $503.14 "$2,851.00" "$3,436.00" "$5,442.62" $503.14 "$5,497.60" "$2,500.00" "$6,872.00" $503.14 "$3,985.76" "$6,872.00" $513.64 $503.14 "$6,872.00" $503.14 N/A N/A 76100117 EAP CPT® 41899 ALVEOPLASTY W/EXTRACTIONS BOTH IP/OP "$2,369.00" "$1,753.50" $207.19 "$2,369.00" "$2,211.00" "$2,211.00" "$2,211.00" "$2,211.00" $208.11 $208.11 $207.19 $493.76 $208.11 "$2,369.00" "$2,369.00" "$2,369.00" "$2,369.00" $493.73 $332.98 $299.82 "$2,369.00" $208.11 "$1,862.00" $208.11 $218.52 "$1,776.75" $208.11 $208.11 $208.11 "$2,369.00" "$1,184.50" "$1,876.25" $208.11 "$1,895.20" "$1,750.00" $470.19 $208.11 "$1,374.02" $218.52 $301.08 $208.11 $493.70 $208.11 N/A N/A 76100118 EAP CPT® 26705 TREAT KNUCKLE DISLOCATION BOTH IP/OP "$1,500.00" "$1,110.00" $312.62 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $396.98 $396.98 $395.40 "$1,500.00" $396.98 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 $635.17 $659.33 "$1,500.00" $396.98 $412.08 $396.98 "$1,500.00" "$1,125.00" $396.98 $396.98 $396.98 "$1,500.00" $750.00 "$1,188.00" $396.98 "$1,200.00" "$1,500.00" "$1,500.00" $396.98 $870.00 "$1,500.00" $397.17 $396.98 "$1,500.00" $396.98 N/A N/A 76100119 EAP CPT® 51784 ANAL/URINARY MUSCLE STUDY BOTH IP/OP $210.00 $155.50 $27.74 $219.74 $114.03 $114.03 $114.03 $114.03 $137.34 $137.34 $136.73 $43.77 $137.34 $210.00 $210.00 $210.00 $210.00 $43.77 $219.74 $209.80 $113.00 $137.34 $27.74 $137.34 $144.20 $157.50 $137.34 $137.34 $137.34 $210.00 $105.00 $166.32 $137.34 $168.00 $210.00 $41.68 $137.34 $121.80 $144.20 $198.69 $137.34 $43.76 $137.34 N/A N/A 76100120 EAP CPT® 26951 AMPUTATION OF FINGER THUMB BOTH IP/OP "$7,787.00" "$5,762.50" $690.09 "$7,787.00" "$7,787.00" "$7,787.00" "$7,787.00" "$7,787.00" $727.76 $727.76 $716.83 "$7,787.00" $727.76 "$7,787.00" "$7,787.00" "$7,787.00" "$7,787.00" "$1,622.90" "$1,164.42" "$1,155.95" "$7,787.00" $727.76 $722.47 $727.76 "$7,787.00" "$5,840.25" $727.76 $727.76 $727.76 "$2,851.00" "$3,893.50" "$6,167.30" $727.76 "$6,229.60" "$2,500.00" "$7,787.00" $727.76 "$4,516.46" "$7,787.00" $690.09 $727.76 "$7,787.00" $727.76 N/A N/A 76100121 EAP CPT® 26705 TREAT KNUCKLE DISLOCATION BOTH IP/OP "$1,500.00" "$1,110.00" $312.62 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $396.98 $396.98 $395.40 "$1,500.00" $396.98 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 $635.17 $659.33 "$1,500.00" $396.98 $412.08 $396.98 "$1,500.00" "$1,125.00" $396.98 $396.98 $396.98 "$1,500.00" $750.00 "$1,188.00" $396.98 "$1,200.00" "$1,500.00" "$1,500.00" $396.98 $870.00 "$1,500.00" $397.17 $396.98 "$1,500.00" $396.98 N/A N/A 76100122 EAP CPT® 62273 INJECTION EPIDURAL BLOOD PATCH BOTH IP/OP "$1,679.00" "$1,242.50" $113.24 "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" $113.78 $113.78 $114.06 "$1,679.00" $113.78 "$1,679.00" "$1,679.00" "$1,679.00" "$1,679.00" $349.92 $182.05 $181.18 "$1,679.00" $113.78 $113.24 $113.78 "$1,679.00" "$1,259.25" $113.78 $113.78 $113.78 "$1,679.00" $839.50 "$1,329.77" $113.78 "$1,343.20" "$1,679.00" "$1,679.00" $624.63 $973.82 "$1,679.00" $117.56 $113.78 "$1,679.00" $113.78 N/A N/A 76100123 EAP CPT® 67904 BLEPHAROPTOSIS BOTH IP/OP "$5,049.00" "$3,736.50" $592.78 "$4,877.00" "$3,558.00" "$3,558.00" "$3,558.00" "$3,558.00" "$1,968.41" "$1,968.41" "$1,959.70" "$1,052.34" "$1,968.41" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,052.27" "$3,149.46" "$3,050.10" "$4,877.00" "$1,968.41" $592.78 "$1,968.41" "$2,066.83" "$3,786.75" "$1,968.41" "$1,968.41" "$1,968.41" "$4,417.00" "$2,524.50" "$3,998.81" "$1,968.41" "$4,039.20" "$3,250.00" "$1,002.10" "$1,968.41" "$2,928.42" "$2,066.83" "$2,847.79" "$1,968.41" "$1,052.21" "$1,968.41" N/A N/A 76100124 EAP CPT® 11760 REPAIR NAIL BED BOTH IP/OP $759.00 $562.00 $111.49 $759.00 $759.00 $759.00 $759.00 $759.00 $112.40 $112.40 $115.04 $759.00 $112.40 $759.00 $759.00 $759.00 $759.00 $158.18 $179.84 $178.38 $759.00 $112.40 $111.49 $112.40 $759.00 $569.25 $112.40 $112.40 $112.40 $759.00 $379.50 $601.13 $112.40 $607.20 $759.00 $759.00 $112.40 $440.22 $759.00 $118.60 $112.40 $759.00 $112.40 N/A N/A 76100125 EAP CPT® 17270 DESTRUCTION MALIGNANT LESION 0.5CM OR LESS BOTH IP/OP $477.00 $353.00 $94.34 $477.00 $477.00 $477.00 $477.00 $477.00 $94.34 $94.34 $95.40 $477.00 $94.34 $477.00 $477.00 $477.00 $477.00 $99.41 $150.94 $153.98 $477.00 $94.34 $96.24 $94.34 $477.00 $357.75 $94.34 $94.34 $94.34 $477.00 $238.50 $377.78 $94.34 $381.60 $477.00 $477.00 $94.34 $276.66 $477.00 $98.78 $94.34 $477.00 $94.34 N/A N/A 76100126 EAP CPT® 41599 TONGUE/MOUTH UNLISTED PROC. BOTH IP/OP $271.00 $201.00 $56.48 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $271.00 $56.48 $271.00 $108.40 $271.00 $271.00 $271.00 $271.00 $271.00 $203.25 $271.00 $271.00 $271.00 $271.00 $135.50 $214.63 $271.00 $216.80 $271.00 $271.00 $271.00 $157.18 $271.00 $162.60 $271.00 $271.00 $271.00 N/A N/A 76100129 EAP CPT® 28405 TREAT HEEL FX BOTH IP/OP "$4,960.00" "$3,670.50" $359.75 "$4,960.00" "$4,960.00" "$4,960.00" "$4,960.00" "$4,960.00" $359.75 $359.75 $363.11 "$4,960.00" $359.75 "$4,960.00" "$4,960.00" "$4,960.00" "$4,960.00" "$1,033.72" $575.60 $670.80 "$4,960.00" $359.75 $419.25 $359.75 "$4,960.00" "$3,720.00" $359.75 $359.75 $359.75 "$2,851.00" "$2,480.00" "$3,928.32" $359.75 "$3,968.00" "$2,150.00" "$4,960.00" $359.75 "$2,876.80" "$4,960.00" $363.35 $359.75 "$4,960.00" $359.75 N/A N/A 76100130 EAP CPT® 31576 "LARYNGOSCOPY, FIBEROPTIC W/BX" BOTH IP/OP "$7,908.00" "$5,852.00" $120.01 "$6,326.40" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,471.71" "$1,471.71" "$1,465.20" "$1,648.22" "$1,471.71" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$1,648.11" "$2,354.73" "$2,306.17" "$2,836.00" "$1,471.71" $120.01 "$1,471.71" "$1,545.29" "$5,931.00" "$1,471.71" "$1,471.71" "$1,471.71" "$2,851.00" "$2,423.00" "$6,263.14" "$1,471.71" "$6,326.40" "$2,500.00" "$1,569.54" "$1,471.71" "$4,586.64" "$1,545.29" "$2,129.19" "$1,471.71" "$1,648.03" "$1,471.71" N/A N/A 76100131 EAP CPT® 42999 THROAT PROC. ( PHARY/ ADEN/TONS) BOTH IP/OP $206.00 $152.50 $42.93 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $42.93 $206.00 $82.40 $206.00 $206.00 $206.00 $206.00 $206.00 $154.50 $206.00 $206.00 $206.00 $206.00 $103.00 $163.15 $206.00 $164.80 $206.00 $206.00 $206.00 $119.48 $206.00 $123.60 $206.00 $206.00 $206.00 N/A N/A 76100132 EAP CPT® 59150 TREAT ECTOPIC PREGNANCY BOTH IP/OP "$21,864.00" "$16,179.50" $801.37 "$21,864.00" "$21,864.00" "$21,864.00" "$21,864.00" "$21,864.00" $805.10 $805.10 $801.37 "$21,864.00" $805.10 "$21,864.00" "$21,864.00" "$21,864.00" "$21,864.00" "$4,556.70" "$1,288.16" "$1,297.62" "$21,864.00" $805.10 $811.01 $805.10 "$21,864.00" "$16,398.00" $805.10 $805.10 $805.10 "$6,679.00" "$10,932.00" "$17,316.29" $805.10 "$17,491.20" "$4,334.00" "$21,864.00" $805.10 "$12,681.12" "$21,864.00" $821.48 $805.10 "$21,864.00" $805.10 N/A N/A 76100133 EAP CPT® 24999 UPPER ARM/ELBOW SURG BOTH IP/OP $483.00 $357.50 $100.66 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $100.66 $483.00 $193.20 $483.00 $483.00 $483.00 $483.00 $483.00 $362.25 $483.00 $483.00 $483.00 $483.00 $241.50 $382.54 $483.00 $386.40 $483.00 $483.00 $483.00 $280.14 $483.00 $289.80 $483.00 $483.00 $483.00 N/A N/A 76100134 EAP CPT® 52001 CYSTO REM OF CLOTS BOTH IP/OP "$5,099.00" "$3,773.50" $284.17 "$4,838.98" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$3,024.36" "$3,024.36" "$3,010.98" "$1,062.76" "$3,024.36" "$1,826.79" "$1,826.79" "$1,897.05" "$1,282.27" "$1,062.69" "$4,838.98" "$4,623.90" "$2,836.00" "$3,024.36" $284.17 "$3,024.36" "$3,175.58" "$3,824.25" "$3,024.36" "$3,024.36" "$3,024.36" "$2,762.00" "$2,348.00" "$4,038.41" "$3,024.36" "$4,079.20" "$2,500.00" "$1,012.02" "$3,024.36" "$2,957.42" "$3,175.58" "$4,375.49" "$3,024.36" "$1,062.63" "$3,024.36" N/A N/A 76100135 EAP CPT® 92025 TOPOGRAPHY BOTH IP/OP $288.00 $213.50 $17.25 $288.00 $156.38 $156.38 $156.38 $156.38 $54.76 $54.76 $54.51 $60.03 $54.76 $288.00 $288.00 $288.00 $288.00 $60.02 $87.61 $82.92 $170.35 $54.76 $17.25 $54.76 $57.49 $216.00 $54.76 $54.76 $54.76 $144.00 $144.00 $228.10 $54.76 $230.40 $187.20 $57.16 $54.76 $167.04 $57.49 $79.22 $54.76 $60.02 $54.76 N/A N/A 76100136 EAP CPT® 59001 AMNIOCENTESIS THERAPEUTIC BOTH IP/OP "$2,089.00" "$1,546.00" $180.67 "$2,089.00" "$2,089.00" "$2,089.00" "$2,089.00" "$2,089.00" $277.43 $277.43 $276.20 $435.40 $277.43 "$1,257.08" "$1,257.08" "$1,305.43" $882.37 $435.37 $443.89 $421.19 "$1,235.64" $277.43 $180.67 $277.43 $291.30 "$1,566.75" $277.43 $277.43 $277.43 "$2,089.00" "$1,044.50" "$1,654.49" $277.43 "$1,671.20" "$1,750.00" $414.61 $277.43 "$1,211.62" $291.30 $401.37 $277.43 $435.35 $277.43 N/A N/A 76100138 EAP CPT® 25111 REMOVAL OF GANGLION CYST BOTH IP/OP "$4,220.00" "$3,123.00" $331.72 "$4,220.00" "$4,220.00" "$4,220.00" "$4,220.00" "$4,220.00" $332.42 $332.42 $331.72 "$4,220.00" $332.42 "$4,220.00" "$4,220.00" "$4,220.00" "$4,220.00" $879.49 $531.87 $536.19 "$4,220.00" $332.42 $335.12 $332.42 "$4,220.00" "$3,165.00" $332.42 $332.42 $332.42 "$3,500.00" "$2,110.00" "$3,342.24" $332.42 "$3,376.00" "$3,250.00" "$4,220.00" $332.42 "$2,447.60" "$4,220.00" $333.01 $332.42 "$4,220.00" $332.42 N/A N/A 76100140 EAP CPT® 27509 TREATMENT OF THIGH FRACTURE BOTH IP/OP "$16,329.00" "$12,083.50" $687.32 "$16,329.00" "$16,329.00" "$16,329.00" "$16,329.00" "$16,329.00" $695.61 $695.61 $689.38 "$16,329.00" $695.61 "$16,329.00" "$16,329.00" "$16,329.00" "$16,329.00" "$3,403.14" "$1,112.98" "$1,110.10" "$16,329.00" $695.61 $693.81 $695.61 "$16,329.00" "$12,246.75" $695.61 $695.61 $695.61 "$3,500.00" "$8,164.50" "$12,932.57" $695.61 "$13,063.20" "$3,250.00" "$16,329.00" $695.61 "$9,470.82" "$16,329.00" $687.32 $695.61 "$16,329.00" $695.61 N/A N/A 76100141 EAP CPT® 92504 EAR MICROSCOPY EXAMINATION BOTH IP/OP $89.00 $66.00 $9.49 $89.00 $48.33 $48.33 $48.33 $48.33 $89.00 $89.00 $89.00 $18.55 $89.00 $89.00 $89.00 $89.00 $89.00 $18.55 $89.00 $89.00 $52.64 $89.00 $9.49 $89.00 $89.00 $66.75 $89.00 $89.00 $89.00 $44.50 $44.50 $70.49 $89.00 $71.20 $57.85 $17.66 $89.00 $51.62 $89.00 $89.00 $89.00 $18.55 $89.00 N/A N/A 76100145 EAP CPT® 31237 BIL NASAL/SINUS ENDOSCOPY BOTH IP/OP "$9,837.00" "$7,279.50" $161.38 "$7,869.60" "$2,622.00" "$2,622.00" "$2,622.00" "$2,622.00" "$1,471.71" "$1,471.71" "$1,465.20" "$2,050.28" "$1,471.71" "$1,541.95" "$1,541.95" "$1,601.25" "$1,082.33" "$2,050.14" "$2,354.73" "$2,306.17" "$2,836.00" "$1,471.71" $161.38 "$1,471.71" "$1,545.29" "$7,377.75" "$1,471.71" "$1,471.71" "$1,471.71" "$2,851.00" "$2,423.00" "$7,790.90" "$1,471.71" "$7,869.60" "$2,500.00" "$1,952.40" "$1,471.71" "$5,705.46" "$1,545.29" "$2,129.19" "$1,471.71" "$2,050.03" "$1,471.71" N/A N/A 76100146 EAP CPT® 97607 NEG PRESSURE WOUND THERAPY NON-DME 50 CM BOTH IP/OP $850.00 $629.00 $25.46 $850.00 $461.55 $461.55 $461.55 $461.55 $340.00 $340.00 $338.49 $177.16 $340.00 $850.00 $850.00 $850.00 $850.00 $177.15 $543.99 $538.21 $502.78 $340.00 $25.46 $340.00 $357.00 $637.50 $340.00 $340.00 $340.00 $425.00 $425.00 $673.20 $340.00 $680.00 $552.50 $168.70 $340.00 $493.00 $357.00 $491.89 $340.00 $177.14 $340.00 N/A N/A 76200002 EAP HCPCS G0378 OBSERVATION ROOM BOTH IP/OP $141.00 $104.50 $27.98 $150.00 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $29.39 $141.00 $104.65 $104.65 $108.68 $73.46 $29.39 $141.00 $150.00 $83.40 $141.00 $150.00 $141.00 $141.00 $105.75 $141.00 $141.00 $141.00 $91.65 $91.65 $111.67 $141.00 $112.80 $141.00 $27.98 $141.00 $81.78 $141.00 $141.00 $141.00 $29.38 $141.00 N/A N/A 76200028 EAP HCPCS G0378 OBS. RM. ECC BOTH IP/OP $141.00 $104.50 $27.98 $150.00 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $29.39 $141.00 $104.65 $104.65 $108.68 $73.46 $29.39 $141.00 $150.00 $83.40 $141.00 $150.00 $141.00 $141.00 $105.75 $141.00 $141.00 $141.00 $91.65 $91.65 $111.67 $141.00 $112.80 $141.00 $27.98 $141.00 $81.78 $141.00 $141.00 $141.00 $29.38 $141.00 N/A N/A 76200077 EAP HCPCS G0378 OBSERVATION ROOM CARVEOUT BOTH IP/OP $141.00 $104.50 $27.98 $150.00 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $29.39 $141.00 $104.65 $104.65 $108.68 $73.46 $29.39 $141.00 $150.00 $83.40 $141.00 $150.00 $141.00 $141.00 $105.75 $141.00 $141.00 $141.00 $91.65 $91.65 $111.67 $141.00 $112.80 $141.00 $27.98 $141.00 $81.78 $141.00 $141.00 $141.00 $29.38 $141.00 N/A N/A 77000001 EAP HCPCS G0101 PELVIC/BREAST EXAM BOTH IP/OP $282.00 $209.00 $27.81 $225.60 $153.13 $153.13 $153.13 $153.13 $73.60 $73.60 $73.28 $58.78 $73.60 $209.30 $209.30 $217.37 $146.92 $58.77 $117.77 $109.43 $166.80 $73.60 $27.81 $73.60 $77.28 $211.50 $73.60 $73.60 $73.60 $141.00 $141.00 $223.34 $73.60 $225.60 $183.30 $55.97 $73.60 $163.56 $77.28 $106.49 $73.60 $58.77 $73.60 N/A N/A 77100006 EAP CPT® 90471 IMMUNIZATION ADMIN 1ST BOTH IP/OP $62.00 $46.00 $12.31 $97.58 $33.67 $33.67 $33.67 $33.67 $60.99 $60.99 $60.72 $12.92 $60.99 $46.02 $46.02 $47.79 $32.30 $12.92 $97.58 $97.33 $36.67 $60.99 $20.31 $60.99 $64.04 $46.50 $60.99 $60.99 $60.99 $31.00 $31.00 $49.10 $60.99 $49.60 $40.30 $12.31 $60.99 $35.96 $64.04 $62.00 $60.99 $12.92 $60.99 N/A N/A 77100007 EAP CPT® 90471 ADMINISTRATION PNEUMO VACCINE BOTH IP/OP $62.00 $46.00 $12.31 $116.00 $33.67 $33.67 $33.67 $33.67 $39.36 $39.36 $39.19 $12.92 $39.36 $46.02 $46.02 $47.79 $32.30 $12.92 $62.98 $61.13 $36.67 $39.36 $116.00 $39.36 $41.33 $46.50 $39.36 $39.36 $39.36 $31.00 $31.00 $49.10 $39.36 $49.60 $40.30 $12.31 $39.36 $35.96 $41.33 $62.00 $60.99 $12.92 $39.36 N/A N/A 77100011 EAP CPT® 90472 IMMUNIZATION ADMIN EA ADDL BOTH IP/OP $62.00 $46.00 $12.31 $116.00 $33.67 $33.67 $33.67 $33.67 $62.00 $62.00 $62.00 $12.92 $62.00 $46.02 $46.02 $47.79 $32.30 $12.92 $62.00 $116.00 $36.67 $62.00 $14.56 $62.00 $62.00 $46.50 $62.00 $62.00 $62.00 $31.00 $31.00 $49.10 $62.00 $49.60 $40.30 $12.31 $62.00 $35.96 $62.00 $62.00 $62.00 $12.92 $62.00 N/A N/A 77100018 EAP HCPCS 90471 ADMINISTRATION FLU VACCINE BOTH IP/OP $62.00 $46.00 $12.31 $116.00 $33.67 $33.67 $33.67 $33.67 $39.36 $39.36 $39.19 $12.92 $39.36 $46.02 $46.02 $47.79 $32.30 $12.92 $62.98 $61.13 $36.67 $39.36 $116.00 $39.36 $41.33 $46.50 $39.36 $39.36 $39.36 $31.00 $31.00 $49.10 $39.36 $49.60 $40.30 $12.31 $39.36 $35.96 $41.33 $62.00 $60.99 $12.92 $39.36 N/A N/A 77100035 EAP CPT® 90471 IMMUNIZATION ADMIN. (PED) BOTH IP/OP $62.00 $46.00 $12.31 $97.58 $33.67 $33.67 $33.67 $33.67 $60.99 $60.99 $60.72 $12.92 $60.99 $46.02 $46.02 $47.79 $32.30 $12.92 $97.58 $97.33 $36.67 $60.99 $20.31 $60.99 $64.04 $46.50 $60.99 $60.99 $60.99 $31.00 $31.00 $49.10 $60.99 $49.60 $40.30 $12.31 $60.99 $35.96 $64.04 $62.00 $60.99 $12.92 $60.99 N/A N/A 77100040 EAP CPT® 90471 ADMINISTRATION OF HEPATITIS B VACCINE BOTH IP/OP $62.00 $46.00 $12.31 $116.00 $33.67 $33.67 $33.67 $33.67 $39.36 $39.36 $39.19 $12.92 $39.36 $46.02 $46.02 $47.79 $32.30 $12.92 $62.98 $61.13 $36.67 $39.36 $116.00 $39.36 $41.33 $46.50 $39.36 $39.36 $39.36 $31.00 $31.00 $49.10 $39.36 $49.60 $40.30 $12.31 $39.36 $35.96 $41.33 $62.00 $60.99 $12.92 $39.36 N/A N/A 77100044 EAP CPT® 90471 R-IMMUNIZATION ADMINISTRATION-24 BOTH IP/OP $66.00 $49.00 $13.10 $97.58 $35.84 $35.84 $35.84 $35.84 $60.99 $60.99 $60.72 $13.76 $60.99 $48.99 $48.99 $50.87 $34.39 $13.76 $97.58 $97.33 $39.04 $60.99 $20.31 $60.99 $64.04 $49.50 $60.99 $60.99 $60.99 $33.00 $33.00 $52.27 $60.99 $52.80 $42.90 $13.10 $60.99 $38.28 $64.04 $66.00 $60.99 $13.75 $60.99 N/A N/A 77100050 EAP CPT® 0124A "PFIZER COVID-19 ADMIN, BIVALENT BOOSTER 12YRS OR OLDER" BOTH IP/OP $80.00 $59.50 $16.67 $80.00 $43.44 $43.44 $43.44 $43.44 $80.00 $80.00 $80.00 $16.67 $80.00 $80.00 $80.00 $80.00 $80.00 $16.67 $80.00 $59.90 $47.32 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 77100051 EAP CPT® 0051A PFIZER COVID ADMIN VACCINE 1ST DOSE DILUTED BOTH IP/OP $80.00 $59.50 $40.00 $80.00 $43.44 $43.44 $43.44 $43.44 $80.00 $80.00 $40.05 $44.75 $80.00 $80.00 $80.00 $80.00 $80.00 $46.99 $80.00 $59.90 $47.32 $80.00 $80.00 $80.00 $42.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $44.75 $80.00 $46.40 $42.00 $48.00 $80.00 $44.75 $80.00 N/A N/A 77100052 EAP CPT® 0052A PFIZER COVID ADMIN VACCINE 2ND DOSE DILUTED BOTH IP/OP $80.00 $59.50 $40.00 $80.00 $43.44 $43.44 $43.44 $43.44 $80.00 $80.00 $40.05 $44.75 $80.00 $80.00 $80.00 $80.00 $80.00 $46.99 $80.00 $59.90 $47.32 $80.00 $80.00 $80.00 $42.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $44.75 $80.00 $46.40 $42.00 $48.00 $80.00 $44.75 $80.00 N/A N/A 77100053 EAP CPT® 0053A PFIZER COVID ADMIN VACCINE 3RD DOSE DILUTED BOTH IP/OP $80.00 $59.50 $40.00 $80.00 $43.44 $43.44 $43.44 $43.44 $80.00 $80.00 $40.05 $44.75 $80.00 $80.00 $80.00 $80.00 $80.00 $46.99 $80.00 $59.90 $47.32 $80.00 $80.00 $80.00 $42.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $44.75 $80.00 $46.40 $42.00 $48.00 $80.00 $44.75 $80.00 N/A N/A 77100054 EAP CPT® 0054A PFIZER COVID ADMIN VACCINE BOOSTER DOSE DILUTED BOTH IP/OP $80.00 $59.50 $40.00 $80.00 $43.44 $43.44 $43.44 $43.44 $80.00 $80.00 $40.05 $44.75 $80.00 $40.00 $40.00 $40.00 $40.00 $46.99 $80.00 $59.90 $47.32 $80.00 $80.00 $80.00 $42.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $44.75 $80.00 $46.40 $42.00 $48.00 $80.00 $44.75 $80.00 N/A N/A 77100080 EAP CPT® 0001A PFIZER COVID ADMIN VACCINE 1ST DOSE BOTH IP/OP $80.00 $59.50 $38.36 $80.00 $43.44 $43.44 $43.44 $43.44 $38.53 $38.53 $38.36 $44.75 $38.53 $80.00 $80.00 $80.00 $80.00 $46.99 $61.64 $59.90 $47.32 $38.53 $80.00 $38.53 $40.45 $60.00 $38.53 $38.53 $38.53 $40.00 $40.00 $63.36 $38.53 $64.00 $52.00 $44.75 $38.53 $46.40 $40.45 $55.74 $38.53 $44.75 $38.53 N/A N/A 77100081 EAP CPT® 0002A PFIZER COVID ADMIN VACCINE 2ND DOSE BOTH IP/OP $80.00 $59.50 $38.36 $80.00 $43.44 $43.44 $43.44 $43.44 $38.53 $38.53 $38.36 $44.75 $38.53 $80.00 $80.00 $80.00 $80.00 $46.99 $61.64 $59.90 $47.32 $38.53 $80.00 $38.53 $40.45 $60.00 $38.53 $38.53 $38.53 $40.00 $40.00 $63.36 $38.53 $64.00 $52.00 $44.75 $38.53 $46.40 $40.45 $55.74 $38.53 $44.75 $38.53 N/A N/A 77100082 EAP CPT® 0031A J&J COVID ADMIN VACCINE BOTH IP/OP $80.00 $59.50 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $40.00 $44.75 $80.00 $80.00 $80.00 $80.00 $80.00 $46.99 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $42.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $42.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 77100083 EAP CPT® 0003A PFIZER COVID ADMIN VACCINE 3RD DOSE BOTH IP/OP $80.00 $59.50 $38.36 $80.00 $43.44 $43.44 $43.44 $43.44 $38.53 $38.53 $38.36 $44.75 $38.53 $80.00 $80.00 $80.00 $80.00 $46.99 $61.64 $59.90 $47.32 $38.53 $80.00 $38.53 $40.45 $60.00 $38.53 $38.53 $38.53 $40.00 $40.00 $63.36 $38.53 $64.00 $52.00 $44.75 $38.53 $46.40 $40.45 $55.74 $38.53 $44.75 $38.53 N/A N/A 77100084 EAP CPT® 0004A PFIZER COVID ADMIN VACCINE BOOSTER BOTH IP/OP $80.00 $59.50 $38.36 $80.00 $43.44 $43.44 $43.44 $43.44 $38.53 $38.53 $38.36 $44.75 $38.53 $80.00 $80.00 $80.00 $80.00 $46.99 $61.64 $59.90 $47.32 $38.53 $80.00 $38.53 $40.45 $60.00 $38.53 $38.53 $38.53 $40.00 $40.00 $63.36 $38.53 $64.00 $52.00 $44.75 $38.53 $46.40 $40.45 $55.74 $38.53 $44.75 $38.53 N/A N/A 77100085 EAP CPT® 0071A PFIZER COVID VACCINE 1ST DOSE PEDIATRIC (5-11YO) BOTH IP/OP $80.00 $59.50 $38.36 $80.00 $43.44 $43.44 $43.44 $43.44 $38.53 $38.53 $38.36 $44.75 $38.53 $80.00 $80.00 $80.00 $80.00 $46.99 $61.64 $59.90 $47.32 $38.53 $80.00 $38.53 $40.45 $60.00 $38.53 $38.53 $38.53 $40.00 $40.00 $63.36 $38.53 $64.00 $52.00 $44.75 $38.53 $46.40 $40.45 $55.74 $38.53 $44.75 $38.53 N/A N/A 77100086 EAP CPT® 0072A PFIZER COVID VACCINE 2ND DOSE PEDIATRIC (5-11YO) BOTH IP/OP $80.00 $59.50 $38.36 $80.00 $43.44 $43.44 $43.44 $43.44 $38.53 $38.53 $38.36 $44.75 $38.53 $80.00 $80.00 $80.00 $80.00 $46.99 $61.64 $59.90 $47.32 $38.53 $80.00 $38.53 $40.45 $60.00 $38.53 $38.53 $38.53 $40.00 $40.00 $63.36 $38.53 $64.00 $52.00 $44.75 $38.53 $46.40 $40.45 $55.74 $38.53 $44.75 $38.53 N/A N/A 77100087 EAP CPT® 0073A PFIZER COVID VACCINE 3RD DOSE PEDIATRIC (5-11YO) BOTH IP/OP $80.00 $59.50 $40.00 $80.00 $43.44 $43.44 $43.44 $43.44 $80.00 $80.00 $80.00 $44.75 $80.00 $80.00 $80.00 $80.00 $80.00 $46.99 $80.00 $59.90 $47.32 $80.00 $80.00 $80.00 $42.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $44.75 $80.00 $46.40 $42.00 $48.00 $80.00 $44.75 $80.00 N/A N/A 77100088 EAP CPT® 0074A PFIZER COVID VACCINE BOOSTER DOSE PEDIATRIC (5-11YO) BOTH IP/OP $80.00 $59.50 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $44.75 $80.00 $80.00 $80.00 $80.00 $80.00 $46.99 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $42.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $42.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 77100089 EAP CPT® 0154A "PFIZER COVID-19 ADMIN, BIVALENT BOOSTER (5-11YO)" BOTH IP/OP $80.00 $59.50 $14.24 $80.00 $43.44 $43.44 $43.44 $43.44 $80.00 $80.00 $14.24 $16.67 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $59.90 $47.32 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $15.88 $80.00 $46.40 $80.00 $48.00 $80.00 $16.67 $80.00 N/A N/A 77100090 EAP CPT® 0011A MODERNA COVID ADMIN VACCINE 1ST DOSE BOTH IP/OP $80.00 $59.50 $38.36 $80.00 $43.44 $43.44 $43.44 $43.44 $38.53 $38.53 $38.36 $44.75 $38.53 $80.00 $80.00 $80.00 $80.00 $46.99 $61.64 $59.90 $47.32 $38.53 $80.00 $38.53 $40.45 $60.00 $38.53 $38.53 $38.53 $40.00 $40.00 $63.36 $38.53 $64.00 $52.00 $44.75 $38.53 $46.40 $40.45 $55.74 $38.53 $44.75 $38.53 N/A N/A 77100091 EAP CPT® 0012A MODERNA COVID VACCINE ADMIN 2ND DOSE BOTH IP/OP $80.00 $59.50 $38.36 $80.00 $43.44 $43.44 $43.44 $43.44 $38.53 $38.53 $38.36 $44.75 $38.53 $80.00 $80.00 $80.00 $80.00 $46.99 $61.64 $59.90 $47.32 $38.53 $80.00 $38.53 $40.45 $60.00 $38.53 $38.53 $38.53 $40.00 $40.00 $63.36 $38.53 $64.00 $52.00 $44.75 $38.53 $46.40 $40.45 $55.74 $38.53 $44.75 $38.53 N/A N/A 77100093 EAP CPT® 0013A MODERNA COVID VACCINE ADMIN 3RD DOSE BOTH IP/OP $80.00 $59.50 $38.36 $80.00 $43.44 $43.44 $43.44 $43.44 $38.53 $38.53 $38.36 $44.75 $38.53 $80.00 $80.00 $80.00 $80.00 $46.99 $61.64 $59.90 $47.32 $38.53 $80.00 $38.53 $40.45 $60.00 $38.53 $38.53 $38.53 $40.00 $40.00 $63.36 $38.53 $64.00 $52.00 $44.75 $38.53 $46.40 $40.45 $55.74 $38.53 $44.75 $38.53 N/A N/A 77100094 EAP CPT® 0064A MODERNA COVID VACCINE ADMIN BOOSTER BOTH IP/OP $80.00 $59.50 $16.67 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $40.00 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $42.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $38.53 $46.40 $42.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 77100095 EAP CPT® 0094A MODERNA COVID VACCINE ADMIN BOOSTER (BLUE CAP) BOTH IP/OP $80.00 $59.50 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $44.75 $80.00 $80.00 $80.00 $80.00 $80.00 $46.99 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $42.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $42.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 77100096 EAP CPT® 0111A MODERNA COVID ADMIN VACCINE 5MO-6YO 1ST DOSE BOTH IP/OP $80.00 $59.50 $16.67 $80.00 $43.44 $43.44 $43.44 $43.44 $80.00 $80.00 $80.00 $16.67 $80.00 $80.00 $80.00 $80.00 $80.00 $16.67 $80.00 $59.90 $47.32 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 77100097 EAP CPT® 0112A MODERNA COVID ADMIN VACCINE 5MO-6YO 2ND DOSE BOTH IP/OP $80.00 $59.50 $16.67 $80.00 $43.44 $43.44 $43.44 $43.44 $80.00 $80.00 $80.00 $16.67 $80.00 $80.00 $80.00 $80.00 $80.00 $16.67 $80.00 $59.90 $47.32 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 77100098 EAP CPT® 0081A PFIZER COVID ADMIN VACCINE 1ST DOSE PEDIATRIC (6MO-4YO) BOTH IP/OP $80.00 $59.50 $16.67 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 77100101 EAP CPT® 0083A PFIZER COVID ADMIN VACCINE 3RD DOSE PEDIATRIC (6MO-4YO) BOTH IP/OP $80.00 $59.50 $16.67 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 77100102 EAP CPT® 0113A MODERNA COVID ADMIN VACCINE 6MO-5YO 3RD DOSE BOTH IP/OP $80.00 $59.50 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 78000010 EAP HCPCS Q3014 TELEHEALTH FACILITY FEE BOTH IP/OP $65.00 $48.50 $13.55 $65.00 $35.30 $35.30 $35.30 $35.30 $27.59 $27.59 $26.81 $20.52 $65.00 $65.00 $65.00 $65.00 $65.00 $20.52 $27.59 $28.64 $38.45 $27.59 $27.59 $27.59 $27.59 $48.75 $27.02 $65.00 $27.59 $32.50 $32.50 $51.48 $27.59 $52.00 $31.14 $20.52 $27.59 $37.70 $27.59 $39.00 $27.59 $13.55 $65.00 N/A N/A 80000016 EAP HCPCS A4215 NEEDLE BIOP 19GA 6CM 2 1/3IN COAXIAL INTROD ECHOTIP BOTH IP/OP $32.00 $24.00 $0.22 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $0.22 $32.00 $32.00 $23.75 $23.75 $24.67 $16.67 $6.67 $32.00 $12.80 $32.00 $32.00 $32.00 $32.00 $32.00 $24.00 $32.00 $32.00 $32.00 $16.00 $16.00 $25.34 $32.00 $25.60 $20.80 $32.00 $32.00 $18.56 $32.00 $19.20 $32.00 $32.00 $32.00 N/A N/A 80000611 EAP HCPCS C1769 GUIDEWIRE VASC 150CM .035IN FIX CORE FLXB 3MM RAD BOTH IP/OP $325.00 $240.50 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 $325.00 $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 80000635 EAP HCPCS C1894 SHEATH INTROD 10CM 6FR PNCL PERI SNPON DILAT LOCK BOTH IP/OP $219.00 $162.50 $43.47 $219.00 $118.92 $118.92 $118.92 $118.92 $219.00 $219.00 $219.00 $45.65 $219.00 $162.54 $162.54 $168.81 $114.10 $45.64 $219.00 $219.00 $129.54 $219.00 $219.00 $219.00 $219.00 $164.25 $219.00 $219.00 $219.00 $109.50 $109.50 $173.45 $219.00 $175.20 $142.35 $43.47 $219.00 $127.02 $219.00 $219.00 $219.00 $45.64 $219.00 N/A N/A 80000652 EAP HCPCS C1757 CATHETER EMBOLECTOMY 5.5FR 11MM 80CM BOTH IP/OP $225.00 $166.50 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 $225.00 $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 80000808 EAP HCPCS C1729 CATHETER DRN PGTL CRV 10FR 25CM SKTR CHC LCK LCK TROC STY LG BOTH IP/OP "$1,175.00" $869.50 $233.21 "$1,175.00" $638.03 $638.03 $638.03 $638.03 "$1,175.00" "$1,175.00" "$1,175.00" $244.90 "$1,175.00" $872.09 $872.09 $905.69 $612.18 $244.88 "$1,175.00" "$1,175.00" $695.01 "$1,175.00" "$1,175.00" "$1,175.00" "$1,175.00" $881.25 "$1,175.00" "$1,175.00" "$1,175.00" $587.50 $587.50 $930.60 "$1,175.00" $940.00 $763.75 $233.21 "$1,175.00" $681.50 "$1,175.00" "$1,175.00" "$1,175.00" $244.87 "$1,175.00" N/A N/A 80001077 EAP HCPCS C1713 FORCEPS BIOPSY CHANNEL-GUARD PRECISOR BRONCHO L115 BOTH IP/OP $98.00 $73.00 $19.45 $98.00 $53.21 $53.21 $53.21 $53.21 $98.00 $98.00 $98.00 $20.43 $98.00 $72.74 $72.74 $75.54 $51.06 $20.42 $98.00 $98.00 $57.97 $98.00 $98.00 $98.00 $98.00 $73.50 $98.00 $98.00 $98.00 $49.00 $49.00 $77.62 $98.00 $78.40 $63.70 $19.45 $98.00 $56.84 $98.00 $58.80 $98.00 $20.42 $98.00 N/A N/A 80002673 EAP HCPCS C1729 CATHETER XTRN DRN 80CM STRL EDM CLS TIP BA IMPRG SIL LMBR BOTH IP/OP $566.00 $419.00 $112.34 $566.00 $307.34 $307.34 $307.34 $307.34 $566.00 $566.00 $566.00 $117.97 $566.00 $420.09 $420.09 $436.27 $294.89 $117.96 $566.00 $566.00 $334.79 $566.00 $566.00 $566.00 $566.00 $424.50 $566.00 $566.00 $566.00 $283.00 $283.00 $448.27 $566.00 $452.80 $367.90 $112.34 $566.00 $328.28 $566.00 $566.00 $566.00 $117.95 $566.00 N/A N/A 80003186 EAP HCPCS C1887 CATHETER GUID BLUE YLW 100CM 7FR CRDS VSBR JL4ST BOTH IP/OP $93.00 $69.00 $18.46 $93.00 $50.50 $50.50 $50.50 $50.50 $93.00 $93.00 $93.00 $19.38 $93.00 $69.02 $69.02 $71.68 $48.45 $19.38 $93.00 $93.00 $55.01 $93.00 $93.00 $93.00 $93.00 $69.75 $93.00 $93.00 $93.00 $46.50 $46.50 $73.66 $93.00 $74.40 $60.45 $18.46 $93.00 $53.94 $93.00 $93.00 $93.00 $19.38 $93.00 N/A N/A 80003206 EAP HCPCS C1725 CATHETER PA 110CM 7FR 10MM ARW 1 LUM BLN WDG PRSS BOTH IP/OP $168.00 $124.50 $33.34 $168.00 $91.22 $91.22 $91.22 $91.22 $168.00 $168.00 $168.00 $35.02 $168.00 $124.69 $124.69 $129.49 $87.53 $35.01 $168.00 $168.00 $99.37 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $109.20 $33.34 $168.00 $97.44 $168.00 $168.00 $168.00 $35.01 $168.00 N/A N/A 80003226 EAP HCPCS C1884 SYSTEM EMBL PRTC 300CM .014IN 110UM 3.2FR CRTD BOTH IP/OP "$4,188.00" "$3,099.50" $831.21 "$4,188.00" "$2,274.08" "$2,274.08" "$2,274.08" "$2,274.08" "$4,188.00" "$4,188.00" "$4,188.00" $872.88 "$4,188.00" "$3,108.33" "$3,108.33" "$3,228.11" "$2,060.15" $872.83 "$4,188.00" "$4,188.00" "$2,477.20" "$4,188.00" "$4,188.00" "$4,188.00" "$4,188.00" "$3,141.00" "$4,188.00" "$4,188.00" "$4,188.00" "$2,094.00" "$2,094.00" "$3,316.90" "$4,188.00" "$3,350.40" "$2,722.20" $831.21 "$4,188.00" "$2,429.04" "$4,188.00" "$4,188.00" "$4,188.00" $872.78 "$4,188.00" N/A N/A 80003239 EAP HCPCS C1757 CATHETER THRMB 140CM 6FR .07IN XPRT AP ASPIRAT BOTH IP/OP "$1,238.00" $916.50 $245.71 "$1,238.00" $672.23 $672.23 $672.23 $672.23 "$1,238.00" "$1,238.00" "$1,238.00" $258.03 "$1,238.00" $918.84 $918.84 $954.25 $645.00 $258.01 "$1,238.00" "$1,238.00" $732.28 "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" $928.50 "$1,238.00" "$1,238.00" "$1,238.00" $619.00 $619.00 $980.50 "$1,238.00" $990.40 $804.70 $245.71 "$1,238.00" $718.04 "$1,238.00" "$1,238.00" "$1,238.00" $258.00 "$1,238.00" N/A N/A 80006190 EAP HCPCS C1769 GUIDEWIRE VASC 145CM .035IN FIX CORE FLPY FLX TP BOTH IP/OP $49.00 $36.50 $9.73 $49.00 $26.61 $26.61 $26.61 $26.61 $49.00 $49.00 $49.00 $10.21 $49.00 $36.37 $36.37 $37.77 $25.53 $10.21 $49.00 $49.00 $28.98 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $31.85 $9.73 $49.00 $28.42 $49.00 $49.00 $49.00 $10.21 $49.00 N/A N/A 80006520 EAP HCPCS C1876 SYSTEM CORON STENT 8MM 3.5MM MTLNK VSN COCR RAPEX BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80006521 EAP HCPCS C1876 SYSTEM CORON STENT 8MM 4MM MTLNK VSN COCR RAPEX LP BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80006522 EAP HCPCS C1876 SYSTEM CORON STENT 12MM 3MM MTLNK VSN COCR RAPEX BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80006523 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3.5MM MTLNK VSN COCR RAPEX BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80006524 EAP HCPCS C1876 SYSTEM CORON STENT 12MM 4MM MTLNK VSN COCR RAPEX BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80006526 EAP HCPCS C1876 SYSTEM CORON STENT 15MM 3.5MM MTLNK VSN COCR RAPEX BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80006531 EAP HCPCS C1876 SYSTEM CORON STENT 23MM 3MM MTLNK VSN COCR RAPEX BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80006535 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3.5MM MTLNK VSN COCR RAPEX BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80006536 EAP HCPCS C1876 SYSTEM CORON STENT 28MM 4MM MTLNK VSN COCR RAPEX BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80006629 EAP HCPCS C1769 NEEDLE BIOP 22GA 10CM CHIBA STERILE DISPOSABLE ASPIRAT BOTH IP/OP $27.00 $20.00 $5.36 $27.00 $14.66 $14.66 $14.66 $14.66 $27.00 $27.00 $27.00 $5.63 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $15.97 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $5.36 $27.00 $15.66 $27.00 $27.00 $27.00 $5.63 $27.00 N/A N/A 80006635 EAP HCPCS C1769 GUIDEWIRE VASC 145CM .038IN ATRM FLPY FLX TP XSTIF BOTH IP/OP $65.00 $48.50 $12.90 $65.00 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $65.00 $38.45 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 $65.00 $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 80006647 EAP HCPCS C1769 .035-150CM ROSEN GUIDEWIRE BOTH IP/OP $30.00 $22.50 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 $30.00 $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A 80006661 EAP HCPCS C1875 8 X 40 FLUENCY STEN BOTH IP/OP "$7,858.00" "$5,815.00" "$1,637.69" "$7,858.00" "$7,858.00" "$7,858.00" "$7,858.00" "$7,858.00" "$7,858.00" "$7,858.00" "$7,858.00" "$7,858.00" "$7,858.00" "$7,858.00" "$7,858.00" "$7,858.00" "$7,858.00" "$1,637.69" "$7,858.00" "$3,143.20" "$7,858.00" "$7,858.00" "$7,858.00" "$7,858.00" "$7,858.00" "$5,893.50" "$7,858.00" "$7,858.00" "$7,858.00" "$3,929.00" "$3,929.00" "$6,223.54" "$7,858.00" "$6,286.40" "$3,536.10" "$7,858.00" "$7,858.00" "$4,557.64" "$7,858.00" "$4,714.80" "$7,858.00" "$7,858.00" "$7,858.00" N/A N/A 80006675 EAP HCPCS C1884 MICROSPHERE EMBOGOLD 900-1200 BOTH IP/OP "$3,125.00" "$2,312.50" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$3,125.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 "$3,125.00" "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 80006680 EAP HCPCS C1894 SHEATH INTROD 10CM 7FR PNCL PERI SS HYDPHI PTFE BOTH IP/OP $219.00 $162.50 $43.47 $219.00 $118.92 $118.92 $118.92 $118.92 $219.00 $219.00 $219.00 $45.65 $219.00 $162.54 $162.54 $168.81 $114.10 $45.64 $219.00 $219.00 $129.54 $219.00 $219.00 $219.00 $219.00 $164.25 $219.00 $219.00 $219.00 $109.50 $109.50 $173.45 $219.00 $175.20 $142.35 $43.47 $219.00 $127.02 $219.00 $219.00 $219.00 $45.64 $219.00 N/A N/A 80006701 EAP HCPCS C1773 KIT SNR 120CM 15MM 6FR AGN NTNL CATH PREFORM LOOP BOTH IP/OP $800.00 $592.00 $158.78 $800.00 $434.40 $434.40 $434.40 $434.40 $800.00 $800.00 $800.00 $166.74 $800.00 $593.76 $593.76 $616.64 $416.80 $166.73 $800.00 $800.00 $473.20 $800.00 $800.00 $800.00 $800.00 $600.00 $800.00 $800.00 $800.00 $400.00 $400.00 $633.60 $800.00 $640.00 $520.00 $158.78 $800.00 $464.00 $800.00 $800.00 $800.00 $166.72 $800.00 N/A N/A 80006724 EAP Custom 80006724 INFLATION DEVICE MONARCH-25 BOTH IP/OP $713.00 $528.00 $126.91 $713.00 $713.00 $713.00 $713.00 $713.00 $713.00 $713.00 $126.91 $713.00 $713.00 $529.19 $529.19 $549.58 $371.47 $148.60 $713.00 $285.20 $713.00 $713.00 $713.00 $713.00 $713.00 $534.75 $713.00 $713.00 $713.00 $356.50 $356.50 $564.70 $713.00 $570.40 $463.45 $713.00 $713.00 $413.54 $713.00 $427.80 $713.00 $713.00 $713.00 N/A N/A 80008328 EAP HCPCS C1876 SYSTEM CORON STENT 8MM 2.5MM MTLNK MVSN COCR RAPEX BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80008330 EAP HCPCS C1876 SYSTEM CORON STENT 15MM 2.5MM MTLNK MVSN COCR BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80008333 EAP HCPCS C1876 SYSTEM CORON STENT 28MM 2.5MM MTLNK MVSN COCR BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80008338 EAP HCPCS A6198 DRESSING BRN 16X16IN STRL LF ACTCT ANBCTRL FST ACT BRR CNTRL BOTH IP/OP $156.00 $115.50 $30.96 $156.00 $84.71 $84.71 $84.71 $84.71 $156.00 $156.00 $156.00 $32.51 $156.00 $115.78 $115.78 $120.24 $81.28 $32.51 $156.00 $156.00 $92.27 $156.00 $156.00 $156.00 $156.00 $117.00 $156.00 $156.00 $156.00 $78.00 $78.00 $123.55 $156.00 $124.80 $101.40 $30.96 $156.00 $90.48 $156.00 $156.00 $156.00 $32.51 $156.00 N/A N/A 80008414 EAP HCPCS C1725 CATHETER BLNDIL 5MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 80008417 EAP HCPCS C1725 CONQUEST DIALATION BALLOON 6MM BOTH IP/OP $463.00 $343.00 $91.89 $463.00 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $463.00 $273.86 $463.00 $463.00 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 $463.00 $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A 80008418 EAP HCPCS C1725 CATHETER BLNDIL 7MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS BOTH IP/OP $663.00 $491.00 $131.59 $663.00 $360.01 $360.01 $360.01 $360.01 $663.00 $663.00 $663.00 $138.19 $663.00 $492.08 $492.08 $511.04 $345.42 $138.18 $663.00 $663.00 $392.16 $663.00 $663.00 $663.00 $663.00 $497.25 $663.00 $663.00 $663.00 $331.50 $331.50 $525.10 $663.00 $530.40 $430.95 $131.59 $663.00 $384.54 $663.00 $663.00 $663.00 $138.17 $663.00 N/A N/A 80008439 EAP HCPCS C1894 SHEATH GUID 45CM 6FR PN DSTN HS CURVE SS NYL BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 80008456 EAP HCPCS C1894 INTROD SHTH 6FR 4CM RADIOPQ LG BORE STPCK PINCH BOTH IP/OP $213.00 $158.00 $42.28 $213.00 $115.66 $115.66 $115.66 $115.66 $213.00 $213.00 $213.00 $44.39 $213.00 $158.09 $158.09 $164.18 $110.97 $44.39 $213.00 $213.00 $125.99 $213.00 $213.00 $213.00 $213.00 $159.75 $213.00 $213.00 $213.00 $106.50 $106.50 $168.70 $213.00 $170.40 $138.45 $42.28 $213.00 $123.54 $213.00 $213.00 $213.00 $44.39 $213.00 N/A N/A 80008465 EAP HCPCS A4215 NEEDLE BX 18GA 9CM ACHV AUTOMATE PRGM LTWT SPRG LD ACT ECHGN BOTH IP/OP $212.00 $157.00 $0.22 $212.00 $212.00 $212.00 $212.00 $212.00 $212.00 $212.00 $0.22 $212.00 $212.00 $157.35 $157.35 $163.41 $110.45 $44.18 $212.00 $84.80 $212.00 $212.00 $212.00 $212.00 $212.00 $159.00 $212.00 $212.00 $212.00 $106.00 $106.00 $167.90 $212.00 $169.60 $137.80 $212.00 $212.00 $122.96 $212.00 $127.20 $212.00 $212.00 $212.00 N/A N/A 80008503 EAP HCPCS C1725 CATHETER ANGIOGRAPHIC CHUANG C CURVE 5FR 80CM TORCON NB BOTH IP/OP $63.00 $47.00 $12.50 $63.00 $34.21 $34.21 $34.21 $34.21 $63.00 $63.00 $63.00 $13.13 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $63.00 $37.26 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $31.50 $31.50 $49.90 $63.00 $50.40 $40.95 $12.50 $63.00 $36.54 $63.00 $63.00 $63.00 $13.13 $63.00 N/A N/A 80008514 EAP HCPCS C1894 SET INTRO .018IN 5FR 21GA 10CM STRL 7CM MPNCH PSH+ TRNSTLS BOTH IP/OP $88.00 $65.50 $17.47 $88.00 $47.78 $47.78 $47.78 $47.78 $88.00 $88.00 $88.00 $18.34 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $88.00 $52.05 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $17.47 $88.00 $51.04 $88.00 $88.00 $88.00 $18.34 $88.00 N/A N/A 80008528 EAP HCPCS C1729 STENT URETERAL PIGTAIL CURVE 10.2FR 24CM RADIOPQ SIDEPORT BOTH IP/OP $312.00 $231.00 $61.92 $312.00 $140.40 $140.40 $140.40 $140.40 $312.00 $312.00 $312.00 $65.03 $312.00 $312.00 $312.00 $312.00 $312.00 $65.02 $312.00 $312.00 $184.55 $312.00 $312.00 $312.00 $312.00 $234.00 $312.00 $312.00 $312.00 $156.00 $156.00 $247.10 $312.00 $249.60 $140.40 $61.92 $312.00 $180.96 $312.00 $312.00 $312.00 $65.02 $312.00 N/A N/A 80008543 EAP HCPCS C1729 CATHETER DRAIN .038IN 14FR 25CM 6 SIDEPORT MAC-LOC LOCKING BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80008556 EAP HCPCS C1894 INTROD SHTH 10FR 2.5CM 25CM DILAT KINK RST PNCL BOTH IP/OP $499.00 $369.50 $99.04 $499.00 $270.96 $270.96 $270.96 $270.96 $499.00 $499.00 $499.00 $104.00 $499.00 $370.36 $370.36 $384.63 $259.98 $104.00 $499.00 $499.00 $295.16 $499.00 $499.00 $499.00 $499.00 $374.25 $499.00 $499.00 $499.00 $249.50 $249.50 $395.21 $499.00 $399.20 $324.35 $99.04 $499.00 $289.42 $499.00 $499.00 $499.00 $103.99 $499.00 N/A N/A 80008561 EAP HCPCS C1894 SHEATH INTROD 25CM 5FR PNCL PERI SS HYDPHI PTFE BOTH IP/OP $499.00 $369.50 $99.04 $499.00 $270.96 $270.96 $270.96 $270.96 $499.00 $499.00 $499.00 $104.00 $499.00 $370.36 $370.36 $384.63 $259.98 $104.00 $499.00 $499.00 $295.16 $499.00 $499.00 $499.00 $499.00 $374.25 $499.00 $499.00 $499.00 $249.50 $249.50 $395.21 $499.00 $399.20 $324.35 $99.04 $499.00 $289.42 $499.00 $499.00 $499.00 $103.99 $499.00 N/A N/A 80008562 EAP HCPCS C1757 CATHETER THROMBECTOMY 5FR 135CM 40CM OCCLUDING BALL WIRE BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80008565 EAP HCPCS C1894 SHEATH INTROD 25CM 6FR PNCL PERI SS HYDPHI PTFE BOTH IP/OP $499.00 $369.50 $99.04 $499.00 $270.96 $270.96 $270.96 $270.96 $499.00 $499.00 $499.00 $104.00 $499.00 $370.36 $370.36 $384.63 $259.98 $104.00 $499.00 $499.00 $295.16 $499.00 $499.00 $499.00 $499.00 $374.25 $499.00 $499.00 $499.00 $249.50 $249.50 $395.21 $499.00 $399.20 $324.35 $99.04 $499.00 $289.42 $499.00 $499.00 $499.00 $103.99 $499.00 N/A N/A 80008566 EAP HCPCS C1894 INTROD SHTH 8FR 2.5CM 25CM DILAT MINI GWIRE KINK BOTH IP/OP $499.00 $369.50 $99.04 $499.00 $270.96 $270.96 $270.96 $270.96 $499.00 $499.00 $499.00 $104.00 $499.00 $370.36 $370.36 $384.63 $259.98 $104.00 $499.00 $499.00 $295.16 $499.00 $499.00 $499.00 $499.00 $374.25 $499.00 $499.00 $499.00 $249.50 $249.50 $395.21 $499.00 $399.20 $324.35 $99.04 $499.00 $289.42 $499.00 $499.00 $499.00 $103.99 $499.00 N/A N/A 80008570 EAP HCPCS C1894 SHEATH INTROD 25CM 7FR PNCL PERI SS HYDPHI PTFE BOTH IP/OP $499.00 $369.50 $99.04 $499.00 $270.96 $270.96 $270.96 $270.96 $499.00 $499.00 $499.00 $104.00 $499.00 $370.36 $370.36 $384.63 $259.98 $104.00 $499.00 $499.00 $295.16 $499.00 $499.00 $499.00 $499.00 $374.25 $499.00 $499.00 $499.00 $249.50 $249.50 $395.21 $499.00 $399.20 $324.35 $99.04 $499.00 $289.42 $499.00 $499.00 $499.00 $103.99 $499.00 N/A N/A 80008571 EAP HCPCS C1750 TITAN HD BASIC SET 15.5F X 28CM STRAIGHT W/SIDEHOLES BOTH IP/OP "$2,188.00" "$1,619.50" $434.26 "$2,188.00" "$1,188.08" "$1,188.08" "$1,188.08" "$1,188.08" "$2,188.00" "$2,188.00" "$2,188.00" $456.03 "$2,188.00" "$1,623.93" "$1,623.93" "$1,686.51" "$1,139.95" $456.00 "$2,188.00" "$2,188.00" "$1,294.20" "$2,188.00" "$2,188.00" "$2,188.00" "$2,188.00" "$1,641.00" "$2,188.00" "$2,188.00" "$2,188.00" "$1,094.00" "$1,094.00" "$1,732.90" "$2,188.00" "$1,750.40" "$1,422.20" $434.26 "$2,188.00" "$1,269.04" "$2,188.00" "$2,188.00" "$2,188.00" $455.98 "$2,188.00" N/A N/A 80008625 EAP HCPCS C1894 SHEATH INTROD 10CM 10FR PNCL PERI SS HYDPHI PTFE BOTH IP/OP $219.00 $162.50 $43.47 $219.00 $118.92 $118.92 $118.92 $118.92 $219.00 $219.00 $219.00 $45.65 $219.00 $162.54 $162.54 $168.81 $114.10 $45.64 $219.00 $219.00 $129.54 $219.00 $219.00 $219.00 $219.00 $164.25 $219.00 $219.00 $219.00 $109.50 $109.50 $173.45 $219.00 $175.20 $142.35 $43.47 $219.00 $127.02 $219.00 $219.00 $219.00 $45.64 $219.00 N/A N/A 80008651 EAP HCPCS C1769 GUIDEWIRE VASCULAR STR .018IN 180CM 25CM SHAPEABLE SHAFT BOTH IP/OP $398.00 $295.00 $78.99 $398.00 $216.11 $216.11 $216.11 $216.11 $398.00 $398.00 $398.00 $82.95 $398.00 $295.40 $295.40 $306.78 $207.36 $82.95 $398.00 $159.20 $235.42 $398.00 $398.00 $398.00 $398.00 $298.50 $398.00 $398.00 $398.00 $199.00 $199.00 $315.22 $398.00 $318.40 $258.70 $78.99 $398.00 $230.84 $398.00 $398.00 $398.00 $82.94 $398.00 N/A N/A 80008715 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL LCB CURVE CORON BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80008773 EAP HCPCS C1876 STENT VASCULAR .035IN 8MM 6FR 30MM 80CM SELF EXPANDING BOTH IP/OP "$2,284.00" "$1,690.50" $453.32 "$2,284.00" "$1,027.80" "$1,027.80" "$1,027.80" "$1,027.80" "$2,284.00" "$2,284.00" "$2,284.00" $476.04 "$2,284.00" "$2,284.00" "$2,284.00" "$2,284.00" "$2,284.00" $476.01 "$2,284.00" "$2,284.00" "$1,350.99" "$2,284.00" "$2,284.00" "$2,284.00" "$2,284.00" "$1,713.00" "$2,284.00" "$2,284.00" "$2,284.00" "$1,142.00" "$1,142.00" "$1,808.93" "$2,284.00" "$1,827.20" "$1,027.80" $453.32 "$2,284.00" "$1,324.72" "$2,284.00" "$2,284.00" "$2,284.00" $475.99 "$2,284.00" N/A N/A 80008831 EAP HCPCS C1769 SET CATH 20CM 15.5FR 3 LUM BASIC GWIRE DILAT SCPL BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80008835 EAP CATHETER ART LN 8FR 110CM SG C VIP 7 LUM CCO AMC THRMBSH BOTH IP/OP $538.00 $398.50 $95.76 $538.00 $538.00 $538.00 $538.00 $538.00 $538.00 $538.00 $95.76 $538.00 $538.00 $399.30 $399.30 $414.69 $280.30 $112.13 $538.00 $215.20 $538.00 $538.00 $538.00 $538.00 $538.00 $403.50 $538.00 $538.00 $538.00 $269.00 $269.00 $426.10 $538.00 $430.40 $349.70 $538.00 $538.00 $312.04 $538.00 $322.80 $538.00 $538.00 $538.00 N/A N/A 80008870 EAP HCPCS C1887 CATHETER GUID BLUE YLW 100CM 7FR CRDS VSBR MPA1 BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80008873 EAP HCPCS C1887 CATHETER GUID BLUE YLW 100CM 7FR CRDS VSBR JR3.5 BOTH IP/OP $93.00 $69.00 $18.46 $93.00 $50.50 $50.50 $50.50 $50.50 $93.00 $93.00 $93.00 $19.38 $93.00 $69.02 $69.02 $71.68 $48.45 $19.38 $93.00 $93.00 $55.01 $93.00 $93.00 $93.00 $93.00 $69.75 $93.00 $93.00 $93.00 $46.50 $46.50 $73.66 $93.00 $74.40 $60.45 $18.46 $93.00 $53.94 $93.00 $93.00 $93.00 $19.38 $93.00 N/A N/A 80008874 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL IMA CURVE PERI BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80008880 EAP HCPCS C1725 CATHETER INTRAVENOUS STANDARD BOTH IP/OP $9.00 $7.00 $1.79 $9.00 $4.89 $4.89 $4.89 $4.89 $9.00 $9.00 $9.00 $1.88 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $9.00 $5.32 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $1.79 $9.00 $5.22 $9.00 $9.00 $9.00 $1.88 $9.00 N/A N/A 80008883 EAP HCPCS C1725 CATHETER IV STD 18GA 1.16IN GR BOTH IP/OP $9.00 $7.00 $1.79 $9.00 $4.89 $4.89 $4.89 $4.89 $9.00 $9.00 $9.00 $1.88 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $9.00 $5.32 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $1.79 $9.00 $5.22 $9.00 $9.00 $9.00 $1.88 $9.00 N/A N/A 80008930 EAP HCPCS C1760 DEVICE CLSR 70CM 6FR ANGSL VIP .035IN VASC CLGN BOTH IP/OP "$1,600.00" "$1,184.00" $317.56 "$1,600.00" $868.80 $868.80 $868.80 $868.80 "$1,600.00" "$1,600.00" "$1,600.00" $333.48 "$1,600.00" "$1,187.52" "$1,187.52" "$1,233.28" $833.60 $333.46 "$1,600.00" "$1,600.00" $946.40 "$1,600.00" "$1,600.00" "$1,600.00" "$1,600.00" "$1,200.00" "$1,600.00" "$1,600.00" "$1,600.00" $800.00 $800.00 "$1,267.20" "$1,600.00" "$1,280.00" "$1,040.00" $317.56 "$1,600.00" $928.00 "$1,600.00" "$1,600.00" "$1,600.00" $333.44 "$1,600.00" N/A N/A 80008931 EAP HCPCS C1760 DEVICE CLOSURE 8FR .038IN 70CM HEMOSTATIC BIOABSORBABLE BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,850.75" "$2,850.75" "$2,850.75" "$2,850.75" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$3,896.55" "$3,896.55" "$4,046.70" "$2,060.15" "$1,094.16" "$5,250.00" "$5,250.00" "$3,094.73" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$3,412.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80008933 EAP Custom 80008933 SLEEVE CMPR LG SCD EXP ANEMB CUF FT BOTH IP/OP $73.00 $54.50 $12.99 $73.00 $73.00 $73.00 $73.00 $73.00 $73.00 $73.00 $12.99 $73.00 $73.00 $54.18 $54.18 $56.27 $38.03 $15.21 $73.00 $29.20 $73.00 $73.00 $73.00 $73.00 $73.00 $54.75 $73.00 $73.00 $73.00 $36.50 $36.50 $57.82 $73.00 $58.40 $47.45 $73.00 $73.00 $42.34 $73.00 $43.80 $73.00 $73.00 $73.00 N/A N/A 80009072 EAP HCPCS C1769 GUIDEWIRE VASC STD ANG .035IN 260CM 3CM GLDWR GLD TCH FLXB BOTH IP/OP $555.00 $411.00 $110.15 $555.00 $301.37 $301.37 $301.37 $301.37 $555.00 $555.00 $555.00 $115.68 $555.00 $411.92 $411.92 $427.79 $289.16 $115.67 $555.00 $555.00 $328.28 $555.00 $555.00 $555.00 $555.00 $416.25 $555.00 $555.00 $555.00 $277.50 $277.50 $439.56 $555.00 $444.00 $360.75 $110.15 $555.00 $321.90 $555.00 $555.00 $555.00 $115.66 $555.00 N/A N/A 80009076 EAP HCPCS C1769 GUIDEWIRE VASC 150CM .035IN RADIOPQ STD SHFT FLXB BOTH IP/OP $402.00 $297.50 $79.79 $402.00 $218.29 $218.29 $218.29 $218.29 $402.00 $402.00 $402.00 $83.79 $402.00 $298.36 $298.36 $309.86 $209.44 $83.78 $402.00 $402.00 $237.78 $402.00 $402.00 $402.00 $402.00 $301.50 $402.00 $402.00 $402.00 $201.00 $201.00 $318.38 $402.00 $321.60 $261.30 $79.79 $402.00 $233.16 $402.00 $402.00 $402.00 $83.78 $402.00 N/A N/A 80009079 EAP HCPCS C1894 SHEATH INTROD 10CM 5FR PNCL PERI SS HYDPHI PTFE BOTH IP/OP $219.00 $162.50 $43.47 $219.00 $118.92 $118.92 $118.92 $118.92 $219.00 $219.00 $219.00 $45.65 $219.00 $162.54 $162.54 $168.81 $114.10 $45.64 $219.00 $219.00 $129.54 $219.00 $219.00 $219.00 $219.00 $164.25 $219.00 $219.00 $219.00 $109.50 $109.50 $173.45 $219.00 $175.20 $142.35 $43.47 $219.00 $127.02 $219.00 $219.00 $219.00 $45.64 $219.00 N/A N/A 80009081 EAP HCPCS C1894 SHEATH INTROD 10CM 8FR PNCL PERI SS HYDPHI PTFE BOTH IP/OP $219.00 $162.50 $43.47 $219.00 $118.92 $118.92 $118.92 $118.92 $219.00 $219.00 $219.00 $45.65 $219.00 $162.54 $162.54 $168.81 $114.10 $45.64 $219.00 $219.00 $129.54 $219.00 $219.00 $219.00 $219.00 $164.25 $219.00 $219.00 $219.00 $109.50 $109.50 $173.45 $219.00 $175.20 $142.35 $43.47 $219.00 $127.02 $219.00 $219.00 $219.00 $45.64 $219.00 N/A N/A 80009082 EAP HCPCS C1894 SHEATH INTROD 10CM 9FR PNCL PERI SS HYDPHI PTFE BOTH IP/OP $272.00 $201.50 $53.99 $272.00 $147.70 $147.70 $147.70 $147.70 $272.00 $272.00 $272.00 $56.69 $272.00 $201.88 $201.88 $209.66 $141.71 $56.69 $272.00 $272.00 $160.89 $272.00 $272.00 $272.00 $272.00 $204.00 $272.00 $272.00 $272.00 $136.00 $136.00 $215.42 $272.00 $217.60 $176.80 $53.99 $272.00 $157.76 $272.00 $272.00 $272.00 $56.68 $272.00 N/A N/A 80009106 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN SFT RBN TIP KINK RST BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80009617 EAP HCPCS B4087 TUBE JJNSTM 12FR 2-3ML STRL LF MC SLK MED PORT RADOPQ STRP BOTH IP/OP $337.00 $249.50 $20.89 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $20.89 $337.00 $337.00 $250.12 $250.12 $259.76 $175.58 $70.23 $337.00 $134.80 $337.00 $337.00 $337.00 $337.00 $337.00 $252.75 $337.00 $337.00 $337.00 $168.50 $168.50 $266.90 $337.00 $269.60 $219.05 $337.00 $337.00 $195.46 $337.00 $202.20 $337.00 $337.00 $337.00 N/A N/A 80009798 EAP HCPCS C1760 DEVICE CLSR 5-7FR CARDIVA CTLST II FEM ART PRTMN BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 "$3,750.00" "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 80009995 EAP HCPCS C1894 SHEATH GUID 45CM 6FR PN DSTN STR SS NYL HYDPHI BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 80010072 EAP HCPCS C1887 CATHETER GUID 100CM 6FR SHR NX BAL AL1 CURVE CORON BOTH IP/OP $118.00 $87.50 $23.42 $118.00 $64.07 $64.07 $64.07 $64.07 $118.00 $118.00 $118.00 $24.59 $118.00 $87.58 $87.58 $90.95 $61.48 $24.59 $118.00 $118.00 $69.80 $118.00 $118.00 $118.00 $118.00 $88.50 $118.00 $118.00 $118.00 $59.00 $59.00 $93.46 $118.00 $94.40 $76.70 $23.42 $118.00 $68.44 $118.00 $118.00 $118.00 $24.59 $118.00 N/A N/A 80010120 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN CORE TO TIP RADIOPQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80010121 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN CORE TO TIP RADIOPQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80010122 EAP HCPCS C1769 EXTENSION GWIRE 145CM .014IN DOC BOTH IP/OP $225.00 $166.50 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 $225.00 $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 80010526 EAP HCPCS C1729 CATHETER DRN PGTL CRV 12FR 25CM SKTR CHC LCK LCK TROC STY LG BOTH IP/OP "$1,175.00" $869.50 $233.21 "$1,175.00" $638.03 $638.03 $638.03 $638.03 "$1,175.00" "$1,175.00" "$1,175.00" $244.90 "$1,175.00" $872.09 $872.09 $905.69 $612.18 $244.88 "$1,175.00" "$1,175.00" $695.01 "$1,175.00" "$1,175.00" "$1,175.00" "$1,175.00" $881.25 "$1,175.00" "$1,175.00" "$1,175.00" $587.50 $587.50 $930.60 "$1,175.00" $940.00 $763.75 $233.21 "$1,175.00" $681.50 "$1,175.00" "$1,175.00" "$1,175.00" $244.87 "$1,175.00" N/A N/A 80010527 EAP HCPCS C1729 CATHETER DRN PGTL CRV 14FR 25CM SKTR CHC LCK LCK TROC STY LG BOTH IP/OP "$1,135.00" $840.00 $225.27 "$1,135.00" $616.31 $616.31 $616.31 $616.31 "$1,135.00" "$1,135.00" "$1,135.00" $236.56 "$1,135.00" $842.40 $842.40 $874.86 $591.34 $236.55 "$1,135.00" "$1,135.00" $671.35 "$1,135.00" "$1,135.00" "$1,135.00" "$1,135.00" $851.25 "$1,135.00" "$1,135.00" "$1,135.00" $567.50 $567.50 $898.92 "$1,135.00" $908.00 $737.75 $225.27 "$1,135.00" $658.30 "$1,135.00" "$1,135.00" "$1,135.00" $236.53 "$1,135.00" N/A N/A 80010528 EAP Custom 80010528 DILATOR VASCULAR 12FR 20CM RADIOPQ HYDPHI STERILE DISPOSABLE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 80010529 EAP HCPCS A4215 "COONS DILATOR 20F, 20CM" BOTH IP/OP $27.00 $20.00 $0.22 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $0.22 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 80010530 EAP HCPCS A4215 NEEDLE BIOP 18GA 15CM CHIBA STERILE DISPOSABLE ASPIRAT BOTH IP/OP $27.00 $20.00 $0.22 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $0.22 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 80010531 EAP HCPCS A4215 NEEDLE BIOP 18GA 20CM CHIBA STERILE DISPOSABLE ASPIRAT BOTH IP/OP $27.00 $20.00 $0.22 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $0.22 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 80010532 EAP HCPCS A4215 NEEDLE BIOP 20GA 10CM CHIBA STERILE DISPOSABLE ASPIRAT BOTH IP/OP $27.00 $20.00 $0.22 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $0.22 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 80010533 EAP HCPCS A4215 NEEDLE BIOP UNIVERSAL 17GA 10CM COAXIAL ECHOTIP INTROD TEMNO BOTH IP/OP $79.00 $58.50 $0.22 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $79.00 $0.22 $79.00 $79.00 $58.63 $58.63 $60.89 $41.16 $16.46 $79.00 $31.60 $79.00 $79.00 $79.00 $79.00 $79.00 $59.25 $79.00 $79.00 $79.00 $39.50 $39.50 $62.57 $79.00 $63.20 $51.35 $79.00 $79.00 $45.82 $79.00 $47.40 $79.00 $79.00 $79.00 N/A N/A 80010534 EAP HCPCS A4215 NEEDLE BIOP UNIVERSAL 17GA 15CM COAXIAL ECHOTIP INTROD BOTH IP/OP $32.00 $24.00 $0.22 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $32.00 $0.22 $32.00 $32.00 $23.75 $23.75 $24.67 $16.67 $6.67 $32.00 $12.80 $32.00 $32.00 $32.00 $32.00 $32.00 $24.00 $32.00 $32.00 $32.00 $16.00 $16.00 $25.34 $32.00 $25.60 $20.80 $32.00 $32.00 $18.56 $32.00 $19.20 $32.00 $32.00 $32.00 N/A N/A 80010535 EAP HCPCS A4215 NEEDLE BIOP 18GA 15CM COAXIAL AUTOMATED PROGRAMMABLE ACHIEVE BOTH IP/OP $98.00 $73.00 $0.22 $98.00 $98.00 $98.00 $98.00 $98.00 $98.00 $98.00 $0.22 $98.00 $98.00 $72.74 $72.74 $75.54 $51.06 $20.42 $98.00 $39.20 $98.00 $98.00 $98.00 $98.00 $98.00 $73.50 $98.00 $98.00 $98.00 $49.00 $49.00 $77.62 $98.00 $78.40 $63.70 $98.00 $98.00 $56.84 $98.00 $58.80 $98.00 $98.00 $98.00 N/A N/A 80010537 EAP HCPCS A4215 NEEDLE BX UNV THNWL 20GA 19GA 20CM CLR 15CM COAX INTRO BLNT BOTH IP/OP $83.00 $61.50 $0.22 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $0.22 $83.00 $83.00 $61.60 $61.60 $63.98 $43.24 $17.30 $83.00 $33.20 $83.00 $83.00 $83.00 $83.00 $83.00 $62.25 $83.00 $83.00 $83.00 $41.50 $41.50 $65.74 $83.00 $66.40 $53.95 $83.00 $83.00 $48.14 $83.00 $49.80 $83.00 $83.00 $83.00 N/A N/A 80010562 EAP DRESSING BURN 36X36IN 17 PLY GAUZE BOTH IP/OP $824.00 $610.00 $146.67 $824.00 $824.00 $824.00 $824.00 $824.00 $824.00 $824.00 $146.67 $824.00 $824.00 $611.57 $611.57 $635.14 $429.30 $171.73 $824.00 $329.60 $824.00 $824.00 $824.00 $824.00 $824.00 $618.00 $824.00 $824.00 $824.00 $412.00 $412.00 $652.61 $824.00 $659.20 $535.60 $824.00 $824.00 $477.92 $824.00 $494.40 $824.00 $824.00 $824.00 N/A N/A 80010609 EAP HCPCS C1769 AMPLATZ SUPER STIFF GUIDEWIRE BOTH IP/OP $507.00 $375.50 $100.63 $507.00 $275.30 $275.30 $275.30 $275.30 $507.00 $507.00 $507.00 $105.67 $507.00 $376.30 $376.30 $390.80 $264.15 $105.66 $507.00 $507.00 $299.89 $507.00 $507.00 $507.00 $507.00 $380.25 $507.00 $507.00 $507.00 $253.50 $253.50 $401.54 $507.00 $405.60 $329.55 $100.63 $507.00 $294.06 $507.00 $507.00 $507.00 $105.66 $507.00 N/A N/A 80010631 EAP HCPCS C1874 STENT TRCHBR 5MM 6FR 22MM 120CM COVER CATH INTROD BOTH IP/OP "$6,288.00" "$4,653.50" "$1,248.01" "$6,288.00" "$2,829.60" "$2,829.60" "$2,829.60" "$2,829.60" "$6,288.00" "$6,288.00" "$6,288.00" "$1,310.58" "$6,288.00" "$6,288.00" "$6,288.00" "$6,288.00" "$6,288.00" "$1,310.49" "$6,288.00" "$6,288.00" "$3,099.98" "$6,288.00" "$6,288.00" "$6,288.00" "$6,288.00" "$4,716.00" "$6,288.00" "$6,288.00" "$6,288.00" "$3,144.00" "$3,144.00" "$4,980.10" "$6,288.00" "$5,030.40" "$2,829.60" "$1,248.01" "$6,288.00" "$3,647.04" "$6,288.00" "$6,288.00" "$6,288.00" "$1,310.42" "$6,288.00" N/A N/A 80010636 EAP HCPCS C1880 FILTER EMBL 65CM 30MM 7FR 49MM STRL 71CM BOTH IP/OP "$2,313.00" "$1,712.00" $482.05 "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" $482.05 "$2,313.00" $925.20 "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$1,734.75" "$2,313.00" "$2,313.00" "$2,313.00" "$1,156.50" "$1,156.50" "$1,831.90" "$2,313.00" "$1,850.40" "$1,040.85" "$2,313.00" "$2,313.00" "$1,341.54" "$2,313.00" "$1,387.80" "$2,313.00" "$2,313.00" "$2,313.00" N/A N/A 80010639 EAP HCPCS C1876 SYSTEM CORON STENT 13MM 4.5MM MTLNK UL XCELON BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80016126 EAP HCPCS C1887 CATHETER GUID 100CM 6FR LNCHR EBU3 CURVE CORON NYL BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80016128 EAP HCPCS C1887 CATHETER GUID 100CM 6FR LNCHR EBU4 CURVE CORON NYL BOTH IP/OP $113.00 $84.00 $22.43 $113.00 $61.36 $61.36 $61.36 $61.36 $113.00 $113.00 $113.00 $23.55 $113.00 $83.87 $83.87 $87.10 $58.87 $23.55 $113.00 $113.00 $66.84 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $73.45 $22.43 $113.00 $65.54 $113.00 $113.00 $113.00 $23.55 $113.00 N/A N/A 80016129 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL EBU3 CURVE BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80016130 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL EBU3.5 CURVE BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80016131 EAP HCPCS C1887 CATHETER GUID 100CM 7FR SHR NX BAL EBU4 CURVE BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80016142 EAP HCPCS C1753 CATHETER US 150CM 3.3-2.9FR 20MM EE PLTN 20MHZ BOTH IP/OP "$1,813.00" "$1,342.00" $359.84 "$1,813.00" $984.46 $984.46 $984.46 $984.46 "$1,813.00" "$1,813.00" "$1,813.00" $377.87 "$1,813.00" "$1,345.61" "$1,345.61" "$1,397.46" $944.57 $377.85 "$1,813.00" "$1,813.00" "$1,072.39" "$1,813.00" "$1,813.00" "$1,813.00" "$1,813.00" "$1,359.75" "$1,813.00" "$1,813.00" "$1,813.00" $906.50 $906.50 "$1,435.90" "$1,813.00" "$1,450.40" "$1,178.45" $359.84 "$1,813.00" "$1,051.54" "$1,813.00" "$1,813.00" "$1,813.00" $377.83 "$1,813.00" N/A N/A 80016144 EAP HCPCS C1773 KIT SNR AGN 90D MIC 175CM 2.3-3FR 2MM CATH LOOP BOTH IP/OP "$1,400.00" "$1,036.00" $277.87 "$1,400.00" $760.20 $760.20 $760.20 $760.20 "$1,400.00" "$1,400.00" "$1,400.00" $291.80 "$1,400.00" "$1,039.08" "$1,039.08" "$1,079.12" $729.40 $291.78 "$1,400.00" "$1,400.00" $828.10 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,050.00" "$1,400.00" "$1,400.00" "$1,400.00" $700.00 $700.00 "$1,108.80" "$1,400.00" "$1,120.00" $910.00 $277.87 "$1,400.00" $812.00 "$1,400.00" "$1,400.00" "$1,400.00" $291.76 "$1,400.00" N/A N/A 80017153 EAP HCPCS C1752 CATHETER SCT KT 2 LUM COIL XTD LGTH BOTH IP/OP $200.00 $148.00 $41.68 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 $200.00 $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A 80017284 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 25MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80017362 EAP Custom 80017362 ENVELOPE ABS 2.7X2.5IN TYRX POLYARYLATE BOTH IP/OP "$1,738.00" "$1,286.50" $309.36 "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" $309.36 "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" $362.22 "$1,738.00" $695.20 "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" "$1,738.00" "$1,303.50" "$1,738.00" "$1,738.00" "$1,738.00" $869.00 $869.00 "$1,376.50" "$1,738.00" "$1,390.40" $782.10 "$1,738.00" "$1,738.00" "$1,008.04" "$1,738.00" "$1,042.80" "$1,738.00" "$1,738.00" "$1,738.00" N/A N/A 80017798 EAP HCPCS A4215 NEEDLE BIOP 6CM 20GA 19GA 11CM 6CM COAXIAL INTROD AUTOMATED BOTH IP/OP $281.00 $208.00 $0.22 $281.00 $281.00 $281.00 $281.00 $281.00 $281.00 $281.00 $0.22 $281.00 $281.00 $208.56 $208.56 $216.59 $146.40 $58.56 $281.00 $112.40 $281.00 $281.00 $281.00 $281.00 $281.00 $210.75 $281.00 $281.00 $281.00 $140.50 $140.50 $222.55 $281.00 $224.80 $182.65 $281.00 $281.00 $162.98 $281.00 $168.60 $281.00 $281.00 $281.00 N/A N/A 80017919 EAP HCPCS C1889 SNARE ENDSCP MINI STANDARD OVAL 2.4MM 195CMX20MM POLYPECTOMY BOTH IP/OP $465.00 $344.50 $92.29 $465.00 $252.50 $252.50 $252.50 $252.50 $465.00 $465.00 $465.00 $96.92 $465.00 $345.12 $345.12 $358.42 $242.27 $96.91 $465.00 $465.00 $275.05 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $302.25 $92.29 $465.00 $269.70 $465.00 $465.00 $465.00 $96.91 $465.00 N/A N/A 80017977 EAP Custom 80017977 ENVELOPE ABS 3.3X2.9IN ANBCTRL TYRX POLYARYLATE BOTH IP/OP "$2,238.00" "$1,656.50" $398.36 "$2,238.00" "$2,238.00" "$2,238.00" "$2,238.00" "$2,238.00" "$2,238.00" "$2,238.00" $398.36 "$2,238.00" "$2,238.00" "$1,661.04" "$1,661.04" "$1,725.05" "$1,166.00" $466.42 "$2,238.00" $895.20 "$2,238.00" "$2,238.00" "$2,238.00" "$2,238.00" "$2,238.00" "$1,678.50" "$2,238.00" "$2,238.00" "$2,238.00" "$1,119.00" "$1,119.00" "$1,772.50" "$2,238.00" "$1,790.40" "$1,454.70" "$2,238.00" "$2,238.00" "$1,298.04" "$2,238.00" "$1,342.80" "$2,238.00" "$2,238.00" "$2,238.00" N/A N/A 80018159 EAP HCPCS C1894 TRAY CATH LF A NEOS 2 TIER DSGN FN TIP FCP INS DEPH FR MGLN BOTH IP/OP $127.00 $94.00 $25.21 $127.00 $68.96 $68.96 $68.96 $68.96 $127.00 $127.00 $127.00 $26.47 $127.00 $94.26 $94.26 $97.89 $66.17 $26.47 $127.00 $127.00 $75.12 $127.00 $127.00 $127.00 $127.00 $95.25 $127.00 $127.00 $127.00 $63.50 $63.50 $100.58 $127.00 $101.60 $82.55 $25.21 $127.00 $73.66 $127.00 $127.00 $127.00 $26.47 $127.00 N/A N/A 80018207 EAP HCPCS C1894 SET CATHETER .035IN 15CM 70CM SIDEHOLE REMOVABLE STYLET TIP BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 80018208 EAP HCPCS C1752 SET CATHETER .035IN 24CM 70CM SIDEHOLE REMOVABLE S BOTH IP/OP $375.00 $277.50 $78.15 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $150.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $375.00 $375.00 $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 80018297 EAP HCPCS A6198 DRESSING BRN 16X16IN STRL LF ACTCT FLX 3 ANMC BRR FLXB SFT BOTH IP/OP $151.00 $112.00 $29.97 $151.00 $81.99 $81.99 $81.99 $81.99 $151.00 $151.00 $151.00 $31.47 $151.00 $112.07 $112.07 $116.39 $78.67 $31.47 $151.00 $151.00 $89.32 $151.00 $151.00 $151.00 $151.00 $113.25 $151.00 $151.00 $151.00 $75.50 $75.50 $119.59 $151.00 $120.80 $98.15 $29.97 $151.00 $87.58 $151.00 $151.00 $151.00 $31.47 $151.00 N/A N/A 80018653 EAP DRESSING FOAM 20X8IN GENTLE ADHERENCE POLYURETHANE FOAM PAD BOTH IP/OP $167.00 $124.00 $29.73 $167.00 $167.00 $167.00 $167.00 $167.00 $167.00 $167.00 $29.73 $167.00 $167.00 $123.95 $123.95 $128.72 $87.01 $34.80 $167.00 $66.80 $167.00 $167.00 $167.00 $167.00 $167.00 $125.25 $167.00 $167.00 $167.00 $83.50 $83.50 $132.26 $167.00 $133.60 $108.55 $167.00 $167.00 $96.86 $167.00 $100.20 $167.00 $167.00 $167.00 N/A N/A 80018676 EAP HCPCS C1725 CATHETER BALDILAT 3MM 12MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80018677 EAP HCPCS C1725 CATHETER BALDILAT 3MM 15MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80018678 EAP HCPCS C1725 CATHETER BALDILAT 3MM 20MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80018679 EAP HCPCS C1725 CATHETER BALDILAT 3MM 25MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80018681 EAP HCPCS C1725 BALLOON NC TREK 3.25 X 15MM BOTH IP/OP $488.00 $361.50 $96.86 $488.00 $264.98 $264.98 $264.98 $264.98 $488.00 $488.00 $488.00 $101.71 $488.00 $362.19 $362.19 $376.15 $254.25 $101.70 $488.00 $488.00 $288.65 $488.00 $488.00 $488.00 $488.00 $366.00 $488.00 $488.00 $488.00 $244.00 $244.00 $386.50 $488.00 $390.40 $317.20 $96.86 $488.00 $283.04 $488.00 $488.00 $488.00 $101.70 $488.00 N/A N/A 80018683 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 8MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80018685 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 15MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80018686 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 20MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80018689 EAP HCPCS C1725 CATHETER BALDILAT 3.75MM 15MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80018690 EAP HCPCS C1725 CATHETER BALDILAT 3.75MM 20MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80018691 EAP HCPCS C1725 CATHETER BALDILAT 4MM 8MM CORON RAPEX RADIOPQ SMTH BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80018692 EAP HCPCS C1725 CATHETER BALDILAT 4MM 12MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80018693 EAP HCPCS C1725 CATHETER BALDILAT 4MM 15MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80018694 EAP HCPCS C1725 CATHETER BALDILAT 4MM 20MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80018696 EAP HCPCS C1725 CATHETER BALDILAT 5MM 12MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80018713 EAP BAND COMPRESSION REGULAR 24CM 2 BALLOON AIR INJEC PORT BOTH IP/OP $83.00 $61.50 $14.77 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $83.00 $14.77 $83.00 $83.00 $61.60 $61.60 $63.98 $43.24 $17.30 $83.00 $33.20 $83.00 $83.00 $83.00 $83.00 $83.00 $62.25 $83.00 $83.00 $83.00 $41.50 $41.50 $65.74 $83.00 $66.40 $53.95 $83.00 $83.00 $48.14 $83.00 $49.80 $83.00 $83.00 $83.00 N/A N/A 80072204 EAP HCPCS C1725 CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 15MM SPNTR LGND BOTH IP/OP $413.00 $306.00 $81.97 $413.00 $224.26 $224.26 $224.26 $224.26 $413.00 $413.00 $413.00 $86.08 $413.00 $306.53 $306.53 $318.34 $215.17 $86.07 $413.00 $413.00 $244.29 $413.00 $413.00 $413.00 $413.00 $309.75 $413.00 $413.00 $413.00 $206.50 $206.50 $327.10 $413.00 $330.40 $268.45 $81.97 $413.00 $239.54 $413.00 $413.00 $413.00 $86.07 $413.00 N/A N/A 80072296 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM .027IN 3.5MM 138CM LF 21MM NC SPNTR RX BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80074158 EAP HCPCS C1898 LEAD PACING 10MM SPACE SMALL STR 6.2FR 2MM 52CM 20 BOTH IP/OP "$1,013.00" $750.00 $211.12 "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" $211.12 "$1,013.00" $405.20 "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" $759.75 "$1,013.00" "$1,013.00" "$1,013.00" $506.50 $506.50 $802.30 "$1,013.00" $810.40 $455.85 "$1,013.00" "$1,013.00" $587.54 "$1,013.00" $607.80 "$1,013.00" "$1,013.00" "$1,013.00" N/A N/A 80074159 EAP HCPCS C1898 LEAD PACING 10MM SPACE SMALL STR 6.2FR 2MM 58CM 20 BOTH IP/OP "$1,013.00" $750.00 $211.12 "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" $211.12 "$1,013.00" $405.20 "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" $759.75 "$1,013.00" "$1,013.00" "$1,013.00" $506.50 $506.50 $802.30 "$1,013.00" $810.40 $455.85 "$1,013.00" "$1,013.00" $587.54 "$1,013.00" $607.80 "$1,013.00" "$1,013.00" "$1,013.00" N/A N/A 80074161 EAP WRENCH KIT 5873W STERILE PACING LEAD REPAIR BOTH IP/OP $80.00 $59.50 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 80078333 EAP HCPCS C1769 CATHETER INFS 90D 5MM MIC 2.1-1.7FR .017IN 155CM .34ML 150CM BOTH IP/OP "$1,588.00" "$1,175.50" $315.18 "$1,588.00" $862.28 $862.28 $862.28 $862.28 "$1,588.00" "$1,588.00" "$1,588.00" $330.98 "$1,588.00" "$1,178.61" "$1,178.61" "$1,224.03" $827.35 $330.96 "$1,588.00" $635.20 $939.30 "$1,588.00" "$1,588.00" "$1,588.00" "$1,588.00" "$1,191.00" "$1,588.00" "$1,588.00" "$1,588.00" $794.00 $794.00 "$1,257.70" "$1,588.00" "$1,270.40" "$1,032.20" $315.18 "$1,588.00" $921.04 "$1,588.00" "$1,588.00" "$1,588.00" $330.94 "$1,588.00" N/A N/A 80078363 EAP HCPCS C2628 CATH.BALLOON GUIDE CONCENT 1 BOTH IP/OP "$2,691.00" "$1,991.50" $534.10 "$2,691.00" "$1,461.21" "$1,461.21" "$1,461.21" "$1,461.21" "$2,691.00" "$2,691.00" "$2,691.00" $560.87 "$2,691.00" "$1,997.26" "$1,997.26" "$2,074.22" "$1,402.01" $560.83 "$2,691.00" "$2,691.00" "$1,591.73" "$2,691.00" "$2,691.00" "$2,691.00" "$2,691.00" "$2,018.25" "$2,691.00" "$2,691.00" "$2,691.00" "$1,345.50" "$1,345.50" "$2,131.27" "$2,691.00" "$2,152.80" "$1,749.15" $534.10 "$2,691.00" "$1,560.78" "$2,691.00" "$2,691.00" "$2,691.00" $560.80 "$2,691.00" N/A N/A 80078368 EAP HCPCS C1884 SYSTEM EMBL PRTC 320CM CRTD LWR XTRMT CPTR WIRE BOTH IP/OP "$3,488.00" "$2,581.50" $692.28 "$3,488.00" "$1,893.98" "$1,893.98" "$1,893.98" "$1,893.98" "$3,488.00" "$3,488.00" "$3,488.00" $726.99 "$3,488.00" "$2,588.79" "$2,588.79" "$2,688.55" "$1,817.25" $726.94 "$3,488.00" "$3,488.00" "$2,063.15" "$3,488.00" "$3,488.00" "$3,488.00" "$3,488.00" "$2,616.00" "$3,488.00" "$3,488.00" "$3,488.00" "$1,744.00" "$1,744.00" "$2,762.50" "$3,488.00" "$2,790.40" "$2,267.20" $692.28 "$3,488.00" "$2,023.04" "$3,488.00" "$3,488.00" "$3,488.00" $726.90 "$3,488.00" N/A N/A 80078369 EAP HCPCS C1884 SYSTEM EMBL PRTC 320CM CRTD LWR XTRMT CPTR WIRE BOTH IP/OP "$4,170.00" "$3,086.00" $827.64 "$4,170.00" "$2,264.31" "$2,264.31" "$2,264.31" "$2,264.31" "$4,170.00" "$4,170.00" "$4,170.00" $869.13 "$4,170.00" "$3,094.97" "$3,094.97" "$3,214.24" "$2,060.15" $869.07 "$4,170.00" "$4,170.00" "$2,466.56" "$4,170.00" "$4,170.00" "$4,170.00" "$4,170.00" "$3,127.50" "$4,170.00" "$4,170.00" "$4,170.00" "$2,085.00" "$2,085.00" "$3,302.64" "$4,170.00" "$3,336.00" "$2,710.50" $827.64 "$4,170.00" "$2,418.60" "$4,170.00" "$4,170.00" "$4,170.00" $869.03 "$4,170.00" N/A N/A 80078381 EAP HCPCS C1769 GUIDEWIRE HYDROPHILIC COAT 0 2 BOTH IP/OP $496.00 $367.50 $98.44 $496.00 $269.33 $269.33 $269.33 $269.33 $496.00 $496.00 $496.00 $103.38 $496.00 $368.13 $368.13 $382.32 $258.42 $103.37 $496.00 $496.00 $293.38 $496.00 $496.00 $496.00 $496.00 $372.00 $496.00 $496.00 $496.00 $248.00 $248.00 $392.83 $496.00 $396.80 $322.40 $98.44 $496.00 $287.68 $496.00 $496.00 $496.00 $103.37 $496.00 N/A N/A 80078382 EAP HCPCS C1769 GUIDEWIRE HYDROPHILIC COAT 0 1 BOTH IP/OP $555.00 $411.00 $110.15 $555.00 $301.37 $301.37 $301.37 $301.37 $555.00 $555.00 $555.00 $115.68 $555.00 $411.92 $411.92 $427.79 $289.16 $115.67 $555.00 $222.00 $328.28 $555.00 $555.00 $555.00 $555.00 $416.25 $555.00 $555.00 $555.00 $277.50 $277.50 $439.56 $555.00 $444.00 $360.75 $110.15 $555.00 $321.90 $555.00 $555.00 $555.00 $115.66 $555.00 N/A N/A 80078384 EAP HCPCS C1769 GUIDEWIRE VASC 260CM .035IN RADIOPQ FLXB CORE TO BOTH IP/OP $623.00 $461.50 $123.65 $623.00 $338.29 $338.29 $338.29 $338.29 $623.00 $623.00 $623.00 $129.85 $623.00 $462.39 $462.39 $480.21 $324.58 $129.84 $623.00 $623.00 $368.50 $623.00 $623.00 $623.00 $623.00 $467.25 $623.00 $623.00 $623.00 $311.50 $311.50 $493.42 $623.00 $498.40 $404.95 $123.65 $623.00 $361.34 $623.00 $623.00 $623.00 $129.83 $623.00 N/A N/A 80078385 EAP HCPCS C1769 GUIDEWIRE VASCULAR BOTH IP/OP $584.00 $432.50 $115.91 $584.00 $317.11 $317.11 $317.11 $317.11 $584.00 $584.00 $584.00 $121.72 $584.00 $433.44 $433.44 $450.15 $304.26 $121.71 $584.00 $584.00 $345.44 $584.00 $584.00 $584.00 $584.00 $438.00 $584.00 $584.00 $584.00 $292.00 $292.00 $462.53 $584.00 $467.20 $379.60 $115.91 $584.00 $338.72 $584.00 $584.00 $584.00 $121.71 $584.00 N/A N/A 80079016 EAP HCPCS C1894 SHEATH GUID 80CM 6FR 2.2MM FLXR SH AQ RADIOPQ STF BOTH IP/OP $378.00 $280.00 $75.02 $378.00 $205.25 $205.25 $205.25 $205.25 $378.00 $378.00 $378.00 $78.78 $378.00 $280.55 $280.55 $291.36 $196.94 $78.78 $378.00 $378.00 $223.59 $378.00 $378.00 $378.00 $378.00 $283.50 $378.00 $378.00 $378.00 $189.00 $189.00 $299.38 $378.00 $302.40 $245.70 $75.02 $378.00 $219.24 $378.00 $378.00 $378.00 $78.78 $378.00 N/A N/A 80079025 EAP HCPCS C1769 GUIDEWIRE STANDARD PRE-SHAP 2 BOTH IP/OP "$1,387.00" "$1,026.50" $275.28 "$1,387.00" $753.14 $753.14 $753.14 $753.14 "$1,387.00" "$1,387.00" "$1,387.00" $289.09 "$1,387.00" "$1,029.43" "$1,029.43" "$1,069.10" $722.63 $289.07 "$1,387.00" "$1,387.00" $820.41 "$1,387.00" "$1,387.00" "$1,387.00" "$1,387.00" "$1,040.25" "$1,387.00" "$1,387.00" "$1,387.00" $693.50 $693.50 "$1,098.50" "$1,387.00" "$1,109.60" $901.55 $275.28 "$1,387.00" $804.46 "$1,387.00" "$1,387.00" "$1,387.00" $289.05 "$1,387.00" N/A N/A 80079147 EAP HCPCS C1760 DEVICE CLOSURE 6FR SUTURE MEDIATE KNOT PUSHER LATEX FREE BOTH IP/OP $650.00 $481.00 $129.01 $650.00 $292.50 $292.50 $292.50 $292.50 $650.00 $650.00 $650.00 $135.48 $650.00 $650.00 $650.00 $650.00 $650.00 $135.47 $650.00 $650.00 $384.48 $650.00 $650.00 $650.00 $650.00 $487.50 $650.00 $650.00 $650.00 $325.00 $325.00 $514.80 $650.00 $520.00 $292.50 $129.01 $650.00 $377.00 $650.00 $650.00 $650.00 $135.46 $650.00 N/A N/A 80079222 EAP HCPCS C1894 INTRODUCER SHEATH SHORT 7FR 21GA 4CM ORANGE HUB TUBING BOTH IP/OP $48.00 $36.00 $9.53 $48.00 $26.06 $26.06 $26.06 $26.06 $48.00 $48.00 $48.00 $10.00 $48.00 $35.63 $35.63 $37.00 $25.01 $10.00 $48.00 $48.00 $28.39 $48.00 $48.00 $48.00 $48.00 $36.00 $48.00 $48.00 $48.00 $24.00 $24.00 $38.02 $48.00 $38.40 $31.20 $9.53 $48.00 $27.84 $48.00 $48.00 $48.00 $10.00 $48.00 N/A N/A 80079315 EAP HCPCS C1729 TRAY DRAIN 8FR 25GA 1IN NEEDLE PRO NEEDLE RETRACTABLE SAFETY BOTH IP/OP $171.00 $127.00 $33.94 $171.00 $92.85 $92.85 $92.85 $92.85 $171.00 $171.00 $171.00 $35.64 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $171.00 $101.15 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $33.94 $171.00 $99.18 $171.00 $171.00 $171.00 $35.64 $171.00 N/A N/A 80079343 EAP HCPCS C1729 PLEURX PERITONEAL CATHETER KIT BOTH IP/OP "$2,439.00" "$1,805.00" $484.08 "$2,439.00" "$1,097.55" "$1,097.55" "$1,097.55" "$1,097.55" "$2,439.00" "$2,439.00" "$2,439.00" $508.35 "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" $508.31 "$2,439.00" "$2,439.00" "$1,442.67" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$1,829.25" "$2,439.00" "$2,439.00" "$2,439.00" "$1,219.50" "$1,219.50" "$1,931.69" "$2,439.00" "$1,951.20" "$1,097.55" $484.08 "$2,439.00" "$1,414.62" "$2,439.00" "$2,439.00" "$2,439.00" $508.29 "$2,439.00" N/A N/A 80079508 EAP Custom 80079508 AMPLATZ SUPER STIFF EXCHANGE GUIDEWIRE .038X260 BOTH IP/OP $106.00 $78.50 $18.87 $106.00 $106.00 $106.00 $106.00 $106.00 $106.00 $106.00 $18.87 $106.00 $106.00 $78.67 $78.67 $81.70 $55.23 $22.09 $106.00 $42.40 $106.00 $106.00 $106.00 $106.00 $106.00 $79.50 $106.00 $106.00 $106.00 $53.00 $53.00 $83.95 $106.00 $84.80 $68.90 $106.00 $106.00 $61.48 $106.00 $63.60 $106.00 $106.00 $106.00 N/A N/A 80079510 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .016IN STR TIP STRBL BOTH IP/OP $744.00 $551.00 $147.67 $744.00 $403.99 $403.99 $403.99 $403.99 $744.00 $744.00 $744.00 $155.07 $744.00 $552.20 $552.20 $573.48 $387.62 $155.06 $744.00 $744.00 $440.08 $744.00 $744.00 $744.00 $744.00 $558.00 $744.00 $744.00 $744.00 $372.00 $372.00 $589.25 $744.00 $595.20 $483.60 $147.67 $744.00 $431.52 $744.00 $744.00 $744.00 $155.05 $744.00 N/A N/A 80079568 EAP Custom 80079568 COIL EMBL 15CM 4MM INTLK FBR IDC 18 COIL 2D STD BOTH IP/OP $943.00 $698.00 $167.85 $943.00 $943.00 $943.00 $943.00 $943.00 $943.00 $943.00 $167.85 $943.00 $943.00 $943.00 $943.00 $943.00 $943.00 $196.53 $943.00 $377.20 $943.00 $943.00 $943.00 $943.00 $943.00 $707.25 $943.00 $943.00 $943.00 $471.50 $471.50 $746.86 $943.00 $754.40 $424.35 $943.00 $943.00 $546.94 $943.00 $565.80 $943.00 $943.00 $943.00 N/A N/A 80079570 EAP Custom 80079570 COIL EMBL 15CM 5MM INTLK FBR IDC 18 COIL 2D STD BOTH IP/OP $943.00 $698.00 $167.85 $943.00 $943.00 $943.00 $943.00 $943.00 $943.00 $943.00 $167.85 $943.00 $943.00 $943.00 $943.00 $943.00 $943.00 $196.53 $943.00 $377.20 $943.00 $943.00 $943.00 $943.00 $943.00 $707.25 $943.00 $943.00 $943.00 $471.50 $471.50 $746.86 $943.00 $754.40 $424.35 $943.00 $943.00 $546.94 $943.00 $565.80 $943.00 $943.00 $943.00 N/A N/A 80079575 EAP COIL EMBOLIZATION .018IN 2D HELIX BUCK 10MM 30CM OCCLUSION BOTH IP/OP "$1,022.00" $756.50 $181.92 "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" $181.92 "$1,022.00" "$1,022.00" $758.53 $758.53 $787.76 $532.46 $213.00 "$1,022.00" $408.80 "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" $766.50 "$1,022.00" "$1,022.00" "$1,022.00" $511.00 $511.00 $809.42 "$1,022.00" $817.60 $664.30 "$1,022.00" "$1,022.00" $592.76 "$1,022.00" $613.20 "$1,022.00" "$1,022.00" "$1,022.00" N/A N/A 80079577 EAP COIL EMBOLIZATION .018IN 2D HELIX TAPER 12MM 30CM 18 COIL BOTH IP/OP "$1,022.00" $756.50 $181.92 "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" $181.92 "$1,022.00" "$1,022.00" $758.53 $758.53 $787.76 $532.46 $213.00 "$1,022.00" $408.80 "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" $766.50 "$1,022.00" "$1,022.00" "$1,022.00" $511.00 $511.00 $809.42 "$1,022.00" $817.60 $664.30 "$1,022.00" "$1,022.00" $592.76 "$1,022.00" $613.20 "$1,022.00" "$1,022.00" "$1,022.00" N/A N/A 80079579 EAP COIL EMBOLIZATION .018IN 2D HELIX 14MM 30CM INTERLOCK IDC BOTH IP/OP "$1,022.00" $756.50 $181.92 "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" $181.92 "$1,022.00" "$1,022.00" $758.53 $758.53 $787.76 $532.46 $213.00 "$1,022.00" $408.80 "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" "$1,022.00" $766.50 "$1,022.00" "$1,022.00" "$1,022.00" $511.00 $511.00 $809.42 "$1,022.00" $817.60 $664.30 "$1,022.00" "$1,022.00" $592.76 "$1,022.00" $613.20 "$1,022.00" "$1,022.00" "$1,022.00" N/A N/A 80097220 EAP Custom 80097220 VALVE ROTATING HEMOSTATIC BOTH IP/OP $58.00 $43.00 $10.32 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $58.00 $10.32 $58.00 $58.00 $43.05 $43.05 $44.71 $30.22 $12.09 $58.00 $23.20 $58.00 $58.00 $58.00 $58.00 $58.00 $43.50 $58.00 $58.00 $58.00 $29.00 $29.00 $45.94 $58.00 $46.40 $37.70 $58.00 $58.00 $33.64 $58.00 $34.80 $58.00 $58.00 $58.00 N/A N/A 80097221 EAP HCPCS C1769 DEVICE TORQUE GLIDECATH .010-. BOTH IP/OP $15.00 $11.50 $2.98 $15.00 $8.15 $8.15 $8.15 $8.15 $15.00 $15.00 $15.00 $3.13 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $15.00 $8.87 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $2.98 $15.00 $8.70 $15.00 $15.00 $15.00 $3.13 $15.00 N/A N/A 80097222 EAP HCPCS C1894 SHEATH INTROD 10CM 5FR PNCL PERI SS HYDPHI PTFE BOTH IP/OP $22.00 $16.50 $4.37 $22.00 $11.95 $11.95 $11.95 $11.95 $22.00 $22.00 $22.00 $4.59 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 80097223 EAP HCPCS C1894 INTRODUCER SHEATH .035IN 6FR 10CM 2.5CM MINI GWIRE DILAT BOTH IP/OP $22.00 $16.50 $4.37 $22.00 $11.95 $11.95 $11.95 $11.95 $22.00 $22.00 $22.00 $4.59 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 80097335 EAP HCPCS C1769 CONTOL WIRE 200CM .018 V-18 BOTH IP/OP $189.00 $140.00 $37.51 $189.00 $102.63 $102.63 $102.63 $102.63 $189.00 $189.00 $189.00 $39.39 $189.00 $140.28 $140.28 $145.68 $98.47 $39.39 $189.00 $189.00 $111.79 $189.00 $189.00 $189.00 $189.00 $141.75 $189.00 $189.00 $189.00 $94.50 $94.50 $149.69 $189.00 $151.20 $122.85 $37.51 $189.00 $109.62 $189.00 $189.00 $189.00 $39.39 $189.00 N/A N/A 80097341 EAP Custom C1751 AXIUM COIL DETACHER BOTH IP/OP $135.00 $100.00 $26.79 $135.00 $73.31 $73.31 $73.31 $73.31 $135.00 $135.00 $135.00 $28.14 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $135.00 $79.85 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $26.79 $135.00 $78.30 $135.00 $135.00 $135.00 $28.13 $135.00 N/A N/A 80097344 EAP HCPCS C1769 GUIDEWIRE VASCULAR TAPER .018IN 300CM 8CM RADIOPQ STR TIP BOTH IP/OP $197.00 $146.00 $39.10 $197.00 $106.97 $106.97 $106.97 $106.97 $197.00 $197.00 $197.00 $41.06 $197.00 $146.21 $146.21 $151.85 $102.64 $41.06 $197.00 $197.00 $116.53 $197.00 $197.00 $197.00 $197.00 $147.75 $197.00 $197.00 $197.00 $98.50 $98.50 $156.02 $197.00 $157.60 $128.05 $39.10 $197.00 $114.26 $197.00 $197.00 $197.00 $41.05 $197.00 N/A N/A 80097363 EAP HCPCS A6010 AGENT HEMOSTATIC MICROFIBRILLAR FLOUR LATEX FREE AVITENE BOTH IP/OP "$15,367.00" "$11,372.00" $11.25 "$15,367.00" "$15,367.00" "$15,367.00" "$15,367.00" "$15,367.00" "$15,367.00" "$15,367.00" $11.25 "$15,367.00" "$15,367.00" "$4,181.12" "$4,181.12" "$11,844.88" "$2,060.15" "$3,202.65" "$15,367.00" $614.80 "$15,367.00" "$15,367.00" "$1,537.00" "$15,367.00" "$15,367.00" "$11,525.25" "$15,367.00" "$15,367.00" "$15,367.00" "$7,683.50" "$7,683.50" "$12,170.66" "$15,367.00" "$12,293.60" "$9,988.55" "$15,367.00" "$15,367.00" "$8,912.86" "$15,367.00" "$9,220.20" "$15,367.00" "$15,367.00" "$15,367.00" N/A N/A 80097383 EAP HCPCS C1876 STENT VASCULAR STR LP 10MM 8FR 40MM 132CM SELF EXPANDABLE BOTH IP/OP "$4,125.00" "$3,052.50" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$4,125.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 "$4,125.00" "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A 80097387 EAP HCPCS C1876 SYSTEM COR STNT 2.25MM 12MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 80097412 EAP HCPCS C1876 SYSTEM COR STNT 3MM 9MM INTGR MICROTRAC RX 1 STRN INTGR TIP BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 80097421 EAP HCPCS C1876 SYSTEM COR STNT 4MM 12MM INTGR MICROTRAC RX 1 STRN INTGR TIP BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 80097435 EAP HCPCS C1757 SET THROMBECTOMY LONG TAPER 4FR 2MM 135CM OTW RAPEX CATHETER BOTH IP/OP "$4,488.00" "$3,321.50" $890.76 "$4,488.00" "$2,436.98" "$2,436.98" "$2,436.98" "$2,436.98" "$4,488.00" "$4,488.00" "$4,488.00" $935.41 "$4,488.00" "$3,330.99" "$3,330.99" "$3,459.35" "$2,060.15" $935.35 "$4,488.00" "$4,488.00" "$2,654.65" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,917.20" $890.76 "$4,488.00" "$2,603.04" "$4,488.00" "$4,488.00" "$4,488.00" $935.30 "$4,488.00" N/A N/A 80097439 EAP KIT TEMP SM NS LF ARC SN ARCTICGEL DISP BOTH IP/OP "$2,405.00" "$1,780.00" $428.09 "$2,405.00" "$2,405.00" "$2,405.00" "$2,405.00" "$2,405.00" "$2,405.00" "$2,405.00" $428.09 "$2,405.00" "$2,405.00" "$1,784.99" "$1,784.99" "$1,853.77" "$1,253.01" $501.23 "$2,405.00" $962.00 "$2,405.00" "$2,405.00" "$2,405.00" "$2,405.00" "$2,405.00" "$1,803.75" "$2,405.00" "$2,405.00" "$2,405.00" "$1,202.50" "$1,202.50" "$1,904.76" "$2,405.00" "$1,924.00" "$1,563.25" "$2,405.00" "$2,405.00" "$1,394.90" "$2,405.00" "$1,443.00" "$2,405.00" "$2,405.00" "$2,405.00" N/A N/A 80097440 EAP Custom 80097440 KIT COOLING LARGE PAD LATEX FREE ARCTICGEL NONSTRL BOTH IP/OP "$4,960.00" "$3,670.50" $882.88 "$4,960.00" "$4,960.00" "$4,960.00" "$4,960.00" "$4,960.00" "$4,960.00" "$4,960.00" $882.88 "$4,960.00" "$4,960.00" "$3,681.31" "$3,681.31" "$3,823.17" "$2,060.15" "$1,033.72" "$4,960.00" "$1,984.00" "$4,960.00" "$4,960.00" "$4,960.00" "$4,960.00" "$4,960.00" "$3,720.00" "$4,960.00" "$4,960.00" "$4,960.00" "$2,480.00" "$2,480.00" "$3,928.32" "$4,960.00" "$3,968.00" "$3,224.00" "$4,960.00" "$4,960.00" "$2,876.80" "$4,960.00" "$2,976.00" "$4,960.00" "$4,960.00" "$4,960.00" N/A N/A 80097441 EAP PAD TEMP UNV THN NS LF ARC SN INLT OTLT CNCT ANTM ARCTICGEL BOTH IP/OP "$4,500.00" "$3,330.00" $801.00 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $801.00 "$4,500.00" "$4,500.00" "$3,339.90" "$3,339.90" "$3,468.60" "$2,060.15" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,925.00" "$4,500.00" "$4,500.00" "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A 80097469 EAP HCPCS C1725 CATHETER BALDILAT 2MM 12MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80097473 EAP HCPCS C1725 CATHETER BALDILAT 3MM 12MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80097474 EAP HCPCS C1725 CATHETER BALDILAT 3MM 15MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80097475 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 12MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 80097476 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 15MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80097477 EAP Custom 80097477 CATHETER BALDILAT 4MM 15MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 $250.00 $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 80100001 EAP Custom 80100001 HEMODIALYSIS INPATIENT BOTH IP/OP "$3,267.00" "$2,418.00" $581.53 "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" $581.53 "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" $680.88 "$3,267.00" "$1,306.80" "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" "$2,450.25" "$3,267.00" "$3,267.00" "$3,267.00" "$1,633.50" "$1,633.50" "$2,587.46" "$3,267.00" "$2,613.60" "$2,123.55" "$3,267.00" "$3,267.00" "$1,894.86" "$3,267.00" "$1,960.20" "$3,267.00" "$3,267.00" "$3,267.00" N/A N/A 80100003 EAP Custom 80100003 HEMODIALYSIS-ACUTE-I/P BOTH IP/OP "$3,300.00" "$2,442.00" $587.40 "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" $587.40 "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" $687.76 "$3,300.00" "$1,320.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$2,475.00" "$3,300.00" "$3,300.00" "$3,300.00" "$1,650.00" "$1,650.00" "$2,613.60" "$3,300.00" "$2,640.00" "$2,145.00" "$3,300.00" "$3,300.00" "$1,914.00" "$3,300.00" "$1,980.00" "$3,300.00" "$3,300.00" "$3,300.00" N/A N/A 80100226 EAP HCPCS C1894 SET INTROD .018IN 5FR 21GA 40C BOTH IP/OP $173.00 $128.50 $34.34 $173.00 $93.94 $93.94 $93.94 $93.94 $173.00 $173.00 $173.00 $36.06 $173.00 $128.40 $128.40 $133.35 $90.13 $36.06 $173.00 $69.20 $102.33 $173.00 $173.00 $173.00 $173.00 $129.75 $173.00 $173.00 $173.00 $86.50 $86.50 $137.02 $173.00 $138.40 $112.45 $34.34 $173.00 $100.34 $173.00 $173.00 $173.00 $36.05 $173.00 N/A N/A 80100234 EAP HCPCS C1894 SHEATH GUID 70CM 6FR 2.2MM FLXR CHK-FLO STR TIP HI BOTH IP/OP $225.00 $166.50 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 $225.00 $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 80100235 EAP HCPCS C1894 SHEATH GUID 70CM 6FR 2.2MM FLXR CHK-FLO CURVE BOTH IP/OP $225.00 $166.50 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 $225.00 $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 80100236 EAP HCPCS C1894 INTROD SHTH 8.8FR 7FR 110CM GW RADIOPQ BAND HI FLX BOTH IP/OP $503.00 $372.50 $99.83 $503.00 $273.13 $273.13 $273.13 $273.13 $503.00 $503.00 $503.00 $104.84 $503.00 $373.33 $373.33 $387.71 $262.06 $104.83 $503.00 $503.00 $297.52 $503.00 $503.00 $503.00 $503.00 $377.25 $503.00 $503.00 $503.00 $251.50 $251.50 $398.38 $503.00 $402.40 $326.95 $99.83 $503.00 $291.74 $503.00 $503.00 $503.00 $104.83 $503.00 N/A N/A 80100237 EAP HCPCS C1894 SHEATH GUID 70CM 7FR 2.5MM FLXR INTROD / FLXR GUID BOTH IP/OP $225.00 $166.50 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 $225.00 $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 80100239 EAP HCPCS C1894 SHEATH GUID 70CM 8FR 2.9MM FLXR CHK-FLO CURVE BOTH IP/OP $225.00 $166.50 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 $225.00 $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 80100242 EAP HCPCS C1894 SHEATH GUID 45CM 6FR .087IN FLXR CHK-FLO ANL0 BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80100243 EAP HCPCS C1894 SHEATH GUID 45CM 6FR 2.2MM FLXR CHK-FLO MULTPUR BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80100244 EAP HCPCS C1894 SHEATH GUID 45CM 6FR 2.2IN FLXR CHK-FLO ANL2 CURVE BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80100245 EAP HCPCS C1894 SHEATH GUID 45CM 7FR .1IN FLXR CHK-FLO ANL0 CURVE BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80100246 EAP HCPCS C1894 SHEATH GUID 45CM 7FR 2.5MM FLXR CHK-FLO ANL3 CURVE BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80100247 EAP HCPCS C1894 SHEATH GUID .018/.038IN ANL0 CURVE 8FR .113IN 45CM RADIOPQ BOTH IP/OP $203.00 $150.50 $40.29 $203.00 $110.23 $110.23 $110.23 $110.23 $203.00 $203.00 $203.00 $42.31 $203.00 $150.67 $150.67 $156.47 $105.76 $42.31 $203.00 $203.00 $120.07 $203.00 $203.00 $203.00 $203.00 $152.25 $203.00 $203.00 $203.00 $101.50 $101.50 $160.78 $203.00 $162.40 $131.95 $40.29 $203.00 $117.74 $203.00 $203.00 $203.00 $42.31 $203.00 N/A N/A 80100254 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .035IN FLX TP FIX CORE EXCH BOTH IP/OP $43.00 $32.00 $8.53 $43.00 $23.35 $23.35 $23.35 $23.35 $43.00 $43.00 $43.00 $8.96 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $43.00 $25.43 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $8.53 $43.00 $24.94 $43.00 $43.00 $43.00 $8.96 $43.00 N/A N/A 80100259 EAP HCPCS C1769 GUIDEWIRE VASCULAR TAPER .014IN 300CM 18GM TIP LOAD APPROACH BOTH IP/OP $417.00 $309.00 $82.76 $417.00 $226.43 $226.43 $226.43 $226.43 $417.00 $417.00 $417.00 $86.91 $417.00 $309.50 $309.50 $321.42 $217.26 $86.91 $417.00 $417.00 $246.66 $417.00 $417.00 $417.00 $417.00 $312.75 $417.00 $417.00 $417.00 $208.50 $208.50 $330.26 $417.00 $333.60 $271.05 $82.76 $417.00 $241.86 $417.00 $417.00 $417.00 $86.90 $417.00 N/A N/A 80100260 EAP HCPCS C1769 GUIDEWIRE VASCULAR TAPER .014IN 300CM 25GM TIP LOAD APPROACH BOTH IP/OP $417.00 $309.00 $82.76 $417.00 $226.43 $226.43 $226.43 $226.43 $417.00 $417.00 $417.00 $86.91 $417.00 $309.50 $309.50 $321.42 $217.26 $86.91 $417.00 $166.80 $246.66 $417.00 $417.00 $417.00 $417.00 $312.75 $417.00 $417.00 $417.00 $208.50 $208.50 $330.26 $417.00 $333.60 $271.05 $82.76 $417.00 $241.86 $417.00 $417.00 $417.00 $86.90 $417.00 N/A N/A 80100269 EAP HCPCS C1887 CXI SUPPORT CATHETER STR/ 4.0FR-.035-135CM BOTH IP/OP $488.00 $361.50 $96.86 $488.00 $264.98 $264.98 $264.98 $264.98 $488.00 $488.00 $488.00 $101.71 $488.00 $362.19 $362.19 $376.15 $254.25 $101.70 $488.00 $195.20 $288.65 $488.00 $488.00 $488.00 $488.00 $366.00 $488.00 $488.00 $488.00 $244.00 $244.00 $386.50 $488.00 $390.40 $317.20 $96.86 $488.00 $283.04 $488.00 $488.00 $488.00 $101.70 $488.00 N/A N/A 80100275 EAP HCPCS C1725 CATHETER ANGIOGRAPHIC ANGLE KMP CURVE TAPER 5FR 65CM LP BOTH IP/OP $325.00 $240.50 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 $325.00 $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 80100322 EAP HCPCS C1876 STENT BIL 5MM 19MM 150CM PRMNT BLN XPD CATH BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80100329 EAP HCPCS C1876 STENT BIL 6MM 17MM 135CM 20MM OTW RADIOPQ NC BLN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80100330 EAP HCPCS C1876 STENT BIL 6MM 37MM 135CM 40MM RADIOPQ OTW NC BLN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80100331 EAP HCPCS C1876 STENT BIL 7MM 17MM 135CM 20MM OTW RADIOPQ NC BLN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80100332 EAP HCPCS C1876 STENT BIL 7MM 37MM 135CM 40MM OTW RADIOPQ NC BLN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80100333 EAP HCPCS C1876 STENT BIL 8MM 17MM 135CM 20MM OTW RADIOPQ NC BLN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80100334 EAP HCPCS C1876 STENT BIL 8MM 37MM 135CM 40MM OTW PRMNT BLN XPD BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80100335 EAP HCPCS C1876 STENT BIL 9MM 25MM 135CM 30MM OTW RADIOPQ NC BLN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80100336 EAP HCPCS C1876 STENT BIL 9MM 57MM 135CM 60MM OTW RADIOPQ NC BLN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80100337 EAP HCPCS C1725 CATHETER BALDILAT 4MM 135CM 20MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100340 EAP HCPCS C1725 CATHETER BALDILAT 5MM 135CM 40MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100343 EAP HCPCS C1725 CATHETER BALDILAT 6MM 135CM 80MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100353 EAP HCPCS C1725 CATHETER BALDILAT 4MM 143CM 20MM OTW ULT LP NYBAX BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100357 EAP HCPCS C1725 CATHETER BALDILAT 2MM 150CM 150MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100359 EAP HCPCS C1725 CATHETER BALDILAT 3MM 150CM 100MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100361 EAP HCPCS C1725 CATHETER BALDILAT 3MM 150CM 150MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100362 EAP HCPCS C1725 CATHETER BALDILAT 3MM 150CM 80MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100363 EAP HCPCS C1725 CATHETER BALDILAT 4MM 150CM 150MM OTW INFL PORT LP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100364 EAP HCPCS C1725 CATHETER BALDILAT 4MM 150CM 80MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100366 EAP HCPCS C1725 CATHETER BALDILAT 4MM 135CM 200MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100371 EAP HCPCS C1725 CATHETER BALDILAT 5MM 135CM 200MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100374 EAP HCPCS C1725 CATHETER BALDILAT 6MM 135CM 200MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100377 EAP HCPCS C1725 CATHETER BALDILAT 8MM 75CM 100MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100381 EAP HCPCS C1726 CATHETER BALDILAT 2MM 150CM 150MM OTW ULT LP NYBAX BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 80100382 EAP HCPCS C1726 CATHETER BALDILAT 2MM 150CM 220MM OTW ULT LP NYBAX BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 80100383 EAP HCPCS C1726 CATHETER BALDILAT 3MM 150CM 100MM OTW ULT LP NYBAX BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 80100385 EAP HCPCS C1725 CATHETER BALDILAT 3MM 150CM 220MM OTW ULT LP NYBAX BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100386 EAP HCPCS C1726 CATHETER BALDILAT 4MM 150CM 100MM OTW ULT LP NYBAX BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 80100392 EAP HCPCS C1876 STENT BIL 10MM 37MM 75CM 40MM OTW RADIOPQ NC BLN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80100413 EAP HCPCS C1725 CATHETER BALDILAT 4MM 135CM 40MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100416 EAP HCPCS C1725 CATHETER BALDILAT 6MM 20MM 135CM OTW TPR TIP LP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100418 EAP HCPCS C1725 CATHETER BALDILAT 6MM 135CM 40MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100420 EAP HCPCS C1725 CATHETER BALDILAT 6MM 135CM 60MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100425 EAP HCPCS C1725 CATHETER BALDILAT 7MM 135CM 60MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100428 EAP HCPCS C1725 CATHETER BALDILAT 8MM 135CM 20MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100430 EAP HCPCS C1725 CATHETER BALDILAT 8MM 135CM 40MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100432 EAP HCPCS C1725 CATHETER BALDILAT 8MM 135CM 40MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80100433 EAP HCPCS C1725 CATHETER BALDILAT 4MM 75CM 20MM HI-PRS NYBAX BOTH IP/OP $430.00 $318.50 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 $430.00 $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A 80100434 EAP HCPCS C1725 CATHETER BALDILAT 4MM 135CM 40MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100435 EAP HCPCS C1726 CATHETER BALDILAT 4MM 75CM 40MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $262.80 $438.00 $91.28 $438.00 N/A N/A 80100436 EAP HCPCS C1725 CATHETER BALDILAT 4MM 135CM 120MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100437 EAP HCPCS C1725 CATHETER BALDILAT 5MM 75CM 20MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100438 EAP HCPCS C1725 CATHETER BALDILAT 5MM 135CM 40MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100439 EAP HCPCS C1725 CATHETER BALDILAT 5MM 75CM 40MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100440 EAP HCPCS C1725 CATHETER BALDILAT 5MM 135CM 100MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100441 EAP HCPCS C1725 CATHETER BALDILAT 5MM 135CM 150MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100443 EAP HCPCS C1725 CATHETER BALDILAT 6MM 75CM 20MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100444 EAP HCPCS C1725 CATHETER BALDILAT 6MM 135CM 40MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100445 EAP HCPCS C1725 CATHETER BALDILAT 6MM 75CM 40MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100446 EAP HCPCS C1725 CATHETER BALDILAT 6MM 135CM 100MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100447 EAP HCPCS C1725 CATHETER BALDILAT 6MM 135CM 150MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100448 EAP HCPCS C1725 CATHETER BALDILAT 7MM 75CM 20MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100449 EAP HCPCS C1725 CATHETER BALDILAT 7MM 135CM 40MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100450 EAP HCPCS C1725 CATHETER BALDILAT .035IN 7MM 75CM 40MM HIGH PRESSURE LP BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100451 EAP HCPCS C1725 CATHETER BALDILAT 8MM 75CM 20MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100453 EAP HCPCS C1725 CATHETER BALDILAT 8MM 75CM 40MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100454 EAP HCPCS C1725 CATHETER BALDILAT 8MM 75CM 80MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100456 EAP HCPCS C1725 CATHETER BALDILAT 10MM 75CM 20MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80100470 EAP HCPCS C1757 SET THROMBECTOMY 6FR 3MM 120CM 15MM OTW CONTRAST INJEC PORT BOTH IP/OP "$4,225.00" "$3,126.50" $838.56 "$4,225.00" "$2,294.18" "$2,294.18" "$2,294.18" "$2,294.18" "$4,225.00" "$4,225.00" "$4,225.00" $880.60 "$4,225.00" "$3,135.80" "$3,135.80" "$3,256.63" "$2,060.15" $880.54 "$4,225.00" "$4,225.00" "$2,499.09" "$4,225.00" "$4,225.00" "$4,225.00" "$4,225.00" "$3,168.75" "$4,225.00" "$4,225.00" "$4,225.00" "$2,112.50" "$2,112.50" "$3,346.20" "$4,225.00" "$3,380.00" "$2,746.25" $838.56 "$4,225.00" "$2,450.50" "$4,225.00" "$4,225.00" "$4,225.00" $880.49 "$4,225.00" N/A N/A 80100527 EAP HCPCS C1768 GRAFT VASCULAR GORE HEPARIN PROPATEN PTFE STANDARD WALL BOTH IP/OP "$3,148.00" "$2,330.00" $624.80 "$3,148.00" "$1,416.60" "$1,416.60" "$1,416.60" "$1,416.60" "$3,148.00" "$3,148.00" "$3,148.00" $656.12 "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" $656.08 "$3,148.00" "$3,148.00" "$1,551.96" "$3,148.00" "$3,148.00" "$3,148.00" "$3,148.00" "$2,361.00" "$3,148.00" "$3,148.00" "$3,148.00" "$1,574.00" "$1,574.00" "$2,493.22" "$3,148.00" "$2,518.40" "$1,416.60" $624.80 "$3,148.00" "$1,825.84" "$3,148.00" "$3,148.00" "$3,148.00" $656.04 "$3,148.00" N/A N/A 80100552 EAP HCPCS C1894 SET INTROD 30CM 14FR 4.6MM CHK-FLO 41CM ACPT .038 BOTH IP/OP $318.00 $235.50 $63.12 $318.00 $172.67 $172.67 $172.67 $172.67 $318.00 $318.00 $318.00 $66.28 $318.00 $236.02 $236.02 $245.11 $165.68 $66.27 $318.00 $318.00 $188.10 $318.00 $318.00 $318.00 $318.00 $238.50 $318.00 $318.00 $318.00 $159.00 $159.00 $251.86 $318.00 $254.40 $206.70 $63.12 $318.00 $184.44 $318.00 $318.00 $318.00 $66.27 $318.00 N/A N/A 80100554 EAP HCPCS C1725 CATHETER BLNDIL 6MM 90CM 20MM PR CTBLN OTW INFL PORT TPR TIP BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 80100555 EAP HCPCS C1726 CATHETER BLNDIL 5MM 135CM 20MM PR CTBLN OTW TPR TIP INFL BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 80100582 EAP HCPCS C1769 GUIDEWIRE VASCULAR ANGLED .035IN 260CM 25CM GLIDEW BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80100584 EAP HCPCS C1887 CATHETER ANGIOGRAPHIC ANGLE 4FR .041IN 100CM 15CM 2 BRAID BOTH IP/OP $121.00 $90.00 $24.02 $121.00 $65.70 $65.70 $65.70 $65.70 $121.00 $121.00 $121.00 $25.22 $121.00 $89.81 $89.81 $93.27 $63.04 $25.22 $121.00 $121.00 $71.57 $121.00 $121.00 $121.00 $121.00 $90.75 $121.00 $121.00 $121.00 $60.50 $60.50 $95.83 $121.00 $96.80 $78.65 $24.02 $121.00 $70.18 $121.00 $121.00 $121.00 $25.22 $121.00 N/A N/A 80100614 EAP HCPCS C1725 CATHETER BALDILAT 4MM 150CM 220MM OTW ULT LP NYBAX BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80200001 EAP Custom 80200001 PERITONEAL DIALYSIS-INPAT BOTH IP/OP "$1,724.00" "$1,276.00" $306.87 "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" $306.87 "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" $359.30 "$1,724.00" $689.60 "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" "$1,293.00" "$1,724.00" "$1,724.00" "$1,724.00" $862.00 $862.00 "$1,365.41" "$1,724.00" "$1,379.20" "$1,120.60" "$1,724.00" "$1,724.00" $999.92 "$1,724.00" "$1,034.40" "$1,724.00" "$1,724.00" "$1,724.00" N/A N/A 80200005 EAP HCPCS C1751 CATHETER CEN VEN .032IN 9.3FR 38CM 75CM 3 INFUS LUMEN EXTN BOTH IP/OP "$1,955.00" "$1,447.00" $388.02 "$1,955.00" "$1,061.57" "$1,061.57" "$1,061.57" "$1,061.57" "$1,955.00" "$1,955.00" "$1,955.00" $407.47 "$1,955.00" "$1,451.00" "$1,451.00" "$1,506.91" "$1,018.56" $407.44 "$1,955.00" "$1,955.00" "$1,156.38" "$1,955.00" "$1,955.00" "$1,955.00" "$1,955.00" "$1,466.25" "$1,955.00" "$1,955.00" "$1,955.00" $977.50 $977.50 "$1,548.36" "$1,955.00" "$1,564.00" "$1,270.75" $388.02 "$1,955.00" "$1,133.90" "$1,955.00" "$1,955.00" "$1,955.00" $407.42 "$1,955.00" N/A N/A 80200008 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN ATRM X FLPY TIP BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 $200.00 $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 80200013 EAP HCPCS C1894 SET ACCES 10CM 5FR 21GA MPNCH SLHT .018IN SS BOTH IP/OP $100.00 $74.00 $19.85 $100.00 $54.30 $54.30 $54.30 $54.30 $100.00 $100.00 $100.00 $20.84 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $100.00 $59.15 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $19.85 $100.00 $58.00 $100.00 $100.00 $100.00 $20.84 $100.00 N/A N/A 80200065 EAP FLEXOR INTRODUCER W/LG CHECK-FLO VALVE 10F .038IN X 3.4MM X 30CM BOTH IP/OP $193.00 $143.00 $34.35 $193.00 $193.00 $193.00 $193.00 $193.00 $193.00 $193.00 $34.35 $193.00 $193.00 $143.24 $143.24 $148.76 $100.55 $40.22 $193.00 $77.20 $193.00 $193.00 $193.00 $193.00 $193.00 $144.75 $193.00 $193.00 $193.00 $96.50 $96.50 $152.86 $193.00 $154.40 $125.45 $193.00 $193.00 $111.94 $193.00 $115.80 $193.00 $193.00 $193.00 N/A N/A 80200098 EAP HCPCS C1769 GUIDEWIRE VASC 260CM .018IN FLPY TIP RADIOPQ SHRT BOTH IP/OP $203.00 $150.50 $40.29 $203.00 $110.23 $110.23 $110.23 $110.23 $203.00 $203.00 $203.00 $42.31 $203.00 $150.67 $150.67 $156.47 $105.76 $42.31 $203.00 $203.00 $120.07 $203.00 $203.00 $203.00 $203.00 $152.25 $203.00 $203.00 $203.00 $101.50 $101.50 $160.78 $203.00 $162.40 $131.95 $40.29 $203.00 $117.74 $203.00 $203.00 $203.00 $42.31 $203.00 N/A N/A 80200103 EAP HCPCS C1887 CATHETER INTVN 6FR 5.1FR .056IN 150CM 25CM RAPEX BOTH IP/OP "$1,183.00" $875.50 $234.80 "$1,183.00" $642.37 $642.37 $642.37 $642.37 "$1,183.00" "$1,183.00" "$1,183.00" $246.57 "$1,183.00" $878.02 $878.02 $911.86 $616.34 $246.55 "$1,183.00" "$1,183.00" $699.74 "$1,183.00" "$1,183.00" "$1,183.00" "$1,183.00" $887.25 "$1,183.00" "$1,183.00" "$1,183.00" $591.50 $591.50 $936.94 "$1,183.00" $946.40 $768.95 $234.80 "$1,183.00" $686.14 "$1,183.00" "$1,183.00" "$1,183.00" $246.54 "$1,183.00" N/A N/A 80200104 EAP HCPCS C1725 CATHETER GUID 100CM 7FR LNCHR EBU3.75 CURVE CORON BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80200105 EAP HCPCS C1725 CATHETER ANGIO 100CM 5FR OPTITORQUE RADL TIG 4.5 BOTH IP/OP $88.00 $65.50 $17.47 $88.00 $47.78 $47.78 $47.78 $47.78 $88.00 $88.00 $88.00 $18.34 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $88.00 $52.05 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $17.47 $88.00 $51.04 $88.00 $88.00 $88.00 $18.34 $88.00 N/A N/A 80200129 EAP HCPCS C1725 CATHETER BALDILAT 9MM 75CM 60MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80200207 EAP HCPCS C1725 CATHETER BALDILAT 8MM 135CM 100MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80200262 EAP HCPCS C1753 CATHETER US .018IN 3.4FR 135CM INTVASC EXCH VSN PV BOTH IP/OP "$1,688.00" "$1,249.50" $335.03 "$1,688.00" $916.58 $916.58 $916.58 $916.58 "$1,688.00" "$1,688.00" "$1,688.00" $351.82 "$1,688.00" "$1,252.83" "$1,252.83" "$1,301.11" $879.45 $351.80 "$1,688.00" "$1,688.00" $998.45 "$1,688.00" "$1,688.00" "$1,688.00" "$1,688.00" "$1,266.00" "$1,688.00" "$1,688.00" "$1,688.00" $844.00 $844.00 "$1,336.90" "$1,688.00" "$1,350.40" "$1,097.20" $335.03 "$1,688.00" $979.04 "$1,688.00" "$1,688.00" "$1,688.00" $351.78 "$1,688.00" N/A N/A 80200271 EAP HCPCS C1769 TRAY TRCH 8.5FR SHLY BLU RHINO FLXB ADLT PERC BOTH IP/OP "$1,631.00" "$1,207.00" $323.71 "$1,631.00" $885.63 $885.63 $885.63 $885.63 "$1,631.00" "$1,631.00" "$1,631.00" $339.94 "$1,631.00" "$1,210.53" "$1,210.53" "$1,257.17" $849.75 $339.92 "$1,631.00" "$1,631.00" $964.74 "$1,631.00" "$1,631.00" "$1,631.00" "$1,631.00" "$1,223.25" "$1,631.00" "$1,631.00" "$1,631.00" $815.50 $815.50 "$1,291.75" "$1,631.00" "$1,304.80" "$1,060.15" $323.71 "$1,631.00" $945.98 "$1,631.00" "$1,631.00" "$1,631.00" $339.90 "$1,631.00" N/A N/A 80202089 EAP Custom 80202089 SET TUBING 2.6MR 2 WAY COMMUNICATION IRRIGATION PUMP BOTH IP/OP $125.00 $92.50 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 $125.00 $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 80202090 EAP HCPCS C1733 CATHETER EP 110CM 7FR SAFIRE TX 2-5-2MM SPC 1MM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" "$1,153.88" "$1,153.88" "$1,153.88" "$1,153.88" "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$1,577.18" "$1,577.18" "$1,637.95" "$1,107.13" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" "$1,381.25" $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80202091 EAP HCPCS C1733 SAFIRE TX CATHETER 8MM LARGE CURL BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $814.50 $814.50 $814.50 $814.50 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80202094 EAP HCPCS C1733 CATHETER EP 115CM 7FR SAFIRE COMFORTGRIP 2-5-2MM BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80202104 EAP NEEDLE TRNSPT 50D BRK CRV 18GA 98CM BVL STY SS ADLT BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 $400.00 $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A 80202112 EAP HCPCS C1893 INTROD SHTH 8.5FR 180CM 63CM HMSTS VLV SDPRT DILAT BOTH IP/OP $363.00 $269.00 $72.05 $363.00 $197.11 $197.11 $197.11 $197.11 $363.00 $363.00 $363.00 $75.66 $363.00 $269.42 $269.42 $279.80 $189.12 $75.65 $363.00 $363.00 $214.71 $363.00 $363.00 $363.00 $363.00 $272.25 $363.00 $363.00 $363.00 $181.50 $181.50 $287.50 $363.00 $290.40 $235.95 $72.05 $363.00 $210.54 $363.00 $363.00 $363.00 $75.65 $363.00 N/A N/A 80202116 EAP HCPCS C1894 INTROD SHTH 8FR 50CM 12CM 2 DISTAL GWIRE HMSTS VLV BOTH IP/OP $28.00 $21.00 $5.56 $28.00 $15.20 $15.20 $15.20 $15.20 $28.00 $28.00 $28.00 $5.84 $28.00 $20.78 $20.78 $21.58 $14.59 $5.84 $28.00 $28.00 $16.56 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $18.20 $5.56 $28.00 $16.24 $28.00 $28.00 $28.00 $5.84 $28.00 N/A N/A 80202118 EAP HCPCS C1894 INTROD SHTH 6FR 50CM 12CM 2 DISTAL GWIRE HMSTS VLV BOTH IP/OP $28.00 $21.00 $5.56 $28.00 $15.20 $15.20 $15.20 $15.20 $28.00 $28.00 $28.00 $5.84 $28.00 $20.78 $20.78 $21.58 $14.59 $5.84 $28.00 $28.00 $16.56 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $18.20 $5.56 $28.00 $16.24 $28.00 $28.00 $28.00 $5.84 $28.00 N/A N/A 80202121 EAP HCPCS C1893 INTROD SHTH 8FR 60CM FSTCTH STRL LATEX FREE DISP BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 80202130 EAP HCPCS C1766 INTROD CATH 40CM 8.5FR 17GA EPICARDIUM RSPN AGILIS BOTH IP/OP "$2,638.00" "$1,952.50" $549.79 "$2,638.00" "$2,638.00" "$2,638.00" "$2,638.00" "$2,638.00" "$2,638.00" "$2,638.00" "$2,638.00" "$2,638.00" "$2,638.00" "$1,957.92" "$1,957.92" "$2,033.37" "$1,374.40" $549.79 "$2,638.00" "$1,055.20" "$2,638.00" "$2,638.00" "$2,638.00" "$2,638.00" "$2,638.00" "$1,978.50" "$2,638.00" "$2,638.00" "$2,638.00" "$1,319.00" "$1,319.00" "$2,089.30" "$2,638.00" "$2,110.40" "$1,714.70" "$2,638.00" "$2,638.00" "$1,530.04" "$2,638.00" "$1,582.80" "$2,638.00" "$2,638.00" "$2,638.00" N/A N/A 80202131 EAP HCPCS C1730 CATHETER EP 120CM 5FR RSPN 5MM SPC CRNND CURVE BOTH IP/OP $213.00 $158.00 $42.28 $213.00 $115.66 $115.66 $115.66 $115.66 $213.00 $213.00 $213.00 $44.39 $213.00 $158.09 $158.09 $164.18 $110.97 $44.39 $213.00 $213.00 $125.99 $213.00 $213.00 $213.00 $213.00 $159.75 $213.00 $213.00 $213.00 $106.50 $106.50 $168.70 $213.00 $170.40 $138.45 $42.28 $213.00 $123.54 $213.00 $213.00 $213.00 $44.39 $213.00 N/A N/A 80202133 EAP HCPCS C1730 CATHETER EP 120CM 5FR RSPN 5MM SPC JSPHSN CURVE BOTH IP/OP $213.00 $158.00 $42.28 $213.00 $115.66 $115.66 $115.66 $115.66 $213.00 $213.00 $213.00 $44.39 $213.00 $158.09 $158.09 $164.18 $110.97 $44.39 $213.00 $213.00 $125.99 $213.00 $213.00 $213.00 $213.00 $159.75 $213.00 $213.00 $213.00 $106.50 $106.50 $168.70 $213.00 $170.40 $138.45 $42.28 $213.00 $123.54 $213.00 $213.00 $213.00 $44.39 $213.00 N/A N/A 80202150 EAP HCPCS C1731 CATHETER EP 95CM 7FR LVWR 2-10-2MM SPC SUP LG CURL BOTH IP/OP "$1,938.00" "$1,434.50" $384.64 "$1,938.00" "$1,052.33" "$1,052.33" "$1,052.33" "$1,052.33" "$1,938.00" "$1,938.00" "$1,938.00" $403.93 "$1,938.00" "$1,438.38" "$1,438.38" "$1,493.81" "$1,009.70" $403.90 "$1,938.00" "$1,938.00" "$1,146.33" "$1,938.00" "$1,938.00" "$1,938.00" "$1,938.00" "$1,453.50" "$1,938.00" "$1,938.00" "$1,938.00" $969.00 $969.00 "$1,534.90" "$1,938.00" "$1,550.40" "$1,259.70" $384.64 "$1,938.00" "$1,124.04" "$1,938.00" "$1,938.00" "$1,938.00" $403.88 "$1,938.00" N/A N/A 80202158 EAP KIT ELTRD NS LF ENSITE NAVX SRFC DISP BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$1,669.95" "$1,669.95" "$1,734.30" "$1,172.25" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,462.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80202163 EAP HCPCS C1898 LEAD PACKING TENDRIL STS STEROID SILICONE HELIX L46CM OD6FR BOTH IP/OP "$1,125.00" $832.50 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 80202164 EAP HCPCS C1898 LEAD PACING TENDRIL STS OPTIM STEROID L52 CM OD6 FR ENDOCARD IS-1 BIPOLAR CON BOTH IP/OP "$1,125.00" $832.50 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 80202165 EAP HCPCS C1898 LEAD PACING TENDRIL STS STEROID SILICONE HELIX L58 OD6 FR ENDOCARD BOTH IP/OP "$1,125.00" $832.50 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 80202184 EAP HCPCS C1769 KIT PROCEDURE .035IN 21GA 65CM BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $543.00 $543.00 $543.00 $543.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" "$1,000.00" $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 $198.48 "$1,000.00" $580.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.40 "$1,000.00" N/A N/A 80202189 EAP HCPCS C1751 KIT CATH .032IN 8.5FR 18GA 16CM LF 2.5IN BLU FLXTP ARWG+ARD BOTH IP/OP $349.00 $258.50 $69.27 $349.00 $189.51 $189.51 $189.51 $189.51 $349.00 $349.00 $349.00 $72.74 $349.00 $259.03 $259.03 $269.01 $181.83 $72.74 $349.00 $349.00 $206.43 $349.00 $349.00 $349.00 $349.00 $261.75 $349.00 $349.00 $349.00 $174.50 $174.50 $276.41 $349.00 $279.20 $226.85 $69.27 $349.00 $202.42 $349.00 $349.00 $349.00 $72.73 $349.00 N/A N/A 80202203 EAP HCPCS C1729 TRAY CATHETERIZATION 16FR 2 CONCTR TEMPERATURE SENSE BOTH IP/OP $69.00 $51.50 $13.69 $69.00 $37.47 $37.47 $37.47 $37.47 $69.00 $69.00 $69.00 $14.38 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $69.00 $40.81 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $13.69 $69.00 $40.02 $69.00 $69.00 $69.00 $14.38 $69.00 N/A N/A 80202219 EAP HCPCS C1726 CATHETER BLNDIL 11 ATM 8MM 180CM 4CM HRCN RX LOPRFL RADOPQ BOTH IP/OP $603.00 $446.50 $119.68 $603.00 $327.43 $327.43 $327.43 $327.43 $603.00 $603.00 $603.00 $125.68 $603.00 $447.55 $447.55 $464.79 $314.16 $125.67 $603.00 $603.00 $356.67 $603.00 $603.00 $603.00 $603.00 $452.25 $603.00 $603.00 $603.00 $301.50 $301.50 $477.58 $603.00 $482.40 $391.95 $119.68 $603.00 $349.74 $603.00 $603.00 $603.00 $125.67 $603.00 N/A N/A 80202586 EAP COIL EMBOLIZATION .02IN COMPLEX 14MM 40CM SOFT THE PENUMBRA BOTH IP/OP "$6,188.00" "$4,579.50" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,289.65" "$6,188.00" "$2,475.20" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$4,641.00" "$6,188.00" "$6,188.00" "$6,188.00" "$3,094.00" "$3,094.00" "$4,900.90" "$6,188.00" "$4,950.40" "$2,784.60" "$6,188.00" "$6,188.00" "$3,589.04" "$6,188.00" "$3,712.80" "$6,188.00" "$6,188.00" "$6,188.00" N/A N/A 80202609 EAP COIL EMBL .02IN CMPLX 5MM 9CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$5,490.00" "$4,063.00" $977.22 "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" $977.22 "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$1,144.18" "$5,490.00" "$2,196.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$4,117.50" "$5,490.00" "$5,490.00" "$5,490.00" "$2,745.00" "$2,745.00" "$4,348.08" "$5,490.00" "$4,392.00" "$2,470.50" "$5,490.00" "$5,490.00" "$3,184.20" "$5,490.00" "$3,294.00" "$5,490.00" "$5,490.00" "$5,490.00" N/A N/A 80202611 EAP COIL EMBOLIZATION .02IN STANDARD COMPLEX 10MM 30CM COMPLEX BOTH IP/OP "$5,513.00" "$4,080.00" $981.31 "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" $981.31 "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$1,148.97" "$5,513.00" "$2,205.20" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$4,134.75" "$5,513.00" "$5,513.00" "$5,513.00" "$2,756.50" "$2,756.50" "$4,366.30" "$5,513.00" "$4,410.40" "$2,480.85" "$5,513.00" "$5,513.00" "$3,197.54" "$5,513.00" "$3,307.80" "$5,513.00" "$5,513.00" "$5,513.00" N/A N/A 80202615 EAP COIL EMBOLIZATION .02IN STANDARD COMPLEX 12MM 35CM COMPLEX BOTH IP/OP "$5,570.00" "$4,122.00" $991.46 "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" $991.46 "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$1,160.85" "$5,570.00" "$2,228.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$4,177.50" "$5,570.00" "$5,570.00" "$5,570.00" "$2,785.00" "$2,785.00" "$4,411.44" "$5,570.00" "$4,456.00" "$2,506.50" "$5,570.00" "$5,570.00" "$3,230.60" "$5,570.00" "$3,342.00" "$5,570.00" "$5,570.00" "$5,570.00" N/A N/A 80202620 EAP Custom 80202620 COIL EMBL .02IN CMPLX 6MM 10CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$5,513.00" "$4,080.00" $981.31 "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" $981.31 "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$1,148.97" "$5,513.00" "$2,205.20" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$5,513.00" "$4,134.75" "$5,513.00" "$5,513.00" "$5,513.00" "$2,756.50" "$2,756.50" "$4,366.30" "$5,513.00" "$4,410.40" "$2,480.85" "$5,513.00" "$5,513.00" "$3,197.54" "$5,513.00" "$3,307.80" "$5,513.00" "$5,513.00" "$5,513.00" N/A N/A 80202624 EAP COIL EMBL .02IN CMPLX 7MM 15CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$5,625.00" "$4,162.50" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$2,250.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$5,625.00" "$5,625.00" "$3,262.50" "$5,625.00" "$3,375.00" "$5,625.00" "$5,625.00" "$5,625.00" N/A N/A 80202626 EAP Custom 80202626 COIL EMBL .02IN CMPLX 8MM 15CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$5,625.00" "$4,162.50" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$2,250.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$5,625.00" "$5,625.00" "$3,262.50" "$5,625.00" "$3,375.00" "$5,625.00" "$5,625.00" "$5,625.00" N/A N/A 80202641 EAP COIL EMBOLIZATION .02IN COMPLEX 10MM 30CM SOFT THE PENUMBRA BOTH IP/OP "$5,963.00" "$4,413.00" "$1,061.41" "$5,963.00" "$5,963.00" "$5,963.00" "$5,963.00" "$5,963.00" "$5,963.00" "$5,963.00" "$1,061.41" "$5,963.00" "$5,963.00" "$5,963.00" "$5,963.00" "$5,963.00" "$5,963.00" "$1,242.75" "$5,963.00" "$2,385.20" "$5,963.00" "$5,963.00" "$5,963.00" "$5,963.00" "$5,963.00" "$4,472.25" "$5,963.00" "$5,963.00" "$5,963.00" "$2,981.50" "$2,981.50" "$4,722.70" "$5,963.00" "$4,770.40" "$2,683.35" "$5,963.00" "$5,963.00" "$3,458.54" "$5,963.00" "$3,577.80" "$5,963.00" "$5,963.00" "$5,963.00" N/A N/A 80202904 EAP HCPCS C1894 NEURON MAX 088 6F SHEATH BOTH IP/OP "$1,138.00" $842.50 $225.86 "$1,138.00" $617.93 $617.93 $617.93 $617.93 "$1,138.00" "$1,138.00" "$1,138.00" $237.19 "$1,138.00" $844.62 $844.62 $877.17 $592.90 $237.17 "$1,138.00" "$1,138.00" $673.13 "$1,138.00" "$1,138.00" "$1,138.00" "$1,138.00" $853.50 "$1,138.00" "$1,138.00" "$1,138.00" $569.00 $569.00 $901.30 "$1,138.00" $910.40 $739.70 $225.86 "$1,138.00" $660.04 "$1,138.00" "$1,138.00" "$1,138.00" $237.16 "$1,138.00" N/A N/A 80202923 EAP HCPCS C1769 GUIDEWIRE VASC 260CM .035IN FLPY TIP XSTIF STR TPR BOTH IP/OP $68.00 $50.50 $13.50 $68.00 $36.92 $36.92 $36.92 $36.92 $68.00 $68.00 $68.00 $14.17 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $68.00 $40.22 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $13.50 $68.00 $39.44 $68.00 $68.00 $68.00 $14.17 $68.00 N/A N/A 80202926 EAP HCPCS C1887 SET INTERVENTIONAL .038IN 10FR 40CM 62.5CM CATHETER CANNU BOTH IP/OP "$1,131.00" $837.00 $224.48 "$1,131.00" $614.13 $614.13 $614.13 $614.13 "$1,131.00" "$1,131.00" "$1,131.00" $235.73 "$1,131.00" $839.43 $839.43 $871.77 $589.25 $235.71 "$1,131.00" "$1,131.00" $668.99 "$1,131.00" "$1,131.00" "$1,131.00" "$1,131.00" $848.25 "$1,131.00" "$1,131.00" "$1,131.00" $565.50 $565.50 $895.75 "$1,131.00" $904.80 $735.15 $224.48 "$1,131.00" $655.98 "$1,131.00" "$1,131.00" "$1,131.00" $235.70 "$1,131.00" N/A N/A 80202933 EAP HCPCS C1894 INTROD CATH 80CM 10FR 3.4MM CHK-FLO FLXR LG VLV BOTH IP/OP $265.00 $196.50 $52.60 $265.00 $143.90 $143.90 $143.90 $143.90 $265.00 $265.00 $265.00 $55.23 $265.00 $196.68 $196.68 $204.26 $138.07 $55.23 $265.00 $265.00 $156.75 $265.00 $265.00 $265.00 $265.00 $198.75 $265.00 $265.00 $265.00 $132.50 $132.50 $209.88 $265.00 $212.00 $172.25 $52.60 $265.00 $153.70 $265.00 $265.00 $265.00 $55.23 $265.00 N/A N/A 80202945 EAP HCPCS C1894 SHEATH GUID 45CM 7FR 2.5MM FLXR CHK-FLO ANL2 CURVE BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80202946 EAP HCPCS C1894 SHEATH GUID 90CM 6FR 2.2MM FLXR CHK-FLO ANL1 CURVE BOTH IP/OP $378.00 $280.00 $75.02 $378.00 $205.25 $205.25 $205.25 $205.25 $378.00 $378.00 $378.00 $78.78 $378.00 $280.55 $280.55 $291.36 $196.94 $78.78 $378.00 $378.00 $223.59 $378.00 $378.00 $378.00 $378.00 $283.50 $378.00 $378.00 $378.00 $189.00 $189.00 $299.38 $378.00 $302.40 $245.70 $75.02 $378.00 $219.24 $378.00 $378.00 $378.00 $78.78 $378.00 N/A N/A 80202956 EAP LIGATOR ENDOSCOPIC DUETTE 2.8MM - 9.15-13MM - 5FR BOTH IP/OP $795.00 $588.50 $141.51 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $141.51 $795.00 $795.00 $590.05 $590.05 $612.79 $414.20 $165.69 $795.00 $318.00 $795.00 $795.00 $795.00 $795.00 $795.00 $596.25 $795.00 $795.00 $795.00 $397.50 $397.50 $629.64 $795.00 $636.00 $516.75 $795.00 $795.00 $461.10 $795.00 $477.00 $795.00 $795.00 $795.00 N/A N/A 80202963 EAP HCPCS C1894 SHEATH GUID 45CM 8FR 2.9MM FLXR CHK-FLO ANL1 CURVE BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80203000 EAP HCPCS C1751 KIT CATHETER 8.5FR 16CM 3 LUMEN EXPAND CHLORAPREP SAFETY BOTH IP/OP $825.00 $610.50 $163.74 $825.00 $447.98 $447.98 $447.98 $447.98 $825.00 $825.00 $825.00 $171.95 $825.00 $612.32 $612.32 $635.91 $429.83 $171.94 $825.00 $825.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $536.25 $163.74 $825.00 $478.50 $825.00 $825.00 $825.00 $171.93 $825.00 N/A N/A 80206650 EAP HCPCS C1898 LEAD PCNG STRG 7FR 58CM ISFLX ABRSN RST IS-1 BP CNCT TINE FX BOTH IP/OP $680.00 $503.50 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 $680.00 $394.40 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 80206746 EAP HCPCS C1898 LEAD PACING STEROID ELUTING L78-88 CM HEART LEFT OTW BIPOLAR BOTH IP/OP "$3,563.00" "$2,637.00" $742.57 "$3,563.00" "$3,563.00" "$3,563.00" "$3,563.00" "$3,563.00" "$3,563.00" "$3,563.00" "$3,563.00" "$3,563.00" "$3,563.00" "$3,563.00" "$3,563.00" "$3,563.00" "$3,563.00" $742.57 "$3,563.00" "$1,425.20" "$3,563.00" "$3,563.00" "$3,563.00" "$3,563.00" "$3,563.00" "$2,672.25" "$3,563.00" "$3,563.00" "$3,563.00" "$1,781.50" "$1,781.50" "$2,821.90" "$3,563.00" "$2,850.40" "$1,603.35" "$3,563.00" "$3,563.00" "$2,066.54" "$3,563.00" "$2,137.80" "$3,563.00" "$3,563.00" "$3,563.00" N/A N/A 80206800 EAP KIT NDL GD 21GA 96IN STRT US BOTH IP/OP $54.00 $40.00 $9.61 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $9.61 $54.00 $54.00 $40.08 $40.08 $41.62 $28.13 $11.25 $54.00 $21.60 $54.00 $54.00 $54.00 $54.00 $54.00 $40.50 $54.00 $54.00 $54.00 $27.00 $27.00 $42.77 $54.00 $43.20 $35.10 $54.00 $54.00 $31.32 $54.00 $32.40 $54.00 $54.00 $54.00 N/A N/A 80206804 EAP HCPCS C1757 CATHETER 6FR X 135 CM 9MM CLEANER STERILE BOTH IP/OP "$1,988.00" "$1,471.50" $394.57 "$1,988.00" "$1,079.48" "$1,079.48" "$1,079.48" "$1,079.48" "$1,988.00" "$1,988.00" "$1,988.00" $414.35 "$1,988.00" "$1,475.49" "$1,475.49" "$1,532.35" "$1,035.75" $414.32 "$1,988.00" "$1,988.00" "$1,175.90" "$1,988.00" "$1,988.00" "$1,988.00" "$1,988.00" "$1,491.00" "$1,988.00" "$1,988.00" "$1,988.00" $994.00 $994.00 "$1,574.50" "$1,988.00" "$1,590.40" "$1,292.20" $394.57 "$1,988.00" "$1,153.04" "$1,988.00" "$1,988.00" "$1,988.00" $414.30 "$1,988.00" N/A N/A 80206850 EAP ANTIMICROBIAL KIT BOTH IP/OP $55.00 $41.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $40.82 $40.82 $42.39 $28.66 $11.46 $55.00 $22.00 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $35.75 $55.00 $55.00 $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A 80206851 EAP Custom 80206851 DRESSING GEL 144X10IN EFFECTIVE PROTECTION KNIT ROLL BOTH IP/OP $118.00 $87.50 $21.00 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $21.00 $118.00 $118.00 $87.58 $87.58 $90.95 $61.48 $24.59 $118.00 $47.20 $118.00 $118.00 $118.00 $118.00 $118.00 $88.50 $118.00 $118.00 $118.00 $59.00 $59.00 $93.46 $118.00 $94.40 $76.70 $118.00 $118.00 $68.44 $118.00 $70.80 $118.00 $118.00 $118.00 N/A N/A 80206898 EAP HCPCS C1725 CATHETER BALDILAT 5MM 135CM 120MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206901 EAP HCPCS C1725 CATHETER BALDILAT 6MM 135CM 120MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206904 EAP HCPCS C1725 CATHETER BALDILAT 7MM 135CM 120MM HI-PRS NYBAX BOTH IP/OP $430.00 $318.50 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 $430.00 $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A 80206906 EAP HCPCS C1725 CATHETER BALDILAT 8MM 135CM 120MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206908 EAP HCPCS C1725 CATHETER BALDILAT 3MM 135CM 150MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206910 EAP HCPCS C1725 CATHETER BALDILAT 4MM 135CM 150MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206916 EAP HCPCS C1725 CATHETER BALDILAT 8MM 135CM 150MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206930 EAP HCPCS C1725 CATHETER BALDILAT 3MM 135CM 200MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206935 EAP HCPCS C1725 CATHETER BALDILAT 7MM 135CM 200MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206937 EAP HCPCS C1725 CATHETER BALDILAT 8MM 135CM 200MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206941 EAP HCPCS C1726 CATHETER BALDILAT 3MM 75CM 20MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $262.80 $438.00 $91.28 $438.00 N/A N/A 80206949 EAP HCPCS C1725 CATHETER BALDILAT 9MM 135CM 20MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206952 EAP HCPCS C1725 CAT BALD LP 5.8FR 10MM 135CM 20MM HIGH PRE BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206984 EAP HCPCS C1725 CATHETER BALDILAT 3MM 135CM 40MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206986 EAP HCPCS C1725 CATHETER BALDILAT 3MM 75CM 40MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206988 EAP HCPCS C1725 CATHETER BALDILAT 9MM 135CM 40MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206997 EAP HCPCS C1753 CATHETER BALDILAT LP 5.3FR 4MM 135CM 60MM HIGH PRESSURE BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80206999 EAP HCPCS C1725 CATHETER BALDILAT LP 5.3FR 4MM 75CM 60MM HIGH PRESSURE BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207000 EAP HCPCS C1725 CATHETER BALDILAT .035IN 5MM 135CM 60MM HIGH PRESSURE LP BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207002 EAP HCPCS C1725 CATHETER BALDILAT 5MM 75CM 60MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207003 EAP HCPCS C1725 CAT BALD LP 5.3FR 6MM 135CM 60MM HIGH PRES BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207005 EAP HCPCS C1725 CAT BALD .035IN 6MM 75CM 60MM HIGH PRES LP BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207009 EAP HCPCS C1725 CATHETER BALDILAT 8MM 135CM 60MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207011 EAP HCPCS C1725 CAT BALD .035IN 8MM 75CM 60MM HIGH PRE LP BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207012 EAP HCPCS C1725 CAT BALD LP 5.8FR 9MM 135CM 60MM HIGH PRES BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207019 EAP HCPCS C1725 CATHETER BALDILAT 3MM 135CM 80MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207021 EAP HCPCS C1725 CATHETER BALDILAT 3MM 75CM 80MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207022 EAP HCPCS C1725 CATHETER BALDILAT 4MM 135CM 80MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207024 EAP HCPCS C1725 CATHETER BALDILAT 4MM 75CM 80MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207025 EAP HCPCS C1725 CATHETER BALLOON DILATATION MUSTANG NYBAX L135CM L80MM OD5.3FR BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207027 EAP HCPCS C1725 CATHETER BALDILAT 5MM 75CM 80MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207028 EAP HCPCS C1725 CATHETER BALDILAT 6MM 135CM 80MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207030 EAP HCPCS C1725 CATHETER BALDILAT 6MM 75CM 80MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207031 EAP HCPCS C1725 CATHETER BALDILAT 7MM 135CM 80MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207033 EAP HCPCS C1725 CATHETER BALDILAT 7MM 75CM 80MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207045 EAP HCPCS C1725 CATHETER BALDILAT 3MM 135CM 100MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207048 EAP HCPCS C1725 CATHETER BALDILAT 4MM 135CM 100MM HI-PRS NYBAX BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207050 EAP HCPCS C1725 CATHETER BLNDIL 4MM 75CM 100MM MUSTANG BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207054 EAP HCPCS C1725 CAT BALD LP 5.3FR 7MM 135CM 100MM HIGH PRES BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80207066 EAP HCPCS C1725 CATHETER BALDILAT 4MM 30MM 135CM OTW TPR TIP LP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207067 EAP Custom 80207067 STERLING OTW 4MM X 60MM X 135CM BOTH IP/OP $425.00 $314.50 $75.65 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $75.65 $425.00 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $170.00 $425.00 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $425.00 $425.00 $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 80207074 EAP HCPCS C1725 CATHETER BALDILAT 5MM 135CM 30MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207075 EAP HCPCS C1725 CATHETER BALDILAT 5MM 135CM 60MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207077 EAP HCPCS C1725 STERLING OTW 5MM X 100MM X 135CM BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207083 EAP HCPCS C1725 CATHETER BALDILAT 6MM 135CM 30MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207084 EAP HCPCS C1725 STERLING OTW 6MM X 100MM X 135CM BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207089 EAP HCPCS C1725 CATHETER BALDILAT 7MM 135CM 30MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207090 EAP HCPCS C1725 CATHETER BALDILAT 7MM 135CM 80MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207091 EAP HCPCS C1725 CATHETER BALDILAT 7MM 135CM 100MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207096 EAP HCPCS C1725 CATHETER BALDILAT 8MM 135CM 30MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207101 EAP HCPCS C1725 CATHETER BALDILAT 9MM 135CM 20MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207102 EAP HCPCS C1725 CATHETER BALDILAT 9MM 135CM 30MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207103 EAP HCPCS C1725 CATHETER BALDILAT 9MM 135CM 60MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207104 EAP HCPCS C1725 CATHETER BALDILAT 9MM 135CM 80MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207125 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 150CM 80MM OTW INFL PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207152 EAP HCPCS C1725 COYOTE OTW 1.5MM X 40MM X 90CM BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 $417.50 $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A 80207155 EAP HCPCS C1753 CATHETER BLNDIL 3MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX BSLD BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 $417.50 $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A 80207170 EAP HCPCS C1753 CATHETER BALDILAT 3MM 150CM 60MM OTW ULT LP NYBAX BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207171 EAP HCPCS C1753 CATHETER BALDILAT 3.5MM 150CM 60MM OTW ULT LP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 80207172 EAP HCPCS C1753 CATHETER BALDILAT 4MM 150CM 60MM OTW ULT LP NYBAX BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207177 EAP HCPCS C1753 CATHETER BALDILAT 4MM 150CM 80MM OTW ULT LP NYBAX BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 80207190 EAP HCPCS C1753 CATHETER BALDILAT 3.5MM 150CM 120MM OTW ULT LP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 80207192 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 150CM 150MM OTW ULT LP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207193 EAP HCPCS C1753 CATHETER BALDILAT 4MM 150CM 150MM OTW ULT LP NYBAX BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 80207199 EAP HCPCS C1725 COYOTE 3.5MM X 220MM X 150CM BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80207556 EAP HCPCS C1725 CATHETER BALDILAT 8MM 135CM 20MM OTW INFLAT PORT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 80207580 EAP HCPCS C1876 STENT BIL 7MM 27MM 135CM 30MM OTW RADIOPQ BLN XPD BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80207581 EAP HCPCS C1876 STENT BIL 8MM 27MM 135CM 30MM OTW RADIOPQ NC BLN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80207585 EAP HCPCS C1876 STENT BIL 7MM 57MM 135CM 60MM OTW RADIOPQ NC BLN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80207586 EAP HCPCS C1876 STENT BIL 8MM 57MM 135CM 60MM OTW RADIOPQ NC BLN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80207662 EAP HCPCS C1876 STENT ENDO 100CM 14MM 40MM 75CM UNCONSTRAIN FLEX BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 "$2,250.00" "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 80207663 EAP HCPCS C1876 STENT ENDOPRSTH TRCHBR 60MM 14MM 9FR MTL WLSTNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 "$2,250.00" "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 80207665 EAP HCPCS C1876 STENT ENDOPRSTH TRCHBR VNS 40MM 16MM ELGILOY BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 "$2,250.00" "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 80207666 EAP HCPCS C1876 STENT ENDOPRSTH TRCHBR 60MM 16MM 9FR MTL WLSTNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 "$2,250.00" "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 80207668 EAP HCPCS C1876 STENT ENDOPRSTH TRCHBR 60MM 18MM 9FR MTL WLSTNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 "$2,250.00" "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 80207678 EAP HCPCS C1876 STENT ENDOPRSTH TRCHBR 90MM 14MM 9FR MTL WLSTNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 "$2,250.00" "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 80207912 EAP HCPCS C1726 DEVICE ATHRCM 165CM .018IN TRUEPATH .017IN PERI BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$2,128.56" "$2,128.56" "$2,128.56" "$2,128.56" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$2,909.42" "$2,909.42" "$3,021.54" "$2,042.32" $816.97 "$3,920.00" "$3,920.00" "$2,318.68" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$2,548.00" $778.02 "$3,920.00" "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A 80207913 EAP HCPCS C1769 WIRE CATH EXTN TRUEPATH CHRNC TOT OCL DEV BOTH IP/OP $210.00 $155.50 $41.68 $210.00 $114.03 $114.03 $114.03 $114.03 $210.00 $210.00 $210.00 $43.77 $210.00 $155.86 $155.86 $161.87 $109.41 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $136.50 $41.68 $210.00 $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A 80207925 EAP HCPCS C1769 GUI VAS ST STR .035IN 260CM FLEXIBLE TIP BOTH IP/OP $100.00 $74.00 $19.85 $100.00 $54.30 $54.30 $54.30 $54.30 $100.00 $100.00 $100.00 $20.84 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $100.00 $59.15 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $19.85 $100.00 $58.00 $100.00 $100.00 $100.00 $20.84 $100.00 N/A N/A 80207926 EAP HCPCS C1769 GUIDEWIRE VASC 260CM .038IN FLPY TIP FLTWR COIL BOTH IP/OP $100.00 $74.00 $19.85 $100.00 $54.30 $54.30 $54.30 $54.30 $100.00 $100.00 $100.00 $20.84 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $100.00 $59.15 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $19.85 $100.00 $58.00 $100.00 $60.00 $100.00 $20.84 $100.00 N/A N/A 80207927 EAP HCPCS C1769 GDWRE VASC TPER .038IN 145CM 6CM STR TIP AM BOTH IP/OP $67.00 $50.00 $13.30 $67.00 $36.38 $36.38 $36.38 $36.38 $67.00 $67.00 $67.00 $13.96 $67.00 $49.73 $49.73 $51.64 $34.91 $13.96 $67.00 $67.00 $39.63 $67.00 $67.00 $67.00 $67.00 $50.25 $67.00 $67.00 $67.00 $33.50 $33.50 $53.06 $67.00 $53.60 $43.55 $13.30 $67.00 $38.86 $67.00 $67.00 $67.00 $13.96 $67.00 N/A N/A 80207931 EAP HCPCS C1769 GUIDEWIRE VASCULAR 6CM J .035IN 145CM 3MM FLEXIBLE TIP BOTH IP/OP $76.00 $56.50 $15.08 $76.00 $41.27 $41.27 $41.27 $41.27 $76.00 $76.00 $76.00 $15.84 $76.00 $56.41 $56.41 $58.58 $39.60 $15.84 $76.00 $76.00 $44.95 $76.00 $76.00 $76.00 $76.00 $57.00 $76.00 $76.00 $76.00 $38.00 $38.00 $60.19 $76.00 $60.80 $49.40 $15.08 $76.00 $44.08 $76.00 $76.00 $76.00 $15.84 $76.00 N/A N/A 80207933 EAP HCPCS C1769 GUIDEWIRE VASCULAR SHORT LARGE J FLAT SPRING COIL .035IN 180 BOTH IP/OP $104.00 $77.00 $20.64 $104.00 $56.47 $56.47 $56.47 $56.47 $104.00 $104.00 $104.00 $21.68 $104.00 $77.19 $77.19 $80.16 $54.18 $21.67 $104.00 $104.00 $61.52 $104.00 $104.00 $104.00 $104.00 $78.00 $104.00 $104.00 $104.00 $52.00 $52.00 $82.37 $104.00 $83.20 $67.60 $20.64 $104.00 $60.32 $104.00 $104.00 $104.00 $21.67 $104.00 N/A N/A 80207935 EAP HCPCS C1769 GUIDEWIRE VASC 260CM .035IN FLPY TIP FLTWR COIL 3 BOTH IP/OP $104.00 $77.00 $20.64 $104.00 $56.47 $56.47 $56.47 $56.47 $104.00 $104.00 $104.00 $21.68 $104.00 $77.19 $77.19 $80.16 $54.18 $21.67 $104.00 $104.00 $61.52 $104.00 $104.00 $104.00 $104.00 $78.00 $104.00 $104.00 $104.00 $52.00 $52.00 $82.37 $104.00 $83.20 $67.60 $20.64 $104.00 $60.32 $104.00 $104.00 $104.00 $21.67 $104.00 N/A N/A 80207943 EAP HCPCS C1769 GUIDEWIRE VASC 260CM .018IN FLPY TIP RADIOPQ LNG BOTH IP/OP $203.00 $150.50 $40.29 $203.00 $110.23 $110.23 $110.23 $110.23 $203.00 $203.00 $203.00 $42.31 $203.00 $150.67 $150.67 $156.47 $105.76 $42.31 $203.00 $203.00 $120.07 $203.00 $203.00 $203.00 $203.00 $152.25 $203.00 $203.00 $203.00 $101.50 $101.50 $160.78 $203.00 $162.40 $131.95 $40.29 $203.00 $117.74 $203.00 $203.00 $203.00 $42.31 $203.00 N/A N/A 80207946 EAP HCPCS C1769 GUIDEWIRE VASCULAR SHORT .025IN 260CM 3CM RADIOPQ PLATINUM BOTH IP/OP $202.00 $149.50 $40.09 $202.00 $109.69 $109.69 $109.69 $109.69 $202.00 $202.00 $202.00 $42.10 $202.00 $149.92 $149.92 $155.70 $105.24 $42.10 $202.00 $202.00 $119.48 $202.00 $202.00 $202.00 $202.00 $151.50 $202.00 $202.00 $202.00 $101.00 $101.00 $159.98 $202.00 $161.60 $131.30 $40.09 $202.00 $117.16 $202.00 $202.00 $202.00 $42.10 $202.00 N/A N/A 80207949 EAP HCPCS C1769 GUIDEWIRE VASCULAR STR SHORT TAPER .014IN 300CM 8CM ROBUST BOTH IP/OP $319.00 $236.50 $63.31 $319.00 $173.22 $173.22 $173.22 $173.22 $319.00 $319.00 $319.00 $66.49 $319.00 $236.76 $236.76 $245.89 $166.20 $66.48 $319.00 $319.00 $188.69 $319.00 $319.00 $319.00 $319.00 $239.25 $319.00 $319.00 $319.00 $159.50 $159.50 $252.65 $319.00 $255.20 $207.35 $63.31 $319.00 $185.02 $319.00 $319.00 $319.00 $66.48 $319.00 N/A N/A 80207950 EAP HCPCS C1769 V-14 CONTROL WIRE .014IN X 300CM 8CM ANGLED TIP BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $143.33 $143.33 $143.33 $143.33 $318.50 $318.50 $318.50 $66.38 $318.50 $318.50 $318.50 $318.50 $318.50 $66.38 $318.50 $318.50 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $143.33 $63.21 $318.50 $184.73 $318.50 $318.50 $318.50 $66.38 $318.50 N/A N/A 80207956 EAP HCPCS C1789 V-18 CONTROL WIRE .018IN X 110CM 8CM STRAIGHT TIP BOTH IP/OP $211.00 $156.50 $41.88 $211.00 $114.57 $114.57 $114.57 $114.57 $211.00 $211.00 $211.00 $43.98 $211.00 $156.60 $156.60 $162.64 $109.93 $43.97 $211.00 $211.00 $124.81 $211.00 $211.00 $211.00 $211.00 $158.25 $211.00 $211.00 $211.00 $105.50 $105.50 $167.11 $211.00 $168.80 $137.15 $41.88 $211.00 $122.38 $211.00 $211.00 $211.00 $43.97 $211.00 N/A N/A 80208051 EAP HCPCS C2617 STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 24CM BOTH IP/OP $266.00 $197.00 $52.79 $266.00 $119.70 $119.70 $119.70 $119.70 $266.00 $266.00 $266.00 $55.44 $266.00 $266.00 $266.00 $266.00 $266.00 $55.44 $266.00 $266.00 $157.34 $266.00 $266.00 $266.00 $266.00 $199.50 $266.00 $266.00 $266.00 $133.00 $133.00 $210.67 $266.00 $212.80 $119.70 $52.79 $266.00 $154.28 $266.00 $266.00 $266.00 $55.43 $266.00 N/A N/A 80208087 EAP HCPCS C1887 MCTH INFUS 150CM 3-2.8FR .027IN RNGD HFL HYDPHI BOTH IP/OP $721.00 $534.00 $143.10 $721.00 $391.50 $391.50 $391.50 $391.50 $721.00 $721.00 $721.00 $150.27 $721.00 $535.13 $535.13 $555.75 $375.64 $150.26 $721.00 $721.00 $426.47 $721.00 $721.00 $721.00 $721.00 $540.75 $721.00 $721.00 $721.00 $360.50 $360.50 $571.03 $721.00 $576.80 $468.65 $143.10 $721.00 $418.18 $721.00 $721.00 $721.00 $150.26 $721.00 N/A N/A 80208096 EAP HCPCS C1887 MCTH INFUS 130CM 3-2.4FR RNGD STC 18 90D PERI HDR BOTH IP/OP "$1,055.00" $781.00 $209.39 "$1,055.00" $572.87 $572.87 $572.87 $572.87 "$1,055.00" "$1,055.00" "$1,055.00" $219.89 "$1,055.00" $783.02 $783.02 $813.19 $549.66 $219.87 "$1,055.00" "$1,055.00" $624.03 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $791.25 "$1,055.00" "$1,055.00" "$1,055.00" $527.50 $527.50 $835.56 "$1,055.00" $844.00 $685.75 $209.39 "$1,055.00" $611.90 "$1,055.00" "$1,055.00" "$1,055.00" $219.86 "$1,055.00" N/A N/A 80208101 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .016IN STRBL MICROFABRICATE BOTH IP/OP $744.00 $551.00 $147.67 $744.00 $403.99 $403.99 $403.99 $403.99 $744.00 $744.00 $744.00 $155.07 $744.00 $552.20 $552.20 $573.48 $387.62 $155.06 $744.00 $744.00 $440.08 $744.00 $744.00 $744.00 $744.00 $558.00 $744.00 $744.00 $744.00 $372.00 $372.00 $589.25 $744.00 $595.20 $483.60 $147.67 $744.00 $431.52 $744.00 $744.00 $744.00 $155.05 $744.00 N/A N/A 80215246 EAP HCPCS C1887 CATHETER ANGIOGRAPHIC .038IN 21ML/SEC RADIAL TIGER CURVE STR BOTH IP/OP $88.00 $65.50 $17.47 $88.00 $47.78 $47.78 $47.78 $47.78 $88.00 $88.00 $88.00 $18.34 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $88.00 $52.05 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $17.47 $88.00 $51.04 $88.00 $88.00 $88.00 $18.34 $88.00 N/A N/A 80284625 EAP HCPCS C1887 CATHETER GUID 100CM 6FR LNCHR EBU3.75 CURVE CORON BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80298657 EAP HCPCS C1894 SET INTROD 25 5/8IN 6FR 8FR S ARWFLX PERC 3W STPCK BOTH IP/OP $257.00 $190.50 $51.01 $257.00 $139.55 $139.55 $139.55 $139.55 $257.00 $257.00 $257.00 $53.57 $257.00 $190.75 $190.75 $198.10 $133.90 $53.56 $257.00 $257.00 $152.02 $257.00 $257.00 $257.00 $257.00 $192.75 $257.00 $257.00 $257.00 $128.50 $128.50 $203.54 $257.00 $205.60 $167.05 $51.01 $257.00 $149.06 $257.00 $257.00 $257.00 $53.56 $257.00 N/A N/A 80300177 EAP HCPCS C1882 DEFIBRILLATOR CARDIAC BOTH IP/OP "$45,500.00" "$33,670.00" "$7,712.84" "$45,500.00" "$20,475.00" "$20,475.00" "$20,475.00" "$20,475.00" "$45,500.00" "$45,500.00" "$45,500.00" "$9,417.94" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$9,482.70" "$45,500.00" "$45,500.00" "$22,431.50" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$34,125.00" "$45,500.00" "$45,500.00" "$45,500.00" "$22,750.00" "$22,750.00" "$36,036.00" "$45,500.00" "$36,400.00" "$20,475.00" "$7,712.84" "$45,500.00" "$26,390.00" "$45,500.00" "$45,500.00" "$45,500.00" "$8,098.48" "$45,500.00" N/A N/A 80307573 EAP HCPCS C1729 TRAY SURG 14FR 18GA 29CM 5CM 19 SIDEPORT CATHETER ECHOGENIC BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80307582 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN CORE TO TIP RADIOPQ BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 $200.00 $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 80307621 EAP SYSTEM DTCH STRL LF INZONE DISP BOTH IP/OP $505.00 $374.00 $89.89 $505.00 $505.00 $505.00 $505.00 $505.00 $505.00 $505.00 $89.89 $505.00 $505.00 $505.00 $505.00 $505.00 $505.00 $105.25 $505.00 $202.00 $505.00 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $227.25 $505.00 $505.00 $292.90 $505.00 $303.00 $505.00 $505.00 $505.00 N/A N/A 80307684 EAP HCPCS C1766 INTROD SHTH 8.5FR STRBL CATH AGILIS NXT 22.4MM BOTH IP/OP "$2,000.00" "$1,480.00" $416.82 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,484.40" "$1,484.40" "$1,541.60" "$1,042.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" "$1,300.00" "$2,000.00" "$2,000.00" "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 80307685 EAP HCPCS C1766 INTROD SHTH 8.5FR 71CM 50MM GWIRE STRBL RADIOPQ BOTH IP/OP "$2,000.00" "$1,480.00" $416.82 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,484.40" "$1,484.40" "$1,541.60" "$1,042.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" "$1,300.00" "$2,000.00" "$2,000.00" "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 80307686 EAP HCPCS C1730 CABLE CATH BLUE 150CM RSPN EP BIPOL TRPLR QDPL BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80307688 EAP Custom 27204151 CABLE CATH BLK 150CM RSPN EP HEXPL OCTPL DCAPL BOTH IP/OP $225.00 $166.50 $40.05 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $40.05 $225.00 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $90.00 $225.00 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $225.00 $225.00 $130.50 $225.00 $135.00 $225.00 $225.00 $225.00 N/A N/A 80307694 EAP CABLE CATH SAFIRE EP GNTR INTFC BOTH IP/OP $375.00 $277.50 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $66.75 $375.00 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $150.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $375.00 $375.00 $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 80307719 EAP HCPCS C1894 SHEATH GUID 55CM 6FR 2.2MM FLXR CHK-FLO STR BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 $200.00 $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 80307720 EAP HCPCS C1894 SHEATH GUID 55CM 6FR 2.2MM FLXR HI-FLX CHK-FLO BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 $200.00 $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 80307768 EAP Custom 80307768 TARGET COILS 360 SOFT 3MM X 6CM BOTH IP/OP "$4,755.00" "$3,519.00" $846.39 "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" $846.39 "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" $990.99 "$4,755.00" "$1,902.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$3,566.25" "$4,755.00" "$4,755.00" "$4,755.00" "$2,377.50" "$2,377.50" "$3,765.96" "$4,755.00" "$3,804.00" "$2,139.75" "$4,755.00" "$4,755.00" "$2,757.90" "$4,755.00" "$2,853.00" "$4,755.00" "$4,755.00" "$4,755.00" N/A N/A 80307775 EAP Custom 80307775 COIL EMBOLIZATION 360D 5MM 10CM DETACHABLE SOFT TARGET BOTH IP/OP "$4,755.00" "$3,519.00" $846.39 "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" $846.39 "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" $990.99 "$4,755.00" "$1,902.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$3,566.25" "$4,755.00" "$4,755.00" "$4,755.00" "$2,377.50" "$2,377.50" "$3,765.96" "$4,755.00" "$3,804.00" "$2,139.75" "$4,755.00" "$4,755.00" "$2,757.90" "$4,755.00" "$2,853.00" "$4,755.00" "$4,755.00" "$4,755.00" N/A N/A 80307782 EAP Custom 27805308 COIL EMBOLIZATION TARGET 360 D L15 CM OD7 MM DETACHABLE SOFT BOTH IP/OP "$4,755.00" "$3,519.00" $846.39 "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" $846.39 "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" $990.99 "$4,755.00" "$1,902.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$3,566.25" "$4,755.00" "$4,755.00" "$4,755.00" "$2,377.50" "$2,377.50" "$3,765.96" "$4,755.00" "$3,804.00" "$2,139.75" "$4,755.00" "$4,755.00" "$2,757.90" "$4,755.00" "$2,853.00" "$4,755.00" "$4,755.00" "$4,755.00" N/A N/A 80307785 EAP Custom 27805311 COIL EMBOLIZATION TARGET 360 D L20 CM OD8 MM DETACHABLE SOFT BOTH IP/OP "$4,755.00" "$3,519.00" $846.39 "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" $846.39 "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" $990.99 "$4,755.00" "$1,902.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$4,755.00" "$3,566.25" "$4,755.00" "$4,755.00" "$4,755.00" "$2,377.50" "$2,377.50" "$3,765.96" "$4,755.00" "$3,804.00" "$2,139.75" "$4,755.00" "$4,755.00" "$2,757.90" "$4,755.00" "$2,853.00" "$4,755.00" "$4,755.00" "$4,755.00" N/A N/A 80307794 EAP Custom 80307794 COIL EMBOLIZATION HELICAL 1.5MM 1CM DETACHABLE ULTRA TARGET BOTH IP/OP "$3,322.00" "$2,458.50" $591.32 "$3,322.00" "$3,322.00" "$3,322.00" "$3,322.00" "$3,322.00" "$3,322.00" "$3,322.00" $591.32 "$3,322.00" "$3,322.00" "$3,322.00" "$3,322.00" "$3,322.00" "$3,322.00" $692.34 "$3,322.00" "$1,328.80" "$3,322.00" "$3,322.00" "$3,322.00" "$3,322.00" "$3,322.00" "$2,491.50" "$3,322.00" "$3,322.00" "$3,322.00" "$1,661.00" "$1,661.00" "$2,631.02" "$3,322.00" "$2,657.60" "$1,494.90" "$3,322.00" "$3,322.00" "$1,926.76" "$3,322.00" "$1,993.20" "$3,322.00" "$3,322.00" "$3,322.00" N/A N/A 80307825 EAP Custom 80307825 TARGET XL DETACHABLE COILS 360 SOFT 18 X 50CM BOTH IP/OP "$6,188.00" "$4,579.50" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,289.65" "$6,188.00" "$2,475.20" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$4,641.00" "$6,188.00" "$6,188.00" "$6,188.00" "$3,094.00" "$3,094.00" "$4,900.90" "$6,188.00" "$4,950.40" "$2,784.60" "$6,188.00" "$6,188.00" "$3,589.04" "$6,188.00" "$3,712.80" "$6,188.00" "$6,188.00" "$6,188.00" N/A N/A 80307826 EAP Custom 80307826 TARGET XL DETACHABLE COILS 360 SOFT 20 X 50CM BOTH IP/OP "$6,188.00" "$4,579.50" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,289.65" "$6,188.00" "$2,475.20" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$4,641.00" "$6,188.00" "$6,188.00" "$6,188.00" "$3,094.00" "$3,094.00" "$4,900.90" "$6,188.00" "$4,950.40" "$2,784.60" "$6,188.00" "$6,188.00" "$3,589.04" "$6,188.00" "$3,712.80" "$6,188.00" "$6,188.00" "$6,188.00" N/A N/A 80307832 EAP Custom 80307832 TARGET XL DETACHABLE COILS 360 STANDARD 12 X 45CM BOTH IP/OP "$6,188.00" "$4,579.50" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,289.65" "$6,188.00" "$2,475.20" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$4,641.00" "$6,188.00" "$6,188.00" "$6,188.00" "$3,094.00" "$3,094.00" "$4,900.90" "$6,188.00" "$4,950.40" "$2,784.60" "$6,188.00" "$6,188.00" "$3,589.04" "$6,188.00" "$3,712.80" "$6,188.00" "$6,188.00" "$6,188.00" N/A N/A 80307833 EAP Custom 80307833 TARGET XL DETACHABLE COILS 360 STANDARD 14 X 50CM BOTH IP/OP "$6,188.00" "$4,579.50" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,289.65" "$6,188.00" "$2,475.20" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$4,641.00" "$6,188.00" "$6,188.00" "$6,188.00" "$3,094.00" "$3,094.00" "$4,900.90" "$6,188.00" "$4,950.40" "$2,784.60" "$6,188.00" "$6,188.00" "$3,589.04" "$6,188.00" "$3,712.80" "$6,188.00" "$6,188.00" "$6,188.00" N/A N/A 80307835 EAP Custom 80307835 TARGET XL DETACHABLE COILS 360 STANDARD 18 X 50CM BOTH IP/OP "$6,188.00" "$4,579.50" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,289.65" "$6,188.00" "$2,475.20" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$4,641.00" "$6,188.00" "$6,188.00" "$6,188.00" "$3,094.00" "$3,094.00" "$4,900.90" "$6,188.00" "$4,950.40" "$2,784.60" "$6,188.00" "$6,188.00" "$3,589.04" "$6,188.00" "$3,712.80" "$6,188.00" "$6,188.00" "$6,188.00" N/A N/A 80307836 EAP Custom 80307836 TARGET XL DETACHABLE COILS 360 STANDARD 20 X 50CM BOTH IP/OP "$6,188.00" "$4,579.50" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,101.46" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$1,289.65" "$6,188.00" "$2,475.20" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$6,188.00" "$4,641.00" "$6,188.00" "$6,188.00" "$6,188.00" "$3,094.00" "$3,094.00" "$4,900.90" "$6,188.00" "$4,950.40" "$2,784.60" "$6,188.00" "$6,188.00" "$3,589.04" "$6,188.00" "$3,712.80" "$6,188.00" "$6,188.00" "$6,188.00" N/A N/A 80307951 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 20MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80307953 EAP HCPCS C1725 CATHETER BALDILAT 4MM 8MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80307954 EAP HCPCS C1725 CATHETER BALDILAT 4MM 12MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80307955 EAP HCPCS C1725 CATH BALDILAT .021IN 5FR 1.5MM 8MM CORON OTW FLXB TUNG MRKR BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80307960 EAP HCPCS C1725 CATHETER BALDILAT 2.25MM 20MM CORON RAPEX RADIOPQ BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $105.00 $175.00 $36.47 $175.00 N/A N/A 80307962 EAP HCPCS C1725 CATHETER BLNDIL 3.25MM 8MM NC TREK RX RADOPQ SMTH RND TIP BOTH IP/OP $213.00 $158.00 $42.28 $213.00 $115.66 $115.66 $115.66 $115.66 $213.00 $213.00 $213.00 $44.39 $213.00 $158.09 $158.09 $164.18 $110.97 $44.39 $213.00 $213.00 $125.99 $213.00 $213.00 $213.00 $213.00 $159.75 $213.00 $213.00 $213.00 $106.50 $106.50 $168.70 $213.00 $170.40 $138.45 $42.28 $213.00 $123.54 $213.00 $213.00 $213.00 $44.39 $213.00 N/A N/A 80307964 EAP HCPCS C1725 CATHETER BALDILAT 3.75MM 8MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80307965 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 8MM CORON RAPEX RADIOPQ BOTH IP/OP $213.00 $158.00 $42.28 $213.00 $115.66 $115.66 $115.66 $115.66 $213.00 $213.00 $213.00 $44.39 $213.00 $158.09 $158.09 $164.18 $110.97 $44.39 $213.00 $213.00 $125.99 $213.00 $213.00 $213.00 $213.00 $159.75 $213.00 $213.00 $213.00 $106.50 $106.50 $168.70 $213.00 $170.40 $138.45 $42.28 $213.00 $123.54 $213.00 $213.00 $213.00 $44.39 $213.00 N/A N/A 80307966 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 15MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80307967 EAP HCPCS C1725 CATHETER BALDILAT 5MM 15MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80308022 EAP HCPCS C1887 DEFIBRILLATOR CRD 40J UNIFY ASR RF TELEM DF1 IS-1 CNCT BOTH IP/OP "$24,250.00" "$17,945.00" "$4,813.02" "$24,250.00" "$10,912.50" "$10,912.50" "$10,912.50" "$10,912.50" "$24,250.00" "$24,250.00" "$24,250.00" "$5,054.31" "$24,250.00" "$24,250.00" "$24,250.00" "$24,250.00" "$24,250.00" "$5,053.97" "$24,250.00" "$24,250.00" "$11,955.25" "$24,250.00" "$24,250.00" "$24,250.00" "$24,250.00" "$18,187.50" "$24,250.00" "$24,250.00" "$24,250.00" "$12,125.00" "$12,125.00" "$19,206.00" "$24,250.00" "$19,400.00" "$10,912.50" "$4,813.02" "$24,250.00" "$14,065.00" "$24,250.00" "$24,250.00" "$24,250.00" "$5,053.70" "$24,250.00" N/A N/A 80308046 EAP 80308046 AGENT HMST SM DISC STRL STATSEAL TOP K FERRATE HDRPH PLMR BOTH IP/OP $225.00 $166.50 $40.05 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $40.05 $225.00 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $90.00 $225.00 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $225.00 $225.00 $130.50 $225.00 $135.00 $225.00 $225.00 $225.00 N/A N/A 80308067 EAP HCPCS C1894 INTRODUCER SHEATH 6FR 25CM 2.5CM DILAT KINK RESISTANT BOTH IP/OP $43.00 $32.00 $8.53 $43.00 $23.35 $23.35 $23.35 $23.35 $43.00 $43.00 $43.00 $8.96 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $43.00 $25.43 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $8.53 $43.00 $24.94 $43.00 $43.00 $43.00 $8.96 $43.00 N/A N/A 80308097 EAP HCPCS C1725 KIT CATH INS 8FR SNS PLUS STLK FO BLN IAB DEV 50CC BOTH IP/OP "$2,614.00" "$1,934.50" $518.81 "$2,614.00" "$1,419.40" "$1,419.40" "$1,419.40" "$1,419.40" "$2,614.00" "$2,614.00" "$2,614.00" $544.82 "$2,614.00" "$1,940.11" "$1,940.11" "$2,014.87" "$1,361.89" $544.79 "$2,614.00" "$2,614.00" "$1,546.18" "$2,614.00" "$2,614.00" "$2,614.00" "$2,614.00" "$1,960.50" "$2,614.00" "$2,614.00" "$2,614.00" "$1,307.00" "$1,307.00" "$2,070.29" "$2,614.00" "$2,091.20" "$1,699.10" $518.81 "$2,614.00" "$1,516.12" "$2,614.00" "$2,614.00" "$2,614.00" $544.76 "$2,614.00" N/A N/A 80308098 EAP HCPCS C1725 CATHETER IAB 6IN 7.5FR 16MM SNS PLUS .025IN 2 STLK BOTH IP/OP "$2,725.00" "$2,016.50" $540.84 "$2,725.00" "$1,479.68" "$1,479.68" "$1,479.68" "$1,479.68" "$2,725.00" "$2,725.00" "$2,725.00" $567.96 "$2,725.00" "$2,022.50" "$2,022.50" "$2,100.43" "$1,419.73" $567.92 "$2,725.00" "$2,725.00" "$1,611.84" "$2,725.00" "$2,725.00" "$2,725.00" "$2,725.00" "$2,043.75" "$2,725.00" "$2,725.00" "$2,725.00" "$1,362.50" "$1,362.50" "$2,158.20" "$2,725.00" "$2,180.00" "$1,771.25" $540.84 "$2,725.00" "$1,580.50" "$2,725.00" "$2,725.00" "$2,725.00" $567.89 "$2,725.00" N/A N/A 80308211 EAP HCPCS C1894 KIT INTROD 10CM 6FR 21GA GLIDESHEATH SLNDR .021IN BOTH IP/OP $138.00 $102.50 $27.39 $138.00 $74.93 $74.93 $74.93 $74.93 $138.00 $138.00 $138.00 $28.76 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $138.00 $81.63 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $27.39 $138.00 $80.04 $138.00 $138.00 $138.00 $28.76 $138.00 N/A N/A 80308219 EAP HCPCS C1769 GUIDEWIRE VASCULAR ANGLE STANDARD .035IN 180CM 3CM BOTH IP/OP $108.00 $80.00 $21.44 $108.00 $58.64 $58.64 $58.64 $58.64 $108.00 $108.00 $108.00 $22.51 $108.00 $80.16 $80.16 $83.25 $56.27 $22.51 $108.00 $108.00 $63.88 $108.00 $108.00 $108.00 $108.00 $81.00 $108.00 $108.00 $108.00 $54.00 $54.00 $85.54 $108.00 $86.40 $70.20 $21.44 $108.00 $62.64 $108.00 $108.00 $108.00 $22.51 $108.00 N/A N/A 80308230 EAP CPT® C1751 KIT CATH .014IN 5ML/SEC 20GA 8CM 1.3IN POWERGLIDE FULL MDLN BOTH IP/OP $208.00 $154.00 $41.28 $208.00 $112.94 $112.94 $112.94 $112.94 $208.00 $208.00 $208.00 $43.35 $208.00 $154.38 $154.38 $160.33 $108.37 $43.35 $208.00 $208.00 $123.03 $208.00 $208.00 $208.00 $208.00 $156.00 $208.00 $208.00 $208.00 $104.00 $104.00 $164.74 $208.00 $166.40 $135.20 $41.28 $208.00 $120.64 $208.00 $208.00 $208.00 $43.35 $208.00 N/A N/A 80308231 EAP CPT® C1751 KIT CATH 5ML/SEC FULL 20GA 10CM POWERGLIDE MDLN PWR INJ IV BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 $205.00 $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A 80308259 EAP HCPCS C1817 OCCLUDER CARDIO 4MM 22MM 32-36MM SPT 2 DISC SLF BOTH IP/OP "$15,163.00" "$11,221.00" "$3,160.14" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$3,160.14" "$15,163.00" "$6,065.20" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$11,372.25" "$15,163.00" "$15,163.00" "$15,163.00" "$7,581.50" "$7,581.50" "$12,009.10" "$15,163.00" "$12,130.40" "$6,823.35" "$15,163.00" "$15,163.00" "$8,794.54" "$15,163.00" "$9,097.80" "$15,163.00" "$15,163.00" "$15,163.00" N/A N/A 80308260 EAP HCPCS C1817 OCCLUDER CARDIO 4MM 24MM 34-38MM SPT 2 DISC SLF BOTH IP/OP "$15,163.00" "$11,221.00" "$3,160.14" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$3,160.14" "$15,163.00" "$6,065.20" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$15,163.00" "$11,372.25" "$15,163.00" "$15,163.00" "$15,163.00" "$7,581.50" "$7,581.50" "$12,009.10" "$15,163.00" "$12,130.40" "$6,823.35" "$15,163.00" "$15,163.00" "$8,794.54" "$15,163.00" "$9,097.80" "$15,163.00" "$15,163.00" "$15,163.00" N/A N/A 80308262 EAP Custom 80308262 CATHETER DLV SYS 45D 10FR 80CM LFRIC RADIOPQ TIP BOTH IP/OP "$1,630.00" "$1,206.50" $290.14 "$1,630.00" "$1,630.00" "$1,630.00" "$1,630.00" "$1,630.00" "$1,630.00" "$1,630.00" $290.14 "$1,630.00" "$1,630.00" "$1,209.79" "$1,209.79" "$1,256.40" $849.23 $339.71 "$1,630.00" $652.00 "$1,630.00" "$1,630.00" "$1,630.00" "$1,630.00" "$1,630.00" "$1,222.50" "$1,630.00" "$1,630.00" "$1,630.00" $815.00 $815.00 "$1,290.96" "$1,630.00" "$1,304.00" "$1,059.50" "$1,630.00" "$1,630.00" $945.40 "$1,630.00" $978.00 "$1,630.00" "$1,630.00" "$1,630.00" N/A N/A 80308264 EAP Custom 80308264 BALLOON SZ 70CM 40MM AMPLZR 3 LUM RADIOPQ SFT BOTH IP/OP $690.00 $511.00 $122.82 $690.00 $690.00 $690.00 $690.00 $690.00 $690.00 $690.00 $122.82 $690.00 $690.00 $512.12 $512.12 $531.85 $359.49 $143.80 $690.00 $276.00 $690.00 $690.00 $690.00 $690.00 $690.00 $517.50 $690.00 $690.00 $690.00 $345.00 $345.00 $546.48 $690.00 $552.00 $448.50 $690.00 $690.00 $400.20 $690.00 $414.00 $690.00 $690.00 $690.00 N/A N/A 80308265 EAP HCPCS C1759 CATHETER US CNSL VIEWFLEXXICE VIEWMATE BOTH IP/OP "$7,000.00" "$5,180.00" "$1,458.88" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$4,181.12" "$4,181.12" "$5,395.60" "$2,060.15" "$1,458.88" "$7,000.00" "$2,800.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$5,250.00" "$7,000.00" "$7,000.00" "$7,000.00" "$3,500.00" "$3,500.00" "$5,544.00" "$7,000.00" "$5,600.00" "$4,550.00" "$7,000.00" "$7,000.00" "$4,060.00" "$7,000.00" "$4,200.00" "$7,000.00" "$7,000.00" "$7,000.00" N/A N/A 80308271 EAP Custom 80308271 PAD INSTR 2 PATIENT TRACKER ALWAYS-ON TIP TRACKED SPIN DRIVE BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $400.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" "$1,000.00" $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A 80308274 EAP Custom 80308274 BRUSH CYTOLOGY ALWAYS-ON TIP TRACKED SPIN DRIVE L15 MM BOTH IP/OP "$1,418.00" "$1,049.50" $252.40 "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" $252.40 "$1,418.00" "$1,418.00" "$1,052.44" "$1,052.44" "$1,092.99" $738.78 $295.53 "$1,418.00" $567.20 "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,063.50" "$1,418.00" "$1,418.00" "$1,418.00" $709.00 $709.00 "$1,123.06" "$1,418.00" "$1,134.40" $921.70 "$1,418.00" "$1,418.00" $822.44 "$1,418.00" $850.80 "$1,418.00" "$1,418.00" "$1,418.00" N/A N/A 80308275 EAP Custom 80308275 FORCEPS BIOPSY ALWAYS-ON TIP TRACKED SPIN DRIVE L900 BOTH IP/OP "$1,418.00" "$1,049.50" $252.40 "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" $252.40 "$1,418.00" "$1,418.00" "$1,052.44" "$1,052.44" "$1,092.99" $738.78 $295.53 "$1,418.00" $567.20 "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,063.50" "$1,418.00" "$1,418.00" "$1,418.00" $709.00 $709.00 "$1,123.06" "$1,418.00" "$1,134.40" $921.70 "$1,418.00" "$1,418.00" $822.44 "$1,418.00" $850.80 "$1,418.00" "$1,418.00" "$1,418.00" N/A N/A 80308278 EAP Custom 80308278 BIOPSY NEEDLE ANSO ALWAYS-ON TIP TRACKED SPIN DRIVE OD21 BOTH IP/OP "$1,418.00" "$1,049.50" $252.40 "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" $252.40 "$1,418.00" "$1,418.00" "$1,052.44" "$1,052.44" "$1,092.99" $738.78 $295.53 "$1,418.00" $567.20 "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,418.00" "$1,063.50" "$1,418.00" "$1,418.00" "$1,418.00" $709.00 $709.00 "$1,123.06" "$1,418.00" "$1,134.40" $921.70 "$1,418.00" "$1,418.00" $822.44 "$1,418.00" $850.80 "$1,418.00" "$1,418.00" "$1,418.00" N/A N/A 80308295 EAP HCPCS C1753 CATHETER US 20MHZ SHRT TPR 5FR 2.9FR 150CM 24CM BOTH IP/OP "$1,813.00" "$1,342.00" $359.84 "$1,813.00" $984.46 $984.46 $984.46 $984.46 "$1,813.00" "$1,813.00" "$1,813.00" $377.87 "$1,813.00" "$1,345.61" "$1,345.61" "$1,397.46" $944.57 $377.85 "$1,813.00" "$1,813.00" "$1,072.39" "$1,813.00" "$1,813.00" "$1,813.00" "$1,813.00" "$1,359.75" "$1,813.00" "$1,813.00" "$1,813.00" $906.50 $906.50 "$1,435.90" "$1,813.00" "$1,450.40" "$1,178.45" $359.84 "$1,813.00" "$1,051.54" "$1,813.00" "$1,813.00" "$1,813.00" $377.83 "$1,813.00" N/A N/A 80308316 EAP HCPCS C1769 GUIDEWIRE VASCULAR STR .014IN BOTH IP/OP $759.00 $562.00 $150.64 $759.00 $412.14 $412.14 $412.14 $412.14 $759.00 $759.00 $759.00 $158.19 $759.00 $563.33 $563.33 $585.04 $395.44 $158.18 $759.00 $759.00 $448.95 $759.00 $759.00 $759.00 $759.00 $569.25 $759.00 $759.00 $759.00 $379.50 $379.50 $601.13 $759.00 $607.20 $493.35 $150.64 $759.00 $440.22 $759.00 $759.00 $759.00 $158.18 $759.00 N/A N/A 80308564 EAP HCPCS C1725 CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 15MM SPNTR LGND BOTH IP/OP $413.00 $306.00 $81.97 $413.00 $224.26 $224.26 $224.26 $224.26 $413.00 $413.00 $413.00 $86.08 $413.00 $306.53 $306.53 $318.34 $215.17 $86.07 $413.00 $413.00 $244.29 $413.00 $413.00 $413.00 $413.00 $309.75 $413.00 $413.00 $413.00 $206.50 $206.50 $327.10 $413.00 $330.40 $268.45 $81.97 $413.00 $239.54 $413.00 $413.00 $413.00 $86.07 $413.00 N/A N/A 80308611 EAP HCPCS C1760 DEVICE CLSR 5FR VASCADE FEM ART BOTH IP/OP $525.00 $388.50 $104.20 $525.00 $236.25 $236.25 $236.25 $236.25 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $310.54 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $236.25 $104.20 $525.00 $304.50 $525.00 $525.00 $525.00 $109.41 $525.00 N/A N/A 80308612 EAP HCPCS C1760 SYSTEM CMPR 6/7FR VASCADE VASC CLGN BABSR BOTH IP/OP $525.00 $388.50 $104.20 $525.00 $236.25 $236.25 $236.25 $236.25 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $310.54 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $236.25 $104.20 $525.00 $304.50 $525.00 $525.00 $525.00 $109.41 $525.00 N/A N/A 80308625 EAP HCPCS C1733 CATHETER CRYOABLATION 3-5-2MM SPACE 55MM MEDIUM 9FR 90CM 8MM BOTH IP/OP "$4,750.00" "$3,515.00" $942.76 "$4,750.00" "$2,579.25" "$2,579.25" "$2,579.25" "$2,579.25" "$4,750.00" "$4,750.00" "$4,750.00" $990.02 "$4,750.00" "$3,525.45" "$3,525.45" "$3,661.30" "$2,060.15" $989.95 "$4,750.00" "$4,750.00" "$2,809.63" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$3,087.50" $942.76 "$4,750.00" "$2,755.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.90 "$4,750.00" N/A N/A 80308630 EAP HCPCS C1733 CATHETER CRYOABLATION 2-5-2MM BOTH IP/OP "$3,125.00" "$2,312.50" $620.23 "$3,125.00" "$1,696.88" "$1,696.88" "$1,696.88" "$1,696.88" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$2,319.38" "$2,319.38" "$2,408.75" "$1,628.13" $651.28 "$3,125.00" "$3,125.00" "$1,848.44" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$2,031.25" $620.23 "$3,125.00" "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 80308633 EAP CABLE CATHETER COAXIAL UMBILICAL DISPOSABLE BOTH IP/OP $260.00 $192.50 $46.28 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $46.28 $260.00 $260.00 $192.97 $192.97 $200.41 $135.46 $54.19 $260.00 $104.00 $260.00 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $169.00 $260.00 $260.00 $150.80 $260.00 $156.00 $260.00 $260.00 $260.00 N/A N/A 80308640 EAP HCPCS C1730 CATHETER ELECTROPHYSIOLOGY 3D BOTH IP/OP "$2,375.00" "$1,757.50" $471.38 "$2,375.00" "$1,289.63" "$1,289.63" "$1,289.63" "$1,289.63" "$2,375.00" "$2,375.00" "$2,375.00" $495.01 "$2,375.00" "$1,762.73" "$1,762.73" "$1,830.65" "$1,237.38" $494.98 "$2,375.00" "$2,375.00" "$1,404.81" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,543.75" $471.38 "$2,375.00" "$1,377.50" "$2,375.00" "$2,375.00" "$2,375.00" $494.95 "$2,375.00" N/A N/A 80308718 EAP HCPCS C1876 STENT VASC 6MM 100MM 120CM EVE BOTH IP/OP "$3,375.00" "$2,497.50" $669.85 "$3,375.00" "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$3,375.00" "$3,375.00" "$3,375.00" $703.43 "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" $703.39 "$3,375.00" "$3,375.00" "$1,663.88" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$2,531.25" "$3,375.00" "$3,375.00" "$3,375.00" "$1,687.50" "$1,687.50" "$2,673.00" "$3,375.00" "$2,700.00" "$1,518.75" $669.85 "$3,375.00" "$1,957.50" "$3,375.00" "$3,375.00" "$3,375.00" $703.35 "$3,375.00" N/A N/A 80308757 EAP Custom 27805656 OG TDL CMPLX FILL COIL 8X24 BOTH IP/OP "$4,364.00" "$3,229.50" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $909.51 "$4,364.00" "$1,745.60" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$3,273.00" "$4,364.00" "$4,364.00" "$4,364.00" "$2,182.00" "$2,182.00" "$3,456.29" "$4,364.00" "$3,491.20" "$1,963.80" "$4,364.00" "$4,364.00" "$2,531.12" "$4,364.00" "$2,618.40" "$4,364.00" "$4,364.00" "$4,364.00" N/A N/A 80308759 EAP Custom 80308759 COIL EMBOLIZATION 9MM 25CM COM BOTH IP/OP "$4,364.00" "$3,229.50" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $909.51 "$4,364.00" "$1,745.60" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$3,273.00" "$4,364.00" "$4,364.00" "$4,364.00" "$2,182.00" "$2,182.00" "$3,456.29" "$4,364.00" "$3,491.20" "$1,963.80" "$4,364.00" "$4,364.00" "$2,531.12" "$4,364.00" "$2,618.40" "$4,364.00" "$4,364.00" "$4,364.00" N/A N/A 80308760 EAP Custom 80308760 COIL EMBOLIZATION 10MM 30CM CO BOTH IP/OP "$4,364.00" "$3,229.50" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $909.51 "$4,364.00" "$1,745.60" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$3,273.00" "$4,364.00" "$4,364.00" "$4,364.00" "$2,182.00" "$2,182.00" "$3,456.29" "$4,364.00" "$3,491.20" "$1,963.80" "$4,364.00" "$4,364.00" "$2,531.12" "$4,364.00" "$2,618.40" "$4,364.00" "$4,364.00" "$4,364.00" N/A N/A 80308761 EAP Custom 80308761 COIL EMBOLIZATION 12MM 30CM CO BOTH IP/OP "$4,364.00" "$3,229.50" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $909.51 "$4,364.00" "$1,745.60" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$3,273.00" "$4,364.00" "$4,364.00" "$4,364.00" "$2,182.00" "$2,182.00" "$3,456.29" "$4,364.00" "$3,491.20" "$1,963.80" "$4,364.00" "$4,364.00" "$2,531.12" "$4,364.00" "$2,618.40" "$4,364.00" "$4,364.00" "$4,364.00" N/A N/A 80308813 EAP Custom 80308813 COIL EMBOLIZATION 2MM 1.5CM CO BOTH IP/OP "$4,364.00" "$3,229.50" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $909.51 "$4,364.00" "$1,745.60" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$3,273.00" "$4,364.00" "$4,364.00" "$4,364.00" "$2,182.00" "$2,182.00" "$3,456.29" "$4,364.00" "$3,491.20" "$1,963.80" "$4,364.00" "$4,364.00" "$2,531.12" "$4,364.00" "$2,618.40" "$4,364.00" "$4,364.00" "$4,364.00" N/A N/A 80308815 EAP Custom 80308815 COIL EMBOLIZATION 3MM 3CM COMP BOTH IP/OP "$4,364.00" "$3,229.50" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $909.51 "$4,364.00" "$1,745.60" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$3,273.00" "$4,364.00" "$4,364.00" "$4,364.00" "$2,182.00" "$2,182.00" "$3,456.29" "$4,364.00" "$3,491.20" "$1,963.80" "$4,364.00" "$4,364.00" "$2,531.12" "$4,364.00" "$2,618.40" "$4,364.00" "$4,364.00" "$4,364.00" N/A N/A 80308823 EAP Custom 80308823 COIL EMBOLIZATION 2.5MM 5CM CO BOTH IP/OP "$4,364.00" "$3,229.50" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $909.51 "$4,364.00" "$1,745.60" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$3,273.00" "$4,364.00" "$4,364.00" "$4,364.00" "$2,182.00" "$2,182.00" "$3,456.29" "$4,364.00" "$3,491.20" "$1,963.80" "$4,364.00" "$4,364.00" "$2,531.12" "$4,364.00" "$2,618.40" "$4,364.00" "$4,364.00" "$4,364.00" N/A N/A 80308827 EAP OG CMPLX XTRASOFT COIL 3.5X9 BOTH IP/OP "$4,364.00" "$3,229.50" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $909.51 "$4,364.00" "$1,745.60" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$3,273.00" "$4,364.00" "$4,364.00" "$4,364.00" "$2,182.00" "$2,182.00" "$3,456.29" "$4,364.00" "$3,491.20" "$1,963.80" "$4,364.00" "$4,364.00" "$2,531.12" "$4,364.00" "$2,618.40" "$4,364.00" "$4,364.00" "$4,364.00" N/A N/A 80308828 EAP Custom 80308828 COIL EMBOLIZATION 3.5MM 7.5CM BOTH IP/OP "$4,364.00" "$3,229.50" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $776.79 "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" $909.51 "$4,364.00" "$1,745.60" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$4,364.00" "$3,273.00" "$4,364.00" "$4,364.00" "$4,364.00" "$2,182.00" "$2,182.00" "$3,456.29" "$4,364.00" "$3,491.20" "$1,963.80" "$4,364.00" "$4,364.00" "$2,531.12" "$4,364.00" "$2,618.40" "$4,364.00" "$4,364.00" "$4,364.00" N/A N/A 80308829 EAP Custom 80308829 COIL EMBOLIZATION 2MM 4CM HELI BOTH IP/OP "$3,333.00" "$2,466.50" $593.27 "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" $593.27 "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" $694.63 "$3,333.00" "$1,333.20" "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" "$2,499.75" "$3,333.00" "$3,333.00" "$3,333.00" "$1,666.50" "$1,666.50" "$2,639.74" "$3,333.00" "$2,666.40" "$1,499.85" "$3,333.00" "$3,333.00" "$1,933.14" "$3,333.00" "$1,999.80" "$3,333.00" "$3,333.00" "$3,333.00" N/A N/A 80308831 EAP Custom 80308831 COIL EMBOLIZATION 2MM 8CM HELI BOTH IP/OP "$3,333.00" "$2,466.50" $593.27 "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" $593.27 "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" $694.63 "$3,333.00" "$1,333.20" "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" "$3,333.00" "$2,499.75" "$3,333.00" "$3,333.00" "$3,333.00" "$1,666.50" "$1,666.50" "$2,639.74" "$3,333.00" "$2,666.40" "$1,499.85" "$3,333.00" "$3,333.00" "$1,933.14" "$3,333.00" "$1,999.80" "$3,333.00" "$3,333.00" "$3,333.00" N/A N/A 80308854 EAP HCPCS C1769 KIT PROCEDURE .035IN 21GA 90CM BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $543.00 $543.00 $543.00 $543.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" "$1,000.00" $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 $198.48 "$1,000.00" $580.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.40 "$1,000.00" N/A N/A 80308874 EAP HCPCS C1887 CATHETER GUID .018IN 150CM SUP BOTH IP/OP $508.00 $376.00 $100.83 $508.00 $275.84 $275.84 $275.84 $275.84 $508.00 $508.00 $508.00 $105.88 $508.00 $377.04 $377.04 $391.57 $264.67 $105.87 $508.00 $508.00 $300.48 $508.00 $508.00 $508.00 $508.00 $381.00 $508.00 $508.00 $508.00 $254.00 $254.00 $402.34 $508.00 $406.40 $330.20 $100.83 $508.00 $294.64 $508.00 $508.00 $508.00 $105.87 $508.00 N/A N/A 80308880 EAP HCPCS C1887 CATHETER SPRT 150CM 1.5FR .026-.039IN QKCRS 15MM BOTH IP/OP $430.00 $318.50 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 $430.00 $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A 80308883 EAP Custom 80308883 QUICK CROSS 4F .018IN X 150CM BOTH IP/OP $430.00 $318.50 $76.54 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $76.54 $430.00 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $172.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $430.00 $430.00 $249.40 $430.00 $258.00 $430.00 $430.00 $430.00 N/A N/A 80308885 EAP HCPCS C1887 CATHETER GUID .035IN 4.8-3.7FR 90CM LOW CROSSING P BOTH IP/OP $418.00 $309.50 $82.96 $418.00 $226.97 $226.97 $226.97 $226.97 $418.00 $418.00 $418.00 $87.12 $418.00 $310.24 $310.24 $322.19 $217.78 $87.12 $418.00 $418.00 $247.25 $418.00 $418.00 $418.00 $418.00 $313.50 $418.00 $418.00 $418.00 $209.00 $209.00 $331.06 $418.00 $334.40 $271.70 $82.96 $418.00 $242.44 $418.00 $418.00 $418.00 $87.11 $418.00 N/A N/A 80308887 EAP HCPCS C1887 CATHETER SPRT 150CM 3.1FR .05-.063IN QKCRS 50MM BOTH IP/OP $418.00 $309.50 $82.96 $418.00 $226.97 $226.97 $226.97 $226.97 $418.00 $418.00 $418.00 $87.12 $418.00 $310.24 $310.24 $322.19 $217.78 $87.12 $418.00 $418.00 $247.25 $418.00 $418.00 $418.00 $418.00 $313.50 $418.00 $418.00 $418.00 $209.00 $209.00 $331.06 $418.00 $334.40 $271.70 $82.96 $418.00 $242.44 $418.00 $418.00 $418.00 $87.11 $418.00 N/A N/A 80308888 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN CORE TO TIP RADIOPQ BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $162.90 $162.90 $162.90 $162.90 $300.00 $300.00 $300.00 $62.53 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $59.54 $300.00 $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 80308889 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN CORE TO TIP RADIOPQ BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $162.90 $162.90 $162.90 $162.90 $300.00 $300.00 $300.00 $62.53 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $59.54 $300.00 $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 80308892 EAP HCPCS C1729 KIT PRESSURE MONITR 38CM TRANSDUCER CATHETER TUNNELING BOTH IP/OP "$2,146.00" "$1,588.50" $425.93 "$2,146.00" "$1,165.28" "$1,165.28" "$1,165.28" "$1,165.28" "$2,146.00" "$2,146.00" "$2,146.00" $447.28 "$2,146.00" "$1,592.76" "$1,592.76" "$1,654.14" "$1,118.07" $447.25 "$2,146.00" "$2,146.00" "$1,269.36" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$1,609.50" "$2,146.00" "$2,146.00" "$2,146.00" "$1,073.00" "$1,073.00" "$1,699.63" "$2,146.00" "$1,716.80" "$1,394.90" $425.93 "$2,146.00" "$1,244.68" "$2,146.00" "$2,146.00" "$2,146.00" $447.23 "$2,146.00" N/A N/A 80308949 EAP HCPCS C1724 SYSTEM ATHRCM 135CM 1.25MM RTBL RTL+ DMD PRECNCT BOTH IP/OP "$3,092.00" "$2,288.50" $644.41 "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$2,294.88" "$2,294.88" "$2,383.31" "$1,610.93" $644.41 "$3,092.00" "$1,236.80" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$2,319.00" "$3,092.00" "$3,092.00" "$3,092.00" "$1,546.00" "$1,546.00" "$2,448.86" "$3,092.00" "$2,473.60" "$2,009.80" "$3,092.00" "$3,092.00" "$1,793.36" "$3,092.00" "$1,855.20" "$3,092.00" "$3,092.00" "$3,092.00" N/A N/A 80308950 EAP HCPCS C1724 SYSTEM ATHRCM 135CM 1.5MM RTBL RTL+ DMD PRECNCT BOTH IP/OP "$2,988.00" "$2,211.50" $622.73 "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,217.69" "$2,217.69" "$2,303.15" "$1,556.75" $622.73 "$2,988.00" "$1,195.20" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,942.20" "$2,988.00" "$2,988.00" "$1,733.04" "$2,988.00" "$1,792.80" "$2,988.00" "$2,988.00" "$2,988.00" N/A N/A 80308951 EAP HCPCS C1724 SYSTEM ATHRCM 135CM 1.75MM RTBL RTL+ DMD PRECNCT BOTH IP/OP "$3,092.00" "$2,288.50" $644.41 "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$2,294.88" "$2,294.88" "$2,383.31" "$1,610.93" $644.41 "$3,092.00" "$1,236.80" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$3,092.00" "$2,319.00" "$3,092.00" "$3,092.00" "$3,092.00" "$1,546.00" "$1,546.00" "$2,448.86" "$3,092.00" "$2,473.60" "$2,009.80" "$3,092.00" "$3,092.00" "$1,793.36" "$3,092.00" "$1,855.20" "$3,092.00" "$3,092.00" "$3,092.00" N/A N/A 80308952 EAP HCPCS C1894 OBTURATOR SHEATH 5FR 10CM 5MM FLEXIBLE BOTH IP/OP $10.00 $7.50 $1.98 $10.00 $5.43 $5.43 $5.43 $5.43 $10.00 $10.00 $10.00 $2.08 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $10.00 $5.92 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $1.98 $10.00 $5.80 $10.00 $10.00 $10.00 $2.08 $10.00 N/A N/A 80308954 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN ATRM X FLPY TIP BOTH IP/OP $213.00 $158.00 $42.28 $213.00 $115.66 $115.66 $115.66 $115.66 $213.00 $213.00 $213.00 $44.39 $213.00 $158.09 $158.09 $164.18 $110.97 $44.39 $213.00 $213.00 $125.99 $213.00 $213.00 $213.00 $213.00 $159.75 $213.00 $213.00 $213.00 $106.50 $106.50 $168.70 $213.00 $170.40 $138.45 $42.28 $213.00 $123.54 $213.00 $213.00 $213.00 $44.39 $213.00 N/A N/A 80308956 EAP HCPCS C1887 CATHETER GUID 150CM 1.8-2.6FR FINECROSS MG CORON BOTH IP/OP "$1,063.00" $787.00 $210.98 "$1,063.00" $577.21 $577.21 $577.21 $577.21 "$1,063.00" "$1,063.00" "$1,063.00" $221.56 "$1,063.00" $788.96 $788.96 $819.36 $553.82 $221.54 "$1,063.00" "$1,063.00" $628.76 "$1,063.00" "$1,063.00" "$1,063.00" "$1,063.00" $797.25 "$1,063.00" "$1,063.00" "$1,063.00" $531.50 $531.50 $841.90 "$1,063.00" $850.40 $690.95 $210.98 "$1,063.00" $616.54 "$1,063.00" "$1,063.00" "$1,063.00" $221.53 "$1,063.00" N/A N/A 80308957 EAP HCPCS C1769 GUIDEWIRE VASC 330CM .014IN SPRG TIP X SPRT STF BOTH IP/OP "$2,070.00" "$1,532.00" $410.84 "$2,070.00" "$1,124.01" "$1,124.01" "$1,124.01" "$1,124.01" "$2,070.00" "$2,070.00" "$2,070.00" $431.44 "$2,070.00" "$1,536.35" "$1,536.35" "$1,595.56" "$1,078.47" $431.41 "$2,070.00" "$2,070.00" "$1,224.41" "$2,070.00" "$2,070.00" "$2,070.00" "$2,070.00" "$1,552.50" "$2,070.00" "$2,070.00" "$2,070.00" "$1,035.00" "$1,035.00" "$1,639.44" "$2,070.00" "$1,656.00" "$1,345.50" $410.84 "$2,070.00" "$1,200.60" "$2,070.00" "$2,070.00" "$2,070.00" $431.39 "$2,070.00" N/A N/A 80308958 EAP HCPCS C1769 GUIDEWIRE VASC 330CM .014IN FLPY FLXB SPRG TIP 2.2 BOTH IP/OP $414.00 $306.50 $82.17 $414.00 $224.80 $224.80 $224.80 $224.80 $414.00 $414.00 $414.00 $86.29 $414.00 $307.27 $307.27 $319.11 $215.69 $86.28 $414.00 $414.00 $244.88 $414.00 $414.00 $414.00 $414.00 $310.50 $414.00 $414.00 $414.00 $207.00 $207.00 $327.89 $414.00 $331.20 $269.10 $82.17 $414.00 $240.12 $414.00 $414.00 $414.00 $86.28 $414.00 N/A N/A 80308961 EAP HCPCS C1887 CATH INFUS MIC 1.9FR 1.25MM .5MM 3CM DLV DRBLTY DTCH TIP BOTH IP/OP "$5,498.00" "$4,069.00" "$1,091.22" "$5,498.00" "$2,985.41" "$2,985.41" "$2,985.41" "$2,985.41" "$5,498.00" "$5,498.00" "$5,498.00" "$1,145.92" "$5,498.00" "$4,080.62" "$4,080.62" "$4,237.86" "$2,060.15" "$1,145.84" "$5,498.00" "$5,498.00" "$3,094.73" "$5,498.00" "$5,498.00" "$5,498.00" "$5,498.00" "$4,123.50" "$5,498.00" "$5,498.00" "$5,498.00" "$2,749.00" "$2,749.00" "$4,354.42" "$5,498.00" "$4,398.40" "$3,573.70" "$1,091.22" "$5,498.00" "$3,188.84" "$5,498.00" "$5,498.00" "$5,498.00" "$1,145.78" "$5,498.00" N/A N/A 80308964 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .035IN FLXB CORE TO TIP BOTH IP/OP $496.00 $367.50 $98.44 $496.00 $269.33 $269.33 $269.33 $269.33 $496.00 $496.00 $496.00 $103.38 $496.00 $368.13 $368.13 $382.32 $258.42 $103.37 $496.00 $496.00 $293.38 $496.00 $496.00 $496.00 $496.00 $372.00 $496.00 $496.00 $496.00 $248.00 $248.00 $392.83 $496.00 $396.80 $322.40 $98.44 $496.00 $287.68 $496.00 $496.00 $496.00 $103.37 $496.00 N/A N/A 80308966 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN KINK RST RADIOPQ STRBL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80308967 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN CORE TO TIP RADIOPQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80308968 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN CORE TO TIP RADIOPQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80308971 EAP HCPCS C1730 CATHETER EP 65CM 6FR RSPN 5-5-5MM SPC CSL CURVE MP BOTH IP/OP $875.00 $647.50 $173.67 $875.00 $475.13 $475.13 $475.13 $475.13 $875.00 $875.00 $875.00 $182.37 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $173.67 $875.00 $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 80308973 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN CORE TO TIP RADIOPQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80309131 EAP HCPCS C1725 OTW MINI TREK II 1.20 X 12MM BDC BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80309147 EAP HCPCS C1725 MINI TREK RX 2.00 X 6MM BDC BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80309150 EAP HCPCS C1725 MINI TREK RX 2.25 X 6MM BDC BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80309151 EAP HCPCS C1725 MINI TREK RX 2.25 X 8MM BDC BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80309152 EAP HCPCS C1725 CATHETER BALDILAT 2.25MM 12MM CORON RAPEX ULT LP BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80309154 EAP HCPCS C1725 MINI TREK RX 2.25 X 20MM BDC BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80309155 EAP HCPCS C1725 MINI TREK RX 2.25 X 25MM BDC BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80309156 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM 30MM TREK SLIM SL RX ULT LOPRFL BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80309159 EAP HCPCS C1725 TREK RX 2.75 X 6MM BDC BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80309161 EAP HCPCS C1725 TREK RX 2.75 X 12MM BDC BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80309162 EAP HCPCS C1725 TREK RX 2.75 X 15MM BDC BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80309166 EAP HCPCS C1725 CATHETER BALDILAT 3MM 6MM CORON RAPEX ULT LP BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 80309170 EAP HCPCS C1725 TREK RX 3.25 X 12MM BDC BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80309175 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 6MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 80309176 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 30MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80309185 EAP HCPCS C1725 CATHETER BALDILAT 4MM 20MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80309186 EAP HCPCS C1725 CATHETER BALDILAT 4MM 25MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80309187 EAP HCPCS C1725 CATHETER BALDILAT 4MM 30MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80309193 EAP HCPCS C1725 CATHETER BALDILAT 2MM 15MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80309195 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM 6MM NC TREK RX RADOPQ SMTH RND TIP BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80309196 EAP HCPCS C1725 NC TREK RX 3.25 X 06MM BDC BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80309197 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 20MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80309198 EAP HCPCS C1725 CATHETER BALDILAT 5MM 20MM CORON RAPEX RADIOPQ BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80309200 EAP HCPCS C1876 SYSTEM CORON STENT 12MM 2.75MM MTLNK VSN COCR BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80309201 EAP HCPCS C1876 SYSTEM CORON STENT 15MM 2.75MM MTLNK VSN COCR BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80309203 EAP HCPCS C1876 SYSTEM CORON STENT 23MM 2.75MM MTLNK VSN COCR BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80309206 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN CORE TO TIP RADIOPQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80309208 EAP Custom 80309208 CATHETER PCNG ELTRD BIPOL DISTAL TIP BLN FLW AST BOTH IP/OP "$1,950.00" "$1,443.00" $347.10 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" $347.10 "$1,950.00" "$1,950.00" "$1,447.29" "$1,447.29" "$1,503.06" "$1,015.95" $406.40 "$1,950.00" $780.00 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,462.50" "$1,950.00" "$1,950.00" "$1,950.00" $975.00 $975.00 "$1,544.40" "$1,950.00" "$1,560.00" "$1,267.50" "$1,950.00" "$1,950.00" "$1,131.00" "$1,950.00" "$1,170.00" "$1,950.00" "$1,950.00" "$1,950.00" N/A N/A 80309257 EAP HCPCS C1887 CATHETER GUID 100CM 6FR LNCHR STD JR5 CURVE CORON BOTH IP/OP $113.00 $84.00 $22.43 $113.00 $61.36 $61.36 $61.36 $61.36 $113.00 $113.00 $113.00 $23.55 $113.00 $83.87 $83.87 $87.10 $58.87 $23.55 $113.00 $113.00 $66.84 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $73.45 $22.43 $113.00 $65.54 $113.00 $67.80 $113.00 $23.55 $113.00 N/A N/A 80309258 EAP HCPCS C1887 CATHETER GUID 100CM 6FR LNCHR LCB CURVE CORON NYL BOTH IP/OP $113.00 $84.00 $22.43 $113.00 $61.36 $61.36 $61.36 $61.36 $113.00 $113.00 $113.00 $23.55 $113.00 $83.87 $83.87 $87.10 $58.87 $23.55 $113.00 $113.00 $66.84 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $73.45 $22.43 $113.00 $65.54 $113.00 $67.80 $113.00 $23.55 $113.00 N/A N/A 80309261 EAP HCPCS C1887 CATHETER GUID 100CM 7FR LNCHR AL1 CURVE CORON PERI BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80309262 EAP HCPCS C1887 CATHETER GUID 100CM 6FR LNCHR RADL CURVE PERI NYL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $97.80 $163.00 $33.97 $163.00 N/A N/A 80309263 EAP HCPCS C1887 CATHETER GUID 100CM 6FR LNCHR LARA CURVE CORON NYL BOTH IP/OP $113.00 $84.00 $22.43 $113.00 $61.36 $61.36 $61.36 $61.36 $113.00 $113.00 $113.00 $23.55 $113.00 $83.87 $83.87 $87.10 $58.87 $23.55 $113.00 $113.00 $66.84 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $73.45 $22.43 $113.00 $65.54 $113.00 $67.80 $113.00 $23.55 $113.00 N/A N/A 80309264 EAP HCPCS C1887 CATHETER GUID 100CM 6FR LNCHR 30D MAC3 CURVE CORON BOTH IP/OP $113.00 $84.00 $22.43 $113.00 $61.36 $61.36 $61.36 $61.36 $113.00 $113.00 $113.00 $23.55 $113.00 $83.87 $83.87 $87.10 $58.87 $23.55 $113.00 $113.00 $66.84 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $73.45 $22.43 $113.00 $65.54 $113.00 $113.00 $113.00 $23.55 $113.00 N/A N/A 80309265 EAP HCPCS C1887 CATHETER GUID 100CM 6FR LNCHR STD IMA CURVE CORON BOTH IP/OP $113.00 $84.00 $22.43 $113.00 $61.36 $61.36 $61.36 $61.36 $113.00 $113.00 $113.00 $23.55 $113.00 $83.87 $83.87 $87.10 $58.87 $23.55 $113.00 $113.00 $66.84 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $73.45 $22.43 $113.00 $65.54 $113.00 $113.00 $113.00 $23.55 $113.00 N/A N/A 80309276 EAP HCPCS C1769 "GUIDEWIRE HI-TORQUE COMM ES .014"" 300CM" BOTH IP/OP $988.00 $731.50 $196.09 $988.00 $536.48 $536.48 $536.48 $536.48 $988.00 $988.00 $988.00 $205.92 $988.00 $733.29 $733.29 $761.55 $514.75 $205.91 $988.00 $988.00 $584.40 $988.00 $988.00 $988.00 $988.00 $741.00 $988.00 $988.00 $988.00 $494.00 $494.00 $782.50 $988.00 $790.40 $642.20 $196.09 $988.00 $573.04 $988.00 $988.00 $988.00 $205.90 $988.00 N/A N/A 80309278 EAP HCPCS C1725 CATHETER BALDILAT 6MM 150CM 200MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80309287 EAP HCPCS C1725 CATHETER BALDILAT 3MM 8MM CORON RAPEX RADIOPQ SMTH BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80309325 EAP HCPCS C1874 STENT EPRSTH 3.5MM 23MM 19MM L BOTH IP/OP "$17,219.00" "$12,742.50" "$3,417.54" "$17,219.00" "$7,748.55" "$7,748.55" "$7,748.55" "$7,748.55" "$17,219.00" "$17,219.00" "$17,219.00" "$3,588.87" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$3,588.63" "$17,219.00" "$17,219.00" "$8,488.97" "$17,219.00" "$17,219.00" "$17,219.00" "$17,219.00" "$12,914.25" "$17,219.00" "$17,219.00" "$17,219.00" "$8,609.50" "$8,609.50" "$13,637.45" "$17,219.00" "$13,775.20" "$7,748.55" "$3,417.54" "$17,219.00" "$9,987.02" "$17,219.00" "$17,219.00" "$17,219.00" "$3,588.44" "$17,219.00" N/A N/A 80309335 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 15MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80309338 EAP HCPCS C1725 CATHETER BALDILAT 4.5MM 12MM CORON RAPEX RADIOPQ BOTH IP/OP $213.00 $158.00 $42.28 $213.00 $115.66 $115.66 $115.66 $115.66 $213.00 $213.00 $213.00 $44.39 $213.00 $158.09 $158.09 $164.18 $110.97 $44.39 $213.00 $213.00 $125.99 $213.00 $213.00 $213.00 $213.00 $159.75 $213.00 $213.00 $213.00 $106.50 $106.50 $168.70 $213.00 $170.40 $138.45 $42.28 $213.00 $123.54 $213.00 $213.00 $213.00 $44.39 $213.00 N/A N/A 80309343 EAP HCPCS C1880 FILTER EMBL 49MM 65CM VC RADIOPQ PRELD FLSH SDPRT BOTH IP/OP "$2,313.00" "$1,712.00" $482.05 "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" $482.05 "$2,313.00" $925.20 "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$1,734.75" "$2,313.00" "$2,313.00" "$2,313.00" "$1,156.50" "$1,156.50" "$1,831.90" "$2,313.00" "$1,850.40" "$1,040.85" "$2,313.00" "$2,313.00" "$1,341.54" "$2,313.00" "$1,387.80" "$2,313.00" "$2,313.00" "$2,313.00" N/A N/A 80309345 EAP HCPCS C1880 FILTER EMBL NAVALIGN DLV UNISET STRL DISP PLTN BOTH IP/OP "$2,313.00" "$1,712.00" $482.05 "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" $482.05 "$2,313.00" $925.20 "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$2,313.00" "$1,734.75" "$2,313.00" "$2,313.00" "$2,313.00" "$1,156.50" "$1,156.50" "$1,831.90" "$2,313.00" "$1,850.40" "$1,040.85" "$2,313.00" "$2,313.00" "$1,341.54" "$2,313.00" "$1,387.80" "$2,313.00" "$2,313.00" "$2,313.00" N/A N/A 80309350 EAP Custom 80309350 VALVE HEMOSTASIS 1 UNIT BLEEDBACK CONTROL VALVE COPILOT BOTH IP/OP $118.00 $87.50 $21.00 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $118.00 $21.00 $118.00 $118.00 $87.58 $87.58 $90.95 $61.48 $24.59 $118.00 $47.20 $118.00 $118.00 $118.00 $118.00 $118.00 $88.50 $118.00 $118.00 $118.00 $59.00 $59.00 $93.46 $118.00 $94.40 $76.70 $118.00 $118.00 $68.44 $118.00 $70.80 $118.00 $118.00 $118.00 N/A N/A 80309407 EAP HCPCS C1876 SYSTEM CORON STENT 8MM 2MM MTLNK MVSN COCR RAPEX BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80309409 EAP HCPCS C1876 SYSTEM CORON STENT 15MM 2MM MTLNK MVSN COCR RAPEX BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80309410 EAP HCPCS C1876 SYSTEM CORON STENT 18MM 2MM MTLNK MVSN COCR RAPEX BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80309411 EAP HCPCS C1876 SYSTEM CORON STENT 23MM 2MM MTLNK MVSN COCR RAPEX BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80309438 EAP HCPCS C1900 LEAD PCNG LV ATN STARFIX BOTH IP/OP "$4,125.00" "$3,052.50" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$4,125.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 "$4,125.00" "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A 80309448 EAP HCPCS C1725 CATHETER PA 110CM 5FR 8MM ARW 1 LUM BLN WDG PRSS BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $162.90 $162.90 $162.90 $162.90 $300.00 $300.00 $300.00 $62.53 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $59.54 $300.00 $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 80309457 EAP Custom 80309457 SYSTEM DRG DLV EKOSONIC MACH 4 MICROSONIC TX ZN BOTH IP/OP "$6,738.00" "$4,986.50" "$1,199.36" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$1,199.36" "$6,738.00" "$6,738.00" "$4,181.12" "$4,181.12" "$5,193.65" "$2,060.15" "$1,404.27" "$6,738.00" "$2,695.20" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$5,053.50" "$6,738.00" "$6,738.00" "$6,738.00" "$3,369.00" "$3,369.00" "$5,336.50" "$6,738.00" "$5,390.40" "$4,379.70" "$6,738.00" "$6,738.00" "$3,908.04" "$6,738.00" "$4,042.80" "$6,738.00" "$6,738.00" "$6,738.00" N/A N/A 80309459 EAP Custom 80309459 DEVICE THRMB 135CM 5.4FR EKOSONIC MACH 4 EVAS BOTH IP/OP "$6,738.00" "$4,986.50" "$1,199.36" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$1,199.36" "$6,738.00" "$6,738.00" "$4,181.12" "$4,181.12" "$5,193.65" "$2,060.15" "$1,404.27" "$6,738.00" "$2,695.20" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$5,053.50" "$6,738.00" "$6,738.00" "$6,738.00" "$3,369.00" "$3,369.00" "$5,336.50" "$6,738.00" "$5,390.40" "$4,379.70" "$6,738.00" "$6,738.00" "$3,908.04" "$6,738.00" "$4,042.80" "$6,738.00" "$6,738.00" "$6,738.00" N/A N/A 80309461 EAP Custom 80309461 DEVICE DRG DLV EKOSONIC MACH 4 INFUS CATH US CORE BOTH IP/OP "$6,738.00" "$4,986.50" "$1,199.36" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$1,199.36" "$6,738.00" "$6,738.00" "$4,181.12" "$4,181.12" "$5,193.65" "$2,060.15" "$1,404.27" "$6,738.00" "$2,695.20" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$5,053.50" "$6,738.00" "$6,738.00" "$6,738.00" "$3,369.00" "$3,369.00" "$5,336.50" "$6,738.00" "$5,390.40" "$4,379.70" "$6,738.00" "$6,738.00" "$3,908.04" "$6,738.00" "$4,042.80" "$6,738.00" "$6,738.00" "$6,738.00" N/A N/A 80309462 EAP Custom 80309462 DEVICE DRG DLV EKOSONIC MACH 4 INFUS CATH US CORE BOTH IP/OP "$6,738.00" "$4,986.50" "$1,199.36" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$1,199.36" "$6,738.00" "$6,738.00" "$4,181.12" "$4,181.12" "$5,193.65" "$2,060.15" "$1,404.27" "$6,738.00" "$2,695.20" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$6,738.00" "$5,053.50" "$6,738.00" "$6,738.00" "$6,738.00" "$3,369.00" "$3,369.00" "$5,336.50" "$6,738.00" "$5,390.40" "$4,379.70" "$6,738.00" "$6,738.00" "$3,908.04" "$6,738.00" "$4,042.80" "$6,738.00" "$6,738.00" "$6,738.00" N/A N/A 80309492 EAP HCPCS A6212 DRESSING FOAM 6X3.5IN 7 DAY ADHESIVE ANTIMICROBIAL FLEXIBLE BOTH IP/OP $45.00 $33.50 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $45.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 $45.00 $26.10 $45.00 $45.00 $45.00 $9.38 $45.00 N/A N/A 80309550 EAP Custom 80309550 SET VNTRC AST 17.4X13.8IN IMPELLA CP 9.3IN 10-40C BOTH IP/OP "$62,500.00" "$46,250.00" "$2,060.15" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$11,125.00" "$62,500.00" "$62,500.00" "$4,181.12" "$4,181.12" "$48,175.00" "$2,060.15" "$13,025.69" "$62,500.00" "$25,000.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$46,875.00" "$62,500.00" "$62,500.00" "$62,500.00" "$31,250.00" "$31,250.00" "$49,500.00" "$62,500.00" "$50,000.00" "$40,625.00" "$62,500.00" "$62,500.00" "$36,250.00" "$62,500.00" "$37,500.00" "$62,500.00" "$62,500.00" "$62,500.00" N/A N/A 80309582 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN SFT RBN TIP KINK RST BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80309583 EAP DVC EMBL 25MM 4.5MM PPLN FLX 55D 75% COCR 25% PLTN BOTH IP/OP "$34,948.00" "$25,862.00" "$6,220.74" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$6,220.74" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$7,283.55" "$34,948.00" "$13,979.20" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$26,211.00" "$34,948.00" "$34,948.00" "$34,948.00" "$17,474.00" "$17,474.00" "$27,678.82" "$34,948.00" "$27,958.40" "$15,726.60" "$34,948.00" "$34,948.00" "$20,269.84" "$34,948.00" "$20,968.80" "$34,948.00" "$34,948.00" "$34,948.00" N/A N/A 80309603 EAP HCPCS C1726 TUBE ENDBR 9FR STRL UNIBLOCKER ADLT BOTH IP/OP $348.00 $258.00 $69.07 $348.00 $188.96 $188.96 $188.96 $188.96 $348.00 $348.00 $348.00 $72.53 $348.00 $258.29 $258.29 $268.24 $181.31 $72.53 $348.00 $348.00 $205.84 $348.00 $348.00 $348.00 $348.00 $261.00 $348.00 $348.00 $348.00 $174.00 $174.00 $275.62 $348.00 $278.40 $226.20 $69.07 $348.00 $201.84 $348.00 $208.80 $348.00 $72.52 $348.00 N/A N/A 80309664 EAP HCPCS C1788 TRAY INFUS PORT LP 1 LUM INTROD NDL TNL TL CATH 6 BOTH IP/OP "$1,613.00" "$1,194.00" $320.14 "$1,613.00" $725.85 $725.85 $725.85 $725.85 "$1,613.00" "$1,613.00" "$1,613.00" $336.19 "$1,613.00" "$1,613.00" "$1,613.00" "$1,613.00" "$1,613.00" $336.17 "$1,613.00" "$1,613.00" $954.09 "$1,613.00" "$1,613.00" "$1,613.00" "$1,613.00" "$1,209.75" "$1,613.00" "$1,613.00" "$1,613.00" $806.50 $806.50 "$1,277.50" "$1,613.00" "$1,290.40" $725.85 $320.14 "$1,613.00" $935.54 "$1,613.00" "$1,613.00" "$1,613.00" $336.15 "$1,613.00" N/A N/A 80309672 EAP HCPCS C1757 CATHETER THRMB 10MM FLOWTRIEVER STRL LATEX FREE BOTH IP/OP "$11,625.00" "$8,602.50" "$2,060.15" "$11,625.00" "$6,312.38" "$6,312.38" "$6,312.38" "$6,312.38" "$11,625.00" "$11,625.00" "$11,625.00" "$2,422.94" "$11,625.00" "$4,181.12" "$4,181.12" "$8,960.55" "$2,060.15" "$2,422.78" "$11,625.00" "$11,625.00" "$3,094.73" "$11,625.00" "$11,625.00" "$11,625.00" "$11,625.00" "$8,718.75" "$11,625.00" "$11,625.00" "$11,625.00" "$5,812.50" "$5,812.50" "$9,207.00" "$11,625.00" "$9,300.00" "$7,556.25" "$2,307.27" "$11,625.00" "$6,742.50" "$11,625.00" "$11,625.00" "$11,625.00" "$2,422.65" "$11,625.00" N/A N/A 80309673 EAP HCPCS C1757 CATHETER THRMB 14MM FLOWTRIEVER STRL LATEX FREE BOTH IP/OP "$11,625.00" "$8,602.50" "$2,060.15" "$11,625.00" "$6,312.38" "$6,312.38" "$6,312.38" "$6,312.38" "$11,625.00" "$11,625.00" "$11,625.00" "$2,422.94" "$11,625.00" "$4,181.12" "$4,181.12" "$8,960.55" "$2,060.15" "$2,422.78" "$11,625.00" "$11,625.00" "$3,094.73" "$11,625.00" "$11,625.00" "$11,625.00" "$11,625.00" "$8,718.75" "$11,625.00" "$11,625.00" "$11,625.00" "$5,812.50" "$5,812.50" "$9,207.00" "$11,625.00" "$9,300.00" "$7,556.25" "$2,307.27" "$11,625.00" "$6,742.50" "$11,625.00" "$11,625.00" "$11,625.00" "$2,422.65" "$11,625.00" N/A N/A 80309674 EAP HCPCS C1757 CATHETER THRMB 18MM STRL LF FLOWTRIEVER BOTH IP/OP "$11,625.00" "$8,602.50" "$2,060.15" "$11,625.00" "$6,312.38" "$6,312.38" "$6,312.38" "$6,312.38" "$11,625.00" "$11,625.00" "$11,625.00" "$2,422.94" "$11,625.00" "$4,181.12" "$4,181.12" "$8,960.55" "$2,060.15" "$2,422.78" "$11,625.00" "$11,625.00" "$3,094.73" "$11,625.00" "$11,625.00" "$11,625.00" "$11,625.00" "$8,718.75" "$11,625.00" "$11,625.00" "$11,625.00" "$5,812.50" "$5,812.50" "$9,207.00" "$11,625.00" "$9,300.00" "$7,556.25" "$2,307.27" "$11,625.00" "$6,742.50" "$11,625.00" "$11,625.00" "$11,625.00" "$2,422.65" "$11,625.00" N/A N/A 80309675 EAP HCPCS C1757 CATHETER GUID 6.7MM FLOWTRIEVER 1 INS ASPIRATE BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80309676 EAP Custom 80309676 FT RETRACTION ASPIRATOR DEVICE SE BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$2,319.38" "$2,319.38" "$2,408.75" "$1,628.13" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$2,031.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 80309726 EAP HCPCS C1887 CATHETER VASC 135CM 2.6-2.9FR 1.6FR TURNPIKE ML LR BOTH IP/OP "$1,313.00" $972.00 $260.60 "$1,313.00" $712.96 $712.96 $712.96 $712.96 "$1,313.00" "$1,313.00" "$1,313.00" $273.66 "$1,313.00" $974.51 $974.51 "$1,012.06" $684.07 $273.64 "$1,313.00" "$1,313.00" $776.64 "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" $984.75 "$1,313.00" "$1,313.00" "$1,313.00" $656.50 $656.50 "$1,039.90" "$1,313.00" "$1,050.40" $853.45 $260.60 "$1,313.00" $761.54 "$1,313.00" "$1,313.00" "$1,313.00" $273.63 "$1,313.00" N/A N/A 80309727 EAP HCPCS C1887 CATHETER VASC 150CM 2.6-3.1FR 1.6FR TURNPIKE ML LR BOTH IP/OP "$1,488.00" "$1,101.50" $295.33 "$1,488.00" $807.98 $807.98 $807.98 $807.98 "$1,488.00" "$1,488.00" "$1,488.00" $310.14 "$1,488.00" "$1,104.39" "$1,104.39" "$1,146.95" $775.25 $310.12 "$1,488.00" "$1,488.00" $880.15 "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" "$1,116.00" "$1,488.00" "$1,488.00" "$1,488.00" $744.00 $744.00 "$1,178.50" "$1,488.00" "$1,190.40" $967.20 $295.33 "$1,488.00" $863.04 "$1,488.00" "$1,488.00" "$1,488.00" $310.10 "$1,488.00" N/A N/A 80309747 EAP HCPCS C1900 LEFT HEART PACING LEAD - QUADRIPOLAR - ATTAIN PERFORMA S MRI SURESCAN BOTH IP/OP "$4,125.00" "$3,052.50" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$4,125.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 "$4,125.00" "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A 80309751 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 4MM PROMUS PRMR MNRL BOTH IP/OP "$4,250.00" "$3,145.00" $843.52 "$4,250.00" "$1,912.50" "$1,912.50" "$1,912.50" "$1,912.50" "$4,250.00" "$4,250.00" "$4,250.00" $885.81 "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" $885.75 "$4,250.00" "$4,250.00" "$2,095.25" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$3,187.50" "$4,250.00" "$4,250.00" "$4,250.00" "$2,125.00" "$2,125.00" "$3,366.00" "$4,250.00" "$3,400.00" "$1,912.50" $843.52 "$4,250.00" "$2,465.00" "$4,250.00" "$4,250.00" "$4,250.00" $885.70 "$4,250.00" N/A N/A 80309753 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 4MM PROMUS PRMR MNRL BOTH IP/OP "$4,250.00" "$3,145.00" $843.52 "$4,250.00" "$1,912.50" "$1,912.50" "$1,912.50" "$1,912.50" "$4,250.00" "$4,250.00" "$4,250.00" $885.81 "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" $885.75 "$4,250.00" "$4,250.00" "$2,095.25" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$3,187.50" "$4,250.00" "$4,250.00" "$4,250.00" "$2,125.00" "$2,125.00" "$3,366.00" "$4,250.00" "$3,400.00" "$1,912.50" $843.52 "$4,250.00" "$2,465.00" "$4,250.00" "$4,250.00" "$4,250.00" $885.70 "$4,250.00" N/A N/A 80309754 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 4MM PROMUS PRMR MNRL BOTH IP/OP "$4,250.00" "$3,145.00" $843.52 "$4,250.00" "$1,912.50" "$1,912.50" "$1,912.50" "$1,912.50" "$4,250.00" "$4,250.00" "$4,250.00" $885.81 "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" $885.75 "$4,250.00" "$4,250.00" "$2,095.25" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$3,187.50" "$4,250.00" "$4,250.00" "$4,250.00" "$2,125.00" "$2,125.00" "$3,366.00" "$4,250.00" "$3,400.00" "$1,912.50" $843.52 "$4,250.00" "$2,465.00" "$4,250.00" "$4,250.00" "$4,250.00" $885.70 "$4,250.00" N/A N/A 80310058 EAP Custom 80310058 DEVICE EMBL 2.5MM 14MM STRL LF BOTH IP/OP "$32,603.00" "$24,126.50" "$5,803.33" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$5,803.33" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$6,794.82" "$32,603.00" "$13,041.20" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$24,452.25" "$32,603.00" "$32,603.00" "$32,603.00" "$16,301.50" "$16,301.50" "$25,821.58" "$32,603.00" "$26,082.40" "$14,671.35" "$32,603.00" "$32,603.00" "$18,909.74" "$32,603.00" "$19,561.80" "$32,603.00" "$32,603.00" "$32,603.00" N/A N/A 80310083 EAP HCPCS C1884 SYSTEM EMBL PRTC 190CM .014IN 110UM CRTD GWIRE BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$2,029.73" "$2,029.73" "$2,029.73" "$2,029.73" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$2,774.34" "$2,774.34" "$2,881.25" "$1,947.50" $779.04 "$3,738.00" "$3,738.00" "$2,211.03" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$2,429.70" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$3,738.00" "$3,738.00" $779.00 "$3,738.00" N/A N/A 80310085 EAP HCPCS C1894 INTROD SHTH PED 5FR 21GA 40CM 7CM GRY HUB DILAT BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80310086 EAP HCPCS C1894 INTROD SHTH PED 6FR 21GA 40CM 7CM GRN HUB DILAT BOTH IP/OP $102.00 $75.50 $20.24 $102.00 $55.39 $55.39 $55.39 $55.39 $102.00 $102.00 $102.00 $21.26 $102.00 $75.70 $75.70 $78.62 $53.14 $21.26 $102.00 $102.00 $60.33 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $66.30 $20.24 $102.00 $59.16 $102.00 $102.00 $102.00 $21.26 $102.00 N/A N/A 80310399 EAP HCPCS C1876 STENT VASC EPIC NITINOL L60MM L120CM OD9MM ILIAC BOTH IP/OP "$1,463.00" "$1,083.00" $290.37 "$1,463.00" $658.35 $658.35 $658.35 $658.35 "$1,463.00" "$1,463.00" "$1,463.00" $304.93 "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" $304.91 "$1,463.00" "$1,463.00" $865.36 "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,097.25" "$1,463.00" "$1,463.00" "$1,463.00" $731.50 $731.50 "$1,158.70" "$1,463.00" "$1,170.40" $658.35 $290.37 "$1,463.00" $848.54 "$1,463.00" "$1,463.00" "$1,463.00" $304.89 "$1,463.00" N/A N/A 80310402 EAP HCPCS C1876 STENT VASC 9MM 80MM 159CM 120CM SLF XPD ILC ART EP BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80310534 EAP HCPCS C1769 GUIDEWIRE VASC 260CM .035IN FLXB SPRG COIL TIP STD BOTH IP/OP $251.00 $186.00 $49.82 $251.00 $136.29 $136.29 $136.29 $136.29 $251.00 $251.00 $251.00 $52.31 $251.00 $186.29 $186.29 $193.47 $130.77 $52.31 $251.00 $251.00 $148.47 $251.00 $251.00 $251.00 $251.00 $188.25 $251.00 $251.00 $251.00 $125.50 $125.50 $198.79 $251.00 $200.80 $163.15 $49.82 $251.00 $145.58 $251.00 $150.60 $251.00 $52.31 $251.00 N/A N/A 80310535 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .035IN FLXB SPRG COIL TIP STD BOTH IP/OP $130.00 $96.50 $25.80 $130.00 $70.59 $70.59 $70.59 $70.59 $130.00 $130.00 $130.00 $27.10 $130.00 $96.49 $96.49 $100.20 $67.73 $27.09 $130.00 $130.00 $76.90 $130.00 $130.00 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $65.00 $65.00 $102.96 $130.00 $104.00 $84.50 $25.80 $130.00 $75.40 $130.00 $130.00 $130.00 $27.09 $130.00 N/A N/A 80310536 EAP HCPCS C1769 GUIDEWIRE VASC 260CM .035IN FLXB SPRG COIL TIP STD BOTH IP/OP "$1,045.00" $773.50 $207.41 "$1,045.00" $567.44 $567.44 $567.44 $567.44 "$1,045.00" "$1,045.00" "$1,045.00" $217.80 "$1,045.00" $775.60 $775.60 $805.49 $544.45 $217.79 "$1,045.00" "$1,045.00" $618.12 "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" $783.75 "$1,045.00" "$1,045.00" "$1,045.00" $522.50 $522.50 $827.64 "$1,045.00" $836.00 $679.25 $207.41 "$1,045.00" $606.10 "$1,045.00" $627.00 "$1,045.00" $217.78 "$1,045.00" N/A N/A 80310746 EAP DEVICE EMBOLIZATION  30MM 4.5MM  PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,948.00" "$25,862.00" "$6,220.74" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$6,220.74" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$7,283.55" "$34,948.00" "$13,979.20" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$26,211.00" "$34,948.00" "$34,948.00" "$34,948.00" "$17,474.00" "$17,474.00" "$27,678.82" "$34,948.00" "$27,958.40" "$15,726.60" "$34,948.00" "$34,948.00" "$20,269.84" "$34,948.00" "$20,968.80" "$34,948.00" "$34,948.00" "$34,948.00" N/A N/A 80310751 EAP DEVICE EMBL 25MM 5MM PIPELINE FLX 55D NRVSC 75% BOTH IP/OP "$34,948.00" "$25,862.00" "$6,220.74" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$6,220.74" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$7,283.55" "$34,948.00" "$13,979.20" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$26,211.00" "$34,948.00" "$34,948.00" "$34,948.00" "$17,474.00" "$17,474.00" "$27,678.82" "$34,948.00" "$27,958.40" "$15,726.60" "$34,948.00" "$34,948.00" "$20,269.84" "$34,948.00" "$20,968.80" "$34,948.00" "$34,948.00" "$34,948.00" N/A N/A 80310753 EAP Custom 27806075 DEVICE EMBL 5MM 35MM STRL LF PIPELINE FLX 48 STRN BRD MESH BOTH IP/OP "$34,948.00" "$25,862.00" "$6,220.74" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$6,220.74" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$7,283.55" "$34,948.00" "$13,979.20" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$34,948.00" "$26,211.00" "$34,948.00" "$34,948.00" "$34,948.00" "$17,474.00" "$17,474.00" "$27,678.82" "$34,948.00" "$27,958.40" "$15,726.60" "$34,948.00" "$34,948.00" "$20,269.84" "$34,948.00" "$20,968.80" "$34,948.00" "$34,948.00" "$34,948.00" N/A N/A 80310803 EAP HCPCS C1884 DEVICE EMBL 55D 4.5MM 14MM STRL LF PIPELINE FLX 48 STRN BRD BOTH IP/OP "$32,603.00" "$24,126.50" "$6,470.88" "$32,603.00" "$14,671.35" "$14,671.35" "$14,671.35" "$14,671.35" "$32,603.00" "$32,603.00" "$32,603.00" "$6,795.28" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$6,794.82" "$32,603.00" "$32,603.00" "$16,073.28" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$24,452.25" "$32,603.00" "$32,603.00" "$32,603.00" "$16,301.50" "$16,301.50" "$25,821.58" "$32,603.00" "$26,082.40" "$14,671.35" "$6,470.88" "$32,603.00" "$18,909.74" "$32,603.00" "$32,603.00" "$32,603.00" "$6,794.47" "$32,603.00" N/A N/A 80310808 EAP DEVICE EMBL 4.75MM 12MM STRL LF PIPELINE FLX 48 STRN BRD BOTH IP/OP "$32,603.00" "$24,126.50" "$5,803.33" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$5,803.33" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$6,794.82" "$32,603.00" "$13,041.20" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$24,452.25" "$32,603.00" "$32,603.00" "$32,603.00" "$16,301.50" "$16,301.50" "$25,821.58" "$32,603.00" "$26,082.40" "$14,671.35" "$32,603.00" "$32,603.00" "$18,909.74" "$32,603.00" "$19,561.80" "$32,603.00" "$32,603.00" "$32,603.00" N/A N/A 80310811 EAP DEVICE EMBL 4.75MM 18MM STRL LF PIPELINE FLX 48 STRN BRD BOTH IP/OP "$32,603.00" "$24,126.50" "$5,803.33" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$5,803.33" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$6,794.82" "$32,603.00" "$13,041.20" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$32,603.00" "$24,452.25" "$32,603.00" "$32,603.00" "$32,603.00" "$16,301.50" "$16,301.50" "$25,821.58" "$32,603.00" "$26,082.40" "$14,671.35" "$32,603.00" "$32,603.00" "$18,909.74" "$32,603.00" "$19,561.80" "$32,603.00" "$32,603.00" "$32,603.00" N/A N/A 80310824 EAP HCPCS C1733 CATHETER ABLT 115CM 8FR 4MM 1-4-1MM SPC F-J CURVE BOTH IP/OP "$4,125.00" "$3,052.50" $818.71 "$4,125.00" "$2,239.88" "$2,239.88" "$2,239.88" "$2,239.88" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$3,061.58" "$3,061.58" "$3,179.55" "$2,060.15" $859.70 "$4,125.00" "$4,125.00" "$2,439.94" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$2,681.25" $818.71 "$4,125.00" "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A 80315167 EAP HCPCS C1894 SHEATH INTROD 28CM 9.8MM 26FR GORE DRYSEAL HYDPHI BOTH IP/OP $863.00 $639.00 $171.28 $863.00 $468.61 $468.61 $468.61 $468.61 $863.00 $863.00 $863.00 $179.87 $863.00 $640.52 $640.52 $665.20 $449.62 $179.86 $863.00 $863.00 $510.46 $863.00 $863.00 $863.00 $863.00 $647.25 $863.00 $863.00 $863.00 $431.50 $431.50 $683.50 $863.00 $690.40 $560.95 $171.28 $863.00 $500.54 $863.00 $863.00 $863.00 $179.85 $863.00 N/A N/A 80315263 EAP HCPCS C1725 CATR BALD 14 ATM LP TAER 7FR 5MM 150CM 150MM BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80315264 EAP HCPCS C1725 CATHETER BALDILAT 5MM 150CM 200MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80315265 EAP HCPCS C1725 CATHETER BALDILAT 6MM 150CM 150MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80315266 EAP HCPCS C1725 CATHETER BALDILAT 6MM 150CM 220MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80315267 EAP HCPCS C1725 CATHETER BALDILAT 7MM 150CM 120MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80315268 EAP HCPCS C1725 CATHETER BALDILAT 7MM 150CM 150MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80315269 EAP HCPCS C1725 COYOTE MR 1.5MM X 40MM X 150CM BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 $417.50 $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A 80315539 EAP HCPCS C1874 STENT ENDOPRSTH 5MM 10CM 120CM FLEXIBLE SELF EXPAND RADIOPQ BOTH IP/OP "$9,875.00" "$7,307.50" "$1,959.94" "$9,875.00" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$9,875.00" "$9,875.00" "$9,875.00" "$2,058.20" "$9,875.00" "$9,875.00" "$9,875.00" "$9,875.00" "$9,875.00" "$2,058.06" "$9,875.00" "$9,875.00" "$4,868.38" "$9,875.00" "$9,875.00" "$9,875.00" "$9,875.00" "$7,406.25" "$9,875.00" "$9,875.00" "$9,875.00" "$4,937.50" "$4,937.50" "$7,821.00" "$9,875.00" "$7,900.00" "$4,443.75" "$1,959.94" "$9,875.00" "$5,727.50" "$9,875.00" "$9,875.00" "$9,875.00" "$2,057.95" "$9,875.00" N/A N/A 80316650 EAP HCPCS B4088 BUTTON GSTRM 18FR 3CM 5ML STRL BOTH IP/OP $260.00 $192.50 $23.24 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $23.24 $260.00 $260.00 $192.97 $192.97 $200.41 $135.46 $54.19 $260.00 $104.00 $260.00 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $169.00 $260.00 $260.00 $150.80 $260.00 $156.00 $260.00 $260.00 $260.00 N/A N/A 80316651 EAP HCPCS B4088 KIT GASTROSTOMY LP TAPER 18FR BOTH IP/OP $260.00 $192.50 $23.24 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $23.24 $260.00 $260.00 $192.97 $192.97 $200.41 $135.46 $54.19 $260.00 $104.00 $260.00 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $169.00 $260.00 $260.00 $150.80 $260.00 $156.00 $260.00 $260.00 $260.00 N/A N/A 80316652 EAP HCPCS B4088 KIT GASTROSTOMY LP TAPER 18FR BOTH IP/OP $260.00 $192.50 $23.24 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $260.00 $23.24 $260.00 $260.00 $192.97 $192.97 $200.41 $135.46 $54.19 $260.00 $104.00 $260.00 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $169.00 $260.00 $260.00 $150.80 $260.00 $156.00 $260.00 $260.00 $260.00 N/A N/A 80316943 EAP HCPCS C1757 SET THRMB 145CM 3-4FR 1.5MM ANGJT ULT SOLENT DISTA BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,715.00" "$2,715.00" "$2,715.00" "$2,715.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$3,711.00" "$3,711.00" "$3,854.00" "$2,060.15" "$1,042.06" "$5,000.00" "$5,000.00" "$2,957.50" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$3,250.00" $992.38 "$5,000.00" "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 80317103 EAP HCPCS C1876 STENT VASCULAR TAPER 8-6MM 30MM SELF EXPANDABLE ER BOTH IP/OP "$6,113.00" "$4,524.00" "$1,213.28" "$6,113.00" "$2,750.85" "$2,750.85" "$2,750.85" "$2,750.85" "$6,113.00" "$6,113.00" "$6,113.00" "$1,274.10" "$6,113.00" "$6,113.00" "$6,113.00" "$6,113.00" "$6,113.00" "$1,274.02" "$6,113.00" "$6,113.00" "$3,013.71" "$6,113.00" "$6,113.00" "$6,113.00" "$6,113.00" "$4,584.75" "$6,113.00" "$6,113.00" "$6,113.00" "$3,056.50" "$3,056.50" "$4,841.50" "$6,113.00" "$4,890.40" "$2,750.85" "$1,213.28" "$6,113.00" "$3,545.54" "$6,113.00" "$6,113.00" "$6,113.00" "$1,273.95" "$6,113.00" N/A N/A 80317120 EAP HCPCS C1760 DEVICE CLSR 6FR STRCLS SE VASC NTNL CLIP STRL DISP BOTH IP/OP $788.00 $583.50 $156.40 $788.00 $354.60 $354.60 $354.60 $354.60 $788.00 $788.00 $788.00 $164.24 $788.00 $788.00 $788.00 $788.00 $788.00 $164.23 $788.00 $788.00 $466.10 $788.00 $788.00 $788.00 $788.00 $591.00 $788.00 $788.00 $788.00 $394.00 $394.00 $624.10 $788.00 $630.40 $354.60 $156.40 $788.00 $457.04 $788.00 $788.00 $788.00 $164.22 $788.00 N/A N/A 80318102 EAP HCPCS C1769 GUIDEWIRE VASC 145CM .035IN FLPY TIP XSTIF STR TPR BOTH IP/OP $65.00 $48.50 $12.90 $65.00 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $65.00 $38.45 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 $65.00 $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 80318107 EAP HCPCS C1894 INTROD CATH 90CM 6FR CHK-FLO FLXR RAABE BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80318123 EAP HCPCS C1894 SHEATH GUID ANL0 CURVE STR 5FR .074IN 90CM CHK-FLO VALVE BOTH IP/OP $392.60 $291.00 $77.92 $392.60 $213.18 $213.18 $213.18 $213.18 $392.60 $392.60 $392.60 $81.83 $392.60 $291.39 $291.39 $302.62 $204.54 $81.82 $392.60 $392.60 $232.22 $392.60 $392.60 $392.60 $392.60 $294.45 $392.60 $392.60 $392.60 $196.30 $196.30 $310.94 $392.60 $314.08 $255.19 $77.92 $392.60 $227.71 $392.60 $392.60 $392.60 $81.82 $392.60 N/A N/A 80318555 EAP HCPCS C1725 CATHETER GUID 135CM 3.2FR STINGRAY LP HYDPHI STRL BOTH IP/OP "$4,738.00" "$3,506.50" $940.37 "$4,738.00" "$2,572.73" "$2,572.73" "$2,572.73" "$2,572.73" "$4,738.00" "$4,738.00" "$4,738.00" $987.52 "$4,738.00" "$3,516.54" "$3,516.54" "$3,652.05" "$2,060.15" $987.45 "$4,738.00" "$4,738.00" "$2,802.53" "$4,738.00" "$4,738.00" "$4,738.00" "$4,738.00" "$3,553.50" "$4,738.00" "$4,738.00" "$4,738.00" "$2,369.00" "$2,369.00" "$3,752.50" "$4,738.00" "$3,790.40" "$3,079.70" $940.37 "$4,738.00" "$2,748.04" "$4,738.00" "$4,738.00" "$4,738.00" $987.40 "$4,738.00" N/A N/A 80318556 EAP HCPCS C1769 GUIDEWIRE VASC 185CM .014IN 20CM STINGRAY HYDPHI BOTH IP/OP "$1,228.00" $909.00 $243.73 "$1,228.00" $666.80 $666.80 $666.80 $666.80 "$1,228.00" "$1,228.00" "$1,228.00" $255.95 "$1,228.00" $911.42 $911.42 $946.54 $639.79 $255.93 "$1,228.00" "$1,228.00" $726.36 "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" $921.00 "$1,228.00" "$1,228.00" "$1,228.00" $614.00 $614.00 $972.58 "$1,228.00" $982.40 $798.20 $243.73 "$1,228.00" $712.24 "$1,228.00" "$1,228.00" "$1,228.00" $255.92 "$1,228.00" N/A N/A 80318557 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN 20CM STINGRAY HYDPHI BOTH IP/OP "$1,228.00" $909.00 $243.73 "$1,228.00" $666.80 $666.80 $666.80 $666.80 "$1,228.00" "$1,228.00" "$1,228.00" $255.95 "$1,228.00" $911.42 $911.42 $946.54 $639.79 $255.93 "$1,228.00" "$1,228.00" $726.36 "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" $921.00 "$1,228.00" "$1,228.00" "$1,228.00" $614.00 $614.00 $972.58 "$1,228.00" $982.40 $798.20 $243.73 "$1,228.00" $712.24 "$1,228.00" "$1,228.00" "$1,228.00" $255.92 "$1,228.00" N/A N/A 80318677 EAP HCPCS C1764 SYSTEM CRD MONITR RVL LINQ MYCARELINK INS LOOP BOTH IP/OP "$11,613.00" "$8,594.00" "$2,304.89" "$11,613.00" "$5,225.85" "$5,225.85" "$5,225.85" "$5,225.85" "$11,613.00" "$11,613.00" "$11,613.00" "$2,420.44" "$11,613.00" "$11,613.00" "$11,613.00" "$11,613.00" "$11,613.00" "$2,420.28" "$11,613.00" "$11,613.00" "$5,725.21" "$11,613.00" "$11,613.00" "$11,613.00" "$11,613.00" "$8,709.75" "$11,613.00" "$11,613.00" "$11,613.00" "$5,806.50" "$5,806.50" "$9,197.50" "$11,613.00" "$9,290.40" "$5,225.85" "$2,304.89" "$11,613.00" "$6,735.54" "$11,613.00" "$11,613.00" "$11,613.00" "$2,420.15" "$11,613.00" N/A N/A 80320653 EAP HCPCS C1894 KIT INTROD 10CM 7FR 21GA GLIDESHEATH SLNDR .021IN BOTH IP/OP $138.00 $102.50 $27.39 $138.00 $74.93 $74.93 $74.93 $74.93 $138.00 $138.00 $138.00 $28.76 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $138.00 $81.63 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $27.39 $138.00 $80.04 $138.00 $138.00 $138.00 $28.76 $138.00 N/A N/A 80320688 EAP HCPCS A4215 NEEDLE BX 23GA 5.1CM PROCYTIN BOTH IP/OP $424.00 $314.00 $0.22 $424.00 $424.00 $424.00 $424.00 $424.00 $424.00 $424.00 $0.22 $424.00 $424.00 $314.69 $314.69 $326.82 $220.90 $88.37 $424.00 $169.60 $424.00 $424.00 $424.00 $424.00 $424.00 $318.00 $424.00 $424.00 $424.00 $212.00 $212.00 $335.81 $424.00 $339.20 $275.60 $424.00 $424.00 $245.92 $424.00 $254.40 $424.00 $424.00 $424.00 N/A N/A 80320723 EAP HCPCS C1769 GUIDEWIRE VASC 80CM .035IN FLXB CORE TO TIP BOTH IP/OP $73.00 $54.50 $14.49 $73.00 $39.64 $39.64 $39.64 $39.64 $73.00 $73.00 $73.00 $15.22 $73.00 $54.18 $54.18 $56.27 $38.03 $15.21 $73.00 $73.00 $43.18 $73.00 $73.00 $73.00 $73.00 $54.75 $73.00 $73.00 $73.00 $36.50 $36.50 $57.82 $73.00 $58.40 $47.45 $14.49 $73.00 $42.34 $73.00 $73.00 $73.00 $15.21 $73.00 N/A N/A 80320735 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 2.0X10 MM 5F BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 80320736 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 2.0X15 MM 5F BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 80320737 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 2.0X20 MM 5F BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 80320738 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 2.5X10 MM 5F BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 80320739 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 2.5X15 MM 5F BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 80320740 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 2.5X20 MM 5F BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 80320741 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 3.0X10 MM 6F BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 80320742 EAP HCPCS C1725 CATHETER BALDILAT 3MM 140CM 15MM RAPEX NTNL LATEX BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 80320743 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 3.0X20 MM 6F BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 80320744 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 3.5X10 MM 6F BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 80320745 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 3.5X15 MM 6F BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 80320746 EAP HCPCS C1725 CHOCOLATE PTCA BALLOON CATHETER 3.5X20 MM 6F BOTH IP/OP "$1,875.00" "$1,387.50" $372.14 "$1,875.00" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" $372.14 "$1,875.00" "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 80320748 EAP HCPCS C1887 CATHETER GUID EBU3.75 CURVE 8FR .09IN 90CM LEFT BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $97.80 $163.00 $33.97 $163.00 N/A N/A 80320749 EAP HCPCS C1887 CATHETER GUID JR4 CURVE 8FR .088IN 90CM CORON SHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80320750 EAP HCPCS C1887 CATHETER GUID JL4 CURVE 8FR 90CM CORON SHR NX BAL BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80320781 EAP HCPCS A6210 DRESSING 8X8IN ANBCTRL LATEX HYDROFERA FOAM BLUE BOTH IP/OP $33.00 $24.50 $6.55 $33.00 $17.92 $17.92 $17.92 $17.92 $33.00 $33.00 $33.00 $6.88 $33.00 $24.49 $24.49 $25.44 $17.19 $6.88 $33.00 $33.00 $19.52 $33.00 $33.00 $33.00 $33.00 $24.75 $33.00 $33.00 $33.00 $16.50 $16.50 $26.14 $33.00 $26.40 $21.45 $6.55 $33.00 $19.14 $33.00 $33.00 $33.00 $6.88 $33.00 N/A N/A 80320783 EAP HCPCS C1887 CATHETER ANGIOGRAPHIC .035IN OMNI FLUSH 0 CURVE 5FR 65CM BOTH IP/OP $35.00 $26.00 $6.95 $35.00 $19.01 $19.01 $19.01 $19.01 $35.00 $35.00 $35.00 $7.29 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $35.00 $20.70 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $6.95 $35.00 $20.30 $35.00 $35.00 $35.00 $7.29 $35.00 N/A N/A 80320785 EAP HCPCS C1894 INTRODUCER SHEATH .035IN 7FR . BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 $200.00 $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 80320787 EAP HCPCS C1729 SET DRAIN .038IN 18FR L 40CM 32 SIDE PORT LUER LOCK LOCK BOTH IP/OP $280.00 $207.50 $55.57 $280.00 $152.04 $152.04 $152.04 $152.04 $280.00 $280.00 $280.00 $58.36 $280.00 $207.82 $207.82 $215.82 $145.88 $58.36 $280.00 $280.00 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $182.00 $55.57 $280.00 $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A 80320788 EAP HCPCS C1750 PACK CATHETER 19FR 36CM 19CM 2 BOTH IP/OP "$2,254.00" "$1,668.00" $447.36 "$2,254.00" "$1,223.92" "$1,223.92" "$1,223.92" "$1,223.92" "$2,254.00" "$2,254.00" "$2,254.00" $469.79 "$2,254.00" "$1,672.92" "$1,672.92" "$1,737.38" "$1,174.33" $469.76 "$2,254.00" "$2,254.00" "$1,333.24" "$2,254.00" "$2,254.00" "$2,254.00" "$2,254.00" "$1,690.50" "$2,254.00" "$2,254.00" "$2,254.00" "$1,127.00" "$1,127.00" "$1,785.17" "$2,254.00" "$1,803.20" "$1,465.10" $447.36 "$2,254.00" "$1,307.32" "$2,254.00" "$2,254.00" "$2,254.00" $469.73 "$2,254.00" N/A N/A 80320791 EAP Custom 80320791 SNARE ENDSCP .59IN 47IN 1 LOOP GOLD PLATED TUNGSTEN BOTH IP/OP $725.00 $536.50 $129.05 $725.00 $725.00 $725.00 $725.00 $725.00 $725.00 $725.00 $129.05 $725.00 $725.00 $538.10 $538.10 $558.83 $377.73 $151.10 $725.00 $290.00 $725.00 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $471.25 $725.00 $725.00 $420.50 $725.00 $435.00 $725.00 $725.00 $725.00 N/A N/A 80320793 EAP HCPCS C1894 INTRODUCER SHEATH 9FR 25CM 2.5CM DILAT KINK RESISTANT BOTH IP/OP $429.00 $317.50 $85.15 $429.00 $232.95 $232.95 $232.95 $232.95 $429.00 $429.00 $429.00 $89.41 $429.00 $318.40 $318.40 $330.67 $223.51 $89.41 $429.00 $429.00 $253.75 $429.00 $429.00 $429.00 $429.00 $321.75 $429.00 $429.00 $429.00 $214.50 $214.50 $339.77 $429.00 $343.20 $278.85 $85.15 $429.00 $248.82 $429.00 $257.40 $429.00 $89.40 $429.00 N/A N/A 80320794 EAP HCPCS C1725 CATHETER ANGIOGRAPHIC .038IN V BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 80320795 EAP HCPCS C1894 INTRODUCER CATHETER .038IN 8FR 90CM TUOHY BORST SIDEARM BOTH IP/OP $378.00 $280.00 $75.02 $378.00 $205.25 $205.25 $205.25 $205.25 $378.00 $378.00 $378.00 $78.78 $378.00 $280.55 $280.55 $291.36 $196.94 $78.78 $378.00 $378.00 $223.59 $378.00 $378.00 $378.00 $378.00 $283.50 $378.00 $378.00 $378.00 $189.00 $189.00 $299.38 $378.00 $302.40 $245.70 $75.02 $378.00 $219.24 $378.00 $378.00 $378.00 $78.78 $378.00 N/A N/A 80320799 EAP HCPCS C1896 ELECTRODE DFBR 45CM TRPLR EBLM S-ICD 11.5FR SBQ BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" "$10,000.00" "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 80320806 EAP HCPCS C1874 SYSTEM COR STNT 2.8MM 16MM GFT BOTH IP/OP "$5,988.00" "$4,431.50" "$1,188.47" "$5,988.00" "$2,694.60" "$2,694.60" "$2,694.60" "$2,694.60" "$5,988.00" "$5,988.00" "$5,988.00" "$1,248.05" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.97" "$5,988.00" "$5,988.00" "$2,952.08" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,491.00" "$5,988.00" "$5,988.00" "$5,988.00" "$2,994.00" "$2,994.00" "$4,742.50" "$5,988.00" "$4,790.40" "$2,694.60" "$1,188.47" "$5,988.00" "$3,473.04" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.90" "$5,988.00" N/A N/A 80320807 EAP HCPCS C1874 SYSTEM COR STNT 2.8MM 26MM GFT BOTH IP/OP "$5,988.00" "$4,431.50" "$1,188.47" "$5,988.00" "$2,694.60" "$2,694.60" "$2,694.60" "$2,694.60" "$5,988.00" "$5,988.00" "$5,988.00" "$1,248.05" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.97" "$5,988.00" "$5,988.00" "$2,952.08" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,491.00" "$5,988.00" "$5,988.00" "$5,988.00" "$2,994.00" "$2,994.00" "$4,742.50" "$5,988.00" "$4,790.40" "$2,694.60" "$1,188.47" "$5,988.00" "$3,473.04" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.90" "$5,988.00" N/A N/A 80320808 EAP HCPCS C1874 SYSTEM COR STNT 3.5MM 16MM GFT BOTH IP/OP "$5,988.00" "$4,431.50" "$1,188.47" "$5,988.00" "$2,694.60" "$2,694.60" "$2,694.60" "$2,694.60" "$5,988.00" "$5,988.00" "$5,988.00" "$1,248.05" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.97" "$5,988.00" "$5,988.00" "$2,952.08" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,491.00" "$5,988.00" "$5,988.00" "$5,988.00" "$2,994.00" "$2,994.00" "$4,742.50" "$5,988.00" "$4,790.40" "$2,694.60" "$1,188.47" "$5,988.00" "$3,473.04" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.90" "$5,988.00" N/A N/A 80320809 EAP HCPCS C1874 SYSTEM COR STNT 3.5MM 26MM GFT BOTH IP/OP "$5,988.00" "$4,431.50" "$1,188.47" "$5,988.00" "$2,694.60" "$2,694.60" "$2,694.60" "$2,694.60" "$5,988.00" "$5,988.00" "$5,988.00" "$1,248.05" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.97" "$5,988.00" "$5,988.00" "$2,952.08" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,491.00" "$5,988.00" "$5,988.00" "$5,988.00" "$2,994.00" "$2,994.00" "$4,742.50" "$5,988.00" "$4,790.40" "$2,694.60" "$1,188.47" "$5,988.00" "$3,473.04" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.90" "$5,988.00" N/A N/A 80320810 EAP HCPCS C1874 SYSTEM COR STNT 4MM 16MM GFTMS BOTH IP/OP "$5,988.00" "$4,431.50" "$1,188.47" "$5,988.00" "$2,694.60" "$2,694.60" "$2,694.60" "$2,694.60" "$5,988.00" "$5,988.00" "$5,988.00" "$1,248.05" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.97" "$5,988.00" "$5,988.00" "$2,952.08" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,491.00" "$5,988.00" "$5,988.00" "$5,988.00" "$2,994.00" "$2,994.00" "$4,742.50" "$5,988.00" "$4,790.40" "$2,694.60" "$1,188.47" "$5,988.00" "$3,473.04" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.90" "$5,988.00" N/A N/A 80320811 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .035IN CORE TO TIP RADIOPQ BOTH IP/OP $225.00 $166.50 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 $225.00 $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 80320812 EAP HCPCS C1725 CATHETER ANGIO 100CM 5FR CRDS INFNT JL3.5 CURVE BOTH IP/OP $97.00 $72.00 $19.25 $97.00 $52.67 $52.67 $52.67 $52.67 $97.00 $97.00 $97.00 $20.22 $97.00 $71.99 $71.99 $74.77 $50.54 $20.22 $97.00 $97.00 $57.38 $97.00 $97.00 $97.00 $97.00 $72.75 $97.00 $97.00 $97.00 $48.50 $48.50 $76.82 $97.00 $77.60 $63.05 $19.25 $97.00 $56.26 $97.00 $58.20 $97.00 $20.21 $97.00 N/A N/A 80320813 EAP HCPCS C1887 CATHETER ANGIO JL 4 CRV 5FR .047IN 100CM INFNT THRLMN RADOPQ BOTH IP/OP $97.00 $72.00 $19.25 $97.00 $52.67 $52.67 $52.67 $52.67 $97.00 $97.00 $97.00 $20.22 $97.00 $71.99 $71.99 $74.77 $50.54 $20.22 $97.00 $97.00 $57.38 $97.00 $97.00 $97.00 $97.00 $72.75 $97.00 $97.00 $97.00 $48.50 $48.50 $76.82 $97.00 $77.60 $63.05 $19.25 $97.00 $56.26 $97.00 $97.00 $97.00 $20.21 $97.00 N/A N/A 80320814 EAP HCPCS C1725 CATHETER ANGIO 100CM 5FR CRDS INFNT JR4 CURVE BOTH IP/OP $97.00 $72.00 $19.25 $97.00 $52.67 $52.67 $52.67 $52.67 $97.00 $97.00 $97.00 $20.22 $97.00 $71.99 $71.99 $74.77 $50.54 $20.22 $97.00 $97.00 $57.38 $97.00 $97.00 $97.00 $97.00 $72.75 $97.00 $97.00 $97.00 $48.50 $48.50 $76.82 $97.00 $77.60 $63.05 $19.25 $97.00 $56.26 $97.00 $58.20 $97.00 $20.21 $97.00 N/A N/A 80320817 EAP HCPCS C1894 SET INTROD 6FR 8FR 17.75IN 3 W BOTH IP/OP $249.00 $184.50 $49.42 $249.00 $135.21 $135.21 $135.21 $135.21 $249.00 $249.00 $249.00 $51.90 $249.00 $184.81 $184.81 $191.93 $129.73 $51.89 $249.00 $249.00 $147.28 $249.00 $249.00 $249.00 $249.00 $186.75 $249.00 $249.00 $249.00 $124.50 $124.50 $197.21 $249.00 $199.20 $161.85 $49.42 $249.00 $144.42 $249.00 $249.00 $249.00 $51.89 $249.00 N/A N/A 80320820 EAP HCPCS C1893 INTROD SHTH 10FR 67CM 63CM GWIRE HMSTS VLV SH BOTH IP/OP $638.00 $472.50 $126.63 $638.00 $346.43 $346.43 $346.43 $346.43 $638.00 $638.00 $638.00 $132.98 $638.00 $473.52 $473.52 $491.77 $332.40 $132.97 $638.00 $638.00 $377.38 $638.00 $638.00 $638.00 $638.00 $478.50 $638.00 $638.00 $638.00 $319.00 $319.00 $505.30 $638.00 $510.40 $414.70 $126.63 $638.00 $370.04 $638.00 $638.00 $638.00 $132.96 $638.00 N/A N/A 80320821 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN SFT RBN TIP KINK RST BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80320830 EAP HCPCS C1725 CATHETER BLNDIL 2MM 150CM 80MM CYTE MNRL ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 $417.50 $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A 80320833 EAP HCPCS C1725 COYOTE MR 3MM X 80MM X 150CM BOTH IP/OP "$1,045.00" $773.50 $207.41 "$1,045.00" $567.44 $567.44 $567.44 $567.44 "$1,045.00" "$1,045.00" "$1,045.00" $217.80 "$1,045.00" $775.60 $775.60 $805.49 $544.45 $217.79 "$1,045.00" "$1,045.00" $618.12 "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" $783.75 "$1,045.00" "$1,045.00" "$1,045.00" $522.50 $522.50 $827.64 "$1,045.00" $836.00 $679.25 $207.41 "$1,045.00" $606.10 "$1,045.00" "$1,045.00" "$1,045.00" $217.78 "$1,045.00" N/A N/A 80320839 EAP HCPCS C1725 CATHETER ANGIO STD AL 1 CRV 5FR 100CM INFNT THRLMN BRD ATRM BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $11.40 $19.00 $3.96 $19.00 N/A N/A 80320840 EAP HCPCS C1725 CATHETER ANGIO IMA CRV 5FR 100 BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80320841 EAP CATHETER ANGIO JL 5 CRV 5FR 100CM INFNT THRLMN SLCT RADOPQ BOTH IP/OP $19.00 $14.50 $3.38 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $19.00 $3.38 $19.00 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $19.00 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $19.00 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 80320843 EAP HCPCS C1725 CATHETER ANGIO IMA CRV 6FR .057IN 100CM INFNT THRLMN RADOPQ BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80320844 EAP HCPCS C1876 SYSTEM CORON STENT 28MM 5MM MTLNK UL XCELON MCGLD BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80320848 EAP HCPCS C1725 CATHETER BALDILAT 3MM 150CM 220MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80320849 EAP HCPCS C1725 CATHETER BALDILAT 3MM 150CM 40MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80320850 EAP HCPCS C1725 CATHETER BALDILAT 4MM 150CM 220MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80320851 EAP HCPCS C1725 CATHETER BALDILAT 7MM 150CM 200MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80320852 EAP HCPCS C1725 CATHETER BALDILAT 7MM 150CM 220MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80320853 EAP HCPCS C1725 CATHETER ANGIO MULTIPURPOSE1 CRD CRV 6FR 100CM ST+ 2 SH BRD BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80320854 EAP HCPCS C1757 CATHETER THRMB 135CM 4FR UNFS FLW-THRU HUB INFUS BOTH IP/OP $438.00 $324.50 $86.93 $438.00 $237.83 $237.83 $237.83 $237.83 $438.00 $438.00 $438.00 $91.29 $438.00 $325.08 $325.08 $337.61 $228.20 $91.28 $438.00 $438.00 $259.08 $438.00 $438.00 $438.00 $438.00 $328.50 $438.00 $438.00 $438.00 $219.00 $219.00 $346.90 $438.00 $350.40 $284.70 $86.93 $438.00 $254.04 $438.00 $438.00 $438.00 $91.28 $438.00 N/A N/A 80320859 EAP HCPCS C1725 CATHETER BLNDIL 20MM 100CM LF BOTH IP/OP "$1,382.00" "$1,023.00" $274.29 "$1,382.00" $750.43 $750.43 $750.43 $750.43 "$1,382.00" "$1,382.00" "$1,382.00" $288.04 "$1,382.00" "$1,025.72" "$1,025.72" "$1,065.25" $720.02 $288.02 "$1,382.00" "$1,382.00" $817.45 "$1,382.00" "$1,382.00" "$1,382.00" "$1,382.00" "$1,036.50" "$1,382.00" "$1,382.00" "$1,382.00" $691.00 $691.00 "$1,094.54" "$1,382.00" "$1,105.60" $898.30 $274.29 "$1,382.00" $801.56 "$1,382.00" "$1,382.00" "$1,382.00" $288.01 "$1,382.00" N/A N/A 80320864 EAP HCPCS C1876 SYSTEM CORON STENT 13MM 5MM MTLNK UL XCELON MCGLD BOTH IP/OP "$1,188.00" $879.50 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 "$1,188.00" $689.04 "$1,188.00" "$1,188.00" "$1,188.00" $247.58 "$1,188.00" N/A N/A 80320865 EAP Custom 80320865 BALLOON SZ 70CM 27MM AMPLZR 3 LUM SFT DISTAL TIP BOTH IP/OP $775.00 $573.50 $137.95 $775.00 $775.00 $775.00 $775.00 $775.00 $775.00 $775.00 $137.95 $775.00 $775.00 $575.21 $575.21 $597.37 $403.78 $161.52 $775.00 $310.00 $775.00 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $503.75 $775.00 $775.00 $449.50 $775.00 $465.00 $775.00 $775.00 $775.00 N/A N/A 80320866 EAP HCPCS C1887 CATHETER GUID 90CM 6FR LNCHR IMA CURVE PERI NYL LG BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80320868 EAP HCPCS C1887 CATHETER GUID 100CM 5FR LNCHR EBU5 CURVE CORON NYL BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80320869 EAP HCPCS C1887 CATHETER GUID 100CM 6FR LNCHR EBU3.5 CURVE PERI BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80320870 EAP HCPCS C1769 CATHETER GUID EXTRA BACKUP 4.5 LEFT CURVE 6FR .071 BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80321005 EAP HCPCS C1725 CATHETER ANGIO STD JL 4 CRV 6F BOTH IP/OP $22.00 $16.50 $4.37 $22.00 $11.95 $11.95 $11.95 $11.95 $22.00 $22.00 $22.00 $4.59 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 80321053 EAP HCPCS C2617 ZIMMON PANCREATIC STENT 7FR 12CM BOTH IP/OP $178.00 $132.00 $35.33 $178.00 $80.10 $80.10 $80.10 $80.10 $178.00 $178.00 $178.00 $37.10 $178.00 $178.00 $178.00 $178.00 $178.00 $37.10 $178.00 $178.00 $105.29 $178.00 $178.00 $178.00 $178.00 $133.50 $178.00 $178.00 $178.00 $89.00 $89.00 $140.98 $178.00 $142.40 $80.10 $35.33 $178.00 $103.24 $178.00 $178.00 $178.00 $37.10 $178.00 N/A N/A 80321087 EAP HCPCS C1757 "INDIGO CATHETER 8, XTORQ TIP 115CM" BOTH IP/OP "$7,225.00" "$5,346.50" "$1,433.98" "$7,225.00" "$3,923.18" "$3,923.18" "$3,923.18" "$3,923.18" "$7,225.00" "$7,225.00" "$7,225.00" "$1,505.87" "$7,225.00" "$4,181.12" "$4,181.12" "$5,569.03" "$2,060.15" "$1,505.77" "$7,225.00" "$7,225.00" "$3,094.73" "$7,225.00" "$7,225.00" "$7,225.00" "$7,225.00" "$5,418.75" "$7,225.00" "$7,225.00" "$7,225.00" "$3,612.50" "$3,612.50" "$5,722.20" "$7,225.00" "$5,780.00" "$4,696.25" "$1,433.98" "$7,225.00" "$4,190.50" "$7,225.00" "$7,225.00" "$7,225.00" "$1,505.69" "$7,225.00" N/A N/A 80321088 EAP Custom 80321088 INDIGO SEPARATOR 8 BOTH IP/OP "$4,700.00" "$3,478.00" $836.60 "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" $836.60 "$4,700.00" "$4,700.00" "$3,488.34" "$3,488.34" "$3,622.76" "$2,060.15" $979.53 "$4,700.00" "$1,880.00" "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" "$3,525.00" "$4,700.00" "$4,700.00" "$4,700.00" "$2,350.00" "$2,350.00" "$3,722.40" "$4,700.00" "$3,760.00" "$3,055.00" "$4,700.00" "$4,700.00" "$2,726.00" "$4,700.00" "$2,820.00" "$4,700.00" "$4,700.00" "$4,700.00" N/A N/A 80321095 EAP HCPCS C1773 KIT SNR AGN 90D 200CM 2.3-3FR 7MM MCTH LOOP COIL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80321106 EAP Custom 80321106 PREVENA NEG. PRSS 13CM PEEL & PLC PTCH BOTH IP/OP "$1,238.00" $916.50 $220.36 "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" $220.36 "$1,238.00" "$1,238.00" $918.84 $918.84 $954.25 $645.00 $258.01 "$1,238.00" $495.20 "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" $928.50 "$1,238.00" "$1,238.00" "$1,238.00" $619.00 $619.00 $980.50 "$1,238.00" $990.40 $804.70 "$1,238.00" "$1,238.00" $718.04 "$1,238.00" $742.80 "$1,238.00" "$1,238.00" "$1,238.00" N/A N/A 80321110 EAP HCPCS C1769 GUIDEWIRE VASC 175CM .014IN RADIOPQ PROX CONCTR BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $814.50 $814.50 $814.50 $814.50 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80321111 EAP Custom 80321111 KIT CATH 135CM 2.7FR IMG 1 SYR RAPEX TIP RADIOPQ BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80321113 EAP Custom 80321113 CABLE PCNG 8FT PACEL EP BIPOL TEMP THRSH BOTH IP/OP $65.00 $48.50 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 $65.00 $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 80321115 EAP HCPCS C1887 CATHETER INTVN 5FR .056IN .046IN 150CM 25CM RAPEX BOTH IP/OP "$1,023.00" $757.50 $203.04 "$1,023.00" $555.49 $555.49 $555.49 $555.49 "$1,023.00" "$1,023.00" "$1,023.00" $213.22 "$1,023.00" $759.27 $759.27 $788.53 $532.98 $213.20 "$1,023.00" "$1,023.00" $605.10 "$1,023.00" "$1,023.00" "$1,023.00" "$1,023.00" $767.25 "$1,023.00" "$1,023.00" "$1,023.00" $511.50 $511.50 $810.22 "$1,023.00" $818.40 $664.95 $203.04 "$1,023.00" $593.34 "$1,023.00" "$1,023.00" "$1,023.00" $213.19 "$1,023.00" N/A N/A 80321116 EAP HCPCS C1887 CATHETER INTVN 7FR .078IN .062IN 150CM 25CM RAPEX BOTH IP/OP "$1,023.00" $757.50 $203.04 "$1,023.00" $555.49 $555.49 $555.49 $555.49 "$1,023.00" "$1,023.00" "$1,023.00" $213.22 "$1,023.00" $759.27 $759.27 $788.53 $532.98 $213.20 "$1,023.00" "$1,023.00" $605.10 "$1,023.00" "$1,023.00" "$1,023.00" "$1,023.00" $767.25 "$1,023.00" "$1,023.00" "$1,023.00" $511.50 $511.50 $810.22 "$1,023.00" $818.40 $664.95 $203.04 "$1,023.00" $593.34 "$1,023.00" "$1,023.00" "$1,023.00" $213.19 "$1,023.00" N/A N/A 80321117 EAP HCPCS C1887 CATHETER INTVN 8FR .088IN .071IN 150CM 25CM RAPEX BOTH IP/OP "$1,023.00" $757.50 $203.04 "$1,023.00" $555.49 $555.49 $555.49 $555.49 "$1,023.00" "$1,023.00" "$1,023.00" $213.22 "$1,023.00" $759.27 $759.27 $788.53 $532.98 $213.20 "$1,023.00" "$1,023.00" $605.10 "$1,023.00" "$1,023.00" "$1,023.00" "$1,023.00" $767.25 "$1,023.00" "$1,023.00" "$1,023.00" $511.50 $511.50 $810.22 "$1,023.00" $818.40 $664.95 $203.04 "$1,023.00" $593.34 "$1,023.00" "$1,023.00" "$1,023.00" $213.19 "$1,023.00" N/A N/A 80321162 EAP HCPCS C1887 SHEATH GUID 65CM 8FR PN DSTN .038IN STR HYDPHI BOTH IP/OP $224.00 $166.00 $44.46 $224.00 $121.63 $121.63 $121.63 $121.63 $224.00 $224.00 $224.00 $46.69 $224.00 $166.25 $166.25 $172.66 $116.70 $46.68 $224.00 $224.00 $132.50 $224.00 $224.00 $224.00 $224.00 $168.00 $224.00 $224.00 $224.00 $112.00 $112.00 $177.41 $224.00 $179.20 $145.60 $44.46 $224.00 $129.92 $224.00 $224.00 $224.00 $46.68 $224.00 N/A N/A 80321202 EAP HCPCS C1894 INTRODUCER SHTH 8FR 2.9MM 80CM BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80321939 EAP HCPCS C1773 SEPARATOR THRMB INDG 6 LATEX FREE BOTH IP/OP "$2,700.00" "$1,998.00" $535.88 "$2,700.00" "$1,466.10" "$1,466.10" "$1,466.10" "$1,466.10" "$2,700.00" "$2,700.00" "$2,700.00" $562.75 "$2,700.00" "$2,003.94" "$2,003.94" "$2,081.16" "$1,406.70" $562.71 "$2,700.00" "$2,700.00" "$1,597.05" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,025.00" "$2,700.00" "$2,700.00" "$2,700.00" "$1,350.00" "$1,350.00" "$2,138.40" "$2,700.00" "$2,160.00" "$1,755.00" $535.88 "$2,700.00" "$1,566.00" "$2,700.00" "$2,700.00" "$2,700.00" $562.68 "$2,700.00" N/A N/A 80321943 EAP HCPCS C1757 CATHETER THRMB 6FR INDG ASPIRAT LATEX FREE BOTH IP/OP "$4,725.00" "$3,496.50" $937.79 "$4,725.00" "$2,565.68" "$2,565.68" "$2,565.68" "$2,565.68" "$4,725.00" "$4,725.00" "$4,725.00" $984.81 "$4,725.00" "$3,506.90" "$3,506.90" "$3,642.03" "$2,060.15" $984.74 "$4,725.00" "$4,725.00" "$2,794.84" "$4,725.00" "$4,725.00" "$4,725.00" "$4,725.00" "$3,543.75" "$4,725.00" "$4,725.00" "$4,725.00" "$2,362.50" "$2,362.50" "$3,742.20" "$4,725.00" "$3,780.00" "$3,071.25" $937.79 "$4,725.00" "$2,740.50" "$4,725.00" "$4,725.00" "$4,725.00" $984.69 "$4,725.00" N/A N/A 80321958 EAP COLOPLAST FISTULA WOUND MGR.-SMALL 14021 BOTH IP/OP $29.00 $21.50 $5.16 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $5.16 $29.00 $29.00 $21.52 $21.52 $22.35 $15.11 $6.04 $29.00 $11.60 $29.00 $29.00 $29.00 $29.00 $29.00 $21.75 $29.00 $29.00 $29.00 $14.50 $14.50 $22.97 $29.00 $23.20 $18.85 $29.00 $29.00 $16.82 $29.00 $17.40 $29.00 $29.00 $29.00 N/A N/A 80321959 EAP SYSTEM 156-228MM OST MIDI CTF 2 SPOUT DRAIN PORT BOTH IP/OP $127.00 $94.00 $22.61 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $22.61 $127.00 $127.00 $94.26 $94.26 $97.89 $66.17 $26.47 $127.00 $50.80 $127.00 $127.00 $127.00 $127.00 $127.00 $95.25 $127.00 $127.00 $127.00 $63.50 $63.50 $100.58 $127.00 $101.60 $82.55 $127.00 $127.00 $73.66 $127.00 $76.20 $127.00 $127.00 $127.00 N/A N/A 80321960 EAP COLOPLAST FISTULA WOUND MGR.-LARGE 14041 BOTH IP/OP $130.00 $96.50 $23.14 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $130.00 $23.14 $130.00 $130.00 $96.49 $96.49 $100.20 $67.73 $27.09 $130.00 $52.00 $130.00 $130.00 $130.00 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $65.00 $65.00 $102.96 $130.00 $104.00 $84.50 $130.00 $130.00 $75.40 $130.00 $78.00 $130.00 $130.00 $130.00 N/A N/A 80321970 EAP HCPCS C1894 INTRODUCER SHTH 7FR 2.5CM 25CM DILAT RADIOPQ MRKR BOTH IP/OP $65.00 $48.50 $12.90 $65.00 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $65.00 $38.45 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 $65.00 $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 80322020 EAP HCPCS C1753 CATHETER ULTRASOUND .035IN 8.5FR 90CM 100CM OTW RADIOPQ BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$1,855.50" "$1,855.50" "$1,927.00" "$1,302.50" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,625.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80322040 EAP HCPCS C1760 PLUG CARDIO 14MM .087IN 10MM 1 BOTH IP/OP "$2,080.00" "$1,539.50" $412.83 "$2,080.00" $936.00 $936.00 $936.00 $936.00 "$2,080.00" "$2,080.00" "$2,080.00" $433.52 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $433.49 "$2,080.00" "$2,080.00" "$1,230.32" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,560.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,040.00" "$1,040.00" "$1,647.36" "$2,080.00" "$1,664.00" $936.00 $412.83 "$2,080.00" "$1,206.40" "$2,080.00" "$2,080.00" "$2,080.00" $433.47 "$2,080.00" N/A N/A 80322152 EAP HCPCS C1713 KYPHON XPEDE BONE CEMENT AND MIXER BOTH IP/OP $625.00 $462.50 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 $625.00 $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A 80322156 EAP HCPCS C1725 CATHETER BALDILAT 2.5MM 30MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80322157 EAP HCPCS C1725 CATHETER BALDILAT 2MM 25MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80322159 EAP HCPCS C1725 CATHETER BALDILAT ULTRA LP 5FR 1.5MM 12MM 2 LUMEN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80322160 EAP HCPCS C1874 CATHETER BALDILAT 1.5MM 8MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 80322163 EAP HCPCS C1725 CATHETER BALDILAT 3MM 25MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80322164 EAP HCPCS C1725 CATHETER BALDILAT 3MM 20MM CORON RAPEX ULT LP BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80322165 EAP HCPCS C1725 CATHETER BALDILAT 3MM 8MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80322166 EAP HCPCS C1725 CATHETER BALDILAT 2.5MM 25MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80322167 EAP HCPCS C1725 TREK CORONARY DILATATION CATHETER 2.50 MM X 8 MM / RAPID-EXCHANGE BOTH IP/OP $213.00 $158.00 $42.28 $213.00 $115.66 $115.66 $115.66 $115.66 $213.00 $213.00 $213.00 $44.39 $213.00 $158.09 $158.09 $164.18 $110.97 $44.39 $213.00 $213.00 $125.99 $213.00 $213.00 $213.00 $213.00 $159.75 $213.00 $213.00 $213.00 $106.50 $106.50 $168.70 $213.00 $170.40 $138.45 $42.28 $213.00 $123.54 $213.00 $213.00 $213.00 $44.39 $213.00 N/A N/A 80322168 EAP HCPCS C1725 CATHETER BALDILAT 2MM 20MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 80322169 EAP HCPCS C1725 CATHETER BALDILAT 2MM 8MM CORON RAPEX ULT LP BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80322170 EAP HCPCS C1725 CATHETER BALDILAT ULTRA LP 5FR 1.5MM 15MM 2 LUMEN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80322173 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN JOINTLESS SPRG COIL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80322174 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN CORE TO TIP RADIOPQ BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80322178 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN JOINTLESS SPRG COIL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80322247 EAP HCPCS A6213 DRESSING 6X6IN ADH HYDROFERA FOAM BLUE BOTH IP/OP $336.00 $249.00 $11.23 $336.00 $336.00 $336.00 $336.00 $336.00 $336.00 $336.00 $11.23 $336.00 $336.00 $249.38 $249.38 $258.99 $175.06 $70.03 $336.00 $134.40 $336.00 $336.00 $336.00 $336.00 $336.00 $252.00 $336.00 $336.00 $336.00 $168.00 $168.00 $266.11 $336.00 $268.80 $218.40 $336.00 $336.00 $194.88 $336.00 $201.60 $336.00 $336.00 $336.00 N/A N/A 80322254 EAP KIT BONE CEMENT KYPHON XPANDER II 3 L15 MM TAMP 1 STEP BOTH IP/OP "$8,000.00" "$5,920.00" "$1,424.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$1,424.00" "$8,000.00" "$8,000.00" "$4,181.12" "$4,181.12" "$6,166.40" "$2,060.15" "$1,667.29" "$8,000.00" "$3,200.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$6,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$4,000.00" "$4,000.00" "$6,336.00" "$8,000.00" "$6,400.00" "$5,200.00" "$8,000.00" "$8,000.00" "$4,640.00" "$8,000.00" "$4,800.00" "$8,000.00" "$8,000.00" "$8,000.00" N/A N/A 80322255 EAP TAMP 20/3 INTROD SURG BONE KPHPK XPNDR II 1STP BOTH IP/OP "$8,000.00" "$5,920.00" "$1,424.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$1,424.00" "$8,000.00" "$8,000.00" "$4,181.12" "$4,181.12" "$6,166.40" "$2,060.15" "$1,667.29" "$8,000.00" "$3,200.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$6,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$4,000.00" "$4,000.00" "$6,336.00" "$8,000.00" "$6,400.00" "$5,200.00" "$8,000.00" "$8,000.00" "$4,640.00" "$8,000.00" "$4,800.00" "$8,000.00" "$8,000.00" "$8,000.00" N/A N/A 80322256 EAP TAMP 15/2 KIT 1ST FRAC SURG BONE XPR II OSTEO BOTH IP/OP "$8,000.00" "$5,920.00" "$1,424.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$1,424.00" "$8,000.00" "$8,000.00" "$4,181.12" "$4,181.12" "$6,166.40" "$2,060.15" "$1,667.29" "$8,000.00" "$3,200.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$6,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$4,000.00" "$4,000.00" "$6,336.00" "$8,000.00" "$6,400.00" "$5,200.00" "$8,000.00" "$8,000.00" "$4,640.00" "$8,000.00" "$4,800.00" "$8,000.00" "$8,000.00" "$8,000.00" N/A N/A 80322257 EAP TAMP 10/2 KIT 1ST FRAC SURG BONE XPR II OSTEO BOTH IP/OP "$8,000.00" "$5,920.00" "$1,424.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$1,424.00" "$8,000.00" "$8,000.00" "$4,181.12" "$4,181.12" "$6,166.40" "$2,060.15" "$1,667.29" "$8,000.00" "$3,200.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$6,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$4,000.00" "$4,000.00" "$6,336.00" "$8,000.00" "$6,400.00" "$5,200.00" "$8,000.00" "$8,000.00" "$4,640.00" "$8,000.00" "$4,800.00" "$8,000.00" "$8,000.00" "$8,000.00" N/A N/A 80322259 EAP Custom 80322259 ADAPTER BN CMNT KYPHON MUL-TAP XPNDR 8 GA BOTH IP/OP $50.00 $37.00 $8.90 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $8.90 $50.00 $50.00 $37.11 $37.11 $38.54 $26.05 $10.42 $50.00 $20.00 $50.00 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $32.50 $50.00 $50.00 $29.00 $50.00 $30.00 $50.00 $50.00 $50.00 N/A N/A 80322260 EAP HCPCS C1713 XPEDE CEMENT AND MIXER WITH SIZE 2 MULTI-TAP BOTH IP/OP $675.00 $499.50 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $675.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 $675.00 $391.50 $675.00 $405.00 $675.00 $140.67 $675.00 N/A N/A 80322261 EAP HCPCS C1713 XPEDE CEMENT AND MIXER WITH SIZE 3 MULTI-TAP BOTH IP/OP $675.00 $499.50 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $675.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 $675.00 $391.50 $675.00 $405.00 $675.00 $140.67 $675.00 N/A N/A 80322311 EAP HCPCS C1769 GUIDEWIRE VASC 180CM ASAHI PTCA SION BLUE BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 80322312 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .014IN STR 3CM SION ASAHI SS BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 80322313 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN 3 RADIOPQ SEG STR 3CM BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 80322314 EAP HCPCS C1769 GUIDEWIRE VASC RG3 BOTH IP/OP $575.00 $425.50 $114.12 $575.00 $312.23 $312.23 $312.23 $312.23 $575.00 $575.00 $575.00 $119.84 $575.00 $426.77 $426.77 $443.21 $299.58 $119.84 $575.00 $575.00 $340.11 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $373.75 $114.12 $575.00 $333.50 $575.00 $575.00 $575.00 $119.83 $575.00 N/A N/A 80322339 EAP HCPCS C1887 CATHETER GUID AL1 CURVE 8FR 90CM CORON SH LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80322340 EAP HCPCS C1887 CATHETER GUID 3DRC CURVE 8FR 90CM CORON LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80322342 EAP HCPCS C1887 CATHETER GUID AL1.5 CURVE 8FR .09IN 90CM CORON BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80322343 EAP HCPCS C1887 CATHETER GUID AL1.5 CURVE 8FR 90CM CORON SH LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80322347 EAP HCPCS C1887 CATHETER GUID XB3.5 CURVE 8FR 90CM CORON SH LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80322349 EAP HCPCS C1887 CATHETER GUID XB4 CURVE 8FR 90CM CORON SH LNCHR BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80322352 EAP HCPCS C2625 STENT URET 10.2FR 26CM PGTL CURVE RADIOPQ SDPRT BOTH IP/OP $312.00 $231.00 $61.92 $312.00 $169.42 $169.42 $169.42 $169.42 $312.00 $312.00 $312.00 $65.03 $312.00 $231.57 $231.57 $240.49 $162.55 $65.02 $312.00 $312.00 $184.55 $312.00 $312.00 $312.00 $312.00 $234.00 $312.00 $312.00 $312.00 $156.00 $156.00 $247.10 $312.00 $249.60 $202.80 $61.92 $312.00 $180.96 $312.00 $312.00 $312.00 $65.02 $312.00 N/A N/A 80322353 EAP HCPCS C2625 STENT URET 10.2FR 28CM PGTL CURVE LP RADIOPQ SDPRT BOTH IP/OP $312.00 $231.00 $61.92 $312.00 $140.40 $140.40 $140.40 $140.40 $312.00 $312.00 $312.00 $65.03 $312.00 $312.00 $312.00 $312.00 $312.00 $65.02 $312.00 $312.00 $184.55 $312.00 $312.00 $312.00 $312.00 $234.00 $312.00 $312.00 $312.00 $156.00 $156.00 $247.10 $312.00 $249.60 $140.40 $61.92 $312.00 $180.96 $312.00 $312.00 $312.00 $65.02 $312.00 N/A N/A 80322411 EAP Custom 80322411 OMNI FLUSH (VCF) 5FR 100CM BOTH IP/OP $35.00 $26.00 $6.23 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $6.23 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 80322554 EAP Custom 80322554 BIOPSY NEEDLE PROCORE ECHOTIP FINE L5 CM OD22 BOTH IP/OP $257.00 $190.50 $45.75 $257.00 $257.00 $257.00 $257.00 $257.00 $257.00 $257.00 $45.75 $257.00 $257.00 $190.75 $190.75 $198.10 $133.90 $53.56 $257.00 $102.80 $257.00 $257.00 $257.00 $257.00 $257.00 $192.75 $257.00 $257.00 $257.00 $128.50 $128.50 $203.54 $257.00 $205.60 $167.05 $257.00 $257.00 $149.06 $257.00 $154.20 $257.00 $257.00 $257.00 N/A N/A 80322620 EAP HCPCS C1750 KIT CATH 61CM PALINDROME PRCS SMTR TIP 44CM CHRNC BOTH IP/OP "$1,445.00" "$1,069.50" $286.80 "$1,445.00" $784.64 $784.64 $784.64 $784.64 "$1,445.00" "$1,445.00" "$1,445.00" $301.17 "$1,445.00" "$1,072.48" "$1,072.48" "$1,113.81" $752.85 $301.15 "$1,445.00" "$1,445.00" $854.72 "$1,445.00" "$1,445.00" "$1,445.00" "$1,445.00" "$1,083.75" "$1,445.00" "$1,445.00" "$1,445.00" $722.50 $722.50 "$1,144.44" "$1,445.00" "$1,156.00" $939.25 $286.80 "$1,445.00" $838.10 "$1,445.00" "$1,445.00" "$1,445.00" $301.14 "$1,445.00" N/A N/A 80322663 EAP HCPCS C1729 CATHETER DRAIN LP TAPER SPIRAL 5FR 19GA 10CM 4 DRAIN HOLE BOTH IP/OP $46.00 $34.50 $9.13 $46.00 $24.98 $24.98 $24.98 $24.98 $46.00 $46.00 $46.00 $9.59 $46.00 $34.14 $34.14 $35.46 $23.97 $9.59 $46.00 $46.00 $27.21 $46.00 $46.00 $46.00 $46.00 $34.50 $46.00 $46.00 $46.00 $23.00 $23.00 $36.43 $46.00 $36.80 $29.90 $9.13 $46.00 $26.68 $46.00 $46.00 $46.00 $9.59 $46.00 N/A N/A 80322674 EAP Custom 80322674 SPONGE ABSORBABLE THK10MM 100 12.5X8CM HEMOSTAT SURGIFOAM BOTH IP/OP $22.00 $16.50 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 80322779 EAP Custom 80322779 SET NDL 15GA 45MM STRL LF EZIO EZ-CNCT WRST BAND STD LL CATH BOTH IP/OP $340.00 $252.00 $60.52 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $60.52 $340.00 $340.00 $252.35 $252.35 $262.07 $177.14 $70.86 $340.00 $136.00 $340.00 $340.00 $340.00 $340.00 $340.00 $255.00 $340.00 $340.00 $340.00 $170.00 $170.00 $269.28 $340.00 $272.00 $221.00 $340.00 $340.00 $197.20 $340.00 $204.00 $340.00 $340.00 $340.00 N/A N/A 80323010 EAP HCPCS C1874 "VIABAHN ENDOPROSTHESIS , 8X5" BOTH IP/OP "$8,765.00" "$6,486.50" "$1,739.63" "$8,765.00" "$3,944.25" "$3,944.25" "$3,944.25" "$3,944.25" "$8,765.00" "$8,765.00" "$8,765.00" "$1,826.85" "$8,765.00" "$8,765.00" "$8,765.00" "$8,765.00" "$8,765.00" "$1,826.72" "$8,765.00" "$8,765.00" "$4,321.15" "$8,765.00" "$8,765.00" "$8,765.00" "$8,765.00" "$6,573.75" "$8,765.00" "$8,765.00" "$8,765.00" "$4,382.50" "$4,382.50" "$6,941.88" "$8,765.00" "$7,012.00" "$3,944.25" "$1,739.63" "$8,765.00" "$5,083.70" "$8,765.00" "$8,765.00" "$8,765.00" "$1,826.63" "$8,765.00" N/A N/A 80323432 EAP 80323432 FORCEPS SURGICAL L5 1/2 IN ALLIGATOR SERRATE JAW STERILE LAT BOTH IP/OP "$1,335.00" $988.00 $237.63 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $237.63 "$1,335.00" "$1,335.00" $990.84 $990.84 "$1,029.02" $695.54 $278.23 "$1,335.00" $534.00 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $867.75 "$1,335.00" "$1,335.00" $774.30 "$1,335.00" $801.00 "$1,335.00" "$1,335.00" "$1,335.00" N/A N/A 80323591 EAP STABILIT FIRST FRACTURE KIT WITH POWERCURVE BOTH IP/OP "$7,000.00" "$5,180.00" "$1,246.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$1,246.00" "$7,000.00" "$7,000.00" "$4,181.12" "$4,181.12" "$5,395.60" "$2,060.15" "$1,458.88" "$7,000.00" "$2,800.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$5,250.00" "$7,000.00" "$7,000.00" "$7,000.00" "$3,500.00" "$3,500.00" "$5,544.00" "$7,000.00" "$5,600.00" "$4,550.00" "$7,000.00" "$7,000.00" "$4,060.00" "$7,000.00" "$4,200.00" "$7,000.00" "$7,000.00" "$7,000.00" N/A N/A 80323602 EAP HCPCS C1725 CATHETER BALDILAT 5FR 5MM 130CM 40MM PCLTXL BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,900.50" "$1,900.50" "$1,900.50" "$1,900.50" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$3,500.00" "$2,070.25" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" $694.66 "$3,500.00" "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 80323626 EAP HCPCS C1874 STENT VASCULAR 6MM 80MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM BOTH IP/OP "$4,488.00" "$3,321.50" $890.76 "$4,488.00" "$2,019.60" "$2,019.60" "$2,019.60" "$2,019.60" "$4,488.00" "$4,488.00" "$4,488.00" $935.41 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$4,488.00" "$2,212.58" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" $890.76 "$4,488.00" "$2,603.04" "$4,488.00" "$4,488.00" "$4,488.00" $935.30 "$4,488.00" N/A N/A 80323627 EAP HCPCS C1874 STENT VASCULAR ZILVER PTX 125CM 80MM 100MM OD6 FR BOTH IP/OP "$4,488.00" "$3,321.50" $890.76 "$4,488.00" "$2,436.98" "$2,436.98" "$2,436.98" "$2,436.98" "$4,488.00" "$4,488.00" "$4,488.00" $935.41 "$4,488.00" "$3,330.99" "$3,330.99" "$3,459.35" "$2,060.15" $935.35 "$4,488.00" "$4,488.00" "$2,654.65" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,917.20" $890.76 "$4,488.00" "$2,603.04" "$4,488.00" "$4,488.00" "$4,488.00" $935.30 "$4,488.00" N/A N/A 80323628 EAP HCPCS C1874 STENT VASCULAR 6MM 120MM 125CM DRUG ELUTE OTW DELIVERY BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 80323642 EAP HCPCS C1751 AXS CATALYST 6 DISTAL ACCESS CATHETER BOTH IP/OP "$5,288.00" "$3,913.50" "$1,049.54" "$5,288.00" "$2,871.38" "$2,871.38" "$2,871.38" "$2,871.38" "$5,288.00" "$5,288.00" "$5,288.00" "$1,102.15" "$5,288.00" "$3,924.75" "$3,924.75" "$4,075.99" "$2,060.15" "$1,102.08" "$5,288.00" "$5,288.00" "$3,094.73" "$5,288.00" "$5,288.00" "$5,288.00" "$5,288.00" "$3,966.00" "$5,288.00" "$5,288.00" "$5,288.00" "$2,644.00" "$2,644.00" "$4,188.10" "$5,288.00" "$4,230.40" "$3,437.20" "$1,049.54" "$5,288.00" "$3,067.04" "$5,288.00" "$5,288.00" "$5,288.00" "$1,102.02" "$5,288.00" N/A N/A 80323683 EAP HCPCS C1874 WALLFLEX 10F 1-USE COLONIC STNT 22MM X 6CM X 2.3M BOTH IP/OP "$6,160.00" "$4,558.50" "$1,222.61" "$6,160.00" "$3,344.88" "$3,344.88" "$3,344.88" "$3,344.88" "$6,160.00" "$6,160.00" "$6,160.00" "$1,283.90" "$6,160.00" "$4,181.12" "$4,181.12" "$4,748.13" "$2,060.15" "$1,283.81" "$6,160.00" "$6,160.00" "$3,094.73" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$4,620.00" "$6,160.00" "$6,160.00" "$6,160.00" "$3,080.00" "$3,080.00" "$4,878.72" "$6,160.00" "$4,928.00" "$4,004.00" "$1,222.61" "$6,160.00" "$3,572.80" "$6,160.00" "$6,160.00" "$6,160.00" "$1,283.74" "$6,160.00" N/A N/A 80323684 EAP HCPCS C1874 WALLFLEX 10F 1-USE COLONIC STENT 22MM X 9CM X 2.3M BOTH IP/OP "$6,160.00" "$4,558.50" "$1,222.61" "$6,160.00" "$3,344.88" "$3,344.88" "$3,344.88" "$3,344.88" "$6,160.00" "$6,160.00" "$6,160.00" "$1,283.90" "$6,160.00" "$4,181.12" "$4,181.12" "$4,748.13" "$2,060.15" "$1,283.81" "$6,160.00" "$6,160.00" "$3,094.73" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$4,620.00" "$6,160.00" "$6,160.00" "$6,160.00" "$3,080.00" "$3,080.00" "$4,878.72" "$6,160.00" "$4,928.00" "$4,004.00" "$1,222.61" "$6,160.00" "$3,572.80" "$6,160.00" "$6,160.00" "$6,160.00" "$1,283.74" "$6,160.00" N/A N/A 80323793 EAP HCPCS C1725 CATHETER ANGIO JR5 CRV 5FR 100 BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80323794 EAP HCPCS C1725 CATHETER ANGIO STD JR 4 CRV 6FR 100CM INFNT THRLMN VESTAN BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80323795 EAP HCPCS C1725 CATHETER ANGIO JR 5 CRV 6FR .0 BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80323798 EAP HCPCS C1725 CATHETER ANGIO AR 1 MOD CRV 6FR .057IN 100CM INFNT THRLMN BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80323801 EAP HCPCS C1725 CATHETER ANGIO LCAB CRV 6FR .079IN .057IN 100CM LF INFNT BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80323828 EAP HCPCS C1769 GUIDEWIRE VASC 190CM .014IN STRBL RADIOPQ KINK RST BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80323833 EAP Custom 80323833 IMPELLA RP US HDE PUMP SET BOTH IP/OP "$62,500.00" "$46,250.00" "$2,060.15" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$11,125.00" "$62,500.00" "$62,500.00" "$4,181.12" "$4,181.12" "$48,175.00" "$2,060.15" "$13,025.69" "$62,500.00" "$25,000.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$46,875.00" "$62,500.00" "$62,500.00" "$62,500.00" "$31,250.00" "$31,250.00" "$49,500.00" "$62,500.00" "$50,000.00" "$40,625.00" "$62,500.00" "$62,500.00" "$36,250.00" "$62,500.00" "$37,500.00" "$62,500.00" "$62,500.00" "$62,500.00" N/A N/A 80323834 EAP WASTE MANAGEMENT KIT BOTH IP/OP $578.00 $428.00 $102.88 $578.00 $578.00 $578.00 $578.00 $578.00 $578.00 $578.00 $102.88 $578.00 $578.00 $428.99 $428.99 $445.52 $301.14 $120.46 $578.00 $231.20 $578.00 $578.00 $578.00 $578.00 $578.00 $433.50 $578.00 $578.00 $578.00 $289.00 $289.00 $457.78 $578.00 $462.40 $375.70 $578.00 $578.00 $335.24 $578.00 $346.80 $578.00 $578.00 $578.00 N/A N/A 80323864 EAP COIL EMBL 5CM 5MM NST PLTN SYNTH FBR ACPT .018IN BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 $250.00 $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 80323876 EAP COIL EMBL 14.2CM 10-4MM TRND MCIOL SFT SPC PUSH BOTH IP/OP $275.00 $203.50 $48.95 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $48.95 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $110.00 $275.00 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $275.00 $275.00 $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A 80324671 EAP HCPCS C1725 CATHETER ANGIO .038IN KA2 CRV 5FR .046IN 40CM IMPR BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 $150.00 $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 80324728 EAP HCPCS C1729 PERIVAC KIT BOTH IP/OP "$1,255.00" $929.00 $249.09 "$1,255.00" $681.47 $681.47 $681.47 $681.47 "$1,255.00" "$1,255.00" "$1,255.00" $261.57 "$1,255.00" $931.46 $931.46 $967.35 $653.86 $261.56 "$1,255.00" "$1,255.00" $742.33 "$1,255.00" "$1,255.00" "$1,255.00" "$1,255.00" $941.25 "$1,255.00" "$1,255.00" "$1,255.00" $627.50 $627.50 $993.96 "$1,255.00" "$1,004.00" $815.75 $249.09 "$1,255.00" $727.90 "$1,255.00" "$1,255.00" "$1,255.00" $261.54 "$1,255.00" N/A N/A 80324729 EAP Custom 80324729 TURNPIKE CATHETER LP 135CM BOTH IP/OP "$1,313.00" $972.00 $233.71 "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" $233.71 "$1,313.00" "$1,313.00" $974.51 $974.51 "$1,012.06" $684.07 $273.64 "$1,313.00" $525.20 "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" $984.75 "$1,313.00" "$1,313.00" "$1,313.00" $656.50 $656.50 "$1,039.90" "$1,313.00" "$1,050.40" $853.45 "$1,313.00" "$1,313.00" $761.54 "$1,313.00" $787.80 "$1,313.00" "$1,313.00" "$1,313.00" N/A N/A 80324730 EAP Custom 80324730 TURNPIKE CATHETER LP 150CM BOTH IP/OP "$1,488.00" "$1,101.50" $264.86 "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" $264.86 "$1,488.00" "$1,488.00" "$1,104.39" "$1,104.39" "$1,146.95" $775.25 $310.12 "$1,488.00" $595.20 "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" "$1,488.00" "$1,116.00" "$1,488.00" "$1,488.00" "$1,488.00" $744.00 $744.00 "$1,178.50" "$1,488.00" "$1,190.40" $967.20 "$1,488.00" "$1,488.00" $863.04 "$1,488.00" $892.80 "$1,488.00" "$1,488.00" "$1,488.00" N/A N/A 80324814 EAP DRESSING HDRCLD 8X8IN CMFL PLUS ABS WTPRF TOP FLM BOTH IP/OP $14.00 $10.50 $2.49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $2.49 $14.00 $14.00 $10.39 $10.39 $10.79 $7.29 $2.92 $14.00 $5.60 $14.00 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $9.10 $14.00 $14.00 $8.12 $14.00 $8.40 $14.00 $14.00 $14.00 N/A N/A 80324863 EAP HCPCS C1874 STENT ENDOPRSTH SPRFC FEM ART ILIUM 10CM 7MM 7FR BOTH IP/OP "$8,950.00" "$6,623.00" "$1,776.35" "$8,950.00" "$4,027.50" "$4,027.50" "$4,027.50" "$4,027.50" "$8,950.00" "$8,950.00" "$8,950.00" "$1,865.40" "$8,950.00" "$8,950.00" "$8,950.00" "$8,950.00" "$8,950.00" "$1,865.28" "$8,950.00" "$8,950.00" "$4,412.35" "$8,950.00" "$8,950.00" "$8,950.00" "$8,950.00" "$6,712.50" "$8,950.00" "$8,950.00" "$8,950.00" "$4,475.00" "$4,475.00" "$7,088.40" "$8,950.00" "$7,160.00" "$4,027.50" "$1,776.35" "$8,950.00" "$5,191.00" "$8,950.00" "$5,370.00" "$8,950.00" "$1,865.18" "$8,950.00" N/A N/A 80324866 EAP HCPCS C1892 INTROD SHTH 9FR 13CM OPTISEAL BOTH IP/OP $130.00 $96.50 $25.80 $130.00 $70.59 $70.59 $70.59 $70.59 $130.00 $130.00 $130.00 $27.10 $130.00 $96.49 $96.49 $100.20 $67.73 $27.09 $130.00 $130.00 $76.90 $130.00 $130.00 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $65.00 $65.00 $102.96 $130.00 $104.00 $84.50 $25.80 $130.00 $75.40 $130.00 $130.00 $130.00 $27.09 $130.00 N/A N/A 80325042 EAP HCPCS C2621 PACEMAKER CRD THK6MM 59X56MM 15CC QD ALR MP RF IS4-LLLL IS-1 BOTH IP/OP "$16,625.00" "$12,302.50" "$3,299.65" "$16,625.00" "$7,481.25" "$7,481.25" "$7,481.25" "$7,481.25" "$16,625.00" "$16,625.00" "$16,625.00" "$3,465.07" "$16,625.00" "$16,625.00" "$16,625.00" "$16,625.00" "$16,625.00" "$3,464.83" "$16,625.00" "$16,625.00" "$8,196.13" "$16,625.00" "$16,625.00" "$16,625.00" "$16,625.00" "$12,468.75" "$16,625.00" "$16,625.00" "$16,625.00" "$8,312.50" "$8,312.50" "$13,167.00" "$16,625.00" "$13,300.00" "$7,481.25" "$3,299.65" "$16,625.00" "$9,642.50" "$16,625.00" "$16,625.00" "$16,625.00" "$3,464.65" "$16,625.00" N/A N/A 80325074 EAP HCPCS C1773 SNARE VASC 47IN .71-1.18IN .055IN .074IN ENSNR BOTH IP/OP $828.00 $613.00 $164.34 $828.00 $449.60 $449.60 $449.60 $449.60 $828.00 $828.00 $828.00 $172.58 $828.00 $614.54 $614.54 $638.22 $431.39 $172.56 $828.00 $828.00 $489.76 $828.00 $828.00 $828.00 $828.00 $621.00 $828.00 $828.00 $828.00 $414.00 $414.00 $655.78 $828.00 $662.40 $538.20 $164.34 $828.00 $480.24 $828.00 $828.00 $828.00 $172.56 $828.00 N/A N/A 80325086 EAP HCPCS C1817 OCCLUDER CARDIO 25MM SPT SFT WIRE FRM FLRSCP IMG BOTH IP/OP "$19,778.00" "$14,636.00" "$4,121.95" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$4,121.95" "$19,778.00" "$7,911.20" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$14,833.50" "$19,778.00" "$19,778.00" "$19,778.00" "$9,889.00" "$9,889.00" "$15,664.18" "$19,778.00" "$15,822.40" "$8,900.10" "$19,778.00" "$19,778.00" "$11,471.24" "$19,778.00" "$11,866.80" "$19,778.00" "$19,778.00" "$19,778.00" N/A N/A 80325087 EAP HCPCS C1817 OCCLUDER CARDIO 30MM SPT SFT WIRE FRM FLRSCP IMG BOTH IP/OP "$19,778.00" "$14,636.00" "$4,121.95" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$4,121.95" "$19,778.00" "$7,911.20" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$19,778.00" "$14,833.50" "$19,778.00" "$19,778.00" "$19,778.00" "$9,889.00" "$9,889.00" "$15,664.18" "$19,778.00" "$15,822.40" "$8,900.10" "$19,778.00" "$19,778.00" "$11,471.24" "$19,778.00" "$11,866.80" "$19,778.00" "$19,778.00" "$19,778.00" N/A N/A 80325088 EAP HCPCS A4649 MEDIHONEY DRESSING 1.5OZ TUBE BOTH IP/OP $28.00 $21.00 $5.56 $28.00 $15.20 $15.20 $15.20 $15.20 $28.00 $28.00 $28.00 $5.84 $28.00 $20.78 $20.78 $21.58 $14.59 $5.84 $28.00 $28.00 $16.56 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $18.20 $5.56 $28.00 $16.24 $28.00 $28.00 $28.00 $5.84 $28.00 N/A N/A 80325219 EAP HCPCS C2628 CATHETER OCL 46MM 140CM CODA B BOTH IP/OP "$1,043.00" $772.00 $207.01 "$1,043.00" $566.35 $566.35 $566.35 $566.35 "$1,043.00" "$1,043.00" "$1,043.00" $217.39 "$1,043.00" $774.11 $774.11 $803.94 $543.40 $217.37 "$1,043.00" "$1,043.00" $616.93 "$1,043.00" "$1,043.00" "$1,043.00" "$1,043.00" $782.25 "$1,043.00" "$1,043.00" "$1,043.00" $521.50 $521.50 $826.06 "$1,043.00" $834.40 $677.95 $207.01 "$1,043.00" $604.94 "$1,043.00" "$1,043.00" "$1,043.00" $217.36 "$1,043.00" N/A N/A 80325319 EAP SPINESTAR ABLATION INSTR 17.5 CM L15 MM L10 MM OD11 GA THERM BOTH IP/OP "$7,250.00" "$5,365.00" "$1,290.50" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$1,290.50" "$7,250.00" "$7,250.00" "$4,181.12" "$4,181.12" "$5,588.30" "$2,060.15" "$1,510.98" "$7,250.00" "$2,900.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$5,437.50" "$7,250.00" "$7,250.00" "$7,250.00" "$3,625.00" "$3,625.00" "$5,742.00" "$7,250.00" "$5,800.00" "$4,712.50" "$7,250.00" "$7,250.00" "$4,205.00" "$7,250.00" "$4,350.00" "$7,250.00" "$7,250.00" "$7,250.00" N/A N/A 80325443 EAP HCPCS C1887 SHEATH GUID 65CM 6FR .109IN .087IN PN DSTN STR SS BOTH IP/OP $225.00 $166.50 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 $225.00 $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 80325490 EAP HCPCS C1725 CATHETER ANGIO SM JL CORON 3.5 BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80325491 EAP HCPCS C1725 CATHETER ANGIO JL CORON 4 CURVE 6FR .079IN .057IN BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80325492 EAP HCPCS C1725 CATHETER ANGIO JL 5 CRV 6FR .0 BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80325494 EAP HCPCS C1725 CATHETER ANGIO 125CM 6FR CRDS ST+ JR4 CURVE CORON BOTH IP/OP $84.00 $62.50 $16.67 $84.00 $45.61 $45.61 $45.61 $45.61 $84.00 $84.00 $84.00 $17.51 $84.00 $62.34 $62.34 $64.75 $43.76 $17.51 $84.00 $84.00 $49.69 $84.00 $84.00 $84.00 $84.00 $63.00 $84.00 $84.00 $84.00 $42.00 $42.00 $66.53 $84.00 $67.20 $54.60 $16.67 $84.00 $48.72 $84.00 $84.00 $84.00 $17.51 $84.00 N/A N/A 80325495 EAP HCPCS C1725 CATHETER ANGIO 125CM 6FR CRDS ST+ JL4 CURVE CORON BOTH IP/OP $84.00 $62.50 $16.67 $84.00 $45.61 $45.61 $45.61 $45.61 $84.00 $84.00 $84.00 $17.51 $84.00 $62.34 $62.34 $64.75 $43.76 $17.51 $84.00 $84.00 $49.69 $84.00 $84.00 $84.00 $84.00 $63.00 $84.00 $84.00 $84.00 $42.00 $42.00 $66.53 $84.00 $67.20 $54.60 $16.67 $84.00 $48.72 $84.00 $84.00 $84.00 $17.51 $84.00 N/A N/A 80325501 EAP HCPCS C1725 CATHETER ANGIO LCAB CRV 5FR .047IN 100CM INFNT THRLMN RADOPQ BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80325505 EAP HCPCS C1725 CATHETER ANGIO MULTPUR A2 CURV BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80325506 EAP HCPCS C1725 INFINITI THRULUMEN ANGIOGRAPHIC CATHETER AL II 6F X 100CM X .057 X .038INCH BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80325507 EAP HCPCS C1725 CATHETER ANGIO 3D RIGHT CORON CURVE THNWL 6FR .057 BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $19.00 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $19.00 $19.00 $3.96 $19.00 N/A N/A 80325526 EAP HCPCS C1876 INNOVA 5MM X 60MM X 75CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80325555 EAP HCPCS C1876 STENT VASC BLUE 40MM 6MM INNOVA SPRFC FEM ART SLF BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80325566 EAP HCPCS C1876 INNOVA 8MM X 20MM X 130CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80325567 EAP HCPCS C1876 INNOVA 8MM X 40MM X 130CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80325568 EAP HCPCS C1876 INNOVA 8MM X 60MM X 130CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80325569 EAP HCPCS C1876 INNOVA 8MM X 80MM X 130CM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80325646 EAP HCPCS C1892 PRELUDE SNAP INTRODUCER SHEATH 7FR .092IN 13CM BOTH IP/OP $193.00 $143.00 $38.31 $193.00 $104.80 $104.80 $104.80 $104.80 $193.00 $193.00 $193.00 $40.23 $193.00 $143.24 $143.24 $148.76 $100.55 $40.22 $193.00 $193.00 $114.16 $193.00 $193.00 $193.00 $193.00 $144.75 $193.00 $193.00 $193.00 $96.50 $96.50 $152.86 $193.00 $154.40 $125.45 $38.31 $193.00 $111.94 $193.00 $193.00 $193.00 $40.22 $193.00 N/A N/A 80325650 EAP HCPCS C1757 SYSTEM THRMB ZELANTEDVT BOTH IP/OP "$7,313.00" "$5,412.00" "$1,451.45" "$7,313.00" "$3,970.96" "$3,970.96" "$3,970.96" "$3,970.96" "$7,313.00" "$7,313.00" "$7,313.00" "$1,524.21" "$7,313.00" "$4,181.12" "$4,181.12" "$5,636.86" "$2,060.15" "$1,524.11" "$7,313.00" "$7,313.00" "$3,094.73" "$7,313.00" "$7,313.00" "$7,313.00" "$7,313.00" "$5,484.75" "$7,313.00" "$7,313.00" "$7,313.00" "$3,656.50" "$3,656.50" "$5,791.90" "$7,313.00" "$5,850.40" "$4,753.45" "$1,451.45" "$7,313.00" "$4,241.54" "$7,313.00" "$7,313.00" "$7,313.00" "$1,524.03" "$7,313.00" N/A N/A 80325671 EAP HCPCS C1874 STENT VASC 60MM 6MM GORE TIGRIS CBAS NTNL FLPLMR BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" $779.00 "$3,738.00" N/A N/A 80325673 EAP HCPCS C1874 STENT VASC 100MM 6MM GORE TIGRIS CBAS NTNL FLPLMR BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" $779.00 "$3,738.00" N/A N/A 80325675 EAP HCPCS C1874 STENT VASC 60MM 7MM GORE TIGRIS CBAS NTNL FLPLMR BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$3,738.00" "$3,738.00" $779.00 "$3,738.00" N/A N/A 80325676 EAP HCPCS C1874 STENT VASC 100MM 7MM GORE TIGRIS CBAS NTNL FLPLMR BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" $779.00 "$3,738.00" N/A N/A 80325686 EAP HCPCS C1887 CATHETER GD EH CRV 9FR 50CM ST BOTH IP/OP $530.00 $392.50 $105.19 $530.00 $287.79 $287.79 $287.79 $287.79 $530.00 $530.00 $530.00 $110.47 $530.00 $393.37 $393.37 $408.52 $276.13 $110.46 $530.00 $530.00 $313.50 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $344.50 $105.19 $530.00 $307.40 $530.00 $530.00 $530.00 $110.45 $530.00 N/A N/A 80325920 EAP SET INTRO 10FR 3.3MM 30CM STRL 41CM CKFL DISP ACPT .038IN GW BOTH IP/OP $112.00 $83.00 $19.94 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $19.94 $112.00 $112.00 $83.13 $83.13 $86.33 $58.35 $23.34 $112.00 $44.80 $112.00 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $72.80 $112.00 $112.00 $64.96 $112.00 $67.20 $112.00 $112.00 $112.00 N/A N/A 80326001 EAP Custom 80326001 PACK SRG CRD CATH HAZ GRADY MEM HSP BOTH IP/OP $247.00 $183.00 $43.97 $247.00 $247.00 $247.00 $247.00 $247.00 $247.00 $247.00 $43.97 $247.00 $247.00 $183.32 $183.32 $190.39 $128.69 $51.48 $247.00 $98.80 $247.00 $247.00 $247.00 $247.00 $247.00 $185.25 $247.00 $247.00 $247.00 $123.50 $123.50 $195.62 $247.00 $197.60 $160.55 $247.00 $247.00 $143.26 $247.00 $148.20 $247.00 $247.00 $247.00 N/A N/A 80326063 EAP HCPCS C1769 INTROD SHTH 6FR .083IN 13CM RBST VLV SPLT SDPRT BOTH IP/OP $88.00 $65.50 $17.47 $88.00 $47.78 $47.78 $47.78 $47.78 $88.00 $88.00 $88.00 $18.34 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $88.00 $52.05 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $17.47 $88.00 $51.04 $88.00 $88.00 $88.00 $18.34 $88.00 N/A N/A 80326064 EAP HCPCS C1894 INTROD SHTH 8FR .105IN 13CM RBST VLV SPLT SDPRT BOTH IP/OP $193.00 $143.00 $38.31 $193.00 $104.80 $104.80 $104.80 $104.80 $193.00 $193.00 $193.00 $40.23 $193.00 $143.24 $143.24 $148.76 $100.55 $40.22 $193.00 $193.00 $114.16 $193.00 $193.00 $193.00 $193.00 $144.75 $193.00 $193.00 $193.00 $96.50 $96.50 $152.86 $193.00 $154.40 $125.45 $38.31 $193.00 $111.94 $193.00 $193.00 $193.00 $40.22 $193.00 N/A N/A 80326066 EAP HCPCS C1892 INTROD SHTH 9FR .118IN 13CM RBST VLV SPLT SDPRT BOTH IP/OP $191.00 $141.50 $37.91 $191.00 $103.71 $103.71 $103.71 $103.71 $191.00 $191.00 $191.00 $39.81 $191.00 $141.76 $141.76 $147.22 $99.51 $39.81 $191.00 $191.00 $112.98 $191.00 $191.00 $191.00 $191.00 $143.25 $191.00 $191.00 $191.00 $95.50 $95.50 $151.27 $191.00 $152.80 $124.15 $37.91 $191.00 $110.78 $191.00 $191.00 $191.00 $39.80 $191.00 N/A N/A 80326081 EAP HCPCS C1887 CATHETER ANGIO JACKY RADL 3.5 CRV 5FR 110CM OPTITORQUE 2 SD BOTH IP/OP $88.00 $65.50 $17.47 $88.00 $47.78 $47.78 $47.78 $47.78 $88.00 $88.00 $88.00 $18.34 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $88.00 $52.05 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $17.47 $88.00 $51.04 $88.00 $88.00 $88.00 $18.34 $88.00 N/A N/A 80326084 EAP HCPCS C1887 CATHETER ANGIO RADIALTIGER CURVE 6FR 4MM 110CM BOTH IP/OP $88.00 $65.50 $17.47 $88.00 $47.78 $47.78 $47.78 $47.78 $88.00 $88.00 $88.00 $18.34 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $88.00 $52.05 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $17.47 $88.00 $51.04 $88.00 $88.00 $88.00 $18.34 $88.00 N/A N/A 80326156 EAP HCPCS A4263 STENT LACRIMAL DUCT MINI MONOKA BOTH IP/OP $146.00 $108.50 $25.99 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $25.99 $146.00 $146.00 $146.00 $146.00 $146.00 $146.00 $30.43 $146.00 $58.40 $146.00 $146.00 $146.00 $146.00 $146.00 $109.50 $146.00 $146.00 $146.00 $73.00 $73.00 $115.63 $146.00 $116.80 $65.70 $146.00 $146.00 $84.68 $146.00 $87.60 $146.00 $146.00 $146.00 N/A N/A 80326288 EAP HCPCS C1769 GUIDEWIRE VASC 325CM .012IN VIPERWIRE ADV CORON BOTH IP/OP $488.00 $361.50 $96.86 $488.00 $264.98 $264.98 $264.98 $264.98 $488.00 $488.00 $488.00 $101.71 $488.00 $362.19 $362.19 $376.15 $254.25 $101.70 $488.00 $488.00 $288.65 $488.00 $488.00 $488.00 $488.00 $366.00 $488.00 $488.00 $488.00 $244.00 $244.00 $386.50 $488.00 $390.40 $317.20 $96.86 $488.00 $283.04 $488.00 $488.00 $488.00 $101.70 $488.00 N/A N/A 80326302 EAP HCPCS C1724 CATHETER ATHRCM 145CM STLTH 360 1.25MM ORBTL CLS BOTH IP/OP "$9,488.00" "$7,021.50" "$1,977.40" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$4,181.12" "$4,181.12" "$7,313.35" "$2,060.15" "$1,977.40" "$9,488.00" "$3,795.20" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$9,488.00" "$7,116.00" "$9,488.00" "$9,488.00" "$9,488.00" "$4,744.00" "$4,744.00" "$7,514.50" "$9,488.00" "$7,590.40" "$6,167.20" "$9,488.00" "$9,488.00" "$5,503.04" "$9,488.00" "$5,692.80" "$9,488.00" "$9,488.00" "$9,488.00" N/A N/A 80326668 EAP HCPCS C1722 GENERATOR PCMKR 83.1X69.1MM EBLM S-ICD 12.7MM 59.5 BOTH IP/OP "$42,500.00" "$31,450.00" "$7,712.84" "$42,500.00" "$19,125.00" "$19,125.00" "$19,125.00" "$19,125.00" "$42,500.00" "$42,500.00" "$42,500.00" "$8,858.06" "$42,500.00" "$42,500.00" "$42,500.00" "$42,500.00" "$42,500.00" "$8,857.47" "$42,500.00" "$42,500.00" "$20,952.50" "$42,500.00" "$42,500.00" "$42,500.00" "$42,500.00" "$31,875.00" "$42,500.00" "$42,500.00" "$42,500.00" "$21,250.00" "$21,250.00" "$33,660.00" "$42,500.00" "$34,000.00" "$19,125.00" "$7,712.84" "$42,500.00" "$24,650.00" "$42,500.00" "$42,500.00" "$42,500.00" "$8,098.48" "$42,500.00" N/A N/A 80332534 EAP Custom 80332534 PACK SRG EP STUP HAZ GRADY MEM HSP BOTH IP/OP $165.00 $122.50 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $74.25 $165.00 $165.00 $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A 80332539 EAP HCPCS C1882 DFBR CRD 13MM 51X73MM CLARIA MRI CRT-D SURESCAN BOTH IP/OP "$52,375.00" "$38,757.50" "$7,712.84" "$52,375.00" "$23,568.75" "$23,568.75" "$23,568.75" "$23,568.75" "$52,375.00" "$52,375.00" "$52,375.00" "$9,417.94" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$10,915.53" "$52,375.00" "$52,375.00" "$25,820.88" "$52,375.00" "$52,375.00" "$52,375.00" "$52,375.00" "$39,281.25" "$52,375.00" "$52,375.00" "$52,375.00" "$26,187.50" "$26,187.50" "$41,481.00" "$52,375.00" "$41,900.00" "$23,568.75" "$7,712.84" "$52,375.00" "$30,377.50" "$52,375.00" "$52,375.00" "$52,375.00" "$8,098.48" "$52,375.00" N/A N/A 80332586 EAP HCPCS C1751 CATHETER ANGEL BOTH IP/OP "$5,625.00" "$4,162.50" "$1,116.42" "$5,625.00" "$3,054.38" "$3,054.38" "$3,054.38" "$3,054.38" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.39" "$5,625.00" "$4,174.88" "$4,174.88" "$4,335.75" "$2,060.15" "$1,172.31" "$5,625.00" "$5,625.00" "$3,094.73" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$3,656.25" "$1,116.42" "$5,625.00" "$3,262.50" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.25" "$5,625.00" N/A N/A 80332596 EAP HCPCS C1757 RETRIEVER ESCP 3MM 20MM TREVO XP PROVUE BOTH IP/OP "$13,118.00" "$9,707.50" "$2,060.15" "$13,118.00" "$7,123.07" "$7,123.07" "$7,123.07" "$7,123.07" "$13,118.00" "$13,118.00" "$13,118.00" "$2,734.12" "$13,118.00" "$4,181.12" "$4,181.12" "$10,111.35" "$2,060.15" "$2,733.94" "$13,118.00" "$13,118.00" "$3,094.73" "$13,118.00" "$13,118.00" "$13,118.00" "$13,118.00" "$9,838.50" "$13,118.00" "$13,118.00" "$13,118.00" "$6,559.00" "$6,559.00" "$10,389.46" "$13,118.00" "$10,494.40" "$8,526.70" "$2,603.60" "$13,118.00" "$7,608.44" "$13,118.00" "$13,118.00" "$13,118.00" "$2,733.79" "$13,118.00" N/A N/A 80332665 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 200CM 35CM SYNCHRO2 SFT ATRM RBN NTNL BOTH IP/OP "$1,238.00" $916.50 $220.36 "$1,238.00" $672.23 $672.23 $672.23 $672.23 "$1,238.00" "$1,238.00" $220.36 $258.03 "$1,238.00" $918.84 $918.84 $954.25 $645.00 $258.01 "$1,238.00" "$1,238.00" $732.28 "$1,238.00" "$1,238.00" "$1,238.00" "$1,238.00" $928.50 "$1,238.00" "$1,238.00" "$1,238.00" $619.00 $619.00 $980.50 "$1,238.00" $990.40 $804.70 $245.71 "$1,238.00" $718.04 "$1,238.00" "$1,238.00" "$1,238.00" $258.00 "$1,238.00" N/A N/A 80332666 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM 35CM SYNCHRO2 SFT HDRPH BOTH IP/OP "$1,313.00" $972.00 $260.60 "$1,313.00" $712.96 $712.96 $712.96 $712.96 "$1,313.00" "$1,313.00" "$1,313.00" $273.66 "$1,313.00" $974.51 $974.51 "$1,012.06" $684.07 $273.64 "$1,313.00" "$1,313.00" $776.64 "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" $984.75 "$1,313.00" "$1,313.00" "$1,313.00" $656.50 $656.50 "$1,039.90" "$1,313.00" "$1,050.40" $853.45 $260.60 "$1,313.00" $761.54 "$1,313.00" "$1,313.00" "$1,313.00" $273.63 "$1,313.00" N/A N/A 80332668 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM 35CM SYNCHRO2 SFT HDRPH BOTH IP/OP "$1,313.00" $972.00 $233.71 "$1,313.00" $712.96 $712.96 $712.96 $712.96 "$1,313.00" "$1,313.00" $233.71 $273.66 "$1,313.00" $974.51 $974.51 "$1,012.06" $684.07 $273.64 "$1,313.00" "$1,313.00" $776.64 "$1,313.00" "$1,313.00" "$1,313.00" "$1,313.00" $984.75 "$1,313.00" "$1,313.00" "$1,313.00" $656.50 $656.50 "$1,039.90" "$1,313.00" "$1,050.40" $853.45 $260.60 "$1,313.00" $761.54 "$1,313.00" "$1,313.00" "$1,313.00" $273.63 "$1,313.00" N/A N/A 80333053 EAP HCPCS C1769 GUIDEWIRE VASC 185CM STRL LF VERRATA + PRSS DISP BOTH IP/OP "$1,688.00" "$1,249.50" $335.03 "$1,688.00" $916.58 $916.58 $916.58 $916.58 "$1,688.00" "$1,688.00" "$1,688.00" $351.82 "$1,688.00" "$1,252.83" "$1,252.83" "$1,301.11" $879.45 $351.80 "$1,688.00" "$1,688.00" $998.45 "$1,688.00" "$1,688.00" "$1,688.00" "$1,688.00" "$1,266.00" "$1,688.00" "$1,688.00" "$1,688.00" $844.00 $844.00 "$1,336.90" "$1,688.00" "$1,350.40" "$1,097.20" $335.03 "$1,688.00" $979.04 "$1,688.00" "$1,688.00" "$1,688.00" $351.78 "$1,688.00" N/A N/A 80338007 EAP HCPCS Q4104 DRESSING BIO 2X2IN STRL LF INTGR BL MX MESH BVN BOTH IP/OP "$6,325.00" "$4,680.50" "$1,255.35" "$6,325.00" "$2,846.25" "$2,846.25" "$2,846.25" "$2,846.25" "$6,325.00" "$6,325.00" "$6,325.00" "$1,318.29" "$6,325.00" "$6,325.00" "$6,325.00" "$6,325.00" "$6,325.00" "$1,318.20" "$6,325.00" "$6,325.00" "$3,118.23" "$6,325.00" "$6,325.00" "$6,325.00" "$6,325.00" "$4,743.75" "$6,325.00" "$6,325.00" "$6,325.00" "$3,162.50" "$3,162.50" "$5,009.40" "$6,325.00" "$5,060.00" "$2,846.25" "$1,255.35" "$6,325.00" "$3,668.50" "$6,325.00" "$6,325.00" "$6,325.00" "$1,318.13" "$6,325.00" N/A N/A 80338397 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .035IN FLX TP ANG 25CM 5CM BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 $400.00 $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A 80339398 EAP HCPCS C1874 STENT EPRSTH .035IN 9MM 13MM 8 BOTH IP/OP "$6,725.00" "$4,976.50" "$1,334.74" "$6,725.00" "$3,026.25" "$3,026.25" "$3,026.25" "$3,026.25" "$6,725.00" "$6,725.00" "$6,725.00" "$1,401.66" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$1,401.56" "$6,725.00" "$6,725.00" "$3,315.43" "$6,725.00" "$6,725.00" "$6,725.00" "$6,725.00" "$5,043.75" "$6,725.00" "$6,725.00" "$6,725.00" "$3,362.50" "$3,362.50" "$5,326.20" "$6,725.00" "$5,380.00" "$3,026.25" "$1,334.74" "$6,725.00" "$3,900.50" "$6,725.00" "$6,725.00" "$6,725.00" "$1,401.49" "$6,725.00" N/A N/A 80339402 EAP HCPCS C1874 STENT ENDOPRSTH 29MM 11MM 16SQ MM 8FR GORE VBHN BOTH IP/OP "$8,548.00" "$6,326.00" "$1,696.56" "$8,548.00" "$3,846.60" "$3,846.60" "$3,846.60" "$3,846.60" "$8,548.00" "$8,548.00" "$8,548.00" "$1,781.62" "$8,548.00" "$8,548.00" "$8,548.00" "$8,548.00" "$8,548.00" "$1,781.50" "$8,548.00" "$8,548.00" "$4,214.16" "$8,548.00" "$8,548.00" "$8,548.00" "$8,548.00" "$6,411.00" "$8,548.00" "$8,548.00" "$8,548.00" "$4,274.00" "$4,274.00" "$6,770.02" "$8,548.00" "$6,838.40" "$3,846.60" "$1,696.56" "$8,548.00" "$4,957.84" "$8,548.00" "$5,128.80" "$8,548.00" "$1,781.40" "$8,548.00" N/A N/A 80339410 EAP HCPCS C1874 STENT ENDOPRSTH 39MM 7MM 11MM 7FR GORE VBHN 135CM BOTH IP/OP "$8,548.00" "$6,326.00" "$1,696.56" "$8,548.00" "$3,846.60" "$3,846.60" "$3,846.60" "$3,846.60" "$8,548.00" "$8,548.00" "$8,548.00" "$1,781.62" "$8,548.00" "$8,548.00" "$8,548.00" "$8,548.00" "$8,548.00" "$1,781.50" "$8,548.00" "$8,548.00" "$4,214.16" "$8,548.00" "$8,548.00" "$8,548.00" "$8,548.00" "$6,411.00" "$8,548.00" "$8,548.00" "$8,548.00" "$4,274.00" "$4,274.00" "$6,770.02" "$8,548.00" "$6,838.40" "$3,846.60" "$1,696.56" "$8,548.00" "$4,957.84" "$8,548.00" "$5,128.80" "$8,548.00" "$1,781.40" "$8,548.00" N/A N/A 80339412 EAP HCPCS C1874 STENT ENDOPRSTH 39MM 8MM 11MM 7FR GORE VBHN 135CM BOTH IP/OP "$8,548.00" "$6,326.00" "$1,696.56" "$8,548.00" "$3,846.60" "$3,846.60" "$3,846.60" "$3,846.60" "$8,548.00" "$8,548.00" "$8,548.00" "$1,781.62" "$8,548.00" "$8,548.00" "$8,548.00" "$8,548.00" "$8,548.00" "$1,781.50" "$8,548.00" "$8,548.00" "$4,214.16" "$8,548.00" "$8,548.00" "$8,548.00" "$8,548.00" "$6,411.00" "$8,548.00" "$8,548.00" "$8,548.00" "$4,274.00" "$4,274.00" "$6,770.02" "$8,548.00" "$6,838.40" "$3,846.60" "$1,696.56" "$8,548.00" "$4,957.84" "$8,548.00" "$8,548.00" "$8,548.00" "$1,781.40" "$8,548.00" N/A N/A 80339426 EAP HCPCS C1874 STENT ENDOPRSTH 59MM 7MM 11MM 7FR GORE VBHN 135CM BOTH IP/OP "$8,548.00" "$6,326.00" "$1,696.56" "$8,548.00" "$3,846.60" "$3,846.60" "$3,846.60" "$3,846.60" "$8,548.00" "$8,548.00" "$8,548.00" "$1,781.62" "$8,548.00" "$8,548.00" "$8,548.00" "$8,548.00" "$8,548.00" "$1,781.50" "$8,548.00" "$8,548.00" "$4,214.16" "$8,548.00" "$8,548.00" "$8,548.00" "$8,548.00" "$6,411.00" "$8,548.00" "$8,548.00" "$8,548.00" "$4,274.00" "$4,274.00" "$6,770.02" "$8,548.00" "$6,838.40" "$3,846.60" "$1,696.56" "$8,548.00" "$4,957.84" "$8,548.00" "$8,548.00" "$8,548.00" "$1,781.40" "$8,548.00" N/A N/A 80339427 EAP HCPCS C1874 STENT EPRSTH .035IN 8MM 11MM 7FR 59MM 80CM GORE VBHN BLN BOTH IP/OP "$8,935.00" "$6,612.00" "$1,773.37" "$8,935.00" "$4,020.75" "$4,020.75" "$4,020.75" "$4,020.75" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.28" "$8,935.00" "$8,935.00" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.15" "$8,935.00" "$8,935.00" "$4,404.96" "$8,935.00" "$8,935.00" "$8,935.00" "$8,935.00" "$6,701.25" "$8,935.00" "$8,935.00" "$8,935.00" "$4,467.50" "$4,467.50" "$7,076.52" "$8,935.00" "$7,148.00" "$4,020.75" "$1,773.37" "$8,935.00" "$5,182.30" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.05" "$8,935.00" N/A N/A 80339428 EAP HCPCS C1874 STENT ENDOPRSTH 59MM 8MM 11MM 7FR GORE VBHN 135CM BOTH IP/OP "$8,138.00" "$6,022.50" "$1,615.19" "$8,138.00" "$3,662.10" "$3,662.10" "$3,662.10" "$3,662.10" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.16" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$1,696.05" "$8,138.00" "$8,138.00" "$4,012.03" "$8,138.00" "$8,138.00" "$8,138.00" "$8,138.00" "$6,103.50" "$8,138.00" "$8,138.00" "$8,138.00" "$4,069.00" "$4,069.00" "$6,445.30" "$8,138.00" "$6,510.40" "$3,662.10" "$1,615.19" "$8,138.00" "$4,720.04" "$8,138.00" "$4,882.80" "$8,138.00" "$1,695.96" "$8,138.00" N/A N/A 80339456 EAP HCPCS C1887 CATHETER GUID BLUE YLW 100CM 6FR CRDS VSBR 3DRC BOTH IP/OP $93.00 $69.00 $18.46 $93.00 $50.50 $50.50 $50.50 $50.50 $93.00 $93.00 $93.00 $19.38 $93.00 $69.02 $69.02 $71.68 $48.45 $19.38 $93.00 $93.00 $55.01 $93.00 $93.00 $93.00 $93.00 $69.75 $93.00 $93.00 $93.00 $46.50 $46.50 $73.66 $93.00 $74.40 $60.45 $18.46 $93.00 $53.94 $93.00 $93.00 $93.00 $19.38 $93.00 N/A N/A 80339548 EAP HCPCS C1751 CATHETER INFS 4 4/3FR 65CM CLARIVEIN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $678.75 $678.75 $678.75 $678.75 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 $248.09 "$1,250.00" $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 80339549 EAP HCPCS C1751 CATHETER INFS 2 2/3FR 45CM CLARIVEIN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $678.75 $678.75 $678.75 $678.75 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 $248.09 "$1,250.00" $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 80339901 EAP HCPCS C1725 CATHETER ANGIO .038IN VTK CRV 5FR 125CM TRNB AD BCNTP NYL SS BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 80339903 EAP CATHETER ANGIO TPR LOPRFL RC2 CRV 5FR 65CM STRL TRNB AD BOTH IP/OP $313.00 $232.00 $55.71 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $55.71 $313.00 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $125.20 $313.00 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $313.00 $313.00 $181.54 $313.00 $187.80 $313.00 $313.00 $313.00 N/A N/A 80339904 EAP HCPCS C1725 CATHETER ANGIO RDC 5FR 65CM TR BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 80340007 EAP HCPCS C1725 CATHETER ANGIO .035IN 5FR 90CM BOTH IP/OP $275.00 $203.50 $54.58 $275.00 $149.33 $149.33 $149.33 $149.33 $275.00 $275.00 $275.00 $57.32 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $275.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $54.58 $275.00 $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A 80340027 EAP HCPCS C1725 CATHETER ANGIO GPC CRV 6.7FR 1 BOTH IP/OP $275.00 $203.50 $54.58 $275.00 $149.33 $149.33 $149.33 $149.33 $275.00 $275.00 $275.00 $57.32 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $275.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $54.58 $275.00 $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A 80340035 EAP HCPCS C1887 CATHETER SPRT .018IN 3.4-2.2FR 150CM CROSSCATH BOTH IP/OP $363.00 $269.00 $72.05 $363.00 $197.11 $197.11 $197.11 $197.11 $363.00 $363.00 $363.00 $75.66 $363.00 $269.42 $269.42 $279.80 $189.12 $75.65 $363.00 $363.00 $214.71 $363.00 $363.00 $363.00 $363.00 $272.25 $363.00 $363.00 $363.00 $181.50 $181.50 $287.50 $363.00 $290.40 $235.95 $72.05 $363.00 $210.54 $363.00 $363.00 $363.00 $75.65 $363.00 N/A N/A 80340040 EAP HCPCS C1887 CATHETER SPRT 2.3FR 150CM CXI ANG TIP BRD KINK RST RADOPQ SS BOTH IP/OP $488.00 $361.50 $96.86 $488.00 $264.98 $264.98 $264.98 $264.98 $488.00 $488.00 $488.00 $101.71 $488.00 $362.19 $362.19 $376.15 $254.25 $101.70 $488.00 $488.00 $288.65 $488.00 $488.00 $488.00 $488.00 $366.00 $488.00 $488.00 $488.00 $244.00 $244.00 $386.50 $488.00 $390.40 $317.20 $96.86 $488.00 $283.04 $488.00 $488.00 $488.00 $101.70 $488.00 N/A N/A 80340047 EAP HCPCS C1887 CXI SUPPORT CATH 2.6F .018IN 90CM ANGLED TIP BOTH IP/OP "$1,363.00" "$1,009.00" $270.52 "$1,363.00" $740.11 $740.11 $740.11 $740.11 "$1,363.00" "$1,363.00" "$1,363.00" $284.08 "$1,363.00" "$1,011.62" "$1,011.62" "$1,050.60" $710.12 $284.06 "$1,363.00" "$1,363.00" $806.21 "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" "$1,022.25" "$1,363.00" "$1,363.00" "$1,363.00" $681.50 $681.50 "$1,079.50" "$1,363.00" "$1,090.40" $885.95 $270.52 "$1,363.00" $790.54 "$1,363.00" "$1,363.00" "$1,363.00" $284.05 "$1,363.00" N/A N/A 80340148 EAP Custom 80340148 CXI SUPPORT CATH 2.6F .018IN 135CM STRAIGHT TIP BOTH IP/OP $545.00 $403.50 $97.01 $545.00 $545.00 $545.00 $545.00 $545.00 $545.00 $545.00 $97.01 $545.00 $545.00 $404.50 $404.50 $420.09 $283.95 $113.58 $545.00 $218.00 $545.00 $545.00 $545.00 $545.00 $545.00 $408.75 $545.00 $545.00 $545.00 $272.50 $272.50 $431.64 $545.00 $436.00 $354.25 $545.00 $545.00 $316.10 $545.00 $327.00 $545.00 $545.00 $545.00 N/A N/A 80340257 EAP HCPCS C1725 CATHETER ANGIO .038IN SIM1 CRV 5FR 100CM TRNB AD BCNTP ANG BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 80340258 EAP HCPCS C1725 CATHETER ANGIO ANG SIM2 CRV 5F BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 80340292 EAP HCPCS C1887 CATHETER GD STRG 2.3FR 135CM CXI MRKR BAND KINK RST RADOPQ BOTH IP/OP $488.00 $361.50 $96.86 $488.00 $264.98 $264.98 $264.98 $264.98 $488.00 $488.00 $488.00 $101.71 $488.00 $362.19 $362.19 $376.15 $254.25 $101.70 $488.00 $488.00 $288.65 $488.00 $488.00 $488.00 $488.00 $366.00 $488.00 $488.00 $488.00 $244.00 $244.00 $386.50 $488.00 $390.40 $317.20 $96.86 $488.00 $283.04 $488.00 $488.00 $488.00 $101.70 $488.00 N/A N/A 80340300 EAP CXI SUPPORT CATH 2.6F .018IN 150CM ANGLED TIP BOTH IP/OP $546.00 $404.50 $97.19 $546.00 $546.00 $546.00 $546.00 $546.00 $546.00 $546.00 $97.19 $546.00 $546.00 $405.24 $405.24 $420.86 $284.47 $113.79 $546.00 $218.40 $546.00 $546.00 $546.00 $546.00 $546.00 $409.50 $546.00 $546.00 $546.00 $273.00 $273.00 $432.43 $546.00 $436.80 $354.90 $546.00 $546.00 $316.68 $546.00 $327.60 $546.00 $546.00 $546.00 N/A N/A 80340303 EAP CXI SUPPORT CATH 2.6F .018IN 65CM ANGLED TIP BOTH IP/OP $546.00 $404.50 $97.19 $546.00 $546.00 $546.00 $546.00 $546.00 $546.00 $546.00 $97.19 $546.00 $546.00 $405.24 $405.24 $420.86 $284.47 $113.79 $546.00 $218.40 $546.00 $546.00 $546.00 $546.00 $546.00 $409.50 $546.00 $546.00 $546.00 $273.00 $273.00 $432.43 $546.00 $436.80 $354.90 $546.00 $546.00 $316.68 $546.00 $327.60 $546.00 $546.00 $546.00 N/A N/A 80340427 EAP HCPCS C1725 CATHETER ANGIO AP2 CRV 5FR 110 BOTH IP/OP $275.00 $203.50 $54.58 $275.00 $149.33 $149.33 $149.33 $149.33 $275.00 $275.00 $275.00 $57.32 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $275.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $54.58 $275.00 $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A 80340435 EAP Custom 80340435 CATHETER ANGIO NEFF CRV 5FR 80CM STRL TRNB AD 8 SDPRT ATRM BOTH IP/OP $275.00 $203.50 $48.95 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $48.95 $275.00 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $110.00 $275.00 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $275.00 $275.00 $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A 80340481 EAP HCPCS C1725 CATHETER ANGIO SIM2 CRV 5FR 12 BOTH IP/OP $613.00 $454.00 $121.67 $613.00 $332.86 $332.86 $332.86 $332.86 $613.00 $613.00 $613.00 $127.76 $613.00 $454.97 $454.97 $472.50 $319.37 $127.76 $613.00 $613.00 $362.59 $613.00 $613.00 $613.00 $613.00 $459.75 $613.00 $613.00 $613.00 $306.50 $306.50 $485.50 $613.00 $490.40 $398.45 $121.67 $613.00 $355.54 $613.00 $613.00 $613.00 $127.75 $613.00 N/A N/A 80340505 EAP HCPCS C1894 INTRODUCER SHTH 7FR 40CM STRL BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80340514 EAP HCPCS C1894 INTRODUCER SHTH .035IN 8FR .11 BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 $200.00 $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 80340523 EAP HCPCS C1894 SHEATH GUID 90CM 2.5FR CHK-FLO FLXR RAABE BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80340526 EAP HCPCS C1894 INTRODUCER SHTH .038IN 9FR .12 BOTH IP/OP $163.00 $121.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $94.54 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80340603 EAP HCPCS C1894 INTRODUCER CATH LG 18FR 5.9MM BOTH IP/OP $318.00 $235.50 $63.12 $318.00 $172.67 $172.67 $172.67 $172.67 $318.00 $318.00 $318.00 $66.28 $318.00 $236.02 $236.02 $245.11 $165.68 $66.27 $318.00 $318.00 $188.10 $318.00 $318.00 $318.00 $318.00 $238.50 $318.00 $318.00 $318.00 $159.00 $159.00 $251.86 $318.00 $254.40 $206.70 $63.12 $318.00 $184.44 $318.00 $318.00 $318.00 $66.27 $318.00 N/A N/A 80340719 EAP HCPCS C1769 GUIDEWIRE VASC .018IN 4FR 40CM STRL 10CM MPNCH SH TRNLS COAX BOTH IP/OP $116.73 $86.50 $23.17 $116.73 $63.38 $63.38 $63.38 $63.38 $116.73 $116.73 $116.73 $24.33 $116.73 $86.64 $86.64 $89.98 $60.82 $24.33 $116.73 $116.73 $69.05 $116.73 $116.73 $116.73 $116.73 $87.55 $116.73 $116.73 $116.73 $58.37 $58.37 $92.45 $116.73 $93.38 $75.87 $23.17 $116.73 $67.70 $116.73 $116.73 $116.73 $24.33 $116.73 N/A N/A 80340741 EAP Custom 80340741 MICROPUNCTURE PUSH-PLUS 4F .018IN 40CM BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 $150.00 $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A 80340822 EAP HCPCS C1894 SHEATH GD .018/.038IN ANL3 CRV BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80341020 EAP HCPCS C1769 GUIDEWIRE VASC CRV .035IN 80CM BOTH IP/OP $73.00 $54.50 $14.49 $73.00 $39.64 $39.64 $39.64 $39.64 $73.00 $73.00 $73.00 $15.22 $73.00 $54.18 $54.18 $56.27 $38.03 $15.21 $73.00 $73.00 $43.18 $73.00 $73.00 $73.00 $73.00 $54.75 $73.00 $73.00 $73.00 $36.50 $36.50 $57.82 $73.00 $58.40 $47.45 $14.49 $73.00 $42.34 $73.00 $73.00 $73.00 $15.21 $73.00 N/A N/A 80341173 EAP HCPCS C1769 GUIDEWIRE VASC 260CM .035IN RADIOPQ FLPY FLX TP BOTH IP/OP $551.00 $408.00 $109.36 $551.00 $299.19 $299.19 $299.19 $299.19 $551.00 $551.00 $551.00 $114.84 $551.00 $408.95 $408.95 $424.71 $287.07 $114.83 $551.00 $551.00 $325.92 $551.00 $551.00 $551.00 $551.00 $413.25 $551.00 $551.00 $551.00 $275.50 $275.50 $436.39 $551.00 $440.80 $358.15 $109.36 $551.00 $319.58 $551.00 $330.60 $551.00 $114.83 $551.00 N/A N/A 80341269 EAP HCPCS C1769 GUIDEWIRE VASC STRG TPR .014IN 300CM APRCH SMTH NVG HDRPH SS BOTH IP/OP $499.00 $369.50 $99.04 $499.00 $270.96 $270.96 $270.96 $270.96 $499.00 $499.00 $499.00 $104.00 $499.00 $370.36 $370.36 $384.63 $259.98 $104.00 $499.00 $499.00 $295.16 $499.00 $499.00 $499.00 $499.00 $374.25 $499.00 $499.00 $499.00 $249.50 $249.50 $395.21 $499.00 $399.20 $324.35 $99.04 $499.00 $289.42 $499.00 $499.00 $499.00 $103.99 $499.00 N/A N/A 80341288 EAP HCPCS C1769 GUIDEWIRE VASC ANG SHRT TPR .018IN 60CM 7CM CP MDRL DIST TIP BOTH IP/OP $106.00 $78.50 $21.04 $106.00 $57.56 $57.56 $57.56 $57.56 $106.00 $106.00 $106.00 $22.09 $106.00 $78.67 $78.67 $81.70 $55.23 $22.09 $106.00 $42.40 $62.70 $106.00 $106.00 $106.00 $106.00 $79.50 $106.00 $106.00 $106.00 $53.00 $53.00 $83.95 $106.00 $84.80 $68.90 $21.04 $106.00 $61.48 $106.00 $106.00 $106.00 $22.09 $106.00 N/A N/A 80341936 EAP HCPCS C1769 GUIDEWIRE VASC 15CM STRG 2 CRV TPR .035IN 180CM 7CM LNDRQS BOTH IP/OP $753.00 $557.50 $149.45 $753.00 $408.88 $408.88 $408.88 $408.88 $753.00 $753.00 $753.00 $156.94 $753.00 $558.88 $558.88 $580.41 $392.31 $156.93 $753.00 $753.00 $445.40 $753.00 $753.00 $753.00 $753.00 $564.75 $753.00 $753.00 $753.00 $376.50 $376.50 $596.38 $753.00 $602.40 $489.45 $149.45 $753.00 $436.74 $753.00 $753.00 $753.00 $156.93 $753.00 N/A N/A 80341943 EAP HCPCS C1894 INTRODUCER CATH 16FR 5.3MM 45CM PRFRMR CK-FLW ACPT .038IN GW BOTH IP/OP $318.00 $235.50 $63.12 $318.00 $172.67 $172.67 $172.67 $172.67 $318.00 $318.00 $318.00 $66.28 $318.00 $236.02 $236.02 $245.11 $165.68 $66.27 $318.00 $318.00 $188.10 $318.00 $318.00 $318.00 $318.00 $238.50 $318.00 $318.00 $318.00 $159.00 $159.00 $251.86 $318.00 $254.40 $206.70 $63.12 $318.00 $184.44 $318.00 $318.00 $318.00 $66.27 $318.00 N/A N/A 80341972 EAP HCPCS C1729 CATHETER DRN .038IN 16FR 40CM BOTH IP/OP $280.00 $207.50 $55.57 $280.00 $152.04 $152.04 $152.04 $152.04 $280.00 $280.00 $280.00 $58.36 $280.00 $207.82 $207.82 $215.82 $145.88 $58.36 $280.00 $280.00 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $182.00 $55.57 $280.00 $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A 80342073 EAP HCPCS C1894 FLEXOR ANSEL GUIDING SHEATH W/CHECK-FLO 5F 1.9MM X 90CM STR BOTH IP/OP "$1,163.00" $861.00 $230.83 "$1,163.00" $631.51 $631.51 $631.51 $631.51 "$1,163.00" "$1,163.00" "$1,163.00" $242.40 "$1,163.00" $863.18 $863.18 $896.44 $605.92 $242.38 "$1,163.00" $925.00 $687.91 "$1,163.00" "$1,163.00" "$1,163.00" "$1,163.00" $872.25 "$1,163.00" "$1,163.00" "$1,163.00" $581.50 $581.50 $921.10 "$1,163.00" $930.40 $755.95 $230.83 "$1,163.00" $674.54 "$1,163.00" "$1,163.00" "$1,163.00" $242.37 "$1,163.00" N/A N/A 80342172 EAP HCPCS C1876 STENT VASC 9MM 6FR 60MM STRL 125CM ZL 635 OTW SLF XPD FLXR BOTH IP/OP "$2,612.50" "$1,933.50" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 "$2,612.50" "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 80349638 EAP HCPCS C1729 CATHETER DRN PGTL CRV 8FR 25CM SKTR CHC LCK LCK TROC STY LG BOTH IP/OP $227.00 $168.00 $45.05 $227.00 $123.26 $123.26 $123.26 $123.26 $227.00 $227.00 $227.00 $47.31 $227.00 $168.48 $168.48 $174.97 $118.27 $47.31 $227.00 $227.00 $134.27 $227.00 $227.00 $227.00 $227.00 $170.25 $227.00 $227.00 $227.00 $113.50 $113.50 $179.78 $227.00 $181.60 $147.55 $45.05 $227.00 $131.66 $227.00 $227.00 $227.00 $47.31 $227.00 N/A N/A 80349650 EAP KIT MCTRDCR .018IN TPR 5FR 40CM 7CM VSI SMTH NDL GW REG DIL BOTH IP/OP $474.00 $351.00 $84.37 $474.00 $474.00 $474.00 $474.00 $474.00 $474.00 $474.00 $84.37 $474.00 $474.00 $351.80 $351.80 $365.36 $246.95 $98.79 $474.00 $189.60 $474.00 $474.00 $474.00 $474.00 $474.00 $355.50 $474.00 $474.00 $474.00 $237.00 $237.00 $375.41 $474.00 $379.20 $308.10 $474.00 $474.00 $274.92 $474.00 $284.40 $474.00 $474.00 $474.00 N/A N/A 80359050 EAP HCPCS C1753 CATHETER US KODAMA BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $162.90 $162.90 $162.90 $162.90 $300.00 $300.00 $300.00 $62.53 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $59.54 $300.00 $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 80359064 EAP HCPCS A6198 DRESSING BRN 48X4IN STRL LF ACTCT FLX 3 ANMC BRR 1 LYR KNIT BOTH IP/OP $179.00 $132.50 $35.53 $179.00 $97.20 $97.20 $97.20 $97.20 $179.00 $179.00 $179.00 $37.31 $179.00 $132.85 $132.85 $137.97 $93.26 $37.31 $179.00 $179.00 $105.88 $179.00 $179.00 $179.00 $179.00 $134.25 $179.00 $179.00 $179.00 $89.50 $89.50 $141.77 $179.00 $143.20 $116.35 $35.53 $179.00 $103.82 $179.00 $179.00 $179.00 $37.30 $179.00 N/A N/A 80367856 EAP HCPCS C1894 SET INTRO 5FR MCSTK NTNL WRE RADOPQ TIP COAX STF BOTH IP/OP $38.00 $28.50 $7.54 $38.00 $20.63 $20.63 $20.63 $20.63 $38.00 $38.00 $38.00 $7.92 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $38.00 $22.48 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $7.54 $38.00 $22.04 $38.00 $38.00 $38.00 $7.92 $38.00 N/A N/A 80367857 EAP HCPCS C1894 SET INTRO 5FR MCSTK RADOPQ COAX STF WRE NTNL BOTH IP/OP $38.00 $28.50 $7.54 $38.00 $20.63 $20.63 $20.63 $20.63 $38.00 $38.00 $38.00 $7.92 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $38.00 $22.48 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $7.54 $38.00 $22.04 $38.00 $38.00 $38.00 $7.92 $38.00 N/A N/A 80370352 EAP HCPCS C1769 GUIDEWIRE SRG 45D .018IN 180CM 3CM GLDWR GL ANG FLX TP HDRPH BOTH IP/OP $301.00 $223.00 $59.74 $301.00 $163.44 $163.44 $163.44 $163.44 $301.00 $301.00 $301.00 $62.74 $301.00 $223.40 $223.40 $232.01 $156.82 $62.73 $301.00 $301.00 $178.04 $301.00 $301.00 $301.00 $301.00 $225.75 $301.00 $301.00 $301.00 $150.50 $150.50 $238.39 $301.00 $240.80 $195.65 $59.74 $301.00 $174.58 $301.00 $301.00 $301.00 $62.73 $301.00 N/A N/A 80370708 EAP HCPCS C1769 GLIDEWIRE ADVANTAGE PERIPHERAL DISTAL 25CM X 0.018IN X 300CM BOTH IP/OP $550.00 $407.00 $109.16 $550.00 $298.65 $298.65 $298.65 $298.65 $550.00 $550.00 $550.00 $114.63 $550.00 $408.21 $408.21 $423.94 $286.55 $114.63 $550.00 $550.00 $325.33 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $357.50 $109.16 $550.00 $319.00 $550.00 $550.00 $550.00 $114.62 $550.00 N/A N/A 80370715 EAP HCPCS C1887 CATHETER INTVN MIC 2.8FR .027IN 150CM 90CM PROGREAT HMST VLV BOTH IP/OP $775.00 $573.50 $153.82 $775.00 $420.83 $420.83 $420.83 $420.83 $775.00 $775.00 $775.00 $161.53 $775.00 $575.21 $575.21 $597.37 $403.78 $161.52 $775.00 $775.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $503.75 $153.82 $775.00 $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A 80370803 EAP HCPCS C1887 CATHETER ANGIO ANG 4FR .041IN 120CM GLDCATH GLD TCH 2 BRD SS BOTH IP/OP $121.00 $90.00 $24.02 $121.00 $65.70 $65.70 $65.70 $65.70 $121.00 $121.00 $121.00 $25.22 $121.00 $89.81 $89.81 $93.27 $63.04 $25.22 $121.00 $121.00 $71.57 $121.00 $121.00 $121.00 $121.00 $90.75 $121.00 $121.00 $121.00 $60.50 $60.50 $95.83 $121.00 $96.80 $78.65 $24.02 $121.00 $70.18 $121.00 $121.00 $121.00 $25.22 $121.00 N/A N/A 80370843 EAP HCPCS C1894 INTRODUCER SHTH .035IN 11FR 10CM 2.5CM PNCL GW DIL KINK RST BOTH IP/OP $22.00 $16.50 $4.37 $22.00 $11.95 $11.95 $11.95 $11.95 $22.00 $22.00 $22.00 $4.59 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 80370953 EAP HCPCS C1874 SYSTEM COR STNT 2.5MM 24MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80370959 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 2.75MM CBR PZF POLYZENE-F BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80370960 EAP HCPCS C1874 SYSTEM CORON STENT 30MM 2.75MM CBR PZF POLYZENE-F BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80370964 EAP HCPCS C1874 SYSTEM COR STNT 3MM 18MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80370965 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 3MM CBR PZF POLYZENE-F BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80370966 EAP HCPCS C1874 SYSTEM CORON STENT 30MM 3MM CBR PZF COCR HYDPHI BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80370969 EAP HCPCS C1876 SYSTEM CORONARY STENT COBRA PZF POLYZENE-F L15MM BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80370970 EAP HCPCS C1876 SYSTEM COR STNT 3.5MM 18MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80370972 EAP HCPCS C1876 SYSTEM CORONARY STENT COBRA L30MM ID3.5MM RAPID EXCHANGE BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80370976 EAP HCPCS C1876 SYSTEM CORONARY STENT COBRA L18MM ID4MM RAPID EXCHANGE BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80370978 EAP HCPCS C1876 SYSTEM CORONARY STENT COBRA L30 MM ID4 MM RAPID EXCHANGE BOTH IP/OP "$2,125.00" "$1,572.50" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 "$2,125.00" "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 80371591 EAP HCPCS C1874 STENT EPRSTH 8MM 7FR 10CM 120CM VBHN DLV SYS HEP SPRFC FEM BOTH IP/OP "$7,488.00" "$5,541.50" "$1,486.18" "$7,488.00" "$3,369.60" "$3,369.60" "$3,369.60" "$3,369.60" "$7,488.00" "$7,488.00" "$7,488.00" "$1,560.69" "$7,488.00" "$7,488.00" "$7,488.00" "$7,488.00" "$7,488.00" "$1,560.58" "$7,488.00" "$7,488.00" "$3,691.58" "$7,488.00" "$7,488.00" "$7,488.00" "$7,488.00" "$5,616.00" "$7,488.00" "$7,488.00" "$7,488.00" "$3,744.00" "$3,744.00" "$5,930.50" "$7,488.00" "$5,990.40" "$3,369.60" "$1,486.18" "$7,488.00" "$4,343.04" "$7,488.00" "$4,492.80" "$7,488.00" "$1,560.50" "$7,488.00" N/A N/A 80379042 EAP HCPCS C1752 KIT CATH 13FR 20CM STRL PWR-TRIALYSIS 3 LUM SHRT TERM DLYS BOTH IP/OP $596.00 $441.50 $124.21 $596.00 $596.00 $596.00 $596.00 $596.00 $596.00 $596.00 $596.00 $596.00 $596.00 $442.35 $442.35 $459.40 $310.52 $124.21 $596.00 $238.40 $596.00 $596.00 $596.00 $596.00 $596.00 $447.00 $596.00 $596.00 $596.00 $298.00 $298.00 $472.03 $596.00 $476.80 $387.40 $596.00 $596.00 $345.68 $596.00 $357.60 $596.00 $596.00 $596.00 N/A N/A 80379099 EAP HCPCS C2621 PERCEPTA QUAD CRTP MRI SURESCAN BOTH IP/OP "$16,500.00" "$12,210.00" "$3,274.84" "$16,500.00" "$7,425.00" "$7,425.00" "$7,425.00" "$7,425.00" "$16,500.00" "$16,500.00" "$16,500.00" "$3,439.01" "$16,500.00" "$16,500.00" "$16,500.00" "$16,500.00" "$16,500.00" "$3,438.78" "$16,500.00" "$16,500.00" "$8,134.50" "$16,500.00" "$16,500.00" "$16,500.00" "$16,500.00" "$12,375.00" "$16,500.00" "$16,500.00" "$16,500.00" "$8,250.00" "$8,250.00" "$13,068.00" "$16,500.00" "$13,200.00" "$7,425.00" "$3,274.84" "$16,500.00" "$9,570.00" "$16,500.00" "$16,500.00" "$16,500.00" "$3,438.60" "$16,500.00" N/A N/A 80379103 EAP HCPCS C1729 CATHETER PRIMAFIT SAGE BOTH IP/OP $27.00 $20.00 $5.36 $27.00 $14.66 $14.66 $14.66 $14.66 $27.00 $27.00 $27.00 $5.63 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $27.00 $15.97 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $5.36 $27.00 $15.66 $27.00 $27.00 $27.00 $5.63 $27.00 N/A N/A 80379263 EAP HCPCS A4215 NEEDLE PRICRDCTS 5FR 15CM 1STP FX LL BOTH IP/OP $46.00 $34.50 $0.22 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $46.00 $0.22 $46.00 $46.00 $34.14 $34.14 $35.46 $23.97 $9.59 $46.00 $18.40 $46.00 $46.00 $46.00 $46.00 $46.00 $34.50 $46.00 $46.00 $46.00 $23.00 $23.00 $36.43 $46.00 $36.80 $29.90 $46.00 $46.00 $26.68 $46.00 $27.60 $46.00 $46.00 $46.00 N/A N/A 80379287 EAP HCPCS C1729 CATHETER DRN 5FR 10CM 1STP 4 SH SLIP FIT VLV LL SMTH INS BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80379354 EAP 80379354 CATHETER ARWYEX LG 19FR 4.7MM 56CM STRL LF ANTR RPFT BLNT BOTH IP/OP $146.23 $108.50 $26.03 $146.23 $146.23 $146.23 $146.23 $146.23 $146.23 $146.23 $26.03 $146.23 $146.23 $108.53 $108.53 $112.71 $76.19 $30.48 $146.23 $58.49 $146.23 $146.23 $146.23 $146.23 $146.23 $109.67 $146.23 $146.23 $146.23 $73.12 $73.12 $115.81 $146.23 $116.98 $95.05 $146.23 $146.23 $84.81 $146.23 $87.74 $146.23 $146.23 $146.23 N/A N/A 80379380 EAP HCPCS A7040 KIT DRN ASPIRA PRTNL CATH INS TRY BLU VLV STRT BOTH IP/OP "$1,788.00" "$1,323.50" $318.26 "$1,788.00" "$1,788.00" "$1,788.00" "$1,788.00" "$1,788.00" "$1,788.00" "$1,788.00" $318.26 "$1,788.00" "$1,788.00" "$1,327.05" "$1,327.05" "$1,378.19" $931.55 $372.64 "$1,788.00" $715.20 "$1,788.00" "$1,788.00" "$1,788.00" "$1,788.00" "$1,788.00" "$1,341.00" "$1,788.00" "$1,788.00" "$1,788.00" $894.00 $894.00 "$1,416.10" "$1,788.00" "$1,430.40" "$1,162.20" "$1,788.00" "$1,788.00" "$1,037.04" "$1,788.00" "$1,072.80" "$1,788.00" "$1,788.00" "$1,788.00" N/A N/A 80379488 EAP HCPCS C1726 RIGIFLEX II SINGLE USE ACHALASIA BALLOON DILATOR BOTH IP/OP "$1,690.00" "$1,251.00" $335.42 "$1,690.00" $917.67 $917.67 $917.67 $917.67 "$1,690.00" "$1,690.00" "$1,690.00" $352.24 "$1,690.00" "$1,254.32" "$1,254.32" "$1,302.65" $880.49 $352.21 "$1,690.00" "$1,690.00" $999.64 "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" "$1,267.50" "$1,690.00" "$1,690.00" "$1,690.00" $845.00 $845.00 "$1,338.48" "$1,690.00" "$1,352.00" "$1,098.50" $335.42 "$1,690.00" $980.20 "$1,690.00" "$1,690.00" "$1,690.00" $352.20 "$1,690.00" N/A N/A 80379581 EAP HCPCS C1892 INTRODUCER SHTH 12FR 30CM SH PLWY TRNSTLS ACPT .038IN GW BOTH IP/OP $165.00 $122.50 $32.75 $165.00 $89.60 $89.60 $89.60 $89.60 $165.00 $165.00 $165.00 $34.39 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $165.00 $97.60 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $32.75 $165.00 $95.70 $165.00 $165.00 $165.00 $34.39 $165.00 N/A N/A 80379595 EAP HCPCS C1894 INTRODUCER CATH .038IN 14FR 45CM CKFL PRFRMR RADOPQ BOTH IP/OP $388.00 $287.50 $77.01 $388.00 $210.68 $210.68 $210.68 $210.68 $388.00 $388.00 $388.00 $80.87 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $388.00 $229.50 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $77.01 $388.00 $225.04 $388.00 $388.00 $388.00 $80.86 $388.00 N/A N/A 80379607 EAP HCPCS C1725 CATHETER ANGIO KMP CRV ANG 5FR BOTH IP/OP $63.00 $47.00 $12.50 $63.00 $34.21 $34.21 $34.21 $34.21 $63.00 $63.00 $63.00 $13.13 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $63.00 $37.26 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $31.50 $31.50 $49.90 $63.00 $50.40 $40.95 $12.50 $63.00 $36.54 $63.00 $63.00 $63.00 $13.13 $63.00 N/A N/A 80379614 EAP HCPCS C1725 CATHETER ANGIO .035IN VANSCHIE4 CRV 5FR 65CM STRL BCNTP BFUR BOTH IP/OP $388.00 $287.50 $77.01 $388.00 $210.68 $210.68 $210.68 $210.68 $388.00 $388.00 $388.00 $80.87 $388.00 $287.97 $287.97 $299.07 $202.15 $80.86 $388.00 $388.00 $229.50 $388.00 $388.00 $388.00 $388.00 $291.00 $388.00 $388.00 $388.00 $194.00 $194.00 $307.30 $388.00 $310.40 $252.20 $77.01 $388.00 $225.04 $388.00 $388.00 $388.00 $80.86 $388.00 N/A N/A 80379622 EAP HCPCS C1725 CATHETER ANGIO VANSCHIE 3 CRV BOTH IP/OP $160.00 $118.50 $31.76 $160.00 $86.88 $86.88 $86.88 $86.88 $160.00 $160.00 $160.00 $33.35 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $160.00 $94.64 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $31.76 $160.00 $92.80 $160.00 $160.00 $160.00 $33.34 $160.00 N/A N/A 80379624 EAP HCPCS C1725 CATHETER ANGIO VANSCHIE 5 CRV BOTH IP/OP $160.00 $118.50 $31.76 $160.00 $86.88 $86.88 $86.88 $86.88 $160.00 $160.00 $160.00 $33.35 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $160.00 $94.64 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $31.76 $160.00 $92.80 $160.00 $160.00 $160.00 $33.34 $160.00 N/A N/A 80379641 EAP HCPCS C1786 SYSTEM DLV 3.2V 120MAH 6.7MM 25.9MM MICRA SURESCAN HBRD BOTH IP/OP "$26,875.00" "$19,887.50" "$5,334.02" "$26,875.00" "$12,093.75" "$12,093.75" "$12,093.75" "$12,093.75" "$26,875.00" "$26,875.00" "$26,875.00" "$5,601.42" "$26,875.00" "$26,875.00" "$26,875.00" "$26,875.00" "$26,875.00" "$5,601.05" "$26,875.00" "$26,875.00" "$13,249.38" "$26,875.00" "$26,875.00" "$26,875.00" "$26,875.00" "$20,156.25" "$26,875.00" "$26,875.00" "$26,875.00" "$13,437.50" "$13,437.50" "$21,285.00" "$26,875.00" "$21,500.00" "$12,093.75" "$5,334.02" "$26,875.00" "$15,587.50" "$26,875.00" "$26,875.00" "$26,875.00" "$5,600.75" "$26,875.00" N/A N/A 80379642 EAP HCPCS C1894 INTRODUCER SHTH 23FR 55.7CM 69.9CM MICRA STPCK RADOPQ DIL BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $814.50 $814.50 $814.50 $814.50 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80379711 EAP HCPCS C1874 STENT EPRSTH 8MM 10CM STRL 120CM VBHN FLXB SLF XPD RADOPQ BOTH IP/OP "$9,808.00" "$7,258.00" "$1,946.64" "$9,808.00" "$4,413.60" "$4,413.60" "$4,413.60" "$4,413.60" "$9,808.00" "$9,808.00" "$9,808.00" "$2,044.23" "$9,808.00" "$9,808.00" "$9,808.00" "$9,808.00" "$9,808.00" "$2,044.10" "$9,808.00" "$9,808.00" "$4,835.34" "$9,808.00" "$9,808.00" "$9,808.00" "$9,808.00" "$7,356.00" "$9,808.00" "$9,808.00" "$9,808.00" "$4,904.00" "$4,904.00" "$7,767.94" "$9,808.00" "$7,846.40" "$4,413.60" "$1,946.64" "$9,808.00" "$5,688.64" "$9,808.00" "$9,808.00" "$9,808.00" "$2,043.99" "$9,808.00" N/A N/A 80379742 EAP Custom 80379742 SET HMDIAL 27X22X9CM 165ML STRL LF PRISMAFLEX HMFLTR BG BOTH IP/OP $426.00 $315.50 $75.83 $426.00 $426.00 $426.00 $426.00 $426.00 $426.00 $426.00 $75.83 $426.00 $426.00 $316.18 $316.18 $328.36 $221.95 $88.78 $426.00 $170.40 $426.00 $426.00 $426.00 $426.00 $426.00 $319.50 $426.00 $426.00 $426.00 $213.00 $213.00 $337.39 $426.00 $340.80 $276.90 $426.00 $426.00 $247.08 $426.00 $255.60 $426.00 $426.00 $426.00 N/A N/A 80379771 EAP TUBE FD 20FR 10CM 20ML ENTUIT BLN RTNT MR CONDITIONAL LG BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 80379775 EAP KIT ANGIO 65IN ACIST CVI ANGIOTOUCH 3W HI-PRS STPCK PRM BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" "$1,500.00" $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 80379801 EAP HCPCS C2623 CATHETER BLNDIL 7MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 80379803 EAP HCPCS C2623 CATHETER BLNDIL 8MM 75CM 60MM LUTONIX DRG COAT ACPT .035IN BOTH IP/OP "$4,250.00" "$3,145.00" $885.75 "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$3,154.35" "$3,154.35" "$3,275.90" "$2,060.15" $885.75 "$4,250.00" "$1,700.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$3,187.50" "$4,250.00" "$4,250.00" "$4,250.00" "$2,125.00" "$2,125.00" "$3,366.00" "$4,250.00" "$3,400.00" "$2,762.50" "$4,250.00" "$4,250.00" "$2,465.00" "$4,250.00" "$2,550.00" "$4,250.00" "$4,250.00" "$4,250.00" N/A N/A 80390068 EAP TRAY CATH 4FR 20CM POWERMIDLINE MICROEZ FLEXURA STLK NRS MAX BOTH IP/OP $337.00 $249.50 $59.99 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $337.00 $59.99 $337.00 $337.00 $250.12 $250.12 $259.76 $175.58 $70.23 $337.00 $134.80 $337.00 $337.00 $337.00 $337.00 $337.00 $252.75 $337.00 $337.00 $337.00 $168.50 $168.50 $266.90 $337.00 $269.60 $219.05 $337.00 $337.00 $195.46 $337.00 $202.20 $337.00 $337.00 $337.00 N/A N/A 80390076 EAP HCPCS C2623 CATHETER BALDILAT 4MM 130CM 100MM PCLTXL LATEX BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 80390081 EAP HCPCS C2623 CATHETER BALDILAT 4MM 130CM 60MM PCLTXL LATEX FREE BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 80390085 EAP HCPCS C2623 CATHETER BALDILAT 5MM 130CM 100MM PCLTXL LATEX BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 80390093 EAP HCPCS C2623 CATHETER BALDILAT 5MM 130CM 60MM PCLTXL LATEX FREE BOTH IP/OP "$3,500.00" "$2,590.00" $729.44 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" "$3,500.00" "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 80390101 EAP HCPCS C2623 CATHETER BLNDIL 5F 6MM 130CM 150MM LUTONIX BOTH IP/OP "$4,250.00" "$3,145.00" $885.75 "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$3,154.35" "$3,154.35" "$3,275.90" "$2,060.15" $885.75 "$4,250.00" "$1,700.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$3,187.50" "$4,250.00" "$4,250.00" "$4,250.00" "$2,125.00" "$2,125.00" "$3,366.00" "$4,250.00" "$3,400.00" "$2,762.50" "$4,250.00" "$4,250.00" "$2,465.00" "$4,250.00" "$2,550.00" "$4,250.00" "$4,250.00" "$4,250.00" N/A N/A 80397345 EAP HCPCS C1898 LEAD PCNG 69CM SELECTSECURE BP FX SCR IN ATR VNTRC CATH DLV BOTH IP/OP "$1,013.00" $750.00 $211.12 "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" $751.85 $751.85 $780.82 $527.77 $211.12 "$1,013.00" $405.20 "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" $759.75 "$1,013.00" "$1,013.00" "$1,013.00" $506.50 $506.50 $802.30 "$1,013.00" $810.40 $658.45 "$1,013.00" "$1,013.00" $587.54 "$1,013.00" $607.80 "$1,013.00" "$1,013.00" "$1,013.00" N/A N/A 80397351 EAP HCPCS C1898 LEAD PACING CAPSURE SENSE STEROID ELUTING L52 CM ATRIUM RIGHT VENT BOTH IP/OP "$1,013.00" $750.00 $211.12 "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" $211.12 "$1,013.00" $405.20 "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" "$1,013.00" $759.75 "$1,013.00" "$1,013.00" "$1,013.00" $506.50 $506.50 $802.30 "$1,013.00" $810.40 $455.85 "$1,013.00" "$1,013.00" $587.54 "$1,013.00" $607.80 "$1,013.00" "$1,013.00" "$1,013.00" N/A N/A 80397421 EAP Custom 80397421 STYLET LD 17CM KT ACC OUS BOTH IP/OP $78.00 $58.00 $13.88 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $13.88 $78.00 $78.00 $57.89 $57.89 $60.12 $40.64 $16.26 $78.00 $31.20 $78.00 $78.00 $78.00 $78.00 $78.00 $58.50 $78.00 $78.00 $78.00 $39.00 $39.00 $61.78 $78.00 $62.40 $50.70 $78.00 $78.00 $45.24 $78.00 $46.80 $78.00 $78.00 $78.00 N/A N/A 80397496 EAP HCPCS C1887 CATHETER GD 130D LNG 7.1FR 5.7FR 65CM ATN SLCT II SUREVALVE BOTH IP/OP $403.00 $298.50 $79.99 $403.00 $218.83 $218.83 $218.83 $218.83 $403.00 $403.00 $403.00 $84.00 $403.00 $299.11 $299.11 $310.63 $209.96 $83.99 $403.00 $403.00 $238.37 $403.00 $403.00 $403.00 $403.00 $302.25 $403.00 $403.00 $403.00 $201.50 $201.50 $319.18 $403.00 $322.40 $261.95 $79.99 $403.00 $233.74 $403.00 $403.00 $403.00 $83.99 $403.00 N/A N/A 80397498 EAP HCPCS C1887 CATHETER GD 90D LNG 7.1FR 5.7FR 65CM ATN SLCT II SUREVALVE BOTH IP/OP $403.00 $298.50 $79.99 $403.00 $218.83 $218.83 $218.83 $218.83 $403.00 $403.00 $403.00 $84.00 $403.00 $299.11 $299.11 $310.63 $209.96 $83.99 $403.00 $403.00 $238.37 $403.00 $403.00 $403.00 $403.00 $302.25 $403.00 $403.00 $403.00 $201.50 $201.50 $319.18 $403.00 $322.40 $261.95 $79.99 $403.00 $233.74 $403.00 $403.00 $403.00 $83.99 $403.00 N/A N/A 80397520 EAP HCPCS C1887 CATHETER GD 9FR 7.2FR 45CM ATN CMND SUREVALVE LH BOTH IP/OP $588.00 $435.50 $116.70 $588.00 $319.28 $319.28 $319.28 $319.28 $588.00 $588.00 $588.00 $122.55 $588.00 $436.41 $436.41 $453.23 $306.35 $122.55 $588.00 $588.00 $347.80 $588.00 $588.00 $588.00 $588.00 $441.00 $588.00 $588.00 $588.00 $294.00 $294.00 $465.70 $588.00 $470.40 $382.20 $116.70 $588.00 $341.04 $588.00 $588.00 $588.00 $122.54 $588.00 N/A N/A 80397527 EAP HCPCS C1887 CATHETER GD .035IN MP RT CRV 9FR 7.2FR 45CM ATN CMND BOTH IP/OP $588.00 $435.50 $116.70 $588.00 $319.28 $319.28 $319.28 $319.28 $588.00 $588.00 $588.00 $122.55 $588.00 $436.41 $436.41 $453.23 $306.35 $122.55 $588.00 $588.00 $347.80 $588.00 $588.00 $588.00 $588.00 $441.00 $588.00 $588.00 $588.00 $294.00 $294.00 $465.70 $588.00 $470.40 $382.20 $116.70 $588.00 $341.04 $588.00 $588.00 $588.00 $122.54 $588.00 N/A N/A 80397542 EAP HCPCS C1777 LEAD PACING SPRINT QUATTRO SECURE L58 CM 1 COIL DEFIB BOTH IP/OP "$7,875.00" "$5,827.50" "$1,562.99" "$7,875.00" "$3,543.75" "$3,543.75" "$3,543.75" "$3,543.75" "$7,875.00" "$7,875.00" "$7,875.00" "$1,641.35" "$7,875.00" "$7,875.00" "$7,875.00" "$7,875.00" "$7,875.00" "$1,641.24" "$7,875.00" "$7,875.00" "$3,882.38" "$7,875.00" "$7,875.00" "$7,875.00" "$7,875.00" "$5,906.25" "$7,875.00" "$7,875.00" "$7,875.00" "$3,937.50" "$3,937.50" "$6,237.00" "$7,875.00" "$6,300.00" "$3,543.75" "$1,562.99" "$7,875.00" "$4,567.50" "$7,875.00" "$7,875.00" "$7,875.00" "$1,641.15" "$7,875.00" N/A N/A 80397543 EAP HCPCS C1777 LEAD PACING SPRINT QUATTRO SECURE STEROID ELUTING SILICONE HELIX L65 BOTH IP/OP "$7,875.00" "$5,827.50" "$1,562.99" "$7,875.00" "$3,543.75" "$3,543.75" "$3,543.75" "$3,543.75" "$7,875.00" "$7,875.00" "$7,875.00" "$1,641.35" "$7,875.00" "$7,875.00" "$7,875.00" "$7,875.00" "$7,875.00" "$1,641.24" "$7,875.00" "$7,875.00" "$3,882.38" "$7,875.00" "$7,875.00" "$7,875.00" "$7,875.00" "$5,906.25" "$7,875.00" "$7,875.00" "$7,875.00" "$3,937.50" "$3,937.50" "$6,237.00" "$7,875.00" "$6,300.00" "$3,543.75" "$1,562.99" "$7,875.00" "$4,567.50" "$7,875.00" "$7,875.00" "$7,875.00" "$1,641.15" "$7,875.00" N/A N/A 80398493 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ KINK RST STR 3 BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 $187.50 $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 80398507 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN STR 3CM HTORQ WHSPR LS BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 $187.50 $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 80398619 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398620 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398621 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398622 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398629 EAP HCPCS C1874 SYSTEM COR STNT 4MM 18MM XIENCE SRR RX EVEROLIMUS BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 80398631 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398632 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398634 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 4MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398635 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 3.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398636 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 3.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398638 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398639 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 3.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398640 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 3.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398647 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 3.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398650 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398655 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 3.5MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398661 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398666 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398672 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398673 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398679 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 3.25MM XIENCE SRR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 80398680 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398682 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398683 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 3.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398684 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398685 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398686 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398687 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398688 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398689 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398690 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398691 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 3MM XIENCE SRR EVEROLIMUS BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398692 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398693 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398699 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398700 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398701 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398702 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 2.75MM XIENCE SRR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 80398703 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398704 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 2.75MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398705 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 2.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398706 EAP HCPCS C1874 SYSTEM CORON STENT 33MM 2.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398707 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 2.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398708 EAP HCPCS C1874 SYSTEM CORON STENT 23MM 2.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398709 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 2.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398710 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 2.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398770 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 2.5MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398771 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 2.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398772 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 2.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398773 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 2.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398774 EAP HCPCS C1874 SYSTEM CORON STENT 18MM 2.25MM XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398775 EAP HCPCS C1874 SYSTEM COR STNT 2.25MM 23MM XIENCE SRR RX EVEROLIMUS BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 80398776 EAP HCPCS C1874 SYSTEM COR STNT 2.25MM 28MM XIENCE SRR RX EVEROLIMUS BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 80398777 EAP HCPCS C1874 STENT CORON 33MM 2.25MM EVEROLIMUS XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398778 EAP HCPCS C1874 STENT CORON 38MM 2.25MM EVEROLIMUS XIENCE SRR BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 80398779 EAP HCPCS C1874 SYSTEM COR STNT 2.5MM 8MM XIENCE SRR RX EVEROLIMUS BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 "$1,750.00" "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 80398790 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN RADIOPQ CORE TO TIP BOTH IP/OP $375.00 $277.50 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 $375.00 $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 80398824 EAP 80398824 KIT VASCATH DRESSING CHANGE TRAY 215 GRADY MEMORIAL HOSP BOTH IP/OP "$1,634.00" "$1,209.50" $290.85 "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" $290.85 "$1,634.00" "$1,634.00" "$1,212.75" "$1,212.75" "$1,259.49" $851.31 $340.54 "$1,634.00" $653.60 "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,225.50" "$1,634.00" "$1,634.00" "$1,634.00" $817.00 $817.00 "$1,294.13" "$1,634.00" "$1,307.20" "$1,062.10" "$1,634.00" "$1,634.00" $947.72 "$1,634.00" $980.40 "$1,634.00" "$1,634.00" "$1,634.00" N/A N/A 80399090 EAP ADVANCE CAPSULE ENDOSCOPY DELIVERY DEVICE BOTH IP/OP $413.00 $306.00 $73.51 $413.00 $413.00 $413.00 $413.00 $413.00 $413.00 $413.00 $73.51 $413.00 $413.00 $306.53 $306.53 $318.34 $215.17 $86.07 $413.00 $165.20 $413.00 $413.00 $413.00 $413.00 $413.00 $309.75 $413.00 $413.00 $413.00 $206.50 $206.50 $327.10 $413.00 $330.40 $268.45 $413.00 $413.00 $239.54 $413.00 $247.80 $413.00 $413.00 $413.00 N/A N/A 80399191 EAP HCPCS C1880 "KIT ALN REMOVAL AND/OR REPOSITIONING, 2IN1 RS" BOTH IP/OP "$1,063.00" $787.00 $221.54 "$1,063.00" "$1,063.00" "$1,063.00" "$1,063.00" "$1,063.00" "$1,063.00" "$1,063.00" "$1,063.00" "$1,063.00" "$1,063.00" "$1,063.00" "$1,063.00" "$1,063.00" "$1,063.00" $221.54 "$1,063.00" $425.20 "$1,063.00" "$1,063.00" "$1,063.00" "$1,063.00" "$1,063.00" $797.25 "$1,063.00" "$1,063.00" "$1,063.00" $531.50 $531.50 $841.90 "$1,063.00" $850.40 $478.35 "$1,063.00" "$1,063.00" $616.54 "$1,063.00" $637.80 "$1,063.00" "$1,063.00" "$1,063.00" N/A N/A 80399207 EAP HCPCS C1887 CATHETER INFUS 10D 3.5FR 135CM OTW 2 LUM BRD TRQ BOTH IP/OP "$1,068.00" $790.50 $211.97 "$1,068.00" $579.92 $579.92 $579.92 $579.92 "$1,068.00" "$1,068.00" "$1,068.00" $222.60 "$1,068.00" $792.67 $792.67 $823.21 $556.43 $222.58 "$1,068.00" "$1,068.00" $631.72 "$1,068.00" "$1,068.00" "$1,068.00" "$1,068.00" $801.00 "$1,068.00" "$1,068.00" "$1,068.00" $534.00 $534.00 $845.86 "$1,068.00" $854.40 $694.20 $211.97 "$1,068.00" $619.44 "$1,068.00" "$1,068.00" "$1,068.00" $222.57 "$1,068.00" N/A N/A 80399252 EAP COIL EMBL 3D 9MM 30CM AXIUM PRM FRM V01 BOTH IP/OP "$5,238.00" "$3,876.50" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" $932.36 "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.66" "$5,238.00" "$2,095.20" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$2,357.10" "$5,238.00" "$5,238.00" "$3,038.04" "$5,238.00" "$3,142.80" "$5,238.00" "$5,238.00" "$5,238.00" N/A N/A 80399275 EAP HCPCS C1887 CATHETER INTVN 5.1FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80399276 EAP HCPCS C1887 CATHETER INTVN 5.7FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" $975.00 "$1,625.00" $338.65 "$1,625.00" N/A N/A 80399277 EAP HCPCS C1887 CATHETER INTVN 6.5FR 150CM 13CM TRAPLINER RX GD XTN RADOPQ BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80399285 EAP HCPCS C1769 SET CATH UNV 5MM 9CM MLKR ER CRICO BOTH IP/OP "$1,186.75" $878.50 $235.54 "$1,186.75" $644.41 $644.41 $644.41 $644.41 "$1,186.75" "$1,186.75" "$1,186.75" $247.35 "$1,186.75" $880.81 $880.81 $914.75 $618.30 $247.33 "$1,186.75" "$1,186.75" $701.96 "$1,186.75" "$1,186.75" "$1,186.75" "$1,186.75" $890.06 "$1,186.75" "$1,186.75" "$1,186.75" $593.38 $593.38 $939.91 "$1,186.75" $949.40 $771.39 $235.54 "$1,186.75" $688.32 "$1,186.75" "$1,186.75" "$1,186.75" $247.32 "$1,186.75" N/A N/A 80405583 EAP HCPCS C1757 CATHETER THRMB .044IN 140CM STRL LF INDG SYS ASP KT COR BOTH IP/OP "$4,850.00" "$3,589.00" $962.60 "$4,850.00" "$2,182.50" "$2,182.50" "$2,182.50" "$2,182.50" "$4,850.00" "$4,850.00" "$4,850.00" "$1,010.86" "$4,850.00" "$4,850.00" "$4,850.00" "$4,850.00" "$4,850.00" "$1,010.79" "$4,850.00" "$4,850.00" "$2,391.05" "$4,850.00" "$4,850.00" "$4,850.00" "$4,850.00" "$3,637.50" "$4,850.00" "$4,850.00" "$4,850.00" "$2,425.00" "$2,425.00" "$3,841.20" "$4,850.00" "$3,880.00" "$2,182.50" $962.60 "$4,850.00" "$2,813.00" "$4,850.00" "$4,850.00" "$4,850.00" "$1,010.74" "$4,850.00" N/A N/A 80405584 EAP Custom 80405584 SEPARATOR THRMB STRL LF INDG SYS 4 DISP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$1,632.84" "$1,632.84" "$1,695.76" "$1,146.20" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" "$1,430.00" "$2,200.00" "$2,200.00" "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 80405589 EAP HCPCS C1874 SYSTEM COR STNT 2MM 8MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1 BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$3,425.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 80405590 EAP HCPCS C1874 SYSTEM COR STNT 2MM 12MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1 BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$3,425.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 80405591 EAP HCPCS C1874 SYSTEM COR STNT 2MM 15MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1 BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$2,055.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 80405592 EAP HCPCS C1874 SYSTEM COR STNT 2MM 18MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1 BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$3,425.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 80405593 EAP HCPCS C1874 SYSTEM COR STNT 2MM 22MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1 BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$3,425.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 80405594 EAP HCPCS C1874 SYSTEM COR STNT 2MM 26MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1 BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$2,055.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 80405595 EAP HCPCS C1874 SYSTEM COR STNT 2MM 30MM 140CM RSLT ONYX RX DLV SYS RADOPQ 1 BOTH IP/OP "$3,425.00" "$2,534.50" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 "$3,425.00" "$1,986.50" "$3,425.00" "$3,425.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 80406242 EAP Custom 80406242 PLUG OCL 3MM 12X5.3MM MVP MECH DTCH FULL RESHEATHABLE NTNL BOTH IP/OP "$3,738.00" "$2,766.50" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$1,495.20" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" "$3,738.00" "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" "$3,738.00" "$3,738.00" N/A N/A 80406243 EAP Custom 80406243 PLUG OCL 5MM 12X6.5MM STRL LF MVP MECH DTCH FULL BOTH IP/OP "$3,738.00" "$2,766.50" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$1,495.20" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" "$3,738.00" "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" "$3,738.00" "$3,738.00" N/A N/A 80406244 EAP HCPCS C1760 PLUG OCL MIC 7MM STRL LF MVP MECH VASC DISP V03 BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$3,738.00" "$3,738.00" $779.00 "$3,738.00" N/A N/A 80406245 EAP Custom 80406245 PLUG OCL 9MM STRL LF MVP V03 BOTH IP/OP "$3,738.00" "$2,766.50" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $665.36 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$1,495.20" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" "$3,738.00" "$3,738.00" "$2,168.04" "$3,738.00" "$2,242.80" "$3,738.00" "$3,738.00" "$3,738.00" N/A N/A 80406248 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 180CM STRL LF CNFNZ PRO 12 DISP BOTH IP/OP $333.00 $246.50 $66.09 $333.00 $180.82 $180.82 $180.82 $180.82 $333.00 $333.00 $333.00 $69.41 $333.00 $247.15 $247.15 $256.68 $173.49 $69.40 $333.00 $333.00 $196.97 $333.00 $333.00 $333.00 $333.00 $249.75 $333.00 $333.00 $333.00 $166.50 $166.50 $263.74 $333.00 $266.40 $216.45 $66.09 $333.00 $193.14 $333.00 $333.00 $333.00 $69.40 $333.00 N/A N/A 80406249 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM STRL LF FIELDER FC DISP BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $107.51 $107.51 $107.51 $107.51 $198.00 $198.00 $198.00 $41.27 $198.00 $146.96 $146.96 $152.62 $103.16 $41.27 $198.00 $198.00 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $128.70 $39.30 $198.00 $114.84 $198.00 $198.00 $198.00 $41.26 $198.00 N/A N/A 80406250 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 180CM STRL LF FIELDER FC DISP BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $107.51 $107.51 $107.51 $107.51 $198.00 $198.00 $198.00 $41.27 $198.00 $146.96 $146.96 $152.62 $103.16 $41.27 $198.00 $198.00 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $128.70 $39.30 $198.00 $114.84 $198.00 $198.00 $198.00 $41.26 $198.00 N/A N/A 80406251 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM STRL LF GRAND SLAM DISP BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80406252 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 180CM STRL LF MRCLBRS 6 DISP BOTH IP/OP $333.00 $246.50 $66.09 $333.00 $180.82 $180.82 $180.82 $180.82 $333.00 $333.00 $333.00 $69.41 $333.00 $247.15 $247.15 $256.68 $173.49 $69.40 $333.00 $333.00 $196.97 $333.00 $333.00 $333.00 $333.00 $249.75 $333.00 $333.00 $333.00 $166.50 $166.50 $263.74 $333.00 $266.40 $216.45 $66.09 $333.00 $193.14 $333.00 $333.00 $333.00 $69.40 $333.00 N/A N/A 80406253 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM STRL LF MRCLBRS 6 DISP BOTH IP/OP $333.00 $246.50 $66.09 $333.00 $180.82 $180.82 $180.82 $180.82 $333.00 $333.00 $333.00 $69.41 $333.00 $247.15 $247.15 $256.68 $173.49 $69.40 $333.00 $333.00 $196.97 $333.00 $333.00 $333.00 $333.00 $249.75 $333.00 $333.00 $333.00 $166.50 $166.50 $263.74 $333.00 $266.40 $216.45 $66.09 $333.00 $193.14 $333.00 $333.00 $333.00 $69.40 $333.00 N/A N/A 80406254 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM STRL LF MRCLBRS 3 DISP BOTH IP/OP $333.00 $246.50 $66.09 $333.00 $180.82 $180.82 $180.82 $180.82 $333.00 $333.00 $333.00 $69.41 $333.00 $247.15 $247.15 $256.68 $173.49 $69.40 $333.00 $333.00 $196.97 $333.00 $333.00 $333.00 $333.00 $249.75 $333.00 $333.00 $333.00 $166.50 $166.50 $263.74 $333.00 $266.40 $216.45 $66.09 $333.00 $193.14 $333.00 $333.00 $333.00 $69.40 $333.00 N/A N/A 80406255 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 180CM STRL LF P-H2O DISP BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $107.51 $107.51 $107.51 $107.51 $198.00 $198.00 $198.00 $41.27 $198.00 $146.96 $146.96 $152.62 $103.16 $41.27 $198.00 $198.00 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $128.70 $39.30 $198.00 $114.84 $198.00 $198.00 $198.00 $41.26 $198.00 N/A N/A 80406275 EAP HCPCS C1894 VASCULAR VEIN KIT BOTH IP/OP $353.00 $261.50 $70.06 $353.00 $191.68 $191.68 $191.68 $191.68 $353.00 $353.00 $353.00 $73.57 $353.00 $262.00 $262.00 $272.09 $183.91 $73.57 $353.00 $353.00 $208.80 $353.00 $353.00 $353.00 $353.00 $264.75 $353.00 $353.00 $353.00 $176.50 $176.50 $279.58 $353.00 $282.40 $229.45 $70.06 $353.00 $204.74 $353.00 $353.00 $353.00 $73.57 $353.00 N/A N/A 80406279 EAP HCPCS C1785 PACEMAKER ASSURITY MRI 6MM X 50MM X 47MM 10.44 CC 2 CHMBR IS-1 CON BOTH IP/OP "$12,225.00" "$9,046.50" "$2,426.36" "$12,225.00" "$5,501.25" "$5,501.25" "$5,501.25" "$5,501.25" "$12,225.00" "$12,225.00" "$12,225.00" "$2,548.00" "$12,225.00" "$12,225.00" "$12,225.00" "$12,225.00" "$12,225.00" "$2,547.82" "$12,225.00" "$12,225.00" "$6,026.93" "$12,225.00" "$12,225.00" "$12,225.00" "$12,225.00" "$9,168.75" "$12,225.00" "$12,225.00" "$12,225.00" "$6,112.50" "$6,112.50" "$9,682.20" "$12,225.00" "$9,780.00" "$5,501.25" "$2,426.36" "$12,225.00" "$7,090.50" "$12,225.00" "$12,225.00" "$12,225.00" "$2,547.69" "$12,225.00" N/A N/A 80406478 EAP HCPCS A6261 DRESSING GEL STRL LF ISRB ABS TUBE NADH CDXMR IOD 10GM BOTH IP/OP $35.00 $26.00 $2.09 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $2.09 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 80406479 EAP DRESSING GEL STRL IODOFLEX 3 IN 1 MODE ABS PD NADH CDXMR IOD BOTH IP/OP $30.00 $22.50 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 $30.00 $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 80406484 EAP 80406484 PROBE SRG STRL ICARE TA01I IC100 BOTH IP/OP $215.00 $159.50 $38.27 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $38.27 $215.00 $215.00 $159.57 $159.57 $165.72 $112.02 $44.81 $215.00 $86.00 $215.00 $215.00 $215.00 $215.00 $215.00 $161.25 $215.00 $215.00 $215.00 $107.50 $107.50 $170.28 $215.00 $172.00 $139.75 $215.00 $215.00 $124.70 $215.00 $129.00 $215.00 $215.00 $215.00 N/A N/A 80406513 EAP MARKER ENDOSCOPIC SPOT EX TATTOO PREFILL PERM SYRINGE BOTH IP/OP $950.00 $703.00 $169.10 $950.00 $950.00 $950.00 $950.00 $950.00 $950.00 $950.00 $169.10 $950.00 $950.00 $705.09 $705.09 $732.26 $494.95 $197.99 $950.00 $380.00 $950.00 $950.00 $950.00 $950.00 $950.00 $712.50 $950.00 $950.00 $950.00 $475.00 $475.00 $752.40 $950.00 $760.00 $617.50 $950.00 $950.00 $551.00 $950.00 $570.00 $950.00 $950.00 $950.00 N/A N/A 80406516 EAP HCPCS C1889 BILIARY ELECTROHYDRAULIC LITHOTRIPTER PROBE 1.9FR 375CM BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 "$1,072.50" $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 80406525 EAP HCPCS C1894 "KIT TRIPLE LUMEN CVC, AGB+ 7 FRENCH, PRESSURE RATED, 20CM" BOTH IP/OP $366.00 $271.00 $72.64 $366.00 $198.74 $198.74 $198.74 $198.74 $366.00 $366.00 $366.00 $76.28 $366.00 $271.65 $271.65 $282.11 $190.69 $76.28 $366.00 $366.00 $216.49 $366.00 $366.00 $366.00 $366.00 $274.50 $366.00 $366.00 $366.00 $183.00 $183.00 $289.87 $366.00 $292.80 $237.90 $72.64 $366.00 $212.28 $366.00 $366.00 $366.00 $76.27 $366.00 N/A N/A 80406587 EAP HCPCS L1830 IMMOBILIZER ORTH XL W 36- IN 20IN 1 PNL FNGR PCKT CRCMF BOTH IP/OP $37.45 $28.00 $7.80 $48.84 $37.45 $37.45 $37.45 $37.45 $37.45 $37.45 $48.84 $37.45 $37.45 $27.80 $27.80 $28.87 $19.51 $7.80 $37.45 $14.98 $37.45 $37.45 $37.45 $37.45 $37.45 $28.09 $37.45 $37.45 $37.45 $18.73 $18.73 $29.66 $37.45 $29.96 $24.34 $37.45 $37.45 $21.72 $37.45 $22.47 $37.45 $37.45 $37.45 N/A N/A 80406669 EAP HCPCS C1730 "CATH, EP, 5-5-5-5-5MM SPC CRNND 2 CRV 5FR 115CM STRBL 8" BOTH IP/OP $130.00 $96.50 $25.80 $130.00 $70.59 $70.59 $70.59 $70.59 $130.00 $130.00 $130.00 $27.10 $130.00 $96.49 $96.49 $100.20 $67.73 $27.09 $130.00 $130.00 $76.90 $130.00 $130.00 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $65.00 $65.00 $102.96 $130.00 $104.00 $84.50 $25.80 $130.00 $75.40 $130.00 $130.00 $130.00 $27.09 $130.00 N/A N/A 80406670 EAP HCPCS C1730 CATHETER EP 2-10-2MM SPC SUP LG CURL CRV 7FR 95CM 2MM LVWR BOTH IP/OP $365.00 $270.50 $72.44 $365.00 $198.20 $198.20 $198.20 $198.20 $365.00 $365.00 $365.00 $76.08 $365.00 $270.90 $270.90 $281.34 $190.17 $76.07 $365.00 $365.00 $215.90 $365.00 $365.00 $365.00 $365.00 $273.75 $365.00 $365.00 $365.00 $182.50 $182.50 $289.08 $365.00 $292.00 $237.25 $72.44 $365.00 $211.70 $365.00 $365.00 $365.00 $76.07 $365.00 N/A N/A 80406671 EAP HCPCS C1730 CATHETER EP 5MM SPC CRNND CRV 5FR 120CM RSPN QDPL BOTH IP/OP $98.00 $73.00 $19.45 $98.00 $53.21 $53.21 $53.21 $53.21 $98.00 $98.00 $98.00 $20.43 $98.00 $72.74 $72.74 $75.54 $51.06 $20.42 $98.00 $98.00 $57.97 $98.00 $98.00 $98.00 $98.00 $73.50 $98.00 $98.00 $98.00 $49.00 $49.00 $77.62 $98.00 $78.40 $63.70 $19.45 $98.00 $56.84 $98.00 $98.00 $98.00 $20.42 $98.00 N/A N/A 80406768 EAP HCPCS C1880 FILTER IVC SENTRY BOTH IP/OP "$3,125.00" "$2,312.50" $651.28 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 80406772 EAP HCPCS A4215 NEEDLE BX 13GA 7CM TRGD COAX U-T WL CLR CD D STP DISP MAG BOTH IP/OP $29.00 $21.50 $0.22 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $0.22 $29.00 $29.00 $21.52 $21.52 $22.35 $15.11 $6.04 $29.00 $11.60 $29.00 $29.00 $29.00 $29.00 $29.00 $21.75 $29.00 $29.00 $29.00 $14.50 $14.50 $22.97 $29.00 $23.20 $18.85 $29.00 $29.00 $16.82 $29.00 $17.40 $29.00 $29.00 $29.00 N/A N/A 80406791 EAP 80406791 SLEEVE CMPR LG KN LGTH KDL SCD EXP DISP REPRO BOTH IP/OP $29.00 $21.50 $5.16 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $29.00 $5.16 $29.00 $29.00 $21.52 $21.52 $22.35 $15.11 $6.04 $29.00 $11.60 $29.00 $29.00 $29.00 $29.00 $29.00 $21.75 $29.00 $29.00 $29.00 $14.50 $14.50 $22.97 $29.00 $23.20 $18.85 $29.00 $29.00 $16.82 $29.00 $17.40 $29.00 $29.00 $29.00 N/A N/A 80406812 EAP DEVICE RBTC CORPATH GRX CSST BOTH IP/OP $313.00 $232.00 $55.71 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $313.00 $55.71 $313.00 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $125.20 $313.00 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $313.00 $313.00 $181.54 $313.00 $187.80 $313.00 $313.00 $313.00 N/A N/A 80407157 EAP HCPCS C1887 CATHETER GD .5IN 150CM STRL LF BOTH IP/OP "$2,625.00" "$1,942.50" $521.00 "$2,625.00" "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$1,948.28" "$1,948.28" "$2,023.35" "$1,367.63" $547.08 "$2,625.00" "$2,625.00" "$1,552.69" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,706.25" $521.00 "$2,625.00" "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 80411446 EAP NESTER EMBOLIZATION MICROCOIL .018IN 2MM X 3CM BOTH IP/OP $264.00 $195.50 $46.99 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $46.99 $264.00 $264.00 $195.94 $195.94 $203.49 $137.54 $55.02 $264.00 $105.60 $264.00 $264.00 $264.00 $264.00 $264.00 $198.00 $264.00 $264.00 $264.00 $132.00 $132.00 $209.09 $264.00 $211.20 $171.60 $264.00 $264.00 $153.12 $264.00 $158.40 $264.00 $264.00 $264.00 N/A N/A 80411450 EAP NESTER EMBOLIZATION MICROCOIL .018IN 5MM X 5CM BOTH IP/OP $264.00 $195.50 $46.99 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $46.99 $264.00 $264.00 $195.94 $195.94 $203.49 $137.54 $55.02 $264.00 $105.60 $264.00 $264.00 $264.00 $264.00 $264.00 $198.00 $264.00 $264.00 $264.00 $132.00 $132.00 $209.09 $264.00 $211.20 $171.60 $264.00 $264.00 $153.12 $264.00 $158.40 $264.00 $264.00 $264.00 N/A N/A 80411458 EAP Custom 80411458 COIL EMBL 12MM 14CM NST MCIOL PLTN .035IN CATH BOTH IP/OP $264.00 $195.50 $46.99 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $46.99 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $55.02 $264.00 $105.60 $264.00 $264.00 $264.00 $264.00 $264.00 $198.00 $264.00 $264.00 $264.00 $132.00 $132.00 $209.09 $264.00 $211.20 $118.80 $264.00 $264.00 $153.12 $264.00 $158.40 $264.00 $264.00 $264.00 N/A N/A 80411479 EAP COIL EMBL 5.8CM 6-3MM TRND SFT .035IN STD SM PLTN BOTH IP/OP $275.00 $203.50 $48.95 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $48.95 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $110.00 $275.00 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $275.00 $275.00 $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A 80411496 EAP HCPCS C1894 SHEATH INTRO LNG .091IN 90CM S BOTH IP/OP "$1,363.00" "$1,009.00" $270.52 "$1,363.00" $740.11 $740.11 $740.11 $740.11 "$1,363.00" "$1,363.00" "$1,363.00" $284.08 "$1,363.00" "$1,011.62" "$1,011.62" "$1,050.60" $710.12 $284.06 "$1,363.00" "$1,363.00" $806.21 "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" "$1,022.25" "$1,363.00" "$1,363.00" "$1,363.00" $681.50 $681.50 "$1,079.50" "$1,363.00" "$1,090.40" $885.95 $270.52 "$1,363.00" $790.54 "$1,363.00" "$1,363.00" "$1,363.00" $284.05 "$1,363.00" N/A N/A 80411641 EAP HCPCS C1725 CATHETER BALDILAT 2.5MM 150CM 220MM OTW INFLAT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 80411645 EAP HCPCS C1725 CATHETER BALDILAT 3MM 150CM 30MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80411648 EAP HCPCS C1725 CATHETER BALDILAT 3MM 150CM 60MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80411651 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 150CM 20MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80411653 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 150CM 30MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80411655 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 150CM 40MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80411657 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 150CM 60MM OTW INFLAT PORT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80411659 EAP HCPCS C1725 CATHETER BALDILAT 3.5MM 150CM 220MM OTW INFLAT BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80411662 EAP HCPCS C1725 CATHETER BALDILAT 5MM 150CM 120MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80411666 EAP HCPCS C1725 CATHETER BALDILAT 5MM 150CM 220MM PERI OTW TPR TIP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80411668 EAP HCPCS C1725 CATHETER BALDILAT 6MM 120MM 150CM OTW TPR TIP LP BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80411678 EAP HCPCS C1725 COYOTE MR 2MM X 60MM X 150CM BOTH IP/OP "$1,045.00" $773.50 $207.41 "$1,045.00" $567.44 $567.44 $567.44 $567.44 "$1,045.00" "$1,045.00" "$1,045.00" $217.80 "$1,045.00" $775.60 $775.60 $805.49 $544.45 $217.79 "$1,045.00" "$1,045.00" $618.12 "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" $783.75 "$1,045.00" "$1,045.00" "$1,045.00" $522.50 $522.50 $827.64 "$1,045.00" $836.00 $679.25 $207.41 "$1,045.00" $606.10 "$1,045.00" "$1,045.00" "$1,045.00" $217.78 "$1,045.00" N/A N/A 80411683 EAP HCPCS C1725 COYOTE MR 2.5MM X 60MM X 150CM BOTH IP/OP "$1,045.00" $773.50 $207.41 "$1,045.00" $567.44 $567.44 $567.44 $567.44 "$1,045.00" "$1,045.00" "$1,045.00" $217.80 "$1,045.00" $775.60 $775.60 $805.49 $544.45 $217.79 "$1,045.00" "$1,045.00" $618.12 "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" $783.75 "$1,045.00" "$1,045.00" "$1,045.00" $522.50 $522.50 $827.64 "$1,045.00" $836.00 $679.25 $207.41 "$1,045.00" $606.10 "$1,045.00" "$1,045.00" "$1,045.00" $217.78 "$1,045.00" N/A N/A 80411691 EAP HCPCS C1725 CATHETER BLNDIL 3MM 150CM 60MM CYTE MNRL ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 $417.50 $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A 80412022 EAP HCPCS C1769 GUIDEWIRE VASC 3MM RDS J CRV . BOTH IP/OP $207.00 $153.50 $41.08 $207.00 $112.40 $112.40 $112.40 $112.40 $207.00 $207.00 $207.00 $43.14 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $41.08 $207.00 $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 80412469 EAP HCPCS C1730 CATHETER EP 10MM SPC JSN CRV 5FR 120CM RSPN QDPL BOTH IP/OP $213.00 $158.00 $42.28 $213.00 $115.66 $115.66 $115.66 $115.66 $213.00 $213.00 $213.00 $44.39 $213.00 $158.09 $158.09 $164.18 $110.97 $44.39 $213.00 $213.00 $125.99 $213.00 $213.00 $213.00 $213.00 $159.75 $213.00 $213.00 $213.00 $106.50 $106.50 $168.70 $213.00 $170.40 $138.45 $42.28 $213.00 $123.54 $213.00 $213.00 $213.00 $44.39 $213.00 N/A N/A 80412587 EAP HCPCS C1731 CATHETER EP 1-4-1MM SPC 7FR 99 BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$2,029.73" "$2,029.73" "$2,029.73" "$2,029.73" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$2,774.34" "$2,774.34" "$2,881.25" "$1,947.50" $779.04 "$3,738.00" "$3,738.00" "$2,211.03" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$2,429.70" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$3,738.00" "$3,738.00" $779.00 "$3,738.00" N/A N/A 80412733 EAP HCPCS C2630 CATHETER ABLATION TACTICATH 2-2-2 MM SPACE DAMATO TYPE BOTH IP/OP "$6,750.00" "$4,995.00" "$1,406.77" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$4,181.12" "$4,181.12" "$5,202.90" "$2,060.15" "$1,406.77" "$6,750.00" "$2,700.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$4,387.50" "$6,750.00" "$6,750.00" "$3,915.00" "$6,750.00" "$4,050.00" "$6,750.00" "$6,750.00" "$6,750.00" N/A N/A 80412736 EAP HCPCS C2630 CATHETER ABLT 2-2-2MM SPC F-J BOTH IP/OP "$6,750.00" "$4,995.00" "$1,406.77" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$4,181.12" "$4,181.12" "$5,202.90" "$2,060.15" "$1,406.77" "$6,750.00" "$2,700.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$4,387.50" "$6,750.00" "$6,750.00" "$3,915.00" "$6,750.00" "$4,050.00" "$6,750.00" "$6,750.00" "$6,750.00" N/A N/A 80412749 EAP HCPCS C1766 INTRODUCER SHTH SM CURL 71CM A BOTH IP/OP "$2,235.00" "$1,654.00" $465.80 "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$1,658.82" "$1,658.82" "$1,722.74" "$1,164.44" $465.80 "$2,235.00" $894.00 "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$2,235.00" "$1,676.25" "$2,235.00" "$2,235.00" "$2,235.00" "$1,117.50" "$1,117.50" "$1,770.12" "$2,235.00" "$1,788.00" "$1,452.75" "$2,235.00" "$2,235.00" "$1,296.30" "$2,235.00" "$1,341.00" "$2,235.00" "$2,235.00" "$2,235.00" N/A N/A 80412750 EAP HCPCS C1766 INTRODUCER SHTH .032IN LG CURL BOTH IP/OP "$2,000.00" "$1,480.00" $416.82 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,484.40" "$1,484.40" "$1,541.60" "$1,042.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" "$1,300.00" "$2,000.00" "$2,000.00" "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 80415153 EAP BASKET SPEC RTRVL 12MM .8MM 120CM STRL 0TP ARWY LOPRFL FLT BOTH IP/OP $622.00 $460.50 $110.72 $622.00 $622.00 $622.00 $622.00 $622.00 $622.00 $622.00 $110.72 $622.00 $622.00 $461.65 $461.65 $479.44 $324.06 $129.63 $622.00 $248.80 $622.00 $622.00 $622.00 $622.00 $622.00 $466.50 $622.00 $622.00 $622.00 $311.00 $311.00 $492.62 $622.00 $497.60 $404.30 $622.00 $622.00 $360.76 $622.00 $373.20 $622.00 $622.00 $622.00 N/A N/A 80415571 EAP HCPCS C1889 BASKET SPEC RTRVL 286CMX15MM STRL LF SPGL DISP BOTH IP/OP "$1,269.00" $939.50 $251.86 "$1,269.00" $571.05 $571.05 $571.05 $571.05 "$1,269.00" "$1,269.00" "$1,269.00" $264.49 "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" $264.47 "$1,269.00" "$1,269.00" $750.61 "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" $951.75 "$1,269.00" "$1,269.00" "$1,269.00" $634.50 $634.50 "$1,005.05" "$1,269.00" "$1,015.20" $571.05 $251.86 "$1,269.00" $736.02 "$1,269.00" "$1,269.00" "$1,269.00" $264.46 "$1,269.00" N/A N/A 80415572 EAP HCPCS C1889 SNARE ESCP 286CMX9MM STRL LF SPGL DISP BOTH IP/OP "$1,269.00" $939.50 $251.86 "$1,269.00" $571.05 $571.05 $571.05 $571.05 "$1,269.00" "$1,269.00" "$1,269.00" $264.49 "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" $264.47 "$1,269.00" "$1,269.00" $750.61 "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" $951.75 "$1,269.00" "$1,269.00" "$1,269.00" $634.50 $634.50 "$1,005.05" "$1,269.00" "$1,015.20" $571.05 $251.86 "$1,269.00" $736.02 "$1,269.00" "$1,269.00" "$1,269.00" $264.46 "$1,269.00" N/A N/A 80415604 EAP HCPCS C1726 DILATOR ENDOSCOPIC CRE L3 CM L75 CM OD10-11-12 MM STERILE DISP JAGWIRE BOTH IP/OP $734.00 $543.50 $145.68 $734.00 $398.56 $398.56 $398.56 $398.56 $734.00 $734.00 $734.00 $152.98 $734.00 $544.77 $544.77 $565.77 $382.41 $152.97 $734.00 $734.00 $434.16 $734.00 $734.00 $734.00 $734.00 $550.50 $734.00 $734.00 $734.00 $367.00 $367.00 $581.33 $734.00 $587.20 $477.10 $145.68 $734.00 $425.72 $734.00 $734.00 $734.00 $152.97 $734.00 N/A N/A 80415621 EAP NEEDLE BIOPSY ACQUIRE OD19 GA ODSES1.14 MM ULT STERILE LF DISP BOTH IP/OP "$1,300.00" $962.00 $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $231.40 "$1,300.00" "$1,300.00" $964.86 $964.86 "$1,002.04" $677.30 $270.93 "$1,300.00" $520.00 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $845.00 "$1,300.00" "$1,300.00" $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A 80416024 EAP CATHETER CHLGM SPYSCOPE DS II ACC DLV BOTH IP/OP "$6,125.00" "$4,532.50" "$1,090.25" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$1,090.25" "$6,125.00" "$6,125.00" "$4,181.12" "$4,181.12" "$4,721.15" "$2,060.15" "$1,276.52" "$6,125.00" "$2,450.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$4,593.75" "$6,125.00" "$6,125.00" "$6,125.00" "$3,062.50" "$3,062.50" "$4,851.00" "$6,125.00" "$4,900.00" "$3,981.25" "$6,125.00" "$6,125.00" "$3,552.50" "$6,125.00" "$3,675.00" "$6,125.00" "$6,125.00" "$6,125.00" N/A N/A 80416028 EAP HCPCS C1777 LEAD PACING ENDOTAK RELIANCE S STEROID SILICONE L59CM ENDOCARDIAL DF4-LLHO BOTH IP/OP "$6,500.00" "$4,810.00" "$1,290.09" "$6,500.00" "$2,925.00" "$2,925.00" "$2,925.00" "$2,925.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.76" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.67" "$6,500.00" "$6,500.00" "$3,204.50" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$4,875.00" "$6,500.00" "$6,500.00" "$6,500.00" "$3,250.00" "$3,250.00" "$5,148.00" "$6,500.00" "$5,200.00" "$2,925.00" "$1,290.09" "$6,500.00" "$3,770.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.60" "$6,500.00" N/A N/A 80416033 EAP HCPCS C1895 "LEAD DEFIBRILLATOR RELIANCE 4-FRONT, DUAL COIL 59CM" BOTH IP/OP "$6,500.00" "$4,810.00" "$1,290.09" "$6,500.00" "$2,925.00" "$2,925.00" "$2,925.00" "$2,925.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.76" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.67" "$6,500.00" "$6,500.00" "$3,204.50" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$4,875.00" "$6,500.00" "$6,500.00" "$6,500.00" "$3,250.00" "$3,250.00" "$5,148.00" "$6,500.00" "$5,200.00" "$2,925.00" "$1,290.09" "$6,500.00" "$3,770.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.60" "$6,500.00" N/A N/A 80416166 EAP HCPCS C1722 DFBR CRD .99CM 5.37X7.79CM MOMENTUM HEARTLOGIC BOTH IP/OP "$22,643.00" "$16,756.00" "$4,494.07" "$22,643.00" "$10,189.35" "$10,189.35" "$10,189.35" "$10,189.35" "$22,643.00" "$22,643.00" "$22,643.00" "$4,719.37" "$22,643.00" "$22,643.00" "$22,643.00" "$22,643.00" "$22,643.00" "$4,719.05" "$22,643.00" "$22,643.00" "$11,163.00" "$22,643.00" "$22,643.00" "$22,643.00" "$22,643.00" "$16,982.25" "$22,643.00" "$22,643.00" "$22,643.00" "$11,321.50" "$11,321.50" "$17,933.26" "$22,643.00" "$18,114.40" "$10,189.35" "$4,494.07" "$22,643.00" "$13,132.94" "$22,643.00" "$22,643.00" "$22,643.00" "$4,718.80" "$22,643.00" N/A N/A 80416179 EAP HCPCS C1721 RESONATE EL AICD DUAL CHAMBER 5.37CM 7.68CM 0.99CM BOTH IP/OP "$28,250.00" "$20,905.00" "$5,887.61" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$5,887.61" "$28,250.00" "$11,300.00" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$21,187.50" "$28,250.00" "$28,250.00" "$28,250.00" "$14,125.00" "$14,125.00" "$22,374.00" "$28,250.00" "$22,600.00" "$12,712.50" "$28,250.00" "$28,250.00" "$16,385.00" "$28,250.00" "$16,950.00" "$28,250.00" "$28,250.00" "$28,250.00" N/A N/A 80416183 EAP HCPCS C1882 DEFIBRILLATOR CRD .99CM 5.37X8.08CM 32CC MMNT HEARTLOGIC BOTH IP/OP "$33,420.00" "$24,731.00" "$6,633.03" "$33,420.00" "$15,039.00" "$15,039.00" "$15,039.00" "$15,039.00" "$33,420.00" "$33,420.00" "$33,420.00" "$6,965.56" "$33,420.00" "$33,420.00" "$33,420.00" "$33,420.00" "$33,420.00" "$6,965.10" "$33,420.00" "$33,420.00" "$16,476.06" "$33,420.00" "$33,420.00" "$33,420.00" "$33,420.00" "$25,065.00" "$33,420.00" "$33,420.00" "$33,420.00" "$16,710.00" "$16,710.00" "$26,468.64" "$33,420.00" "$26,736.00" "$15,039.00" "$6,633.03" "$33,420.00" "$19,383.60" "$33,420.00" "$33,420.00" "$33,420.00" "$6,964.73" "$33,420.00" N/A N/A 80416197 EAP HCPCS C1786 PACEMAKER CRD .75CM 4.45X4.81CM ACLD PACESAFE LTD BOTH IP/OP "$6,680.00" "$4,943.50" "$1,325.81" "$6,680.00" "$3,006.00" "$3,006.00" "$3,006.00" "$3,006.00" "$6,680.00" "$6,680.00" "$6,680.00" "$1,392.28" "$6,680.00" "$6,680.00" "$6,680.00" "$6,680.00" "$6,680.00" "$1,392.19" "$6,680.00" "$6,680.00" "$3,293.24" "$6,680.00" "$6,680.00" "$6,680.00" "$6,680.00" "$5,010.00" "$6,680.00" "$6,680.00" "$6,680.00" "$3,340.00" "$3,340.00" "$5,290.56" "$6,680.00" "$5,344.00" "$3,006.00" "$1,325.81" "$6,680.00" "$3,874.40" "$6,680.00" "$6,680.00" "$6,680.00" "$1,392.11" "$6,680.00" N/A N/A 80416198 EAP HCPCS C1785 PACEMAKER CRD .75CM 4.45X5.02CM ACLD PACESAFE LTD BOTH IP/OP "$7,625.00" "$5,642.50" "$1,513.37" "$7,625.00" "$3,431.25" "$3,431.25" "$3,431.25" "$3,431.25" "$7,625.00" "$7,625.00" "$7,625.00" "$1,589.24" "$7,625.00" "$7,625.00" "$7,625.00" "$7,625.00" "$7,625.00" "$1,589.13" "$7,625.00" "$7,625.00" "$3,759.13" "$7,625.00" "$7,625.00" "$7,625.00" "$7,625.00" "$5,718.75" "$7,625.00" "$7,625.00" "$7,625.00" "$3,812.50" "$3,812.50" "$6,039.00" "$7,625.00" "$6,100.00" "$3,431.25" "$1,513.37" "$7,625.00" "$4,422.50" "$7,625.00" "$7,625.00" "$7,625.00" "$1,589.05" "$7,625.00" N/A N/A 80416207 EAP HCPCS C1729 CATHETER DRN 10FR 5CM 5CC STRL LTX WORD 2W FL BLN BARTH GL BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80418587 EAP HCPCS C1757 CATHETER REPERFUSION 4.7-3.8FR .035IN 164CM 3MAX BOTH IP/OP "$3,725.00" "$2,756.50" $739.32 "$3,725.00" "$2,022.68" "$2,022.68" "$2,022.68" "$2,022.68" "$3,725.00" "$3,725.00" "$3,725.00" $776.38 "$3,725.00" "$2,764.70" "$2,764.70" "$2,871.23" "$1,940.73" $776.33 "$3,725.00" "$3,725.00" "$2,203.34" "$3,725.00" "$3,725.00" "$3,725.00" "$3,725.00" "$2,793.75" "$3,725.00" "$3,725.00" "$3,725.00" "$1,862.50" "$1,862.50" "$2,950.20" "$3,725.00" "$2,980.00" "$2,421.25" $739.32 "$3,725.00" "$2,160.50" "$3,725.00" "$3,725.00" "$3,725.00" $776.29 "$3,725.00" N/A N/A 80418588 EAP COIL EMBL 15MM 45CM PENUMBRA COIL 400 CMPLX SFT BOTH IP/OP "$6,300.00" "$4,662.00" "$1,121.40" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,121.40" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$6,300.00" "$6,300.00" "$3,654.00" "$6,300.00" "$3,780.00" "$6,300.00" "$6,300.00" "$6,300.00" N/A N/A 80418589 EAP Custom 80418589 COIL EMBL 18MM 45CM PENUMBRA COIL 400 CMPLX SFT BOTH IP/OP "$6,300.00" "$4,662.00" "$1,121.40" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,121.40" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$6,300.00" "$6,300.00" "$3,654.00" "$6,300.00" "$3,780.00" "$6,300.00" "$6,300.00" "$6,300.00" N/A N/A 80418590 EAP Custom 80418590 COIL EMBL HLX 1MM 1CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418591 EAP Custom 80418591 COIL EMBL HLX 1MM 2CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418592 EAP Custom 80418592 COIL EMBL HLX 1MM 3CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418593 EAP Custom 80418593 COIL EMBL HLX 2MM 2CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418594 EAP Custom 80418594 COIL EMBL HLX 2MM 3CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418595 EAP Custom 80418595 COIL EMBL HLX 2MM 4CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418596 EAP Custom 80418596 COIL EMBL HLCL 2MM 6CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418597 EAP Custom 80418597 COIL EMBL HLCL 2MM 8CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418598 EAP Custom 80418598 COIL EMBL HLX 3MM 4CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418599 EAP Custom 80418599 COIL EMBL HLX 3MM 6CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418600 EAP Custom 80418600 COIL EMBL HLX 3MM 8CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418601 EAP Custom 80418601 COIL EMBL HLX 4MM 6CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418602 EAP Custom 80418602 COIL EMBL HLX 4MM 8CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418603 EAP Custom 80418603 COIL EMBL HLCL 4MM 10CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418604 EAP Custom 80418604 COIL EMBL HLCL 4MM 15CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418605 EAP Custom 80418605 COIL EMBL HLCL 5MM 10CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418606 EAP Custom 80418606 COIL EMBL HLCL 5MM 15CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418607 EAP Custom 80418607 COIL EMBL HLX 1.5MM 1CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418608 EAP Custom 80418608 COIL EMBL HLX 1.5MM 2CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418609 EAP Custom 80418609 COIL EMBL HLX 1.5MM 3CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418610 EAP Custom 80418610 COIL EMBL HLX 2.5MM 4CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418611 EAP Custom 80418611 COIL EMBL HLCL 2.5MM 6CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418612 EAP Custom 80418612 COIL EMBL HLCL 2.5MM 8CM SMRT COIL X SFT BOTH IP/OP "$2,675.00" "$1,979.50" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $476.15 "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" $557.50 "$2,675.00" "$1,070.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,203.75" "$2,675.00" "$2,675.00" "$1,551.50" "$2,675.00" "$1,605.00" "$2,675.00" "$2,675.00" "$2,675.00" N/A N/A 80418613 EAP Custom 80418613 COIL EMBL 4.5MM 15CM SMRT COIL WV X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418614 EAP Custom 80418614 COIL EMBL 2MM 3CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418615 EAP Custom 80418615 COIL EMBL 3MM 4CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418616 EAP Custom 80418616 COIL EMBL 3MM 6CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418617 EAP Custom 80418617 COIL EMBL 3MM 8CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418618 EAP Custom 80418618 COIL EMBL 4MM 6CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418619 EAP Custom 80418619 COIL EMBL 4MM 8CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418620 EAP Custom 80418620 COIL EMBL 4MM 10CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418621 EAP Custom 80418621 COIL EMBL 5MM 6CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418622 EAP Custom 80418622 COIL EMBL 5MM 10CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418623 EAP Custom 80418623 COIL EMBL 5MM 15CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418624 EAP Custom 80418624 COIL EMBL 6MM 10CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418625 EAP Custom 80418625 COIL EMBL 6MM 15CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418626 EAP Custom 80418626 COIL EMBL 7MM 15CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418627 EAP Custom 80418627 COIL EMBL 7MM 20CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418628 EAP Custom 80418628 COIL EMBL 8MM 20CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418629 EAP Custom 80418629 COIL EMBL 9MM 20CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418630 EAP Custom 80418630 COIL EMBL SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418631 EAP Custom 80418631 COIL EMBL 10MM 30CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418632 EAP Custom 80418632 COIL EMBL 3.5MM 6CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418633 EAP Custom 80418633 COIL EMBL 3.5MM 8CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418634 EAP Custom 80418634 COIL EMBL 4.5MM 10CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418635 EAP Custom 80418635 COIL EMBL STD 4MM 8CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418636 EAP Custom 80418636 COIL EMBL STD 5MM 10CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418637 EAP Custom 80418637 COIL EMBL STD 5MM 15CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418638 EAP Custom 80418638 COIL EMBL STD 6MM 15CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418639 EAP Custom 80418639 COIL EMBL STD 6MM 20CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418640 EAP Custom 80418640 COIL EMBL STD 7MM 15CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418641 EAP Custom 80418641 COIL EMBL STD 7MM 20CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418642 EAP Custom 80418642 COIL EMBL STD 7MM 25CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418643 EAP Custom 80418643 COIL EMBL STD 8MM 20CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418644 EAP Custom 80418644 COIL EMBL STD 8MM 30CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418645 EAP Custom 80418645 COIL EMBL STD 9MM 20CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418646 EAP Custom 80418646 COIL EMBL STD 9MM 30CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418647 EAP Custom 80418647 COIL EMBL STD 10MM 30CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418648 EAP Custom 80418648 COIL EMBL STD 10MM 45CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418649 EAP Custom 80418649 COIL EMBL STD 11IN 35IN SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418650 EAP Custom 80418650 COIL EMBL STD 11MM 45CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418651 EAP Custom 80418651 COIL EMBL STD 11MM 60CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418652 EAP Custom 80418652 COIL EMBL STD 12IN 35IN SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418653 EAP Custom 80418653 COIL EMBL STD 12MM 45CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418654 EAP Custom 80418654 COIL EMBL STD 12MM 60CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418655 EAP Custom 80418655 COIL EMBL STD 13MM 45CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418656 EAP Custom 80418656 COIL EMBL STD 13MM 60CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418657 EAP Custom 80418657 COIL EMBL STD 14MM 45CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418658 EAP Custom 80418658 COIL EMBL STD 14MM 60CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418659 EAP Custom 80418659 COIL EMBL STD 15IN 45IN SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418660 EAP Custom 80418660 COIL EMBL STD 15IN 60IN SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418661 EAP Custom 80418661 COIL EMBL STD 16IN 45IN SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418662 EAP Custom 80418662 COIL EMBL STD 16MM 60CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418663 EAP Custom 80418663 COIL EMBL STD 18IN 45IN SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418664 EAP Custom 80418664 COIL EMBL STD 18MM 60CM SMRT COIL BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418665 EAP Custom 80418665 COIL EMBL 1MM 1CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418666 EAP Custom 80418666 COIL EMBL 1MM 2CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418667 EAP Custom 80418667 COIL EMBL 1MM 3CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418668 EAP Custom 80418668 COIL EMBL 1MM 4CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418669 EAP Custom 80418669 COIL EMBL 1MM 1.5CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418670 EAP Custom 80418670 COIL EMBL 2MM 2CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418671 EAP Custom 80418671 COIL EMBL 2MM 3CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418672 EAP Custom 80418672 COIL EMBL 2MM 4CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418673 EAP Custom 80418673 COIL EMBL 2MM 5CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418674 EAP Custom 80418674 COIL EMBL 2MM 6CM SMRT COIL SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418675 EAP Custom 80418675 COIL EMBL 8MM 2CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418676 EAP Custom 80418676 COIL EMBL 3MM 4CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418677 EAP Custom 80418677 COIL EMBL 3MM 6CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418678 EAP Custom 80418678 COIL EMBL 3MM 8CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418679 EAP Custom 80418679 COIL EMBL 4MM 6CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418680 EAP Custom 80418680 COIL EMBL 4MM 8CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418681 EAP Custom 80418681 COIL EMBL 4MM 10CM PENUMBRA SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418682 EAP Custom 80418682 COIL EMBL 1.5MM 2CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418683 EAP Custom 80418683 COIL EMBL 1.5MM 3CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418684 EAP Custom 80418684 COIL EMBL 1.5MM 4CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418685 EAP Custom 80418685 COIL EMBL 2.5MM 3CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418686 EAP Custom 80418686 COIL EMBL 2.5MM 4CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418687 EAP Custom 80418687 COIL EMBL 2.5MM 6CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418688 EAP Custom 80418688 COIL EMBL 2.5MM 8CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418689 EAP Custom 80418689 COIL EMBL 3.5MM 6CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418690 EAP Custom 80418690 COIL EMBL 3.5MM 8CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418691 EAP Custom 80418691 COIL EMBL 4.5MM 12CM SMRT COIL X SFT BOTH IP/OP "$4,025.00" "$2,978.50" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $716.45 "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" $838.85 "$4,025.00" "$1,610.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$4,025.00" "$3,018.75" "$4,025.00" "$4,025.00" "$4,025.00" "$2,012.50" "$2,012.50" "$3,187.80" "$4,025.00" "$3,220.00" "$1,811.25" "$4,025.00" "$4,025.00" "$2,334.50" "$4,025.00" "$2,415.00" "$4,025.00" "$4,025.00" "$4,025.00" N/A N/A 80418692 EAP HCPCS C1757 CATHETER DLV SYS .053IN 4.3-6FR 134CM 130CM 4MAX MAX TRK TCH BOTH IP/OP "$3,725.00" "$2,756.50" $739.32 "$3,725.00" "$2,022.68" "$2,022.68" "$2,022.68" "$2,022.68" "$3,725.00" "$3,725.00" "$3,725.00" $776.38 "$3,725.00" "$2,764.70" "$2,764.70" "$2,871.23" "$1,940.73" $776.33 "$3,725.00" "$3,725.00" "$2,203.34" "$3,725.00" "$3,725.00" "$3,725.00" "$3,725.00" "$2,793.75" "$3,725.00" "$3,725.00" "$3,725.00" "$1,862.50" "$1,862.50" "$2,950.20" "$3,725.00" "$2,980.00" "$2,421.25" $739.32 "$3,725.00" "$2,160.50" "$3,725.00" "$3,725.00" "$3,725.00" $776.29 "$3,725.00" N/A N/A 80418693 EAP HCPCS C1757 RED 68 REPERFUSION CATHETER BOTH IP/OP "$5,975.00" "$4,421.50" "$1,185.89" "$5,975.00" "$3,244.43" "$3,244.43" "$3,244.43" "$3,244.43" "$5,975.00" "$5,975.00" "$5,975.00" "$1,245.34" "$5,975.00" "$4,181.12" "$4,181.12" "$4,605.53" "$2,060.15" "$1,245.26" "$5,975.00" "$5,975.00" "$3,094.73" "$5,975.00" "$5,975.00" "$5,975.00" "$5,975.00" "$4,481.25" "$5,975.00" "$5,975.00" "$5,975.00" "$2,987.50" "$2,987.50" "$4,732.20" "$5,975.00" "$4,780.00" "$3,883.75" "$1,185.89" "$5,975.00" "$3,465.50" "$5,975.00" "$5,975.00" "$5,975.00" "$1,245.19" "$5,975.00" N/A N/A 80418694 EAP HCPCS C1757 CATHETER DLV SYS .062IN 5-6FR 115CM 119CM 5MAX TPR INR SHFT BOTH IP/OP "$3,725.00" "$2,756.50" $739.32 "$3,725.00" "$2,022.68" "$2,022.68" "$2,022.68" "$2,022.68" "$3,725.00" "$3,725.00" "$3,725.00" $776.38 "$3,725.00" "$2,764.70" "$2,764.70" "$2,871.23" "$1,940.73" $776.33 "$3,725.00" "$3,725.00" "$2,203.34" "$3,725.00" "$3,725.00" "$3,725.00" "$3,725.00" "$2,793.75" "$3,725.00" "$3,725.00" "$3,725.00" "$1,862.50" "$1,862.50" "$2,950.20" "$3,725.00" "$2,980.00" "$2,421.25" $739.32 "$3,725.00" "$2,160.50" "$3,725.00" "$3,725.00" "$3,725.00" $776.29 "$3,725.00" N/A N/A 80418695 EAP HCPCS C1757 RED 62 REPERFUSION CATHETER BOTH IP/OP "$5,975.00" "$4,421.50" "$1,185.89" "$5,975.00" "$3,244.43" "$3,244.43" "$3,244.43" "$3,244.43" "$5,975.00" "$5,975.00" "$5,975.00" "$1,245.34" "$5,975.00" "$4,181.12" "$4,181.12" "$4,605.53" "$2,060.15" "$1,245.26" "$5,975.00" "$5,975.00" "$3,094.73" "$5,975.00" "$5,975.00" "$5,975.00" "$5,975.00" "$4,481.25" "$5,975.00" "$5,975.00" "$5,975.00" "$2,987.50" "$2,987.50" "$4,732.20" "$5,975.00" "$4,780.00" "$3,883.75" "$1,185.89" "$5,975.00" "$3,465.50" "$5,975.00" "$5,975.00" "$5,975.00" "$1,245.19" "$5,975.00" N/A N/A 80418696 EAP HCPCS C1757 RED 62 REPERFUSION CATHETER AND PENUMBRA ASPIRATION TUBING BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80418699 EAP HCPCS C1757 CATHETER DLV SYS STRG .07IN 105CM LF BNCHMRK BOTH IP/OP "$2,238.00" "$1,656.50" $444.19 "$2,238.00" "$1,215.23" "$1,215.23" "$1,215.23" "$1,215.23" "$2,238.00" "$2,238.00" "$2,238.00" $466.46 "$2,238.00" "$1,661.04" "$1,661.04" "$1,725.05" "$1,166.00" $466.42 "$2,238.00" "$2,238.00" "$1,323.78" "$2,238.00" "$2,238.00" "$2,238.00" "$2,238.00" "$1,678.50" "$2,238.00" "$2,238.00" "$2,238.00" "$1,119.00" "$1,119.00" "$1,772.50" "$2,238.00" "$1,790.40" "$1,454.70" $444.19 "$2,238.00" "$1,298.04" "$2,238.00" "$2,238.00" "$2,238.00" $466.40 "$2,238.00" N/A N/A 80418700 EAP HCPCS C1757 CATHETER DLV SYS BRNSTN CRV 6FR .07IN 130CM LF 105CM BNCHMRK BOTH IP/OP "$2,238.00" "$1,656.50" $444.19 "$2,238.00" "$1,215.23" "$1,215.23" "$1,215.23" "$1,215.23" "$2,238.00" "$2,238.00" "$2,238.00" $466.46 "$2,238.00" "$1,661.04" "$1,661.04" "$1,725.05" "$1,166.00" $466.42 "$2,238.00" "$2,238.00" "$1,323.78" "$2,238.00" "$2,238.00" "$2,238.00" "$2,238.00" "$1,678.50" "$2,238.00" "$2,238.00" "$2,238.00" "$1,119.00" "$1,119.00" "$1,772.50" "$2,238.00" "$1,790.40" "$1,454.70" $444.19 "$2,238.00" "$1,298.04" "$2,238.00" "$2,238.00" "$2,238.00" $466.40 "$2,238.00" N/A N/A 80418701 EAP HCPCS C1757 CATHETER PRSS MNTR MP CRV .07IN 105CM LF BNCHMRK BOTH IP/OP "$2,238.00" "$1,656.50" $444.19 "$2,238.00" "$1,215.23" "$1,215.23" "$1,215.23" "$1,215.23" "$2,238.00" "$2,238.00" "$2,238.00" $466.46 "$2,238.00" "$1,661.04" "$1,661.04" "$1,725.05" "$1,166.00" $466.42 "$2,238.00" "$2,238.00" "$1,323.78" "$2,238.00" "$2,238.00" "$2,238.00" "$2,238.00" "$1,678.50" "$2,238.00" "$2,238.00" "$2,238.00" "$1,119.00" "$1,119.00" "$1,772.50" "$2,238.00" "$1,790.40" "$1,454.70" $444.19 "$2,238.00" "$1,298.04" "$2,238.00" "$2,238.00" "$2,238.00" $466.40 "$2,238.00" N/A N/A 80418702 EAP HCPCS C1757 CATHETER DLV SYS BRNSTN CRV 5FR .07IN 130CM LF 105CM BNCHMRK BOTH IP/OP "$2,238.00" "$1,656.50" $444.19 "$2,238.00" "$1,215.23" "$1,215.23" "$1,215.23" "$1,215.23" "$2,238.00" "$2,238.00" "$2,238.00" $466.46 "$2,238.00" "$1,661.04" "$1,661.04" "$1,725.05" "$1,166.00" $466.42 "$2,238.00" "$2,238.00" "$1,323.78" "$2,238.00" "$2,238.00" "$2,238.00" "$2,238.00" "$1,678.50" "$2,238.00" "$2,238.00" "$2,238.00" "$1,119.00" "$1,119.00" "$1,772.50" "$2,238.00" "$1,790.40" "$1,454.70" $444.19 "$2,238.00" "$1,298.04" "$2,238.00" "$2,238.00" "$2,238.00" $466.40 "$2,238.00" N/A N/A 80418703 EAP HCPCS C1757 CATHETER DLV SYS STRG .07IN 95CM LF BNCHMRK BOTH IP/OP "$2,238.00" "$1,656.50" $444.19 "$2,238.00" "$1,215.23" "$1,215.23" "$1,215.23" "$1,215.23" "$2,238.00" "$2,238.00" "$2,238.00" $466.46 "$2,238.00" "$1,661.04" "$1,661.04" "$1,725.05" "$1,166.00" $466.42 "$2,238.00" "$2,238.00" "$1,323.78" "$2,238.00" "$2,238.00" "$2,238.00" "$2,238.00" "$1,678.50" "$2,238.00" "$2,238.00" "$2,238.00" "$1,119.00" "$1,119.00" "$1,772.50" "$2,238.00" "$1,790.40" "$1,454.70" $444.19 "$2,238.00" "$1,298.04" "$2,238.00" "$2,238.00" "$2,238.00" $466.40 "$2,238.00" N/A N/A 80418704 EAP HCPCS C1757 CATHETER DLV SYS BRNSTN CRV STRG 5FR .07IN 120CM LF 95CM BOTH IP/OP "$2,238.00" "$1,656.50" $444.19 "$2,238.00" "$1,215.23" "$1,215.23" "$1,215.23" "$1,215.23" "$2,238.00" "$2,238.00" "$2,238.00" $466.46 "$2,238.00" "$1,661.04" "$1,661.04" "$1,725.05" "$1,166.00" $466.42 "$2,238.00" "$2,238.00" "$1,323.78" "$2,238.00" "$2,238.00" "$2,238.00" "$2,238.00" "$1,678.50" "$2,238.00" "$2,238.00" "$2,238.00" "$1,119.00" "$1,119.00" "$1,772.50" "$2,238.00" "$1,790.40" "$1,454.70" $444.19 "$2,238.00" "$1,298.04" "$2,238.00" "$2,238.00" "$2,238.00" $466.40 "$2,238.00" N/A N/A 80418705 EAP HCPCS C1757 CATHETER PRSS MNTR MP CRV .07IN 95CM LF BNCHMRK BOTH IP/OP "$2,238.00" "$1,656.50" $444.19 "$2,238.00" "$1,215.23" "$1,215.23" "$1,215.23" "$1,215.23" "$2,238.00" "$2,238.00" "$2,238.00" $466.46 "$2,238.00" "$1,661.04" "$1,661.04" "$1,725.05" "$1,166.00" $466.42 "$2,238.00" "$2,238.00" "$1,323.78" "$2,238.00" "$2,238.00" "$2,238.00" "$2,238.00" "$1,678.50" "$2,238.00" "$2,238.00" "$2,238.00" "$1,119.00" "$1,119.00" "$1,772.50" "$2,238.00" "$1,790.40" "$1,454.70" $444.19 "$2,238.00" "$1,298.04" "$2,238.00" "$2,238.00" "$2,238.00" $466.40 "$2,238.00" N/A N/A 80418706 EAP HCPCS C1757 CATHETER DLV SYS BRNSTN CRV MP 5FR .07IN 120CM LF 95CM BOTH IP/OP "$2,238.00" "$1,656.50" $444.19 "$2,238.00" "$1,215.23" "$1,215.23" "$1,215.23" "$1,215.23" "$2,238.00" "$2,238.00" "$2,238.00" $466.46 "$2,238.00" "$1,661.04" "$1,661.04" "$1,725.05" "$1,166.00" $466.42 "$2,238.00" "$2,238.00" "$1,323.78" "$2,238.00" "$2,238.00" "$2,238.00" "$2,238.00" "$1,678.50" "$2,238.00" "$2,238.00" "$2,238.00" "$1,119.00" "$1,119.00" "$1,772.50" "$2,238.00" "$1,790.40" "$1,454.70" $444.19 "$2,238.00" "$1,298.04" "$2,238.00" "$2,238.00" "$2,238.00" $466.40 "$2,238.00" N/A N/A 80418708 EAP HCPCS C1757 CATHETER DLV SYS MP CRV 6FR .07IN 105CM 8CM NEURON LUM FLXB BOTH IP/OP "$1,588.00" "$1,175.50" $315.18 "$1,588.00" $862.28 $862.28 $862.28 $862.28 "$1,588.00" "$1,588.00" "$1,588.00" $330.98 "$1,588.00" "$1,178.61" "$1,178.61" "$1,224.03" $827.35 $330.96 "$1,588.00" "$1,588.00" $939.30 "$1,588.00" "$1,588.00" "$1,588.00" "$1,588.00" "$1,191.00" "$1,588.00" "$1,588.00" "$1,588.00" $794.00 $794.00 "$1,257.70" "$1,588.00" "$1,270.40" "$1,032.20" $315.18 "$1,588.00" $921.04 "$1,588.00" "$1,588.00" "$1,588.00" $330.94 "$1,588.00" N/A N/A 80418709 EAP HCPCS C1757 CATHETER DLV SYS .035IN .038IN 6FR .07IN 95CM 6CM NEURON LUM BOTH IP/OP "$1,588.00" "$1,175.50" $315.18 "$1,588.00" $862.28 $862.28 $862.28 $862.28 "$1,588.00" "$1,588.00" "$1,588.00" $330.98 "$1,588.00" "$1,178.61" "$1,178.61" "$1,224.03" $827.35 $330.96 "$1,588.00" "$1,588.00" $939.30 "$1,588.00" "$1,588.00" "$1,588.00" "$1,588.00" "$1,191.00" "$1,588.00" "$1,588.00" "$1,588.00" $794.00 $794.00 "$1,257.70" "$1,588.00" "$1,270.40" "$1,032.20" $315.18 "$1,588.00" $921.04 "$1,588.00" "$1,588.00" "$1,588.00" $330.94 "$1,588.00" N/A N/A 80418710 EAP HCPCS C1757 CATHETER DLV SYS STRG TPR 5-6FR .053IN 105CM 12CM NEURON LUM BOTH IP/OP "$1,588.00" "$1,175.50" $315.18 "$1,588.00" $862.28 $862.28 $862.28 $862.28 "$1,588.00" "$1,588.00" "$1,588.00" $330.98 "$1,588.00" "$1,178.61" "$1,178.61" "$1,224.03" $827.35 $330.96 "$1,588.00" "$1,588.00" $939.30 "$1,588.00" "$1,588.00" "$1,588.00" "$1,588.00" "$1,191.00" "$1,588.00" "$1,588.00" "$1,588.00" $794.00 $794.00 "$1,257.70" "$1,588.00" "$1,270.40" "$1,032.20" $315.18 "$1,588.00" $921.04 "$1,588.00" "$1,588.00" "$1,588.00" $330.94 "$1,588.00" N/A N/A 80418711 EAP HCPCS C1757 CATHETER DLV SYS .035IN .038IN 5FR .053IN 105CM 12CM NEURON BOTH IP/OP "$1,588.00" "$1,175.50" $315.18 "$1,588.00" $862.28 $862.28 $862.28 $862.28 "$1,588.00" "$1,588.00" "$1,588.00" $330.98 "$1,588.00" "$1,178.61" "$1,178.61" "$1,224.03" $827.35 $330.96 "$1,588.00" "$1,588.00" $939.30 "$1,588.00" "$1,588.00" "$1,588.00" "$1,588.00" "$1,191.00" "$1,588.00" "$1,588.00" "$1,588.00" $794.00 $794.00 "$1,257.70" "$1,588.00" "$1,270.40" "$1,032.20" $315.18 "$1,588.00" $921.04 "$1,588.00" "$1,588.00" "$1,588.00" $330.94 "$1,588.00" N/A N/A 80418712 EAP HCPCS C1757 CATHETER DLV SYS .035IN .038IN 5FR .053IN 105CM 6CM NEURON BOTH IP/OP "$1,588.00" "$1,175.50" $315.18 "$1,588.00" $862.28 $862.28 $862.28 $862.28 "$1,588.00" "$1,588.00" "$1,588.00" $330.98 "$1,588.00" "$1,178.61" "$1,178.61" "$1,224.03" $827.35 $330.96 "$1,588.00" "$1,588.00" $939.30 "$1,588.00" "$1,588.00" "$1,588.00" "$1,588.00" "$1,191.00" "$1,588.00" "$1,588.00" "$1,588.00" $794.00 $794.00 "$1,257.70" "$1,588.00" "$1,270.40" "$1,032.20" $315.18 "$1,588.00" $921.04 "$1,588.00" "$1,588.00" "$1,588.00" $330.94 "$1,588.00" N/A N/A 80418713 EAP HCPCS C1757 CATHETER DLV SYS .035IN .038IN 6FR .053IN 115CM 12CM NEURON - PND6F11512 BOTH IP/OP "$1,588.00" "$1,175.50" $315.18 "$1,588.00" $862.28 $862.28 $862.28 $862.28 "$1,588.00" "$1,588.00" "$1,588.00" $330.98 "$1,588.00" "$1,178.61" "$1,178.61" "$1,224.03" $827.35 $330.96 "$1,588.00" "$1,588.00" $939.30 "$1,588.00" "$1,588.00" "$1,588.00" "$1,588.00" "$1,191.00" "$1,588.00" "$1,588.00" "$1,588.00" $794.00 $794.00 "$1,257.70" "$1,588.00" "$1,270.40" "$1,032.20" $315.18 "$1,588.00" $921.04 "$1,588.00" "$1,588.00" "$1,588.00" $330.94 "$1,588.00" N/A N/A 80418714 EAP HCPCS C1757 CATHETER DLV SYS .035IN .038IN 6FR .053IN 115CM 12CM NEURON - PND6F11512M BOTH IP/OP "$1,588.00" "$1,175.50" $315.18 "$1,588.00" $862.28 $862.28 $862.28 $862.28 "$1,588.00" "$1,588.00" "$1,588.00" $330.98 "$1,588.00" "$1,178.61" "$1,178.61" "$1,224.03" $827.35 $330.96 "$1,588.00" "$1,588.00" $939.30 "$1,588.00" "$1,588.00" "$1,588.00" "$1,588.00" "$1,191.00" "$1,588.00" "$1,588.00" "$1,588.00" $794.00 $794.00 "$1,257.70" "$1,588.00" "$1,270.40" "$1,032.20" $315.18 "$1,588.00" $921.04 "$1,588.00" "$1,588.00" "$1,588.00" $330.94 "$1,588.00" N/A N/A 80418715 EAP HCPCS C1757 CATHETER DLV SYS .035IN .038IN 6FR .053IN 115CM 6CM NEURON BOTH IP/OP "$1,588.00" "$1,175.50" $315.18 "$1,588.00" $862.28 $862.28 $862.28 $862.28 "$1,588.00" "$1,588.00" "$1,588.00" $330.98 "$1,588.00" "$1,178.61" "$1,178.61" "$1,224.03" $827.35 $330.96 "$1,588.00" "$1,588.00" $939.30 "$1,588.00" "$1,588.00" "$1,588.00" "$1,588.00" "$1,191.00" "$1,588.00" "$1,588.00" "$1,588.00" $794.00 $794.00 "$1,257.70" "$1,588.00" "$1,270.40" "$1,032.20" $315.18 "$1,588.00" $921.04 "$1,588.00" "$1,588.00" "$1,588.00" $330.94 "$1,588.00" N/A N/A 80418716 EAP HCPCS C1894 SHEATH INTRO LNG MP CRV 6FR 8FR .088IN 80CM 4CM NEURON MXSS BOTH IP/OP "$1,138.00" $842.50 $225.86 "$1,138.00" $617.93 $617.93 $617.93 $617.93 "$1,138.00" "$1,138.00" "$1,138.00" $237.19 "$1,138.00" $844.62 $844.62 $877.17 $592.90 $237.17 "$1,138.00" "$1,138.00" $673.13 "$1,138.00" "$1,138.00" "$1,138.00" "$1,138.00" $853.50 "$1,138.00" "$1,138.00" "$1,138.00" $569.00 $569.00 $901.30 "$1,138.00" $910.40 $739.70 $225.86 "$1,138.00" $660.04 "$1,138.00" "$1,138.00" "$1,138.00" $237.16 "$1,138.00" N/A N/A 80418717 EAP HCPCS C1757 CATHETER DLV SYS STRG .088IN 90CM LF NEURON MAX DIL BOTH IP/OP "$1,138.00" $842.50 $225.86 "$1,138.00" $617.93 $617.93 $617.93 $617.93 "$1,138.00" "$1,138.00" "$1,138.00" $237.19 "$1,138.00" $844.62 $844.62 $877.17 $592.90 $237.17 "$1,138.00" "$1,138.00" $673.13 "$1,138.00" "$1,138.00" "$1,138.00" "$1,138.00" $853.50 "$1,138.00" "$1,138.00" "$1,138.00" $569.00 $569.00 $901.30 "$1,138.00" $910.40 $739.70 $225.86 "$1,138.00" $660.04 "$1,138.00" "$1,138.00" "$1,138.00" $237.16 "$1,138.00" N/A N/A 80418718 EAP HCPCS C1757 CATHETER DLV SYS .035IN .038IN SIM CRV FULL LGTH 5FR .04IN BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 80418719 EAP HCPCS C1757 CATHETER DLV SYS .018IN 1 CRV 5FR .04IN 130CM 9CM NEURON LUM BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 80418720 EAP HCPCS C1757 CATHETER DLV SYS BERNSTEIN CRV 6FR 5.6FR .04IN 105CM LF 9CM BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 80418721 EAP HCPCS C1757 CATHETER DLV SYS .035IN .038IN 1 6FR .04IN 105CM 9CM MAX BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 80418722 EAP HCPCS C1757 CATHETER DLV SYS BRNSTN CRV 6FR 5.6FR .04IN 125CM LF 9CM BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 80418723 EAP HCPCS C1757 CATHETER THRMB 1 CRV 6FR 5.6FR .04IN 125CM LF 9CM NEURON BOTH IP/OP $313.00 $232.00 $62.12 $313.00 $169.96 $169.96 $169.96 $169.96 $313.00 $313.00 $313.00 $65.24 $313.00 $232.31 $232.31 $241.26 $163.07 $65.23 $313.00 $313.00 $185.14 $313.00 $313.00 $313.00 $313.00 $234.75 $313.00 $313.00 $313.00 $156.50 $156.50 $247.90 $313.00 $250.40 $203.45 $62.12 $313.00 $181.54 $313.00 $313.00 $313.00 $65.23 $313.00 N/A N/A 80418724 EAP HCPCS C1757 CATHETER THRMB 54CM STRL LF PENUMBRA SYS KT REPERFUSION BOTH IP/OP "$4,375.00" "$3,237.50" $868.33 "$4,375.00" "$2,375.63" "$2,375.63" "$2,375.63" "$2,375.63" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$3,247.13" "$3,247.13" "$3,372.25" "$2,060.15" $911.80 "$4,375.00" "$4,375.00" "$2,587.81" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$2,843.75" $868.33 "$4,375.00" "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A 80418730 EAP HCPCS C1757 CATHETER DLV SYS MIC 3D 2.6-2.95FR .025IN 160CM PX 400 VLC BOTH IP/OP "$2,590.00" "$1,917.00" $514.05 "$2,590.00" "$1,406.37" "$1,406.37" "$1,406.37" "$1,406.37" "$2,590.00" "$2,590.00" "$2,590.00" $539.82 "$2,590.00" "$1,922.30" "$1,922.30" "$1,996.37" "$1,349.39" $539.78 "$2,590.00" "$2,590.00" "$1,531.99" "$2,590.00" "$2,590.00" "$2,590.00" "$2,590.00" "$1,942.50" "$2,590.00" "$2,590.00" "$2,590.00" "$1,295.00" "$1,295.00" "$2,051.28" "$2,590.00" "$2,072.00" "$1,683.50" $514.05 "$2,590.00" "$1,502.20" "$2,590.00" "$2,590.00" "$2,590.00" $539.76 "$2,590.00" N/A N/A 80418731 EAP HCPCS C1757 CATHETER REPERFUSION 6-4.3FR .041IN 143CM 4MAX BOTH IP/OP "$3,725.00" "$2,756.50" $739.32 "$3,725.00" "$2,022.68" "$2,022.68" "$2,022.68" "$2,022.68" "$3,725.00" "$3,725.00" "$3,725.00" $776.38 "$3,725.00" "$2,764.70" "$2,764.70" "$2,871.23" "$1,940.73" $776.33 "$3,725.00" "$3,725.00" "$2,203.34" "$3,725.00" "$3,725.00" "$3,725.00" "$3,725.00" "$2,793.75" "$3,725.00" "$3,725.00" "$3,725.00" "$1,862.50" "$1,862.50" "$2,950.20" "$3,725.00" "$2,980.00" "$2,421.25" $739.32 "$3,725.00" "$2,160.50" "$3,725.00" "$3,725.00" "$3,725.00" $776.29 "$3,725.00" N/A N/A 80418732 EAP HCPCS C1757 CATHETER THRMB 6FR .64IN 132CM LF PENUMBRA SYS 5MAX ACE BOTH IP/OP "$5,975.00" "$4,421.50" "$1,185.89" "$5,975.00" "$3,244.43" "$3,244.43" "$3,244.43" "$3,244.43" "$5,975.00" "$5,975.00" "$5,975.00" "$1,245.34" "$5,975.00" "$4,181.12" "$4,181.12" "$4,605.53" "$2,060.15" "$1,245.26" "$5,975.00" "$5,975.00" "$3,094.73" "$5,975.00" "$5,975.00" "$5,975.00" "$5,975.00" "$4,481.25" "$5,975.00" "$5,975.00" "$5,975.00" "$2,987.50" "$2,987.50" "$4,732.20" "$5,975.00" "$4,780.00" "$3,883.75" "$1,185.89" "$5,975.00" "$3,465.50" "$5,975.00" "$5,975.00" "$5,975.00" "$1,245.19" "$5,975.00" N/A N/A 80418733 EAP HCPCS C1757 CATHETER THRMB 132CM LF PENUMBRA SYS 5MAX ACE REPERFUSION BOTH IP/OP "$5,725.00" "$4,236.50" "$1,136.27" "$5,725.00" "$3,108.68" "$3,108.68" "$3,108.68" "$3,108.68" "$5,725.00" "$5,725.00" "$5,725.00" "$1,193.23" "$5,725.00" "$4,181.12" "$4,181.12" "$4,412.83" "$2,060.15" "$1,193.15" "$5,725.00" "$5,725.00" "$3,094.73" "$5,725.00" "$5,725.00" "$5,725.00" "$5,725.00" "$4,293.75" "$5,725.00" "$5,725.00" "$5,725.00" "$2,862.50" "$2,862.50" "$4,534.20" "$5,725.00" "$4,580.00" "$3,721.25" "$1,136.27" "$5,725.00" "$3,320.50" "$5,725.00" "$5,725.00" "$5,725.00" "$1,193.09" "$5,725.00" N/A N/A 80418758 EAP HCPCS C1769 GUIDEWIRE VASCULAR ASAHI GLADIUS MONGO L190 CM OD.014 IN STERILE BOTH IP/OP "$1,663.00" "$1,231.00" $330.06 "$1,663.00" $903.01 $903.01 $903.01 $903.01 "$1,663.00" "$1,663.00" "$1,663.00" $346.61 "$1,663.00" "$1,234.28" "$1,234.28" "$1,281.84" $866.42 $346.59 "$1,663.00" "$1,663.00" $983.66 "$1,663.00" "$1,663.00" "$1,663.00" "$1,663.00" "$1,247.25" "$1,663.00" "$1,663.00" "$1,663.00" $831.50 $831.50 "$1,317.10" "$1,663.00" "$1,330.40" "$1,080.95" $330.06 "$1,663.00" $964.54 "$1,663.00" "$1,663.00" "$1,663.00" $346.57 "$1,663.00" N/A N/A 80418763 EAP HCPCS C1769 GUIDEWIRE VASC STRG TPR .014IN BOTH IP/OP $333.00 $246.50 $66.09 $333.00 $180.82 $180.82 $180.82 $180.82 $333.00 $333.00 $333.00 $69.41 $333.00 $247.15 $247.15 $256.68 $173.49 $69.40 $333.00 $333.00 $196.97 $333.00 $333.00 $333.00 $333.00 $249.75 $333.00 $333.00 $333.00 $166.50 $166.50 $263.74 $333.00 $266.40 $216.45 $66.09 $333.00 $193.14 $333.00 $333.00 $333.00 $69.40 $333.00 N/A N/A 80418764 EAP HCPCS C1769 GUIDEWIRE VASC STRG TPR .014IN 190CM STRL LF 16CM A FLDR BOTH IP/OP $333.00 $246.50 $66.09 $333.00 $180.82 $180.82 $180.82 $180.82 $333.00 $333.00 $333.00 $69.41 $333.00 $247.15 $247.15 $256.68 $173.49 $69.40 $333.00 $333.00 $196.97 $333.00 $333.00 $333.00 $333.00 $249.75 $333.00 $333.00 $333.00 $166.50 $166.50 $263.74 $333.00 $266.40 $216.45 $66.09 $333.00 $193.14 $333.00 $333.00 $333.00 $69.40 $333.00 N/A N/A 80418767 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 190CM STRL LF ASAHI SION DISP BOTH IP/OP $333.00 $246.50 $66.09 $333.00 $180.82 $180.82 $180.82 $180.82 $333.00 $333.00 $333.00 $69.41 $333.00 $247.15 $247.15 $256.68 $173.49 $69.40 $333.00 $333.00 $196.97 $333.00 $333.00 $333.00 $333.00 $249.75 $333.00 $333.00 $333.00 $166.50 $166.50 $263.74 $333.00 $266.40 $216.45 $66.09 $333.00 $193.14 $333.00 $333.00 $333.00 $69.40 $333.00 N/A N/A 80418768 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM FI BOTH IP/OP $60.00 $44.50 $11.91 $60.00 $32.58 $32.58 $32.58 $32.58 $60.00 $60.00 $60.00 $12.51 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $60.00 $35.49 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $11.91 $60.00 $34.80 $60.00 $60.00 $60.00 $12.50 $60.00 N/A N/A 80418769 EAP HCPCS C1769 GUIDEWIRE VASC STRG TPR .014IN BOTH IP/OP $60.00 $44.50 $11.91 $60.00 $32.58 $32.58 $32.58 $32.58 $60.00 $60.00 $60.00 $12.51 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $60.00 $35.49 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $11.91 $60.00 $34.80 $60.00 $60.00 $60.00 $12.50 $60.00 N/A N/A 80435214 EAP HCPCS C1887 KIT CATHETER GD 9FR 80CM STRL LF MRC BLN SIL WITH AXS CATALYST BOTH IP/OP "$7,979.00" "$5,904.50" "$1,583.63" "$7,979.00" "$4,332.60" "$4,332.60" "$4,332.60" "$4,332.60" "$7,979.00" "$7,979.00" "$7,979.00" "$1,663.02" "$7,979.00" "$4,181.12" "$4,181.12" "$6,150.21" "$2,060.15" "$1,662.91" "$7,979.00" "$7,979.00" "$3,094.73" "$7,979.00" "$7,979.00" "$7,979.00" "$7,979.00" "$5,984.25" "$7,979.00" "$7,979.00" "$7,979.00" "$3,989.50" "$3,989.50" "$6,319.37" "$7,979.00" "$6,383.20" "$5,186.35" "$1,583.63" "$7,979.00" "$4,627.82" "$7,979.00" "$7,979.00" "$7,979.00" "$1,662.82" "$7,979.00" N/A N/A 80435215 EAP HCPCS C1887 KIT CATHETER GD 9FR 95CM STRL LF MRC BLN SIL WITH AXS CATALYST BOTH IP/OP "$7,979.00" "$5,904.50" "$1,583.63" "$7,979.00" "$4,332.60" "$4,332.60" "$4,332.60" "$4,332.60" "$7,979.00" "$7,979.00" "$7,979.00" "$1,663.02" "$7,979.00" "$4,181.12" "$4,181.12" "$6,150.21" "$2,060.15" "$1,662.91" "$7,979.00" "$7,979.00" "$3,094.73" "$7,979.00" "$7,979.00" "$7,979.00" "$7,979.00" "$5,984.25" "$7,979.00" "$7,979.00" "$7,979.00" "$3,989.50" "$3,989.50" "$6,319.37" "$7,979.00" "$6,383.20" "$5,186.35" "$1,583.63" "$7,979.00" "$4,627.82" "$7,979.00" "$7,979.00" "$7,979.00" "$1,662.82" "$7,979.00" N/A N/A 80435628 EAP NEEDLE ASPIRATION L1400 MM L80 MMOD2.2 MM ODSEC22 W/O SIDEHOLE BOTH IP/OP "$4,595.00" "$3,400.50" $817.91 "$4,595.00" "$4,595.00" "$4,595.00" "$4,595.00" "$4,595.00" "$4,595.00" "$4,595.00" $817.91 "$4,595.00" "$4,595.00" "$3,410.41" "$3,410.41" "$3,541.83" "$2,060.15" $957.65 "$4,595.00" "$1,838.00" "$4,595.00" "$4,595.00" "$4,595.00" "$4,595.00" "$4,595.00" "$3,446.25" "$4,595.00" "$4,595.00" "$4,595.00" "$2,297.50" "$2,297.50" "$3,639.24" "$4,595.00" "$3,676.00" "$2,986.75" "$4,595.00" "$4,595.00" "$2,665.10" "$4,595.00" "$2,757.00" "$4,595.00" "$4,595.00" "$4,595.00" N/A N/A 80435629 EAP NEEDLE ASPIRATION L1400 MM L80 MMOD2.2 MM ODSEC22 WITH SIDEHOLE BOTH IP/OP "$4,595.00" "$3,400.50" $817.91 "$4,595.00" "$4,595.00" "$4,595.00" "$4,595.00" "$4,595.00" "$4,595.00" "$4,595.00" $817.91 "$4,595.00" "$4,595.00" "$3,410.41" "$3,410.41" "$3,541.83" "$2,060.15" $957.65 "$4,595.00" "$1,838.00" "$4,595.00" "$4,595.00" "$4,595.00" "$4,595.00" "$4,595.00" "$3,446.25" "$4,595.00" "$4,595.00" "$4,595.00" "$2,297.50" "$2,297.50" "$3,639.24" "$4,595.00" "$3,676.00" "$2,986.75" "$4,595.00" "$4,595.00" "$2,665.10" "$4,595.00" "$2,757.00" "$4,595.00" "$4,595.00" "$4,595.00" N/A N/A 80436768 EAP HCPCS C1817 PLUG CV .038IN LOPRFL 6MM 4FR 11MM STRL LF 125CM AMPLZR 2 BOTH IP/OP "$2,375.00" "$1,757.50" $494.98 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" $950.00 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" "$2,375.00" "$2,375.00" "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" "$2,375.00" "$2,375.00" N/A N/A 80436769 EAP HCPCS C1817 PLUG CARDIO 13.5MM 8MM 4FR AMPLZR .038IN LP NTNL BOTH IP/OP "$2,375.00" "$1,757.50" $494.98 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" $950.00 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" "$2,375.00" "$2,375.00" "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" "$2,375.00" "$2,375.00" N/A N/A 80436770 EAP HCPCS C1769 KIT TREVO 3X20 PACKAGED WITH SYNCHRO2 STD CUSTOM GRADY BOTH IP/OP "$14,432.00" "$10,680.00" "$2,060.15" "$14,432.00" "$7,836.58" "$7,836.58" "$7,836.58" "$7,836.58" "$14,432.00" "$14,432.00" "$14,432.00" "$3,007.99" "$14,432.00" "$4,181.12" "$4,181.12" "$11,124.19" "$2,060.15" "$3,007.79" "$14,432.00" "$14,432.00" "$3,094.73" "$14,432.00" "$14,432.00" "$14,432.00" "$14,432.00" "$10,824.00" "$14,432.00" "$14,432.00" "$14,432.00" "$7,216.00" "$7,216.00" "$11,430.14" "$14,432.00" "$11,545.60" "$9,380.80" "$2,864.39" "$14,432.00" "$8,370.56" "$14,432.00" "$8,659.20" "$14,432.00" "$3,007.63" "$14,432.00" N/A N/A 80436771 EAP HCPCS C1769 KIT TREVO 4X20 PACKAGED WITH SYNCHRO2 STD CUSTOM GRADY BOTH IP/OP "$14,432.00" "$10,680.00" "$2,060.15" "$14,432.00" "$7,836.58" "$7,836.58" "$7,836.58" "$7,836.58" "$14,432.00" "$14,432.00" "$14,432.00" "$3,007.99" "$14,432.00" "$4,181.12" "$4,181.12" "$11,124.19" "$2,060.15" "$3,007.79" "$14,432.00" "$14,432.00" "$3,094.73" "$14,432.00" "$14,432.00" "$14,432.00" "$14,432.00" "$10,824.00" "$14,432.00" "$14,432.00" "$14,432.00" "$7,216.00" "$7,216.00" "$11,430.14" "$14,432.00" "$11,545.60" "$9,380.80" "$2,864.39" "$14,432.00" "$8,370.56" "$14,432.00" "$8,659.20" "$14,432.00" "$3,007.63" "$14,432.00" N/A N/A 80436772 EAP HCPCS C1769 KIT TREVO 4X30 PACKAGED WITH SYNCHRO2 STD CUSTOM GRADY BOTH IP/OP "$14,432.00" "$10,680.00" "$2,060.15" "$14,432.00" "$7,836.58" "$7,836.58" "$7,836.58" "$7,836.58" "$14,432.00" "$14,432.00" "$14,432.00" "$3,007.99" "$14,432.00" "$4,181.12" "$4,181.12" "$11,124.19" "$2,060.15" "$3,007.79" "$14,432.00" "$14,432.00" "$3,094.73" "$14,432.00" "$14,432.00" "$14,432.00" "$14,432.00" "$10,824.00" "$14,432.00" "$14,432.00" "$14,432.00" "$7,216.00" "$7,216.00" "$11,430.14" "$14,432.00" "$11,545.60" "$9,380.80" "$2,864.39" "$14,432.00" "$8,370.56" "$14,432.00" "$14,432.00" "$14,432.00" "$3,007.63" "$14,432.00" N/A N/A 80436773 EAP HCPCS C1769 KIT TREVO 6X25 PACKAGED WITH SYNCHRO2 STD CUSTOM GRADY BOTH IP/OP "$14,432.00" "$10,680.00" "$2,060.15" "$14,432.00" "$7,836.58" "$7,836.58" "$7,836.58" "$7,836.58" "$14,432.00" "$14,432.00" "$14,432.00" "$3,007.99" "$14,432.00" "$4,181.12" "$4,181.12" "$11,124.19" "$2,060.15" "$3,007.79" "$14,432.00" "$14,432.00" "$3,094.73" "$14,432.00" "$14,432.00" "$14,432.00" "$14,432.00" "$10,824.00" "$14,432.00" "$14,432.00" "$14,432.00" "$7,216.00" "$7,216.00" "$11,430.14" "$14,432.00" "$11,545.60" "$9,380.80" "$2,864.39" "$14,432.00" "$8,370.56" "$14,432.00" "$14,432.00" "$14,432.00" "$3,007.63" "$14,432.00" N/A N/A 80436775 EAP HCPCS C1884 KIT INTVN ENROUTE NEUROPROTECTION TRANSCAROTID BOTH IP/OP "$8,875.00" "$6,567.50" "$1,761.47" "$8,875.00" "$4,819.13" "$4,819.13" "$4,819.13" "$4,819.13" "$8,875.00" "$8,875.00" "$8,875.00" "$1,849.77" "$8,875.00" "$4,181.12" "$4,181.12" "$6,840.85" "$2,060.15" "$1,849.65" "$8,875.00" "$8,875.00" "$3,094.73" "$8,875.00" "$8,875.00" "$8,875.00" "$8,875.00" "$6,656.25" "$8,875.00" "$8,875.00" "$8,875.00" "$4,437.50" "$4,437.50" "$7,029.00" "$8,875.00" "$7,100.00" "$5,768.75" "$1,761.47" "$8,875.00" "$5,147.50" "$8,875.00" "$8,875.00" "$8,875.00" "$1,849.55" "$8,875.00" N/A N/A 80436776 EAP HCPCS C1894 KIT MCTRDCR 21GA 7CM NDL BOTH IP/OP "$4,375.00" "$3,237.50" $868.33 "$4,375.00" "$2,375.63" "$2,375.63" "$2,375.63" "$2,375.63" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$3,247.13" "$3,247.13" "$3,372.25" "$2,060.15" $911.80 "$4,375.00" "$4,375.00" "$2,587.81" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$2,843.75" $868.33 "$4,375.00" "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A 80436777 EAP HCPCS C1769 GUIDEWIRE VASC 5CM .014IN 95CM 15CM ENROUTE RADOPQ PTFE BOTH IP/OP "$2,375.00" "$1,757.50" $471.38 "$2,375.00" "$1,289.63" "$1,289.63" "$1,289.63" "$1,289.63" "$2,375.00" "$2,375.00" "$2,375.00" $495.01 "$2,375.00" "$1,762.73" "$1,762.73" "$1,830.65" "$1,237.38" $494.98 "$2,375.00" "$2,375.00" "$1,404.81" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,543.75" $471.38 "$2,375.00" "$1,377.50" "$2,375.00" "$2,375.00" "$2,375.00" $494.95 "$2,375.00" N/A N/A 80436783 EAP HCPCS C1757 CATHETER ASP .074IN 125CM STRL LF AXS VECTA 74 LUM DISP BOTH IP/OP "$7,375.00" "$5,457.50" "$1,463.75" "$7,375.00" "$4,004.63" "$4,004.63" "$4,004.63" "$4,004.63" "$7,375.00" "$7,375.00" "$7,375.00" "$1,537.13" "$7,375.00" "$4,181.12" "$4,181.12" "$5,684.65" "$2,060.15" "$1,537.03" "$7,375.00" "$7,375.00" "$3,094.73" "$7,375.00" "$7,375.00" "$7,375.00" "$7,375.00" "$5,531.25" "$7,375.00" "$7,375.00" "$7,375.00" "$3,687.50" "$3,687.50" "$5,841.00" "$7,375.00" "$5,900.00" "$4,793.75" "$1,463.75" "$7,375.00" "$4,277.50" "$7,375.00" "$7,375.00" "$7,375.00" "$1,536.95" "$7,375.00" N/A N/A 80436784 EAP HCPCS C1757 CATHETER ASP .074IN 132CM STRL LF AXS VECTA 74 LUM DISP BOTH IP/OP "$7,375.00" "$5,457.50" "$1,463.75" "$7,375.00" "$4,004.63" "$4,004.63" "$4,004.63" "$4,004.63" "$7,375.00" "$7,375.00" "$7,375.00" "$1,537.13" "$7,375.00" "$4,181.12" "$4,181.12" "$5,684.65" "$2,060.15" "$1,537.03" "$7,375.00" "$7,375.00" "$3,094.73" "$7,375.00" "$7,375.00" "$7,375.00" "$7,375.00" "$5,531.25" "$7,375.00" "$7,375.00" "$7,375.00" "$3,687.50" "$3,687.50" "$5,841.00" "$7,375.00" "$5,900.00" "$4,793.75" "$1,463.75" "$7,375.00" "$4,277.50" "$7,375.00" "$7,375.00" "$7,375.00" "$1,536.95" "$7,375.00" N/A N/A 80436791 EAP HCPCS C1894 KIT INTRO .021IN 80CM 6FR 21GA 25CM STRL 1.5IN GLIDESHEATH BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80436798 EAP HCPCS C1894 SHEATH INTRO 8.2MM 22FR 33CM GORE DRYSEAL FLX HDRPH BOTH IP/OP "$1,585.00" "$1,173.00" $314.58 "$1,585.00" $860.66 $860.66 $860.66 $860.66 "$1,585.00" "$1,585.00" "$1,585.00" $330.35 "$1,585.00" "$1,176.39" "$1,176.39" "$1,221.72" $825.79 $330.33 "$1,585.00" "$1,585.00" $937.53 "$1,585.00" "$1,585.00" "$1,585.00" "$1,585.00" "$1,188.75" "$1,585.00" "$1,585.00" "$1,585.00" $792.50 $792.50 "$1,255.32" "$1,585.00" "$1,268.00" "$1,030.25" $314.58 "$1,585.00" $919.30 "$1,585.00" "$1,585.00" "$1,585.00" $330.31 "$1,585.00" N/A N/A 80436800 EAP HCPCS C1894 SHEATH INTRO 8.8MM 24FR 33CM GORE DRYSEAL FLX HDRPH BOTH IP/OP "$1,585.00" "$1,173.00" $314.58 "$1,585.00" $860.66 $860.66 $860.66 $860.66 "$1,585.00" "$1,585.00" "$1,585.00" $330.35 "$1,585.00" "$1,176.39" "$1,176.39" "$1,221.72" $825.79 $330.33 "$1,585.00" "$1,585.00" $937.53 "$1,585.00" "$1,585.00" "$1,585.00" "$1,585.00" "$1,188.75" "$1,585.00" "$1,585.00" "$1,585.00" $792.50 $792.50 "$1,255.32" "$1,585.00" "$1,268.00" "$1,030.25" $314.58 "$1,585.00" $919.30 "$1,585.00" "$1,585.00" "$1,585.00" $330.31 "$1,585.00" N/A N/A 80436802 EAP HCPCS C1894 SHEATH INTRODUCER GORE DRYSEAL FLEX HYDRO L33 CM OD9.5 MM ID26 FR BOTH IP/OP "$1,585.00" "$1,173.00" $314.58 "$1,585.00" $860.66 $860.66 $860.66 $860.66 "$1,585.00" "$1,585.00" "$1,585.00" $330.35 "$1,585.00" "$1,176.39" "$1,176.39" "$1,221.72" $825.79 $330.33 "$1,585.00" "$1,585.00" $937.53 "$1,585.00" "$1,585.00" "$1,585.00" "$1,585.00" "$1,188.75" "$1,585.00" "$1,585.00" "$1,585.00" $792.50 $792.50 "$1,255.32" "$1,585.00" "$1,268.00" "$1,030.25" $314.58 "$1,585.00" $919.30 "$1,585.00" "$1,585.00" "$1,585.00" $330.31 "$1,585.00" N/A N/A 80436934 EAP HCPCS C1876 STENT EPRSTH 14MM 90MM 100MM VICI VNS STNT CATH NTNL ACPT BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" "$5,250.00" "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80437111 EAP HCPCS C1887 CATHETER INFS MIC 2.8-3FR .027IN 155CM DIREXION HFL BOTH IP/OP "$1,287.00" $952.50 $255.44 "$1,287.50" $698.84 $698.84 $698.84 $698.84 "$1,287.00" "$1,287.00" "$1,287.00" $268.24 "$1,287.00" $955.21 $955.21 $992.02 $670.53 $268.22 "$1,287.00" "$1,287.50" $761.26 "$1,287.00" "$1,287.50" "$1,287.00" "$1,287.00" $965.25 "$1,287.00" "$1,287.00" "$1,287.00" $643.50 $643.50 "$1,019.30" "$1,287.00" "$1,029.60" $836.55 $255.44 "$1,287.00" $746.46 "$1,287.00" "$1,287.00" "$1,287.00" $268.21 "$1,287.00" N/A N/A 80437420 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 130CM ST BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 $200.00 $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 80437421 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 190CM ST BOTH IP/OP $208.00 $154.00 $41.28 $208.00 $112.94 $112.94 $112.94 $112.94 $208.00 $208.00 $208.00 $43.35 $208.00 $154.38 $154.38 $160.33 $108.37 $43.35 $208.00 $208.00 $123.03 $208.00 $208.00 $208.00 $208.00 $156.00 $208.00 $208.00 $208.00 $104.00 $104.00 $164.74 $208.00 $166.40 $135.20 $41.28 $208.00 $120.64 $208.00 $208.00 $208.00 $43.35 $208.00 N/A N/A 80437445 EAP HCPCS C1725 CATHETER BLNDIL 5.5MM 135CM 15 BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80437446 EAP HCPCS C1725 CATHETER BLNDIL 5.5MM 135CM 30 BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80437447 EAP HCPCS C1725 CATHETER BLNDIL 5.5MM 135CM 40 BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80437452 EAP HCPCS C1725 CATHETER BLNDIL 6MM 135CM 15MM BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80437453 EAP HCPCS C1725 CATHETER BLNDIL 6MM 135CM 40MM BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80437702 EAP HCPCS C1725 CATHETER BLNDIL 6MM 90CM 40MM BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $107.51 $107.51 $107.51 $107.51 $198.00 $198.00 $198.00 $41.27 $198.00 $146.96 $146.96 $152.62 $103.16 $41.27 $198.00 $198.00 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $128.70 $39.30 $198.00 $114.84 $198.00 $198.00 $198.00 $41.26 $198.00 N/A N/A 80438567 EAP HCPCS C1760 DEVICE CLSR 14FR MANTA VASC BOTH IP/OP "$3,125.00" "$2,312.50" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$3,125.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 "$3,125.00" "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 80438594 EAP HCPCS C1894 KIT INTRO .018IN MIC 5FR 21GA 3FR 45CM STRL 15CM BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $135.75 $135.75 $135.75 $135.75 $250.00 $250.00 $250.00 $52.11 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $49.62 $250.00 $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 80438621 EAP BRONCHOSCOPE GLIDESCOPE BOTH IP/OP $369.00 $273.50 $65.68 $369.00 $369.00 $369.00 $369.00 $369.00 $369.00 $369.00 $65.68 $369.00 $369.00 $273.87 $273.87 $284.43 $192.25 $76.90 $369.00 $147.60 $369.00 $369.00 $369.00 $369.00 $369.00 $276.75 $369.00 $369.00 $369.00 $184.50 $184.50 $292.25 $369.00 $295.20 $239.85 $369.00 $369.00 $214.02 $369.00 $221.40 $369.00 $369.00 $369.00 N/A N/A 80462380 EAP HCPCS C1887 CATHETER DX 100CM 5FR .047IN DXTERITY NOTO CURVE BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80462743 EAP HCPCS C1887 CATHETER GD 3DRC CRV 6FR 100CM STRL LF LNCHR LG LUM RADOPQ BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80462749 EAP HCPCS C1887 CATHETER GD 3DRIGHT CRV 6FR 10 BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80462786 EAP HCPCS C1887 CATHETER GD AL.75 CRV 6FR 100CM STRL LF LNCHR LG LUM RADOPQ BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80462851 EAP HCPCS C1887 CATHETER GD EBU3.5 CRV 6FR 90C BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80463011 EAP HCPCS C1887 CATHETER GD STD JR3.5 CRV 6FR BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80463074 EAP HCPCS C1887 CATHETER GD MP1 CRV 6FR 100CM STRL LF LNCHR LG LUM RADOPQ BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80463110 EAP HCPCS C1887 CATHETER GD RCB CRV 6FR 100CM BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80463182 EAP HCPCS C1887 CATHETER GD 3DRIGHT CRV 7FR 10 BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80463185 EAP HCPCS C1887 CATHETER GD AL1 CRV 7FR 90CM S BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80463262 EAP HCPCS C1887 CATHETER GD EBU3 CRV 7FR 100CM STRL LF LNCHR LG LUM RADOPQ BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80463270 EAP HCPCS C1887 CATHETER GUIDING LAUNCHER NYLON EBU3.5 CURVE L90CM OD7 FR BOTH IP/OP $125.00 $92.50 $24.81 $125.00 $67.88 $67.88 $67.88 $67.88 $125.00 $125.00 $125.00 $26.05 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $24.81 $125.00 $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 80463283 EAP HCPCS C1887 CATHETER GD EBU4 CRV 7FR 90CM BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80463387 EAP HCPCS C1887 CATHETER GD STD JR4 CRV 7FR 100CM STRL LF LNCHR LG LUM BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80463914 EAP HCPCS C1725 CATHETER BLNDIL 4MM 142CM LF 8MM NC EUPHORA RX LOPRFL RADOPQ BOTH IP/OP $425.00 $314.50 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 $425.00 $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 80464046 EAP HCPCS C1874 SYSTEM COR STNT 3MM 15MM 140CM BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,457.10" "$1,457.10" "$1,457.10" "$1,457.10" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" $674.83 "$3,238.00" "$3,238.00" "$1,596.33" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$1,457.10" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80464064 EAP HCPCS C1874 SYSTEM COR STNT 3.5MM 15MM 140 BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,457.10" "$1,457.10" "$1,457.10" "$1,457.10" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" $674.83 "$3,238.00" "$3,238.00" "$1,596.33" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$1,457.10" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80464076 EAP HCPCS C1874 SYSTEM COR STNT 3.5MM 38MM 140 BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,457.10" "$1,457.10" "$1,457.10" "$1,457.10" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" $674.83 "$3,238.00" "$3,238.00" "$1,596.33" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$1,457.10" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80464684 EAP HCPCS C1887 CATHETER GD AR2 CRV 6FR 100CM BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80464714 EAP HCPCS C1887 CATHETER GD EBU3 CRV 6FR 100CM STRL SHR NX BAL SFTP DIST SLV BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $48.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80464781 EAP HCPCS C1887 CATHETER GD IMA CRV 6FR 100CM BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80464812 EAP HCPCS C1887 CATHETER GD STD JL3 CRV 6FR 100CM STRL SHR NX BAL SFTP DIST BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80465083 EAP HCPCS C1887 CATHETER GD STD JL3 CRV 7FR 100CM STRL SHR NX BAL SFTP DIST BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 $120.00 $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 80467374 EAP HCPCS C1769 GUIDEWIRE VASC 220CM .008-.012IN HBRD RADIOPQ STR BOTH IP/OP "$1,426.00" "$1,055.50" $283.03 "$1,426.00" $774.32 $774.32 $774.32 $774.32 "$1,426.00" "$1,426.00" "$1,426.00" $297.21 "$1,426.00" "$1,058.38" "$1,058.38" "$1,099.16" $742.95 $297.19 "$1,426.00" "$1,426.00" $843.48 "$1,426.00" "$1,426.00" "$1,426.00" "$1,426.00" "$1,069.50" "$1,426.00" "$1,426.00" "$1,426.00" $713.00 $713.00 "$1,129.39" "$1,426.00" "$1,140.80" $926.90 $283.03 "$1,426.00" $827.08 "$1,426.00" "$1,426.00" "$1,426.00" $297.18 "$1,426.00" N/A N/A 80467375 EAP HCPCS C1769 GUIDEWIRE VASC 220CM .008-.012IN DISTAL TIP BOTH IP/OP "$1,495.00" "$1,106.50" $296.72 "$1,495.00" $811.79 $811.79 $811.79 $811.79 "$1,495.00" "$1,495.00" "$1,495.00" $311.60 "$1,495.00" "$1,109.59" "$1,109.59" "$1,152.35" $778.90 $311.57 "$1,495.00" "$1,495.00" $884.29 "$1,495.00" "$1,495.00" "$1,495.00" "$1,495.00" "$1,121.25" "$1,495.00" "$1,495.00" "$1,495.00" $747.50 $747.50 "$1,184.04" "$1,495.00" "$1,196.00" $971.75 $296.72 "$1,495.00" $867.10 "$1,495.00" $897.00 "$1,495.00" $311.56 "$1,495.00" N/A N/A 80467376 EAP HCPCS C1769 GUIDEWIRE VASC 200CM .012-.014IN HBRD RADIOPQ STR BOTH IP/OP "$1,035.00" $766.00 $205.42 "$1,035.00" $562.01 $562.01 $562.01 $562.01 "$1,035.00" "$1,035.00" "$1,035.00" $215.72 "$1,035.00" $768.18 $768.18 $797.78 $539.24 $215.71 "$1,035.00" "$1,035.00" $612.20 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $776.25 "$1,035.00" "$1,035.00" "$1,035.00" $517.50 $517.50 $819.72 "$1,035.00" $828.00 $672.75 $205.42 "$1,035.00" $600.30 "$1,035.00" $621.00 "$1,035.00" $215.69 "$1,035.00" N/A N/A 80467381 EAP HCPCS C1894 INTRODUCER SHEATH 088 80 CM BOTH IP/OP "$1,100.00" $814.00 $218.32 "$1,100.00" $597.30 $597.30 $597.30 $597.30 "$1,100.00" "$1,100.00" "$1,100.00" $229.27 "$1,100.00" $816.42 $816.42 $847.88 $573.10 $229.25 "$1,100.00" "$1,100.00" $650.65 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $715.00 $218.32 "$1,100.00" $638.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.24 "$1,100.00" N/A N/A 80467382 EAP HCPCS C1894 INTRODUCER SHEATH 088 90 CM BOTH IP/OP "$1,100.00" $814.00 $218.32 "$1,100.00" $597.30 $597.30 $597.30 $597.30 "$1,100.00" "$1,100.00" "$1,100.00" $229.27 "$1,100.00" $816.42 $816.42 $847.88 $573.10 $229.25 "$1,100.00" "$1,100.00" $650.65 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $715.00 $218.32 "$1,100.00" $638.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.24 "$1,100.00" N/A N/A 80467384 EAP HCPCS C1769 GUIDEWIRE VASC 180CM .035IN STD TIP RADIOPQ STRBL BOTH IP/OP $155.00 $115.00 $30.76 $155.00 $84.17 $84.17 $84.17 $84.17 $155.00 $155.00 $155.00 $32.31 $155.00 $115.04 $115.04 $119.47 $80.76 $32.30 $155.00 $155.00 $91.68 $155.00 $155.00 $155.00 $155.00 $116.25 $155.00 $155.00 $155.00 $77.50 $77.50 $122.76 $155.00 $124.00 $100.75 $30.76 $155.00 $89.90 $155.00 $155.00 $155.00 $32.30 $155.00 N/A N/A 80467400 EAP HCPCS C2628 CATHETER BLNOCC THK.9MM 3CM 3MM 1.1IN 6- MM 2FR BOTH IP/OP "$5,238.00" "$3,876.50" "$1,039.61" "$5,238.00" "$2,844.23" "$2,844.23" "$2,844.23" "$2,844.23" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.73" "$5,238.00" "$3,887.64" "$3,887.64" "$4,037.45" "$2,060.15" "$1,091.66" "$5,238.00" "$5,238.00" "$3,094.73" "$5,238.00" "$5,238.00" "$5,238.00" "$5,238.00" "$3,928.50" "$5,238.00" "$5,238.00" "$5,238.00" "$2,619.00" "$2,619.00" "$4,148.50" "$5,238.00" "$4,190.40" "$3,404.70" "$1,039.61" "$5,238.00" "$3,038.04" "$5,238.00" "$5,238.00" "$5,238.00" "$1,091.60" "$5,238.00" N/A N/A 80469324 EAP HCPCS C1895 LEAD DFBR 64CM 7.3FR RLNC 4-FRN RV MP35N IROX STRD BOTH IP/OP "$6,500.00" "$4,810.00" "$1,290.09" "$6,500.00" "$2,925.00" "$2,925.00" "$2,925.00" "$2,925.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.76" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.67" "$6,500.00" "$6,500.00" "$3,204.50" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$4,875.00" "$6,500.00" "$6,500.00" "$6,500.00" "$3,250.00" "$3,250.00" "$5,148.00" "$6,500.00" "$5,200.00" "$2,925.00" "$1,290.09" "$6,500.00" "$3,770.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.60" "$6,500.00" N/A N/A 80469325 EAP HCPCS C1777 LEAD DFBR 64CM 7.3FR RLNC 4-FRN RV MP35N IROX STRD 1 COIL BOTH IP/OP "$6,500.00" "$4,810.00" "$1,290.09" "$6,500.00" "$2,925.00" "$2,925.00" "$2,925.00" "$2,925.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.76" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.67" "$6,500.00" "$6,500.00" "$3,204.50" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$4,875.00" "$6,500.00" "$6,500.00" "$6,500.00" "$3,250.00" "$3,250.00" "$5,148.00" "$6,500.00" "$5,200.00" "$2,925.00" "$1,290.09" "$6,500.00" "$3,770.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.60" "$6,500.00" N/A N/A 80469326 EAP HCPCS C1895 LEAD DFBR 59CM 7.3FR RLNC 4-FRN RV MP35N IROX STRD 2 COIL BOTH IP/OP "$6,500.00" "$4,810.00" "$1,290.09" "$6,500.00" "$2,925.00" "$2,925.00" "$2,925.00" "$2,925.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.76" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.67" "$6,500.00" "$6,500.00" "$3,204.50" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$4,875.00" "$6,500.00" "$6,500.00" "$6,500.00" "$3,250.00" "$3,250.00" "$5,148.00" "$6,500.00" "$5,200.00" "$2,925.00" "$1,290.09" "$6,500.00" "$3,770.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.60" "$6,500.00" N/A N/A 80472491 EAP HCPCS C1887 CATHETER DLV SYS MIC .025IN 135CM LNTRN HFLO STRG TIP BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80472492 EAP HCPCS C1887 CATHETER DLV SYS 45D MIC .025IN 135CM LNTRN HFLO BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80472494 EAP HCPCS C1887 CATHETER DLV SYS MIC .025IN 150CM LNTRN HFLO STRG TIP BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80472495 EAP HCPCS C1887 CATHETER DLV SYS 45D MIC .025IN 150CM LNTRN HFLO BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80472496 EAP HCPCS C1887 CATHETER DLV SYS 150CM .025IN LNTRN 90D MIC HFLO BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80472497 EAP Custom 80472497 COIL EMBL STD .02IN 3MM 5CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$1,975.00" "$1,461.50" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" "$1,975.00" "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A 80472498 EAP Custom 80472498 COIL EMBL STD .02IN 3MM 12CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80472499 EAP COIL EMBL STD .02IN 3MM 20CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80472501 EAP Custom 80472501 COIL EMBL STD .02IN 4MM 20CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80472503 EAP Custom 80472503 COIL EMBL STD .02IN 4MM 35CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472504 EAP Custom 80472504 COIL EMBL STD .02IN 5MM 12CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80472506 EAP COIL EMBL 30CM .02IN 5MM PENUMBRA COIL 400 RUBY BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472508 EAP Custom 80472508 COIL EMBL STD CMPLX .02IN 6MM 20CM RUBY LG VOLUME FULL DTCH BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80472509 EAP Custom 80472509 COIL EMBL STD .02IN 6MM 30CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472510 EAP COIL EMBL STD .02IN 7MM 25CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80472512 EAP COIL EMBL STD .02IN 8MM 25CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80472513 EAP COIL EMBL STD .02IN 8MM 40CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472515 EAP Custom 80472515 COIL EMBL STD .02IN 10MM 35CM PENUMBRA COIL 400 RUBY CMPLX BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472517 EAP Custom 80472517 COIL EMBL STD .02IN 12MM 60CM PENUMBRA COIL 400 RUBY CMPLX BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472519 EAP Custom 80472519 COIL EMBL STD .02IN 14MM 60CM PENUMBRA COIL 400 RUBY CMPLX BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472520 EAP Custom 80472520 COIL EMBL STD .02IN 16MM 60CM PENUMBRA COIL 400 RUBY CMPLX BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472521 EAP Custom 80472521 COIL EMBL STD .02IN 18MM 60CM RUBY CMPLX LG VOLUME DTCH FRM BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472522 EAP Custom 80472522 COIL EMBL STD .02IN 20MM 60CM RUBY CMPLX LG VOLUME FLLY DTCH BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472523 EAP Custom 80472523 COIL EMBL STD .02IN 24MM 60CM RUBY CMPLX LG VOLUME DTCH FRM BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472524 EAP Custom 80472524 COIL EMBL STD .02IN 28MM 60CM PENUMBRA COIL 400 RUBY CMPLX BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472525 EAP Custom 80472525 COIL EMBL STD .02IN 32MM 60CM PENUMBRA COIL 400 RUBY CMPLX BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472526 EAP Custom 80472526 COIL EMBL STD 36MM 60CM RUBY BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472527 EAP Custom 80472527 COIL EMBL STD 40MM 60CM RUBY BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472528 EAP COIL EMBL .02IN 2MM 1CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$1,975.00" "$1,461.50" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" "$1,975.00" "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A 80472529 EAP Custom 80472529 COIL EMBL .02IN 2MM 2CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$1,975.00" "$1,461.50" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" "$1,975.00" "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A 80472530 EAP COIL EMBL .02IN 2MM 4CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$1,975.00" "$1,461.50" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" "$1,975.00" "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A 80472531 EAP Custom 80472531 COIL EMBL STD CMPLX .02IN 3MM 5CM RUBY LG VOLUME FULL DTCH BOTH IP/OP "$1,975.00" "$1,461.50" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" "$1,975.00" "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A 80472532 EAP Custom 80472532 COIL EMBL .02IN 3MM 15CM RUBY CMPLX LG VOLUME FLLY DTCH BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80472533 EAP Custom 80472533 COIL EMBL .02IN 4MM 6CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$1,975.00" "$1,461.50" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" "$1,975.00" "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A 80472534 EAP Custom 80472534 COIL EMBL .02IN 4MM 15CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80472535 EAP Custom 80472535 COIL EMBL .02IN 6MM 20CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80472536 EAP Custom 80472536 COIL EMBL .02IN 6MM 30CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472537 EAP Custom 80472537 COIL EMBL .02IN 8MM 35CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472538 EAP Custom 80472538 COIL EMBL .02IN 8MM 60CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472541 EAP Custom 80472541 COIL EMBL .02IN 16MM 50CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472542 EAP Custom 80472542 COIL EMBL .02IN 20MM 60CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472543 EAP Custom 80472543 COIL EMBL 8-10MM 60CM POD BOTH IP/OP "$4,475.00" "$3,311.50" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $932.64 "$4,475.00" "$1,790.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$3,356.25" "$4,475.00" "$4,475.00" "$4,475.00" "$2,237.50" "$2,237.50" "$3,544.20" "$4,475.00" "$3,580.00" "$2,013.75" "$4,475.00" "$4,475.00" "$2,595.50" "$4,475.00" "$2,685.00" "$4,475.00" "$4,475.00" "$4,475.00" N/A N/A 80472544 EAP Custom 80472544 COIL EMBL 10-12MM 60CM POD BOTH IP/OP "$4,475.00" "$3,311.50" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $932.64 "$4,475.00" "$1,790.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$3,356.25" "$4,475.00" "$4,475.00" "$4,475.00" "$2,237.50" "$2,237.50" "$3,544.20" "$4,475.00" "$3,580.00" "$2,013.75" "$4,475.00" "$4,475.00" "$2,595.50" "$4,475.00" "$2,685.00" "$4,475.00" "$4,475.00" "$4,475.00" N/A N/A 80472545 EAP Custom 80472545 COIL EMBL 12-14MM 60CM POD BOTH IP/OP "$4,475.00" "$3,311.50" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $932.64 "$4,475.00" "$1,790.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$3,356.25" "$4,475.00" "$4,475.00" "$4,475.00" "$2,237.50" "$2,237.50" "$3,544.20" "$4,475.00" "$3,580.00" "$2,013.75" "$4,475.00" "$4,475.00" "$2,595.50" "$4,475.00" "$2,685.00" "$4,475.00" "$4,475.00" "$4,475.00" N/A N/A 80472546 EAP Custom 80472546 COIL EMBL 3MM 20CM POD BOTH IP/OP "$4,475.00" "$3,311.50" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $932.64 "$4,475.00" "$1,790.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$3,356.25" "$4,475.00" "$4,475.00" "$4,475.00" "$2,237.50" "$2,237.50" "$3,544.20" "$4,475.00" "$3,580.00" "$2,013.75" "$4,475.00" "$4,475.00" "$2,595.50" "$4,475.00" "$2,685.00" "$4,475.00" "$4,475.00" "$4,475.00" N/A N/A 80472547 EAP Custom 80472547 COIL EMBL 4MM 30CM RUBY POD CMPLX OCCULUSION DEV BOTH IP/OP "$4,475.00" "$3,311.50" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $932.64 "$4,475.00" "$1,790.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$3,356.25" "$4,475.00" "$4,475.00" "$4,475.00" "$2,237.50" "$2,237.50" "$3,544.20" "$4,475.00" "$3,580.00" "$2,013.75" "$4,475.00" "$4,475.00" "$2,595.50" "$4,475.00" "$2,685.00" "$4,475.00" "$4,475.00" "$4,475.00" N/A N/A 80472548 EAP Custom 80472548 COIL EMBL 5MM 30CM RUBY POD CMPLX OCCULUSION DEV BOTH IP/OP "$4,475.00" "$3,311.50" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $932.64 "$4,475.00" "$1,790.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$3,356.25" "$4,475.00" "$4,475.00" "$4,475.00" "$2,237.50" "$2,237.50" "$3,544.20" "$4,475.00" "$3,580.00" "$2,013.75" "$4,475.00" "$4,475.00" "$2,595.50" "$4,475.00" "$2,685.00" "$4,475.00" "$4,475.00" "$4,475.00" N/A N/A 80472549 EAP Custom 80472549 COIL EMBL 6MM 50CM RUBY POD CMPLX BOTH IP/OP "$4,475.00" "$3,311.50" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $932.64 "$4,475.00" "$1,790.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$3,356.25" "$4,475.00" "$4,475.00" "$4,475.00" "$2,237.50" "$2,237.50" "$3,544.20" "$4,475.00" "$3,580.00" "$2,013.75" "$4,475.00" "$4,475.00" "$2,595.50" "$4,475.00" "$2,685.00" "$4,475.00" "$4,475.00" "$4,475.00" N/A N/A 80472550 EAP COIL EMBL 8MM 60CM RUBY POD CMPLX OCCULUSION DEV BOTH IP/OP "$4,475.00" "$3,311.50" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $932.64 "$4,475.00" "$1,790.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$3,356.25" "$4,475.00" "$4,475.00" "$4,475.00" "$2,237.50" "$2,237.50" "$3,544.20" "$4,475.00" "$3,580.00" "$2,013.75" "$4,475.00" "$4,475.00" "$2,595.50" "$4,475.00" "$2,685.00" "$4,475.00" "$4,475.00" "$4,475.00" N/A N/A 80472551 EAP Custom 80472551 COIL EMBL J-SFT 15CM STRL LF POD PK BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80472552 EAP COIL EMBL J-SFT 30CM STRL LF POD PK BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472553 EAP Custom 80472553 COIL EMBL J-SFT 45CM STRL LF POD PK BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472554 EAP COIL EMBL J 5CM POD PK SFT BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80472555 EAP COIL EMBL J-SFT 60CM STRL LF POD PK BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80472556 EAP HANDLE INST RUBY DTCH COIL BOTH IP/OP $595.00 $440.50 $105.91 $595.00 $595.00 $595.00 $595.00 $595.00 $595.00 $595.00 $105.91 $595.00 $595.00 $595.00 $595.00 $595.00 $595.00 $124.00 $595.00 $238.00 $595.00 $595.00 $595.00 $595.00 $595.00 $446.25 $595.00 $595.00 $595.00 $297.50 $297.50 $471.24 $595.00 $476.00 $267.75 $595.00 $595.00 $345.10 $595.00 $357.00 $595.00 $595.00 $595.00 N/A N/A 80479796 EAP HCPCS C1874 STENT EPRSTH 11MM 5CM 120CM GO BOTH IP/OP "$8,940.00" "$6,616.00" "$1,774.37" "$8,940.00" "$4,023.00" "$4,023.00" "$4,023.00" "$4,023.00" "$8,940.00" "$8,940.00" "$8,940.00" "$1,863.32" "$8,940.00" "$8,940.00" "$8,940.00" "$8,940.00" "$8,940.00" "$1,863.19" "$8,940.00" "$8,940.00" "$4,407.42" "$8,940.00" "$8,940.00" "$8,940.00" "$8,940.00" "$6,705.00" "$8,940.00" "$8,940.00" "$8,940.00" "$4,470.00" "$4,470.00" "$7,080.48" "$8,940.00" "$7,152.00" "$4,023.00" "$1,774.37" "$8,940.00" "$5,185.20" "$8,940.00" "$8,940.00" "$8,940.00" "$1,863.10" "$8,940.00" N/A N/A 80479860 EAP HCPCS C1874 STENT EPRSTH 6MM 5CM STRL 120C BOTH IP/OP "$8,940.00" "$6,616.00" "$1,774.37" "$8,940.00" "$4,023.00" "$4,023.00" "$4,023.00" "$4,023.00" "$8,940.00" "$8,940.00" "$8,940.00" "$1,863.32" "$8,940.00" "$8,940.00" "$8,940.00" "$8,940.00" "$8,940.00" "$1,863.19" "$8,940.00" "$8,940.00" "$4,407.42" "$8,940.00" "$8,940.00" "$8,940.00" "$8,940.00" "$6,705.00" "$8,940.00" "$8,940.00" "$8,940.00" "$4,470.00" "$4,470.00" "$7,080.48" "$8,940.00" "$7,152.00" "$4,023.00" "$1,774.37" "$8,940.00" "$5,185.20" "$8,940.00" "$8,940.00" "$8,940.00" "$1,863.10" "$8,940.00" N/A N/A 80479863 EAP HCPCS C1874 STENT EPRSTH 6MM 10CM STRL 120CM VBHN FLXB SLF XPD RADOPQ BOTH IP/OP "$9,808.00" "$7,258.00" "$1,946.64" "$9,808.00" "$4,413.60" "$4,413.60" "$4,413.60" "$4,413.60" "$9,808.00" "$9,808.00" "$9,808.00" "$2,044.23" "$9,808.00" "$9,808.00" "$9,808.00" "$9,808.00" "$9,808.00" "$2,044.10" "$9,808.00" "$9,808.00" "$4,835.34" "$9,808.00" "$9,808.00" "$9,808.00" "$9,808.00" "$7,356.00" "$9,808.00" "$9,808.00" "$9,808.00" "$4,904.00" "$4,904.00" "$7,767.94" "$9,808.00" "$7,846.40" "$4,413.60" "$1,946.64" "$9,808.00" "$5,688.64" "$9,808.00" "$5,884.80" "$9,808.00" "$2,043.99" "$9,808.00" N/A N/A 80479964 EAP HCPCS C1887 CATHETER GD IL3.5 CRV 6FR 100CM HEARTRAIL III RADOPQ LG INR BOTH IP/OP $175.00 $129.50 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 $175.00 $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 80479980 EAP HCPCS C1894 KIT INTRO .021IN 6FR 22GA 10CM 45CM GLIDESHEATH SLNDR SHTH BOTH IP/OP $234.00 $173.50 $46.44 $234.00 $127.06 $127.06 $127.06 $127.06 $234.00 $234.00 $234.00 $48.77 $234.00 $173.67 $173.67 $180.37 $121.91 $48.77 $234.00 $234.00 $138.41 $234.00 $234.00 $234.00 $234.00 $175.50 $234.00 $234.00 $234.00 $117.00 $117.00 $185.33 $234.00 $187.20 $152.10 $46.44 $234.00 $135.72 $234.00 $234.00 $234.00 $48.77 $234.00 N/A N/A 80479987 EAP HCPCS C1725 CATHETER BLNDIL 1.5MM 6MM TAKERU OTW PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80479988 EAP HCPCS C1725 CATHETER BLNDIL 1.5MM 12MM TAKERU OTW PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80479989 EAP HCPCS C1725 CATHETER BLNDIL 1.5MM 15MM TAKERU OTW PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80479990 EAP HCPCS C1725 CATHETER BLNDIL 2MM 8MM TAKERU OTW PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80479991 EAP HCPCS C1725 CATHETER BLNDIL 2MM 12MM TAKERU OTW PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80479992 EAP HCPCS C1725 CATHETER BLNDIL 2MM 15MM TAKERU OTW PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80479993 EAP HCPCS C1725 CATHETER BLNDIL 2MM 20MM TAKERU OTW PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80479994 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM 12MM TAKERU OTW PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80479995 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM 15MM TAKERU OTW PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80479996 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM 20MM TAKERU OTW PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80479997 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM 8MM TAKERU OTW PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80479998 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM 12MM TAKERU OTW PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80479999 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM 15MM TAKERU OTW PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480000 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM 20MM TAKERU OTW PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480001 EAP HCPCS C1725 CATHETER BLNDIL 1.5MM 6MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480002 EAP HCPCS C1725 CATHETER BLNDIL 1.5MM 12MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480003 EAP HCPCS C1725 CATHETER BLNDIL 1.5MM 15MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480004 EAP HCPCS C1725 CATHETER BLNDIL 2MM 8MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480005 EAP HCPCS C1725 CATHETER BLNDIL 2MM 12MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480006 EAP HCPCS C1725 CATHETER BLNDIL 2MM 15MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480007 EAP HCPCS C1725 CATHETER BLNDIL 2MM 20MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480008 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM 12MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480009 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM 15MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480010 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM 20MM TAKERU RX SMCPNT PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480011 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM 8MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480012 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM 12MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480013 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM 15MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480014 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM 20MM TAKERU RX SMCPNT PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480015 EAP HCPCS C1725 CATHETER BLNDIL 2MM 8MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480016 EAP HCPCS C1725 CATHETER BLNDIL 2MM 12MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480017 EAP HCPCS C1725 CATHETER BLNDIL 2MM 15MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480018 EAP HCPCS C1725 CATHETER BLNDIL 2MM 21MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480019 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM 8MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480020 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM 12MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480021 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM 15MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480022 EAP HCPCS C1725 CATHETER BLNDIL 2.25MM 21MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480023 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM 8MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480024 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM 12MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480025 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM 15MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480026 EAP HCPCS C1725 CATHETER BLNDIL 2.5MM 21MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480027 EAP HCPCS C1725 CATHETER BLNDIL 2.75MM 8MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480028 EAP HCPCS C1725 CATHETER BLNDIL 2.75MM 12MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480029 EAP HCPCS C1725 CATHETER BLNDIL 2.75MM 15MM TAKERU RX PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480030 EAP HCPCS C1725 CATHETER BLNDIL 2.75MM 21MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480031 EAP HCPCS C1725 CATHETER BLNDIL 3MM 8MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480032 EAP HCPCS C1725 CATHETER BLNDIL 3MM 12MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480033 EAP HCPCS C1725 CATHETER BLNDIL 3MM 15MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480034 EAP HCPCS C1725 CATHETER BLNDIL 3MM 21MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480035 EAP HCPCS C1725 CATHETER BLNDIL 3.25MM 8MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480036 EAP HCPCS C1725 CATHETER BLNDIL 3.25MM 12MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480037 EAP HCPCS C1725 CATHETER BLNDIL 3.25MM 15MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480038 EAP HCPCS C1725 CATHETER BLNDIL 3.25MM 21MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480039 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM 8MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480040 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM 12MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480041 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM 15MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480042 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM 21MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480043 EAP HCPCS C1725 CATHETER BLNDIL 4MM 8MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480044 EAP HCPCS C1725 CATHETER BLNDIL 4MM 12MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480045 EAP HCPCS C1725 CATHETER BLNDIL 4MM 15MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480046 EAP HCPCS C1725 CATHETER BLNDIL 4MM 21MM TAKERU PTCA BOTH IP/OP $288.00 $213.50 $57.16 $288.00 $156.38 $156.38 $156.38 $156.38 $288.00 $288.00 $288.00 $60.03 $288.00 $213.75 $213.75 $221.99 $150.05 $60.02 $288.00 $288.00 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $187.20 $57.16 $288.00 $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 80480267 EAP HCPCS C1725 CATHETER ANGIO FL3.5 CRV 6FR 1 BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 80480297 EAP HCPCS C1725 CATHETER ANGIO PGTL FL4 FR4 CR BOTH IP/OP $18.00 $13.50 $3.57 $18.00 $9.77 $9.77 $9.77 $9.77 $18.00 $18.00 $18.00 $3.75 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $18.00 $10.65 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $3.57 $18.00 $10.44 $18.00 $18.00 $18.00 $3.75 $18.00 N/A N/A 80480434 EAP HCPCS C1769 GUIDEWIRE VASC STRG .014IN 185 BOTH IP/OP $159.00 $118.00 $31.56 $159.00 $86.34 $86.34 $86.34 $86.34 $159.00 $159.00 $159.00 $33.14 $159.00 $118.01 $118.01 $122.56 $82.84 $33.14 $159.00 $159.00 $94.05 $159.00 $159.00 $159.00 $159.00 $119.25 $159.00 $159.00 $159.00 $79.50 $79.50 $125.93 $159.00 $127.20 $103.35 $31.56 $159.00 $92.22 $159.00 $159.00 $159.00 $33.14 $159.00 N/A N/A 80480440 EAP HCPCS C1769 VASCULAR GUIDEWIRE BOTH IP/OP $159.00 $118.00 $31.56 $159.00 $86.34 $86.34 $86.34 $86.34 $159.00 $159.00 $159.00 $33.14 $159.00 $118.01 $118.01 $122.56 $82.84 $33.14 $159.00 $159.00 $94.05 $159.00 $159.00 $159.00 $159.00 $119.25 $159.00 $159.00 $159.00 $79.50 $79.50 $125.93 $159.00 $127.20 $103.35 $31.56 $159.00 $92.22 $159.00 $159.00 $159.00 $33.14 $159.00 N/A N/A 80483366 EAP HCPCS C1887 CATHETER GD 6FR 150CM GUIDEZIL BOTH IP/OP $968.00 $716.50 $192.12 $968.00 $525.62 $525.62 $525.62 $525.62 $968.00 $968.00 $968.00 $201.76 $968.00 $718.45 $718.45 $746.13 $504.33 $201.74 $968.00 $968.00 $572.57 $968.00 $968.00 $968.00 $968.00 $726.00 $968.00 $968.00 $968.00 $484.00 $484.00 $766.66 $968.00 $774.40 $629.20 $192.12 $968.00 $561.44 $968.00 $968.00 $968.00 $201.73 $968.00 N/A N/A 80483368 EAP HCPCS C1887 CATHETER GD 7FR 150CM GUIDEZIL BOTH IP/OP $968.00 $716.50 $192.12 $968.00 $525.62 $525.62 $525.62 $525.62 $968.00 $968.00 $968.00 $201.76 $968.00 $718.45 $718.45 $746.13 $504.33 $201.74 $968.00 $968.00 $572.57 $968.00 $968.00 $968.00 $968.00 $726.00 $968.00 $968.00 $968.00 $484.00 $484.00 $766.66 $968.00 $774.40 $629.20 $192.12 $968.00 $561.44 $968.00 $968.00 $968.00 $201.73 $968.00 N/A N/A 80483728 EAP HCPCS C1757 CATHETER THRMB 24FR TRIEVER24 BOTH IP/OP "$30,000.00" "$22,200.00" "$2,060.15" "$30,000.00" "$16,290.00" "$16,290.00" "$16,290.00" "$16,290.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$4,181.12" "$4,181.12" "$23,124.00" "$2,060.15" "$6,252.33" "$30,000.00" "$30,000.00" "$3,094.73" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$19,500.00" "$5,954.25" "$30,000.00" "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 80483729 EAP HCPCS C1757 CATHETER ASP 16FR 113CM TRIEVE BOTH IP/OP "$30,000.00" "$22,200.00" "$2,060.15" "$30,000.00" "$16,290.00" "$16,290.00" "$16,290.00" "$16,290.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$4,181.12" "$4,181.12" "$23,124.00" "$2,060.15" "$6,252.33" "$30,000.00" "$30,000.00" "$3,094.73" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$19,500.00" "$5,954.25" "$30,000.00" "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 80484687 EAP HCPCS C1769 GUIDEWIRE VASC 3MM RDS J CRV . BOTH IP/OP $26.00 $19.50 $5.16 $26.00 $14.12 $14.12 $14.12 $14.12 $26.00 $26.00 $26.00 $5.42 $26.00 $19.30 $19.30 $20.04 $13.55 $5.42 $26.00 $26.00 $15.38 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $16.90 $5.16 $26.00 $15.08 $26.00 $26.00 $26.00 $5.42 $26.00 N/A N/A 80484901 EAP HCPCS C1894 INTRODUCER SHTH .021IN 29CM 7F BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80485079 EAP HCPCS C1894 INTRODUCER SHTH 9FR .035IN 45C BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $407.25 $407.25 $407.25 $407.25 $750.00 $750.00 $750.00 $156.32 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $148.86 $750.00 $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 80485932 EAP HCPCS C1769 GUIDEWIRE VASC 300CM ASAHI MRC BOTH IP/OP $238.00 $176.50 $47.24 $238.00 $129.23 $129.23 $129.23 $129.23 $238.00 $238.00 $238.00 $49.61 $238.00 $176.64 $176.64 $183.45 $124.00 $49.60 $238.00 $238.00 $140.78 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $154.70 $47.24 $238.00 $138.04 $238.00 $238.00 $238.00 $49.60 $238.00 N/A N/A 80486783 EAP HCPCS C1887 CATHETER INFUSION ASAHI SASUKE L145 CM OD3.3 FR STERILE BOTH IP/OP "$1,088.00" $805.50 $215.94 "$1,088.00" $590.78 $590.78 $590.78 $590.78 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" $807.51 $807.51 $838.63 $566.85 $226.75 "$1,088.00" "$1,088.00" $643.55 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $707.20 $215.94 "$1,088.00" $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 80488018 EAP Custom 80488018 COIL EMBL HLX 10MM 30CM CONCER BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $351.45 $781.00 $781.00 $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A 80488019 EAP Custom 80488019 COIL EMBL HLX 2MM 4CM CONCERTO BOTH IP/OP "$1,563.00" "$1,157.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $325.75 "$1,563.00" $625.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,172.25" "$1,563.00" "$1,563.00" "$1,563.00" $781.50 $781.50 "$1,237.90" "$1,563.00" "$1,250.40" $703.35 "$1,563.00" "$1,563.00" $906.54 "$1,563.00" $937.80 "$1,563.00" "$1,563.00" "$1,563.00" N/A N/A 80488020 EAP Custom 80488020 COIL EMBL HLX 2MM 6CM CONCERTO LATTICEFX DTCH POS LD BOTH IP/OP "$1,563.00" "$1,157.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $325.75 "$1,563.00" $625.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,172.25" "$1,563.00" "$1,563.00" "$1,563.00" $781.50 $781.50 "$1,237.90" "$1,563.00" "$1,250.40" $703.35 "$1,563.00" "$1,563.00" $906.54 "$1,563.00" $937.80 "$1,563.00" "$1,563.00" "$1,563.00" N/A N/A 80488021 EAP Custom 80488021 COIL EMBL HLX 3MM 4CM CONCERTO LATTICEFX DTCH POS LD BOTH IP/OP $521.00 $386.00 $92.74 $521.00 $521.00 $521.00 $521.00 $521.00 $521.00 $521.00 $92.74 $521.00 $521.00 $521.00 $521.00 $521.00 $521.00 $108.58 $521.00 $208.40 $521.00 $521.00 $521.00 $521.00 $521.00 $390.75 $521.00 $521.00 $521.00 $260.50 $260.50 $412.63 $521.00 $416.80 $234.45 $521.00 $521.00 $302.18 $521.00 $312.60 $521.00 $521.00 $521.00 N/A N/A 80488022 EAP COIL EMBL HLX 4MM 10CM CONCERTO LATTICEFX DTCH POS LD BOTH IP/OP $521.00 $386.00 $92.74 $521.00 $521.00 $521.00 $521.00 $521.00 $521.00 $521.00 $92.74 $521.00 $521.00 $521.00 $521.00 $521.00 $521.00 $108.58 $521.00 $208.40 $521.00 $521.00 $521.00 $521.00 $521.00 $390.75 $521.00 $521.00 $521.00 $260.50 $260.50 $412.63 $521.00 $416.80 $234.45 $521.00 $521.00 $302.18 $521.00 $312.60 $521.00 $521.00 $521.00 N/A N/A 80488023 EAP COIL EMBL HLX 4MM 8CM CONCERTO LATTICEFX DTCH POS LD BOTH IP/OP $521.00 $386.00 $92.74 $521.00 $521.00 $521.00 $521.00 $521.00 $521.00 $521.00 $92.74 $521.00 $521.00 $521.00 $521.00 $521.00 $521.00 $108.58 $521.00 $208.40 $521.00 $521.00 $521.00 $521.00 $521.00 $390.75 $521.00 $521.00 $521.00 $260.50 $260.50 $412.63 $521.00 $416.80 $234.45 $521.00 $521.00 $302.18 $521.00 $312.60 $521.00 $521.00 $521.00 N/A N/A 80488024 EAP Custom 80488024 COIL EMBL HLX 5MM 15CM CONCERTO LATTICEFX DTCH POS LD BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $351.45 $781.00 $781.00 $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A 80488025 EAP Custom 80488025 COIL EMBL HLX 5MM 20CM CONCERT BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $351.45 $781.00 $781.00 $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A 80488026 EAP Custom 80488026 COIL EMBL HLX 6MM 20CM CONCERTO LATTICEFX DTCH POS LD BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $351.45 $781.00 $781.00 $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A 80488027 EAP Custom 80488027 COIL EMBL HLX 7MM 30CM CONCERTO LATTICEFX DTCH POS LD BOTH IP/OP $521.00 $386.00 $92.74 $521.00 $521.00 $521.00 $521.00 $521.00 $521.00 $521.00 $92.74 $521.00 $521.00 $521.00 $521.00 $521.00 $521.00 $108.58 $521.00 $208.40 $521.00 $521.00 $521.00 $521.00 $521.00 $390.75 $521.00 $521.00 $521.00 $260.50 $260.50 $412.63 $521.00 $416.80 $234.45 $521.00 $521.00 $302.18 $521.00 $312.60 $521.00 $521.00 $521.00 N/A N/A 80488028 EAP Custom 80488028 COIL EMBL HLX 8MM 30CM CONCERT BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $351.45 $781.00 $781.00 $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A 80488029 EAP Custom 80488029 COIL EMBL HLX 9MM 30CM CONCERT BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $351.45 $781.00 $781.00 $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A 80488030 EAP Custom 80488030 COIL EMBL 3D 10MM 30CM CONCERT BOTH IP/OP "$1,563.00" "$1,157.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $325.75 "$1,563.00" $625.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,172.25" "$1,563.00" "$1,563.00" "$1,563.00" $781.50 $781.50 "$1,237.90" "$1,563.00" "$1,250.40" $703.35 "$1,563.00" "$1,563.00" $906.54 "$1,563.00" $937.80 "$1,563.00" "$1,563.00" "$1,563.00" N/A N/A 80488031 EAP Custom 80488031 COIL EMBL HLX 12MM 30CM CONCER BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $351.45 $781.00 $781.00 $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A 80488032 EAP Custom 80488032 COIL EMBL 3D 12MM 40CM CONCERT BOTH IP/OP "$1,563.00" "$1,157.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $325.75 "$1,563.00" $625.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,172.25" "$1,563.00" "$1,563.00" "$1,563.00" $781.50 $781.50 "$1,237.90" "$1,563.00" "$1,250.40" $703.35 "$1,563.00" "$1,563.00" $906.54 "$1,563.00" $937.80 "$1,563.00" "$1,563.00" "$1,563.00" N/A N/A 80488033 EAP Custom 80488033 COIL EMBL HLX 14MM 30CM CONCER BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $351.45 $781.00 $781.00 $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A 80488034 EAP Custom 80488034 COIL EMBL 3D 14MM 40CM CONCERT BOTH IP/OP "$1,563.00" "$1,157.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $325.75 "$1,563.00" $625.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,172.25" "$1,563.00" "$1,563.00" "$1,563.00" $781.50 $781.50 "$1,237.90" "$1,563.00" "$1,250.40" $703.35 "$1,563.00" "$1,563.00" $906.54 "$1,563.00" $937.80 "$1,563.00" "$1,563.00" "$1,563.00" N/A N/A 80488035 EAP Custom 80488035 COIL EMBL 3D 16MM 40CM CONCERT BOTH IP/OP "$1,563.00" "$1,157.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $325.75 "$1,563.00" $625.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,172.25" "$1,563.00" "$1,563.00" "$1,563.00" $781.50 $781.50 "$1,237.90" "$1,563.00" "$1,250.40" $703.35 "$1,563.00" "$1,563.00" $906.54 "$1,563.00" $937.80 "$1,563.00" "$1,563.00" "$1,563.00" N/A N/A 80488036 EAP Custom 80488036 COIL EMBL HLX 16MM 40CM CONCER BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $351.45 $781.00 $781.00 $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A 80488037 EAP Custom 80488037 COIL EMBL 3D 18MM 40CM CONCERT BOTH IP/OP "$1,563.00" "$1,157.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $325.75 "$1,563.00" $625.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,172.25" "$1,563.00" "$1,563.00" "$1,563.00" $781.50 $781.50 "$1,237.90" "$1,563.00" "$1,250.40" $703.35 "$1,563.00" "$1,563.00" $906.54 "$1,563.00" $937.80 "$1,563.00" "$1,563.00" "$1,563.00" N/A N/A 80488038 EAP Custom 80488038 COIL EMBL HLX 18MM 40CM CONCER BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $351.45 $781.00 $781.00 $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A 80488039 EAP Custom 80488039 COIL EMBL 3D 2MM 2CM CONCERTO BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $351.45 $781.00 $781.00 $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A 80488040 EAP Custom 80488040 COIL EMBL 3D 2MM 4CM CONCERTO BOTH IP/OP "$1,563.00" "$1,157.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $325.75 "$1,563.00" $625.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,172.25" "$1,563.00" "$1,563.00" "$1,563.00" $781.50 $781.50 "$1,237.90" "$1,563.00" "$1,250.40" $703.35 "$1,563.00" "$1,563.00" $906.54 "$1,563.00" $937.80 "$1,563.00" "$1,563.00" "$1,563.00" N/A N/A 80488041 EAP Custom 80488041 COIL EMBL HLX 20MM 50CM CONCER BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $351.45 $781.00 $781.00 $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A 80488042 EAP COIL EMBL 3D 3MM 4CM CONCERTO BOTH IP/OP "$1,562.00" "$1,156.00" $278.04 "$1,562.00" "$1,562.00" "$1,562.00" "$1,562.00" "$1,562.00" "$1,562.00" "$1,562.00" $278.04 "$1,562.00" "$1,562.00" "$1,562.00" "$1,562.00" "$1,562.00" "$1,562.00" $325.54 "$1,562.00" $624.80 "$1,562.00" "$1,562.00" "$1,562.00" "$1,562.00" "$1,562.00" "$1,171.50" "$1,562.00" "$1,562.00" "$1,562.00" $781.00 $781.00 "$1,237.10" "$1,562.00" "$1,249.60" $702.90 "$1,562.00" "$1,562.00" $905.96 "$1,562.00" $937.20 "$1,562.00" "$1,562.00" "$1,562.00" N/A N/A 80488043 EAP COIL EMBL 3D 4MM 10CM CONCERTO BOTH IP/OP "$1,563.00" "$1,157.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $325.75 "$1,563.00" $625.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,172.25" "$1,563.00" "$1,563.00" "$1,563.00" $781.50 $781.50 "$1,237.90" "$1,563.00" "$1,250.40" $703.35 "$1,563.00" "$1,563.00" $906.54 "$1,563.00" $937.80 "$1,563.00" "$1,563.00" "$1,563.00" N/A N/A 80488044 EAP Custom 80488044 COIL EMBL 3D 6MM 20CM CONCERTO BOTH IP/OP "$1,563.00" "$1,157.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $325.75 "$1,563.00" $625.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,172.25" "$1,563.00" "$1,563.00" "$1,563.00" $781.50 $781.50 "$1,237.90" "$1,563.00" "$1,250.40" $703.35 "$1,563.00" "$1,563.00" $906.54 "$1,563.00" $937.80 "$1,563.00" "$1,563.00" "$1,563.00" N/A N/A 80488045 EAP Custom 80488045 COIL EMBL 3D 7MM 30CM CONCERTO BOTH IP/OP "$1,563.00" "$1,157.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $325.75 "$1,563.00" $625.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,172.25" "$1,563.00" "$1,563.00" "$1,563.00" $781.50 $781.50 "$1,237.90" "$1,563.00" "$1,250.40" $703.35 "$1,563.00" "$1,563.00" $906.54 "$1,563.00" $937.80 "$1,563.00" "$1,563.00" "$1,563.00" N/A N/A 80488046 EAP Custom 80488046 COIL EMBL 3D 8MM 30CM CONCERTO BOTH IP/OP "$1,563.00" "$1,157.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $325.75 "$1,563.00" $625.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,172.25" "$1,563.00" "$1,563.00" "$1,563.00" $781.50 $781.50 "$1,237.90" "$1,563.00" "$1,250.40" $703.35 "$1,563.00" "$1,563.00" $906.54 "$1,563.00" $937.80 "$1,563.00" "$1,563.00" "$1,563.00" N/A N/A 80488047 EAP Custom 80488047 COIL EMBL 3D 9MM 30CM CONCERTO BOTH IP/OP "$1,563.00" "$1,157.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $278.21 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" $325.75 "$1,563.00" $625.20 "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,563.00" "$1,172.25" "$1,563.00" "$1,563.00" "$1,563.00" $781.50 $781.50 "$1,237.90" "$1,563.00" "$1,250.40" $703.35 "$1,563.00" "$1,563.00" $906.54 "$1,563.00" $937.80 "$1,563.00" "$1,563.00" "$1,563.00" N/A N/A 80488443 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 215CM STRL LF SYNCHRO2 HDRPH DISP BOTH IP/OP "$1,484.00" "$1,098.50" $294.54 "$1,484.00" $805.81 $805.81 $805.81 $805.81 "$1,484.00" "$1,484.00" "$1,484.00" $309.30 "$1,484.00" "$1,101.42" "$1,101.42" "$1,143.87" $773.16 $309.28 "$1,484.00" "$1,484.00" $877.79 "$1,484.00" "$1,484.00" "$1,484.00" "$1,484.00" "$1,113.00" "$1,484.00" "$1,484.00" "$1,484.00" $742.00 $742.00 "$1,175.33" "$1,484.00" "$1,187.20" $964.60 $294.54 "$1,484.00" $860.72 "$1,484.00" "$1,484.00" "$1,484.00" $309.27 "$1,484.00" N/A N/A 80488444 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 215CM STRL LF SYNCHRO2 PSHP HDRPH DISP BOTH IP/OP "$1,484.00" "$1,098.50" $294.54 "$1,484.00" $805.81 $805.81 $805.81 $805.81 "$1,484.00" "$1,484.00" "$1,484.00" $309.30 "$1,484.00" "$1,101.42" "$1,101.42" "$1,143.87" $773.16 $309.28 "$1,484.00" "$1,484.00" $877.79 "$1,484.00" "$1,484.00" "$1,484.00" "$1,484.00" "$1,113.00" "$1,484.00" "$1,484.00" "$1,484.00" $742.00 $742.00 "$1,175.33" "$1,484.00" "$1,187.20" $964.60 $294.54 "$1,484.00" $860.72 "$1,484.00" "$1,484.00" "$1,484.00" $309.27 "$1,484.00" N/A N/A 80488445 EAP HCPCS C1769 GUIDEWIRE VASC .014IN 300CM ST BOTH IP/OP "$1,841.00" "$1,362.50" $365.39 "$1,841.00" $999.66 $999.66 $999.66 $999.66 "$1,841.00" "$1,841.00" "$1,841.00" $383.71 "$1,841.00" "$1,366.39" "$1,366.39" "$1,419.04" $959.16 $383.68 "$1,841.00" "$1,841.00" "$1,088.95" "$1,841.00" "$1,841.00" "$1,841.00" "$1,841.00" "$1,380.75" "$1,841.00" "$1,841.00" "$1,841.00" $920.50 $920.50 "$1,458.07" "$1,841.00" "$1,472.80" "$1,196.65" $365.39 "$1,841.00" "$1,067.78" "$1,841.00" "$1,841.00" "$1,841.00" $383.66 "$1,841.00" N/A N/A 80488825 EAP NEEDLE BX 16FR 50.5CM TRNJUG I BOTH IP/OP $954.00 $706.00 $169.81 $954.00 $954.00 $954.00 $954.00 $954.00 $954.00 $954.00 $169.81 $954.00 $954.00 $708.06 $708.06 $735.34 $497.03 $198.82 $954.00 $381.60 $954.00 $954.00 $954.00 $954.00 $954.00 $715.50 $954.00 $954.00 $954.00 $477.00 $477.00 $755.57 $954.00 $763.20 $620.10 $954.00 $954.00 $553.32 $954.00 $572.40 $954.00 $954.00 $954.00 N/A N/A 80488968 EAP HCPCS C1721 PACEMAKER CRD STRL CBLT DR 2 CHMBR DF4 INLN CNCT RADOPQ BOTH IP/OP "$33,750.00" "$24,975.00" "$7,033.87" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$7,033.87" "$33,750.00" "$13,500.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$25,312.50" "$33,750.00" "$33,750.00" "$33,750.00" "$16,875.00" "$16,875.00" "$26,730.00" "$33,750.00" "$27,000.00" "$15,187.50" "$33,750.00" "$33,750.00" "$19,575.00" "$33,750.00" "$20,250.00" "$33,750.00" "$33,750.00" "$33,750.00" N/A N/A 80488974 EAP HCPCS C1882 COBALT HF QUAD CRT-D MRI SURESCAN BOTH IP/OP "$44,750.00" "$33,115.00" "$7,712.84" "$44,750.00" "$20,137.50" "$20,137.50" "$20,137.50" "$20,137.50" "$44,750.00" "$44,750.00" "$44,750.00" "$9,327.02" "$44,750.00" "$44,750.00" "$44,750.00" "$44,750.00" "$44,750.00" "$9,326.39" "$44,750.00" "$44,750.00" "$22,061.75" "$44,750.00" "$44,750.00" "$44,750.00" "$44,750.00" "$33,562.50" "$44,750.00" "$44,750.00" "$44,750.00" "$22,375.00" "$22,375.00" "$35,442.00" "$44,750.00" "$35,800.00" "$20,137.50" "$7,712.84" "$44,750.00" "$25,955.00" "$44,750.00" "$44,750.00" "$44,750.00" "$8,098.48" "$44,750.00" N/A N/A 80488978 EAP HCPCS C1722 COBALT VR MRI SURESCAN SINGLE-CHAMBER ICD SYSTEM W/SURESCAN DR-ICD DEVICE & SURESCAN DEFIBRILLATION LEAD BOTH IP/OP "$28,250.00" "$20,905.00" "$5,606.92" "$28,250.00" "$12,712.50" "$12,712.50" "$12,712.50" "$12,712.50" "$28,250.00" "$28,250.00" "$28,250.00" "$5,888.01" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$5,887.61" "$28,250.00" "$28,250.00" "$13,927.25" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$21,187.50" "$28,250.00" "$28,250.00" "$28,250.00" "$14,125.00" "$14,125.00" "$22,374.00" "$28,250.00" "$22,600.00" "$12,712.50" "$5,606.92" "$28,250.00" "$16,385.00" "$28,250.00" "$28,250.00" "$28,250.00" "$5,887.30" "$28,250.00" N/A N/A 80492559 EAP OVERTUBE ESCP 13.2MM 11MM 1320MM LF 1 BLN ENTRSCP SPLNT TUBE BOTH IP/OP $640.00 $474.00 $113.92 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $113.92 $640.00 $640.00 $475.01 $475.01 $493.31 $333.44 $133.38 $640.00 $256.00 $640.00 $640.00 $640.00 $640.00 $640.00 $480.00 $640.00 $640.00 $640.00 $320.00 $320.00 $506.88 $640.00 $512.00 $416.00 $640.00 $640.00 $371.20 $640.00 $384.00 $640.00 $640.00 $640.00 N/A N/A 80494565 EAP HCPCS C1876 STENT VASC 10MM SPC 3-1 4MM 31 BOTH IP/OP "$10,563.00" "$7,817.00" "$2,096.49" "$10,563.00" "$4,753.35" "$4,753.35" "$4,753.35" "$4,753.35" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.59" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.45" "$10,563.00" "$10,563.00" "$5,207.56" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$7,922.25" "$10,563.00" "$10,563.00" "$10,563.00" "$5,281.50" "$5,281.50" "$8,365.90" "$10,563.00" "$8,450.40" "$4,753.35" "$2,096.49" "$10,563.00" "$6,126.54" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.33" "$10,563.00" N/A N/A 80494566 EAP HCPCS C1876 STENT VASC 10MM SPC 3-1 4MM 50MM 40MM SOLITAIRE PARAMETRIC BOTH IP/OP "$10,563.00" "$7,817.00" "$2,096.49" "$10,563.00" "$4,753.35" "$4,753.35" "$4,753.35" "$4,753.35" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.59" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.45" "$10,563.00" "$10,563.00" "$5,207.56" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$7,922.25" "$10,563.00" "$10,563.00" "$10,563.00" "$5,281.50" "$5,281.50" "$8,365.90" "$10,563.00" "$8,450.40" "$4,753.35" "$2,096.49" "$10,563.00" "$6,126.54" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.33" "$10,563.00" N/A N/A 80494569 EAP HCPCS C1757 DEVICE THRMB 200CM 6MM .021-.0 BOTH IP/OP "$10,638.00" "$7,872.50" "$2,060.15" "$10,638.00" "$5,776.43" "$5,776.43" "$5,776.43" "$5,776.43" "$10,638.00" "$10,638.00" "$10,638.00" "$2,217.23" "$10,638.00" "$4,181.12" "$4,181.12" "$8,199.77" "$2,060.15" "$2,217.08" "$10,638.00" "$10,638.00" "$3,094.73" "$10,638.00" "$10,638.00" "$10,638.00" "$10,638.00" "$7,978.50" "$10,638.00" "$10,638.00" "$10,638.00" "$5,319.00" "$5,319.00" "$8,425.30" "$10,638.00" "$8,510.40" "$6,914.70" "$2,111.38" "$10,638.00" "$6,170.04" "$10,638.00" "$10,638.00" "$10,638.00" "$2,216.96" "$10,638.00" N/A N/A 80494576 EAP HCPCS C1751 CATH ENDOVAS BASHIR STER LF SI BOTH IP/OP "$6,988.00" "$5,171.50" "$1,386.94" "$6,988.00" "$3,794.48" "$3,794.48" "$3,794.48" "$3,794.48" "$6,988.00" "$6,988.00" "$6,988.00" "$1,456.47" "$6,988.00" "$4,181.12" "$4,181.12" "$5,386.35" "$2,060.15" "$1,456.38" "$6,988.00" "$6,988.00" "$3,094.73" "$6,988.00" "$6,988.00" "$6,988.00" "$6,988.00" "$5,241.00" "$6,988.00" "$6,988.00" "$6,988.00" "$3,494.00" "$3,494.00" "$5,534.50" "$6,988.00" "$5,590.40" "$4,542.20" "$1,386.94" "$6,988.00" "$4,053.04" "$6,988.00" "$6,988.00" "$6,988.00" "$1,456.30" "$6,988.00" N/A N/A 80496386 EAP HCPCS C1713 BLADE IM HLCL 10.35MM 70MM AU NS TFN-ADV CNN TI NIOBIUM BOTH IP/OP "$1,533.60" "$1,135.00" $304.38 "$1,533.60" $832.74 $832.74 $832.74 $832.74 "$1,533.60" "$1,533.60" "$1,533.60" $319.64 "$1,533.60" "$1,138.24" "$1,138.24" "$1,182.10" $799.01 $319.62 "$1,533.60" "$1,533.60" $907.12 "$1,533.60" "$1,533.60" "$1,533.60" "$1,533.60" "$1,150.20" "$1,533.60" "$1,533.60" "$1,533.60" $766.80 $766.80 "$1,214.61" "$1,533.60" "$1,226.88" $996.84 $304.38 "$1,533.60" $889.49 "$1,533.60" $920.16 "$1,533.60" $319.60 "$1,533.60" N/A N/A 80500867 EAP HCPCS C1724 CATHETER ATHRCM STRL LF ROTAPRO PRECNCT EXCHGL BUR CATH ADV BOTH IP/OP "$5,988.00" "$4,431.50" "$1,247.97" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,181.12" "$4,181.12" "$4,615.55" "$2,060.15" "$1,247.97" "$5,988.00" "$2,395.20" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,491.00" "$5,988.00" "$5,988.00" "$5,988.00" "$2,994.00" "$2,994.00" "$4,742.50" "$5,988.00" "$4,790.40" "$3,892.20" "$5,988.00" "$5,988.00" "$3,473.04" "$5,988.00" "$3,592.80" "$5,988.00" "$5,988.00" "$5,988.00" N/A N/A 80500868 EAP HCPCS C1724 SYSTEM ATHRCM STRL LF ROTAPRO PRECNCT EXCHGL BUR CATH ADV BOTH IP/OP "$5,988.00" "$4,431.50" "$1,247.97" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,181.12" "$4,181.12" "$4,615.55" "$2,060.15" "$1,247.97" "$5,988.00" "$2,395.20" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,491.00" "$5,988.00" "$5,988.00" "$5,988.00" "$2,994.00" "$2,994.00" "$4,742.50" "$5,988.00" "$4,790.40" "$3,892.20" "$5,988.00" "$5,988.00" "$3,473.04" "$5,988.00" "$3,592.80" "$5,988.00" "$5,988.00" "$5,988.00" N/A N/A 80500869 EAP HCPCS C1724 CATHETER ATHRCM STRL LF ROTAPRO PRECNCT EXCHGL BUR CATH ADV BOTH IP/OP "$5,988.00" "$4,431.50" "$1,247.97" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,181.12" "$4,181.12" "$4,615.55" "$2,060.15" "$1,247.97" "$5,988.00" "$2,395.20" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,491.00" "$5,988.00" "$5,988.00" "$5,988.00" "$2,994.00" "$2,994.00" "$4,742.50" "$5,988.00" "$4,790.40" "$3,892.20" "$5,988.00" "$5,988.00" "$3,473.04" "$5,988.00" "$3,592.80" "$5,988.00" "$5,988.00" "$5,988.00" N/A N/A 80500870 EAP HCPCS C1724 CATHETER ATHRCM STRL LF ROTAPRO PRECNCT EXCHGL BUR CATH ADV BOTH IP/OP "$5,988.00" "$4,431.50" "$1,247.97" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,181.12" "$4,181.12" "$4,615.55" "$2,060.15" "$1,247.97" "$5,988.00" "$2,395.20" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,491.00" "$5,988.00" "$5,988.00" "$5,988.00" "$2,994.00" "$2,994.00" "$4,742.50" "$5,988.00" "$4,790.40" "$3,892.20" "$5,988.00" "$5,988.00" "$3,473.04" "$5,988.00" "$3,592.80" "$5,988.00" "$5,988.00" "$5,988.00" N/A N/A 80501124 EAP HCPCS C1757 TREVO NXT PROVUE RETRIEVER 3X32 MICROCATHETER BOTH IP/OP "$13,116.00" "$9,706.00" "$2,060.15" "$13,116.00" "$7,121.99" "$7,121.99" "$7,121.99" "$7,121.99" "$13,116.00" "$13,116.00" "$13,116.00" "$2,733.70" "$13,116.00" "$4,181.12" "$4,181.12" "$10,109.81" "$2,060.15" "$2,733.52" "$13,116.00" "$13,116.00" "$3,094.73" "$13,116.00" "$13,116.00" "$13,116.00" "$13,116.00" "$9,837.00" "$13,116.00" "$13,116.00" "$13,116.00" "$6,558.00" "$6,558.00" "$10,387.87" "$13,116.00" "$10,492.80" "$8,525.40" "$2,603.20" "$13,116.00" "$7,607.28" "$13,116.00" "$13,116.00" "$13,116.00" "$2,733.37" "$13,116.00" N/A N/A 80501125 EAP HCPCS C1757 RETRIEVER TREVO NXT PROVUE  4X41 MICROCATHETER BOTH IP/OP "$12,500.00" "$9,250.00" "$2,060.15" "$12,500.00" "$6,787.50" "$6,787.50" "$6,787.50" "$6,787.50" "$12,500.00" "$12,500.00" "$12,500.00" "$2,605.31" "$12,500.00" "$4,181.12" "$4,181.12" "$9,635.00" "$2,060.15" "$2,605.14" "$12,500.00" "$12,500.00" "$3,094.73" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$9,375.00" "$12,500.00" "$12,500.00" "$12,500.00" "$6,250.00" "$6,250.00" "$9,900.00" "$12,500.00" "$10,000.00" "$8,125.00" "$2,480.94" "$12,500.00" "$7,250.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,605.00" "$12,500.00" N/A N/A 80501126 EAP HCPCS C1887 MICROCATHETER TREVO TRACK 21 BOTH IP/OP "$1,748.00" "$1,294.00" $346.93 "$1,748.00" $949.16 $949.16 $949.16 $949.16 "$1,748.00" "$1,748.00" "$1,748.00" $364.33 "$1,748.00" "$1,297.37" "$1,297.37" "$1,347.36" $910.71 $364.30 "$1,748.00" "$1,748.00" "$1,033.94" "$1,748.00" "$1,748.00" "$1,748.00" "$1,748.00" "$1,311.00" "$1,748.00" "$1,748.00" "$1,748.00" $874.00 $874.00 "$1,384.42" "$1,748.00" "$1,398.40" "$1,136.20" $346.93 "$1,748.00" "$1,013.84" "$1,748.00" "$1,748.00" "$1,748.00" $364.28 "$1,748.00" N/A N/A 80501239 EAP HCPCS B4088 BUTTON GSTRM 20FR 3CM 5ML STRL BOTH IP/OP $256.00 $189.50 $23.24 $256.00 $256.00 $256.00 $256.00 $256.00 $256.00 $256.00 $23.24 $256.00 $256.00 $190.00 $190.00 $197.32 $133.38 $53.35 $256.00 $102.40 $256.00 $256.00 $256.00 $256.00 $256.00 $192.00 $256.00 $256.00 $256.00 $128.00 $128.00 $202.75 $256.00 $204.80 $166.40 $256.00 $256.00 $148.48 $256.00 $153.60 $256.00 $256.00 $256.00 N/A N/A 80501376 EAP HCPCS B4088 KIT JJNSTM 22FR 45CM 7-10ML ST BOTH IP/OP $854.00 $632.00 $23.24 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $23.24 $854.00 $854.00 $633.84 $633.84 $658.26 $444.93 $177.98 $854.00 $341.60 $854.00 $854.00 $854.00 $854.00 $854.00 $640.50 $854.00 $854.00 $854.00 $427.00 $427.00 $676.37 $854.00 $683.20 $555.10 $854.00 $854.00 $495.32 $854.00 $512.40 $854.00 $854.00 $854.00 N/A N/A 80501378 EAP HCPCS B4088 KIT JJNSTM 22FR 45CM 7-10ML ST BOTH IP/OP $854.00 $632.00 $23.24 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $23.24 $854.00 $854.00 $633.84 $633.84 $658.26 $444.93 $177.98 $854.00 $341.60 $854.00 $854.00 $854.00 $854.00 $854.00 $640.50 $854.00 $854.00 $854.00 $427.00 $427.00 $676.37 $854.00 $683.20 $555.10 $854.00 $854.00 $495.32 $854.00 $512.40 $854.00 $854.00 $854.00 N/A N/A 80501379 EAP HCPCS B4088 KIT JJNSTM 22FR 45CM 7-10ML ST BOTH IP/OP $854.00 $632.00 $23.24 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $854.00 $23.24 $854.00 $854.00 $633.84 $633.84 $658.26 $444.93 $177.98 $854.00 $341.60 $854.00 $854.00 $854.00 $854.00 $854.00 $640.50 $854.00 $854.00 $854.00 $427.00 $427.00 $676.37 $854.00 $683.20 $555.10 $854.00 $854.00 $495.32 $854.00 $512.40 $854.00 $854.00 $854.00 N/A N/A 80501692 EAP HCPCS B4088 BUTTON GSTRM 18FR 5CM 5ML STRL BOTH IP/OP $256.00 $189.50 $23.24 $256.00 $256.00 $256.00 $256.00 $256.00 $256.00 $256.00 $23.24 $256.00 $256.00 $190.00 $190.00 $197.32 $133.38 $53.35 $256.00 $102.40 $256.00 $256.00 $256.00 $256.00 $256.00 $192.00 $256.00 $256.00 $256.00 $128.00 $128.00 $202.75 $256.00 $204.80 $166.40 $256.00 $256.00 $148.48 $256.00 $153.60 $256.00 $256.00 $256.00 N/A N/A 80501790 EAP HCPCS C1722 DFBR CRD CBLT VR DF4 MR CONDITIONAL BOTH IP/OP "$28,250.00" "$20,905.00" "$5,606.92" "$28,250.00" "$12,712.50" "$12,712.50" "$12,712.50" "$12,712.50" "$28,250.00" "$28,250.00" "$28,250.00" "$5,888.01" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$5,887.61" "$28,250.00" "$28,250.00" "$13,927.25" "$28,250.00" "$28,250.00" "$28,250.00" "$28,250.00" "$21,187.50" "$28,250.00" "$28,250.00" "$28,250.00" "$14,125.00" "$14,125.00" "$22,374.00" "$28,250.00" "$22,600.00" "$12,712.50" "$5,606.92" "$28,250.00" "$16,385.00" "$28,250.00" "$28,250.00" "$28,250.00" "$5,887.30" "$28,250.00" N/A N/A 80501791 EAP HCPCS C1882 DFBR CRD CROME DF1 MR CONDITIONAL BOTH IP/OP "$43,250.00" "$32,005.00" "$7,712.84" "$43,250.00" "$19,462.50" "$19,462.50" "$19,462.50" "$19,462.50" "$43,250.00" "$43,250.00" "$43,250.00" "$9,014.38" "$43,250.00" "$43,250.00" "$43,250.00" "$43,250.00" "$43,250.00" "$9,013.78" "$43,250.00" "$43,250.00" "$21,322.25" "$43,250.00" "$43,250.00" "$43,250.00" "$43,250.00" "$32,437.50" "$43,250.00" "$43,250.00" "$43,250.00" "$21,625.00" "$21,625.00" "$34,254.00" "$43,250.00" "$34,600.00" "$19,462.50" "$7,712.84" "$43,250.00" "$25,085.00" "$43,250.00" "$43,250.00" "$43,250.00" "$8,098.48" "$43,250.00" N/A N/A 80501813 EAP HCPCS C2621 DEFIBRILLATOR CRD EDORA 8 QDPL HF-T BOTH IP/OP "$18,500.00" "$13,690.00" "$3,671.79" "$18,500.00" "$8,325.00" "$8,325.00" "$8,325.00" "$8,325.00" "$18,500.00" "$18,500.00" "$18,500.00" "$3,855.86" "$18,500.00" "$18,500.00" "$18,500.00" "$18,500.00" "$18,500.00" "$3,855.60" "$18,500.00" "$18,500.00" "$9,120.50" "$18,500.00" "$18,500.00" "$18,500.00" "$18,500.00" "$13,875.00" "$18,500.00" "$18,500.00" "$18,500.00" "$9,250.00" "$9,250.00" "$14,652.00" "$18,500.00" "$14,800.00" "$8,325.00" "$3,671.79" "$18,500.00" "$10,730.00" "$18,500.00" "$18,500.00" "$18,500.00" "$3,855.40" "$18,500.00" N/A N/A 80501816 EAP HCPCS C1900 LEAD ICD SENTUS PROMRI OTW QDPL LT VNTRC L 85/49 BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" "$6,750.00" "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A 80501822 EAP HCPCS C1882 DEFIBRILLATOR CRD ACTICOR 7 HF-T QP BOTH IP/OP "$49,500.00" "$36,630.00" "$7,712.84" "$49,500.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$49,500.00" "$49,500.00" "$49,500.00" "$9,417.94" "$49,500.00" "$49,500.00" "$49,500.00" "$49,500.00" "$49,500.00" "$10,316.34" "$49,500.00" "$49,500.00" "$24,403.50" "$49,500.00" "$49,500.00" "$49,500.00" "$49,500.00" "$37,125.00" "$49,500.00" "$49,500.00" "$49,500.00" "$24,750.00" "$24,750.00" "$39,204.00" "$49,500.00" "$39,600.00" "$22,275.00" "$7,712.84" "$49,500.00" "$28,710.00" "$49,500.00" "$49,500.00" "$49,500.00" "$8,098.48" "$49,500.00" N/A N/A 80501824 EAP HCPCS C1722 DEFIBRILLATOR CRD ACTICOR 7 VR-T DX BOTH IP/OP "$43,500.00" "$32,190.00" "$7,712.84" "$43,500.00" "$19,575.00" "$19,575.00" "$19,575.00" "$19,575.00" "$43,500.00" "$43,500.00" "$43,500.00" "$9,066.49" "$43,500.00" "$43,500.00" "$43,500.00" "$43,500.00" "$43,500.00" "$9,065.88" "$43,500.00" "$43,500.00" "$21,445.50" "$43,500.00" "$43,500.00" "$43,500.00" "$43,500.00" "$32,625.00" "$43,500.00" "$43,500.00" "$43,500.00" "$21,750.00" "$21,750.00" "$34,452.00" "$43,500.00" "$34,800.00" "$19,575.00" "$7,712.84" "$43,500.00" "$25,230.00" "$43,500.00" "$43,500.00" "$43,500.00" "$8,098.48" "$43,500.00" N/A N/A 80501825 EAP HCPCS C1721 DEFIBRILLATOR CARDIAC ILIVIA NEO 7 DR T CONN BOTH IP/OP "$43,750.00" "$32,375.00" "$9,117.98" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$9,117.98" "$43,750.00" "$17,500.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$32,812.50" "$43,750.00" "$43,750.00" "$43,750.00" "$21,875.00" "$21,875.00" "$34,650.00" "$43,750.00" "$35,000.00" "$19,687.50" "$43,750.00" "$43,750.00" "$25,375.00" "$43,750.00" "$26,250.00" "$43,750.00" "$43,750.00" "$43,750.00" N/A N/A 80501837 EAP HCPCS C1895 LEAD DFBR 65CM STRL LF 15CM PLEXA PROMRI DF4 CRD DISP S DX BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" "$10,000.00" "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 80501838 EAP HCPCS C1895 LEAD DFBR 65CM STRL LF 17CM PLEXA PROMRI DF4 CRD DISP S DX BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" "$10,000.00" "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 80501858 EAP FILTER BCTR/VIR LG 22X15MM 92ML STRVNT CMPCT BOTH IP/OP $276.00 $204.50 $49.13 $276.00 $276.00 $276.00 $276.00 $276.00 $276.00 $276.00 $49.13 $276.00 $276.00 $204.85 $204.85 $212.74 $143.80 $57.52 $276.00 $110.40 $276.00 $276.00 $276.00 $276.00 $276.00 $207.00 $276.00 $276.00 $276.00 $138.00 $138.00 $218.59 $276.00 $220.80 $179.40 $276.00 $276.00 $160.08 $276.00 $165.60 $276.00 $276.00 $276.00 N/A N/A 80501887 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 2.5MM PK PAPYRUS THK90UM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" "$7,500.00" "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 80501888 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 3MM PK PAPYRUS THK90UM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" "$7,500.00" "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 80501889 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 3.5MM PK PAPYRUS THK90UM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" "$7,500.00" "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 80501890 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 4MM PK PAPYRUS THK90UM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" "$7,500.00" "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 80501891 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 4.5MM PK PAPYRUS THK90UM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" "$7,500.00" "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 80501892 EAP HCPCS C1874 SYSTEM CORON STENT 15MM 5MM PK PAPYRUS THK90UM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" "$7,500.00" "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 80502188 EAP HCPCS C1721 DEFIBRILLATOR CRD THK12MM 51X69MM 31CC GALLANT IMPL 2 CHMBR BOTH IP/OP "$18,750.00" "$13,875.00" "$3,907.71" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$3,907.71" "$18,750.00" "$7,500.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$14,062.50" "$18,750.00" "$18,750.00" "$18,750.00" "$9,375.00" "$9,375.00" "$14,850.00" "$18,750.00" "$15,000.00" "$8,437.50" "$18,750.00" "$18,750.00" "$10,875.00" "$18,750.00" "$11,250.00" "$18,750.00" "$18,750.00" "$18,750.00" N/A N/A 80502190 EAP HCPCS C1882 DEFIBRILLATOR CRD THK12MM 51X74MM 34CC GALLANT HF DF4 IS-4 BOTH IP/OP "$24,250.00" "$17,945.00" "$4,813.02" "$24,250.00" "$10,912.50" "$10,912.50" "$10,912.50" "$10,912.50" "$24,250.00" "$24,250.00" "$24,250.00" "$5,054.31" "$24,250.00" "$24,250.00" "$24,250.00" "$24,250.00" "$24,250.00" "$5,053.97" "$24,250.00" "$24,250.00" "$11,955.25" "$24,250.00" "$24,250.00" "$24,250.00" "$24,250.00" "$18,187.50" "$24,250.00" "$24,250.00" "$24,250.00" "$12,125.00" "$12,125.00" "$19,206.00" "$24,250.00" "$19,400.00" "$10,912.50" "$4,813.02" "$24,250.00" "$14,065.00" "$24,250.00" "$24,250.00" "$24,250.00" "$5,053.70" "$24,250.00" N/A N/A 80502192 EAP HCPCS C1722 DEFIBRILLATOR CRD THK12MM 51X63MM 30CC GALLANT 1 CHMBR DF4 BOTH IP/OP "$18,750.00" "$13,875.00" "$3,721.41" "$18,750.00" "$8,437.50" "$8,437.50" "$8,437.50" "$8,437.50" "$18,750.00" "$18,750.00" "$18,750.00" "$3,907.97" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$3,907.71" "$18,750.00" "$18,750.00" "$9,243.75" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$14,062.50" "$18,750.00" "$18,750.00" "$18,750.00" "$9,375.00" "$9,375.00" "$14,850.00" "$18,750.00" "$15,000.00" "$8,437.50" "$3,721.41" "$18,750.00" "$10,875.00" "$18,750.00" "$18,750.00" "$18,750.00" "$3,907.50" "$18,750.00" N/A N/A 80502268 EAP HCPCS C1900 LEAD PCNG 47MM SPC TRD S 4.7FR 86CM NS LF QRTT 4 ELTRD IS-4 BOTH IP/OP "$3,400.00" "$2,516.00" $674.82 "$3,400.00" "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" "$3,400.00" "$3,400.00" "$3,400.00" $708.65 "$3,400.00" "$3,400.00" "$3,400.00" "$3,400.00" "$3,400.00" $708.60 "$3,400.00" "$3,400.00" "$1,676.20" "$3,400.00" "$3,400.00" "$3,400.00" "$3,400.00" "$2,550.00" "$3,400.00" "$3,400.00" "$3,400.00" "$1,700.00" "$1,700.00" "$2,692.80" "$3,400.00" "$2,720.00" "$1,530.00" $674.82 "$3,400.00" "$1,972.00" "$3,400.00" "$3,400.00" "$3,400.00" $708.56 "$3,400.00" N/A N/A 80502278 EAP HCPCS C1786 GENERATOR PACEMAKER ASSURITY MRI THK6 MM W50 MM X H47 MM BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$4,000.00" "$1,972.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" $793.90 "$4,000.00" "$2,320.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.60 "$4,000.00" N/A N/A 80502307 EAP PARTICLES EMBL 2.5MM 1ML GRN EMBOCUBE SYR GELTN 50MG .024IN BOTH IP/OP $138.00 $102.50 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $62.10 $138.00 $138.00 $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 80502308 EAP PARTICLES EMBL 5MM 3ML RD EMBOCUBE SYR GELTN 50MG .04IN MCTH BOTH IP/OP $325.00 $240.50 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $325.00 $325.00 $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A 80502316 EAP HCPCS C1751 MICROCATHETER INFS .021IN 160CM STRL LF PHENOM DISP BOTH IP/OP "$2,988.00" "$2,211.50" $593.04 "$2,988.00" "$1,622.48" "$1,622.48" "$1,622.48" "$1,622.48" "$2,988.00" "$2,988.00" "$2,988.00" $622.77 "$2,988.00" "$2,217.69" "$2,217.69" "$2,303.15" "$1,556.75" $622.73 "$2,988.00" "$2,988.00" "$1,767.40" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,942.20" $593.04 "$2,988.00" "$1,733.04" "$2,988.00" "$2,988.00" "$2,988.00" $622.70 "$2,988.00" N/A N/A 80502317 EAP HCPCS C1751 CATHETER INFS MIC STRG .021IN 150CM PHENOM BOTH IP/OP "$2,988.00" "$2,211.50" $593.04 "$2,988.00" "$1,622.48" "$1,622.48" "$1,622.48" "$1,622.48" "$2,988.00" "$2,988.00" "$2,988.00" $622.77 "$2,988.00" "$2,217.69" "$2,217.69" "$2,303.15" "$1,556.75" $622.73 "$2,988.00" "$2,988.00" "$1,767.40" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,942.20" $593.04 "$2,988.00" "$1,733.04" "$2,988.00" "$2,988.00" "$2,988.00" $622.70 "$2,988.00" N/A N/A 80502318 EAP HCPCS C1729 CATHETER SCT 71 125CM LG BORE BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,665.25" "$3,665.25" "$3,665.25" "$3,665.25" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$4,181.12" "$4,181.12" "$5,202.90" "$2,060.15" "$1,406.77" "$6,750.00" "$6,750.00" "$3,094.73" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$4,387.50" "$1,339.71" "$6,750.00" "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A 80502319 EAP HCPCS C1729 CATHETER SCT 71 132CM LG BORE BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,665.25" "$3,665.25" "$3,665.25" "$3,665.25" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$4,181.12" "$4,181.12" "$5,202.90" "$2,060.15" "$1,406.77" "$6,750.00" "$6,750.00" "$3,094.73" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$4,387.50" "$1,339.71" "$6,750.00" "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A 80502333 EAP HCPCS C1887 MICROCATHETER CRBRVASC 6FR .108IN .088IN 95CM STRL LF 90CM BOTH IP/OP "$2,988.00" "$2,211.50" $593.04 "$2,988.00" "$1,622.48" "$1,622.48" "$1,622.48" "$1,622.48" "$2,988.00" "$2,988.00" "$2,988.00" $622.77 "$2,988.00" "$2,217.69" "$2,217.69" "$2,303.15" "$1,556.75" $622.73 "$2,988.00" "$2,988.00" "$1,767.40" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,942.20" $593.04 "$2,988.00" "$1,733.04" "$2,988.00" "$2,988.00" "$2,988.00" $622.70 "$2,988.00" N/A N/A 80502334 EAP HCPCS C1887 MICROCATHETER CRBRVASC 6FR .108IN .088IN 105CM STRL LF 90CM BOTH IP/OP "$2,988.00" "$2,211.50" $593.04 "$2,988.00" "$1,622.48" "$1,622.48" "$1,622.48" "$1,622.48" "$2,988.00" "$2,988.00" "$2,988.00" $622.77 "$2,988.00" "$2,217.69" "$2,217.69" "$2,303.15" "$1,556.75" $622.73 "$2,988.00" "$2,988.00" "$1,767.40" "$2,988.00" "$2,988.00" "$2,988.00" "$2,988.00" "$2,241.00" "$2,988.00" "$2,988.00" "$2,988.00" "$1,494.00" "$1,494.00" "$2,366.50" "$2,988.00" "$2,390.40" "$1,942.20" $593.04 "$2,988.00" "$1,733.04" "$2,988.00" "$2,988.00" "$2,988.00" $622.70 "$2,988.00" N/A N/A 80502335 EAP HCPCS C1757 CATHETER THRMB 6FR .108IN .088IN 100CM STRL LF ZOOM LG DIST BOTH IP/OP "$7,488.00" "$5,541.50" "$1,486.18" "$7,488.00" "$4,065.98" "$4,065.98" "$4,065.98" "$4,065.98" "$7,488.00" "$7,488.00" "$7,488.00" "$1,560.69" "$7,488.00" "$4,181.12" "$4,181.12" "$5,771.75" "$2,060.15" "$1,560.58" "$7,488.00" "$7,488.00" "$3,094.73" "$7,488.00" "$7,488.00" "$7,488.00" "$7,488.00" "$5,616.00" "$7,488.00" "$7,488.00" "$7,488.00" "$3,744.00" "$3,744.00" "$5,930.50" "$7,488.00" "$5,990.40" "$4,867.20" "$1,486.18" "$7,488.00" "$4,343.04" "$7,488.00" "$7,488.00" "$7,488.00" "$1,560.50" "$7,488.00" N/A N/A 80502336 EAP HCPCS C1757 CATHETER THRMB 6FR .108IN .088IN 110CM STRL LF ZOOM LG DIST BOTH IP/OP "$7,488.00" "$5,541.50" "$1,486.18" "$7,488.00" "$4,065.98" "$4,065.98" "$4,065.98" "$4,065.98" "$7,488.00" "$7,488.00" "$7,488.00" "$1,560.69" "$7,488.00" "$4,181.12" "$4,181.12" "$5,771.75" "$2,060.15" "$1,560.58" "$7,488.00" "$7,488.00" "$3,094.73" "$7,488.00" "$7,488.00" "$7,488.00" "$7,488.00" "$5,616.00" "$7,488.00" "$7,488.00" "$7,488.00" "$3,744.00" "$3,744.00" "$5,930.50" "$7,488.00" "$5,990.40" "$4,867.20" "$1,486.18" "$7,488.00" "$4,343.04" "$7,488.00" "$7,488.00" "$7,488.00" "$1,560.50" "$7,488.00" N/A N/A 80502337 EAP HCPCS C1757 CATHETER THRMB .083IN 137CM STRL LF ZOOM REPERFUSION BOTH IP/OP "$6,213.00" "$4,598.00" "$1,233.13" "$6,213.00" "$3,373.66" "$3,373.66" "$3,373.66" "$3,373.66" "$6,213.00" "$6,213.00" "$6,213.00" "$1,294.94" "$6,213.00" "$4,181.12" "$4,181.12" "$4,788.98" "$2,060.15" "$1,294.86" "$6,213.00" "$6,213.00" "$3,094.73" "$6,213.00" "$6,213.00" "$6,213.00" "$6,213.00" "$4,659.75" "$6,213.00" "$6,213.00" "$6,213.00" "$3,106.50" "$3,106.50" "$4,920.70" "$6,213.00" "$4,970.40" "$4,038.45" "$1,233.13" "$6,213.00" "$3,603.54" "$6,213.00" "$6,213.00" "$6,213.00" "$1,294.79" "$6,213.00" N/A N/A 80502338 EAP HCPCS C1757 CATHETER THRMB .055IN 137CM STRL LF ZOOM REPERFUSION BOTH IP/OP "$6,213.00" "$4,598.00" "$1,233.13" "$6,213.00" "$3,373.66" "$3,373.66" "$3,373.66" "$3,373.66" "$6,213.00" "$6,213.00" "$6,213.00" "$1,294.94" "$6,213.00" "$4,181.12" "$4,181.12" "$4,788.98" "$2,060.15" "$1,294.86" "$6,213.00" "$6,213.00" "$3,094.73" "$6,213.00" "$6,213.00" "$6,213.00" "$6,213.00" "$4,659.75" "$6,213.00" "$6,213.00" "$6,213.00" "$3,106.50" "$3,106.50" "$4,920.70" "$6,213.00" "$4,970.40" "$4,038.45" "$1,233.13" "$6,213.00" "$3,603.54" "$6,213.00" "$6,213.00" "$6,213.00" "$1,294.79" "$6,213.00" N/A N/A 80502339 EAP HCPCS C1757 CATHETER THRMB .045IN 144CM STRL LF ZOOM REPERFUSION BOTH IP/OP "$6,213.00" "$4,598.00" "$1,233.13" "$6,213.00" "$3,373.66" "$3,373.66" "$3,373.66" "$3,373.66" "$6,213.00" "$6,213.00" "$6,213.00" "$1,294.94" "$6,213.00" "$4,181.12" "$4,181.12" "$4,788.98" "$2,060.15" "$1,294.86" "$6,213.00" "$6,213.00" "$3,094.73" "$6,213.00" "$6,213.00" "$6,213.00" "$6,213.00" "$4,659.75" "$6,213.00" "$6,213.00" "$6,213.00" "$3,106.50" "$3,106.50" "$4,920.70" "$6,213.00" "$4,970.40" "$4,038.45" "$1,233.13" "$6,213.00" "$3,603.54" "$6,213.00" "$6,213.00" "$6,213.00" "$1,294.79" "$6,213.00" N/A N/A 80502340 EAP HCPCS C1757 CATHETER THRMB .051IN .035IN 158CM STRL LF ZOOM REPERFUSION BOTH IP/OP "$4,213.00" "$3,118.00" $836.18 "$4,213.00" "$2,287.66" "$2,287.66" "$2,287.66" "$2,287.66" "$4,213.00" "$4,213.00" "$4,213.00" $878.09 "$4,213.00" "$3,126.89" "$3,126.89" "$3,247.38" "$2,060.15" $878.04 "$4,213.00" "$4,213.00" "$2,491.99" "$4,213.00" "$4,213.00" "$4,213.00" "$4,213.00" "$3,159.75" "$4,213.00" "$4,213.00" "$4,213.00" "$2,106.50" "$2,106.50" "$3,336.70" "$4,213.00" "$3,370.40" "$2,738.45" $836.18 "$4,213.00" "$2,443.54" "$4,213.00" "$4,213.00" "$4,213.00" $877.99 "$4,213.00" N/A N/A 80502347 EAP MAC ARROWGUARDBLUE CATHETER KIT BOTH IP/OP $402.00 $297.50 $71.56 $402.00 $402.00 $402.00 $402.00 $402.00 $402.00 $402.00 $71.56 $402.00 $402.00 $298.36 $298.36 $309.86 $209.44 $83.78 $402.00 $160.80 $402.00 $402.00 $402.00 $402.00 $402.00 $301.50 $402.00 $402.00 $402.00 $201.00 $201.00 $318.38 $402.00 $321.60 $261.30 $402.00 $402.00 $233.16 $402.00 $241.20 $402.00 $402.00 $402.00 N/A N/A 80502430 EAP EMBOTRAP III REVASCULARIZATION 5X22 194CM BOTH IP/OP "$9,500.00" "$7,030.00" "$1,691.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,691.00" "$9,500.00" "$9,500.00" "$4,181.12" "$4,181.12" "$7,322.60" "$2,060.15" "$1,979.90" "$9,500.00" "$3,800.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$7,125.00" "$9,500.00" "$9,500.00" "$9,500.00" "$4,750.00" "$4,750.00" "$7,524.00" "$9,500.00" "$7,600.00" "$6,175.00" "$9,500.00" "$9,500.00" "$5,510.00" "$9,500.00" "$5,700.00" "$9,500.00" "$9,500.00" "$9,500.00" N/A N/A 80502431 EAP EMBOTRAP III REVASCULARIZATION 5X37 195CM BOTH IP/OP "$9,500.00" "$7,030.00" "$1,691.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,691.00" "$9,500.00" "$9,500.00" "$4,181.12" "$4,181.12" "$7,322.60" "$2,060.15" "$1,979.90" "$9,500.00" "$3,800.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$7,125.00" "$9,500.00" "$9,500.00" "$9,500.00" "$4,750.00" "$4,750.00" "$7,524.00" "$9,500.00" "$7,600.00" "$6,175.00" "$9,500.00" "$9,500.00" "$5,510.00" "$9,500.00" "$5,700.00" "$9,500.00" "$9,500.00" "$9,500.00" N/A N/A 80502434 EAP HCPCS C1894 "CEREBASE LONG GUIDE SHEATH 0.090"" X 8F X 90CM" BOTH IP/OP "$1,125.00" $832.50 $223.28 "$1,125.00" $610.88 $610.88 $610.88 $610.88 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 $223.28 "$1,125.00" $652.50 "$1,125.00" "$1,125.00" "$1,125.00" $234.45 "$1,125.00" N/A N/A 80502435 EAP HCPCS C1894 "CEREBASE LONG GUIDE SHEATH 0.090"" X 8F X 95CM" BOTH IP/OP "$1,125.00" $832.50 $223.28 "$1,125.00" $610.88 $610.88 $610.88 $610.88 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 $223.28 "$1,125.00" $652.50 "$1,125.00" "$1,125.00" "$1,125.00" $234.45 "$1,125.00" N/A N/A 80502436 EAP HCPCS C1894 "CEREBASE LONG GUIDE SHEATH 0.090"" X 8F X 80CM" BOTH IP/OP "$1,125.00" $832.50 $223.28 "$1,125.00" $610.88 $610.88 $610.88 $610.88 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 $223.28 "$1,125.00" $652.50 "$1,125.00" "$1,125.00" "$1,125.00" $234.45 "$1,125.00" N/A N/A 80502439 EAP HCPCS C1894 INTRODUCER CATH XL 20FR 40CM STRL 56CM CKFL DIL RADOPQ DISP BOTH IP/OP $981.00 $726.00 $194.70 $981.00 $532.68 $532.68 $532.68 $532.68 $981.00 $981.00 $981.00 $204.46 $981.00 $728.10 $728.10 $756.15 $511.10 $204.45 $981.00 $981.00 $580.26 $981.00 $981.00 $981.00 $981.00 $735.75 $981.00 $981.00 $981.00 $490.50 $490.50 $776.95 $981.00 $784.80 $637.65 $194.70 $981.00 $568.98 $981.00 $981.00 $981.00 $204.44 $981.00 N/A N/A 80502440 EAP HCPCS C1817 PLUG CV 155CM 7MM 12.5MM STRL LF 125CM AMPLZR TY IV DLV SYS BOTH IP/OP "$2,375.00" "$1,757.50" $494.98 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" $950.00 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" "$2,375.00" "$2,375.00" "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" "$2,375.00" "$2,375.00" N/A N/A 80502477 EAP HCPCS C1751 CATHETER PA STD 8FR 110CM STRL LTX SG CCOMBO VIP SVO2 TD CO BOTH IP/OP $670.00 $496.00 $132.98 $670.00 $363.81 $363.81 $363.81 $363.81 $670.00 $670.00 $670.00 $139.64 $670.00 $497.27 $497.27 $516.44 $349.07 $139.64 $670.00 $670.00 $396.31 $670.00 $670.00 $670.00 $670.00 $502.50 $670.00 $670.00 $670.00 $335.00 $335.00 $530.64 $670.00 $536.00 $435.50 $132.98 $670.00 $388.60 $670.00 $670.00 $670.00 $139.63 $670.00 N/A N/A 80502486 EAP HCPCS C1769 GUIDEWIRE VASC 80CM .014IN INTMD TIP RADIOPQ KINK BOTH IP/OP $608.00 $450.00 $120.67 $608.00 $330.14 $330.14 $330.14 $330.14 $608.00 $608.00 $608.00 $126.72 $608.00 $451.26 $451.26 $468.65 $316.77 $126.71 $608.00 $608.00 $359.63 $608.00 $608.00 $608.00 $608.00 $456.00 $608.00 $608.00 $608.00 $304.00 $304.00 $481.54 $608.00 $486.40 $395.20 $120.67 $608.00 $352.64 $608.00 $608.00 $608.00 $126.71 $608.00 N/A N/A 80502523 EAP SET NDL 15GA 15MM STRL LF EZIO WRST BAND SHRP BLCK XTN DISP BOTH IP/OP $342.00 $253.50 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 $342.00 $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 80502524 EAP SET NDL 15GA 44MM STRL LF EZ-CNCT NDL VISE WRSBND SHRP BOTH IP/OP $342.00 $253.50 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 $342.00 $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 80502638 EAP Custom 80502638 BUTTON GSTRM 20FR 3.5CM 5ML ST BOTH IP/OP $256.00 $189.50 $45.57 $256.00 $256.00 $256.00 $256.00 $256.00 $256.00 $256.00 $45.57 $256.00 $256.00 $190.00 $190.00 $197.32 $133.38 $53.35 $256.00 $102.40 $256.00 $256.00 $256.00 $256.00 $256.00 $192.00 $256.00 $256.00 $256.00 $128.00 $128.00 $202.75 $256.00 $204.80 $166.40 $256.00 $256.00 $148.48 $256.00 $153.60 $256.00 $256.00 $256.00 N/A N/A 80502639 EAP HCPCS B4087 KIT PG 20FR PUL EVV ENFIT BOTH IP/OP $227.00 $168.00 $20.89 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $20.89 $227.00 $227.00 $168.48 $168.48 $174.97 $118.27 $47.31 $227.00 $90.80 $227.00 $227.00 $227.00 $227.00 $227.00 $170.25 $227.00 $227.00 $227.00 $113.50 $113.50 $179.78 $227.00 $181.60 $147.55 $227.00 $227.00 $131.66 $227.00 $136.20 $227.00 $227.00 $227.00 N/A N/A 80502640 EAP HCPCS B4087 KIT PG 20FR PUSH EVV ENFIT BOTH IP/OP $227.00 $168.00 $20.89 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $20.89 $227.00 $227.00 $168.48 $168.48 $174.97 $118.27 $47.31 $227.00 $90.80 $227.00 $227.00 $227.00 $227.00 $227.00 $170.25 $227.00 $227.00 $227.00 $113.50 $113.50 $179.78 $227.00 $181.60 $147.55 $227.00 $227.00 $131.66 $227.00 $136.20 $227.00 $227.00 $227.00 N/A N/A 80502641 EAP HCPCS B4087 KIT PG 24FR PUL EVV ENFIT BOTH IP/OP $227.00 $168.00 $20.89 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $20.89 $227.00 $227.00 $168.48 $168.48 $174.97 $118.27 $47.31 $227.00 $90.80 $227.00 $227.00 $227.00 $227.00 $227.00 $170.25 $227.00 $227.00 $227.00 $113.50 $113.50 $179.78 $227.00 $181.60 $147.55 $227.00 $227.00 $131.66 $227.00 $136.20 $227.00 $227.00 $227.00 N/A N/A 80502642 EAP HCPCS B4087 KIT PG 20FR PUL EVV ENFIT STD BOTH IP/OP $155.00 $115.00 $20.89 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $20.89 $155.00 $155.00 $115.04 $115.04 $119.47 $80.76 $32.30 $155.00 $62.00 $155.00 $155.00 $155.00 $155.00 $155.00 $116.25 $155.00 $155.00 $155.00 $77.50 $77.50 $122.76 $155.00 $124.00 $100.75 $155.00 $155.00 $89.90 $155.00 $93.00 $155.00 $155.00 $155.00 N/A N/A 80502643 EAP HCPCS B4087 KIT PG 20FR PUSH EVV ENFIT STD BOTH IP/OP $155.00 $115.00 $20.89 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $20.89 $155.00 $155.00 $115.04 $115.04 $119.47 $80.76 $32.30 $155.00 $62.00 $155.00 $155.00 $155.00 $155.00 $155.00 $116.25 $155.00 $155.00 $155.00 $77.50 $77.50 $122.76 $155.00 $124.00 $100.75 $155.00 $155.00 $89.90 $155.00 $93.00 $155.00 $155.00 $155.00 N/A N/A 80502644 EAP HCPCS B4087 BUTTON 1.7CM 24FR LP REPL GSTRM EVV ENFIT BOTH IP/OP $310.00 $229.50 $20.89 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $20.89 $310.00 $310.00 $230.08 $230.08 $238.95 $161.51 $64.61 $310.00 $124.00 $310.00 $310.00 $310.00 $310.00 $310.00 $232.50 $310.00 $310.00 $310.00 $155.00 $155.00 $245.52 $310.00 $248.00 $201.50 $310.00 $310.00 $179.80 $310.00 $186.00 $310.00 $310.00 $310.00 N/A N/A 80502645 EAP HCPCS B4087 BUTTON 2.4CM 24FR LP REPL GSTRM EVV ENFIT BOTH IP/OP $310.00 $229.50 $20.89 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $20.89 $310.00 $310.00 $230.08 $230.08 $238.95 $161.51 $64.61 $310.00 $124.00 $310.00 $310.00 $310.00 $310.00 $310.00 $232.50 $310.00 $310.00 $310.00 $155.00 $155.00 $245.52 $310.00 $248.00 $201.50 $310.00 $310.00 $179.80 $310.00 $186.00 $310.00 $310.00 $310.00 N/A N/A 80502646 EAP HCPCS B4087 BUTTON 3.4CM 24FR LP REPL GSTRM EVV ENFIT BOTH IP/OP $310.00 $229.50 $20.89 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $20.89 $310.00 $310.00 $230.08 $230.08 $238.95 $161.51 $64.61 $310.00 $124.00 $310.00 $310.00 $310.00 $310.00 $310.00 $232.50 $310.00 $310.00 $310.00 $155.00 $155.00 $245.52 $310.00 $248.00 $201.50 $310.00 $310.00 $179.80 $310.00 $186.00 $310.00 $310.00 $310.00 N/A N/A 80502647 EAP HCPCS B4087 BUTTON 4.4CM 24FR LP REPL GSTRM EVV ENFIT BOTH IP/OP $310.00 $229.50 $20.89 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $20.89 $310.00 $310.00 $230.08 $230.08 $238.95 $161.51 $64.61 $310.00 $124.00 $310.00 $310.00 $310.00 $310.00 $310.00 $232.50 $310.00 $310.00 $310.00 $155.00 $155.00 $245.52 $310.00 $248.00 $201.50 $310.00 $310.00 $179.80 $310.00 $186.00 $310.00 $310.00 $310.00 N/A N/A 80502648 EAP HCPCS B4087 KIT PG 24FR SIL LP ANRFLX V RTRVL SNR PUL EVV BOTH IP/OP $455.00 $337.00 $20.89 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $20.89 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 80502649 EAP HCPCS B4087 KIT PG 24FR SIL LP ANRFLX V RTRVL SNR PUL EVV BOTH IP/OP $455.00 $337.00 $20.89 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $20.89 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 80502650 EAP HCPCS B4087 KIT PG 24FR SIL LP ANRFLX V RTRVL SNR PUL EVV BOTH IP/OP $455.00 $337.00 $20.89 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $20.89 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 80502651 EAP HCPCS B4087 KIT PG 24FR SIL LP ANRFLX V RTRVL SNR PUL EVV BOTH IP/OP $455.00 $337.00 $20.89 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $20.89 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 80502652 EAP HCPCS B4087 KIT PG 24FR SIL LP ANRFLX V RTRVL SNR PUSH EVV BOTH IP/OP $455.00 $337.00 $20.89 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $20.89 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 80502653 EAP HCPCS B4087 KIT PG 24FR SIL LP ANRFLX V RTRVL SNR PUSH EVV BOTH IP/OP $455.00 $337.00 $20.89 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $20.89 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 80502654 EAP HCPCS B4087 KIT PG 24FR SIL LP ANRFLX V RTRVL SNR PUSH EVV BOTH IP/OP $455.00 $337.00 $20.89 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $20.89 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 80502655 EAP HCPCS B4087 KIT PG 18FR SIL LP ANRFLX V RTRVL SNR PUL EVV BOTH IP/OP $455.00 $337.00 $20.89 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $20.89 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 80502656 EAP HCPCS B4087 KIT PG 18FR SIL LP ANRFLX V RTRVL SNR PUL EVV BOTH IP/OP $455.00 $337.00 $20.89 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $20.89 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 80502657 EAP HCPCS B4087 KIT PG 18FR SIL LP ANRFLX V RTRVL SNR PUL EVV BOTH IP/OP $455.00 $337.00 $20.89 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $20.89 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 80502658 EAP HCPCS B4087 KIT PG 18FR SIL LP ANRFLX V RTRVL SNR PUL EVV BOTH IP/OP $455.00 $337.00 $20.89 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $20.89 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 80502659 EAP HCPCS B4087 KIT PG 18FR SIL LP ANRFLX V RTRVL SNR PUSH EVV BOTH IP/OP $455.00 $337.00 $20.89 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $20.89 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 80502660 EAP HCPCS B4087 KIT PG 18FR SIL LP ANRFLX V RTRVL SNR PUSH EVV BOTH IP/OP $455.00 $337.00 $20.89 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $20.89 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 80502661 EAP HCPCS B4087 KIT PG 20FR SIL CLMP FENESTRATE DRP PUSH EVV STD BOTH IP/OP $148.00 $110.00 $20.89 $148.00 $148.00 $148.00 $148.00 $148.00 $148.00 $148.00 $20.89 $148.00 $148.00 $109.85 $109.85 $114.08 $77.11 $30.84 $148.00 $59.20 $148.00 $148.00 $148.00 $148.00 $148.00 $111.00 $148.00 $148.00 $148.00 $74.00 $74.00 $117.22 $148.00 $118.40 $96.20 $148.00 $148.00 $85.84 $148.00 $88.80 $148.00 $148.00 $148.00 N/A N/A 80502664 EAP HCPCS C1764 MONITOR CRD LUX-DX INS STRL LATEX FREE DISP BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" "$11,250.00" "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 80502665 EAP HCPCS C1876 STENT ENDOPRSTH VNS 20MM 10MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502666 EAP HCPCS C1876 STENT ENDOPRSTH VNS 42MM 10MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502667 EAP HCPCS C1876 STENT ENDOPRSTH VNS 68MM 10MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502668 EAP HCPCS C1876 STENT ENDOPRSTH VNS 94MM 10MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502669 EAP HCPCS C1876 STENT ENDOPRSTH VNS 20MM 12MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502670 EAP HCPCS C1876 STENT ENDOPRSTH VNS 40MM 12MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502671 EAP HCPCS C1876 STENT ENDOPRSTH VNS 40MM 12MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502672 EAP HCPCS C1876 STENT ENDOPRSTH VNS 60MM 12MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502673 EAP HCPCS C1876 STENT ENDOPRSTH VNS 60MM 12MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502674 EAP HCPCS C1876 STENT ENDOPRSTH VNS 90MM 12MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502675 EAP HCPCS C1876 STENT ENDOPRSTH VNS 90MM 12MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502676 EAP HCPCS C1876 STENT ENDOPRSTH VNS 20MM 14MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502677 EAP HCPCS C1876 STENT ENDOPRSTH VNS 40MM 14MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502678 EAP HCPCS C1876 STENT ENDOPRSTH VNS 60MM 14MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502679 EAP HCPCS C1876 STENT ENDOPRSTH VNS 90MM 14MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502680 EAP HCPCS C1876 STENT ENDOPRSTH VNS 20MM 16MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502681 EAP HCPCS C1876 STENT ENDOPRSTH VNS 40MM 16MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502682 EAP HCPCS C1876 STENT ENDOPRSTH VNS 60MM 16MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502683 EAP HCPCS C1876 STENT ENDOPRSTH VNS 90MM 16MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502684 EAP HCPCS C1876 STENT ENDOPRSTH VNS 40MM 18MM ELGILOY WLSTNT BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502685 EAP HCPCS C1876 STENT ENDOPRSTH VNS 60MM 18MM WLSTNT CATH 75CM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502686 EAP HCPCS C1876 STENT ENDOPRSTH VNS 40MM 20MM WLSTNT CATH 75CM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502687 EAP HCPCS C1876 STENT ENDOPRSTH VNS 55MM 20MM WLSTNT CATH 75CM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502688 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 3.5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502689 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 4MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502690 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 4.5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502691 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502692 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3.5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502693 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 4MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502694 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 4.5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502695 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502696 EAP HCPCS C1874 SYSTEM CORON STENT 16MM 3.5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502697 EAP HCPCS C1874 SYSTEM CORON STENT 16MM 4MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502698 EAP HCPCS C1874 SYSTEM CORON STENT 16MM 4.5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502699 EAP HCPCS C1874 SYSTEM CORON STENT 16MM 5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502700 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 3.5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502701 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 4MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502702 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 4.5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502703 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502704 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 3.5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502705 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 4MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502706 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 4.5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502707 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502708 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3.5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502709 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 4MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502710 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 4.5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502711 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502712 EAP HCPCS C1874 SYSTEM CORON STENT 32MM 3.5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502713 EAP HCPCS C1874 SYSTEM CORON STENT 32MM 4MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502714 EAP HCPCS C1874 SYSTEM CORON STENT 32MM 4.5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502715 EAP HCPCS C1874 SYSTEM CORON STENT 32MM 5MM SNG MEGATRON LV PROX BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80502736 EAP HCPCS C1730 CATHETER EP 100CM 5FR XPLR ST 5MM SPC CRNND CURVE BOTH IP/OP $988.00 $731.50 $196.09 $988.00 $536.48 $536.48 $536.48 $536.48 $988.00 $988.00 $988.00 $205.92 $988.00 $733.29 $733.29 $761.55 $514.75 $205.91 $988.00 $988.00 $584.40 $988.00 $988.00 $988.00 $988.00 $741.00 $988.00 $988.00 $988.00 $494.00 $494.00 $782.50 $988.00 $790.40 $642.20 $196.09 $988.00 $573.04 $988.00 $988.00 $988.00 $205.90 $988.00 N/A N/A 80502750 EAP HCPCS B4087 KIT PG 18FR SIL LP ANRFLX V RTRVL SNR PUL EVV BOTH IP/OP $455.00 $337.00 $20.89 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $455.00 $20.89 $455.00 $455.00 $337.70 $337.70 $350.71 $237.06 $94.83 $455.00 $182.00 $455.00 $455.00 $455.00 $455.00 $455.00 $341.25 $455.00 $455.00 $455.00 $227.50 $227.50 $360.36 $455.00 $364.00 $295.75 $455.00 $455.00 $263.90 $455.00 $273.00 $455.00 $455.00 $455.00 N/A N/A 80502751 EAP HCPCS B4087 TUBE 14FR 3 PORT REPL STR BLSTR GSTRM EVV ENFIT BOTH IP/OP $71.00 $53.00 $14.80 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $20.89 $71.00 $71.00 $52.70 $52.70 $54.73 $36.99 $14.80 $71.00 $28.40 $71.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $46.15 $71.00 $71.00 $41.18 $71.00 $42.60 $71.00 $71.00 $71.00 N/A N/A 80502752 EAP HCPCS B4087 TUBE 16FR REPL STR ANG BLSTR GSTRM EVV ENFIT BOTH IP/OP $71.00 $53.00 $14.80 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $20.89 $71.00 $71.00 $52.70 $52.70 $54.73 $36.99 $14.80 $71.00 $28.40 $71.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $46.15 $71.00 $71.00 $41.18 $71.00 $42.60 $71.00 $71.00 $71.00 N/A N/A 80502753 EAP HCPCS B4087 TUBE 18FR REPL STR ANG BLSTR GSTRM EVV ENFIT BOTH IP/OP $71.00 $53.00 $14.80 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $20.89 $71.00 $71.00 $52.70 $52.70 $54.73 $36.99 $14.80 $71.00 $28.40 $71.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $46.15 $71.00 $71.00 $41.18 $71.00 $42.60 $71.00 $71.00 $71.00 N/A N/A 80502754 EAP HCPCS B4087 TUBE 20FR REPL STR ANG BLSTR GSTRM EVV ENFIT BOTH IP/OP $71.00 $53.00 $14.80 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $20.89 $71.00 $71.00 $52.70 $52.70 $54.73 $36.99 $14.80 $71.00 $28.40 $71.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $46.15 $71.00 $71.00 $41.18 $71.00 $42.60 $71.00 $71.00 $71.00 N/A N/A 80502755 EAP HCPCS B4087 TUBE 22FR REPL STR ANG BLSTR GSTRM EVV ENFIT BOTH IP/OP $71.00 $53.00 $14.80 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $20.89 $71.00 $71.00 $52.70 $52.70 $54.73 $36.99 $14.80 $71.00 $28.40 $71.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $46.15 $71.00 $71.00 $41.18 $71.00 $42.60 $71.00 $71.00 $71.00 N/A N/A 80502756 EAP HCPCS B4087 TUBE 24FR REPL STR ANG BLSTR GSTRM EVV ENFIT BOTH IP/OP $71.00 $53.00 $14.80 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $71.00 $20.89 $71.00 $71.00 $52.70 $52.70 $54.73 $36.99 $14.80 $71.00 $28.40 $71.00 $71.00 $71.00 $71.00 $71.00 $53.25 $71.00 $71.00 $71.00 $35.50 $35.50 $56.23 $71.00 $56.80 $46.15 $71.00 $71.00 $41.18 $71.00 $42.60 $71.00 $71.00 $71.00 N/A N/A 80502757 EAP Custom 80502757 FORCEPS ENDSCP 130CM 1.2MM COREDX MINI STRL DISP BOTH IP/OP "$1,310.00" $969.50 $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $233.18 "$1,310.00" "$1,310.00" $972.28 $972.28 "$1,009.75" $682.51 $273.02 "$1,310.00" $524.00 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $851.50 "$1,310.00" "$1,310.00" $759.80 "$1,310.00" $786.00 "$1,310.00" "$1,310.00" "$1,310.00" N/A N/A 80502758 EAP Custom 80502758 KIT SYR 1 PK GEL PREFL PREDYE ORISE 10ML BOTH IP/OP $238.00 $176.50 $42.36 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $42.36 $238.00 $238.00 $176.64 $176.64 $183.45 $124.00 $49.60 $238.00 $95.20 $238.00 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $154.70 $238.00 $238.00 $138.04 $238.00 $142.80 $238.00 $238.00 $238.00 N/A N/A 80502759 EAP Custom 80502759 KIT SYR 1 PK GEL PREFL PREDYE ORISE INTJCT 10ML 23 BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 $300.00 $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 80502760 EAP Custom 80502760 DEVICE HMST RSL 360 235CM 11MM 2.8MM CHNL BOTH IP/OP "$17,900.00" "$13,246.00" "$2,060.15" "$17,900.00" "$17,900.00" "$17,900.00" "$17,900.00" "$17,900.00" "$17,900.00" "$17,900.00" "$3,186.20" "$17,900.00" "$17,900.00" "$4,181.12" "$4,181.12" "$13,797.32" "$2,060.15" "$3,730.56" "$17,900.00" "$7,160.00" "$17,900.00" "$17,900.00" "$17,900.00" "$17,900.00" "$17,900.00" "$13,425.00" "$17,900.00" "$17,900.00" "$17,900.00" "$8,950.00" "$8,950.00" "$14,176.80" "$17,900.00" "$14,320.00" "$11,635.00" "$17,900.00" "$17,900.00" "$10,382.00" "$17,900.00" "$10,740.00" "$17,900.00" "$17,900.00" "$17,900.00" N/A N/A 80502761 EAP Custom 80502761 FORCEPS ENDSCP ALGTR GRSP CATH 9MM 2.4MM RSC 230CM BOTH IP/OP $188.00 $139.50 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $188.00 $188.00 $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 80502762 EAP Custom 80502762 FORCEPS GRSP RAT TOOTH ALGTR JAW CATH 230CM 2.4MM BOTH IP/OP $213.00 $158.00 $37.91 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $213.00 $37.91 $213.00 $213.00 $158.09 $158.09 $164.18 $110.97 $44.39 $213.00 $85.20 $213.00 $213.00 $213.00 $213.00 $213.00 $159.75 $213.00 $213.00 $213.00 $106.50 $106.50 $168.70 $213.00 $170.40 $138.45 $213.00 $213.00 $123.54 $213.00 $127.80 $213.00 $213.00 $213.00 N/A N/A 80502777 EAP Custom 80502777 DEVICE BIOP 22GA ACQUIRE ENDBR US FN NDL STRL BOTH IP/OP $888.00 $657.50 $158.06 $888.00 $888.00 $888.00 $888.00 $888.00 $888.00 $888.00 $158.06 $888.00 $888.00 $659.07 $659.07 $684.47 $462.65 $185.07 $888.00 $355.20 $888.00 $888.00 $888.00 $888.00 $888.00 $666.00 $888.00 $888.00 $888.00 $444.00 $444.00 $703.30 $888.00 $710.40 $577.20 $888.00 $888.00 $515.04 $888.00 $532.80 $888.00 $888.00 $888.00 N/A N/A 80502778 EAP Custom 80502778 DEVICE BIOP 25GA ACQUIRE ENDBR US FN NDL STRL BOTH IP/OP $888.00 $657.50 $158.06 $888.00 $888.00 $888.00 $888.00 $888.00 $888.00 $888.00 $158.06 $888.00 $888.00 $659.07 $659.07 $684.47 $462.65 $185.07 $888.00 $355.20 $888.00 $888.00 $888.00 $888.00 $888.00 $666.00 $888.00 $888.00 $888.00 $444.00 $444.00 $703.30 $888.00 $710.40 $577.20 $888.00 $888.00 $515.04 $888.00 $532.80 $888.00 $888.00 $888.00 N/A N/A 80502779 EAP Custom 80502779 MARKER FDCL STR 5MM .018IN LUMICOIL PLTN BOTH IP/OP $416.00 $308.00 $74.05 $416.00 $416.00 $416.00 $416.00 $416.00 $416.00 $416.00 $74.05 $416.00 $416.00 $308.76 $308.76 $320.65 $216.74 $86.70 $416.00 $166.40 $416.00 $416.00 $416.00 $416.00 $416.00 $312.00 $416.00 $416.00 $416.00 $208.00 $208.00 $329.47 $416.00 $332.80 $270.40 $416.00 $416.00 $241.28 $416.00 $249.60 $416.00 $416.00 $416.00 N/A N/A 80502780 EAP Custom 80502780 MARKER FDCL 5MM .018IN LUMICOIL FIG 8 PLTN BOTH IP/OP $416.00 $308.00 $74.05 $416.00 $416.00 $416.00 $416.00 $416.00 $416.00 $416.00 $74.05 $416.00 $416.00 $308.76 $308.76 $320.65 $216.74 $86.70 $416.00 $166.40 $416.00 $416.00 $416.00 $416.00 $416.00 $312.00 $416.00 $416.00 $416.00 $208.00 $208.00 $329.47 $416.00 $332.80 $270.40 $416.00 $416.00 $241.28 $416.00 $249.60 $416.00 $416.00 $416.00 N/A N/A 80502781 EAP Custom 80502781 DEVICE BIOP 139CM 25GA ACQUIRE ENDSCP US FN NDL BOTH IP/OP "$4,938.00" "$3,654.50" $878.96 "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" $878.96 "$4,938.00" "$4,938.00" "$3,664.98" "$3,664.98" "$3,806.21" "$2,060.15" "$1,029.13" "$4,938.00" "$1,975.20" "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" "$3,703.50" "$4,938.00" "$4,938.00" "$4,938.00" "$2,469.00" "$2,469.00" "$3,910.90" "$4,938.00" "$3,950.40" "$3,209.70" "$4,938.00" "$4,938.00" "$2,864.04" "$4,938.00" "$2,962.80" "$4,938.00" "$4,938.00" "$4,938.00" N/A N/A 80502782 EAP HCPCS C1769 GUIDEWIRE ENDSCP .025FR 260CM JGWR REV TUNG RND BOTH IP/OP $424.00 $314.00 $84.15 $424.00 $230.23 $230.23 $230.23 $230.23 $424.00 $424.00 $424.00 $88.37 $424.00 $314.69 $314.69 $326.82 $220.90 $88.37 $424.00 $424.00 $250.80 $424.00 $424.00 $424.00 $424.00 $318.00 $424.00 $424.00 $424.00 $212.00 $212.00 $335.81 $424.00 $339.20 $275.60 $84.15 $424.00 $245.92 $424.00 $424.00 $424.00 $88.36 $424.00 N/A N/A 80502783 EAP HCPCS C1769 GUIDEWIRE ENDSCP .025FR 260CM JGWR REV TUNG RND BOTH IP/OP $424.00 $314.00 $84.15 $424.00 $230.23 $230.23 $230.23 $230.23 $424.00 $424.00 $424.00 $88.37 $424.00 $314.69 $314.69 $326.82 $220.90 $88.37 $424.00 $424.00 $250.80 $424.00 $424.00 $424.00 $424.00 $318.00 $424.00 $424.00 $424.00 $212.00 $212.00 $335.81 $424.00 $339.20 $275.60 $84.15 $424.00 $245.92 $424.00 $424.00 $424.00 $88.36 $424.00 N/A N/A 80502784 EAP HCPCS C1769 GUIDEWIRE ENDSCP .025IN 450CM RND TIP JGWR REV ANG BOTH IP/OP $424.00 $314.00 $84.15 $424.00 $230.23 $230.23 $230.23 $230.23 $424.00 $424.00 $424.00 $88.37 $424.00 $314.69 $314.69 $326.82 $220.90 $88.37 $424.00 $424.00 $250.80 $424.00 $424.00 $424.00 $424.00 $318.00 $424.00 $424.00 $424.00 $212.00 $212.00 $335.81 $424.00 $339.20 $275.60 $84.15 $424.00 $245.92 $424.00 $424.00 $424.00 $88.36 $424.00 N/A N/A 80502785 EAP HCPCS C1769 GUIDEWIRE ENDSCP .025FR 500CM REV JGWR TUNG STR BOTH IP/OP $424.00 $314.00 $84.15 $424.00 $230.23 $230.23 $230.23 $230.23 $424.00 $424.00 $424.00 $88.37 $424.00 $314.69 $314.69 $326.82 $220.90 $88.37 $424.00 $424.00 $250.80 $424.00 $424.00 $424.00 $424.00 $318.00 $424.00 $424.00 $424.00 $212.00 $212.00 $335.81 $424.00 $339.20 $275.60 $84.15 $424.00 $245.92 $424.00 $424.00 $424.00 $88.36 $424.00 N/A N/A 80502786 EAP HCPCS B4087 BUTTON 1.2CM 18FR LP REPL GSTRM EVV BOTH IP/OP $296.00 $219.50 $20.89 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $20.89 $296.00 $296.00 $219.69 $219.69 $228.16 $154.22 $61.69 $296.00 $118.40 $296.00 $296.00 $296.00 $296.00 $296.00 $222.00 $296.00 $296.00 $296.00 $148.00 $148.00 $234.43 $296.00 $236.80 $192.40 $296.00 $296.00 $171.68 $296.00 $177.60 $296.00 $296.00 $296.00 N/A N/A 80502787 EAP HCPCS B4087 BUTTON 1.7CM 18FR LP REPL GSTRM EVV BOTH IP/OP $296.00 $219.50 $20.89 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $20.89 $296.00 $296.00 $219.69 $219.69 $228.16 $154.22 $61.69 $296.00 $118.40 $296.00 $296.00 $296.00 $296.00 $296.00 $222.00 $296.00 $296.00 $296.00 $148.00 $148.00 $234.43 $296.00 $236.80 $192.40 $296.00 $296.00 $171.68 $296.00 $177.60 $296.00 $296.00 $296.00 N/A N/A 80502788 EAP HCPCS B4087 BUTTON 3.4CM 18FR LP REPL GSTRM EVV BOTH IP/OP $296.00 $219.50 $20.89 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $20.89 $296.00 $296.00 $219.69 $219.69 $228.16 $154.22 $61.69 $296.00 $118.40 $296.00 $296.00 $296.00 $296.00 $296.00 $222.00 $296.00 $296.00 $296.00 $148.00 $148.00 $234.43 $296.00 $236.80 $192.40 $296.00 $296.00 $171.68 $296.00 $177.60 $296.00 $296.00 $296.00 N/A N/A 80502789 EAP HCPCS B4087 BUTTON 4.4CM 18FR LP REPL GSTRM EVV BOTH IP/OP $296.00 $219.50 $20.89 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $20.89 $296.00 $296.00 $219.69 $219.69 $228.16 $154.22 $61.69 $296.00 $118.40 $296.00 $296.00 $296.00 $296.00 $296.00 $222.00 $296.00 $296.00 $296.00 $148.00 $148.00 $234.43 $296.00 $236.80 $192.40 $296.00 $296.00 $171.68 $296.00 $177.60 $296.00 $296.00 $296.00 N/A N/A 80502790 EAP HCPCS B4087 BUTTON 1.7CM 24FR LP REPL GSTRM EVV BOTH IP/OP $296.00 $219.50 $20.89 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $20.89 $296.00 $296.00 $219.69 $219.69 $228.16 $154.22 $61.69 $296.00 $118.40 $296.00 $296.00 $296.00 $296.00 $296.00 $222.00 $296.00 $296.00 $296.00 $148.00 $148.00 $234.43 $296.00 $236.80 $192.40 $296.00 $296.00 $171.68 $296.00 $177.60 $296.00 $296.00 $296.00 N/A N/A 80502791 EAP HCPCS B4087 BUTTON 2.4CM 24FR LP REPL GSTRM EVV BOTH IP/OP $296.00 $219.50 $20.89 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $20.89 $296.00 $296.00 $219.69 $219.69 $228.16 $154.22 $61.69 $296.00 $118.40 $296.00 $296.00 $296.00 $296.00 $296.00 $222.00 $296.00 $296.00 $296.00 $148.00 $148.00 $234.43 $296.00 $236.80 $192.40 $296.00 $296.00 $171.68 $296.00 $177.60 $296.00 $296.00 $296.00 N/A N/A 80502792 EAP HCPCS B4087 BUTTON 3.4CM 24FR LP REPL GSTRM EVV BOTH IP/OP $296.00 $219.50 $20.89 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $20.89 $296.00 $296.00 $219.69 $219.69 $228.16 $154.22 $61.69 $296.00 $118.40 $296.00 $296.00 $296.00 $296.00 $296.00 $222.00 $296.00 $296.00 $296.00 $148.00 $148.00 $234.43 $296.00 $236.80 $192.40 $296.00 $296.00 $171.68 $296.00 $177.60 $296.00 $296.00 $296.00 N/A N/A 80502793 EAP HCPCS B4087 BUTTON 4.4CM 24FR LP REPL GSTRM EVV BOTH IP/OP $296.00 $219.50 $20.89 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $296.00 $20.89 $296.00 $296.00 $219.69 $219.69 $228.16 $154.22 $61.69 $296.00 $118.40 $296.00 $296.00 $296.00 $296.00 $296.00 $222.00 $296.00 $296.00 $296.00 $148.00 $148.00 $234.43 $296.00 $236.80 $192.40 $296.00 $296.00 $171.68 $296.00 $177.60 $296.00 $296.00 $296.00 N/A N/A 80502794 EAP HCPCS B4087 KIT PG 24FR SIL LP ANRFLX V RTRVL SNR PUL EVV 1STP BOTH IP/OP $440.00 $326.00 $20.89 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $20.89 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 80502795 EAP HCPCS B4087 KIT PG 24FR SIL LP ANRFLX V RTRVL SNR PUL EVV 1STP BOTH IP/OP $440.00 $326.00 $20.89 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $20.89 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 80502796 EAP HCPCS B4087 KIT PG 24FR SIL LP ANRFLX V RTRVL SNR PUL EVV 1STP BOTH IP/OP $440.00 $326.00 $20.89 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $20.89 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 80502797 EAP HCPCS B4087 KIT PG 24FR SIL LP ANRFLX V RTRVL SNR PUL EVV 1STP BOTH IP/OP $440.00 $326.00 $20.89 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $20.89 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 80502798 EAP HCPCS B4087 KIT PG 24FR SIL LP ANRFLX V RTRVL SNR PUSH EVV BOTH IP/OP $440.00 $326.00 $20.89 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $20.89 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 80502799 EAP HCPCS B4087 KIT PG 24FR SIL LP ANRFLX V RTRVL SNR PUSH EVV BOTH IP/OP $440.00 $326.00 $20.89 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $20.89 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 80502800 EAP HCPCS B4087 KIT PG 24FR SIL LP ANRFLX V RTRVL SNR PUSH EVV BOTH IP/OP $440.00 $326.00 $20.89 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $20.89 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 80502801 EAP HCPCS B4087 KIT PG 18FR SIL LP ANRFLX V RTRVL SNR PUL EVV 1STP BOTH IP/OP $440.00 $326.00 $20.89 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $20.89 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 80502802 EAP HCPCS B4087 KIT PG 18FR SIL LP ANRFLX V RTRVL SNR PUL EVV 1STP BOTH IP/OP $440.00 $326.00 $20.89 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $20.89 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 80502803 EAP HCPCS B4087 KIT PG 18FR SIL LP ANRFLX V RTRVL SNR PUL EVV 1STP BOTH IP/OP $440.00 $326.00 $20.89 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $20.89 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 80502804 EAP HCPCS B4087 KIT PG 18FR SIL LP ANRFLX V RTRVL SNR PUL EVV 1STP BOTH IP/OP $440.00 $326.00 $20.89 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $20.89 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 80502805 EAP HCPCS B4087 KIT PG 18FR SIL LP ANRFLX V RTRVL SNR PUL EVV 1STP BOTH IP/OP $440.00 $326.00 $20.89 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $20.89 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 80502806 EAP HCPCS B4087 KIT PG 18FR SIL LP ANRFLX V RTRVL SNR PUSH EVV BOTH IP/OP $440.00 $326.00 $20.89 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $20.89 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 80502807 EAP HCPCS B4087 KIT PG 18FR SIL LP ANRFLX V RTRVL SNR PUSH EVV BOTH IP/OP $440.00 $326.00 $20.89 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $440.00 $20.89 $440.00 $440.00 $326.57 $326.57 $339.15 $229.24 $91.70 $440.00 $176.00 $440.00 $440.00 $440.00 $440.00 $440.00 $330.00 $440.00 $440.00 $440.00 $220.00 $220.00 $348.48 $440.00 $352.00 $286.00 $440.00 $440.00 $255.20 $440.00 $264.00 $440.00 $440.00 $440.00 N/A N/A 80502808 EAP HCPCS C1876 STENT TRCHBR 10MM 16FR 20MM UNCOVER XPD PROX RELS BOTH IP/OP "$7,168.00" "$5,304.50" "$1,422.67" "$7,168.00" "$3,892.22" "$3,892.22" "$3,892.22" "$3,892.22" "$7,168.00" "$7,168.00" "$7,168.00" "$1,493.99" "$7,168.00" "$4,181.12" "$4,181.12" "$5,525.09" "$2,060.15" "$1,493.89" "$7,168.00" "$7,168.00" "$3,094.73" "$7,168.00" "$7,168.00" "$7,168.00" "$7,168.00" "$5,376.00" "$7,168.00" "$7,168.00" "$7,168.00" "$3,584.00" "$3,584.00" "$5,677.06" "$7,168.00" "$5,734.40" "$4,659.20" "$1,422.67" "$7,168.00" "$4,157.44" "$7,168.00" "$7,168.00" "$7,168.00" "$1,493.81" "$7,168.00" N/A N/A 80502809 EAP HCPCS B4087 TUBE JJNSTM 8.5FR EVV PGTL TIP FEED THR THE PG STF BOTH IP/OP $341.00 $252.50 $20.89 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $20.89 $341.00 $341.00 $253.09 $253.09 $262.84 $177.66 $71.07 $341.00 $136.40 $341.00 $341.00 $341.00 $341.00 $341.00 $255.75 $341.00 $341.00 $341.00 $170.50 $170.50 $270.07 $341.00 $272.80 $221.65 $341.00 $341.00 $197.78 $341.00 $204.60 $341.00 $341.00 $341.00 N/A N/A 80502810 EAP HCPCS B4087 TUBE JJNSTM 8.5FR EVV PGTL TIP FEED THR THE PG STF BOTH IP/OP $341.00 $252.50 $20.89 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $20.89 $341.00 $341.00 $253.09 $253.09 $262.84 $177.66 $71.07 $341.00 $136.40 $341.00 $341.00 $341.00 $341.00 $341.00 $255.75 $341.00 $341.00 $341.00 $170.50 $170.50 $270.07 $341.00 $272.80 $221.65 $341.00 $341.00 $197.78 $341.00 $204.60 $341.00 $341.00 $341.00 N/A N/A 80502811 EAP HCPCS B4087 TUBE JJNSTM 68CM 12FR EVV BNTP THR THE PG SUTURE BOTH IP/OP $341.00 $252.50 $20.89 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $20.89 $341.00 $341.00 $253.09 $253.09 $262.84 $177.66 $71.07 $341.00 $136.40 $341.00 $341.00 $341.00 $341.00 $341.00 $255.75 $341.00 $341.00 $341.00 $170.50 $170.50 $270.07 $341.00 $272.80 $221.65 $341.00 $341.00 $197.78 $341.00 $204.60 $341.00 $341.00 $341.00 N/A N/A 80502812 EAP HCPCS B4087 TUBE JJNSTM 12FR EVV PGTL TIP FEED THR THE PG STF BOTH IP/OP $341.00 $252.50 $20.89 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $20.89 $341.00 $341.00 $253.09 $253.09 $262.84 $177.66 $71.07 $341.00 $136.40 $341.00 $341.00 $341.00 $341.00 $341.00 $255.75 $341.00 $341.00 $341.00 $170.50 $170.50 $270.07 $341.00 $272.80 $221.65 $341.00 $341.00 $197.78 $341.00 $204.60 $341.00 $341.00 $341.00 N/A N/A 80502813 EAP HCPCS B4087 KIT PG 24FR XLCN SIL TROCAR CANNU RND XTRN BLSTR BOTH IP/OP $219.00 $162.50 $20.89 $219.00 $219.00 $219.00 $219.00 $219.00 $219.00 $219.00 $20.89 $219.00 $219.00 $162.54 $162.54 $168.81 $114.10 $45.64 $219.00 $87.60 $219.00 $219.00 $219.00 $219.00 $219.00 $164.25 $219.00 $219.00 $219.00 $109.50 $109.50 $173.45 $219.00 $175.20 $142.35 $219.00 $219.00 $127.02 $219.00 $131.40 $219.00 $219.00 $219.00 N/A N/A 80502814 EAP HCPCS B4087 KIT PG 24FR SIL CLMP FENESTRATE DRP PUSH EVV STD BOTH IP/OP $148.00 $110.00 $20.89 $148.00 $148.00 $148.00 $148.00 $148.00 $148.00 $148.00 $20.89 $148.00 $148.00 $109.85 $109.85 $114.08 $77.11 $30.84 $148.00 $59.20 $148.00 $148.00 $148.00 $148.00 $148.00 $111.00 $148.00 $148.00 $148.00 $74.00 $74.00 $117.22 $148.00 $118.40 $96.20 $148.00 $148.00 $85.84 $148.00 $88.80 $148.00 $148.00 $148.00 N/A N/A 80502815 EAP HCPCS B4087 KIT PG 18FR LP PUL 1STP BTN 2.4CM BOTH IP/OP $447.00 $331.00 $20.89 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $20.89 $447.00 $447.00 $331.76 $331.76 $344.55 $232.89 $93.16 $447.00 $178.80 $447.00 $447.00 $447.00 $447.00 $447.00 $335.25 $447.00 $447.00 $447.00 $223.50 $223.50 $354.02 $447.00 $357.60 $290.55 $447.00 $447.00 $259.26 $447.00 $268.20 $447.00 $447.00 $447.00 N/A N/A 80502816 EAP HCPCS B4087 KIT PG 18FR LP PUL 1STP BTN 3.4CM BOTH IP/OP $447.00 $331.00 $20.89 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $20.89 $447.00 $447.00 $331.76 $331.76 $344.55 $232.89 $93.16 $447.00 $178.80 $447.00 $447.00 $447.00 $447.00 $447.00 $335.25 $447.00 $447.00 $447.00 $223.50 $223.50 $354.02 $447.00 $357.60 $290.55 $447.00 $447.00 $259.26 $447.00 $268.20 $447.00 $447.00 $447.00 N/A N/A 80502817 EAP HCPCS B4087 KIT PG 18FR LP PUL 1STP BTN 4.4CM BOTH IP/OP $447.00 $331.00 $20.89 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $20.89 $447.00 $447.00 $331.76 $331.76 $344.55 $232.89 $93.16 $447.00 $178.80 $447.00 $447.00 $447.00 $447.00 $447.00 $335.25 $447.00 $447.00 $447.00 $223.50 $223.50 $354.02 $447.00 $357.60 $290.55 $447.00 $447.00 $259.26 $447.00 $268.20 $447.00 $447.00 $447.00 N/A N/A 80502818 EAP HCPCS B4087 KIT PG 24FR LP PUL 1STP BTN 2.4CM BOTH IP/OP $447.00 $331.00 $20.89 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $20.89 $447.00 $447.00 $331.76 $331.76 $344.55 $232.89 $93.16 $447.00 $178.80 $447.00 $447.00 $447.00 $447.00 $447.00 $335.25 $447.00 $447.00 $447.00 $223.50 $223.50 $354.02 $447.00 $357.60 $290.55 $447.00 $447.00 $259.26 $447.00 $268.20 $447.00 $447.00 $447.00 N/A N/A 80502819 EAP HCPCS B4087 KIT PG 24FR LP PUL 1STP BTN 3.4CM BOTH IP/OP $447.00 $331.00 $20.89 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $20.89 $447.00 $447.00 $331.76 $331.76 $344.55 $232.89 $93.16 $447.00 $178.80 $447.00 $447.00 $447.00 $447.00 $447.00 $335.25 $447.00 $447.00 $447.00 $223.50 $223.50 $354.02 $447.00 $357.60 $290.55 $447.00 $447.00 $259.26 $447.00 $268.20 $447.00 $447.00 $447.00 N/A N/A 80502820 EAP HCPCS B4087 KIT PG 24FR LP PUL 1STP BTN 4.4CM BOTH IP/OP $447.00 $331.00 $20.89 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $20.89 $447.00 $447.00 $331.76 $331.76 $344.55 $232.89 $93.16 $447.00 $178.80 $447.00 $447.00 $447.00 $447.00 $447.00 $335.25 $447.00 $447.00 $447.00 $223.50 $223.50 $354.02 $447.00 $357.60 $290.55 $447.00 $447.00 $259.26 $447.00 $268.20 $447.00 $447.00 $447.00 N/A N/A 80502821 EAP HCPCS B4087 KIT PG 18FR LP PUSH 1STP BTN 2.4CM BOTH IP/OP $447.00 $331.00 $20.89 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $20.89 $447.00 $447.00 $331.76 $331.76 $344.55 $232.89 $93.16 $447.00 $178.80 $447.00 $447.00 $447.00 $447.00 $447.00 $335.25 $447.00 $447.00 $447.00 $223.50 $223.50 $354.02 $447.00 $357.60 $290.55 $447.00 $447.00 $259.26 $447.00 $268.20 $447.00 $447.00 $447.00 N/A N/A 80502822 EAP HCPCS B4087 KIT PG 18FR LP PUSH 1STP BTN 3.4CM BOTH IP/OP $447.00 $331.00 $20.89 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $20.89 $447.00 $447.00 $331.76 $331.76 $344.55 $232.89 $93.16 $447.00 $178.80 $447.00 $447.00 $447.00 $447.00 $447.00 $335.25 $447.00 $447.00 $447.00 $223.50 $223.50 $354.02 $447.00 $357.60 $290.55 $447.00 $447.00 $259.26 $447.00 $268.20 $447.00 $447.00 $447.00 N/A N/A 80502823 EAP HCPCS B4087 KIT PG 18FR LP PUSH 1STP BTN 4.4CM BOTH IP/OP $447.00 $331.00 $20.89 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $20.89 $447.00 $447.00 $331.76 $331.76 $344.55 $232.89 $93.16 $447.00 $178.80 $447.00 $447.00 $447.00 $447.00 $447.00 $335.25 $447.00 $447.00 $447.00 $223.50 $223.50 $354.02 $447.00 $357.60 $290.55 $447.00 $447.00 $259.26 $447.00 $268.20 $447.00 $447.00 $447.00 N/A N/A 80502824 EAP HCPCS B4087 KIT PG 24FR LP PUSH 1STP BTN 1.7CM BOTH IP/OP $447.00 $331.00 $20.89 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $447.00 $20.89 $447.00 $447.00 $331.76 $331.76 $344.55 $232.89 $93.16 $447.00 $178.80 $447.00 $447.00 $447.00 $447.00 $447.00 $335.25 $447.00 $447.00 $447.00 $223.50 $223.50 $354.02 $447.00 $357.60 $290.55 $447.00 $447.00 $259.26 $447.00 $268.20 $447.00 $447.00 $447.00 N/A N/A 80502839 EAP HCPCS B4087 TUBE 12FR STD PR REPL BLN BLSTR GSTRM EVV STR BOTH IP/OP $68.00 $50.50 $14.17 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $20.89 $68.00 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $27.20 $68.00 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $68.00 $68.00 $39.44 $68.00 $40.80 $68.00 $68.00 $68.00 N/A N/A 80502840 EAP HCPCS B4087 TUBE 14FR REPL BLN STD PR BLSTR GSTRM EVV STR BOTH IP/OP $68.00 $50.50 $14.17 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $20.89 $68.00 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $27.20 $68.00 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $68.00 $68.00 $39.44 $68.00 $40.80 $68.00 $68.00 $68.00 N/A N/A 80502841 EAP HCPCS B4087 TUBE 16FR STD PR REPL BLN BLSTR GSTRM EVV STR BOTH IP/OP $68.00 $50.50 $14.17 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $20.89 $68.00 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $27.20 $68.00 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $68.00 $68.00 $39.44 $68.00 $40.80 $68.00 $68.00 $68.00 N/A N/A 80502842 EAP HCPCS B4087 TUBE 18FR REPL BLN STD PR BLSTR GSTRM EVV STR BOTH IP/OP $68.00 $50.50 $14.17 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $20.89 $68.00 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $27.20 $68.00 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $68.00 $68.00 $39.44 $68.00 $40.80 $68.00 $68.00 $68.00 N/A N/A 80502843 EAP HCPCS B4087 TUBE 20FR STD PR REPL BLN BLSTR GSTRM EVV STR BOTH IP/OP $68.00 $50.50 $14.17 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $20.89 $68.00 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $27.20 $68.00 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $68.00 $68.00 $39.44 $68.00 $40.80 $68.00 $68.00 $68.00 N/A N/A 80502844 EAP HCPCS B4087 TUBE 24FR REPL BLN STD PR BLSTR GSTRM EVV STR BOTH IP/OP $68.00 $50.50 $14.17 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $20.89 $68.00 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $27.20 $68.00 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $68.00 $68.00 $39.44 $68.00 $40.80 $68.00 $68.00 $68.00 N/A N/A 80502845 EAP HCPCS B4087 TUBE 28FR REPL BLN STD PR BLSTR GSTRM EVV STR BOTH IP/OP $68.00 $50.50 $14.17 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $20.89 $68.00 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $27.20 $68.00 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $68.00 $68.00 $39.44 $68.00 $40.80 $68.00 $68.00 $68.00 N/A N/A 80502846 EAP HCPCS B4087 TUBE 12FR STD PR REPL BLN BLSTR GSTRM EVV RIGHT BOTH IP/OP $78.00 $58.00 $16.26 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $20.89 $78.00 $78.00 $57.89 $57.89 $60.12 $40.64 $16.26 $78.00 $31.20 $78.00 $78.00 $78.00 $78.00 $78.00 $58.50 $78.00 $78.00 $78.00 $39.00 $39.00 $61.78 $78.00 $62.40 $50.70 $78.00 $78.00 $45.24 $78.00 $46.80 $78.00 $78.00 $78.00 N/A N/A 80502847 EAP HCPCS B4087 TUBE 28FR STD PR REPL BLN BLSTR GSTRM EVV RIGHT BOTH IP/OP $78.00 $58.00 $16.26 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $20.89 $78.00 $78.00 $57.89 $57.89 $60.12 $40.64 $16.26 $78.00 $31.20 $78.00 $78.00 $78.00 $78.00 $78.00 $58.50 $78.00 $78.00 $78.00 $39.00 $39.00 $61.78 $78.00 $62.40 $50.70 $78.00 $78.00 $45.24 $78.00 $46.80 $78.00 $78.00 $78.00 N/A N/A 80502848 EAP HCPCS B4087 TUBE 22FR STD PR REPL BLN BLSTR GSTRM EVV STR BOTH IP/OP $68.00 $50.50 $14.17 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $68.00 $20.89 $68.00 $68.00 $50.47 $50.47 $52.41 $35.43 $14.17 $68.00 $27.20 $68.00 $68.00 $68.00 $68.00 $68.00 $51.00 $68.00 $68.00 $68.00 $34.00 $34.00 $53.86 $68.00 $54.40 $44.20 $68.00 $68.00 $39.44 $68.00 $40.80 $68.00 $68.00 $68.00 N/A N/A 80502849 EAP HCPCS C1769 SPHNTM 5MM 450CM 3.9FR TRUETOME JGWR CANN PRELD BOTH IP/OP $950.00 $703.00 $188.55 $950.00 $515.85 $515.85 $515.85 $515.85 $950.00 $950.00 $950.00 $198.00 $950.00 $705.09 $705.09 $732.26 $494.95 $197.99 $950.00 $950.00 $561.93 $950.00 $950.00 $950.00 $950.00 $712.50 $950.00 $950.00 $950.00 $475.00 $475.00 $752.40 $950.00 $760.00 $617.50 $188.55 $950.00 $551.00 $950.00 $950.00 $950.00 $197.98 $950.00 N/A N/A 80502850 EAP HCPCS C1769 SPHNTM 5MM 450CM 4.4FR TRUETOME JGWR CANN PRELD BOTH IP/OP $950.00 $703.00 $188.55 $950.00 $515.85 $515.85 $515.85 $515.85 $950.00 $950.00 $950.00 $198.00 $950.00 $705.09 $705.09 $732.26 $494.95 $197.99 $950.00 $950.00 $561.93 $950.00 $950.00 $950.00 $950.00 $712.50 $950.00 $950.00 $950.00 $475.00 $475.00 $752.40 $950.00 $760.00 $617.50 $188.55 $950.00 $551.00 $950.00 $950.00 $950.00 $197.98 $950.00 N/A N/A 80502851 EAP HCPCS C1769 SPHNTM 5MM 450CM 3.9FR TRUETOME JGWR CANN PRELD BOTH IP/OP $950.00 $703.00 $188.55 $950.00 $515.85 $515.85 $515.85 $515.85 $950.00 $950.00 $950.00 $198.00 $950.00 $705.09 $705.09 $732.26 $494.95 $197.99 $950.00 $950.00 $561.93 $950.00 $950.00 $950.00 $950.00 $712.50 $950.00 $950.00 $950.00 $475.00 $475.00 $752.40 $950.00 $760.00 $617.50 $188.55 $950.00 $551.00 $950.00 $950.00 $950.00 $197.98 $950.00 N/A N/A 80502852 EAP HCPCS C1769 SPHNTM 5MM 450CM 4.4FR TRUETOME JGWR CANN PRELD BOTH IP/OP $950.00 $703.00 $188.55 $950.00 $515.85 $515.85 $515.85 $515.85 $950.00 $950.00 $950.00 $198.00 $950.00 $705.09 $705.09 $732.26 $494.95 $197.99 $950.00 $950.00 $561.93 $950.00 $950.00 $950.00 $950.00 $712.50 $950.00 $950.00 $950.00 $475.00 $475.00 $752.40 $950.00 $760.00 $617.50 $188.55 $950.00 $551.00 $950.00 $950.00 $950.00 $197.98 $950.00 N/A N/A 80502853 EAP HCPCS C1769 GUIDEWIRE ENDSCP 3.9FR 20MM JGWR REV TUNG STR 5MM BOTH IP/OP "$1,002.00" $741.50 $198.87 "$1,002.00" $544.09 $544.09 $544.09 $544.09 "$1,002.00" "$1,002.00" "$1,002.00" $208.84 "$1,002.00" $743.68 $743.68 $772.34 $522.04 $208.83 "$1,002.00" "$1,002.00" $592.68 "$1,002.00" "$1,002.00" "$1,002.00" "$1,002.00" $751.50 "$1,002.00" "$1,002.00" "$1,002.00" $501.00 $501.00 $793.58 "$1,002.00" $801.60 $651.30 $198.87 "$1,002.00" $581.16 "$1,002.00" "$1,002.00" "$1,002.00" $208.82 "$1,002.00" N/A N/A 80502854 EAP HCPCS C1769 SPHNTM 20MM 5MM 3.9FR .025IN JGWR JAGTOME ATME REV BOTH IP/OP "$1,002.00" $741.50 $198.87 "$1,002.00" $544.09 $544.09 $544.09 $544.09 "$1,002.00" "$1,002.00" "$1,002.00" $208.84 "$1,002.00" $743.68 $743.68 $772.34 $522.04 $208.83 "$1,002.00" "$1,002.00" $592.68 "$1,002.00" "$1,002.00" "$1,002.00" "$1,002.00" $751.50 "$1,002.00" "$1,002.00" "$1,002.00" $501.00 $501.00 $793.58 "$1,002.00" $801.60 $651.30 $198.87 "$1,002.00" $581.16 "$1,002.00" "$1,002.00" "$1,002.00" $208.82 "$1,002.00" N/A N/A 80502855 EAP HCPCS C1769 GUIDEWIRE ENDSCP 3.9FR .025IN 20MM REV HPRFR JGWR BOTH IP/OP "$1,002.00" $741.50 $198.87 "$1,002.00" $544.09 $544.09 $544.09 $544.09 "$1,002.00" "$1,002.00" "$1,002.00" $208.84 "$1,002.00" $743.68 $743.68 $772.34 $522.04 $208.83 "$1,002.00" "$1,002.00" $592.68 "$1,002.00" "$1,002.00" "$1,002.00" "$1,002.00" $751.50 "$1,002.00" "$1,002.00" "$1,002.00" $501.00 $501.00 $793.58 "$1,002.00" $801.60 $651.30 $198.87 "$1,002.00" $581.16 "$1,002.00" "$1,002.00" "$1,002.00" $208.82 "$1,002.00" N/A N/A 80502856 EAP HCPCS C1769 GUIDEWIRE ENDSCP 3.9FR .025IN 20MM STRP HYDPHI TPR BOTH IP/OP "$1,002.00" $741.50 $198.87 "$1,002.00" $544.09 $544.09 $544.09 $544.09 "$1,002.00" "$1,002.00" "$1,002.00" $208.84 "$1,002.00" $743.68 $743.68 $772.34 $522.04 $208.83 "$1,002.00" "$1,002.00" $592.68 "$1,002.00" "$1,002.00" "$1,002.00" "$1,002.00" $751.50 "$1,002.00" "$1,002.00" "$1,002.00" $501.00 $501.00 $793.58 "$1,002.00" $801.60 $651.30 $198.87 "$1,002.00" $581.16 "$1,002.00" "$1,002.00" "$1,002.00" $208.82 "$1,002.00" N/A N/A 80502860 EAP HCPCS C1777 LEAD DFBR 70CM 7.3FR RLNC 4-FRN RV MP35N IROX STRD BOTH IP/OP "$6,500.00" "$4,810.00" "$1,290.09" "$6,500.00" "$2,925.00" "$2,925.00" "$2,925.00" "$2,925.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.76" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.67" "$6,500.00" "$6,500.00" "$3,204.50" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$4,875.00" "$6,500.00" "$6,500.00" "$6,500.00" "$3,250.00" "$3,250.00" "$5,148.00" "$6,500.00" "$5,200.00" "$2,925.00" "$1,290.09" "$6,500.00" "$3,770.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.60" "$6,500.00" N/A N/A 80502861 EAP HCPCS C1777 LEAD DFBR 64CM 7.3FR RLNC 4-FRN RV MP35N IROX STRD BOTH IP/OP "$6,500.00" "$4,810.00" "$1,290.09" "$6,500.00" "$2,925.00" "$2,925.00" "$2,925.00" "$2,925.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.76" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.67" "$6,500.00" "$6,500.00" "$3,204.50" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$4,875.00" "$6,500.00" "$6,500.00" "$6,500.00" "$3,250.00" "$3,250.00" "$5,148.00" "$6,500.00" "$5,200.00" "$2,925.00" "$1,290.09" "$6,500.00" "$3,770.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.60" "$6,500.00" N/A N/A 80502862 EAP HCPCS C1777 LEAD DFBR 59CM 7.3FR RLNC 4-FRN RV MP35N IROX STRD BOTH IP/OP "$6,500.00" "$4,810.00" "$1,290.09" "$6,500.00" "$2,925.00" "$2,925.00" "$2,925.00" "$2,925.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.76" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.67" "$6,500.00" "$6,500.00" "$3,204.50" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$4,875.00" "$6,500.00" "$6,500.00" "$6,500.00" "$3,250.00" "$3,250.00" "$5,148.00" "$6,500.00" "$5,200.00" "$2,925.00" "$1,290.09" "$6,500.00" "$3,770.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.60" "$6,500.00" N/A N/A 80502863 EAP HCPCS C1764 SYSTEM CRD MONITR LUX-DX CLN AST KIT MBL DEV BOTH IP/OP $498.00 $369.00 $98.84 $498.00 $224.10 $224.10 $224.10 $224.10 $498.00 $498.00 $498.00 $103.80 $498.00 $498.00 $498.00 $498.00 $498.00 $103.79 $498.00 $498.00 $294.57 $498.00 $498.00 $498.00 $498.00 $373.50 $498.00 $498.00 $498.00 $249.00 $249.00 $394.42 $498.00 $398.40 $224.10 $98.84 $498.00 $288.84 $498.00 $498.00 $498.00 $103.78 $498.00 N/A N/A 80502864 EAP Custom 80502864 NEEDLE ASPIRAT 15MM 20GA 1.8MM EXCELON TRNBR SYR BOTH IP/OP $315.00 $233.50 $56.07 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $56.07 $315.00 $315.00 $233.79 $233.79 $242.80 $164.12 $65.65 $315.00 $126.00 $315.00 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $204.75 $315.00 $315.00 $182.70 $315.00 $189.00 $315.00 $315.00 $315.00 N/A N/A 80502865 EAP Custom 80502865 STYLET LEAD GRN ORNG 90CM .014IN STR SFT KNOB CAP BOTH IP/OP $113.00 $84.00 $20.11 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $20.11 $113.00 $113.00 $83.87 $83.87 $87.10 $58.87 $23.55 $113.00 $45.20 $113.00 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $73.45 $113.00 $113.00 $65.54 $113.00 $67.80 $113.00 $113.00 $113.00 N/A N/A 80502867 EAP HCPCS C1898 LEAD PCNG 45CM LNG TPR ATR VNTRC XTD RTRCT FIX BOTH IP/OP $850.00 $629.00 $177.15 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $177.15 $850.00 $340.00 $850.00 $850.00 $850.00 $850.00 $850.00 $637.50 $850.00 $850.00 $850.00 $425.00 $425.00 $673.20 $850.00 $680.00 $382.50 $850.00 $850.00 $493.00 $850.00 $510.00 $850.00 $850.00 $850.00 N/A N/A 80502868 EAP HCPCS C1898 LEAD PCNG 52CM LNG TPR ATR VNTRC XTD RTRCT FIX BOTH IP/OP $850.00 $629.00 $177.15 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $177.15 $850.00 $340.00 $850.00 $850.00 $850.00 $850.00 $850.00 $637.50 $850.00 $850.00 $850.00 $425.00 $425.00 $673.20 $850.00 $680.00 $382.50 $850.00 $850.00 $493.00 $850.00 $510.00 $850.00 $850.00 $850.00 N/A N/A 80502869 EAP HCPCS C1898 LEAD PCNG 59CM LNG TPR ATR VNTRC XTD RTRCT FIX BOTH IP/OP $850.00 $629.00 $177.15 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $177.15 $850.00 $340.00 $850.00 $850.00 $850.00 $850.00 $850.00 $637.50 $850.00 $850.00 $850.00 $425.00 $425.00 $673.20 $850.00 $680.00 $382.50 $850.00 $850.00 $493.00 $850.00 $510.00 $850.00 $850.00 $850.00 N/A N/A 80502870 EAP Custom 80502870 CATHETER CARDIO 40CM AUST C MULTPUR ST SLCT PCNG BOTH IP/OP "$1,125.00" $832.50 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 80502871 EAP HCPCS C1887 MCTH INFUS 80CM 3-2.8FR .027IN RNGD HFL HYDPHI KIT BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $488.70 $488.70 $488.70 $488.70 $900.00 $900.00 $900.00 $187.58 $900.00 $667.98 $667.98 $693.72 $468.90 $187.57 $900.00 $900.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $585.00 $178.63 $900.00 $522.00 $900.00 $900.00 $900.00 $187.56 $900.00 N/A N/A 80502872 EAP HCPCS C1876 STENT VASC 7MM 20MM 75CM SLF XPD ILC ART EP NTNL BOTH IP/OP "$1,463.00" "$1,083.00" $290.37 "$1,463.00" $658.35 $658.35 $658.35 $658.35 "$1,463.00" "$1,463.00" "$1,463.00" $304.93 "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" $304.91 "$1,463.00" "$1,463.00" $865.36 "$1,463.00" "$1,463.00" "$1,463.00" "$1,463.00" "$1,097.25" "$1,463.00" "$1,463.00" "$1,463.00" $731.50 $731.50 "$1,158.70" "$1,463.00" "$1,170.40" $658.35 $290.37 "$1,463.00" $848.54 "$1,463.00" "$1,463.00" "$1,463.00" $304.89 "$1,463.00" N/A N/A 80502874 EAP HCPCS C1876 STENT ENDOPRSTH VNS 90MM 18MM WLSTNT CATH 75CM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502875 EAP HCPCS C1876 STENT ENDOPRSTH VNS 80MM 20MM WLSTNT CATH 75CM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 "$2,200.00" "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 80502876 EAP HCPCS C1725 CATHETER BALDILAT 4MM 80CM 40MM OTW DRG COAT BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,758.23" "$1,758.23" "$1,758.23" "$1,758.23" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$3,238.00" "$1,915.28" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80502877 EAP HCPCS C1725 CATHETER BALDILAT 4MM 80CM 60MM OTW DRG COAT BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,758.23" "$1,758.23" "$1,758.23" "$1,758.23" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$3,238.00" "$1,915.28" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80502878 EAP HCPCS C1725 CATHETER BALDILAT 4MM 80CM 80MM OTW DRG COAT BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,758.23" "$1,758.23" "$1,758.23" "$1,758.23" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$3,238.00" "$1,915.28" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80502879 EAP HCPCS C1725 CATHETER BALDILAT 4MM 80CM 100MM OTW DRG COAT BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,758.23" "$1,758.23" "$1,758.23" "$1,758.23" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$3,238.00" "$1,915.28" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$1,942.80" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80502880 EAP HCPCS C1725 CATHETER BALDILAT 4MM 90CM 150MM OTW DRG COAT BOTH IP/OP "$3,988.00" "$2,951.50" $791.52 "$3,988.00" "$2,165.48" "$2,165.48" "$2,165.48" "$2,165.48" "$3,988.00" "$3,988.00" "$3,988.00" $831.20 "$3,988.00" "$2,959.89" "$2,959.89" "$3,073.95" "$2,060.15" $831.14 "$3,988.00" "$3,988.00" "$2,358.90" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$2,592.20" $791.52 "$3,988.00" "$2,313.04" "$3,988.00" "$3,988.00" "$3,988.00" $831.10 "$3,988.00" N/A N/A 80502881 EAP HCPCS C1725 CATHETER BALDILAT 4MM 90CM 200MM OTW DRG COAT BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,708.48" "$2,708.48" "$2,708.48" "$2,708.48" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$3,702.09" "$3,702.09" "$3,844.75" "$2,060.15" "$1,039.55" "$4,988.00" "$4,988.00" "$2,950.40" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$3,242.20" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 80502882 EAP HCPCS C1725 CATHETER BALDILAT 5MM 80CM 40MM OTW DRG COAT BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,758.23" "$1,758.23" "$1,758.23" "$1,758.23" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$3,238.00" "$1,915.28" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80502883 EAP HCPCS C1725 CATHETER BALDILAT 5MM 80CM 60MM OTW DRG COAT BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,758.23" "$1,758.23" "$1,758.23" "$1,758.23" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$3,238.00" "$1,915.28" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80502884 EAP HCPCS C1725 CATHETER BALDILAT 5MM 80CM 80MM OTW DRG COAT BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,758.23" "$1,758.23" "$1,758.23" "$1,758.23" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$3,238.00" "$1,915.28" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80502885 EAP HCPCS C1725 CATHETER BALDILAT 5MM 80CM 100MM OTW DRG COAT BOTH IP/OP "$3,488.00" "$2,581.50" $692.28 "$3,488.00" "$1,893.98" "$1,893.98" "$1,893.98" "$1,893.98" "$3,488.00" "$3,488.00" "$3,488.00" $726.99 "$3,488.00" "$2,588.79" "$2,588.79" "$2,688.55" "$1,817.25" $726.94 "$3,488.00" "$3,488.00" "$2,063.15" "$3,488.00" "$3,488.00" "$3,488.00" "$3,488.00" "$2,616.00" "$3,488.00" "$3,488.00" "$3,488.00" "$1,744.00" "$1,744.00" "$2,762.50" "$3,488.00" "$2,790.40" "$2,267.20" $692.28 "$3,488.00" "$2,023.04" "$3,488.00" "$3,488.00" "$3,488.00" $726.90 "$3,488.00" N/A N/A 80502886 EAP HCPCS C1725 CATHETER BALDILAT 5MM 90CM 150MM OTW DRG COAT BOTH IP/OP "$3,988.00" "$2,951.50" $791.52 "$3,988.00" "$2,165.48" "$2,165.48" "$2,165.48" "$2,165.48" "$3,988.00" "$3,988.00" "$3,988.00" $831.20 "$3,988.00" "$2,959.89" "$2,959.89" "$3,073.95" "$2,060.15" $831.14 "$3,988.00" "$3,988.00" "$2,358.90" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$2,592.20" $791.52 "$3,988.00" "$2,313.04" "$3,988.00" "$3,988.00" "$3,988.00" $831.10 "$3,988.00" N/A N/A 80502887 EAP HCPCS C1725 CATHETER BALDILAT 5MM 90CM 200MM OTW DRG COAT BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,708.48" "$2,708.48" "$2,708.48" "$2,708.48" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$3,702.09" "$3,702.09" "$3,844.75" "$2,060.15" "$1,039.55" "$4,988.00" "$4,988.00" "$2,950.40" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$3,242.20" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 80502888 EAP HCPCS C1725 CATHETER BALDILAT 6MM 80CM 40MM OTW DRG COAT BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,758.23" "$1,758.23" "$1,758.23" "$1,758.23" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$3,238.00" "$1,915.28" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80502889 EAP HCPCS C1725 CATHETER BALDILAT 6MM 80CM 60MM OTW DRG COAT BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,758.23" "$1,758.23" "$1,758.23" "$1,758.23" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$3,238.00" "$1,915.28" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80502890 EAP HCPCS C1725 CATHETER BALDILAT 6MM 80CM 80MM OTW DRG COAT BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,758.23" "$1,758.23" "$1,758.23" "$1,758.23" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$3,238.00" "$1,915.28" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80502891 EAP HCPCS C1725 CATHETER BALDILAT 6MM 80CM 100MM OTW DRG COAT BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,758.23" "$1,758.23" "$1,758.23" "$1,758.23" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$3,238.00" "$1,915.28" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80502892 EAP HCPCS C1725 CATHETER BALDILAT 6MM 90CM 150MM OTW DRG COAT BOTH IP/OP "$3,988.00" "$2,951.50" $791.52 "$3,988.00" "$2,165.48" "$2,165.48" "$2,165.48" "$2,165.48" "$3,988.00" "$3,988.00" "$3,988.00" $831.20 "$3,988.00" "$2,959.89" "$2,959.89" "$3,073.95" "$2,060.15" $831.14 "$3,988.00" "$3,988.00" "$2,358.90" "$3,988.00" "$3,988.00" "$3,988.00" "$3,988.00" "$2,991.00" "$3,988.00" "$3,988.00" "$3,988.00" "$1,994.00" "$1,994.00" "$3,158.50" "$3,988.00" "$3,190.40" "$2,592.20" $791.52 "$3,988.00" "$2,313.04" "$3,988.00" "$3,988.00" "$3,988.00" $831.10 "$3,988.00" N/A N/A 80502893 EAP HCPCS C1725 CATHETER BALDILAT 6MM 90CM 200MM OTW DRG COAT BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,708.48" "$2,708.48" "$2,708.48" "$2,708.48" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$3,702.09" "$3,702.09" "$3,844.75" "$2,060.15" "$1,039.55" "$4,988.00" "$4,988.00" "$2,950.40" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$3,242.20" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 80502894 EAP HCPCS C1725 CATHETER BALDILAT 7MM 80CM 40MM OTW DRG COAT BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,758.23" "$1,758.23" "$1,758.23" "$1,758.23" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$3,238.00" "$1,915.28" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80502895 EAP HCPCS C1725 CATHETER BALDILAT 7MM 80CM 60MM OTW DRG COAT BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,758.23" "$1,758.23" "$1,758.23" "$1,758.23" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$3,238.00" "$1,915.28" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80502896 EAP HCPCS C1725 CATHETER BALDILAT 7MM 80CM 80MM OTW DRG COAT BOTH IP/OP "$3,238.00" "$2,396.50" $642.66 "$3,238.00" "$1,758.23" "$1,758.23" "$1,758.23" "$1,758.23" "$3,238.00" "$3,238.00" "$3,238.00" $674.88 "$3,238.00" "$2,403.24" "$2,403.24" "$2,495.85" "$1,687.00" $674.83 "$3,238.00" "$3,238.00" "$1,915.28" "$3,238.00" "$3,238.00" "$3,238.00" "$3,238.00" "$2,428.50" "$3,238.00" "$3,238.00" "$3,238.00" "$1,619.00" "$1,619.00" "$2,564.50" "$3,238.00" "$2,590.40" "$2,104.70" $642.66 "$3,238.00" "$1,878.04" "$3,238.00" "$3,238.00" "$3,238.00" $674.80 "$3,238.00" N/A N/A 80502897 EAP HCPCS C1887 CATHETER GUID 7FR HFLO SFTP DX CRD BOTH IP/OP $606.00 $448.50 $120.28 $606.00 $329.06 $329.06 $329.06 $329.06 $606.00 $606.00 $606.00 $126.31 $606.00 $449.77 $449.77 $467.10 $315.73 $126.30 $606.00 $606.00 $358.45 $606.00 $606.00 $606.00 $606.00 $454.50 $606.00 $606.00 $606.00 $303.00 $303.00 $479.95 $606.00 $484.80 $393.90 $120.28 $606.00 $351.48 $606.00 $606.00 $606.00 $126.29 $606.00 N/A N/A 80502898 EAP HCPCS C1725 CATHETER BALDILAT 3MM 142CM 25MM OTW PUSH COIL BOTH IP/OP $270.00 $200.00 $53.59 $270.00 $146.61 $146.61 $146.61 $146.61 $270.00 $270.00 $270.00 $56.27 $270.00 $200.39 $200.39 $208.12 $140.67 $56.27 $270.00 $270.00 $159.71 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $175.50 $53.59 $270.00 $156.60 $270.00 $270.00 $270.00 $56.27 $270.00 N/A N/A 80502899 EAP HCPCS C1887 CATHETER GUID 100CM 6FR MACH1 FR4 CURVE FEM PERI BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80502900 EAP HCPCS C1887 CATHETER GUID 100CM 6FR MACH1 Q-CURVE 4.5 FEM PERI BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80502901 EAP HCPCS C1887 CATHETER GUID 100CM 6FR MACH1 FR3 CURVE FEM PERI BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80502902 EAP HCPCS C1887 CATHETER GUID 100CM 6FR MACH1 RC4 CURVE FEM PERI BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80502903 EAP HCPCS C1887 CATHETER GUID 100CM 6FR MACH1 FR3.5 CURVE FEM PERI BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80502904 EAP HCPCS C1887 CATHETER GUID 100CM 6FR MACH1 RADL CURVE PERI BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80502905 EAP HCPCS C1887 CATHETER GUID 100CM 6FR MACH1 ART4 CURVE FEM PERI BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80502906 EAP HCPCS C1887 CATHETER GUID 100CM 6FR MACH1 ML4.5 CURVE PERI BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80502907 EAP HCPCS C1887 CATHETER GUID 90CM 6FR MACH1 MANN IM CURVE PERI BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80502908 EAP HCPCS C1887 CATHETER GUID 100CM 8FR MACH1 FL3 CURVE FEM PERI BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80502909 EAP HCPCS C1887 CATHETER GUID 100CM 8FR MACH1 JR4.5 CURVE FEM PERI BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80502910 EAP HCPCS C1725 CATHETER BALDILAT 2.25MM 142CM 25MM TPR DISTAL BOTH IP/OP $270.00 $200.00 $53.59 $270.00 $146.61 $146.61 $146.61 $146.61 $270.00 $270.00 $270.00 $56.27 $270.00 $200.39 $200.39 $208.12 $140.67 $56.27 $270.00 $270.00 $159.71 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $175.50 $53.59 $270.00 $156.60 $270.00 $270.00 $270.00 $56.27 $270.00 N/A N/A 80502911 EAP HCPCS C1769 GUIDEWIRE VASC 185CM .014IN FLXB INTMD TIP MDRT BOTH IP/OP $159.00 $118.00 $31.56 $159.00 $86.34 $86.34 $86.34 $86.34 $159.00 $159.00 $159.00 $33.14 $159.00 $118.01 $118.01 $122.56 $82.84 $33.14 $159.00 $159.00 $94.05 $159.00 $159.00 $159.00 $159.00 $119.25 $159.00 $159.00 $159.00 $79.50 $79.50 $125.93 $159.00 $127.20 $103.35 $31.56 $159.00 $92.22 $159.00 $159.00 $159.00 $33.14 $159.00 N/A N/A 80502912 EAP HCPCS C1725 CATHETER BALDILAT 2MM 142CM 40MM RADIOPQ OPTILEAP BOTH IP/OP $275.00 $203.50 $54.58 $275.00 $149.33 $149.33 $149.33 $149.33 $275.00 $275.00 $275.00 $57.32 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $275.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $54.58 $275.00 $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A 80502913 EAP HCPCS C1887 CATHETER GUID 100CM 6FR RWY FCR3.5 CURVE FEM PTFE BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80502914 EAP HCPCS C1887 CATHETER GUID 100CM 6FR RWY VL5 CURVE FEM PTFE LG BOTH IP/OP $103.00 $76.50 $20.44 $103.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $103.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80502915 EAP Custom 80502915 STYLET LEAD 100CM .014IN SFT WHT CAP GRN KNOB STR BOTH IP/OP $113.00 $84.00 $20.11 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $20.11 $113.00 $113.00 $83.87 $83.87 $87.10 $58.87 $23.55 $113.00 $45.20 $113.00 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $73.45 $113.00 $113.00 $65.54 $113.00 $67.80 $113.00 $113.00 $113.00 N/A N/A 80502916 EAP Custom 80502916 STYLET LEAD 45CM .014IN STR LIMBER BOTH IP/OP $113.00 $84.00 $20.11 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $20.11 $113.00 $113.00 $83.87 $83.87 $87.10 $58.87 $23.55 $113.00 $45.20 $113.00 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $73.45 $113.00 $113.00 $65.54 $113.00 $67.80 $113.00 $113.00 $113.00 N/A N/A 80502925 EAP HCPCS C1817 OCCLUDER CV 45D 5MM 13-17MM 3MM STRL LF AMPLZR 2 DISC SLF BOTH IP/OP "$16,558.00" "$12,253.00" "$3,450.87" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$3,450.87" "$16,558.00" "$6,623.20" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$12,418.50" "$16,558.00" "$16,558.00" "$16,558.00" "$8,279.00" "$8,279.00" "$13,113.94" "$16,558.00" "$13,246.40" "$7,451.10" "$16,558.00" "$16,558.00" "$9,603.64" "$16,558.00" "$9,934.80" "$16,558.00" "$16,558.00" "$16,558.00" N/A N/A 80502926 EAP HCPCS C1817 OCCLUDER CV 45D CRV 7MM 15-19MM 3MM STRL LF AMPLZR 2 DISK BOTH IP/OP "$16,558.00" "$12,253.00" "$3,450.87" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$3,450.87" "$16,558.00" "$6,623.20" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$12,418.50" "$16,558.00" "$16,558.00" "$16,558.00" "$8,279.00" "$8,279.00" "$13,113.94" "$16,558.00" "$13,246.40" "$7,451.10" "$16,558.00" "$16,558.00" "$9,603.64" "$16,558.00" "$9,934.80" "$16,558.00" "$16,558.00" "$16,558.00" N/A N/A 80502927 EAP HCPCS C1817 OCCLUDER CV 45D CRV 10MM 18-22MM 3MM STRL LF AMPLZR 2 DISC BOTH IP/OP "$16,558.00" "$12,253.00" "$3,450.87" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$3,450.87" "$16,558.00" "$6,623.20" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$12,418.50" "$16,558.00" "$16,558.00" "$16,558.00" "$8,279.00" "$8,279.00" "$13,113.94" "$16,558.00" "$13,246.40" "$7,451.10" "$16,558.00" "$16,558.00" "$9,603.64" "$16,558.00" "$9,934.80" "$16,558.00" "$16,558.00" "$16,558.00" N/A N/A 80502928 EAP HCPCS C1817 OCCLUDER CV 45D CRV 12MM 22-26MM 4MM STRL LF AMPLZR 2 DISC BOTH IP/OP "$16,558.00" "$12,253.00" "$3,450.87" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$3,450.87" "$16,558.00" "$6,623.20" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$12,418.50" "$16,558.00" "$16,558.00" "$16,558.00" "$8,279.00" "$8,279.00" "$13,113.94" "$16,558.00" "$13,246.40" "$7,451.10" "$16,558.00" "$16,558.00" "$9,603.64" "$16,558.00" "$9,934.80" "$16,558.00" "$16,558.00" "$16,558.00" N/A N/A 80502929 EAP HCPCS C1817 OCCLUDER CV 45D CRV 15MM 25-29MM 4MM STRL LF AMPLZR 2 DISC BOTH IP/OP "$16,558.00" "$12,253.00" "$3,450.87" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$3,450.87" "$16,558.00" "$6,623.20" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$12,418.50" "$16,558.00" "$16,558.00" "$16,558.00" "$8,279.00" "$8,279.00" "$13,113.94" "$16,558.00" "$13,246.40" "$7,451.10" "$16,558.00" "$16,558.00" "$9,603.64" "$16,558.00" "$9,934.80" "$16,558.00" "$16,558.00" "$16,558.00" N/A N/A 80502930 EAP HCPCS C1817 OCCLUDER CV 45D CRV 18MM 28-32MM 4MM AMPLZR 2 DISC SLF XPD BOTH IP/OP "$16,558.00" "$12,253.00" "$3,450.87" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$3,450.87" "$16,558.00" "$6,623.20" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$12,418.50" "$16,558.00" "$16,558.00" "$16,558.00" "$8,279.00" "$8,279.00" "$13,113.94" "$16,558.00" "$13,246.40" "$7,451.10" "$16,558.00" "$16,558.00" "$9,603.64" "$16,558.00" "$9,934.80" "$16,558.00" "$16,558.00" "$16,558.00" N/A N/A 80502931 EAP HCPCS C1817 OCCLUDER CV 45D CRV 30MM 40-44MM 4MM STRL LF AMPLZR 2 DISC BOTH IP/OP "$16,558.00" "$12,253.00" "$3,450.87" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$3,450.87" "$16,558.00" "$6,623.20" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$12,418.50" "$16,558.00" "$16,558.00" "$16,558.00" "$8,279.00" "$8,279.00" "$13,113.94" "$16,558.00" "$13,246.40" "$7,451.10" "$16,558.00" "$16,558.00" "$9,603.64" "$16,558.00" "$9,934.80" "$16,558.00" "$16,558.00" "$16,558.00" N/A N/A 80502932 EAP HCPCS C1817 OCCLUDER CV 45D CRV 18MM STRL LF AMPLZR 2 DISC BOTH IP/OP "$16,558.00" "$12,253.00" "$3,450.87" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$3,450.87" "$16,558.00" "$6,623.20" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$12,418.50" "$16,558.00" "$16,558.00" "$16,558.00" "$8,279.00" "$8,279.00" "$13,113.94" "$16,558.00" "$13,246.40" "$7,451.10" "$16,558.00" "$16,558.00" "$9,603.64" "$16,558.00" "$9,934.80" "$16,558.00" "$16,558.00" "$16,558.00" N/A N/A 80502933 EAP HCPCS C1817 OCCLUDER CV 45D CRV 25MM AMPLZR 2 DISC SLF XPD NTNL PLSTR BOTH IP/OP "$16,558.00" "$12,253.00" "$3,450.87" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$3,450.87" "$16,558.00" "$6,623.20" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$12,418.50" "$16,558.00" "$16,558.00" "$16,558.00" "$8,279.00" "$8,279.00" "$13,113.94" "$16,558.00" "$13,246.40" "$7,451.10" "$16,558.00" "$16,558.00" "$9,603.64" "$16,558.00" "$9,934.80" "$16,558.00" "$16,558.00" "$16,558.00" N/A N/A 80502934 EAP HCPCS C1817 OCCLUDER CV 45D CRV 30MM AMPLZR 2 DISC SLF XPD NTNL PLSTR BOTH IP/OP "$16,558.00" "$12,253.00" "$3,450.87" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$3,450.87" "$16,558.00" "$6,623.20" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$16,558.00" "$12,418.50" "$16,558.00" "$16,558.00" "$16,558.00" "$8,279.00" "$8,279.00" "$13,113.94" "$16,558.00" "$13,246.40" "$7,451.10" "$16,558.00" "$16,558.00" "$9,603.64" "$16,558.00" "$9,934.80" "$16,558.00" "$16,558.00" "$16,558.00" N/A N/A 80502935 EAP HCPCS C1773 CATHETER ES 180D 6FR 80CM AMPLZR TORQVUE SHTH REINF RADOPQ BOTH IP/OP "$1,840.00" "$1,362.00" $365.19 "$1,840.00" $999.12 $999.12 $999.12 $999.12 "$1,840.00" "$1,840.00" "$1,840.00" $383.50 "$1,840.00" "$1,365.65" "$1,365.65" "$1,418.27" $958.64 $383.48 "$1,840.00" "$1,840.00" "$1,088.36" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,380.00" "$1,840.00" "$1,840.00" "$1,840.00" $920.00 $920.00 "$1,457.28" "$1,840.00" "$1,472.00" "$1,196.00" $365.19 "$1,840.00" "$1,067.20" "$1,840.00" "$1,840.00" "$1,840.00" $383.46 "$1,840.00" N/A N/A 80502936 EAP HCPCS C1769 GUIDEWIRE VASC MOD J CRV .035IN 260CM STRL LF 7.5MM AMPLZR BOTH IP/OP $133.00 $98.50 $26.40 $133.00 $72.22 $72.22 $72.22 $72.22 $133.00 $133.00 $133.00 $27.72 $133.00 $98.71 $98.71 $102.52 $69.29 $27.72 $133.00 $133.00 $78.67 $133.00 $133.00 $133.00 $133.00 $99.75 $133.00 $133.00 $133.00 $66.50 $66.50 $105.34 $133.00 $106.40 $86.45 $26.40 $133.00 $77.14 $133.00 $133.00 $133.00 $27.72 $133.00 N/A N/A 80502937 EAP HCPCS C1769 GUIDEWIRE VASC MOD J CRV .035IN 260CM STRL LF 1.5MM AMPLZR BOTH IP/OP $133.00 $98.50 $26.40 $133.00 $72.22 $72.22 $72.22 $72.22 $133.00 $133.00 $133.00 $27.72 $133.00 $98.71 $98.71 $102.52 $69.29 $27.72 $133.00 $133.00 $78.67 $133.00 $133.00 $133.00 $133.00 $99.75 $133.00 $133.00 $133.00 $66.50 $66.50 $105.34 $133.00 $106.40 $86.45 $26.40 $133.00 $77.14 $133.00 $133.00 $133.00 $27.72 $133.00 N/A N/A 80502938 EAP HCPCS C1769 GUIDEWIRE VASC J CRV .035IN 300CM STRL LF 6MM AMPLZR FLX TP BOTH IP/OP $133.00 $98.50 $26.40 $133.00 $72.22 $72.22 $72.22 $72.22 $133.00 $133.00 $133.00 $27.72 $133.00 $98.71 $98.71 $102.52 $69.29 $27.72 $133.00 $133.00 $78.67 $133.00 $133.00 $133.00 $133.00 $99.75 $133.00 $133.00 $133.00 $66.50 $66.50 $105.34 $133.00 $106.40 $86.45 $26.40 $133.00 $77.14 $133.00 $133.00 $133.00 $27.72 $133.00 N/A N/A 80502939 EAP HCPCS C1769 GUIDEWIRE VASC J CRV .035IN 300CM STRL LF 6MM AMPLZR FLX TP BOTH IP/OP $133.00 $98.50 $26.40 $133.00 $72.22 $72.22 $72.22 $72.22 $133.00 $133.00 $133.00 $27.72 $133.00 $98.71 $98.71 $102.52 $69.29 $27.72 $133.00 $133.00 $78.67 $133.00 $133.00 $133.00 $133.00 $99.75 $133.00 $133.00 $133.00 $66.50 $66.50 $105.34 $133.00 $106.40 $86.45 $26.40 $133.00 $77.14 $133.00 $133.00 $133.00 $27.72 $133.00 N/A N/A 80502940 EAP HCPCS C1773 CATHETER DLV SYS 180D 5FR 60CM AMPLZR TORQVUE SHTH DIL REINF BOTH IP/OP "$1,840.00" "$1,362.00" $365.19 "$1,840.00" $999.12 $999.12 $999.12 $999.12 "$1,840.00" "$1,840.00" "$1,840.00" $383.50 "$1,840.00" "$1,365.65" "$1,365.65" "$1,418.27" $958.64 $383.48 "$1,840.00" "$1,840.00" "$1,088.36" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,380.00" "$1,840.00" "$1,840.00" "$1,840.00" $920.00 $920.00 "$1,457.28" "$1,840.00" "$1,472.00" "$1,196.00" $365.19 "$1,840.00" "$1,067.20" "$1,840.00" "$1,840.00" "$1,840.00" $383.46 "$1,840.00" N/A N/A 80502941 EAP HCPCS C1773 CATHETER DLV SYS 45D 6FR 60CM AMPLZR TORQVUE LFRIC RADOPQ BOTH IP/OP "$1,840.00" "$1,362.00" $365.19 "$1,840.00" $999.12 $999.12 $999.12 $999.12 "$1,840.00" "$1,840.00" "$1,840.00" $383.50 "$1,840.00" "$1,365.65" "$1,365.65" "$1,418.27" $958.64 $383.48 "$1,840.00" "$1,840.00" "$1,088.36" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,380.00" "$1,840.00" "$1,840.00" "$1,840.00" $920.00 $920.00 "$1,457.28" "$1,840.00" "$1,472.00" "$1,196.00" $365.19 "$1,840.00" "$1,067.20" "$1,840.00" "$1,840.00" "$1,840.00" $383.46 "$1,840.00" N/A N/A 80502942 EAP HCPCS C1773 CATHETER DLV SYS 45D 7FR 60CM AMPLZR TORQVUE LFRIC RADOPQ BOTH IP/OP "$1,840.00" "$1,362.00" $365.19 "$1,840.00" $999.12 $999.12 $999.12 $999.12 "$1,840.00" "$1,840.00" "$1,840.00" $383.50 "$1,840.00" "$1,365.65" "$1,365.65" "$1,418.27" $958.64 $383.48 "$1,840.00" "$1,840.00" "$1,088.36" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,380.00" "$1,840.00" "$1,840.00" "$1,840.00" $920.00 $920.00 "$1,457.28" "$1,840.00" "$1,472.00" "$1,196.00" $365.19 "$1,840.00" "$1,067.20" "$1,840.00" "$1,840.00" "$1,840.00" $383.46 "$1,840.00" N/A N/A 80502943 EAP HCPCS C1766 SYSTEM DLV 45D 7FR 80CM AMPLZR TORQVUE LFRIC RADOPQ TIP BOTH IP/OP "$1,840.00" "$1,362.00" $383.48 "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,365.65" "$1,365.65" "$1,418.27" $958.64 $383.48 "$1,840.00" $736.00 "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,380.00" "$1,840.00" "$1,840.00" "$1,840.00" $920.00 $920.00 "$1,457.28" "$1,840.00" "$1,472.00" "$1,196.00" "$1,840.00" "$1,840.00" "$1,067.20" "$1,840.00" "$1,104.00" "$1,840.00" "$1,840.00" "$1,840.00" N/A N/A 80502944 EAP HCPCS C1773 CATHETER DLV SYS 45D 8FR 60CM AMPLZR TORQVUE LFRIC RADOPQ BOTH IP/OP "$1,840.00" "$1,362.00" $365.19 "$1,840.00" $999.12 $999.12 $999.12 $999.12 "$1,840.00" "$1,840.00" "$1,840.00" $383.50 "$1,840.00" "$1,365.65" "$1,365.65" "$1,418.27" $958.64 $383.48 "$1,840.00" "$1,840.00" "$1,088.36" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,380.00" "$1,840.00" "$1,840.00" "$1,840.00" $920.00 $920.00 "$1,457.28" "$1,840.00" "$1,472.00" "$1,196.00" $365.19 "$1,840.00" "$1,067.20" "$1,840.00" "$1,840.00" "$1,840.00" $383.46 "$1,840.00" N/A N/A 80502945 EAP HCPCS C1773 CATHETER DLV SYS 45D 8FR 80CM AMPLZR TORQVUE LFRIC RADOPQ BOTH IP/OP "$1,840.00" "$1,362.00" $365.19 "$1,840.00" $999.12 $999.12 $999.12 $999.12 "$1,840.00" "$1,840.00" "$1,840.00" $383.50 "$1,840.00" "$1,365.65" "$1,365.65" "$1,418.27" $958.64 $383.48 "$1,840.00" "$1,840.00" "$1,088.36" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,380.00" "$1,840.00" "$1,840.00" "$1,840.00" $920.00 $920.00 "$1,457.28" "$1,840.00" "$1,472.00" "$1,196.00" $365.19 "$1,840.00" "$1,067.20" "$1,840.00" "$1,840.00" "$1,840.00" $383.46 "$1,840.00" N/A N/A 80502946 EAP HCPCS C1773 CATHETER DLV SYS 45D 9FR 80CM AMPLZR TORQVUE RADOPQ TIP BOTH IP/OP "$1,840.00" "$1,362.00" $365.19 "$1,840.00" $999.12 $999.12 $999.12 $999.12 "$1,840.00" "$1,840.00" "$1,840.00" $383.50 "$1,840.00" "$1,365.65" "$1,365.65" "$1,418.27" $958.64 $383.48 "$1,840.00" "$1,840.00" "$1,088.36" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,380.00" "$1,840.00" "$1,840.00" "$1,840.00" $920.00 $920.00 "$1,457.28" "$1,840.00" "$1,472.00" "$1,196.00" $365.19 "$1,840.00" "$1,067.20" "$1,840.00" "$1,840.00" "$1,840.00" $383.46 "$1,840.00" N/A N/A 80502947 EAP HCPCS C1817 OCCLUDER CV CONE 6-4MM 10MM 7MM STRL LF AMPLZR SLF XPD SCR BOTH IP/OP "$10,763.00" "$7,965.00" "$2,243.13" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$2,243.13" "$10,763.00" "$4,305.20" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$8,072.25" "$10,763.00" "$10,763.00" "$10,763.00" "$5,381.50" "$5,381.50" "$8,524.30" "$10,763.00" "$8,610.40" "$4,843.35" "$10,763.00" "$10,763.00" "$6,242.54" "$10,763.00" "$6,457.80" "$10,763.00" "$10,763.00" "$10,763.00" N/A N/A 80502948 EAP HCPCS C1817 OCCLUDER CV 10MM STRL LF AMPLZR DUCTAL DISP BOTH IP/OP "$10,763.00" "$7,965.00" "$2,243.13" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$2,243.13" "$10,763.00" "$4,305.20" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$8,072.25" "$10,763.00" "$10,763.00" "$10,763.00" "$5,381.50" "$5,381.50" "$8,524.30" "$10,763.00" "$8,610.40" "$4,843.35" "$10,763.00" "$10,763.00" "$6,242.54" "$10,763.00" "$6,457.80" "$10,763.00" "$10,763.00" "$10,763.00" N/A N/A 80502949 EAP HCPCS C1817 OCCLUDER CV 8MM STRL LF AMPLZR DUCTAL DISP BOTH IP/OP "$10,763.00" "$7,965.00" "$2,243.13" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$2,243.13" "$10,763.00" "$4,305.20" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$10,763.00" "$8,072.25" "$10,763.00" "$10,763.00" "$10,763.00" "$5,381.50" "$5,381.50" "$8,524.30" "$10,763.00" "$8,610.40" "$4,843.35" "$10,763.00" "$10,763.00" "$6,242.54" "$10,763.00" "$6,457.80" "$10,763.00" "$10,763.00" "$10,763.00" N/A N/A 80502950 EAP HCPCS C1817 OCCLUDER CV 9MM 3MM 6MM AMPLZR TORQVUE LP 2 ARTC DISC 6 PLN BOTH IP/OP "$12,863.00" "$9,519.00" "$2,680.79" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$2,680.79" "$12,863.00" "$5,145.20" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$9,647.25" "$12,863.00" "$12,863.00" "$12,863.00" "$6,431.50" "$6,431.50" "$10,187.50" "$12,863.00" "$10,290.40" "$5,788.35" "$12,863.00" "$12,863.00" "$7,460.54" "$12,863.00" "$7,717.80" "$12,863.00" "$12,863.00" "$12,863.00" N/A N/A 80502951 EAP HCPCS C1817 OCCLUDER CV 10MM 4MM 6MM AMPLZR TORQVUE LP 2 ARTC DISC 6 PLN BOTH IP/OP "$12,863.00" "$9,519.00" "$2,680.79" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$2,680.79" "$12,863.00" "$5,145.20" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$9,647.25" "$12,863.00" "$12,863.00" "$12,863.00" "$6,431.50" "$6,431.50" "$10,187.50" "$12,863.00" "$10,290.40" "$5,788.35" "$12,863.00" "$12,863.00" "$7,460.54" "$12,863.00" "$7,717.80" "$12,863.00" "$12,863.00" "$12,863.00" N/A N/A 80502952 EAP HCPCS C1817 OCCLUDER CV 11MM 5MM 4MM AMPLZR TORQVUE LP 2 ARTC DISC 6 PLN BOTH IP/OP "$12,863.00" "$9,519.00" "$2,680.79" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$2,680.79" "$12,863.00" "$5,145.20" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$9,647.25" "$12,863.00" "$12,863.00" "$12,863.00" "$6,431.50" "$6,431.50" "$10,187.50" "$12,863.00" "$10,290.40" "$5,788.35" "$12,863.00" "$12,863.00" "$7,460.54" "$12,863.00" "$7,717.80" "$12,863.00" "$12,863.00" "$12,863.00" N/A N/A 80502953 EAP HCPCS C1817 OCCLUDER CV 11MM 5MM 6MM AMPLZR TORQVUE LP 2 ARTC DISC 6 PLN BOTH IP/OP "$12,863.00" "$9,519.00" "$2,680.79" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$2,680.79" "$12,863.00" "$5,145.20" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$9,647.25" "$12,863.00" "$12,863.00" "$12,863.00" "$6,431.50" "$6,431.50" "$10,187.50" "$12,863.00" "$10,290.40" "$5,788.35" "$12,863.00" "$12,863.00" "$7,460.54" "$12,863.00" "$7,717.80" "$12,863.00" "$12,863.00" "$12,863.00" N/A N/A 80502954 EAP HCPCS C1817 OCCLUDER CV 12MM 6MM 4.25MM AMPLZR TORQVUE LP 2 ARTC DISC 6 BOTH IP/OP "$12,863.00" "$9,519.00" "$2,680.79" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$2,680.79" "$12,863.00" "$5,145.20" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$9,647.25" "$12,863.00" "$12,863.00" "$12,863.00" "$6,431.50" "$6,431.50" "$10,187.50" "$12,863.00" "$10,290.40" "$5,788.35" "$12,863.00" "$12,863.00" "$7,460.54" "$12,863.00" "$7,717.80" "$12,863.00" "$12,863.00" "$12,863.00" N/A N/A 80502955 EAP HCPCS C1817 OCCLUDER CV 12MM 6MM 6.25MM AMPLZR TORQVUE LP 2 ARTC DISC 6 BOTH IP/OP "$12,863.00" "$9,519.00" "$2,680.79" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$2,680.79" "$12,863.00" "$5,145.20" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$12,863.00" "$9,647.25" "$12,863.00" "$12,863.00" "$12,863.00" "$6,431.50" "$6,431.50" "$10,187.50" "$12,863.00" "$10,290.40" "$5,788.35" "$12,863.00" "$12,863.00" "$7,460.54" "$12,863.00" "$7,717.80" "$12,863.00" "$12,863.00" "$12,863.00" N/A N/A 80502956 EAP HCPCS C1817 OCCLUDER CV 35MM STRL LF AMPLZR BOTH IP/OP "$24,988.00" "$18,491.50" "$5,207.77" "$24,988.00" "$24,988.00" "$24,988.00" "$24,988.00" "$24,988.00" "$24,988.00" "$24,988.00" "$24,988.00" "$24,988.00" "$24,988.00" "$24,988.00" "$24,988.00" "$24,988.00" "$24,988.00" "$5,207.77" "$24,988.00" "$9,995.20" "$24,988.00" "$24,988.00" "$24,988.00" "$24,988.00" "$24,988.00" "$18,741.00" "$24,988.00" "$24,988.00" "$24,988.00" "$12,494.00" "$12,494.00" "$19,790.50" "$24,988.00" "$19,990.40" "$11,244.60" "$24,988.00" "$24,988.00" "$14,493.04" "$24,988.00" "$14,992.80" "$24,988.00" "$24,988.00" "$24,988.00" N/A N/A 80502957 EAP HCPCS C1817 SHEATH DLV 45D 9FR .15IN .118IN 100CM STRL LF AMPLZR TORQVUE BOTH IP/OP "$2,170.00" "$1,606.00" $452.25 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" $452.25 "$2,170.00" $868.00 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$1,627.50" "$2,170.00" "$2,170.00" "$2,170.00" "$1,085.00" "$1,085.00" "$1,718.64" "$2,170.00" "$1,736.00" $976.50 "$2,170.00" "$2,170.00" "$1,258.60" "$2,170.00" "$1,302.00" "$2,170.00" "$2,170.00" "$2,170.00" N/A N/A 80502958 EAP HCPCS C1817 SHEATH DLV 45D 12FR .189IN .157IN 100CM STRL LF AMPLZR BOTH IP/OP "$2,170.00" "$1,606.00" $452.25 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" $452.25 "$2,170.00" $868.00 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$1,627.50" "$2,170.00" "$2,170.00" "$2,170.00" "$1,085.00" "$1,085.00" "$1,718.64" "$2,170.00" "$1,736.00" $976.50 "$2,170.00" "$2,170.00" "$1,258.60" "$2,170.00" "$1,302.00" "$2,170.00" "$2,170.00" "$2,170.00" N/A N/A 80502959 EAP HCPCS C1817 SHEATH DLV 45D 14FR .215IN .184IN 100CM STRL LF AMPLZR BOTH IP/OP "$2,170.00" "$1,606.00" $452.25 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" $452.25 "$2,170.00" $868.00 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$1,627.50" "$2,170.00" "$2,170.00" "$2,170.00" "$1,085.00" "$1,085.00" "$1,718.64" "$2,170.00" "$1,736.00" $976.50 "$2,170.00" "$2,170.00" "$1,258.60" "$2,170.00" "$1,302.00" "$2,170.00" "$2,170.00" "$2,170.00" N/A N/A 80502960 EAP HCPCS C1766 SYSTEM DLV 90D 4FR 1.4IN 1.17IN 60CM 160CM AMPLZR TORQVUE SS BOTH IP/OP "$1,840.00" "$1,362.00" $383.48 "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,365.65" "$1,365.65" "$1,418.27" $958.64 $383.48 "$1,840.00" $736.00 "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,380.00" "$1,840.00" "$1,840.00" "$1,840.00" $920.00 $920.00 "$1,457.28" "$1,840.00" "$1,472.00" "$1,196.00" "$1,840.00" "$1,840.00" "$1,067.20" "$1,840.00" "$1,104.00" "$1,840.00" "$1,840.00" "$1,840.00" N/A N/A 80502961 EAP HCPCS C1766 SYSTEM DLV 90D 4FR .055IN .046IN 80CM 195CM AMPLZR TORQVUE BOTH IP/OP "$1,840.00" "$1,362.00" $383.48 "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,365.65" "$1,365.65" "$1,418.27" $958.64 $383.48 "$1,840.00" $736.00 "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,380.00" "$1,840.00" "$1,840.00" "$1,840.00" $920.00 $920.00 "$1,457.28" "$1,840.00" "$1,472.00" "$1,196.00" "$1,840.00" "$1,840.00" "$1,067.20" "$1,840.00" "$1,104.00" "$1,840.00" "$1,840.00" "$1,840.00" N/A N/A 80502962 EAP HCPCS C1766 SYSTEM DLV 90D 5FR .068IN .059IN 60CM 160CM AMPLZR TORQVUE BOTH IP/OP "$1,840.00" "$1,362.00" $383.48 "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,365.65" "$1,365.65" "$1,418.27" $958.64 $383.48 "$1,840.00" $736.00 "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,380.00" "$1,840.00" "$1,840.00" "$1,840.00" $920.00 $920.00 "$1,457.28" "$1,840.00" "$1,472.00" "$1,196.00" "$1,840.00" "$1,840.00" "$1,067.20" "$1,840.00" "$1,104.00" "$1,840.00" "$1,840.00" "$1,840.00" N/A N/A 80502963 EAP HCPCS C1766 SYSTEM DLV 90D 5FR .068IN .059IN 80CM 195CM AMPLZR TORQVUE BOTH IP/OP "$1,840.00" "$1,362.00" $383.48 "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,365.65" "$1,365.65" "$1,418.27" $958.64 $383.48 "$1,840.00" $736.00 "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,840.00" "$1,380.00" "$1,840.00" "$1,840.00" "$1,840.00" $920.00 $920.00 "$1,457.28" "$1,840.00" "$1,472.00" "$1,196.00" "$1,840.00" "$1,840.00" "$1,067.20" "$1,840.00" "$1,104.00" "$1,840.00" "$1,840.00" "$1,840.00" N/A N/A 80502964 EAP HCPCS C1817 OCCLUDER CV CRV 6MM 7MM STRL LF AMPLZR 2 DISC SLF XPD DLV BOTH IP/OP "$19,933.00" "$14,750.50" "$4,154.26" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$4,154.26" "$19,933.00" "$7,973.20" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$14,949.75" "$19,933.00" "$19,933.00" "$19,933.00" "$9,966.50" "$9,966.50" "$15,786.94" "$19,933.00" "$15,946.40" "$8,969.85" "$19,933.00" "$19,933.00" "$11,561.14" "$19,933.00" "$11,959.80" "$19,933.00" "$19,933.00" "$19,933.00" N/A N/A 80502965 EAP HCPCS C1817 OCCLUDER CV CRV 8MM 7MM STRL LF AMPLZR 2 DISC SLF XPD DLV BOTH IP/OP "$19,933.00" "$14,750.50" "$4,154.26" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$4,154.26" "$19,933.00" "$7,973.20" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$14,949.75" "$19,933.00" "$19,933.00" "$19,933.00" "$9,966.50" "$9,966.50" "$15,786.94" "$19,933.00" "$15,946.40" "$8,969.85" "$19,933.00" "$19,933.00" "$11,561.14" "$19,933.00" "$11,959.80" "$19,933.00" "$19,933.00" "$19,933.00" N/A N/A 80502966 EAP HCPCS C1817 OCCLUDER CV 12MM 7MM STRL LF AMPLZR 2 DISC SLF XPD DLV SYS BOTH IP/OP "$19,933.00" "$14,750.50" "$4,154.26" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$4,154.26" "$19,933.00" "$7,973.20" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$14,949.75" "$19,933.00" "$19,933.00" "$19,933.00" "$9,966.50" "$9,966.50" "$15,786.94" "$19,933.00" "$15,946.40" "$8,969.85" "$19,933.00" "$19,933.00" "$11,561.14" "$19,933.00" "$11,959.80" "$19,933.00" "$19,933.00" "$19,933.00" N/A N/A 80502967 EAP HCPCS C1817 OCCLUDER CV 14MM 22MM 7MM AMPLZR 2 DISC SLF XPD NTNL PLSTR BOTH IP/OP "$19,933.00" "$14,750.50" "$4,154.26" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$4,154.26" "$19,933.00" "$7,973.20" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$14,949.75" "$19,933.00" "$19,933.00" "$19,933.00" "$9,966.50" "$9,966.50" "$15,786.94" "$19,933.00" "$15,946.40" "$8,969.85" "$19,933.00" "$19,933.00" "$11,561.14" "$19,933.00" "$11,959.80" "$19,933.00" "$19,933.00" "$19,933.00" N/A N/A 80502968 EAP HCPCS C1817 OCCLUDER CV CRV 18MM 7MM STRL LF AMPLZR 2 DISC SLF XPD DLV BOTH IP/OP "$19,933.00" "$14,750.50" "$4,154.26" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$4,154.26" "$19,933.00" "$7,973.20" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$19,933.00" "$14,949.75" "$19,933.00" "$19,933.00" "$19,933.00" "$9,966.50" "$9,966.50" "$15,786.94" "$19,933.00" "$15,946.40" "$8,969.85" "$19,933.00" "$19,933.00" "$11,561.14" "$19,933.00" "$11,959.80" "$19,933.00" "$19,933.00" "$19,933.00" N/A N/A 80502972 EAP HCPCS C1894 INTRODUCER SHTH .038IN 8FR 80CM STRL FLXR SHTL SL 1 DIL T-B BOTH IP/OP $188.00 $139.50 $37.31 $188.00 $102.08 $102.08 $102.08 $102.08 $188.00 $188.00 $188.00 $39.18 $188.00 $139.53 $139.53 $144.91 $97.95 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $122.20 $37.31 $188.00 $109.04 $188.00 $188.00 $188.00 $39.18 $188.00 N/A N/A 80502973 EAP HCPCS C1757 RETRIEVER TREVO NXT PROVUE 6 X BOTH IP/OP "$13,116.00" "$9,706.00" "$2,060.15" "$13,116.00" "$7,121.99" "$7,121.99" "$7,121.99" "$7,121.99" "$13,116.00" "$13,116.00" "$13,116.00" "$2,733.70" "$13,116.00" "$4,181.12" "$4,181.12" "$10,109.81" "$2,060.15" "$2,733.52" "$13,116.00" "$13,116.00" "$3,094.73" "$13,116.00" "$13,116.00" "$13,116.00" "$13,116.00" "$9,837.00" "$13,116.00" "$13,116.00" "$13,116.00" "$6,558.00" "$6,558.00" "$10,387.87" "$13,116.00" "$10,492.80" "$8,525.40" "$2,603.20" "$13,116.00" "$7,607.28" "$13,116.00" "$13,116.00" "$13,116.00" "$2,733.37" "$13,116.00" N/A N/A 80502976 EAP CANISTER SCT NS PENUMBRA ENG BOTH IP/OP $900.00 $666.00 $160.20 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $160.20 $900.00 $900.00 $667.98 $667.98 $693.72 $468.90 $187.57 $900.00 $360.00 $900.00 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $585.00 $900.00 $900.00 $522.00 $900.00 $540.00 $900.00 $900.00 $900.00 N/A N/A 80502978 EAP COIL EMBL STD .02IN 4MM 10CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80502979 EAP COIL EMBL 1MM 2CM STRL LF RUBY LP BOTH IP/OP "$1,975.00" "$1,461.50" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" "$1,975.00" "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A 80502980 EAP COIL EMBL 1MM 5CM STRL LF RUBY LP BOTH IP/OP "$1,975.00" "$1,461.50" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" "$1,975.00" "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A 80502981 EAP COIL EMBL 2MM 2CM STRL LF RUBY LP BOTH IP/OP "$1,975.00" "$1,461.50" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" "$1,975.00" "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A 80502982 EAP COIL EMBL 2MM 4CM STRL LF RUBY LP BOTH IP/OP "$1,975.00" "$1,461.50" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" "$1,975.00" "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A 80502983 EAP COIL EMBL 2MM 10CM STRL LF RUBY LP BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80502984 EAP COIL EMBL 3MM 4CM STRL LF RUBY LP BOTH IP/OP "$1,975.00" "$1,461.50" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" "$1,975.00" "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A 80502985 EAP COIL EMBL 3MM 10CM STRL LF RUBY LP BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80502986 EAP COIL EMBL 3MM 15CM STRL LF RUBY LP BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80502987 EAP COIL EMBL 4MM 6CM STRL LF RUBY LP BOTH IP/OP "$1,975.00" "$1,461.50" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" "$1,975.00" "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A 80502988 EAP COIL EMBL 4MM 15CM STRL LF RUBY LP BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80502989 EAP COIL EMBL 4MM 30CM STRL LF RUBY LP BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80502990 EAP COIL EMBL 3CM STRL LF PK COIL LP BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80502991 EAP COIL EMBL 6CM STRL LF PK COIL LP BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80502992 EAP COIL EMBL 10CM STRL LF PK COIL LP BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80502993 EAP COIL EMBL 15CM STRL LF PK COIL LP BOTH IP/OP "$2,475.00" "$1,831.50" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" "$2,475.00" "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A 80502994 EAP COIL EMBL 30CM STRL LF PK COIL LP BOTH IP/OP "$3,225.00" "$2,386.50" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" "$3,225.00" "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A 80502995 EAP HANDLE INST STRL LF DTCH DISP LP COIL SYS BOTH IP/OP $595.00 $440.50 $105.91 $595.00 $595.00 $595.00 $595.00 $595.00 $595.00 $595.00 $105.91 $595.00 $595.00 $441.61 $441.61 $458.63 $310.00 $124.00 $595.00 $238.00 $595.00 $595.00 $595.00 $595.00 $595.00 $446.25 $595.00 $595.00 $595.00 $297.50 $297.50 $471.24 $595.00 $476.00 $386.75 $595.00 $595.00 $345.10 $595.00 $357.00 $595.00 $595.00 $595.00 N/A N/A 80503313 EAP HCPCS C1767 SYSTEM NRSTM BAROSTIM NEO IPG 1 MODL 1036 CSL CMBN KT CSL LD BOTH IP/OP "$87,500.00" "$64,750.00" "$18,235.96" "$87,500.00" "$87,500.00" "$87,500.00" "$87,500.00" "$87,500.00" "$87,500.00" "$87,500.00" "$87,500.00" "$87,500.00" "$87,500.00" "$87,500.00" "$87,500.00" "$87,500.00" "$87,500.00" "$18,235.96" "$87,500.00" "$35,000.00" "$87,500.00" "$87,500.00" "$87,500.00" "$87,500.00" "$87,500.00" "$65,625.00" "$87,500.00" "$87,500.00" "$87,500.00" "$43,750.00" "$43,750.00" "$69,300.00" "$87,500.00" "$70,000.00" "$39,375.00" "$87,500.00" "$87,500.00" "$50,750.00" "$87,500.00" "$52,500.00" "$87,500.00" "$87,500.00" "$87,500.00" N/A N/A 80503314 EAP HCPCS C1767 GENERATOR NRSTM STRL LF BAROSTIM NEO PLS MODL 2102 BOTH IP/OP "$78,750.00" "$58,275.00" "$16,412.37" "$78,750.00" "$78,750.00" "$78,750.00" "$78,750.00" "$78,750.00" "$78,750.00" "$78,750.00" "$78,750.00" "$78,750.00" "$78,750.00" "$78,750.00" "$78,750.00" "$78,750.00" "$78,750.00" "$16,412.37" "$78,750.00" "$31,500.00" "$78,750.00" "$78,750.00" "$78,750.00" "$78,750.00" "$78,750.00" "$59,062.50" "$78,750.00" "$78,750.00" "$78,750.00" "$39,375.00" "$39,375.00" "$62,370.00" "$78,750.00" "$63,000.00" "$35,437.50" "$78,750.00" "$78,750.00" "$45,675.00" "$78,750.00" "$47,250.00" "$78,750.00" "$78,750.00" "$78,750.00" N/A N/A 80503315 EAP HCPCS C1778 KIT NRSTM SHRT STRL LF BAROSTIM NEO LD CRTD SIN MODL 1036 BOTH IP/OP "$17,500.00" "$12,950.00" "$3,647.19" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$3,647.19" "$17,500.00" "$7,000.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$13,125.00" "$17,500.00" "$17,500.00" "$17,500.00" "$8,750.00" "$8,750.00" "$13,860.00" "$17,500.00" "$14,000.00" "$7,875.00" "$17,500.00" "$17,500.00" "$10,150.00" "$17,500.00" "$10,500.00" "$17,500.00" "$17,500.00" "$17,500.00" N/A N/A 80512489 EAP KIT BIOPSY DISPOSABLE NEEDLE SEMI-AUTOMATIC 18G X 10CM BOTH IP/OP $140.00 $104.00 $24.92 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $24.92 $140.00 $140.00 $103.91 $103.91 $107.91 $72.94 $29.18 $140.00 $56.00 $140.00 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $91.00 $140.00 $140.00 $81.20 $140.00 $84.00 $140.00 $140.00 $140.00 N/A N/A 80512490 EAP KIT BIOPSY DISPOSABLE NEEDLE SEMI-AUTOMATIC 18G X 16CM BOTH IP/OP $140.00 $104.00 $24.92 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $24.92 $140.00 $140.00 $103.91 $103.91 $107.91 $72.94 $29.18 $140.00 $56.00 $140.00 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $91.00 $140.00 $140.00 $81.20 $140.00 $84.00 $140.00 $140.00 $140.00 N/A N/A 80512491 EAP KIT BIOPSY DISPOSABLE NEEDLE SEMI-AUTOMATIC 18G X 20CM BOTH IP/OP $140.00 $104.00 $24.92 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $24.92 $140.00 $140.00 $103.91 $103.91 $107.91 $72.94 $29.18 $140.00 $56.00 $140.00 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $91.00 $140.00 $140.00 $81.20 $140.00 $84.00 $140.00 $140.00 $140.00 N/A N/A 80512492 EAP KIT BIOPSY DISPOSABLE NEEDLE SEMI-AUTOMATIC 20G X 10CM BOTH IP/OP $140.00 $104.00 $24.92 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $24.92 $140.00 $140.00 $103.91 $103.91 $107.91 $72.94 $29.18 $140.00 $56.00 $140.00 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $91.00 $140.00 $140.00 $81.20 $140.00 $84.00 $140.00 $140.00 $140.00 N/A N/A 80512493 EAP KIT BIOPSY DISPOSABLE NEEDLE SEMI-AUTOMATIC 20G X 16CM BOTH IP/OP $140.00 $104.00 $24.92 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $24.92 $140.00 $140.00 $103.91 $103.91 $107.91 $72.94 $29.18 $140.00 $56.00 $140.00 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $91.00 $140.00 $140.00 $81.20 $140.00 $84.00 $140.00 $140.00 $140.00 N/A N/A 80512494 EAP KIT BIOPSY DISPOSABLE NEEDLE SEMI-AUTOMATIC 20G X 20CM BOTH IP/OP $140.00 $104.00 $24.92 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $24.92 $140.00 $140.00 $103.91 $103.91 $107.91 $72.94 $29.18 $140.00 $56.00 $140.00 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $91.00 $140.00 $140.00 $81.20 $140.00 $84.00 $140.00 $140.00 $140.00 N/A N/A 80513519 EAP HCPCS C1757 CATHETER FLOWTRIEVER SYS 40 MICRON FILTRATION 60CC COLLECT SYRINGE BOTH IP/OP "$30,000.00" "$22,200.00" "$2,060.15" "$30,000.00" "$16,290.00" "$16,290.00" "$16,290.00" "$16,290.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$4,181.12" "$4,181.12" "$23,124.00" "$2,060.15" "$6,252.33" "$30,000.00" "$30,000.00" "$3,094.73" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$19,500.00" "$5,954.25" "$30,000.00" "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 80513606 EAP HCPCS C1757 DEVICE THRMB 20MM 4MM PRST CLOSE RING HLCL SLT 2 BOTH IP/OP "$10,563.00" "$7,817.00" "$2,060.15" "$10,563.00" "$5,735.71" "$5,735.71" "$5,735.71" "$5,735.71" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.59" "$10,563.00" "$4,181.12" "$4,181.12" "$8,141.96" "$2,060.15" "$2,201.45" "$10,563.00" "$10,563.00" "$3,094.73" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$7,922.25" "$10,563.00" "$10,563.00" "$10,563.00" "$5,281.50" "$5,281.50" "$8,365.90" "$10,563.00" "$8,450.40" "$6,865.95" "$2,096.49" "$10,563.00" "$6,126.54" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.33" "$10,563.00" N/A N/A 80513607 EAP HCPCS C1757 DEVICE THRMB 40MM 5MM PRST CLOSE RING HLCL SLT 2 BOTH IP/OP "$10,563.00" "$7,817.00" "$2,060.15" "$10,563.00" "$5,735.71" "$5,735.71" "$5,735.71" "$5,735.71" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.59" "$10,563.00" "$4,181.12" "$4,181.12" "$8,141.96" "$2,060.15" "$2,201.45" "$10,563.00" "$10,563.00" "$3,094.73" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$7,922.25" "$10,563.00" "$10,563.00" "$10,563.00" "$5,281.50" "$5,281.50" "$8,365.90" "$10,563.00" "$8,450.40" "$6,865.95" "$2,096.49" "$10,563.00" "$6,126.54" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.33" "$10,563.00" N/A N/A 80513608 EAP HCPCS C1757 DEVICE THRMB 30MM 6MM PRST CLOSE RING HLCL SLT 2 BOTH IP/OP "$10,563.00" "$7,817.00" "$2,060.15" "$10,563.00" "$5,735.71" "$5,735.71" "$5,735.71" "$5,735.71" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.59" "$10,563.00" "$4,181.12" "$4,181.12" "$8,141.96" "$2,060.15" "$2,201.45" "$10,563.00" "$10,563.00" "$3,094.73" "$10,563.00" "$10,563.00" "$10,563.00" "$10,563.00" "$7,922.25" "$10,563.00" "$10,563.00" "$10,563.00" "$5,281.50" "$5,281.50" "$8,365.90" "$10,563.00" "$8,450.40" "$6,865.95" "$2,096.49" "$10,563.00" "$6,126.54" "$10,563.00" "$10,563.00" "$10,563.00" "$2,201.33" "$10,563.00" N/A N/A 80513610 EAP HCPCS C9358 MATRIX TISS 25CMX13CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$12,187.50" "$9,019.00" $14.42 "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" $14.42 "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" "$2,540.01" "$12,187.50" "$4,875.00" "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" "$9,140.63" "$12,187.50" "$12,187.50" "$12,187.50" "$6,093.75" "$6,093.75" "$9,652.50" "$12,187.50" "$9,750.00" "$5,484.38" "$12,187.50" "$12,187.50" "$7,068.75" "$12,187.50" "$7,312.50" "$12,187.50" "$12,187.50" "$12,187.50" N/A N/A 80513611 EAP HCPCS C9358 MATRIX TISS 16CMX4CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$2,400.00" "$1,776.00" $14.42 "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" $14.42 "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" $500.19 "$2,400.00" $960.00 "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$1,800.00" "$2,400.00" "$2,400.00" "$2,400.00" "$1,200.00" "$1,200.00" "$1,900.80" "$2,400.00" "$1,920.00" "$1,080.00" "$2,400.00" "$2,400.00" "$1,392.00" "$2,400.00" "$1,440.00" "$2,400.00" "$2,400.00" "$2,400.00" N/A N/A 80513612 EAP HCPCS C9358 MATRIX TISS 3CMX3CMX1MM SURGIMEND FLAT SQ BVN DERM BOTH IP/OP $337.50 $250.00 $14.42 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $14.42 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $337.50 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $337.50 $337.50 $195.75 $337.50 $202.50 $337.50 $337.50 $337.50 N/A N/A 80513613 EAP HCPCS C9358 MATRIX TISS 7CMX4CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$1,050.00" $777.00 $14.42 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $14.42 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $218.83 "$1,050.00" $420.00 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $787.50 "$1,050.00" "$1,050.00" "$1,050.00" $525.00 $525.00 $831.60 "$1,050.00" $840.00 $472.50 "$1,050.00" "$1,050.00" $609.00 "$1,050.00" $630.00 "$1,050.00" "$1,050.00" "$1,050.00" N/A N/A 80513614 EAP HCPCS C9358 MATRIX TISS 30CMX20CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$22,500.00" "$16,650.00" $14.42 "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" $14.42 "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$4,689.25" "$22,500.00" "$9,000.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$16,875.00" "$22,500.00" "$22,500.00" "$22,500.00" "$11,250.00" "$11,250.00" "$17,820.00" "$22,500.00" "$18,000.00" "$10,125.00" "$22,500.00" "$22,500.00" "$13,050.00" "$22,500.00" "$13,500.00" "$22,500.00" "$22,500.00" "$22,500.00" N/A N/A 80513615 EAP HCPCS C9358 MATRIX TISS 7CMX4CMX.6MM SURGIMEND THN FLAT RECT BOTH IP/OP "$1,050.00" $777.00 $14.42 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $14.42 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $218.83 "$1,050.00" $420.00 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $787.50 "$1,050.00" "$1,050.00" "$1,050.00" $525.00 $525.00 $831.60 "$1,050.00" $840.00 $472.50 "$1,050.00" "$1,050.00" $609.00 "$1,050.00" $630.00 "$1,050.00" "$1,050.00" "$1,050.00" N/A N/A 80513616 EAP HCPCS C9358 MESH SURG SURGIMEND 6X5CM STRL ACLR DRML TISS MTRX BOTH IP/OP "$1,125.00" $832.50 $14.42 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $14.42 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 80513617 EAP HCPCS C9358 MATRIX TISS 3CMX3CMX.6MM SURGIMEND THN FLAT SQ BVN BOTH IP/OP $337.50 $250.00 $14.42 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $14.42 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $337.50 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $337.50 $337.50 $195.75 $337.50 $202.50 $337.50 $337.50 $337.50 N/A N/A 80513618 EAP HCPCS C9358 MATRIX TISS 25CMX.3CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP $282.50 $209.50 $14.42 $282.50 $282.50 $282.50 $282.50 $282.50 $282.50 $282.50 $14.42 $282.50 $282.50 $282.50 $282.50 $282.50 $282.50 $58.88 $282.50 $113.00 $282.50 $282.50 $282.50 $282.50 $282.50 $211.88 $282.50 $282.50 $282.50 $141.25 $141.25 $223.74 $282.50 $226.00 $127.13 $282.50 $282.50 $163.85 $282.50 $169.50 $282.50 $282.50 $282.50 N/A N/A 80513619 EAP HCPCS C9358 MATRIX TISS 25CMX.6CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP $562.50 $416.50 $14.42 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $14.42 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $562.50 $562.50 $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A 80513620 EAP HCPCS C9358 MATRIX TISS 25CMX1CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP $937.50 $694.00 $14.42 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $14.42 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $375.00 $937.50 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $937.50 $937.50 $543.75 $937.50 $562.50 $937.50 $937.50 $937.50 N/A N/A 80513621 EAP HCPCS C9358 MATRIX TISS 15CMX10CMX1MM SURGIMEND FLAT SEMIOVAL BOTH IP/OP "$6,750.00" "$4,995.00" $14.42 "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" $14.42 "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$2,700.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$6,750.00" "$6,750.00" "$3,915.00" "$6,750.00" "$4,050.00" "$6,750.00" "$6,750.00" "$6,750.00" N/A N/A 80513622 EAP HCPCS C9358 MATRIX TISS 17CMX7CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$5,355.00" "$3,963.00" $14.42 "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" $14.42 "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$1,116.04" "$5,355.00" "$2,142.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$4,016.25" "$5,355.00" "$5,355.00" "$5,355.00" "$2,677.50" "$2,677.50" "$4,241.16" "$5,355.00" "$4,284.00" "$2,409.75" "$5,355.00" "$5,355.00" "$3,105.90" "$5,355.00" "$3,213.00" "$5,355.00" "$5,355.00" "$5,355.00" N/A N/A 80513623 EAP HCPCS C9358 MATRIX TISS 15CMX15CMX1MM SURGIMEND FLAT SEMIOVAL BOTH IP/OP "$10,125.00" "$7,492.50" $14.42 "$10,125.00" "$10,125.00" "$10,125.00" "$10,125.00" "$10,125.00" "$10,125.00" "$10,125.00" $14.42 "$10,125.00" "$10,125.00" "$10,125.00" "$10,125.00" "$10,125.00" "$10,125.00" "$2,110.16" "$10,125.00" "$4,050.00" "$10,125.00" "$10,125.00" "$10,125.00" "$10,125.00" "$10,125.00" "$7,593.75" "$10,125.00" "$10,125.00" "$10,125.00" "$5,062.50" "$5,062.50" "$8,019.00" "$10,125.00" "$8,100.00" "$4,556.25" "$10,125.00" "$10,125.00" "$5,872.50" "$10,125.00" "$6,075.00" "$10,125.00" "$10,125.00" "$10,125.00" N/A N/A 80513624 EAP HCPCS C9358 MATRIX TISS 20CMX8CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$7,200.00" "$5,328.00" $14.42 "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" $14.42 "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" "$1,500.56" "$7,200.00" "$2,880.00" "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" "$5,400.00" "$7,200.00" "$7,200.00" "$7,200.00" "$3,600.00" "$3,600.00" "$5,702.40" "$7,200.00" "$5,760.00" "$3,240.00" "$7,200.00" "$7,200.00" "$4,176.00" "$7,200.00" "$4,320.00" "$7,200.00" "$7,200.00" "$7,200.00" N/A N/A 80513625 EAP HCPCS C9358 MATRIX TISS 15CMX10CMX1MM SURGIMEND FLAT SEMIOVAL BOTH IP/OP "$5,130.00" "$3,796.50" $14.42 "$5,130.00" "$5,130.00" "$5,130.00" "$5,130.00" "$5,130.00" "$5,130.00" "$5,130.00" $14.42 "$5,130.00" "$5,130.00" "$5,130.00" "$5,130.00" "$5,130.00" "$5,130.00" "$1,069.15" "$5,130.00" "$2,052.00" "$5,130.00" "$5,130.00" "$5,130.00" "$5,130.00" "$5,130.00" "$3,847.50" "$5,130.00" "$5,130.00" "$5,130.00" "$2,565.00" "$2,565.00" "$4,062.96" "$5,130.00" "$4,104.00" "$2,308.50" "$5,130.00" "$5,130.00" "$2,975.40" "$5,130.00" "$3,078.00" "$5,130.00" "$5,130.00" "$5,130.00" N/A N/A 80513626 EAP HCPCS C9358 MATRIX TISS 17CMX7CMX1MM SURGIMEND FLAT SEMIOVAL BOTH IP/OP "$5,355.00" "$3,963.00" $14.42 "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" $14.42 "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$1,116.04" "$5,355.00" "$2,142.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$4,016.25" "$5,355.00" "$5,355.00" "$5,355.00" "$2,677.50" "$2,677.50" "$4,241.16" "$5,355.00" "$4,284.00" "$2,409.75" "$5,355.00" "$5,355.00" "$3,105.90" "$5,355.00" "$3,213.00" "$5,355.00" "$5,355.00" "$5,355.00" N/A N/A 80513627 EAP HCPCS C9358 MATRIX TISS 16CMX8CMX.6MM SURGIMEND THN FLAT BOTH IP/OP "$5,760.00" "$4,262.50" $14.42 "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" $14.42 "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$1,200.45" "$5,760.00" "$2,304.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$4,320.00" "$5,760.00" "$5,760.00" "$5,760.00" "$2,880.00" "$2,880.00" "$4,561.92" "$5,760.00" "$4,608.00" "$2,592.00" "$5,760.00" "$5,760.00" "$3,340.80" "$5,760.00" "$3,456.00" "$5,760.00" "$5,760.00" "$5,760.00" N/A N/A 80513628 EAP HCPCS C9358 MATRIX TISS 20CMX10CMX.6MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$9,000.00" "$6,660.00" $14.42 "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" $14.42 "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$1,875.70" "$9,000.00" "$3,600.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$6,750.00" "$9,000.00" "$9,000.00" "$9,000.00" "$4,500.00" "$4,500.00" "$7,128.00" "$9,000.00" "$7,200.00" "$4,050.00" "$9,000.00" "$9,000.00" "$5,220.00" "$9,000.00" "$5,400.00" "$9,000.00" "$9,000.00" "$9,000.00" N/A N/A 80513629 EAP HCPCS C9358 MATRIX TISS 16CMX6CMX1MM SURGIMEND FLAT SEMIOVAL BOTH IP/OP "$4,320.00" "$3,197.00" $14.42 "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" $14.42 "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" $900.34 "$4,320.00" "$1,728.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$3,240.00" "$4,320.00" "$4,320.00" "$4,320.00" "$2,160.00" "$2,160.00" "$3,421.44" "$4,320.00" "$3,456.00" "$1,944.00" "$4,320.00" "$4,320.00" "$2,505.60" "$4,320.00" "$2,592.00" "$4,320.00" "$4,320.00" "$4,320.00" N/A N/A 80513630 EAP HCPCS C9358 MATRIX TISS 12CMX8CMX.6MM SURGIMEND THN FLAT OVL BOTH IP/OP "$4,320.00" "$3,197.00" $14.42 "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" $14.42 "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" $900.34 "$4,320.00" "$1,728.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$3,240.00" "$4,320.00" "$4,320.00" "$4,320.00" "$2,160.00" "$2,160.00" "$3,421.44" "$4,320.00" "$3,456.00" "$1,944.00" "$4,320.00" "$4,320.00" "$2,505.60" "$4,320.00" "$2,592.00" "$4,320.00" "$4,320.00" "$4,320.00" N/A N/A 80513631 EAP HCPCS C9358 MATRIX TISS 15CMX10CMX.6MM SURGIMEND THN FLAT OVL BOTH IP/OP "$6,750.00" "$4,995.00" $14.42 "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" $14.42 "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$2,700.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$6,750.00" "$6,750.00" "$3,915.00" "$6,750.00" "$4,050.00" "$6,750.00" "$6,750.00" "$6,750.00" N/A N/A 80513632 EAP HCPCS C9358 MATRIX TISS 12CMX8CMX.6MM SURGIMEND THN FLAT RECT BOTH IP/OP "$3,600.00" "$2,664.00" $14.42 "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" $14.42 "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" $750.28 "$3,600.00" "$1,440.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$2,700.00" "$3,600.00" "$3,600.00" "$3,600.00" "$1,800.00" "$1,800.00" "$2,851.20" "$3,600.00" "$2,880.00" "$1,620.00" "$3,600.00" "$3,600.00" "$2,088.00" "$3,600.00" "$2,160.00" "$3,600.00" "$3,600.00" "$3,600.00" N/A N/A 80513633 EAP HCPCS C9358 MATRIX TISS 15CMX10CMX.6MM SURGIMEND THN FLAT RECT BOTH IP/OP "$5,625.00" "$4,162.50" $14.42 "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" $14.42 "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$2,250.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$5,625.00" "$5,625.00" "$3,262.50" "$5,625.00" "$3,375.00" "$5,625.00" "$5,625.00" "$5,625.00" N/A N/A 80513634 EAP HCPCS C9358 MATRIX TISS 6CMX5CMX2MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$1,125.00" $832.50 $14.42 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $14.42 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 80513635 EAP HCPCS C9360 MATRIX TISS 25CMX13CMX2MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$12,187.50" "$9,019.00" "$2,418.91" "$12,187.50" "$5,484.38" "$5,484.38" "$5,484.38" "$5,484.38" "$12,187.50" "$12,187.50" "$12,187.50" "$2,540.18" "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" "$2,540.01" "$12,187.50" "$12,187.50" "$6,008.44" "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" "$9,140.63" "$12,187.50" "$12,187.50" "$12,187.50" "$6,093.75" "$6,093.75" "$9,652.50" "$12,187.50" "$9,750.00" "$5,484.38" "$2,418.91" "$12,187.50" "$7,068.75" "$12,187.50" "$12,187.50" "$12,187.50" "$2,539.88" "$12,187.50" N/A N/A 80513636 EAP HCPCS C9358 MATRIX TISS 30CMX20CMX2MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$22,500.00" "$16,650.00" $14.42 "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" $14.42 "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$4,689.25" "$22,500.00" "$9,000.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$16,875.00" "$22,500.00" "$22,500.00" "$22,500.00" "$11,250.00" "$11,250.00" "$17,820.00" "$22,500.00" "$18,000.00" "$10,125.00" "$22,500.00" "$22,500.00" "$13,050.00" "$22,500.00" "$13,500.00" "$22,500.00" "$22,500.00" "$22,500.00" N/A N/A 80513637 EAP HCPCS C9360 MATRIX TISS 20CMX20CMX2MM SURGIMEND FLAT SQ BVN BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$15,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" "$15,000.00" "$8,700.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 80513638 EAP HCPCS C9358 MATRIX TISS 25CMX20CMX2MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$18,750.00" "$13,875.00" $14.42 "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" $14.42 "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$3,907.71" "$18,750.00" "$7,500.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$14,062.50" "$18,750.00" "$18,750.00" "$18,750.00" "$9,375.00" "$9,375.00" "$14,850.00" "$18,750.00" "$15,000.00" "$8,437.50" "$18,750.00" "$18,750.00" "$10,875.00" "$18,750.00" "$11,250.00" "$18,750.00" "$18,750.00" "$18,750.00" N/A N/A 80513639 EAP HCPCS C9360 MATRIX TISS 15CMX10CMX2MM SURGIMEND FLAT BVN DERM BOTH IP/OP "$5,625.00" "$4,162.50" "$1,116.42" "$5,625.00" "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.39" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$5,625.00" "$2,773.13" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$1,116.42" "$5,625.00" "$3,262.50" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.25" "$5,625.00" N/A N/A 80513640 EAP HCPCS C9360 MESH SURG SURGIMEND 20X20MM PRFR ACLR CLGN MTRX BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$15,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" "$15,000.00" "$8,700.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 80513641 EAP HCPCS C9360 MATRIX TISS 25CMX13CMX2MM SURGIMEND FLAT BVN DERM BOTH IP/OP "$12,187.50" "$9,019.00" "$2,418.91" "$12,187.50" "$5,484.38" "$5,484.38" "$5,484.38" "$5,484.38" "$12,187.50" "$12,187.50" "$12,187.50" "$2,540.18" "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" "$2,540.01" "$12,187.50" "$12,187.50" "$6,008.44" "$12,187.50" "$12,187.50" "$12,187.50" "$12,187.50" "$9,140.63" "$12,187.50" "$12,187.50" "$12,187.50" "$6,093.75" "$6,093.75" "$9,652.50" "$12,187.50" "$9,750.00" "$5,484.38" "$2,418.91" "$12,187.50" "$7,068.75" "$12,187.50" "$12,187.50" "$12,187.50" "$2,539.88" "$12,187.50" N/A N/A 80513642 EAP HCPCS C9360 MATRIX TISS 20CMX16CMX2MM SURGIMEND FLAT BVN DERM BOTH IP/OP "$12,000.00" "$8,880.00" "$2,381.70" "$12,000.00" "$5,400.00" "$5,400.00" "$5,400.00" "$5,400.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,501.10" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,500.93" "$12,000.00" "$12,000.00" "$5,916.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$9,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$6,000.00" "$6,000.00" "$9,504.00" "$12,000.00" "$9,600.00" "$5,400.00" "$2,381.70" "$12,000.00" "$6,960.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,500.80" "$12,000.00" N/A N/A 80513643 EAP HCPCS C9360 MESH SURG SURGIMEND MP 25CMX20CMX2MM BOTH IP/OP "$18,750.00" "$13,875.00" "$3,721.41" "$18,750.00" "$8,437.50" "$8,437.50" "$8,437.50" "$8,437.50" "$18,750.00" "$18,750.00" "$18,750.00" "$3,907.97" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$3,907.71" "$18,750.00" "$18,750.00" "$9,243.75" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$14,062.50" "$18,750.00" "$18,750.00" "$18,750.00" "$9,375.00" "$9,375.00" "$14,850.00" "$18,750.00" "$15,000.00" "$8,437.50" "$3,721.41" "$18,750.00" "$10,875.00" "$18,750.00" "$18,750.00" "$18,750.00" "$3,907.50" "$18,750.00" N/A N/A 80513644 EAP HCPCS C9360 MESH SURG SURGIMEND 30X20CM MACROPOROUS ACLR CLGN BOTH IP/OP "$22,500.00" "$16,650.00" "$4,465.69" "$22,500.00" "$10,125.00" "$10,125.00" "$10,125.00" "$10,125.00" "$22,500.00" "$22,500.00" "$22,500.00" "$4,689.56" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$4,689.25" "$22,500.00" "$22,500.00" "$11,092.50" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$16,875.00" "$22,500.00" "$22,500.00" "$22,500.00" "$11,250.00" "$11,250.00" "$17,820.00" "$22,500.00" "$18,000.00" "$10,125.00" "$4,465.69" "$22,500.00" "$13,050.00" "$22,500.00" "$22,500.00" "$22,500.00" "$4,689.00" "$22,500.00" N/A N/A 80513645 EAP HCPCS C9360 MESH SURG SURGIMEND 40X25CM THK2MM BOTH IP/OP "$37,500.00" "$27,750.00" "$7,442.81" "$37,500.00" "$16,875.00" "$16,875.00" "$16,875.00" "$16,875.00" "$37,500.00" "$37,500.00" "$37,500.00" "$7,815.94" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$7,815.41" "$37,500.00" "$37,500.00" "$18,487.50" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$28,125.00" "$37,500.00" "$37,500.00" "$37,500.00" "$18,750.00" "$18,750.00" "$29,700.00" "$37,500.00" "$30,000.00" "$16,875.00" "$7,442.81" "$37,500.00" "$21,750.00" "$37,500.00" "$37,500.00" "$37,500.00" "$7,815.00" "$37,500.00" N/A N/A 80513646 EAP HCPCS C9360 MATRIX TISS 6CMX5CMX3MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$1,350.00" $999.00 $267.94 "$1,350.00" $607.50 $607.50 $607.50 $607.50 "$1,350.00" "$1,350.00" "$1,350.00" $281.37 "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" $281.35 "$1,350.00" "$1,350.00" $798.53 "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,012.50" "$1,350.00" "$1,350.00" "$1,350.00" $675.00 $675.00 "$1,069.20" "$1,350.00" "$1,080.00" $607.50 $267.94 "$1,350.00" $783.00 "$1,350.00" "$1,350.00" "$1,350.00" $281.34 "$1,350.00" N/A N/A 80513647 EAP HCPCS C9358 MATRIX TISS 20CMX20CMX3MM SURGIMEND FLAT SQ BVN BOTH IP/OP "$18,000.00" "$13,320.00" $14.42 "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" $14.42 "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$3,751.40" "$18,000.00" "$7,200.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$13,500.00" "$18,000.00" "$18,000.00" "$18,000.00" "$9,000.00" "$9,000.00" "$14,256.00" "$18,000.00" "$14,400.00" "$8,100.00" "$18,000.00" "$18,000.00" "$10,440.00" "$18,000.00" "$10,800.00" "$18,000.00" "$18,000.00" "$18,000.00" N/A N/A 80513648 EAP HCPCS C9360 MATRIX TISS 25CMX10CMX3MM SURGIMEND FLAT ELLIPSE BOTH IP/OP "$9,800.00" "$7,252.00" "$1,945.06" "$9,800.00" "$4,410.00" "$4,410.00" "$4,410.00" "$4,410.00" "$9,800.00" "$9,800.00" "$9,800.00" "$2,042.57" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$2,042.43" "$9,800.00" "$9,800.00" "$4,831.40" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$7,350.00" "$9,800.00" "$9,800.00" "$9,800.00" "$4,900.00" "$4,900.00" "$7,761.60" "$9,800.00" "$7,840.00" "$4,410.00" "$1,945.06" "$9,800.00" "$5,684.00" "$9,800.00" "$9,800.00" "$9,800.00" "$2,042.32" "$9,800.00" N/A N/A 80513649 EAP HCPCS C9358 MATRIX TISS 25CMX10CMX3MM SURGIMEND FLAT ELLIPSE BOTH IP/OP "$9,800.00" "$7,252.00" $14.42 "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" $14.42 "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$2,042.43" "$9,800.00" "$3,920.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$7,350.00" "$9,800.00" "$9,800.00" "$9,800.00" "$4,900.00" "$4,900.00" "$7,761.60" "$9,800.00" "$7,840.00" "$4,410.00" "$9,800.00" "$9,800.00" "$5,684.00" "$9,800.00" "$5,880.00" "$9,800.00" "$9,800.00" "$9,800.00" N/A N/A 80513650 EAP HCPCS C9360 MATRIX TISS 6CMX5CMX4MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$1,425.00" "$1,054.50" $282.83 "$1,425.00" $641.25 $641.25 $641.25 $641.25 "$1,425.00" "$1,425.00" "$1,425.00" $297.01 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" $296.99 "$1,425.00" "$1,425.00" $842.89 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,068.75" "$1,425.00" "$1,425.00" "$1,425.00" $712.50 $712.50 "$1,128.60" "$1,425.00" "$1,140.00" $641.25 $282.83 "$1,425.00" $826.50 "$1,425.00" "$1,425.00" "$1,425.00" $296.97 "$1,425.00" N/A N/A 80513651 EAP HCPCS C9358 MATRIX TISS 25CMX10CMX4MM SURGIMEND FLAT ELLIPSE BOTH IP/OP "$9,800.00" "$7,252.00" $14.42 "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" $14.42 "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$2,042.43" "$9,800.00" "$3,920.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$7,350.00" "$9,800.00" "$9,800.00" "$9,800.00" "$4,900.00" "$4,900.00" "$7,761.60" "$9,800.00" "$7,840.00" "$4,410.00" "$9,800.00" "$9,800.00" "$5,684.00" "$9,800.00" "$5,880.00" "$9,800.00" "$9,800.00" "$9,800.00" N/A N/A 80513652 EAP HCPCS C9358 MATRIX TISS 25CMX10CMX4MM SURGIMEND FLAT ELLIPSE BOTH IP/OP "$9,800.00" "$7,252.00" $14.42 "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" $14.42 "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$2,042.43" "$9,800.00" "$3,920.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$9,800.00" "$7,350.00" "$9,800.00" "$9,800.00" "$9,800.00" "$4,900.00" "$4,900.00" "$7,761.60" "$9,800.00" "$7,840.00" "$4,410.00" "$9,800.00" "$9,800.00" "$5,684.00" "$9,800.00" "$5,880.00" "$9,800.00" "$9,800.00" "$9,800.00" N/A N/A 80513653 EAP HCPCS Q4100 MATRIX TISS BIODRESTORE SM AMNIO ALGRF MORSELIZE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 "$1,500.00" $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 80513654 EAP HCPCS Q4100 MATRIX TISS BIODRESTORE MED AMNIO ALGRF MORSELIZE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 "$2,750.00" "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 80513655 EAP HCPCS Q4100 MATRIX TISS BIODRESTORE LG AMNIO ALGRF MORSELIZE BOTH IP/OP "$4,375.00" "$3,237.50" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 "$4,375.00" "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A 80513656 EAP HCPCS Q4100 MATRIX TISS BIODRESTORE XL AMNIO ALGRF MORSELIZE BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" "$7,500.00" "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 80513657 EAP HCPCS Q4100 MATRIX TISS BIODRESTORE 2XL AMNIO ALGRF MORSELIZE BOTH IP/OP "$10,375.00" "$7,677.50" "$2,059.18" "$10,375.00" "$4,668.75" "$4,668.75" "$4,668.75" "$4,668.75" "$10,375.00" "$10,375.00" "$10,375.00" "$2,162.41" "$10,375.00" "$10,375.00" "$10,375.00" "$10,375.00" "$10,375.00" "$2,162.26" "$10,375.00" "$10,375.00" "$5,114.88" "$10,375.00" "$10,375.00" "$10,375.00" "$10,375.00" "$7,781.25" "$10,375.00" "$10,375.00" "$10,375.00" "$5,187.50" "$5,187.50" "$8,217.00" "$10,375.00" "$8,300.00" "$4,668.75" "$2,059.18" "$10,375.00" "$6,017.50" "$10,375.00" "$10,375.00" "$10,375.00" "$2,162.15" "$10,375.00" N/A N/A 80513658 EAP HCPCS Q4100 MATRIX TISS BIODFACTOR SM AMNIO ALGRF MORSELIZE BOTH IP/OP "$2,337.50" "$1,730.00" $463.94 "$2,337.50" "$1,051.88" "$1,051.88" "$1,051.88" "$1,051.88" "$2,337.50" "$2,337.50" "$2,337.50" $487.19 "$2,337.50" "$2,337.50" "$2,337.50" "$2,337.50" "$2,337.50" $487.16 "$2,337.50" "$2,337.50" "$1,382.63" "$2,337.50" "$2,337.50" "$2,337.50" "$2,337.50" "$1,753.13" "$2,337.50" "$2,337.50" "$2,337.50" "$1,168.75" "$1,168.75" "$1,851.30" "$2,337.50" "$1,870.00" "$1,051.88" $463.94 "$2,337.50" "$1,355.75" "$2,337.50" "$2,337.50" "$2,337.50" $487.14 "$2,337.50" N/A N/A 80513659 EAP HCPCS Q4100 MATRIX TISS BIODFACTOR MED AMNIO ALGRF MORSELIZE BOTH IP/OP "$3,700.00" "$2,738.00" $734.36 "$3,700.00" "$1,665.00" "$1,665.00" "$1,665.00" "$1,665.00" "$3,700.00" "$3,700.00" "$3,700.00" $771.17 "$3,700.00" "$3,700.00" "$3,700.00" "$3,700.00" "$3,700.00" $771.12 "$3,700.00" "$3,700.00" "$1,824.10" "$3,700.00" "$3,700.00" "$3,700.00" "$3,700.00" "$2,775.00" "$3,700.00" "$3,700.00" "$3,700.00" "$1,850.00" "$1,850.00" "$2,930.40" "$3,700.00" "$2,960.00" "$1,665.00" $734.36 "$3,700.00" "$2,146.00" "$3,700.00" "$3,700.00" "$3,700.00" $771.08 "$3,700.00" N/A N/A 80513660 EAP HCPCS Q4100 MATRIX TISS BIODFACTOR LG AMNIO ALGRF MORSELIZE BOTH IP/OP "$7,200.00" "$5,328.00" "$1,429.02" "$7,200.00" "$3,240.00" "$3,240.00" "$3,240.00" "$3,240.00" "$7,200.00" "$7,200.00" "$7,200.00" "$1,500.66" "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" "$1,500.56" "$7,200.00" "$7,200.00" "$3,549.60" "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" "$5,400.00" "$7,200.00" "$7,200.00" "$7,200.00" "$3,600.00" "$3,600.00" "$5,702.40" "$7,200.00" "$5,760.00" "$3,240.00" "$1,429.02" "$7,200.00" "$4,176.00" "$7,200.00" "$7,200.00" "$7,200.00" "$1,500.48" "$7,200.00" N/A N/A 80513661 EAP HCPCS Q4100 MATRIX TISS BIODFACTOR XL AMNIO ALGRF MORSELIZE BOTH IP/OP "$14,250.00" "$10,545.00" "$2,828.27" "$14,250.00" "$6,412.50" "$6,412.50" "$6,412.50" "$6,412.50" "$14,250.00" "$14,250.00" "$14,250.00" "$2,970.06" "$14,250.00" "$14,250.00" "$14,250.00" "$14,250.00" "$14,250.00" "$2,969.86" "$14,250.00" "$14,250.00" "$7,025.25" "$14,250.00" "$14,250.00" "$14,250.00" "$14,250.00" "$10,687.50" "$14,250.00" "$14,250.00" "$14,250.00" "$7,125.00" "$7,125.00" "$11,286.00" "$14,250.00" "$11,400.00" "$6,412.50" "$2,828.27" "$14,250.00" "$8,265.00" "$14,250.00" "$14,250.00" "$14,250.00" "$2,969.70" "$14,250.00" N/A N/A 80513662 EAP HCPCS Q4100 MATRIX TISS BIODFACTOR 2XL AMNIO ALGRF MORSELIZE BOTH IP/OP "$21,875.00" "$16,187.50" "$4,341.64" "$21,875.00" "$9,843.75" "$9,843.75" "$9,843.75" "$9,843.75" "$21,875.00" "$21,875.00" "$21,875.00" "$4,559.30" "$21,875.00" "$21,875.00" "$21,875.00" "$21,875.00" "$21,875.00" "$4,558.99" "$21,875.00" "$21,875.00" "$10,784.38" "$21,875.00" "$21,875.00" "$21,875.00" "$21,875.00" "$16,406.25" "$21,875.00" "$21,875.00" "$21,875.00" "$10,937.50" "$10,937.50" "$17,325.00" "$21,875.00" "$17,500.00" "$9,843.75" "$4,341.64" "$21,875.00" "$12,687.50" "$21,875.00" "$21,875.00" "$21,875.00" "$4,558.75" "$21,875.00" N/A N/A 80513663 EAP HCPCS Q4138 GRAFT SFT TIS 2X1.5CM BIODDRYFLEX PLCNT MEMBR BOTH IP/OP "$2,870.00" "$2,124.00" $184.60 "$2,870.00" "$2,870.00" "$2,870.00" "$2,870.00" "$2,870.00" "$2,870.00" "$2,870.00" $184.60 "$2,870.00" "$2,870.00" "$2,870.00" "$2,870.00" "$2,870.00" "$2,870.00" $598.14 "$2,870.00" "$1,148.00" "$2,870.00" "$2,870.00" "$2,870.00" "$2,870.00" "$2,870.00" "$2,152.50" "$2,870.00" "$2,870.00" "$2,870.00" "$1,435.00" "$1,435.00" "$2,273.04" "$2,870.00" "$2,296.00" "$1,291.50" "$2,870.00" "$2,870.00" "$1,664.60" "$2,870.00" "$1,722.00" "$2,870.00" "$2,870.00" "$2,870.00" N/A N/A 80513664 EAP HCPCS Q4138 GRAFT SFT TIS 3X2CM BIODDRYFLEX PLCNT MEMBR ALGRF BOTH IP/OP "$3,150.00" "$2,331.00" $184.60 "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" $184.60 "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" $656.49 "$3,150.00" "$1,260.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$2,362.50" "$3,150.00" "$3,150.00" "$3,150.00" "$1,575.00" "$1,575.00" "$2,494.80" "$3,150.00" "$2,520.00" "$1,417.50" "$3,150.00" "$3,150.00" "$1,827.00" "$3,150.00" "$1,890.00" "$3,150.00" "$3,150.00" "$3,150.00" N/A N/A 80513665 EAP HCPCS Q4138 GRAFT SFT TIS 6X2CM BIODDRYFLEX PLCNT MEMBR ALGRF BOTH IP/OP "$5,132.50" "$3,798.50" $184.60 "$5,132.50" "$5,132.50" "$5,132.50" "$5,132.50" "$5,132.50" "$5,132.50" "$5,132.50" $184.60 "$5,132.50" "$5,132.50" "$5,132.50" "$5,132.50" "$5,132.50" "$5,132.50" "$1,069.67" "$5,132.50" "$2,053.00" "$5,132.50" "$5,132.50" "$5,132.50" "$5,132.50" "$5,132.50" "$3,849.38" "$5,132.50" "$5,132.50" "$5,132.50" "$2,566.25" "$2,566.25" "$4,064.94" "$5,132.50" "$4,106.00" "$2,309.63" "$5,132.50" "$5,132.50" "$2,976.85" "$5,132.50" "$3,079.50" "$5,132.50" "$5,132.50" "$5,132.50" N/A N/A 80513666 EAP HCPCS Q4138 GRAFT SFT TIS 4X4CM BIODDRYFLEX PLCNT MEMBR ALGRF BOTH IP/OP "$6,482.50" "$4,797.50" $184.60 "$6,482.50" "$6,482.50" "$6,482.50" "$6,482.50" "$6,482.50" "$6,482.50" "$6,482.50" $184.60 "$6,482.50" "$6,482.50" "$6,482.50" "$6,482.50" "$6,482.50" "$6,482.50" "$1,351.02" "$6,482.50" "$2,593.00" "$6,482.50" "$6,482.50" "$6,482.50" "$6,482.50" "$6,482.50" "$4,861.88" "$6,482.50" "$6,482.50" "$6,482.50" "$3,241.25" "$3,241.25" "$5,134.14" "$6,482.50" "$5,186.00" "$2,917.13" "$6,482.50" "$6,482.50" "$3,759.85" "$6,482.50" "$3,889.50" "$6,482.50" "$6,482.50" "$6,482.50" N/A N/A 80513708 EAP HCPCS Q4138 GRAFT SFT TIS 8X4CM BIODDRYFLEX PLCNT MEMBR ALGRF BOTH IP/OP "$11,250.00" "$8,325.00" $184.60 "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" $184.60 "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$11,250.00" "$11,250.00" "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$11,250.00" "$11,250.00" N/A N/A 80513709 EAP HCPCS Q4140 GRAFT SFT TIS 2X1.5CM BIODFENCE G3 PLCNT MEMBR BOTH IP/OP "$2,375.00" "$1,757.50" $220.75 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $220.75 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" $950.00 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" "$2,375.00" "$2,375.00" "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" "$2,375.00" "$2,375.00" N/A N/A 80513710 EAP HCPCS Q4140 GRAFT SFT TIS 2X2CM BIODFENCE G3 PLCNT MEMBR ALGRF BOTH IP/OP "$3,000.00" "$2,220.00" $220.75 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $220.75 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$1,200.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" "$3,000.00" "$3,000.00" "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" "$3,000.00" "$3,000.00" N/A N/A 80513711 EAP HCPCS Q4140 GRAFT SFT TIS 3X2CM BIODFENCE G3 PLCNT MEMBR ALGRF BOTH IP/OP "$3,250.00" "$2,405.00" $220.75 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $220.75 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" "$3,250.00" "$3,250.00" "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" "$3,250.00" "$3,250.00" N/A N/A 80513712 EAP HCPCS Q4140 GRAFT SFT TIS 4X2CM BIODFENCE G3 PLCNT MEMBR ALGRF BOTH IP/OP "$5,000.00" "$3,700.00" $220.75 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $220.75 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" "$5,000.00" "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 80513713 EAP HCPCS Q4140 GRAFT SFT TIS 6X2CM BIODFENCE G3 PLCNT MEMBR ALGRF BOTH IP/OP "$5,500.00" "$4,070.00" $220.75 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $220.75 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" "$5,500.00" "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 80513714 EAP HCPCS Q4140 GRAFT SFT TIS 6X3CM BIODFENCE G3 PLCNT MEMBR ALGRF BOTH IP/OP "$7,125.00" "$5,272.50" $220.75 "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" $220.75 "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$1,484.93" "$7,125.00" "$2,850.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$5,343.75" "$7,125.00" "$7,125.00" "$7,125.00" "$3,562.50" "$3,562.50" "$5,643.00" "$7,125.00" "$5,700.00" "$3,206.25" "$7,125.00" "$7,125.00" "$4,132.50" "$7,125.00" "$4,275.00" "$7,125.00" "$7,125.00" "$7,125.00" N/A N/A 80513715 EAP HCPCS Q4140 GRAFT SFT TIS 8X4CM BIODFENCE G3 PLCNT MEMBR ALGRF BOTH IP/OP "$12,000.00" "$8,880.00" $220.75 "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" $220.75 "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,500.93" "$12,000.00" "$4,800.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$9,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$6,000.00" "$6,000.00" "$9,504.00" "$12,000.00" "$9,600.00" "$5,400.00" "$12,000.00" "$12,000.00" "$6,960.00" "$12,000.00" "$7,200.00" "$12,000.00" "$12,000.00" "$12,000.00" N/A N/A 80513716 EAP HCPCS Q4140 GRAFT SFT TIS 6X3CM BIODFENCE SNTR PLCNT MEMBR BOTH IP/OP "$7,125.00" "$5,272.50" $220.75 "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" $220.75 "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$1,484.93" "$7,125.00" "$2,850.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$5,343.75" "$7,125.00" "$7,125.00" "$7,125.00" "$3,562.50" "$3,562.50" "$5,643.00" "$7,125.00" "$5,700.00" "$3,206.25" "$7,125.00" "$7,125.00" "$4,132.50" "$7,125.00" "$4,275.00" "$7,125.00" "$7,125.00" "$7,125.00" N/A N/A 80513717 EAP HCPCS Q4140 GRAFT SFT TIS 4X4CM BIODFENCE SNTR PLCNT MEMBR BOTH IP/OP "$6,750.00" "$4,995.00" $220.75 "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" $220.75 "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$2,700.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$6,750.00" "$6,750.00" "$3,915.00" "$6,750.00" "$4,050.00" "$6,750.00" "$6,750.00" "$6,750.00" N/A N/A 80513718 EAP HCPCS Q4140 GRAFT SFT TIS 8X4CM BIODFENCE SNTR PLCNT MEMBR BOTH IP/OP "$12,000.00" "$8,880.00" $220.75 "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" $220.75 "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,500.93" "$12,000.00" "$4,800.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$9,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$6,000.00" "$6,000.00" "$9,504.00" "$12,000.00" "$9,600.00" "$5,400.00" "$12,000.00" "$12,000.00" "$6,960.00" "$12,000.00" "$7,200.00" "$12,000.00" "$12,000.00" "$12,000.00" N/A N/A 80513719 EAP HCPCS Q4140 GRAFT SFT TIS 4X2CM BIODFENCE SNTR PLCNT TISS BOTH IP/OP "$5,250.00" "$3,885.00" $220.75 "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" $220.75 "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$2,100.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$5,250.00" "$5,250.00" "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$5,250.00" "$5,250.00" N/A N/A 80513720 EAP HCPCS Q4140 GRAFT SFT TIS 6X2CM BIODFENCE SNTR PLCNT TISS BOTH IP/OP "$5,500.00" "$4,070.00" $220.75 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $220.75 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" "$5,500.00" "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 80513721 EAP HCPCS Q4140 GRAFT SFT TIS 8X2CM BIODFENCE SNTR PLCNT TISS BOTH IP/OP "$6,000.00" "$4,440.00" $220.75 "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" $220.75 "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.47" "$6,000.00" "$2,400.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$4,500.00" "$6,000.00" "$6,000.00" "$6,000.00" "$3,000.00" "$3,000.00" "$4,752.00" "$6,000.00" "$4,800.00" "$2,700.00" "$6,000.00" "$6,000.00" "$3,480.00" "$6,000.00" "$3,600.00" "$6,000.00" "$6,000.00" "$6,000.00" N/A N/A 80513722 EAP HCPCS Q4140 GRAFT SFT TIS 4X3CM BIODFENCE SNTR PLCNT TISS BOTH IP/OP "$6,500.00" "$4,810.00" $220.75 "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" $220.75 "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.67" "$6,500.00" "$2,600.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$4,875.00" "$6,500.00" "$6,500.00" "$6,500.00" "$3,250.00" "$3,250.00" "$5,148.00" "$6,500.00" "$5,200.00" "$2,925.00" "$6,500.00" "$6,500.00" "$3,770.00" "$6,500.00" "$3,900.00" "$6,500.00" "$6,500.00" "$6,500.00" N/A N/A 80513723 EAP HCPCS C9358 MATRIX TISS 40CMX25CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$37,500.00" "$27,750.00" $14.42 "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" $14.42 "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$7,815.41" "$37,500.00" "$15,000.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$28,125.00" "$37,500.00" "$37,500.00" "$37,500.00" "$18,750.00" "$18,750.00" "$29,700.00" "$37,500.00" "$30,000.00" "$16,875.00" "$37,500.00" "$37,500.00" "$21,750.00" "$37,500.00" "$22,500.00" "$37,500.00" "$37,500.00" "$37,500.00" N/A N/A 80513724 EAP HCPCS C9358 MATRIX TISS 20CMX10CMX1MM SURGIMEND FLAT BVN DERM BOTH IP/OP "$17,250.00" "$12,765.00" $14.42 "$17,250.00" "$17,250.00" "$17,250.00" "$17,250.00" "$17,250.00" "$17,250.00" "$17,250.00" $14.42 "$17,250.00" "$17,250.00" "$17,250.00" "$17,250.00" "$17,250.00" "$17,250.00" "$3,595.09" "$17,250.00" "$6,900.00" "$17,250.00" "$17,250.00" "$17,250.00" "$17,250.00" "$17,250.00" "$12,937.50" "$17,250.00" "$17,250.00" "$17,250.00" "$8,625.00" "$8,625.00" "$13,662.00" "$17,250.00" "$13,800.00" "$7,762.50" "$17,250.00" "$17,250.00" "$10,005.00" "$17,250.00" "$10,350.00" "$17,250.00" "$17,250.00" "$17,250.00" N/A N/A 80513725 EAP HCPCS C9360 MATRIX TISS 20CMX16CMX2MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$12,000.00" "$8,880.00" "$2,381.70" "$12,000.00" "$5,400.00" "$5,400.00" "$5,400.00" "$5,400.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,501.10" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,500.93" "$12,000.00" "$12,000.00" "$5,916.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$9,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$6,000.00" "$6,000.00" "$9,504.00" "$12,000.00" "$9,600.00" "$5,400.00" "$2,381.70" "$12,000.00" "$6,960.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,500.80" "$12,000.00" N/A N/A 80513726 EAP HCPCS C9360 MATRIX TISS 40CMX25CMX2MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$37,500.00" "$27,750.00" "$7,442.81" "$37,500.00" "$16,875.00" "$16,875.00" "$16,875.00" "$16,875.00" "$37,500.00" "$37,500.00" "$37,500.00" "$7,815.94" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$7,815.41" "$37,500.00" "$37,500.00" "$18,487.50" "$37,500.00" "$37,500.00" "$37,500.00" "$37,500.00" "$28,125.00" "$37,500.00" "$37,500.00" "$37,500.00" "$18,750.00" "$18,750.00" "$29,700.00" "$37,500.00" "$30,000.00" "$16,875.00" "$7,442.81" "$37,500.00" "$21,750.00" "$37,500.00" "$37,500.00" "$37,500.00" "$7,815.00" "$37,500.00" N/A N/A 80513727 EAP HCPCS C9360 MATRIX TISS 25CMX20CMX3MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$22,500.00" "$16,650.00" "$4,465.69" "$22,500.00" "$10,125.00" "$10,125.00" "$10,125.00" "$10,125.00" "$22,500.00" "$22,500.00" "$22,500.00" "$4,689.56" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$4,689.25" "$22,500.00" "$22,500.00" "$11,092.50" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$16,875.00" "$22,500.00" "$22,500.00" "$22,500.00" "$11,250.00" "$11,250.00" "$17,820.00" "$22,500.00" "$18,000.00" "$10,125.00" "$4,465.69" "$22,500.00" "$13,050.00" "$22,500.00" "$22,500.00" "$22,500.00" "$4,689.00" "$22,500.00" N/A N/A 80513728 EAP HCPCS Q4140 GRAFT SFT TIS 4X4CM BIODFENCE G3 PLCNT MEMBR ALGRF BOTH IP/OP "$6,750.00" "$4,995.00" $220.75 "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" $220.75 "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$2,700.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$6,750.00" "$6,750.00" "$3,915.00" "$6,750.00" "$4,050.00" "$6,750.00" "$6,750.00" "$6,750.00" N/A N/A 80513729 EAP HCPCS C9358 MATRIX TISS 6CMX5CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$1,125.00" $832.50 $14.42 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $14.42 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" "$1,125.00" $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 80513730 EAP HCPCS C9358 MATRIX TISS 12CMX6CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$2,700.00" "$1,998.00" $14.42 "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" $14.42 "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" $562.71 "$2,700.00" "$1,080.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,025.00" "$2,700.00" "$2,700.00" "$2,700.00" "$1,350.00" "$1,350.00" "$2,138.40" "$2,700.00" "$2,160.00" "$1,215.00" "$2,700.00" "$2,700.00" "$1,566.00" "$2,700.00" "$1,620.00" "$2,700.00" "$2,700.00" "$2,700.00" N/A N/A 80513731 EAP HCPCS C9358 MATRIX TISS 10CMX10CMX1MM SURGIMEND FLAT SQ BVN BOTH IP/OP "$3,750.00" "$2,775.00" $14.42 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $14.42 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" "$3,750.00" "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 80513732 EAP HCPCS C9358 MATRIX TISS 15CMX10CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$5,625.00" "$4,162.50" $14.42 "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" $14.42 "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$2,250.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$5,625.00" "$5,625.00" "$3,262.50" "$5,625.00" "$3,375.00" "$5,625.00" "$5,625.00" "$5,625.00" N/A N/A 80513733 EAP HCPCS C9358 MATRIX TISS 20CMX10CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$7,500.00" "$5,550.00" $14.42 "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" $14.42 "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80513734 EAP HCPCS C9358 MATRIX TISS 12CMX4CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$1,800.00" "$1,332.00" $14.42 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $14.42 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 "$1,800.00" "$1,800.00" "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" "$1,800.00" "$1,800.00" N/A N/A 80513735 EAP HCPCS C9358 MATRIX TISS 16CMX6CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$3,600.00" "$2,664.00" $14.42 "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" $14.42 "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" $750.28 "$3,600.00" "$1,440.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$2,700.00" "$3,600.00" "$3,600.00" "$3,600.00" "$1,800.00" "$1,800.00" "$2,851.20" "$3,600.00" "$2,880.00" "$1,620.00" "$3,600.00" "$3,600.00" "$2,088.00" "$3,600.00" "$2,160.00" "$3,600.00" "$3,600.00" "$3,600.00" N/A N/A 80513736 EAP HCPCS C9358 MATRIX TISS 16CMX8CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$4,800.00" "$3,552.00" $14.42 "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" $14.42 "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$1,000.37" "$4,800.00" "$1,920.00" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$3,600.00" "$4,800.00" "$4,800.00" "$4,800.00" "$2,400.00" "$2,400.00" "$3,801.60" "$4,800.00" "$3,840.00" "$2,160.00" "$4,800.00" "$4,800.00" "$2,784.00" "$4,800.00" "$2,880.00" "$4,800.00" "$4,800.00" "$4,800.00" N/A N/A 80513737 EAP HCPCS C9360 MATRIX TISS 12CMX6CMX3MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$3,240.00" "$2,398.00" $643.06 "$3,240.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$3,240.00" "$3,240.00" "$3,240.00" $675.30 "$3,240.00" "$3,240.00" "$3,240.00" "$3,240.00" "$3,240.00" $675.25 "$3,240.00" "$3,240.00" "$1,597.32" "$3,240.00" "$3,240.00" "$3,240.00" "$3,240.00" "$2,430.00" "$3,240.00" "$3,240.00" "$3,240.00" "$1,620.00" "$1,620.00" "$2,566.08" "$3,240.00" "$2,592.00" "$1,458.00" $643.06 "$3,240.00" "$1,879.20" "$3,240.00" "$3,240.00" "$3,240.00" $675.22 "$3,240.00" N/A N/A 80513738 EAP HCPCS C9360 MATRIX TISS 15CMX10CMX3MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" "$6,750.00" "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A 80513739 EAP HCPCS C9360 MATRIX TISS 20CMX16CMX3MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$14,400.00" "$10,656.00" "$2,858.04" "$14,400.00" "$6,480.00" "$6,480.00" "$6,480.00" "$6,480.00" "$14,400.00" "$14,400.00" "$14,400.00" "$3,001.32" "$14,400.00" "$14,400.00" "$14,400.00" "$14,400.00" "$14,400.00" "$3,001.12" "$14,400.00" "$14,400.00" "$7,099.20" "$14,400.00" "$14,400.00" "$14,400.00" "$14,400.00" "$10,800.00" "$14,400.00" "$14,400.00" "$14,400.00" "$7,200.00" "$7,200.00" "$11,404.80" "$14,400.00" "$11,520.00" "$6,480.00" "$2,858.04" "$14,400.00" "$8,352.00" "$14,400.00" "$14,400.00" "$14,400.00" "$3,000.96" "$14,400.00" N/A N/A 80513740 EAP HCPCS C9360 MATRIX TISS 40CMX25CMX3MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$45,000.00" "$33,300.00" "$7,712.84" "$45,000.00" "$20,250.00" "$20,250.00" "$20,250.00" "$20,250.00" "$45,000.00" "$45,000.00" "$45,000.00" "$9,379.13" "$45,000.00" "$45,000.00" "$45,000.00" "$45,000.00" "$45,000.00" "$9,378.50" "$45,000.00" "$45,000.00" "$22,185.00" "$45,000.00" "$45,000.00" "$45,000.00" "$45,000.00" "$33,750.00" "$45,000.00" "$45,000.00" "$45,000.00" "$22,500.00" "$22,500.00" "$35,640.00" "$45,000.00" "$36,000.00" "$20,250.00" "$7,712.84" "$45,000.00" "$26,100.00" "$45,000.00" "$45,000.00" "$45,000.00" "$8,098.48" "$45,000.00" N/A N/A 80513741 EAP HCPCS C9358 MATRIX TISS 30CMX20CMX3MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$27,000.00" "$19,980.00" $14.42 "$27,000.00" "$27,000.00" "$27,000.00" "$27,000.00" "$27,000.00" "$27,000.00" "$27,000.00" $14.42 "$27,000.00" "$27,000.00" "$27,000.00" "$27,000.00" "$27,000.00" "$27,000.00" "$5,627.10" "$27,000.00" "$10,800.00" "$27,000.00" "$27,000.00" "$27,000.00" "$27,000.00" "$27,000.00" "$20,250.00" "$27,000.00" "$27,000.00" "$27,000.00" "$13,500.00" "$13,500.00" "$21,384.00" "$27,000.00" "$21,600.00" "$12,150.00" "$27,000.00" "$27,000.00" "$15,660.00" "$27,000.00" "$16,200.00" "$27,000.00" "$27,000.00" "$27,000.00" N/A N/A 80513742 EAP HCPCS C9358 MATRIX TISS 12CMX6CMX4MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$3,420.00" "$2,531.00" $14.42 "$3,420.00" "$3,420.00" "$3,420.00" "$3,420.00" "$3,420.00" "$3,420.00" "$3,420.00" $14.42 "$3,420.00" "$3,420.00" "$3,420.00" "$3,420.00" "$3,420.00" "$3,420.00" $712.77 "$3,420.00" "$1,368.00" "$3,420.00" "$3,420.00" "$3,420.00" "$3,420.00" "$3,420.00" "$2,565.00" "$3,420.00" "$3,420.00" "$3,420.00" "$1,710.00" "$1,710.00" "$2,708.64" "$3,420.00" "$2,736.00" "$1,539.00" "$3,420.00" "$3,420.00" "$1,983.60" "$3,420.00" "$2,052.00" "$3,420.00" "$3,420.00" "$3,420.00" N/A N/A 80513743 EAP HCPCS C9360 MATRIX TISS 15CMX10CMX4MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$7,125.00" "$5,272.50" "$1,414.13" "$7,125.00" "$3,206.25" "$3,206.25" "$3,206.25" "$3,206.25" "$7,125.00" "$7,125.00" "$7,125.00" "$1,485.03" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$1,484.93" "$7,125.00" "$7,125.00" "$3,512.63" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$5,343.75" "$7,125.00" "$7,125.00" "$7,125.00" "$3,562.50" "$3,562.50" "$5,643.00" "$7,125.00" "$5,700.00" "$3,206.25" "$1,414.13" "$7,125.00" "$4,132.50" "$7,125.00" "$7,125.00" "$7,125.00" "$1,484.85" "$7,125.00" N/A N/A 80513744 EAP HCPCS C9358 MATRIX TISS 25CMX13CMX4MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$15,437.50" "$11,424.00" $14.42 "$15,437.50" "$15,437.50" "$15,437.50" "$15,437.50" "$15,437.50" "$15,437.50" "$15,437.50" $14.42 "$15,437.50" "$15,437.50" "$15,437.50" "$15,437.50" "$15,437.50" "$15,437.50" "$3,217.34" "$15,437.50" "$6,175.00" "$15,437.50" "$15,437.50" "$15,437.50" "$15,437.50" "$15,437.50" "$11,578.13" "$15,437.50" "$15,437.50" "$15,437.50" "$7,718.75" "$7,718.75" "$12,226.50" "$15,437.50" "$12,350.00" "$6,946.88" "$15,437.50" "$15,437.50" "$8,953.75" "$15,437.50" "$9,262.50" "$15,437.50" "$15,437.50" "$15,437.50" N/A N/A 80513745 EAP HCPCS C9358 MATRIX TISS 40CMX25CMX4MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$47,500.00" "$35,150.00" $14.42 "$47,500.00" "$47,500.00" "$47,500.00" "$47,500.00" "$47,500.00" "$47,500.00" "$47,500.00" $14.42 "$47,500.00" "$47,500.00" "$47,500.00" "$47,500.00" "$47,500.00" "$47,500.00" "$9,899.52" "$47,500.00" "$19,000.00" "$47,500.00" "$47,500.00" "$47,500.00" "$47,500.00" "$47,500.00" "$35,625.00" "$47,500.00" "$47,500.00" "$47,500.00" "$23,750.00" "$23,750.00" "$37,620.00" "$47,500.00" "$38,000.00" "$21,375.00" "$47,500.00" "$47,500.00" "$27,550.00" "$47,500.00" "$28,500.00" "$47,500.00" "$47,500.00" "$47,500.00" N/A N/A 80513746 EAP HCPCS C9360 MATRIX TISS 30CMX20CMX4MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$28,500.00" "$21,090.00" "$5,656.54" "$28,500.00" "$12,825.00" "$12,825.00" "$12,825.00" "$12,825.00" "$28,500.00" "$28,500.00" "$28,500.00" "$5,940.11" "$28,500.00" "$28,500.00" "$28,500.00" "$28,500.00" "$28,500.00" "$5,939.71" "$28,500.00" "$28,500.00" "$14,050.50" "$28,500.00" "$28,500.00" "$28,500.00" "$28,500.00" "$21,375.00" "$28,500.00" "$28,500.00" "$28,500.00" "$14,250.00" "$14,250.00" "$22,572.00" "$28,500.00" "$22,800.00" "$12,825.00" "$5,656.54" "$28,500.00" "$16,530.00" "$28,500.00" "$28,500.00" "$28,500.00" "$5,939.40" "$28,500.00" N/A N/A 80513747 EAP HCPCS C9358 MATRIX TISS 20CMX16CMX1MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$12,000.00" "$8,880.00" $14.42 "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" $14.42 "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,500.93" "$12,000.00" "$4,800.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$9,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$6,000.00" "$6,000.00" "$9,504.00" "$12,000.00" "$9,600.00" "$5,400.00" "$12,000.00" "$12,000.00" "$6,960.00" "$12,000.00" "$7,200.00" "$12,000.00" "$12,000.00" "$12,000.00" N/A N/A 80513748 EAP HCPCS C9358 MATRIX TISS 25CMX13CMX3MM SURGIMEND FLAT RECT BVN BOTH IP/OP "$14,625.00" "$10,822.50" $14.42 "$14,625.00" "$14,625.00" "$14,625.00" "$14,625.00" "$14,625.00" "$14,625.00" "$14,625.00" $14.42 "$14,625.00" "$14,625.00" "$14,625.00" "$14,625.00" "$14,625.00" "$14,625.00" "$3,048.01" "$14,625.00" "$5,850.00" "$14,625.00" "$14,625.00" "$14,625.00" "$14,625.00" "$14,625.00" "$10,968.75" "$14,625.00" "$14,625.00" "$14,625.00" "$7,312.50" "$7,312.50" "$11,583.00" "$14,625.00" "$11,700.00" "$6,581.25" "$14,625.00" "$14,625.00" "$8,482.50" "$14,625.00" "$8,775.00" "$14,625.00" "$14,625.00" "$14,625.00" N/A N/A 80514007 EAP HCPCS C1725 CATHETER BLNDIL .064IN 3.5MM 110CM LF 60MM LITHOPLASTY OTW BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$2,750.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80514008 EAP HCPCS C1725 CATHETER BLNDIL .064IN 4MM 110CM LF 60MM LITHOPLASTY OTW BLN BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80514009 EAP HCPCS C1725 CATHETER BLNDIL .064IN 4.5MM 110CM LF 60MM LITHOPLASTY OTW BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80514010 EAP HCPCS C1725 CATHETER BLNDIL .064IN 5MM 110CM LF 60MM LITHOPLASTY OTW BLN BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80514011 EAP HCPCS C1725 CATHETER BLNDIL .064IN 5.5MM 110CM LF 60MM LITHOPLASTY OTW BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80514012 EAP HCPCS C1725 CATHETER BLNDIL .064IN 6MM 110CM LF 60MM LITHOPLASTY OTW BLN BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$2,750.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$4,125.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80514013 EAP HCPCS C1725 CATHETER BLNDIL .064IN 6.5MM 110CM LF 60MM LITHOPLASTY OTW BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$2,750.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80514014 EAP HCPCS C1725 CATHETER BLNDIL .064IN 7MM 110CM LF 60MM LITHOPLASTY OTW BLN BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$2,750.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80514015 EAP HCPCS C1725 CATHETER BLNDIL 10 ATM 6 ATM .014IN 2.5-.052MM 135CM STRL LF BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$2,750.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$4,125.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80514016 EAP HCPCS C1725 CATHETER BLNDIL 10 ATM 6 ATM .014IN 3-.052MM 40MM STRL LF BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$4,125.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80514017 EAP HCPCS C1725 CATHETER BLNDIL 10 ATM 6 ATM .014IN 3.5-.052MM 135CM STRL LF BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80514018 EAP HCPCS C1725 CATHETER BLNDIL 10 ATM 6 ATM .014IN 4-.052MM 40MM STRL LF BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80514019 EAP HCPCS C1769 GUIDEWIRE SRG STRG TIP 185CM OMNIWIRE PRSS GW BOTH IP/OP "$1,688.00" "$1,249.50" $335.03 "$1,688.00" $916.58 $916.58 $916.58 $916.58 "$1,688.00" "$1,688.00" "$1,688.00" $351.82 "$1,688.00" "$1,252.83" "$1,252.83" "$1,301.11" $879.45 $351.80 "$1,688.00" "$1,688.00" $998.45 "$1,688.00" "$1,688.00" "$1,688.00" "$1,688.00" "$1,266.00" "$1,688.00" "$1,688.00" "$1,688.00" $844.00 $844.00 "$1,336.90" "$1,688.00" "$1,350.40" "$1,097.20" $335.03 "$1,688.00" $979.04 "$1,688.00" "$1,688.00" "$1,688.00" $351.78 "$1,688.00" N/A N/A 80514065 EAP HCPCS C1729 M-DRAIN CATHETER L25 CM OD8 FR LOCK 1 STEP LARGE OVAL SIDEHOLE BOTH IP/OP $29.00 $21.50 $5.76 $29.00 $15.75 $15.75 $15.75 $15.75 $29.00 $29.00 $29.00 $6.04 $29.00 $21.52 $21.52 $22.35 $15.11 $6.04 $29.00 $29.00 $17.15 $29.00 $29.00 $29.00 $29.00 $21.75 $29.00 $29.00 $29.00 $14.50 $14.50 $22.97 $29.00 $23.20 $18.85 $5.76 $29.00 $16.82 $29.00 $29.00 $29.00 $6.04 $29.00 N/A N/A 80514066 EAP HCPCS C1729 M-DRAIN CATHETER L25 CM OD10 FR LOCK 1 STEP LARGE OVAL SIDEHOLE STIFFENER BOTH IP/OP $29.00 $21.50 $5.76 $29.00 $15.75 $15.75 $15.75 $15.75 $29.00 $29.00 $29.00 $6.04 $29.00 $21.52 $21.52 $22.35 $15.11 $6.04 $29.00 $29.00 $17.15 $29.00 $29.00 $29.00 $29.00 $21.75 $29.00 $29.00 $29.00 $14.50 $14.50 $22.97 $29.00 $23.20 $18.85 $5.76 $29.00 $16.82 $29.00 $29.00 $29.00 $6.04 $29.00 N/A N/A 80514067 EAP HCPCS C1729 M-DRAIN CATHETER L25 CM OD12 FR LOCK 1 STEP LARGE OVAL SIDEHOLE STIFFENER BOTH IP/OP $29.00 $21.50 $5.76 $29.00 $15.75 $15.75 $15.75 $15.75 $29.00 $29.00 $29.00 $6.04 $29.00 $21.52 $21.52 $22.35 $15.11 $6.04 $29.00 $29.00 $17.15 $29.00 $29.00 $29.00 $29.00 $21.75 $29.00 $29.00 $29.00 $14.50 $14.50 $22.97 $29.00 $23.20 $18.85 $5.76 $29.00 $16.82 $29.00 $29.00 $29.00 $6.04 $29.00 N/A N/A 80514068 EAP HCPCS C1729 M-DRAIN CATHETER L25 CM OD14 FR LOCK 1 STEP LARGE OVAL SIDEHOLE STIFFENER BOTH IP/OP $29.00 $21.50 $5.76 $29.00 $15.75 $15.75 $15.75 $15.75 $29.00 $29.00 $29.00 $6.04 $29.00 $21.52 $21.52 $22.35 $15.11 $6.04 $29.00 $29.00 $17.15 $29.00 $29.00 $29.00 $29.00 $21.75 $29.00 $29.00 $29.00 $14.50 $14.50 $22.97 $29.00 $23.20 $18.85 $5.76 $29.00 $16.82 $29.00 $29.00 $29.00 $6.04 $29.00 N/A N/A 80514069 EAP HCPCS C1729 M-DRAIN CATHETER L25 CM OD16 FR 1 STEP LOCK STERILE LATEX FREE DISP BOTH IP/OP $29.00 $21.50 $5.76 $29.00 $15.75 $15.75 $15.75 $15.75 $29.00 $29.00 $29.00 $6.04 $29.00 $21.52 $21.52 $22.35 $15.11 $6.04 $29.00 $29.00 $17.15 $29.00 $29.00 $29.00 $29.00 $21.75 $29.00 $29.00 $29.00 $14.50 $14.50 $22.97 $29.00 $23.20 $18.85 $5.76 $29.00 $16.82 $29.00 $29.00 $29.00 $6.04 $29.00 N/A N/A 80514070 EAP HCPCS C1729 M-DRAIN CATHETER L40 CM OD8 FR BILIARY LARGE OVAL SIDEHOLE RADPQ PIGTAIL STRAIGHT BOTH IP/OP $36.00 $27.00 $7.15 $36.00 $19.55 $19.55 $19.55 $19.55 $36.00 $36.00 $36.00 $7.50 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $36.00 $21.29 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $7.15 $36.00 $20.88 $36.00 $36.00 $36.00 $7.50 $36.00 N/A N/A 80514071 EAP HCPCS C1729 M-DRAIN CATHETER L40 CM OD10 FR BILIARY LARGE OVAL SIDEHOLE RADPQ PIGTAIL STRAIGHT BOTH IP/OP $36.00 $27.00 $7.15 $36.00 $19.55 $19.55 $19.55 $19.55 $36.00 $36.00 $36.00 $7.50 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $36.00 $21.29 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $7.15 $36.00 $20.88 $36.00 $36.00 $36.00 $7.50 $36.00 N/A N/A 80514072 EAP HCPCS C1729 M-DRAIN CATHETER L40 CM OD12 FR BILIARY LARGE OVAL SIDEHOLE RADPQ PIGTAIL STRAIGHT BOTH IP/OP $36.00 $27.00 $7.15 $36.00 $19.55 $19.55 $19.55 $19.55 $36.00 $36.00 $36.00 $7.50 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $36.00 $21.29 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $7.15 $36.00 $20.88 $36.00 $36.00 $36.00 $7.50 $36.00 N/A N/A 80514073 EAP HCPCS C1729 M-DRAIN CATHETER L40 CM OD14 FR BILIARY LARGE OVAL SIDEHOLE RADPQ PIGTAIL STRAIGHT BOTH IP/OP $36.00 $27.00 $7.15 $36.00 $19.55 $19.55 $19.55 $19.55 $36.00 $36.00 $36.00 $7.50 $36.00 $26.72 $26.72 $27.75 $18.76 $7.50 $36.00 $36.00 $21.29 $36.00 $36.00 $36.00 $36.00 $27.00 $36.00 $36.00 $36.00 $18.00 $18.00 $28.51 $36.00 $28.80 $23.40 $7.15 $36.00 $20.88 $36.00 $36.00 $36.00 $7.50 $36.00 N/A N/A 80514076 EAP CATHETER CHLGM 65CM SPGL CHOLANGIOSCOPY BOTH IP/OP "$6,875.00" "$5,087.50" "$1,223.75" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$1,223.75" "$6,875.00" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$2,750.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$6,875.00" "$6,875.00" "$3,987.50" "$6,875.00" "$4,125.00" "$6,875.00" "$6,875.00" "$6,875.00" N/A N/A 80527810 EAP HCPCS C1769 GUIDEWIRE VASC 215CM .014IN SFT ACCES PSHP 45CM BOTH IP/OP "$1,484.00" "$1,098.50" $264.15 "$1,484.00" $805.81 $805.81 $805.81 $805.81 "$1,484.00" "$1,484.00" $264.15 $309.30 "$1,484.00" "$1,101.42" "$1,101.42" "$1,143.87" $773.16 $309.28 "$1,484.00" $593.60 $877.79 "$1,484.00" "$1,484.00" "$1,484.00" "$1,484.00" "$1,113.00" "$1,484.00" "$1,484.00" "$1,484.00" $742.00 $742.00 "$1,175.33" "$1,484.00" "$1,187.20" $964.60 $294.54 "$1,484.00" $860.72 "$1,484.00" "$1,484.00" "$1,484.00" $309.27 "$1,484.00" N/A N/A 80527811 EAP HCPCS C1769 GUIDEWIRE VASC 215CM .014IN SFT ACCES LGTH STR 35 BOTH IP/OP "$1,484.00" "$1,098.50" $264.15 "$1,484.00" $805.81 $805.81 $805.81 $805.81 "$1,484.00" "$1,484.00" $264.15 $309.30 "$1,484.00" "$1,101.42" "$1,101.42" "$1,143.87" $773.16 $309.28 "$1,484.00" "$1,484.00" $877.79 "$1,484.00" "$1,484.00" "$1,484.00" "$1,484.00" "$1,113.00" "$1,484.00" "$1,484.00" "$1,484.00" $742.00 $742.00 "$1,175.33" "$1,484.00" "$1,187.20" $964.60 $294.54 "$1,484.00" $860.72 "$1,484.00" "$1,484.00" "$1,484.00" $309.27 "$1,484.00" N/A N/A 80527812 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN SFT EXCH PSHP 45CM BOTH IP/OP "$1,841.00" "$1,362.50" $327.70 "$1,841.00" $999.66 $999.66 $999.66 $999.66 "$1,841.00" "$1,841.00" $327.70 $383.71 "$1,841.00" "$1,366.39" "$1,366.39" "$1,419.04" $959.16 $383.68 "$1,841.00" "$1,841.00" "$1,088.95" "$1,841.00" "$1,841.00" "$1,841.00" "$1,841.00" "$1,380.75" "$1,841.00" "$1,841.00" "$1,841.00" $920.50 $920.50 "$1,458.07" "$1,841.00" "$1,472.80" "$1,196.65" $365.39 "$1,841.00" "$1,067.78" "$1,841.00" "$1,841.00" "$1,841.00" $383.66 "$1,841.00" N/A N/A 80527813 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN SFT EXCH LGTH STR 35CM BOTH IP/OP "$1,841.00" "$1,362.50" $365.39 "$1,841.00" $999.66 $999.66 $999.66 $999.66 "$1,841.00" "$1,841.00" "$1,841.00" $383.71 "$1,841.00" "$1,366.39" "$1,366.39" "$1,419.04" $959.16 $383.68 "$1,841.00" "$1,841.00" "$1,088.95" "$1,841.00" "$1,841.00" "$1,841.00" "$1,841.00" "$1,380.75" "$1,841.00" "$1,841.00" "$1,841.00" $920.50 $920.50 "$1,458.07" "$1,841.00" "$1,472.80" "$1,196.65" $365.39 "$1,841.00" "$1,067.78" "$1,841.00" "$1,841.00" "$1,841.00" $383.66 "$1,841.00" N/A N/A 80527814 EAP HCPCS C1769 GUIDEWIRE VASC 215CM .014IN PSHP ACCES STD 45CM BOTH IP/OP "$1,484.00" "$1,098.50" $264.15 "$1,484.00" $805.81 $805.81 $805.81 $805.81 "$1,484.00" "$1,484.00" $264.15 $309.30 "$1,484.00" "$1,101.42" "$1,101.42" "$1,143.87" $773.16 $309.28 "$1,484.00" "$1,484.00" $877.79 "$1,484.00" "$1,484.00" "$1,484.00" "$1,484.00" "$1,113.00" "$1,484.00" "$1,484.00" "$1,484.00" $742.00 $742.00 "$1,175.33" "$1,484.00" "$1,187.20" $964.60 $294.54 "$1,484.00" $860.72 "$1,484.00" "$1,484.00" "$1,484.00" $309.27 "$1,484.00" N/A N/A 80527815 EAP HCPCS C1769 GUIDEWIRE VASC 215CM .014IN ACCES STD 45CM NTNL SS BOTH IP/OP "$1,484.00" "$1,098.50" $294.54 "$1,484.00" $805.81 $805.81 $805.81 $805.81 "$1,484.00" "$1,484.00" "$1,484.00" $309.30 "$1,484.00" "$1,101.42" "$1,101.42" "$1,143.87" $773.16 $309.28 "$1,484.00" "$1,484.00" $877.79 "$1,484.00" "$1,484.00" "$1,484.00" "$1,484.00" "$1,113.00" "$1,484.00" "$1,484.00" "$1,484.00" $742.00 $742.00 "$1,175.33" "$1,484.00" "$1,187.20" $964.60 $294.54 "$1,484.00" $860.72 "$1,484.00" "$1,484.00" "$1,484.00" $309.27 "$1,484.00" N/A N/A 80527816 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN EXCH PSHP STD 35CM BOTH IP/OP "$1,841.00" "$1,362.50" $327.70 "$1,841.00" $999.66 $999.66 $999.66 $999.66 "$1,841.00" "$1,841.00" $327.70 $383.71 "$1,841.00" "$1,366.39" "$1,366.39" "$1,419.04" $959.16 $383.68 "$1,841.00" $736.40 "$1,088.95" "$1,841.00" "$1,841.00" "$1,841.00" "$1,841.00" "$1,380.75" "$1,841.00" "$1,841.00" "$1,841.00" $920.50 $920.50 "$1,458.07" "$1,841.00" "$1,472.80" "$1,196.65" $365.39 "$1,841.00" "$1,067.78" "$1,841.00" "$1,841.00" "$1,841.00" $383.66 "$1,841.00" N/A N/A 80527817 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN EXCH STD 35CM SNCHR BOTH IP/OP "$1,841.00" "$1,362.50" $365.39 "$1,841.00" $999.66 $999.66 $999.66 $999.66 "$1,841.00" "$1,841.00" "$1,841.00" $383.71 "$1,841.00" "$1,366.39" "$1,366.39" "$1,419.04" $959.16 $383.68 "$1,841.00" "$1,841.00" "$1,088.95" "$1,841.00" "$1,841.00" "$1,841.00" "$1,841.00" "$1,380.75" "$1,841.00" "$1,841.00" "$1,841.00" $920.50 $920.50 "$1,458.07" "$1,841.00" "$1,472.80" "$1,196.65" $365.39 "$1,841.00" "$1,067.78" "$1,841.00" "$1,841.00" "$1,841.00" $383.66 "$1,841.00" N/A N/A 80527818 EAP HCPCS C1769 GUIDEWIRE VASC 215CM .014IN ACCES SPRT PSHP 35CM BOTH IP/OP "$1,484.00" "$1,098.50" $264.15 "$1,484.00" $805.81 $805.81 $805.81 $805.81 "$1,484.00" "$1,484.00" $264.15 $309.30 "$1,484.00" "$1,101.42" "$1,101.42" "$1,143.87" $773.16 $309.28 "$1,484.00" $593.60 $877.79 "$1,484.00" "$1,484.00" "$1,484.00" "$1,484.00" "$1,113.00" "$1,484.00" "$1,484.00" "$1,484.00" $742.00 $742.00 "$1,175.33" "$1,484.00" "$1,187.20" $964.60 $294.54 "$1,484.00" $860.72 "$1,484.00" "$1,484.00" "$1,484.00" $309.27 "$1,484.00" N/A N/A 80527819 EAP HCPCS C1769 GUIDEWIRE VASC 215CM .014IN ACCES SPRT 35 SNCHR BOTH IP/OP "$1,484.00" "$1,098.50" $264.15 "$1,484.00" $805.81 $805.81 $805.81 $805.81 "$1,484.00" "$1,484.00" $264.15 $309.30 "$1,484.00" "$1,101.42" "$1,101.42" "$1,143.87" $773.16 $309.28 "$1,484.00" "$1,484.00" $877.79 "$1,484.00" "$1,484.00" "$1,484.00" "$1,484.00" "$1,113.00" "$1,484.00" "$1,484.00" "$1,484.00" $742.00 $742.00 "$1,175.33" "$1,484.00" "$1,187.20" $964.60 $294.54 "$1,484.00" $860.72 "$1,484.00" "$1,484.00" "$1,484.00" $309.27 "$1,484.00" N/A N/A 80527820 EAP HCPCS C1769 GUIDEWIRE VASC 300CM .014IN EXCH SPRT PSHP 35CM BOTH IP/OP "$1,841.00" "$1,362.50" $365.39 "$1,841.00" $999.66 $999.66 $999.66 $999.66 "$1,841.00" "$1,841.00" "$1,841.00" $383.71 "$1,841.00" "$1,366.39" "$1,366.39" "$1,419.04" $959.16 $383.68 "$1,841.00" $736.40 "$1,088.95" "$1,841.00" "$1,841.00" "$1,841.00" "$1,841.00" "$1,380.75" "$1,841.00" "$1,841.00" "$1,841.00" $920.50 $920.50 "$1,458.07" "$1,841.00" "$1,472.80" "$1,196.65" $365.39 "$1,841.00" "$1,067.78" "$1,841.00" "$1,841.00" "$1,841.00" $383.66 "$1,841.00" N/A N/A 80527868 EAP HCPCS C1894 KIT MCTRDCR 6FR 21GA 20CM MNSTCK ECHTP CHBA GW NTNL TUNG BOTH IP/OP $838.00 $620.50 $166.32 $838.00 $455.03 $455.03 $455.03 $455.03 $838.00 $838.00 $838.00 $174.66 $838.00 $621.96 $621.96 $645.93 $436.60 $174.65 $838.00 $838.00 $495.68 $838.00 $838.00 $838.00 $838.00 $628.50 $838.00 $838.00 $838.00 $419.00 $419.00 $663.70 $838.00 $670.40 $544.70 $166.32 $838.00 $486.04 $838.00 $838.00 $838.00 $174.64 $838.00 N/A N/A 80527869 EAP HCPCS C1894 KIT MCTRDCR .018IN 6FR 21GA 20CM MNSTCK ECHTP TROC GW TUNG BOTH IP/OP $838.00 $620.50 $166.32 $838.00 $455.03 $455.03 $455.03 $455.03 $838.00 $838.00 $838.00 $174.66 $838.00 $621.96 $621.96 $645.93 $436.60 $174.65 $838.00 $838.00 $495.68 $838.00 $838.00 $838.00 $838.00 $628.50 $838.00 $838.00 $838.00 $419.00 $419.00 $663.70 $838.00 $670.40 $544.70 $166.32 $838.00 $486.04 $838.00 $838.00 $838.00 $174.64 $838.00 N/A N/A 80527870 EAP HCPCS C1894 KIT MCTRDCR .018IN .038IN RSN CRV 6FR 20CM 80CM MNSTCK ECHTP BOTH IP/OP $838.00 $620.50 $166.32 $838.00 $455.03 $455.03 $455.03 $455.03 $838.00 $838.00 $838.00 $174.66 $838.00 $621.96 $621.96 $645.93 $436.60 $174.65 $838.00 $838.00 $495.68 $838.00 $838.00 $838.00 $838.00 $628.50 $838.00 $838.00 $838.00 $419.00 $419.00 $663.70 $838.00 $670.40 $544.70 $166.32 $838.00 $486.04 $838.00 $838.00 $838.00 $174.64 $838.00 N/A N/A 80528373 EAP Custom 80528373 KIT SURGICAL OSTEOCOOL OD10 GA BONE ACCESS STERILE LATEX FREE DISPOSABLE BOTH IP/OP "$1,260.00" $932.50 $224.28 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $224.28 "$1,260.00" "$1,260.00" $935.17 $935.17 $971.21 $656.46 $262.60 "$1,260.00" $504.00 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $819.00 "$1,260.00" "$1,260.00" $730.80 "$1,260.00" $756.00 "$1,260.00" "$1,260.00" "$1,260.00" N/A N/A 80528374 EAP HCPCS C1713 SYSTEM BONE CEMENT KYPHON 2 DELIVERY GUN FILLER DEVICE BOTH IP/OP "$1,363.00" "$1,009.00" $270.52 "$1,363.00" $613.35 $613.35 $613.35 $613.35 "$1,363.00" "$1,363.00" "$1,363.00" $284.08 "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" $284.06 "$1,363.00" "$1,363.00" $806.21 "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" "$1,022.25" "$1,363.00" "$1,363.00" "$1,363.00" $681.50 $681.50 "$1,079.50" "$1,363.00" "$1,090.40" $613.35 $270.52 "$1,363.00" $790.54 "$1,363.00" "$1,363.00" "$1,363.00" $284.05 "$1,363.00" N/A N/A 80528375 EAP HCPCS C1874 STENT VASC 5MM 40MM ZL PTX DRG ELUTE ACPT .035IN GW BOTH IP/OP "$2,938.00" "$2,174.50" $583.12 "$2,938.00" "$1,322.10" "$1,322.10" "$1,322.10" "$1,322.10" "$2,938.00" "$2,938.00" "$2,938.00" $612.35 "$2,938.00" "$2,938.00" "$2,938.00" "$2,938.00" "$2,938.00" $612.31 "$2,938.00" "$2,938.00" "$1,448.43" "$2,938.00" "$2,938.00" "$2,938.00" "$2,938.00" "$2,203.50" "$2,938.00" "$2,938.00" "$2,938.00" "$1,469.00" "$1,469.00" "$2,326.90" "$2,938.00" "$2,350.40" "$1,322.10" $583.12 "$2,938.00" "$1,704.04" "$2,938.00" "$2,938.00" "$2,938.00" $612.28 "$2,938.00" N/A N/A 80528376 EAP HCPCS C1874 STENT VASC 5MM 60MM ZL PTX DRG ELUTE ACPT .035IN GW BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$3,738.00" "$3,738.00" $779.00 "$3,738.00" N/A N/A 80528377 EAP HCPCS C1874 STENT VASC 5MM 80MM ZL PTX DRG ELUTE ACPT .035IN GW BOTH IP/OP "$4,488.00" "$3,321.50" $890.76 "$4,488.00" "$2,019.60" "$2,019.60" "$2,019.60" "$2,019.60" "$4,488.00" "$4,488.00" "$4,488.00" $935.41 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$4,488.00" "$2,212.58" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" $890.76 "$4,488.00" "$2,603.04" "$4,488.00" "$4,488.00" "$4,488.00" $935.30 "$4,488.00" N/A N/A 80528378 EAP HCPCS C1874 STENT VASC 5MM 100MM ZL PTX DRG ELUTE ACPT .035IN GW BOTH IP/OP "$4,488.00" "$3,321.50" $890.76 "$4,488.00" "$2,019.60" "$2,019.60" "$2,019.60" "$2,019.60" "$4,488.00" "$4,488.00" "$4,488.00" $935.41 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$4,488.00" "$2,212.58" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" $890.76 "$4,488.00" "$2,603.04" "$4,488.00" "$4,488.00" "$4,488.00" $935.30 "$4,488.00" N/A N/A 80528379 EAP HCPCS C1874 STENT VASC 5MM 120MM ZL PTX DRG ELUTE ACPT .035IN GW BOTH IP/OP "$4,988.00" "$3,691.50" $989.99 "$4,988.00" "$2,244.60" "$2,244.60" "$2,244.60" "$2,244.60" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.62" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.55" "$4,988.00" "$4,988.00" "$2,459.08" "$4,988.00" "$4,988.00" "$4,988.00" "$4,988.00" "$3,741.00" "$4,988.00" "$4,988.00" "$4,988.00" "$2,494.00" "$2,494.00" "$3,950.50" "$4,988.00" "$3,990.40" "$2,244.60" $989.99 "$4,988.00" "$2,893.04" "$4,988.00" "$4,988.00" "$4,988.00" "$1,039.50" "$4,988.00" N/A N/A 80528380 EAP HCPCS C1874 STENT VASC 5MM 140MM ZL PTX DRG ELUTE ACPT .035IN GW BOTH IP/OP "$5,988.00" "$4,431.50" "$1,188.47" "$5,988.00" "$2,694.60" "$2,694.60" "$2,694.60" "$2,694.60" "$5,988.00" "$5,988.00" "$5,988.00" "$1,248.05" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.97" "$5,988.00" "$5,988.00" "$2,952.08" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,491.00" "$5,988.00" "$5,988.00" "$5,988.00" "$2,994.00" "$2,994.00" "$4,742.50" "$5,988.00" "$4,790.40" "$2,694.60" "$1,188.47" "$5,988.00" "$3,473.04" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.90" "$5,988.00" N/A N/A 80528381 EAP HCPCS C1874 STENT VASC 6MM 140MM 125CM ZL PTX OTW DRG ELUTE DLV SYS PERI BOTH IP/OP "$5,988.00" "$4,431.50" "$1,188.47" "$5,988.00" "$2,694.60" "$2,694.60" "$2,694.60" "$2,694.60" "$5,988.00" "$5,988.00" "$5,988.00" "$1,248.05" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.97" "$5,988.00" "$5,988.00" "$2,952.08" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,491.00" "$5,988.00" "$5,988.00" "$5,988.00" "$2,994.00" "$2,994.00" "$4,742.50" "$5,988.00" "$4,790.40" "$2,694.60" "$1,188.47" "$5,988.00" "$3,473.04" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.90" "$5,988.00" N/A N/A 80528382 EAP HCPCS C1874 STENT VASC 7MM 140MM 125CM ZL PTX OTW DRG ELUTE PERI ACPT BOTH IP/OP "$5,988.00" "$4,431.50" "$1,188.47" "$5,988.00" "$2,694.60" "$2,694.60" "$2,694.60" "$2,694.60" "$5,988.00" "$5,988.00" "$5,988.00" "$1,248.05" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.97" "$5,988.00" "$5,988.00" "$2,952.08" "$5,988.00" "$5,988.00" "$5,988.00" "$5,988.00" "$4,491.00" "$5,988.00" "$5,988.00" "$5,988.00" "$2,994.00" "$2,994.00" "$4,742.50" "$5,988.00" "$4,790.40" "$2,694.60" "$1,188.47" "$5,988.00" "$3,473.04" "$5,988.00" "$5,988.00" "$5,988.00" "$1,247.90" "$5,988.00" N/A N/A 80528383 EAP HCPCS C1874 STENT VASC 8MM 40MM 125CM ZL PTX OTW DRG ELUTE DLV SYS PERI BOTH IP/OP "$2,938.00" "$2,174.50" $583.12 "$2,938.00" "$1,322.10" "$1,322.10" "$1,322.10" "$1,322.10" "$2,938.00" "$2,938.00" "$2,938.00" $612.35 "$2,938.00" "$2,938.00" "$2,938.00" "$2,938.00" "$2,938.00" $612.31 "$2,938.00" "$2,938.00" "$1,448.43" "$2,938.00" "$2,938.00" "$2,938.00" "$2,938.00" "$2,203.50" "$2,938.00" "$2,938.00" "$2,938.00" "$1,469.00" "$1,469.00" "$2,326.90" "$2,938.00" "$2,350.40" "$1,322.10" $583.12 "$2,938.00" "$1,704.04" "$2,938.00" "$2,938.00" "$2,938.00" $612.28 "$2,938.00" N/A N/A 80528384 EAP HCPCS C1874 STENT VASC 8MM 60MM 125CM ZL PTX OTW DRG ELUTE DLV SYS PERI BOTH IP/OP "$3,738.00" "$2,766.50" $741.90 "$3,738.00" "$1,682.10" "$1,682.10" "$1,682.10" "$1,682.10" "$3,738.00" "$3,738.00" "$3,738.00" $779.09 "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" $779.04 "$3,738.00" "$3,738.00" "$1,842.83" "$3,738.00" "$3,738.00" "$3,738.00" "$3,738.00" "$2,803.50" "$3,738.00" "$3,738.00" "$3,738.00" "$1,869.00" "$1,869.00" "$2,960.50" "$3,738.00" "$2,990.40" "$1,682.10" $741.90 "$3,738.00" "$2,168.04" "$3,738.00" "$3,738.00" "$3,738.00" $779.00 "$3,738.00" N/A N/A 80528385 EAP HCPCS C1874 STENT VASC 8MM 80MM 125CM ZL PTX OTW DRG ELUTE DLV SYS PERI BOTH IP/OP "$4,488.00" "$3,321.50" $890.76 "$4,488.00" "$2,019.60" "$2,019.60" "$2,019.60" "$2,019.60" "$4,488.00" "$4,488.00" "$4,488.00" $935.41 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$4,488.00" "$2,212.58" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" $890.76 "$4,488.00" "$2,603.04" "$4,488.00" "$4,488.00" "$4,488.00" $935.30 "$4,488.00" N/A N/A 80528386 EAP HCPCS C1874 STENT VASC 8MM 100MM 125CM ZL PTX OTW DRG ELUTE DLV SYS PERI BOTH IP/OP "$4,488.00" "$3,321.50" $890.76 "$4,488.00" "$2,019.60" "$2,019.60" "$2,019.60" "$2,019.60" "$4,488.00" "$4,488.00" "$4,488.00" $935.41 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$4,488.00" "$2,212.58" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" $890.76 "$4,488.00" "$2,603.04" "$4,488.00" "$4,488.00" "$4,488.00" $935.30 "$4,488.00" N/A N/A 80528388 EAP Custom 80528388 KIT ELTX 17GA 100MM STRL 4MM ACT TIP RF TUBE PRB INTRO DISP BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80528389 EAP Custom 80528389 KIT ELTX 17GA 150MM STRL LF 4MM COOLIEF CL RF PRB DISP BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80528390 EAP Custom 80528390 KIT ELTX 17GA 50MM STRL LF 2MM COOLIEF ACT TIP CL RAD FRQ BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80528391 EAP Custom 80528391 KIT ELTX 17GA 50MM STRL LF COOLIEF DISP BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80528392 EAP Custom 80528392 KIT ELTX 17GA 75MM STRL LF 2MM COOLIEF ACT TIP PRB INTRO BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80528393 EAP Custom 80528393 KIT ELTX 17GA 75MM STRL 4MM COOLIEF ACT TIP RF TUBE PRB BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80528394 EAP Custom 80528394 KIT ELTX 17GA 75MM STRL 5.5MM COOLIEF ACT TIP RF TUBE PRB BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80528395 EAP Custom 80528395 KIT ELTX 17GA 100MM STRL LF 4MM 2 BRTT CL RF PRB INTRO DISP BOTH IP/OP "$3,325.00" "$2,460.50" $591.85 "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" $591.85 "$3,325.00" "$3,325.00" "$2,467.82" "$2,467.82" "$2,562.91" "$1,732.33" $692.97 "$3,325.00" "$1,330.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$2,493.75" "$3,325.00" "$3,325.00" "$3,325.00" "$1,662.50" "$1,662.50" "$2,633.40" "$3,325.00" "$2,660.00" "$2,161.25" "$3,325.00" "$3,325.00" "$1,928.50" "$3,325.00" "$1,995.00" "$3,325.00" "$3,325.00" "$3,325.00" N/A N/A 80528396 EAP Custom 80528396 KIT ESURG STRL COOLIEF MULTICOOL RF DISP BOTH IP/OP "$3,325.00" "$2,460.50" $591.85 "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" $591.85 "$3,325.00" "$3,325.00" "$2,467.82" "$2,467.82" "$2,562.91" "$1,732.33" $692.97 "$3,325.00" "$1,330.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$2,493.75" "$3,325.00" "$3,325.00" "$3,325.00" "$1,662.50" "$1,662.50" "$2,633.40" "$3,325.00" "$2,660.00" "$2,161.25" "$3,325.00" "$3,325.00" "$1,928.50" "$3,325.00" "$1,995.00" "$3,325.00" "$3,325.00" "$3,325.00" N/A N/A 80528397 EAP Custom 80528397 KIT ELTX 17GA 50MM STRL LF 2MM 2 BRTT RF PRB INTRO DISP BOTH IP/OP "$3,325.00" "$2,460.50" $591.85 "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" $591.85 "$3,325.00" "$3,325.00" "$2,467.82" "$2,467.82" "$2,562.91" "$1,732.33" $692.97 "$3,325.00" "$1,330.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$2,493.75" "$3,325.00" "$3,325.00" "$3,325.00" "$1,662.50" "$1,662.50" "$2,633.40" "$3,325.00" "$2,660.00" "$2,161.25" "$3,325.00" "$3,325.00" "$1,928.50" "$3,325.00" "$1,995.00" "$3,325.00" "$3,325.00" "$3,325.00" N/A N/A 80528398 EAP Custom 80528398 KIT ELTX COOLIEF 2 PRB 4 INTRO 2 TUBE MULTICOOL KN BOTH IP/OP "$3,325.00" "$2,460.50" $591.85 "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" $591.85 "$3,325.00" "$3,325.00" "$2,467.82" "$2,467.82" "$2,562.91" "$1,732.33" $692.97 "$3,325.00" "$1,330.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$2,493.75" "$3,325.00" "$3,325.00" "$3,325.00" "$1,662.50" "$1,662.50" "$2,633.40" "$3,325.00" "$2,660.00" "$2,161.25" "$3,325.00" "$3,325.00" "$1,928.50" "$3,325.00" "$1,995.00" "$3,325.00" "$3,325.00" "$3,325.00" N/A N/A 80528399 EAP Custom 80528399 KIT ELTX COOLIEF CL RF CRV BOTH IP/OP "$3,325.00" "$2,460.50" $591.85 "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" $591.85 "$3,325.00" "$3,325.00" "$2,467.82" "$2,467.82" "$2,562.91" "$1,732.33" $692.97 "$3,325.00" "$1,330.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$2,493.75" "$3,325.00" "$3,325.00" "$3,325.00" "$1,662.50" "$1,662.50" "$2,633.40" "$3,325.00" "$2,660.00" "$2,161.25" "$3,325.00" "$3,325.00" "$1,928.50" "$3,325.00" "$1,995.00" "$3,325.00" "$3,325.00" "$3,325.00" N/A N/A 80528400 EAP Custom 80528400 KIT ELTX 17GA 75MM STRL LF 4MM 2 BRTT CL RF PRB INTRO DISP BOTH IP/OP "$3,325.00" "$2,460.50" $591.85 "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" $591.85 "$3,325.00" "$3,325.00" "$2,467.82" "$2,467.82" "$2,562.91" "$1,732.33" $692.97 "$3,325.00" "$1,330.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$2,493.75" "$3,325.00" "$3,325.00" "$3,325.00" "$1,662.50" "$1,662.50" "$2,633.40" "$3,325.00" "$2,660.00" "$2,161.25" "$3,325.00" "$3,325.00" "$1,928.50" "$3,325.00" "$1,995.00" "$3,325.00" "$3,325.00" "$3,325.00" N/A N/A 80528401 EAP Custom 80528401 KIT ELTX COOLIEF MULTICOOL RF THOR BOTH IP/OP "$3,325.00" "$2,460.50" $591.85 "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" $591.85 "$3,325.00" "$3,325.00" "$2,467.82" "$2,467.82" "$2,562.91" "$1,732.33" $692.97 "$3,325.00" "$1,330.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$2,493.75" "$3,325.00" "$3,325.00" "$3,325.00" "$1,662.50" "$1,662.50" "$2,633.40" "$3,325.00" "$2,660.00" "$2,161.25" "$3,325.00" "$3,325.00" "$1,928.50" "$3,325.00" "$1,995.00" "$3,325.00" "$3,325.00" "$3,325.00" N/A N/A 80528488 EAP HCPCS C1713 MIXER BN CMNT C20GM STRL KYPHON LL FIT DSPNS PLNG STIRR PDL BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 $220.00 $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A 80528489 EAP HCPCS C1713 CEMENT BN STRL KPHX HV-R PWDR MX BD DSPNS PLNG 30% BASO4 BOTH IP/OP $358.00 $265.00 $71.05 $358.00 $161.10 $161.10 $161.10 $161.10 $358.00 $358.00 $358.00 $74.62 $358.00 $358.00 $358.00 $358.00 $358.00 $74.61 $358.00 $358.00 $211.76 $358.00 $358.00 $358.00 $358.00 $268.50 $358.00 $358.00 $358.00 $179.00 $179.00 $283.54 $358.00 $286.40 $161.10 $71.05 $358.00 $207.64 $358.00 $358.00 $358.00 $74.61 $358.00 N/A N/A 80528490 EAP HCPCS C1713 CEMENT BN STRL LF HV-R KPHX MXR GRAD MRK DSPNS PLNG LL FIT BOTH IP/OP $578.00 $428.00 $114.72 $578.00 $260.10 $260.10 $260.10 $260.10 $578.00 $578.00 $578.00 $120.47 $578.00 $578.00 $578.00 $578.00 $578.00 $120.46 $578.00 $578.00 $341.89 $578.00 $578.00 $578.00 $578.00 $433.50 $578.00 $578.00 $578.00 $289.00 $289.00 $457.78 $578.00 $462.40 $260.10 $114.72 $578.00 $335.24 $578.00 $578.00 $578.00 $120.46 $578.00 N/A N/A 80528491 EAP HCPCS C1713 CEMENT BN KYPHON 10% HA ACTIVOS 10 BOTH IP/OP $840.00 $622.00 $166.72 $840.00 $378.00 $378.00 $378.00 $378.00 $840.00 $840.00 $840.00 $175.08 $840.00 $840.00 $840.00 $840.00 $840.00 $175.07 $840.00 $840.00 $496.86 $840.00 $840.00 $840.00 $840.00 $630.00 $840.00 $840.00 $840.00 $420.00 $420.00 $665.28 $840.00 $672.00 $378.00 $166.72 $840.00 $487.20 $840.00 $840.00 $840.00 $175.06 $840.00 N/A N/A 80528492 EAP HCPCS C1713 CEMENT BN CRTDG CNCRT CRNG SYS BOTH IP/OP $275.00 $203.50 $54.58 $275.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $275.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 $275.00 $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A 80528493 EAP HCPCS C1713 SYSTEM BN CMNT 3 KYPHON GUN FIL DEV BOTH IP/OP "$1,363.00" "$1,009.00" $270.52 "$1,363.00" $613.35 $613.35 $613.35 $613.35 "$1,363.00" "$1,363.00" "$1,363.00" $284.08 "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" $284.06 "$1,363.00" "$1,363.00" $806.21 "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" "$1,022.25" "$1,363.00" "$1,363.00" "$1,363.00" $681.50 $681.50 "$1,079.50" "$1,363.00" "$1,090.40" $613.35 $270.52 "$1,363.00" $790.54 "$1,363.00" "$1,363.00" "$1,363.00" $284.05 "$1,363.00" N/A N/A 80528494 EAP HCPCS C1713 CEMENT BN KYPHON XPEDE MXR BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $345.00 $71.91 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 80528495 EAP Custom 80528495 INTRODUCER ORTH BVL KPHX 1 STP OSTEO SYS BOTH IP/OP $413.00 $306.00 $73.51 $413.00 $413.00 $413.00 $413.00 $413.00 $413.00 $413.00 $73.51 $413.00 $413.00 $306.53 $306.53 $318.34 $215.17 $86.07 $413.00 $165.20 $413.00 $413.00 $413.00 $413.00 $413.00 $309.75 $413.00 $413.00 $413.00 $206.50 $206.50 $327.10 $413.00 $330.40 $268.45 $413.00 $413.00 $239.54 $413.00 $247.80 $413.00 $413.00 $413.00 N/A N/A 80528496 EAP Custom 80528496 CURETTE SRG 2 XPR KYPHON T TIP DISP BOTH IP/OP "$1,363.00" "$1,009.00" $242.61 "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" $242.61 "$1,363.00" "$1,363.00" "$1,011.62" "$1,011.62" "$1,050.60" $710.12 $284.06 "$1,363.00" $545.20 "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" "$1,363.00" "$1,022.25" "$1,363.00" "$1,363.00" "$1,363.00" $681.50 $681.50 "$1,079.50" "$1,363.00" "$1,090.40" $885.95 "$1,363.00" "$1,363.00" $790.54 "$1,363.00" $817.80 "$1,363.00" "$1,363.00" "$1,363.00" N/A N/A 80528497 EAP HCPCS C1713 INJECTOR BN CMNT 3 KPHX BLN KYPHPL BOTH IP/OP $345.00 $255.50 $68.47 $345.00 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $345.00 $71.91 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $68.47 $345.00 $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A 80528498 EAP Custom 80528498 DEVICE BN BX 3 KPHX KYPHON SPNE BOTH IP/OP $413.00 $306.00 $73.51 $413.00 $413.00 $413.00 $413.00 $413.00 $413.00 $413.00 $73.51 $413.00 $413.00 $306.53 $306.53 $318.34 $215.17 $86.07 $413.00 $165.20 $413.00 $413.00 $413.00 $413.00 $413.00 $309.75 $413.00 $413.00 $413.00 $206.50 $206.50 $327.10 $413.00 $330.40 $268.45 $413.00 $413.00 $239.54 $413.00 $247.80 $413.00 $413.00 $413.00 N/A N/A 80528499 EAP Custom 80528499 FILLER BN VOID 2 KPHX BOTH IP/OP $345.00 $255.50 $61.41 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $345.00 $61.41 $345.00 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $138.00 $345.00 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $345.00 $345.00 $200.10 $345.00 $207.00 $345.00 $345.00 $345.00 N/A N/A 80528500 EAP Custom 80528500 DEVICE BN BX 2 CONE TPR XPNDR KPHX XPR LL FIT SPEC CLT CNN BOTH IP/OP $385.00 $285.00 $68.53 $385.00 $385.00 $385.00 $385.00 $385.00 $385.00 $385.00 $68.53 $385.00 $385.00 $285.75 $285.75 $296.76 $200.59 $80.24 $385.00 $154.00 $385.00 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $250.25 $385.00 $385.00 $223.30 $385.00 $231.00 $385.00 $385.00 $385.00 N/A N/A 80528501 EAP Custom 80528501 TAMP SRG 20/2 XPR II KT OSTEO INTRO SYS BOTH IP/OP "$8,000.00" "$5,920.00" "$1,424.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$1,424.00" "$8,000.00" "$8,000.00" "$4,181.12" "$4,181.12" "$6,166.40" "$2,060.15" "$1,667.29" "$8,000.00" "$3,200.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$6,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$4,000.00" "$4,000.00" "$6,336.00" "$8,000.00" "$6,400.00" "$5,200.00" "$8,000.00" "$8,000.00" "$4,640.00" "$8,000.00" "$4,800.00" "$8,000.00" "$8,000.00" "$8,000.00" N/A N/A 80528502 EAP Custom 80528502 KIT ELTX 17GA 7MM YLW OSTEOCOOL RF PRB BOTH IP/OP "$10,183.00" "$7,535.50" "$1,812.57" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$1,812.57" "$10,183.00" "$10,183.00" "$4,181.12" "$4,181.12" "$7,849.06" "$2,060.15" "$2,122.25" "$10,183.00" "$4,073.20" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$7,637.25" "$10,183.00" "$10,183.00" "$10,183.00" "$5,091.50" "$5,091.50" "$8,064.94" "$10,183.00" "$8,146.40" "$6,618.95" "$10,183.00" "$10,183.00" "$5,906.14" "$10,183.00" "$6,109.80" "$10,183.00" "$10,183.00" "$10,183.00" N/A N/A 80528503 EAP Custom 80528503 KIT ELTX 17GA 10MM OSTEOCOOL PRB RF BOTH IP/OP "$10,183.00" "$7,535.50" "$1,812.57" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$1,812.57" "$10,183.00" "$10,183.00" "$4,181.12" "$4,181.12" "$7,849.06" "$2,060.15" "$2,122.25" "$10,183.00" "$4,073.20" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$7,637.25" "$10,183.00" "$10,183.00" "$10,183.00" "$5,091.50" "$5,091.50" "$8,064.94" "$10,183.00" "$8,146.40" "$6,618.95" "$10,183.00" "$10,183.00" "$5,906.14" "$10,183.00" "$6,109.80" "$10,183.00" "$10,183.00" "$10,183.00" N/A N/A 80528504 EAP Custom 80528504 PROBE ESURG 17GA 15MM ORNG OSTEOCOOL KT RF ABLT SYS BOTH IP/OP "$10,183.00" "$7,535.50" "$1,812.57" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$1,812.57" "$10,183.00" "$10,183.00" "$4,181.12" "$4,181.12" "$7,849.06" "$2,060.15" "$2,122.25" "$10,183.00" "$4,073.20" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$7,637.25" "$10,183.00" "$10,183.00" "$10,183.00" "$5,091.50" "$5,091.50" "$8,064.94" "$10,183.00" "$8,146.40" "$6,618.95" "$10,183.00" "$10,183.00" "$5,906.14" "$10,183.00" "$6,109.80" "$10,183.00" "$10,183.00" "$10,183.00" N/A N/A 80528505 EAP Custom 80528505 KIT ELTX 17GA 20MM OSTEOCOOL PRB RF BOTH IP/OP "$10,183.00" "$7,535.50" "$1,812.57" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$1,812.57" "$10,183.00" "$10,183.00" "$4,181.12" "$4,181.12" "$7,849.06" "$2,060.15" "$2,122.25" "$10,183.00" "$4,073.20" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$10,183.00" "$7,637.25" "$10,183.00" "$10,183.00" "$10,183.00" "$5,091.50" "$5,091.50" "$8,064.94" "$10,183.00" "$8,146.40" "$6,618.95" "$10,183.00" "$10,183.00" "$5,906.14" "$10,183.00" "$6,109.80" "$10,183.00" "$10,183.00" "$10,183.00" N/A N/A 80528506 EAP Custom 80528506 INTRODUCER ORTH 3 8GA KYPHON 1STP OSTEO INTRO KT TROC DMD BOTH IP/OP "$3,300.00" "$2,442.00" $587.40 "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" $587.40 "$3,300.00" "$3,300.00" "$2,449.26" "$2,449.26" "$2,543.64" "$1,719.30" $687.76 "$3,300.00" "$1,320.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$2,475.00" "$3,300.00" "$3,300.00" "$3,300.00" "$1,650.00" "$1,650.00" "$2,613.60" "$3,300.00" "$2,640.00" "$2,145.00" "$3,300.00" "$3,300.00" "$1,914.00" "$3,300.00" "$1,980.00" "$3,300.00" "$3,300.00" "$3,300.00" N/A N/A 80528507 EAP Custom 80528507 CANNULA SRG 3 STRL KYPHON AST DRCT BN PERC DISP BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" "$1,500.00" $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 80528508 EAP Custom 80528508 INTRODUCER ORTH BVL DMD PUR TAUPE STRL XPR KYPHON OSTEO BOTH IP/OP "$3,300.00" "$2,442.00" $587.40 "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" $587.40 "$3,300.00" "$3,300.00" "$2,449.26" "$2,449.26" "$2,543.64" "$1,719.30" $687.76 "$3,300.00" "$1,320.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$3,300.00" "$2,475.00" "$3,300.00" "$3,300.00" "$3,300.00" "$1,650.00" "$1,650.00" "$2,613.60" "$3,300.00" "$2,640.00" "$2,145.00" "$3,300.00" "$3,300.00" "$1,914.00" "$3,300.00" "$1,980.00" "$3,300.00" "$3,300.00" "$3,300.00" N/A N/A 80528509 EAP Custom 80528509 INTRODUCER ORTH WHT XPR STY TROC HNDL CNN DISP KYPHPL BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" $857.24 $857.24 $890.27 $601.76 $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $750.75 "$1,155.00" "$1,155.00" $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 80528510 EAP Custom 80528510 INTRODUCER ORTH XPR KYPHON ADV OSTEO BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" $857.24 $857.24 $890.27 $601.76 $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $750.75 "$1,155.00" "$1,155.00" $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 80528511 EAP Custom 80528511 INTRODUCER ORTH 2 DMD 3.4MM KYPHON XPR OSTEO INTRO BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" $857.24 $857.24 $890.27 $601.76 $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $750.75 "$1,155.00" "$1,155.00" $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 80528512 EAP Custom 80528512 INTRODUCER ORTH 2 BVL 3.4MM KYPHON XPR OSTEO INTRO BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" $857.24 $857.24 $890.27 $601.76 $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $750.75 "$1,155.00" "$1,155.00" $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 80528513 EAP Custom 80528513 KIT BN CMNT VRTBPL BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$1,669.95" "$1,669.95" "$1,734.30" "$1,172.25" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,462.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80528515 EAP Custom 80528515 NEEDLE TROC STRG 10GA KYPHON V OSTEO INTRO VRTBPL BOTH IP/OP $625.00 $462.50 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $625.00 $625.00 $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 80528516 EAP Custom 80528516 KIT BN CMNT CRV 13GA VRTBPL BOTH IP/OP "$1,450.00" "$1,073.00" $258.10 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" $258.10 "$1,450.00" "$1,450.00" "$1,076.19" "$1,076.19" "$1,117.66" $755.45 $302.20 "$1,450.00" $580.00 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,087.50" "$1,450.00" "$1,450.00" "$1,450.00" $725.00 $725.00 "$1,148.40" "$1,450.00" "$1,160.00" $942.50 "$1,450.00" "$1,450.00" $841.00 "$1,450.00" $870.00 "$1,450.00" "$1,450.00" "$1,450.00" N/A N/A 80528517 EAP Custom 80528517 INTRODUCER ORTH BVL 11GA ACC TROC VRTBPL BOTH IP/OP $625.00 $462.50 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $625.00 $625.00 $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 80528536 EAP HCPCS A6209 ALLEVYN AG FOAM BOTH IP/OP $56.00 $41.50 $11.11 $56.00 $30.41 $30.41 $30.41 $30.41 $56.00 $56.00 $56.00 $11.67 $56.00 $41.56 $41.56 $43.16 $29.18 $11.67 $56.00 $56.00 $33.12 $56.00 $56.00 $56.00 $56.00 $42.00 $56.00 $56.00 $56.00 $28.00 $28.00 $44.35 $56.00 $44.80 $36.40 $11.11 $56.00 $32.48 $56.00 $56.00 $56.00 $11.67 $56.00 N/A N/A 80528613 EAP HCPCS C1876 STENT VASC 10MM 40MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528614 EAP HCPCS C1876 STENT VASC 10MM 60MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528615 EAP HCPCS C1876 STENT VASC 10MM 80MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528616 EAP HCPCS C1876 STENT VASC 10MM 100MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528617 EAP HCPCS C1876 STENT VASC 10MM 120MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528618 EAP HCPCS C1876 STENT VASC 10MM 150MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,563.00" "$3,377.00" $905.64 "$4,563.00" "$2,053.35" "$2,053.35" "$2,053.35" "$2,053.35" "$4,563.00" "$4,563.00" "$4,563.00" $951.04 "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" $950.98 "$4,563.00" "$4,563.00" "$2,249.56" "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" "$3,422.25" "$4,563.00" "$4,563.00" "$4,563.00" "$2,281.50" "$2,281.50" "$3,613.90" "$4,563.00" "$3,650.40" "$2,053.35" $905.64 "$4,563.00" "$2,646.54" "$4,563.00" "$4,563.00" "$4,563.00" $950.93 "$4,563.00" N/A N/A 80528619 EAP HCPCS C1876 STENT VASC 12MM 60MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528620 EAP HCPCS C1876 STENT VASC 12MM 80MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528621 EAP HCPCS C1876 STENT VASC 12MM 100MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528622 EAP HCPCS C1876 STENT VASC 12MM 120MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528623 EAP HCPCS C1876 STENT VASC 12MM 150MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,563.00" "$3,377.00" $905.64 "$4,563.00" "$2,053.35" "$2,053.35" "$2,053.35" "$2,053.35" "$4,563.00" "$4,563.00" "$4,563.00" $951.04 "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" $950.98 "$4,563.00" "$4,563.00" "$2,249.56" "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" "$3,422.25" "$4,563.00" "$4,563.00" "$4,563.00" "$2,281.50" "$2,281.50" "$3,613.90" "$4,563.00" "$3,650.40" "$2,053.35" $905.64 "$4,563.00" "$2,646.54" "$4,563.00" "$4,563.00" "$4,563.00" $950.93 "$4,563.00" N/A N/A 80528624 EAP HCPCS C1876 STENT VASC 14MM 60MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528625 EAP HCPCS C1876 STENT VASC 14MM 80MM SLF XPD ROT THBWHL HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528626 EAP HCPCS C1876 STENT VASC 14MM 100MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528627 EAP HCPCS C1876 STENT VASC 14MM 120MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528628 EAP HCPCS C1876 STENT VASC 14MM 150MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,563.00" "$3,377.00" $905.64 "$4,563.00" "$2,053.35" "$2,053.35" "$2,053.35" "$2,053.35" "$4,563.00" "$4,563.00" "$4,563.00" $951.04 "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" $950.98 "$4,563.00" "$4,563.00" "$2,249.56" "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" "$3,422.25" "$4,563.00" "$4,563.00" "$4,563.00" "$2,281.50" "$2,281.50" "$3,613.90" "$4,563.00" "$3,650.40" "$2,053.35" $905.64 "$4,563.00" "$2,646.54" "$4,563.00" "$4,563.00" "$4,563.00" $950.93 "$4,563.00" N/A N/A 80528629 EAP HCPCS C1876 STENT VASC 16MM 60MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528630 EAP HCPCS C1876 STENT VASC 16MM 80MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528631 EAP HCPCS C1876 STENT VASC 16MM 100MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528632 EAP HCPCS C1876 STENT VASC 16MM 120MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528633 EAP HCPCS C1876 STENT VASC 18MM 150MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,563.00" "$3,377.00" $905.64 "$4,563.00" "$2,053.35" "$2,053.35" "$2,053.35" "$2,053.35" "$4,563.00" "$4,563.00" "$4,563.00" $951.04 "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" $950.98 "$4,563.00" "$4,563.00" "$2,249.56" "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" "$3,422.25" "$4,563.00" "$4,563.00" "$4,563.00" "$2,281.50" "$2,281.50" "$3,613.90" "$4,563.00" "$3,650.40" "$2,053.35" $905.64 "$4,563.00" "$2,646.54" "$4,563.00" "$4,563.00" "$4,563.00" $950.93 "$4,563.00" N/A N/A 80528634 EAP HCPCS C1876 STENT VASC 18MM 60MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528635 EAP HCPCS C1876 STENT VASC 18MM 80MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528636 EAP HCPCS C1876 STENT VASC 18MM 100MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528637 EAP HCPCS C1876 STENT VASC 18MM 120MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528638 EAP HCPCS C1876 STENT VASC 18MM 150MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,563.00" "$3,377.00" $905.64 "$4,563.00" "$2,053.35" "$2,053.35" "$2,053.35" "$2,053.35" "$4,563.00" "$4,563.00" "$4,563.00" $951.04 "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" $950.98 "$4,563.00" "$4,563.00" "$2,249.56" "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" "$3,422.25" "$4,563.00" "$4,563.00" "$4,563.00" "$2,281.50" "$2,281.50" "$3,613.90" "$4,563.00" "$3,650.40" "$2,053.35" $905.64 "$4,563.00" "$2,646.54" "$4,563.00" "$4,563.00" "$4,563.00" $950.93 "$4,563.00" N/A N/A 80528639 EAP HCPCS C1876 STENT VASC 20MM 60MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528640 EAP HCPCS C1876 STENT VASC 20MM 80MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528641 EAP HCPCS C1876 STENT VASC 20MM 100MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528642 EAP HCPCS C1876 STENT VASC 20MM 120MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,063.00" "$3,007.00" $806.40 "$4,063.00" "$1,828.35" "$1,828.35" "$1,828.35" "$1,828.35" "$4,063.00" "$4,063.00" "$4,063.00" $846.83 "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" $846.77 "$4,063.00" "$4,063.00" "$2,003.06" "$4,063.00" "$4,063.00" "$4,063.00" "$4,063.00" "$3,047.25" "$4,063.00" "$4,063.00" "$4,063.00" "$2,031.50" "$2,031.50" "$3,217.90" "$4,063.00" "$3,250.40" "$1,828.35" $806.40 "$4,063.00" "$2,356.54" "$4,063.00" "$4,063.00" "$4,063.00" $846.73 "$4,063.00" N/A N/A 80528643 EAP HCPCS C1876 STENT VASC 20MM 150MM SLF XPD 3 AX SHFT HMST VLV BOTH IP/OP "$4,563.00" "$3,377.00" $905.64 "$4,563.00" "$2,053.35" "$2,053.35" "$2,053.35" "$2,053.35" "$4,563.00" "$4,563.00" "$4,563.00" $951.04 "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" $950.98 "$4,563.00" "$4,563.00" "$2,249.56" "$4,563.00" "$4,563.00" "$4,563.00" "$4,563.00" "$3,422.25" "$4,563.00" "$4,563.00" "$4,563.00" "$2,281.50" "$2,281.50" "$3,613.90" "$4,563.00" "$3,650.40" "$2,053.35" $905.64 "$4,563.00" "$2,646.54" "$4,563.00" "$4,563.00" "$4,563.00" $950.93 "$4,563.00" N/A N/A 80528645 EAP HCPCS C1769 GUIDEWIRE VASC 15D ANG .018IN 80CM 5CM NTRX RADOPQ BOTH IP/OP $145.00 $107.50 $28.78 $145.00 $78.74 $78.74 $78.74 $78.74 $145.00 $145.00 $145.00 $30.22 $145.00 $107.62 $107.62 $111.77 $75.55 $30.22 $145.00 $145.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $94.25 $28.78 $145.00 $84.10 $145.00 $145.00 $145.00 $30.22 $145.00 N/A N/A 80528660 EAP Custom 80528660 COIL EMBL 3MM 20MM STRL LF POD DISP BOTH IP/OP "$4,475.00" "$3,311.50" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $932.64 "$4,475.00" "$1,790.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$3,356.25" "$4,475.00" "$4,475.00" "$4,475.00" "$2,237.50" "$2,237.50" "$3,544.20" "$4,475.00" "$3,580.00" "$2,013.75" "$4,475.00" "$4,475.00" "$2,595.50" "$4,475.00" "$2,685.00" "$4,475.00" "$4,475.00" "$4,475.00" N/A N/A 80528661 EAP Custom 80528661 COIL EMBL 4MM 30MM STRL LF POD DISP BOTH IP/OP "$4,475.00" "$3,311.50" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $932.64 "$4,475.00" "$1,790.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$3,356.25" "$4,475.00" "$4,475.00" "$4,475.00" "$2,237.50" "$2,237.50" "$3,544.20" "$4,475.00" "$3,580.00" "$2,013.75" "$4,475.00" "$4,475.00" "$2,595.50" "$4,475.00" "$2,685.00" "$4,475.00" "$4,475.00" "$4,475.00" N/A N/A 80528662 EAP Custom 80528662 COIL EMBL 5MM 30MM STRL LF POD DISP BOTH IP/OP "$4,475.00" "$3,311.50" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $932.64 "$4,475.00" "$1,790.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$3,356.25" "$4,475.00" "$4,475.00" "$4,475.00" "$2,237.50" "$2,237.50" "$3,544.20" "$4,475.00" "$3,580.00" "$2,013.75" "$4,475.00" "$4,475.00" "$2,595.50" "$4,475.00" "$2,685.00" "$4,475.00" "$4,475.00" "$4,475.00" N/A N/A 80528663 EAP Custom 80528663 COIL EMBL 6MM 50MM STRL LF POD DISP BOTH IP/OP "$4,475.00" "$3,311.50" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $932.64 "$4,475.00" "$1,790.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$3,356.25" "$4,475.00" "$4,475.00" "$4,475.00" "$2,237.50" "$2,237.50" "$3,544.20" "$4,475.00" "$3,580.00" "$2,013.75" "$4,475.00" "$4,475.00" "$2,595.50" "$4,475.00" "$2,685.00" "$4,475.00" "$4,475.00" "$4,475.00" N/A N/A 80528664 EAP Custom 80528664 COIL EMBL .02IN THK SHAPELESS 7CM STRL THE PENUMBRA COIL 400 BOTH IP/OP "$2,600.00" "$1,924.00" $462.80 "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" $462.80 "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" $541.87 "$2,600.00" "$1,040.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$1,950.00" "$2,600.00" "$2,600.00" "$2,600.00" "$1,300.00" "$1,300.00" "$2,059.20" "$2,600.00" "$2,080.00" "$1,170.00" "$2,600.00" "$2,600.00" "$1,508.00" "$2,600.00" "$1,560.00" "$2,600.00" "$2,600.00" "$2,600.00" N/A N/A 80528665 EAP Custom 80528665 COIL EMBL .02IN THK SHAPELESS 10CM STRL THE PENUMBRA COIL BOTH IP/OP "$2,600.00" "$1,924.00" $462.80 "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" $462.80 "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" $541.87 "$2,600.00" "$1,040.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$1,950.00" "$2,600.00" "$2,600.00" "$2,600.00" "$1,300.00" "$1,300.00" "$2,059.20" "$2,600.00" "$2,080.00" "$1,170.00" "$2,600.00" "$2,600.00" "$1,508.00" "$2,600.00" "$1,560.00" "$2,600.00" "$2,600.00" "$2,600.00" N/A N/A 80528666 EAP Custom 80528666 COIL EMBL .02IN THK SHAPELESS 15CM STRL THE PENUMBRA COIL BOTH IP/OP "$2,600.00" "$1,924.00" $462.80 "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" $462.80 "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" $541.87 "$2,600.00" "$1,040.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$2,600.00" "$1,950.00" "$2,600.00" "$2,600.00" "$2,600.00" "$1,300.00" "$1,300.00" "$2,059.20" "$2,600.00" "$2,080.00" "$1,170.00" "$2,600.00" "$2,600.00" "$1,508.00" "$2,600.00" "$1,560.00" "$2,600.00" "$2,600.00" "$2,600.00" N/A N/A 80528667 EAP Custom 80528667 COIL EMBL .02IN THK SHAPELESS 25CM STRL THE PENUMBRA COIL BOTH IP/OP "$3,475.00" "$2,571.50" $618.55 "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" $618.55 "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" $724.23 "$3,475.00" "$1,390.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$2,606.25" "$3,475.00" "$3,475.00" "$3,475.00" "$1,737.50" "$1,737.50" "$2,752.20" "$3,475.00" "$2,780.00" "$1,563.75" "$3,475.00" "$3,475.00" "$2,015.50" "$3,475.00" "$2,085.00" "$3,475.00" "$3,475.00" "$3,475.00" N/A N/A 80528668 EAP Custom 80528668 COIL EMBL .02IN THK SHAPELESS 35CM STRL THE PENUMBRA COIL BOTH IP/OP "$3,475.00" "$2,571.50" $618.55 "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" $618.55 "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" $724.23 "$3,475.00" "$1,390.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$2,606.25" "$3,475.00" "$3,475.00" "$3,475.00" "$1,737.50" "$1,737.50" "$2,752.20" "$3,475.00" "$2,780.00" "$1,563.75" "$3,475.00" "$3,475.00" "$2,015.50" "$3,475.00" "$2,085.00" "$3,475.00" "$3,475.00" "$3,475.00" N/A N/A 80528669 EAP Custom 80528669 COIL EMBL .02IN THK SHAPELESS 40CM STRL THE PENUMBRA COIL BOTH IP/OP "$3,475.00" "$2,571.50" $618.55 "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" $618.55 "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" $724.23 "$3,475.00" "$1,390.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$2,606.25" "$3,475.00" "$3,475.00" "$3,475.00" "$1,737.50" "$1,737.50" "$2,752.20" "$3,475.00" "$2,780.00" "$1,563.75" "$3,475.00" "$3,475.00" "$2,015.50" "$3,475.00" "$2,085.00" "$3,475.00" "$3,475.00" "$3,475.00" N/A N/A 80528670 EAP Custom 80528670 COIL EMBL .02IN THK SHAPELESS 50CM STRL THE PENUMBRA COIL BOTH IP/OP "$3,475.00" "$2,571.50" $618.55 "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" $618.55 "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" $724.23 "$3,475.00" "$1,390.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$2,606.25" "$3,475.00" "$3,475.00" "$3,475.00" "$1,737.50" "$1,737.50" "$2,752.20" "$3,475.00" "$2,780.00" "$1,563.75" "$3,475.00" "$3,475.00" "$2,015.50" "$3,475.00" "$2,085.00" "$3,475.00" "$3,475.00" "$3,475.00" N/A N/A 80528671 EAP Custom 80528671 COIL EMBL .02IN THK SHAPELESS 60CM STRL THE PENUMBRA COIL BOTH IP/OP "$3,475.00" "$2,571.50" $618.55 "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" $618.55 "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" $724.23 "$3,475.00" "$1,390.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$3,475.00" "$2,606.25" "$3,475.00" "$3,475.00" "$3,475.00" "$1,737.50" "$1,737.50" "$2,752.20" "$3,475.00" "$2,780.00" "$1,563.75" "$3,475.00" "$3,475.00" "$2,015.50" "$3,475.00" "$2,085.00" "$3,475.00" "$3,475.00" "$3,475.00" N/A N/A 80528672 EAP TRANSDUCER US REFINITY INTRAVASCULAR SHORT TIP STRL LATEX FREE DISP BOTH IP/OP "$1,688.00" "$1,249.50" $300.46 "$1,688.00" "$1,688.00" "$1,688.00" "$1,688.00" "$1,688.00" "$1,688.00" "$1,688.00" $300.46 "$1,688.00" "$1,688.00" "$1,252.83" "$1,252.83" "$1,301.11" $879.45 $351.80 "$1,688.00" $675.20 "$1,688.00" "$1,688.00" "$1,688.00" "$1,688.00" "$1,688.00" "$1,266.00" "$1,688.00" "$1,688.00" "$1,688.00" $844.00 $844.00 "$1,336.90" "$1,688.00" "$1,350.40" "$1,097.20" "$1,688.00" "$1,688.00" $979.04 "$1,688.00" "$1,012.80" "$1,688.00" "$1,688.00" "$1,688.00" N/A N/A 80528680 EAP ELLIPSYS VASCULAR ACCESS SYSTEM 6F AMI6005 BOTH IP/OP "$22,413.00" "$16,586.00" "$2,060.15" "$22,413.00" "$22,413.00" "$22,413.00" "$22,413.00" "$22,413.00" "$22,413.00" "$22,413.00" "$3,989.51" "$22,413.00" "$22,413.00" "$4,181.12" "$4,181.12" "$17,275.94" "$2,060.15" "$4,671.12" "$22,413.00" "$8,965.20" "$22,413.00" "$22,413.00" "$22,413.00" "$22,413.00" "$22,413.00" "$16,809.75" "$22,413.00" "$22,413.00" "$22,413.00" "$11,206.50" "$11,206.50" "$17,751.10" "$22,413.00" "$17,930.40" "$14,568.45" "$22,413.00" "$22,413.00" "$12,999.54" "$22,413.00" "$13,447.80" "$22,413.00" "$22,413.00" "$22,413.00" N/A N/A 80528686 EAP Custom 80528686 PRESTIGE PLUS COMPLEX XTRA COIL PACK 1.5MM X 3CM BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80528687 EAP Custom 80528687 PRESTIGE PLUS COMPLEX XTRA COIL PACK 2MM X 6CM BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80528690 EAP Custom 80528690 PRESTIGE PLUS COMPLEX XTRA COIL PACK 3.5MM X 8CM BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80528691 EAP Custom 80528691 PRESTIGE PLUS COMPLEX COIL PACK 4MM X 13CM BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80528692 EAP Custom 80528692 PRESTIGE PLUS COMPLEX COIL PACK 4.5MM X 10CM BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80528693 EAP Custom 80528693 PRESTIGE PLUS COMPLEX COIL PACK 5MM X 17CM BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$1,577.18" "$1,577.18" "$1,637.95" "$1,107.13" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" "$1,381.25" "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 80528694 EAP Custom 80528694 PRESTIGE PLUS COMPLEX COIL PACK 6MM X 20CM BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$1,577.18" "$1,577.18" "$1,637.95" "$1,107.13" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" "$1,381.25" "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 80528703 EAP DEVICE CLSR 35MM ATRICLIP PROV TIP 1ST OP-EN LT ATR BOTH IP/OP "$13,750.00" "$10,175.00" "$2,447.50" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,447.50" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$13,750.00" "$13,750.00" "$7,975.00" "$13,750.00" "$8,250.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 80528704 EAP DEVICE CLSR 40MM ATRICLIP PROV TIP 1ST OP-EN LT ATR BOTH IP/OP "$13,750.00" "$10,175.00" "$2,447.50" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,447.50" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$13,750.00" "$13,750.00" "$7,975.00" "$13,750.00" "$8,250.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 80528705 EAP DEVICE CLSR 45MM ATRICLIP PROV TIP 1ST OP-EN CLIP LT ATR BOTH IP/OP "$13,750.00" "$10,175.00" "$2,447.50" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,447.50" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$13,750.00" "$13,750.00" "$7,975.00" "$13,750.00" "$8,250.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 80528706 EAP DEVICE CLSR 50MM ATRICLIP PROV TIP 1ST OP-EN CLIP LT ATR BOTH IP/OP "$13,750.00" "$10,175.00" "$2,447.50" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,447.50" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$13,750.00" "$13,750.00" "$7,975.00" "$13,750.00" "$8,250.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 80528710 EAP PROBE ELTX 17GA 15MM OSTEOCOOL 2 RF BOTH IP/OP "$13,018.00" "$9,633.50" "$2,060.15" "$13,018.00" "$13,018.00" "$13,018.00" "$13,018.00" "$13,018.00" "$13,018.00" "$13,018.00" "$2,317.20" "$13,018.00" "$13,018.00" "$4,181.12" "$4,181.12" "$10,034.27" "$2,060.15" "$2,713.09" "$13,018.00" "$5,207.20" "$13,018.00" "$13,018.00" "$13,018.00" "$13,018.00" "$13,018.00" "$9,763.50" "$13,018.00" "$13,018.00" "$13,018.00" "$6,509.00" "$6,509.00" "$10,310.26" "$13,018.00" "$10,414.40" "$8,461.70" "$13,018.00" "$13,018.00" "$7,550.44" "$13,018.00" "$7,810.80" "$13,018.00" "$13,018.00" "$13,018.00" N/A N/A 80528716 EAP Custom 80528716 CATHETER ANGIO RBT CRV 5FR 90CM STRL LF BCNTP RADOPQ BRD TPR BOTH IP/OP $812.00 $601.00 $144.54 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $812.00 $144.54 $812.00 $812.00 $602.67 $602.67 $625.89 $423.05 $169.23 $812.00 $324.80 $812.00 $812.00 $812.00 $812.00 $812.00 $609.00 $812.00 $812.00 $812.00 $406.00 $406.00 $643.10 $812.00 $649.60 $527.80 $812.00 $812.00 $470.96 $812.00 $487.20 $812.00 $812.00 $812.00 N/A N/A 80528717 EAP HCPCS C1761 CATHETER US 2.5MM .044IN 138CM STRL LF 12MM SHOCKWAVE C2 BOTH IP/OP "$11,750.00" "$8,695.00" "$2,060.15" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$4,181.12" "$4,181.12" "$9,056.90" "$2,060.15" "$2,448.83" "$11,750.00" "$4,700.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$8,812.50" "$11,750.00" "$11,750.00" "$11,750.00" "$5,875.00" "$5,875.00" "$9,306.00" "$11,750.00" "$9,400.00" "$7,637.50" "$11,750.00" "$11,750.00" "$6,815.00" "$11,750.00" "$7,050.00" "$11,750.00" "$11,750.00" "$11,750.00" N/A N/A 80528718 EAP HCPCS C1761 CATHETER US 3MM .045IN 138CM STRL LF 12MM SHOCKWAVE C2 CNCT BOTH IP/OP "$11,750.00" "$8,695.00" "$2,060.15" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$4,181.12" "$4,181.12" "$9,056.90" "$2,060.15" "$2,448.83" "$11,750.00" "$4,700.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$8,812.50" "$11,750.00" "$11,750.00" "$11,750.00" "$5,875.00" "$5,875.00" "$9,306.00" "$11,750.00" "$9,400.00" "$7,637.50" "$11,750.00" "$11,750.00" "$6,815.00" "$11,750.00" "$7,050.00" "$11,750.00" "$11,750.00" "$11,750.00" N/A N/A 80528719 EAP HCPCS C1761 CATHETER US 3.5MM .045IN 138CM STRL LF 12MM SHOCKWAVE C2 BOTH IP/OP "$11,750.00" "$8,695.00" "$2,060.15" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$4,181.12" "$4,181.12" "$9,056.90" "$2,060.15" "$2,448.83" "$11,750.00" "$4,700.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$8,812.50" "$11,750.00" "$11,750.00" "$11,750.00" "$5,875.00" "$5,875.00" "$9,306.00" "$11,750.00" "$9,400.00" "$7,637.50" "$11,750.00" "$11,750.00" "$6,815.00" "$11,750.00" "$7,050.00" "$11,750.00" "$11,750.00" "$11,750.00" N/A N/A 80528720 EAP HCPCS C1761 CATHETER US 4MM .047IN 138CM STRL LF 12MM SHOCKWAVE C2 CNCT BOTH IP/OP "$11,750.00" "$8,695.00" "$2,060.15" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$4,181.12" "$4,181.12" "$9,056.90" "$2,060.15" "$2,448.83" "$11,750.00" "$4,700.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$8,812.50" "$11,750.00" "$11,750.00" "$11,750.00" "$5,875.00" "$5,875.00" "$9,306.00" "$11,750.00" "$9,400.00" "$7,637.50" "$11,750.00" "$11,750.00" "$6,815.00" "$11,750.00" "$7,050.00" "$11,750.00" "$11,750.00" "$11,750.00" N/A N/A 80528721 EAP CABLE SLV 13CMX244CM STRL BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 $150.00 $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A 80528722 EAP CABLE US CNCT INTVASC LTHTRP BOTH IP/OP "$2,798.00" "$2,071.00" $498.04 "$2,798.00" "$2,798.00" "$2,798.00" "$2,798.00" "$2,798.00" "$2,798.00" "$2,798.00" $498.04 "$2,798.00" "$2,798.00" "$2,076.68" "$2,076.68" "$2,156.70" "$1,457.76" $583.13 "$2,798.00" "$1,119.20" "$2,798.00" "$2,798.00" "$2,798.00" "$2,798.00" "$2,798.00" "$2,098.50" "$2,798.00" "$2,798.00" "$2,798.00" "$1,399.00" "$1,399.00" "$2,216.02" "$2,798.00" "$2,238.40" "$1,818.70" "$2,798.00" "$2,798.00" "$1,622.84" "$2,798.00" "$1,678.80" "$2,798.00" "$2,798.00" "$2,798.00" N/A N/A 80528724 EAP HCPCS C1725 CATHETER BLNDIL 3.5MM 110CM 60MM SHOCKWAVE M5 PERI ACPT 6FR BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80528725 EAP HCPCS C1725 CATHETER BLNDIL 4MM 110CM 60MM SHOCKWAVE M5 PERI ACPT 6FR BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80528726 EAP HCPCS C1725 CATHETER BLNDIL 4.5MM 110CM 60MM SHOCKWAVE M5 PERI ACPT 6FR BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80528727 EAP HCPCS C1725 CATHETER BLNDIL 5MM 110CM 60MM SHOCKWAVE M5 PERI ACPT 6FR BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80528728 EAP HCPCS C1725 CATHETER BLNDIL 5.5MM 110CM 60MM SHOCKWAVE M5 PERI ACPT 6FR BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80528729 EAP HCPCS C1725 CATHETER BLNDIL 6MM 110CM 60MM SHOCKWAVE M5 PERI ACPT 6FR BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80528730 EAP HCPCS C1725 CATHETER BLNDIL 6.5MM 110CM 60MM SHOCKWAVE M5 PERI ACPT 7FR BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80528731 EAP HCPCS C1725 DEVICE STON REM 7MM 60MM 110MM SHOCKWAVE M5 ACPT 7FR SHTH BOTH IP/OP "$6,875.00" "$5,087.50" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" "$6,875.00" "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A 80528732 EAP HCPCS C1761 CATHETER BLNDIL 10 ATM 6 ATM .052IN OD SEC 2.5MM GUIDEWARE BOTH IP/OP "$6,875.00" "$5,087.50" "$1,432.83" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$2,750.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$6,875.00" "$6,875.00" "$3,987.50" "$6,875.00" "$4,125.00" "$6,875.00" "$6,875.00" "$6,875.00" N/A N/A 80528733 EAP HCPCS C1761 CATHETER BLNDIL 10 ATM 6 ATM .052IN OD 3.052MM GUIDEWARE DIA BOTH IP/OP "$6,875.00" "$5,087.50" "$1,432.83" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$2,750.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$6,875.00" "$6,875.00" "$3,987.50" "$6,875.00" "$4,125.00" "$6,875.00" "$6,875.00" "$6,875.00" N/A N/A 80528734 EAP HCPCS C1761 CATHETER BLNDIL 10 ATM 6 ATM .054IN OD 3.5MM GUIDEWARE DIA BOTH IP/OP "$6,875.00" "$5,087.50" "$1,432.83" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$2,750.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$6,875.00" "$6,875.00" "$3,987.50" "$6,875.00" "$4,125.00" "$6,875.00" "$6,875.00" "$6,875.00" N/A N/A 80528735 EAP HCPCS C1761 CATHETER BLNDIL 10 ATM 6 ATM .054IN OD 4MM GUIDEWARE DIA BOTH IP/OP "$6,875.00" "$5,087.50" "$1,432.83" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$2,750.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$6,875.00" "$6,875.00" "$3,987.50" "$6,875.00" "$4,125.00" "$6,875.00" "$6,875.00" "$6,875.00" N/A N/A 80529959 EAP CATHETER ENDO HEMOSPRAY L220 HEMOSTAT 3.7 HEMO-10 BOTH IP/OP "$3,663.00" "$2,711.00" $652.01 "$3,663.00" "$3,663.00" "$3,663.00" "$3,663.00" "$3,663.00" "$3,663.00" "$3,663.00" $652.01 "$3,663.00" "$3,663.00" "$2,718.68" "$2,718.68" "$2,823.44" "$1,908.42" $763.41 "$3,663.00" "$1,465.20" "$3,663.00" "$3,663.00" "$3,663.00" "$3,663.00" "$3,663.00" "$2,747.25" "$3,663.00" "$3,663.00" "$3,663.00" "$1,831.50" "$1,831.50" "$2,901.10" "$3,663.00" "$2,930.40" "$2,380.95" "$3,663.00" "$3,663.00" "$2,124.54" "$3,663.00" "$2,197.80" "$3,663.00" "$3,663.00" "$3,663.00" N/A N/A 80529960 EAP CATHETER ENDO HEMOSPRAY L220 HEMOSTAT 2.8 HEMO-7 BOTH IP/OP "$3,663.00" "$2,711.00" $652.01 "$3,663.00" "$3,663.00" "$3,663.00" "$3,663.00" "$3,663.00" "$3,663.00" "$3,663.00" $652.01 "$3,663.00" "$3,663.00" "$2,718.68" "$2,718.68" "$2,823.44" "$1,908.42" $763.41 "$3,663.00" "$1,465.20" "$3,663.00" "$3,663.00" "$3,663.00" "$3,663.00" "$3,663.00" "$2,747.25" "$3,663.00" "$3,663.00" "$3,663.00" "$1,831.50" "$1,831.50" "$2,901.10" "$3,663.00" "$2,930.40" "$2,380.95" "$3,663.00" "$3,663.00" "$2,124.54" "$3,663.00" "$2,197.80" "$3,663.00" "$3,663.00" "$3,663.00" N/A N/A 80529966 EAP HCPCS C1821 CAGE SPNL 8D SM 5MM STRL LF EIT CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529967 EAP HCPCS C1821 CAGE SPNL 8D SM 6MM STRL LF EIT CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529968 EAP HCPCS C1821 CAGE SPNL 8D SM 7MM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529969 EAP HCPCS C1821 CAGE SPNL 8D SM 8MM STRL LF EIT CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529970 EAP HCPCS C1821 CAGE SPNL 8D SM 9MM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529971 EAP HCPCS C1821 CAGE SPNL 8D SM 10MM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529972 EAP HCPCS C1821 CAGE SPNL 8D LG 5MM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529973 EAP HCPCS C1821 CAGE SPNL 8D LG 6MM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529974 EAP HCPCS C1821 CAGE SPNL 8D LG 7MM STRL LF EIT CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529975 EAP HCPCS C1821 CAGE SPNL 8D LG 8MM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529976 EAP HCPCS C1821 CAGE SPNL 8D LG 9MM STRL LF EIT CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529977 EAP HCPCS C1821 CAGE SPNL 8D LG 10MM STRL LF EIT CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529978 EAP HCPCS C1821 CAGE SPNL 4D SM 5MM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529979 EAP HCPCS C1821 CAGE SPNL 4D SM 6MM STRL CNDT RGH ELEV SRFC FTPRNT EIT CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529980 EAP HCPCS C1821 CAGE SPNL 4D SM 7MM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529981 EAP HCPCS C1821 CAGE SPNL 4D SM 8MM STRL LF EIT CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529982 EAP HCPCS C1821 CAGE SPNL 4D SM 9MM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529983 EAP HCPCS C1821 CAGE SPNL 4D SM 10MM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529984 EAP HCPCS C1821 CAGE SPNL 4D LG 5MM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529985 EAP HCPCS C1821 CAGE SPNL 4D LG 6MM STRL LF EIT CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529986 EAP HCPCS C1821 CAGE SPNL 4D LG 7MM STRL LF EIT CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529987 EAP HCPCS C1821 CAGE SPNL 4D LG 8MM STRL LF EIT CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529988 EAP HCPCS C1821 CAGE SPNL 4D LG 9MM STRL LF EIT CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529989 EAP HCPCS C1821 CAGE SPNL 4D LG 10MM STRL LF EIT CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" "$2,250.00" "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 80529990 EAP HCPCS C1821 CAGE SPNL 0D 28X10X7MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80529991 EAP HCPCS C1821 CAGE SPNL 0D 28X10X8MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80529992 EAP HCPCS C1821 CAGE SPNL 0D 28X10X9MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80529993 EAP HCPCS C1821 CAGE SPNL 0D 28X10X10MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80529994 EAP HCPCS C1821 CAGE SPNL 0D 28X10X11MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80529995 EAP HCPCS C1821 CAGE SPNL 0D 28X10X12MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80529996 EAP HCPCS C1821 CAGE SPNL 0D 28X10X13MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80529997 EAP HCPCS C1821 CAGE SPNL 0D 28X10X15MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80529998 EAP HCPCS C1821 CAGE SPNL 8D 28X10X8MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80529999 EAP HCPCS C1821 CAGE SPNL 8D 28X10X9MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530000 EAP HCPCS C1821 CAGE SPNL 8D 28X10X10MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530001 EAP HCPCS C1821 CAGE SPNL 8D 28X10X11MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530002 EAP HCPCS C1821 CAGE SPNL 8D 28X10X12MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530003 EAP HCPCS C1821 CAGE SPNL 8D 28X10X13MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530004 EAP HCPCS C1821 CAGE SPNL 8D 28X10X14MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530005 EAP HCPCS C1821 CAGE SPNL 8D 28X10X15MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530006 EAP HCPCS C1821 CAGE SPNL 0D 32X12X8MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530007 EAP HCPCS C1821 CAGE SPNL 0D 32X12X9MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530008 EAP HCPCS C1821 CAGE SPNL 0D 32X12X10MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530009 EAP HCPCS C1821 CAGE SPNL 0D 32X12X11MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530010 EAP HCPCS C1821 CAGE SPNL 0D 32X12X13MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530011 EAP HCPCS C1821 CAGE SPNL 8D 28X10X15MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530012 EAP HCPCS C1821 CAGE SPNL 8D 32X12X8MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530013 EAP HCPCS C1821 CAGE SPNL 8D 32X12X9MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530014 EAP HCPCS C1821 CAGE SPNL 8D 32X12X10MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530015 EAP HCPCS C1821 CAGE SPNL 8D 32X12X11MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530016 EAP HCPCS C1821 CAGE SPNL 8D 32X12X12MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530017 EAP HCPCS C1821 CAGE SPNL 8D 32X12X13MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530018 EAP HCPCS C1821 CAGE SPNL 8D 32X12X14MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530019 EAP HCPCS C1821 CAGE SPNL 8D 32X12X15MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530020 EAP HCPCS C1821 CAGE SPNL 12D 32X12X9MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530021 EAP HCPCS C1821 CAGE SPNL 12D 32X12X10MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530022 EAP HCPCS C1821 CAGE SPNL 12D 32X12X11MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530023 EAP HCPCS C1821 CAGE SPNL 12D 32X12X12MM STRL LF EIT TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530024 EAP HCPCS C1821 CAGE SPNL 12D CRV 32X12X13MM STRL CNDT RGH ELEV SRFC FTPRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530025 EAP 80530025 CAGE SPNL 4D 22X9X7MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530026 EAP HCPCS C1821 CAGE SPNL 4D STRG BLT 22X9X8MM STRL CNDT RGH ELEV SRFC BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530027 EAP HCPCS C1821 CAGE SPNL 4D 22X9X9MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530028 EAP HCPCS C1821 CAGE SPNL 4D 22X9X10MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530029 EAP HCPCS C1821 CAGE SPNL 4D 22X9X11MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530030 EAP HCPCS C1821 CAGE SPNL 4D 22X9X12MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530031 EAP HCPCS C1821 CAGE SPNL 4D 22X9X13MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530032 EAP HCPCS C1821 CAGE SPNL 4D 22X9X14MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530033 EAP HCPCS C1821 CAGE SPNL 4D 22X9X15MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530034 EAP HCPCS C1821 CAGE SPNL 8D 22X9X8MM PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530035 EAP HCPCS C1821 CAGE SPNL 8D 22X9X9MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530036 EAP HCPCS C1821 CAGE SPNL 8D 22X9X10MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530037 EAP HCPCS C1821 CAGE SPNL 8D 22X9X11MM PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530038 EAP HCPCS C1821 CAGE SPNL 8D 22X9X12MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530039 EAP HCPCS C1821 CAGE SPNL 8D 22X9X13MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530040 EAP HCPCS C1821 CAGE SPNL 8D STRG 22X9X14MM STRL CNDT RGH ELEV SRFC FTPRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530041 EAP HCPCS C1821 CAGE SPNL 8D STRG 22X9X15MM STRL CNDT RGH ELEV SRFC FTPRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530042 EAP HCPCS C1821 CAGE SPNL 12D STRG 22X9X9MM STRL CNDT RGH ELEV SRFC FTPRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530043 EAP HCPCS C1821 CAGE SPNL 12D 22X9X11MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530044 EAP HCPCS C1821 CAGE SPNL 12D STRG 22X9X13MM STRL CNDT RGH ELEV SRFC FTPRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530045 EAP HCPCS C1821 CAGE SPNL 12D 22X9X15MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530046 EAP HCPCS C1821 CAGE SPNL 18D STRG 22X9X11MM STRL CNDT RGH ELEV SRFC FTPRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530047 EAP HCPCS C1821 CAGE SPNL 18D 22X9X13MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530048 EAP HCPCS C1821 CAGE SPNL 18D 22X9X15MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530049 EAP HCPCS C1821 CAGE SPNL 4D 26X9X7MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530050 EAP HCPCS C1821 CAGE SPNL 4D 26X9X8MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530051 EAP HCPCS C1821 CAGE SPNL 4D 26X9X9MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530052 EAP HCPCS C1821 CAGE SPNL 4D 26X9X10MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530053 EAP HCPCS C1821 CAGE SPNL 4D STRG 26X9X11MM STRL CNDT RGH ELEV SRFC FTPRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530054 EAP HCPCS C1821 CAGE SPNL 4D 12MM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530055 EAP HCPCS C1821 CAGE SPNL 4D 26X9X13MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530056 EAP HCPCS C1821 CAGE SPNL 4D 26X9X14MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530057 EAP HCPCS C1821 CAGE SPNL 4D 26X9X15MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530058 EAP HCPCS C1821 CAGE SPNL 8D STRG 26X9X8MM STRL CNDT RGH ELEV SRFC FTPRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530059 EAP HCPCS C1821 CAGE SPNL 8D 26X9X9MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530060 EAP HCPCS C1821 CAGE SPNL 8D 26X9X10MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530061 EAP HCPCS C1821 CAGE SPNL 8D 26X9X11MM PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530062 EAP HCPCS C1821 CAGE SPNL 8D 26X9X12MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530063 EAP HCPCS C1821 CAGE SPNL 8D 26X9X13MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530064 EAP HCPCS C1821 CAGE SPNL 8D STRG 26X9X14MM STRL CNDT RGH ELEV SRFC FTPRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530065 EAP HCPCS C1821 CAGE SPNL 8D STRG 26X9X15MM STRL CNDT RGH ELEV SRFC FTPRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530066 EAP HCPCS C1821 CAGE SPNL 12D STRG 26X9X10MM STRL CNDT RGH ELEV SRFC FTPRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530067 EAP HCPCS C1821 CAGE SPNL 12D 26X9X11MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530068 EAP HCPCS C1821 CAGE SPNL 12D 26X9X13MM PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530069 EAP HCPCS C1821 CAGE SPNL 12D 26X9X15MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530070 EAP HCPCS C1821 CAGE SPNL 18D STRG 26X9X11MM STRL CNDT RGH ELEV SRFC FTPRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530071 EAP HCPCS C1821 CAGE SPNL 18D 26X9X13MM PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530072 EAP HCPCS C1821 CAGE SPNL 18D 26X9X15MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530073 EAP HCPCS C1821 CAGE SPNL 4D 30X9X9MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530074 EAP HCPCS C1821 CAGE SPNL 4D 30X9X11MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530075 EAP HCPCS C1821 CAGE SPNL 4D 30X9X13MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530076 EAP HCPCS C1821 CAGE SPNL 4D 30X9X15MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530077 EAP HCPCS C1821 CAGE SPNL 4D 26X11X7MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530078 EAP HCPCS C1821 CAGE SPNL 4D 26X11X9MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530079 EAP HCPCS C1821 CAGE SPNL 4D 26X11X11MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530080 EAP HCPCS C1821 CAGE SPNL 4D 26X11X13MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530081 EAP HCPCS C1821 CAGE SPNL 4D 26X11X15MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530082 EAP HCPCS C1821 CAGE SPNL 8D STRG 22X11X9MM STRL CNDT RGH ELEV SRFC FTPRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530083 EAP HCPCS C1821 CAGE SPNL 8D 26X11X11MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530084 EAP HCPCS C1821 CAGE SPNL 8D 26X11X13MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530085 EAP HCPCS C1821 CAGE SPNL 8D 26X11X15MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530086 EAP HCPCS C1821 CAGE SPNL 12D 26X11X11MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530087 EAP HCPCS C1821 CAGE SPNL 12D 26X11X13MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530088 EAP HCPCS C1821 CAGE SPNL 12D 26X11X15MM STRL LF EIT PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530089 EAP HCPCS C1821 CAGE SPNL 5D SM 8MM STRL LF EIT ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" "$7,500.00" "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 80530090 EAP HCPCS C1821 CAGE SPNL 5D SM 10MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530091 EAP HCPCS C1821 CAGE SPNL 5D SM 12MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530092 EAP HCPCS C1821 CAGE SPNL 5D SM 14MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530093 EAP HCPCS C1821 CAGE SPNL 10D SM 10MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530094 EAP HCPCS C1821 CAGE SPNL 10D SM 12MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530095 EAP HCPCS C1821 CAGE SPNL 10D SM 14MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530096 EAP HCPCS C1821 CAGE SPNL 10D SM 16MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530097 EAP HCPCS C1821 CAGE SPNL 10D SM 18MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530098 EAP HCPCS C1821 CAGE SPNL 15D SM 10MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530099 EAP HCPCS C1821 CAGE SPNL 15D SM 12MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530100 EAP HCPCS C1821 CAGE SPNL 15D SM 14MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530101 EAP HCPCS C1821 CAGE SPNL 15D SM 16MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530102 EAP HCPCS C1821 CAGE SPNL 15D SM 18MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530103 EAP HCPCS C1821 CAGE SPNL 20D SM 12MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530104 EAP 80530104 CAGE SPNL 20D SM 14MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530105 EAP HCPCS C1821 CAGE SPNL 20D SM 16MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530106 EAP HCPCS C1821 CAGE SPNL 5D MED 8MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530107 EAP HCPCS C1821 CAGE SPNL 5D MED 10MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530108 EAP HCPCS C1821 CAGE SPNL 5D MED 12MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530109 EAP HCPCS C1821 CAGE SPNL 10D MED 10MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530110 EAP HCPCS C1821 CAGE SPNL 10D MED 12MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530111 EAP HCPCS C1821 CAGE SPNL 10D MED 14MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530112 EAP HCPCS C1821 CAGE SPNL 10D MED 16MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530113 EAP HCPCS C1821 CAGE SPNL 10D MED 18MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530114 EAP HCPCS C1821 CAGE SPNL 15D MED 10MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530115 EAP HCPCS C1821 CAGE SPNL 15D MED 12MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530116 EAP HCPCS C1821 CAGE SPNL 15D MED 14MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530117 EAP HCPCS C1821 CAGE SPNL 15D MED 16MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530118 EAP HCPCS C1821 CAGE SPNL 15D MED 18MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530119 EAP HCPCS C1821 CAGE SPNL 20D MED 12MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530120 EAP HCPCS C1821 CAGE SPNL 20D MED 14MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530121 EAP HCPCS C1821 CAGE SPNL 20D MED 16MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530122 EAP HCPCS C1821 CAGE SPNL 20D MED 18MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530123 EAP HCPCS C1821 CAGE SPNL 5D LG 8MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530124 EAP HCPCS C1821 CAGE SPNL 5D LG 10MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530125 EAP HCPCS C1821 CAGE SPNL 5D LG 12MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530126 EAP HCPCS C1821 CAGE SPNL 5D LG 14MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530127 EAP HCPCS C1821 CAGE SPNL 10D LG 10MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530128 EAP HCPCS C1821 CAGE SPNL 10D LG 12MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530129 EAP HCPCS C1821 CAGE SPNL 10D LG 14MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530130 EAP HCPCS C1821 CAGE SPNL 10D LG 16MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530131 EAP HCPCS C1821 CAGE SPNL 10D LG 18MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530132 EAP HCPCS C1821 CAGE SPNL 15D LG 10MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530133 EAP HCPCS C1821 CAGE SPNL 15D LG 12MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530134 EAP HCPCS C1821 CAGE SPNL 15D LG 14MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530135 EAP HCPCS C1821 CAGE SPNL 15D LG 16MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530136 EAP HCPCS C1821 CAGE SPNL 15D LG 18MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530137 EAP HCPCS C1821 CAGE SPNL 20D 29MM LG 40X12MM STRL EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530138 EAP HCPCS C1821 CAGE SPNL 20D LG 14MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530139 EAP HCPCS C1821 CAGE SPNL 20D LG 16MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530140 EAP HCPCS C1821 CAGE SPNL 20D LG 18MM STRL LF EIT ALIF BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530141 EAP HCPCS C1821 CAGE SPNL 0D 40X18X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530142 EAP HCPCS C1821 CAGE SPNL 0D 40X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" "$8,750.00" "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 80530143 EAP HCPCS C1821 CAGE SPNL 0D 40X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530144 EAP HCPCS C1821 CAGE SPNL 0D 40X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530145 EAP HCPCS C1821 CAGE SPNL 0D 40X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530146 EAP HCPCS C1821 CAGE SPNL 0D 45X18X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530147 EAP HCPCS C1821 CAGE SPNL 0D 45X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530148 EAP HCPCS C1821 CAGE SPNL 0D 45X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530149 EAP HCPCS C1821 CAGE SPNL 0D 45X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530150 EAP HCPCS C1821 CAGE SPNL 0D 45X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530151 EAP HCPCS C1821 CAGE SPNL 0D 50X18X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530152 EAP HCPCS C1821 CAGE SPNL 0D 50X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530153 EAP HCPCS C1821 CAGE SPNL 0D 50X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530154 EAP HCPCS C1821 CAGE SPNL 0D 50X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530155 EAP HCPCS C1821 CAGE SPNL 0D 50X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530156 EAP HCPCS C1821 CAGE SPNL 0D 55X18X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530157 EAP HCPCS C1821 CAGE SPNL 0D 55X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530158 EAP HCPCS C1821 CAGE SPNL 0D 55X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530159 EAP HCPCS C1821 CAGE SPNL 0D 55X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530160 EAP HCPCS C1821 CAGE SPNL 0D 55X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530161 EAP HCPCS C1821 CAGE SPNL 0D 60X18X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530162 EAP HCPCS C1821 CAGE SPNL 0D 60X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530163 EAP HCPCS C1821 CAGE SPNL 0D 60X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530164 EAP HCPCS C1821 CAGE SPNL 0D 60X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530165 EAP HCPCS C1821 CAGE SPNL 0D 60X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530166 EAP HCPCS C1821 CAGE SPNL 0D 40X22X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530167 EAP HCPCS C1821 CAGE SPNL 0D 40X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530168 EAP HCPCS C1821 CAGE SPNL 0D 40X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530169 EAP HCPCS C1821 CAGE SPNL 0D 40X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530170 EAP HCPCS C1821 CAGE SPNL 0D 40X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530171 EAP HCPCS C1821 CAGE SPNL 0D 45X22X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530172 EAP HCPCS C1821 CAGE SPNL 0D 45X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530173 EAP HCPCS C1821 CAGE SPNL 0D 45X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530174 EAP HCPCS C1821 CAGE SPNL 0D 45X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530175 EAP HCPCS C1821 CAGE SPNL 0D 45X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530176 EAP HCPCS C1821 CAGE SPNL 0D 50X22X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530177 EAP HCPCS C1821 CAGE SPNL 0D 50X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530178 EAP HCPCS C1821 CAGE SPNL 0D 50X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530179 EAP HCPCS C1821 CAGE SPNL 0D 50X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530180 EAP HCPCS C1821 CAGE SPNL 0D 50X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530181 EAP HCPCS C1821 CAGE SPNL 0D 55X22X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530182 EAP HCPCS C1821 CAGE SPNL 0D 55X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530183 EAP HCPCS C1821 CAGE SPNL 0D 55X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530184 EAP HCPCS C1821 CAGE SPNL 0D 55X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530185 EAP HCPCS C1821 CAGE SPNL 0D 55X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530186 EAP HCPCS C1821 CAGE SPNL 0D 60X22X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530187 EAP HCPCS C1821 CAGE SPNL 0D 60X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530188 EAP HCPCS C1821 CAGE SPNL 0D 60X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530189 EAP HCPCS C1821 CAGE SPNL 0D 60X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530190 EAP HCPCS C1821 CAGE SPNL 0D 60X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530191 EAP HCPCS C1821 CAGE SPNL 0D 40X26X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530192 EAP HCPCS C1821 CAGE SPNL 0D 40X26X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530193 EAP HCPCS C1821 CAGE SPNL 0D 40X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530194 EAP HCPCS C1821 CAGE SPNL 0D 40X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530195 EAP HCPCS C1821 CAGE SPNL 0D 40X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530196 EAP HCPCS C1821 CAGE SPNL 0D 45X26X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530197 EAP HCPCS C1821 CAGE SPNL 0D 45X26X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530198 EAP HCPCS C1821 CAGE SPNL 0D 45X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530199 EAP HCPCS C1821 CAGE SPNL 0D 45X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530200 EAP HCPCS C1821 CAGE SPNL 0D 45X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530201 EAP HCPCS C1821 CAGE SPNL 0D 50X26X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530202 EAP HCPCS C1821 CAGE SPNL 0D 50X26X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530203 EAP HCPCS C1821 CAGE SPNL 0D 50X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530204 EAP HCPCS C1821 CAGE SPNL 0D 50X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530205 EAP HCPCS C1821 CAGE SPNL 0D 50X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530206 EAP HCPCS C1821 CAGE SPNL 0D 55X26X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530207 EAP HCPCS C1821 CAGE SPNL 0D 55X26X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530208 EAP HCPCS C1821 CAGE SPNL 0D 55X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530209 EAP HCPCS C1821 CAGE SPNL 0D 55X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530210 EAP HCPCS C1821 CAGE SPNL 0D 55X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530211 EAP HCPCS C1821 CAGE SPNL 0D 60X26X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530212 EAP HCPCS C1821 CAGE SPNL 0D 60X26X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530213 EAP HCPCS C1821 CAGE SPNL 0D 60X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530214 EAP HCPCS C1821 CAGE SPNL 0D 60X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530215 EAP HCPCS C1821 CAGE SPNL 0D 60X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530216 EAP HCPCS C1821 CAGE SPNL 8D 40X18X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530217 EAP HCPCS C1821 CAGE SPNL 8D 40X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530218 EAP HCPCS C1821 CAGE SPNL 8D 40X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530219 EAP HCPCS C1821 CAGE SPNL 8D 40X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530220 EAP HCPCS C1821 CAGE SPNL 8D 40X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530221 EAP HCPCS C1821 CAGE SPNL 8D 45X18X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530222 EAP HCPCS C1821 CAGE SPNL 8D 45X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530223 EAP HCPCS C1821 CAGE SPNL 8D 45X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530224 EAP HCPCS C1821 CAGE SPNL 8D 45X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530225 EAP HCPCS C1821 CAGE SPNL 8D 45X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530226 EAP HCPCS C1821 CAGE SPNL 8D 50X18X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530227 EAP HCPCS C1821 CAGE SPNL 8D 50X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530228 EAP HCPCS C1821 CAGE SPNL 8D 50X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530229 EAP HCPCS C1821 CAGE SPNL 8D 50X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530230 EAP HCPCS C1821 CAGE SPNL 8D 50X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530231 EAP HCPCS C1821 CAGE SPNL 8D 55X18X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530232 EAP HCPCS C1821 CAGE SPNL 8D 55X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530233 EAP HCPCS C1821 CAGE SPNL 8D 55X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530234 EAP HCPCS C1821 CAGE SPNL 8D 55X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530235 EAP HCPCS C1821 CAGE SPNL 8D 55X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530236 EAP HCPCS C1821 CAGE SPNL 8D 60X18X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530237 EAP HCPCS C1821 CAGE SPNL 8D 60X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530238 EAP HCPCS C1821 CAGE SPNL 8D 60X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530239 EAP HCPCS C1821 CAGE SPNL 8D 60X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530240 EAP HCPCS C1821 CAGE SPNL 8D 60X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530241 EAP HCPCS C1821 CAGE SPNL 8D 40X22X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530242 EAP HCPCS C1821 CAGE SPNL 8D 40X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530243 EAP HCPCS C1821 CAGE SPNL 8D 40X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530244 EAP HCPCS C1821 CAGE SPNL 8D 40X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530245 EAP HCPCS C1821 CAGE SPNL 8D 40X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530246 EAP HCPCS C1821 CAGE SPNL 8D 45X22X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530247 EAP HCPCS C1821 CAGE SPNL 8D 45X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530248 EAP HCPCS C1821 CAGE SPNL 8D 45X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530249 EAP HCPCS C1821 CAGE SPNL 8D 45X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530250 EAP HCPCS C1821 CAGE SPNL 8D 45X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530251 EAP HCPCS C1821 CAGE SPNL 8D 50X22X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530252 EAP HCPCS C1821 CAGE SPNL 8D 50X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530253 EAP HCPCS C1821 CAGE SPNL 8D 50X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530254 EAP HCPCS C1821 CAGE SPNL 8D 50X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530255 EAP HCPCS C1821 CAGE SPNL 8D 50X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530256 EAP HCPCS C1821 CAGE SPNL 8D 55X22X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530257 EAP HCPCS C1821 CAGE SPNL 8D 55X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530258 EAP HCPCS C1821 CAGE SPNL 8D 55X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530259 EAP HCPCS C1821 CAGE SPNL 8D 55X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530260 EAP HCPCS C1821 CAGE SPNL 8D 55X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530261 EAP HCPCS C1821 CAGE SPNL 8D 60X22X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530262 EAP HCPCS C1821 CAGE SPNL 8D 60X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530263 EAP HCPCS C1821 CAGE SPNL 8D 60X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530264 EAP HCPCS C1821 CAGE SPNL 8D 60X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530265 EAP HCPCS C1821 CAGE SPNL 8D 60X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530266 EAP HCPCS C1821 CAGE SPNL 8D 40X26X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530267 EAP HCPCS C1821 CAGE SPNL 8D 40X26X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530268 EAP HCPCS C1821 CAGE SPNL 8D 40X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530269 EAP HCPCS C1821 CAGE SPNL 8D 40X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530270 EAP HCPCS C1821 CAGE SPNL 8D 40X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530271 EAP HCPCS C1821 CAGE SPNL 8D 45X26X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530272 EAP HCPCS C1821 CAGE SPNL 8D 45X26X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530273 EAP HCPCS C1821 CAGE SPNL 8D 45X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530274 EAP HCPCS C1821 CAGE SPNL 8D 45X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530275 EAP HCPCS C1821 CAGE SPNL 8D 45X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530276 EAP HCPCS C1821 CAGE SPNL 8D 50X26X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530277 EAP HCPCS C1821 CAGE SPNL 8D 50X26X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530278 EAP HCPCS C1821 CAGE SPNL 8D 50X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530279 EAP HCPCS C1821 CAGE SPNL 8D 50X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530280 EAP HCPCS C1821 CAGE SPNL 8D 50X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530281 EAP HCPCS C1821 CAGE SPNL 8D 55X26X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530282 EAP HCPCS C1821 CAGE SPNL 8D 55X26X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530283 EAP HCPCS C1821 CAGE SPNL 8D 55X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530284 EAP HCPCS C1821 CAGE SPNL 8D 55X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530285 EAP HCPCS C1821 CAGE SPNL 8D 55X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530286 EAP HCPCS C1821 CAGE SPNL 8D 60X26X8MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530287 EAP HCPCS C1821 CAGE SPNL 8D 60X26X10MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530288 EAP HCPCS C1821 CAGE SPNL 8D 60X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530289 EAP HCPCS C1821 CAGE SPNL 8D 60X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530290 EAP HCPCS C1821 CAGE SPNL 8D 60X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT LAT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530291 EAP HCPCS C1821 CAGE SPNL 16D 40X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530292 EAP HCPCS C1821 CAGE SPNL 16D 40X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530293 EAP HCPCS C1821 CAGE SPNL 16D 40X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530294 EAP HCPCS C1821 CAGE SPNL 16D 40X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530295 EAP HCPCS C1821 CAGE SPNL 16D 45X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530296 EAP HCPCS C1821 CAGE SPNL 16D 45X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530297 EAP HCPCS C1821 CAGE SPNL 16D 45X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530298 EAP HCPCS C1821 CAGE SPNL 16D 45X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530299 EAP HCPCS C1821 CAGE SPNL 16D 50X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530300 EAP HCPCS C1821 CAGE SPNL 16D 50X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530301 EAP HCPCS C1821 CAGE SPNL 16D 50X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530302 EAP HCPCS C1821 CAGE SPNL 16D 50X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530303 EAP HCPCS C1821 CAGE SPNL 16D 55X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530304 EAP HCPCS C1821 CAGE SPNL 16D 55X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530305 EAP HCPCS C1821 CAGE SPNL 16D 55X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530306 EAP HCPCS C1821 CAGE SPNL 16D 55X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530307 EAP HCPCS C1821 CAGE SPNL 16D 60X18X10MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530308 EAP HCPCS C1821 CAGE SPNL 16D 60X18X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530309 EAP HCPCS C1821 CAGE SPNL 16D 60X18X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530310 EAP HCPCS C1821 CAGE SPNL 16D 60X18X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530311 EAP HCPCS C1821 CAGE SPNL 16D 40X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530312 EAP HCPCS C1821 CAGE SPNL 16D 40X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530313 EAP HCPCS C1821 CAGE SPNL 16D 40X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530314 EAP HCPCS C1821 CAGE SPNL 16D 40X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530315 EAP HCPCS C1821 CAGE SPNL 16D 45X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530316 EAP HCPCS C1821 CAGE SPNL 16D 45X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530317 EAP HCPCS C1821 CAGE SPNL 16D 45X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530318 EAP HCPCS C1821 CAGE SPNL 16D 45X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530319 EAP HCPCS C1821 CAGE SPNL 16D 50X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530320 EAP HCPCS C1821 CAGE SPNL 16D 50X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530321 EAP HCPCS C1821 CAGE SPNL 16D 50X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530322 EAP HCPCS C1821 CAGE SPNL 16D 50X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530323 EAP HCPCS C1821 CAGE SPNL 16D 55X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530324 EAP HCPCS C1821 CAGE SPNL 16D 55X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530325 EAP HCPCS C1821 CAGE SPNL 16D 55X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530326 EAP HCPCS C1821 CAGE SPNL 16D 55X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530327 EAP HCPCS C1821 CAGE SPNL 16D 60X22X10MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530328 EAP HCPCS C1821 CAGE SPNL 16D 60X22X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530329 EAP HCPCS C1821 CAGE SPNL 16D 60X22X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530330 EAP HCPCS C1821 CAGE SPNL 16D 60X22X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530331 EAP HCPCS C1821 CAGE SPNL 16D 40X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530332 EAP HCPCS C1821 CAGE SPNL 16D 40X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530333 EAP HCPCS C1821 CAGE SPNL 16D 40X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530334 EAP HCPCS C1821 CAGE SPNL 16D 45X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530335 EAP HCPCS C1821 CAGE SPNL 16D 45X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530336 EAP HCPCS C1821 CAGE SPNL 16D 45X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530337 EAP HCPCS C1821 CAGE SPNL 16D 50X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530338 EAP HCPCS C1821 CAGE SPNL 16D 50X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530339 EAP HCPCS C1821 CAGE SPNL 16D 50X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530340 EAP HCPCS C1821 CAGE SPNL 16D 55X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530341 EAP HCPCS C1821 CAGE SPNL 16D 55X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530342 EAP HCPCS C1821 CAGE SPNL 16D 55X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530343 EAP HCPCS C1821 CAGE SPNL 16D 60X26X12MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530344 EAP HCPCS C1821 CAGE SPNL 16D 60X26X14MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530345 EAP HCPCS C1821 CAGE SPNL 16D 60X26X16MM STRL LF RGH ELEV SRFC FTPRNT EIT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" "$10,000.00" "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 80530346 EAP HCPCS C1757 CANNULA PRFSN 20D ANGIOVAC DIL FNL TIP RADOPQ COIL REINF (3000) BOTH IP/OP "$18,750.00" "$13,875.00" "$2,060.15" "$18,750.00" "$10,181.25" "$10,181.25" "$10,181.25" "$10,181.25" "$18,750.00" "$18,750.00" "$18,750.00" "$3,907.97" "$18,750.00" "$4,181.12" "$4,181.12" "$14,452.50" "$2,060.15" "$3,907.71" "$18,750.00" "$18,750.00" "$3,094.73" "$18,750.00" "$18,750.00" "$18,750.00" "$18,750.00" "$14,062.50" "$18,750.00" "$18,750.00" "$18,750.00" "$9,375.00" "$9,375.00" "$14,850.00" "$18,750.00" "$15,000.00" "$12,187.50" "$3,721.41" "$18,750.00" "$10,875.00" "$18,750.00" "$18,750.00" "$18,750.00" "$3,907.50" "$18,750.00" N/A N/A 80530355 EAP Custom 80530355 COIL EMBL HLCL 1MM 1CM STRL LF PSTG+ X PK DISP BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80530356 EAP Custom 80530356 COIL EMBL HLCL 2MM 4CM STRL PSTG+ HLCLXPK BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80530357 EAP Custom 80530357 PRESTIGE PLUS HELICAL XTRA COIL PACK 2MM X 6CM BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80530358 EAP Custom 80530358 PRESTIGE PLUS HELICAL XTRA COIL PACK 2MM X 8CM BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80530363 EAP Custom 80530363 PRESTIGE PLUS HELICAL COIL PACK 4MM X 20CM BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$1,577.18" "$1,577.18" "$1,637.95" "$1,107.13" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" "$1,381.25" "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 80530365 EAP Custom 80530365 PRESTIGE PLUS HELICAL COIL PACK 5MM X 20CM BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$1,577.18" "$1,577.18" "$1,637.95" "$1,107.13" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" "$1,381.25" "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 80530376 EAP Custom 80530376 PRESTIGE PLUS COMPLEX XTRA COIL PACK 2MM X 4CM BOTH IP/OP "$1,875.00" "$1,387.50" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" "$1,875.00" "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 80530383 EAP Custom 80530383 PRESTIGE PLUS COMPLEX COIL PACK 8MM X 30CM BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$1,577.18" "$1,577.18" "$1,637.95" "$1,107.13" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" "$1,381.25" "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 80530386 EAP Custom 80530386 PRESTIGE PLUS COMPLEX COIL PACK 10MM X 40CM BOTH IP/OP "$2,375.00" "$1,757.50" $422.75 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $422.75 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" $950.00 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" "$2,375.00" "$2,375.00" "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" "$2,375.00" "$2,375.00" N/A N/A 80530387 EAP Custom 80530387 PRESTIGE PLUS COMPLEX 18 COIL 12MM X 40CM BOTH IP/OP "$2,375.00" "$1,757.50" $422.75 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $422.75 "$2,375.00" "$2,375.00" "$1,762.73" "$1,762.73" "$1,830.65" "$1,237.38" $494.98 "$2,375.00" $950.00 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,543.75" "$2,375.00" "$2,375.00" "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" "$2,375.00" "$2,375.00" N/A N/A 80530388 EAP Custom 80530388 PRESTIGE PLUS COMPLEX 18 COIL 14MM X 47CM BOTH IP/OP "$2,375.00" "$1,757.50" $422.75 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $422.75 "$2,375.00" "$2,375.00" "$1,762.73" "$1,762.73" "$1,830.65" "$1,237.38" $494.98 "$2,375.00" $950.00 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,543.75" "$2,375.00" "$2,375.00" "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" "$2,375.00" "$2,375.00" N/A N/A 80530389 EAP Custom 80530389 PRESTIGE PLUS COMPLEX 18 COIL 16MM X 55CM BOTH IP/OP "$2,375.00" "$1,757.50" $422.75 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $422.75 "$2,375.00" "$2,375.00" "$1,762.73" "$1,762.73" "$1,830.65" "$1,237.38" $494.98 "$2,375.00" $950.00 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,543.75" "$2,375.00" "$2,375.00" "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" "$2,375.00" "$2,375.00" N/A N/A 80530390 EAP Custom 80530390 PRESTIGE PLUS COMPLEX 18 COIL 18MM X 60CM BOTH IP/OP "$2,375.00" "$1,757.50" $422.75 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $422.75 "$2,375.00" "$2,375.00" "$1,762.73" "$1,762.73" "$1,830.65" "$1,237.38" $494.98 "$2,375.00" $950.00 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,543.75" "$2,375.00" "$2,375.00" "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" "$2,375.00" "$2,375.00" N/A N/A 80530391 EAP Custom 80530391 PRESTIGE PLUS COMPLEX 18 COIL 20MM X 65CM BOTH IP/OP "$2,375.00" "$1,757.50" $422.75 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $422.75 "$2,375.00" "$2,375.00" "$1,762.73" "$1,762.73" "$1,830.65" "$1,237.38" $494.98 "$2,375.00" $950.00 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,543.75" "$2,375.00" "$2,375.00" "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" "$2,375.00" "$2,375.00" N/A N/A 80530392 EAP Custom 80530392 PRESTIGE PLUS COMPLEX 18 COIL 22MM X 65CM BOTH IP/OP "$2,375.00" "$1,757.50" $422.75 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $422.75 "$2,375.00" "$2,375.00" "$1,762.73" "$1,762.73" "$1,830.65" "$1,237.38" $494.98 "$2,375.00" $950.00 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,543.75" "$2,375.00" "$2,375.00" "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" "$2,375.00" "$2,375.00" N/A N/A 80530393 EAP Custom 80530393 PRESTIGE PLUS COMPLEX 18 COIL 24MM X 65CM BOTH IP/OP "$2,375.00" "$1,757.50" $422.75 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $422.75 "$2,375.00" "$2,375.00" "$1,762.73" "$1,762.73" "$1,830.65" "$1,237.38" $494.98 "$2,375.00" $950.00 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,543.75" "$2,375.00" "$2,375.00" "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" "$2,375.00" "$2,375.00" N/A N/A 80530394 EAP COIL EMBL PSTG+ DETACHMENT CNTRLR BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 $487.50 $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A 80530408 EAP HCPCS C1725 CATHETER BALDILAT 60MM 3.5MM 7MM SHOCKWAVE M5 CX BOTH IP/OP "$8,625.00" "$6,382.50" "$1,711.85" "$8,625.00" "$4,683.38" "$4,683.38" "$4,683.38" "$4,683.38" "$8,625.00" "$8,625.00" "$8,625.00" "$1,797.67" "$8,625.00" "$4,181.12" "$4,181.12" "$6,648.15" "$2,060.15" "$1,797.54" "$8,625.00" "$8,625.00" "$3,094.73" "$8,625.00" "$8,625.00" "$8,625.00" "$8,625.00" "$6,468.75" "$8,625.00" "$8,625.00" "$8,625.00" "$4,312.50" "$4,312.50" "$6,831.00" "$8,625.00" "$6,900.00" "$5,606.25" "$1,711.85" "$8,625.00" "$5,002.50" "$8,625.00" "$8,625.00" "$8,625.00" "$1,797.45" "$8,625.00" N/A N/A 80530424 EAP Custom 80530424 JET PORT PLUS II HP PUR KIT 6.6F BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $500.00 $500.00 $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 80530426 EAP HCPCS A4550 SURGICAL PACK CLEAN CLOSURE CUSTOM BOTH IP/OP $397.00 $294.00 $15.41 $397.00 $397.00 $397.00 $397.00 $397.00 $397.00 $397.00 $15.41 $397.00 $397.00 $294.65 $294.65 $306.01 $206.84 $82.74 $397.00 $158.80 $397.00 $397.00 $397.00 $397.00 $397.00 $297.75 $397.00 $397.00 $397.00 $198.50 $198.50 $314.42 $397.00 $317.60 $258.05 $397.00 $397.00 $230.26 $397.00 $238.20 $397.00 $397.00 $397.00 N/A N/A 80530838 EAP Custom 80530838 PRESTIGE PLUS COMPLEX COIL PACK 8MM X 30CM BOTH IP/OP "$2,125.00" "$1,572.50" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$1,577.18" "$1,577.18" "$1,637.95" "$1,107.13" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" "$1,381.25" "$2,125.00" "$2,125.00" "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 80544566 EAP Custom 80544566 GUIDEWIRE VASC 300CM .014IN RADIOPQ J 3CM HTRQ WH BOTH IP/OP $177.50 $131.50 $31.60 $177.50 $177.50 $177.50 $177.50 $177.50 $177.50 $177.50 $31.60 $177.50 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $71.00 $177.50 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $177.50 $177.50 $102.95 $177.50 $106.50 $177.50 $177.50 $177.50 N/A N/A 80544567 EAP Custom 80544567 GUIDEWIRE VASC HYDPHI COAT JTP LD 11 167KG/IN BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 $300.00 $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 80544568 EAP Custom 80544568 GUIDEWIRE VASC HYDPHI COAT JTP LD 11 167KG/IN BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 $300.00 $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 80544569 EAP Custom 80544569 GUIDEWIRE VASC HYDPHI COAT JTP LD 14 224KG/IN BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 $300.00 $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 80544570 EAP Custom 80544570 GUIDEWIRE VASC HYDPHI COAT JTP LD 14 224KG/IN BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 $300.00 $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 80544571 EAP Custom 80544571 GUIDEWIRE VASC 300CM .014IN STR 3CM HTORQ ADV LT BOTH IP/OP $177.50 $131.50 $31.60 $177.50 $177.50 $177.50 $177.50 $177.50 $177.50 $177.50 $31.60 $177.50 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $71.00 $177.50 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $177.50 $177.50 $102.95 $177.50 $106.50 $177.50 $177.50 $177.50 N/A N/A 80544572 EAP Custom 80544572 SYSTEM CORON STENT 12MM 4.5MM XIENCE SKYPOINT BOTH IP/OP $912.50 $675.50 $162.43 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $162.43 $912.50 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $365.00 $912.50 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $912.50 $912.50 $529.25 $912.50 $547.50 $912.50 $912.50 $912.50 N/A N/A 80544573 EAP Custom 80544573 SYSTEM CORON STENT 15MM 4.5MM XIENCE SKYPOINT BOTH IP/OP $912.50 $675.50 $162.43 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $162.43 $912.50 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $365.00 $912.50 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $912.50 $912.50 $529.25 $912.50 $547.50 $912.50 $912.50 $912.50 N/A N/A 80544574 EAP Custom 80544574 SYSTEM CORON STENT 18MM 4.5MM XIENCE SKYPOINT BOTH IP/OP $912.50 $675.50 $162.43 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $162.43 $912.50 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $365.00 $912.50 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $912.50 $912.50 $529.25 $912.50 $547.50 $912.50 $912.50 $912.50 N/A N/A 80544575 EAP Custom 80544575 SYSTEM CORON STENT 23MM 4.5MM XIENCE SKYPOINT BOTH IP/OP $912.50 $675.50 $162.43 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $162.43 $912.50 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $365.00 $912.50 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $912.50 $912.50 $529.25 $912.50 $547.50 $912.50 $912.50 $912.50 N/A N/A 80544576 EAP Custom 80544576 SYSTEM CORON STENT 28MM 4.5MM XIENCE SKYPOINT BOTH IP/OP $912.50 $675.50 $162.43 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $162.43 $912.50 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $365.00 $912.50 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $912.50 $912.50 $529.25 $912.50 $547.50 $912.50 $912.50 $912.50 N/A N/A 80544577 EAP Custom 80544577 SYSTEM CORON STENT 33MM 4.5MM XIENCE SKYPOINT BOTH IP/OP $912.50 $675.50 $162.43 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $162.43 $912.50 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $365.00 $912.50 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $912.50 $912.50 $529.25 $912.50 $547.50 $912.50 $912.50 $912.50 N/A N/A 80544578 EAP Custom 80544578 SYSTEM CORON STENT 12MM 5MM XIENCE SKYPOINT MTLNK BOTH IP/OP $912.50 $675.50 $162.43 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $162.43 $912.50 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $365.00 $912.50 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $912.50 $912.50 $529.25 $912.50 $547.50 $912.50 $912.50 $912.50 N/A N/A 80544579 EAP Custom 80544579 SYSTEM CORON STENT 15MM 5MM XIENCE SKYPOINT MTLNK BOTH IP/OP $912.50 $675.50 $162.43 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $162.43 $912.50 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $365.00 $912.50 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $912.50 $912.50 $529.25 $912.50 $547.50 $912.50 $912.50 $912.50 N/A N/A 80544580 EAP Custom 80544580 SYSTEM CORON STENT 18MM 5MM XIENCE SKYPOINT MTLNK BOTH IP/OP $912.50 $675.50 $162.43 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $162.43 $912.50 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $365.00 $912.50 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $912.50 $912.50 $529.25 $912.50 $547.50 $912.50 $912.50 $912.50 N/A N/A 80544581 EAP Custom 80544581 SYSTEM CORON STENT 23MM 5MM XIENCE SKYPOINT MTLNK BOTH IP/OP $912.50 $675.50 $162.43 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $162.43 $912.50 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $365.00 $912.50 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $912.50 $912.50 $529.25 $912.50 $547.50 $912.50 $912.50 $912.50 N/A N/A 80544582 EAP Custom 80544582 SYSTEM CORON STENT 28MM 5MM XIENCE SKYPOINT MTLNK BOTH IP/OP $912.50 $675.50 $162.43 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $162.43 $912.50 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $365.00 $912.50 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $912.50 $912.50 $529.25 $912.50 $547.50 $912.50 $912.50 $912.50 N/A N/A 80544583 EAP Custom 80544583 SYSTEM CORON STENT 33MM 5MM XIENCE SKYPOINT MTLNK BOTH IP/OP $912.50 $675.50 $162.43 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $162.43 $912.50 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $365.00 $912.50 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $912.50 $912.50 $529.25 $912.50 $547.50 $912.50 $912.50 $912.50 N/A N/A 80544584 EAP Custom 80544584 GUIDEWIRE VASC 50CM .018IN STR 2CM HTRQ FL BOTH IP/OP $177.50 $131.50 $31.60 $177.50 $177.50 $177.50 $177.50 $177.50 $177.50 $177.50 $31.60 $177.50 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $71.00 $177.50 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $177.50 $177.50 $102.95 $177.50 $106.50 $177.50 $177.50 $177.50 N/A N/A 80544585 EAP Custom 80544585 GUIDEWIRE VASC 175CM .014IN STR 3CM HTRQ ESPRT BOTH IP/OP $177.50 $131.50 $31.60 $177.50 $177.50 $177.50 $177.50 $177.50 $177.50 $177.50 $31.60 $177.50 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $71.00 $177.50 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $177.50 $177.50 $102.95 $177.50 $106.50 $177.50 $177.50 $177.50 N/A N/A 80544587 EAP Custom 80544587 INTROD SHTH 5FR 50CM 12CM HMSTS VLV GWIRE SDPRT BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544588 EAP Custom 80544588 INTROD SHTH 6FR 50CM 12CM 2 DISTAL GWIRE HMSTS VLV BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544590 EAP Custom 80544590 INTROD SHTH 7FR 50CM 12CM HMSTS VLV SDPRT DILAT BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544592 EAP Custom 80544592 INTROD SHTH 6FR 50CM 12CM HMSTS VLV SDPRT DILAT BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544593 EAP Custom 80544593 INTROD SHTH 8FR 12CM DILAT GWIRE LUER LOCK LOCK BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544595 EAP Custom 80544595 INTROD SHTH 8FR 5FR 23CM HMSTS VLV SDPRT DILAT BOTH IP/OP $53.13 $39.50 $9.46 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $9.46 $53.13 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $21.25 $53.13 $53.13 $53.13 $53.13 $53.13 $39.85 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $53.13 $53.13 $30.82 $53.13 $31.88 $53.13 $53.13 $53.13 N/A N/A 80544596 EAP Custom 80544596 INTROD SHTH 9FR 12CM HMSTS GWIRE FSTCTH .038IN BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544599 EAP Custom 80544599 INTROD SHTH 11FR 50CM 12CM LG LUM HMSTS VLV SDPRT BOTH IP/OP $33.98 $25.50 $6.05 $33.98 $33.98 $33.98 $33.98 $33.98 $33.98 $33.98 $6.05 $33.98 $33.98 $25.22 $25.22 $26.19 $17.70 $7.08 $33.98 $13.59 $33.98 $33.98 $33.98 $33.98 $33.98 $25.49 $33.98 $33.98 $33.98 $16.99 $16.99 $26.91 $33.98 $27.18 $22.09 $33.98 $33.98 $19.71 $33.98 $20.39 $33.98 $33.98 $33.98 N/A N/A 80544600 EAP Custom 80544600 INTROD SHTH 10FR 23CM HMSTS FSTCTH TRNSPT BOTH IP/OP $53.13 $39.50 $9.46 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $9.46 $53.13 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $21.25 $53.13 $53.13 $53.13 $53.13 $53.13 $39.85 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $53.13 $53.13 $30.82 $53.13 $31.88 $53.13 $53.13 $53.13 N/A N/A 80544601 EAP Custom 80544601 INTROD SHTH 12FR 12CM LG LUM DILAT GWIRE FSTCTH BOTH IP/OP $33.98 $25.50 $6.05 $33.98 $33.98 $33.98 $33.98 $33.98 $33.98 $33.98 $6.05 $33.98 $33.98 $25.22 $25.22 $26.19 $17.70 $7.08 $33.98 $13.59 $33.98 $33.98 $33.98 $33.98 $33.98 $25.49 $33.98 $33.98 $33.98 $16.99 $16.99 $26.91 $33.98 $27.18 $22.09 $33.98 $33.98 $19.71 $33.98 $20.39 $33.98 $33.98 $33.98 N/A N/A 80544602 EAP Custom 80544602 INTROD SHTH 6FR 23CM HMSTS VLV GWIRE SDPRT DILAT BOTH IP/OP $53.13 $39.50 $9.46 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $9.46 $53.13 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $21.25 $53.13 $53.13 $53.13 $53.13 $53.13 $39.85 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $53.13 $53.13 $30.82 $53.13 $31.88 $53.13 $53.13 $53.13 N/A N/A 80544603 EAP Custom 80544603 INTROD SHTH 13FR 12CM HMSTS FSTCTH .038IN TRNSPT BOTH IP/OP $33.98 $25.50 $6.05 $33.98 $33.98 $33.98 $33.98 $33.98 $33.98 $33.98 $6.05 $33.98 $33.98 $25.22 $25.22 $26.19 $17.70 $7.08 $33.98 $13.59 $33.98 $33.98 $33.98 $33.98 $33.98 $25.49 $33.98 $33.98 $33.98 $16.99 $16.99 $26.91 $33.98 $27.18 $22.09 $33.98 $33.98 $19.71 $33.98 $20.39 $33.98 $33.98 $33.98 N/A N/A 80544604 EAP Custom 80544604 INTROD SHTH 9.5FR 12CM HMSTS FSTCTH .038IN TRNSPT BOTH IP/OP $33.98 $25.50 $6.05 $33.98 $33.98 $33.98 $33.98 $33.98 $33.98 $33.98 $6.05 $33.98 $33.98 $25.22 $25.22 $26.19 $17.70 $7.08 $33.98 $13.59 $33.98 $33.98 $33.98 $33.98 $33.98 $25.49 $33.98 $33.98 $33.98 $16.99 $16.99 $26.91 $33.98 $27.18 $22.09 $33.98 $33.98 $19.71 $33.98 $20.39 $33.98 $33.98 $33.98 N/A N/A 80544605 EAP Custom 80544605 INTROD SHTH 10.5FR 12CM HMSTS FSTCTH .038IN TRNSPT BOTH IP/OP $33.98 $25.50 $6.05 $33.98 $33.98 $33.98 $33.98 $33.98 $33.98 $33.98 $6.05 $33.98 $33.98 $25.22 $25.22 $26.19 $17.70 $7.08 $33.98 $13.59 $33.98 $33.98 $33.98 $33.98 $33.98 $25.49 $33.98 $33.98 $33.98 $16.99 $16.99 $26.91 $33.98 $27.18 $22.09 $33.98 $33.98 $19.71 $33.98 $20.39 $33.98 $33.98 $33.98 N/A N/A 80544606 EAP Custom 80544606 INTROD SHTH 8.5FR 50CM 12CM 2 DISTAL GWIRE HMSTS BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544607 EAP Custom 80544607 INTROD SHTH 5FR 23CM HMSTS FSTCTH .038IN TRNSPT BOTH IP/OP $53.13 $39.50 $9.46 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $9.46 $53.13 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $21.25 $53.13 $53.13 $53.13 $53.13 $53.13 $39.85 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $53.13 $53.13 $30.82 $53.13 $31.88 $53.13 $53.13 $53.13 N/A N/A 80544608 EAP Custom 80544608 INTROD SHTH 6FR 23CM HMSTS FSTCTH .038IN TRNSPT BOTH IP/OP $53.13 $39.50 $9.46 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $9.46 $53.13 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $21.25 $53.13 $53.13 $53.13 $53.13 $53.13 $39.85 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $53.13 $53.13 $30.82 $53.13 $31.88 $53.13 $53.13 $53.13 N/A N/A 80544609 EAP Custom 80544609 INTROD SHTH 7FR 23CM HMSTS FSTCTH .038IN TRNSPT BOTH IP/OP $53.13 $39.50 $9.46 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $9.46 $53.13 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $21.25 $53.13 $53.13 $53.13 $53.13 $53.13 $39.85 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $53.13 $53.13 $30.82 $53.13 $31.88 $53.13 $53.13 $53.13 N/A N/A 80544610 EAP Custom 80544610 INTROD SHTH 8FR 23CM HMSTS FSTCTH .038IN TRNSPT BOTH IP/OP $53.13 $39.50 $9.46 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $9.46 $53.13 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $21.25 $53.13 $53.13 $53.13 $53.13 $53.13 $39.85 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $53.13 $53.13 $30.82 $53.13 $31.88 $53.13 $53.13 $53.13 N/A N/A 80544611 EAP Custom 80544611 INTROD SHTH 8.5FR 23CM HMSTS FSTCTH .038IN TRNSPT BOTH IP/OP $53.13 $39.50 $9.46 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $9.46 $53.13 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $21.25 $53.13 $53.13 $53.13 $53.13 $53.13 $39.85 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $53.13 $53.13 $30.82 $53.13 $31.88 $53.13 $53.13 $53.13 N/A N/A 80544612 EAP Custom 80544612 INTROD SHTH 9FR 23CM HMSTS FSTCTH .038IN TRNSPT BOTH IP/OP $53.13 $39.50 $9.46 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $9.46 $53.13 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $21.25 $53.13 $53.13 $53.13 $53.13 $53.13 $39.85 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $53.13 $53.13 $30.82 $53.13 $31.88 $53.13 $53.13 $53.13 N/A N/A 80544615 EAP Custom 80544615 INTROD SHTH 4FR 5CM HMSTS FSTCTH .021IN TRNSPT BOTH IP/OP $28.13 $21.00 $5.01 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $5.01 $28.13 $28.13 $20.88 $20.88 $21.68 $14.66 $5.86 $28.13 $11.25 $28.13 $28.13 $28.13 $28.13 $28.13 $21.10 $28.13 $28.13 $28.13 $14.07 $14.07 $22.28 $28.13 $22.50 $18.28 $28.13 $28.13 $16.32 $28.13 $16.88 $28.13 $28.13 $28.13 N/A N/A 80544616 EAP Custom 80544616 INTROD SHTH 5FR 5CM HMSTS FSTCTH .038IN TRNSPT BOTH IP/OP $28.13 $21.00 $5.01 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $5.01 $28.13 $28.13 $20.88 $20.88 $21.68 $14.66 $5.86 $28.13 $11.25 $28.13 $28.13 $28.13 $28.13 $28.13 $21.10 $28.13 $28.13 $28.13 $14.07 $14.07 $22.28 $28.13 $22.50 $18.28 $28.13 $28.13 $16.32 $28.13 $16.88 $28.13 $28.13 $28.13 N/A N/A 80544617 EAP Custom 80544617 INTROD SHTH 5FR 5CM HMSTS SET FSTCTH .021IN TRNSPT BOTH IP/OP $28.13 $21.00 $5.01 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $5.01 $28.13 $28.13 $20.88 $20.88 $21.68 $14.66 $5.86 $28.13 $11.25 $28.13 $28.13 $28.13 $28.13 $28.13 $21.10 $28.13 $28.13 $28.13 $14.07 $14.07 $22.28 $28.13 $22.50 $18.28 $28.13 $28.13 $16.32 $28.13 $16.88 $28.13 $28.13 $28.13 N/A N/A 80544618 EAP Custom 80544618 INTROD CATH 5CM 6FR .038IN FSTCTH HMSTS BOTH IP/OP $28.13 $21.00 $5.01 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $5.01 $28.13 $28.13 $20.88 $20.88 $21.68 $14.66 $5.86 $28.13 $11.25 $28.13 $28.13 $28.13 $28.13 $28.13 $21.10 $28.13 $28.13 $28.13 $14.07 $14.07 $22.28 $28.13 $22.50 $18.28 $28.13 $28.13 $16.32 $28.13 $16.88 $28.13 $28.13 $28.13 N/A N/A 80544619 EAP Custom 80544619 INTROD SHTH 6FR 5CM HMSTS SET FSTCTH .021IN TRNSPT BOTH IP/OP $28.13 $21.00 $5.01 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $5.01 $28.13 $28.13 $20.88 $20.88 $21.68 $14.66 $5.86 $28.13 $11.25 $28.13 $28.13 $28.13 $28.13 $28.13 $21.10 $28.13 $28.13 $28.13 $14.07 $14.07 $22.28 $28.13 $22.50 $18.28 $28.13 $28.13 $16.32 $28.13 $16.88 $28.13 $28.13 $28.13 N/A N/A 80544620 EAP Custom 80544620 INTROD SHTH 7FR 5CM HMSTS SDPRT DILAT GWIRE FSTCTH BOTH IP/OP $28.13 $21.00 $5.01 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $5.01 $28.13 $28.13 $20.88 $20.88 $21.68 $14.66 $5.86 $28.13 $11.25 $28.13 $28.13 $28.13 $28.13 $28.13 $21.10 $28.13 $28.13 $28.13 $14.07 $14.07 $22.28 $28.13 $22.50 $18.28 $28.13 $28.13 $16.32 $28.13 $16.88 $28.13 $28.13 $28.13 N/A N/A 80544621 EAP Custom 80544621 INTROD SHTH 10FR 80CM 30CM HMSTS VLV SDPRT DILAT BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544622 EAP Custom 80544622 INTROD SHTH 11FR 30CM HMSTS FSTCTH TRNSPT BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544623 EAP Custom 80544623 INTROD SHTH 10.5FR 30CM HMSTS FSTCTH .038IN TRNSPT BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544624 EAP Custom 80544624 INTROD SHTH 12FR 30CM LG LUM HMSTS VLV DILAT GWIRE BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544625 EAP Custom 80544625 INTROD SHTH 14FR 80CM 30CM LG LUM HMSTS VLV SDPRT BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544634 EAP Custom 80544634 SLEEVE CATH 30CM 9- FR REPOSITION LUER LOCK LOCK BOTH IP/OP $26.25 $19.50 $4.67 $26.25 $26.25 $26.25 $26.25 $26.25 $26.25 $26.25 $4.67 $26.25 $26.25 $19.48 $19.48 $20.23 $13.68 $5.47 $26.25 $10.50 $26.25 $26.25 $26.25 $26.25 $26.25 $19.69 $26.25 $26.25 $26.25 $13.13 $13.13 $20.79 $26.25 $21.00 $17.06 $26.25 $26.25 $15.23 $26.25 $15.75 $26.25 $26.25 $26.25 N/A N/A 80544635 EAP Custom 80544635 SLEEVE CATH 60CM 9- FR REPOSITION LUER LOCK LOCK BOTH IP/OP $26.88 $20.00 $4.78 $26.88 $26.88 $26.88 $26.88 $26.88 $26.88 $26.88 $4.78 $26.88 $26.88 $19.95 $19.95 $20.72 $14.00 $5.60 $26.88 $10.75 $26.88 $26.88 $26.88 $26.88 $26.88 $20.16 $26.88 $26.88 $26.88 $13.44 $13.44 $21.29 $26.88 $21.50 $17.47 $26.88 $26.88 $15.59 $26.88 $16.13 $26.88 $26.88 $26.88 N/A N/A 80544636 EAP Custom 80544636 SLEEVE CATH 30CM 9- FR REPOSITION LUER LOCK LOCK BOTH IP/OP $27.50 $20.50 $4.90 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $4.90 $27.50 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $11.00 $27.50 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $27.50 $27.50 $15.95 $27.50 $16.50 $27.50 $27.50 $27.50 N/A N/A 80544637 EAP Custom 80544637 SLEEVE CATH 60CM 9- FR REPOSITION LUER LOCK LOCK BOTH IP/OP $27.50 $20.50 $4.90 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $4.90 $27.50 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $11.00 $27.50 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $27.50 $27.50 $15.95 $27.50 $16.50 $27.50 $27.50 $27.50 N/A N/A 80544638 EAP Custom 80544638 INTROD SHTH 4FR 50CM 8.5CM 2 DISTAL GWIRE HMSTS BOTH IP/OP $28.13 $21.00 $5.01 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $5.01 $28.13 $28.13 $20.88 $20.88 $21.68 $14.66 $5.86 $28.13 $11.25 $28.13 $28.13 $28.13 $28.13 $28.13 $21.10 $28.13 $28.13 $28.13 $14.07 $14.07 $22.28 $28.13 $22.50 $18.28 $28.13 $28.13 $16.32 $28.13 $16.88 $28.13 $28.13 $28.13 N/A N/A 80544639 EAP Custom 80544639 INTROD SHTH 5FR 50CM 8.5CM HMSTS VLV FSTCTH .021IN BOTH IP/OP $28.13 $21.00 $5.01 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $5.01 $28.13 $28.13 $20.88 $20.88 $21.68 $14.66 $5.86 $28.13 $11.25 $28.13 $28.13 $28.13 $28.13 $28.13 $21.10 $28.13 $28.13 $28.13 $14.07 $14.07 $22.28 $28.13 $22.50 $18.28 $28.13 $28.13 $16.32 $28.13 $16.88 $28.13 $28.13 $28.13 N/A N/A 80544640 EAP Custom 80544640 INTROD SHTH 6FR 50CM 8.5CM HMSTS VLV FSTCTH .021IN BOTH IP/OP $28.13 $21.00 $5.01 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $5.01 $28.13 $28.13 $20.88 $20.88 $21.68 $14.66 $5.86 $28.13 $11.25 $28.13 $28.13 $28.13 $28.13 $28.13 $21.10 $28.13 $28.13 $28.13 $14.07 $14.07 $22.28 $28.13 $22.50 $18.28 $28.13 $28.13 $16.32 $28.13 $16.88 $28.13 $28.13 $28.13 N/A N/A 80544641 EAP Custom 80544641 INTROD CATH 8.5CM 7FR .025IN TRNSPT FSTCTH HMSTS BOTH IP/OP $28.13 $21.00 $5.01 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $5.01 $28.13 $28.13 $20.88 $20.88 $21.68 $14.66 $5.86 $28.13 $11.25 $28.13 $28.13 $28.13 $28.13 $28.13 $21.10 $28.13 $28.13 $28.13 $14.07 $14.07 $22.28 $28.13 $22.50 $18.28 $28.13 $28.13 $16.32 $28.13 $16.88 $28.13 $28.13 $28.13 N/A N/A 80544642 EAP Custom 80544642 INTROD SHTH 6FR 40CM CATH FSTCTH .038IN BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544643 EAP Custom 80544643 INTROD CATH 40CM 7FR .038IN TRNSPT FSTCTH HMSTS BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544644 EAP Custom 80544644 INTROD SHTH 8FR 40CM CATH FSTCTH .038IN BOTH IP/OP $43.75 $32.50 $7.79 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $43.75 $7.79 $43.75 $43.75 $32.47 $32.47 $33.72 $22.79 $9.12 $43.75 $17.50 $43.75 $43.75 $43.75 $43.75 $43.75 $32.81 $43.75 $43.75 $43.75 $21.88 $21.88 $34.65 $43.75 $35.00 $28.44 $43.75 $43.75 $25.38 $43.75 $26.25 $43.75 $43.75 $43.75 N/A N/A 80544645 EAP Custom 80544645 SET INTROD 85CM 8FR FSTCTH VASC CATH BOTH IP/OP $112.50 $83.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 $112.50 $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 80544646 EAP Custom 80544646 INTROD SHTH 8FR 7CM 85CM J CURVE HMSTS FSTCTH BOTH IP/OP $112.50 $83.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 $112.50 $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 80544647 EAP Custom 80544647 INTROD SHTH 7FR 45CM HMSTS FSTCTH 30D .038IN BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 80544648 EAP Custom 80544648 INTROD SHTH 6FR 45CM HMSTS FSTCTH 30D TRNSPT BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 80544649 EAP Custom 80544649 INTROD SHTH 7FR 85CM HMSTS FSTCTH J CURVE TRNSPT BOTH IP/OP $112.50 $83.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 $112.50 $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 80544650 EAP Custom 80544650 INTROD SHTH 7FR 85CM HMSTS FSTCTH TRNSPT BOTH IP/OP $112.50 $83.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 $112.50 $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 80544651 EAP Custom 80544651 INTROD SHTH 7FR 40CM HMSTS VLV SDPRT DILAT FSTCTH BOTH IP/OP $125.63 $93.00 $22.36 $125.63 $125.63 $125.63 $125.63 $125.63 $125.63 $125.63 $22.36 $125.63 $125.63 $93.24 $93.24 $96.84 $65.45 $26.18 $125.63 $50.25 $125.63 $125.63 $125.63 $125.63 $125.63 $94.22 $125.63 $125.63 $125.63 $62.82 $62.82 $99.50 $125.63 $100.50 $81.66 $125.63 $125.63 $72.87 $125.63 $75.38 $125.63 $125.63 $125.63 N/A N/A 80544652 EAP Custom 80544652 INTROD SHTH 7FR 98CM HMSTS FSTCTH 40D .038IN BOTH IP/OP $110.00 $81.50 $19.58 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $19.58 $110.00 $110.00 $81.64 $81.64 $84.79 $57.31 $22.93 $110.00 $44.00 $110.00 $110.00 $110.00 $110.00 $110.00 $82.50 $110.00 $110.00 $110.00 $55.00 $55.00 $87.12 $110.00 $88.00 $71.50 $110.00 $110.00 $63.80 $110.00 $66.00 $110.00 $110.00 $110.00 N/A N/A 80544653 EAP Custom 80544653 INTROD SHTH 7FR 40CM HMSTS FSTCTH 60D TRNSPT BOTH IP/OP $86.88 $64.50 $15.46 $86.88 $86.88 $86.88 $86.88 $86.88 $86.88 $86.88 $15.46 $86.88 $86.88 $64.48 $64.48 $66.97 $45.26 $18.11 $86.88 $34.75 $86.88 $86.88 $86.88 $86.88 $86.88 $65.16 $86.88 $86.88 $86.88 $43.44 $43.44 $68.81 $86.88 $69.50 $56.47 $86.88 $86.88 $50.39 $86.88 $52.13 $86.88 $86.88 $86.88 N/A N/A 80544654 EAP Custom 80544654 INTROD SHTH 7FR 85CM HMSTS FSTCTH .038IN GSPC BOTH IP/OP $148.13 $110.00 $26.37 $148.13 $148.13 $148.13 $148.13 $148.13 $148.13 $148.13 $26.37 $148.13 $148.13 $109.94 $109.94 $114.18 $77.18 $30.87 $148.13 $59.25 $148.13 $148.13 $148.13 $148.13 $148.13 $111.10 $148.13 $148.13 $148.13 $74.07 $74.07 $117.32 $148.13 $118.50 $96.28 $148.13 $148.13 $85.92 $148.13 $88.88 $148.13 $148.13 $148.13 N/A N/A 80544655 EAP Custom 80544655 INTROD SHTH 5FR 5CM RADIOPQ HMSTS VLV SDPRT GWIRE BOTH IP/OP $27.50 $20.50 $4.90 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $4.90 $27.50 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $11.00 $27.50 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $27.50 $27.50 $15.95 $27.50 $16.50 $27.50 $27.50 $27.50 N/A N/A 80544656 EAP Custom 80544656 INTROD SHTH 6FR 5CM RADIOPQ HMSTS VLV SDPRT GWIRE BOTH IP/OP $27.50 $20.50 $4.90 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $4.90 $27.50 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $11.00 $27.50 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $27.50 $27.50 $15.95 $27.50 $16.50 $27.50 $27.50 $27.50 N/A N/A 80544657 EAP Custom 80544657 INTROD SHTH 7FR 5CM RADIOPQ HMSTS VLV SDPRT GWIRE BOTH IP/OP $28.13 $21.00 $5.01 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $28.13 $5.01 $28.13 $28.13 $20.88 $20.88 $21.68 $14.66 $5.86 $28.13 $11.25 $28.13 $28.13 $28.13 $28.13 $28.13 $21.10 $28.13 $28.13 $28.13 $14.07 $14.07 $22.28 $28.13 $22.50 $18.28 $28.13 $28.13 $16.32 $28.13 $16.88 $28.13 $28.13 $28.13 N/A N/A 80544666 EAP Custom 80544666 INTROD SHTH 4FR 23CM RADIOPQ HMSTS VLV SDPRT GWIRE BOTH IP/OP $53.13 $39.50 $9.46 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $9.46 $53.13 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $21.25 $53.13 $53.13 $53.13 $53.13 $53.13 $39.85 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $53.13 $53.13 $30.82 $53.13 $31.88 $53.13 $53.13 $53.13 N/A N/A 80544667 EAP Custom 80544667 INTROD SHTH 6FR 80CM 23CM 2 DISTAL GWIRE HMSTS VLV BOTH IP/OP $53.13 $39.50 $9.46 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $9.46 $53.13 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $21.25 $53.13 $53.13 $53.13 $53.13 $53.13 $39.85 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $53.13 $53.13 $30.82 $53.13 $31.88 $53.13 $53.13 $53.13 N/A N/A 80544668 EAP Custom 80544668 INTROD SHTH 7FR 23CM RADIOPQ HMSTS VLV SDPRT GWIRE BOTH IP/OP $53.13 $39.50 $9.46 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $9.46 $53.13 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $21.25 $53.13 $53.13 $53.13 $53.13 $53.13 $39.85 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $53.13 $53.13 $30.82 $53.13 $31.88 $53.13 $53.13 $53.13 N/A N/A 80544669 EAP Custom 80544669 INTROD SHTH 10FR 23CM RADIOPQ HMSTS VLV SDPRT BOTH IP/OP $53.13 $39.50 $9.46 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $53.13 $9.46 $53.13 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $21.25 $53.13 $53.13 $53.13 $53.13 $53.13 $39.85 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $53.13 $53.13 $30.82 $53.13 $31.88 $53.13 $53.13 $53.13 N/A N/A 80544670 EAP Custom 80544670 INTROD SHTH 14FR 30CM RADIOPQ HMSTS VLV SDPRT BOTH IP/OP $62.50 $46.50 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 $62.50 $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A 80544671 EAP Custom 80544671 INTROD SHTH 16FR 35CM 2 TPR DILAT HMSTS VLV GWIRE BOTH IP/OP $56.25 $42.00 $10.01 $56.25 $56.25 $56.25 $56.25 $56.25 $56.25 $56.25 $10.01 $56.25 $56.25 $41.75 $41.75 $43.36 $29.31 $11.72 $56.25 $22.50 $56.25 $56.25 $56.25 $56.25 $56.25 $42.19 $56.25 $56.25 $56.25 $28.13 $28.13 $44.55 $56.25 $45.00 $36.56 $56.25 $56.25 $32.63 $56.25 $33.75 $56.25 $56.25 $56.25 N/A N/A 80544672 EAP Custom 80544672 INTROD SHTH 18FR 30CM RADIOPQ HMSTS VLV SDPRT BOTH IP/OP $106.88 $79.50 $19.02 $106.88 $106.88 $106.88 $106.88 $106.88 $106.88 $106.88 $19.02 $106.88 $106.88 $79.33 $79.33 $82.38 $55.68 $22.27 $106.88 $42.75 $106.88 $106.88 $106.88 $106.88 $106.88 $80.16 $106.88 $106.88 $106.88 $53.44 $53.44 $84.65 $106.88 $85.50 $69.47 $106.88 $106.88 $61.99 $106.88 $64.13 $106.88 $106.88 $106.88 N/A N/A 80544673 EAP Custom 80544673 INTROD SHTH 20FR 30CM RADIOPQ HMSTS VLV SDPRT BOTH IP/OP $110.63 $82.00 $19.69 $110.63 $110.63 $110.63 $110.63 $110.63 $110.63 $110.63 $19.69 $110.63 $110.63 $82.11 $82.11 $85.27 $57.64 $23.06 $110.63 $44.25 $110.63 $110.63 $110.63 $110.63 $110.63 $82.97 $110.63 $110.63 $110.63 $55.32 $55.32 $87.62 $110.63 $88.50 $71.91 $110.63 $110.63 $64.17 $110.63 $66.38 $110.63 $110.63 $110.63 N/A N/A 80544674 EAP Custom 80544674 INTROD SHTH 6FR 12CM RADIOPQ HMSTS VLV SDPRT GWIRE BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 $200.00 $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A 80544675 EAP Custom 80544675 INTROD SHTH 7FR 12CM RADIOPQ HMSTS VLV SDPRT GWIRE BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 $200.00 $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A 80544676 EAP Custom 80544676 INTROD SHTH 8FR 12CM RADIOPQ HMSTS VLV SDPRT GWIRE BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 $200.00 $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A 80544677 EAP Custom 80544677 INTROD SHTH 12FR 30CM RADIOPQ HMSTS VLV SDPRT BOTH IP/OP $62.50 $46.50 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 $62.50 $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A 80544678 EAP Custom 80544678 SET INTROD 5CM 4FR ULTM VASC CATH BOTH IP/OP $27.50 $20.50 $4.90 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $4.90 $27.50 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $11.00 $27.50 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $27.50 $27.50 $15.95 $27.50 $16.50 $27.50 $27.50 $27.50 N/A N/A 80544679 EAP Custom 80544679 SET INTROD 5CM 5FR ULTM VASC CATH BOTH IP/OP $27.50 $20.50 $4.90 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $4.90 $27.50 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $11.00 $27.50 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $27.50 $27.50 $15.95 $27.50 $16.50 $27.50 $27.50 $27.50 N/A N/A 80544680 EAP Custom 80544680 INTROD SHTH 6FR 50CM 5CM GWIRE HMSTS VLV SDPRT BOTH IP/OP $27.50 $20.50 $4.90 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $4.90 $27.50 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $11.00 $27.50 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $27.50 $27.50 $15.95 $27.50 $16.50 $27.50 $27.50 $27.50 N/A N/A 80544681 EAP Custom 80544681 SET INTROD 5CM 7FR ULTM VASC CATH BOTH IP/OP $27.50 $20.50 $4.90 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $4.90 $27.50 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $11.00 $27.50 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $27.50 $27.50 $15.95 $27.50 $16.50 $27.50 $27.50 $27.50 N/A N/A 80544682 EAP Custom 80544682 SET INTROD 5CM 8FR ULTM VASC CATH BOTH IP/OP $27.50 $20.50 $4.90 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $4.90 $27.50 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $11.00 $27.50 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $27.50 $27.50 $15.95 $27.50 $16.50 $27.50 $27.50 $27.50 N/A N/A 80544683 EAP Custom 80544683 INTROD SHTH 5FR 8.5CM HMSTS VLV SDPRT DILAT ULTM BOTH IP/OP $27.50 $20.50 $4.90 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $4.90 $27.50 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $11.00 $27.50 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $27.50 $27.50 $15.95 $27.50 $16.50 $27.50 $27.50 $27.50 N/A N/A 80544684 EAP Custom 80544684 INTROD SHTH 6FR 8.5CM HMSTS VLV SDPRT DILAT ULTM BOTH IP/OP $27.50 $20.50 $4.90 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $4.90 $27.50 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $11.00 $27.50 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $27.50 $27.50 $15.95 $27.50 $16.50 $27.50 $27.50 $27.50 N/A N/A 80544685 EAP Custom 80544685 INTROD SHTH 7FR 8.5CM HMSTS VLV SDPRT DILAT ULTM BOTH IP/OP $27.50 $20.50 $4.90 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $4.90 $27.50 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $11.00 $27.50 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $27.50 $27.50 $15.95 $27.50 $16.50 $27.50 $27.50 $27.50 N/A N/A 80544697 EAP Custom 80544697 INTROD SHTH 4FR 80CM 23CM 2 DISTAL GWIRE HMSTS VLV BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 80544698 EAP Custom 80544698 INTROD SHTH 4FR 50CM 23CM GWIRE HMSTS VLV SDPRT LP BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 80544699 EAP Custom 80544699 INTROD SHTH 5FR 50CM 23CM GWIRE HMSTS VLV SDPRT LP BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 80544700 EAP Custom 80544700 INTROD SHTH 5FR 50CM 23CM GWIRE HMSTS VLV SDPRT LP BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 80544701 EAP Custom 80544701 INTROD SHTH 6FR 50CM 23CM GWIRE HMSTS VLV SDPRT LP BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 80544702 EAP Custom 80544702 INTROD SHTH 6FR 80CM 23CM 2 DISTAL GWIRE HMSTS VLV BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 80544703 EAP Custom 80544703 INTROD SHTH 7FR 50CM 23CM GWIRE HMSTS VLV SDPRT LP BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 80544704 EAP Custom 80544704 INTROD SHTH 7FR 80CM 23CM 2 DISTAL GWIRE HMSTS VLV BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 80544705 EAP Custom 80544705 INTROD SHTH 8FR 50CM 23CM GWIRE HMSTS VLV SDPRT LP BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 80544706 EAP Custom 80544706 INTROD SHTH 8FR 50CM 23CM GWIRE HMSTS VLV SDPRT LP BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 80544707 EAP Custom 80544707 INTROD SHTH 9FR 50CM 23CM GWIRE HMSTS VLV SDPRT LP BOTH IP/OP $45.00 $33.50 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 80544708 EAP Custom 80544708 FORCEPS BIOP LSR SHRP JAW LP 50CM 5.4FR CURVE BOTH IP/OP $362.50 $268.50 $64.53 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $145.00 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 $362.50 $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A 80544709 EAP Custom 80544709 FORCEPS BIOP LG VOLUME LSR SHRP JAW LP 50CM 5.4FR BOTH IP/OP $362.50 $268.50 $64.53 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $145.00 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 $362.50 $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A 80544710 EAP Custom 80544710 FORCEPS BIOP LG VOLUME LSR SHRP JAW LP 105CM 5.4FR BOTH IP/OP $362.50 $268.50 $64.53 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $145.00 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 $362.50 $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A 80544711 EAP Custom 80544711 FORCEPS BIOP LSR SHRP JAW LP 50CM 7FR CURVE BOTH IP/OP $362.50 $268.50 $64.53 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $145.00 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 $362.50 $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A 80544712 EAP Custom 80544712 FORCEPS BIOP LSR SHRP JAW LP 50CM 7FR CURVE BOTH IP/OP $362.50 $268.50 $64.53 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $145.00 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 $362.50 $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A 80544713 EAP Custom 80544713 FORCEPS BIOP LSR SHRP JAW LP 105CM 7FR STR BOTH IP/OP $362.50 $268.50 $64.53 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $145.00 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 $362.50 $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A 80544714 EAP Custom 80544714 FORCEPS BIOP LSR SHRP JAW LP COAT 105CM 7FR STR BOTH IP/OP $362.50 $268.50 $64.53 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $145.00 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 $362.50 $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A 80544726 EAP Custom 80544726 INTROD SHTH 4FR 25CM GWIRE HMSTS VLV SDPRT DILAT BOTH IP/OP $46.25 $34.50 $8.23 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $8.23 $46.25 $46.25 $34.33 $34.33 $35.65 $24.10 $9.64 $46.25 $18.50 $46.25 $46.25 $46.25 $46.25 $46.25 $34.69 $46.25 $46.25 $46.25 $23.13 $23.13 $36.63 $46.25 $37.00 $30.06 $46.25 $46.25 $26.83 $46.25 $27.75 $46.25 $46.25 $46.25 N/A N/A 80544727 EAP Custom 80544727 INTROD SHTH 5FR 25CM GWIRE HMSTS VLV SDPRT DILAT BOTH IP/OP $46.25 $34.50 $8.23 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $8.23 $46.25 $46.25 $34.33 $34.33 $35.65 $24.10 $9.64 $46.25 $18.50 $46.25 $46.25 $46.25 $46.25 $46.25 $34.69 $46.25 $46.25 $46.25 $23.13 $23.13 $36.63 $46.25 $37.00 $30.06 $46.25 $46.25 $26.83 $46.25 $27.75 $46.25 $46.25 $46.25 N/A N/A 80544728 EAP Custom 80544728 INTROD SHTH 6FR 25CM GWIRE HMSTS VLV SDPRT DILAT BOTH IP/OP $46.25 $34.50 $8.23 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $8.23 $46.25 $46.25 $34.33 $34.33 $35.65 $24.10 $9.64 $46.25 $18.50 $46.25 $46.25 $46.25 $46.25 $46.25 $34.69 $46.25 $46.25 $46.25 $23.13 $23.13 $36.63 $46.25 $37.00 $30.06 $46.25 $46.25 $26.83 $46.25 $27.75 $46.25 $46.25 $46.25 N/A N/A 80544729 EAP Custom 80544729 INTROD SHTH 7FR 25CM GWIRE HMSTS VLV SDPRT DILAT BOTH IP/OP $46.25 $34.50 $8.23 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $8.23 $46.25 $46.25 $34.33 $34.33 $35.65 $24.10 $9.64 $46.25 $18.50 $46.25 $46.25 $46.25 $46.25 $46.25 $34.69 $46.25 $46.25 $46.25 $23.13 $23.13 $36.63 $46.25 $37.00 $30.06 $46.25 $46.25 $26.83 $46.25 $27.75 $46.25 $46.25 $46.25 N/A N/A 80544730 EAP Custom 80544730 INTROD SHTH 8FR 25CM GWIRE HMSTS VLV SDPRT DILAT BOTH IP/OP $46.25 $34.50 $8.23 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $8.23 $46.25 $46.25 $34.33 $34.33 $35.65 $24.10 $9.64 $46.25 $18.50 $46.25 $46.25 $46.25 $46.25 $46.25 $34.69 $46.25 $46.25 $46.25 $23.13 $23.13 $36.63 $46.25 $37.00 $30.06 $46.25 $46.25 $26.83 $46.25 $27.75 $46.25 $46.25 $46.25 N/A N/A 80544731 EAP Custom 80544731 INTROD SHTH 9FR 25CM GWIRE HMSTS VLV SDPRT DILAT BOTH IP/OP $46.25 $34.50 $8.23 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $8.23 $46.25 $46.25 $34.33 $34.33 $35.65 $24.10 $9.64 $46.25 $18.50 $46.25 $46.25 $46.25 $46.25 $46.25 $34.69 $46.25 $46.25 $46.25 $23.13 $23.13 $36.63 $46.25 $37.00 $30.06 $46.25 $46.25 $26.83 $46.25 $27.75 $46.25 $46.25 $46.25 N/A N/A 80544732 EAP Custom 80544732 INTROD SHTH 5FR 25CM GWIRE HMSTS VLV SDPRT DILAT BOTH IP/OP $46.25 $34.50 $8.23 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $8.23 $46.25 $46.25 $34.33 $34.33 $35.65 $24.10 $9.64 $46.25 $18.50 $46.25 $46.25 $46.25 $46.25 $46.25 $34.69 $46.25 $46.25 $46.25 $23.13 $23.13 $36.63 $46.25 $37.00 $30.06 $46.25 $46.25 $26.83 $46.25 $27.75 $46.25 $46.25 $46.25 N/A N/A 80544733 EAP Custom 80544733 INTROD SHTH 6FR 25CM GWIRE HMSTS VLV SDPRT DILAT BOTH IP/OP $46.25 $34.50 $8.23 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $8.23 $46.25 $46.25 $34.33 $34.33 $35.65 $24.10 $9.64 $46.25 $18.50 $46.25 $46.25 $46.25 $46.25 $46.25 $34.69 $46.25 $46.25 $46.25 $23.13 $23.13 $36.63 $46.25 $37.00 $30.06 $46.25 $46.25 $26.83 $46.25 $27.75 $46.25 $46.25 $46.25 N/A N/A 80544734 EAP Custom 80544734 INTROD SHTH 7FR 25CM GWIRE HMSTS VLV SDPRT DILAT BOTH IP/OP $46.25 $34.50 $8.23 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $8.23 $46.25 $46.25 $34.33 $34.33 $35.65 $24.10 $9.64 $46.25 $18.50 $46.25 $46.25 $46.25 $46.25 $46.25 $34.69 $46.25 $46.25 $46.25 $23.13 $23.13 $36.63 $46.25 $37.00 $30.06 $46.25 $46.25 $26.83 $46.25 $27.75 $46.25 $46.25 $46.25 N/A N/A 80544735 EAP Custom 80544735 INTROD SHTH 8FR 25CM GWIRE HMSTS VLV SDPRT DILAT BOTH IP/OP $46.25 $34.50 $8.23 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $8.23 $46.25 $46.25 $34.33 $34.33 $35.65 $24.10 $9.64 $46.25 $18.50 $46.25 $46.25 $46.25 $46.25 $46.25 $34.69 $46.25 $46.25 $46.25 $23.13 $23.13 $36.63 $46.25 $37.00 $30.06 $46.25 $46.25 $26.83 $46.25 $27.75 $46.25 $46.25 $46.25 N/A N/A 80544736 EAP Custom 80544736 INTROD SHTH 9FR 25CM GWIRE HMSTS VLV SDPRT DILAT BOTH IP/OP $46.25 $34.50 $8.23 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $8.23 $46.25 $46.25 $34.33 $34.33 $35.65 $24.10 $9.64 $46.25 $18.50 $46.25 $46.25 $46.25 $46.25 $46.25 $34.69 $46.25 $46.25 $46.25 $23.13 $23.13 $36.63 $46.25 $37.00 $30.06 $46.25 $46.25 $26.83 $46.25 $27.75 $46.25 $46.25 $46.25 N/A N/A 80544737 EAP Custom 80544737 INTROD CATH 12CM 4FR .025IN STD RAD ENGAGE TR BOTH IP/OP $87.50 $65.00 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $35.00 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $87.50 $87.50 $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A 80544738 EAP Custom 80544738 INTROD CATH 12CM 5FR .025IN STD RAD ENGAGE TR NDL BOTH IP/OP $87.50 $65.00 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $35.00 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $87.50 $87.50 $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A 80544739 EAP Custom 80544739 INTROD CATH 12CM 6FR .025IN STD RAD ENGAGE TR NDL BOTH IP/OP $87.50 $65.00 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $35.00 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $87.50 $87.50 $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A 80544740 EAP Custom 80544740 INTROD CATH 25CM 4FR .025IN STD RAD ENGAGE TR NDL BOTH IP/OP $87.50 $65.00 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $35.00 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $87.50 $87.50 $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A 80544741 EAP Custom 80544741 INTROD CATH 25CM 5FR .025IN STD RAD ENGAGE TR NDL BOTH IP/OP $87.50 $65.00 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $35.00 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $87.50 $87.50 $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A 80544742 EAP Custom 80544742 INTROD CATH 25CM 6FR .025IN STD RAD ENGAGE TR NDL BOTH IP/OP $87.50 $65.00 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $35.00 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $87.50 $87.50 $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A 80544743 EAP Custom 80544743 INTROD CATH 12CM 5FR .025IN RAD ENGAGE TR NDL SHTH BOTH IP/OP $93.75 $69.50 $16.69 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $16.69 $93.75 $93.75 $69.58 $69.58 $72.26 $48.84 $19.54 $93.75 $37.50 $93.75 $93.75 $93.75 $93.75 $93.75 $70.31 $93.75 $93.75 $93.75 $46.88 $46.88 $74.25 $93.75 $75.00 $60.94 $93.75 $93.75 $54.38 $93.75 $56.25 $93.75 $93.75 $93.75 N/A N/A 80544744 EAP Custom 80544744 INTROD CATH 12CM 6FR .025IN RAD ENGAGE TR NDL SHTH BOTH IP/OP $93.75 $69.50 $16.69 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $16.69 $93.75 $93.75 $69.58 $69.58 $72.26 $48.84 $19.54 $93.75 $37.50 $93.75 $93.75 $93.75 $93.75 $93.75 $70.31 $93.75 $93.75 $93.75 $46.88 $46.88 $74.25 $93.75 $75.00 $60.94 $93.75 $93.75 $54.38 $93.75 $56.25 $93.75 $93.75 $93.75 N/A N/A 80544745 EAP Custom 80544745 INTROD CATH 25CM 6FR .025IN RAD ENGAGE TR NDL SHTH BOTH IP/OP $93.75 $69.50 $16.69 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $16.69 $93.75 $93.75 $69.58 $69.58 $72.26 $48.84 $19.54 $93.75 $37.50 $93.75 $93.75 $93.75 $93.75 $93.75 $70.31 $93.75 $93.75 $93.75 $46.88 $46.88 $74.25 $93.75 $75.00 $60.94 $93.75 $93.75 $54.38 $93.75 $56.25 $93.75 $93.75 $93.75 N/A N/A 80544746 EAP Custom 80544746 INTROD CATH 8.5CM 4FR .025IN STD RAD ENGAGE TR BOTH IP/OP $87.50 $65.00 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $35.00 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $87.50 $87.50 $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A 80544747 EAP Custom 80544747 INTROD CATH 8.5CM 5FR .025IN RAD ENGAGE TR COAT BOTH IP/OP $93.75 $69.50 $16.69 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $16.69 $93.75 $93.75 $69.58 $69.58 $72.26 $48.84 $19.54 $93.75 $37.50 $93.75 $93.75 $93.75 $93.75 $93.75 $70.31 $93.75 $93.75 $93.75 $46.88 $46.88 $74.25 $93.75 $75.00 $60.94 $93.75 $93.75 $54.38 $93.75 $56.25 $93.75 $93.75 $93.75 N/A N/A 80544748 EAP Custom 80544748 SET INTROD 5FR ENGAGE TR VASC CATH BOTH IP/OP $87.50 $65.00 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $35.00 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $87.50 $87.50 $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A 80544749 EAP Custom 80544749 INTROD CATH 8.5CM 6FR .025IN RAD ENGAGE TR COAT BOTH IP/OP $93.75 $69.50 $16.69 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $93.75 $16.69 $93.75 $93.75 $69.58 $69.58 $72.26 $48.84 $19.54 $93.75 $37.50 $93.75 $93.75 $93.75 $93.75 $93.75 $70.31 $93.75 $93.75 $93.75 $46.88 $46.88 $74.25 $93.75 $75.00 $60.94 $93.75 $93.75 $54.38 $93.75 $56.25 $93.75 $93.75 $93.75 N/A N/A 80544750 EAP Custom 80544750 INTROD SHTH 6FR 20GA 50CM 8.5CM 1 DISTAL GWIRE BOTH IP/OP $87.50 $65.00 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $35.00 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $87.50 $87.50 $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A 80544752 EAP HCPCS C2623 CATHETER BALDILAT 5MM 135CM 60MM OTW PCLTXL RNGR BOTH IP/OP "$3,237.50" "$2,396.00" $576.28 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $576.28 "$3,237.50" "$3,237.50" "$2,402.87" "$2,402.87" "$2,495.47" "$1,686.74" $674.73 "$3,237.50" "$1,295.00" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$2,104.38" "$3,237.50" "$3,237.50" "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" "$3,237.50" "$3,237.50" N/A N/A 80544753 EAP HCPCS C2623 CATHETER BALDILAT 7MM 150CM 200MM OTW PCLTXL RNGR BOTH IP/OP "$4,987.50" "$3,691.00" $887.78 "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" $887.78 "$4,987.50" "$4,987.50" "$3,701.72" "$3,701.72" "$3,844.37" "$2,060.15" "$1,039.45" "$4,987.50" "$1,995.00" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$3,740.63" "$4,987.50" "$4,987.50" "$4,987.50" "$2,493.75" "$2,493.75" "$3,950.10" "$4,987.50" "$3,990.00" "$3,241.88" "$4,987.50" "$4,987.50" "$2,892.75" "$4,987.50" "$2,992.50" "$4,987.50" "$4,987.50" "$4,987.50" N/A N/A 80544754 EAP HCPCS C1757 CATHETER THRMB ZELANTEDVT CLOTHUNTER HLCL ROT ACPT BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,665.25" "$3,665.25" "$3,665.25" "$3,665.25" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$4,181.12" "$4,181.12" "$5,202.90" "$2,060.15" "$1,406.77" "$6,750.00" "$6,750.00" "$3,094.73" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$4,387.50" "$1,339.71" "$6,750.00" "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A 80544755 EAP HCPCS C1725 CATHETER BALDILAT 4MM 50CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544756 EAP HCPCS C1725 CATHETER BALDILAT 4MM 75CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544757 EAP HCPCS C1725 CATHETER BALDILAT 4MM 50CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544758 EAP HCPCS C1725 CATHETER BALDILAT 4MM 75CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544759 EAP HCPCS C1725 CATHETER BALDILAT 4MM 50CM 60MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544760 EAP HCPCS C1725 CATHETER BALDILAT 4MM 75CM 60MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544761 EAP HCPCS C1725 CATHETER BALDILAT 4MM 50CM 80MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544762 EAP HCPCS C1725 CATHETER BALDILAT 4MM 75CM 80MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544763 EAP HCPCS C1725 CATHETER BALDILAT 4MM 50CM 100MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544764 EAP HCPCS C1725 CATHETER BALDILAT 4MM 75CM 100MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544765 EAP HCPCS C1725 CATHETER BALDILAT 5MM 50CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544766 EAP HCPCS C1725 CATHETER BALDILAT 5MM 75CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544767 EAP HCPCS C1725 CATHETER BALDILAT 5MM 135CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544768 EAP HCPCS C1725 CATHETER BALDILAT 5MM 50CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544769 EAP HCPCS C1725 CATHETER BALDILAT 5MM 75CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544770 EAP HCPCS C1725 CATHETER BALDILAT 5MM 50CM 60MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544771 EAP HCPCS C1725 CATHETER BALDILAT 5MM 75CM 60MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544772 EAP HCPCS C1725 CATHETER BALDILAT 5MM 50CM 80MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544773 EAP HCPCS C1725 CATHETER BALDILAT 5MM 75CM 80MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544774 EAP HCPCS C1725 CATHETER BALDILAT 5MM 50CM 100MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544775 EAP HCPCS C1725 CATHETER BALDILAT 5MM 75CM 100MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544776 EAP HCPCS C1725 CATHETER BALDILAT 6MM 135CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544777 EAP HCPCS C1725 CATHETER BALDILAT 6MM 50CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544778 EAP HCPCS C1725 CATHETER BALDILAT 6MM 75CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544779 EAP HCPCS C1725 CATHETER BALDILAT 6MM 135CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544780 EAP HCPCS C1725 CATHETER BALDILAT 6MM 50CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544781 EAP HCPCS C1725 CATHETER BALDILAT 6MM 75CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544782 EAP HCPCS C1725 CATHETER BALDILAT 6MM 50CM 60MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544783 EAP HCPCS C1725 CATHETER BALDILAT 6MM 75CM 60MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544784 EAP HCPCS C1725 CATHETER BALDILAT 6MM 50CM 80MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $270.00 $450.00 $93.78 $450.00 N/A N/A 80544785 EAP HCPCS C1725 CATHETER BALDILAT 6MM 75CM 80MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $270.00 $450.00 $93.78 $450.00 N/A N/A 80544786 EAP HCPCS C1725 CATHETER BALDILAT 6MM 50CM 100MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544787 EAP HCPCS C1725 CATHETER BALDILAT 6MM 75CM 100MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544788 EAP HCPCS C1725 CATHETER BALDILAT 7MM 135CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544789 EAP HCPCS C1725 CATHETER BALDILAT 7MM 50CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544790 EAP HCPCS C1725 CATHETER BALDILAT 7MM 75CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544791 EAP HCPCS C1725 CATHETER BALDILAT 7MM 135CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544792 EAP HCPCS C1725 CATHETER BALDILAT 7MM 50CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $80.10 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $80.10 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544793 EAP HCPCS C1725 CATHETER BALDILAT 7MM 75CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544794 EAP HCPCS C1725 CATHETER BALDILAT 7MM 50CM 60MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544795 EAP HCPCS C1725 CATHETER BALDILAT 7MM 75CM 60MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544796 EAP HCPCS C1725 CATHETER BALDILAT 7MM 50CM 80MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544797 EAP HCPCS C1725 CATHETER BALDILAT 7MM 75CM 80MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544798 EAP HCPCS C1725 CATHETER BALDILAT 7MM 50CM 100MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544799 EAP HCPCS C1725 CATHETER BALDILAT 7MM 75CM 100MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544800 EAP HCPCS C1725 CATHETER BALDILAT 8MM 135CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544801 EAP HCPCS C1725 CATHETER BALDILAT 8MM 50CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544802 EAP HCPCS C1725 CATHETER BALDILAT 8MM 75CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544803 EAP HCPCS C1725 CATHETER BALDILAT 8MM 50CM 30MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544804 EAP HCPCS C1725 CATHETER BALDILAT 8MM 75CM 30MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544805 EAP HCPCS C1725 CATHETER BALDILAT 8MM 135CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544806 EAP HCPCS C1725 CATHETER BALDILAT 8MM 50CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544807 EAP HCPCS C1725 CATHETER BALDILAT 8MM 75CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544808 EAP HCPCS C1725 CATHETER BALDILAT 8MM 50CM 60MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544809 EAP HCPCS C1725 CATHETER BALDILAT 8MM 75CM 60MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544810 EAP HCPCS C1725 CATHETER BALDILAT 8MM 50CM 80MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544811 EAP HCPCS C1725 CATHETER BALDILAT 8MM 75CM 80MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544812 EAP HCPCS C1725 CATHETER BALDILAT 8MM 50CM 100MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544813 EAP HCPCS C1725 CATHETER BALDILAT 8MM 75CM 100MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544814 EAP HCPCS C1725 CATHETER BALDILAT 9MM 50CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544815 EAP HCPCS C1725 CATHETER BALDILAT 9MM 75CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544816 EAP HCPCS C1725 CATHETER BALDILAT 9MM 135CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544817 EAP HCPCS C1725 CATHETER BALDILAT 9MM 50CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544818 EAP HCPCS C1725 CATHETER BALDILAT 9MM 75CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544819 EAP HCPCS C1725 CATHETER BALDILAT 9MM 50CM 80MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544820 EAP HCPCS C1725 CATHETER BALDILAT 9MM 75CM 80MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544821 EAP HCPCS C1725 CATHETER BALDILAT 10MM 75CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544822 EAP HCPCS C1725 CATHETER BALDILAT 10MM 135CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544823 EAP HCPCS C1725 CATHETER BALDILAT 10MM 75CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544824 EAP HCPCS C1725 CATHETER BALDILAT 10MM 75CM 80MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544825 EAP HCPCS C1725 CATHETER BALDILAT 12MM 135CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544826 EAP HCPCS C1725 CATHETER BALDILAT 12MM 75CM 20MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544827 EAP HCPCS C1725 CATHETER BALDILAT 12MM 135CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544828 EAP HCPCS C1725 CATHETER BALDILAT 12MM 75CM 40MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544829 EAP HCPCS C1725 CATHETER BALDILAT 12MM 135CM 60MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544830 EAP HCPCS C1725 CATHETER BALDILAT 12MM 75CM 60MM STRL LATEX FREE BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 $450.00 $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 80544831 EAP HCPCS C2623 CATHETER BALDILAT 4MM 135CM 80MM OTW PCLTXL RNGR BOTH IP/OP "$3,237.50" "$2,396.00" $576.28 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $576.28 "$3,237.50" "$3,237.50" "$2,402.87" "$2,402.87" "$2,495.47" "$1,686.74" $674.73 "$3,237.50" "$1,295.00" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$2,104.38" "$3,237.50" "$3,237.50" "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" "$3,237.50" "$3,237.50" N/A N/A 80544832 EAP HCPCS C2623 CATHETER BALDILAT 4MM 150CM 120MM OTW PCLTXL RNGR BOTH IP/OP "$3,487.50" "$2,581.00" $620.78 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $620.78 "$3,487.50" "$3,487.50" "$2,588.42" "$2,588.42" "$2,688.17" "$1,816.99" $726.83 "$3,487.50" "$1,395.00" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$2,266.88" "$3,487.50" "$3,487.50" "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" "$3,487.50" "$3,487.50" N/A N/A 80544833 EAP HCPCS C2623 CATHETER BALDILAT 4MM 150CM 200MM OTW PCLTXL RNGR BOTH IP/OP "$4,987.50" "$3,691.00" $887.78 "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" $887.78 "$4,987.50" "$4,987.50" "$3,701.72" "$3,701.72" "$3,844.37" "$2,060.15" "$1,039.45" "$4,987.50" "$1,995.00" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$3,740.63" "$4,987.50" "$4,987.50" "$4,987.50" "$2,493.75" "$2,493.75" "$3,950.10" "$4,987.50" "$3,990.00" "$3,241.88" "$4,987.50" "$4,987.50" "$2,892.75" "$4,987.50" "$2,992.50" "$4,987.50" "$4,987.50" "$4,987.50" N/A N/A 80544834 EAP HCPCS C2623 CATHETER BALDILAT 5MM 135CM 80MM OTW PCLTXL RNGR BOTH IP/OP "$3,237.50" "$2,396.00" $576.28 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $576.28 "$3,237.50" "$3,237.50" "$2,402.87" "$2,402.87" "$2,495.47" "$1,686.74" $674.73 "$3,237.50" "$1,295.00" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$2,104.38" "$3,237.50" "$3,237.50" "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" "$3,237.50" "$3,237.50" N/A N/A 80544835 EAP HCPCS C2623 CATHETER BALDILAT 5MM 150CM 120MM OTW PCLTXL RNGR BOTH IP/OP "$3,487.50" "$2,581.00" $620.78 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $620.78 "$3,487.50" "$3,487.50" "$2,588.42" "$2,588.42" "$2,688.17" "$1,816.99" $726.83 "$3,487.50" "$1,395.00" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$2,266.88" "$3,487.50" "$3,487.50" "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" "$3,487.50" "$3,487.50" N/A N/A 80544836 EAP HCPCS C2623 CATHETER BALDILAT 6MM 135CM 80MM OTW PCLTXL RNGR BOTH IP/OP "$3,237.50" "$2,396.00" $576.28 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $576.28 "$3,237.50" "$3,237.50" "$2,402.87" "$2,402.87" "$2,495.47" "$1,686.74" $674.73 "$3,237.50" "$1,295.00" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$2,104.38" "$3,237.50" "$3,237.50" "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" "$3,237.50" "$3,237.50" N/A N/A 80544837 EAP HCPCS C2623 CATHETER BALDILAT 6MM 150CM 120MM OTW PCLTXL RNGR BOTH IP/OP "$3,487.50" "$2,581.00" $620.78 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $620.78 "$3,487.50" "$3,487.50" "$2,588.42" "$2,588.42" "$2,688.17" "$1,816.99" $726.83 "$3,487.50" "$1,395.00" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$2,266.88" "$3,487.50" "$3,487.50" "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" "$3,487.50" "$3,487.50" N/A N/A 80544838 EAP HCPCS C2623 CATHETER BALDILAT 7MM 135CM 60MM OTW PCLTXL RNGR BOTH IP/OP "$3,237.50" "$2,396.00" $576.28 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $576.28 "$3,237.50" "$3,237.50" "$2,402.87" "$2,402.87" "$2,495.47" "$1,686.74" $674.73 "$3,237.50" "$1,295.00" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$2,104.38" "$3,237.50" "$3,237.50" "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" "$3,237.50" "$3,237.50" N/A N/A 80544839 EAP HCPCS C2623 CATHETER BALDILAT 7MM 135CM 80MM OTW PCLTXL RNGR BOTH IP/OP "$3,237.50" "$2,396.00" $576.28 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $576.28 "$3,237.50" "$3,237.50" "$2,402.87" "$2,402.87" "$2,495.47" "$1,686.74" $674.73 "$3,237.50" "$1,295.00" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$2,104.38" "$3,237.50" "$3,237.50" "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" "$3,237.50" "$3,237.50" N/A N/A 80544840 EAP HCPCS C1725 CATHETER BALDILAT 7MM 80CM 100MM OTW DRG COAT BOTH IP/OP "$3,237.50" "$2,396.00" $642.56 "$3,237.50" "$1,757.96" "$1,757.96" "$1,757.96" "$1,757.96" "$3,237.50" "$3,237.50" "$3,237.50" $674.78 "$3,237.50" "$2,402.87" "$2,402.87" "$2,495.47" "$1,686.74" $674.73 "$3,237.50" "$3,237.50" "$1,914.98" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$2,104.38" $642.56 "$3,237.50" "$1,877.75" "$3,237.50" "$3,237.50" "$3,237.50" $674.70 "$3,237.50" N/A N/A 80544841 EAP HCPCS C2623 CATHETER BALDILAT 7MM 150CM 120MM OTW PCLTXL RNGR BOTH IP/OP "$3,487.50" "$2,581.00" $620.78 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $620.78 "$3,487.50" "$3,487.50" "$2,588.42" "$2,588.42" "$2,688.17" "$1,816.99" $726.83 "$3,487.50" "$1,395.00" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$2,266.88" "$3,487.50" "$3,487.50" "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" "$3,487.50" "$3,487.50" N/A N/A 80544842 EAP HCPCS C1725 CATHETER BALDILAT 3.75MM 142CM 9MM TPR DISTAL SHFT BOTH IP/OP $269.50 $199.50 $53.49 $269.50 $146.34 $146.34 $146.34 $146.34 $269.50 $269.50 $269.50 $56.17 $269.50 $200.02 $200.02 $207.73 $140.41 $56.17 $269.50 $269.50 $159.41 $269.50 $269.50 $269.50 $269.50 $202.13 $269.50 $269.50 $269.50 $134.75 $134.75 $213.44 $269.50 $215.60 $175.18 $53.49 $269.50 $156.31 $269.50 $269.50 $269.50 $56.16 $269.50 N/A N/A 80544843 EAP HCPCS C1887 CATHETER GUID LCB CURVE 6FR 90CM FEM LG LUM BOTH IP/OP $102.90 $76.50 $20.42 $102.90 $55.87 $55.87 $55.87 $55.87 $102.90 $102.90 $102.90 $21.45 $102.90 $76.37 $76.37 $79.32 $53.61 $21.45 $102.90 $102.90 $60.87 $102.90 $102.90 $102.90 $102.90 $77.18 $102.90 $102.90 $102.90 $51.45 $51.45 $81.50 $102.90 $82.32 $66.89 $20.42 $102.90 $59.68 $102.90 $102.90 $102.90 $21.44 $102.90 N/A N/A 80544844 EAP HCPCS C1725 CATHETER BALDILAT .017IN 6MM 143CM 8MM 2 LUM TPR BOTH IP/OP $275.00 $203.50 $54.58 $275.00 $149.33 $149.33 $149.33 $149.33 $275.00 $275.00 $275.00 $57.32 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $275.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $54.58 $275.00 $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A 80544845 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 2.25MM SNG XD EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544846 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 2.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544847 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 2.75MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544848 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 3MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544849 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 3.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544850 EAP HCPCS C1874 SYSTEM CORON STENT 8MM 4MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544851 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 2.25MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544852 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 2.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544853 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 2.75MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544854 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544855 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 3.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544856 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 4MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544857 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 4.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544858 EAP HCPCS C1874 SYSTEM CORON STENT 12MM 5MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544859 EAP HCPCS C1874 SYSTEM CORON STENT 16MM 2.25MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544860 EAP HCPCS C1874 SYSTEM CORON STENT 16MM 2.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544861 EAP HCPCS C1874 SYSTEM CORON STENT 16MM 2.75MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544862 EAP HCPCS C1874 SYSTEM CORON STENT 16MM 3MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544863 EAP HCPCS C1874 SYSTEM CORON STENT 16MM 3.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544864 EAP HCPCS C1874 SYSTEM CORON STENT 16MM 4MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544865 EAP HCPCS C1874 SYSTEM CORON STENT 16MM 4.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544866 EAP HCPCS C1874 SYSTEM CORON STENT 16MM 5MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544867 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 2.25MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544868 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 2.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544869 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 2.75MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544870 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 3MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544871 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 3.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544872 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 4MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544873 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 4.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544874 EAP HCPCS C1874 SYSTEM CORON STENT 20MM 5MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544875 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 2.25MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544876 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 2.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544877 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 2.75MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544878 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 3MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544879 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 3.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544880 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 4MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544881 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 4.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544882 EAP HCPCS C1874 SYSTEM CORON STENT 24MM 5MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544883 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 2.25MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $289.25 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" $289.25 $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544884 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 2.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $289.25 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" $289.25 $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544885 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 2.75MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544886 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544887 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 3.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544888 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 4MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544889 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 4.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544890 EAP HCPCS C1874 SYSTEM CORON STENT 28MM 5MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544891 EAP HCPCS C1874 SYSTEM CORON STENT 32MM 2.25MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544892 EAP HCPCS C1874 SYSTEM CORON STENT 32MM 2.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544893 EAP HCPCS C1874 SYSTEM CORON STENT 32MM 2.75MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544894 EAP HCPCS C1874 SYSTEM CORON STENT 32MM 3MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544895 EAP HCPCS C1874 SYSTEM CORON STENT 32MM 3.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544896 EAP HCPCS C1874 SYSTEM CORON STENT 32MM 4MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544897 EAP HCPCS C1874 SYSTEM CORON STENT 32MM 4.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544898 EAP HCPCS C1874 SYSTEM CORON STENT 32MM 5MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $289.25 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" $289.25 $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544899 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 2.25MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544900 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 2.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $289.25 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" $289.25 $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544901 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 2.75MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544902 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 3MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544903 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 3.5MM SNG XD MNRL BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544904 EAP HCPCS C1874 SYSTEM CORON STENT 38MM 4MM SNG XD MNRL EVEROLIMUS BOTH IP/OP "$1,625.00" "$1,202.50" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 "$1,625.00" $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 80544905 EAP HCPCS C1874 SYSTEM CORON STENT 48MM 2.5MM SNG XD MNRL BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$1,855.50" "$1,855.50" "$1,927.00" "$1,302.50" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,625.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80544906 EAP HCPCS C1874 SYSTEM CORON STENT 48MM 2.75MM SNG XD MNRL BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$1,855.50" "$1,855.50" "$1,927.00" "$1,302.50" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,625.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80544907 EAP HCPCS C1874 SYSTEM CORON STENT 48MM 3MM SNG XD EVEROLIMUS BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$1,855.50" "$1,855.50" "$1,927.00" "$1,302.50" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,625.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80544908 EAP HCPCS C1874 SYSTEM CORON STENT 48MM 3.5MM SNG XD EVEROLIMUS BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$1,855.50" "$1,855.50" "$1,927.00" "$1,302.50" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,625.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80544909 EAP HCPCS C1874 SYSTEM CORON STENT 48MM 4MM SNG XD EVEROLIMUS BOTH IP/OP "$2,500.00" "$1,850.00" $445.00 "$2,500.00" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$2,500.00" "$2,500.00" $445.00 $521.06 "$2,500.00" "$1,855.50" "$1,855.50" "$1,927.00" "$1,302.50" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,625.00" $496.19 "$2,500.00" "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 80549321 EAP Custom 80549321 SOFT-VU ANGIO CATH COBRA 2 NON-BRAIDED .035IN 5F X 65CM BOTH IP/OP $35.00 $26.00 $6.23 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $6.23 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 80549629 EAP HCPCS C1750 KIT CATH ADLT 28CM 15.5FR PU BIOFLO DURAMAX ENDEXO BOTH IP/OP $863.00 $639.00 $153.61 $863.00 $468.61 $468.61 $468.61 $468.61 $863.00 $863.00 $153.61 $179.87 $863.00 $640.52 $640.52 $665.20 $449.62 $179.86 $863.00 $863.00 $510.46 $863.00 $863.00 $863.00 $863.00 $647.25 $863.00 $863.00 $863.00 $431.50 $431.50 $683.50 $863.00 $690.40 $560.95 $171.28 $863.00 $500.54 $863.00 $863.00 $863.00 $179.85 $863.00 N/A N/A 80549631 EAP HCPCS C1750 CATHETER HMDIAL CLR 32CM 15.5FR BIOFLO DURAMAX BOTH IP/OP $718.00 $531.50 $127.80 $718.00 $389.87 $389.87 $389.87 $389.87 $718.00 $718.00 $127.80 $149.65 $718.00 $532.90 $532.90 $553.43 $374.08 $149.64 $718.00 $718.00 $424.70 $718.00 $718.00 $718.00 $718.00 $538.50 $718.00 $718.00 $718.00 $359.00 $359.00 $568.66 $718.00 $574.40 $466.70 $142.51 $718.00 $416.44 $718.00 $718.00 $718.00 $149.63 $718.00 N/A N/A 80549644 EAP HCPCS C1752 CATHETER HMDIAL 15CM SCHN XL SIL KINK RST TIP CLIP BOTH IP/OP $217.50 $161.00 $38.72 $217.50 $217.50 $217.50 $217.50 $217.50 $217.50 $217.50 $38.72 $217.50 $217.50 $161.43 $161.43 $167.65 $113.32 $45.33 $217.50 $87.00 $217.50 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $141.38 $217.50 $217.50 $126.15 $217.50 $130.50 $217.50 $217.50 $217.50 N/A N/A 80549645 EAP HCPCS C1752 CATHETER HMDIAL 20CM SCHN XL SIL KINK RST TIP CLIP BOTH IP/OP $217.50 $161.00 $38.72 $217.50 $217.50 $217.50 $217.50 $217.50 $217.50 $217.50 $38.72 $217.50 $217.50 $161.43 $161.43 $167.65 $113.32 $45.33 $217.50 $87.00 $217.50 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $141.38 $217.50 $217.50 $126.15 $217.50 $130.50 $217.50 $217.50 $217.50 N/A N/A 80549654 EAP HCPCS C1757 CATHETER THRMB 18FR 85CM STRL LF ALPHAVAC MP MECH ASP BOTH IP/OP "$22,500.00" "$16,650.00" "$2,060.15" "$22,500.00" "$12,217.50" "$12,217.50" "$12,217.50" "$12,217.50" "$22,500.00" "$22,500.00" "$22,500.00" "$4,689.56" "$22,500.00" "$4,181.12" "$4,181.12" "$17,343.00" "$2,060.15" "$4,689.25" "$22,500.00" "$22,500.00" "$3,094.73" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$16,875.00" "$22,500.00" "$22,500.00" "$22,500.00" "$11,250.00" "$11,250.00" "$17,820.00" "$22,500.00" "$18,000.00" "$14,625.00" "$4,465.69" "$22,500.00" "$13,050.00" "$22,500.00" "$22,500.00" "$22,500.00" "$4,689.00" "$22,500.00" N/A N/A 80549655 EAP HCPCS C1062 SPINEJACK CASE KIT 4.2MM BOTH IP/OP "$9,371.00" "$6,935.00" "$1,953.02" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$1,953.02" "$9,371.00" "$3,748.40" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$7,028.25" "$9,371.00" "$9,371.00" "$9,371.00" "$4,685.50" "$4,685.50" "$7,421.83" "$9,371.00" "$7,496.80" "$4,216.95" "$9,371.00" "$9,371.00" "$5,435.18" "$9,371.00" "$5,622.60" "$9,371.00" "$9,371.00" "$9,371.00" N/A N/A 80549656 EAP HCPCS C1062 SPINEJACK CASE KIT 5.0MM BOTH IP/OP "$9,371.00" "$6,935.00" "$1,953.02" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$1,953.02" "$9,371.00" "$3,748.40" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$7,028.25" "$9,371.00" "$9,371.00" "$9,371.00" "$4,685.50" "$4,685.50" "$7,421.83" "$9,371.00" "$7,496.80" "$4,216.95" "$9,371.00" "$9,371.00" "$5,435.18" "$9,371.00" "$5,622.60" "$9,371.00" "$9,371.00" "$9,371.00" N/A N/A 80549657 EAP HCPCS C1062 SPINEJACK CASE KIT 5.8MM BOTH IP/OP "$9,371.00" "$6,935.00" "$1,953.02" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$1,953.02" "$9,371.00" "$3,748.40" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$9,371.00" "$7,028.25" "$9,371.00" "$9,371.00" "$9,371.00" "$4,685.50" "$4,685.50" "$7,421.83" "$9,371.00" "$7,496.80" "$4,216.95" "$9,371.00" "$9,371.00" "$5,435.18" "$9,371.00" "$5,622.60" "$9,371.00" "$9,371.00" "$9,371.00" N/A N/A 80549660 EAP HCPCS C1887 MCTH INFUS 135CM 3-2.8FR RNGD PERI VORTEC PLUS HDR BOTH IP/OP "$1,861.20" "$1,377.50" $369.40 "$1,861.20" "$1,010.63" "$1,010.63" "$1,010.63" "$1,010.63" "$1,861.20" "$1,861.20" "$1,861.20" $387.92 "$1,861.20" "$1,381.38" "$1,381.38" "$1,434.61" $969.69 $387.89 "$1,861.20" "$1,861.20" "$1,100.90" "$1,861.20" "$1,861.20" "$1,861.20" "$1,861.20" "$1,395.90" "$1,861.20" "$1,861.20" "$1,861.20" $930.60 $930.60 "$1,474.07" "$1,861.20" "$1,488.96" "$1,209.78" $369.40 "$1,861.20" "$1,079.50" "$1,861.20" "$1,861.20" "$1,861.20" $387.87 "$1,861.20" N/A N/A 80549661 EAP HCPCS C1889 STENT INTRCRAN 9MM 4.5MM WINGSPAN HYDPHI SLF XPD BOTH IP/OP "$15,980.00" "$11,825.50" "$2,060.15" "$15,980.00" "$8,677.14" "$8,677.14" "$8,677.14" "$8,677.14" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.63" "$15,980.00" "$4,181.12" "$4,181.12" "$12,317.38" "$2,060.15" "$3,330.41" "$15,980.00" "$15,980.00" "$3,094.73" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$11,985.00" "$15,980.00" "$15,980.00" "$15,980.00" "$7,990.00" "$7,990.00" "$12,656.16" "$15,980.00" "$12,784.00" "$10,387.00" "$3,171.63" "$15,980.00" "$9,268.40" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.23" "$15,980.00" N/A N/A 80549662 EAP 80549662 CATHETER ASPIRAT AXS VECTA 74 AXS INFNT LS PLUS BOTH IP/OP "$6,662.50" "$4,930.50" "$1,185.93" "$6,662.50" "$6,662.50" "$6,662.50" "$6,662.50" "$6,662.50" "$6,662.50" "$6,662.50" "$1,185.93" "$6,662.50" "$6,662.50" "$4,181.12" "$4,181.12" "$5,135.46" "$2,060.15" "$1,388.54" "$6,662.50" "$2,665.00" "$6,662.50" "$6,662.50" "$6,662.50" "$6,662.50" "$6,662.50" "$4,996.88" "$6,662.50" "$6,662.50" "$6,662.50" "$3,331.25" "$3,331.25" "$5,276.70" "$6,662.50" "$5,330.00" "$4,330.63" "$6,662.50" "$6,662.50" "$3,864.25" "$6,662.50" "$3,997.50" "$6,662.50" "$6,662.50" "$6,662.50" N/A N/A 80549663 EAP 80549663 CATHETER ASPIRAT AXS VECTA 74 AXS INFNT LS PLUS BOTH IP/OP "$7,175.00" "$5,309.50" "$1,277.15" "$7,175.00" "$7,175.00" "$7,175.00" "$7,175.00" "$7,175.00" "$7,175.00" "$7,175.00" "$1,277.15" "$7,175.00" "$7,175.00" "$4,181.12" "$4,181.12" "$5,530.49" "$2,060.15" "$1,495.35" "$7,175.00" "$2,870.00" "$7,175.00" "$7,175.00" "$7,175.00" "$7,175.00" "$7,175.00" "$5,381.25" "$7,175.00" "$7,175.00" "$7,175.00" "$3,587.50" "$3,587.50" "$5,682.60" "$7,175.00" "$5,740.00" "$4,663.75" "$7,175.00" "$7,175.00" "$4,161.50" "$7,175.00" "$4,305.00" "$7,175.00" "$7,175.00" "$7,175.00" N/A N/A 80549664 EAP 80549664 KIT SURG VECTA 71 ASPIRAT CATH 132X90X71CM BOTH IP/OP "$6,662.50" "$4,930.50" "$1,185.93" "$6,662.50" "$6,662.50" "$6,662.50" "$6,662.50" "$6,662.50" "$6,662.50" "$6,662.50" "$1,185.93" "$6,662.50" "$6,662.50" "$4,181.12" "$4,181.12" "$5,135.46" "$2,060.15" "$1,388.54" "$6,662.50" "$2,665.00" "$6,662.50" "$6,662.50" "$6,662.50" "$6,662.50" "$6,662.50" "$4,996.88" "$6,662.50" "$6,662.50" "$6,662.50" "$3,331.25" "$3,331.25" "$5,276.70" "$6,662.50" "$5,330.00" "$4,330.63" "$6,662.50" "$6,662.50" "$3,864.25" "$6,662.50" "$3,997.50" "$6,662.50" "$6,662.50" "$6,662.50" N/A N/A 80549665 EAP 80549665 CATHETER ASPIRAT AXS VECTA 74 AXS INFNT LS PLUS BOTH IP/OP "$7,175.00" "$5,309.50" "$1,277.15" "$7,175.00" "$7,175.00" "$7,175.00" "$7,175.00" "$7,175.00" "$7,175.00" "$7,175.00" "$1,277.15" "$7,175.00" "$7,175.00" "$4,181.12" "$4,181.12" "$5,530.49" "$2,060.15" "$1,495.35" "$7,175.00" "$2,870.00" "$7,175.00" "$7,175.00" "$7,175.00" "$7,175.00" "$7,175.00" "$5,381.25" "$7,175.00" "$7,175.00" "$7,175.00" "$3,587.50" "$3,587.50" "$5,682.60" "$7,175.00" "$5,740.00" "$4,663.75" "$7,175.00" "$7,175.00" "$4,161.50" "$7,175.00" "$4,305.00" "$7,175.00" "$7,175.00" "$7,175.00" N/A N/A 80549666 EAP 80549666 CATHETER GUID 132CM 3MM STRK FST PK TREVO NXT AXS BOTH IP/OP "$17,991.00" "$13,313.50" "$2,060.15" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$3,202.40" "$17,991.00" "$17,991.00" "$4,181.12" "$4,181.12" "$13,867.46" "$2,060.15" "$3,749.52" "$17,991.00" "$7,196.40" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$13,493.25" "$17,991.00" "$17,991.00" "$17,991.00" "$8,995.50" "$8,995.50" "$14,248.87" "$17,991.00" "$14,392.80" "$11,694.15" "$17,991.00" "$17,991.00" "$10,434.78" "$17,991.00" "$10,794.60" "$17,991.00" "$17,991.00" "$17,991.00" N/A N/A 80549667 EAP 80549667 CATHETER GUID 132CM 3MM STRK FST PK TREVO NXT AXS BOTH IP/OP "$17,991.00" "$13,313.50" "$2,060.15" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$3,202.40" "$17,991.00" "$17,991.00" "$4,181.12" "$4,181.12" "$13,867.46" "$2,060.15" "$3,749.52" "$17,991.00" "$7,196.40" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$13,493.25" "$17,991.00" "$17,991.00" "$17,991.00" "$8,995.50" "$8,995.50" "$14,248.87" "$17,991.00" "$14,392.80" "$11,694.15" "$17,991.00" "$17,991.00" "$10,434.78" "$17,991.00" "$10,794.60" "$17,991.00" "$17,991.00" "$17,991.00" N/A N/A 80549668 EAP 80549668 CATHETER GUID 132CM 4MM STRK FST PK TREVO NXT AXS BOTH IP/OP "$17,991.00" "$13,313.50" "$2,060.15" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$3,202.40" "$17,991.00" "$17,991.00" "$4,181.12" "$4,181.12" "$13,867.46" "$2,060.15" "$3,749.52" "$17,991.00" "$7,196.40" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$13,493.25" "$17,991.00" "$17,991.00" "$17,991.00" "$8,995.50" "$8,995.50" "$14,248.87" "$17,991.00" "$14,392.80" "$11,694.15" "$17,991.00" "$17,991.00" "$10,434.78" "$17,991.00" "$10,794.60" "$17,991.00" "$17,991.00" "$17,991.00" N/A N/A 80549669 EAP 80549669 CATHETER GUID 132CM 4MM STRK FST PK TREVO NXT AXS BOTH IP/OP "$17,991.00" "$13,313.50" "$2,060.15" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$3,202.40" "$17,991.00" "$17,991.00" "$4,181.12" "$4,181.12" "$13,867.46" "$2,060.15" "$3,749.52" "$17,991.00" "$7,196.40" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$13,493.25" "$17,991.00" "$17,991.00" "$17,991.00" "$8,995.50" "$8,995.50" "$14,248.87" "$17,991.00" "$14,392.80" "$11,694.15" "$17,991.00" "$17,991.00" "$10,434.78" "$17,991.00" "$10,794.60" "$17,991.00" "$17,991.00" "$17,991.00" N/A N/A 80549670 EAP 80549670 CATHETER GUID 132CM 6MM 7MM STRK FST PK TREVO NXT BOTH IP/OP "$17,991.00" "$13,313.50" "$2,060.15" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$3,202.40" "$17,991.00" "$17,991.00" "$4,181.12" "$4,181.12" "$13,867.46" "$2,060.15" "$3,749.52" "$17,991.00" "$7,196.40" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$13,493.25" "$17,991.00" "$17,991.00" "$17,991.00" "$8,995.50" "$8,995.50" "$14,248.87" "$17,991.00" "$14,392.80" "$11,694.15" "$17,991.00" "$17,991.00" "$10,434.78" "$17,991.00" "$10,794.60" "$17,991.00" "$17,991.00" "$17,991.00" N/A N/A 80549671 EAP 80549671 CATHETER GUID 132CM 6MM 3MM STRK FST PK TREVO NXT BOTH IP/OP "$17,991.00" "$13,313.50" "$2,060.15" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$3,202.40" "$17,991.00" "$17,991.00" "$4,181.12" "$4,181.12" "$13,867.46" "$2,060.15" "$3,749.52" "$17,991.00" "$7,196.40" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$13,493.25" "$17,991.00" "$17,991.00" "$17,991.00" "$8,995.50" "$8,995.50" "$14,248.87" "$17,991.00" "$14,392.80" "$11,694.15" "$17,991.00" "$17,991.00" "$10,434.78" "$17,991.00" "$10,794.60" "$17,991.00" "$17,991.00" "$17,991.00" N/A N/A 80549672 EAP 80549672 CATHETER GUID 132CM 6MM 3MM STRK FST PK TREVO NXT BOTH IP/OP "$17,991.00" "$13,313.50" "$2,060.15" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$3,202.40" "$17,991.00" "$17,991.00" "$4,181.12" "$4,181.12" "$13,867.46" "$2,060.15" "$3,749.52" "$17,991.00" "$7,196.40" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$13,493.25" "$17,991.00" "$17,991.00" "$17,991.00" "$8,995.50" "$8,995.50" "$14,248.87" "$17,991.00" "$14,392.80" "$11,694.15" "$17,991.00" "$17,991.00" "$10,434.78" "$17,991.00" "$10,794.60" "$17,991.00" "$17,991.00" "$17,991.00" N/A N/A 80549673 EAP 80549673 CATHETER GUID 132CM 6MM 3MM STRK FST PK TREVO NXT BOTH IP/OP "$17,991.00" "$13,313.50" "$2,060.15" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$3,202.40" "$17,991.00" "$17,991.00" "$4,181.12" "$4,181.12" "$13,867.46" "$2,060.15" "$3,749.52" "$17,991.00" "$7,196.40" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$13,493.25" "$17,991.00" "$17,991.00" "$17,991.00" "$8,995.50" "$8,995.50" "$14,248.87" "$17,991.00" "$14,392.80" "$11,694.15" "$17,991.00" "$17,991.00" "$10,434.78" "$17,991.00" "$10,794.60" "$17,991.00" "$17,991.00" "$17,991.00" N/A N/A 80549674 EAP 80549674 CATHETER GUID 132CM 6MM 3MM STRK FST PK TREVO NXT BOTH IP/OP "$17,991.00" "$13,313.50" "$2,060.15" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$3,202.40" "$17,991.00" "$17,991.00" "$4,181.12" "$4,181.12" "$13,867.46" "$2,060.15" "$3,749.52" "$17,991.00" "$7,196.40" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$17,991.00" "$13,493.25" "$17,991.00" "$17,991.00" "$17,991.00" "$8,995.50" "$8,995.50" "$14,248.87" "$17,991.00" "$14,392.80" "$11,694.15" "$17,991.00" "$17,991.00" "$10,434.78" "$17,991.00" "$10,794.60" "$17,991.00" "$17,991.00" "$17,991.00" N/A N/A 80549675 EAP HCPCS C1757 RETRIEVER ENDSCP 200CM 4MM TREVO NXT PROVUE NTNL BOTH IP/OP "$13,116.25" "$9,706.50" "$2,060.15" "$13,116.25" "$7,122.12" "$7,122.12" "$7,122.12" "$7,122.12" "$13,116.25" "$13,116.25" "$13,116.25" "$2,733.75" "$13,116.25" "$4,181.12" "$4,181.12" "$10,110.01" "$2,060.15" "$2,733.57" "$13,116.25" "$13,116.25" "$3,094.73" "$13,116.25" "$13,116.25" "$13,116.25" "$13,116.25" "$9,837.19" "$13,116.25" "$13,116.25" "$13,116.25" "$6,558.13" "$6,558.13" "$10,388.07" "$13,116.25" "$10,493.00" "$8,525.56" "$2,603.25" "$13,116.25" "$7,607.43" "$13,116.25" "$13,116.25" "$13,116.25" "$2,733.43" "$13,116.25" N/A N/A 80549676 EAP HCPCS C1876 STENT INTRCRAN 12MM 4MM SRPS EVOL FLW DVRTR STRL BOTH IP/OP "$34,155.00" "$25,275.00" "$2,060.15" "$34,155.00" "$18,546.17" "$18,546.17" "$18,546.17" "$18,546.17" "$34,155.00" "$34,155.00" "$34,155.00" "$7,118.76" "$34,155.00" "$4,181.12" "$4,181.12" "$26,326.67" "$2,060.15" "$7,118.28" "$34,155.00" "$34,155.00" "$3,094.73" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$25,616.25" "$34,155.00" "$34,155.00" "$34,155.00" "$17,077.50" "$17,077.50" "$27,050.76" "$34,155.00" "$27,324.00" "$22,200.75" "$6,778.91" "$34,155.00" "$19,809.90" "$34,155.00" "$34,155.00" "$34,155.00" "$7,117.90" "$34,155.00" N/A N/A 80549677 EAP HCPCS C1877 STENT INTRCRAN 20MM 4MM SRPS EVOL FLW DVRTR STRL BOTH IP/OP "$34,155.00" "$25,275.00" "$2,060.15" "$34,155.00" "$18,546.17" "$18,546.17" "$18,546.17" "$18,546.17" "$34,155.00" "$34,155.00" "$34,155.00" "$7,118.76" "$34,155.00" "$4,181.12" "$4,181.12" "$26,326.67" "$2,060.15" "$7,118.28" "$34,155.00" "$34,155.00" "$3,094.73" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$25,616.25" "$34,155.00" "$34,155.00" "$34,155.00" "$17,077.50" "$17,077.50" "$27,050.76" "$34,155.00" "$27,324.00" "$22,200.75" "$6,778.91" "$34,155.00" "$19,809.90" "$34,155.00" "$20,493.00" "$34,155.00" "$7,117.90" "$34,155.00" N/A N/A 80549678 EAP HCPCS C1878 STENT INTRCRAN 20MM 5MM SRPS EVOL FLW DVRTR STRL BOTH IP/OP "$34,155.00" "$25,275.00" "$2,060.15" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$4,181.12" "$4,181.12" "$26,326.67" "$2,060.15" "$7,118.28" "$34,155.00" "$13,662.00" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$25,616.25" "$34,155.00" "$34,155.00" "$34,155.00" "$17,077.50" "$17,077.50" "$27,050.76" "$34,155.00" "$27,324.00" "$22,200.75" "$34,155.00" "$34,155.00" "$19,809.90" "$34,155.00" "$20,493.00" "$34,155.00" "$34,155.00" "$34,155.00" N/A N/A 80549679 EAP HCPCS C1879 STENT INTRCRAN 30MM 5MM SRPS EVOL FLW DVRTR STRL BOTH IP/OP "$34,155.00" "$25,275.00" "$2,060.15" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$6,079.59" "$34,155.00" "$34,155.00" "$4,181.12" "$4,181.12" "$26,326.67" "$2,060.15" "$7,118.28" "$34,155.00" "$13,662.00" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$34,155.00" "$25,616.25" "$34,155.00" "$34,155.00" "$34,155.00" "$17,077.50" "$17,077.50" "$27,050.76" "$34,155.00" "$27,324.00" "$22,200.75" "$34,155.00" "$34,155.00" "$19,809.90" "$34,155.00" "$20,493.00" "$34,155.00" "$34,155.00" "$34,155.00" N/A N/A 80549680 EAP HCPCS C1880 STENT INTRCRAN 40MM 5MM SRPS EVOL FLW DVRTR STRL BOTH IP/OP "$37,145.00" "$27,487.50" "$2,060.15" "$37,145.00" "$37,145.00" "$37,145.00" "$37,145.00" "$37,145.00" "$37,145.00" "$37,145.00" "$37,145.00" "$37,145.00" "$37,145.00" "$4,181.12" "$4,181.12" "$28,631.37" "$2,060.15" "$7,741.43" "$37,145.00" "$14,858.00" "$37,145.00" "$37,145.00" "$37,145.00" "$37,145.00" "$37,145.00" "$27,858.75" "$37,145.00" "$37,145.00" "$37,145.00" "$18,572.50" "$18,572.50" "$29,418.84" "$37,145.00" "$29,716.00" "$24,144.25" "$37,145.00" "$37,145.00" "$21,544.10" "$37,145.00" "$22,287.00" "$37,145.00" "$37,145.00" "$37,145.00" N/A N/A 80549713 EAP HCPCS C1751 KIT CATH 1.4FR LF RADOPQ DEHP-FR SFT STAB WNG PU PERI BOTH IP/OP $269.00 $199.50 $53.39 "$1,342.00" $146.07 $146.07 $146.07 $146.07 $269.00 $269.00 $269.00 $56.07 $269.00 $199.65 $199.65 $207.35 $140.15 $56.06 $269.00 "$1,342.00" $159.11 $269.00 $269.00 $269.00 $269.00 $201.75 $269.00 $269.00 $269.00 $134.50 $134.50 $213.05 $269.00 $215.20 $174.85 $53.39 $269.00 $156.02 $269.00 $269.00 $269.00 $56.06 $269.00 N/A N/A 80549714 EAP HCPCS C1894 INTRODUCER SHTH 1.4FR STRL LF PLWY DISP BOTH IP/OP $94.00 $70.00 $18.66 $468.00 $51.04 $51.04 $51.04 $51.04 $94.00 $94.00 $94.00 $19.59 $94.00 $69.77 $69.77 $72.46 $48.97 $19.59 $94.00 $468.00 $55.60 $94.00 $94.00 $94.00 $94.00 $70.50 $94.00 $94.00 $94.00 $47.00 $47.00 $74.45 $94.00 $75.20 $61.10 $18.66 $94.00 $54.52 $94.00 $94.00 $94.00 $19.59 $94.00 N/A N/A 80549715 EAP HCPCS C1751 CATHETER CV 1.4FR LF RADOPQ DEHP-FR SFT STAB WNG PU PERI BOTH IP/OP $103.00 $76.50 $20.44 $513.00 $55.93 $55.93 $55.93 $55.93 $103.00 $103.00 $103.00 $21.47 $103.00 $76.45 $76.45 $79.39 $53.66 $21.47 $103.00 $513.00 $60.92 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $66.95 $20.44 $103.00 $59.74 $103.00 $103.00 $103.00 $21.47 $103.00 N/A N/A 80549716 EAP Custom 80549716 KIT CATH 1.9FR LF 1 LUM RADOPQ PICC CMPLT PU BOTH IP/OP $254.00 $188.00 $45.21 $508.00 $254.00 $254.00 $254.00 $254.00 $254.00 $254.00 $45.21 $254.00 $254.00 $188.52 $188.52 $195.78 $132.33 $52.94 $254.00 $508.00 $254.00 $254.00 $254.00 $254.00 $254.00 $190.50 $254.00 $254.00 $254.00 $127.00 $127.00 $201.17 $254.00 $203.20 $165.10 $254.00 $254.00 $147.32 $254.00 $152.40 $254.00 $254.00 $254.00 N/A N/A 80549717 EAP HCPCS C1894 INTRODUCER SHTH 1.9FR PLWY LOPRFL BOTH IP/OP $89.00 $66.00 $17.66 $443.00 $48.33 $48.33 $48.33 $48.33 $89.00 $89.00 $89.00 $18.55 $89.00 $66.06 $66.06 $68.60 $46.37 $18.55 $89.00 $443.00 $52.64 $89.00 $89.00 $89.00 $89.00 $66.75 $89.00 $89.00 $89.00 $44.50 $44.50 $70.49 $89.00 $71.20 $57.85 $17.66 $89.00 $51.62 $89.00 $89.00 $89.00 $18.55 $89.00 N/A N/A 80549718 EAP HCPCS C1751 CATHETER CV 1.9FR LF FTPRNT PICC 1 LUM RADOPQ SFT STAB WNG BOTH IP/OP $97.00 $72.00 $19.25 $485.00 $52.67 $52.67 $52.67 $52.67 $97.00 $97.00 $97.00 $20.22 $97.00 $71.99 $71.99 $74.77 $50.54 $20.22 $97.00 $485.00 $57.38 $97.00 $97.00 $97.00 $97.00 $72.75 $97.00 $97.00 $97.00 $48.50 $48.50 $76.82 $97.00 $77.60 $63.05 $19.25 $97.00 $56.26 $97.00 $97.00 $97.00 $20.21 $97.00 N/A N/A 80549719 EAP HCPCS C1751 KIT CATH 1.9FR LF 2 LUM RADOPQ PICC CMPLT PU BOTH IP/OP $352.00 $260.50 $69.86 "$1,760.00" $191.14 $191.14 $191.14 $191.14 $352.00 $352.00 $352.00 $73.37 $352.00 $261.25 $261.25 $271.32 $183.39 $73.36 $352.00 "$1,760.00" $208.21 $352.00 $352.00 $352.00 $352.00 $264.00 $352.00 $352.00 $352.00 $176.00 $176.00 $278.78 $352.00 $281.60 $228.80 $69.86 $352.00 $204.16 $352.00 $352.00 $352.00 $73.36 $352.00 N/A N/A 80549720 EAP HCPCS C1751 CATHETER IV 1.9FR LF FTPRNT PLWY 2 LUM RADOPQ DEHP-FR PICC BOTH IP/OP $180.00 $133.50 $35.73 $900.00 $97.74 $97.74 $97.74 $97.74 $180.00 $180.00 $180.00 $37.52 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $900.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $35.73 $180.00 $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A 80549721 EAP Custom 80549721 KIT DRSG CHG PICC BOTH IP/OP $38.00 $28.50 $6.76 $150.00 $38.00 $38.00 $38.00 $38.00 $38.00 $38.00 $6.76 $38.00 $38.00 $28.20 $28.20 $29.29 $19.80 $7.92 $38.00 $150.00 $38.00 $38.00 $38.00 $38.00 $38.00 $28.50 $38.00 $38.00 $38.00 $19.00 $19.00 $30.10 $38.00 $30.40 $24.70 $38.00 $38.00 $22.04 $38.00 $22.80 $38.00 $38.00 $38.00 N/A N/A 80549722 EAP HCPCS C1764 RECORDER CRD SM SLIM CNFRM RX 1 TCH PRGM DATA STOR RMT MNTR BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" "$11,250.00" "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 80549723 EAP HCPCS C1764 RECORDER CRD SM SLIM CNFRM RX 1 TCH PRGM DATA STOR RMT MNTR BOTH IP/OP "$50,000.00" "$37,000.00" "$7,712.84" "$50,000.00" "$22,500.00" "$22,500.00" "$22,500.00" "$22,500.00" "$50,000.00" "$50,000.00" "$50,000.00" "$9,417.94" "$50,000.00" "$50,000.00" "$50,000.00" "$50,000.00" "$50,000.00" "$10,420.55" "$50,000.00" "$50,000.00" "$24,650.00" "$50,000.00" "$50,000.00" "$50,000.00" "$50,000.00" "$37,500.00" "$50,000.00" "$50,000.00" "$50,000.00" "$25,000.00" "$25,000.00" "$39,600.00" "$50,000.00" "$40,000.00" "$22,500.00" "$7,712.84" "$50,000.00" "$29,000.00" "$50,000.00" "$50,000.00" "$50,000.00" "$8,098.48" "$50,000.00" N/A N/A 80549724 EAP HCPCS C1764 RECORDER CRD SM SLIM CNFRM RX 1 TCH PRGM DATA STOR RMT MNTR BOTH IP/OP "$92,500.00" "$68,450.00" "$7,712.84" "$92,500.00" "$41,625.00" "$41,625.00" "$41,625.00" "$41,625.00" "$92,500.00" "$92,500.00" "$92,500.00" "$9,417.94" "$92,500.00" "$92,500.00" "$92,500.00" "$92,500.00" "$92,500.00" "$19,278.02" "$92,500.00" "$92,500.00" "$45,602.50" "$92,500.00" "$92,500.00" "$92,500.00" "$92,500.00" "$69,375.00" "$92,500.00" "$92,500.00" "$92,500.00" "$46,250.00" "$46,250.00" "$73,260.00" "$92,500.00" "$74,000.00" "$41,625.00" "$7,712.84" "$92,500.00" "$53,650.00" "$92,500.00" "$92,500.00" "$92,500.00" "$8,098.48" "$92,500.00" N/A N/A 80549725 EAP Custom 80549725 KIT TEMP NS LF ARC SN ARCTICGEL NEO DISP BOTH IP/OP "$3,125.00" "$2,312.50" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$2,319.38" "$2,319.38" "$2,408.75" "$1,628.13" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$2,031.25" "$3,125.00" "$3,125.00" "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 82000002 EAP CPT® G0257 EMERGENCY DIALYSIS BOTH IP/OP "$3,267.00" "$2,418.00" $641.42 "$3,267.00" "$1,773.98" "$1,773.98" "$1,773.98" "$1,773.98" $644.27 $644.27 $641.42 $680.92 $644.27 "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" $680.88 "$1,030.83" $909.63 "$1,932.43" $644.27 "$3,267.00" $644.27 $676.48 "$2,450.25" $644.27 $644.27 $644.27 "$1,633.50" "$1,633.50" "$2,587.46" $644.27 "$2,613.60" "$2,123.55" $648.42 $644.27 "$1,894.86" $676.48 $932.09 $644.27 $680.84 $644.27 N/A N/A 83100001 EAP CPT® 90947 INTPATIENT DIALYSIS CRRT BOTH IP/OP "$3,267.00" "$2,418.00" $122.37 "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" $124.96 $124.96 $124.35 "$3,267.00" $124.96 "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" $680.88 $199.94 $195.79 "$3,267.00" $124.96 $122.37 $124.96 "$3,267.00" "$2,450.25" $124.96 $124.96 $124.96 "$1,633.50" "$1,633.50" "$2,587.46" $124.96 "$2,613.60" "$2,123.55" "$3,267.00" $124.96 "$1,894.86" "$3,267.00" $127.67 $124.96 "$3,267.00" $124.96 N/A N/A 83100005 EAP CPT® 90945 PERITONEAL DIALYSIS OP BOTH IP/OP "$1,724.00" "$1,276.00" $85.39 "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" $86.47 $86.47 $86.49 "$1,724.00" $86.47 "$1,724.00" "$1,724.00" "$1,724.00" "$1,724.00" $359.30 $138.35 $136.62 "$1,724.00" $86.47 $85.39 $86.47 "$1,724.00" "$1,293.00" $86.47 $86.47 $86.47 $862.00 $862.00 "$1,365.41" $86.47 "$1,379.20" "$1,120.60" "$1,724.00" $86.47 $999.92 "$1,724.00" $87.99 $86.47 "$1,724.00" $86.47 N/A N/A 90000011 EAP CPT® 90882 BRIEF EVALUATION MANAGEMENT BOTH IP/OP $62.00 $46.00 $12.92 $85.07 $62.00 $62.00 $62.00 $62.00 $62.00 $62.00 $85.07 $62.00 $62.00 $46.02 $46.02 $47.79 $32.30 $12.92 $62.00 $24.80 $62.00 $62.00 $62.00 $62.00 $62.00 $46.50 $62.00 $62.00 $62.00 $31.00 $31.00 $49.10 $62.00 $49.60 $40.30 $62.00 $62.00 $35.96 $62.00 $37.20 $62.00 $62.00 $62.00 N/A N/A 90000012 EAP CPT® 90885 PSYCH EVAL OF RECORDS BOTH IP/OP $400.00 $296.00 $49.92 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $49.92 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 $400.00 $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A 90000013 EAP CPT® 90887 CONSULTATION WITH FAMILY BOTH IP/OP $242.00 $179.50 $50.44 $242.00 $242.00 $242.00 $242.00 $242.00 $242.00 $242.00 $75.59 $242.00 $242.00 $179.61 $179.61 $186.53 $126.08 $50.44 $242.00 $96.80 $242.00 $242.00 $242.00 $242.00 $242.00 $181.50 $242.00 $242.00 $242.00 $121.00 $121.00 $191.66 $242.00 $193.60 $157.30 $242.00 $242.00 $140.36 $242.00 $145.20 $242.00 $242.00 $242.00 N/A N/A 90000014 EAP CPT® 90889 PREPARATION OF REPORTS BOTH IP/OP $240.00 $178.00 $50.02 $240.00 $240.00 $240.00 $240.00 $240.00 $240.00 $240.00 $71.87 $240.00 $240.00 $178.13 $178.13 $184.99 $125.04 $50.02 $240.00 $96.00 $240.00 $240.00 $240.00 $240.00 $240.00 $180.00 $240.00 $240.00 $240.00 $120.00 $120.00 $190.08 $240.00 $192.00 $156.00 $240.00 $240.00 $139.20 $240.00 $144.00 $240.00 $240.00 $240.00 N/A N/A 90000020 EAP HCPCS H0004 GROUP OUTPATIENT SERVICES BOTH IP/OP $19.00 $14.50 $3.77 $19.00 $10.32 $10.32 $10.32 $10.32 $19.00 $19.00 $19.00 $3.96 $19.00 $14.10 $14.10 $14.65 $9.90 $3.96 $19.00 $7.60 $11.24 $19.00 $19.00 $19.00 $19.00 $14.25 $19.00 $19.00 $19.00 $9.50 $9.50 $15.05 $19.00 $15.20 $12.35 $3.77 $19.00 $11.02 $19.00 $11.40 $19.00 $19.00 $19.00 N/A N/A 90000022 EAP HCPCS H0004 GROUP OUTPATIENT SERVICES BOTH IP/OP $85.00 $63.00 $16.87 $85.00 $46.16 $46.16 $46.16 $46.16 $85.00 $85.00 $85.00 $17.72 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $50.28 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $16.87 $85.00 $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 90000023 EAP HCPCS H0020 METHADONE ADMINISTRATION BOTH IP/OP $131.00 $97.00 $27.30 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $131.00 $97.23 $97.23 $100.97 $68.25 $27.30 $131.00 $52.40 $131.00 $131.00 $131.00 $131.00 $131.00 $98.25 $131.00 $131.00 $131.00 $65.50 $65.50 $103.75 $131.00 $104.80 $85.15 $131.00 $131.00 $75.98 $131.00 $78.60 $131.00 $131.00 $131.00 N/A N/A 90000024 EAP HCPCS H0031 MH ASSESSMENT BY A NON-PHYSICIAN BOTH IP/OP $168.00 $124.50 $33.34 $168.00 $91.22 $91.22 $91.22 $91.22 $168.00 $168.00 $168.00 $35.02 $168.00 $124.69 $124.69 $129.49 $87.53 $35.01 $168.00 $67.20 $99.37 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $109.20 $33.34 $168.00 $97.44 $168.00 $100.80 $168.00 $168.00 $168.00 N/A N/A 90000026 EAP HCPCS H0032 SERVICE PLAN DEVELOPMENT BOTH IP/OP $85.00 $63.00 $16.87 $85.00 $46.16 $46.16 $46.16 $46.16 $85.00 $85.00 $85.00 $17.72 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $50.28 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $16.87 $85.00 $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 90000027 EAP HCPCS H0038 PEER SUPPORT BOTH IP/OP $28.00 $21.00 $5.56 $28.00 $15.20 $15.20 $15.20 $15.20 $28.00 $28.00 $28.00 $5.84 $28.00 $20.78 $20.78 $21.58 $14.59 $5.84 $28.00 $11.20 $16.56 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $18.20 $5.56 $28.00 $16.24 $28.00 $16.80 $28.00 $28.00 $28.00 N/A N/A 90000028 EAP HCPCS H0039 ASSERTIVE COMMUNITY TREATMENT BOTH IP/OP $93.00 $69.00 $18.46 $93.00 $50.50 $50.50 $50.50 $50.50 $93.00 $93.00 $93.00 $19.38 $93.00 $69.02 $69.02 $71.68 $48.45 $19.38 $93.00 $37.20 $55.01 $93.00 $93.00 $93.00 $93.00 $69.75 $93.00 $93.00 $93.00 $46.50 $46.50 $73.66 $93.00 $74.40 $60.45 $18.46 $93.00 $53.94 $93.00 $55.80 $93.00 $93.00 $93.00 N/A N/A 90000030 EAP HCPCS H2010 MEDICATION ADMINIST COMP BOTH IP/OP $86.00 $64.00 $17.07 $86.00 $46.70 $46.70 $46.70 $46.70 $86.00 $86.00 $86.00 $17.92 $86.00 $63.83 $63.83 $66.29 $44.81 $17.92 $86.00 $34.40 $50.87 $86.00 $86.00 $86.00 $86.00 $64.50 $86.00 $86.00 $86.00 $43.00 $43.00 $68.11 $86.00 $68.80 $55.90 $17.07 $86.00 $49.88 $86.00 $51.60 $86.00 $86.00 $86.00 N/A N/A 90000035 EAP HCPCS H2014 GROUP SKILLS TRAIN/DEVL 15 MIN BOTH IP/OP $15.00 $11.50 $2.98 $17.00 $8.15 $8.15 $8.15 $8.15 $15.00 $15.00 $15.00 $3.13 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.80 $8.87 $15.00 $17.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $2.98 $15.00 $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 90000045 EAP HCPCS H2011 CRISIS INTERVENTION BOTH IP/OP $137.00 $101.50 $27.19 $137.00 $74.39 $74.39 $74.39 $74.39 $137.00 $137.00 $137.00 $28.55 $137.00 $101.68 $101.68 $105.60 $71.38 $28.55 $137.00 $54.80 $81.04 $137.00 $137.00 $137.00 $137.00 $102.75 $137.00 $137.00 $137.00 $68.50 $68.50 $108.50 $137.00 $109.60 $89.05 $27.19 $137.00 $79.46 $137.00 $82.20 $137.00 $137.00 $137.00 N/A N/A 90000048 EAP HCPCS H2017 PSYCHOSOCIAL REHABILITATION BOTH IP/OP $28.00 $21.00 $5.84 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $28.00 $20.78 $20.78 $21.58 $14.59 $5.84 $28.00 $11.20 $28.00 $28.00 $28.00 $28.00 $28.00 $21.00 $28.00 $28.00 $28.00 $14.00 $14.00 $22.18 $28.00 $22.40 $18.20 $28.00 $28.00 $16.24 $28.00 $16.80 $28.00 $28.00 $28.00 N/A N/A 90000049 EAP HCPCS H2014 GRP/FAM SKILL TRAIN W/PAT15MIN BOTH IP/OP $17.00 $13.00 $3.37 $17.00 $9.23 $9.23 $9.23 $9.23 $17.00 $17.00 $17.00 $3.54 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $10.06 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $3.37 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 90000051 EAP HCPCS H2014 GROUP SKILLS TRAINING 15MINS BOTH IP/OP $17.00 $13.00 $3.37 $17.00 $9.23 $9.23 $9.23 $9.23 $17.00 $17.00 $17.00 $3.54 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $10.06 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $3.37 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 90000052 EAP HCPCS H2014 FAMILY TRAINING W/PAT 15MINS BOTH IP/OP $72.00 $53.50 $14.29 $72.00 $39.10 $39.10 $39.10 $39.10 $72.00 $72.00 $72.00 $15.01 $72.00 $53.44 $53.44 $55.50 $37.51 $15.01 $72.00 $28.80 $42.59 $72.00 $72.00 $72.00 $72.00 $54.00 $72.00 $72.00 $72.00 $36.00 $36.00 $57.02 $72.00 $57.60 $46.80 $14.29 $72.00 $41.76 $72.00 $43.20 $72.00 $72.00 $72.00 N/A N/A 90000053 EAP HCPCS H2014 FAMILY TRAINING W/O PAT 15MINS BOTH IP/OP $72.00 $53.50 $14.29 $72.00 $39.10 $39.10 $39.10 $39.10 $72.00 $72.00 $72.00 $15.01 $72.00 $53.44 $53.44 $55.50 $37.51 $15.01 $72.00 $28.80 $42.59 $72.00 $72.00 $72.00 $72.00 $54.00 $72.00 $72.00 $72.00 $36.00 $36.00 $57.02 $72.00 $57.60 $46.80 $14.29 $72.00 $41.76 $72.00 $43.20 $72.00 $72.00 $72.00 N/A N/A 90000054 EAP HCPCS T1001 NURSING ASSESSMENT BOTH IP/OP $99.00 $73.50 $19.65 $99.00 $53.76 $53.76 $53.76 $53.76 $99.00 $99.00 $99.00 $20.63 $99.00 $73.48 $73.48 $76.31 $51.58 $20.63 $99.00 $39.60 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $64.35 $19.65 $99.00 $57.42 $99.00 $59.40 $99.00 $99.00 $99.00 N/A N/A 90000056 EAP HCPCS T1002 RN SERVICES 15MINS BOTH IP/OP $99.00 $73.50 $19.65 $99.00 $53.76 $53.76 $53.76 $53.76 $99.00 $99.00 $99.00 $20.63 $99.00 $73.48 $73.48 $76.31 $51.58 $20.63 $99.00 $39.60 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $64.35 $19.65 $99.00 $57.42 $99.00 $59.40 $99.00 $99.00 $99.00 N/A N/A 90000057 EAP HCPCS T1003 LPN SERVICES 15MINS BOTH IP/OP $75.00 $55.50 $14.89 $75.00 $40.73 $40.73 $40.73 $40.73 $75.00 $75.00 $75.00 $15.63 $75.00 $55.67 $55.67 $57.81 $39.08 $15.63 $75.00 $30.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $48.75 $14.89 $75.00 $43.50 $75.00 $45.00 $75.00 $75.00 $75.00 N/A N/A 90000058 EAP HCPCS T2038 COMMUNITY TRANSITIONAL PLANNING BOTH IP/OP $70.00 $52.00 $13.89 $70.00 $38.01 $38.01 $38.01 $38.01 $70.00 $70.00 $70.00 $14.59 $70.00 $51.95 $51.95 $53.96 $36.47 $14.59 $70.00 $28.00 $41.41 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $45.50 $13.89 $70.00 $40.60 $70.00 $42.00 $70.00 $70.00 $70.00 N/A N/A 90000067 EAP CPT® 90791 PSYCH DX EVAL (NO MED SERVICE) BOTH IP/OP $576.00 $426.50 $114.32 $576.00 $312.77 $312.77 $312.77 $312.77 $131.62 $131.62 $131.03 $120.05 $131.62 $427.51 $427.51 $443.98 $300.10 $120.04 $210.59 $210.20 $340.70 $131.62 $150.82 $131.62 $138.20 $432.00 $131.62 $131.62 $131.62 $288.00 $288.00 $456.19 $131.62 $460.80 $374.40 $114.32 $131.62 $334.08 $138.20 $190.41 $131.62 $576.00 $131.62 N/A N/A 90000068 EAP CPT® 90792 PSYCH DX EVAL (WITH MED SERVICE) BOTH IP/OP $576.00 $426.50 $114.32 $576.00 $312.77 $312.77 $312.77 $312.77 $131.62 $131.62 $131.03 $120.05 $131.62 $427.51 $427.51 $443.98 $300.10 $120.04 $210.59 $210.20 $340.70 $131.62 $172.19 $131.62 $138.20 $432.00 $131.62 $131.62 $131.62 $288.00 $288.00 $456.19 $131.62 $460.80 $374.40 $114.32 $131.62 $334.08 $138.20 $190.41 $131.62 $576.00 $131.62 N/A N/A 90000069 EAP CPT® 90785 INTERACTIVE COMPLEXITY BOTH IP/OP $321.00 $238.00 $13.22 $321.00 $174.30 $174.30 $174.30 $174.30 $321.00 $321.00 $321.00 $66.90 $321.00 $238.25 $238.25 $247.43 $167.24 $321.00 $321.00 $321.00 $189.87 $321.00 $13.22 $321.00 $321.00 $240.75 $321.00 $321.00 $321.00 $160.50 $160.50 $254.23 $321.00 $256.80 $208.65 $321.00 $321.00 $186.18 $321.00 $321.00 $321.00 $321.00 $321.00 N/A N/A 90000070 EAP HCPCS T1016 CASE MANAGEMENT BOTH IP/OP $45.00 $33.50 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 90000071 EAP HCPCS T1016 "CASE MANAGEMENT - PRACTITIONER LEVEL 5," BOTH IP/OP $45.00 $33.50 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 90000072 EAP HCPCS T1016 "CASE MANAGEMENT - PRACTITIONER LEVEL 4," BOTH IP/OP $45.00 $33.50 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 90000073 EAP HCPCS T1016 "CASE MANAGEMENT - PRACTITIONER LEVEL 5," BOTH IP/OP $45.00 $33.50 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 90000074 EAP HCPCS T1016 "CASE MANAGEMENT-PRACTITIONER LEVEL 4, COLLATERAL CONTACT" BOTH IP/OP $45.00 $33.50 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 90000076 EAP HCPCS T1016 "CASE MANAGEMENT-PRACTITIONER LEVEL 4,COLLATERAL CONTACT" BOTH IP/OP $45.00 $33.50 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 $45.00 $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 90000078 EAP HCPCS H0025 PEER SUPPORT WHOLE HEALTH & WELLNESS BOTH IP/OP $34.00 $25.50 $6.75 $34.00 $18.46 $18.46 $18.46 $18.46 $34.00 $34.00 $34.00 $7.09 $34.00 $25.23 $25.23 $26.21 $17.71 $7.09 $34.00 $13.60 $20.11 $34.00 $34.00 $34.00 $34.00 $25.50 $34.00 $34.00 $34.00 $17.00 $17.00 $26.93 $34.00 $27.20 $22.10 $6.75 $34.00 $19.72 $34.00 $20.40 $34.00 $34.00 $34.00 N/A N/A 90000080 EAP CPT® G0447 BEHAVIOR COUNSEL OBESITY 15M BOTH IP/OP $101.00 $75.00 $20.05 $117.77 $54.84 $54.84 $54.84 $54.84 $73.60 $73.60 $73.28 $21.05 $73.60 $74.96 $74.96 $77.85 $52.62 $21.05 $117.77 $109.43 $59.74 $73.60 $23.05 $73.60 $77.28 $75.75 $73.60 $73.60 $73.60 $50.50 $50.50 $79.99 $73.60 $80.80 $65.65 $20.05 $73.60 $58.58 $77.28 $101.00 $73.60 $21.05 $73.60 N/A N/A 90000081 EAP HCPCS G0444 "ANNUAL DEPRESSION SCREENING, 5 TO 15 MINUTES" BOTH IP/OP $71.00 $53.00 #N/A #N/A $71.00 $71.00 $71.00 $71.00 $9.30 $9.30 $9.38 $71.00 $9.30 $52.70 $52.70 $54.73 $36.99 $14.80 $14.88 #N/A $71.00 $9.30 #N/A $9.30 $71.00 $53.25 $9.30 $9.30 $9.30 $35.50 $35.50 $56.23 $9.30 $56.80 $46.15 $71.00 $9.30 $41.18 $71.00 $9.74 $9.30 $71.00 $9.30 N/A N/A 91400004 EAP CPT® 90832 INDIVIDUAL PSYCHOTHERAPY 30 MINS BOTH IP/OP $541.00 $400.50 $66.43 $541.00 $293.76 $293.76 $293.76 $293.76 $131.62 $131.62 $131.03 $112.76 $131.62 $401.53 $401.53 $417.00 $281.86 $112.75 $210.59 $210.20 $320.00 $131.62 $66.43 $131.62 $138.20 $405.75 $131.62 $131.62 $131.62 $270.50 $270.50 $428.47 $131.62 $432.80 $351.65 $107.37 $131.62 $313.78 $138.20 $190.41 $131.62 $541.00 $131.62 N/A N/A 91400006 EAP CPT® 90837 INDIVIDUAL PSYCHOTHERAPY 60 MIN BOTH IP/OP $658.00 $487.00 $129.46 $658.00 $357.29 $357.29 $357.29 $357.29 $131.62 $131.62 $131.03 $137.14 $131.62 $488.37 $488.37 $507.19 $342.82 $137.13 $210.59 $210.20 $389.21 $131.62 $129.46 $131.62 $138.20 $493.50 $131.62 $131.62 $131.62 $329.00 $329.00 $521.14 $131.62 $526.40 $427.70 $130.60 $131.62 $381.64 $138.20 $190.41 $131.62 $658.00 $131.62 N/A N/A 91400024 EAP CPT® 90834 INDIVIDUAL PSYCHOTHERAPY 45 MIN BOTH IP/OP $541.00 $400.50 $88.12 $541.00 $293.76 $293.76 $293.76 $293.76 $131.62 $131.62 $131.03 $112.76 $131.62 $401.53 $401.53 $417.00 $281.86 $112.75 $210.59 $210.20 $320.00 $131.62 $88.12 $131.62 $138.20 $405.75 $131.62 $131.62 $131.62 $270.50 $270.50 $428.47 $131.62 $432.80 $351.65 $107.37 $131.62 $313.78 $138.20 $190.41 $131.62 $541.00 $131.62 N/A N/A 91400061 EAP CPT® 90833 PSYCHOTHERAPY W/PAT W/E&M SRVCS 30 MIN (ADD-ON) BOTH IP/OP $382.00 $283.00 $62.03 $382.00 $382.00 $382.00 $382.00 $382.00 $382.00 $382.00 $382.00 $69.65 $382.00 $382.00 $382.00 $382.00 $382.00 $382.00 $382.00 $382.00 $382.00 $382.00 $62.03 $382.00 $382.00 $286.50 $382.00 $382.00 $382.00 $382.00 $382.00 $382.00 $382.00 $382.00 $248.30 $382.00 $382.00 $221.56 $382.00 $382.00 $382.00 $382.00 $382.00 N/A N/A 91400062 EAP CPT® 90836 INDIVIDUAL COUNSELING 45 MIN ADD ON BOTH IP/OP $541.00 $400.50 $78.64 $541.00 $541.00 $541.00 $541.00 $541.00 $80.00 $80.00 $80.03 $541.00 $80.00 $401.53 $401.53 $417.00 $281.86 $112.75 $128.00 $125.82 $541.00 $80.00 $78.64 $80.00 $541.00 $405.75 $80.00 $80.00 $80.00 $270.50 $270.50 $428.47 $80.00 $432.80 $351.65 $541.00 $80.00 $313.78 $541.00 $84.05 $80.00 $541.00 $80.00 N/A N/A 91400063 EAP CPT® 90838 "PSYCHOTHERAPY, 60MIN W/PAT AND OR FAM W E/M(ADD-ON)" BOTH IP/OP $658.00 $487.00 $104.40 $658.00 $658.00 $658.00 $658.00 $658.00 $105.88 $105.88 $106.41 $658.00 $105.88 $488.37 $488.37 $507.19 $342.82 $137.13 $169.41 $167.04 $658.00 $105.88 $104.40 $105.88 $658.00 $493.50 $105.88 $105.88 $105.88 $329.00 $329.00 $521.14 $105.88 $526.40 $427.70 $658.00 $105.88 $381.64 $658.00 $110.39 $105.88 $658.00 $105.88 N/A N/A 91400071 EAP CPT® 90839 PSYCHOTHERAPY FOR CRISIS FIRST 60 MINUTES BOTH IP/OP $682.00 $505.00 $125.07 $682.00 $370.33 $370.33 $370.33 $370.33 $131.62 $131.62 $131.03 $142.15 $131.62 $506.18 $506.18 $525.69 $355.32 $142.14 $210.59 $210.20 $403.40 $131.62 $125.07 $131.62 $138.20 $511.50 $131.62 $131.62 $131.62 $341.00 $341.00 $540.14 $131.62 $545.60 $443.30 $135.36 $131.62 $395.56 $138.20 $190.41 $131.62 $682.00 $131.62 N/A N/A 91400072 EAP CPT® 90840 PSYCHOTHERAPY FOR CRISIS; ADDL 30 MIN BOTH IP/OP $218.00 $161.50 $45.43 $218.00 $218.00 $218.00 $218.00 $218.00 $63.98 $63.98 $60.53 $218.00 $63.98 $161.80 $161.80 $168.03 $113.58 $45.43 $102.37 $100.35 $218.00 $63.98 $62.72 $63.98 $218.00 $163.50 $63.98 $63.98 $63.98 $109.00 $109.00 $172.66 $63.98 $174.40 $141.70 $218.00 $63.98 $126.44 $218.00 $63.85 $63.98 $218.00 $63.98 N/A N/A 91500001 EAP CPT® 90853 PSY GROUP THERAPY BOTH IP/OP $247.00 $183.00 $23.39 $247.00 $134.12 $134.12 $134.12 $134.12 $73.60 $73.60 $73.28 $51.48 $73.60 $183.32 $183.32 $190.39 $128.69 $51.48 $117.77 $109.43 $146.10 $73.60 $23.39 $73.60 $77.28 $185.25 $73.60 $73.60 $73.60 $123.50 $123.50 $195.62 $73.60 $197.60 $160.55 $49.02 $73.60 $143.26 $77.28 $106.49 $73.60 $247.00 $73.60 N/A N/A 91500006 EAP HCPCS H2014 GROUP SKILLS TRAINING 15MINS BOTH IP/OP $17.00 $13.00 $3.37 $17.00 $9.23 $9.23 $9.23 $9.23 $17.00 $17.00 $17.00 $3.54 $17.00 $12.62 $12.62 $13.10 $8.86 $3.54 $17.00 $6.80 $10.06 $17.00 $17.00 $17.00 $17.00 $12.75 $17.00 $17.00 $17.00 $8.50 $8.50 $13.46 $17.00 $13.60 $11.05 $3.37 $17.00 $9.86 $17.00 $10.20 $17.00 $17.00 $17.00 N/A N/A 91600001 EAP CPT® 90846 FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MIN BOTH IP/OP "$1,054.00" $780.00 $95.24 "$1,054.00" $572.32 $572.32 $572.32 $572.32 $131.62 $131.62 $131.03 $219.68 $131.62 $782.28 $782.28 $812.42 $549.13 $219.67 $210.59 $210.20 $623.44 $131.62 $95.24 $131.62 $138.20 $790.50 $131.62 $131.62 $131.62 $527.00 $527.00 $834.77 $131.62 $843.20 $685.10 $209.19 $131.62 $611.32 $138.20 $190.41 $131.62 "$1,054.00" $131.62 N/A N/A 91600009 EAP CPT® 90847 PSY FAMILY THERAPY W PT BOTH IP/OP "$1,054.00" $780.00 $99.30 "$1,054.00" $572.32 $572.32 $572.32 $572.32 $131.62 $131.62 $131.03 $219.68 $131.62 $782.28 $782.28 $812.42 $549.13 $219.67 $210.59 $210.20 $623.44 $131.62 $99.30 $131.62 $138.20 $790.50 $131.62 $131.62 $131.62 $527.00 $527.00 $834.77 $131.62 $843.20 $685.10 $209.19 $131.62 $611.32 $138.20 $190.41 $131.62 "$1,054.00" $131.62 N/A N/A 91600010 EAP CPT® 90849 MULTIPLE FAMILY GROUP THERAPY BOTH IP/OP $258.00 $191.00 $28.18 $258.00 $258.00 $258.00 $258.00 $258.00 $28.30 $28.30 $28.18 $258.00 $28.30 $191.49 $191.49 $198.87 $134.42 $53.77 $45.28 $46.08 $258.00 $28.30 $28.80 $28.30 $258.00 $193.50 $28.30 $28.30 $28.30 $129.00 $129.00 $204.34 $28.30 $206.40 $167.70 $258.00 $28.30 $149.64 $258.00 $29.58 $28.30 $258.00 $28.30 N/A N/A 91600012 EAP HCPCS H2014 GROUP OUTPATIENT SERVICES BOTH IP/OP $72.00 $53.50 $14.29 $72.00 $39.10 $39.10 $39.10 $39.10 $72.00 $72.00 $72.00 $15.01 $72.00 $53.44 $53.44 $55.50 $37.51 $15.01 $72.00 $28.80 $42.59 $72.00 $72.00 $72.00 $72.00 $54.00 $72.00 $72.00 $72.00 $36.00 $36.00 $57.02 $72.00 $57.60 $46.80 $14.29 $72.00 $41.76 $72.00 $43.20 $72.00 $72.00 $72.00 N/A N/A 91600013 EAP HCPCS H2014 GROUP OUTPATIENT SERVICES BOTH IP/OP $72.00 $53.50 $14.29 $72.00 $39.10 $39.10 $39.10 $39.10 $72.00 $72.00 $72.00 $15.01 $72.00 $53.44 $53.44 $55.50 $37.51 $15.01 $72.00 $28.80 $42.59 $72.00 $72.00 $72.00 $72.00 $54.00 $72.00 $72.00 $72.00 $36.00 $36.00 $57.02 $72.00 $57.60 $46.80 $14.29 $72.00 $41.76 $72.00 $43.20 $72.00 $72.00 $72.00 N/A N/A 91800005 EAP CPT® 96110 "NICU/PED/DEVELOP.TESTING,LIMI" BOTH IP/OP $192.00 $142.50 $10.07 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $10.07 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $76.80 $192.00 $192.00 $192.00 $192.00 $192.00 $144.00 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $124.80 $192.00 $192.00 $111.36 $192.00 $115.20 $192.00 $192.00 $192.00 N/A N/A 91800013 EAP CPT® 96125 COGNITIVE TESTING BOTH IP/OP $702.00 $519.50 $146.30 $702.00 $702.00 $702.00 $702.00 $702.00 $702.00 $702.00 $702.00 $702.00 $702.00 $444.74 $444.74 $461.84 $312.17 $146.30 $702.00 $160.00 $702.00 $702.00 $342.00 $702.00 $702.00 $526.50 $702.00 $702.00 $702.00 $351.00 $351.00 $555.98 $702.00 $561.60 $702.00 $702.00 $702.00 $407.16 $702.00 $702.00 $702.00 $702.00 $702.00 N/A N/A 91800017 EAP CPT® 96125 COGNITIVE TESTING_52 BOTH IP/OP $353.00 $261.50 $73.57 $461.84 $353.00 $353.00 $353.00 $353.00 $353.00 $353.00 $353.00 $353.00 $353.00 $444.74 $444.74 $461.84 $312.17 $73.57 $353.00 $160.00 $353.00 $353.00 $342.00 $353.00 $353.00 $264.75 $353.00 $353.00 $353.00 $176.50 $176.50 $279.58 $353.00 $282.40 $353.00 $353.00 $353.00 $204.74 $353.00 $353.00 $353.00 $353.00 $353.00 N/A N/A 91800019 EAP CPT® 96130 PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR BOTH IP/OP $568.00 $420.50 $108.12 $568.00 $568.00 $568.00 $568.00 $568.00 $108.96 $108.96 $108.12 $568.00 $108.96 $421.57 $421.57 $437.81 $295.93 $118.38 $174.34 $174.06 $568.00 $108.96 $108.79 $108.96 $568.00 $426.00 $108.96 $108.96 $108.96 $284.00 $284.00 $449.86 $108.96 $454.40 $369.20 $568.00 $108.96 $329.44 $568.00 $111.11 $108.96 $568.00 $108.96 N/A N/A 91800020 EAP CPT® 96131 PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR BOTH IP/OP $300.00 $222.00 $62.52 $300.00 $300.00 $300.00 $300.00 $300.00 $79.97 $79.97 $81.33 $300.00 $79.97 $222.66 $222.66 $231.24 $156.30 $62.52 $127.95 $122.54 $300.00 $79.97 $76.59 $79.97 $300.00 $225.00 $79.97 $79.97 $79.97 $150.00 $150.00 $237.60 $79.97 $240.00 $195.00 $300.00 $79.97 $174.00 $300.00 $85.50 $79.97 $300.00 $79.97 N/A N/A 91800021 EAP CPT® 96112 DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR BOTH IP/OP $699.00 $517.50 $125.39 $699.00 $699.00 $699.00 $699.00 $699.00 $127.23 $127.23 $128.91 $699.00 $127.23 $518.80 $518.80 $538.79 $364.18 $145.68 $203.57 $200.62 $699.00 $127.23 $125.39 $127.23 $699.00 $524.25 $127.23 $127.23 $127.23 $349.50 $349.50 $553.61 $127.23 $559.20 $454.35 $699.00 $127.23 $405.42 $699.00 $131.28 $127.23 $699.00 $127.23 N/A N/A 91800022 EAP CPT® 96113 DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN BOTH IP/OP $300.00 $222.00 $54.24 $300.00 $300.00 $300.00 $300.00 $300.00 $56.84 $56.84 $54.24 $300.00 $56.84 $222.66 $222.66 $231.24 $156.30 $62.52 $90.94 $90.02 $300.00 $56.84 $56.26 $56.84 $300.00 $225.00 $56.84 $56.84 $56.84 $150.00 $150.00 $237.60 $56.84 $240.00 $195.00 $300.00 $56.84 $174.00 $300.00 $59.51 $56.84 $300.00 $56.84 N/A N/A 91800023 EAP CPT® 96116 NEUROBEHAVIORAL STATUS XM PHYS/QHP 1ST HOUR BOTH IP/OP $609.00 $451.00 $80.33 $487.20 $330.69 $330.69 $330.69 $330.69 $256.17 $256.17 $255.04 $126.93 $256.17 $452.00 $452.00 $469.42 $317.29 $126.92 $409.87 $386.95 $360.22 $256.17 $80.33 $256.17 $268.98 $456.75 $256.17 $256.17 $256.17 $304.50 $304.50 $482.33 $256.17 $487.20 $395.85 $120.87 $256.17 $353.22 $268.98 $370.62 $256.17 $126.92 $256.17 N/A N/A 91800024 EAP CPT® 96121 NEUROBEHAVIORAL STATUS XM PHYS/QHP EA ADDL HOUR BOTH IP/OP $300.00 $222.00 $62.52 $300.00 $300.00 $300.00 $300.00 $300.00 $71.35 $71.35 $74.00 $300.00 $71.35 $222.66 $222.66 $231.24 $156.30 $62.52 $114.16 $107.36 $300.00 $71.35 $67.10 $71.35 $300.00 $225.00 $71.35 $71.35 $71.35 $150.00 $150.00 $237.60 $71.35 $240.00 $195.00 $300.00 $71.35 $174.00 $300.00 $80.08 $71.35 $300.00 $71.35 N/A N/A 91800025 EAP CPT® 96132 NEUROPSYCHOL TST EVAL PHYS/QHP 1ST HOUR BOTH IP/OP $329.00 $243.50 $65.30 $409.87 $178.65 $178.65 $178.65 $178.65 $256.17 $256.17 $255.04 $68.57 $256.17 $244.18 $244.18 $253.59 $171.41 $68.57 $409.87 $386.95 $194.60 $256.17 $106.09 $256.17 $268.98 $246.75 $256.17 $256.17 $256.17 $164.50 $164.50 $260.57 $256.17 $263.20 $213.85 $65.30 $256.17 $190.82 $268.98 $329.00 $256.17 $68.56 $256.17 N/A N/A 91800026 EAP CPT® 96133 NEUROPSYCHOL TST EVAL PHYSL/QPH EA ADDL HR BOTH IP/OP $165.00 $122.50 $34.39 $165.00 $165.00 $165.00 $165.00 $165.00 $79.31 $79.31 $79.69 $165.00 $79.31 $122.46 $122.46 $127.18 $85.97 $34.39 $126.90 $122.54 $165.00 $79.31 $76.59 $79.31 $165.00 $123.75 $79.31 $79.31 $79.31 $82.50 $82.50 $130.68 $79.31 $132.00 $107.25 $165.00 $79.31 $95.70 $165.00 $84.42 $79.31 $165.00 $79.31 N/A N/A 91800027 EAP CPT® 96138 PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN BOTH IP/OP $41.00 $30.50 $8.14 $409.87 $22.26 $22.26 $22.26 $22.26 $256.17 $256.17 $255.04 $8.55 $256.17 $30.43 $30.43 $31.60 $21.36 $8.54 $409.87 $386.95 $24.25 $256.17 $34.16 $256.17 $268.98 $30.75 $256.17 $256.17 $256.17 $20.50 $20.50 $32.47 $256.17 $32.80 $26.65 $8.14 $256.17 $23.78 $268.98 $41.00 $256.17 $8.54 $256.17 N/A N/A 91800028 EAP CPT® 96139 PSYCL/NRPSYC TST TECH 2+ TST EA ADDL 30 MIN BOTH IP/OP $20.00 $15.00 $3.97 $35.18 $10.86 $10.86 $10.86 $10.86 $20.00 $20.00 $20.00 $4.17 $20.00 $14.84 $14.84 $15.42 $10.42 $4.17 $20.00 $20.00 $11.83 $20.00 $35.18 $20.00 $20.00 $15.00 $20.00 $20.00 $20.00 $10.00 $10.00 $15.84 $20.00 $16.00 $13.00 $3.97 $20.00 $11.60 $20.00 $20.00 $20.00 $4.17 $20.00 N/A N/A 91800029 EAP CPT® 96136 PSYCL/NRPSYCL TST PHY/QHP TST 1ST 30 MIN BOTH IP/OP $55.00 $41.00 $10.92 $177.47 $29.87 $29.87 $29.87 $29.87 $110.92 $110.92 $110.43 $11.46 $110.92 $40.82 $40.82 $42.39 $28.66 $11.46 $177.47 $167.51 $32.53 $110.92 $23.38 $110.92 $116.46 $41.25 $110.92 $110.92 $110.92 $27.50 $27.50 $43.56 $110.92 $44.00 $35.75 $10.92 $110.92 $31.90 $116.46 $55.00 $110.92 $11.46 $110.92 N/A N/A 91800030 EAP CPT® 96137 PSYCL/NRPSYCL TST PHY/QHP TST ADDL 30 MIN BOTH IP/OP $21.00 $16.00 $4.17 $21.00 $11.40 $11.40 $11.40 $11.40 $21.00 $21.00 $21.00 $4.38 $21.00 $15.59 $15.59 $16.19 $10.94 $4.38 $21.00 $21.00 $12.42 $21.00 $17.96 $21.00 $21.00 $15.75 $21.00 $21.00 $21.00 $10.50 $10.50 $16.63 $21.00 $16.80 $13.65 $4.17 $21.00 $12.18 $21.00 $21.00 $21.00 $4.38 $21.00 N/A N/A 91800031 EAP CPT® 96156 HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT BOTH IP/OP $189.00 $140.00 $37.51 $151.20 $102.63 $102.63 $102.63 $102.63 $73.60 $73.60 $73.28 $39.39 $73.60 $140.28 $140.28 $145.68 $98.47 $39.39 $117.77 $109.43 $111.79 $73.60 $84.39 $73.60 $77.28 $141.75 $73.60 $73.60 $73.60 $94.50 $94.50 $149.69 $73.60 $151.20 $122.85 $37.51 $73.60 $109.62 $77.28 $106.49 $73.60 $39.39 $73.60 N/A N/A 91800032 EAP CPT® 96158 HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN BOTH IP/OP $189.00 $140.00 $39.39 $189.00 $189.00 $189.00 $189.00 $189.00 $59.28 $59.28 $58.79 $189.00 $59.28 $140.28 $140.28 $145.68 $98.47 $39.39 $94.85 $91.65 $189.00 $59.28 $57.28 $59.28 $189.00 $141.75 $59.28 $59.28 $59.28 $94.50 $94.50 $149.69 $59.28 $151.20 $122.85 $189.00 $59.28 $109.62 $189.00 $61.69 $59.28 $189.00 $59.28 N/A N/A 92000001 EAP CPT® 51725 "CYSTOMETROGRAM, SIMPLE" BOTH IP/OP "$1,683.00" "$1,245.50" $139.03 "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" $161.91 $161.91 $233.21 "$1,683.00" $161.91 "$1,249.12" "$1,249.12" "$1,297.26" $876.84 $350.76 $259.06 $250.02 "$1,683.00" $161.91 $156.26 $161.91 "$1,683.00" "$1,262.25" $161.91 $161.91 $161.91 "$1,683.00" $841.50 "$1,332.94" $161.91 "$1,346.40" "$1,683.00" "$1,683.00" $161.91 $976.14 "$1,683.00" $139.03 $161.91 "$1,683.00" $161.91 N/A N/A 92000002 EAP CPT® 51726 "CYSTOMETROGRAM, COMPLEX" BOTH IP/OP "$1,649.00" "$1,220.50" $208.90 "$1,649.00" "$1,649.00" "$1,649.00" "$1,649.00" "$1,649.00" $229.95 $229.95 $313.67 "$1,649.00" $229.95 "$1,223.89" "$1,223.89" "$1,271.05" $859.13 $343.67 $367.92 $354.45 "$1,649.00" $229.95 $221.53 $229.95 "$1,649.00" "$1,236.75" $229.95 $229.95 $229.95 "$1,649.00" $824.50 "$1,306.01" $229.95 "$1,319.20" "$1,649.00" "$1,649.00" $229.95 $956.42 "$1,649.00" $208.90 $229.95 "$1,649.00" $229.95 N/A N/A 92000003 EAP CPT® 51736 UROFLOWMETRY SIMPLE BOTH IP/OP $293.00 $217.00 $5.15 $293.00 $293.00 $293.00 $293.00 $293.00 $5.15 $5.15 $13.53 $293.00 $5.15 $217.46 $217.46 $225.84 $152.65 $61.06 $8.24 $8.67 $293.00 $5.15 $5.42 $5.15 $293.00 $219.75 $5.15 $5.15 $5.15 $293.00 $146.50 $232.06 $5.15 $234.40 $293.00 $293.00 $5.15 $169.94 $293.00 $5.40 $5.15 $293.00 $5.15 N/A N/A 92000004 EAP CPT® 51741 "UROFLOWMETRY, COMPLEX" BOTH IP/OP $277.00 $205.00 $5.76 $277.00 $150.41 $150.41 $150.41 $150.41 $137.34 $137.34 $136.73 $57.73 $137.34 $205.59 $205.59 $213.51 $144.32 $57.73 $219.74 $209.80 $113.00 $137.34 $5.76 $137.34 $144.20 $207.75 $137.34 $137.34 $137.34 $277.00 $138.50 $219.38 $137.34 $221.60 $277.00 $54.98 $137.34 $160.66 $144.20 $198.69 $137.34 $57.73 $137.34 N/A N/A 92000007 EAP CPT® 51797 INTRA-ABDOMINAL PRESSURE TEST BOTH IP/OP $460.00 $340.50 $91.30 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $95.88 $460.00 $341.41 $341.41 $354.57 $239.66 $95.87 $460.00 $460.00 $272.09 $460.00 $155.91 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $460.00 $230.00 $364.32 $460.00 $368.00 $460.00 $91.30 $460.00 $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A 92000009 EAP CPT® 59020 FETAL CONTRACTION STRESS TEST BOTH IP/OP "$2,603.00" "$1,926.50" $33.50 "$2,603.00" "$2,603.00" "$2,603.00" "$2,603.00" "$2,603.00" $34.16 $34.16 $71.22 "$2,603.00" $34.16 "$1,931.95" "$1,931.95" "$2,006.39" "$1,356.16" $542.49 $54.66 $54.66 "$2,603.00" $34.16 $34.16 $34.16 "$2,603.00" "$1,952.25" $34.16 $34.16 $34.16 "$2,603.00" "$1,301.50" "$2,061.58" $34.16 "$2,082.40" "$1,750.00" "$2,603.00" $34.16 "$1,509.74" "$2,603.00" $33.50 $34.16 "$2,603.00" $34.16 N/A N/A 92000010 EAP CPT® 59025 FETAL NON STRESS TEST BOTH IP/OP $427.00 $316.00 $20.30 $427.00 $231.86 $231.86 $231.86 $231.86 $167.58 $167.58 $166.84 $89.00 $167.58 $316.92 $316.92 $329.13 $222.47 $88.99 $268.13 $256.98 $252.57 $167.58 $20.30 $167.58 $175.96 $320.25 $167.58 $167.58 $167.58 $427.00 $213.50 $338.18 $167.58 $341.60 $427.00 $84.75 $167.58 $247.66 $175.96 $242.45 $167.58 $88.99 $167.58 N/A N/A 92000011 EAP CPT® 92081 VISION SCREEN BOTH IP/OP $267.00 $198.00 $17.59 $213.60 $144.98 $144.98 $144.98 $144.98 $54.76 $54.76 $54.51 $55.65 $54.76 $198.17 $198.17 $205.80 $139.11 $55.65 $87.61 $82.92 $157.93 $54.76 $17.59 $54.76 $57.49 $200.25 $54.76 $54.76 $54.76 $133.50 $133.50 $211.46 $54.76 $213.60 $173.55 $52.99 $54.76 $154.86 $57.49 $79.22 $54.76 $55.64 $54.76 N/A N/A 92000013 EAP CPT® 92081 VISUAL EXAM LIMITED-LT BOTH IP/OP $269.00 $199.50 $17.59 $215.20 $146.07 $146.07 $146.07 $146.07 $54.76 $54.76 $54.51 $56.07 $54.76 $199.65 $199.65 $207.35 $140.15 $56.06 $87.61 $82.92 $159.11 $54.76 $17.59 $54.76 $57.49 $201.75 $54.76 $54.76 $54.76 $134.50 $134.50 $213.05 $54.76 $215.20 $174.85 $53.39 $54.76 $156.02 $57.49 $79.22 $54.76 $56.06 $54.76 N/A N/A 92000014 EAP CPT® 92081 VISUAL FIELD EXAM UNILAT/BILAT BOTH IP/OP $529.00 $391.50 $17.59 $423.20 $287.25 $287.25 $287.25 $287.25 $54.76 $54.76 $54.51 $110.26 $54.76 $392.62 $392.62 $407.75 $275.61 $110.25 $87.61 $82.92 $312.90 $54.76 $17.59 $54.76 $57.49 $396.75 $54.76 $54.76 $54.76 $264.50 $264.50 $418.97 $54.76 $423.20 $343.85 $104.99 $54.76 $306.82 $57.49 $79.22 $54.76 $110.24 $54.76 N/A N/A 92000016 EAP CPT® 92081 VISUAL FIELD EXAM LIMITED-LT BOTH IP/OP $269.00 $199.50 $17.59 $215.20 $146.07 $146.07 $146.07 $146.07 $54.76 $54.76 $54.51 $56.07 $54.76 $199.65 $199.65 $207.35 $140.15 $56.06 $87.61 $82.92 $159.11 $54.76 $17.59 $54.76 $57.49 $201.75 $54.76 $54.76 $54.76 $134.50 $134.50 $213.05 $54.76 $215.20 $174.85 $53.39 $54.76 $156.02 $57.49 $79.22 $54.76 $56.06 $54.76 N/A N/A 92000017 EAP CPT® 92081 VISUAL FIELD EXAM LIMITED-RT BOTH IP/OP $269.00 $199.50 $17.59 $215.20 $146.07 $146.07 $146.07 $146.07 $54.76 $54.76 $54.51 $56.07 $54.76 $199.65 $199.65 $207.35 $140.15 $56.06 $87.61 $82.92 $159.11 $54.76 $17.59 $54.76 $57.49 $201.75 $54.76 $54.76 $54.76 $134.50 $134.50 $213.05 $54.76 $215.20 $174.85 $53.39 $54.76 $156.02 $57.49 $79.22 $54.76 $56.06 $54.76 N/A N/A 92000020 EAP CPT® 92082 VISUAL FIELD EXAM UNI/BIL INTERMED BOTH IP/OP $570.00 $422.00 $26.22 $570.00 $570.00 $570.00 $570.00 $570.00 $26.22 $26.22 $48.02 $570.00 $26.22 $423.05 $423.05 $439.36 $296.97 $118.79 $41.95 $42.22 $570.00 $26.22 $26.39 $26.22 $570.00 $427.50 $26.22 $26.22 $26.22 $285.00 $285.00 $451.44 $26.22 $456.00 $370.50 $570.00 $26.22 $330.60 $570.00 $26.29 $26.22 $570.00 $26.22 N/A N/A 92000028 EAP CPT® 92083 VISUAL FIELD EXAM UNI/BIL EXTENDED BOTH IP/OP $578.00 $428.00 $36.19 $462.40 $313.85 $313.85 $313.85 $313.85 $110.92 $110.92 $110.43 $120.47 $110.92 $428.99 $428.99 $445.52 $301.14 $120.46 $177.47 $167.51 $341.89 $110.92 $36.19 $110.92 $116.46 $433.50 $110.92 $110.92 $110.92 $289.00 $289.00 $457.78 $110.92 $462.40 $375.70 $114.72 $110.92 $335.24 $116.46 $160.47 $110.92 $120.46 $110.92 N/A N/A 92000032 EAP CPT® 92235 FLOURESCEIN ANGIOSCOPY W PHOTO BOTH IP/OP $959.00 $710.00 $96.39 $767.20 $520.74 $520.74 $520.74 $520.74 $260.33 $260.33 $259.18 $199.88 $260.33 $711.77 $711.77 $739.20 $499.64 $199.87 $416.53 $404.03 $567.25 $260.33 $96.39 $260.33 $273.35 $719.25 $260.33 $260.33 $260.33 $479.50 $479.50 $759.53 $260.33 $767.20 $623.35 $190.34 $260.33 $556.22 $273.35 $376.64 $260.33 $199.86 $260.33 N/A N/A 92000033 EAP CPT® 92235 FLOURESCEIN PHOTO W PHOTO BOTH BOTH IP/OP $960.00 $710.50 $96.39 $768.00 $521.28 $521.28 $521.28 $521.28 $260.33 $260.33 $259.18 $200.09 $260.33 $712.51 $712.51 $739.97 $500.16 $200.07 $416.53 $404.03 $567.84 $260.33 $96.39 $260.33 $273.35 $720.00 $260.33 $260.33 $260.33 $480.00 $480.00 $760.32 $260.33 $768.00 $624.00 $190.54 $260.33 $556.80 $273.35 $376.64 $260.33 $200.06 $260.33 N/A N/A 92000035 EAP CPT® 92250 OPHTHALMOSCOPY W/ FUNDUS PHOTO BOTH IP/OP $407.00 $301.50 $16.58 $325.60 $221.00 $221.00 $221.00 $221.00 $110.92 $110.92 $110.43 $84.83 $110.92 $302.08 $302.08 $313.72 $212.05 $84.82 $177.47 $167.51 $240.74 $110.92 $16.58 $110.92 $116.46 $305.25 $110.92 $110.92 $110.92 $203.50 $203.50 $322.34 $110.92 $325.60 $264.55 $80.78 $110.92 $236.06 $116.46 $160.47 $110.92 $84.82 $110.92 N/A N/A 92000036 EAP CPT® 92285 SLIT LAMP PHOTOGRAPHY BOTH IP/OP $159.00 $118.00 $20.30 $127.20 $86.34 $86.34 $86.34 $86.34 $54.76 $54.76 $54.51 $33.14 $54.76 $118.01 $118.01 $122.56 $82.84 $33.14 $87.61 $82.92 $94.05 $54.76 $20.30 $54.76 $57.49 $119.25 $54.76 $54.76 $54.76 $79.50 $79.50 $125.93 $54.76 $127.20 $103.35 $31.56 $54.76 $92.22 $57.49 $79.22 $54.76 $33.14 $54.76 N/A N/A 92000037 EAP CPT® 95810 POLYSOMNOGRAPHY BOTH IP/OP "$5,967.00" "$4,416.00" $496.55 "$4,773.60" "$1,527.91" "$1,527.91" "$1,527.91" "$1,527.91" $904.99 $904.99 $900.99 "$1,243.67" $904.99 "$3,372.63" "$3,372.63" "$3,502.34" "$2,367.32" "$1,243.59" "$1,447.99" "$1,348.00" "$3,094.73" $904.99 $496.55 $904.99 $950.24 "$4,475.25" $904.99 $904.99 $904.99 "$2,983.50" "$2,983.50" "$4,725.86" $904.99 "$4,773.60" "$3,878.55" "$1,184.30" $904.99 "$3,460.86" $950.24 "$1,309.30" $904.99 "$1,243.52" $904.99 N/A N/A 92000038 EAP CPT® 95811 POLYSOMNOGRAPHY W/CPAP BOTH IP/OP "$7,160.00" "$5,298.50" $520.58 "$5,728.00" "$1,605.23" "$1,605.23" "$1,605.23" "$1,605.23" $904.99 $904.99 $900.99 "$1,492.32" $904.99 "$2,890.83" "$2,890.83" "$3,002.01" "$2,029.14" "$1,492.22" "$1,447.99" "$1,348.00" "$3,094.73" $904.99 $520.58 $904.99 $950.24 "$5,370.00" $904.99 $904.99 $904.99 "$3,580.00" "$3,580.00" "$5,670.72" $904.99 "$5,728.00" "$4,654.00" "$1,421.08" $904.99 "$4,152.80" $950.24 "$1,309.30" $904.99 "$1,492.14" $904.99 N/A N/A 92000039 EAP CPT® 95857 TENSILON TEST BOTH IP/OP $257.00 $190.50 $28.47 $257.00 $257.00 $257.00 $257.00 $257.00 $28.92 $28.92 $29.85 $257.00 $28.92 $190.75 $190.75 $198.10 $133.90 $53.56 $46.27 $45.55 $257.00 $28.92 $28.47 $28.92 $257.00 $192.75 $28.92 $28.92 $28.92 $128.50 $128.50 $203.54 $28.92 $205.60 $167.05 $257.00 $28.92 $149.06 $257.00 $31.01 $28.92 $257.00 $28.92 N/A N/A 92000041 EAP CPT® 95970 ANALYZE NEUROSTIM NO PROG BOTH IP/OP $345.00 $255.50 $18.65 $345.00 $345.00 $345.00 $345.00 $345.00 $18.89 $18.89 $19.05 $345.00 $18.89 $256.06 $256.06 $265.93 $179.75 $71.90 $30.22 $29.84 $345.00 $18.89 $18.65 $18.89 $345.00 $258.75 $18.89 $18.89 $18.89 $172.50 $172.50 $273.24 $18.89 $276.00 $224.25 $345.00 $18.89 $200.10 $345.00 $19.47 $18.89 $345.00 $18.89 N/A N/A 92000050 EAP CPT® 95972 "COMPLEX PROGRAMMING, UP TO 1 HR" BOTH IP/OP $443.00 $328.00 $40.70 $443.00 $443.00 $443.00 $443.00 $443.00 $40.86 $40.86 $41.55 $443.00 $40.86 $328.79 $328.79 $341.46 $230.80 $92.33 $65.38 $65.12 $443.00 $40.86 $40.70 $40.86 $443.00 $332.25 $40.86 $40.86 $40.86 $221.50 $221.50 $350.86 $40.86 $354.40 $287.95 $443.00 $40.86 $256.94 $443.00 $42.91 $40.86 $443.00 $40.86 N/A N/A 92000054 EAP CPT® 51728 CYSTOMETROGRAM W/VP BOTH IP/OP $790.00 $585.00 $164.64 $790.00 $790.00 $790.00 $790.00 $790.00 $278.30 $278.30 $380.84 $790.00 $278.30 $586.34 $586.34 $608.93 $411.59 $164.64 $445.28 $427.50 $790.00 $278.30 $267.19 $278.30 $790.00 $592.50 $278.30 $278.30 $278.30 $790.00 $395.00 $625.68 $278.30 $632.00 $790.00 $790.00 $278.30 $458.20 $790.00 $251.40 $278.30 $790.00 $278.30 N/A N/A 92000055 EAP CPT® 95873 GUIDE NERV DESTR ELEC STIM BOTH IP/OP $168.00 $124.50 $33.34 $168.00 $91.22 $91.22 $91.22 $91.22 $168.00 $168.00 $168.00 $35.02 $168.00 $124.69 $124.69 $129.49 $87.53 $35.01 $168.00 $168.00 $99.37 $168.00 $53.43 $168.00 $168.00 $126.00 $168.00 $58.71 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $109.20 $33.34 $168.00 $97.44 $168.00 $168.00 $168.00 $35.01 $168.00 N/A N/A 92000056 EAP CPT® 95874 GUIDE NERV DESTR NEEDLE EMG BOTH IP/OP $197.00 $146.00 $39.10 $235.00 $106.97 $106.97 $106.97 $106.97 $197.00 $197.00 $197.00 $41.06 $197.00 $146.21 $146.21 $151.85 $102.64 $41.06 $197.00 $235.00 $116.53 $197.00 $58.85 $197.00 $197.00 $147.75 $197.00 $197.00 $197.00 $98.50 $98.50 $156.02 $197.00 $157.60 $128.05 $39.10 $197.00 $114.26 $197.00 $197.00 $197.00 $41.05 $197.00 N/A N/A 92000057 EAP CPT® 95971 ANALYZE NEUROSTIM SIMPLE BOTH IP/OP $375.00 $277.50 $38.99 $375.00 $375.00 $375.00 $375.00 $375.00 $40.20 $40.20 $40.25 $375.00 $40.20 $278.33 $278.33 $289.05 $195.38 $78.15 $64.32 $62.38 $375.00 $40.20 $38.99 $40.20 $375.00 $281.25 $40.20 $40.20 $40.20 $187.50 $187.50 $297.00 $40.20 $300.00 $243.75 $375.00 $40.20 $217.50 $375.00 $42.19 $40.20 $375.00 $40.20 N/A N/A 92000058 EAP CPT® 91200 LIVER ELASTOGRAPHY BOTH IP/OP $305.00 $226.00 $20.30 $244.00 $165.62 $165.62 $165.62 $165.62 $137.34 $137.34 $136.73 $63.57 $137.34 $226.37 $226.37 $235.09 $158.91 $63.57 $219.74 $209.80 $180.41 $137.34 $20.30 $137.34 $144.20 $228.75 $137.34 $137.34 $137.34 $152.50 $152.50 $241.56 $137.34 $244.00 $198.25 $60.53 $137.34 $176.90 $144.20 $198.69 $137.34 $63.56 $137.34 N/A N/A 92000059 EAP CPT® 92132 CMPTR OPHTHALMIC DX IMG ANT SEGMT W/I&R UNI/BI BOTH IP/OP $210.00 $155.50 $15.56 $168.00 $114.03 $114.03 $114.03 $114.03 $54.76 $54.76 $54.51 $43.77 $54.76 $155.86 $155.86 $161.87 $109.41 $43.77 $87.61 $82.92 $124.22 $54.76 $15.56 $54.76 $57.49 $157.50 $54.76 $54.76 $54.76 $105.00 $105.00 $166.32 $54.76 $168.00 $136.50 $41.68 $54.76 $121.80 $57.49 $79.22 $54.76 $43.76 $54.76 N/A N/A 92000060 EAP CPT® 92240 ICG ANGIOGRAPHY - ONE EYE BOTH IP/OP $940.00 $696.00 $145.43 $940.00 $940.00 $940.00 $940.00 $940.00 $149.86 $149.86 $206.36 $940.00 $149.86 $697.67 $697.67 $724.55 $489.74 $195.91 $239.78 $232.69 $940.00 $149.86 $145.43 $149.86 $940.00 $705.00 $149.86 $149.86 $149.86 $470.00 $470.00 $744.48 $149.86 $752.00 $611.00 $940.00 $149.86 $545.20 $940.00 $156.68 $149.86 $940.00 $149.86 N/A N/A 92000061 EAP CPT® 92240 ICG ANGIOGRAPHY - BOTH EYES BOTH IP/OP "$1,410.00" "$1,043.50" $145.43 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $149.86 $149.86 $206.36 "$1,410.00" $149.86 "$1,046.50" "$1,046.50" "$1,086.83" $734.61 $293.86 $239.78 $232.69 "$1,410.00" $149.86 $145.43 $149.86 "$1,410.00" "$1,057.50" $149.86 $149.86 $149.86 $705.00 $705.00 "$1,116.72" $149.86 "$1,128.00" $916.50 "$1,410.00" $149.86 $817.80 "$1,410.00" $156.68 $149.86 "$1,410.00" $149.86 N/A N/A 92000062 EAP CPT® 92060 SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX BOTH IP/OP $200.00 $148.00 $25.93 $200.00 $200.00 $200.00 $200.00 $200.00 $26.56 $26.56 $64.06 $200.00 $26.56 $148.44 $148.44 $154.16 $104.20 $41.68 $42.50 $43.30 $200.00 $26.56 $27.06 $26.56 $200.00 $150.00 $26.56 $26.56 $26.56 $100.00 $100.00 $158.40 $26.56 $160.00 $130.00 $200.00 $26.56 $116.00 $200.00 $25.93 $26.56 $200.00 $26.56 N/A N/A 92000065 EAP CPT® 92283 COLOR VISION EXAMINATION BOTH IP/OP $198.00 $147.00 $39.30 $158.40 $107.51 $107.51 $107.51 $107.51 $54.76 $54.76 $54.51 $41.27 $54.76 $146.96 $146.96 $152.62 $103.16 $41.27 $87.61 $82.92 $117.12 $54.76 $45.66 $54.76 $57.49 $148.50 $54.76 $54.76 $54.76 $99.00 $99.00 $156.82 $54.76 $158.40 $128.70 $39.30 $54.76 $114.84 $57.49 $79.22 $54.76 $41.26 $54.76 N/A N/A 92000066 EAP CPT® 95976 ELEC ALYS IMPLT SMPL CN NPGT PRGRMG BOTH IP/OP $554.00 $410.00 $35.56 $554.00 $554.00 $554.00 $554.00 $554.00 $40.20 $40.20 $39.90 $554.00 $40.20 $411.18 $411.18 $427.02 $288.63 $115.46 $64.32 $62.37 $554.00 $40.20 $38.98 $40.20 $554.00 $415.50 $40.20 $40.20 $40.20 $277.00 $277.00 $438.77 $40.20 $443.20 $360.10 $554.00 $40.20 $321.32 $554.00 $35.56 $40.20 $554.00 $40.20 N/A N/A 92000067 EAP CPT® 95977 ELEC ALYS IMPLT CPLX CN NPGT PRGRMG BOTH IP/OP $554.00 $410.00 $52.21 $554.00 $554.00 $554.00 $554.00 $554.00 $52.93 $52.93 $53.37 $554.00 $52.93 $411.18 $411.18 $427.02 $288.63 $115.46 $84.69 $83.54 $554.00 $52.93 $52.21 $52.93 $554.00 $415.50 $52.93 $52.93 $52.93 $277.00 $277.00 $438.77 $52.93 $443.20 $360.10 $554.00 $52.93 $321.32 $554.00 $54.81 $52.93 $554.00 $52.93 N/A N/A 92000068 EAP CPT® 0509T ELECTRORETINOGRAPHY (ERG) W/I&R PATTERN (PERG) BOTH IP/OP $327.00 $242.00 $54.88 $327.00 $327.00 $327.00 $327.00 $327.00 $54.88 $54.88 $78.66 $327.00 $54.88 $242.70 $242.70 $252.05 $170.37 $68.15 $87.81 $88.21 $327.00 $54.88 $55.13 $54.88 $327.00 $245.25 $54.88 $54.88 $54.88 $163.50 $163.50 $258.98 $54.88 $261.60 $212.55 $327.00 $54.88 $189.66 $327.00 $56.19 $54.88 $327.00 $54.88 N/A N/A 92000069 EAP CPT® 92273 "ELECTRORETINOGRAPHY (ERG), W/I&R; FULL FIELD" BOTH IP/OP $606.00 $448.50 $91.66 $606.00 $606.00 $606.00 $606.00 $606.00 $92.15 $92.15 $133.32 $606.00 $92.15 $449.77 $449.77 $467.10 $315.73 $126.30 $147.44 $146.66 $606.00 $92.15 $91.66 $92.15 $606.00 $454.50 $92.15 $92.15 $92.15 $606.00 $303.00 $479.95 $92.15 $484.80 $393.90 $606.00 $92.15 $351.48 $606.00 $94.72 $92.15 $606.00 $92.15 N/A N/A 92000070 EAP CPT® 92274 "ELECTRORETINOGRAPHY (ERG), W/I&R; MULTIFOCAL (MFERG)" BOTH IP/OP $327.00 $242.00 $55.57 $327.00 $327.00 $327.00 $327.00 $327.00 $55.57 $55.57 $90.52 $327.00 $55.57 $242.70 $242.70 $252.05 $170.37 $68.15 $88.91 $90.91 $327.00 $55.57 $56.82 $55.57 $327.00 $245.25 $55.57 $55.57 $55.57 $163.50 $163.50 $258.98 $55.57 $261.60 $212.55 $327.00 $55.57 $189.66 $327.00 $56.19 $55.57 $327.00 $55.57 N/A N/A 92000071 EAP CPT® 95249 CONT GLUC MNTR PT PROV EQP BOTH IP/OP $155.00 $115.00 $32.30 $155.00 $155.00 $155.00 $155.00 $155.00 $59.62 $59.62 $58.37 $155.00 $59.62 $115.04 $115.04 $119.47 $80.76 $32.30 $95.39 $98.53 $155.00 $59.62 $61.58 $59.62 $155.00 $116.25 $59.62 $59.62 $59.62 $155.00 $77.50 $122.76 $59.62 $124.00 $100.75 $155.00 $59.62 $89.90 $155.00 $55.46 $59.62 $155.00 $59.62 N/A N/A 92000072 EAP CPT® 95250 CONT GLUC MNTR PHYS/QHP PROV EQP BOTH IP/OP $302.00 $223.50 $59.94 $241.60 $163.99 $163.99 $163.99 $163.99 $116.88 $116.88 $116.36 $62.94 $116.88 $224.14 $224.14 $232.78 $157.34 $62.94 $187.01 $174.36 $178.63 $116.88 $146.80 $116.88 $122.72 $226.50 $116.88 $116.88 $116.88 $151.00 $151.00 $239.18 $116.88 $241.60 $196.30 $59.94 $116.88 $175.16 $122.72 $169.10 $116.88 $62.94 $116.88 N/A N/A 92000073 EAP HCPCS G0399 HOME SLEEP STUDY BOTH IP/OP $772.00 $571.50 $160.89 $772.00 $772.00 $772.00 $772.00 $772.00 $772.00 $772.00 $165.36 $772.00 $772.00 $572.98 $572.98 $595.06 $402.21 $160.89 $772.00 $308.80 $772.00 $772.00 $772.00 $772.00 $772.00 $579.00 $772.00 $772.00 $772.00 $386.00 $386.00 $611.42 $772.00 $617.60 $501.80 $772.00 $772.00 $447.76 $772.00 $463.20 $772.00 $772.00 $772.00 N/A N/A 92000075 EAP CPT® 92202 OPHTHALMOSCOPY EXT OPTIC NERVE DRAWING UNI OR BIL BOTH IP/OP $175.00 $129.50 $14.57 $140.00 $95.03 $95.03 $95.03 $95.03 $54.76 $54.76 $54.51 $36.47 $54.76 $129.89 $129.89 $134.89 $91.18 $36.47 $87.61 $82.92 $103.51 $54.76 $14.57 $54.76 $57.49 $131.25 $54.76 $54.76 $54.76 $87.50 $87.50 $138.60 $54.76 $140.00 $113.75 $34.73 $54.76 $101.50 $57.49 $79.22 $54.76 $36.47 $54.76 N/A N/A 92000080 EAP CPT® 95800 SLP STDY UNATTENDED W/HRT RATE/O2 SAT/RESP/SLP TIME BOTH IP/OP $772.00 $571.50 $110.26 $772.00 $772.00 $772.00 $772.00 $772.00 $122.23 $122.23 $169.83 $772.00 $122.23 $572.98 $572.98 $595.06 $402.21 $160.89 $195.57 $176.42 $772.00 $122.23 $110.26 $122.23 $772.00 $579.00 $122.23 $122.23 $122.23 $386.00 $386.00 $611.42 $122.23 $617.60 $501.80 $772.00 $122.23 $447.76 $772.00 $126.06 $122.23 $772.00 $122.23 N/A N/A 92000081 EAP CPT® 95801 SLP STDY UNATND W/MIN HRT RATE/O2 SAT/RESP ANALYSIS BOTH IP/OP $644.00 $477.00 $48.26 $644.00 $644.00 $644.00 $644.00 $644.00 $51.08 $51.08 $91.13 $644.00 $51.08 $477.98 $477.98 $496.40 $335.52 $134.22 $81.73 $85.52 $644.00 $51.08 $53.45 $51.08 $644.00 $483.00 $51.08 $51.08 $51.08 $322.00 $322.00 $510.05 $51.08 $515.20 $418.60 $644.00 $51.08 $373.52 $644.00 $48.26 $51.08 $644.00 $51.08 N/A N/A 92000090 EAP CPT® 0648T QUAN MR TIS WO MRI 1ORGN BOTH IP/OP "$2,289.00" "$1,694.00" $477.05 "$2,289.00" "$2,289.00" "$2,289.00" "$2,289.00" "$2,289.00" "$2,289.00" "$2,289.00" "$2,289.00" "$2,289.00" "$2,289.00" "$1,698.90" "$1,698.90" "$1,764.36" "$1,192.57" $477.05 "$2,289.00" $915.60 "$2,289.00" "$2,289.00" "$2,289.00" "$2,289.00" "$2,289.00" "$1,716.75" "$2,289.00" "$2,289.00" "$2,289.00" "$1,144.50" "$1,144.50" "$1,812.89" "$2,289.00" "$1,831.20" "$1,487.85" "$2,289.00" "$2,289.00" "$1,327.62" "$2,289.00" "$1,373.40" "$2,289.00" "$2,289.00" "$2,289.00" N/A N/A 92000091 EAP CPT® 0649T QUAN MR TISS W/MRI 1ORGN BOTH IP/OP "$1,144.00" $847.00 $238.42 "$1,144.00" "$1,144.00" "$1,144.00" "$1,144.00" "$1,144.00" "$1,144.00" "$1,144.00" "$1,144.00" "$1,144.00" "$1,144.00" $849.08 $849.08 $881.80 $596.02 $238.42 "$1,144.00" $457.60 "$1,144.00" "$1,144.00" "$1,144.00" "$1,144.00" "$1,144.00" $858.00 "$1,144.00" "$1,144.00" "$1,144.00" $572.00 $572.00 $906.05 "$1,144.00" $915.20 $743.60 "$1,144.00" "$1,144.00" $663.52 "$1,144.00" $686.40 "$1,144.00" "$1,144.00" "$1,144.00" N/A N/A 92100001 EAP CPT® 93279 SINGLE LEAD PACEMAKER PROGRAM / EVAL IN PERSON BOTH IP/OP $204.00 $151.00 $36.47 $163.20 $105.65 $105.65 $105.65 $105.65 $36.63 $36.63 $36.47 $42.52 $36.63 $151.41 $151.41 $157.24 $106.28 $42.52 $58.61 $50.50 $120.67 $36.63 $37.55 $36.63 $38.46 $153.00 $36.63 $36.63 $36.63 $102.00 $102.00 $161.57 $36.63 $163.20 $132.60 $40.49 $36.63 $118.32 $38.46 $52.99 $36.63 $42.51 $36.63 N/A N/A 92100002 EAP CPT® 93280 DUAL LEAD PACEMAKER PROGRAM / EVAL IN PERSON BOTH IP/OP $204.00 $151.00 $36.47 $163.20 $122.76 $122.76 $122.76 $122.76 $36.63 $36.63 $36.47 $42.52 $36.63 $151.41 $151.41 $157.24 $106.28 $42.52 $58.61 $50.50 $120.67 $36.63 $43.63 $36.63 $38.46 $153.00 $36.63 $36.63 $36.63 $102.00 $102.00 $161.57 $36.63 $163.20 $132.60 $40.49 $36.63 $118.32 $38.46 $52.99 $36.63 $42.51 $36.63 N/A N/A 92100003 EAP CPT® 93288 PACEMAKER SNGL/DUAL/MULTI INTERROG / EVAL IN PERSON BOTH IP/OP $204.00 $151.00 $28.45 $204.00 $204.00 $204.00 $204.00 $204.00 $38.65 $38.65 $55.68 $204.00 $38.65 $151.41 $151.41 $157.24 $106.28 $42.52 $61.84 $58.99 $204.00 $38.65 $36.87 $38.65 $204.00 $153.00 $38.65 $38.65 $38.65 $102.00 $102.00 $161.57 $38.65 $163.20 $132.60 $204.00 $38.65 $118.32 $204.00 $28.45 $38.65 $204.00 $38.65 N/A N/A 92100005 EAP CPT® 93880 US DUPLEX CA BOTH IP/OP "$3,057.00" "$2,262.50" $155.59 "$2,445.60" $426.40 $426.40 $426.40 $426.40 $226.34 $226.34 $225.34 $637.16 $226.34 $541.69 $541.69 $562.53 $395.43 $637.11 $362.15 $336.89 "$1,808.22" $226.34 $155.59 $226.34 $237.66 "$2,292.75" $226.34 $226.34 $226.34 "$1,528.50" "$1,528.50" "$2,421.14" $226.34 "$2,445.60" "$1,987.05" $606.74 $226.34 "$1,773.06" $237.66 $327.46 $226.34 $637.08 $226.34 N/A N/A 92100007 EAP CPT® 93882 US DUPLEX CA BOTH IP/OP "$2,599.00" "$1,923.50" $101.81 "$2,599.00" "$2,599.00" "$2,599.00" "$2,599.00" "$2,599.00" $105.27 $105.27 $132.45 "$2,599.00" $105.27 $356.80 $356.80 $370.53 $260.46 $541.66 $168.43 $162.90 "$2,599.00" $105.27 $101.81 $105.27 "$2,599.00" "$1,949.25" $105.27 $105.27 $105.27 "$1,299.50" "$1,299.50" "$2,058.41" $105.27 "$2,079.20" "$1,689.35" "$2,599.00" $105.27 "$1,507.42" "$2,599.00" $105.17 $105.27 "$2,599.00" $105.27 N/A N/A 92100009 EAP CPT® 93886 US TRANSCRAN INTRACRAN COMPLETE BOTH IP/OP "$2,429.00" "$1,797.50" $225.34 "$1,943.20" $568.52 $568.52 $568.52 $568.52 $226.34 $226.34 $225.34 $506.26 $226.34 $624.57 $624.57 $648.59 $455.93 $506.23 $362.15 $336.89 "$1,436.75" $226.34 $228.31 $226.34 $237.66 "$1,821.75" $226.34 $226.34 $226.34 "$1,214.50" "$1,214.50" "$1,923.77" $226.34 "$1,943.20" "$1,578.85" $482.10 $226.34 "$1,408.82" $237.66 $327.46 $226.34 $506.20 $226.34 N/A N/A 92100011 EAP CPT® 93888 US TRANSCRAN INTRACRAN LIMITED BOTH IP/OP "$2,429.00" "$1,797.50" $136.30 "$2,429.00" "$2,429.00" "$2,429.00" "$2,429.00" "$2,429.00" $140.85 $140.85 $170.47 "$2,429.00" $140.85 $425.90 $425.90 $442.28 $310.90 $506.23 $225.36 $218.08 "$2,429.00" $140.85 $136.30 $140.85 "$2,429.00" "$1,821.75" $140.85 $140.85 $140.85 "$1,214.50" "$1,214.50" "$1,923.77" $140.85 "$1,943.20" "$1,578.85" "$2,429.00" $140.85 "$1,408.82" "$2,429.00" $138.31 $140.85 "$2,429.00" $140.85 N/A N/A 92100013 EAP Custom 92100013 ANKLE/BRACHIAL INDICES (ABI) BOTH IP/OP $768.00 $568.50 $136.70 $768.00 $768.00 $768.00 $768.00 $768.00 $768.00 $768.00 $136.70 $768.00 $768.00 $570.01 $570.01 $591.97 $400.13 $160.06 $768.00 $307.20 $768.00 $768.00 $768.00 $768.00 $768.00 $576.00 $768.00 $768.00 $768.00 $384.00 $384.00 $608.26 $768.00 $614.40 $499.20 $768.00 $768.00 $445.44 $768.00 $460.80 $768.00 $768.00 $768.00 N/A N/A 92100014 EAP CPT® 93922 ABI -NON-INV DOPPLER TEST BOTH IP/OP "$1,074.00" $795.00 $71.03 "$1,074.00" "$1,074.00" "$1,074.00" "$1,074.00" "$1,074.00" $72.15 $72.15 $86.91 "$1,074.00" $72.15 $269.29 $269.29 $279.64 $196.58 $223.83 $115.44 $113.65 "$1,074.00" $72.15 $71.03 $72.15 "$1,074.00" $805.50 $72.15 $72.15 $72.15 $537.00 $537.00 $850.61 $72.15 $859.20 $698.10 "$1,074.00" $72.15 $622.92 "$1,074.00" $73.47 $72.15 "$1,074.00" $72.15 N/A N/A 92100015 EAP CPT® 93923 EXT ARTERIAL PVR STUDY BOTH IP/OP "$1,355.00" "$1,003.00" $108.23 "$1,084.00" $290.23 $290.23 $290.23 $290.23 $137.34 $137.34 $136.73 $282.42 $137.34 $406.72 $406.72 $422.37 $296.90 $282.40 $219.74 $209.80 $801.48 $137.34 $108.23 $137.34 $144.20 "$1,016.25" $137.34 $137.34 $137.34 $677.50 $677.50 "$1,073.16" $137.34 "$1,084.00" $880.75 $268.93 $137.34 $785.90 $144.20 $198.69 $137.34 $282.38 $137.34 N/A N/A 92100017 EAP CPT® 93925 US LOW EXT ARTERIES COMP BOTH IP/OP "$2,478.00" "$1,834.00" $206.32 "$1,982.40" $545.45 $545.45 $545.45 $545.45 $226.34 $226.34 $225.34 $516.48 $226.34 $695.99 $695.99 $722.76 $508.07 $516.44 $362.15 $336.89 "$1,465.74" $226.34 $206.32 $226.34 $237.66 "$1,858.50" $226.34 $226.34 $226.34 "$1,239.00" "$1,239.00" "$1,962.58" $226.34 "$1,982.40" "$1,610.70" $491.82 $226.34 "$1,437.24" $237.66 $327.46 $226.34 $516.42 $226.34 N/A N/A 92100018 EAP CPT® 93926 LOW EXT ARTERIES LTD BOTH IP/OP "$1,346.00" $996.50 $106.62 "$1,076.80" $285.04 $285.04 $285.04 $285.04 $107.09 $107.09 $106.62 $280.54 $107.09 $441.03 $441.03 $458.00 $321.95 $280.52 $171.35 $154.19 $796.16 $107.09 $122.10 $107.09 $112.45 "$1,009.50" $107.09 $107.09 $107.09 $673.00 $673.00 "$1,066.03" $107.09 "$1,076.80" $874.90 $267.15 $107.09 $780.68 $112.45 $154.94 $107.09 $280.51 $107.09 N/A N/A 92100020 EAP CPT® 93930 UPPER EXT ARTERIES COMP BOTH IP/OP "$2,291.00" "$1,695.50" $160.67 "$1,832.80" $438.32 $438.32 $438.32 $438.32 $226.34 $226.34 $225.34 $477.50 $226.34 $548.65 $548.65 $569.75 $400.51 $477.47 $362.15 $336.89 "$1,355.13" $226.34 $160.67 $226.34 $237.66 "$1,718.25" $226.34 $226.34 $226.34 "$1,145.50" "$1,145.50" "$1,814.47" $226.34 "$1,832.80" "$1,489.15" $454.71 $226.34 "$1,328.78" $237.66 $327.46 $226.34 $477.44 $226.34 N/A N/A 92100022 EAP CPT® 93931 UPPER EXT ARTERIES LTD BOTH IP/OP "$1,346.00" $996.50 $102.15 "$1,076.80" $270.88 $270.88 $270.88 $270.88 $107.09 $107.09 $106.62 $280.54 $107.09 $367.39 $367.39 $381.52 $268.19 $280.52 $171.35 $154.19 $796.16 $107.09 $102.15 $107.09 $112.45 "$1,009.50" $107.09 $107.09 $107.09 $673.00 $673.00 "$1,066.03" $107.09 "$1,076.80" $874.90 $267.15 $107.09 $780.68 $112.45 $154.94 $107.09 $280.51 $107.09 N/A N/A 92100025 EAP CPT® 93970 US EXT VEINS DOPPLER COMP BOTH IP/OP "$2,823.00" "$2,089.50" $157.96 "$2,258.40" $415.23 $415.23 $415.23 $415.23 $226.34 $226.34 $225.34 $588.38 $226.34 $544.52 $544.52 $565.47 $397.50 $588.34 $362.15 $336.89 "$1,669.80" $226.34 $157.96 $226.34 $237.66 "$2,117.25" $226.34 $226.34 $226.34 "$1,411.50" "$1,411.50" "$2,235.82" $226.34 "$2,258.40" "$1,834.95" $560.29 $226.34 "$1,637.34" $237.66 $327.46 $226.34 $588.31 $226.34 N/A N/A 92100028 EAP CPT® 93971 US EXT VEINS DOPPLER LTD BOTH IP/OP "$2,071.00" "$1,533.00" $99.78 "$1,656.80" $253.01 $253.01 $253.01 $253.01 $107.09 $107.09 $106.62 $431.65 $107.09 $360.55 $360.55 $374.41 $263.20 $431.62 $171.35 $154.19 "$1,225.00" $107.09 $99.78 $107.09 $112.45 "$1,553.25" $107.09 $107.09 $107.09 "$1,035.50" "$1,035.50" "$1,640.23" $107.09 "$1,656.80" "$1,346.15" $411.04 $107.09 "$1,201.18" $112.45 $154.94 $107.09 $431.60 $107.09 N/A N/A 92100029 EAP CPT® 93971 PERIPH.VAS. UNI. & EXT NON-VAS BOTH IP/OP "$1,604.00" "$1,187.00" $99.78 "$1,283.20" $253.01 $253.01 $253.01 $253.01 $107.09 $107.09 $106.62 $334.31 $107.09 $360.55 $360.55 $374.41 $263.20 $334.29 $171.35 $154.19 $948.77 $107.09 $99.78 $107.09 $112.45 "$1,203.00" $107.09 $107.09 $107.09 $802.00 $802.00 "$1,270.37" $107.09 "$1,283.20" "$1,042.60" $318.35 $107.09 $930.32 $112.45 $154.94 $107.09 $334.27 $107.09 N/A N/A 92100030 EAP CPT® 93971 PERIPH.VAS. UNI. W/MAPPING BOTH IP/OP "$1,604.00" "$1,187.00" $99.78 "$1,283.20" $253.01 $253.01 $253.01 $253.01 $107.09 $107.09 $106.62 $334.31 $107.09 $360.55 $360.55 $374.41 $263.20 $334.29 $171.35 $154.19 $948.77 $107.09 $99.78 $107.09 $112.45 "$1,203.00" $107.09 $107.09 $107.09 $802.00 $802.00 "$1,270.37" $107.09 "$1,283.20" "$1,042.60" $318.35 $107.09 $930.32 $112.45 $154.94 $107.09 $334.27 $107.09 N/A N/A 92100032 EAP CPT® 93975 ABD/RETROPER DOPPLER COMP US BOTH IP/OP "$3,461.00" "$2,561.50" $214.44 "$3,461.00" "$3,461.00" "$3,461.00" "$3,461.00" "$3,461.00" $219.87 $219.87 $283.12 "$3,461.00" $219.87 $711.04 $711.04 $738.39 $519.05 $721.31 $351.79 $343.10 "$3,461.00" $219.87 $214.44 $219.87 "$3,461.00" "$2,595.75" $219.87 $219.87 $219.87 "$1,730.50" "$1,730.50" "$2,741.11" $219.87 "$2,768.80" "$2,249.65" "$3,461.00" $219.87 "$2,007.38" "$3,461.00" $223.31 $219.87 "$3,461.00" $219.87 N/A N/A 92100033 EAP CPT® 93976 ABD/RETROPER DOPPLER LTD US BOTH IP/OP "$1,882.00" "$1,393.00" $106.62 "$1,505.60" $318.47 $318.47 $318.47 $318.47 $107.09 $107.09 $106.62 $392.26 $107.09 $390.03 $390.03 $405.03 $284.72 $392.23 $171.35 $154.19 "$1,113.20" $107.09 $122.78 $107.09 $112.45 "$1,411.50" $107.09 $107.09 $107.09 $941.00 $941.00 "$1,490.54" $107.09 "$1,505.60" "$1,223.30" $373.53 $107.09 "$1,091.56" $112.45 $154.94 $107.09 $392.21 $107.09 N/A N/A 92100034 EAP Custom 92100034 SNGL LEAD PM PROGRAM EVAL BOTH IP/OP $204.00 $151.00 $36.31 $204.00 $204.00 $204.00 $204.00 $204.00 $204.00 $204.00 $36.31 $204.00 $204.00 $151.41 $151.41 $157.24 $106.28 $42.52 $204.00 $81.60 $204.00 $204.00 $204.00 $204.00 $204.00 $153.00 $204.00 $204.00 $204.00 $102.00 $102.00 $161.57 $204.00 $163.20 $132.60 $204.00 $204.00 $118.32 $204.00 $122.40 $204.00 $204.00 $204.00 N/A N/A 92100035 EAP Custom 92100035 SNGL LEAD ICD PROGRAM EVAL BOTH IP/OP $262.00 $194.00 $46.64 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $46.64 $262.00 $262.00 $194.46 $194.46 $201.95 $136.50 $54.60 $262.00 $104.80 $262.00 $262.00 $262.00 $262.00 $262.00 $196.50 $262.00 $262.00 $262.00 $131.00 $131.00 $207.50 $262.00 $209.60 $170.30 $262.00 $262.00 $151.96 $262.00 $157.20 $262.00 $262.00 $262.00 N/A N/A 92100036 EAP CPT® 93286 PACEMAKER SNGL/DUAL/MULTI PERI-PROCEDURE EVAL IN PERSON BOTH IP/OP $234.00 $173.50 $25.21 $234.00 $234.00 $234.00 $234.00 $234.00 $33.81 $33.81 $45.92 $234.00 $33.81 $173.67 $173.67 $180.37 $121.91 $48.77 $54.10 $51.41 $234.00 $33.81 $32.13 $33.81 $234.00 $175.50 $33.81 $33.81 $33.81 $117.00 $117.00 $185.33 $33.81 $187.20 $152.10 $234.00 $33.81 $135.72 $234.00 $25.21 $33.81 $234.00 $33.81 N/A N/A 92100037 EAP CPT® 93287 ICD SNGL/DUAL/MULTI PERI-PROCEDURE EVAL IN PERSON BOTH IP/OP $311.00 $230.50 $32.13 $311.00 $77.38 $77.38 $77.38 $77.38 $311.00 $311.00 $311.00 $64.82 $311.00 $230.82 $230.82 $239.72 $162.03 $64.82 $311.00 $150.00 $183.96 $311.00 $32.13 $311.00 $311.00 $233.25 $311.00 $311.00 $311.00 $155.50 $155.50 $246.31 $311.00 $248.80 $202.15 $61.73 $311.00 $180.38 $311.00 $311.00 $311.00 $64.81 $311.00 N/A N/A 92100038 EAP CPT® 93296 PACEMAKER/ICD INTERROG / EVAL REMOTE UP TO 90 DAYS BOTH IP/OP $253.00 $187.50 $22.67 $202.40 $55.07 $55.07 $55.07 $55.07 $36.63 $36.63 $36.47 $52.73 $36.63 $187.78 $187.78 $195.01 $131.81 $52.73 $58.61 $50.50 $149.65 $36.63 $22.67 $36.63 $38.46 $189.75 $36.63 $36.63 $36.63 $126.50 $126.50 $200.38 $36.63 $202.40 $164.45 $50.21 $36.63 $146.74 $38.46 $52.99 $36.63 $52.73 $36.63 N/A N/A 92100039 EAP Custom 92100039 MULT LEAD PM PROGRAM EVAL BOTH IP/OP $163.00 $121.00 $29.01 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $163.00 $29.01 $163.00 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $65.20 $163.00 $163.00 $163.00 $163.00 $163.00 $122.25 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $163.00 $163.00 $94.54 $163.00 $97.80 $163.00 $163.00 $163.00 N/A N/A 92100040 EAP CPT® 93284 MULTI-LEAD ICD PROGRAM / EVAL IN PERSON BOTH IP/OP $328.00 $243.00 $36.47 $262.40 $190.46 $190.46 $190.46 $190.46 $36.63 $36.63 $36.47 $68.36 $36.63 $243.44 $243.44 $252.82 $170.89 $68.36 $58.61 $50.50 $194.01 $36.63 $47.02 $36.63 $38.46 $246.00 $36.63 $36.63 $36.63 $164.00 $164.00 $259.78 $36.63 $262.40 $213.20 $65.10 $36.63 $190.24 $38.46 $52.99 $36.63 $68.36 $36.63 N/A N/A 92100041 EAP CPT® 93291 INTERROG / EVAL SCRMS OR LOOP RECORDER IN CLINIC BOTH IP/OP $203.00 $150.50 $24.85 $203.00 $203.00 $203.00 $203.00 $203.00 $34.16 $34.16 $49.06 $203.00 $34.16 $150.67 $150.67 $156.47 $105.76 $42.31 $54.66 $51.95 $203.00 $34.16 $32.47 $34.16 $203.00 $152.25 $34.16 $34.16 $34.16 $101.50 $101.50 $160.78 $34.16 $162.40 $131.95 $203.00 $34.16 $117.74 $203.00 $24.85 $34.16 $203.00 $34.16 N/A N/A 92100043 EAP Custom 92100043 ICD INTERROGATION BOTH IP/OP $262.00 $194.00 $46.64 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $262.00 $46.64 $262.00 $262.00 $194.46 $194.46 $201.95 $136.50 $54.60 $262.00 $104.80 $262.00 $262.00 $262.00 $262.00 $262.00 $196.50 $262.00 $262.00 $262.00 $131.00 $131.00 $207.50 $262.00 $209.60 $170.30 $262.00 $262.00 $151.96 $262.00 $157.20 $262.00 $262.00 $262.00 N/A N/A 92100044 EAP Custom 92100044 DUAL LEAD PM PROGRAM EVAL BOTH IP/OP $204.00 $151.00 $36.31 $204.00 $204.00 $204.00 $204.00 $204.00 $204.00 $204.00 $36.31 $204.00 $204.00 $151.41 $151.41 $157.24 $106.28 $42.52 $204.00 $81.60 $204.00 $204.00 $204.00 $204.00 $204.00 $153.00 $204.00 $204.00 $204.00 $102.00 $102.00 $161.57 $204.00 $163.20 $132.60 $204.00 $204.00 $118.32 $204.00 $122.40 $204.00 $204.00 $204.00 N/A N/A 92100045 EAP Custom 92100045 DUAL LEAD ICD PROGRAM EVAL BOTH IP/OP $264.00 $195.50 $46.99 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $46.99 $264.00 $264.00 $195.94 $195.94 $203.49 $137.54 $55.02 $264.00 $105.60 $264.00 $264.00 $264.00 $264.00 $264.00 $198.00 $264.00 $264.00 $264.00 $132.00 $132.00 $209.09 $264.00 $211.20 $171.60 $264.00 $264.00 $153.12 $264.00 $158.40 $264.00 $264.00 $264.00 N/A N/A 92100050 EAP CPT® 93978 AORTA DUPLEX BOTH IP/OP "$1,539.00" "$1,139.00" $145.11 "$1,231.20" $401.88 $401.88 $401.88 $401.88 $226.34 $226.34 $225.34 $320.77 $226.34 $510.54 $510.54 $530.17 $372.69 $320.74 $362.15 $336.89 $910.32 $226.34 $145.11 $226.34 $237.66 "$1,154.25" $226.34 $226.34 $226.34 $769.50 $769.50 "$1,218.89" $226.34 "$1,231.20" "$1,000.35" $305.45 $226.34 $892.62 $237.66 $327.46 $226.34 $320.73 $226.34 N/A N/A 92100052 EAP CPT® 93880 CAROTID DUPLEX BOTH IP/OP "$2,558.00" "$1,893.00" $155.59 "$2,046.40" $426.40 $426.40 $426.40 $426.40 $226.34 $226.34 $225.34 $533.15 $226.34 $541.69 $541.69 $562.53 $395.43 $533.12 $362.15 $336.89 "$1,513.06" $226.34 $155.59 $226.34 $237.66 "$1,918.50" $226.34 $226.34 $226.34 "$1,279.00" "$1,279.00" "$2,025.94" $226.34 "$2,046.40" "$1,662.70" $507.70 $226.34 "$1,483.64" $237.66 $327.46 $226.34 $533.09 $226.34 N/A N/A 92100063 EAP CPT® 93978 VASCULAR STUDY ULT BOTH IP/OP "$1,753.00" "$1,297.50" $145.11 "$1,402.40" $401.88 $401.88 $401.88 $401.88 $226.34 $226.34 $225.34 $365.37 $226.34 $510.54 $510.54 $530.17 $372.69 $365.34 $362.15 $336.89 "$1,036.90" $226.34 $145.11 $226.34 $237.66 "$1,314.75" $226.34 $226.34 $226.34 $876.50 $876.50 "$1,388.38" $226.34 "$1,402.40" "$1,139.45" $347.93 $226.34 "$1,016.74" $237.66 $327.46 $226.34 $365.33 $226.34 N/A N/A 92100065 EAP CPT® 93979 VASCULAR STUDY LIMITED ULT BOTH IP/OP $965.00 $714.50 $95.72 $965.00 $965.00 $965.00 $965.00 $965.00 $98.02 $98.02 $124.12 $965.00 $98.02 $354.68 $354.68 $368.32 $258.91 $201.12 $156.83 $153.15 $965.00 $98.02 $95.72 $98.02 $965.00 $723.75 $98.02 $98.02 $98.02 $482.50 $482.50 $764.28 $98.02 $772.00 $627.25 $965.00 $98.02 $559.70 $965.00 $97.97 $98.02 $965.00 $98.02 N/A N/A 92100072 EAP CPT® 93281 MULTI-LEAD PACEMAKER PROGRAM / EVAL IN PERSON BOTH IP/OP $204.00 $151.00 $36.47 $163.20 $144.33 $144.33 $144.33 $144.33 $36.63 $36.63 $36.47 $42.52 $36.63 $151.41 $151.41 $157.24 $106.28 $42.52 $58.61 $50.50 $120.67 $36.63 $44.31 $36.63 $38.46 $153.00 $36.63 $36.63 $36.63 $102.00 $102.00 $161.57 $36.63 $163.20 $132.60 $40.49 $36.63 $118.32 $38.46 $52.99 $36.63 $42.51 $36.63 N/A N/A 92100080 EAP CPT® 93886 TRANSCRAN DOPPLER COMP US BOTH IP/OP "$2,903.00" "$2,148.50" $225.34 "$2,322.40" $568.52 $568.52 $568.52 $568.52 $226.34 $226.34 $225.34 $605.06 $226.34 $624.57 $624.57 $648.59 $455.93 $605.02 $362.15 $336.89 "$1,717.12" $226.34 $228.31 $226.34 $237.66 "$2,177.25" $226.34 $226.34 $226.34 "$1,451.50" "$1,451.50" "$2,299.18" $226.34 "$2,322.40" "$1,886.95" $576.17 $226.34 "$1,683.74" $237.66 $327.46 $226.34 $604.99 $226.34 N/A N/A 92100081 EAP CPT® 93888 TRANSCRAN DOPPLER LTD US BOTH IP/OP "$2,903.00" "$2,148.50" $136.30 "$2,903.00" "$2,903.00" "$2,903.00" "$2,903.00" "$2,903.00" $140.85 $140.85 $170.47 "$2,903.00" $140.85 $425.90 $425.90 $442.28 $310.90 $605.02 $225.36 $218.08 "$2,903.00" $140.85 $136.30 $140.85 "$2,903.00" "$2,177.25" $140.85 $140.85 $140.85 "$1,451.50" "$1,451.50" "$2,299.18" $140.85 "$2,322.40" "$1,886.95" "$2,903.00" $140.85 "$1,683.74" "$2,903.00" $138.31 $140.85 "$2,903.00" $140.85 N/A N/A 92100082 EAP CPT® 93890 TCD. VASOREACTIVITY STUDY BOTH IP/OP "$1,989.00" "$1,472.00" $225.34 "$1,591.20" $577.43 $577.43 $577.43 $577.43 $226.34 $226.34 $225.34 $414.56 $226.34 $526.52 $526.52 $546.77 $384.36 $414.53 $362.15 $336.89 "$1,176.49" $226.34 $231.35 $226.34 $237.66 "$1,491.75" $226.34 $226.34 $226.34 $994.50 $994.50 "$1,575.29" $226.34 "$1,591.20" "$1,292.85" $394.77 $226.34 "$1,153.62" $237.66 $327.46 $226.34 $414.51 $226.34 N/A N/A 92100083 EAP CPT® 93892 TCD. EMBOLI DETCT W/O INJ BOTH IP/OP $967.00 $716.00 $201.53 $967.00 $967.00 $967.00 $967.00 $967.00 $265.80 $265.80 $326.43 $967.00 $265.80 $571.93 $571.93 $593.92 $417.50 $201.53 $425.28 $422.64 $967.00 $265.80 $264.15 $265.80 $967.00 $725.25 $265.80 $265.80 $265.80 $483.50 $483.50 $765.86 $265.80 $773.60 $628.55 $967.00 $265.80 $560.86 $967.00 $255.72 $265.80 $967.00 $265.80 N/A N/A 92100084 EAP CPT® 93893 TCD. EMBOLI DETECT W/INJ BOTH IP/OP $967.00 $716.00 $106.62 $773.60 $360.13 $360.13 $360.13 $360.13 $107.09 $107.09 $106.62 $201.55 $107.09 $569.21 $569.21 $591.11 $415.52 $201.53 $171.35 $154.19 $571.98 $107.09 $340.59 $107.09 $112.45 $725.25 $107.09 $107.09 $107.09 $483.50 $483.50 $765.86 $107.09 $773.60 $628.55 $191.93 $107.09 $560.86 $112.45 $154.94 $107.09 $201.52 $107.09 N/A N/A 92100086 EAP CPT® 93922 ABI -NON-INV DOPPLER TEST BOTH IP/OP "$1,085.00" $803.00 $71.03 "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" $72.15 $72.15 $86.91 "$1,085.00" $72.15 $269.29 $269.29 $279.64 $196.58 $226.13 $115.44 $113.65 "$1,085.00" $72.15 $71.03 $72.15 "$1,085.00" $813.75 $72.15 $72.15 $72.15 $542.50 $542.50 $859.32 $72.15 $868.00 $705.25 "$1,085.00" $72.15 $629.30 "$1,085.00" $73.47 $72.15 "$1,085.00" $72.15 N/A N/A 92100088 EAP CPT® 93922 LIMITED BILATERAL PVR EXAM BOTH IP/OP "$1,085.00" $803.00 $71.03 "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" $72.15 $72.15 $86.91 "$1,085.00" $72.15 $269.29 $269.29 $279.64 $196.58 $226.13 $115.44 $113.65 "$1,085.00" $72.15 $71.03 $72.15 "$1,085.00" $813.75 $72.15 $72.15 $72.15 $542.50 $542.50 $859.32 $72.15 $868.00 $705.25 "$1,085.00" $72.15 $629.30 "$1,085.00" $73.47 $72.15 "$1,085.00" $72.15 N/A N/A 92100089 EAP CPT® 93980 PENILE VASCULAR STUDY BOTH IP/OP "$1,392.00" "$1,030.50" $58.18 "$1,392.00" "$1,392.00" "$1,392.00" "$1,392.00" "$1,392.00" $58.68 $58.68 $122.47 "$1,392.00" $58.68 $295.01 $295.01 $306.35 $215.35 $290.11 $93.89 $93.09 "$1,392.00" $58.68 $58.18 $58.68 "$1,392.00" "$1,044.00" $58.68 $58.68 $58.68 $696.00 $696.00 "$1,102.46" $58.68 "$1,113.60" $904.80 "$1,392.00" $58.68 $807.36 "$1,392.00" $61.59 $58.68 "$1,392.00" $58.68 N/A N/A 92100090 EAP CPT® 93924 VAS LAB PVR LOWER EXT WITH EXERCISE BOTH IP/OP "$1,188.00" $879.50 $135.64 $950.40 $361.67 $361.67 $361.67 $361.67 $260.33 $260.33 $259.18 $247.61 $260.33 $506.06 $506.06 $525.53 $369.42 $247.59 $416.53 $404.03 $702.70 $260.33 $135.64 $260.33 $273.35 $891.00 $260.33 $260.33 $260.33 $594.00 $594.00 $940.90 $260.33 $950.40 $772.20 $235.79 $260.33 $689.04 $273.35 $376.64 $260.33 $247.58 $260.33 N/A N/A 92100091 EAP CPT® 93985 VESSEL MAPPING FOR HD ACCESS BILATERAL BOTH IP/OP $580.00 $429.50 $115.12 $561.71 $561.71 $561.71 $561.71 $561.71 $226.34 $226.34 $225.34 $120.89 $226.34 $430.48 $430.48 $447.06 $302.18 $120.88 $362.15 $336.89 $343.07 $226.34 $213.76 $226.34 $237.66 $435.00 $226.34 $226.34 $226.34 $290.00 $290.00 $459.36 $226.34 $464.00 $377.00 $115.12 $226.34 $336.40 $237.66 $327.46 $226.34 $120.87 $226.34 N/A N/A 92100092 EAP CPT® 93986 VESSEL MAPPING FOR HD ACCESS UNILATERAL BOTH IP/OP $279.00 $206.50 $58.15 $279.00 $279.00 $279.00 $279.00 $279.00 $130.48 $130.48 $157.52 $279.00 $130.48 $207.07 $207.07 $215.05 $145.36 $58.15 $208.77 $201.86 $279.00 $130.48 $126.16 $130.48 $279.00 $209.25 $130.48 $130.48 $130.48 $139.50 $139.50 $220.97 $130.48 $223.20 $181.35 $279.00 $130.48 $161.82 $279.00 $131.82 $130.48 $279.00 $130.48 N/A N/A 92200001 EAP CPT® 95860 ELECTROMYOGRAM - 1 EXTERMITY BOTH IP/OP $440.00 $326.00 $63.25 $440.00 $440.00 $440.00 $440.00 $440.00 $65.59 $65.59 $121.44 $440.00 $65.59 $326.57 $326.57 $339.15 $229.24 $91.70 $104.94 $101.20 $440.00 $65.59 $63.25 $65.59 $440.00 $330.00 $65.59 $65.59 $65.59 $220.00 $220.00 $348.48 $65.59 $352.00 $286.00 $440.00 $65.59 $255.20 $440.00 $68.79 $65.59 $440.00 $65.59 N/A N/A 92200002 EAP CPT® 95861 ELECTROMYORGAM - 2 EXTERMITIES BOTH IP/OP $421.00 $312.00 $81.85 $421.00 $421.00 $421.00 $421.00 $421.00 $86.66 $86.66 $175.39 $421.00 $86.66 $312.47 $312.47 $324.51 $219.34 $87.74 $138.66 $130.96 $421.00 $86.66 $81.85 $86.66 $421.00 $315.75 $86.66 $86.66 $86.66 $210.50 $210.50 $333.43 $86.66 $336.80 $273.65 $421.00 $86.66 $244.18 $421.00 $90.40 $86.66 $421.00 $86.66 N/A N/A 92200003 EAP CPT® 95869 EMG LIMITED (THORACIC PSP) BOTH IP/OP $186.00 $138.00 $38.76 $186.00 $186.00 $186.00 $186.00 $186.00 $82.51 $82.51 $104.40 $186.00 $82.51 $138.05 $138.05 $143.37 $96.91 $38.76 $132.02 $123.92 $186.00 $82.51 $77.45 $82.51 $186.00 $139.50 $82.51 $82.51 $82.51 $93.00 $93.00 $147.31 $82.51 $148.80 $120.90 $186.00 $82.51 $107.88 $186.00 $77.08 $82.51 $186.00 $82.51 N/A N/A 92200004 EAP CPT® 95870 EMG LIMITED EXT BOTH IP/OP $317.00 $235.00 $62.92 $253.60 $172.13 $172.13 $172.13 $172.13 $110.92 $110.92 $110.43 $66.07 $110.92 $235.28 $235.28 $244.34 $165.16 $66.07 $177.47 $167.51 $187.51 $110.92 $64.94 $110.92 $116.46 $237.75 $110.92 $110.92 $110.92 $158.50 $158.50 $251.06 $110.92 $253.60 $206.05 $62.92 $110.92 $183.86 $116.46 $160.47 $110.92 $66.06 $110.92 N/A N/A 92200010 EAP CPT® 95937 RNS BOTH IP/OP $192.00 $142.50 $38.11 $219.74 $104.26 $104.26 $104.26 $104.26 $137.34 $137.34 $136.73 $40.02 $137.34 $142.50 $142.50 $147.99 $100.03 $40.01 $219.74 $209.80 $113.57 $137.34 $72.38 $137.34 $144.20 $144.00 $137.34 $137.34 $137.34 $96.00 $96.00 $152.06 $137.34 $153.60 $124.80 $38.11 $137.34 $111.36 $144.20 $192.00 $137.34 $40.01 $137.34 N/A N/A 92200011 EAP CPT® 95907 NVR CNDJ TST 1-2 STUDIES BOTH IP/OP $706.00 $522.50 $38.22 $564.80 $383.36 $383.36 $383.36 $383.36 $137.34 $137.34 $136.73 $147.15 $137.34 $523.99 $523.99 $544.18 $367.83 $147.14 $219.74 $209.80 $417.60 $137.34 $38.22 $137.34 $144.20 $529.50 $137.34 $137.34 $137.34 $353.00 $353.00 $559.15 $137.34 $564.80 $458.90 $140.12 $137.34 $409.48 $144.20 $198.69 $137.34 $147.13 $137.34 N/A N/A 92200012 EAP CPT® 95908 NRV CNDJ TST 3-4 STUDIES BOTH IP/OP "$1,040.00" $770.00 $47.35 $832.00 $564.72 $564.72 $564.72 $564.72 $260.33 $260.33 $259.18 $216.76 $260.33 $771.89 $771.89 $801.63 $541.84 $216.75 $416.53 $404.03 $615.16 $260.33 $47.35 $260.33 $273.35 $780.00 $260.33 $260.33 $260.33 $520.00 $520.00 $823.68 $260.33 $832.00 $676.00 $206.41 $260.33 $603.20 $273.35 $376.64 $260.33 $216.74 $260.33 N/A N/A 92200013 EAP CPT® 95909 NRV CNDJ TST 5-6 STUDIES BOTH IP/OP "$1,374.00" "$1,017.00" $56.82 "$1,099.20" $746.08 $746.08 $746.08 $746.08 $260.33 $260.33 $259.18 $286.38 $260.33 "$1,019.78" "$1,019.78" "$1,059.08" $715.85 $286.36 $416.53 $404.03 $812.72 $260.33 $56.82 $260.33 $273.35 "$1,030.50" $260.33 $260.33 $260.33 $687.00 $687.00 "$1,088.21" $260.33 "$1,099.20" $893.10 $272.70 $260.33 $796.92 $273.35 $376.64 $260.33 $286.34 $260.33 N/A N/A 92200014 EAP CPT® 95910 NRV CNDJ TEST 7-8 STUDIES BOTH IP/OP "$1,711.00" "$1,266.50" $72.72 "$1,368.80" $929.07 $929.07 $929.07 $929.07 $260.33 $260.33 $259.18 $356.62 $260.33 "$1,269.90" "$1,269.90" "$1,318.84" $891.43 $356.59 $416.53 $404.03 "$1,012.06" $260.33 $72.72 $260.33 $273.35 "$1,283.25" $260.33 $260.33 $260.33 $855.50 $855.50 "$1,355.11" $260.33 "$1,368.80" "$1,112.15" $339.59 $260.33 $992.38 $273.35 $376.64 $260.33 $356.57 $260.33 N/A N/A 92200015 EAP CPT® 95911 NRV CNDJ TEST 9-10 STUDIES BOTH IP/OP "$2,045.00" "$1,513.50" $83.54 "$1,636.00" "$1,110.44" "$1,110.44" "$1,110.44" "$1,110.44" $480.16 $480.16 $478.04 $426.23 $480.16 "$1,517.80" "$1,517.80" "$1,576.29" "$1,065.45" $426.20 $768.26 $697.42 "$1,209.62" $480.16 $83.54 $480.16 $504.17 "$1,533.75" $480.16 $480.16 $480.16 "$1,022.50" "$1,022.50" "$1,619.64" $480.16 "$1,636.00" "$1,329.25" $405.88 $480.16 "$1,186.10" $504.17 $694.68 $480.16 $426.18 $480.16 N/A N/A 92200016 EAP CPT® 95912 NVR CNDJ TST 11-12 STUDIES BOTH IP/OP "$2,380.00" "$1,761.50" $94.03 "$1,904.00" "$1,292.34" "$1,292.34" "$1,292.34" "$1,292.34" $480.16 $480.16 $478.04 $496.05 $480.16 "$1,766.44" "$1,766.44" "$1,834.50" "$1,239.98" $496.02 $768.26 $697.42 "$1,407.77" $480.16 $94.03 $480.16 $504.17 "$1,785.00" $480.16 $480.16 $480.16 "$1,190.00" "$1,190.00" "$1,884.96" $480.16 "$1,904.00" "$1,547.00" $472.37 $480.16 "$1,380.40" $504.17 $694.68 $480.16 $495.99 $480.16 N/A N/A 92200017 EAP CPT® 95913 NRV CNDJ TST 13- OR MORE STUDIES BOTH IP/OP "$2,715.00" "$2,009.50" $103.84 "$2,172.00" "$1,474.25" "$1,474.25" "$1,474.25" "$1,474.25" $480.16 $480.16 $478.04 $565.87 $480.16 "$2,015.07" "$2,015.07" "$2,092.72" "$1,414.52" $565.84 $768.26 $697.42 "$1,605.92" $480.16 $103.84 $480.16 $504.17 "$2,036.25" $480.16 $480.16 $480.16 "$1,357.50" "$1,357.50" "$2,150.28" $480.16 "$2,172.00" "$1,764.75" $538.86 $480.16 "$1,574.70" $504.17 $694.68 $480.16 $565.81 $480.16 N/A N/A 92200018 EAP CPT® 95872 NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER BOTH IP/OP $647.00 $479.00 $47.18 $647.00 $647.00 $647.00 $647.00 $647.00 $63.52 $63.52 $208.96 $647.00 $63.52 $480.20 $480.20 $498.71 $337.09 $134.84 $101.63 $80.64 $647.00 $63.52 $50.40 $63.52 $647.00 $485.25 $63.52 $63.52 $63.52 $323.50 $323.50 $512.42 $63.52 $517.60 $420.55 $647.00 $63.52 $375.26 $647.00 $47.18 $63.52 $647.00 $63.52 N/A N/A 92200040 EAP CPT® 95933 ORBICULARIS OCULI REFLEX BOTH IP/OP $461.00 $341.50 $51.50 $461.00 $461.00 $461.00 $461.00 $461.00 $55.57 $55.57 $87.98 $461.00 $55.57 $342.15 $342.15 $355.34 $240.18 $96.08 $88.91 $83.34 $461.00 $55.57 $52.09 $55.57 $461.00 $345.75 $55.57 $55.57 $55.57 $230.50 $230.50 $365.11 $55.57 $368.80 $299.65 $461.00 $55.57 $267.38 $461.00 $51.50 $55.57 $461.00 $55.57 N/A N/A 92200041 EAP CPT® 95925 SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS BOTH IP/OP "$1,372.00" "$1,015.50" $113.45 "$1,372.00" "$1,372.00" "$1,372.00" "$1,372.00" "$1,372.00" $160.47 $160.47 $160.72 "$1,372.00" $160.47 "$1,018.30" "$1,018.30" "$1,057.54" $714.81 $285.94 $256.75 $242.99 "$1,372.00" $160.47 $151.87 $160.47 "$1,372.00" "$1,029.00" $160.47 $160.47 $160.47 $686.00 $686.00 "$1,086.62" $160.47 "$1,097.60" $891.80 "$1,372.00" $160.47 $795.76 "$1,372.00" $113.45 $160.47 "$1,372.00" $160.47 N/A N/A 92200042 EAP CPT® 95926 SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS BOTH IP/OP "$1,372.00" "$1,015.50" $107.33 "$1,372.00" "$1,372.00" "$1,372.00" "$1,372.00" "$1,372.00" $135.95 $135.95 $148.25 "$1,372.00" $135.95 "$1,018.30" "$1,018.30" "$1,057.54" $714.81 $285.94 $217.52 $207.82 "$1,372.00" $135.95 $129.89 $135.95 "$1,372.00" "$1,029.00" $135.95 $135.95 $135.95 $686.00 $686.00 "$1,086.62" $135.95 "$1,097.60" $891.80 "$1,372.00" $135.95 $795.76 "$1,372.00" $107.33 $135.95 "$1,372.00" $135.95 N/A N/A 92200043 EAP CPT® 95867 EMG CRANIAL NERVE UNILATERAL BOTH IP/OP $625.00 $462.50 $65.91 $625.00 $625.00 $625.00 $625.00 $625.00 $69.39 $69.39 $114.46 $625.00 $69.39 $463.88 $463.88 $481.75 $325.63 $130.26 $111.02 $107.15 $625.00 $69.39 $66.97 $69.39 $625.00 $468.75 $69.39 $69.39 $69.39 $312.50 $312.50 $495.00 $69.39 $500.00 $406.25 $625.00 $69.39 $362.50 $625.00 $65.91 $69.39 $625.00 $69.39 N/A N/A 92200044 EAP CPT® 95868 EMG CRANIAL NERVE BILATERAL BOTH IP/OP $836.00 $619.00 $79.24 $836.00 $836.00 $836.00 $836.00 $836.00 $84.58 $84.58 $149.28 $836.00 $84.58 $620.48 $620.48 $644.39 $435.56 $174.23 $135.33 $127.17 $836.00 $84.58 $79.48 $84.58 $836.00 $627.00 $84.58 $84.58 $84.58 $418.00 $418.00 $662.11 $84.58 $668.80 $543.40 $836.00 $84.58 $484.88 $836.00 $79.24 $84.58 $836.00 $84.58 N/A N/A 92400001 EAP CPT® 95004 "PERC. ALLERGY TEST, IMMED. REA" BOTH IP/OP $999.00 $739.50 $4.07 "$1,447.99" $542.46 $542.46 $542.46 $542.46 $904.99 $904.99 $900.99 $208.22 $904.99 $741.46 $741.46 $770.03 $520.48 $208.20 "$1,447.99" "$1,348.00" $590.91 $904.99 $4.07 $904.99 $950.24 $749.25 $904.99 $904.99 $904.99 $499.50 $499.50 $791.21 $904.99 $799.20 $649.35 $198.28 $904.99 $579.42 $950.24 $999.00 $904.99 $208.19 $904.99 N/A N/A 92400002 EAP CPT® 95004 "ALLERGY TESTING, EXTRACTS" BOTH IP/OP $941.00 $696.50 $4.07 "$1,447.99" $510.96 $510.96 $510.96 $510.96 $904.99 $904.99 $900.99 $196.13 $904.99 $698.41 $698.41 $725.32 $490.26 $196.11 "$1,447.99" "$1,348.00" $556.60 $904.99 $4.07 $904.99 $950.24 $705.75 $904.99 $904.99 $904.99 $470.50 $470.50 $745.27 $904.99 $752.80 $611.65 $186.76 $904.99 $545.78 $950.24 $941.00 $904.99 $196.10 $904.99 N/A N/A 92400011 EAP CPT® 95028 INTRADERMAL TEST # BOTH IP/OP $163.00 $121.00 $12.86 $163.00 $163.00 $163.00 $163.00 $163.00 $13.09 $13.09 $13.20 $163.00 $13.09 $120.98 $120.98 $125.64 $84.92 $33.97 $20.94 $20.58 $163.00 $13.09 $12.86 $13.09 $163.00 $122.25 $13.09 $13.09 $13.09 $81.50 $81.50 $129.10 $13.09 $130.40 $105.95 $163.00 $13.09 $94.54 $163.00 $12.97 $13.09 $163.00 $13.09 N/A N/A 92400012 EAP CPT® 95044 PATCH TESTS - EACH BOTH IP/OP $904.00 $669.00 $5.08 "$1,447.99" $490.87 $490.87 $490.87 $490.87 $904.99 $904.99 $900.99 $188.42 $904.99 $670.95 $670.95 $696.80 $470.98 $188.40 "$1,447.99" "$1,348.00" $534.72 $904.99 $5.08 $904.99 $950.24 $678.00 $904.99 $904.99 $904.99 $452.00 $452.00 $715.97 $904.99 $723.20 $587.60 $179.42 $904.99 $524.32 $950.24 $904.00 $904.99 $188.39 $904.99 N/A N/A 92400030 EAP CPT® 95180 RAPID DESENSITIZATION BOTH IP/OP $385.00 $285.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $103.11 $103.11 $103.27 $385.00 $103.11 $285.75 $285.75 $296.76 $200.59 $80.24 $164.98 $163.17 $385.00 $103.11 $101.98 $103.11 $385.00 $288.75 $103.11 $103.11 $103.11 $192.50 $192.50 $304.92 $103.11 $308.00 $250.25 $385.00 $103.11 $223.30 $385.00 $106.39 $103.11 $385.00 $103.11 N/A N/A 92400034 EAP CPT® 95076 INGEST CHALLENGE INI 120 MIN BOTH IP/OP $695.00 $514.50 $73.53 $695.00 $695.00 $695.00 $695.00 $695.00 $74.48 $74.48 $74.46 $695.00 $74.48 $515.83 $515.83 $535.71 $362.10 $144.85 $119.17 $117.65 $695.00 $74.48 $73.53 $74.48 $695.00 $521.25 $74.48 $74.48 $74.48 $347.50 $347.50 $550.44 $74.48 $556.00 $451.75 $695.00 $74.48 $403.10 $695.00 $76.82 $74.48 $695.00 $74.48 N/A N/A 92900002 EAP CPT® 93293 "TRANSTELEPHONIC RHYTHM STRIP PM EVAL / SNGL, DUAL, MULTI-LEAD" BOTH IP/OP $264.00 $195.50 $31.80 $264.00 $264.00 $264.00 $264.00 $264.00 $33.81 $33.81 $51.49 $264.00 $33.81 $195.94 $195.94 $203.49 $137.54 $55.02 $54.10 $50.88 $264.00 $33.81 $31.80 $33.81 $264.00 $198.00 $33.81 $33.81 $33.81 $132.00 $132.00 $209.09 $33.81 $211.20 $171.60 $264.00 $33.81 $153.12 $264.00 $37.10 $33.81 $264.00 $33.81 N/A N/A 94000001 EAP CPT® 43753 GASTRIC INTUBATION/ASPIRATION W/WO LAVAGE BOTH IP/OP $269.00 $199.50 $21.72 $269.00 $269.00 $269.00 $269.00 $269.00 $22.19 $22.19 $22.37 $269.00 $22.19 $269.00 $269.00 $269.00 $269.00 $56.06 $35.50 $34.75 $269.00 $22.19 $21.72 $22.19 $269.00 $201.75 $22.19 $22.19 $22.19 $269.00 $134.50 $213.05 $22.19 $215.20 $269.00 $269.00 $22.19 $156.02 $269.00 $23.44 $22.19 $269.00 $22.19 N/A N/A 94000002 EAP CPT® 95115 ALLERGY INJECTION BOTH IP/OP $40.00 $30.00 $7.94 $62.98 $21.72 $21.72 $21.72 $21.72 $39.36 $39.36 $39.19 $8.34 $39.36 $29.69 $29.69 $30.83 $20.84 $8.34 $62.98 $61.13 $23.66 $39.36 $10.15 $39.36 $41.33 $30.00 $39.36 $39.36 $39.36 $20.00 $20.00 $31.68 $39.36 $32.00 $26.00 $7.94 $39.36 $23.20 $41.33 $40.00 $39.36 $8.34 $39.36 N/A N/A 94000003 EAP CPT® 95117 "ALLERGY INJECTIONS, 2 OR MORE" BOTH IP/OP $67.00 $50.00 $10.80 $67.00 $67.00 $67.00 $67.00 $67.00 $11.71 $11.71 $11.46 $67.00 $11.71 $49.73 $49.73 $51.64 $34.91 $13.96 $18.74 $18.94 $67.00 $11.71 $11.84 $11.71 $67.00 $50.25 $11.71 $11.71 $11.71 $33.50 $33.50 $53.06 $11.71 $53.60 $43.55 $67.00 $11.71 $38.86 $67.00 $10.80 $11.71 $67.00 $11.71 N/A N/A 94000006 EAP CPT® 96910 "PHOTOCHEMOTHERAPY,UVB" BOTH IP/OP $126.00 $93.50 $25.01 $119.39 $68.42 $68.42 $68.42 $68.42 $54.76 $54.76 $54.51 $26.26 $54.76 $93.52 $93.52 $97.12 $65.65 $26.26 $87.61 $82.92 $74.53 $54.76 $119.39 $54.76 $57.49 $94.50 $54.76 $54.76 $54.76 $63.00 $63.00 $99.79 $54.76 $100.80 $81.90 $25.01 $54.76 $73.08 $57.49 $79.22 $54.76 $26.26 $54.76 N/A N/A 94000007 EAP CPT® 96912 "PHOTOCHEMOTHERAPY, PUVA" BOTH IP/OP $204.00 $151.00 $42.52 $204.00 $204.00 $204.00 $204.00 $204.00 $103.58 $103.58 $104.79 $204.00 $103.58 $151.41 $151.41 $157.24 $106.28 $42.52 $165.73 $162.88 $204.00 $103.58 $101.80 $103.58 $204.00 $153.00 $103.58 $103.58 $103.58 $102.00 $102.00 $161.57 $103.58 $163.20 $132.60 $204.00 $103.58 $118.32 $204.00 $100.85 $103.58 $204.00 $103.58 N/A N/A 94000021 EAP CPT® 99195 PHLEBOTOMY BOTH IP/OP $189.00 $140.00 $37.51 $177.47 $102.63 $102.63 $102.63 $102.63 $110.92 $110.92 $110.43 $39.39 $110.92 $140.28 $140.28 $145.68 $98.47 $39.39 $177.47 $167.51 $111.79 $110.92 $98.11 $110.92 $116.46 $141.75 $110.92 $110.92 $110.92 $94.50 $94.50 $149.69 $110.92 $151.20 $122.85 $37.51 $110.92 $109.62 $116.46 $160.47 $110.92 $39.39 $110.92 N/A N/A 94000022 EAP CPT® 99195 THERAPEUTIC PHLEBOTOMY BOTH IP/OP $189.00 $140.00 $37.51 $177.47 $102.63 $102.63 $102.63 $102.63 $110.92 $110.92 $110.43 $39.39 $110.92 $140.28 $140.28 $145.68 $98.47 $39.39 $177.47 $167.51 $111.79 $110.92 $98.11 $110.92 $116.46 $141.75 $110.92 $110.92 $110.92 $94.50 $94.50 $149.69 $110.92 $151.20 $122.85 $37.51 $110.92 $109.62 $116.46 $160.47 $110.92 $39.39 $110.92 N/A N/A 94000031 EAP CPT® 95907 NERVE CONDUCTIONSTUDIES 1-2 STUDIE BOTH IP/OP $706.00 $522.50 $38.22 $564.80 $383.36 $383.36 $383.36 $383.36 $137.34 $137.34 $136.73 $147.15 $137.34 $523.99 $523.99 $544.18 $367.83 $147.14 $219.74 $209.80 $417.60 $137.34 $38.22 $137.34 $144.20 $529.50 $137.34 $137.34 $137.34 $353.00 $353.00 $559.15 $137.34 $564.80 $458.90 $140.12 $137.34 $409.48 $144.20 $198.69 $137.34 $147.13 $137.34 N/A N/A 94000033 EAP CPT® 97810 ACUPUNCT W/O STIMUL 15 MIN BOTH IP/OP $61.00 $45.50 $12.71 $61.00 $61.00 $61.00 $61.00 $61.00 $31.69 $31.69 $30.52 $61.00 $31.69 $45.27 $45.27 $47.02 $31.78 $12.71 $50.70 $49.34 $61.00 $31.69 $30.84 $31.69 $61.00 $45.75 $31.69 $31.69 $31.69 $30.50 $30.50 $48.31 $31.69 $48.80 $39.65 $61.00 $31.69 $35.38 $61.00 $36.60 $31.69 $61.00 $31.69 N/A N/A 94000034 EAP CPT® 97811 ACUPUNCT W/O STIMUL ADDL 15M BOTH IP/OP $31.00 $23.00 $6.46 $42.94 $31.00 $31.00 $31.00 $31.00 $26.84 $26.84 $25.32 $31.00 $26.84 $23.01 $23.01 $23.89 $16.15 $6.46 $42.94 $41.76 $31.00 $26.84 $26.10 $26.84 $31.00 $23.25 $26.84 $26.84 $26.84 $15.50 $15.50 $24.55 $26.84 $24.80 $20.15 $31.00 $26.84 $17.98 $31.00 $18.60 $26.84 $31.00 $26.84 N/A N/A 94000035 EAP CPT® 97813 ACUPUNCT W/STIMUL 15 MIN BOTH IP/OP $61.00 $45.50 $12.11 $48.80 $33.12 $33.12 $33.12 $33.12 $24.30 $24.30 $24.19 $12.71 $24.30 $45.27 $45.27 $47.02 $31.78 $12.71 $38.88 $36.00 $36.08 $24.30 $33.55 $24.30 $25.52 $45.75 $24.30 $24.30 $24.30 $30.50 $30.50 $48.31 $24.30 $48.80 $39.65 $12.11 $24.30 $35.38 $25.52 $35.16 $24.30 $12.71 $24.30 N/A N/A 94000036 EAP CPT® 97814 ACUPUNCT W/STIMUL ADDL 15M BOTH IP/OP $31.00 $23.00 $6.15 $31.00 $16.83 $16.83 $16.83 $16.83 $31.00 $31.00 $31.00 $6.46 $31.00 $23.01 $23.01 $23.89 $16.15 $6.46 $31.00 $31.00 $18.34 $31.00 $28.47 $31.00 $31.00 $23.25 $31.00 $31.00 $31.00 $15.50 $15.50 $24.55 $31.00 $24.80 $20.15 $6.15 $31.00 $17.98 $31.00 $31.00 $31.00 $6.46 $31.00 N/A N/A 94200001 EAP CPT® 97802 "MNT - INDIVIDUAL, INITIAL PER 15 MIN" BOTH IP/OP $98.00 $73.00 $19.45 $98.00 $53.21 $53.21 $53.21 $53.21 $32.78 $32.78 $33.05 $20.43 $32.78 $72.74 $72.74 $75.54 $51.06 $20.42 $52.45 $52.02 $57.97 $32.78 $32.51 $32.78 $98.00 $73.50 $32.78 $32.78 $32.78 $49.00 $49.00 $77.62 $32.78 $78.40 $63.70 $19.45 $32.78 $56.84 $98.00 $34.61 $32.78 $20.42 $32.78 N/A N/A 94200002 EAP CPT® 97803 "MNT - INDIVIDUAL, FOLLOW-UP PER 15 MIN" BOTH IP/OP $85.00 $63.00 $16.87 $85.00 $46.16 $46.16 $46.16 $46.16 $27.94 $27.94 $28.17 $17.72 $27.94 $63.09 $63.09 $65.52 $44.29 $17.71 $44.70 $43.89 $50.28 $27.94 $27.43 $27.94 $85.00 $63.75 $27.94 $27.94 $27.94 $42.50 $42.50 $67.32 $27.94 $68.00 $55.25 $16.87 $27.94 $49.30 $85.00 $29.21 $27.94 $17.71 $27.94 N/A N/A 94200003 EAP CPT® 97804 "MNT - GROUP, INITIAL OR FOLLOW-UP PER 30 MIN" BOTH IP/OP $46.00 $34.50 $9.13 $46.00 $24.98 $24.98 $24.98 $24.98 $15.53 $15.53 $15.66 $9.59 $15.53 $34.14 $34.14 $35.46 $23.97 $9.59 $24.85 $24.93 $27.21 $15.53 $15.58 $15.53 $46.00 $34.50 $15.53 $15.53 $15.53 $23.00 $23.00 $36.43 $15.53 $36.80 $29.90 $9.13 $15.53 $26.68 $46.00 $16.23 $15.53 $9.59 $15.53 N/A N/A 94200004 EAP HCPCS G0108 "DSMT - INDIVIDUAL, INITIAL OR FOLLOW-UP PER 30 MIN" BOTH IP/OP $155.00 $115.00 $30.76 $155.00 $84.17 $84.17 $84.17 $84.17 $55.85 $55.85 $55.96 $32.31 $55.85 $115.04 $115.04 $119.47 $80.76 $32.30 $89.36 $87.79 $91.68 $55.85 $54.87 $55.85 $155.00 $116.25 $55.85 $55.85 $55.85 $77.50 $77.50 $122.76 $55.85 $124.00 $100.75 $30.76 $55.85 $89.90 $155.00 $56.97 $55.85 $32.30 $55.85 N/A N/A 94200005 EAP HCPCS G0109 "DSMT - GROUP, INITIAL OR FOLLOW-UP PER 30 MIN" BOTH IP/OP $118.00 $87.50 $15.58 $118.00 $64.07 $64.07 $64.07 $64.07 $15.87 $15.87 $15.66 $24.59 $15.87 $87.58 $87.58 $90.95 $61.48 $24.59 $25.39 $24.93 $69.80 $15.87 $15.58 $15.87 $118.00 $88.50 $15.87 $15.87 $15.87 $59.00 $59.00 $93.46 $15.87 $94.40 $76.70 $23.42 $15.87 $68.44 $118.00 $15.86 $15.87 $24.59 $15.87 N/A N/A 94200012 EAP HCPCS G0270 MNT - INDIVIDUAL (BEYOND INITIAL 3HRS OR BEYOND 2HRS IN SUBQ YRS) - PER 15 MIN BOTH IP/OP $108.00 $80.00 $22.51 $108.00 $108.00 $108.00 $108.00 $108.00 $27.94 $27.94 $28.17 $108.00 $27.94 $80.16 $80.16 $83.25 $56.27 $22.51 $44.70 $43.89 $108.00 $27.94 $27.43 $27.94 $108.00 $81.00 $27.94 $27.94 $27.94 $54.00 $54.00 $85.54 $27.94 $86.40 $70.20 $108.00 $27.94 $62.64 $108.00 $29.21 $27.94 $108.00 $27.94 N/A N/A 94200013 EAP HCPCS G0271 MNT - GROUP (BEYOND INITIAL 3HRS OR BEYOND 2HRS IN SEBQ YRS) - PER 30 MIN BOTH IP/OP $59.00 $44.00 $11.71 $59.00 $32.04 $32.04 $32.04 $32.04 $15.53 $15.53 $15.66 $12.30 $15.53 $43.79 $43.79 $45.48 $30.74 $12.30 $24.85 $24.93 $34.90 $15.53 $15.58 $15.53 $59.00 $44.25 $15.53 $15.53 $15.53 $29.50 $29.50 $46.73 $15.53 $47.20 $38.35 $11.71 $15.53 $34.22 $59.00 $16.23 $15.53 $12.30 $15.53 N/A N/A 94200014 EAP CPT® 99412 CHILDBIRTH EDUCATION CLASS BOTH IP/OP $35.00 $26.00 $7.29 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $12.84 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 $35.00 $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 94200015 EAP CPT® 99078 CENTERING PREG GROUP SESSION BOTH IP/OP $126.00 $93.50 $25.01 $126.00 $68.42 $68.42 $68.42 $68.42 $126.00 $126.00 $126.00 $26.26 $126.00 $93.52 $93.52 $97.12 $65.65 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $81.90 $25.01 $126.00 $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 94300001 EAP CPT® 93797 CARDIAC REHAB - REGULAR BOTH IP/OP $143.00 $106.00 $8.81 $143.00 $143.00 $143.00 $143.00 $143.00 $9.27 $9.27 $9.35 $143.00 $9.27 $106.13 $106.13 $110.22 $74.50 $29.80 $14.83 $14.10 $143.00 $9.27 $8.81 $9.27 $143.00 $107.25 $9.27 $9.27 $9.27 $71.50 $71.50 $113.26 $9.27 $114.40 $92.95 $143.00 $9.27 $82.94 $143.00 $9.02 $9.27 $143.00 $9.27 N/A N/A 94400001 EAP CPT® 99408 ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN BOTH IP/OP $63.00 $47.00 $12.50 $63.00 $34.21 $34.21 $34.21 $34.21 $25.85 $25.85 $25.74 $13.13 $25.85 $46.76 $46.76 $48.56 $32.82 $13.13 $41.36 $42.82 $37.26 $25.85 $31.52 $25.85 $27.14 $47.25 $25.85 $25.85 $25.85 $31.50 $31.50 $49.90 $25.85 $50.40 $40.95 $12.50 $25.85 $36.54 $27.14 $37.80 $63.00 $13.13 $25.85 N/A N/A 94400002 EAP CPT® 99409 ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN BOTH IP/OP $320.00 $237.00 $64.15 $320.00 $320.00 $320.00 $320.00 $320.00 $65.70 $65.70 $64.15 $320.00 $65.70 $237.50 $237.50 $246.66 $166.72 $66.69 $105.12 $104.69 $320.00 $65.70 $65.43 $65.70 $320.00 $240.00 $65.70 $65.70 $65.70 $160.00 $160.00 $253.44 $65.70 $256.00 $208.00 $320.00 $65.70 $185.60 $320.00 $192.00 $320.00 $320.00 $65.70 N/A N/A 94600011 EAP Custom 94600011 KINAIR III W/O SCALE BOTH IP/OP $178.00 $132.00 $31.68 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $178.00 $31.68 $178.00 $178.00 $132.11 $132.11 $137.20 $92.74 $37.10 $178.00 $71.20 $178.00 $178.00 $178.00 $178.00 $178.00 $133.50 $178.00 $178.00 $178.00 $89.00 $89.00 $140.98 $178.00 $142.40 $115.70 $178.00 $178.00 $103.24 $178.00 $106.80 $178.00 $178.00 $178.00 N/A N/A 99900120 EAP HCPCS G1004 "CDSM NATIONAL DECISION SUPPORT COMPANY, MEDICARE AUC PROGRAM" BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 99900132 EAP Custom 99900132 "TRAUMA PROTOCOL, ECT" BOTH IP/OP "$27,445.00" "$20,309.50" "$4,885.21" "$27,445.00" "$27,445.00" "$27,445.00" "$27,445.00" "$27,445.00" "$27,445.00" "$27,445.00" "$4,885.21" "$27,445.00" "$27,445.00" "$27,445.00" "$27,445.00" "$27,445.00" "$27,445.00" "$5,719.84" "$27,445.00" "$10,648.00" "$27,445.00" "$27,445.00" "$26,620.00" "$27,445.00" "$27,445.00" "$20,583.75" "$27,445.00" "$27,445.00" "$27,445.00" "$13,722.50" "$13,722.50" "$21,736.44" "$27,445.00" "$21,956.00" "$17,839.25" "$27,445.00" "$27,445.00" "$15,918.10" "$27,445.00" "$16,467.00" "$27,445.00" "$27,445.00" "$27,445.00" N/A N/A 99900529 EAP Custom 99900529 "HEAD/NECK CTA W&W/O DYE,NCT" BOTH IP/OP "$13,698.00" "$10,137.00" $540.00 "$13,698.00" "$13,698.00" "$13,698.00" "$13,698.00" "$13,698.00" "$13,698.00" "$13,698.00" "$2,438.24" "$13,698.00" "$13,698.00" "$13,698.00" "$13,698.00" "$13,698.00" "$13,698.00" "$2,854.81" "$13,698.00" "$5,479.20" "$1,106.00" "$13,698.00" "$13,698.00" "$13,698.00" "$13,698.00" "$10,273.50" "$13,698.00" "$13,698.00" "$13,698.00" "$6,849.00" "$6,849.00" "$10,848.82" "$13,698.00" "$10,958.40" $540.00 "$13,698.00" "$13,698.00" "$7,944.84" "$13,698.00" "$8,218.80" "$13,698.00" "$13,698.00" "$13,698.00" N/A N/A 0002A EAP CPT® 0002A IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 2ND DOSE BOTH IP/OP $80.00 $59.50 $38.36 $80.00 $43.44 $43.44 $43.44 $43.44 $38.53 $38.53 $38.36 $44.75 $38.53 $80.00 $80.00 $80.00 $80.00 $46.99 $61.64 $59.90 $47.32 $38.53 $80.00 $38.53 $40.45 $60.00 $38.53 $38.53 $38.53 $40.00 $40.00 $63.36 $38.53 $64.00 $52.00 $44.75 $38.53 $46.40 $40.45 $55.74 $38.53 $44.75 $38.53 N/A N/A 0124A EAP CPT® 0124A "PR PFIZER COVID-19 ADMIN, BIVALENT BOOSTER 12 YEARS OR OLDER" BOTH IP/OP $80.00 $59.50 $16.67 $80.00 $43.44 $43.44 $43.44 $43.44 $80.00 $80.00 $80.00 $16.67 $80.00 $80.00 $80.00 $80.00 $80.00 $16.67 $80.00 $59.90 $47.32 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 $80.00 $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 0232T EAP CPT® 0232T INJECT PLATELET RICH PLASMA W/IMG HARVEST/PREPARATOIN BOTH IP/OP $600.00 $444.00 $113.00 $600.00 $600.00 $600.00 $600.00 $600.00 $266.97 $266.97 $265.79 $600.00 $266.97 $600.00 $600.00 $600.00 $600.00 $600.00 $427.15 $544.70 $113.00 $266.97 $600.00 $266.97 $280.32 $450.00 $266.97 $266.97 $266.97 $600.00 $600.00 $600.00 $266.97 $600.00 $600.00 $600.00 $266.97 $348.00 $280.32 $386.24 $266.97 $600.00 $266.97 N/A N/A 1111F EAP CPT® 1111F DISCHARGE MEDS RECONCILED W/ CURRENT OUTPATIENT MED LIST BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 1170F EAP CPT® 1170F PR FUNCTIONAL STATUS ASSESSED BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 3074F EAP CPT® 3074F MOST RECENT SYSTOLIC BLOOD PRESSURE < 130 MM HG BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 3075F EAP CPT® 3075F MOST RECENT SYSTOLIC BLOOD PRESS GE 130-139MM HG BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 3077F EAP CPT® 3077F MOST RECENT SYSTOLIC BLOOD PRESSURE >= 140 MM HG BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 3078F EAP CPT® 3078F MOST RECENT DIASTOLIC BLOOD PRESSURE < 80 MM HG BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 3079F EAP CPT® 3079F MOST RECENT DIASTOLIC BLOOD PRESSURE 80-89 MM HG BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A 3080F EAP CPT® 3080F MOST RECENT DIASTOLIC BLOOD PRESSURE >= 90 MM HG BOTH IP/OP $0.01 $0.50 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 $0.01 N/A N/A G0101 EAP HCPCS G0101 CA SCREEN;PELVIC/BREAST EXAM BOTH IP/OP $111.00 $82.50 $22.03 $117.77 $60.27 $60.27 $60.27 $60.27 $73.60 $73.60 $73.28 $23.14 $73.60 $82.38 $82.38 $85.56 $57.83 $23.13 $117.77 $109.43 $65.66 $73.60 $27.81 $73.60 $77.28 $83.25 $73.60 $73.60 $73.60 $55.50 $55.50 $87.91 $73.60 $88.80 $72.15 $22.03 $73.60 $64.38 $77.28 $106.49 $73.60 $23.13 $73.60 N/A N/A G0108 EAP HCPCS G0108 DIAB MANAGE TRN PER INDIV BOTH IP/OP $155.00 $115.00 $30.76 $155.00 $84.17 $84.17 $84.17 $84.17 $55.85 $55.85 $55.96 $32.31 $55.85 $115.04 $115.04 $119.47 $80.76 $32.30 $89.36 $87.79 $91.68 $55.85 $54.87 $55.85 $155.00 $116.25 $55.85 $55.85 $55.85 $77.50 $77.50 $122.76 $55.85 $124.00 $100.75 $30.76 $55.85 $89.90 $155.00 $56.97 $55.85 $32.30 $55.85 N/A N/A G0109 EAP HCPCS G0109 DIAB MANAGE TRN IND/GROUP BOTH IP/OP $44.00 $33.00 $8.73 $44.00 $23.89 $23.89 $23.89 $23.89 $15.87 $15.87 $15.66 $9.17 $15.87 $32.66 $32.66 $33.92 $22.92 $9.17 $25.39 $24.93 $26.03 $15.87 $15.58 $15.87 $44.00 $33.00 $15.87 $15.87 $15.87 $22.00 $22.00 $34.85 $15.87 $35.20 $28.60 $8.73 $15.87 $25.52 $44.00 $15.86 $15.87 $9.17 $15.87 N/A N/A G0402 EAP HCPCS G0402 WELCOME TO MEDICARE -PREVENTIVE VISIT BOTH IP/OP $468.00 $346.50 $67.13 $468.00 $468.00 $468.00 $468.00 $468.00 $116.88 $116.88 $116.36 $67.13 $116.88 $311.31 $311.31 $323.29 $218.52 $97.54 $187.01 $174.36 $276.82 $116.88 $131.51 $116.88 $122.72 $351.00 $116.88 $116.88 $116.88 $234.00 $234.00 $370.66 $116.88 $374.40 $468.00 $92.89 $116.88 $271.44 $122.72 $169.10 $116.88 $97.53 $116.88 N/A N/A G0438 EAP HCPCS G0438 FIRST ANNUAL WELLNESS VISIT BOTH IP/OP $468.00 $346.50 $67.13 $468.00 $468.00 $468.00 $468.00 $468.00 $168.86 $168.86 $468.00 $67.13 $168.86 $311.31 $311.31 $323.29 $218.52 $97.54 $270.18 $266.14 $276.82 $168.86 $166.34 $168.86 $468.00 $351.00 $168.86 $168.86 $168.86 $234.00 $234.00 $370.66 $168.86 $374.40 $468.00 $92.89 $168.86 $271.44 $468.00 $172.69 $168.86 $97.53 $168.86 N/A N/A G0439 EAP HCPCS G0439 SUBSEQUENT ANNUAL WELLNESS VISIT-MDICARE BOTH IP/OP $366.00 $271.00 $67.13 $366.00 $366.00 $366.00 $366.00 $366.00 $132.05 $132.05 $366.00 $67.13 $132.05 $311.31 $311.31 $323.29 $218.52 $76.28 $211.28 $208.11 $216.49 $132.05 $130.07 $132.05 $366.00 $274.50 $132.05 $132.05 $132.05 $183.00 $183.00 $289.87 $132.05 $292.80 $366.00 $72.64 $132.05 $212.28 $366.00 $117.16 $132.05 $76.27 $132.05 N/A N/A G0447 EAP HCPCS G0447 "FACE-TO-FACE BEHAVIORAL COUNSELING FOR OBESITY, 15 MINUS" BOTH IP/OP $74.00 $55.00 $14.69 $117.77 $40.18 $40.18 $40.18 $40.18 $73.60 $73.60 $73.28 $15.42 $73.60 $54.92 $54.92 $57.04 $38.55 $15.42 $117.77 $109.43 $43.77 $73.60 $23.05 $73.60 $77.28 $55.50 $73.60 $73.60 $73.60 $37.00 $37.00 $58.61 $73.60 $59.20 $48.10 $14.69 $73.60 $42.92 $77.28 $74.00 $73.60 $15.42 $73.60 N/A N/A 103 ERX HCPCS 25000001 45802-0732-30 ACETAMINOPHEN 120 MG RECTAL SUPP BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 104 ERX HCPCS 25000001 ACETAMINOPHEN 325 MG RECTAL SUPP BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 105 ERX HCPCS 25000001 45802-0730-32 ACETAMINOPHEN 650 MG RECTAL SUPP BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 113 ERX HCPCS 63700001 51672-4023-01 ACETAZOLAMIDE 250 MG PO TABS BOTH IP/OP $12.50 $9.00 $2.60 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $2.60 $12.46 $4.98 $12.46 $12.46 $12.46 $12.46 $12.46 $9.38 $12.46 $12.46 $12.46 $6.23 $6.23 $9.87 $12.46 $9.97 $8.10 $12.46 $12.46 $7.25 $12.46 $7.48 $12.46 $12.46 $12.46 N/A N/A 114 ERX HCPCS J1120 00143-9503-01 ACETAZOLAMIDE SODIUM 500 MG IJ SOLR BOTH IP/OP $105.00 $78.00 $23.48 $104.98 $47.24 $47.24 $47.24 $47.24 $104.98 $104.98 $104.98 $41.60 $104.98 $24.42 $24.42 $25.36 $23.48 $27.59 $104.98 $104.98 $62.10 $104.98 $104.98 $104.98 $104.98 $78.75 $104.98 $104.98 $104.98 $52.49 $52.49 $83.14 $104.98 $83.98 $47.24 $26.27 $104.98 $60.90 $104.98 $104.98 $104.98 $26.27 $104.98 N/A N/A 123 ERX HCPCS J7608 00517-7604-25 ACETYLCYSTEINE 20 % IN SOLN BOTH IP/OP $48.50 $36.00 $6.08 $48.49 $48.49 $48.49 $48.49 $48.49 $48.49 $48.49 $6.08 $48.49 $48.49 $6.35 $6.35 $6.60 $6.11 $10.11 $48.49 $19.40 $48.49 $48.49 $48.49 $48.49 $48.49 $36.38 $48.49 $48.49 $48.49 $24.25 $24.25 $38.40 $48.49 $38.79 $21.82 $48.49 $48.49 $28.13 $48.49 $29.09 $48.49 $48.49 $48.49 N/A N/A 250 ERX HCPCS 25000001 00487-9501-01 ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 252 ERX HCPCS 25000001 99999-6010-97 ALBUTEROL SULFATE 2 MG/5ML PO SYRP BOTH IP/OP $22.50 $17.00 $3.92 $22.04 $22.04 $22.04 $22.04 $22.04 $22.04 $22.04 $3.92 $22.04 $22.04 $16.36 $16.36 $16.99 $11.48 $4.59 $22.04 $8.82 $22.04 $22.04 $22.04 $22.04 $22.04 $16.88 $22.04 $22.04 $22.04 $11.02 $11.02 $17.46 $22.04 $17.63 $14.33 $22.04 $22.04 $13.05 $22.04 $13.22 $22.04 $22.04 $22.04 N/A N/A 310 ERX HCPCS 63700001 62584-0988-01 ALLOPURINOL 100 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 311 ERX HCPCS 63700001 51079-0206-20 ALLOPURINOL 300 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 345 ERX HCPCS 25000001 00395-0049-96 ALUM AMMONIUM POWD BOTH IP/OP $36.00 $27.00 $6.41 $35.99 $35.99 $35.99 $35.99 $35.99 $35.99 $35.99 $6.41 $35.99 $35.99 $26.71 $26.71 $27.74 $18.75 $7.50 $35.99 $14.40 $35.99 $35.99 $35.99 $35.99 $35.99 $27.00 $35.99 $35.99 $35.99 $18.00 $18.00 $28.50 $35.99 $28.79 $23.39 $35.99 $35.99 $20.88 $35.99 $21.59 $35.99 $35.99 $35.99 N/A N/A 353 ERX HCPCS 63700001 99999-6009-93 ALUMINUM HYDROXIDE GEL 320 MG/5ML PO SUSP BOTH IP/OP $12.50 $9.00 $2.59 $12.45 $12.45 $12.45 $12.45 $12.45 $12.45 $12.45 $12.45 $12.45 $12.45 $12.45 $12.45 $12.45 $12.45 $2.59 $12.45 $4.98 $12.45 $12.45 $12.45 $12.45 $12.45 $9.38 $12.45 $12.45 $12.45 $6.23 $6.23 $9.86 $12.45 $9.96 $8.09 $12.45 $12.45 $7.25 $12.45 $7.47 $12.45 $12.45 $12.45 N/A N/A 364 ERX HCPCS 63700001 62332-0246-31 AMANTADINE HCL 100 MG PO CAPS BOTH IP/OP $8.50 $6.00 $1.75 $8.38 $8.38 $8.38 $8.38 $8.38 $8.38 $8.38 $8.38 $8.38 $8.38 $8.38 $8.38 $8.38 $8.38 $1.75 $8.38 $3.35 $8.38 $8.38 $8.38 $8.38 $8.38 $6.38 $8.38 $8.38 $8.38 $4.19 $4.19 $6.64 $8.38 $6.70 $5.45 $8.38 $8.38 $4.93 $8.38 $5.03 $8.38 $8.38 $8.38 N/A N/A 391 ERX HCPCS 63700001 00574-0292-01 AMILORIDE HCL 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 403 ERX HCPCS 25000001 00409-4346-73 AMINOCAPROIC ACID 250 MG/ML IV SOLN BOTH IP/OP $38.00 $28.00 $6.72 $37.76 $37.76 $37.76 $37.76 $37.76 $37.76 $37.76 $6.72 $37.76 $37.76 $28.03 $28.03 $29.11 $19.67 $7.87 $37.76 $15.10 $37.76 $37.76 $37.76 $37.76 $37.76 $28.50 $37.76 $37.76 $37.76 $18.88 $18.88 $29.91 $37.76 $30.21 $24.54 $37.76 $37.76 $22.04 $37.76 $22.66 $37.76 $37.76 $37.76 N/A N/A 407 ERX HCPCS J0280 00409-5922-01 AMINOPHYLLINE 25 MG/ML IV SOLN BOTH IP/OP $22.00 $16.00 $6.14 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $8.57 $22.00 $22.00 $6.39 $6.39 $6.63 $6.14 $7.21 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 437 ERX HCPCS 63700001 16714-0449-01 AMITRIPTYLINE HCL 75 MG PO TABS BOTH IP/OP $8.00 $6.00 $1.63 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $1.63 $7.84 $3.14 $7.84 $7.84 $7.84 $7.84 $7.84 $6.00 $7.84 $7.84 $7.84 $3.92 $3.92 $6.21 $7.84 $6.27 $5.10 $7.84 $7.84 $4.64 $7.84 $4.70 $7.84 $7.84 $7.84 N/A N/A 449 ERX HCPCS 63700001 00591-5714-01 AMOXAPINE 50 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 450 ERX HCPCS 63700001 00781-2020-01 AMOXICILLIN 250 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 451 ERX HCPCS 63700001 65862-0017-05 AMOXICILLIN 500 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 452 ERX HCPCS 63700001 00093-2268-01 AMOXICILLIN 250 MG PO CHEW BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 454 ERX HCPCS 63700001 00143-9889-15 AMOXICILLIN 250 MG/5ML PO SUSR BOTH IP/OP $30.50 $23.00 $6.35 $30.46 $30.46 $30.46 $30.46 $30.46 $30.46 $30.46 $30.46 $30.46 $30.46 $30.46 $30.46 $30.46 $30.46 $6.35 $30.46 $12.18 $30.46 $30.46 $30.46 $30.46 $30.46 $22.88 $30.46 $30.46 $30.46 $15.23 $15.23 $24.12 $30.46 $24.37 $19.80 $30.46 $30.46 $17.69 $30.46 $18.28 $30.46 $30.46 $30.46 N/A N/A 464 ERX HCPCS J0285 39822-1055-05 AMPHOTERICIN B 50 MG IV SOLR BOTH IP/OP $196.00 $145.00 $41.00 $195.58 $195.58 $195.58 $195.58 $195.58 $195.58 $195.58 $42.65 $195.58 $195.58 $42.64 $42.64 $44.28 $41.00 $48.17 $195.58 $78.23 $195.58 $195.58 $195.58 $195.58 $195.58 $147.00 $195.58 $195.58 $195.58 $97.79 $97.79 $154.90 $195.58 $156.46 $88.01 $195.58 $195.58 $113.68 $195.58 $117.35 $195.58 $195.58 $195.58 N/A N/A 466 ERX HCPCS 63700001 00781-2145-01 AMPICILLIN 500 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 469 ERX HCPCS J0290 00781-9404-95 AMPICILLIN SODIUM 1 G IJ SOLR BOTH IP/OP $37.50 $28.00 $1.42 $37.31 $16.79 $16.79 $16.79 $16.79 $37.31 $37.31 $37.31 $5.22 $37.31 $1.48 $1.48 $1.53 $1.42 $1.67 $37.31 $37.31 $22.07 $37.31 $37.31 $37.31 $37.31 $28.13 $37.31 $37.31 $37.31 $18.66 $18.66 $29.55 $37.31 $29.85 $16.79 $1.59 $37.31 $21.75 $37.31 $37.31 $37.31 $1.59 $37.31 N/A N/A 471 ERX HCPCS 25000001 00781-3400-95 AMPICILLIN SODIUM 125 MG IJ SOLR BOTH IP/OP $23.00 $17.00 $4.02 $22.56 $22.56 $22.56 $22.56 $22.56 $22.56 $22.56 $4.02 $22.56 $22.56 $16.74 $16.74 $17.39 $11.75 $4.70 $22.56 $9.02 $22.56 $22.56 $22.56 $22.56 $22.56 $17.25 $22.56 $22.56 $22.56 $11.28 $11.28 $17.87 $22.56 $18.05 $14.66 $22.56 $22.56 $13.34 $22.56 $13.54 $22.56 $22.56 $22.56 N/A N/A 472 ERX HCPCS J0290 00781-9408-95 AMPICILLIN SODIUM 2 G IJ SOLR BOTH IP/OP $72.50 $54.00 $2.84 $72.38 $32.57 $32.57 $32.57 $32.57 $72.38 $72.38 $72.38 $10.43 $72.38 $2.95 $2.95 $3.07 $2.84 $3.34 $72.38 $72.38 $42.81 $72.38 $72.38 $72.38 $72.38 $54.38 $72.38 $72.38 $72.38 $36.19 $36.19 $57.32 $72.38 $57.90 $32.57 $3.18 $72.38 $42.05 $72.38 $72.38 $72.38 $3.18 $72.38 N/A N/A 474 ERX HCPCS J0290 00781-3407-95 AMPICILLIN SODIUM 500 MG IJ SOLR BOTH IP/OP $22.00 $16.00 $0.71 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $2.61 $22.00 $0.74 $0.74 $0.77 $0.71 $0.83 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.79 $22.00 $12.76 $22.00 $22.00 $22.00 $0.79 $22.00 N/A N/A 612 ERX HCPCS 63700001 72140-0452-31 AQUAPHOR EX OINT BOTH IP/OP $32.50 $24.00 $6.71 $32.19 $32.19 $32.19 $32.19 $32.19 $32.19 $32.19 $32.19 $32.19 $32.19 $32.19 $32.19 $32.19 $32.19 $6.71 $32.19 $12.88 $32.19 $32.19 $32.19 $32.19 $32.19 $24.38 $32.19 $32.19 $32.19 $16.10 $16.10 $25.49 $32.19 $25.75 $20.92 $32.19 $32.19 $18.85 $32.19 $19.31 $32.19 $32.19 $32.19 N/A N/A 680 ERX HCPCS 25000001 00536-1008-36 ASPIRIN 81 MG PO CHEW BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 681 ERX HCPCS 25000001 66553-0001-01 ASPIRIN 325 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 693 ERX HCPCS 25000001 00574-7034-12 ASPIRIN 300 MG RECTAL SUPP BOTH IP/OP $6.50 $5.00 $1.12 $6.30 $6.30 $6.30 $6.30 $6.30 $6.30 $6.30 $1.12 $6.30 $6.30 $4.68 $4.68 $4.86 $3.28 $1.31 $6.30 $2.52 $6.30 $6.30 $6.30 $6.30 $6.30 $4.88 $6.30 $6.30 $6.30 $3.15 $3.15 $4.99 $6.30 $5.04 $4.10 $6.30 $6.30 $3.77 $6.30 $3.78 $6.30 $6.30 $6.30 N/A N/A 716 ERX HCPCS 63700001 51079-0685-20 ATENOLOL 100 MG PO TABS BOTH IP/OP $6.50 $5.00 $1.34 $6.45 $6.45 $6.45 $6.45 $6.45 $6.45 $6.45 $6.45 $6.45 $6.45 $6.45 $6.45 $6.45 $6.45 $1.34 $6.45 $2.58 $6.45 $6.45 $6.45 $6.45 $6.45 $4.88 $6.45 $6.45 $6.45 $3.23 $3.23 $5.11 $6.45 $5.16 $4.19 $6.45 $6.45 $3.77 $6.45 $3.87 $6.45 $6.45 $6.45 N/A N/A 717 ERX HCPCS 63700001 51079-0759-20 ATENOLOL 25 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 731 ERX HCPCS J0461 00517-0401-25 ATROPINE SULFATE 0.4 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $1.80 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $1.87 $1.87 $1.94 $1.80 $2.11 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $2.01 $22.00 $12.76 $22.00 $22.00 $22.00 $2.01 $22.00 N/A N/A 734 ERX HCPCS J0461 00517-1010-25 ATROPINE SULFATE 1 MG/ML IJ SOLN BOTH IP/OP $65.50 $48.00 $9.00 $65.12 $29.30 $29.30 $29.30 $29.30 $65.12 $65.12 $65.12 $13.57 $65.12 $9.36 $9.36 $9.72 $9.00 $10.57 $65.12 $65.12 $38.52 $65.12 $65.12 $65.12 $65.12 $49.13 $65.12 $65.12 $65.12 $32.56 $32.56 $51.58 $65.12 $52.10 $29.30 $10.07 $65.12 $37.99 $65.12 $65.12 $65.12 $10.07 $65.12 N/A N/A 735 ERX HCPCS 25000001 24208-0825-55 ATROPINE SULFATE 1 % OP OINT BOTH IP/OP $84.00 $62.00 $14.89 $83.63 $83.63 $83.63 $83.63 $83.63 $83.63 $83.63 $14.89 $83.63 $83.63 $62.07 $62.07 $64.46 $43.57 $17.43 $83.63 $33.45 $83.63 $83.63 $83.63 $83.63 $83.63 $63.00 $83.63 $83.63 $83.63 $41.82 $41.82 $66.23 $83.63 $66.90 $54.36 $83.63 $83.63 $48.72 $83.63 $50.18 $83.63 $83.63 $83.63 N/A N/A 850 ERX HCPCS 25000001 00713-0280-31 BACITRACIN 500 UNIT/GM EX OINT BOTH IP/OP $15.00 $11.00 $2.66 $14.97 $14.97 $14.97 $14.97 $14.97 $14.97 $14.97 $2.66 $14.97 $14.97 $11.11 $11.11 $11.54 $7.80 $3.12 $14.97 $5.99 $14.97 $14.97 $14.97 $14.97 $14.97 $11.25 $14.97 $14.97 $14.97 $7.49 $7.49 $11.86 $14.97 $11.98 $9.73 $14.97 $14.97 $8.70 $14.97 $8.98 $14.97 $14.97 $14.97 N/A N/A 854 ERX HCPCS 25000001 45802-0143-03 BACITRACIN-NEOMYCIN-POLYMYXIN 400-5-5000 EX OINT BOTH IP/OP $27.00 $20.00 $4.74 $26.62 $26.62 $26.62 $26.62 $26.62 $26.62 $26.62 $4.74 $26.62 $26.62 $19.76 $19.76 $20.52 $13.87 $5.55 $26.62 $10.65 $26.62 $26.62 $26.62 $26.62 $26.62 $20.25 $26.62 $26.62 $26.62 $13.31 $13.31 $21.08 $26.62 $21.30 $17.30 $26.62 $26.62 $15.66 $26.62 $15.97 $26.62 $26.62 $26.62 N/A N/A 856 ERX HCPCS 25000001 24208-0555-55 BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM OP OINT BOTH IP/OP $114.50 $85.00 $20.30 $114.04 $114.04 $114.04 $114.04 $114.04 $114.04 $114.04 $20.30 $114.04 $114.04 $84.64 $84.64 $87.90 $59.41 $23.77 $114.04 $45.62 $114.04 $114.04 $114.04 $114.04 $114.04 $85.88 $114.04 $114.04 $114.04 $57.02 $57.02 $90.32 $114.04 $91.23 $74.13 $114.04 $114.04 $66.41 $114.04 $68.42 $114.04 $114.04 $114.04 N/A N/A 860 ERX HCPCS 63700001 63739-0479-10 BACLOFEN 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 987 ERX HCPCS 25000001 00395-0243-92 BENZOIN COMPOUND EX TINC BOTH IP/OP $43.50 $32.00 $7.67 $43.08 $43.08 $43.08 $43.08 $43.08 $43.08 $43.08 $7.67 $43.08 $43.08 $31.97 $31.97 $33.21 $22.44 $8.98 $43.08 $17.23 $43.08 $43.08 $43.08 $43.08 $43.08 $32.63 $43.08 $43.08 $43.08 $21.54 $21.54 $34.12 $43.08 $34.46 $28.00 $43.08 $43.08 $25.23 $43.08 $25.85 $43.08 $43.08 $43.08 N/A N/A 988 ERX HCPCS 63700001 68382-0247-01 BENZONATATE 100 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 989 ERX HCPCS 25000001 00536-1056-56 BENZOYL PEROXIDE 10 % EX GEL BOTH IP/OP $30.00 $22.00 $5.33 $29.93 $29.93 $29.93 $29.93 $29.93 $29.93 $29.93 $5.33 $29.93 $29.93 $22.21 $22.21 $23.07 $15.59 $6.24 $29.93 $11.97 $29.93 $29.93 $29.93 $29.93 $29.93 $22.50 $29.93 $29.93 $29.93 $14.97 $14.97 $23.70 $29.93 $23.94 $19.45 $29.93 $29.93 $17.40 $29.93 $17.96 $29.93 $29.93 $29.93 N/A N/A 991 ERX HCPCS 25000001 00536-1055-56 BENZOYL PEROXIDE 5 % EX GEL BOTH IP/OP $25.00 $19.00 $4.38 $24.61 $24.61 $24.61 $24.61 $24.61 $24.61 $24.61 $4.38 $24.61 $24.61 $18.27 $18.27 $18.97 $12.82 $5.13 $24.61 $9.84 $24.61 $24.61 $24.61 $24.61 $24.61 $18.75 $24.61 $24.61 $24.61 $12.31 $12.31 $19.49 $24.61 $19.69 $16.00 $24.61 $24.61 $14.50 $24.61 $14.77 $24.61 $24.61 $24.61 N/A N/A 998 ERX HCPCS 63700001 68084-0381-01 BENZTROPINE MESYLATE 0.5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 999 ERX HCPCS 63700001 10135-0607-01 BENZTROPINE MESYLATE 1 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 1029 ERX HCPCS 63700001 00168-0056-15 BETAMETHASONE DIPROPIONATE 0.05 % EX OINT BOTH IP/OP $220.50 $163.00 $45.88 $220.12 $220.12 $220.12 $220.12 $220.12 $220.12 $220.12 $220.12 $220.12 $220.12 $220.12 $220.12 $220.12 $220.12 $45.88 $220.12 $88.05 $220.12 $220.12 $220.12 $220.12 $220.12 $165.38 $220.12 $220.12 $220.12 $110.06 $110.06 $174.34 $220.12 $176.10 $143.08 $220.12 $220.12 $127.89 $220.12 $132.07 $220.12 $220.12 $220.12 N/A N/A 1044 ERX HCPCS 63700001 53746-0573-01 BETHANECHOL CHLORIDE 25 MG PO TABS BOTH IP/OP $9.50 $7.00 $1.93 $9.25 $9.25 $9.25 $9.25 $9.25 $9.25 $9.25 $9.25 $9.25 $9.25 $9.25 $9.25 $9.25 $9.25 $1.93 $9.25 $3.70 $9.25 $9.25 $9.25 $9.25 $9.25 $7.13 $9.25 $9.25 $9.25 $4.63 $4.63 $7.33 $9.25 $7.40 $6.01 $9.25 $9.25 $5.51 $9.25 $5.55 $9.25 $9.25 $9.25 N/A N/A 1045 ERX HCPCS 63700001 53746-0571-01 BETHANECHOL CHLORIDE 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 1080 ERX HCPCS 63700001 00574-7050-12 BISACODYL 10 MG RECTAL SUPP BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 1090 ERX HCPCS 25000001 00536-1286-36 BISMUTH SUBSALICYLATE 262 MG/15ML PO SUSP BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 1262 ERX HCPCS 25000001 00517-2502-10 CAFFEINE-SODIUM BENZOATE 125-125 MG/ML IJ SOLN BOTH IP/OP $72.00 $53.00 $12.74 $71.57 $71.57 $71.57 $71.57 $71.57 $71.57 $71.57 $12.74 $71.57 $71.57 $53.12 $53.12 $55.17 $37.29 $14.92 $71.57 $28.63 $71.57 $71.57 $71.57 $71.57 $71.57 $54.00 $71.57 $71.57 $71.57 $35.79 $35.79 $56.68 $71.57 $57.26 $46.52 $71.57 $71.57 $41.76 $71.57 $42.94 $71.57 $71.57 $71.57 N/A N/A 1306 ERX HCPCS 25000001 76329-3304-01 CALCIUM CHLORIDE 10 % IV SOLN BOTH IP/OP $92.50 $68.00 $16.43 $92.30 $92.30 $92.30 $92.30 $92.30 $92.30 $92.30 $16.43 $92.30 $92.30 $68.51 $68.51 $71.14 $48.09 $19.24 $92.30 $36.92 $92.30 $92.30 $92.30 $92.30 $92.30 $69.38 $92.30 $92.30 $92.30 $46.15 $46.15 $73.10 $92.30 $73.84 $60.00 $92.30 $92.30 $53.65 $92.30 $55.38 $92.30 $92.30 $92.30 N/A N/A 1312 ERX HCPCS J0613 63323-0360-19 CALCIUM GLUCONATE 10 % IV SOLN BOTH IP/OP $52.00 $38.00 $9.24 $51.93 $51.93 $51.93 $51.93 $51.93 $51.93 $51.93 $9.24 $51.93 $51.93 $51.93 $51.93 $51.93 $51.93 $10.82 $51.93 $20.77 $51.93 $51.93 $51.93 $51.93 $51.93 $39.00 $51.93 $51.93 $51.93 $25.97 $25.97 $41.13 $51.93 $41.54 $23.37 $51.93 $51.93 $30.16 $51.93 $31.16 $51.93 $51.93 $51.93 N/A N/A 1350 ERX HCPCS 63700001 00536-2525-25 CAPSAICIN 0.025 % EX CREA BOTH IP/OP $43.50 $32.00 $8.97 $43.03 $43.03 $43.03 $43.03 $43.03 $43.03 $43.03 $43.03 $43.03 $43.03 $43.03 $43.03 $43.03 $43.03 $8.97 $43.03 $17.21 $43.03 $43.03 $43.03 $43.03 $43.03 $32.63 $43.03 $43.03 $43.03 $21.52 $21.52 $34.08 $43.03 $34.42 $27.97 $43.03 $43.03 $25.23 $43.03 $25.82 $43.03 $43.03 $43.03 N/A N/A 1355 ERX HCPCS 63700001 00904-3854-61 CARBAMAZEPINE 100 MG PO CHEW BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 1356 ERX HCPCS 25000001 99999-6004-61 CARBAMAZEPINE 100 MG/5ML PO SUSP BOTH IP/OP $110.50 $82.00 $19.64 $110.33 $110.33 $110.33 $110.33 $110.33 $110.33 $110.33 $19.64 $110.33 $110.33 $81.89 $81.89 $85.04 $57.48 $22.99 $110.33 $44.13 $110.33 $110.33 $110.33 $110.33 $110.33 $82.88 $110.33 $110.33 $110.33 $55.17 $55.17 $87.38 $110.33 $88.26 $71.71 $110.33 $110.33 $64.09 $110.33 $66.20 $110.33 $110.33 $110.33 N/A N/A 1446 ERX HCPCS J0690 25021-0102-99 CEFAZOLIN SODIUM 10 G IJ SOLR BOTH IP/OP $62.50 $46.00 $13.87 $62.21 $27.99 $27.99 $27.99 $27.99 $62.21 $62.21 $62.21 $13.87 $62.21 $16.02 $16.02 $16.63 $15.40 $18.09 $62.21 $62.21 $36.80 $62.21 $62.21 $62.21 $62.21 $46.88 $62.21 $62.21 $62.21 $31.11 $31.11 $49.27 $62.21 $49.77 $27.99 $17.23 $62.21 $36.25 $62.21 $62.21 $62.21 $17.23 $62.21 N/A N/A 1448 ERX HCPCS J0690 63323-0236-10 CEFAZOLIN SODIUM 500 MG IJ SOLR BOTH IP/OP $22.00 $16.00 $0.69 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.69 $22.00 $0.80 $0.80 $0.83 $0.77 $0.90 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.86 $22.00 $12.76 $22.00 $22.00 $22.00 $0.86 $22.00 N/A N/A 1465 ERX HCPCS J0697 25021-0118-10 CEFUROXIME SODIUM 750 MG IJ SOLR BOTH IP/OP $22.00 $16.00 $1.99 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $2.01 $22.00 $22.00 $2.07 $2.07 $2.15 $1.99 $2.34 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 1622 ERX HCPCS 25000001 51079-0375-01 CHLORDIAZEPOXIDE HCL 10 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 1623 ERX HCPCS 25000001 00555-0159-02 CHLORDIAZEPOXIDE HCL 25 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 1637 ERX HCPCS 63700001 64980-0177-50 CHLOROQUINE PHOSPHATE 250 MG PO TABS BOTH IP/OP $40.00 $30.00 $8.28 $39.72 $39.72 $39.72 $39.72 $39.72 $39.72 $39.72 $39.72 $39.72 $39.72 $39.72 $39.72 $39.72 $39.72 $8.28 $39.72 $15.89 $39.72 $39.72 $39.72 $39.72 $39.72 $30.00 $39.72 $39.72 $39.72 $19.86 $19.86 $31.46 $39.72 $31.78 $25.82 $39.72 $39.72 $23.20 $39.72 $23.83 $39.72 $39.72 $39.72 N/A N/A 1645 ERX HCPCS 63700001 00904-0012-59 CHLORPHENIRAMINE MALEATE 4 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 1649 ERX HCPCS J3230 00641-1397-35 CHLORPROMAZINE HCL 25 MG/ML IJ SOLN BOTH IP/OP $138.00 $102.00 $32.02 $137.98 $137.98 $137.98 $137.98 $137.98 $137.98 $137.98 $32.87 $137.98 $137.98 $33.30 $33.30 $34.58 $32.02 $37.62 $137.98 $55.19 $137.98 $137.98 $137.98 $137.98 $137.98 $103.50 $137.98 $137.98 $137.98 $68.99 $68.99 $109.28 $137.98 $110.38 $62.09 $137.98 $137.98 $80.04 $137.98 $82.79 $137.98 $137.98 $137.98 N/A N/A 1653 ERX HCPCS Q0161 00832-6017-00 CHLORPROMAZINE HCL 10 MG PO TABS BOTH IP/OP $18.50 $14.00 $2.64 $18.15 $8.17 $8.17 $8.17 $8.17 $18.15 $18.15 $18.15 $3.78 $18.15 $2.75 $2.75 $2.85 $2.64 $3.78 $18.15 $18.15 $10.74 $18.15 $18.15 $18.15 $18.15 $13.88 $18.15 $18.15 $18.15 $9.08 $9.08 $14.37 $18.15 $14.52 $8.17 $3.60 $18.15 $10.73 $18.15 $18.15 $18.15 $3.78 $18.15 N/A N/A 1657 ERX HCPCS Q0161 00832-0302-00 CHLORPROMAZINE HCL 50 MG PO TABS BOTH IP/OP $45.00 $33.00 $8.90 $44.82 $20.17 $20.17 $20.17 $20.17 $44.82 $44.82 $44.82 $9.34 $44.82 $13.73 $13.73 $14.26 $13.20 $9.34 $44.82 $44.82 $26.51 $44.82 $44.82 $44.82 $44.82 $33.75 $44.82 $44.82 $44.82 $22.41 $22.41 $35.50 $44.82 $35.86 $20.17 $8.90 $44.82 $26.10 $44.82 $44.82 $44.82 $9.34 $44.82 N/A N/A 1661 ERX HCPCS 63700001 00378-0222-01 CHLORTHALIDONE 25 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 1662 ERX HCPCS 63700001 00378-0213-01 CHLORTHALIDONE 50 MG PO TABS BOTH IP/OP $6.50 $5.00 $1.34 $6.43 $6.43 $6.43 $6.43 $6.43 $6.43 $6.43 $6.43 $6.43 $6.43 $6.43 $6.43 $6.43 $6.43 $1.34 $6.43 $2.57 $6.43 $6.43 $6.43 $6.43 $6.43 $4.88 $6.43 $6.43 $6.43 $3.22 $3.22 $5.09 $6.43 $5.14 $4.18 $6.43 $6.43 $3.77 $6.43 $3.86 $6.43 $6.43 $6.43 N/A N/A 1664 ERX HCPCS 63700001 00591-2520-01 CHLORZOXAZONE 500 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 1676 ERX HCPCS J0725 55566-1501-01 CHORIONIC GONADOTROPIN 10000 UNITS IM SOLR BOTH IP/OP $78.00 $58.00 $22.62 $77.79 $77.79 $77.79 $77.79 $77.79 $77.79 $77.79 $22.62 $77.79 $77.79 $23.54 $23.54 $24.44 $22.63 $26.59 $77.79 $31.12 $77.79 $77.79 $77.79 $77.79 $77.79 $58.50 $77.79 $77.79 $77.79 $38.90 $38.90 $61.61 $77.79 $62.23 $35.01 $77.79 $77.79 $45.24 $77.79 $46.67 $77.79 $77.79 $77.79 N/A N/A 1754 ERX HCPCS 63700001 00781-2037-01 CLOMIPRAMINE HCL 50 MG PO CAPS BOTH IP/OP $49.00 $36.00 $10.12 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $10.12 $48.57 $19.43 $48.57 $48.57 $48.57 $48.57 $48.57 $36.75 $48.57 $48.57 $48.57 $24.29 $24.29 $38.47 $48.57 $38.86 $31.57 $48.57 $48.57 $28.42 $48.57 $29.14 $48.57 $48.57 $48.57 N/A N/A 1757 ERX HCPCS 63700001 29300-0137-01 CLONIDINE HCL 0.3 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 1767 ERX HCPCS 25000001 45802-0434-11 CLOTRIMAZOLE 1 % EX CREA BOTH IP/OP $37.50 $28.00 $6.60 $37.07 $37.07 $37.07 $37.07 $37.07 $37.07 $37.07 $6.60 $37.07 $37.07 $27.51 $27.51 $28.57 $19.31 $7.73 $37.07 $14.83 $37.07 $37.07 $37.07 $37.07 $37.07 $28.13 $37.07 $37.07 $37.07 $18.54 $18.54 $29.36 $37.07 $29.66 $24.10 $37.07 $37.07 $21.75 $37.07 $22.24 $37.07 $37.07 $37.07 N/A N/A 1768 ERX HCPCS 25000001 51672-1260-03 CLOTRIMAZOLE 1 % EX SOLN BOTH IP/OP $268.00 $198.00 $47.62 $267.54 $267.54 $267.54 $267.54 $267.54 $267.54 $267.54 $47.62 $267.54 $267.54 $198.57 $198.57 $206.22 $139.39 $55.76 $267.54 $107.02 $267.54 $267.54 $267.54 $267.54 $267.54 $201.00 $267.54 $267.54 $267.54 $133.77 $133.77 $211.89 $267.54 $214.03 $173.90 $267.54 $267.54 $155.44 $267.54 $160.52 $267.54 $267.54 $267.54 N/A N/A 1770 ERX HCPCS 25000001 00395-1949-88 CLOVE OIL OIL BOTH IP/OP $28.50 $21.00 $4.99 $28.04 $28.04 $28.04 $28.04 $28.04 $28.04 $28.04 $4.99 $28.04 $28.04 $20.81 $20.81 $21.61 $14.61 $5.84 $28.04 $11.22 $28.04 $28.04 $28.04 $28.04 $28.04 $21.38 $28.04 $28.04 $28.04 $14.02 $14.02 $22.21 $28.04 $22.43 $18.23 $28.04 $28.04 $16.53 $28.04 $16.82 $28.04 $28.04 $28.04 N/A N/A 1802 ERX HCPCS 25000001 00054-0244-24 CODEINE SULFATE 30 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 1821 ERX HCPCS 63700006 00254-2008-01 COLCHICINE 0.6 MG PO TABS BOTH IP/OP $29.50 $22.00 $6.06 $29.10 $29.10 $29.10 $29.10 $29.10 $29.10 $29.10 $29.10 $29.10 $29.10 $29.10 $29.10 $29.10 $29.10 $6.06 $29.10 $11.64 $29.10 $29.10 $29.10 $29.10 $29.10 $22.13 $29.10 $29.10 $29.10 $14.55 $14.55 $23.05 $29.10 $23.28 $18.92 $29.10 $29.10 $17.11 $29.10 $17.46 $29.10 $29.10 $29.10 N/A N/A 1985 ERX HCPCS 25000001 00409-4092-01 CUPRIC CHLORIDE 0.4 MG/ML IV SOLN BOTH IP/OP $114.00 $84.00 $20.25 $113.79 $113.79 $113.79 $113.79 $113.79 $113.79 $113.79 $20.25 $113.79 $113.79 $84.45 $84.45 $87.71 $59.28 $23.72 $113.79 $45.52 $113.79 $113.79 $113.79 $113.79 $113.79 $85.50 $113.79 $113.79 $113.79 $56.90 $56.90 $90.12 $113.79 $91.03 $73.96 $113.79 $113.79 $66.12 $113.79 $68.27 $113.79 $113.79 $113.79 N/A N/A 2007 ERX HCPCS J3420 16729-0533-08 CYANOCOBALAMIN 1000 MCG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.31 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.31 $22.00 $1.87 $1.87 $1.94 $1.80 $2.11 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $2.01 $22.00 $12.76 $22.00 $22.00 $22.00 $2.01 $22.00 N/A N/A 2025 ERX HCPCS 25000001 00065-0396-05 CYCLOPENTOLATE HCL 1 % OP SOLN BOTH IP/OP $246.00 $182.00 $43.77 $245.92 $245.92 $245.92 $245.92 $245.92 $245.92 $245.92 $43.77 $245.92 $245.92 $182.52 $182.52 $189.56 $128.12 $51.25 $245.92 $98.37 $245.92 $245.92 $245.92 $245.92 $245.92 $184.50 $245.92 $245.92 $245.92 $122.96 $122.96 $194.77 $245.92 $196.74 $159.85 $245.92 $245.92 $142.68 $245.92 $147.55 $245.92 $245.92 $245.92 N/A N/A 2033 ERX HCPCS 63700001 51991-0838-01 CYPROHEPTADINE HCL 4 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 2091 ERX HCPCS J9130 00703-5075-01 DACARBAZINE 200 MG IV SOLR BOTH IP/OP $85.50 $63.00 $7.24 $85.07 $38.28 $38.28 $38.28 $38.28 $85.07 $85.07 $85.07 $10.32 $85.07 $7.53 $7.53 $7.82 $7.24 $8.51 $85.07 $85.07 $50.32 $85.07 $85.07 $85.07 $85.07 $64.13 $85.07 $85.07 $85.07 $42.54 $42.54 $67.38 $85.07 $68.06 $38.28 $8.10 $85.07 $49.59 $85.07 $85.07 $85.07 $8.10 $85.07 N/A N/A 2120 ERX HCPCS 25000001 00555-0635-02 DANAZOL 200 MG PO CAPS BOTH IP/OP $39.50 $29.00 $6.97 $39.18 $39.18 $39.18 $39.18 $39.18 $39.18 $39.18 $6.97 $39.18 $39.18 $29.08 $29.08 $30.20 $20.41 $8.17 $39.18 $15.67 $39.18 $39.18 $39.18 $39.18 $39.18 $29.63 $39.18 $39.18 $39.18 $19.59 $19.59 $31.03 $39.18 $31.34 $25.47 $39.18 $39.18 $22.91 $39.18 $23.51 $39.18 $39.18 $39.18 N/A N/A 2131 ERX HCPCS 63700001 70954-0136-20 DAPSONE 100 MG PO TABS BOTH IP/OP $12.00 $9.00 $2.43 $11.67 $11.67 $11.67 $11.67 $11.67 $11.67 $11.67 $11.67 $11.67 $11.67 $11.67 $11.67 $11.67 $11.67 $2.43 $11.67 $4.67 $11.67 $11.67 $11.67 $11.67 $11.67 $9.00 $11.67 $11.67 $11.67 $5.84 $5.84 $9.24 $11.67 $9.34 $7.59 $11.67 $11.67 $6.96 $11.67 $7.00 $11.67 $11.67 $11.67 N/A N/A 2132 ERX HCPCS 63700001 49938-0102-30 DAPSONE 25 MG PO TABS BOTH IP/OP $12.00 $9.00 $2.47 $11.83 $11.83 $11.83 $11.83 $11.83 $11.83 $11.83 $11.83 $11.83 $11.83 $11.83 $11.83 $11.83 $11.83 $2.47 $11.83 $4.73 $11.83 $11.83 $11.83 $11.83 $11.83 $9.00 $11.83 $11.83 $11.83 $5.92 $5.92 $9.37 $11.83 $9.46 $7.69 $11.83 $11.83 $6.96 $11.83 $7.10 $11.83 $11.83 $11.83 N/A N/A 2286 ERX HCPCS 63700001 69238-1055-01 DESIPRAMINE HCL 25 MG PO TABS BOTH IP/OP $9.00 $7.00 $1.81 $8.67 $8.67 $8.67 $8.67 $8.67 $8.67 $8.67 $8.67 $8.67 $8.67 $8.67 $8.67 $8.67 $8.67 $1.81 $8.67 $3.47 $8.67 $8.67 $8.67 $8.67 $8.67 $6.75 $8.67 $8.67 $8.67 $4.34 $4.34 $6.87 $8.67 $6.94 $5.64 $8.67 $8.67 $5.22 $8.67 $5.20 $8.67 $8.67 $8.67 N/A N/A 2287 ERX HCPCS 63700001 45963-0343-02 DESIPRAMINE HCL 50 MG PO TABS BOTH IP/OP $12.00 $9.00 $2.41 $11.57 $11.57 $11.57 $11.57 $11.57 $11.57 $11.57 $11.57 $11.57 $11.57 $11.57 $11.57 $11.57 $11.57 $2.41 $11.57 $4.63 $11.57 $11.57 $11.57 $11.57 $11.57 $9.00 $11.57 $11.57 $11.57 $5.79 $5.79 $9.16 $11.57 $9.26 $7.52 $11.57 $11.57 $6.96 $11.57 $6.94 $11.57 $11.57 $11.57 N/A N/A 2320 ERX HCPCS J8540 99999-6013-27 DEXAMETHASONE 0.5 MG/5ML PO SOLN BOTH IP/OP $11.00 $8.00 $0.18 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $0.20 $11.00 $11.00 $0.19 $0.19 $0.19 $0.18 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $4.95 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 2322 ERX HCPCS J8540 00054-8179-25 DEXAMETHASONE 0.5 MG PO TABS BOTH IP/OP $6.00 $4.00 $0.18 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $0.20 $6.00 $6.00 $0.19 $0.19 $0.19 $0.18 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $2.70 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 2327 ERX HCPCS 25000001 00054-8175-25 DEXAMETHASONE 4 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 2332 ERX HCPCS J1100 63323-0165-01 DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.42 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.42 $22.00 $0.50 $0.50 $0.52 $0.48 $0.56 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.54 $22.00 $12.76 $22.00 $22.00 $22.00 $0.54 $22.00 N/A N/A 2335 ERX HCPCS 25000001 24208-0720-02 DEXAMETHASONE SODIUM PHOSPHATE 0.1 % OP SOLN BOTH IP/OP $232.00 $172.00 $41.22 $231.56 $231.56 $231.56 $231.56 $231.56 $231.56 $231.56 $41.22 $231.56 $231.56 $171.86 $171.86 $178.49 $120.64 $48.26 $231.56 $92.62 $231.56 $231.56 $231.56 $231.56 $231.56 $174.00 $231.56 $231.56 $231.56 $115.78 $115.78 $183.40 $231.56 $185.25 $150.51 $231.56 $231.56 $134.56 $231.56 $138.94 $231.56 $231.56 $231.56 N/A N/A 2354 ERX HCPCS 63700001 00406-8958-01 DEXTROAMPHETAMINE SULFATE 5 MG PO TABS BOTH IP/OP $13.00 $10.00 $2.61 $12.53 $12.53 $12.53 $12.53 $12.53 $12.53 $12.53 $12.53 $12.53 $12.53 $12.53 $12.53 $12.53 $12.53 $2.61 $12.53 $5.01 $12.53 $12.53 $12.53 $12.53 $12.53 $9.75 $12.53 $12.53 $12.53 $6.27 $6.27 $9.92 $12.53 $10.02 $8.14 $12.53 $12.53 $7.54 $12.53 $7.52 $12.53 $12.53 $12.53 N/A N/A 2357 ERX HCPCS 25000001 00338-0023-04 DEXTROSE 10 % IV SOLN BOTH IP/OP $39.00 $29.00 $6.92 $38.88 $38.88 $38.88 $38.88 $38.88 $38.88 $38.88 $6.92 $38.88 $38.88 $28.86 $28.86 $29.97 $20.26 $8.10 $38.88 $15.55 $38.88 $38.88 $38.88 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $25.27 $38.88 $38.88 $22.62 $38.88 $23.33 $38.88 $38.88 $38.88 N/A N/A 2361 ERX HCPCS 25000001 00409-1775-10 DEXTROSE 250 MG/ML IV SOLN BOTH IP/OP $66.50 $49.00 $11.80 $66.27 $66.27 $66.27 $66.27 $66.27 $66.27 $66.27 $11.80 $66.27 $66.27 $49.19 $49.19 $51.08 $34.53 $13.81 $66.27 $26.51 $66.27 $66.27 $66.27 $66.27 $66.27 $49.88 $66.27 $66.27 $66.27 $33.14 $33.14 $52.49 $66.27 $53.02 $43.08 $66.27 $66.27 $38.57 $66.27 $39.76 $66.27 $66.27 $66.27 N/A N/A 2364 ERX HCPCS J7060 00338-0017-03 DEXTROSE 5 % IV SOLN BOTH IP/OP $22.00 $16.00 $1.28 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.28 $22.00 $1.81 $1.81 $1.88 $1.74 $2.04 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.95 $22.00 $12.76 $22.00 $22.00 $22.00 $1.95 $22.00 N/A N/A 2365 ERX HCPCS 25000001 99999-6007-48 DEXTROSE 50 % IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 2367 ERX HCPCS 25000001 00338-0719-06 DEXTROSE 70 % IV SOLN BOTH IP/OP $78.00 $58.00 $13.84 $77.76 $77.76 $77.76 $77.76 $77.76 $77.76 $77.76 $13.84 $77.76 $77.76 $57.71 $57.71 $59.94 $40.51 $16.21 $77.76 $31.10 $77.76 $77.76 $77.76 $77.76 $77.76 $58.50 $77.76 $77.76 $77.76 $38.88 $38.88 $61.59 $77.76 $62.21 $50.54 $77.76 $77.76 $45.24 $77.76 $46.66 $77.76 $77.76 $77.76 N/A N/A 2414 ERX HCPCS 63700001 00781-2248-01 DICLOXACILLIN SODIUM 250 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 2418 ERX HCPCS 63700001 00378-1610-01 DICYCLOMINE HCL 10 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 2442 ERX HCPCS J1160 00641-1410-35 DIGOXIN 0.25 MG/ML IJ SOLN BOTH IP/OP $29.00 $21.00 $11.41 $28.52 $28.52 $28.52 $28.52 $28.52 $28.52 $28.52 $14.42 $28.52 $28.52 $22.61 $22.61 $23.48 $21.74 $25.54 $28.52 $11.41 $28.52 $28.52 $28.52 $28.52 $28.52 $21.75 $28.52 $28.52 $28.52 $14.26 $14.26 $22.59 $28.52 $22.82 $12.83 $28.52 $28.52 $16.82 $28.52 $17.11 $28.52 $28.52 $28.52 N/A N/A 2444 ERX HCPCS 63700001 16714-0590-01 DIGOXIN 0.125 MG PO TABS BOTH IP/OP $9.50 $7.00 $1.90 $9.10 $9.10 $9.10 $9.10 $9.10 $9.10 $9.10 $9.10 $9.10 $9.10 $9.10 $9.10 $9.10 $9.10 $1.90 $9.10 $3.64 $9.10 $9.10 $9.10 $9.10 $9.10 $7.13 $9.10 $9.10 $9.10 $4.55 $4.55 $7.21 $9.10 $7.28 $5.92 $9.10 $9.10 $5.51 $9.10 $5.46 $9.10 $9.10 $9.10 N/A N/A 2474 ERX HCPCS 63700001 00093-0321-01 DILTIAZEM HCL 120 MG PO TABS BOTH IP/OP $12.50 $9.00 $2.60 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $12.46 $2.60 $12.46 $4.98 $12.46 $12.46 $12.46 $12.46 $12.46 $9.38 $12.46 $12.46 $12.46 $6.23 $6.23 $9.87 $12.46 $9.97 $8.10 $12.46 $12.46 $7.25 $12.46 $7.48 $12.46 $12.46 $12.46 N/A N/A 2477 ERX HCPCS 63700001 50228-0483-01 DILTIAZEM HCL 90 MG PO TABS BOTH IP/OP $9.50 $7.00 $1.93 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $1.93 $9.26 $3.70 $9.26 $9.26 $9.26 $9.26 $9.26 $7.13 $9.26 $9.26 $9.26 $4.63 $4.63 $7.33 $9.26 $7.41 $6.02 $9.26 $9.26 $5.51 $9.26 $5.56 $9.26 $9.26 $9.26 N/A N/A 2508 ERX HCPCS J1200 63323-0664-01 DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.86 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.86 $22.00 $1.10 $1.10 $1.14 $1.06 $1.25 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.19 $22.00 $12.76 $22.00 $22.00 $22.00 $1.19 $22.00 N/A N/A 2510 ERX HCPCS Q0163 00904-2056-61 DIPHENHYDRAMINE HCL 50 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.19 $6.00 $3.26 $3.26 $3.26 $3.26 $6.00 $6.00 $6.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $6.00 $3.55 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $1.19 $6.00 $3.48 $6.00 $6.00 $6.00 $1.25 $6.00 N/A N/A 2511 ERX HCPCS Q0163 00121-0489-05 DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX BOTH IP/OP $12.00 $9.00 $0.02 $11.80 $5.31 $5.31 $5.31 $5.31 $11.80 $11.80 $11.80 $2.46 $11.80 $0.02 $0.02 $0.02 $0.02 $2.46 $11.80 $11.80 $6.98 $11.80 $11.80 $11.80 $11.80 $9.00 $11.80 $11.80 $11.80 $5.90 $5.90 $9.35 $11.80 $9.44 $5.31 $2.34 $11.80 $6.96 $11.80 $11.80 $11.80 $2.46 $11.80 N/A N/A 2515 ERX HCPCS 63700001 99999-6009-38 DIPHENOXYLATE-ATROPINE 2.5-0.025 MG/5ML PO LIQD BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 2516 ERX HCPCS 63700001 59762-1061-01 DIPHENOXYLATE-ATROPINE 2.5-0.025 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 2528 ERX HCPCS 63700001 64980-0133-01 DIPYRIDAMOLE 25 MG PO TABS BOTH IP/OP $12.50 $9.00 $2.56 $12.28 $12.28 $12.28 $12.28 $12.28 $12.28 $12.28 $12.28 $12.28 $12.28 $12.28 $12.28 $12.28 $12.28 $2.56 $12.28 $4.91 $12.28 $12.28 $12.28 $12.28 $12.28 $9.38 $12.28 $12.28 $12.28 $6.14 $6.14 $9.73 $12.28 $9.82 $7.98 $12.28 $12.28 $7.25 $12.28 $7.37 $12.28 $12.28 $12.28 N/A N/A 2537 ERX HCPCS 63700001 00025-2732-31 DISOPYRAMIDE PHOSPHATE ER 100 MG PO CP12 BOTH IP/OP $22.00 $16.00 $4.57 $21.95 $21.95 $21.95 $21.95 $21.95 $21.95 $21.95 $21.95 $21.95 $21.95 $21.95 $21.95 $21.95 $21.95 $4.57 $21.95 $8.78 $21.95 $21.95 $21.95 $21.95 $21.95 $16.50 $21.95 $21.95 $21.95 $10.98 $10.98 $17.38 $21.95 $17.56 $14.27 $21.95 $21.95 $12.76 $21.95 $13.17 $21.95 $21.95 $21.95 N/A N/A 2552 ERX HCPCS 63700001 00832-7123-15 DIVALPROEX SODIUM 250 MG PO TBEC BOTH IP/OP $9.50 $7.00 $1.95 $9.36 $9.36 $9.36 $9.36 $9.36 $9.36 $9.36 $9.36 $9.36 $9.36 $9.36 $9.36 $9.36 $9.36 $1.95 $9.36 $3.74 $9.36 $9.36 $9.36 $9.36 $9.36 $7.13 $9.36 $9.36 $9.36 $4.68 $4.68 $7.41 $9.36 $7.49 $6.08 $9.36 $9.36 $5.51 $9.36 $5.62 $9.36 $9.36 $9.36 N/A N/A 2553 ERX HCPCS 63700001 62756-0798-88 DIVALPROEX SODIUM 500 MG PO TBEC BOTH IP/OP $14.00 $10.00 $2.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $2.89 $13.89 $5.56 $13.89 $13.89 $13.89 $13.89 $13.89 $10.50 $13.89 $13.89 $13.89 $6.95 $6.95 $11.00 $13.89 $11.11 $9.03 $13.89 $13.89 $8.12 $13.89 $8.33 $13.89 $13.89 $13.89 N/A N/A 2595 ERX HCPCS J1265 00409-5820-01 DOPAMINE HCL 40 MG/ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.20 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.95 $22.00 $22.00 $3.33 $3.33 $3.46 $3.20 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 2608 ERX HCPCS 63700001 51079-0436-20 DOXEPIN HCL 10 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 2609 ERX HCPCS 63700001 51079-0651-20 DOXEPIN HCL 100 MG PO CAPS BOTH IP/OP $9.00 $7.00 $1.80 $8.63 $8.63 $8.63 $8.63 $8.63 $8.63 $8.63 $8.63 $8.63 $8.63 $8.63 $8.63 $8.63 $8.63 $1.80 $8.63 $3.45 $8.63 $8.63 $8.63 $8.63 $8.63 $6.75 $8.63 $8.63 $8.63 $4.32 $4.32 $6.83 $8.63 $6.90 $5.61 $8.63 $8.63 $5.22 $8.63 $5.18 $8.63 $8.63 $8.63 N/A N/A 2610 ERX HCPCS 63700001 49884-0222-01 DOXEPIN HCL 150 MG PO CAPS BOTH IP/OP $14.50 $11.00 $3.00 $14.38 $14.38 $14.38 $14.38 $14.38 $14.38 $14.38 $14.38 $14.38 $14.38 $14.38 $14.38 $14.38 $14.38 $3.00 $14.38 $5.75 $14.38 $14.38 $14.38 $14.38 $14.38 $10.88 $14.38 $14.38 $14.38 $7.19 $7.19 $11.39 $14.38 $11.50 $9.35 $14.38 $14.38 $8.41 $14.38 $8.63 $14.38 $14.38 $14.38 N/A N/A 2611 ERX HCPCS 63700001 51079-0437-20 DOXEPIN HCL 25 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 2612 ERX HCPCS 63700001 51079-0438-20 DOXEPIN HCL 50 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 2613 ERX HCPCS 63700001 00378-5375-01 DOXEPIN HCL 75 MG PO CAPS BOTH IP/OP $8.00 $6.00 $1.63 $7.82 $7.82 $7.82 $7.82 $7.82 $7.82 $7.82 $7.82 $7.82 $7.82 $7.82 $7.82 $7.82 $7.82 $1.63 $7.82 $3.13 $7.82 $7.82 $7.82 $7.82 $7.82 $6.00 $7.82 $7.82 $7.82 $3.91 $3.91 $6.19 $7.82 $6.26 $5.08 $7.82 $7.82 $4.64 $7.82 $4.69 $7.82 $7.82 $7.82 N/A N/A 2614 ERX HCPCS 63700001 54838-0512-40 DOXEPIN HCL 10 MG/ML PO CONC BOTH IP/OP $255.00 $189.00 $53.09 $254.76 $254.76 $254.76 $254.76 $254.76 $254.76 $254.76 $254.76 $254.76 $254.76 $254.76 $254.76 $254.76 $254.76 $53.09 $254.76 $101.90 $254.76 $254.76 $254.76 $254.76 $254.76 $191.25 $254.76 $254.76 $254.76 $127.38 $127.38 $201.77 $254.76 $203.81 $165.59 $254.76 $254.76 $147.90 $254.76 $152.86 $254.76 $254.76 $254.76 N/A N/A 2616 ERX HCPCS J9000 45963-0733-60 DOXORUBICIN HCL 2 MG/ML IV SOLN BOTH IP/OP $583.00 $431.00 $69.60 $582.96 $262.33 $262.33 $262.33 $262.33 $582.96 $582.96 $582.96 $89.07 $582.96 $72.38 $72.38 $75.17 $69.60 $81.77 $582.96 $582.96 $344.82 $582.96 $582.96 $582.96 $582.96 $437.25 $582.96 $582.96 $582.96 $291.48 $291.48 $461.70 $582.96 $466.37 $262.33 $77.87 $582.96 $338.14 $582.96 $582.96 $582.96 $77.87 $582.96 N/A N/A 2619 ERX HCPCS J9000 00143-9093-01 DOXORUBICIN HCL 50 MG IV SOLR BOTH IP/OP $953.50 $706.00 $17.40 $953.24 $428.96 $428.96 $428.96 $428.96 $953.24 $953.24 $953.24 $22.27 $953.24 $18.10 $18.10 $18.79 $17.40 $20.44 $953.24 $953.24 $563.84 $953.24 $953.24 $953.24 $953.24 $715.13 $953.24 $953.24 $953.24 $476.62 $476.62 $754.97 $953.24 $762.59 $428.96 $19.47 $953.24 $553.03 $953.24 $953.24 $953.24 $19.47 $953.24 N/A N/A 2622 ERX HCPCS 25000001 63323-0130-13 DOXYCYCLINE HYCLATE 100 MG IV SOLR BOTH IP/OP $100.50 $74.00 $17.85 $100.30 $100.30 $100.30 $100.30 $100.30 $100.30 $100.30 $17.85 $100.30 $100.30 $74.44 $74.44 $77.31 $52.26 $20.90 $100.30 $40.12 $100.30 $100.30 $100.30 $100.30 $100.30 $75.38 $100.30 $100.30 $100.30 $50.15 $50.15 $79.44 $100.30 $80.24 $65.20 $100.30 $100.30 $58.29 $100.30 $60.18 $100.30 $100.30 $100.30 N/A N/A 2654 ERX HCPCS J1790 00517-9702-01 DROPERIDOL 2.5 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $7.87 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $7.87 $22.00 $22.00 $8.53 $8.53 $8.86 $8.20 $9.63 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 2805 ERX HCPCS 25000001 00536-7415-51 ENEMA 7-19 GM/133ML RECTAL ENEM BOTH IP/OP $7.50 $6.00 $1.33 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $1.33 $7.47 $7.47 $5.54 $5.54 $5.76 $3.89 $1.56 $7.47 $2.99 $7.47 $7.47 $7.47 $7.47 $7.47 $5.63 $7.47 $7.47 $7.47 $3.74 $3.74 $5.92 $7.47 $5.98 $4.86 $7.47 $7.47 $4.35 $7.47 $4.48 $7.47 $7.47 $7.47 N/A N/A 2887 ERX HCPCS 25000001 60432-0671-60 ERYTHROMYCIN 2 % EX SOLN BOTH IP/OP $199.00 $147.00 $35.41 $198.93 $198.93 $198.93 $198.93 $198.93 $198.93 $198.93 $35.41 $198.93 $198.93 $147.65 $147.65 $153.34 $103.64 $41.46 $198.93 $79.57 $198.93 $198.93 $198.93 $198.93 $198.93 $149.25 $198.93 $198.93 $198.93 $99.47 $99.47 $157.55 $198.93 $159.14 $129.30 $198.93 $198.93 $115.42 $198.93 $119.36 $198.93 $198.93 $198.93 N/A N/A 2888 ERX HCPCS 25000001 24208-0910-55 ERYTHROMYCIN 5 MG/GM OP OINT BOTH IP/OP $151.50 $112.00 $26.92 $151.26 $151.26 $151.26 $151.26 $151.26 $151.26 $151.26 $26.92 $151.26 $151.26 $112.27 $112.27 $116.59 $78.81 $31.52 $151.26 $60.50 $151.26 $151.26 $151.26 $151.26 $151.26 $113.63 $151.26 $151.26 $151.26 $75.63 $75.63 $119.80 $151.26 $121.01 $98.32 $151.26 $151.26 $87.87 $151.26 $90.76 $151.26 $151.26 $151.26 N/A N/A 2899 ERX HCPCS 63700001 24338-0134-02 ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5ML PO SUSR BOTH IP/OP "$1,364.00" "$1,009.00" $284.17 "$1,363.53" "$1,363.53" "$1,363.53" "$1,363.53" "$1,363.53" "$1,363.53" "$1,363.53" "$1,363.53" "$1,363.53" "$1,363.53" "$1,363.53" "$1,363.53" "$1,363.53" "$1,363.53" $284.17 "$1,363.53" $545.41 "$1,363.53" "$1,363.53" "$1,363.53" "$1,363.53" "$1,363.53" "$1,023.00" "$1,363.53" "$1,363.53" "$1,363.53" $681.77 $681.77 "$1,079.92" "$1,363.53" "$1,090.82" $886.29 "$1,363.53" "$1,363.53" $791.12 "$1,363.53" $818.12 "$1,363.53" "$1,363.53" "$1,363.53" N/A N/A 2903 ERX HCPCS J1364 00409-6482-01 ERYTHROMYCIN LACTOBIONATE 500 MG IV SOLR BOTH IP/OP $378.50 $280.00 $75.25 $378.45 $378.45 $378.45 $378.45 $378.45 $378.45 $378.45 $77.75 $378.45 $378.45 $78.26 $78.26 $81.27 $75.25 $88.41 $378.45 $151.38 $378.45 $378.45 $378.45 $378.45 $378.45 $283.88 $378.45 $378.45 $378.45 $189.23 $189.23 $299.73 $378.45 $302.76 $170.30 $378.45 $378.45 $219.53 $378.45 $227.07 $378.45 $378.45 $378.45 N/A N/A 2930 ERX HCPCS 63600001 42023-0110-01 ESTRADIOL VALERATE 10 MG/ML IM OIL BOTH IP/OP $69.00 $51.00 $12.25 $68.81 $68.81 $68.81 $68.81 $68.81 $68.81 $68.81 $12.25 $68.81 $68.81 $68.81 $68.81 $68.81 $68.81 $14.34 $68.81 $27.52 $68.81 $68.81 $68.81 $68.81 $68.81 $51.75 $68.81 $68.81 $68.81 $34.41 $34.41 $54.50 $68.81 $55.05 $30.96 $68.81 $68.81 $40.02 $68.81 $41.29 $68.81 $68.81 $68.81 N/A N/A 2931 ERX HCPCS J1380 42023-0111-01 ESTRADIOL VALERATE 20 MG/ML IM OIL BOTH IP/OP $48.50 $36.00 $9.62 $48.49 $21.82 $21.82 $21.82 $21.82 $48.49 $48.49 $48.49 $10.11 $48.49 $11.16 $11.16 $11.59 $10.73 $10.11 $48.49 $48.49 $28.68 $48.49 $48.49 $48.49 $48.49 $36.38 $48.49 $48.49 $48.49 $24.25 $24.25 $38.40 $48.49 $38.79 $21.82 $9.62 $48.49 $28.13 $48.49 $48.49 $48.49 $10.11 $48.49 N/A N/A 2938 ERX HCPCS 63700001 00046-1104-81 ESTROGENS CONJUGATED 1.25 MG PO TABS BOTH IP/OP $35.00 $26.00 $7.24 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $7.24 $34.76 $13.90 $34.76 $34.76 $34.76 $34.76 $34.76 $26.25 $34.76 $34.76 $34.76 $17.38 $17.38 $27.53 $34.76 $27.81 $22.59 $34.76 $34.76 $20.30 $34.76 $20.86 $34.76 $34.76 $34.76 N/A N/A 3000 ERX HCPCS 25000001 10119-0002-52 EYE WASH OP SOLN BOTH IP/OP $12.50 $9.00 $2.18 $12.24 $12.24 $12.24 $12.24 $12.24 $12.24 $12.24 $2.18 $12.24 $12.24 $9.08 $9.08 $9.43 $6.38 $2.55 $12.24 $4.90 $12.24 $12.24 $12.24 $12.24 $12.24 $9.38 $12.24 $12.24 $12.24 $6.12 $6.12 $9.69 $12.24 $9.79 $7.96 $12.24 $12.24 $7.25 $12.24 $7.34 $12.24 $12.24 $12.24 N/A N/A 3059 ERX HCPCS 63700001 48783-0112-08 FERRIC SUBSULFATE PASTE BOTH IP/OP $65.00 $48.00 $13.51 $64.80 $64.80 $64.80 $64.80 $64.80 $64.80 $64.80 $64.80 $64.80 $64.80 $64.80 $64.80 $64.80 $64.80 $13.51 $64.80 $25.92 $64.80 $64.80 $64.80 $64.80 $64.80 $48.75 $64.80 $64.80 $64.80 $32.40 $32.40 $51.32 $64.80 $51.84 $42.12 $64.80 $64.80 $37.70 $64.80 $38.88 $64.80 $64.80 $64.80 N/A N/A 3071 ERX HCPCS 63700001 63739-0157-10 FERROUS SULFATE 300 (60 FE) MG/5ML PO SYRP BOTH IP/OP $15.50 $11.00 $3.14 $15.06 $15.06 $15.06 $15.06 $15.06 $15.06 $15.06 $15.06 $15.06 $15.06 $15.06 $15.06 $15.06 $15.06 $3.14 $15.06 $6.02 $15.06 $15.06 $15.06 $15.06 $15.06 $11.63 $15.06 $15.06 $15.06 $7.53 $7.53 $11.93 $15.06 $12.05 $9.79 $15.06 $15.06 $8.99 $15.06 $9.04 $15.06 $15.06 $15.06 N/A N/A 3074 ERX HCPCS 63700006 00904-7591-61 FERROUS SULFATE 325 (65 FE) MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3128 ERX HCPCS 25000001 00132-0202-20 FLEET PEDIATRIC 3.5-9.5 GM/66ML RECTAL ENEM BOTH IP/OP $9.50 $7.00 $1.67 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $9.41 $1.67 $9.41 $9.41 $6.98 $6.98 $7.25 $4.90 $1.96 $9.41 $3.76 $9.41 $9.41 $9.41 $9.41 $9.41 $7.13 $9.41 $9.41 $9.41 $4.71 $4.71 $7.45 $9.41 $7.53 $6.12 $9.41 $9.41 $5.51 $9.41 $5.65 $9.41 $9.41 $9.41 N/A N/A 3184 ERX HCPCS 25000001 00168-0060-15 FLUOCINOLONE ACETONIDE 0.025 % EX CREA BOTH IP/OP $134.50 $100.00 $23.92 $134.39 $134.39 $134.39 $134.39 $134.39 $134.39 $134.39 $23.92 $134.39 $134.39 $99.74 $99.74 $103.59 $70.02 $28.01 $134.39 $53.76 $134.39 $134.39 $134.39 $134.39 $134.39 $100.88 $134.39 $134.39 $134.39 $67.20 $67.20 $106.44 $134.39 $107.51 $87.35 $134.39 $134.39 $78.01 $134.39 $80.63 $134.39 $134.39 $134.39 N/A N/A 3185 ERX HCPCS 25000001 00168-0064-15 FLUOCINOLONE ACETONIDE 0.025 % EX OINT BOTH IP/OP $134.50 $100.00 $23.92 $134.39 $134.39 $134.39 $134.39 $134.39 $134.39 $134.39 $23.92 $134.39 $134.39 $99.74 $99.74 $103.59 $70.02 $28.01 $134.39 $53.76 $134.39 $134.39 $134.39 $134.39 $134.39 $100.88 $134.39 $134.39 $134.39 $67.20 $67.20 $106.44 $134.39 $107.51 $87.35 $134.39 $134.39 $78.01 $134.39 $80.63 $134.39 $134.39 $134.39 N/A N/A 3186 ERX HCPCS 25000001 00168-0059-60 FLUOCINOLONE ACETONIDE 0.01 % EX SOLN BOTH IP/OP $160.00 $118.00 $28.39 $159.52 $159.52 $159.52 $159.52 $159.52 $159.52 $159.52 $28.39 $159.52 $159.52 $118.40 $118.40 $122.96 $83.11 $33.25 $159.52 $63.81 $159.52 $159.52 $159.52 $159.52 $159.52 $120.00 $159.52 $159.52 $159.52 $79.76 $79.76 $126.34 $159.52 $127.62 $103.69 $159.52 $159.52 $92.80 $159.52 $95.71 $159.52 $159.52 $159.52 N/A N/A 3187 ERX HCPCS 25000001 51672-1386-01 FLUOCINONIDE 0.05 % EX CREA BOTH IP/OP $181.50 $134.00 $32.27 $181.31 $181.31 $181.31 $181.31 $181.31 $181.31 $181.31 $32.27 $181.31 $181.31 $134.57 $134.57 $139.75 $94.46 $37.79 $181.31 $72.52 $181.31 $181.31 $181.31 $181.31 $181.31 $136.13 $181.31 $181.31 $181.31 $90.66 $90.66 $143.60 $181.31 $145.05 $117.85 $181.31 $181.31 $105.27 $181.31 $108.79 $181.31 $181.31 $181.31 N/A N/A 3188 ERX HCPCS 25000001 51672-1279-03 FLUOCINONIDE 0.05 % EX GEL BOTH IP/OP $719.50 $532.00 $128.05 $719.37 $719.37 $719.37 $719.37 $719.37 $719.37 $719.37 $128.05 $719.37 $719.37 $533.92 $533.92 $554.49 $374.79 $149.92 $719.37 $287.75 $719.37 $719.37 $719.37 $719.37 $719.37 $539.63 $719.37 $719.37 $719.37 $359.69 $359.69 $569.74 $719.37 $575.50 $467.59 $719.37 $719.37 $417.31 $719.37 $431.62 $719.37 $719.37 $719.37 N/A N/A 3189 ERX HCPCS 25000001 51672-1264-01 FLUOCINONIDE 0.05 % EX OINT BOTH IP/OP $253.50 $188.00 $45.09 $253.31 $253.31 $253.31 $253.31 $253.31 $253.31 $253.31 $45.09 $253.31 $253.31 $188.01 $188.01 $195.25 $131.97 $52.79 $253.31 $101.32 $253.31 $253.31 $253.31 $253.31 $253.31 $190.13 $253.31 $253.31 $253.31 $126.66 $126.66 $200.62 $253.31 $202.65 $164.65 $253.31 $253.31 $147.03 $253.31 $151.99 $253.31 $253.31 $253.31 N/A N/A 3215 ERX HCPCS J2680 63323-0272-05 FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN BOTH IP/OP $80.50 $60.00 $4.27 $80.34 $36.15 $36.15 $36.15 $36.15 $80.34 $80.34 $80.34 $4.27 $80.34 $10.69 $10.69 $11.10 $10.28 $12.08 $80.34 $80.34 $47.52 $80.34 $80.34 $80.34 $80.34 $60.38 $80.34 $80.34 $80.34 $40.17 $40.17 $63.63 $80.34 $64.27 $36.15 $11.50 $80.34 $46.69 $80.34 $80.34 $80.34 $11.50 $80.34 N/A N/A 3216 ERX HCPCS 25000001 63323-0281-10 FLUPHENAZINE HCL 2.5 MG/ML IJ SOLN BOTH IP/OP $696.50 $515.00 $123.90 $696.05 $696.05 $696.05 $696.05 $696.05 $696.05 $696.05 $123.90 $696.05 $696.05 $516.61 $516.61 $536.52 $362.64 $145.06 $696.05 $278.42 $696.05 $696.05 $696.05 $696.05 $696.05 $522.38 $696.05 $696.05 $696.05 $348.03 $348.03 $551.27 $696.05 $556.84 $452.43 $696.05 $696.05 $403.97 $696.05 $417.63 $696.05 $696.05 $696.05 N/A N/A 3218 ERX HCPCS 63700001 00527-1788-01 FLUPHENAZINE HCL 1 MG PO TABS BOTH IP/OP $19.00 $14.00 $3.96 $18.98 $18.98 $18.98 $18.98 $18.98 $18.98 $18.98 $18.98 $18.98 $18.98 $18.98 $18.98 $18.98 $18.98 $3.96 $18.98 $7.59 $18.98 $18.98 $18.98 $18.98 $18.98 $14.25 $18.98 $18.98 $18.98 $9.49 $9.49 $15.03 $18.98 $15.18 $12.34 $18.98 $18.98 $11.02 $18.98 $11.39 $18.98 $18.98 $18.98 N/A N/A 3219 ERX HCPCS 63700006 00527-1791-01 FLUPHENAZINE HCL 10 MG PO TABS BOTH IP/OP $50.50 $37.00 $10.45 $50.12 $50.12 $50.12 $50.12 $50.12 $50.12 $50.12 $50.12 $50.12 $50.12 $50.12 $50.12 $50.12 $50.12 $10.45 $50.12 $20.05 $50.12 $50.12 $50.12 $50.12 $50.12 $37.88 $50.12 $50.12 $50.12 $25.06 $25.06 $39.70 $50.12 $40.10 $32.58 $50.12 $50.12 $29.29 $50.12 $30.07 $50.12 $50.12 $50.12 N/A N/A 3220 ERX HCPCS 63700001 00527-1789-01 FLUPHENAZINE HCL 2.5 MG PO TABS BOTH IP/OP $29.50 $22.00 $6.12 $29.38 $29.38 $29.38 $29.38 $29.38 $29.38 $29.38 $29.38 $29.38 $29.38 $29.38 $29.38 $29.38 $29.38 $6.12 $29.38 $11.75 $29.38 $29.38 $29.38 $29.38 $29.38 $22.13 $29.38 $29.38 $29.38 $14.69 $14.69 $23.27 $29.38 $23.50 $19.10 $29.38 $29.38 $17.11 $29.38 $17.63 $29.38 $29.38 $29.38 N/A N/A 3221 ERX HCPCS 63700001 00527-1790-01 FLUPHENAZINE HCL 5 MG PO TABS BOTH IP/OP $40.00 $30.00 $8.28 $39.75 $39.75 $39.75 $39.75 $39.75 $39.75 $39.75 $39.75 $39.75 $39.75 $39.75 $39.75 $39.75 $39.75 $8.28 $39.75 $15.90 $39.75 $39.75 $39.75 $39.75 $39.75 $30.00 $39.75 $39.75 $39.75 $19.88 $19.88 $31.48 $39.75 $31.80 $25.84 $39.75 $39.75 $23.20 $39.75 $23.85 $39.75 $39.75 $39.75 N/A N/A 3232 ERX HCPCS 25000001 99999-6005-63 FOLIC ACID 5 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 3233 ERX HCPCS 63700001 65162-0361-11 FOLIC ACID 1 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3291 ERX HCPCS J1940 00409-6102-02 FUROSEMIDE 10 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.25 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.25 $22.00 $0.54 $0.54 $0.56 $0.52 $0.61 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.58 $22.00 $12.76 $22.00 $22.00 $22.00 $0.58 $22.00 N/A N/A 3291 ERX HCPCS J1940 00409-6102-04 FUROSEMIDE 10 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.25 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.25 $22.00 $0.54 $0.54 $0.56 $0.52 $0.61 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.58 $22.00 $12.76 $22.00 $22.00 $22.00 $0.58 $22.00 N/A N/A 3291 ERX HCPCS J1940 00409-6102-10 FUROSEMIDE 10 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.25 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.25 $22.00 $0.54 $0.54 $0.56 $0.52 $0.61 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.58 $22.00 $12.76 $22.00 $22.00 $22.00 $0.58 $22.00 N/A N/A 3292 ERX HCPCS 25000001 00054-3294-46 FUROSEMIDE 10 MG/ML PO SOLN BOTH IP/OP $39.50 $29.00 $7.01 $39.40 $39.40 $39.40 $39.40 $39.40 $39.40 $39.40 $7.01 $39.40 $39.40 $29.24 $29.24 $30.37 $20.53 $8.21 $39.40 $15.76 $39.40 $39.40 $39.40 $39.40 $39.40 $29.63 $39.40 $39.40 $39.40 $19.70 $19.70 $31.20 $39.40 $31.52 $25.61 $39.40 $39.40 $22.91 $39.40 $23.64 $39.40 $39.40 $39.40 N/A N/A 3294 ERX HCPCS 63700001 51079-0072-20 FUROSEMIDE 20 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3295 ERX HCPCS 63700001 00054-8299-25 FUROSEMIDE 40 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3296 ERX HCPCS 63700001 00054-4301-25 FUROSEMIDE 80 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3378 ERX HCPCS 63700001 16714-0101-05 GEMFIBROZIL 600 MG PO TABS BOTH IP/OP $10.00 $7.00 $2.04 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $2.04 $9.79 $3.92 $9.79 $9.79 $9.79 $9.79 $9.79 $7.50 $9.79 $9.79 $9.79 $4.90 $4.90 $7.75 $9.79 $7.83 $6.36 $9.79 $9.79 $5.80 $9.79 $5.87 $9.79 $9.79 $9.79 N/A N/A 3423 ERX HCPCS 25000001 45802-0056-11 GENTAMICIN SULFATE 0.1 % EX CREA BOTH IP/OP $354.00 $262.00 $62.94 $353.57 $353.57 $353.57 $353.57 $353.57 $353.57 $353.57 $62.94 $353.57 $353.57 $262.42 $262.42 $272.53 $184.21 $73.69 $353.57 $141.43 $353.57 $353.57 $353.57 $353.57 $353.57 $265.50 $353.57 $353.57 $353.57 $176.79 $176.79 $280.03 $353.57 $282.86 $229.82 $353.57 $353.57 $205.32 $353.57 $212.14 $353.57 $353.57 $353.57 N/A N/A 3424 ERX HCPCS 25000001 00713-0682-31 GENTAMICIN SULFATE 0.1 % EX OINT BOTH IP/OP $354.00 $262.00 $62.94 $353.57 $353.57 $353.57 $353.57 $353.57 $353.57 $353.57 $62.94 $353.57 $353.57 $262.42 $262.42 $272.53 $184.21 $73.69 $353.57 $141.43 $353.57 $353.57 $353.57 $353.57 $353.57 $265.50 $353.57 $353.57 $353.57 $176.79 $176.79 $280.03 $353.57 $282.86 $229.82 $353.57 $353.57 $205.32 $353.57 $212.14 $353.57 $353.57 $353.57 N/A N/A 3425 ERX HCPCS J1580 63323-0173-02 GENTAMICIN SULFATE 10 MG/ML (NICU) IM INJ BOTH IP/OP $28.50 $21.00 $1.02 $28.05 $12.62 $12.62 $12.62 $12.62 $28.05 $28.05 $28.05 $1.02 $28.05 $1.47 $1.47 $1.52 $1.41 $1.66 $28.05 $28.05 $16.59 $28.05 $28.05 $28.05 $28.05 $21.38 $28.05 $28.05 $28.05 $14.03 $14.03 $22.22 $28.05 $22.44 $12.62 $1.58 $28.05 $16.53 $28.05 $28.05 $28.05 $1.58 $28.05 N/A N/A 3426 ERX HCPCS J1580 00409-1207-25 GENTAMICIN SULFATE 40 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $1.02 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.02 $22.00 $1.47 $1.47 $1.52 $1.41 $1.66 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.58 $22.00 $12.76 $22.00 $22.00 $22.00 $1.58 $22.00 N/A N/A 3428 ERX HCPCS 25000001 61314-0633-05 GENTAMICIN SULFATE 0.3 % OP SOLN BOTH IP/OP $86.50 $64.00 $15.37 $86.37 $86.37 $86.37 $86.37 $86.37 $86.37 $86.37 $15.37 $86.37 $86.37 $64.10 $64.10 $66.57 $45.00 $18.00 $86.37 $34.55 $86.37 $86.37 $86.37 $86.37 $86.37 $64.88 $86.37 $86.37 $86.37 $43.19 $43.19 $68.41 $86.37 $69.10 $56.14 $86.37 $86.37 $50.17 $86.37 $51.82 $86.37 $86.37 $86.37 N/A N/A 3430 ERX HCPCS 25000001 00395-1003-92 GENTIAN VIOLET 1 % EX SOLN BOTH IP/OP $36.00 $27.00 $6.40 $35.94 $35.94 $35.94 $35.94 $35.94 $35.94 $35.94 $6.40 $35.94 $35.94 $26.67 $26.67 $27.70 $18.72 $7.49 $35.94 $14.38 $35.94 $35.94 $35.94 $35.94 $35.94 $27.00 $35.94 $35.94 $35.94 $17.97 $17.97 $28.46 $35.94 $28.75 $23.36 $35.94 $35.94 $20.88 $35.94 $21.56 $35.94 $35.94 $35.94 N/A N/A 3497 ERX HCPCS 25000001 70121-1394-05 GLYCOPYRROLATE 0.2 MG/ML IJ SOLN BOTH IP/OP $37.00 $27.00 $6.50 $36.53 $36.53 $36.53 $36.53 $36.53 $36.53 $36.53 $6.50 $36.53 $36.53 $27.11 $27.11 $28.16 $19.03 $7.61 $36.53 $14.61 $36.53 $36.53 $36.53 $36.53 $36.53 $27.75 $36.53 $36.53 $36.53 $18.27 $18.27 $28.93 $36.53 $29.22 $23.74 $36.53 $36.53 $21.46 $36.53 $21.92 $36.53 $36.53 $36.53 N/A N/A 3534 ERX HCPCS 63700001 00115-1724-01 GRISEOFULVIN ULTRAMICROSIZE 125 MG PO TABS BOTH IP/OP $21.00 $16.00 $4.31 $20.68 $20.68 $20.68 $20.68 $20.68 $20.68 $20.68 $20.68 $20.68 $20.68 $20.68 $20.68 $20.68 $20.68 $4.31 $20.68 $8.27 $20.68 $20.68 $20.68 $20.68 $20.68 $15.75 $20.68 $20.68 $20.68 $10.34 $10.34 $16.38 $20.68 $16.54 $13.44 $20.68 $20.68 $12.18 $20.68 $12.41 $20.68 $20.68 $20.68 N/A N/A 3579 ERX HCPCS 25000001 51079-0734-20 HALOPERIDOL 1 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3581 ERX HCPCS 63700001 00378-0214-01 HALOPERIDOL 2 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3582 ERX HCPCS 63700001 00378-0335-01 HALOPERIDOL 20 MG PO TABS BOTH IP/OP $16.00 $12.00 $3.26 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $3.26 $15.64 $6.26 $15.64 $15.64 $15.64 $15.64 $15.64 $12.00 $15.64 $15.64 $15.64 $7.82 $7.82 $12.39 $15.64 $12.51 $10.17 $15.64 $15.64 $9.28 $15.64 $9.38 $15.64 $15.64 $15.64 N/A N/A 3584 ERX HCPCS J1630 63323-0474-01 HALOPERIDOL LACTATE 5 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $1.09 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.80 $22.00 $1.13 $1.13 $1.18 $1.09 $1.28 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.22 $22.00 $12.76 $22.00 $22.00 $22.00 $1.22 $22.00 N/A N/A 3585 ERX HCPCS 25000001 99999-6007-06 HALOPERIDOL LACTATE 2 MG/ML PO CONC BOTH IP/OP $10.00 $7.00 $1.74 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $1.74 $9.79 $9.79 $7.27 $7.27 $7.55 $5.10 $2.04 $9.79 $3.92 $9.79 $9.79 $9.79 $9.79 $9.79 $7.50 $9.79 $9.79 $9.79 $4.90 $4.90 $7.75 $9.79 $7.83 $6.36 $9.79 $9.79 $5.80 $9.79 $5.87 $9.79 $9.79 $9.79 N/A N/A 3697 ERX HCPCS J0360 63323-0614-01 HYDRALAZINE HCL 20 MG/ML IJ SOLN BOTH IP/OP $74.50 $55.00 $5.35 $74.24 $33.41 $33.41 $33.41 $33.41 $74.24 $74.24 $74.24 $5.77 $74.24 $5.56 $5.56 $5.78 $5.35 $6.29 $74.24 $74.24 $43.91 $74.24 $74.24 $74.24 $74.24 $55.88 $74.24 $74.24 $74.24 $37.12 $37.12 $58.80 $74.24 $59.39 $33.41 $5.99 $74.24 $43.21 $74.24 $74.24 $74.24 $5.99 $74.24 N/A N/A 3698 ERX HCPCS 63700006 51079-0074-01 HYDRALAZINE HCL 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3699 ERX HCPCS 63700001 50111-0397-01 HYDRALAZINE HCL 100 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3700 ERX HCPCS 63700001 51079-0075-01 HYDRALAZINE HCL 25 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3701 ERX HCPCS 63700001 62584-0734-01 HYDRALAZINE HCL 50 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3721 ERX HCPCS 63700001 16729-0184-01 HYDROCHLOROTHIAZIDE 50 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3726 ERX HCPCS 63700001 00168-0015-31 HYDROCORTISONE 1 % EX CREA BOTH IP/OP $31.50 $23.00 $6.48 $31.11 $31.11 $31.11 $31.11 $31.11 $31.11 $31.11 $31.11 $31.11 $31.11 $31.11 $31.11 $31.11 $31.11 $6.48 $31.11 $12.44 $31.11 $31.11 $31.11 $31.11 $31.11 $23.63 $31.11 $31.11 $31.11 $15.56 $15.56 $24.64 $31.11 $24.89 $20.22 $31.11 $31.11 $18.27 $31.11 $18.67 $31.11 $31.11 $31.11 N/A N/A 3727 ERX HCPCS 63700001 00168-0080-31 HYDROCORTISONE 2.5 % EX CREA BOTH IP/OP $48.00 $36.00 $9.91 $47.57 $47.57 $47.57 $47.57 $47.57 $47.57 $47.57 $47.57 $47.57 $47.57 $47.57 $47.57 $47.57 $47.57 $9.91 $47.57 $19.03 $47.57 $47.57 $47.57 $47.57 $47.57 $36.00 $47.57 $47.57 $47.57 $23.79 $23.79 $37.68 $47.57 $38.06 $30.92 $47.57 $47.57 $27.84 $47.57 $28.54 $47.57 $47.57 $47.57 N/A N/A 3728 ERX HCPCS 63700001 00394-0859-32 HYDROCORTISONE 1 % EX LOTN BOTH IP/OP $29.00 $21.00 $5.95 $28.57 $28.57 $28.57 $28.57 $28.57 $28.57 $28.57 $28.57 $28.57 $28.57 $28.57 $28.57 $28.57 $28.57 $5.95 $28.57 $11.43 $28.57 $28.57 $28.57 $28.57 $28.57 $21.75 $28.57 $28.57 $28.57 $14.29 $14.29 $22.63 $28.57 $22.86 $18.57 $28.57 $28.57 $16.82 $28.57 $17.14 $28.57 $28.57 $28.57 N/A N/A 3732 ERX HCPCS 63700001 00168-0146-30 HYDROCORTISONE 2.5 % EX OINT BOTH IP/OP $48.00 $36.00 $9.90 $47.52 $47.52 $47.52 $47.52 $47.52 $47.52 $47.52 $47.52 $47.52 $47.52 $47.52 $47.52 $47.52 $47.52 $9.90 $47.52 $19.01 $47.52 $47.52 $47.52 $47.52 $47.52 $36.00 $47.52 $47.52 $47.52 $23.76 $23.76 $37.64 $47.52 $38.02 $30.89 $47.52 $47.52 $27.84 $47.52 $28.51 $47.52 $47.52 $47.52 N/A N/A 3733 ERX HCPCS 63700001 59762-0074-01 HYDROCORTISONE 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3738 ERX HCPCS 25000001 65649-0411-12 HYDROCORTISONE ACETATE 25 MG RECTAL SUPP BOTH IP/OP $262.50 $194.00 $46.68 $262.25 $262.25 $262.25 $262.25 $262.25 $262.25 $262.25 $46.68 $262.25 $262.25 $194.64 $194.64 $202.14 $136.63 $54.66 $262.25 $104.90 $262.25 $262.25 $262.25 $262.25 $262.25 $196.88 $262.25 $262.25 $262.25 $131.13 $131.13 $207.70 $262.25 $209.80 $170.46 $262.25 $262.25 $152.25 $262.25 $157.35 $262.25 $262.25 $262.25 N/A N/A 3747 ERX HCPCS 25000001 51672-2010-02 HYDROCORTISONE-ALOE 0.5 % EX CREA BOTH IP/OP $24.00 $18.00 $4.24 $23.81 $23.81 $23.81 $23.81 $23.81 $23.81 $23.81 $4.24 $23.81 $23.81 $17.67 $17.67 $18.35 $12.41 $4.96 $23.81 $9.52 $23.81 $23.81 $23.81 $23.81 $23.81 $18.00 $23.81 $23.81 $23.81 $11.91 $11.91 $18.86 $23.81 $19.05 $15.48 $23.81 $23.81 $13.92 $23.81 $14.29 $23.81 $23.81 $23.81 N/A N/A 3757 ERX HCPCS J1170 00409-1283-03 HYDROMORPHONE HCL 1 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $1.56 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.56 $22.00 $2.86 $2.86 $2.97 $2.75 $3.23 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $3.08 $22.00 $12.76 $22.00 $22.00 $22.00 $3.08 $22.00 N/A N/A 3761 ERX HCPCS 25000001 00054-0264-24 HYDROMORPHONE HCL 4 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3770 ERX HCPCS J3410 00517-5602-25 HYDROXYZINE HCL 50 MG/ML IM SOLN BOTH IP/OP $93.00 $69.00 $16.86 $92.54 $92.54 $92.54 $92.54 $92.54 $92.54 $92.54 $18.06 $92.54 $92.54 $17.53 $17.53 $18.21 $16.86 $19.81 $92.54 $37.02 $92.54 $92.54 $92.54 $92.54 $92.54 $69.75 $92.54 $92.54 $92.54 $46.27 $46.27 $73.29 $92.54 $74.03 $41.64 $92.54 $92.54 $53.94 $92.54 $55.52 $92.54 $92.54 $92.54 N/A N/A 3771 ERX HCPCS 63700001 99999-6004-67 HYDROXYZINE HCL 10 MG/5ML PO SYRP BOTH IP/OP $44.00 $33.00 $9.08 $43.55 $43.55 $43.55 $43.55 $43.55 $43.55 $43.55 $43.55 $43.55 $43.55 $43.55 $43.55 $43.55 $43.55 $9.08 $43.55 $17.42 $43.55 $43.55 $43.55 $43.55 $43.55 $33.00 $43.55 $43.55 $43.55 $21.78 $21.78 $34.49 $43.55 $34.84 $28.31 $43.55 $43.55 $25.52 $43.55 $26.13 $43.55 $43.55 $43.55 N/A N/A 3772 ERX HCPCS 63700006 63739-0483-10 HYDROXYZINE HCL 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3774 ERX HCPCS 63700006 16714-0082-10 HYDROXYZINE HCL 25 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3781 ERX HCPCS 25000001 99999-6008-10 HYOSCYAMINE SULFATE 0.125 MG/5ML PO ELIX BOTH IP/OP $59.50 $44.00 $10.52 $59.10 $59.10 $59.10 $59.10 $59.10 $59.10 $59.10 $10.52 $59.10 $59.10 $43.86 $43.86 $45.55 $30.79 $12.32 $59.10 $23.64 $59.10 $59.10 $59.10 $59.10 $59.10 $44.63 $59.10 $59.10 $59.10 $29.55 $29.55 $46.81 $59.10 $47.28 $38.42 $59.10 $59.10 $34.51 $59.10 $35.46 $59.10 $59.10 $59.10 N/A N/A 3841 ERX HCPCS 25000001 00904-7914-59 IBUPROFEN 200 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3843 ERX HCPCS 25000001 00904-5853-61 IBUPROFEN 400 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3844 ERX HCPCS 25000001 00904-5854-61 IBUPROFEN 600 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3860 ERX HCPCS 63700001 49884-0054-01 IMIPRAMINE HCL 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3861 ERX HCPCS 63700001 69584-0426-10 IMIPRAMINE HCL 25 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3862 ERX HCPCS 63700001 69584-0427-10 IMIPRAMINE HCL 50 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 3900 ERX HCPCS 25000001 99999-6012-44 INDOMETHACIN 25 MG/5ML PO SUSP BOTH IP/OP $198.00 $147.00 $35.16 $197.55 $197.55 $197.55 $197.55 $197.55 $197.55 $197.55 $35.16 $197.55 $197.55 $146.62 $146.62 $152.27 $102.92 $41.17 $197.55 $79.02 $197.55 $197.55 $197.55 $197.55 $197.55 $148.50 $197.55 $197.55 $197.55 $98.78 $98.78 $156.46 $197.55 $158.04 $128.41 $197.55 $197.55 $114.84 $197.55 $118.53 $197.55 $197.55 $197.55 N/A N/A 3961 ERX HCPCS 25000001 48433-0230-15 IODINE STRONG 5 % SOLN BOTH IP/OP $154.50 $114.00 $27.42 $154.02 $154.02 $154.02 $154.02 $154.02 $154.02 $154.02 $27.42 $154.02 $154.02 $114.31 $114.31 $118.72 $80.24 $32.10 $154.02 $61.61 $154.02 $154.02 $154.02 $154.02 $154.02 $115.88 $154.02 $154.02 $154.02 $77.01 $77.01 $121.98 $154.02 $123.22 $100.11 $154.02 $154.02 $89.61 $154.02 $92.41 $154.02 $154.02 $154.02 N/A N/A 3990 ERX HCPCS J1750 00023-6082-01 IRON DEXTRAN 50 MG/ML IJ SOLN BOTH IP/OP $44.00 $33.00 $9.14 $43.83 $19.72 $19.72 $19.72 $19.72 $15.83 $15.83 $15.83 $9.14 $15.83 $16.46 $16.46 $17.10 $15.83 $18.60 $15.83 $16.57 $25.93 $15.83 $43.83 $15.83 $16.62 $33.00 $15.83 $15.83 $15.83 $21.92 $21.92 $34.71 $15.83 $35.06 $19.72 $17.71 $15.83 $25.52 $16.62 $22.95 $15.83 $17.71 $15.83 N/A N/A 4008 ERX HCPCS 25000001 10019-0360-40 ISOFLURANE IN SOLN BOTH IP/OP $115.00 $85.00 $20.40 $114.63 $114.63 $114.63 $114.63 $114.63 $114.63 $114.63 $20.40 $114.63 $114.63 $85.08 $85.08 $88.36 $59.72 $23.89 $114.63 $45.85 $114.63 $114.63 $114.63 $114.63 $114.63 $86.25 $114.63 $114.63 $114.63 $57.32 $57.32 $90.79 $114.63 $91.70 $74.51 $114.63 $114.63 $66.70 $114.63 $68.78 $114.63 $114.63 $114.63 N/A N/A 4024 ERX HCPCS 25000001 00781-3056-70 ISONIAZID 100 MG/ML IJ SOLN BOTH IP/OP $366.50 $271.00 $65.24 $366.50 $366.50 $366.50 $366.50 $366.50 $366.50 $366.50 $65.24 $366.50 $366.50 $272.02 $272.02 $282.50 $190.95 $76.38 $366.50 $146.60 $366.50 $366.50 $366.50 $366.50 $366.50 $274.88 $366.50 $366.50 $366.50 $183.25 $183.25 $290.27 $366.50 $293.20 $238.23 $366.50 $366.50 $212.57 $366.50 $219.90 $366.50 $366.50 $366.50 N/A N/A 4025 ERX HCPCS 63700001 99999-6004-68 ISONIAZID 50 MG/5ML PO SYRP BOTH IP/OP $72.00 $53.00 $14.91 $71.54 $71.54 $71.54 $71.54 $71.54 $71.54 $71.54 $71.54 $71.54 $71.54 $71.54 $71.54 $71.54 $71.54 $14.91 $71.54 $28.62 $71.54 $71.54 $71.54 $71.54 $71.54 $54.00 $71.54 $71.54 $71.54 $35.77 $35.77 $56.66 $71.54 $57.23 $46.50 $71.54 $71.54 $41.76 $71.54 $42.92 $71.54 $71.54 $71.54 N/A N/A 4026 ERX HCPCS 63700001 00555-0066-02 ISONIAZID 100 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4027 ERX HCPCS 63700001 51079-0083-20 ISONIAZID 300 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4030 ERX HCPCS 25000001 49348-0030-38 ISOPROPYL ALCOHOL 70 % SOLN BOTH IP/OP $11.00 $8.00 $1.96 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $1.96 $11.00 $11.00 $8.16 $8.16 $8.48 $5.73 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 4064 ERX HCPCS 63700001 00781-1556-01 ISOSORBIDE DINITRATE 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4068 ERX HCPCS 63700001 00781-1635-01 ISOSORBIDE DINITRATE 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4236 ERX HCPCS J3490 42023-0113-10 KETAMINE HCL 10 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $4.37 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $22.00 $22.00 $22.00 $22.00 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 4237 ERX HCPCS 25000001 00143-9509-10 KETAMINE HCL 100 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 4238 ERX HCPCS J3490 42023-0114-10 KETAMINE HCL 50 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $4.37 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $22.00 $22.00 $22.00 $22.00 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 4318 ERX HCPCS J7120 00338-0117-04 LACTATED RINGERS IV SOLN BOTH IP/OP $26.00 $19.00 $1.13 $25.92 $11.66 $11.66 $11.66 $11.66 $25.92 $25.92 $25.92 $1.13 $25.92 $2.57 $2.57 $2.67 $2.47 $2.90 $25.92 $25.92 $15.33 $25.92 $25.92 $25.92 $25.92 $19.50 $25.92 $25.92 $25.92 $12.96 $12.96 $20.53 $25.92 $20.74 $11.66 $2.76 $25.92 $15.08 $25.92 $25.92 $25.92 $2.76 $25.92 N/A N/A 4323 ERX HCPCS 63700001 08290-2367-12 LACTINEX PO PACK BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4392 ERX HCPCS J0640 67457-0528-10 LEUCOVORIN CALCIUM 100 MG IJ SOLR BOTH IP/OP $52.00 $38.00 $1.05 $51.84 $23.33 $23.33 $23.33 $23.33 $51.84 $51.84 $51.84 $1.05 $51.84 $4.62 $4.62 $4.80 $4.44 $5.22 $51.84 $51.84 $30.66 $51.84 $51.84 $51.84 $51.84 $39.00 $51.84 $51.84 $51.84 $25.92 $25.92 $41.06 $51.84 $41.47 $23.33 $4.97 $51.84 $30.16 $51.84 $51.84 $51.84 $4.97 $51.84 N/A N/A 4393 ERX HCPCS J0640 00143-9552-01 LEUCOVORIN CALCIUM 350 MG IJ SOLR BOTH IP/OP $124.50 $92.00 $7.32 $124.18 $55.88 $55.88 $55.88 $55.88 $124.18 $124.18 $124.18 $7.32 $124.18 $32.32 $32.32 $33.57 $31.08 $36.51 $124.18 $124.18 $73.45 $124.18 $124.18 $124.18 $124.18 $93.38 $124.18 $124.18 $124.18 $62.09 $62.09 $98.35 $124.18 $99.34 $55.88 $34.77 $124.18 $72.21 $124.18 $124.18 $124.18 $34.77 $124.18 N/A N/A 4394 ERX HCPCS J0640 25021-0813-10 LEUCOVORIN CALCIUM 50 MG IJ SOLR BOTH IP/OP $52.00 $38.00 $1.05 $51.84 $23.33 $23.33 $23.33 $23.33 $51.84 $51.84 $51.84 $1.05 $51.84 $4.62 $4.62 $4.80 $4.44 $5.22 $51.84 $51.84 $30.66 $51.84 $51.84 $51.84 $51.84 $39.00 $51.84 $51.84 $51.84 $25.92 $25.92 $41.06 $51.84 $41.47 $23.33 $4.97 $51.84 $30.16 $51.84 $51.84 $51.84 $4.97 $51.84 N/A N/A 4397 ERX HCPCS 63700001 51079-0582-05 LEUCOVORIN CALCIUM 25 MG PO TABS BOTH IP/OP $59.50 $44.00 $12.33 $59.14 $59.14 $59.14 $59.14 $59.14 $59.14 $59.14 $59.14 $59.14 $59.14 $59.14 $59.14 $59.14 $59.14 $12.33 $59.14 $23.66 $59.14 $59.14 $59.14 $59.14 $59.14 $44.63 $59.14 $59.14 $59.14 $29.57 $29.57 $46.84 $59.14 $47.31 $38.44 $59.14 $59.14 $34.51 $59.14 $35.48 $59.14 $59.14 $59.14 N/A N/A 4421 ERX HCPCS 63700001 00378-1803-77 LEVOTHYROXINE SODIUM 50 MCG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4450 ERX HCPCS 25000001 00054-3505-47 LIDOCAINE HCL 4 % EX SOLN BOTH IP/OP $191.50 $142.00 $34.01 $191.04 $191.04 $191.04 $191.04 $191.04 $191.04 $191.04 $34.01 $191.04 $191.04 $141.79 $141.79 $147.25 $99.53 $39.81 $191.04 $76.42 $191.04 $191.04 $191.04 $191.04 $191.04 $143.63 $191.04 $191.04 $191.04 $95.52 $95.52 $151.30 $191.04 $152.83 $124.18 $191.04 $191.04 $111.07 $191.04 $114.62 $191.04 $191.04 $191.04 N/A N/A 4451 ERX HCPCS 25000001 63323-0484-57 LIDOCAINE HCL 0.5 % IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 4452 ERX HCPCS 25000001 00409-4276-01 LIDOCAINE HCL 1 % IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 4454 ERX HCPCS 25000001 55150-0254-10 LIDOCAINE HCL 2 % IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 4498 ERX HCPCS 25000001 60432-0834-60 LINDANE 1 % EX SHAM BOTH IP/OP $475.00 $352.00 $84.53 $474.91 $474.91 $474.91 $474.91 $474.91 $474.91 $474.91 $84.53 $474.91 $474.91 $352.48 $352.48 $366.06 $247.43 $98.98 $474.91 $189.96 $474.91 $474.91 $474.91 $474.91 $474.91 $356.25 $474.91 $474.91 $474.91 $237.46 $237.46 $376.13 $474.91 $379.93 $308.69 $474.91 $474.91 $275.50 $474.91 $284.95 $474.91 $474.91 $474.91 N/A N/A 4504 ERX HCPCS 63700001 60793-0116-01 LIOTHYRONINE SODIUM 25 MCG PO TABS BOTH IP/OP $14.00 $10.00 $2.87 $13.79 $13.79 $13.79 $13.79 $13.79 $13.79 $13.79 $13.79 $13.79 $13.79 $13.79 $13.79 $13.79 $13.79 $2.87 $13.79 $5.52 $13.79 $13.79 $13.79 $13.79 $13.79 $10.50 $13.79 $13.79 $13.79 $6.90 $6.90 $10.92 $13.79 $11.03 $8.96 $13.79 $13.79 $8.12 $13.79 $8.27 $13.79 $13.79 $13.79 N/A N/A 4505 ERX HCPCS 63700001 16714-0168-01 LIOTHYRONINE SODIUM 50 MCG PO TABS BOTH IP/OP $11.00 $8.00 $2.29 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 4529 ERX HCPCS 63700001 00054-2527-25 LITHIUM CARBONATE 300 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4560 ERX HCPCS 63700001 51079-0690-20 LOPERAMIDE HCL 2 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4571 ERX HCPCS 25000001 99999-6007-84 LORAZEPAM 2 MG/ML PO CONC BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 4599 ERX HCPCS 63700001 00527-1395-01 LOXAPINE SUCCINATE 10 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4602 ERX HCPCS 63700001 00591-0372-01 LOXAPINE SUCCINATE 50 MG PO CAPS BOTH IP/OP $11.50 $9.00 $2.32 $11.12 $11.12 $11.12 $11.12 $11.12 $11.12 $11.12 $11.12 $11.12 $11.12 $11.12 $11.12 $11.12 $11.12 $2.32 $11.12 $4.45 $11.12 $11.12 $11.12 $11.12 $11.12 $8.63 $11.12 $11.12 $11.12 $5.56 $5.56 $8.81 $11.12 $8.90 $7.23 $11.12 $11.12 $6.67 $11.12 $6.67 $11.12 $11.12 $11.12 N/A N/A 4715 ERX HCPCS 63700001 59016-0420-17 MAGNESIUM LACTATE 84 MG (7MEQ) PO TBCR BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4720 ERX HCPCS J3475 51754-1000-04 MAGNESIUM SULFATE 50 % IJ SOLN BOTH IP/OP $22.00 $16.00 $0.12 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.12 $22.00 $1.27 $1.27 $1.32 $1.22 $1.43 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.36 $22.00 $12.76 $22.00 $22.00 $22.00 $1.36 $22.00 N/A N/A 4744 ERX HCPCS 25000001 00409-4091-01 MANGANESE CHLORIDE 0.1 MG/ML IV SOLN BOTH IP/OP $134.00 $99.00 $23.81 $133.77 $133.77 $133.77 $133.77 $133.77 $133.77 $133.77 $23.81 $133.77 $133.77 $99.28 $99.28 $103.11 $69.69 $27.88 $133.77 $53.51 $133.77 $133.77 $133.77 $133.77 $133.77 $100.50 $133.77 $133.77 $133.77 $66.89 $66.89 $105.95 $133.77 $107.02 $86.95 $133.77 $133.77 $77.72 $133.77 $80.26 $133.77 $133.77 $133.77 N/A N/A 4749 ERX HCPCS 25000001 00264-7578-10 MANNITOL 20 % IV SOLN BOTH IP/OP $119.50 $88.00 $21.25 $119.40 $119.40 $119.40 $119.40 $119.40 $119.40 $119.40 $21.25 $119.40 $119.40 $88.62 $88.62 $92.03 $62.21 $24.88 $119.40 $47.76 $119.40 $119.40 $119.40 $119.40 $119.40 $89.63 $119.40 $119.40 $119.40 $59.70 $59.70 $94.56 $119.40 $95.52 $77.61 $119.40 $119.40 $69.31 $119.40 $71.64 $119.40 $119.40 $119.40 N/A N/A 4750 ERX HCPCS J2150 00409-4031-01 MANNITOL 25 % IV SOLN BOTH IP/OP $22.00 $16.00 $2.52 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $2.52 $22.00 $22.00 $4.82 $4.82 $5.00 $4.63 $5.44 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 4855 ERX HCPCS 63700001 00555-0872-02 MEDROXYPROGESTERONE ACETATE 2.5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4856 ERX HCPCS 63700001 00555-0873-02 MEDROXYPROGESTERONE ACETATE 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4903 ERX HCPCS J2175 00641-6052-25 MEPERIDINE HCL 25 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $1.67 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.67 $22.00 $6.47 $6.47 $6.72 $6.22 $7.31 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $6.96 $22.00 $12.76 $22.00 $22.00 $22.00 $6.96 $22.00 N/A N/A 4904 ERX HCPCS J2175 00641-6053-25 MEPERIDINE HCL 50 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $1.67 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.67 $22.00 $6.47 $6.47 $6.72 $6.22 $7.31 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $6.96 $22.00 $12.76 $22.00 $22.00 $22.00 $6.96 $22.00 N/A N/A 4905 ERX HCPCS J2175 00409-1179-30 MEPERIDINE HCL 75 MG/ML IJ SOLN BOTH IP/OP $22.50 $17.00 $1.67 $22.12 $9.95 $9.95 $9.95 $9.95 $22.12 $22.12 $22.12 $1.67 $22.12 $6.47 $6.47 $6.72 $6.22 $7.31 $22.12 $22.12 $13.08 $22.12 $22.12 $22.12 $22.12 $16.88 $22.12 $22.12 $22.12 $11.06 $11.06 $17.52 $22.12 $17.70 $9.95 $6.96 $22.12 $13.05 $22.12 $22.12 $22.12 $6.96 $22.12 N/A N/A 4952 ERX HCPCS 63700001 99999-6011-43 METHADONE HCL 5 MG/5ML PO SOLN BOTH IP/OP $41.00 $30.00 $8.51 $40.83 $40.83 $40.83 $40.83 $40.83 $40.83 $40.83 $40.83 $40.83 $40.83 $40.83 $40.83 $40.83 $40.83 $8.51 $40.83 $16.33 $40.83 $40.83 $40.83 $40.83 $40.83 $30.75 $40.83 $40.83 $40.83 $20.42 $20.42 $32.34 $40.83 $32.66 $26.54 $40.83 $40.83 $23.78 $40.83 $24.50 $40.83 $40.83 $40.83 N/A N/A 4953 ERX HCPCS 63700001 00406-5771-62 METHADONE HCL 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4954 ERX HCPCS 63700001 00406-5755-62 METHADONE HCL 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4966 ERX HCPCS 63700001 13925-0107-01 METHENAMINE MANDELATE 1 G PO TABS BOTH IP/OP $10.50 $8.00 $2.13 $10.24 $10.24 $10.24 $10.24 $10.24 $10.24 $10.24 $10.24 $10.24 $10.24 $10.24 $10.24 $10.24 $10.24 $2.13 $10.24 $4.10 $10.24 $10.24 $10.24 $10.24 $10.24 $7.88 $10.24 $10.24 $10.24 $5.12 $5.12 $8.11 $10.24 $8.19 $6.66 $10.24 $10.24 $6.09 $10.24 $6.14 $10.24 $10.24 $10.24 N/A N/A 4971 ERX HCPCS 63700001 76385-0123-50 METHOCARBAMOL 500 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4972 ERX HCPCS 63700001 31722-0534-01 METHOCARBAMOL 750 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4975 ERX HCPCS J9260 00143-9830-01 METHOTREXATE SODIUM 1 G IJ SOLR BOTH IP/OP $273.50 $202.00 $41.40 $273.23 $122.95 $122.95 $122.95 $122.95 $273.23 $273.23 $273.23 $54.05 $273.23 $43.06 $43.06 $44.71 $41.40 $48.64 $273.23 $273.23 $161.62 $273.23 $273.23 $273.23 $273.23 $205.13 $273.23 $273.23 $273.23 $136.62 $136.62 $216.40 $273.23 $218.58 $122.95 $46.32 $273.23 $158.63 $273.23 $273.23 $273.23 $46.32 $273.23 N/A N/A 4986 ERX HCPCS 63700001 00406-1144-01 METHYLPHENIDATE HCL 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4988 ERX HCPCS 63700001 00406-1142-01 METHYLPHENIDATE HCL 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 4991 ERX HCPCS J7509 00781-5022-07 METHYLPREDNISOLONE 4 MG PO TBPK BOTH IP/OP $120.00 $89.00 $5.25 $119.52 $119.52 $119.52 $119.52 $119.52 $119.52 $119.52 $5.46 $119.52 $119.52 $5.46 $5.46 $5.67 $5.25 $24.91 $119.52 $47.81 $119.52 $119.52 $119.52 $119.52 $119.52 $90.00 $119.52 $119.52 $119.52 $59.76 $59.76 $94.66 $119.52 $95.62 $53.78 $119.52 $119.52 $69.60 $119.52 $71.71 $119.52 $119.52 $119.52 N/A N/A 4992 ERX HCPCS J7509 00009-0073-01 METHYLPREDNISOLONE 16 MG PO TABS BOTH IP/OP $15.00 $11.00 $1.00 $14.91 $14.91 $14.91 $14.91 $14.91 $14.91 $14.91 $1.04 $14.91 $14.91 $1.04 $1.04 $1.08 $1.00 $3.11 $14.91 $5.96 $14.91 $14.91 $14.91 $14.91 $14.91 $11.25 $14.91 $14.91 $14.91 $7.46 $7.46 $11.81 $14.91 $11.93 $6.71 $14.91 $14.91 $8.70 $14.91 $8.95 $14.91 $14.91 $14.91 N/A N/A 4993 ERX HCPCS J7509 59746-0001-06 METHYLPREDNISOLONE 4 MG PO TABS BOTH IP/OP $7.50 $6.00 $0.25 $7.13 $7.13 $7.13 $7.13 $7.13 $7.13 $7.13 $0.26 $7.13 $7.13 $0.26 $0.26 $0.27 $0.25 $1.49 $7.13 $2.85 $7.13 $7.13 $7.13 $7.13 $7.13 $5.63 $7.13 $7.13 $7.13 $3.57 $3.57 $5.65 $7.13 $5.70 $3.21 $7.13 $7.13 $4.35 $7.13 $4.28 $7.13 $7.13 $7.13 N/A N/A 4995 ERX HCPCS J1030 00009-3073-01 METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP BOTH IP/OP $29.50 $22.00 $4.86 $29.45 $13.25 $13.25 $13.25 $13.25 $29.45 $29.45 $29.45 $4.86 $29.45 $5.93 $5.93 $6.16 $5.70 $6.70 $29.45 $29.45 $17.42 $29.45 $29.45 $29.45 $29.45 $22.13 $29.45 $29.45 $29.45 $14.73 $14.73 $23.32 $29.45 $23.56 $13.25 $6.38 $29.45 $17.11 $29.45 $29.45 $29.45 $6.38 $29.45 N/A N/A 5002 ERX HCPCS J2765 00409-3414-01 METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $1.07 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $1.11 $1.11 $1.16 $1.07 $1.26 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.20 $22.00 $12.76 $22.00 $22.00 $22.00 $1.20 $22.00 N/A N/A 5005 ERX HCPCS 25000001 51079-0888-20 METOCLOPRAMIDE HCL 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 5009 ERX HCPCS 63700001 51079-0801-20 METOPROLOL TARTRATE 50 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 5015 ERX HCPCS 63700001 00904-7156-61 METRONIDAZOLE 250 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 5039 ERX HCPCS 63700001 49348-0689-72 MICONAZOLE NITRATE 2 % EX CREA BOTH IP/OP $23.00 $17.00 $4.75 $22.81 $22.81 $22.81 $22.81 $22.81 $22.81 $22.81 $22.81 $22.81 $22.81 $22.81 $22.81 $22.81 $22.81 $4.75 $22.81 $9.12 $22.81 $22.81 $22.81 $22.81 $22.81 $17.25 $22.81 $22.81 $22.81 $11.41 $11.41 $18.07 $22.81 $18.25 $14.83 $22.81 $22.81 $13.34 $22.81 $13.69 $22.81 $22.81 $22.81 N/A N/A 5086 ERX HCPCS 25000001 48433-0202-30 MINERAL OIL PO OIL BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 5110 ERX HCPCS 63700001 00591-5695-50 MINOCYCLINE HCL 100 MG PO CAPS BOTH IP/OP $15.00 $11.00 $3.06 $14.68 $14.68 $14.68 $14.68 $14.68 $14.68 $14.68 $14.68 $14.68 $14.68 $14.68 $14.68 $14.68 $14.68 $3.06 $14.68 $5.87 $14.68 $14.68 $14.68 $14.68 $14.68 $11.25 $14.68 $14.68 $14.68 $7.34 $7.34 $11.63 $14.68 $11.74 $9.54 $14.68 $14.68 $8.70 $14.68 $8.81 $14.68 $14.68 $14.68 N/A N/A 5111 ERX HCPCS 63700001 00591-5694-01 MINOCYCLINE HCL 50 MG PO CAPS BOTH IP/OP $7.50 $6.00 $1.53 $7.34 $7.34 $7.34 $7.34 $7.34 $7.34 $7.34 $7.34 $7.34 $7.34 $7.34 $7.34 $7.34 $7.34 $1.53 $7.34 $2.94 $7.34 $7.34 $7.34 $7.34 $7.34 $5.63 $7.34 $7.34 $7.34 $3.67 $3.67 $5.81 $7.34 $5.87 $4.77 $7.34 $7.34 $4.35 $7.34 $4.40 $7.34 $7.34 $7.34 N/A N/A 5114 ERX HCPCS 63700001 68084-0205-11 MINOXIDIL 10 MG PO TABS BOTH IP/OP $9.50 $7.00 $1.91 $9.16 $9.16 $9.16 $9.16 $9.16 $9.16 $9.16 $9.16 $9.16 $9.16 $9.16 $9.16 $9.16 $9.16 $1.91 $9.16 $3.66 $9.16 $9.16 $9.16 $9.16 $9.16 $7.13 $9.16 $9.16 $9.16 $4.58 $4.58 $7.25 $9.16 $7.33 $5.95 $9.16 $9.16 $5.51 $9.16 $5.50 $9.16 $9.16 $9.16 N/A N/A 5115 ERX HCPCS 63700001 00591-5642-01 MINOXIDIL 2.5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 5176 ERX HCPCS 25000001 68094-0001-62 MORPHINE SULFATE 10 MG/5ML PO SOLN BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 5178 ERX HCPCS 25000001 00054-0235-24 MORPHINE SULFATE 15 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 5179 ERX HCPCS 25000001 00054-0236-25 MORPHINE SULFATE 30 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 5180 ERX HCPCS 25000001 00574-7112-12 MORPHINE SULFATE 10 MG RECTAL SUPP BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 5330 ERX HCPCS 63700001 69238-1123-09 NADOLOL 20 MG PO TABS BOTH IP/OP $20.50 $15.00 $4.20 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $4.20 $20.14 $8.06 $20.14 $20.14 $20.14 $20.14 $20.14 $15.38 $20.14 $20.14 $20.14 $10.07 $10.07 $15.95 $20.14 $16.11 $13.09 $20.14 $20.14 $11.89 $20.14 $12.08 $20.14 $20.14 $20.14 N/A N/A 5332 ERX HCPCS 63700001 69238-1125-09 NADOLOL 80 MG PO TABS BOTH IP/OP $32.50 $24.00 $6.74 $32.36 $32.36 $32.36 $32.36 $32.36 $32.36 $32.36 $32.36 $32.36 $32.36 $32.36 $32.36 $32.36 $32.36 $6.74 $32.36 $12.94 $32.36 $32.36 $32.36 $32.36 $32.36 $24.38 $32.36 $32.36 $32.36 $16.18 $16.18 $25.63 $32.36 $25.89 $21.03 $32.36 $32.36 $18.85 $32.36 $19.42 $32.36 $32.36 $32.36 N/A N/A 5333 ERX HCPCS 25000001 55150-0122-15 NAFCILLIN SODIUM 1 G IJ SOLR BOTH IP/OP $63.00 $47.00 $11.15 $62.64 $62.64 $62.64 $62.64 $62.64 $62.64 $62.64 $11.15 $62.64 $62.64 $46.49 $46.49 $48.28 $32.64 $13.05 $62.64 $25.06 $62.64 $62.64 $62.64 $62.64 $62.64 $47.25 $62.64 $62.64 $62.64 $31.32 $31.32 $49.61 $62.64 $50.11 $40.72 $62.64 $62.64 $36.54 $62.64 $37.58 $62.64 $62.64 $62.64 N/A N/A 5335 ERX HCPCS 25000001 55150-0123-15 NAFCILLIN SODIUM 2 G IJ SOLR BOTH IP/OP $113.00 $84.00 $20.03 $112.54 $112.54 $112.54 $112.54 $112.54 $112.54 $112.54 $20.03 $112.54 $112.54 $83.53 $83.53 $86.75 $58.63 $23.45 $112.54 $45.02 $112.54 $112.54 $112.54 $112.54 $112.54 $84.75 $112.54 $112.54 $112.54 $56.27 $56.27 $89.13 $112.54 $90.03 $73.15 $112.54 $112.54 $65.54 $112.54 $67.52 $112.54 $112.54 $112.54 N/A N/A 5339 ERX HCPCS J2300 00409-1463-69 NALBUPHINE HCL 10 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $2.85 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $2.85 $22.00 $22.00 $3.19 $3.19 $3.32 $3.07 $3.61 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 5340 ERX HCPCS J2300 00409-1465-01 NALBUPHINE HCL 20 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $2.85 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $2.85 $22.00 $22.00 $3.19 $3.19 $3.32 $3.07 $3.61 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 5373 ERX HCPCS J2310 00641-6132-25 NALOXONE HCL 0.4 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $10.93 $22.00 $22.00 $11.22 $11.22 $11.65 $10.79 $12.68 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 5384 ERX HCPCS 25000001 69968-0063-01 NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OP SOLN BOTH IP/OP $65.00 $48.00 $11.53 $64.80 $64.80 $64.80 $64.80 $64.80 $64.80 $64.80 $11.53 $64.80 $64.80 $48.09 $48.09 $49.95 $33.76 $13.51 $64.80 $25.92 $64.80 $64.80 $64.80 $64.80 $64.80 $48.75 $64.80 $64.80 $64.80 $32.40 $32.40 $51.32 $64.80 $51.84 $42.12 $64.80 $64.80 $37.70 $64.80 $38.88 $64.80 $64.80 $64.80 N/A N/A 5391 ERX HCPCS 63700001 51079-0793-01 NAPROXEN 250 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 5472 ERX HCPCS 63700001 51079-0015-20 NEOMYCIN SULFATE 500 MG PO TABS BOTH IP/OP $9.00 $7.00 $1.78 $8.54 $8.54 $8.54 $8.54 $8.54 $8.54 $8.54 $8.54 $8.54 $8.54 $8.54 $8.54 $8.54 $8.54 $1.78 $8.54 $3.42 $8.54 $8.54 $8.54 $8.54 $8.54 $6.75 $8.54 $8.54 $8.54 $4.27 $4.27 $6.76 $8.54 $6.83 $5.55 $8.54 $8.54 $5.22 $8.54 $5.12 $8.54 $8.54 $8.54 N/A N/A 5474 ERX HCPCS 25000001 24208-0790-62 NEOMYCIN-POLYMYXIN-GRAMICIDIN 1.75-10000-.025 OP SOLN BOTH IP/OP $219.50 $162.00 $39.04 $219.32 $219.32 $219.32 $219.32 $219.32 $219.32 $219.32 $39.04 $219.32 $219.32 $162.78 $162.78 $169.05 $114.27 $45.71 $219.32 $87.73 $219.32 $219.32 $219.32 $219.32 $219.32 $164.63 $219.32 $219.32 $219.32 $109.66 $109.66 $173.70 $219.32 $175.46 $142.56 $219.32 $219.32 $127.31 $219.32 $131.59 $219.32 $219.32 $219.32 N/A N/A 5542 ERX HCPCS 63700001 00536-4078-10 NIACIN 500 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 5558 ERX HCPCS 63700001 00228-2497-10 NIFEDIPINE 10 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 5559 ERX HCPCS 63700001 00228-2530-10 NIFEDIPINE 20 MG PO CAPS BOTH IP/OP $10.00 $7.00 $2.07 $9.95 $9.95 $9.95 $9.95 $9.95 $9.95 $9.95 $9.95 $9.95 $9.95 $9.95 $9.95 $9.95 $9.95 $2.07 $9.95 $3.98 $9.95 $9.95 $9.95 $9.95 $9.95 $7.50 $9.95 $9.95 $9.95 $4.98 $4.98 $7.88 $9.95 $7.96 $6.47 $9.95 $9.95 $5.80 $9.95 $5.97 $9.95 $9.95 $9.95 N/A N/A 5595 ERX HCPCS 63700006 47781-0307-01 NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS BOTH IP/OP $10.00 $7.00 $2.05 $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $9.82 $2.05 $9.82 $3.93 $9.82 $9.82 $9.82 $9.82 $9.82 $7.50 $9.82 $9.82 $9.82 $4.91 $4.91 $7.78 $9.82 $7.86 $6.38 $9.82 $9.82 $5.80 $9.82 $5.89 $9.82 $9.82 $9.82 N/A N/A 5599 ERX HCPCS 25000001 00517-4810-25 NITROGLYCERIN 5 MG/ML IV SOLN BOTH IP/OP $74.00 $55.00 $13.16 $73.96 $73.96 $73.96 $73.96 $73.96 $73.96 $73.96 $13.16 $73.96 $73.96 $54.89 $54.89 $57.01 $38.53 $15.41 $73.96 $29.58 $73.96 $73.96 $73.96 $73.96 $73.96 $55.50 $73.96 $73.96 $73.96 $36.98 $36.98 $58.58 $73.96 $59.17 $48.07 $73.96 $73.96 $42.92 $73.96 $44.38 $73.96 $73.96 $73.96 N/A N/A 5603 ERX HCPCS 25000001 00071-0417-24 NITROGLYCERIN 0.3 MG SL SUBL BOTH IP/OP $303.50 $225.00 $53.97 $303.23 $303.23 $303.23 $303.23 $303.23 $303.23 $303.23 $53.97 $303.23 $303.23 $225.06 $225.06 $233.73 $157.98 $63.20 $303.23 $121.29 $303.23 $303.23 $303.23 $303.23 $303.23 $227.63 $303.23 $303.23 $303.23 $151.62 $151.62 $240.16 $303.23 $242.58 $197.10 $303.23 $303.23 $176.03 $303.23 $181.94 $303.23 $303.23 $303.23 N/A N/A 5604 ERX HCPCS 25000001 68462-0639-45 NITROGLYCERIN 0.4 MG SL SUBL BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 5605 ERX HCPCS 25000001 00071-0419-24 NITROGLYCERIN 0.6 MG SL SUBL BOTH IP/OP $303.50 $225.00 $53.97 $303.23 $303.23 $303.23 $303.23 $303.23 $303.23 $303.23 $53.97 $303.23 $303.23 $225.06 $225.06 $233.73 $157.98 $63.20 $303.23 $121.29 $303.23 $303.23 $303.23 $303.23 $303.23 $227.63 $303.23 $303.23 $303.23 $151.62 $151.62 $240.16 $303.23 $242.58 $197.10 $303.23 $303.23 $176.03 $303.23 $181.94 $303.23 $303.23 $303.23 N/A N/A 5606 ERX HCPCS 25000001 00281-0326-08 NITROGLYCERIN 2 % TD OINT BOTH IP/OP $12.00 $9.00 $2.12 $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $2.12 $11.91 $11.91 $8.84 $8.84 $9.18 $6.21 $2.48 $11.91 $4.76 $11.91 $11.91 $11.91 $11.91 $11.91 $9.00 $11.91 $11.91 $11.91 $5.96 $5.96 $9.43 $11.91 $9.53 $7.74 $11.91 $11.91 $6.96 $11.91 $7.15 $11.91 $11.91 $11.91 N/A N/A 5674 ERX HCPCS 63700001 60687-0281-01 NORTRIPTYLINE HCL 10 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 5675 ERX HCPCS 63700001 51672-4002-01 NORTRIPTYLINE HCL 25 MG PO CAPS BOTH IP/OP $6.50 $5.00 $1.32 $6.34 $6.34 $6.34 $6.34 $6.34 $6.34 $6.34 $6.34 $6.34 $6.34 $6.34 $6.34 $6.34 $6.34 $1.32 $6.34 $2.54 $6.34 $6.34 $6.34 $6.34 $6.34 $4.88 $6.34 $6.34 $6.34 $3.17 $3.17 $5.02 $6.34 $5.07 $4.12 $6.34 $6.34 $3.77 $6.34 $3.80 $6.34 $6.34 $6.34 N/A N/A 5677 ERX HCPCS 63700001 00093-0813-01 NORTRIPTYLINE HCL 75 MG PO CAPS BOTH IP/OP $18.50 $14.00 $3.80 $18.23 $18.23 $18.23 $18.23 $18.23 $18.23 $18.23 $18.23 $18.23 $18.23 $18.23 $18.23 $18.23 $18.23 $3.80 $18.23 $7.29 $18.23 $18.23 $18.23 $18.23 $18.23 $13.88 $18.23 $18.23 $18.23 $9.12 $9.12 $14.44 $18.23 $14.58 $11.85 $18.23 $18.23 $10.73 $18.23 $10.94 $18.23 $18.23 $18.23 N/A N/A 5749 ERX HCPCS 25000001 51672-1289-02 NYSTATIN 100000 UNIT/GM EX CREA BOTH IP/OP $105.00 $78.00 $18.66 $104.84 $104.84 $104.84 $104.84 $104.84 $104.84 $104.84 $18.66 $104.84 $104.84 $77.81 $77.81 $80.81 $54.62 $21.85 $104.84 $41.94 $104.84 $104.84 $104.84 $104.84 $104.84 $78.75 $104.84 $104.84 $104.84 $52.42 $52.42 $83.03 $104.84 $83.87 $68.15 $104.84 $104.84 $60.90 $104.84 $62.90 $104.84 $104.84 $104.84 N/A N/A 5750 ERX HCPCS 25000001 00168-0007-30 NYSTATIN 100000 UNIT/GM EX OINT BOTH IP/OP $100.50 $74.00 $17.85 $100.30 $100.30 $100.30 $100.30 $100.30 $100.30 $100.30 $17.85 $100.30 $100.30 $74.44 $74.44 $77.31 $52.26 $20.90 $100.30 $40.12 $100.30 $100.30 $100.30 $100.30 $100.30 $75.38 $100.30 $100.30 $100.30 $50.15 $50.15 $79.44 $100.30 $80.24 $65.20 $100.30 $100.30 $58.29 $100.30 $60.18 $100.30 $100.30 $100.30 N/A N/A 5751 ERX HCPCS 25000001 60432-0537-60 NYSTATIN 100000 UNIT/ML MT SUSP BOTH IP/OP $73.50 $54.00 $42.63 $402.13 $402.13 $402.13 $402.13 $402.13 $402.13 $402.13 $71.58 $402.13 $402.13 $298.46 $298.46 $309.96 $209.51 $83.81 $402.13 $160.85 $402.13 $402.13 $402.13 $402.13 $402.13 $55.13 $402.13 $402.13 $402.13 $201.07 $201.07 $318.49 $402.13 $321.70 $261.38 $402.13 $402.13 $42.63 $402.13 $241.28 $402.13 $402.13 $402.13 N/A N/A 5751 ERX HCPCS 25000001 51672-4117-09 NYSTATIN 100000 UNIT/ML MT SUSP BOTH IP/OP $402.50 $298.00 $71.58 $402.13 $402.13 $402.13 $402.13 $402.13 $402.13 $402.13 $71.58 $402.13 $402.13 $298.46 $298.46 $309.96 $209.51 $83.81 $402.13 $160.85 $402.13 $402.13 $402.13 $402.13 $402.13 $301.88 $402.13 $402.13 $402.13 $201.07 $201.07 $318.49 $402.13 $321.70 $261.38 $402.13 $402.13 $233.45 $402.13 $241.28 $402.13 $402.13 $402.13 N/A N/A 5755 ERX HCPCS 25000001 51672-1272-01 NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX OINT BOTH IP/OP $388.50 $287.00 $69.14 $388.45 $388.45 $388.45 $388.45 $388.45 $388.45 $388.45 $69.14 $388.45 $388.45 $288.31 $288.31 $299.42 $202.38 $80.96 $388.45 $155.38 $388.45 $388.45 $388.45 $388.45 $388.45 $291.38 $388.45 $388.45 $388.45 $194.23 $194.23 $307.65 $388.45 $310.76 $252.49 $388.45 $388.45 $225.33 $388.45 $233.07 $388.45 $388.45 $388.45 N/A N/A 5851 ERX HCPCS 25000001 99999-6006-21 ORA-PLUS PO LIQD BOTH IP/OP $22.00 $16.00 $3.88 $21.78 $21.78 $21.78 $21.78 $21.78 $21.78 $21.78 $3.88 $21.78 $21.78 $16.17 $16.17 $16.79 $11.35 $4.54 $21.78 $8.71 $21.78 $21.78 $21.78 $21.78 $21.78 $16.50 $21.78 $21.78 $21.78 $10.89 $10.89 $17.25 $21.78 $17.42 $14.16 $21.78 $21.78 $12.76 $21.78 $13.07 $21.78 $21.78 $21.78 N/A N/A 5852 ERX HCPCS 25000001 00574-0304-16 ORA-SWEET PO SYRP BOTH IP/OP $88.50 $65.00 $15.75 $88.48 $88.48 $88.48 $88.48 $88.48 $88.48 $88.48 $15.75 $88.48 $88.48 $65.67 $65.67 $68.20 $46.10 $18.44 $88.48 $35.39 $88.48 $88.48 $88.48 $88.48 $88.48 $66.38 $88.48 $88.48 $88.48 $44.24 $44.24 $70.08 $88.48 $70.78 $57.51 $88.48 $88.48 $51.33 $88.48 $53.09 $88.48 $88.48 $88.48 N/A N/A 5853 ERX HCPCS 25000001 00574-0302-16 ORA-SWEET SF PO SYRP BOTH IP/OP $88.50 $65.00 $15.75 $88.48 $88.48 $88.48 $88.48 $88.48 $88.48 $88.48 $15.75 $88.48 $88.48 $65.67 $65.67 $68.20 $46.10 $18.44 $88.48 $35.39 $88.48 $88.48 $88.48 $88.48 $88.48 $66.38 $88.48 $88.48 $88.48 $44.24 $44.24 $70.08 $88.48 $70.78 $57.51 $88.48 $88.48 $51.33 $88.48 $53.09 $88.48 $88.48 $88.48 N/A N/A 5924 ERX HCPCS J2700 25021-0146-10 OXACILLIN SODIUM 1 G IJ SOLR BOTH IP/OP $29.50 $22.00 $2.56 $29.16 $29.16 $29.16 $29.16 $29.16 $29.16 $29.16 $2.56 $29.16 $29.16 $2.66 $2.66 $2.76 $2.56 $3.01 $29.16 $11.66 $29.16 $29.16 $29.16 $29.16 $29.16 $22.13 $29.16 $29.16 $29.16 $14.58 $14.58 $23.09 $29.16 $23.33 $13.12 $29.16 $29.16 $17.11 $29.16 $17.50 $29.16 $29.16 $29.16 N/A N/A 5940 ERX HCPCS 25000001 00406-0512-62 OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 5943 ERX HCPCS 25000001 00904-6761-30 OXYMETAZOLINE HCL 0.05 % NA SOLN BOTH IP/OP $17.50 $13.00 $3.07 $17.24 $17.24 $17.24 $17.24 $17.24 $17.24 $17.24 $3.07 $17.24 $17.24 $12.80 $12.80 $13.29 $8.98 $3.59 $17.24 $6.90 $17.24 $17.24 $17.24 $17.24 $17.24 $13.13 $17.24 $17.24 $17.24 $8.62 $8.62 $13.65 $17.24 $13.79 $11.21 $17.24 $17.24 $10.15 $17.24 $10.34 $17.24 $17.24 $17.24 N/A N/A 5955 ERX HCPCS 63700001 00904-1883-61 OYSTER CALCIUM 500 (1250 CA CARB) MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6030 ERX HCPCS J2440 00517-4002-25 PAPAVERINE HCL 30 MG/ML IJ SOLN BOTH IP/OP $99.00 $73.00 $19.63 $98.89 $44.50 $44.50 $44.50 $44.50 $98.89 $98.89 $98.89 $20.61 $98.89 $39.00 $39.00 $40.50 $37.50 $20.61 $98.89 $98.89 $58.49 $98.89 $98.89 $98.89 $98.89 $74.25 $98.89 $98.89 $98.89 $49.45 $49.45 $78.32 $98.89 $79.11 $44.50 $19.63 $98.89 $57.42 $98.89 $98.89 $98.89 $20.61 $98.89 N/A N/A 6040 ERX HCPCS J7300 59365-5128-01 PARAGARD INTRAUTERINE COPPER IU IUD BOTH IP/OP "$2,866.00" "$2,121.00" $750.43 "$2,865.90" "$1,289.66" "$1,289.66" "$1,289.66" "$1,289.66" "$2,865.90" "$2,865.90" $899.52 $750.43 "$2,865.90" $974.48 $974.48 "$1,011.96" $937.00 "$1,100.83" "$2,865.90" "$1,146.36" "$1,412.89" "$2,865.90" "$2,865.90" "$2,865.90" "$2,865.90" "$2,149.50" "$2,865.90" "$2,865.90" "$2,865.90" "$1,432.95" "$1,432.95" "$2,269.79" "$2,865.90" "$2,292.72" "$1,289.66" "$1,048.32" "$2,865.90" "$1,662.28" "$2,865.90" "$1,719.54" "$2,865.90" "$1,048.32" "$2,865.90" N/A N/A 6085 ERX HCPCS J2540 00049-0530-22 PENICILLIN G POTASSIUM 20000000 UNITS IJ SOLR BOTH IP/OP $22.00 $16.00 $0.77 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $0.92 $22.00 $22.00 $0.80 $0.80 $0.83 $0.77 $0.90 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 6086 ERX HCPCS J2540 00049-0520-83 PENICILLIN G POTASSIUM 5000000 UNITS IJ SOLR BOTH IP/OP $66.00 $49.00 $6.16 $65.95 $65.95 $65.95 $65.95 $65.95 $65.95 $65.95 $7.36 $65.95 $65.95 $6.41 $6.41 $6.65 $6.16 $7.24 $65.95 $26.38 $65.95 $65.95 $65.95 $65.95 $65.95 $49.50 $65.95 $65.95 $65.95 $32.98 $32.98 $52.23 $65.95 $52.76 $29.68 $65.95 $65.95 $38.28 $65.95 $39.57 $65.95 $65.95 $65.95 N/A N/A 6087 ERX HCPCS 25000001 00781-6153-94 PENICILLIN G SODIUM 5000000 UNITS IJ SOLR BOTH IP/OP $30.00 $22.00 $5.32 $29.86 $29.86 $29.86 $29.86 $29.86 $29.86 $29.86 $5.32 $29.86 $29.86 $22.16 $22.16 $23.02 $15.56 $6.22 $29.86 $11.94 $29.86 $29.86 $29.86 $29.86 $29.86 $22.50 $29.86 $29.86 $29.86 $14.93 $14.93 $23.65 $29.86 $23.89 $19.41 $29.86 $29.86 $17.40 $29.86 $17.92 $29.86 $29.86 $29.86 N/A N/A 6090 ERX HCPCS 63700001 00093-4125-73 PENICILLIN V POTASSIUM 125 MG/5ML PO SOLR BOTH IP/OP $43.50 $32.00 $9.00 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $9.00 $43.20 $17.28 $43.20 $43.20 $43.20 $43.20 $43.20 $32.63 $43.20 $43.20 $43.20 $21.60 $21.60 $34.21 $43.20 $34.56 $28.08 $43.20 $43.20 $25.23 $43.20 $25.92 $43.20 $43.20 $43.20 N/A N/A 6091 ERX HCPCS 25000001 00093-4127-73 PENICILLIN V POTASSIUM 250 MG/5ML PO SOLR BOTH IP/OP $48.50 $36.00 $8.61 $48.39 $48.39 $48.39 $48.39 $48.39 $48.39 $48.39 $8.61 $48.39 $48.39 $35.92 $35.92 $37.30 $25.21 $10.09 $48.39 $19.36 $48.39 $48.39 $48.39 $48.39 $48.39 $36.38 $48.39 $48.39 $48.39 $24.20 $24.20 $38.32 $48.39 $38.71 $31.45 $48.39 $48.39 $28.13 $48.39 $29.03 $48.39 $48.39 $48.39 N/A N/A 6092 ERX HCPCS 63700001 00093-1172-10 PENICILLIN V POTASSIUM 250 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6093 ERX HCPCS 63700001 16714-0235-01 PENICILLIN V POTASSIUM 500 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6097 ERX HCPCS J2515 25021-0676-20 PENTOBARBITAL SODIUM 50 MG/ML IJ SOLN BOTH IP/OP "$3,914.50" "$2,897.00" $482.60 "$3,914.40" "$3,914.40" "$3,914.40" "$3,914.40" "$3,914.40" "$3,914.40" "$3,914.40" $528.20 "$3,914.40" "$3,914.40" $501.90 $501.90 $521.21 $482.60 $566.98 "$3,914.40" "$1,565.76" "$3,914.40" "$3,914.40" "$3,914.40" "$3,914.40" "$3,914.40" "$2,935.88" "$3,914.40" "$3,914.40" "$3,914.40" "$1,957.20" "$1,957.20" "$3,100.20" "$3,914.40" "$3,131.52" "$1,761.48" "$3,914.40" "$3,914.40" "$2,270.41" "$3,914.40" "$2,348.64" "$3,914.40" "$3,914.40" "$3,914.40" N/A N/A 6116 ERX HCPCS 25000001 00395-2015-91 PEPPERMINT OIL OIL BOTH IP/OP $102.00 $75.00 $18.13 $101.85 $101.85 $101.85 $101.85 $101.85 $101.85 $101.85 $18.13 $101.85 $101.85 $75.59 $75.59 $78.51 $53.06 $21.23 $101.85 $40.74 $101.85 $101.85 $101.85 $101.85 $101.85 $76.50 $101.85 $101.85 $101.85 $50.93 $50.93 $80.67 $101.85 $81.48 $66.20 $101.85 $101.85 $59.16 $101.85 $61.11 $101.85 $101.85 $101.85 N/A N/A 6193 ERX HCPCS 63700001 10135-0620-01 PHENAZOPYRIDINE HCL 100 MG PO TABS BOTH IP/OP $7.00 $5.00 $1.43 $6.87 $6.87 $6.87 $6.87 $6.87 $6.87 $6.87 $6.87 $6.87 $6.87 $6.87 $6.87 $6.87 $6.87 $1.43 $6.87 $2.75 $6.87 $6.87 $6.87 $6.87 $6.87 $5.25 $6.87 $6.87 $6.87 $3.44 $3.44 $5.44 $6.87 $5.50 $4.47 $6.87 $6.87 $4.06 $6.87 $4.12 $6.87 $6.87 $6.87 N/A N/A 6212 ERX HCPCS 63700001 99999-6006-84 PHENOBARBITAL 20 MG/5ML PO ELIX BOTH IP/OP $6.50 $5.00 $1.34 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $1.34 $6.42 $2.57 $6.42 $6.42 $6.42 $6.42 $6.42 $4.88 $6.42 $6.42 $6.42 $3.21 $3.21 $5.08 $6.42 $5.14 $4.17 $6.42 $6.42 $3.77 $6.42 $3.85 $6.42 $6.42 $6.42 N/A N/A 6217 ERX HCPCS 63700001 00904-6575-61 PHENOBARBITAL 32.4 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6220 ERX HCPCS 63700001 00603-5168-21 PHENOBARBITAL 97.2 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6221 ERX HCPCS J2560 00641-0477-21 PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN BOTH IP/OP $226.50 $168.00 $40.22 $226.27 $226.27 $226.27 $226.27 $226.27 $226.27 $226.27 $40.22 $226.27 $226.27 $43.93 $43.93 $45.62 $42.24 $49.63 $226.27 $90.51 $226.27 $226.27 $226.27 $226.27 $226.27 $169.88 $226.27 $226.27 $226.27 $113.14 $113.14 $179.21 $226.27 $181.02 $101.82 $226.27 $226.27 $131.37 $226.27 $135.76 $226.27 $226.27 $226.27 N/A N/A 6224 ERX HCPCS J2560 00641-0476-25 PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN BOTH IP/OP $126.00 $93.00 $40.22 $125.87 $125.87 $125.87 $125.87 $125.87 $125.87 $125.87 $40.22 $125.87 $125.87 $43.93 $43.93 $45.62 $42.24 $49.63 $125.87 $50.35 $125.87 $125.87 $125.87 $125.87 $125.87 $94.50 $125.87 $125.87 $125.87 $62.94 $62.94 $99.69 $125.87 $100.70 $56.64 $125.87 $125.87 $73.08 $125.87 $75.52 $125.87 $125.87 $125.87 N/A N/A 6227 ERX HCPCS 25000001 49452-5220-02 PHENOL EX LIQD BOTH IP/OP "$1,412.50" "$1,045.00" $251.41 "$1,412.43" "$1,412.43" "$1,412.43" "$1,412.43" "$1,412.43" "$1,412.43" "$1,412.43" $251.41 "$1,412.43" "$1,412.43" "$1,048.31" "$1,048.31" "$1,088.70" $735.88 $294.37 "$1,412.43" $564.97 "$1,412.43" "$1,412.43" "$1,412.43" "$1,412.43" "$1,412.43" "$1,059.38" "$1,412.43" "$1,412.43" "$1,412.43" $706.22 $706.22 "$1,118.64" "$1,412.43" "$1,129.94" $918.08 "$1,412.43" "$1,412.43" $819.25 "$1,412.43" $847.46 "$1,412.43" "$1,412.43" "$1,412.43" N/A N/A 6243 ERX HCPCS 25000001 00225-0800-47 PHENYLEPHRINE HCL 0.25 % NA SOLN BOTH IP/OP $17.00 $13.00 $3.01 $16.92 $16.92 $16.92 $16.92 $16.92 $16.92 $16.92 $3.01 $16.92 $16.92 $12.56 $12.56 $13.04 $8.82 $3.53 $16.92 $6.77 $16.92 $16.92 $16.92 $16.92 $16.92 $12.75 $16.92 $16.92 $16.92 $8.46 $8.46 $13.40 $16.92 $13.54 $11.00 $16.92 $16.92 $9.86 $16.92 $10.15 $16.92 $16.92 $16.92 N/A N/A 6244 ERX HCPCS 25000001 00225-0805-47 PHENYLEPHRINE HCL 0.5 % NA SOLN BOTH IP/OP $17.00 $13.00 $3.01 $16.92 $16.92 $16.92 $16.92 $16.92 $16.92 $16.92 $3.01 $16.92 $16.92 $12.56 $12.56 $13.04 $8.82 $3.53 $16.92 $6.77 $16.92 $16.92 $16.92 $16.92 $16.92 $12.75 $16.92 $16.92 $16.92 $8.46 $8.46 $13.40 $16.92 $13.54 $11.00 $16.92 $16.92 $9.86 $16.92 $10.15 $16.92 $16.92 $16.92 N/A N/A 6246 ERX HCPCS 25000001 42702-0102-10 PHENYLEPHRINE HCL 2.5 % OP SOLN BOTH IP/OP $258.00 $191.00 $45.88 $257.76 $257.76 $257.76 $257.76 $257.76 $257.76 $257.76 $45.88 $257.76 $257.76 $191.31 $191.31 $198.68 $134.29 $53.72 $257.76 $103.10 $257.76 $257.76 $257.76 $257.76 $257.76 $193.50 $257.76 $257.76 $257.76 $128.88 $128.88 $204.15 $257.76 $206.21 $167.54 $257.76 $257.76 $149.64 $257.76 $154.66 $257.76 $257.76 $257.76 N/A N/A 6255 ERX HCPCS 63700001 99999-6010-65 PHENYTOIN 125 MG/5ML PO SUSP BOTH IP/OP $85.50 $63.00 $17.77 $85.28 $85.28 $85.28 $85.28 $85.28 $85.28 $85.28 $85.28 $85.28 $85.28 $85.28 $85.28 $85.28 $85.28 $17.77 $85.28 $34.11 $85.28 $85.28 $85.28 $85.28 $85.28 $64.13 $85.28 $85.28 $85.28 $42.64 $42.64 $67.54 $85.28 $68.22 $55.43 $85.28 $85.28 $49.59 $85.28 $51.17 $85.28 $85.28 $85.28 N/A N/A 6256 ERX HCPCS J1165 00641-0493-25 PHENYTOIN SODIUM 50 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.90 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $0.90 $22.00 $22.00 $1.06 $1.06 $1.10 $1.02 $1.20 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 6279 ERX HCPCS 25000001 61314-0203-15 PILOCARPINE HCL 1 % OP SOLN BOTH IP/OP $353.00 $261.00 $62.81 $352.87 $352.87 $352.87 $352.87 $352.87 $352.87 $352.87 $62.81 $352.87 $352.87 $261.90 $261.90 $271.99 $183.85 $73.54 $352.87 $141.15 $352.87 $352.87 $352.87 $352.87 $352.87 $264.75 $352.87 $352.87 $352.87 $176.44 $176.44 $279.47 $352.87 $282.30 $229.37 $352.87 $352.87 $204.74 $352.87 $211.72 $352.87 $352.87 $352.87 N/A N/A 6280 ERX HCPCS 25000001 61314-0204-15 PILOCARPINE HCL 2 % OP SOLN BOTH IP/OP $350.00 $259.00 $62.27 $349.83 $349.83 $349.83 $349.83 $349.83 $349.83 $349.83 $62.27 $349.83 $349.83 $259.64 $259.64 $269.65 $182.26 $72.91 $349.83 $139.93 $349.83 $349.83 $349.83 $349.83 $349.83 $262.50 $349.83 $349.83 $349.83 $174.92 $174.92 $277.07 $349.83 $279.86 $227.39 $349.83 $349.83 $203.00 $349.83 $209.90 $349.83 $349.83 $349.83 N/A N/A 6282 ERX HCPCS 25000001 61314-0206-15 PILOCARPINE HCL 4 % OP SOLN BOTH IP/OP $367.00 $272.00 $65.28 $366.75 $366.75 $366.75 $366.75 $366.75 $366.75 $366.75 $65.28 $366.75 $366.75 $272.20 $272.20 $282.69 $191.08 $76.43 $366.75 $146.70 $366.75 $366.75 $366.75 $366.75 $366.75 $275.25 $366.75 $366.75 $366.75 $183.38 $183.38 $290.47 $366.75 $293.40 $238.39 $366.75 $366.75 $212.86 $366.75 $220.05 $366.75 $366.75 $366.75 N/A N/A 6296 ERX HCPCS 63700001 00378-0127-01 PINDOLOL 10 MG PO TABS BOTH IP/OP $8.00 $6.00 $1.62 $7.77 $7.77 $7.77 $7.77 $7.77 $7.77 $7.77 $7.77 $7.77 $7.77 $7.77 $7.77 $7.77 $7.77 $1.62 $7.77 $3.11 $7.77 $7.77 $7.77 $7.77 $7.77 $6.00 $7.77 $7.77 $7.77 $3.89 $3.89 $6.15 $7.77 $6.22 $5.05 $7.77 $7.77 $4.64 $7.77 $4.66 $7.77 $7.77 $7.77 N/A N/A 6297 ERX HCPCS 63700001 00378-0052-01 PINDOLOL 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6331 ERX HCPCS 25000001 00338-0221-04 PLASMA-LYTE A IV SOLN BOTH IP/OP $78.00 $58.00 $13.84 $77.76 $77.76 $77.76 $77.76 $77.76 $77.76 $77.76 $13.84 $77.76 $77.76 $57.71 $57.71 $59.94 $40.51 $16.21 $77.76 $31.10 $77.76 $77.76 $77.76 $77.76 $77.76 $58.50 $77.76 $77.76 $77.76 $38.88 $38.88 $61.59 $77.76 $62.21 $50.54 $77.76 $77.76 $45.24 $77.76 $46.66 $77.76 $77.76 $77.76 N/A N/A 6374 ERX HCPCS 63700001 00087-0402-03 POLY-VI-SOL PO SOLN BOTH IP/OP $43.00 $32.00 $8.87 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $8.87 $42.56 $17.02 $42.56 $42.56 $42.56 $42.56 $42.56 $32.25 $42.56 $42.56 $42.56 $21.28 $21.28 $33.71 $42.56 $34.05 $27.66 $42.56 $42.56 $24.94 $42.56 $25.54 $42.56 $42.56 $42.56 N/A N/A 6420 ERX HCPCS 25000001 00409-8183-01 POTASSIUM ACETATE 2 MEQ/ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 6429 ERX HCPCS J3480 63323-0965-10 KCL 2 MEQ/ML IV SOLN BOTH IP/OP $22.00 $16.00 $0.24 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.24 $22.00 $1.56 $1.56 $1.62 $1.50 $1.76 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.68 $22.00 $12.76 $22.00 $22.00 $22.00 $1.68 $22.00 N/A N/A 6458 ERX HCPCS 25000001 49348-0622-37 POVIDONE-IODINE 10 % EX SOLN BOTH IP/OP $28.00 $21.00 $4.92 $27.65 $27.65 $27.65 $27.65 $27.65 $27.65 $27.65 $4.92 $27.65 $27.65 $20.52 $20.52 $21.31 $14.41 $5.76 $27.65 $11.06 $27.65 $27.65 $27.65 $27.65 $27.65 $21.00 $27.65 $27.65 $27.65 $13.83 $13.83 $21.90 $27.65 $22.12 $17.97 $27.65 $27.65 $16.24 $27.65 $16.59 $27.65 $27.65 $27.65 N/A N/A 6462 ERX HCPCS J2730 60977-0141-01 PRALIDOXIME CHLORIDE 1 G IV SOLR BOTH IP/OP $104.00 $77.00 $21.57 $103.52 $103.52 $103.52 $103.52 $103.52 $103.52 $103.52 $83.23 $103.52 $103.52 $90.17 $90.17 $93.64 $86.70 $21.57 $103.52 $41.41 $103.52 $103.52 $103.52 $103.52 $103.52 $78.00 $103.52 $103.52 $103.52 $51.76 $51.76 $81.99 $103.52 $82.82 $46.58 $103.52 $103.52 $60.32 $103.52 $62.11 $103.52 $103.52 $103.52 N/A N/A 6468 ERX HCPCS 63700001 51079-0630-20 PRAZOSIN HCL 1 MG PO CAPS BOTH IP/OP $8.00 $6.00 $1.63 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $1.63 $7.83 $3.13 $7.83 $7.83 $7.83 $7.83 $7.83 $6.00 $7.83 $7.83 $7.83 $3.92 $3.92 $6.20 $7.83 $6.26 $5.09 $7.83 $7.83 $4.64 $7.83 $4.70 $7.83 $7.83 $7.83 N/A N/A 6469 ERX HCPCS 63700001 00093-4068-01 PRAZOSIN HCL 2 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6470 ERX HCPCS 63700001 51079-0632-20 PRAZOSIN HCL 5 MG PO CAPS BOTH IP/OP $19.00 $14.00 $3.88 $18.62 $18.62 $18.62 $18.62 $18.62 $18.62 $18.62 $18.62 $18.62 $18.62 $18.62 $18.62 $18.62 $18.62 $3.88 $18.62 $7.45 $18.62 $18.62 $18.62 $18.62 $18.62 $14.25 $18.62 $18.62 $18.62 $9.31 $9.31 $14.75 $18.62 $14.90 $12.10 $18.62 $18.62 $11.02 $18.62 $11.17 $18.62 $18.62 $18.62 N/A N/A 6487 ERX HCPCS 25000001 60758-0119-10 PREDNISOLONE ACETATE 1 % OP SUSP BOTH IP/OP $366.50 $271.00 $65.23 $366.44 $366.44 $366.44 $366.44 $366.44 $366.44 $366.44 $65.23 $366.44 $366.44 $271.97 $271.97 $282.45 $190.92 $76.37 $366.44 $146.58 $366.44 $366.44 $366.44 $366.44 $366.44 $274.88 $366.44 $366.44 $366.44 $183.22 $183.22 $290.22 $366.44 $293.15 $238.19 $366.44 $366.44 $212.57 $366.44 $219.86 $366.44 $366.44 $366.44 N/A N/A 6493 ERX HCPCS 25000001 00054-4741-25 PREDNISONE 1 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6496 ERX HCPCS 25000001 00054-0018-20 PREDNISONE 20 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6497 ERX HCPCS 25000001 00054-8724-25 PREDNISONE 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6498 ERX HCPCS 25000001 00054-0019-20 PREDNISONE 50 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6544 ERX HCPCS 63700001 68084-0203-01 PRIMIDONE 250 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6561 ERX HCPCS 63700001 00591-5347-01 PROBENECID 500 MG PO TABS BOTH IP/OP $8.50 $6.00 $1.77 $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 $8.50 $1.77 $8.50 $3.40 $8.50 $8.50 $8.50 $8.50 $8.50 $6.38 $8.50 $8.50 $8.50 $4.25 $4.25 $6.73 $8.50 $6.80 $5.53 $8.50 $8.50 $4.93 $8.50 $5.10 $8.50 $8.50 $8.50 N/A N/A 6597 ERX HCPCS J2675 00591-3128-79 PROGESTERONE 50 MG/ML IM OIL BOTH IP/OP $22.00 $16.00 $1.15 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $1.41 $22.00 $22.00 $1.20 $1.20 $1.24 $1.15 $1.35 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 6618 ERX HCPCS J2550 00641-0928-25 PROMETHAZINE HCL 25 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $1.93 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.93 $22.00 $2.45 $2.45 $2.55 $2.36 $2.77 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $2.64 $22.00 $12.76 $22.00 $22.00 $22.00 $2.64 $22.00 N/A N/A 6622 ERX HCPCS Q0169 68084-0155-01 PROMETHAZINE HCL 25 MG PO TABS BOTH IP/OP $6.00 $4.00 $0.18 $6.00 $2.70 $2.70 $2.70 $2.70 $6.00 $6.00 $6.00 $1.25 $6.00 $0.19 $0.19 $0.19 $0.18 $1.25 $6.00 $6.00 $3.55 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $2.70 $1.19 $6.00 $3.48 $6.00 $6.00 $6.00 $6.00 $6.00 N/A N/A 6644 ERX HCPCS 25000001 61314-0016-01 PROPARACAINE HCL 0.5 % OP SOLN BOTH IP/OP $175.00 $130.00 $31.08 $174.63 $174.63 $174.63 $174.63 $174.63 $174.63 $174.63 $31.08 $174.63 $174.63 $129.61 $129.61 $134.60 $90.98 $36.39 $174.63 $69.85 $174.63 $174.63 $174.63 $174.63 $174.63 $131.25 $174.63 $174.63 $174.63 $87.32 $87.32 $138.31 $174.63 $139.70 $113.51 $174.63 $174.63 $101.50 $174.63 $104.78 $174.63 $174.63 $174.63 N/A N/A 6654 ERX HCPCS 25000001 99999-6010-68 PROPRANOLOL HCL 20 MG/5ML PO SOLN BOTH IP/OP $21.00 $16.00 $3.69 $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $3.69 $20.74 $20.74 $15.39 $15.39 $15.99 $10.81 $4.32 $20.74 $8.30 $20.74 $20.74 $20.74 $20.74 $20.74 $15.75 $20.74 $20.74 $20.74 $10.37 $10.37 $16.43 $20.74 $16.59 $13.48 $20.74 $20.74 $12.18 $20.74 $12.44 $20.74 $20.74 $20.74 N/A N/A 6656 ERX HCPCS 63700001 00904-6550-61 PROPRANOLOL HCL 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6658 ERX HCPCS 63700001 00603-5484-21 PROPRANOLOL HCL 40 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6659 ERX HCPCS 63700001 00603-5485-21 PROPRANOLOL HCL 60 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6660 ERX HCPCS 63700001 00603-5486-21 PROPRANOLOL HCL 80 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6662 ERX HCPCS 63700001 68084-0964-25 PROPYLTHIOURACIL 50 MG PO TABS BOTH IP/OP $15.00 $11.00 $3.03 $14.52 $14.52 $14.52 $14.52 $14.52 $14.52 $14.52 $14.52 $14.52 $14.52 $14.52 $14.52 $14.52 $14.52 $3.03 $14.52 $5.81 $14.52 $14.52 $14.52 $14.52 $14.52 $11.25 $14.52 $14.52 $14.52 $7.26 $7.26 $11.50 $14.52 $11.62 $9.44 $14.52 $14.52 $8.70 $14.52 $8.71 $14.52 $14.52 $14.52 N/A N/A 6677 ERX HCPCS J2720 63323-0229-05 PROTAMINE SULFATE 10 MG/ML IV SOLN BOTH IP/OP $22.00 $16.00 $0.60 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.60 $22.00 $1.47 $1.47 $1.52 $1.41 $1.66 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.58 $22.00 $12.76 $22.00 $22.00 $22.00 $1.58 $22.00 N/A N/A 6714 ERX HCPCS 63700001 00904-5053-59 PSEUDOEPHEDRINE HCL 30 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6744 ERX HCPCS J3415 63323-0180-01 PYRIDOXINE HCL 100 MG/ML IJ SOLN BOTH IP/OP $49.50 $37.00 $5.69 $49.41 $49.41 $49.41 $49.41 $49.41 $49.41 $49.41 $11.23 $49.41 $49.41 $5.92 $5.92 $6.15 $5.69 $10.30 $49.41 $19.76 $49.41 $49.41 $49.41 $49.41 $49.41 $37.13 $49.41 $49.41 $49.41 $24.71 $24.71 $39.13 $49.41 $39.53 $22.23 $49.41 $49.41 $28.71 $49.41 $29.65 $49.41 $49.41 $49.41 N/A N/A 6777 ERX HCPCS 63700001 42806-0513-30 QUINIDINE SULFATE 200 MG PO TABS BOTH IP/OP $65.50 $48.00 $13.59 $65.19 $65.19 $65.19 $65.19 $65.19 $65.19 $65.19 $65.19 $65.19 $65.19 $65.19 $65.19 $65.19 $65.19 $13.59 $65.19 $26.08 $65.19 $65.19 $65.19 $65.19 $65.19 $49.13 $65.19 $65.19 $65.19 $32.60 $32.60 $51.63 $65.19 $52.15 $42.37 $65.19 $65.19 $37.99 $65.19 $39.11 $65.19 $65.19 $65.19 N/A N/A 6781 ERX HCPCS 63700001 13310-0153-07 QUININE SULFATE 324 MG PO CAPS BOTH IP/OP $34.00 $25.00 $7.08 $33.95 $33.95 $33.95 $33.95 $33.95 $33.95 $33.95 $33.95 $33.95 $33.95 $33.95 $33.95 $33.95 $33.95 $7.08 $33.95 $13.58 $33.95 $33.95 $33.95 $33.95 $33.95 $25.50 $33.95 $33.95 $33.95 $16.98 $16.98 $26.89 $33.95 $27.16 $22.07 $33.95 $33.95 $19.72 $33.95 $20.37 $33.95 $33.95 $33.95 N/A N/A 6839 ERX HCPCS 25000001 00327-0012-30 RENACIDIN IR SOLN BOTH IP/OP $32.50 $24.00 $5.70 $32.02 $32.02 $32.02 $32.02 $32.02 $32.02 $32.02 $5.70 $32.02 $32.02 $23.77 $23.77 $24.68 $16.68 $6.67 $32.02 $12.81 $32.02 $32.02 $32.02 $32.02 $32.02 $24.38 $32.02 $32.02 $32.02 $16.01 $16.01 $25.36 $32.02 $25.62 $20.81 $32.02 $32.02 $18.85 $32.02 $19.21 $32.02 $32.02 $32.02 N/A N/A 6969 ERX HCPCS 25000001 51801-0004-40 ROSE BENGAL 1.3 MG OP STRP BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7030 ERX HCPCS 25000001 00904-3865-75 SALINE NASAL SPRAY 0.65 % NA SOLN BOTH IP/OP $11.00 $8.00 $1.96 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $1.96 $11.00 $11.00 $8.16 $8.16 $8.48 $5.73 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 7035 ERX HCPCS 63700001 65162-0513-10 SALSALATE 750 MG PO TABS BOTH IP/OP $12.50 $9.00 $2.52 $12.10 $12.10 $12.10 $12.10 $12.10 $12.10 $12.10 $12.10 $12.10 $12.10 $12.10 $12.10 $12.10 $12.10 $2.52 $12.10 $4.84 $12.10 $12.10 $12.10 $12.10 $12.10 $9.38 $12.10 $12.10 $12.10 $6.05 $6.05 $9.58 $12.10 $9.68 $7.87 $12.10 $12.10 $7.25 $12.10 $7.26 $12.10 $12.10 $12.10 N/A N/A 7222 ERX HCPCS 25000001 62991-2927-03 SILVER NITRATE CRYS BOTH IP/OP "$1,200.50" $888.00 $213.68 "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" $213.68 "$1,200.45" "$1,200.45" $890.97 $890.97 $925.31 $625.43 $250.19 "$1,200.45" $480.18 "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" $900.38 "$1,200.45" "$1,200.45" "$1,200.45" $600.23 $600.23 $950.76 "$1,200.45" $960.36 $780.29 "$1,200.45" "$1,200.45" $696.29 "$1,200.45" $720.27 "$1,200.45" "$1,200.45" "$1,200.45" N/A N/A 7224 ERX HCPCS 25000001 67877-0124-05 SILVER SULFADIAZINE 1 % EX CREA BOTH IP/OP $65.50 $48.00 $11.61 $65.24 $65.24 $65.24 $65.24 $65.24 $65.24 $65.24 $11.61 $65.24 $65.24 $48.42 $48.42 $50.29 $33.99 $13.60 $65.24 $26.10 $65.24 $65.24 $65.24 $65.24 $65.24 $49.13 $65.24 $65.24 $65.24 $32.62 $32.62 $51.67 $65.24 $52.19 $42.41 $65.24 $65.24 $37.99 $65.24 $39.14 $65.24 $65.24 $65.24 N/A N/A 7242 ERX HCPCS 25000001 00802-3920-16 SIMPLE SYRUP PO SYRP BOTH IP/OP $87.00 $64.00 $15.41 $86.60 $86.60 $86.60 $86.60 $86.60 $86.60 $86.60 $15.41 $86.60 $86.60 $64.27 $64.27 $66.75 $45.12 $18.05 $86.60 $34.64 $86.60 $86.60 $86.60 $86.60 $86.60 $65.25 $86.60 $86.60 $86.60 $43.30 $43.30 $68.59 $86.60 $69.28 $56.29 $86.60 $86.60 $50.46 $86.60 $51.96 $86.60 $86.60 $86.60 N/A N/A 7301 ERX HCPCS 25000001 00409-3299-06 SODIUM ACETATE 2 MEQ/ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 7306 ERX HCPCS 25000001 51754-5012-04 SODIUM BICARBONATE 4.2 % IV SOLN BOTH IP/OP $38.50 $28.00 $6.83 $38.37 $38.37 $38.37 $38.37 $38.37 $38.37 $38.37 $6.83 $38.37 $38.37 $28.48 $28.48 $29.58 $19.99 $8.00 $38.37 $15.35 $38.37 $38.37 $38.37 $38.37 $38.37 $28.88 $38.37 $38.37 $38.37 $19.19 $19.19 $30.39 $38.37 $30.70 $24.94 $38.37 $38.37 $22.33 $38.37 $23.02 $38.37 $38.37 $38.37 N/A N/A 7306 ERX HCPCS 25000001 63323-0083-05 SODIUM BICARBONATE 4.2 % IV SOLN BOTH IP/OP $99.00 $73.00 $6.83 $74.25 $38.37 $38.37 $38.37 $38.37 $38.37 $38.37 $6.83 $38.37 $38.37 $28.48 $28.48 $29.58 $19.99 $8.00 $38.37 $15.35 $38.37 $38.37 $38.37 $38.37 $38.37 $74.25 $38.37 $38.37 $38.37 $19.19 $19.19 $30.39 $38.37 $30.70 $24.94 $38.37 $38.37 $57.42 $38.37 $23.02 $38.37 $38.37 $38.37 N/A N/A 7313 ERX HCPCS 63700001 66553-0008-01 SODIUM BICARBONATE 650 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7318 ERX HCPCS 25000001 00338-0043-04 SODIUM CHLORIDE 0.45 % IV SOLN BOTH IP/OP $30.50 $23.00 $5.38 $30.24 $30.24 $30.24 $30.24 $30.24 $30.24 $30.24 $5.38 $30.24 $30.24 $22.44 $22.44 $23.31 $15.76 $6.30 $30.24 $12.10 $30.24 $30.24 $30.24 $30.24 $30.24 $22.88 $30.24 $30.24 $30.24 $15.12 $15.12 $23.95 $30.24 $24.19 $19.66 $30.24 $30.24 $17.69 $30.24 $18.14 $30.24 $30.24 $30.24 N/A N/A 7320 ERX HCPCS J7131 00409-6660-75 SODIUM CHLORIDE 2.5 MEQ/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $1.28 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $1.28 $22.00 $22.00 $1.66 $1.66 $1.73 $1.60 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 7321 ERX HCPCS 25000001 00264-7805-10 SODIUM CHLORIDE 3 % IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 7323 ERX HCPCS 25000001 00264-7806-10 SODIUM CHLORIDE 5 % IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 7325 ERX HCPCS 25000001 00487-9301-03 SODIUM CHLORIDE 0.9 % IN NEBU BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7328 ERX HCPCS 63700001 00223-1760-02 SODIUM CHLORIDE 1000 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7331 ERX HCPCS 25000001 24208-0385-55 SODIUM CHLORIDE (HYPERTONIC) 5 % OP OINT BOTH IP/OP $83.00 $61.00 $14.75 $82.86 $82.86 $82.86 $82.86 $82.86 $82.86 $82.86 $14.75 $82.86 $82.86 $61.50 $61.50 $63.87 $43.17 $17.27 $82.86 $33.14 $82.86 $82.86 $82.86 $82.86 $82.86 $62.25 $82.86 $82.86 $82.86 $41.43 $41.43 $65.63 $82.86 $66.29 $53.86 $82.86 $82.86 $48.14 $82.86 $49.72 $82.86 $82.86 $82.86 N/A N/A 7332 ERX HCPCS 25000001 00536-1254-94 SODIUM CHLORIDE (HYPERTONIC) 5 % OP SOLN BOTH IP/OP $21.50 $16.00 $3.77 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $3.77 $21.19 $21.19 $15.73 $15.73 $16.33 $11.04 $4.42 $21.19 $8.48 $21.19 $21.19 $21.19 $21.19 $21.19 $16.13 $21.19 $21.19 $21.19 $10.60 $10.60 $16.78 $21.19 $16.95 $13.77 $21.19 $21.19 $12.47 $21.19 $12.71 $21.19 $21.19 $21.19 N/A N/A 7356 ERX HCPCS 25000001 99999-6007-33 SODIUM POLYSTYRENE SULFONATE PO POWD BOTH IP/OP $29.00 $21.00 $5.13 $28.84 $28.84 $28.84 $28.84 $28.84 $28.84 $28.84 $5.13 $28.84 $28.84 $21.41 $21.41 $22.23 $15.03 $6.01 $28.84 $11.54 $28.84 $28.84 $28.84 $28.84 $28.84 $21.75 $28.84 $28.84 $28.84 $14.42 $14.42 $22.84 $28.84 $23.07 $18.75 $28.84 $28.84 $16.82 $28.84 $17.30 $28.84 $28.84 $28.84 N/A N/A 7359 ERX HCPCS 25000001 24208-0670-04 SULFACETAMIDE SODIUM 10 % OP SOLN BOTH IP/OP $218.50 $162.00 $38.88 $218.40 $218.40 $218.40 $218.40 $218.40 $218.40 $218.40 $38.88 $218.40 $218.40 $162.10 $162.10 $168.34 $113.79 $45.52 $218.40 $87.36 $218.40 $218.40 $218.40 $218.40 $218.40 $163.88 $218.40 $218.40 $218.40 $109.20 $109.20 $172.97 $218.40 $174.72 $141.96 $218.40 $218.40 $126.73 $218.40 $131.04 $218.40 $218.40 $218.40 N/A N/A 7437 ERX HCPCS 63700001 63739-0544-10 SPIRONOLACTONE 25 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7484 ERX HCPCS 25000001 00641-6147-01 STERILE WATER FOR INJECTION IJ SOLN BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 7485 ERX HCPCS 25000001 00338-0004-04 STERILE WATER FOR IRRIGATION IR SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 7508 ERX HCPCS J3000 39822-0706-02 STREPTOMYCIN SULFATE 1 G IM SOLR BOTH IP/OP $336.00 $249.00 $32.94 $335.63 $335.63 $335.63 $335.63 $335.63 $335.63 $335.63 $34.55 $335.63 $335.63 $34.26 $34.26 $35.58 $32.94 $38.70 $335.63 $134.25 $335.63 $335.63 $335.63 $335.63 $335.63 $252.00 $335.63 $335.63 $335.63 $167.82 $167.82 $265.82 $335.63 $268.50 $151.03 $335.63 $335.63 $194.88 $335.63 $201.38 $335.63 $335.63 $335.63 N/A N/A 7554 ERX HCPCS 63700001 42806-0757-60 SULFADIAZINE 500 MG PO TABS BOTH IP/OP $80.00 $59.00 $16.62 $79.75 $79.75 $79.75 $79.75 $79.75 $79.75 $79.75 $79.75 $79.75 $79.75 $79.75 $79.75 $79.75 $79.75 $16.62 $79.75 $31.90 $79.75 $79.75 $79.75 $79.75 $79.75 $60.00 $79.75 $79.75 $79.75 $39.88 $39.88 $63.16 $79.75 $63.80 $51.84 $79.75 $79.75 $46.40 $79.75 $47.85 $79.75 $79.75 $79.75 N/A N/A 7556 ERX HCPCS 25000001 00703-9514-03 SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5ML IV SOLN BOTH IP/OP $65.50 $48.00 $11.57 $65.02 $65.02 $65.02 $65.02 $65.02 $65.02 $65.02 $11.57 $65.02 $65.02 $48.26 $48.26 $50.12 $33.88 $13.55 $65.02 $26.01 $65.02 $65.02 $65.02 $65.02 $65.02 $49.13 $65.02 $65.02 $65.02 $32.51 $32.51 $51.50 $65.02 $52.02 $42.26 $65.02 $65.02 $37.99 $65.02 $39.01 $65.02 $65.02 $65.02 N/A N/A 7557 ERX HCPCS 63700001 53746-0271-01 SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7579 ERX HCPCS 63700001 42806-0011-01 SULINDAC 200 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7711 ERX HCPCS 63700001 00591-2472-60 TAMOXIFEN CITRATE 10 MG PO TABS BOTH IP/OP $8.50 $6.00 $1.71 $8.19 $8.19 $8.19 $8.19 $8.19 $8.19 $8.19 $8.19 $8.19 $8.19 $8.19 $8.19 $8.19 $8.19 $1.71 $8.19 $3.28 $8.19 $8.19 $8.19 $8.19 $8.19 $6.38 $8.19 $8.19 $8.19 $4.10 $4.10 $6.49 $8.19 $6.55 $5.32 $8.19 $8.19 $4.93 $8.19 $4.91 $8.19 $8.19 $8.19 N/A N/A 7784 ERX HCPCS J1071 00009-0417-01 TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN BOTH IP/OP $27.50 $20.00 $1.50 $27.22 $12.25 $12.25 $12.25 $12.25 $27.22 $27.22 $27.22 $5.67 $27.22 $1.56 $1.56 $1.62 $1.50 $1.76 $27.22 $27.22 $16.10 $27.22 $27.22 $27.22 $27.22 $20.63 $27.22 $27.22 $27.22 $13.61 $13.61 $21.56 $27.22 $21.78 $12.25 $1.68 $27.22 $15.95 $27.22 $27.22 $27.22 $1.68 $27.22 N/A N/A 7785 ERX HCPCS J3121 99999-6005-75 TESTOSTERONE ENANTHATE 200 MG/ML IM SOLN BOTH IP/OP $22.00 $16.00 $2.50 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $2.60 $2.60 $2.70 $2.50 $2.94 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $2.80 $22.00 $12.76 $22.00 $22.00 $22.00 $2.80 $22.00 N/A N/A 7795 ERX HCPCS 25000001 00065-0741-14 TETRACAINE HCL 0.5 % OP SOLN BOTH IP/OP $65.00 $48.00 $11.51 $64.65 $64.65 $64.65 $64.65 $64.65 $64.65 $64.65 $11.51 $64.65 $64.65 $47.98 $47.98 $49.83 $33.68 $13.47 $64.65 $25.86 $64.65 $64.65 $64.65 $64.65 $64.65 $48.75 $64.65 $64.65 $64.65 $32.33 $32.33 $51.20 $64.65 $51.72 $42.02 $64.65 $64.65 $37.70 $64.65 $38.79 $64.65 $64.65 $64.65 N/A N/A 7797 ERX HCPCS 63700006 69238-1523-01 TETRACYCLINE HCL 500 MG PO CAPS BOTH IP/OP $68.50 $51.00 $14.18 $68.04 $68.04 $68.04 $68.04 $68.04 $68.04 $68.04 $68.04 $68.04 $68.04 $68.04 $68.04 $68.04 $68.04 $14.18 $68.04 $27.22 $68.04 $68.04 $68.04 $68.04 $68.04 $51.38 $68.04 $68.04 $68.04 $34.02 $34.02 $53.89 $68.04 $54.43 $44.23 $68.04 $68.04 $39.73 $68.04 $40.82 $68.04 $68.04 $68.04 N/A N/A 7821 ERX HCPCS 63700001 00121-4820-40 THEOPHYLLINE 80 MG/15ML PO SOLN BOTH IP/OP $54.50 $40.00 $11.28 $54.11 $54.11 $54.11 $54.11 $54.11 $54.11 $54.11 $54.11 $54.11 $54.11 $54.11 $54.11 $54.11 $54.11 $11.28 $54.11 $21.64 $54.11 $54.11 $54.11 $54.11 $54.11 $40.88 $54.11 $54.11 $54.11 $27.06 $27.06 $42.86 $54.11 $43.29 $35.17 $54.11 $54.11 $31.61 $54.11 $32.47 $54.11 $54.11 $54.11 N/A N/A 7825 ERX HCPCS 63700001 00904-0539-61 THERA PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7876 ERX HCPCS J3411 63323-0013-09 THIAMINE HCL 100 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $2.82 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $2.93 $2.93 $3.05 $2.82 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $22.00 $22.00 N/A N/A 7894 ERX HCPCS 63700001 51079-0565-01 THIORIDAZINE HCL 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7895 ERX HCPCS 63700001 51079-0580-20 THIORIDAZINE HCL 100 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7899 ERX HCPCS 63700001 51079-0566-01 THIORIDAZINE HCL 25 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7900 ERX HCPCS 63700001 51079-0567-01 THIORIDAZINE HCL 50 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7902 ERX HCPCS 63700001 00378-1001-01 THIOTHIXENE 1 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7903 ERX HCPCS 63700001 00378-5010-01 THIOTHIXENE 10 MG PO CAPS BOTH IP/OP $15.00 $11.00 $3.02 $14.51 $14.51 $14.51 $14.51 $14.51 $14.51 $14.51 $14.51 $14.51 $14.51 $14.51 $14.51 $14.51 $14.51 $3.02 $14.51 $5.80 $14.51 $14.51 $14.51 $14.51 $14.51 $11.25 $14.51 $14.51 $14.51 $7.26 $7.26 $11.49 $14.51 $11.61 $9.43 $14.51 $14.51 $8.70 $14.51 $8.71 $14.51 $14.51 $14.51 N/A N/A 7906 ERX HCPCS 63700001 51079-0588-01 THIOTHIXENE 5 MG PO CAPS BOTH IP/OP $16.00 $12.00 $3.26 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $3.26 $15.64 $6.26 $15.64 $15.64 $15.64 $15.64 $15.64 $12.00 $15.64 $15.64 $15.64 $7.82 $7.82 $12.39 $15.64 $12.51 $10.17 $15.64 $15.64 $9.28 $15.64 $9.38 $15.64 $15.64 $15.64 N/A N/A 7940 ERX HCPCS 63700001 42192-0327-01 THYROID 15 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7947 ERX HCPCS 63700001 00456-0459-01 THYROID 60 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 7993 ERX HCPCS 25000001 63323-0305-02 TOBRAMYCIN SULFATE 10 MG/ML IJ SOLN BOTH IP/OP $32.00 $24.00 $5.67 $31.83 $31.83 $31.83 $31.83 $31.83 $31.83 $31.83 $5.67 $31.83 $31.83 $23.62 $23.62 $24.53 $16.58 $6.63 $31.83 $12.73 $31.83 $31.83 $31.83 $31.83 $31.83 $24.00 $31.83 $31.83 $31.83 $15.92 $15.92 $25.21 $31.83 $25.46 $20.69 $31.83 $31.83 $18.56 $31.83 $19.10 $31.83 $31.83 $31.83 N/A N/A 7995 ERX HCPCS 25000001 70069-0131-01 TOBRAMYCIN 0.3 % OP SOLN BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 8112 ERX HCPCS 63700001 45802-0063-35 TRIAMCINOLONE ACETONIDE 0.025 % EX CREA BOTH IP/OP $19.50 $14.00 $4.01 $19.25 $19.25 $19.25 $19.25 $19.25 $19.25 $19.25 $19.25 $19.25 $19.25 $19.25 $19.25 $19.25 $19.25 $4.01 $19.25 $7.70 $19.25 $19.25 $19.25 $19.25 $19.25 $14.63 $19.25 $19.25 $19.25 $9.63 $9.63 $15.25 $19.25 $15.40 $12.51 $19.25 $19.25 $11.31 $19.25 $11.55 $19.25 $19.25 $19.25 N/A N/A 8113 ERX HCPCS 63700001 00168-0004-15 TRIAMCINOLONE ACETONIDE 0.1 % EX CREA BOTH IP/OP $16.00 $12.00 $3.24 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $3.24 $15.56 $6.22 $15.56 $15.56 $15.56 $15.56 $15.56 $12.00 $15.56 $15.56 $15.56 $7.78 $7.78 $12.32 $15.56 $12.45 $10.11 $15.56 $15.56 $9.28 $15.56 $9.34 $15.56 $15.56 $15.56 N/A N/A 8114 ERX HCPCS 63700001 00168-0002-15 TRIAMCINOLONE ACETONIDE 0.5 % EX CREA BOTH IP/OP $48.00 $36.00 $10.00 $47.96 $47.96 $47.96 $47.96 $47.96 $47.96 $47.96 $47.96 $47.96 $47.96 $47.96 $47.96 $47.96 $47.96 $10.00 $47.96 $19.18 $47.96 $47.96 $47.96 $47.96 $47.96 $36.00 $47.96 $47.96 $47.96 $23.98 $23.98 $37.98 $47.96 $38.37 $31.17 $47.96 $47.96 $27.84 $47.96 $28.78 $47.96 $47.96 $47.96 N/A N/A 8117 ERX HCPCS 25000001 45802-0054-35 TRIAMCINOLONE ACETONIDE 0.025 % EX OINT BOTH IP/OP $26.50 $20.00 $4.71 $26.44 $26.44 $26.44 $26.44 $26.44 $26.44 $26.44 $4.71 $26.44 $26.44 $19.62 $19.62 $20.38 $13.78 $5.51 $26.44 $10.58 $26.44 $26.44 $26.44 $26.44 $26.44 $19.88 $26.44 $26.44 $26.44 $13.22 $13.22 $20.94 $26.44 $21.15 $17.19 $26.44 $26.44 $15.37 $26.44 $15.86 $26.44 $26.44 $26.44 N/A N/A 8118 ERX HCPCS 63700001 45802-0055-05 TRIAMCINOLONE ACETONIDE 0.1 % EX OINT BOTH IP/OP $164.50 $122.00 $34.27 $164.43 $164.43 $164.43 $164.43 $164.43 $164.43 $164.43 $164.43 $164.43 $164.43 $164.43 $164.43 $164.43 $164.43 $34.27 $164.43 $65.77 $164.43 $164.43 $164.43 $164.43 $164.43 $123.38 $164.43 $164.43 $164.43 $82.22 $82.22 $130.23 $164.43 $131.54 $106.88 $164.43 $164.43 $95.41 $164.43 $98.66 $164.43 $164.43 $164.43 N/A N/A 8120 ERX HCPCS J3301 70121-1049-05 TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP BOTH IP/OP $44.50 $33.00 $4.44 $44.07 $19.83 $19.83 $19.83 $19.83 $44.07 $44.07 $44.07 $7.10 $44.07 $4.62 $4.62 $4.80 $4.44 $5.22 $44.07 $44.07 $26.07 $44.07 $44.07 $44.07 $44.07 $33.38 $44.07 $44.07 $44.07 $22.04 $22.04 $34.90 $44.07 $35.26 $19.83 $4.97 $44.07 $25.81 $44.07 $44.07 $44.07 $4.97 $44.07 N/A N/A 8121 ERX HCPCS 25000001 51672-1267-05 TRIAMCINOLONE ACETONIDE 0.1 % MT PSTE BOTH IP/OP $289.00 $214.00 $51.36 $288.52 $288.52 $288.52 $288.52 $288.52 $288.52 $288.52 $51.36 $288.52 $288.52 $214.14 $214.14 $222.39 $150.32 $60.13 $288.52 $115.41 $288.52 $288.52 $288.52 $288.52 $288.52 $216.75 $288.52 $288.52 $288.52 $144.26 $144.26 $228.51 $288.52 $230.82 $187.54 $288.52 $288.52 $167.62 $288.52 $173.11 $288.52 $288.52 $288.52 N/A N/A 8132 ERX HCPCS 63700001 00591-0424-01 TRIAMTERENE-HCTZ 37.5-25 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 8162 ERX HCPCS 63700001 00378-2410-01 TRIFLUOPERAZINE HCL 10 MG PO TABS BOTH IP/OP $11.00 $8.00 $2.20 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $2.20 $10.58 $4.23 $10.58 $10.58 $10.58 $10.58 $10.58 $8.25 $10.58 $10.58 $10.58 $5.29 $5.29 $8.38 $10.58 $8.46 $6.88 $10.58 $10.58 $6.38 $10.58 $6.35 $10.58 $10.58 $10.58 N/A N/A 8163 ERX HCPCS 63700001 51079-0573-01 TRIFLUOPERAZINE HCL 2 MG PO TABS BOTH IP/OP $9.00 $7.00 $1.80 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $1.80 $8.64 $3.46 $8.64 $8.64 $8.64 $8.64 $8.64 $6.75 $8.64 $8.64 $8.64 $4.32 $4.32 $6.84 $8.64 $6.91 $5.62 $8.64 $8.64 $5.22 $8.64 $5.18 $8.64 $8.64 $8.64 N/A N/A 8164 ERX HCPCS 63700001 00781-8034-01 TRIFLUOPERAZINE HCL 5 MG PO TABS BOTH IP/OP $7.50 $6.00 $1.46 $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $7.02 $1.46 $7.02 $2.81 $7.02 $7.02 $7.02 $7.02 $7.02 $5.63 $7.02 $7.02 $7.02 $3.51 $3.51 $5.56 $7.02 $5.62 $4.56 $7.02 $7.02 $4.35 $7.02 $4.21 $7.02 $7.02 $7.02 N/A N/A 8166 ERX HCPCS 63700001 00591-5335-01 TRIHEXYPHENIDYL HCL 2 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 8167 ERX HCPCS 63700001 00591-5337-01 TRIHEXYPHENIDYL HCL 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 8249 ERX HCPCS 25000001 24208-0590-64 TROPICAMIDE 0.5 % OP SOLN BOTH IP/OP $100.00 $74.00 $17.71 $99.52 $99.52 $99.52 $99.52 $99.52 $99.52 $99.52 $17.71 $99.52 $99.52 $73.86 $73.86 $76.71 $51.85 $20.74 $99.52 $39.81 $99.52 $99.52 $99.52 $99.52 $99.52 $75.00 $99.52 $99.52 $99.52 $49.76 $49.76 $78.82 $99.52 $79.62 $64.69 $99.52 $99.52 $58.00 $99.52 $59.71 $99.52 $99.52 $99.52 N/A N/A 8259 ERX HCPCS 25000001 99999-6005-54 TUBERCULIN PPD 5 UNIT/0.1ML ID SOLN BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 8443 ERX HCPCS J3370 00409-4332-01 VANCOMYCIN HCL 500 MG IV SOLR BOTH IP/OP $22.00 $16.00 $2.78 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $2.84 $3.62 $22.00 $2.89 $2.89 $3.00 $2.78 $3.27 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $3.11 $22.00 $12.76 $22.00 $22.00 $22.00 $3.11 $22.00 N/A N/A 8527 ERX HCPCS 25000001 51754-0203-04 VERAPAMIL HCL 2.5 MG/ML IV SOLN BOTH IP/OP $83.50 $62.00 $14.83 $83.34 $83.34 $83.34 $83.34 $83.34 $83.34 $83.34 $14.83 $83.34 $83.34 $61.85 $61.85 $64.24 $43.42 $17.37 $83.34 $33.34 $83.34 $83.34 $83.34 $83.34 $83.34 $62.63 $83.34 $83.34 $83.34 $41.67 $41.67 $66.01 $83.34 $66.67 $54.17 $83.34 $83.34 $48.43 $83.34 $50.00 $83.34 $83.34 $83.34 N/A N/A 8594 ERX HCPCS J9360 63323-0278-10 VINBLASTINE SULFATE 1 MG/ML IV SOLN BOTH IP/OP $203.00 $150.00 $39.10 $202.60 $91.17 $91.17 $91.17 $91.17 $202.60 $202.60 $202.60 $42.23 $202.60 $40.66 $40.66 $42.23 $39.10 $45.94 $202.60 $202.60 $119.84 $202.60 $202.60 $202.60 $202.60 $152.25 $202.60 $202.60 $202.60 $101.30 $101.30 $160.46 $202.60 $162.08 $91.17 $43.75 $202.60 $117.74 $202.60 $202.60 $202.60 $43.75 $202.60 N/A N/A 8597 ERX HCPCS J9370 00703-4402-11 VINCRISTINE SULFATE 1 MG/ML IV SOLN BOTH IP/OP $72.50 $54.00 $9.88 $72.49 $32.62 $32.62 $32.62 $32.62 $72.49 $72.49 $72.49 $15.09 $72.49 $10.28 $10.28 $10.67 $9.88 $11.61 $72.49 $72.49 $42.88 $72.49 $72.49 $72.49 $72.49 $54.38 $72.49 $72.49 $72.49 $36.25 $36.25 $57.41 $72.49 $57.99 $32.62 $11.05 $72.49 $42.05 $72.49 $72.49 $72.49 $11.05 $72.49 N/A N/A 8639 ERX HCPCS 63700001 00904-2085-60 VITAMIN A 3 MG (10000 UT) PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 8654 ERX HCPCS 63700001 77333-0938-10 VITAMIN B-12 1000 MCG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 8661 ERX HCPCS 63700001 43292-0555-38 VITAMIN B-2 25 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 8680 ERX HCPCS 63700006 00904-0523-61 VITAMIN C 500 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 8718 ERX HCPCS J3430 00409-9158-01 VITAMIN K1 10 MG/ML IJ SOLN BOTH IP/OP $51.00 $38.00 $6.84 $50.77 $22.85 $22.85 $22.85 $22.85 $50.77 $50.77 $50.77 $9.96 $50.77 $7.11 $7.11 $7.39 $6.84 $8.04 $50.77 $50.77 $30.03 $50.77 $50.77 $50.77 $50.77 $38.25 $50.77 $50.77 $50.77 $25.39 $25.39 $40.21 $50.77 $40.62 $22.85 $7.65 $50.77 $29.58 $50.77 $50.77 $50.77 $7.65 $50.77 N/A N/A 8780 ERX HCPCS 63700001 00168-0053-16 WHITE PETROLATUM EX OINT BOTH IP/OP $96.00 $71.00 $19.94 $95.69 $95.69 $95.69 $95.69 $95.69 $95.69 $95.69 $95.69 $95.69 $95.69 $95.69 $95.69 $95.69 $95.69 $19.94 $95.69 $38.28 $95.69 $95.69 $95.69 $95.69 $95.69 $72.00 $95.69 $95.69 $95.69 $47.85 $47.85 $75.79 $95.69 $76.55 $62.20 $95.69 $95.69 $55.68 $95.69 $57.41 $95.69 $95.69 $95.69 N/A N/A 8865 ERX HCPCS 25000001 00409-4090-01 ZINC CHLORIDE 1 MG/ML IV SOLN BOTH IP/OP $113.50 $84.00 $20.14 $113.16 $113.16 $113.16 $113.16 $113.16 $113.16 $113.16 $20.14 $113.16 $113.16 $83.99 $83.99 $87.22 $58.96 $23.58 $113.16 $45.26 $113.16 $113.16 $113.16 $113.16 $113.16 $85.13 $113.16 $113.16 $113.16 $56.58 $56.58 $89.62 $113.16 $90.53 $73.55 $113.16 $113.16 $65.83 $113.16 $67.90 $113.16 $113.16 $113.16 N/A N/A 8943 ERX HCPCS 25000001 70677-0118-01 ACETAMINOPHEN 160 MG/5ML PO SUSP BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 8946 ERX HCPCS 25000001 51672-2114-00 ACETAMINOPHEN 80 MG RECTAL SUPP BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 8958 ERX HCPCS 63700001 00603-2544-21 BUTALBITAL-APAP-CAFFEINE 50-325-40 MG PO TABS BOTH IP/OP $7.50 $6.00 $1.52 $7.30 $7.30 $7.30 $7.30 $7.30 $7.30 $7.30 $7.30 $7.30 $7.30 $7.30 $7.30 $7.30 $7.30 $1.52 $7.30 $2.92 $7.30 $7.30 $7.30 $7.30 $7.30 $5.63 $7.30 $7.30 $7.30 $3.65 $3.65 $5.78 $7.30 $5.84 $4.75 $7.30 $7.30 $4.35 $7.30 $4.38 $7.30 $7.30 $7.30 N/A N/A 8962 ERX HCPCS 63700001 16729-0331-01 ACETAZOLAMIDE ER 500 MG PO CP12 BOTH IP/OP $19.00 $14.00 $3.87 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $3.87 $18.56 $7.42 $18.56 $18.56 $18.56 $18.56 $18.56 $14.25 $18.56 $18.56 $18.56 $9.28 $9.28 $14.70 $18.56 $14.85 $12.06 $18.56 $18.56 $11.02 $18.56 $11.14 $18.56 $18.56 $18.56 N/A N/A 8963 ERX HCPCS 25000001 00338-0656-04 ACETIC ACID 0.25 % IR SOLN BOTH IP/OP $35.00 $26.00 $6.15 $34.56 $34.56 $34.56 $34.56 $34.56 $34.56 $34.56 $6.15 $34.56 $34.56 $25.65 $25.65 $26.64 $18.01 $7.20 $34.56 $13.82 $34.56 $34.56 $34.56 $34.56 $34.56 $26.25 $34.56 $34.56 $34.56 $17.28 $17.28 $27.37 $34.56 $27.65 $22.46 $34.56 $34.56 $20.30 $34.56 $20.74 $34.56 $34.56 $34.56 N/A N/A 8968 ERX HCPCS 63700001 13668-0515-01 ACYCLOVIR 5 % EX OINT BOTH IP/OP "$1,204.50" $891.00 $251.01 "$1,204.40" "$1,204.40" "$1,204.40" "$1,204.40" "$1,204.40" "$1,204.40" "$1,204.40" "$1,204.40" "$1,204.40" "$1,204.40" "$1,204.40" "$1,204.40" "$1,204.40" "$1,204.40" $251.01 "$1,204.40" $481.76 "$1,204.40" "$1,204.40" "$1,204.40" "$1,204.40" "$1,204.40" $903.38 "$1,204.40" "$1,204.40" "$1,204.40" $602.20 $602.20 $953.88 "$1,204.40" $963.52 $782.86 "$1,204.40" "$1,204.40" $698.61 "$1,204.40" $722.64 "$1,204.40" "$1,204.40" "$1,204.40" N/A N/A 8969 ERX HCPCS 63700001 00904-5789-61 ACYCLOVIR 200 MG PO CAPS BOTH IP/OP $7.00 $5.00 $1.38 $6.61 $6.61 $6.61 $6.61 $6.61 $6.61 $6.61 $6.61 $6.61 $6.61 $6.61 $6.61 $6.61 $6.61 $1.38 $6.61 $2.64 $6.61 $6.61 $6.61 $6.61 $6.61 $5.25 $6.61 $6.61 $6.61 $3.31 $3.31 $5.24 $6.61 $5.29 $4.30 $6.61 $6.61 $4.06 $6.61 $3.97 $6.61 $6.61 $6.61 N/A N/A 8970 ERX HCPCS 63700001 99999-6004-74 ACYCLOVIR 200 MG/5ML PO SUSP BOTH IP/OP $188.00 $139.00 $39.08 $187.53 $187.53 $187.53 $187.53 $187.53 $187.53 $187.53 $187.53 $187.53 $187.53 $187.53 $187.53 $187.53 $187.53 $39.08 $187.53 $75.01 $187.53 $187.53 $187.53 $187.53 $187.53 $141.00 $187.53 $187.53 $187.53 $93.77 $93.77 $148.52 $187.53 $150.02 $121.89 $187.53 $187.53 $109.04 $187.53 $112.52 $187.53 $187.53 $187.53 N/A N/A 8971 ERX HCPCS 63700001 63304-0504-01 ACYCLOVIR 400 MG PO TABS BOTH IP/OP $9.50 $7.00 $1.95 $9.38 $9.38 $9.38 $9.38 $9.38 $9.38 $9.38 $9.38 $9.38 $9.38 $9.38 $9.38 $9.38 $9.38 $1.95 $9.38 $3.75 $9.38 $9.38 $9.38 $9.38 $9.38 $7.13 $9.38 $9.38 $9.38 $4.69 $4.69 $7.43 $9.38 $7.50 $6.10 $9.38 $9.38 $5.51 $9.38 $5.63 $9.38 $9.38 $9.38 N/A N/A 8972 ERX HCPCS 63700001 60505-5307-01 ACYCLOVIR 800 MG PO TABS BOTH IP/OP $18.50 $14.00 $3.80 $18.22 $18.22 $18.22 $18.22 $18.22 $18.22 $18.22 $18.22 $18.22 $18.22 $18.22 $18.22 $18.22 $18.22 $3.80 $18.22 $7.29 $18.22 $18.22 $18.22 $18.22 $18.22 $13.88 $18.22 $18.22 $18.22 $9.11 $9.11 $14.43 $18.22 $14.58 $11.84 $18.22 $18.22 $10.73 $18.22 $10.93 $18.22 $18.22 $18.22 N/A N/A 8981 ERX HCPCS P9047 76125-0792-25 ALBUMIN HUMAN 25 % IV SOLN BOTH IP/OP $206.50 $153.00 $52.45 $206.21 $92.79 $92.79 $92.79 $92.79 $52.45 $52.45 $52.45 $60.16 $52.45 $54.55 $54.55 $56.65 $52.45 $61.62 $52.45 $53.08 $121.97 $52.45 $206.21 $52.45 $55.07 $154.88 $52.45 $52.45 $52.45 $103.11 $103.11 $163.32 $52.45 $164.97 $92.79 $58.68 $52.45 $119.77 $55.07 $76.05 $52.45 $58.68 $52.45 N/A N/A 8982 ERX HCPCS P9045 00944-0495-05 ALBUMIN HUMAN 5 % IV SOLN BOTH IP/OP $206.00 $152.00 $27.86 $205.85 $92.63 $92.63 $92.63 $92.63 $52.45 $52.45 $52.45 $27.86 $52.45 $54.55 $54.55 $56.65 $52.45 $42.90 $52.45 $53.08 $121.76 $52.45 $205.85 $52.45 $55.07 $154.50 $52.45 $52.45 $52.45 $102.93 $102.93 $163.03 $52.45 $164.68 $92.63 $40.86 $52.45 $119.48 $55.07 $76.05 $52.45 $42.90 $52.45 N/A N/A 8985 ERX HCPCS 25000001 51672-1306-01 ALCLOMETASONE DIPROPIONATE 0.05 % EX CREA BOTH IP/OP $191.50 $142.00 $34.06 $191.34 $191.34 $191.34 $191.34 $191.34 $191.34 $191.34 $34.06 $191.34 $191.34 $142.01 $142.01 $147.48 $99.69 $39.88 $191.34 $76.54 $191.34 $191.34 $191.34 $191.34 $191.34 $143.63 $191.34 $191.34 $191.34 $95.67 $95.67 $151.54 $191.34 $153.07 $124.37 $191.34 $191.34 $111.07 $191.34 $114.80 $191.34 $191.34 $191.34 N/A N/A 8986 ERX HCPCS 25000001 00168-0264-15 ALCLOMETASONE DIPROPIONATE 0.05 % EX OINT BOTH IP/OP $86.50 $64.00 $15.38 $86.38 $86.38 $86.38 $86.38 $86.38 $86.38 $86.38 $15.38 $86.38 $86.38 $64.11 $64.11 $66.58 $45.00 $18.00 $86.38 $34.55 $86.38 $86.38 $86.38 $86.38 $86.38 $64.88 $86.38 $86.38 $86.38 $43.19 $43.19 $68.41 $86.38 $69.10 $56.15 $86.38 $86.38 $50.17 $86.38 $51.83 $86.38 $86.38 $86.38 N/A N/A 9001 ERX HCPCS J0270 00009-3169-06 ALPROSTADIL 500 MCG/ML IJ SOLN BOTH IP/OP $451.50 $334.00 $94.02 "$3,866.40" $451.13 $451.13 $451.13 $451.13 $451.13 $451.13 "$3,436.80" $451.13 $451.13 "$3,723.20" "$3,723.20" "$3,866.40" "$3,580.00" $94.02 $451.13 $180.45 $451.13 $451.13 $451.13 $451.13 $451.13 $338.63 $451.13 $451.13 $451.13 $225.57 $225.57 $357.29 $451.13 $360.90 $293.23 $451.13 $451.13 $261.87 $451.13 $270.68 $451.13 $451.13 $451.13 N/A N/A 9002 ERX HCPCS J2997 50242-0085-27 ALTEPLASE 100 MG IV SOLR BOTH IP/OP "$2,461.00" "$1,821.00" $488.37 "$2,460.59" "$1,107.27" "$1,107.27" "$1,107.27" "$1,107.27" $876.70 $876.70 $876.70 $512.85 $876.70 $911.77 $911.77 $946.84 $876.70 $512.81 $876.70 $875.65 "$1,213.07" $876.70 "$2,460.59" $876.70 $920.54 "$1,845.75" $876.70 $876.70 $876.70 "$1,230.30" "$1,230.30" "$1,948.79" $876.70 "$1,968.47" "$1,107.27" $488.37 $876.70 "$1,427.38" $920.54 "$1,271.22" $876.70 $512.79 $876.70 N/A N/A 9003 ERX HCPCS J2997 50242-0044-13 ALTEPLASE 50 MG IV SOLR BOTH IP/OP "$12,303.00" "$9,104.00" "$2,441.82" "$12,302.92" "$5,536.31" "$5,536.31" "$5,536.31" "$5,536.31" "$4,383.50" "$4,383.50" "$4,383.50" "$2,564.24" "$4,383.50" "$4,558.84" "$4,558.84" "$4,734.18" "$4,383.50" "$2,564.06" "$4,383.50" "$4,378.25" "$6,065.34" "$4,383.50" "$12,302.92" "$4,383.50" "$4,602.68" "$9,227.25" "$4,383.50" "$4,383.50" "$4,383.50" "$6,151.46" "$6,151.46" "$9,743.91" "$4,383.50" "$9,842.34" "$5,536.31" "$2,441.82" "$4,383.50" "$7,135.74" "$4,602.68" "$6,356.08" "$4,383.50" "$2,563.93" "$4,383.50" N/A N/A 9009 ERX HCPCS 25000001 00121-1761-30 ALUM & MAG HYDROXIDE-SIMETH 200-200-20 MG/5ML PO SUSP BOTH IP/OP $8.50 $6.00 $1.45 $8.17 $8.17 $8.17 $8.17 $8.17 $8.17 $8.17 $1.45 $8.17 $8.17 $6.06 $6.06 $6.30 $4.26 $1.70 $8.17 $3.27 $8.17 $8.17 $8.17 $8.17 $8.17 $6.38 $8.17 $8.17 $8.17 $4.09 $4.09 $6.47 $8.17 $6.54 $5.31 $8.17 $8.17 $4.93 $8.17 $4.90 $8.17 $8.17 $8.17 N/A N/A 9028 ERX HCPCS 25000001 00096-0707-37 ALUMINUM CHLORIDE 20 % EX SOLN BOTH IP/OP $40.50 $30.00 $7.21 $40.50 $40.50 $40.50 $40.50 $40.50 $40.50 $40.50 $7.21 $40.50 $40.50 $30.06 $30.06 $31.22 $21.10 $8.44 $40.50 $16.20 $40.50 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $26.33 $40.50 $40.50 $23.49 $40.50 $24.30 $40.50 $40.50 $40.50 N/A N/A 9063 ERX HCPCS 63700001 49411-0050-30 AMINOCAPROIC ACID 500 MG PO TABS BOTH IP/OP $97.50 $72.00 $20.27 $97.24 $97.24 $97.24 $97.24 $97.24 $97.24 $97.24 $97.24 $97.24 $97.24 $97.24 $97.24 $97.24 $97.24 $20.27 $97.24 $38.90 $97.24 $97.24 $97.24 $97.24 $97.24 $73.13 $97.24 $97.24 $97.24 $48.62 $48.62 $77.01 $97.24 $77.79 $63.21 $97.24 $97.24 $56.55 $97.24 $58.34 $97.24 $97.24 $97.24 N/A N/A 9070 ERX HCPCS 63700001 00904-6369-61 AMLODIPINE BESYLATE 2.5 MG PO TABS BOTH IP/OP $7.00 $5.00 $1.44 $6.89 $6.89 $6.89 $6.89 $6.89 $6.89 $6.89 $6.89 $6.89 $6.89 $6.89 $6.89 $6.89 $6.89 $1.44 $6.89 $2.76 $6.89 $6.89 $6.89 $6.89 $6.89 $5.25 $6.89 $6.89 $6.89 $3.45 $3.45 $5.46 $6.89 $5.51 $4.48 $6.89 $6.89 $4.06 $6.89 $4.13 $6.89 $6.89 $6.89 N/A N/A 9081 ERX HCPCS 63700001 00555-0972-02 AMPHETAMINE-DEXTROAMPHETAMINE 10 MG PO TABS BOTH IP/OP $7.50 $6.00 $1.54 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $1.54 $7.41 $2.96 $7.41 $7.41 $7.41 $7.41 $7.41 $5.63 $7.41 $7.41 $7.41 $3.71 $3.71 $5.87 $7.41 $5.93 $4.82 $7.41 $7.41 $4.35 $7.41 $4.45 $7.41 $7.41 $7.41 N/A N/A 9084 ERX HCPCS J0295 44567-0211-10 AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR BOTH IP/OP $83.00 $61.00 $5.46 $82.69 $37.21 $37.21 $37.21 $37.21 $82.69 $82.69 $82.69 $8.48 $82.69 $5.68 $5.68 $5.90 $5.46 $6.41 $82.69 $82.69 $48.91 $82.69 $82.69 $82.69 $82.69 $62.25 $82.69 $82.69 $82.69 $41.35 $41.35 $65.49 $82.69 $66.15 $37.21 $6.11 $82.69 $48.14 $82.69 $82.69 $82.69 $6.11 $82.69 N/A N/A 9119 ERX HCPCS 25000001 61314-0665-05 APRACLONIDINE HCL 0.5 % OP SOLN BOTH IP/OP $311.00 $230.00 $55.29 $310.64 $310.64 $310.64 $310.64 $310.64 $310.64 $310.64 $55.29 $310.64 $310.64 $230.56 $230.56 $239.44 $161.84 $64.74 $310.64 $124.26 $310.64 $310.64 $310.64 $310.64 $310.64 $233.25 $310.64 $310.64 $310.64 $155.32 $155.32 $246.03 $310.64 $248.51 $201.92 $310.64 $310.64 $180.38 $310.64 $186.38 $310.64 $310.64 $310.64 N/A N/A 9120 ERX HCPCS 25000001 00065-0660-10 APRACLONIDINE HCL 1 % OP SOLN BOTH IP/OP "$2,132.50" "$1,578.00" $379.52 "$2,132.14" "$2,132.14" "$2,132.14" "$2,132.14" "$2,132.14" "$2,132.14" "$2,132.14" $379.52 "$2,132.14" "$2,132.14" "$1,582.47" "$1,582.47" "$1,643.45" "$1,110.84" $444.36 "$2,132.14" $852.86 "$2,132.14" "$2,132.14" "$2,132.14" "$2,132.14" "$2,132.14" "$1,599.38" "$2,132.14" "$2,132.14" "$2,132.14" "$1,066.07" "$1,066.07" "$1,688.65" "$2,132.14" "$1,705.71" "$1,385.89" "$2,132.14" "$2,132.14" "$1,236.85" "$2,132.14" "$1,279.28" "$2,132.14" "$2,132.14" "$2,132.14" N/A N/A 9123 ERX HCPCS 25000001 00009-0436-01 ARGININE HCL (DIAGNOSTIC) 10 % IV SOLN BOTH IP/OP $167.50 $124.00 $29.75 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $29.75 $167.16 $167.16 $124.07 $124.07 $128.85 $87.09 $34.84 $167.16 $66.86 $167.16 $167.16 $167.16 $167.16 $167.16 $125.63 $167.16 $167.16 $167.16 $83.58 $83.58 $132.39 $167.16 $133.73 $108.65 $167.16 $167.16 $97.15 $167.16 $100.30 $167.16 $167.16 $167.16 N/A N/A 9183 ERX HCPCS J7500 68084-0229-01 AZATHIOPRINE 50 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $8.33 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.58 $6.00 $6.00 $8.02 $8.02 $8.33 $7.71 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $2.70 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9185 ERX HCPCS 25000001 63323-0401-20 AZTREONAM 1 G IJ SOLR BOTH IP/OP $86.50 $64.00 $15.34 $86.16 $86.16 $86.16 $86.16 $86.16 $86.16 $86.16 $15.34 $86.16 $86.16 $63.95 $63.95 $66.41 $44.89 $17.96 $86.16 $34.46 $86.16 $86.16 $86.16 $86.16 $86.16 $64.88 $86.16 $86.16 $86.16 $43.08 $43.08 $68.24 $86.16 $68.93 $56.00 $86.16 $86.16 $50.17 $86.16 $51.70 $86.16 $86.16 $86.16 N/A N/A 9186 ERX HCPCS 25000001 63323-0402-20 AZTREONAM 2 G IJ SOLR BOTH IP/OP $88.00 $65.00 $15.58 $87.54 $87.54 $87.54 $87.54 $87.54 $87.54 $87.54 $15.58 $87.54 $87.54 $64.97 $64.97 $67.48 $45.61 $18.24 $87.54 $35.02 $87.54 $87.54 $87.54 $87.54 $87.54 $66.00 $87.54 $87.54 $87.54 $43.77 $43.77 $69.33 $87.54 $70.03 $56.90 $87.54 $87.54 $51.04 $87.54 $52.52 $87.54 $87.54 $87.54 N/A N/A 9254 ERX HCPCS 25000001 64980-0328-01 BENZOYL PEROXIDE-ERYTHROMYCIN 5-3 % EX GEL BOTH IP/OP $626.50 $464.00 $111.49 $626.33 $626.33 $626.33 $626.33 $626.33 $626.33 $626.33 $111.49 $626.33 $626.33 $464.86 $464.86 $482.78 $326.32 $130.53 $626.33 $250.53 $626.33 $626.33 $626.33 $626.33 $626.33 $469.88 $626.33 $626.33 $626.33 $313.17 $313.17 $496.05 $626.33 $501.06 $407.11 $626.33 $626.33 $363.37 $626.33 $375.80 $626.33 $626.33 $626.33 N/A N/A 9259 ERX HCPCS J0515 63323-0970-02 BENZTROPINE MESYLATE 1 MG/ML IJ SOLN BOTH IP/OP $71.50 $53.00 $19.02 $71.28 $71.28 $71.28 $71.28 $71.28 $71.28 $71.28 $19.51 $71.28 $71.28 $19.78 $19.78 $20.54 $19.02 $22.35 $71.28 $28.51 $71.28 $71.28 $71.28 $71.28 $71.28 $53.63 $71.28 $71.28 $71.28 $35.64 $35.64 $56.45 $71.28 $57.02 $32.08 $71.28 $71.28 $41.47 $71.28 $42.77 $71.28 $71.28 $71.28 N/A N/A 9260 ERX HCPCS 25000001 49471-0001-05 BENZYLPENICILLOYL POLYLYSINE 0.25 ML ID SOLN BOTH IP/OP $676.50 $501.00 $120.37 $676.24 $676.24 $676.24 $676.24 $676.24 $676.24 $676.24 $120.37 $676.24 $676.24 $501.91 $501.91 $521.25 $352.32 $140.94 $676.24 $270.50 $676.24 $676.24 $676.24 $676.24 $676.24 $507.38 $676.24 $676.24 $676.24 $338.12 $338.12 $535.58 $676.24 $540.99 $439.56 $676.24 $676.24 $392.37 $676.24 $405.74 $676.24 $676.24 $676.24 N/A N/A 9266 ERX HCPCS J0702 00517-0720-01 BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP BOTH IP/OP $57.50 $43.00 $6.78 $57.06 $25.68 $25.68 $25.68 $25.68 $57.06 $57.06 $57.06 $7.14 $57.06 $7.05 $7.05 $7.32 $6.78 $7.97 $57.06 $57.06 $33.75 $57.06 $57.06 $57.06 $57.06 $43.13 $57.06 $57.06 $57.06 $28.53 $28.53 $45.19 $57.06 $45.65 $25.68 $7.59 $57.06 $33.35 $57.06 $57.06 $57.06 $7.59 $57.06 N/A N/A 9284 ERX HCPCS 63700001 00904-1315-46 BISMUTH SUBSALICYLATE 262 MG PO CHEW BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9289 ERX HCPCS J9040 63323-0136-10 BLEOMYCIN SULFATE 15 UNITS IJ SOLR BOTH IP/OP $165.00 $122.00 $26.80 $164.78 $74.15 $74.15 $74.15 $74.15 $164.78 $164.78 $164.78 $37.40 $164.78 $27.87 $27.87 $28.94 $26.80 $31.49 $164.78 $164.78 $97.47 $164.78 $164.78 $164.78 $164.78 $123.75 $164.78 $164.78 $164.78 $82.39 $82.39 $130.51 $164.78 $131.82 $74.15 $29.98 $164.78 $95.70 $164.78 $164.78 $164.78 $29.98 $164.78 N/A N/A 9296 ERX HCPCS 63700001 63304-0158-30 BROMOCRIPTINE MESYLATE 5 MG PO CAPS BOTH IP/OP $40.50 $30.00 $8.38 $40.22 $40.22 $40.22 $40.22 $40.22 $40.22 $40.22 $40.22 $40.22 $40.22 $40.22 $40.22 $40.22 $40.22 $8.38 $40.22 $16.09 $40.22 $40.22 $40.22 $40.22 $40.22 $30.38 $40.22 $40.22 $40.22 $20.11 $20.11 $31.85 $40.22 $32.18 $26.14 $40.22 $40.22 $23.49 $40.22 $24.13 $40.22 $40.22 $40.22 N/A N/A 9297 ERX HCPCS 63700001 00574-0106-03 BROMOCRIPTINE MESYLATE 2.5 MG PO TABS BOTH IP/OP $18.00 $13.00 $3.73 $17.88 $17.88 $17.88 $17.88 $17.88 $17.88 $17.88 $17.88 $17.88 $17.88 $17.88 $17.88 $17.88 $17.88 $3.73 $17.88 $7.15 $17.88 $17.88 $17.88 $17.88 $17.88 $13.50 $17.88 $17.88 $17.88 $8.94 $8.94 $14.16 $17.88 $14.30 $11.62 $17.88 $17.88 $10.44 $17.88 $10.73 $17.88 $17.88 $17.88 N/A N/A 9309 ERX HCPCS 63700001 42799-0119-01 BUMETANIDE 0.5 MG PO TABS BOTH IP/OP $10.50 $8.00 $2.17 $10.39 $10.39 $10.39 $10.39 $10.39 $10.39 $10.39 $10.39 $10.39 $10.39 $10.39 $10.39 $10.39 $10.39 $2.17 $10.39 $4.16 $10.39 $10.39 $10.39 $10.39 $10.39 $7.88 $10.39 $10.39 $10.39 $5.20 $5.20 $8.23 $10.39 $8.31 $6.75 $10.39 $10.39 $6.09 $10.39 $6.23 $10.39 $10.39 $10.39 N/A N/A 9310 ERX HCPCS 63700006 42799-0120-01 BUMETANIDE 1 MG PO TABS BOTH IP/OP $12.00 $9.00 $2.41 $11.54 $11.54 $11.54 $11.54 $11.54 $11.54 $11.54 $11.54 $11.54 $11.54 $11.54 $11.54 $11.54 $11.54 $2.41 $11.54 $4.62 $11.54 $11.54 $11.54 $11.54 $11.54 $9.00 $11.54 $11.54 $11.54 $5.77 $5.77 $9.14 $11.54 $9.23 $7.50 $11.54 $11.54 $6.96 $11.54 $6.92 $11.54 $11.54 $11.54 N/A N/A 9316 ERX HCPCS 25000001 00409-3613-01 BUPIVACAINE IN DEXTROSE 0.75-8.25 % IT SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 9320 ERX HCPCS J0592 00409-2012-32 BUPRENORPHINE HCL 0.3 MG/ML IJ SOLN BOTH IP/OP $79.00 $58.00 $12.27 $78.65 $78.65 $78.65 $78.65 $78.65 $78.65 $78.65 $13.11 $78.65 $78.65 $12.76 $12.76 $13.25 $12.27 $16.39 $78.65 $31.46 $78.65 $78.65 $78.65 $78.65 $78.65 $59.25 $78.65 $78.65 $78.65 $39.33 $39.33 $62.29 $78.65 $62.92 $35.39 $78.65 $78.65 $45.82 $78.65 $47.19 $78.65 $78.65 $78.65 N/A N/A 9321 ERX HCPCS 63700001 23155-0192-01 BUPROPION HCL 100 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9322 ERX HCPCS 63700001 23155-0191-01 BUPROPION HCL 75 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9323 ERX HCPCS 63700001 51079-0986-01 BUSPIRONE HCL 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9324 ERX HCPCS 63700001 51079-0985-20 BUSPIRONE HCL 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9333 ERX HCPCS J0595 00409-1623-01 BUTORPHANOL TARTRATE 1 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $2.89 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $2.94 $22.00 $22.00 $3.01 $3.01 $3.12 $2.89 $3.40 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 9347 ERX HCPCS J0630 67457-0675-02 CALCITONIN (SALMON) 200 UNIT/ML IJ SOLN BOTH IP/OP "$8,757.50" "$6,481.00" "$1,825.13" "$8,757.36" "$8,757.36" "$8,757.36" "$8,757.36" "$8,757.36" "$8,757.36" "$8,757.36" "$3,100.79" "$8,757.36" "$8,757.36" "$8,757.36" "$8,757.36" "$8,757.36" "$8,757.36" "$1,825.13" "$8,757.36" "$3,502.94" "$8,757.36" "$8,757.36" "$8,757.36" "$8,757.36" "$8,757.36" "$6,568.13" "$8,757.36" "$8,757.36" "$8,757.36" "$4,378.68" "$4,378.68" "$6,935.83" "$8,757.36" "$7,005.89" "$5,692.28" "$8,757.36" "$8,757.36" "$5,079.35" "$8,757.36" "$5,254.42" "$8,757.36" "$8,757.36" "$8,757.36" N/A N/A 9350 ERX HCPCS 63700001 23155-0662-01 CALCITRIOL 0.25 MCG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9400 ERX HCPCS 63700001 00143-1174-01 CAPTOPRIL 100 MG PO TABS BOTH IP/OP $16.50 $12.00 $3.43 $16.45 $16.45 $16.45 $16.45 $16.45 $16.45 $16.45 $16.45 $16.45 $16.45 $16.45 $16.45 $16.45 $16.45 $3.43 $16.45 $6.58 $16.45 $16.45 $16.45 $16.45 $16.45 $12.38 $16.45 $16.45 $16.45 $8.23 $8.23 $13.03 $16.45 $13.16 $10.69 $16.45 $16.45 $9.57 $16.45 $9.87 $16.45 $16.45 $16.45 N/A N/A 9401 ERX HCPCS 63700001 00781-8052-01 CAPTOPRIL 12.5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9403 ERX HCPCS 63700001 00781-8075-01 CAPTOPRIL 50 MG PO TABS BOTH IP/OP $10.50 $8.00 $2.12 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $2.12 $10.18 $4.07 $10.18 $10.18 $10.18 $10.18 $10.18 $7.88 $10.18 $10.18 $10.18 $5.09 $5.09 $8.06 $10.18 $8.14 $6.62 $10.18 $10.18 $6.09 $10.18 $6.11 $10.18 $10.18 $10.18 N/A N/A 9408 ERX HCPCS 63700006 00904-6238-61 CARBIDOPA-LEVODOPA 25-250 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9413 ERX HCPCS 25000001 00009-0856-08 CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN BOTH IP/OP "$1,156.50" $856.00 $205.77 "$1,156.02" "$1,156.02" "$1,156.02" "$1,156.02" "$1,156.02" "$1,156.02" "$1,156.02" $205.77 "$1,156.02" "$1,156.02" $858.00 $858.00 $891.06 $602.29 $240.93 "$1,156.02" $462.41 "$1,156.02" "$1,156.02" "$1,156.02" "$1,156.02" "$1,156.02" $867.38 "$1,156.02" "$1,156.02" "$1,156.02" $578.01 $578.01 $915.57 "$1,156.02" $924.82 $751.41 "$1,156.02" "$1,156.02" $670.77 "$1,156.02" $693.61 "$1,156.02" "$1,156.02" "$1,156.02" N/A N/A 9430 ERX HCPCS 63700001 61442-0171-30 CEFACLOR 250 MG PO CAPS BOTH IP/OP $11.50 $9.00 $2.33 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $2.33 $11.18 $4.47 $11.18 $11.18 $11.18 $11.18 $11.18 $8.63 $11.18 $11.18 $11.18 $5.59 $5.59 $8.85 $11.18 $8.94 $7.27 $11.18 $11.18 $6.67 $11.18 $6.71 $11.18 $11.18 $11.18 N/A N/A 9431 ERX HCPCS 63700001 61442-0172-30 CEFACLOR 500 MG PO CAPS BOTH IP/OP $22.00 $16.00 $4.56 $21.88 $21.88 $21.88 $21.88 $21.88 $21.88 $21.88 $21.88 $21.88 $21.88 $21.88 $21.88 $21.88 $21.88 $4.56 $21.88 $8.75 $21.88 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $21.88 $21.88 $12.76 $21.88 $13.13 $21.88 $21.88 $21.88 N/A N/A 9436 ERX HCPCS 63700001 16714-0388-02 CEFADROXIL 500 MG PO CAPS BOTH IP/OP $16.00 $12.00 $3.24 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $15.56 $3.24 $15.56 $6.22 $15.56 $15.56 $15.56 $15.56 $15.56 $12.00 $15.56 $15.56 $15.56 $7.78 $7.78 $12.32 $15.56 $12.45 $10.11 $15.56 $15.56 $9.28 $15.56 $9.34 $15.56 $15.56 $15.56 N/A N/A 9439 ERX HCPCS 63700001 16714-0390-01 CEFADROXIL 500 MG/5ML PO SUSR BOTH IP/OP $18.50 $14.00 $3.79 $18.19 $18.19 $18.19 $18.19 $18.19 $18.19 $18.19 $18.19 $18.19 $18.19 $18.19 $18.19 $18.19 $18.19 $3.79 $18.19 $7.28 $18.19 $18.19 $18.19 $18.19 $18.19 $13.88 $18.19 $18.19 $18.19 $9.10 $9.10 $14.41 $18.19 $14.55 $11.82 $18.19 $18.19 $10.73 $18.19 $10.91 $18.19 $18.19 $18.19 N/A N/A 9452 ERX HCPCS J0698 CEFOTAXIME SODIUM 1 G IJ SOLR BOTH IP/OP $28.50 $21.00 $9.41 $28.08 $28.08 $28.08 $28.08 $28.08 $28.08 $28.08 $9.41 $28.08 $28.08 $10.19 $10.19 $10.58 $9.80 $11.51 $28.08 $11.23 $28.08 $28.08 $28.08 $28.08 $28.08 $21.38 $28.08 $28.08 $28.08 $14.04 $14.04 $22.24 $28.08 $22.46 $12.64 $28.08 $28.08 $16.53 $28.08 $16.85 $28.08 $28.08 $28.08 N/A N/A 9455 ERX HCPCS 25000001 CEFOTAXIME SODIUM 500 MG IJ SOLR BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 9461 ERX HCPCS J0694 25021-0109-10 CEFOXITIN SODIUM 1 G IV SOLR BOTH IP/OP $31.50 $23.00 $4.68 $31.11 $14.00 $14.00 $14.00 $14.00 $31.11 $31.11 $31.11 $8.06 $31.11 $4.87 $4.87 $5.05 $4.68 $5.50 $31.11 $31.11 $18.40 $31.11 $31.11 $31.11 $31.11 $23.63 $31.11 $31.11 $31.11 $15.56 $15.56 $24.64 $31.11 $24.89 $14.00 $5.24 $31.11 $18.27 $31.11 $31.11 $31.11 $5.24 $31.11 N/A N/A 9463 ERX HCPCS J0694 44567-0246-25 CEFOXITIN SODIUM 2 G IV SOLR BOTH IP/OP $95.50 $71.00 $9.36 $95.29 $42.88 $42.88 $42.88 $42.88 $95.29 $95.29 $95.29 $16.12 $95.29 $9.73 $9.73 $10.11 $9.36 $11.00 $95.29 $95.29 $56.36 $95.29 $95.29 $95.29 $95.29 $71.63 $95.29 $95.29 $95.29 $47.65 $47.65 $75.47 $95.29 $76.23 $42.88 $10.47 $95.29 $55.39 $95.29 $95.29 $95.29 $10.47 $95.29 N/A N/A 9468 ERX HCPCS 63700001 16714-0394-01 CEFPODOXIME PROXETIL 100 MG PO TABS BOTH IP/OP $29.50 $22.00 $6.07 $29.11 $29.11 $29.11 $29.11 $29.11 $29.11 $29.11 $29.11 $29.11 $29.11 $29.11 $29.11 $29.11 $29.11 $6.07 $29.11 $11.64 $29.11 $29.11 $29.11 $29.11 $29.11 $22.13 $29.11 $29.11 $29.11 $14.56 $14.56 $23.06 $29.11 $23.29 $18.92 $29.11 $29.11 $17.11 $29.11 $17.47 $29.11 $29.11 $29.11 N/A N/A 9469 ERX HCPCS 63700001 65862-0096-20 CEFPODOXIME PROXETIL 200 MG PO TABS BOTH IP/OP $37.00 $27.00 $7.62 $36.54 $36.54 $36.54 $36.54 $36.54 $36.54 $36.54 $36.54 $36.54 $36.54 $36.54 $36.54 $36.54 $36.54 $7.62 $36.54 $14.62 $36.54 $36.54 $36.54 $36.54 $36.54 $27.75 $36.54 $36.54 $36.54 $18.27 $18.27 $28.94 $36.54 $29.23 $23.75 $36.54 $36.54 $21.46 $36.54 $21.92 $36.54 $36.54 $36.54 N/A N/A 9474 ERX HCPCS J0713 44567-0235-25 CEFTAZIDIME 1 G IJ SOLR BOTH IP/OP $23.50 $17.00 $3.92 $23.33 $23.33 $23.33 $23.33 $23.33 $23.33 $23.33 $3.94 $23.33 $23.33 $4.08 $4.08 $4.23 $3.92 $4.86 $23.33 $9.33 $23.33 $23.33 $23.33 $23.33 $23.33 $17.63 $23.33 $23.33 $23.33 $11.67 $11.67 $18.48 $23.33 $18.66 $10.50 $23.33 $23.33 $13.63 $23.33 $14.00 $23.33 $23.33 $23.33 N/A N/A 9487 ERX HCPCS J0696 00781-3208-95 CEFTRIAXONE SODIUM 1 G IJ SOLR BOTH IP/OP $183.50 $136.00 $1.92 $183.08 $82.39 $82.39 $82.39 $82.39 $183.08 $183.08 $183.08 $5.64 $183.08 $2.00 $2.00 $2.07 $1.92 $2.26 $183.08 $183.08 $108.29 $183.08 $183.08 $183.08 $183.08 $137.63 $183.08 $183.08 $183.08 $91.54 $91.54 $145.00 $183.08 $146.46 $82.39 $2.15 $183.08 $106.43 $183.08 $183.08 $183.08 $2.15 $183.08 N/A N/A 9488 ERX HCPCS J0696 00409-7335-03 CEFTRIAXONE SODIUM 2 G IJ SOLR BOTH IP/OP $22.00 $16.00 $3.84 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $11.28 $22.00 $3.99 $3.99 $4.15 $3.84 $4.51 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $4.30 $22.00 $12.76 $22.00 $22.00 $22.00 $4.30 $22.00 N/A N/A 9489 ERX HCPCS J0696 00409-7337-01 CEFTRIAXONE SODIUM 250 MG IJ SOLR BOTH IP/OP $22.00 $16.00 $0.48 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.41 $22.00 $0.50 $0.50 $0.52 $0.48 $0.56 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.54 $22.00 $12.76 $22.00 $22.00 $22.00 $0.54 $22.00 N/A N/A 9490 ERX HCPCS J0696 00409-7338-01 CEFTRIAXONE SODIUM 500 MG IJ SOLR BOTH IP/OP $22.00 $16.00 $0.96 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $2.82 $22.00 $1.00 $1.00 $1.04 $0.96 $1.13 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.07 $22.00 $12.76 $22.00 $22.00 $22.00 $1.07 $22.00 N/A N/A 9491 ERX HCPCS J0696 00409-7334-10 CEFTRIAXONE SODIUM 10 G IV SOLR BOTH IP/OP $83.00 $61.00 $19.20 $82.71 $37.22 $37.22 $37.22 $37.22 $82.71 $82.71 $82.71 $56.40 $82.71 $19.97 $19.97 $20.74 $19.20 $22.56 $82.71 $82.71 $48.92 $82.71 $82.71 $82.71 $82.71 $62.25 $82.71 $82.71 $82.71 $41.36 $41.36 $65.51 $82.71 $66.17 $37.22 $21.48 $82.71 $48.14 $82.71 $82.71 $82.71 $21.48 $82.71 N/A N/A 9495 ERX HCPCS 63700001 64679-0921-02 CEFUROXIME AXETIL 250 MG PO TABS BOTH IP/OP $19.50 $14.00 $3.96 $19.01 $19.01 $19.01 $19.01 $19.01 $19.01 $19.01 $19.01 $19.01 $19.01 $19.01 $19.01 $19.01 $19.01 $3.96 $19.01 $7.60 $19.01 $19.01 $19.01 $19.01 $19.01 $14.63 $19.01 $19.01 $19.01 $9.51 $9.51 $15.06 $19.01 $15.21 $12.36 $19.01 $19.01 $11.31 $19.01 $11.41 $19.01 $19.01 $19.01 N/A N/A 9499 ERX HCPCS 63700001 50268-0151-15 CEPHALEXIN 250 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9500 ERX HCPCS 63700001 68180-0122-02 CEPHALEXIN 500 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9501 ERX HCPCS 63700001 00093-4175-73 CEPHALEXIN 125 MG/5ML PO SUSR BOTH IP/OP $95.00 $70.00 $19.74 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $19.74 $94.73 $37.89 $94.73 $94.73 $94.73 $94.73 $94.73 $71.25 $94.73 $94.73 $94.73 $47.37 $47.37 $75.03 $94.73 $75.78 $61.57 $94.73 $94.73 $55.10 $94.73 $56.84 $94.73 $94.73 $94.73 N/A N/A 9502 ERX HCPCS 63700001 68180-0441-02 CEPHALEXIN 250 MG/5ML PO SUSR BOTH IP/OP $183.50 $136.00 $38.20 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $38.20 $183.30 $73.32 $183.30 $183.30 $183.30 $183.30 $183.30 $137.63 $183.30 $183.30 $183.30 $91.65 $91.65 $145.17 $183.30 $146.64 $119.15 $183.30 $183.30 $106.43 $183.30 $109.98 $183.30 $183.30 $183.30 N/A N/A 9506 ERX HCPCS 63700001 51079-0597-01 CETIRIZINE HCL 10 MG PO TABS BOTH IP/OP $11.00 $8.00 $2.25 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $2.25 $10.78 $4.31 $10.78 $10.78 $10.78 $10.78 $10.78 $8.25 $10.78 $10.78 $10.78 $5.39 $5.39 $8.54 $10.78 $8.62 $7.01 $10.78 $10.78 $6.38 $10.78 $6.47 $10.78 $10.78 $10.78 N/A N/A 9516 ERX HCPCS 25000001 69339-0138-19 CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN BOTH IP/OP $9.50 $7.00 $1.64 $9.21 $9.21 $9.21 $9.21 $9.21 $9.21 $9.21 $1.64 $9.21 $9.21 $6.84 $6.84 $7.10 $4.80 $1.92 $9.21 $3.68 $9.21 $9.21 $9.21 $9.21 $9.21 $7.13 $9.21 $9.21 $9.21 $4.61 $4.61 $7.29 $9.21 $7.37 $5.99 $9.21 $9.21 $5.51 $9.21 $5.53 $9.21 $9.21 $9.21 N/A N/A 9523 ERX HCPCS J2400 63323-0475-37 CHLOROPROCAINE HCL 1 % IJ SOLN BOTH IP/OP $86.50 $64.00 $17.97 $86.21 $86.21 $86.21 $86.21 $86.21 $86.21 $86.21 $29.03 $86.21 $86.21 $31.30 $31.30 $32.51 $30.10 $17.97 $86.21 $34.48 $86.21 $86.21 $86.21 $86.21 $86.21 $64.88 $86.21 $86.21 $86.21 $43.11 $43.11 $68.28 $86.21 $68.97 $38.79 $86.21 $86.21 $50.17 $86.21 $51.73 $86.21 $86.21 $86.21 N/A N/A 9525 ERX HCPCS 25000001 99999-6012-04 CHLOROTHIAZIDE 250 MG/5ML PO SUSP BOTH IP/OP $8.00 $6.00 $1.34 $7.54 $7.54 $7.54 $7.54 $7.54 $7.54 $7.54 $1.34 $7.54 $7.54 $5.60 $5.60 $5.81 $3.93 $1.57 $7.54 $3.02 $7.54 $7.54 $7.54 $7.54 $7.54 $6.00 $7.54 $7.54 $7.54 $3.77 $3.77 $5.97 $7.54 $6.03 $4.90 $7.54 $7.54 $4.64 $7.54 $4.52 $7.54 $7.54 $7.54 N/A N/A 9526 ERX HCPCS J1205 25021-0305-20 CHLOROTHIAZIDE SODIUM 500 MG IV SOLR BOTH IP/OP $143.50 $106.00 $29.86 $143.28 $143.28 $143.28 $143.28 $143.28 $143.28 $143.28 $56.14 $143.28 $143.28 $45.67 $45.67 $47.42 $43.91 $29.86 $143.28 $57.31 $143.28 $143.28 $143.28 $143.28 $143.28 $107.63 $143.28 $143.28 $143.28 $71.64 $71.64 $113.48 $143.28 $114.62 $64.48 $143.28 $143.28 $83.23 $143.28 $85.97 $143.28 $143.28 $143.28 N/A N/A 9598 ERX HCPCS 25000001 45802-0138-35 CICLOPIROX OLAMINE 0.77 % EX CREA BOTH IP/OP $126.00 $93.00 $22.39 $125.79 $125.79 $125.79 $125.79 $125.79 $125.79 $125.79 $22.39 $125.79 $125.79 $93.36 $93.36 $96.96 $65.54 $26.22 $125.79 $50.32 $125.79 $125.79 $125.79 $125.79 $125.79 $94.50 $125.79 $125.79 $125.79 $62.90 $62.90 $99.63 $125.79 $100.63 $81.76 $125.79 $125.79 $73.08 $125.79 $75.47 $125.79 $125.79 $125.79 N/A N/A 9603 ERX HCPCS J0743 00006-3516-59 IMIPENEM-CILASTATIN 500 MG IV SOLR BOTH IP/OP $156.00 $115.00 $14.70 $155.95 $155.95 $155.95 $155.95 $155.95 $155.95 $155.95 $15.22 $155.95 $155.95 $15.29 $15.29 $15.88 $14.70 $17.27 $155.95 $62.38 $155.95 $155.95 $155.95 $155.95 $155.95 $117.00 $155.95 $155.95 $155.95 $77.98 $77.98 $123.51 $155.95 $124.76 $70.18 $155.95 $155.95 $90.48 $155.95 $93.57 $155.95 $155.95 $155.95 N/A N/A 9607 ERX HCPCS 63700001 00378-0541-01 CIMETIDINE 800 MG PO TABS BOTH IP/OP $22.00 $16.00 $4.52 $21.68 $21.68 $21.68 $21.68 $21.68 $21.68 $21.68 $21.68 $21.68 $21.68 $21.68 $21.68 $21.68 $21.68 $4.52 $21.68 $8.67 $21.68 $21.68 $21.68 $21.68 $21.68 $16.50 $21.68 $21.68 $21.68 $10.84 $10.84 $17.17 $21.68 $17.34 $14.09 $21.68 $21.68 $12.76 $21.68 $13.01 $21.68 $21.68 $21.68 N/A N/A 9610 ERX HCPCS 25000001 69315-0308-05 CIPROFLOXACIN HCL 0.3 % OP SOLN BOTH IP/OP $73.00 $54.00 $12.92 $72.58 $72.58 $72.58 $72.58 $72.58 $72.58 $72.58 $12.92 $72.58 $72.58 $53.87 $53.87 $55.94 $37.81 $15.13 $72.58 $29.03 $72.58 $72.58 $72.58 $72.58 $72.58 $54.75 $72.58 $72.58 $72.58 $36.29 $36.29 $57.48 $72.58 $58.06 $47.18 $72.58 $72.58 $42.34 $72.58 $43.55 $72.58 $72.58 $72.58 N/A N/A 9616 ERX HCPCS 63700001 65862-0225-60 CLARITHROMYCIN 250 MG PO TABS BOTH IP/OP $26.00 $19.00 $5.42 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $5.42 $25.99 $10.40 $25.99 $25.99 $25.99 $25.99 $25.99 $19.50 $25.99 $25.99 $25.99 $13.00 $13.00 $20.58 $25.99 $20.79 $16.89 $25.99 $25.99 $15.08 $25.99 $15.59 $25.99 $25.99 $25.99 N/A N/A 9617 ERX HCPCS 63700001 00781-1962-60 CLARITHROMYCIN 500 MG PO TABS BOTH IP/OP $26.00 $19.00 $5.42 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $5.42 $25.99 $10.40 $25.99 $25.99 $25.99 $25.99 $25.99 $19.50 $25.99 $25.99 $25.99 $13.00 $13.00 $20.58 $25.99 $20.79 $16.89 $25.99 $25.99 $15.08 $25.99 $15.59 $25.99 $25.99 $25.99 N/A N/A 9623 ERX HCPCS 25000001 00168-0202-30 CLINDAMYCIN PHOSPHATE 1 % EX GEL BOTH IP/OP $360.00 $266.00 $64.02 $359.67 $359.67 $359.67 $359.67 $359.67 $359.67 $359.67 $64.02 $359.67 $359.67 $266.95 $266.95 $277.23 $187.39 $74.96 $359.67 $143.87 $359.67 $359.67 $359.67 $359.67 $359.67 $270.00 $359.67 $359.67 $359.67 $179.84 $179.84 $284.86 $359.67 $287.74 $233.79 $359.67 $359.67 $208.80 $359.67 $215.80 $359.67 $359.67 $359.67 N/A N/A 9624 ERX HCPCS 25000001 00168-0277-40 CLINDAMYCIN PHOSPHATE 2 % VA CREA BOTH IP/OP $452.50 $335.00 $80.50 $452.22 $452.22 $452.22 $452.22 $452.22 $452.22 $452.22 $80.50 $452.22 $452.22 $335.64 $335.64 $348.57 $235.61 $94.25 $452.22 $180.89 $452.22 $452.22 $452.22 $452.22 $452.22 $339.38 $452.22 $452.22 $452.22 $226.11 $226.11 $358.16 $452.22 $361.78 $293.94 $452.22 $452.22 $262.45 $452.22 $271.33 $452.22 $452.22 $452.22 N/A N/A 9626 ERX HCPCS S0077 00781-3289-09 CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN BOTH IP/OP $64.50 $48.00 $2.70 $64.16 $28.87 $28.87 $28.87 $28.87 $64.16 $64.16 $2.70 $7.07 $64.16 $4.39 $4.39 $4.56 $4.22 $3.31 $64.16 $25.66 $37.95 $64.16 $64.16 $64.16 $64.16 $48.38 $64.16 $64.16 $64.16 $32.08 $32.08 $50.81 $64.16 $51.33 $28.87 $3.16 $64.16 $37.41 $64.16 $38.50 $64.16 $3.16 $64.16 N/A N/A 9627 ERX HCPCS S0077 00781-3290-09 CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN BOTH IP/OP $78.50 $58.00 $4.06 $78.20 $35.19 $35.19 $35.19 $35.19 $78.20 $78.20 $4.06 $10.61 $78.20 $6.58 $6.58 $6.84 $6.33 $4.97 $78.20 $31.28 $46.26 $78.20 $78.20 $78.20 $78.20 $58.88 $78.20 $78.20 $78.20 $39.10 $39.10 $61.93 $78.20 $62.56 $35.19 $4.73 $78.20 $45.53 $78.20 $46.92 $78.20 $4.73 $78.20 N/A N/A 9630 ERX HCPCS 25000001 51672-1258-01 CLOBETASOL PROPIONATE 0.05 % EX CREA BOTH IP/OP $445.00 $329.00 $79.21 $444.98 $444.98 $444.98 $444.98 $444.98 $444.98 $444.98 $79.21 $444.98 $444.98 $330.26 $330.26 $342.99 $231.83 $92.74 $444.98 $177.99 $444.98 $444.98 $444.98 $444.98 $444.98 $333.75 $444.98 $444.98 $444.98 $222.49 $222.49 $352.42 $444.98 $355.98 $289.24 $444.98 $444.98 $258.10 $444.98 $266.99 $444.98 $444.98 $444.98 N/A N/A 9631 ERX HCPCS 25000001 51672-1259-01 CLOBETASOL PROPIONATE 0.05 % EX OINT BOTH IP/OP $539.50 $399.00 $96.01 $539.40 $539.40 $539.40 $539.40 $539.40 $539.40 $539.40 $96.01 $539.40 $539.40 $400.34 $400.34 $415.77 $281.03 $112.42 $539.40 $215.76 $539.40 $539.40 $539.40 $539.40 $539.40 $404.63 $539.40 $539.40 $539.40 $269.70 $269.70 $427.20 $539.40 $431.52 $350.61 $539.40 $539.40 $312.91 $539.40 $323.64 $539.40 $539.40 $539.40 N/A N/A 9632 ERX HCPCS 25000001 51672-1293-02 CLOBETASOL PROPIONATE 0.05 % EX SOLN BOTH IP/OP $358.00 $265.00 $63.71 $357.94 $357.94 $357.94 $357.94 $357.94 $357.94 $357.94 $63.71 $357.94 $357.94 $265.66 $265.66 $275.90 $186.49 $74.60 $357.94 $143.18 $357.94 $357.94 $357.94 $357.94 $357.94 $268.50 $357.94 $357.94 $357.94 $178.97 $178.97 $283.49 $357.94 $286.35 $232.66 $357.94 $357.94 $207.64 $357.94 $214.76 $357.94 $357.94 $357.94 N/A N/A 9635 ERX HCPCS 63700001 51672-4011-05 CLOMIPRAMINE HCL 25 MG PO CAPS BOTH IP/OP $49.00 $36.00 $10.12 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $10.12 $48.57 $19.43 $48.57 $48.57 $48.57 $48.57 $48.57 $36.75 $48.57 $48.57 $48.57 $24.29 $24.29 $38.47 $48.57 $38.86 $31.57 $48.57 $48.57 $28.42 $48.57 $29.14 $48.57 $48.57 $48.57 N/A N/A 9636 ERX HCPCS 63700001 51672-4013-05 CLOMIPRAMINE HCL 75 MG PO CAPS BOTH IP/OP $49.00 $36.00 $10.12 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $10.12 $48.57 $19.43 $48.57 $48.57 $48.57 $48.57 $48.57 $36.75 $48.57 $48.57 $48.57 $24.29 $24.29 $38.47 $48.57 $38.86 $31.57 $48.57 $48.57 $28.42 $48.57 $29.14 $48.57 $48.57 $48.57 N/A N/A 9644 ERX HCPCS 63700001 00054-4146-22 CLOTRIMAZOLE 10 MG MT TROC BOTH IP/OP $14.00 $10.00 $2.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $2.89 $13.89 $5.56 $13.89 $13.89 $13.89 $13.89 $13.89 $10.50 $13.89 $13.89 $13.89 $6.95 $6.95 $11.00 $13.89 $11.11 $9.03 $13.89 $13.89 $8.12 $13.89 $8.33 $13.89 $13.89 $13.89 N/A N/A 9647 ERX HCPCS 63700001 00378-0860-01 CLOZAPINE 100 MG PO TABS BOTH IP/OP $15.00 $11.00 $3.08 $14.78 $14.78 $14.78 $14.78 $14.78 $14.78 $14.78 $14.78 $14.78 $14.78 $14.78 $14.78 $14.78 $14.78 $3.08 $14.78 $5.91 $14.78 $14.78 $14.78 $14.78 $14.78 $11.25 $14.78 $14.78 $14.78 $7.39 $7.39 $11.71 $14.78 $11.82 $9.61 $14.78 $14.78 $8.70 $14.78 $8.87 $14.78 $14.78 $14.78 N/A N/A 9648 ERX HCPCS 63700001 00378-0825-01 CLOZAPINE 25 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9682 ERX HCPCS 25000001 50484-0010-30 COLLAGENASE 250 UNIT/GM EX OINT BOTH IP/OP "$1,044.00" $773.00 $185.75 "$1,043.54" "$1,043.54" "$1,043.54" "$1,043.54" "$1,043.54" "$1,043.54" "$1,043.54" $185.75 "$1,043.54" "$1,043.54" $774.52 $774.52 $804.36 $543.68 $217.49 "$1,043.54" $417.42 "$1,043.54" "$1,043.54" "$1,043.54" "$1,043.54" "$1,043.54" $783.00 "$1,043.54" "$1,043.54" "$1,043.54" $521.77 $521.77 $826.48 "$1,043.54" $834.83 $678.30 "$1,043.54" "$1,043.54" $605.52 "$1,043.54" $626.12 "$1,043.54" "$1,043.54" "$1,043.54" N/A N/A 9686 ERX HCPCS J0833 67457-0227-02 COSYNTROPIN 0.25 MG IJ SOLR BOTH IP/OP $367.50 $272.00 $32.10 $367.16 $165.22 $165.22 $165.22 $165.22 $367.16 $367.16 $367.16 $76.53 $367.16 $33.38 $33.38 $34.67 $32.10 $37.71 $367.16 $367.16 $217.18 $367.16 $367.16 $367.16 $367.16 $275.63 $367.16 $367.16 $367.16 $183.58 $183.58 $290.79 $367.16 $293.73 $165.22 $35.91 $367.16 $213.15 $367.16 $367.16 $367.16 $35.91 $367.16 N/A N/A 9690 ERX HCPCS J7631 00172-6406-49 CROMOLYN SODIUM 20 MG/2ML IN NEBU BOTH IP/OP $29.50 $22.00 $5.00 $29.37 $29.37 $29.37 $29.37 $29.37 $29.37 $29.37 $5.24 $29.37 $29.37 $5.20 $5.20 $5.40 $5.00 $6.12 $29.37 $11.75 $29.37 $29.37 $29.37 $29.37 $29.37 $22.13 $29.37 $29.37 $29.37 $14.69 $14.69 $23.26 $29.37 $23.50 $13.22 $29.37 $29.37 $17.11 $29.37 $17.62 $29.37 $29.37 $29.37 N/A N/A 9691 ERX HCPCS 25000001 61314-0237-10 CROMOLYN SODIUM 4 % OP SOLN BOTH IP/OP $148.50 $110.00 $26.35 $148.06 $148.06 $148.06 $148.06 $148.06 $148.06 $148.06 $26.35 $148.06 $148.06 $109.89 $109.89 $114.12 $77.14 $30.86 $148.06 $59.22 $148.06 $148.06 $148.06 $148.06 $148.06 $111.38 $148.06 $148.06 $148.06 $74.03 $74.03 $117.26 $148.06 $118.45 $96.24 $148.06 $148.06 $86.13 $148.06 $88.84 $148.06 $148.06 $148.06 N/A N/A 9699 ERX HCPCS 25000001 00065-0395-15 CYCLOPENTOLATE HCL 0.5 % OP SOLN BOTH IP/OP $379.00 $280.00 $67.42 $378.77 $378.77 $378.77 $378.77 $378.77 $378.77 $378.77 $67.42 $378.77 $378.77 $281.12 $281.12 $291.96 $197.34 $78.94 $378.77 $151.51 $378.77 $378.77 $378.77 $378.77 $378.77 $284.25 $378.77 $378.77 $378.77 $189.39 $189.39 $299.99 $378.77 $303.02 $246.20 $378.77 $378.77 $219.82 $378.77 $227.26 $378.77 $378.77 $378.77 N/A N/A 9700 ERX HCPCS 25000001 00065-0397-02 CYCLOPENTOLATE HCL 2 % OP SOLN BOTH IP/OP $199.00 $147.00 $35.42 $198.97 $198.97 $198.97 $198.97 $198.97 $198.97 $198.97 $35.42 $198.97 $198.97 $147.68 $147.68 $153.37 $103.66 $41.47 $198.97 $79.59 $198.97 $198.97 $198.97 $198.97 $198.97 $149.25 $198.97 $198.97 $198.97 $99.49 $99.49 $157.58 $198.97 $159.18 $129.33 $198.97 $198.97 $115.42 $198.97 $119.38 $198.97 $198.97 $198.97 N/A N/A 9701 ERX HCPCS 25000001 00065-0359-05 CYCLOPENTOLATE-PHENYLEPHRINE 0.2-1 % OP SOLN BOTH IP/OP $251.50 $186.00 $44.68 $251.03 $251.03 $251.03 $251.03 $251.03 $251.03 $251.03 $44.68 $251.03 $251.03 $186.31 $186.31 $193.49 $130.79 $52.32 $251.03 $100.41 $251.03 $251.03 $251.03 $251.03 $251.03 $188.63 $251.03 $251.03 $251.03 $125.52 $125.52 $198.82 $251.03 $200.82 $163.17 $251.03 $251.03 $145.87 $251.03 $150.62 $251.03 $251.03 $251.03 N/A N/A 9704 ERX HCPCS 63700001 13845-1202-02 CYCLOSERINE 250 MG PO CAPS BOTH IP/OP $299.50 $222.00 $62.38 $299.29 $299.29 $299.29 $299.29 $299.29 $299.29 $299.29 $299.29 $299.29 $299.29 $299.29 $299.29 $299.29 $299.29 $62.38 $299.29 $119.72 $299.29 $299.29 $299.29 $299.29 $299.29 $224.63 $299.29 $299.29 $299.29 $149.65 $149.65 $237.04 $299.29 $239.43 $194.54 $299.29 $299.29 $173.71 $299.29 $179.57 $299.29 $299.29 $299.29 N/A N/A 9705 ERX HCPCS j7516 00574-0866-10 CYCLOSPORINE 50 MG/ML IV SOLN BOTH IP/OP $187.00 $138.00 $33.25 $186.77 $186.77 $186.77 $186.77 $186.77 $186.77 $186.77 $33.25 $186.77 $186.77 $186.77 $186.77 $186.77 $186.77 $38.92 $186.77 $74.71 $186.77 $186.77 $186.77 $186.77 $186.77 $140.25 $186.77 $186.77 $186.77 $93.39 $93.39 $147.92 $186.77 $149.42 $84.05 $186.77 $186.77 $108.46 $186.77 $112.06 $186.77 $186.77 $186.77 N/A N/A 9706 ERX HCPCS J7502 60505-0134-00 CYCLOSPORINE 100 MG PO CAPS BOTH IP/OP $66.50 $49.00 $2.42 $66.33 $66.33 $66.33 $66.33 $66.33 $66.33 $66.33 $2.42 $66.33 $66.33 $2.53 $2.53 $2.62 $2.43 $13.82 $66.33 $26.53 $66.33 $66.33 $66.33 $66.33 $66.33 $49.88 $66.33 $66.33 $66.33 $33.17 $33.17 $52.53 $66.33 $53.06 $29.85 $66.33 $66.33 $38.57 $66.33 $39.80 $66.33 $66.33 $66.33 N/A N/A 9707 ERX HCPCS J7515 60505-0133-00 CYCLOSPORINE (SANDIMMUNE) 25 MG PO CAPS BOTH IP/OP $33.50 $25.00 $1.64 $33.24 $33.24 $33.24 $33.24 $33.24 $33.24 $33.24 $1.64 $33.24 $33.24 $1.81 $1.81 $1.88 $1.74 $6.93 $33.24 $13.30 $33.24 $33.24 $33.24 $33.24 $33.24 $25.13 $33.24 $33.24 $33.24 $16.62 $16.62 $26.33 $33.24 $26.59 $14.96 $33.24 $33.24 $19.43 $33.24 $19.94 $33.24 $33.24 $33.24 N/A N/A 9708 ERX HCPCS J7502 00078-0110-22 CYCLOSPORINE 100 MG/ML PO SOLN BOTH IP/OP "$2,573.50" "$1,904.00" $121.00 "$2,573.08" "$2,573.08" "$2,573.08" "$2,573.08" "$2,573.08" "$2,573.08" "$2,573.08" $121.00 "$2,573.08" "$2,573.08" $126.36 $126.36 $131.22 $121.50 $536.26 "$2,573.08" "$1,029.23" "$2,573.08" "$2,573.08" "$2,573.08" "$2,573.08" "$2,573.08" "$1,930.13" "$2,573.08" "$2,573.08" "$2,573.08" "$1,286.54" "$1,286.54" "$2,037.88" "$2,573.08" "$2,058.46" "$1,157.89" "$2,573.08" "$2,573.08" "$1,492.63" "$2,573.08" "$1,543.85" "$2,573.08" "$2,573.08" "$2,573.08" N/A N/A 9715 ERX HCPCS 63700001 00555-0633-02 DANAZOL 50 MG PO CAPS BOTH IP/OP $16.00 $12.00 $3.27 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $3.27 $15.67 $6.27 $15.67 $15.67 $15.67 $15.67 $15.67 $12.00 $15.67 $15.67 $15.67 $7.84 $7.84 $12.41 $15.67 $12.54 $10.19 $15.67 $15.67 $9.28 $15.67 $9.40 $15.67 $15.67 $15.67 N/A N/A 9716 ERX HCPCS 25000001 00143-9297-01 DANTROLENE SODIUM 20 MG IV SOLR BOTH IP/OP $305.00 $226.00 $54.22 $304.63 $304.63 $304.63 $304.63 $304.63 $304.63 $304.63 $54.22 $304.63 $304.63 $226.10 $226.10 $234.81 $158.71 $63.49 $304.63 $121.85 $304.63 $304.63 $304.63 $304.63 $304.63 $228.75 $304.63 $304.63 $304.63 $152.32 $152.32 $241.27 $304.63 $243.70 $198.01 $304.63 $304.63 $176.90 $304.63 $182.78 $304.63 $304.63 $304.63 N/A N/A 9717 ERX HCPCS 63700001 00115-4433-01 DANTROLENE SODIUM 100 MG PO CAPS BOTH IP/OP $9.50 $7.00 $1.95 $9.37 $9.37 $9.37 $9.37 $9.37 $9.37 $9.37 $9.37 $9.37 $9.37 $9.37 $9.37 $9.37 $9.37 $1.95 $9.37 $3.75 $9.37 $9.37 $9.37 $9.37 $9.37 $7.13 $9.37 $9.37 $9.37 $4.69 $4.69 $7.42 $9.37 $7.50 $6.09 $9.37 $9.37 $5.51 $9.37 $5.62 $9.37 $9.37 $9.37 N/A N/A 9718 ERX HCPCS 63700001 00115-4411-01 DANTROLENE SODIUM 25 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9719 ERX HCPCS 63700001 00115-4422-01 DANTROLENE SODIUM 50 MG PO CAPS BOTH IP/OP $7.50 $6.00 $1.56 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $1.56 $7.47 $2.99 $7.47 $7.47 $7.47 $7.47 $7.47 $5.63 $7.47 $7.47 $7.47 $3.74 $3.74 $5.92 $7.47 $5.98 $4.86 $7.47 $7.47 $4.35 $7.47 $4.48 $7.47 $7.47 $7.47 N/A N/A 9722 ERX HCPCS J0895 00409-2337-25 DEFEROXAMINE MESYLATE 2 G IJ SOLR BOTH IP/OP $153.50 $114.00 $30.64 $153.10 $153.10 $153.10 $153.10 $153.10 $153.10 $153.10 $30.64 $153.10 $153.10 $32.74 $32.74 $34.00 $31.48 $36.98 $153.10 $61.24 $153.10 $153.10 $153.10 $153.10 $153.10 $115.13 $153.10 $153.10 $153.10 $76.55 $76.55 $121.26 $153.10 $122.48 $68.90 $153.10 $153.10 $89.03 $153.10 $91.86 $153.10 $153.10 $153.10 N/A N/A 9727 ERX HCPCS 63700001 42806-0144-48 DEMECLOCYCLINE HCL 300 MG PO TABS BOTH IP/OP $136.00 $101.00 $28.31 $135.86 $135.86 $135.86 $135.86 $135.86 $135.86 $135.86 $135.86 $135.86 $135.86 $135.86 $135.86 $135.86 $135.86 $28.31 $135.86 $54.34 $135.86 $135.86 $135.86 $135.86 $135.86 $102.00 $135.86 $135.86 $135.86 $67.93 $67.93 $107.60 $135.86 $108.69 $88.31 $135.86 $135.86 $78.88 $135.86 $81.52 $135.86 $135.86 $135.86 N/A N/A 9748 ERX HCPCS J2597 25021-0460-01 DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN BOTH IP/OP $66.50 $49.00 $9.29 $66.10 $66.10 $66.10 $66.10 $66.10 $66.10 $66.10 $9.40 $66.10 $66.10 $9.66 $9.66 $10.03 $9.29 $13.78 $66.10 $26.44 $66.10 $66.10 $66.10 $66.10 $66.10 $49.88 $66.10 $66.10 $66.10 $33.05 $33.05 $52.35 $66.10 $52.88 $29.75 $66.10 $66.10 $38.57 $66.10 $39.66 $66.10 $66.10 $66.10 N/A N/A 9759 ERX HCPCS 25000001 00409-7418-03 DEXTRAN 40 IN D5W 10 % IV SOLN BOTH IP/OP $153.50 $114.00 $27.27 $153.23 $153.23 $153.23 $153.23 $153.23 $153.23 $153.23 $27.27 $153.23 $153.23 $113.73 $113.73 $118.11 $79.83 $31.93 $153.23 $61.29 $153.23 $153.23 $153.23 $153.23 $153.23 $115.13 $153.23 $153.23 $153.23 $76.62 $76.62 $121.36 $153.23 $122.58 $99.60 $153.23 $153.23 $89.03 $153.23 $91.94 $153.23 $153.23 $153.23 N/A N/A 9788 ERX HCPCS J7120 00338-0125-04 DEXTROSE IN LACTATED RINGERS 5 % IV SOLN BOTH IP/OP $30.50 $23.00 $1.13 $30.24 $13.61 $13.61 $13.61 $13.61 $30.24 $30.24 $30.24 $1.13 $30.24 $2.57 $2.57 $2.67 $2.47 $2.90 $30.24 $30.24 $17.89 $30.24 $30.24 $30.24 $30.24 $22.88 $30.24 $30.24 $30.24 $15.12 $15.12 $23.95 $30.24 $24.19 $13.61 $2.76 $30.24 $17.69 $30.24 $30.24 $30.24 $2.76 $30.24 N/A N/A 9823 ERX HCPCS Q9958 00270-1410-30 DIATRIZOATE MEGLUMINE 18 % UR SOLN BOTH IP/OP $154.50 $114.00 $21.00 $154.03 $69.31 $69.31 $69.31 $69.31 $154.03 $154.03 $154.03 $32.10 $154.03 $154.03 $154.03 $22.68 $21.00 $32.10 $154.03 $154.03 $91.11 $154.03 $154.03 $154.03 $154.03 $115.88 $154.03 $154.03 $154.03 $77.02 $77.02 $121.99 $154.03 $123.22 $69.31 $30.57 $154.03 $89.61 $154.03 $154.03 $154.03 $32.10 $154.03 N/A N/A 9828 ERX HCPCS Q9963 00270-0445-40 DIATRIZOATE MEGLUMINE & SODIUM 66-10 % (37% IODINE) SOLN BOTH IP/OP $299.50 $222.00 $22.80 $299.44 $134.75 $134.75 $134.75 $134.75 $299.44 $299.44 $299.44 $62.41 $299.44 $299.44 $299.44 $24.62 $22.80 $62.41 $299.44 $299.44 $177.12 $299.44 $299.44 $299.44 $299.44 $224.63 $299.44 $299.44 $299.44 $149.72 $149.72 $237.16 $299.44 $239.55 $134.75 $59.43 $299.44 $173.71 $299.44 $299.44 $299.44 $62.40 $299.44 N/A N/A 9859 ERX HCPCS J1110 00574-0850-05 DIHYDROERGOTAMINE MESYLATE 1 MG/ML IJ SOLN BOTH IP/OP $282.50 $209.00 $47.42 $282.14 $282.14 $282.14 $282.14 $282.14 $282.14 $282.14 $47.42 $282.14 $282.14 $57.13 $57.13 $59.32 $54.93 $64.53 $282.14 $112.86 $282.14 $282.14 $282.14 $282.14 $282.14 $211.88 $282.14 $282.14 $282.14 $141.07 $141.07 $223.45 $282.14 $225.71 $126.96 $282.14 $282.14 $163.85 $282.14 $169.28 $282.14 $282.14 $282.14 N/A N/A 9891 ERX HCPCS J1245 00641-2569-41 DIPYRIDAMOLE 5 MG/ML IV SOLN BOTH IP/OP $95.00 $70.00 $18.25 $94.57 $94.57 $94.57 $94.57 $94.57 $94.57 $94.57 $18.25 $94.57 $94.57 $18.98 $18.98 $19.71 $18.25 $21.44 $94.57 $37.83 $94.57 $94.57 $94.57 $94.57 $94.57 $71.25 $94.57 $94.57 $94.57 $47.29 $47.29 $74.90 $94.57 $75.66 $42.56 $94.57 $94.57 $55.10 $94.57 $56.74 $94.57 $94.57 $94.57 N/A N/A 9894 ERX HCPCS 63700001 16729-0211-01 DOXAZOSIN MESYLATE 1 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9896 ERX HCPCS 63700001 00904-5524-61 DOXAZOSIN MESYLATE 4 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9897 ERX HCPCS 63700001 68382-0786-01 DOXAZOSIN MESYLATE 8 MG PO TABS BOTH IP/OP $6.50 $5.00 $1.34 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $6.42 $1.34 $6.42 $2.57 $6.42 $6.42 $6.42 $6.42 $6.42 $4.88 $6.42 $6.42 $6.42 $3.21 $3.21 $5.08 $6.42 $5.14 $4.17 $6.42 $6.42 $3.77 $6.42 $3.85 $6.42 $6.42 $6.42 N/A N/A 9927 ERX HCPCS 63700001 16714-0443-01 ENALAPRIL MALEATE 5 MG PO TABS BOTH IP/OP $7.00 $5.00 $1.37 $6.55 $6.55 $6.55 $6.55 $6.55 $6.55 $6.55 $6.55 $6.55 $6.55 $6.55 $6.55 $6.55 $6.55 $1.37 $6.55 $2.62 $6.55 $6.55 $6.55 $6.55 $6.55 $5.25 $6.55 $6.55 $6.55 $3.28 $3.28 $5.19 $6.55 $5.24 $4.26 $6.55 $6.55 $4.06 $6.55 $3.93 $6.55 $6.55 $6.55 N/A N/A 9929 ERX HCPCS 25000001 00143-9786-10 ENALAPRILAT 1.25 MG/ML IV INJ BOTH IP/OP $25.00 $19.00 $4.38 $24.58 $24.58 $24.58 $24.58 $24.58 $24.58 $24.58 $4.38 $24.58 $24.58 $18.24 $18.24 $18.95 $12.81 $5.12 $24.58 $9.83 $24.58 $24.58 $24.58 $24.58 $24.58 $18.75 $24.58 $24.58 $24.58 $12.29 $12.29 $19.47 $24.58 $19.66 $15.98 $24.58 $24.58 $14.50 $24.58 $14.75 $24.58 $24.58 $24.58 N/A N/A 9938 ERX HCPCS J0885 59676-0310-02 EPOETIN ALFA 10000 UNIT/ML IJ SOLN BOTH IP/OP $775.00 $574.00 $65.20 $774.79 $774.79 $774.79 $774.79 $774.79 $774.79 $774.79 $65.20 $774.79 $774.79 $774.79 $774.79 $774.79 $774.79 $161.47 $774.79 $309.92 $774.79 $774.79 $774.79 $774.79 $774.79 $581.25 $774.79 $774.79 $774.79 $387.40 $387.40 $613.63 $774.79 $619.83 $503.61 $774.79 $774.79 $449.50 $774.79 $464.87 $774.79 $774.79 $774.79 N/A N/A 9939 ERX HCPCS J0885 55513-0126-01 EPOETIN ALFA (EPOGEN) 2000 UNIT/ML IJ SOLN BOTH IP/OP $158.50 $117.00 $16.30 $158.37 $158.37 $158.37 $158.37 $158.37 $158.37 $158.37 $16.30 $158.37 $158.37 $158.37 $158.37 $158.37 $158.37 $33.01 $158.37 $63.35 $158.37 $158.37 $158.37 $158.37 $158.37 $118.88 $158.37 $158.37 $158.37 $79.19 $79.19 $125.43 $158.37 $126.70 $102.94 $158.37 $158.37 $91.93 $158.37 $95.02 $158.37 $158.37 $158.37 N/A N/A 9941 ERX HCPCS J0885 55513-0148-10 EPOETIN ALFA (EPOGEN) 4000 UNIT/ML IJ SOLN BOTH IP/OP $158.50 $117.00 $16.30 $158.38 $158.38 $158.38 $158.38 $158.38 $158.38 $158.38 $16.30 $158.38 $158.38 $158.38 $158.38 $158.38 $158.38 $33.01 $158.38 $63.35 $158.38 $158.38 $158.38 $158.38 $158.38 $118.88 $158.38 $158.38 $158.38 $79.19 $79.19 $125.44 $158.38 $126.70 $102.95 $158.38 $158.38 $91.93 $158.38 $95.03 $158.38 $158.38 $158.38 N/A N/A 9949 ERX HCPCS 63700001 00781-5405-01 ERGOTAMINE-CAFFEINE 1-100 MG PO TABS BOTH IP/OP $67.00 $50.00 $13.90 $66.69 $66.69 $66.69 $66.69 $66.69 $66.69 $66.69 $66.69 $66.69 $66.69 $66.69 $66.69 $66.69 $66.69 $13.90 $66.69 $26.68 $66.69 $66.69 $66.69 $66.69 $66.69 $50.25 $66.69 $66.69 $66.69 $33.35 $33.35 $52.82 $66.69 $53.35 $43.35 $66.69 $66.69 $38.86 $66.69 $40.01 $66.69 $66.69 $66.69 N/A N/A 9963 ERX HCPCS 63700001 61570-0072-01 ESTERIFIED ESTROGENS 0.3 MG PO TABS BOTH IP/OP $10.00 $7.00 $2.00 $9.62 $9.62 $9.62 $9.62 $9.62 $9.62 $9.62 $9.62 $9.62 $9.62 $9.62 $9.62 $9.62 $9.62 $2.00 $9.62 $3.85 $9.62 $9.62 $9.62 $9.62 $9.62 $7.50 $9.62 $9.62 $9.62 $4.81 $4.81 $7.62 $9.62 $7.70 $6.25 $9.62 $9.62 $5.80 $9.62 $5.77 $9.62 $9.62 $9.62 N/A N/A 9964 ERX HCPCS 63700001 61570-0073-01 ESTERIFIED ESTROGENS 0.625 MG PO TABS BOTH IP/OP $14.00 $10.00 $2.85 $13.66 $13.66 $13.66 $13.66 $13.66 $13.66 $13.66 $13.66 $13.66 $13.66 $13.66 $13.66 $13.66 $13.66 $2.85 $13.66 $5.46 $13.66 $13.66 $13.66 $13.66 $13.66 $10.50 $13.66 $13.66 $13.66 $6.83 $6.83 $10.82 $13.66 $10.93 $8.88 $13.66 $13.66 $8.12 $13.66 $8.20 $13.66 $13.66 $13.66 N/A N/A 9965 ERX HCPCS 63700001 61570-0074-01 ESTERIFIED ESTROGENS 1.25 MG PO TABS BOTH IP/OP $19.50 $14.00 $3.97 $19.05 $19.05 $19.05 $19.05 $19.05 $19.05 $19.05 $19.05 $19.05 $19.05 $19.05 $19.05 $19.05 $19.05 $3.97 $19.05 $7.62 $19.05 $19.05 $19.05 $19.05 $19.05 $14.63 $19.05 $19.05 $19.05 $9.53 $9.53 $15.09 $19.05 $15.24 $12.38 $19.05 $19.05 $11.31 $19.05 $11.43 $19.05 $19.05 $19.05 N/A N/A 9967 ERX HCPCS 63700001 00555-0886-02 ESTRADIOL 1 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9968 ERX HCPCS 63700001 00555-0887-04 ESTRADIOL 2 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9969 ERX HCPCS 25000001 00430-3754-14 ESTRADIOL 0.1 MG/GM VA CREA BOTH IP/OP $84.50 $63.00 $14.97 $84.12 $84.12 $84.12 $84.12 $84.12 $84.12 $84.12 $14.97 $84.12 $84.12 $62.43 $62.43 $64.84 $43.83 $17.53 $84.12 $33.65 $84.12 $84.12 $84.12 $84.12 $84.12 $63.38 $84.12 $84.12 $84.12 $42.06 $42.06 $66.62 $84.12 $67.30 $54.68 $84.12 $84.12 $49.01 $84.12 $50.47 $84.12 $84.12 $84.12 N/A N/A 9971 ERX HCPCS 63700001 00013-0132-02 ESTRAMUSTINE PHOSPHATE SODIUM 140 MG PO CAPS BOTH IP/OP $80.50 $60.00 $16.68 $80.04 $80.04 $80.04 $80.04 $80.04 $80.04 $80.04 $80.04 $80.04 $80.04 $80.04 $80.04 $80.04 $80.04 $16.68 $80.04 $32.02 $80.04 $80.04 $80.04 $80.04 $80.04 $60.38 $80.04 $80.04 $80.04 $40.02 $40.02 $63.39 $80.04 $64.03 $52.03 $80.04 $80.04 $46.69 $80.04 $48.02 $80.04 $80.04 $80.04 N/A N/A 9972 ERX HCPCS J1410 00046-0749-05 ESTROGENS CONJUGATED 25 MG IJ SOLR BOTH IP/OP "$1,295.00" $958.00 $341.46 "$1,294.98" "$1,294.98" "$1,294.98" "$1,294.98" "$1,294.98" "$1,294.98" "$1,294.98" $341.46 "$1,294.98" "$1,294.98" $355.16 $355.16 $368.82 $341.50 $401.21 "$1,294.98" $517.99 "$1,294.98" "$1,294.98" "$1,294.98" "$1,294.98" "$1,294.98" $971.25 "$1,294.98" "$1,294.98" "$1,294.98" $647.49 $647.49 "$1,025.62" "$1,294.98" "$1,035.98" $582.74 "$1,294.98" "$1,294.98" $751.10 "$1,294.98" $776.99 "$1,294.98" "$1,294.98" "$1,294.98" N/A N/A 9973 ERX HCPCS 63700001 00046-1100-81 ESTROGENS CONJUGATED 0.3 MG PO TABS BOTH IP/OP $35.00 $26.00 $7.24 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $7.24 $34.76 $13.90 $34.76 $34.76 $34.76 $34.76 $34.76 $26.25 $34.76 $34.76 $34.76 $17.38 $17.38 $27.53 $34.76 $27.81 $22.59 $34.76 $34.76 $20.30 $34.76 $20.86 $34.76 $34.76 $34.76 N/A N/A 9974 ERX HCPCS 63700001 00046-1102-81 ESTROGENS CONJUGATED 0.625 MG PO TABS BOTH IP/OP $35.00 $26.00 $7.24 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $7.24 $34.76 $13.90 $34.76 $34.76 $34.76 $34.76 $34.76 $26.25 $34.76 $34.76 $34.76 $17.38 $17.38 $27.53 $34.76 $27.81 $22.59 $34.76 $34.76 $20.30 $34.76 $20.86 $34.76 $34.76 $34.76 N/A N/A 9977 ERX HCPCS 63700001 00046-0872-21 ESTROGENS CONJUGATED 0.625 MG/GM VA CREA BOTH IP/OP "$1,400.00" "$1,036.00" $291.77 "$1,399.99" "$1,399.99" "$1,399.99" "$1,399.99" "$1,399.99" "$1,399.99" "$1,399.99" "$1,399.99" "$1,399.99" "$1,399.99" "$1,399.99" "$1,399.99" "$1,399.99" "$1,399.99" $291.77 "$1,399.99" $560.00 "$1,399.99" "$1,399.99" "$1,399.99" "$1,399.99" "$1,399.99" "$1,050.00" "$1,399.99" "$1,399.99" "$1,399.99" $700.00 $700.00 "$1,108.79" "$1,399.99" "$1,119.99" $909.99 "$1,399.99" "$1,399.99" $812.00 "$1,399.99" $839.99 "$1,399.99" "$1,399.99" "$1,399.99" N/A N/A 9979 ERX HCPCS 25000001 25010-0210-27 ETHACRYNATE SODIUM 50 MG IV SOLR BOTH IP/OP "$14,021.00" "$10,376.00" "$2,060.15" "$14,020.99" "$14,020.99" "$14,020.99" "$14,020.99" "$14,020.99" "$14,020.99" "$14,020.99" "$2,495.74" "$14,020.99" "$14,020.99" "$4,181.12" "$4,181.12" "$10,807.38" "$2,060.15" "$2,922.13" "$14,020.99" "$5,608.40" "$14,020.99" "$14,020.99" "$14,020.99" "$14,020.99" "$14,020.99" "$10,515.75" "$14,020.99" "$14,020.99" "$14,020.99" "$7,010.50" "$7,010.50" "$11,104.62" "$14,020.99" "$11,216.79" "$9,113.64" "$14,020.99" "$14,020.99" "$8,132.18" "$14,020.99" "$8,412.59" "$14,020.99" "$14,020.99" "$14,020.99" N/A N/A 9980 ERX HCPCS 63700001 25010-0215-15 ETHACRYNIC ACID 25 MG PO TABS BOTH IP/OP $117.00 $87.00 $24.33 $116.75 $116.75 $116.75 $116.75 $116.75 $116.75 $116.75 $116.75 $116.75 $116.75 $116.75 $116.75 $116.75 $116.75 $24.33 $116.75 $46.70 $116.75 $116.75 $116.75 $116.75 $116.75 $87.75 $116.75 $116.75 $116.75 $58.38 $58.38 $92.47 $116.75 $93.40 $75.89 $116.75 $116.75 $67.86 $116.75 $70.05 $116.75 $116.75 $116.75 N/A N/A 9988 ERX HCPCS 25000001 00008-4117-01 ETHIONAMIDE 250 MG PO TABS BOTH IP/OP $29.50 $22.00 $5.17 $29.06 $29.06 $29.06 $29.06 $29.06 $29.06 $29.06 $5.17 $29.06 $29.06 $21.57 $21.57 $22.40 $15.14 $6.06 $29.06 $11.62 $29.06 $29.06 $29.06 $29.06 $29.06 $22.13 $29.06 $29.06 $29.06 $14.53 $14.53 $23.02 $29.06 $23.25 $18.89 $29.06 $29.06 $17.11 $29.06 $17.44 $29.06 $29.06 $29.06 N/A N/A 9989 ERX HCPCS 63700001 00071-0237-24 ETHOSUXIMIDE 250 MG PO CAPS BOTH IP/OP $20.50 $15.00 $4.22 $20.25 $20.25 $20.25 $20.25 $20.25 $20.25 $20.25 $20.25 $20.25 $20.25 $20.25 $20.25 $20.25 $20.25 $4.22 $20.25 $8.10 $20.25 $20.25 $20.25 $20.25 $20.25 $15.38 $20.25 $20.25 $20.25 $10.13 $10.13 $16.04 $20.25 $16.20 $13.16 $20.25 $20.25 $11.89 $20.25 $12.15 $20.25 $20.25 $20.25 N/A N/A 10001 ERX HCPCS J8560 00378-3266-94 ETOPOSIDE 50 MG PO CAPS BOTH IP/OP $349.00 $258.00 $72.64 $348.53 $348.53 $348.53 $348.53 $348.53 $348.53 $348.53 $75.63 $348.53 $348.53 $78.53 $78.53 $81.55 $75.51 $72.64 $348.53 $139.41 $348.53 $348.53 $348.53 $348.53 $348.53 $261.75 $348.53 $348.53 $348.53 $174.27 $174.27 $276.04 $348.53 $278.82 $156.84 $348.53 $348.53 $202.42 $348.53 $209.12 $348.53 $348.53 $348.53 N/A N/A 10010 ERX HCPCS 63700001 68180-0150-01 FAMOTIDINE 40 MG/5ML PO SUSR BOTH IP/OP $614.50 $455.00 $127.97 $614.02 $614.02 $614.02 $614.02 $614.02 $614.02 $614.02 $614.02 $614.02 $614.02 $614.02 $614.02 $614.02 $614.02 $127.97 $614.02 $245.61 $614.02 $614.02 $614.02 $614.02 $614.02 $460.88 $614.02 $614.02 $614.02 $307.01 $307.01 $486.30 $614.02 $491.22 $399.11 $614.02 $614.02 $356.41 $614.02 $368.41 $614.02 $614.02 $614.02 192.03 84.14 10011 ERX HCPCS 63700001 00172-5728-60 FAMOTIDINE 20 MG PO TABS BOTH IP/OP $10.50 $8.00 $2.18 $10.47 $10.47 $10.47 $10.47 $10.47 $10.47 $10.47 $10.47 $10.47 $10.47 $10.47 $10.47 $10.47 $10.47 $2.18 $10.47 $4.19 $10.47 $10.47 $10.47 $10.47 $10.47 $7.88 $10.47 $10.47 $10.47 $5.24 $5.24 $8.29 $10.47 $8.38 $6.81 $10.47 $10.47 $6.09 $10.47 $6.28 $10.47 $10.47 $10.47 N/A N/A 10023 ERX HCPCS 25000001 99999-6004-76 FELBAMATE 600 MG/5ML PO SUSP BOTH IP/OP $323.50 $239.00 $57.58 $323.49 $323.49 $323.49 $323.49 $323.49 $323.49 $323.49 $57.58 $323.49 $323.49 $240.09 $240.09 $249.35 $168.54 $67.42 $323.49 $129.40 $323.49 $323.49 $323.49 $323.49 $323.49 $242.63 $323.49 $323.49 $323.49 $161.75 $161.75 $256.20 $323.49 $258.79 $210.27 $323.49 $323.49 $187.63 $323.49 $194.09 $323.49 $323.49 $323.49 N/A N/A 10037 ERX HCPCS 63700001 00093-7355-98 FINASTERIDE 5 MG PO TABS BOTH IP/OP $14.00 $10.00 $2.82 $13.53 $13.53 $13.53 $13.53 $13.53 $13.53 $13.53 $13.53 $13.53 $13.53 $13.53 $13.53 $13.53 $13.53 $2.82 $13.53 $5.41 $13.53 $13.53 $13.53 $13.53 $13.53 $10.50 $13.53 $13.53 $13.53 $6.77 $6.77 $10.72 $13.53 $10.82 $8.79 $13.53 $13.53 $8.12 $13.53 $8.12 $13.53 $13.53 $13.53 N/A N/A 10041 ERX HCPCS 63700001 00054-0011-21 FLECAINIDE ACETATE 100 MG PO TABS BOTH IP/OP $15.50 $11.00 $3.22 $15.47 $15.47 $15.47 $15.47 $15.47 $15.47 $15.47 $15.47 $15.47 $15.47 $15.47 $15.47 $15.47 $15.47 $3.22 $15.47 $6.19 $15.47 $15.47 $15.47 $15.47 $15.47 $11.63 $15.47 $15.47 $15.47 $7.74 $7.74 $12.25 $15.47 $12.38 $10.06 $15.47 $15.47 $8.99 $15.47 $9.28 $15.47 $15.47 $15.47 N/A N/A 10042 ERX HCPCS 63700001 00054-0012-25 FLECAINIDE ACETATE 150 MG PO TABS BOTH IP/OP $19.00 $14.00 $3.91 $18.77 $18.77 $18.77 $18.77 $18.77 $18.77 $18.77 $18.77 $18.77 $18.77 $18.77 $18.77 $18.77 $18.77 $3.91 $18.77 $7.51 $18.77 $18.77 $18.77 $18.77 $18.77 $14.25 $18.77 $18.77 $18.77 $9.39 $9.39 $14.87 $18.77 $15.02 $12.20 $18.77 $18.77 $11.02 $18.77 $11.26 $18.77 $18.77 $18.77 N/A N/A 10043 ERX HCPCS 63700001 00054-0010-21 FLECAINIDE ACETATE 50 MG PO TABS BOTH IP/OP $9.00 $7.00 $1.82 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $1.82 $8.73 $3.49 $8.73 $8.73 $8.73 $8.73 $8.73 $6.75 $8.73 $8.73 $8.73 $4.37 $4.37 $6.91 $8.73 $6.98 $5.67 $8.73 $8.73 $5.22 $8.73 $5.24 $8.73 $8.73 $8.73 N/A N/A 10045 ERX HCPCS 63700001 00904-6501-61 FLUCONAZOLE 200 MG PO TABS BOTH IP/OP $71.00 $53.00 $14.72 $70.62 $70.62 $70.62 $70.62 $70.62 $70.62 $70.62 $70.62 $70.62 $70.62 $70.62 $70.62 $70.62 $70.62 $14.72 $70.62 $28.25 $70.62 $70.62 $70.62 $70.62 $70.62 $53.25 $70.62 $70.62 $70.62 $35.31 $35.31 $55.93 $70.62 $56.50 $45.90 $70.62 $70.62 $41.18 $70.62 $42.37 $70.62 $70.62 $70.62 N/A N/A 10051 ERX HCPCS 63700006 42794-0009-08 FLUCYTOSINE 250 MG PO CAPS BOTH IP/OP $149.50 $111.00 $31.11 $149.25 $149.25 $149.25 $149.25 $149.25 $149.25 $149.25 $149.25 $149.25 $149.25 $149.25 $149.25 $149.25 $149.25 $31.11 $149.25 $59.70 $149.25 $149.25 $149.25 $149.25 $149.25 $112.13 $149.25 $149.25 $149.25 $74.63 $74.63 $118.21 $149.25 $119.40 $97.01 $149.25 $149.25 $86.71 $149.25 $89.55 $149.25 $149.25 $149.25 N/A N/A 10052 ERX HCPCS 63700001 42794-0010-08 FLUCYTOSINE 500 MG PO CAPS BOTH IP/OP $254.00 $188.00 $52.85 $253.59 $253.59 $253.59 $253.59 $253.59 $253.59 $253.59 $253.59 $253.59 $253.59 $253.59 $253.59 $253.59 $253.59 $52.85 $253.59 $101.44 $253.59 $253.59 $253.59 $253.59 $253.59 $190.50 $253.59 $253.59 $253.59 $126.80 $126.80 $200.84 $253.59 $202.87 $164.83 $253.59 $253.59 $147.32 $253.59 $152.15 $253.59 $253.59 $253.59 N/A N/A 10053 ERX HCPCS J9185 45963-0609-55 FLUDARABINE PHOSPHATE 50 MG IV SOLR BOTH IP/OP $393.50 $291.00 $57.02 $393.50 $393.50 $393.50 $393.50 $393.50 $393.50 $393.50 $69.34 $393.50 $393.50 $59.30 $59.30 $61.58 $57.02 $66.99 $393.50 $157.40 $393.50 $393.50 $393.50 $393.50 $393.50 $295.13 $393.50 $393.50 $393.50 $196.75 $196.75 $311.65 $393.50 $314.80 $177.08 $393.50 $393.50 $228.23 $393.50 $236.10 $393.50 $393.50 $393.50 N/A N/A 10054 ERX HCPCS 63700001 00555-0997-02 FLUDROCORTISONE ACETATE 0.1 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10061 ERX HCPCS 25000001 59390-0218-05 FLUORESCEIN-BENOXINATE 0.25-0.4 % OP SOLN BOTH IP/OP $153.00 $113.00 $27.21 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $27.21 $152.84 $152.84 $113.44 $113.44 $117.81 $79.63 $31.85 $152.84 $61.14 $152.84 $152.84 $152.84 $152.84 $152.84 $114.75 $152.84 $152.84 $152.84 $76.42 $76.42 $121.05 $152.84 $122.27 $99.35 $152.84 $152.84 $88.74 $152.84 $91.70 $152.84 $152.84 $152.84 412.05 194.91 10063 ERX HCPCS 25000001 00065-0096-05 FLUOROMETHOLONE ACETATE 0.1 % OP SUSP BOTH IP/OP $375.00 $278.00 $66.68 $374.59 $374.59 $374.59 $374.59 $374.59 $374.59 $374.59 $66.68 $374.59 $374.59 $278.02 $278.02 $288.73 $195.16 $78.07 $374.59 $149.84 $374.59 $374.59 $374.59 $374.59 $374.59 $281.25 $374.59 $374.59 $374.59 $187.30 $187.30 $296.68 $374.59 $299.67 $243.48 $374.59 $374.59 $217.50 $374.59 $224.75 $374.59 $374.59 $374.59 N/A N/A 10069 ERX HCPCS 63700001 65862-0192-01 FLUOXETINE HCL 10 MG PO CAPS BOTH IP/OP $11.50 $9.00 $2.34 $11.23 $11.23 $11.23 $11.23 $11.23 $11.23 $11.23 $11.23 $11.23 $11.23 $11.23 $11.23 $11.23 $11.23 $2.34 $11.23 $4.49 $11.23 $11.23 $11.23 $11.23 $11.23 $8.63 $11.23 $11.23 $11.23 $5.62 $5.62 $8.89 $11.23 $8.98 $7.30 $11.23 $11.23 $6.67 $11.23 $6.74 $11.23 $11.23 $11.23 N/A N/A 10070 ERX HCPCS 63700001 00904-5785-61 FLUOXETINE HCL 20 MG PO CAPS BOTH IP/OP $11.00 $8.00 $2.24 $10.74 $10.74 $10.74 $10.74 $10.74 $10.74 $10.74 $10.74 $10.74 $10.74 $10.74 $10.74 $10.74 $10.74 $2.24 $10.74 $4.30 $10.74 $10.74 $10.74 $10.74 $10.74 $8.25 $10.74 $10.74 $10.74 $5.37 $5.37 $8.51 $10.74 $8.59 $6.98 $10.74 $10.74 $6.38 $10.74 $6.44 $10.74 $10.74 $10.74 N/A N/A 10072 ERX HCPCS 63700001 00121-0654-02 FLUPHENAZINE HCL 2.5 MG/5ML PO ELIX BOTH IP/OP $153.00 $113.00 $31.85 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $31.85 $152.84 $61.14 $152.84 $152.84 $152.84 $152.84 $152.84 $114.75 $152.84 $152.84 $152.84 $76.42 $76.42 $121.05 $152.84 $122.27 $99.35 $152.84 $152.84 $88.74 $152.84 $91.70 $152.84 $152.84 $152.84 N/A N/A 10078 ERX HCPCS 63700001 00093-0711-01 FLURBIPROFEN 100 MG PO TABS BOTH IP/OP $9.00 $7.00 $1.86 $8.93 $8.93 $8.93 $8.93 $8.93 $8.93 $8.93 $8.93 $8.93 $8.93 $8.93 $8.93 $8.93 $8.93 $1.86 $8.93 $3.57 $8.93 $8.93 $8.93 $8.93 $8.93 $6.75 $8.93 $8.93 $8.93 $4.47 $4.47 $7.07 $8.93 $7.14 $5.80 $8.93 $8.93 $5.22 $8.93 $5.36 $8.93 $8.93 $8.93 N/A N/A 10082 ERX HCPCS 25000001 45802-0222-11 FLUTICASONE PROPIONATE 0.05 % EX CREA BOTH IP/OP $136.50 $101.00 $24.29 $136.48 $136.48 $136.48 $136.48 $136.48 $136.48 $136.48 $24.29 $136.48 $136.48 $101.30 $101.30 $105.20 $71.11 $28.44 $136.48 $54.59 $136.48 $136.48 $136.48 $136.48 $136.48 $102.38 $136.48 $136.48 $136.48 $68.24 $68.24 $108.09 $136.48 $109.18 $88.71 $136.48 $136.48 $79.17 $136.48 $81.89 $136.48 $136.48 $136.48 N/A N/A 10083 ERX HCPCS 25000001 45802-0221-11 FLUTICASONE PROPIONATE 0.005 % EX OINT BOTH IP/OP $136.50 $101.00 $24.29 $136.48 $136.48 $136.48 $136.48 $136.48 $136.48 $136.48 $24.29 $136.48 $136.48 $101.30 $101.30 $105.20 $71.11 $28.44 $136.48 $54.59 $136.48 $136.48 $136.48 $136.48 $136.48 $102.38 $136.48 $136.48 $136.48 $68.24 $68.24 $108.09 $136.48 $109.18 $88.71 $136.48 $136.48 $79.17 $136.48 $81.89 $136.48 $136.48 $136.48 N/A N/A 10084 ERX HCPCS 63700001 60505-0166-01 FLUVOXAMINE MALEATE 100 MG PO TABS BOTH IP/OP $11.50 $9.00 $2.38 $11.41 $11.41 $11.41 $11.41 $11.41 $11.41 $11.41 $11.41 $11.41 $11.41 $11.41 $11.41 $11.41 $11.41 $2.38 $11.41 $4.56 $11.41 $11.41 $11.41 $11.41 $11.41 $8.63 $11.41 $11.41 $11.41 $5.71 $5.71 $9.04 $11.41 $9.13 $7.42 $11.41 $11.41 $6.67 $11.41 $6.85 $11.41 $11.41 $11.41 N/A N/A 10100 ERX HCPCS A9579 00270-1111-01 GADOTERIDOL 279.3 MG/ML IV SOLN BOTH IP/OP $250.00 $185.00 $15.80 $249.89 $112.45 $112.45 $112.45 $112.45 $249.89 $249.89 $249.89 $52.08 $249.89 $249.89 $249.89 $17.06 $15.80 $52.08 $249.89 $249.89 $147.81 $249.89 $249.89 $249.89 $249.89 $187.50 $249.89 $249.89 $249.89 $124.95 $124.95 $197.91 $249.89 $199.91 $112.45 $49.60 $249.89 $145.00 $249.89 $249.89 $249.89 $52.08 $249.89 N/A N/A 10101 ERX HCPCS J1570 63323-0315-10 GANCICLOVIR SODIUM 500 MG IV SOLR BOTH IP/OP $405.50 $300.00 $47.37 $405.04 $405.04 $405.04 $405.04 $405.04 $405.04 $405.04 $49.40 $405.04 $405.04 $49.26 $49.26 $51.16 $47.37 $55.65 $405.04 $162.02 $405.04 $405.04 $405.04 $405.04 $405.04 $304.13 $405.04 $405.04 $405.04 $202.52 $202.52 $320.79 $405.04 $324.03 $182.27 $405.04 $405.04 $235.19 $405.04 $243.02 $405.04 $405.04 $405.04 N/A N/A 10126 ERX HCPCS 63700001 00093-8343-01 GLYBURIDE 2.5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10130 ERX HCPCS 25000001 23155-0606-01 GLYCOPYRROLATE 1 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10137 ERX HCPCS J9202 70720-0950-36 GOSERELIN ACETATE 3.6 MG SC IMPL BOTH IP/OP "$2,408.00" "$1,782.00" $525.21 "$2,407.90" "$2,407.90" "$2,407.90" "$2,407.90" "$2,407.90" "$2,407.90" "$2,407.90" $525.21 "$2,407.90" "$2,407.90" $564.89 $564.89 $586.61 $543.16 $638.13 "$2,407.90" $963.16 "$2,407.90" "$2,407.90" "$2,407.90" "$2,407.90" "$2,407.90" "$1,806.00" "$2,407.90" "$2,407.90" "$2,407.90" "$1,203.95" "$1,203.95" "$1,907.06" "$2,407.90" "$1,926.32" "$1,083.56" "$2,407.90" "$2,407.90" "$1,396.64" "$2,407.90" "$1,444.74" "$2,407.90" "$2,407.90" "$2,407.90" N/A N/A 10149 ERX HCPCS 63700001 00591-0444-01 GUANFACINE HCL 1 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10162 ERX HCPCS J1631 00143-9295-01 HALOPERIDOL DECANOATE 100 MG/ML IM SOLN BOTH IP/OP $57.50 $43.00 $3.87 $57.33 $25.80 $25.80 $25.80 $25.80 $57.33 $57.33 $57.33 $3.87 $57.33 $8.49 $8.49 $8.81 $8.16 $9.59 $57.33 $57.33 $33.91 $57.33 $57.33 $57.33 $57.33 $43.13 $57.33 $57.33 $57.33 $28.67 $28.67 $45.41 $57.33 $45.86 $25.80 $9.13 $57.33 $33.35 $57.33 $57.33 $57.33 $9.13 $57.33 N/A N/A 10176 ERX HCPCS J1644 00069-0058-01 HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.24 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.24 $22.00 $0.26 $0.26 $0.27 $0.25 $0.29 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.28 $22.00 $12.76 $22.00 $22.00 $22.00 $0.28 $22.00 N/A N/A 10177 ERX HCPCS J1644 25021-0403-04 HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $2.35 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $2.35 $22.00 $2.60 $2.60 $2.70 $2.50 $2.94 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $2.80 $22.00 $12.76 $22.00 $22.00 $22.00 $2.80 $22.00 N/A N/A 10185 ERX HCPCS 90740 00006-4992-00 HEPATITIS B VAC RECOMBINANT 40 MCG/ML IJ SUSP BOTH IP/OP $638.00 $472.00 $90.56 $637.77 $287.00 $287.00 $287.00 $287.00 $165.82 $165.82 $140.76 $140.32 $165.82 $146.39 $146.39 $152.02 $140.76 $132.92 $637.77 $255.11 $377.24 $165.82 $165.82 $165.82 $637.77 $478.50 $165.82 $90.56 $165.82 $318.89 $318.89 $505.11 $165.82 $510.22 $287.00 $126.58 $165.82 $370.04 $637.77 $382.66 $165.82 $132.91 $165.82 N/A N/A 10203 ERX HCPCS 25000001 51927-1647-00 HYDROCHLORIC ACID 37 % LIQD BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 10230 ERX HCPCS 25000001 42192-0151-01 HYDROQUINONE 4 % EX CREA BOTH IP/OP $371.00 $275.00 $66.02 $370.88 $370.88 $370.88 $370.88 $370.88 $370.88 $370.88 $66.02 $370.88 $370.88 $275.27 $275.27 $285.87 $193.23 $77.30 $370.88 $148.35 $370.88 $370.88 $370.88 $370.88 $370.88 $278.25 $370.88 $370.88 $370.88 $185.44 $185.44 $293.74 $370.88 $296.70 $241.07 $370.88 $370.88 $215.18 $370.88 $222.53 $370.88 $370.88 $370.88 N/A N/A 10235 ERX HCPCS 63700001 68084-0269-11 HYDROXYCHLOROQUINE SULFATE 200 MG PO TABS BOTH IP/OP $19.00 $14.00 $3.95 $18.97 $18.97 $18.97 $18.97 $18.97 $18.97 $18.97 $18.97 $18.97 $18.97 $18.97 $18.97 $18.97 $18.97 $3.95 $18.97 $7.59 $18.97 $18.97 $18.97 $18.97 $18.97 $14.25 $18.97 $18.97 $18.97 $9.49 $9.49 $15.02 $18.97 $15.18 $12.33 $18.97 $18.97 $11.02 $18.97 $11.38 $18.97 $18.97 $18.97 N/A N/A 10236 ERX HCPCS 63700001 00555-0882-02 HYDROXYUREA 500 MG PO CAPS BOTH IP/OP $6.50 $5.00 $1.33 $6.37 $6.37 $6.37 $6.37 $6.37 $6.37 $6.37 $6.37 $6.37 $6.37 $6.37 $6.37 $6.37 $6.37 $1.33 $6.37 $2.55 $6.37 $6.37 $6.37 $6.37 $6.37 $4.88 $6.37 $6.37 $6.37 $3.19 $3.19 $5.05 $6.37 $5.10 $4.14 $6.37 $6.37 $3.77 $6.37 $3.82 $6.37 $6.37 $6.37 N/A N/A 10246 ERX HCPCS 25000001 51672-2130-08 IBUPROFEN 100 MG/5ML PO SUSP BOTH IP/OP $16.50 $12.00 $3.72 $20.91 $20.91 $20.91 $20.91 $20.91 $20.91 $20.91 $3.72 $20.91 $20.91 $15.52 $15.52 $16.12 $10.89 $4.36 $20.91 $8.36 $20.91 $20.91 $20.91 $20.91 $20.91 $12.38 $20.91 $20.91 $20.91 $10.46 $10.46 $16.56 $20.91 $16.73 $13.59 $20.91 $20.91 $9.57 $20.91 $12.55 $20.91 $20.91 $20.91 N/A N/A 10246 ERX HCPCS 25000001 45802-0140-26 IBUPROFEN 100 MG/5ML PO SUSP BOTH IP/OP $21.00 $16.00 $3.72 $20.91 $20.91 $20.91 $20.91 $20.91 $20.91 $20.91 $3.72 $20.91 $20.91 $15.52 $15.52 $16.12 $10.89 $4.36 $20.91 $8.36 $20.91 $20.91 $20.91 $20.91 $20.91 $15.75 $20.91 $20.91 $20.91 $10.46 $10.46 $16.56 $20.91 $16.73 $13.59 $20.91 $20.91 $12.18 $20.91 $12.55 $20.91 $20.91 $20.91 N/A N/A 10248 ERX HCPCS J9208 63323-0142-10 IFOSFAMIDE 1 G IV SOLR BOTH IP/OP $249.50 $185.00 $26.49 $249.39 $249.39 $249.39 $249.39 $249.39 $249.39 $249.39 $26.76 $249.39 $249.39 $27.55 $27.55 $28.61 $26.49 $31.12 $249.39 $99.76 $249.39 $249.39 $249.39 $249.39 $249.39 $187.13 $249.39 $249.39 $249.39 $124.70 $124.70 $197.52 $249.39 $199.51 $112.23 $249.39 $249.39 $144.71 $249.39 $149.63 $249.39 $249.39 $249.39 N/A N/A 10265 ERX HCPCS 25000001 00517-0375-01 INDIGOTINDISULFONATE SODIUM 8 MG/ML IJ SOLN BOTH IP/OP $683.00 $505.00 $121.54 $682.83 $682.83 $682.83 $682.83 $682.83 $682.83 $682.83 $121.54 $682.83 $682.83 $506.80 $506.80 $526.33 $355.75 $142.31 $682.83 $273.13 $682.83 $682.83 $682.83 $682.83 $682.83 $512.25 $682.83 $682.83 $682.83 $341.42 $341.42 $540.80 $682.83 $546.26 $443.84 $682.83 $682.83 $396.14 $682.83 $409.70 $682.83 $682.83 $682.83 N/A N/A 10267 ERX HCPCS 25000001 63323-0659-09 INDOMETHACIN SODIUM 1 MG IV SOLR BOTH IP/OP "$1,435.50" "$1,062.00" $255.45 "$1,435.11" "$1,435.11" "$1,435.11" "$1,435.11" "$1,435.11" "$1,435.11" "$1,435.11" $255.45 "$1,435.11" "$1,435.11" "$1,065.14" "$1,065.14" "$1,106.18" $747.69 $299.09 "$1,435.11" $574.04 "$1,435.11" "$1,435.11" "$1,435.11" "$1,435.11" "$1,435.11" "$1,076.63" "$1,435.11" "$1,435.11" "$1,435.11" $717.56 $717.56 "$1,136.61" "$1,435.11" "$1,148.09" $932.82 "$1,435.11" "$1,435.11" $832.59 "$1,435.11" $861.07 "$1,435.11" "$1,435.11" "$1,435.11" N/A N/A 10284 ERX HCPCS J1815 00002-8315-01 INSULIN NOVOLIN NPH 100 UNIT/ML SC SUSP BOTH IP/OP $10.00 $7.00 $1.98 $201.38 $5.43 $5.43 $5.43 $5.43 $10.00 $10.00 $10.00 $2.08 $10.00 $10.00 $10.00 $10.00 $10.00 $2.08 $10.00 $10.00 $5.92 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $1.98 $10.00 $5.80 $10.00 $10.00 $10.00 $201.38 $10.00 N/A N/A 10289 ERX HCPCS J1815 00002-8215-01 INSULIN NOVOLIN REGULAR 100 UNIT/ML IJ SOLN BOTH IP/OP $10.00 $7.00 $1.01 $10.00 $5.43 $5.43 $5.43 $5.43 $10.00 $10.00 $10.00 $2.08 $10.00 $10.00 $10.00 $10.00 $10.00 $2.08 $10.00 $10.00 $5.92 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $1.98 $10.00 $5.80 $10.00 $10.00 $10.00 $1.01 $10.00 N/A N/A 10321 ERX HCPCS Q9966 00407-1412-30 IOHEXOL 240 MG/ML IJ SOLN BOTH IP/OP $243.00 $180.00 $25.50 $243.00 $109.35 $109.35 $109.35 $109.35 $243.00 $243.00 $243.00 $50.65 $243.00 $243.00 $243.00 $27.54 $25.50 $50.64 $243.00 $243.00 $143.73 $243.00 $243.00 $243.00 $243.00 $182.25 $243.00 $243.00 $243.00 $121.50 $121.50 $192.46 $243.00 $194.40 $109.35 $48.23 $243.00 $140.94 $243.00 $243.00 $243.00 $50.64 $243.00 N/A N/A 10322 ERX HCPCS Q9967 00407-1413-63 IOHEXOL 300 MG/ML IJ SOLN BOTH IP/OP $201.50 $149.00 $1.20 $201.27 $90.57 $90.57 $90.57 $90.57 $201.27 $201.27 $201.27 $41.95 $201.27 $201.27 $201.27 $1.30 $1.20 $41.95 $201.27 $201.27 $119.05 $201.27 $201.27 $201.27 $201.27 $151.13 $201.27 $201.27 $201.27 $100.64 $100.64 $159.41 $201.27 $161.02 $90.57 $39.95 $201.27 $116.87 $201.27 $201.27 $201.27 $41.94 $201.27 N/A N/A 10323 ERX HCPCS Q9967 00407-1414-93 IOHEXOL 350 MG/ML IV SOLN BOTH IP/OP $217.00 $161.00 $6.00 $216.77 $97.55 $97.55 $97.55 $97.55 $216.77 $216.77 $216.77 $45.18 $216.77 $216.77 $216.77 $6.48 $6.00 $45.18 $216.77 $216.77 $128.22 $216.77 $216.77 $216.77 $216.77 $162.75 $216.77 $216.77 $216.77 $108.39 $108.39 $171.68 $216.77 $173.42 $97.55 $43.02 $216.77 $125.86 $216.77 $216.77 $216.77 $45.17 $216.77 N/A N/A 10328 ERX HCPCS Q9967 00270-1316-37 IOPAMIDOL 76 % IV SOLN BOTH IP/OP $90.00 $67.00 $4.80 $89.63 $40.33 $40.33 $40.33 $40.33 $89.63 $89.63 $89.63 $18.68 $89.63 $89.63 $89.63 $5.18 $4.80 $18.68 $89.63 $89.63 $53.02 $89.63 $89.63 $89.63 $89.63 $67.50 $89.63 $89.63 $89.63 $44.82 $44.82 $70.99 $89.63 $71.70 $40.33 $17.79 $89.63 $52.20 $89.63 $89.63 $89.63 $18.68 $89.63 N/A N/A 10358 ERX HCPCS Q9968 55150-0240-05 ISOSULFAN BLUE 1 % SC SOLN BOTH IP/OP "$1,962.50" "$1,452.00" $222.03 "$1,962.45" $883.10 $883.10 $883.10 $883.10 $232.89 $232.89 $232.89 $409.02 $232.89 "$1,962.45" "$1,962.45" "$1,962.45" "$1,962.45" $409.00 $232.89 $222.03 $967.49 $232.89 "$1,962.45" $232.89 $244.53 "$1,471.88" $232.89 $232.89 $232.89 $981.23 $981.23 "$1,554.26" $232.89 "$1,569.96" $883.10 $389.50 $232.89 "$1,138.25" $244.53 $337.69 $232.89 $408.97 $232.89 N/A N/A 10359 ERX HCPCS 63700001 00555-1054-86 ISOTRETINOIN 10 MG PO CAPS BOTH IP/OP $82.00 $61.00 $17.01 $81.61 $81.61 $81.61 $81.61 $81.61 $81.61 $81.61 $81.61 $81.61 $81.61 $81.61 $81.61 $81.61 $81.61 $17.01 $81.61 $32.64 $81.61 $81.61 $81.61 $81.61 $81.61 $61.50 $81.61 $81.61 $81.61 $40.81 $40.81 $64.64 $81.61 $65.29 $53.05 $81.61 $81.61 $47.56 $81.61 $48.97 $81.61 $81.61 $81.61 N/A N/A 10360 ERX HCPCS 63700001 00555-1055-86 ISOTRETINOIN 20 MG PO CAPS BOTH IP/OP $97.00 $72.00 $20.17 $96.77 $96.77 $96.77 $96.77 $96.77 $96.77 $96.77 $96.77 $96.77 $96.77 $96.77 $96.77 $96.77 $96.77 $20.17 $96.77 $38.71 $96.77 $96.77 $96.77 $96.77 $96.77 $72.75 $96.77 $96.77 $96.77 $48.39 $48.39 $76.64 $96.77 $77.42 $62.90 $96.77 $96.77 $56.26 $96.77 $58.06 $96.77 $96.77 $96.77 N/A N/A 10361 ERX HCPCS 63700001 55111-0137-81 ISOTRETINOIN 40 MG PO CAPS BOTH IP/OP $99.00 $73.00 $20.60 $98.82 $98.82 $98.82 $98.82 $98.82 $98.82 $98.82 $98.82 $98.82 $98.82 $98.82 $98.82 $98.82 $98.82 $20.60 $98.82 $39.53 $98.82 $98.82 $98.82 $98.82 $98.82 $74.25 $98.82 $98.82 $98.82 $49.41 $49.41 $78.27 $98.82 $79.06 $64.23 $98.82 $98.82 $57.42 $98.82 $59.29 $98.82 $98.82 $98.82 N/A N/A 10364 ERX HCPCS 63700001 67877-0454-30 ITRACONAZOLE 100 MG PO CAPS BOTH IP/OP $96.50 $71.00 $20.03 $96.10 $96.10 $96.10 $96.10 $96.10 $96.10 $96.10 $96.10 $96.10 $96.10 $96.10 $96.10 $96.10 $96.10 $20.03 $96.10 $38.44 $96.10 $96.10 $96.10 $96.10 $96.10 $72.38 $96.10 $96.10 $96.10 $48.05 $48.05 $76.11 $96.10 $76.88 $62.47 $96.10 $96.10 $55.97 $96.10 $57.66 $96.10 $96.10 $96.10 N/A N/A 10368 ERX HCPCS 63700001 51672-1298-01 KETOCONAZOLE 2 % EX CREA BOTH IP/OP $456.00 $337.00 $94.97 $455.70 $455.70 $455.70 $455.70 $455.70 $455.70 $455.70 $455.70 $455.70 $455.70 $455.70 $455.70 $455.70 $455.70 $94.97 $455.70 $182.28 $455.70 $455.70 $455.70 $455.70 $455.70 $342.00 $455.70 $455.70 $455.70 $227.85 $227.85 $360.91 $455.70 $364.56 $296.21 $455.70 $455.70 $264.48 $455.70 $273.42 $455.70 $455.70 $455.70 N/A N/A 10371 ERX HCPCS 63700001 00378-1134-01 KETOROLAC TROMETHAMINE 10 MG PO TABS BOTH IP/OP $10.00 $7.00 $2.04 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $9.79 $2.04 $9.79 $3.92 $9.79 $9.79 $9.79 $9.79 $9.79 $7.50 $9.79 $9.79 $9.79 $4.90 $4.90 $7.75 $9.79 $7.83 $6.36 $9.79 $9.79 $5.80 $9.79 $5.87 $9.79 $9.79 $9.79 N/A N/A 10372 ERX HCPCS 25000001 36000-0320-01 LABETALOL HCL 5 MG/ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 10373 ERX HCPCS 63700001 00185-0010-01 LABETALOL HCL 100 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10375 ERX HCPCS 63700001 00185-0118-01 LABETALOL HCL 300 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10380 ERX HCPCS 63700001 45802-0419-54 AMMONIUM LACTATE 12 % EX LOTN BOTH IP/OP $132.00 $98.00 $27.44 $131.64 $131.64 $131.64 $131.64 $131.64 $131.64 $131.64 $131.64 $131.64 $131.64 $131.64 $131.64 $131.64 $131.64 $27.44 $131.64 $52.66 $131.64 $131.64 $131.64 $131.64 $131.64 $99.00 $131.64 $131.64 $131.64 $65.82 $65.82 $104.26 $131.64 $105.31 $85.57 $131.64 $131.64 $76.56 $131.64 $78.98 $131.64 $131.64 $131.64 N/A N/A 10392 ERX HCPCS J9217 00074-3642-03 LEUPROLIDE ACETATE 7.5 MG IM KIT BOTH IP/OP "$5,443.50" "$4,028.00" $172.56 "$5,443.14" "$2,449.41" "$2,449.41" "$2,449.41" "$2,449.41" $200.73 $200.73 $200.73 $246.83 $200.73 $208.76 $208.76 $216.79 $200.73 $235.83 $200.73 $172.56 "$2,683.47" $200.73 "$5,443.14" $200.73 $210.77 "$4,082.63" $200.73 $200.73 $200.73 "$2,721.57" "$2,721.57" "$4,310.97" $200.73 "$4,354.51" "$2,449.41" $224.58 $200.73 "$3,157.23" $210.77 $291.06 $200.73 $224.58 $200.73 N/A N/A 10394 ERX HCPCS 25000001 24208-0505-05 LEVOBUNOLOL HCL 0.5 % OP SOLN BOTH IP/OP $96.50 $71.00 $17.13 $96.24 $96.24 $96.24 $96.24 $96.24 $96.24 $96.24 $17.13 $96.24 $96.24 $71.43 $71.43 $74.18 $50.14 $20.06 $96.24 $38.50 $96.24 $96.24 $96.24 $96.24 $96.24 $72.38 $96.24 $96.24 $96.24 $48.12 $48.12 $76.22 $96.24 $76.99 $62.56 $96.24 $96.24 $55.97 $96.24 $57.74 $96.24 $96.24 $96.24 N/A N/A 10426 ERX HCPCS 25000001 00409-3177-01 LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 10427 ERX HCPCS 25000001 63323-0482-27 LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 10428 ERX HCPCS 25000001 63323-0487-37 LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN MPF BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 10429 ERX HCPCS 25000001 00409-3181-11 LIDOCAINE-EPINEPHRINE 1.5 %-1:200000 IJ SOLN MPF BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 10430 ERX HCPCS 25000001 63323-0483-27 LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 10431 ERX HCPCS 25000001 63323-0489-27 LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN MPF BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 10442 ERX HCPCS 25000001 39822-0151-01 LIOTHYRONINE SODIUM 10 MCG/ML IV SOLN BOTH IP/OP $417.50 $309.00 $74.31 $417.49 $417.49 $417.49 $417.49 $417.49 $417.49 $417.49 $74.31 $417.49 $417.49 $309.86 $309.86 $321.80 $217.51 $87.01 $417.49 $167.00 $417.49 $417.49 $417.49 $417.49 $417.49 $313.13 $417.49 $417.49 $417.49 $208.75 $208.75 $330.65 $417.49 $333.99 $271.37 $417.49 $417.49 $242.15 $417.49 $250.49 $417.49 $417.49 $417.49 N/A N/A 10443 ERX HCPCS 63700001 59762-1206-01 LIOTHYRONINE SODIUM 5 MCG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10449 ERX HCPCS 63700001 00904-6798-61 LISINOPRIL 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10451 ERX HCPCS 63700001 43547-0352-10 LISINOPRIL 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10452 ERX HCPCS 63700001 00591-0861-01 LISINOPRIL-HCTZ 20-12.5 MG TABLET BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10453 ERX HCPCS 63700001 68180-0520-01 LISINOPRIL-HCTZ 20-25 MG TABLET BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10454 ERX HCPCS 63700001 00054-0021-25 LITHIUM CARBONATE ER 300 MG PO TBCR BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10455 ERX HCPCS 63700001 00054-0020-25 LITHIUM CARBONATE ER 450 MG PO TBCR BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10460 ERX HCPCS 63700001 58181-3042-05 LOMUSTINE 100 MG PO CAPS BOTH IP/OP "$3,005.50" "$2,224.00" $626.33 "$3,005.26" "$3,005.26" "$3,005.26" "$3,005.26" "$3,005.26" "$3,005.26" "$3,005.26" "$3,005.26" "$3,005.26" "$3,005.26" "$3,005.26" "$3,005.26" "$3,005.26" "$3,005.26" $626.33 "$3,005.26" "$1,202.10" "$3,005.26" "$3,005.26" "$3,005.26" "$3,005.26" "$3,005.26" "$2,254.13" "$3,005.26" "$3,005.26" "$3,005.26" "$1,502.63" "$1,502.63" "$2,380.17" "$3,005.26" "$2,404.21" "$1,953.42" "$3,005.26" "$3,005.26" "$1,743.19" "$3,005.26" "$1,803.16" "$3,005.26" "$3,005.26" "$3,005.26" N/A N/A 10461 ERX HCPCS 63700001 58181-3041-05 LOMUSTINE 40 MG PO CAPS BOTH IP/OP "$1,411.50" "$1,045.00" $294.08 "$1,411.05" "$1,411.05" "$1,411.05" "$1,411.05" "$1,411.05" "$1,411.05" "$1,411.05" "$1,411.05" "$1,411.05" "$1,411.05" "$1,411.05" "$1,411.05" "$1,411.05" "$1,411.05" $294.08 "$1,411.05" $564.42 "$1,411.05" "$1,411.05" "$1,411.05" "$1,411.05" "$1,411.05" "$1,058.63" "$1,411.05" "$1,411.05" "$1,411.05" $705.53 $705.53 "$1,117.55" "$1,411.05" "$1,128.84" $917.18 "$1,411.05" "$1,411.05" $818.67 "$1,411.05" $846.63 "$1,411.05" "$1,411.05" "$1,411.05" N/A N/A 10466 ERX HCPCS 63700001 68084-0248-01 LORATADINE 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10467 ERX HCPCS J2060 99999-6013-42 LORAZEPAM 2 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.72 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $0.75 $0.75 $0.78 $0.72 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 10475 ERX HCPCS J7504 00009-7224-01 "LYMPHOCYTE,ANTI-THYMO IMM GLOB 50 MG/ML IV INJ" BOTH IP/OP "$8,805.50" "$6,516.00" "$1,835.08" "$8,805.12" "$8,805.12" "$8,805.12" "$8,805.12" "$8,805.12" "$8,805.12" "$8,805.12" "$2,355.53" "$8,805.12" "$8,805.12" "$2,449.57" "$2,449.57" "$2,543.79" "$2,355.36" "$1,835.08" "$8,805.12" "$3,522.05" "$8,805.12" "$8,805.12" "$8,805.12" "$8,805.12" "$8,805.12" "$6,604.13" "$8,805.12" "$8,805.12" "$8,805.12" "$4,402.56" "$4,402.56" "$6,973.66" "$8,805.12" "$7,044.10" "$3,962.30" "$8,805.12" "$8,805.12" "$5,107.19" "$8,805.12" "$5,283.07" "$8,805.12" "$8,805.12" "$8,805.12" N/A N/A 10520 ERX HCPCS 63700001 00054-0025-11 MEFLOQUINE HCL 250 MG PO TABS BOTH IP/OP $59.00 $44.00 $12.20 $58.53 $58.53 $58.53 $58.53 $58.53 $58.53 $58.53 $58.53 $58.53 $58.53 $58.53 $58.53 $58.53 $58.53 $12.20 $58.53 $23.41 $58.53 $58.53 $58.53 $58.53 $58.53 $44.25 $58.53 $58.53 $58.53 $29.27 $29.27 $46.36 $58.53 $46.82 $38.04 $58.53 $58.53 $34.22 $58.53 $35.12 $58.53 $58.53 $58.53 N/A N/A 10521 ERX HCPCS 63700001 99999-6005-55 MEGESTROL ACETATE 40 MG/ML PO SUSP BOTH IP/OP $143.50 $106.00 $29.86 $143.28 $143.28 $143.28 $143.28 $143.28 $143.28 $143.28 $143.28 $143.28 $143.28 $143.28 $143.28 $143.28 $143.28 $29.86 $143.28 $57.31 $143.28 $143.28 $143.28 $143.28 $143.28 $107.63 $143.28 $143.28 $143.28 $71.64 $71.64 $113.48 $143.28 $114.62 $93.13 $143.28 $143.28 $83.23 $143.28 $85.97 $143.28 $143.28 $143.28 N/A N/A 10523 ERX HCPCS J8600 47781-0200-50 MELPHALAN 2 MG PO TABS BOTH IP/OP $57.00 $42.00 $8.79 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $8.79 $57.00 $57.00 $9.53 $9.53 $9.89 $9.16 $11.88 $57.00 $22.80 $57.00 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $57.00 $57.00 $33.06 $57.00 $34.20 $57.00 $57.00 $57.00 N/A N/A 10531 ERX HCPCS 63700001 00378-3547-52 MERCAPTOPURINE 50 MG PO TABS BOTH IP/OP $18.00 $13.00 $3.68 $17.67 $17.67 $17.67 $17.67 $17.67 $17.67 $17.67 $17.67 $17.67 $17.67 $17.67 $17.67 $17.67 $17.67 $3.68 $17.67 $7.07 $17.67 $17.67 $17.67 $17.67 $17.67 $13.50 $17.67 $17.67 $17.67 $8.84 $8.84 $13.99 $17.67 $14.14 $11.49 $17.67 $17.67 $10.44 $17.67 $10.60 $17.67 $17.67 $17.67 N/A N/A 10533 ERX HCPCS 63700001 54092-0189-81 MESALAMINE ER 250 MG PO CPCR BOTH IP/OP $31.50 $23.00 $6.56 $31.48 $31.48 $31.48 $31.48 $31.48 $31.48 $31.48 $31.48 $31.48 $31.48 $31.48 $31.48 $31.48 $31.48 $6.56 $31.48 $12.59 $31.48 $31.48 $31.48 $31.48 $31.48 $23.63 $31.48 $31.48 $31.48 $15.74 $15.74 $24.93 $31.48 $25.18 $20.46 $31.48 $31.48 $18.27 $31.48 $18.89 $31.48 $31.48 $31.48 N/A N/A 10535 ERX HCPCS 25000001 45802-0098-51 MESALAMINE 4 G RECTAL ENEM BOTH IP/OP $97.00 $72.00 $17.22 $96.72 $96.72 $96.72 $96.72 $96.72 $96.72 $96.72 $17.22 $96.72 $96.72 $71.79 $71.79 $74.55 $50.39 $20.16 $96.72 $38.69 $96.72 $96.72 $96.72 $96.72 $96.72 $72.75 $96.72 $96.72 $96.72 $48.36 $48.36 $76.60 $96.72 $77.38 $62.87 $96.72 $96.72 $56.26 $96.72 $58.03 $96.72 $96.72 $96.72 N/A N/A 10537 ERX HCPCS J9209 25021-0201-11 MESNA 100 MG/ML IV SOLN BOTH IP/OP $96.00 $71.00 $8.65 $95.52 $95.52 $95.52 $95.52 $95.52 $95.52 $95.52 $10.55 $95.52 $95.52 $9.00 $9.00 $9.34 $8.65 $10.16 $95.52 $38.21 $95.52 $95.52 $95.52 $95.52 $95.52 $72.00 $95.52 $95.52 $95.52 $47.76 $47.76 $75.65 $95.52 $76.42 $42.98 $95.52 $95.52 $55.68 $95.52 $57.31 $95.52 $95.52 $95.52 N/A N/A 10546 ERX HCPCS J1230 99999-6005-49 METHADONE HCL 10 MG/ML IJ SOLN BOTH IP/OP $34.00 $25.00 $7.01 $33.64 $33.64 $33.64 $33.64 $33.64 $33.64 $33.64 $17.80 $33.64 $33.64 $18.17 $18.17 $18.87 $17.47 $7.01 $33.64 $13.46 $33.64 $33.64 $33.64 $33.64 $33.64 $25.50 $33.64 $33.64 $33.64 $16.82 $16.82 $26.64 $33.64 $26.91 $15.14 $33.64 $33.64 $19.72 $33.64 $20.18 $33.64 $33.64 $33.64 N/A N/A 10552 ERX HCPCS 63700006 49884-0641-01 METHIMAZOLE 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10571 ERX HCPCS J2210 00517-0740-01 METHYLERGONOVINE MALEATE 0.2 MG/ML IJ SOLN BOTH IP/OP $140.50 $104.00 $6.51 $140.10 $63.05 $63.05 $63.05 $63.05 $140.10 $140.10 $140.10 $6.51 $140.10 $20.16 $20.16 $20.93 $19.38 $22.77 $140.10 $140.10 $82.87 $140.10 $140.10 $140.10 $140.10 $105.38 $140.10 $140.10 $140.10 $70.05 $70.05 $110.96 $140.10 $112.08 $63.05 $21.68 $140.10 $81.49 $140.10 $140.10 $140.10 $21.68 $140.10 N/A N/A 10572 ERX HCPCS 63700001 16571-0735-21 METHYLERGONOVINE MALEATE 0.2 MG PO TABS BOTH IP/OP $254.50 $188.00 $52.95 $254.06 $254.06 $254.06 $254.06 $254.06 $254.06 $254.06 $254.06 $254.06 $254.06 $254.06 $254.06 $254.06 $254.06 $52.95 $254.06 $101.62 $254.06 $254.06 $254.06 $254.06 $254.06 $190.88 $254.06 $254.06 $254.06 $127.03 $127.03 $201.22 $254.06 $203.25 $165.14 $254.06 $254.06 $147.61 $254.06 $152.44 $254.06 $254.06 $254.06 N/A N/A 10573 ERX HCPCS 63700001 00009-0020-01 METHYLPREDNISOLONE 2 MG PO TABS BOTH IP/OP $9.00 $7.00 $1.78 $8.52 $8.52 $8.52 $8.52 $8.52 $8.52 $8.52 $8.52 $8.52 $8.52 $8.52 $8.52 $8.52 $8.52 $1.78 $8.52 $3.41 $8.52 $8.52 $8.52 $8.52 $8.52 $6.75 $8.52 $8.52 $8.52 $4.26 $4.26 $6.75 $8.52 $6.82 $5.54 $8.52 $8.52 $5.22 $8.52 $5.11 $8.52 $8.52 $8.52 N/A N/A 10576 ERX HCPCS J7509 00009-0022-01 METHYLPREDNISOLONE 8 MG PO TABS BOTH IP/OP $9.50 $7.00 $0.50 $9.27 $9.27 $9.27 $9.27 $9.27 $9.27 $9.27 $0.52 $9.27 $9.27 $0.52 $0.52 $0.54 $0.50 $1.93 $9.27 $3.71 $9.27 $9.27 $9.27 $9.27 $9.27 $7.13 $9.27 $9.27 $9.27 $4.64 $4.64 $7.34 $9.27 $7.42 $4.17 $9.27 $9.27 $5.51 $9.27 $5.56 $9.27 $9.27 $9.27 N/A N/A 10578 ERX HCPCS J2930 00009-0047-22 METHYLPREDNISOLONE SODIUM SUCC 125 MG IJ SOLR BOTH IP/OP $32.50 $24.00 $3.71 $32.31 $14.54 $14.54 $14.54 $14.54 $32.31 $32.31 $32.31 $3.71 $32.31 $6.13 $6.13 $6.36 $5.89 $6.92 $32.31 $32.31 $19.11 $32.31 $32.31 $32.31 $32.31 $24.38 $32.31 $32.31 $32.31 $16.16 $16.16 $25.59 $32.31 $25.85 $14.54 $6.59 $32.31 $18.85 $32.31 $32.31 $32.31 $6.59 $32.31 N/A N/A 10580 ERX HCPCS J2920 00009-0039-28 METHYLPREDNISOLONE SODIUM SUCC 40 MG IJ SOLR BOTH IP/OP $22.00 $16.00 $2.64 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $2.64 $22.00 $4.39 $4.39 $4.56 $4.22 $4.96 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $4.72 $22.00 $12.76 $22.00 $22.00 $22.00 $4.72 $22.00 N/A N/A 10581 ERX HCPCS J2930 00009-0758-01 METHYLPREDNISOLONE SODIUM SUCC 500 MG IJ SOLR BOTH IP/OP $116.00 $86.00 $14.85 $115.98 $52.19 $52.19 $52.19 $52.19 $115.98 $115.98 $115.98 $14.85 $115.98 $24.50 $24.50 $25.44 $23.56 $27.68 $115.98 $115.98 $68.60 $115.98 $115.98 $115.98 $115.98 $87.00 $115.98 $115.98 $115.98 $57.99 $57.99 $91.86 $115.98 $92.78 $52.19 $26.36 $115.98 $67.28 $115.98 $115.98 $115.98 $26.36 $115.98 N/A N/A 10586 ERX HCPCS 63700001 00185-5600-01 METOLAZONE 10 MG PO TABS BOTH IP/OP $12.50 $9.00 $2.54 $12.19 $12.19 $12.19 $12.19 $12.19 $12.19 $12.19 $12.19 $12.19 $12.19 $12.19 $12.19 $12.19 $12.19 $2.54 $12.19 $4.88 $12.19 $12.19 $12.19 $12.19 $12.19 $9.38 $12.19 $12.19 $12.19 $6.10 $6.10 $9.65 $12.19 $9.75 $7.92 $12.19 $12.19 $7.25 $12.19 $7.31 $12.19 $12.19 $12.19 N/A N/A 10587 ERX HCPCS 63700006 00527-2215-37 METOLAZONE 2.5 MG PO TABS BOTH IP/OP $11.00 $8.00 $2.20 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $10.58 $2.20 $10.58 $4.23 $10.58 $10.58 $10.58 $10.58 $10.58 $8.25 $10.58 $10.58 $10.58 $5.29 $5.29 $8.38 $10.58 $8.46 $6.88 $10.58 $10.58 $6.38 $10.58 $6.35 $10.58 $10.58 $10.58 N/A N/A 10588 ERX HCPCS 63700001 00527-2216-37 METOLAZONE 5 MG PO TABS BOTH IP/OP $12.50 $9.00 $2.51 $12.03 $12.03 $12.03 $12.03 $12.03 $12.03 $12.03 $12.03 $12.03 $12.03 $12.03 $12.03 $12.03 $12.03 $2.51 $12.03 $4.81 $12.03 $12.03 $12.03 $12.03 $12.03 $9.38 $12.03 $12.03 $12.03 $6.02 $6.02 $9.53 $12.03 $9.62 $7.82 $12.03 $12.03 $7.25 $12.03 $7.22 $12.03 $12.03 $12.03 N/A N/A 10592 ERX HCPCS 63700001 00245-0860-70 METRONIDAZOLE 0.75 % VA GEL BOTH IP/OP $566.00 $419.00 $117.90 $565.72 $565.72 $565.72 $565.72 $565.72 $565.72 $565.72 $565.72 $565.72 $565.72 $565.72 $565.72 $565.72 $565.72 $117.90 $565.72 $226.29 $565.72 $565.72 $565.72 $565.72 $565.72 $424.50 $565.72 $565.72 $565.72 $282.86 $282.86 $448.05 $565.72 $452.58 $367.72 $565.72 $565.72 $328.28 $565.72 $339.43 $565.72 $565.72 $565.72 N/A N/A 10594 ERX HCPCS 63700001 25010-0305-15 METYROSINE 250 MG PO CAPS BOTH IP/OP "$1,446.50" "$1,070.00" $301.40 "$1,446.18" "$1,446.18" "$1,446.18" "$1,446.18" "$1,446.18" "$1,446.18" "$1,446.18" "$1,446.18" "$1,446.18" "$1,446.18" "$1,446.18" "$1,446.18" "$1,446.18" "$1,446.18" $301.40 "$1,446.18" $578.47 "$1,446.18" "$1,446.18" "$1,446.18" "$1,446.18" "$1,446.18" "$1,084.88" "$1,446.18" "$1,446.18" "$1,446.18" $723.09 $723.09 "$1,145.37" "$1,446.18" "$1,156.94" $940.02 "$1,446.18" "$1,446.18" $838.97 "$1,446.18" $867.71 "$1,446.18" "$1,446.18" "$1,446.18" N/A N/A 10595 ERX HCPCS 63700001 50742-0239-01 MEXILETINE HCL 150 MG PO CAPS BOTH IP/OP $11.00 $8.00 $2.28 $10.96 $10.96 $10.96 $10.96 $10.96 $10.96 $10.96 $10.96 $10.96 $10.96 $10.96 $10.96 $10.96 $10.96 $2.28 $10.96 $4.38 $10.96 $10.96 $10.96 $10.96 $10.96 $8.25 $10.96 $10.96 $10.96 $5.48 $5.48 $8.68 $10.96 $8.77 $7.12 $10.96 $10.96 $6.38 $10.96 $6.58 $10.96 $10.96 $10.96 N/A N/A 10596 ERX HCPCS 63700001 00093-8740-01 MEXILETINE HCL 200 MG PO CAPS BOTH IP/OP $13.50 $10.00 $2.73 $13.08 $13.08 $13.08 $13.08 $13.08 $13.08 $13.08 $13.08 $13.08 $13.08 $13.08 $13.08 $13.08 $13.08 $2.73 $13.08 $5.23 $13.08 $13.08 $13.08 $13.08 $13.08 $10.13 $13.08 $13.08 $13.08 $6.54 $6.54 $10.36 $13.08 $10.46 $8.50 $13.08 $13.08 $7.83 $13.08 $7.85 $13.08 $13.08 $13.08 N/A N/A 10608 ERX HCPCS J2250 00641-6061-25 MIDAZOLAM HCL 5 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.55 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.94 $22.00 $0.57 $0.57 $0.59 $0.55 $0.65 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.62 $22.00 $12.76 $22.00 $22.00 $22.00 $0.62 $22.00 N/A N/A 10609 ERX HCPCS 63700001 00245-0211-11 MIDODRINE HCL 2.5 MG PO TABS BOTH IP/OP $7.50 $6.00 $1.52 $7.31 $7.31 $7.31 $7.31 $7.31 $7.31 $7.31 $7.31 $7.31 $7.31 $7.31 $7.31 $7.31 $7.31 $1.52 $7.31 $2.92 $7.31 $7.31 $7.31 $7.31 $7.31 $5.63 $7.31 $7.31 $7.31 $3.66 $3.66 $5.79 $7.31 $5.85 $4.75 $7.31 $7.31 $4.35 $7.31 $4.39 $7.31 $7.31 $7.31 N/A N/A 10610 ERX HCPCS 63700006 00245-0212-11 MIDODRINE HCL 5 MG PO TABS BOTH IP/OP $18.00 $13.00 $3.74 $17.96 $17.96 $17.96 $17.96 $17.96 $17.96 $17.96 $17.96 $17.96 $17.96 $17.96 $17.96 $17.96 $17.96 $3.74 $17.96 $7.18 $17.96 $17.96 $17.96 $17.96 $17.96 $13.50 $17.96 $17.96 $17.96 $8.98 $8.98 $14.22 $17.96 $14.37 $11.67 $17.96 $17.96 $10.44 $17.96 $10.78 $17.96 $17.96 $17.96 N/A N/A 10612 ERX HCPCS J2265 70842-0160-10 MINOCYCLINE HCL 100 MG IV SOLR BOTH IP/OP $866.50 $641.00 $180.51 $866.14 $866.14 $866.14 $866.14 $866.14 $866.14 $866.14 $185.60 $866.14 $866.14 $201.76 $201.76 $209.52 $194.00 $180.51 $866.14 $346.46 $866.14 $866.14 $866.14 $866.14 $866.14 $649.88 $866.14 $866.14 $866.14 $433.07 $433.07 $685.98 $866.14 $692.91 $389.76 $866.14 $866.14 $502.57 $866.14 $519.68 $866.14 $866.14 $866.14 N/A N/A 10629 ERX HCPCS 63700001 10135-0746-60 MISOPROSTOL 200 MCG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10630 ERX HCPCS J9280 16729-0108-11 MITOMYCIN 20 MG IV SOLR BOTH IP/OP "$1,069.00" $791.00 $35.96 "$1,068.81" $480.96 $480.96 $480.96 $480.96 $101.33 $101.33 $101.33 $35.96 $101.33 $105.37 $105.37 $109.43 $101.32 $119.03 $101.33 $48.05 $632.20 $101.33 "$1,068.81" $101.33 $106.39 $801.75 $101.33 $101.33 $101.33 $534.41 $534.41 $846.50 $101.33 $855.05 $480.96 $113.36 $101.33 $620.02 $106.39 $146.92 $101.33 $113.36 $101.33 N/A N/A 10631 ERX HCPCS J9280 16729-0116-38 MITOMYCIN 40 MG IV SOLR BOTH IP/OP "$1,069.00" $791.00 $35.96 "$1,068.81" $480.96 $480.96 $480.96 $480.96 $101.33 $101.33 $101.33 $35.96 $101.33 $105.37 $105.37 $109.43 $101.32 $119.03 $101.33 $48.05 $632.20 $101.33 "$1,068.81" $101.33 $106.39 $801.75 $101.33 $101.33 $101.33 $534.41 $534.41 $846.50 $101.33 $855.05 $480.96 $113.36 $101.33 $620.02 $106.39 $146.92 $101.33 $113.36 $101.33 N/A N/A 10632 ERX HCPCS J9280 16729-0115-05 MITOMYCIN 5 MG IV SOLR BOTH IP/OP "$1,455.00" "$1,077.00" $35.96 "$1,454.94" $654.72 $654.72 $654.72 $654.72 $101.33 $101.33 $101.33 $35.96 $101.33 $105.37 $105.37 $109.43 $101.32 $119.03 $101.33 $48.05 $860.60 $101.33 "$1,454.94" $101.33 $106.39 "$1,091.25" $101.33 $101.33 $101.33 $727.47 $727.47 "$1,152.31" $101.33 "$1,163.95" $654.72 $113.36 $101.33 $843.90 $106.39 $146.92 $101.33 $113.36 $101.33 N/A N/A 10646 ERX HCPCS 25000001 45802-0257-42 MOMETASONE FUROATE 0.1 % EX CREA BOTH IP/OP $189.50 $140.00 $33.72 $189.46 $189.46 $189.46 $189.46 $189.46 $189.46 $189.46 $33.72 $189.46 $189.46 $140.62 $140.62 $146.04 $98.71 $39.49 $189.46 $75.78 $189.46 $189.46 $189.46 $189.46 $189.46 $142.13 $189.46 $189.46 $189.46 $94.73 $94.73 $150.05 $189.46 $151.57 $123.15 $189.46 $189.46 $109.91 $189.46 $113.68 $189.46 $189.46 $189.46 N/A N/A 10648 ERX HCPCS 25000001 45802-0119-42 MOMETASONE FUROATE 0.1 % EX OINT BOTH IP/OP $177.50 $131.00 $31.59 $177.49 $177.49 $177.49 $177.49 $177.49 $177.49 $177.49 $31.59 $177.49 $177.49 $131.73 $131.73 $136.81 $92.47 $36.99 $177.49 $71.00 $177.49 $177.49 $177.49 $177.49 $177.49 $133.13 $177.49 $177.49 $177.49 $88.75 $88.75 $140.57 $177.49 $141.99 $115.37 $177.49 $177.49 $102.95 $177.49 $106.49 $177.49 $177.49 $177.49 N/A N/A 10674 ERX HCPCS 25000001 45802-0112-22 MUPIROCIN 2 % EX OINT BOTH IP/OP $49.00 $36.00 $8.65 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $48.57 $8.65 $48.57 $48.57 $36.05 $36.05 $37.44 $25.30 $10.12 $48.57 $19.43 $48.57 $48.57 $48.57 $48.57 $48.57 $36.75 $48.57 $48.57 $48.57 $24.29 $24.29 $38.47 $48.57 $38.86 $31.57 $48.57 $48.57 $28.42 $48.57 $29.14 $48.57 $48.57 $48.57 N/A N/A 10685 ERX HCPCS 63700001 00406-1170-03 DEPADE: NALTREXONE HCL 50 MG PO TABS BOTH IP/OP $18.50 $14.00 $3.85 $18.47 $18.47 $18.47 $18.47 $18.47 $18.47 $18.47 $18.47 $18.47 $18.47 $18.47 $18.47 $18.47 $18.47 $3.85 $18.47 $7.39 $18.47 $18.47 $18.47 $18.47 $18.47 $13.88 $18.47 $18.47 $18.47 $9.24 $9.24 $14.63 $18.47 $14.78 $12.01 $18.47 $18.47 $10.73 $18.47 $11.08 $18.47 $18.47 $18.47 N/A N/A 10712 ERX HCPCS 63700001 42806-0501-09 NICARDIPINE HCL 20 MG PO CAPS BOTH IP/OP $67.00 $50.00 $13.95 $66.94 $66.94 $66.94 $66.94 $66.94 $66.94 $66.94 $66.94 $66.94 $66.94 $66.94 $66.94 $66.94 $66.94 $13.95 $66.94 $26.78 $66.94 $66.94 $66.94 $66.94 $66.94 $50.25 $66.94 $66.94 $66.94 $33.47 $33.47 $53.02 $66.94 $53.55 $43.51 $66.94 $66.94 $38.86 $66.94 $40.16 $66.94 $66.94 $66.94 N/A N/A 10722 ERX HCPCS 63700001 63739-0797-33 NIMODIPINE 30 MG PO CAPS BOTH IP/OP $30.00 $22.00 $6.21 $29.80 $29.80 $29.80 $29.80 $29.80 $29.80 $29.80 $29.80 $29.80 $29.80 $29.80 $29.80 $29.80 $29.80 $6.21 $29.80 $11.92 $29.80 $29.80 $29.80 $29.80 $29.80 $22.50 $29.80 $29.80 $29.80 $14.90 $14.90 $23.60 $29.80 $23.84 $19.37 $29.80 $29.80 $17.40 $29.80 $17.88 $29.80 $29.80 $29.80 N/A N/A 10724 ERX HCPCS 63700001 16714-0439-01 NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS BOTH IP/OP $15.50 $11.00 $3.18 $15.28 $15.28 $15.28 $15.28 $15.28 $15.28 $15.28 $15.28 $15.28 $15.28 $15.28 $15.28 $15.28 $15.28 $3.18 $15.28 $6.11 $15.28 $15.28 $15.28 $15.28 $15.28 $11.63 $15.28 $15.28 $15.28 $7.64 $7.64 $12.10 $15.28 $12.22 $9.93 $15.28 $15.28 $8.99 $15.28 $9.17 $15.28 $15.28 $15.28 N/A N/A 10735 ERX HCPCS 63700001 00378-7283-53 NORETHIN ACE-ETH ESTRAD-FE 1-20 MG-MCG PO TABS BOTH IP/OP $11.00 $8.00 $2.29 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 10747 ERX HCPCS 63700006 50742-0267-50 NORETHINDRONE ACETATE 5 MG PO TABS BOTH IP/OP $11.50 $9.00 $2.39 $11.45 $11.45 $11.45 $11.45 $11.45 $11.45 $11.45 $11.45 $11.45 $11.45 $11.45 $11.45 $11.45 $11.45 $2.39 $11.45 $4.58 $11.45 $11.45 $11.45 $11.45 $11.45 $8.63 $11.45 $11.45 $11.45 $5.73 $5.73 $9.07 $11.45 $9.16 $7.44 $11.45 $11.45 $6.67 $11.45 $6.87 $11.45 $11.45 $11.45 N/A N/A 10749 ERX HCPCS 63700001 99999-6009-94 NORGESTIMATE-ETH ESTRADIOL 0.25-35 MG-MCG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10752 ERX HCPCS 63700001 16714-0365-04 NORGESTREL-ETHINYL ESTRADIOL 0.3-30 MG-MCG PO TABS BOTH IP/OP $121.50 $90.00 $25.32 $121.47 $121.47 $121.47 $121.47 $121.47 $121.47 $121.47 $121.47 $121.47 $121.47 $121.47 $121.47 $121.47 $121.47 $25.32 $121.47 $48.59 $121.47 $121.47 $121.47 $121.47 $121.47 $91.13 $121.47 $121.47 $121.47 $60.74 $60.74 $96.20 $121.47 $97.18 $78.96 $121.47 $121.47 $70.47 $121.47 $72.88 $121.47 $121.47 $121.47 N/A N/A 10779 ERX HCPCS Q0162 62756-0131-01 ONDANSETRON HCL 8 MG PO TABS BOTH IP/OP $157.00 $116.00 $31.07 $156.55 $85.01 $85.01 $85.01 $85.01 $156.55 $156.55 $156.55 $32.63 $156.55 $156.55 $156.55 $156.55 $156.55 $32.63 $156.55 $156.55 $92.60 $156.55 $156.55 $156.55 $156.55 $117.75 $156.55 $156.55 $156.55 $78.28 $78.28 $123.99 $156.55 $125.24 $101.76 $31.07 $156.55 $91.06 $156.55 $156.55 $156.55 $32.63 $156.55 N/A N/A 10803 ERX HCPCS 63700001 49884-0301-01 OXANDROLONE 2.5 MG PO TABS BOTH IP/OP $24.00 $18.00 $4.98 $23.89 $23.89 $23.89 $23.89 $23.89 $23.89 $23.89 $23.89 $23.89 $23.89 $23.89 $23.89 $23.89 $23.89 $4.98 $23.89 $9.56 $23.89 $23.89 $23.89 $23.89 $23.89 $18.00 $23.89 $23.89 $23.89 $11.95 $11.95 $18.92 $23.89 $19.11 $15.53 $23.89 $23.89 $13.92 $23.89 $14.33 $23.89 $23.89 $23.89 N/A N/A 10810 ERX HCPCS 63700001 99999-6004-78 OXYBUTYNIN CHLORIDE 5 MG/5ML PO SYRP BOTH IP/OP $54.50 $40.00 $11.35 $54.44 $54.44 $54.44 $54.44 $54.44 $54.44 $54.44 $54.44 $54.44 $54.44 $54.44 $54.44 $54.44 $54.44 $11.35 $54.44 $21.78 $54.44 $54.44 $54.44 $54.44 $54.44 $40.88 $54.44 $54.44 $54.44 $27.22 $27.22 $43.12 $54.44 $43.55 $35.39 $54.44 $54.44 $31.61 $54.44 $32.66 $54.44 $54.44 $54.44 N/A N/A 10812 ERX HCPCS 25000001 99999-6005-57 OXYCODONE HCL 100 MG/5ML PO CONC BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 10813 ERX HCPCS 25000001 66689-0401-01 OXYCODONE HCL 5 MG/5ML PO SOLN BOTH IP/OP $37.50 $28.00 $6.63 $37.26 $37.26 $37.26 $37.26 $37.26 $37.26 $37.26 $6.63 $37.26 $37.26 $27.65 $27.65 $28.72 $19.41 $7.77 $37.26 $14.90 $37.26 $37.26 $37.26 $37.26 $37.26 $28.13 $37.26 $37.26 $37.26 $18.63 $18.63 $29.51 $37.26 $29.81 $24.22 $37.26 $37.26 $21.75 $37.26 $22.36 $37.26 $37.26 $37.26 N/A N/A 10814 ERX HCPCS 25000001 00406-0552-62 OXYCODONE HCL 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10839 ERX HCPCS 63700001 43386-0090-19 PEG 3350-KCL-NABCB-NACL-NASULF 236 G PO SOLR BOTH IP/OP $127.50 $94.00 $26.54 $127.36 $127.36 $127.36 $127.36 $127.36 $127.36 $127.36 $127.36 $127.36 $127.36 $127.36 $127.36 $127.36 $127.36 $26.54 $127.36 $50.94 $127.36 $127.36 $127.36 $127.36 $127.36 $95.63 $127.36 $127.36 $127.36 $63.68 $63.68 $100.87 $127.36 $101.89 $82.78 $127.36 $127.36 $73.95 $127.36 $76.42 $127.36 $127.36 $127.36 N/A N/A 10854 ERX HCPCS 63700001 23155-0038-01 PAROMOMYCIN SULFATE 250 MG PO CAPS BOTH IP/OP $24.50 $18.00 $5.11 $24.50 $24.50 $24.50 $24.50 $24.50 $24.50 $24.50 $24.50 $24.50 $24.50 $24.50 $24.50 $24.50 $24.50 $5.11 $24.50 $9.80 $24.50 $24.50 $24.50 $24.50 $24.50 $18.38 $24.50 $24.50 $24.50 $12.25 $12.25 $19.40 $24.50 $19.60 $15.93 $24.50 $24.50 $14.21 $24.50 $14.70 $24.50 $24.50 $24.50 N/A N/A 10910 ERX HCPCS J9268 00409-0801-01 PENTOSTATIN 10 MG IV SOLR BOTH IP/OP "$6,820.00" "$5,047.00" "$1,421.29" "$6,819.64" "$6,819.64" "$6,819.64" "$6,819.64" "$6,819.64" "$6,819.64" "$6,819.64" "$1,880.67" "$6,819.64" "$6,819.64" "$2,011.83" "$2,011.83" "$2,089.21" "$1,934.45" "$1,421.29" "$6,819.64" "$2,727.86" "$6,819.64" "$6,819.64" "$6,819.64" "$6,819.64" "$6,819.64" "$5,115.00" "$6,819.64" "$6,819.64" "$6,819.64" "$3,409.82" "$3,409.82" "$5,401.15" "$6,819.64" "$5,455.71" "$3,068.84" "$6,819.64" "$6,819.64" "$3,955.60" "$6,819.64" "$4,091.78" "$6,819.64" "$6,819.64" "$6,819.64" N/A N/A 10917 ERX HCPCS 25000001 00472-0242-60 PERMETHRIN 5 % EX CREA BOTH IP/OP $430.00 $318.00 $76.45 $429.52 $429.52 $429.52 $429.52 $429.52 $429.52 $429.52 $76.45 $429.52 $429.52 $318.79 $318.79 $331.07 $223.78 $89.52 $429.52 $171.81 $429.52 $429.52 $429.52 $429.52 $429.52 $322.50 $429.52 $429.52 $429.52 $214.76 $214.76 $340.18 $429.52 $343.62 $279.19 $429.52 $429.52 $249.40 $429.52 $257.71 $429.52 $429.52 $429.52 N/A N/A 10918 ERX HCPCS 25000001 63736-0024-03 PERMETHRIN 1 % EX LIQD BOTH IP/OP $44.00 $33.00 $7.76 $43.59 $43.59 $43.59 $43.59 $43.59 $43.59 $43.59 $7.76 $43.59 $43.59 $32.35 $32.35 $33.60 $22.71 $9.08 $43.59 $17.44 $43.59 $43.59 $43.59 $43.59 $43.59 $33.00 $43.59 $43.59 $43.59 $21.80 $21.80 $34.52 $43.59 $34.87 $28.33 $43.59 $43.59 $25.52 $43.59 $26.15 $43.59 $43.59 $43.59 N/A N/A 10933 ERX HCPCS 63700001 59762-0119-01 PHENELZINE SULFATE 15 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 10945 ERX HCPCS 63700001 49884-0038-01 PHENOXYBENZAMINE HCL 10 MG PO CAPS BOTH IP/OP $449.50 $333.00 $93.61 $449.18 $449.18 $449.18 $449.18 $449.18 $449.18 $449.18 $449.18 $449.18 $449.18 $449.18 $449.18 $449.18 $449.18 $93.61 $449.18 $179.67 $449.18 $449.18 $449.18 $449.18 $449.18 $337.13 $449.18 $449.18 $449.18 $224.59 $224.59 $355.75 $449.18 $359.34 $291.97 $449.18 $449.18 $260.71 $449.18 $269.51 $449.18 $449.18 $449.18 N/A N/A 10947 ERX HCPCS J2760 00143-9564-01 PHENTOLAMINE MESYLATE 5 MG IJ SOLR BOTH IP/OP "$1,570.00" "$1,162.00" $327.17 "$1,569.83" "$1,569.83" "$1,569.83" "$1,569.83" "$1,569.83" "$1,569.83" "$1,569.83" $416.00 "$1,569.83" "$1,569.83" $430.68 $430.68 $447.25 $414.12 $327.17 "$1,569.83" $627.93 "$1,569.83" "$1,569.83" "$1,569.83" "$1,569.83" "$1,569.83" "$1,177.50" "$1,569.83" "$1,569.83" "$1,569.83" $784.92 $784.92 "$1,243.31" "$1,569.83" "$1,255.86" $706.42 "$1,569.83" "$1,569.83" $910.60 "$1,569.83" $941.90 "$1,569.83" "$1,569.83" "$1,569.83" N/A N/A 11018 ERX HCPCS 63700001 00071-0007-40 PHENYTOIN 50 MG PO CHEW BOTH IP/OP $11.50 $9.00 $2.30 $11.04 $11.04 $11.04 $11.04 $11.04 $11.04 $11.04 $11.04 $11.04 $11.04 $11.04 $11.04 $11.04 $11.04 $2.30 $11.04 $4.42 $11.04 $11.04 $11.04 $11.04 $11.04 $8.63 $11.04 $11.04 $11.04 $5.52 $5.52 $8.74 $11.04 $8.83 $7.18 $11.04 $11.04 $6.67 $11.04 $6.62 $11.04 $11.04 $11.04 N/A N/A 11019 ERX HCPCS 63700001 00071-3740-66 PHENYTOIN SODIUM EXTENDED 30 MG PO CAPS BOTH IP/OP $7.50 $6.00 $1.49 $7.17 $7.17 $7.17 $7.17 $7.17 $7.17 $7.17 $7.17 $7.17 $7.17 $7.17 $7.17 $7.17 $7.17 $1.49 $7.17 $2.87 $7.17 $7.17 $7.17 $7.17 $7.17 $5.63 $7.17 $7.17 $7.17 $3.59 $3.59 $5.68 $7.17 $5.74 $4.66 $7.17 $7.17 $4.35 $7.17 $4.30 $7.17 $7.17 $7.17 N/A N/A 11037 ERX HCPCS 90732 00006-4837-01 PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML IJ INJ BOTH IP/OP $488.00 $361.00 $9.40 $487.54 $219.39 $219.39 $219.39 $219.39 $126.76 $126.76 $125.92 $9.40 $126.76 $138.81 $138.81 $144.15 $133.47 $156.81 $487.54 $195.02 $288.38 $126.76 $126.76 $126.76 $487.54 $366.00 $126.76 $69.23 $126.76 $243.77 $243.77 $386.13 $126.76 $390.03 $219.39 $149.33 $126.76 $283.04 $487.54 $71.18 $126.76 $149.33 $126.76 N/A N/A 11038 ERX HCPCS 25000001 00574-0611-05 PODOFILOX 0.5 % EX SOLN BOTH IP/OP $375.50 $278.00 $66.80 $375.29 $375.29 $375.29 $375.29 $375.29 $375.29 $375.29 $66.80 $375.29 $375.29 $278.54 $278.54 $289.27 $195.53 $78.21 $375.29 $150.12 $375.29 $375.29 $375.29 $375.29 $375.29 $281.63 $375.29 $375.29 $375.29 $187.65 $187.65 $297.23 $375.29 $300.23 $243.94 $375.29 $375.29 $217.79 $375.29 $225.17 $375.29 $375.29 $375.29 N/A N/A 11058 ERX HCPCS 25000001 60258-0002-16 K & NA CIT-CIT AC 550-500-334 MG/5ML PO SYRP BOTH IP/OP $11.00 $8.00 $1.96 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $1.96 $11.00 $11.00 $8.16 $8.16 $8.48 $5.73 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 11074 ERX HCPCS J3480 00338-0709-48 POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN BOTH IP/OP $25.50 $19.00 $0.12 $25.06 $11.28 $11.28 $11.28 $11.28 $25.06 $25.06 $25.06 $0.12 $25.06 $0.78 $0.78 $0.81 $0.75 $0.88 $25.06 $25.06 $14.82 $25.06 $25.06 $25.06 $25.06 $19.13 $25.06 $25.06 $25.06 $12.53 $12.53 $19.85 $25.06 $20.05 $11.28 $0.84 $25.06 $14.79 $25.06 $25.06 $25.06 $0.84 $25.06 N/A N/A 11076 ERX HCPCS J3480 00338-0705-48 POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN BOTH IP/OP $22.00 $16.00 $0.24 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.24 $22.00 $1.56 $1.56 $1.62 $1.50 $1.76 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.68 $22.00 $12.76 $22.00 $22.00 $22.00 $1.68 $22.00 N/A N/A 11083 ERX HCPCS 63700001 00245-0071-11 POTASSIUM CITRATE ER 10 MEQ (1080 MG) PO TBCR BOTH IP/OP $12.00 $9.00 $2.48 $11.92 $11.92 $11.92 $11.92 $11.92 $11.92 $11.92 $11.92 $11.92 $11.92 $11.92 $11.92 $11.92 $11.92 $2.48 $11.92 $4.77 $11.92 $11.92 $11.92 $11.92 $11.92 $9.00 $11.92 $11.92 $11.92 $5.96 $5.96 $9.44 $11.92 $9.54 $7.75 $11.92 $11.92 $6.96 $11.92 $7.15 $11.92 $11.92 $11.92 N/A N/A 11087 ERX HCPCS 25000001 00486-1111-01 POTASSIUM PHOSPHATE MONOBASIC 500 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 11110 ERX HCPCS 63700001 00093-0771-98 PRAVASTATIN SODIUM 10 MG PO TABS BOTH IP/OP $14.00 $10.00 $2.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $13.89 $2.89 $13.89 $5.56 $13.89 $13.89 $13.89 $13.89 $13.89 $10.50 $13.89 $13.89 $13.89 $6.95 $6.95 $11.00 $13.89 $11.11 $9.03 $13.89 $13.89 $8.12 $13.89 $8.33 $13.89 $13.89 $13.89 N/A N/A 11111 ERX HCPCS 63700006 00904-5892-61 PRAVASTATIN SODIUM 20 MG PO TABS BOTH IP/OP $11.00 $8.00 $2.25 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $10.78 $2.25 $10.78 $4.31 $10.78 $10.78 $10.78 $10.78 $10.78 $8.25 $10.78 $10.78 $10.78 $5.39 $5.39 $8.54 $10.78 $8.62 $7.01 $10.78 $10.78 $6.38 $10.78 $6.47 $10.78 $10.78 $10.78 N/A N/A 11112 ERX HCPCS 63700001 00904-5893-61 PRAVASTATIN SODIUM 40 MG PO TABS BOTH IP/OP $19.00 $14.00 $3.87 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $3.87 $18.56 $7.42 $18.56 $18.56 $18.56 $18.56 $18.56 $14.25 $18.56 $18.56 $18.56 $9.28 $9.28 $14.70 $18.56 $14.85 $12.06 $18.56 $18.56 $11.02 $18.56 $11.14 $18.56 $18.56 $18.56 N/A N/A 11113 ERX HCPCS 63700001 50419-0747-01 PRAZIQUANTEL 600 MG PO TABS BOTH IP/OP $357.00 $264.00 $74.35 $356.74 $356.74 $356.74 $356.74 $356.74 $356.74 $356.74 $356.74 $356.74 $356.74 $356.74 $356.74 $356.74 $356.74 $74.35 $356.74 $142.70 $356.74 $356.74 $356.74 $356.74 $356.74 $267.75 $356.74 $356.74 $356.74 $178.37 $178.37 $282.54 $356.74 $285.39 $231.88 $356.74 $356.74 $207.06 $356.74 $214.04 $356.74 $356.74 $356.74 N/A N/A 11129 ERX HCPCS 63700001 68084-0202-01 PRIMIDONE 50 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 11138 ERX HCPCS 25000001 00574-7226-12 PROCHLORPERAZINE 25 MG RECTAL SUPP BOTH IP/OP $54.50 $40.00 $9.68 $54.36 $54.36 $54.36 $54.36 $54.36 $54.36 $54.36 $9.68 $54.36 $54.36 $40.35 $40.35 $41.90 $28.32 $11.33 $54.36 $21.74 $54.36 $54.36 $54.36 $54.36 $54.36 $40.88 $54.36 $54.36 $54.36 $27.18 $27.18 $43.05 $54.36 $43.49 $35.33 $54.36 $54.36 $31.61 $54.36 $32.62 $54.36 $54.36 $54.36 N/A N/A 11143 ERX HCPCS 25000001 00713-0536-12 PROMETHAZINE HCL 12.5 MG RECTAL SUPP BOTH IP/OP $76.50 $57.00 $13.62 $76.49 $76.49 $76.49 $76.49 $76.49 $76.49 $76.49 $13.62 $76.49 $76.49 $56.77 $56.77 $58.96 $39.85 $15.94 $76.49 $30.60 $76.49 $76.49 $76.49 $76.49 $76.49 $57.38 $76.49 $76.49 $76.49 $38.25 $38.25 $60.58 $76.49 $61.19 $49.72 $76.49 $76.49 $44.37 $76.49 $45.89 $76.49 $76.49 $76.49 N/A N/A 11144 ERX HCPCS 25000001 45802-0759-30 PROMETHAZINE HCL 25 MG RECTAL SUPP BOTH IP/OP $76.50 $57.00 $13.62 $76.49 $76.49 $76.49 $76.49 $76.49 $76.49 $76.49 $13.62 $76.49 $76.49 $56.77 $56.77 $58.96 $39.85 $15.94 $76.49 $30.60 $76.49 $76.49 $76.49 $76.49 $76.49 $57.38 $76.49 $76.49 $76.49 $38.25 $38.25 $60.58 $76.49 $61.19 $49.72 $76.49 $76.49 $44.37 $76.49 $45.89 $76.49 $76.49 $76.49 N/A N/A 11146 ERX HCPCS 63700006 00591-0582-01 PROPAFENONE HCL 150 MG PO TABS BOTH IP/OP $7.50 $6.00 $1.47 $7.07 $7.07 $7.07 $7.07 $7.07 $7.07 $7.07 $7.07 $7.07 $7.07 $7.07 $7.07 $7.07 $7.07 $1.47 $7.07 $2.83 $7.07 $7.07 $7.07 $7.07 $7.07 $5.63 $7.07 $7.07 $7.07 $3.54 $3.54 $5.60 $7.07 $5.66 $4.60 $7.07 $7.07 $4.35 $7.07 $4.24 $7.07 $7.07 $7.07 N/A N/A 11147 ERX HCPCS 63700001 59651-0257-01 PROPAFENONE HCL 225 MG PO TABS BOTH IP/OP $10.50 $8.00 $2.10 $10.07 $10.07 $10.07 $10.07 $10.07 $10.07 $10.07 $10.07 $10.07 $10.07 $10.07 $10.07 $10.07 $10.07 $2.10 $10.07 $4.03 $10.07 $10.07 $10.07 $10.07 $10.07 $7.88 $10.07 $10.07 $10.07 $5.04 $5.04 $7.98 $10.07 $8.06 $6.55 $10.07 $10.07 $6.09 $10.07 $6.04 $10.07 $10.07 $10.07 N/A N/A 11164 ERX HCPCS 63700001 00054-0210-25 PROTRIPTYLINE HCL 5 MG PO TABS BOTH IP/OP $25.00 $19.00 $5.16 $24.77 $24.77 $24.77 $24.77 $24.77 $24.77 $24.77 $24.77 $24.77 $24.77 $24.77 $24.77 $24.77 $24.77 $5.16 $24.77 $9.91 $24.77 $24.77 $24.77 $24.77 $24.77 $18.75 $24.77 $24.77 $24.77 $12.39 $12.39 $19.62 $24.77 $19.82 $16.10 $24.77 $24.77 $14.50 $24.77 $14.86 $24.77 $24.77 $24.77 N/A N/A 11217 ERX HCPCS 63700001 37000-0740-87 PSYLLIUM 28 % PO PACK BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 11239 ERX HCPCS 63700001 68682-0302-10 PYRIDOSTIGMINE BROMIDE 60 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 11240 ERX HCPCS 63700001 47781-0335-30 PYRIDOSTIGMINE BROMIDE ER 180 MG PO TBCR BOTH IP/OP $99.00 $73.00 $20.58 $98.74 $98.74 $98.74 $98.74 $98.74 $98.74 $98.74 $98.74 $98.74 $98.74 $98.74 $98.74 $98.74 $98.74 $20.58 $98.74 $39.50 $98.74 $98.74 $98.74 $98.74 $98.74 $74.25 $98.74 $98.74 $98.74 $49.37 $49.37 $78.20 $98.74 $78.99 $64.18 $98.74 $98.74 $57.42 $98.74 $59.24 $98.74 $98.74 $98.74 N/A N/A 11246 ERX HCPCS 63700001 69413-0330-30 PYRIMETHAMINE 25 MG PO TABS BOTH IP/OP "$4,194.00" "$3,104.00" $874.08 "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" $874.08 "$4,194.00" "$1,677.60" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$3,145.50" "$4,194.00" "$4,194.00" "$4,194.00" "$2,097.00" "$2,097.00" "$3,321.65" "$4,194.00" "$3,355.20" "$2,726.10" "$4,194.00" "$4,194.00" "$2,432.52" "$4,194.00" "$2,516.40" "$4,194.00" "$4,194.00" "$4,194.00" N/A N/A 11259 ERX HCPCS 63700001 68180-0591-01 RAMIPRIL 10 MG PO CAPS BOTH IP/OP $10.00 $7.00 $2.00 $9.58 $9.58 $9.58 $9.58 $9.58 $9.58 $9.58 $9.58 $9.58 $9.58 $9.58 $9.58 $9.58 $9.58 $2.00 $9.58 $3.83 $9.58 $9.58 $9.58 $9.58 $9.58 $7.50 $9.58 $9.58 $9.58 $4.79 $4.79 $7.59 $9.58 $7.66 $6.23 $9.58 $9.58 $5.80 $9.58 $5.75 $9.58 $9.58 $9.58 N/A N/A 11290 ERX HCPCS 63700001 00013-5301-17 RIFABUTIN 150 MG PO CAPS BOTH IP/OP $93.00 $69.00 $19.37 $92.92 $92.92 $92.92 $92.92 $92.92 $92.92 $92.92 $92.92 $92.92 $92.92 $92.92 $92.92 $92.92 $92.92 $19.37 $92.92 $37.17 $92.92 $92.92 $92.92 $92.92 $92.92 $69.75 $92.92 $92.92 $92.92 $46.46 $46.46 $73.59 $92.92 $74.34 $60.40 $92.92 $92.92 $53.94 $92.92 $55.75 $92.92 $92.92 $92.92 N/A N/A 11291 ERX HCPCS 25000001 00068-0599-01 RIFAMPIN 600 MG IV SOLR BOTH IP/OP $372.00 $275.00 $66.17 $371.76 $371.76 $371.76 $371.76 $371.76 $371.76 $371.76 $66.17 $371.76 $371.76 $275.92 $275.92 $286.55 $193.69 $77.48 $371.76 $148.70 $371.76 $371.76 $371.76 $371.76 $371.76 $279.00 $371.76 $371.76 $371.76 $185.88 $185.88 $294.43 $371.76 $297.41 $241.64 $371.76 $371.76 $215.76 $371.76 $223.06 $371.76 $371.76 $371.76 N/A N/A 11292 ERX HCPCS 63700001 68180-0658-06 RIFAMPIN 150 MG PO CAPS BOTH IP/OP $14.50 $11.00 $2.92 $14.01 $14.01 $14.01 $14.01 $14.01 $14.01 $14.01 $14.01 $14.01 $14.01 $14.01 $14.01 $14.01 $14.01 $2.92 $14.01 $5.60 $14.01 $14.01 $14.01 $14.01 $14.01 $10.88 $14.01 $14.01 $14.01 $7.01 $7.01 $11.10 $14.01 $11.21 $9.11 $14.01 $14.01 $8.41 $14.01 $8.41 $14.01 $14.01 $14.01 N/A N/A 11293 ERX HCPCS 63700006 63739-0415-10 RIFAMPIN 300 MG PO CAPS BOTH IP/OP $16.50 $12.00 $3.42 $16.43 $16.43 $16.43 $16.43 $16.43 $16.43 $16.43 $16.43 $16.43 $16.43 $16.43 $16.43 $16.43 $16.43 $3.42 $16.43 $6.57 $16.43 $16.43 $16.43 $16.43 $16.43 $12.38 $16.43 $16.43 $16.43 $8.22 $8.22 $13.01 $16.43 $13.14 $10.68 $16.43 $16.43 $9.57 $16.43 $9.86 $16.43 $16.43 $16.43 N/A N/A 11308 ERX HCPCS 25000001 11086-0030-10 SALICYLIC ACID 6 % EX GEL BOTH IP/OP $220.00 $163.00 $39.13 $219.82 $219.82 $219.82 $219.82 $219.82 $219.82 $219.82 $39.13 $219.82 $219.82 $163.15 $163.15 $169.44 $114.53 $45.81 $219.82 $87.93 $219.82 $219.82 $219.82 $219.82 $219.82 $165.00 $219.82 $219.82 $219.82 $109.91 $109.91 $174.10 $219.82 $175.86 $142.88 $219.82 $219.82 $127.60 $219.82 $131.89 $219.82 $219.82 $219.82 170.36 74.76 11323 ERX HCPCS 25000001 11017-0252-20 SALICYLIC ACID 17 % EX SOLN BOTH IP/OP $26.50 $20.00 $4.67 $26.21 $26.21 $26.21 $26.21 $26.21 $26.21 $26.21 $4.67 $26.21 $26.21 $19.45 $19.45 $20.20 $13.66 $5.46 $26.21 $10.48 $26.21 $26.21 $26.21 $26.21 $26.21 $19.88 $26.21 $26.21 $26.21 $13.11 $13.11 $20.76 $26.21 $20.97 $17.04 $26.21 $26.21 $15.37 $26.21 $15.73 $26.21 $26.21 $26.21 N/A N/A 11340 ERX HCPCS 63700001 60505-3438-03 SELEGILINE HCL 5 MG PO TABS BOTH IP/OP $9.50 $7.00 $1.89 $9.09 $9.09 $9.09 $9.09 $9.09 $9.09 $9.09 $9.09 $9.09 $9.09 $9.09 $9.09 $9.09 $9.09 $1.89 $9.09 $3.64 $9.09 $9.09 $9.09 $9.09 $9.09 $7.13 $9.09 $9.09 $9.09 $4.55 $4.55 $7.20 $9.09 $7.27 $5.91 $9.09 $9.09 $5.51 $9.09 $5.45 $9.09 $9.09 $9.09 N/A N/A 11351 ERX HCPCS 63700006 60687-0242-01 SERTRALINE HCL 50 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 11359 ERX HCPCS 25000001 12870-0001-02 SILVER NITRATE-POT NITRATE 75-25 % EX MISC BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 11364 ERX HCPCS 63700001 63739-0571-10 SIMVASTATIN 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 11367 ERX HCPCS 63700001 63739-0570-10 SIMVASTATIN 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 11394 ERX HCPCS 25000001 00121-1190-00 SOD CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN BOTH IP/OP $22.50 $17.00 $3.92 $22.04 $22.04 $22.04 $22.04 $22.04 $22.04 $22.04 $3.92 $22.04 $22.04 $16.36 $16.36 $16.99 $11.48 $4.59 $22.04 $8.82 $22.04 $22.04 $22.04 $22.04 $22.04 $16.88 $22.04 $22.04 $22.04 $11.02 $11.02 $17.46 $22.04 $17.63 $14.33 $22.04 $22.04 $13.05 $22.04 $13.22 $22.04 $22.04 $22.04 N/A N/A 11400 ERX HCPCS 25000001 00409-6609-25 SODIUM BICARBONATE 4 % IV SOLN BOTH IP/OP $40.00 $30.00 $7.04 $39.55 $39.55 $39.55 $39.55 $39.55 $39.55 $39.55 $7.04 $39.55 $39.55 $29.35 $29.35 $30.49 $20.61 $8.24 $39.55 $15.82 $39.55 $39.55 $39.55 $39.55 $39.55 $30.00 $39.55 $39.55 $39.55 $19.78 $19.78 $31.32 $39.55 $31.64 $25.71 $39.55 $39.55 $23.20 $39.55 $23.73 $39.55 $39.55 $39.55 184.4 88.54 11403 ERX HCPCS 25000001 00338-0048-04 SODIUM CHLORIDE 0.9 % IR SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 339.32 157.03 11403 ERX HCPCS 25000001 00338-0048-03 SODIUM CHLORIDE 0.9 % IR SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 339.32 157.03 11403 ERX HCPCS 25000001 00990-6138-22 SODIUM CHLORIDE 0.9 % IR SOLN BOTH IP/OP $27.00 $20.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $20.25 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $15.66 $22.00 $13.20 $22.00 $22.00 $22.00 339.32 157.03 11420 ERX HCPCS 63700001 00093-1063-01 SOTALOL HCL 240 MG PO TABS BOTH IP/OP $22.00 $16.00 $4.58 $21.99 $21.99 $21.99 $21.99 $21.99 $21.99 $21.99 $21.99 $21.99 $21.99 $21.99 $21.99 $21.99 $21.99 $4.58 $21.99 $8.80 $21.99 $21.99 $21.99 $21.99 $21.99 $16.50 $21.99 $21.99 $21.99 $11.00 $11.00 $17.42 $21.99 $17.59 $14.29 $21.99 $21.99 $12.76 $21.99 $13.19 $21.99 $21.99 $21.99 750.54 348.52 11421 ERX HCPCS 63700001 68084-0654-01 SOTALOL HCL 80 MG PO TABS BOTH IP/OP $10.50 $8.00 $2.09 $10.03 $10.03 $10.03 $10.03 $10.03 $10.03 $10.03 $10.03 $10.03 $10.03 $10.03 $10.03 $10.03 $10.03 $2.09 $10.03 $4.01 $10.03 $10.03 $10.03 $10.03 $10.03 $7.88 $10.03 $10.03 $10.03 $5.02 $5.02 $7.94 $10.03 $8.02 $6.52 $10.03 $10.03 $6.09 $10.03 $6.02 $10.03 $10.03 $10.03 252.63 115.57 11436 ERX HCPCS J9320 00703-4636-01 STREPTOZOCIN 1 G IV SOLR BOTH IP/OP "$1,266.00" $937.00 $263.77 "$1,265.63" "$1,265.63" "$1,265.63" "$1,265.63" "$1,265.63" "$1,265.63" "$1,265.63" $348.51 "$1,265.63" "$1,265.63" $361.80 $361.80 $375.71 $347.88 $263.77 "$1,265.63" $506.25 "$1,265.63" "$1,265.63" "$1,265.63" "$1,265.63" "$1,265.63" $949.50 "$1,265.63" "$1,265.63" "$1,265.63" $632.82 $632.82 "$1,002.38" "$1,265.63" "$1,012.50" $569.53 "$1,265.63" "$1,265.63" $734.28 "$1,265.63" $759.38 "$1,265.63" "$1,265.63" "$1,265.63" N/A N/A 11438 ERX HCPCS 63700001 55292-0201-11 SUCCIMER 100 MG PO CAPS BOTH IP/OP $115.00 $85.00 $23.93 $114.82 $114.82 $114.82 $114.82 $114.82 $114.82 $114.82 $114.82 $114.82 $114.82 $114.82 $114.82 $114.82 $114.82 $23.93 $114.82 $45.93 $114.82 $114.82 $114.82 $114.82 $114.82 $86.25 $114.82 $114.82 $114.82 $57.41 $57.41 $90.94 $114.82 $91.86 $74.63 $114.82 $114.82 $66.70 $114.82 $68.89 $114.82 $114.82 $114.82 N/A N/A 11441 ERX HCPCS 63700001 58914-0170-14 SUCRALFATE 1 GM/10ML PO SUSP BOTH IP/OP $61.00 $45.00 $12.62 $60.53 $60.53 $60.53 $60.53 $60.53 $60.53 $60.53 $60.53 $60.53 $60.53 $60.53 $60.53 $60.53 $60.53 $12.62 $60.53 $24.21 $60.53 $60.53 $60.53 $60.53 $60.53 $45.75 $60.53 $60.53 $60.53 $30.27 $30.27 $47.94 $60.53 $48.42 $39.34 $60.53 $60.53 $35.38 $60.53 $36.32 $60.53 $60.53 $60.53 302.66 140.49 11442 ERX HCPCS 63700001 00093-2210-05 SUCRALFATE 1 G PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 334.7 154.89 11498 ERX HCPCS 25000001 59651-0300-30 TAMOXIFEN CITRATE 20 MG PO TABS BOTH IP/OP $57.00 $42.00 $10.15 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $57.00 $10.15 $57.00 $57.00 $42.31 $42.31 $43.94 $29.70 $11.88 $57.00 $22.80 $57.00 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $37.05 $57.00 $57.00 $33.06 $57.00 $34.20 $57.00 $57.00 $57.00 N/A N/A 11507 ERX HCPCS J3105 00143-9746-01 TERBUTALINE SULFATE 1 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $1.80 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $2.94 $22.00 $1.87 $1.87 $1.94 $1.80 $2.11 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $2.01 $22.00 $12.76 $22.00 $22.00 $22.00 $2.01 $22.00 N/A N/A 11508 ERX HCPCS 63700001 10135-0579-01 TERBUTALINE SULFATE 2.5 MG PO TABS BOTH IP/OP $59.50 $44.00 $12.36 $59.31 $59.31 $59.31 $59.31 $59.31 $59.31 $59.31 $59.31 $59.31 $59.31 $59.31 $59.31 $59.31 $59.31 $12.36 $59.31 $23.72 $59.31 $59.31 $59.31 $59.31 $59.31 $44.63 $59.31 $59.31 $59.31 $29.66 $29.66 $46.97 $59.31 $47.45 $38.55 $59.31 $59.31 $34.51 $59.31 $35.59 $59.31 $59.31 $59.31 N/A N/A 11509 ERX HCPCS 63700001 10135-0580-01 TERBUTALINE SULFATE 5 MG PO TABS BOTH IP/OP $72.50 $54.00 $15.10 $72.43 $72.43 $72.43 $72.43 $72.43 $72.43 $72.43 $72.43 $72.43 $72.43 $72.43 $72.43 $72.43 $72.43 $15.10 $72.43 $28.97 $72.43 $72.43 $72.43 $72.43 $72.43 $54.38 $72.43 $72.43 $72.43 $36.22 $36.22 $57.36 $72.43 $57.94 $47.08 $72.43 $72.43 $42.05 $72.43 $43.46 $72.43 $72.43 $72.43 N/A N/A 11510 ERX HCPCS 63700001 51672-1304-06 TERCONAZOLE 0.4 % VA CREA BOTH IP/OP $177.50 $131.00 $36.95 $177.31 $177.31 $177.31 $177.31 $177.31 $177.31 $177.31 $177.31 $177.31 $177.31 $177.31 $177.31 $177.31 $177.31 $36.95 $177.31 $70.92 $177.31 $177.31 $177.31 $177.31 $177.31 $133.13 $177.31 $177.31 $177.31 $88.66 $88.66 $140.43 $177.31 $141.85 $115.25 $177.31 $177.31 $102.95 $177.31 $106.39 $177.31 $177.31 $177.31 N/A N/A 11511 ERX HCPCS 63700001 51672-1302-00 TERCONAZOLE 0.8 % VA CREA BOTH IP/OP $163.00 $121.00 $33.96 $162.95 $162.95 $162.95 $162.95 $162.95 $162.95 $162.95 $162.95 $162.95 $162.95 $162.95 $162.95 $162.95 $162.95 $33.96 $162.95 $65.18 $162.95 $162.95 $162.95 $162.95 $162.95 $122.25 $162.95 $162.95 $162.95 $81.48 $81.48 $129.06 $162.95 $130.36 $105.92 $162.95 $162.95 $94.54 $162.95 $97.77 $162.95 $162.95 $162.95 N/A N/A 11512 ERX HCPCS 63700001 45802-0717-08 TERCONAZOLE 80 MG VA SUPP BOTH IP/OP $130.00 $96.00 $27.06 $129.86 $129.86 $129.86 $129.86 $129.86 $129.86 $129.86 $129.86 $129.86 $129.86 $129.86 $129.86 $129.86 $129.86 $27.06 $129.86 $51.94 $129.86 $129.86 $129.86 $129.86 $129.86 $97.50 $129.86 $129.86 $129.86 $64.93 $64.93 $102.85 $129.86 $103.89 $84.41 $129.86 $129.86 $75.40 $129.86 $77.92 $129.86 $129.86 $129.86 N/A N/A 11538 ERX HCPCS 25000001 77333-0934-25 THIAMINE MONONITRATE 100 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 11562 ERX HCPCS 25000001 61314-0227-05 TIMOLOL MALEATE 0.5 % OP SOLN BOTH IP/OP $73.50 $54.00 $13.07 $73.44 $73.44 $73.44 $73.44 $73.44 $73.44 $73.44 $13.07 $73.44 $73.44 $54.51 $54.51 $56.61 $38.26 $15.31 $73.44 $29.38 $73.44 $73.44 $73.44 $73.44 $73.44 $55.13 $73.44 $73.44 $73.44 $36.72 $36.72 $58.16 $73.44 $58.75 $47.74 $73.44 $73.44 $42.63 $73.44 $44.06 $73.44 $73.44 $73.44 N/A N/A 11565 ERX HCPCS J3260 39822-0412-01 TOBRAMYCIN SULFATE 1.2 G IJ SOLR BOTH IP/OP $358.00 $265.00 $38.42 $358.00 $161.10 $161.10 $161.10 $161.10 $358.00 $358.00 $358.00 $38.42 $358.00 $64.27 $64.27 $66.74 $61.80 $72.61 $358.00 $358.00 $211.76 $358.00 $358.00 $358.00 $358.00 $268.50 $358.00 $358.00 $358.00 $179.00 $179.00 $283.54 $358.00 $286.40 $161.10 $69.14 $358.00 $207.64 $358.00 $214.80 $358.00 $69.14 $358.00 N/A N/A 11576 ERX HCPCS 25000001 00187-5160-20 TRETINOIN 0.025 % EX CREA BOTH IP/OP $78.00 $58.00 $13.84 $77.76 $77.76 $77.76 $77.76 $77.76 $77.76 $77.76 $13.84 $77.76 $77.76 $57.71 $57.71 $59.94 $40.51 $16.21 $77.76 $31.10 $77.76 $77.76 $77.76 $77.76 $77.76 $58.50 $77.76 $77.76 $77.76 $38.88 $38.88 $61.59 $77.76 $62.21 $50.54 $77.76 $77.76 $45.24 $77.76 $46.66 $77.76 $77.76 $77.76 N/A N/A 11577 ERX HCPCS 25000001 00187-5162-20 TRETINOIN 0.05 % EX CREA BOTH IP/OP $78.00 $58.00 $13.84 $77.76 $77.76 $77.76 $77.76 $77.76 $77.76 $77.76 $13.84 $77.76 $77.76 $57.71 $57.71 $59.94 $40.51 $16.21 $77.76 $31.10 $77.76 $77.76 $77.76 $77.76 $77.76 $58.50 $77.76 $77.76 $77.76 $38.88 $38.88 $61.59 $77.76 $62.21 $50.54 $77.76 $77.76 $45.24 $77.76 $46.66 $77.76 $77.76 $77.76 N/A N/A 11578 ERX HCPCS 25000001 00187-5164-20 TRETINOIN 0.1 % EX CREA BOTH IP/OP $96.00 $71.00 $17.00 $95.52 $95.52 $95.52 $95.52 $95.52 $95.52 $95.52 $17.00 $95.52 $95.52 $70.89 $70.89 $73.63 $49.77 $19.91 $95.52 $38.21 $95.52 $95.52 $95.52 $95.52 $95.52 $72.00 $95.52 $95.52 $95.52 $47.76 $47.76 $75.65 $95.52 $76.42 $62.09 $95.52 $95.52 $55.68 $95.52 $57.31 $95.52 $95.52 $95.52 N/A N/A 11584 ERX HCPCS J3301 00003-0494-20 TRIAMCINOLONE ACETONIDE 10 MG/ML IJ SUSP BOTH IP/OP $22.00 $16.00 $1.11 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.77 $22.00 $1.15 $1.15 $1.20 $1.11 $1.30 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.24 $22.00 $12.76 $22.00 $22.00 $22.00 $1.24 $22.00 N/A N/A 11595 ERX HCPCS 25000001 61314-0044-75 TRIFLURIDINE 1 % OP SOLN BOTH IP/OP $673.50 $498.00 $119.84 $673.28 $673.28 $673.28 $673.28 $673.28 $673.28 $673.28 $119.84 $673.28 $673.28 $499.71 $499.71 $518.96 $350.78 $140.32 $673.28 $269.31 $673.28 $673.28 $673.28 $673.28 $673.28 $505.13 $673.28 $673.28 $673.28 $336.64 $336.64 $533.24 $673.28 $538.62 $437.63 $673.28 $673.28 $390.63 $673.28 $403.97 $673.28 $673.28 $673.28 N/A N/A 11596 ERX HCPCS 25000001 24208-0315-10 POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN BOTH IP/OP $58.50 $43.00 $10.34 $58.07 $58.07 $58.07 $58.07 $58.07 $58.07 $58.07 $10.34 $58.07 $58.07 $43.10 $43.10 $44.76 $30.25 $12.10 $58.07 $23.23 $58.07 $58.07 $58.07 $58.07 $58.07 $43.88 $58.07 $58.07 $58.07 $29.04 $29.04 $45.99 $58.07 $46.46 $37.75 $58.07 $58.07 $33.93 $58.07 $34.84 $58.07 $58.07 $58.07 N/A N/A 11628 ERX HCPCS 63700001 47781-0729-02 VANCOMYCIN HCL 125 MG PO CAPS BOTH IP/OP $125.00 $93.00 $25.97 $124.60 $124.60 $124.60 $124.60 $124.60 $124.60 $124.60 $124.60 $124.60 $124.60 $124.60 $124.60 $124.60 $124.60 $25.97 $124.60 $49.84 $124.60 $124.60 $124.60 $124.60 $124.60 $93.75 $124.60 $124.60 $124.60 $62.30 $62.30 $98.68 $124.60 $99.68 $80.99 $124.60 $124.60 $72.50 $124.60 $74.76 $124.60 $124.60 $124.60 N/A N/A 11634 ERX HCPCS 25000001 00409-1632-01 VECURONIUM BROMIDE 10 MG IV SOLR BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 11691 ERX HCPCS J3485 49702-0213-26 ZIDOVUDINE 10 MG/ML IV SOLN BOTH IP/OP $139.50 $103.00 $29.05 $139.38 $139.38 $139.38 $139.38 $139.38 $139.38 $139.38 $30.20 $139.38 $139.38 $31.41 $31.41 $32.62 $30.20 $29.05 $139.38 $55.75 $139.38 $139.38 $139.38 $139.38 $139.38 $104.63 $139.38 $139.38 $139.38 $69.69 $69.69 $110.39 $139.38 $111.50 $62.72 $139.38 $139.38 $80.91 $139.38 $83.63 $139.38 $139.38 $139.38 N/A N/A 11692 ERX HCPCS 63700001 65862-0107-01 ZIDOVUDINE 100 MG PO CAPS BOTH IP/OP $9.00 $7.00 $1.82 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $1.82 $8.73 $3.49 $8.73 $8.73 $8.73 $8.73 $8.73 $6.75 $8.73 $8.73 $8.73 $4.37 $4.37 $6.91 $8.73 $6.98 $5.67 $8.73 $8.73 $5.22 $8.73 $5.24 $8.73 $8.73 $8.73 N/A N/A 11700 ERX HCPCS 63700001 63739-0526-10 ZOLPIDEM TARTRATE 10 MG PO TABS BOTH IP/OP $20.50 $15.00 $4.18 $20.07 $20.07 $20.07 $20.07 $20.07 $20.07 $20.07 $20.07 $20.07 $20.07 $20.07 $20.07 $20.07 $20.07 $4.18 $20.07 $8.03 $20.07 $20.07 $20.07 $20.07 $20.07 $15.38 $20.07 $20.07 $20.07 $10.04 $10.04 $15.90 $20.07 $16.06 $13.05 $20.07 $20.07 $11.89 $20.07 $12.04 $20.07 $20.07 $20.07 N/A N/A 11931 ERX HCPCS 90648 49281-0545-03 HAEMOPHILUS B POLYSAC CONJ VAC IM SOLR BOTH IP/OP $90.00 $67.00 $11.57 $89.86 $40.44 $40.44 $40.44 $40.44 $89.86 $89.86 $89.86 $18.73 $89.86 $12.03 $12.03 $12.50 $11.57 $18.73 $89.86 $89.86 $53.15 $89.86 $89.86 $89.86 $89.86 $67.50 $89.86 $89.86 $89.86 $44.93 $44.93 $71.17 $89.86 $71.89 $40.44 $17.83 $89.86 $52.20 $89.86 $89.86 $89.86 $18.73 $89.86 N/A N/A 11934 ERX HCPCS 25000001 00168-0357-56 LIDOCAINE-PRILOCAINE 2.5-2.5 % EX KIT BOTH IP/OP $197.50 $146.00 $35.12 $197.33 $197.33 $197.33 $197.33 $197.33 $197.33 $197.33 $35.12 $197.33 $197.33 $146.46 $146.46 $152.10 $102.81 $41.13 $197.33 $78.93 $197.33 $197.33 $197.33 $197.33 $197.33 $148.13 $197.33 $197.33 $197.33 $98.67 $98.67 $156.29 $197.33 $157.86 $128.26 $197.33 $197.33 $114.55 $197.33 $118.40 $197.33 $197.33 $197.33 N/A N/A 12098 ERX HCPCS 63700001 62332-0025-31 THEOPHYLLINE ER 300 MG PO TB12 BOTH IP/OP $19.00 $14.00 $3.87 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $3.87 $18.56 $7.42 $18.56 $18.56 $18.56 $18.56 $18.56 $14.25 $18.56 $18.56 $18.56 $9.28 $9.28 $14.70 $18.56 $14.85 $12.06 $18.56 $18.56 $11.02 $18.56 $11.14 $18.56 $18.56 $18.56 N/A N/A 12207 ERX HCPCS 63700001 68084-0844-01 VENLAFAXINE HCL 37.5 MG PO TABS BOTH IP/OP $9.00 $7.00 $1.80 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $8.64 $1.80 $8.64 $3.46 $8.64 $8.64 $8.64 $8.64 $8.64 $6.75 $8.64 $8.64 $8.64 $4.32 $4.32 $6.84 $8.64 $6.91 $5.62 $8.64 $8.64 $5.22 $8.64 $5.18 $8.64 $8.64 $8.64 N/A N/A 12211 ERX HCPCS J7639 50242-0100-39 DORNASE ALFA 2.5 MG/2.5ML IN SOLN BOTH IP/OP $525.50 $389.00 $95.60 $525.09 $525.09 $525.09 $525.09 $525.09 $525.09 $525.09 $95.60 $525.09 $525.09 $99.42 $99.42 $103.25 $95.60 $109.43 $525.09 $210.04 $525.09 $525.09 $525.09 $525.09 $525.09 $394.13 $525.09 $525.09 $525.09 $262.55 $262.55 $415.87 $525.09 $420.07 $236.29 $525.09 $525.09 $304.79 $525.09 $315.05 $525.09 $525.09 $525.09 N/A N/A 12244 ERX HCPCS 63700001 51672-5278-03 CALCIPOTRIENE 0.005 % EX OINT BOTH IP/OP "$1,157.00" $856.00 $241.05 "$1,156.60" "$1,156.60" "$1,156.60" "$1,156.60" "$1,156.60" "$1,156.60" "$1,156.60" "$1,156.60" "$1,156.60" "$1,156.60" "$1,156.60" "$1,156.60" "$1,156.60" "$1,156.60" $241.05 "$1,156.60" $462.64 "$1,156.60" "$1,156.60" "$1,156.60" "$1,156.60" "$1,156.60" $867.75 "$1,156.60" "$1,156.60" "$1,156.60" $578.30 $578.30 $916.03 "$1,156.60" $925.28 $751.79 "$1,156.60" "$1,156.60" $671.06 "$1,156.60" $693.96 "$1,156.60" "$1,156.60" "$1,156.60" N/A N/A 12370 ERX HCPCS 25000001 00143-9593-10 NICARDIPINE HCL 2.5 MG/ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 12411 ERX HCPCS 63700001 00378-8020-93 FLUVASTATIN SODIUM 20 MG PO CAPS BOTH IP/OP $22.00 $16.00 $4.51 $21.63 $21.63 $21.63 $21.63 $21.63 $21.63 $21.63 $21.63 $21.63 $21.63 $21.63 $21.63 $21.63 $21.63 $4.51 $21.63 $8.65 $21.63 $21.63 $21.63 $21.63 $21.63 $16.50 $21.63 $21.63 $21.63 $10.82 $10.82 $17.13 $21.63 $17.30 $14.06 $21.63 $21.63 $12.76 $21.63 $12.98 $21.63 $21.63 $21.63 N/A N/A 12412 ERX HCPCS 63700001 00093-7443-01 FLUVASTATIN SODIUM 40 MG PO CAPS BOTH IP/OP $22.00 $16.00 $4.50 $21.59 $21.59 $21.59 $21.59 $21.59 $21.59 $21.59 $21.59 $21.59 $21.59 $21.59 $21.59 $21.59 $21.59 $4.50 $21.59 $8.64 $21.59 $21.59 $21.59 $21.59 $21.59 $16.50 $21.59 $21.59 $21.59 $10.80 $10.80 $17.10 $21.59 $17.27 $14.03 $21.59 $21.59 $12.76 $21.59 $12.95 $21.59 $21.59 $21.59 N/A N/A 12556 ERX HCPCS Q0163 70677-0144-02 DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD BOTH IP/OP $15.50 $11.00 $0.22 $15.30 $6.89 $6.89 $6.89 $6.89 $15.30 $15.30 $15.30 $3.19 $15.30 $0.23 $0.23 $0.24 $0.22 $3.19 $15.30 $15.30 $9.05 $15.30 $15.30 $15.30 $15.30 $11.63 $15.30 $15.30 $15.30 $7.65 $7.65 $12.12 $15.30 $12.24 $6.89 $3.04 $15.30 $8.99 $15.30 $15.30 $15.30 $3.19 $15.30 N/A N/A 12580 ERX HCPCS 25000001 00487-9801-01 IPRATROPIUM BROMIDE 0.02 % IN SOLN BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 12587 ERX HCPCS J2543 63323-0304-74 PIPERACILLIN SOD-TAZOBACTAM SO 40.5 (36-4.5) G IV SOLR BOTH IP/OP $611.50 $453.00 $57.19 $611.14 $331.85 $331.85 $331.85 $331.85 $611.14 $611.14 $611.14 $127.38 $611.14 $453.59 $453.59 $471.07 $318.40 $127.37 $611.14 $611.14 $361.49 $611.14 $611.14 $611.14 $611.14 $458.63 $611.14 $611.14 $611.14 $305.57 $305.57 $484.02 $611.14 $488.91 $397.24 $121.30 $611.14 $354.67 $611.14 $611.14 $611.14 $57.19 $611.14 N/A N/A 12729 ERX HCPCS 63700001 00781-2074-10 TRIAMTERENE-HCTZ 37.5-25 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 12803 ERX HCPCS 63700001 00527-1313-01 PILOCARPINE HCL 5 MG PO TABS BOTH IP/OP $8.00 $6.00 $1.63 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $7.84 $1.63 $7.84 $3.14 $7.84 $7.84 $7.84 $7.84 $7.84 $6.00 $7.84 $7.84 $7.84 $3.92 $3.92 $6.21 $7.84 $6.27 $5.10 $7.84 $7.84 $4.64 $7.84 $4.70 $7.84 $7.84 $7.84 N/A N/A 12886 ERX HCPCS 63700001 00781-6023-46 CLARITHROMYCIN 250 MG/5ML PO SUSR BOTH IP/OP $689.00 $510.00 $143.55 $688.80 $688.80 $688.80 $688.80 $688.80 $688.80 $688.80 $688.80 $688.80 $688.80 $688.80 $688.80 $688.80 $688.80 $143.55 $688.80 $275.52 $688.80 $688.80 $688.80 $688.80 $688.80 $516.75 $688.80 $688.80 $688.80 $344.40 $344.40 $545.53 $688.80 $551.04 $447.72 $688.80 $688.80 $399.62 $688.80 $413.28 $688.80 $688.80 $688.80 N/A N/A 12933 ERX HCPCS J7507 00781-2103-01 TACROLIMUS 1 MG PO CAPS BOTH IP/OP $19.50 $14.00 $0.55 $19.27 $19.27 $19.27 $19.27 $19.27 $19.27 $19.27 $0.55 $19.27 $19.27 $19.27 $19.27 $19.27 $19.27 $4.02 $19.27 $7.71 $19.27 $19.27 $19.27 $19.27 $19.27 $14.63 $19.27 $19.27 $19.27 $9.64 $9.64 $15.26 $19.27 $15.42 $12.53 $19.27 $19.27 $11.31 $19.27 $11.56 $19.27 $19.27 $19.27 N/A N/A 12935 ERX HCPCS J7525 00469-3016-01 TACROLIMUS 5 MG/ML IV SOLN BOTH IP/OP $871.50 $645.00 $181.56 $871.18 $871.18 $871.18 $871.18 $871.18 $871.18 $871.18 $219.33 $871.18 $871.18 $228.46 $228.46 $237.24 $219.67 $181.56 $871.18 $348.47 $871.18 $871.18 $871.18 $871.18 $871.18 $653.63 $871.18 $871.18 $871.18 $435.59 $435.59 $689.97 $871.18 $696.94 $392.03 $871.18 $871.18 $505.47 $871.18 $522.71 $871.18 $871.18 $871.18 N/A N/A 13132 ERX HCPCS 63700001 57237-0043-30 VALACYCLOVIR HCL 1 G PO TABS BOTH IP/OP $55.00 $41.00 $11.38 $54.62 $54.62 $54.62 $54.62 $54.62 $54.62 $54.62 $54.62 $54.62 $54.62 $54.62 $54.62 $54.62 $54.62 $11.38 $54.62 $21.85 $54.62 $54.62 $54.62 $54.62 $54.62 $41.25 $54.62 $54.62 $54.62 $27.31 $27.31 $43.26 $54.62 $43.70 $35.50 $54.62 $54.62 $31.90 $54.62 $32.77 $54.62 $54.62 $54.62 729.62 318.78 13133 ERX HCPCS 63700001 57237-0042-90 VALACYCLOVIR HCL 500 MG PO TABS BOTH IP/OP $31.50 $23.00 $6.50 $31.21 $31.21 $31.21 $31.21 $31.21 $31.21 $31.21 $31.21 $31.21 $31.21 $31.21 $31.21 $31.21 $31.21 $6.50 $31.21 $12.48 $31.21 $31.21 $31.21 $31.21 $31.21 $23.63 $31.21 $31.21 $31.21 $15.61 $15.61 $24.72 $31.21 $24.97 $20.29 $31.21 $31.21 $18.27 $31.21 $18.73 $31.21 $31.21 $31.21 304.26 131.67 13369 ERX HCPCS 63700001 SUMATRIPTAN SUCCINATE 100 MG PO TABS BOTH IP/OP $100.50 $74.00 $20.85 $100.06 $100.06 $100.06 $100.06 $100.06 $100.06 $100.06 $100.06 $100.06 $100.06 $100.06 $100.06 $100.06 $100.06 $20.85 $100.06 $40.02 $100.06 $100.06 $100.06 $100.06 $100.06 $75.38 $100.06 $100.06 $100.06 $50.03 $50.03 $79.25 $100.06 $80.05 $65.04 $100.06 $100.06 $58.29 $100.06 $60.04 $100.06 $100.06 $100.06 N/A N/A 13444 ERX HCPCS 63700001 00093-1024-06 NEFAZODONE HCL 100 MG PO TABS BOTH IP/OP $21.00 $16.00 $4.32 $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $20.74 $4.32 $20.74 $8.30 $20.74 $20.74 $20.74 $20.74 $20.74 $15.75 $20.74 $20.74 $20.74 $10.37 $10.37 $16.43 $20.74 $16.59 $13.48 $20.74 $20.74 $12.18 $20.74 $12.44 $20.74 $20.74 $20.74 N/A N/A 13445 ERX HCPCS 63700001 00093-7113-06 NEFAZODONE HCL 150 MG PO TABS BOTH IP/OP $21.50 $16.00 $4.40 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $21.13 $4.40 $21.13 $8.45 $21.13 $21.13 $21.13 $21.13 $21.13 $16.13 $21.13 $21.13 $21.13 $10.57 $10.57 $16.73 $21.13 $16.90 $13.73 $21.13 $21.13 $12.47 $21.13 $12.68 $21.13 $21.13 $21.13 N/A N/A 13577 ERX HCPCS 63700001 16714-0692-11 FLUCONAZOLE 150 MG PO TABS BOTH IP/OP $59.00 $44.00 $12.24 $58.73 $58.73 $58.73 $58.73 $58.73 $58.73 $58.73 $58.73 $58.73 $58.73 $58.73 $58.73 $58.73 $58.73 $12.24 $58.73 $23.49 $58.73 $58.73 $58.73 $58.73 $58.73 $44.25 $58.73 $58.73 $58.73 $29.37 $29.37 $46.51 $58.73 $46.98 $38.17 $58.73 $58.73 $34.22 $58.73 $35.24 $58.73 $58.73 $58.73 N/A N/A 13654 ERX HCPCS 25000001 63739-0523-01 ASPIRIN EC 325 MG PO TBEC BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 13691 ERX HCPCS J1950 00074-3641-03 LEUPROLIDE ACETATE 3.75 MG IM KIT BOTH IP/OP "$4,568.00" "$3,380.00" $549.12 "$4,567.71" "$2,055.47" "$2,055.47" "$2,055.47" "$2,055.47" "$1,366.01" "$1,366.01" "$1,366.01" $549.12 "$1,366.01" "$1,420.65" "$1,420.65" "$1,475.29" "$1,366.01" "$1,604.84" "$1,366.01" "$1,480.89" "$2,251.88" "$1,366.01" "$4,567.71" "$1,366.01" "$1,434.31" "$3,426.00" "$1,366.01" "$1,366.01" "$1,366.01" "$2,283.86" "$2,283.86" "$3,617.63" "$1,366.01" "$3,654.17" "$2,055.47" "$1,528.29" "$1,366.01" "$2,649.44" "$1,434.31" "$1,980.71" "$1,366.01" "$1,528.29" "$1,366.01" N/A N/A 13884 ERX HCPCS 63700001 59762-0450-01 COLESTIPOL HCL 1 G PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 13980 ERX HCPCS 63700001 42291-0086-30 ACITRETIN 10 MG PO CAPS BOTH IP/OP $124.50 $92.00 $25.88 $124.19 $124.19 $124.19 $124.19 $124.19 $124.19 $124.19 $124.19 $124.19 $124.19 $124.19 $124.19 $124.19 $124.19 $25.88 $124.19 $49.68 $124.19 $124.19 $124.19 $124.19 $124.19 $93.38 $124.19 $124.19 $124.19 $62.10 $62.10 $98.36 $124.19 $99.35 $80.72 $124.19 $124.19 $72.21 $124.19 $74.51 $124.19 $124.19 $124.19 N/A N/A 13982 ERX HCPCS 63700001 13668-0047-01 LAMOTRIGINE 100 MG PO TABS BOTH IP/OP $21.00 $16.00 $4.28 $20.52 $20.52 $20.52 $20.52 $20.52 $20.52 $20.52 $20.52 $20.52 $20.52 $20.52 $20.52 $20.52 $20.52 $4.28 $20.52 $8.21 $20.52 $20.52 $20.52 $20.52 $20.52 $15.75 $20.52 $20.52 $20.52 $10.26 $10.26 $16.25 $20.52 $16.42 $13.34 $20.52 $20.52 $12.18 $20.52 $12.31 $20.52 $20.52 $20.52 N/A N/A 13983 ERX HCPCS 63700001 51672-4133-04 LAMOTRIGINE 200 MG PO TABS BOTH IP/OP $27.00 $20.00 $5.52 $26.51 $26.51 $26.51 $26.51 $26.51 $26.51 $26.51 $26.51 $26.51 $26.51 $26.51 $26.51 $26.51 $26.51 $5.52 $26.51 $10.60 $26.51 $26.51 $26.51 $26.51 $26.51 $20.25 $26.51 $26.51 $26.51 $13.26 $13.26 $21.00 $26.51 $21.21 $17.23 $26.51 $26.51 $15.66 $26.51 $15.91 $26.51 $26.51 $26.51 N/A N/A 14087 ERX HCPCS 25000001 65162-0033-10 ACETAMINOPHEN-CODEINE #3 300-30 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 14132 ERX HCPCS 63700001 45802-0465-64 KETOCONAZOLE 2 % EX SHAM BOTH IP/OP $120.50 $89.00 $25.08 $120.36 $120.36 $120.36 $120.36 $120.36 $120.36 $120.36 $120.36 $120.36 $120.36 $120.36 $120.36 $120.36 $120.36 $25.08 $120.36 $48.14 $120.36 $120.36 $120.36 $120.36 $120.36 $90.38 $120.36 $120.36 $120.36 $60.18 $60.18 $95.33 $120.36 $96.29 $78.23 $120.36 $120.36 $69.89 $120.36 $72.22 $120.36 $120.36 $120.36 N/A N/A 14196 ERX HCPCS 63700001 00046-1107-11 CONJ ESTROG-MEDROXYPROGEST ACE 0.625-2.5 MG PO TABS BOTH IP/OP $43.50 $32.00 $9.06 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $9.06 $43.47 $17.39 $43.47 $43.47 $43.47 $43.47 $43.47 $32.63 $43.47 $43.47 $43.47 $21.74 $21.74 $34.43 $43.47 $34.78 $28.26 $43.47 $43.47 $25.23 $43.47 $26.08 $43.47 $43.47 $43.47 N/A N/A 14232 ERX HCPCS 63700001 59762-5029-01 FLUCONAZOLE 10 MG/ML PO SUSR BOTH IP/OP $137.50 $102.00 $28.65 $137.49 $137.49 $137.49 $137.49 $137.49 $137.49 $137.49 $137.49 $137.49 $137.49 $137.49 $137.49 $137.49 $137.49 $28.65 $137.49 $55.00 $137.49 $137.49 $137.49 $137.49 $137.49 $103.13 $137.49 $137.49 $137.49 $68.75 $68.75 $108.89 $137.49 $109.99 $89.37 $137.49 $137.49 $79.75 $137.49 $82.49 $137.49 $137.49 $137.49 N/A N/A 14233 ERX HCPCS 63700001 00049-3450-19 FLUCONAZOLE 40 MG/ML PO SUSR BOTH IP/OP $134.50 $100.00 $27.99 $134.29 $134.29 $134.29 $134.29 $134.29 $134.29 $134.29 $134.29 $134.29 $134.29 $134.29 $134.29 $134.29 $134.29 $27.99 $134.29 $53.72 $134.29 $134.29 $134.29 $134.29 $134.29 $100.88 $134.29 $134.29 $134.29 $67.15 $67.15 $106.36 $134.29 $107.43 $87.29 $134.29 $134.29 $78.01 $134.29 $80.57 $134.29 $134.29 $134.29 N/A N/A 14468 ERX HCPCS 25000001 99999-6007-11 ACETAMINOPHEN-CODEINE 120-12 MG/5ML PO SOLN BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 14553 ERX HCPCS 63700001 59746-0385-06 TERAZOSIN HCL 5 MG PO CAPS BOTH IP/OP $7.00 $5.00 $1.45 $6.94 $6.94 $6.94 $6.94 $6.94 $6.94 $6.94 $6.94 $6.94 $6.94 $6.94 $6.94 $6.94 $6.94 $1.45 $6.94 $2.78 $6.94 $6.94 $6.94 $6.94 $6.94 $5.25 $6.94 $6.94 $6.94 $3.47 $3.47 $5.50 $6.94 $5.55 $4.51 $6.94 $6.94 $4.06 $6.94 $4.16 $6.94 $6.94 $6.94 N/A N/A 14643 ERX HCPCS J0885 59676-0320-04 EPOETIN ALFA 20000 UNIT/ML IJ SOLN BOTH IP/OP "$1,713.00" "$1,268.00" $163.00 "$1,712.54" "$1,712.54" "$1,712.54" "$1,712.54" "$1,712.54" "$1,712.54" "$1,712.54" $163.00 "$1,712.54" "$1,712.54" "$1,712.54" "$1,712.54" "$1,712.54" "$1,712.54" $356.91 "$1,712.54" $685.02 "$1,712.54" "$1,712.54" "$1,712.54" "$1,712.54" "$1,712.54" "$1,284.75" "$1,712.54" "$1,712.54" "$1,712.54" $856.27 $856.27 "$1,356.33" "$1,712.54" "$1,370.03" "$1,113.15" "$1,712.54" "$1,712.54" $993.54 "$1,712.54" "$1,027.52" "$1,712.54" "$1,712.54" "$1,712.54" N/A N/A 14678 ERX HCPCS 25000001 49281-0790-51 TYPHOID VI POLYSACCHARIDE VACC 25 MCG/0.5ML IM SOLN BOTH IP/OP $509.00 $377.00 $90.57 $508.81 $508.81 $508.81 $508.81 $508.81 $508.81 $508.81 $90.57 $508.81 $508.81 $377.64 $377.64 $392.19 $265.09 $106.04 $508.81 $203.52 $508.81 $508.81 $508.81 $508.81 $508.81 $381.75 $508.81 $508.81 $508.81 $254.41 $254.41 $402.98 $508.81 $407.05 $330.73 $508.81 $508.81 $295.22 $508.81 $305.29 $508.81 $508.81 $508.81 N/A N/A 14719 ERX HCPCS 63700001 57664-0435-51 METFORMIN HCL 850 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 14820 ERX HCPCS 63700001 55111-0338-01 AMLODIPINE-BENAZEPRIL HCL 2.5-10 MG PO CAPS BOTH IP/OP $11.50 $9.00 $2.39 $11.47 $11.47 $11.47 $11.47 $11.47 $11.47 $11.47 $11.47 $11.47 $11.47 $11.47 $11.47 $11.47 $11.47 $2.39 $11.47 $4.59 $11.47 $11.47 $11.47 $11.47 $11.47 $8.63 $11.47 $11.47 $11.47 $5.74 $5.74 $9.08 $11.47 $9.18 $7.46 $11.47 $11.47 $6.67 $11.47 $6.88 $11.47 $11.47 $11.47 N/A N/A 14821 ERX HCPCS 63700001 55111-0339-01 AMLODIPINE-BENAZEPRIL HCL 5-10 MG PO CAPS BOTH IP/OP $12.00 $9.00 $2.44 $11.70 $11.70 $11.70 $11.70 $11.70 $11.70 $11.70 $11.70 $11.70 $11.70 $11.70 $11.70 $11.70 $11.70 $2.44 $11.70 $4.68 $11.70 $11.70 $11.70 $11.70 $11.70 $9.00 $11.70 $11.70 $11.70 $5.85 $5.85 $9.27 $11.70 $9.36 $7.61 $11.70 $11.70 $6.96 $11.70 $7.02 $11.70 $11.70 $11.70 N/A N/A 14822 ERX HCPCS 63700001 55111-0340-01 AMLODIPINE-BENAZEPRIL HCL 5-20 MG PO CAPS BOTH IP/OP $12.50 $9.00 $2.58 $12.36 $12.36 $12.36 $12.36 $12.36 $12.36 $12.36 $12.36 $12.36 $12.36 $12.36 $12.36 $12.36 $12.36 $2.58 $12.36 $4.94 $12.36 $12.36 $12.36 $12.36 $12.36 $9.38 $12.36 $12.36 $12.36 $6.18 $6.18 $9.79 $12.36 $9.89 $8.03 $12.36 $12.36 $7.25 $12.36 $7.42 $12.36 $12.36 $12.36 N/A N/A 14823 ERX HCPCS 63700006 63739-0673-10 LOSARTAN POTASSIUM 25 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 14824 ERX HCPCS 63700006 68084-0347-01 LOSARTAN POTASSIUM 50 MG PO TABS BOTH IP/OP $10.00 $7.00 $2.03 $9.72 $9.72 $9.72 $9.72 $9.72 $9.72 $9.72 $9.72 $9.72 $9.72 $9.72 $9.72 $9.72 $9.72 $2.03 $9.72 $3.89 $9.72 $9.72 $9.72 $9.72 $9.72 $7.50 $9.72 $9.72 $9.72 $4.86 $4.86 $7.70 $9.72 $7.78 $6.32 $9.72 $9.72 $5.80 $9.72 $5.83 $9.72 $9.72 $9.72 N/A N/A 14825 ERX HCPCS 63700001 69097-0579-67 FOSFOMYCIN TROMETHAMINE 3 G PO PACK BOTH IP/OP $348.50 $258.00 $72.61 $348.39 $348.39 $348.39 $348.39 $348.39 $348.39 $348.39 $348.39 $348.39 $348.39 $348.39 $348.39 $348.39 $348.39 $72.61 $348.39 $139.36 $348.39 $348.39 $348.39 $348.39 $348.39 $261.38 $348.39 $348.39 $348.39 $174.20 $174.20 $275.92 $348.39 $278.71 $226.45 $348.39 $348.39 $202.13 $348.39 $209.03 $348.39 $348.39 $348.39 N/A N/A 14845 ERX HCPCS J1265 00409-7809-24 DOPAMINE IN D5W 1.6-5 MG/ML-% IV SOLN BOTH IP/OP $92.00 $68.00 $12.80 $91.54 $91.54 $91.54 $91.54 $91.54 $91.54 $91.54 $15.80 $91.54 $91.54 $13.31 $13.31 $13.82 $12.80 $19.08 $91.54 $36.62 $91.54 $91.54 $91.54 $91.54 $91.54 $69.00 $91.54 $91.54 $91.54 $45.77 $45.77 $72.50 $91.54 $73.23 $41.19 $91.54 $91.54 $53.36 $91.54 $54.92 $91.54 $91.54 $91.54 N/A N/A 14868 ERX HCPCS J2001 00264-9594-20 LIDOCAINE IN D5W 4-5 MG/ML-% IV SOLN BOTH IP/OP $38.00 $28.00 $3.00 $37.80 $37.80 $37.80 $37.80 $37.80 $37.80 $37.80 $3.00 $37.80 $37.80 $3.12 $3.12 $3.24 $3.00 $3.52 $37.80 $15.12 $37.80 $37.80 $37.80 $37.80 $37.80 $28.50 $37.80 $37.80 $37.80 $18.90 $18.90 $29.94 $37.80 $30.24 $17.01 $37.80 $37.80 $22.04 $37.80 $22.68 $37.80 $37.80 $37.80 N/A N/A 14923 ERX HCPCS 25000001 00409-1966-07 SODIUM CHLORIDE BACTERIOSTATIC 0.9 % IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 14953 ERX HCPCS 63700001 99999-6008-29 ATOVAQUONE 750 MG/5ML PO SUSP BOTH IP/OP $145.50 $108.00 $30.28 $145.27 $145.27 $145.27 $145.27 $145.27 $145.27 $145.27 $145.27 $145.27 $145.27 $145.27 $145.27 $145.27 $145.27 $30.28 $145.27 $58.11 $145.27 $145.27 $145.27 $145.27 $145.27 $109.13 $145.27 $145.27 $145.27 $72.64 $72.64 $115.05 $145.27 $116.22 $94.43 $145.27 $145.27 $84.39 $145.27 $87.16 $145.27 $145.27 $145.27 N/A N/A 14979 ERX HCPCS 25000001 00409-3977-03 BACTERIOSTATIC WATER(BENZ ALC) IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 15113 ERX HCPCS J7517 00093-7334-05 MYCOPHENOLATE MOFETIL 250 MG PO CAPS BOTH IP/OP $17.50 $13.00 $0.30 $17.14 $17.14 $17.14 $17.14 $17.14 $17.14 $17.14 $0.32 $17.14 $17.14 $0.31 $0.31 $0.32 $0.30 $3.57 $17.14 $6.86 $17.14 $17.14 $17.14 $17.14 $17.14 $13.13 $17.14 $17.14 $17.14 $8.57 $8.57 $13.57 $17.14 $13.71 $7.71 $17.14 $17.14 $10.15 $17.14 $10.28 $17.14 $17.14 $17.14 N/A N/A 15119 ERX HCPCS 25000001 00074-4456-04 SEVOFLURANE IN SOLN BOTH IP/OP $681.50 $504.00 $121.22 $681.01 $681.01 $681.01 $681.01 $681.01 $681.01 $681.01 $121.22 $681.01 $681.01 $505.45 $505.45 $524.92 $354.81 $141.93 $681.01 $272.40 $681.01 $681.01 $681.01 $681.01 $681.01 $511.13 $681.01 $681.01 $681.01 $340.51 $340.51 $539.36 $681.01 $544.81 $442.66 $681.01 $681.01 $395.27 $681.01 $408.61 $681.01 $681.01 $681.01 N/A N/A 15168 ERX HCPCS 63700001 99999-6009-06 SENNOSIDES 8.8 MG/5ML PO SYRP BOTH IP/OP $11.00 $8.00 $2.29 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 15235 ERX HCPCS J1642 64253-0333-35 HEPARIN SOD (PORK) LOCK FLUSH 100 UNIT/ML IV SOLN BOTH IP/OP $22.00 $16.00 $1.00 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $5.29 $22.00 $1.04 $1.04 $1.08 $1.00 $1.17 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.12 $22.00 $12.76 $22.00 $22.00 $22.00 $1.12 $22.00 N/A N/A 15255 ERX HCPCS 25000001 10956-0618-01 PYRANTEL PAMOATE 144 (50 BASE) MG/ML PO SUSP BOTH IP/OP $33.50 $25.00 $5.95 $33.44 $33.44 $33.44 $33.44 $33.44 $33.44 $33.44 $5.95 $33.44 $33.44 $24.82 $24.82 $25.78 $17.42 $6.97 $33.44 $13.38 $33.44 $33.44 $33.44 $33.44 $33.44 $25.13 $33.44 $33.44 $33.44 $16.72 $16.72 $26.48 $33.44 $26.75 $21.74 $33.44 $33.44 $19.43 $33.44 $20.06 $33.44 $33.44 $33.44 N/A N/A 15327 ERX HCPCS 63700001 16714-0796-01 SUMATRIPTAN SUCCINATE 25 MG PO TABS BOTH IP/OP $108.00 $80.00 $22.44 $107.67 $107.67 $107.67 $107.67 $107.67 $107.67 $107.67 $107.67 $107.67 $107.67 $107.67 $107.67 $107.67 $107.67 $22.44 $107.67 $43.07 $107.67 $107.67 $107.67 $107.67 $107.67 $81.00 $107.67 $107.67 $107.67 $53.84 $53.84 $85.27 $107.67 $86.14 $69.99 $107.67 $107.67 $62.64 $107.67 $64.60 $107.67 $107.67 $107.67 N/A N/A 15330 ERX HCPCS J0153 00703-8777-01 ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN BOTH IP/OP $532.00 $394.00 $46.80 $531.54 $239.19 $239.19 $239.19 $239.19 $531.54 $531.54 $531.54 $110.79 $531.54 $48.67 $48.67 $50.54 $46.80 $54.98 $531.54 $531.54 $314.41 $531.54 $531.54 $531.54 $531.54 $399.00 $531.54 $531.54 $531.54 $265.77 $265.77 $420.98 $531.54 $425.23 $239.19 $52.36 $531.54 $308.56 $531.54 $531.54 $531.54 $52.36 $531.54 N/A N/A 15372 ERX HCPCS 63700001 00225-0525-47 AYR SALINE NASAL NA GEL BOTH IP/OP $14.00 $10.00 $2.87 $13.77 $13.77 $13.77 $13.77 $13.77 $13.77 $13.77 $13.77 $13.77 $13.77 $13.77 $13.77 $13.77 $13.77 $2.87 $13.77 $5.51 $13.77 $13.77 $13.77 $13.77 $13.77 $10.50 $13.77 $13.77 $13.77 $6.89 $6.89 $10.91 $13.77 $11.02 $8.95 $13.77 $13.77 $8.12 $13.77 $8.26 $13.77 $13.77 $13.77 N/A N/A 15661 ERX HCPCS 63700001 64980-0340-01 ALENDRONATE SODIUM 10 MG PO TABS BOTH IP/OP $13.00 $10.00 $2.63 $12.63 $12.63 $12.63 $12.63 $12.63 $12.63 $12.63 $12.63 $12.63 $12.63 $12.63 $12.63 $12.63 $12.63 $2.63 $12.63 $5.05 $12.63 $12.63 $12.63 $12.63 $12.63 $9.75 $12.63 $12.63 $12.63 $6.32 $6.32 $10.00 $12.63 $10.10 $8.21 $12.63 $12.63 $7.54 $12.63 $7.58 $12.63 $12.63 $12.63 N/A N/A 15738 ERX HCPCS 63700001 60505-0823-06 CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN BOTH IP/OP $411.50 $305.00 $85.73 $411.34 $411.34 $411.34 $411.34 $411.34 $411.34 $411.34 $411.34 $411.34 $411.34 $411.34 $411.34 $411.34 $411.34 $85.73 $411.34 $164.54 $411.34 $411.34 $411.34 $411.34 $411.34 $308.63 $411.34 $411.34 $411.34 $205.67 $205.67 $325.78 $411.34 $329.07 $267.37 $411.34 $411.34 $238.67 $411.34 $246.80 $411.34 $411.34 $411.34 2844.98 1355.83 15747 ERX HCPCS 63700001 51079-0930-01 CARVEDILOL 6.25 MG PO TABS BOTH IP/OP $9.50 $7.00 $1.92 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $1.92 $9.22 $3.69 $9.22 $9.22 $9.22 $9.22 $9.22 $7.13 $9.22 $9.22 $9.22 $4.61 $4.61 $7.30 $9.22 $7.38 $5.99 $9.22 $9.22 $5.51 $9.22 $5.53 $9.22 $9.22 $9.22 N/A N/A 15748 ERX HCPCS 63700001 51079-0932-01 CARVEDILOL 25 MG PO TABS BOTH IP/OP $9.50 $7.00 $1.92 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $1.92 $9.22 $3.69 $9.22 $9.22 $9.22 $9.22 $9.22 $7.13 $9.22 $9.22 $9.22 $4.61 $4.61 $7.30 $9.22 $7.38 $5.99 $9.22 $9.22 $5.51 $9.22 $5.53 $9.22 $9.22 $9.22 N/A N/A 15749 ERX HCPCS 63700001 51079-0931-01 CARVEDILOL 12.5 MG PO TABS BOTH IP/OP $9.50 $7.00 $1.92 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $1.92 $9.22 $3.69 $9.22 $9.22 $9.22 $9.22 $9.22 $7.13 $9.22 $9.22 $9.22 $4.61 $4.61 $7.30 $9.22 $7.38 $5.99 $9.22 $9.22 $5.51 $9.22 $5.53 $9.22 $9.22 $9.22 N/A N/A 15796 ERX HCPCS 63700001 00069-3110-19 AZITHROMYCIN 100 MG/5ML PO SUSR BOTH IP/OP $127.00 $94.00 $26.43 $126.81 $126.81 $126.81 $126.81 $126.81 $126.81 $126.81 $126.81 $126.81 $126.81 $126.81 $126.81 $126.81 $126.81 $26.43 $126.81 $50.72 $126.81 $126.81 $126.81 $126.81 $126.81 $95.25 $126.81 $126.81 $126.81 $63.41 $63.41 $100.43 $126.81 $101.45 $82.43 $126.81 $126.81 $73.66 $126.81 $76.09 $126.81 $126.81 $126.81 N/A N/A 15797 ERX HCPCS 63700001 59762-3120-01 AZITHROMYCIN 200 MG/5ML PO SUSR BOTH IP/OP $139.00 $103.00 $28.93 $138.81 $138.81 $138.81 $138.81 $138.81 $138.81 $138.81 $138.81 $138.81 $138.81 $138.81 $138.81 $138.81 $138.81 $28.93 $138.81 $55.52 $138.81 $138.81 $138.81 $138.81 $138.81 $104.25 $138.81 $138.81 $138.81 $69.41 $69.41 $109.94 $138.81 $111.05 $90.23 $138.81 $138.81 $80.62 $138.81 $83.29 $138.81 $138.81 $138.81 N/A N/A 15816 ERX HCPCS 63700001 00121-1276-00 GUAIFENESIN-DM 100-10 MG/5ML PO SYRP BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 15852 ERX HCPCS J2274 00409-3815-12 MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $11.08 $22.00 $22.00 $14.45 $14.45 $15.00 $13.89 $16.32 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 108.26 49.53 15852 ERX HCPCS J2274 99999-6012-28 MORPHINE SULFATE (PF) 1 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $11.08 $22.00 $22.00 $14.45 $14.45 $15.00 $13.89 $16.32 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 108.26 49.53 15859 ERX HCPCS 25000001 00338-1049-02 NITROGLYCERIN IN D5W 200-5 MCG/ML-% IV SOLN BOTH IP/OP $107.50 $80.00 $19.13 $107.46 $107.46 $107.46 $107.46 $107.46 $107.46 $107.46 $19.13 $107.46 $107.46 $79.76 $79.76 $82.83 $55.99 $22.40 $107.46 $42.98 $107.46 $107.46 $107.46 $107.46 $107.46 $80.63 $107.46 $107.46 $107.46 $53.73 $53.73 $85.11 $107.46 $85.97 $69.85 $107.46 $107.46 $62.35 $107.46 $64.48 $107.46 $107.46 $107.46 N/A N/A 15861 ERX HCPCS J7042 00338-0085-04 DEXTROSE-NACL 5-0.45 % IV SOLN BOTH IP/OP $26.00 $19.00 $0.73 $25.92 $11.66 $11.66 $11.66 $11.66 $25.92 $25.92 $25.92 $0.73 $25.92 $2.20 $2.20 $2.29 $2.12 $2.49 $25.92 $25.92 $15.33 $25.92 $25.92 $25.92 $25.92 $19.50 $25.92 $25.92 $25.92 $12.96 $12.96 $20.53 $25.92 $20.74 $11.66 $2.37 $25.92 $15.08 $25.92 $25.92 $25.92 $2.37 $25.92 N/A N/A 15863 ERX HCPCS J7042 00338-0077-04 DEXTROSE-NACL 5-0.2 % IV SOLN BOTH IP/OP $30.50 $23.00 $0.73 $30.24 $13.61 $13.61 $13.61 $13.61 $30.24 $30.24 $30.24 $0.73 $30.24 $2.20 $2.20 $2.29 $2.12 $2.49 $30.24 $30.24 $17.89 $30.24 $30.24 $30.24 $30.24 $22.88 $30.24 $30.24 $30.24 $15.12 $15.12 $23.95 $30.24 $24.19 $13.61 $2.37 $30.24 $17.69 $30.24 $30.24 $30.24 $2.37 $30.24 N/A N/A 15865 ERX HCPCS J7042 00264-7623-20 DEXTROSE-NACL 10-0.2 % IV SOLN BOTH IP/OP $22.00 $16.00 $0.36 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.36 $22.00 $1.10 $1.10 $1.14 $1.06 $1.25 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.19 $22.00 $12.76 $22.00 $22.00 $22.00 $1.19 $22.00 N/A N/A 15880 ERX HCPCS 63700001 50742-0623-60 LAMIVUDINE 150 MG PO TABS BOTH IP/OP $31.00 $23.00 $6.44 $30.91 $30.91 $30.91 $30.91 $30.91 $30.91 $30.91 $30.91 $30.91 $30.91 $30.91 $30.91 $30.91 $30.91 $6.44 $30.91 $12.36 $30.91 $30.91 $30.91 $30.91 $30.91 $23.25 $30.91 $30.91 $30.91 $15.46 $15.46 $24.48 $30.91 $24.73 $20.09 $30.91 $30.91 $17.98 $30.91 $18.55 $30.91 $30.91 $30.91 N/A N/A 15881 ERX HCPCS 63700001 99999-6010-41 LAMIVUDINE 10 MG/ML PO SOLN BOTH IP/OP $65.00 $48.00 $13.48 $64.68 $64.68 $64.68 $64.68 $64.68 $64.68 $64.68 $64.68 $64.68 $64.68 $64.68 $64.68 $64.68 $64.68 $13.48 $64.68 $25.87 $64.68 $64.68 $64.68 $64.68 $64.68 $48.75 $64.68 $64.68 $64.68 $32.34 $32.34 $51.23 $64.68 $51.74 $42.04 $64.68 $64.68 $37.70 $64.68 $38.81 $64.68 $64.68 $64.68 N/A N/A 15882 ERX HCPCS J7042 00338-0089-04 DEXTROSE-NACL 5-0.9 % IV SOLN BOTH IP/OP $26.00 $19.00 $0.73 $25.92 $11.66 $11.66 $11.66 $11.66 $25.92 $25.92 $25.92 $0.73 $25.92 $2.20 $2.20 $2.29 $2.12 $2.49 $25.92 $25.92 $15.33 $25.92 $25.92 $25.92 $25.92 $19.50 $25.92 $25.92 $25.92 $12.96 $12.96 $20.53 $25.92 $20.74 $11.66 $2.37 $25.92 $15.08 $25.92 $25.92 $25.92 $2.37 $25.92 N/A N/A 15898 ERX HCPCS J1325 66215-0402-01 EPOPROSTENOL SODIUM 1.5 MG IV SOLR BOTH IP/OP $211.50 $157.00 $44.04 $211.30 $211.30 $211.30 $211.30 $211.30 $211.30 $211.30 $48.63 $211.30 $211.30 $50.73 $50.73 $52.68 $48.78 $44.04 $211.30 $84.52 $211.30 $211.30 $211.30 $211.30 $211.30 $158.63 $211.30 $211.30 $211.30 $105.65 $105.65 $167.35 $211.30 $169.04 $95.09 $211.30 $211.30 $122.67 $211.30 $126.78 $211.30 $211.30 $211.30 N/A N/A 15906 ERX HCPCS J1580 00338-0503-48 GENTAMICIN IN SALINE 0.8-0.9 MG/ML-% IV SOLN BOTH IP/OP $22.00 $16.00 $1.02 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.02 $22.00 $1.47 $1.47 $1.52 $1.41 $1.66 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.58 $22.00 $12.76 $22.00 $22.00 $22.00 $1.58 $22.00 N/A N/A 15908 ERX HCPCS J1580 00338-0505-48 GENTAMICIN IN SALINE 1-0.9 MG/ML-% IV SOLN BOTH IP/OP $22.50 $17.00 $1.02 $22.04 $9.92 $9.92 $9.92 $9.92 $22.04 $22.04 $22.04 $1.02 $22.04 $1.47 $1.47 $1.52 $1.41 $1.66 $22.04 $22.04 $13.04 $22.04 $22.04 $22.04 $22.04 $16.88 $22.04 $22.04 $22.04 $11.02 $11.02 $17.46 $22.04 $17.63 $9.92 $1.58 $22.04 $13.05 $22.04 $22.04 $22.04 $1.58 $22.04 N/A N/A 15911 ERX HCPCS J1580 00338-0509-41 GENTAMICIN IN SALINE 1.6-0.9 MG/ML-% IV SOLN BOTH IP/OP $22.00 $16.00 $1.02 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.02 $22.00 $1.47 $1.47 $1.52 $1.41 $1.66 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.58 $22.00 $12.76 $22.00 $22.00 $22.00 $1.58 $22.00 N/A N/A 16005 ERX HCPCS 63700001 00555-0808-02 TRETINOIN 10 MG PO CAPS BOTH IP/OP $648.50 $480.00 $135.06 $648.06 $648.06 $648.06 $648.06 $648.06 $648.06 $648.06 $648.06 $648.06 $648.06 $648.06 $648.06 $648.06 $648.06 $135.06 $648.06 $259.22 $648.06 $648.06 $648.06 $648.06 $648.06 $486.38 $648.06 $648.06 $648.06 $324.03 $324.03 $513.26 $648.06 $518.45 $421.24 $648.06 $648.06 $376.13 $648.06 $388.84 $648.06 $648.06 $648.06 N/A N/A 16032 ERX HCPCS 63700001 00046-2575-12 CONJ ESTROG-MEDROXYPROGEST ACE PO TABS BOTH IP/OP $43.50 $32.00 $9.06 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $9.06 $43.47 $17.39 $43.47 $43.47 $43.47 $43.47 $43.47 $32.63 $43.47 $43.47 $43.47 $21.74 $21.74 $34.43 $43.47 $34.78 $28.26 $43.47 $43.47 $25.23 $43.47 $26.08 $43.47 $43.47 $43.47 N/A N/A 16124 ERX HCPCS 63700001 68462-0381-60 (RILUTEK) RILUZOLE 50 MG PO TABS BOTH IP/OP $130.50 $97.00 $27.12 $130.14 $130.14 $130.14 $130.14 $130.14 $130.14 $130.14 $130.14 $130.14 $130.14 $130.14 $130.14 $130.14 $130.14 $27.12 $130.14 $52.06 $130.14 $130.14 $130.14 $130.14 $130.14 $97.88 $130.14 $130.14 $130.14 $65.07 $65.07 $103.07 $130.14 $104.11 $84.59 $130.14 $130.14 $75.69 $130.14 $78.08 $130.14 $130.14 $130.14 N/A N/A 16205 ERX HCPCS 63700001 00093-7536-56 ANASTROZOLE 1 MG PO TABS BOTH IP/OP $58.50 $43.00 $12.15 $58.31 $58.31 $58.31 $58.31 $58.31 $58.31 $58.31 $58.31 $58.31 $58.31 $58.31 $58.31 $58.31 $58.31 $12.15 $58.31 $23.32 $58.31 $58.31 $58.31 $58.31 $58.31 $43.88 $58.31 $58.31 $58.31 $29.16 $29.16 $46.18 $58.31 $46.65 $37.90 $58.31 $58.31 $33.93 $58.31 $34.99 $58.31 $58.31 $58.31 N/A N/A 16208 ERX HCPCS 25000001 60258-0001-16 CYTRA-2 500-334 MG/5ML PO SOLN BOTH IP/OP $11.00 $8.00 $1.96 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $1.96 $11.00 $11.00 $8.16 $8.16 $8.48 $5.73 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 16218 ERX HCPCS 63700001 00054-3120-41 CALCITRIOL 1 MCG/ML PO SOLN BOTH IP/OP $621.50 $460.00 $129.45 $621.12 $621.12 $621.12 $621.12 $621.12 $621.12 $621.12 $621.12 $621.12 $621.12 $621.12 $621.12 $621.12 $621.12 $129.45 $621.12 $248.45 $621.12 $621.12 $621.12 $621.12 $621.12 $466.13 $621.12 $621.12 $621.12 $310.56 $310.56 $491.93 $621.12 $496.90 $403.73 $621.12 $621.12 $360.47 $621.12 $372.67 $621.12 $621.12 $621.12 N/A N/A 16254 ERX HCPCS J9202 70720-0951-30 GOSERELIN ACETATE 10.8 MG SC IMPL BOTH IP/OP "$6,751.50" "$4,996.00" "$1,575.63" "$6,751.11" "$6,751.11" "$6,751.11" "$6,751.11" "$6,751.11" "$6,751.11" "$6,751.11" "$1,575.63" "$6,751.11" "$6,751.11" "$1,694.66" "$1,694.66" "$1,759.84" "$1,629.48" "$1,914.38" "$6,751.11" "$2,700.44" "$6,751.11" "$6,751.11" "$6,751.11" "$6,751.11" "$6,751.11" "$5,063.63" "$6,751.11" "$6,751.11" "$6,751.11" "$3,375.56" "$3,375.56" "$5,346.88" "$6,751.11" "$5,400.89" "$3,038.00" "$6,751.11" "$6,751.11" "$3,915.87" "$6,751.11" "$4,050.67" "$6,751.11" "$6,751.11" "$6,751.11" N/A N/A 16357 ERX HCPCS 63700001 55111-0322-01 GLIMEPIRIDE 4 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 16369 ERX HCPCS J0692 60505-6146-04 CEFEPIME HCL 1 G IJ SOLR BOTH IP/OP $81.00 $60.00 $3.52 $80.93 $36.42 $36.42 $36.42 $36.42 $80.93 $80.93 $80.93 $16.87 $80.93 $3.66 $3.66 $3.80 $3.52 $16.87 $80.93 $80.93 $47.87 $80.93 $80.93 $80.93 $80.93 $60.75 $80.93 $80.93 $80.93 $40.47 $40.47 $64.10 $80.93 $64.74 $36.42 $16.06 $80.93 $46.98 $80.93 $80.93 $80.93 $16.87 $80.93 N/A N/A 16371 ERX HCPCS J0692 60505-6147-00 CEFEPIME HCL 2 G IJ SOLR BOTH IP/OP $161.00 $119.00 $7.04 $160.64 $72.29 $72.29 $72.29 $72.29 $160.64 $160.64 $160.64 $33.48 $160.64 $7.32 $7.32 $7.60 $7.04 $33.48 $160.64 $160.64 $95.02 $160.64 $160.64 $160.64 $160.64 $120.75 $160.64 $160.64 $160.64 $80.32 $80.32 $127.23 $160.64 $128.51 $72.29 $31.88 $160.64 $93.38 $160.64 $160.64 $160.64 $33.48 $160.64 N/A N/A 16632 ERX HCPCS 63700001 00904-5676-61 PAROXETINE HCL 10 MG PO TABS BOTH IP/OP $12.50 $9.00 $2.53 $12.16 $12.16 $12.16 $12.16 $12.16 $12.16 $12.16 $12.16 $12.16 $12.16 $12.16 $12.16 $12.16 $12.16 $2.53 $12.16 $4.86 $12.16 $12.16 $12.16 $12.16 $12.16 $9.38 $12.16 $12.16 $12.16 $6.08 $6.08 $9.63 $12.16 $9.73 $7.90 $12.16 $12.16 $7.25 $12.16 $7.30 $12.16 $12.16 $12.16 N/A N/A 16633 ERX HCPCS 63700001 68382-0001-16 PAROXETINE HCL 40 MG PO TABS BOTH IP/OP $12.50 $9.00 $2.59 $12.43 $12.43 $12.43 $12.43 $12.43 $12.43 $12.43 $12.43 $12.43 $12.43 $12.43 $12.43 $12.43 $12.43 $2.59 $12.43 $4.97 $12.43 $12.43 $12.43 $12.43 $12.43 $9.38 $12.43 $12.43 $12.43 $6.22 $6.22 $9.84 $12.43 $9.94 $8.08 $12.43 $12.43 $7.25 $12.43 $7.46 $12.43 $12.43 $12.43 N/A N/A 16825 ERX HCPCS 25000001 00942-0641-04 ACD FORMULA A 0.73-2.45-2.2 GM/100ML VI SOLN BOTH IP/OP $30.50 $23.00 $5.38 $30.24 $30.24 $30.24 $30.24 $30.24 $30.24 $30.24 $5.38 $30.24 $30.24 $22.44 $22.44 $23.31 $15.76 $6.30 $30.24 $12.10 $30.24 $30.24 $30.24 $30.24 $30.24 $22.88 $30.24 $30.24 $30.24 $15.12 $15.12 $23.95 $30.24 $24.19 $19.66 $30.24 $30.24 $17.69 $30.24 $18.14 $30.24 $30.24 $30.24 N/A N/A 17012 ERX HCPCS J9040 61703-0323-22 BLEOMYCIN SULFATE 30 UNITS IJ SOLR BOTH IP/OP $390.00 $289.00 $53.60 $389.82 $175.42 $175.42 $175.42 $175.42 $389.82 $389.82 $389.82 $74.80 $389.82 $55.74 $55.74 $57.89 $53.60 $62.97 $389.82 $389.82 $230.58 $389.82 $389.82 $389.82 $389.82 $292.50 $389.82 $389.82 $389.82 $194.91 $194.91 $308.74 $389.82 $311.86 $175.42 $59.97 $389.82 $226.20 $389.82 $389.82 $389.82 $59.97 $389.82 N/A N/A 17023 ERX HCPCS 63700001 70156-0105-01 HYOSCYAMINE SULFATE 0.125 MG SL SUBL BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 17122 ERX HCPCS J9201 25021-0235-50 GEMCITABINE HCL 1 G IV SOLR BOTH IP/OP $213.50 $158.00 $19.25 $811.87 $95.99 $95.99 $95.99 $95.99 $213.30 $213.30 $213.30 $811.87 $213.30 $20.02 $20.02 $20.79 $19.25 $22.62 $213.30 $213.30 $126.17 $213.30 $213.30 $213.30 $213.30 $160.13 $213.30 $213.30 $213.30 $106.65 $106.65 $168.93 $213.30 $170.64 $95.99 $21.54 $213.30 $123.83 $213.30 $213.30 $213.30 $21.54 $213.30 N/A N/A 17285 ERX HCPCS J9351 63323-0762-10 TOPOTECAN HCL 4 MG IV SOLR BOTH IP/OP $852.00 $630.00 $36.00 $851.64 $383.24 $383.24 $383.24 $383.24 $851.64 $851.64 $851.64 $177.50 $851.64 $37.44 $37.44 $38.88 $36.00 $42.29 $851.64 $851.64 $503.75 $851.64 $851.64 $851.64 $851.64 $639.00 $851.64 $851.64 $851.64 $425.82 $425.82 $674.50 $851.64 $681.31 $383.24 $40.28 $851.64 $494.16 $851.64 $851.64 $851.64 $40.28 $851.64 N/A N/A 17378 ERX HCPCS J0740 23155-0216-31 CIDOFOVIR 75 MG/ML IV SOLN BOTH IP/OP "$2,371.00" "$1,755.00" $494.13 "$2,370.96" "$2,370.96" "$2,370.96" "$2,370.96" "$2,370.96" "$2,370.96" "$2,370.96" $563.76 "$2,370.96" "$2,370.96" $590.64 $590.64 $613.35 $567.92 $494.13 "$2,370.96" $948.38 "$2,370.96" "$2,370.96" "$2,370.96" "$2,370.96" "$2,370.96" "$1,778.25" "$2,370.96" "$2,370.96" "$2,370.96" "$1,185.48" "$1,185.48" "$1,877.80" "$2,370.96" "$1,896.77" "$1,066.93" "$2,370.96" "$2,370.96" "$1,375.18" "$2,370.96" "$1,422.58" "$2,370.96" "$2,370.96" "$2,370.96" N/A N/A 17379 ERX HCPCS J2185 55150-0207-20 MEROPENEM 500 MG IV SOLR BOTH IP/OP $48.00 $36.00 $3.70 $47.52 $21.38 $21.38 $21.38 $21.38 $47.52 $47.52 $47.52 $9.90 $47.52 $3.85 $3.85 $4.00 $3.70 $4.35 $47.52 $47.52 $28.11 $47.52 $47.52 $47.52 $47.52 $36.00 $47.52 $47.52 $47.52 $23.76 $23.76 $37.64 $47.52 $38.02 $21.38 $4.14 $47.52 $27.84 $47.52 $47.52 $47.52 $4.14 $47.52 N/A N/A 17380 ERX HCPCS J2185 55150-0208-30 MEROPENEM 1 G IV SOLR BOTH IP/OP $88.00 $65.00 $7.40 $87.56 $39.40 $39.40 $39.40 $39.40 $87.56 $87.56 $87.56 $18.25 $87.56 $7.70 $7.70 $7.99 $7.40 $8.69 $87.56 $87.56 $51.79 $87.56 $87.56 $87.56 $87.56 $66.00 $87.56 $87.56 $87.56 $43.78 $43.78 $69.35 $87.56 $70.05 $39.40 $8.28 $87.56 $51.04 $87.56 $87.56 $87.56 $8.28 $87.56 129 N/A 17405 ERX HCPCS J1815 00002-7510-01 INSULIN LISPRO 100 UNIT/ML SC SOLN BOTH IP/OP $15.00 $11.00 $1.01 $15.00 $8.15 $8.15 $8.15 $8.15 $15.00 $15.00 $15.00 $3.13 $15.00 $15.00 $15.00 $15.00 $15.00 $3.13 $15.00 $15.00 $8.87 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $2.98 $15.00 $8.70 $15.00 $15.00 $15.00 $1.01 $15.00 N/A N/A 17464 ERX HCPCS 63700006 00093-1003-01 BUSPIRONE HCL 15 MG PO TABS BOTH IP/OP $9.00 $7.00 $1.82 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $8.73 $1.82 $8.73 $3.49 $8.73 $8.73 $8.73 $8.73 $8.73 $6.75 $8.73 $8.73 $8.73 $4.37 $4.37 $6.91 $8.73 $6.98 $5.67 $8.73 $8.73 $5.22 $8.73 $5.24 $8.73 $8.73 $8.73 N/A N/A 17500 ERX HCPCS 25000001 62991-2015-01 CAFFEINE ANHYDROUS POWD BOTH IP/OP $310.50 $230.00 $55.25 $310.39 $310.39 $310.39 $310.39 $310.39 $310.39 $310.39 $55.25 $310.39 $310.39 $230.37 $230.37 $239.25 $161.71 $64.69 $310.39 $124.16 $310.39 $310.39 $310.39 $310.39 $310.39 $232.88 $310.39 $310.39 $310.39 $155.20 $155.20 $245.83 $310.39 $248.31 $201.75 $310.39 $310.39 $180.09 $310.39 $186.23 $310.39 $310.39 $310.39 N/A N/A 17524 ERX HCPCS 25000001 59584-0138-01 CANDIDA ALBICANS SKN TST ANTGN ID SOLN BOTH IP/OP $130.00 $96.00 $23.12 $129.91 $129.91 $129.91 $129.91 $129.91 $129.91 $129.91 $23.12 $129.91 $129.91 $96.42 $96.42 $100.13 $67.68 $27.07 $129.91 $51.96 $129.91 $129.91 $129.91 $129.91 $129.91 $97.50 $129.91 $129.91 $129.91 $64.96 $64.96 $102.89 $129.91 $103.93 $84.44 $129.91 $129.91 $75.40 $129.91 $77.95 $129.91 $129.91 $129.91 N/A N/A 17594 ERX HCPCS Q9966 00407-2222-19 IODIXANOL 270 MG/ML IV SOLN BOTH IP/OP $216.00 $160.00 $17.00 $215.52 $96.98 $96.98 $96.98 $96.98 $215.52 $215.52 $215.52 $44.92 $215.52 $215.52 $215.52 $18.36 $17.00 $44.92 $215.52 $215.52 $127.48 $215.52 $215.52 $215.52 $215.52 $162.00 $215.52 $215.52 $215.52 $107.76 $107.76 $170.69 $215.52 $172.42 $96.98 $42.78 $215.52 $125.28 $215.52 $215.52 $215.52 $44.91 $215.52 N/A N/A 17837 ERX HCPCS 25000001 00173-0682-24 ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS BOTH IP/OP $109.00 $81.00 $19.32 $108.52 $108.52 $108.52 $108.52 $108.52 $108.52 $108.52 $19.32 $108.52 $108.52 $80.54 $80.54 $83.65 $56.54 $22.62 $108.52 $43.41 $108.52 $108.52 $108.52 $108.52 $108.52 $81.75 $108.52 $108.52 $108.52 $54.26 $54.26 $85.95 $108.52 $86.82 $70.54 $108.52 $108.52 $63.22 $108.52 $65.11 $108.52 $108.52 $108.52 N/A N/A 17881 ERX HCPCS 63700001 70069-0231-01 BRIMONIDINE TARTRATE 0.2 % OP SOLN BOTH IP/OP $54.00 $40.00 $11.25 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $11.25 $54.00 $21.60 $54.00 $54.00 $54.00 $54.00 $54.00 $40.50 $54.00 $54.00 $54.00 $27.00 $27.00 $42.77 $54.00 $43.20 $35.10 $54.00 $54.00 $31.32 $54.00 $32.40 $54.00 $54.00 $54.00 N/A N/A 17938 ERX HCPCS 63700001 60505-3112-00 OLANZAPINE 7.5 MG PO TABS BOTH IP/OP $69.50 $51.00 $14.48 $69.48 $69.48 $69.48 $69.48 $69.48 $69.48 $69.48 $69.48 $69.48 $69.48 $69.48 $69.48 $69.48 $69.48 $14.48 $69.48 $27.79 $69.48 $69.48 $69.48 $69.48 $69.48 $52.13 $69.48 $69.48 $69.48 $34.74 $34.74 $55.03 $69.48 $55.58 $45.16 $69.48 $69.48 $40.31 $69.48 $41.69 $69.48 $69.48 $69.48 N/A N/A 17946 ERX HCPCS J8540 00054-3176-44 DEXAMETHASONE 1 MG/ML PO CONC BOTH IP/OP $128.00 $95.00 $10.80 $128.00 $128.00 $128.00 $128.00 $128.00 $128.00 $128.00 $12.00 $128.00 $128.00 $11.23 $11.23 $11.66 $10.80 $26.68 $128.00 $51.20 $128.00 $128.00 $128.00 $128.00 $128.00 $96.00 $128.00 $128.00 $128.00 $64.00 $64.00 $101.38 $128.00 $102.40 $57.60 $128.00 $128.00 $74.24 $128.00 $76.80 $128.00 $128.00 $128.00 N/A N/A 17961 ERX HCPCS 63700001 65862-0024-60 ZIDOVUDINE 300 MG PO TABS BOTH IP/OP $26.00 $19.00 $5.42 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $25.99 $5.42 $25.99 $10.40 $25.99 $25.99 $25.99 $25.99 $25.99 $19.50 $25.99 $25.99 $25.99 $13.00 $13.00 $20.58 $25.99 $20.79 $16.89 $25.99 $25.99 $15.08 $25.99 $15.59 $25.99 $25.99 $25.99 N/A N/A 18031 ERX HCPCS 25000001 00187-0245-03 DIHYDROERGOTAMINE MESYLATE 4 MG/ML NA SOLN BOTH IP/OP "$1,531.50" "$1,133.00" $272.53 "$1,531.09" "$1,531.09" "$1,531.09" "$1,531.09" "$1,531.09" "$1,531.09" "$1,531.09" $272.53 "$1,531.09" "$1,531.09" "$1,136.37" "$1,136.37" "$1,180.16" $797.70 $319.10 "$1,531.09" $612.44 "$1,531.09" "$1,531.09" "$1,531.09" "$1,531.09" "$1,531.09" "$1,148.63" "$1,531.09" "$1,531.09" "$1,531.09" $765.55 $765.55 "$1,212.62" "$1,531.09" "$1,224.87" $995.21 "$1,531.09" "$1,531.09" $888.27 "$1,531.09" $918.65 "$1,531.09" "$1,531.09" "$1,531.09" N/A N/A 18192 ERX HCPCS J2795 00143-9263-10 ROPIVACAINE HCL 2 MG/ML IJ SOLN BOTH IP/OP $25.50 $19.00 $1.40 $25.10 $11.30 $11.30 $11.30 $11.30 $25.10 $25.10 $25.10 $5.23 $25.10 $1.46 $1.46 $1.51 $1.40 $5.23 $25.10 $25.10 $14.85 $25.10 $25.10 $25.10 $25.10 $19.13 $25.10 $25.10 $25.10 $12.55 $12.55 $19.88 $25.10 $20.08 $11.30 $4.98 $25.10 $14.79 $25.10 $25.10 $25.10 $5.23 $25.10 N/A N/A 18193 ERX HCPCS J2795 63323-0287-20 ROPIVACAINE HCL 7.5 MG/ML IJ SOLN BOTH IP/OP $97.00 $72.00 $7.84 $96.72 $43.52 $43.52 $43.52 $43.52 $96.72 $96.72 $96.72 $20.16 $96.72 $8.15 $8.15 $8.47 $7.84 $20.16 $96.72 $38.69 $57.21 $96.72 $96.72 $96.72 $96.72 $72.75 $96.72 $96.72 $96.72 $48.36 $48.36 $76.60 $96.72 $77.38 $43.52 $19.20 $96.72 $56.26 $96.72 $96.72 $96.72 $20.16 $96.72 N/A N/A 18195 ERX HCPCS J2795 63323-0286-31 ROPIVACAINE HCL 5 MG/ML IJ SOLN BOTH IP/OP $54.50 $40.00 $3.50 $54.44 $24.50 $24.50 $24.50 $24.50 $54.44 $54.44 $54.44 $11.35 $54.44 $3.64 $3.64 $3.78 $3.50 $11.35 $54.44 $54.44 $32.20 $54.44 $54.44 $54.44 $54.44 $40.88 $54.44 $54.44 $54.44 $27.22 $27.22 $43.12 $54.44 $43.55 $24.50 $10.80 $54.44 $31.61 $54.44 $54.44 $54.44 $11.35 $54.44 N/A N/A 18266 ERX HCPCS 25000001 00517-9203-25 TRACE MINERALS CR-CU-MN-ZN 1-100-25-1000 MCG/ML IV SOLN BOTH IP/OP $63.00 $47.00 $11.21 $62.99 $62.99 $62.99 $62.99 $62.99 $62.99 $62.99 $11.21 $62.99 $62.99 $46.75 $46.75 $48.55 $32.82 $13.13 $62.99 $25.20 $62.99 $62.99 $62.99 $62.99 $62.99 $47.25 $62.99 $62.99 $62.99 $31.50 $31.50 $49.89 $62.99 $50.39 $40.94 $62.99 $62.99 $36.54 $62.99 $37.79 $62.99 $62.99 $62.99 N/A N/A 18287 ERX HCPCS 63700001 29300-0127-13 BISOPROLOL FUMARATE 10 MG PO TABS BOTH IP/OP $6.50 $5.00 $1.27 $6.07 $6.07 $6.07 $6.07 $6.07 $6.07 $6.07 $6.07 $6.07 $6.07 $6.07 $6.07 $6.07 $6.07 $1.27 $6.07 $2.43 $6.07 $6.07 $6.07 $6.07 $6.07 $4.88 $6.07 $6.07 $6.07 $3.04 $3.04 $4.81 $6.07 $4.86 $3.95 $6.07 $6.07 $3.77 $6.07 $3.64 $6.07 $6.07 $6.07 N/A N/A 18292 ERX HCPCS 63700001 50111-0916-01 TORSEMIDE 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 18293 ERX HCPCS 63700001 50111-0917-01 TORSEMIDE 20 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 18294 ERX HCPCS 63700001 50111-0918-01 TORSEMIDE 100 MG PO TABS BOTH IP/OP $13.50 $10.00 $2.74 $13.15 $13.15 $13.15 $13.15 $13.15 $13.15 $13.15 $13.15 $13.15 $13.15 $13.15 $13.15 $13.15 $13.15 $2.74 $13.15 $5.26 $13.15 $13.15 $13.15 $13.15 $13.15 $10.13 $13.15 $13.15 $13.15 $6.58 $6.58 $10.41 $13.15 $10.52 $8.55 $13.15 $13.15 $7.83 $13.15 $7.89 $13.15 $13.15 $13.15 N/A N/A 18295 ERX HCPCS 63700001 31722-0529-01 TORSEMIDE 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 18302 ERX HCPCS J2543 00781-3114-95 PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR BOTH IP/OP $93.50 $69.00 $5.68 $93.08 $41.89 $41.89 $41.89 $41.89 $93.08 $93.08 $93.08 $26.18 $93.08 $5.91 $5.91 $6.13 $5.68 $6.67 $93.08 $93.08 $55.06 $93.08 $93.08 $93.08 $93.08 $70.13 $93.08 $93.08 $93.08 $46.54 $46.54 $73.72 $93.08 $74.46 $41.89 $6.35 $93.08 $54.23 $93.08 $93.08 $93.08 $6.35 $93.08 N/A N/A 18303 ERX HCPCS J2543 00409-3385-13 PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR BOTH IP/OP $54.50 $40.00 $4.26 $54.21 $24.39 $24.39 $24.39 $24.39 $54.21 $54.21 $54.21 $19.63 $54.21 $4.43 $4.43 $4.60 $4.26 $5.00 $54.21 $54.21 $32.07 $54.21 $54.21 $54.21 $54.21 $40.88 $54.21 $54.21 $54.21 $27.11 $27.11 $42.93 $54.21 $43.37 $24.39 $4.77 $54.21 $31.61 $54.21 $54.21 $54.21 $4.77 $54.21 N/A N/A 18304 ERX HCPCS J2543 00409-3383-02 PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR BOTH IP/OP $36.50 $27.00 $2.84 $36.14 $16.26 $16.26 $16.26 $16.26 $36.14 $36.14 $36.14 $13.09 $36.14 $2.95 $2.95 $3.07 $2.84 $3.34 $36.14 $36.14 $21.38 $36.14 $36.14 $36.14 $36.14 $27.38 $36.14 $36.14 $36.14 $18.07 $18.07 $28.62 $36.14 $28.91 $16.26 $3.18 $36.14 $21.17 $36.14 $36.14 $36.14 $3.18 $36.14 N/A N/A 18307 ERX HCPCS 63700001 00904-6667-61 GABAPENTIN 400 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 18308 ERX HCPCS 63700006 63739-0903-10 GABAPENTIN 300 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 18315 ERX HCPCS J1250 00338-1075-02 DOBUTAMINE IN D5W 2 MG/ML IV SOLN BOTH IP/OP $191.50 $142.00 $13.16 $191.04 $85.97 $85.97 $85.97 $85.97 $191.04 $191.04 $191.04 $13.16 $191.04 $14.14 $14.14 $14.69 $13.60 $15.98 $191.04 $191.04 $113.00 $191.04 $191.04 $191.04 $191.04 $143.63 $191.04 $191.04 $191.04 $95.52 $95.52 $151.30 $191.04 $152.83 $85.97 $15.22 $191.04 $111.07 $191.04 $191.04 $191.04 $15.22 $191.04 N/A N/A 18385 ERX HCPCS 63700001 68084-0697-01 BUPROPION HCL ER (SR) 100 MG PO TB12 BOTH IP/OP $7.50 $6.00 $1.50 $7.19 $7.19 $7.19 $7.19 $7.19 $7.19 $7.19 $7.19 $7.19 $7.19 $7.19 $7.19 $7.19 $7.19 $1.50 $7.19 $2.88 $7.19 $7.19 $7.19 $7.19 $7.19 $5.63 $7.19 $7.19 $7.19 $3.60 $3.60 $5.69 $7.19 $5.75 $4.67 $7.19 $7.19 $4.35 $7.19 $4.31 $7.19 $7.19 $7.19 N/A N/A 18386 ERX HCPCS 63700001 00173-0135-55 BUPROPION HCL ER (SR) 150 MG PO TB12 BOTH IP/OP $41.00 $30.00 $8.51 $40.82 $40.82 $40.82 $40.82 $40.82 $40.82 $40.82 $40.82 $40.82 $40.82 $40.82 $40.82 $40.82 $40.82 $8.51 $40.82 $16.33 $40.82 $40.82 $40.82 $40.82 $40.82 $30.75 $40.82 $40.82 $40.82 $20.41 $20.41 $32.33 $40.82 $32.66 $26.53 $40.82 $40.82 $23.78 $40.82 $24.49 $40.82 $40.82 $40.82 N/A N/A 18400 ERX HCPCS 25000001 67457-0198-05 REMIFENTANIL HCL 2 MG IV SOLR BOTH IP/OP $510.50 $378.00 $90.86 $510.43 $510.43 $510.43 $510.43 $510.43 $510.43 $510.43 $90.86 $510.43 $510.43 $378.84 $378.84 $393.44 $265.93 $106.38 $510.43 $204.17 $510.43 $510.43 $510.43 $510.43 $510.43 $382.88 $510.43 $510.43 $510.43 $255.22 $255.22 $404.26 $510.43 $408.34 $331.78 $510.43 $510.43 $296.09 $510.43 $306.26 $510.43 $510.43 $510.43 N/A N/A 18551 ERX HCPCS 63700001 51079-0771-01 CARVEDILOL 3.125 MG PO TABS BOTH IP/OP $9.50 $7.00 $1.92 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $9.22 $1.92 $9.22 $3.69 $9.22 $9.22 $9.22 $9.22 $9.22 $7.13 $9.22 $9.22 $9.22 $4.61 $4.61 $7.30 $9.22 $7.38 $5.99 $9.22 $9.22 $5.51 $9.22 $5.53 $9.22 $9.22 $9.22 N/A N/A 18621 ERX HCPCS 25000001 00013-8303-04 LATANOPROST 0.005 % OP SOLN BOTH IP/OP $912.50 $675.00 $162.37 $912.17 $912.17 $912.17 $912.17 $912.17 $912.17 $912.17 $162.37 $912.17 $912.17 $677.01 $677.01 $703.10 $475.24 $190.11 $912.17 $364.87 $912.17 $912.17 $912.17 $912.17 $912.17 $684.38 $912.17 $912.17 $912.17 $456.09 $456.09 $722.44 $912.17 $729.74 $592.91 $912.17 $912.17 $529.25 $912.17 $547.30 $912.17 $912.17 $912.17 N/A N/A 18786 ERX HCPCS 63700006 00904-6477-61 DONEPEZIL HCL 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 18787 ERX HCPCS 63700001 60687-0303-01 DONEPEZIL HCL 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 18918 ERX HCPCS 63700001 65862-0536-50 LEVOFLOXACIN 250 MG PO TABS BOTH IP/OP $73.00 $54.00 $15.14 $72.63 $72.63 $72.63 $72.63 $72.63 $72.63 $72.63 $72.63 $72.63 $72.63 $72.63 $72.63 $72.63 $72.63 $15.14 $72.63 $29.05 $72.63 $72.63 $72.63 $72.63 $72.63 $54.75 $72.63 $72.63 $72.63 $36.32 $36.32 $57.52 $72.63 $58.10 $47.21 $72.63 $72.63 $42.34 $72.63 $43.58 $72.63 $72.63 $72.63 N/A N/A 18919 ERX HCPCS 63700001 65862-0537-50 LEVOFLOXACIN 500 MG PO TABS BOTH IP/OP $83.50 $62.00 $17.35 $83.23 $83.23 $83.23 $83.23 $83.23 $83.23 $83.23 $83.23 $83.23 $83.23 $83.23 $83.23 $83.23 $83.23 $17.35 $83.23 $33.29 $83.23 $83.23 $83.23 $83.23 $83.23 $62.63 $83.23 $83.23 $83.23 $41.62 $41.62 $65.92 $83.23 $66.58 $54.10 $83.23 $83.23 $48.43 $83.23 $49.94 $83.23 $83.23 $83.23 N/A N/A 18920 ERX HCPCS 63700001 68084-0342-01 TOPIRAMATE 25 MG PO TABS BOTH IP/OP $9.50 $7.00 $1.89 $9.08 $9.08 $9.08 $9.08 $9.08 $9.08 $9.08 $9.08 $9.08 $9.08 $9.08 $9.08 $9.08 $9.08 $1.89 $9.08 $3.63 $9.08 $9.08 $9.08 $9.08 $9.08 $7.13 $9.08 $9.08 $9.08 $4.54 $4.54 $7.19 $9.08 $7.26 $5.90 $9.08 $9.08 $5.51 $9.08 $5.45 $9.08 $9.08 $9.08 N/A N/A 18921 ERX HCPCS 63700001 68084-0345-21 TOPIRAMATE 200 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 18922 ERX HCPCS 63700001 62756-0711-86 TOPIRAMATE 100 MG PO TABS BOTH IP/OP $30.50 $23.00 $6.26 $30.03 $30.03 $30.03 $30.03 $30.03 $30.03 $30.03 $30.03 $30.03 $30.03 $30.03 $30.03 $30.03 $30.03 $6.26 $30.03 $12.01 $30.03 $30.03 $30.03 $30.03 $30.03 $22.88 $30.03 $30.03 $30.03 $15.02 $15.02 $23.78 $30.03 $24.02 $19.52 $30.03 $30.03 $17.69 $30.03 $18.02 $30.03 $30.03 $30.03 N/A N/A 18925 ERX HCPCS J1956 55150-0156-20 LEVOFLOXACIN 25 MG/ML IV SOLN BOTH IP/OP $88.00 $65.00 $0.98 $87.56 $39.40 $39.40 $39.40 $39.40 $87.56 $87.56 $87.56 $18.25 $87.56 $1.02 $1.02 $1.06 $0.98 $18.25 $87.56 $87.56 $51.79 $87.56 $87.56 $87.56 $87.56 $66.00 $87.56 $87.56 $87.56 $43.78 $43.78 $69.35 $87.56 $70.05 $39.40 $17.38 $87.56 $51.04 $87.56 $87.56 $87.56 $18.25 $87.56 N/A N/A 19176 ERX HCPCS 63700001 00904-6290-61 ATORVASTATIN CALCIUM 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 19177 ERX HCPCS 63700001 60505-2580-09 ATORVASTATIN CALCIUM 40 MG PO TABS BOTH IP/OP $25.00 $19.00 $5.20 $24.95 $24.95 $24.95 $24.95 $24.95 $24.95 $24.95 $24.95 $24.95 $24.95 $24.95 $24.95 $24.95 $24.95 $5.20 $24.95 $9.98 $24.95 $24.95 $24.95 $24.95 $24.95 $18.75 $24.95 $24.95 $24.95 $12.48 $12.48 $19.76 $24.95 $19.96 $16.22 $24.95 $24.95 $14.50 $24.95 $14.97 $24.95 $24.95 $24.95 N/A N/A 19178 ERX HCPCS 63700006 68084-0098-01 ATORVASTATIN CALCIUM 20 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 19226 ERX HCPCS 63700001 59762-1005-01 CABERGOLINE 0.5 MG PO TABS BOTH IP/OP $146.00 $108.00 $30.41 $145.91 $145.91 $145.91 $145.91 $145.91 $145.91 $145.91 $145.91 $145.91 $145.91 $145.91 $145.91 $145.91 $145.91 $30.41 $145.91 $58.36 $145.91 $145.91 $145.91 $145.91 $145.91 $109.50 $145.91 $145.91 $145.91 $72.96 $72.96 $115.56 $145.91 $116.73 $94.84 $145.91 $145.91 $84.68 $145.91 $87.55 $145.91 $145.91 $145.91 N/A N/A 19333 ERX HCPCS J0735 67457-0218-10 CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN BOTH IP/OP $46.00 $34.00 $9.51 $45.62 $45.62 $45.62 $45.62 $45.62 $45.62 $45.62 $24.77 $45.62 $45.62 $35.32 $35.32 $36.68 $33.96 $9.51 $45.62 $18.25 $45.62 $45.62 $45.62 $45.62 $45.62 $34.50 $45.62 $45.62 $45.62 $22.81 $22.81 $36.13 $45.62 $36.50 $20.53 $45.62 $45.62 $26.68 $45.62 $27.37 $45.62 $45.62 $45.62 N/A N/A 19691 ERX HCPCS 25000001 00283-0871-31 BENZOCAINE 20 % MT GEL BOTH IP/OP $39.00 $29.00 $6.92 $38.88 $38.88 $38.88 $38.88 $38.88 $38.88 $38.88 $6.92 $38.88 $38.88 $28.86 $28.86 $29.97 $20.26 $8.10 $38.88 $15.55 $38.88 $38.88 $38.88 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $25.27 $38.88 $38.88 $22.62 $38.88 $23.33 $38.88 $38.88 $38.88 N/A N/A 19704 ERX HCPCS 25000001 00065-0023-15 CARBACHOL 0.01 % IO SOLN BOTH IP/OP $181.50 $134.00 $32.23 $181.08 $181.08 $181.08 $181.08 $181.08 $181.08 $181.08 $32.23 $181.08 $181.08 $134.40 $134.40 $139.58 $94.34 $37.74 $181.08 $72.43 $181.08 $181.08 $181.08 $181.08 $181.08 $136.13 $181.08 $181.08 $181.08 $90.54 $90.54 $143.42 $181.08 $144.86 $117.70 $181.08 $181.08 $105.27 $181.08 $108.65 $181.08 $181.08 $181.08 N/A N/A 19711 ERX HCPCS 25000001 59762-3744-01 CLINDAMYCIN PHOSPHATE 1 % EX LOTN BOTH IP/OP $417.50 $309.00 $74.23 $417.03 $417.03 $417.03 $417.03 $417.03 $417.03 $417.03 $74.23 $417.03 $417.03 $309.52 $309.52 $321.45 $217.27 $86.91 $417.03 $166.81 $417.03 $417.03 $417.03 $417.03 $417.03 $313.13 $417.03 $417.03 $417.03 $208.52 $208.52 $330.29 $417.03 $333.62 $271.07 $417.03 $417.03 $242.15 $417.03 $250.22 $417.03 $417.03 $417.03 N/A N/A 19713 ERX HCPCS j1730 00575-6200-30 DIAZOXIDE 50 MG/ML PO SUSP BOTH IP/OP "$1,474.00" "$1,091.00" $262.29 "$1,473.52" "$1,473.52" "$1,473.52" "$1,473.52" "$1,473.52" "$1,473.52" "$1,473.52" $262.29 "$1,473.52" "$1,473.52" "$1,473.52" "$1,473.52" "$1,473.52" "$1,473.52" $307.10 "$1,473.52" $589.41 "$1,473.52" "$1,473.52" "$1,473.52" "$1,473.52" "$1,473.52" "$1,105.50" "$1,473.52" "$1,473.52" "$1,473.52" $736.76 $736.76 "$1,167.03" "$1,473.52" "$1,178.82" $663.08 "$1,473.52" "$1,473.52" $854.92 "$1,473.52" $884.11 "$1,473.52" "$1,473.52" "$1,473.52" N/A N/A 19714 ERX HCPCS 25000001 61314-0014-05 DICLOFENAC SODIUM 0.1 % OP SOLN BOTH IP/OP $261.50 $194.00 $46.54 $261.45 $261.45 $261.45 $261.45 $261.45 $261.45 $261.45 $46.54 $261.45 $261.45 $194.05 $194.05 $201.53 $136.22 $54.49 $261.45 $104.58 $261.45 $261.45 $261.45 $261.45 $261.45 $196.13 $261.45 $261.45 $261.45 $130.73 $130.73 $207.07 $261.45 $209.16 $169.94 $261.45 $261.45 $151.67 $261.45 $156.87 $261.45 $261.45 $261.45 N/A N/A 19732 ERX HCPCS 25000001 00037-6830-15 HYDROCORTISONE ACETATE 10 % EX FOAM BOTH IP/OP "$1,338.50" $990.00 $238.23 "$1,338.36" "$1,338.36" "$1,338.36" "$1,338.36" "$1,338.36" "$1,338.36" "$1,338.36" $238.23 "$1,338.36" "$1,338.36" $993.33 $993.33 "$1,031.61" $697.29 $278.93 "$1,338.36" $535.34 "$1,338.36" "$1,338.36" "$1,338.36" "$1,338.36" "$1,338.36" "$1,003.88" "$1,338.36" "$1,338.36" "$1,338.36" $669.18 $669.18 "$1,059.98" "$1,338.36" "$1,070.69" $869.93 "$1,338.36" "$1,338.36" $776.33 "$1,338.36" $803.02 "$1,338.36" "$1,338.36" "$1,338.36" N/A N/A 19736 ERX HCPCS J1050 00703-6801-01 MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP BOTH IP/OP $193.50 $143.00 $40.29 $193.32 $86.99 $86.99 $86.99 $86.99 $193.32 $193.32 $193.32 $40.29 $193.32 $88.92 $88.92 $92.34 $85.50 $100.45 $193.32 $193.32 $114.35 $193.32 $193.32 $193.32 $193.32 $145.13 $193.32 $193.32 $193.32 $96.66 $96.66 $153.11 $193.32 $154.66 $86.99 $95.66 $193.32 $112.23 $193.32 $193.32 $193.32 $95.66 $193.32 N/A N/A 19741 ERX HCPCS 63700001 51672-4116-06 METRONIDAZOLE 0.75 % EX GEL BOTH IP/OP $964.50 $714.00 $201.01 $964.49 $964.49 $964.49 $964.49 $964.49 $964.49 $964.49 $964.49 $964.49 $964.49 $964.49 $964.49 $964.49 $964.49 $201.01 $964.49 $385.80 $964.49 $964.49 $964.49 $964.49 $964.49 $723.38 $964.49 $964.49 $964.49 $482.25 $482.25 $763.88 $964.49 $771.59 $626.92 $964.49 $964.49 $559.41 $964.49 $578.69 $964.49 $964.49 $964.49 N/A N/A 19769 ERX HCPCS 25000001 00078-0813-01 TOBRAMYCIN 0.3 % OP OINT BOTH IP/OP $896.50 $663.00 $159.57 $896.44 $896.44 $896.44 $896.44 $896.44 $896.44 $896.44 $159.57 $896.44 $896.44 $665.34 $665.34 $690.98 $467.05 $186.83 $896.44 $358.58 $896.44 $896.44 $896.44 $896.44 $896.44 $672.38 $896.44 $896.44 $896.44 $448.22 $448.22 $709.98 $896.44 $717.15 $582.69 $896.44 $896.44 $519.97 $896.44 $537.86 $896.44 $896.44 $896.44 N/A N/A 19776 ERX HCPCS 25000001 00536-1109-45 UREA 20 % EX CREA BOTH IP/OP $63.00 $47.00 $11.18 $62.80 $62.80 $62.80 $62.80 $62.80 $62.80 $62.80 $11.18 $62.80 $62.80 $46.61 $46.61 $48.41 $32.72 $13.09 $62.80 $25.12 $62.80 $62.80 $62.80 $62.80 $62.80 $47.25 $62.80 $62.80 $62.80 $31.40 $31.40 $49.74 $62.80 $50.24 $40.82 $62.80 $62.80 $36.54 $62.80 $37.68 $62.80 $62.80 $62.80 N/A N/A 19791 ERX HCPCS 63700001 00065-0411-30 POVIDONE-IODINE 5 % OP SOLN BOTH IP/OP $83.50 $62.00 $17.40 $83.47 $83.47 $83.47 $83.47 $83.47 $83.47 $83.47 $83.47 $83.47 $83.47 $83.47 $83.47 $83.47 $83.47 $17.40 $83.47 $33.39 $83.47 $83.47 $83.47 $83.47 $83.47 $62.63 $83.47 $83.47 $83.47 $41.74 $41.74 $66.11 $83.47 $66.78 $54.26 $83.47 $83.47 $48.43 $83.47 $50.08 $83.47 $83.47 $83.47 N/A N/A 19805 ERX HCPCS 63700001 00299-3836-45 METRONIDAZOLE 0.75 % EX CREA BOTH IP/OP "$2,004.00" "$1,483.00" $417.60 "$2,003.75" "$2,003.75" "$2,003.75" "$2,003.75" "$2,003.75" "$2,003.75" "$2,003.75" "$2,003.75" "$2,003.75" "$2,003.75" "$2,003.75" "$2,003.75" "$2,003.75" "$2,003.75" $417.60 "$2,003.75" $801.50 "$2,003.75" "$2,003.75" "$2,003.75" "$2,003.75" "$2,003.75" "$1,503.00" "$2,003.75" "$2,003.75" "$2,003.75" "$1,001.88" "$1,001.88" "$1,586.97" "$2,003.75" "$1,603.00" "$1,302.44" "$2,003.75" "$2,003.75" "$1,162.32" "$2,003.75" "$1,202.25" "$2,003.75" "$2,003.75" "$2,003.75" N/A N/A 19813 ERX HCPCS J7195 70504-0282-05 COAGULATION FACTOR IX (RECOMB IXINITY) 500 UNITS IV SOLR BOTH IP/OP "$2,458.50" "$1,819.00" $512.31 "$2,458.15" "$2,458.15" "$2,458.15" "$2,458.15" "$2,458.15" "$2,458.15" "$2,458.15" $805.00 "$2,458.15" "$2,458.15" $826.80 $826.80 $858.60 $795.00 $512.31 "$2,458.15" $983.26 "$2,458.15" "$2,458.15" "$2,458.15" "$2,458.15" "$2,458.15" "$1,843.88" "$2,458.15" "$2,458.15" "$2,458.15" "$1,229.08" "$1,229.08" "$1,946.85" "$2,458.15" "$1,966.52" "$1,106.17" "$2,458.15" "$2,458.15" "$1,425.93" "$2,458.15" "$1,474.89" "$2,458.15" "$2,458.15" "$2,458.15" N/A N/A 19814 ERX HCPCS J7195 70504-0283-05 COAGULATION FACTOR IX (RECOMB IXINITY) 1000 UNITS IV SOLR BOTH IP/OP "$4,916.50" "$3,638.00" "$1,024.61" "$4,916.30" "$4,916.30" "$4,916.30" "$4,916.30" "$4,916.30" "$4,916.30" "$4,916.30" "$1,610.00" "$4,916.30" "$4,916.30" "$1,653.60" "$1,653.60" "$1,717.20" "$1,590.00" "$1,024.61" "$4,916.30" "$1,966.52" "$4,916.30" "$4,916.30" "$4,916.30" "$4,916.30" "$4,916.30" "$3,687.38" "$4,916.30" "$4,916.30" "$4,916.30" "$2,458.15" "$2,458.15" "$3,893.71" "$4,916.30" "$3,933.04" "$2,212.34" "$4,916.30" "$4,916.30" "$2,851.57" "$4,916.30" "$2,949.78" "$4,916.30" "$4,916.30" "$4,916.30" N/A N/A 19882 ERX HCPCS 63700001 16714-0611-01 SERTRALINE HCL 25 MG PO TABS BOTH IP/OP $12.50 $9.00 $2.57 $12.31 $12.31 $12.31 $12.31 $12.31 $12.31 $12.31 $12.31 $12.31 $12.31 $12.31 $12.31 $12.31 $12.31 $2.57 $12.31 $4.92 $12.31 $12.31 $12.31 $12.31 $12.31 $9.38 $12.31 $12.31 $12.31 $6.16 $6.16 $9.75 $12.31 $9.85 $8.00 $12.31 $12.31 $7.25 $12.31 $7.39 $12.31 $12.31 $12.31 N/A N/A 19928 ERX HCPCS 63700001 99999-6009-61 ITRACONAZOLE 10 MG/ML ORAL SOLUTION BOTH IP/OP $188.50 $139.00 $39.25 $188.34 $188.34 $188.34 $188.34 $188.34 $188.34 $188.34 $188.34 $188.34 $188.34 $188.34 $188.34 $188.34 $188.34 $39.25 $188.34 $75.34 $188.34 $188.34 $188.34 $188.34 $188.34 $141.38 $188.34 $188.34 $188.34 $94.17 $94.17 $149.17 $188.34 $150.67 $122.42 $188.34 $188.34 $109.33 $188.34 $113.00 $188.34 $188.34 $188.34 N/A N/A 20039 ERX HCPCS 25000001 00173-0523-00 SUMATRIPTAN 20 MG/ACT NA SOLN BOTH IP/OP $389.50 $288.00 $69.33 $389.48 $389.48 $389.48 $389.48 $389.48 $389.48 $389.48 $69.33 $389.48 $389.48 $289.07 $289.07 $300.21 $202.92 $81.17 $389.48 $155.79 $389.48 $389.48 $389.48 $389.48 $389.48 $292.13 $389.48 $389.48 $389.48 $194.74 $194.74 $308.47 $389.48 $311.58 $253.16 $389.48 $389.48 $225.91 $389.48 $233.69 $389.48 $389.48 $389.48 N/A N/A 20077 ERX HCPCS 63700001 67108-3565-09 MESNA 400 MG PO TABS BOTH IP/OP $655.00 $485.00 $136.41 $654.51 $654.51 $654.51 $654.51 $654.51 $654.51 $654.51 $654.51 $654.51 $654.51 $654.51 $654.51 $654.51 $654.51 $136.41 $654.51 $261.80 $654.51 $654.51 $654.51 $654.51 $654.51 $491.25 $654.51 $654.51 $654.51 $327.26 $327.26 $518.37 $654.51 $523.61 $425.43 $654.51 $654.51 $379.90 $654.51 $392.71 $654.51 $654.51 $654.51 N/A N/A 20446 ERX HCPCS 63700001 54092-0063-01 ANAGRELIDE HCL 0.5 MG PO CAPS BOTH IP/OP $43.00 $32.00 $8.93 $42.87 $42.87 $42.87 $42.87 $42.87 $42.87 $42.87 $42.87 $42.87 $42.87 $42.87 $42.87 $42.87 $42.87 $8.93 $42.87 $17.15 $42.87 $42.87 $42.87 $42.87 $42.87 $32.25 $42.87 $42.87 $42.87 $21.44 $21.44 $33.95 $42.87 $34.30 $27.87 $42.87 $42.87 $24.94 $42.87 $25.72 $42.87 $42.87 $42.87 N/A N/A 20447 ERX HCPCS 63700001 00172-5240-60 ANAGRELIDE HCL 1 MG PO CAPS BOTH IP/OP $96.00 $71.00 $19.97 $95.80 $95.80 $95.80 $95.80 $95.80 $95.80 $95.80 $95.80 $95.80 $95.80 $95.80 $95.80 $95.80 $95.80 $19.97 $95.80 $38.32 $95.80 $95.80 $95.80 $95.80 $95.80 $72.00 $95.80 $95.80 $95.80 $47.90 $47.90 $75.87 $95.80 $76.64 $62.27 $95.80 $95.80 $55.68 $95.80 $57.48 $95.80 $95.80 $95.80 N/A N/A 20472 ERX HCPCS 25000001 00143-9506-10 ETOMIDATE 2 MG/ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 20566 ERX HCPCS 63700001 50268-0525-15 MELOXICAM 7.5 MG PO TABS BOTH IP/OP $13.50 $10.00 $2.79 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $13.39 $2.79 $13.39 $5.36 $13.39 $13.39 $13.39 $13.39 $13.39 $10.13 $13.39 $13.39 $13.39 $6.70 $6.70 $10.60 $13.39 $10.71 $8.70 $13.39 $13.39 $7.83 $13.39 $8.03 $13.39 $13.39 $13.39 N/A N/A 20580 ERX HCPCS 63700001 50268-0526-15 MELOXICAM 15 MG PO TABS BOTH IP/OP $20.50 $15.00 $4.20 $20.15 $20.15 $20.15 $20.15 $20.15 $20.15 $20.15 $20.15 $20.15 $20.15 $20.15 $20.15 $20.15 $20.15 $4.20 $20.15 $8.06 $20.15 $20.15 $20.15 $20.15 $20.15 $15.38 $20.15 $20.15 $20.15 $10.08 $10.08 $15.96 $20.15 $16.12 $13.10 $20.15 $20.15 $11.89 $20.15 $12.09 $20.15 $20.15 $20.15 N/A N/A 20638 ERX HCPCS 63700001 16714-0359-04 "FALMINA,ORSYTHIA,LEVONORG-ETHINYL ESTRAD 0.1/0.02MG TAB" BOTH IP/OP $140.00 $104.00 $29.17 $139.97 $139.97 $139.97 $139.97 $139.97 $139.97 $139.97 $139.97 $139.97 $139.97 $139.97 $139.97 $139.97 $139.97 $29.17 $139.97 $55.99 $139.97 $139.97 $139.97 $139.97 $139.97 $105.00 $139.97 $139.97 $139.97 $69.99 $69.99 $110.86 $139.97 $111.98 $90.98 $139.97 $139.97 $81.20 $139.97 $83.98 $139.97 $139.97 $139.97 N/A N/A 20718 ERX HCPCS 63700006 68462-0536-70 IMIQUIMOD 5 % EX CREA BOTH IP/OP $145.00 $107.00 $30.13 $144.55 $144.55 $144.55 $144.55 $144.55 $144.55 $144.55 $144.55 $144.55 $144.55 $144.55 $144.55 $144.55 $144.55 $30.13 $144.55 $57.82 $144.55 $144.55 $144.55 $144.55 $144.55 $108.75 $144.55 $144.55 $144.55 $72.28 $72.28 $114.48 $144.55 $115.64 $93.96 $144.55 $144.55 $84.10 $144.55 $86.73 $144.55 $144.55 $144.55 N/A N/A 20887 ERX HCPCS 25000001 00143-9785-10 VALPROATE SODIUM 100 MG/ML IV SOLN BOTH IP/OP $83.00 $61.00 $14.70 $82.57 $82.57 $82.57 $82.57 $82.57 $82.57 $82.57 $14.70 $82.57 $82.57 $61.28 $61.28 $63.64 $43.02 $17.21 $82.57 $33.03 $82.57 $82.57 $82.57 $82.57 $82.57 $62.25 $82.57 $82.57 $82.57 $41.29 $41.29 $65.40 $82.57 $66.06 $53.67 $82.57 $82.57 $48.14 $82.57 $49.54 $82.57 $82.57 $82.57 N/A N/A 20954 ERX HCPCS J1955 54482-0147-01 LEVOCARNITINE 200 MG/ML IV SOLN BOTH IP/OP $176.00 $130.00 $21.06 $175.62 $175.62 $175.62 $175.62 $175.62 $175.62 $175.62 $21.06 $175.62 $175.62 $22.63 $22.63 $23.50 $21.76 $25.56 $175.62 $70.25 $175.62 $175.62 $175.62 $175.62 $175.62 $132.00 $175.62 $175.62 $175.62 $87.81 $87.81 $139.09 $175.62 $140.50 $79.03 $175.62 $175.62 $102.08 $175.62 $105.37 $175.62 $175.62 $175.62 N/A N/A 21044 ERX HCPCS J1950 00074-3663-03 LEUPROLIDE ACETATE (3 MONTH) 11.25 MG IM KIT BOTH IP/OP "$13,703.50" "$10,141.00" "$1,647.37" "$13,703.25" "$6,166.46" "$6,166.46" "$6,166.46" "$6,166.46" "$4,098.03" "$4,098.03" "$4,098.03" "$1,647.37" "$4,098.03" "$4,261.95" "$4,261.95" "$4,425.87" "$4,098.03" "$4,814.53" "$4,098.03" "$4,442.66" "$6,755.70" "$4,098.03" "$13,703.25" "$4,098.03" "$4,302.93" "$10,277.63" "$4,098.03" "$4,098.03" "$4,098.03" "$6,851.63" "$6,851.63" "$10,852.97" "$4,098.03" "$10,962.60" "$6,166.46" "$4,584.88" "$4,098.03" "$7,948.03" "$4,302.93" "$5,942.14" "$4,098.03" "$4,584.88" "$4,098.03" 2039.93 922.35 21045 ERX HCPCS J9217 00074-3346-03 LEUPROLIDE ACETATE (3 MONTH) 22.5 MG IM KIT BOTH IP/OP "$16,329.50" "$12,084.00" $517.68 "$16,329.37" "$7,348.22" "$7,348.22" "$7,348.22" "$7,348.22" $602.20 $602.20 $602.20 $740.50 $602.20 $626.28 $626.28 $650.37 $602.19 $707.48 $602.20 $517.68 "$8,050.38" $602.20 "$16,329.37" $602.20 $632.31 "$12,247.13" $602.20 $602.20 $602.20 "$8,164.69" "$8,164.69" "$12,932.86" $602.20 "$13,063.50" "$7,348.22" $673.73 $602.20 "$9,471.11" $632.31 $873.19 $602.20 $673.73 $602.20 2859.02 1277.69 21057 ERX HCPCS 63700001 60505-3110-00 OLANZAPINE 2.5 MG PO TABS BOTH IP/OP $48.50 $36.00 $10.08 $48.38 $48.38 $48.38 $48.38 $48.38 $48.38 $48.38 $48.38 $48.38 $48.38 $48.38 $48.38 $48.38 $48.38 $10.08 $48.38 $19.35 $48.38 $48.38 $48.38 $48.38 $48.38 $36.38 $48.38 $48.38 $48.38 $24.19 $24.19 $38.32 $48.38 $38.70 $31.45 $48.38 $48.38 $28.13 $48.38 $29.03 $48.38 $48.38 $48.38 N/A N/A 21062 ERX HCPCS 63700001 00904-6085-61 CITALOPRAM HYDROBROMIDE 20 MG PO TABS BOTH IP/OP $12.00 $9.00 $2.43 $11.64 $11.64 $11.64 $11.64 $11.64 $11.64 $11.64 $11.64 $11.64 $11.64 $11.64 $11.64 $11.64 $11.64 $2.43 $11.64 $4.66 $11.64 $11.64 $11.64 $11.64 $11.64 $9.00 $11.64 $11.64 $11.64 $5.82 $5.82 $9.22 $11.64 $9.31 $7.57 $11.64 $11.64 $6.96 $11.64 $6.98 $11.64 $11.64 $11.64 N/A N/A 21063 ERX HCPCS J0456 00069-3150-83 AZITHROMYCIN 500 MG IV SOLR BOTH IP/OP $22.00 $16.00 $2.63 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $2.74 $2.74 $2.84 $2.63 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $22.00 $22.00 N/A N/A 21064 ERX HCPCS 25000001 00904-6488-38 LUBRIFRESH P.M. OP OINT BOTH IP/OP $28.00 $21.00 $4.98 $27.96 $27.96 $27.96 $27.96 $27.96 $27.96 $27.96 $4.98 $27.96 $27.96 $20.75 $20.75 $21.55 $14.57 $5.83 $27.96 $11.18 $27.96 $27.96 $27.96 $27.96 $27.96 $21.00 $27.96 $27.96 $27.96 $13.98 $13.98 $22.14 $27.96 $22.37 $18.17 $27.96 $27.96 $16.24 $27.96 $16.78 $27.96 $27.96 $27.96 N/A N/A 21086 ERX HCPCS 63700001 60687-0659-01 FLUOXETINE HCL 40 MG PO CAPS BOTH IP/OP $16.00 $12.00 $3.27 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $15.67 $3.27 $15.67 $6.27 $15.67 $15.67 $15.67 $15.67 $15.67 $12.00 $15.67 $15.67 $15.67 $7.84 $7.84 $12.41 $15.67 $12.54 $10.19 $15.67 $15.67 $9.28 $15.67 $9.40 $15.67 $15.67 $15.67 3654.17 1358.54 21108 ERX HCPCS J9217 00074-3683-03 LEUPROLIDE ACETATE (4 MONTH) 30 MG IM KIT BOTH IP/OP "$21,773.00" "$16,112.00" $690.24 "$21,772.55" "$9,797.65" "$9,797.65" "$9,797.65" "$9,797.65" $802.93 $802.93 $802.93 $987.33 $802.93 $835.04 $835.04 $867.15 $802.92 $943.30 $802.93 $690.24 "$10,733.87" $802.93 "$21,772.55" $802.93 $843.08 "$16,329.75" $802.93 $802.93 $802.93 "$10,886.28" "$10,886.28" "$17,243.86" $802.93 "$17,418.04" "$9,797.65" $898.31 $802.93 "$12,628.34" $843.08 "$1,164.25" $802.93 $898.31 $802.93 N/A N/A 21135 ERX HCPCS 25000001 47335-0788-91 DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN BOTH IP/OP $744.00 $551.00 $132.38 $743.68 $743.68 $743.68 $743.68 $743.68 $743.68 $743.68 $132.38 $743.68 $743.68 $551.96 $551.96 $573.23 $387.46 $154.99 $743.68 $297.47 $743.68 $743.68 $743.68 $743.68 $743.68 $558.00 $743.68 $743.68 $743.68 $371.84 $371.84 $588.99 $743.68 $594.94 $483.39 $743.68 $743.68 $431.52 $743.68 $446.21 $743.68 $743.68 $743.68 N/A N/A 21284 ERX HCPCS 63700001 13107-0068-01 AMPHETAMINE-DEXTROAMPHETAMINE 5 MG PO TABS BOTH IP/OP $7.50 $6.00 $1.54 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $7.41 $1.54 $7.41 $2.96 $7.41 $7.41 $7.41 $7.41 $7.41 $5.63 $7.41 $7.41 $7.41 $3.71 $3.71 $5.87 $7.41 $5.93 $4.82 $7.41 $7.41 $4.35 $7.41 $4.45 $7.41 $7.41 $7.41 N/A N/A 21300 ERX HCPCS 63700001 00904-5448-61 PENTOXIFYLLINE ER 400 MG PO TBCR BOTH IP/OP $6.50 $5.00 $1.35 $6.48 $6.48 $6.48 $6.48 $6.48 $6.48 $6.48 $6.48 $6.48 $6.48 $6.48 $6.48 $6.48 $6.48 $1.35 $6.48 $2.59 $6.48 $6.48 $6.48 $6.48 $6.48 $4.88 $6.48 $6.48 $6.48 $3.24 $3.24 $5.13 $6.48 $5.18 $4.21 $6.48 $6.48 $3.77 $6.48 $3.89 $6.48 $6.48 $6.48 N/A N/A 21321 ERX HCPCS 63700001 52544-0256-54 PROGESTERONE 8 % VA GEL BOTH IP/OP $143.00 $106.00 $29.75 $142.73 $142.73 $142.73 $142.73 $142.73 $142.73 $142.73 $142.73 $142.73 $142.73 $142.73 $142.73 $142.73 $142.73 $29.75 $142.73 $57.09 $142.73 $142.73 $142.73 $142.73 $142.73 $107.25 $142.73 $142.73 $142.73 $71.37 $71.37 $113.04 $142.73 $114.18 $92.77 $142.73 $142.73 $82.94 $142.73 $85.64 $142.73 $142.73 $142.73 N/A N/A 21374 ERX HCPCS J7517 00004-0260-01 MYCOPHENOLATE MOFETIL 500 MG PO TABS BOTH IP/OP $86.00 $64.00 $0.60 $85.93 $85.93 $85.93 $85.93 $85.93 $85.93 $85.93 $0.64 $85.93 $85.93 $0.62 $0.62 $0.65 $0.60 $17.91 $85.93 $34.37 $85.93 $85.93 $85.93 $85.93 $85.93 $64.50 $85.93 $85.93 $85.93 $42.97 $42.97 $68.06 $85.93 $68.74 $38.67 $85.93 $85.93 $49.88 $85.93 $51.56 $85.93 $85.93 $85.93 N/A N/A 21381 ERX HCPCS 25000001 10858-0081-10 BARIUM SULFATE PO CAPS BOTH IP/OP $86.00 $64.00 $15.30 $85.97 $85.97 $85.97 $85.97 $85.97 $85.97 $85.97 $15.30 $85.97 $85.97 $63.81 $63.81 $66.27 $44.79 $17.92 $85.97 $34.39 $85.97 $85.97 $85.97 $85.97 $85.97 $64.50 $85.97 $85.97 $85.97 $42.99 $42.99 $68.09 $85.97 $68.78 $55.88 $85.97 $85.97 $49.88 $85.97 $51.58 $85.97 $85.97 $85.97 N/A N/A 21509 ERX HCPCS 63700001 00078-0249-15 LETROZOLE 2.5 MG PO TABS BOTH IP/OP $123.00 $91.00 $25.60 $122.84 $122.84 $122.84 $122.84 $122.84 $122.84 $122.84 $122.84 $122.84 $122.84 $122.84 $122.84 $122.84 $122.84 $25.60 $122.84 $49.14 $122.84 $122.84 $122.84 $122.84 $122.84 $92.25 $122.84 $122.84 $122.84 $61.42 $61.42 $97.29 $122.84 $98.27 $79.85 $122.84 $122.84 $71.34 $122.84 $73.70 $122.84 $122.84 $122.84 N/A N/A 21570 ERX HCPCS J9030 00052-0602-02 BCG LIVE 50 MG IS SUSR BOTH IP/OP $654.50 $484.00 $136.32 $654.03 $294.31 $294.31 $294.31 $294.31 $654.03 $654.03 $654.03 $136.32 $654.03 $147.16 $147.16 $152.82 $141.50 $166.24 $654.03 $654.03 $386.86 $654.03 $654.03 $654.03 $654.03 $490.88 $654.03 $654.03 $654.03 $327.02 $327.02 $517.99 $654.03 $523.22 $294.31 $158.31 $654.03 $379.61 $654.03 $654.03 $654.03 $158.31 $654.03 N/A N/A 21688 ERX HCPCS 63700006 43547-0268-10 ROPINIROLE HCL 0.25 MG PO TABS BOTH IP/OP $11.00 $8.00 $2.25 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $2.25 $10.80 $4.32 $10.80 $10.80 $10.80 $10.80 $10.80 $8.25 $10.80 $10.80 $10.80 $5.40 $5.40 $8.55 $10.80 $8.64 $7.02 $10.80 $10.80 $6.38 $10.80 $6.48 $10.80 $10.80 $10.80 N/A N/A 21689 ERX HCPCS 63700001 68462-0255-01 ROPINIROLE HCL 1 MG PO TABS BOTH IP/OP $11.00 $8.00 $2.26 $10.83 $10.83 $10.83 $10.83 $10.83 $10.83 $10.83 $10.83 $10.83 $10.83 $10.83 $10.83 $10.83 $10.83 $2.26 $10.83 $4.33 $10.83 $10.83 $10.83 $10.83 $10.83 $8.25 $10.83 $10.83 $10.83 $5.42 $5.42 $8.58 $10.83 $8.66 $7.04 $10.83 $10.83 $6.38 $10.83 $6.50 $10.83 $10.83 $10.83 N/A N/A 21690 ERX HCPCS 63700001 43547-0271-10 ROPINIROLE HCL 2 MG PO TABS BOTH IP/OP $11.00 $8.00 $2.25 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $2.25 $10.80 $4.32 $10.80 $10.80 $10.80 $10.80 $10.80 $8.25 $10.80 $10.80 $10.80 $5.40 $5.40 $8.55 $10.80 $8.64 $7.02 $10.80 $10.80 $6.38 $10.80 $6.48 $10.80 $10.80 $10.80 N/A N/A 21691 ERX HCPCS 63700001 43547-0274-10 ROPINIROLE HCL 5 MG PO TABS BOTH IP/OP $11.50 $9.00 $2.34 $11.24 $11.24 $11.24 $11.24 $11.24 $11.24 $11.24 $11.24 $11.24 $11.24 $11.24 $11.24 $11.24 $11.24 $2.34 $11.24 $4.50 $11.24 $11.24 $11.24 $11.24 $11.24 $8.63 $11.24 $11.24 $11.24 $5.62 $5.62 $8.90 $11.24 $8.99 $7.31 $11.24 $11.24 $6.67 $11.24 $6.74 $11.24 $11.24 $11.24 N/A N/A 21800 ERX HCPCS 63700001 43547-0269-10 ROPINIROLE HCL 0.5 MG PO TABS BOTH IP/OP $11.00 $8.00 $2.25 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $2.25 $10.80 $4.32 $10.80 $10.80 $10.80 $10.80 $10.80 $8.25 $10.80 $10.80 $10.80 $5.40 $5.40 $8.55 $10.80 $8.64 $7.02 $10.80 $10.80 $6.38 $10.80 $6.48 $10.80 $10.80 $10.80 N/A N/A 21810 ERX HCPCS 63700001 31722-0506-60 COMBIVIR: LAMIVUDINE-ZIDOVUDINE 150-300 MG PO TABS BOTH IP/OP $67.50 $50.00 $13.98 $67.08 $67.08 $67.08 $67.08 $67.08 $67.08 $67.08 $67.08 $67.08 $67.08 $67.08 $67.08 $67.08 $67.08 $13.98 $67.08 $26.83 $67.08 $67.08 $67.08 $67.08 $67.08 $50.63 $67.08 $67.08 $67.08 $33.54 $33.54 $53.13 $67.08 $53.66 $43.60 $67.08 $67.08 $39.15 $67.08 $40.25 $67.08 $67.08 $67.08 N/A N/A 21823 ERX HCPCS 63700001 00310-0275-10 QUETIAPINE FUMARATE 25 MG PO TABS BOTH IP/OP $20.50 $15.00 $4.20 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $20.14 $4.20 $20.14 $8.06 $20.14 $20.14 $20.14 $20.14 $20.14 $15.38 $20.14 $20.14 $20.14 $10.07 $10.07 $15.95 $20.14 $16.11 $13.09 $20.14 $20.14 $11.89 $20.14 $12.08 $20.14 $20.14 $20.14 N/A N/A 21824 ERX HCPCS 63700001 00904-6640-61 QUETIAPINE FUMARATE 100 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 21825 ERX HCPCS 63700001 47335-0905-88 QUETIAPINE FUMARATE 200 MG PO TABS BOTH IP/OP $56.00 $41.00 $11.65 $55.89 $55.89 $55.89 $55.89 $55.89 $55.89 $55.89 $55.89 $55.89 $55.89 $55.89 $55.89 $55.89 $55.89 $11.65 $55.89 $22.36 $55.89 $55.89 $55.89 $55.89 $55.89 $42.00 $55.89 $55.89 $55.89 $27.95 $27.95 $44.26 $55.89 $44.71 $36.33 $55.89 $55.89 $32.48 $55.89 $33.53 $55.89 $55.89 $55.89 1253.52 587.65 21827 ERX HCPCS 25000001 63459-0404-30 TIAGABINE HCL 4 MG PO TABS BOTH IP/OP $62.00 $46.00 $10.99 $61.75 $61.75 $61.75 $61.75 $61.75 $61.75 $61.75 $10.99 $61.75 $61.75 $45.83 $45.83 $47.60 $32.17 $12.87 $61.75 $24.70 $61.75 $61.75 $61.75 $61.75 $61.75 $46.50 $61.75 $61.75 $61.75 $30.88 $30.88 $48.91 $61.75 $49.40 $40.14 $61.75 $61.75 $35.96 $61.75 $37.05 $61.75 $61.75 $61.75 N/A N/A 21867 ERX HCPCS 63700001 76336-0455-18 METYRAPONE 250 MG PO CAPS BOTH IP/OP $199.00 $147.00 $41.45 $198.90 $198.90 $198.90 $198.90 $198.90 $198.90 $198.90 $198.90 $198.90 $198.90 $198.90 $198.90 $198.90 $198.90 $41.45 $198.90 $79.56 $198.90 $198.90 $198.90 $198.90 $198.90 $149.25 $198.90 $198.90 $198.90 $99.45 $99.45 $157.53 $198.90 $159.12 $129.29 $198.90 $198.90 $115.42 $198.90 $119.34 $198.90 $198.90 $198.90 N/A N/A 21900 ERX HCPCS J0289 62756-0233-01 AMPHOTERICIN B LIPOSOME 50 MG IV SUSR BOTH IP/OP $923.50 $683.00 $143.75 $923.19 $923.19 $923.19 $923.19 $923.19 $923.19 $923.19 $143.75 $923.19 $923.19 $153.24 $153.24 $159.14 $147.35 $192.40 $923.19 $369.28 $923.19 $923.19 $923.19 $923.19 $923.19 $692.63 $923.19 $923.19 $923.19 $461.60 $461.60 $731.17 $923.19 $738.55 $415.44 $923.19 $923.19 $535.63 $923.19 $553.91 $923.19 $923.19 $923.19 N/A N/A 22120 ERX HCPCS 90675 58160-0964-12 "RABIES VACCINE, PCEC IM SUSR" BOTH IP/OP "$1,374.00" "$1,017.00" $327.53 "$1,373.65" "$1,373.65" "$1,373.65" "$1,373.65" "$1,373.65" "$1,373.65" "$1,373.65" $327.53 "$1,373.65" "$1,373.65" $355.63 $355.63 $369.31 $341.95 $401.74 "$1,373.65" $549.46 "$1,373.65" "$1,373.65" "$1,373.65" "$1,373.65" "$1,373.65" "$1,030.50" "$1,373.65" "$1,373.65" "$1,373.65" $686.83 $686.83 "$1,087.93" "$1,373.65" "$1,098.92" $618.14 "$1,373.65" "$1,373.65" $796.92 "$1,373.65" $824.19 "$1,373.65" "$1,373.65" "$1,373.65" N/A N/A 22142 ERX HCPCS 25000001 00904-6294-61 CLOPIDOGREL BISULFATE 75 MG PO TABS BOTH IP/OP $19.00 $14.00 $3.36 $18.85 $18.85 $18.85 $18.85 $18.85 $18.85 $18.85 $3.36 $18.85 $18.85 $13.99 $13.99 $14.53 $9.82 $3.93 $18.85 $7.54 $18.85 $18.85 $18.85 $18.85 $18.85 $14.25 $18.85 $18.85 $18.85 $9.43 $9.43 $14.93 $18.85 $15.08 $12.25 $18.85 $18.85 $11.02 $18.85 $11.31 $18.85 $18.85 $18.85 N/A N/A 22148 ERX HCPCS 63700001 69543-0120-10 ACARBOSE 25 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 22220 ERX HCPCS 25000001 50484-0810-15 BECAPLERMIN 0.01 % EX GEL BOTH IP/OP "$3,621.00" "$2,680.00" $644.48 "$3,620.69" "$3,620.69" "$3,620.69" "$3,620.69" "$3,620.69" "$3,620.69" "$3,620.69" $644.48 "$3,620.69" "$3,620.69" "$2,687.28" "$2,687.28" "$2,790.83" "$1,886.38" $754.59 "$3,620.69" "$1,448.28" "$3,620.69" "$3,620.69" "$3,620.69" "$3,620.69" "$3,620.69" "$2,715.75" "$3,620.69" "$3,620.69" "$3,620.69" "$1,810.35" "$1,810.35" "$2,867.59" "$3,620.69" "$2,896.55" "$2,353.45" "$3,620.69" "$3,620.69" "$2,100.18" "$3,620.69" "$2,172.41" "$3,620.69" "$3,620.69" "$3,620.69" 3711.9 1722.46 22289 ERX HCPCS 63700001 16714-0391-01 CEFDINIR 300 MG PO CAPS BOTH IP/OP $22.50 $17.00 $4.61 $22.10 $22.10 $22.10 $22.10 $22.10 $22.10 $22.10 $22.10 $22.10 $22.10 $22.10 $22.10 $22.10 $22.10 $4.61 $22.10 $8.84 $22.10 $22.10 $22.10 $22.10 $22.10 $16.88 $22.10 $22.10 $22.10 $11.05 $11.05 $17.50 $22.10 $17.68 $14.37 $22.10 $22.10 $13.05 $22.10 $13.26 $22.10 $22.10 $22.10 N/A N/A 22290 ERX HCPCS 25000001 00093-4136-73 CEFDINIR 125 MG/5ML PO SUSR BOTH IP/OP $289.50 $214.00 $51.49 $289.27 $289.27 $289.27 $289.27 $289.27 $289.27 $289.27 $51.49 $289.27 $289.27 $214.70 $214.70 $222.97 $150.71 $60.29 $289.27 $115.71 $289.27 $289.27 $289.27 $289.27 $289.27 $217.13 $289.27 $289.27 $289.27 $144.64 $144.64 $229.10 $289.27 $231.42 $188.03 $289.27 $289.27 $167.91 $289.27 $173.56 $289.27 $289.27 $289.27 N/A N/A 22456 ERX HCPCS 63700001 71321-0803-20 CALCIUM ACETATE (PHOS BINDER) 667 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 22469 ERX HCPCS 63700001 00904-5224-52 LACTASE 3000 UNITS PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 22472 ERX HCPCS J1885 00409-3793-01 KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.32 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.32 $22.00 $0.57 $0.57 $0.59 $0.55 $0.65 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.62 $22.00 $12.76 $22.00 $22.00 $22.00 $0.62 $22.00 N/A N/A 22509 ERX HCPCS 63700001 68084-0875-01 MONTELUKAST SODIUM 10 MG PO TABS BOTH IP/OP $24.00 $18.00 $4.96 $23.79 $23.79 $23.79 $23.79 $23.79 $23.79 $23.79 $23.79 $23.79 $23.79 $23.79 $23.79 $23.79 $23.79 $4.96 $23.79 $9.52 $23.79 $23.79 $23.79 $23.79 $23.79 $18.00 $23.79 $23.79 $23.79 $11.90 $11.90 $18.84 $23.79 $19.03 $15.46 $23.79 $23.79 $13.92 $23.79 $14.27 $23.79 $23.79 $23.79 N/A N/A 22510 ERX HCPCS 63700001 57237-0213-30 MONTELUKAST SODIUM 5 MG PO CHEW BOTH IP/OP $22.00 $16.00 $4.53 $21.73 $21.73 $21.73 $21.73 $21.73 $21.73 $21.73 $21.73 $21.73 $21.73 $21.73 $21.73 $21.73 $21.73 $4.53 $21.73 $8.69 $21.73 $21.73 $21.73 $21.73 $21.73 $16.50 $21.73 $21.73 $21.73 $10.87 $10.87 $17.21 $21.73 $17.38 $14.12 $21.73 $21.73 $12.76 $21.73 $13.04 $21.73 $21.73 $21.73 1051.58 455.9 22560 ERX HCPCS 63700001 99999-6005-56 SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP BOTH IP/OP $88.50 $65.00 $18.37 $88.12 $88.12 $88.12 $88.12 $88.12 $88.12 $88.12 $88.12 $88.12 $88.12 $88.12 $88.12 $88.12 $88.12 $18.37 $88.12 $35.25 $88.12 $88.12 $88.12 $88.12 $88.12 $66.38 $88.12 $88.12 $88.12 $44.06 $44.06 $69.79 $88.12 $70.50 $57.28 $88.12 $88.12 $51.33 $88.12 $52.87 $88.12 $88.12 $88.12 N/A N/A 22953 ERX HCPCS 63700001 00078-0722-10 BRINZOLAMIDE 1 % OP SUSP BOTH IP/OP "$1,306.50" $967.00 $272.20 "$1,306.06" "$1,306.06" "$1,306.06" "$1,306.06" "$1,306.06" "$1,306.06" "$1,306.06" "$1,306.06" "$1,306.06" "$1,306.06" "$1,306.06" "$1,306.06" "$1,306.06" "$1,306.06" $272.20 "$1,306.06" $522.42 "$1,306.06" "$1,306.06" "$1,306.06" "$1,306.06" "$1,306.06" $979.88 "$1,306.06" "$1,306.06" "$1,306.06" $653.03 $653.03 "$1,034.40" "$1,306.06" "$1,044.85" $848.94 "$1,306.06" "$1,306.06" $757.77 "$1,306.06" $783.64 "$1,306.06" "$1,306.06" "$1,306.06" N/A N/A 22959 ERX HCPCS 25000001 99999-6004-88 PAROXETINE HCL 10 MG/5ML PO SUSP BOTH IP/OP $272.00 $201.00 $48.33 $271.51 $271.51 $271.51 $271.51 $271.51 $271.51 $271.51 $48.33 $271.51 $271.51 $201.51 $201.51 $209.28 $141.46 $56.59 $271.51 $108.60 $271.51 $271.51 $271.51 $271.51 $271.51 $204.00 $271.51 $271.51 $271.51 $135.76 $135.76 $215.04 $271.51 $217.21 $176.48 $271.51 $271.51 $157.76 $271.51 $162.91 $271.51 $271.51 $271.51 N/A N/A 22981 ERX HCPCS J0287 57665-0101-41 AMPHOTERICIN B LIPID 5 MG/ML IV SUSP BOTH IP/OP $437.50 $324.00 $95.00 $437.22 $437.22 $437.22 $437.22 $437.22 $437.22 $437.22 $95.00 $437.22 $437.22 $99.84 $99.84 $103.68 $96.00 $112.78 $437.22 $174.89 $437.22 $437.22 $437.22 $437.22 $437.22 $328.13 $437.22 $437.22 $437.22 $218.61 $218.61 $346.28 $437.22 $349.78 $196.75 $437.22 $437.22 $253.75 $437.22 $262.33 $437.22 $437.22 $437.22 N/A N/A 22982 ERX HCPCS 25000001 65862-0946-01 DORZOLAMIDE HCL-TIMOLOL MAL 22.3-6.8 MG/ML OP SOLN BOTH IP/OP $423.50 $313.00 $75.35 $423.34 $423.34 $423.34 $423.34 $423.34 $423.34 $423.34 $75.35 $423.34 $423.34 $314.20 $314.20 $326.31 $220.56 $88.23 $423.34 $169.34 $423.34 $423.34 $423.34 $423.34 $423.34 $317.63 $423.34 $423.34 $423.34 $211.67 $211.67 $335.29 $423.34 $338.67 $275.17 $423.34 $423.34 $245.63 $423.34 $254.00 $423.34 $423.34 $423.34 N/A N/A 22993 ERX HCPCS J8520 00004-1100-20 CAPECITABINE 150 MG PO TABS BOTH IP/OP $70.50 $52.00 $0.37 $70.29 $70.29 $70.29 $70.29 $70.29 $70.29 $70.29 $0.59 $70.29 $70.29 $0.38 $0.38 $0.40 $0.37 $14.65 $70.29 $28.12 $70.29 $70.29 $70.29 $70.29 $70.29 $52.88 $70.29 $70.29 $70.29 $35.15 $35.15 $55.67 $70.29 $56.23 $31.63 $70.29 $70.29 $40.89 $70.29 $42.17 $70.29 $70.29 $70.29 N/A N/A 22994 ERX HCPCS J8521 00004-1101-50 CAPECITABINE 500 MG PO TABS BOTH IP/OP $194.50 $144.00 $0.84 $194.12 $194.12 $194.12 $194.12 $194.12 $194.12 $194.12 $0.92 $194.12 $194.12 $0.87 $0.87 $0.91 $0.84 $40.46 $194.12 $77.65 $194.12 $194.12 $194.12 $194.12 $194.12 $145.88 $194.12 $194.12 $194.12 $97.06 $97.06 $153.74 $194.12 $155.30 $87.35 $194.12 $194.12 $112.81 $194.12 $116.47 $194.12 $194.12 $194.12 N/A N/A 23009 ERX HCPCS 63700001 00003-6335-17 HYDROXYUREA 200 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 23010 ERX HCPCS 63700001 00003-6336-17 HYDROXYUREA 300 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 23011 ERX HCPCS 63700001 00003-6337-17 HYDROXYUREA 400 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 23036 ERX HCPCS 25000001 51552-0071-05 POTASSIUM HYDROXIDE 10 % SOLN BOTH IP/OP $227.50 $168.00 $40.46 $227.33 $227.33 $227.33 $227.33 $227.33 $227.33 $227.33 $40.46 $227.33 $227.33 $168.72 $168.72 $175.23 $118.44 $47.38 $227.33 $90.93 $227.33 $227.33 $227.33 $227.33 $227.33 $170.63 $227.33 $227.33 $227.33 $113.67 $113.67 $180.05 $227.33 $181.86 $147.76 $227.33 $227.33 $131.95 $227.33 $136.40 $227.33 $227.33 $227.33 N/A N/A 23065 ERX HCPCS 63700001 19076-9022-00 ELTA EX CREA BOTH IP/OP $34.00 $25.00 $7.05 $33.83 $33.83 $33.83 $33.83 $33.83 $33.83 $33.83 $33.83 $33.83 $33.83 $33.83 $33.83 $33.83 $33.83 $7.05 $33.83 $13.53 $33.83 $33.83 $33.83 $33.83 $33.83 $25.50 $33.83 $33.83 $33.83 $16.92 $16.92 $26.79 $33.83 $27.06 $21.99 $33.83 $33.83 $19.72 $33.83 $20.30 $33.83 $33.83 $33.83 387.47 170.93 23365 ERX HCPCS 63700001 00088-2102-01 RIFAPENTINE 150 MG PO TABS BOTH IP/OP $39.50 $29.00 $8.21 $39.39 $39.39 $39.39 $39.39 $39.39 $39.39 $39.39 $39.39 $39.39 $39.39 $39.39 $39.39 $39.39 $39.39 $8.21 $39.39 $15.76 $39.39 $39.39 $39.39 $39.39 $39.39 $29.63 $39.39 $39.39 $39.39 $19.70 $19.70 $31.20 $39.39 $31.51 $25.60 $39.39 $39.39 $22.91 $39.39 $23.63 $39.39 $39.39 $39.39 N/A N/A 23449 ERX HCPCS 63700001 65862-0054-30 SIMVASTATIN 80 MG PO TABS BOTH IP/OP $21.50 $16.00 $4.42 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $4.42 $21.19 $8.48 $21.19 $21.19 $21.19 $21.19 $21.19 $16.13 $21.19 $21.19 $21.19 $10.60 $10.60 $16.78 $21.19 $16.95 $13.77 $21.19 $21.19 $12.47 $21.19 $12.71 $21.19 $21.19 $21.19 N/A N/A 23458 ERX HCPCS 63700001 65862-0015-01 AMOXICILLIN 875 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 23461 ERX HCPCS 25000001 00496-0882-06 LIDOCAINE 4 % EX CREA BOTH IP/OP $36.50 $27.00 $6.46 $36.29 $36.29 $36.29 $36.29 $36.29 $36.29 $36.29 $6.46 $36.29 $36.29 $26.93 $26.93 $27.97 $18.91 $7.56 $36.29 $14.52 $36.29 $36.29 $36.29 $36.29 $36.29 $27.38 $36.29 $36.29 $36.29 $18.15 $18.15 $28.74 $36.29 $29.03 $23.59 $36.29 $36.29 $21.17 $36.29 $21.77 $36.29 $36.29 $36.29 N/A N/A 23796 ERX HCPCS J1745 57894-0030-01 INFLIXIMAB 100 MG IV SOLR BOTH IP/OP "$3,265.50" "$2,416.00" $340.43 "$3,265.22" "$1,469.35" "$1,469.35" "$1,469.35" "$1,469.35" $378.76 $378.76 $378.76 $668.93 $378.76 $393.95 $393.95 $409.10 $378.80 $445.03 $378.76 $340.43 "$1,609.75" $378.76 "$3,265.22" $378.76 $397.70 "$2,449.13" $378.76 $378.76 $378.76 "$1,632.61" "$1,632.61" "$2,586.05" $378.76 "$2,612.18" "$1,469.35" $423.80 $378.76 "$1,893.99" $397.70 $549.20 $378.76 $423.80 $378.76 N/A N/A 23814 ERX HCPCS 63700001 00173-0675-02 ATOVAQUONE-PROGUANIL HCL 250-100 MG PO TABS BOTH IP/OP $36.00 $27.00 $7.42 $35.60 $35.60 $35.60 $35.60 $35.60 $35.60 $35.60 $35.60 $35.60 $35.60 $35.60 $35.60 $35.60 $35.60 $7.42 $35.60 $14.24 $35.60 $35.60 $35.60 $35.60 $35.60 $27.00 $35.60 $35.60 $35.60 $17.80 $17.80 $28.20 $35.60 $28.48 $23.14 $35.60 $35.60 $20.88 $35.60 $21.36 $35.60 $35.60 $35.60 N/A N/A 23872 ERX HCPCS 63700001 00088-2160-30 LEFLUNOMIDE 10 MG PO TABS BOTH IP/OP $214.50 $159.00 $44.60 $214.01 $214.01 $214.01 $214.01 $214.01 $214.01 $214.01 $214.01 $214.01 $214.01 $214.01 $214.01 $214.01 $214.01 $44.60 $214.01 $85.60 $214.01 $214.01 $214.01 $214.01 $214.01 $160.88 $214.01 $214.01 $214.01 $107.01 $107.01 $169.50 $214.01 $171.21 $139.11 $214.01 $214.01 $124.41 $214.01 $128.41 $214.01 $214.01 $214.01 N/A N/A 23873 ERX HCPCS 63700006 60505-2503-01 LEFLUNOMIDE 20 MG PO TABS BOTH IP/OP $71.00 $53.00 $14.77 $70.88 $70.88 $70.88 $70.88 $70.88 $70.88 $70.88 $70.88 $70.88 $70.88 $70.88 $70.88 $70.88 $70.88 $14.77 $70.88 $28.35 $70.88 $70.88 $70.88 $70.88 $70.88 $53.25 $70.88 $70.88 $70.88 $35.44 $35.44 $56.14 $70.88 $56.70 $46.07 $70.88 $70.88 $41.18 $70.88 $42.53 $70.88 $70.88 $70.88 N/A N/A 23876 ERX HCPCS 25000001 00409-7419-03 DEXTRAN 40 IN SALINE 10-0.9 % IV SOLN BOTH IP/OP $159.50 $118.00 $28.34 $159.20 $159.20 $159.20 $159.20 $159.20 $159.20 $159.20 $28.34 $159.20 $159.20 $118.16 $118.16 $122.71 $82.94 $33.18 $159.20 $63.68 $159.20 $159.20 $159.20 $159.20 $159.20 $119.63 $159.20 $159.20 $159.20 $79.60 $79.60 $126.09 $159.20 $127.36 $103.48 $159.20 $159.20 $92.51 $159.20 $95.52 $159.20 $159.20 $159.20 N/A N/A 23901 ERX HCPCS 63700001 61269-0460-90 ORLISTAT 120 MG PO CAPS BOTH IP/OP $43.50 $32.00 $9.05 $43.42 $43.42 $43.42 $43.42 $43.42 $43.42 $43.42 $43.42 $43.42 $43.42 $43.42 $43.42 $43.42 $43.42 $9.05 $43.42 $17.37 $43.42 $43.42 $43.42 $43.42 $43.42 $32.63 $43.42 $43.42 $43.42 $21.71 $21.71 $34.39 $43.42 $34.74 $28.22 $43.42 $43.42 $25.23 $43.42 $26.05 $43.42 $43.42 $43.42 N/A N/A 23968 ERX HCPCS 25000001 00004-0298-09 MYCOPHENOLATE MOFETIL HCL 500 MG IV SOLR BOTH IP/OP $783.00 $579.00 $139.31 $782.63 $782.63 $782.63 $782.63 $782.63 $782.63 $782.63 $139.31 $782.63 $782.63 $580.87 $580.87 $603.25 $407.75 $163.11 $782.63 $313.05 $782.63 $782.63 $782.63 $782.63 $782.63 $587.25 $782.63 $782.63 $782.63 $391.32 $391.32 $619.84 $782.63 $626.10 $508.71 $782.63 $782.63 $454.14 $782.63 $469.58 $782.63 $782.63 $782.63 N/A N/A 24061 ERX HCPCS 25000001 24357-0300-30 POTASSIUM ALUM POWD BOTH IP/OP $294.00 $218.00 $52.25 $293.56 $293.56 $293.56 $293.56 $293.56 $293.56 $293.56 $52.25 $293.56 $293.56 $217.88 $217.88 $226.28 $152.94 $61.18 $293.56 $117.42 $293.56 $293.56 $293.56 $293.56 $293.56 $220.50 $293.56 $293.56 $293.56 $146.78 $146.78 $232.50 $293.56 $234.85 $190.81 $293.56 $293.56 $170.52 $293.56 $176.14 $293.56 $293.56 $293.56 N/A N/A 24176 ERX HCPCS 25000001 00054-3566-99 MIDAZOLAM HCL 2 MG/ML PO SYRP BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 24176 ERX HCPCS 25000001 68094-0762-62 MIDAZOLAM HCL 2 MG/ML PO SYRP BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 24188 ERX HCPCS 25000001 00006-5424-02 ANTIVENIN LATRODECTUS MACTANS IJ KIT BOTH IP/OP $132.50 $98.00 $23.56 $132.34 $132.34 $132.34 $132.34 $132.34 $132.34 $132.34 $23.56 $132.34 $132.34 $98.22 $98.22 $102.01 $68.95 $27.58 $132.34 $52.94 $132.34 $132.34 $132.34 $132.34 $132.34 $99.38 $132.34 $132.34 $132.34 $66.17 $66.17 $104.81 $132.34 $105.87 $86.02 $132.34 $132.34 $76.85 $132.34 $79.40 $132.34 $132.34 $132.34 N/A N/A 24325 ERX HCPCS 25000001 57782-0397-26 CROMOLYN SODIUM 5.2 MG/ACT NA AERS BOTH IP/OP $11.00 $8.00 $1.96 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $1.96 $11.00 $11.00 $8.16 $8.16 $8.48 $5.73 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 24384 ERX HCPCS 63700001 65862-0470-90 LOSARTAN-HCTZ 100-25 MG PO TABS BOTH IP/OP $15.00 $11.00 $3.07 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $3.07 $14.73 $5.89 $14.73 $14.73 $14.73 $14.73 $14.73 $11.25 $14.73 $14.73 $14.73 $7.37 $7.37 $11.67 $14.73 $11.78 $9.57 $14.73 $14.73 $8.70 $14.73 $8.84 $14.73 $14.73 $14.73 N/A N/A 24398 ERX HCPCS 63700006 57664-0474-58 METFORMIN HCL 1000 MG PO TABS BOTH IP/OP $6.50 $5.00 $1.30 $6.23 $6.23 $6.23 $6.23 $6.23 $6.23 $6.23 $6.23 $6.23 $6.23 $6.23 $6.23 $6.23 $6.23 $1.30 $6.23 $2.49 $6.23 $6.23 $6.23 $6.23 $6.23 $4.88 $6.23 $6.23 $6.23 $3.12 $3.12 $4.93 $6.23 $4.98 $4.05 $6.23 $6.23 $3.77 $6.23 $3.74 $6.23 $6.23 $6.23 N/A N/A 24435 ERX HCPCS J2353 00078-0818-81 OCTREOTIDE ACETATE 20 MG IM KIT BOTH IP/OP "$12,163.00" "$9,001.00" "$2,535.01" "$12,162.70" "$5,473.22" "$5,473.22" "$5,473.22" "$5,473.22" "$4,131.24" "$4,131.24" "$4,131.24" "$2,535.01" "$4,131.24" "$4,296.45" "$4,296.45" "$4,461.70" "$4,131.20" "$4,853.50" "$4,131.24" "$4,090.74" "$5,996.21" "$4,131.24" "$12,162.70" "$4,131.24" "$4,337.80" "$9,122.25" "$4,131.24" "$4,131.24" "$4,131.24" "$6,081.35" "$6,081.35" "$9,632.86" "$4,131.24" "$9,730.16" "$5,473.22" "$4,621.99" "$4,131.24" "$7,054.54" "$4,337.80" "$5,990.30" "$4,131.24" "$4,621.99" "$4,131.24" 2486.64 1153.39 24436 ERX HCPCS J2353 00078-0825-81 OCTREOTIDE ACETATE 30 MG IM KIT BOTH IP/OP "$18,213.00" "$13,478.00" "$3,795.99" "$18,212.75" "$8,195.74" "$8,195.74" "$8,195.74" "$8,195.74" "$6,196.86" "$6,196.86" "$6,196.86" "$3,795.99" "$6,196.86" "$6,444.67" "$6,444.67" "$6,692.54" "$6,196.80" "$7,280.25" "$6,196.86" "$6,136.11" "$8,978.89" "$6,196.86" "$18,212.75" "$6,196.86" "$6,506.70" "$13,659.75" "$6,196.86" "$6,196.86" "$6,196.86" "$9,106.38" "$9,106.38" "$14,424.50" "$6,196.86" "$14,570.20" "$8,195.74" "$6,932.98" "$6,196.86" "$10,563.54" "$6,506.70" "$8,985.45" "$6,196.86" "$6,932.98" "$6,196.86" N/A N/A 24438 ERX HCPCS 63700001 64380-0717-03 ABACAVIR SULFATE 300 MG PO TABS BOTH IP/OP $43.50 $32.00 $9.05 $43.40 $43.40 $43.40 $43.40 $43.40 $43.40 $43.40 $43.40 $43.40 $43.40 $43.40 $43.40 $43.40 $43.40 $9.05 $43.40 $17.36 $43.40 $43.40 $43.40 $43.40 $43.40 $32.63 $43.40 $43.40 $43.40 $21.70 $21.70 $34.37 $43.40 $34.72 $28.21 $43.40 $43.40 $25.23 $43.40 $26.04 $43.40 $43.40 $43.40 N/A N/A 24439 ERX HCPCS 63700001 99999-6005-00 ABACAVIR SULFATE 20 MG/ML PO SOLN BOTH IP/OP $315.50 $233.00 $65.72 $315.33 $315.33 $315.33 $315.33 $315.33 $315.33 $315.33 $315.33 $315.33 $315.33 $315.33 $315.33 $315.33 $315.33 $65.72 $315.33 $126.13 $315.33 $315.33 $315.33 $315.33 $315.33 $236.63 $315.33 $315.33 $315.33 $157.67 $157.67 $249.74 $315.33 $252.26 $204.96 $315.33 $315.33 $182.99 $315.33 $189.20 $315.33 $315.33 $315.33 N/A N/A 24467 ERX HCPCS 25000001 54838-0005-30 VITAMIN E 15 UNIT/0.3ML PO SOLN BOTH IP/OP $161.50 $120.00 $28.69 $161.19 $161.19 $161.19 $161.19 $161.19 $161.19 $161.19 $28.69 $161.19 $161.19 $119.64 $119.64 $124.25 $83.98 $33.59 $161.19 $64.48 $161.19 $161.19 $161.19 $161.19 $161.19 $121.13 $161.19 $161.19 $161.19 $80.60 $80.60 $127.66 $161.19 $128.95 $104.77 $161.19 $161.19 $93.67 $161.19 $96.71 $161.19 $161.19 $161.19 N/A N/A 24474 ERX HCPCS 63700001 00093-2064-06 CILOSTAZOL 100 MG PO TABS BOTH IP/OP $8.00 $6.00 $1.64 $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $1.64 $7.89 $3.16 $7.89 $7.89 $7.89 $7.89 $7.89 $6.00 $7.89 $7.89 $7.89 $3.95 $3.95 $6.25 $7.89 $6.31 $5.13 $7.89 $7.89 $4.64 $7.89 $4.73 $7.89 $7.89 $7.89 N/A N/A 24500 ERX HCPCS 63700001 60687-0436-01 CELECOXIB 100 MG PO CAPS BOTH IP/OP $20.00 $15.00 $4.16 $19.96 $19.96 $19.96 $19.96 $19.96 $19.96 $19.96 $19.96 $19.96 $19.96 $19.96 $19.96 $19.96 $19.96 $4.16 $19.96 $7.98 $19.96 $19.96 $19.96 $19.96 $19.96 $15.00 $19.96 $19.96 $19.96 $9.98 $9.98 $15.81 $19.96 $15.97 $12.97 $19.96 $19.96 $11.60 $19.96 $11.98 $19.96 $19.96 $19.96 747.62 362.41 24501 ERX HCPCS 63700001 33342-0157-11 CELECOXIB 200 MG PO CAPS BOTH IP/OP $33.00 $24.00 $6.82 $32.71 $32.71 $32.71 $32.71 $32.71 $32.71 $32.71 $32.71 $32.71 $32.71 $32.71 $32.71 $32.71 $32.71 $6.82 $32.71 $13.08 $32.71 $32.71 $32.71 $32.71 $32.71 $24.75 $32.71 $32.71 $32.71 $16.36 $16.36 $25.91 $32.71 $26.17 $21.26 $32.71 $32.71 $19.14 $32.71 $19.63 $32.71 $32.71 $32.71 N/A N/A 24513 ERX HCPCS J0885 59676-0340-01 EPOETIN ALFA 40000 UNIT/ML IJ SOLN BOTH IP/OP "$2,989.00" "$2,212.00" $326.00 "$2,988.93" "$2,988.93" "$2,988.93" "$2,988.93" "$2,988.93" "$2,988.93" "$2,988.93" $326.00 "$2,988.93" "$2,988.93" "$2,988.93" "$2,988.93" "$2,988.93" "$2,988.93" $622.93 "$2,988.93" "$1,195.57" "$2,988.93" "$2,988.93" "$2,988.93" "$2,988.93" "$2,988.93" "$2,241.75" "$2,988.93" "$2,988.93" "$2,988.93" "$1,494.47" "$1,494.47" "$2,367.23" "$2,988.93" "$2,391.14" "$1,942.80" "$2,988.93" "$2,988.93" "$1,733.62" "$2,988.93" "$1,793.36" "$2,988.93" "$2,988.93" "$2,988.93" N/A N/A 24585 ERX HCPCS J7511 58468-0080-01 ANTI-THYMOCYTE GLOB (RABBIT) 25 MG IV SOLR BOTH IP/OP "$2,854.00" "$2,112.00" $594.80 "$2,854.00" "$2,854.00" "$2,854.00" "$2,854.00" "$2,854.00" "$2,854.00" "$2,854.00" $837.42 "$2,854.00" "$2,854.00" $871.86 $871.86 $905.40 $838.33 $594.80 "$2,854.00" "$1,141.60" "$2,854.00" "$2,854.00" "$2,854.00" "$2,854.00" "$2,854.00" "$2,140.50" "$2,854.00" "$2,854.00" "$2,854.00" "$1,427.00" "$1,427.00" "$2,260.37" "$2,854.00" "$2,283.20" "$1,284.30" "$2,854.00" "$2,854.00" "$1,655.32" "$2,854.00" "$1,712.40" "$2,854.00" "$2,854.00" "$2,854.00" N/A N/A 24702 ERX HCPCS 63700001 60505-2526-03 MODAFINIL 100 MG PO TABS BOTH IP/OP $105.00 $78.00 $21.88 $104.99 $104.99 $104.99 $104.99 $104.99 $104.99 $104.99 $104.99 $104.99 $104.99 $104.99 $104.99 $104.99 $104.99 $21.88 $104.99 $42.00 $104.99 $104.99 $104.99 $104.99 $104.99 $78.75 $104.99 $104.99 $104.99 $52.50 $52.50 $83.15 $104.99 $83.99 $68.24 $104.99 $104.99 $60.90 $104.99 $62.99 $104.99 $104.99 $104.99 N/A N/A 24711 ERX HCPCS 63700001 68180-0518-01 LISINOPRIL-HCTZ 10-12.5 MG TABLET BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 24788 ERX HCPCS 63700001 38485-0808-57 PSYLLIUM 95 % PO PACK BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 24914 ERX HCPCS 63700001 00781-2102-01 TACROLIMUS 0.5 MG PO CAPS BOTH IP/OP $10.00 $7.00 $2.01 $9.64 $9.64 $9.64 $9.64 $9.64 $9.64 $9.64 $9.64 $9.64 $9.64 $9.64 $9.64 $9.64 $9.64 $2.01 $9.64 $3.86 $9.64 $9.64 $9.64 $9.64 $9.64 $7.50 $9.64 $9.64 $9.64 $4.82 $4.82 $7.63 $9.64 $7.71 $6.27 $9.64 $9.64 $5.80 $9.64 $5.78 $9.64 $9.64 $9.64 N/A N/A 24915 ERX HCPCS 25000001 76204-0800-01 LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU BOTH IP/OP $9.00 $7.00 $1.54 $8.65 $8.65 $8.65 $8.65 $8.65 $8.65 $8.65 $1.54 $8.65 $8.65 $6.42 $6.42 $6.67 $4.51 $1.80 $8.65 $3.46 $8.65 $8.65 $8.65 $8.65 $8.65 $6.75 $8.65 $8.65 $8.65 $4.33 $4.33 $6.85 $8.65 $6.92 $5.62 $8.65 $8.65 $5.22 $8.65 $5.19 $8.65 $8.65 $8.65 N/A N/A 24916 ERX HCPCS J7614 43598-0409-25 LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU BOTH IP/OP $28.00 $21.00 $0.12 $27.82 $12.52 $12.52 $12.52 $12.52 $27.82 $27.82 $0.12 $2.96 $27.82 $0.12 $0.12 $0.13 $0.12 $5.80 $27.82 $11.13 $16.46 $27.82 $27.82 $27.82 $27.82 $21.00 $27.82 $27.82 $27.82 $13.91 $13.91 $22.03 $27.82 $22.26 $12.52 $5.52 $27.82 $16.24 $27.82 $16.69 $27.82 $5.80 $27.82 N/A N/A 24932 ERX HCPCS J2916 00024-2792-10 NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN BOTH IP/OP $152.00 $112.00 $9.60 $151.88 $68.35 $68.35 $68.35 $68.35 $151.88 $151.88 $151.88 $27.85 $151.88 $9.98 $9.98 $10.37 $9.60 $11.28 $151.88 $151.88 $89.84 $151.88 $151.88 $151.88 $151.88 $114.00 $151.88 $151.88 $151.88 $75.94 $75.94 $120.29 $151.88 $121.50 $68.35 $10.74 $151.88 $88.16 $151.88 $151.88 $151.88 $10.74 $151.88 N/A N/A 24945 ERX HCPCS 63700001 51079-0088-01 MIRTAZAPINE 45 MG PO TABS BOTH IP/OP $12.50 $9.00 $2.57 $12.32 $12.32 $12.32 $12.32 $12.32 $12.32 $12.32 $12.32 $12.32 $12.32 $12.32 $12.32 $12.32 $12.32 $2.57 $12.32 $4.93 $12.32 $12.32 $12.32 $12.32 $12.32 $9.38 $12.32 $12.32 $12.32 $6.16 $6.16 $9.76 $12.32 $9.86 $8.01 $12.32 $12.32 $7.25 $12.32 $7.39 $12.32 $12.32 $12.32 N/A N/A 25005 ERX HCPCS J7517 67877-0230-22 MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR BOTH IP/OP $49.00 $36.00 $0.30 $48.92 $48.92 $48.92 $48.92 $48.92 $48.92 $48.92 $0.32 $48.92 $48.92 $0.31 $0.31 $0.32 $0.30 $10.20 $48.92 $19.57 $48.92 $48.92 $48.92 $48.92 $48.92 $36.75 $48.92 $48.92 $48.92 $24.46 $24.46 $38.74 $48.92 $39.14 $22.01 $48.92 $48.92 $28.42 $48.92 $29.35 $48.92 $48.92 $48.92 N/A N/A 25119 ERX HCPCS 63700006 68084-0070-01 CIPROFLOXACIN HCL 500 MG PO TABS BOTH IP/OP $14.00 $10.00 $2.86 $13.73 $13.73 $13.73 $13.73 $13.73 $13.73 $13.73 $13.73 $13.73 $13.73 $13.73 $13.73 $13.73 $13.73 $2.86 $13.73 $5.49 $13.73 $13.73 $13.73 $13.73 $13.73 $10.50 $13.73 $13.73 $13.73 $6.87 $6.87 $10.87 $13.73 $10.98 $8.92 $13.73 $13.73 $8.12 $13.73 $8.24 $13.73 $13.73 $13.73 1136.67 540.76 25174 ERX HCPCS 25000001 00264-1965-10 HETASTARCH-NACL 6-0.9 % IV SOLN BOTH IP/OP $125.50 $93.00 $22.32 $125.37 $125.37 $125.37 $125.37 $125.37 $125.37 $125.37 $22.32 $125.37 $125.37 $93.05 $93.05 $96.64 $65.32 $26.13 $125.37 $50.15 $125.37 $125.37 $125.37 $125.37 $125.37 $94.13 $125.37 $125.37 $125.37 $62.69 $62.69 $99.29 $125.37 $100.30 $81.49 $125.37 $125.37 $72.79 $125.37 $75.22 $125.37 $125.37 $125.37 N/A N/A 25238 ERX HCPCS 63700001 00591-2880-01 VERAPAMIL HCL CR 120 MG PO CP24 BOTH IP/OP $8.00 $6.00 $1.57 $7.55 $7.55 $7.55 $7.55 $7.55 $7.55 $7.55 $7.55 $7.55 $7.55 $7.55 $7.55 $7.55 $7.55 $1.57 $7.55 $3.02 $7.55 $7.55 $7.55 $7.55 $7.55 $6.00 $7.55 $7.55 $7.55 $3.78 $3.78 $5.98 $7.55 $6.04 $4.91 $7.55 $7.55 $4.64 $7.55 $4.53 $7.55 $7.55 $7.55 N/A N/A 25354 ERX HCPCS 63700001 00955-1722-50 DOXERCALCIFEROL 2.5 MCG PO CAPS BOTH IP/OP $72.50 $54.00 $15.02 $72.06 $72.06 $72.06 $72.06 $72.06 $72.06 $72.06 $72.06 $72.06 $72.06 $72.06 $72.06 $72.06 $72.06 $15.02 $72.06 $28.82 $72.06 $72.06 $72.06 $72.06 $72.06 $54.38 $72.06 $72.06 $72.06 $36.03 $36.03 $57.07 $72.06 $57.65 $46.84 $72.06 $72.06 $42.05 $72.06 $43.24 $72.06 $72.06 $72.06 N/A N/A 25408 ERX HCPCS 25000001 67457-0187-50 ALLOPURINOL SODIUM 500 MG IV SOLR BOTH IP/OP "$11,148.00" "$8,250.00" "$1,984.31" "$11,147.82" "$11,147.82" "$11,147.82" "$11,147.82" "$11,147.82" "$11,147.82" "$11,147.82" "$1,984.31" "$11,147.82" "$11,147.82" "$4,181.12" "$4,181.12" "$8,592.74" "$2,060.15" "$2,323.33" "$11,147.82" "$4,459.13" "$11,147.82" "$11,147.82" "$11,147.82" "$11,147.82" "$11,147.82" "$8,361.00" "$11,147.82" "$11,147.82" "$11,147.82" "$5,573.91" "$5,573.91" "$8,829.07" "$11,147.82" "$8,918.26" "$7,246.08" "$11,147.82" "$11,147.82" "$6,465.84" "$11,147.82" "$6,688.69" "$11,147.82" "$11,147.82" "$11,147.82" N/A N/A 25518 ERX HCPCS 25000001 63323-0011-15 CHLORAMPHENICOL SOD SUCCINATE 1 G IV SOLR BOTH IP/OP $209.50 $155.00 $37.20 $209.01 $209.01 $209.01 $209.01 $209.01 $209.01 $209.01 $37.20 $209.01 $209.01 $155.13 $155.13 $161.10 $108.89 $43.56 $209.01 $83.60 $209.01 $209.01 $209.01 $209.01 $209.01 $157.13 $209.01 $209.01 $209.01 $104.51 $104.51 $165.54 $209.01 $167.21 $135.86 $209.01 $209.01 $121.51 $209.01 $125.41 $209.01 $209.01 $209.01 N/A N/A 25528 ERX HCPCS 63700001 64764-0151-04 PIOGLITAZONE HCL 15 MG PO TABS BOTH IP/OP $67.50 $50.00 $13.99 $67.15 $67.15 $67.15 $67.15 $67.15 $67.15 $67.15 $67.15 $67.15 $67.15 $67.15 $67.15 $67.15 $67.15 $13.99 $67.15 $26.86 $67.15 $67.15 $67.15 $67.15 $67.15 $50.63 $67.15 $67.15 $67.15 $33.58 $33.58 $53.18 $67.15 $53.72 $43.65 $67.15 $67.15 $39.15 $67.15 $40.29 $67.15 $67.15 $67.15 N/A N/A 25820 ERX HCPCS 63700001 00006-0032-20 IVERMECTIN 3 MG PO TABS BOTH IP/OP $24.50 $18.00 $5.03 $24.12 $24.12 $24.12 $24.12 $24.12 $24.12 $24.12 $24.12 $24.12 $24.12 $24.12 $24.12 $24.12 $24.12 $5.03 $24.12 $9.65 $24.12 $24.12 $24.12 $24.12 $24.12 $18.38 $24.12 $24.12 $24.12 $12.06 $12.06 $19.10 $24.12 $19.30 $15.68 $24.12 $24.12 $14.21 $24.12 $14.47 $24.12 $24.12 $24.12 1414.07 700.31 25856 ERX HCPCS 63700001 16714-0332-01 GABAPENTIN 800 MG PO TABS BOTH IP/OP $13.50 $10.00 $2.74 $13.14 $13.14 $13.14 $13.14 $13.14 $13.14 $13.14 $13.14 $13.14 $13.14 $13.14 $13.14 $13.14 $13.14 $2.74 $13.14 $5.26 $13.14 $13.14 $13.14 $13.14 $13.14 $10.13 $13.14 $13.14 $13.14 $6.57 $6.57 $10.41 $13.14 $10.51 $8.54 $13.14 $13.14 $7.83 $13.14 $7.88 $13.14 $13.14 $13.14 N/A N/A 25893 ERX HCPCS J8700 65162-0802-51 TEMOZOLOMIDE 20 MG PO CAPS BOTH IP/OP $206.50 $153.00 $1.40 $206.08 $206.08 $206.08 $206.08 $206.08 $206.08 $206.08 $1.44 $206.08 $206.08 $1.46 $1.46 $1.51 $1.40 $42.95 $206.08 $82.43 $206.08 $206.08 $206.08 $206.08 $206.08 $154.88 $206.08 $206.08 $206.08 $103.04 $103.04 $163.22 $206.08 $164.86 $92.74 $206.08 $206.08 $119.77 $206.08 $123.65 $206.08 $206.08 $206.08 N/A N/A 25894 ERX HCPCS J8700 16729-0050-53 TEMOZOLOMIDE 100 MG PO CAPS BOTH IP/OP $869.50 $643.00 $7.00 $869.04 $869.04 $869.04 $869.04 $869.04 $869.04 $869.04 $7.20 $869.04 $869.04 $7.28 $7.28 $7.56 $7.00 $181.12 $869.04 $347.62 $869.04 $869.04 $869.04 $869.04 $869.04 $652.13 $869.04 $869.04 $869.04 $434.52 $434.52 $688.28 $869.04 $695.23 $391.07 $869.04 $869.04 $504.31 $869.04 $521.42 $869.04 $869.04 $869.04 N/A N/A 25895 ERX HCPCS J8700 65162-0806-51 TEMOZOLOMIDE 250 MG PO CAPS BOTH IP/OP "$1,921.50" "$1,422.00" $17.50 "$1,921.34" "$1,921.34" "$1,921.34" "$1,921.34" "$1,921.34" "$1,921.34" "$1,921.34" $18.00 "$1,921.34" "$1,921.34" $18.20 $18.20 $18.90 $17.50 $400.43 "$1,921.34" $768.54 "$1,921.34" "$1,921.34" "$1,921.34" "$1,921.34" "$1,921.34" "$1,441.13" "$1,921.34" "$1,921.34" "$1,921.34" $960.67 $960.67 "$1,521.70" "$1,921.34" "$1,537.07" $864.60 "$1,921.34" "$1,921.34" "$1,114.47" "$1,921.34" "$1,152.80" "$1,921.34" "$1,921.34" "$1,921.34" N/A N/A 26224 ERX HCPCS 63700006 50268-0585-15 PANTOPRAZOLE SODIUM 20 MG PO TBEC BOTH IP/OP $17.50 $13.00 $3.59 $17.22 $17.22 $17.22 $17.22 $17.22 $17.22 $17.22 $17.22 $17.22 $17.22 $17.22 $17.22 $17.22 $17.22 $3.59 $17.22 $6.89 $17.22 $17.22 $17.22 $17.22 $17.22 $13.13 $17.22 $17.22 $17.22 $8.61 $8.61 $13.64 $17.22 $13.78 $11.19 $17.22 $17.22 $10.15 $17.22 $10.33 $17.22 $17.22 $17.22 N/A N/A 26225 ERX HCPCS 63700006 55111-0333-90 PANTOPRAZOLE SODIUM 40 MG PO TBEC BOTH IP/OP $18.00 $13.00 $3.68 $17.68 $17.68 $17.68 $17.68 $17.68 $17.68 $17.68 $17.68 $17.68 $17.68 $17.68 $17.68 $17.68 $17.68 $3.68 $17.68 $7.07 $17.68 $17.68 $17.68 $17.68 $17.68 $13.50 $17.68 $17.68 $17.68 $8.84 $8.84 $14.00 $17.68 $14.14 $11.49 $17.68 $17.68 $10.44 $17.68 $10.61 $17.68 $17.68 $17.68 N/A N/A 26226 ERX HCPCS 25000001 00008-0923-55 PANTOPRAZOLE SODIUM 40 MG IV SOLR BOTH IP/OP $26.50 $20.00 $4.68 $26.31 $26.31 $26.31 $26.31 $26.31 $26.31 $26.31 $4.68 $26.31 $26.31 $19.53 $19.53 $20.28 $13.71 $5.48 $26.31 $10.52 $26.31 $26.31 $26.31 $26.31 $26.31 $19.88 $26.31 $26.31 $26.31 $13.16 $13.16 $20.84 $26.31 $21.05 $17.10 $26.31 $26.31 $15.37 $26.31 $15.79 $26.31 $26.31 $26.31 N/A N/A 26336 ERX HCPCS J7520 00008-1030-06 SIROLIMUS 1 MG/ML PO SOLN BOTH IP/OP "$5,492.50" "$4,064.00" $270.00 "$5,492.05" "$5,492.05" "$5,492.05" "$5,492.05" "$5,492.05" "$5,492.05" "$5,492.05" $270.00 "$5,492.05" "$5,492.05" $280.80 $280.80 $291.60 $270.00 "$1,144.60" "$5,492.05" "$2,196.82" "$5,492.05" "$5,492.05" "$5,492.05" "$5,492.05" "$5,492.05" "$4,119.38" "$5,492.05" "$5,492.05" "$5,492.05" "$2,746.03" "$2,746.03" "$4,349.70" "$5,492.05" "$4,393.64" "$2,471.42" "$5,492.05" "$5,492.05" "$3,185.65" "$5,492.05" "$3,295.23" "$5,492.05" "$5,492.05" "$5,492.05" N/A N/A 26546 ERX HCPCS 63700001 33342-0258-66 OSELTAMIVIR PHOSPHATE 75 MG PO CAPS BOTH IP/OP $67.00 $50.00 $13.92 $66.78 $66.78 $66.78 $66.78 $66.78 $66.78 $66.78 $66.78 $66.78 $66.78 $66.78 $66.78 $66.78 $66.78 $13.92 $66.78 $26.71 $66.78 $66.78 $66.78 $66.78 $66.78 $50.25 $66.78 $66.78 $66.78 $33.39 $33.39 $52.89 $66.78 $53.42 $43.41 $66.78 $66.78 $38.86 $66.78 $40.07 $66.78 $66.78 $66.78 2253.6 1124.27 26547 ERX HCPCS 63700001 33342-0260-11 ENTACAPONE 200 MG PO TABS BOTH IP/OP $17.50 $13.00 $3.56 $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $3.56 $17.07 $6.83 $17.07 $17.07 $17.07 $17.07 $17.07 $13.13 $17.07 $17.07 $17.07 $8.54 $8.54 $13.52 $17.07 $13.66 $11.10 $17.07 $17.07 $10.15 $17.07 $10.24 $17.07 $17.07 $17.07 N/A N/A 26551 ERX HCPCS 63700001 00832-0595-30 EXEMESTANE 25 MG PO TABS BOTH IP/OP $81.00 $60.00 $16.78 $80.52 $80.52 $80.52 $80.52 $80.52 $80.52 $80.52 $80.52 $80.52 $80.52 $80.52 $80.52 $80.52 $80.52 $16.78 $80.52 $32.21 $80.52 $80.52 $80.52 $80.52 $80.52 $60.75 $80.52 $80.52 $80.52 $40.26 $40.26 $63.77 $80.52 $64.42 $52.34 $80.52 $80.52 $46.98 $80.52 $48.31 $80.52 $80.52 $80.52 6547.43 3530.48 26688 ERX HCPCS 63700001 60258-0161-01 RENA-VITE RX 1 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 26817 ERX HCPCS 63700001 63739-0411-10 LEVETIRACETAM 500 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 26818 ERX HCPCS 63700006 00378-5617-78 LEVETIRACETAM 750 MG PO TABS BOTH IP/OP $21.00 $16.00 $4.29 $20.57 $20.57 $20.57 $20.57 $20.57 $20.57 $20.57 $20.57 $20.57 $20.57 $20.57 $20.57 $20.57 $20.57 $4.29 $20.57 $8.23 $20.57 $20.57 $20.57 $20.57 $20.57 $15.75 $20.57 $20.57 $20.57 $10.29 $10.29 $16.29 $20.57 $16.46 $13.37 $20.57 $20.57 $12.18 $20.57 $12.34 $20.57 $20.57 $20.57 N/A N/A 26854 ERX HCPCS 63700001 65862-0603-30 MOXIFLOXACIN HCL 400 MG PO TABS BOTH IP/OP $108.50 $80.00 $22.58 $108.36 $108.36 $108.36 $108.36 $108.36 $108.36 $108.36 $108.36 $108.36 $108.36 $108.36 $108.36 $108.36 $108.36 $22.58 $108.36 $43.34 $108.36 $108.36 $108.36 $108.36 $108.36 $81.38 $108.36 $108.36 $108.36 $54.18 $54.18 $85.82 $108.36 $86.69 $70.43 $108.36 $108.36 $62.93 $108.36 $65.02 $108.36 $108.36 $108.36 N/A N/A 26950 ERX HCPCS 63700001 51285-0063-90 ESTRADIOL-NORGESTIMATE 1/1-0.09 MG (15/15) PO TABS BOTH IP/OP $33.50 $25.00 $6.96 $33.40 $33.40 $33.40 $33.40 $33.40 $33.40 $33.40 $33.40 $33.40 $33.40 $33.40 $33.40 $33.40 $33.40 $6.96 $33.40 $13.36 $33.40 $33.40 $33.40 $33.40 $33.40 $25.13 $33.40 $33.40 $33.40 $16.70 $16.70 $26.45 $33.40 $26.72 $21.71 $33.40 $33.40 $19.43 $33.40 $20.04 $33.40 $33.40 $33.40 N/A N/A 26952 ERX HCPCS 63700001 55111-0167-30 OLANZAPINE 15 MG PO TABS BOTH IP/OP $119.00 $88.00 $24.78 $118.90 $118.90 $118.90 $118.90 $118.90 $118.90 $118.90 $118.90 $118.90 $118.90 $118.90 $118.90 $118.90 $118.90 $24.78 $118.90 $47.56 $118.90 $118.90 $118.90 $118.90 $118.90 $89.25 $118.90 $118.90 $118.90 $59.45 $59.45 $94.17 $118.90 $95.12 $77.29 $118.90 $118.90 $69.02 $118.90 $71.34 $118.90 $118.90 $118.90 1461.78 747.73 26965 ERX HCPCS 63700001 00069-5800-43 DOFETILIDE 125 MCG PO CAPS BOTH IP/OP $57.00 $42.00 $11.85 $56.88 $56.88 $56.88 $56.88 $56.88 $56.88 $56.88 $56.88 $56.88 $56.88 $56.88 $56.88 $56.88 $56.88 $11.85 $56.88 $22.75 $56.88 $56.88 $56.88 $56.88 $56.88 $42.75 $56.88 $56.88 $56.88 $28.44 $28.44 $45.05 $56.88 $45.50 $36.97 $56.88 $56.88 $33.06 $56.88 $34.13 $56.88 $56.88 $56.88 N/A N/A 26967 ERX HCPCS 25000001 51862-0005-60 DOFETILIDE 500 MCG PO CAPS BOTH IP/OP $37.00 $27.00 $6.58 $36.96 $36.96 $36.96 $36.96 $36.96 $36.96 $36.96 $6.58 $36.96 $36.96 $27.43 $27.43 $28.49 $19.26 $7.70 $36.96 $14.78 $36.96 $36.96 $36.96 $36.96 $36.96 $27.75 $36.96 $36.96 $36.96 $18.48 $18.48 $29.27 $36.96 $29.57 $24.02 $36.96 $36.96 $21.46 $36.96 $22.18 $36.96 $36.96 $36.96 N/A N/A 27023 ERX HCPCS 63700001 51672-2080-01 TERBINAFINE HCL 1 % EX CREA BOTH IP/OP $35.00 $26.00 $7.24 $34.74 $34.74 $34.74 $34.74 $34.74 $34.74 $34.74 $34.74 $34.74 $34.74 $34.74 $34.74 $34.74 $34.74 $7.24 $34.74 $13.90 $34.74 $34.74 $34.74 $34.74 $34.74 $26.25 $34.74 $34.74 $34.74 $17.37 $17.37 $27.51 $34.74 $27.79 $22.58 $34.74 $34.74 $20.30 $34.74 $20.84 $34.74 $34.74 $34.74 N/A N/A 27027 ERX HCPCS 63700001 00187-5526-75 BEXAROTENE 75 MG PO CAPS BOTH IP/OP $901.50 $667.00 $187.87 $901.46 $901.46 $901.46 $901.46 $901.46 $901.46 $901.46 $901.46 $901.46 $901.46 $901.46 $901.46 $901.46 $901.46 $187.87 $901.46 $360.58 $901.46 $901.46 $901.46 $901.46 $901.46 $676.13 $901.46 $901.46 $901.46 $450.73 $450.73 $713.96 $901.46 $721.17 $585.95 $901.46 $901.46 $522.87 $901.46 $540.88 $901.46 $901.46 $901.46 2078.6 945.44 27032 ERX HCPCS J7674 64281-0100-06 METHACHOLINE CHLORIDE 100 MG IN SOLR BOTH IP/OP $357.00 $264.00 $74.31 $356.57 $356.57 $356.57 $356.57 $356.57 $356.57 $356.57 $81.00 $356.57 $356.57 $84.24 $84.24 $87.48 $81.00 $74.31 $356.57 $142.63 $356.57 $356.57 $356.57 $356.57 $356.57 $267.75 $356.57 $356.57 $356.57 $178.29 $178.29 $282.40 $356.57 $285.26 $160.46 $356.57 $356.57 $207.06 $356.57 $213.94 $356.57 $356.57 $356.57 N/A N/A 27049 ERX HCPCS 63700006 60687-0711-01 OXCARBAZEPINE 150 MG PO TABS BOTH IP/OP $7.00 $5.00 $1.36 $6.52 $6.52 $6.52 $6.52 $6.52 $6.52 $6.52 $6.52 $6.52 $6.52 $6.52 $6.52 $6.52 $6.52 $1.36 $6.52 $2.61 $6.52 $6.52 $6.52 $6.52 $6.52 $5.25 $6.52 $6.52 $6.52 $3.26 $3.26 $5.16 $6.52 $5.22 $4.24 $6.52 $6.52 $4.06 $6.52 $3.91 $6.52 $6.52 $6.52 3119.66 1434.54 27099 ERX HCPCS 25000001 66689-0201-08 CHARCOAL ACTIVATED PO LIQD BOTH IP/OP $161.50 $120.00 $28.73 $161.43 $161.43 $161.43 $161.43 $161.43 $161.43 $161.43 $28.73 $161.43 $161.43 $119.81 $119.81 $124.43 $84.11 $33.64 $161.43 $64.57 $161.43 $161.43 $161.43 $161.43 $161.43 $121.13 $161.43 $161.43 $161.43 $80.72 $80.72 $127.85 $161.43 $129.14 $104.93 $161.43 $161.43 $93.67 $161.43 $96.86 $161.43 $161.43 $161.43 N/A N/A 27112 ERX HCPCS 63700001 00093-3099-56 RISEDRONATE SODIUM 5 MG PO TABS BOTH IP/OP $38.50 $28.00 $7.97 $38.26 $38.26 $38.26 $38.26 $38.26 $38.26 $38.26 $38.26 $38.26 $38.26 $38.26 $38.26 $38.26 $38.26 $7.97 $38.26 $15.30 $38.26 $38.26 $38.26 $38.26 $38.26 $28.88 $38.26 $38.26 $38.26 $19.13 $19.13 $30.30 $38.26 $30.61 $24.87 $38.26 $38.26 $22.33 $38.26 $22.96 $38.26 $38.26 $38.26 N/A N/A 27181 ERX HCPCS 63700006 65162-0321-09 NIACIN ER (ANTIHYPERLIPIDEMIC) 500 MG PO TBCR BOTH IP/OP $23.00 $17.00 $4.70 $22.54 $22.54 $22.54 $22.54 $22.54 $22.54 $22.54 $22.54 $22.54 $22.54 $22.54 $22.54 $22.54 $22.54 $4.70 $22.54 $9.02 $22.54 $22.54 $22.54 $22.54 $22.54 $17.25 $22.54 $22.54 $22.54 $11.27 $11.27 $17.85 $22.54 $18.03 $14.65 $22.54 $22.54 $13.34 $22.54 $13.52 $22.54 $22.54 $22.54 2228.34 1194.09 27182 ERX HCPCS 63700001 47335-0614-81 NIACIN ER (ANTIHYPERLIPIDEMIC) 750 MG PO TBCR BOTH IP/OP $26.50 $20.00 $5.44 $26.08 $26.08 $26.08 $26.08 $26.08 $26.08 $26.08 $26.08 $26.08 $26.08 $26.08 $26.08 $26.08 $26.08 $5.44 $26.08 $10.43 $26.08 $26.08 $26.08 $26.08 $26.08 $19.88 $26.08 $26.08 $26.08 $13.04 $13.04 $20.66 $26.08 $20.86 $16.95 $26.08 $26.08 $15.37 $26.08 $15.65 $26.08 $26.08 $26.08 N/A N/A 27183 ERX HCPCS 63700001 47335-0613-81 NIACIN ER (ANTIHYPERLIPIDEMIC) 1000 MG PO TBCR BOTH IP/OP $32.50 $24.00 $6.74 $32.34 $32.34 $32.34 $32.34 $32.34 $32.34 $32.34 $32.34 $32.34 $32.34 $32.34 $32.34 $32.34 $32.34 $6.74 $32.34 $12.94 $32.34 $32.34 $32.34 $32.34 $32.34 $24.38 $32.34 $32.34 $32.34 $16.17 $16.17 $25.61 $32.34 $25.87 $21.02 $32.34 $32.34 $18.85 $32.34 $19.40 $32.34 $32.34 $32.34 N/A N/A 27234 ERX HCPCS 63700001 00781-5554-31 MONTELUKAST SODIUM 4 MG PO CHEW BOTH IP/OP $24.50 $18.00 $5.09 $24.44 $24.44 $24.44 $24.44 $24.44 $24.44 $24.44 $24.44 $24.44 $24.44 $24.44 $24.44 $24.44 $24.44 $5.09 $24.44 $9.78 $24.44 $24.44 $24.44 $24.44 $24.44 $18.38 $24.44 $24.44 $24.44 $12.22 $12.22 $19.36 $24.44 $19.55 $15.89 $24.44 $24.44 $14.21 $24.44 $14.66 $24.44 $24.44 $24.44 N/A N/A 27278 ERX HCPCS 63700001 62175-0129-37 ISOSORBIDE MONONITRATE ER 120 MG PO TB24 BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 27283 ERX HCPCS 63600001 00409-2987-03 AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IV SOLR BOTH IP/OP $48.00 $36.00 $8.52 $47.89 $47.89 $47.89 $47.89 $47.89 $47.89 $47.89 $8.52 $47.89 $47.89 $47.89 $47.89 $47.89 $47.89 $9.98 $47.89 $19.16 $47.89 $47.89 $47.89 $47.89 $47.89 $36.00 $47.89 $47.89 $47.89 $23.95 $23.95 $37.93 $47.89 $38.31 $21.55 $47.89 $47.89 $27.84 $47.89 $28.73 $47.89 $47.89 $47.89 N/A N/A 27291 ERX HCPCS J0713 00409-5084-11 CEFTAZIDIME 2 G IV SOLR BOTH IP/OP $25.00 $19.00 $3.92 $24.76 $24.76 $24.76 $24.76 $24.76 $24.76 $24.76 $3.94 $24.76 $24.76 $4.08 $4.08 $4.23 $3.92 $5.16 $24.76 $9.90 $24.76 $24.76 $24.76 $24.76 $24.76 $18.75 $24.76 $24.76 $24.76 $12.38 $12.38 $19.61 $24.76 $19.81 $11.14 $24.76 $24.76 $14.50 $24.76 $14.86 $24.76 $24.76 $24.76 N/A N/A 27299 ERX HCPCS J0697 00143-9977-22 CEFUROXIME SODIUM 1.5 G IV SOLR BOTH IP/OP $30.50 $23.00 $3.98 $30.31 $30.31 $30.31 $30.31 $30.31 $30.31 $30.31 $4.02 $30.31 $30.31 $4.14 $4.14 $4.30 $3.98 $4.68 $30.31 $12.12 $30.31 $30.31 $30.31 $30.31 $30.31 $22.88 $30.31 $30.31 $30.31 $15.16 $15.16 $24.01 $30.31 $24.25 $13.64 $30.31 $30.31 $17.69 $30.31 $18.19 $30.31 $30.31 $30.31 N/A N/A 27314 ERX HCPCS J2941 55566-1801-01 SOMATROPIN (ZOMACTON) 5 MG SC SOLR BOTH IP/OP "$1,051.00" $778.00 $219.03 "$1,050.96" "$1,050.96" "$1,050.96" "$1,050.96" "$1,050.96" "$1,050.96" "$1,050.96" $707.44 "$1,050.96" "$1,050.96" $766.38 $766.38 $795.85 $736.90 $219.03 "$1,050.96" $420.38 "$1,050.96" "$1,050.96" "$1,050.96" "$1,050.96" "$1,050.96" $788.25 "$1,050.96" "$1,050.96" "$1,050.96" $525.48 $525.48 $832.36 "$1,050.96" $840.77 $683.12 "$1,050.96" "$1,050.96" $609.58 "$1,050.96" $630.58 "$1,050.96" "$1,050.96" "$1,050.96" N/A N/A 27324 ERX HCPCS 90744 00006-4094-02 HEPATITIS B VAC RECOMBINANT 10 MCG/ML IJ SUSP BOTH IP/OP $278.50 $206.00 $28.22 $278.29 $125.23 $125.23 $125.23 $125.23 $72.36 $72.36 $28.22 $58.00 $72.36 $29.91 $29.91 $31.06 $28.76 $58.00 $278.29 $111.32 $164.61 $72.36 $72.36 $72.36 $278.29 $208.88 $72.36 $39.52 $72.36 $139.15 $139.15 $220.41 $72.36 $222.63 $125.23 $55.23 $72.36 $161.53 $278.29 $166.97 $72.36 $58.00 $72.36 919.35 436.45 27386 ERX HCPCS 25000001 63323-0254-10 MINERAL OIL LIGHT OIL BOTH IP/OP $84.00 $62.00 $14.91 $83.74 $83.74 $83.74 $83.74 $83.74 $83.74 $83.74 $14.91 $83.74 $83.74 $62.15 $62.15 $64.55 $43.63 $17.45 $83.74 $33.50 $83.74 $83.74 $83.74 $83.74 $83.74 $63.00 $83.74 $83.74 $83.74 $41.87 $41.87 $66.32 $83.74 $66.99 $54.43 $83.74 $83.74 $48.72 $83.74 $50.24 $83.74 $83.74 $83.74 1912.29 923.73 27393 ERX HCPCS 63600001 00409-1134-05 MORPHINE SULFATE 50 MG/ML IV SOLN BOTH IP/OP $143.50 $106.00 $25.54 $143.48 $143.48 $143.48 $143.48 $143.48 $143.48 $143.48 $25.54 $143.48 $143.48 $143.48 $143.48 $143.48 $143.48 $29.90 $143.48 $57.39 $143.48 $143.48 $143.48 $143.48 $143.48 $107.63 $143.48 $143.48 $143.48 $71.74 $71.74 $113.64 $143.48 $114.78 $64.57 $143.48 $143.48 $83.23 $143.48 $86.09 $143.48 $143.48 $143.48 1167.39 539.64 27430 ERX HCPCS 25000001 63323-0113-10 PENTAMIDINE ISETHIONATE 300 MG IJ SOLR BOTH IP/OP $605.00 $448.00 $107.66 $604.81 $604.81 $604.81 $604.81 $604.81 $604.81 $604.81 $107.66 $604.81 $604.81 $448.89 $448.89 $466.19 $315.11 $126.05 $604.81 $241.92 $604.81 $604.81 $604.81 $604.81 $604.81 $453.75 $604.81 $604.81 $604.81 $302.41 $302.41 $479.01 $604.81 $483.85 $393.13 $604.81 $604.81 $350.90 $604.81 $362.89 $604.81 $604.81 $604.81 1705.61 795.8 27431 ERX HCPCS Q2050 43598-0283-35 DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV INJ BOTH IP/OP "$1,442.00" "$1,067.00" $156.13 "$1,441.80" $648.81 $648.81 $648.81 $648.81 $401.03 $401.03 $401.03 $300.51 $401.03 $417.08 $417.08 $433.12 $401.04 $471.16 $401.03 $156.13 $852.82 $401.03 "$1,441.80" $401.03 $421.08 "$1,081.50" $401.03 $401.03 $401.03 $720.90 $720.90 "$1,141.91" $401.03 "$1,153.44" $648.81 $448.68 $401.03 $836.36 $421.08 $581.49 $401.03 $448.68 $401.03 N/A N/A 27459 ERX HCPCS 63700001 00378-4642-26 ESTRADIOL 0.05 MG/24HR TD PTTW BOTH IP/OP $49.00 $36.00 $10.21 $48.98 $48.98 $48.98 $48.98 $48.98 $48.98 $48.98 $48.98 $48.98 $48.98 $48.98 $48.98 $48.98 $48.98 $10.21 $48.98 $19.59 $48.98 $48.98 $48.98 $48.98 $48.98 $36.75 $48.98 $48.98 $48.98 $24.49 $24.49 $38.79 $48.98 $39.18 $31.84 $48.98 $48.98 $28.42 $48.98 $29.39 $48.98 $48.98 $48.98 N/A N/A 27471 ERX HCPCS 25000001 00378-9102-93 NITROGLYCERIN 0.1 MG/HR TD PT24 BOTH IP/OP $8.50 $6.00 $1.43 $8.04 $8.04 $8.04 $8.04 $8.04 $8.04 $8.04 $1.43 $8.04 $8.04 $5.97 $5.97 $6.20 $4.19 $1.68 $8.04 $3.22 $8.04 $8.04 $8.04 $8.04 $8.04 $6.38 $8.04 $8.04 $8.04 $4.02 $4.02 $6.37 $8.04 $6.43 $5.23 $8.04 $8.04 $4.93 $8.04 $4.82 $8.04 $8.04 $8.04 N/A N/A 27473 ERX HCPCS 25000001 50742-0515-30 NITROGLYCERIN 0.3 MG/HR TD PT24 BOTH IP/OP $228.00 $169.00 $40.52 $227.65 $227.65 $227.65 $227.65 $227.65 $227.65 $227.65 $40.52 $227.65 $227.65 $168.96 $168.96 $175.47 $118.61 $47.44 $227.65 $91.06 $227.65 $227.65 $227.65 $227.65 $227.65 $171.00 $227.65 $227.65 $227.65 $113.83 $113.83 $180.30 $227.65 $182.12 $147.97 $227.65 $227.65 $132.24 $227.65 $136.59 $227.65 $227.65 $227.65 N/A N/A 27474 ERX HCPCS 25000001 NITROGLYCERIN 0.4 MG/HR TD PT24 BOTH IP/OP $8.00 $6.00 $1.42 $7.98 $7.98 $7.98 $7.98 $7.98 $7.98 $7.98 $1.42 $7.98 $7.98 $5.92 $5.92 $6.15 $4.16 $1.66 $7.98 $3.19 $7.98 $7.98 $7.98 $7.98 $7.98 $6.00 $7.98 $7.98 $7.98 $3.99 $3.99 $6.32 $7.98 $6.38 $5.19 $7.98 $7.98 $4.64 $7.98 $4.79 $7.98 $7.98 $7.98 N/A N/A 27475 ERX HCPCS 25000001 NITROGLYCERIN 0.6 MG/HR TD PT24 BOTH IP/OP $10.50 $8.00 $1.84 $10.36 $10.36 $10.36 $10.36 $10.36 $10.36 $10.36 $1.84 $10.36 $10.36 $7.69 $7.69 $7.99 $5.40 $2.16 $10.36 $4.14 $10.36 $10.36 $10.36 $10.36 $10.36 $7.88 $10.36 $10.36 $10.36 $5.18 $5.18 $8.21 $10.36 $8.29 $6.73 $10.36 $10.36 $6.09 $10.36 $6.22 $10.36 $10.36 $10.36 1527.12 712.03 27489 ERX HCPCS 63700001 53489-0368-01 FELODIPINE ER 2.5 MG PO TB24 BOTH IP/OP $7.00 $5.00 $1.36 $6.53 $6.53 $6.53 $6.53 $6.53 $6.53 $6.53 $6.53 $6.53 $6.53 $6.53 $6.53 $6.53 $6.53 $1.36 $6.53 $2.61 $6.53 $6.53 $6.53 $6.53 $6.53 $5.25 $6.53 $6.53 $6.53 $3.27 $3.27 $5.17 $6.53 $5.22 $4.24 $6.53 $6.53 $4.06 $6.53 $3.92 $6.53 $6.53 $6.53 N/A N/A 27491 ERX HCPCS 63700001 53489-0370-01 FELODIPINE ER 10 MG PO TB24 BOTH IP/OP $12.00 $9.00 $2.44 $11.73 $11.73 $11.73 $11.73 $11.73 $11.73 $11.73 $11.73 $11.73 $11.73 $11.73 $11.73 $11.73 $11.73 $2.44 $11.73 $4.69 $11.73 $11.73 $11.73 $11.73 $11.73 $9.00 $11.73 $11.73 $11.73 $5.87 $5.87 $9.29 $11.73 $9.38 $7.62 $11.73 $11.73 $6.96 $11.73 $7.04 $11.73 $11.73 $11.73 N/A N/A 27494 ERX HCPCS 63700001 00378-2223-01 NISOLDIPINE ER 30 MG PO TB24 BOTH IP/OP $78.00 $58.00 $16.15 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $16.15 $77.51 $31.00 $77.51 $77.51 $77.51 $77.51 $77.51 $58.50 $77.51 $77.51 $77.51 $38.76 $38.76 $61.39 $77.51 $62.01 $50.38 $77.51 $77.51 $45.24 $77.51 $46.51 $77.51 $77.51 $77.51 N/A N/A 27495 ERX HCPCS 63700001 00378-2224-01 NISOLDIPINE ER 40 MG PO TB24 BOTH IP/OP $78.00 $58.00 $16.15 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $77.51 $16.15 $77.51 $31.00 $77.51 $77.51 $77.51 $77.51 $77.51 $58.50 $77.51 $77.51 $77.51 $38.76 $38.76 $61.39 $77.51 $62.01 $50.38 $77.51 $77.51 $45.24 $77.51 $46.51 $77.51 $77.51 $77.51 2607.23 1205.55 27520 ERX HCPCS 63700006 00573-2660-24 LORATADINE-PSEUDOEPHEDRINE ER 5-120 MG PO TB12 BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 676.07 326.72 27529 ERX HCPCS 63700001 63824-0057-18 PSEUDOEPHEDRINE-GUAIFENESIN ER 60-600 MG PO TB12 BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 27631 ERX HCPCS 63700001 68084-0313-01 DIVALPROEX SODIUM 125 MG PO CSDR BOTH IP/OP $6.50 $5.00 $1.28 $6.14 $6.14 $6.14 $6.14 $6.14 $6.14 $6.14 $6.14 $6.14 $6.14 $6.14 $6.14 $6.14 $6.14 $1.28 $6.14 $2.46 $6.14 $6.14 $6.14 $6.14 $6.14 $4.88 $6.14 $6.14 $6.14 $3.07 $3.07 $4.86 $6.14 $4.91 $3.99 $6.14 $6.14 $3.77 $6.14 $3.68 $6.14 $6.14 $6.14 N/A N/A 27632 ERX HCPCS 63700001 54092-0172-12 CARBAMAZEPINE ER 200 MG PO CP12 BOTH IP/OP $9.50 $7.00 $1.92 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $1.92 $9.19 $3.68 $9.19 $9.19 $9.19 $9.19 $9.19 $7.13 $9.19 $9.19 $9.19 $4.60 $4.60 $7.28 $9.19 $7.35 $5.97 $9.19 $9.19 $5.51 $9.19 $5.51 $9.19 $9.19 $9.19 958.94 441.35 27633 ERX HCPCS 63700001 54092-0173-12 CARBAMAZEPINE ER 300 MG PO CP12 BOTH IP/OP $9.50 $7.00 $1.92 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $9.19 $1.92 $9.19 $3.68 $9.19 $9.19 $9.19 $9.19 $9.19 $7.13 $9.19 $9.19 $9.19 $4.60 $4.60 $7.28 $9.19 $7.35 $5.97 $9.19 $9.19 $5.51 $9.19 $5.51 $9.19 $9.19 $9.19 N/A N/A 27634 ERX HCPCS 63700001 00781-8016-01 CARBAMAZEPINE ER 100 MG PO TB12 BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 1587.98 721.69 27635 ERX HCPCS 63700001 51672-4124-01 CARBAMAZEPINE ER 200 MG PO TB12 BOTH IP/OP $9.00 $7.00 $1.87 $8.99 $8.99 $8.99 $8.99 $8.99 $8.99 $8.99 $8.99 $8.99 $8.99 $8.99 $8.99 $8.99 $8.99 $1.87 $8.99 $3.60 $8.99 $8.99 $8.99 $8.99 $8.99 $6.75 $8.99 $8.99 $8.99 $4.50 $4.50 $7.12 $8.99 $7.19 $5.84 $8.99 $8.99 $5.22 $8.99 $5.39 $8.99 $8.99 $8.99 1356.89 620.24 27636 ERX HCPCS 63700001 00078-0512-05 CARBAMAZEPINE ER 400 MG PO TB12 BOTH IP/OP $32.50 $24.00 $6.75 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $6.75 $32.37 $12.95 $32.37 $32.37 $32.37 $32.37 $32.37 $24.38 $32.37 $32.37 $32.37 $16.19 $16.19 $25.64 $32.37 $25.90 $21.04 $32.37 $32.37 $18.85 $32.37 $19.42 $32.37 $32.37 $32.37 N/A N/A 27641 ERX HCPCS 63700001 50458-0647-65 TOPIRAMATE 15 MG PO CPSP BOTH IP/OP $32.50 $24.00 $6.70 $32.14 $32.14 $32.14 $32.14 $32.14 $32.14 $32.14 $32.14 $32.14 $32.14 $32.14 $32.14 $32.14 $32.14 $6.70 $32.14 $12.86 $32.14 $32.14 $32.14 $32.14 $32.14 $24.38 $32.14 $32.14 $32.14 $16.07 $16.07 $25.45 $32.14 $25.71 $20.89 $32.14 $32.14 $18.85 $32.14 $19.28 $32.14 $32.14 $32.14 1545.51 696.96 27642 ERX HCPCS 63700001 00093-7336-06 TOPIRAMATE 25 MG PO CPSP BOTH IP/OP $13.00 $10.00 $2.63 $12.64 $12.64 $12.64 $12.64 $12.64 $12.64 $12.64 $12.64 $12.64 $12.64 $12.64 $12.64 $12.64 $12.64 $2.63 $12.64 $5.06 $12.64 $12.64 $12.64 $12.64 $12.64 $9.75 $12.64 $12.64 $12.64 $6.32 $6.32 $10.01 $12.64 $10.11 $8.22 $12.64 $12.64 $7.54 $12.64 $7.58 $12.64 $12.64 $12.64 N/A N/A 27644 ERX HCPCS 25000001 65162-0596-06 ASPIRIN-DIPYRIDAMOLE ER 25-200 MG PO CP12 BOTH IP/OP $36.50 $27.00 $6.43 $36.10 $36.10 $36.10 $36.10 $36.10 $36.10 $36.10 $6.43 $36.10 $36.10 $26.79 $26.79 $27.83 $18.81 $7.52 $36.10 $14.44 $36.10 $36.10 $36.10 $36.10 $36.10 $27.38 $36.10 $36.10 $36.10 $18.05 $18.05 $28.59 $36.10 $28.88 $23.47 $36.10 $36.10 $21.17 $36.10 $21.66 $36.10 $36.10 $36.10 N/A N/A 27659 ERX HCPCS 63700001 71205-0964-00 NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24 BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 1113.63 502.39 27692 ERX HCPCS 63700001 00378-8030-93 LANSOPRAZOLE 30 MG PO CPDR BOTH IP/OP $25.50 $19.00 $5.31 $25.48 $25.48 $25.48 $25.48 $25.48 $25.48 $25.48 $25.48 $25.48 $25.48 $25.48 $25.48 $25.48 $25.48 $5.31 $25.48 $10.19 $25.48 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $25.48 $25.48 $14.79 $25.48 $15.29 $25.48 $25.48 $25.48 242.97 106.79 27735 ERX HCPCS Q9958 00270-0149-57 DIATRIZOATE MEGLUMINE 30 % UR SOLN BOTH IP/OP $237.50 $176.00 $21.00 $237.36 $106.81 $106.81 $106.81 $106.81 $237.36 $237.36 $237.36 $49.47 $237.36 $237.36 $237.36 $22.68 $21.00 $49.47 $237.36 $237.36 $140.40 $237.36 $237.36 $237.36 $237.36 $178.13 $237.36 $237.36 $237.36 $118.68 $118.68 $187.99 $237.36 $189.89 $106.81 $47.11 $237.36 $137.75 $237.36 $237.36 $237.36 $49.47 $237.36 N/A N/A 27770 ERX HCPCS 25000001 24208-0342-05 DESMOPRESSIN ACE SPRAY REFRIG 0.01 % NA SOLN BOTH IP/OP $744.00 $551.00 $132.38 $743.71 $743.71 $743.71 $743.71 $743.71 $743.71 $743.71 $132.38 $743.71 $743.71 $551.98 $551.98 $573.25 $387.47 $155.00 $743.71 $297.48 $743.71 $743.71 $743.71 $743.71 $743.71 $558.00 $743.71 $743.71 $743.71 $371.86 $371.86 $589.02 $743.71 $594.97 $483.41 $743.71 $743.71 $431.52 $743.71 $446.23 $743.71 $743.71 $743.71 N/A N/A 27780 ERX HCPCS 63700001 60687-0230-01 ZONISAMIDE 100 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 639.96 309.8 27838 ERX HCPCS J7030 00338-0049-04 SODIUM CHLORIDE 0.9 % IV SOLN BOTH IP/OP $22.00 $16.00 $1.27 $21.60 $9.72 $9.72 $9.72 $9.72 $21.60 $21.60 $21.60 $1.27 $21.60 $2.85 $2.85 $2.96 $2.74 $3.22 $21.60 $21.60 $12.78 $21.60 $21.60 $21.60 $21.60 $16.50 $21.60 $21.60 $21.60 $10.80 $10.80 $17.11 $21.60 $17.28 $9.72 $3.07 $21.60 $12.76 $21.60 $21.60 $21.60 $3.07 $21.60 N/A N/A 27855 ERX HCPCS 25000001 00013-2150-36 ESTRADIOL 2 MG VA RING BOTH IP/OP "$1,697.50" "$1,256.00" $302.12 "$1,697.32" "$1,697.32" "$1,697.32" "$1,697.32" "$1,697.32" "$1,697.32" "$1,697.32" $302.12 "$1,697.32" "$1,697.32" "$1,259.75" "$1,259.75" "$1,308.29" $884.30 $353.74 "$1,697.32" $678.93 "$1,697.32" "$1,697.32" "$1,697.32" "$1,697.32" "$1,697.32" "$1,273.13" "$1,697.32" "$1,697.32" "$1,697.32" $848.66 $848.66 "$1,344.28" "$1,697.32" "$1,357.86" "$1,103.26" "$1,697.32" "$1,697.32" $984.55 "$1,697.32" "$1,018.39" "$1,697.32" "$1,697.32" "$1,697.32" N/A N/A 27857 ERX HCPCS 63700001 00093-7384-98 VENLAFAXINE HCL ER 37.5 MG PO CP24 BOTH IP/OP $18.00 $13.00 $3.75 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $3.75 $17.99 $7.20 $17.99 $17.99 $17.99 $17.99 $17.99 $13.50 $17.99 $17.99 $17.99 $9.00 $9.00 $14.25 $17.99 $14.39 $11.69 $17.99 $17.99 $10.44 $17.99 $10.79 $17.99 $17.99 $17.99 N/A N/A 27858 ERX HCPCS 63700001 00093-7385-98 VENLAFAXINE HCL ER 75 MG PO CP24 BOTH IP/OP $20.50 $15.00 $4.20 $20.16 $20.16 $20.16 $20.16 $20.16 $20.16 $20.16 $20.16 $20.16 $20.16 $20.16 $20.16 $20.16 $20.16 $4.20 $20.16 $8.06 $20.16 $20.16 $20.16 $20.16 $20.16 $15.38 $20.16 $20.16 $20.16 $10.08 $10.08 $15.97 $20.16 $16.13 $13.10 $20.16 $20.16 $11.89 $20.16 $12.10 $20.16 $20.16 $20.16 N/A N/A 27859 ERX HCPCS 63700001 00093-7386-98 VENLAFAXINE HCL ER 150 MG PO CP24 BOTH IP/OP $22.00 $16.00 $4.58 $21.96 $21.96 $21.96 $21.96 $21.96 $21.96 $21.96 $21.96 $21.96 $21.96 $21.96 $21.96 $21.96 $21.96 $4.58 $21.96 $8.78 $21.96 $21.96 $21.96 $21.96 $21.96 $16.50 $21.96 $21.96 $21.96 $10.98 $10.98 $17.39 $21.96 $17.57 $14.27 $21.96 $21.96 $12.76 $21.96 $13.18 $21.96 $21.96 $21.96 N/A N/A 27860 ERX HCPCS 63700001 70677-0030-01 NICOTINE 7 MG/24HR TD PT24 BOTH IP/OP $8.50 $6.00 $1.70 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $1.70 $8.18 $3.27 $8.18 $8.18 $8.18 $8.18 $8.18 $6.38 $8.18 $8.18 $8.18 $4.09 $4.09 $6.48 $8.18 $6.54 $5.32 $8.18 $8.18 $4.93 $8.18 $4.91 $8.18 $8.18 $8.18 404.28 177.03 27862 ERX HCPCS 63700006 00536-5895-88 NICOTINE 14 MG/24HR TD PT24 BOTH IP/OP $9.50 $7.00 $1.93 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $9.26 $1.93 $9.26 $3.70 $9.26 $9.26 $9.26 $9.26 $9.26 $7.13 $9.26 $9.26 $9.26 $4.63 $4.63 $7.33 $9.26 $7.41 $6.02 $9.26 $9.26 $5.51 $9.26 $5.56 $9.26 $9.26 $9.26 N/A N/A 27863 ERX HCPCS 63700001 70677-0032-01 NICOTINE 21 MG/24HR TD PT24 BOTH IP/OP $8.50 $6.00 $1.70 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $8.18 $1.70 $8.18 $3.27 $8.18 $8.18 $8.18 $8.18 $8.18 $6.38 $8.18 $8.18 $8.18 $4.09 $4.09 $6.48 $8.18 $6.54 $5.32 $8.18 $8.18 $4.93 $8.18 $4.91 $8.18 $8.18 $8.18 N/A N/A 27905 ERX HCPCS 63700001 00378-9121-98 FENTANYL 25 MCG/HR TD PATCH 72 HR BOTH IP/OP $62.50 $46.00 $12.98 $62.30 $62.30 $62.30 $62.30 $62.30 $62.30 $62.30 $62.30 $62.30 $62.30 $62.30 $62.30 $62.30 $62.30 $12.98 $62.30 $24.92 $62.30 $62.30 $62.30 $62.30 $62.30 $46.88 $62.30 $62.30 $62.30 $31.15 $31.15 $49.34 $62.30 $49.84 $40.50 $62.30 $62.30 $36.25 $62.30 $37.38 $62.30 $62.30 $62.30 N/A N/A 27906 ERX HCPCS 63700001 47781-0426-47 FENTANYL 50 MCG/HR TD PATCH 72 HR BOTH IP/OP $155.00 $115.00 $32.25 $154.76 $154.76 $154.76 $154.76 $154.76 $154.76 $154.76 $154.76 $154.76 $154.76 $154.76 $154.76 $154.76 $154.76 $32.25 $154.76 $61.90 $154.76 $154.76 $154.76 $154.76 $154.76 $116.25 $154.76 $154.76 $154.76 $77.38 $77.38 $122.57 $154.76 $123.81 $100.59 $154.76 $154.76 $89.90 $154.76 $92.86 $154.76 $154.76 $154.76 N/A N/A 27907 ERX HCPCS 63700006 60505-7008-02 FENTANYL 75 MCG/HR TD PATCH 72 HR BOTH IP/OP $212.50 $157.00 $44.25 $212.32 $212.32 $212.32 $212.32 $212.32 $212.32 $212.32 $212.32 $212.32 $212.32 $212.32 $212.32 $212.32 $212.32 $44.25 $212.32 $84.93 $212.32 $212.32 $212.32 $212.32 $212.32 $159.38 $212.32 $212.32 $212.32 $106.16 $106.16 $168.16 $212.32 $169.86 $138.01 $212.32 $212.32 $123.25 $212.32 $127.39 $212.32 $212.32 $212.32 N/A N/A 27908 ERX HCPCS 63700001 60505-7009-02 FENTANYL 100 MCG/HR TD PATCH 72 HR BOTH IP/OP $282.00 $209.00 $58.73 $281.79 $281.79 $281.79 $281.79 $281.79 $281.79 $281.79 $281.79 $281.79 $281.79 $281.79 $281.79 $281.79 $281.79 $58.73 $281.79 $112.72 $281.79 $281.79 $281.79 $281.79 $281.79 $211.50 $281.79 $281.79 $281.79 $140.90 $140.90 $223.18 $281.79 $225.43 $183.16 $281.79 $281.79 $163.56 $281.79 $169.07 $281.79 $281.79 $281.79 N/A N/A 28001 ERX HCPCS 25000001 00093-9614-13 SILVER NITRATE 0.5 % EX SOLN BOTH IP/OP $326.50 $242.00 $58.12 $326.50 $326.50 $326.50 $326.50 $326.50 $326.50 $326.50 $58.12 $326.50 $326.50 $242.33 $242.33 $251.67 $170.11 $68.05 $326.50 $130.60 $326.50 $326.50 $326.50 $326.50 $326.50 $244.88 $326.50 $326.50 $326.50 $163.25 $163.25 $258.59 $326.50 $261.20 $212.23 $326.50 $326.50 $189.37 $326.50 $195.90 $326.50 $326.50 $326.50 392.07 102.85 28158 ERX HCPCS 63700001 00904-6287-06 OLANZAPINE 20 MG PO TABS BOTH IP/OP $159.00 $118.00 $33.04 $158.53 $158.53 $158.53 $158.53 $158.53 $158.53 $158.53 $158.53 $158.53 $158.53 $158.53 $158.53 $158.53 $158.53 $33.04 $158.53 $63.41 $158.53 $158.53 $158.53 $158.53 $158.53 $119.25 $158.53 $158.53 $158.53 $79.27 $79.27 $125.56 $158.53 $126.82 $103.04 $158.53 $158.53 $92.22 $158.53 $95.12 $158.53 $158.53 $158.53 N/A N/A 28159 ERX HCPCS 63700001 13668-0086-30 OLANZAPINE 5 MG PO TBDP BOTH IP/OP $60.50 $45.00 $12.60 $60.48 $60.48 $60.48 $60.48 $60.48 $60.48 $60.48 $60.48 $60.48 $60.48 $60.48 $60.48 $60.48 $60.48 $12.60 $60.48 $24.19 $60.48 $60.48 $60.48 $60.48 $60.48 $45.38 $60.48 $60.48 $60.48 $30.24 $30.24 $47.90 $60.48 $48.38 $39.31 $60.48 $60.48 $35.09 $60.48 $36.29 $60.48 $60.48 $60.48 N/A N/A 28160 ERX HCPCS 63700001 13668-0088-30 OLANZAPINE 10 MG PO TBDP BOTH IP/OP $82.50 $61.00 $17.14 $82.26 $82.26 $82.26 $82.26 $82.26 $82.26 $82.26 $82.26 $82.26 $82.26 $82.26 $82.26 $82.26 $82.26 $17.14 $82.26 $32.90 $82.26 $82.26 $82.26 $82.26 $82.26 $61.88 $82.26 $82.26 $82.26 $41.13 $41.13 $65.15 $82.26 $65.81 $53.47 $82.26 $82.26 $47.85 $82.26 $49.36 $82.26 $82.26 $82.26 625.71 283.98 28161 ERX HCPCS 63700001 13668-0089-30 OLANZAPINE 15 MG PO TBDP BOTH IP/OP $121.00 $90.00 $25.16 $120.73 $120.73 $120.73 $120.73 $120.73 $120.73 $120.73 $120.73 $120.73 $120.73 $120.73 $120.73 $120.73 $120.73 $25.16 $120.73 $48.29 $120.73 $120.73 $120.73 $120.73 $120.73 $90.75 $120.73 $120.73 $120.73 $60.37 $60.37 $95.62 $120.73 $96.58 $78.47 $120.73 $120.73 $70.18 $120.73 $72.44 $120.73 $120.73 $120.73 N/A N/A 28162 ERX HCPCS 63700001 13668-0090-30 OLANZAPINE 20 MG PO TBDP BOTH IP/OP $159.50 $118.00 $33.18 $159.20 $159.20 $159.20 $159.20 $159.20 $159.20 $159.20 $159.20 $159.20 $159.20 $159.20 $159.20 $159.20 $159.20 $33.18 $159.20 $63.68 $159.20 $159.20 $159.20 $159.20 $159.20 $119.63 $159.20 $159.20 $159.20 $79.60 $79.60 $126.09 $159.20 $127.36 $103.48 $159.20 $159.20 $92.51 $159.20 $95.52 $159.20 $159.20 $159.20 N/A N/A 28188 ERX HCPCS 25000001 67618-0200-08 CHLORHEXIDINE GLUCONATE 4 % EX LIQD BOTH IP/OP $40.00 $30.00 $7.11 $39.93 $39.93 $39.93 $39.93 $39.93 $39.93 $39.93 $7.11 $39.93 $39.93 $29.64 $29.64 $30.78 $20.80 $8.32 $39.93 $15.97 $39.93 $39.93 $39.93 $39.93 $39.93 $30.00 $39.93 $39.93 $39.93 $19.97 $19.97 $31.62 $39.93 $31.94 $25.95 $39.93 $39.93 $23.20 $39.93 $23.96 $39.93 $39.93 $39.93 N/A N/A 28203 ERX HCPCS 25000001 00591-3525-30 LIDOCAINE 5 % EX PTCH BOTH IP/OP $40.50 $30.00 $7.20 $40.44 $40.44 $40.44 $40.44 $40.44 $40.44 $40.44 $7.20 $40.44 $40.44 $30.01 $30.01 $31.17 $21.07 $8.43 $40.44 $16.18 $40.44 $40.44 $40.44 $40.44 $40.44 $30.38 $40.44 $40.44 $40.44 $20.22 $20.22 $32.03 $40.44 $32.35 $26.29 $40.44 $40.44 $23.49 $40.44 $24.26 $40.44 $40.44 $40.44 N/A N/A 28205 ERX HCPCS 25000001 00395-2243-91 PEPPERMINT SPIRIT SPRT BOTH IP/OP $42.00 $31.00 $7.48 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $42.00 $7.48 $42.00 $42.00 $31.17 $31.17 $32.37 $21.88 $8.75 $42.00 $16.80 $42.00 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $27.30 $42.00 $42.00 $24.36 $42.00 $25.20 $42.00 $42.00 $42.00 N/A N/A 28246 ERX HCPCS 25000001 00173-0521-00 SALMETEROL XINAFOATE 50 MCG/DOSE INH BOTH IP/OP "$1,357.00" "$1,004.00" $241.50 "$1,356.74" "$1,356.74" "$1,356.74" "$1,356.74" "$1,356.74" "$1,356.74" "$1,356.74" $241.50 "$1,356.74" "$1,356.74" "$1,006.97" "$1,006.97" "$1,045.78" $706.86 $282.76 "$1,356.74" $542.70 "$1,356.74" "$1,356.74" "$1,356.74" "$1,356.74" "$1,356.74" "$1,017.75" "$1,356.74" "$1,356.74" "$1,356.74" $678.37 $678.37 "$1,074.54" "$1,356.74" "$1,085.39" $881.88 "$1,356.74" "$1,356.74" $787.06 "$1,356.74" $814.04 "$1,356.74" "$1,356.74" "$1,356.74" N/A N/A 28252 ERX HCPCS 63700001 00115-5522-10 FENOFIBRATE 160 MG PO TABS BOTH IP/OP $10.50 $8.00 $2.14 $10.27 $10.27 $10.27 $10.27 $10.27 $10.27 $10.27 $10.27 $10.27 $10.27 $10.27 $10.27 $10.27 $10.27 $2.14 $10.27 $4.11 $10.27 $10.27 $10.27 $10.27 $10.27 $7.88 $10.27 $10.27 $10.27 $5.14 $5.14 $8.13 $10.27 $8.22 $6.68 $10.27 $10.27 $6.09 $10.27 $6.16 $10.27 $10.27 $10.27 N/A N/A 28278 ERX HCPCS 63700001 55111-0352-60 RIVASTIGMINE TARTRATE 1.5 MG PO CAPS BOTH IP/OP $18.50 $14.00 $3.82 $18.34 $18.34 $18.34 $18.34 $18.34 $18.34 $18.34 $18.34 $18.34 $18.34 $18.34 $18.34 $18.34 $18.34 $3.82 $18.34 $7.34 $18.34 $18.34 $18.34 $18.34 $18.34 $13.88 $18.34 $18.34 $18.34 $9.17 $9.17 $14.53 $18.34 $14.67 $11.92 $18.34 $18.34 $10.73 $18.34 $11.00 $18.34 $18.34 $18.34 N/A N/A 28280 ERX HCPCS 63700001 62756-0147-86 RIVASTIGMINE TARTRATE 4.5 MG PO CAPS BOTH IP/OP $18.50 $14.00 $3.80 $18.24 $18.24 $18.24 $18.24 $18.24 $18.24 $18.24 $18.24 $18.24 $18.24 $18.24 $18.24 $18.24 $18.24 $3.80 $18.24 $7.30 $18.24 $18.24 $18.24 $18.24 $18.24 $13.88 $18.24 $18.24 $18.24 $9.12 $9.12 $14.45 $18.24 $14.59 $11.86 $18.24 $18.24 $10.73 $18.24 $10.94 $18.24 $18.24 $18.24 811.22 369.42 28282 ERX HCPCS J1815 00088-2220-33 INSULIN GLARGINE (LANTUS) 100 UNIT/ML SC SOLN BOTH IP/OP $12.50 $9.00 $2.48 $201.38 $6.79 $6.79 $6.79 $6.79 $12.50 $12.50 $12.50 $2.61 $12.50 $12.50 $12.50 $12.50 $12.50 $2.61 $12.50 $12.50 $7.39 $12.50 $12.50 $12.50 $12.50 $9.38 $12.50 $12.50 $12.50 $6.25 $6.25 $9.90 $12.50 $10.00 $8.13 $2.48 $12.50 $7.25 $12.50 $12.50 $12.50 $201.38 $12.50 N/A N/A 28400 ERX HCPCS 25000001 00338-0013-04 STERILE WATER FOR INJECTION IV SOLN BOTH IP/OP $48.00 $36.00 $8.46 $47.52 $47.52 $47.52 $47.52 $47.52 $47.52 $47.52 $8.46 $47.52 $47.52 $35.27 $35.27 $36.63 $24.76 $9.90 $47.52 $19.01 $47.52 $47.52 $47.52 $47.52 $47.52 $36.00 $47.52 $47.52 $47.52 $23.76 $23.76 $37.64 $47.52 $38.02 $30.89 $47.52 $47.52 $27.84 $47.52 $28.51 $47.52 $47.52 $47.52 525.15 247.31 28530 ERX HCPCS J3100 50242-0120-47 TENECTEPLASE 50 MG IV KIT BOTH IP/OP "$10,315.00" "$7,633.00" "$1,836.04" "$14,440.73" "$10,314.81" "$10,314.81" "$10,314.81" "$10,314.81" "$10,314.81" "$10,314.81" "$1,836.04" "$10,314.81" "$10,314.81" "$10,314.81" "$10,314.81" "$10,314.81" "$10,314.81" "$2,149.72" "$10,314.81" "$4,125.92" "$10,314.81" "$10,314.81" "$10,314.81" "$10,314.81" "$10,314.81" "$7,736.25" "$10,314.81" "$10,314.81" "$10,314.81" "$5,157.41" "$5,157.41" "$8,169.33" "$10,314.81" "$8,251.85" "$4,641.66" "$10,314.81" "$14,440.73" "$5,982.70" "$10,314.81" "$6,188.89" "$10,314.81" "$10,314.81" "$10,314.81" 237.03 105.26 28534 ERX HCPCS J1815 00169-7501-11 INSULIN ASPART (NOVOLOG) 100 UNIT/ML SC SOLN BOTH IP/OP $12.50 $9.00 $2.48 $201.38 $6.79 $6.79 $6.79 $6.79 $12.50 $12.50 $12.50 $2.61 $12.50 $12.50 $12.50 $12.50 $12.50 $2.61 $12.50 $12.50 $7.39 $12.50 $12.50 $12.50 $12.50 $9.38 $12.50 $12.50 $12.50 $6.25 $6.25 $9.90 $12.50 $10.00 $8.13 $2.48 $12.50 $7.25 $12.50 $12.50 $12.50 $201.38 $12.50 N/A N/A 28643 ERX HCPCS 63700001 50742-0260-01 NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24 BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 28645 ERX HCPCS 63700006 00904-6293-04 ATORVASTATIN CALCIUM 80 MG PO TABS BOTH IP/OP $8.50 $6.00 $1.75 $8.39 $8.39 $8.39 $8.39 $8.39 $8.39 $8.39 $8.39 $8.39 $8.39 $8.39 $8.39 $8.39 $8.39 $1.75 $8.39 $3.36 $8.39 $8.39 $8.39 $8.39 $8.39 $6.38 $8.39 $8.39 $8.39 $4.20 $4.20 $6.64 $8.39 $6.71 $5.45 $8.39 $8.39 $4.93 $8.39 $5.03 $8.39 $8.39 $8.39 1124.01 515.78 28686 ERX HCPCS 63700001 68462-0402-01 ATOVAQUONE-PROGUANIL HCL 62.5-25 MG PO TABS BOTH IP/OP $23.50 $17.00 $4.84 $23.20 $23.20 $23.20 $23.20 $23.20 $23.20 $23.20 $23.20 $23.20 $23.20 $23.20 $23.20 $23.20 $23.20 $4.84 $23.20 $9.28 $23.20 $23.20 $23.20 $23.20 $23.20 $17.63 $23.20 $23.20 $23.20 $11.60 $11.60 $18.37 $23.20 $18.56 $15.08 $23.20 $23.20 $13.63 $23.20 $13.92 $23.20 $23.20 $23.20 N/A N/A 28774 ERX HCPCS J7626 00487-9601-30 BUDESONIDE 0.25 MG/2ML IN SUSP BOTH IP/OP $26.00 $19.00 $1.05 $25.71 $25.71 $25.71 $25.71 $25.71 $25.71 $25.71 $1.05 $25.71 $25.71 $1.14 $1.14 $1.19 $1.10 $5.36 $25.71 $10.28 $25.71 $25.71 $25.71 $25.71 $25.71 $19.50 $25.71 $25.71 $25.71 $12.86 $12.86 $20.36 $25.71 $20.57 $11.57 $25.71 $25.71 $15.08 $25.71 $15.43 $25.71 $25.71 $25.71 N/A N/A 28775 ERX HCPCS J7626 00186-1989-04 BUDESONIDE 0.5 MG/2ML IN SUSP BOTH IP/OP $53.50 $40.00 $1.05 $53.18 $53.18 $53.18 $53.18 $53.18 $53.18 $53.18 $1.05 $53.18 $53.18 $1.14 $1.14 $1.19 $1.10 $11.08 $53.18 $21.27 $53.18 $53.18 $53.18 $53.18 $53.18 $40.13 $53.18 $53.18 $53.18 $26.59 $26.59 $42.12 $53.18 $42.54 $23.93 $53.18 $53.18 $31.03 $53.18 $31.91 $53.18 $53.18 $53.18 N/A N/A 28810 ERX HCPCS 25000001 24208-0635-62 NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP BOTH IP/OP $349.50 $259.00 $62.19 $349.36 $349.36 $349.36 $349.36 $349.36 $349.36 $349.36 $62.19 $349.36 $349.36 $259.29 $259.29 $269.29 $182.02 $72.81 $349.36 $139.74 $349.36 $349.36 $349.36 $349.36 $349.36 $262.13 $349.36 $349.36 $349.36 $174.68 $174.68 $276.69 $349.36 $279.49 $227.08 $349.36 $349.36 $202.71 $349.36 $209.62 $349.36 $349.36 $349.36 1004.57 451.65 28824 ERX HCPCS 25000001 10631-0407-01 HYDROCORTISONE (PERIANAL) 2.5 % EX CREA BOTH IP/OP $313.00 $232.00 $55.64 $312.60 $312.60 $312.60 $312.60 $312.60 $312.60 $312.60 $55.64 $312.60 $312.60 $232.01 $232.01 $240.95 $162.86 $65.15 $312.60 $125.04 $312.60 $312.60 $312.60 $312.60 $312.60 $234.75 $312.60 $312.60 $312.60 $156.30 $156.30 $247.58 $312.60 $250.08 $203.19 $312.60 $312.60 $181.54 $312.60 $187.56 $312.60 $312.60 $312.60 N/A N/A 28836 ERX HCPCS 63700001 00121-0431-30 MAGNESIUM HYDROXIDE 400 MG/5ML PO SUSP BOTH IP/OP $11.00 $8.00 $2.29 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 28844 ERX HCPCS J7502 00172-7313-20 CYCLOSPORINE MODIFIED (GENGRAF) 100 MG/ML PO SOLN BOTH IP/OP $905.00 $670.00 $121.00 $904.65 $904.65 $904.65 $904.65 $904.65 $904.65 $904.65 $121.00 $904.65 $904.65 $126.36 $126.36 $131.22 $121.50 $188.54 $904.65 $361.86 $904.65 $904.65 $904.65 $904.65 $904.65 $678.75 $904.65 $904.65 $904.65 $452.33 $452.33 $716.48 $904.65 $723.72 $407.09 $904.65 $904.65 $524.90 $904.65 $542.79 $904.65 $904.65 $904.65 N/A N/A 28849 ERX HCPCS 25000001 00037-6822-10 HYDROCORT-PRAMOXINE (PERIANAL) 1-1 % EX FOAM BOTH IP/OP $639.00 $473.00 $113.73 $638.92 $638.92 $638.92 $638.92 $638.92 $638.92 $638.92 $113.73 $638.92 $638.92 $474.21 $474.21 $492.48 $332.88 $133.16 $638.92 $255.57 $638.92 $638.92 $638.92 $638.92 $638.92 $479.25 $638.92 $638.92 $638.92 $319.46 $319.46 $506.02 $638.92 $511.14 $415.30 $638.92 $638.92 $370.62 $638.92 $383.35 $638.92 $638.92 $638.92 N/A N/A 28917 ERX HCPCS 25000001 08065-1831-50 NA HYALUR & NA CHOND-NA HYALUR 0.55-0.5 ML IO KIT BOTH IP/OP $906.50 $671.00 $161.28 $906.04 $906.04 $906.04 $906.04 $906.04 $906.04 $906.04 $161.28 $906.04 $906.04 $672.46 $672.46 $698.38 $472.05 $188.83 $906.04 $362.42 $906.04 $906.04 $906.04 $906.04 $906.04 $679.88 $906.04 $906.04 $906.04 $453.02 $453.02 $717.58 $906.04 $724.83 $588.93 $906.04 $906.04 $525.77 $906.04 $543.62 $906.04 $906.04 $906.04 N/A N/A 28929 ERX HCPCS 63700001 99999-6004-92 KALETRA:LOPINAVIR-RITONAVIR 400-100 MG/5ML PO SOLN BOTH IP/OP $548.00 $406.00 $114.16 $547.78 $547.78 $547.78 $547.78 $547.78 $547.78 $547.78 $547.78 $547.78 $547.78 $547.78 $547.78 $547.78 $547.78 $114.16 $547.78 $219.11 $547.78 $547.78 $547.78 $547.78 $547.78 $411.00 $547.78 $547.78 $547.78 $273.89 $273.89 $433.84 $547.78 $438.22 $356.06 $547.78 $547.78 $317.84 $547.78 $328.67 $547.78 $547.78 $547.78 N/A N/A 28947 ERX HCPCS J0883 42023-0182-01 ARGATROBAN 250 MG/2.5ML IV SOLN BOTH IP/OP "$1,634.50" "$1,210.00" $340.55 "$1,634.04" "$1,634.04" "$1,634.04" "$1,634.04" "$1,634.04" "$1,634.04" "$1,634.04" $950.00 "$1,634.04" "$1,634.04" "$1,014.00" "$1,014.00" "$1,053.00" $975.00 $340.55 "$1,634.04" $653.62 "$1,634.04" "$1,634.04" "$1,634.04" "$1,634.04" "$1,634.04" "$1,225.88" "$1,634.04" "$1,634.04" "$1,634.04" $817.02 $817.02 "$1,294.16" "$1,634.04" "$1,307.23" $735.32 "$1,634.04" "$1,634.04" $948.01 "$1,634.04" $980.42 "$1,634.04" "$1,634.04" "$1,634.04" N/A N/A 28958 ERX HCPCS J7520 55111-0653-01 SIROLIMUS 1 MG PO TABS BOTH IP/OP $74.00 $55.00 $4.50 $73.65 $73.65 $73.65 $73.65 $73.65 $73.65 $73.65 $4.50 $73.65 $73.65 $4.68 $4.68 $4.86 $4.50 $15.35 $73.65 $29.46 $73.65 $73.65 $73.65 $73.65 $73.65 $55.50 $73.65 $73.65 $73.65 $36.83 $36.83 $58.33 $73.65 $58.92 $33.14 $73.65 $73.65 $42.92 $73.65 $44.19 $73.65 $73.65 $73.65 N/A N/A 28995 ERX HCPCS 63700001 70010-0491-01 METFORMIN HCL ER 500 MG PO TB24 BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 29048 ERX HCPCS 63700001 16714-0633-01 ALENDRONATE SODIUM 70 MG PO TABS BOTH IP/OP $81.50 $60.00 $16.93 $81.25 $81.25 $81.25 $81.25 $81.25 $81.25 $81.25 $81.25 $81.25 $81.25 $81.25 $81.25 $81.25 $81.25 $16.93 $81.25 $32.50 $81.25 $81.25 $81.25 $81.25 $81.25 $61.13 $81.25 $81.25 $81.25 $40.63 $40.63 $64.35 $81.25 $65.00 $52.81 $81.25 $81.25 $47.27 $81.25 $48.75 $81.25 $81.25 $81.25 N/A N/A 29071 ERX HCPCS J9017 ARSENIC TRIOXIDE 10 MG/10ML IV SOLN BOTH IP/OP "$1,903.50" "$1,409.00" $128.10 "$1,903.18" "$1,903.18" "$1,903.18" "$1,903.18" "$1,903.18" "$1,903.18" "$1,903.18" $131.10 "$1,903.18" "$1,903.18" $133.22 $133.22 $138.35 $128.10 $150.50 "$1,903.18" $761.27 "$1,903.18" "$1,903.18" "$1,903.18" "$1,903.18" "$1,903.18" "$1,427.63" "$1,903.18" "$1,903.18" "$1,903.18" $951.59 $951.59 "$1,507.32" "$1,903.18" "$1,522.54" $856.43 "$1,903.18" "$1,903.18" "$1,104.03" "$1,903.18" "$1,141.91" "$1,903.18" "$1,903.18" "$1,903.18" N/A N/A 29072 ERX HCPCS 63700001 16714-0632-01 ALENDRONATE SODIUM 35 MG PO TABS BOTH IP/OP $82.50 $61.00 $17.11 $82.11 $82.11 $82.11 $82.11 $82.11 $82.11 $82.11 $82.11 $82.11 $82.11 $82.11 $82.11 $82.11 $82.11 $17.11 $82.11 $32.84 $82.11 $82.11 $82.11 $82.11 $82.11 $61.88 $82.11 $82.11 $82.11 $41.06 $41.06 $65.03 $82.11 $65.69 $53.37 $82.11 $82.11 $47.85 $82.11 $49.27 $82.11 $82.11 $82.11 N/A N/A 29132 ERX HCPCS J1756 00517-2340-10 IRON SUCROSE 20 MG/ML IV SOLN BOTH IP/OP $248.50 $184.00 $22.00 $248.10 $111.65 $111.65 $111.65 $111.65 $248.10 $248.10 $248.10 $43.48 $248.10 $22.88 $22.88 $23.76 $22.00 $25.85 $248.10 $248.10 $146.75 $248.10 $248.10 $248.10 $248.10 $186.38 $248.10 $248.10 $248.10 $124.05 $124.05 $196.50 $248.10 $198.48 $111.65 $24.61 $248.10 $144.13 $248.10 $248.10 $248.10 $24.61 $248.10 N/A N/A 29267 ERX HCPCS 63700001 50268-0634-15 QUETIAPINE FUMARATE 300 MG PO TABS BOTH IP/OP $44.00 $33.00 $9.14 $43.84 $43.84 $43.84 $43.84 $43.84 $43.84 $43.84 $43.84 $43.84 $43.84 $43.84 $43.84 $43.84 $43.84 $9.14 $43.84 $17.54 $43.84 $43.84 $43.84 $43.84 $43.84 $33.00 $43.84 $43.84 $43.84 $21.92 $21.92 $34.72 $43.84 $35.07 $28.50 $43.84 $43.84 $25.52 $43.84 $26.30 $43.84 $43.84 $43.84 N/A N/A 29274 ERX HCPCS 63700001 10370-0831-11 DILTIAZEM HCL ER COATED BEADS 240 MG PO CP24 BOTH IP/OP $9.00 $7.00 $1.85 $8.87 $8.87 $8.87 $8.87 $8.87 $8.87 $8.87 $8.87 $8.87 $8.87 $8.87 $8.87 $8.87 $8.87 $1.85 $8.87 $3.55 $8.87 $8.87 $8.87 $8.87 $8.87 $6.75 $8.87 $8.87 $8.87 $4.44 $4.44 $7.03 $8.87 $7.10 $5.77 $8.87 $8.87 $5.22 $8.87 $5.32 $8.87 $8.87 $8.87 N/A N/A 29276 ERX HCPCS 63700001 60687-0228-01 DILTIAZEM HCL ER COATED BEADS 300 MG PO CP24 BOTH IP/OP $12.00 $9.00 $2.41 $11.58 $11.58 $11.58 $11.58 $11.58 $11.58 $11.58 $11.58 $11.58 $11.58 $11.58 $11.58 $11.58 $11.58 $2.41 $11.58 $4.63 $11.58 $11.58 $11.58 $11.58 $11.58 $9.00 $11.58 $11.58 $11.58 $5.79 $5.79 $9.17 $11.58 $9.26 $7.53 $11.58 $11.58 $6.96 $11.58 $6.95 $11.58 $11.58 $11.58 N/A N/A 29277 ERX HCPCS 63700001 47335-0673-81 DILTIAZEM HCL ER BEADS 360 MG PO CP24 BOTH IP/OP $10.50 $8.00 $2.11 $10.14 $10.14 $10.14 $10.14 $10.14 $10.14 $10.14 $10.14 $10.14 $10.14 $10.14 $10.14 $10.14 $10.14 $2.11 $10.14 $4.06 $10.14 $10.14 $10.14 $10.14 $10.14 $7.88 $10.14 $10.14 $10.14 $5.07 $5.07 $8.03 $10.14 $8.11 $6.59 $10.14 $10.14 $6.09 $10.14 $6.08 $10.14 $10.14 $10.14 N/A N/A 29280 ERX HCPCS J7298 50419-0423-01 LEVONORGESTREL 20 MCG/DAY IU IUD BOTH IP/OP "$3,080.50" "$2,280.00" $642.02 "$3,080.36" "$1,386.16" "$1,386.16" "$1,386.16" "$1,386.16" "$3,080.36" "$3,080.36" $959.31 $642.02 "$3,080.36" "$1,039.25" "$1,039.25" "$1,079.22" $999.28 "$1,174.00" "$3,080.36" "$1,232.14" "$1,518.62" "$3,080.36" "$3,080.36" "$3,080.36" "$3,080.36" "$2,310.38" "$3,080.36" "$3,080.36" "$3,080.36" "$1,540.18" "$1,540.18" "$2,439.65" "$3,080.36" "$2,464.29" "$1,386.16" "$1,117.99" "$3,080.36" "$1,786.69" "$3,080.36" "$1,848.22" "$3,080.36" "$1,117.99" "$3,080.36" 46.61 20.93 29302 ERX HCPCS J7510 99999-6005-14 PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN BOTH IP/OP $221.50 $164.00 $18.00 $221.25 $99.56 $99.56 $99.56 $99.56 $221.25 $221.25 $221.25 $46.11 $221.25 $18.72 $18.72 $19.44 $18.00 $46.11 $221.25 $221.25 $130.87 $221.25 $221.25 $221.25 $221.25 $166.13 $221.25 $221.25 $221.25 $110.63 $110.63 $175.23 $221.25 $177.00 $99.56 $43.91 $221.25 $128.47 $221.25 $221.25 $221.25 $46.11 $221.25 N/A N/A 29302 ERX HCPCS J7510 00121-0759-08 PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN BOTH IP/OP $265.00 $196.00 $18.00 $221.25 $99.56 $99.56 $99.56 $99.56 $221.25 $221.25 $221.25 $46.11 $221.25 $18.72 $18.72 $19.44 $18.00 $46.11 $221.25 $221.25 $130.87 $221.25 $221.25 $221.25 $221.25 $198.75 $221.25 $221.25 $221.25 $110.63 $110.63 $175.23 $221.25 $177.00 $99.56 $43.91 $221.25 $153.70 $221.25 $221.25 $221.25 $46.11 $221.25 N/A N/A 29313 ERX HCPCS J0840 50633-0110-11 CROTALIDAE POLYVAL IMMUNE FAB IV SOLR BOTH IP/OP "$17,883.50" "$13,234.00" "$3,727.06" "$17,883.22" "$17,883.22" "$17,883.22" "$17,883.22" "$17,883.22" "$17,883.22" "$17,883.22" "$5,486.72" "$17,883.22" "$17,883.22" "$5,484.32" "$5,484.32" "$5,695.25" "$5,273.38" "$3,727.06" "$17,883.22" "$7,153.29" "$17,883.22" "$17,883.22" "$17,883.22" "$17,883.22" "$17,883.22" "$13,412.63" "$17,883.22" "$17,883.22" "$17,883.22" "$8,941.61" "$8,941.61" "$14,163.51" "$17,883.22" "$14,306.58" "$8,047.45" "$17,883.22" "$17,883.22" "$10,372.43" "$17,883.22" "$10,729.93" "$17,883.22" "$17,883.22" "$17,883.22" N/A N/A 29335 ERX HCPCS J1800 00143-9872-01 PROPRANOLOL HCL 1 MG/ML IV SOLN BOTH IP/OP $41.50 $31.00 $7.68 $41.48 $41.48 $41.48 $41.48 $41.48 $41.48 $41.48 $7.68 $41.48 $41.48 $8.32 $8.32 $8.64 $8.00 $9.40 $41.48 $16.59 $41.48 $41.48 $41.48 $41.48 $41.48 $31.13 $41.48 $41.48 $41.48 $20.74 $20.74 $32.85 $41.48 $33.18 $18.67 $41.48 $41.48 $24.07 $41.48 $24.89 $41.48 $41.48 $41.48 N/A N/A 29434 ERX HCPCS 63700001 27241-0191-30 TOLTERODINE TARTRATE ER 2 MG PO CP24 BOTH IP/OP $57.00 $42.00 $11.83 $56.77 $56.77 $56.77 $56.77 $56.77 $56.77 $56.77 $56.77 $56.77 $56.77 $56.77 $56.77 $56.77 $56.77 $11.83 $56.77 $22.71 $56.77 $56.77 $56.77 $56.77 $56.77 $42.75 $56.77 $56.77 $56.77 $28.39 $28.39 $44.96 $56.77 $45.42 $36.90 $56.77 $56.77 $33.06 $56.77 $34.06 $56.77 $56.77 $56.77 N/A N/A 29435 ERX HCPCS 63700001 59762-0048-01 TOLTERODINE TARTRATE ER 4 MG PO CP24 BOTH IP/OP $41.50 $31.00 $8.60 $41.25 $41.25 $41.25 $41.25 $41.25 $41.25 $41.25 $41.25 $41.25 $41.25 $41.25 $41.25 $41.25 $41.25 $8.60 $41.25 $16.50 $41.25 $41.25 $41.25 $41.25 $41.25 $31.13 $41.25 $41.25 $41.25 $20.63 $20.63 $32.67 $41.25 $33.00 $26.81 $41.25 $41.25 $24.07 $41.25 $24.75 $41.25 $41.25 $41.25 191.22 84.26 29437 ERX HCPCS 63700001 49884-0984-01 NATEGLINIDE 60 MG PO TABS BOTH IP/OP $7.50 $6.00 $1.50 $7.18 $7.18 $7.18 $7.18 $7.18 $7.18 $7.18 $7.18 $7.18 $7.18 $7.18 $7.18 $7.18 $7.18 $1.50 $7.18 $2.87 $7.18 $7.18 $7.18 $7.18 $7.18 $5.63 $7.18 $7.18 $7.18 $3.59 $3.59 $5.69 $7.18 $5.74 $4.67 $7.18 $7.18 $4.35 $7.18 $4.31 $7.18 $7.18 $7.18 N/A N/A 29438 ERX HCPCS 63700001 49884-0985-01 NATEGLINIDE 120 MG PO TABS BOTH IP/OP $7.50 $6.00 $1.56 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $7.47 $1.56 $7.47 $2.99 $7.47 $7.47 $7.47 $7.47 $7.47 $5.63 $7.47 $7.47 $7.47 $3.74 $3.74 $5.92 $7.47 $5.98 $4.86 $7.47 $7.47 $4.35 $7.47 $4.48 $7.47 $7.47 $7.47 N/A N/A 29443 ERX HCPCS 25000001 68462-0534-35 TACROLIMUS 0.1 % EX OINT BOTH IP/OP $787.00 $582.00 $140.01 $786.59 $786.59 $786.59 $786.59 $786.59 $786.59 $786.59 $140.01 $786.59 $786.59 $583.81 $583.81 $606.30 $409.81 $163.93 $786.59 $314.64 $786.59 $786.59 $786.59 $786.59 $786.59 $590.25 $786.59 $786.59 $786.59 $393.30 $393.30 $622.98 $786.59 $629.27 $511.28 $786.59 $786.59 $456.46 $786.59 $471.95 $786.59 $786.59 $786.59 N/A N/A 29464 ERX HCPCS J2274 15082-0248-70 MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN BOTH IP/OP $50.50 $37.00 $11.08 $50.12 $50.12 $50.12 $50.12 $50.12 $50.12 $50.12 $11.08 $50.12 $50.12 $14.45 $14.45 $15.00 $13.89 $16.32 $50.12 $20.05 $50.12 $50.12 $50.12 $50.12 $50.12 $37.88 $50.12 $50.12 $50.12 $25.06 $25.06 $39.70 $50.12 $40.10 $22.55 $50.12 $50.12 $29.29 $50.12 $30.07 $50.12 $50.12 $50.12 N/A N/A 29531 ERX HCPCS 63700001 65862-0021-06 MIRTAZAPINE 15 MG PO TBDP BOTH IP/OP $10.50 $8.00 $2.12 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $10.18 $2.12 $10.18 $4.07 $10.18 $10.18 $10.18 $10.18 $10.18 $7.88 $10.18 $10.18 $10.18 $5.09 $5.09 $8.06 $10.18 $8.14 $6.62 $10.18 $10.18 $6.09 $10.18 $6.11 $10.18 $10.18 $10.18 N/A N/A 29532 ERX HCPCS 63700001 65862-0022-06 MIRTAZAPINE 30 MG PO TBDP BOTH IP/OP $10.50 $8.00 $2.19 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $2.19 $10.49 $4.20 $10.49 $10.49 $10.49 $10.49 $10.49 $7.88 $10.49 $10.49 $10.49 $5.25 $5.25 $8.31 $10.49 $8.39 $6.82 $10.49 $10.49 $6.09 $10.49 $6.29 $10.49 $10.49 $10.49 N/A N/A 29567 ERX HCPCS J0637 00006-3822-10 CASPOFUNGIN ACETATE 50 MG IV SOLR BOTH IP/OP "$1,224.00" $906.00 $62.50 "$1,223.86" "$1,223.86" "$1,223.86" "$1,223.86" "$1,223.86" "$1,223.86" "$1,223.86" $62.50 "$1,223.86" "$1,223.86" $68.33 $68.33 $70.96 $65.70 $255.07 "$1,223.86" $489.54 "$1,223.86" "$1,223.86" "$1,223.86" "$1,223.86" "$1,223.86" $918.00 "$1,223.86" "$1,223.86" "$1,223.86" $611.93 $611.93 $969.30 "$1,223.86" $979.09 $550.74 "$1,223.86" "$1,223.86" $709.92 "$1,223.86" $734.32 "$1,223.86" "$1,223.86" "$1,223.86" N/A N/A 29568 ERX HCPCS J0637 00006-3823-10 CASPOFUNGIN ACETATE 70 MG IV SOLR BOTH IP/OP "$1,272.00" $941.00 $87.50 "$1,271.61" "$1,271.61" "$1,271.61" "$1,271.61" "$1,271.61" "$1,271.61" "$1,271.61" $87.50 "$1,271.61" "$1,271.61" $95.66 $95.66 $99.34 $91.98 $265.02 "$1,271.61" $508.64 "$1,271.61" "$1,271.61" "$1,271.61" "$1,271.61" "$1,271.61" $954.00 "$1,271.61" "$1,271.61" "$1,271.61" $635.81 $635.81 "$1,007.12" "$1,271.61" "$1,017.29" $572.22 "$1,271.61" "$1,271.61" $737.76 "$1,271.61" $762.97 "$1,271.61" "$1,271.61" "$1,271.61" N/A N/A 29745 ERX HCPCS 63700006 43598-0509-30 ESOMEPRAZOLE 20 MG PO CPDR BOTH IP/OP $39.00 $29.00 $8.13 $38.99 $38.99 $38.99 $38.99 $38.99 $38.99 $38.99 $38.99 $38.99 $38.99 $38.99 $38.99 $38.99 $38.99 $8.13 $38.99 $15.60 $38.99 $38.99 $38.99 $38.99 $38.99 $29.25 $38.99 $38.99 $38.99 $19.50 $19.50 $30.88 $38.99 $31.19 $25.34 $38.99 $38.99 $22.62 $38.99 $23.39 $38.99 $38.99 $38.99 N/A N/A 29778 ERX HCPCS 63700001 68084-0103-09 ZIPRASIDONE HCL 20 MG PO CAPS BOTH IP/OP $37.00 $27.00 $7.62 $36.58 $36.58 $36.58 $36.58 $36.58 $36.58 $36.58 $36.58 $36.58 $36.58 $36.58 $36.58 $36.58 $36.58 $7.62 $36.58 $14.63 $36.58 $36.58 $36.58 $36.58 $36.58 $27.75 $36.58 $36.58 $36.58 $18.29 $18.29 $28.97 $36.58 $29.26 $23.78 $36.58 $36.58 $21.46 $36.58 $21.95 $36.58 $36.58 $36.58 N/A N/A 29779 ERX HCPCS 63700001 60505-2529-06 ZIPRASIDONE HCL 40 MG PO CAPS BOTH IP/OP $39.00 $29.00 $8.07 $38.73 $38.73 $38.73 $38.73 $38.73 $38.73 $38.73 $38.73 $38.73 $38.73 $38.73 $38.73 $38.73 $38.73 $8.07 $38.73 $15.49 $38.73 $38.73 $38.73 $38.73 $38.73 $29.25 $38.73 $38.73 $38.73 $19.37 $19.37 $30.67 $38.73 $30.98 $25.17 $38.73 $38.73 $22.62 $38.73 $23.24 $38.73 $38.73 $38.73 N/A N/A 29780 ERX HCPCS 63700001 00904-6271-08 ZIPRASIDONE HCL 60 MG PO CAPS BOTH IP/OP $47.00 $35.00 $9.79 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $9.79 $46.99 $18.80 $46.99 $46.99 $46.99 $46.99 $46.99 $35.25 $46.99 $46.99 $46.99 $23.50 $23.50 $37.22 $46.99 $37.59 $30.54 $46.99 $46.99 $27.26 $46.99 $28.19 $46.99 $46.99 $46.99 N/A N/A 29781 ERX HCPCS 63700001 00904-6272-08 ZIPRASIDONE HCL 80 MG PO CAPS BOTH IP/OP $47.00 $35.00 $9.79 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $9.79 $46.99 $18.80 $46.99 $46.99 $46.99 $46.99 $46.99 $35.25 $46.99 $46.99 $46.99 $23.50 $23.50 $37.22 $46.99 $37.59 $30.54 $46.99 $46.99 $27.26 $46.99 $28.19 $46.99 $46.99 $46.99 N/A N/A 29805 ERX HCPCS 25000001 10019-0055-61 ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN BOTH IP/OP "$1,499.00" "$1,109.00" $266.74 "$1,498.54" "$1,498.54" "$1,498.54" "$1,498.54" "$1,498.54" "$1,498.54" "$1,498.54" $266.74 "$1,498.54" "$1,498.54" "$1,112.22" "$1,112.22" "$1,155.07" $780.74 $312.31 "$1,498.54" $599.42 "$1,498.54" "$1,498.54" "$1,498.54" "$1,498.54" "$1,498.54" "$1,124.25" "$1,498.54" "$1,498.54" "$1,498.54" $749.27 $749.27 "$1,186.84" "$1,498.54" "$1,198.83" $974.05 "$1,498.54" "$1,498.54" $869.42 "$1,498.54" $899.12 "$1,498.54" "$1,498.54" "$1,498.54" 1090.91 502.66 29822 ERX HCPCS 63700001 00225-0295-15 HYOSCYAMINE SULFATE 0.125 MG PO TBDP BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 1310.19 580.3 29858 ERX HCPCS 63700006 55111-0466-01 METOPROLOL SUCCINATE ER 25 MG PO TB24 BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 30070 ERX HCPCS 63700001 55111-0467-05 METOPROLOL SUCCINATE ER 50 MG PO TB24 BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 30071 ERX HCPCS 63700001 50742-0617-01 METOPROLOL SUCCINATE ER 100 MG PO TB24 BOTH IP/OP $9.00 $7.00 $1.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $1.84 $8.84 $3.54 $8.84 $8.84 $8.84 $8.84 $8.84 $6.75 $8.84 $8.84 $8.84 $4.42 $4.42 $7.00 $8.84 $7.07 $5.75 $8.84 $8.84 $5.22 $8.84 $5.30 $8.84 $8.84 $8.84 N/A N/A 30072 ERX HCPCS 63700001 55111-0469-01 METOPROLOL SUCCINATE ER 200 MG PO TB24 BOTH IP/OP $11.00 $8.00 $2.27 $10.89 $10.89 $10.89 $10.89 $10.89 $10.89 $10.89 $10.89 $10.89 $10.89 $10.89 $10.89 $10.89 $10.89 $2.27 $10.89 $4.36 $10.89 $10.89 $10.89 $10.89 $10.89 $8.25 $10.89 $10.89 $10.89 $5.45 $5.45 $8.62 $10.89 $8.71 $7.08 $10.89 $10.89 $6.38 $10.89 $6.53 $10.89 $10.89 $10.89 N/A N/A 30148 ERX HCPCS 63700001 55111-0762-60 VALGANCICLOVIR HCL 450 MG PO TABS BOTH IP/OP $231.00 $171.00 $48.05 $230.55 $230.55 $230.55 $230.55 $230.55 $230.55 $230.55 $230.55 $230.55 $230.55 $230.55 $230.55 $230.55 $230.55 $48.05 $230.55 $92.22 $230.55 $230.55 $230.55 $230.55 $230.55 $173.25 $230.55 $230.55 $230.55 $115.28 $115.28 $182.60 $230.55 $184.44 $149.86 $230.55 $230.55 $133.98 $230.55 $138.33 $230.55 $230.55 $230.55 N/A N/A 30264 ERX HCPCS 63700001 00904-6084-61 CITALOPRAM HYDROBROMIDE 10 MG PO TABS BOTH IP/OP $10.50 $8.00 $2.19 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $10.49 $2.19 $10.49 $4.20 $10.49 $10.49 $10.49 $10.49 $10.49 $7.88 $10.49 $10.49 $10.49 $5.25 $5.25 $8.31 $10.49 $8.39 $6.82 $10.49 $10.49 $6.09 $10.49 $6.29 $10.49 $10.49 $10.49 N/A N/A 30433 ERX HCPCS 63700001 50419-0402-03 DROSPIRENONE-ETHINYL ESTRADIOL 3-0.03 MG PO TABS BOTH IP/OP $536.50 $397.00 $111.78 $536.33 $536.33 $536.33 $536.33 $536.33 $536.33 $536.33 $536.33 $536.33 $536.33 $536.33 $536.33 $536.33 $536.33 $111.78 $536.33 $214.53 $536.33 $536.33 $536.33 $536.33 $536.33 $402.38 $536.33 $536.33 $536.33 $268.17 $268.17 $424.77 $536.33 $429.06 $348.61 $536.33 $536.33 $311.17 $536.33 $321.80 $536.33 $536.33 $536.33 N/A N/A 30479 ERX HCPCS 63700001 68094-0123-62 OXCARBAZEPINE 300 MG/5ML PO SUSP BOTH IP/OP $19.00 $14.00 $3.93 $18.84 $18.84 $18.84 $18.84 $18.84 $18.84 $18.84 $18.84 $18.84 $18.84 $18.84 $18.84 $18.84 $18.84 $3.93 $18.84 $7.54 $18.84 $18.84 $18.84 $18.84 $18.84 $14.25 $18.84 $18.84 $18.84 $9.42 $9.42 $14.92 $18.84 $15.07 $12.25 $18.84 $18.84 $11.02 $18.84 $11.30 $18.84 $18.84 $18.84 N/A N/A 30699 ERX HCPCS 63700001 43547-0272-10 ROPINIROLE HCL 3 MG PO TABS BOTH IP/OP $11.00 $8.00 $2.25 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $2.25 $10.80 $4.32 $10.80 $10.80 $10.80 $10.80 $10.80 $8.25 $10.80 $10.80 $10.80 $5.40 $5.40 $8.55 $10.80 $8.64 $7.02 $10.80 $10.80 $6.38 $10.80 $6.48 $10.80 $10.80 $10.80 N/A N/A 31086 ERX HCPCS J0690 66288-1100-01 CEFAZOLIN SODIUM 100 G IJ SOLR BOTH IP/OP $500.00 $370.00 $138.65 $499.68 $224.86 $224.86 $224.86 $224.86 $499.68 $499.68 $499.68 $138.65 $499.68 $160.16 $160.16 $166.32 $154.00 $180.93 $499.68 $499.68 $295.56 $499.68 $499.68 $499.68 $499.68 $375.00 $499.68 $499.68 $499.68 $249.84 $249.84 $395.75 $499.68 $399.74 $224.86 $172.30 $499.68 $290.00 $499.68 $499.68 $499.68 $172.30 $499.68 2600.28 1277.85 31087 ERX HCPCS J0690 66288-1300-01 CEFAZOLIN SODIUM 300 G IJ SOLR BOTH IP/OP "$1,268.50" $939.00 $415.95 "$1,268.40" $570.78 $570.78 $570.78 $570.78 "$1,268.40" "$1,268.40" "$1,268.40" $415.95 "$1,268.40" $480.48 $480.48 $498.96 $462.00 $542.78 "$1,268.40" "$1,268.40" $750.26 "$1,268.40" "$1,268.40" "$1,268.40" "$1,268.40" $951.38 "$1,268.40" "$1,268.40" "$1,268.40" $634.20 $634.20 "$1,004.57" "$1,268.40" "$1,014.72" $570.78 $516.89 "$1,268.40" $735.73 "$1,268.40" "$1,268.40" "$1,268.40" $516.89 "$1,268.40" 2495.78 1212.86 31177 ERX HCPCS 63700001 00093-8675-78 AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5ML PO SUSR BOTH IP/OP $153.00 $113.00 $31.85 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $152.84 $31.85 $152.84 $61.14 $152.84 $152.84 $152.84 $152.84 $152.84 $114.75 $152.84 $152.84 $152.84 $76.42 $76.42 $121.05 $152.84 $122.27 $99.35 $152.84 $152.84 $88.74 $152.84 $91.70 $152.84 $152.84 $152.84 N/A N/A 31209 ERX HCPCS 63700001 00078-0358-34 VALSARTAN 80 MG PO TABS BOTH IP/OP $47.00 $35.00 $9.79 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $46.99 $9.79 $46.99 $18.80 $46.99 $46.99 $46.99 $46.99 $46.99 $35.25 $46.99 $46.99 $46.99 $23.50 $23.50 $37.22 $46.99 $37.59 $30.54 $46.99 $46.99 $27.26 $46.99 $28.19 $46.99 $46.99 $46.99 N/A N/A 31211 ERX HCPCS 63700001 00078-0360-34 VALSARTAN 320 MG PO TABS BOTH IP/OP $64.00 $47.00 $13.32 $63.92 $63.92 $63.92 $63.92 $63.92 $63.92 $63.92 $63.92 $63.92 $63.92 $63.92 $63.92 $63.92 $63.92 $13.32 $63.92 $25.57 $63.92 $63.92 $63.92 $63.92 $63.92 $48.00 $63.92 $63.92 $63.92 $31.96 $31.96 $50.62 $63.92 $51.14 $41.55 $63.92 $63.92 $37.12 $63.92 $38.35 $63.92 $63.92 $63.92 N/A N/A 31270 ERX HCPCS Q9957 11994-0011-04 PERFLUTREN LIPID MICROSPHERE 6.52 MG/ML IV SUSP BOTH IP/OP "$1,190.50" $881.00 $92.30 "$1,190.21" "$1,190.21" "$1,190.21" "$1,190.21" "$1,190.21" "$1,190.21" "$1,190.21" $92.72 "$1,190.21" "$1,190.21" $95.99 $95.99 $99.68 $92.30 $248.05 "$1,190.21" $476.08 "$1,190.21" "$1,190.21" "$1,190.21" "$1,190.21" "$1,190.21" $892.88 "$1,190.21" "$1,190.21" "$1,190.21" $595.11 $595.11 $942.65 "$1,190.21" $952.17 $535.59 "$1,190.21" "$1,190.21" $690.49 "$1,190.21" $714.13 "$1,190.21" "$1,190.21" "$1,190.21" N/A N/A 31310 ERX HCPCS J2997 50242-0041-64 ALTEPLASE 2 MG IJ SOLR BOTH IP/OP $609.00 $451.00 $120.80 $608.66 $273.90 $273.90 $273.90 $273.90 $175.34 $175.34 $175.34 $126.86 $175.34 $182.35 $182.35 $189.37 $175.34 $126.85 $175.34 $175.13 $360.02 $175.34 $608.66 $175.34 $184.11 $456.75 $175.34 $175.34 $175.34 $304.33 $304.33 $482.06 $175.34 $486.93 $273.90 $120.80 $175.34 $353.22 $184.11 $254.24 $175.34 $126.84 $175.34 N/A N/A 31336 ERX HCPCS 63700001 00115-5511-10 FENOFIBRATE 54 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 31432 ERX HCPCS J1162 50633-0120-11 DIGOXIN IMMUNE FAB 40 MG IV SOLR BOTH IP/OP "$123,639.50" "$91,493.00" "$25,767.75" "$123,639.12" "$123,639.12" "$123,639.12" "$123,639.12" "$123,639.12" "$123,639.12" "$123,639.12" "$41,281.90" "$123,639.12" "$123,639.12" "$42,933.18" "$42,933.18" "$44,584.45" "$41,281.90" "$25,767.75" "$123,639.12" "$49,455.65" "$123,639.12" "$123,639.12" "$123,639.12" "$123,639.12" "$123,639.12" "$92,729.63" "$123,639.12" "$123,639.12" "$123,639.12" "$61,819.56" "$61,819.56" "$97,922.18" "$123,639.12" "$98,911.30" "$55,637.60" "$123,639.12" "$123,639.12" "$71,710.91" "$123,639.12" "$74,183.47" "$123,639.12" "$123,639.12" "$123,639.12" N/A N/A 31530 ERX HCPCS 25000001 78206-0146-03 ETONOGESTREL-ETHINYL ESTRADIOL 0.12-0.015 MG/24HR VA RING BOTH IP/OP $677.50 $501.00 $120.54 $677.20 $677.20 $677.20 $677.20 $677.20 $677.20 $677.20 $120.54 $677.20 $677.20 $502.62 $502.62 $521.99 $352.82 $141.14 $677.20 $270.88 $677.20 $677.20 $677.20 $677.20 $677.20 $508.13 $677.20 $677.20 $677.20 $338.60 $338.60 $536.34 $677.20 $541.76 $440.18 $677.20 $677.20 $392.95 $677.20 $406.32 $677.20 $677.20 $677.20 461.73 210.28 31576 ERX HCPCS 63700001 16714-0829-01 BUDESONIDE 3 MG PO CPEP BOTH IP/OP $83.00 $61.00 $17.20 $82.51 $82.51 $82.51 $82.51 $82.51 $82.51 $82.51 $82.51 $82.51 $82.51 $82.51 $82.51 $82.51 $82.51 $17.20 $82.51 $33.00 $82.51 $82.51 $82.51 $82.51 $82.51 $62.25 $82.51 $82.51 $82.51 $41.26 $41.26 $65.35 $82.51 $66.01 $53.63 $82.51 $82.51 $48.14 $82.51 $49.51 $82.51 $82.51 $82.51 287.7 125.12 31684 ERX HCPCS 63700001 42291-0800-30 TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS BOTH IP/OP $24.50 $18.00 $5.02 $24.08 $24.08 $24.08 $24.08 $24.08 $24.08 $24.08 $24.08 $24.08 $24.08 $24.08 $24.08 $24.08 $24.08 $5.02 $24.08 $9.63 $24.08 $24.08 $24.08 $24.08 $24.08 $18.38 $24.08 $24.08 $24.08 $12.04 $12.04 $19.07 $24.08 $19.26 $15.65 $24.08 $24.08 $14.21 $24.08 $14.45 $24.08 $24.08 $24.08 N/A N/A 31688 ERX HCPCS J2501 00074-4637-01 PARICALCITOL 2 MCG/ML IV SOLN BOTH IP/OP $22.00 $16.00 $0.69 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.30 $22.00 $0.72 $0.72 $0.75 $0.69 $0.81 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.77 $22.00 $12.76 $22.00 $22.00 $22.00 $0.77 $22.00 N/A N/A 31784 ERX HCPCS 25000001 66658-0234-07 ANAKINRA 100 MG/0.67ML SC SOSY BOTH IP/OP $667.00 $494.00 $118.71 $666.89 $666.89 $666.89 $666.89 $666.89 $666.89 $666.89 $118.71 $666.89 $666.89 $494.97 $494.97 $514.04 $347.45 $138.99 $666.89 $266.76 $666.89 $666.89 $666.89 $666.89 $666.89 $500.25 $666.89 $666.89 $666.89 $333.45 $333.45 $528.18 $666.89 $533.51 $433.48 $666.89 $666.89 $386.86 $666.89 $400.13 $666.89 $666.89 $666.89 N/A N/A 31864 ERX HCPCS 63700006 00406-0523-62 OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABS BOTH IP/OP $15.50 $11.00 $3.20 $15.35 $15.35 $15.35 $15.35 $15.35 $15.35 $15.35 $15.35 $15.35 $15.35 $15.35 $15.35 $15.35 $15.35 $3.20 $15.35 $6.14 $15.35 $15.35 $15.35 $15.35 $15.35 $11.63 $15.35 $15.35 $15.35 $7.68 $7.68 $12.16 $15.35 $12.28 $9.98 $15.35 $15.35 $8.99 $15.35 $9.21 $15.35 $15.35 $15.35 N/A N/A 31876 ERX HCPCS 63700001 66215-0102-06 BOSENTAN 125 MG PO TABS BOTH IP/OP $737.00 $545.00 $153.59 $736.98 $736.98 $736.98 $736.98 $736.98 $736.98 $736.98 $736.98 $736.98 $736.98 $736.98 $736.98 $736.98 $736.98 $153.59 $736.98 $294.79 $736.98 $736.98 $736.98 $736.98 $736.98 $552.75 $736.98 $736.98 $736.98 $368.49 $368.49 $583.69 $736.98 $589.58 $479.04 $736.98 $736.98 $427.46 $736.98 $442.19 $736.98 $736.98 $736.98 N/A N/A 31922 ERX HCPCS J1335 42023-0221-10 ERTAPENEM SODIUM 1 G IJ SOLR BOTH IP/OP $251.50 $186.00 $24.48 $251.47 $251.47 $251.47 $251.47 $251.47 $251.47 $251.47 $28.24 $251.47 $251.47 $25.46 $25.46 $26.44 $24.48 $28.76 $251.47 $100.59 $251.47 $251.47 $251.47 $251.47 $251.47 $188.63 $251.47 $251.47 $251.47 $125.74 $125.74 $199.16 $251.47 $201.18 $113.16 $251.47 $251.47 $145.87 $251.47 $150.88 $251.47 $251.47 $251.47 N/A N/A 32052 ERX HCPCS 25000001 68462-0609-35 PIMECROLIMUS 1 % EX CREA BOTH IP/OP $971.50 $719.00 $172.88 $971.24 $971.24 $971.24 $971.24 $971.24 $971.24 $971.24 $172.88 $971.24 $971.24 $720.85 $720.85 $748.63 $506.02 $202.42 $971.24 $388.50 $971.24 $971.24 $971.24 $971.24 $971.24 $728.63 $971.24 $971.24 $971.24 $485.62 $485.62 $769.22 $971.24 $776.99 $631.31 $971.24 $971.24 $563.47 $971.24 $582.74 $971.24 $971.24 $971.24 N/A N/A 32128 ERX HCPCS 63700001 68462-0198-90 PRAVASTATIN SODIUM 80 MG PO TABS BOTH IP/OP $21.00 $16.00 $4.32 $20.72 $20.72 $20.72 $20.72 $20.72 $20.72 $20.72 $20.72 $20.72 $20.72 $20.72 $20.72 $20.72 $20.72 $4.32 $20.72 $8.29 $20.72 $20.72 $20.72 $20.72 $20.72 $15.75 $20.72 $20.72 $20.72 $10.36 $10.36 $16.41 $20.72 $16.58 $13.47 $20.72 $20.72 $12.18 $20.72 $12.43 $20.72 $20.72 $20.72 N/A N/A 32215 ERX HCPCS J1652 55111-0678-10 FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN BOTH IP/OP $196.00 $145.00 $7.15 $195.66 $195.66 $195.66 $195.66 $195.66 $195.66 $195.66 $7.15 $195.66 $195.66 $7.64 $7.64 $7.94 $7.35 $40.78 $195.66 $78.26 $195.66 $195.66 $195.66 $195.66 $195.66 $147.00 $195.66 $195.66 $195.66 $97.83 $97.83 $154.96 $195.66 $156.53 $88.05 $195.66 $195.66 $113.68 $195.66 $117.40 $195.66 $195.66 $195.66 1852.67 843.69 32248 ERX HCPCS J7304 00378-3340-16 NORELGESTROMIN-ETH ESTRADIOL 150-35 MCG/24HR TD PTWK BOTH IP/OP $182.50 $135.00 $18.48 $182.23 $82.00 $82.00 $82.00 $82.00 $182.23 $182.23 $182.23 $18.48 $182.23 $182.23 $182.23 $182.23 $182.23 $37.98 $182.23 $72.89 $107.79 $182.23 $182.23 $182.23 $182.23 $136.88 $182.23 $182.23 $182.23 $91.12 $91.12 $144.33 $182.23 $145.78 $82.00 $36.17 $182.23 $105.85 $182.23 $109.34 $182.23 $182.23 $182.23 N/A N/A 32354 ERX HCPCS 25000001 42192-0139-01 SULFACETAMIDE SODIUM-SULFUR 10-5 % EX CREA BOTH IP/OP $412.00 $305.00 $73.26 $411.57 $411.57 $411.57 $411.57 $411.57 $411.57 $411.57 $73.26 $411.57 $411.57 $305.47 $305.47 $317.24 $214.43 $85.78 $411.57 $164.63 $411.57 $411.57 $411.57 $411.57 $411.57 $309.00 $411.57 $411.57 $411.57 $205.79 $205.79 $325.96 $411.57 $329.26 $267.52 $411.57 $411.57 $238.96 $411.57 $246.94 $411.57 $411.57 $411.57 N/A N/A 32375 ERX HCPCS 25000001 24208-0344-25 FLUNISOLIDE 25 MCG/ACT (0.025%) NA SOLN BOTH IP/OP $258.00 $191.00 $45.85 $257.59 $257.59 $257.59 $257.59 $257.59 $257.59 $257.59 $45.85 $257.59 $257.59 $191.18 $191.18 $198.55 $134.20 $53.68 $257.59 $103.04 $257.59 $257.59 $257.59 $257.59 $257.59 $193.50 $257.59 $257.59 $257.59 $128.80 $128.80 $204.01 $257.59 $206.07 $167.43 $257.59 $257.59 $149.64 $257.59 $154.55 $257.59 $257.59 $257.59 N/A N/A 32589 ERX HCPCS J2430 61703-0324-18 PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN BOTH IP/OP $73.00 $54.00 $9.16 $72.67 $72.67 $72.67 $72.67 $72.67 $72.67 $72.67 $9.16 $72.67 $72.67 $10.97 $10.97 $11.39 $10.55 $12.39 $72.67 $29.07 $72.67 $72.67 $72.67 $72.67 $72.67 $54.75 $72.67 $72.67 $72.67 $36.34 $36.34 $57.55 $72.67 $58.14 $32.70 $72.67 $72.67 $42.34 $72.67 $43.60 $72.67 $72.67 $72.67 N/A N/A 32703 ERX HCPCS 25000001 08212-4271-81 ILEX SKIN PROTECTANT 58.3 % EX PSTE BOTH IP/OP $27.00 $20.00 $4.80 $26.96 $26.96 $26.96 $26.96 $26.96 $26.96 $26.96 $4.80 $26.96 $26.96 $20.01 $20.01 $20.78 $14.05 $5.62 $26.96 $10.78 $26.96 $26.96 $26.96 $26.96 $26.96 $20.25 $26.96 $26.96 $26.96 $13.48 $13.48 $21.35 $26.96 $21.57 $17.52 $26.96 $26.96 $15.66 $26.96 $16.18 $26.96 $26.96 $26.96 N/A N/A 32893 ERX HCPCS J9217 62935-0753-75 LEUPROLIDE ACETATE 7.5 MG SC KIT BOTH IP/OP "$1,447.50" "$1,071.00" $172.56 "$1,447.23" $651.25 $651.25 $651.25 $651.25 $200.73 $200.73 $200.73 $246.83 $200.73 $208.76 $208.76 $216.79 $200.73 $235.83 $200.73 $172.56 $856.04 $200.73 "$1,447.23" $200.73 $210.77 "$1,085.63" $200.73 $200.73 $200.73 $723.62 $723.62 "$1,146.21" $200.73 "$1,157.78" $651.25 $224.58 $200.73 $839.55 $210.77 $291.06 $200.73 $224.58 $200.73 N/A N/A 32895 ERX HCPCS 63700001 00430-0472-03 RISEDRONATE SODIUM 35 MG PO TABS BOTH IP/OP $355.00 $263.00 $73.98 $354.97 $354.97 $354.97 $354.97 $354.97 $354.97 $354.97 $354.97 $354.97 $354.97 $354.97 $354.97 $354.97 $354.97 $73.98 $354.97 $141.99 $354.97 $354.97 $354.97 $354.97 $354.97 $266.25 $354.97 $354.97 $354.97 $177.49 $177.49 $281.14 $354.97 $283.98 $230.73 $354.97 $354.97 $205.90 $354.97 $212.98 $354.97 $354.97 $354.97 N/A N/A 32960 ERX HCPCS J7192 00026-3783-35 ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 500 UNITS IV KIT BOTH IP/OP "$2,630.00" "$1,946.00" $548.11 "$2,629.95" "$2,629.95" "$2,629.95" "$2,629.95" "$2,629.95" "$2,629.95" "$2,629.95" $715.00 "$2,629.95" "$2,629.95" $743.60 $743.60 $772.20 $715.00 $548.11 "$2,629.95" "$1,051.98" "$2,629.95" "$2,629.95" "$2,629.95" "$2,629.95" "$2,629.95" "$1,972.50" "$2,629.95" "$2,629.95" "$2,629.95" "$1,314.98" "$1,314.98" "$2,082.92" "$2,629.95" "$2,103.96" "$1,183.48" "$2,629.95" "$2,629.95" "$1,525.40" "$2,629.95" "$1,577.97" "$2,629.95" "$2,629.95" "$2,629.95" 231.54 95.82 32961 ERX HCPCS J7192 00026-3785-55 ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 1000 UNITS IV KIT BOTH IP/OP "$4,590.50" "$3,397.00" $956.63 "$4,590.10" "$4,590.10" "$4,590.10" "$4,590.10" "$4,590.10" "$4,590.10" "$4,590.10" "$1,430.00" "$4,590.10" "$4,590.10" "$1,487.20" "$1,487.20" "$1,544.40" "$1,430.00" $956.63 "$4,590.10" "$1,836.04" "$4,590.10" "$4,590.10" "$4,590.10" "$4,590.10" "$4,590.10" "$3,442.88" "$4,590.10" "$4,590.10" "$4,590.10" "$2,295.05" "$2,295.05" "$3,635.36" "$4,590.10" "$3,672.08" "$2,065.55" "$4,590.10" "$4,590.10" "$2,662.49" "$4,590.10" "$2,754.06" "$4,590.10" "$4,590.10" "$4,590.10" N/A N/A 32979 ERX HCPCS 63700001 00078-0401-34 IMATINIB MESYLATE 100 MG PO TABS BOTH IP/OP "$1,357.50" "$1,005.00" $282.90 "$1,357.39" "$1,357.39" "$1,357.39" "$1,357.39" "$1,357.39" "$1,357.39" "$1,357.39" "$1,357.39" "$1,357.39" "$1,357.39" "$1,357.39" "$1,357.39" "$1,357.39" "$1,357.39" $282.90 "$1,357.39" $542.96 "$1,357.39" "$1,357.39" "$1,357.39" "$1,357.39" "$1,357.39" "$1,018.13" "$1,357.39" "$1,357.39" "$1,357.39" $678.70 $678.70 "$1,075.05" "$1,357.39" "$1,085.91" $882.30 "$1,357.39" "$1,357.39" $787.35 "$1,357.39" $814.43 "$1,357.39" "$1,357.39" "$1,357.39" N/A N/A 33008 ERX HCPCS 63700001 16714-0198-01 VORICONAZOLE 50 MG PO TABS BOTH IP/OP $143.00 $106.00 $29.80 $142.99 $142.99 $142.99 $142.99 $142.99 $142.99 $142.99 $142.99 $142.99 $142.99 $142.99 $142.99 $142.99 $142.99 $29.80 $142.99 $57.20 $142.99 $142.99 $142.99 $142.99 $142.99 $107.25 $142.99 $142.99 $142.99 $71.50 $71.50 $113.25 $142.99 $114.39 $92.94 $142.99 $142.99 $82.94 $142.99 $85.79 $142.99 $142.99 $142.99 N/A N/A 33009 ERX HCPCS 63700001 00049-3180-30 VORICONAZOLE 200 MG PO TABS BOTH IP/OP $19.50 $14.00 $4.02 $19.31 $19.31 $19.31 $19.31 $19.31 $19.31 $19.31 $19.31 $19.31 $19.31 $19.31 $19.31 $19.31 $19.31 $4.02 $19.31 $7.72 $19.31 $19.31 $19.31 $19.31 $19.31 $14.63 $19.31 $19.31 $19.31 $9.66 $9.66 $15.29 $19.31 $15.45 $12.55 $19.31 $19.31 $11.31 $19.31 $11.59 $19.31 $19.31 $19.31 N/A N/A 33010 ERX HCPCS J3465 00781-3416-94 VORICONAZOLE 200 MG IV SOLR BOTH IP/OP $529.50 $392.00 $35.00 $529.46 $529.46 $529.46 $529.46 $529.46 $529.46 $529.46 $35.00 $529.46 $529.46 $38.06 $38.06 $39.53 $36.60 $110.35 $529.46 $211.78 $529.46 $529.46 $529.46 $529.46 $529.46 $397.13 $529.46 $529.46 $529.46 $264.73 $264.73 $419.33 $529.46 $423.57 $238.26 $529.46 $529.46 $307.11 $529.46 $317.68 $529.46 $529.46 $529.46 N/A N/A 33083 ERX HCPCS 63700001 59651-0248-01 MIDODRINE HCL 10 MG PO TABS BOTH IP/OP $38.00 $28.00 $7.87 $37.76 $37.76 $37.76 $37.76 $37.76 $37.76 $37.76 $37.76 $37.76 $37.76 $37.76 $37.76 $37.76 $37.76 $7.87 $37.76 $15.10 $37.76 $37.76 $37.76 $37.76 $37.76 $28.50 $37.76 $37.76 $37.76 $18.88 $18.88 $29.91 $37.76 $30.21 $24.54 $37.76 $37.76 $22.04 $37.76 $22.66 $37.76 $37.76 $37.76 N/A N/A 33111 ERX HCPCS 63700001 65862-0586-01 AMLODIPINE-BENAZEPRIL HCL 10-20 MG PO CAPS BOTH IP/OP $14.50 $11.00 $2.99 $14.35 $14.35 $14.35 $14.35 $14.35 $14.35 $14.35 $14.35 $14.35 $14.35 $14.35 $14.35 $14.35 $14.35 $2.99 $14.35 $5.74 $14.35 $14.35 $14.35 $14.35 $14.35 $10.88 $14.35 $14.35 $14.35 $7.18 $7.18 $11.37 $14.35 $11.48 $9.33 $14.35 $14.35 $8.41 $14.35 $8.61 $14.35 $14.35 $14.35 N/A N/A 33175 ERX HCPCS J3486 72266-0160-10 ZIPRASIDONE MESYLATE 20 MG IM SOLR BOTH IP/OP $85.00 $63.00 $13.38 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $14.85 $85.00 $85.00 $13.92 $13.92 $14.45 $13.38 $15.72 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $38.25 $85.00 $85.00 $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 33226 ERX HCPCS 63700001 00093-2272-34 AMOXICILLIN-POT CLAVULANATE 400-57 MG PO CHEW BOTH IP/OP $25.50 $19.00 $5.29 $25.39 $25.39 $25.39 $25.39 $25.39 $25.39 $25.39 $25.39 $25.39 $25.39 $25.39 $25.39 $25.39 $25.39 $5.29 $25.39 $10.16 $25.39 $25.39 $25.39 $25.39 $25.39 $19.13 $25.39 $25.39 $25.39 $12.70 $12.70 $20.11 $25.39 $20.31 $16.50 $25.39 $25.39 $14.79 $25.39 $15.23 $25.39 $25.39 $25.39 1147.52 521.04 33228 ERX HCPCS 63700001 16714-0478-02 AMOXICILLIN-POT CLAVULANATE 875-125 MG PO TABS BOTH IP/OP $21.50 $16.00 $4.42 $21.22 $21.22 $21.22 $21.22 $21.22 $21.22 $21.22 $21.22 $21.22 $21.22 $21.22 $21.22 $21.22 $21.22 $4.42 $21.22 $8.49 $21.22 $21.22 $21.22 $21.22 $21.22 $16.13 $21.22 $21.22 $21.22 $10.61 $10.61 $16.81 $21.22 $16.98 $13.79 $21.22 $21.22 $12.47 $21.22 $12.73 $21.22 $21.22 $21.22 849.18 377.88 33229 ERX HCPCS 25000001 16714-0292-01 AMOXICILLIN-POT CLAVULANATE 200-28.5 MG/5ML PO SUSR BOTH IP/OP $81.00 $60.00 $14.38 $80.79 $80.79 $80.79 $80.79 $80.79 $80.79 $80.79 $14.38 $80.79 $80.79 $59.96 $59.96 $62.27 $42.09 $16.84 $80.79 $32.32 $80.79 $80.79 $80.79 $80.79 $80.79 $60.75 $80.79 $80.79 $80.79 $40.40 $40.40 $63.99 $80.79 $64.63 $52.51 $80.79 $80.79 $46.98 $80.79 $48.47 $80.79 $80.79 $80.79 894.87 399.14 33230 ERX HCPCS 63700006 65862-0534-75 AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR BOTH IP/OP $186.50 $138.00 $38.82 $186.27 $186.27 $186.27 $186.27 $186.27 $186.27 $186.27 $186.27 $186.27 $186.27 $186.27 $186.27 $186.27 $186.27 $38.82 $186.27 $74.51 $186.27 $186.27 $186.27 $186.27 $186.27 $139.88 $186.27 $186.27 $186.27 $93.14 $93.14 $147.53 $186.27 $149.02 $121.08 $186.27 $186.27 $108.17 $186.27 $111.76 $186.27 $186.27 $186.27 921.08 408.73 33512 ERX HCPCS 63700001 43547-0281-10 ESCITALOPRAM OXALATE 10 MG PO TABS BOTH IP/OP $19.00 $14.00 $3.90 $18.71 $18.71 $18.71 $18.71 $18.71 $18.71 $18.71 $18.71 $18.71 $18.71 $18.71 $18.71 $18.71 $18.71 $3.90 $18.71 $7.48 $18.71 $18.71 $18.71 $18.71 $18.71 $14.25 $18.71 $18.71 $18.71 $9.36 $9.36 $14.82 $18.71 $14.97 $12.16 $18.71 $18.71 $11.02 $18.71 $11.23 $18.71 $18.71 $18.71 5619.95 2545.18 33513 ERX HCPCS 63700001 43547-0282-10 ESCITALOPRAM OXALATE 20 MG PO TABS BOTH IP/OP $20.00 $15.00 $4.07 $19.53 $19.53 $19.53 $19.53 $19.53 $19.53 $19.53 $19.53 $19.53 $19.53 $19.53 $19.53 $19.53 $19.53 $4.07 $19.53 $7.81 $19.53 $19.53 $19.53 $19.53 $19.53 $15.00 $19.53 $19.53 $19.53 $9.77 $9.77 $15.47 $19.53 $15.62 $12.69 $19.53 $19.53 $11.60 $19.53 $11.72 $19.53 $19.53 $19.53 5782.2 2605.81 33541 ERX HCPCS 63700006 00378-5807-93 VALSARTAN 40 MG PO TABS BOTH IP/OP $18.00 $13.00 $3.65 $17.52 $17.52 $17.52 $17.52 $17.52 $17.52 $17.52 $17.52 $17.52 $17.52 $17.52 $17.52 $17.52 $17.52 $3.65 $17.52 $7.01 $17.52 $17.52 $17.52 $17.52 $17.52 $13.50 $17.52 $17.52 $17.52 $8.76 $8.76 $13.88 $17.52 $14.02 $11.39 $17.52 $17.52 $10.44 $17.52 $10.51 $17.52 $17.52 $17.52 N/A N/A 33591 ERX HCPCS J2783 00024-5150-10 RASBURICASE 1.5 MG IV SOLR BOTH IP/OP "$2,916.50" "$2,158.00" $945.18 "$2,916.28" "$2,916.28" "$2,916.28" "$2,916.28" "$2,916.28" "$2,916.28" "$2,916.28" $945.18 "$2,916.28" "$2,916.28" "$1,003.61" "$1,003.61" "$1,042.21" $965.01 "$1,133.73" "$2,916.28" "$1,166.51" "$2,916.28" "$2,916.28" "$2,916.28" "$2,916.28" "$2,916.28" "$2,187.38" "$2,916.28" "$2,916.28" "$2,916.28" "$1,458.14" "$1,458.14" "$2,309.69" "$2,916.28" "$2,333.02" "$1,312.33" "$2,916.28" "$2,916.28" "$1,691.57" "$2,916.28" "$1,749.77" "$2,916.28" "$2,916.28" "$2,916.28" N/A N/A 33666 ERX HCPCS J1815 00169-3685-12 INSULIN ASPART PROT & ASPART (70-30) 100 UNIT/ML SC SUSP BOTH IP/OP $12.50 $9.00 $2.48 $201.38 $6.79 $6.79 $6.79 $6.79 $12.50 $12.50 $12.50 $2.61 $12.50 $12.50 $12.50 $12.50 $12.50 $2.61 $12.50 $12.50 $7.39 $12.50 $12.50 $12.50 $12.50 $9.38 $12.50 $12.50 $12.50 $6.25 $6.25 $9.90 $12.50 $10.00 $8.13 $2.48 $12.50 $7.25 $12.50 $12.50 $12.50 $201.38 $12.50 N/A N/A 33669 ERX HCPCS J9217 62935-0223-05 LEUPROLIDE ACETATE (3 MONTH) 22.5 MG SC KIT BOTH IP/OP "$3,789.00" "$2,804.00" $517.68 "$3,788.77" "$1,704.95" "$1,704.95" "$1,704.95" "$1,704.95" $602.20 $602.20 $602.20 $740.50 $602.20 $626.28 $626.28 $650.37 $602.19 $707.48 $602.20 $517.68 "$1,867.86" $602.20 "$3,788.77" $602.20 $632.31 "$2,841.75" $602.20 $602.20 $602.20 "$1,894.39" "$1,894.39" "$3,000.71" $602.20 "$3,031.02" "$1,704.95" $673.73 $602.20 "$2,197.62" $632.31 $873.19 $602.20 $673.73 $602.20 N/A N/A 33826 ERX HCPCS 63700001 49884-0302-02 OXANDROLONE 10 MG PO TABS BOTH IP/OP $81.50 $60.00 $16.88 $81.01 $81.01 $81.01 $81.01 $81.01 $81.01 $81.01 $81.01 $81.01 $81.01 $81.01 $81.01 $81.01 $81.01 $16.88 $81.01 $32.40 $81.01 $81.01 $81.01 $81.01 $81.01 $61.13 $81.01 $81.01 $81.01 $40.51 $40.51 $64.16 $81.01 $64.81 $52.66 $81.01 $81.01 $47.27 $81.01 $48.61 $81.01 $81.01 $81.01 N/A N/A 33862 ERX HCPCS 63700001 00781-1943-82 AMOXICILLIN-POT CLAVULANATE ER 1000-62.5 MG PO TB12 BOTH IP/OP $66.50 $49.00 $13.82 $66.29 $66.29 $66.29 $66.29 $66.29 $66.29 $66.29 $66.29 $66.29 $66.29 $66.29 $66.29 $66.29 $66.29 $13.82 $66.29 $26.52 $66.29 $66.29 $66.29 $66.29 $66.29 $49.88 $66.29 $66.29 $66.29 $33.15 $33.15 $52.50 $66.29 $53.03 $43.09 $66.29 $66.29 $38.57 $66.29 $39.77 $66.29 $66.29 $66.29 N/A N/A 33863 ERX HCPCS J7192 00026-3786-65 ANTIHEMOPHILIC FACTOR VIII RECOMB (KOGENATE FS) 2000 UNITS IV KIT BOTH IP/OP "$9,180.50" "$6,794.00" "$1,913.25" "$9,180.20" "$9,180.20" "$9,180.20" "$9,180.20" "$9,180.20" "$9,180.20" "$9,180.20" "$2,860.00" "$9,180.20" "$9,180.20" "$2,974.40" "$2,974.40" "$3,088.80" "$2,860.00" "$1,913.25" "$9,180.20" "$3,672.08" "$9,180.20" "$9,180.20" "$9,180.20" "$9,180.20" "$9,180.20" "$6,885.38" "$9,180.20" "$9,180.20" "$9,180.20" "$4,590.10" "$4,590.10" "$7,270.72" "$9,180.20" "$7,344.16" "$4,131.09" "$9,180.20" "$9,180.20" "$5,324.69" "$9,180.20" "$5,508.12" "$9,180.20" "$9,180.20" "$9,180.20" 7339.22 3300.89 33937 ERX HCPCS 63700001 64380-0711-04 LAMIVUDINE 300 MG PO TABS BOTH IP/OP $62.00 $46.00 $12.88 $61.81 $61.81 $61.81 $61.81 $61.81 $61.81 $61.81 $61.81 $61.81 $61.81 $61.81 $61.81 $61.81 $61.81 $12.88 $61.81 $24.72 $61.81 $61.81 $61.81 $61.81 $61.81 $46.50 $61.81 $61.81 $61.81 $30.91 $30.91 $48.95 $61.81 $49.45 $40.18 $61.81 $61.81 $35.96 $61.81 $37.09 $61.81 $61.81 $61.81 N/A N/A 34153 ERX HCPCS 63700001 00781-5690-92 EZETIMIBE 10 MG PO TABS BOTH IP/OP $11.50 $9.00 $2.36 $11.30 $11.30 $11.30 $11.30 $11.30 $11.30 $11.30 $11.30 $11.30 $11.30 $11.30 $11.30 $11.30 $11.30 $2.36 $11.30 $4.52 $11.30 $11.30 $11.30 $11.30 $11.30 $8.63 $11.30 $11.30 $11.30 $5.65 $5.65 $8.95 $11.30 $9.04 $7.35 $11.30 $11.30 $6.67 $11.30 $6.78 $11.30 $11.30 $11.30 N/A N/A 34369 ERX HCPCS 63700001 16714-0785-01 ARIPIPRAZOLE 10 MG PO TABS BOTH IP/OP $127.00 $94.00 $26.44 $126.86 $126.86 $126.86 $126.86 $126.86 $126.86 $126.86 $126.86 $126.86 $126.86 $126.86 $126.86 $126.86 $126.86 $26.44 $126.86 $50.74 $126.86 $126.86 $126.86 $126.86 $126.86 $95.25 $126.86 $126.86 $126.86 $63.43 $63.43 $100.47 $126.86 $101.49 $82.46 $126.86 $126.86 $73.66 $126.86 $76.12 $126.86 $126.86 $126.86 N/A N/A 34370 ERX HCPCS 63700001 67877-0433-03 ARIPIPRAZOLE 15 MG PO TABS BOTH IP/OP $127.50 $94.00 $26.55 $127.38 $127.38 $127.38 $127.38 $127.38 $127.38 $127.38 $127.38 $127.38 $127.38 $127.38 $127.38 $127.38 $127.38 $26.55 $127.38 $50.95 $127.38 $127.38 $127.38 $127.38 $127.38 $95.63 $127.38 $127.38 $127.38 $63.69 $63.69 $100.88 $127.38 $101.90 $82.80 $127.38 $127.38 $73.95 $127.38 $76.43 $127.38 $127.38 $127.38 N/A N/A 34372 ERX HCPCS 63700001 65862-0666-30 ARIPIPRAZOLE 30 MG PO TABS BOTH IP/OP $181.00 $134.00 $37.67 $180.73 $180.73 $180.73 $180.73 $180.73 $180.73 $180.73 $180.73 $180.73 $180.73 $180.73 $180.73 $180.73 $180.73 $37.67 $180.73 $72.29 $180.73 $180.73 $180.73 $180.73 $180.73 $135.75 $180.73 $180.73 $180.73 $90.37 $90.37 $143.14 $180.73 $144.58 $117.47 $180.73 $180.73 $104.98 $180.73 $108.44 $180.73 $180.73 $180.73 N/A N/A 34418 ERX HCPCS 63700001 65862-0594-01 DIVALPROEX SODIUM ER 250 MG PO TB24 BOTH IP/OP $11.00 $8.00 $2.21 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $2.21 $10.61 $4.24 $10.61 $10.61 $10.61 $10.61 $10.61 $8.25 $10.61 $10.61 $10.61 $5.31 $5.31 $8.40 $10.61 $8.49 $6.90 $10.61 $10.61 $6.38 $10.61 $6.37 $10.61 $10.61 $10.61 N/A N/A 34447 ERX HCPCS 63700001 00002-3229-30 ATOMOXETINE HCL 40 MG PO CAPS BOTH IP/OP $74.50 $55.00 $15.47 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $15.47 $74.24 $29.70 $74.24 $74.24 $74.24 $74.24 $74.24 $55.88 $74.24 $74.24 $74.24 $37.12 $37.12 $58.80 $74.24 $59.39 $48.26 $74.24 $74.24 $43.21 $74.24 $44.54 $74.24 $74.24 $74.24 N/A N/A 34448 ERX HCPCS 63700001 00002-3239-30 ATOMOXETINE HCL 60 MG PO CAPS BOTH IP/OP $74.50 $55.00 $15.47 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $74.24 $15.47 $74.24 $29.70 $74.24 $74.24 $74.24 $74.24 $74.24 $55.88 $74.24 $74.24 $74.24 $37.12 $37.12 $58.80 $74.24 $59.39 $48.26 $74.24 $74.24 $43.21 $74.24 $44.54 $74.24 $74.24 $74.24 N/A N/A 34505 ERX HCPCS 63700001 00406-0123-62 HYDROCODONE-ACETAMINOPHEN 5-325 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 34524 ERX HCPCS J2543 00206-8861-02 PIPERACILLIN-TAZOBACTAM IN DEX 3-0.375 GM/50ML IV SOLN BOTH IP/OP $112.00 $83.00 $4.26 $111.92 $50.36 $50.36 $50.36 $50.36 $111.92 $111.92 $111.92 $19.63 $111.92 $4.43 $4.43 $4.60 $4.26 $5.00 $111.92 $111.92 $66.20 $111.92 $111.92 $111.92 $111.92 $84.00 $111.92 $111.92 $111.92 $55.96 $55.96 $88.64 $111.92 $89.54 $50.36 $4.77 $111.92 $64.96 $111.92 $111.92 $111.92 $4.77 $111.92 N/A N/A 34550 ERX HCPCS 90723 58160-0811-52 DTAP-HEPATITIS B RECOMB-IPV IM SUSY BOTH IP/OP $383.50 $284.00 $76.04 $383.13 $172.41 $172.41 $172.41 $172.41 $383.13 $383.13 $85.84 $79.85 $383.13 $93.65 $93.65 $97.25 $90.05 $79.85 $383.13 $153.25 $226.62 $383.13 $383.13 $383.13 $383.13 $287.63 $383.13 $383.13 $383.13 $191.57 $191.57 $303.44 $383.13 $306.50 $172.41 $76.04 $383.13 $222.43 $383.13 $229.88 $383.13 $79.84 $383.13 N/A N/A 34683 ERX HCPCS 63700001 00093-8310-18 ELETRIPTAN HYDROBROMIDE 20 MG PO TABS BOTH IP/OP $220.50 $163.00 $45.86 $220.03 $220.03 $220.03 $220.03 $220.03 $220.03 $220.03 $220.03 $220.03 $220.03 $220.03 $220.03 $220.03 $220.03 $45.86 $220.03 $88.01 $220.03 $220.03 $220.03 $220.03 $220.03 $165.38 $220.03 $220.03 $220.03 $110.02 $110.02 $174.26 $220.03 $176.02 $143.02 $220.03 $220.03 $127.89 $220.03 $132.02 $220.03 $220.03 $220.03 N/A N/A 34684 ERX HCPCS 63700001 00049-2340-79 ELETRIPTAN HYDROBROMIDE 40 MG PO TABS BOTH IP/OP $330.50 $245.00 $68.87 $330.44 $330.44 $330.44 $330.44 $330.44 $330.44 $330.44 $330.44 $330.44 $330.44 $330.44 $330.44 $330.44 $330.44 $68.87 $330.44 $132.18 $330.44 $330.44 $330.44 $330.44 $330.44 $247.88 $330.44 $330.44 $330.44 $165.22 $165.22 $261.71 $330.44 $264.35 $214.79 $330.44 $330.44 $191.69 $330.44 $198.26 $330.44 $330.44 $330.44 N/A N/A 34708 ERX HCPCS 25000001 67546-0212-21 NITAZOXANIDE 100 MG/5ML PO SUSR BOTH IP/OP "$1,672.50" "$1,238.00" $297.70 "$1,672.49" "$1,672.49" "$1,672.49" "$1,672.49" "$1,672.49" "$1,672.49" "$1,672.49" $297.70 "$1,672.49" "$1,672.49" "$1,241.32" "$1,241.32" "$1,289.16" $871.37 $348.57 "$1,672.49" $669.00 "$1,672.49" "$1,672.49" "$1,672.49" "$1,672.49" "$1,672.49" "$1,254.38" "$1,672.49" "$1,672.49" "$1,672.49" $836.25 $836.25 "$1,324.61" "$1,672.49" "$1,337.99" "$1,087.12" "$1,672.49" "$1,672.49" $970.05 "$1,672.49" "$1,003.49" "$1,672.49" "$1,672.49" "$1,672.49" 4288.64 1935.69 34711 ERX HCPCS 63700001 00054-0176-13 BUPRENORPHINE HCL 2 MG SL SUBL BOTH IP/OP $18.00 $13.00 $3.73 $17.89 $17.89 $17.89 $17.89 $17.89 $17.89 $17.89 $17.89 $17.89 $17.89 $17.89 $17.89 $17.89 $17.89 $3.73 $17.89 $7.16 $17.89 $17.89 $17.89 $17.89 $17.89 $13.50 $17.89 $17.89 $17.89 $8.95 $8.95 $14.17 $17.89 $14.31 $11.63 $17.89 $17.89 $10.44 $17.89 $10.73 $17.89 $17.89 $17.89 692.28 308.14 34712 ERX HCPCS 63700001 42858-0502-03 BUPRENORPHINE HCL 8 MG SL SUBL BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 1592.01 686.71 34713 ERX HCPCS 25000001 62175-0452-32 BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL SUBL BOTH IP/OP $25.50 $19.00 $4.48 $25.17 $25.17 $25.17 $25.17 $25.17 $25.17 $25.17 $4.48 $25.17 $25.17 $18.68 $18.68 $19.40 $13.11 $5.25 $25.17 $10.07 $25.17 $25.17 $25.17 $25.17 $25.17 $19.13 $25.17 $25.17 $25.17 $12.59 $12.59 $19.93 $25.17 $20.14 $16.36 $25.17 $25.17 $14.79 $25.17 $15.10 $25.17 $25.17 $25.17 299.25 129.05 34714 ERX HCPCS 25000001 00054-0189-13 BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL SUBL BOTH IP/OP $45.50 $34.00 $8.01 $45.02 $45.02 $45.02 $45.02 $45.02 $45.02 $45.02 $8.01 $45.02 $45.02 $33.41 $33.41 $34.70 $23.46 $9.38 $45.02 $18.01 $45.02 $45.02 $45.02 $45.02 $45.02 $34.13 $45.02 $45.02 $45.02 $22.51 $22.51 $35.66 $45.02 $36.02 $29.26 $45.02 $45.02 $26.39 $45.02 $27.01 $45.02 $45.02 $45.02 628.29 281.84 34814 ERX HCPCS 25000001 61314-0646-10 NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SOLN BOTH IP/OP $364.00 $269.00 $64.78 $363.94 $363.94 $363.94 $363.94 $363.94 $363.94 $363.94 $64.78 $363.94 $363.94 $270.12 $270.12 $280.52 $189.61 $75.85 $363.94 $145.58 $363.94 $363.94 $363.94 $363.94 $363.94 $273.00 $363.94 $363.94 $363.94 $181.97 $181.97 $288.24 $363.94 $291.15 $236.56 $363.94 $363.94 $211.12 $363.94 $218.36 $363.94 $363.94 $363.94 N/A N/A 35134 ERX HCPCS 63700001 57237-0169-90 ROSUVASTATIN CALCIUM 10 MG PO TABS BOTH IP/OP $39.00 $29.00 $8.06 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $8.06 $38.65 $15.46 $38.65 $38.65 $38.65 $38.65 $38.65 $29.25 $38.65 $38.65 $38.65 $19.33 $19.33 $30.61 $38.65 $30.92 $25.12 $38.65 $38.65 $22.62 $38.65 $23.19 $38.65 $38.65 $38.65 N/A N/A 35135 ERX HCPCS 63700001 27808-0157-01 ROSUVASTATIN CALCIUM 20 MG PO TABS BOTH IP/OP $39.00 $29.00 $8.06 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $38.65 $8.06 $38.65 $15.46 $38.65 $38.65 $38.65 $38.65 $38.65 $29.25 $38.65 $38.65 $38.65 $19.33 $19.33 $30.61 $38.65 $30.92 $25.12 $38.65 $38.65 $22.62 $38.65 $23.19 $38.65 $38.65 $38.65 N/A N/A 35136 ERX HCPCS 63700001 70377-0009-11 ROSUVASTATIN CALCIUM 40 MG PO TABS BOTH IP/OP $39.00 $29.00 $8.05 $38.64 $38.64 $38.64 $38.64 $38.64 $38.64 $38.64 $38.64 $38.64 $38.64 $38.64 $38.64 $38.64 $38.64 $8.05 $38.64 $15.46 $38.64 $38.64 $38.64 $38.64 $38.64 $29.25 $38.64 $38.64 $38.64 $19.32 $19.32 $30.60 $38.64 $30.91 $25.12 $38.64 $38.64 $22.62 $38.64 $23.18 $38.64 $38.64 $38.64 N/A N/A 35184 ERX HCPCS 63700001 69097-0845-07 CYCLOBENZAPRINE HCL 5 MG PO TABS BOTH IP/OP $7.50 $6.00 $1.48 $7.09 $7.09 $7.09 $7.09 $7.09 $7.09 $7.09 $7.09 $7.09 $7.09 $7.09 $7.09 $7.09 $7.09 $1.48 $7.09 $2.84 $7.09 $7.09 $7.09 $7.09 $7.09 $5.63 $7.09 $7.09 $7.09 $3.55 $3.55 $5.62 $7.09 $5.67 $4.61 $7.09 $7.09 $4.35 $7.09 $4.25 $7.09 $7.09 $7.09 2462.84 1011.18 35209 ERX HCPCS 63700001 00023-9163-30 CYCLOSPORINE 0.05 % OP EMUL BOTH IP/OP $56.00 $41.00 $11.63 $55.78 $55.78 $55.78 $55.78 $55.78 $55.78 $55.78 $55.78 $55.78 $55.78 $55.78 $55.78 $55.78 $55.78 $11.63 $55.78 $22.31 $55.78 $55.78 $55.78 $55.78 $55.78 $42.00 $55.78 $55.78 $55.78 $27.89 $27.89 $44.18 $55.78 $44.62 $36.26 $55.78 $55.78 $32.48 $55.78 $33.47 $55.78 $55.78 $55.78 N/A N/A 35262 ERX HCPCS J7520 00008-1042-05 SIROLIMUS 2 MG PO TABS BOTH IP/OP $295.50 $219.00 $9.00 $295.34 $295.34 $295.34 $295.34 $295.34 $295.34 $295.34 $9.00 $295.34 $295.34 $9.36 $9.36 $9.72 $9.00 $61.55 $295.34 $118.14 $295.34 $295.34 $295.34 $295.34 $295.34 $221.63 $295.34 $295.34 $295.34 $147.67 $147.67 $233.91 $295.34 $236.27 $132.90 $295.34 $295.34 $171.39 $295.34 $177.20 $295.34 $295.34 $295.34 N/A N/A 35263 ERX HCPCS 63700001 59572-0210-15 THALIDOMIDE 100 MG PO CAPS BOTH IP/OP "$1,005.50" $744.00 $209.52 "$1,005.33" "$1,005.33" "$1,005.33" "$1,005.33" "$1,005.33" "$1,005.33" "$1,005.33" "$1,005.33" "$1,005.33" "$1,005.33" "$1,005.33" "$1,005.33" "$1,005.33" "$1,005.33" $209.52 "$1,005.33" $402.13 "$1,005.33" "$1,005.33" "$1,005.33" "$1,005.33" "$1,005.33" $754.13 "$1,005.33" "$1,005.33" "$1,005.33" $502.67 $502.67 $796.22 "$1,005.33" $804.26 $653.46 "$1,005.33" "$1,005.33" $583.19 "$1,005.33" $603.20 "$1,005.33" "$1,005.33" "$1,005.33" N/A N/A 35439 ERX HCPCS J2850 67066-0006-01 SECRETIN ACETATE 16 MCG IV SOLR BOTH IP/OP $28.00 $21.00 $5.74 $35.43 $27.54 $27.54 $27.54 $27.54 $27.54 $27.54 $31.50 $27.54 $27.54 $34.12 $34.12 $35.43 $32.81 $5.74 $27.54 $11.02 $27.54 $27.54 $27.54 $27.54 $27.54 $21.00 $27.54 $27.54 $27.54 $13.77 $13.77 $21.81 $27.54 $22.03 $12.39 $27.54 $27.54 $16.24 $27.54 $16.52 $27.54 $27.54 $27.54 N/A N/A 35488 ERX HCPCS J8501 68462-0584-76 APREPITANT 80 MG PO CAPS BOTH IP/OP $615.50 $455.00 $67.04 $615.36 $276.91 $276.91 $276.91 $276.91 $615.36 $615.36 $615.36 $125.02 $615.36 $69.72 $69.72 $72.40 $67.04 $128.25 $615.36 $615.36 $363.99 $615.36 $615.36 $615.36 $615.36 $461.63 $615.36 $615.36 $615.36 $307.68 $307.68 $487.37 $615.36 $492.29 $276.91 $122.13 $615.36 $356.99 $615.36 $615.36 $615.36 $128.24 $615.36 N/A N/A 35489 ERX HCPCS J8501 APREPITANT 125 MG PO CAPS BOTH IP/OP $604.50 $447.00 $104.75 $604.37 $271.97 $271.97 $271.97 $271.97 $604.37 $604.37 $604.37 $195.34 $604.37 $108.94 $108.94 $113.13 $104.75 $125.96 $604.37 $604.37 $357.48 $604.37 $604.37 $604.37 $604.37 $453.38 $604.37 $604.37 $604.37 $302.19 $302.19 $478.66 $604.37 $483.50 $271.97 $119.95 $604.37 $350.61 $604.37 $604.37 $604.37 $125.95 $604.37 N/A N/A 35490 ERX HCPCS J8501 00006-3862-03 APREPITANT 80 & 125 MG PO MISC BOTH IP/OP $935.50 $692.00 $4.19 $935.43 $420.94 $420.94 $420.94 $420.94 $935.43 $935.43 $935.43 $7.81 $935.43 $4.36 $4.36 $4.53 $4.19 $194.95 $935.43 $935.43 $553.31 $935.43 $935.43 $935.43 $935.43 $701.63 $935.43 $935.43 $935.43 $467.72 $467.72 $740.86 $935.43 $748.34 $420.94 $185.66 $935.43 $542.59 $935.43 $935.43 $935.43 $194.94 $935.43 N/A N/A 35639 ERX HCPCS 25000001 10019-0075-87 ESMOLOL HCL-SODIUM CHLORIDE 2000 MG/100ML IV SOLN BOTH IP/OP "$1,615.00" "$1,195.00" $287.39 "$1,614.55" "$1,614.55" "$1,614.55" "$1,614.55" "$1,614.55" "$1,614.55" "$1,614.55" $287.39 "$1,614.55" "$1,614.55" "$1,198.32" "$1,198.32" "$1,244.50" $841.18 $336.49 "$1,614.55" $645.82 "$1,614.55" "$1,614.55" "$1,614.55" "$1,614.55" "$1,614.55" "$1,211.25" "$1,614.55" "$1,614.55" "$1,614.55" $807.28 $807.28 "$1,278.72" "$1,614.55" "$1,291.64" "$1,049.46" "$1,614.55" "$1,614.55" $936.70 "$1,614.55" $968.73 "$1,614.55" "$1,614.55" "$1,614.55" N/A N/A 35640 ERX HCPCS J3489 67457-0390-54 ZOLEDRONIC ACID 4 MG/5ML IV CONC BOTH IP/OP $189.50 $140.00 $23.08 $189.03 $85.06 $85.06 $85.06 $85.06 $189.03 $189.03 $189.03 $39.40 $189.03 $24.00 $24.00 $24.93 $23.08 $27.12 $189.03 $189.03 $111.81 $189.03 $189.03 $189.03 $189.03 $142.13 $189.03 $189.03 $189.03 $94.52 $94.52 $149.71 $189.03 $151.22 $85.06 $25.82 $189.03 $109.91 $189.03 $189.03 $189.03 $25.82 $189.03 N/A N/A 35688 ERX HCPCS 63700001 49884-0401-91 RISPERIDONE 2 MG PO TBDP BOTH IP/OP $40.50 $30.00 $8.41 $40.35 $40.35 $40.35 $40.35 $40.35 $40.35 $40.35 $40.35 $40.35 $40.35 $40.35 $40.35 $40.35 $40.35 $8.41 $40.35 $16.14 $40.35 $40.35 $40.35 $40.35 $40.35 $30.38 $40.35 $40.35 $40.35 $20.18 $20.18 $31.96 $40.35 $32.28 $26.23 $40.35 $40.35 $23.49 $40.35 $24.21 $40.35 $40.35 $40.35 N/A N/A 35699 ERX HCPCS 25000001 00781-7135-93 MOXIFLOXACIN HCL 0.5 % OP SOLN BOTH IP/OP $605.00 $448.00 $107.68 $604.93 $604.93 $604.93 $604.93 $604.93 $604.93 $604.93 $107.68 $604.93 $604.93 $448.98 $448.98 $466.28 $315.17 $126.07 $604.93 $241.97 $604.93 $604.93 $604.93 $604.93 $604.93 $453.75 $604.93 $604.93 $604.93 $302.47 $302.47 $479.10 $604.93 $483.94 $393.20 $604.93 $604.93 $350.90 $604.93 $362.96 $604.93 $604.93 $604.93 N/A N/A 35771 ERX HCPCS 63700001 67877-0414-01 METFORMIN HCL ER 750 MG PO TB24 BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 35780 ERX HCPCS 63700001 00310-0482-30 GEFITINIB 250 MG PO TABS BOTH IP/OP $941.00 $696.00 $196.09 $940.90 $940.90 $940.90 $940.90 $940.90 $940.90 $940.90 $940.90 $940.90 $940.90 $940.90 $940.90 $940.90 $940.90 $196.09 $940.90 $376.36 $940.90 $940.90 $940.90 $940.90 $940.90 $705.75 $940.90 $940.90 $940.90 $470.45 $470.45 $745.19 $940.90 $752.72 $611.59 $940.90 $940.90 $545.78 $940.90 $564.54 $940.90 $940.90 $940.90 N/A N/A 35957 ERX HCPCS 63700001 00046-1106-11 CONJ ESTROG-MEDROXYPROGEST ACE 0.45-1.5 MG PO TABS BOTH IP/OP $43.50 $32.00 $9.06 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $43.47 $9.06 $43.47 $17.39 $43.47 $43.47 $43.47 $43.47 $43.47 $32.63 $43.47 $43.47 $43.47 $21.74 $21.74 $34.43 $43.47 $34.78 $28.26 $43.47 $43.47 $25.23 $43.47 $26.08 $43.47 $43.47 $43.47 N/A N/A 36046 ERX HCPCS J3480 00338-0704-34 POTASSIUM CHLORIDE IN NACL 20-0.45 MEQ/L-% IV SOLN BOTH IP/OP $39.00 $29.00 $0.24 $38.88 $17.50 $17.50 $17.50 $17.50 $38.88 $38.88 $38.88 $0.24 $38.88 $1.56 $1.56 $1.62 $1.50 $1.76 $38.88 $38.88 $23.00 $38.88 $38.88 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $17.50 $1.68 $38.88 $22.62 $38.88 $38.88 $38.88 $1.68 $38.88 N/A N/A 36092 ERX HCPCS 63700001 00078-0649-30 IMATINIB MESYLATE 400 MG PO TABS BOTH IP/OP "$1,223.00" $905.00 $254.84 "$1,222.79" "$1,222.79" "$1,222.79" "$1,222.79" "$1,222.79" "$1,222.79" "$1,222.79" "$1,222.79" "$1,222.79" "$1,222.79" "$1,222.79" "$1,222.79" "$1,222.79" "$1,222.79" $254.84 "$1,222.79" $489.12 "$1,222.79" "$1,222.79" "$1,222.79" "$1,222.79" "$1,222.79" $917.25 "$1,222.79" "$1,222.79" "$1,222.79" $611.40 $611.40 $968.45 "$1,222.79" $978.23 $794.81 "$1,222.79" "$1,222.79" $709.34 "$1,222.79" $733.67 "$1,222.79" "$1,222.79" "$1,222.79" N/A N/A 36150 ERX HCPCS 63700001 00003-3631-12 ATAZANAVIR SULFATE 200 MG PO CAPS BOTH IP/OP $210.00 $155.00 $43.67 $209.54 $209.54 $209.54 $209.54 $209.54 $209.54 $209.54 $209.54 $209.54 $209.54 $209.54 $209.54 $209.54 $209.54 $43.67 $209.54 $83.82 $209.54 $209.54 $209.54 $209.54 $209.54 $157.50 $209.54 $209.54 $209.54 $104.77 $104.77 $165.96 $209.54 $167.63 $136.20 $209.54 $209.54 $121.80 $209.54 $125.72 $209.54 $209.54 $209.54 N/A N/A 36198 ERX HCPCS 63700001 00046-1101-81 ESTROGENS CONJUGATED 0.45 MG PO TABS BOTH IP/OP $35.00 $26.00 $7.24 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $34.76 $7.24 $34.76 $13.90 $34.76 $34.76 $34.76 $34.76 $34.76 $26.25 $34.76 $34.76 $34.76 $17.38 $17.38 $27.53 $34.76 $27.81 $22.59 $34.76 $34.76 $20.30 $34.76 $20.86 $34.76 $34.76 $34.76 N/A N/A 36252 ERX HCPCS 63700001 69097-0642-02 EMTRICITABINE 200 MG PO CAPS BOTH IP/OP $83.50 $62.00 $17.39 $83.44 $83.44 $83.44 $83.44 $83.44 $83.44 $83.44 $83.44 $83.44 $83.44 $83.44 $83.44 $83.44 $83.44 $17.39 $83.44 $33.38 $83.44 $83.44 $83.44 $83.44 $83.44 $62.63 $83.44 $83.44 $83.44 $41.72 $41.72 $66.08 $83.44 $66.75 $54.24 $83.44 $83.44 $48.43 $83.44 $50.06 $83.44 $83.44 $83.44 875.99 375.11 36438 ERX HCPCS 63700001 72865-0181-30 ARIPIPRAZOLE 5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 36576 ERX HCPCS 25000001 43598-0326-75 CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP BOTH IP/OP $812.50 $601.00 $144.61 $812.44 $812.44 $812.44 $812.44 $812.44 $812.44 $812.44 $144.61 $812.44 $812.44 $602.99 $602.99 $626.23 $423.28 $169.32 $812.44 $324.98 $812.44 $812.44 $812.44 $812.44 $812.44 $609.38 $812.44 $812.44 $812.44 $406.22 $406.22 $643.45 $812.44 $649.95 $528.09 $812.44 $812.44 $471.25 $812.44 $487.46 $812.44 $812.44 $812.44 461.13 195.54 36590 ERX HCPCS 25000001 99999-6012-25 LEVETIRACETAM 100 MG/ML PO SOLN BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 477.29 201.79 36631 ERX HCPCS 25000001 00023-9277-05 KETOROLAC TROMETHAMINE 0.4 % OP SOLN BOTH IP/OP "$1,026.50" $760.00 $182.65 "$1,026.14" "$1,026.14" "$1,026.14" "$1,026.14" "$1,026.14" "$1,026.14" "$1,026.14" $182.65 "$1,026.14" "$1,026.14" $761.60 $761.60 $790.95 $534.62 $213.86 "$1,026.14" $410.46 "$1,026.14" "$1,026.14" "$1,026.14" "$1,026.14" "$1,026.14" $769.88 "$1,026.14" "$1,026.14" "$1,026.14" $513.07 $513.07 $812.70 "$1,026.14" $820.91 $666.99 "$1,026.14" "$1,026.14" $595.37 "$1,026.14" $615.68 "$1,026.14" "$1,026.14" "$1,026.14" N/A N/A 36775 ERX HCPCS 63700001 16729-0443-15 BUPROPION HCL ER (XL) 150 MG PO TB24 BOTH IP/OP $23.00 $17.00 $4.70 $22.56 $22.56 $22.56 $22.56 $22.56 $22.56 $22.56 $22.56 $22.56 $22.56 $22.56 $22.56 $22.56 $22.56 $4.70 $22.56 $9.02 $22.56 $22.56 $22.56 $22.56 $22.56 $17.25 $22.56 $22.56 $22.56 $11.28 $11.28 $17.87 $22.56 $18.05 $14.66 $22.56 $22.56 $13.34 $22.56 $13.54 $22.56 $22.56 $22.56 N/A N/A 36776 ERX HCPCS 63700001 68180-0320-09 BUPROPION HCL ER (XL) 300 MG PO TB24 BOTH IP/OP $21.00 $16.00 $4.29 $20.60 $20.60 $20.60 $20.60 $20.60 $20.60 $20.60 $20.60 $20.60 $20.60 $20.60 $20.60 $20.60 $20.60 $4.29 $20.60 $8.24 $20.60 $20.60 $20.60 $20.60 $20.60 $15.75 $20.60 $20.60 $20.60 $10.30 $10.30 $16.32 $20.60 $16.48 $13.39 $20.60 $20.60 $12.18 $20.60 $12.36 $20.60 $20.60 $20.60 N/A N/A 36966 ERX HCPCS 63700001 00456-3210-63 MEMANTINE HCL 10 MG PO TABS BOTH IP/OP $38.50 $28.00 $8.01 $38.43 $38.43 $38.43 $38.43 $38.43 $38.43 $38.43 $38.43 $38.43 $38.43 $38.43 $38.43 $38.43 $38.43 $8.01 $38.43 $15.37 $38.43 $38.43 $38.43 $38.43 $38.43 $28.88 $38.43 $38.43 $38.43 $19.22 $19.22 $30.44 $38.43 $30.74 $24.98 $38.43 $38.43 $22.33 $38.43 $23.06 $38.43 $38.43 $38.43 N/A N/A 36976 ERX HCPCS 25000001 49348-0991-36 PHENOL 1.4 % MT LIQD BOTH IP/OP $11.00 $8.00 $1.96 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $1.96 $11.00 $11.00 $8.16 $8.16 $8.48 $5.73 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 36982 ERX HCPCS 25000001 47335-0956-88 ALFUZOSIN HCL ER 10 MG PO TB24 BOTH IP/OP $18.50 $14.00 $3.24 $18.21 $18.21 $18.21 $18.21 $18.21 $18.21 $18.21 $3.24 $18.21 $18.21 $13.52 $13.52 $14.04 $9.49 $3.80 $18.21 $7.28 $18.21 $18.21 $18.21 $18.21 $18.21 $13.88 $18.21 $18.21 $18.21 $9.11 $9.11 $14.42 $18.21 $14.57 $11.84 $18.21 $18.21 $10.73 $18.21 $10.93 $18.21 $18.21 $18.21 N/A N/A 36983 ERX HCPCS 63700001 71205-0863-30 EPLERENONE 25 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 36984 ERX HCPCS 63700001 00185-5369-30 EPLERENONE 50 MG PO TABS BOTH IP/OP $19.00 $14.00 $3.91 $18.75 $18.75 $18.75 $18.75 $18.75 $18.75 $18.75 $18.75 $18.75 $18.75 $18.75 $18.75 $18.75 $18.75 $3.91 $18.75 $7.50 $18.75 $18.75 $18.75 $18.75 $18.75 $14.25 $18.75 $18.75 $18.75 $9.38 $9.38 $14.85 $18.75 $15.00 $12.19 $18.75 $18.75 $11.02 $18.75 $11.25 $18.75 $18.75 $18.75 N/A N/A 36986 ERX HCPCS 63700001 00002-4464-30 TADALAFIL 20 MG PO TABS BOTH IP/OP $579.00 $428.00 $120.63 $578.80 $578.80 $578.80 $578.80 $578.80 $578.80 $578.80 $578.80 $578.80 $578.80 $578.80 $578.80 $578.80 $578.80 $120.63 $578.80 $231.52 $578.80 $578.80 $578.80 $578.80 $578.80 $434.25 $578.80 $578.80 $578.80 $289.40 $289.40 $458.41 $578.80 $463.04 $376.22 $578.80 $578.80 $335.82 $578.80 $347.28 $578.80 $578.80 $578.80 N/A N/A 36987 ERX HCPCS 63700001 62756-0258-02 ZONISAMIDE 25 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 36988 ERX HCPCS 63700001 62756-0259-02 ZONISAMIDE 50 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 36989 ERX HCPCS J0878 00143-9378-01 DAPTOMYCIN 500 MG IV SOLR BOTH IP/OP $167.50 $124.00 $25.00 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $30.00 $167.16 $167.16 $26.00 $26.00 $27.00 $25.00 $29.37 $167.16 $66.86 $167.16 $167.16 $167.16 $167.16 $167.16 $125.63 $167.16 $167.16 $167.16 $83.58 $83.58 $132.39 $167.16 $133.73 $75.22 $167.16 $167.16 $97.15 $167.16 $100.30 $167.16 $167.16 $167.16 N/A N/A 37170 ERX HCPCS 63700001 00456-3205-11 MEMANTINE HCL 5 MG PO TABS BOTH IP/OP $38.50 $28.00 $8.01 $38.41 $38.41 $38.41 $38.41 $38.41 $38.41 $38.41 $38.41 $38.41 $38.41 $38.41 $38.41 $38.41 $38.41 $8.01 $38.41 $15.36 $38.41 $38.41 $38.41 $38.41 $38.41 $28.88 $38.41 $38.41 $38.41 $19.21 $19.21 $30.42 $38.41 $30.73 $24.97 $38.41 $38.41 $22.33 $38.41 $23.05 $38.41 $38.41 $38.41 N/A N/A 37459 ERX HCPCS 63700001 00046-1105-11 CONJ ESTROG-MEDROXYPROGEST ACE 0.3-1.5 MG PO TABS BOTH IP/OP $851.00 $630.00 $177.31 $850.76 $850.76 $850.76 $850.76 $850.76 $850.76 $850.76 $850.76 $850.76 $850.76 $850.76 $850.76 $850.76 $850.76 $177.31 $850.76 $340.30 $850.76 $850.76 $850.76 $850.76 $850.76 $638.25 $850.76 $850.76 $850.76 $425.38 $425.38 $673.80 $850.76 $680.61 $552.99 $850.76 $850.76 $493.58 $850.76 $510.46 $850.76 $850.76 $850.76 N/A N/A 37482 ERX HCPCS 63700001 00245-0036-89 CHOLESTYRAMINE LIGHT 4 G PO PACK BOTH IP/OP $22.50 $17.00 $4.60 $22.08 $22.08 $22.08 $22.08 $22.08 $22.08 $22.08 $22.08 $22.08 $22.08 $22.08 $22.08 $22.08 $22.08 $4.60 $22.08 $8.83 $22.08 $22.08 $22.08 $22.08 $22.08 $16.88 $22.08 $22.08 $22.08 $11.04 $11.04 $17.49 $22.08 $17.66 $14.35 $22.08 $22.08 $13.05 $22.08 $13.25 $22.08 $22.08 $22.08 N/A N/A 37579 ERX HCPCS 25000001 00065-0795-15 BSS IO SOLN BOTH IP/OP $59.50 $44.00 $10.59 $59.49 $59.49 $59.49 $59.49 $59.49 $59.49 $59.49 $10.59 $59.49 $59.49 $44.15 $44.15 $45.85 $30.99 $12.40 $59.49 $23.80 $59.49 $59.49 $59.49 $59.49 $59.49 $44.63 $59.49 $59.49 $59.49 $29.75 $29.75 $47.12 $59.49 $47.59 $38.67 $59.49 $59.49 $34.51 $59.49 $35.69 $59.49 $59.49 $59.49 N/A N/A 37616 ERX HCPCS 63700001 69097-0123-03 TOPIRAMATE 50 MG PO TABS BOTH IP/OP $22.00 $16.00 $4.54 $21.79 $21.79 $21.79 $21.79 $21.79 $21.79 $21.79 $21.79 $21.79 $21.79 $21.79 $21.79 $21.79 $21.79 $4.54 $21.79 $8.72 $21.79 $21.79 $21.79 $21.79 $21.79 $16.50 $21.79 $21.79 $21.79 $10.90 $10.90 $17.26 $21.79 $17.43 $14.16 $21.79 $21.79 $12.76 $21.79 $13.07 $21.79 $21.79 $21.79 2570.13 1165.48 37630 ERX HCPCS 63700001 45802-0040-64 SELENIUM SULFIDE 2.5 % EX LOTN BOTH IP/OP $86.00 $64.00 $17.83 $85.54 $85.54 $85.54 $85.54 $85.54 $85.54 $85.54 $85.54 $85.54 $85.54 $85.54 $85.54 $85.54 $85.54 $17.83 $85.54 $34.22 $85.54 $85.54 $85.54 $85.54 $85.54 $64.50 $85.54 $85.54 $85.54 $42.77 $42.77 $67.75 $85.54 $68.43 $55.60 $85.54 $85.54 $49.88 $85.54 $51.32 $85.54 $85.54 $85.54 N/A N/A 37635 ERX HCPCS 63700001 43547-0280-10 ESCITALOPRAM OXALATE 5 MG PO TABS BOTH IP/OP $18.00 $13.00 $3.74 $17.93 $17.93 $17.93 $17.93 $17.93 $17.93 $17.93 $17.93 $17.93 $17.93 $17.93 $17.93 $17.93 $17.93 $3.74 $17.93 $7.17 $17.93 $17.93 $17.93 $17.93 $17.93 $13.50 $17.93 $17.93 $17.93 $8.97 $8.97 $14.20 $17.93 $14.34 $11.65 $17.93 $17.93 $10.44 $17.93 $10.76 $17.93 $17.93 $17.93 N/A N/A 37637 ERX HCPCS 63700001 51079-0255-01 METOPROLOL TARTRATE 25 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 37642 ERX HCPCS 63700001 00009-0760-04 CLINDAMYCIN PALMITATE HCL 75 MG/5ML PO SOLR BOTH IP/OP $148.50 $110.00 $30.86 $148.06 $148.06 $148.06 $148.06 $148.06 $148.06 $148.06 $148.06 $148.06 $148.06 $148.06 $148.06 $148.06 $148.06 $30.86 $148.06 $59.22 $148.06 $148.06 $148.06 $148.06 $148.06 $111.38 $148.06 $148.06 $148.06 $74.03 $74.03 $117.26 $148.06 $118.45 $96.24 $148.06 $148.06 $86.13 $148.06 $88.84 $148.06 $148.06 $148.06 N/A N/A 37644 ERX HCPCS 63700001 49884-0210-02 PROPAFENONE HCL ER 325 MG PO CP12 BOTH IP/OP $43.50 $32.00 $9.00 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $9.00 $43.20 $17.28 $43.20 $43.20 $43.20 $43.20 $43.20 $32.63 $43.20 $43.20 $43.20 $21.60 $21.60 $34.21 $43.20 $34.56 $28.08 $43.20 $43.20 $25.23 $43.20 $25.92 $43.20 $43.20 $43.20 N/A N/A 37645 ERX HCPCS 63700001 68462-0410-60 PROPAFENONE HCL ER 425 MG PO CP12 BOTH IP/OP $43.50 $32.00 $9.00 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $9.00 $43.20 $17.28 $43.20 $43.20 $43.20 $43.20 $43.20 $32.63 $43.20 $43.20 $43.20 $21.60 $21.60 $34.21 $43.20 $34.56 $28.08 $43.20 $43.20 $25.23 $43.20 $25.92 $43.20 $43.20 $43.20 N/A N/A 37649 ERX HCPCS 63700001 59651-0269-05 GLIPIZIDE ER 5 MG PO TB24 BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 37650 ERX HCPCS 63700001 68084-0112-11 GLIPIZIDE ER 10 MG PO TB24 BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 1193.9 483.6 37651 ERX HCPCS 63700001 63824-0008-50 GUAIFENESIN ER 600 MG PO TB12 BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 37662 ERX HCPCS 63700001 50742-0622-01 NIFEDIPINE 90 MG PO TB24 BOTH IP/OP $13.50 $10.00 $2.73 $13.10 $13.10 $13.10 $13.10 $13.10 $13.10 $13.10 $13.10 $13.10 $13.10 $13.10 $13.10 $13.10 $13.10 $2.73 $13.10 $5.24 $13.10 $13.10 $13.10 $13.10 $13.10 $10.13 $13.10 $13.10 $13.10 $6.55 $6.55 $10.38 $13.10 $10.48 $8.52 $13.10 $13.10 $7.83 $13.10 $7.86 $13.10 $13.10 $13.10 N/A N/A 37848 ERX HCPCS 25000001 99999-6014-94 HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN BOTH IP/OP $15.50 $11.00 $2.73 $15.34 $15.34 $15.34 $15.34 $15.34 $15.34 $15.34 $2.73 $15.34 $15.34 $11.39 $11.39 $11.82 $7.99 $3.20 $15.34 $6.14 $15.34 $15.34 $15.34 $15.34 $15.34 $11.63 $15.34 $15.34 $15.34 $7.67 $7.67 $12.15 $15.34 $12.27 $9.97 $15.34 $15.34 $8.99 $15.34 $9.20 $15.34 $15.34 $15.34 N/A N/A 37894 ERX HCPCS J9305 00002-7623-01 PEMETREXED DISODIUM 500 MG IV SOLR BOTH IP/OP "$11,304.50" "$8,365.00" $857.05 "$11,304.23" "$5,086.90" "$5,086.90" "$5,086.90" "$5,086.90" "$3,801.85" "$3,801.85" "$3,801.85" "$2,832.93" "$3,801.85" "$3,954.08" "$3,954.08" "$4,106.16" "$3,802.00" "$4,466.75" "$3,801.85" $857.05 "$5,572.99" "$3,801.85" "$11,304.23" "$3,801.85" "$3,991.94" "$8,478.38" "$3,801.85" "$3,801.85" "$3,801.85" "$5,652.12" "$5,652.12" "$8,952.95" "$3,801.85" "$9,043.38" "$5,086.90" "$4,253.68" "$3,801.85" "$6,556.61" "$3,991.94" "$5,512.68" "$3,801.85" "$4,253.68" "$3,801.85" N/A N/A 37989 ERX HCPCS J9055 66733-0948-23 CETUXIMAB 100 MG/50ML IV SOLN BOTH IP/OP "$2,404.50" "$1,779.00" $584.45 "$2,404.21" "$1,081.89" "$1,081.89" "$1,081.89" "$1,081.89" $676.18 $676.18 $676.18 $584.45 $676.18 $703.25 $703.25 $730.30 $676.20 $794.43 $676.18 $701.42 "$1,185.28" $676.18 "$2,404.21" $676.18 $709.99 "$1,803.38" $676.18 $676.18 $676.18 "$1,202.11" "$1,202.11" "$1,904.13" $676.18 "$1,923.37" "$1,081.89" $756.53 $676.18 "$1,394.61" $709.99 $980.46 $676.18 $756.53 $676.18 N/A N/A 38063 ERX HCPCS 63700001 60505-2966-07 MYCOPHENOLATE SODIUM 360 MG PO TBEC BOTH IP/OP $39.50 $29.00 $8.23 $39.48 $39.48 $39.48 $39.48 $39.48 $39.48 $39.48 $39.48 $39.48 $39.48 $39.48 $39.48 $39.48 $39.48 $8.23 $39.48 $15.79 $39.48 $39.48 $39.48 $39.48 $39.48 $29.63 $39.48 $39.48 $39.48 $19.74 $19.74 $31.27 $39.48 $31.58 $25.66 $39.48 $39.48 $22.91 $39.48 $23.69 $39.48 $39.48 $39.48 N/A N/A 38100 ERX HCPCS 63700001 67877-0503-30 CINACALCET HCL 30 MG PO TABS BOTH IP/OP $122.00 $90.00 $25.42 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $25.42 $121.99 $48.80 $121.99 $121.99 $121.99 $121.99 $121.99 $91.50 $121.99 $121.99 $121.99 $61.00 $61.00 $96.62 $121.99 $97.59 $79.29 $121.99 $121.99 $70.76 $121.99 $73.19 $121.99 $121.99 $121.99 2680.74 1227.58 38101 ERX HCPCS 63700001 70436-0008-04 CINACALCET HCL 60 MG PO TABS BOTH IP/OP $221.50 $164.00 $46.15 $221.42 $221.42 $221.42 $221.42 $221.42 $221.42 $221.42 $221.42 $221.42 $221.42 $221.42 $221.42 $221.42 $221.42 $46.15 $221.42 $88.57 $221.42 $221.42 $221.42 $221.42 $221.42 $166.13 $221.42 $221.42 $221.42 $110.71 $110.71 $175.36 $221.42 $177.14 $143.92 $221.42 $221.42 $128.47 $221.42 $132.85 $221.42 $221.42 $221.42 2689.43 1244.36 38102 ERX HCPCS 63700006 55513-0075-30 CINACALCET HCL 90 MG PO TABS BOTH IP/OP $347.00 $257.00 $72.23 $346.56 $346.56 $346.56 $346.56 $346.56 $346.56 $346.56 $346.56 $346.56 $346.56 $346.56 $346.56 $346.56 $346.56 $72.23 $346.56 $138.62 $346.56 $346.56 $346.56 $346.56 $346.56 $260.25 $346.56 $346.56 $346.56 $173.28 $173.28 $274.48 $346.56 $277.25 $225.26 $346.56 $346.56 $201.26 $346.56 $207.94 $346.56 $346.56 $346.56 609.56 276.65 38224 ERX HCPCS 63700001 00527-4116-37 PROPRANOLOL HCL ER 60 MG PO CP24 BOTH IP/OP $9.00 $7.00 $1.85 $8.90 $8.90 $8.90 $8.90 $8.90 $8.90 $8.90 $8.90 $8.90 $8.90 $8.90 $8.90 $8.90 $8.90 $1.85 $8.90 $3.56 $8.90 $8.90 $8.90 $8.90 $8.90 $6.75 $8.90 $8.90 $8.90 $4.45 $4.45 $7.05 $8.90 $7.12 $5.79 $8.90 $8.90 $5.22 $8.90 $5.34 $8.90 $8.90 $8.90 N/A N/A 38225 ERX HCPCS 63700001 42291-0523-10 PROPRANOLOL HCL ER 80 MG PO CP24 BOTH IP/OP $10.00 $7.00 $2.05 $9.85 $9.85 $9.85 $9.85 $9.85 $9.85 $9.85 $9.85 $9.85 $9.85 $9.85 $9.85 $9.85 $9.85 $2.05 $9.85 $3.94 $9.85 $9.85 $9.85 $9.85 $9.85 $7.50 $9.85 $9.85 $9.85 $4.93 $4.93 $7.80 $9.85 $7.88 $6.40 $9.85 $9.85 $5.80 $9.85 $5.91 $9.85 $9.85 $9.85 N/A N/A 38226 ERX HCPCS 63700001 00228-2780-11 PROPRANOLOL HCL ER 120 MG PO CP24 BOTH IP/OP $13.00 $10.00 $2.69 $12.89 $12.89 $12.89 $12.89 $12.89 $12.89 $12.89 $12.89 $12.89 $12.89 $12.89 $12.89 $12.89 $12.89 $2.69 $12.89 $5.16 $12.89 $12.89 $12.89 $12.89 $12.89 $9.75 $12.89 $12.89 $12.89 $6.45 $6.45 $10.21 $12.89 $10.31 $8.38 $12.89 $12.89 $7.54 $12.89 $7.73 $12.89 $12.89 $12.89 N/A N/A 38227 ERX HCPCS 63700001 00228-2781-11 PROPRANOLOL HCL ER 160 MG PO CP24 BOTH IP/OP $17.00 $13.00 $3.52 $16.87 $16.87 $16.87 $16.87 $16.87 $16.87 $16.87 $16.87 $16.87 $16.87 $16.87 $16.87 $16.87 $16.87 $3.52 $16.87 $6.75 $16.87 $16.87 $16.87 $16.87 $16.87 $12.75 $16.87 $16.87 $16.87 $8.44 $8.44 $13.36 $16.87 $13.50 $10.97 $16.87 $16.87 $9.86 $16.87 $10.12 $16.87 $16.87 $16.87 N/A N/A 38263 ERX HCPCS 25000001 00781-3159-72 OLANZAPINE 10 MG IM SOLR BOTH IP/OP $45.00 $33.00 $7.98 $44.82 $44.82 $44.82 $44.82 $44.82 $44.82 $44.82 $7.98 $44.82 $44.82 $33.27 $33.27 $34.55 $23.35 $9.34 $44.82 $17.93 $44.82 $44.82 $44.82 $44.82 $44.82 $33.75 $44.82 $44.82 $44.82 $22.41 $22.41 $35.50 $44.82 $35.86 $29.13 $44.82 $44.82 $26.10 $44.82 $26.89 $44.82 $44.82 $44.82 N/A N/A 38270 ERX HCPCS J9070 10019-0956-01 CYCLOPHOSPHAMIDE 1 G IJ SOLR BOTH IP/OP "$2,347.00" "$1,737.00" $216.37 "$2,346.93" "$1,056.12" "$1,056.12" "$1,056.12" "$1,056.12" $274.73 $274.73 $274.73 $489.16 $274.73 $285.69 $285.69 $296.68 $274.70 $322.73 $274.73 $216.37 "$1,157.04" $274.73 "$2,346.93" $274.73 $288.47 "$1,760.25" $274.73 $274.73 $274.73 "$1,173.47" "$1,173.47" "$1,858.77" $274.73 "$1,877.54" "$1,056.12" $307.33 $274.73 "$1,361.26" $288.47 $398.36 $274.73 $307.33 $274.73 N/A N/A 38271 ERX HCPCS J9070 10019-0955-01 CYCLOPHOSPHAMIDE 500 MG IJ SOLR BOTH IP/OP "$1,327.50" $982.00 $108.19 "$1,327.29" $597.28 $597.28 $597.28 $597.28 $137.37 $137.37 $137.37 $276.64 $137.37 $142.84 $142.84 $148.34 $137.35 $161.36 $137.37 $108.19 $785.09 $137.37 "$1,327.29" $137.37 $144.23 $995.63 $137.37 $137.37 $137.37 $663.65 $663.65 "$1,051.21" $137.37 "$1,061.83" $597.28 $153.67 $137.37 $769.95 $144.23 $199.18 $137.37 $153.67 $137.37 N/A N/A 38280 ERX HCPCS J9070 10019-0957-01 CYCLOPHOSPHAMIDE 2 G IJ SOLR BOTH IP/OP "$4,096.50" "$3,031.00" $432.74 "$4,096.14" "$1,843.26" "$1,843.26" "$1,843.26" "$1,843.26" $549.46 $549.46 $549.46 $853.74 $549.46 $571.38 $571.38 $593.35 $549.40 $645.46 $549.46 $432.74 "$2,019.40" $549.46 "$4,096.14" $549.46 $576.93 "$3,072.38" $549.46 $549.46 $549.46 "$2,048.07" "$2,048.07" "$3,244.14" $549.46 "$3,276.91" "$1,843.26" $614.67 $549.46 "$2,375.97" $576.93 $796.72 $549.46 $614.67 $549.46 N/A N/A 38303 ERX HCPCS J0132 66220-0207-30 ACETYLCYSTEINE 200 MG/ML IV SOLN BOTH IP/OP $828.50 $613.00 $47.40 $828.27 $828.27 $828.27 $828.27 $828.27 $828.27 $828.27 $49.80 $828.27 $828.27 $49.30 $49.30 $51.19 $47.40 $172.62 $828.27 $331.31 $828.27 $828.27 $828.27 $828.27 $828.27 $621.38 $828.27 $828.27 $828.27 $414.14 $414.14 $655.99 $828.27 $662.62 $372.72 $828.27 $828.27 $480.53 $828.27 $496.96 $828.27 $828.27 $828.27 N/A N/A 38315 ERX HCPCS 25000001 00597-0075-41 TIOTROPIUM BROMIDE MONOHYDRATE 18 MCG IN CAPS BOTH IP/OP "$1,641.00" "$1,214.00" $292.01 "$1,640.53" "$1,640.53" "$1,640.53" "$1,640.53" "$1,640.53" "$1,640.53" "$1,640.53" $292.01 "$1,640.53" "$1,640.53" "$1,217.60" "$1,217.60" "$1,264.52" $854.72 $341.90 "$1,640.53" $656.21 "$1,640.53" "$1,640.53" "$1,640.53" "$1,640.53" "$1,640.53" "$1,230.75" "$1,640.53" "$1,640.53" "$1,640.53" $820.27 $820.27 "$1,299.30" "$1,640.53" "$1,312.42" "$1,066.34" "$1,640.53" "$1,640.53" $951.78 "$1,640.53" $984.32 "$1,640.53" "$1,640.53" "$1,640.53" N/A N/A 38480 ERX HCPCS 63700001 00093-5419-84 CLOZAPINE 100 MG PO TBDP BOTH IP/OP $35.50 $26.00 $7.36 $35.32 $35.32 $35.32 $35.32 $35.32 $35.32 $35.32 $35.32 $35.32 $35.32 $35.32 $35.32 $35.32 $35.32 $7.36 $35.32 $14.13 $35.32 $35.32 $35.32 $35.32 $35.32 $26.63 $35.32 $35.32 $35.32 $17.66 $17.66 $27.97 $35.32 $28.26 $22.96 $35.32 $35.32 $20.59 $35.32 $21.19 $35.32 $35.32 $35.32 N/A N/A 38489 ERX HCPCS 63700001 99999-6005-07 ETHOSUXIMIDE 250 MG/5ML PO SOLN BOTH IP/OP $108.50 $80.00 $22.60 $108.42 $108.42 $108.42 $108.42 $108.42 $108.42 $108.42 $108.42 $108.42 $108.42 $108.42 $108.42 $108.42 $108.42 $22.60 $108.42 $43.37 $108.42 $108.42 $108.42 $108.42 $108.42 $81.38 $108.42 $108.42 $108.42 $54.21 $54.21 $85.87 $108.42 $86.74 $70.47 $108.42 $108.42 $62.93 $108.42 $65.05 $108.42 $108.42 $108.42 N/A N/A 39063 ERX HCPCS 63700001 65649-0301-03 RIFAXIMIN 200 MG PO TABS BOTH IP/OP $147.00 $109.00 $30.59 $146.76 $146.76 $146.76 $146.76 $146.76 $146.76 $146.76 $146.76 $146.76 $146.76 $146.76 $146.76 $146.76 $146.76 $30.59 $146.76 $58.70 $146.76 $146.76 $146.76 $146.76 $146.76 $110.25 $146.76 $146.76 $146.76 $73.38 $73.38 $116.23 $146.76 $117.41 $95.39 $146.76 $146.76 $85.26 $146.76 $88.06 $146.76 $146.76 $146.76 N/A N/A 39136 ERX HCPCS 63700001 00574-2008-15 NYSTATIN 100000 UNIT/GM EX POWD BOTH IP/OP $109.50 $81.00 $22.78 $109.32 $109.32 $109.32 $109.32 $109.32 $109.32 $109.32 $109.32 $109.32 $109.32 $109.32 $109.32 $109.32 $109.32 $22.78 $109.32 $43.73 $109.32 $109.32 $109.32 $109.32 $109.32 $82.13 $109.32 $109.32 $109.32 $54.66 $54.66 $86.58 $109.32 $87.46 $71.06 $109.32 $109.32 $63.51 $109.32 $65.59 $109.32 $109.32 $109.32 N/A N/A 39254 ERX HCPCS 63700001 67546-0111-12 NITAZOXANIDE 500 MG PO TABS BOTH IP/OP $561.00 $415.00 $116.84 $560.62 $560.62 $560.62 $560.62 $560.62 $560.62 $560.62 $560.62 $560.62 $560.62 $560.62 $560.62 $560.62 $560.62 $116.84 $560.62 $224.25 $560.62 $560.62 $560.62 $560.62 $560.62 $420.75 $560.62 $560.62 $560.62 $280.31 $280.31 $444.01 $560.62 $448.50 $364.40 $560.62 $560.62 $325.38 $560.62 $336.37 $560.62 $560.62 $560.62 N/A N/A 39255 ERX HCPCS 63700006 61958-0701-01 TRUVADA:EMTRICITABINE-TENOFOVIR 200-300 MG TAB PO BOTH IP/OP $264.00 $195.00 $54.98 $263.82 $263.82 $263.82 $263.82 $263.82 $263.82 $263.82 $263.82 $263.82 $263.82 $263.82 $263.82 $263.82 $263.82 $54.98 $263.82 $105.53 $263.82 $263.82 $263.82 $263.82 $263.82 $198.00 $263.82 $263.82 $263.82 $131.91 $131.91 $208.95 $263.82 $211.06 $171.48 $263.82 $263.82 $153.12 $263.82 $158.29 $263.82 $263.82 $263.82 N/A N/A 39267 ERX HCPCS J9045 00703-4248-01 CARBOPLATIN 450 MG/45ML IV SOLN BOTH IP/OP $279.50 $207.00 $23.49 $279.19 $125.64 $125.64 $125.64 $125.64 $279.19 $279.19 $279.19 $60.81 $279.19 $24.43 $24.43 $25.37 $23.49 $27.60 $279.19 $279.19 $165.14 $279.19 $279.19 $279.19 $279.19 $209.63 $279.19 $279.19 $279.19 $139.60 $139.60 $221.12 $279.19 $223.35 $125.64 $26.28 $279.19 $162.11 $279.19 $279.19 $279.19 $26.28 $279.19 N/A N/A 39275 ERX HCPCS 63700001 00002-3235-60 DULOXETINE HCL 20 MG PO CPEP BOTH IP/OP $43.50 $32.00 $9.01 $43.24 $43.24 $43.24 $43.24 $43.24 $43.24 $43.24 $43.24 $43.24 $43.24 $43.24 $43.24 $43.24 $43.24 $9.01 $43.24 $17.30 $43.24 $43.24 $43.24 $43.24 $43.24 $32.63 $43.24 $43.24 $43.24 $21.62 $21.62 $34.25 $43.24 $34.59 $28.11 $43.24 $43.24 $25.23 $43.24 $25.94 $43.24 $43.24 $43.24 N/A N/A 39276 ERX HCPCS 63700001 57237-0018-30 DULOXETINE HCL 30 MG PO CPEP BOTH IP/OP $34.00 $25.00 $7.07 $33.93 $33.93 $33.93 $33.93 $33.93 $33.93 $33.93 $33.93 $33.93 $33.93 $33.93 $33.93 $33.93 $33.93 $7.07 $33.93 $13.57 $33.93 $33.93 $33.93 $33.93 $33.93 $25.50 $33.93 $33.93 $33.93 $16.97 $16.97 $26.87 $33.93 $27.14 $22.05 $33.93 $33.93 $19.72 $33.93 $20.36 $33.93 $33.93 $33.93 N/A N/A 39522 ERX HCPCS 25000001 00781-6078-46 CEFDINIR 250 MG/5ML PO SUSR BOTH IP/OP $547.00 $405.00 $97.28 $546.53 $546.53 $546.53 $546.53 $546.53 $546.53 $546.53 $97.28 $546.53 $546.53 $405.63 $405.63 $421.27 $284.74 $113.90 $546.53 $218.61 $546.53 $546.53 $546.53 $546.53 $546.53 $410.25 $546.53 $546.53 $546.53 $273.27 $273.27 $432.85 $546.53 $437.22 $355.24 $546.53 $546.53 $317.26 $546.53 $327.92 $546.53 $546.53 $546.53 N/A N/A 39594 ERX HCPCS 63700001 49411-0051-30 AMINOCAPROIC ACID 1000 MG PO TABS BOTH IP/OP $194.50 $144.00 $40.53 $194.48 $194.48 $194.48 $194.48 $194.48 $194.48 $194.48 $194.48 $194.48 $194.48 $194.48 $194.48 $194.48 $194.48 $40.53 $194.48 $77.79 $194.48 $194.48 $194.48 $194.48 $194.48 $145.88 $194.48 $194.48 $194.48 $97.24 $97.24 $154.03 $194.48 $155.58 $126.41 $194.48 $194.48 $112.81 $194.48 $116.69 $194.48 $194.48 $194.48 N/A N/A 39744 ERX HCPCS 25000001 00143-9784-10 FLUMAZENIL 0.5 MG/5ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 39802 ERX HCPCS 25000001 00386-0008-03 PENTAFLUOROPROP-TETRAFLUOROETH EX AERO BOTH IP/OP $138.50 $102.00 $24.57 $138.05 $138.05 $138.05 $138.05 $138.05 $138.05 $138.05 $24.57 $138.05 $138.05 $102.46 $102.46 $106.41 $71.92 $28.77 $138.05 $55.22 $138.05 $138.05 $138.05 $138.05 $138.05 $103.88 $138.05 $138.05 $138.05 $69.03 $69.03 $109.34 $138.05 $110.44 $89.73 $138.05 $138.05 $80.33 $138.05 $82.83 $138.05 $138.05 $138.05 N/A N/A 39918 ERX HCPCS J3260 63323-0306-02 TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN BOTH IP/OP $22.00 $16.00 $2.56 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $3.84 $2.56 $22.00 $4.28 $4.28 $4.45 $4.12 $4.84 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $4.61 $22.00 $12.76 $22.00 $22.00 $22.00 $4.61 $22.00 N/A N/A 39975 ERX HCPCS 63700001 54092-0252-90 LANTHANUM CARBONATE 500 MG PO CHEW BOTH IP/OP $62.50 $46.00 $12.97 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $12.97 $62.25 $24.90 $62.25 $62.25 $62.25 $62.25 $62.25 $46.88 $62.25 $62.25 $62.25 $31.13 $31.13 $49.30 $62.25 $49.80 $40.46 $62.25 $62.25 $36.25 $62.25 $37.35 $62.25 $62.25 $62.25 N/A N/A 40089 ERX HCPCS 63700001 50242-0062-01 ERLOTINIB HCL 25 MG PO TABS BOTH IP/OP $378.00 $280.00 $78.70 $377.60 $377.60 $377.60 $377.60 $377.60 $377.60 $377.60 $377.60 $377.60 $377.60 $377.60 $377.60 $377.60 $377.60 $78.70 $377.60 $151.04 $377.60 $377.60 $377.60 $377.60 $377.60 $283.50 $377.60 $377.60 $377.60 $188.80 $188.80 $299.06 $377.60 $302.08 $245.44 $377.60 $377.60 $219.24 $377.60 $226.56 $377.60 $377.60 $377.60 N/A N/A 40090 ERX HCPCS 63700001 50242-0063-01 ERLOTINIB HCL 100 MG PO TABS BOTH IP/OP $903.00 $668.00 $188.12 $902.63 $902.63 $902.63 $902.63 $902.63 $902.63 $902.63 $902.63 $902.63 $902.63 $902.63 $902.63 $902.63 $902.63 $188.12 $902.63 $361.05 $902.63 $902.63 $902.63 $902.63 $902.63 $677.25 $902.63 $902.63 $902.63 $451.32 $451.32 $714.88 $902.63 $722.10 $586.71 $902.63 $902.63 $523.74 $902.63 $541.58 $902.63 $902.63 $902.63 N/A N/A 40091 ERX HCPCS 63700001 50242-0064-01 ERLOTINIB HCL 150 MG PO TABS BOTH IP/OP "$1,021.00" $756.00 $212.77 "$1,020.93" "$1,020.93" "$1,020.93" "$1,020.93" "$1,020.93" "$1,020.93" "$1,020.93" "$1,020.93" "$1,020.93" "$1,020.93" "$1,020.93" "$1,020.93" "$1,020.93" "$1,020.93" $212.77 "$1,020.93" $408.37 "$1,020.93" "$1,020.93" "$1,020.93" "$1,020.93" "$1,020.93" $765.75 "$1,020.93" "$1,020.93" "$1,020.93" $510.47 $510.47 $808.58 "$1,020.93" $816.74 $663.60 "$1,020.93" "$1,020.93" $592.18 "$1,020.93" $612.56 "$1,020.93" "$1,020.93" "$1,020.93" N/A N/A 40321 ERX HCPCS 63700001 00378-5271-01 ESZOPICLONE 2 MG PO TABS BOTH IP/OP $50.50 $37.00 $10.50 $50.38 $50.38 $50.38 $50.38 $50.38 $50.38 $50.38 $50.38 $50.38 $50.38 $50.38 $50.38 $50.38 $50.38 $10.50 $50.38 $20.15 $50.38 $50.38 $50.38 $50.38 $50.38 $37.88 $50.38 $50.38 $50.38 $25.19 $25.19 $39.90 $50.38 $40.30 $32.75 $50.38 $50.38 $29.29 $50.38 $30.23 $50.38 $50.38 $50.38 N/A N/A 40369 ERX HCPCS 25000001 69918-0560-30 MESALAMINE 1000 MG RECTAL SUPP BOTH IP/OP $166.50 $123.00 $29.63 $166.45 $166.45 $166.45 $166.45 $166.45 $166.45 $166.45 $29.63 $166.45 $166.45 $123.54 $123.54 $128.30 $86.72 $34.69 $166.45 $66.58 $166.45 $166.45 $166.45 $166.45 $166.45 $124.88 $166.45 $166.45 $166.45 $83.23 $83.23 $131.83 $166.45 $133.16 $108.19 $166.45 $166.45 $96.57 $166.45 $99.87 $166.45 $166.45 $166.45 N/A N/A 40413 ERX HCPCS 63600001 66215-0302-00 ILOPROST 10 MCG/ML IN SOLN BOTH IP/OP $169.00 $125.00 $30.06 $168.89 $168.89 $168.89 $168.89 $168.89 $168.89 $168.89 $30.06 $168.89 $168.89 $168.89 $168.89 $168.89 $168.89 $35.20 $168.89 $67.56 $168.89 $168.89 $168.89 $168.89 $168.89 $126.75 $168.89 $168.89 $168.89 $84.45 $84.45 $133.76 $168.89 $135.11 $76.00 $168.89 $168.89 $98.02 $168.89 $101.33 $168.89 $168.89 $168.89 N/A N/A 40449 ERX HCPCS J3471 24208-0002-02 HYALURONIDASE OVINE 200 UNIT/ML IJ SOLN BOTH IP/OP $324.50 $240.00 $17.63 $324.42 $145.99 $145.99 $145.99 $145.99 $324.42 $324.42 $324.42 $17.63 $324.42 $73.32 $73.32 $76.14 $70.50 $67.61 $324.42 $324.42 $191.89 $324.42 $324.42 $324.42 $324.42 $243.38 $324.42 $324.42 $324.42 $162.21 $162.21 $256.94 $324.42 $259.54 $145.99 $64.39 $324.42 $188.21 $324.42 $324.42 $324.42 $67.61 $324.42 N/A N/A 40475 ERX HCPCS J9264 68817-0134-50 NAB-PACLITAXEL 100 MG IV SUSR BOTH IP/OP "$4,418.00" "$3,269.00" "$1,065.73" "$4,417.85" "$1,988.03" "$1,988.03" "$1,988.03" "$1,988.03" "$1,404.40" "$1,404.40" "$1,404.40" "$1,065.73" "$1,404.40" "$1,460.16" "$1,460.16" "$1,516.32" "$1,404.00" "$1,649.48" "$1,404.40" "$1,178.40" "$2,178.00" "$1,404.40" "$4,417.85" "$1,404.40" "$1,474.62" "$3,313.50" "$1,404.40" "$1,404.40" "$1,404.40" "$2,208.93" "$2,208.93" "$3,498.94" "$1,404.40" "$3,534.28" "$1,988.03" "$1,570.80" "$1,404.40" "$2,562.44" "$1,474.62" "$2,036.38" "$1,404.40" "$1,570.80" "$1,404.40" N/A N/A 40697 ERX HCPCS 25000001 00173-0718-20 FLUTICASONE PROPIONATE HFA 44 MCG/ACT IN AERO BOTH IP/OP $741.50 $549.00 $131.95 $741.27 $741.27 $741.27 $741.27 $741.27 $741.27 $741.27 $131.95 $741.27 $741.27 $550.17 $550.17 $571.37 $386.20 $154.49 $741.27 $296.51 $741.27 $741.27 $741.27 $741.27 $741.27 $556.13 $741.27 $741.27 $741.27 $370.64 $370.64 $587.09 $741.27 $593.02 $481.83 $741.27 $741.27 $430.07 $741.27 $444.76 $741.27 $741.27 $741.27 N/A N/A 40698 ERX HCPCS 25000001 00173-0719-20 FLUTICASONE PROPIONATE HFA 110 MCG/ACT IN AERO BOTH IP/OP $992.50 $734.00 $176.64 $992.36 $992.36 $992.36 $992.36 $992.36 $992.36 $992.36 $176.64 $992.36 $992.36 $736.53 $736.53 $764.91 $517.02 $206.82 $992.36 $396.94 $992.36 $992.36 $992.36 $992.36 $992.36 $744.38 $992.36 $992.36 $992.36 $496.18 $496.18 $785.95 $992.36 $793.89 $645.03 $992.36 $992.36 $575.65 $992.36 $595.42 $992.36 $992.36 $992.36 N/A N/A 40699 ERX HCPCS 25000001 00173-0720-20 FLUTICASONE PROPIONATE HFA 220 MCG/ACT IN AERO BOTH IP/OP "$1,363.00" "$1,009.00" $242.57 "$1,362.76" "$1,362.76" "$1,362.76" "$1,362.76" "$1,362.76" "$1,362.76" "$1,362.76" $242.57 "$1,362.76" "$1,362.76" "$1,011.44" "$1,011.44" "$1,050.42" $710.00 $284.01 "$1,362.76" $545.10 "$1,362.76" "$1,362.76" "$1,362.76" "$1,362.76" "$1,362.76" "$1,022.25" "$1,362.76" "$1,362.76" "$1,362.76" $681.38 $681.38 "$1,079.31" "$1,362.76" "$1,090.21" $885.79 "$1,362.76" "$1,362.76" $790.54 "$1,362.76" $817.66 "$1,362.76" "$1,362.76" "$1,362.76" N/A N/A 40801 ERX HCPCS J9217 62935-0453-45 LEUPROLIDE ACETATE (6 MONTH) 45 MG SC KIT BOTH IP/OP "$7,578.00" "$5,608.00" "$1,035.37" "$7,577.54" "$3,409.89" "$3,409.89" "$3,409.89" "$3,409.89" "$1,204.40" "$1,204.40" "$1,204.40" "$1,480.99" "$1,204.40" "$1,252.56" "$1,252.56" "$1,300.73" "$1,204.38" "$1,414.96" "$1,204.40" "$1,035.37" "$3,735.73" "$1,204.40" "$7,577.54" "$1,204.40" "$1,264.62" "$5,683.50" "$1,204.40" "$1,204.40" "$1,204.40" "$3,788.77" "$3,788.77" "$6,001.41" "$1,204.40" "$6,062.03" "$3,409.89" "$1,347.46" "$1,204.40" "$4,395.24" "$1,264.62" "$1,746.38" "$1,204.40" "$1,347.46" "$1,204.40" 526.25 209.31 40994 ERX HCPCS 25000001 00132-0079-12 GLYCERIN (ADULT) 2 G RECTAL SUPP BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 41124 ERX HCPCS 25000001 62991-2502-01 PHENOL LIQD BOTH IP/OP $997.00 $738.00 $177.39 $996.60 $996.60 $996.60 $996.60 $996.60 $996.60 $996.60 $177.39 $996.60 $996.60 $739.68 $739.68 $768.18 $519.23 $207.70 $996.60 $398.64 $996.60 $996.60 $996.60 $996.60 $996.60 $747.75 $996.60 $996.60 $996.60 $498.30 $498.30 $789.31 $996.60 $797.28 $647.79 $996.60 $996.60 $578.26 $996.60 $597.96 $996.60 $996.60 $996.60 N/A N/A 41137 ERX HCPCS A9577 00270-5164-13 GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN BOTH IP/OP $250.00 $185.00 $18.80 $249.89 $112.45 $112.45 $112.45 $112.45 $249.89 $249.89 $249.89 $52.08 $249.89 $249.89 $249.89 $20.30 $18.80 $52.08 $249.89 $249.89 $147.81 $249.89 $249.89 $249.89 $249.89 $187.50 $249.89 $249.89 $249.89 $124.95 $124.95 $197.91 $249.89 $199.91 $112.45 $49.60 $249.89 $145.00 $249.89 $249.89 $249.89 $52.08 $249.89 N/A N/A 41137 ERX HCPCS A9577 00270-5164-14 GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN BOTH IP/OP $250.00 $185.00 $18.80 $249.89 $112.45 $112.45 $112.45 $112.45 $249.89 $249.89 $249.89 $52.08 $249.89 $249.89 $249.89 $20.30 $18.80 $52.08 $249.89 $249.89 $147.81 $249.89 $249.89 $249.89 $249.89 $187.50 $249.89 $249.89 $249.89 $124.95 $124.95 $197.91 $249.89 $199.91 $112.45 $49.60 $249.89 $145.00 $249.89 $249.89 $249.89 $52.08 $249.89 N/A N/A 41137 ERX HCPCS A9577 00270-5164-15 GADOBENATE DIMEGLUMINE 529 MG/ML IV SOLN BOTH IP/OP $250.00 $185.00 $18.80 $249.89 $112.45 $112.45 $112.45 $112.45 $249.89 $249.89 $249.89 $52.08 $249.89 $249.89 $249.89 $20.30 $18.80 $52.08 $249.89 $249.89 $147.81 $249.89 $249.89 $249.89 $249.89 $187.50 $249.89 $249.89 $249.89 $124.95 $124.95 $197.91 $249.89 $199.91 $112.45 $49.60 $249.89 $145.00 $249.89 $249.89 $249.89 $52.08 $249.89 N/A N/A 41142 ERX HCPCS 25000001 00597-0087-17 IPRATROPIUM BROMIDE HFA 17 MCG/ACT IN AERS BOTH IP/OP "$2,563.00" "$1,897.00" $456.19 "$2,562.85" "$2,562.85" "$2,562.85" "$2,562.85" "$2,562.85" "$2,562.85" "$2,562.85" $456.19 "$2,562.85" "$2,562.85" "$1,902.15" "$1,902.15" "$1,975.44" "$1,335.24" $534.13 "$2,562.85" "$1,025.14" "$2,562.85" "$2,562.85" "$2,562.85" "$2,562.85" "$2,562.85" "$1,922.25" "$2,562.85" "$2,562.85" "$2,562.85" "$1,281.43" "$1,281.43" "$2,029.78" "$2,562.85" "$2,050.28" "$1,665.85" "$2,562.85" "$2,562.85" "$1,486.54" "$2,562.85" "$1,537.71" "$2,562.85" "$2,562.85" "$2,562.85" N/A N/A 41144 ERX HCPCS J2248 00469-3250-10 MICAFUNGIN SODIUM 50 MG IV SOLR BOTH IP/OP $389.50 $288.00 $43.00 $389.34 $389.34 $389.34 $389.34 $389.34 $389.34 $389.34 $48.50 $389.34 $389.34 $44.72 $44.72 $46.44 $43.00 $50.52 $389.34 $155.74 $389.34 $389.34 $389.34 $389.34 $389.34 $292.13 $389.34 $389.34 $389.34 $194.67 $194.67 $308.36 $389.34 $311.47 $175.20 $389.34 $389.34 $225.91 $389.34 $233.60 $389.34 $389.34 $389.34 N/A N/A 41149 ERX HCPCS 25000001 99999-6013-63 ENTECAVIR 0.05 MG/ML PO SOLN BOTH IP/OP $197.00 $146.00 $34.99 $196.55 $196.55 $196.55 $196.55 $196.55 $196.55 $196.55 $34.99 $196.55 $196.55 $145.88 $145.88 $151.50 $102.40 $40.96 $196.55 $78.62 $196.55 $196.55 $196.55 $196.55 $196.55 $147.75 $196.55 $196.55 $196.55 $98.28 $98.28 $155.67 $196.55 $157.24 $127.76 $196.55 $196.55 $114.26 $196.55 $117.93 $196.55 $196.55 $196.55 N/A N/A 41294 ERX HCPCS J9185 25021-0242-02 FLUDARABINE PHOSPHATE 50 MG/2ML IV SOLN BOTH IP/OP $788.50 $583.00 $57.02 $788.22 $788.22 $788.22 $788.22 $788.22 $788.22 $788.22 $69.34 $788.22 $788.22 $59.30 $59.30 $61.58 $57.02 $66.99 $788.22 $315.29 $788.22 $788.22 $788.22 $788.22 $788.22 $591.38 $788.22 $788.22 $788.22 $394.11 $394.11 $624.27 $788.22 $630.58 $354.70 $788.22 $788.22 $457.33 $788.22 $472.93 $788.22 $788.22 $788.22 N/A N/A 41382 ERX HCPCS 63700001 47781-0423-47 FENTANYL 12 MCG/HR TD PATCH 72 HR BOTH IP/OP $81.00 $60.00 $16.84 $80.81 $80.81 $80.81 $80.81 $80.81 $80.81 $80.81 $80.81 $80.81 $80.81 $80.81 $80.81 $80.81 $80.81 $16.84 $80.81 $32.32 $80.81 $80.81 $80.81 $80.81 $80.81 $60.75 $80.81 $80.81 $80.81 $40.41 $40.41 $64.00 $80.81 $64.65 $52.53 $80.81 $80.81 $46.98 $80.81 $48.49 $80.81 $80.81 $80.81 N/A N/A 41581 ERX HCPCS J1610 00597-0053-45 GLUCAGON HCL RDNA (DIAGNOSTIC) 1 MG IJ SOLR BOTH IP/OP $357.50 $265.00 $88.07 $357.28 $160.78 $160.78 $160.78 $160.78 $166.77 $166.77 $166.77 $88.07 $166.77 $173.44 $173.44 $180.11 $166.77 $195.93 $166.77 $190.26 $211.33 $166.77 $357.28 $166.77 $175.11 $268.13 $166.77 $166.77 $166.77 $178.64 $178.64 $282.97 $166.77 $285.82 $160.78 $186.58 $166.77 $207.35 $175.11 $241.82 $166.77 $186.58 $166.77 N/A N/A 41623 ERX HCPCS 25000001 99999-6010-71 LEVOCARNITINE 1 GM/10ML PO SOLN BOTH IP/OP $51.00 $38.00 $9.04 $50.81 $50.81 $50.81 $50.81 $50.81 $50.81 $50.81 $9.04 $50.81 $50.81 $37.71 $37.71 $39.16 $26.47 $10.59 $50.81 $20.32 $50.81 $50.81 $50.81 $50.81 $50.81 $38.25 $50.81 $50.81 $50.81 $25.41 $25.41 $40.24 $50.81 $40.65 $33.03 $50.81 $50.81 $29.58 $50.81 $30.49 $50.81 $50.81 $50.81 N/A N/A 41624 ERX HCPCS J3430 00409-9157-01 VITAMIN K1 1 MG/0.5ML IJ SOLN BOTH IP/OP $22.00 $16.00 $3.42 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.98 $22.00 $3.56 $3.56 $3.69 $3.42 $4.02 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $3.83 $22.00 $12.76 $22.00 $22.00 $22.00 $3.83 $22.00 N/A N/A 41628 ERX HCPCS 90715 49281-0400-58 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2-15.5 LF-MCG/0.5 IM SUSP BOTH IP/OP $224.00 $166.00 $36.16 $223.54 $100.59 $100.59 $100.59 $100.59 $223.54 $223.54 $223.54 $46.59 $223.54 $37.61 $37.61 $39.05 $36.16 $42.48 $223.54 $223.54 $132.22 $223.54 $223.54 $223.54 $223.54 $168.00 $223.54 $223.54 $223.54 $111.77 $111.77 $177.04 $223.54 $178.83 $100.59 $40.46 $223.54 $129.92 $223.54 $223.54 $223.54 $40.46 $223.54 N/A N/A 41652 ERX HCPCS J3243 00781-3481-92 TIGECYCLINE 50 MG IV SOLR BOTH IP/OP $543.50 $402.00 $53.00 $543.06 $543.06 $543.06 $543.06 $543.06 $543.06 $543.06 $56.00 $543.06 $543.06 $55.12 $55.12 $57.24 $53.00 $113.18 $543.06 $217.22 $543.06 $543.06 $543.06 $543.06 $543.06 $407.63 $543.06 $543.06 $543.06 $271.53 $271.53 $430.10 $543.06 $434.45 $244.38 $543.06 $543.06 $315.23 $543.06 $325.84 $543.06 $543.06 $543.06 N/A N/A 41676 ERX HCPCS 63700001 00597-0003-02 TIPRANAVIR 250 MG PO CAPS BOTH IP/OP $159.00 $118.00 $33.09 $158.79 $158.79 $158.79 $158.79 $158.79 $158.79 $158.79 $158.79 $158.79 $158.79 $158.79 $158.79 $158.79 $158.79 $33.09 $158.79 $63.52 $158.79 $158.79 $158.79 $158.79 $158.79 $119.25 $158.79 $158.79 $158.79 $79.40 $79.40 $125.76 $158.79 $127.03 $103.21 $158.79 $158.79 $92.22 $158.79 $95.27 $158.79 $158.79 $158.79 N/A N/A 41793 ERX HCPCS 25000001 24201-0201-05 SODIUM TETRADECYL SULFATE 3 % IV SOLN BOTH IP/OP $92.00 $68.00 $16.37 $91.94 $91.94 $91.94 $91.94 $91.94 $91.94 $91.94 $16.37 $91.94 $91.94 $68.24 $68.24 $70.87 $47.90 $19.16 $91.94 $36.78 $91.94 $91.94 $91.94 $91.94 $91.94 $69.00 $91.94 $91.94 $91.94 $45.97 $45.97 $72.82 $91.94 $73.55 $59.76 $91.94 $91.94 $53.36 $91.94 $55.16 $91.94 $91.94 $91.94 N/A N/A 41828 ERX HCPCS 25000001 78206-0114-04 MOMETASONE FUROATE 220 MCG/ACT IN AEPB BOTH IP/OP $728.50 $539.00 $129.62 $728.19 $728.19 $728.19 $728.19 $728.19 $728.19 $728.19 $129.62 $728.19 $728.19 $540.46 $540.46 $561.29 $379.39 $151.76 $728.19 $291.28 $728.19 $728.19 $728.19 $728.19 $728.19 $546.38 $728.19 $728.19 $728.19 $364.10 $364.10 $576.73 $728.19 $582.55 $473.32 $728.19 $728.19 $422.53 $728.19 $436.91 $728.19 $728.19 $728.19 504.48 236.18 41832 ERX HCPCS 63700001 00093-5517-98 SILDENAFIL CITRATE 20 MG PO TABS BOTH IP/OP $88.00 $65.00 $18.29 $87.76 $87.76 $87.76 $87.76 $87.76 $87.76 $87.76 $87.76 $87.76 $87.76 $87.76 $87.76 $87.76 $87.76 $18.29 $87.76 $35.10 $87.76 $87.76 $87.76 $87.76 $87.76 $66.00 $87.76 $87.76 $87.76 $43.88 $43.88 $69.51 $87.76 $70.21 $57.04 $87.76 $87.76 $51.04 $87.76 $52.66 $87.76 $87.76 $87.76 N/A N/A 41938 ERX HCPCS 63700001 00054-4538-25 METHADONE HCL 40 MG PO TBSO BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 42064 ERX HCPCS 63700001 64764-0805-30 RAMELTEON 8 MG PO TABS BOTH IP/OP $67.50 $50.00 $14.01 $67.23 $67.23 $67.23 $67.23 $67.23 $67.23 $67.23 $67.23 $67.23 $67.23 $67.23 $67.23 $67.23 $67.23 $14.01 $67.23 $26.89 $67.23 $67.23 $67.23 $67.23 $67.23 $50.63 $67.23 $67.23 $67.23 $33.62 $33.62 $53.25 $67.23 $53.78 $43.70 $67.23 $67.23 $39.15 $67.23 $40.34 $67.23 $67.23 $67.23 N/A N/A 42162 ERX HCPCS 63700001 00071-1012-68 PREGABALIN 25 MG PO CAPS BOTH IP/OP $50.00 $37.00 $10.41 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $10.41 $49.97 $19.99 $49.97 $49.97 $49.97 $49.97 $49.97 $37.50 $49.97 $49.97 $49.97 $24.99 $24.99 $39.58 $49.97 $39.98 $32.48 $49.97 $49.97 $29.00 $49.97 $29.98 $49.97 $49.97 $49.97 N/A N/A 42163 ERX HCPCS 63700001 76282-0569-90 PREGABALIN 50 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 42164 ERX HCPCS 63700001 76282-0570-90 PREGABALIN 75 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 42165 ERX HCPCS 63700006 00071-1015-41 PREGABALIN 100 MG PO CAPS BOTH IP/OP $55.00 $41.00 $11.45 $54.96 $54.96 $54.96 $54.96 $54.96 $54.96 $54.96 $54.96 $54.96 $54.96 $54.96 $54.96 $54.96 $54.96 $11.45 $54.96 $21.98 $54.96 $54.96 $54.96 $54.96 $54.96 $41.25 $54.96 $54.96 $54.96 $27.48 $27.48 $43.53 $54.96 $43.97 $35.72 $54.96 $54.96 $31.90 $54.96 $32.98 $54.96 $54.96 $54.96 N/A N/A 42166 ERX HCPCS 63700001 43598-0295-66 PREGABALIN 150 MG PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 42167 ERX HCPCS 63700001 00071-1017-68 PREGABALIN 200 MG PO CAPS BOTH IP/OP $50.00 $37.00 $10.41 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $10.41 $49.97 $19.99 $49.97 $49.97 $49.97 $49.97 $49.97 $37.50 $49.97 $49.97 $49.97 $24.99 $24.99 $39.58 $49.97 $39.98 $32.48 $49.97 $49.97 $29.00 $49.97 $29.98 $49.97 $49.97 $49.97 N/A N/A 42168 ERX HCPCS 63700001 62332-0125-90 PREGABALIN 225 MG PO CAPS BOTH IP/OP $25.50 $19.00 $5.27 $25.29 $25.29 $25.29 $25.29 $25.29 $25.29 $25.29 $25.29 $25.29 $25.29 $25.29 $25.29 $25.29 $25.29 $5.27 $25.29 $10.12 $25.29 $25.29 $25.29 $25.29 $25.29 $19.13 $25.29 $25.29 $25.29 $12.65 $12.65 $20.03 $25.29 $20.23 $16.44 $25.29 $25.29 $14.79 $25.29 $15.17 $25.29 $25.29 $25.29 N/A N/A 42169 ERX HCPCS 63700006 00071-1018-68 PREGABALIN 300 MG PO CAPS BOTH IP/OP $50.00 $37.00 $10.41 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $49.97 $10.41 $49.97 $19.99 $49.97 $49.97 $49.97 $49.97 $49.97 $37.50 $49.97 $49.97 $49.97 $24.99 $24.99 $39.58 $49.97 $39.98 $32.48 $49.97 $49.97 $29.00 $49.97 $29.98 $49.97 $49.97 $49.97 N/A N/A 42219 ERX HCPCS 63700001 70677-0054-01 LOPERAMIDE HCL 1 MG/7.5ML PO LIQD BOTH IP/OP $18.00 $13.00 $3.67 $17.63 $17.63 $17.63 $17.63 $17.63 $17.63 $17.63 $17.63 $17.63 $17.63 $17.63 $17.63 $17.63 $17.63 $3.67 $17.63 $7.05 $17.63 $17.63 $17.63 $17.63 $17.63 $13.50 $17.63 $17.63 $17.63 $8.82 $8.82 $13.96 $17.63 $14.10 $11.46 $17.63 $17.63 $10.44 $17.63 $10.58 $17.63 $17.63 $17.63 N/A N/A 42918 ERX HCPCS 63700001 99999-6005-12 ZIDOVUDINE 50 MG/5ML PO SYRP BOTH IP/OP $115.50 $85.00 $23.99 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $23.99 $115.11 $46.04 $115.11 $115.11 $115.11 $115.11 $115.11 $86.63 $115.11 $115.11 $115.11 $57.56 $57.56 $91.17 $115.11 $92.09 $74.82 $115.11 $115.11 $66.99 $115.11 $69.07 $115.11 $115.11 $115.11 N/A N/A 42918 ERX HCPCS 63700001 65862-0048-24 ZIDOVUDINE 50 MG/5ML PO SYRP BOTH IP/OP $202.00 $149.00 $23.99 $151.50 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $115.11 $23.99 $115.11 $46.04 $115.11 $115.11 $115.11 $115.11 $115.11 $151.50 $115.11 $115.11 $115.11 $57.56 $57.56 $91.17 $115.11 $92.09 $74.82 $115.11 $115.11 $117.16 $115.11 $69.07 $115.11 $115.11 $115.11 N/A N/A 42939 ERX HCPCS 25000001 65628-0063-01 PROGESTERONE 200 MG VA SUPP BOTH IP/OP $32.50 $24.00 $5.75 $32.32 $32.32 $32.32 $32.32 $32.32 $32.32 $32.32 $5.75 $32.32 $32.32 $23.99 $23.99 $24.91 $16.84 $6.74 $32.32 $12.93 $32.32 $32.32 $32.32 $32.32 $32.32 $24.38 $32.32 $32.32 $32.32 $16.16 $16.16 $25.60 $32.32 $25.86 $21.01 $32.32 $32.32 $18.85 $32.32 $19.39 $32.32 $32.32 $32.32 N/A N/A 43010 ERX HCPCS 63700001 00904-5313-60 PRENATAL 27-0.8 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 43230 ERX HCPCS 63700001 13668-0117-30 LOSARTAN-HCTZ 100-12.5 MG PO TABS BOTH IP/OP $15.00 $11.00 $3.07 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $14.73 $3.07 $14.73 $5.89 $14.73 $14.73 $14.73 $14.73 $14.73 $11.25 $14.73 $14.73 $14.73 $7.37 $7.37 $11.67 $14.73 $11.78 $9.57 $14.73 $14.73 $8.70 $14.73 $8.84 $14.73 $14.73 $14.73 N/A N/A 43391 ERX HCPCS 63700001 00074-6799-22 KALETRA:LOPINAVIR-RITONAVIR 200-50 MG PO TABS BOTH IP/OP $82.00 $61.00 $16.99 $81.52 $81.52 $81.52 $81.52 $81.52 $81.52 $81.52 $81.52 $81.52 $81.52 $81.52 $81.52 $81.52 $81.52 $16.99 $81.52 $32.61 $81.52 $81.52 $81.52 $81.52 $81.52 $61.50 $81.52 $81.52 $81.52 $40.76 $40.76 $64.56 $81.52 $65.22 $52.99 $81.52 $81.52 $47.56 $81.52 $48.91 $81.52 $81.52 $81.52 N/A N/A 43416 ERX HCPCS 63700001 00078-0469-15 DEFERASIROX 250 MG PO TBSO BOTH IP/OP $406.00 $300.00 $84.58 $405.81 $405.81 $405.81 $405.81 $405.81 $405.81 $405.81 $405.81 $405.81 $405.81 $405.81 $405.81 $405.81 $405.81 $84.58 $405.81 $162.32 $405.81 $405.81 $405.81 $405.81 $405.81 $304.50 $405.81 $405.81 $405.81 $202.91 $202.91 $321.40 $405.81 $324.65 $263.78 $405.81 $405.81 $235.48 $405.81 $243.49 $405.81 $405.81 $405.81 N/A N/A 43417 ERX HCPCS 63700001 00078-0470-15 DEFERASIROX 500 MG PO TBSO BOTH IP/OP $706.50 $523.00 $147.21 $706.36 $706.36 $706.36 $706.36 $706.36 $706.36 $706.36 $706.36 $706.36 $706.36 $706.36 $706.36 $706.36 $706.36 $147.21 $706.36 $282.54 $706.36 $706.36 $706.36 $706.36 $706.36 $529.88 $706.36 $706.36 $706.36 $353.18 $353.18 $559.44 $706.36 $565.09 $459.13 $706.36 $706.36 $409.77 $706.36 $423.82 $706.36 $706.36 $706.36 N/A N/A 43472 ERX HCPCS 25000001 63402-0510-01 LEVALBUTEROL TARTRATE 45 MCG/ACT IN AERO BOTH IP/OP $293.50 $217.00 $52.18 $293.15 $293.15 $293.15 $293.15 $293.15 $293.15 $293.15 $52.18 $293.15 $293.15 $217.58 $217.58 $225.96 $152.73 $61.10 $293.15 $117.26 $293.15 $293.15 $293.15 $293.15 $293.15 $220.13 $293.15 $293.15 $293.15 $146.58 $146.58 $232.17 $293.15 $234.52 $190.55 $293.15 $293.15 $170.23 $293.15 $175.89 $293.15 $293.15 $293.15 N/A N/A 43548 ERX HCPCS 63700001 54092-0254-10 LANTHANUM CARBONATE 1000 MG PO CHEW BOTH IP/OP $62.50 $46.00 $12.97 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $62.25 $12.97 $62.25 $24.90 $62.25 $62.25 $62.25 $62.25 $62.25 $46.88 $62.25 $62.25 $62.25 $31.13 $31.13 $49.30 $62.25 $49.80 $40.46 $62.25 $62.25 $36.25 $62.25 $37.35 $62.25 $62.25 $62.25 N/A N/A 43556 ERX HCPCS 63700001 00054-0057-46 DIGOXIN 0.05 MG/ML PO SOLN BOTH IP/OP $583.00 $431.00 $121.50 $582.96 $582.96 $582.96 $582.96 $582.96 $582.96 $582.96 $582.96 $582.96 $582.96 $582.96 $582.96 $582.96 $582.96 $121.50 $582.96 $233.18 $582.96 $582.96 $582.96 $582.96 $582.96 $437.25 $582.96 $582.96 $582.96 $291.48 $291.48 $461.70 $582.96 $466.37 $378.92 $582.96 $582.96 $338.14 $582.96 $349.78 $582.96 $582.96 $582.96 N/A N/A 43675 ERX HCPCS 63700001 50419-0488-58 SORAFENIB TOSYLATE 200 MG PO TABS BOTH IP/OP "$1,454.00" "$1,076.00" $302.99 "$1,453.81" "$1,453.81" "$1,453.81" "$1,453.81" "$1,453.81" "$1,453.81" "$1,453.81" "$1,453.81" "$1,453.81" "$1,453.81" "$1,453.81" "$1,453.81" "$1,453.81" "$1,453.81" $302.99 "$1,453.81" $581.52 "$1,453.81" "$1,453.81" "$1,453.81" "$1,453.81" "$1,453.81" "$1,090.50" "$1,453.81" "$1,453.81" "$1,453.81" $726.91 $726.91 "$1,151.42" "$1,453.81" "$1,163.05" $944.98 "$1,453.81" "$1,453.81" $843.32 "$1,453.81" $872.29 "$1,453.81" "$1,453.81" "$1,453.81" N/A N/A 43718 ERX HCPCS 63700001 59572-0405-28 LENALIDOMIDE 5 MG PO CAPS BOTH IP/OP "$2,670.00" "$1,976.00" $556.39 "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" $556.39 "$2,669.66" "$1,067.86" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,002.50" "$2,669.66" "$2,669.66" "$2,669.66" "$1,334.83" "$1,334.83" "$2,114.37" "$2,669.66" "$2,135.73" "$1,735.28" "$2,669.66" "$2,669.66" "$1,548.60" "$2,669.66" "$1,601.80" "$2,669.66" "$2,669.66" "$2,669.66" N/A N/A 43719 ERX HCPCS 63700001 59572-0410-28 LENALIDOMIDE 10 MG PO CAPS BOTH IP/OP "$2,670.00" "$1,976.00" $556.39 "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" $556.39 "$2,669.66" "$1,067.86" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,002.50" "$2,669.66" "$2,669.66" "$2,669.66" "$1,334.83" "$1,334.83" "$2,114.37" "$2,669.66" "$2,135.73" "$1,735.28" "$2,669.66" "$2,669.66" "$1,548.60" "$2,669.66" "$1,601.80" "$2,669.66" "$2,669.66" "$2,669.66" N/A N/A 70257 ERX HCPCS 63700001 49884-0402-91 RISPERIDONE 3 MG PO TBDP BOTH IP/OP $51.00 $38.00 $10.61 $50.90 $50.90 $50.90 $50.90 $50.90 $50.90 $50.90 $50.90 $50.90 $50.90 $50.90 $50.90 $50.90 $50.90 $10.61 $50.90 $20.36 $50.90 $50.90 $50.90 $50.90 $50.90 $38.25 $50.90 $50.90 $50.90 $25.45 $25.45 $40.31 $50.90 $40.72 $33.09 $50.90 $50.90 $29.58 $50.90 $30.54 $50.90 $50.90 $50.90 N/A N/A 70261 ERX HCPCS J1815 00169-3687-12 INSULIN DETEMIR (LEVEMIR) 100 UNIT/ML SC SOLN BOTH IP/OP $15.00 $11.00 $2.98 $201.38 $8.15 $8.15 $8.15 $8.15 $15.00 $15.00 $15.00 $3.13 $15.00 $15.00 $15.00 $15.00 $15.00 $3.13 $15.00 $15.00 $8.87 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $2.98 $15.00 $8.70 $15.00 $15.00 $15.00 $201.38 $15.00 N/A N/A 70284 ERX HCPCS 63700001 60258-0006-01 K & NA PHOSPHATES 280-160-250 MG PO PACK BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 70397 ERX HCPCS 63700001 50268-0631-15 QUETIAPINE FUMARATE 50 MG PO TABS BOTH IP/OP $27.00 $20.00 $5.57 $26.74 $26.74 $26.74 $26.74 $26.74 $26.74 $26.74 $26.74 $26.74 $26.74 $26.74 $26.74 $26.74 $26.74 $5.57 $26.74 $10.70 $26.74 $26.74 $26.74 $26.74 $26.74 $20.25 $26.74 $26.74 $26.74 $13.37 $13.37 $21.18 $26.74 $21.39 $17.38 $26.74 $26.74 $15.66 $26.74 $16.04 $26.74 $26.74 $26.74 N/A N/A 70398 ERX HCPCS 63700001 16714-0457-01 QUETIAPINE FUMARATE 400 MG PO TABS BOTH IP/OP $86.00 $64.00 $17.88 $85.80 $85.80 $85.80 $85.80 $85.80 $85.80 $85.80 $85.80 $85.80 $85.80 $85.80 $85.80 $85.80 $85.80 $17.88 $85.80 $34.32 $85.80 $85.80 $85.80 $85.80 $85.80 $64.50 $85.80 $85.80 $85.80 $42.90 $42.90 $67.95 $85.80 $68.64 $55.77 $85.80 $85.80 $49.88 $85.80 $51.48 $85.80 $85.80 $85.80 N/A N/A 70405 ERX HCPCS J7187 63833-0616-02 ANTIHEMOPHILIC FACTOR-VWF 500-1200 UNITS IV SOLR BOTH IP/OP $22.00 $16.00 $1.26 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $1.26 $22.00 $22.00 $1.31 $1.31 $1.36 $1.26 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 70424 ERX HCPCS 63700001 00069-0550-38 SUNITINIB MALATE 12.5 MG PO CAPS BOTH IP/OP $811.50 $601.00 $169.09 $811.31 $811.31 $811.31 $811.31 $811.31 $811.31 $811.31 $811.31 $811.31 $811.31 $811.31 $811.31 $811.31 $811.31 $169.09 $811.31 $324.52 $811.31 $811.31 $811.31 $811.31 $811.31 $608.63 $811.31 $811.31 $811.31 $405.66 $405.66 $642.56 $811.31 $649.05 $527.35 $811.31 $811.31 $470.67 $811.31 $486.79 $811.31 $811.31 $811.31 N/A N/A 70425 ERX HCPCS 63700001 00069-0770-38 SUNITINIB MALATE 25 MG PO CAPS BOTH IP/OP "$1,435.00" "$1,062.00" $298.98 "$1,434.57" "$1,434.57" "$1,434.57" "$1,434.57" "$1,434.57" "$1,434.57" "$1,434.57" "$1,434.57" "$1,434.57" "$1,434.57" "$1,434.57" "$1,434.57" "$1,434.57" "$1,434.57" $298.98 "$1,434.57" $573.83 "$1,434.57" "$1,434.57" "$1,434.57" "$1,434.57" "$1,434.57" "$1,076.25" "$1,434.57" "$1,434.57" "$1,434.57" $717.29 $717.29 "$1,136.18" "$1,434.57" "$1,147.66" $932.47 "$1,434.57" "$1,434.57" $832.30 "$1,434.57" $860.74 "$1,434.57" "$1,434.57" "$1,434.57" N/A N/A 70426 ERX HCPCS 63700001 00069-0980-38 SUNITINIB MALATE 50 MG PO CAPS BOTH IP/OP "$2,497.50" "$1,848.00" $520.48 "$2,497.38" "$2,497.38" "$2,497.38" "$2,497.38" "$2,497.38" "$2,497.38" "$2,497.38" "$2,497.38" "$2,497.38" "$2,497.38" "$2,497.38" "$2,497.38" "$2,497.38" "$2,497.38" $520.48 "$2,497.38" $998.95 "$2,497.38" "$2,497.38" "$2,497.38" "$2,497.38" "$2,497.38" "$1,873.13" "$2,497.38" "$2,497.38" "$2,497.38" "$1,248.69" "$1,248.69" "$1,977.92" "$2,497.38" "$1,997.90" "$1,623.30" "$2,497.38" "$2,497.38" "$1,448.55" "$2,497.38" "$1,498.43" "$2,497.38" "$2,497.38" "$2,497.38" N/A N/A 70472 ERX HCPCS 63700001 64764-0240-60 LUBIPROSTONE 24 MCG PO CAPS BOTH IP/OP $32.50 $24.00 $6.68 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $6.68 $32.07 $12.83 $32.07 $32.07 $32.07 $32.07 $32.07 $24.38 $32.07 $32.07 $32.07 $16.04 $16.04 $25.40 $32.07 $25.66 $20.85 $32.07 $32.07 $18.85 $32.07 $19.24 $32.07 $32.07 $32.07 N/A N/A 70545 ERX HCPCS 25000001 42023-0105-01 METHOHEXITAL SODIUM 0.5 G IJ SOLR BOTH IP/OP $358.00 $265.00 $63.68 $357.76 $357.76 $357.76 $357.76 $357.76 $357.76 $357.76 $63.68 $357.76 $357.76 $265.53 $265.53 $275.76 $186.39 $74.56 $357.76 $143.10 $357.76 $357.76 $357.76 $357.76 $357.76 $268.50 $357.76 $357.76 $357.76 $178.88 $178.88 $283.35 $357.76 $286.21 $232.54 $357.76 $357.76 $207.64 $357.76 $214.66 $357.76 $357.76 $357.76 209 209 70678 ERX HCPCS 25000001 39822-1201-02 NEOMYCIN-POLYMYXIN B GU 40-200000 IR SOLN BOTH IP/OP $163.50 $121.00 $29.02 $163.06 $163.06 $163.06 $163.06 $163.06 $163.06 $163.06 $29.02 $163.06 $163.06 $121.02 $121.02 $125.69 $84.95 $33.98 $163.06 $65.22 $163.06 $163.06 $163.06 $163.06 $163.06 $122.63 $163.06 $163.06 $163.06 $81.53 $81.53 $129.14 $163.06 $130.45 $105.99 $163.06 $163.06 $94.83 $163.06 $97.84 $163.06 $163.06 $163.06 N/A N/A 70693 ERX HCPCS 25000001 00002-7511-01 HUMALOG MIX 75-25 VIAL BOTH IP/OP "$1,032.00" $764.00 $183.65 "$1,031.76" "$1,031.76" "$1,031.76" "$1,031.76" "$1,031.76" "$1,031.76" "$1,031.76" $183.65 "$1,031.76" "$1,031.76" $765.77 $765.77 $795.28 $537.55 $215.03 "$1,031.76" $412.70 "$1,031.76" "$1,031.76" "$1,031.76" "$1,031.76" "$1,031.76" $774.00 "$1,031.76" "$1,031.76" "$1,031.76" $515.88 $515.88 $817.15 "$1,031.76" $825.41 $670.64 "$1,031.76" "$1,031.76" $598.56 "$1,031.76" $619.06 "$1,031.76" "$1,031.76" "$1,031.76" N/A N/A 70784 ERX HCPCS 63700001 50419-0405-03 DROSPIRENONE-ETHINYL ESTRADIOL 3-0.02 MG PO TABS BOTH IP/OP $621.50 $460.00 $129.43 $621.01 $621.01 $621.01 $621.01 $621.01 $621.01 $621.01 $621.01 $621.01 $621.01 $621.01 $621.01 $621.01 $621.01 $129.43 $621.01 $248.40 $621.01 $621.01 $621.01 $621.01 $621.01 $466.13 $621.01 $621.01 $621.01 $310.51 $310.51 $491.84 $621.01 $496.81 $403.66 $621.01 $621.01 $360.47 $621.01 $372.61 $621.01 $621.01 $621.01 N/A N/A 76396 ERX HCPCS 25000001 68968-5555-03 METHYLPHENIDATE 30 MG/9HR TD PTCH BOTH IP/OP $80.50 $60.00 $14.24 $80.01 $80.01 $80.01 $80.01 $80.01 $80.01 $80.01 $14.24 $80.01 $80.01 $59.38 $59.38 $61.67 $41.69 $16.67 $80.01 $32.00 $80.01 $80.01 $80.01 $80.01 $80.01 $60.38 $80.01 $80.01 $80.01 $40.01 $40.01 $63.37 $80.01 $64.01 $52.01 $80.01 $80.01 $46.69 $80.01 $48.01 $80.01 $80.01 $80.01 N/A N/A 76437 ERX HCPCS 63700001 55111-0587-01 AMLODIPINE-BENAZEPRIL 5-40 MG PO CAPSULE BOTH IP/OP $17.50 $13.00 $3.61 $17.32 $17.32 $17.32 $17.32 $17.32 $17.32 $17.32 $17.32 $17.32 $17.32 $17.32 $17.32 $17.32 $17.32 $3.61 $17.32 $6.93 $17.32 $17.32 $17.32 $17.32 $17.32 $13.13 $17.32 $17.32 $17.32 $8.66 $8.66 $13.72 $17.32 $13.86 $11.26 $17.32 $17.32 $10.15 $17.32 $10.39 $17.32 $17.32 $17.32 N/A N/A 76438 ERX HCPCS 63700001 55111-0586-01 AMLODIPINE-BENAZEPRIL HCL 10-40 MG PO CAPS BOTH IP/OP $21.00 $16.00 $4.36 $20.92 $20.92 $20.92 $20.92 $20.92 $20.92 $20.92 $20.92 $20.92 $20.92 $20.92 $20.92 $20.92 $20.92 $4.36 $20.92 $8.37 $20.92 $20.92 $20.92 $20.92 $20.92 $15.75 $20.92 $20.92 $20.92 $10.46 $10.46 $16.57 $20.92 $16.74 $13.60 $20.92 $20.92 $12.18 $20.92 $12.55 $20.92 $20.92 $20.92 N/A N/A 76480 ERX HCPCS 25000001 67877-0259-30 RASAGILINE MESYLATE 0.5 MG PO TABS BOTH IP/OP $99.50 $74.00 $17.70 $99.44 $99.44 $99.44 $99.44 $99.44 $99.44 $99.44 $17.70 $99.44 $99.44 $73.80 $73.80 $76.65 $51.81 $20.72 $99.44 $39.78 $99.44 $99.44 $99.44 $99.44 $99.44 $74.63 $99.44 $99.44 $99.44 $49.72 $49.72 $78.76 $99.44 $79.55 $64.64 $99.44 $99.44 $57.71 $99.44 $59.66 $99.44 $99.44 $99.44 N/A N/A 76481 ERX HCPCS 25000001 42571-0221-30 RASAGILINE MESYLATE 1 MG PO TABS BOTH IP/OP $99.50 $74.00 $17.71 $99.50 $99.50 $99.50 $99.50 $99.50 $99.50 $99.50 $17.71 $99.50 $99.50 $73.85 $73.85 $76.69 $51.84 $20.74 $99.50 $39.80 $99.50 $99.50 $99.50 $99.50 $99.50 $74.63 $99.50 $99.50 $99.50 $49.75 $49.75 $78.80 $99.50 $79.60 $64.68 $99.50 $99.50 $57.71 $99.50 $59.70 $99.50 $99.50 $99.50 N/A N/A 76618 ERX HCPCS 25000001 00065-0356-10 OPTI-FREE REPLENISH SOLN BOTH IP/OP $41.50 $31.00 $7.38 $41.48 $41.48 $41.48 $41.48 $41.48 $41.48 $41.48 $7.38 $41.48 $41.48 $30.79 $30.79 $31.97 $21.61 $8.64 $41.48 $16.59 $41.48 $41.48 $41.48 $41.48 $41.48 $31.13 $41.48 $41.48 $41.48 $20.74 $20.74 $32.85 $41.48 $33.18 $26.96 $41.48 $41.48 $24.07 $41.48 $24.89 $41.48 $41.48 $41.48 N/A N/A 76641 ERX HCPCS 25000001 24208-0539-20 ACETYLCHOLINE CHLORIDE 20 MG IO SOLR BOTH IP/OP $505.50 $374.00 $89.95 $505.34 $505.34 $505.34 $505.34 $505.34 $505.34 $505.34 $89.95 $505.34 $505.34 $375.06 $375.06 $389.52 $263.28 $105.32 $505.34 $202.14 $505.34 $505.34 $505.34 $505.34 $505.34 $379.13 $505.34 $505.34 $505.34 $252.67 $252.67 $400.23 $505.34 $404.27 $328.47 $505.34 $505.34 $293.19 $505.34 $303.20 $505.34 $505.34 $505.34 111 111 76717 ERX HCPCS 63700001 00003-0527-11 DASATINIB 20 MG PO TABS BOTH IP/OP "$1,990.50" "$1,473.00" $414.80 "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" $414.80 "$1,990.28" $796.11 "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,492.88" "$1,990.28" "$1,990.28" "$1,990.28" $995.14 $995.14 "$1,576.30" "$1,990.28" "$1,592.22" "$1,293.68" "$1,990.28" "$1,990.28" "$1,154.49" "$1,990.28" "$1,194.17" "$1,990.28" "$1,990.28" "$1,990.28" N/A N/A 76718 ERX HCPCS 63700001 00003-0528-11 DASATINIB 50 MG PO TABS BOTH IP/OP "$1,990.50" "$1,473.00" $414.80 "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" $414.80 "$1,990.28" $796.11 "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,990.28" "$1,492.88" "$1,990.28" "$1,990.28" "$1,990.28" $995.14 $995.14 "$1,576.30" "$1,990.28" "$1,592.22" "$1,293.68" "$1,990.28" "$1,990.28" "$1,154.49" "$1,990.28" "$1,194.17" "$1,990.28" "$1,990.28" "$1,990.28" N/A N/A 76719 ERX HCPCS 63700001 00003-0524-11 DASATINIB 70 MG PO TABS BOTH IP/OP "$1,126.00" $833.00 $234.59 "$1,125.59" "$1,125.59" "$1,125.59" "$1,125.59" "$1,125.59" "$1,125.59" "$1,125.59" "$1,125.59" "$1,125.59" "$1,125.59" "$1,125.59" "$1,125.59" "$1,125.59" "$1,125.59" $234.59 "$1,125.59" $450.24 "$1,125.59" "$1,125.59" "$1,125.59" "$1,125.59" "$1,125.59" $844.50 "$1,125.59" "$1,125.59" "$1,125.59" $562.80 $562.80 $891.47 "$1,125.59" $900.47 $731.63 "$1,125.59" "$1,125.59" $653.08 "$1,125.59" $675.35 "$1,125.59" "$1,125.59" "$1,125.59" N/A N/A 76780 ERX HCPCS 25000001 66993-0490-36 IBUPROFEN LYSINE 10 MG/ML IV SOLN BOTH IP/OP "$1,462.00" "$1,082.00" $260.20 "$1,461.79" "$1,461.79" "$1,461.79" "$1,461.79" "$1,461.79" "$1,461.79" "$1,461.79" $260.20 "$1,461.79" "$1,461.79" "$1,084.94" "$1,084.94" "$1,126.75" $761.59 $304.65 "$1,461.79" $584.72 "$1,461.79" "$1,461.79" "$1,461.79" "$1,461.79" "$1,461.79" "$1,096.50" "$1,461.79" "$1,461.79" "$1,461.79" $730.90 $730.90 "$1,157.74" "$1,461.79" "$1,169.43" $950.16 "$1,461.79" "$1,461.79" $847.96 "$1,461.79" $877.07 "$1,461.79" "$1,461.79" "$1,461.79" N/A N/A 76783 ERX HCPCS 63700001 59572-0415-21 LENALIDOMIDE 15 MG PO CAPS BOTH IP/OP "$2,670.00" "$1,976.00" $556.39 "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" $556.39 "$2,669.66" "$1,067.86" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,002.50" "$2,669.66" "$2,669.66" "$2,669.66" "$1,334.83" "$1,334.83" "$2,114.37" "$2,669.66" "$2,135.73" "$1,735.28" "$2,669.66" "$2,669.66" "$1,548.60" "$2,669.66" "$1,601.80" "$2,669.66" "$2,669.66" "$2,669.66" N/A N/A 76784 ERX HCPCS 63700001 59572-0425-21 LENALIDOMIDE 25 MG PO CAPS BOTH IP/OP "$2,670.00" "$1,976.00" $556.39 "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" $556.39 "$2,669.66" "$1,067.86" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,002.50" "$2,669.66" "$2,669.66" "$2,669.66" "$1,334.83" "$1,334.83" "$2,114.37" "$2,669.66" "$2,135.73" "$1,735.28" "$2,669.66" "$2,669.66" "$1,548.60" "$2,669.66" "$1,601.80" "$2,669.66" "$2,669.66" "$2,669.66" N/A N/A 76829 ERX HCPCS 63700001 00121-1744-05 GUAIFENESIN 100 MG/5ML PO LIQD BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 76913 ERX HCPCS 25000001 66689-0047-50 KCL 20 MEQ/15ML (10%) PO SOLN BOTH IP/OP $101.50 $75.00 $17.98 $101.02 $101.02 $101.02 $101.02 $101.02 $101.02 $101.02 $17.98 $101.02 $101.02 $74.98 $74.98 $77.87 $52.63 $21.05 $101.02 $40.41 $101.02 $101.02 $101.02 $101.02 $101.02 $76.13 $101.02 $101.02 $101.02 $50.51 $50.51 $80.01 $101.02 $80.82 $65.66 $101.02 $101.02 $58.87 $101.02 $60.61 $101.02 $101.02 $101.02 N/A N/A 76974 ERX HCPCS 25000001 00713-0102-06 GLYCERIN (LAXATIVE) 1.2 G RECTAL SUPP BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 77006 ERX HCPCS J2270 99999-6011-51 MORPHINE SULFATE PCA 5 MG/ML IV SOLN BOTH IP/OP $313.50 $232.00 $15.85 $313.25 $140.96 $140.96 $140.96 $140.96 $313.25 $313.25 $313.25 $65.29 $313.25 $16.48 $16.48 $17.12 $15.85 $18.62 $313.25 $313.25 $185.29 $313.25 $313.25 $313.25 $313.25 $235.13 $313.25 $313.25 $313.25 $156.63 $156.63 $248.09 $313.25 $250.60 $140.96 $17.73 $313.25 $181.83 $313.25 $313.25 $313.25 $17.73 $313.25 N/A N/A 77174 ERX HCPCS 25000001 00173-0716-20 FLUTICASONE-SALMETEROL 115-21 MCG/ACT IN AERO BOTH IP/OP "$1,470.50" "$1,088.00" $261.74 "$1,470.44" "$1,470.44" "$1,470.44" "$1,470.44" "$1,470.44" "$1,470.44" "$1,470.44" $261.74 "$1,470.44" "$1,470.44" "$1,091.36" "$1,091.36" "$1,133.42" $766.10 $306.46 "$1,470.44" $588.18 "$1,470.44" "$1,470.44" "$1,470.44" "$1,470.44" "$1,470.44" "$1,102.88" "$1,470.44" "$1,470.44" "$1,470.44" $735.22 $735.22 "$1,164.59" "$1,470.44" "$1,176.35" $955.79 "$1,470.44" "$1,470.44" $852.89 "$1,470.44" $882.26 "$1,470.44" "$1,470.44" "$1,470.44" N/A N/A 77195 ERX HCPCS J1953 55150-0177-05 LEVETIRACETAM 500 MG/5ML IV SOLN BOTH IP/OP $32.50 $24.00 $2.25 $32.40 $32.40 $32.40 $32.40 $32.40 $32.40 $32.40 $2.25 $32.40 $32.40 $2.34 $2.34 $2.43 $2.25 $6.75 $32.40 $12.96 $32.40 $32.40 $32.40 $32.40 $32.40 $24.38 $32.40 $32.40 $32.40 $16.20 $16.20 $25.66 $32.40 $25.92 $14.58 $32.40 $32.40 $18.85 $32.40 $19.44 $32.40 $32.40 $32.40 N/A N/A 77318 ERX HCPCS J1250 00409-2344-02 DOBUTAMINE HCL 250 MG/20ML IV SOLN BOTH IP/OP $34.00 $25.00 $6.58 $33.61 $15.12 $15.12 $15.12 $15.12 $33.61 $33.61 $33.61 $6.58 $33.61 $7.07 $7.07 $7.34 $6.80 $7.99 $33.61 $33.61 $19.88 $33.61 $33.61 $33.61 $33.61 $25.50 $33.61 $33.61 $33.61 $16.81 $16.81 $26.62 $33.61 $26.89 $15.12 $7.61 $33.61 $19.72 $33.61 $33.61 $33.61 $7.61 $33.61 471 471 77371 ERX HCPCS 25000001 00085-1328-01 POSACONAZOLE 40 MG/ML PO SUSP BOTH IP/OP "$4,025.00" "$2,979.00" $716.45 "$4,024.99" "$4,024.99" "$4,024.99" "$4,024.99" "$4,024.99" "$4,024.99" "$4,024.99" $716.45 "$4,024.99" "$4,024.99" "$2,987.35" "$2,987.35" "$3,102.46" "$2,060.15" $838.85 "$4,024.99" "$1,610.00" "$4,024.99" "$4,024.99" "$4,024.99" "$4,024.99" "$4,024.99" "$3,018.75" "$4,024.99" "$4,024.99" "$4,024.99" "$2,012.50" "$2,012.50" "$3,187.79" "$4,024.99" "$3,219.99" "$2,616.24" "$4,024.99" "$4,024.99" "$2,334.50" "$4,024.99" "$2,414.99" "$4,024.99" "$4,024.99" "$4,024.99" 1635.83 2552.45 77411 ERX HCPCS 25000001 99999-6004-97 CAFFEINE CITRATE 20 MG/ML PO SOLN BOTH IP/OP "$1,463.00" "$1,083.00" $260.40 "$1,462.92" "$1,462.92" "$1,462.92" "$1,462.92" "$1,462.92" "$1,462.92" "$1,462.92" $260.40 "$1,462.92" "$1,462.92" "$1,085.78" "$1,085.78" "$1,127.62" $762.18 $304.89 "$1,462.92" $585.17 "$1,462.92" "$1,462.92" "$1,462.92" "$1,462.92" "$1,462.92" "$1,097.25" "$1,462.92" "$1,462.92" "$1,462.92" $731.46 $731.46 "$1,158.63" "$1,462.92" "$1,170.34" $950.90 "$1,462.92" "$1,462.92" $848.54 "$1,462.92" $877.75 "$1,462.92" "$1,462.92" "$1,462.92" N/A N/A 77539 ERX HCPCS 63700001 00006-0568-40 VORINOSTAT 100 MG PO CAPS BOTH IP/OP "$1,360.00" "$1,006.00" $283.41 "$1,359.87" "$1,359.87" "$1,359.87" "$1,359.87" "$1,359.87" "$1,359.87" "$1,359.87" "$1,359.87" "$1,359.87" "$1,359.87" "$1,359.87" "$1,359.87" "$1,359.87" "$1,359.87" $283.41 "$1,359.87" $543.95 "$1,359.87" "$1,359.87" "$1,359.87" "$1,359.87" "$1,359.87" "$1,020.00" "$1,359.87" "$1,359.87" "$1,359.87" $679.94 $679.94 "$1,077.02" "$1,359.87" "$1,087.90" $883.92 "$1,359.87" "$1,359.87" $788.80 "$1,359.87" $815.92 "$1,359.87" "$1,359.87" "$1,359.87" N/A N/A 77615 ERX HCPCS 63700001 00006-0221-28 SITAGLIPTIN PHOSPHATE 25 MG PO TABS BOTH IP/OP $87.50 $65.00 $18.16 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $18.16 $87.12 $34.85 $87.12 $87.12 $87.12 $87.12 $87.12 $65.63 $87.12 $87.12 $87.12 $43.56 $43.56 $69.00 $87.12 $69.70 $56.63 $87.12 $87.12 $50.75 $87.12 $52.27 $87.12 $87.12 $87.12 447 447 77616 ERX HCPCS 63700001 00006-0112-28 SITAGLIPTIN PHOSPHATE 50 MG PO TABS BOTH IP/OP $87.50 $65.00 $18.16 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $18.16 $87.12 $34.85 $87.12 $87.12 $87.12 $87.12 $87.12 $65.63 $87.12 $87.12 $87.12 $43.56 $43.56 $69.00 $87.12 $69.70 $56.63 $87.12 $87.12 $50.75 $87.12 $52.27 $87.12 $87.12 $87.12 N/A N/A 77617 ERX HCPCS 63700001 00006-0277-28 SITAGLIPTIN PHOSPHATE 100 MG PO TABS BOTH IP/OP $87.50 $65.00 $18.16 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $18.16 $87.12 $34.85 $87.12 $87.12 $87.12 $87.12 $87.12 $65.63 $87.12 $87.12 $87.12 $43.56 $43.56 $69.00 $87.12 $69.70 $56.63 $87.12 $87.12 $50.75 $87.12 $52.27 $87.12 $87.12 $87.12 N/A N/A 77648 ERX HCPCS 63700001 65862-0713-30 ATAZANAVIR SULFATE 300 MG PO CAPS BOTH IP/OP $197.50 $146.00 $41.09 $197.18 $197.18 $197.18 $197.18 $197.18 $197.18 $197.18 $197.18 $197.18 $197.18 $197.18 $197.18 $197.18 $197.18 $41.09 $197.18 $78.87 $197.18 $197.18 $197.18 $197.18 $197.18 $148.13 $197.18 $197.18 $197.18 $98.59 $98.59 $156.17 $197.18 $157.74 $128.17 $197.18 $197.18 $114.55 $197.18 $118.31 $197.18 $197.18 $197.18 N/A N/A 77685 ERX HCPCS J2248 25021-0191-10 MICAFUNGIN SODIUM 100 MG IV SOLR BOTH IP/OP $678.00 $502.00 $86.00 $677.69 $677.69 $677.69 $677.69 $677.69 $677.69 $677.69 $97.00 $677.69 $677.69 $89.44 $89.44 $92.88 $86.00 $101.04 $677.69 $271.08 $677.69 $677.69 $677.69 $677.69 $677.69 $508.50 $677.69 $677.69 $677.69 $338.85 $338.85 $536.73 $677.69 $542.15 $304.96 $677.69 $677.69 $393.24 $677.69 $406.61 $677.69 $677.69 $677.69 N/A N/A 77710 ERX HCPCS 25000001 00121-1576-10 METOCLOPRAMIDE HCL 10 MG/10ML PO SOLN BOTH IP/OP $9.50 $7.00 $1.63 $9.14 $9.14 $9.14 $9.14 $9.14 $9.14 $9.14 $1.63 $9.14 $9.14 $6.78 $6.78 $7.05 $4.76 $1.90 $9.14 $3.66 $9.14 $9.14 $9.14 $9.14 $9.14 $7.13 $9.14 $9.14 $9.14 $4.57 $4.57 $7.24 $9.14 $7.31 $5.94 $9.14 $9.14 $5.51 $9.14 $5.48 $9.14 $9.14 $9.14 N/A N/A 77822 ERX HCPCS 63700001 00173-0388-79 BECLOMETHASONE DIPROP MONOHYD 42 MCG/SPRAY NA SUSP BOTH IP/OP "$1,063.50" $787.00 $221.57 "$1,063.12" "$1,063.12" "$1,063.12" "$1,063.12" "$1,063.12" "$1,063.12" "$1,063.12" "$1,063.12" "$1,063.12" "$1,063.12" "$1,063.12" "$1,063.12" "$1,063.12" "$1,063.12" $221.57 "$1,063.12" $425.25 "$1,063.12" "$1,063.12" "$1,063.12" "$1,063.12" "$1,063.12" $797.63 "$1,063.12" "$1,063.12" "$1,063.12" $531.56 $531.56 $841.99 "$1,063.12" $850.50 $691.03 "$1,063.12" "$1,063.12" $616.83 "$1,063.12" $637.87 "$1,063.12" "$1,063.12" "$1,063.12" N/A N/A 78044 ERX HCPCS 25000001 63736-0008-85 DYCLONINE HCL 2 MG MT LOZG BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 78066 ERX HCPCS 63700001 00591-3695-30 PALIPERIDONE ER 9 MG PO TB24 BOTH IP/OP $183.00 $135.00 $38.07 $182.66 $182.66 $182.66 $182.66 $182.66 $182.66 $182.66 $182.66 $182.66 $182.66 $182.66 $182.66 $182.66 $182.66 $38.07 $182.66 $73.06 $182.66 $182.66 $182.66 $182.66 $182.66 $137.25 $182.66 $182.66 $182.66 $91.33 $91.33 $144.67 $182.66 $146.13 $118.73 $182.66 $182.66 $106.14 $182.66 $109.60 $182.66 $182.66 $182.66 N/A N/A 78420 ERX HCPCS J9025 59572-0102-01 AZACITIDINE 100 MG IJ SUSR BOTH IP/OP "$1,875.50" "$1,388.00" $89.00 "$1,875.12" "$1,875.12" "$1,875.12" "$1,875.12" "$1,875.12" "$1,875.12" "$1,875.12" $93.00 "$1,875.12" "$1,875.12" $92.56 $92.56 $96.12 $89.00 $104.56 "$1,875.12" $750.05 "$1,875.12" "$1,875.12" "$1,875.12" "$1,875.12" "$1,875.12" "$1,406.63" "$1,875.12" "$1,875.12" "$1,875.12" $937.56 $937.56 "$1,485.10" "$1,875.12" "$1,500.10" $843.80 "$1,875.12" "$1,875.12" "$1,087.79" "$1,875.12" "$1,125.07" "$1,875.12" "$1,875.12" "$1,875.12" N/A N/A 78615 ERX HCPCS 63700001 00186-4020-01 ESOMEPRAZOLE 20 MG PO PACK BOTH IP/OP $50.00 $37.00 $10.35 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $10.35 $49.65 $19.86 $49.65 $49.65 $49.65 $49.65 $49.65 $37.50 $49.65 $49.65 $49.65 $24.83 $24.83 $39.32 $49.65 $39.72 $32.27 $49.65 $49.65 $29.00 $49.65 $29.79 $49.65 $49.65 $49.65 N/A N/A 78616 ERX HCPCS 63700001 00186-4040-01 ESOMEPRAZOLE 40 MG PO PACK BOTH IP/OP $50.00 $37.00 $10.35 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $49.65 $10.35 $49.65 $19.86 $49.65 $49.65 $49.65 $49.65 $49.65 $37.50 $49.65 $49.65 $49.65 $24.83 $24.83 $39.32 $49.65 $39.72 $32.27 $49.65 $49.65 $29.00 $49.65 $29.79 $49.65 $49.65 $49.65 N/A N/A 78879 ERX HCPCS 63700001 00904-2533-21 CALAMINE 8-8 % EX LOTN BOTH IP/OP $11.00 $8.00 $2.29 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 79088 ERX HCPCS 63700001 00121-1775-05 GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 81453 ERX HCPCS 63700001 00186-0372-28 BUDESONIDE-FORMOTEROL FUMARATE 80-4.5 MCG/ACT IN AERO BOTH IP/OP $836.00 $619.00 $174.21 $835.90 $835.90 $835.90 $835.90 $835.90 $835.90 $835.90 $835.90 $835.90 $835.90 $835.90 $835.90 $835.90 $835.90 $174.21 $835.90 $334.36 $835.90 $835.90 $835.90 $835.90 $835.90 $627.00 $835.90 $835.90 $835.90 $417.95 $417.95 $662.03 $835.90 $668.72 $543.34 $835.90 $835.90 $484.88 $835.90 $501.54 $835.90 $835.90 $835.90 N/A N/A 81454 ERX HCPCS 63700001 00186-0370-28 BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO BOTH IP/OP $962.00 $712.00 $200.41 $961.60 $961.60 $961.60 $961.60 $961.60 $961.60 $961.60 $961.60 $961.60 $961.60 $961.60 $961.60 $961.60 $961.60 $200.41 $961.60 $384.64 $961.60 $961.60 $961.60 $961.60 $961.60 $721.50 $961.60 $961.60 $961.60 $480.80 $480.80 $761.59 $961.60 $769.28 $625.04 $961.60 $961.60 $557.96 $961.60 $576.96 $961.60 $961.60 $961.60 N/A N/A 81474 ERX HCPCS 63700001 59417-0103-10 LISDEXAMFETAMINE DIMESYLATE 30 MG PO CAPS BOTH IP/OP $64.00 $47.00 $13.30 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $13.30 $63.82 $25.53 $63.82 $63.82 $63.82 $63.82 $63.82 $48.00 $63.82 $63.82 $63.82 $31.91 $31.91 $50.55 $63.82 $51.06 $41.48 $63.82 $63.82 $37.12 $63.82 $38.29 $63.82 $63.82 $63.82 N/A N/A 81479 ERX HCPCS 63700001 58914-0601-20 BIS SUBCIT-METRONID-TETRACYC 140-125-125 MG PO CAPS BOTH IP/OP $110.50 $82.00 $22.93 $110.03 $110.03 $110.03 $110.03 $110.03 $110.03 $110.03 $110.03 $110.03 $110.03 $110.03 $110.03 $110.03 $110.03 $22.93 $110.03 $44.01 $110.03 $110.03 $110.03 $110.03 $110.03 $82.88 $110.03 $110.03 $110.03 $55.02 $55.02 $87.14 $110.03 $88.02 $71.52 $110.03 $110.03 $64.09 $110.03 $66.02 $110.03 $110.03 $110.03 N/A N/A 81540 ERX HCPCS 63700001 00006-0577-61 JANUMET 50-1000 MG (SITAGLIPTIN-METFORMIN) PO TABS BOTH IP/OP $47.50 $35.00 $9.85 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $9.85 $47.28 $18.91 $47.28 $47.28 $47.28 $47.28 $47.28 $35.63 $47.28 $47.28 $47.28 $23.64 $23.64 $37.45 $47.28 $37.82 $30.73 $47.28 $47.28 $27.55 $47.28 $28.37 $47.28 $47.28 $47.28 N/A N/A 81541 ERX HCPCS 63700001 00006-0575-61 JANUMET 50-500 MG (SITAGLIPTIN-METFORMIN) PO TABS BOTH IP/OP $47.50 $35.00 $9.85 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $9.85 $47.28 $18.91 $47.28 $47.28 $47.28 $47.28 $47.28 $35.63 $47.28 $47.28 $47.28 $23.64 $23.64 $37.45 $47.28 $37.82 $30.73 $47.28 $47.28 $27.55 $47.28 $28.37 $47.28 $47.28 $47.28 N/A N/A 81696 ERX HCPCS J1300 25682-0001-01 ECULIZUMAB 300 MG/30ML IV SOLN BOTH IP/OP "$18,238.50" "$13,496.00" "$6,868.20" "$18,238.31" "$18,238.31" "$18,238.31" "$18,238.31" "$18,238.31" "$18,238.31" "$18,238.31" "$6,876.90" "$18,238.31" "$18,238.31" "$7,142.93" "$7,142.93" "$7,417.66" "$6,868.20" "$8,069.04" "$18,238.31" "$7,295.32" "$18,238.31" "$18,238.31" "$18,238.31" "$18,238.31" "$18,238.31" "$13,678.88" "$18,238.31" "$18,238.31" "$18,238.31" "$9,119.16" "$9,119.16" "$14,444.74" "$18,238.31" "$14,590.65" "$8,207.24" "$18,238.31" "$18,238.31" "$10,578.33" "$18,238.31" "$10,942.99" "$18,238.31" "$18,238.31" "$18,238.31" N/A N/A 81725 ERX HCPCS 25000001 99073-0708-22 FREESTYLE LITE TEST VI STRP BOTH IP/OP $312.00 $231.00 $55.50 $311.82 $311.82 $311.82 $311.82 $311.82 $311.82 $311.82 $55.50 $311.82 $311.82 $231.43 $231.43 $240.35 $162.46 $64.99 $311.82 $124.73 $311.82 $311.82 $311.82 $311.82 $311.82 $234.00 $311.82 $311.82 $311.82 $155.91 $155.91 $246.96 $311.82 $249.46 $202.68 $311.82 $311.82 $180.96 $311.82 $187.09 $311.82 $311.82 $311.82 N/A N/A 81823 ERX HCPCS 25000001 00574-0069-15 GLUCOSE 40 % PO GEL BOTH IP/OP $17.50 $13.00 $3.04 $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $17.07 $3.04 $17.07 $17.07 $12.67 $12.67 $13.16 $8.89 $3.56 $17.07 $6.83 $17.07 $17.07 $17.07 $17.07 $17.07 $13.13 $17.07 $17.07 $17.07 $8.54 $8.54 $13.52 $17.07 $13.66 $11.10 $17.07 $17.07 $10.15 $17.07 $10.24 $17.07 $17.07 $17.07 N/A N/A 82021 ERX HCPCS 25000001 00121-0677-16 TRICITRATES 550-500-334 MG/5ML PO SOLN BOTH IP/OP $213.50 $158.00 $37.98 $213.37 $213.37 $213.37 $213.37 $213.37 $213.37 $213.37 $37.98 $213.37 $213.37 $158.36 $158.36 $164.47 $111.17 $44.47 $213.37 $85.35 $213.37 $213.37 $213.37 $213.37 $213.37 $160.13 $213.37 $213.37 $213.37 $106.69 $106.69 $168.99 $213.37 $170.70 $138.69 $213.37 $213.37 $123.83 $213.37 $128.02 $213.37 $213.37 $213.37 N/A N/A 82085 ERX HCPCS 25000001 63323-0652-10 ESMOLOL HCL 100 MG/10ML IV SOLN BOTH IP/OP $65.50 $48.00 $11.63 $65.32 $65.32 $65.32 $65.32 $65.32 $65.32 $65.32 $11.63 $65.32 $65.32 $48.48 $48.48 $50.35 $34.03 $13.61 $65.32 $26.13 $65.32 $65.32 $65.32 $65.32 $65.32 $49.13 $65.32 $65.32 $65.32 $32.66 $32.66 $51.73 $65.32 $52.26 $42.46 $65.32 $65.32 $37.99 $65.32 $39.19 $65.32 $65.32 $65.32 30 N/A 82100 ERX HCPCS 63700001 50474-0802-03 ROTIGOTINE 2 MG/24HR TD PT24 BOTH IP/OP $128.50 $95.00 $26.76 $128.42 $128.42 $128.42 $128.42 $128.42 $128.42 $128.42 $128.42 $128.42 $128.42 $128.42 $128.42 $128.42 $128.42 $26.76 $128.42 $51.37 $128.42 $128.42 $128.42 $128.42 $128.42 $96.38 $128.42 $128.42 $128.42 $64.21 $64.21 $101.71 $128.42 $102.74 $83.47 $128.42 $128.42 $74.53 $128.42 $77.05 $128.42 $128.42 $128.42 N/A N/A 82134 ERX HCPCS 25000001 83490-0307-60 SODIUM CHLORIDE 7 % IN NEBU BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 82177 ERX HCPCS Q9956 00407-2707-03 PERFLUTREN PROTEIN A MICROSPH IV SUSP BOTH IP/OP $112.00 $83.00 $22.18 $111.76 $50.29 $50.29 $50.29 $50.29 $111.76 $111.76 $111.76 $23.29 $111.76 $32.00 $32.00 $33.23 $30.77 $23.29 $111.76 $111.76 $66.11 $111.76 $111.76 $111.76 $111.76 $84.00 $111.76 $111.76 $111.76 $55.88 $55.88 $88.51 $111.76 $89.41 $50.29 $22.18 $111.76 $64.96 $111.76 $111.76 $111.76 $23.29 $111.76 N/A N/A 82228 ERX HCPCS J9330 00008-1179-01 TEMSIROLIMUS 25 MG/ML IV SOLN BOTH IP/OP "$5,430.00" "$4,018.00" $804.20 "$5,430.00" "$2,443.50" "$2,443.50" "$2,443.50" "$2,443.50" $868.70 $868.70 $868.70 "$1,131.75" $868.70 $903.50 $903.50 $938.25 $868.75 "$1,020.64" $868.70 $804.20 "$2,676.99" $868.70 "$5,430.00" $868.70 $912.14 "$4,072.50" $868.70 $868.70 $868.70 "$2,715.00" "$2,715.00" "$4,300.56" $868.70 "$4,344.00" "$2,443.50" $971.96 $868.70 "$3,149.40" $912.14 "$1,259.62" $868.70 $971.96 $868.70 N/A N/A 82301 ERX HCPCS S0077 00009-0775-26 CLINDAMYCIN PHOSPHATE 600 MG/4ML IJ SOLN BOTH IP/OP $22.00 $16.00 $2.70 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $2.70 $7.07 $22.00 $4.39 $4.39 $4.56 $4.22 $3.31 $22.00 $8.80 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $3.16 $22.00 $12.76 $22.00 $13.20 $22.00 $3.16 $22.00 N/A N/A 82302 ERX HCPCS S0077 25021-0115-06 CLINDAMYCIN PHOSPHATE 900 MG/6ML IJ SOLN BOTH IP/OP $22.00 $16.00 $2.70 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $2.70 $7.07 $22.00 $4.39 $4.39 $4.56 $4.22 $3.31 $22.00 $8.80 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $3.16 $22.00 $12.76 $22.00 $13.20 $22.00 $3.16 $22.00 N/A N/A 82363 ERX HCPCS 63700001 65862-0737-30 AMLODIPINE-VALSARTAN 5 MG-160 MG TABS BOTH IP/OP $24.00 $18.00 $4.92 $23.62 $23.62 $23.62 $23.62 $23.62 $23.62 $23.62 $23.62 $23.62 $23.62 $23.62 $23.62 $23.62 $23.62 $4.92 $23.62 $9.45 $23.62 $23.62 $23.62 $23.62 $23.62 $18.00 $23.62 $23.62 $23.62 $11.81 $11.81 $18.71 $23.62 $18.90 $15.35 $23.62 $23.62 $13.92 $23.62 $14.17 $23.62 $23.62 $23.62 N/A N/A 82364 ERX HCPCS 63700001 65862-0738-30 AMLODIPINE-VALSARTAN 5 MG-320 MG TABS BOTH IP/OP $30.00 $22.00 $6.24 $29.96 $29.96 $29.96 $29.96 $29.96 $29.96 $29.96 $29.96 $29.96 $29.96 $29.96 $29.96 $29.96 $29.96 $6.24 $29.96 $11.98 $29.96 $29.96 $29.96 $29.96 $29.96 $22.50 $29.96 $29.96 $29.96 $14.98 $14.98 $23.73 $29.96 $23.97 $19.47 $29.96 $29.96 $17.40 $29.96 $17.98 $29.96 $29.96 $29.96 N/A N/A 82365 ERX HCPCS 63700001 65862-0739-30 AMLODIPINE-VALSARTAN 10-160 MG TABLET BOTH IP/OP $27.00 $20.00 $5.59 $26.80 $26.80 $26.80 $26.80 $26.80 $26.80 $26.80 $26.80 $26.80 $26.80 $26.80 $26.80 $26.80 $26.80 $5.59 $26.80 $10.72 $26.80 $26.80 $26.80 $26.80 $26.80 $20.25 $26.80 $26.80 $26.80 $13.40 $13.40 $21.23 $26.80 $21.44 $17.42 $26.80 $26.80 $15.66 $26.80 $16.08 $26.80 $26.80 $26.80 53.5 N/A 82366 ERX HCPCS 63700001 65862-0740-30 AMLODIPINE-VALSARTAN 10 MG-320 MG TABS BOTH IP/OP $34.50 $26.00 $7.09 $34.02 $34.02 $34.02 $34.02 $34.02 $34.02 $34.02 $34.02 $34.02 $34.02 $34.02 $34.02 $34.02 $34.02 $7.09 $34.02 $13.61 $34.02 $34.02 $34.02 $34.02 $34.02 $25.88 $34.02 $34.02 $34.02 $17.01 $17.01 $26.94 $34.02 $27.22 $22.11 $34.02 $34.02 $20.01 $34.02 $20.41 $34.02 $34.02 $34.02 N/A N/A 82391 ERX HCPCS 63700001 55566-6500-03 PROGESTERONE 100 MG VA INST BOTH IP/OP $73.50 $54.00 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $73.50 $73.50 $73.50 $73.50 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $73.50 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $47.78 $73.50 $73.50 $42.63 $73.50 $44.10 $73.50 $73.50 $73.50 N/A N/A 82504 ERX HCPCS 63700001 00078-0501-15 RIVASTIGMINE 4.6 MG/24HR TD PT24 BOTH IP/OP $109.50 $81.00 $22.76 $109.22 $109.22 $109.22 $109.22 $109.22 $109.22 $109.22 $109.22 $109.22 $109.22 $109.22 $109.22 $109.22 $109.22 $22.76 $109.22 $43.69 $109.22 $109.22 $109.22 $109.22 $109.22 $82.13 $109.22 $109.22 $109.22 $54.61 $54.61 $86.50 $109.22 $87.38 $70.99 $109.22 $109.22 $63.51 $109.22 $65.53 $109.22 $109.22 $109.22 N/A N/A 87795 ERX HCPCS 25000001 10702-0056-01 OXYCODONE HCL 10 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 87801 ERX HCPCS 25000001 99999-6009-13 CALCIUM GLUCONATE (ANTIDOTE) 2.5 % EX GEL BOTH IP/OP $129.00 $95.00 $22.95 $128.96 $128.96 $128.96 $128.96 $128.96 $128.96 $128.96 $22.95 $128.96 $128.96 $95.71 $95.71 $99.40 $67.19 $26.88 $128.96 $51.58 $128.96 $128.96 $128.96 $128.96 $128.96 $96.75 $128.96 $128.96 $128.96 $64.48 $64.48 $102.14 $128.96 $103.17 $83.82 $128.96 $128.96 $74.82 $128.96 $77.38 $128.96 $128.96 $128.96 N/A N/A 87822 ERX HCPCS 25000001 42858-0004-01 OXYCODONE HCL 20 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 87834 ERX HCPCS 63700001 00023-9211-05 COMBIGAN: BRIMONIDINE-TIMOLOL 0.2-0.5 % OP SOLN BOTH IP/OP $740.00 $548.00 $154.18 $739.78 $739.78 $739.78 $739.78 $739.78 $739.78 $739.78 $739.78 $739.78 $739.78 $739.78 $739.78 $739.78 $739.78 $154.18 $739.78 $295.91 $739.78 $739.78 $739.78 $739.78 $739.78 $555.00 $739.78 $739.78 $739.78 $369.89 $369.89 $585.91 $739.78 $591.82 $480.86 $739.78 $739.78 $429.20 $739.78 $443.87 $739.78 $739.78 $739.78 N/A N/A 87861 ERX HCPCS J1930 15054-1120-04 LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN BOTH IP/OP "$26,735.50" "$19,784.00" "$5,572.32" "$26,735.36" "$12,030.91" "$12,030.91" "$12,030.91" "$12,030.91" "$7,941.96" "$7,941.96" "$7,941.96" "$5,572.32" "$7,941.96" "$8,259.26" "$8,259.26" "$8,576.93" "$7,941.60" "$9,330.12" "$7,941.96" "$6,890.16" "$13,180.53" "$7,941.96" "$26,735.36" "$7,941.96" "$8,339.06" "$20,051.63" "$7,941.96" "$7,941.96" "$7,941.96" "$13,367.68" "$13,367.68" "$21,174.41" "$7,941.96" "$21,388.29" "$12,030.91" "$7,712.84" "$7,941.96" "$15,506.59" "$8,339.06" "$11,515.84" "$7,941.96" "$8,098.48" "$7,941.96" N/A N/A 87865 ERX HCPCS 25000001 66490-0650-20 DIAZEPAM 2.5 MG RECTAL GEL BOTH IP/OP "$1,072.00" $793.00 $190.74 "$1,071.56" "$1,071.56" "$1,071.56" "$1,071.56" "$1,071.56" "$1,071.56" "$1,071.56" $190.74 "$1,071.56" "$1,071.56" $795.31 $795.31 $825.96 $558.28 $223.32 "$1,071.56" $428.62 "$1,071.56" "$1,071.56" "$1,071.56" "$1,071.56" "$1,071.56" $804.00 "$1,071.56" "$1,071.56" "$1,071.56" $535.78 $535.78 $848.68 "$1,071.56" $857.25 $696.51 "$1,071.56" "$1,071.56" $621.76 "$1,071.56" $642.94 "$1,071.56" "$1,071.56" "$1,071.56" N/A N/A 87867 ERX HCPCS 25000001 00187-0658-20 DIAZEPAM 10 MG RECTAL GEL BOTH IP/OP "$1,271.50" $941.00 $226.26 "$1,271.12" "$1,271.12" "$1,271.12" "$1,271.12" "$1,271.12" "$1,271.12" "$1,271.12" $226.26 "$1,271.12" "$1,271.12" $943.43 $943.43 $979.78 $662.25 $264.92 "$1,271.12" $508.45 "$1,271.12" "$1,271.12" "$1,271.12" "$1,271.12" "$1,271.12" $953.63 "$1,271.12" "$1,271.12" "$1,271.12" $635.56 $635.56 "$1,006.73" "$1,271.12" "$1,016.90" $826.23 "$1,271.12" "$1,271.12" $737.47 "$1,271.12" $762.67 "$1,271.12" "$1,271.12" "$1,271.12" N/A N/A 87869 ERX HCPCS 25000001 00187-0659-20 DIAZEPAM 20 MG RECTAL GEL BOTH IP/OP "$1,271.50" $941.00 $226.26 "$1,271.12" "$1,271.12" "$1,271.12" "$1,271.12" "$1,271.12" "$1,271.12" "$1,271.12" $226.26 "$1,271.12" "$1,271.12" $943.43 $943.43 $979.78 $662.25 $264.92 "$1,271.12" $508.45 "$1,271.12" "$1,271.12" "$1,271.12" "$1,271.12" "$1,271.12" $953.63 "$1,271.12" "$1,271.12" "$1,271.12" $635.56 $635.56 "$1,006.73" "$1,271.12" "$1,016.90" $826.23 "$1,271.12" "$1,271.12" $737.47 "$1,271.12" $762.67 "$1,271.12" "$1,271.12" "$1,271.12" N/A N/A 87889 ERX HCPCS 25000001 00088-2500-33 INSULIN GLULISINE 100 UNIT/ML IJ SOLN BOTH IP/OP "$1,029.50" $762.00 $183.17 "$1,029.04" "$1,029.04" "$1,029.04" "$1,029.04" "$1,029.04" "$1,029.04" "$1,029.04" $183.17 "$1,029.04" "$1,029.04" $763.75 $763.75 $793.18 $536.13 $214.46 "$1,029.04" $411.62 "$1,029.04" "$1,029.04" "$1,029.04" "$1,029.04" "$1,029.04" $772.13 "$1,029.04" "$1,029.04" "$1,029.04" $514.52 $514.52 $815.00 "$1,029.04" $823.23 $668.88 "$1,029.04" "$1,029.04" $597.11 "$1,029.04" $617.42 "$1,029.04" "$1,029.04" "$1,029.04" N/A N/A 87912 ERX HCPCS 63700001 51801-0012-30 POTASSIUM BICARB-CITRIC ACID 20 MEQ PO TBEF BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 87926 ERX HCPCS J9208 00143-9530-01 IFOSFAMIDE 3 GM/60ML IV SOLN BOTH IP/OP $448.00 $332.00 $79.47 $447.84 $447.84 $447.84 $447.84 $447.84 $447.84 $447.84 $80.28 $447.84 $447.84 $82.65 $82.65 $85.83 $79.47 $93.36 $447.84 $179.14 $447.84 $447.84 $447.84 $447.84 $447.84 $336.00 $447.84 $447.84 $447.84 $223.92 $223.92 $354.69 $447.84 $358.27 $201.53 $447.84 $447.84 $259.84 $447.84 $268.70 $447.84 $447.84 $447.84 N/A N/A 87998 ERX HCPCS 63700001 49702-0223-18 MARAVIROC 150 MG PO TABS BOTH IP/OP $138.00 $102.00 $28.70 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $28.70 $137.72 $55.09 $137.72 $137.72 $137.72 $137.72 $137.72 $103.50 $137.72 $137.72 $137.72 $68.86 $68.86 $109.07 $137.72 $110.18 $89.52 $137.72 $137.72 $80.04 $137.72 $82.63 $137.72 $137.72 $137.72 N/A N/A 87999 ERX HCPCS 63700001 49702-0224-18 MARAVIROC 300 MG PO TABS BOTH IP/OP $138.00 $102.00 $28.70 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $137.72 $28.70 $137.72 $55.09 $137.72 $137.72 $137.72 $137.72 $137.72 $103.50 $137.72 $137.72 $137.72 $68.86 $68.86 $109.07 $137.72 $110.18 $89.52 $137.72 $137.72 $80.04 $137.72 $82.63 $137.72 $137.72 $137.72 N/A N/A 88010 ERX HCPCS Q2009 00641-6137-10 FOSPHENYTOIN SODIUM 500 MG PE/10ML IJ SOLN BOTH IP/OP $204.50 $151.00 $42.53 $204.06 $204.06 $204.06 $204.06 $204.06 $204.06 $204.06 $46.08 $204.06 $204.06 $49.40 $49.40 $51.30 $47.50 $42.53 $204.06 $81.62 $204.06 $204.06 $204.06 $204.06 $204.06 $153.38 $204.06 $204.06 $204.06 $102.03 $102.03 $161.62 $204.06 $163.25 $91.83 $204.06 $204.06 $118.61 $204.06 $122.44 $204.06 $204.06 $204.06 N/A N/A 88011 ERX HCPCS Q2009 70121-1381-05 FOSPHENYTOIN SODIUM 100 MG PE/2ML IJ SOLN BOTH IP/OP $78.00 $58.00 $9.22 $77.76 $77.76 $77.76 $77.76 $77.76 $77.76 $77.76 $9.22 $77.76 $77.76 $9.88 $9.88 $10.26 $9.50 $16.21 $77.76 $31.10 $77.76 $77.76 $77.76 $77.76 $77.76 $58.50 $77.76 $77.76 $77.76 $38.88 $38.88 $61.59 $77.76 $62.21 $34.99 $77.76 $77.76 $45.24 $77.76 $46.66 $77.76 $77.76 $77.76 N/A N/A 88093 ERX HCPCS J0348 00049-0116-28 ANIDULAFUNGIN 100 MG IV SOLR BOTH IP/OP $692.00 $512.00 $57.00 $691.80 $691.80 $691.80 $691.80 $691.80 $691.80 $691.80 $57.00 $691.80 $691.80 $59.28 $59.28 $61.56 $57.00 $66.97 $691.80 $276.72 $691.80 $691.80 $691.80 $691.80 $691.80 $519.00 $691.80 $691.80 $691.80 $345.90 $345.90 $547.91 $691.80 $553.44 $311.31 $691.80 $691.80 $401.36 $691.80 $415.08 $691.80 $691.80 $691.80 N/A N/A 88241 ERX HCPCS J9211 00703-4154-11 IDARUBICIN HCL 5 MG/5ML IV SOLN BOTH IP/OP $354.00 $262.00 $34.75 $353.78 $353.78 $353.78 $353.78 $353.78 $353.78 $353.78 $34.75 $353.78 $353.78 $38.84 $38.84 $40.34 $37.35 $73.73 $353.78 $141.51 $353.78 $353.78 $353.78 $353.78 $353.78 $265.50 $353.78 $353.78 $353.78 $176.89 $176.89 $280.19 $353.78 $283.02 $159.20 $353.78 $353.78 $205.32 $353.78 $212.27 $353.78 $353.78 $353.78 99.5 N/A 88242 ERX HCPCS J9211 00013-2586-91 IDARUBICIN HCL 10 MG/10ML IV SOLN BOTH IP/OP $449.00 $332.00 $69.50 $448.81 $448.81 $448.81 $448.81 $448.81 $448.81 $448.81 $69.50 $448.81 $448.81 $77.69 $77.69 $80.68 $74.70 $93.54 $448.81 $179.52 $448.81 $448.81 $448.81 $448.81 $448.81 $336.75 $448.81 $448.81 $448.81 $224.41 $224.41 $355.46 $448.81 $359.05 $201.96 $448.81 $448.81 $260.42 $448.81 $269.29 $448.81 $448.81 $448.81 N/A N/A 88317 ERX HCPCS 25000001 68803-0612-10 VISIONBLUE 0.06 % IO SOSY BOTH IP/OP $328.00 $243.00 $58.35 $327.79 $327.79 $327.79 $327.79 $327.79 $327.79 $327.79 $58.35 $327.79 $327.79 $243.29 $243.29 $252.66 $170.78 $68.32 $327.79 $131.12 $327.79 $327.79 $327.79 $327.79 $327.79 $246.00 $327.79 $327.79 $327.79 $163.90 $163.90 $259.61 $327.79 $262.23 $213.06 $327.79 $327.79 $190.24 $327.79 $196.67 $327.79 $327.79 $327.79 N/A N/A 88376 ERX HCPCS J9060 63323-0103-51 CISPLATIN 50 MG/50ML IV SOLN BOTH IP/OP $86.50 $64.00 $9.30 $86.17 $38.78 $38.78 $38.78 $38.78 $86.17 $86.17 $86.17 $13.10 $86.17 $9.67 $9.67 $10.04 $9.30 $10.93 $86.17 $86.17 $50.97 $86.17 $86.17 $86.17 $86.17 $64.88 $86.17 $86.17 $86.17 $43.09 $43.09 $68.25 $86.17 $68.94 $38.78 $10.40 $86.17 $50.17 $86.17 $86.17 $86.17 $10.40 $86.17 N/A N/A 88378 ERX HCPCS J9060 63323-0103-64 CISPLATIN 200 MG/200ML IV SOLN BOTH IP/OP $310.50 $230.00 $37.20 $310.03 $139.51 $139.51 $139.51 $139.51 $310.03 $310.03 $310.03 $52.41 $310.03 $38.69 $38.69 $40.18 $37.20 $43.70 $310.03 $310.03 $183.38 $310.03 $310.03 $310.03 $310.03 $232.88 $310.03 $310.03 $310.03 $155.02 $155.02 $245.54 $310.03 $248.02 $139.51 $41.62 $310.03 $180.09 $310.03 $310.03 $310.03 $41.62 $310.03 N/A N/A 88608 ERX HCPCS 63700001 00006-0227-61 RALTEGRAVIR POTASSIUM 400 MG PO TABS BOTH IP/OP $152.50 $113.00 $31.69 $152.07 $152.07 $152.07 $152.07 $152.07 $152.07 $152.07 $152.07 $152.07 $152.07 $152.07 $152.07 $152.07 $152.07 $31.69 $152.07 $60.83 $152.07 $152.07 $152.07 $152.07 $152.07 $114.38 $152.07 $152.07 $152.07 $76.04 $76.04 $120.44 $152.07 $121.66 $98.85 $152.07 $152.07 $88.45 $152.07 $91.24 $152.07 $152.07 $152.07 N/A N/A 88705 ERX HCPCS 63700001 00004-0801-85 OSELTAMIVIR PHOSPHATE 45 MG PO CAPS BOTH IP/OP $72.50 $54.00 $15.06 $72.24 $72.24 $72.24 $72.24 $72.24 $72.24 $72.24 $72.24 $72.24 $72.24 $72.24 $72.24 $72.24 $72.24 $15.06 $72.24 $28.90 $72.24 $72.24 $72.24 $72.24 $72.24 $54.38 $72.24 $72.24 $72.24 $36.12 $36.12 $57.21 $72.24 $57.79 $46.96 $72.24 $72.24 $42.05 $72.24 $43.34 $72.24 $72.24 $72.24 N/A N/A 88720 ERX HCPCS 63700001 00078-0526-51 NILOTINIB HCL 200 MG PO CAPS BOTH IP/OP $690.00 $511.00 $143.79 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $143.79 $689.92 $275.97 $689.92 $689.92 $689.92 $689.92 $689.92 $517.50 $689.92 $689.92 $689.92 $344.96 $344.96 $546.42 $689.92 $551.94 $448.45 $689.92 $689.92 $400.20 $689.92 $413.95 $689.92 $689.92 $689.92 N/A N/A 88806 ERX HCPCS 63700001 00074-0522-60 KALETRA:LOPINAVIR-RITONAVIR 100-25 MG PO TABS BOTH IP/OP $22.50 $17.00 $4.61 $22.13 $22.13 $22.13 $22.13 $22.13 $22.13 $22.13 $22.13 $22.13 $22.13 $22.13 $22.13 $22.13 $22.13 $4.61 $22.13 $8.85 $22.13 $22.13 $22.13 $22.13 $22.13 $16.88 $22.13 $22.13 $22.13 $11.07 $11.07 $17.53 $22.13 $17.70 $14.38 $22.13 $22.13 $13.05 $22.13 $13.28 $22.13 $22.13 $22.13 N/A N/A 88945 ERX HCPCS 63700001 53191-0362-01 CHOLECALCIFEROL-D3 50000 UNITS PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 89128 ERX HCPCS J3300 00065-0543-01 TRIAMCINOLONE ACETONIDE 40 MG/ML IO SUSP BOTH IP/OP $84.00 $62.00 $15.52 $83.51 $83.51 $83.51 $83.51 $83.51 $83.51 $83.51 $15.52 $83.51 $83.51 $16.18 $16.18 $16.80 $15.56 $17.40 $83.51 $33.40 $83.51 $83.51 $83.51 $83.51 $83.51 $63.00 $83.51 $83.51 $83.51 $41.76 $41.76 $66.14 $83.51 $66.81 $37.58 $83.51 $83.51 $48.72 $83.51 $50.11 $83.51 $83.51 $83.51 N/A N/A 89201 ERX HCPCS 63700001 65162-0058-27 SEVELAMER CARBONATE 800 MG PO TABS BOTH IP/OP $26.50 $20.00 $5.49 $26.34 $26.34 $26.34 $26.34 $26.34 $26.34 $26.34 $26.34 $26.34 $26.34 $26.34 $26.34 $26.34 $26.34 $5.49 $26.34 $10.54 $26.34 $26.34 $26.34 $26.34 $26.34 $19.88 $26.34 $26.34 $26.34 $13.17 $13.17 $20.86 $26.34 $21.07 $17.12 $26.34 $26.34 $15.37 $26.34 $15.80 $26.34 $26.34 $26.34 N/A N/A 89284 ERX HCPCS 63700001 00456-1405-30 NEBIVOLOL HCL 5 MG PO TABS BOTH IP/OP $30.50 $23.00 $6.27 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $6.27 $30.09 $12.04 $30.09 $30.09 $30.09 $30.09 $30.09 $22.88 $30.09 $30.09 $30.09 $15.05 $15.05 $23.83 $30.09 $24.07 $19.56 $30.09 $30.09 $17.69 $30.09 $18.05 $30.09 $30.09 $30.09 N/A N/A 89286 ERX HCPCS 63700001 00456-1410-30 NEBIVOLOL HCL 10 MG PO TABS BOTH IP/OP $30.50 $23.00 $6.27 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $6.27 $30.09 $12.04 $30.09 $30.09 $30.09 $30.09 $30.09 $22.88 $30.09 $30.09 $30.09 $15.05 $15.05 $23.83 $30.09 $24.07 $19.56 $30.09 $30.09 $17.69 $30.09 $18.05 $30.09 $30.09 $30.09 N/A N/A 89350 ERX HCPCS J9305 00002-7640-01 PEMETREXED DISODIUM 100 MG IV SOLR BOTH IP/OP "$2,591.00" "$1,917.00" $171.41 "$2,590.76" "$1,165.84" "$1,165.84" "$1,165.84" "$1,165.84" $760.37 $760.37 $760.37 $566.59 $760.37 $790.82 $790.82 $821.23 $760.40 $893.35 $760.37 $171.41 "$1,277.24" $760.37 "$2,590.76" $760.37 $798.39 "$1,943.25" $760.37 $760.37 $760.37 "$1,295.38" "$1,295.38" "$2,051.88" $760.37 "$2,072.61" "$1,165.84" $850.74 $760.37 "$1,502.78" $798.39 "$1,102.54" $760.37 $850.74 $760.37 N/A N/A 89432 ERX HCPCS 63700001 60219-1721-07 ETRAVIRINE 100 MG PO TABS BOTH IP/OP $107.00 $79.00 $22.25 $106.74 $106.74 $106.74 $106.74 $106.74 $106.74 $106.74 $106.74 $106.74 $106.74 $106.74 $106.74 $106.74 $106.74 $22.25 $106.74 $42.70 $106.74 $106.74 $106.74 $106.74 $106.74 $80.25 $106.74 $106.74 $106.74 $53.37 $53.37 $84.54 $106.74 $85.39 $69.38 $106.74 $106.74 $62.06 $106.74 $64.04 $106.74 $106.74 $106.74 N/A N/A 89783 ERX HCPCS 63700001 59417-0102-10 LISDEXAMFETAMINE DIMESYLATE 20 MG PO CAPS BOTH IP/OP $64.00 $47.00 $13.30 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $63.82 $13.30 $63.82 $25.53 $63.82 $63.82 $63.82 $63.82 $63.82 $48.00 $63.82 $63.82 $63.82 $31.91 $31.91 $50.55 $63.82 $51.06 $41.48 $63.82 $63.82 $37.12 $63.82 $38.29 $63.82 $63.82 $63.82 N/A N/A 89791 ERX HCPCS 63700001 00008-0844-02 PANTOPRAZOLE SODIUM 40 MG PO PACK BOTH IP/OP $83.00 $61.00 $17.28 $82.92 $82.92 $82.92 $82.92 $82.92 $82.92 $82.92 $82.92 $82.92 $82.92 $82.92 $82.92 $82.92 $82.92 $17.28 $82.92 $33.17 $82.92 $82.92 $82.92 $82.92 $82.92 $62.25 $82.92 $82.92 $82.92 $41.46 $41.46 $65.67 $82.92 $66.34 $53.90 $82.92 $82.92 $48.14 $82.92 $49.75 $82.92 $82.92 $82.92 N/A N/A 90996 ERX HCPCS 63600001 31382-0753-05 MEPIVACAINE HCL 3 % IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 91001 ERX HCPCS 63700001 10122-0901-12 ZILEUTON 600 MG PO TABS BOTH IP/OP $150.00 $111.00 $31.18 $149.61 $149.61 $149.61 $149.61 $149.61 $149.61 $149.61 $149.61 $149.61 $149.61 $149.61 $149.61 $149.61 $149.61 $31.18 $149.61 $59.84 $149.61 $149.61 $149.61 $149.61 $149.61 $112.50 $149.61 $149.61 $149.61 $74.81 $74.81 $118.49 $149.61 $119.69 $97.25 $149.61 $149.61 $87.00 $149.61 $89.77 $149.61 $149.61 $149.61 N/A N/A 91028 ERX HCPCS 63700001 68012-0003-16 METFORMIN HCL ER (MOD) 1000 MG PO TB24 BOTH IP/OP $464.00 $343.00 $96.62 $463.58 $463.58 $463.58 $463.58 $463.58 $463.58 $463.58 $463.58 $463.58 $463.58 $463.58 $463.58 $463.58 $463.58 $96.62 $463.58 $185.43 $463.58 $463.58 $463.58 $463.58 $463.58 $348.00 $463.58 $463.58 $463.58 $231.79 $231.79 $367.16 $463.58 $370.86 $301.33 $463.58 $463.58 $269.12 $463.58 $278.15 $463.58 $463.58 $463.58 N/A N/A 91033 ERX HCPCS 90633 58160-0825-52 HEPATITIS A VACCINE 720 EL U/0.5ML IM SUSP BOTH IP/OP $176.00 $130.00 $9.40 $175.76 $79.09 $79.09 $79.09 $79.09 $175.76 $175.76 $175.76 $9.40 $175.76 $36.24 $36.24 $37.64 $34.85 $36.63 $175.76 $175.76 $103.96 $175.76 $175.76 $175.76 $175.76 $132.00 $175.76 $175.76 $175.76 $87.88 $87.88 $139.20 $175.76 $140.61 $79.09 $34.88 $175.76 $102.08 $175.76 $175.76 $175.76 $36.63 $175.76 N/A N/A 91034 ERX HCPCS 90632 58160-0826-52 HEPATITIS A VACCINE 1440 EL U/ML IM SUSP BOTH IP/OP $342.00 $253.00 $56.67 $341.89 $153.85 $153.85 $153.85 $153.85 $341.89 $341.89 $341.89 $56.67 $341.89 $67.33 $67.33 $69.92 $64.74 $76.06 $341.89 $341.89 $202.23 $341.89 $341.89 $341.89 $341.89 $256.50 $341.89 $341.89 $341.89 $170.95 $170.95 $270.78 $341.89 $273.51 $153.85 $72.43 $341.89 $198.36 $341.89 $341.89 $341.89 $72.43 $341.89 156 156 91037 ERX HCPCS J3470 00548-9090-10 HYALURONIDASE BOVINE 150 UNIT/ML IJ SOLN BOTH IP/OP $240.00 $178.00 $29.38 $239.72 $107.87 $107.87 $107.87 $107.87 $239.72 $239.72 $239.72 $29.38 $239.72 $58.03 $58.03 $60.26 $55.80 $49.96 $239.72 $239.72 $141.79 $239.72 $239.72 $239.72 $239.72 $180.00 $239.72 $239.72 $239.72 $119.86 $119.86 $189.86 $239.72 $191.78 $107.87 $47.58 $239.72 $139.20 $239.72 $239.72 $239.72 $49.96 $239.72 155 155 91054 ERX HCPCS J9206 63323-0193-55 IRINOTECAN HCL 100 MG/5ML IV SOLN BOTH IP/OP $162.50 $120.00 $12.25 $162.39 $73.08 $73.08 $73.08 $73.08 $162.39 $162.39 $162.39 $127.61 $162.39 $12.74 $12.74 $13.23 $12.25 $14.39 $162.39 $162.39 $96.05 $162.39 $162.39 $162.39 $162.39 $121.88 $162.39 $162.39 $162.39 $81.20 $81.20 $128.61 $162.39 $129.91 $73.08 $13.71 $162.39 $94.25 $162.39 $162.39 $162.39 $13.71 $162.39 N/A N/A 91073 ERX HCPCS 63700001 00008-1211-30 DESVENLAFAXINE SUCCINATE ER 50 MG PO TB24 BOTH IP/OP $76.00 $56.00 $15.77 $75.69 $75.69 $75.69 $75.69 $75.69 $75.69 $75.69 $75.69 $75.69 $75.69 $75.69 $75.69 $75.69 $75.69 $15.77 $75.69 $30.28 $75.69 $75.69 $75.69 $75.69 $75.69 $57.00 $75.69 $75.69 $75.69 $37.85 $37.85 $59.95 $75.69 $60.55 $49.20 $75.69 $75.69 $44.08 $75.69 $45.41 $75.69 $75.69 $75.69 N/A N/A 91238 ERX HCPCS J0744 36000-0009-24 CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN BOTH IP/OP $22.00 $16.00 $1.90 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $1.98 $1.98 $2.05 $1.90 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 91278 ERX HCPCS J2354 00641-6174-10 OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.95 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $0.95 $22.00 $22.00 $1.01 $1.01 $1.05 $0.97 $1.14 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 91279 ERX HCPCS J2354 63323-0376-01 OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN BOTH IP/OP $52.00 $38.00 $3.80 $51.53 $51.53 $51.53 $51.53 $51.53 $51.53 $51.53 $3.80 $51.53 $51.53 $4.04 $4.04 $4.19 $3.88 $4.56 $51.53 $20.61 $51.53 $51.53 $51.53 $51.53 $51.53 $39.00 $51.53 $51.53 $51.53 $25.77 $25.77 $40.81 $51.53 $41.22 $23.19 $51.53 $51.53 $30.16 $51.53 $30.92 $51.53 $51.53 $51.53 N/A N/A 91281 ERX HCPCS J2354 63323-0377-01 OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN BOTH IP/OP $213.50 $158.00 $19.00 $213.47 $213.47 $213.47 $213.47 $213.47 $213.47 $213.47 $19.00 $213.47 $213.47 $20.18 $20.18 $20.95 $19.40 $22.79 $213.47 $85.39 $213.47 $213.47 $213.47 $213.47 $213.47 $160.13 $213.47 $213.47 $213.47 $106.74 $106.74 $169.07 $213.47 $170.78 $138.76 $213.47 $213.47 $123.83 $213.47 $128.08 $213.47 $213.47 $213.47 N/A N/A 91408 ERX HCPCS J2785 55150-0443-01 REGADENOSON 0.4 MG/5ML IV SOLN BOTH IP/OP $625.00 $463.00 $130.18 $624.60 $281.07 $281.07 $281.07 $281.07 $624.60 $624.60 $624.60 $130.18 $624.60 $254.97 $254.97 $264.77 $245.16 $288.02 $624.60 $624.60 $369.45 $624.60 $624.60 $624.60 $624.60 $468.75 $624.60 $624.60 $624.60 $312.30 $312.30 $494.68 $624.60 $499.68 $281.07 $274.29 $624.60 $362.50 $624.60 $624.60 $624.60 $274.29 $624.60 N/A N/A 91534 ERX HCPCS 63700001 64764-0080-60 LUBIPROSTONE 8 MCG PO CAPS BOTH IP/OP $32.50 $24.00 $6.68 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $32.07 $6.68 $32.07 $12.83 $32.07 $32.07 $32.07 $32.07 $32.07 $24.38 $32.07 $32.07 $32.07 $16.04 $16.04 $25.40 $32.07 $25.66 $20.85 $32.07 $32.07 $18.85 $32.07 $19.24 $32.07 $32.07 $32.07 N/A N/A 91651 ERX HCPCS J2212 65649-0551-02 METHYLNALTREXONE BROMIDE 12 MG/0.6ML SC SOLN BOTH IP/OP $641.00 $474.00 $129.60 $640.64 $640.64 $640.64 $640.64 $640.64 $640.64 $640.64 $129.60 $640.64 $640.64 $139.78 $139.78 $145.15 $134.40 $133.52 $640.64 $256.26 $640.64 $640.64 $640.64 $640.64 $640.64 $480.75 $640.64 $640.64 $640.64 $320.32 $320.32 $507.39 $640.64 $512.51 $288.29 $640.64 $640.64 $371.78 $640.64 $384.38 $640.64 $640.64 $640.64 N/A N/A 91870 ERX HCPCS 63700006 67919-0020-10 ALVIMOPAN 12 MG PO CAPS BOTH IP/OP $659.00 $488.00 $137.34 $658.99 $658.99 $658.99 $658.99 $658.99 $658.99 $658.99 $658.99 $658.99 $658.99 $658.99 $658.99 $658.99 $658.99 $137.34 $658.99 $263.60 $658.99 $658.99 $658.99 $658.99 $658.99 $494.25 $658.99 $658.99 $658.99 $329.50 $329.50 $521.92 $658.99 $527.19 $428.34 $658.99 $658.99 $382.22 $658.99 $395.39 $658.99 $658.99 $658.99 N/A N/A 92079 ERX HCPCS 25000001 00143-9873-25 METOPROLOL TARTRATE 5 MG/5ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 92851 ERX HCPCS 63700001 59676-0562-01 DARUNAVIR 600 MG PO TABS BOTH IP/OP $167.00 $124.00 $34.76 $166.79 $166.79 $166.79 $166.79 $166.79 $166.79 $166.79 $166.79 $166.79 $166.79 $166.79 $166.79 $166.79 $166.79 $34.76 $166.79 $66.72 $166.79 $166.79 $166.79 $166.79 $166.79 $125.25 $166.79 $166.79 $166.79 $83.40 $83.40 $132.10 $166.79 $133.43 $108.41 $166.79 $166.79 $96.86 $166.79 $100.07 $166.79 $166.79 $166.79 N/A N/A 92854 ERX HCPCS J7189 00169-7202-01 COAGULATION FACTOR VIIA RECOMB 2 MG IV SOLR BOTH IP/OP "$12,535.50" "$9,276.00" "$2,612.52" "$12,535.40" "$12,535.40" "$12,535.40" "$12,535.40" "$12,535.40" "$12,535.40" "$12,535.40" "$4,660.00" "$12,535.40" "$12,535.40" "$4,804.80" "$4,804.80" "$4,989.60" "$4,620.00" "$2,612.52" "$12,535.40" "$5,014.16" "$12,535.40" "$12,535.40" "$12,535.40" "$12,535.40" "$12,535.40" "$9,401.63" "$12,535.40" "$12,535.40" "$12,535.40" "$6,267.70" "$6,267.70" "$9,928.04" "$12,535.40" "$10,028.32" "$5,640.93" "$12,535.40" "$12,535.40" "$7,270.59" "$12,535.40" "$7,521.24" "$12,535.40" "$12,535.40" "$12,535.40" N/A N/A 92895 ERX HCPCS J3370 00338-3552-48 VANCOMYCIN HCL IN DEXTROSE 1000 MG/200ML IV SOLN BOTH IP/OP $129.00 $95.00 $5.56 $128.96 $58.03 $58.03 $58.03 $58.03 $128.96 $128.96 $5.68 $7.24 $128.96 $5.78 $5.78 $6.00 $5.56 $6.53 $128.96 $128.96 $76.28 $128.96 $128.96 $128.96 $128.96 $96.75 $128.96 $128.96 $128.96 $64.48 $64.48 $102.14 $128.96 $103.17 $58.03 $6.22 $128.96 $74.82 $128.96 $128.96 $128.96 $6.22 $128.96 N/A N/A 92897 ERX HCPCS 63700001 00003-0852-22 DASATINIB 100 MG PO TABS BOTH IP/OP "$1,794.00" "$1,328.00" $373.80 "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" $373.80 "$1,793.57" $717.43 "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,345.50" "$1,793.57" "$1,793.57" "$1,793.57" $896.79 $896.79 "$1,420.51" "$1,793.57" "$1,434.86" "$1,165.82" "$1,793.57" "$1,793.57" "$1,040.52" "$1,793.57" "$1,076.14" "$1,793.57" "$1,793.57" "$1,793.57" N/A N/A 93084 ERX HCPCS J0282 00143-9875-10 AMIODARONE HCL 150 MG/3ML IV SOLN BOTH IP/OP $22.00 $16.00 $2.04 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $2.04 $22.00 $22.00 $2.24 $2.24 $2.32 $2.15 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 93352 ERX HCPCS 63700001 64980-0146-12 FLORANEX PO PACK BOTH IP/OP $9.00 $7.00 $1.83 $8.78 $8.78 $8.78 $8.78 $8.78 $8.78 $8.78 $8.78 $8.78 $8.78 $8.78 $8.78 $8.78 $8.78 $1.83 $8.78 $3.51 $8.78 $8.78 $8.78 $8.78 $8.78 $6.75 $8.78 $8.78 $8.78 $4.39 $4.39 $6.95 $8.78 $7.02 $5.71 $8.78 $8.78 $5.22 $8.78 $5.27 $8.78 $8.78 $8.78 53.85 35.85 93566 ERX HCPCS J2796 55513-0221-01 ROMIPLOSTIM 250 MCG SC SOLR BOTH IP/OP "$6,668.50" "$4,935.00" "$2,086.75" "$6,668.37" "$6,668.37" "$6,668.37" "$6,668.37" "$6,668.37" "$6,668.37" "$6,668.37" "$2,086.75" "$6,668.37" "$6,668.37" "$2,174.12" "$2,174.12" "$2,257.74" "$2,090.50" "$2,456.01" "$6,668.37" "$2,667.35" "$6,668.37" "$6,668.37" "$6,668.37" "$6,668.37" "$6,668.37" "$5,001.38" "$6,668.37" "$6,668.37" "$6,668.37" "$3,334.19" "$3,334.19" "$5,281.35" "$6,668.37" "$5,334.70" "$3,000.77" "$6,668.37" "$6,668.37" "$3,867.73" "$6,668.37" "$4,001.02" "$6,668.37" "$6,668.37" "$6,668.37" 74.44 48.41 93574 ERX HCPCS A9581 50419-0320-05 GADOXETATE DISODIUM 0.25 MOL/L IV SOLN BOTH IP/OP $591.50 $438.00 $117.32 $591.12 $266.00 $266.00 $266.00 $266.00 $591.12 $591.12 $591.12 $123.20 $591.12 $591.12 $591.12 $159.19 $147.40 $123.20 $591.12 $591.12 $349.65 $591.12 $591.12 $591.12 $591.12 $443.63 $591.12 $591.12 $591.12 $295.56 $295.56 $468.17 $591.12 $472.90 $266.00 $117.32 $591.12 $343.07 $591.12 $591.12 $591.12 $123.19 $591.12 N/A N/A 93748 ERX HCPCS J9293 61703-0343-18 MITOXANTRONE HCL 20 MG/10ML IV CONC BOTH IP/OP $625.50 $463.00 $105.16 $625.36 $625.36 $625.36 $625.36 $625.36 $625.36 $625.36 $105.16 $625.36 $625.36 $122.30 $122.30 $127.01 $117.60 $138.16 $625.36 $250.14 $625.36 $625.36 $625.36 $625.36 $625.36 $469.13 $625.36 $625.36 $625.36 $312.68 $312.68 $495.29 $625.36 $500.29 $281.41 $625.36 $625.36 $362.79 $625.36 $375.22 $625.36 $625.36 $625.36 N/A N/A 93927 ERX HCPCS 25000001 46287-0500-30 SORBITOL 70 % SOLN BOTH IP/OP $14.00 $10.00 $2.49 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $14.00 $2.49 $14.00 $14.00 $10.39 $10.39 $10.79 $7.29 $2.92 $14.00 $5.60 $14.00 $14.00 $14.00 $14.00 $14.00 $10.50 $14.00 $14.00 $14.00 $7.00 $7.00 $11.09 $14.00 $11.20 $9.10 $14.00 $14.00 $8.12 $14.00 $8.40 $14.00 $14.00 $14.00 N/A N/A 93931 ERX HCPCS 25000001 00487-0201-01 IPRATROPIUM-ALBUTEROL BASE 0.5-2.5 (3) MG/3ML IN SOLN BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 76 76 94096 ERX HCPCS J2405 00641-6080-25 ONDANSETRON HCL 4 MG/2ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.32 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.99 $22.00 $0.33 $0.33 $0.35 $0.32 $0.38 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.36 $22.00 $12.76 $22.00 $22.00 $22.00 $0.36 $22.00 N/A N/A 94097 ERX HCPCS J2405 00143-9890-01 ONDANSETRON HCL 40 MG/20ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.32 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.99 $22.00 $0.33 $0.33 $0.35 $0.32 $0.38 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.36 $22.00 $12.76 $22.00 $22.00 $22.00 $0.36 $22.00 N/A N/A 94141 ERX HCPCS 25000001 63824-0715-16 BENZOCAINE-MENTHOL 15-3.6 MG MT LOZG BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 94563 ERX HCPCS 63700006 70436-0101-09 TETRABENAZINE 12.5 MG PO TABS BOTH IP/OP $282.00 $209.00 $58.74 $281.84 $281.84 $281.84 $281.84 $281.84 $281.84 $281.84 $281.84 $281.84 $281.84 $281.84 $281.84 $281.84 $281.84 $58.74 $281.84 $112.74 $281.84 $281.84 $281.84 $281.84 $281.84 $211.50 $281.84 $281.84 $281.84 $140.92 $140.92 $223.22 $281.84 $225.47 $183.20 $281.84 $281.84 $163.56 $281.84 $169.10 $281.84 $281.84 $281.84 N/A N/A 95687 ERX HCPCS 63700001 67877-0717-12 MESALAMINE ER 0.375 G PO CP24 BOTH IP/OP $79.50 $59.00 $16.52 $79.27 $79.27 $79.27 $79.27 $79.27 $79.27 $79.27 $79.27 $79.27 $79.27 $79.27 $79.27 $79.27 $79.27 $16.52 $79.27 $31.71 $79.27 $79.27 $79.27 $79.27 $79.27 $59.63 $79.27 $79.27 $79.27 $39.64 $39.64 $62.78 $79.27 $63.42 $51.53 $79.27 $79.27 $46.11 $79.27 $47.56 $79.27 $79.27 $79.27 N/A N/A 95693 ERX HCPCS 63700001 39328-0057-50 FERROUS SULFATE 75 (15 FE) MG/ML PO SOLN BOTH IP/OP $38.00 $28.00 $7.88 $37.80 $37.80 $37.80 $37.80 $37.80 $37.80 $37.80 $37.80 $37.80 $37.80 $37.80 $37.80 $37.80 $37.80 $7.88 $37.80 $15.12 $37.80 $37.80 $37.80 $37.80 $37.80 $28.50 $37.80 $37.80 $37.80 $18.90 $18.90 $29.94 $37.80 $30.24 $24.57 $37.80 $37.80 $22.04 $37.80 $22.68 $37.80 $37.80 $37.80 N/A N/A 95811 ERX HCPCS 25000001 00409-9558-05 ROCURONIUM BROMIDE 50 MG/5ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 525 525 95812 ERX HCPCS 25000001 00409-9558-10 ROCURONIUM BROMIDE 100 MG/10ML IV SOLN BOTH IP/OP $37.50 $28.00 $6.61 $37.11 $37.11 $37.11 $37.11 $37.11 $37.11 $37.11 $6.61 $37.11 $37.11 $27.54 $27.54 $28.60 $19.33 $7.73 $37.11 $14.84 $37.11 $37.11 $37.11 $37.11 $37.11 $28.13 $37.11 $37.11 $37.11 $18.56 $18.56 $29.39 $37.11 $29.69 $24.12 $37.11 $37.11 $21.75 $37.11 $22.27 $37.11 $37.11 $37.11 177 177 96941 ERX HCPCS 63700001 43598-0552-30 LAMOTRIGINE 100 MG PO TBDP BOTH IP/OP $44.50 $33.00 $9.20 $44.14 $44.14 $44.14 $44.14 $44.14 $44.14 $44.14 $44.14 $44.14 $44.14 $44.14 $44.14 $44.14 $44.14 $9.20 $44.14 $17.66 $44.14 $44.14 $44.14 $44.14 $44.14 $33.38 $44.14 $44.14 $44.14 $22.07 $22.07 $34.96 $44.14 $35.31 $28.69 $44.14 $44.14 $25.81 $44.14 $26.48 $44.14 $44.14 $44.14 N/A N/A 96948 ERX HCPCS 63700001 00078-0568-45 ARTEMETHER-LUMEFANTRINE 20-120 MG PO TABS BOTH IP/OP $107.50 $80.00 $22.36 $107.27 $107.27 $107.27 $107.27 $107.27 $107.27 $107.27 $107.27 $107.27 $107.27 $107.27 $107.27 $107.27 $107.27 $22.36 $107.27 $42.91 $107.27 $107.27 $107.27 $107.27 $107.27 $80.63 $107.27 $107.27 $107.27 $53.64 $53.64 $84.96 $107.27 $85.82 $69.73 $107.27 $107.27 $62.35 $107.27 $64.36 $107.27 $107.27 $107.27 N/A N/A 96968 ERX HCPCS 63700001 68462-0678-60 LACOSAMIDE 50 MG PO TABS BOTH IP/OP $46.50 $34.00 $9.68 $46.45 $46.45 $46.45 $46.45 $46.45 $46.45 $46.45 $46.45 $46.45 $46.45 $46.45 $46.45 $46.45 $46.45 $9.68 $46.45 $18.58 $46.45 $46.45 $46.45 $46.45 $46.45 $34.88 $46.45 $46.45 $46.45 $23.23 $23.23 $36.79 $46.45 $37.16 $30.19 $46.45 $46.45 $26.97 $46.45 $27.87 $46.45 $46.45 $46.45 N/A N/A 96969 ERX HCPCS 63700001 68462-0679-60 LACOSAMIDE 100 MG PO TABS BOTH IP/OP $73.00 $54.00 $15.13 $72.62 $72.62 $72.62 $72.62 $72.62 $72.62 $72.62 $72.62 $72.62 $72.62 $72.62 $72.62 $72.62 $72.62 $15.13 $72.62 $29.05 $72.62 $72.62 $72.62 $72.62 $72.62 $54.75 $72.62 $72.62 $72.62 $36.31 $36.31 $57.52 $72.62 $58.10 $47.20 $72.62 $72.62 $42.34 $72.62 $43.57 $72.62 $72.62 $72.62 N/A N/A 96970 ERX HCPCS 63700001 67877-0735-60 LACOSAMIDE 150 MG PO TABS BOTH IP/OP $81.50 $60.00 $16.95 $81.31 $81.31 $81.31 $81.31 $81.31 $81.31 $81.31 $81.31 $81.31 $81.31 $81.31 $81.31 $81.31 $81.31 $16.95 $81.31 $32.52 $81.31 $81.31 $81.31 $81.31 $81.31 $61.13 $81.31 $81.31 $81.31 $40.66 $40.66 $64.40 $81.31 $65.05 $52.85 $81.31 $81.31 $47.27 $81.31 $48.79 $81.31 $81.31 $81.31 N/A N/A 96971 ERX HCPCS 63700001 68462-0681-60 LACOSAMIDE 200 MG PO TABS BOTH IP/OP $77.00 $57.00 $16.04 $76.94 $76.94 $76.94 $76.94 $76.94 $76.94 $76.94 $76.94 $76.94 $76.94 $76.94 $76.94 $76.94 $76.94 $16.04 $76.94 $30.78 $76.94 $76.94 $76.94 $76.94 $76.94 $57.75 $76.94 $76.94 $76.94 $38.47 $38.47 $60.94 $76.94 $61.55 $50.01 $76.94 $76.94 $44.66 $76.94 $46.16 $76.94 $76.94 $76.94 N/A N/A 96972 ERX HCPCS C9254 00131-1810-67 LACOSAMIDE 200 MG/20ML IV SOLN BOTH IP/OP $110.50 $82.00 $20.50 $110.45 $49.70 $49.70 $49.70 $49.70 $110.45 $110.45 $110.45 $23.02 $110.45 $21.32 $21.32 $22.14 $20.50 $23.02 $110.45 $110.45 $65.33 $110.45 $110.45 $110.45 $110.45 $82.88 $110.45 $110.45 $110.45 $55.23 $55.23 $87.48 $110.45 $88.36 $49.70 $21.92 $110.45 $64.09 $110.45 $110.45 $110.45 $23.02 $110.45 N/A N/A 96976 ERX HCPCS 25000001 00186-0917-06 BUDESONIDE 90 MCG/ACT IN AEPB BOTH IP/OP $716.50 $530.00 $127.47 $716.11 $716.11 $716.11 $716.11 $716.11 $716.11 $716.11 $127.47 $716.11 $716.11 $531.50 $531.50 $551.98 $373.09 $149.25 $716.11 $286.44 $716.11 $716.11 $716.11 $716.11 $716.11 $537.38 $716.11 $716.11 $716.11 $358.06 $358.06 $567.16 $716.11 $572.89 $465.47 $716.11 $716.11 $415.57 $716.11 $429.67 $716.11 $716.11 $716.11 N/A N/A 96977 ERX HCPCS 25000001 00186-0916-12 BUDESONIDE 180 MCG/ACT IN AEPB BOTH IP/OP $959.00 $710.00 $170.69 $958.92 $958.92 $958.92 $958.92 $958.92 $958.92 $958.92 $170.69 $958.92 $958.92 $711.71 $711.71 $739.14 $499.60 $199.85 $958.92 $383.57 $958.92 $958.92 $958.92 $958.92 $958.92 $719.25 $958.92 $958.92 $958.92 $479.46 $479.46 $759.46 $958.92 $767.14 $623.30 $958.92 $958.92 $556.22 $958.92 $575.35 $958.92 $958.92 $958.92 N/A N/A 96982 ERX HCPCS J9100 61703-0303-46 CYTARABINE (PF) 20 MG/ML IJ SOLN BOTH IP/OP $131.50 $97.00 $6.80 $131.34 $131.34 $131.34 $131.34 $131.34 $131.34 $131.34 $6.80 $131.34 $131.34 $9.15 $9.15 $9.50 $8.80 $10.34 $131.34 $52.54 $131.34 $131.34 $131.34 $131.34 $131.34 $98.63 $131.34 $131.34 $131.34 $65.67 $65.67 $104.02 $131.34 $105.07 $59.10 $131.34 $131.34 $76.27 $131.34 $78.80 $131.34 $131.34 $131.34 N/A N/A 96986 ERX HCPCS J9155 55566-8303-01 DEGARELIX ACETATE 80 MG SC SOLR BOTH IP/OP "$1,565.00" "$1,158.00" $324.80 "$1,565.00" $704.25 $704.25 $704.25 $704.25 $324.88 $324.88 $324.88 $326.19 $324.88 $337.79 $337.79 $350.78 $324.80 $381.59 $324.88 $325.12 $925.70 $324.88 "$1,565.00" $324.88 $341.12 "$1,173.75" $324.88 $324.88 $324.88 $782.50 $782.50 "$1,239.48" $324.88 "$1,252.00" $704.25 $363.39 $324.88 $907.70 $341.12 $471.08 $324.88 $363.39 $324.88 N/A N/A 96988 ERX HCPCS 25000001 66220-0160-10 CONIVAPTAN HCL IN DEXTROSE 20-5 MG/100ML-% IV SOLN BOTH IP/OP "$2,596.50" "$1,921.00" $462.10 "$2,596.09" "$2,596.09" "$2,596.09" "$2,596.09" "$2,596.09" "$2,596.09" "$2,596.09" $462.10 "$2,596.09" "$2,596.09" "$1,926.82" "$1,926.82" "$2,001.07" "$1,352.56" $541.05 "$2,596.09" "$1,038.44" "$2,596.09" "$2,596.09" "$2,596.09" "$2,596.09" "$2,596.09" "$1,947.38" "$2,596.09" "$2,596.09" "$2,596.09" "$1,298.05" "$1,298.05" "$2,056.10" "$2,596.09" "$2,076.87" "$1,687.46" "$2,596.09" "$2,596.09" "$1,505.97" "$2,596.09" "$1,557.65" "$2,596.09" "$2,596.09" "$2,596.09" N/A N/A 97005 ERX HCPCS 63700001 30768-0003-48 MILK THISTLE XTRA PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 80 N/A 97053 ERX HCPCS 63700001 59676-0563-01 DARUNAVIR 75 MG PO TABS BOTH IP/OP $167.00 $124.00 $34.76 $166.78 $166.78 $166.78 $166.78 $166.78 $166.78 $166.78 $166.78 $166.78 $166.78 $166.78 $166.78 $166.78 $166.78 $34.76 $166.78 $66.71 $166.78 $166.78 $166.78 $166.78 $166.78 $125.25 $166.78 $166.78 $166.78 $83.39 $83.39 $132.09 $166.78 $133.42 $108.41 $166.78 $166.78 $96.86 $166.78 $100.07 $166.78 $166.78 $166.78 N/A N/A 97133 ERX HCPCS 63700001 64764-0918-30 FEBUXOSTAT 40 MG PO TABS BOTH IP/OP $57.50 $43.00 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $22.81 $57.03 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $37.07 $57.03 $57.03 $33.35 $57.03 $34.22 $57.03 $57.03 $57.03 N/A N/A 97134 ERX HCPCS 63700001 64764-0677-30 FEBUXOSTAT 80 MG PO TABS BOTH IP/OP $57.50 $43.00 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $22.81 $57.03 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $37.07 $57.03 $57.03 $33.35 $57.03 $34.22 $57.03 $57.03 $57.03 N/A N/A 97252 ERX HCPCS J3490 99999-6010-51 DILTIAZEM HCL 25 MG/5ML IV SOLN BOTH IP/OP $840.00 $622.00 $166.63 $839.56 $377.80 $377.80 $377.80 $377.80 $839.56 $839.56 $839.56 $174.99 $839.56 $839.56 $839.56 $839.56 $839.56 $174.97 $839.56 $839.56 $496.60 $839.56 $839.56 $839.56 $839.56 $630.00 $839.56 $839.56 $839.56 $419.78 $419.78 $664.93 $839.56 $671.65 $377.80 $166.63 $839.56 $487.20 $839.56 $839.56 $839.56 $174.96 $839.56 N/A N/A 97253 ERX HCPCS 25000001 00641-6015-10 DILTIAZEM HCL 125 MG/25ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 97266 ERX HCPCS 63700001 00456-1420-90 NEBIVOLOL HCL 20 MG PO TABS BOTH IP/OP $30.50 $23.00 $6.27 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $30.09 $6.27 $30.09 $12.04 $30.09 $30.09 $30.09 $30.09 $30.09 $22.88 $30.09 $30.09 $30.09 $15.05 $15.05 $23.83 $30.09 $24.07 $19.56 $30.09 $30.09 $17.69 $30.09 $18.05 $30.09 $30.09 $30.09 N/A N/A 97343 ERX HCPCS 63700001 55150-0173-01 SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN BOTH IP/OP $57.50 $43.00 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $22.81 $57.03 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $37.07 $57.03 $57.03 $33.35 $57.03 $34.22 $57.03 $57.03 $57.03 N/A N/A 97371 ERX HCPCS J3370 63323-0203-20 VANCOMYCIN HCL 750 MG IV SOLR BOTH IP/OP $49.50 $37.00 $2.78 $49.25 $22.16 $22.16 $22.16 $22.16 $49.25 $49.25 $2.84 $3.62 $49.25 $2.89 $2.89 $3.00 $2.78 $3.27 $49.25 $49.25 $29.13 $49.25 $49.25 $49.25 $49.25 $37.13 $49.25 $49.25 $49.25 $24.63 $24.63 $39.01 $49.25 $39.40 $22.16 $3.11 $49.25 $28.71 $49.25 $49.25 $49.25 $3.11 $49.25 N/A N/A 97389 ERX HCPCS J7527 00078-0566-51 EVEROLIMUS 5 MG PO TABS BOTH IP/OP "$2,074.00" "$1,535.00" $114.00 "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" $118.40 "$2,073.99" "$2,073.99" $118.56 $118.56 $123.12 $114.00 $432.24 "$2,073.99" $829.60 "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$1,555.50" "$2,073.99" "$2,073.99" "$2,073.99" "$1,037.00" "$1,037.00" "$1,642.60" "$2,073.99" "$1,659.19" $933.30 "$2,073.99" "$2,073.99" "$1,202.92" "$2,073.99" "$1,244.39" "$2,073.99" "$2,073.99" "$2,073.99" N/A N/A 97390 ERX HCPCS J7527 00078-0567-51 EVEROLIMUS 10 MG PO TABS BOTH IP/OP "$2,074.00" "$1,535.00" $228.00 "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" $236.80 "$2,073.99" "$2,073.99" $237.12 $237.12 $246.24 $228.00 $432.24 "$2,073.99" $829.60 "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$1,555.50" "$2,073.99" "$2,073.99" "$2,073.99" "$1,037.00" "$1,037.00" "$1,642.60" "$2,073.99" "$1,659.19" $933.30 "$2,073.99" "$2,073.99" "$1,202.92" "$2,073.99" "$1,244.39" "$2,073.99" "$2,073.99" "$2,073.99" N/A N/A 97480 ERX HCPCS J7510 99999-6010-77 PREDNISOLONE 15 MG/5ML PO SOLN BOTH IP/OP $123.00 $91.00 $9.00 $122.99 $55.35 $55.35 $55.35 $55.35 $122.99 $122.99 $122.99 $25.63 $122.99 $9.36 $9.36 $9.72 $9.00 $25.63 $122.99 $122.99 $72.75 $122.99 $122.99 $122.99 $122.99 $92.25 $122.99 $122.99 $122.99 $61.50 $61.50 $97.41 $122.99 $98.39 $55.35 $24.41 $122.99 $71.34 $122.99 $122.99 $122.99 $25.63 $122.99 N/A N/A 97660 ERX HCPCS 25000001 48582-0512-01 BIOTENE ORALBALANCE DRY MOUTH MT GEL BOTH IP/OP $24.50 $18.00 $4.36 $24.50 $24.50 $24.50 $24.50 $24.50 $24.50 $24.50 $4.36 $24.50 $24.50 $18.18 $18.18 $18.88 $12.76 $5.11 $24.50 $9.80 $24.50 $24.50 $24.50 $24.50 $24.50 $18.38 $24.50 $24.50 $24.50 $12.25 $12.25 $19.40 $24.50 $19.60 $15.93 $24.50 $24.50 $14.21 $24.50 $14.70 $24.50 $24.50 $24.50 N/A N/A 97692 ERX HCPCS J0282 67457-0153-09 AMIODARONE HCL 450 MG/9ML IV SOLN BOTH IP/OP $22.00 $16.00 $2.04 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $2.04 $22.00 $22.00 $2.24 $2.24 $2.32 $2.15 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 97716 ERX HCPCS J1885 00409-3796-01 KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN BOTH IP/OP $22.00 $16.00 $0.63 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.63 $22.00 $1.14 $1.14 $1.19 $1.10 $1.29 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.23 $22.00 $12.76 $22.00 $22.00 $22.00 $1.23 $22.00 N/A N/A 97790 ERX HCPCS J3260 63323-0306-30 TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN BOTH IP/OP $105.50 $78.00 $38.42 $105.08 $47.29 $47.29 $47.29 $47.29 $105.08 $105.08 $57.60 $38.42 $105.08 $64.27 $64.27 $66.74 $61.80 $72.61 $105.08 $105.08 $62.15 $105.08 $105.08 $105.08 $105.08 $79.13 $105.08 $105.08 $105.08 $52.54 $52.54 $83.22 $105.08 $84.06 $47.29 $69.14 $105.08 $61.19 $105.08 $105.08 $105.08 $69.14 $105.08 N/A N/A 97830 ERX HCPCS 63700001 00173-0772-02 LAMOTRIGINE 25 MG PO TBDP BOTH IP/OP $69.50 $51.00 $14.47 $69.42 $69.42 $69.42 $69.42 $69.42 $69.42 $69.42 $69.42 $69.42 $69.42 $69.42 $69.42 $69.42 $69.42 $14.47 $69.42 $27.77 $69.42 $69.42 $69.42 $69.42 $69.42 $52.13 $69.42 $69.42 $69.42 $34.71 $34.71 $54.98 $69.42 $55.54 $45.12 $69.42 $69.42 $40.31 $69.42 $41.65 $69.42 $69.42 $69.42 N/A N/A 97893 ERX HCPCS 63700001 99999-6011-58 TOLVAPTAN 15 MG PO TABS BOTH IP/OP $847.50 $627.00 $176.61 $847.39 $847.39 $847.39 $847.39 $847.39 $847.39 $847.39 $847.39 $847.39 $847.39 $847.39 $847.39 $847.39 $847.39 $176.61 $847.39 $338.96 $847.39 $847.39 $847.39 $847.39 $847.39 $635.63 $847.39 $847.39 $847.39 $423.70 $423.70 $671.13 $847.39 $677.91 $550.80 $847.39 $847.39 $491.55 $847.39 $508.43 $847.39 $847.39 $847.39 N/A N/A 97894 ERX HCPCS 25000001 59148-0021-50 TOLVAPTAN 30 MG PO TABS BOTH IP/OP "$1,729.50" "$1,280.00" $307.77 "$1,729.02" "$1,729.02" "$1,729.02" "$1,729.02" "$1,729.02" "$1,729.02" "$1,729.02" $307.77 "$1,729.02" "$1,729.02" "$1,283.28" "$1,283.28" "$1,332.73" $900.82 $360.35 "$1,729.02" $691.61 "$1,729.02" "$1,729.02" "$1,729.02" "$1,729.02" "$1,729.02" "$1,297.13" "$1,729.02" "$1,729.02" "$1,729.02" $864.51 $864.51 "$1,369.38" "$1,729.02" "$1,383.22" "$1,123.86" "$1,729.02" "$1,729.02" "$1,003.11" "$1,729.02" "$1,037.41" "$1,729.02" "$1,729.02" "$1,729.02" N/A N/A 98035 ERX HCPCS 63700001 00032-1212-01 PANCRELIPASE (LIP-PROT-AMYL) 12000-38000 UNITS PO CPEP BOTH IP/OP $21.00 $16.00 $4.27 $20.51 $20.51 $20.51 $20.51 $20.51 $20.51 $20.51 $20.51 $20.51 $20.51 $20.51 $20.51 $20.51 $20.51 $4.27 $20.51 $8.20 $20.51 $20.51 $20.51 $20.51 $20.51 $15.75 $20.51 $20.51 $20.51 $10.26 $10.26 $16.24 $20.51 $16.41 $13.33 $20.51 $20.51 $12.18 $20.51 $12.31 $20.51 $20.51 $20.51 N/A N/A 98127 ERX HCPCS 25000001 08271-0361-00 LANCETS ULTRA THIN MISC BOTH IP/OP $12.00 $9.00 $2.08 $11.67 $11.67 $11.67 $11.67 $11.67 $11.67 $11.67 $2.08 $11.67 $11.67 $8.66 $8.66 $9.00 $6.08 $2.43 $11.67 $4.67 $11.67 $11.67 $11.67 $11.67 $11.67 $9.00 $11.67 $11.67 $11.67 $5.84 $5.84 $9.24 $11.67 $9.34 $7.59 $11.67 $11.67 $6.96 $11.67 $7.00 $11.67 $11.67 $11.67 N/A N/A 98329 ERX HCPCS 25000001 00024-4142-60 DRONEDARONE HCL 400 MG PO TABS BOTH IP/OP $66.00 $49.00 $11.69 $65.67 $65.67 $65.67 $65.67 $65.67 $65.67 $65.67 $11.69 $65.67 $65.67 $48.74 $48.74 $50.62 $34.21 $13.69 $65.67 $26.27 $65.67 $65.67 $65.67 $65.67 $65.67 $49.50 $65.67 $65.67 $65.67 $32.84 $32.84 $52.01 $65.67 $52.54 $42.69 $65.67 $65.67 $38.28 $65.67 $39.40 $65.67 $65.67 $65.67 N/A N/A 98372 ERX HCPCS 63700001 60505-4642-03 PRASUGREL HCL 5 MG PO TABS BOTH IP/OP $71.50 $53.00 $14.86 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $14.86 $71.31 $28.52 $71.31 $71.31 $71.31 $71.31 $71.31 $53.63 $71.31 $71.31 $71.31 $35.66 $35.66 $56.48 $71.31 $57.05 $46.35 $71.31 $71.31 $41.47 $71.31 $42.79 $71.31 $71.31 $71.31 N/A N/A 98373 ERX HCPCS 63700001 60505-4643-03 PRASUGREL HCL 10 MG PO TABS BOTH IP/OP $71.50 $53.00 $14.86 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $71.31 $14.86 $71.31 $28.52 $71.31 $71.31 $71.31 $71.31 $71.31 $53.63 $71.31 $71.31 $71.31 $35.66 $35.66 $56.48 $71.31 $57.05 $46.35 $71.31 $71.31 $41.47 $71.31 $42.79 $71.31 $71.31 $71.31 N/A N/A 99404 ERX HCPCS 25000001 62559-0153-04 OPIUM 10 MG/ML (1%) PO TINC BOTH IP/OP "$1,976.00" "$1,462.00" $351.68 "$1,975.75" "$1,975.75" "$1,975.75" "$1,975.75" "$1,975.75" "$1,975.75" "$1,975.75" $351.68 "$1,975.75" "$1,975.75" "$1,466.40" "$1,466.40" "$1,522.91" "$1,029.37" $411.77 "$1,975.75" $790.30 "$1,975.75" "$1,975.75" "$1,975.75" "$1,975.75" "$1,975.75" "$1,482.00" "$1,975.75" "$1,975.75" "$1,975.75" $987.88 $987.88 "$1,564.79" "$1,975.75" "$1,580.60" "$1,284.24" "$1,975.75" "$1,975.75" "$1,146.08" "$1,975.75" "$1,185.45" "$1,975.75" "$1,975.75" "$1,975.75" 173.08 N/A 99450 ERX HCPCS 25000001 43068-0112-02 ILOPERIDONE 12 MG PO TABS BOTH IP/OP $247.50 $183.00 $44.04 $247.42 $247.42 $247.42 $247.42 $247.42 $247.42 $247.42 $44.04 $247.42 $247.42 $183.64 $183.64 $190.71 $128.91 $51.57 $247.42 $98.97 $247.42 $247.42 $247.42 $247.42 $247.42 $185.63 $247.42 $247.42 $247.42 $123.71 $123.71 $195.96 $247.42 $197.94 $160.82 $247.42 $247.42 $143.55 $247.42 $148.45 $247.42 $247.42 $247.42 N/A N/A 99452 ERX HCPCS J7312 00023-3348-07 DEXAMETHASONE 0.7 MG INTRAVITREAL IMPL BOTH IP/OP "$3,839.00" "$2,841.00" $800.12 "$3,838.91" "$1,727.51" "$1,727.51" "$1,727.51" "$1,727.51" "$1,399.97" "$1,399.97" "$1,399.97" $800.12 "$1,399.97" "$1,456.00" "$1,456.00" "$1,512.00" "$1,400.00" "$1,644.78" "$1,399.97" "$1,398.85" "$1,892.58" "$1,399.97" "$3,838.91" "$1,399.97" "$1,469.96" "$2,879.25" "$1,399.97" "$1,399.97" "$1,399.97" "$1,919.46" "$1,919.46" "$3,040.42" "$1,399.97" "$3,071.13" "$1,727.51" "$1,566.32" "$1,399.97" "$2,226.62" "$1,469.96" "$2,029.95" "$1,399.97" "$1,566.32" "$1,399.97" 63.81 38.62 99602 ERX HCPCS J9263 00703-3985-01 OXALIPLATIN 50 MG/10ML IV SOLN BOTH IP/OP $215.00 $159.00 $7.00 "$1,124.48" $96.66 $96.66 $96.66 $96.66 $214.80 $214.80 $214.80 "$1,124.48" $214.80 $7.28 $7.28 $7.56 $7.00 $8.22 $214.80 $214.80 $127.05 $214.80 $214.80 $214.80 $214.80 $161.25 $214.80 $214.80 $214.80 $107.40 $107.40 $170.12 $214.80 $171.84 $96.66 $7.83 $214.80 $124.70 $214.80 $214.80 $214.80 $7.83 $214.80 N/A N/A 99604 ERX HCPCS J9263 25021-0233-20 OXALIPLATIN 100 MG/20ML IV SOLN BOTH IP/OP $215.00 $159.00 $14.00 "$2,248.95" $96.66 $96.66 $96.66 $96.66 $214.80 $214.80 $214.80 "$2,248.95" $214.80 $14.56 $14.56 $15.12 $14.00 $16.45 $214.80 $214.80 $127.05 $214.80 $214.80 $214.80 $214.80 $161.25 $214.80 $214.80 $214.80 $107.40 $107.40 $170.12 $214.80 $171.84 $96.66 $15.66 $214.80 $124.70 $214.80 $214.80 $214.80 $15.66 $214.80 N/A N/A 99686 ERX HCPCS 63700001 00955-1052-90 SEVELAMER CARBONATE 0.8 G PO PACK BOTH IP/OP $49.50 $37.00 $10.22 $49.02 $49.02 $49.02 $49.02 $49.02 $49.02 $49.02 $49.02 $49.02 $49.02 $49.02 $49.02 $49.02 $49.02 $10.22 $49.02 $19.61 $49.02 $49.02 $49.02 $49.02 $49.02 $37.13 $49.02 $49.02 $49.02 $24.51 $24.51 $38.82 $49.02 $39.22 $31.86 $49.02 $49.02 $28.71 $49.02 $29.41 $49.02 $49.02 $49.02 N/A N/A 99687 ERX HCPCS 63700006 58468-0131-02 SEVELAMER CARBONATE 2.4 G PO PACK BOTH IP/OP $85.50 $63.00 $17.76 $85.24 $85.24 $85.24 $85.24 $85.24 $85.24 $85.24 $85.24 $85.24 $85.24 $85.24 $85.24 $85.24 $85.24 $17.76 $85.24 $34.10 $85.24 $85.24 $85.24 $85.24 $85.24 $64.13 $85.24 $85.24 $85.24 $42.62 $42.62 $67.51 $85.24 $68.19 $55.41 $85.24 $85.24 $49.59 $85.24 $51.14 $85.24 $85.24 $85.24 N/A N/A 99744 ERX HCPCS 25000001 58160-0818-11 HAEMOPHILUS B POLYSAC CONJ VAC 10 MCG IJ SOLR BOTH IP/OP $64.00 $47.00 $11.38 $63.91 $63.91 $63.91 $63.91 $63.91 $63.91 $63.91 $11.38 $63.91 $63.91 $47.43 $47.43 $49.26 $33.30 $13.32 $63.91 $25.56 $63.91 $63.91 $63.91 $63.91 $63.91 $48.00 $63.91 $63.91 $63.91 $31.96 $31.96 $50.62 $63.91 $51.13 $41.54 $63.91 $63.91 $37.12 $63.91 $38.35 $63.91 $63.91 $63.91 N/A N/A 99746 ERX HCPCS 63700001 00456-2405-60 ASENAPINE MALEATE 5 MG SL SUBL BOTH IP/OP $96.00 $71.00 $19.92 $95.59 $95.59 $95.59 $95.59 $95.59 $95.59 $95.59 $95.59 $95.59 $95.59 $95.59 $95.59 $95.59 $95.59 $19.92 $95.59 $38.24 $95.59 $95.59 $95.59 $95.59 $95.59 $72.00 $95.59 $95.59 $95.59 $47.80 $47.80 $75.71 $95.59 $76.47 $62.13 $95.59 $95.59 $55.68 $95.59 $57.35 $95.59 $95.59 $95.59 N/A N/A 99765 ERX HCPCS Q4074 66215-0303-00 ILOPROST 20 MCG/ML IN SOLN BOTH IP/OP $88.00 $65.00 $18.30 $151.64 $87.82 $87.82 $87.82 $87.82 $87.82 $87.82 $140.24 $87.82 $87.82 $146.03 $146.03 $151.64 $140.41 $18.30 $87.82 $35.13 $87.82 $87.82 $87.82 $87.82 $87.82 $66.00 $87.82 $87.82 $87.82 $43.91 $43.91 $69.55 $87.82 $70.26 $39.52 $87.82 $87.82 $51.04 $87.82 $52.69 $87.82 $87.82 $87.82 N/A N/A 100004 ERX HCPCS 63700001 16714-0866-01 PALIPERIDONE ER 1.5 MG PO TB24 BOTH IP/OP $122.00 $90.00 $25.32 $121.51 $121.51 $121.51 $121.51 $121.51 $121.51 $121.51 $121.51 $121.51 $121.51 $121.51 $121.51 $121.51 $121.51 $25.32 $121.51 $48.60 $121.51 $121.51 $121.51 $121.51 $121.51 $91.50 $121.51 $121.51 $121.51 $60.76 $60.76 $96.24 $121.51 $97.21 $78.98 $121.51 $121.51 $70.76 $121.51 $72.91 $121.51 $121.51 $121.51 N/A N/A 100258 ERX HCPCS J9302 00078-0669-13 OFATUMUMAB 100 MG/5ML IV CONC BOTH IP/OP "$1,933.50" "$1,431.00" $639.60 "$1,933.21" "$1,933.21" "$1,933.21" "$1,933.21" "$1,933.21" "$1,933.21" "$1,933.21" $639.60 "$1,933.21" "$1,933.21" $665.18 $665.18 $690.77 $639.60 $751.43 "$1,933.21" $773.28 "$1,933.21" "$1,933.21" "$1,933.21" "$1,933.21" "$1,933.21" "$1,450.13" "$1,933.21" "$1,933.21" "$1,933.21" $966.61 $966.61 "$1,531.10" "$1,933.21" "$1,546.57" $869.94 "$1,933.21" "$1,933.21" "$1,121.43" "$1,933.21" "$1,159.93" "$1,933.21" "$1,933.21" "$1,933.21" N/A N/A 100265 ERX HCPCS J0597 63833-0825-02 C1 ESTERASE INHIBITOR (HUMAN) 500 UNITS IV KIT BOTH IP/OP "$5,061,727.00" "$3,745,678.00" "$1,054,919.58" "$5,061,726.95" "$5,061,726.95" "$5,061,726.95" "$5,061,726.95" "$5,061,726.95" "$5,061,726.95" "$5,061,726.95" "$1,434,750.00" "$5,061,726.95" "$5,061,726.95" "$1,492,400.00" "$1,492,400.00" "$1,549,800.00" "$1,435,000.00" "$1,054,919.58" "$5,061,726.95" "$2,024,690.78" "$5,061,726.95" "$5,061,726.95" "$5,061,726.95" "$5,061,726.95" "$5,061,726.95" "$3,796,295.25" "$5,061,726.95" "$5,061,726.95" "$5,061,726.95" "$2,530,863.48" "$2,530,863.48" "$4,008,887.74" "$5,061,726.95" "$4,049,381.56" "$2,277,777.13" "$5,061,726.95" "$5,061,726.95" "$2,935,801.66" "$5,061,726.95" "$3,037,036.17" "$5,061,726.95" "$5,061,726.95" "$5,061,726.95" N/A N/A 100482 ERX HCPCS 63700001 69452-0151-20 VITAMIN D (ERGOCALCIFEROL) 1.25 MG (50000 UT) PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 101316 ERX HCPCS 63700001 99999-6012-26 VALGANCICLOVIR HCL 50 MG/ML PO SOLR BOTH IP/OP $355.00 $263.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $142.00 $355.00 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $230.75 $355.00 $355.00 $205.90 $355.00 $213.00 $355.00 $355.00 $355.00 N/A N/A 101323 ERX HCPCS J3490 55150-0166-13 SILDENAFIL CITRATE 10 MG/12.5ML IV SOLN BOTH IP/OP $664.50 $492.00 $131.87 $664.40 $298.98 $298.98 $298.98 $298.98 $664.40 $664.40 $664.40 $138.48 $664.40 $664.40 $664.40 $664.40 $664.40 $138.47 $664.40 $664.40 $392.99 $664.40 $664.40 $664.40 $664.40 $498.38 $664.40 $664.40 $664.40 $332.20 $332.20 $526.20 $664.40 $531.52 $298.98 $131.87 $664.40 $385.41 $664.40 $664.40 $664.40 $138.46 $664.40 N/A N/A 101445 ERX HCPCS J1742 00009-3794-01 IBUTILIDE FUMARATE 1 MG/10ML IV SOLN BOTH IP/OP "$1,675.00" "$1,240.00" $205.06 "$1,674.76" "$1,674.76" "$1,674.76" "$1,674.76" "$1,674.76" "$1,674.76" "$1,674.76" $205.06 "$1,674.76" "$1,674.76" $310.23 $310.23 $322.16 $298.30 $349.04 "$1,674.76" $669.90 "$1,674.76" "$1,674.76" "$1,674.76" "$1,674.76" "$1,674.76" "$1,256.25" "$1,674.76" "$1,674.76" "$1,674.76" $837.38 $837.38 "$1,326.41" "$1,674.76" "$1,339.81" $753.64 "$1,674.76" "$1,674.76" $971.50 "$1,674.76" "$1,004.86" "$1,674.76" "$1,674.76" "$1,674.76" N/A N/A 101584 ERX HCPCS 63700001 16714-0363-04 "ORTHO TRI-CYCLEN,TRINESSA,0.18/0.215/0.25 MG-35 MCG PO TABS" BOTH IP/OP $156.50 $116.00 $32.61 $156.47 $156.47 $156.47 $156.47 $156.47 $156.47 $156.47 $156.47 $156.47 $156.47 $156.47 $156.47 $156.47 $156.47 $32.61 $156.47 $62.59 $156.47 $156.47 $156.47 $156.47 $156.47 $117.38 $156.47 $156.47 $156.47 $78.24 $78.24 $123.92 $156.47 $125.18 $101.71 $156.47 $156.47 $90.77 $156.47 $93.88 $156.47 $156.47 $156.47 N/A N/A 101739 ERX HCPCS 90734 58160-0955-09 MENVEO MENINGOCOCCAL A C Y&W-135 OLIG IM SOLR BOTH IP/OP $618.00 $457.00 $9.40 $617.79 $278.01 $278.01 $278.01 $278.01 $617.79 $617.79 $129.26 $9.40 $617.79 $140.16 $140.16 $145.55 $134.77 $158.33 $617.79 $247.12 $365.42 $617.79 $617.79 $617.79 $617.79 $463.50 $617.79 $617.79 $617.79 $308.90 $308.90 $489.29 $617.79 $494.23 $278.01 $150.78 $617.79 $358.44 $617.79 $370.67 $617.79 $150.78 $617.79 N/A N/A 102037 ERX HCPCS 25000001 00173-0696-04 FLUTICASONE-SALMETEROL 250-50 MCG/ACT IN AEPB BOTH IP/OP $632.00 $468.00 $112.47 $631.84 $631.84 $631.84 $631.84 $631.84 $631.84 $631.84 $112.47 $631.84 $631.84 $468.95 $468.95 $487.02 $329.19 $131.68 $631.84 $252.74 $631.84 $631.84 $631.84 $631.84 $631.84 $474.00 $631.84 $631.84 $631.84 $315.92 $315.92 $500.42 $631.84 $505.47 $410.70 $631.84 $631.84 $366.56 $631.84 $379.10 $631.84 $631.84 $631.84 N/A N/A 102038 ERX HCPCS 25000001 00173-0697-04 FLUTICASONE-SALMETEROL 500-50 MCG/ACT IN AEPB BOTH IP/OP $896.50 $663.00 $159.53 $896.21 $896.21 $896.21 $896.21 $896.21 $896.21 $896.21 $159.53 $896.21 $896.21 $665.17 $665.17 $690.80 $466.93 $186.78 $896.21 $358.48 $896.21 $896.21 $896.21 $896.21 $896.21 $672.38 $896.21 $896.21 $896.21 $448.11 $448.11 $709.80 $896.21 $716.97 $582.54 $896.21 $896.21 $519.97 $896.21 $537.73 $896.21 $896.21 $896.21 N/A N/A 102040 ERX HCPCS 63700001 00173-0526-00 LAMOTRIGINE 5 MG PO CHEW BOTH IP/OP $80.00 $59.00 $16.64 $79.85 $79.85 $79.85 $79.85 $79.85 $79.85 $79.85 $79.85 $79.85 $79.85 $79.85 $79.85 $79.85 $79.85 $16.64 $79.85 $31.94 $79.85 $79.85 $79.85 $79.85 $79.85 $60.00 $79.85 $79.85 $79.85 $39.93 $39.93 $63.24 $79.85 $63.88 $51.90 $79.85 $79.85 $46.40 $79.85 $47.91 $79.85 $79.85 $79.85 N/A N/A 102058 ERX HCPCS 90670 00005-1971-02 PNEUMOCOCCAL 13-VAL CONJ VACC IM SUSP BOTH IP/OP $820.50 $607.00 $116.46 $820.14 $369.06 $369.06 $369.06 $369.06 $213.24 $213.24 $241.38 $170.94 $213.24 $251.04 $251.04 $260.69 $241.38 $283.58 $820.14 $328.06 $485.11 $213.24 $213.24 $213.24 $820.14 $615.38 $213.24 $116.46 $213.24 $410.07 $410.07 $649.55 $213.24 $656.11 $369.06 $270.06 $213.24 $475.89 $820.14 $119.74 $213.24 $270.06 $213.24 N/A N/A 102397 ERX HCPCS 63700001 65649-0303-03 RIFAXIMIN 550 MG PO TABS BOTH IP/OP $226.50 $168.00 $47.15 $226.25 $226.25 $226.25 $226.25 $226.25 $226.25 $226.25 $226.25 $226.25 $226.25 $226.25 $226.25 $226.25 $226.25 $47.15 $226.25 $90.50 $226.25 $226.25 $226.25 $226.25 $226.25 $169.88 $226.25 $226.25 $226.25 $113.13 $113.13 $179.19 $226.25 $181.00 $147.06 $226.25 $226.25 $131.37 $226.25 $135.75 $226.25 $226.25 $226.25 N/A N/A 102415 ERX HCPCS 25000001 63323-0492-57 LIDOCAINE HCL (PF) 1 % IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 102416 ERX HCPCS 25000001 00409-4282-02 LIDOCAINE HCL (PF) 2 % IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 102429 ERX HCPCS J0585 00023-1145-01 ONABOTULINUMTOXINA 100 UNITS IJ SOLR BOTH IP/OP "$2,031.50" "$1,503.00" $618.50 "$2,031.34" $914.10 $914.10 $914.10 $914.10 $618.50 $618.50 $618.50 $642.73 $618.50 $643.76 $643.76 $668.52 $619.00 $727.23 $618.50 $631.80 "$1,001.45" $618.50 "$2,031.34" $618.50 $649.43 "$1,523.63" $618.50 $618.50 $618.50 "$1,015.67" "$1,015.67" "$1,608.82" $618.50 "$1,625.07" $914.10 $692.54 $618.50 "$1,178.27" $649.43 $896.83 $618.50 $692.54 $618.50 N/A N/A 102431 ERX HCPCS J3480 00338-0695-04 KCL IN NACL 40-0.9 MEQ/L-% IV SOLN BOTH IP/OP $56.50 $42.00 $0.47 $56.16 $25.27 $25.27 $25.27 $25.27 $56.16 $56.16 $56.16 $0.47 $56.16 $3.12 $3.12 $3.24 $3.00 $3.52 $56.16 $56.16 $33.22 $56.16 $56.16 $56.16 $56.16 $42.38 $56.16 $56.16 $56.16 $28.08 $28.08 $44.48 $56.16 $44.93 $25.27 $3.36 $56.16 $32.77 $56.16 $56.16 $56.16 $3.36 $56.16 N/A N/A 102452 ERX HCPCS 25000001 00338-0803-04 KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN BOTH IP/OP $52.00 $38.00 $9.23 $51.84 $51.84 $51.84 $51.84 $51.84 $51.84 $51.84 $9.23 $51.84 $51.84 $38.48 $38.48 $39.96 $27.01 $10.80 $51.84 $20.74 $51.84 $51.84 $51.84 $51.84 $51.84 $39.00 $51.84 $51.84 $51.84 $25.92 $25.92 $41.06 $51.84 $41.47 $33.70 $51.84 $51.84 $30.16 $51.84 $31.10 $51.84 $51.84 $51.84 N/A N/A 102456 ERX HCPCS 25000001 00338-0669-04 KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN BOTH IP/OP $52.00 $38.00 $9.23 $51.84 $51.84 $51.84 $51.84 $51.84 $51.84 $51.84 $9.23 $51.84 $51.84 $38.48 $38.48 $39.96 $27.01 $10.80 $51.84 $20.74 $51.84 $51.84 $51.84 $51.84 $51.84 $39.00 $51.84 $51.84 $51.84 $25.92 $25.92 $41.06 $51.84 $41.47 $33.70 $51.84 $51.84 $30.16 $51.84 $31.10 $51.84 $51.84 $51.84 N/A N/A 102458 ERX HCPCS 25000001 00338-0663-04 KCL IN DEXTROSE-NACL 20-5-0.2 MEQ/L-%-% IV SOLN BOTH IP/OP $48.00 $36.00 $8.46 $47.52 $47.52 $47.52 $47.52 $47.52 $47.52 $47.52 $8.46 $47.52 $47.52 $35.27 $35.27 $36.63 $24.76 $9.90 $47.52 $19.01 $47.52 $47.52 $47.52 $47.52 $47.52 $36.00 $47.52 $47.52 $47.52 $23.76 $23.76 $37.64 $47.52 $38.02 $30.89 $47.52 $47.52 $27.84 $47.52 $28.51 $47.52 $47.52 $47.52 N/A N/A 102459 ERX HCPCS 25000001 00338-0671-04 KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN BOTH IP/OP $30.50 $23.00 $5.38 $30.24 $30.24 $30.24 $30.24 $30.24 $30.24 $30.24 $5.38 $30.24 $30.24 $22.44 $22.44 $23.31 $15.76 $6.30 $30.24 $12.10 $30.24 $30.24 $30.24 $30.24 $30.24 $22.88 $30.24 $30.24 $30.24 $15.12 $15.12 $23.95 $30.24 $24.19 $19.66 $30.24 $30.24 $17.69 $30.24 $18.14 $30.24 $30.24 $30.24 N/A N/A 102578 ERX HCPCS 25000001 08290-3065-45 SODIUM CHLORIDE FLUSH 0.9 % IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 103756 ERX HCPCS 63700001 00078-0592-51 NILOTINIB HCL 150 MG PO CAPS BOTH IP/OP $690.00 $511.00 $143.79 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $689.92 $143.79 $689.92 $275.97 $689.92 $689.92 $689.92 $689.92 $689.92 $517.50 $689.92 $689.92 $689.92 $344.96 $344.96 $546.42 $689.92 $551.94 $448.45 $689.92 $689.92 $400.20 $689.92 $413.95 $689.92 $689.92 $689.92 N/A N/A 104015 ERX HCPCS J9043 00024-5824-11 CABAZITAXEL 60 MG/6ML IV SOLN BOTH IP/OP "$35,835.50" "$26,518.00" "$7,468.98" "$35,835.36" "$16,125.91" "$16,125.91" "$16,125.91" "$16,125.91" "$11,478.66" "$11,478.66" "$11,478.66" "$7,468.98" "$11,478.66" "$11,937.74" "$11,937.74" "$12,396.89" "$11,478.60" "$13,485.53" "$11,478.66" "$11,975.04" "$17,666.83" "$11,478.66" "$35,835.36" "$11,478.66" "$12,052.59" "$26,876.63" "$11,478.66" "$11,478.66" "$11,478.66" "$17,917.68" "$17,917.68" "$28,381.61" "$11,478.66" "$28,668.29" "$16,125.91" "$7,712.84" "$11,478.66" "$20,784.59" "$12,052.59" "$16,644.06" "$11,478.66" "$8,098.48" "$11,478.66" N/A N/A 104022 ERX HCPCS 63700001 67618-0107-60 MAGNESIUM CHLORIDE DELAY RELEASE 71.5 MG PO TAB BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 104100 ERX HCPCS J7527 00078-0594-51 EVEROLIMUS 2.5 MG PO TABS BOTH IP/OP "$1,983.00" "$1,467.00" $57.00 "$1,982.82" "$1,982.82" "$1,982.82" "$1,982.82" "$1,982.82" "$1,982.82" "$1,982.82" $59.20 "$1,982.82" "$1,982.82" $59.28 $59.28 $61.56 $57.00 $413.24 "$1,982.82" $793.13 "$1,982.82" "$1,982.82" "$1,982.82" "$1,982.82" "$1,982.82" "$1,487.25" "$1,982.82" "$1,982.82" "$1,982.82" $991.41 $991.41 "$1,570.39" "$1,982.82" "$1,586.26" $892.27 "$1,982.82" "$1,982.82" "$1,150.14" "$1,982.82" "$1,189.69" "$1,982.82" "$1,982.82" "$1,982.82" N/A N/A 104175 ERX HCPCS J1650 00955-1004-10 ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY BOTH IP/OP $44.50 $33.00 $3.20 $44.27 $19.92 $19.92 $19.92 $19.92 $44.27 $44.27 $44.27 $9.23 $44.27 $3.33 $3.33 $3.46 $3.20 $9.23 $44.27 $44.27 $26.19 $44.27 $44.27 $44.27 $44.27 $33.38 $44.27 $44.27 $44.27 $22.14 $22.14 $35.06 $44.27 $35.42 $19.92 $8.79 $44.27 $25.81 $44.27 $44.27 $44.27 $9.23 $44.27 N/A N/A 104407 ERX HCPCS J0588 00259-1610-01 INCOBOTULINUMTOXINA 100 UNITS IM SOLR BOTH IP/OP "$1,589.50" "$1,176.00" $505.00 "$1,589.19" "$1,589.19" "$1,589.19" "$1,589.19" "$1,589.19" "$1,589.19" "$1,589.19" $505.00 "$1,589.19" "$1,589.19" $526.24 $526.24 $546.48 $506.00 $594.47 "$1,589.19" $635.68 "$1,589.19" "$1,589.19" "$1,589.19" "$1,589.19" "$1,589.19" "$1,192.13" "$1,589.19" "$1,589.19" "$1,589.19" $794.60 $794.60 "$1,258.64" "$1,589.19" "$1,271.35" $715.14 "$1,589.19" "$1,589.19" $921.91 "$1,589.19" $953.51 "$1,589.19" "$1,589.19" "$1,589.19" N/A N/A 104804 ERX HCPCS 63700001 00023-3205-03 BIMATOPROST 0.01 % OP SOLN BOTH IP/OP $868.00 $642.00 $180.83 $867.65 $867.65 $867.65 $867.65 $867.65 $867.65 $867.65 $867.65 $867.65 $867.65 $867.65 $867.65 $867.65 $867.65 $180.83 $867.65 $347.06 $867.65 $867.65 $867.65 $867.65 $867.65 $651.00 $867.65 $867.65 $867.65 $433.83 $433.83 $687.18 $867.65 $694.12 $563.97 $867.65 $867.65 $503.44 $867.65 $520.59 $867.65 $867.65 $867.65 N/A N/A 104822 ERX HCPCS 25000001 63323-0468-02 BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 104823 ERX HCPCS 25000001 00409-9045-17 BUPIVACAINE-EPINEPHRINE (PF) 0.5-1:200000 % IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 104827 ERX HCPCS 25000001 63323-0464-17 BUPIVACAINE HCL (PF) 0.25 % IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 104828 ERX HCPCS 25000001 00409-1162-10 BUPIVACAINE HCL (PF) 0.5 % IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 104858 ERX HCPCS 25000001 12496-1202-03 SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 2-0.5 MG SL FILM BOTH IP/OP $26.00 $19.00 $4.62 $25.98 $25.98 $25.98 $25.98 $25.98 $25.98 $25.98 $4.62 $25.98 $25.98 $19.28 $19.28 $20.03 $13.54 $5.41 $25.98 $10.39 $25.98 $25.98 $25.98 $25.98 $25.98 $19.50 $25.98 $25.98 $25.98 $12.99 $12.99 $20.58 $25.98 $20.78 $16.89 $25.98 $25.98 $15.08 $25.98 $15.59 $25.98 $25.98 $25.98 N/A N/A 104859 ERX HCPCS 25000001 12496-1208-03 SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 8-2 MG SL FILM BOTH IP/OP $47.00 $35.00 $8.29 $46.56 $46.56 $46.56 $46.56 $46.56 $46.56 $46.56 $8.29 $46.56 $46.56 $34.56 $34.56 $35.89 $24.26 $9.70 $46.56 $18.62 $46.56 $46.56 $46.56 $46.56 $46.56 $35.25 $46.56 $46.56 $46.56 $23.28 $23.28 $36.88 $46.56 $37.25 $30.26 $46.56 $46.56 $27.26 $46.56 $27.94 $46.56 $46.56 $46.56 N/A N/A 104955 ERX HCPCS J0257 00944-2884-01 ALPHA1-PROTEINASE INHIBITOR 1000 MG/50ML IV SOLN BOTH IP/OP "$1,976.00" "$1,462.00" $495.00 "$1,975.80" "$1,975.80" "$1,975.80" "$1,975.80" "$1,975.80" "$1,975.80" "$1,975.80" $495.00 "$1,975.80" "$1,975.80" $517.92 $517.92 $537.84 $498.00 $585.07 "$1,975.80" $790.32 "$1,975.80" "$1,975.80" "$1,975.80" "$1,975.80" "$1,975.80" "$1,482.00" "$1,975.80" "$1,975.80" "$1,975.80" $987.90 $987.90 "$1,564.83" "$1,975.80" "$1,580.64" $889.11 "$1,975.80" "$1,975.80" "$1,146.08" "$1,975.80" "$1,185.48" "$1,975.80" "$1,975.80" "$1,975.80" N/A N/A 105032 ERX HCPCS 25000001 63323-0491-57 LIDOCAINE HCL (PF) 0.5 % IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 105295 ERX HCPCS J9171 00143-9204-01 DOCETAXEL 20 MG/ML IV CONC BOTH IP/OP $279.50 $207.00 $9.20 $279.24 $125.66 $125.66 $125.66 $125.66 $279.24 $279.24 $279.24 $58.20 $279.24 $9.57 $9.57 $9.94 $9.20 $10.81 $279.24 $279.24 $165.17 $279.24 $279.24 $279.24 $279.24 $209.63 $279.24 $279.24 $279.24 $139.62 $139.62 $221.16 $279.24 $223.39 $125.66 $10.29 $279.24 $162.11 $279.24 $279.24 $279.24 $10.29 $279.24 N/A N/A 105342 ERX HCPCS 63700001 00597-0360-82 DABIGATRAN ETEXILATE MESYLATE 150 MG PO CAPS BOTH IP/OP $43.00 $32.00 $8.93 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $8.93 $42.86 $17.14 $42.86 $42.86 $42.86 $42.86 $42.86 $32.25 $42.86 $42.86 $42.86 $21.43 $21.43 $33.95 $42.86 $34.29 $27.86 $42.86 $42.86 $24.94 $42.86 $25.72 $42.86 $42.86 $42.86 N/A N/A 105512 ERX HCPCS 63700001 73302-0456-01 ULIPRISTAL ACETATE 30 MG PO TABS BOTH IP/OP $185.50 $137.00 $38.57 $185.07 $185.07 $185.07 $185.07 $185.07 $185.07 $185.07 $185.07 $185.07 $185.07 $185.07 $185.07 $185.07 $185.07 $38.57 $185.07 $74.03 $185.07 $185.07 $185.07 $185.07 $185.07 $139.13 $185.07 $185.07 $185.07 $92.54 $92.54 $146.58 $185.07 $148.06 $120.30 $185.07 $185.07 $107.59 $185.07 $111.04 $185.07 $185.07 $185.07 N/A N/A 105514 ERX HCPCS 63700001 00597-0355-09 DABIGATRAN ETEXILATE MESYLATE 75 MG PO CAPS BOTH IP/OP $43.00 $32.00 $8.93 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $8.93 $42.86 $17.14 $42.86 $42.86 $42.86 $42.86 $42.86 $32.25 $42.86 $42.86 $42.86 $21.43 $21.43 $33.95 $42.86 $34.29 $27.86 $42.86 $42.86 $24.94 $42.86 $25.72 $42.86 $42.86 $42.86 N/A N/A 105737 ERX HCPCS J9179 62856-0389-01 ERIBULIN MESYLATE 1 MG/2ML IV SOLN BOTH IP/OP "$3,730.00" "$2,760.00" $777.40 "$3,729.87" "$1,678.44" "$1,678.44" "$1,678.44" "$1,678.44" "$1,274.36" "$1,274.36" "$1,274.36" $777.40 "$1,274.36" "$1,325.38" "$1,325.38" "$1,376.35" "$1,274.40" "$1,497.22" "$1,274.36" "$1,269.19" "$1,838.83" "$1,274.36" "$3,729.87" "$1,274.36" "$1,338.08" "$2,797.50" "$1,274.36" "$1,274.36" "$1,274.36" "$1,864.94" "$1,864.94" "$2,954.06" "$1,274.36" "$2,983.90" "$1,678.44" "$1,425.80" "$1,274.36" "$2,163.40" "$1,338.08" "$1,847.82" "$1,274.36" "$1,425.80" "$1,274.36" N/A N/A 105747 ERX HCPCS J1453 67457-0889-10 FOSAPREPITANT DIMEGLUMINE 150 MG IV SOLR BOTH IP/OP "$1,090.50" $807.00 $28.50 "$1,090.22" $490.60 $490.60 $490.60 $490.60 "$1,090.22" "$1,090.22" "$1,090.22" $227.23 "$1,090.22" $29.64 $29.64 $30.78 $28.50 $33.48 "$1,090.22" "$1,090.22" $644.87 "$1,090.22" "$1,090.22" "$1,090.22" "$1,090.22" $817.88 "$1,090.22" "$1,090.22" "$1,090.22" $545.11 $545.11 $863.45 "$1,090.22" $872.18 $490.60 $31.89 "$1,090.22" $632.49 "$1,090.22" "$1,090.22" "$1,090.22" $31.89 "$1,090.22" N/A N/A 105768 ERX HCPCS J0897 55513-0730-01 DENOSUMAB 120 MG/1.7ML SC SOLN BOTH IP/OP "$8,045.50" "$5,954.00" "$1,676.86" "$8,045.38" "$3,620.42" "$3,620.42" "$3,620.42" "$3,620.42" "$2,544.60" "$2,544.60" "$2,544.60" "$1,676.86" "$2,544.60" "$2,647.01" "$2,647.01" "$2,748.82" "$2,545.20" "$2,990.21" "$2,544.60" "$2,762.16" "$3,966.37" "$2,544.60" "$8,045.38" "$2,544.60" "$2,671.83" "$6,034.13" "$2,544.60" "$2,544.60" "$2,544.60" "$4,022.69" "$4,022.69" "$6,371.94" "$2,544.60" "$6,436.30" "$3,620.42" "$2,847.57" "$2,544.60" "$4,666.39" "$2,671.83" "$3,689.67" "$2,544.60" "$2,847.57" "$2,544.60" N/A N/A 106031 ERX HCPCS 25000001 63402-0304-30 LURASIDONE HCL 40 MG PO TABS BOTH IP/OP $203.50 $151.00 $36.16 $203.16 $203.16 $203.16 $203.16 $203.16 $203.16 $203.16 $36.16 $203.16 $203.16 $150.79 $150.79 $156.60 $105.85 $42.34 $203.16 $81.26 $203.16 $203.16 $203.16 $203.16 $203.16 $152.63 $203.16 $203.16 $203.16 $101.58 $101.58 $160.90 $203.16 $162.53 $132.05 $203.16 $203.16 $118.03 $203.16 $121.90 $203.16 $203.16 $203.16 N/A N/A 106033 ERX HCPCS J0712 00456-0400-10 CEFTAROLINE FOSAMIL 400 MG IV SOLR BOTH IP/OP $846.50 $626.00 $140.40 $846.30 $846.30 $846.30 $846.30 $846.30 $846.30 $846.30 $140.40 $846.30 $846.30 $148.51 $148.51 $154.22 $142.80 $176.38 $846.30 $338.52 $846.30 $846.30 $846.30 $846.30 $846.30 $634.88 $846.30 $846.30 $846.30 $423.15 $423.15 $670.27 $846.30 $677.04 $380.84 $846.30 $846.30 $490.97 $846.30 $507.78 $846.30 $846.30 $846.30 N/A N/A 106034 ERX HCPCS J0712 00456-0600-10 CEFTAROLINE FOSAMIL 600 MG IV SOLR BOTH IP/OP $846.50 $626.00 $176.38 $846.30 $846.30 $846.30 $846.30 $846.30 $846.30 $846.30 $210.60 $846.30 $846.30 $222.77 $222.77 $231.34 $214.20 $176.38 $846.30 $338.52 $846.30 $846.30 $846.30 $846.30 $846.30 $634.88 $846.30 $846.30 $846.30 $423.15 $423.15 $670.27 $846.30 $677.04 $380.84 $846.30 $846.30 $490.97 $846.30 $507.78 $846.30 $846.30 $846.30 N/A N/A 106035 ERX HCPCS 25000001 64597-0301-60 DEXTROMETHORPHAN-QUINIDINE 20-10 MG PO CAPS BOTH IP/OP $121.00 $90.00 $21.50 $120.81 $120.81 $120.81 $120.81 $120.81 $120.81 $120.81 $21.50 $120.81 $120.81 $89.67 $89.67 $93.12 $62.94 $25.18 $120.81 $48.32 $120.81 $120.81 $120.81 $120.81 $120.81 $90.75 $120.81 $120.81 $120.81 $60.41 $60.41 $95.68 $120.81 $96.65 $78.53 $120.81 $120.81 $70.18 $120.81 $72.49 $120.81 $120.81 $120.81 N/A N/A 106115 ERX HCPCS J1561 13533-0800-20 IMMUNE GLOBULIN (HUMAN) 5 GM/50ML IJ SOLN BOTH IP/OP "$2,193.50" "$1,623.00" $457.16 "$2,193.41" $987.03 $987.03 $987.03 $987.03 $465.09 $465.09 $465.09 $457.16 $465.09 $483.70 $483.70 $502.31 $465.10 $546.42 $465.09 $477.03 "$1,081.35" $465.09 "$2,193.41" $465.09 $488.34 "$1,645.13" $465.09 $465.09 $465.09 "$1,096.71" "$1,096.71" "$1,737.18" $465.09 "$1,754.73" $987.03 $520.35 $465.09 "$1,272.23" $488.34 $674.38 $465.09 $520.35 $465.09 N/A N/A 106116 ERX HCPCS J1561 13533-0800-71 IMMUNE GLOBULIN (HUMAN) 10 GM/100ML IJ SOLN BOTH IP/OP "$3,828.50" "$2,833.00" $797.89 "$3,828.19" "$1,722.69" "$1,722.69" "$1,722.69" "$1,722.69" $930.18 $930.18 $930.18 $797.89 $930.18 $967.41 $967.41 "$1,004.62" $930.20 "$1,092.84" $930.18 $954.06 "$1,887.30" $930.18 "$3,828.19" $930.18 $976.69 "$2,871.38" $930.18 $930.18 $930.18 "$1,914.10" "$1,914.10" "$3,031.93" $930.18 "$3,062.55" "$1,722.69" "$1,040.71" $930.18 "$2,220.53" $976.69 "$1,348.76" $930.18 "$1,040.71" $930.18 N/A N/A 106117 ERX HCPCS J1561 13533-0800-25 IMMUNE GLOBULIN (HUMAN) 20 GM/200ML IJ SOLN BOTH IP/OP "$7,656.50" "$5,666.00" "$1,595.78" "$7,656.38" "$3,445.37" "$3,445.37" "$3,445.37" "$3,445.37" "$1,860.36" "$1,860.36" "$1,860.36" "$1,595.78" "$1,860.36" "$1,934.82" "$1,934.82" "$2,009.23" "$1,860.40" "$2,185.67" "$1,860.36" "$1,908.12" "$3,774.60" "$1,860.36" "$7,656.38" "$1,860.36" "$1,953.38" "$5,742.38" "$1,860.36" "$1,860.36" "$1,860.36" "$3,828.19" "$3,828.19" "$6,063.85" "$1,860.36" "$6,125.10" "$3,445.37" "$2,081.42" "$1,860.36" "$4,440.77" "$1,953.38" "$2,697.52" "$1,860.36" "$2,081.42" "$1,860.36" N/A N/A 106208 ERX HCPCS 25000001 51672-2073-08 LORATADINE 5 MG/5ML PO SOLN BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 106374 ERX HCPCS J0131 00781-3156-95 ACETAMINOPHEN 10 MG/ML IV SOLN BOTH IP/OP $177.00 $131.00 $23.20 $176.72 $176.72 $176.72 $176.72 $176.72 $176.72 $176.72 $23.20 $176.72 $176.72 $24.96 $24.96 $25.92 $24.00 $36.83 $176.72 $70.69 $176.72 $176.72 $176.72 $176.72 $176.72 $132.75 $176.72 $176.72 $176.72 $88.36 $88.36 $139.96 $176.72 $141.38 $79.52 $176.72 $176.72 $102.66 $176.72 $106.03 $176.72 $176.72 $176.72 N/A N/A 106621 ERX HCPCS 63700001 00003-0857-22 DASATINIB 140 MG PO TABS BOTH IP/OP "$1,794.00" "$1,328.00" $373.80 "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" $373.80 "$1,793.57" $717.43 "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,793.57" "$1,345.50" "$1,793.57" "$1,793.57" "$1,793.57" $896.79 $896.79 "$1,420.51" "$1,793.57" "$1,434.86" "$1,165.82" "$1,793.57" "$1,793.57" "$1,040.52" "$1,793.57" "$1,076.14" "$1,793.57" "$1,793.57" "$1,793.57" N/A N/A 106632 ERX HCPCS 63700001 59676-0571-01 ETRAVIRINE 200 MG PO TABS BOTH IP/OP $117.00 $87.00 $24.36 $116.90 $116.90 $116.90 $116.90 $116.90 $116.90 $116.90 $116.90 $116.90 $116.90 $116.90 $116.90 $116.90 $116.90 $24.36 $116.90 $46.76 $116.90 $116.90 $116.90 $116.90 $116.90 $87.75 $116.90 $116.90 $116.90 $58.45 $58.45 $92.58 $116.90 $93.52 $75.99 $116.90 $116.90 $67.86 $116.90 $70.14 $116.90 $116.90 $116.90 N/A N/A 106862 ERX HCPCS J9351 00409-0302-01 TOPOTECAN HCL 4 MG/4ML IV SOLN BOTH IP/OP $298.00 $221.00 $36.00 $297.65 $133.94 $133.94 $133.94 $133.94 $297.65 $297.65 $297.65 $62.04 $297.65 $37.44 $37.44 $38.88 $36.00 $42.29 $297.65 $297.65 $176.06 $297.65 $297.65 $297.65 $297.65 $223.50 $297.65 $297.65 $297.65 $148.83 $148.83 $235.74 $297.65 $238.12 $133.94 $40.28 $297.65 $172.84 $297.65 $297.65 $297.65 $40.28 $297.65 N/A N/A 107058 ERX HCPCS J1652 55111-0679-10 FONDAPARINUX SODIUM 5 MG/0.4ML SC SOLN BOTH IP/OP $446.50 $330.00 $14.30 $446.28 $446.28 $446.28 $446.28 $446.28 $446.28 $446.28 $14.30 $446.28 $446.28 $15.29 $15.29 $15.88 $14.70 $93.01 $446.28 $178.51 $446.28 $446.28 $446.28 $446.28 $446.28 $334.88 $446.28 $446.28 $446.28 $223.14 $223.14 $353.45 $446.28 $357.02 $200.83 $446.28 $446.28 $258.97 $446.28 $267.77 $446.28 $446.28 $446.28 N/A N/A 107059 ERX HCPCS J1652 55111-0680-02 FONDAPARINUX SODIUM 7.5 MG/0.6ML SC SOLN BOTH IP/OP $471.50 $349.00 $21.45 $471.23 $471.23 $471.23 $471.23 $471.23 $471.23 $471.23 $21.45 $471.23 $471.23 $22.93 $22.93 $23.81 $22.05 $98.21 $471.23 $188.49 $471.23 $471.23 $471.23 $471.23 $471.23 $353.63 $471.23 $471.23 $471.23 $235.62 $235.62 $373.21 $471.23 $376.98 $212.05 $471.23 $471.23 $273.47 $471.23 $282.74 $471.23 $471.23 $471.23 N/A N/A 107060 ERX HCPCS J1652 55111-0681-02 FONDAPARINUX SODIUM 10 MG/0.8ML SC SOLN BOTH IP/OP $471.50 $349.00 $28.60 $471.23 $471.23 $471.23 $471.23 $471.23 $471.23 $471.23 $28.60 $471.23 $471.23 $30.58 $30.58 $31.75 $29.40 $98.21 $471.23 $188.49 $471.23 $471.23 $471.23 $471.23 $471.23 $353.63 $471.23 $471.23 $471.23 $235.62 $235.62 $373.21 $471.23 $376.98 $212.05 $471.23 $471.23 $273.47 $471.23 $282.74 $471.23 $471.23 $471.23 N/A N/A 107078 ERX HCPCS J0561 60793-0701-10 PENICILLIN G BENZATHINE 1200000 UNIT/2ML IM SUSY BOTH IP/OP $477.50 $353.00 $90.24 $477.08 $214.69 $214.69 $214.69 $214.69 $90.26 $90.26 $90.26 $99.44 $90.26 $93.85 $93.85 $97.46 $90.24 $106.02 $90.26 $111.54 $282.19 $90.26 $477.08 $90.26 $94.78 $358.13 $90.26 $90.26 $90.26 $238.54 $238.54 $377.85 $90.26 $381.66 $214.69 $100.96 $90.26 $276.95 $94.78 $130.88 $90.26 $100.96 $90.26 N/A N/A 107084 ERX HCPCS J9303 55513-0954-01 PANITUMUMAB 100 MG/5ML IV SOLN BOTH IP/OP "$4,388.50" "$3,247.00" $914.61 "$4,388.21" "$1,974.69" "$1,974.69" "$1,974.69" "$1,974.69" "$1,304.07" "$1,304.07" "$1,304.07" $914.61 "$1,304.07" "$1,356.26" "$1,356.26" "$1,408.43" "$1,304.10" "$1,532.11" "$1,304.07" "$1,424.21" "$2,163.39" "$1,304.07" "$4,388.21" "$1,304.07" "$1,369.27" "$3,291.38" "$1,304.07" "$1,304.07" "$1,304.07" "$2,194.11" "$2,194.11" "$3,475.46" "$1,304.07" "$3,510.57" "$1,974.69" "$1,459.03" "$1,304.07" "$2,545.33" "$1,369.27" "$1,890.90" "$1,304.07" "$1,459.03" "$1,304.07" N/A N/A 107086 ERX HCPCS J9303 55513-0956-01 PANITUMUMAB 400 MG/20ML IV SOLN BOTH IP/OP "$17,553.00" "$12,989.00" "$3,658.44" "$17,552.78" "$7,898.75" "$7,898.75" "$7,898.75" "$7,898.75" "$5,216.28" "$5,216.28" "$5,216.28" "$3,658.44" "$5,216.28" "$5,425.06" "$5,425.06" "$5,633.71" "$5,216.40" "$6,128.44" "$5,216.28" "$5,696.84" "$8,653.52" "$5,216.28" "$17,552.78" "$5,216.28" "$5,477.09" "$13,164.75" "$5,216.28" "$5,216.28" "$5,216.28" "$8,776.39" "$8,776.39" "$13,901.80" "$5,216.28" "$14,042.22" "$7,898.75" "$5,836.11" "$5,216.28" "$10,180.74" "$5,477.09" "$7,563.61" "$5,216.28" "$5,836.11" "$5,216.28" N/A N/A 107089 ERX HCPCS 90378 66658-0230-01 PALIVIZUMAB 50 MG/0.5ML IM SOLN BOTH IP/OP "$5,091.00" "$3,767.00" "$1,563.15" "$5,090.57" "$5,090.57" "$5,090.57" "$5,090.57" "$5,090.57" "$5,090.57" "$5,090.57" "$1,563.15" "$5,090.57" "$5,090.57" "$1,693.41" "$1,693.41" "$1,758.54" "$1,628.28" "$1,912.97" "$5,090.57" "$2,036.23" "$5,090.57" "$5,090.57" "$5,090.57" "$5,090.57" "$5,090.57" "$3,818.25" "$5,090.57" "$5,090.57" "$5,090.57" "$2,545.29" "$2,545.29" "$4,031.73" "$5,090.57" "$4,072.46" "$2,290.76" "$5,090.57" "$5,090.57" "$2,952.78" "$5,090.57" "$3,054.34" "$5,090.57" "$5,090.57" "$5,090.57" N/A N/A 107090 ERX HCPCS J3262 50242-0135-01 TOCILIZUMAB 80 MG/4ML IV SOLN BOTH IP/OP "$1,702.00" "$1,259.00" $444.00 "$1,701.84" "$1,701.84" "$1,701.84" "$1,701.84" "$1,701.84" "$1,701.84" "$1,701.84" $444.00 "$1,701.84" "$1,701.84" $476.74 $476.74 $495.07 $458.40 $538.55 "$1,701.84" $680.74 "$1,701.84" "$1,701.84" "$1,701.84" "$1,701.84" "$1,701.84" "$1,276.50" "$1,701.84" "$1,701.84" "$1,701.84" $850.92 $850.92 "$1,347.86" "$1,701.84" "$1,361.47" $765.83 "$1,701.84" "$1,701.84" $987.16 "$1,701.84" "$1,021.10" "$1,701.84" "$1,701.84" "$1,701.84" N/A N/A 107091 ERX HCPCS J3262 50242-0136-01 TOCILIZUMAB 200 MG/10ML IV SOLN BOTH IP/OP "$3,713.00" "$2,748.00" "$1,110.00" "$3,712.84" "$3,712.84" "$3,712.84" "$3,712.84" "$3,712.84" "$3,712.84" "$3,712.84" "$1,110.00" "$3,712.84" "$3,712.84" "$1,191.84" "$1,191.84" "$1,237.68" "$1,146.00" "$1,346.37" "$3,712.84" "$1,485.14" "$3,712.84" "$3,712.84" "$3,712.84" "$3,712.84" "$3,712.84" "$2,784.75" "$3,712.84" "$3,712.84" "$3,712.84" "$1,856.42" "$1,856.42" "$2,940.57" "$3,712.84" "$2,970.27" "$1,670.78" "$3,712.84" "$3,712.84" "$2,153.54" "$3,712.84" "$2,227.70" "$3,712.84" "$3,712.84" "$3,712.84" N/A N/A 107092 ERX HCPCS J3262 50242-0137-01 TOCILIZUMAB 400 MG/20ML IV SOLN BOTH IP/OP "$7,426.00" "$5,495.00" "$2,220.00" "$7,425.67" "$7,425.67" "$7,425.67" "$7,425.67" "$7,425.67" "$7,425.67" "$7,425.67" "$2,220.00" "$7,425.67" "$7,425.67" "$2,383.68" "$2,383.68" "$2,475.36" "$2,292.00" "$2,692.74" "$7,425.67" "$2,970.27" "$7,425.67" "$7,425.67" "$7,425.67" "$7,425.67" "$7,425.67" "$5,569.50" "$7,425.67" "$7,425.67" "$7,425.67" "$3,712.84" "$3,712.84" "$5,881.13" "$7,425.67" "$5,940.54" "$3,341.55" "$7,425.67" "$7,425.67" "$4,307.08" "$7,425.67" "$4,455.40" "$7,425.67" "$7,425.67" "$7,425.67" N/A N/A 107094 ERX HCPCS J9035 50242-0060-01 BEVACIZUMAB 100 MG/4ML IV SOLN BOTH IP/OP "$2,553.50" "$1,890.00" $674.22 "$2,553.41" "$1,149.03" "$1,149.03" "$1,149.03" "$1,149.03" $678.61 $678.61 $678.61 $674.22 $678.61 $705.74 $705.74 $732.89 $678.60 $797.25 $678.61 $713.54 "$1,258.83" $678.61 "$2,553.41" $678.61 $712.54 "$1,915.13" $678.61 $678.61 $678.61 "$1,276.71" "$1,276.71" "$2,022.30" $678.61 "$2,042.73" "$1,149.03" $759.22 $678.61 "$1,481.03" $712.54 $983.98 $678.61 $759.22 $678.61 N/A N/A 107095 ERX HCPCS J9035 50242-0061-01 BEVACIZUMAB 400 MG/16ML IV SOLN BOTH IP/OP "$8,913.00" "$6,596.00" "$2,696.86" "$8,912.98" "$4,010.84" "$4,010.84" "$4,010.84" "$4,010.84" "$2,714.44" "$2,714.44" "$2,714.44" "$2,696.86" "$2,714.44" "$2,822.98" "$2,822.98" "$2,931.55" "$2,714.40" "$3,188.99" "$2,714.44" "$2,854.16" "$4,394.10" "$2,714.44" "$8,912.98" "$2,714.44" "$2,850.16" "$6,684.75" "$2,714.44" "$2,714.44" "$2,714.44" "$4,456.49" "$4,456.49" "$7,059.08" "$2,714.44" "$7,130.38" "$4,010.84" "$3,036.87" "$2,714.44" "$5,169.54" "$2,850.16" "$3,935.94" "$2,714.44" "$3,036.87" "$2,714.44" N/A N/A 107101 ERX HCPCS J9055 66733-0958-23 CETUXIMAB 200 MG/100ML IV SOLN BOTH IP/OP "$4,196.50" "$3,105.00" "$1,168.89" "$4,196.10" "$1,888.25" "$1,888.25" "$1,888.25" "$1,888.25" "$1,352.36" "$1,352.36" "$1,352.36" "$1,168.89" "$1,352.36" "$1,406.50" "$1,406.50" "$1,460.59" "$1,352.40" "$1,588.85" "$1,352.36" "$1,402.84" "$2,068.68" "$1,352.36" "$4,196.10" "$1,352.36" "$1,419.98" "$3,147.38" "$1,352.36" "$1,352.36" "$1,352.36" "$2,098.05" "$2,098.05" "$3,323.31" "$1,352.36" "$3,356.88" "$1,888.25" "$1,513.07" "$1,352.36" "$2,433.97" "$1,419.98" "$1,960.92" "$1,352.36" "$1,513.07" "$1,352.36" N/A N/A 107125 ERX HCPCS J9395 68462-0317-32 FULVESTRANT 250 MG/5ML IM SOSY BOTH IP/OP "$2,541.50" "$1,881.00" $120.86 "$2,541.39" "$1,143.63" "$1,143.63" "$1,143.63" "$1,143.63" $156.46 $156.46 $156.46 $956.22 $156.46 $162.76 $162.76 $169.02 $156.50 $183.86 $156.46 $120.86 "$1,252.91" $156.46 "$2,541.39" $156.46 $164.28 "$1,906.13" $156.46 $156.46 $156.46 "$1,270.70" "$1,270.70" "$2,012.78" $156.46 "$2,033.11" "$1,143.63" $175.09 $156.46 "$1,474.07" $164.28 $226.87 $156.46 $175.09 $156.46 N/A N/A 107142 ERX HCPCS 90744 00006-4981-00 HEPATITIS B VAC RECOMBINANT 5 MCG/0.5ML IJ SUSP BOTH IP/OP $125.50 $93.00 $17.79 $125.25 $56.36 $56.36 $56.36 $56.36 $32.57 $32.57 $28.22 $26.11 $32.57 $29.91 $29.91 $31.06 $28.76 $26.10 $125.25 $50.10 $74.09 $32.57 $32.57 $32.57 $125.25 $94.13 $32.57 $17.79 $32.57 $62.63 $62.63 $99.20 $32.57 $100.20 $56.36 $24.86 $32.57 $72.79 $125.25 $75.15 $32.57 $26.10 $32.57 N/A N/A 107147 ERX HCPCS J1956 00143-9722-24 LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN BOTH IP/OP $31.50 $23.00 $0.98 $31.11 $14.00 $14.00 $14.00 $14.00 $31.11 $31.11 $31.11 $6.48 $31.11 $1.02 $1.02 $1.06 $0.98 $6.48 $31.11 $31.11 $18.40 $31.11 $31.11 $31.11 $31.11 $23.63 $31.11 $31.11 $31.11 $15.56 $15.56 $24.64 $31.11 $24.89 $14.00 $6.17 $31.11 $18.27 $31.11 $31.11 $31.11 $6.48 $31.11 N/A N/A 107148 ERX HCPCS J1956 00143-9721-24 LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN BOTH IP/OP $32.00 $24.00 $1.96 $31.54 $14.19 $14.19 $14.19 $14.19 $31.54 $31.54 $31.54 $6.57 $31.54 $2.04 $2.04 $2.12 $1.96 $6.57 $31.54 $31.54 $18.66 $31.54 $31.54 $31.54 $31.54 $24.00 $31.54 $31.54 $31.54 $15.77 $15.77 $24.98 $31.54 $25.23 $14.19 $6.26 $31.54 $18.56 $31.54 $31.54 $31.54 $6.57 $31.54 N/A N/A 107149 ERX HCPCS J1956 25021-0132-83 LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN BOTH IP/OP $57.50 $43.00 $2.94 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $3.06 $3.06 $3.18 $2.94 $11.89 $57.03 $57.03 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 $57.03 $33.35 $57.03 $57.03 $57.03 $11.89 $57.03 N/A N/A 107150 ERX HCPCS J2543 00206-8862-01 PIPERACILLIN-TAZOBACTAM IN DEX 4-0.5 GM/100ML IV SOLN FROZEN BOTH IP/OP $121.50 $90.00 $5.68 $121.39 $54.63 $54.63 $54.63 $54.63 $121.39 $121.39 $121.39 $26.18 $121.39 $5.91 $5.91 $6.13 $5.68 $6.67 $121.39 $121.39 $71.80 $121.39 $121.39 $121.39 $121.39 $91.13 $121.39 $121.39 $121.39 $60.70 $60.70 $96.14 $121.39 $97.11 $54.63 $6.35 $121.39 $70.47 $121.39 $121.39 $121.39 $6.35 $121.39 N/A N/A 107151 ERX HCPCS J9171 45963-0765-52 DOCETAXEL 80 MG/4ML IV CONC BOTH IP/OP "$2,563.50" "$1,897.00" $36.80 "$2,563.20" "$1,153.44" "$1,153.44" "$1,153.44" "$1,153.44" "$2,563.20" "$2,563.20" "$2,563.20" $534.23 "$2,563.20" $38.27 $38.27 $39.74 $36.80 $43.23 "$2,563.20" "$2,563.20" "$1,263.66" "$2,563.20" "$2,563.20" "$2,563.20" "$2,563.20" "$1,922.63" "$2,563.20" "$2,563.20" "$2,563.20" "$1,281.60" "$1,281.60" "$2,030.05" "$2,563.20" "$2,050.56" "$1,153.44" $41.17 "$2,563.20" "$1,486.83" "$2,563.20" "$2,563.20" "$2,563.20" $41.17 "$2,563.20" N/A N/A 107154 ERX HCPCS 63700001 58406-0010-04 ETANERCEPT 25 MG/0.5ML SC SOSY BOTH IP/OP "$2,464.00" "$1,823.00" $513.47 "$2,463.76" "$2,463.76" "$2,463.76" "$2,463.76" "$2,463.76" "$2,463.76" "$2,463.76" "$2,463.76" "$2,463.76" "$2,463.76" "$2,463.76" "$2,463.76" "$2,463.76" "$2,463.76" $513.47 "$2,463.76" $985.50 "$2,463.76" "$2,463.76" "$2,463.76" "$2,463.76" "$2,463.76" "$1,848.00" "$2,463.76" "$2,463.76" "$2,463.76" "$1,231.88" "$1,231.88" "$1,951.30" "$2,463.76" "$1,971.01" "$1,601.44" "$2,463.76" "$2,463.76" "$1,429.12" "$2,463.76" "$1,478.26" "$2,463.76" "$2,463.76" "$2,463.76" N/A N/A 107156 ERX HCPCS 90713 49281-0860-10 POLIOVIRUS VACCINE INACTIVATED IJ INJ BOTH IP/OP $194.00 $144.00 $9.40 $193.52 $87.08 $87.08 $87.08 $87.08 $193.52 $193.52 $193.52 $9.40 $193.52 $38.37 $38.37 $39.84 $36.89 $43.34 $193.52 $193.52 $114.47 $193.52 $193.52 $193.52 $193.52 $145.50 $193.52 $193.52 $193.52 $96.76 $96.76 $153.27 $193.52 $154.82 $87.08 $41.27 $193.52 $112.52 $193.52 $193.52 $193.52 $41.27 $193.52 N/A N/A 107157 ERX HCPCS J0744 00409-4777-23 CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN BOTH IP/OP $22.00 $16.00 $0.95 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $0.99 $0.99 $1.03 $0.95 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 107158 ERX HCPCS J0278 00703-9032-01 AMIKACIN SULFATE 500 MG/2ML IJ SOLN BOTH IP/OP $64.00 $47.00 $4.55 $63.53 $63.53 $63.53 $63.53 $63.53 $63.53 $63.53 $5.30 $63.53 $63.53 $4.73 $4.73 $4.91 $4.55 $5.35 $63.53 $25.41 $63.53 $63.53 $63.53 $63.53 $63.53 $48.00 $63.53 $63.53 $63.53 $31.77 $31.77 $50.32 $63.53 $50.82 $28.59 $63.53 $63.53 $37.12 $63.53 $38.12 $63.53 $63.53 $63.53 N/A N/A 107159 ERX HCPCS J0278 00703-9040-03 AMIKACIN SULFATE 1 GM/4ML IJ SOLN BOTH IP/OP $117.50 $87.00 $9.10 $117.06 $117.06 $117.06 $117.06 $117.06 $117.06 $117.06 $10.60 $117.06 $117.06 $9.46 $9.46 $9.83 $9.10 $10.69 $117.06 $46.82 $117.06 $117.06 $117.06 $117.06 $117.06 $88.13 $117.06 $117.06 $117.06 $58.53 $58.53 $92.71 $117.06 $93.65 $52.68 $117.06 $117.06 $68.15 $117.06 $70.24 $117.06 $117.06 $117.06 N/A N/A 107160 ERX HCPCS 25000001 63323-0282-60 CLINDAMYCIN PHOSPHATE 9 GM/60ML IJ SOLN BOTH IP/OP $112.00 $83.00 $19.94 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $112.00 $19.94 $112.00 $112.00 $83.13 $83.13 $86.33 $58.35 $23.34 $112.00 $44.80 $112.00 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $72.80 $112.00 $112.00 $64.96 $112.00 $67.20 $112.00 $112.00 $112.00 N/A N/A 107378 ERX HCPCS J0490 49401-0101-01 BELIMUMAB 120 MG IV SOLR BOTH IP/OP "$1,889.00" "$1,398.00" $393.68 "$1,888.82" $849.97 $849.97 $849.97 $849.97 $578.80 $578.80 $578.80 $393.68 $578.80 $601.91 $601.91 $625.06 $578.76 $679.95 $578.80 $602.48 $931.19 $578.80 "$1,888.82" $578.80 $607.74 "$1,416.75" $578.80 $578.80 $578.80 $944.41 $944.41 "$1,495.95" $578.80 "$1,511.06" $849.97 $647.52 $578.80 "$1,095.62" $607.74 $839.25 $578.80 $647.52 $578.80 N/A N/A 107379 ERX HCPCS J0490 49401-0102-01 BELIMUMAB 400 MG IV SOLR BOTH IP/OP "$5,494.50" "$4,066.00" "$1,145.10" "$5,494.05" "$2,472.32" "$2,472.32" "$2,472.32" "$2,472.32" "$1,929.32" "$1,929.32" "$1,929.32" "$1,145.10" "$1,929.32" "$2,006.37" "$2,006.37" "$2,083.54" "$1,929.20" "$2,266.50" "$1,929.32" "$2,008.28" "$2,708.57" "$1,929.32" "$5,494.05" "$1,929.32" "$2,025.79" "$4,120.88" "$1,929.32" "$1,929.32" "$1,929.32" "$2,747.03" "$2,747.03" "$4,351.29" "$1,929.32" "$4,395.24" "$2,472.32" "$2,158.39" "$1,929.32" "$3,186.81" "$2,025.79" "$2,797.51" "$1,929.32" "$2,158.39" "$1,929.32" N/A N/A 107443 ERX HCPCS J9171 67457-0532-08 DOCETAXEL 80 MG/8ML IV SOLN BOTH IP/OP $997.00 $738.00 $36.80 $996.60 $448.47 $448.47 $448.47 $448.47 $996.60 $996.60 $996.60 $207.72 $996.60 $38.27 $38.27 $39.74 $36.80 $43.23 $996.60 $996.60 $589.49 $996.60 $996.60 $996.60 $996.60 $747.75 $996.60 $996.60 $996.60 $498.30 $498.30 $789.31 $996.60 $797.28 $448.47 $41.17 $996.60 $578.26 $996.60 $996.60 $996.60 $41.17 $996.60 N/A N/A 107446 ERX HCPCS J9171 43066-0001-01 DOCETAXEL 20 MG/2ML IV SOLN BOTH IP/OP $189.50 $140.00 $9.20 $189.03 $85.06 $85.06 $85.06 $85.06 $189.03 $189.03 $189.03 $39.40 $189.03 $9.57 $9.57 $9.94 $9.20 $10.81 $189.03 $189.03 $111.81 $189.03 $189.03 $189.03 $189.03 $142.13 $189.03 $189.03 $189.03 $94.52 $94.52 $149.71 $189.03 $151.22 $85.06 $10.29 $189.03 $109.91 $189.03 $189.03 $189.03 $10.29 $189.03 N/A N/A 107491 ERX HCPCS J9228 00003-2327-11 IPILIMUMAB 50 MG/10ML IV SOLN BOTH IP/OP "$22,930.50" "$16,969.00" "$4,779.28" "$22,930.47" "$10,318.71" "$10,318.71" "$10,318.71" "$10,318.71" "$8,035.15" "$8,035.15" "$8,035.15" "$4,779.28" "$8,035.15" "$8,356.40" "$8,356.40" "$8,677.80" "$8,035.00" "$9,439.85" "$8,035.15" "$8,272.65" "$11,304.72" "$8,035.15" "$22,930.47" "$8,035.15" "$8,436.91" "$17,197.88" "$8,035.15" "$8,035.15" "$8,035.15" "$11,465.24" "$11,465.24" "$18,160.93" "$8,035.15" "$18,344.38" "$10,318.71" "$7,712.84" "$8,035.15" "$13,299.69" "$8,436.91" "$11,650.97" "$8,035.15" "$8,098.48" "$8,035.15" N/A N/A 107492 ERX HCPCS J9228 00003-2328-22 IPILIMUMAB 200 MG/40ML IV SOLN BOTH IP/OP "$91,722.00" "$67,874.00" "$7,712.84" "$91,721.57" "$41,274.71" "$41,274.71" "$41,274.71" "$41,274.71" "$32,140.60" "$32,140.60" "$32,140.60" "$9,417.94" "$32,140.60" "$33,425.60" "$33,425.60" "$34,711.20" "$32,140.00" "$37,759.39" "$32,140.60" "$33,090.60" "$45,218.73" "$32,140.60" "$91,721.57" "$32,140.60" "$33,747.63" "$68,791.50" "$32,140.60" "$32,140.60" "$32,140.60" "$45,860.79" "$45,860.79" "$72,643.48" "$32,140.60" "$73,377.26" "$41,274.71" "$7,712.84" "$32,140.60" "$53,198.76" "$33,747.63" "$46,603.87" "$32,140.60" "$8,098.48" "$32,140.60" N/A N/A 107815 ERX HCPCS 63700001 33342-0238-07 NEVIRAPINE ER 400 MG PO TB24 BOTH IP/OP $86.00 $64.00 $17.86 $85.68 $85.68 $85.68 $85.68 $85.68 $85.68 $85.68 $85.68 $85.68 $85.68 $85.68 $85.68 $85.68 $85.68 $17.86 $85.68 $34.27 $85.68 $85.68 $85.68 $85.68 $85.68 $64.50 $85.68 $85.68 $85.68 $42.84 $42.84 $67.86 $85.68 $68.54 $55.69 $85.68 $85.68 $49.88 $85.68 $51.41 $85.68 $85.68 $85.68 N/A N/A 107843 ERX HCPCS 63700001 62103-0333-02 ZINC OXIDE 16 % EX OINT BOTH IP/OP $25.00 $19.00 $5.13 $24.63 $24.63 $24.63 $24.63 $24.63 $24.63 $24.63 $24.63 $24.63 $24.63 $24.63 $24.63 $24.63 $24.63 $5.13 $24.63 $9.85 $24.63 $24.63 $24.63 $24.63 $24.63 $18.75 $24.63 $24.63 $24.63 $12.32 $12.32 $19.51 $24.63 $19.70 $16.01 $24.63 $24.63 $14.50 $24.63 $14.78 $24.63 $24.63 $24.63 N/A N/A 108161 ERX HCPCS 63700001 00456-1120-30 VILAZODONE HCL 20 MG PO TABS BOTH IP/OP $57.50 $43.00 $11.92 $57.18 $57.18 $57.18 $57.18 $57.18 $57.18 $57.18 $57.18 $57.18 $57.18 $57.18 $57.18 $57.18 $57.18 $11.92 $57.18 $22.87 $57.18 $57.18 $57.18 $57.18 $57.18 $43.13 $57.18 $57.18 $57.18 $28.59 $28.59 $45.29 $57.18 $45.74 $37.17 $57.18 $57.18 $33.35 $57.18 $34.31 $57.18 $57.18 $57.18 N/A N/A 108272 ERX HCPCS 63600001 57894-0150-12 ABIRATERONE ACETATE 250 MG PO TABS BOTH IP/OP "$1,315.50" $973.00 $234.10 "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" $234.10 "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" $274.09 "$1,315.15" $526.06 "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" $986.63 "$1,315.15" "$1,315.15" "$1,315.15" $657.58 $657.58 "$1,041.60" "$1,315.15" "$1,052.12" $591.82 "$1,315.15" "$1,315.15" $762.99 "$1,315.15" $789.09 "$1,315.15" "$1,315.15" "$1,315.15" N/A N/A 108405 ERX HCPCS 63700001 59676-0278-01 RILPIVIRINE HCL 25 MG PO TABS BOTH IP/OP $193.50 $143.00 $40.30 $193.36 $193.36 $193.36 $193.36 $193.36 $193.36 $193.36 $193.36 $193.36 $193.36 $193.36 $193.36 $193.36 $193.36 $40.30 $193.36 $77.34 $193.36 $193.36 $193.36 $193.36 $193.36 $145.13 $193.36 $193.36 $193.36 $96.68 $96.68 $153.14 $193.36 $154.69 $125.68 $193.36 $193.36 $112.23 $193.36 $116.02 $193.36 $193.36 $193.36 N/A N/A 108619 ERX HCPCS J0282 43066-0150-10 AMIODARONE HCL IN DEXTROSE 150-4.21 MG/100ML-% IV SOLN BOTH IP/OP $166.00 $123.00 $2.04 $165.57 $165.57 $165.57 $165.57 $165.57 $165.57 $165.57 $2.04 $165.57 $165.57 $2.24 $2.24 $2.32 $2.15 $34.51 $165.57 $66.23 $165.57 $165.57 $165.57 $165.57 $165.57 $124.50 $165.57 $165.57 $165.57 $82.79 $82.79 $131.13 $165.57 $132.46 $74.51 $165.57 $165.57 $96.28 $165.57 $99.34 $165.57 $165.57 $165.57 N/A N/A 108620 ERX HCPCS J0282 43066-0360-20 AMIODARONE HCL IN DEXTROSE 360-4.14 MG/200ML-% IV SOLN BOTH IP/OP $198.50 $147.00 $4.90 $198.34 $198.34 $198.34 $198.34 $198.34 $198.34 $198.34 $4.90 $198.34 $198.34 $5.37 $5.37 $5.57 $5.16 $41.34 $198.34 $79.34 $198.34 $198.34 $198.34 $198.34 $198.34 $148.88 $198.34 $198.34 $198.34 $99.17 $99.17 $157.09 $198.34 $158.67 $89.25 $198.34 $198.34 $115.13 $198.34 $119.00 $198.34 $198.34 $198.34 N/A N/A 108708 ERX HCPCS 63700001 52015-0080-01 FIDAXOMICIN 200 MG PO TABS BOTH IP/OP $851.50 $630.00 $177.45 $851.43 $851.43 $851.43 $851.43 $851.43 $851.43 $851.43 $851.43 $851.43 $851.43 $851.43 $851.43 $851.43 $851.43 $177.45 $851.43 $340.57 $851.43 $851.43 $851.43 $851.43 $851.43 $638.63 $851.43 $851.43 $851.43 $425.72 $425.72 $674.33 $851.43 $681.14 $553.43 $851.43 $851.43 $493.87 $851.43 $510.86 $851.43 $851.43 $851.43 N/A N/A 108992 ERX HCPCS J0485 00003-0371-13 BELATACEPT 250 MG IV SOLR BOTH IP/OP "$2,646.00" "$1,958.00" $947.50 "$2,645.63" "$2,645.63" "$2,645.63" "$2,645.63" "$2,645.63" "$2,645.63" "$2,645.63" $950.00 "$2,645.63" "$2,645.63" $985.40 $985.40 "$1,023.30" $947.50 "$1,113.16" "$2,645.63" "$1,058.25" "$2,645.63" "$2,645.63" "$2,645.63" "$2,645.63" "$2,645.63" "$1,984.50" "$2,645.63" "$2,645.63" "$2,645.63" "$1,322.82" "$1,322.82" "$2,095.34" "$2,645.63" "$2,116.50" "$1,190.53" "$2,645.63" "$2,645.63" "$1,534.68" "$2,645.63" "$1,587.38" "$2,645.63" "$2,645.63" "$2,645.63" N/A N/A 109063 ERX HCPCS J9217 00074-3473-03 LEUPROLIDE ACETATE (6 MONTH) 45 MG IM KIT BOTH IP/OP "$32,659.50" "$24,168.00" "$1,035.37" "$32,659.27" "$14,696.67" "$14,696.67" "$14,696.67" "$14,696.67" "$1,204.40" "$1,204.40" "$1,204.40" "$1,480.99" "$1,204.40" "$1,252.56" "$1,252.56" "$1,300.73" "$1,204.38" "$1,414.96" "$1,204.40" "$1,035.37" "$16,101.02" "$1,204.40" "$32,659.27" "$1,204.40" "$1,264.62" "$24,494.63" "$1,204.40" "$1,204.40" "$1,204.40" "$16,329.64" "$16,329.64" "$25,866.14" "$1,204.40" "$26,127.42" "$14,696.67" "$1,347.46" "$1,204.40" "$18,942.51" "$1,264.62" "$1,746.38" "$1,204.40" "$1,347.46" "$1,204.40" N/A N/A 109481 ERX HCPCS 63700001 50458-0580-10 RIVAROXABAN 10 MG PO TABS BOTH IP/OP $86.50 $64.00 $18.00 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $18.00 $86.36 $34.54 $86.36 $86.36 $86.36 $86.36 $86.36 $64.88 $86.36 $86.36 $86.36 $43.18 $43.18 $68.40 $86.36 $69.09 $56.13 $86.36 $86.36 $50.17 $86.36 $51.82 $86.36 $86.36 $86.36 N/A N/A 109484 ERX HCPCS 63700001 00186-0777-39 TICAGRELOR 90 MG PO TABS BOTH IP/OP $38.00 $28.00 $7.89 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $7.89 $37.85 $15.14 $37.85 $37.85 $37.85 $37.85 $37.85 $28.50 $37.85 $37.85 $37.85 $18.93 $18.93 $29.98 $37.85 $30.28 $24.60 $37.85 $37.85 $22.04 $37.85 $22.71 $37.85 $37.85 $37.85 N/A N/A 109651 ERX HCPCS 25000001 00004-0822-05 OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR BOTH IP/OP $633.00 $468.00 $112.59 $632.52 $632.52 $632.52 $632.52 $632.52 $632.52 $632.52 $112.59 $632.52 $632.52 $469.46 $469.46 $487.55 $329.54 $131.82 $632.52 $253.01 $632.52 $632.52 $632.52 $632.52 $632.52 $474.75 $632.52 $632.52 $632.52 $316.26 $316.26 $500.96 $632.52 $506.02 $411.14 $632.52 $632.52 $367.14 $632.52 $379.51 $632.52 $632.52 $632.52 N/A N/A 110050 ERX HCPCS 25000001 99999-6006-74 PENICILLIN G 100 UNITS/ML ID INJ BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 110052 ERX HCPCS 25000001 99999-6006-75 PENICILLIN G 1000 UNITS/ML ID INJ BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 110232 ERX HCPCS 63700001 61958-1101-01 COMPLERA:EMTRICITAB-RILPIVIR-TENOFOVIR200-25-300MGTAB BOTH IP/OP $479.50 $355.00 $99.91 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $99.91 $479.41 $191.76 $479.41 $479.41 $479.41 $479.41 $479.41 $359.63 $479.41 $479.41 $479.41 $239.71 $239.71 $379.69 $479.41 $383.53 $311.62 $479.41 $479.41 $278.11 $479.41 $287.65 $479.41 $479.41 $479.41 N/A N/A 110284 ERX HCPCS 63700001 50242-0090-02 VEMURAFENIB 240 MG PO TABS BOTH IP/OP $719.50 $532.00 $149.87 $719.13 $719.13 $719.13 $719.13 $719.13 $719.13 $719.13 $719.13 $719.13 $719.13 $719.13 $719.13 $719.13 $719.13 $149.87 $719.13 $287.65 $719.13 $719.13 $719.13 $719.13 $719.13 $539.63 $719.13 $719.13 $719.13 $359.57 $359.57 $569.55 $719.13 $575.30 $467.43 $719.13 $719.13 $417.31 $719.13 $431.48 $719.13 $719.13 $719.13 N/A N/A 110307 ERX HCPCS J9042 51144-0050-01 BRENTUXIMAB VEDOTIN 50 MG IV SOLR BOTH IP/OP "$29,274.50" "$21,663.00" "$9,467.00" "$29,274.12" "$29,274.12" "$29,274.12" "$29,274.12" "$29,274.12" "$29,274.12" "$29,274.12" "$9,467.00" "$29,274.12" "$29,274.12" "$10,220.60" "$10,220.60" "$10,613.70" "$9,827.50" "$11,545.75" "$29,274.12" "$11,709.65" "$29,274.12" "$29,274.12" "$29,274.12" "$29,274.12" "$29,274.12" "$21,955.88" "$29,274.12" "$29,274.12" "$29,274.12" "$14,637.06" "$14,637.06" "$23,185.10" "$29,274.12" "$23,419.30" "$13,173.35" "$29,274.12" "$9,827.35" "$16,979.21" "$29,274.12" "$17,564.47" "$29,274.12" "$29,274.12" "$29,274.12" N/A N/A 110349 ERX HCPCS 63700001 00069-8141-20 CRIZOTINIB 200 MG PO CAPS BOTH IP/OP "$1,278.00" $946.00 $266.34 "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" $266.34 "$1,277.95" $511.18 "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" $958.50 "$1,277.95" "$1,277.95" "$1,277.95" $638.98 $638.98 "$1,012.14" "$1,277.95" "$1,022.36" $830.67 "$1,277.95" "$1,277.95" $741.24 "$1,277.95" $766.77 "$1,277.95" "$1,277.95" "$1,277.95" N/A N/A 110350 ERX HCPCS 63700001 00069-8140-20 CRIZOTINIB 250 MG PO CAPS BOTH IP/OP "$1,278.00" $946.00 $266.34 "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" $266.34 "$1,277.95" $511.18 "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" "$1,277.95" $958.50 "$1,277.95" "$1,277.95" "$1,277.95" $638.98 $638.98 "$1,012.14" "$1,277.95" "$1,022.36" $830.67 "$1,277.95" "$1,277.95" $741.24 "$1,277.95" $766.77 "$1,277.95" "$1,277.95" "$1,277.95" N/A N/A 110369 ERX HCPCS J1569 00944-2700-05 GAMMAGARD 10 GM/100ML IJ SOLN BOTH IP/OP "$4,514.50" "$3,341.00" $930.04 "$4,514.15" "$2,031.37" "$2,031.37" "$2,031.37" "$2,031.37" $933.34 $933.34 $933.34 $940.86 $933.34 $970.74 $970.74 "$1,008.07" $933.40 "$1,096.60" $933.34 $930.04 "$2,225.48" $933.34 "$4,514.15" $933.34 $980.01 "$3,385.88" $933.34 $933.34 $933.34 "$2,257.08" "$2,257.08" "$3,575.21" $933.34 "$3,611.32" "$2,031.37" "$1,044.29" $933.34 "$2,618.41" $980.01 "$1,353.34" $933.34 "$1,044.29" $933.34 N/A N/A 110370 ERX HCPCS J1569 00944-2700-06 GAMMAGARD 20 GM/200ML IJ SOLN BOTH IP/OP "$9,028.50" "$6,681.00" "$1,860.08" "$9,028.29" "$4,062.73" "$4,062.73" "$4,062.73" "$4,062.73" "$1,866.68" "$1,866.68" "$1,866.68" "$1,881.72" "$1,866.68" "$1,941.47" "$1,941.47" "$2,016.14" "$1,866.80" "$2,193.19" "$1,866.68" "$1,860.08" "$4,450.95" "$1,866.68" "$9,028.29" "$1,866.68" "$1,960.01" "$6,771.38" "$1,866.68" "$1,866.68" "$1,866.68" "$4,514.15" "$4,514.15" "$7,150.41" "$1,866.68" "$7,222.63" "$4,062.73" "$2,088.58" "$1,866.68" "$5,236.53" "$1,960.01" "$2,706.69" "$1,866.68" "$2,088.58" "$1,866.68" N/A N/A 110577 ERX HCPCS 25000001 11704-0370-01 HYDROXOCOBALAMIN 5 G IV SOLR BOTH IP/OP "$2,631.50" "$1,947.00" $468.41 "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" $468.41 "$2,631.50" "$2,631.50" "$1,953.10" "$1,953.10" "$2,028.36" "$1,371.01" $548.43 "$2,631.50" "$1,052.60" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$1,973.63" "$2,631.50" "$2,631.50" "$2,631.50" "$1,315.75" "$1,315.75" "$2,084.15" "$2,631.50" "$2,105.20" "$1,710.48" "$2,631.50" "$2,631.50" "$1,526.27" "$2,631.50" "$1,578.90" "$2,631.50" "$2,631.50" "$2,631.50" N/A N/A 110604 ERX HCPCS J3489 25021-0826-82 ZOLEDRONIC ACID 4 MG/100ML IV SOLN BOTH IP/OP $258.00 $191.00 $23.08 $257.76 $115.99 $115.99 $115.99 $115.99 $257.76 $257.76 $257.76 $53.72 $257.76 $24.00 $24.00 $24.93 $23.08 $27.12 $257.76 $257.76 $152.47 $257.76 $257.76 $257.76 $257.76 $193.50 $257.76 $257.76 $257.76 $128.88 $128.88 $204.15 $257.76 $206.21 $115.99 $25.82 $257.76 $149.64 $257.76 $257.76 $257.76 $25.82 $257.76 N/A N/A 110617 ERX HCPCS J0883 99999-6013-13 ARGATROBAN 50 MG/50ML IV SOLN BOTH IP/OP "$2,768.50" "$2,049.00" $576.89 "$2,768.04" "$2,768.04" "$2,768.04" "$2,768.04" "$2,768.04" "$2,768.04" "$2,768.04" $950.00 "$2,768.04" "$2,768.04" "$1,014.00" "$1,014.00" "$1,053.00" $975.00 $576.89 "$2,768.04" "$1,107.22" "$2,768.04" "$2,768.04" "$2,768.04" "$2,768.04" "$2,768.04" "$2,076.38" "$2,768.04" "$2,768.04" "$2,768.04" "$1,384.02" "$1,384.02" "$2,192.29" "$2,768.04" "$2,214.43" "$1,245.62" "$2,768.04" "$2,768.04" "$1,605.73" "$2,768.04" "$1,660.82" "$2,768.04" "$2,768.04" "$2,768.04" N/A N/A 111020 ERX HCPCS 25000001 65702-0407-10 ACCU-CHEK AVIVA PLUS VI STRP BOTH IP/OP $335.50 $248.00 $59.71 $335.45 $335.45 $335.45 $335.45 $335.45 $335.45 $335.45 $59.71 $335.45 $335.45 $248.97 $248.97 $258.56 $174.77 $69.91 $335.45 $134.18 $335.45 $335.45 $335.45 $335.45 $335.45 $251.63 $335.45 $335.45 $335.45 $167.73 $167.73 $265.68 $335.45 $268.36 $218.04 $335.45 $335.45 $194.59 $335.45 $201.27 $335.45 $335.45 $335.45 N/A N/A 111273 ERX HCPCS 25000001 69238-1306-01 CLOBAZAM 20 MG PO TABS BOTH IP/OP $166.50 $123.00 $29.57 $166.11 $166.11 $166.11 $166.11 $166.11 $166.11 $166.11 $29.57 $166.11 $166.11 $123.29 $123.29 $128.04 $86.54 $34.62 $166.11 $66.44 $166.11 $166.11 $166.11 $166.11 $166.11 $124.88 $166.11 $166.11 $166.11 $83.06 $83.06 $131.56 $166.11 $132.89 $107.97 $166.11 $166.11 $96.57 $166.11 $99.67 $166.11 $166.11 $166.11 N/A N/A 111314 ERX HCPCS C9290 65250-0133-09 BUPIVACAINE LIPOSOME 1.3 % IJ SUSP BOTH IP/OP $778.50 $576.00 $154.47 $778.26 $350.22 $350.22 $350.22 $350.22 $778.26 $778.26 $778.26 $162.21 $778.26 $174.28 $174.28 $180.99 $167.58 $162.20 $778.26 $778.26 $460.34 $778.26 $778.26 $778.26 $778.26 $583.88 $778.26 $778.26 $778.26 $389.13 $389.13 $616.38 $778.26 $622.61 $350.22 $154.47 $778.26 $451.53 $778.26 $778.26 $778.26 $162.19 $778.26 N/A N/A 111314 ERX HCPCS C9290 65250-0266-09 BUPIVACAINE LIPOSOME 1.3 % IJ SUSP BOTH IP/OP $778.50 $576.00 $154.47 $778.26 $350.22 $350.22 $350.22 $350.22 $778.26 $778.26 $778.26 $162.21 $778.26 $174.28 $174.28 $180.99 $167.58 $162.20 $778.26 $778.26 $460.34 $778.26 $778.26 $778.26 $778.26 $583.88 $778.26 $778.26 $778.26 $389.13 $389.13 $616.38 $778.26 $622.61 $350.22 $154.47 $778.26 $451.53 $778.26 $778.26 $778.26 $162.19 $778.26 N/A N/A 111320 ERX HCPCS J9201 00409-0181-01 GEMCITABINE HCL 1 GM/26.3ML IV SOLN BOTH IP/OP $195.00 $144.00 $19.25 $811.87 $87.58 $87.58 $87.58 $87.58 $194.62 $194.62 $194.62 $811.87 $194.62 $20.02 $20.02 $20.79 $19.25 $22.62 $194.62 $194.62 $115.12 $194.62 $194.62 $194.62 $194.62 $146.25 $194.62 $194.62 $194.62 $97.31 $97.31 $154.14 $194.62 $155.70 $87.58 $21.54 $194.62 $113.10 $194.62 $194.62 $194.62 $21.54 $194.62 N/A N/A 111367 ERX HCPCS 63700001 50458-0578-10 RIVAROXABAN 15 MG PO TABS BOTH IP/OP $86.50 $64.00 $18.00 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $18.00 $86.36 $34.54 $86.36 $86.36 $86.36 $86.36 $86.36 $64.88 $86.36 $86.36 $86.36 $43.18 $43.18 $68.40 $86.36 $69.09 $56.13 $86.36 $86.36 $50.17 $86.36 $51.82 $86.36 $86.36 $86.36 N/A N/A 111368 ERX HCPCS 63700001 50458-0579-10 RIVAROXABAN 20 MG PO TABS BOTH IP/OP $86.50 $64.00 $18.00 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $86.36 $18.00 $86.36 $34.54 $86.36 $86.36 $86.36 $86.36 $86.36 $64.88 $86.36 $86.36 $86.36 $43.18 $43.18 $68.40 $86.36 $69.09 $56.13 $86.36 $86.36 $50.17 $86.36 $51.82 $86.36 $86.36 $86.36 N/A N/A 111436 ERX HCPCS 63700001 50881-0005-60 RUXOLITINIB PHOSPHATE 5 MG PO TABS BOTH IP/OP "$1,008.00" $746.00 $210.04 "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" $210.04 "$1,007.84" $403.14 "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" $756.00 "$1,007.84" "$1,007.84" "$1,007.84" $503.92 $503.92 $798.21 "$1,007.84" $806.27 $655.10 "$1,007.84" "$1,007.84" $584.64 "$1,007.84" $604.70 "$1,007.84" "$1,007.84" "$1,007.84" N/A N/A 111437 ERX HCPCS 63700001 50881-0010-60 RUXOLITINIB PHOSPHATE 10 MG PO TABS BOTH IP/OP "$1,008.00" $746.00 $210.04 "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" $210.04 "$1,007.84" $403.14 "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" $756.00 "$1,007.84" "$1,007.84" "$1,007.84" $503.92 $503.92 $798.21 "$1,007.84" $806.27 $655.10 "$1,007.84" "$1,007.84" $584.64 "$1,007.84" $604.70 "$1,007.84" "$1,007.84" "$1,007.84" N/A N/A 111438 ERX HCPCS 63700001 50881-0015-60 RUXOLITINIB PHOSPHATE 15 MG PO TABS BOTH IP/OP "$1,008.00" $746.00 $210.04 "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" $210.04 "$1,007.84" $403.14 "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" $756.00 "$1,007.84" "$1,007.84" "$1,007.84" $503.92 $503.92 $798.21 "$1,007.84" $806.27 $655.10 "$1,007.84" "$1,007.84" $584.64 "$1,007.84" $604.70 "$1,007.84" "$1,007.84" "$1,007.84" N/A N/A 111439 ERX HCPCS 63700001 50881-0020-60 RUXOLITINIB PHOSPHATE 20 MG PO TABS BOTH IP/OP "$1,008.00" $746.00 $210.04 "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" $210.04 "$1,007.84" $403.14 "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" $756.00 "$1,007.84" "$1,007.84" "$1,007.84" $503.92 $503.92 $798.21 "$1,007.84" $806.27 $655.10 "$1,007.84" "$1,007.84" $584.64 "$1,007.84" $604.70 "$1,007.84" "$1,007.84" "$1,007.84" N/A N/A 111440 ERX HCPCS 63700001 50881-0025-60 RUXOLITINIB PHOSPHATE 25 MG PO TABS BOTH IP/OP "$1,008.00" $746.00 $210.04 "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" $210.04 "$1,007.84" $403.14 "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" "$1,007.84" $756.00 "$1,007.84" "$1,007.84" "$1,007.84" $503.92 $503.92 $798.21 "$1,007.84" $806.27 $655.10 "$1,007.84" "$1,007.84" $584.64 "$1,007.84" $604.70 "$1,007.84" "$1,007.84" "$1,007.84" N/A N/A 111479 ERX HCPCS J0178 61755-0005-02 AFLIBERCEPT 2 MG/0.05ML INTRAVITREAL SOLN BOTH IP/OP "$5,173.00" "$3,828.00" "$1,078.10" "$5,172.60" "$2,327.67" "$2,327.67" "$2,327.67" "$2,327.67" "$1,831.49" "$1,831.49" "$1,831.49" "$1,078.10" "$1,831.49" "$1,904.76" "$1,904.76" "$1,978.02" "$1,831.50" "$2,151.72" "$1,831.49" "$1,787.10" "$2,550.09" "$1,831.49" "$5,172.60" "$1,831.49" "$1,923.07" "$3,879.75" "$1,831.49" "$1,831.49" "$1,831.49" "$2,586.30" "$2,586.30" "$4,096.70" "$1,831.49" "$4,138.08" "$2,327.67" "$2,049.08" "$1,831.49" "$3,000.34" "$1,923.07" "$2,655.67" "$1,831.49" "$2,049.08" "$1,831.49" N/A N/A 111525 ERX HCPCS J3490 63323-0648-10 LEVOTHYROXINE SODIUM 500 MCG IV SOLR BOTH IP/OP $440.00 $326.00 $87.26 $439.65 $197.84 $197.84 $197.84 $197.84 $439.65 $439.65 $439.65 $91.63 $439.65 $439.65 $439.65 $439.65 $439.65 $91.63 $439.65 $439.65 $260.05 $439.65 $439.65 $439.65 $439.65 $330.00 $439.65 $439.65 $439.65 $219.83 $219.83 $348.20 $439.65 $351.72 $197.84 $87.26 $439.65 $255.20 $439.65 $439.65 $439.65 $91.62 $439.65 N/A N/A 111526 ERX HCPCS 25000001 63323-0649-07 LEVOTHYROXINE SODIUM 100 MCG IV SOLR BOTH IP/OP $440.00 $326.00 $78.26 $439.65 $439.65 $439.65 $439.65 $439.65 $439.65 $439.65 $78.26 $439.65 $439.65 $326.31 $326.31 $338.88 $229.06 $91.63 $439.65 $175.86 $439.65 $439.65 $439.65 $439.65 $439.65 $330.00 $439.65 $439.65 $439.65 $219.83 $219.83 $348.20 $439.65 $351.72 $285.77 $439.65 $439.65 $255.20 $439.65 $263.79 $439.65 $439.65 $439.65 N/A N/A 112303 ERX HCPCS J1953 55150-0246-47 LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN BOTH IP/OP $133.00 $98.00 $4.50 $132.54 $132.54 $132.54 $132.54 $132.54 $132.54 $132.54 $4.50 $132.54 $132.54 $4.68 $4.68 $4.86 $4.50 $27.62 $132.54 $53.02 $132.54 $132.54 $132.54 $132.54 $132.54 $99.75 $132.54 $132.54 $132.54 $66.27 $66.27 $104.97 $132.54 $106.03 $59.64 $132.54 $132.54 $77.14 $132.54 $79.52 $132.54 $132.54 $132.54 N/A N/A 112304 ERX HCPCS J1953 67457-0265-00 LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN BOTH IP/OP $103.00 $76.00 $9.00 $102.69 $102.69 $102.69 $102.69 $102.69 $102.69 $102.69 $9.00 $102.69 $102.69 $9.36 $9.36 $9.72 $9.00 $21.40 $102.69 $41.08 $102.69 $102.69 $102.69 $102.69 $102.69 $77.25 $102.69 $102.69 $102.69 $51.35 $51.35 $81.33 $102.69 $82.15 $46.21 $102.69 $102.69 $59.74 $102.69 $61.61 $102.69 $102.69 $102.69 N/A N/A 112305 ERX HCPCS J1953 43598-0637-10 LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN BOTH IP/OP $191.50 $142.00 $13.50 $191.04 $191.04 $191.04 $191.04 $191.04 $191.04 $191.04 $13.50 $191.04 $191.04 $14.04 $14.04 $14.58 $13.50 $39.81 $191.04 $76.42 $191.04 $191.04 $191.04 $191.04 $191.04 $143.63 $191.04 $191.04 $191.04 $95.52 $95.52 $151.30 $191.04 $152.83 $85.97 $191.04 $191.04 $111.07 $191.04 $114.62 $191.04 $191.04 $191.04 N/A N/A 112380 ERX HCPCS 25000001 63402-0302-30 LURASIDONE HCL 20 MG PO TABS BOTH IP/OP $203.50 $151.00 $36.16 $203.16 $203.16 $203.16 $203.16 $203.16 $203.16 $203.16 $36.16 $203.16 $203.16 $150.79 $150.79 $156.60 $105.85 $42.34 $203.16 $81.26 $203.16 $203.16 $203.16 $203.16 $203.16 $152.63 $203.16 $203.16 $203.16 $101.58 $101.58 $160.90 $203.16 $162.53 $132.05 $203.16 $203.16 $118.03 $203.16 $121.90 $203.16 $203.16 $203.16 N/A N/A 112618 ERX HCPCS J2212 65649-0552-04 METHYLNALTREXONE BROMIDE 8 MG/0.4ML SC SOLN BOTH IP/OP $641.00 $474.00 $86.40 $640.63 $640.63 $640.63 $640.63 $640.63 $640.63 $640.63 $86.40 $640.63 $640.63 $93.18 $93.18 $96.77 $89.60 $133.51 $640.63 $256.25 $640.63 $640.63 $640.63 $640.63 $640.63 $480.75 $640.63 $640.63 $640.63 $320.32 $320.32 $507.38 $640.63 $512.50 $288.28 $640.63 $640.63 $371.78 $640.63 $384.38 $640.63 $640.63 $640.63 N/A N/A 112638 ERX HCPCS 63600001 50242-0140-01 VISMODEGIB 150 MG PO CAPS BOTH IP/OP "$1,485.50" "$1,099.00" $264.36 "$1,485.19" "$1,485.19" "$1,485.19" "$1,485.19" "$1,485.19" "$1,485.19" "$1,485.19" $264.36 "$1,485.19" "$1,485.19" "$1,485.19" "$1,485.19" "$1,485.19" "$1,485.19" $309.53 "$1,485.19" $594.08 "$1,485.19" "$1,485.19" "$1,485.19" "$1,485.19" "$1,485.19" "$1,114.13" "$1,485.19" "$1,485.19" "$1,485.19" $742.60 $742.60 "$1,176.27" "$1,485.19" "$1,188.15" $668.34 "$1,485.19" "$1,485.19" $861.59 "$1,485.19" $891.11 "$1,485.19" "$1,485.19" "$1,485.19" N/A N/A 112683 ERX HCPCS 25000001 00006-0078-82 JANUMET XR 50-500 MG (SITAGLIPTIN-METFORMIN ER) PO TB24 BOTH IP/OP $47.50 $35.00 $8.42 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $8.42 $47.28 $47.28 $35.09 $35.09 $36.44 $24.63 $9.85 $47.28 $18.91 $47.28 $47.28 $47.28 $47.28 $47.28 $35.63 $47.28 $47.28 $47.28 $23.64 $23.64 $37.45 $47.28 $37.82 $30.73 $47.28 $47.28 $27.55 $47.28 $28.37 $47.28 $47.28 $47.28 N/A N/A 112684 ERX HCPCS 25000001 00006-0080-82 JANUMET XR 50-1000 MG (SITAGLIPTIN-METFORMIN ER) PO TB24 BOTH IP/OP $47.50 $35.00 $8.42 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $47.28 $8.42 $47.28 $47.28 $35.09 $35.09 $36.44 $24.63 $9.85 $47.28 $18.91 $47.28 $47.28 $47.28 $47.28 $47.28 $35.63 $47.28 $47.28 $47.28 $23.64 $23.64 $37.45 $47.28 $37.82 $30.73 $47.28 $47.28 $27.55 $47.28 $28.37 $47.28 $47.28 $47.28 N/A N/A 112685 ERX HCPCS 25000001 00006-0081-31 JANUMET XR 100-1000 MG (SITAGLIPTIN-METFORMIN ER) PO TB24 BOTH IP/OP $87.50 $65.00 $15.51 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $87.12 $15.51 $87.12 $87.12 $64.66 $64.66 $67.15 $45.39 $18.16 $87.12 $34.85 $87.12 $87.12 $87.12 $87.12 $87.12 $65.63 $87.12 $87.12 $87.12 $43.56 $43.56 $69.00 $87.12 $69.70 $56.63 $87.12 $87.12 $50.75 $87.12 $52.27 $87.12 $87.12 $87.12 N/A N/A 112975 ERX HCPCS J7527 00078-0620-51 EVEROLIMUS 7.5 MG PO TABS BOTH IP/OP "$2,074.00" "$1,535.00" $171.00 "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" $177.60 "$2,073.99" "$2,073.99" $177.84 $177.84 $184.68 $171.00 $432.24 "$2,073.99" $829.60 "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$2,073.99" "$1,555.50" "$2,073.99" "$2,073.99" "$2,073.99" "$1,037.00" "$1,037.00" "$1,642.60" "$2,073.99" "$1,659.19" $933.30 "$2,073.99" "$2,073.99" "$1,202.92" "$2,073.99" "$1,244.39" "$2,073.99" "$2,073.99" "$2,073.99" N/A N/A 113288 ERX HCPCS 63700001 59572-0402-28 LENALIDOMIDE 2.5 MG PO CAPS BOTH IP/OP "$13,978.50" "$10,344.00" "$2,913.20" "$13,978.17" "$13,978.17" "$13,978.17" "$13,978.17" "$13,978.17" "$13,978.17" "$13,978.17" "$13,978.17" "$13,978.17" "$13,978.17" "$13,978.17" "$13,978.17" "$13,978.17" "$13,978.17" "$2,913.20" "$13,978.17" "$5,591.27" "$13,978.17" "$13,978.17" "$13,978.17" "$13,978.17" "$13,978.17" "$10,483.88" "$13,978.17" "$13,978.17" "$13,978.17" "$6,989.09" "$6,989.09" "$11,070.71" "$13,978.17" "$11,182.54" "$9,085.81" "$13,978.17" "$13,978.17" "$8,107.53" "$13,978.17" "$8,386.90" "$13,978.17" "$13,978.17" "$13,978.17" N/A N/A 113303 ERX HCPCS 63700001 00487-5901-99 RACEPINEPHRINE HCL 2.25 % IN NEBU BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 113304 ERX HCPCS 90716 00006-4827-00 VARICELLA VIRUS VACCINE LIVE 1350 PFU/0.5ML SC INJ BOTH IP/OP $666.00 $493.00 $9.40 $665.69 $299.56 $299.56 $299.56 $299.56 $665.69 $665.69 $144.82 $9.40 $665.69 $157.02 $157.02 $163.06 $150.98 $177.38 $665.69 $266.28 $393.76 $665.69 $665.69 $665.69 $665.69 $499.50 $665.69 $665.69 $665.69 $332.85 $332.85 $527.23 $665.69 $532.55 $299.56 $168.92 $665.69 $386.28 $665.69 $399.41 $665.69 $168.92 $665.69 N/A N/A 113363 ERX HCPCS 25000001 00054-3188-63 DIAZEPAM 5 MG/5ML PO SOLN BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 113624 ERX HCPCS J1324 00004-0381-40 ENFUVIRTIDE 90 MG SC SOLR BOTH IP/OP $257.00 $190.00 $53.51 $256.73 $256.73 $256.73 $256.73 $256.73 $256.73 $256.73 $57.60 $256.73 $256.73 $61.78 $61.78 $64.15 $59.40 $53.51 $256.73 $102.69 $256.73 $256.73 $256.73 $256.73 $256.73 $192.75 $256.73 $256.73 $256.73 $128.37 $128.37 $203.33 $256.73 $205.38 $115.53 $256.73 $256.73 $149.06 $256.73 $154.04 $256.73 $256.73 $256.73 N/A N/A 114621 ERX HCPCS 25000001 49100-0400-08 CULTURELLE KIDS PO PACK BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 115133 ERX HCPCS 25000001 99999-6007-10 TRICHLOROACETIC ACID 40 % EX SOLN BOTH IP/OP $86.50 $64.00 $15.38 $86.40 $86.40 $86.40 $86.40 $86.40 $86.40 $86.40 $15.38 $86.40 $86.40 $64.13 $64.13 $66.60 $45.01 $18.01 $86.40 $34.56 $86.40 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $56.16 $86.40 $86.40 $50.17 $86.40 $51.84 $86.40 $86.40 $86.40 N/A N/A 115145 ERX HCPCS J7315 49771-0002-01 MITOMYCIN 0.2 MG OP KIT BOTH IP/OP "$1,378.00" "$1,020.00" $273.44 "$1,377.72" $619.97 $619.97 $619.97 $619.97 "$1,377.72" "$1,377.72" "$1,377.72" $287.15 "$1,377.72" $426.40 $426.40 $442.80 $410.00 $287.13 "$1,377.72" "$1,377.72" $814.92 "$1,377.72" "$1,377.72" "$1,377.72" "$1,377.72" "$1,033.50" "$1,377.72" "$1,377.72" "$1,377.72" $688.86 $688.86 "$1,091.15" "$1,377.72" "$1,102.18" $619.97 $273.44 "$1,377.72" $799.24 "$1,377.72" "$1,377.72" "$1,377.72" $287.12 "$1,377.72" N/A N/A 115244 ERX HCPCS J9306 50242-0145-01 PERTUZUMAB 420 MG/14ML IV SOLN BOTH IP/OP "$17,717.50" "$13,111.00" "$3,692.74" "$17,717.36" "$7,972.81" "$7,972.81" "$7,972.81" "$7,972.81" "$5,693.10" "$5,693.10" "$5,693.10" "$3,692.74" "$5,693.10" "$5,923.01" "$5,923.01" "$6,150.82" "$5,695.20" "$6,690.95" "$5,693.10" "$6,059.34" "$8,734.66" "$5,693.10" "$17,717.36" "$5,693.10" "$5,977.76" "$13,288.13" "$5,693.10" "$5,693.10" "$5,693.10" "$8,858.68" "$8,858.68" "$14,032.15" "$5,693.10" "$14,173.89" "$7,972.81" "$6,371.79" "$5,693.10" "$10,276.15" "$5,977.76" "$8,255.00" "$5,693.10" "$6,371.79" "$5,693.10" N/A N/A 115824 ERX HCPCS J9250 00143-9519-10 METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN BOTH IP/OP $57.00 $42.00 $2.10 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $2.18 $2.18 $2.27 $2.10 $2.47 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $2.35 $57.00 $33.06 $57.00 $57.00 $57.00 $2.35 $57.00 N/A N/A 115826 ERX HCPCS J9260 61703-0408-41 METHOTREXATE SODIUM (PF) 1 GM/40ML IJ SOLN BOTH IP/OP $175.50 $130.00 $41.40 $175.44 $78.95 $78.95 $78.95 $78.95 $175.44 $175.44 $175.44 $54.05 $175.44 $43.06 $43.06 $44.71 $41.40 $48.64 $175.44 $175.44 $103.77 $175.44 $175.44 $175.44 $175.44 $131.63 $175.44 $175.44 $175.44 $87.72 $87.72 $138.95 $175.44 $140.35 $78.95 $46.32 $175.44 $101.79 $175.44 $175.44 $175.44 $46.32 $175.44 N/A N/A 115839 ERX HCPCS J9047 76075-0101-01 CARFILZOMIB 60 MG IV SOLR BOTH IP/OP "$8,330.00" "$6,164.00" "$1,736.15" "$8,329.85" "$3,748.43" "$3,748.43" "$3,748.43" "$3,748.43" "$2,466.66" "$2,466.66" "$2,466.66" "$1,736.15" "$2,466.66" "$2,565.26" "$2,565.26" "$2,663.93" "$2,466.60" "$2,897.86" "$2,466.66" "$2,685.84" "$4,106.62" "$2,466.66" "$8,329.85" "$2,466.66" "$2,589.99" "$6,247.50" "$2,466.66" "$2,466.66" "$2,466.66" "$4,164.93" "$4,164.93" "$6,597.24" "$2,466.66" "$6,663.88" "$3,748.43" "$2,759.63" "$2,466.66" "$4,831.40" "$2,589.99" "$3,576.66" "$2,466.66" "$2,759.63" "$2,466.66" N/A N/A 116010 ERX HCPCS J2300 99999-6011-83 NALBUPHINE (NUBAIN) 10 MG/0.5 ML IV SYRINGE BOTH IP/OP $27.00 $20.00 $2.85 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $2.85 $27.00 $27.00 $3.19 $3.19 $3.32 $3.07 $3.61 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $12.15 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 116012 ERX HCPCS 63700001 61958-1201-01 STRIBILD:150-150-200-300 MG PO TABS BOTH IP/OP $553.00 $409.00 $115.17 $552.60 $552.60 $552.60 $552.60 $552.60 $552.60 $552.60 $552.60 $552.60 $552.60 $552.60 $552.60 $552.60 $552.60 $115.17 $552.60 $221.04 $552.60 $552.60 $552.60 $552.60 $552.60 $414.75 $552.60 $552.60 $552.60 $276.30 $276.30 $437.66 $552.60 $442.08 $359.19 $552.60 $552.60 $320.74 $552.60 $331.56 $552.60 $552.60 $552.60 N/A N/A 116047 ERX HCPCS J9302 00078-0690-61 OFATUMUMAB 1000 MG/50ML IV CONC BOTH IP/OP "$16,870.50" "$12,484.00" "$6,396.00" "$16,870.25" "$16,870.25" "$16,870.25" "$16,870.25" "$16,870.25" "$16,870.25" "$16,870.25" "$6,396.00" "$16,870.25" "$16,870.25" "$6,651.84" "$6,651.84" "$6,907.68" "$6,396.00" "$7,514.28" "$16,870.25" "$6,748.10" "$16,870.25" "$16,870.25" "$16,870.25" "$16,870.25" "$16,870.25" "$12,652.88" "$16,870.25" "$16,870.25" "$16,870.25" "$8,435.13" "$8,435.13" "$13,361.24" "$16,870.25" "$13,496.20" "$7,591.61" "$16,870.25" "$16,870.25" "$9,784.89" "$16,870.25" "$10,122.15" "$16,870.25" "$16,870.25" "$16,870.25" N/A N/A 116049 ERX HCPCS 63700001 00006-0473-61 RALTEGRAVIR POTASSIUM 25 MG PO CHEW BOTH IP/OP $10.50 $8.00 $2.15 $10.32 $10.32 $10.32 $10.32 $10.32 $10.32 $10.32 $10.32 $10.32 $10.32 $10.32 $10.32 $10.32 $10.32 $2.15 $10.32 $4.13 $10.32 $10.32 $10.32 $10.32 $10.32 $7.88 $10.32 $10.32 $10.32 $5.16 $5.16 $8.17 $10.32 $8.26 $6.71 $10.32 $10.32 $6.09 $10.32 $6.19 $10.32 $10.32 $10.32 N/A N/A 116050 ERX HCPCS 63700001 00006-0477-61 RALTEGRAVIR POTASSIUM 100 MG PO CHEW BOTH IP/OP $41.50 $31.00 $8.60 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $8.60 $41.27 $16.51 $41.27 $41.27 $41.27 $41.27 $41.27 $31.13 $41.27 $41.27 $41.27 $20.64 $20.64 $32.69 $41.27 $33.02 $26.83 $41.27 $41.27 $24.07 $41.27 $24.76 $41.27 $41.27 $41.27 N/A N/A 116053 ERX HCPCS J1100 63323-0506-01 DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.53 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.53 $22.00 $0.62 $0.62 $0.65 $0.60 $0.70 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.67 $22.00 $12.76 $22.00 $22.00 $22.00 $0.67 $22.00 N/A N/A 116079 ERX HCPCS 63700001 00469-2601-90 MIRABEGRON ER 25 MG PO TB24 BOTH IP/OP $77.50 $57.00 $16.10 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $16.10 $77.23 $30.89 $77.23 $77.23 $77.23 $77.23 $77.23 $58.13 $77.23 $77.23 $77.23 $38.62 $38.62 $61.17 $77.23 $61.78 $50.20 $77.23 $77.23 $44.95 $77.23 $46.34 $77.23 $77.23 $77.23 N/A N/A 116080 ERX HCPCS 63700001 00469-2602-90 MIRABEGRON ER 50 MG PO TB24 BOTH IP/OP $77.50 $57.00 $16.10 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $77.23 $16.10 $77.23 $30.89 $77.23 $77.23 $77.23 $77.23 $77.23 $58.13 $77.23 $77.23 $77.23 $38.62 $38.62 $61.17 $77.23 $61.78 $50.20 $77.23 $77.23 $44.95 $77.23 $46.34 $77.23 $77.23 $77.23 N/A N/A 116294 ERX HCPCS 25000001 63402-0312-30 LURASIDONE HCL 120 MG PO TABS BOTH IP/OP $303.50 $225.00 $53.98 $303.26 $303.26 $303.26 $303.26 $303.26 $303.26 $303.26 $53.98 $303.26 $303.26 $225.08 $225.08 $233.75 $158.00 $63.20 $303.26 $121.30 $303.26 $303.26 $303.26 $303.26 $303.26 $227.63 $303.26 $303.26 $303.26 $151.63 $151.63 $240.18 $303.26 $242.61 $197.12 $303.26 $303.26 $176.03 $303.26 $181.96 $303.26 $303.26 $303.26 N/A N/A 116340 ERX HCPCS 25000001 99999-6005-51 MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 116365 ERX HCPCS J2270 00409-1891-01 MORPHINE SULFATE (PF) 4 MG/ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.17 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $3.30 $3.30 $3.42 $3.17 $3.72 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $3.55 $22.00 $12.76 $22.00 $22.00 $22.00 $3.55 $22.00 N/A N/A 116374 ERX HCPCS J2270 00409-1893-01 MORPHINE SULFATE (PF) 10 MG/ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.17 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $3.30 $3.30 $3.42 $3.17 $3.72 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $3.55 $22.00 $12.76 $22.00 $22.00 $22.00 $3.55 $22.00 N/A N/A 116385 ERX HCPCS 63700001 00469-0125-99 ENZALUTAMIDE 40 MG PO CAPS BOTH IP/OP $824.50 $610.00 $171.83 $824.47 $824.47 $824.47 $824.47 $824.47 $824.47 $824.47 $824.47 $824.47 $824.47 $824.47 $824.47 $824.47 $824.47 $171.83 $824.47 $329.79 $824.47 $824.47 $824.47 $824.47 $824.47 $618.38 $824.47 $824.47 $824.47 $412.24 $412.24 $652.98 $824.47 $659.58 $535.91 $824.47 $824.47 $478.21 $824.47 $494.68 $824.47 $824.47 $824.47 N/A N/A 116397 ERX HCPCS J8999 00069-0135-01 BOSUTINIB 100 MG PO TABS BOTH IP/OP $650.50 $481.00 $135.48 $650.05 $650.05 $650.05 $650.05 $650.05 $650.05 $650.05 $650.05 $650.05 $650.05 $650.05 $650.05 $650.05 $650.05 $135.48 $650.05 $260.02 $650.05 $650.05 $650.05 $650.05 $650.05 $487.88 $650.05 $650.05 $650.05 $325.03 $325.03 $514.84 $650.05 $520.04 $292.52 $650.05 $650.05 $377.29 $650.05 $390.03 $650.05 $650.05 $650.05 N/A N/A 116398 ERX HCPCS 63600001 00069-0136-01 BOSUTINIB 500 MG PO TABS BOTH IP/OP "$2,001.00" "$1,481.00" $356.13 "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" $356.13 "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" $416.97 "$2,000.72" $800.29 "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$1,500.75" "$2,000.72" "$2,000.72" "$2,000.72" "$1,000.36" "$1,000.36" "$1,584.57" "$2,000.72" "$1,600.58" $900.32 "$2,000.72" "$2,000.72" "$1,160.58" "$2,000.72" "$1,200.43" "$2,000.72" "$2,000.72" "$2,000.72" N/A N/A 116540 ERX HCPCS 25000001 08290-3065-46 NORMAL SALINE FLUSH 0.9 % IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 116996 ERX HCPCS 25000001 00268-0247-05 HISTAMINE PHOSPHATE 2.75 MG/ML IJ SOLN BOTH IP/OP $30.50 $23.00 $5.39 $30.26 $30.26 $30.26 $30.26 $30.26 $30.26 $30.26 $5.39 $30.26 $30.26 $22.46 $22.46 $23.32 $15.77 $6.31 $30.26 $12.10 $30.26 $30.26 $30.26 $30.26 $30.26 $22.88 $30.26 $30.26 $30.26 $15.13 $15.13 $23.97 $30.26 $24.21 $19.67 $30.26 $30.26 $17.69 $30.26 $18.16 $30.26 $30.26 $30.26 N/A N/A 117006 ERX HCPCS 25000001 12496-1204-03 SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 4-1 MG SL FILM BOTH IP/OP $47.00 $35.00 $8.29 $46.56 $46.56 $46.56 $46.56 $46.56 $46.56 $46.56 $8.29 $46.56 $46.56 $34.56 $34.56 $35.89 $24.26 $9.70 $46.56 $18.62 $46.56 $46.56 $46.56 $46.56 $46.56 $35.25 $46.56 $46.56 $46.56 $23.28 $23.28 $36.88 $46.56 $37.25 $30.26 $46.56 $46.56 $27.26 $46.56 $27.94 $46.56 $46.56 $46.56 N/A N/A 117007 ERX HCPCS 25000001 12496-1212-03 SUBOXONE:BUPRENORPHINE HCL-NALOXONE HCL 12-3 MG SL FILM BOTH IP/OP $86.00 $64.00 $15.27 $85.78 $85.78 $85.78 $85.78 $85.78 $85.78 $85.78 $15.27 $85.78 $85.78 $63.67 $63.67 $66.12 $44.69 $17.88 $85.78 $34.31 $85.78 $85.78 $85.78 $85.78 $85.78 $64.50 $85.78 $85.78 $85.78 $42.89 $42.89 $67.94 $85.78 $68.62 $55.76 $85.78 $85.78 $49.88 $85.78 $51.47 $85.78 $85.78 $85.78 N/A N/A 117011 ERX HCPCS 63700001 00456-1201-30 LINACLOTIDE 145 MCG PO CAPS BOTH IP/OP $82.50 $61.00 $17.09 $82.02 $82.02 $82.02 $82.02 $82.02 $82.02 $82.02 $82.02 $82.02 $82.02 $82.02 $82.02 $82.02 $82.02 $17.09 $82.02 $32.81 $82.02 $82.02 $82.02 $82.02 $82.02 $61.88 $82.02 $82.02 $82.02 $41.01 $41.01 $64.96 $82.02 $65.62 $53.31 $82.02 $82.02 $47.85 $82.02 $49.21 $82.02 $82.02 $82.02 N/A N/A 117021 ERX HCPCS 25000001 50419-0171-03 REGORAFENIB 40 MG PO TABS BOTH IP/OP "$1,650.00" "$1,221.00" $293.69 "$1,649.94" "$1,649.94" "$1,649.94" "$1,649.94" "$1,649.94" "$1,649.94" "$1,649.94" $293.69 "$1,649.94" "$1,649.94" "$1,224.59" "$1,224.59" "$1,271.77" $859.62 $343.87 "$1,649.94" $659.98 "$1,649.94" "$1,649.94" "$1,649.94" "$1,649.94" "$1,649.94" "$1,237.50" "$1,649.94" "$1,649.94" "$1,649.94" $824.97 $824.97 "$1,306.75" "$1,649.94" "$1,319.95" "$1,072.46" "$1,649.94" "$1,649.94" $957.00 "$1,649.94" $989.96 "$1,649.94" "$1,649.94" "$1,649.94" N/A N/A 117338 ERX HCPCS 63700001 00069-1001-01 TOFACITINIB CITRATE 5 MG PO TABS BOTH IP/OP $383.00 $283.00 $79.75 $382.66 $382.66 $382.66 $382.66 $382.66 $382.66 $382.66 $382.66 $382.66 $382.66 $382.66 $382.66 $382.66 $382.66 $79.75 $382.66 $153.06 $382.66 $382.66 $382.66 $382.66 $382.66 $287.25 $382.66 $382.66 $382.66 $191.33 $191.33 $303.07 $382.66 $306.13 $248.73 $382.66 $382.66 $222.14 $382.66 $229.60 $382.66 $382.66 $382.66 N/A N/A 117385 ERX HCPCS 63700001 59676-0566-30 DARUNAVIR 800 MG PO TABS BOTH IP/OP $300.50 $222.00 $62.53 $300.05 $300.05 $300.05 $300.05 $300.05 $300.05 $300.05 $300.05 $300.05 $300.05 $300.05 $300.05 $300.05 $300.05 $62.53 $300.05 $120.02 $300.05 $300.05 $300.05 $300.05 $300.05 $225.38 $300.05 $300.05 $300.05 $150.03 $150.03 $237.64 $300.05 $240.04 $195.03 $300.05 $300.05 $174.29 $300.05 $180.03 $300.05 $300.05 $300.05 N/A N/A 117943 ERX HCPCS 63700006 00054-0508-23 ICOSAPENT ETHYL 1 G PO CAPS BOTH IP/OP $27.50 $20.00 $5.66 $27.17 $27.17 $27.17 $27.17 $27.17 $27.17 $27.17 $27.17 $27.17 $27.17 $27.17 $27.17 $27.17 $27.17 $5.66 $27.17 $10.87 $27.17 $27.17 $27.17 $27.17 $27.17 $20.63 $27.17 $27.17 $27.17 $13.59 $13.59 $21.52 $27.17 $21.74 $17.66 $27.17 $27.17 $15.95 $27.17 $16.30 $27.17 $27.17 $27.17 N/A N/A 117945 ERX HCPCS 25000001 24208-0503-07 LOTEPREDNOL ETABONATE 0.5 % OP GEL BOTH IP/OP $873.00 $646.00 $155.33 $872.63 $872.63 $872.63 $872.63 $872.63 $872.63 $872.63 $155.33 $872.63 $872.63 $647.67 $647.67 $672.62 $454.64 $181.87 $872.63 $349.05 $872.63 $872.63 $872.63 $872.63 $872.63 $654.75 $872.63 $872.63 $872.63 $436.32 $436.32 $691.12 $872.63 $698.10 $567.21 $872.63 $872.63 $506.34 $872.63 $523.58 $872.63 $872.63 $872.63 N/A N/A 118189 ERX HCPCS 25000001 54643-5649-01 INFUVITE ADULT IV INJ BOTH IP/OP $69.50 $51.00 $12.34 $69.34 $69.34 $69.34 $69.34 $69.34 $69.34 $69.34 $12.34 $69.34 $69.34 $51.46 $51.46 $53.45 $36.13 $14.45 $69.34 $27.74 $69.34 $69.34 $69.34 $69.34 $69.34 $52.13 $69.34 $69.34 $69.34 $34.67 $34.67 $54.92 $69.34 $55.47 $45.07 $69.34 $69.34 $40.31 $69.34 $41.60 $69.34 $69.34 $69.34 N/A N/A 118319 ERX HCPCS 63700001 00003-0893-31 APIXABAN 2.5 MG PO TABS BOTH IP/OP $48.50 $36.00 $10.10 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $10.10 $48.46 $19.38 $48.46 $48.46 $48.46 $48.46 $48.46 $36.38 $48.46 $48.46 $48.46 $24.23 $24.23 $38.38 $48.46 $38.77 $31.50 $48.46 $48.46 $28.13 $48.46 $29.08 $48.46 $48.46 $48.46 N/A N/A 118352 ERX HCPCS 63700001 00003-0894-31 APIXABAN 5 MG PO TABS BOTH IP/OP $48.50 $36.00 $10.10 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $48.46 $10.10 $48.46 $19.38 $48.46 $48.46 $48.46 $48.46 $48.46 $36.38 $48.46 $48.46 $48.46 $24.23 $24.23 $38.38 $48.46 $38.77 $31.50 $48.46 $48.46 $28.13 $48.46 $29.08 $48.46 $48.46 $48.46 N/A N/A 118810 ERX HCPCS 63700001 00536-4085-01 PRENATAL VITAMINS 28-0.8 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 118851 ERX HCPCS 25000001 59572-0501-21 POMALIDOMIDE 1 MG PO CAPS BOTH IP/OP "$2,811.00" "$2,080.00" $500.36 "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" $500.36 "$2,810.99" "$2,810.99" "$2,086.32" "$2,086.32" "$2,166.71" "$1,464.53" $585.84 "$2,810.99" "$1,124.40" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,108.25" "$2,810.99" "$2,810.99" "$2,810.99" "$1,405.50" "$1,405.50" "$2,226.30" "$2,810.99" "$2,248.79" "$1,827.14" "$2,810.99" "$2,810.99" "$1,630.38" "$2,810.99" "$1,686.59" "$2,810.99" "$2,810.99" "$2,810.99" N/A N/A 118852 ERX HCPCS 25000001 59572-0502-21 POMALIDOMIDE 2 MG PO CAPS BOTH IP/OP "$2,811.00" "$2,080.00" $500.36 "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" $500.36 "$2,810.99" "$2,810.99" "$2,086.32" "$2,086.32" "$2,166.71" "$1,464.53" $585.84 "$2,810.99" "$1,124.40" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,108.25" "$2,810.99" "$2,810.99" "$2,810.99" "$1,405.50" "$1,405.50" "$2,226.30" "$2,810.99" "$2,248.79" "$1,827.14" "$2,810.99" "$2,810.99" "$1,630.38" "$2,810.99" "$1,686.59" "$2,810.99" "$2,810.99" "$2,810.99" N/A N/A 118853 ERX HCPCS 25000001 59572-0503-21 POMALIDOMIDE 3 MG PO CAPS BOTH IP/OP "$2,811.00" "$2,080.00" $500.36 "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" $500.36 "$2,810.99" "$2,810.99" "$2,086.32" "$2,086.32" "$2,166.71" "$1,464.53" $585.84 "$2,810.99" "$1,124.40" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,108.25" "$2,810.99" "$2,810.99" "$2,810.99" "$1,405.50" "$1,405.50" "$2,226.30" "$2,810.99" "$2,248.79" "$1,827.14" "$2,810.99" "$2,810.99" "$1,630.38" "$2,810.99" "$1,686.59" "$2,810.99" "$2,810.99" "$2,810.99" N/A N/A 118854 ERX HCPCS 25000001 59572-0504-21 POMALIDOMIDE 4 MG PO CAPS BOTH IP/OP "$2,811.00" "$2,080.00" $500.36 "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" $500.36 "$2,810.99" "$2,810.99" "$2,086.32" "$2,086.32" "$2,166.71" "$1,464.53" $585.84 "$2,810.99" "$1,124.40" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,810.99" "$2,108.25" "$2,810.99" "$2,810.99" "$2,810.99" "$1,405.50" "$1,405.50" "$2,226.30" "$2,810.99" "$2,248.79" "$1,827.14" "$2,810.99" "$2,810.99" "$1,630.38" "$2,810.99" "$1,686.59" "$2,810.99" "$2,810.99" "$2,810.99" N/A N/A 118951 ERX HCPCS J9354 50242-0087-01 ADO-TRASTUZUMAB EMTANSINE 160 MG IV SOLR BOTH IP/OP "$16,740.50" "$12,388.00" "$3,489.14" "$16,740.50" "$7,533.23" "$7,533.23" "$7,533.23" "$7,533.23" "$5,464.16" "$5,464.16" "$5,464.16" "$3,489.14" "$5,464.16" "$5,682.56" "$5,682.56" "$5,901.12" "$5,464.00" "$6,419.33" "$5,464.16" "$5,799.20" "$8,253.07" "$5,464.16" "$16,740.50" "$5,464.16" "$5,737.37" "$12,555.38" "$5,464.16" "$5,464.16" "$5,464.16" "$8,370.25" "$8,370.25" "$13,258.48" "$5,464.16" "$13,392.40" "$7,533.23" "$6,113.12" "$5,464.16" "$9,709.49" "$5,737.37" "$7,923.03" "$5,464.16" "$6,113.12" "$5,464.16" N/A N/A 119091 ERX HCPCS 63700001 00406-8330-23 MORPHINE SULFATE CR 30 MG PO TB12 BOTH IP/OP $15.00 $11.00 $3.04 $14.61 $14.61 $14.61 $14.61 $14.61 $14.61 $14.61 $14.61 $14.61 $14.61 $14.61 $14.61 $14.61 $14.61 $3.04 $14.61 $5.84 $14.61 $14.61 $14.61 $14.61 $14.61 $11.25 $14.61 $14.61 $14.61 $7.31 $7.31 $11.57 $14.61 $11.69 $9.50 $14.61 $14.61 $8.70 $14.61 $8.77 $14.61 $14.61 $14.61 N/A N/A 119102 ERX HCPCS 63700001 00456-3407-33 MEMANTINE HCL ER 7 MG PO CP24 BOTH IP/OP $80.50 $60.00 $16.74 $80.32 $80.32 $80.32 $80.32 $80.32 $80.32 $80.32 $80.32 $80.32 $80.32 $80.32 $80.32 $80.32 $80.32 $16.74 $80.32 $32.13 $80.32 $80.32 $80.32 $80.32 $80.32 $60.38 $80.32 $80.32 $80.32 $40.16 $40.16 $63.61 $80.32 $64.26 $52.21 $80.32 $80.32 $46.69 $80.32 $48.19 $80.32 $80.32 $80.32 N/A N/A 119105 ERX HCPCS 63700001 43975-0266-03 MEMANTINE HCL ER 28 MG PO CP24 BOTH IP/OP $66.50 $49.00 $13.76 $66.01 $66.01 $66.01 $66.01 $66.01 $66.01 $66.01 $66.01 $66.01 $66.01 $66.01 $66.01 $66.01 $66.01 $13.76 $66.01 $26.40 $66.01 $66.01 $66.01 $66.01 $66.01 $49.88 $66.01 $66.01 $66.01 $33.01 $33.01 $52.28 $66.01 $52.81 $42.91 $66.01 $66.01 $38.57 $66.01 $39.61 $66.01 $66.01 $66.01 N/A N/A 119111 ERX HCPCS 63700001 99999-6012-64 DARUNAVIR 100 MG/ML PO SUSP BOTH IP/OP $141.00 $104.00 $29.29 $140.54 $140.54 $140.54 $140.54 $140.54 $140.54 $140.54 $140.54 $140.54 $140.54 $140.54 $140.54 $140.54 $140.54 $29.29 $140.54 $56.22 $140.54 $140.54 $140.54 $140.54 $140.54 $105.75 $140.54 $140.54 $140.54 $70.27 $70.27 $111.31 $140.54 $112.43 $91.35 $140.54 $140.54 $81.78 $140.54 $84.32 $140.54 $140.54 $140.54 N/A N/A 119120 ERX HCPCS J2270 00409-1890-03 MORPHINE SULFATE (PF) 2 MG/ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.17 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $3.30 $3.30 $3.42 $3.17 $3.72 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $3.55 $22.00 $12.76 $22.00 $22.00 $22.00 $3.55 $22.00 N/A N/A 119122 ERX HCPCS 25000001 00703-2033-03 CISATRACURIUM BESYLATE (PF) 10 MG/5ML IV SOLN BOTH IP/OP $73.00 $54.00 $12.92 $72.58 $72.58 $72.58 $72.58 $72.58 $72.58 $72.58 $12.92 $72.58 $72.58 $53.87 $53.87 $55.94 $37.81 $15.13 $72.58 $29.03 $72.58 $72.58 $72.58 $72.58 $72.58 $54.75 $72.58 $72.58 $72.58 $36.29 $36.29 $57.48 $72.58 $58.06 $47.18 $72.58 $72.58 $42.34 $72.58 $43.55 $72.58 $72.58 $72.58 N/A N/A 119123 ERX HCPCS 25000001 63323-0417-10 CISATRACURIUM BESYLATE 20 MG/10ML IV SOLN BOTH IP/OP $110.00 $81.00 $19.55 $109.85 $109.85 $109.85 $109.85 $109.85 $109.85 $109.85 $19.55 $109.85 $109.85 $81.53 $81.53 $84.67 $57.23 $22.89 $109.85 $43.94 $109.85 $109.85 $109.85 $109.85 $109.85 $82.50 $109.85 $109.85 $109.85 $54.93 $54.93 $87.00 $109.85 $87.88 $71.40 $109.85 $109.85 $63.80 $109.85 $65.91 $109.85 $109.85 $109.85 N/A N/A 119129 ERX HCPCS 63700001 00406-8315-23 MORPHINE SULFATE CR 15 MG PO TB12 BOTH IP/OP $8.50 $6.00 $1.69 $8.09 $8.09 $8.09 $8.09 $8.09 $8.09 $8.09 $8.09 $8.09 $8.09 $8.09 $8.09 $8.09 $8.09 $1.69 $8.09 $3.24 $8.09 $8.09 $8.09 $8.09 $8.09 $6.38 $8.09 $8.09 $8.09 $4.05 $4.05 $6.41 $8.09 $6.47 $5.26 $8.09 $8.09 $4.93 $8.09 $4.85 $8.09 $8.09 $8.09 N/A N/A 119131 ERX HCPCS 63700001 00406-8390-62 MORPHINE SULFATE CR 100 MG PO TB12 BOTH IP/OP $33.00 $24.00 $6.88 $32.99 $32.99 $32.99 $32.99 $32.99 $32.99 $32.99 $32.99 $32.99 $32.99 $32.99 $32.99 $32.99 $32.99 $6.88 $32.99 $13.20 $32.99 $32.99 $32.99 $32.99 $32.99 $24.75 $32.99 $32.99 $32.99 $16.50 $16.50 $26.13 $32.99 $26.39 $21.44 $32.99 $32.99 $19.14 $32.99 $19.79 $32.99 $32.99 $32.99 N/A N/A 119134 ERX HCPCS 25000001 63037-0125-25 GLYCOPYRROLATE 1 MG/5ML IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 119650 ERX HCPCS 63700001 00065-4147-27 (SIMBRINZA) BRINZOLAMIDE-BRIMONIDINE 1-0.2 % OP SUSP BOTH IP/OP $722.00 $534.00 $150.38 $721.57 $721.57 $721.57 $721.57 $721.57 $721.57 $721.57 $721.57 $721.57 $721.57 $721.57 $721.57 $721.57 $721.57 $150.38 $721.57 $288.63 $721.57 $721.57 $721.57 $721.57 $721.57 $541.50 $721.57 $721.57 $721.57 $360.79 $360.79 $571.48 $721.57 $577.26 $469.02 $721.57 $721.57 $418.76 $721.57 $432.94 $721.57 $721.57 $721.57 N/A N/A 119958 ERX HCPCS 25000001 68180-0423-11 CEFIXIME 400 MG PO CAPS BOTH IP/OP $99.50 $74.00 $17.65 $99.14 $99.14 $99.14 $99.14 $99.14 $99.14 $99.14 $17.65 $99.14 $99.14 $73.58 $73.58 $76.42 $51.65 $20.66 $99.14 $39.66 $99.14 $99.14 $99.14 $99.14 $99.14 $74.63 $99.14 $99.14 $99.14 $49.57 $49.57 $78.52 $99.14 $79.31 $64.44 $99.14 $99.14 $57.71 $99.14 $59.48 $99.14 $99.14 $99.14 N/A N/A 120301 ERX HCPCS 25000001 00904-6488-38 ARTIFICIAL TEARS 83-15 % OP OINT BOTH IP/OP $28.00 $21.00 $4.98 $27.96 $27.96 $27.96 $27.96 $27.96 $27.96 $27.96 $4.98 $27.96 $27.96 $20.75 $20.75 $21.55 $14.57 $5.83 $27.96 $11.18 $27.96 $27.96 $27.96 $27.96 $27.96 $21.00 $27.96 $27.96 $27.96 $13.98 $13.98 $22.14 $27.96 $22.37 $18.17 $27.96 $27.96 $16.24 $27.96 $16.78 $27.96 $27.96 $27.96 N/A N/A 120319 ERX HCPCS C9132 63833-0386-02 PROTHROMBIN COMPLEX CONC HUMAN 500 UNITS IV KIT BOTH IP/OP "$4,171.00" "$3,087.00" $869.22 "$4,170.70" "$4,170.70" "$4,170.70" "$4,170.70" "$4,170.70" "$4,170.70" "$4,170.70" "$1,256.00" "$4,170.70" "$4,170.70" "$4,170.70" "$4,170.70" "$4,170.70" "$4,170.70" $869.22 "$4,170.70" "$1,668.28" "$4,170.70" "$4,170.70" "$4,170.70" "$4,170.70" "$4,170.70" "$3,128.25" "$4,170.70" "$4,170.70" "$4,170.70" "$2,085.35" "$2,085.35" "$3,303.19" "$4,170.70" "$3,336.56" "$1,876.82" "$4,170.70" "$4,170.70" "$2,419.18" "$4,170.70" "$2,502.42" "$4,170.70" "$4,170.70" "$4,170.70" N/A N/A 120606 ERX HCPCS 63700001 00078-0681-66 DABRAFENIB MESYLATE 75 MG PO CAPS BOTH IP/OP $815.00 $603.00 $169.79 $814.69 $814.69 $814.69 $814.69 $814.69 $814.69 $814.69 $814.69 $814.69 $814.69 $814.69 $814.69 $814.69 $814.69 $169.79 $814.69 $325.88 $814.69 $814.69 $814.69 $814.69 $814.69 $611.25 $814.69 $814.69 $814.69 $407.35 $407.35 $645.23 $814.69 $651.75 $529.55 $814.69 $814.69 $472.70 $814.69 $488.81 $814.69 $814.69 $814.69 N/A N/A 120608 ERX HCPCS 63700001 00078-0668-15 TRAMETINIB DIMETHYL SULFOXIDE 2 MG PO TABS BOTH IP/OP "$1,448.50" "$1,072.00" $301.82 "$1,448.18" "$1,448.18" "$1,448.18" "$1,448.18" "$1,448.18" "$1,448.18" "$1,448.18" "$1,448.18" "$1,448.18" "$1,448.18" "$1,448.18" "$1,448.18" "$1,448.18" "$1,448.18" $301.82 "$1,448.18" $579.27 "$1,448.18" "$1,448.18" "$1,448.18" "$1,448.18" "$1,448.18" "$1,086.38" "$1,448.18" "$1,448.18" "$1,448.18" $724.09 $724.09 "$1,146.96" "$1,448.18" "$1,158.54" $941.32 "$1,448.18" "$1,448.18" $840.13 "$1,448.18" $868.91 "$1,448.18" "$1,448.18" "$1,448.18" N/A N/A 120646 ERX HCPCS 63700001 59572-0420-21 LENALIDOMIDE 20 MG PO CAPS BOTH IP/OP "$2,670.00" "$1,976.00" $556.39 "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" $556.39 "$2,669.66" "$1,067.86" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,669.66" "$2,002.50" "$2,669.66" "$2,669.66" "$2,669.66" "$1,334.83" "$1,334.83" "$2,114.37" "$2,669.66" "$2,135.73" "$1,735.28" "$2,669.66" "$2,669.66" "$1,548.60" "$2,669.66" "$1,601.80" "$2,669.66" "$2,669.66" "$2,669.66" N/A N/A 120650 ERX HCPCS J2710 00641-6149-10 NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN BOTH IP/OP $22.00 $16.00 $0.12 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.12 $22.00 $0.96 $0.96 $0.99 $0.92 $1.08 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.03 $22.00 $12.76 $22.00 $22.00 $22.00 $1.03 $22.00 N/A N/A 121069 ERX HCPCS J1602 57894-0350-01 GOLIMUMAB 50 MG/4ML IV SOLN BOTH IP/OP "$5,590.00" "$4,137.00" $692.45 "$5,589.75" "$2,515.39" "$2,515.39" "$2,515.39" "$2,515.39" $805.00 $805.00 $805.00 "$1,165.04" $805.00 $837.20 $837.20 $869.40 $805.00 $945.75 $805.00 $692.45 "$2,755.75" $805.00 "$5,589.75" $805.00 $845.25 "$4,192.50" $805.00 $805.00 $805.00 "$2,794.88" "$2,794.88" "$4,427.08" $805.00 "$4,471.80" "$2,515.39" $900.63 $805.00 "$3,242.20" $845.25 "$1,167.25" $805.00 $900.63 $805.00 N/A N/A 121091 ERX HCPCS J1439 00517-0650-01 FERRIC CARBOXYMALTOSE 750 MG/15ML IV SOLN BOTH IP/OP "$3,848.00" "$2,848.00" $802.02 "$3,848.00" "$1,731.60" "$1,731.60" "$1,731.60" "$1,731.60" $842.25 $842.25 $842.25 $802.02 $842.25 $873.60 $873.60 $907.20 $840.00 $986.87 $842.25 $850.50 "$1,897.06" $842.25 "$3,848.00" $842.25 $884.36 "$2,886.00" $842.25 $842.25 $842.25 "$1,924.00" "$1,924.00" "$3,047.62" $842.25 "$3,078.40" "$1,731.60" $939.79 $842.25 "$2,231.84" $884.36 "$1,221.26" $842.25 $939.79 $842.25 N/A N/A 121301 ERX HCPCS J0171 54288-0120-01 EPINEPHRINE 1 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.72 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $0.75 $0.75 $0.78 $0.72 $0.85 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.81 $22.00 $12.76 $22.00 $22.00 $22.00 $0.81 $22.00 N/A N/A 121434 ERX HCPCS 63700001 49702-0228-13 DOLUTEGRAVIR SODIUM 50 MG PO TABS BOTH IP/OP $305.50 $226.00 $63.59 $305.14 $305.14 $305.14 $305.14 $305.14 $305.14 $305.14 $305.14 $305.14 $305.14 $305.14 $305.14 $305.14 $305.14 $63.59 $305.14 $122.06 $305.14 $305.14 $305.14 $305.14 $305.14 $229.13 $305.14 $305.14 $305.14 $152.57 $152.57 $241.67 $305.14 $244.11 $198.34 $305.14 $305.14 $177.19 $305.14 $183.08 $305.14 $305.14 $305.14 N/A N/A 121708 ERX HCPCS 63700001 62856-0278-30 PERAMPANEL 8 MG PO TABS BOTH IP/OP $184.50 $137.00 $38.42 $184.36 $184.36 $184.36 $184.36 $184.36 $184.36 $184.36 $184.36 $184.36 $184.36 $184.36 $184.36 $184.36 $184.36 $38.42 $184.36 $73.74 $184.36 $184.36 $184.36 $184.36 $184.36 $138.38 $184.36 $184.36 $184.36 $92.18 $92.18 $146.01 $184.36 $147.49 $119.83 $184.36 $184.36 $107.01 $184.36 $110.62 $184.36 $184.36 $184.36 N/A N/A 121712 ERX HCPCS 90680 00006-4047-41 ROTAVIRUS VAC LIVE PENTAVALENT PO SOLN BOTH IP/OP $388.00 $287.00 $76.92 $387.53 $174.39 $174.39 $174.39 $174.39 $387.53 $387.53 $387.53 $80.77 $387.53 $94.12 $94.12 $97.74 $90.50 $80.77 $387.53 $155.01 $229.22 $387.53 $387.53 $387.53 $387.53 $291.00 $387.53 $387.53 $387.53 $193.77 $193.77 $306.92 $387.53 $310.02 $174.39 $76.92 $387.53 $225.04 $387.53 $387.53 $387.53 $80.76 $387.53 N/A N/A 121713 ERX HCPCS 25000001 00008-0423-03 ANTIVENIN MICRURUS FULVIUS IV SOLR BOTH IP/OP "$55,233.00" "$40,872.00" "$2,060.15" "$55,232.82" "$55,232.82" "$55,232.82" "$55,232.82" "$55,232.82" "$55,232.82" "$55,232.82" "$9,831.44" "$55,232.82" "$55,232.82" "$4,181.12" "$4,181.12" "$42,573.46" "$2,060.15" "$11,511.13" "$55,232.82" "$22,093.13" "$55,232.82" "$55,232.82" "$55,232.82" "$55,232.82" "$55,232.82" "$41,424.75" "$55,232.82" "$55,232.82" "$55,232.82" "$27,616.41" "$27,616.41" "$43,744.39" "$55,232.82" "$44,186.26" "$35,901.33" "$55,232.82" "$55,232.82" "$32,035.14" "$55,232.82" "$33,139.69" "$55,232.82" "$55,232.82" "$55,232.82" N/A N/A 121715 ERX HCPCS 25000001 63323-0472-17 BUPIVACAINE HCL (PF) 0.75 % IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 121718 ERX HCPCS J2260 00143-9710-10 MILRINONE LACTATE 10 MG/10ML IV SOLN BOTH IP/OP $32.50 $24.00 $3.22 $32.40 $14.58 $14.58 $14.58 $14.58 $32.40 $32.40 $32.40 $6.75 $32.40 $3.35 $3.35 $3.48 $3.22 $3.78 $32.40 $32.40 $19.16 $32.40 $32.40 $32.40 $32.40 $24.38 $32.40 $32.40 $32.40 $16.20 $16.20 $25.66 $32.40 $25.92 $14.58 $3.60 $32.40 $18.85 $32.40 $32.40 $32.40 $3.60 $32.40 N/A N/A 121722 ERX HCPCS J9181 16729-0114-08 ETOPOSIDE 500 MG/25ML IV SOLN BOTH IP/OP $204.00 $151.00 $38.00 $203.53 $91.59 $91.59 $91.59 $91.59 $203.53 $203.53 $203.53 $42.42 $203.53 $39.52 $39.52 $41.04 $38.00 $44.64 $203.53 $203.53 $120.39 $203.53 $203.53 $203.53 $203.53 $153.00 $203.53 $203.53 $203.53 $101.77 $101.77 $161.20 $203.53 $162.82 $91.59 $42.51 $203.53 $118.32 $203.53 $203.53 $203.53 $42.51 $203.53 N/A N/A 121723 ERX HCPCS J9181 63323-0104-50 ETOPOSIDE 1 GM/50ML IV SOLN BOTH IP/OP $518.00 $383.00 $76.00 $517.90 $233.06 $233.06 $233.06 $233.06 $517.90 $517.90 $517.90 $107.94 $517.90 $79.04 $79.04 $82.08 $76.00 $89.29 $517.90 $517.90 $306.34 $517.90 $517.90 $517.90 $517.90 $388.50 $517.90 $517.90 $517.90 $258.95 $258.95 $410.18 $517.90 $414.32 $233.06 $85.03 $517.90 $300.44 $517.90 $517.90 $517.90 $85.03 $517.90 N/A N/A 121727 ERX HCPCS 63700001 60258-0172-01 MAGNESIUM GLUCONATE 500 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 121730 ERX HCPCS 25000001 59011-0410-20 OXYCODONE HCL ER 10 MG PO T12A BOTH IP/OP $26.50 $20.00 $4.64 $26.04 $26.04 $26.04 $26.04 $26.04 $26.04 $26.04 $4.64 $26.04 $26.04 $19.33 $19.33 $20.07 $13.57 $5.43 $26.04 $10.42 $26.04 $26.04 $26.04 $26.04 $26.04 $19.88 $26.04 $26.04 $26.04 $13.02 $13.02 $20.62 $26.04 $20.83 $16.93 $26.04 $26.04 $15.37 $26.04 $15.62 $26.04 $26.04 $26.04 N/A N/A 121733 ERX HCPCS 25000001 59011-0420-20 OXYCODONE HCL ER 20 MG PO T12A BOTH IP/OP $49.00 $36.00 $8.63 $48.51 $48.51 $48.51 $48.51 $48.51 $48.51 $48.51 $8.63 $48.51 $48.51 $36.00 $36.00 $37.39 $25.27 $10.11 $48.51 $19.40 $48.51 $48.51 $48.51 $48.51 $48.51 $36.75 $48.51 $48.51 $48.51 $24.26 $24.26 $38.42 $48.51 $38.81 $31.53 $48.51 $48.51 $28.42 $48.51 $29.11 $48.51 $48.51 $48.51 N/A N/A 121735 ERX HCPCS 25000001 59011-0440-10 OXYCODONE HCL ER 40 MG PO T12A BOTH IP/OP $81.00 $60.00 $14.42 $81.00 $81.00 $81.00 $81.00 $81.00 $81.00 $81.00 $14.42 $81.00 $81.00 $60.12 $60.12 $62.43 $42.20 $16.88 $81.00 $32.40 $81.00 $81.00 $81.00 $81.00 $81.00 $60.75 $81.00 $81.00 $81.00 $40.50 $40.50 $64.15 $81.00 $64.80 $52.65 $81.00 $81.00 $46.98 $81.00 $48.60 $81.00 $81.00 $81.00 N/A N/A 121737 ERX HCPCS 25000001 59011-0480-20 OXYCODONE HCL ER 80 MG PO T12A BOTH IP/OP $134.00 $99.00 $23.77 $133.56 $133.56 $133.56 $133.56 $133.56 $133.56 $133.56 $23.77 $133.56 $133.56 $99.13 $99.13 $102.95 $69.58 $27.84 $133.56 $53.42 $133.56 $133.56 $133.56 $133.56 $133.56 $100.50 $133.56 $133.56 $133.56 $66.78 $66.78 $105.78 $133.56 $106.85 $86.81 $133.56 $133.56 $77.72 $133.56 $80.14 $133.56 $133.56 $133.56 N/A N/A 121854 ERX HCPCS 25000001 63402-0306-30 LURASIDONE HCL 60 MG PO TABS BOTH IP/OP $203.50 $151.00 $36.16 $203.16 $203.16 $203.16 $203.16 $203.16 $203.16 $203.16 $36.16 $203.16 $203.16 $150.79 $150.79 $156.60 $105.85 $42.34 $203.16 $81.26 $203.16 $203.16 $203.16 $203.16 $203.16 $152.63 $203.16 $203.16 $203.16 $101.58 $101.58 $160.90 $203.16 $162.53 $132.05 $203.16 $203.16 $118.03 $203.16 $121.90 $203.16 $203.16 $203.16 N/A N/A 121934 ERX HCPCS 25000001 66794-0230-42 DEXMEDETOMIDINE HCL 200 MCG/2ML IV SOLN BOTH IP/OP $27.50 $20.00 $4.85 $27.22 $27.22 $27.22 $27.22 $27.22 $27.22 $27.22 $4.85 $27.22 $27.22 $20.20 $20.20 $20.98 $14.18 $5.67 $27.22 $10.89 $27.22 $27.22 $27.22 $27.22 $27.22 $20.63 $27.22 $27.22 $27.22 $13.61 $13.61 $21.56 $27.22 $21.78 $17.69 $27.22 $27.22 $15.95 $27.22 $16.33 $27.22 $27.22 $27.22 N/A N/A 121955 ERX HCPCS J9041 63020-0049-01 BORTEZOMIB 3.5 MG IJ SOLR BOTH IP/OP "$4,482.00" "$3,317.00" $217.53 "$4,481.99" "$2,016.90" "$2,016.90" "$2,016.90" "$2,016.90" "$1,567.79" "$1,567.79" "$1,567.79" "$1,491.60" "$1,567.79" "$1,630.36" "$1,630.36" "$1,693.06" "$1,567.65" "$1,841.74" "$1,567.79" $217.53 "$2,209.62" "$1,567.79" "$4,481.99" "$1,567.79" "$1,646.18" "$3,361.50" "$1,567.79" "$1,567.79" "$1,567.79" "$2,241.00" "$2,241.00" "$3,549.74" "$1,567.79" "$3,585.59" "$2,016.90" "$1,753.89" "$1,567.79" "$2,599.56" "$1,646.18" "$2,273.30" "$1,567.79" "$1,753.89" "$1,567.79" N/A N/A 122027 ERX HCPCS 63700001 64764-0750-30 VORTIOXETINE HBR 20 MG PO TABS BOTH IP/OP $81.00 $60.00 $16.80 $80.59 $80.59 $80.59 $80.59 $80.59 $80.59 $80.59 $80.59 $80.59 $80.59 $80.59 $80.59 $80.59 $80.59 $16.80 $80.59 $32.24 $80.59 $80.59 $80.59 $80.59 $80.59 $60.75 $80.59 $80.59 $80.59 $40.30 $40.30 $63.83 $80.59 $64.47 $52.38 $80.59 $80.59 $46.98 $80.59 $48.35 $80.59 $80.59 $80.59 N/A N/A 122192 ERX HCPCS J9301 50242-0070-01 OBINUTUZUMAB 1000 MG/40ML IV SOLN BOTH IP/OP "$21,740.00" "$16,088.00" "$6,411.00" "$21,739.84" "$21,739.84" "$21,739.84" "$21,739.84" "$21,739.84" "$21,739.84" "$21,739.84" "$6,454.00" "$21,739.84" "$21,739.84" "$6,667.44" "$6,667.44" "$6,923.88" "$6,411.00" "$7,531.91" "$21,739.84" "$8,695.94" "$21,739.84" "$21,739.84" "$21,739.84" "$21,739.84" "$21,739.84" "$16,305.00" "$21,739.84" "$21,739.84" "$21,739.84" "$10,869.92" "$10,869.92" "$17,217.95" "$21,739.84" "$17,391.87" "$9,782.93" "$21,739.84" "$21,739.84" "$12,609.20" "$21,739.84" "$13,043.90" "$21,739.84" "$21,739.84" "$21,739.84" N/A N/A 122260 ERX HCPCS 63700001 57962-0140-09 IBRUTINIB 140 MG PO CAPS BOTH IP/OP "$1,371.00" "$1,015.00" $285.63 "$1,370.51" "$1,370.51" "$1,370.51" "$1,370.51" "$1,370.51" "$1,370.51" "$1,370.51" "$1,370.51" "$1,370.51" "$1,370.51" "$1,370.51" "$1,370.51" "$1,370.51" "$1,370.51" $285.63 "$1,370.51" $548.20 "$1,370.51" "$1,370.51" "$1,370.51" "$1,370.51" "$1,370.51" "$1,028.25" "$1,370.51" "$1,370.51" "$1,370.51" $685.26 $685.26 "$1,085.44" "$1,370.51" "$1,096.41" $890.83 "$1,370.51" "$1,370.51" $795.18 "$1,370.51" $822.31 "$1,370.51" "$1,370.51" "$1,370.51" N/A N/A 122312 ERX HCPCS 25000001 00085-4324-02 POSACONAZOLE 100 MG PO TBEC BOTH IP/OP $745.50 $552.00 $132.62 $745.06 $745.06 $745.06 $745.06 $745.06 $745.06 $745.06 $132.62 $745.06 $745.06 $552.98 $552.98 $574.29 $388.18 $155.28 $745.06 $298.02 $745.06 $745.06 $745.06 $745.06 $745.06 $559.13 $745.06 $745.06 $745.06 $372.53 $372.53 $590.09 $745.06 $596.05 $484.29 $745.06 $745.06 $432.39 $745.06 $447.04 $745.06 $745.06 $745.06 N/A N/A 122959 ERX HCPCS 63700001 00310-6205-30 DAPAGLIFLOZIN PROPANEDIOL 5 MG PO TABS BOTH IP/OP $90.00 $67.00 $18.76 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 122960 ERX HCPCS 63700001 00310-6210-30 DAPAGLIFLOZIN PROPANEDIOL 10 MG PO TABS BOTH IP/OP $90.00 $67.00 $18.76 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 $90.00 $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 123430 ERX HCPCS J9181 16729-0114-31 ETOPOSIDE 100 MG/5ML IV SOLN BOTH IP/OP $57.00 $42.00 $7.60 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $7.90 $7.90 $8.21 $7.60 $8.93 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $8.50 $57.00 $33.06 $57.00 $57.00 $57.00 $8.50 $57.00 N/A N/A 123462 ERX HCPCS 25000001 00169-4060-12 (VICTOZA) LIRAGLUTIDE 18 MG/3ML SC SOPN BOTH IP/OP $517.00 $383.00 $91.98 $516.72 $516.72 $516.72 $516.72 $516.72 $516.72 $516.72 $91.98 $516.72 $516.72 $383.51 $383.51 $398.29 $269.21 $107.69 $516.72 $206.69 $516.72 $516.72 $516.72 $516.72 $516.72 $387.75 $516.72 $516.72 $516.72 $258.36 $258.36 $409.24 $516.72 $413.38 $335.87 $516.72 $516.72 $299.86 $516.72 $310.03 $516.72 $516.72 $516.72 N/A N/A 123464 ERX HCPCS J1720 00009-0825-01 HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR BOTH IP/OP $35.50 $26.00 $7.40 $35.49 $15.97 $15.97 $15.97 $15.97 $35.49 $35.49 $35.49 $7.40 $35.49 $15.35 $15.35 $15.94 $14.76 $17.34 $35.49 $35.49 $20.99 $35.49 $35.49 $35.49 $35.49 $26.63 $35.49 $35.49 $35.49 $17.75 $17.75 $28.11 $35.49 $28.39 $15.97 $16.51 $35.49 $20.59 $35.49 $35.49 $35.49 $16.51 $35.49 N/A N/A 123468 ERX HCPCS 25000001 63323-0739-12 FAMOTIDINE (PF) 20 MG/2ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 123472 ERX HCPCS J1100 63323-0165-05 DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN BOTH IP/OP $22.00 $16.00 $1.06 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.06 $22.00 $1.25 $1.25 $1.30 $1.20 $1.41 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.34 $22.00 $12.76 $22.00 $22.00 $22.00 $1.34 $22.00 N/A N/A 123475 ERX HCPCS J0171 49502-0501-01 EPINEPHRINE 0.15 MG/0.3ML IJ SOAJ BOTH IP/OP $354.50 $262.00 $0.72 $354.39 $159.48 $159.48 $159.48 $159.48 $354.39 $354.39 $354.39 $73.86 $354.39 $0.75 $0.75 $0.78 $0.72 $0.85 $354.39 $354.39 $209.62 $354.39 $354.39 $354.39 $354.39 $265.88 $354.39 $354.39 $354.39 $177.20 $177.20 $280.68 $354.39 $283.51 $159.48 $0.81 $354.39 $205.61 $354.39 $354.39 $354.39 $0.81 $354.39 N/A N/A 123476 ERX HCPCS J0171 49502-0500-02 EPINEPHRINE 0.3 MG/0.3ML IJ SOAJ BOTH IP/OP "$1,103.00" $816.00 $2.16 "$1,102.80" $496.26 $496.26 $496.26 $496.26 "$1,102.80" "$1,102.80" "$1,102.80" $229.85 "$1,102.80" $2.25 $2.25 $2.33 $2.16 $2.54 "$1,102.80" "$1,102.80" $652.31 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" $827.25 "$1,102.80" "$1,102.80" "$1,102.80" $551.40 $551.40 $873.42 "$1,102.80" $882.24 $496.26 $2.42 "$1,102.80" $639.74 "$1,102.80" "$1,102.80" "$1,102.80" $2.42 "$1,102.80" N/A N/A 123622 ERX HCPCS 25000001 00085-4331-01 POSACONAZOLE 300 MG/16.7ML IV SOLN BOTH IP/OP "$1,700.00" "$1,258.00" $302.52 "$1,699.56" "$1,699.56" "$1,699.56" "$1,699.56" "$1,699.56" "$1,699.56" "$1,699.56" $302.52 "$1,699.56" "$1,699.56" "$1,261.41" "$1,261.41" "$1,310.02" $885.47 $354.21 "$1,699.56" $679.82 "$1,699.56" "$1,699.56" "$1,699.56" "$1,699.56" "$1,699.56" "$1,275.00" "$1,699.56" "$1,699.56" "$1,699.56" $849.78 $849.78 "$1,346.05" "$1,699.56" "$1,359.65" "$1,104.71" "$1,699.56" "$1,699.56" $986.00 "$1,699.56" "$1,019.74" "$1,699.56" "$1,699.56" "$1,699.56" N/A N/A 123623 ERX HCPCS J7168 63833-0387-02 PROTHROMBIN COMPLEX CONC HUMAN 1000 UNITS/40 ML IV KIT BOTH IP/OP "$8,341.50" "$6,173.00" "$1,738.44" "$8,341.40" "$8,341.40" "$8,341.40" "$8,341.40" "$8,341.40" "$8,341.40" "$8,341.40" "$2,608.00" "$8,341.40" "$8,341.40" "$2,828.80" "$2,828.80" "$2,937.60" "$2,720.00" "$1,738.44" "$8,341.40" "$3,336.56" "$8,341.40" "$8,341.40" "$8,341.40" "$8,341.40" "$8,341.40" "$6,256.13" "$8,341.40" "$8,341.40" "$8,341.40" "$4,170.70" "$4,170.70" "$6,606.39" "$8,341.40" "$6,673.12" "$3,753.63" "$8,341.40" "$8,341.40" "$4,838.07" "$8,341.40" "$5,004.84" "$8,341.40" "$8,341.40" "$8,341.40" N/A N/A 123899 ERX HCPCS 25000001 41167-0058-77 LIDOCAINE 4 % EX CREAM- LARGE TUBE BOTH IP/OP $46.00 $34.00 $8.12 $45.61 $45.61 $45.61 $45.61 $45.61 $45.61 $45.61 $8.12 $45.61 $45.61 $33.85 $33.85 $35.16 $23.76 $9.51 $45.61 $18.24 $45.61 $45.61 $45.61 $45.61 $45.61 $34.50 $45.61 $45.61 $45.61 $22.81 $22.81 $36.12 $45.61 $36.49 $29.65 $45.61 $45.61 $26.68 $45.61 $27.37 $45.61 $45.61 $45.61 N/A N/A 123951 ERX HCPCS J7327 59676-0820-01 HYALURONAN 88 MG/4ML I-ARTICULAR SOSY BOTH IP/OP "$4,194.00" "$3,104.00" $719.33 "$4,194.00" "$1,887.30" "$1,887.30" "$1,887.30" "$1,887.30" $790.78 $790.78 $790.78 $874.13 $790.78 $822.41 $822.41 $854.04 $790.78 $874.08 $790.78 $719.33 "$2,067.64" $790.78 "$4,194.00" $790.78 $830.31 "$3,145.50" $790.78 $790.78 $790.78 "$2,097.00" "$2,097.00" "$3,321.65" $790.78 "$3,355.20" "$1,887.30" $832.40 $790.78 "$2,432.52" $830.31 "$1,146.62" $790.78 $874.03 $790.78 N/A N/A 123968 ERX HCPCS J9308 00002-7669-01 RAMUCIRUMAB 100 MG/10ML IV SOLN BOTH IP/OP "$3,801.00" "$2,813.00" $792.22 "$3,801.00" "$1,710.45" "$1,710.45" "$1,710.45" "$1,710.45" "$1,271.14" "$1,271.14" "$1,271.14" $792.22 "$1,271.14" "$1,322.05" "$1,322.05" "$1,372.90" "$1,271.20" "$1,493.46" "$1,271.14" "$1,336.98" "$1,873.89" "$1,271.14" "$3,801.00" "$1,271.14" "$1,334.70" "$2,850.75" "$1,271.14" "$1,271.14" "$1,271.14" "$1,900.50" "$1,900.50" "$3,010.39" "$1,271.14" "$3,040.80" "$1,710.45" "$1,422.22" "$1,271.14" "$2,204.58" "$1,334.70" "$1,843.15" "$1,271.14" "$1,422.22" "$1,271.14" N/A N/A 123969 ERX HCPCS J9308 00002-7678-01 RAMUCIRUMAB 500 MG/50ML IV SOLN BOTH IP/OP "$19,005.00" "$14,064.00" "$3,961.12" "$19,005.00" "$8,552.25" "$8,552.25" "$8,552.25" "$8,552.25" "$6,355.70" "$6,355.70" "$6,355.70" "$3,961.12" "$6,355.70" "$6,610.24" "$6,610.24" "$6,864.48" "$6,356.00" "$7,467.29" "$6,355.70" "$6,684.90" "$9,369.47" "$6,355.70" "$19,005.00" "$6,355.70" "$6,673.49" "$14,253.75" "$6,355.70" "$6,355.70" "$6,355.70" "$9,502.50" "$9,502.50" "$15,051.96" "$6,355.70" "$15,204.00" "$8,552.25" "$7,111.09" "$6,355.70" "$11,022.90" "$6,673.49" "$9,215.77" "$6,355.70" "$7,111.09" "$6,355.70" N/A N/A 124228 ERX HCPCS J3380 64764-0300-20 VEDOLIZUMAB 300 MG IV SOLR BOTH IP/OP "$22,860.50" "$16,917.00" "$4,764.63" "$22,860.15" "$10,287.07" "$10,287.07" "$10,287.07" "$10,287.07" "$6,387.90" "$6,387.90" "$6,387.90" "$4,764.63" "$6,387.90" "$6,642.48" "$6,642.48" "$6,897.96" "$6,387.00" "$7,503.71" "$6,387.90" "$6,552.00" "$11,270.05" "$6,387.90" "$22,860.15" "$6,387.90" "$6,707.30" "$17,145.38" "$6,387.90" "$6,387.90" "$6,387.90" "$11,430.08" "$11,430.08" "$18,105.24" "$6,387.90" "$18,288.12" "$10,287.07" "$7,145.78" "$6,387.90" "$13,259.09" "$6,707.30" "$9,262.46" "$6,387.90" "$7,145.78" "$6,387.90" N/A N/A 124458 ERX HCPCS 63700001 00069-0830-38 SUNITINIB MALATE 37.5 MG PO CAPS BOTH IP/OP "$2,152.00" "$1,592.00" $448.47 "$2,151.85" "$2,151.85" "$2,151.85" "$2,151.85" "$2,151.85" "$2,151.85" "$2,151.85" "$2,151.85" "$2,151.85" "$2,151.85" "$2,151.85" "$2,151.85" "$2,151.85" "$2,151.85" $448.47 "$2,151.85" $860.74 "$2,151.85" "$2,151.85" "$2,151.85" "$2,151.85" "$2,151.85" "$1,614.00" "$2,151.85" "$2,151.85" "$2,151.85" "$1,075.93" "$1,075.93" "$1,704.27" "$2,151.85" "$1,721.48" "$1,398.70" "$2,151.85" "$2,151.85" "$1,248.16" "$2,151.85" "$1,291.11" "$2,151.85" "$2,151.85" "$2,151.85" N/A N/A 124486 ERX HCPCS J0875 57970-0100-01 DALBAVANCIN HCL 500 MG IV SOLR BOTH IP/OP "$4,830.00" "$3,574.00" "$1,006.60" "$4,829.56" "$2,173.30" "$2,173.30" "$2,173.30" "$2,173.30" "$1,589.10" "$1,589.10" "$1,589.10" "$1,006.60" "$1,589.10" "$1,652.56" "$1,652.56" "$1,716.12" "$1,589.00" "$1,866.82" "$1,589.10" "$1,531.50" "$2,380.97" "$1,589.10" "$4,829.56" "$1,589.10" "$1,668.56" "$3,622.50" "$1,589.10" "$1,589.10" "$1,589.10" "$2,414.78" "$2,414.78" "$3,825.01" "$1,589.10" "$3,863.65" "$2,173.30" "$1,777.77" "$1,589.10" "$2,801.40" "$1,668.56" "$2,304.20" "$1,589.10" "$1,777.77" "$1,589.10" N/A N/A 124555 ERX HCPCS 25000001 00536-1186-12 PHENYLEPHRINE-COCOA BUTTER 0.25-88.44 % RECTAL SUPP BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 124599 ERX HCPCS 63700001 00006-3603-61 RALTEGRAVIR POTASSIUM 100 MG PO PACK BOTH IP/OP $41.50 $31.00 $8.60 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $41.27 $8.60 $41.27 $16.51 $41.27 $41.27 $41.27 $41.27 $41.27 $31.13 $41.27 $41.27 $41.27 $20.64 $20.64 $32.69 $41.27 $33.02 $26.83 $41.27 $41.27 $24.07 $41.27 $24.76 $41.27 $41.27 $41.27 N/A N/A 124607 ERX HCPCS J8530 00054-0383-25 CYCLOPHOSPHAMIDE 50 MG PO CAPS BOTH IP/OP $74.50 $55.00 $1.62 $74.23 $74.23 $74.23 $74.23 $74.23 $74.23 $74.23 $1.62 $74.23 $74.23 $1.83 $1.83 $1.90 $1.76 $15.47 $74.23 $29.69 $74.23 $74.23 $74.23 $74.23 $74.23 $55.88 $74.23 $74.23 $74.23 $37.12 $37.12 $58.79 $74.23 $59.38 $33.40 $74.23 $74.23 $43.21 $74.23 $44.54 $74.23 $74.23 $74.23 N/A N/A 125003 ERX HCPCS 25000001 00597-0192-61 OLODATEROL HCL 2.5 MCG/ACT IN AERS BOTH IP/OP $915.50 $677.00 $162.94 $915.37 $915.37 $915.37 $915.37 $915.37 $915.37 $915.37 $162.94 $915.37 $915.37 $679.39 $679.39 $705.57 $476.91 $190.77 $915.37 $366.15 $915.37 $915.37 $915.37 $915.37 $915.37 $686.63 $915.37 $915.37 $915.37 $457.69 $457.69 $724.97 $915.37 $732.30 $594.99 $915.37 $915.37 $530.99 $915.37 $549.22 $915.37 $915.37 $915.37 N/A N/A 125122 ERX HCPCS 63700001 49702-0231-13 TRIUMEQ:ABACAVIR-DOLUTEGRAVIR-LAMIVUD 600-50-300 MG PO TABS BOTH IP/OP $491.00 $363.00 $102.33 $491.00 $491.00 $491.00 $491.00 $491.00 $491.00 $491.00 $491.00 $491.00 $491.00 $491.00 $491.00 $491.00 $491.00 $102.33 $491.00 $196.40 $491.00 $491.00 $491.00 $491.00 $491.00 $368.25 $491.00 $491.00 $491.00 $245.50 $245.50 $388.87 $491.00 $392.80 $319.15 $491.00 $491.00 $284.78 $491.00 $294.60 $491.00 $491.00 $491.00 N/A N/A 125240 ERX HCPCS 63600001 57894-0061-03 USTEKINUMAB 90 MG/ML SC SOSY BOTH IP/OP "$74,142.00" "$54,865.00" "$13,197.19" "$74,141.54" "$74,141.54" "$74,141.54" "$74,141.54" "$74,141.54" "$74,141.54" "$74,141.54" "$13,197.19" "$74,141.54" "$74,141.54" "$74,141.54" "$74,141.54" "$74,141.54" "$74,141.54" "$15,451.91" "$74,141.54" "$29,656.62" "$74,141.54" "$74,141.54" "$74,141.54" "$74,141.54" "$74,141.54" "$55,606.50" "$74,141.54" "$74,141.54" "$74,141.54" "$37,070.77" "$37,070.77" "$58,720.10" "$74,141.54" "$59,313.23" "$33,363.69" "$74,141.54" "$74,141.54" "$43,002.36" "$74,141.54" "$44,484.92" "$74,141.54" "$74,141.54" "$74,141.54" N/A N/A 125244 ERX HCPCS 63600001 00006-4897-00 HAEMOPHILUS B POLYSAC CONJ VAC 7.5 MCG/0.5 ML IM SUSP BOTH IP/OP $137.50 $102.00 $24.43 $137.27 $137.27 $137.27 $137.27 $137.27 $137.27 $137.27 $24.43 $137.27 $137.27 $137.27 $137.27 $137.27 $137.27 $28.61 $137.27 $54.91 $137.27 $137.27 $137.27 $137.27 $137.27 $103.13 $137.27 $137.27 $137.27 $68.64 $68.64 $108.72 $137.27 $109.82 $61.77 $137.27 $137.27 $79.75 $137.27 $82.36 $137.27 $137.27 $137.27 N/A N/A 125258 ERX HCPCS J7321 89130-4444-01 SODIUM HYALURONATE (VISCOSUP) 25 MG/2.5ML I-ARTICULAR SOSY BOTH IP/OP $860.00 $636.00 $75.94 $859.65 $386.84 $386.84 $386.84 $386.84 $859.65 $859.65 $859.65 $179.17 $859.65 $78.98 $78.98 $82.02 $75.94 $89.22 $859.65 $859.65 $508.48 $859.65 $859.65 $859.65 $859.65 $645.00 $859.65 $859.65 $859.65 $429.83 $429.83 $680.84 $859.65 $687.72 $386.84 $84.96 $859.65 $498.80 $859.65 $859.65 $859.65 $84.96 $859.65 N/A N/A 125724 ERX HCPCS J2370 70121-1577-01 PHENYLEPHRINE HCL 50 MG/5 ML IV SOLN BOTH IP/OP $22.00 $16.00 $0.96 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.96 $22.00 $3.49 $3.49 $3.63 $3.36 $3.95 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $3.76 $22.00 $12.76 $22.00 $22.00 $22.00 $3.76 $22.00 N/A N/A 125794 ERX HCPCS 25000001 00799-0001-02 MENTHOL-ZINC OXIDE 0.44-20.6 % EX OINT BOTH IP/OP $30.50 $23.00 $5.41 $30.37 $30.37 $30.37 $30.37 $30.37 $30.37 $30.37 $5.41 $30.37 $30.37 $22.54 $22.54 $23.41 $15.82 $6.33 $30.37 $12.15 $30.37 $30.37 $30.37 $30.37 $30.37 $22.88 $30.37 $30.37 $30.37 $15.19 $15.19 $24.05 $30.37 $24.30 $19.74 $30.37 $30.37 $17.69 $30.37 $18.22 $30.37 $30.37 $30.37 N/A N/A 125803 ERX HCPCS 63700006 50458-0584-51 RIVAROXABAN STARTER PACK 15MG & 20MG BOTH IP/OP $86.50 $64.00 $18.00 $86.37 $86.37 $86.37 $86.37 $86.37 $86.37 $86.37 $86.37 $86.37 $86.37 $86.37 $86.37 $86.37 $86.37 $18.00 $86.37 $34.55 $86.37 $86.37 $86.37 $86.37 $86.37 $64.88 $86.37 $86.37 $86.37 $43.19 $43.19 $68.41 $86.37 $69.10 $56.14 $86.37 $86.37 $50.17 $86.37 $51.82 $86.37 $86.37 $86.37 N/A N/A 126034 ERX HCPCS J7188 00944-5001-01 OBIZUR:ANTIHEMOPHILIC FACTOR RPFVIII 500 UNITS IV SOLR BOTH IP/OP "$3,786.50" "$2,802.00" $789.10 "$3,786.25" "$3,786.25" "$3,786.25" "$3,786.25" "$3,786.25" "$3,786.25" "$3,786.25" "$1,595.00" "$3,786.25" "$3,786.25" "$1,664.00" "$1,664.00" "$1,728.00" "$1,600.00" $789.10 "$3,786.25" "$1,514.50" "$3,786.25" "$3,786.25" "$3,786.25" "$3,786.25" "$3,786.25" "$2,839.88" "$3,786.25" "$3,786.25" "$3,786.25" "$1,893.13" "$1,893.13" "$2,998.71" "$3,786.25" "$3,029.00" "$1,703.81" "$3,786.25" "$3,786.25" "$2,196.17" "$3,786.25" "$2,271.75" "$3,786.25" "$3,786.25" "$3,786.25" N/A N/A 126056 ERX HCPCS 25000001 00005-0100-05 MENINGOCOCCAL B VAC (RECOMB) IM SUSY BOTH IP/OP $651.00 $482.00 $115.84 $650.80 $650.80 $650.80 $650.80 $650.80 $650.80 $650.80 $115.84 $650.80 $650.80 $483.02 $483.02 $501.64 $339.07 $135.63 $650.80 $260.32 $650.80 $650.80 $650.80 $650.80 $650.80 $488.25 $650.80 $650.80 $650.80 $325.40 $325.40 $515.43 $650.80 $520.64 $423.02 $650.80 $650.80 $377.58 $650.80 $390.48 $650.80 $650.80 $650.80 N/A N/A 126084 ERX HCPCS 25000001 42367-0570-87 VASOPRESSIN 20 UNIT/ML IV SOLN BOTH IP/OP $189.00 $140.00 $33.59 $188.71 $188.71 $188.71 $188.71 $188.71 $188.71 $188.71 $33.59 $188.71 $188.71 $140.06 $140.06 $145.46 $98.32 $39.33 $188.71 $75.48 $188.71 $188.71 $188.71 $188.71 $188.71 $141.75 $188.71 $188.71 $188.71 $94.36 $94.36 $149.46 $188.71 $150.97 $122.66 $188.71 $188.71 $109.62 $188.71 $113.23 $188.71 $188.71 $188.71 N/A N/A 126108 ERX HCPCS 25000001 08317-5411-00 GLUCOCARD SHINE W/DEVICE KIT BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 126110 ERX HCPCS 25000001 08317-5400-50 GLUCOCARD SHINE TEST VI STRP BOTH IP/OP $78.00 $58.00 $13.84 $77.76 $77.76 $77.76 $77.76 $77.76 $77.76 $77.76 $13.84 $77.76 $77.76 $57.71 $57.71 $59.94 $40.51 $16.21 $77.76 $31.10 $77.76 $77.76 $77.76 $77.76 $77.76 $58.50 $77.76 $77.76 $77.76 $38.88 $38.88 $61.59 $77.76 $62.21 $50.54 $77.76 $77.76 $45.24 $77.76 $46.66 $77.76 $77.76 $77.76 N/A N/A 126226 ERX HCPCS J2547 72769-0181-03 PERAMIVIR 200 MG/20ML IV SOLN BOTH IP/OP "$1,148.00" $850.00 $239.17 "$1,147.60" "$1,147.60" "$1,147.60" "$1,147.60" "$1,147.60" "$1,147.60" "$1,147.60" $304.00 "$1,147.60" "$1,147.60" $328.64 $328.64 $341.28 $316.00 $239.17 "$1,147.60" $459.04 "$1,147.60" "$1,147.60" "$1,147.60" "$1,147.60" "$1,147.60" $861.00 "$1,147.60" "$1,147.60" "$1,147.60" $573.80 $573.80 $908.90 "$1,147.60" $918.08 $516.42 "$1,147.60" "$1,147.60" $665.84 "$1,147.60" $688.56 "$1,147.60" "$1,147.60" "$1,147.60" N/A N/A 126229 ERX HCPCS 63700001 00173-0873-10 UMECLIDINIUM BROMIDE 62.5 MCG/ACT IN AEPB BOTH IP/OP "$1,283.50" $950.00 $267.45 "$1,283.26" "$1,283.26" "$1,283.26" "$1,283.26" "$1,283.26" "$1,283.26" "$1,283.26" "$1,283.26" "$1,283.26" "$1,283.26" "$1,283.26" "$1,283.26" "$1,283.26" "$1,283.26" $267.45 "$1,283.26" $513.30 "$1,283.26" "$1,283.26" "$1,283.26" "$1,283.26" "$1,283.26" $962.63 "$1,283.26" "$1,283.26" "$1,283.26" $641.63 $641.63 "$1,016.34" "$1,283.26" "$1,026.61" $834.12 "$1,283.26" "$1,283.26" $744.43 "$1,283.26" $769.96 "$1,283.26" "$1,283.26" "$1,283.26" N/A N/A 126242 ERX HCPCS J7313 68611-0190-02 FLUOCINOLONE ACETONIDE 0.19 MG INTRAVITREAL IMPL BOTH IP/OP "$24,605.00" "$18,208.00" "$9,328.05" "$24,604.80" "$24,604.80" "$24,604.80" "$24,604.80" "$24,604.80" "$24,604.80" "$24,604.80" "$9,328.05" "$24,604.80" "$24,604.80" "$9,701.17" "$9,701.17" "$10,074.29" "$9,328.05" "$10,958.98" "$24,604.80" "$9,841.92" "$24,604.80" "$24,604.80" "$24,604.80" "$24,604.80" "$24,604.80" "$18,453.75" "$24,604.80" "$24,604.80" "$24,604.80" "$12,302.40" "$12,302.40" "$19,487.00" "$24,604.80" "$19,683.84" "$11,072.16" "$24,604.80" "$24,604.80" "$14,270.90" "$24,604.80" "$14,762.88" "$24,604.80" "$24,604.80" "$24,604.80" N/A N/A 126317 ERX HCPCS 90651 00006-4119-03 HPV 9-VALENT RECOMB VACCINE IM SUSP BOTH IP/OP $974.00 $721.00 $202.92 $973.59 $438.12 $438.12 $438.12 $438.12 $973.59 $973.59 $243.34 $202.92 $973.59 $263.74 $263.74 $273.89 $253.60 $297.94 $973.59 $389.44 $575.88 $973.59 $973.59 $973.59 $973.59 $730.50 $973.59 $973.59 $973.59 $486.80 $486.80 $771.08 $973.59 $778.87 $438.12 $283.73 $973.59 $564.92 $973.59 $584.15 $973.59 $283.73 $973.59 N/A N/A 126371 ERX HCPCS J0695 67919-0030-01 CEFTOLOZANE-TAZOBACTAM 1.5 (1-0.5) G IV SOLR BOTH IP/OP $601.50 $445.00 $125.28 $601.12 $601.12 $601.12 $601.12 $601.12 $601.12 $601.12 $199.20 $601.12 $601.12 $207.17 $207.17 $215.14 $199.20 $125.28 $601.12 $240.45 $601.12 $601.12 $601.12 $601.12 $601.12 $451.13 $601.12 $601.12 $601.12 $300.56 $300.56 $476.09 $601.12 $480.90 $270.50 $601.12 $601.12 $348.87 $601.12 $360.67 $601.12 $601.12 $601.12 N/A N/A 126373 ERX HCPCS J9299 00003-3772-11 NIVOLUMAB 40 MG/4ML IV SOLN BOTH IP/OP "$3,353.00" "$2,481.00" $698.76 "$3,352.55" "$1,508.65" "$1,508.65" "$1,508.65" "$1,508.65" "$1,169.80" "$1,169.80" "$1,169.80" $698.76 "$1,169.80" "$1,216.80" "$1,216.80" "$1,263.60" "$1,170.00" "$1,374.56" "$1,169.80" "$1,196.44" "$1,652.81" "$1,169.80" "$3,352.55" "$1,169.80" "$1,228.29" "$2,514.75" "$1,169.80" "$1,169.80" "$1,169.80" "$1,676.28" "$1,676.28" "$2,655.22" "$1,169.80" "$2,682.04" "$1,508.65" "$1,309.00" "$1,169.80" "$1,944.74" "$1,228.29" "$1,696.21" "$1,169.80" "$1,309.00" "$1,169.80" N/A N/A 126374 ERX HCPCS J9299 00003-3774-12 NIVOLUMAB 100 MG/10ML IV SOLN BOTH IP/OP "$8,381.50" "$6,202.00" "$1,746.88" "$8,381.34" "$3,771.60" "$3,771.60" "$3,771.60" "$3,771.60" "$2,924.50" "$2,924.50" "$2,924.50" "$1,746.88" "$2,924.50" "$3,042.00" "$3,042.00" "$3,159.00" "$2,925.00" "$3,436.41" "$2,924.50" "$2,991.10" "$4,132.00" "$2,924.50" "$8,381.34" "$2,924.50" "$3,070.73" "$6,286.13" "$2,924.50" "$2,924.50" "$2,924.50" "$4,190.67" "$4,190.67" "$6,638.02" "$2,924.50" "$6,705.07" "$3,771.60" "$3,272.49" "$2,924.50" "$4,861.27" "$3,070.73" "$4,240.53" "$2,924.50" "$3,272.49" "$2,924.50" N/A N/A 126594 ERX HCPCS 90620 58160-0976-20 MENINGOCOCCAL B RECOMB OMV ADJ IM SUSY BOTH IP/OP $765.50 $566.00 $159.52 $765.38 $344.42 $344.42 $344.42 $344.42 $765.38 $765.38 $183.95 $159.52 $765.38 $199.42 $199.42 $207.09 $191.75 $225.28 $765.38 $306.15 $452.72 $765.38 $765.38 $765.38 $765.38 $574.13 $765.38 $765.38 $765.38 $382.69 $382.69 $606.18 $765.38 $612.30 $344.42 $214.53 $765.38 $443.99 $765.38 $459.23 $765.38 $214.53 $765.38 N/A N/A 126697 ERX HCPCS J9271 00006-3026-02 PEMBROLIZUMAB 100 MG/4ML IV SOLN BOTH IP/OP "$15,234.50" "$11,274.00" "$3,175.18" "$15,234.18" "$6,855.38" "$6,855.38" "$6,855.38" "$6,855.38" "$5,230.00" "$5,230.00" "$5,230.00" "$3,175.18" "$5,230.00" "$5,439.20" "$5,439.20" "$5,648.40" "$5,230.00" "$6,144.42" "$5,230.00" "$5,541.70" "$7,510.45" "$5,230.00" "$15,234.18" "$5,230.00" "$5,491.50" "$11,425.88" "$5,230.00" "$5,230.00" "$5,230.00" "$7,617.09" "$7,617.09" "$12,065.47" "$5,230.00" "$12,187.34" "$6,855.38" "$5,851.32" "$5,230.00" "$8,836.01" "$5,491.50" "$7,583.50" "$5,230.00" "$5,851.32" "$5,230.00" N/A N/A 126882 ERX HCPCS 63700001 59676-0575-30 PREZCOBIX:DARUNAVIR-COBICISTAT 800-150 MG PO TABS BOTH IP/OP $343.00 $254.00 $71.47 $342.95 $342.95 $342.95 $342.95 $342.95 $342.95 $342.95 $342.95 $342.95 $342.95 $342.95 $342.95 $342.95 $342.95 $71.47 $342.95 $137.18 $342.95 $342.95 $342.95 $342.95 $342.95 $257.25 $342.95 $342.95 $342.95 $171.48 $171.48 $271.62 $342.95 $274.36 $222.92 $342.95 $342.95 $198.94 $342.95 $205.77 $342.95 $342.95 $342.95 N/A N/A 126886 ERX HCPCS J1595 68546-0317-30 GLATIRAMER ACETATE 20 MG/ML SC SOSY BOTH IP/OP $859.50 $636.00 $62.40 $859.38 $859.38 $859.38 $859.38 $859.38 $859.38 $859.38 $62.40 $859.38 $859.38 $67.60 $67.60 $70.20 $65.00 $179.10 $859.38 $343.75 $859.38 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $859.38 $859.38 $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 126887 ERX HCPCS 25000001 00409-4093-01 CHROMIC CHLORIDE 40 MCG/10ML IV SOLN BOTH IP/OP $95.00 $70.00 $16.86 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $16.86 $94.73 $94.73 $70.31 $70.31 $73.02 $49.35 $19.74 $94.73 $37.89 $94.73 $94.73 $94.73 $94.73 $94.73 $71.25 $94.73 $94.73 $94.73 $47.37 $47.37 $75.03 $94.73 $75.78 $61.57 $94.73 $94.73 $55.10 $94.73 $56.84 $94.73 $94.73 $94.73 N/A N/A 126889 ERX HCPCS 25000001 00409-7295-01 KPHOS DIBASIC 3 MMOLE/ML IV SOLN BOTH IP/OP $77.00 $57.00 $13.65 $76.66 $76.66 $76.66 $76.66 $76.66 $76.66 $76.66 $13.65 $76.66 $76.66 $56.90 $56.90 $59.09 $39.94 $15.98 $76.66 $30.66 $76.66 $76.66 $76.66 $76.66 $76.66 $57.75 $76.66 $76.66 $76.66 $38.33 $38.33 $60.71 $76.66 $61.33 $49.83 $76.66 $76.66 $44.66 $76.66 $46.00 $76.66 $76.66 $76.66 N/A N/A 126893 ERX HCPCS 25000001 00781-3040-95 PYRIDOSTIGMINE BROMIDE 10 MG/2ML IV SOLN BOTH IP/OP $33.50 $25.00 $5.91 $33.18 $33.18 $33.18 $33.18 $33.18 $33.18 $33.18 $5.91 $33.18 $33.18 $24.63 $24.63 $25.58 $17.29 $6.92 $33.18 $13.27 $33.18 $33.18 $33.18 $33.18 $33.18 $25.13 $33.18 $33.18 $33.18 $16.59 $16.59 $26.28 $33.18 $26.54 $21.57 $33.18 $33.18 $19.43 $33.18 $19.91 $33.18 $33.18 $33.18 N/A N/A 126894 ERX HCPCS J0135 00074-4339-02 ADALIMUMAB 40 MG/0.8ML SC PNKT BOTH IP/OP "$9,678.00" "$7,162.00" "$1,722.65" "$9,677.82" "$9,677.82" "$9,677.82" "$9,677.82" "$9,677.82" "$9,677.82" "$9,677.82" "$1,722.65" "$9,677.82" "$9,677.82" "$9,677.82" "$9,677.82" "$9,677.82" "$9,677.82" "$2,016.96" "$9,677.82" "$3,871.13" "$9,677.82" "$9,677.82" "$9,677.82" "$9,677.82" "$9,677.82" "$7,258.50" "$9,677.82" "$9,677.82" "$9,677.82" "$4,838.91" "$4,838.91" "$7,664.83" "$9,677.82" "$7,742.26" "$4,355.02" "$9,677.82" "$9,677.82" "$5,613.24" "$9,677.82" "$5,806.69" "$9,677.82" "$9,677.82" "$9,677.82" N/A N/A 126907 ERX HCPCS 90686 58160-0890-52 INFLUENZA VAC SPLIT QUAD 0.5 ML IM SUSY BOTH IP/OP $90.50 $67.00 $12.80 $90.15 $40.57 $40.57 $40.57 $40.57 $23.44 $23.44 $20.53 $18.79 $23.44 $21.35 $21.35 $22.17 $20.53 $24.12 $90.15 $36.06 $53.32 $23.44 $23.44 $23.44 $90.15 $67.88 $23.44 $12.80 $23.44 $45.08 $45.08 $71.40 $23.44 $72.12 $40.57 $22.97 $23.44 $52.49 $90.15 $13.16 $23.44 $22.97 $23.44 N/A N/A 126921 ERX HCPCS 25000001 00078-0639-68 SECUKINUMAB 150 MG/ML SC SOAJ BOTH IP/OP "$19,360.50" "$14,327.00" "$2,060.15" "$19,360.23" "$19,360.23" "$19,360.23" "$19,360.23" "$19,360.23" "$19,360.23" "$19,360.23" "$3,446.12" "$19,360.23" "$19,360.23" "$4,181.12" "$4,181.12" "$14,922.87" "$2,060.15" "$4,034.88" "$19,360.23" "$7,744.09" "$19,360.23" "$19,360.23" "$19,360.23" "$19,360.23" "$19,360.23" "$14,520.38" "$19,360.23" "$19,360.23" "$19,360.23" "$9,680.12" "$9,680.12" "$15,333.30" "$19,360.23" "$15,488.18" "$12,584.15" "$19,360.23" "$19,360.23" "$11,229.09" "$19,360.23" "$11,616.14" "$19,360.23" "$19,360.23" "$19,360.23" N/A N/A 126934 ERX HCPCS 63700001 00003-3641-11 EVOTAZ:ATAZANAVIR-COBICISTAT 300-150 MG PO TABS BOTH IP/OP $230.00 $170.00 $47.92 $229.91 $229.91 $229.91 $229.91 $229.91 $229.91 $229.91 $229.91 $229.91 $229.91 $229.91 $229.91 $229.91 $229.91 $47.92 $229.91 $91.96 $229.91 $229.91 $229.91 $229.91 $229.91 $172.50 $229.91 $229.91 $229.91 $114.96 $114.96 $182.09 $229.91 $183.93 $149.44 $229.91 $229.91 $133.40 $229.91 $137.95 $229.91 $229.91 $229.91 N/A N/A 126960 ERX HCPCS 25000001 00069-0187-21 PALBOCICLIB 75 MG PO CAPS BOTH IP/OP "$2,300.50" "$1,702.00" $409.48 "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" $409.48 "$2,300.44" "$2,300.44" "$1,707.39" "$1,707.39" "$1,773.18" "$1,198.53" $479.44 "$2,300.44" $920.18 "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$1,725.38" "$2,300.44" "$2,300.44" "$2,300.44" "$1,150.22" "$1,150.22" "$1,821.95" "$2,300.44" "$1,840.35" "$1,495.29" "$2,300.44" "$2,300.44" "$1,334.29" "$2,300.44" "$1,380.26" "$2,300.44" "$2,300.44" "$2,300.44" N/A N/A 126961 ERX HCPCS 25000001 00069-0188-21 PALBOCICLIB 100 MG PO CAPS BOTH IP/OP "$2,300.50" "$1,702.00" $409.48 "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" $409.48 "$2,300.44" "$2,300.44" "$1,707.39" "$1,707.39" "$1,773.18" "$1,198.53" $479.44 "$2,300.44" $920.18 "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$1,725.38" "$2,300.44" "$2,300.44" "$2,300.44" "$1,150.22" "$1,150.22" "$1,821.95" "$2,300.44" "$1,840.35" "$1,495.29" "$2,300.44" "$2,300.44" "$1,334.29" "$2,300.44" "$1,380.26" "$2,300.44" "$2,300.44" "$2,300.44" N/A N/A 126962 ERX HCPCS 25000001 00069-0189-21 PALBOCICLIB 125 MG PO CAPS BOTH IP/OP "$2,300.50" "$1,702.00" $409.48 "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" $409.48 "$2,300.44" "$2,300.44" "$1,707.39" "$1,707.39" "$1,773.18" "$1,198.53" $479.44 "$2,300.44" $920.18 "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$1,725.38" "$2,300.44" "$2,300.44" "$2,300.44" "$1,150.22" "$1,150.22" "$1,821.95" "$2,300.44" "$1,840.35" "$1,495.29" "$2,300.44" "$2,300.44" "$1,334.29" "$2,300.44" "$1,380.26" "$2,300.44" "$2,300.44" "$2,300.44" N/A N/A 127008 ERX HCPCS 63700001 62856-0720-30 LENVATINIB (20 MG DAILY DOSE) 2 X 10 MG PO CPPK BOTH IP/OP "$2,356.00" "$1,743.00" $490.97 "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" $490.97 "$2,355.80" $942.32 "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$1,767.00" "$2,355.80" "$2,355.80" "$2,355.80" "$1,177.90" "$1,177.90" "$1,865.79" "$2,355.80" "$1,884.64" "$1,531.27" "$2,355.80" "$2,355.80" "$1,366.48" "$2,355.80" "$1,413.48" "$2,355.80" "$2,355.80" "$2,355.80" N/A N/A 127009 ERX HCPCS 63700001 62856-0714-05 LENVATINIB (14 MG DAILY DOSE) 10 & 4 MG PO CPPK BOTH IP/OP "$1,332.50" $986.00 $277.67 "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" $277.67 "$1,332.31" $532.92 "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" $999.38 "$1,332.31" "$1,332.31" "$1,332.31" $666.16 $666.16 "$1,055.19" "$1,332.31" "$1,065.85" $866.00 "$1,332.31" "$1,332.31" $772.85 "$1,332.31" $799.39 "$1,332.31" "$1,332.31" "$1,332.31" N/A N/A 127013 ERX HCPCS 63700001 62856-0710-30 LENVATINIB (10 MG DAILY DOSE) 10 MG PO CPPK BOTH IP/OP "$2,356.00" "$1,743.00" $490.97 "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" $490.97 "$2,355.80" $942.32 "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$1,767.00" "$2,355.80" "$2,355.80" "$2,355.80" "$1,177.90" "$1,177.90" "$1,865.79" "$2,355.80" "$1,884.64" "$1,531.27" "$2,355.80" "$2,355.80" "$1,366.48" "$2,355.80" "$1,413.48" "$2,355.80" "$2,355.80" "$2,355.80" N/A N/A 127014 ERX HCPCS 63700001 62856-0724-05 LENVATINIB (24 MG DAILY DOSE) 2 X 10 MG & 4 MG PO CPPK BOTH IP/OP $888.50 $657.00 $185.11 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $185.11 $888.21 $355.28 $888.21 $888.21 $888.21 $888.21 $888.21 $666.38 $888.21 $888.21 $888.21 $444.11 $444.11 $703.46 $888.21 $710.57 $577.34 $888.21 $888.21 $515.33 $888.21 $532.93 $888.21 $888.21 $888.21 N/A N/A 127054 ERX HCPCS 25000001 66758-0208-58 SCOPOLAMINE 1 MG/3DAYS TD PT72 (1 MG BASE) BOTH IP/OP $85.50 $63.00 $15.16 $85.18 $85.18 $85.18 $85.18 $85.18 $85.18 $85.18 $15.16 $85.18 $85.18 $63.22 $63.22 $65.66 $44.38 $17.75 $85.18 $34.07 $85.18 $85.18 $85.18 $85.18 $85.18 $64.13 $85.18 $85.18 $85.18 $42.59 $42.59 $67.46 $85.18 $68.14 $55.37 $85.18 $85.18 $49.59 $85.18 $51.11 $85.18 $85.18 $85.18 N/A N/A 127096 ERX HCPCS 25000001 PLENAMINE 15 % IV SOLN BOTH IP/OP "$1,498.00" "$1,109.00" $266.63 "$1,497.92" "$1,497.92" "$1,497.92" "$1,497.92" "$1,497.92" "$1,497.92" "$1,497.92" $266.63 "$1,497.92" "$1,497.92" "$1,111.76" "$1,111.76" "$1,154.60" $780.42 $312.18 "$1,497.92" $599.17 "$1,497.92" "$1,497.92" "$1,497.92" "$1,497.92" "$1,497.92" "$1,123.50" "$1,497.92" "$1,497.92" "$1,497.92" $748.96 $748.96 "$1,186.35" "$1,497.92" "$1,198.34" $973.65 "$1,497.92" "$1,497.92" $868.84 "$1,497.92" $898.75 "$1,497.92" "$1,497.92" "$1,497.92" N/A N/A 127226 ERX HCPCS 25000001 00409-3375-04 NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN BOTH IP/OP $107.50 $80.00 $19.11 $107.35 $107.35 $107.35 $107.35 $107.35 $107.35 $107.35 $19.11 $107.35 $107.35 $79.68 $79.68 $82.75 $55.93 $22.37 $107.35 $42.94 $107.35 $107.35 $107.35 $107.35 $107.35 $80.63 $107.35 $107.35 $107.35 $53.68 $53.68 $85.02 $107.35 $85.88 $69.78 $107.35 $107.35 $62.35 $107.35 $64.41 $107.35 $107.35 $107.35 N/A N/A 127500 ERX HCPCS J0714 00456-2700-10 CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR BOTH IP/OP "$1,365.50" "$1,010.00" $284.55 "$1,365.34" "$1,365.34" "$1,365.34" "$1,365.34" "$1,365.34" "$1,365.34" "$1,365.34" $461.95 "$1,365.34" "$1,365.34" $480.32 $480.32 $498.80 $461.85 $284.55 "$1,365.34" $546.14 "$1,365.34" "$1,365.34" "$1,365.34" "$1,365.34" "$1,365.34" "$1,024.13" "$1,365.34" "$1,365.34" "$1,365.34" $682.67 $682.67 "$1,081.35" "$1,365.34" "$1,092.27" $614.40 "$1,365.34" "$1,365.34" $791.99 "$1,365.34" $819.20 "$1,365.34" "$1,365.34" "$1,365.34" N/A N/A 127504 ERX HCPCS J1833 00469-0420-01 ISAVUCONAZONIUM SULFATE 372 MG IV SOLR BOTH IP/OP "$1,322.00" $978.00 $275.42 "$1,321.53" "$1,321.53" "$1,321.53" "$1,321.53" "$1,321.53" "$1,321.53" "$1,321.53" $312.48 "$1,321.53" "$1,321.53" $336.59 $336.59 $349.53 $323.64 $275.42 "$1,321.53" $528.61 "$1,321.53" "$1,321.53" "$1,321.53" "$1,321.53" "$1,321.53" $991.50 "$1,321.53" "$1,321.53" "$1,321.53" $660.77 $660.77 "$1,046.65" "$1,321.53" "$1,057.22" $594.69 "$1,321.53" "$1,321.53" $766.76 "$1,321.53" $792.92 "$1,321.53" "$1,321.53" "$1,321.53" N/A N/A 127577 ERX HCPCS 63700001 70700-0269-30 DEFERASIROX 90 MG PO TABS BOTH IP/OP $181.50 $134.00 $37.79 $181.32 $181.32 $181.32 $181.32 $181.32 $181.32 $181.32 $181.32 $181.32 $181.32 $181.32 $181.32 $181.32 $181.32 $37.79 $181.32 $72.53 $181.32 $181.32 $181.32 $181.32 $181.32 $136.13 $181.32 $181.32 $181.32 $90.66 $90.66 $143.61 $181.32 $145.06 $117.86 $181.32 $181.32 $105.27 $181.32 $108.79 $181.32 $181.32 $181.32 N/A N/A 127578 ERX HCPCS 63700001 70700-0270-30 DEFERASIROX 180 MG PO TABS BOTH IP/OP $326.50 $242.00 $67.98 $326.19 $326.19 $326.19 $326.19 $326.19 $326.19 $326.19 $326.19 $326.19 $326.19 $326.19 $326.19 $326.19 $326.19 $67.98 $326.19 $130.48 $326.19 $326.19 $326.19 $326.19 $326.19 $244.88 $326.19 $326.19 $326.19 $163.10 $163.10 $258.34 $326.19 $260.95 $212.02 $326.19 $326.19 $189.37 $326.19 $195.71 $326.19 $326.19 $326.19 N/A N/A 127579 ERX HCPCS 63700001 70700-0271-30 DEFERASIROX 360 MG PO TABS BOTH IP/OP $632.50 $468.00 $131.78 $632.30 $632.30 $632.30 $632.30 $632.30 $632.30 $632.30 $632.30 $632.30 $632.30 $632.30 $632.30 $632.30 $632.30 $131.78 $632.30 $252.92 $632.30 $632.30 $632.30 $632.30 $632.30 $474.38 $632.30 $632.30 $632.30 $316.15 $316.15 $500.78 $632.30 $505.84 $411.00 $632.30 $632.30 $366.85 $632.30 $379.38 $632.30 $632.30 $632.30 N/A N/A 127581 ERX HCPCS 63700006 00054-0603-13 DESVENLAFAXINE SUCCINATE ER 25 MG PO TB24 BOTH IP/OP $52.00 $38.00 $10.76 $51.63 $51.63 $51.63 $51.63 $51.63 $51.63 $51.63 $51.63 $51.63 $51.63 $51.63 $51.63 $51.63 $51.63 $10.76 $51.63 $20.65 $51.63 $51.63 $51.63 $51.63 $51.63 $39.00 $51.63 $51.63 $51.63 $25.82 $25.82 $40.89 $51.63 $41.30 $33.56 $51.63 $51.63 $30.16 $51.63 $30.98 $51.63 $51.63 $51.63 N/A N/A 127687 ERX HCPCS 63700001 55513-0800-60 IVABRADINE HCL 5 MG PO TABS BOTH IP/OP $49.50 $37.00 $10.22 $49.06 $49.06 $49.06 $49.06 $49.06 $49.06 $49.06 $49.06 $49.06 $49.06 $49.06 $49.06 $49.06 $49.06 $10.22 $49.06 $19.62 $49.06 $49.06 $49.06 $49.06 $49.06 $37.13 $49.06 $49.06 $49.06 $24.53 $24.53 $38.86 $49.06 $39.25 $31.89 $49.06 $49.06 $28.71 $49.06 $29.44 $49.06 $49.06 $49.06 N/A N/A 128092 ERX HCPCS J1610 63323-0593-03 GLUCAGON HCL 1 MG IJ SOLR BOTH IP/OP $461.50 $342.00 $88.07 $461.48 $207.67 $207.67 $207.67 $207.67 $166.77 $166.77 $166.77 $88.07 $166.77 $173.44 $173.44 $180.11 $166.77 $195.93 $166.77 $190.26 $272.97 $166.77 $461.48 $166.77 $175.11 $346.13 $166.77 $166.77 $166.77 $230.74 $230.74 $365.49 $166.77 $369.18 $207.67 $186.58 $166.77 $267.67 $175.11 $241.82 $166.77 $186.58 $166.77 N/A N/A 128482 ERX HCPCS C9460 10122-0620-01 CANGRELOR TETRASODIUM 50 MG IV SOLR BOTH IP/OP "$2,494.50" "$1,846.00" $519.78 "$2,494.01" "$2,494.01" "$2,494.01" "$2,494.01" "$2,494.01" "$2,494.01" "$2,494.01" $719.20 "$2,494.01" "$2,494.01" $778.96 $778.96 $808.92 $749.00 $519.78 "$2,494.01" $997.60 "$2,494.01" "$2,494.01" "$2,494.01" "$2,494.01" "$2,494.01" "$1,870.88" "$2,494.01" "$2,494.01" "$2,494.01" "$1,247.01" "$1,247.01" "$1,975.26" "$2,494.01" "$1,995.21" "$1,122.30" "$2,494.01" "$2,494.01" "$1,446.81" "$2,494.01" "$1,496.41" "$2,494.01" "$2,494.01" "$2,494.01" N/A N/A 128545 ERX HCPCS 25000001 00078-0659-20 SACUBITRIL-VALSARTAN 24-26 MG PO TABS BOTH IP/OP $58.00 $43.00 $10.27 $57.72 $57.72 $57.72 $57.72 $57.72 $57.72 $57.72 $10.27 $57.72 $57.72 $42.84 $42.84 $44.49 $30.07 $12.03 $57.72 $23.09 $57.72 $57.72 $57.72 $57.72 $57.72 $43.50 $57.72 $57.72 $57.72 $28.86 $28.86 $45.71 $57.72 $46.18 $37.52 $57.72 $57.72 $33.64 $57.72 $34.63 $57.72 $57.72 $57.72 N/A N/A 128546 ERX HCPCS 25000001 00078-0777-20 SACUBITRIL-VALSARTAN 49-51 MG PO TABS BOTH IP/OP $58.00 $43.00 $10.27 $57.72 $57.72 $57.72 $57.72 $57.72 $57.72 $57.72 $10.27 $57.72 $57.72 $42.84 $42.84 $44.49 $30.07 $12.03 $57.72 $23.09 $57.72 $57.72 $57.72 $57.72 $57.72 $43.50 $57.72 $57.72 $57.72 $28.86 $28.86 $45.71 $57.72 $46.18 $37.52 $57.72 $57.72 $33.64 $57.72 $34.63 $57.72 $57.72 $57.72 N/A N/A 128547 ERX HCPCS 25000001 00078-0696-20 SACUBITRIL-VALSARTAN 97-103 MG PO TABS BOTH IP/OP $58.00 $43.00 $10.27 $57.72 $57.72 $57.72 $57.72 $57.72 $57.72 $57.72 $10.27 $57.72 $57.72 $42.84 $42.84 $44.49 $30.07 $12.03 $57.72 $23.09 $57.72 $57.72 $57.72 $57.72 $57.72 $43.50 $57.72 $57.72 $57.72 $28.86 $28.86 $45.71 $57.72 $46.18 $37.52 $57.72 $57.72 $33.64 $57.72 $34.63 $57.72 $57.72 $57.72 N/A N/A 128559 ERX HCPCS 63700001 99999-6006-28 AMINOCAPROIC ACID 0.25 GM/ML PO SOLN BOTH IP/OP $350.00 $259.00 $72.90 $349.78 $349.78 $349.78 $349.78 $349.78 $349.78 $349.78 $349.78 $349.78 $349.78 $349.78 $349.78 $349.78 $349.78 $72.90 $349.78 $139.91 $349.78 $349.78 $349.78 $349.78 $349.78 $262.50 $349.78 $349.78 $349.78 $174.89 $174.89 $277.03 $349.78 $279.82 $227.36 $349.78 $349.78 $203.00 $349.78 $209.87 $349.78 $349.78 $349.78 N/A N/A 128685 ERX HCPCS J2280 63323-0850-74 MOXIFLOXACIN HCL 400 MG/250ML IV SOLN BOTH IP/OP $198.00 $147.00 $33.28 $197.80 $197.80 $197.80 $197.80 $197.80 $197.80 $197.80 $36.88 $197.80 $197.80 $34.61 $34.61 $35.94 $33.28 $41.22 $197.80 $79.12 $197.80 $197.80 $197.80 $197.80 $197.80 $148.50 $197.80 $197.80 $197.80 $98.90 $98.90 $156.66 $197.80 $158.24 $89.01 $197.80 $197.80 $114.84 $197.80 $118.68 $197.80 $197.80 $197.80 N/A N/A 129082 ERX HCPCS Q5101 61314-0318-05 FILGRASTIM-SNDZ 300 MCG/0.5ML IJ SOSY BOTH IP/OP $994.50 $736.00 $93.00 $994.30 $994.30 $994.30 $994.30 $994.30 $994.30 $994.30 $96.00 $994.30 $994.30 $96.72 $96.72 $100.44 $93.00 $109.26 $994.30 $397.72 $994.30 $994.30 $994.30 $994.30 $994.30 $745.88 $994.30 $994.30 $994.30 $497.15 $497.15 $787.49 $994.30 $795.44 $447.44 $994.30 $994.30 $576.81 $994.30 $596.58 $994.30 $994.30 $994.30 N/A N/A 129083 ERX HCPCS Q5101 61314-0326-10 FILGRASTIM-SNDZ 480 MCG/0.8ML IJ SOSY BOTH IP/OP "$1,406.50" "$1,041.00" $148.80 "$1,406.50" "$1,406.50" "$1,406.50" "$1,406.50" "$1,406.50" "$1,406.50" "$1,406.50" $153.60 "$1,406.50" "$1,406.50" $154.75 $154.75 $160.70 $148.80 $174.82 "$1,406.50" $562.60 "$1,406.50" "$1,406.50" "$1,406.50" "$1,406.50" "$1,406.50" "$1,054.88" "$1,406.50" "$1,406.50" "$1,406.50" $703.25 $703.25 "$1,113.95" "$1,406.50" "$1,125.20" $632.93 "$1,406.50" "$1,406.50" $815.77 "$1,406.50" $843.90 "$1,406.50" "$1,406.50" "$1,406.50" N/A N/A 129084 ERX HCPCS J9310 50242-0051-21 RITUXIMAB 100 MG/10ML IV SOLN BOTH IP/OP "$2,627.00" "$1,944.00" $547.51 "$2,626.89" "$1,182.10" "$1,182.10" "$1,182.10" "$1,182.10" $856.33 $856.33 $856.33 $547.51 $856.33 $890.55 $890.55 $924.80 $856.30 "$1,006.02" $856.33 $811.87 "$1,295.06" $856.33 "$2,626.89" $856.33 $899.15 "$1,970.25" $856.33 $856.33 $856.33 "$1,313.45" "$1,313.45" "$2,080.50" $856.33 "$2,101.51" "$1,182.10" $958.03 $856.33 "$1,523.66" $899.15 "$1,241.68" $856.33 $958.03 $856.33 N/A N/A 129085 ERX HCPCS J9310 50242-0053-06 RITUXIMAB 500 MG/50ML IV SOLN BOTH IP/OP "$13,134.50" "$9,720.00" "$2,737.55" "$13,134.45" "$5,910.50" "$5,910.50" "$5,910.50" "$5,910.50" "$4,281.65" "$4,281.65" "$4,281.65" "$2,737.55" "$4,281.65" "$4,452.76" "$4,452.76" "$4,624.02" "$4,281.50" "$5,030.08" "$4,281.65" "$4,059.35" "$6,475.28" "$4,281.65" "$13,134.45" "$4,281.65" "$4,495.73" "$9,850.88" "$4,281.65" "$4,281.65" "$4,281.65" "$6,567.23" "$6,567.23" "$10,402.48" "$4,281.65" "$10,507.56" "$5,910.50" "$4,790.14" "$4,281.65" "$7,618.01" "$4,495.73" "$6,208.39" "$4,281.65" "$4,790.14" "$4,281.65" N/A N/A 129088 ERX HCPCS J3475 00409-6729-23 MAGNESIUM SULFATE 4 GM/100ML IV SOLN BOTH IP/OP $38.50 $28.00 $0.47 $38.02 $17.11 $17.11 $17.11 $17.11 $38.02 $38.02 $38.02 $0.47 $38.02 $5.08 $5.08 $5.27 $4.88 $5.73 $38.02 $38.02 $22.49 $38.02 $38.02 $38.02 $38.02 $28.88 $38.02 $38.02 $38.02 $19.01 $19.01 $30.11 $38.02 $30.42 $17.11 $5.46 $38.02 $22.33 $38.02 $38.02 $38.02 $5.46 $38.02 N/A N/A 129090 ERX HCPCS J3475 63323-0106-10 MAGNESIUM SULFATE 40 GM/1000ML IV SOLN BOTH IP/OP $48.00 $36.00 $4.70 $54.60 $21.38 $21.38 $21.38 $21.38 $47.52 $47.52 $47.52 $4.70 $47.52 $50.75 $50.75 $52.70 $48.80 $47.52 $47.52 $47.52 $28.11 $47.52 $47.52 $47.52 $47.52 $36.00 $47.52 $47.52 $47.52 $23.76 $23.76 $37.64 $47.52 $38.02 $21.38 $47.52 $47.52 $27.84 $47.52 $47.52 $47.52 $54.60 $47.52 N/A N/A 129092 ERX HCPCS J2505 55513-0190-01 PEGFILGRASTIM 6 MG/0.6ML SC SOSY BOTH IP/OP "$17,945.00" "$13,279.00" "$2,184.36" "$17,944.71" "$17,944.71" "$17,944.71" "$17,944.71" "$17,944.71" "$17,944.71" "$17,944.71" "$6,161.28" "$17,944.71" "$17,944.71" "$2,271.73" "$2,271.73" "$2,359.11" "$2,184.36" "$2,566.28" "$17,944.71" "$7,177.88" "$17,944.71" "$17,944.71" "$17,944.71" "$17,944.71" "$17,944.71" "$13,458.75" "$17,944.71" "$17,944.71" "$17,944.71" "$8,972.36" "$8,972.36" "$14,212.21" "$17,944.71" "$14,355.77" "$8,075.12" "$17,944.71" "$17,944.71" "$10,408.10" "$17,944.71" "$10,766.83" "$17,944.71" "$17,944.71" "$17,944.71" N/A N/A 129102 ERX HCPCS J3230 00641-1398-35 CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN BOTH IP/OP $86.00 $64.00 $32.02 $85.80 $85.80 $85.80 $85.80 $85.80 $85.80 $85.80 $32.87 $85.80 $85.80 $33.30 $33.30 $34.58 $32.02 $37.62 $85.80 $34.32 $85.80 $85.80 $85.80 $85.80 $85.80 $64.50 $85.80 $85.80 $85.80 $42.90 $42.90 $67.95 $85.80 $68.64 $38.61 $85.80 $85.80 $49.88 $85.80 $51.48 $85.80 $85.80 $85.80 N/A N/A 129103 ERX HCPCS 63700001 62175-0310-37 METHYLPHENIDATE HCL ER 18 MG PO TB24 BOTH IP/OP $27.00 $20.00 $5.60 $26.88 $26.88 $26.88 $26.88 $26.88 $26.88 $26.88 $26.88 $26.88 $26.88 $26.88 $26.88 $26.88 $26.88 $5.60 $26.88 $10.75 $26.88 $26.88 $26.88 $26.88 $26.88 $20.25 $26.88 $26.88 $26.88 $13.44 $13.44 $21.29 $26.88 $21.50 $17.47 $26.88 $26.88 $15.66 $26.88 $16.13 $26.88 $26.88 $26.88 N/A N/A 129105 ERX HCPCS 63700001 00406-0136-01 METHYLPHENIDATE HCL ER 36 MG PO TB24 BOTH IP/OP $28.50 $21.00 $5.93 $28.43 $28.43 $28.43 $28.43 $28.43 $28.43 $28.43 $28.43 $28.43 $28.43 $28.43 $28.43 $28.43 $28.43 $5.93 $28.43 $11.37 $28.43 $28.43 $28.43 $28.43 $28.43 $21.38 $28.43 $28.43 $28.43 $14.22 $14.22 $22.52 $28.43 $22.74 $18.48 $28.43 $28.43 $16.53 $28.43 $17.06 $28.43 $28.43 $28.43 N/A N/A 129106 ERX HCPCS 63700001 00406-0154-01 METHYLPHENIDATE HCL ER 54 MG PO TB24 BOTH IP/OP $31.00 $23.00 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $30.93 $30.93 $30.93 $30.93 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $12.37 $30.93 $30.93 $30.93 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $20.10 $30.93 $30.93 $17.98 $30.93 $18.56 $30.93 $30.93 $30.93 N/A N/A 129107 ERX HCPCS J0881 55513-0057-04 DARBEPOETIN ALFA 25 MCG/0.42ML IJ SOSY BOTH IP/OP $701.50 $519.00 $77.23 $701.25 $315.56 $315.56 $315.56 $315.56 $77.35 $77.35 $77.35 $89.89 $77.35 $80.34 $80.34 $83.43 $77.25 $90.76 $77.35 $77.23 $414.79 $77.35 $701.25 $77.35 $81.22 $526.13 $77.35 $77.35 $77.35 $350.63 $350.63 $555.39 $77.35 $561.00 $315.56 $86.43 $77.35 $406.87 $81.22 $112.16 $77.35 $86.43 $77.35 N/A N/A 129109 ERX HCPCS J0881 55513-0021-04 DARBEPOETIN ALFA 40 MCG/0.4ML IJ SOSY BOTH IP/OP "$1,122.00" $830.00 $123.56 "$1,122.00" $504.90 $504.90 $504.90 $504.90 $123.76 $123.76 $123.76 $143.82 $123.76 $128.54 $128.54 $133.49 $123.60 $145.21 $123.76 $123.56 $663.66 $123.76 "$1,122.00" $123.76 $129.95 $841.50 $123.76 $123.76 $123.76 $561.00 $561.00 $888.62 $123.76 $897.60 $504.90 $138.28 $123.76 $650.76 $129.95 $179.45 $123.76 $138.28 $123.76 N/A N/A 129111 ERX HCPCS J0881 55513-0023-04 DARBEPOETIN ALFA 60 MCG/0.3ML IJ SOSY BOTH IP/OP "$1,488.00" "$1,101.00" $185.34 "$1,487.94" $669.57 $669.57 $669.57 $669.57 $185.64 $185.64 $185.64 $215.73 $185.64 $192.82 $192.82 $200.23 $185.40 $217.82 $185.64 $185.34 $880.12 $185.64 "$1,487.94" $185.64 $194.92 "$1,116.00" $185.64 $185.64 $185.64 $743.97 $743.97 "$1,178.45" $185.64 "$1,190.35" $669.57 $207.43 $185.64 $863.04 $194.92 $269.18 $185.64 $207.43 $185.64 N/A N/A 129113 ERX HCPCS J0881 55513-0025-04 DARBEPOETIN ALFA 100 MCG/0.5ML IJ SOSY BOTH IP/OP "$2,480.00" "$1,835.00" $308.90 "$2,479.90" "$1,115.96" "$1,115.96" "$1,115.96" "$1,115.96" $309.40 $309.40 $309.40 $359.55 $309.40 $321.36 $321.36 $333.72 $309.00 $363.03 $309.40 $308.90 "$1,222.59" $309.40 "$2,479.90" $309.40 $324.87 "$1,860.00" $309.40 $309.40 $309.40 "$1,239.95" "$1,239.95" "$1,964.08" $309.40 "$1,983.92" "$1,115.96" $345.71 $309.40 "$1,438.40" $324.87 $448.63 $309.40 $345.71 $309.40 N/A N/A 129115 ERX HCPCS J0881 55513-0027-04 DARBEPOETIN ALFA 150 MCG/0.3ML IJ SOSY BOTH IP/OP "$3,246.50" "$2,402.00" $463.35 "$3,246.16" "$1,460.77" "$1,460.77" "$1,460.77" "$1,460.77" $464.10 $464.10 $464.10 $539.33 $464.10 $482.04 $482.04 $500.58 $463.50 $544.54 $464.10 $463.35 "$1,600.36" $464.10 "$3,246.16" $464.10 $487.31 "$2,434.88" $464.10 $464.10 $464.10 "$1,623.08" "$1,623.08" "$2,570.96" $464.10 "$2,596.93" "$1,460.77" $518.56 $464.10 "$1,882.97" $487.31 $672.95 $464.10 $518.56 $464.10 N/A N/A 129116 ERX HCPCS J0881 55513-0028-01 DARBEPOETIN ALFA 200 MCG/0.4ML IJ SOSY BOTH IP/OP "$4,328.50" "$3,203.00" $617.80 "$4,328.21" "$1,947.69" "$1,947.69" "$1,947.69" "$1,947.69" $618.80 $618.80 $618.80 $719.10 $618.80 $642.72 $642.72 $667.44 $618.00 $726.05 $618.80 $617.80 "$2,133.81" $618.80 "$4,328.21" $618.80 $649.74 "$3,246.38" $618.80 $618.80 $618.80 "$2,164.11" "$2,164.11" "$3,427.94" $618.80 "$3,462.57" "$1,947.69" $691.42 $618.80 "$2,510.53" $649.74 $897.26 $618.80 $691.42 $618.80 N/A N/A 129117 ERX HCPCS J0881 55513-0111-01 DARBEPOETIN ALFA 300 MCG/0.6ML IJ SOSY BOTH IP/OP "$6,492.50" "$4,804.00" $926.70 "$6,492.32" "$2,921.54" "$2,921.54" "$2,921.54" "$2,921.54" $928.20 $928.20 $928.20 "$1,078.65" $928.20 $964.08 $964.08 "$1,001.16" $927.00 "$1,089.08" $928.20 $926.70 "$3,200.71" $928.20 "$6,492.32" $928.20 $974.61 "$4,869.38" $928.20 $928.20 $928.20 "$3,246.16" "$3,246.16" "$5,141.92" $928.20 "$5,193.86" "$2,921.54" "$1,037.13" $928.20 "$3,765.65" $974.61 "$1,345.89" $928.20 "$1,037.13" $928.20 N/A N/A 129118 ERX HCPCS J0881 55513-0032-01 DARBEPOETIN ALFA 500 MCG/ML IJ SOSY BOTH IP/OP "$10,821.00" "$8,008.00" "$1,544.50" "$10,820.52" "$4,869.23" "$4,869.23" "$4,869.23" "$4,869.23" "$1,547.00" "$1,547.00" "$1,547.00" "$1,797.75" "$1,547.00" "$1,606.80" "$1,606.80" "$1,668.60" "$1,545.00" "$1,815.13" "$1,547.00" "$1,544.50" "$5,334.52" "$1,547.00" "$10,820.52" "$1,547.00" "$1,624.35" "$8,115.75" "$1,547.00" "$1,547.00" "$1,547.00" "$5,410.26" "$5,410.26" "$8,569.85" "$1,547.00" "$8,656.42" "$4,869.23" "$1,728.55" "$1,547.00" "$6,276.18" "$1,624.35" "$2,243.15" "$1,547.00" "$1,728.55" "$1,547.00" N/A N/A 129167 ERX HCPCS 63700001 00186-0776-60 TICAGRELOR 60 MG PO TABS BOTH IP/OP $38.00 $28.00 $7.89 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $37.85 $7.89 $37.85 $15.14 $37.85 $37.85 $37.85 $37.85 $37.85 $28.50 $37.85 $37.85 $37.85 $18.93 $18.93 $29.98 $37.85 $30.28 $24.60 $37.85 $37.85 $22.04 $37.85 $22.71 $37.85 $37.85 $37.85 N/A N/A 129213 ERX HCPCS J2710 71266-2003-02 NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY BOTH IP/OP $22.00 $16.00 $0.12 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.12 $22.00 $0.96 $0.96 $0.99 $0.92 $1.08 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.03 $22.00 $12.76 $22.00 $22.00 $22.00 $1.03 $22.00 N/A N/A 129243 ERX HCPCS 25000001 64842-1025-01 TRIFLURIDINE-TIPIRACIL 15-6.14 MG PO TABS BOTH IP/OP $722.00 $534.00 $128.49 $721.87 $721.87 $721.87 $721.87 $721.87 $721.87 $721.87 $128.49 $721.87 $721.87 $535.77 $535.77 $556.42 $376.09 $150.45 $721.87 $288.75 $721.87 $721.87 $721.87 $721.87 $721.87 $541.50 $721.87 $721.87 $721.87 $360.94 $360.94 $571.72 $721.87 $577.50 $469.22 $721.87 $721.87 $418.76 $721.87 $433.12 $721.87 $721.87 $721.87 N/A N/A 129244 ERX HCPCS 25000001 64842-1020-01 TRIFLURIDINE-TIPIRACIL 20-8.19 MG PO TABS BOTH IP/OP $962.50 $712.00 $171.33 $962.50 $962.50 $962.50 $962.50 $962.50 $962.50 $962.50 $171.33 $962.50 $962.50 $714.37 $714.37 $741.90 $501.46 $200.60 $962.50 $385.00 $962.50 $962.50 $962.50 $962.50 $962.50 $721.88 $962.50 $962.50 $962.50 $481.25 $481.25 $762.30 $962.50 $770.00 $625.63 $962.50 $962.50 $558.25 $962.50 $577.50 $962.50 $962.50 $962.50 N/A N/A 129506 ERX HCPCS J9352 59676-0610-01 TRABECTEDIN 1 MG IV SOLR BOTH IP/OP "$9,010.00" "$6,667.00" "$3,250.30" "$9,009.86" "$9,009.86" "$9,009.86" "$9,009.86" "$9,009.86" "$9,009.86" "$9,009.86" "$3,250.30" "$9,009.86" "$9,009.86" "$3,380.31" "$3,380.31" "$3,510.32" "$3,250.30" "$3,818.59" "$9,009.86" "$3,603.94" "$9,009.86" "$9,009.86" "$9,009.86" "$9,009.86" "$9,009.86" "$6,757.50" "$9,009.86" "$9,009.86" "$9,009.86" "$4,504.93" "$4,504.93" "$7,135.81" "$9,009.86" "$7,207.89" "$4,054.44" "$9,009.86" "$9,009.86" "$5,225.80" "$9,009.86" "$5,405.92" "$9,009.86" "$9,009.86" "$9,009.86" N/A N/A 129598 ERX HCPCS J3490 00597-0197-05 IDARUCIZUMAB 2.5 GM/50ML IV SOLN BOTH IP/OP "$13,190.50" "$9,761.00" "$2,617.91" "$13,190.13" "$5,935.56" "$5,935.56" "$5,935.56" "$5,935.56" "$13,190.13" "$13,190.13" "$13,190.13" "$2,749.15" "$13,190.13" "$13,190.13" "$13,190.13" "$13,190.13" "$13,190.13" "$2,748.97" "$13,190.13" "$13,190.13" "$6,502.73" "$13,190.13" "$13,190.13" "$13,190.13" "$13,190.13" "$9,892.88" "$13,190.13" "$13,190.13" "$13,190.13" "$6,595.07" "$6,595.07" "$10,446.58" "$13,190.13" "$10,552.10" "$5,935.56" "$2,617.91" "$13,190.13" "$7,650.49" "$13,190.13" "$13,190.13" "$13,190.13" "$2,748.82" "$13,190.13" N/A N/A 129616 ERX HCPCS C9474 15054-0043-01 IRINOTECAN HCL LIPOSOME 43 MG/10ML IV INJ BOTH IP/OP "$7,546.50" "$5,584.00" "$2,459.60" "$7,546.41" "$7,546.41" "$7,546.41" "$7,546.41" "$7,546.41" "$7,546.41" "$7,546.41" "$2,459.60" "$7,546.41" "$7,546.41" "$2,565.59" "$2,565.59" "$2,664.26" "$2,466.91" "$2,898.23" "$7,546.41" "$3,018.56" "$7,546.41" "$7,546.41" "$7,546.41" "$7,546.41" "$7,546.41" "$5,659.88" "$7,546.41" "$7,546.41" "$7,546.41" "$3,773.21" "$3,773.21" "$5,976.76" "$7,546.41" "$6,037.13" "$3,395.88" "$7,546.41" "$7,546.41" "$4,376.97" "$7,546.41" "$4,527.85" "$7,546.41" "$7,546.41" "$7,546.41" N/A N/A 129781 ERX HCPCS 63700001 53436-0084-04 PATIROMER SORBITEX CALCIUM 8.4 G PO PACK BOTH IP/OP $189.50 $140.00 $39.49 $189.46 $189.46 $189.46 $189.46 $189.46 $189.46 $189.46 $189.46 $189.46 $189.46 $189.46 $189.46 $189.46 $189.46 $39.49 $189.46 $75.78 $189.46 $189.46 $189.46 $189.46 $189.46 $142.13 $189.46 $189.46 $189.46 $94.73 $94.73 $150.05 $189.46 $151.57 $123.15 $189.46 $189.46 $109.91 $189.46 $113.68 $189.46 $189.46 $189.46 N/A N/A 129832 ERX HCPCS J2182 00173-0881-01 MEPOLIZUMAB 100 MG SC SOLR BOTH IP/OP "$9,259.50" "$6,852.00" "$2,829.00" "$9,259.38" "$9,259.38" "$9,259.38" "$9,259.38" "$9,259.38" "$9,259.38" "$9,259.38" "$2,829.00" "$9,259.38" "$9,259.38" "$2,983.76" "$2,983.76" "$3,098.52" "$2,869.00" "$3,370.62" "$9,259.38" "$3,703.75" "$9,259.38" "$9,259.38" "$9,259.38" "$9,259.38" "$9,259.38" "$6,944.63" "$9,259.38" "$9,259.38" "$9,259.38" "$4,629.69" "$4,629.69" "$7,333.43" "$9,259.38" "$7,407.50" "$4,166.72" "$9,259.38" "$2,868.50" "$5,370.51" "$9,259.38" "$5,555.63" "$9,259.38" "$9,259.38" "$9,259.38" N/A N/A 129834 ERX HCPCS 25000001 61958-1901-01 GENVOYA:150-150-200-10 MG PO TABLET BOTH IP/OP $527.00 $390.00 $93.77 $526.79 $526.79 $526.79 $526.79 $526.79 $526.79 $526.79 $93.77 $526.79 $526.79 $390.98 $390.98 $406.05 $274.46 $109.79 $526.79 $210.72 $526.79 $526.79 $526.79 $526.79 $526.79 $395.25 $526.79 $526.79 $526.79 $263.40 $263.40 $417.22 $526.79 $421.43 $342.41 $526.79 $526.79 $305.66 $526.79 $316.07 $526.79 $526.79 $526.79 N/A N/A 129842 ERX HCPCS J0690 99999-6009-29 CEFAZOLIN SODIUM-DEXTROSE 2-4 GM/100ML-% IV SOLN BOTH IP/OP $22.00 $16.00 $2.77 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $2.77 $22.00 $3.20 $3.20 $3.33 $3.08 $3.62 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $3.45 $22.00 $12.76 $22.00 $13.20 $22.00 $3.45 $22.00 N/A N/A 129853 ERX HCPCS 25000001 50242-0717-01 COBIMETINIB FUMARATE 20 MG PO TABS BOTH IP/OP $508.50 $376.00 $90.43 $508.03 $508.03 $508.03 $508.03 $508.03 $508.03 $508.03 $90.43 $508.03 $508.03 $377.06 $377.06 $391.59 $264.68 $105.88 $508.03 $203.21 $508.03 $508.03 $508.03 $508.03 $508.03 $381.38 $508.03 $508.03 $508.03 $254.02 $254.02 $402.36 $508.03 $406.42 $330.22 $508.03 $508.03 $294.93 $508.03 $304.82 $508.03 $508.03 $508.03 N/A N/A 129873 ERX HCPCS 63700001 00310-1349-30 OSIMERTINIB MESYLATE 40 MG PO TABS BOTH IP/OP "$1,723.50" "$1,275.00" $359.13 "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" $359.13 "$1,723.19" $689.28 "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,292.63" "$1,723.19" "$1,723.19" "$1,723.19" $861.60 $861.60 "$1,364.77" "$1,723.19" "$1,378.55" "$1,120.07" "$1,723.19" "$1,723.19" $999.63 "$1,723.19" "$1,033.91" "$1,723.19" "$1,723.19" "$1,723.19" N/A N/A 129874 ERX HCPCS 63700001 00310-1350-30 OSIMERTINIB MESYLATE 80 MG PO TABS BOTH IP/OP "$1,723.50" "$1,275.00" $359.13 "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" $359.13 "$1,723.19" $689.28 "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,723.19" "$1,292.63" "$1,723.19" "$1,723.19" "$1,723.19" $861.60 $861.60 "$1,364.77" "$1,723.19" "$1,378.55" "$1,120.07" "$1,723.19" "$1,723.19" $999.63 "$1,723.19" "$1,033.91" "$1,723.19" "$1,723.19" "$1,723.19" N/A N/A 129889 ERX HCPCS J9145 57894-0502-05 DARATUMUMAB 100 MG/5ML IV SOLN BOTH IP/OP "$2,143.50" "$1,586.00" $572.20 "$2,143.48" "$2,143.48" "$2,143.48" "$2,143.48" "$2,143.48" "$2,143.48" "$2,143.48" $575.50 "$2,143.48" "$2,143.48" $595.09 $595.09 $617.98 $572.20 $672.24 "$2,143.48" $857.39 "$2,143.48" "$2,143.48" "$2,143.48" "$2,143.48" "$2,143.48" "$1,607.63" "$2,143.48" "$2,143.48" "$2,143.48" "$1,071.74" "$1,071.74" "$1,697.64" "$2,143.48" "$1,714.78" $964.57 "$2,143.48" $572.22 "$1,243.23" "$2,143.48" "$1,286.09" "$2,143.48" "$2,143.48" "$2,143.48" N/A N/A 129890 ERX HCPCS J9145 57894-0502-20 DARATUMUMAB 400 MG/20ML IV SOLN BOTH IP/OP "$7,482.50" "$5,537.00" "$2,288.80" "$7,482.10" "$7,482.10" "$7,482.10" "$7,482.10" "$7,482.10" "$7,482.10" "$7,482.10" "$2,302.00" "$7,482.10" "$7,482.10" "$2,380.35" "$2,380.35" "$2,471.90" "$2,288.80" "$2,688.98" "$7,482.10" "$2,992.84" "$7,482.10" "$7,482.10" "$7,482.10" "$7,482.10" "$7,482.10" "$5,611.88" "$7,482.10" "$7,482.10" "$7,482.10" "$3,741.05" "$3,741.05" "$5,925.82" "$7,482.10" "$5,985.68" "$3,366.95" "$7,482.10" "$2,288.88" "$4,339.85" "$7,482.10" "$4,489.26" "$7,482.10" "$7,482.10" "$7,482.10" N/A N/A 129908 ERX HCPCS 25000001 69547-0353-02 NALOXONE HCL 4 MG/0.1ML NA LIQD BOTH IP/OP $268.50 $199.00 $47.79 $268.50 $268.50 $268.50 $268.50 $268.50 $268.50 $268.50 $47.79 $268.50 $268.50 $199.28 $199.28 $206.96 $139.89 $55.96 $268.50 $107.40 $268.50 $268.50 $268.50 $268.50 $268.50 $201.38 $268.50 $268.50 $268.50 $134.25 $134.25 $212.65 $268.50 $214.80 $174.53 $268.50 $268.50 $155.73 $268.50 $161.10 $268.50 $268.50 $268.50 N/A N/A 129989 ERX HCPCS J1976 00003-2291-11 ELOTUZUMAB 300 MG IV SOLR BOTH IP/OP "$5,878.50" "$4,350.00" "$1,225.16" "$5,878.18" "$2,645.18" "$2,645.18" "$2,645.18" "$2,645.18" "$2,058.00" "$2,058.00" "$2,058.00" "$1,225.16" "$2,058.00" "$2,140.32" "$2,140.32" "$2,222.64" "$2,058.00" "$2,417.82" "$2,058.00" "$2,118.00" "$2,897.94" "$2,058.00" "$5,878.18" "$2,058.00" "$2,160.90" "$4,408.88" "$2,058.00" "$2,058.00" "$2,058.00" "$2,939.09" "$2,939.09" "$4,655.52" "$2,058.00" "$4,702.54" "$2,645.18" "$2,302.49" "$2,058.00" "$3,409.53" "$2,160.90" "$2,984.10" "$2,058.00" "$2,302.49" "$2,058.00" N/A N/A 129990 ERX HCPCS J1976 00003-4522-11 ELOTUZUMAB 400 MG IV SOLR BOTH IP/OP "$7,838.00" "$5,800.00" "$1,633.54" "$7,837.52" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,744.00" "$2,744.00" "$2,744.00" "$1,633.54" "$2,744.00" "$2,853.76" "$2,853.76" "$2,963.52" "$2,744.00" "$3,223.76" "$2,744.00" "$2,824.00" "$3,863.90" "$2,744.00" "$7,837.52" "$2,744.00" "$2,881.20" "$5,878.50" "$2,744.00" "$2,744.00" "$2,744.00" "$3,918.76" "$3,918.76" "$6,207.32" "$2,744.00" "$6,270.02" "$3,526.88" "$3,069.99" "$2,744.00" "$4,546.04" "$2,881.20" "$3,978.80" "$2,744.00" "$3,069.99" "$2,744.00" N/A N/A 130051 ERX HCPCS J9034 63459-0348-04 BENDAMUSTINE HCL 100 MG/4ML IV SOLN BOTH IP/OP "$6,917.00" "$5,119.00" "$1,441.62" "$6,916.75" "$3,112.54" "$3,112.54" "$3,112.54" "$3,112.54" "$1,907.60" "$1,907.60" "$1,907.60" "$1,441.62" "$1,907.60" "$1,984.32" "$1,984.32" "$2,060.64" "$1,908.00" "$2,241.60" "$1,907.60" "$1,690.60" "$3,409.96" "$1,907.60" "$6,916.75" "$1,907.60" "$2,002.98" "$5,187.75" "$1,907.60" "$1,907.60" "$1,907.60" "$3,458.38" "$3,458.38" "$5,478.07" "$1,907.60" "$5,533.40" "$3,112.54" "$2,134.67" "$1,907.60" "$4,011.86" "$2,002.98" "$2,766.02" "$1,907.60" "$2,134.67" "$1,907.60" N/A N/A 130073 ERX HCPCS 25000001 50242-0130-01 ALECTINIB HCL 150 MG PO CAPS BOTH IP/OP "$1,056.50" $782.00 $188.04 "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" $188.04 "$1,056.38" "$1,056.38" $784.05 $784.05 $814.26 $550.37 $220.16 "$1,056.38" $422.55 "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" $792.38 "$1,056.38" "$1,056.38" "$1,056.38" $528.19 $528.19 $836.65 "$1,056.38" $845.10 $686.65 "$1,056.38" "$1,056.38" $612.77 "$1,056.38" $633.83 "$1,056.38" "$1,056.38" "$1,056.38" N/A N/A 130409 ERX HCPCS 25000001 00006-5423-12 SUGAMMADEX SODIUM 200 MG/2ML IV SOLN BOTH IP/OP $514.50 $381.00 $91.54 $514.26 $514.26 $514.26 $514.26 $514.26 $514.26 $514.26 $91.54 $514.26 $514.26 $381.68 $381.68 $396.39 $267.93 $107.18 $514.26 $205.70 $514.26 $514.26 $514.26 $514.26 $514.26 $385.88 $514.26 $514.26 $514.26 $257.13 $257.13 $407.29 $514.26 $411.41 $334.27 $514.26 $514.26 $298.41 $514.26 $308.56 $514.26 $514.26 $514.26 N/A N/A 130411 ERX HCPCS J3490 00006-5425-15 SUGAMMADEX SODIUM 500 MG/5ML IV SOLN BOTH IP/OP $820.00 $607.00 $162.70 $819.75 $368.89 $368.89 $368.89 $368.89 $819.75 $819.75 $819.75 $170.86 $819.75 $819.75 $819.75 $819.75 $819.75 $170.84 $819.75 $819.75 $484.88 $819.75 $819.75 $819.75 $819.75 $615.00 $819.75 $819.75 $819.75 $409.88 $409.88 $649.24 $819.75 $655.80 $368.89 $162.70 $819.75 $475.60 $819.75 $819.75 $819.75 $170.84 $819.75 N/A N/A 130651 ERX HCPCS 63700001 61874-0130-30 CARIPRAZINE HCL 3 MG PO CAPS BOTH IP/OP $197.50 $146.00 $41.12 $197.29 $197.29 $197.29 $197.29 $197.29 $197.29 $197.29 $197.29 $197.29 $197.29 $197.29 $197.29 $197.29 $197.29 $41.12 $197.29 $78.92 $197.29 $197.29 $197.29 $197.29 $197.29 $148.13 $197.29 $197.29 $197.29 $98.65 $98.65 $156.25 $197.29 $157.83 $128.24 $197.29 $197.29 $114.55 $197.29 $118.37 $197.29 $197.29 $197.29 N/A N/A 130656 ERX HCPCS 25000001 69468-0151-20 URIDINE TRIACETATE 10 G PO PACK BOTH IP/OP "$11,220.50" "$8,303.00" "$1,997.22" "$11,220.35" "$11,220.35" "$11,220.35" "$11,220.35" "$11,220.35" "$11,220.35" "$11,220.35" "$1,997.22" "$11,220.35" "$11,220.35" "$4,181.12" "$4,181.12" "$8,648.65" "$2,060.15" "$2,338.44" "$11,220.35" "$4,488.14" "$11,220.35" "$11,220.35" "$11,220.35" "$11,220.35" "$11,220.35" "$8,415.38" "$11,220.35" "$11,220.35" "$11,220.35" "$5,610.18" "$5,610.18" "$8,886.52" "$11,220.35" "$8,976.28" "$7,293.23" "$11,220.35" "$11,220.35" "$6,507.89" "$11,220.35" "$6,732.21" "$11,220.35" "$11,220.35" "$11,220.35" N/A N/A 130661 ERX HCPCS 25000001 00006-3074-02 ELBASVIR-GRAZOPREVIR 50-100 MG PO TABS BOTH IP/OP $942.50 $697.00 $167.72 $942.24 $942.24 $942.24 $942.24 $942.24 $942.24 $942.24 $167.72 $942.24 $942.24 $699.33 $699.33 $726.28 $490.91 $196.37 $942.24 $376.90 $942.24 $942.24 $942.24 $942.24 $942.24 $706.88 $942.24 $942.24 $942.24 $471.12 $471.12 $746.25 $942.24 $753.79 $612.46 $942.24 $942.24 $546.65 $942.24 $565.34 $942.24 $942.24 $942.24 N/A N/A 130884 ERX HCPCS J2020 00781-3433-95 LINEZOLID 600 MG/300ML IV SOLN BOTH IP/OP $279.50 $207.00 $18.75 $279.24 $279.24 $279.24 $279.24 $279.24 $279.24 $279.24 $19.86 $279.24 $279.24 $19.50 $19.50 $20.25 $18.75 $22.03 $279.24 $111.70 $279.24 $279.24 $279.24 $279.24 $279.24 $209.63 $279.24 $279.24 $279.24 $139.62 $139.62 $221.16 $279.24 $223.39 $125.66 $279.24 $279.24 $162.11 $279.24 $167.54 $279.24 $279.24 $279.24 N/A N/A 130886 ERX HCPCS J9065 63323-0140-10 CLADRIBINE 10 MG/10ML IV SOLN BOTH IP/OP "$1,394.00" "$1,032.00" $150.80 "$1,393.74" "$1,393.74" "$1,393.74" "$1,393.74" "$1,393.74" "$1,393.74" "$1,393.74" $180.20 "$1,393.74" "$1,393.74" $156.83 $156.83 $162.86 $150.80 $177.17 "$1,393.74" $557.50 "$1,393.74" "$1,393.74" "$1,393.74" "$1,393.74" "$1,393.74" "$1,045.50" "$1,393.74" "$1,393.74" "$1,393.74" $696.87 $696.87 "$1,103.84" "$1,393.74" "$1,114.99" $627.18 "$1,393.74" "$1,393.74" $808.52 "$1,393.74" $836.24 "$1,393.74" "$1,393.74" "$1,393.74" N/A N/A 130887 ERX HCPCS 25000001 00074-4382-20 CISATRACURIUM BESYLATE (PF) 200 MG/20ML IV SOLN BOTH IP/OP "$1,076.50" $797.00 $191.59 "$1,076.33" "$1,076.33" "$1,076.33" "$1,076.33" "$1,076.33" "$1,076.33" "$1,076.33" $191.59 "$1,076.33" "$1,076.33" $798.85 $798.85 $829.64 $560.77 $224.32 "$1,076.33" $430.53 "$1,076.33" "$1,076.33" "$1,076.33" "$1,076.33" "$1,076.33" $807.38 "$1,076.33" "$1,076.33" "$1,076.33" $538.17 $538.17 $852.45 "$1,076.33" $861.06 $699.61 "$1,076.33" "$1,076.33" $624.37 "$1,076.33" $645.80 "$1,076.33" "$1,076.33" "$1,076.33" N/A N/A 130897 ERX HCPCS J1455 76310-0024-25 FOSCARNET SODIUM 6000 MG/250ML IV SOLN BOTH IP/OP "$1,515.00" "$1,121.00" $315.65 "$1,514.56" "$1,514.56" "$1,514.56" "$1,514.56" "$1,514.56" "$1,514.56" "$1,514.56" $453.84 "$1,514.56" "$1,514.56" $491.71 $491.71 $510.62 $472.80 $315.65 "$1,514.56" $605.82 "$1,514.56" "$1,514.56" "$1,514.56" "$1,514.56" "$1,514.56" "$1,136.25" "$1,514.56" "$1,514.56" "$1,514.56" $757.28 $757.28 "$1,199.53" "$1,514.56" "$1,211.65" $681.55 "$1,514.56" "$1,514.56" $878.70 "$1,514.56" $908.74 "$1,514.56" "$1,514.56" "$1,514.56" N/A N/A 130900 ERX HCPCS 25000001 00013-1114-21 TRANEXAMIC ACID 1000 MG/10ML IV SOLN BOTH IP/OP $96.00 $71.00 $17.00 $95.52 $95.52 $95.52 $95.52 $95.52 $95.52 $95.52 $17.00 $95.52 $95.52 $70.89 $70.89 $73.63 $49.77 $19.91 $95.52 $38.21 $95.52 $95.52 $95.52 $95.52 $95.52 $72.00 $95.52 $95.52 $95.52 $47.76 $47.76 $75.65 $95.52 $76.42 $62.09 $95.52 $95.52 $55.68 $95.52 $57.31 $95.52 $95.52 $95.52 N/A N/A 130905 ERX HCPCS J2704 25021-0608-20 PROPOFOL 200 MG/20ML IV EMUL BOTH IP/OP $30.50 $23.00 $2.80 $30.24 $13.61 $13.61 $13.61 $13.61 $30.24 $30.24 $30.24 $6.30 $30.24 $2.91 $2.91 $3.02 $2.80 $6.30 $30.24 $30.24 $17.89 $30.24 $30.24 $30.24 $30.24 $22.88 $30.24 $30.24 $30.24 $15.12 $15.12 $23.95 $30.24 $24.19 $13.61 $6.00 $30.24 $17.69 $30.24 $30.24 $30.24 $6.30 $30.24 N/A N/A 130980 ERX HCPCS 63700001 00069-0501-30 TOFACITINIB CITRATE ER 11 MG PO TB24 BOTH IP/OP $666.50 $493.00 $138.82 $666.07 $666.07 $666.07 $666.07 $666.07 $666.07 $666.07 $666.07 $666.07 $666.07 $666.07 $666.07 $666.07 $666.07 $138.82 $666.07 $266.43 $666.07 $666.07 $666.07 $666.07 $666.07 $499.88 $666.07 $666.07 $666.07 $333.04 $333.04 $527.53 $666.07 $532.86 $432.95 $666.07 $666.07 $386.57 $666.07 $399.64 $666.07 $666.07 $666.07 N/A N/A 131019 ERX HCPCS 63700001 61958-2101-01 ODEFSEY:EMTRICIT-RILPIV-TENOFOV AF 200-25-25 MG TAB BOTH IP/OP $479.50 $355.00 $99.91 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $479.41 $99.91 $479.41 $191.76 $479.41 $479.41 $479.41 $479.41 $479.41 $359.63 $479.41 $479.41 $479.41 $239.71 $239.71 $379.69 $479.41 $383.53 $311.62 $479.41 $479.41 $278.11 $479.41 $287.65 $479.41 $479.41 $479.41 N/A N/A 131430 ERX HCPCS 25000001 00299-3921-08 CETAPHIL GENTLE CLEANSER EX LIQD BOTH IP/OP $28.00 $21.00 $4.92 $27.65 $27.65 $27.65 $27.65 $27.65 $27.65 $27.65 $4.92 $27.65 $27.65 $20.52 $20.52 $21.31 $14.41 $5.76 $27.65 $11.06 $27.65 $27.65 $27.65 $27.65 $27.65 $21.00 $27.65 $27.65 $27.65 $13.83 $13.83 $21.90 $27.65 $22.12 $17.97 $27.65 $27.65 $16.24 $27.65 $16.59 $27.65 $27.65 $27.65 N/A N/A 131443 ERX HCPCS J1815 00002-8824-27 INSULIN REGULAR HUMAN (CONC) 500 UNIT/ML SC SOPN BOTH IP/OP $15.00 $11.00 $2.98 $302.08 $8.15 $8.15 $8.15 $8.15 $15.00 $15.00 $15.00 $3.13 $15.00 $15.00 $15.00 $15.00 $15.00 $3.13 $15.00 $15.00 $8.87 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $2.98 $15.00 $8.70 $15.00 $15.00 $15.00 $302.08 $15.00 N/A N/A 131448 ERX HCPCS 63700001 50474-0470-66 BRIVARACETAM 25 MG PO TABS BOTH IP/OP $109.50 $81.00 $22.81 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $22.81 $109.47 $43.79 $109.47 $109.47 $109.47 $109.47 $109.47 $82.13 $109.47 $109.47 $109.47 $54.74 $54.74 $86.70 $109.47 $87.58 $71.16 $109.47 $109.47 $63.51 $109.47 $65.68 $109.47 $109.47 $109.47 N/A N/A 131449 ERX HCPCS 25000001 50474-0570-09 BRIVARACETAM 50 MG PO TABS BOTH IP/OP $109.50 $81.00 $19.49 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $19.49 $109.47 $109.47 $81.25 $81.25 $84.38 $57.03 $22.81 $109.47 $43.79 $109.47 $109.47 $109.47 $109.47 $109.47 $82.13 $109.47 $109.47 $109.47 $54.74 $54.74 $86.70 $109.47 $87.58 $71.16 $109.47 $109.47 $63.51 $109.47 $65.68 $109.47 $109.47 $109.47 N/A N/A 131450 ERX HCPCS 25000001 50474-0670-66 BRIVARACETAM 75 MG PO TABS BOTH IP/OP $109.50 $81.00 $19.49 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $19.49 $109.47 $109.47 $81.25 $81.25 $84.38 $57.03 $22.81 $109.47 $43.79 $109.47 $109.47 $109.47 $109.47 $109.47 $82.13 $109.47 $109.47 $109.47 $54.74 $54.74 $86.70 $109.47 $87.58 $71.16 $109.47 $109.47 $63.51 $109.47 $65.68 $109.47 $109.47 $109.47 N/A N/A 131451 ERX HCPCS 25000001 50474-0770-09 BRIVARACETAM 100 MG PO TABS BOTH IP/OP $109.50 $81.00 $19.49 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $109.47 $19.49 $109.47 $109.47 $81.25 $81.25 $84.38 $57.03 $22.81 $109.47 $43.79 $109.47 $109.47 $109.47 $109.47 $109.47 $82.13 $109.47 $109.47 $109.47 $54.74 $54.74 $86.70 $109.47 $87.58 $71.16 $109.47 $109.47 $63.51 $109.47 $65.68 $109.47 $109.47 $109.47 N/A N/A 131458 ERX HCPCS J2786 59310-0610-31 RESLIZUMAB 100 MG/10ML IV SOLN BOTH IP/OP "$2,936.00" "$2,173.00" "$1,011.00" "$2,935.80" "$2,935.80" "$2,935.80" "$2,935.80" "$2,935.80" "$2,935.80" "$2,935.80" "$1,011.00" "$2,935.80" "$2,935.80" "$1,053.52" "$1,053.52" "$1,094.04" "$1,013.00" "$1,190.11" "$2,935.80" "$1,174.32" "$2,935.80" "$2,935.80" "$2,935.80" "$2,935.80" "$2,935.80" "$2,202.00" "$2,935.80" "$2,935.80" "$2,935.80" "$1,467.90" "$1,467.90" "$2,325.15" "$2,935.80" "$2,348.64" "$1,321.11" "$2,935.80" "$2,935.80" "$1,702.88" "$2,935.80" "$1,761.48" "$2,935.80" "$2,935.80" "$2,935.80" N/A N/A 131469 ERX HCPCS J0330 71266-2001-02 SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY BOTH IP/OP $22.00 $16.00 $1.10 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $1.14 $1.14 $1.19 $1.10 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 131499 ERX HCPCS 63700001 61958-2002-01 DESCOVY:EMTRICITABINE-TENOFOVIR AF 200-25 MG TAB BOTH IP/OP $309.50 $229.00 $64.44 $309.19 $309.19 $309.19 $309.19 $309.19 $309.19 $309.19 $309.19 $309.19 $309.19 $309.19 $309.19 $309.19 $309.19 $64.44 $309.19 $123.68 $309.19 $309.19 $309.19 $309.19 $309.19 $232.13 $309.19 $309.19 $309.19 $154.60 $154.60 $244.88 $309.19 $247.35 $200.97 $309.19 $309.19 $179.51 $309.19 $185.51 $309.19 $309.19 $309.19 N/A N/A 131510 ERX HCPCS J2370 71286-6009-01 PHENYLEPHRINE HCL-NACL 1-0.9 MG/10ML-% IV SOSY BOTH IP/OP $27.00 $20.00 $0.96 $27.00 $12.15 $12.15 $12.15 $12.15 $27.00 $27.00 $27.00 $0.96 $27.00 $3.49 $3.49 $3.63 $3.36 $3.95 $27.00 $27.00 $15.97 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $12.15 $3.76 $27.00 $15.66 $27.00 $16.20 $27.00 $3.76 $27.00 N/A N/A 131520 ERX HCPCS 63600001 68982-0182-01 WILATE:ANTIHEMOPHILIC FACTOR-VWF 500-500 UNITS IV KIT BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 131521 ERX HCPCS J7183 68982-0182-02 WILATE:ANTIHEMOPHILIC FACTOR-VWF 1000-1000 UNITS IV KIT BOTH IP/OP "$4,241.00" "$3,138.00" $883.79 "$4,240.60" "$4,240.60" "$4,240.60" "$4,240.60" "$4,240.60" "$4,240.60" "$4,240.60" "$1,160.00" "$4,240.60" "$4,240.60" "$1,185.60" "$1,185.60" "$1,231.20" "$1,140.00" $883.79 "$4,240.60" "$1,696.24" "$4,240.60" "$4,240.60" "$4,240.60" "$4,240.60" "$4,240.60" "$3,180.75" "$4,240.60" "$4,240.60" "$4,240.60" "$2,120.30" "$2,120.30" "$3,358.56" "$4,240.60" "$3,392.48" "$1,908.27" "$4,240.60" "$4,240.60" "$2,459.78" "$4,240.60" "$2,544.36" "$4,240.60" "$4,240.60" "$4,240.60" N/A N/A 131529 ERX HCPCS 25000001 00074-0576-22 VENETOCLAX 100 MG PO TABS BOTH IP/OP $513.50 $380.00 $91.38 $513.36 $513.36 $513.36 $513.36 $513.36 $513.36 $513.36 $91.38 $513.36 $513.36 $381.02 $381.02 $395.70 $267.46 $106.99 $513.36 $205.34 $513.36 $513.36 $513.36 $513.36 $513.36 $385.13 $513.36 $513.36 $513.36 $256.68 $256.68 $406.58 $513.36 $410.69 $333.68 $513.36 $513.36 $297.83 $513.36 $308.02 $513.36 $513.36 $513.36 N/A N/A 131530 ERX HCPCS 25000001 00074-0579-28 VENETOCLAX 10 & 50 & 100 MG PO TBPK BOTH IP/OP "$8,928.00" "$6,607.00" "$1,589.14" "$8,927.77" "$8,927.77" "$8,927.77" "$8,927.77" "$8,927.77" "$8,927.77" "$8,927.77" "$1,589.14" "$8,927.77" "$8,927.77" "$4,181.12" "$4,181.12" "$6,881.53" "$2,060.15" "$1,860.65" "$8,927.77" "$3,571.11" "$8,927.77" "$8,927.77" "$8,927.77" "$8,927.77" "$8,927.77" "$6,696.00" "$8,927.77" "$8,927.77" "$8,927.77" "$4,463.89" "$4,463.89" "$7,070.79" "$8,927.77" "$7,142.22" "$5,803.05" "$8,927.77" "$8,927.77" "$5,178.24" "$8,927.77" "$5,356.66" "$8,927.77" "$8,927.77" "$8,927.77" N/A N/A 131594 ERX HCPCS 63700001 42388-0024-26 CABOZANTINIB S-MALATE 20 MG PO TABS BOTH IP/OP "$2,333.50" "$1,727.00" $486.26 "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" $486.26 "$2,333.18" $933.27 "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$1,750.13" "$2,333.18" "$2,333.18" "$2,333.18" "$1,166.59" "$1,166.59" "$1,847.88" "$2,333.18" "$1,866.54" "$1,516.57" "$2,333.18" "$2,333.18" "$1,353.43" "$2,333.18" "$1,399.91" "$2,333.18" "$2,333.18" "$2,333.18" N/A N/A 131595 ERX HCPCS 63700001 42388-0025-26 CABOZANTINIB S-MALATE 40 MG PO TABS BOTH IP/OP "$2,333.50" "$1,727.00" $486.26 "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" $486.26 "$2,333.18" $933.27 "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$1,750.13" "$2,333.18" "$2,333.18" "$2,333.18" "$1,166.59" "$1,166.59" "$1,847.88" "$2,333.18" "$1,866.54" "$1,516.57" "$2,333.18" "$2,333.18" "$1,353.43" "$2,333.18" "$1,399.91" "$2,333.18" "$2,333.18" "$2,333.18" N/A N/A 131596 ERX HCPCS 63700001 42388-0023-26 CABOZANTINIB S-MALATE 60 MG PO TABS BOTH IP/OP "$2,333.50" "$1,727.00" $486.26 "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" $486.26 "$2,333.18" $933.27 "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$2,333.18" "$1,750.13" "$2,333.18" "$2,333.18" "$2,333.18" "$1,166.59" "$1,166.59" "$1,847.88" "$2,333.18" "$1,866.54" "$1,516.57" "$2,333.18" "$2,333.18" "$1,353.43" "$2,333.18" "$1,399.91" "$2,333.18" "$2,333.18" "$2,333.18" N/A N/A 131610 ERX HCPCS 63700001 24510-0115-10 OXYCODONE ER 13.5 MG PO C12A BOTH IP/OP $47.50 $35.00 $9.88 $47.40 $47.40 $47.40 $47.40 $47.40 $47.40 $47.40 $47.40 $47.40 $47.40 $47.40 $47.40 $47.40 $47.40 $9.88 $47.40 $18.96 $47.40 $47.40 $47.40 $47.40 $47.40 $35.63 $47.40 $47.40 $47.40 $23.70 $23.70 $37.54 $47.40 $37.92 $30.81 $47.40 $47.40 $27.55 $47.40 $28.44 $47.40 $47.40 $47.40 N/A N/A 131700 ERX HCPCS J9022 50242-0917-01 ATEZOLIZUMAB 1200 MG/20ML IV SOLN BOTH IP/OP "$28,225.50" "$20,887.00" "$5,882.85" "$28,225.25" "$12,701.36" "$12,701.36" "$12,701.36" "$12,701.36" "$9,549.12" "$9,549.12" "$9,549.12" "$5,882.85" "$9,549.12" "$9,931.58" "$9,931.58" "$10,313.57" "$9,549.60" "$11,219.26" "$9,549.12" "$9,727.56" "$13,915.05" "$9,549.12" "$28,225.25" "$9,549.12" "$10,026.58" "$21,169.13" "$9,549.12" "$9,549.12" "$9,549.12" "$14,112.63" "$14,112.63" "$22,354.40" "$9,549.12" "$22,580.20" "$12,701.36" "$7,712.84" "$9,549.12" "$16,370.79" "$10,026.58" "$13,846.22" "$9,549.12" "$8,098.48" "$9,549.12" N/A N/A 131713 ERX HCPCS 63700001 62856-0708-05 LENVATINIB (8 MG DAILY DOSE) 2 X 4 MG PO CPPK BOTH IP/OP "$1,332.50" $986.00 $277.67 "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" $277.67 "$1,332.31" $532.92 "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" "$1,332.31" $999.38 "$1,332.31" "$1,332.31" "$1,332.31" $666.16 $666.16 "$1,055.19" "$1,332.31" "$1,065.85" $866.00 "$1,332.31" "$1,332.31" $772.85 "$1,332.31" $799.39 "$1,332.31" "$1,332.31" "$1,332.31" N/A N/A 131714 ERX HCPCS 63700001 62856-0718-05 LENVATINIB (18 MG DAILY DOSE) 10 MG & 2 X 4 MG PO CPPK BOTH IP/OP $888.50 $657.00 $185.11 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $185.11 $888.21 $355.28 $888.21 $888.21 $888.21 $888.21 $888.21 $666.38 $888.21 $888.21 $888.21 $444.11 $444.11 $703.46 $888.21 $710.57 $577.34 $888.21 $888.21 $515.33 $888.21 $532.93 $888.21 $888.21 $888.21 N/A N/A 132039 ERX HCPCS J9047 76075-0102-01 CARFILZOMIB 30 MG IV SOLR BOTH IP/OP "$4,165.00" "$3,082.00" $868.08 "$4,164.93" "$1,874.22" "$1,874.22" "$1,874.22" "$1,874.22" "$1,233.33" "$1,233.33" "$1,233.33" $868.08 "$1,233.33" "$1,282.63" "$1,282.63" "$1,331.96" "$1,233.30" "$1,448.93" "$1,233.33" "$1,342.92" "$2,053.31" "$1,233.33" "$4,164.93" "$1,233.33" "$1,295.00" "$3,123.75" "$1,233.33" "$1,233.33" "$1,233.33" "$2,082.47" "$2,082.47" "$3,298.62" "$1,233.33" "$3,331.94" "$1,874.22" "$1,379.82" "$1,233.33" "$2,415.70" "$1,295.00" "$1,788.33" "$1,233.33" "$1,379.82" "$1,233.33" N/A N/A 132135 ERX HCPCS 63700001 72626-2701-01 (EPCLUSA) SOFOSBUVIR-VELPATASVIR 400-100 MG PO TABS BOTH IP/OP "$1,035.50" $766.00 $215.80 "$1,035.43" "$1,035.43" "$1,035.43" "$1,035.43" "$1,035.43" "$1,035.43" "$1,035.43" "$1,035.43" "$1,035.43" "$1,035.43" "$1,035.43" "$1,035.43" "$1,035.43" "$1,035.43" $215.80 "$1,035.43" $414.17 "$1,035.43" "$1,035.43" "$1,035.43" "$1,035.43" "$1,035.43" $776.63 "$1,035.43" "$1,035.43" "$1,035.43" $517.72 $517.72 $820.06 "$1,035.43" $828.34 $673.03 "$1,035.43" "$1,035.43" $600.59 "$1,035.43" $621.26 "$1,035.43" "$1,035.43" "$1,035.43" N/A N/A 132336 ERX HCPCS 25000001 00310-4600-12 BEVESPI:GLYCOPYRROLATE-FORMOTEROL 9-4.8 MCG/ACT IN AERO BOTH IP/OP "$2,344.50" "$1,735.00" $417.24 "$2,344.07" "$2,344.07" "$2,344.07" "$2,344.07" "$2,344.07" "$2,344.07" "$2,344.07" $417.24 "$2,344.07" "$2,344.07" "$1,739.77" "$1,739.77" "$1,806.81" "$1,221.26" $488.53 "$2,344.07" $937.63 "$2,344.07" "$2,344.07" "$2,344.07" "$2,344.07" "$2,344.07" "$1,758.38" "$2,344.07" "$2,344.07" "$2,344.07" "$1,172.04" "$1,172.04" "$1,856.50" "$2,344.07" "$1,875.26" "$1,523.65" "$2,344.07" "$2,344.07" "$1,359.81" "$2,344.07" "$1,406.44" "$2,344.07" "$2,344.07" "$2,344.07" N/A N/A 132344 ERX HCPCS 25000001 00065-0426-36 GENTEAL TEARS 0.1-0.2-0.3 % OP SOLN BOTH IP/OP $34.50 $26.00 $6.10 $34.28 $34.28 $34.28 $34.28 $34.28 $34.28 $34.28 $6.10 $34.28 $34.28 $25.44 $25.44 $26.42 $17.86 $7.14 $34.28 $13.71 $34.28 $34.28 $34.28 $34.28 $34.28 $25.88 $34.28 $34.28 $34.28 $17.14 $17.14 $27.15 $34.28 $27.42 $22.28 $34.28 $34.28 $20.01 $34.28 $20.57 $34.28 $34.28 $34.28 N/A N/A 132810 ERX HCPCS 25800001 63323-0820-50 FAT EMUL FISH OIL/PLANT BASED 20 % IV EMUL BOTH IP/OP $163.50 $121.00 $29.05 $163.18 $163.18 $163.18 $163.18 $163.18 $163.18 $163.18 $29.05 $163.18 $163.18 $121.11 $121.11 $125.78 $85.02 $34.01 $163.18 $65.27 $163.18 $163.18 $163.18 $163.18 $163.18 $122.63 $163.18 $163.18 $163.18 $81.59 $81.59 $129.24 $163.18 $130.54 $106.07 $163.18 $163.18 $94.83 $163.18 $97.91 $163.18 $163.18 $163.18 N/A N/A 132815 ERX HCPCS J3490 00517-0374-05 METHYLENE BLUE (ANTIDOTE) 50 MG/10ML IV SOLN BOTH IP/OP $944.00 $699.00 $187.32 $943.82 $424.72 $424.72 $424.72 $424.72 $943.82 $943.82 $943.82 $196.72 $943.82 $943.82 $943.82 $943.82 $943.82 $196.70 $943.82 $943.82 $558.27 $943.82 $943.82 $943.82 $943.82 $708.00 $943.82 $943.82 $943.82 $471.91 $471.91 $747.51 $943.82 $755.06 $424.72 $187.32 $943.82 $547.52 $943.82 $943.82 $943.82 $196.69 $943.82 N/A N/A 132818 ERX HCPCS J2400 63323-0478-27 CHLOROPROCAINE HCL (PF) 3 % IJ SOLN BOTH IP/OP $107.00 $79.00 $22.28 $106.91 $106.91 $106.91 $106.91 $106.91 $106.91 $106.91 $29.03 $106.91 $106.91 $31.30 $31.30 $32.51 $30.10 $22.28 $106.91 $42.76 $106.91 $106.91 $106.91 $106.91 $106.91 $80.25 $106.91 $106.91 $106.91 $53.46 $53.46 $84.67 $106.91 $85.53 $48.11 $106.91 $106.91 $62.06 $106.91 $64.15 $106.91 $106.91 $106.91 N/A N/A 132822 ERX HCPCS J3246 25208-0002-02 TIROFIBAN HCL IN NACL 12.5-0.9 MG/250ML-% IV SOLN BOTH IP/OP $866.00 $641.00 $179.20 $865.99 $865.99 $865.99 $865.99 $865.99 $865.99 $865.99 $179.20 $865.99 $865.99 $193.96 $193.96 $201.42 $186.50 $180.48 $865.99 $346.40 $865.99 $865.99 $865.99 $865.99 $865.99 $649.50 $865.99 $865.99 $865.99 $433.00 $433.00 $685.86 $865.99 $692.79 $389.70 $865.99 $865.99 $502.28 $865.99 $519.59 $865.99 $865.99 $865.99 N/A N/A 132824 ERX HCPCS J2310 00409-1219-01 NALOXONE HCL 4 MG/10ML IJ SOLN BOTH IP/OP $494.50 $366.00 $43.16 $494.45 $494.45 $494.45 $494.45 $494.45 $494.45 $494.45 $43.72 $494.45 $494.45 $44.89 $44.89 $46.61 $43.16 $50.71 $494.45 $197.78 $494.45 $494.45 $494.45 $494.45 $494.45 $370.88 $494.45 $494.45 $494.45 $247.23 $247.23 $391.60 $494.45 $395.56 $222.50 $494.45 $494.45 $286.81 $494.45 $296.67 $494.45 $494.45 $494.45 N/A N/A 132826 ERX HCPCS J7195 58394-0633-03 COAGULATION FACTOR IX (RECOMB) 250 UNITS IV KIT BOTH IP/OP $22.00 $16.00 $4.59 $429.30 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $402.50 $22.00 $22.00 $413.40 $413.40 $429.30 $397.50 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 132827 ERX HCPCS J7195 58394-0634-03 COAGULATION FACTOR IX (RECOMB) 500 UNITS IV KIT BOTH IP/OP $22.00 $16.00 $4.59 $858.60 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $805.00 $22.00 $22.00 $826.80 $826.80 $858.60 $795.00 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 132828 ERX HCPCS J7195 58394-0635-03 COAGULATION FACTOR IX (RECOMB BENEFIX) 1000 UNITS IV KIT BOTH IP/OP "$3,821.50" "$2,828.00" $796.38 "$3,821.20" "$3,821.20" "$3,821.20" "$3,821.20" "$3,821.20" "$3,821.20" "$3,821.20" "$1,610.00" "$3,821.20" "$3,821.20" "$1,653.60" "$1,653.60" "$1,717.20" "$1,590.00" $796.38 "$3,821.20" "$1,528.48" "$3,821.20" "$3,821.20" "$3,821.20" "$3,821.20" "$3,821.20" "$2,866.13" "$3,821.20" "$3,821.20" "$3,821.20" "$1,910.60" "$1,910.60" "$3,026.39" "$3,821.20" "$3,056.96" "$1,719.54" "$3,821.20" "$3,821.20" "$2,216.47" "$3,821.20" "$2,292.72" "$3,821.20" "$3,821.20" "$3,821.20" N/A N/A 132829 ERX HCPCS J7195 58394-0636-03 COAGULATION FACTOR IX (RECOMB) 2000 UNITS IV KIT BOTH IP/OP $22.00 $16.00 $4.59 "$3,434.40" $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 "$3,220.00" $22.00 $22.00 "$3,307.20" "$3,307.20" "$3,434.40" "$3,180.00" $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 132861 ERX HCPCS 25000001 69374-0924-05 ROCURONIUM BROMIDE 50 MG/5ML IV SOSY BOTH IP/OP $39.00 $29.00 $6.92 $38.88 $38.88 $38.88 $38.88 $38.88 $38.88 $38.88 $6.92 $38.88 $38.88 $28.86 $28.86 $29.97 $20.26 $8.10 $38.88 $15.55 $38.88 $38.88 $38.88 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $25.27 $38.88 $38.88 $22.62 $38.88 $23.33 $38.88 $38.88 $38.88 N/A N/A 132871 ERX HCPCS 63700001 65649-0150-90 METHYLNALTREXONE BROMIDE 150 MG PO TABS BOTH IP/OP $123.50 $91.00 $25.69 $123.28 $123.28 $123.28 $123.28 $123.28 $123.28 $123.28 $123.28 $123.28 $123.28 $123.28 $123.28 $123.28 $123.28 $25.69 $123.28 $49.31 $123.28 $123.28 $123.28 $123.28 $123.28 $92.63 $123.28 $123.28 $123.28 $61.64 $61.64 $97.64 $123.28 $98.62 $80.13 $123.28 $123.28 $71.63 $123.28 $73.97 $123.28 $123.28 $123.28 N/A N/A 133062 ERX HCPCS J7999 00338-0108-20 NOREPINEPHRINE-DEXTROSE 8-5 MG/250ML-% IV SOLN BOTH IP/OP $167.50 $124.00 $34.84 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $34.84 $167.16 $66.86 $167.16 $167.16 $167.16 $167.16 $167.16 $125.63 $167.16 $167.16 $167.16 $83.58 $83.58 $132.39 $167.16 $133.73 $75.22 $167.16 $167.16 $97.15 $167.16 $100.30 $167.16 $167.16 $167.16 N/A N/A 133290 ERX HCPCS 25000001 68176-0000-13 DEKAS ESSENTIAL PO LIQD BOTH IP/OP $179.50 $133.00 $31.88 $179.10 $179.10 $179.10 $179.10 $179.10 $179.10 $179.10 $31.88 $179.10 $179.10 $132.93 $132.93 $138.05 $93.31 $37.33 $179.10 $71.64 $179.10 $179.10 $179.10 $179.10 $179.10 $134.63 $179.10 $179.10 $179.10 $89.55 $89.55 $141.85 $179.10 $143.28 $116.42 $179.10 $179.10 $104.11 $179.10 $107.46 $179.10 $179.10 $179.10 N/A N/A 133367 ERX HCPCS J3358 57894-0054-27 USTEKINUMAB 130 MG/26ML IV SOLN BOTH IP/OP "$5,391.00" "$3,989.00" "$1,123.61" "$5,390.96" "$2,425.93" "$2,425.93" "$2,425.93" "$2,425.93" "$1,509.95" "$1,509.95" "$1,509.95" "$1,123.61" "$1,509.95" "$1,571.02" "$1,571.02" "$1,631.45" "$1,510.60" "$1,774.71" "$1,509.95" "$1,591.98" "$2,657.74" "$1,509.95" "$5,390.96" "$1,509.95" "$1,585.45" "$4,043.25" "$1,509.95" "$1,509.95" "$1,509.95" "$2,695.48" "$2,695.48" "$4,269.64" "$1,509.95" "$4,312.77" "$2,425.93" "$1,690.06" "$1,509.95" "$3,126.78" "$1,585.45" "$2,189.43" "$1,509.95" "$1,690.06" "$1,509.95" N/A N/A 133767 ERX HCPCS 63700001 59310-0302-40 BECLOMETHASONE DIPROP HFA 40 MCG/ACT IN AERB BOTH IP/OP $759.50 $562.00 $158.24 $759.27 $759.27 $759.27 $759.27 $759.27 $759.27 $759.27 $759.27 $759.27 $759.27 $759.27 $759.27 $759.27 $759.27 $158.24 $759.27 $303.71 $759.27 $759.27 $759.27 $759.27 $759.27 $569.63 $759.27 $759.27 $759.27 $379.64 $379.64 $601.34 $759.27 $607.42 $493.53 $759.27 $759.27 $440.51 $759.27 $455.56 $759.27 $759.27 $759.27 N/A N/A 133768 ERX HCPCS 63700001 59310-0304-80 BECLOMETHASONE DIPROP HFA 80 MCG/ACT IN AERB BOTH IP/OP "$1,017.00" $753.00 $211.87 "$1,016.58" "$1,016.58" "$1,016.58" "$1,016.58" "$1,016.58" "$1,016.58" "$1,016.58" "$1,016.58" "$1,016.58" "$1,016.58" "$1,016.58" "$1,016.58" "$1,016.58" "$1,016.58" $211.87 "$1,016.58" $406.63 "$1,016.58" "$1,016.58" "$1,016.58" "$1,016.58" "$1,016.58" $762.75 "$1,016.58" "$1,016.58" "$1,016.58" $508.29 $508.29 $805.13 "$1,016.58" $813.26 $660.78 "$1,016.58" "$1,016.58" $589.86 "$1,016.58" $609.95 "$1,016.58" "$1,016.58" "$1,016.58" N/A N/A 133781 ERX HCPCS Q5103 00069-0809-01 INFLIXIMAB-DYYB 100 MG IV SOLR BOTH IP/OP "$2,646.00" "$1,958.00" $205.91 "$2,645.81" "$1,190.61" "$1,190.61" "$1,190.61" "$1,190.61" $405.74 $405.74 $405.74 $551.45 $405.74 $421.93 $421.93 $438.16 $405.70 $551.42 $405.74 $205.91 "$1,304.38" $405.74 "$2,645.81" $405.74 $426.03 "$1,984.50" $405.74 $405.74 $405.74 "$1,322.91" "$1,322.91" "$2,095.48" $405.74 "$2,116.65" "$1,190.61" $525.13 $405.74 "$1,534.68" $426.03 $588.32 $405.74 $551.39 $405.74 N/A N/A 133797 ERX HCPCS J7999 70324-0577-01 NOREPINEPHRINE-SODIUM CHLORIDE 8-0.9 MG/250ML-% IV SOLN BOTH IP/OP $197.00 $146.00 $41.04 $196.90 $196.90 $196.90 $196.90 $196.90 $196.90 $196.90 $196.90 $196.90 $196.90 $196.90 $196.90 $196.90 $196.90 $41.04 $196.90 $78.76 $196.90 $196.90 $196.90 $196.90 $196.90 $147.75 $196.90 $196.90 $196.90 $98.45 $98.45 $155.94 $196.90 $157.52 $88.61 $196.90 $196.90 $114.26 $196.90 $118.14 $196.90 $196.90 $196.90 N/A N/A 133838 ERX HCPCS J7296 50419-0424-01 LEVONORGESTREL 19.5 MG IU IUD BOTH IP/OP "$3,080.50" "$2,280.00" $959.31 "$3,080.36" "$3,080.36" "$3,080.36" "$3,080.36" "$3,080.36" "$3,080.36" "$3,080.36" $959.31 "$3,080.36" "$3,080.36" "$1,039.25" "$1,039.25" "$1,079.22" $999.28 "$1,174.00" "$3,080.36" "$1,232.14" "$3,080.36" "$3,080.36" "$3,080.36" "$3,080.36" "$3,080.36" "$2,310.38" "$3,080.36" "$3,080.36" "$3,080.36" "$1,540.18" "$1,540.18" "$2,439.65" "$3,080.36" "$2,464.29" "$1,386.16" "$3,080.36" "$3,080.36" "$1,786.69" "$3,080.36" "$1,848.22" "$3,080.36" "$3,080.36" "$3,080.36" N/A N/A 134049 ERX HCPCS J3246 25208-0001-04 TIROFIBAN HCL 3.75 MG/15ML IV CONC BOTH IP/OP $241.00 $178.00 $50.14 $240.58 $240.58 $240.58 $240.58 $240.58 $240.58 $240.58 $53.76 $240.58 $240.58 $58.19 $58.19 $60.43 $55.95 $50.14 $240.58 $96.23 $240.58 $240.58 $240.58 $240.58 $240.58 $180.75 $240.58 $240.58 $240.58 $120.29 $120.29 $190.54 $240.58 $192.46 $108.26 $240.58 $240.58 $139.78 $240.58 $144.35 $240.58 $240.58 $240.58 N/A N/A 134129 ERX HCPCS 63700001 61958-2301-01 TENOFOVIR ALAFENAMIDE FUMARATE 25 MG PO TABS BOTH IP/OP $197.00 $146.00 $41.02 $196.80 $196.80 $196.80 $196.80 $196.80 $196.80 $196.80 $196.80 $196.80 $196.80 $196.80 $196.80 $196.80 $196.80 $41.02 $196.80 $78.72 $196.80 $196.80 $196.80 $196.80 $196.80 $147.75 $196.80 $196.80 $196.80 $98.40 $98.40 $155.87 $196.80 $157.44 $127.92 $196.80 $196.80 $114.26 $196.80 $118.08 $196.80 $196.80 $196.80 N/A N/A 134529 ERX HCPCS 25000001 62530-0000-11 UREA 15 G PO PACK BOTH IP/OP $18.50 $14.00 $3.23 $18.15 $18.15 $18.15 $18.15 $18.15 $18.15 $18.15 $3.23 $18.15 $18.15 $13.47 $13.47 $13.99 $9.46 $3.78 $18.15 $7.26 $18.15 $18.15 $18.15 $18.15 $18.15 $13.88 $18.15 $18.15 $18.15 $9.08 $9.08 $14.37 $18.15 $14.52 $11.80 $18.15 $18.15 $10.73 $18.15 $10.89 $18.15 $18.15 $18.15 N/A N/A 134557 ERX HCPCS 63600001 69660-0201-91 RUCAPARIB CAMSYLATE 200 MG PO TABS BOTH IP/OP $603.00 $446.00 $107.29 $602.74 $602.74 $602.74 $602.74 $602.74 $602.74 $602.74 $107.29 $602.74 $602.74 $602.74 $602.74 $602.74 $602.74 $125.62 $602.74 $241.10 $602.74 $602.74 $602.74 $602.74 $602.74 $452.25 $602.74 $602.74 $602.74 $301.37 $301.37 $477.37 $602.74 $482.19 $271.23 $602.74 $602.74 $349.74 $602.74 $361.64 $602.74 $602.74 $602.74 N/A N/A 134558 ERX HCPCS 63600001 69660-0203-91 RUCAPARIB CAMSYLATE 300 MG PO TABS BOTH IP/OP $603.00 $446.00 $107.29 $602.74 $602.74 $602.74 $602.74 $602.74 $602.74 $602.74 $107.29 $602.74 $602.74 $602.74 $602.74 $602.74 $602.74 $125.62 $602.74 $241.10 $602.74 $602.74 $602.74 $602.74 $602.74 $452.25 $602.74 $602.74 $602.74 $301.37 $301.37 $477.37 $602.74 $482.19 $271.23 $602.74 $602.74 $349.74 $602.74 $361.64 $602.74 $602.74 $602.74 N/A N/A 134827 ERX HCPCS J7999 71285-6044-01 OXYTOCIN-SODIUM CHLORIDE 30-0.9 UT/500ML-% IV SOLN BOTH IP/OP $55.50 $41.00 $11.51 $55.21 $55.21 $55.21 $55.21 $55.21 $55.21 $55.21 $55.21 $55.21 $55.21 $55.21 $55.21 $55.21 $55.21 $11.51 $55.21 $22.08 $55.21 $55.21 $55.21 $55.21 $55.21 $41.63 $55.21 $55.21 $55.21 $27.61 $27.61 $43.73 $55.21 $44.17 $24.84 $55.21 $55.21 $32.19 $55.21 $33.13 $55.21 $55.21 $55.21 N/A N/A 134890 ERX HCPCS 25000001 00283-0679-02 BENZOCAINE 20 % MT AERO BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 $125.00 $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 134897 ERX HCPCS 25000001 63323-0170-05 SODIUM PHOSPHATES 15 MMOLE/5ML IV SOLN BOTH IP/OP $84.00 $62.00 $14.90 $83.68 $83.68 $83.68 $83.68 $83.68 $83.68 $83.68 $14.90 $83.68 $83.68 $62.11 $62.11 $64.50 $43.60 $17.44 $83.68 $33.47 $83.68 $83.68 $83.68 $83.68 $83.68 $63.00 $83.68 $83.68 $83.68 $41.84 $41.84 $66.27 $83.68 $66.94 $54.39 $83.68 $83.68 $48.72 $83.68 $50.21 $83.68 $83.68 $83.68 N/A N/A 134969 ERX HCPCS J0461 00641-6006-01 ATROPINE SULFATE 8 MG/20ML IJ SOLN BOTH IP/OP $22.00 $16.00 $1.80 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $1.87 $1.87 $1.94 $1.80 $2.11 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $2.01 $22.00 $12.76 $22.00 $22.00 $22.00 $2.01 $22.00 N/A N/A 135137 ERX HCPCS 25000001 00121-1971-21 ACETAMINOPHEN 650 MG/20.3ML PO SOLN BOTH IP/OP $11.00 $8.00 $1.87 $10.53 $10.53 $10.53 $10.53 $10.53 $10.53 $10.53 $1.87 $10.53 $10.53 $7.82 $7.82 $8.12 $5.49 $2.19 $10.53 $4.21 $10.53 $10.53 $10.53 $10.53 $10.53 $8.25 $10.53 $10.53 $10.53 $5.27 $5.27 $8.34 $10.53 $8.42 $6.84 $10.53 $10.53 $6.38 $10.53 $6.32 $10.53 $10.53 $10.53 N/A N/A 135334 ERX HCPCS 25000001 61938-0456-03 CALFACTANT IN NACL 35-0.9 MG/ML-% INTRATRACHEA SUSP BOTH IP/OP "$1,456.50" "$1,078.00" $259.20 "$1,456.17" "$1,456.17" "$1,456.17" "$1,456.17" "$1,456.17" "$1,456.17" "$1,456.17" $259.20 "$1,456.17" "$1,456.17" "$1,080.77" "$1,080.77" "$1,122.42" $758.66 $303.48 "$1,456.17" $582.47 "$1,456.17" "$1,456.17" "$1,456.17" "$1,456.17" "$1,456.17" "$1,092.38" "$1,456.17" "$1,456.17" "$1,456.17" $728.09 $728.09 "$1,153.29" "$1,456.17" "$1,164.94" $946.51 "$1,456.17" "$1,456.17" $844.77 "$1,456.17" $873.70 "$1,456.17" "$1,456.17" "$1,456.17" N/A N/A 135365 ERX HCPCS 25000001 49348-0274-72 SM DOUBLE ANTIBIOTIC 500-10000 UNIT/GM EX OINT BOTH IP/OP $14.50 $11.00 $2.56 $14.36 $14.36 $14.36 $14.36 $14.36 $14.36 $14.36 $2.56 $14.36 $14.36 $10.66 $10.66 $11.07 $7.48 $2.99 $14.36 $5.74 $14.36 $14.36 $14.36 $14.36 $14.36 $10.88 $14.36 $14.36 $14.36 $7.18 $7.18 $11.37 $14.36 $11.49 $9.33 $14.36 $14.36 $8.41 $14.36 $8.62 $14.36 $14.36 $14.36 N/A N/A 135444 ERX HCPCS 25000001 51754-1006-01 NITROPRUSSIDE SODIUM-NACL 50-0.9 MG/100ML-% IV SOLN BOTH IP/OP $236.50 $175.00 $42.06 $236.28 $236.28 $236.28 $236.28 $236.28 $236.28 $236.28 $42.06 $236.28 $236.28 $175.37 $175.37 $182.12 $123.10 $49.24 $236.28 $94.51 $236.28 $236.28 $236.28 $236.28 $236.28 $177.38 $236.28 $236.28 $236.28 $118.14 $118.14 $187.13 $236.28 $189.02 $153.58 $236.28 $236.28 $137.17 $236.28 $141.77 $236.28 $236.28 $236.28 N/A N/A 135513 ERX HCPCS J9023 44087-3535-01 AVELUMAB 200 MG/10ML IV SOLN BOTH IP/OP "$5,002.50" "$3,702.00" "$1,042.62" "$18,923.76" "$2,251.07" "$2,251.07" "$2,251.07" "$2,251.07" "$17,521.60" "$17,521.60" "$17,521.60" "$1,042.62" "$17,521.60" "$18,222.88" "$18,222.88" "$18,923.76" "$17,522.00" "$5,002.38" "$17,521.60" "$17,835.40" "$2,466.17" "$17,521.60" "$5,002.38" "$17,521.60" "$18,397.68" "$3,751.88" "$17,521.60" "$17,521.60" "$17,521.60" "$2,501.19" "$2,501.19" "$3,961.88" "$17,521.60" "$4,001.90" "$2,251.07" "$5,002.38" "$5,002.38" "$2,901.45" "$18,397.68" "$5,002.38" "$17,521.60" "$8,098.48" "$17,521.60" N/A N/A 135585 ERX HCPCS J2260 00338-6010-48 MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN BOTH IP/OP $161.00 $119.00 $6.44 $160.80 $72.36 $72.36 $72.36 $72.36 $160.80 $160.80 $160.80 $33.51 $160.80 $6.70 $6.70 $6.96 $6.44 $7.57 $160.80 $160.80 $95.11 $160.80 $160.80 $160.80 $160.80 $120.75 $160.80 $160.80 $160.80 $80.40 $80.40 $127.35 $160.80 $128.64 $72.36 $7.21 $160.80 $93.38 $160.80 $160.80 $160.80 $7.21 $160.80 N/A N/A 135586 ERX HCPCS 25000001 00065-0092-65 FLUORESCEIN SODIUM 10 % IV SOLN BOTH IP/OP $53.50 $40.00 $9.52 $53.50 $53.50 $53.50 $53.50 $53.50 $53.50 $53.50 $9.52 $53.50 $53.50 $39.71 $39.71 $41.24 $27.87 $11.15 $53.50 $21.40 $53.50 $53.50 $53.50 $53.50 $53.50 $40.13 $53.50 $53.50 $53.50 $26.75 $26.75 $42.37 $53.50 $42.80 $34.78 $53.50 $53.50 $31.03 $53.50 $32.10 $53.50 $53.50 $53.50 N/A N/A 135611 ERX HCPCS J3590 00024-5914-01 DUPILUMAB 300 MG/2ML SC SOSY BOTH IP/OP "$5,016.00" "$3,712.00" $995.53 "$5,015.91" "$2,257.16" "$2,257.16" "$2,257.16" "$2,257.16" "$5,015.91" "$5,015.91" "$5,015.91" "$1,045.44" "$5,015.91" "$5,015.91" "$5,015.91" "$5,015.91" "$5,015.91" "$1,045.37" "$5,015.91" "$5,015.91" "$2,472.84" "$5,015.91" "$5,015.91" "$5,015.91" "$5,015.91" "$3,762.00" "$5,015.91" "$5,015.91" "$5,015.91" "$2,507.96" "$2,507.96" "$3,972.60" "$5,015.91" "$4,012.73" "$2,257.16" $995.53 "$5,015.91" "$2,909.28" "$5,015.91" "$5,015.91" "$5,015.91" "$1,045.32" "$5,015.91" N/A N/A 135612 ERX HCPCS J2350 50242-0150-01 OCRELIZUMAB 300 MG/10ML IV SOLN BOTH IP/OP "$52,497.00" "$38,848.00" "$7,712.84" "$52,496.58" "$23,623.46" "$23,623.46" "$23,623.46" "$23,623.46" "$17,672.10" "$17,672.10" "$17,672.10" "$9,417.94" "$17,672.10" "$18,379.92" "$18,379.92" "$19,086.84" "$17,673.00" "$20,762.96" "$17,672.10" "$17,690.10" "$25,880.81" "$17,672.10" "$52,496.58" "$17,672.10" "$18,555.71" "$39,372.75" "$17,672.10" "$17,672.10" "$17,672.10" "$26,248.29" "$26,248.29" "$41,577.29" "$17,672.10" "$41,997.26" "$23,623.46" "$7,712.84" "$17,672.10" "$30,448.26" "$18,555.71" "$25,624.55" "$17,672.10" "$8,098.48" "$17,672.10" N/A N/A 136063 ERX HCPCS J8999 00069-0193-01 BOSUTINIB 400 MG PO TABS BOTH IP/OP "$2,001.00" "$1,481.00" $416.97 "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" $416.97 "$2,000.72" $800.29 "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$2,000.72" "$1,500.75" "$2,000.72" "$2,000.72" "$2,000.72" "$1,000.36" "$1,000.36" "$1,584.57" "$2,000.72" "$1,600.58" $900.32 "$2,000.72" "$2,000.72" "$1,160.58" "$2,000.72" "$1,200.43" "$2,000.72" "$2,000.72" "$2,000.72" N/A N/A 136459 ERX HCPCS J9355 50242-0132-01 TRASTUZUMAB 150 MG IV SOLR BOTH IP/OP "$4,357.50" "$3,225.00" "$1,086.41" "$4,357.34" "$1,960.80" "$1,960.80" "$1,960.80" "$1,960.80" "$1,296.15" "$1,296.15" "$1,296.15" "$1,086.41" "$1,296.15" "$1,348.00" "$1,348.00" "$1,399.84" "$1,296.15" "$1,522.77" "$1,296.15" "$1,203.74" "$2,148.17" "$1,296.15" "$4,357.34" "$1,296.15" "$1,360.96" "$3,268.13" "$1,296.15" "$1,296.15" "$1,296.15" "$2,178.67" "$2,178.67" "$3,451.01" "$1,296.15" "$3,485.87" "$1,960.80" "$1,450.13" "$1,296.15" "$2,527.35" "$1,360.96" "$1,879.42" "$1,296.15" "$1,450.13" "$1,296.15" N/A N/A 136472 ERX HCPCS 63600001 57894-0195-06 ABIRATERONE ACETATE 500 MG PO TABS BOTH IP/OP "$1,315.50" $973.00 $234.10 "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" $234.10 "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" $274.09 "$1,315.15" $526.06 "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" "$1,315.15" $986.63 "$1,315.15" "$1,315.15" "$1,315.15" $657.58 $657.58 "$1,041.60" "$1,315.15" "$1,052.12" $591.82 "$1,315.15" "$1,315.15" $762.99 "$1,315.15" $789.09 "$1,315.15" "$1,315.15" "$1,315.15" N/A N/A 136501 ERX HCPCS S0077 00338-9549-24 CLINDAMYCIN PHOSPHATE IN NACL 600-0.9 MG/50ML-% IV SOLN BOTH IP/OP $55.50 $41.00 $2.70 $55.30 $24.89 $24.89 $24.89 $24.89 $55.30 $55.30 $2.70 $7.07 $55.30 $4.39 $4.39 $4.56 $4.22 $3.31 $55.30 $22.12 $32.71 $55.30 $55.30 $55.30 $55.30 $41.63 $55.30 $55.30 $55.30 $27.65 $27.65 $43.80 $55.30 $44.24 $24.89 $3.16 $55.30 $32.19 $55.30 $33.18 $55.30 $3.16 $55.30 N/A N/A 136518 ERX HCPCS 63700001 00078-0698-99 MIDOSTAURIN 25 MG PO CAPS BOTH IP/OP "$1,395.50" "$1,033.00" $290.80 "$1,395.32" "$1,395.32" "$1,395.32" "$1,395.32" "$1,395.32" "$1,395.32" "$1,395.32" "$1,395.32" "$1,395.32" "$1,395.32" "$1,395.32" "$1,395.32" "$1,395.32" "$1,395.32" $290.80 "$1,395.32" $558.13 "$1,395.32" "$1,395.32" "$1,395.32" "$1,395.32" "$1,395.32" "$1,046.63" "$1,395.32" "$1,395.32" "$1,395.32" $697.66 $697.66 "$1,105.09" "$1,395.32" "$1,116.26" $906.96 "$1,395.32" "$1,395.32" $809.39 "$1,395.32" $837.19 "$1,395.32" "$1,395.32" "$1,395.32" N/A N/A 136524 ERX HCPCS J9173 00310-4500-12 DURVALUMAB 120 MG/2.4ML IV SOLN BOTH IP/OP "$2,610.50" "$1,932.00" $544.05 "$2,610.31" "$1,174.64" "$1,174.64" "$1,174.64" "$1,174.64" $922.31 $922.31 $922.31 $544.05 $922.31 $959.21 $959.21 $996.11 $922.32 "$1,083.58" $922.31 $942.86 "$1,286.88" $922.31 "$2,610.31" $922.31 $968.42 "$1,957.88" $922.31 $922.31 $922.31 "$1,305.16" "$1,305.16" "$2,067.37" $922.31 "$2,088.25" "$1,174.64" "$1,031.89" $922.31 "$1,514.09" $968.42 "$1,337.35" $922.31 "$1,031.89" $922.31 N/A N/A 136525 ERX HCPCS J9173 00310-4611-50 DURVALUMAB 500 MG/10ML IV SOLN BOTH IP/OP "$10,876.50" "$8,049.00" "$2,266.87" "$10,876.17" "$4,894.28" "$4,894.28" "$4,894.28" "$4,894.28" "$3,842.95" "$3,842.95" "$3,842.95" "$2,266.87" "$3,842.95" "$3,996.72" "$3,996.72" "$4,150.44" "$3,843.00" "$4,514.91" "$3,842.95" "$3,928.60" "$5,361.95" "$3,842.95" "$10,876.17" "$3,842.95" "$4,035.10" "$8,157.38" "$3,842.95" "$3,842.95" "$3,842.95" "$5,438.09" "$5,438.09" "$8,613.93" "$3,842.95" "$8,700.94" "$4,894.28" "$4,299.55" "$3,842.95" "$6,308.37" "$4,035.10" "$5,572.28" "$3,842.95" "$4,299.55" "$3,842.95" N/A N/A 136642 ERX HCPCS 25000001 56151-1625-01 GLUCOSE 15 GM/32ML PO GEL BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 136839 ERX HCPCS J9017 63459-0601-06 ARSENIC TRIOXIDE 12 MG/6ML IV SOLN BOTH IP/OP "$2,982.00" "$2,207.00" $153.72 "$2,981.60" "$2,981.60" "$2,981.60" "$2,981.60" "$2,981.60" "$2,981.60" "$2,981.60" $157.32 "$2,981.60" "$2,981.60" $159.87 $159.87 $166.02 $153.72 $180.60 "$2,981.60" "$1,192.64" "$2,981.60" "$2,981.60" "$2,981.60" "$2,981.60" "$2,981.60" "$2,236.50" "$2,981.60" "$2,981.60" "$2,981.60" "$1,490.80" "$1,490.80" "$2,361.43" "$2,981.60" "$2,385.28" "$1,341.72" "$2,981.60" "$2,981.60" "$1,729.56" "$2,981.60" "$1,788.96" "$2,981.60" "$2,981.60" "$2,981.60" N/A N/A 137000 ERX HCPCS J9311 50242-0108-01 RITUXIMAB-HYALURONIDASE HUMAN 1400-23400 MG -UT/11.7ML SC SOLN BOTH IP/OP "$18,388.50" "$13,607.00" "$5,311.60" "$18,388.12" "$18,388.12" "$18,388.12" "$18,388.12" "$18,388.12" "$18,388.12" "$18,388.12" "$5,311.60" "$18,388.12" "$18,388.12" "$5,563.38" "$5,563.38" "$5,777.35" "$5,349.40" "$6,284.69" "$18,388.12" "$7,355.25" "$18,388.12" "$18,388.12" "$18,388.12" "$18,388.12" "$18,388.12" "$13,791.38" "$18,388.12" "$18,388.12" "$18,388.12" "$9,194.06" "$9,194.06" "$14,563.39" "$18,388.12" "$14,710.50" "$8,274.65" "$18,388.12" "$18,388.12" "$10,665.33" "$18,388.12" "$11,032.87" "$18,388.12" "$18,388.12" "$18,388.12" N/A N/A 137001 ERX HCPCS J9311 50242-0109-01 RITUXIMAB-HYALURONIDASE HUMAN 1600-26800 MG -UT/13.4ML SC SOLN BOTH IP/OP "$21,015.00" "$15,551.00" "$6,070.40" "$21,015.00" "$21,015.00" "$21,015.00" "$21,015.00" "$21,015.00" "$21,015.00" "$21,015.00" "$6,070.40" "$21,015.00" "$21,015.00" "$6,358.14" "$6,358.14" "$6,602.69" "$6,113.60" "$7,182.51" "$21,015.00" "$8,406.00" "$21,015.00" "$21,015.00" "$21,015.00" "$21,015.00" "$21,015.00" "$15,761.25" "$21,015.00" "$21,015.00" "$21,015.00" "$10,507.50" "$10,507.50" "$16,643.88" "$21,015.00" "$16,812.00" "$9,456.75" "$21,015.00" "$21,015.00" "$12,188.70" "$21,015.00" "$12,609.00" "$21,015.00" "$21,015.00" "$21,015.00" N/A N/A 137149 ERX HCPCS Q5104 00006-4305-02 INFLIXIMAB-ABDA 100 MG IV SOLR BOTH IP/OP "$2,414.00" "$1,786.00" $364.30 "$2,413.87" "$1,086.24" "$1,086.24" "$1,086.24" "$1,086.24" $395.84 $395.84 $395.84 $503.11 $395.84 $411.63 $411.63 $427.46 $395.80 $465.00 $395.84 $364.30 "$1,190.04" $395.84 "$2,413.87" $395.84 $415.63 "$1,810.50" $395.84 $395.84 $395.84 "$1,206.94" "$1,206.94" "$1,911.79" $395.84 "$1,931.10" "$1,086.24" $442.82 $395.84 "$1,400.12" $415.63 $573.97 $395.84 $442.82 $395.84 N/A N/A 137213 ERX HCPCS 25000001 70437-0240-26 NERATINIB MALEATE 40 MG PO TABS BOTH IP/OP $330.00 $244.00 $58.72 $329.91 $329.91 $329.91 $329.91 $329.91 $329.91 $329.91 $58.72 $329.91 $329.91 $244.86 $244.86 $254.29 $171.88 $68.76 $329.91 $131.96 $329.91 $329.91 $329.91 $329.91 $329.91 $247.50 $329.91 $329.91 $329.91 $164.96 $164.96 $261.29 $329.91 $263.93 $214.44 $329.91 $329.91 $191.40 $329.91 $197.95 $329.91 $329.91 $329.91 N/A N/A 137222 ERX HCPCS 25000001 99999-6012-48 BIOGAIA PROTECTIS BABY/VIT D PO LIQD BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 137495 ERX HCPCS 63700001 00310-0668-60 OLAPARIB 100 MG PO TABS BOTH IP/OP $551.50 $408.00 $114.89 $551.28 $551.28 $551.28 $551.28 $551.28 $551.28 $551.28 $551.28 $551.28 $551.28 $551.28 $551.28 $551.28 $551.28 $114.89 $551.28 $220.51 $551.28 $551.28 $551.28 $551.28 $551.28 $413.63 $551.28 $551.28 $551.28 $275.64 $275.64 $436.61 $551.28 $441.02 $358.33 $551.28 $551.28 $319.87 $551.28 $330.77 $551.28 $551.28 $551.28 N/A N/A 137683 ERX HCPCS 25000001 00121-4766-05 CALCIUM CARBONATE ANTACID 1250 MG/5ML PO SUSP BOTH IP/OP $7.00 $5.00 $1.18 $6.65 $6.65 $6.65 $6.65 $6.65 $6.65 $6.65 $1.18 $6.65 $6.65 $4.94 $4.94 $5.13 $3.46 $1.39 $6.65 $2.66 $6.65 $6.65 $6.65 $6.65 $6.65 $5.25 $6.65 $6.65 $6.65 $3.33 $3.33 $5.27 $6.65 $5.32 $4.32 $6.65 $6.65 $4.06 $6.65 $3.99 $6.65 $6.65 $6.65 N/A N/A 137687 ERX HCPCS 25000001 00023-4554-30 CARBOXYMETHYLCELLULOSE SOD PF 1 % OP GEL BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 137688 ERX HCPCS J0401 59148-0045-80 ARIPIPRAZOLE ER 300 MG IM PRSY BOTH IP/OP "$5,702.50" "$4,220.00" "$1,188.48" "$5,702.21" "$2,565.99" "$2,565.99" "$2,565.99" "$2,565.99" "$1,797.00" "$1,797.00" "$1,797.00" "$1,188.48" "$1,797.00" "$1,868.88" "$1,868.88" "$1,940.76" "$1,797.00" "$2,111.19" "$1,797.00" "$1,925.10" "$2,811.19" "$1,797.00" "$5,702.21" "$1,797.00" "$1,886.85" "$4,276.88" "$1,797.00" "$1,797.00" "$1,797.00" "$2,851.11" "$2,851.11" "$4,516.15" "$1,797.00" "$4,561.77" "$2,565.99" "$2,010.48" "$1,797.00" "$3,307.45" "$1,886.85" "$2,605.65" "$1,797.00" "$2,010.48" "$1,797.00" N/A N/A 137697 ERX HCPCS J0171 54288-0103-10 EPINEPHRINE PF 1 MG/ML IJ SOLN BOTH IP/OP $23.00 $17.00 $2.16 $22.68 $10.21 $10.21 $10.21 $10.21 $22.68 $22.68 $22.68 $4.73 $22.68 $2.25 $2.25 $2.33 $2.16 $2.54 $22.68 $22.68 $13.42 $22.68 $22.68 $22.68 $22.68 $17.25 $22.68 $22.68 $22.68 $11.34 $11.34 $17.96 $22.68 $18.14 $10.21 $2.42 $22.68 $13.34 $22.68 $22.68 $22.68 $2.42 $22.68 N/A N/A 137726 ERX HCPCS J3490 70842-0120-06 MEROPENEM-VABORBACTAM 2 (1-1) G IV SOLR BOTH IP/OP $783.00 $579.00 $155.36 $782.79 $352.26 $352.26 $352.26 $352.26 $782.79 $782.79 $782.79 $163.15 $782.79 $782.79 $782.79 $782.79 $782.79 $163.14 $782.79 $782.79 $463.02 $782.79 $782.79 $782.79 $782.79 $587.25 $782.79 $782.79 $782.79 $391.40 $391.40 $619.97 $782.79 $626.23 $352.26 $155.36 $782.79 $454.14 $782.79 $782.79 $782.79 $163.13 $782.79 N/A N/A 137728 ERX HCPCS J9203 00008-4510-01 GEMTUZUMAB OZOGAMICIN 4.5 MG IV SOLR BOTH IP/OP "$26,332.50" "$19,486.00" "$9,359.55" "$26,332.34" "$26,332.34" "$26,332.34" "$26,332.34" "$26,332.34" "$26,332.34" "$26,332.34" "$9,359.55" "$26,332.34" "$26,332.34" "$9,879.95" "$9,879.95" "$10,259.95" "$9,499.95" "$11,160.93" "$26,332.34" "$10,532.94" "$26,332.34" "$26,332.34" "$26,332.34" "$26,332.34" "$26,332.34" "$19,749.38" "$26,332.34" "$26,332.34" "$26,332.34" "$13,166.17" "$13,166.17" "$20,855.21" "$26,332.34" "$21,065.87" "$11,849.55" "$26,332.34" "$26,332.34" "$15,272.85" "$26,332.34" "$15,799.40" "$26,332.34" "$26,332.34" "$26,332.34" N/A N/A 137829 ERX HCPCS J0171 42023-0159-25 EPINEPHRINE (ANAPHYLAXIS) 1 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.72 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $0.75 $0.75 $0.78 $0.72 $0.85 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.81 $22.00 $12.76 $22.00 $22.00 $22.00 $0.81 $22.00 N/A N/A 137999 ERX HCPCS J3370 66288-7100-01 VANCOMYCIN HCL 100 G IV SOLR BOTH IP/OP "$1,602.00" "$1,185.00" $556.00 "$1,602.00" $720.90 $720.90 $720.90 $720.90 "$1,602.00" "$1,602.00" "$1,602.00" $723.80 "$1,602.00" $578.24 $578.24 $600.48 $556.00 $653.21 "$1,602.00" "$1,602.00" $947.58 "$1,602.00" "$1,602.00" "$1,602.00" "$1,602.00" "$1,201.50" "$1,602.00" "$1,602.00" "$1,602.00" $801.00 $801.00 "$1,268.78" "$1,602.00" "$1,281.60" $720.90 $622.05 "$1,602.00" $929.16 "$1,602.00" "$1,602.00" "$1,602.00" $622.05 "$1,602.00" N/A N/A 138034 ERX HCPCS 25000001 00002-4483-54 ABEMACICLIB 50 MG PO TABS BOTH IP/OP $941.00 $696.00 $167.42 $940.54 $940.54 $940.54 $940.54 $940.54 $940.54 $940.54 $167.42 $940.54 $940.54 $698.07 $698.07 $724.97 $490.02 $196.02 $940.54 $376.22 $940.54 $940.54 $940.54 $940.54 $940.54 $705.75 $940.54 $940.54 $940.54 $470.27 $470.27 $744.91 $940.54 $752.43 $611.35 $940.54 $940.54 $545.78 $940.54 $564.32 $940.54 $940.54 $940.54 N/A N/A 138035 ERX HCPCS 25000001 00002-4815-54 ABEMACICLIB 100 MG PO TABS BOTH IP/OP $941.00 $696.00 $167.42 $940.54 $940.54 $940.54 $940.54 $940.54 $940.54 $940.54 $167.42 $940.54 $940.54 $698.07 $698.07 $724.97 $490.02 $196.02 $940.54 $376.22 $940.54 $940.54 $940.54 $940.54 $940.54 $705.75 $940.54 $940.54 $940.54 $470.27 $470.27 $744.91 $940.54 $752.43 $611.35 $940.54 $940.54 $545.78 $940.54 $564.32 $940.54 $940.54 $940.54 N/A N/A 138036 ERX HCPCS 25000001 00002-5337-54 ABEMACICLIB 150 MG PO TABS BOTH IP/OP $941.00 $696.00 $167.42 $940.54 $940.54 $940.54 $940.54 $940.54 $940.54 $940.54 $167.42 $940.54 $940.54 $698.07 $698.07 $724.97 $490.02 $196.02 $940.54 $376.22 $940.54 $940.54 $940.54 $940.54 $940.54 $705.75 $940.54 $940.54 $940.54 $470.27 $470.27 $744.91 $940.54 $752.43 $611.35 $940.54 $940.54 $545.78 $940.54 $564.32 $940.54 $940.54 $940.54 N/A N/A 138037 ERX HCPCS 25000001 00002-6216-54 ABEMACICLIB 200 MG PO TABS BOTH IP/OP $941.00 $696.00 $167.42 $940.54 $940.54 $940.54 $940.54 $940.54 $940.54 $940.54 $167.42 $940.54 $940.54 $698.07 $698.07 $724.97 $490.02 $196.02 $940.54 $376.22 $940.54 $940.54 $940.54 $940.54 $940.54 $705.75 $940.54 $940.54 $940.54 $470.27 $470.27 $744.91 $940.54 $752.43 $611.35 $940.54 $940.54 $545.78 $940.54 $564.32 $940.54 $940.54 $940.54 N/A N/A 138138 ERX HCPCS J0171 42023-0168-01 EPINEPHRINE 30 MG/30ML IJ SOLN BOTH IP/OP $22.00 $16.00 $2.16 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $2.25 $2.25 $2.33 $2.16 $2.54 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $2.42 $22.00 $12.76 $22.00 $22.00 $22.00 $2.42 $22.00 N/A N/A 138150 ERX HCPCS 63700001 24208-0504-02 LATANOPROSTENE BUNOD 0.024 % OP SOLN BOTH IP/OP $25.00 $19.00 $5.21 $24.98 $24.98 $24.98 $24.98 $24.98 $24.98 $24.98 $24.98 $24.98 $24.98 $24.98 $24.98 $24.98 $24.98 $5.21 $24.98 $9.99 $24.98 $24.98 $24.98 $24.98 $24.98 $18.75 $24.98 $24.98 $24.98 $12.49 $12.49 $19.78 $24.98 $19.98 $16.24 $24.98 $24.98 $14.50 $24.98 $14.99 $24.98 $24.98 $24.98 N/A N/A 138155 ERX HCPCS J9041 10019-0991-01 BORTEZOMIB 3.5 MG (GENERIC) IV SOLR BOTH IP/OP $271.50 $201.00 $121.97 "$1,753.89" $121.97 $121.97 $121.97 $121.97 "$1,567.79" "$1,567.79" "$1,567.79" "$1,491.60" "$1,567.79" "$1,630.36" "$1,630.36" "$1,693.06" "$1,567.65" $271.05 "$1,567.79" $217.53 $160.33 "$1,567.79" $271.05 "$1,567.79" "$1,646.18" $203.63 "$1,567.79" "$1,567.79" "$1,567.79" $135.53 $135.53 $214.67 "$1,567.79" $216.84 $121.97 $271.05 "$1,567.79" $157.47 "$1,646.18" $271.05 "$1,567.79" "$1,753.89" "$1,567.79" N/A N/A 138195 ERX HCPCS J7170 50242-0921-01 EMICIZUMAB-KXWH 60 MG/0.4ML SC SOLN BOTH IP/OP "$18,189.50" "$13,460.00" "$3,790.86" "$18,189.34" "$18,189.34" "$18,189.34" "$18,189.34" "$18,189.34" "$18,189.34" "$18,189.34" "$5,865.60" "$18,189.34" "$18,189.34" "$6,084.00" "$6,084.00" "$6,318.00" "$5,850.00" "$3,790.86" "$18,189.34" "$7,275.74" "$18,189.34" "$18,189.34" "$18,189.34" "$18,189.34" "$18,189.34" "$13,642.13" "$18,189.34" "$18,189.34" "$18,189.34" "$9,094.67" "$9,094.67" "$14,405.96" "$18,189.34" "$14,551.47" "$8,185.20" "$18,189.34" "$18,189.34" "$10,549.91" "$18,189.34" "$10,913.60" "$18,189.34" "$18,189.34" "$18,189.34" N/A N/A 138537 ERX HCPCS J3490 68547-0501-02 ANGIOTENSIN II ACETATE 2.5 MG/ML IV SOLN BOTH IP/OP "$4,194.00" "$3,104.00" $832.40 "$4,194.00" "$1,887.30" "$1,887.30" "$1,887.30" "$1,887.30" "$4,194.00" "$4,194.00" "$4,194.00" $874.13 "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" $874.08 "$4,194.00" "$4,194.00" "$2,067.64" "$4,194.00" "$4,194.00" "$4,194.00" "$4,194.00" "$3,145.50" "$4,194.00" "$4,194.00" "$4,194.00" "$2,097.00" "$2,097.00" "$3,321.65" "$4,194.00" "$3,355.20" "$1,887.30" $832.40 "$4,194.00" "$2,432.52" "$4,194.00" "$4,194.00" "$4,194.00" $874.03 "$4,194.00" N/A N/A 138555 ERX HCPCS J9299 00003-3734-13 NIVOLUMAB 240 MG/24ML IV SOLN BOTH IP/OP "$20,115.50" "$14,885.00" "$4,192.53" "$20,115.27" "$9,051.87" "$9,051.87" "$9,051.87" "$9,051.87" "$7,018.80" "$7,018.80" "$7,018.80" "$4,192.53" "$7,018.80" "$7,300.80" "$7,300.80" "$7,581.60" "$7,020.00" "$8,247.38" "$7,018.80" "$7,178.64" "$9,916.83" "$7,018.80" "$20,115.27" "$7,018.80" "$7,369.74" "$15,086.63" "$7,018.80" "$7,018.80" "$7,018.80" "$10,057.64" "$10,057.64" "$15,931.29" "$7,018.80" "$16,092.22" "$9,051.87" "$7,712.84" "$7,018.80" "$11,666.99" "$7,369.74" "$10,177.26" "$7,018.80" "$7,853.98" "$7,018.80" N/A N/A 138899 ERX HCPCS J8499 61958-2501-01 BIKTARVY:BICTEGRAVIR-EMTRICITABINE-TENOFOVIR ALAFENAMIDE 50-200-25 PO TAB BOTH IP/OP $527.00 $390.00 $104.55 $526.79 $286.05 $286.05 $286.05 $286.05 $526.79 $526.79 $526.79 $109.80 $526.79 $526.79 $526.79 $526.79 $526.79 $109.79 $526.79 $210.72 $311.60 $526.79 $526.79 $526.79 $526.79 $395.25 $526.79 $526.79 $526.79 $263.40 $263.40 $417.22 $526.79 $421.43 $342.41 $104.55 $526.79 $305.66 $526.79 $316.07 $526.79 $109.78 $526.79 N/A N/A 138939 ERX HCPCS 25000001 59676-0600-12 APALUTAMIDE 60 MG PO TABS BOTH IP/OP "$1,517.00" "$1,123.00" $270.00 "$1,516.84" "$1,516.84" "$1,516.84" "$1,516.84" "$1,516.84" "$1,516.84" "$1,516.84" $270.00 "$1,516.84" "$1,516.84" "$1,125.80" "$1,125.80" "$1,169.18" $790.27 $316.13 "$1,516.84" $606.74 "$1,516.84" "$1,516.84" "$1,516.84" "$1,516.84" "$1,516.84" "$1,137.75" "$1,516.84" "$1,516.84" "$1,516.84" $758.42 $758.42 "$1,201.34" "$1,516.84" "$1,213.47" $985.95 "$1,516.84" "$1,516.84" $879.86 "$1,516.84" $910.10 "$1,516.84" "$1,516.84" "$1,516.84" N/A N/A 139004 ERX HCPCS 63700001 57962-0070-28 IBRUTINIB 70 MG PO CAPS BOTH IP/OP "$6,344.50" "$4,695.00" "$1,322.22" "$6,344.27" "$6,344.27" "$6,344.27" "$6,344.27" "$6,344.27" "$6,344.27" "$6,344.27" "$6,344.27" "$6,344.27" "$6,344.27" "$6,344.27" "$6,344.27" "$6,344.27" "$6,344.27" "$1,322.22" "$6,344.27" "$2,537.71" "$6,344.27" "$6,344.27" "$6,344.27" "$6,344.27" "$6,344.27" "$4,758.38" "$6,344.27" "$6,344.27" "$6,344.27" "$3,172.14" "$3,172.14" "$5,024.66" "$6,344.27" "$5,075.42" "$4,123.78" "$6,344.27" "$6,344.27" "$3,679.81" "$6,344.27" "$3,806.56" "$6,344.27" "$6,344.27" "$6,344.27" N/A N/A 139005 ERX HCPCS J8999 57962-0014-28 IBRUTINIB 140 MG PO TABS BOTH IP/OP "$3,172.50" "$2,348.00" $661.11 "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" $661.11 "$3,172.14" "$1,268.86" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$2,379.38" "$3,172.14" "$3,172.14" "$3,172.14" "$1,586.07" "$1,586.07" "$2,512.33" "$3,172.14" "$2,537.71" "$2,061.89" "$3,172.14" "$3,172.14" "$1,840.05" "$3,172.14" "$1,903.28" "$3,172.14" "$3,172.14" "$3,172.14" N/A N/A 139006 ERX HCPCS 63700001 57962-0280-28 IBRUTINIB 280 MG PO TABS BOTH IP/OP "$3,172.50" "$2,348.00" $661.11 "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" $661.11 "$3,172.14" "$1,268.86" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$3,172.14" "$2,379.38" "$3,172.14" "$3,172.14" "$3,172.14" "$1,586.07" "$1,586.07" "$2,512.33" "$3,172.14" "$2,537.71" "$2,061.89" "$3,172.14" "$3,172.14" "$1,840.05" "$3,172.14" "$1,903.28" "$3,172.14" "$3,172.14" "$3,172.14" N/A N/A 139007 ERX HCPCS 63700001 57962-0420-28 IBRUTINIB 420 MG PO TABS BOTH IP/OP "$1,818.00" "$1,345.00" $378.79 "$1,817.51" "$1,817.51" "$1,817.51" "$1,817.51" "$1,817.51" "$1,817.51" "$1,817.51" "$1,817.51" "$1,817.51" "$1,817.51" "$1,817.51" "$1,817.51" "$1,817.51" "$1,817.51" $378.79 "$1,817.51" $727.00 "$1,817.51" "$1,817.51" "$1,817.51" "$1,817.51" "$1,817.51" "$1,363.50" "$1,817.51" "$1,817.51" "$1,817.51" $908.76 $908.76 "$1,439.47" "$1,817.51" "$1,454.01" "$1,181.38" "$1,817.51" "$1,817.51" "$1,054.44" "$1,817.51" "$1,090.51" "$1,817.51" "$1,817.51" "$1,817.51" N/A N/A 139272 ERX HCPCS J0690 00338-3503-41 CEFAZOLIN 1G IN 50ML DEXTROSE (ISO-OSMOTIC) PREMIXED SOLUTION BOTH IP/OP $27.50 $20.00 $1.39 $27.22 $12.25 $12.25 $12.25 $12.25 $27.22 $27.22 $27.22 $1.39 $27.22 $1.60 $1.60 $1.66 $1.54 $1.81 $27.22 $27.22 $16.10 $27.22 $27.22 $27.22 $27.22 $20.63 $27.22 $27.22 $27.22 $13.61 $13.61 $21.56 $27.22 $21.78 $12.25 $1.72 $27.22 $15.95 $27.22 $16.33 $27.22 $1.72 $27.22 N/A N/A 139273 ERX HCPCS 25000001 00781-3126-46 NAFCILLIN SODIUM 10 G IV SOLR BOTH IP/OP $482.00 $357.00 $85.71 $481.54 $481.54 $481.54 $481.54 $481.54 $481.54 $481.54 $85.71 $481.54 $481.54 $357.40 $357.40 $371.17 $250.88 $100.36 $481.54 $192.62 $481.54 $481.54 $481.54 $481.54 $481.54 $361.50 $481.54 $481.54 $481.54 $240.77 $240.77 $381.38 $481.54 $385.23 $313.00 $481.54 $481.54 $279.56 $481.54 $288.92 $481.54 $481.54 $481.54 N/A N/A 139276 ERX HCPCS 25000001 00065-0416-63 DEXTRAN 70-HYPROMELLOSE (PF) 0.1-0.3 % OP SOLN BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 139283 ERX HCPCS 25000001 00023-0506-01 POLYVINYL ALCOHOL-POVIDONE PF 1.4-0.6 % OP SOLN BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 139285 ERX HCPCS 25000001 71740-0112-30 POTASSIUM IODIDE (EXPECTORANT) 1 GM/ML PO SOLN BOTH IP/OP "$1,388.00" "$1,027.00" $247.02 "$1,387.74" "$1,387.74" "$1,387.74" "$1,387.74" "$1,387.74" "$1,387.74" "$1,387.74" $247.02 "$1,387.74" "$1,387.74" "$1,029.98" "$1,029.98" "$1,069.67" $723.01 $289.22 "$1,387.74" $555.10 "$1,387.74" "$1,387.74" "$1,387.74" "$1,387.74" "$1,387.74" "$1,041.00" "$1,387.74" "$1,387.74" "$1,387.74" $693.87 $693.87 "$1,099.09" "$1,387.74" "$1,110.19" $902.03 "$1,387.74" "$1,387.74" $805.04 "$1,387.74" $832.64 "$1,387.74" "$1,387.74" "$1,387.74" N/A N/A 139286 ERX HCPCS J0583 70860-0402-10 BIVALIRUDIN TRIFLUOROACETATE 250 MG IV SOLR BOTH IP/OP $604.00 $447.00 $72.50 $603.78 $603.78 $603.78 $603.78 $603.78 $603.78 $603.78 $72.50 $603.78 $603.78 $109.20 $109.20 $113.40 $105.00 $125.83 $603.78 $241.51 $603.78 $603.78 $603.78 $603.78 $603.78 $453.00 $603.78 $603.78 $603.78 $301.89 $301.89 $478.19 $603.78 $483.02 $271.70 $603.78 $603.78 $350.32 $603.78 $362.27 $603.78 $603.78 $603.78 N/A N/A 139292 ERX HCPCS J0770 39822-0615-01 COLISTIMETHATE SODIUM (CBA) 150 MG IJ SOLR BOTH IP/OP $76.00 $56.00 $14.14 $75.60 $75.60 $75.60 $75.60 $75.60 $75.60 $75.60 $15.78 $75.60 $75.60 $14.71 $14.71 $15.27 $14.14 $16.61 $75.60 $30.24 $75.60 $75.60 $75.60 $75.60 $75.60 $57.00 $75.60 $75.60 $75.60 $37.80 $37.80 $59.88 $75.60 $60.48 $34.02 $75.60 $75.60 $44.08 $75.60 $45.36 $75.60 $75.60 $75.60 N/A N/A 139365 ERX HCPCS J1746 62064-0122-02 IBALIZUMAB-UIYK 200 MG/1.33ML IV SOLN BOTH IP/OP "$4,002.50" "$2,962.00" "$1,325.00" "$4,002.48" "$4,002.48" "$4,002.48" "$4,002.48" "$4,002.48" "$4,002.48" "$4,002.48" "$1,327.80" "$4,002.48" "$4,002.48" "$1,378.00" "$1,378.00" "$1,431.00" "$1,325.00" "$1,556.66" "$4,002.48" "$1,600.99" "$4,002.48" "$4,002.48" "$4,002.48" "$4,002.48" "$4,002.48" "$3,001.88" "$4,002.48" "$4,002.48" "$4,002.48" "$2,001.24" "$2,001.24" "$3,169.96" "$4,002.48" "$3,201.98" "$1,801.12" "$4,002.48" "$4,002.48" "$2,321.45" "$4,002.48" "$2,401.49" "$4,002.48" "$4,002.48" "$4,002.48" N/A N/A 139459 ERX HCPCS 63700001 00078-0951-66 NILOTINIB HCL 50 MG PO CAPS BOTH IP/OP "$1,593.00" "$1,179.00" $331.91 "$1,592.59" "$1,592.59" "$1,592.59" "$1,592.59" "$1,592.59" "$1,592.59" "$1,592.59" "$1,592.59" "$1,592.59" "$1,592.59" "$1,592.59" "$1,592.59" "$1,592.59" "$1,592.59" $331.91 "$1,592.59" $637.04 "$1,592.59" "$1,592.59" "$1,592.59" "$1,592.59" "$1,592.59" "$1,194.75" "$1,592.59" "$1,592.59" "$1,592.59" $796.30 $796.30 "$1,261.33" "$1,592.59" "$1,274.07" "$1,035.18" "$1,592.59" "$1,592.59" $923.94 "$1,592.59" $955.55 "$1,592.59" "$1,592.59" "$1,592.59" N/A N/A 139649 ERX HCPCS 25000001 62327-0222-02 TALC 2 G PL POWD BOTH IP/OP $494.50 $366.00 $88.02 $494.48 $494.48 $494.48 $494.48 $494.48 $494.48 $494.48 $88.02 $494.48 $494.48 $367.00 $367.00 $381.15 $257.62 $103.06 $494.48 $197.79 $494.48 $494.48 $494.48 $494.48 $494.48 $370.88 $494.48 $494.48 $494.48 $247.24 $247.24 $391.63 $494.48 $395.58 $321.41 $494.48 $494.48 $286.81 $494.48 $296.69 $494.48 $494.48 $494.48 N/A N/A 139651 ERX HCPCS 25000001 62327-0333-43 TALC 3 G PL POWD BOTH IP/OP $635.50 $470.00 $113.03 $635.01 $635.01 $635.01 $635.01 $635.01 $635.01 $635.01 $113.03 $635.01 $635.01 $471.30 $471.30 $489.47 $330.84 $132.34 $635.01 $254.00 $635.01 $635.01 $635.01 $635.01 $635.01 $476.63 $635.01 $635.01 $635.01 $317.51 $317.51 $502.93 $635.01 $508.01 $412.76 $635.01 $635.01 $368.59 $635.01 $381.01 $635.01 $635.01 $635.01 N/A N/A 139692 ERX HCPCS 90375 13533-0318-05 RABIES IMMUNE GLOBULIN 1500 UNIT/5ML IJ SOLN BOTH IP/OP "$9,513.50" "$7,040.00" $267.30 "$9,513.30" "$9,513.30" "$9,513.30" "$9,513.30" "$9,513.30" "$9,513.30" "$9,513.30" $267.30 "$9,513.30" "$9,513.30" $321.02 $321.02 $333.36 $308.67 $362.64 "$9,513.30" "$3,805.32" "$9,513.30" "$9,513.30" "$9,513.30" "$9,513.30" "$9,513.30" "$7,135.13" "$9,513.30" "$9,513.30" "$9,513.30" "$4,756.65" "$4,756.65" "$7,534.53" "$9,513.30" "$7,610.64" "$4,280.99" "$9,513.30" "$9,513.30" "$5,517.83" "$9,513.30" "$5,707.98" "$9,513.30" "$9,513.30" "$9,513.30" N/A N/A 139937 ERX HCPCS 63700001 00074-3399-30 RITONAVIR 100 MG PO PACK BOTH IP/OP $44.50 $33.00 $9.26 $44.44 $44.44 $44.44 $44.44 $44.44 $44.44 $44.44 $44.44 $44.44 $44.44 $44.44 $44.44 $44.44 $44.44 $9.26 $44.44 $17.78 $44.44 $44.44 $44.44 $44.44 $44.44 $33.38 $44.44 $44.44 $44.44 $22.22 $22.22 $35.20 $44.44 $35.55 $28.89 $44.44 $44.44 $25.81 $44.44 $26.66 $44.44 $44.44 $44.44 N/A N/A 139948 ERX HCPCS 25000001 64950-0362-04 COCAINE HCL 40 MG/ML NA SOLN BOTH IP/OP $888.00 $657.00 $158.04 $887.88 $887.88 $887.88 $887.88 $887.88 $887.88 $887.88 $158.04 $887.88 $887.88 $658.98 $658.98 $684.38 $462.59 $185.04 $887.88 $355.15 $887.88 $887.88 $887.88 $887.88 $887.88 $666.00 $887.88 $887.88 $887.88 $443.94 $443.94 $703.20 $887.88 $710.30 $577.12 $887.88 $887.88 $515.04 $887.88 $532.73 $887.88 $887.88 $887.88 N/A N/A 139956 ERX HCPCS J0171 69194-0975-10 EPINEPHRINE HCL-NACL 8-0.9 MG/250ML-% IV SOLN BOTH IP/OP $358.50 $265.00 $57.60 $358.28 $161.23 $161.23 $161.23 $161.23 $358.28 $358.28 $358.28 $74.67 $358.28 $59.90 $59.90 $62.21 $57.60 $67.67 $358.28 $358.28 $211.92 $358.28 $358.28 $358.28 $358.28 $268.88 $358.28 $358.28 $358.28 $179.14 $179.14 $283.76 $358.28 $286.62 $161.23 $64.44 $358.28 $207.93 $358.28 $358.28 $358.28 $64.44 $358.28 N/A N/A 140052 ERX HCPCS Q5106 00069-1305-01 EPOETIN ALFA-EPBX 2000 UNIT/ML IJ SOLN BOTH IP/OP $105.50 $78.00 $16.25 $105.36 $57.21 $57.21 $57.21 $57.21 $16.25 $16.25 $16.25 $21.96 $16.25 $105.36 $105.36 $105.36 $105.36 $21.96 $26.00 $105.36 $62.32 $16.25 $105.36 $16.25 $17.06 $79.13 $16.25 $16.25 $16.25 $52.68 $52.68 $83.45 $16.25 $84.29 $68.48 $20.91 $105.36 $61.19 $17.06 $23.57 $16.25 $18.19 $16.25 N/A N/A 140054 ERX HCPCS Q5106 00069-1307-01 EPOETIN ALFA-EPBX 4000 UNIT/ML IJ SOLN BOTH IP/OP $190.00 $141.00 $32.50 $189.54 $102.92 $102.92 $102.92 $102.92 $32.50 $32.50 $32.50 $39.50 $32.50 $189.54 $189.54 $189.54 $189.54 $39.50 $52.01 $189.54 $112.11 $32.50 $189.54 $32.50 $34.13 $142.50 $32.50 $32.50 $32.50 $94.77 $94.77 $150.12 $32.50 $151.63 $123.20 $37.62 $189.54 $110.20 $34.13 $47.13 $32.50 $36.38 $32.50 N/A N/A 140055 ERX HCPCS Q5106 00069-1308-01 EPOETIN ALFA-EPBX 10000 UNIT/ML IJ SOLN BOTH IP/OP $459.50 $340.00 $81.26 $459.29 $249.39 $249.39 $249.39 $249.39 $81.26 $81.26 $81.26 $95.73 $81.26 $459.29 $459.29 $459.29 $459.29 $95.72 $130.02 $459.29 $271.67 $81.26 $459.29 $81.26 $85.32 $344.63 $81.26 $81.26 $81.26 $229.65 $229.65 $363.76 $81.26 $367.43 $298.54 $91.16 $459.29 $266.51 $85.32 $117.83 $81.26 $90.96 $81.26 N/A N/A 140089 ERX HCPCS J9150 00703-5233-13 DAUNORUBICIN HCL 20 MG/4ML IV SOLN BOTH IP/OP $559.00 $414.00 $80.72 $558.58 $558.58 $558.58 $558.58 $558.58 $558.58 $558.58 $80.72 $558.58 $558.58 $85.78 $85.78 $89.08 $82.48 $96.90 $558.58 $223.43 $558.58 $558.58 $558.58 $558.58 $558.58 $419.25 $558.58 $558.58 $558.58 $279.29 $279.29 $442.40 $558.58 $446.86 $251.36 $558.58 $558.58 $324.22 $558.58 $335.15 $558.58 $558.58 $558.58 N/A N/A 140312 ERX HCPCS J0878 25021-0179-16 DAPTOMYCIN 350 MG IV SOLR BOTH IP/OP $279.50 $207.00 $17.50 $279.24 $279.24 $279.24 $279.24 $279.24 $279.24 $279.24 $21.00 $279.24 $279.24 $18.20 $18.20 $18.90 $17.50 $20.56 $279.24 $111.70 $279.24 $279.24 $279.24 $279.24 $279.24 $209.63 $279.24 $279.24 $279.24 $139.62 $139.62 $221.16 $279.24 $223.39 $125.66 $279.24 $279.24 $162.11 $279.24 $167.54 $279.24 $279.24 $279.24 N/A N/A 140319 ERX HCPCS 25000001 59676-0800-30 DARUN-COBIC-EMTRICIT-TENOFAF 800-150-200-10 MG PO TABS BOTH IP/OP $637.50 $472.00 $113.48 $637.50 $637.50 $637.50 $637.50 $637.50 $637.50 $637.50 $113.48 $637.50 $637.50 $473.15 $473.15 $491.39 $332.14 $132.86 $637.50 $255.00 $637.50 $637.50 $637.50 $637.50 $637.50 $478.13 $637.50 $637.50 $637.50 $318.75 $318.75 $504.90 $637.50 $510.00 $414.38 $637.50 $637.50 $369.75 $637.50 $382.50 $637.50 $637.50 $637.50 N/A N/A 140323 ERX HCPCS 63700001 00002-4182-30 BARICITINIB 2 MG PO TABS BOTH IP/OP $633.50 $469.00 $132.02 $633.48 $633.48 $633.48 $633.48 $633.48 $633.48 $633.48 $633.48 $633.48 $633.48 $633.48 $633.48 $633.48 $633.48 $132.02 $633.48 $253.39 $633.48 $633.48 $633.48 $633.48 $633.48 $475.13 $633.48 $633.48 $633.48 $316.74 $316.74 $501.72 $633.48 $506.78 $411.76 $633.48 $633.48 $367.43 $633.48 $380.09 $633.48 $633.48 $633.48 N/A N/A 140359 ERX HCPCS Q5108 67457-0833-06 PEGFILGRASTIM-JMDB 6 MG/0.6ML SC SOSY BOTH IP/OP "$11,673.50" "$8,638.00" "$1,590.18" "$11,673.30" "$5,252.99" "$5,252.99" "$5,252.99" "$5,252.99" "$2,449.66" "$2,449.66" "$2,449.66" "$2,433.01" "$2,449.66" "$2,547.67" "$2,547.67" "$2,645.65" "$2,449.68" "$2,877.98" "$2,449.66" "$1,590.18" "$5,754.94" "$2,449.66" "$11,673.30" "$2,449.66" "$2,572.14" "$8,755.13" "$2,449.66" "$2,449.66" "$2,449.66" "$5,836.65" "$5,836.65" "$9,245.25" "$2,449.66" "$9,338.64" "$5,252.99" "$2,740.70" "$2,449.66" "$6,770.63" "$2,572.14" "$3,552.00" "$2,449.66" "$2,740.70" "$2,449.66" N/A N/A 140467 ERX HCPCS 63700001 70255-0010-02 BINIMETINIB 15 MG PO TABS BOTH IP/OP $338.00 $250.00 $70.42 $337.91 $337.91 $337.91 $337.91 $337.91 $337.91 $337.91 $337.91 $337.91 $337.91 $337.91 $337.91 $337.91 $337.91 $70.42 $337.91 $135.16 $337.91 $337.91 $337.91 $337.91 $337.91 $253.50 $337.91 $337.91 $337.91 $168.96 $168.96 $267.62 $337.91 $270.33 $219.64 $337.91 $337.91 $196.04 $337.91 $202.75 $337.91 $337.91 $337.91 N/A N/A 140469 ERX HCPCS 63700001 70255-0025-01 ENCORAFENIB 75 MG PO CAPS BOTH IP/OP $344.50 $255.00 $71.78 $344.41 $344.41 $344.41 $344.41 $344.41 $344.41 $344.41 $344.41 $344.41 $344.41 $344.41 $344.41 $344.41 $344.41 $71.78 $344.41 $137.76 $344.41 $344.41 $344.41 $344.41 $344.41 $258.38 $344.41 $344.41 $344.41 $172.21 $172.21 $272.77 $344.41 $275.53 $223.87 $344.41 $344.41 $199.81 $344.41 $206.65 $344.41 $344.41 $344.41 N/A N/A 140767 ERX HCPCS J9047 76075-0103-01 CARFILZOMIB 10 MG IV SOLR BOTH IP/OP "$1,591.00" "$1,177.00" $331.58 "$1,590.90" $715.91 $715.91 $715.91 $715.91 $411.11 $411.11 $411.11 $331.58 $411.11 $427.54 $427.54 $443.99 $411.10 $482.98 $411.11 $447.64 $941.02 $411.11 "$1,590.90" $411.11 $431.67 "$1,193.25" $411.11 $411.11 $411.11 $795.45 $795.45 "$1,259.99" $411.11 "$1,272.72" $715.91 $459.94 $411.11 $922.78 $431.67 $596.11 $411.11 $459.94 $411.11 N/A N/A 140769 ERX HCPCS J0171 76329-3316-01 EPINEPHRINE 1 MG/10ML IJ SOSY BOTH IP/OP $51.50 $38.00 $7.20 $51.07 $22.98 $22.98 $22.98 $22.98 $51.07 $51.07 $51.07 $10.64 $51.07 $7.49 $7.49 $7.78 $7.20 $8.46 $51.07 $51.07 $30.21 $51.07 $51.07 $51.07 $51.07 $38.63 $51.07 $51.07 $51.07 $25.54 $25.54 $40.45 $51.07 $40.86 $22.98 $8.06 $51.07 $29.87 $51.07 $51.07 $51.07 $8.06 $51.07 N/A N/A 140776 ERX HCPCS 25000001 00310-1105-01 SODIUM ZIRCONIUM CYCLOSILICATE 5 G PO PACK BOTH IP/OP $122.00 $90.00 $21.71 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $21.71 $121.99 $121.99 $90.54 $90.54 $94.03 $63.56 $25.42 $121.99 $48.80 $121.99 $121.99 $121.99 $121.99 $121.99 $91.50 $121.99 $121.99 $121.99 $61.00 $61.00 $96.62 $121.99 $97.59 $79.29 $121.99 $121.99 $70.76 $121.99 $73.19 $121.99 $121.99 $121.99 N/A N/A 140777 ERX HCPCS 25000001 00310-1110-01 SODIUM ZIRCONIUM CYCLOSILICATE 10 G PO PACK BOTH IP/OP $122.00 $90.00 $21.71 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $21.71 $121.99 $121.99 $90.54 $90.54 $94.03 $63.56 $25.42 $121.99 $48.80 $121.99 $121.99 $121.99 $121.99 $121.99 $91.50 $121.99 $121.99 $121.99 $61.00 $61.00 $96.62 $121.99 $97.59 $79.29 $121.99 $121.99 $70.76 $121.99 $73.19 $121.99 $121.99 $121.99 N/A N/A 140796 ERX HCPCS 90739 43528-0003-05 HEPATITIS B VAC RECOMB ADJ 20 MCG/0.5ML IM SOSY BOTH IP/OP $585.50 $433.00 $83.14 $585.46 $585.46 $585.46 $585.46 $585.46 $152.22 $152.22 $144.21 $585.46 $152.22 $149.98 $149.98 $155.75 $144.21 $169.42 $585.46 $234.18 $585.46 $152.22 $152.22 $152.22 $585.46 $439.13 $152.22 $83.14 $152.22 $292.73 $292.73 $463.68 $152.22 $468.37 $263.46 $585.46 $152.22 $339.59 $585.46 $351.28 $152.22 $585.46 $152.22 N/A N/A 140827 ERX HCPCS 25000001 74312-0026-10 ACIDOPHILUS PROBIOTIC 0.5 MG PO TABS BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 140845 ERX HCPCS J2370 69374-0957-10 PHENYLEPHRINE HCL 1 MG/10ML IV SOSY BOTH IP/OP $27.00 $20.00 $0.96 $27.00 $12.15 $12.15 $12.15 $12.15 $27.00 $27.00 $27.00 $0.96 $27.00 $3.49 $3.49 $3.63 $3.36 $3.95 $27.00 $27.00 $15.97 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $12.15 $3.76 $27.00 $15.66 $27.00 $27.00 $27.00 $3.76 $27.00 N/A N/A 140890 ERX HCPCS J9204 42747-0761-01 MOGAMULIZUMAB-KPKC 20 MG/5ML IV SOLN BOTH IP/OP "$11,993.50" "$8,875.00" "$4,201.00" "$11,993.47" "$11,993.47" "$11,993.47" "$11,993.47" "$11,993.47" "$11,993.47" "$11,993.47" "$4,201.00" "$11,993.47" "$11,993.47" "$4,422.91" "$4,422.91" "$4,593.02" "$4,252.80" "$4,996.36" "$11,993.47" "$4,797.39" "$11,993.47" "$11,993.47" "$11,993.47" "$11,993.47" "$11,993.47" "$8,995.13" "$11,993.47" "$11,993.47" "$11,993.47" "$5,996.74" "$5,996.74" "$9,498.83" "$11,993.47" "$9,594.78" "$5,397.06" "$11,993.47" "$11,993.47" "$6,956.23" "$11,993.47" "$7,196.08" "$11,993.47" "$11,993.47" "$11,993.47" N/A N/A 140942 ERX HCPCS 63700001 62856-0712-05 LENVATINIB (12 MG DAILY DOSE) 3 X 4 MG PO CPPK BOTH IP/OP $888.50 $657.00 $185.11 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $888.21 $185.11 $888.21 $355.28 $888.21 $888.21 $888.21 $888.21 $888.21 $666.38 $888.21 $888.21 $888.21 $444.11 $444.11 $703.46 $888.21 $710.57 $577.34 $888.21 $888.21 $515.33 $888.21 $532.93 $888.21 $888.21 $888.21 N/A N/A 140943 ERX HCPCS 63700001 62856-0704-30 LENVATINIB (4 MG DAILY DOSE) 4 MG PO CPPK BOTH IP/OP "$2,356.00" "$1,743.00" $490.97 "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" $490.97 "$2,355.80" $942.32 "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$2,355.80" "$1,767.00" "$2,355.80" "$2,355.80" "$2,355.80" "$1,177.90" "$1,177.90" "$1,865.79" "$2,355.80" "$1,884.64" "$1,531.27" "$2,355.80" "$2,355.80" "$1,366.48" "$2,355.80" "$1,413.48" "$2,355.80" "$2,355.80" "$2,355.80" N/A N/A 141224 ERX HCPCS 63700001 50458-0577-10 RIVAROXABAN 2.5 MG PO TABS BOTH IP/OP $47.00 $35.00 $9.77 $46.87 $46.87 $46.87 $46.87 $46.87 $46.87 $46.87 $46.87 $46.87 $46.87 $46.87 $46.87 $46.87 $46.87 $9.77 $46.87 $18.75 $46.87 $46.87 $46.87 $46.87 $46.87 $35.25 $46.87 $46.87 $46.87 $23.44 $23.44 $37.12 $46.87 $37.50 $30.47 $46.87 $46.87 $27.26 $46.87 $28.12 $46.87 $46.87 $46.87 N/A N/A 141226 ERX HCPCS J2357 50242-0215-01 OMALIZUMAB 150 MG/ML SC SOSY BOTH IP/OP "$53,776.00" "$39,794.00" "$7,712.84" "$53,775.82" "$24,199.12" "$24,199.12" "$24,199.12" "$24,199.12" "$16,878.15" "$16,878.15" "$16,878.15" "$9,417.94" "$16,878.15" "$17,554.68" "$17,554.68" "$18,229.86" "$16,879.50" "$19,830.73" "$16,878.15" "$17,062.20" "$26,511.48" "$16,878.15" "$53,775.82" "$16,878.15" "$17,722.06" "$40,332.00" "$16,878.15" "$16,878.15" "$16,878.15" "$26,887.91" "$26,887.91" "$42,590.45" "$16,878.15" "$43,020.66" "$24,199.12" "$7,712.84" "$16,878.15" "$31,190.08" "$17,722.06" "$24,473.32" "$16,878.15" "$8,098.48" "$16,878.15" N/A N/A 141227 ERX HCPCS J2357 50242-0214-01 OMALIZUMAB 75 MG/0.5ML SC SOSY BOTH IP/OP "$2,054.50" "$1,520.00" $348.98 "$2,054.09" $924.34 $924.34 $924.34 $924.34 $562.61 $562.61 $562.61 $348.98 $562.61 $585.16 $585.16 $607.66 $562.65 $661.02 $562.61 $568.74 "$1,012.67" $562.61 "$2,054.09" $562.61 $590.74 "$1,540.88" $562.61 $562.61 $562.61 "$1,027.05" "$1,027.05" "$1,626.84" $562.61 "$1,643.27" $924.34 $629.49 $562.61 "$1,191.61" $590.74 $815.78 $562.61 $629.49 $562.61 N/A N/A 141229 ERX HCPCS J0841 66621-0790-02 CROTALIDAE IMMUNE FAB (EQUINE) IV SOLR BOTH IP/OP "$14,763.00" "$10,925.00" "$3,076.75" "$14,762.88" "$14,762.88" "$14,762.88" "$14,762.88" "$14,762.88" "$14,762.88" "$14,762.88" "$4,759.24" "$14,762.88" "$14,762.88" "$4,253.39" "$4,253.39" "$4,416.98" "$4,089.80" "$3,076.75" "$14,762.88" "$5,905.15" "$14,762.88" "$14,762.88" "$14,762.88" "$14,762.88" "$14,762.88" "$11,072.25" "$14,762.88" "$14,762.88" "$14,762.88" "$7,381.44" "$7,381.44" "$11,692.20" "$14,762.88" "$11,810.30" "$6,643.30" "$14,762.88" "$14,762.88" "$8,562.54" "$14,762.88" "$8,857.73" "$14,762.88" "$14,762.88" "$14,762.88" N/A N/A 141259 ERX HCPCS 63700001 00378-0871-99 CLONIDINE 0.1 MG/24HR TD PTWK BOTH IP/OP $132.00 $98.00 $27.47 $131.83 $131.83 $131.83 $131.83 $131.83 $131.83 $131.83 $131.83 $131.83 $131.83 $131.83 $131.83 $131.83 $131.83 $27.47 $131.83 $52.73 $131.83 $131.83 $131.83 $131.83 $131.83 $99.00 $131.83 $131.83 $131.83 $65.92 $65.92 $104.41 $131.83 $105.46 $85.69 $131.83 $131.83 $76.56 $131.83 $79.10 $131.83 $131.83 $131.83 N/A N/A 141260 ERX HCPCS 63700001 00378-0872-99 CLONIDINE 0.2 MG/24HR TD PTWK BOTH IP/OP $200.00 $148.00 $41.61 $199.64 $199.64 $199.64 $199.64 $199.64 $199.64 $199.64 $199.64 $199.64 $199.64 $199.64 $199.64 $199.64 $199.64 $41.61 $199.64 $79.86 $199.64 $199.64 $199.64 $199.64 $199.64 $150.00 $199.64 $199.64 $199.64 $99.82 $99.82 $158.11 $199.64 $159.71 $129.77 $199.64 $199.64 $116.00 $199.64 $119.78 $199.64 $199.64 $199.64 N/A N/A 141261 ERX HCPCS 63700001 00378-0873-99 CLONIDINE 0.3 MG/24HR TD PTWK BOTH IP/OP $277.00 $205.00 $57.72 $276.95 $276.95 $276.95 $276.95 $276.95 $276.95 $276.95 $276.95 $276.95 $276.95 $276.95 $276.95 $276.95 $276.95 $57.72 $276.95 $110.78 $276.95 $276.95 $276.95 $276.95 $276.95 $207.75 $276.95 $276.95 $276.95 $138.48 $138.48 $219.34 $276.95 $221.56 $180.02 $276.95 $276.95 $160.66 $276.95 $166.17 $276.95 $276.95 $276.95 N/A N/A 141262 ERX HCPCS 90710 00006-4171-00 MEASLES-MUMPS-RUBELLA-VARICELL SC SUSR BOTH IP/OP $949.50 $703.00 $160.00 $949.01 $427.05 $427.05 $427.05 $427.05 $949.01 $949.01 $949.01 $197.80 $949.01 $260.02 $260.02 $270.02 $250.02 $197.78 $949.01 $160.00 $561.34 $949.01 $949.01 $949.01 $949.01 $712.13 $949.01 $949.01 $949.01 $474.51 $474.51 $751.62 $949.01 $759.21 $427.05 $188.35 $949.01 $550.71 $949.01 $949.01 $949.01 $197.77 $949.01 N/A N/A 141264 ERX HCPCS J3370 00409-6509-01 VANCOMYCIN HCL 5 G IV SOLR BOTH IP/OP $376.00 $278.00 $27.80 $375.84 $169.13 $169.13 $169.13 $169.13 $375.84 $375.84 $375.84 $36.19 $375.84 $28.91 $28.91 $30.02 $27.80 $32.66 $375.84 $375.84 $222.31 $375.84 $375.84 $375.84 $375.84 $282.00 $375.84 $375.84 $375.84 $187.92 $187.92 $297.67 $375.84 $300.67 $169.13 $31.10 $375.84 $218.08 $375.84 $225.50 $375.84 $31.10 $375.84 N/A N/A 141306 ERX HCPCS 63700001 00006-3069-01 DORAVIRINE 100 MG PO TABS BOTH IP/OP $240.50 $178.00 $50.05 $240.15 $240.15 $240.15 $240.15 $240.15 $240.15 $240.15 $240.15 $240.15 $240.15 $240.15 $240.15 $240.15 $240.15 $50.05 $240.15 $96.06 $240.15 $240.15 $240.15 $240.15 $240.15 $180.38 $240.15 $240.15 $240.15 $120.08 $120.08 $190.20 $240.15 $192.12 $156.10 $240.15 $240.15 $139.49 $240.15 $144.09 $240.15 $240.15 $240.15 N/A N/A 141430 ERX HCPCS J0690 00264-3105-11 CEFAZOLIN SODIUM-DEXTROSE 2-3 GM-%(50ML) IV SOLR BOTH IP/OP $77.00 $57.00 $2.77 $76.52 $34.43 $34.43 $34.43 $34.43 $76.52 $76.52 $76.52 $2.77 $76.52 $3.20 $3.20 $3.33 $3.08 $3.62 $76.52 $76.52 $45.26 $76.52 $76.52 $76.52 $76.52 $57.75 $76.52 $76.52 $76.52 $38.26 $38.26 $60.60 $76.52 $61.22 $34.43 $3.45 $76.52 $44.66 $76.52 $76.52 $76.52 $3.45 $76.52 N/A N/A 141478 ERX HCPCS J9119 61755-0008-01 CEMIPLIMAB-RWLC 350 MG/7ML IV SOLN BOTH IP/OP "$26,869.00" "$19,883.00" "$9,639.00" "$26,868.59" "$26,868.59" "$26,868.59" "$26,868.59" "$26,868.59" "$26,868.59" "$26,868.59" "$9,639.00" "$26,868.59" "$26,868.59" "$10,071.88" "$10,071.88" "$10,459.26" "$9,684.50" "$11,377.75" "$26,868.59" "$10,747.44" "$26,868.59" "$26,868.59" "$26,868.59" "$26,868.59" "$26,868.59" "$20,151.75" "$26,868.59" "$26,868.59" "$26,868.59" "$13,434.30" "$13,434.30" "$21,279.92" "$26,868.59" "$21,494.87" "$12,090.87" "$26,868.59" "$26,868.59" "$15,584.02" "$26,868.59" "$16,121.15" "$26,868.59" "$26,868.59" "$26,868.59" N/A N/A 141480 ERX HCPCS 25000001 71558-0590-28 AMIKACIN SULFATE LIPOSOME 590 MG/8.4ML IN SUSP BOTH IP/OP "$1,653.00" "$1,223.00" $294.16 "$1,652.59" "$1,652.59" "$1,652.59" "$1,652.59" "$1,652.59" "$1,652.59" "$1,652.59" $294.16 "$1,652.59" "$1,652.59" "$1,226.55" "$1,226.55" "$1,273.82" $861.00 $344.42 "$1,652.59" $661.04 "$1,652.59" "$1,652.59" "$1,652.59" "$1,652.59" "$1,652.59" "$1,239.75" "$1,652.59" "$1,652.59" "$1,652.59" $826.30 $826.30 "$1,308.85" "$1,652.59" "$1,322.07" "$1,074.18" "$1,652.59" "$1,652.59" $958.74 "$1,652.59" $991.55 "$1,652.59" "$1,652.59" "$1,652.59" N/A N/A 141582 ERX HCPCS 25000001 00069-0296-30 TALAZOPARIB TOSYLATE 0.25 MG PO CAPS BOTH IP/OP "$2,494.50" "$1,846.00" $443.93 "$2,494.01" "$2,494.01" "$2,494.01" "$2,494.01" "$2,494.01" "$2,494.01" "$2,494.01" $443.93 "$2,494.01" "$2,494.01" "$1,851.05" "$1,851.05" "$1,922.38" "$1,299.38" $519.78 "$2,494.01" $997.60 "$2,494.01" "$2,494.01" "$2,494.01" "$2,494.01" "$2,494.01" "$1,870.88" "$2,494.01" "$2,494.01" "$2,494.01" "$1,247.01" "$1,247.01" "$1,975.26" "$2,494.01" "$1,995.21" "$1,621.11" "$2,494.01" "$2,494.01" "$1,446.81" "$2,494.01" "$1,496.41" "$2,494.01" "$2,494.01" "$2,494.01" N/A N/A 141584 ERX HCPCS 25000001 00069-1195-30 TALAZOPARIB TOSYLATE 1 MG PO CAPS BOTH IP/OP "$1,871.00" "$1,385.00" $332.95 "$1,870.51" "$1,870.51" "$1,870.51" "$1,870.51" "$1,870.51" "$1,870.51" "$1,870.51" $332.95 "$1,870.51" "$1,870.51" "$1,388.29" "$1,388.29" "$1,441.79" $974.54 $389.83 "$1,870.51" $748.20 "$1,870.51" "$1,870.51" "$1,870.51" "$1,870.51" "$1,870.51" "$1,403.25" "$1,870.51" "$1,870.51" "$1,870.51" $935.26 $935.26 "$1,481.44" "$1,870.51" "$1,496.41" "$1,215.83" "$1,870.51" "$1,870.51" "$1,085.18" "$1,870.51" "$1,122.31" "$1,870.51" "$1,870.51" "$1,870.51" N/A N/A 141712 ERX HCPCS 63700001 00069-0227-01 LORLATINIB 25 MG PO TABS BOTH IP/OP $811.50 $601.00 $169.10 $811.40 $811.40 $811.40 $811.40 $811.40 $811.40 $811.40 $811.40 $811.40 $811.40 $811.40 $811.40 $811.40 $811.40 $169.10 $811.40 $324.56 $811.40 $811.40 $811.40 $811.40 $811.40 $608.63 $811.40 $811.40 $811.40 $405.70 $405.70 $642.63 $811.40 $649.12 $527.41 $811.40 $811.40 $470.67 $811.40 $486.84 $811.40 $811.40 $811.40 N/A N/A 141713 ERX HCPCS 63700001 00069-0231-01 LORLATINIB 100 MG PO TABS BOTH IP/OP "$2,152.50" "$1,593.00" $448.52 "$2,152.07" "$2,152.07" "$2,152.07" "$2,152.07" "$2,152.07" "$2,152.07" "$2,152.07" "$2,152.07" "$2,152.07" "$2,152.07" "$2,152.07" "$2,152.07" "$2,152.07" "$2,152.07" $448.52 "$2,152.07" $860.83 "$2,152.07" "$2,152.07" "$2,152.07" "$2,152.07" "$2,152.07" "$1,614.38" "$2,152.07" "$2,152.07" "$2,152.07" "$1,076.04" "$1,076.04" "$1,704.44" "$2,152.07" "$1,721.66" "$1,398.85" "$2,152.07" "$2,152.07" "$1,248.45" "$2,152.07" "$1,291.24" "$2,152.07" "$2,152.07" "$2,152.07" N/A N/A 142181 ERX HCPCS 25000001 71469-0231-01 AMINOLEVULINIC ACID HCL 1.5 G PO SOLR BOTH IP/OP "$7,798.50" "$5,771.00" "$1,388.05" "$7,798.05" "$7,798.05" "$7,798.05" "$7,798.05" "$7,798.05" "$7,798.05" "$7,798.05" "$1,388.05" "$7,798.05" "$7,798.05" "$4,181.12" "$4,181.12" "$6,010.74" "$2,060.15" "$1,625.20" "$7,798.05" "$3,119.22" "$7,798.05" "$7,798.05" "$7,798.05" "$7,798.05" "$7,798.05" "$5,848.88" "$7,798.05" "$7,798.05" "$7,798.05" "$3,899.03" "$3,899.03" "$6,176.06" "$7,798.05" "$6,238.44" "$5,068.73" "$7,798.05" "$7,798.05" "$4,523.13" "$7,798.05" "$4,678.83" "$7,798.05" "$7,798.05" "$7,798.05" N/A N/A 142188 ERX HCPCS 63700001 00173-0889-39 TAFENOQUINE SUCCINATE 150 MG PO TABS BOTH IP/OP $83.00 $61.00 $17.29 $82.95 $82.95 $82.95 $82.95 $82.95 $82.95 $82.95 $82.95 $82.95 $82.95 $82.95 $82.95 $82.95 $82.95 $17.29 $82.95 $33.18 $82.95 $82.95 $82.95 $82.95 $82.95 $62.25 $82.95 $82.95 $82.95 $41.48 $41.48 $65.70 $82.95 $66.36 $53.92 $82.95 $82.95 $48.14 $82.95 $49.77 $82.95 $82.95 $82.95 N/A N/A 142198 ERX HCPCS Q5111 70114-0101-01 PEGFILGRASTIM-CBQV 6 MG/0.6ML SC SOSY BOTH IP/OP "$11,673.50" "$8,638.00" "$1,693.99" "$11,673.30" "$5,252.99" "$5,252.99" "$5,252.99" "$5,252.99" "$2,425.19" "$2,425.19" "$2,425.19" "$2,433.01" "$2,425.19" "$2,522.21" "$2,522.21" "$2,619.22" "$2,425.20" "$2,849.22" "$2,425.19" "$1,693.99" "$5,754.94" "$2,425.19" "$11,673.30" "$2,425.19" "$2,546.45" "$8,755.13" "$2,425.19" "$2,425.19" "$2,425.19" "$5,836.65" "$5,836.65" "$9,245.25" "$2,425.19" "$9,338.64" "$5,252.99" "$2,713.31" "$2,425.19" "$6,770.63" "$2,546.45" "$3,516.52" "$2,425.19" "$2,713.31" "$2,425.19" N/A N/A 142324 ERX HCPCS J3490 00169-2662-11 INSULIN DEGLUDEC 100 UNIT/ML SC SOLN BOTH IP/OP $12.50 $9.00 $2.48 $12.50 $6.79 $6.79 $6.79 $6.79 $12.50 $12.50 $12.50 $2.61 $12.50 $12.50 $12.50 $12.50 $12.50 $2.61 $12.50 $12.50 $7.39 $12.50 $12.50 $12.50 $12.50 $9.38 $12.50 $12.50 $12.50 $6.25 $6.25 $9.90 $12.50 $10.00 $8.13 $2.48 $12.50 $7.25 $12.50 $12.50 $12.50 $2.61 $12.50 N/A N/A 142346 ERX HCPCS 63700001 00078-0972-61 ELTROMBOPAG OLAMINE 12.5 MG PO PACK BOTH IP/OP $811.00 $600.00 $168.93 $810.55 $810.55 $810.55 $810.55 $810.55 $810.55 $810.55 $810.55 $810.55 $810.55 $810.55 $810.55 $810.55 $810.55 $168.93 $810.55 $324.22 $810.55 $810.55 $810.55 $810.55 $810.55 $608.25 $810.55 $810.55 $810.55 $405.28 $405.28 $641.96 $810.55 $648.44 $526.86 $810.55 $810.55 $470.38 $810.55 $486.33 $810.55 $810.55 $810.55 N/A N/A 142406 ERX HCPCS J0613 44567-0620-01 CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN BOTH IP/OP $94.50 $70.00 $16.79 $94.33 $94.33 $94.33 $94.33 $94.33 $94.33 $94.33 $16.79 $94.33 $94.33 $94.33 $94.33 $94.33 $94.33 $19.66 $94.33 $37.73 $94.33 $94.33 $94.33 $94.33 $94.33 $70.88 $94.33 $94.33 $94.33 $47.17 $47.17 $74.71 $94.33 $75.46 $42.45 $94.33 $94.33 $54.81 $94.33 $56.60 $94.33 $94.33 $94.33 N/A N/A 142802 ERX HCPCS C9047 58468-0225-01 CAPLACIZUMAB-YHDP 11 MG IJ KIT BOTH IP/OP "$22,158.50" "$16,397.00" "$4,618.03" "$22,158.30" "$22,158.30" "$22,158.30" "$22,158.30" "$22,158.30" "$22,158.30" "$22,158.30" "$7,007.97" "$22,158.30" "$22,158.30" "$7,592.04" "$7,592.04" "$7,884.04" "$7,300.04" "$4,618.03" "$22,158.30" "$8,863.32" "$22,158.30" "$22,158.30" "$22,158.30" "$22,158.30" "$22,158.30" "$16,618.88" "$22,158.30" "$22,158.30" "$22,158.30" "$11,079.15" "$11,079.15" "$17,549.37" "$22,158.30" "$17,726.64" "$9,971.24" "$22,158.30" "$22,158.30" "$12,851.93" "$22,158.30" "$13,294.98" "$22,158.30" "$22,158.30" "$22,158.30" N/A N/A 142912 ERX HCPCS 25000001 54288-0105-15 ABLYSINOL IA SOLN BOTH IP/OP "$2,669.00" "$1,975.00" $475.02 "$2,668.67" "$2,668.67" "$2,668.67" "$2,668.67" "$2,668.67" "$2,668.67" "$2,668.67" $475.02 "$2,668.67" "$2,668.67" "$1,980.69" "$1,980.69" "$2,057.01" "$1,390.38" $556.18 "$2,668.67" "$1,067.47" "$2,668.67" "$2,668.67" "$2,668.67" "$2,668.67" "$2,668.67" "$2,001.75" "$2,668.67" "$2,668.67" "$2,668.67" "$1,334.34" "$1,334.34" "$2,113.59" "$2,668.67" "$2,134.94" "$1,734.64" "$2,668.67" "$2,668.67" "$1,548.02" "$2,668.67" "$1,601.20" "$2,668.67" "$2,668.67" "$2,668.67" N/A N/A 143099 ERX HCPCS 63700001 00469-1330-50 TACROLIMUS 1 MG PO PACK BOTH IP/OP $40.50 $30.00 $8.39 $40.24 $40.24 $40.24 $40.24 $40.24 $40.24 $40.24 $40.24 $40.24 $40.24 $40.24 $40.24 $40.24 $40.24 $8.39 $40.24 $16.10 $40.24 $40.24 $40.24 $40.24 $40.24 $30.38 $40.24 $40.24 $40.24 $20.12 $20.12 $31.87 $40.24 $32.19 $26.16 $40.24 $40.24 $23.49 $40.24 $24.14 $40.24 $40.24 $40.24 N/A N/A 143112 ERX HCPCS J0780 23155-0294-42 PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN BOTH IP/OP $23.50 $17.00 $2.40 $23.33 $10.50 $10.50 $10.50 $10.50 $23.33 $23.33 $23.33 $2.40 $23.33 $4.36 $4.36 $4.53 $4.19 $4.92 $23.33 $23.33 $13.80 $23.33 $23.33 $23.33 $23.33 $17.63 $23.33 $23.33 $23.33 $11.67 $11.67 $18.48 $23.33 $18.66 $10.50 $4.69 $23.33 $13.63 $23.33 $23.33 $23.33 $4.69 $23.33 N/A N/A 143121 ERX HCPCS J2426 50458-0560-01 PALIPERIDONE PALMITATE ER 39 MG/0.25ML IM SUSY BOTH IP/OP "$1,788.00" "$1,323.00" $493.35 "$1,787.78" "$1,787.78" "$1,787.78" "$1,787.78" "$1,787.78" "$1,787.78" "$1,787.78" $493.74 "$1,787.78" "$1,787.78" $513.08 $513.08 $532.82 $493.35 $579.61 "$1,787.78" $715.11 "$1,787.78" "$1,787.78" "$1,787.78" "$1,787.78" "$1,787.78" "$1,341.00" "$1,787.78" "$1,787.78" "$1,787.78" $893.89 $893.89 "$1,415.92" "$1,787.78" "$1,430.22" $804.50 "$1,787.78" "$1,787.78" "$1,037.04" "$1,787.78" "$1,072.67" "$1,787.78" "$1,787.78" "$1,787.78" N/A N/A 143122 ERX HCPCS J2426 50458-0561-01 PALIPERIDONE PALMITATE ER 78 MG/0.5ML IM SUSY BOTH IP/OP "$3,120.50" "$2,309.00" $986.70 "$3,120.36" "$3,120.36" "$3,120.36" "$3,120.36" "$3,120.36" "$3,120.36" "$3,120.36" $987.48 "$3,120.36" "$3,120.36" "$1,026.17" "$1,026.17" "$1,065.64" $986.70 "$1,159.22" "$3,120.36" "$1,248.14" "$3,120.36" "$3,120.36" "$3,120.36" "$3,120.36" "$3,120.36" "$2,340.38" "$3,120.36" "$3,120.36" "$3,120.36" "$1,560.18" "$1,560.18" "$2,471.33" "$3,120.36" "$2,496.29" "$1,404.16" "$3,120.36" "$3,120.36" "$1,809.89" "$3,120.36" "$1,872.22" "$3,120.36" "$3,120.36" "$3,120.36" N/A N/A 143130 ERX HCPCS 25000001 00078-0860-01 RIBOCICLIB SUCC (200 MG DOSE) 200 MG PO TBPK BOTH IP/OP "$1,130.50" $837.00 $201.21 "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" $201.21 "$1,130.37" "$1,130.37" $838.96 $838.96 $871.29 $588.92 $235.58 "$1,130.37" $452.15 "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" $847.88 "$1,130.37" "$1,130.37" "$1,130.37" $565.19 $565.19 $895.25 "$1,130.37" $904.30 $734.74 "$1,130.37" "$1,130.37" $655.69 "$1,130.37" $678.22 "$1,130.37" "$1,130.37" "$1,130.37" N/A N/A 143131 ERX HCPCS 25000001 00078-0867-42 RIBOCICLIB SUCC (400 MG DOSE) 200 MG PO TBPK BOTH IP/OP "$1,130.50" $837.00 $201.21 "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" $201.21 "$1,130.37" "$1,130.37" $838.96 $838.96 $871.29 $588.92 $235.58 "$1,130.37" $452.15 "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" $847.88 "$1,130.37" "$1,130.37" "$1,130.37" $565.19 $565.19 $895.25 "$1,130.37" $904.30 $734.74 "$1,130.37" "$1,130.37" $655.69 "$1,130.37" $678.22 "$1,130.37" "$1,130.37" "$1,130.37" N/A N/A 143132 ERX HCPCS 25000001 00078-0874-63 RIBOCICLIB SUCC (600 MG DOSE) 200 MG PO TBPK BOTH IP/OP $942.00 $697.00 $167.67 $941.98 $941.98 $941.98 $941.98 $941.98 $941.98 $941.98 $167.67 $941.98 $941.98 $699.14 $699.14 $726.08 $490.77 $196.32 $941.98 $376.79 $941.98 $941.98 $941.98 $941.98 $941.98 $706.50 $941.98 $941.98 $941.98 $470.99 $470.99 $746.05 $941.98 $753.58 $612.29 $941.98 $941.98 $546.36 $941.98 $565.19 $941.98 $941.98 $941.98 N/A N/A 143138 ERX HCPCS 25000001 63323-0208-05 LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 143139 ERX HCPCS 25000001 76329-3390-01 LIDOCAINE HCL (CARDIAC) 100 MG/5ML IV SOSY BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 143140 ERX HCPCS 25000001 00409-1323-05 LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOSY BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 143142 ERX HCPCS 90636 58160-0815-52 HEPATITIS A-HEP B RECOMB VAC 720-20 ELU-MCG/ML IM SUSY BOTH IP/OP $504.50 $373.00 $107.88 $504.47 $227.01 $227.01 $227.01 $227.01 $504.47 $504.47 $504.47 $107.88 $504.47 $116.84 $116.84 $121.34 $112.35 $131.99 $504.47 $504.47 $298.39 $504.47 $504.47 $504.47 $504.47 $378.38 $504.47 $504.47 $504.47 $252.24 $252.24 $399.54 $504.47 $403.58 $227.01 $125.70 $504.47 $292.61 $504.47 $504.47 $504.47 $125.70 $504.47 N/A N/A 143143 ERX HCPCS J0897 55513-0710-01 DENOSUMAB 60 MG/ML SC SOSY BOTH IP/OP "$4,374.00" "$3,237.00" $911.61 "$4,373.81" "$1,968.21" "$1,968.21" "$1,968.21" "$1,968.21" "$1,272.30" "$1,272.30" "$1,272.30" $911.61 "$1,272.30" "$1,323.50" "$1,323.50" "$1,374.41" "$1,272.60" "$1,495.10" "$1,272.30" "$1,381.08" "$2,156.29" "$1,272.30" "$4,373.81" "$1,272.30" "$1,335.92" "$3,280.50" "$1,272.30" "$1,272.30" "$1,272.30" "$2,186.91" "$2,186.91" "$3,464.06" "$1,272.30" "$3,499.05" "$1,968.21" "$1,423.78" "$1,272.30" "$2,536.92" "$1,335.92" "$1,844.84" "$1,272.30" "$1,423.78" "$1,272.30" N/A N/A 143147 ERX HCPCS J7198 64193-0426-02 ANTIINHIBITOR COAGULANT CMPLX 500 UNITS IV SOLR BOTH IP/OP "$3,145.50" "$2,328.00" $655.56 "$3,145.50" "$3,145.50" "$3,145.50" "$3,145.50" "$3,145.50" "$3,145.50" "$3,145.50" "$1,105.00" "$3,145.50" "$3,145.50" "$1,144.00" "$1,144.00" "$1,188.00" "$1,100.00" $655.56 "$3,145.50" "$1,258.20" "$3,145.50" "$3,145.50" "$3,145.50" "$3,145.50" "$3,145.50" "$2,359.13" "$3,145.50" "$3,145.50" "$3,145.50" "$1,572.75" "$1,572.75" "$2,491.24" "$3,145.50" "$2,516.40" "$1,415.48" "$3,145.50" "$3,145.50" "$1,824.39" "$3,145.50" "$1,887.30" "$3,145.50" "$3,145.50" "$3,145.50" N/A N/A 143148 ERX HCPCS J7198 64193-0424-02 ANTIINHIBITOR COAGULANT CMPLX 1000 UNITS IV SOLR BOTH IP/OP "$6,291.00" "$4,655.00" "$1,311.11" "$6,291.00" "$6,291.00" "$6,291.00" "$6,291.00" "$6,291.00" "$6,291.00" "$6,291.00" "$2,210.00" "$6,291.00" "$6,291.00" "$2,288.00" "$2,288.00" "$2,376.00" "$2,200.00" "$1,311.11" "$6,291.00" "$2,516.40" "$6,291.00" "$6,291.00" "$6,291.00" "$6,291.00" "$6,291.00" "$4,718.25" "$6,291.00" "$6,291.00" "$6,291.00" "$3,145.50" "$3,145.50" "$4,982.47" "$6,291.00" "$5,032.80" "$2,830.95" "$6,291.00" "$6,291.00" "$3,648.78" "$6,291.00" "$3,774.60" "$6,291.00" "$6,291.00" "$6,291.00" N/A N/A 143149 ERX HCPCS J7198 64193-0425-02 ANTIINHIBITOR COAGULANT CMPLX 2500 UNITS IV SOLR BOTH IP/OP "$15,727.50" "$11,638.00" "$3,277.78" "$15,727.50" "$15,727.50" "$15,727.50" "$15,727.50" "$15,727.50" "$15,727.50" "$15,727.50" "$5,525.00" "$15,727.50" "$15,727.50" "$5,720.00" "$5,720.00" "$5,940.00" "$5,500.00" "$3,277.78" "$15,727.50" "$6,291.00" "$15,727.50" "$15,727.50" "$15,727.50" "$15,727.50" "$15,727.50" "$11,795.63" "$15,727.50" "$15,727.50" "$15,727.50" "$7,863.75" "$7,863.75" "$12,456.18" "$15,727.50" "$12,582.00" "$7,077.38" "$15,727.50" "$15,727.50" "$9,121.95" "$15,727.50" "$9,436.50" "$15,727.50" "$15,727.50" "$15,727.50" N/A N/A 143153 ERX HCPCS J1644 00264-9872-10 HEPARIN (PORCINE) IN NACL 1000-0.9 UT/500ML-% IV SOLN BOTH IP/OP $22.00 $16.00 $0.24 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.24 $22.00 $0.26 $0.26 $0.27 $0.25 $0.29 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.28 $22.00 $12.76 $22.00 $22.00 $22.00 $0.28 $22.00 N/A N/A 143157 ERX HCPCS J3370 70594-0042-03 VANCOMYCIN HCL 1000 MG/200ML IV SOLN BOTH IP/OP $83.00 $61.00 $5.56 $82.95 $37.33 $37.33 $37.33 $37.33 $82.95 $82.95 $82.95 $7.24 $82.95 $5.78 $5.78 $6.00 $5.56 $6.53 $82.95 $82.95 $49.06 $82.95 $82.95 $82.95 $82.95 $62.25 $82.95 $82.95 $82.95 $41.48 $41.48 $65.70 $82.95 $66.36 $37.33 $6.22 $82.95 $48.14 $82.95 $82.95 $82.95 $6.22 $82.95 N/A N/A 143158 ERX HCPCS J3370 70594-0043-02 VANCOMYCIN HCL 1500 MG/300ML IV SOLN BOTH IP/OP $110.00 $81.00 $8.34 $109.85 $49.43 $49.43 $49.43 $49.43 $109.85 $109.85 $8.52 $10.86 $109.85 $8.67 $8.67 $9.01 $8.34 $9.80 $109.85 $109.85 $64.98 $109.85 $109.85 $109.85 $109.85 $82.50 $109.85 $109.85 $109.85 $54.93 $54.93 $87.00 $109.85 $87.88 $49.43 $9.33 $109.85 $63.80 $109.85 $109.85 $109.85 $9.33 $109.85 N/A N/A 143187 ERX HCPCS 25000001 00187-3012-20 PYRIDOSTIGMINE BROMIDE 60 MG/5ML PO SOLN BOTH IP/OP "$4,478.00" "$3,314.00" $797.05 "$4,477.80" "$4,477.80" "$4,477.80" "$4,477.80" "$4,477.80" "$4,477.80" "$4,477.80" $797.05 "$4,477.80" "$4,477.80" "$3,323.42" "$3,323.42" "$3,451.49" "$2,060.15" $933.22 "$4,477.80" "$1,791.12" "$4,477.80" "$4,477.80" "$4,477.80" "$4,477.80" "$4,477.80" "$3,358.50" "$4,477.80" "$4,477.80" "$4,477.80" "$2,238.90" "$2,238.90" "$3,546.42" "$4,477.80" "$3,582.24" "$2,910.57" "$4,477.80" "$4,477.80" "$2,597.24" "$4,477.80" "$2,686.68" "$4,477.80" "$4,477.80" "$4,477.80" N/A N/A 143206 ERX HCPCS J9022 50242-0918-01 ATEZOLIZUMAB 840 MG/14ML IV SOLN BOTH IP/OP "$19,758.00" "$14,621.00" "$4,117.99" "$19,757.65" "$8,890.94" "$8,890.94" "$8,890.94" "$8,890.94" "$6,684.38" "$6,684.38" "$6,684.38" "$4,117.99" "$6,684.38" "$6,952.11" "$6,952.11" "$7,219.50" "$6,684.72" "$7,853.48" "$6,684.38" "$6,809.29" "$9,740.52" "$6,684.38" "$19,757.65" "$6,684.38" "$7,018.60" "$14,818.50" "$6,684.38" "$6,684.38" "$6,684.38" "$9,878.83" "$9,878.83" "$15,648.06" "$6,684.38" "$15,806.12" "$8,890.94" "$7,478.86" "$6,684.38" "$11,459.64" "$7,018.60" "$9,692.36" "$6,684.38" "$7,478.86" "$6,684.38" N/A N/A 143464 ERX HCPCS J9356 50242-0077-01 TRASTUZUMAB-HYALURONIDASE-OYSK 600-10000 MG-UNT/5ML SC SOLN BOTH IP/OP "$13,072.00" "$9,673.00" "$2,724.53" "$13,071.98" "$5,882.39" "$5,882.39" "$5,882.39" "$5,882.39" "$4,289.64" "$4,289.64" "$4,289.64" "$2,724.53" "$4,289.64" "$4,460.98" "$4,460.98" "$4,632.55" "$4,289.40" "$5,039.36" "$4,289.64" "$3,904.62" "$6,444.49" "$4,289.64" "$13,071.98" "$4,289.64" "$4,504.12" "$9,804.00" "$4,289.64" "$4,289.64" "$4,289.64" "$6,535.99" "$6,535.99" "$10,353.01" "$4,289.64" "$10,457.58" "$5,882.39" "$4,798.98" "$4,289.64" "$7,581.76" "$4,504.12" "$6,219.98" "$4,289.64" "$4,798.98" "$4,289.64" N/A N/A 143520 ERX HCPCS 63700001 49702-0246-13 DOVATO:DOLUTEGRAVIR-LAMIVUDINE 50-300 MG PO TABS BOTH IP/OP $390.00 $289.00 $81.28 $389.99 $389.99 $389.99 $389.99 $389.99 $389.99 $389.99 $389.99 $389.99 $389.99 $389.99 $389.99 $389.99 $389.99 $81.28 $389.99 $156.00 $389.99 $389.99 $389.99 $389.99 $389.99 $292.50 $389.99 $389.99 $389.99 $195.00 $195.00 $308.87 $389.99 $311.99 $253.49 $389.99 $389.99 $226.20 $389.99 $233.99 $389.99 $389.99 $389.99 N/A N/A 143872 ERX HCPCS 25000001 00078-0701-84 ALPELISIB (200 MG DAILY DOSE) 200 MG PO TBPK BOTH IP/OP "$2,335.50" "$1,728.00" $415.65 "$2,335.14" "$2,335.14" "$2,335.14" "$2,335.14" "$2,335.14" "$2,335.14" "$2,335.14" $415.65 "$2,335.14" "$2,335.14" "$1,733.14" "$1,733.14" "$1,799.93" "$1,216.61" $486.67 "$2,335.14" $934.06 "$2,335.14" "$2,335.14" "$2,335.14" "$2,335.14" "$2,335.14" "$1,751.63" "$2,335.14" "$2,335.14" "$2,335.14" "$1,167.57" "$1,167.57" "$1,849.43" "$2,335.14" "$1,868.11" "$1,517.84" "$2,335.14" "$2,335.14" "$1,354.59" "$2,335.14" "$1,401.08" "$2,335.14" "$2,335.14" "$2,335.14" N/A N/A 143873 ERX HCPCS 25000001 00078-0715-02 ALPELISIB (250 MG DAILY DOSE) 200 & 50 MG PO TBPK BOTH IP/OP "$1,321.00" $978.00 $235.07 "$1,320.63" "$1,320.63" "$1,320.63" "$1,320.63" "$1,320.63" "$1,320.63" "$1,320.63" $235.07 "$1,320.63" "$1,320.63" $980.17 $980.17 "$1,017.94" $688.05 $275.23 "$1,320.63" $528.25 "$1,320.63" "$1,320.63" "$1,320.63" "$1,320.63" "$1,320.63" $990.75 "$1,320.63" "$1,320.63" "$1,320.63" $660.32 $660.32 "$1,045.94" "$1,320.63" "$1,056.50" $858.41 "$1,320.63" "$1,320.63" $766.18 "$1,320.63" $792.38 "$1,320.63" "$1,320.63" "$1,320.63" N/A N/A 143874 ERX HCPCS 25000001 00078-0708-02 ALPELISIB (300 MG DAILY DOSE) 2 X 150 MG PO TBPK BOTH IP/OP "$1,321.00" $978.00 $235.07 "$1,320.63" "$1,320.63" "$1,320.63" "$1,320.63" "$1,320.63" "$1,320.63" "$1,320.63" $235.07 "$1,320.63" "$1,320.63" $980.17 $980.17 "$1,017.94" $688.05 $275.23 "$1,320.63" $528.25 "$1,320.63" "$1,320.63" "$1,320.63" "$1,320.63" "$1,320.63" $990.75 "$1,320.63" "$1,320.63" "$1,320.63" $660.32 $660.32 "$1,045.94" "$1,320.63" "$1,056.50" $858.41 "$1,320.63" "$1,320.63" $766.18 "$1,320.63" $792.38 "$1,320.63" "$1,320.63" "$1,320.63" N/A N/A 144001 ERX HCPCS J2182 00173-0892-01 MEPOLIZUMAB 100 MG/ML SC SOAJ BOTH IP/OP "$10,014.00" "$7,410.00" "$2,829.00" "$10,013.58" "$10,013.58" "$10,013.58" "$10,013.58" "$10,013.58" "$10,013.58" "$10,013.58" "$2,829.00" "$10,013.58" "$10,013.58" "$2,983.76" "$2,983.76" "$3,098.52" "$2,869.00" "$3,370.62" "$10,013.58" "$4,005.43" "$10,013.58" "$10,013.58" "$10,013.58" "$10,013.58" "$10,013.58" "$7,510.50" "$10,013.58" "$10,013.58" "$10,013.58" "$5,006.79" "$5,006.79" "$7,930.76" "$10,013.58" "$8,010.86" "$4,506.11" "$10,013.58" "$2,868.50" "$5,808.12" "$10,013.58" "$6,008.15" "$10,013.58" "$10,013.58" "$10,013.58" N/A N/A 144008 ERX HCPCS J9309 50242-0105-01 POLATUZUMAB VEDOTIN-PIIQ 140 MG IV SOLR BOTH IP/OP "$44,926.50" "$33,246.00" "$15,899.80" "$44,926.13" "$44,926.13" "$44,926.13" "$44,926.13" "$44,926.13" "$44,926.13" "$44,926.13" "$15,899.80" "$44,926.13" "$44,926.13" "$16,535.79" "$16,535.79" "$17,171.78" "$15,899.80" "$18,679.74" "$44,926.13" "$17,970.45" "$44,926.13" "$44,926.13" "$44,926.13" "$44,926.13" "$44,926.13" "$33,694.88" "$44,926.13" "$44,926.13" "$44,926.13" "$22,463.07" "$22,463.07" "$35,581.49" "$44,926.13" "$35,940.90" "$20,216.76" "$44,926.13" "$44,926.13" "$26,057.37" "$44,926.13" "$26,955.68" "$44,926.13" "$44,926.13" "$44,926.13" N/A N/A 144263 ERX HCPCS Q5107 55513-0206-01 BEVACIZUMAB-AWWB 100 MG/4ML IV SOLN BOTH IP/OP "$2,236.00" "$1,655.00" $285.67 "$2,235.54" "$1,005.99" "$1,005.99" "$1,005.99" "$1,005.99" $397.68 $397.68 $397.68 $465.94 $397.68 $413.61 $413.61 $429.52 $397.70 $467.23 $397.68 $285.67 "$1,102.12" $397.68 "$2,235.54" $397.68 $417.56 "$1,677.00" $397.68 $397.68 $397.68 "$1,117.77" "$1,117.77" "$1,770.55" $397.68 "$1,788.43" "$1,005.99" $444.95 $397.68 "$1,296.88" $417.56 $576.64 $397.68 $444.95 $397.68 N/A N/A 144264 ERX HCPCS Q5107 55513-0207-01 BEVACIZUMAB-AWWB 400 MG/16ML IV SOLN BOTH IP/OP "$7,803.50" "$5,775.00" "$1,142.68" "$7,803.34" "$3,511.50" "$3,511.50" "$3,511.50" "$3,511.50" "$1,590.72" "$1,590.72" "$1,590.72" "$1,626.41" "$1,590.72" "$1,654.43" "$1,654.43" "$1,718.06" "$1,590.80" "$1,868.94" "$1,590.72" "$1,142.68" "$3,847.05" "$1,590.72" "$7,803.34" "$1,590.72" "$1,670.26" "$5,852.63" "$1,590.72" "$1,590.72" "$1,590.72" "$3,901.67" "$3,901.67" "$6,180.25" "$1,590.72" "$6,242.67" "$3,511.50" "$1,779.79" "$1,590.72" "$4,526.03" "$1,670.26" "$2,306.54" "$1,590.72" "$1,779.79" "$1,590.72" N/A N/A 144270 ERX HCPCS J3370 70594-0044-02 VANCOMYCIN HCL 2000 MG/400ML IV SOLN BOTH IP/OP $134.00 $99.00 $11.12 $133.73 $60.18 $60.18 $60.18 $60.18 $133.73 $133.73 $11.36 $14.48 $133.73 $11.56 $11.56 $12.01 $11.12 $13.06 $133.73 $133.73 $79.10 $133.73 $133.73 $133.73 $133.73 $100.50 $133.73 $133.73 $133.73 $66.87 $66.87 $105.91 $133.73 $106.98 $60.18 $12.44 $133.73 $77.72 $133.73 $133.73 $133.73 $12.44 $133.73 N/A N/A 144275 ERX HCPCS Q5117 55513-0132-01 TRASTUZUMAB-ANNS 420 MG IV SOLR BOTH IP/OP "$10,648.00" "$7,880.00" "$1,088.89" "$10,647.69" "$4,791.46" "$4,791.46" "$4,791.46" "$4,791.46" "$1,991.18" "$1,991.18" "$1,991.18" "$2,219.24" "$1,991.18" "$2,070.87" "$2,070.87" "$2,150.52" "$1,991.22" "$2,339.37" "$1,991.18" "$1,088.89" "$5,249.31" "$1,991.18" "$10,647.69" "$1,991.18" "$2,090.74" "$7,986.00" "$1,991.18" "$1,991.18" "$1,991.18" "$5,323.85" "$5,323.85" "$8,432.97" "$1,991.18" "$8,518.15" "$4,791.46" "$2,227.78" "$1,991.18" "$6,175.84" "$2,090.74" "$2,887.21" "$1,991.18" "$2,227.78" "$1,991.18" N/A N/A 144334 ERX HCPCS J0613 44567-0621-01 CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN BOTH IP/OP $189.00 $140.00 $33.58 $188.66 $188.66 $188.66 $188.66 $188.66 $188.66 $188.66 $33.58 $188.66 $188.66 $188.66 $188.66 $188.66 $188.66 $39.32 $188.66 $75.46 $188.66 $188.66 $188.66 $188.66 $188.66 $141.75 $188.66 $188.66 $188.66 $94.33 $94.33 $149.42 $188.66 $150.93 $84.90 $188.66 $188.66 $109.62 $188.66 $113.20 $188.66 $188.66 $188.66 N/A N/A 144426 ERX HCPCS 63700001 52536-0183-03 ERYTHROMYCIN 333 MG PO TBEC BOTH IP/OP $46.00 $34.00 $9.51 $45.63 $45.63 $45.63 $45.63 $45.63 $45.63 $45.63 $45.63 $45.63 $45.63 $45.63 $45.63 $45.63 $45.63 $9.51 $45.63 $18.25 $45.63 $45.63 $45.63 $45.63 $45.63 $34.50 $45.63 $45.63 $45.63 $22.82 $22.82 $36.14 $45.63 $36.50 $29.66 $45.63 $45.63 $26.68 $45.63 $27.38 $45.63 $45.63 $45.63 N/A N/A 144767 ERX HCPCS 25000001 65862-0947-60 DORZOLAMIDE HCL-TIMOLOL MAL PF 2-0.5 % OP SOLN BOTH IP/OP $169.00 $125.00 $30.02 $168.66 $168.66 $168.66 $168.66 $168.66 $168.66 $168.66 $30.02 $168.66 $168.66 $125.18 $125.18 $130.00 $87.87 $35.15 $168.66 $67.46 $168.66 $168.66 $168.66 $168.66 $168.66 $126.75 $168.66 $168.66 $168.66 $84.33 $84.33 $133.58 $168.66 $134.93 $109.63 $168.66 $168.66 $98.02 $168.66 $101.20 $168.66 $168.66 $168.66 N/A N/A 144934 ERX HCPCS 90707 00006-4681-00 "MEASLES, MUMPS & RUBELLA VAC IJ SOLR" BOTH IP/OP $373.00 $276.00 $11.75 $372.64 $167.69 $167.69 $167.69 $167.69 $372.64 $372.64 $372.64 $11.75 $372.64 $90.80 $90.80 $94.29 $87.31 $102.58 $372.64 $372.64 $220.42 $372.64 $372.64 $372.64 $372.64 $279.75 $372.64 $372.64 $372.64 $186.32 $186.32 $295.13 $372.64 $298.11 $167.69 $97.68 $372.64 $216.34 $372.64 $372.64 $372.64 $97.68 $372.64 N/A N/A 144938 ERX HCPCS 25000001 00078-0639-41 SECUKINUMAB (300 MG DOSE) 150 MG/ML SC SOAJ BOTH IP/OP "$9,680.50" "$7,164.00" "$1,723.06" "$9,680.12" "$9,680.12" "$9,680.12" "$9,680.12" "$9,680.12" "$9,680.12" "$9,680.12" "$1,723.06" "$9,680.12" "$9,680.12" "$4,181.12" "$4,181.12" "$7,461.44" "$2,060.15" "$2,017.44" "$9,680.12" "$3,872.05" "$9,680.12" "$9,680.12" "$9,680.12" "$9,680.12" "$9,680.12" "$7,260.38" "$9,680.12" "$9,680.12" "$9,680.12" "$4,840.06" "$4,840.06" "$7,666.66" "$9,680.12" "$7,744.10" "$6,292.08" "$9,680.12" "$9,680.12" "$5,614.69" "$9,680.12" "$5,808.07" "$9,680.12" "$9,680.12" "$9,680.12" N/A N/A 144941 ERX HCPCS J2250 00409-2308-01 MIDAZOLAM HCL (PF) 5 MG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.55 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.94 $22.00 $0.57 $0.57 $0.59 $0.55 $0.65 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.62 $22.00 $12.76 $22.00 $22.00 $22.00 $0.62 $22.00 N/A N/A 144943 ERX HCPCS J2250 00409-2305-04 MIDAZOLAM HCL (PF) 5 MG/5ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.55 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.94 $22.00 $0.57 $0.57 $0.59 $0.55 $0.65 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.62 $22.00 $12.76 $22.00 $22.00 $22.00 $0.62 $22.00 N/A N/A 144946 ERX HCPCS J2794 50458-0306-11 RISPERIDONE MICROSPHERES ER 25 MG IM SRER BOTH IP/OP "$1,879.00" "$1,390.00" $552.00 "$1,878.86" "$1,878.86" "$1,878.86" "$1,878.86" "$1,878.86" "$1,878.86" "$1,878.86" $552.00 "$1,878.86" "$1,878.86" $574.08 $574.08 $596.16 $552.00 $648.51 "$1,878.86" $751.54 "$1,878.86" "$1,878.86" "$1,878.86" "$1,878.86" "$1,878.86" "$1,409.25" "$1,878.86" "$1,878.86" "$1,878.86" $939.43 $939.43 "$1,488.06" "$1,878.86" "$1,503.09" $845.49 "$1,878.86" "$1,878.86" "$1,089.82" "$1,878.86" "$1,127.32" "$1,878.86" "$1,878.86" "$1,878.86" N/A N/A 144953 ERX HCPCS J3590 00024-5918-01 DUPILUMAB 200 MG/1.14ML SC SOSY BOTH IP/OP "$5,016.00" "$3,712.00" $995.53 "$5,015.91" "$2,257.16" "$2,257.16" "$2,257.16" "$2,257.16" "$5,015.91" "$5,015.91" "$5,015.91" "$1,045.44" "$5,015.91" "$5,015.91" "$5,015.91" "$5,015.91" "$5,015.91" "$1,045.37" "$5,015.91" "$5,015.91" "$2,472.84" "$5,015.91" "$5,015.91" "$5,015.91" "$5,015.91" "$3,762.00" "$5,015.91" "$5,015.91" "$5,015.91" "$2,507.96" "$2,507.96" "$3,972.60" "$5,015.91" "$4,012.73" "$2,257.16" $995.53 "$5,015.91" "$2,909.28" "$5,015.91" "$5,015.91" "$5,015.91" "$1,045.32" "$5,015.91" N/A N/A 144962 ERX HCPCS 25000001 00409-4888-10 SODIUM CHLORIDE (PF) 0.9 % IJ SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 145128 ERX HCPCS 63700001 99999-6009-67 ERGOCALCIFEROL 8000 UNIT/ML PO SOLN BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 145154 ERX HCPCS 25000001 76329-3013-05 LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY BOTH IP/OP $33.50 $25.00 $5.91 $33.23 $33.23 $33.23 $33.23 $33.23 $33.23 $33.23 $5.91 $33.23 $33.23 $24.66 $24.66 $25.61 $17.31 $6.93 $33.23 $13.29 $33.23 $33.23 $33.23 $33.23 $33.23 $25.13 $33.23 $33.23 $33.23 $16.62 $16.62 $26.32 $33.23 $26.58 $21.60 $33.23 $33.23 $19.43 $33.23 $19.94 $33.23 $33.23 $33.23 N/A N/A 145230 ERX HCPCS 25000001 54838-0006-50 CHOLECALCIFEROL 400 UNIT/ML PO LIQD BOTH IP/OP $99.50 $74.00 $17.71 $99.50 $99.50 $99.50 $99.50 $99.50 $99.50 $99.50 $17.71 $99.50 $99.50 $73.85 $73.85 $76.69 $51.84 $20.74 $99.50 $39.80 $99.50 $99.50 $99.50 $99.50 $99.50 $74.63 $99.50 $99.50 $99.50 $49.75 $49.75 $78.80 $99.50 $79.60 $64.68 $99.50 $99.50 $57.71 $99.50 $59.70 $99.50 $99.50 $99.50 N/A N/A 145469 ERX HCPCS q5114 67457-0847-44 TRASTUZUMAB-DKST 420 MG IV SOLR BOTH IP/OP "$10,338.00" "$7,650.00" "$1,840.08" "$10,337.54" "$10,337.54" "$10,337.54" "$10,337.54" "$10,337.54" "$10,337.54" "$10,337.54" "$1,840.08" "$10,337.54" "$10,337.54" "$10,337.54" "$10,337.54" "$10,337.54" "$10,337.54" "$2,154.46" "$10,337.54" "$4,135.02" "$10,337.54" "$10,337.54" "$10,337.54" "$10,337.54" "$10,337.54" "$7,753.50" "$10,337.54" "$10,337.54" "$10,337.54" "$5,168.77" "$5,168.77" "$8,187.33" "$10,337.54" "$8,270.03" "$4,651.89" "$10,337.54" "$10,337.54" "$5,996.04" "$10,337.54" "$6,202.52" "$10,337.54" "$10,337.54" "$10,337.54" N/A N/A 145473 ERX HCPCS Q5114 67457-0991-15 TRASTUZUMAB-DKST 150 MG IV SOLR BOTH IP/OP "$3,704.00" "$2,741.00" $706.98 "$3,703.75" "$1,666.69" "$1,666.69" "$1,666.69" "$1,666.69" $835.73 $835.73 $835.73 $771.95 $835.73 $869.23 $869.23 $902.66 $835.80 $981.93 $835.73 $706.98 "$1,825.95" $835.73 "$3,703.75" $835.73 $877.51 "$2,778.00" $835.73 $835.73 $835.73 "$1,851.88" "$1,851.88" "$2,933.37" $835.73 "$2,963.00" "$1,666.69" $935.09 $835.73 "$2,148.32" $877.51 "$1,211.80" $835.73 $935.09 $835.73 N/A N/A 145547 ERX HCPCS J0517 00310-1830-30 BENRALIZUMAB 30 MG/ML SC SOAJ BOTH IP/OP "$15,410.00" "$11,403.00" "$3,211.81" "$15,409.90" "$6,934.46" "$6,934.46" "$6,934.46" "$6,934.46" "$5,023.20" "$5,023.20" "$5,023.20" "$3,211.81" "$5,023.20" "$5,224.13" "$5,224.13" "$5,425.06" "$5,023.20" "$5,901.46" "$5,023.20" "$5,013.45" "$7,597.08" "$5,023.20" "$15,409.90" "$5,023.20" "$5,274.36" "$11,557.50" "$5,023.20" "$5,023.20" "$5,023.20" "$7,704.95" "$7,704.95" "$12,204.64" "$5,023.20" "$12,327.92" "$6,934.46" "$5,619.96" "$5,023.20" "$8,937.80" "$5,274.36" "$7,283.64" "$5,023.20" "$5,619.96" "$5,023.20" N/A N/A 145641 ERX HCPCS Q5117 55513-0141-01 TRASTUZUMAB-ANNS 150 MG IV SOLR BOTH IP/OP "$3,803.00" "$2,814.00" $388.89 "$3,802.75" "$1,711.24" "$1,711.24" "$1,711.24" "$1,711.24" $711.14 $711.14 $711.14 $792.59 $711.14 $739.60 $739.60 $768.04 $711.15 $835.49 $711.14 $388.89 "$1,874.76" $711.14 "$3,802.75" $711.14 $746.69 "$2,852.25" $711.14 $711.14 $711.14 "$1,901.38" "$1,901.38" "$3,011.78" $711.14 "$3,042.20" "$1,711.24" $795.63 $711.14 "$2,205.74" $746.69 "$1,031.15" $711.14 $795.63 $711.14 N/A N/A 145743 ERX HCPCS Q5115 63459-0103-10 RITUXIMAB-ABBS 100 MG/10ML IV SOLN BOTH IP/OP "$2,364.50" "$1,750.00" $478.01 "$2,364.16" "$1,063.87" "$1,063.87" "$1,063.87" "$1,063.87" $573.47 $573.47 $573.47 $492.75 $573.47 $596.44 $596.44 $619.38 $573.50 $673.77 $573.47 $478.01 "$1,165.53" $573.47 "$2,364.16" $573.47 $602.14 "$1,773.38" $573.47 $573.47 $573.47 "$1,182.08" "$1,182.08" "$1,872.41" $573.47 "$1,891.33" "$1,063.87" $641.63 $573.47 "$1,371.41" $602.14 $831.53 $573.47 $641.63 $573.47 N/A N/A 145744 ERX HCPCS Q5115 63459-0104-50 RITUXIMAB-ABBS 500 MG/50ML IV SOLN BOTH IP/OP "$11,821.00" "$8,748.00" "$2,390.05" "$11,820.79" "$5,319.36" "$5,319.36" "$5,319.36" "$5,319.36" "$2,867.35" "$2,867.35" "$2,867.35" "$2,463.75" "$2,867.35" "$2,982.20" "$2,982.20" "$3,096.90" "$2,867.50" "$3,368.86" "$2,867.35" "$2,390.05" "$5,827.65" "$2,867.35" "$11,820.79" "$2,867.35" "$3,010.72" "$8,865.75" "$2,867.35" "$2,867.35" "$2,867.35" "$5,910.40" "$5,910.40" "$9,362.07" "$2,867.35" "$9,456.63" "$5,319.36" "$3,208.16" "$2,867.35" "$6,856.18" "$3,010.72" "$4,157.66" "$2,867.35" "$3,208.16" "$2,867.35" N/A N/A 145763 ERX HCPCS Q5120 61314-0866-01 PEGFILGRASTIM-BMEZ 6 MG/0.6ML SC SOSY BOTH IP/OP "$10,976.00" "$8,122.00" $960.74 "$10,975.80" "$4,939.11" "$4,939.11" "$4,939.11" "$4,939.11" "$2,674.33" "$2,674.33" "$2,674.33" "$2,287.63" "$2,674.33" "$2,781.29" "$2,781.29" "$2,888.27" "$2,674.32" "$3,141.90" "$2,674.33" $960.74 "$5,411.07" "$2,674.33" "$10,975.80" "$2,674.33" "$2,808.05" "$8,232.00" "$2,674.33" "$2,674.33" "$2,674.33" "$5,487.90" "$5,487.90" "$8,692.83" "$2,674.33" "$8,780.64" "$4,939.11" "$2,992.03" "$2,674.33" "$6,366.08" "$2,808.05" "$3,877.78" "$2,674.33" "$2,992.03" "$2,674.33" N/A N/A 145779 ERX HCPCS J0896 59572-0711-01 LUSPATERCEPT-AAMT 25 MG SC SOLR BOTH IP/OP "$10,416.50" "$7,708.00" "$3,685.00" "$10,416.20" "$10,416.20" "$10,416.20" "$10,416.20" "$10,416.20" "$10,416.20" "$10,416.20" "$3,685.00" "$10,416.20" "$10,416.20" "$3,889.60" "$3,889.60" "$4,039.20" "$3,740.00" "$4,393.91" "$10,416.20" "$4,166.48" "$10,416.20" "$10,416.20" "$10,416.20" "$10,416.20" "$10,416.20" "$7,812.38" "$10,416.20" "$10,416.20" "$10,416.20" "$5,208.10" "$5,208.10" "$8,249.63" "$10,416.20" "$8,332.96" "$4,687.29" "$10,416.20" "$10,416.20" "$6,041.57" "$10,416.20" "$6,249.72" "$10,416.20" "$10,416.20" "$10,416.20" N/A N/A 145780 ERX HCPCS J0896 59572-0775-01 LUSPATERCEPT-AAMT 75 MG SC SOLR BOTH IP/OP "$31,249.00" "$23,124.00" "$11,055.00" "$31,248.54" "$31,248.54" "$31,248.54" "$31,248.54" "$31,248.54" "$31,248.54" "$31,248.54" "$11,055.00" "$31,248.54" "$31,248.54" "$11,668.80" "$11,668.80" "$12,117.60" "$11,220.00" "$13,181.72" "$31,248.54" "$12,499.42" "$31,248.54" "$31,248.54" "$31,248.54" "$31,248.54" "$31,248.54" "$23,436.75" "$31,248.54" "$31,248.54" "$31,248.54" "$15,624.27" "$15,624.27" "$24,748.84" "$31,248.54" "$24,998.83" "$14,061.84" "$31,248.54" "$31,248.54" "$18,124.42" "$31,248.54" "$18,749.12" "$31,248.54" "$31,248.54" "$31,248.54" N/A N/A 145814 ERX HCPCS 63600001 72579-0011-02 ZANUBRUTINIB 80 MG PO CAPS BOTH IP/OP $875.50 $648.00 $155.75 $875.02 $875.02 $875.02 $875.02 $875.02 $875.02 $875.02 $155.75 $875.02 $875.02 $875.02 $875.02 $875.02 $875.02 $182.36 $875.02 $350.01 $875.02 $875.02 $875.02 $875.02 $875.02 $656.63 $875.02 $875.02 $875.02 $437.51 $437.51 $693.02 $875.02 $700.02 $393.76 $875.02 $875.02 $507.79 $875.02 $525.01 $875.02 $875.02 $875.02 N/A N/A 145824 ERX HCPCS C9053 00078-0883-61 CRIZANLIZUMAB-TMCA 100 MG/10ML IV SOLN BOTH IP/OP "$6,858.50" "$5,075.00" "$1,429.47" "$6,858.43" "$3,086.29" "$3,086.29" "$3,086.29" "$3,086.29" "$2,482.44" "$2,482.44" "$2,482.44" "$1,429.47" "$2,482.44" "$2,581.70" "$2,581.70" "$2,680.99" "$2,482.40" "$2,916.43" "$2,482.44" "$2,505.62" "$3,381.21" "$2,482.44" "$6,858.43" "$2,482.44" "$2,606.56" "$5,143.88" "$2,482.44" "$2,482.44" "$2,482.44" "$3,429.22" "$3,429.22" "$5,431.88" "$2,482.44" "$5,486.74" "$3,086.29" "$2,777.31" "$2,482.44" "$3,977.93" "$2,606.56" "$3,599.54" "$2,482.44" "$2,777.31" "$2,482.44" N/A N/A 146009 ERX HCPCS 25000001 44677-0102-02 LANSINOH LANOLIN EX CREA BOTH IP/OP $11.00 $8.00 $1.96 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $1.96 $11.00 $11.00 $8.16 $8.16 $8.48 $5.73 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 146059 ERX HCPCS J9177 51144-0020-01 ENFORTUMAB VEDOTIN-EJFV 20 MG IV SOLR BOTH IP/OP "$7,412.50" "$5,485.00" "$1,544.78" "$7,412.20" "$7,412.20" "$7,412.20" "$7,412.20" "$7,412.20" "$7,412.20" "$7,412.20" "$2,413.60" "$7,412.20" "$7,412.20" "$4,181.12" "$4,181.12" "$5,713.32" "$2,060.15" "$1,544.78" "$7,412.20" "$2,964.88" "$7,412.20" "$7,412.20" "$7,412.20" "$7,412.20" "$7,412.20" "$5,559.38" "$7,412.20" "$7,412.20" "$7,412.20" "$3,706.10" "$3,706.10" "$5,870.46" "$7,412.20" "$5,929.76" "$4,817.93" "$7,412.20" "$7,412.20" "$4,299.25" "$7,412.20" "$4,447.32" "$7,412.20" "$7,412.20" "$7,412.20" N/A N/A 146060 ERX HCPCS J9177 51144-0030-01 ENFORTUMAB VEDOTIN-EJFV 30 MG IV SOLR BOTH IP/OP "$11,118.50" "$8,228.00" "$2,060.15" "$11,118.30" "$11,118.30" "$11,118.30" "$11,118.30" "$11,118.30" "$11,118.30" "$11,118.30" "$3,620.40" "$11,118.30" "$11,118.30" "$4,181.12" "$4,181.12" "$8,569.99" "$2,060.15" "$2,317.18" "$11,118.30" "$4,447.32" "$11,118.30" "$11,118.30" "$11,118.30" "$11,118.30" "$11,118.30" "$8,338.88" "$11,118.30" "$11,118.30" "$11,118.30" "$5,559.15" "$5,559.15" "$8,805.69" "$11,118.30" "$8,894.64" "$7,226.90" "$11,118.30" "$11,118.30" "$6,448.73" "$11,118.30" "$6,670.98" "$11,118.30" "$11,118.30" "$11,118.30" N/A N/A 146089 ERX HCPCS J9358 65597-0406-01 FAM-TRASTUZUMAB DERUXTEC-NXKI 100 MG IV SOLR BOTH IP/OP "$7,087.50" "$5,245.00" "$1,477.18" "$7,087.35" "$3,189.31" "$3,189.31" "$3,189.31" "$3,189.31" "$2,460.00" "$2,460.00" "$2,460.00" "$1,477.18" "$2,460.00" "$2,558.40" "$2,558.40" "$2,656.80" "$2,460.00" "$2,890.11" "$2,460.00" "$2,563.10" "$3,494.06" "$2,460.00" "$7,087.35" "$2,460.00" "$2,583.00" "$5,315.63" "$2,460.00" "$2,460.00" "$2,460.00" "$3,543.68" "$3,543.68" "$5,613.18" "$2,460.00" "$5,669.88" "$3,189.31" "$2,752.25" "$2,460.00" "$4,110.75" "$2,583.00" "$3,567.00" "$2,460.00" "$2,752.25" "$2,460.00" N/A N/A 146213 ERX HCPCS Q5118 00069-0315-01 BEVACIZUMAB-BVZR 100 MG/4ML IV SOLN BOTH IP/OP "$1,965.50" "$1,454.00" $310.67 "$1,965.34" $884.40 $884.40 $884.40 $884.40 $505.89 $505.89 $505.89 $409.63 $505.89 $526.14 $526.14 $546.37 $505.90 $594.35 $505.89 $310.67 $968.91 $505.89 "$1,965.34" $505.89 $531.18 "$1,474.13" $505.89 $505.89 $505.89 $982.67 $982.67 "$1,556.55" $505.89 "$1,572.27" $884.40 $566.00 $505.89 "$1,139.99" $531.18 $733.54 $505.89 $566.00 $505.89 N/A N/A 146214 ERX HCPCS Q5118 00069-0342-01 BEVACIZUMAB-BVZR 400 MG/16ML IV SOLN BOTH IP/OP "$6,860.50" "$5,077.00" "$1,242.68" "$6,860.27" "$3,087.12" "$3,087.12" "$3,087.12" "$3,087.12" "$2,023.56" "$2,023.56" "$2,023.56" "$1,429.85" "$2,023.56" "$2,104.54" "$2,104.54" "$2,185.49" "$2,023.60" "$2,377.41" "$2,023.56" "$1,242.68" "$3,382.11" "$2,023.56" "$6,860.27" "$2,023.56" "$2,124.74" "$5,145.38" "$2,023.56" "$2,023.56" "$2,023.56" "$3,430.14" "$3,430.14" "$5,433.33" "$2,023.56" "$5,488.22" "$3,087.12" "$2,264.00" "$2,023.56" "$3,979.09" "$2,124.74" "$2,934.16" "$2,023.56" "$2,264.00" "$2,023.56" N/A N/A 146216 ERX HCPCS Q5119 00069-0238-01 RITUXIMAB-PVVR 100 MG/10ML IV SOLN BOTH IP/OP "$2,297.00" "$1,700.00" $299.74 "$2,296.63" "$1,033.48" "$1,033.48" "$1,033.48" "$1,033.48" $563.70 $563.70 $563.70 $478.68 $563.70 $586.25 $586.25 $608.80 $563.70 $662.26 $563.70 $299.74 "$1,132.24" $563.70 "$2,296.63" $563.70 $591.89 "$1,722.75" $563.70 $563.70 $563.70 "$1,148.32" "$1,148.32" "$1,818.93" $563.70 "$1,837.30" "$1,033.48" $630.67 $563.70 "$1,332.26" $591.89 $817.37 $563.70 $630.67 $563.70 N/A N/A 146217 ERX HCPCS Q5119 00069-0249-01 RITUXIMAB-PVVR 500 MG/50ML IV SOLN BOTH IP/OP "$10,021.00" "$7,416.00" "$1,498.70" "$10,020.87" "$4,509.39" "$4,509.39" "$4,509.39" "$4,509.39" "$2,818.50" "$2,818.50" "$2,818.50" "$2,088.60" "$2,818.50" "$2,931.24" "$2,931.24" "$3,043.98" "$2,818.50" "$3,311.29" "$2,818.50" "$1,498.70" "$4,940.29" "$2,818.50" "$10,020.87" "$2,818.50" "$2,959.43" "$7,515.75" "$2,818.50" "$2,818.50" "$2,818.50" "$5,010.44" "$5,010.44" "$7,936.53" "$2,818.50" "$8,016.70" "$4,509.39" "$3,153.34" "$2,818.50" "$5,812.18" "$2,959.43" "$4,086.83" "$2,818.50" "$3,153.34" "$2,818.50" N/A N/A 146362 ERX HCPCS J3241 75987-0130-15 TEPROTUMUMAB-TRBW 500 MG IV SOLR BOTH IP/OP "$43,259.00" "$32,012.00" "$15,794.00" "$43,258.60" "$43,258.60" "$43,258.60" "$43,258.60" "$43,258.60" "$43,258.60" "$43,258.60" "$15,794.00" "$43,258.60" "$43,258.60" "$16,425.76" "$16,425.76" "$17,057.52" "$15,794.00" "$18,555.44" "$43,258.60" "$17,303.44" "$43,258.60" "$43,258.60" "$43,258.60" "$43,258.60" "$43,258.60" "$32,444.25" "$43,258.60" "$43,258.60" "$43,258.60" "$21,629.30" "$21,629.30" "$34,260.81" "$43,258.60" "$34,606.88" "$19,466.37" "$43,258.60" "$43,258.60" "$25,090.22" "$43,258.60" "$25,955.16" "$43,258.60" "$43,258.60" "$43,258.60" N/A N/A 146561 ERX HCPCS J0693 59630-0266-10 CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR BOTH IP/OP $653.50 $484.00 $136.16 $653.34 $653.34 $653.34 $653.34 $653.34 $653.34 $653.34 $136.80 $653.34 $653.34 $653.34 $653.34 $653.34 $653.34 $136.16 $653.34 $261.34 $653.34 $653.34 $653.34 $653.34 $653.34 $490.13 $653.34 $653.34 $653.34 $326.67 $326.67 $517.45 $653.34 $522.67 $294.00 $653.34 $653.34 $379.03 $653.34 $392.00 $653.34 $653.34 $653.34 N/A N/A 147244 ERX HCPCS Q5113 63459-0305-47 TRASTUZUMAB-PKRB 420 MG IV SOLR BOTH IP/OP "$10,980.00" "$8,125.00" "$2,037.00" "$10,979.90" "$10,979.90" "$10,979.90" "$10,979.90" "$10,979.90" "$10,979.90" "$10,979.90" "$2,406.60" "$10,979.90" "$10,979.90" "$2,118.48" "$2,118.48" "$2,199.96" "$2,037.00" "$2,393.15" "$10,979.90" "$4,391.96" "$10,979.90" "$10,979.90" "$10,979.90" "$10,979.90" "$10,979.90" "$8,235.00" "$10,979.90" "$10,979.90" "$10,979.90" "$5,489.95" "$5,489.95" "$8,696.08" "$10,979.90" "$8,783.92" "$4,940.96" "$10,979.90" "$10,979.90" "$6,368.40" "$10,979.90" "$6,587.94" "$10,979.90" "$10,979.90" "$10,979.90" N/A N/A 147295 ERX HCPCS Q5113 63459-0303-43 TRASTUZUMAB-PKRB 150 MG IV SOLR BOTH IP/OP "$3,921.50" "$2,902.00" $727.50 "$3,921.39" "$3,921.39" "$3,921.39" "$3,921.39" "$3,921.39" "$3,921.39" "$3,921.39" $859.50 "$3,921.39" "$3,921.39" $756.60 $756.60 $785.70 $727.50 $854.70 "$3,921.39" "$1,568.56" "$3,921.39" "$3,921.39" "$3,921.39" "$3,921.39" "$3,921.39" "$2,941.13" "$3,921.39" "$3,921.39" "$3,921.39" "$1,960.70" "$1,960.70" "$3,105.74" "$3,921.39" "$3,137.11" "$1,764.63" "$3,921.39" "$3,921.39" "$2,274.47" "$3,921.39" "$2,352.83" "$3,921.39" "$3,921.39" "$3,921.39" N/A N/A 147298 ERX HCPCS J9155 55566-8403-01 DEGARELIX ACETATE(240 MG DOSE) 120 MG/VIAL SC SOLR BOTH IP/OP "$1,628.00" "$1,205.00" $324.80 "$1,627.83" $732.52 $732.52 $732.52 $732.52 $324.88 $324.88 $324.88 $339.28 $324.88 $337.79 $337.79 $350.78 $324.80 $381.59 $324.88 $325.12 $962.86 $324.88 "$1,627.83" $324.88 $341.12 "$1,221.00" $324.88 $324.88 $324.88 $813.92 $813.92 "$1,289.24" $324.88 "$1,302.26" $732.52 $363.39 $324.88 $944.24 $341.12 $471.08 $324.88 $363.39 $324.88 N/A N/A 147299 ERX HCPCS 25000001 99999-6013-32 SODIUM HYPOCHLORITE 0.125 % EX SOLN BOTH IP/OP $51.50 $38.00 $9.09 $51.09 $51.09 $51.09 $51.09 $51.09 $51.09 $51.09 $9.09 $51.09 $51.09 $37.92 $37.92 $39.38 $26.62 $10.65 $51.09 $20.44 $51.09 $51.09 $51.09 $51.09 $51.09 $38.63 $51.09 $51.09 $51.09 $25.55 $25.55 $40.46 $51.09 $40.87 $33.21 $51.09 $51.09 $29.87 $51.09 $30.65 $51.09 $51.09 $51.09 N/A N/A 147300 ERX HCPCS 25000001 99999-6013-33 SODIUM HYPOCHLORITE 0.25 % EX SOLN BOTH IP/OP $51.50 $38.00 $9.09 $51.09 $51.09 $51.09 $51.09 $51.09 $51.09 $51.09 $9.09 $51.09 $51.09 $37.92 $37.92 $39.38 $26.62 $10.65 $51.09 $20.44 $51.09 $51.09 $51.09 $51.09 $51.09 $38.63 $51.09 $51.09 $51.09 $25.55 $25.55 $40.46 $51.09 $40.87 $33.21 $51.09 $51.09 $29.87 $51.09 $30.65 $51.09 $51.09 $51.09 N/A N/A 147301 ERX HCPCS 25000001 99999-6013-34 SODIUM HYPOCHLORITE 0.5 % EX SOLN BOTH IP/OP $51.50 $38.00 $9.09 $51.09 $51.09 $51.09 $51.09 $51.09 $51.09 $51.09 $9.09 $51.09 $51.09 $37.92 $37.92 $39.38 $26.62 $10.65 $51.09 $20.44 $51.09 $51.09 $51.09 $51.09 $51.09 $38.63 $51.09 $51.09 $51.09 $25.55 $25.55 $40.46 $51.09 $40.87 $33.21 $51.09 $51.09 $29.87 $51.09 $30.65 $51.09 $51.09 $51.09 N/A N/A 147303 ERX HCPCS 25000001 00069-0284-03 PALBOCICLIB 75 MG PO TABS BOTH IP/OP "$2,300.50" "$1,702.00" $409.48 "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" $409.48 "$2,300.44" "$2,300.44" "$1,707.39" "$1,707.39" "$1,773.18" "$1,198.53" $479.44 "$2,300.44" $920.18 "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$1,725.38" "$2,300.44" "$2,300.44" "$2,300.44" "$1,150.22" "$1,150.22" "$1,821.95" "$2,300.44" "$1,840.35" "$1,495.29" "$2,300.44" "$2,300.44" "$1,334.29" "$2,300.44" "$1,380.26" "$2,300.44" "$2,300.44" "$2,300.44" N/A N/A 147304 ERX HCPCS 25000001 00069-0486-03 PALBOCICLIB 100 MG PO TABS BOTH IP/OP "$2,300.50" "$1,702.00" $409.48 "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" $409.48 "$2,300.44" "$2,300.44" "$1,707.39" "$1,707.39" "$1,773.18" "$1,198.53" $479.44 "$2,300.44" $920.18 "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$1,725.38" "$2,300.44" "$2,300.44" "$2,300.44" "$1,150.22" "$1,150.22" "$1,821.95" "$2,300.44" "$1,840.35" "$1,495.29" "$2,300.44" "$2,300.44" "$1,334.29" "$2,300.44" "$1,380.26" "$2,300.44" "$2,300.44" "$2,300.44" N/A N/A 147305 ERX HCPCS 25000001 00069-0688-03 PALBOCICLIB 125 MG PO TABS BOTH IP/OP "$2,300.50" "$1,702.00" $409.48 "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" $409.48 "$2,300.44" "$2,300.44" "$1,707.39" "$1,707.39" "$1,773.18" "$1,198.53" $479.44 "$2,300.44" $920.18 "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$2,300.44" "$1,725.38" "$2,300.44" "$2,300.44" "$2,300.44" "$1,150.22" "$1,150.22" "$1,821.95" "$2,300.44" "$1,840.35" "$1,495.29" "$2,300.44" "$2,300.44" "$1,334.29" "$2,300.44" "$1,380.26" "$2,300.44" "$2,300.44" "$2,300.44" N/A N/A 147355 ERX HCPCS J9227 00024-0654-01 ISATUXIMAB-IRFC 100 MG/5ML IV SOLN BOTH IP/OP "$2,355.00" "$1,743.00" $676.00 "$2,354.92" "$2,354.92" "$2,354.92" "$2,354.92" "$2,354.92" "$2,354.92" "$2,354.92" $676.00 "$2,354.92" "$2,354.92" $717.81 $717.81 $745.42 $690.20 $810.88 "$2,354.92" $941.97 "$2,354.92" "$2,354.92" "$2,354.92" "$2,354.92" "$2,354.92" "$1,766.25" "$2,354.92" "$2,354.92" "$2,354.92" "$1,177.46" "$1,177.46" "$1,865.10" "$2,354.92" "$1,883.94" "$1,059.71" "$2,354.92" "$2,354.92" "$1,365.90" "$2,354.92" "$1,412.95" "$2,354.92" "$2,354.92" "$2,354.92" N/A N/A 147356 ERX HCPCS J9227 00024-0656-01 ISATUXIMAB-IRFC 500 MG/25ML IV SOLN BOTH IP/OP "$10,275.50" "$7,604.00" "$3,380.00" "$10,275.07" "$10,275.07" "$10,275.07" "$10,275.07" "$10,275.07" "$10,275.07" "$10,275.07" "$3,380.00" "$10,275.07" "$10,275.07" "$3,589.04" "$3,589.04" "$3,727.08" "$3,451.00" "$4,054.38" "$10,275.07" "$4,110.03" "$10,275.07" "$10,275.07" "$10,275.07" "$10,275.07" "$10,275.07" "$7,706.63" "$10,275.07" "$10,275.07" "$10,275.07" "$5,137.54" "$5,137.54" "$8,137.86" "$10,275.07" "$8,220.06" "$4,623.78" "$10,275.07" "$10,275.07" "$5,959.79" "$10,275.07" "$6,165.04" "$10,275.07" "$10,275.07" "$10,275.07" N/A N/A 147467 ERX HCPCS 25000001 62559-0430-01 HYDROCORTISONE (PERIANAL) 1 % EX CREA BOTH IP/OP $215.00 $159.00 $38.24 $214.84 $214.84 $214.84 $214.84 $214.84 $214.84 $214.84 $38.24 $214.84 $214.84 $159.45 $159.45 $165.60 $111.93 $44.78 $214.84 $85.94 $214.84 $214.84 $214.84 $214.84 $214.84 $161.25 $214.84 $214.84 $214.84 $107.42 $107.42 $170.15 $214.84 $171.87 $139.65 $214.84 $214.84 $124.70 $214.84 $128.90 $214.84 $214.84 $214.84 N/A N/A 147827 ERX HCPCS Q5112 78206-0147-01 TRASTUZUMAB-DTTB 150 MG IV SOLR BOTH IP/OP "$3,704.00" "$2,741.00" $916.65 "$3,703.75" "$3,703.75" "$3,703.75" "$3,703.75" "$3,703.75" "$3,703.75" "$3,703.75" $998.25 "$3,703.75" "$3,703.75" $953.32 $953.32 $989.98 $916.65 "$1,076.92" "$3,703.75" "$1,481.50" "$3,703.75" "$3,703.75" "$3,703.75" "$3,703.75" "$3,703.75" "$2,778.00" "$3,703.75" "$3,703.75" "$3,703.75" "$1,851.88" "$1,851.88" "$2,933.37" "$3,703.75" "$2,963.00" "$1,666.69" "$3,703.75" "$3,703.75" "$2,148.32" "$3,703.75" "$2,222.25" "$3,703.75" "$3,703.75" "$3,703.75" N/A N/A 147869 ERX HCPCS J3490 61958-2901-01 REMDESIVIR 100 MG IV SOLR BOTH IP/OP "$1,666.50" "$1,233.00" $330.68 "$1,666.08" $749.74 $749.74 $749.74 $749.74 "$1,666.08" "$1,666.08" "$1,666.08" $347.25 "$1,666.08" "$1,666.08" "$1,666.08" "$1,666.08" "$1,666.08" $347.23 "$1,666.08" "$1,666.08" $985.49 "$1,666.08" "$1,666.08" "$1,666.08" "$1,666.08" "$1,249.88" "$1,666.08" "$1,666.08" "$1,666.08" $833.04 $833.04 "$1,319.54" "$1,666.08" "$1,332.86" $749.74 $330.68 "$1,666.08" $966.57 "$1,666.08" "$1,666.08" "$1,666.08" $347.21 "$1,666.08" N/A N/A 147917 ERX HCPCS 63700001 24338-0230-05 NIMODIPINE 6 MG/ML PO SOLN BOTH IP/OP $193.50 $143.00 $40.25 $193.13 $193.13 $193.13 $193.13 $193.13 $193.13 $193.13 $193.13 $193.13 $193.13 $193.13 $193.13 $193.13 $193.13 $40.25 $193.13 $77.25 $193.13 $193.13 $193.13 $193.13 $193.13 $145.13 $193.13 $193.13 $193.13 $96.57 $96.57 $152.96 $193.13 $154.50 $125.53 $193.13 $193.13 $112.23 $193.13 $115.88 $193.13 $193.13 $193.13 N/A N/A 147956 ERX HCPCS 25000001 51144-0001-60 TUCATINIB 50 MG PO TABS BOTH IP/OP $406.00 $300.00 $72.23 $405.79 $405.79 $405.79 $405.79 $405.79 $405.79 $405.79 $72.23 $405.79 $405.79 $301.18 $301.18 $312.78 $211.42 $84.57 $405.79 $162.32 $405.79 $405.79 $405.79 $405.79 $405.79 $304.50 $405.79 $405.79 $405.79 $202.90 $202.90 $321.39 $405.79 $324.63 $263.76 $405.79 $405.79 $235.48 $405.79 $243.47 $405.79 $405.79 $405.79 N/A N/A 147957 ERX HCPCS 25000001 51144-0002-12 TUCATINIB 150 MG PO TABS BOTH IP/OP $710.50 $526.00 $126.40 $710.13 $710.13 $710.13 $710.13 $710.13 $710.13 $710.13 $126.40 $710.13 $710.13 $527.06 $527.06 $547.37 $369.98 $148.00 $710.13 $284.05 $710.13 $710.13 $710.13 $710.13 $710.13 $532.88 $710.13 $710.13 $710.13 $355.07 $355.07 $562.42 $710.13 $568.10 $461.58 $710.13 $710.13 $412.09 $710.13 $426.08 $710.13 $710.13 $710.13 N/A N/A 147974 ERX HCPCS C9066 55135-0132-01 SACITUZUMAB GOVITECAN-HZIY 180 MG IV SOLR BOTH IP/OP "$6,397.50" "$4,734.00" "$1,333.37" "$6,397.35" "$2,878.81" "$2,878.81" "$2,878.81" "$2,878.81" "$2,250.58" "$2,250.58" "$2,250.58" "$1,333.37" "$2,250.58" "$2,340.75" "$2,340.75" "$2,430.78" "$2,250.72" "$2,644.24" "$2,250.58" "$2,343.74" "$3,153.89" "$2,250.58" "$6,397.35" "$2,250.58" "$2,363.10" "$4,798.13" "$2,250.58" "$2,250.58" "$2,250.58" "$3,198.68" "$3,198.68" "$5,066.70" "$2,250.58" "$5,117.88" "$2,878.81" "$2,518.11" "$2,250.58" "$3,710.55" "$2,363.10" "$3,263.34" "$2,250.58" "$2,518.11" "$2,250.58" N/A N/A 147993 ERX HCPCS J2250 44567-0610-10 MIDAZOLAM HCL-SODIUM CHLORIDE 50-0.8 MG/50ML-% IV SOLN BOTH IP/OP $77.50 $57.00 $5.50 $77.21 $34.74 $34.74 $34.74 $34.74 $77.21 $77.21 $77.21 $9.40 $77.21 $5.72 $5.72 $5.94 $5.50 $6.46 $77.21 $77.21 $45.67 $77.21 $77.21 $77.21 $77.21 $58.13 $77.21 $77.21 $77.21 $38.61 $38.61 $61.15 $77.21 $61.77 $34.74 $6.15 $77.21 $44.95 $77.21 $77.21 $77.21 $6.15 $77.21 N/A N/A 147994 ERX HCPCS J2250 51754-9131-01 MIDAZOLAM HCL-SODIUM CHLORIDE 100-0.8 MG/100ML-% IV SOLN BOTH IP/OP $120.50 $89.00 $11.00 $120.08 $54.04 $54.04 $54.04 $54.04 $120.08 $120.08 $120.08 $18.80 $120.08 $11.44 $11.44 $11.88 $11.00 $12.92 $120.08 $120.08 $71.03 $120.08 $120.08 $120.08 $120.08 $90.38 $120.08 $120.08 $120.08 $60.04 $60.04 $95.10 $120.08 $96.06 $54.04 $12.31 $120.08 $69.89 $120.08 $120.08 $120.08 $12.31 $120.08 N/A N/A 148314 ERX HCPCS Q5121 55513-0670-01 INFLIXIMAB-AXXQ 100 MG IV SOLR BOTH IP/OP "$1,602.00" "$1,185.00" $284.59 "$1,602.00" $720.90 $720.90 $720.90 $720.90 $453.04 $453.04 $453.04 $333.90 $453.04 $471.12 $471.12 $489.24 $453.00 $532.20 $453.04 $284.59 $947.58 $453.04 "$1,602.00" $453.04 $475.69 "$1,201.50" $453.04 $453.04 $453.04 $801.00 $801.00 "$1,268.78" $453.04 "$1,281.60" $720.90 $506.82 $453.04 $929.16 $475.69 $656.91 $453.04 $506.82 $453.04 N/A N/A 148342 ERX HCPCS J9144 57894-0503-01 DARATUMUMAB-HYALURONIDASE-FIHJ 1800-30000 MG-UT/15ML SC SOLN BOTH IP/OP "$25,496.00" "$18,867.00" "$5,313.92" "$25,495.61" "$11,473.02" "$11,473.02" "$11,473.02" "$11,473.02" "$8,106.12" "$8,106.12" "$8,106.12" "$5,313.92" "$8,106.12" "$8,429.62" "$8,429.62" "$8,753.83" "$8,105.40" "$9,522.56" "$8,106.12" "$8,677.44" "$12,569.34" "$8,106.12" "$25,495.61" "$8,106.12" "$8,511.43" "$19,122.00" "$8,106.12" "$8,106.12" "$8,106.12" "$12,747.81" "$12,747.81" "$20,192.52" "$8,106.12" "$20,396.49" "$11,473.02" "$7,712.84" "$8,106.12" "$14,787.68" "$8,511.43" "$11,753.87" "$8,106.12" "$8,098.48" "$8,106.12" N/A N/A 148429 ERX HCPCS 63600001 73207-0101-30 RIPRETINIB 50 MG PO TABS BOTH IP/OP "$1,346.00" $996.00 $239.53 "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" $239.53 "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" $280.45 "$1,345.68" $538.27 "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,009.50" "$1,345.68" "$1,345.68" "$1,345.68" $672.84 $672.84 "$1,065.78" "$1,345.68" "$1,076.54" $605.56 "$1,345.68" "$1,345.68" $780.68 "$1,345.68" $807.41 "$1,345.68" "$1,345.68" "$1,345.68" N/A N/A 148482 ERX HCPCS 25000001 70324-0326-03 SODIUM BICARBONATE-DEXTROSE 150-5 MEQ/L-% IV SOLN BOTH IP/OP $167.50 $124.00 $29.75 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $167.16 $29.75 $167.16 $167.16 $124.07 $124.07 $128.85 $87.09 $34.84 $167.16 $66.86 $167.16 $167.16 $167.16 $167.16 $167.16 $125.63 $167.16 $167.16 $167.16 $83.58 $83.58 $132.39 $167.16 $133.73 $108.65 $167.16 $167.16 $97.15 $167.16 $100.30 $167.16 $167.16 $167.16 N/A N/A 148628 ERX HCPCS J9223 68727-0712-01 LURBINECTEDIN 4 MG IV SOLR BOTH IP/OP "$21,361.50" "$15,808.00" "$4,452.26" "$21,361.44" "$9,612.65" "$9,612.65" "$9,612.65" "$9,612.65" "$7,209.28" "$7,209.28" "$7,209.28" "$4,452.26" "$7,209.28" "$7,497.57" "$7,497.57" "$7,785.94" "$7,209.20" "$8,469.66" "$7,209.28" "$7,532.00" "$10,531.19" "$7,209.28" "$21,361.44" "$7,209.28" "$7,569.74" "$16,021.13" "$7,209.28" "$7,209.28" "$7,209.28" "$10,680.72" "$10,680.72" "$16,918.26" "$7,209.28" "$17,089.15" "$9,612.65" "$7,712.84" "$7,209.28" "$12,389.67" "$7,569.74" "$10,453.46" "$7,209.28" "$8,065.65" "$7,209.28" N/A N/A 148640 ERX HCPCS 25000001 69374-0544-10 EPINEPHRINE 0.1 MG/10ML IV SOSY BOTH IP/OP $23.50 $17.00 $4.15 $23.33 $23.33 $23.33 $23.33 $23.33 $23.33 $23.33 $4.15 $23.33 $23.33 $17.32 $17.32 $17.98 $12.15 $4.86 $23.33 $9.33 $23.33 $23.33 $23.33 $23.33 $23.33 $17.63 $23.33 $23.33 $23.33 $11.67 $11.67 $18.48 $23.33 $18.66 $15.16 $23.33 $23.33 $13.63 $23.33 $14.00 $23.33 $23.33 $23.33 N/A N/A 148696 ERX HCPCS J9316 50242-0260-01 PERTUZ-TRASTUZ-HYALURON-ZZXF 60-60-2000 MG-MG-U/ML MAINTENANCE SC SOLN BOTH IP/OP "$23,685.00" "$17,527.00" "$4,936.53" "$23,684.92" "$10,658.21" "$10,658.21" "$10,658.21" "$10,658.21" "$8,598.12" "$8,598.12" "$8,598.12" "$4,936.53" "$8,598.12" "$8,941.92" "$8,941.92" "$9,285.84" "$8,598.00" "$10,101.28" "$8,598.12" "$8,212.80" "$11,676.67" "$8,598.12" "$23,684.92" "$8,598.12" "$9,028.03" "$17,763.75" "$8,598.12" "$8,598.12" "$8,598.12" "$11,842.46" "$11,842.46" "$18,758.46" "$8,598.12" "$18,947.94" "$10,658.21" "$7,712.84" "$8,598.12" "$13,737.30" "$9,028.03" "$12,467.27" "$8,598.12" "$8,098.48" "$8,598.12" N/A N/A 148697 ERX HCPCS J9316 50242-0245-01 PERTUZ-TRASTUZ-HYALURON-ZZXF 80-40-2000 MG-MG-U/ML LOAD SC SOLN BOTH IP/OP "$35,529.00" "$26,291.00" "$7,405.09" "$35,528.78" "$15,987.95" "$15,987.95" "$15,987.95" "$15,987.95" "$12,897.18" "$12,897.18" "$12,897.18" "$7,405.09" "$12,897.18" "$13,412.88" "$13,412.88" "$13,928.76" "$12,897.00" "$15,151.92" "$12,897.18" "$12,319.20" "$17,515.69" "$12,897.18" "$35,528.78" "$12,897.18" "$13,542.04" "$26,646.75" "$12,897.18" "$12,897.18" "$12,897.18" "$17,764.39" "$17,764.39" "$28,138.79" "$12,897.18" "$28,423.02" "$15,987.95" "$7,712.84" "$12,897.18" "$20,606.82" "$13,542.04" "$18,700.91" "$12,897.18" "$8,098.48" "$12,897.18" N/A N/A 148727 ERX HCPCS 63700001 49702-0250-18 FOSTEMSAVIR TROMETHAMINE ER 600 MG PO TB12 BOTH IP/OP $590.50 $437.00 $123.01 $590.23 $590.23 $590.23 $590.23 $590.23 $590.23 $590.23 $590.23 $590.23 $590.23 $590.23 $590.23 $590.23 $590.23 $123.01 $590.23 $236.09 $590.23 $590.23 $590.23 $590.23 $590.23 $442.88 $590.23 $590.23 $590.23 $295.12 $295.12 $467.46 $590.23 $472.18 $383.65 $590.23 $590.23 $342.49 $590.23 $354.14 $590.23 $590.23 $590.23 N/A N/A 148740 ERX HCPCS 63700001 00087-0405-01 POLY-VI-SOL/IRON 11 MG/ML PO SOLN BOTH IP/OP $43.00 $32.00 $8.87 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $42.56 $8.87 $42.56 $17.02 $42.56 $42.56 $42.56 $42.56 $42.56 $32.25 $42.56 $42.56 $42.56 $21.28 $21.28 $33.71 $42.56 $34.05 $27.66 $42.56 $42.56 $24.94 $42.56 $25.54 $42.56 $42.56 $42.56 N/A N/A 149207 ERX HCPCS 63700006 64842-0727-09 DECITABINE-CEDAZURIDINE 35-100 MG PO TABS BOTH IP/OP "$4,529.50" "$3,352.00" $943.97 "$4,529.39" "$4,529.39" "$4,529.39" "$4,529.39" "$4,529.39" "$4,529.39" "$4,529.39" "$4,529.39" "$4,529.39" "$4,529.39" "$4,529.39" "$4,529.39" "$4,529.39" "$4,529.39" $943.97 "$4,529.39" "$1,811.76" "$4,529.39" "$4,529.39" "$4,529.39" "$4,529.39" "$4,529.39" "$3,397.13" "$4,529.39" "$4,529.39" "$4,529.39" "$2,264.70" "$2,264.70" "$3,587.28" "$4,529.39" "$3,623.51" "$2,944.10" "$4,529.39" "$4,529.39" "$2,627.11" "$4,529.39" "$2,717.63" "$4,529.39" "$4,529.39" "$4,529.39" N/A N/A 149208 ERX HCPCS 25000001 00517-9305-01 TRACE MINERALS CU-MN-SE-ZN 300-55-60-3000 MCG/ML IV SOLN BOTH IP/OP $107.50 $80.00 $19.10 $107.31 $107.31 $107.31 $107.31 $107.31 $107.31 $107.31 $19.10 $107.31 $107.31 $79.65 $79.65 $82.71 $55.91 $22.36 $107.31 $42.92 $107.31 $107.31 $107.31 $107.31 $107.31 $80.63 $107.31 $107.31 $107.31 $53.66 $53.66 $84.99 $107.31 $85.85 $69.75 $107.31 $107.31 $62.35 $107.31 $64.39 $107.31 $107.31 $107.31 N/A N/A 149226 ERX HCPCS J9349 73535-0208-01 TAFASITAMAB-CXIX 200 MG/5 ML IV SOLN BOTH IP/OP "$3,561.50" "$2,636.00" "$1,262.00" "$3,561.08" "$3,561.08" "$3,561.08" "$3,561.08" "$3,561.08" "$3,561.08" "$3,561.08" "$1,262.00" "$3,561.08" "$3,561.08" "$1,331.20" "$1,331.20" "$1,382.40" "$1,280.00" "$1,503.80" "$3,561.08" "$1,424.43" "$3,561.08" "$3,561.08" "$3,561.08" "$3,561.08" "$3,561.08" "$2,671.13" "$3,561.08" "$3,561.08" "$3,561.08" "$1,780.54" "$1,780.54" "$2,820.38" "$3,561.08" "$2,848.86" "$1,602.49" "$3,561.08" "$3,561.08" "$2,065.67" "$3,561.08" "$2,136.65" "$3,561.08" "$3,561.08" "$3,561.08" N/A N/A 149257 ERX HCPCS J3370 70594-0056-01 VANCOMYCIN HCL 750 MG/150ML IV SOLN BOTH IP/OP $62.50 $46.00 $2.78 $62.21 $27.99 $27.99 $27.99 $27.99 $62.21 $62.21 $62.21 $3.62 $62.21 $2.89 $2.89 $3.00 $2.78 $3.27 $62.21 $62.21 $36.80 $62.21 $62.21 $62.21 $62.21 $46.88 $62.21 $62.21 $62.21 $31.11 $31.11 $49.27 $62.21 $49.77 $27.99 $3.11 $62.21 $36.25 $62.21 $62.21 $62.21 $3.11 $62.21 N/A N/A 149258 ERX HCPCS J3370 70594-0057-01 VANCOMYCIN HCL 1250 MG/250ML IV SOLN BOTH IP/OP $91.00 $67.00 $5.56 $90.55 $40.75 $40.75 $40.75 $40.75 $90.55 $90.55 $90.55 $7.24 $90.55 $5.78 $5.78 $6.00 $5.56 $6.53 $90.55 $90.55 $53.56 $90.55 $90.55 $90.55 $90.55 $68.25 $90.55 $90.55 $90.55 $45.28 $45.28 $71.72 $90.55 $72.44 $40.75 $6.22 $90.55 $52.78 $90.55 $90.55 $90.55 $6.22 $90.55 N/A N/A 149259 ERX HCPCS J3370 70594-0058-01 VANCOMYCIN HCL 1750 MG/350ML IV SOLN BOTH IP/OP $124.00 $92.00 $8.34 $123.98 $55.79 $55.79 $55.79 $55.79 $123.98 $123.98 $123.98 $10.86 $123.98 $8.67 $8.67 $9.01 $8.34 $9.80 $123.98 $123.98 $73.33 $123.98 $123.98 $123.98 $123.98 $93.00 $123.98 $123.98 $123.98 $61.99 $61.99 $98.19 $123.98 $99.18 $55.79 $9.33 $123.98 $71.92 $123.98 $123.98 $123.98 $9.33 $123.98 N/A N/A 149445 ERX HCPCS 63700006 00003-3764-74 APIXABAN STARTER PACK 5 MG PO TBPK BOTH IP/OP $48.50 $36.00 $10.10 $48.45 $48.45 $48.45 $48.45 $48.45 $48.45 $48.45 $48.45 $48.45 $48.45 $48.45 $48.45 $48.45 $48.45 $10.10 $48.45 $19.38 $48.45 $48.45 $48.45 $48.45 $48.45 $36.38 $48.45 $48.45 $48.45 $24.23 $24.23 $38.37 $48.45 $38.76 $31.49 $48.45 $48.45 $28.13 $48.45 $29.07 $48.45 $48.45 $48.45 N/A N/A 149629 ERX HCPCS J2250 44567-0611-01 MIDAZOLAM 100 MG/100ML IV SOLN BOTH IP/OP $120.50 $89.00 $11.00 $120.08 $54.04 $54.04 $54.04 $54.04 $120.08 $120.08 $120.08 $18.80 $120.08 $11.44 $11.44 $11.88 $11.00 $12.92 $120.08 $120.08 $71.03 $120.08 $120.08 $120.08 $120.08 $90.38 $120.08 $120.08 $120.08 $60.04 $60.04 $95.10 $120.08 $96.06 $54.04 $12.31 $120.08 $69.89 $120.08 $120.08 $120.08 $12.31 $120.08 N/A N/A 149943 ERX HCPCS J1303 25682-0025-01 RAVULIZUMAB-CWVZ 300 MG/3ML IV SOLN BOTH IP/OP "$17,906.00" "$13,250.00" "$3,731.97" "$17,905.59" "$8,057.52" "$8,057.52" "$8,057.52" "$8,057.52" "$6,738.96" "$6,738.96" "$6,738.96" "$3,731.97" "$6,738.96" "$7,008.46" "$7,008.46" "$7,278.01" "$6,738.90" "$7,917.14" "$6,738.96" "$6,669.69" "$8,827.46" "$6,738.96" "$17,905.59" "$6,738.96" "$7,075.91" "$13,429.50" "$6,738.96" "$6,738.96" "$6,738.96" "$8,952.80" "$8,952.80" "$14,181.23" "$6,738.96" "$14,324.47" "$8,057.52" "$7,539.48" "$6,738.96" "$10,385.48" "$7,075.91" "$9,771.49" "$6,738.96" "$7,539.48" "$6,738.96" N/A N/A 149944 ERX HCPCS J1303 25682-0028-01 RAVULIZUMAB-CWVZ 1100 MG/11ML IV SOLN BOTH IP/OP "$65,654.00" "$48,584.00" "$7,712.84" "$65,653.81" "$29,544.21" "$29,544.21" "$29,544.21" "$29,544.21" "$24,709.52" "$24,709.52" "$24,709.52" "$9,417.94" "$24,709.52" "$25,697.67" "$25,697.67" "$26,686.04" "$24,709.30" "$29,029.50" "$24,709.52" "$24,455.53" "$32,367.33" "$24,709.52" "$65,653.81" "$24,709.52" "$25,945.00" "$49,240.50" "$24,709.52" "$24,709.52" "$24,709.52" "$32,826.91" "$32,826.91" "$51,997.82" "$24,709.52" "$52,523.05" "$29,544.21" "$7,712.84" "$24,709.52" "$38,079.32" "$25,945.00" "$35,828.80" "$24,709.52" "$8,098.48" "$24,709.52" N/A N/A 150015 ERX HCPCS 25000001 65162-0833-66 DICLOFENAC SODIUM 1 % EX GEL BOTH IP/OP $196.50 $145.00 $34.92 $196.19 $196.19 $196.19 $196.19 $196.19 $196.19 $196.19 $34.92 $196.19 $196.19 $145.61 $145.61 $151.22 $102.21 $40.89 $196.19 $78.48 $196.19 $196.19 $196.19 $196.19 $196.19 $147.38 $196.19 $196.19 $196.19 $98.10 $98.10 $155.38 $196.19 $156.95 $127.52 $196.19 $196.19 $113.97 $196.19 $117.71 $196.19 $196.19 $196.19 N/A N/A 150511 ERX HCPCS 25000001 71390-0011-00 REMIMAZOLAM BESYLATE 20 MG IV SOLR BOTH IP/OP $197.50 $146.00 $35.15 $197.45 $197.45 $197.45 $197.45 $197.45 $197.45 $197.45 $35.15 $197.45 $197.45 $146.55 $146.55 $152.19 $102.87 $41.15 $197.45 $78.98 $197.45 $197.45 $197.45 $197.45 $197.45 $148.13 $197.45 $197.45 $197.45 $98.73 $98.73 $156.38 $197.45 $157.96 $128.34 $197.45 $197.45 $114.55 $197.45 $118.47 $197.45 $197.45 $197.45 N/A N/A 150593 ERX HCPCS 63600001 63361-0243-15 DTAP-IPV-HIB-HEPATITIS B RECMB IM SUSY BOTH IP/OP $607.50 $450.00 $108.10 $607.28 $607.28 $607.28 $607.28 $607.28 $607.28 $607.28 $108.10 $607.28 $607.28 $607.28 $607.28 $607.28 $607.28 $126.56 $607.28 $242.91 $607.28 $607.28 $607.28 $607.28 $607.28 $455.63 $607.28 $607.28 $607.28 $303.64 $303.64 $480.97 $607.28 $485.82 $273.28 $607.28 $607.28 $352.35 $607.28 $364.37 $607.28 $607.28 $607.28 N/A N/A 150673 ERX HCPCS Q5123 55513-0224-01 RITUXIMAB-ARRX 100 MG/10ML IV SOLN BOTH IP/OP "$2,297.00" "$1,700.00" $643.30 "$2,296.63" "$2,296.63" "$2,296.63" "$2,296.63" "$2,296.63" "$2,296.63" "$2,296.63" $722.30 "$2,296.63" "$2,296.63" $669.03 $669.03 $694.76 $643.30 $755.78 "$2,296.63" $918.65 "$2,296.63" "$2,296.63" "$2,296.63" "$2,296.63" "$2,296.63" "$1,722.75" "$2,296.63" "$2,296.63" "$2,296.63" "$1,148.32" "$1,148.32" "$1,818.93" "$2,296.63" "$1,837.30" "$1,033.48" "$2,296.63" "$2,296.63" "$1,332.26" "$2,296.63" "$1,377.98" "$2,296.63" "$2,296.63" "$2,296.63" N/A N/A 150674 ERX HCPCS Q5123 55513-0326-01 RITUXIMAB-ARRX 500 MG/50ML IV SOLN BOTH IP/OP "$10,021.00" "$7,416.00" "$3,216.50" "$10,020.87" "$10,020.87" "$10,020.87" "$10,020.87" "$10,020.87" "$10,020.87" "$10,020.87" "$3,611.50" "$10,020.87" "$10,020.87" "$3,345.16" "$3,345.16" "$3,473.82" "$3,216.50" "$3,778.88" "$10,020.87" "$4,008.35" "$10,020.87" "$10,020.87" "$10,020.87" "$10,020.87" "$10,020.87" "$7,515.75" "$10,020.87" "$10,020.87" "$10,020.87" "$5,010.44" "$5,010.44" "$7,936.53" "$10,020.87" "$8,016.70" "$4,509.39" "$10,020.87" "$10,020.87" "$5,812.18" "$10,020.87" "$6,012.52" "$10,020.87" "$10,020.87" "$10,020.87" N/A N/A 150677 ERX HCPCS 25000001 72974-0120-01 RELUGOLIX 120 MG PO TABS BOTH IP/OP $361.50 $268.00 $64.33 $361.41 $361.41 $361.41 $361.41 $361.41 $361.41 $361.41 $64.33 $361.41 $361.41 $268.24 $268.24 $278.57 $188.29 $75.32 $361.41 $144.56 $361.41 $361.41 $361.41 $361.41 $361.41 $271.13 $361.41 $361.41 $361.41 $180.71 $180.71 $286.24 $361.41 $289.13 $234.92 $361.41 $361.41 $209.67 $361.41 $216.85 $361.41 $361.41 $361.41 N/A N/A 150959 ERX HCPCS J0741 49702-0253-15 CABENUVA ER 400 & 600 MG/2ML IM BOTH IP/OP "$11,807.50" "$8,738.00" "$2,460.91" "$11,807.19" "$5,313.24" "$5,313.24" "$5,313.24" "$5,313.24" "$4,111.20" "$4,111.20" "$4,111.20" "$2,460.91" "$4,111.20" "$4,276.48" "$4,276.48" "$4,440.96" "$4,112.00" "$4,830.95" "$4,111.20" "$4,311.00" "$5,820.94" "$4,111.20" "$11,807.19" "$4,111.20" "$4,316.76" "$8,855.63" "$4,111.20" "$4,111.20" "$4,111.20" "$5,903.60" "$5,903.60" "$9,351.29" "$4,111.20" "$9,445.75" "$5,313.24" "$4,600.51" "$4,111.20" "$6,848.35" "$4,316.76" "$5,961.24" "$4,111.20" "$4,600.51" "$4,111.20" N/A N/A 150960 ERX HCPCS J0741 49702-0240-15 CABENUVA ER 600 & 900 MG/3ML IM BOTH IP/OP "$17,711.00" "$13,106.00" "$3,691.36" "$17,710.75" "$7,969.84" "$7,969.84" "$7,969.84" "$7,969.84" "$6,166.80" "$6,166.80" "$6,166.80" "$3,691.36" "$6,166.80" "$6,414.72" "$6,414.72" "$6,661.44" "$6,168.00" "$7,246.42" "$6,166.80" "$6,466.50" "$8,731.40" "$6,166.80" "$17,710.75" "$6,166.80" "$6,475.14" "$13,283.25" "$6,166.80" "$6,166.80" "$6,166.80" "$8,855.38" "$8,855.38" "$14,026.91" "$6,166.80" "$14,168.60" "$7,969.84" "$6,900.76" "$6,166.80" "$10,272.38" "$6,475.14" "$8,941.86" "$6,166.80" "$6,900.76" "$6,166.80" N/A N/A 151228 ERX HCPCS 25000001 00169-4130-13 SEMAGLUTIDE (1 MG/DOSE) 4 MG/3ML SC SOPN BOTH IP/OP "$2,616.50" "$1,936.00" $465.72 "$2,616.41" "$2,616.41" "$2,616.41" "$2,616.41" "$2,616.41" "$2,616.41" "$2,616.41" $465.72 "$2,616.41" "$2,616.41" "$1,941.90" "$1,941.90" "$2,016.73" "$1,363.15" $545.29 "$2,616.41" "$1,046.56" "$2,616.41" "$2,616.41" "$2,616.41" "$2,616.41" "$2,616.41" "$1,962.38" "$2,616.41" "$2,616.41" "$2,616.41" "$1,308.21" "$1,308.21" "$2,072.20" "$2,616.41" "$2,093.13" "$1,700.67" "$2,616.41" "$2,616.41" "$1,517.57" "$2,616.41" "$1,569.85" "$2,616.41" "$2,616.41" "$2,616.41" N/A N/A 151582 ERX HCPCS 63700001 00469-0725-60 ENZALUTAMIDE 80 MG PO TABS BOTH IP/OP "$1,458.00" "$1,079.00" $303.83 "$1,457.82" "$1,457.82" "$1,457.82" "$1,457.82" "$1,457.82" "$1,457.82" "$1,457.82" "$1,457.82" "$1,457.82" "$1,457.82" "$1,457.82" "$1,457.82" "$1,457.82" "$1,457.82" $303.83 "$1,457.82" $583.13 "$1,457.82" "$1,457.82" "$1,457.82" "$1,457.82" "$1,457.82" "$1,093.50" "$1,457.82" "$1,457.82" "$1,457.82" $728.91 $728.91 "$1,154.59" "$1,457.82" "$1,166.26" $947.58 "$1,457.82" "$1,457.82" $845.64 "$1,457.82" $874.69 "$1,457.82" "$1,457.82" "$1,457.82" N/A N/A 151592 ERX HCPCS J9353 74527-0022-02 MARGETUXIMAB-CMKB 250 MG/10ML IV SOLN BOTH IP/OP "$6,133.00" "$4,538.00" "$1,278.18" "$6,132.56" "$2,759.65" "$2,759.65" "$2,759.65" "$2,759.65" "$2,187.85" "$2,187.85" "$2,187.85" "$1,278.18" "$2,187.85" "$2,275.52" "$2,275.52" "$2,363.04" "$2,188.00" "$2,570.55" "$2,187.85" "$2,252.05" "$3,023.35" "$2,187.85" "$6,132.56" "$2,187.85" "$2,297.24" "$4,599.75" "$2,187.85" "$2,187.85" "$2,187.85" "$3,066.28" "$3,066.28" "$4,856.99" "$2,187.85" "$4,906.05" "$2,759.65" "$2,447.93" "$2,187.85" "$3,557.14" "$2,297.24" "$3,172.38" "$2,187.85" "$2,447.93" "$2,187.85" N/A N/A 151822 ERX HCPCS 63700001 57896-0752-01 VITAMIN E 400 UNITS PO CAPS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 152574 ERX HCPCS 25000001 08065-1999-07 NA HYALUR & NA CHOND-NA HYALUR 0.85-0.5 ML IO KIT BOTH IP/OP $960.50 $711.00 $170.89 $960.03 $960.03 $960.03 $960.03 $960.03 $960.03 $960.03 $170.89 $960.03 $960.03 $712.53 $712.53 $739.99 $500.18 $200.08 $960.03 $384.01 $960.03 $960.03 $960.03 $960.03 $960.03 $720.38 $960.03 $960.03 $960.03 $480.02 $480.02 $760.34 $960.03 $768.02 $624.02 $960.03 $960.03 $557.09 $960.03 $576.02 $960.03 $960.03 $960.03 N/A N/A 152715 ERX HCPCS 63700001 00024-1596-01 PRIMAQUINE (BASE) 15 MG (PRIMAQUINE PHOSPHATE 26.3 MG) PO TABS BOTH IP/OP $11.00 $8.00 $2.21 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $2.21 $10.61 $4.24 $10.61 $10.61 $10.61 $10.61 $10.61 $8.25 $10.61 $10.61 $10.61 $5.31 $5.31 $8.40 $10.61 $8.49 $6.90 $10.61 $10.61 $6.38 $10.61 $6.37 $10.61 $10.61 $10.61 N/A N/A 153192 ERX HCPCS 90677 00005-2000-10 PNEUMOCOCCAL 20-VAL CONJ VACC 0.5 ML IM SUSY BOTH IP/OP $920.00 $681.00 $182.58 $919.92 $413.96 $413.96 $413.96 $413.96 $919.92 $919.92 $264.74 $191.73 $919.92 $275.33 $275.33 $285.92 $264.74 $191.72 $919.92 $367.97 $544.13 $919.92 $919.92 $919.92 $919.92 $690.00 $919.92 $919.92 $919.92 $459.96 $459.96 $728.58 $919.92 $735.94 $413.96 $182.58 $919.92 $533.60 $919.92 $551.95 $919.92 $191.71 $919.92 N/A N/A 153222 ERX HCPCS C9086 00310-3040-00 ANIFROLUMAB-FNIA 300 MG/2ML IV SOLN BOTH IP/OP "$13,448.00" "$9,952.00" "$2,802.66" "$13,447.76" "$13,447.76" "$13,447.76" "$13,447.76" "$13,447.76" "$13,447.76" "$13,447.76" "$4,416.00" "$13,447.76" "$13,447.76" "$4,786.08" "$4,786.08" "$4,970.16" "$4,602.00" "$2,802.66" "$13,447.76" "$4,867.50" "$13,447.76" "$13,447.76" "$13,447.76" "$13,447.76" "$13,447.76" "$10,086.00" "$13,447.76" "$13,447.76" "$13,447.76" "$6,723.88" "$6,723.88" "$10,650.63" "$13,447.76" "$10,758.21" "$6,051.49" "$13,447.76" "$13,447.76" "$7,799.84" "$13,447.76" "$8,068.66" "$13,447.76" "$13,447.76" "$13,447.76" N/A N/A 153344 ERX HCPCS 25000001 00517-9302-01 TRACE MINERALS CU-MN-SE-ZN 60-3-6-1000 MCG/ML IV SOLN BOTH IP/OP $100.00 $74.00 $17.77 $99.82 $99.82 $99.82 $99.82 $99.82 $99.82 $99.82 $17.77 $99.82 $99.82 $74.09 $74.09 $76.94 $52.01 $20.80 $99.82 $39.93 $99.82 $99.82 $99.82 $99.82 $99.82 $75.00 $99.82 $99.82 $99.82 $49.91 $49.91 $79.06 $99.82 $79.86 $64.88 $99.82 $99.82 $58.00 $99.82 $59.89 $99.82 $99.82 $99.82 N/A N/A 153514 ERX HCPCS 25000001 00338-0519-58 FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL BOTH IP/OP $150.50 $111.00 $26.71 $150.05 $150.05 $150.05 $150.05 $150.05 $150.05 $150.05 $26.71 $150.05 $150.05 $111.37 $111.37 $115.66 $78.18 $31.27 $150.05 $60.02 $150.05 $150.05 $150.05 $150.05 $150.05 $112.88 $150.05 $150.05 $150.05 $75.03 $75.03 $118.84 $150.05 $120.04 $97.53 $150.05 $150.05 $87.29 $150.05 $90.03 $150.05 $150.05 $150.05 N/A N/A 153514 ERX HCPCS 25000001 00338-0519-13 FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL BOTH IP/OP $199.00 $147.00 $26.71 $150.05 $150.05 $150.05 $150.05 $150.05 $150.05 $150.05 $26.71 $150.05 $150.05 $111.37 $111.37 $115.66 $78.18 $31.27 $150.05 $60.02 $150.05 $150.05 $150.05 $150.05 $150.05 $149.25 $150.05 $150.05 $150.05 $75.03 $75.03 $118.84 $150.05 $120.04 $97.53 $150.05 $150.05 $115.42 $150.05 $90.03 $150.05 $150.05 $150.05 N/A N/A 153514 ERX HCPCS 25000001 00338-0519-09 FAT EMULSION PLANT BASED (SOY) 20 % IV EMUL BOTH IP/OP $202.50 $150.00 $26.71 $151.88 $150.05 $150.05 $150.05 $150.05 $150.05 $150.05 $26.71 $150.05 $150.05 $111.37 $111.37 $115.66 $78.18 $31.27 $150.05 $60.02 $150.05 $150.05 $150.05 $150.05 $150.05 $151.88 $150.05 $150.05 $150.05 $75.03 $75.03 $118.84 $150.05 $120.04 $97.53 $150.05 $150.05 $117.45 $150.05 $90.03 $150.05 $150.05 $150.05 N/A N/A 153516 ERX HCPCS J2354 67457-0239-00 OCTREOTIDE ACETATE 50 MCG/ML SC SOSY BOTH IP/OP $22.00 $16.00 $0.95 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $0.95 $22.00 $22.00 $1.01 $1.01 $1.05 $0.97 $1.14 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 153517 ERX HCPCS 63700002 67457-0245-00 OCTREOTIDE ACETATE 100 MCG/ML SC SOSY BOTH IP/OP $41.00 $30.00 $7.29 $40.96 $40.96 $40.96 $40.96 $40.96 $40.96 $40.96 $7.29 $40.96 $40.96 $40.96 $40.96 $40.96 $40.96 $8.54 $40.96 $16.38 $40.96 $40.96 $40.96 $40.96 $40.96 $30.75 $40.96 $40.96 $40.96 $20.48 $20.48 $32.44 $40.96 $32.77 $26.62 $40.96 $40.96 $23.78 $40.96 $24.58 $40.96 $40.96 $40.96 N/A N/A 153518 ERX HCPCS J2354 67457-0246-00 OCTREOTIDE ACETATE 500 MCG/ML SC SOSY BOTH IP/OP $190.00 $141.00 $19.00 $189.61 $189.61 $189.61 $189.61 $189.61 $189.61 $189.61 $19.00 $189.61 $189.61 $20.18 $20.18 $20.95 $19.40 $22.79 $189.61 $75.84 $189.61 $189.61 $189.61 $189.61 $189.61 $142.50 $189.61 $189.61 $189.61 $94.81 $94.81 $150.17 $189.61 $151.69 $123.25 $189.61 $189.61 $110.20 $189.61 $113.77 $189.61 $189.61 $189.61 N/A N/A 153523 ERX HCPCS 25000001 67684-1901-02 ETHIODIZED OIL 480 MG/ML IJ OIL BOTH IP/OP $510.00 $377.00 $90.72 $509.68 $509.68 $509.68 $509.68 $509.68 $509.68 $509.68 $90.72 $509.68 $509.68 $378.28 $378.28 $392.86 $265.54 $106.22 $509.68 $203.87 $509.68 $509.68 $509.68 $509.68 $509.68 $382.50 $509.68 $509.68 $509.68 $254.84 $254.84 $403.67 $509.68 $407.74 $331.29 $509.68 $509.68 $295.80 $509.68 $305.81 $509.68 $509.68 $509.68 N/A N/A 153524 ERX HCPCS 63700001 99999-6008-86 AMANTADINE HCL 50 MG/5ML PO SOLN BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 153529 ERX HCPCS 90734 49281-0589-05 MENING ACY&W-135 DIPHTH CONJ IM SOLN BOTH IP/OP $619.00 $458.00 $9.40 $618.87 $278.49 $278.49 $278.49 $278.49 $618.87 $618.87 $129.26 $9.40 $618.87 $140.16 $140.16 $145.55 $134.77 $158.33 $618.87 $247.55 $366.06 $618.87 $618.87 $618.87 $618.87 $464.25 $618.87 $618.87 $618.87 $309.44 $309.44 $490.15 $618.87 $495.10 $278.49 $150.78 $618.87 $359.02 $618.87 $371.32 $618.87 $150.78 $618.87 N/A N/A 153537 ERX HCPCS 63600001 58160-0812-52 DTAP-IPV VACCINE 0.5 ML IM SUSY BOTH IP/OP $253.00 $187.00 $45.03 $252.98 $252.98 $252.98 $252.98 $252.98 $252.98 $252.98 $45.03 $252.98 $252.98 $252.98 $252.98 $252.98 $252.98 $52.72 $252.98 $101.19 $252.98 $252.98 $252.98 $252.98 $252.98 $189.75 $252.98 $252.98 $252.98 $126.49 $126.49 $200.36 $252.98 $202.38 $113.84 $252.98 $252.98 $146.74 $252.98 $151.79 $252.98 $252.98 $252.98 N/A N/A 153538 ERX HCPCS 90715 58160-0842-52 TETANUS-DIPHTH-ACELL PERTUSSIS 5-2.5-18.5 LF-MCG/0.5 IM SUSY BOTH IP/OP $196.50 $145.00 $36.16 $196.34 $88.35 $88.35 $88.35 $88.35 $196.34 $196.34 $196.34 $40.92 $196.34 $37.61 $37.61 $39.05 $36.16 $42.48 $196.34 $196.34 $116.14 $196.34 $196.34 $196.34 $196.34 $147.38 $196.34 $196.34 $196.34 $98.17 $98.17 $155.50 $196.34 $157.07 $88.35 $40.46 $196.34 $113.97 $196.34 $196.34 $196.34 $40.46 $196.34 N/A N/A 153540 ERX HCPCS 25000001 00338-0520-13 FAT EMULSION PLANT BASED (SOY) 30 % IV EMUL BOTH IP/OP $267.00 $198.00 $47.47 $266.71 $266.71 $266.71 $266.71 $266.71 $266.71 $266.71 $47.47 $266.71 $266.71 $197.95 $197.95 $205.58 $138.96 $55.59 $266.71 $106.68 $266.71 $266.71 $266.71 $266.71 $266.71 $200.25 $266.71 $266.71 $266.71 $133.36 $133.36 $211.23 $266.71 $213.37 $173.36 $266.71 $266.71 $154.86 $266.71 $160.03 $266.71 $266.71 $266.71 N/A N/A 153541 ERX HCPCS J1670 13533-0634-02 TETANUS IMMUNE GLOBULIN 250 UNIT/ML IM SOSY BOTH IP/OP "$1,961.00" "$1,451.00" $441.70 "$1,960.53" "$1,960.53" "$1,960.53" "$1,960.53" "$1,960.53" "$1,960.53" "$1,960.53" $441.70 "$1,960.53" "$1,960.53" $501.36 $501.36 $520.65 $482.08 $566.37 "$1,960.53" $784.21 "$1,960.53" "$1,960.53" "$1,960.53" "$1,960.53" "$1,960.53" "$1,470.75" "$1,960.53" "$1,960.53" "$1,960.53" $980.27 $980.27 "$1,552.74" "$1,960.53" "$1,568.42" $882.24 "$1,960.53" "$1,960.53" "$1,137.38" "$1,960.53" "$1,176.32" "$1,960.53" "$1,960.53" "$1,960.53" N/A N/A 153543 ERX HCPCS 90371 13533-0636-03 HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5ML IM SOSY BOTH IP/OP $368.50 $273.00 $130.31 $368.31 $368.31 $368.31 $368.31 $368.31 $368.31 $368.31 $130.31 $368.31 $368.31 $141.01 $141.01 $146.44 $135.59 $159.30 $368.31 $147.32 $368.31 $368.31 $368.31 $368.31 $368.31 $276.38 $368.31 $368.31 $368.31 $184.16 $184.16 $291.70 $368.31 $294.65 $165.74 $368.31 $368.31 $213.73 $368.31 $220.99 $368.31 $368.31 $368.31 N/A N/A 153546 ERX HCPCS 90371 13533-0636-05 HEPATITIS B IMMUNE GLOBULIN 220 UNIT/ML IM SOLN BOTH IP/OP "$2,564.00" "$1,897.00" "$1,025.58" "$2,563.95" "$2,563.95" "$2,563.95" "$2,563.95" "$2,563.95" "$2,563.95" "$2,563.95" "$1,303.10" "$2,563.95" "$2,563.95" "$1,410.14" "$1,410.14" "$1,464.37" "$1,355.90" "$1,592.97" "$2,563.95" "$1,025.58" "$2,563.95" "$2,563.95" "$2,563.95" "$2,563.95" "$2,563.95" "$1,923.00" "$2,563.95" "$2,563.95" "$2,563.95" "$1,281.98" "$1,281.98" "$2,030.65" "$2,563.95" "$2,051.16" "$1,153.78" "$2,563.95" "$2,563.95" "$1,487.12" "$2,563.95" "$1,538.37" "$2,563.95" "$2,563.95" "$2,563.95" N/A N/A 153551 ERX HCPCS J3240 58468-0030-02 THYROTROPIN ALFA 0.9 MG IM SOLR BOTH IP/OP "$5,394.00" "$3,992.00" "$1,135.46" "$5,393.54" "$2,427.09" "$2,427.09" "$2,427.09" "$2,427.09" "$1,858.04" "$1,858.04" "$1,858.04" "$1,135.46" "$1,858.04" "$1,932.36" "$1,932.36" "$2,006.68" "$1,858.04" "$2,182.90" "$1,858.04" "$1,926.74" "$2,659.02" "$1,858.04" "$5,393.54" "$1,858.04" "$1,950.94" "$4,045.50" "$1,858.04" "$1,858.04" "$1,858.04" "$2,696.77" "$2,696.77" "$4,271.68" "$1,858.04" "$4,314.83" "$2,427.09" "$2,078.78" "$1,858.04" "$3,128.52" "$1,950.94" "$2,694.16" "$1,858.04" "$2,078.78" "$1,858.04" N/A N/A 153560 ERX HCPCS 25000001 08065-1839-05 NA CHONDROIT SULF-NA HYALURON 20-15 MG/0.5ML IO SOSY BOTH IP/OP $652.00 $482.00 $116.02 $651.78 $651.78 $651.78 $651.78 $651.78 $651.78 $651.78 $116.02 $651.78 $651.78 $483.75 $483.75 $502.39 $339.58 $135.84 $651.78 $260.71 $651.78 $651.78 $651.78 $651.78 $651.78 $489.00 $651.78 $651.78 $651.78 $325.89 $325.89 $516.21 $651.78 $521.42 $423.66 $651.78 $651.78 $378.16 $651.78 $391.07 $651.78 $651.78 $651.78 N/A N/A 153706 ERX HCPCS J9299 00003-3756-14 NIVOLUMAB 120 MG/12ML IV SOLN BOTH IP/OP "$10,058.00" "$7,443.00" "$2,096.26" "$10,057.61" "$4,525.92" "$4,525.92" "$4,525.92" "$4,525.92" "$3,509.40" "$3,509.40" "$3,509.40" "$2,096.26" "$3,509.40" "$3,650.40" "$3,650.40" "$3,790.80" "$3,510.00" "$4,123.69" "$3,509.40" "$3,589.32" "$4,958.40" "$3,509.40" "$10,057.61" "$3,509.40" "$3,684.87" "$7,543.50" "$3,509.40" "$3,509.40" "$3,509.40" "$5,028.81" "$5,028.81" "$7,965.63" "$3,509.40" "$8,046.09" "$4,525.92" "$3,926.99" "$3,509.40" "$5,833.64" "$3,684.87" "$5,088.63" "$3,509.40" "$3,926.99" "$3,509.40" N/A N/A 153812 ERX HCPCS J9273 51144-0003-01 TISOTUMAB VEDOTIN-TFTV 40 MG IV SOLR BOTH IP/OP "$17,760.50" "$13,143.00" "$3,161.32" "$17,760.20" "$17,760.20" "$17,760.20" "$17,760.20" "$17,760.20" "$17,760.20" "$17,760.20" "$3,161.32" "$17,760.20" "$17,760.20" "$17,760.20" "$17,760.20" "$17,760.20" "$17,760.20" "$3,701.42" "$17,760.20" "$7,104.08" "$17,760.20" "$17,760.20" "$17,760.20" "$17,760.20" "$17,760.20" "$13,320.38" "$17,760.20" "$17,760.20" "$17,760.20" "$8,880.10" "$8,880.10" "$14,066.08" "$17,760.20" "$14,208.16" "$7,992.09" "$17,760.20" "$17,760.20" "$10,301.09" "$17,760.20" "$10,656.12" "$17,760.20" "$17,760.20" "$17,760.20" N/A N/A 153866 ERX HCPCS 25000001 60267-0705-50 SODIUM THIOSULFATE 25 % IV SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 153883 ERX HCPCS 25000001 24571-0105-06 PRISMASOL BGK 4/2.5 32-4-2.5 MEQ/L EC SOLN BOTH IP/OP $304.50 $225.00 $54.17 $304.30 $304.30 $304.30 $304.30 $304.30 $304.30 $304.30 $54.17 $304.30 $304.30 $225.85 $225.85 $234.55 $158.54 $63.42 $304.30 $121.72 $304.30 $304.30 $304.30 $304.30 $304.30 $228.38 $304.30 $304.30 $304.30 $152.15 $152.15 $241.01 $304.30 $243.44 $197.80 $304.30 $304.30 $176.61 $304.30 $182.58 $304.30 $304.30 $304.30 N/A N/A 153885 ERX HCPCS 25000001 24571-0103-06 PRISMASOL BGK 2/3.5 32-2-3.5 MEQ/L EC SOLN BOTH IP/OP $304.50 $225.00 $54.17 $304.30 $304.30 $304.30 $304.30 $304.30 $304.30 $304.30 $54.17 $304.30 $304.30 $225.85 $225.85 $234.55 $158.54 $63.42 $304.30 $121.72 $304.30 $304.30 $304.30 $304.30 $304.30 $228.38 $304.30 $304.30 $304.30 $152.15 $152.15 $241.01 $304.30 $243.44 $197.80 $304.30 $304.30 $176.61 $304.30 $182.58 $304.30 $304.30 $304.30 N/A N/A 153889 ERX HCPCS 25000001 24571-0116-06 PHOXILLUM BK4/2.5 32-4-2.5-1 MEQ-MMOL/L EC SOLN BOTH IP/OP $358.00 $265.00 $63.72 $358.00 $358.00 $358.00 $358.00 $358.00 $358.00 $358.00 $63.72 $358.00 $358.00 $265.71 $265.71 $275.95 $186.52 $74.61 $358.00 $143.20 $358.00 $358.00 $358.00 $358.00 $358.00 $268.50 $358.00 $358.00 $358.00 $179.00 $179.00 $283.54 $358.00 $286.40 $232.70 $358.00 $358.00 $207.64 $358.00 $214.80 $358.00 $358.00 $358.00 N/A N/A 153912 ERX HCPCS 63700001 00904-5460-92 OYSTER SHELL CALCIUM W/D 500-5 MG-MCG PO TABS BOTH IP/OP $6.00 $4.00 $1.25 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 154328 ERX HCPCS 25000001 00132-0201-40 FLEET ENEMA RECTAL ENEM BOTH IP/OP $8.50 $6.00 $1.43 $8.05 $8.05 $8.05 $8.05 $8.05 $8.05 $8.05 $1.43 $8.05 $8.05 $5.97 $5.97 $6.20 $4.19 $1.68 $8.05 $3.22 $8.05 $8.05 $8.05 $8.05 $8.05 $6.38 $8.05 $8.05 $8.05 $4.03 $4.03 $6.38 $8.05 $6.44 $5.23 $8.05 $8.05 $4.93 $8.05 $4.83 $8.05 $8.05 $8.05 N/A N/A 154938 ERX HCPCS 25000001 42023-0237-10 VASOPRESSIN 0.2 UNIT/ML IV SOLN BOTH IP/OP $770.00 $570.00 $137.02 $769.80 $769.80 $769.80 $769.80 $769.80 $769.80 $769.80 $137.02 $769.80 $769.80 $571.35 $571.35 $593.36 $401.07 $160.43 $769.80 $307.92 $769.80 $769.80 $769.80 $769.80 $769.80 $577.50 $769.80 $769.80 $769.80 $384.90 $384.90 $609.68 $769.80 $615.84 $500.37 $769.80 $769.80 $446.60 $769.80 $461.88 $769.80 $769.80 $769.80 N/A N/A 155174 ERX HCPCS J0690 60505-6231-00 CEFAZOLIN SODIUM 2 G IJ SOLR BOTH IP/OP $22.00 $16.00 $1.39 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.39 $22.00 $1.60 $1.60 $1.66 $1.54 $1.81 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.72 $22.00 $12.76 $22.00 $22.00 $22.00 $1.72 $22.00 N/A N/A 155220 ERX HCPCS 25000001 08065-1830-85 SODIUM HYALURONATE 8.5 MG/0.85ML IO SOSY BOTH IP/OP $807.00 $597.00 $143.57 $806.59 $806.59 $806.59 $806.59 $806.59 $806.59 $806.59 $143.57 $806.59 $806.59 $598.65 $598.65 $621.72 $420.23 $168.10 $806.59 $322.64 $806.59 $806.59 $806.59 $806.59 $806.59 $605.25 $806.59 $806.59 $806.59 $403.30 $403.30 $638.82 $806.59 $645.27 $524.28 $806.59 $806.59 $468.06 $806.59 $483.95 $806.59 $806.59 $806.59 N/A N/A 155386 ERX HCPCS 25000001 00003-7125-11 NIVOLUMAB-RELATLIMAB-RMBW 240-80 MG/20ML IV SOLN BOTH IP/OP "$39,055.00" "$28,901.00" "$2,060.15" "$39,055.00" "$39,055.00" "$39,055.00" "$39,055.00" "$39,055.00" "$39,055.00" "$39,055.00" "$6,951.79" "$39,055.00" "$39,055.00" "$4,181.12" "$4,181.12" "$30,103.59" "$2,060.15" "$8,139.49" "$39,055.00" "$15,622.00" "$39,055.00" "$39,055.00" "$39,055.00" "$39,055.00" "$39,055.00" "$29,291.25" "$39,055.00" "$39,055.00" "$39,055.00" "$19,527.50" "$19,527.50" "$30,931.56" "$39,055.00" "$31,244.00" "$25,385.75" "$39,055.00" "$39,055.00" "$22,651.90" "$39,055.00" "$23,433.00" "$39,055.00" "$39,055.00" "$39,055.00" N/A N/A 157910 ERX HCPCS 25000001 00310-4535-30 TREMELIMUMAB-ACTL 300 MG/15ML IV SOLN BOTH IP/OP "$109,044.00" "$80,693.00" "$2,060.15" "$109,044.00" "$109,044.00" "$109,044.00" "$109,044.00" "$109,044.00" "$109,044.00" "$109,044.00" "$19,409.83" "$109,044.00" "$109,044.00" "$4,181.12" "$4,181.12" "$84,051.12" "$2,060.15" "$22,725.97" "$109,044.00" "$43,617.60" "$109,044.00" "$109,044.00" "$109,044.00" "$109,044.00" "$109,044.00" "$81,783.00" "$109,044.00" "$109,044.00" "$109,044.00" "$54,522.00" "$54,522.00" "$86,362.85" "$109,044.00" "$87,235.20" "$70,878.60" "$109,044.00" "$109,044.00" "$63,245.52" "$109,044.00" "$65,426.40" "$109,044.00" "$109,044.00" "$109,044.00" N/A N/A 157997 ERX HCPCS 25000001 24201-0002-01 LEVOTHYROXINE SODIUM 100 MCG/ML IV SOLN BOTH IP/OP $322.00 $238.00 $57.30 $321.92 $321.92 $321.92 $321.92 $321.92 $321.92 $321.92 $57.30 $321.92 $321.92 $238.93 $238.93 $248.14 $167.72 $67.09 $321.92 $128.77 $321.92 $321.92 $321.92 $321.92 $321.92 $241.50 $321.92 $321.92 $321.92 $160.96 $160.96 $254.96 $321.92 $257.54 $209.25 $321.92 $321.92 $186.76 $321.92 $193.15 $321.92 $321.92 $321.92 N/A N/A 158494 ERX HCPCS 63600001 61958-3002-01 LENACAPAVIR SODIUM 463.5 MG/1.5ML SC SOLN BOTH IP/OP "$54,522.00" "$40,346.00" "$9,704.92" "$54,522.00" "$54,522.00" "$54,522.00" "$54,522.00" "$54,522.00" "$54,522.00" "$54,522.00" "$9,704.92" "$54,522.00" "$54,522.00" "$54,522.00" "$54,522.00" "$54,522.00" "$54,522.00" "$11,362.98" "$54,522.00" "$21,808.80" "$54,522.00" "$54,522.00" "$54,522.00" "$54,522.00" "$54,522.00" "$40,891.50" "$54,522.00" "$54,522.00" "$54,522.00" "$27,261.00" "$27,261.00" "$43,181.42" "$54,522.00" "$43,617.60" "$24,534.90" "$54,522.00" "$54,522.00" "$31,622.76" "$54,522.00" "$32,713.20" "$54,522.00" "$54,522.00" "$54,522.00" N/A N/A 158684 ERX HCPCS 63700001 61958-3001-01 LENACAPAVIR SODIUM 4 X 300 MG PO TBPK BOTH IP/OP "$4,543.50" "$3,362.00" $946.92 "$4,543.50" "$4,543.50" "$4,543.50" "$4,543.50" "$4,543.50" "$4,543.50" "$4,543.50" "$4,543.50" "$4,543.50" "$4,543.50" "$4,543.50" "$4,543.50" "$4,543.50" "$4,543.50" $946.92 "$4,543.50" "$1,817.40" "$4,543.50" "$4,543.50" "$4,543.50" "$4,543.50" "$4,543.50" "$3,407.63" "$4,543.50" "$4,543.50" "$4,543.50" "$2,271.75" "$2,271.75" "$3,598.45" "$4,543.50" "$3,634.80" "$2,953.28" "$4,543.50" "$4,543.50" "$2,635.23" "$4,543.50" "$2,726.10" "$4,543.50" "$4,543.50" "$4,543.50" N/A N/A 158863 ERX HCPCS 63600001 72187-0101-03 ELACESTRANT HYDROCHLORIDE 86 MG PO TABS BOTH IP/OP "$1,521.50" "$1,126.00" $270.82 "$1,521.48" "$1,521.48" "$1,521.48" "$1,521.48" "$1,521.48" "$1,521.48" "$1,521.48" $270.82 "$1,521.48" "$1,521.48" "$1,521.48" "$1,521.48" "$1,521.48" "$1,521.48" $317.09 "$1,521.48" $608.59 "$1,521.48" "$1,521.48" "$1,521.48" "$1,521.48" "$1,521.48" "$1,141.13" "$1,521.48" "$1,521.48" "$1,521.48" $760.74 $760.74 "$1,205.01" "$1,521.48" "$1,217.18" $684.67 "$1,521.48" "$1,521.48" $882.47 "$1,521.48" $912.89 "$1,521.48" "$1,521.48" "$1,521.48" N/A N/A 158864 ERX HCPCS 63600001 72187-0102-03 ELACESTRANT HYDROCHLORIDE 345 MG PO TABS BOTH IP/OP "$2,282.50" "$1,689.00" $406.23 "$2,282.21" "$2,282.21" "$2,282.21" "$2,282.21" "$2,282.21" "$2,282.21" "$2,282.21" $406.23 "$2,282.21" "$2,282.21" "$2,282.21" "$2,282.21" "$2,282.21" "$2,282.21" $475.64 "$2,282.21" $912.88 "$2,282.21" "$2,282.21" "$2,282.21" "$2,282.21" "$2,282.21" "$1,711.88" "$2,282.21" "$2,282.21" "$2,282.21" "$1,141.11" "$1,141.11" "$1,807.51" "$2,282.21" "$1,825.77" "$1,026.99" "$2,282.21" "$2,282.21" "$1,323.85" "$2,282.21" "$1,369.33" "$2,282.21" "$2,282.21" "$2,282.21" N/A N/A 159283 ERX HCPCS J1744 69097-0664-34 ICATIBANT ACETATE 30 MG/3ML SC SOSY BOTH IP/OP "$29,610.00" "$21,911.00" "$4,879.92" "$29,609.97" "$29,609.97" "$29,609.97" "$29,609.97" "$29,609.97" "$29,609.97" "$29,609.97" "$4,879.92" "$29,609.97" "$29,609.97" "$5,286.53" "$5,286.53" "$5,489.86" "$5,083.20" "$6,171.04" "$29,609.97" "$11,843.99" "$29,609.97" "$29,609.97" "$29,609.97" "$29,609.97" "$29,609.97" "$22,207.50" "$29,609.97" "$29,609.97" "$29,609.97" "$14,804.99" "$14,804.99" "$23,451.10" "$29,609.97" "$23,687.98" "$13,324.49" "$29,609.97" "$29,609.97" "$17,173.80" "$29,609.97" "$17,765.98" "$29,609.97" "$29,609.97" "$29,609.97" N/A N/A 400291 ERX HCPCS J7040 00338-0049-03 SODIUM CHLORIDE 0.9 % IV BOLUS BOTH IP/OP $22.00 $16.00 $0.63 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.63 $22.00 $1.42 $1.42 $1.48 $1.37 $1.61 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.53 $22.00 $12.76 $22.00 $22.00 $22.00 $1.53 $22.00 N/A N/A 400292 ERX HCPCS 25000001 00338-0043-03 SODIUM CHLORIDE 0.45 % IV BOLUS BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 400293 ERX HCPCS 25000001 00338-0017-03 DEXTROSE 5 % IV BOLUS BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 400294 ERX HCPCS 25000001 00338-0089-03 DEXTROSE 5 % AND 0.9 % NACL IV BOLUS BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 400295 ERX HCPCS 25000001 00338-0085-03 DEXTROSE 5 % AND 0.45 % NACL IV BOLUS BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 400296 ERX HCPCS J7120 00338-0117-04 LACTATED RINGERS IV BOLUS ML BOTH IP/OP $23.00 $17.00 $1.13 $22.68 $10.21 $10.21 $10.21 $10.21 $22.68 $22.68 $22.68 $1.13 $22.68 $2.57 $2.57 $2.67 $2.47 $2.90 $22.68 $22.68 $13.42 $22.68 $22.68 $22.68 $22.68 $17.25 $22.68 $22.68 $22.68 $11.34 $11.34 $17.96 $22.68 $18.14 $10.21 $2.76 $22.68 $13.34 $22.68 $22.68 $22.68 $2.76 $22.68 N/A N/A 400297 ERX HCPCS 25000001 00264-7751-10 DEXTROSE 5 % IN LACTATED RINGERS IV BOLUS BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600002 ERX HCPCS 25000001 99999-6008-77 ACETIC ACID 6% SOLN BOTH IP/OP $11.00 $8.00 $1.96 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $1.96 $11.00 $11.00 $8.16 $8.16 $8.48 $5.73 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 600003 ERX HCPCS 25000001 99999-6012-80 ADULT MAGIC MOUTHWASH(MLX:BEN:NYS:LIDO) BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 600007 ERX HCPCS J0290 99999-6010-85 AMPICILLIN 1 G/100ML NS MB PLUS BOTH IP/OP $72.00 $53.00 $1.42 $71.51 $32.18 $32.18 $32.18 $32.18 $71.51 $71.51 $71.51 $5.22 $71.51 $1.48 $1.48 $1.53 $1.42 $1.67 $71.51 $71.51 $42.30 $71.51 $71.51 $71.51 $71.51 $54.00 $71.51 $71.51 $71.51 $35.76 $35.76 $56.64 $71.51 $57.21 $32.18 $1.59 $71.51 $41.76 $71.51 $71.51 $71.51 $1.59 $71.51 N/A N/A 600008 ERX HCPCS J0290 99999-6000-08 AMPICILLIN 2 G/ NS 100ML MB PLUS BOTH IP/OP $82.50 $61.00 $2.84 $82.09 $36.94 $36.94 $36.94 $36.94 $82.09 $82.09 $82.09 $10.43 $82.09 $2.95 $2.95 $3.07 $2.84 $3.34 $82.09 $82.09 $48.56 $82.09 $82.09 $82.09 $82.09 $61.88 $82.09 $82.09 $82.09 $41.05 $41.05 $65.02 $82.09 $65.67 $36.94 $3.18 $82.09 $47.85 $82.09 $82.09 $82.09 $3.18 $82.09 N/A N/A 600009 ERX HCPCS J0713 99999-6011-20 CEFTAZIDIME 1G/D5W 100 ML MB PLUS BOTH IP/OP $61.50 $46.00 $3.92 $61.08 $61.08 $61.08 $61.08 $61.08 $61.08 $61.08 $3.94 $61.08 $61.08 $4.08 $4.08 $4.23 $3.92 $12.73 $61.08 $24.43 $61.08 $61.08 $61.08 $61.08 $61.08 $46.13 $61.08 $61.08 $61.08 $30.54 $30.54 $48.38 $61.08 $48.86 $27.49 $61.08 $61.08 $35.67 $61.08 $36.65 $61.08 $61.08 $61.08 N/A N/A 600010 ERX HCPCS J0713 99999-6000-10 CEFTAZIDIME 2 G/D5W 100ML MB PLUS BOTH IP/OP $119.50 $88.00 $7.84 $119.12 $119.12 $119.12 $119.12 $119.12 $119.12 $119.12 $7.88 $119.12 $119.12 $8.15 $8.15 $8.47 $7.84 $24.83 $119.12 $47.65 $119.12 $119.12 $119.12 $119.12 $119.12 $89.63 $119.12 $119.12 $119.12 $59.56 $59.56 $94.34 $119.12 $95.30 $53.60 $119.12 $119.12 $69.31 $119.12 $71.47 $119.12 $119.12 $119.12 N/A N/A 600011 ERX HCPCS 25000001 99999-6011-16 NAFCILLIN 1 G/D5W 100 ML MB PLUS BOTH IP/OP $109.50 $81.00 $19.42 $109.09 $109.09 $109.09 $109.09 $109.09 $109.09 $109.09 $19.42 $109.09 $109.09 $80.97 $80.97 $84.09 $56.84 $22.74 $109.09 $43.64 $109.09 $109.09 $109.09 $109.09 $109.09 $82.13 $109.09 $109.09 $109.09 $54.55 $54.55 $86.40 $109.09 $87.27 $70.91 $109.09 $109.09 $63.51 $109.09 $65.45 $109.09 $109.09 $109.09 N/A N/A 600012 ERX HCPCS 25000001 99999-6000-12 NAFCILLIN 2GM/D5W 100ML MB PLUS BOTH IP/OP $162.50 $120.00 $28.88 $162.26 $162.26 $162.26 $162.26 $162.26 $162.26 $162.26 $28.88 $162.26 $162.26 $120.43 $120.43 $125.07 $84.54 $33.82 $162.26 $64.90 $162.26 $162.26 $162.26 $162.26 $162.26 $121.88 $162.26 $162.26 $162.26 $81.13 $81.13 $128.51 $162.26 $129.81 $105.47 $162.26 $162.26 $94.25 $162.26 $97.36 $162.26 $162.26 $162.26 N/A N/A 600013 ERX HCPCS J0743 99999-6000-13 IMIPENEM-CILAST 500MG/NS 100ML MB PLUS BOTH IP/OP $209.50 $155.00 $14.70 $209.18 $209.18 $209.18 $209.18 $209.18 $209.18 $209.18 $15.22 $209.18 $209.18 $15.29 $15.29 $15.88 $14.70 $17.27 $209.18 $83.67 $209.18 $209.18 $209.18 $209.18 $209.18 $157.13 $209.18 $209.18 $209.18 $104.59 $104.59 $165.67 $209.18 $167.34 $94.13 $209.18 $209.18 $121.51 $209.18 $125.51 $209.18 $209.18 $209.18 N/A N/A 600014 ERX HCPCS J0696 99999-6011-31 CEFTRIAXONE 1 G/D5W 100 ML MB PLUS BOTH IP/OP $52.00 $38.00 $1.92 $52.00 $23.40 $23.40 $23.40 $23.40 $52.00 $52.00 $52.00 $5.64 $52.00 $2.00 $2.00 $2.07 $1.92 $2.26 $52.00 $52.00 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $2.15 $52.00 $30.16 $52.00 $52.00 $52.00 $2.15 $52.00 N/A N/A 600015 ERX HCPCS J0295 99999-6000-15 AMPICILLIN-SULB 1.5 G/NS 50ML MB PLUS BOTH IP/OP $113.00 $84.00 $2.73 $112.51 $50.63 $50.63 $50.63 $50.63 $112.51 $112.51 $112.51 $4.24 $112.51 $2.84 $2.84 $2.95 $2.73 $3.21 $112.51 $112.51 $66.55 $112.51 $112.51 $112.51 $112.51 $84.75 $112.51 $112.51 $112.51 $56.26 $56.26 $89.11 $112.51 $90.01 $50.63 $3.05 $112.51 $65.54 $112.51 $112.51 $112.51 $3.05 $112.51 N/A N/A 600016 ERX HCPCS J0295 99999-6000-16 AMPICILLIN-SULB 3 G/NS 100ML MB PLUS BOTH IP/OP $146.50 $108.00 $5.46 $146.07 $65.73 $65.73 $65.73 $65.73 $146.07 $146.07 $146.07 $8.48 $146.07 $5.68 $5.68 $5.90 $5.46 $6.41 $146.07 $146.07 $86.40 $146.07 $146.07 $146.07 $146.07 $109.88 $146.07 $146.07 $146.07 $73.04 $73.04 $115.69 $146.07 $116.86 $65.73 $6.11 $146.07 $84.97 $146.07 $146.07 $146.07 $6.11 $146.07 N/A N/A 600017 ERX HCPCS j3370 99999-6000-17 VANCOMYCIN 1000 MG/250 ML D5W MB PLUS BOTH IP/OP $55.00 $41.00 $9.76 $54.81 $54.81 $54.81 $54.81 $54.81 $54.81 $54.81 $9.76 $54.81 $54.81 $54.81 $54.81 $54.81 $54.81 $11.42 $54.81 $21.92 $54.81 $54.81 $54.81 $54.81 $54.81 $41.25 $54.81 $54.81 $54.81 $27.41 $27.41 $43.41 $54.81 $43.85 $24.66 $54.81 $54.81 $31.90 $54.81 $32.89 $54.81 $54.81 $54.81 N/A N/A 600018 ERX HCPCS J0697 99999-6011-23 CEFUROXIME 0.75 G/D5W 100 ML MB PLUS BOTH IP/OP $102.00 $75.00 $1.99 $101.61 $101.61 $101.61 $101.61 $101.61 $101.61 $101.61 $2.01 $101.61 $101.61 $2.07 $2.07 $2.15 $1.99 $2.34 $101.61 $40.64 $101.61 $101.61 $101.61 $101.61 $101.61 $76.50 $101.61 $101.61 $101.61 $50.81 $50.81 $80.48 $101.61 $81.29 $45.72 $101.61 $101.61 $59.16 $101.61 $60.97 $101.61 $101.61 $101.61 N/A N/A 600019 ERX HCPCS J0697 99999-6000-19 CEFUROXIME 1.5 G/D5W 100ML MB PLUS BOTH IP/OP $130.50 $97.00 $3.98 $130.19 $130.19 $130.19 $130.19 $130.19 $130.19 $130.19 $4.02 $130.19 $130.19 $4.14 $4.14 $4.30 $3.98 $4.68 $130.19 $52.08 $130.19 $130.19 $130.19 $130.19 $130.19 $97.88 $130.19 $130.19 $130.19 $65.10 $65.10 $103.11 $130.19 $104.15 $58.59 $130.19 $130.19 $75.69 $130.19 $78.11 $130.19 $130.19 $130.19 N/A N/A 600020 ERX HCPCS J0690 99999-6000-20 CEFAZOLIN 1GM/D5W 50ML MB PLUS BOTH IP/OP $52.00 $38.00 $1.39 $52.00 $23.40 $23.40 $23.40 $23.40 $52.00 $52.00 $52.00 $1.39 $52.00 $1.60 $1.60 $1.66 $1.54 $1.81 $52.00 $52.00 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $1.72 $52.00 $30.16 $52.00 $52.00 $52.00 $1.72 $52.00 N/A N/A 600021 ERX HCPCS 25000001 99999-6000-21 DOXYCYCLINE 100MG/ NS 100ML MB PLUS BOTH IP/OP $113.00 $84.00 $20.06 $112.72 $112.72 $112.72 $112.72 $112.72 $112.72 $112.72 $20.06 $112.72 $112.72 $83.66 $83.66 $86.88 $58.73 $23.49 $112.72 $45.09 $112.72 $112.72 $112.72 $112.72 $112.72 $84.75 $112.72 $112.72 $112.72 $56.36 $56.36 $89.27 $112.72 $90.18 $73.27 $112.72 $112.72 $65.54 $112.72 $67.63 $112.72 $112.72 $112.72 N/A N/A 600022 ERX HCPCS j3370 99999-6000-22 VANCOMYCIN 500MG/100 ML D5W MB PLUS BOTH IP/OP $60.00 $44.00 $10.67 $59.95 $59.95 $59.95 $59.95 $59.95 $59.95 $59.95 $10.67 $59.95 $59.95 $59.95 $59.95 $59.95 $59.95 $12.49 $59.95 $23.98 $59.95 $59.95 $59.95 $59.95 $59.95 $45.00 $59.95 $59.95 $59.95 $29.98 $29.98 $47.48 $59.95 $47.96 $26.98 $59.95 $59.95 $34.80 $59.95 $35.97 $59.95 $59.95 $59.95 N/A N/A 600023 ERX HCPCS J0694 99999-6011-24 CEFOXITIN 1 G/D5W 100 ML MB PLUS BOTH IP/OP $122.50 $91.00 $4.68 $122.39 $55.08 $55.08 $55.08 $55.08 $122.39 $122.39 $122.39 $8.06 $122.39 $4.87 $4.87 $5.05 $4.68 $5.50 $122.39 $122.39 $72.39 $122.39 $122.39 $122.39 $122.39 $91.88 $122.39 $122.39 $122.39 $61.20 $61.20 $96.93 $122.39 $97.91 $55.08 $5.24 $122.39 $71.05 $122.39 $122.39 $122.39 $5.24 $122.39 N/A N/A 600027 ERX HCPCS J0694 99999-6000-27 CEFOXITIN 2 G/D5W 100ML MB PLUS BOTH IP/OP $110.50 $82.00 $9.36 $110.01 $49.50 $49.50 $49.50 $49.50 $110.01 $110.01 $110.01 $16.12 $110.01 $9.73 $9.73 $10.11 $9.36 $11.00 $110.01 $110.01 $65.07 $110.01 $110.01 $110.01 $110.01 $82.88 $110.01 $110.01 $110.01 $55.01 $55.01 $87.13 $110.01 $88.01 $49.50 $10.47 $110.01 $64.09 $110.01 $110.01 $110.01 $10.47 $110.01 N/A N/A 600028 ERX HCPCS 25000001 99999-6000-28 UVC FLUID 100ML BOTH IP/OP $36.50 $27.00 $6.41 $36.03 $36.03 $36.03 $36.03 $36.03 $36.03 $36.03 $6.41 $36.03 $36.03 $26.74 $26.74 $27.77 $18.77 $7.51 $36.03 $14.41 $36.03 $36.03 $36.03 $36.03 $36.03 $27.38 $36.03 $36.03 $36.03 $18.02 $18.02 $28.54 $36.03 $28.82 $23.42 $36.03 $36.03 $21.17 $36.03 $21.62 $36.03 $36.03 $36.03 N/A N/A 600029 ERX HCPCS 25000001 99999-6000-29 UAC FLUID 100ML BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600030 ERX HCPCS 25000001 99999-6000-30 PAL FLUID 100ML BOTH IP/OP $71.00 $53.00 $12.58 $70.70 $70.70 $70.70 $70.70 $70.70 $70.70 $70.70 $12.58 $70.70 $70.70 $52.47 $52.47 $54.50 $36.83 $14.73 $70.70 $28.28 $70.70 $70.70 $70.70 $70.70 $70.70 $53.25 $70.70 $70.70 $70.70 $35.35 $35.35 $55.99 $70.70 $56.56 $45.96 $70.70 $70.70 $41.18 $70.70 $42.42 $70.70 $70.70 $70.70 N/A N/A 600031 ERX HCPCS J0456 99999-6000-31 AZITHROMYCIN 500MG/D5W 250ML MB PLUS BOTH IP/OP $54.00 $40.00 $2.63 $53.67 $24.15 $24.15 $24.15 $24.15 $53.67 $53.67 $53.67 $11.19 $53.67 $2.74 $2.74 $2.84 $2.63 $11.19 $53.67 $53.67 $31.75 $53.67 $53.67 $53.67 $53.67 $40.50 $53.67 $53.67 $53.67 $26.84 $26.84 $42.51 $53.67 $42.94 $24.15 $10.65 $53.67 $31.32 $53.67 $53.67 $53.67 $53.67 $53.67 N/A N/A 600032 ERX HCPCS J0698 99999-6011-21 CEFOTAXIME 1 G/D5W 100 ML MB PLUS BOTH IP/OP $100.00 $74.00 $9.41 $99.54 $99.54 $99.54 $99.54 $99.54 $99.54 $99.54 $9.41 $99.54 $99.54 $10.19 $10.19 $10.58 $9.80 $11.51 $99.54 $39.82 $99.54 $99.54 $99.54 $99.54 $99.54 $75.00 $99.54 $99.54 $99.54 $49.77 $49.77 $78.84 $99.54 $79.63 $44.79 $99.54 $99.54 $58.00 $99.54 $59.72 $99.54 $99.54 $99.54 N/A N/A 600033 ERX HCPCS J2543 99999-6000-33 PIPERACIL-TAZO 2.25 G/D5W 50ML MB PLUS BOTH IP/OP $79.50 $59.00 $2.84 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $13.09 $79.43 $2.95 $2.95 $3.07 $2.84 $3.34 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $3.18 $79.43 $46.11 $79.43 $79.43 $79.43 $3.18 $79.43 N/A N/A 600034 ERX HCPCS J2543 99999-6000-34 PIPERACIL-TAZ 3.375 G/D5W 50ML MB PLUS BOTH IP/OP $98.50 $73.00 $4.26 $98.41 $44.28 $44.28 $44.28 $44.28 $98.41 $98.41 $98.41 $19.63 $98.41 $4.43 $4.43 $4.60 $4.26 $5.00 $98.41 $98.41 $58.21 $98.41 $98.41 $98.41 $98.41 $73.88 $98.41 $98.41 $98.41 $49.21 $49.21 $77.94 $98.41 $78.73 $44.28 $4.77 $98.41 $57.13 $98.41 $98.41 $98.41 $4.77 $98.41 N/A N/A 600035 ERX HCPCS J2543 99999-6000-35 PIPERACIL-TAZO 4.5 G/100 ML D5W MB PLUS BOTH IP/OP $106.50 $79.00 $5.68 $106.18 $47.78 $47.78 $47.78 $47.78 $106.18 $106.18 $106.18 $26.18 $106.18 $5.91 $5.91 $6.13 $5.68 $6.67 $106.18 $106.18 $62.81 $106.18 $106.18 $106.18 $106.18 $79.88 $106.18 $106.18 $106.18 $53.09 $53.09 $84.09 $106.18 $84.94 $47.78 $6.35 $106.18 $61.77 $106.18 $106.18 $106.18 $6.35 $106.18 N/A N/A 600036 ERX HCPCS J3010 99999-6000-36 FENTANYL 2000MCG/NS 100ML PREMIX BOTH IP/OP $247.50 $183.00 $13.40 $247.02 $111.16 $111.16 $111.16 $111.16 $247.02 $247.02 $247.02 $51.49 $247.02 $13.94 $13.94 $14.47 $13.40 $15.74 $247.02 $247.02 $146.11 $247.02 $247.02 $247.02 $247.02 $185.63 $247.02 $247.02 $247.02 $123.51 $123.51 $195.64 $247.02 $197.62 $111.16 $14.99 $247.02 $143.55 $247.02 $247.02 $247.02 $14.99 $247.02 N/A N/A 600037 ERX HCPCS J2250 99999-6000-37 MIDAZOLAM 50MG/NS 50ML PREMIX BOTH IP/OP $117.50 $87.00 $5.50 $117.06 $52.68 $52.68 $52.68 $52.68 $117.06 $117.06 $117.06 $9.40 $117.06 $5.72 $5.72 $5.94 $5.50 $6.46 $117.06 $117.06 $69.24 $117.06 $117.06 $117.06 $117.06 $88.13 $117.06 $117.06 $117.06 $58.53 $58.53 $92.71 $117.06 $93.65 $52.68 $6.15 $117.06 $68.15 $117.06 $117.06 $117.06 $6.15 $117.06 N/A N/A 600038 ERX HCPCS J1335 99999-6013-23 ERTAPENEM 1 G/NS 100ML MB PLUS BOTH IP/OP $263.50 $195.00 $48.96 $263.46 $263.46 $263.46 $263.46 $263.46 $263.46 $263.46 $56.48 $263.46 $263.46 $50.92 $50.92 $52.88 $48.96 $57.52 $263.46 $105.38 $263.46 $263.46 $263.46 $263.46 $263.46 $197.63 $263.46 $263.46 $263.46 $131.73 $131.73 $208.66 $263.46 $210.77 $118.56 $263.46 $263.46 $152.83 $263.46 $158.08 $263.46 $263.46 $263.46 N/A N/A 600040 ERX HCPCS J2185 99999-6000-40 MEROPENEM 1 G/NS 100 ML MB PLUS BOTH IP/OP $191.50 $142.00 $7.40 $191.04 $85.97 $85.97 $85.97 $85.97 $191.04 $191.04 $191.04 $39.82 $191.04 $7.70 $7.70 $7.99 $7.40 $8.69 $191.04 $191.04 $113.00 $191.04 $191.04 $191.04 $191.04 $143.63 $191.04 $191.04 $191.04 $95.52 $95.52 $151.30 $191.04 $152.83 $85.97 $8.28 $191.04 $111.07 $191.04 $191.04 $191.04 $8.28 $191.04 N/A N/A 600041 ERX HCPCS J2700 99999-6000-41 OXACILLIN 2 G/D5W 100ML MB PLUS BOTH IP/OP $135.50 $100.00 $10.24 $135.32 $135.32 $135.32 $135.32 $135.32 $135.32 $135.32 $10.24 $135.32 $135.32 $10.65 $10.65 $11.06 $10.24 $12.03 $135.32 $54.13 $135.32 $135.32 $135.32 $135.32 $135.32 $101.63 $135.32 $135.32 $135.32 $67.66 $67.66 $107.17 $135.32 $108.26 $60.89 $135.32 $135.32 $78.59 $135.32 $81.19 $135.32 $135.32 $135.32 N/A N/A 600042 ERX HCPCS J2700 99999-6011-22 OXACILLIN 1 G/D5W 100 ML MB PLUS BOTH IP/OP $106.00 $78.00 $5.12 $105.95 $105.95 $105.95 $105.95 $105.95 $105.95 $105.95 $5.12 $105.95 $105.95 $5.32 $5.32 $5.53 $5.12 $6.02 $105.95 $42.38 $105.95 $105.95 $105.95 $105.95 $105.95 $79.50 $105.95 $105.95 $105.95 $52.98 $52.98 $83.91 $105.95 $84.76 $47.68 $105.95 $105.95 $61.48 $105.95 $63.57 $105.95 $105.95 $105.95 N/A N/A 600043 ERX HCPCS J0696 99999-6011-32 CEFTRIAXONE 2 G/D5W 100 ML MB PLUS BOTH IP/OP $163.50 $121.00 $3.84 $163.06 $73.38 $73.38 $73.38 $73.38 $163.06 $163.06 $163.06 $11.28 $163.06 $3.99 $3.99 $4.15 $3.84 $4.51 $163.06 $163.06 $96.45 $163.06 $163.06 $163.06 $163.06 $122.63 $163.06 $163.06 $163.06 $81.53 $81.53 $129.14 $163.06 $130.45 $73.38 $4.30 $163.06 $94.83 $163.06 $163.06 $163.06 $4.30 $163.06 N/A N/A 600046 ERX HCPCS 25000001 99999-6000-46 TOBRAMYCIN FORT 95MG/7ML OPHTH SOLN BOTH IP/OP $43.50 $32.00 $7.69 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $7.69 $43.20 $43.20 $32.06 $32.06 $33.30 $22.51 $9.00 $43.20 $17.28 $43.20 $43.20 $43.20 $43.20 $43.20 $32.63 $43.20 $43.20 $43.20 $21.60 $21.60 $34.21 $43.20 $34.56 $28.08 $43.20 $43.20 $25.23 $43.20 $25.92 $43.20 $43.20 $43.20 N/A N/A 600048 ERX HCPCS 25000001 99999-6000-48 CEFAZOLIN FORT OPHTH 50 MG/ML 10ML BOTH IP/OP $54.00 $40.00 $9.61 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $54.00 $9.61 $54.00 $54.00 $40.08 $40.08 $41.62 $28.13 $11.25 $54.00 $21.60 $54.00 $54.00 $54.00 $54.00 $54.00 $40.50 $54.00 $54.00 $54.00 $27.00 $27.00 $42.77 $54.00 $43.20 $35.10 $54.00 $54.00 $31.32 $54.00 $32.40 $54.00 $54.00 $54.00 N/A N/A 600049 ERX HCPCS 25000001 99999-6000-49 VANCOMYCIN 30 MG/ML (3%) OPHTH SOLN BOTH IP/OP $90.50 $67.00 $16.06 $90.25 $90.25 $90.25 $90.25 $90.25 $90.25 $90.25 $16.06 $90.25 $90.25 $66.98 $66.98 $69.56 $47.02 $18.81 $90.25 $36.10 $90.25 $90.25 $90.25 $90.25 $90.25 $67.88 $90.25 $90.25 $90.25 $45.13 $45.13 $71.48 $90.25 $72.20 $58.66 $90.25 $90.25 $52.49 $90.25 $54.15 $90.25 $90.25 $90.25 N/A N/A 600051 ERX HCPCS 25000001 99999-6000-51 GENTAMICIN FORT 95MG/7ML OPHTH SOL BOTH IP/OP $43.50 $32.00 $7.69 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $7.69 $43.20 $43.20 $32.06 $32.06 $33.30 $22.51 $9.00 $43.20 $17.28 $43.20 $43.20 $43.20 $43.20 $43.20 $32.63 $43.20 $43.20 $43.20 $21.60 $21.60 $34.21 $43.20 $34.56 $28.08 $43.20 $43.20 $25.23 $43.20 $25.92 $43.20 $43.20 $43.20 N/A N/A 600052 ERX HCPCS 25000001 99999-6000-52 LEECH BOTH IP/OP $86.50 $64.00 $15.38 $86.40 $86.40 $86.40 $86.40 $86.40 $86.40 $86.40 $15.38 $86.40 $86.40 $64.13 $64.13 $66.60 $45.01 $18.01 $86.40 $34.56 $86.40 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $56.16 $86.40 $86.40 $50.17 $86.40 $51.84 $86.40 $86.40 $86.40 N/A N/A 600053 ERX HCPCS 25000001 99999-6000-53 BEER BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 600054 ERX HCPCS 25000001 99999-6000-54 L.E.T. TOPICAL GEL 3ML BOTH IP/OP $22.00 $16.00 $3.84 $21.60 $21.60 $21.60 $21.60 $21.60 $21.60 $21.60 $3.84 $21.60 $21.60 $16.03 $16.03 $16.65 $11.25 $4.50 $21.60 $8.64 $21.60 $21.60 $21.60 $21.60 $21.60 $16.50 $21.60 $21.60 $21.60 $10.80 $10.80 $17.11 $21.60 $17.28 $14.04 $21.60 $21.60 $12.76 $21.60 $12.96 $21.60 $21.60 $21.60 N/A N/A 600055 ERX HCPCS 25000001 99999-6000-55 MIDAZOLAM 2MG/1 ML ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600056 ERX HCPCS 25000001 99999-6000-56 MIDAZOLAM 5MG/2.5ML ORAL SYRINGE BOTH IP/OP $13.00 $10.00 $2.31 $12.96 $12.96 $12.96 $12.96 $12.96 $12.96 $12.96 $2.31 $12.96 $12.96 $9.62 $9.62 $9.99 $6.75 $2.70 $12.96 $5.18 $12.96 $12.96 $12.96 $12.96 $12.96 $9.75 $12.96 $12.96 $12.96 $6.48 $6.48 $10.26 $12.96 $10.37 $8.42 $12.96 $12.96 $7.54 $12.96 $7.78 $12.96 $12.96 $12.96 N/A N/A 600058 ERX HCPCS 25000001 99999-6000-58 METHADONE 1MG/1ML ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600060 ERX HCPCS 25000001 99999-6000-60 METHADONE 0.5MG/0.5ML ORAL SYRINGE (NICU) BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600061 ERX HCPCS 63700001 99999-6000-61 METHADONE 5MG/5ML ORAL SYRINGE BOTH IP/OP $11.00 $8.00 $2.25 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $10.80 $2.25 $10.80 $4.32 $10.80 $10.80 $10.80 $10.80 $10.80 $8.25 $10.80 $10.80 $10.80 $5.40 $5.40 $8.55 $10.80 $8.64 $7.02 $10.80 $10.80 $6.38 $10.80 $6.48 $10.80 $10.80 $10.80 N/A N/A 600062 ERX HCPCS 25000001 99999-6000-62 OXYCODONE LIQ 120MG/6ML ORAL SYRINGE BOTH IP/OP $30.00 $22.00 $5.29 $29.74 $29.74 $29.74 $29.74 $29.74 $29.74 $29.74 $5.29 $29.74 $29.74 $22.07 $22.07 $22.92 $15.49 $6.20 $29.74 $11.90 $29.74 $29.74 $29.74 $29.74 $29.74 $22.50 $29.74 $29.74 $29.74 $14.87 $14.87 $23.55 $29.74 $23.79 $19.33 $29.74 $29.74 $17.40 $29.74 $17.84 $29.74 $29.74 $29.74 N/A N/A 600063 ERX HCPCS 25000001 99999-6000-63 DIAZEPAM ELIXIR 1MG/ML ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600065 ERX HCPCS 63700001 99999-6000-65 OXANDROLONE 1MG/1ML ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600066 ERX HCPCS 63700001 99999-6000-66 OXANDROLONE 10MG/10ML ORAL SYRINGE BOTH IP/OP $665.50 $492.00 $138.66 $665.31 $665.31 $665.31 $665.31 $665.31 $665.31 $665.31 $665.31 $665.31 $665.31 $665.31 $665.31 $665.31 $665.31 $138.66 $665.31 $266.12 $665.31 $665.31 $665.31 $665.31 $665.31 $499.13 $665.31 $665.31 $665.31 $332.66 $332.66 $526.93 $665.31 $532.25 $432.45 $665.31 $665.31 $385.99 $665.31 $399.19 $665.31 $665.31 $665.31 N/A N/A 600067 ERX HCPCS 25000001 99999-6000-67 MORPHINE SULFATE 20MG/ML O/S 5ML BOTH IP/OP $12.00 $9.00 $2.11 $11.88 $11.88 $11.88 $11.88 $11.88 $11.88 $11.88 $2.11 $11.88 $11.88 $8.82 $8.82 $9.16 $6.19 $2.48 $11.88 $4.75 $11.88 $11.88 $11.88 $11.88 $11.88 $9.00 $11.88 $11.88 $11.88 $5.94 $5.94 $9.41 $11.88 $9.50 $7.72 $11.88 $11.88 $6.96 $11.88 $7.13 $11.88 $11.88 $11.88 N/A N/A 600068 ERX HCPCS 25000001 99999-6000-68 MORPHINE SULFATE 20MG/ML O/S 3ML BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600069 ERX HCPCS 25000001 99999-6000-69 MORPHINE SULFATE 20MG/ML O/S 2ML BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600079 ERX HCPCS 25000001 99999-6000-79 CALCITRIOL 1MCG/ML ORAL SYRINGE (NICU) BOTH IP/OP $52.00 $38.00 $9.17 $51.54 $51.54 $51.54 $51.54 $51.54 $51.54 $51.54 $9.17 $51.54 $51.54 $38.25 $38.25 $39.73 $26.85 $10.74 $51.54 $20.62 $51.54 $51.54 $51.54 $51.54 $51.54 $39.00 $51.54 $51.54 $51.54 $25.77 $25.77 $40.82 $51.54 $41.23 $33.50 $51.54 $51.54 $30.16 $51.54 $30.92 $51.54 $51.54 $51.54 N/A N/A 600107 ERX HCPCS 63700001 99999-6001-07 FUROSEMIDE 10MG/ML ORAL SYRINGE (NICU) BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600112 ERX HCPCS 25000001 99999-6001-12 ALUM-MG HYDRX-SIMETH 15ML ORAL SYRINGE BOTH IP/OP $19.50 $14.00 $3.46 $19.44 $19.44 $19.44 $19.44 $19.44 $19.44 $19.44 $3.46 $19.44 $19.44 $14.43 $14.43 $14.98 $10.13 $4.05 $19.44 $7.78 $19.44 $19.44 $19.44 $19.44 $19.44 $14.63 $19.44 $19.44 $19.44 $9.72 $9.72 $15.40 $19.44 $15.55 $12.64 $19.44 $19.44 $11.31 $19.44 $11.66 $19.44 $19.44 $19.44 N/A N/A 600126 ERX HCPCS 63700001 99999-6001-26 KALETRA 80MG/20MG/ML ORAL SYRINGE BOTH IP/OP $56.00 $41.00 $11.65 $55.91 $55.91 $55.91 $55.91 $55.91 $55.91 $55.91 $55.91 $55.91 $55.91 $55.91 $55.91 $55.91 $55.91 $11.65 $55.91 $22.36 $55.91 $55.91 $55.91 $55.91 $55.91 $42.00 $55.91 $55.91 $55.91 $27.96 $27.96 $44.28 $55.91 $44.73 $36.34 $55.91 $55.91 $32.48 $55.91 $33.55 $55.91 $55.91 $55.91 N/A N/A 600134 ERX HCPCS 63700001 99999-6001-34 POSACONAZOLE 200MG/5 ML ORAL SYRINGE BOTH IP/OP $114.00 $84.00 $23.68 $113.63 $113.63 $113.63 $113.63 $113.63 $113.63 $113.63 $113.63 $113.63 $113.63 $113.63 $113.63 $113.63 $113.63 $23.68 $113.63 $45.45 $113.63 $113.63 $113.63 $113.63 $113.63 $85.50 $113.63 $113.63 $113.63 $56.82 $56.82 $89.99 $113.63 $90.90 $73.86 $113.63 $113.63 $66.12 $113.63 $68.18 $113.63 $113.63 $113.63 N/A N/A 600137 ERX HCPCS 63700001 99999-6001-37 ERGOCALCIFEROL 8000 UNITS/ML (NICU) ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600138 ERX HCPCS 25000001 99999-6001-38 PENICILLIN VK 50MG/ML (NICU/PEDS) ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600141 ERX HCPCS 25000001 99999-6001-41 TRIFLUOPERAZINE 10MG/ML ORAL SYRINGE BOTH IP/OP $10.50 $8.00 $1.84 $10.33 $10.33 $10.33 $10.33 $10.33 $10.33 $10.33 $1.84 $10.33 $10.33 $7.67 $7.67 $7.96 $5.38 $2.15 $10.33 $4.13 $10.33 $10.33 $10.33 $10.33 $10.33 $7.88 $10.33 $10.33 $10.33 $5.17 $5.17 $8.18 $10.33 $8.26 $6.71 $10.33 $10.33 $6.09 $10.33 $6.20 $10.33 $10.33 $10.33 N/A N/A 600144 ERX HCPCS 63700001 99999-6001-44 ZIDOVUDINE 10MG/ML ORAL SYRINGE (NICU) BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600151 ERX HCPCS 25000001 99999-6001-51 BACLOFEN 1MG/ML ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600152 ERX HCPCS 25000001 99999-6001-52 BACLOFEN 10MG/ML ORAL SYRINGE HI CONC BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600153 ERX HCPCS 25000001 99999-6001-53 SIMETHICONE 40MG/0.6ML ORAL SYRINGE (NICU) BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600157 ERX HCPCS 25000001 99999-6001-57 LANSOPRAZOLE 3MG/ML ORAL SYRINGE (NICU) BOTH IP/OP $71.50 $53.00 $12.64 $71.03 $71.03 $71.03 $71.03 $71.03 $71.03 $71.03 $12.64 $71.03 $71.03 $52.72 $52.72 $54.75 $37.01 $14.80 $71.03 $28.41 $71.03 $71.03 $71.03 $71.03 $71.03 $53.63 $71.03 $71.03 $71.03 $35.52 $35.52 $56.26 $71.03 $56.82 $46.17 $71.03 $71.03 $41.47 $71.03 $42.62 $71.03 $71.03 $71.03 N/A N/A 600159 ERX HCPCS 63700001 99999-6001-59 MULTIPLE VIT W/IRON ORAL SYRINGE (NICU) BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600162 ERX HCPCS 25000001 99999-6001-62 PREDNISOLONE 9MG/3ML ORAL SYRINGE BOTH IP/OP $17.50 $13.00 $3.12 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $17.50 $3.12 $17.50 $17.50 $12.99 $12.99 $13.49 $9.12 $3.65 $17.50 $7.00 $17.50 $17.50 $17.50 $17.50 $17.50 $13.13 $17.50 $17.50 $17.50 $8.75 $8.75 $13.86 $17.50 $14.00 $11.38 $17.50 $17.50 $10.15 $17.50 $10.50 $17.50 $17.50 $17.50 N/A N/A 600163 ERX HCPCS 25000001 99999-6001-63 PREDNISOLONE 30MG/10ML ORAL SYRINGE BOTH IP/OP $179.50 $133.00 $31.88 $179.10 $179.10 $179.10 $179.10 $179.10 $179.10 $179.10 $31.88 $179.10 $179.10 $132.93 $132.93 $138.05 $93.31 $37.33 $179.10 $71.64 $179.10 $179.10 $179.10 $179.10 $179.10 $134.63 $179.10 $179.10 $179.10 $89.55 $89.55 $141.85 $179.10 $143.28 $116.42 $179.10 $179.10 $104.11 $179.10 $107.46 $179.10 $179.10 $179.10 N/A N/A 600164 ERX HCPCS 25000001 99999-6001-64 PREDNISOLONE 15MG/5ML ORAL SYRINGE BOTH IP/OP $29.50 $22.00 $5.19 $29.16 $29.16 $29.16 $29.16 $29.16 $29.16 $29.16 $5.19 $29.16 $29.16 $21.64 $21.64 $22.48 $15.19 $6.08 $29.16 $11.66 $29.16 $29.16 $29.16 $29.16 $29.16 $22.13 $29.16 $29.16 $29.16 $14.58 $14.58 $23.09 $29.16 $23.33 $18.95 $29.16 $29.16 $17.11 $29.16 $17.50 $29.16 $29.16 $29.16 N/A N/A 600166 ERX HCPCS 25000001 99999-6001-66 CHLORHEXIDINE MTHWASH 0.12% 1ML ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600175 ERX HCPCS 63700001 99999-6001-75 NYSTATIN 100000U/ML ORAL SYRINGE (NICU) BOTH IP/OP $9.00 $7.00 #N/A #N/A $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 #N/A $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600177 ERX HCPCS 63700001 99999-6001-77 NYSTATIN 200000U/2ML ORAL SYRNGE BOTH IP/OP $9.00 $7.00 #N/A #N/A $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 #N/A $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600181 ERX HCPCS 63700001 99999-6001-81 SODIUM CHLORIDE 4 MEQ/ML ORAL SYRINGE (NICU) BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600191 ERX HCPCS 63700001 99999-6001-91 FLUOXETINE 4MG/ML ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600199 ERX HCPCS 63700001 99999-6001-99 FLUPHENAZINE 2.5MG/5ML ORAL SYRINGE BOTH IP/OP $40.50 $30.00 $8.36 $40.09 $40.09 $40.09 $40.09 $40.09 $40.09 $40.09 $40.09 $40.09 $40.09 $40.09 $40.09 $40.09 $40.09 $8.36 $40.09 $16.04 $40.09 $40.09 $40.09 $40.09 $40.09 $30.38 $40.09 $40.09 $40.09 $20.05 $20.05 $31.75 $40.09 $32.07 $26.06 $40.09 $40.09 $23.49 $40.09 $24.05 $40.09 $40.09 $40.09 N/A N/A 600200 ERX HCPCS 63700001 99999-6002-00 FLUPHENAZINE 0.5MG/ML ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600206 ERX HCPCS 63700001 99999-6002-06 SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 1 BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600207 ERX HCPCS 63700001 99999-6002-07 SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 2 BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600208 ERX HCPCS 63700001 99999-6002-08 SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 3 BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600209 ERX HCPCS 63700001 99999-6002-09 SULFAMETHOXAZOLE-TMP SUSP 5ML O/S DOSE # 5 BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600210 ERX HCPCS 63700001 99999-6002-10 SULFAMETHOXAZOLE-TMP SUSP 20ML O/S DOSE # 6 BOTH IP/OP $10.50 $8.00 $2.16 $10.37 $10.37 $10.37 $10.37 $10.37 $10.37 $10.37 $10.37 $10.37 $10.37 $10.37 $10.37 $10.37 $10.37 $2.16 $10.37 $4.15 $10.37 $10.37 $10.37 $10.37 $10.37 $7.88 $10.37 $10.37 $10.37 $5.19 $5.19 $8.21 $10.37 $8.30 $6.74 $10.37 $10.37 $6.09 $10.37 $6.22 $10.37 $10.37 $10.37 N/A N/A 600211 ERX HCPCS 63700001 99999-6002-11 SULFAMETHOXAZOLE-TMP SUSP 1ML O/S DOSE # 4 BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600220 ERX HCPCS 63700001 99999-6014-75 MULTIPLE VITAMIN (NICU) ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600220 ERX HCPCS 63700001 99999-6002-20 MULTIPLE VITAMIN (NICU) ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600221 ERX HCPCS 25000001 99999-6002-21 GUAIFENESIN DM 1ML ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600231 ERX HCPCS 25000001 99999-6002-31 NITAZOXANIDE 100MG/5ML ORAL SYRNGE BOTH IP/OP $133.50 $99.00 $23.73 $133.33 $133.33 $133.33 $133.33 $133.33 $133.33 $133.33 $23.73 $133.33 $133.33 $98.96 $98.96 $102.77 $69.46 $27.79 $133.33 $53.33 $133.33 $133.33 $133.33 $133.33 $133.33 $100.13 $133.33 $133.33 $133.33 $66.67 $66.67 $105.60 $133.33 $106.66 $86.66 $133.33 $133.33 $77.43 $133.33 $80.00 $133.33 $133.33 $133.33 N/A N/A 600232 ERX HCPCS 25000001 99999-6002-32 BENADRYL/MAALOX 1:1 BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600237 ERX HCPCS 63700001 99999-6002-37 RISPERIDONE 2 MG/2 ML ORAL SYRINGE BOTH IP/OP $57.00 $42.00 $11.85 $56.86 $56.86 $56.86 $56.86 $56.86 $56.86 $56.86 $56.86 $56.86 $56.86 $56.86 $56.86 $56.86 $56.86 $11.85 $56.86 $22.74 $56.86 $56.86 $56.86 $56.86 $56.86 $42.75 $56.86 $56.86 $56.86 $28.43 $28.43 $45.03 $56.86 $45.49 $36.96 $56.86 $56.86 $33.06 $56.86 $34.12 $56.86 $56.86 $56.86 N/A N/A 600240 ERX HCPCS 25000001 99999-6002-40 HYDROMORPHONE 15000MCG/30ML NS PED BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600241 ERX HCPCS 25000001 99999-6002-41 HYDROMORPHONE 30000MCG/30ML NS PED BOTH IP/OP $43.00 $32.00 $7.63 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $42.86 $7.63 $42.86 $42.86 $31.81 $31.81 $33.04 $22.33 $8.93 $42.86 $17.14 $42.86 $42.86 $42.86 $42.86 $42.86 $32.25 $42.86 $42.86 $42.86 $21.43 $21.43 $33.95 $42.86 $34.29 $27.86 $42.86 $42.86 $24.94 $42.86 $25.72 $42.86 $42.86 $42.86 N/A N/A 600245 ERX HCPCS 25000001 99999-6010-93 AZTREONAM 1 G/100ML D5W MB PLUS BOTH IP/OP $201.00 $149.00 $35.75 $200.83 $200.83 $200.83 $200.83 $200.83 $200.83 $200.83 $35.75 $200.83 $200.83 $149.06 $149.06 $154.80 $104.63 $41.86 $200.83 $80.33 $200.83 $200.83 $200.83 $200.83 $200.83 $150.75 $200.83 $200.83 $200.83 $100.42 $100.42 $159.06 $200.83 $160.66 $130.54 $200.83 $200.83 $116.58 $200.83 $120.50 $200.83 $200.83 $200.83 N/A N/A 600246 ERX HCPCS 25000001 99999-6010-94 AZTREONAM 2 G/100ML D5W MB PLUS BOTH IP/OP $328.50 $243.00 $58.42 $328.22 $328.22 $328.22 $328.22 $328.22 $328.22 $328.22 $58.42 $328.22 $328.22 $243.60 $243.60 $252.99 $171.00 $68.40 $328.22 $131.29 $328.22 $328.22 $328.22 $328.22 $328.22 $246.38 $328.22 $328.22 $328.22 $164.11 $164.11 $259.95 $328.22 $262.58 $213.34 $328.22 $328.22 $190.53 $328.22 $196.93 $328.22 $328.22 $328.22 N/A N/A 600247 ERX HCPCS 25000001 99999-6002-47 KETAMINE 50MG/1 ML IV SYRINGE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600253 ERX HCPCS 25000001 99999-6002-53 AMPHOTERICIN B 5MCG/0.1ML OPHTH SYRINGE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600255 ERX HCPCS 25000001 99999-6002-55 GANCICLOVIR 2MG/0.1 ML OPHTH SYRINGE BOTH IP/OP $348.50 $258.00 $61.99 $348.24 $348.24 $348.24 $348.24 $348.24 $348.24 $348.24 $61.99 $348.24 $348.24 $258.46 $258.46 $268.42 $181.43 $72.58 $348.24 $139.30 $348.24 $348.24 $348.24 $348.24 $348.24 $261.38 $348.24 $348.24 $348.24 $174.12 $174.12 $275.81 $348.24 $278.59 $226.36 $348.24 $348.24 $202.13 $348.24 $208.94 $348.24 $348.24 $348.24 N/A N/A 600263 ERX HCPCS 25000001 99999-6002-63 NICARDIPINE 1MG/10ML NS BOTH IP/OP $166.00 $123.00 $29.54 $165.97 $165.97 $165.97 $165.97 $165.97 $165.97 $165.97 $29.54 $165.97 $165.97 $123.18 $123.18 $127.93 $86.47 $34.59 $165.97 $66.39 $165.97 $165.97 $165.97 $165.97 $165.97 $124.50 $165.97 $165.97 $165.97 $82.99 $82.99 $131.45 $165.97 $132.78 $107.88 $165.97 $165.97 $96.28 $165.97 $99.58 $165.97 $165.97 $165.97 N/A N/A 600273 ERX HCPCS 25000001 99999-6002-73 AMIKACIN 400MCG/0.1ML OPHTH SYRINGE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600283 ERX HCPCS 25000001 99999-6002-83 VORICONAZOLE 40MCG/0.1 ML NS OPHTH SYRINGE BOTH IP/OP $529.50 $392.00 $94.24 $529.46 $529.46 $529.46 $529.46 $529.46 $529.46 $529.46 $94.24 $529.46 $529.46 $392.97 $392.97 $408.11 $275.85 $110.35 $529.46 $211.78 $529.46 $529.46 $529.46 $529.46 $529.46 $397.13 $529.46 $529.46 $529.46 $264.73 $264.73 $419.33 $529.46 $423.57 $344.15 $529.46 $529.46 $307.11 $529.46 $317.68 $529.46 $529.46 $529.46 N/A N/A 600285 ERX HCPCS 25000001 99999-6002-85 COSYNTROPIN 1 MCG/1 ML (NICU) IV SYRINGE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600297 ERX HCPCS 25000001 99999-6002-97 NACL 0.45% FLUSH 2ML IV SYRINGE (NICU) BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600306 ERX HCPCS 25000001 99999-6003-06 CEFTAZIDIME 2.25MG/0.1ML OPHTH SYRINGE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600307 ERX HCPCS 25000001 99999-6003-07 VITAMIN A 5000U/0.1ML IM SYRINGE (NICU) BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600313 ERX HCPCS 25000001 99999-6003-13 VANCOMYCIN 0.75MG/0.1ML OPHTH SYRINGE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600314 ERX HCPCS 25000001 99999-6003-14 VANCOMYCIN 1MG/0.1ML OPHTH SYRINGE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600316 ERX HCPCS 25000001 99999-6003-16 VASOPRESSIN 4 UNITS/10 ML NS SYRINGE BOTH IP/OP $47.00 $35.00 $8.31 $46.66 $46.66 $46.66 $46.66 $46.66 $46.66 $46.66 $8.31 $46.66 $46.66 $34.63 $34.63 $35.97 $24.31 $9.72 $46.66 $18.66 $46.66 $46.66 $46.66 $46.66 $46.66 $35.25 $46.66 $46.66 $46.66 $23.33 $23.33 $36.95 $46.66 $37.33 $30.33 $46.66 $46.66 $27.26 $46.66 $28.00 $46.66 $46.66 $46.66 N/A N/A 600328 ERX HCPCS 25000001 99999-6003-28 HEPARIN FLUSH 1 UNIT/ML 0.45% NS (NICU) 6ML BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600333 ERX HCPCS J2997 99999-6003-33 ALTEPLASE 1MG/1 ML SW IV SYRINGE(NICU) BOTH IP/OP $589.50 $436.00 $87.57 $589.25 $265.16 $265.16 $265.16 $265.16 $87.67 $87.67 $87.67 $122.81 $87.67 $91.18 $91.18 $94.68 $87.67 $122.81 $87.67 $87.57 $348.54 $87.67 $589.25 $87.67 $92.05 $442.13 $87.67 $87.67 $87.67 $294.63 $294.63 $466.69 $87.67 $471.40 $265.16 $116.95 $87.67 $341.91 $92.05 $127.12 $87.67 $122.80 $87.67 N/A N/A 600340 ERX HCPCS 25000001 99999-6003-40 EPHEDRINE 50MG/10ML NS IV SYRINGE BOTH IP/OP $65.50 $48.00 $11.66 $65.50 $65.50 $65.50 $65.50 $65.50 $65.50 $65.50 $11.66 $65.50 $65.50 $48.61 $48.61 $50.49 $34.13 $13.65 $65.50 $26.20 $65.50 $65.50 $65.50 $65.50 $65.50 $49.13 $65.50 $65.50 $65.50 $32.75 $32.75 $51.88 $65.50 $52.40 $42.58 $65.50 $65.50 $37.99 $65.50 $39.30 $65.50 $65.50 $65.50 N/A N/A 600356 ERX HCPCS 25000001 99999-6003-56 ON-Q PUMP 270 ML 2 ML/HR SINGLE LUMEN BOTH IP/OP $559.50 $414.00 $99.51 $559.06 $559.06 $559.06 $559.06 $559.06 $559.06 $559.06 $99.51 $559.06 $559.06 $414.93 $414.93 $430.92 $291.27 $116.51 $559.06 $223.62 $559.06 $559.06 $559.06 $559.06 $559.06 $419.63 $559.06 $559.06 $559.06 $279.53 $279.53 $442.78 $559.06 $447.25 $363.39 $559.06 $559.06 $324.51 $559.06 $335.44 $559.06 $559.06 $559.06 N/A N/A 600357 ERX HCPCS 25000001 99999-6003-57 ON-Q PUMP 400 ML 4 ML/HR DUAL LUMEN BOTH IP/OP "$1,468.50" "$1,087.00" $261.39 "$1,468.50" "$1,468.50" "$1,468.50" "$1,468.50" "$1,468.50" "$1,468.50" "$1,468.50" $261.39 "$1,468.50" "$1,468.50" "$1,089.92" "$1,089.92" "$1,131.92" $765.09 $306.05 "$1,468.50" $587.40 "$1,468.50" "$1,468.50" "$1,468.50" "$1,468.50" "$1,468.50" "$1,101.38" "$1,468.50" "$1,468.50" "$1,468.50" $734.25 $734.25 "$1,163.05" "$1,468.50" "$1,174.80" $954.53 "$1,468.50" "$1,468.50" $851.73 "$1,468.50" $881.10 "$1,468.50" "$1,468.50" "$1,468.50" N/A N/A 600358 ERX HCPCS 25000001 99999-6003-58 ON-Q PUMP 400 ML 5 ML/HR SINGLE LUMEN BOTH IP/OP $793.00 $587.00 $141.11 $792.75 $792.75 $792.75 $792.75 $792.75 $792.75 $792.75 $141.11 $792.75 $792.75 $588.38 $588.38 $611.05 $413.02 $165.22 $792.75 $317.10 $792.75 $792.75 $792.75 $792.75 $792.75 $594.75 $792.75 $792.75 $792.75 $396.38 $396.38 $627.86 $792.75 $634.20 $515.29 $792.75 $792.75 $459.94 $792.75 $475.65 $792.75 $792.75 $792.75 N/A N/A 600359 ERX HCPCS 25000001 99999-6003-59 ON-Q C-BLOC PUMP 400ML BOTH IP/OP $906.00 $670.00 $161.27 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $906.00 $161.27 $906.00 $906.00 $672.43 $672.43 $698.34 $472.03 $188.82 $906.00 $362.40 $906.00 $906.00 $906.00 $906.00 $906.00 $679.50 $906.00 $906.00 $906.00 $453.00 $453.00 $717.55 $906.00 $724.80 $588.90 $906.00 $906.00 $525.48 $906.00 $543.60 $906.00 $906.00 $906.00 N/A N/A 600360 ERX HCPCS 25000001 99999-6003-60 FOSCARNET SODIUM 2.4MG/0.1ML OPHTH SYRINGE BOTH IP/OP $855.00 $633.00 $152.13 $854.66 $854.66 $854.66 $854.66 $854.66 $854.66 $854.66 $152.13 $854.66 $854.66 $634.33 $634.33 $658.77 $445.28 $178.12 $854.66 $341.86 $854.66 $854.66 $854.66 $854.66 $854.66 $641.25 $854.66 $854.66 $854.66 $427.33 $427.33 $676.89 $854.66 $683.73 $555.53 $854.66 $854.66 $495.90 $854.66 $512.80 $854.66 $854.66 $854.66 N/A N/A 600362 ERX HCPCS J0690 99999-6003-62 CEFAZOLIN 1GM/NS 50ML MB PLUS-OR ONLY BOTH IP/OP $52.00 $38.00 $1.39 $52.00 $23.40 $23.40 $23.40 $23.40 $52.00 $52.00 $52.00 $1.39 $52.00 $1.60 $1.60 $1.66 $1.54 $1.81 $52.00 $52.00 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $1.72 $52.00 $30.16 $52.00 $31.20 $52.00 $1.72 $52.00 N/A N/A 600364 ERX HCPCS J2543 99999-6003-64 PIPERACIL-TAZ 3.375 G/NS 50ML MB PLUS BOTH IP/OP $98.50 $73.00 $4.26 $98.41 $44.28 $44.28 $44.28 $44.28 $98.41 $98.41 $98.41 $19.63 $98.41 $4.43 $4.43 $4.60 $4.26 $5.00 $98.41 $98.41 $58.21 $98.41 $98.41 $98.41 $98.41 $73.88 $98.41 $98.41 $98.41 $49.21 $49.21 $77.94 $98.41 $78.73 $44.28 $4.77 $98.41 $57.13 $98.41 $98.41 $98.41 $4.77 $98.41 N/A N/A 600365 ERX HCPCS J2543 99999-6003-65 PIPERACIL-TAZO 4.5 G/NS 100ML MB PLUS BOTH IP/OP $106.50 $79.00 $5.68 $106.18 $47.78 $47.78 $47.78 $47.78 $106.18 $106.18 $106.18 $26.18 $106.18 $5.91 $5.91 $6.13 $5.68 $6.67 $106.18 $106.18 $62.81 $106.18 $106.18 $106.18 $106.18 $79.88 $106.18 $106.18 $106.18 $53.09 $53.09 $84.09 $106.18 $84.94 $47.78 $6.35 $106.18 $61.77 $106.18 $106.18 $106.18 $6.35 $106.18 N/A N/A 600367 ERX HCPCS J0694 99999-6011-25 CEFOXITIN 1 G/NS 100 ML MB PLUS-OR ONLY BOTH IP/OP $122.50 $91.00 $4.68 $122.39 $55.08 $55.08 $55.08 $55.08 $122.39 $122.39 $122.39 $8.06 $122.39 $4.87 $4.87 $5.05 $4.68 $5.50 $122.39 $122.39 $72.39 $122.39 $122.39 $122.39 $122.39 $91.88 $122.39 $122.39 $122.39 $61.20 $61.20 $96.93 $122.39 $97.91 $55.08 $5.24 $122.39 $71.05 $122.39 $122.39 $122.39 $5.24 $122.39 N/A N/A 600368 ERX HCPCS 25000001 99999-6003-68 PENICILLIN G 2 MU/NS 50ML-OR ONLY BOTH IP/OP $206.00 $152.00 $36.58 $205.53 $205.53 $205.53 $205.53 $205.53 $205.53 $205.53 $36.58 $205.53 $205.53 $152.54 $152.54 $158.42 $107.08 $42.83 $205.53 $82.21 $205.53 $205.53 $205.53 $205.53 $205.53 $154.50 $205.53 $205.53 $205.53 $102.77 $102.77 $162.78 $205.53 $164.42 $133.59 $205.53 $205.53 $119.48 $205.53 $123.32 $205.53 $205.53 $205.53 N/A N/A 600369 ERX HCPCS 25000001 99999-6003-69 DESMOPRESSIN 0.25 MCG/0.5 ML SYRINGE BOTH IP/OP $38.50 $28.00 $6.79 $38.13 $38.13 $38.13 $38.13 $38.13 $38.13 $38.13 $6.79 $38.13 $38.13 $28.30 $28.30 $29.39 $19.87 $7.95 $38.13 $15.25 $38.13 $38.13 $38.13 $38.13 $38.13 $28.88 $38.13 $38.13 $38.13 $19.07 $19.07 $30.20 $38.13 $30.50 $24.78 $38.13 $38.13 $22.33 $38.13 $22.88 $38.13 $38.13 $38.13 N/A N/A 600378 ERX HCPCS 25000001 99999-6003-78 KAOPECTATE AND BENADRYL 1:1 ORAL SOLUTION BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600380 ERX HCPCS 25000001 99999-6003-80 GENTAMICIN 0.5ML (80MG/ML) WITH 0.5ML OF DEXAMETHASONE-OR BOTH IP/OP $52.00 $38.00 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 600381 ERX HCPCS 25000001 99999-6003-81 "EPINEPHRINE 0.3ML (1:1000,1MG/ML) IN 500ML BSS PLUS-OR" BOTH IP/OP $103.50 $77.00 $18.36 $103.16 $103.16 $103.16 $103.16 $103.16 $103.16 $103.16 $18.36 $103.16 $103.16 $76.57 $76.57 $79.52 $53.75 $21.50 $103.16 $41.26 $103.16 $103.16 $103.16 $103.16 $103.16 $77.63 $103.16 $103.16 $103.16 $51.58 $51.58 $81.70 $103.16 $82.53 $67.05 $103.16 $103.16 $60.03 $103.16 $61.90 $103.16 $103.16 $103.16 N/A N/A 600382 ERX HCPCS 25000001 99999-6003-82 LIDOCAINE 2% 3ML/.75% MARCAINE 3ML/200MG WYDASE 1ML BOTH IP/OP $240.00 $178.00 $42.71 $239.94 $239.94 $239.94 $239.94 $239.94 $239.94 $239.94 $42.71 $239.94 $239.94 $178.08 $178.08 $184.95 $125.01 $50.01 $239.94 $95.98 $239.94 $239.94 $239.94 $239.94 $239.94 $180.00 $239.94 $239.94 $239.94 $119.97 $119.97 $190.03 $239.94 $191.95 $155.96 $239.94 $239.94 $139.20 $239.94 $143.96 $239.94 $239.94 $239.94 N/A N/A 600383 ERX HCPCS 25000001 99999-6003-83 SUGARCAINE MIXTURE 5ML-OR BOTH IP/OP $50.50 $37.00 $8.92 $50.13 $50.13 $50.13 $50.13 $50.13 $50.13 $50.13 $8.92 $50.13 $50.13 $37.21 $37.21 $38.64 $26.12 $10.45 $50.13 $20.05 $50.13 $50.13 $50.13 $50.13 $50.13 $37.88 $50.13 $50.13 $50.13 $25.07 $25.07 $39.70 $50.13 $40.10 $32.58 $50.13 $50.13 $29.29 $50.13 $30.08 $50.13 $50.13 $50.13 N/A N/A 600384 ERX HCPCS 25000001 99999-6003-84 LIDOCAINE/BUPIVACAINE/HYALURONIDASE - OR EYE BLOCK BOTH IP/OP $248.50 $184.00 $44.21 $248.39 $248.39 $248.39 $248.39 $248.39 $248.39 $248.39 $44.21 $248.39 $248.39 $184.36 $184.36 $191.46 $129.41 $51.77 $248.39 $99.36 $248.39 $248.39 $248.39 $248.39 $248.39 $186.38 $248.39 $248.39 $248.39 $124.20 $124.20 $196.72 $248.39 $198.71 $161.45 $248.39 $248.39 $144.13 $248.39 $149.03 $248.39 $248.39 $248.39 N/A N/A 600385 ERX HCPCS 25000001 99999-6003-85 LIDOCAINE/EPI/NS-OR TUMESCENT MIXTURE BOTH IP/OP $64.50 $48.00 $11.43 $64.21 $64.21 $64.21 $64.21 $64.21 $64.21 $64.21 $11.43 $64.21 $64.21 $47.66 $47.66 $49.49 $33.45 $13.38 $64.21 $25.68 $64.21 $64.21 $64.21 $64.21 $64.21 $48.38 $64.21 $64.21 $64.21 $32.11 $32.11 $50.85 $64.21 $51.37 $41.74 $64.21 $64.21 $37.41 $64.21 $38.53 $64.21 $64.21 $64.21 N/A N/A 600386 ERX HCPCS 25000001 99999-6003-86 LIDOCAINE 1% 14 ML/PAPAVERINE (30 MG/ML) 2 ML-OR BOTH IP/OP $55.50 $41.00 $9.84 $55.27 $55.27 $55.27 $55.27 $55.27 $55.27 $55.27 $9.84 $55.27 $55.27 $41.02 $41.02 $42.60 $28.80 $11.52 $55.27 $22.11 $55.27 $55.27 $55.27 $55.27 $55.27 $41.63 $55.27 $55.27 $55.27 $27.64 $27.64 $43.77 $55.27 $44.22 $35.93 $55.27 $55.27 $32.19 $55.27 $33.16 $55.27 $55.27 $55.27 N/A N/A 600389 ERX HCPCS 25000001 99999-6003-89 IOHEXOL 300 MG/ML 50 ML MIXED WITH 50ML STERILE WATER-OR GU BOTH IP/OP $253.50 $188.00 $45.05 $253.07 $253.07 $253.07 $253.07 $253.07 $253.07 $253.07 $45.05 $253.07 $253.07 $187.83 $187.83 $195.07 $131.85 $52.74 $253.07 $101.23 $253.07 $253.07 $253.07 $253.07 $253.07 $190.13 $253.07 $253.07 $253.07 $126.54 $126.54 $200.43 $253.07 $202.46 $164.50 $253.07 $253.07 $147.03 $253.07 $151.84 $253.07 $253.07 $253.07 N/A N/A 600390 ERX HCPCS 25000001 99999-6003-90 VASOPRESSIN 20 UNITS IN 50 ML NS - OR GYN BOTH IP/OP $52.00 $38.00 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 600391 ERX HCPCS 25000001 42023-0237-10 VASOPRESSIN 20 UNITS IN 100 ML - OR GYN BOTH IP/OP $785.00 $581.00 $139.69 $784.80 $784.80 $784.80 $784.80 $784.80 $784.80 $784.80 $139.69 $784.80 $784.80 $582.48 $582.48 $604.92 $408.88 $163.56 $784.80 $313.92 $784.80 $784.80 $784.80 $784.80 $784.80 $588.75 $784.80 $784.80 $784.80 $392.40 $392.40 $621.56 $784.80 $627.84 $510.12 $784.80 $784.80 $455.30 $784.80 $470.88 $784.80 $784.80 $784.80 N/A N/A 600392 ERX HCPCS 25000001 99999-6003-92 VASOPRESSIN 20 UNITS IN 200 ML OF NS - OR GYN BOTH IP/OP $52.00 $38.00 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 600393 ERX HCPCS 25000001 99999-6003-93 INDIGO CARMINE 5 ML/100 ML 0.9% SODIUM CHLORIDE -OR BOTH IP/OP $97.50 $72.00 $17.28 $97.08 $97.08 $97.08 $97.08 $97.08 $97.08 $97.08 $17.28 $97.08 $97.08 $72.05 $72.05 $74.83 $50.58 $20.23 $97.08 $38.83 $97.08 $97.08 $97.08 $97.08 $97.08 $73.13 $97.08 $97.08 $97.08 $48.54 $48.54 $76.89 $97.08 $77.66 $63.10 $97.08 $97.08 $56.55 $97.08 $58.25 $97.08 $97.08 $97.08 N/A N/A 600394 ERX HCPCS 25000001 99999-6003-94 INDIGO CARMINE 5 ML/200 ML 0.9% SODIUM CHLORIDE -OR BOTH IP/OP $97.50 $72.00 $17.28 $97.08 $97.08 $97.08 $97.08 $97.08 $97.08 $97.08 $17.28 $97.08 $97.08 $72.05 $72.05 $74.83 $50.58 $20.23 $97.08 $38.83 $97.08 $97.08 $97.08 $97.08 $97.08 $73.13 $97.08 $97.08 $97.08 $48.54 $48.54 $76.89 $97.08 $77.66 $63.10 $97.08 $97.08 $56.55 $97.08 $58.25 $97.08 $97.08 $97.08 N/A N/A 600395 ERX HCPCS 25000001 99999-6003-95 INDIGO CARMINE 5 ML/250 ML 0.9% SODIUM CHLORIDE -OR BOTH IP/OP $97.50 $72.00 $17.28 $97.08 $97.08 $97.08 $97.08 $97.08 $97.08 $97.08 $17.28 $97.08 $97.08 $72.05 $72.05 $74.83 $50.58 $20.23 $97.08 $38.83 $97.08 $97.08 $97.08 $97.08 $97.08 $73.13 $97.08 $97.08 $97.08 $48.54 $48.54 $76.89 $97.08 $77.66 $63.10 $97.08 $97.08 $56.55 $97.08 $58.25 $97.08 $97.08 $97.08 N/A N/A 600396 ERX HCPCS 25000001 99999-6003-96 INDIGO CARMINE 5 ML/300 ML 0.9% SODIUM CHLORIDE -OR BOTH IP/OP $97.50 $72.00 $17.28 $97.08 $97.08 $97.08 $97.08 $97.08 $97.08 $97.08 $17.28 $97.08 $97.08 $72.05 $72.05 $74.83 $50.58 $20.23 $97.08 $38.83 $97.08 $97.08 $97.08 $97.08 $97.08 $73.13 $97.08 $97.08 $97.08 $48.54 $48.54 $76.89 $97.08 $77.66 $63.10 $97.08 $97.08 $56.55 $97.08 $58.25 $97.08 $97.08 $97.08 N/A N/A 600397 ERX HCPCS J3475 42852-0902-05 MAGNESIUM SULFATE 2 G IN 50ML D5W PREMIX BOTH IP/OP $52.00 $38.00 $0.24 $52.00 $23.40 $23.40 $23.40 $23.40 $52.00 $52.00 $52.00 $0.24 $52.00 $2.54 $2.54 $2.64 $2.44 $2.87 $52.00 $52.00 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $2.73 $52.00 $30.16 $52.00 $52.00 $52.00 $2.73 $52.00 N/A N/A 600398 ERX HCPCS J3475 99999-6006-44 MAGNESIUM SULFATE 4 G IN 50ML D5W PREMIX BOTH IP/OP $22.00 $16.00 $0.47 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $0.47 $22.00 $5.08 $5.08 $5.27 $4.88 $5.73 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $5.46 $22.00 $12.76 $22.00 $22.00 $22.00 $5.46 $22.00 N/A N/A 600403 ERX HCPCS 25000001 99999-6007-22 FENTANYL 200MCG + 0.1% BUPIVACAINE/100ML NS EPIDURAL BOTH IP/OP $52.00 $38.00 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 600420 ERX HCPCS 25000001 99999-6008-76 ACETIC ACID 3% SOLN BOTH IP/OP $11.00 $8.00 $1.96 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $1.96 $11.00 $11.00 $8.16 $8.16 $8.48 $5.73 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 600421 ERX HCPCS 25000001 535rf-p401-0j NXSTAGE RFP 401 DIALYSIS SOLUTION BOTH IP/OP $95.00 $70.00 $16.83 $94.53 $94.53 $94.53 $94.53 $94.53 $94.53 $94.53 $16.83 $94.53 $94.53 $70.16 $70.16 $72.86 $49.25 $19.70 $94.53 $37.81 $94.53 $94.53 $94.53 $94.53 $94.53 $71.25 $94.53 $94.53 $94.53 $47.27 $47.27 $74.87 $94.53 $75.62 $61.44 $94.53 $94.53 $55.10 $94.53 $56.72 $94.53 $94.53 $94.53 N/A N/A 600422 ERX HCPCS 25000001 535rf-p400-0i NXSTAGE RFP 400 DIALYSIS SOLUTION BOTH IP/OP $95.00 $70.00 $16.83 $94.53 $94.53 $94.53 $94.53 $94.53 $94.53 $94.53 $16.83 $94.53 $94.53 $70.16 $70.16 $72.86 $49.25 $19.70 $94.53 $37.81 $94.53 $94.53 $94.53 $94.53 $94.53 $71.25 $94.53 $94.53 $94.53 $47.27 $47.27 $74.87 $94.53 $75.62 $61.44 $94.53 $94.53 $55.10 $94.53 $56.72 $94.53 $94.53 $94.53 N/A N/A 600423 ERX HCPCS 25000001 99999-6004-27 CLINDAMYCIN 50MG/ML OPHTH SOLN 5 ML BOTH IP/OP $50.50 $37.00 $8.92 $50.12 $50.12 $50.12 $50.12 $50.12 $50.12 $50.12 $8.92 $50.12 $50.12 $37.20 $37.20 $38.63 $26.11 $10.45 $50.12 $20.05 $50.12 $50.12 $50.12 $50.12 $50.12 $37.88 $50.12 $50.12 $50.12 $25.06 $25.06 $39.70 $50.12 $40.10 $32.58 $50.12 $50.12 $29.29 $50.12 $30.07 $50.12 $50.12 $50.12 N/A N/A 600435 ERX HCPCS 25000001 99999-6004-39 CHOCOLATE SYRUP BOTH IP/OP $11.00 $8.00 $1.96 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $1.96 $11.00 $11.00 $8.16 $8.16 $8.48 $5.73 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $8.25 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $6.38 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 600438 ERX HCPCS 25000001 99999-6005-87 OR NEOMYCIN-POLYMYXIN B (NEOSPORIN GU) 3 ML/3000 ML NS IR BOTH IP/OP $246.50 $182.00 $43.85 $246.37 $246.37 $246.37 $246.37 $246.37 $246.37 $246.37 $43.85 $246.37 $246.37 $182.86 $182.86 $189.90 $128.36 $51.35 $246.37 $98.55 $246.37 $246.37 $246.37 $246.37 $246.37 $184.88 $246.37 $246.37 $246.37 $123.19 $123.19 $195.13 $246.37 $197.10 $160.14 $246.37 $246.37 $142.97 $246.37 $147.82 $246.37 $246.37 $246.37 N/A N/A 600441 ERX HCPCS 25000001 99999-6004-41 PUMP PORTABLE (2 ML/HR) 100ML BOTH IP/OP $199.50 $148.00 $35.46 $199.23 $199.23 $199.23 $199.23 $199.23 $199.23 $199.23 $35.46 $199.23 $199.23 $147.87 $147.87 $153.57 $103.80 $41.52 $199.23 $79.69 $199.23 $199.23 $199.23 $199.23 $199.23 $149.63 $199.23 $199.23 $199.23 $99.62 $99.62 $157.79 $199.23 $159.38 $129.50 $199.23 $199.23 $115.71 $199.23 $119.54 $199.23 $199.23 $199.23 N/A N/A 600442 ERX HCPCS A4305 68065-1135-60 PUMP PORTABLE (0.5 ML/HR) 100ML BOTH IP/OP $199.50 $148.00 $6.79 $199.23 $199.23 $199.23 $199.23 $199.23 $199.23 $199.23 $6.79 $199.23 $199.23 $147.87 $147.87 $153.57 $103.80 $41.52 $199.23 $79.69 $199.23 $199.23 $199.23 $199.23 $199.23 $149.63 $199.23 $199.23 $199.23 $99.62 $99.62 $157.79 $199.23 $159.38 $129.50 $199.23 $199.23 $115.71 $199.23 $119.54 $199.23 $199.23 $199.23 N/A N/A 600443 ERX HCPCS 25000001 68065-1135-66 PUMP PORTABLE (2 ML/HR) 270ML BOTH IP/OP $199.50 $148.00 $35.46 $199.23 $199.23 $199.23 $199.23 $199.23 $199.23 $199.23 $35.46 $199.23 $199.23 $147.87 $147.87 $153.57 $103.80 $41.52 $199.23 $79.69 $199.23 $199.23 $199.23 $199.23 $199.23 $149.63 $199.23 $199.23 $199.23 $99.62 $99.62 $157.79 $199.23 $159.38 $129.50 $199.23 $199.23 $115.71 $199.23 $119.54 $199.23 $199.23 $199.23 N/A N/A 600444 ERX HCPCS 25000001 68065-1135-68 PUMP PORTABLE (5 ML/HR) 270ML BOTH IP/OP $199.50 $148.00 $35.46 $199.23 $199.23 $199.23 $199.23 $199.23 $199.23 $199.23 $35.46 $199.23 $199.23 $147.87 $147.87 $153.57 $103.80 $41.52 $199.23 $79.69 $199.23 $199.23 $199.23 $199.23 $199.23 $149.63 $199.23 $199.23 $199.23 $99.62 $99.62 $157.79 $199.23 $159.38 $129.50 $199.23 $199.23 $115.71 $199.23 $119.54 $199.23 $199.23 $199.23 N/A N/A 600450 ERX HCPCS 25000001 99999-6004-58 PENICILLIN 160 UNITS/ML D5W DESENSITIZATION BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600453 ERX HCPCS J1644 15082-0747-99 HEPARIN 4000 UNITS/1000 ML NS IR BOTH IP/OP $135.50 $100.00 $0.94 $135.32 $19.44 $19.44 $19.44 $19.44 $135.32 $135.32 $135.32 $0.94 $135.32 $1.04 $1.04 $1.08 $1.00 $1.17 $135.32 $43.20 $25.55 $43.20 $43.20 $135.32 $43.20 $101.63 $43.20 $43.20 $135.32 $21.60 $21.60 $34.21 $43.20 $34.56 $19.44 $1.12 $135.32 $78.59 $43.20 $135.32 $135.32 $1.12 $135.32 N/A N/A 600456 ERX HCPCS 25000001 99999-6005-64 DEXTROSE 5% FLUSH 2 ML IV SYRINGE (NICU) BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600457 ERX HCPCS 25000001 00338-0023-03 DEXTROSE 10% (NICU) IV BOLUS SYRINGE BOTH IP/OP $30.50 $23.00 $5.38 $30.24 $30.24 $30.24 $30.24 $30.24 $30.24 $30.24 $5.38 $30.24 $30.24 $22.44 $22.44 $23.31 $15.76 $6.30 $30.24 $12.10 $30.24 $30.24 $30.24 $30.24 $30.24 $22.88 $30.24 $30.24 $30.24 $15.12 $15.12 $23.95 $30.24 $24.19 $19.66 $30.24 $30.24 $17.69 $30.24 $18.14 $30.24 $30.24 $30.24 N/A N/A 600493 ERX HCPCS 25000001 99999-6005-84 MYCOPHENOLATE MOFETIL 200 MG/ML ORAL SYRINGE BOTH IP/OP $28.50 $21.00 $5.04 $28.33 $28.33 $28.33 $28.33 $28.33 $28.33 $28.33 $5.04 $28.33 $28.33 $21.03 $21.03 $21.84 $14.76 $5.90 $28.33 $11.33 $28.33 $28.33 $28.33 $28.33 $28.33 $21.38 $28.33 $28.33 $28.33 $14.17 $14.17 $22.44 $28.33 $22.66 $18.41 $28.33 $28.33 $16.53 $28.33 $17.00 $28.33 $28.33 $28.33 N/A N/A 600496 ERX HCPCS 63700001 99999-6005-77 VITAMIN K 1 MG/ML (NICU) ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600499 ERX HCPCS 25000001 99999-6005-65 AMPHOTERICIN 1MG/ML (NICU) COMPOUNDING BOTH IP/OP $98.00 $73.00 $17.36 $97.51 $97.51 $97.51 $97.51 $97.51 $97.51 $97.51 $17.36 $97.51 $97.51 $72.37 $72.37 $75.16 $50.80 $20.32 $97.51 $39.00 $97.51 $97.51 $97.51 $97.51 $97.51 $73.50 $97.51 $97.51 $97.51 $48.76 $48.76 $77.23 $97.51 $78.01 $63.38 $97.51 $97.51 $56.84 $97.51 $58.51 $97.51 $97.51 $97.51 N/A N/A 600501 ERX HCPCS 25000001 99999-6005-66 OR ONLY-CEFAZOLIN 1G/NS 1000ML IRRIGATION SOLN BOTH IP/OP $69.00 $51.00 $12.26 $68.85 $68.85 $68.85 $68.85 $68.85 $68.85 $68.85 $12.26 $68.85 $68.85 $51.10 $51.10 $53.07 $35.87 $14.35 $68.85 $27.54 $68.85 $68.85 $68.85 $68.85 $68.85 $51.75 $68.85 $68.85 $68.85 $34.43 $34.43 $54.53 $68.85 $55.08 $44.75 $68.85 $68.85 $40.02 $68.85 $41.31 $68.85 $68.85 $68.85 N/A N/A 600502 ERX HCPCS 25000001 99999-6005-67 OR ONLY-CEFAZOLIN 1GM/NS 1500ML IRRIG BOTH IP/OP $93.00 $69.00 $16.48 $92.61 $92.61 $92.61 $92.61 $92.61 $92.61 $92.61 $16.48 $92.61 $92.61 $68.74 $68.74 $71.38 $48.25 $19.30 $92.61 $37.04 $92.61 $92.61 $92.61 $92.61 $92.61 $69.75 $92.61 $92.61 $92.61 $46.31 $46.31 $73.35 $92.61 $74.09 $60.20 $92.61 $92.61 $53.94 $92.61 $55.57 $92.61 $92.61 $92.61 N/A N/A 600506 ERX HCPCS C9257 99999-6005-71 BEVACIZUMAB 5 MG/0.2 ML OPHTH SYRINGE BOTH IP/OP $137.00 $101.00 $8.49 $136.82 $61.57 $61.57 $61.57 $61.57 $8.49 $8.49 $8.49 $28.52 $8.49 $10.35 $10.35 $10.75 $9.95 $28.51 $8.49 $8.92 $80.93 $8.49 $136.82 $8.49 $8.91 $102.75 $8.49 $8.49 $8.49 $68.41 $68.41 $108.36 $8.49 $109.46 $61.57 $27.16 $8.49 $79.46 $8.91 $12.30 $8.49 $28.51 $8.49 N/A N/A 600511 ERX HCPCS 25000001 99999-6005-80 HYDROXYPROGESTERONE-17 250 MG/ML IM INJ BOTH IP/OP "$2,211.00" "$1,636.00" $393.52 "$2,210.76" "$2,210.76" "$2,210.76" "$2,210.76" "$2,210.76" "$2,210.76" "$2,210.76" $393.52 "$2,210.76" "$2,210.76" "$1,640.83" "$1,640.83" "$1,704.05" "$1,151.81" $460.75 "$2,210.76" $884.30 "$2,210.76" "$2,210.76" "$2,210.76" "$2,210.76" "$2,210.76" "$1,658.25" "$2,210.76" "$2,210.76" "$2,210.76" "$1,105.38" "$1,105.38" "$1,750.92" "$2,210.76" "$1,768.61" "$1,436.99" "$2,210.76" "$2,210.76" "$1,282.38" "$2,210.76" "$1,326.46" "$2,210.76" "$2,210.76" "$2,210.76" N/A N/A 600521 ERX HCPCS 25000001 99999-6005-97 "OR BACITRACIN 50,000 UNITS IN 1500 ML NS IR-NEURO" BOTH IP/OP $118.50 $88.00 $21.04 $118.21 $118.21 $118.21 $118.21 $118.21 $118.21 $118.21 $21.04 $118.21 $118.21 $87.74 $87.74 $91.12 $61.59 $24.64 $118.21 $47.28 $118.21 $118.21 $118.21 $118.21 $118.21 $88.88 $118.21 $118.21 $118.21 $59.11 $59.11 $93.62 $118.21 $94.57 $76.84 $118.21 $118.21 $68.73 $118.21 $70.93 $118.21 $118.21 $118.21 N/A N/A 600522 ERX HCPCS 25000001 99999-6005-98 OR NEOMYCIN-POLYMYXIN B 2 ML/1500 ML NS IR BOTH IP/OP $129.50 $96.00 $22.98 $129.11 $129.11 $129.11 $129.11 $129.11 $129.11 $129.11 $22.98 $129.11 $129.11 $95.83 $95.83 $99.52 $67.27 $26.91 $129.11 $51.64 $129.11 $129.11 $129.11 $129.11 $129.11 $97.13 $129.11 $129.11 $129.11 $64.56 $64.56 $102.26 $129.11 $103.29 $83.92 $129.11 $129.11 $75.11 $129.11 $77.47 $129.11 $129.11 $129.11 N/A N/A 600523 ERX HCPCS 25000001 99999-6005-99 "OR CEFAZOLIN 1G+BACITRACIN 50,000UNITS+GENT80/1500 ML" BOTH IP/OP $131.50 $97.00 $23.40 $131.44 $131.44 $131.44 $131.44 $131.44 $131.44 $131.44 $23.40 $131.44 $131.44 $97.55 $97.55 $101.31 $68.48 $27.39 $131.44 $52.58 $131.44 $131.44 $131.44 $131.44 $131.44 $98.63 $131.44 $131.44 $131.44 $65.72 $65.72 $104.10 $131.44 $105.15 $85.44 $131.44 $131.44 $76.27 $131.44 $78.86 $131.44 $131.44 $131.44 N/A N/A 600524 ERX HCPCS 25000001 99999-6006-06 CIDOFOVIR 1% CREAM 37.5G BOTH IP/OP "$2,382.00" "$1,763.00" $423.98 "$2,381.92" "$2,381.92" "$2,381.92" "$2,381.92" "$2,381.92" "$2,381.92" "$2,381.92" $423.98 "$2,381.92" "$2,381.92" "$1,767.86" "$1,767.86" "$1,835.98" "$1,240.98" $496.42 "$2,381.92" $952.77 "$2,381.92" "$2,381.92" "$2,381.92" "$2,381.92" "$2,381.92" "$1,786.50" "$2,381.92" "$2,381.92" "$2,381.92" "$1,190.96" "$1,190.96" "$1,886.48" "$2,381.92" "$1,905.54" "$1,548.25" "$2,381.92" "$2,381.92" "$1,381.56" "$2,381.92" "$1,429.15" "$2,381.92" "$2,381.92" "$2,381.92" N/A N/A 600531 ERX HCPCS 25000001 99999-6006-16 OR CHLORHEXIDINE 0.12% 473 ML WITH 500 ML NSIR BOTH IP/OP $84.00 $62.00 $14.93 $83.86 $83.86 $83.86 $83.86 $83.86 $83.86 $83.86 $14.93 $83.86 $83.86 $62.24 $62.24 $64.64 $43.69 $17.48 $83.86 $33.54 $83.86 $83.86 $83.86 $83.86 $83.86 $63.00 $83.86 $83.86 $83.86 $41.93 $41.93 $66.42 $83.86 $67.09 $54.51 $83.86 $83.86 $48.72 $83.86 $50.32 $83.86 $83.86 $83.86 N/A N/A 600534 ERX HCPCS 25000001 99999-6006-19 CEFTRIAXONE +LIDOCAINE 1% IM INJ BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600539 ERX HCPCS 25000001 99999-6006-24 AMIKACIN 250 MG/ML NEBU SOLN BOTH IP/OP $19.50 $14.00 $3.42 $19.19 $19.19 $19.19 $19.19 $19.19 $19.19 $19.19 $3.42 $19.19 $19.19 $14.24 $14.24 $14.79 $10.00 $4.00 $19.19 $7.68 $19.19 $19.19 $19.19 $19.19 $19.19 $14.63 $19.19 $19.19 $19.19 $9.60 $9.60 $15.20 $19.19 $15.35 $12.47 $19.19 $19.19 $11.31 $19.19 $11.51 $19.19 $19.19 $19.19 N/A N/A 600541 ERX HCPCS 25000001 99999-6006-26 TOBRAMYCIN 40 MG/ML NEBU SOLN BOTH IP/OP $18.00 $13.00 $3.13 $17.58 $17.58 $17.58 $17.58 $17.58 $17.58 $17.58 $3.13 $17.58 $17.58 $13.05 $13.05 $13.55 $9.16 $3.66 $17.58 $7.03 $17.58 $17.58 $17.58 $17.58 $17.58 $13.50 $17.58 $17.58 $17.58 $8.79 $8.79 $13.92 $17.58 $14.06 $11.43 $17.58 $17.58 $10.44 $17.58 $10.55 $17.58 $17.58 $17.58 N/A N/A 600543 ERX HCPCS J0878 99999-6006-30 DAPTOMYCIN 500MG/NS 50ML MB PLUS BOTH IP/OP $973.00 $720.00 $25.00 $972.95 $972.95 $972.95 $972.95 $972.95 $972.95 $972.95 $30.00 $972.95 $972.95 $26.00 $26.00 $27.00 $25.00 $29.37 $972.95 $389.18 $972.95 $972.95 $972.95 $972.95 $972.95 $729.75 $972.95 $972.95 $972.95 $486.48 $486.48 $770.58 $972.95 $778.36 $437.83 $972.95 $972.95 $564.34 $972.95 $583.77 $972.95 $972.95 $972.95 N/A N/A 600544 ERX HCPCS 25000001 99999-6006-32 SODIUM BICARBONATE 1% ET IRRIGATION SOLUTION BOTH IP/OP $21.50 $16.00 $3.77 $21.17 $21.17 $21.17 $21.17 $21.17 $21.17 $21.17 $3.77 $21.17 $21.17 $15.71 $15.71 $16.32 $11.03 $4.41 $21.17 $8.47 $21.17 $21.17 $21.17 $21.17 $21.17 $16.13 $21.17 $21.17 $21.17 $10.59 $10.59 $16.77 $21.17 $16.94 $13.76 $21.17 $21.17 $12.47 $21.17 $12.70 $21.17 $21.17 $21.17 N/A N/A 600548 ERX HCPCS 25000001 99999-6006-38 PODOPHYLLUM 40% IN BENZOIN BOTH IP/OP $286.50 $212.00 $50.97 $286.33 $286.33 $286.33 $286.33 $286.33 $286.33 $286.33 $50.97 $286.33 $286.33 $212.51 $212.51 $220.70 $149.18 $59.67 $286.33 $114.53 $286.33 $286.33 $286.33 $286.33 $286.33 $214.88 $286.33 $286.33 $286.33 $143.17 $143.17 $226.77 $286.33 $229.06 $186.11 $286.33 $286.33 $166.17 $286.33 $171.80 $286.33 $286.33 $286.33 N/A N/A 600550 ERX HCPCS 25000001 99999-6006-43 VITAMIN K1 1 MG/0.1ML (NICU) >=1250 G BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600556 ERX HCPCS 25000001 "PENICILLIN G 10,000 UNITS/ML ID INJ" BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600557 ERX HCPCS 25000001 99999-6006-55 SQUARIC ACID 2% TOP SOLN BOTH IP/OP $520.50 $385.00 $92.65 $520.50 $520.50 $520.50 $520.50 $520.50 $520.50 $520.50 $92.65 $520.50 $520.50 $386.32 $386.32 $401.20 $271.18 $108.48 $520.50 $208.20 $520.50 $520.50 $520.50 $520.50 $520.50 $390.38 $520.50 $520.50 $520.50 $260.25 $260.25 $412.24 $520.50 $416.40 $338.33 $520.50 $520.50 $301.89 $520.50 $312.30 $520.50 $520.50 $520.50 N/A N/A 600560 ERX HCPCS J0640 99999-6006-60 LEUCOVORIN 50 MG/50 ML NS IVPB MB PLUS BOTH IP/OP $52.00 $38.00 $1.05 $52.00 $23.40 $23.40 $23.40 $23.40 $52.00 $52.00 $52.00 $1.05 $52.00 $4.62 $4.62 $4.80 $4.44 $5.22 $52.00 $52.00 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $4.97 $52.00 $30.16 $52.00 $52.00 $52.00 $4.97 $52.00 N/A N/A 600561 ERX HCPCS 25000001 99999-6006-59 POLYMYXIN B 10 MG/ML D5W DESENSITIZATION BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600562 ERX HCPCS 25000001 99999-6006-61 POLYMYXIN B 1 MG/ML D5W DESENSITIZATION BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600563 ERX HCPCS 25000001 99999-6006-62 POLYMYXIN B 0.1 MG/ML D5W DESENSITIZATION BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600564 ERX HCPCS 25000001 99999-6006-63 POLYMYXIN B 0.01 MG/ML D5W DESENSITIZATION BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600565 ERX HCPCS 25000001 99999-6006-64 POLYMYXIN B 0.001 MG/ML D5W DESENSITIZATION BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600566 ERX HCPCS 25000001 99999-6006-65 POLYMYXIN B 0.0001 MG/ML D5W DESENSITIZATION BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600570 ERX HCPCS 25000001 00002-1036-13 DOMPERIDONE 10 MG TABLET BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 600571 ERX HCPCS 25000001 99999-6006-72 VANCOMYCIN 15 MG/ML(1.5%) OPHTH SOLN BOTH IP/OP $60.50 $45.00 $10.76 $60.47 $60.47 $60.47 $60.47 $60.47 $60.47 $60.47 $10.76 $60.47 $60.47 $44.88 $44.88 $46.61 $31.50 $12.60 $60.47 $24.19 $60.47 $60.47 $60.47 $60.47 $60.47 $45.38 $60.47 $60.47 $60.47 $30.24 $30.24 $47.89 $60.47 $48.38 $39.31 $60.47 $60.47 $35.09 $60.47 $36.28 $60.47 $60.47 $60.47 N/A N/A 600575 ERX HCPCS J8530 99999-6006-76 CYCLOPHOSPHAMIDE 100 MG/10 ML ORAL SYRINGE BOTH IP/OP $119.50 $88.00 $3.24 $119.40 $119.40 $119.40 $119.40 $119.40 $119.40 $119.40 $3.24 $119.40 $119.40 $3.66 $3.66 $3.80 $3.52 $24.88 $119.40 $47.76 $119.40 $119.40 $119.40 $119.40 $119.40 $89.63 $119.40 $119.40 $119.40 $59.70 $59.70 $94.56 $119.40 $95.52 $53.73 $119.40 $119.40 $69.31 $119.40 $71.64 $119.40 $119.40 $119.40 N/A N/A 600578 ERX HCPCS 25000001 99999-6006-82 VANCOMYCIN 10MG-HEPARIN 5000 UNITS/2 ML FLUSH BOTH IP/OP $52.00 $38.00 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 600589 ERX HCPCS 25000001 99999-6007-00 STREPTOMYCIN 5 MG/ML NS (NICU) IV SYRINGE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600595 ERX HCPCS 25000001 99999-6007-08 TRICHLOROACETIC ACID 70 % EXTERNAL SOLN BOTH IP/OP $190.50 $141.00 $33.90 $190.46 $190.46 $190.46 $190.46 $190.46 $190.46 $190.46 $33.90 $190.46 $190.46 $141.36 $141.36 $146.81 $99.23 $39.69 $190.46 $76.18 $190.46 $190.46 $190.46 $190.46 $190.46 $142.88 $190.46 $190.46 $190.46 $95.23 $95.23 $150.84 $190.46 $152.37 $123.80 $190.46 $190.46 $110.49 $190.46 $114.28 $190.46 $190.46 $190.46 N/A N/A 600603 ERX HCPCS 25000001 99999-6007-15 DILTIAZEM 2% OINTMENT BOTH IP/OP $22.50 $17.00 $3.94 $22.12 $22.12 $22.12 $22.12 $22.12 $22.12 $22.12 $3.94 $22.12 $22.12 $16.42 $16.42 $17.05 $11.52 $4.61 $22.12 $8.85 $22.12 $22.12 $22.12 $22.12 $22.12 $16.88 $22.12 $22.12 $22.12 $11.06 $11.06 $17.52 $22.12 $17.70 $14.38 $22.12 $22.12 $13.05 $22.12 $13.27 $22.12 $22.12 $22.12 N/A N/A 600608 ERX HCPCS J0613 24200-0066-10 CALCIUM GLUCONATE 3 GM IN SODIUM CHLORIDE 250 ML BOTH IP/OP $65.00 $48.00 $11.53 $64.80 $64.80 $64.80 $64.80 $64.80 $64.80 $64.80 $11.53 $64.80 $64.80 $64.80 $64.80 $64.80 $64.80 $13.51 $64.80 $25.92 $64.80 $64.80 $64.80 $64.80 $64.80 $48.75 $64.80 $64.80 $64.80 $32.40 $32.40 $51.32 $64.80 $51.84 $29.16 $64.80 $64.80 $37.70 $64.80 $38.88 $64.80 $64.80 $64.80 N/A N/A 600626 ERX HCPCS 25000001 99999-6007-47 BOSENTAN 6.25 MG/ML (NICU) ORAL SYRINGE BOTH IP/OP $55.00 $41.00 $9.71 $54.57 $54.57 $54.57 $54.57 $54.57 $54.57 $54.57 $9.71 $54.57 $54.57 $40.50 $40.50 $42.06 $28.43 $11.37 $54.57 $21.83 $54.57 $54.57 $54.57 $54.57 $54.57 $41.25 $54.57 $54.57 $54.57 $27.29 $27.29 $43.22 $54.57 $43.66 $35.47 $54.57 $54.57 $31.90 $54.57 $32.74 $54.57 $54.57 $54.57 N/A N/A 600627 ERX HCPCS 25000001 99999-6007-49 CEFTAZIDIME 50MG/ML FORTIFIED OPHTH SOLN 10 ML BOTH IP/OP $43.50 $32.00 $7.69 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $43.20 $7.69 $43.20 $43.20 $32.06 $32.06 $33.30 $22.51 $9.00 $43.20 $17.28 $43.20 $43.20 $43.20 $43.20 $43.20 $32.63 $43.20 $43.20 $43.20 $21.60 $21.60 $34.21 $43.20 $34.56 $28.08 $43.20 $43.20 $25.23 $43.20 $25.92 $43.20 $43.20 $43.20 N/A N/A 600632 ERX HCPCS 25000001 99999-6007-51 GENTAMICIN 40 MG/ML NEBU SOLN BOTH IP/OP $10.50 $8.00 $1.87 $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $1.87 $10.50 $10.50 $7.79 $7.79 $8.09 $5.47 $2.19 $10.50 $4.20 $10.50 $10.50 $10.50 $10.50 $10.50 $7.88 $10.50 $10.50 $10.50 $5.25 $5.25 $8.32 $10.50 $8.40 $6.83 $10.50 $10.50 $6.09 $10.50 $6.30 $10.50 $10.50 $10.50 N/A N/A 600633 ERX HCPCS 63700001 99999-6007-52 AZATHIOPRINE 50 MG/ML ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600638 ERX HCPCS 25000001 99999-6007-56 CYCLOSPORINE 2% OPHTH SOLN BOTH IP/OP $130.50 $97.00 $23.15 $130.03 $130.03 $130.03 $130.03 $130.03 $130.03 $130.03 $23.15 $130.03 $130.03 $96.51 $96.51 $100.23 $67.75 $27.10 $130.03 $52.01 $130.03 $130.03 $130.03 $130.03 $130.03 $97.88 $130.03 $130.03 $130.03 $65.02 $65.02 $102.98 $130.03 $104.02 $84.52 $130.03 $130.03 $75.69 $130.03 $78.02 $130.03 $130.03 $130.03 N/A N/A 600639 ERX HCPCS 25000001 99999-6007-57 DEXTROSE 5% FLUSH IV SYRINGE (ADULT) BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600640 ERX HCPCS 25000001 99999-6007-58 PEDIATRACE ELEMENTS BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600641 ERX HCPCS 25000001 99999-6007-59 METRONIDAZOLE 0.005 MG/ML NS IV DESENSITIZATION BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600642 ERX HCPCS 25000001 99999-6007-60 METRONIDAZOLE 0.05 MG/ML NS IV DESENSITIZATION BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600643 ERX HCPCS 25000001 99999-6007-61 METRONIDAZOLE 0.5 MG/ML NS IV DESENSITIZATION BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600644 ERX HCPCS 25000001 99999-6007-62 METRONIDAZOLE 5 MG/ML NS IV DESENSITIZATION BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600646 ERX HCPCS 25000001 99999-6007-64 VANCOMYCIN 125 MG/5 ML ORAL SOLUTION UNIT-DOSE CUP BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 600647 ERX HCPCS 25000001 99999-6007-65 HEPARIN SODIUM NEBU 5000 UNITS/1 ML SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600658 ERX HCPCS 25000001 99999-6007-79 ASPIRIN 1 MG/1 ML SUSP DESENSITIZATION BTL A BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600660 ERX HCPCS 63600001 99999-6007-81 TERBUTALINE SULFATE 1 MG/ML NEBU SOLN BOTH IP/OP $86.00 $64.00 $15.30 $85.93 $85.93 $85.93 $85.93 $85.93 $85.93 $85.93 $15.30 $85.93 $85.93 $85.93 $85.93 $85.93 $85.93 $17.91 $85.93 $34.37 $85.93 $85.93 $85.93 $85.93 $85.93 $64.50 $85.93 $85.93 $85.93 $42.97 $42.97 $68.06 $85.93 $68.74 $38.67 $85.93 $85.93 $49.88 $85.93 $51.56 $85.93 $85.93 $85.93 N/A N/A 600661 ERX HCPCS 25000001 99999-6007-85 CLINDAMYCIN 1 MG/0.1 ML NS 0.5 ML INTRAVITREAL SYRINGE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600668 ERX HCPCS 25000001 99999-6007-92 OSELTAMIVIR PEDS 6 MG/ML ORAL SYRINGE BOTH IP/OP $10.00 $7.00 $1.70 $9.57 $9.57 $9.57 $9.57 $9.57 $9.57 $9.57 $1.70 $9.57 $9.57 $7.10 $7.10 $7.38 $4.99 $1.99 $9.57 $3.83 $9.57 $9.57 $9.57 $9.57 $9.57 $7.50 $9.57 $9.57 $9.57 $4.79 $4.79 $7.58 $9.57 $7.66 $6.22 $9.57 $9.57 $5.80 $9.57 $5.74 $9.57 $9.57 $9.57 N/A N/A 600672 ERX HCPCS 63700001 99999-6007-94 CHOLECALCIFEROL 400 UNIT/ML (NICU) ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600673 ERX HCPCS 25000001 99999-6007-95 AMPHOTERICIN B ORAL SOLUTION 1MG/ML BOTH IP/OP $633.00 $468.00 $112.66 $632.93 $632.93 $632.93 $632.93 $632.93 $632.93 $632.93 $112.66 $632.93 $632.93 $469.76 $469.76 $487.86 $329.76 $131.91 $632.93 $253.17 $632.93 $632.93 $632.93 $632.93 $632.93 $474.75 $632.93 $632.93 $632.93 $316.47 $316.47 $501.28 $632.93 $506.34 $411.40 $632.93 $632.93 $367.14 $632.93 $379.76 $632.93 $632.93 $632.93 N/A N/A 600676 ERX HCPCS 25000001 99999-6007-97 MORPHINE SULF 0.4 MG/1 ML ORAL SYRINGE (NICU) BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600683 ERX HCPCS Q4074 99999-6008-05 ILOPROST 5 MCG/0.25 ML NEB SYRINGE BOTH IP/OP $52.00 $38.00 $10.82 $151.64 $51.90 $51.90 $51.90 $51.90 $51.90 $51.90 $140.24 $51.90 $51.90 $146.03 $146.03 $151.64 $140.41 $10.82 $51.90 $20.76 $51.90 $51.90 $51.90 $51.90 $51.90 $39.00 $51.90 $51.90 $51.90 $25.95 $25.95 $41.10 $51.90 $41.52 $23.36 $51.90 $51.90 $30.16 $51.90 $31.14 $51.90 $51.90 $51.90 N/A N/A 600686 ERX HCPCS J0712 99999-6008-78 CEFTAROLINE FOSAMIL 400MG/NS 250 ML MB PLUS BOTH IP/OP $541.50 $401.00 $112.77 $541.11 $541.11 $541.11 $541.11 $541.11 $541.11 $541.11 $140.40 $541.11 $541.11 $148.51 $148.51 $154.22 $142.80 $112.77 $541.11 $216.44 $541.11 $541.11 $541.11 $541.11 $541.11 $406.13 $541.11 $541.11 $541.11 $270.56 $270.56 $428.56 $541.11 $432.89 $243.50 $541.11 $541.11 $314.07 $541.11 $324.67 $541.11 $541.11 $541.11 N/A N/A 600689 ERX HCPCS 25000001 99999-6008-11 DIGOXIN 2 MG (0.25 MG/ML)/8 ML SYRINGE INTRA-AMNIOTIC BOTH IP/OP $31.00 $23.00 $5.46 $30.66 $30.66 $30.66 $30.66 $30.66 $30.66 $30.66 $5.46 $30.66 $30.66 $22.76 $22.76 $23.63 $15.97 $6.39 $30.66 $12.26 $30.66 $30.66 $30.66 $30.66 $30.66 $23.25 $30.66 $30.66 $30.66 $15.33 $15.33 $24.28 $30.66 $24.53 $19.93 $30.66 $30.66 $17.98 $30.66 $18.40 $30.66 $30.66 $30.66 N/A N/A 600690 ERX HCPCS 25000001 99999-6009-23 EVACUATED BAG 1000 ML BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600692 ERX HCPCS J2543 99999-6008-21 PIPERACIL-TAZ 2.25 G/NS 50 ML MB PLUS BOTH IP/OP $79.50 $59.00 $2.84 $79.37 $35.72 $35.72 $35.72 $35.72 $79.37 $79.37 $79.37 $13.09 $79.37 $2.95 $2.95 $3.07 $2.84 $3.34 $79.37 $79.37 $46.95 $79.37 $79.37 $79.37 $79.37 $59.63 $79.37 $79.37 $79.37 $39.69 $39.69 $62.86 $79.37 $63.50 $35.72 $3.18 $79.37 $46.11 $79.37 $79.37 $79.37 $3.18 $79.37 N/A N/A 600698 ERX HCPCS 25000001 99999-6008-27 LIDOCAINE HCL 0.1 % IJ SOLN-ALLERGY CLINIC BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600699 ERX HCPCS 25000001 99999-6008-28 LIDOCAINE HCL 0.01 % IJ SOLN-ALLERGY CLINIC BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600700 ERX HCPCS 25000001 99999-6008-30 ONDANSETRON 0.8 MG/ML ORAL SYRINGE (NICU) BOTH IP/OP $27.00 $20.00 $4.80 $26.94 $26.94 $26.94 $26.94 $26.94 $26.94 $26.94 $4.80 $26.94 $26.94 $19.99 $19.99 $20.77 $14.04 $5.61 $26.94 $10.78 $26.94 $26.94 $26.94 $26.94 $26.94 $20.25 $26.94 $26.94 $26.94 $13.47 $13.47 $21.34 $26.94 $21.55 $17.51 $26.94 $26.94 $15.66 $26.94 $16.16 $26.94 $26.94 $26.94 N/A N/A 600701 ERX HCPCS J0696 00409-7332-01 CEFTRIAXONE CUSTOM 1 G VIAL FOR DESENSITIZATION BOTH IP/OP $22.00 $16.00 $1.92 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $5.64 $22.00 $2.00 $2.00 $2.07 $1.92 $2.26 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $2.15 $22.00 $12.76 $22.00 $22.00 $22.00 $2.15 $22.00 N/A N/A 600706 ERX HCPCS Q9967 00407-1413-59 IOHEXOL 300 MG/ML 30 ML PO SOLUTION BOTH IP/OP $198.50 $147.00 $0.12 $198.33 $89.25 $89.25 $89.25 $89.25 $198.33 $198.33 $198.33 $41.34 $198.33 $198.33 $198.33 $0.13 $0.12 $41.33 $198.33 $198.33 $117.31 $198.33 $198.33 $198.33 $198.33 $148.88 $198.33 $198.33 $198.33 $99.17 $99.17 $157.08 $198.33 $158.66 $89.25 $39.36 $198.33 $115.13 $198.33 $198.33 $198.33 $41.33 $198.33 N/A N/A 600707 ERX HCPCS 95165 99999-6008-39 ALLERGEN EXTRACTS PREPARATION BOTH IP/OP $99.50 $74.00 $3.08 $99.50 $99.50 $99.50 $99.50 $99.50 $3.08 $3.08 $3.11 $99.50 $3.08 $73.85 $73.85 $76.69 $51.84 $20.74 $4.93 $5.42 $99.50 $3.08 $3.39 $3.08 $99.50 $74.63 $3.08 $3.08 $3.08 $49.75 $49.75 $78.80 $3.08 $79.60 $64.68 $99.50 $3.08 $57.71 $99.50 $3.25 $3.08 $99.50 $3.08 N/A N/A 600710 ERX HCPCS 25000001 99999-6008-42 METHOHEXITAL 1MG/ML SW IV SYRINGE-NEURO BOTH IP/OP $28.50 $21.00 $4.99 $28.05 $28.05 $28.05 $28.05 $28.05 $28.05 $28.05 $4.99 $28.05 $28.05 $20.82 $20.82 $21.62 $14.61 $5.85 $28.05 $11.22 $28.05 $28.05 $28.05 $28.05 $28.05 $21.38 $28.05 $28.05 $28.05 $14.03 $14.03 $22.22 $28.05 $22.44 $18.23 $28.05 $28.05 $16.53 $28.05 $16.83 $28.05 $28.05 $28.05 N/A N/A 600714 ERX HCPCS 25000001 99999-6008-45 KPHOS 0.05 MM/ML D5W (NICU) IV SYRINGE BOTH IP/OP $30.00 $22.00 $5.29 $29.73 $29.73 $29.73 $29.73 $29.73 $29.73 $29.73 $5.29 $29.73 $29.73 $22.07 $22.07 $22.92 $15.49 $6.20 $29.73 $11.89 $29.73 $29.73 $29.73 $29.73 $29.73 $22.50 $29.73 $29.73 $29.73 $14.87 $14.87 $23.55 $29.73 $23.78 $19.32 $29.73 $29.73 $17.40 $29.73 $17.84 $29.73 $29.73 $29.73 N/A N/A 600715 ERX HCPCS 25000001 99999-6008-46 SODIUM PHOSPHATE 0.05 MM/ML D5W (NICU) IV SYRINGE BOTH IP/OP $30.00 $22.00 $5.29 $29.73 $29.73 $29.73 $29.73 $29.73 $29.73 $29.73 $5.29 $29.73 $29.73 $22.07 $22.07 $22.92 $15.49 $6.20 $29.73 $11.89 $29.73 $29.73 $29.73 $29.73 $29.73 $22.50 $29.73 $29.73 $29.73 $14.87 $14.87 $23.55 $29.73 $23.78 $19.32 $29.73 $29.73 $17.40 $29.73 $17.84 $29.73 $29.73 $29.73 N/A N/A 600722 ERX HCPCS 25000001 00338-0221-04 PLASMA-LYTE A IV BOLUS BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600725 ERX HCPCS 25000001 99999-6008-55 VORICONAZOLE 100MCG/0.1 ML NS OPHTH SYRINGE BOTH IP/OP $529.50 $392.00 $94.24 $529.46 $529.46 $529.46 $529.46 $529.46 $529.46 $529.46 $94.24 $529.46 $529.46 $392.97 $392.97 $408.11 $275.85 $110.35 $529.46 $211.78 $529.46 $529.46 $529.46 $529.46 $529.46 $397.13 $529.46 $529.46 $529.46 $264.73 $264.73 $419.33 $529.46 $423.57 $344.15 $529.46 $529.46 $307.11 $529.46 $317.68 $529.46 $529.46 $529.46 N/A N/A 600726 ERX HCPCS 25000001 99999-6008-56 DEXTROSE 25% SOLN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600727 ERX HCPCS 25000001 99999-6008-57 AMPHOTERICIN B 0.15% OPHTHALMIC SOLN BOTH IP/OP $59.50 $44.00 $10.52 $59.10 $59.10 $59.10 $59.10 $59.10 $59.10 $59.10 $10.52 $59.10 $59.10 $43.86 $43.86 $45.55 $30.79 $12.32 $59.10 $23.64 $59.10 $59.10 $59.10 $59.10 $59.10 $44.63 $59.10 $59.10 $59.10 $29.55 $29.55 $46.81 $59.10 $47.28 $38.42 $59.10 $59.10 $34.51 $59.10 $35.46 $59.10 $59.10 $59.10 N/A N/A 600732 ERX HCPCS 25000001 99999-6008-64 ASCORBIC ACID OPHTH SOLN 100 MG/ML BOTH IP/OP $31.50 $23.00 $5.53 $31.07 $31.07 $31.07 $31.07 $31.07 $31.07 $31.07 $5.53 $31.07 $31.07 $23.06 $23.06 $23.95 $16.19 $6.48 $31.07 $12.43 $31.07 $31.07 $31.07 $31.07 $31.07 $23.63 $31.07 $31.07 $31.07 $15.54 $15.54 $24.61 $31.07 $24.86 $20.20 $31.07 $31.07 $18.27 $31.07 $18.64 $31.07 $31.07 $31.07 N/A N/A 600733 ERX HCPCS J9214 99999-6008-65 INTERFERON ALFA-2B OPHTH SOLN 1000000 UNITS/ML BOTH IP/OP "$5,634.00" "$4,169.00" $32.74 "$5,633.94" "$5,633.94" "$5,633.94" "$5,633.94" "$5,633.94" "$5,633.94" "$5,633.94" $33.24 "$5,633.94" "$5,633.94" $34.05 $34.05 $35.36 $32.74 $38.46 "$5,633.94" "$2,253.58" "$5,633.94" "$5,633.94" "$5,633.94" "$5,633.94" "$5,633.94" "$4,225.50" "$5,633.94" "$5,633.94" "$5,633.94" "$2,816.97" "$2,816.97" "$4,462.08" "$5,633.94" "$4,507.15" "$3,662.06" "$5,633.94" "$5,633.94" "$3,267.72" "$5,633.94" "$3,380.36" "$5,633.94" "$5,633.94" "$5,633.94" N/A N/A 600735 ERX HCPCS 25000001 99999-6008-66 METRONIDAZOLE 0.0005MG/ML ORAL SYRINGE DESENSITIZATIO BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600736 ERX HCPCS 25000001 99999-6008-67 METRONIDAZOLE 0.005MG/ML ORAL SYRINGE DESENSITIZATION BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600737 ERX HCPCS 25000001 99999-6008-68 METRONIDAZOLE 0.05MG/ML ORAL SYRINGE DESENSITIZATION BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600738 ERX HCPCS 25000001 99999-6008-69 METRONIDAZOLE 0.5MG/ML ORAL SYRINGE DESENSITIZATION BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600739 ERX HCPCS 25000001 99999-6008-70 METRONIDAZOLE 5MG/ML ORAL SYRINGE DESENSITIZATION BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 600743 ERX HCPCS 63700001 99999-6008-74 MERCAPTOPURINE 25 MG PO TAB BOTH IP/OP $9.00 $7.00 $1.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $8.84 $1.84 $8.84 $3.54 $8.84 $8.84 $8.84 $8.84 $8.84 $6.75 $8.84 $8.84 $8.84 $4.42 $4.42 $7.00 $8.84 $7.07 $5.75 $8.84 $8.84 $5.22 $8.84 $5.30 $8.84 $8.84 $8.84 N/A N/A 600744 ERX HCPCS 25000001 99999-6008-75 WHISKY (40% ABV) BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 600745 ERX HCPCS J0712 99999-6008-79 CEFTAROLINE FOSAMIL 600MG/NS 250 ML MB PLUS BOTH IP/OP $541.50 $401.00 $112.77 $541.11 $541.11 $541.11 $541.11 $541.11 $541.11 $541.11 $210.60 $541.11 $541.11 $222.77 $222.77 $231.34 $214.20 $112.77 $541.11 $216.44 $541.11 $541.11 $541.11 $541.11 $541.11 $406.13 $541.11 $541.11 $541.11 $270.56 $270.56 $428.56 $541.11 $432.89 $243.50 $541.11 $541.11 $314.07 $541.11 $324.67 $541.11 $541.11 $541.11 N/A N/A 600747 ERX HCPCS J3301 99999-6008-81 TRIAMCINOLONE 40MG/1 ML + LIDOCAINE 1% 1 ML BOTH IP/OP $52.00 $38.00 $2.22 $52.00 $23.40 $23.40 $23.40 $23.40 $52.00 $52.00 $52.00 $3.55 $52.00 $2.31 $2.31 $2.40 $2.22 $2.61 $52.00 $52.00 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $2.48 $52.00 $30.16 $52.00 $52.00 $52.00 $2.48 $52.00 N/A N/A 600756 ERX HCPCS 25000001 99999-6008-94 GENTIAN VIOLET 0.00165% SOLUTION BOTH IP/OP $149.50 $111.00 $26.57 $149.25 $149.25 $149.25 $149.25 $149.25 $149.25 $149.25 $26.57 $149.25 $149.25 $110.77 $110.77 $115.04 $77.76 $31.11 $149.25 $59.70 $149.25 $149.25 $149.25 $149.25 $149.25 $112.13 $149.25 $149.25 $149.25 $74.63 $74.63 $118.21 $149.25 $119.40 $97.01 $149.25 $149.25 $86.71 $149.25 $89.55 $149.25 $149.25 $149.25 N/A N/A 600765 ERX HCPCS 25000001 99999-6009-00 NALOXONE ORAL SYRINGE 0.4 MG/ML BOTH IP/OP $340.50 $252.00 $60.54 $340.10 $340.10 $340.10 $340.10 $340.10 $340.10 $340.10 $60.54 $340.10 $340.10 $252.42 $252.42 $262.15 $177.19 $70.88 $340.10 $136.04 $340.10 $340.10 $340.10 $340.10 $340.10 $255.38 $340.10 $340.10 $340.10 $170.05 $170.05 $269.36 $340.10 $272.08 $221.07 $340.10 $340.10 $197.49 $340.10 $204.06 $340.10 $340.10 $340.10 N/A N/A 600767 ERX HCPCS 25000001 99999-6009-02 GLYCOPYRROLATE 0.2 MG/ML NEBU SOLN BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 600768 ERX HCPCS J1580 99999-6009-04 GENTAMICIN 80 MG/500 ML NS FOR IRRIGATION BOTH IP/OP $52.00 $38.00 $1.02 $52.00 $23.40 $23.40 $23.40 $23.40 $52.00 $52.00 $52.00 $1.02 $52.00 $1.47 $1.47 $1.52 $1.41 $1.66 $52.00 $52.00 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $1.58 $52.00 $30.16 $52.00 $52.00 $52.00 $1.58 $52.00 N/A N/A 600772 ERX HCPCS 25000001 99999-6009-09 PEDIATRIC MAGIC MOUTH WASH BOTH IP/OP $614.50 $455.00 $109.33 $614.19 $614.19 $614.19 $614.19 $614.19 $614.19 $614.19 $109.33 $614.19 $614.19 $455.85 $455.85 $473.42 $319.99 $128.00 $614.19 $245.68 $614.19 $614.19 $614.19 $614.19 $614.19 $460.88 $614.19 $614.19 $614.19 $307.10 $307.10 $486.44 $614.19 $491.35 $399.22 $614.19 $614.19 $356.41 $614.19 $368.51 $614.19 $614.19 $614.19 N/A N/A 600773 ERX HCPCS 25000001 15082-0828-68 GLYCOPYRROLATE 0.6 MG/3 ML IV SYRINGE BOTH IP/OP $141.50 $105.00 $25.12 $141.14 $141.14 $141.14 $141.14 $141.14 $141.14 $141.14 $25.12 $141.14 $141.14 $104.75 $104.75 $108.79 $73.53 $29.42 $141.14 $56.46 $141.14 $141.14 $141.14 $141.14 $141.14 $106.13 $141.14 $141.14 $141.14 $70.57 $70.57 $111.78 $141.14 $112.91 $91.74 $141.14 $141.14 $82.07 $141.14 $84.68 $141.14 $141.14 $141.14 N/A N/A 600774 ERX HCPCS 25000001 99999-6009-11 WBC NUCLEAR ISOTOPE BOTH IP/OP "$1,057.00" $782.00 $188.15 "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" $188.15 "$1,057.00" "$1,057.00" $784.51 $784.51 $814.74 $550.70 $220.29 "$1,057.00" $422.80 "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" $792.75 "$1,057.00" "$1,057.00" "$1,057.00" $528.50 $528.50 $837.14 "$1,057.00" $845.60 $687.05 "$1,057.00" "$1,057.00" $613.06 "$1,057.00" $634.20 "$1,057.00" "$1,057.00" "$1,057.00" N/A N/A 600779 ERX HCPCS 25000001 99999-6010-37 DEXTROSE 5 % FLUSH BOTH IP/OP "$1,842.50" "$1,363.00" $327.93 "$1,842.30" "$1,842.30" "$1,842.30" "$1,842.30" "$1,842.30" "$1,842.30" "$1,842.30" $327.93 "$1,842.30" "$1,842.30" "$1,367.36" "$1,367.36" "$1,420.04" $959.84 $383.96 "$1,842.30" $736.92 "$1,842.30" "$1,842.30" "$1,842.30" "$1,842.30" "$1,842.30" "$1,381.88" "$1,842.30" "$1,842.30" "$1,842.30" $921.15 $921.15 "$1,459.10" "$1,842.30" "$1,473.84" "$1,197.50" "$1,842.30" "$1,842.30" "$1,068.65" "$1,842.30" "$1,105.38" "$1,842.30" "$1,842.30" "$1,842.30" N/A N/A 600798 ERX HCPCS 25000001 99999-6009-41 RBC NUCLEAR ISOTOPE BOTH IP/OP "$1,057.00" $782.00 $188.15 "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" $188.15 "$1,057.00" "$1,057.00" $784.51 $784.51 $814.74 $550.70 $220.29 "$1,057.00" $422.80 "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" "$1,057.00" $792.75 "$1,057.00" "$1,057.00" "$1,057.00" $528.50 $528.50 $837.14 "$1,057.00" $845.60 $687.05 "$1,057.00" "$1,057.00" $613.06 "$1,057.00" $634.20 "$1,057.00" "$1,057.00" "$1,057.00" N/A N/A 600799 ERX HCPCS 25000001 99999-6009-42 METRONIDAZOLE 20MG/ML PEDIATRIC ORAL SUSPENSION BOTH IP/OP $360.50 $267.00 $64.08 $360.02 $360.02 $360.02 $360.02 $360.02 $360.02 $360.02 $64.08 $360.02 $360.02 $267.21 $267.21 $277.50 $187.57 $75.03 $360.02 $144.01 $360.02 $360.02 $360.02 $360.02 $360.02 $270.38 $360.02 $360.02 $360.02 $180.01 $180.01 $285.14 $360.02 $288.02 $234.01 $360.02 $360.02 $209.09 $360.02 $216.01 $360.02 $360.02 $360.02 N/A N/A 600801 ERX HCPCS 63700001 99999-6009-44 MISOPROSTOL 25 MCG PO TABLET BOTH IP/OP $14.50 $11.00 $2.99 $14.36 $14.36 $14.36 $14.36 $14.36 $14.36 $14.36 $14.36 $14.36 $14.36 $14.36 $14.36 $14.36 $14.36 $2.99 $14.36 $5.74 $14.36 $14.36 $14.36 $14.36 $14.36 $10.88 $14.36 $14.36 $14.36 $7.18 $7.18 $11.37 $14.36 $11.49 $9.33 $14.36 $14.36 $8.41 $14.36 $8.62 $14.36 $14.36 $14.36 N/A N/A 600811 ERX HCPCS 25000001 99999-6009-52 NITROGLYCERIN 200 MCG/ML D5W 5 ML IV SYRINGE ANGIO BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600814 ERX HCPCS 25000001 99999-6009-55 ARGATROBAN 100 MCG/1000 ML NS BOTH IP/OP "$1,178.00" $872.00 $209.65 "$1,177.80" "$1,177.80" "$1,177.80" "$1,177.80" "$1,177.80" "$1,177.80" "$1,177.80" $209.65 "$1,177.80" "$1,177.80" $874.16 $874.16 $907.85 $613.63 $245.47 "$1,177.80" $471.12 "$1,177.80" "$1,177.80" "$1,177.80" "$1,177.80" "$1,177.80" $883.50 "$1,177.80" "$1,177.80" "$1,177.80" $588.90 $588.90 $932.82 "$1,177.80" $942.24 $765.57 "$1,177.80" "$1,177.80" $683.24 "$1,177.80" $706.68 "$1,177.80" "$1,177.80" "$1,177.80" N/A N/A 600816 ERX HCPCS 63700001 99999-6011-79 HYDROXYUREA ORAL SOLN 100 MG/ML BOTH IP/OP $10.00 $7.00 $2.04 $9.81 $9.81 $9.81 $9.81 $9.81 $9.81 $9.81 $9.81 $9.81 $9.81 $9.81 $9.81 $9.81 $9.81 $2.04 $9.81 $3.92 $9.81 $9.81 $9.81 $9.81 $9.81 $7.50 $9.81 $9.81 $9.81 $4.91 $4.91 $7.77 $9.81 $7.85 $6.38 $9.81 $9.81 $5.80 $9.81 $5.89 $9.81 $9.81 $9.81 N/A N/A 600821 ERX HCPCS J1956 99999-6009-64 LEVOFLOXACIN 7.5 MG/1.5 ML D5W PO SOLN BOTH IP/OP $9.00 $7.00 $0.98 $9.00 $4.05 $4.05 $4.05 $4.05 $9.00 $9.00 $9.00 $1.88 $9.00 $1.02 $1.02 $1.06 $0.98 $1.88 $9.00 $9.00 $5.32 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $4.05 $1.79 $9.00 $5.22 $9.00 $9.00 $9.00 $1.88 $9.00 N/A N/A 600822 ERX HCPCS J1956 99999-6009-65 LEVOFLOXACIN 75 MG/15 ML D5W PO SOLN BOTH IP/OP $15.00 $11.00 $0.98 $14.52 $6.53 $6.53 $6.53 $6.53 $14.52 $14.52 $14.52 $3.03 $14.52 $1.02 $1.02 $1.06 $0.98 $3.03 $14.52 $14.52 $8.59 $14.52 $14.52 $14.52 $14.52 $11.25 $14.52 $14.52 $14.52 $7.26 $7.26 $11.50 $14.52 $11.62 $6.53 $2.88 $14.52 $8.70 $14.52 $14.52 $14.52 $3.03 $14.52 N/A N/A 600824 ERX HCPCS 25000001 CANTHARIDIN 0.7% TOPICAL LIQUID BOTH IP/OP $692.50 $512.00 $123.22 $692.27 $692.27 $692.27 $692.27 $692.27 $692.27 $692.27 $123.22 $692.27 $692.27 $513.80 $513.80 $533.60 $360.67 $144.28 $692.27 $276.91 $692.27 $692.27 $692.27 $692.27 $692.27 $519.38 $692.27 $692.27 $692.27 $346.14 $346.14 $548.28 $692.27 $553.82 $449.98 $692.27 $692.27 $401.65 $692.27 $415.36 $692.27 $692.27 $692.27 N/A N/A 600827 ERX HCPCS C9132 99999-6009-70 "PROTHROMBIN COMPLEX CONCENTRATE, 4-FACTOR (KCENTRA) IV 500 UNITS/20ML" BOTH IP/OP "$6,174.50" "$4,569.00" "$1,286.83" "$6,174.50" "$6,174.50" "$6,174.50" "$6,174.50" "$6,174.50" "$6,174.50" "$6,174.50" "$2,512.00" "$6,174.50" "$6,174.50" "$6,174.50" "$6,174.50" "$6,174.50" "$6,174.50" "$1,286.83" "$6,174.50" "$2,469.80" "$6,174.50" "$6,174.50" "$6,174.50" "$6,174.50" "$6,174.50" "$4,630.88" "$6,174.50" "$6,174.50" "$6,174.50" "$3,087.25" "$3,087.25" "$4,890.20" "$6,174.50" "$4,939.60" "$2,778.53" "$6,174.50" "$6,174.50" "$3,581.21" "$6,174.50" "$3,704.70" "$6,174.50" "$6,174.50" "$6,174.50" N/A N/A 600845 ERX HCPCS J3370 99999-6009-81 VANCOMYCIN 1.5 G IN D5W 500 ML PREMIX BOTH IP/OP $88.50 $65.00 $8.34 $88.44 $39.80 $39.80 $39.80 $39.80 $88.44 $88.44 $8.52 $10.86 $88.44 $8.67 $8.67 $9.01 $8.34 $9.80 $88.44 $88.44 $52.31 $88.44 $88.44 $88.44 $88.44 $66.38 $88.44 $88.44 $88.44 $44.22 $44.22 $70.04 $88.44 $70.75 $39.80 $9.33 $88.44 $51.33 $88.44 $88.44 $88.44 $9.33 $88.44 N/A N/A 600855 ERX HCPCS J2543 99999-6009-85 PIPERACIL-TAZO 4.5 G/50 ML D5W MB PLUS BOTH IP/OP $106.50 $79.00 $5.68 $106.18 $47.78 $47.78 $47.78 $47.78 $106.18 $106.18 $106.18 $26.18 $106.18 $5.91 $5.91 $6.13 $5.68 $6.67 $106.18 $106.18 $62.81 $106.18 $106.18 $106.18 $106.18 $79.88 $106.18 $106.18 $106.18 $53.09 $53.09 $84.09 $106.18 $84.94 $47.78 $6.35 $106.18 $61.77 $106.18 $106.18 $106.18 $6.35 $106.18 N/A N/A 600858 ERX HCPCS J7120 00338-0117-04 LACTATED RINGERS IV BOLUS ML/KG BOTH IP/OP $26.00 $19.00 $1.13 $25.92 $11.66 $11.66 $11.66 $11.66 $25.92 $25.92 $25.92 $1.13 $25.92 $2.57 $2.57 $2.67 $2.47 $2.90 $25.92 $25.92 $15.33 $25.92 $25.92 $25.92 $25.92 $19.50 $25.92 $25.92 $25.92 $12.96 $12.96 $20.53 $25.92 $20.74 $11.66 $2.76 $25.92 $15.08 $25.92 $25.92 $25.92 $2.76 $25.92 N/A N/A 600859 ERX HCPCS 25000001 99999-6009-88 GENTAMICIN 160MG+POLYMIXIN B 200MG+NEOMYCIN 1000MG/2L IRRIGATION SOLN BOTH IP/OP $694.00 $514.00 $123.53 $694.00 $694.00 $694.00 $694.00 $694.00 $694.00 $694.00 $123.53 $694.00 $694.00 $515.09 $515.09 $534.94 $361.57 $144.64 $694.00 $277.60 $694.00 $694.00 $694.00 $694.00 $694.00 $520.50 $694.00 $694.00 $694.00 $347.00 $347.00 $549.65 $694.00 $555.20 $451.10 $694.00 $694.00 $402.52 $694.00 $416.40 $694.00 $694.00 $694.00 N/A N/A 600865 ERX HCPCS 25000001 99999-6009-95 AMIKACIN 4 MG/ML OPHTH SOLN 10 ML BOTH IP/OP $19.50 $14.00 $3.42 $19.19 $19.19 $19.19 $19.19 $19.19 $19.19 $19.19 $3.42 $19.19 $19.19 $14.24 $14.24 $14.79 $10.00 $4.00 $19.19 $7.68 $19.19 $19.19 $19.19 $19.19 $19.19 $14.63 $19.19 $19.19 $19.19 $9.60 $9.60 $15.20 $19.19 $15.35 $12.47 $19.19 $19.19 $11.31 $19.19 $11.51 $19.19 $19.19 $19.19 N/A N/A 600868 ERX HCPCS J3301 99999-6009-98 TRIAMCINOLONE ACETONIDE 2.5 MG/ML IJ SUSP BOTH IP/OP $22.00 $16.00 $1.11 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.77 $22.00 $1.15 $1.15 $1.20 $1.11 $1.30 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.24 $22.00 $12.76 $22.00 $22.00 $22.00 $1.24 $22.00 N/A N/A 600869 ERX HCPCS J3301 99999-6009-99 TRIAMCINOLONE ACETONIDE 5 MG/ML IJ SUSP BOTH IP/OP $22.00 $16.00 $1.11 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.77 $22.00 $1.15 $1.15 $1.20 $1.11 $1.30 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.24 $22.00 $12.76 $22.00 $22.00 $22.00 $1.24 $22.00 N/A N/A 600870 ERX HCPCS J3301 99999-6010-00 TRIAMCINOLONE ACETONIDE 4 MG/ML IJ SUSP BOTH IP/OP $22.00 $16.00 $1.11 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.77 $22.00 $1.15 $1.15 $1.20 $1.11 $1.30 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $1.24 $22.00 $12.76 $22.00 $22.00 $22.00 $1.24 $22.00 N/A N/A 600871 ERX HCPCS J3301 99999-6010-01 TRIAMCINOLONE ACETONIDE 20 MG/ML IJ SUSP BOTH IP/OP $23.50 $17.00 $2.22 $23.48 $10.57 $10.57 $10.57 $10.57 $23.48 $23.48 $23.48 $3.55 $23.48 $2.31 $2.31 $2.40 $2.22 $2.61 $23.48 $23.48 $13.89 $23.48 $23.48 $23.48 $23.48 $17.63 $23.48 $23.48 $23.48 $11.74 $11.74 $18.60 $23.48 $18.78 $10.57 $2.48 $23.48 $13.63 $23.48 $23.48 $23.48 $2.48 $23.48 N/A N/A 600878 ERX HCPCS 25000001 99999-6010-06 "ON-Q PAIN PUMP SINGLE LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR" BOTH IP/OP $830.50 $615.00 $147.83 $830.50 $830.50 $830.50 $830.50 $830.50 $830.50 $830.50 $147.83 $830.50 $830.50 $616.40 $616.40 $640.15 $432.69 $173.09 $830.50 $332.20 $830.50 $830.50 $830.50 $830.50 $830.50 $622.88 $830.50 $830.50 $830.50 $415.25 $415.25 $657.76 $830.50 $664.40 $539.83 $830.50 $830.50 $481.69 $830.50 $498.30 $830.50 $830.50 $830.50 N/A N/A 600879 ERX HCPCS 25000001 99999-6010-07 "ON-Q PAIN PUMP DUAL LUMEN SELECT-A-FLOW, 400 ML, 2-14 ML/HR" BOTH IP/OP "$1,001.50" $741.00 $178.26 "$1,001.44" "$1,001.44" "$1,001.44" "$1,001.44" "$1,001.44" "$1,001.44" "$1,001.44" $178.26 "$1,001.44" "$1,001.44" $743.27 $743.27 $771.91 $521.75 $208.71 "$1,001.44" $400.58 "$1,001.44" "$1,001.44" "$1,001.44" "$1,001.44" "$1,001.44" $751.13 "$1,001.44" "$1,001.44" "$1,001.44" $500.72 $500.72 $793.14 "$1,001.44" $801.15 $650.94 "$1,001.44" "$1,001.44" $580.87 "$1,001.44" $600.86 "$1,001.44" "$1,001.44" "$1,001.44" N/A N/A 600880 ERX HCPCS J0692 99999-6011-00 CEFEPIME 1 G/100 ML NS MB PLUS BOTH IP/OP $55.50 $41.00 $3.52 $55.35 $24.91 $24.91 $24.91 $24.91 $55.35 $55.35 $55.35 $11.54 $55.35 $3.66 $3.66 $3.80 $3.52 $11.54 $55.35 $55.35 $32.74 $55.35 $55.35 $55.35 $55.35 $41.63 $55.35 $55.35 $55.35 $27.68 $27.68 $43.84 $55.35 $44.28 $24.91 $10.99 $55.35 $32.19 $55.35 $55.35 $55.35 $11.53 $55.35 N/A N/A 600881 ERX HCPCS J0692 99999-6011-01 CEFEPIME 2 G/100 ML NS MB PLUS BOTH IP/OP $67.00 $50.00 $7.04 $66.84 $30.08 $30.08 $30.08 $30.08 $66.84 $66.84 $66.84 $13.93 $66.84 $7.32 $7.32 $7.60 $7.04 $13.93 $66.84 $66.84 $39.54 $66.84 $66.84 $66.84 $66.84 $50.25 $66.84 $66.84 $66.84 $33.42 $33.42 $52.94 $66.84 $53.47 $30.08 $13.27 $66.84 $38.86 $66.84 $66.84 $66.84 $13.93 $66.84 N/A N/A 600885 ERX HCPCS J0295 99999-6010-13 AMPICILLIN-SULB 3 G/D5W 100ML MB PLUS BOTH IP/OP $146.00 $108.00 $5.46 $145.95 $65.68 $65.68 $65.68 $65.68 $145.95 $145.95 $145.95 $8.48 $145.95 $5.68 $5.68 $5.90 $5.46 $6.41 $145.95 $145.95 $86.33 $145.95 $145.95 $145.95 $145.95 $109.50 $145.95 $145.95 $145.95 $72.98 $72.98 $115.59 $145.95 $116.76 $65.68 $6.11 $145.95 $84.68 $145.95 $145.95 $145.95 $6.11 $145.95 N/A N/A 600886 ERX HCPCS J0290 99999-6012-11 AMPICILLIN 2 G/100ML D5W MB PLUS BOTH IP/OP $82.50 $61.00 $2.84 $82.09 $36.94 $36.94 $36.94 $36.94 $82.09 $82.09 $82.09 $10.43 $82.09 $2.95 $2.95 $3.07 $2.84 $3.34 $82.09 $82.09 $48.56 $82.09 $82.09 $82.09 $82.09 $61.88 $82.09 $82.09 $82.09 $41.05 $41.05 $65.02 $82.09 $65.67 $36.94 $3.18 $82.09 $47.85 $82.09 $82.09 $82.09 $3.18 $82.09 N/A N/A 600889 ERX HCPCS J3370 99999-6010-17 VANCOMYCIN 1.5 G IN NS 250 ML PREMIX BOTH IP/OP $319.50 $236.00 $8.34 $319.30 $143.69 $143.69 $143.69 $143.69 $319.30 $319.30 $8.52 $10.86 $319.30 $8.67 $8.67 $9.01 $8.34 $9.80 $319.30 $319.30 $188.87 $319.30 $319.30 $319.30 $319.30 $239.63 $319.30 $319.30 $319.30 $159.65 $159.65 $252.89 $319.30 $255.44 $143.69 $9.33 $319.30 $185.31 $319.30 $319.30 $319.30 $9.33 $319.30 N/A N/A 600892 ERX HCPCS J0740 99999-6012-61 CIDOFOVIR INTRALESIONAL 15 MG/ML INJ BOTH IP/OP $616.50 $456.00 $128.44 $616.28 $616.28 $616.28 $616.28 $616.28 $616.28 $616.28 $563.76 $616.28 $616.28 $590.64 $590.64 $613.35 $567.92 $128.44 $616.28 $246.51 $616.28 $616.28 $616.28 $616.28 $616.28 $462.38 $616.28 $616.28 $616.28 $308.14 $308.14 $488.09 $616.28 $493.02 $277.33 $616.28 $616.28 $357.57 $616.28 $369.77 $616.28 $616.28 $616.28 N/A N/A 600893 ERX HCPCS 25000001 99999-6011-34 ADULT MAGIC MOUTHWASH(MLX:BEN:LIDO) SUSPENSION BOTH IP/OP $25.50 $19.00 $4.54 $25.49 $25.49 $25.49 $25.49 $25.49 $25.49 $25.49 $4.54 $25.49 $25.49 $18.92 $18.92 $19.65 $13.28 $5.31 $25.49 $10.20 $25.49 $25.49 $25.49 $25.49 $25.49 $19.13 $25.49 $25.49 $25.49 $12.75 $12.75 $20.19 $25.49 $20.39 $16.57 $25.49 $25.49 $14.79 $25.49 $15.29 $25.49 $25.49 $25.49 N/A N/A 600894 ERX HCPCS 25000001 99999-6011-35 NITROFURANTOIN 10MG/ML ORAL SUSPENSION BOTH IP/OP $59.00 $44.00 $10.47 $58.84 $58.84 $58.84 $58.84 $58.84 $58.84 $58.84 $10.47 $58.84 $58.84 $43.67 $43.67 $45.35 $30.66 $12.26 $58.84 $23.54 $58.84 $58.84 $58.84 $58.84 $58.84 $44.25 $58.84 $58.84 $58.84 $29.42 $29.42 $46.60 $58.84 $47.07 $38.25 $58.84 $58.84 $34.22 $58.84 $35.30 $58.84 $58.84 $58.84 N/A N/A 600895 ERX HCPCS J3010 99999-6011-36 FENTANYL DRIP SYRINGE BOTH IP/OP $85.00 $63.00 $16.75 $84.98 $38.24 $38.24 $38.24 $38.24 $84.98 $84.98 $84.98 $17.71 $84.98 $17.42 $17.42 $18.09 $16.75 $19.68 $84.98 $84.98 $50.27 $84.98 $84.98 $84.98 $84.98 $63.75 $84.98 $84.98 $84.98 $42.49 $42.49 $67.30 $84.98 $67.98 $38.24 $18.74 $84.98 $49.30 $84.98 $50.99 $84.98 $18.74 $84.98 N/A N/A 600897 ERX HCPCS J3010 99999-6011-36 FENTANYL CITRATE PF PCA 50 MCG/ML IV SOLN 50 ML BOTH IP/OP $85.00 $63.00 $16.75 $84.98 $38.24 $38.24 $38.24 $38.24 $84.98 $84.98 $84.98 $17.71 $84.98 $17.42 $17.42 $18.09 $16.75 $19.68 $84.98 $84.98 $50.27 $84.98 $84.98 $84.98 $84.98 $63.75 $84.98 $84.98 $84.98 $42.49 $42.49 $67.30 $84.98 $67.98 $38.24 $18.74 $84.98 $49.30 $84.98 $84.98 $84.98 $18.74 $84.98 N/A N/A 600898 ERX HCPCS J3010 00409-9094-61 FENTANYL 2500 MCG/50 ML PREMIX BOTH IP/OP $110.00 $81.00 $16.75 $120.08 $54.04 $54.04 $54.04 $54.04 $109.53 $109.53 $109.53 $22.83 $109.53 $17.42 $17.42 $18.09 $16.75 $19.68 $109.53 $120.08 $71.03 $120.08 $120.08 $109.53 $120.08 $82.50 $120.08 $120.08 $109.53 $60.04 $60.04 $95.10 $120.08 $96.06 $54.04 $18.74 $109.53 $63.80 $120.08 $65.72 $109.53 $18.74 $109.53 N/A N/A 600900 ERX HCPCS J3010 51754-9160-01 FENTANYL 5000 MCG/100 ML PREMIX BOTH IP/OP $185.00 $137.00 $33.50 $184.95 $83.23 $83.23 $83.23 $83.23 $184.95 $184.95 $184.95 $38.55 $184.95 $34.84 $34.84 $36.18 $33.50 $39.36 $184.95 $184.95 $109.40 $184.95 $184.95 $184.95 $184.95 $138.75 $184.95 $184.95 $184.95 $92.48 $92.48 $146.48 $184.95 $147.96 $83.23 $37.48 $184.95 $107.30 $184.95 $184.95 $184.95 $37.48 $184.95 N/A N/A 600915 ERX HCPCS J0834 99999-6011-50 COSYNTROPIN 2 MCG/ML SYRINGE- ENDOCRINOLOGY CLINIC BOTH IP/OP $22.00 $16.00 $4.59 $35.91 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $33.38 $33.38 $34.67 $32.10 $22.00 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $22.00 $22.00 $35.91 $22.00 N/A N/A 600925 ERX HCPCS 25000001 99999-6011-65 GANCICLOVIR 5 MG/ML NS (NICU) IV SYRINGE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 600926 ERX HCPCS J1561 99999-6011-67 IMMUNE GLOBULIN (HUMAN) 10 GM/100ML- MD BOTH IP/OP "$3,252.00" "$2,406.00" $677.75 "$3,251.75" "$1,463.29" "$1,463.29" "$1,463.29" "$1,463.29" $930.18 $930.18 $930.18 $677.75 $930.18 $967.41 $967.41 "$1,004.62" $930.20 "$1,092.84" $930.18 $954.06 "$1,603.11" $930.18 "$3,251.75" $930.18 $976.69 "$2,439.00" $930.18 $930.18 $930.18 "$1,625.88" "$1,625.88" "$2,575.39" $930.18 "$2,601.40" "$1,463.29" "$1,040.71" $930.18 "$1,886.16" $976.69 "$1,348.76" $930.18 "$1,040.71" $930.18 N/A N/A 600931 ERX HCPCS J9250 99999-6011-73 METHOTREXATE PF OPHTHALMIC INJECTION 0.4 MG/0.1 ML BOTH IP/OP $57.00 $42.00 $0.21 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $0.22 $0.22 $0.23 $0.21 $0.25 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $0.23 $57.00 $33.06 $57.00 $57.00 $57.00 $0.23 $57.00 N/A N/A 600932 ERX HCPCS 25000001 99999-6011-74 SELENIUM 4 MCG/ML IV SOLN- TPN BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600975 ERX HCPCS J3490 99999-6012-29 REMDESIVIR 100 MG/ NS 100 ML MB+ BOTH IP/OP "$1,403.50" "$1,039.00" $278.54 "$1,403.40" $631.53 $631.53 $631.53 $631.53 "$1,403.40" "$1,403.40" "$1,403.40" $292.50 "$1,403.40" "$1,403.40" "$1,403.40" "$1,403.40" "$1,403.40" $292.48 "$1,403.40" "$1,403.40" $830.11 "$1,403.40" "$1,403.40" "$1,403.40" "$1,403.40" "$1,052.63" "$1,403.40" "$1,403.40" "$1,403.40" $701.70 $701.70 "$1,111.49" "$1,403.40" "$1,122.72" $631.53 $278.54 "$1,403.40" $814.03 "$1,403.40" "$1,403.40" "$1,403.40" $292.47 "$1,403.40" N/A N/A 600981 ERX HCPCS 25000001 99999-6012-35 TRANEXAMIC ACID - NEBULIZER 1000 MG/10 ML FOR HEMOPTYSIS BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 600982 ERX HCPCS 25000001 99999-6012-36 VANCOMYCIN 500 MG/20 ML ORAL SOLUTION UNIT-DOSE CUP BOTH IP/OP $10.50 $8.00 $1.85 $10.37 $10.37 $10.37 $10.37 $10.37 $10.37 $10.37 $1.85 $10.37 $10.37 $7.70 $7.70 $7.99 $5.40 $2.16 $10.37 $4.15 $10.37 $10.37 $10.37 $10.37 $10.37 $7.88 $10.37 $10.37 $10.37 $5.19 $5.19 $8.21 $10.37 $8.30 $6.74 $10.37 $10.37 $6.09 $10.37 $6.22 $10.37 $10.37 $10.37 N/A N/A 600983 ERX HCPCS 25000001 99999-6012-37 DEXMEDETOMIDINE 1000 MCG/ 250 ML NS PREMIXED BOTH IP/OP $733.00 $542.00 $130.40 $732.56 $732.56 $732.56 $732.56 $732.56 $732.56 $732.56 $130.40 $732.56 $732.56 $543.71 $543.71 $564.66 $381.66 $152.67 $732.56 $293.02 $732.56 $732.56 $732.56 $732.56 $732.56 $549.75 $732.56 $732.56 $732.56 $366.28 $366.28 $580.19 $732.56 $586.05 $476.16 $732.56 $732.56 $425.14 $732.56 $439.54 $732.56 $732.56 $732.56 N/A N/A 600990 ERX HCPCS J2543 99999-6010-18 PIPERACIL-TAZO 4.5 G/NS 70 ML IVPB BOTH IP/OP $106.50 $79.00 $5.68 $106.18 $47.78 $47.78 $47.78 $47.78 $106.18 $106.18 $106.18 $26.18 $106.18 $5.91 $5.91 $6.13 $5.68 $6.67 $106.18 $106.18 $62.81 $106.18 $106.18 $106.18 $106.18 $79.88 $106.18 $106.18 $106.18 $53.09 $53.09 $84.09 $106.18 $84.94 $47.78 $6.35 $106.18 $61.77 $106.18 $106.18 $106.18 $6.35 $106.18 N/A N/A 600991 ERX HCPCS 25000001 99999-6010-19 PEDIATRIC OPHTHALMIC DILATING DROPS-EYE CLINIC USE ONLY (CYCLOPENTOLATE/PHENYLEPHRINE/TETRACAINE/TROPICAMIDE) BOTH IP/OP $199.00 $147.00 $35.42 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $35.42 $199.00 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $79.60 $199.00 $199.00 $199.00 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $199.00 $199.00 $115.42 $199.00 $119.40 $199.00 $199.00 $199.00 N/A N/A 600995 ERX HCPCS 25000001 99999-6010-28 DEXTROSE 10% WITH HEPARIN 1 UNIT/ML PREMIX (NICU) 250 ML (AKA UVC) BOTH IP/OP $83.00 $61.00 $14.77 $82.99 $82.99 $82.99 $82.99 $82.99 $82.99 $82.99 $14.77 $82.99 $82.99 $61.60 $61.60 $63.97 $43.24 $17.30 $82.99 $33.20 $82.99 $82.99 $82.99 $82.99 $82.99 $62.25 $82.99 $82.99 $82.99 $41.50 $41.50 $65.73 $82.99 $66.39 $53.94 $82.99 $82.99 $48.14 $82.99 $49.79 $82.99 $82.99 $82.99 N/A N/A 600996 ERX HCPCS 25000001 99999-6013-25 UAC FLUID 50 ML BOTH IP/OP $52.00 $38.00 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 600997 ERX HCPCS 25000001 99999-6013-24 PAL FLUID 50 ML BOTH IP/OP $69.00 $51.00 $12.28 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $69.00 $12.28 $69.00 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $27.60 $69.00 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $69.00 $69.00 $40.02 $69.00 $41.40 $69.00 $69.00 $69.00 N/A N/A 601004 ERX HCPCS J0697 25021-0118-10 CEFUROXIME SODIUM 750 MG IM SOLR BOTH IP/OP $22.00 $16.00 $1.99 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $2.01 $22.00 $22.00 $2.07 $2.07 $2.15 $1.99 $2.34 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 601005 ERX HCPCS J0697 00143-9977-22 CEFUROXIME SODIUM 1.5 G IM SOLR BOTH IP/OP $30.50 $23.00 $3.98 $30.31 $30.31 $30.31 $30.31 $30.31 $30.31 $30.31 $4.02 $30.31 $30.31 $4.14 $4.14 $4.30 $3.98 $4.68 $30.31 $12.12 $30.31 $30.31 $30.31 $30.31 $30.31 $22.88 $30.31 $30.31 $30.31 $15.16 $15.16 $24.01 $30.31 $24.25 $13.64 $30.31 $30.31 $17.69 $30.31 $18.19 $30.31 $30.31 $30.31 N/A N/A 601007 ERX HCPCS J2185 99999-6010-39 MEROPENEM 500 MG/NS 100ML MB PLUS BOTH IP/OP $195.00 $144.00 $3.70 $194.96 $87.73 $87.73 $87.73 $87.73 $194.96 $194.96 $194.96 $40.63 $194.96 $3.85 $3.85 $4.00 $3.70 $4.35 $194.96 $194.96 $115.32 $194.96 $194.96 $194.96 $194.96 $146.25 $194.96 $194.96 $194.96 $97.48 $97.48 $154.41 $194.96 $155.97 $87.73 $4.14 $194.96 $113.10 $194.96 $194.96 $194.96 $4.14 $194.96 N/A N/A 601009 ERX HCPCS J0295 99999-6010-92 AMPICILLIN-SULB 1.5 G/D5W 100ML MB PLUS BOTH IP/OP $113.00 $84.00 $2.73 $112.91 $50.81 $50.81 $50.81 $50.81 $112.91 $112.91 $112.91 $4.24 $112.91 $2.84 $2.84 $2.95 $2.73 $3.21 $112.91 $112.91 $66.79 $112.91 $112.91 $112.91 $112.91 $84.75 $112.91 $112.91 $112.91 $56.46 $56.46 $89.42 $112.91 $90.33 $50.81 $3.05 $112.91 $65.54 $112.91 $112.91 $112.91 $3.05 $112.91 N/A N/A 601010 ERX HCPCS 25000001 71286-3022-01 KETAMINE 50MG/5ML IV SYRINGE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 601011 ERX HCPCS J1335 99999-6010-45 ERTAPENEM 1 G/NS 100ML MB PLUS- DO NOT USE BOTH IP/OP $263.50 $195.00 $48.96 $263.46 $263.46 $263.46 $263.46 $263.46 $263.46 $263.46 $56.48 $263.46 $263.46 $50.92 $50.92 $52.88 $48.96 $57.52 $263.46 $105.38 $263.46 $263.46 $263.46 $263.46 $263.46 $197.63 $263.46 $263.46 $263.46 $131.73 $131.73 $208.66 $263.46 $210.77 $118.56 $263.46 $263.46 $152.83 $263.46 $158.08 $263.46 $263.46 $263.46 N/A N/A 601016 ERX HCPCS 25000001 99999-6010-53 MORPHINE 0.1% TOPICAL GEL 15G BOTH IP/OP $62.00 $46.00 $10.99 $61.74 $61.74 $61.74 $61.74 $61.74 $61.74 $61.74 $10.99 $61.74 $61.74 $45.82 $45.82 $47.59 $32.17 $12.87 $61.74 $24.70 $61.74 $61.74 $61.74 $61.74 $61.74 $46.50 $61.74 $61.74 $61.74 $30.87 $30.87 $48.90 $61.74 $49.39 $40.13 $61.74 $61.74 $35.96 $61.74 $37.04 $61.74 $61.74 $61.74 N/A N/A 601018 ERX HCPCS J1650 99999-6010-54 ENOXAPARIN SODIUM 10 MG/0.1ML SC SOLN BOTH IP/OP $22.00 $16.00 $0.80 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $0.83 $0.83 $0.86 $0.80 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 601019 ERX HCPCS J1650 99999-6010-55 ENOXAPARIN SODIUM 20 MG/0.2ML SC SOLN BOTH IP/OP $22.00 $16.00 $1.60 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $1.66 $1.66 $1.73 $1.60 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $4.37 $22.00 $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 601021 ERX HCPCS J2590 99999-6011-30 OXYTOCIN 20 UNITS IN 1000ML NS PREMIX BOTH IP/OP $214.00 $158.00 $1.74 $214.00 $96.30 $96.30 $96.30 $96.30 $214.00 $214.00 $214.00 $2.94 $214.00 $1.81 $1.81 $1.88 $1.74 $44.60 $214.00 $214.00 $126.58 $214.00 $214.00 $214.00 $214.00 $160.50 $214.00 $214.00 $214.00 $107.00 $107.00 $169.49 $214.00 $171.20 $96.30 $42.47 $214.00 $124.12 $214.00 $214.00 $214.00 $214.00 $214.00 N/A N/A 601024 ERX HCPCS 25000001 99999-6010-63 KETAMINE 10MG/1 ML IV SYRINGE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 601025 ERX HCPCS 25000001 99999-6010-64 NITROGLYCERIN 0.2 % OINT BOTH IP/OP $180.00 $133.00 $31.95 $179.51 $179.51 $179.51 $179.51 $179.51 $179.51 $179.51 $31.95 $179.51 $179.51 $133.23 $133.23 $138.37 $93.52 $37.41 $179.51 $71.80 $179.51 $179.51 $179.51 $179.51 $179.51 $135.00 $179.51 $179.51 $179.51 $89.76 $89.76 $142.17 $179.51 $143.61 $116.68 $179.51 $179.51 $104.40 $179.51 $107.71 $179.51 $179.51 $179.51 N/A N/A 601028 ERX HCPCS P9041 99999-6010-76 ALBUMIN 5 % IV CONTINUOUS INFUSION SYRINGE (NICU) BOTH IP/OP $27.00 $20.00 $5.25 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $5.25 $27.00 $27.00 $10.91 $10.91 $11.33 $10.49 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $12.15 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 601030 ERX HCPCS J1170 76045-0009-05 HYDROMORPHONE 0.5MG/0.5ML INJ BOTH IP/OP $22.00 $16.00 $1.56 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $1.56 $22.00 $2.86 $2.86 $2.97 $2.75 $3.23 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $3.08 $22.00 $12.76 $22.00 $22.00 $22.00 $3.08 $22.00 N/A N/A 601034 ERX HCPCS 25000001 99999-6010-84 ESMOLOL DRIP (NICU) 10 MG/ML BOTH IP/OP $185.50 $137.00 $33.00 $185.38 $185.38 $185.38 $185.38 $185.38 $185.38 $185.38 $33.00 $185.38 $185.38 $137.59 $137.59 $142.89 $96.58 $38.64 $185.38 $74.15 $185.38 $185.38 $185.38 $185.38 $185.38 $139.13 $185.38 $185.38 $185.38 $92.69 $92.69 $146.82 $185.38 $148.30 $120.50 $185.38 $185.38 $107.59 $185.38 $111.23 $185.38 $185.38 $185.38 N/A N/A 601035 ERX HCPCS 25000001 76154-0477-05 VASOPRESSIN 20 UNITS/100 ML NS PREMIX BOTH IP/OP $371.50 $275.00 $66.09 $371.29 $371.29 $371.29 $371.29 $371.29 $371.29 $371.29 $66.09 $371.29 $371.29 $275.57 $275.57 $286.19 $193.44 $77.38 $371.29 $148.52 $371.29 $371.29 $371.29 $371.29 $371.29 $278.63 $371.29 $371.29 $371.29 $185.65 $185.65 $294.06 $371.29 $297.03 $241.34 $371.29 $371.29 $215.47 $371.29 $222.77 $371.29 $371.29 $371.29 N/A N/A 601036 ERX HCPCS 25000001 76154-0477-05 VASOPRESSIN 20 UNITS/100 ML NS FOR DIABETES INSIPIDUS PREMIX BOTH IP/OP $371.50 $275.00 $66.09 $371.29 $371.29 $371.29 $371.29 $371.29 $371.29 $371.29 $66.09 $371.29 $371.29 $275.57 $275.57 $286.19 $193.44 $77.38 $371.29 $148.52 $371.29 $371.29 $371.29 $371.29 $371.29 $278.63 $371.29 $371.29 $371.29 $185.65 $185.65 $294.06 $371.29 $297.03 $241.34 $371.29 $371.29 $215.47 $371.29 $222.77 $371.29 $371.29 $371.29 N/A N/A 601047 ERX HCPCS j3370 99999-6011-04 VANCOMYCIN 500MG/NS 100ML MB PLUS BOTH IP/OP $60.00 $44.00 $10.67 $59.95 $59.95 $59.95 $59.95 $59.95 $59.95 $59.95 $10.67 $59.95 $59.95 $59.95 $59.95 $59.95 $59.95 $12.49 $59.95 $23.98 $59.95 $59.95 $59.95 $59.95 $59.95 $45.00 $59.95 $59.95 $59.95 $29.98 $29.98 $47.48 $59.95 $47.96 $26.98 $59.95 $59.95 $34.80 $59.95 $35.97 $59.95 $59.95 $59.95 N/A N/A 601050 ERX HCPCS J1335 42023-0221-10 ERTAPENEM SODIUM 1 G IJ SOLR FOR DESENSITIZATION BOTH IP/OP $487.50 $361.00 $48.96 $487.48 $487.48 $487.48 $487.48 $487.48 $487.48 $487.48 $56.48 $487.48 $487.48 $50.92 $50.92 $52.88 $48.96 $57.52 $487.48 $194.99 $487.48 $487.48 $487.48 $487.48 $487.48 $365.63 $487.48 $487.48 $487.48 $243.74 $243.74 $386.08 $487.48 $389.98 $219.37 $487.48 $487.48 $282.75 $487.48 $292.49 $487.48 $487.48 $487.48 N/A N/A 601053 ERX HCPCS 25000001 99999-6100-01 METHACHOLINE (PROVOCHOLINE) 1 MG/ML INHALATION SOLN C BOTH IP/OP $119.50 $88.00 $21.25 $119.40 $119.40 $119.40 $119.40 $119.40 $119.40 $119.40 $21.25 $119.40 $119.40 $88.62 $88.62 $92.03 $62.21 $24.88 $119.40 $47.76 $119.40 $119.40 $119.40 $119.40 $119.40 $89.63 $119.40 $119.40 $119.40 $59.70 $59.70 $94.56 $119.40 $95.52 $77.61 $119.40 $119.40 $69.31 $119.40 $71.64 $119.40 $119.40 $119.40 N/A N/A 601054 ERX HCPCS 25000001 99999-6100-02 METHACHOLINE (PROVOCHOLINE) 0.25 MG/ML INH SOLN D BOTH IP/OP $119.50 $88.00 $21.25 $119.40 $119.40 $119.40 $119.40 $119.40 $119.40 $119.40 $21.25 $119.40 $119.40 $88.62 $88.62 $92.03 $62.21 $24.88 $119.40 $47.76 $119.40 $119.40 $119.40 $119.40 $119.40 $89.63 $119.40 $119.40 $119.40 $59.70 $59.70 $94.56 $119.40 $95.52 $77.61 $119.40 $119.40 $69.31 $119.40 $71.64 $119.40 $119.40 $119.40 N/A N/A 601055 ERX HCPCS 25000001 99999-6100-03 METHACHOLINE (PROVOCHOLINE) 0.0625 MG/ML INH SOLN E BOTH IP/OP $119.50 $88.00 $21.25 $119.40 $119.40 $119.40 $119.40 $119.40 $119.40 $119.40 $21.25 $119.40 $119.40 $88.62 $88.62 $92.03 $62.21 $24.88 $119.40 $47.76 $119.40 $119.40 $119.40 $119.40 $119.40 $89.63 $119.40 $119.40 $119.40 $59.70 $59.70 $94.56 $119.40 $95.52 $77.61 $119.40 $119.40 $69.31 $119.40 $71.64 $119.40 $119.40 $119.40 N/A N/A 601058 ERX HCPCS 25000001 99999-6100-04 METHACHOLINE (PROVOCHOLINE) 4 MG/ML INH SOLN B BOTH IP/OP $119.50 $88.00 $21.25 $119.40 $119.40 $119.40 $119.40 $119.40 $119.40 $119.40 $21.25 $119.40 $119.40 $88.62 $88.62 $92.03 $62.21 $24.88 $119.40 $47.76 $119.40 $119.40 $119.40 $119.40 $119.40 $89.63 $119.40 $119.40 $119.40 $59.70 $59.70 $94.56 $119.40 $95.52 $77.61 $119.40 $119.40 $69.31 $119.40 $71.64 $119.40 $119.40 $119.40 N/A N/A 601059 ERX HCPCS 25000001 99999-6100-05 METHACHOLINE (PROVOCHOLINE) 16 MG/ML INH SOLN A BOTH IP/OP $119.50 $88.00 $21.25 $119.40 $119.40 $119.40 $119.40 $119.40 $119.40 $119.40 $21.25 $119.40 $119.40 $88.62 $88.62 $92.03 $62.21 $24.88 $119.40 $47.76 $119.40 $119.40 $119.40 $119.40 $119.40 $89.63 $119.40 $119.40 $119.40 $59.70 $59.70 $94.56 $119.40 $95.52 $77.61 $119.40 $119.40 $69.31 $119.40 $71.64 $119.40 $119.40 $119.40 N/A N/A 601060 ERX HCPCS 25000001 99999-6011-17 NAFCILLIN 2 G/NS 100ML MB PLUS BOTH IP/OP $109.50 $81.00 $19.42 $109.09 $109.09 $109.09 $109.09 $109.09 $109.09 $109.09 $19.42 $109.09 $109.09 $80.97 $80.97 $84.09 $56.84 $22.74 $109.09 $43.64 $109.09 $109.09 $109.09 $109.09 $109.09 $82.13 $109.09 $109.09 $109.09 $54.55 $54.55 $86.40 $109.09 $87.27 $70.91 $109.09 $109.09 $63.51 $109.09 $65.45 $109.09 $109.09 $109.09 N/A N/A 601061 ERX HCPCS 25000001 99999-6011-18 NAFCILLIN 1 G/NS 100ML MB PLUS BOTH IP/OP $109.50 $81.00 $19.42 $109.09 $109.09 $109.09 $109.09 $109.09 $109.09 $109.09 $19.42 $109.09 $109.09 $80.97 $80.97 $84.09 $56.84 $22.74 $109.09 $43.64 $109.09 $109.09 $109.09 $109.09 $109.09 $82.13 $109.09 $109.09 $109.09 $54.55 $54.55 $86.40 $109.09 $87.27 $70.91 $109.09 $109.09 $63.51 $109.09 $65.45 $109.09 $109.09 $109.09 N/A N/A 601063 ERX HCPCS 63600001 00338-0017-03 DEXTROSE 5% FLUID - DIALYSIS BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 601064 ERX HCPCS 63600001 00264-7805-10 SODIUM CHLORIDE 3% IV SOLUTION - DIALYSIS BOTH IP/OP $28.50 $21.00 $5.00 $28.08 $28.08 $28.08 $28.08 $28.08 $28.08 $28.08 $5.00 $28.08 $28.08 $28.08 $28.08 $28.08 $28.08 $5.85 $28.08 $11.23 $28.08 $28.08 $28.08 $28.08 $28.08 $21.38 $28.08 $28.08 $28.08 $14.04 $14.04 $22.24 $28.08 $22.46 $12.64 $28.08 $28.08 $16.53 $28.08 $16.85 $28.08 $28.08 $28.08 N/A N/A 601072 ERX HCPCS J1940 00409-6102-10 FUROSEMIDE 100 MG/10 ML INJ- OUTPATIENT IV DIURETIC CLINIC ONLY BOTH IP/OP $30.50 $23.00 $1.23 $30.24 $13.61 $13.61 $13.61 $13.61 $30.24 $30.24 $30.24 $1.23 $30.24 $2.70 $2.70 $2.81 $2.60 $3.05 $30.24 $30.24 $17.89 $30.24 $30.24 $30.24 $30.24 $22.88 $30.24 $30.24 $30.24 $15.12 $15.12 $23.95 $30.24 $24.19 $13.61 $2.91 $30.24 $17.69 $30.24 $30.24 $30.24 $2.91 $30.24 N/A N/A 601073 ERX HCPCS 25000001 99999-6012-08 DOXYCYCLINE 100MG/D5W 100ML MB PLUS BOTH IP/OP $113.00 $84.00 $20.06 $112.72 $112.72 $112.72 $112.72 $112.72 $112.72 $112.72 $20.06 $112.72 $112.72 $83.66 $83.66 $86.88 $58.73 $23.49 $112.72 $45.09 $112.72 $112.72 $112.72 $112.72 $112.72 $84.75 $112.72 $112.72 $112.72 $56.36 $56.36 $89.27 $112.72 $90.18 $73.27 $112.72 $112.72 $65.54 $112.72 $67.63 $112.72 $112.72 $112.72 N/A N/A 601074 ERX HCPCS J0290 99999-6012-12 AMPICILLIN 1 G/50 ML NS MB PLUS BOTH IP/OP $72.00 $53.00 $1.42 $71.51 $32.18 $32.18 $32.18 $32.18 $71.51 $71.51 $71.51 $5.22 $71.51 $1.48 $1.48 $1.53 $1.42 $1.67 $71.51 $71.51 $42.30 $71.51 $71.51 $71.51 $71.51 $54.00 $71.51 $71.51 $71.51 $35.76 $35.76 $56.64 $71.51 $57.21 $32.18 $1.59 $71.51 $41.76 $71.51 $71.51 $71.51 $1.59 $71.51 N/A N/A 601075 ERX HCPCS 63700001 99999-6012-45 PROPYLTHIOURACIL 400 MG RECTAL ENEMA BOTH IP/OP $107.00 $79.00 $22.30 $106.99 $106.99 $106.99 $106.99 $106.99 $106.99 $106.99 $106.99 $106.99 $106.99 $106.99 $106.99 $106.99 $106.99 $22.30 $106.99 $42.80 $106.99 $106.99 $106.99 $106.99 $106.99 $80.25 $106.99 $106.99 $106.99 $53.50 $53.50 $84.74 $106.99 $85.59 $69.54 $106.99 $106.99 $62.06 $106.99 $64.19 $106.99 $106.99 $106.99 N/A N/A 601076 ERX HCPCS J0348 99999-6012-46 ANIDULAFUNGIN 100 MG/ D5W 100 ML MB PLUS BOTH IP/OP $667.50 $494.00 $57.00 $667.32 $667.32 $667.32 $667.32 $667.32 $667.32 $667.32 $57.00 $667.32 $667.32 $59.28 $59.28 $61.56 $57.00 $66.97 $667.32 $266.93 $667.32 $667.32 $667.32 $667.32 $667.32 $500.63 $667.32 $667.32 $667.32 $333.66 $333.66 $528.52 $667.32 $533.86 $300.29 $667.32 $667.32 $387.15 $667.32 $400.39 $667.32 $667.32 $667.32 N/A N/A 601082 ERX HCPCS 25000001 99999-6012-66 DESMOPRESSIN 0.1 MCG/ML NS (NICU) SYRINGE BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 $27.00 $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 601084 ERX HCPCS J3480 99999-6012-68 KCL 40 MEQ/ 500 ML NS PREMIXED BOTH IP/OP $52.00 $38.00 $0.47 $52.00 $23.40 $23.40 $23.40 $23.40 $52.00 $52.00 $52.00 $0.47 $52.00 $3.12 $3.12 $3.24 $3.00 $3.52 $52.00 $52.00 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $3.36 $52.00 $30.16 $52.00 $52.00 $52.00 $3.36 $52.00 N/A N/A 601087 ERX HCPCS J1815 99999-6012-71 INSULIN DRIP- DKA 100 UNITS/100 ML NS PREMIXED BOTH IP/OP $52.00 $38.00 $10.32 $52.00 $28.24 $28.24 $28.24 $28.24 $52.00 $52.00 $52.00 $10.84 $52.00 $52.00 $52.00 $52.00 $52.00 $10.84 $52.00 $52.00 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $10.32 $52.00 $30.16 $52.00 $52.00 $52.00 $20.14 $52.00 N/A N/A 601093 ERX HCPCS J1815 99999-6012-78 INSULIN DRIP 100 UNITS/100 ML NS-GLUCOMMANDER PREMIX BOTH IP/OP $52.00 $38.00 $1.01 $52.00 $28.24 $28.24 $28.24 $28.24 $52.00 $52.00 $52.00 $10.84 $52.00 $52.00 $52.00 $52.00 $52.00 $10.84 $52.00 $52.00 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $10.32 $52.00 $30.16 $52.00 $52.00 $52.00 $1.01 $52.00 N/A N/A 601099 ERX HCPCS 25000001 99999-6012-87 ESMOLOL DRIP (NICU) 20 MG/ML DOUBLE CONCENTRATED BOTH IP/OP "$1,096.00" $811.00 $195.04 "$1,095.72" "$1,095.72" "$1,095.72" "$1,095.72" "$1,095.72" "$1,095.72" "$1,095.72" $195.04 "$1,095.72" "$1,095.72" $813.24 $813.24 $844.58 $570.87 $228.36 "$1,095.72" $438.29 "$1,095.72" "$1,095.72" "$1,095.72" "$1,095.72" "$1,095.72" $822.00 "$1,095.72" "$1,095.72" "$1,095.72" $547.86 $547.86 $867.81 "$1,095.72" $876.58 $712.22 "$1,095.72" "$1,095.72" $635.68 "$1,095.72" $657.43 "$1,095.72" "$1,095.72" "$1,095.72" N/A N/A 601101 ERX HCPCS 63600001 99999-6012-90 TRANEXAMIC ACID IV INFUSION 1G/100ML NS BOTH IP/OP $313.50 $232.00 $55.76 $313.25 $313.25 $313.25 $313.25 $313.25 $313.25 $313.25 $55.76 $313.25 $313.25 $313.25 $313.25 $313.25 $313.25 $65.28 $313.25 $125.30 $313.25 $313.25 $313.25 $313.25 $313.25 $235.13 $313.25 $313.25 $313.25 $156.63 $156.63 $248.09 $313.25 $250.60 $140.96 $313.25 $313.25 $181.83 $313.25 $187.95 $313.25 $313.25 $313.25 N/A N/A 601113 ERX HCPCS 25000001 99999-6013-06 LIDOCAINE 2% (NEBULIZED USE ONLY) BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 601118 ERX HCPCS 63600001 99999-6013-11 INSULIN DRIP 100 UNITS/100 ML NS-GLUCOMMANDER PREMIX CTS BOTH IP/OP $52.00 $38.00 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 601129 ERX HCPCS J0456 99999-6013-22 AZITHROMYCIN 500MG/NS 250ML MB PLUS BOTH IP/OP $54.00 $40.00 $2.63 $53.67 $24.15 $24.15 $24.15 $24.15 $53.67 $53.67 $53.67 $11.19 $53.67 $2.74 $2.74 $2.84 $2.63 $11.19 $53.67 $53.67 $31.75 $53.67 $53.67 $53.67 $53.67 $40.50 $53.67 $53.67 $53.67 $26.84 $26.84 $42.51 $53.67 $42.94 $24.15 $10.65 $53.67 $31.32 $53.67 $53.67 $53.67 $53.67 $53.67 N/A N/A 601136 ERX HCPCS J9171 99999-6013-31 DOCETAXEL 40 MG/50 ML NS INTRAVESICAL SYRINGE BOTH IP/OP $542.50 $401.00 $18.40 $542.19 $243.99 $243.99 $243.99 $243.99 $542.19 $542.19 $542.19 $113.01 $542.19 $19.14 $19.14 $19.87 $18.40 $21.62 $542.19 $542.19 $320.71 $542.19 $542.19 $542.19 $542.19 $406.88 $542.19 $542.19 $542.19 $271.10 $271.10 $429.41 $542.19 $433.75 $243.99 $20.59 $542.19 $314.65 $542.19 $542.19 $542.19 $20.59 $542.19 N/A N/A 601137 ERX HCPCS J9260 99999-6013-35 METHOTREXATE FOR SUBCUTANEOUS 25 MG/ML SYRINGE BOTH IP/OP $57.00 $42.00 $2.07 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $2.70 $57.00 $2.15 $2.15 $2.24 $2.07 $2.43 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $2.32 $57.00 $33.06 $57.00 $57.00 $57.00 $2.32 $57.00 N/A N/A 601143 ERX HCPCS Q9967 00407-1414-72 IOHEXOL 350 MG/ML IV SOLN 500ML BOTH IP/OP $184.50 $137.00 $6.00 $184.37 $82.97 $82.97 $82.97 $82.97 $184.37 $184.37 $184.37 $38.43 $184.37 $184.37 $184.37 $6.48 $6.00 $38.42 $184.37 $184.37 $109.05 $184.37 $184.37 $184.37 $184.37 $138.38 $184.37 $184.37 $184.37 $92.19 $92.19 $146.02 $184.37 $147.50 $82.97 $36.59 $184.37 $107.01 $184.37 $184.37 $184.37 $38.42 $184.37 N/A N/A 601145 ERX HCPCS J9305 71288-0166-10 PEMETREXED (GENERIC) DISODIUM 100 MG IV SOLR BOTH IP/OP $143.50 $106.00 $64.48 $850.74 $64.48 $64.48 $64.48 $64.48 $760.37 $760.37 $760.37 $566.59 $760.37 $790.82 $790.82 $821.23 $760.40 $143.28 $760.37 $171.41 $84.75 $760.37 $143.28 $760.37 $798.39 $107.63 $760.37 $760.37 $760.37 $71.64 $71.64 $113.48 $760.37 $114.62 $64.48 $143.28 $760.37 $83.23 $798.39 $143.28 $760.37 $850.74 $760.37 N/A N/A 601146 ERX HCPCS J9305 71288-0167-50 PEMETREXED (GENERIC) DISODIUM 500 MG IV SOLR BOTH IP/OP $625.00 $463.00 $281.07 "$4,253.68" $281.07 $281.07 $281.07 $281.07 "$3,801.85" "$3,801.85" "$3,801.85" "$2,832.93" "$3,801.85" "$3,954.08" "$3,954.08" "$4,106.16" "$3,802.00" $624.60 "$3,801.85" $857.05 $369.45 "$3,801.85" $624.60 "$3,801.85" "$3,991.94" $468.75 "$3,801.85" "$3,801.85" "$3,801.85" $312.30 $312.30 $494.68 "$3,801.85" $499.68 $281.07 $624.60 "$3,801.85" $362.50 "$3,991.94" $624.60 "$3,801.85" "$4,253.68" "$3,801.85" N/A N/A 601147 ERX HCPCS 63700001 99999-6013-43 AMOXICILLIN 500 MG/10 ML ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 601148 ERX HCPCS 25000001 99999-6013-44 GLUCOSE GEL 1.5 GRAM/3 ML (NICU) ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 601155 ERX HCPCS 25000001 99999-6013-48 DEXTROSE 10% WITH HEPARIN 1 UNIT/ML PREMIX (NICU) 500 ML (AKA UVC) BOTH IP/OP $181.00 $134.00 $32.21 $180.97 $180.97 $180.97 $180.97 $180.97 $180.97 $180.97 $32.21 $180.97 $180.97 $134.32 $134.32 $139.49 $94.29 $37.72 $180.97 $72.39 $180.97 $180.97 $180.97 $180.97 $180.97 $135.75 $180.97 $180.97 $180.97 $90.49 $90.49 $143.33 $180.97 $144.78 $117.63 $180.97 $180.97 $104.98 $180.97 $108.58 $180.97 $180.97 $180.97 N/A N/A 601156 ERX HCPCS Q9967 99999-6013-49 IOHEXOL 350 MG/ML 25 ML ORAL SOLUTION BOTH IP/OP $120.50 $89.00 $0.12 $120.20 $54.09 $54.09 $54.09 $54.09 $120.20 $120.20 $120.20 $25.05 $120.20 $120.20 $120.20 $0.13 $0.12 $25.05 $120.20 $120.20 $71.10 $120.20 $120.20 $120.20 $120.20 $90.38 $120.20 $120.20 $120.20 $60.10 $60.10 $95.20 $120.20 $96.16 $54.09 $23.86 $120.20 $69.89 $120.20 $120.20 $120.20 $25.05 $120.20 N/A N/A 601165 ERX HCPCS 25000001 99999-6013-59 GENTAMICIN 10MG-HEPARIN 2000 UNITS/2 ML FLUSH (FOR HEMODIALYSIS CATHETER) 2 ML BOTH IP/OP $52.00 $38.00 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 601168 ERX HCPCS 25000001 99999-6013-61 GENVOYA 3-TABLET PACK:150-150-200-10 MG PO TABLET BOTH IP/OP $497.50 $368.00 $88.54 $497.44 $497.44 $497.44 $497.44 $497.44 $497.44 $497.44 $88.54 $497.44 $497.44 $369.20 $369.20 $383.43 $259.17 $103.67 $497.44 $198.98 $497.44 $497.44 $497.44 $497.44 $497.44 $373.13 $497.44 $497.44 $497.44 $248.72 $248.72 $393.97 $497.44 $397.95 $323.34 $497.44 $497.44 $288.55 $497.44 $298.46 $497.44 $497.44 $497.44 N/A N/A 601171 ERX HCPCS J0690 99999-6013-67 CEFAZOLIN 2G/10ML FOR OR USE BOTH IP/OP $52.00 $38.00 $2.77 $52.00 $23.40 $23.40 $23.40 $23.40 $52.00 $52.00 $52.00 $2.77 $52.00 $3.20 $3.20 $3.33 $3.08 $3.62 $52.00 $52.00 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $3.45 $52.00 $30.16 $52.00 $52.00 $52.00 $3.45 $52.00 N/A N/A 601178 ERX HCPCS J7999 99999-6014-73 NOREPINEPHRINE-SODIUM CHLORIDE 16-0.9 MG/500ML-% IV SOLN BOTH IP/OP "$6,109.50" "$4,521.00" "$1,273.24" "$6,109.26" "$6,109.26" "$6,109.26" "$6,109.26" "$6,109.26" "$6,109.26" "$6,109.26" "$6,109.26" "$6,109.26" "$6,109.26" "$6,109.26" "$6,109.26" "$6,109.26" "$6,109.26" "$1,273.24" "$6,109.26" "$2,443.70" "$6,109.26" "$6,109.26" "$6,109.26" "$6,109.26" "$6,109.26" "$4,582.13" "$6,109.26" "$6,109.26" "$6,109.26" "$3,054.63" "$3,054.63" "$4,838.53" "$6,109.26" "$4,887.41" "$2,749.17" "$6,109.26" "$6,109.26" "$3,543.51" "$6,109.26" "$3,665.56" "$6,109.26" "$6,109.26" "$6,109.26" N/A N/A 601205 ERX HCPCS 25000001 99999-6015-02 MULTIVITAMIN (DEKAS ESSENTIAL) ORAL SYRINGE (NICU) (AKA DEKA) BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 601207 ERX HCPCS J1815 99999-6015-04 INSULIN 3 UNIT/ML (NICU) DILUTION - DRIP COMPOUNDING ONLY BOTH IP/OP $10.00 $7.00 $1.98 $12.08 $5.43 $5.43 $5.43 $5.43 $10.00 $10.00 $10.00 $2.08 $10.00 $10.00 $10.00 $10.00 $10.00 $2.08 $10.00 $10.00 $5.92 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $1.98 $10.00 $5.80 $10.00 $10.00 $10.00 $12.08 $10.00 N/A N/A 601209 ERX HCPCS 25000001 53462-0003-15 CHLORHEXIDINE GLUCONATE 0.12 % MT SOLN NOSE TO TOES FLOOR STOCK KIT BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 601215 ERX HCPCS 25000001 53462-0375-60 CORINZ MOISTURIZER/PLAQUE PREVENTER MOUTH SWAB BOTH IP/OP $6.00 $4.00 $1.07 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $4.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $3.48 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 601216 ERX HCPCS 25000001 99999-6015-15 TRIALYSIS HD CATHETER LOCK SOLUTION – VANCOMYCIN 10 MG/2ML - HEPARIN 2500 UNITS/2ML BOTH IP/OP $52.00 $38.00 $9.26 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $52.00 $9.26 $52.00 $52.00 $38.59 $38.59 $40.08 $27.09 $10.84 $52.00 $20.80 $52.00 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $33.80 $52.00 $52.00 $30.16 $52.00 $31.20 $52.00 $52.00 $52.00 N/A N/A 601219 ERX HCPCS 25000001 99999-6015-17 DEL NIDO CARDIOPLEGIA SOLUTION - COMPOUNDED BOTH IP/OP $217.00 $161.00 $38.55 $216.59 $216.59 $216.59 $216.59 $216.59 $216.59 $216.59 $38.55 $216.59 $216.59 $160.75 $160.75 $166.95 $112.84 $45.14 $216.59 $86.64 $216.59 $216.59 $216.59 $216.59 $216.59 $162.75 $216.59 $216.59 $216.59 $108.30 $108.30 $171.54 $216.59 $173.27 $140.78 $216.59 $216.59 $125.86 $216.59 $129.95 $216.59 $216.59 $216.59 N/A N/A 601220 ERX HCPCS J2997 99999-6015-18 ALTEPLASE BOLUS FROM BAG BOTH IP/OP "$2,461.00" "$1,821.00" $488.36 "$2,460.58" "$1,107.26" "$1,107.26" "$1,107.26" "$1,107.26" $876.70 $876.70 $876.70 $512.85 $876.70 $911.77 $911.77 $946.84 $876.70 $512.81 $876.70 $875.65 "$1,213.07" $876.70 "$2,460.58" $876.70 $920.54 "$1,845.75" $876.70 $876.70 $876.70 "$1,230.29" "$1,230.29" "$1,948.78" $876.70 "$1,968.46" "$1,107.26" $488.36 $876.70 "$1,427.38" $920.54 "$1,271.22" $876.70 $512.78 $876.70 N/A N/A 900083 ERX HCPCS 63700001 99999-9000-83 AMLODIPINE 1MG/ML ORAL SUSP BOTH IP/OP $37.50 $28.00 $7.76 $37.25 $37.25 $37.25 $37.25 $37.25 $37.25 $37.25 $37.25 $37.25 $37.25 $37.25 $37.25 $37.25 $37.25 $7.76 $37.25 $14.90 $37.25 $37.25 $37.25 $37.25 $37.25 $28.13 $37.25 $37.25 $37.25 $18.63 $18.63 $29.50 $37.25 $29.80 $24.21 $37.25 $37.25 $21.75 $37.25 $22.35 $37.25 $37.25 $37.25 N/A N/A 900092 ERX HCPCS 25000001 99999-9000-92 OMEPRAZOLE 2MG/ML ORAL SUSP 50ML BOTH IP/OP $58.00 $43.00 $10.30 $57.85 $57.85 $57.85 $57.85 $57.85 $57.85 $57.85 $10.30 $57.85 $57.85 $42.94 $42.94 $44.59 $30.14 $12.06 $57.85 $23.14 $57.85 $57.85 $57.85 $57.85 $57.85 $43.50 $57.85 $57.85 $57.85 $28.93 $28.93 $45.82 $57.85 $46.28 $37.60 $57.85 $57.85 $33.64 $57.85 $34.71 $57.85 $57.85 $57.85 N/A N/A 900093 ERX HCPCS 63700001 99999-6012-89 PYRAZINAMIDE 100MG/ML SUSP ORAL SYRINGE BOTH IP/OP $9.00 $7.00 $1.88 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 $9.00 $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 900094 ERX HCPCS 63700001 99999-9000-94 RIFABUTIN 1200MG/60ML SUSPENSION BOTH IP/OP $159.00 $118.00 $33.09 $158.77 $158.77 $158.77 $158.77 $158.77 $158.77 $158.77 $158.77 $158.77 $158.77 $158.77 $158.77 $158.77 $158.77 $33.09 $158.77 $63.51 $158.77 $158.77 $158.77 $158.77 $158.77 $119.25 $158.77 $158.77 $158.77 $79.39 $79.39 $125.75 $158.77 $127.02 $103.20 $158.77 $158.77 $92.22 $158.77 $95.26 $158.77 $158.77 $158.77 N/A N/A 900095 ERX HCPCS 63700001 99999-6010-59 RIFAMPIN 10MG/ML ORAL SUSP BOTH IP/OP $17.50 $13.00 $3.57 $17.11 $17.11 $17.11 $17.11 $17.11 $17.11 $17.11 $17.11 $17.11 $17.11 $17.11 $17.11 $17.11 $17.11 $3.57 $17.11 $6.84 $17.11 $17.11 $17.11 $17.11 $17.11 $13.13 $17.11 $17.11 $17.11 $8.56 $8.56 $13.55 $17.11 $13.69 $11.12 $17.11 $17.11 $10.15 $17.11 $10.27 $17.11 $17.11 $17.11 N/A N/A 900097 ERX HCPCS 25000001 99999-6006-02 DAKINS (1/8 STRENGTH) 0.0625% EX SOLN BOTH IP/OP $40.50 $30.00 $7.20 $40.44 $40.44 $40.44 $40.44 $40.44 $40.44 $40.44 $7.20 $40.44 $40.44 $30.01 $30.01 $31.17 $21.07 $8.43 $40.44 $16.18 $40.44 $40.44 $40.44 $40.44 $40.44 $30.38 $40.44 $40.44 $40.44 $20.22 $20.22 $32.03 $40.44 $32.35 $26.29 $40.44 $40.44 $23.49 $40.44 $24.26 $40.44 $40.44 $40.44 N/A N/A 900098 ERX HCPCS 25000001 99999-6008-14 URSODIOL 15MG/ML ORAL SOLUTION BOTH IP/OP $20.50 $15.00 $3.57 $20.05 $20.05 $20.05 $20.05 $20.05 $20.05 $20.05 $3.57 $20.05 $20.05 $14.88 $14.88 $15.45 $10.45 $4.18 $20.05 $8.02 $20.05 $20.05 $20.05 $20.05 $20.05 $15.38 $20.05 $20.05 $20.05 $10.03 $10.03 $15.88 $20.05 $16.04 $13.03 $20.05 $20.05 $11.89 $20.05 $12.03 $20.05 $20.05 $20.05 N/A N/A 900131 ERX HCPCS J1644 99999-6006-11 HEPARIN 1500 UNITS IN NS 500 ML IR USE ONLY BOTH IP/OP $78.00 $58.00 $0.24 $77.76 $34.99 $34.99 $34.99 $34.99 $77.76 $77.76 $77.76 $0.24 $77.76 $0.26 $0.26 $0.27 $0.25 $0.29 $77.76 $77.76 $46.00 $77.76 $77.76 $77.76 $77.76 $58.50 $77.76 $77.76 $77.76 $38.88 $38.88 $61.59 $77.76 $62.21 $34.99 $0.28 $77.76 $45.24 $77.76 $77.76 $77.76 $0.28 $77.76 N/A N/A 900147 ERX HCPCS 63700001 99999-6005-86 OPIUM TINCTURE 6MG/0.6ML ORAL SYRINGE BOTH IP/OP $12.00 $9.00 $2.48 $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $11.91 $2.48 $11.91 $4.76 $11.91 $11.91 $11.91 $11.91 $11.91 $9.00 $11.91 $11.91 $11.91 $5.96 $5.96 $9.43 $11.91 $9.53 $7.74 $11.91 $11.91 $6.96 $11.91 $7.15 $11.91 $11.91 $11.91 N/A N/A 900288 ERX HCPCS 25000001 99999-6010-21 "MAFENIDE 5% (PLUS NYSTATIN 500,000 UNITS) TOP SOL-50GM/1000ML SW" BOTH IP/OP $191.00 $141.00 $33.97 $190.87 $190.87 $190.87 $190.87 $190.87 $190.87 $190.87 $33.97 $190.87 $190.87 $141.66 $141.66 $147.12 $99.44 $39.78 $190.87 $76.35 $190.87 $190.87 $190.87 $190.87 $190.87 $143.25 $190.87 $190.87 $190.87 $95.44 $95.44 $151.17 $190.87 $152.70 $124.07 $190.87 $190.87 $110.78 $190.87 $114.52 $190.87 $190.87 $190.87 N/A N/A 900333 ERX HCPCS J9201 00409-0181-01 GEMCITABINE 2G INTRAVESICAL SYRINGE-UROLOGY CLINIC ONLY BOTH IP/OP $377.50 $279.00 $38.50 "$1,623.73" $169.78 $169.78 $169.78 $169.78 $377.28 $377.28 $377.28 "$1,623.73" $377.28 $40.04 $40.04 $41.58 $38.50 $45.23 $377.28 $377.28 $223.16 $377.28 $377.28 $377.28 $377.28 $283.13 $377.28 $377.28 $377.28 $188.64 $188.64 $298.81 $377.28 $301.82 $169.78 $43.07 $377.28 $218.95 $377.28 $377.28 $377.28 $43.07 $377.28 N/A N/A 900445 ERX HCPCS 25000001 99999-6013-62 PARACERVICAL BLOCK LIDOCAINE/VASOPRESSIN BOTH IP/OP $391.00 $289.00 $69.57 $390.82 $390.82 $390.82 $390.82 $390.82 $390.82 $390.82 $69.57 $390.82 $390.82 $290.07 $290.07 $301.24 $203.62 $81.45 $390.82 $156.33 $390.82 $390.82 $390.82 $390.82 $390.82 $293.25 $390.82 $390.82 $390.82 $195.41 $195.41 $309.53 $390.82 $312.66 $254.03 $390.82 $390.82 $226.78 $390.82 $234.49 $390.82 $390.82 $390.82 N/A N/A 900575 ERX HCPCS 25000001 99999-6009-03 PHENYLEPHRINE BOLUS FROM IV BAG FOR CARDIAC NARRATOR BOTH IP/OP $22.00 $16.00 $3.92 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $12.76 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 900576 ERX HCPCS J0171 99999-6009-80 EPINEPHRINE 16000 MCG/500 ML NS - ANE BOTH IP/OP $173.50 $128.00 $36.08 $173.13 $77.91 $77.91 $77.91 $77.91 $173.13 $173.13 $173.13 $36.08 $173.13 $119.81 $119.81 $124.42 $115.20 $135.34 $173.13 $173.13 $102.41 $173.13 $173.13 $173.13 $173.13 $130.13 $173.13 $173.13 $173.13 $86.57 $86.57 $137.12 $173.13 $138.50 $77.91 $128.89 $173.13 $100.63 $173.13 $173.13 $173.13 $128.89 $173.13 N/A N/A 900940 ERX HCPCS 25000001 99999-6013-05 KETAMINE INFUSION - HIGHLY CONCENTRATED BOTH IP/OP $301.50 $223.00 $53.66 $301.44 $301.44 $301.44 $301.44 $301.44 $301.44 $301.44 $53.66 $301.44 $301.44 $223.73 $223.73 $232.35 $157.05 $62.82 $301.44 $120.58 $301.44 $301.44 $301.44 $301.44 $301.44 $226.13 $301.44 $301.44 $301.44 $150.72 $150.72 $238.74 $301.44 $241.15 $195.94 $301.44 $301.44 $174.87 $301.44 $180.86 $301.44 $301.44 $301.44 N/A N/A 900944 ERX HCPCS J9201 99999-6013-30 GEMCITABINE 1G INTRAVESICAL SYRINGE-UROLOGY CLINIC ONLY BOTH IP/OP $192.00 $142.00 $19.25 $811.87 $86.24 $86.24 $86.24 $86.24 $191.64 $191.64 $191.64 $811.87 $191.64 $20.02 $20.02 $20.79 $19.25 $22.62 $191.64 $191.64 $113.36 $191.64 $191.64 $191.64 $191.64 $144.00 $191.64 $191.64 $191.64 $95.82 $95.82 $151.78 $191.64 $153.31 $86.24 $21.54 $191.64 $111.36 $191.64 $191.64 $191.64 $21.54 $191.64 N/A N/A 4083037 ERX HCPCS J3010 00409-9094-22 FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.67 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $0.70 $0.70 $0.72 $0.67 $0.79 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.75 $22.00 $12.76 $22.00 $13.20 $22.00 $0.75 $22.00 N/A N/A 4083037 ERX HCPCS J3010 00641-6028-25 FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.67 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $0.70 $0.70 $0.72 $0.67 $0.79 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.75 $22.00 $12.76 $22.00 $13.20 $22.00 $0.75 $22.00 N/A N/A 4083037 ERX HCPCS J3010 00641-6030-01 FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.67 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $0.70 $0.70 $0.72 $0.67 $0.79 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.75 $22.00 $12.76 $22.00 $13.20 $22.00 $0.75 $22.00 N/A N/A 4083037 ERX HCPCS J3010 00641-6247-25 FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN BOTH IP/OP $22.00 $16.00 $0.67 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $0.70 $0.70 $0.72 $0.67 $0.79 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $0.75 $22.00 $12.76 $22.00 $13.20 $22.00 $0.75 $22.00 N/A N/A 40811150 ERX HCPCS J2704 25021-0608-50 PROPOFOL 10 MG/ML IV EMUL 50 OR 100 ML BOTH IP/OP $76.00 $56.00 $7.00 $75.82 $34.12 $34.12 $34.12 $34.12 $75.82 $75.82 $75.82 $15.80 $75.82 $7.28 $7.28 $7.56 $7.00 $15.80 $75.82 $75.82 $44.85 $75.82 $75.82 $75.82 $75.82 $57.00 $75.82 $75.82 $75.82 $37.91 $37.91 $60.05 $75.82 $60.66 $34.12 $15.05 $75.82 $44.08 $75.82 $75.82 $75.82 $15.80 $75.82 N/A N/A 4.081E+12 ERX HCPCS J1815 00002-7510-01 INSULIN LISPRO 100 UNIT/ML SC SOLN BOTH IP/OP $15.00 $11.00 $1.01 $15.00 $8.15 $8.15 $8.15 $8.15 $15.00 $15.00 $15.00 $3.13 $15.00 $15.00 $15.00 $15.00 $15.00 $3.13 $15.00 $15.00 $8.87 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $2.98 $15.00 $8.70 $15.00 $15.00 $15.00 $1.01 $15.00 N/A N/A -86548 SUP Custom 27203010 86548- - TUBE ET 6.9MM STRL LF SHLY CUF MRPH EYE REINF PVC SIL NSL BOTH IP/OP $45.00 $33.00 $26.10 $40.76 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $40.76 N/A N/A N/A N/A N/A $33.75 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $26.10 N/A N/A N/A N/A N/A N/A N/A -86548 SUP Custom 27203010 86548- - TUBE ENDOTRAC 6MM CUFF REINFORCE MURPHY EYE PVC SILICONE BOTH IP/OP $45.50 $34.00 $26.39 $40.76 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $40.76 N/A N/A N/A N/A N/A $34.13 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $26.39 N/A N/A N/A N/A N/A N/A N/A 15 SUP Custom 27203010 00015 - HANDGRIP CRCH CHLD GRY BOTH IP/OP $15.50 $11.00 $2.74 $15.40 $15.40 $15.40 $15.40 $15.40 $15.40 $15.40 $2.74 $15.40 $15.40 $11.43 $11.43 $11.87 $8.02 $3.21 $15.40 $6.16 $15.40 $15.40 $15.40 $15.40 $15.40 $11.63 $15.40 $15.40 $15.40 $7.70 $7.70 $12.20 $15.40 $12.32 $10.01 $15.40 N/A $8.99 $15.40 $9.24 $15.40 $15.40 $15.40 N/A N/A 15.201 SUP HCPCS C1713 015.2010 - PLATE SQ RECT GRID MESH 1.5 MM SCR CRANIAL TI TIMESH BONE BOTH IP/OP "$1,010.00" $747.00 $200.46 "$1,010.00" $454.50 $454.50 $454.50 $454.50 "$1,010.00" "$1,010.00" "$1,010.00" $210.51 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $210.50 "$1,010.00" "$1,010.00" $597.42 "$1,010.00" "$1,010.00" "$1,010.00" "$1,010.00" $757.50 "$1,010.00" "$1,010.00" "$1,010.00" $505.00 $505.00 $799.92 "$1,010.00" $808.00 $454.50 $200.46 N/A $585.80 "$1,010.00" $606.00 "$1,010.00" $210.48 "$1,010.00" N/A N/A 76 SUP Custom 27203010 000076 - PLUG CATHETER CAP FOLEY DRAIN LUMEN LATEX FREE BARD STERILE BOTH IP/OP $1.00 $1.00 $0.14 $0.80 $0.78 $0.78 $0.78 $0.78 $0.78 $0.78 $0.14 $0.78 $0.78 $0.58 $0.58 $0.60 $0.41 $0.16 $0.78 $0.32 $0.78 $0.78 $0.80 $0.78 $0.78 $0.75 $0.78 $0.78 $0.78 $0.39 $0.39 $0.62 $0.78 $0.62 $0.51 $0.78 N/A $0.58 $0.78 $0.47 $0.78 $0.78 $0.78 N/A N/A 86 SUP HCPCS C1886 0086 - NOVASURE 2007 ENDOMETRIAL ABLATION SYSTEM BOTH IP/OP "$3,050.00" "$2,257.00" $635.65 "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$2,263.71" "$2,263.71" "$2,350.94" "$1,589.05" $635.65 "$3,050.00" "$1,220.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$2,287.50" "$3,050.00" "$3,050.00" "$3,050.00" "$1,525.00" "$1,525.00" "$2,415.60" "$3,050.00" "$2,440.00" "$1,982.50" "$3,050.00" N/A "$1,769.00" "$3,050.00" "$1,830.00" "$3,050.00" "$3,050.00" "$3,050.00" N/A N/A 90 SUP Custom 27803010 90 - PLATE BN 152X152MM MESH PNL TI CRNM BOTH IP/OP "$2,316.50" "$1,714.00" $412.29 "$2,316.25" "$2,316.25" "$2,316.25" "$2,316.25" "$2,316.25" "$2,316.25" "$2,316.25" $412.29 "$2,316.25" "$2,316.25" "$2,316.25" "$2,316.25" "$2,316.25" "$2,316.25" $482.73 "$2,316.25" $926.50 "$2,316.25" "$2,316.25" "$2,316.25" "$2,316.25" "$2,316.25" "$1,737.38" "$2,316.25" "$2,316.25" "$2,316.25" "$1,158.13" "$1,158.13" "$1,834.47" "$2,316.25" "$1,853.00" "$1,042.31" "$2,316.25" N/A "$1,343.57" "$2,316.25" "$1,389.75" "$2,316.25" "$2,316.25" "$2,316.25" N/A N/A 101.107 SUP Custom 27803010 101.107 - SPACER SPNL SM 22X10X7MM NS LF SUST RDLCNT PEEK LMBR INTRBD BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 101.109 SUP Custom 27803010 101.109 - SPACER SPNL SM 22X10X9MM NS LF SUST RDLCNT PEEK LMBR INTRBD BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 101.111 SUP Custom 27803010 101.111 - SPACER SPNL SM 22X10X11MM NS LF SUST RDLCNT PEEK LMBR INTRBD BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 101.113 SUP Custom 27803010 101.113 - SPACER SPNL SM 22X10X13MM NS LF SUST RDLCNT PEEK LMBR INTRBD BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 101.115 SUP Custom 27803010 101.115 - SPACER SPNL SM 22X10X15MM NS LF SUST RDLCNT PEEK LMBR INTRBD BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 101.117 SUP Custom 27803010 101.117 - SPACER SPNL SM 22X10X17MM NS LF SUST RDLCNT PEEK LMBR INTRBD BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 101.205 SUP Custom 27803010 101.205 - SPACER SPNL 13MM MED PRLL 14X5MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.206 SUP Custom 27803010 101.206 - SPACER SPNL 13MM MED PRLL 14X6MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.207 SUP Custom 27803010 101.207 - SPACER SPNL 13MM MED PRLL 14X7MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.208 SUP Custom 27803010 101.208 - SPACER SPNL 13MM MED PRLL 14X8MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.209 SUP Custom 27803010 101.209 - SPACER SPNL 13MM MED PRLL 14X9MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.21 SUP Custom 27803010 101.210 - SPACER SPNL 13MM MED PRLL 14X10MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.211 SUP Custom 27803010 101.211 - SPACER SPNL 13MM MED PRLL 14X11MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.212 SUP Custom 27803010 101.212 - SPACER SPNL 13MM MED PRLL 14X12MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.225 SUP Custom 27803010 101.225 - SPACER SPNL 7D LRDTC 13MM MED 14X5MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.226 SUP Custom 27803010 101.226 - SPACER SPNL 7D LRDTC 13MM MED 14X6MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.227 SUP Custom 27803010 101.227 - SPACER SPNL 7D LRDTC 13MM MED 14X7MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.228 SUP Custom 27803010 101.228 - SPACER SPNL 7D LRDTC 13MM MED 14X8MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.229 SUP Custom 27803010 101.229 - SPACER SPNL 7D LRDTC 13MM MED 14X9MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.23 SUP Custom 27803010 101.230 - SPACER SPNL 7D LRDTC 13MM MED 14X10MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.231 SUP Custom 27803010 101.231 - SPACER SPNL 7D LRDTC 13MM MED 14X11MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.232 SUP Custom 27803010 101.232 - SPACER SPNL 7D LRDTC 13MM MED 14X12MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.245 SUP Custom 27803010 101.245 - SPACER SPNL 13MM MED CNVX 14X5MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.246 SUP Custom 27803010 101.246 - SPACER SPNL 13MM MED CNVX 14X6MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.247 SUP Custom 27803010 101.247 - SPACER SPNL 13MM MED CNVX 14X7MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.248 SUP Custom 27803010 101.248 - SPACER SPNL 13MM MED CNVX 14X8MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.249 SUP Custom 27803010 101.249 - SPACER SPNL 13MM MED CNVX 14X9MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.25 SUP Custom 27803010 101.250 - SPACER SPNL 13MM MED CNVX 14X10MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.251 SUP Custom 27803010 101.251 - SPACER SPNL 13MM MED CNVX 14X11MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.252 SUP Custom 27803010 101.252 - SPACER SPNL 13MM MED CNVX 14X12MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.309 SUP Custom 27803010 101.309 - SPACER SPNL 31MM LG 25X9MM NS LF SUST RDLCNT PEEK THORLMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.311 SUP Custom 27803010 101.311 - SPACER SPNL 31MM LG 25X11MM NS LF SUST RDLCNT PEEK THORLMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.313 SUP Custom 27803010 101.313 - SPACER SPNL 31MM LG 25X13MM NS LF SUST RDLCNT PEEK THORLMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.315 SUP Custom 27803010 101.315 - SPACER SPNL 31MM LG 25X15MM NS LF SUST RDLCNT PEEK THORLMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.317 SUP Custom 27803010 101.317 - SPACER SPNL 31MM LG 25X17MM NS LF SUST RDLCNT PEEK THORLMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.319 SUP Custom 27803010 101.319 - SPACER SPNL 31MM LG 25X19MM NS LF SUST RDLCNT PEEK THORLMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.321 SUP Custom 27803010 101.321 - SPACER SPNL 31MM LG 25X21MM NS LF SUST RDLCNT PEEK THORLMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.409 SUP Custom 27803010 101.409 - SPACER SPNL 31MM LG 25X9MM NS LF SUST RDLCNT PEEK LAT INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.411 SUP Custom 27803010 101.411 - SPACER SPNL 31MM LG 25X11MM NS LF SUST RDLCNT PEEK LAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.413 SUP Custom 27803010 101.413 - SPACER SPNL 31MM LG 25X13MM NS LF SUST RDLCNT PEEK LAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.415 SUP Custom 27803010 101.415 - SPACER SPNL 31MM LG 25X15MM NS LF SUST RDLCNT PEEK LAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.417 SUP Custom 27803010 101.417 - SPACER SPNL 31MM LG 25X17MM NS LF SUST RDLCNT PEEK LAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.419 SUP Custom 27803010 101.419 - SPACER SPNL 31MM LG 25X19MM NS LF SUST RDLCNT PEEK LAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.421 SUP Custom 27803010 101.421 - SPACER SPNL 31MM LG 25X21MM NS LF SUST RDLCNT PEEK LAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.509 SUP Custom 27803010 101.509 - SPACER SPNL 31MM LG 25X9MM NS LF SUST RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.511 SUP Custom 27803010 101.511 - SPACER SPNL 31MM LG 25X11MM NS LF SUST RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.513 SUP Custom 27803010 101.513 - SPACER SPNL 31MM LG 25X13MM NS LF SUST RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.515 SUP Custom 27803010 101.515 - SPACER SPNL 31MM LG 25X15MM NS LF SUST RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.517 SUP Custom 27803010 101.517 - SPACER SPNL 31MM LG 25X17MM NS LF SUST RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.519 SUP Custom 27803010 101.519 - SPACER SPNL 31MM LG 25X19MM NS LF SUST RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.521 SUP Custom 27803010 101.521 - SPACER SPNL 31MM LG 25X21MM NS LF SUST RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 101.607 SUP Custom 27803010 101.607 - SPACER SPNL ARCH 27X9.5X7MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 101.609 SUP Custom 27803010 101.609 - SPACER SPNL ARCH 27X9.5X9MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 101.611 SUP Custom 27803010 101.611 - SPACER SPNL ARCH 27X9.5X11MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 101.613 SUP Custom 27803010 101.613 - SPACER SPNL ARCH 27X9.5X13MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 101.615 SUP Custom 27803010 101.615 - SPACER SPNL ARCH 27X9.5X15MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 101.617 SUP Custom 27803010 101.617 - SPACER SPNL ARCH 27X9.5X17MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 101.707 SUP Custom 27803010 101.707 - SPACER SPNL SM NAR 22X8X7MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 101.709 SUP Custom 27803010 101.709 - SPACER SPNL SM NAR 22X8X9MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 101.711 SUP Custom 27803010 101.711 - SPACER SPNL SM NAR 22X8X11MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 101.713 SUP Custom 27803010 101.713 - SPACER SPNL SM NAR 22X8X13MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 101.715 SUP Custom 27803010 101.715 - SPACER SPNL SM NAR 22X8X15MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 101.717 SUP Custom 27803010 101.717 - SPACER SPNL SM NAR 22X8X17MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 101.805 SUP Custom 27803010 101.805 - SPACER SPNL 11MM MED NAR PRLL 12X5MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.806 SUP Custom 27803010 101.806 - SPACER SPNL 11MM MED NAR PRLL 12X6MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.807 SUP Custom 27803010 101.807 - SPACER SPNL 11MM MED NAR PRLL 12X7MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.808 SUP Custom 27803010 101.808 - SPACER SPNL 11MM MED NAR PRLL 12X8MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.809 SUP Custom 27803010 101.809 - SPACER SPNL 11MM MED NAR PRLL 12X9MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.81 SUP Custom 27803010 101.810 - SPACER SPNL 11MM MED NAR PRLL 12X10MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.811 SUP Custom 27803010 101.811 - SPACER SPNL 11MM MED NAR PRLL 12X11MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.812 SUP Custom 27803010 101.812 - SPACER SPNL 11MM MED NAR PRLL 12X12MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.825 SUP Custom 27803010 101.825 - SPACER SPNL 7D LRDTC MED NAR 12X5MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.826 SUP Custom 27803010 101.826 - SPACER SPNL 7D LRDTC MED NAR 12X6MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.827 SUP Custom 27803010 101.827 - SPACER SPNL 7D LRDTC MED NAR 12X7MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.828 SUP Custom 27803010 101.828 - SPACER SPNL 7D LRDTC MED NAR 12X8MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.829 SUP Custom 27803010 101.829 - SPACER SPNL 7D LRDTC MED NAR 12X9MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.83 SUP Custom 27803010 101.830 - SPACER SPNL 7D LRDTC MED NAR 12X10MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.831 SUP Custom 27803010 101.831 - SPACER SPNL 7D LRDTC MED NAR 12X11MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.832 SUP Custom 27803010 101.832 - SPACER SPNL 7D LRDTC MED NAR 12X12MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.845 SUP Custom 27803010 101.845 - SPACER SPNL 11MM MED CNVX NAR 12X5MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.846 SUP Custom 27803010 101.846 - SPACER SPNL 11MM MED CNVX NAR 12X6MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.847 SUP Custom 27803010 101.847 - SPACER SPNL 11MM MED CNVX NAR 12X7MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.848 SUP Custom 27803010 101.848 - SPACER SPNL 11MM MED CNVX NAR 12X8MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.849 SUP Custom 27803010 101.849 - SPACER SPNL 11MM MED CNVX NAR 12X9MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.85 SUP Custom 27803010 101.850 - SPACER SPNL 11MM MED CNVX NAR 12X10MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.851 SUP Custom 27803010 101.851 - SPACER SPNL 11MM MED CNVX NAR 12X11MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 101.852 SUP Custom 27803010 101.852 - SPACER SPNL 11MM MED CNVX NAR 12X12MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 102.041 SUP HCPCS C1713 102.041 - SCREW BONE 7MM 70MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.042 SUP HCPCS C1713 102.042 - SCREW BONE 7MM 75MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.043 SUP HCPCS C1713 102.043 - SCREW BONE 7MM 80MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$3,627.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.044 SUP HCPCS C1713 102.044 - SCREW BONE 7MM 85MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.045 SUP HCPCS C1713 102.045 - SCREW BONE 7MM 90MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.051 SUP HCPCS C1713 102.051 - SCREW BONE 8MM 70MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.052 SUP HCPCS C1713 102.052 - SCREW BONE 8MM 75MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.053 SUP HCPCS C1713 102.053 - SCREW BONE 8MM 80MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.054 SUP HCPCS C1713 102.054 - SCREW BONE 8MM 85MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.055 SUP HCPCS C1713 102.055 - SCREW BONE 8MM 90MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.061 SUP HCPCS C1713 102.061 - SCREW BONE 9MM 70MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.062 SUP HCPCS C1713 102.062 - SCREW BONE 9MM 75MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.063 SUP HCPCS C1713 102.063 - SCREW BONE 9MM 80MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.064 SUP HCPCS C1713 102.064 - SCREW BONE 9MM 85MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$3,627.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.065 SUP HCPCS C1713 102.065 - SCREW BONE 9MM 90MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.071 SUP HCPCS C1713 102.071 - SCREW BONE 7MM 70MM SLFTAP LP PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.072 SUP HCPCS C1713 102.072 - SCREW BONE 7MM 75MM SLFTAP LP PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.073 SUP HCPCS C1713 102.073 - SCREW BONE 7MM 80MM SLFTAP LP PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.074 SUP HCPCS C1713 102.074 - SCREW BONE 7MM 85MM SLFTAP LP PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.075 SUP HCPCS C1713 102.075 - SCREW BONE 7MM 90MM SLFTAP LP PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.081 SUP HCPCS C1713 102.081 - SCREW BONE 8MM 70MM SLFTAP LP PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.082 SUP HCPCS C1713 102.082 - SCREW BONE 8MM 75MM SLFTAP LP PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.083 SUP HCPCS C1713 102.083 - SCREW BONE 8MM 80MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.084 SUP HCPCS C1713 102.084 - SCREW BONE 8MM 85MM SLFTAP LP PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.085 SUP HCPCS C1713 102.085 - SCREW BONE 8MM 90MM SLFTAP LP PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.091 SUP HCPCS C1713 102.091 - SCREW BONE 9MM 70MM SLFTAP LP PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.092 SUP HCPCS C1713 102.092 - SCREW BONE 9MM 75MM SLFTAP LP PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.093 SUP HCPCS C1713 102.093 - SCREW BONE 9MM 80MM SLFTAP LP PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.094 SUP HCPCS C1713 102.094 - SCREW BONE 9MM 85MM SLFTAP LP PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.095 SUP HCPCS C1713 102.095 - SCREW BONE 9MM 90MM SLFTAP LP PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.352 SUP HCPCS C1713 102.352 - SCREW BONE 5MM 30MM MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$3,627.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.353 SUP HCPCS C1713 102.353 - SCREW BONE 5MM 35MM MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.354 SUP HCPCS C1713 102.354 - SCREW BONE 5MM 40MM MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.355 SUP HCPCS C1713 102.355 - SCREW BONE 5MM 45MM MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$3,627.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.356 SUP HCPCS C1713 102.356 - SCREW BONE 5MM 50MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.357 SUP HCPCS C1713 102.357 - SCREW BONE 5MM 55MM MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.362 SUP HCPCS C1713 102.362 - SCREW BONE 6MM 30MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.363 SUP HCPCS C1713 102.363 - SCREW BONE 6MM 35MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.364 SUP HCPCS C1713 102.364 - SCREW BONE 6MM 40MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.365 SUP HCPCS C1713 102.365 - SCREW BONE 6MM 45MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.366 SUP HCPCS C1713 102.366 - SCREW BONE 6MM 50MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.367 SUP HCPCS C1713 102.367 - SCREW BONE 6MM 55MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$3,627.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.368 SUP HCPCS C1713 102.368 - SCREW BONE 6MM 60MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.369 SUP HCPCS C1713 102.369 - SCREW BONE 6MM 65MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.372 SUP HCPCS C1713 102.372 - SCREW BONE 7MM 30MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$3,627.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.373 SUP HCPCS C1713 102.373 - SCREW BONE 7MM 35MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.374 SUP HCPCS C1713 102.374 - SCREW BONE 7MM 40MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.375 SUP HCPCS C1713 102.375 - SCREW BONE 6MM 45MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.376 SUP HCPCS C1713 102.376 - SCREW BONE 7MM 50MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$3,627.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.377 SUP HCPCS C1713 102.377 - SCREW BONE 7MM 55MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$3,627.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.378 SUP HCPCS C1713 102.378 - SCREW BONE 7MM 60MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.379 SUP HCPCS C1713 102.379 - SCREW BONE 7MM 65MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.382 SUP HCPCS C1713 102.382 - SCREW BONE 8MM 30MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.383 SUP HCPCS C1713 102.383 - SCREW BONE 8MM 35MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.384 SUP HCPCS C1713 102.384 - SCREW BONE 8MM 40MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.385 SUP HCPCS C1713 102.385 - SCREW BONE 8MM 45MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$3,627.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.386 SUP HCPCS C1713 102.386 - SCREW BONE 8MM 50MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.387 SUP HCPCS C1713 102.387 - SCREW BONE 8MM 55MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.388 SUP HCPCS C1713 102.388 - SCREW BONE 8MM 60MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.389 SUP HCPCS C1713 102.389 - SCREW BONE 8MM 65MM PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.392 SUP HCPCS C1713 102.392 - SCREW BONE 9MM 30MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.393 SUP HCPCS C1713 102.393 - SCREW BONE 9MM 35MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.394 SUP HCPCS C1713 102.394 - SCREW BONE 9MM 40MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.395 SUP HCPCS C1713 102.395 - SCREW BONE 9MM 45MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.396 SUP HCPCS C1713 102.396 - SCREW BONE 9MM 50MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.397 SUP HCPCS C1713 102.397 - SCREW BONE 9MM 55MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.398 SUP HCPCS C1713 102.398 - SCREW BONE 9MM 60MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$1,451.00" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$2,176.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.399 SUP HCPCS C1713 102.399 - SCREW BONE 9MM 65MM SLFTAP LP MNOAX PROTEX SPN PEDICLE BOTH IP/OP "$3,627.50" "$2,684.00" $719.97 "$3,627.50" "$1,632.38" "$1,632.38" "$1,632.38" "$1,632.38" "$3,627.50" "$3,627.50" "$3,627.50" $756.06 "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" $756.01 "$3,627.50" "$3,627.50" "$1,788.36" "$3,627.50" "$3,627.50" "$3,627.50" "$3,627.50" "$2,720.63" "$3,627.50" "$3,627.50" "$3,627.50" "$1,813.75" "$1,813.75" "$2,872.98" "$3,627.50" "$2,902.00" "$1,632.38" $719.97 N/A "$2,103.95" "$3,627.50" "$3,627.50" "$3,627.50" $755.97 "$3,627.50" N/A N/A 102.452 SUP HCPCS C1713 102.452 - SCREW BONE 5MM 30MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.453 SUP HCPCS C1713 102.453 - SCREW BONE 5MM 35MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.454 SUP HCPCS C1713 102.454 - SCREW BONE 5MM 40MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.455 SUP HCPCS C1713 102.455 - SCREW BONE 5MM 45MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.456 SUP HCPCS C1713 102.456 - SCREW BONE 5MM 50MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.457 SUP HCPCS C1713 102.457 - SCREW BONE 5MM 55MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.462 SUP HCPCS C1713 102.462 - SCREW BONE 6MM 30MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.463 SUP HCPCS C1713 102.463 - SCREW BONE 6MM 35MM POLYAX PROTEX TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.464 SUP HCPCS C1713 102.464 - SCREW BONE 6MM 40MM SLFTAP POLYAX PROTEX SPN PEDICLE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.465 SUP HCPCS C1713 102.465 - SCREW BONE 6MM 45MM POLYAX PROTEX TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.466 SUP HCPCS C1713 102.466 - SCREW BONE 6MM 50MM POLYAX PROTEX TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.467 SUP HCPCS C1713 102.467 - SCREW BONE 6MM 55MM POLYAX PROTEX TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.468 SUP HCPCS C1713 102.468 - SCREW BONE 6MM 60MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.469 SUP HCPCS C1713 102.469 - SCREW BONE 6MM 65MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.472 SUP HCPCS C1713 102.472 - SCREW BONE 7MM 30MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.473 SUP HCPCS C1713 102.473 - SCREW BONE 7MM 35MM PROTEX TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.474 SUP HCPCS C1713 102.474 - SCREW BONE 7MM 40MM PROTEX TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.475 SUP HCPCS C1713 102.475 - SCREW BONE 7MM 45MM POLYAX PROTEX TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.476 SUP HCPCS C1713 102.476 - SCREW BONE 7MM 50MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.477 SUP HCPCS C1713 102.477 - SCREW BONE 7MM 55MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.478 SUP HCPCS C1713 102.478 - SCREW BONE 7MM 60MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.479 SUP HCPCS C1713 102.479 - SCREW BONE 7MM 65MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.482 SUP HCPCS C1713 102.482 - SCREW BONE 8MM 30MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.483 SUP HCPCS C1713 102.483 - SCREW BONE 8MM 35MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.484 SUP HCPCS C1713 102.484 - SCREW BONE 8MM 40MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.485 SUP HCPCS C1713 102.485 - SCREW BONE 8MM 45MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.486 SUP HCPCS C1713 102.486 - SCREW BONE 8MM 50MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.487 SUP HCPCS C1713 102.487 - SCREW BONE 8MM 55MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.488 SUP HCPCS C1713 102.488 - SCREW BONE 8MM 60MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.489 SUP HCPCS C1713 102.489 - SCREW BONE 8MM 65MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.49 SUP HCPCS C1713 102.490 - CAP LOCKING NONTHREADED PROTEX TITANIUM THORACOLUMBAR SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 102.492 SUP HCPCS C1713 102.492 - SCREW BONE 9MM 30MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.493 SUP HCPCS C1713 102.493 - SCREW BONE 9MM 35MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.494 SUP HCPCS C1713 102.494 - SCREW BONE 9MM 40MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.495 SUP HCPCS C1713 102.495 - SCREW BONE 9MM 45MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.496 SUP HCPCS C1713 102.496 - SCREW BONE 9MM 50MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.497 SUP HCPCS C1713 102.497 - SCREW BONE 9MM 55MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.498 SUP HCPCS C1713 102.498 - SCREW BONE 9MM 60MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.499 SUP HCPCS C1713 102.499 - SCREW BONE 9MM 65MM SLFTAP POLYAX PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 102.51 SUP Custom 27803010 102.510 - ROD SPINAL 6.5MM 100MM STR TITANIUM BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $209.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 102.512 SUP Custom 27803010 102.512 - ROD SPINAL 6.5MM 125MM STR BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $209.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 102.515 SUP Custom 27803010 102.515 - ROD SPINAL 6.5MM 150MM STR BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $209.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 102.517 SUP Custom 27803010 102.517 - ROD SPINAL 6.5MM 200MM STR BOTH IP/OP $795.00 $588.00 $141.51 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $141.51 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $165.69 $795.00 $318.00 $795.00 $795.00 $795.00 $795.00 $795.00 $596.25 $795.00 $795.00 $795.00 $397.50 $397.50 $629.64 $795.00 $636.00 $357.75 $795.00 N/A $461.10 $795.00 $477.00 $795.00 $795.00 $795.00 N/A N/A 102.519 SUP Custom 27803010 102.519 - ROD SPINAL 6.5MM 300MM STR BOTH IP/OP $927.50 $686.00 $165.10 $927.50 $927.50 $927.50 $927.50 $927.50 $927.50 $927.50 $165.10 $927.50 $927.50 $927.50 $927.50 $927.50 $927.50 $193.30 $927.50 $371.00 $927.50 $927.50 $927.50 $927.50 $927.50 $695.63 $927.50 $927.50 $927.50 $463.75 $463.75 $734.58 $927.50 $742.00 $417.38 $927.50 N/A $537.95 $927.50 $556.50 $927.50 $927.50 $927.50 N/A N/A 102.52 SUP Custom 27803010 102.520 - ROD SPINAL 6.5MM 20MM STR TITANIUM BOTH IP/OP "$1,527.50" "$1,130.00" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $318.35 "$1,527.50" $611.00 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,145.63" "$1,527.50" "$1,527.50" "$1,527.50" $763.75 $763.75 "$1,209.78" "$1,527.50" "$1,222.00" $687.38 "$1,527.50" N/A $885.95 "$1,527.50" $916.50 "$1,527.50" "$1,527.50" "$1,527.50" N/A N/A 102.521 SUP Custom 27803010 102.521 - ROD SPNL STRG 6.5MM 500MM PRTX BOTH IP/OP "$1,060.00" $784.00 $188.68 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $188.68 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $220.92 "$1,060.00" $424.00 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $795.00 "$1,060.00" "$1,060.00" "$1,060.00" $530.00 $530.00 $839.52 "$1,060.00" $848.00 $477.00 "$1,060.00" N/A $614.80 "$1,060.00" $636.00 "$1,060.00" "$1,060.00" "$1,060.00" N/A N/A 102.53 SUP Custom 27803010 102.530 - ROD SPINAL 6.5MM 30MM STR TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.535 SUP Custom 27803010 102.535 - ROD SPINAL 6.5MM 35MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.54 SUP Custom 27803010 102.540 - ROD SPINAL 6.5MM 40MM STR TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.545 SUP Custom 27803010 102.545 - ROD SPINAL 6.5MM 45MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.55 SUP Custom 27803010 102.550 - ROD SPINAL 6.5MM 50MM STR TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.555 SUP Custom 27803010 102.555 - ROD SPINAL 6.5MM 55MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.56 SUP Custom 27803010 102.560 - ROD SPINAL 6.5MM 60MM STR TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.565 SUP Custom 27803010 102.565 - ROD SPINAL 6.5MM 65MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.57 SUP Custom 27803010 102.570 - ROD SPINAL 6.5MM 70MM STR TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.575 SUP Custom 27803010 102.575 - ROD SPINAL 6.5MM 75MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.58 SUP Custom 27803010 102.580 - ROD SPINAL 6.5MM 80MM STR TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.585 SUP Custom 27803010 102.585 - ROD SPINAL 6.5MM 85MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.61 SUP Custom 27803010 102.610 - ROD SPINAL 6.5MM 100MM CVD TITANIUM BOTH IP/OP $765.00 $566.00 $136.17 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $136.17 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $765.00 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $765.00 N/A $443.70 $765.00 $459.00 $765.00 $765.00 $765.00 N/A N/A 102.612 SUP Custom 27803010 102.612 - ROD SPINAL 6.5MM 120MM CVD BOTH IP/OP $765.00 $566.00 $136.17 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $136.17 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $765.00 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $765.00 N/A $443.70 $765.00 $459.00 $765.00 $765.00 $765.00 N/A N/A 102.615 SUP Custom 27803010 102.615 - ROD SPINAL 6.5MM 150MM CVD BOTH IP/OP $765.00 $566.00 $136.17 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $136.17 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $765.00 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $765.00 N/A $443.70 $765.00 $459.00 $765.00 $765.00 $765.00 N/A N/A 102.635 SUP Custom 27803010 102.635 - ROD SPINAL 6.5MM 35MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.64 SUP Custom 27803010 102.640 - ROD SPINAL 6.5MM 40MM CVD TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.645 SUP Custom 27803010 102.645 - ROD SPINAL 6.5MM 45MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.65 SUP Custom 27803010 102.650 - ROD SPINAL 6.5MM 50MM CVD TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.655 SUP Custom 27803010 102.655 - ROD SPINAL 6.5MM 55MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.66 SUP Custom 27803010 102.660 - ROD SPINAL 6.5MM 60MM CVD TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.665 SUP Custom 27803010 102.665 - ROD SPINAL 6.5MM 65MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.67 SUP Custom 27803010 102.670 - ROD SPINAL 6.5MM 70MM CVD TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.675 SUP Custom 27803010 102.675 - ROD SPINAL 6.5MM 75MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.68 SUP Custom 27803010 102.680 - ROD SPINAL 6.5MM 80MM CVD TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.685 SUP Custom 27803010 102.685 - ROD SPINAL 6.5MM 85MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 102.911 SUP Custom 27803010 102.911 - CONNECTOR ROD 28-40MM TRNSVRS ADJUSTABLE SPN BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 102.912 SUP Custom 27803010 102.912 - CONNECTOR ROD 38-50MM TRNSVRS ADJUSTABLE PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 102.913 SUP Custom 27803010 102.913 - CONNECTOR ROD 48-60MM TRNSVRS ADJUSTABLE PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 102.914 SUP Custom 27803010 102.914 - CONNECTOR ROD 58-70MM TRNSVRS ADJUSTABLE PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 102.915 SUP Custom 27803010 102.915 - CONNECTOR ROD 68-80MM TRNSVRS ADJUSTABLE PROTEX TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 102.916 SUP Custom 27803010 "102.916 - Adjustable T Connector, 78mm-90mm" BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 102.921 SUP Custom 27803010 "102.921 - PROTEX Lamina Hook, Small" BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 102.922 SUP Custom 27803010 "102.922 - PROTEX Lamina Hook, Medium" BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 102.923 SUP Custom 27803010 102.923 - HOOK SPINAL LARGE PROTEX LMNR BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 102.925 SUP Custom 27803010 "102.925 - PROTEX Angled Lamina Hook, Small" BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 102.926 SUP Custom 27803010 "102.926 - PROTEX Angled Lamina Hook, Medium" BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 102.927 SUP Custom 27803010 102.927 - HOOK SPINAL LARGE ANGLED PROTEX LMNR BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 102.941 SUP Custom 27803010 102.941 - HOOK SPINAL PROTEX PEDICLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 102.951 SUP Custom 27803010 "102.951 - PROTEX Transverse Process Hook, Right" BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 102.952 SUP Custom 27803010 "102.952 - PROTEX Transverse Process Hook, Left" BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 102.971 SUP Custom 27803010 102.971 - CONNECTOR ROD 6.5MM PARALLEL SPN BOTH IP/OP "$2,120.00" "$1,569.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $441.83 "$2,120.00" $848.00 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,590.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,060.00" "$1,060.00" "$1,679.04" "$2,120.00" "$1,696.00" $954.00 "$2,120.00" N/A "$1,229.60" "$2,120.00" "$1,272.00" "$2,120.00" "$2,120.00" "$2,120.00" N/A N/A 102.974 SUP Custom 27803010 "102.974 - Offset Connector, 15mm" BOTH IP/OP $572.50 $424.00 $101.91 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $101.91 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $119.32 $572.50 $229.00 $572.50 $572.50 $572.50 $572.50 $572.50 $429.38 $572.50 $572.50 $572.50 $286.25 $286.25 $453.42 $572.50 $458.00 $257.63 $572.50 N/A $332.05 $572.50 $343.50 $572.50 $572.50 $572.50 N/A N/A 102.975 SUP Custom 27803010 "102.975 - Offset Connector, 20mm" BOTH IP/OP $572.50 $424.00 $101.91 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $101.91 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $119.32 $572.50 $229.00 $572.50 $572.50 $572.50 $572.50 $572.50 $429.38 $572.50 $572.50 $572.50 $286.25 $286.25 $453.42 $572.50 $458.00 $257.63 $572.50 N/A $332.05 $572.50 $343.50 $572.50 $572.50 $572.50 N/A N/A 102.976 SUP Custom 27803010 "102.976 - Offset Connector, 25mm" BOTH IP/OP $572.50 $424.00 $101.91 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $101.91 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $119.32 $572.50 $229.00 $572.50 $572.50 $572.50 $572.50 $572.50 $429.38 $572.50 $572.50 $572.50 $286.25 $286.25 $453.42 $572.50 $458.00 $257.63 $572.50 N/A $332.05 $572.50 $343.50 $572.50 $572.50 $572.50 N/A N/A 102.99 SUP Custom 27803010 102.990 - CONNECTOR ROD 6MM CLOSE OFFST SPN BOTH IP/OP "$1,325.00" $981.00 $235.85 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $235.85 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $276.14 "$1,325.00" $530.00 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $596.25 "$1,325.00" N/A $768.50 "$1,325.00" $795.00 "$1,325.00" "$1,325.00" "$1,325.00" N/A N/A 102.991 SUP Custom 27803010 102.991 - CONNECTOR ROD 6MM CLOSE OFFST SPN BOTH IP/OP "$1,325.00" $981.00 $235.85 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $235.85 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $276.14 "$1,325.00" $530.00 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $596.25 "$1,325.00" N/A $768.50 "$1,325.00" $795.00 "$1,325.00" "$1,325.00" "$1,325.00" N/A N/A 102.992 SUP Custom 27803010 102.992 - CONNECTOR ROD 6MM CLOSE OFFST SPN BOTH IP/OP "$1,325.00" $981.00 $235.85 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $235.85 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $276.14 "$1,325.00" $530.00 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $596.25 "$1,325.00" N/A $768.50 "$1,325.00" $795.00 "$1,325.00" "$1,325.00" "$1,325.00" N/A N/A 102.993 SUP Custom 27803010 102.993 - CONNECTOR ROD 6MM CLOSE OFFST SPN BOTH IP/OP "$1,325.00" $981.00 $235.85 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $235.85 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $276.14 "$1,325.00" $530.00 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $596.25 "$1,325.00" N/A $768.50 "$1,325.00" $795.00 "$1,325.00" "$1,325.00" "$1,325.00" N/A N/A 102.994 SUP Custom 27803010 102.994 - CONNECTOR ROD 6MM CLOSE OFFST SPN BOTH IP/OP "$1,325.00" $981.00 $235.85 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $235.85 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $276.14 "$1,325.00" $530.00 "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" "$1,325.00" $993.75 "$1,325.00" "$1,325.00" "$1,325.00" $662.50 $662.50 "$1,049.40" "$1,325.00" "$1,060.00" $596.25 "$1,325.00" N/A $768.50 "$1,325.00" $795.00 "$1,325.00" "$1,325.00" "$1,325.00" N/A N/A 102.995 SUP Custom 27803010 102.995 - CONNECTOR ROD 6MM CLOSE OFFST SPN BOTH IP/OP "$1,457.50" "$1,079.00" $259.44 "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" $259.44 "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" $303.76 "$1,457.50" $583.00 "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,093.13" "$1,457.50" "$1,457.50" "$1,457.50" $728.75 $728.75 "$1,154.34" "$1,457.50" "$1,166.00" $655.88 "$1,457.50" N/A $845.35 "$1,457.50" $874.50 "$1,457.50" "$1,457.50" "$1,457.50" N/A N/A 102.996 SUP Custom 27803010 102.996 - CONNECTOR ROD 6MM CLOSE OFFST SPN BOTH IP/OP "$1,457.50" "$1,079.00" $259.44 "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" $259.44 "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" $303.76 "$1,457.50" $583.00 "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,093.13" "$1,457.50" "$1,457.50" "$1,457.50" $728.75 $728.75 "$1,154.34" "$1,457.50" "$1,166.00" $655.88 "$1,457.50" N/A $845.35 "$1,457.50" $874.50 "$1,457.50" "$1,457.50" "$1,457.50" N/A N/A 102.997 SUP Custom 27803010 102.997 - CONNECTOR ROD 6MM CLOSE OFFST SPN BOTH IP/OP "$1,457.50" "$1,079.00" $259.44 "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" $259.44 "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" $303.76 "$1,457.50" $583.00 "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,093.13" "$1,457.50" "$1,457.50" "$1,457.50" $728.75 $728.75 "$1,154.34" "$1,457.50" "$1,166.00" $655.88 "$1,457.50" N/A $845.35 "$1,457.50" $874.50 "$1,457.50" "$1,457.50" "$1,457.50" N/A N/A 103 SUP HCPCS C1767 103 - GENERATOR ELECTROSURGICAL NCP DEMIPULSE BOTH IP/OP "$54,430.00" "$40,278.00" $1.07 "$40,822.50" $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 "$40,822.50" $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 "$31,569.40" $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 104 SUP Custom 27203010 104 - MARKER RAD 1.5MM PIK UP DSPT ARROW PELT TAB NPL BOTH IP/OP $112.50 $83.00 $1.07 $84.38 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $84.38 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $65.25 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 104 SUP Custom 27203010 104 - DEVICE OPHTHALMIC MILOOP LEN FRAGMENTATION BOTH IP/OP $325.00 $241.00 $1.07 $243.75 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $243.75 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $188.50 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 104 SUP HCPCS C1713 104 - PLATE BONE T 3X3 HOLE CRANIAL BOTH IP/OP $408.00 $302.00 $1.07 $306.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $306.00 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $236.64 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 104 SUP HCPCS C1713 104 - PLATE 104 SINGLE T 3H X 3H BOTH IP/OP $408.00 $302.00 $1.07 $306.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $306.00 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $236.64 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 105 SUP HCPCS C1713 105 - PLATE BONE 1T 3X2 HOLE BOTH IP/OP $408.00 $302.00 $1.07 $306.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.07 $6.00 $6.00 $4.45 $4.45 $4.62 $3.13 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $306.00 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $236.64 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 109.041 SUP HCPCS C1713 109.041 - SCREW BONE 7MM 70MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.042 SUP HCPCS C1713 109.042 - SCREW BONE 7MM 75MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.043 SUP HCPCS C1713 109.043 - SCREW BONE 7MM 80MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.044 SUP HCPCS C1713 109.044 - SCREW BONE 7MM 85MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.045 SUP HCPCS C1713 109.045 - SCREW BONE 7MM 90MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.051 SUP HCPCS C1713 109.051 - SCREW BONE 8MM 70MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.052 SUP HCPCS C1713 109.052 - SCREW BONE 8MM 75MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.053 SUP HCPCS C1713 109.053 - SCREW BONE 8MM 80MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$2,517.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.054 SUP HCPCS C1713 109.054 - SCREW BONE 8MM 85MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$2,517.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.055 SUP HCPCS C1713 109.055 - SCREW BONE 8MM 90MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.061 SUP HCPCS C1713 109.061 - SCREW BONE 9MM 70MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.062 SUP HCPCS C1713 109.062 - SCREW BONE 9MM 75MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.063 SUP HCPCS C1713 109.063 - SCREW BONE 9MM 80MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.064 SUP HCPCS C1713 109.064 - SCREW BONE 9MM 85MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.065 SUP HCPCS C1713 109.065 - SCREW BONE 9MM 90MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.071 SUP HCPCS C1713 109.071 - SCREW BONE 7MM 70MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$1,832.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$4,580.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.072 SUP HCPCS C1713 109.072 - SCREW BONE 7MM 75MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$4,580.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$4,580.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.073 SUP HCPCS C1713 109.073 - SCREW BONE 7MM 80MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$1,832.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$4,580.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.074 SUP HCPCS C1713 109.074 - SCREW BONE 7MM 85MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$4,580.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$4,580.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.075 SUP HCPCS C1713 109.075 - SCREW BONE 7MM 90MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$1,832.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$4,580.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.081 SUP HCPCS C1713 109.081 - SCREW BONE 8MM 70MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$4,580.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$4,580.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.082 SUP HCPCS C1713 109.082 - SCREW BONE 8MM 75MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$1,832.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$2,748.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.083 SUP HCPCS C1713 109.083 - SCREW BONE 8MM 80MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$4,580.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$2,748.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.084 SUP HCPCS C1713 109.084 - SCREW BONE 8MM 85MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$1,832.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$2,748.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.085 SUP HCPCS C1713 109.085 - SCREW BONE 8MM 90MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$4,580.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$2,748.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.091 SUP HCPCS C1713 109.091 - SCREW BONE 9MM 70MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$1,832.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$2,748.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.092 SUP HCPCS C1713 109.092 - SCREW BONE 9MM 75MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$4,580.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$2,748.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.093 SUP HCPCS C1713 109.093 - SCREW BONE 9MM 80MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$1,832.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$4,580.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.094 SUP HCPCS C1713 109.094 - SCREW BONE 9MM 85MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$4,580.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$4,580.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.095 SUP HCPCS C1713 109.095 - SCREW BONE 9MM 90MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$4,580.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$4,580.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.351 SUP HCPCS C1713 109.351 - SCREW BONE 5MM 25MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$2,517.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.352 SUP HCPCS C1713 109.352 - SCREW BONE 5MM 30MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.353 SUP HCPCS C1713 109.353 - SCREW BONE 5MM 35MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.354 SUP HCPCS C1713 109.354 - SCREW BONE 5MM 40MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.355 SUP HCPCS C1713 109.355 - SCREW BONE 5MM 45MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.356 SUP HCPCS C1713 109.356 - SCREW BONE 5MM 50MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$2,517.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.357 SUP HCPCS C1713 109.357 - SCREW BONE 5MM 55MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.358 SUP HCPCS C1713 109.358 - SCREW BONE 5MM 60MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.359 SUP HCPCS C1713 109.359 - SCREW BONE 5MM 65MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.362 SUP HCPCS C1713 109.362 - SCREW BONE 6MM 30MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$2,517.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.363 SUP HCPCS C1713 109.363 - SCREW BONE 6MM 35MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$2,517.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.364 SUP HCPCS C1713 109.364 - SCREW BONE 6MM 40MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.365 SUP HCPCS C1713 109.365 - SCREW BONE 6MM 45MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.366 SUP HCPCS C1713 109.366 - SCREW BONE 6MM 50MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.367 SUP HCPCS C1713 109.367 - SCREW BONE 6MM 55MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.368 SUP HCPCS C1713 109.368 - SCREW BONE 6MM 60MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.369 SUP HCPCS C1713 109.369 - SCREW BONE 6MM 65MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.372 SUP HCPCS C1713 109.372 - SCREW BONE 7MM 30MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.373 SUP HCPCS C1713 109.373 - SCREW BONE 7MM 35MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.374 SUP HCPCS C1713 109.374 - SCREW BONE 7MM 40MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.375 SUP HCPCS C1713 109.375 - SCREW BONE 7MM 45MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.376 SUP HCPCS C1713 109.376 - SCREW BONE 7MM 50MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.377 SUP HCPCS C1713 109.377 - SCREW BONE 7MM 55MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.378 SUP HCPCS C1713 109.378 - SCREW BONE 7MM 60MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.379 SUP HCPCS C1713 109.379 - SCREW BONE 7MM 65MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$2,517.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.382 SUP HCPCS C1713 109.382 - SCREW BONE 8MM 30MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$2,517.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.383 SUP HCPCS C1713 109.383 - SCREW BONE 8MM 35MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$2,517.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.384 SUP HCPCS C1713 109.384 - SCREW BONE 8MM 40MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.385 SUP HCPCS C1713 109.385 - SCREW BONE 8MM 45MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.386 SUP HCPCS C1713 109.386 - SCREW BONE 8MM 50MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.387 SUP HCPCS C1713 109.387 - SCREW BONE 8MM 55MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$2,517.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.388 SUP HCPCS C1713 109.388 - SCREW BONE 8MM 60MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.389 SUP HCPCS C1713 109.389 - SCREW BONE 8MM 65MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.392 SUP HCPCS C1713 109.392 - SCREW BONE 9MM 30MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.393 SUP HCPCS C1713 109.393 - SCREW BONE 9MM 35MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.394 SUP HCPCS C1713 109.394 - SCREW BONE 9MM 40MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.395 SUP HCPCS C1713 109.395 - SCREW BONE 9MM 45MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.396 SUP HCPCS C1713 109.396 - SCREW BONE 9MM 50MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.397 SUP HCPCS C1713 109.397 - SCREW BONE 9MM 55MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$2,517.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.398 SUP HCPCS C1713 109.398 - SCREW BONE 9MM 60MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$2,517.50" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.399 SUP HCPCS C1713 109.399 - SCREW BONE 9MM 65MM SLFTAP LP MNOAX PROTEX SPN 6MM ROD BOTH IP/OP "$2,517.50" "$1,863.00" $499.66 "$2,517.50" "$1,132.88" "$1,132.88" "$1,132.88" "$1,132.88" "$2,517.50" "$2,517.50" "$2,517.50" $524.71 "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" $524.67 "$2,517.50" "$1,007.00" "$1,241.13" "$2,517.50" "$2,517.50" "$2,517.50" "$2,517.50" "$1,888.13" "$2,517.50" "$2,517.50" "$2,517.50" "$1,258.75" "$1,258.75" "$1,993.86" "$2,517.50" "$2,014.00" "$1,132.88" $499.66 N/A "$1,460.15" "$2,517.50" "$1,510.50" "$2,517.50" $524.65 "$2,517.50" N/A N/A 109.441 SUP HCPCS C1713 109.441 - SCREW BONE 4.5MM 25MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$4,580.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$2,748.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.442 SUP HCPCS C1713 109.442 - SCREW BONE 4.5MM 30MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$1,832.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$2,748.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.443 SUP HCPCS C1713 109.443 - SCREW BONE 4.5MM 35MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$4,580.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$2,748.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.444 SUP HCPCS C1713 109.444 - SCREW BONE 4.5MM 40MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$1,832.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$2,748.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.445 SUP HCPCS C1713 109.445 - SCREW BONE 4.5MM 45MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$4,580.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$2,748.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.446 SUP HCPCS C1713 109.446 - SCREW BONE 4.5MM 50MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$4,580.00" "$3,389.00" $909.02 "$4,580.00" "$2,061.00" "$2,061.00" "$2,061.00" "$2,061.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.59 "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" $954.52 "$4,580.00" "$1,832.00" "$2,257.94" "$4,580.00" "$4,580.00" "$4,580.00" "$4,580.00" "$3,435.00" "$4,580.00" "$4,580.00" "$4,580.00" "$2,290.00" "$2,290.00" "$3,627.36" "$4,580.00" "$3,664.00" "$2,061.00" $909.02 N/A "$2,656.40" "$4,580.00" "$2,748.00" "$4,580.00" $954.47 "$4,580.00" N/A N/A 109.452 SUP HCPCS C1713 109.452 - SCREW BONE 5MM 30MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.453 SUP HCPCS C1713 109.453 - SCREW BONE 5MM 35MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.454 SUP HCPCS C1713 109.454 - SCREW BONE 5MM 40MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$2,915.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.455 SUP HCPCS C1713 109.455 - SCREW BONE 5MM 45MM SLFTAP POLYAX PROTEX THORACOLUMBAR SPN BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.456 SUP HCPCS C1713 109.456 - SCREW BONE 5MM 50MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.457 SUP HCPCS C1713 109.457 - SCREW BONE 5MM 55MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.462 SUP HCPCS C1713 109.462 - SCREW BONE 6MM 30MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.463 SUP HCPCS C1713 109.463 - SCREW BONE 6MM 35MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.464 SUP HCPCS C1713 109.464 - SCREW BONE 6MM 40MM POLYAX PROTEX THORACOLUMBAR SPN BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.465 SUP HCPCS C1713 109.465 - SCREW BONE 6MM 45MM POLYAX PROTEX TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.466 SUP HCPCS C1713 109.466 - SCREW BONE 6MM 50MM SLFTAP POLYAX PROTEX THORACOLUMBAR SPN BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.467 SUP HCPCS C1713 109.467 - SCREW BONE 6MM 55MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.468 SUP HCPCS C1713 109.468 - SCREW BONE 6MM 60MM SLFTAP POLYAX PROTEX THORACOLUMBAR SPN BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.469 SUP HCPCS C1713 109.469 - SCREW BONE 6MM 65MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.472 SUP HCPCS C1713 109.472 - SCREW BONE 7MM 30MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$2,915.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.473 SUP HCPCS C1713 109.473 - SCREW BONE 7MM 35MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.474 SUP HCPCS C1713 109.474 - SCREW BONE 7MM 40MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.475 SUP HCPCS C1713 109.475 - SCREW BONE 7MM 45MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.476 SUP HCPCS C1713 109.476 - SCREW BONE 7MM 50MM SLFTAP POLYAX PROTEX THORACOLUMBAR SPN BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.477 SUP HCPCS C1713 109.477 - SCREW BONE 7MM 55MM SLFTAP POLYAX PROTEX THORACOLUMBAR SPN BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.478 SUP HCPCS C1713 109.478 - SCREW BONE 7MM 60MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$2,915.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.479 SUP HCPCS C1713 109.479 - SCREW BONE 7MM 65MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.482 SUP HCPCS C1713 109.482 - SCREW BONE 8MM 30MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.483 SUP HCPCS C1713 109.483 - SCREW BONE 8MM 35MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.484 SUP HCPCS C1713 109.484 - SCREW BONE 8MM 40MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.485 SUP HCPCS C1713 109.485 - SCREW BONE 8MM 45MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.486 SUP HCPCS C1713 109.486 - SCREW BONE 8MM 50MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.487 SUP HCPCS C1713 109.487 - SCREW BONE 8MM 55MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.488 SUP HCPCS C1713 109.488 - SCREW BONE 8MM 60MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$2,915.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.489 SUP HCPCS C1713 109.489 - SCREW BONE 8MM 65MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$2,915.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.492 SUP HCPCS C1713 109.492 - SCREW BONE 9MM 30MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.493 SUP HCPCS C1713 109.493 - SCREW BONE 9MM 35MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$2,915.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.494 SUP HCPCS C1713 109.494 - SCREW BONE 9MM 40MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.495 SUP HCPCS C1713 109.495 - SCREW BONE 9MM 45MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.496 SUP HCPCS C1713 109.496 - SCREW BONE 9MM 50MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$2,915.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.497 SUP HCPCS C1713 109.497 - SCREW BONE 9MM 55MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.498 SUP HCPCS C1713 109.498 - SCREW BONE 9MM 60MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.499 SUP HCPCS C1713 109.499 - SCREW BONE 9MM 65MM SLFTAP LP SOLID PROTEX SPN PEDICLE BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,311.75" "$1,311.75" "$1,311.75" "$1,311.75" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" $607.52 "$2,915.00" "$1,166.00" "$1,437.10" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,311.75" $578.55 N/A "$1,690.70" "$2,915.00" "$1,749.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A 109.51 SUP HCPCS C1713 109.510 - ROD SPINAL 6MM 100MM STR TITANIUM BOTH IP/OP $670.00 $496.00 $132.98 $670.00 $301.50 $301.50 $301.50 $301.50 $670.00 $670.00 $670.00 $139.64 $670.00 $670.00 $670.00 $670.00 $670.00 $139.64 $670.00 $268.00 $396.31 $670.00 $670.00 $670.00 $670.00 $502.50 $670.00 $670.00 $670.00 $335.00 $335.00 $530.64 $670.00 $536.00 $301.50 $132.98 N/A $388.60 $670.00 $402.00 $670.00 $139.63 $670.00 N/A N/A 109.512 SUP Custom 27803010 109.512 - ROD SPINAL 6MM 125MM STR BOTH IP/OP $670.00 $496.00 $119.26 $670.00 $670.00 $670.00 $670.00 $670.00 $670.00 $670.00 $119.26 $670.00 $670.00 $670.00 $670.00 $670.00 $670.00 $139.64 $670.00 $268.00 $670.00 $670.00 $670.00 $670.00 $670.00 $502.50 $670.00 $670.00 $670.00 $335.00 $335.00 $530.64 $670.00 $536.00 $301.50 $670.00 N/A $388.60 $670.00 $402.00 $670.00 $670.00 $670.00 N/A N/A 109.515 SUP Custom 27803010 109.515 - ROD SPINAL 6MM 150MM STR BOTH IP/OP $670.00 $496.00 $119.26 $670.00 $670.00 $670.00 $670.00 $670.00 $670.00 $670.00 $119.26 $670.00 $670.00 $670.00 $670.00 $670.00 $670.00 $139.64 $670.00 $268.00 $670.00 $670.00 $670.00 $670.00 $670.00 $502.50 $670.00 $670.00 $670.00 $335.00 $335.00 $530.64 $670.00 $536.00 $301.50 $670.00 N/A $388.60 $670.00 $402.00 $670.00 $670.00 $670.00 N/A N/A 109.517 SUP Custom 27803010 109.517 - ROD SPINAL 6MM 200MM STR BOTH IP/OP $795.00 $588.00 $141.51 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $141.51 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $165.69 $795.00 $318.00 $795.00 $795.00 $795.00 $795.00 $795.00 $596.25 $795.00 $795.00 $795.00 $397.50 $397.50 $629.64 $795.00 $636.00 $357.75 $795.00 N/A $461.10 $795.00 $477.00 $795.00 $795.00 $795.00 N/A N/A 109.519 SUP Custom 27803010 109.519 - ROD SPINAL 6MM 300MM STR BOTH IP/OP $927.50 $686.00 $165.10 $927.50 $927.50 $927.50 $927.50 $927.50 $927.50 $927.50 $165.10 $927.50 $927.50 $927.50 $927.50 $927.50 $927.50 $193.30 $927.50 $371.00 $927.50 $927.50 $927.50 $927.50 $927.50 $695.63 $927.50 $927.50 $927.50 $463.75 $463.75 $734.58 $927.50 $742.00 $417.38 $927.50 N/A $537.95 $927.50 $556.50 $927.50 $927.50 $927.50 N/A N/A 109.52 SUP Custom 27803010 109.520 - ROD SPINAL 6MM 400MM STR TITANIUM BOTH IP/OP "$1,527.50" "$1,130.00" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $318.35 "$1,527.50" $611.00 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,145.63" "$1,527.50" "$1,527.50" "$1,527.50" $763.75 $763.75 "$1,209.78" "$1,527.50" "$1,222.00" $687.38 "$1,527.50" N/A $885.95 "$1,527.50" $916.50 "$1,527.50" "$1,527.50" "$1,527.50" N/A N/A 109.521 SUP Custom 27803010 109.521 - ROD SPINAL 6MM 500MM STR BOTH IP/OP "$1,060.00" $784.00 $188.68 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $188.68 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $220.92 "$1,060.00" $424.00 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $795.00 "$1,060.00" "$1,060.00" "$1,060.00" $530.00 $530.00 $839.52 "$1,060.00" $848.00 $477.00 "$1,060.00" N/A $614.80 "$1,060.00" $636.00 "$1,060.00" "$1,060.00" "$1,060.00" N/A N/A 109.53 SUP Custom 27803010 109.530 - ROD SPINAL 6MM 30MM STR TITANIUM BOTH IP/OP $670.00 $496.00 $119.26 $670.00 $670.00 $670.00 $670.00 $670.00 $670.00 $670.00 $119.26 $670.00 $670.00 $670.00 $670.00 $670.00 $670.00 $139.64 $670.00 $268.00 $670.00 $670.00 $670.00 $670.00 $670.00 $502.50 $670.00 $670.00 $670.00 $335.00 $335.00 $530.64 $670.00 $536.00 $301.50 $670.00 N/A $388.60 $670.00 $402.00 $670.00 $670.00 $670.00 N/A N/A 109.535 SUP Custom 27803010 109.535 - ROD SPINAL 6MM 35MM STR BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $209.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 109.54 SUP Custom 27803010 109.540 - ROD SPINAL 6MM 40MM STR PROTEX BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $209.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 109.545 SUP Custom 27803010 109.545 - ROD SPINAL 6MM 45MM STR PROTEX BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $209.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 109.55 SUP Custom 27803010 109.550 - ROD SPINAL 6MM 50MM STR TITANIUM BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $209.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 109.555 SUP Custom 27803010 109.555 - ROD SPINAL 6MM 55MM STR BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $209.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 109.56 SUP Custom 27803010 109.560 - ROD SPINAL 6MM 60MM STR TITANIUM BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $209.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 109.565 SUP Custom 27803010 109.565 - ROD SPINAL 6MM 65MM STR BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $209.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 109.57 SUP Custom 27803010 109.570 - ROD SPINAL 6MM 70MM STR PROTEX TITANIUM BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $209.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 109.575 SUP Custom 27803010 109.575 - ROD SPINAL 6MM 75MM STR BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $209.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 109.58 SUP Custom 27803010 109.580 - ROD SPINAL 6MM 80MM STR TITANIUM BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $209.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 109.585 SUP Custom 27803010 109.585 - ROD SPINAL 6MM 85MM STR PROTEX TITANIUM BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $209.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 109.61 SUP Custom 27803010 109.610 - ROD SPINAL 6MM 100MM CVD TITANIUM BOTH IP/OP $765.00 $566.00 $136.17 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $136.17 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $765.00 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $765.00 N/A $443.70 $765.00 $459.00 $765.00 $765.00 $765.00 N/A N/A 109.612 SUP Custom 27803010 109.612 - ROD SPINAL 6MM 125MM CVD BOTH IP/OP $765.00 $566.00 $136.17 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $136.17 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $765.00 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $765.00 N/A $443.70 $765.00 $459.00 $765.00 $765.00 $765.00 N/A N/A 109.615 SUP Custom 27803010 109.615 - ROD SPINAL 6MM 150MM CVD PROTEX TITANIUM BOTH IP/OP $765.00 $566.00 $136.17 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $136.17 $765.00 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $765.00 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $765.00 N/A $443.70 $765.00 $459.00 $765.00 $765.00 $765.00 N/A N/A 109.635 SUP Custom 27803010 109.635 - ROD SPINAL 6MM 35MM CVD PROTEX TITANIUM BOTH IP/OP $530.00 $392.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $530.00 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $530.00 N/A $307.40 $530.00 $318.00 $530.00 $530.00 $530.00 N/A N/A 109.64 SUP Custom 27803010 109.640 - ROD SPINAL 6MM 40MM CVD TITANIUM BOTH IP/OP $530.00 $392.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $530.00 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $530.00 N/A $307.40 $530.00 $318.00 $530.00 $530.00 $530.00 N/A N/A 109.645 SUP Custom 27803010 109.645 - ROD SPINAL 6MM 45MM CVD PROTEX TITANIUM BOTH IP/OP $530.00 $392.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $530.00 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $530.00 N/A $307.40 $530.00 $318.00 $530.00 $530.00 $530.00 N/A N/A 109.65 SUP Custom 27803010 109.650 - ROD SPINAL 6MM 50MM CVD TITANIUM BOTH IP/OP $530.00 $392.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $530.00 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $530.00 N/A $307.40 $530.00 $318.00 $530.00 $530.00 $530.00 N/A N/A 109.655 SUP Custom 27803010 109.655 - ROD SPINAL 6MM 55MM CVD BOTH IP/OP $530.00 $392.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $530.00 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $530.00 N/A $307.40 $530.00 $318.00 $530.00 $530.00 $530.00 N/A N/A 109.66 SUP Custom 27803010 109.660 - ROD SPINAL 6MM 60MM CVD TITANIUM BOTH IP/OP $530.00 $392.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $530.00 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $530.00 N/A $307.40 $530.00 $318.00 $530.00 $530.00 $530.00 N/A N/A 109.665 SUP Custom 27803010 109.665 - ROD SPINAL 6MM 65MM CVD PROTEX TITANIUM BOTH IP/OP $530.00 $392.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $530.00 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $530.00 N/A $307.40 $530.00 $318.00 $530.00 $530.00 $530.00 N/A N/A 109.67 SUP Custom 27803010 109.670 - ROD SPINAL 6MM 70MM CVD TITANIUM BOTH IP/OP $530.00 $392.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $530.00 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $530.00 N/A $307.40 $530.00 $318.00 $530.00 $530.00 $530.00 N/A N/A 109.675 SUP Custom 27803010 109.675 - ROD SPINAL 6MM 75MM CVD PROTEX TITANIUM BOTH IP/OP $530.00 $392.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $530.00 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $530.00 N/A $307.40 $530.00 $318.00 $530.00 $530.00 $530.00 N/A N/A 109.68 SUP Custom 27803010 109.680 - ROD SPINAL 6MM 80MM CVD TITANIUM BOTH IP/OP $530.00 $392.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $530.00 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $530.00 N/A $307.40 $530.00 $318.00 $530.00 $530.00 $530.00 N/A N/A 109.685 SUP Custom 27803010 109.685 - ROD SPINAL 6MM 85MM CVD PROTEX TITANIUM BOTH IP/OP $530.00 $392.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $94.34 $530.00 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $530.00 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $530.00 N/A $307.40 $530.00 $318.00 $530.00 $530.00 $530.00 N/A N/A 109.921 SUP Custom 27803010 109.921 - HOOK SPINAL SMALL PROTEX LMNR 6MM ROD BOTH IP/OP "$2,120.00" "$1,569.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $441.83 "$2,120.00" $848.00 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,590.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,060.00" "$1,060.00" "$1,679.04" "$2,120.00" "$1,696.00" $954.00 "$2,120.00" N/A "$1,229.60" "$2,120.00" "$1,272.00" "$2,120.00" "$2,120.00" "$2,120.00" N/A N/A 109.922 SUP Custom 27803010 109.922 - HOOK SPINAL MEDIUM PROTEX LMNR 6MM ROD BOTH IP/OP "$2,120.00" "$1,569.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $441.83 "$2,120.00" $848.00 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,590.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,060.00" "$1,060.00" "$1,679.04" "$2,120.00" "$1,696.00" $954.00 "$2,120.00" N/A "$1,229.60" "$2,120.00" "$1,272.00" "$2,120.00" "$2,120.00" "$2,120.00" N/A N/A 109.923 SUP Custom 27803010 109.923 - HOOK SPINAL LARGE PROTEX LMNR 6MM ROD BOTH IP/OP "$2,120.00" "$1,569.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $441.83 "$2,120.00" $848.00 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,590.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,060.00" "$1,060.00" "$1,679.04" "$2,120.00" "$1,696.00" $954.00 "$2,120.00" N/A "$1,229.60" "$2,120.00" "$1,272.00" "$2,120.00" "$2,120.00" "$2,120.00" N/A N/A 109.925 SUP Custom 27803010 109.925 - HOOK SPINAL SMALL ANGLED PROTEX LMNR 6MM ROD BOTH IP/OP "$2,120.00" "$1,569.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $441.83 "$2,120.00" $848.00 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,590.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,060.00" "$1,060.00" "$1,679.04" "$2,120.00" "$1,696.00" $954.00 "$2,120.00" N/A "$1,229.60" "$2,120.00" "$1,272.00" "$2,120.00" "$2,120.00" "$2,120.00" N/A N/A 109.926 SUP Custom 27803010 109.926 - HOOK SPINAL MEDIUM ANGLED PROTEX LMNR 6MM ROD BOTH IP/OP "$2,120.00" "$1,569.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $441.83 "$2,120.00" $848.00 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,590.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,060.00" "$1,060.00" "$1,679.04" "$2,120.00" "$1,696.00" $954.00 "$2,120.00" N/A "$1,229.60" "$2,120.00" "$1,272.00" "$2,120.00" "$2,120.00" "$2,120.00" N/A N/A 109.927 SUP Custom 27803010 109.927 - HOOK SPINAL LARGE ANGLED PROTEX LMNR 6MM ROD BOTH IP/OP "$2,120.00" "$1,569.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $441.83 "$2,120.00" $848.00 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,590.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,060.00" "$1,060.00" "$1,679.04" "$2,120.00" "$1,696.00" $954.00 "$2,120.00" N/A "$1,229.60" "$2,120.00" "$1,272.00" "$2,120.00" "$2,120.00" "$2,120.00" N/A N/A 109.941 SUP Custom 27803010 109.941 - HOOK SPINAL PROTEX PEDICLE 6 MM ROD BOTH IP/OP "$2,120.00" "$1,569.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $441.83 "$2,120.00" $848.00 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,590.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,060.00" "$1,060.00" "$1,679.04" "$2,120.00" "$1,696.00" $954.00 "$2,120.00" N/A "$1,229.60" "$2,120.00" "$1,272.00" "$2,120.00" "$2,120.00" "$2,120.00" N/A N/A 109.951 SUP Custom 27803010 109.951 - HOOK SPINAL RIGHT OPENING TRNSVRS PROCESS PROTEX 6 MM ROD BOTH IP/OP "$2,120.00" "$1,569.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $441.83 "$2,120.00" $848.00 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,590.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,060.00" "$1,060.00" "$1,679.04" "$2,120.00" "$1,696.00" $954.00 "$2,120.00" N/A "$1,229.60" "$2,120.00" "$1,272.00" "$2,120.00" "$2,120.00" "$2,120.00" N/A N/A 109.952 SUP Custom 27803010 109.952 - HOOK SPINAL LEFT OPENING TRNSVRS PROCESS PROTEX 6 MM ROD BOTH IP/OP "$2,120.00" "$1,569.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $377.36 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $441.83 "$2,120.00" $848.00 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,590.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,060.00" "$1,060.00" "$1,679.04" "$2,120.00" "$1,696.00" $954.00 "$2,120.00" N/A "$1,229.60" "$2,120.00" "$1,272.00" "$2,120.00" "$2,120.00" "$2,120.00" N/A N/A 110.01 SUP HCPCS C1713 110.010 - SCREW BONE 4MM 10MM SLFDRILL RIGID TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.012 SUP HCPCS C1713 110.012 - SCREW BONE 4MM 12MM SLFDRILL RIGID ASSURE TITANIUM ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.014 SUP HCPCS C1713 110.014 - SCREW BONE 4MM 14MM SLFDRILL RIGID ASSURE TITANIUM ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.016 SUP HCPCS C1713 110.016 - SCREW BONE 4MM 16MM SLFDRILL RIGID ASSURE TITANIUM ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.026 SUP HCPCS C1713 110.026 - SCREW BONE 4MM SPN OCCPTL BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.028 SUP HCPCS C1713 110.028 - SCREW BONE 4MM RIDGE SPN OCCPTL BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.03 SUP HCPCS C1713 110.030 - SCREW BONE 4MM 10MM SLFTAP RIGID ASSURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.032 SUP HCPCS C1713 110.032 - SCREW BONE 4MM 12MM SLFTAP RIGID ASSURE TITANIUM ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.034 SUP HCPCS C1713 110.034 - SCREW BONE 4MM 14MM SLFTAP RIGID ASSURE TITANIUM ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.036 SUP HCPCS C1713 110.036 - SCREW BONE 4MM 16MM SLFTAP RIGID ASSURE TITANIUM ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.038 SUP HCPCS C1713 110.038 - SCREW BONE 4MM 18MM SLFTAP RIGID ASSURE SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.04 SUP HCPCS C1713 110.040 - SCREW BONE 4MM 20MM SLFTAP RIGID ASSURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.05 SUP HCPCS C1713 110.050 - SCREW SET TITANIUM SPN CERV ANTERIOR RIGID SCREW BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 110.11 SUP HCPCS C1713 110.110 - PLATE BONE 10MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 110.112 SUP HCPCS C1713 110.112 - PLATE BONE 12MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 110.114 SUP HCPCS C1713 110.114 - PLATE BONE 14MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 110.116 SUP HCPCS C1713 110.116 - PLATE BONE 16MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 110.118 SUP HCPCS C1713 110.118 - PLATE BONE 18MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 110.12 SUP HCPCS C1713 110.120 - PLATE BONE 20MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 110.122 SUP HCPCS C1713 110.122 - PLATE BONE 22MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 110.124 SUP HCPCS C1713 110.124 - PLATE BONE 24MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 110.126 SUP HCPCS C1713 110.126 - PLATE BONE 26MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 110.224 SUP HCPCS C1713 110.224 - PLATE BONE 24MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 110.226 SUP HCPCS C1713 110.226 - PLATE BONE 26MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 110.228 SUP HCPCS C1713 110.228 - PLATE BONE 28MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 110.23 SUP HCPCS C1713 110.230 - PLATE BONE 30MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 110.232 SUP HCPCS C1713 110.232 - PLATE BONE 32MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 110.234 SUP HCPCS C1713 110.234 - PLATE BONE 34MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 110.236 SUP HCPCS C1713 110.236 - PLATE BONE 36MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 110.238 SUP HCPCS C1713 110.238 - PLATE BONE 38MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 110.24 SUP HCPCS C1713 110.240 - PLATE BONE 40MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 110.242 SUP HCPCS C1713 110.242 - PLATE BONE 42MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 110.244 SUP HCPCS C1713 110.244 - PLATE BONE 44MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 110.246 SUP HCPCS C1713 110.246 - PLATE BONE 46MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 110.339 SUP HCPCS C1713 110.339 - PLATE BONE 39MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 110.342 SUP HCPCS C1713 110.342 - PLATE BONE 42MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 110.345 SUP HCPCS C1713 110.345 - PLATE BONE 45MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 110.348 SUP HCPCS C1713 110.348 - PLATE BONE 48MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 110.351 SUP HCPCS C1713 110.351 - PLATE BONE 51MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 110.354 SUP HCPCS C1713 110.354 - PLATE BONE 54MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 110.357 SUP HCPCS C1713 110.357 - PLATE BONE 57MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 110.36 SUP HCPCS C1713 110.360 - PLATE BONE 60MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 110.363 SUP HCPCS C1713 110.363 - PLATE BONE 63MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 110.366 SUP HCPCS C1713 110.366 - PLATE BONE 66MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 110.369 SUP HCPCS C1713 110.369 - PLATE BONE 69MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 110.46 SUP HCPCS C1713 110.460 - PLATE BONE 60MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 110.464 SUP HCPCS C1713 110.464 - PLATE BONE 64MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 110.468 SUP HCPCS C1713 110.468 - PLATE BONE 68MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 110.472 SUP HCPCS C1713 110.472 - PLATE BONE 72MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 110.476 SUP HCPCS C1713 110.476 - PLATE BONE 76MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 110.48 SUP HCPCS C1713 110.480 - PLATE BONE 80MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 110.484 SUP HCPCS C1713 110.484 - PLATE BONE 84MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 110.488 SUP HCPCS C1713 110.488 - PLATE BONE 88MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 110.492 SUP HCPCS C1713 110.492 - PLATE BONE 92MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 110.496 SUP HCPCS C1713 110.496 - PLATE BONE 96MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 110.5 SUP HCPCS C1713 110.500 - PLATE BONE 100MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 110.512 SUP HCPCS C1713 110.512 - SCREW BONE 4.5MM 12MM SLFDRILL RIGID ASSURE TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.514 SUP HCPCS C1713 110.514 - SCREW BONE 4.5MM 14MM SLFDRILL RIGID ASSURE TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.516 SUP HCPCS C1713 110.516 - SCREW BONE 4.5MM 16MM SLFDRILL RIGID ASSURE TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.526 SUP HCPCS C1713 110.526 - SCREW BONE 4.5MM SLFTAP RIGID SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.528 SUP HCPCS C1713 110.528 - SCREW BONE 4.5MM SLFTAP RIGID SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.53 SUP HCPCS C1713 110.530 - SCREW BONE 4.5MM 10MM SLFDRILL RIGID ASSURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.532 SUP HCPCS C1713 110.532 - SCREW BONE 4.5MM 12MM SLFTAP RIGID ASSURE TITANIUM ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.534 SUP HCPCS C1713 110.534 - SCREW BONE 4.5MM 14MM SLFTAP RIGID ASSURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.536 SUP HCPCS C1713 110.536 - SCREW BONE 4.5MM 16MM SLFTAP RIGID ASSURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 110.538 SUP HCPCS C1713 110.538 - SCREW BONE 4.5MM 18MM SLFTAP RIGID ASSURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.54 SUP HCPCS C1713 110.540 - SCREW BONE 4.5MM 20MM SLFTAP RIGID ASSURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.61 SUP HCPCS C1713 110.610 - SCREW BONE STANDARD 4MM 10MM SLFDRILL ASSURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.612 SUP HCPCS C1713 110.612 - SCREW BONE STANDARD 4MM 12MM SLFDRILL ASSURE TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.614 SUP HCPCS C1713 110.614 - SCREW BONE STANDARD 4MM 14MM SLFDRILL ASSURE TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.616 SUP HCPCS C1713 110.616 - SCREW BONE STANDARD 4MM 16MM SLFDRILL ASSURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.712 SUP HCPCS C1713 110.712 - SCREW BONE STANDARD 4.5MM 12MM SLFDRILL ASSURE TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.714 SUP HCPCS C1713 110.714 - SCREW BONE STANDARD 4.5MM 14MM SLFDRILL ASSURE TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.716 SUP HCPCS C1713 110.716 - SCREW BONE STANDARD 4.5MM 16MM SLFDRILL ASSURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 110.806 SUP HCPCS C1713 110.806 - SCREW BN STD 4MM 6MM PRTX CT ST SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.808 SUP HCPCS C1713 110.808 - SCREW BONE STANDARD 4MM 8MM SLFTAP TITANIUM SPN BOTH IP/OP $967.50 $716.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $967.50 $572.28 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $561.15 $967.50 $967.50 $967.50 $201.63 $967.50 N/A N/A 110.81 SUP HCPCS C1713 110.810 - SCREW BONE STANDARD 4MM 10MM SLFTAP TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.812 SUP HCPCS C1713 110.812 - SCREW BONE STANDARD 4MM 12MM SLFTAP ASSURE TITANIUM ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.814 SUP HCPCS C1713 110.814 - SCREW BONE STANDARD 4MM 14MM SLFTAP ASSURE TITANIUM ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.816 SUP HCPCS C1713 110.816 - SCREW BONE STANDARD 4MM 16MM SLFTAP ASSURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.818 SUP HCPCS C1713 110.818 - SCREW BONE STANDARD 4MM 18MM SLFTAP ASSURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.82 SUP HCPCS C1713 110.820 - SCREW BONE STANDARD 4MM 20MM SLFTAP ASSURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.906 SUP HCPCS C1713 110.906 - SCREW BONE 4.5MM 6MM SLFTAP PROTEX SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.908 SUP HCPCS C1713 110.908 - SCREW BONE 4.5MM 6MM SLFTAP PROTEX SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.91 SUP HCPCS C1713 110.910 - SCREW BONE STANDARD 4.5MM 10MM SLFTAP ASSURE TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 110.912 SUP HCPCS C1713 110.912 - SCREW BONE STANDARD 4.5MM 12MM SLFTAP ASSURE TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.914 SUP HCPCS C1713 110.914 - SCREW BONE STANDARD 4.5MM 14MM SLFTAP ASSURE TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.916 SUP HCPCS C1713 110.916 - SCREW BONE STANDARD 4.5MM 16MM SLFTAP ASSURE TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.918 SUP HCPCS C1713 110.918 - SCREW BONE STANDARD 4.5MM 18MM SLFTAP ASSURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 110.92 SUP HCPCS C1713 110.920 - SCREW BONE STANDARD 4.5MM 20MM SLFTAP PROTEX TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 111 SUP Custom 27203010 111 - ADAPTER SUCTION 15MM 15MM CLOSE SYSTEM SWIVEL LATEX FREE BOTH IP/OP $80.00 $59.00 $46.40 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $68.98 $387.50 $387.50 $287.60 $287.60 $298.69 $201.89 $80.76 $387.50 $155.00 $387.50 $387.50 $387.50 $387.50 $387.50 $60.00 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $251.88 $387.50 N/A $46.40 $387.50 $232.50 $387.50 $387.50 $387.50 N/A N/A 111 SUP Custom 27203010 111 - KIT PEG GASTRODOME 24FR INITIAL PLACEMENT PULL METHOD 2/BOX BOTH IP/OP $387.50 $287.00 $68.98 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $68.98 $387.50 $387.50 $287.60 $287.60 $298.69 $201.89 $80.76 $387.50 $155.00 $387.50 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $251.88 $387.50 N/A $224.75 $387.50 $232.50 $387.50 $387.50 $387.50 N/A N/A 115 SUP HCPCS C1713 115.000 - SCREW SET M4X .75 ROUND TIP SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 115.222 SUP HCPCS C1713 115.222 - SCREW BONE 3.5MM 22MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.224 SUP HCPCS C1713 115.224 - SCREW BONE 3.5MM 24MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.226 SUP HCPCS C1713 115.226 - SCREW BONE 3.5MM 26MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.228 SUP HCPCS C1713 115.228 - SCREW BONE 3.5MM 28MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.23 SUP HCPCS C1713 115.230 - SCREW BONE 3.5MM 30MM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.232 SUP HCPCS C1713 115.232 - SCREW BONE 3.5MM 32MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.234 SUP HCPCS C1713 115.234 - SCREW BONE 3.5MM 34MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.236 SUP HCPCS C1713 115.236 - SCREW BONE 3.5MM 36MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.308 SUP HCPCS C1713 115.308 - SCREW BONE 3.5MM 8MM POLYAX PROTEX CT TITANIUM BOTH IP/OP "$3,097.50" "$2,292.00" $614.78 "$3,097.50" "$1,393.88" "$1,393.88" "$1,393.88" "$1,393.88" "$3,097.50" "$3,097.50" "$3,097.50" $645.60 "$3,097.50" "$3,097.50" "$3,097.50" "$3,097.50" "$3,097.50" $645.55 "$3,097.50" "$3,097.50" "$1,527.07" "$3,097.50" "$3,097.50" "$3,097.50" "$3,097.50" "$2,323.13" "$3,097.50" "$3,097.50" "$3,097.50" "$1,548.75" "$1,548.75" "$2,453.22" "$3,097.50" "$2,478.00" "$1,393.88" $614.78 N/A "$1,796.55" "$3,097.50" "$3,097.50" "$3,097.50" $645.52 "$3,097.50" N/A N/A 115.31 SUP HCPCS C1713 115.310 - SCREW BONE 3.5MM 10MM PROTEX CT TITANIUM POSTERIOR THORACIC BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.312 SUP HCPCS C1713 115.312 - SCREW BONE 3.5MM 12MM POLYAX PROTEX CT TITANIUM BOTH IP/OP "$3,097.50" "$2,292.00" $614.78 "$3,097.50" "$1,393.88" "$1,393.88" "$1,393.88" "$1,393.88" "$3,097.50" "$3,097.50" "$3,097.50" $645.60 "$3,097.50" "$3,097.50" "$3,097.50" "$3,097.50" "$3,097.50" $645.55 "$3,097.50" "$3,097.50" "$1,527.07" "$3,097.50" "$3,097.50" "$3,097.50" "$3,097.50" "$2,323.13" "$3,097.50" "$3,097.50" "$3,097.50" "$1,548.75" "$1,548.75" "$2,453.22" "$3,097.50" "$2,478.00" "$1,393.88" $614.78 N/A "$1,796.55" "$3,097.50" "$3,097.50" "$3,097.50" $645.52 "$3,097.50" N/A N/A 115.314 SUP HCPCS C1713 115.314 - SCREW BONE 3.5MM 14MM POLYAX PROTEX CT TITANIUM BOTH IP/OP "$3,097.50" "$2,292.00" $614.78 "$3,097.50" "$1,393.88" "$1,393.88" "$1,393.88" "$1,393.88" "$3,097.50" "$3,097.50" "$3,097.50" $645.60 "$3,097.50" "$3,097.50" "$3,097.50" "$3,097.50" "$3,097.50" $645.55 "$3,097.50" "$1,239.00" "$1,527.07" "$3,097.50" "$3,097.50" "$3,097.50" "$3,097.50" "$2,323.13" "$3,097.50" "$3,097.50" "$3,097.50" "$1,548.75" "$1,548.75" "$2,453.22" "$3,097.50" "$2,478.00" "$1,393.88" $614.78 N/A "$1,796.55" "$3,097.50" "$3,097.50" "$3,097.50" $645.52 "$3,097.50" N/A N/A 115.316 SUP HCPCS C1713 115.316 - SCREW BONE 3.5MM 16MM POLYAX PROTEX CT TITANIUM BOTH IP/OP "$3,097.50" "$2,292.00" $614.78 "$3,097.50" "$1,393.88" "$1,393.88" "$1,393.88" "$1,393.88" "$3,097.50" "$3,097.50" "$3,097.50" $645.60 "$3,097.50" "$3,097.50" "$3,097.50" "$3,097.50" "$3,097.50" $645.55 "$3,097.50" "$1,239.00" "$1,527.07" "$3,097.50" "$3,097.50" "$3,097.50" "$3,097.50" "$2,323.13" "$3,097.50" "$3,097.50" "$3,097.50" "$1,548.75" "$1,548.75" "$2,453.22" "$3,097.50" "$2,478.00" "$1,393.88" $614.78 N/A "$1,796.55" "$3,097.50" "$3,097.50" "$3,097.50" $645.52 "$3,097.50" N/A N/A 115.318 SUP HCPCS C1713 115.318 - SCREW BONE 3.5MM 18MM POLYAX PROTEX CT TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.32 SUP HCPCS C1713 115.320 - SCREW BONE 3.5MM 20MM POLYAX PROTEX CT TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.322 SUP HCPCS C1713 115.322 - SCREW BONE 3.5MM 22MM POLYAX PROTEX CT TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.324 SUP HCPCS C1713 115.324 - SCREW BONE 3.5MM 24MM PROTEX CT SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.326 SUP HCPCS C1713 115.326 - SCREW BONE 3.5MM 26MM PORTEX CT SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.328 SUP HCPCS C1713 115.328 - SCREW BONE 3.5MM 28MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.33 SUP HCPCS C1713 115.330 - SCREW BONE 3.5MM 30MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.332 SUP HCPCS C1713 115.332 - SCREW BONE 3.5MM 32MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.334 SUP HCPCS C1713 115.334 - SCREW BONE 3.5MM 34MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.336 SUP HCPCS C1713 115.336 - SCREW BONE 3.5MM 36MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.338 SUP HCPCS C1713 115.338 - SCREW BONE 3.5MM 38MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.34 SUP HCPCS C1713 115.340 - SCREW BONE 4MM 30MM POLYAX PROTEX CT TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.342 SUP HCPCS C1713 115.342 - SCREW BONE 3.5MM 42MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.344 SUP HCPCS C1713 115.344 - SCREW BONE 3.5MM 44MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.346 SUP HCPCS C1713 115.346 - SCREW BONE 3.5MM 46MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.348 SUP HCPCS C1713 115.348 - SCREW BONE 3.5MM 48MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.35 SUP HCPCS C1713 115.350 - SCREW BONE 3.5MM 50MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.41 SUP HCPCS C1713 115.410 - SCREW BONE 4MM 10MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.412 SUP HCPCS C1713 115.412 - SCREW BN 4MM 12MM PRTX CT PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.414 SUP HCPCS C1713 115.414 - SCREW BN 4MM 14MM PRTX CT PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.416 SUP HCPCS C1713 115.416 - SCREW BONE 4MM 16MM PROTEX CT SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.418 SUP HCPCS C1713 115.418 - SCREW BN 4MM 18MM PRTX CT PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.42 SUP HCPCS C1713 115.420 - SCREW BONE 4MM 20MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.422 SUP HCPCS C1713 115.422 - SCREW BONE 4MM 22MM PROTEX-CT TITANIUM POSTERIOR THORACIC BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.424 SUP HCPCS C1713 115.424 - SCREW BONE 4MM 24MM PROTEX CT SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.426 SUP HCPCS C1713 115.426 - SCREW BONE 4MM 26MM PROTEX CT SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.428 SUP HCPCS C1713 115.428 - SCREW BONE 4MM 28MM PROTEX CT SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.43 SUP HCPCS C1713 115.430 - SCREW BONE 4MM 30MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.432 SUP HCPCS C1713 115.432 - SCREW BONE 4MM 32MM PROTEX CT SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.434 SUP HCPCS C1713 115.434 - SCREW BONE 4MM 34MM PROTEX CT SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.436 SUP HCPCS C1713 115.436 - SCREW BONE 4MM 36MM POLYAX PROTEX CT TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.438 SUP HCPCS C1713 115.438 - SCREW BONE 4MM 38MM PROTEX CT SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.44 SUP HCPCS C1713 115.440 - SCREW BONE 4MM 40MM SLFTAP PROTEX CT TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.442 SUP HCPCS C1713 115.442 - SCREW BONE 4MM 42MM PROTEX CT SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.444 SUP HCPCS C1713 115.444 - SCREW BONE 4MM 44MM PROTEX CT SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.446 SUP HCPCS C1713 115.446 - SCREW BONE 4MM 46MM PROTEX CT SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.448 SUP HCPCS C1713 115.448 - SCREW BONE 4MM 48MM PROTEX CT SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.45 SUP HCPCS C1713 115.450 - SCREW BONE 4MM 50MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.5 SUP Custom 27803010 115.500 - CAP LOCKING STANDARD POLYAX PROTEX CT TITANIUM BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 115.501 SUP Custom 27803010 115.501 - HOOK SPINAL PROTEX CT BOTH IP/OP $955.00 $707.00 $169.99 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $169.99 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $199.03 $955.00 $382.00 $955.00 $955.00 $955.00 $955.00 $955.00 $716.25 $955.00 $955.00 $955.00 $477.50 $477.50 $756.36 $955.00 $764.00 $429.75 $955.00 N/A $553.90 $955.00 $573.00 $955.00 $955.00 $955.00 N/A N/A 115.503 SUP Custom 27803010 115.503 - HOOK SPINAL RIGHT ANGLED PROTEX CT BOTH IP/OP $955.00 $707.00 $169.99 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $169.99 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $199.03 $955.00 $382.00 $955.00 $955.00 $955.00 $955.00 $955.00 $716.25 $955.00 $955.00 $955.00 $477.50 $477.50 $756.36 $955.00 $764.00 $429.75 $955.00 N/A $553.90 $955.00 $573.00 $955.00 $955.00 $955.00 N/A N/A 115.504 SUP Custom 27803010 115.504 - HOOK SPINAL LEFT ANGLED PROTEX CT BOTH IP/OP $955.00 $707.00 $169.99 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $169.99 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $199.03 $955.00 $382.00 $955.00 $955.00 $955.00 $955.00 $955.00 $716.25 $955.00 $955.00 $955.00 $477.50 $477.50 $756.36 $955.00 $764.00 $429.75 $955.00 N/A $553.90 $955.00 $573.00 $955.00 $955.00 $955.00 N/A N/A 115.506 SUP Custom 27803010 115.506 - HOOK SPINAL 7MM RIGHT OFFST PROTEX CT BOTH IP/OP $955.00 $707.00 $169.99 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $169.99 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $199.03 $955.00 $382.00 $955.00 $955.00 $955.00 $955.00 $955.00 $716.25 $955.00 $955.00 $955.00 $477.50 $477.50 $756.36 $955.00 $764.00 $429.75 $955.00 N/A $553.90 $955.00 $573.00 $955.00 $955.00 $955.00 N/A N/A 115.507 SUP Custom 27803010 115.507 - HOOK SPINAL 5MM RIGHT OFFST PROTEX CT BOTH IP/OP $955.00 $707.00 $169.99 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $169.99 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $199.03 $955.00 $382.00 $955.00 $955.00 $955.00 $955.00 $955.00 $716.25 $955.00 $955.00 $955.00 $477.50 $477.50 $756.36 $955.00 $764.00 $429.75 $955.00 N/A $553.90 $955.00 $573.00 $955.00 $955.00 $955.00 N/A N/A 115.508 SUP Custom 27803010 115.508 - HOOK SPINAL 7MM LEFT OFFST PROTEX CT BOTH IP/OP $955.00 $707.00 $169.99 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $169.99 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $199.03 $955.00 $382.00 $955.00 $955.00 $955.00 $955.00 $955.00 $716.25 $955.00 $955.00 $955.00 $477.50 $477.50 $756.36 $955.00 $764.00 $429.75 $955.00 N/A $553.90 $955.00 $573.00 $955.00 $955.00 $955.00 N/A N/A 115.509 SUP Custom 27803010 115.509 - HOOK SPINAL 5MM LEFT OFFST PROTEX CT BOTH IP/OP $955.00 $707.00 $169.99 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $169.99 $955.00 $955.00 $955.00 $955.00 $955.00 $955.00 $199.03 $955.00 $382.00 $955.00 $955.00 $955.00 $955.00 $955.00 $716.25 $955.00 $955.00 $955.00 $477.50 $477.50 $756.36 $955.00 $764.00 $429.75 $955.00 N/A $553.90 $955.00 $573.00 $955.00 $955.00 $955.00 N/A N/A 115.51 SUP HCPCS C1713 115.510 - SCREW BONE 4.5MM 10MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.512 SUP HCPCS C1713 115.512 - SCREW BONE 4.5MM 12MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.514 SUP HCPCS C1713 115.514 - SCREW BONE 4.5MM 14MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.516 SUP HCPCS C1713 115.516 - SCREW BONE 4.5MM 16MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.518 SUP HCPCS C1713 115.518 - SCREW BONE 4.5MM 18MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.52 SUP HCPCS C1713 115.520 - SCREW BONE 4.5MM 20MM SLFTAP PROTEX CT TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.522 SUP HCPCS C1713 115.522 - SCREW BONE 4.5MM 22MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.524 SUP HCPCS C1713 115.524 - SCREW BONE 4.5MM 24MM POLYAX PROTEX CT TITANIUM BOTH IP/OP "$3,365.00" "$2,490.00" $667.87 "$3,365.00" "$1,514.25" "$1,514.25" "$1,514.25" "$1,514.25" "$3,365.00" "$3,365.00" "$3,365.00" $701.35 "$3,365.00" "$3,365.00" "$3,365.00" "$3,365.00" "$3,365.00" $701.30 "$3,365.00" "$3,365.00" "$1,658.95" "$3,365.00" "$3,365.00" "$3,365.00" "$3,365.00" "$2,523.75" "$3,365.00" "$3,365.00" "$3,365.00" "$1,682.50" "$1,682.50" "$2,665.08" "$3,365.00" "$2,692.00" "$1,514.25" $667.87 N/A "$1,951.70" "$3,365.00" "$3,365.00" "$3,365.00" $701.27 "$3,365.00" N/A N/A 115.526 SUP HCPCS C1713 115.526 - SCREW BONE 4.5MM 26MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$3,365.00" "$2,490.00" $667.87 "$3,365.00" "$1,514.25" "$1,514.25" "$1,514.25" "$1,514.25" "$3,365.00" "$3,365.00" "$3,365.00" $701.35 "$3,365.00" "$3,365.00" "$3,365.00" "$3,365.00" "$3,365.00" $701.30 "$3,365.00" "$3,365.00" "$1,658.95" "$3,365.00" "$3,365.00" "$3,365.00" "$3,365.00" "$2,523.75" "$3,365.00" "$3,365.00" "$3,365.00" "$1,682.50" "$1,682.50" "$2,665.08" "$3,365.00" "$2,692.00" "$1,514.25" $667.87 N/A "$1,951.70" "$3,365.00" "$3,365.00" "$3,365.00" $701.27 "$3,365.00" N/A N/A 115.528 SUP HCPCS C1713 115.528 - SCREW BONE 4.5MM 28MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.53 SUP HCPCS C1713 115.530 - SCREW BONE 4.5MM 30MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.532 SUP HCPCS C1713 115.532 - SCREW BONE 4.5MM 32MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.534 SUP HCPCS C1713 115.534 - SCREW BONE 4.5MM 34MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.536 SUP HCPCS C1713 115.536 - SCREW BONE 4.5MM 36MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.538 SUP HCPCS C1713 115.538 - SCREW BONE 4.5MM 38MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.54 SUP HCPCS C1713 115.540 - SCREW BONE 4.5MM 40MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.542 SUP HCPCS C1713 115.542 - SCREW BONE 4.5MM 42MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.544 SUP HCPCS C1713 115.544 - SCREW BONE 4.5MM 44MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.546 SUP HCPCS C1713 115.546 - SCREW BONE 4.5MM 46MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.548 SUP HCPCS C1713 115.548 - SCREW BONE 4.5MM 48MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.55 SUP HCPCS C1713 115.550 - SCREW BONE 4.5MM 50MM SLFTAP LP POLYAX PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 115.701 SUP Custom 27803010 115.701 - ROD SPINAL 80MM CONNCTNG GLOBUS BOTH IP/OP $777.50 $575.00 $138.40 $777.50 $777.50 $777.50 $777.50 $777.50 $777.50 $777.50 $138.40 $777.50 $777.50 $777.50 $777.50 $777.50 $777.50 $162.04 $777.50 $311.00 $777.50 $777.50 $777.50 $777.50 $777.50 $583.13 $777.50 $777.50 $777.50 $388.75 $388.75 $615.78 $777.50 $622.00 $349.88 $777.50 N/A $450.95 $777.50 $466.50 $777.50 $777.50 $777.50 N/A N/A 115.702 SUP Custom 27803010 115.702 - ROD SPINAL 120MM GLOBUS BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 115.703 SUP Custom 27803010 115.703 - ROD SPNL STRG 3.2MM 240MM NS PRTX CTTI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 115.704 SUP Custom 27803010 115.704 - ROD SPINAL 3.4MM 40MM ORTHOPEDIC SPINAL GLOBUS BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 115.801 SUP Custom 27803010 115.801 - ROD SPINAL 3.7MM 80MM STR PROTEX CT TITANIUM BOTH IP/OP $777.50 $575.00 $138.40 $777.50 $777.50 $777.50 $777.50 $777.50 $777.50 $777.50 $138.40 $777.50 $777.50 $777.50 $777.50 $777.50 $777.50 $162.04 $777.50 $311.00 $777.50 $777.50 $777.50 $777.50 $777.50 $583.13 $777.50 $777.50 $777.50 $388.75 $388.75 $615.78 $777.50 $622.00 $349.88 $777.50 N/A $450.95 $777.50 $466.50 $777.50 $777.50 $777.50 N/A N/A 115.802 SUP Custom 27803010 115.802 - ROD SPINAL 3.7MM 120MM STR PROTEX CT TITANIUM BOTH IP/OP $967.50 $716.00 $172.22 $967.50 $967.50 $967.50 $967.50 $967.50 $967.50 $967.50 $172.22 $967.50 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $387.00 $967.50 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $967.50 N/A $561.15 $967.50 $580.50 $967.50 $967.50 $967.50 N/A N/A 115.803 SUP Custom 27803010 115.803 - ROD SPINAL 3.7-6.5MM 500MM STR PROTEX CT TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 115.804 SUP Custom 27803010 115.804 - ROD SPINAL 3.7MM 40MM STR PROTEX CT TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 115.911 SUP Custom 27803010 115.911 - CONNECTOR ROD 3.7MM 20-41MM TRNSVRS ADJUSTABLE PROTEX CT BOTH IP/OP "$3,482.50" "$2,577.00" $619.89 "$3,482.50" "$3,482.50" "$3,482.50" "$3,482.50" "$3,482.50" "$3,482.50" "$3,482.50" $619.89 "$3,482.50" "$3,482.50" "$3,482.50" "$3,482.50" "$3,482.50" "$3,482.50" $725.79 "$3,482.50" "$1,393.00" "$3,482.50" "$3,482.50" "$3,482.50" "$3,482.50" "$3,482.50" "$2,611.88" "$3,482.50" "$3,482.50" "$3,482.50" "$1,741.25" "$1,741.25" "$2,758.14" "$3,482.50" "$2,786.00" "$1,567.13" "$3,482.50" N/A "$2,019.85" "$3,482.50" "$2,089.50" "$3,482.50" "$3,482.50" "$3,482.50" N/A N/A 115.912 SUP Custom 27803010 115.912 - CONNECTOR ROD 3.7MM 35-56MM TRNSVRS ADJUSTABLE PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 115.918 SUP Custom 27803010 115.918 - CONNECTOR ROD 3.7MM 21-33MM TRNSVRS ADJUSTABLE PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 115.919 SUP Custom 27803010 115.919 - CONNECTOR ROD 3.7MM 26-46MM TRNSVRS ADJUSTABLE PROTEX CT BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 115.92 SUP Custom 27803010 "115.920 - Top-Loading T-Connector for 3.2mm Rod, 26-46mm, Straight" BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 115.921 SUP Custom 27803010 115.921 - SET EXTN 36-56MM T CONCTR SPN BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 115.922 SUP Custom 27803010 "115.922 - Top-Loading T-Connector for 3.2mm Rod, 36-56, Straight" BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 115.923 SUP Custom 27803010 115.923 - CONNECTOR ROD 21-33MM CROSS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 115.924 SUP Custom 27803010 115.924 - CONNECTOR ROD 26-46MM CVD TOP LOADING T SPN 3.7MM BOTH IP/OP "$3,915.00" "$2,897.00" $696.87 "$3,915.00" "$3,915.00" "$3,915.00" "$3,915.00" "$3,915.00" "$3,915.00" "$3,915.00" $696.87 "$3,915.00" "$3,915.00" "$3,915.00" "$3,915.00" "$3,915.00" "$3,915.00" $815.93 "$3,915.00" "$1,566.00" "$3,915.00" "$3,915.00" "$3,915.00" "$3,915.00" "$3,915.00" "$2,936.25" "$3,915.00" "$3,915.00" "$3,915.00" "$1,957.50" "$1,957.50" "$3,100.68" "$3,915.00" "$3,132.00" "$1,761.75" "$3,915.00" N/A "$2,270.70" "$3,915.00" "$2,349.00" "$3,915.00" "$3,915.00" "$3,915.00" N/A N/A 115.925 SUP Custom 27803010 "115.925 - Top-Loading T-Connector for 3.7mm Rod, 26-46mm, Straight" BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 115.926 SUP Custom 27803010 "115.926 - Top-Loading T-Connector for 3.7mm Rod, 36-56mm, Curved" BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 115.927 SUP Custom 27803010 115.927 - CONNECTOR ROD 3.7MM 36-56MM TOP SPN BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 115.93 SUP Custom 27803010 115.930 - CONNECTOR ROD PROTEX CT TITANIUM LEFT BOTH IP/OP "$1,832.50" "$1,356.00" $326.19 "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" $326.19 "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" $381.91 "$1,832.50" $733.00 "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" "$1,374.38" "$1,832.50" "$1,832.50" "$1,832.50" $916.25 $916.25 "$1,451.34" "$1,832.50" "$1,466.00" $824.63 "$1,832.50" N/A "$1,062.85" "$1,832.50" "$1,099.50" "$1,832.50" "$1,832.50" "$1,832.50" N/A N/A 115.931 SUP Custom 27803010 115.931 - CLAMP SPINAL RIGHT TRNCON BOTH IP/OP "$1,832.50" "$1,356.00" $326.19 "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" $326.19 "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" $381.91 "$1,832.50" $733.00 "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" "$1,832.50" "$1,374.38" "$1,832.50" "$1,832.50" "$1,832.50" $916.25 $916.25 "$1,451.34" "$1,832.50" "$1,466.00" $824.63 "$1,832.50" N/A "$1,062.85" "$1,832.50" "$1,099.50" "$1,832.50" "$1,832.50" "$1,832.50" N/A N/A 115.949 SUP Custom 27803010 115.949 - NUT LOCK 4.5X.75MM 3.5MM ROUND TIP HEXAGONAL SPN BOTH IP/OP $192.50 $142.00 $34.27 $192.50 $192.50 $192.50 $192.50 $192.50 $192.50 $192.50 $34.27 $192.50 $192.50 $192.50 $192.50 $192.50 $192.50 $40.12 $192.50 $77.00 $192.50 $192.50 $192.50 $192.50 $192.50 $144.38 $192.50 $192.50 $192.50 $96.25 $96.25 $152.46 $192.50 $154.00 $86.63 $192.50 N/A $111.65 $192.50 $115.50 $192.50 $192.50 $192.50 N/A N/A 115.95 SUP Custom 27803010 115.950 - CLAMP SPINAL SHORT OCCPTL BOTH IP/OP $795.00 $588.00 $141.51 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $141.51 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $165.69 $795.00 $318.00 $795.00 $795.00 $795.00 $795.00 $795.00 $596.25 $795.00 $795.00 $795.00 $397.50 $397.50 $629.64 $795.00 $636.00 $357.75 $795.00 N/A $461.10 $795.00 $477.00 $795.00 $795.00 $795.00 N/A N/A 115.951 SUP Custom 27803010 115.951 - CLAMP SPINAL LONG OCCPTL BOTH IP/OP $795.00 $588.00 $141.51 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $141.51 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $165.69 $795.00 $318.00 $795.00 $795.00 $795.00 $795.00 $795.00 $596.25 $795.00 $795.00 $795.00 $397.50 $397.50 $629.64 $795.00 $636.00 $357.75 $795.00 N/A $461.10 $795.00 $477.00 $795.00 $795.00 $795.00 N/A N/A 115.952 SUP HCPCS C1713 "115.952 - Set Screw, M4.5 x 0.75" BOTH IP/OP $192.50 $142.00 $38.21 $192.50 $86.63 $86.63 $86.63 $86.63 $192.50 $192.50 $192.50 $40.12 $192.50 $192.50 $192.50 $192.50 $192.50 $40.12 $192.50 $77.00 $113.86 $192.50 $192.50 $192.50 $192.50 $144.38 $192.50 $192.50 $192.50 $96.25 $96.25 $152.46 $192.50 $154.00 $86.63 $38.21 N/A $111.65 $192.50 $115.50 $192.50 $40.12 $192.50 N/A N/A 115.953 SUP Custom 27803010 115.953 - ROD SPINAL 100 3.7MM 240MM OCCPTL BOTH IP/OP "$1,527.50" "$1,130.00" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $318.35 "$1,527.50" $611.00 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,145.63" "$1,527.50" "$1,527.50" "$1,527.50" $763.75 $763.75 "$1,209.78" "$1,527.50" "$1,222.00" $687.38 "$1,527.50" N/A $885.95 "$1,527.50" $916.50 "$1,527.50" "$1,527.50" "$1,527.50" N/A N/A 115.954 SUP Custom 27803010 115.954 - ROD SPINAL 115 3.7MM 240MM OCCPTL BOTH IP/OP "$1,527.50" "$1,130.00" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $318.35 "$1,527.50" $611.00 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,145.63" "$1,527.50" "$1,527.50" "$1,527.50" $763.75 $763.75 "$1,209.78" "$1,527.50" "$1,222.00" $687.38 "$1,527.50" N/A $885.95 "$1,527.50" $916.50 "$1,527.50" "$1,527.50" "$1,527.50" N/A N/A 115.955 SUP Custom 27803010 115.955 - ROD SPINAL 130 3.7MM 240MM PROTEX CT TITANIUM OCCPTL BOTH IP/OP "$1,547.50" "$1,145.00" $275.46 "$1,547.50" "$1,547.50" "$1,547.50" "$1,547.50" "$1,547.50" "$1,547.50" "$1,547.50" $275.46 "$1,547.50" "$1,547.50" "$1,547.50" "$1,547.50" "$1,547.50" "$1,547.50" $322.52 "$1,547.50" $619.00 "$1,547.50" "$1,547.50" "$1,547.50" "$1,547.50" "$1,547.50" "$1,160.63" "$1,547.50" "$1,547.50" "$1,547.50" $773.75 $773.75 "$1,225.62" "$1,547.50" "$1,238.00" $696.38 "$1,547.50" N/A $897.55 "$1,547.50" $928.50 "$1,547.50" "$1,547.50" "$1,547.50" N/A N/A 115.956 SUP Custom 27803010 115.956 - CLAMP SPINAL SHORT 3 OCCPTL BOTH IP/OP "$1,272.50" $942.00 $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $265.20 "$1,272.50" $509.00 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $954.38 "$1,272.50" "$1,272.50" "$1,272.50" $636.25 $636.25 "$1,007.82" "$1,272.50" "$1,018.00" $572.63 "$1,272.50" N/A $738.05 "$1,272.50" $763.50 "$1,272.50" "$1,272.50" "$1,272.50" N/A N/A 115.957 SUP Custom 27803010 115.957 - CLAMP SPINAL LONG 3 OCCPTL BOTH IP/OP "$1,272.50" $942.00 $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $265.20 "$1,272.50" $509.00 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $954.38 "$1,272.50" "$1,272.50" "$1,272.50" $636.25 $636.25 "$1,007.82" "$1,272.50" "$1,018.00" $572.63 "$1,272.50" N/A $738.05 "$1,272.50" $763.50 "$1,272.50" "$1,272.50" "$1,272.50" N/A N/A 115.958 SUP Custom 27803010 115.958 - CLAMP SPINAL SHORT 2 OCCPTL BOTH IP/OP "$1,035.00" $766.00 $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 "$1,035.00" $414.00 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $776.25 "$1,035.00" "$1,035.00" "$1,035.00" $517.50 $517.50 $819.72 "$1,035.00" $828.00 $465.75 "$1,035.00" N/A $600.30 "$1,035.00" $621.00 "$1,035.00" "$1,035.00" "$1,035.00" N/A N/A 115.959 SUP Custom 27803010 115.959 - CLAMP SPINAL LONG 2 OCCPTL BOTH IP/OP "$1,260.00" $932.00 $224.28 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $224.28 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 "$1,260.00" N/A $730.80 "$1,260.00" $756.00 "$1,260.00" "$1,260.00" "$1,260.00" N/A N/A 115.96 SUP Custom 27803010 115.960 - CONNECTOR ROD 3.7MM ADJUSTABLE TRNSVRS BUTTRESSED PROTEX BOTH IP/OP "$1,432.50" "$1,060.00" $254.99 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" $254.99 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" $298.55 "$1,432.50" $573.00 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,074.38" "$1,432.50" "$1,432.50" "$1,432.50" $716.25 $716.25 "$1,134.54" "$1,432.50" "$1,146.00" $644.63 "$1,432.50" N/A $830.85 "$1,432.50" $859.50 "$1,432.50" "$1,432.50" "$1,432.50" N/A N/A 115.961 SUP Custom 27803010 115.961 - CONNECTOR ROD 3.7-4.5MM PARALLEL SPN BOTH IP/OP "$1,432.50" "$1,060.00" $254.99 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" $254.99 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" $298.55 "$1,432.50" $573.00 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,074.38" "$1,432.50" "$1,432.50" "$1,432.50" $716.25 $716.25 "$1,134.54" "$1,432.50" "$1,146.00" $644.63 "$1,432.50" N/A $830.85 "$1,432.50" $859.50 "$1,432.50" "$1,432.50" "$1,432.50" N/A N/A 115.962 SUP Custom 27803010 115.962 - CONNECTOR ROD 3.7-5MM PARALLEL SPN BOTH IP/OP "$1,432.50" "$1,060.00" $254.99 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" $254.99 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" $298.55 "$1,432.50" $573.00 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,074.38" "$1,432.50" "$1,432.50" "$1,432.50" $716.25 $716.25 "$1,134.54" "$1,432.50" "$1,146.00" $644.63 "$1,432.50" N/A $830.85 "$1,432.50" $859.50 "$1,432.50" "$1,432.50" "$1,432.50" N/A N/A 115.963 SUP Custom 27803010 115.963 - CONNECTOR ROD 3.7-5.5MM PARALLEL SPN BOTH IP/OP "$1,432.50" "$1,060.00" $254.99 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" $254.99 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" $298.55 "$1,432.50" $573.00 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,074.38" "$1,432.50" "$1,432.50" "$1,432.50" $716.25 $716.25 "$1,134.54" "$1,432.50" "$1,146.00" $644.63 "$1,432.50" N/A $830.85 "$1,432.50" $859.50 "$1,432.50" "$1,432.50" "$1,432.50" N/A N/A 115.964 SUP Custom 27803010 115.964 - CONNECTOR ROD 3.7-6MM PARALLEL SPN BOTH IP/OP "$1,432.50" "$1,060.00" $254.99 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" $254.99 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" $298.55 "$1,432.50" $573.00 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,074.38" "$1,432.50" "$1,432.50" "$1,432.50" $716.25 $716.25 "$1,134.54" "$1,432.50" "$1,146.00" $644.63 "$1,432.50" N/A $830.85 "$1,432.50" $859.50 "$1,432.50" "$1,432.50" "$1,432.50" N/A N/A 115.965 SUP Custom 27803010 115.965 - CONNECTOR ROD 3.7-6.5MM PARALLEL SPN BOTH IP/OP "$1,432.50" "$1,060.00" $254.99 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" $254.99 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" $298.55 "$1,432.50" $573.00 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,074.38" "$1,432.50" "$1,432.50" "$1,432.50" $716.25 $716.25 "$1,134.54" "$1,432.50" "$1,146.00" $644.63 "$1,432.50" N/A $830.85 "$1,432.50" $859.50 "$1,432.50" "$1,432.50" "$1,432.50" N/A N/A 115.966 SUP Custom 27803010 115.966 - CONNECTOR ROD 3.7/4MM PARALLEL SPN BOTH IP/OP "$1,717.50" "$1,271.00" $305.72 "$1,717.50" "$1,717.50" "$1,717.50" "$1,717.50" "$1,717.50" "$1,717.50" "$1,717.50" $305.72 "$1,717.50" "$1,717.50" "$1,717.50" "$1,717.50" "$1,717.50" "$1,717.50" $357.95 "$1,717.50" $687.00 "$1,717.50" "$1,717.50" "$1,717.50" "$1,717.50" "$1,717.50" "$1,288.13" "$1,717.50" "$1,717.50" "$1,717.50" $858.75 $858.75 "$1,360.26" "$1,717.50" "$1,374.00" $772.88 "$1,717.50" N/A $996.15 "$1,717.50" "$1,030.50" "$1,717.50" "$1,717.50" "$1,717.50" N/A N/A 115.979 SUP Custom 27803010 "115.979 - Tapered Rod, 3.2mm to 3.7mm, 240mm" BOTH IP/OP "$1,620.00" "$1,199.00" $288.36 "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" $288.36 "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" $337.63 "$1,620.00" $648.00 "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" "$1,215.00" "$1,620.00" "$1,620.00" "$1,620.00" $810.00 $810.00 "$1,283.04" "$1,620.00" "$1,296.00" $729.00 "$1,620.00" N/A $939.60 "$1,620.00" $972.00 "$1,620.00" "$1,620.00" "$1,620.00" N/A N/A 115.981 SUP Custom 27803010 115.981 - CONNECTOR ROD 3.7/6.5MM 350MM TAPERED SPN BOTH IP/OP "$1,527.50" "$1,130.00" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $318.35 "$1,527.50" $611.00 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,145.63" "$1,527.50" "$1,527.50" "$1,527.50" $763.75 $763.75 "$1,209.78" "$1,527.50" "$1,222.00" $687.38 "$1,527.50" N/A $885.95 "$1,527.50" $916.50 "$1,527.50" "$1,527.50" "$1,527.50" N/A N/A 115.983 SUP Custom 27803010 115.983 - CONNECTOR ROD 3.7/6MM 350MM TAPERED SPN BOTH IP/OP "$1,527.50" "$1,130.00" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $318.35 "$1,527.50" $611.00 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,145.63" "$1,527.50" "$1,527.50" "$1,527.50" $763.75 $763.75 "$1,209.78" "$1,527.50" "$1,222.00" $687.38 "$1,527.50" N/A $885.95 "$1,527.50" $916.50 "$1,527.50" "$1,527.50" "$1,527.50" N/A N/A 115.984 SUP Custom 27803010 115.984 - CONNECTOR ROD 3.7/5.5MM 350MM TAPERED SPN BOTH IP/OP "$1,527.50" "$1,130.00" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $318.35 "$1,527.50" $611.00 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,145.63" "$1,527.50" "$1,527.50" "$1,527.50" $763.75 $763.75 "$1,209.78" "$1,527.50" "$1,222.00" $687.38 "$1,527.50" N/A $885.95 "$1,527.50" $916.50 "$1,527.50" "$1,527.50" "$1,527.50" N/A N/A 115.985 SUP Custom 27803010 115.985 - CONNECTOR ROD 3.7/5MM 350MM TAPERED SPN BOTH IP/OP "$1,527.50" "$1,130.00" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $318.35 "$1,527.50" $611.00 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,145.63" "$1,527.50" "$1,527.50" "$1,527.50" $763.75 $763.75 "$1,209.78" "$1,527.50" "$1,222.00" $687.38 "$1,527.50" N/A $885.95 "$1,527.50" $916.50 "$1,527.50" "$1,527.50" "$1,527.50" N/A N/A 115.986 SUP Custom 27803010 115.986 - CONNECTOR ROD 3.7/4.5MM 350MM TAPERED SPN BOTH IP/OP "$1,527.50" "$1,130.00" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $318.35 "$1,527.50" $611.00 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,145.63" "$1,527.50" "$1,527.50" "$1,527.50" $763.75 $763.75 "$1,209.78" "$1,527.50" "$1,222.00" $687.38 "$1,527.50" N/A $885.95 "$1,527.50" $916.50 "$1,527.50" "$1,527.50" "$1,527.50" N/A N/A 115.987 SUP Custom 27803010 115.987 - CONNECTOR ROD 3.7/4MM 350MM TAPERED SPN BOTH IP/OP "$1,527.50" "$1,130.00" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $318.35 "$1,527.50" $611.00 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,145.63" "$1,527.50" "$1,527.50" "$1,527.50" $763.75 $763.75 "$1,209.78" "$1,527.50" "$1,222.00" $687.38 "$1,527.50" N/A $885.95 "$1,527.50" $916.50 "$1,527.50" "$1,527.50" "$1,527.50" N/A N/A 115.988 SUP Custom 27803010 "115.988 - Tapered Rod, 3.2mm to 5.5mm, 350mm" BOTH IP/OP "$1,620.00" "$1,199.00" $288.36 "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" $288.36 "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" $337.63 "$1,620.00" $648.00 "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" "$1,620.00" "$1,215.00" "$1,620.00" "$1,620.00" "$1,620.00" $810.00 $810.00 "$1,283.04" "$1,620.00" "$1,296.00" $729.00 "$1,620.00" N/A $939.60 "$1,620.00" $972.00 "$1,620.00" "$1,620.00" "$1,620.00" N/A N/A 115.989 SUP Custom 27803010 115.989 - ROD SPINAL 3.7-5.5MM 500MM TAPERED BOTH IP/OP "$1,060.00" $784.00 $188.68 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $188.68 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $220.92 "$1,060.00" $424.00 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $795.00 "$1,060.00" "$1,060.00" "$1,060.00" $530.00 $530.00 $839.52 "$1,060.00" $848.00 $477.00 "$1,060.00" N/A $614.80 "$1,060.00" $636.00 "$1,060.00" "$1,060.00" "$1,060.00" N/A N/A 115.99 SUP Custom 27803010 115.990 - CONNECTOR ROD PROTEX CT TITANIUM LATERAL BOTH IP/OP "$1,527.50" "$1,130.00" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $318.35 "$1,527.50" $611.00 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,145.63" "$1,527.50" "$1,527.50" "$1,527.50" $763.75 $763.75 "$1,209.78" "$1,527.50" "$1,222.00" $687.38 "$1,527.50" N/A $885.95 "$1,527.50" $916.50 "$1,527.50" "$1,527.50" "$1,527.50" N/A N/A 115.991 SUP Custom 27803010 115.991 - CONNECTOR ROD SHORT ADJUSTABLE TRNSVRS BUTTRESSED PROTEX SPN BOTH IP/OP "$1,527.50" "$1,130.00" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $271.90 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" $318.35 "$1,527.50" $611.00 "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,527.50" "$1,145.63" "$1,527.50" "$1,527.50" "$1,527.50" $763.75 $763.75 "$1,209.78" "$1,527.50" "$1,222.00" $687.38 "$1,527.50" N/A $885.95 "$1,527.50" $916.50 "$1,527.50" "$1,527.50" "$1,527.50" N/A N/A 116.001 SUP Custom 27203010 116.001 - SPACER SPNL 0D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.002 SUP Custom 27203010 116.002 - SPACER SPNL 0D 25MM LG 32X32MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.003 SUP Custom 27203010 116.003 - SPACER SPNL 0D 25MM LG 32X44MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.004 SUP Custom 27203010 116.004 - SPACER SPNL 8D 25MM LG 32X39MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.005 SUP Custom 27203010 116.005 - SPACER SPNL 8D 25MM LG 32X40MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.006 SUP Custom 27203010 116.006 - SPACER SPNL 8D 25MM LG 32X60MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.007 SUP Custom 27203010 116.007 - SPACER SPNL 16D 25MM LG 32X41MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.008 SUP Custom 27203010 116.008 - SPACER SPNL 16D 25MM LG 32X57MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.009 SUP Custom 27203010 116.009 - SPACER SPNL -8D 25MM LG 32X47MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.01 SUP Custom 27203010 116.010 - SPACER SPNL 8D 25MM LG 32X61MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.011 SUP Custom 27203010 116.011 - SPACER SPNL 16D 25MM LG 32X47MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.012 SUP Custom 27203010 116.012 - SPACER SPNL 16D 25MM LG 32X58MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.013 SUP Custom 27203010 116.013 - SPACER SPNL 16D 25MM LG 32X73MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.014 SUP Custom 27203010 116.014 - SPACER SPNL 0D 25MM LG 32X39MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.015 SUP Custom 27203010 116.015 - SPACER SPNL 16D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.016 SUP Custom 27203010 116.016 - SPACER SPNL -8D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.017 SUP Custom 27803010 116.017 - SPACER SPNL 0D 25MM LG 32X41MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$3,312.14" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$8,373.38" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.018 SUP Custom 27203010 116.018 - SPACER SPNL 8D 25MM LG 32X41MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.019 SUP Custom 27203010 116.019 - SPACER SPNL 0D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.02 SUP Custom 27203010 116.020 - SPACER SPNL 8D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.021 SUP Custom 27203010 116.021 - SPACER SPNL 16D 25MM LG 32X51MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.022 SUP Custom 27203010 116.022 - SPACER SPNL -8D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.023 SUP Custom 27203010 116.023 - SPACER SPNL 0D 25MM LG 32X29MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.024 SUP Custom 27203010 116.024 - SPACER SPNL 0D 25MM LG 32X32MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,607.50" "$13,770.00" "$2,060.15" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$3,312.14" "$18,607.50" "$18,607.50" "$4,181.12" "$4,181.12" "$14,342.66" "$2,060.15" "$3,878.01" "$18,607.50" "$7,443.00" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$18,607.50" "$13,955.63" "$18,607.50" "$18,607.50" "$18,607.50" "$9,303.75" "$9,303.75" "$14,737.14" "$18,607.50" "$14,886.00" "$12,094.88" "$18,607.50" N/A "$10,792.35" "$18,607.50" "$11,164.50" "$18,607.50" "$18,607.50" "$18,607.50" N/A N/A 116.101 SUP Custom 27203010 116.101 - SPACER SPNL 0D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.102 SUP Custom 27203010 116.102 - SPACER SPNL 0D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.103 SUP Custom 27203010 116.103 - SPACER SPNL 0D 12MM SM 14X23MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.104 SUP Custom 27203010 116.104 - SPACER SPNL 0D 12MM SM 14X32MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.105 SUP Custom 27203010 116.105 - SPACER SPNL 0D 12MM SM 14X42MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.106 SUP Custom 27203010 116.106 - SPACER SPNL 0D 12MM SM 14X56MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.107 SUP Custom 27203010 116.107 - SPACER SPNL 7D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.108 SUP Custom 27203010 116.108 - SPACER SPNL 7D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.109 SUP Custom 27203010 116.109 - SPACER SPNL 7D 12MM SM 14X26MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.11 SUP Custom 27203010 116.110 - SPACER SPNL 7D 12MM SM 14X28MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.111 SUP Custom 27203010 116.111 - SPACER SPNL 7D 12MM SM 14X42MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.112 SUP Custom 27203010 116.112 - SPACER SPNL 7D 12MM SM 14X56MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.113 SUP Custom 27203010 116.113 - SPACER SPNL 16D 12MM SM 14X56MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.114 SUP Custom 27203010 116.114 - SPACER SPNL 0D 12MM SM 14X74MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.115 SUP Custom 27203010 116.115 - SPACER SPNL 7D 12MM SM 14X74MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.116 SUP Custom 27203010 116.116 - SPACER SPNL 16D 12MM SM 14X74MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.117 SUP Custom 27203010 116.117 - SPACER SPNL 0D 12MM SM 14X19MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.118 SUP Custom 27203010 116.118 - SPACER SPNL 7D 12MM SM 14X19MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.119 SUP Custom 27203010 116.119 - SPACER SPNL 0D 12MM SM 14X29MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.12 SUP Custom 27203010 116.120 - SPACER SPNL 7D 12MM SM 14X29MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.121 SUP Custom 27203010 116.121 - SPACER SPNL 0D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.122 SUP Custom 27203010 116.122 - SPACER SPNL 7D 12MM SM 14X15MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.123 SUP Custom 27203010 116.123 - SPACER SPNL 0D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.124 SUP Custom 27203010 116.124 - SPACER SPNL 7D 12MM SM 14X18MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.125 SUP Custom 27203010 116.125 - SPACER SPNL 0D 12MM SM 14X19MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.126 SUP Custom 27203010 116.126 - SPACER SPNL 7D 12MM SM 14X29MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$14,315.00" "$10,593.00" "$2,060.15" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$2,548.07" "$14,315.00" "$14,315.00" "$4,181.12" "$4,181.12" "$11,034.00" "$2,060.15" "$2,983.40" "$14,315.00" "$5,726.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$14,315.00" "$10,736.25" "$14,315.00" "$14,315.00" "$14,315.00" "$7,157.50" "$7,157.50" "$11,337.48" "$14,315.00" "$11,452.00" "$9,304.75" "$14,315.00" N/A "$8,302.70" "$14,315.00" "$8,589.00" "$14,315.00" "$14,315.00" "$14,315.00" N/A N/A 116.201 SUP Custom 27203010 116.201 - SPACER SPNL -6D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.202 SUP Custom 27203010 116.202 - SPACER SPNL -6D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.203 SUP Custom 27203010 116.203 - SPACER SPNL -6D 21MM MED 23X37MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$17,655.00" "$13,065.00" "$2,060.15" "$17,655.00" "$17,655.00" "$17,655.00" "$17,655.00" "$17,655.00" "$17,655.00" "$17,655.00" "$3,142.59" "$17,655.00" "$17,655.00" "$4,181.12" "$4,181.12" "$13,608.47" "$2,060.15" "$3,679.50" "$17,655.00" "$7,062.00" "$17,655.00" "$17,655.00" "$17,655.00" "$17,655.00" "$17,655.00" "$13,241.25" "$17,655.00" "$17,655.00" "$17,655.00" "$8,827.50" "$8,827.50" "$13,982.76" "$17,655.00" "$14,124.00" "$11,475.75" "$17,655.00" N/A "$10,239.90" "$17,655.00" "$10,593.00" "$17,655.00" "$17,655.00" "$17,655.00" N/A N/A 116.204 SUP Custom 27203010 116.204 - SPACER SPNL -6D 21MM MED 23X49MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$20,040.00" "$14,830.00" "$2,060.15" "$20,040.00" "$20,040.00" "$20,040.00" "$20,040.00" "$20,040.00" "$20,040.00" "$20,040.00" "$3,567.12" "$20,040.00" "$20,040.00" "$4,181.12" "$4,181.12" "$15,446.83" "$2,060.15" "$4,176.56" "$20,040.00" "$8,016.00" "$20,040.00" "$20,040.00" "$20,040.00" "$20,040.00" "$20,040.00" "$15,030.00" "$20,040.00" "$20,040.00" "$20,040.00" "$10,020.00" "$10,020.00" "$15,871.68" "$20,040.00" "$16,032.00" "$13,026.00" "$20,040.00" N/A "$11,623.20" "$20,040.00" "$12,024.00" "$20,040.00" "$20,040.00" "$20,040.00" N/A N/A 116.205 SUP Custom 27203010 116.205 - SPACER SPNL 0D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.206 SUP Custom 27203010 116.206 - SPACER SPNL 0D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.207 SUP Custom 27203010 116.207 - SPACER SPNL 0D 21MM MED 23X37MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$17,655.00" "$13,065.00" "$2,060.15" "$17,655.00" "$17,655.00" "$17,655.00" "$17,655.00" "$17,655.00" "$17,655.00" "$17,655.00" "$3,142.59" "$17,655.00" "$17,655.00" "$4,181.12" "$4,181.12" "$13,608.47" "$2,060.15" "$3,679.50" "$17,655.00" "$7,062.00" "$17,655.00" "$17,655.00" "$17,655.00" "$17,655.00" "$17,655.00" "$13,241.25" "$17,655.00" "$17,655.00" "$17,655.00" "$8,827.50" "$8,827.50" "$13,982.76" "$17,655.00" "$14,124.00" "$11,475.75" "$17,655.00" N/A "$10,239.90" "$17,655.00" "$10,593.00" "$17,655.00" "$17,655.00" "$17,655.00" N/A N/A 116.208 SUP Custom 27203010 116.208 - SPACER SPNL 0D 21MM MED 23X49MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$20,040.00" "$14,830.00" "$2,060.15" "$20,040.00" "$20,040.00" "$20,040.00" "$20,040.00" "$20,040.00" "$20,040.00" "$20,040.00" "$3,567.12" "$20,040.00" "$20,040.00" "$4,181.12" "$4,181.12" "$15,446.83" "$2,060.15" "$4,176.56" "$20,040.00" "$8,016.00" "$20,040.00" "$20,040.00" "$20,040.00" "$20,040.00" "$20,040.00" "$15,030.00" "$20,040.00" "$20,040.00" "$20,040.00" "$10,020.00" "$10,020.00" "$15,871.68" "$20,040.00" "$16,032.00" "$13,026.00" "$20,040.00" N/A "$11,623.20" "$20,040.00" "$12,024.00" "$20,040.00" "$20,040.00" "$20,040.00" N/A N/A 116.209 SUP Custom 27203010 116.209 - SPACER SPNL 0D 21MM MED 23X33MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.21 SUP Custom 27203010 116.210 - SPACER SPNL -6D 21MM MED 23X33MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.211 SUP Custom 27203010 116.211 - SPACER SPNL 0D 21MM MED 23X43MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,017.50" "$13,333.00" "$2,060.15" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,207.12" "$18,017.50" "$18,017.50" "$4,181.12" "$4,181.12" "$13,887.89" "$2,060.15" "$3,755.05" "$18,017.50" "$7,207.00" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$13,513.13" "$18,017.50" "$18,017.50" "$18,017.50" "$9,008.75" "$9,008.75" "$14,269.86" "$18,017.50" "$14,414.00" "$11,711.38" "$18,017.50" N/A "$10,450.15" "$18,017.50" "$10,810.50" "$18,017.50" "$18,017.50" "$18,017.50" N/A N/A 116.212 SUP Custom 27203010 116.212 - SPACER SPNL -6D 21MM MED 23X43MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,017.50" "$13,333.00" "$2,060.15" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,207.12" "$18,017.50" "$18,017.50" "$4,181.12" "$4,181.12" "$13,887.89" "$2,060.15" "$3,755.05" "$18,017.50" "$7,207.00" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$13,513.13" "$18,017.50" "$18,017.50" "$18,017.50" "$9,008.75" "$9,008.75" "$14,269.86" "$18,017.50" "$14,414.00" "$11,711.38" "$18,017.50" N/A "$10,450.15" "$18,017.50" "$10,810.50" "$18,017.50" "$18,017.50" "$18,017.50" N/A N/A 116.213 SUP Custom 27203010 116.213 - SPACER SPNL 8D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.214 SUP Custom 27203010 116.214 - SPACER SPNL 8D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.215 SUP Custom 27203010 116.215 - SPACER SPNL 8D 21MM MED 23X33MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.216 SUP Custom 27203010 116.216 - SPACER SPNL 8D 21MM MED 23X37MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,017.50" "$13,333.00" "$2,060.15" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,207.12" "$18,017.50" "$18,017.50" "$4,181.12" "$4,181.12" "$13,887.89" "$2,060.15" "$3,755.05" "$18,017.50" "$7,207.00" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$13,513.13" "$18,017.50" "$18,017.50" "$18,017.50" "$9,008.75" "$9,008.75" "$14,269.86" "$18,017.50" "$14,414.00" "$11,711.38" "$18,017.50" N/A "$10,450.15" "$18,017.50" "$10,810.50" "$18,017.50" "$18,017.50" "$18,017.50" N/A N/A 116.217 SUP Custom 27203010 116.217 - SPACER SPNL 8D 21MM MED 23X43MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,017.50" "$13,333.00" "$2,060.15" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,207.12" "$18,017.50" "$18,017.50" "$4,181.12" "$4,181.12" "$13,887.89" "$2,060.15" "$3,755.05" "$18,017.50" "$7,207.00" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$13,513.13" "$18,017.50" "$18,017.50" "$18,017.50" "$9,008.75" "$9,008.75" "$14,269.86" "$18,017.50" "$14,414.00" "$11,711.38" "$18,017.50" N/A "$10,450.15" "$18,017.50" "$10,810.50" "$18,017.50" "$18,017.50" "$18,017.50" N/A N/A 116.218 SUP Custom 27203010 116.218 - SPACER SPNL 8D 21MM MED 23X49MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$18,017.50" "$13,333.00" "$2,060.15" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,207.12" "$18,017.50" "$18,017.50" "$4,181.12" "$4,181.12" "$13,887.89" "$2,060.15" "$3,755.05" "$18,017.50" "$7,207.00" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$13,513.13" "$18,017.50" "$18,017.50" "$18,017.50" "$9,008.75" "$9,008.75" "$14,269.86" "$18,017.50" "$14,414.00" "$11,711.38" "$18,017.50" N/A "$10,450.15" "$18,017.50" "$10,810.50" "$18,017.50" "$18,017.50" "$18,017.50" N/A N/A 116.219 SUP Custom 27203010 116.219 - SPACER SPNL 8D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.22 SUP Custom 27203010 116.220 - SPACER SPNL 8D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.221 SUP Custom 27203010 116.221 - SPACER SPNL -6D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.222 SUP Custom 27203010 116.222 - SPACER SPNL -6D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.223 SUP Custom 27203010 116.223 - SPACER SPNL 0D 21MM MED 23X24MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.224 SUP Custom 27203010 116.224 - SPACER SPNL 0D 21MM MED 23X27MM NS LF XPAND SLF DSTRCT SMTH BOTH IP/OP "$16,222.50" "$12,005.00" "$2,060.15" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$2,887.61" "$16,222.50" "$16,222.50" "$4,181.12" "$4,181.12" "$12,504.30" "$2,060.15" "$3,380.95" "$16,222.50" "$6,489.00" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$16,222.50" "$12,166.88" "$16,222.50" "$16,222.50" "$16,222.50" "$8,111.25" "$8,111.25" "$12,848.22" "$16,222.50" "$12,978.00" "$10,544.63" "$16,222.50" N/A "$9,409.05" "$16,222.50" "$9,733.50" "$16,222.50" "$16,222.50" "$16,222.50" N/A N/A 116.301 SUP Custom 27203010 116.301 - SPACER SPNL 0D 21MM S/MED 23X18MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$15,267.50" "$11,298.00" "$2,060.15" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$2,717.62" "$15,267.50" "$15,267.50" "$4,181.12" "$4,181.12" "$11,768.19" "$2,060.15" "$3,181.91" "$15,267.50" "$6,107.00" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$11,450.63" "$15,267.50" "$15,267.50" "$15,267.50" "$7,633.75" "$7,633.75" "$12,091.86" "$15,267.50" "$12,214.00" "$9,923.88" "$15,267.50" N/A "$8,855.15" "$15,267.50" "$9,160.50" "$15,267.50" "$15,267.50" "$15,267.50" N/A N/A 116.302 SUP Custom 27203010 116.302 - SPACER SPNL 0D 21MM S/MED 23X19MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$15,267.50" "$11,298.00" "$2,060.15" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$2,717.62" "$15,267.50" "$15,267.50" "$4,181.12" "$4,181.12" "$11,768.19" "$2,060.15" "$3,181.91" "$15,267.50" "$6,107.00" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$11,450.63" "$15,267.50" "$15,267.50" "$15,267.50" "$7,633.75" "$7,633.75" "$12,091.86" "$15,267.50" "$12,214.00" "$9,923.88" "$15,267.50" N/A "$8,855.15" "$15,267.50" "$9,160.50" "$15,267.50" "$15,267.50" "$15,267.50" N/A N/A 116.303 SUP Custom 27203010 116.303 - SPACER SPNL 0D 21MM S/MED 23X21MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$15,267.50" "$11,298.00" "$2,060.15" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$2,717.62" "$15,267.50" "$15,267.50" "$4,181.12" "$4,181.12" "$11,768.19" "$2,060.15" "$3,181.91" "$15,267.50" "$6,107.00" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$11,450.63" "$15,267.50" "$15,267.50" "$15,267.50" "$7,633.75" "$7,633.75" "$12,091.86" "$15,267.50" "$12,214.00" "$9,923.88" "$15,267.50" N/A "$8,855.15" "$15,267.50" "$9,160.50" "$15,267.50" "$15,267.50" "$15,267.50" N/A N/A 116.304 SUP Custom 27203010 116.304 - SPACER SPNL 0D 21MM S/MED 23X18MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$15,267.50" "$11,298.00" "$2,060.15" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$2,717.62" "$15,267.50" "$15,267.50" "$4,181.12" "$4,181.12" "$11,768.19" "$2,060.15" "$3,181.91" "$15,267.50" "$6,107.00" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$11,450.63" "$15,267.50" "$15,267.50" "$15,267.50" "$7,633.75" "$7,633.75" "$12,091.86" "$15,267.50" "$12,214.00" "$9,923.88" "$15,267.50" N/A "$8,855.15" "$15,267.50" "$9,160.50" "$15,267.50" "$15,267.50" "$15,267.50" N/A N/A 116.305 SUP Custom 27203010 116.305 - SPACER SPNL 0D 21MM S/MED 23X19MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$15,267.50" "$11,298.00" "$2,060.15" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$2,717.62" "$15,267.50" "$15,267.50" "$4,181.12" "$4,181.12" "$11,768.19" "$2,060.15" "$3,181.91" "$15,267.50" "$6,107.00" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$11,450.63" "$15,267.50" "$15,267.50" "$15,267.50" "$7,633.75" "$7,633.75" "$12,091.86" "$15,267.50" "$12,214.00" "$9,923.88" "$15,267.50" N/A "$8,855.15" "$15,267.50" "$9,160.50" "$15,267.50" "$15,267.50" "$15,267.50" N/A N/A 116.306 SUP Custom 27203010 116.306 - SPACER SPNL 0D 21MM S/MED 23X21MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$15,267.50" "$11,298.00" "$2,060.15" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$2,717.62" "$15,267.50" "$15,267.50" "$4,181.12" "$4,181.12" "$11,768.19" "$2,060.15" "$3,181.91" "$15,267.50" "$6,107.00" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$15,267.50" "$11,450.63" "$15,267.50" "$15,267.50" "$15,267.50" "$7,633.75" "$7,633.75" "$12,091.86" "$15,267.50" "$12,214.00" "$9,923.88" "$15,267.50" N/A "$8,855.15" "$15,267.50" "$9,160.50" "$15,267.50" "$15,267.50" "$15,267.50" N/A N/A 116.401 SUP Custom 27203010 116.401 - SPACER SPNL 0D 25MM MED LG 32X24MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$17,412.50" "$12,885.00" "$2,060.15" "$17,412.50" "$17,412.50" "$17,412.50" "$17,412.50" "$17,412.50" "$17,412.50" "$17,412.50" "$3,099.43" "$17,412.50" "$17,412.50" "$4,181.12" "$4,181.12" "$13,421.56" "$2,060.15" "$3,628.96" "$17,412.50" "$6,965.00" "$17,412.50" "$17,412.50" "$17,412.50" "$17,412.50" "$17,412.50" "$13,059.38" "$17,412.50" "$17,412.50" "$17,412.50" "$8,706.25" "$8,706.25" "$13,790.70" "$17,412.50" "$13,930.00" "$11,318.13" "$17,412.50" N/A "$10,099.25" "$17,412.50" "$10,447.50" "$17,412.50" "$17,412.50" "$17,412.50" N/A N/A 116.402 SUP Custom 27203010 116.402 - SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$17,412.50" "$12,885.00" "$2,060.15" "$17,412.50" "$17,412.50" "$17,412.50" "$17,412.50" "$17,412.50" "$17,412.50" "$17,412.50" "$3,099.43" "$17,412.50" "$17,412.50" "$4,181.12" "$4,181.12" "$13,421.56" "$2,060.15" "$3,628.96" "$17,412.50" "$6,965.00" "$17,412.50" "$17,412.50" "$17,412.50" "$17,412.50" "$17,412.50" "$13,059.38" "$17,412.50" "$17,412.50" "$17,412.50" "$8,706.25" "$8,706.25" "$13,790.70" "$17,412.50" "$13,930.00" "$11,318.13" "$17,412.50" N/A "$10,099.25" "$17,412.50" "$10,447.50" "$17,412.50" "$17,412.50" "$17,412.50" N/A N/A 116.403 SUP Custom 27203010 116.403 - SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$18,130.00" "$13,416.00" "$2,060.15" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$3,227.14" "$18,130.00" "$18,130.00" "$4,181.12" "$4,181.12" "$13,974.60" "$2,060.15" "$3,778.49" "$18,130.00" "$7,252.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$13,597.50" "$18,130.00" "$18,130.00" "$18,130.00" "$9,065.00" "$9,065.00" "$14,358.96" "$18,130.00" "$14,504.00" "$11,784.50" "$18,130.00" N/A "$10,515.40" "$18,130.00" "$10,878.00" "$18,130.00" "$18,130.00" "$18,130.00" N/A N/A 116.404 SUP Custom 27203010 116.404 - SPACER SPNL 0D 25MM MED LG 32X41MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$20,277.50" "$15,005.00" "$2,060.15" "$20,277.50" "$20,277.50" "$20,277.50" "$20,277.50" "$20,277.50" "$20,277.50" "$20,277.50" "$3,609.40" "$20,277.50" "$20,277.50" "$4,181.12" "$4,181.12" "$15,629.90" "$2,060.15" "$4,226.05" "$20,277.50" "$8,111.00" "$20,277.50" "$20,277.50" "$20,277.50" "$20,277.50" "$20,277.50" "$15,208.13" "$20,277.50" "$20,277.50" "$20,277.50" "$10,138.75" "$10,138.75" "$16,059.78" "$20,277.50" "$16,222.00" "$13,180.38" "$20,277.50" N/A "$11,760.95" "$20,277.50" "$12,166.50" "$20,277.50" "$20,277.50" "$20,277.50" N/A N/A 116.405 SUP Custom 27203010 116.405 - SPACER SPNL 0D 25MM MED LG 32X51MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$20,992.50" "$15,534.00" "$2,060.15" "$20,992.50" "$20,992.50" "$20,992.50" "$20,992.50" "$20,992.50" "$20,992.50" "$20,992.50" "$3,736.67" "$20,992.50" "$20,992.50" "$4,181.12" "$4,181.12" "$16,181.02" "$2,060.15" "$4,375.07" "$20,992.50" "$8,397.00" "$20,992.50" "$20,992.50" "$20,992.50" "$20,992.50" "$20,992.50" "$15,744.38" "$20,992.50" "$20,992.50" "$20,992.50" "$10,496.25" "$10,496.25" "$16,626.06" "$20,992.50" "$16,794.00" "$13,645.13" "$20,992.50" N/A "$12,175.65" "$20,992.50" "$12,595.50" "$20,992.50" "$20,992.50" "$20,992.50" N/A N/A 116.406 SUP Custom 27203010 116.406 - SPACER SPNL 0D 25MM MED LG 32X24MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$17,417.50" "$12,889.00" "$2,060.15" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$3,100.32" "$17,417.50" "$17,417.50" "$4,181.12" "$4,181.12" "$13,425.41" "$2,060.15" "$3,630.00" "$17,417.50" "$6,967.00" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$13,063.13" "$17,417.50" "$17,417.50" "$17,417.50" "$8,708.75" "$8,708.75" "$13,794.66" "$17,417.50" "$13,934.00" "$11,321.38" "$17,417.50" N/A "$10,102.15" "$17,417.50" "$10,450.50" "$17,417.50" "$17,417.50" "$17,417.50" N/A N/A 116.407 SUP Custom 27203010 116.407 - SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$17,417.50" "$12,889.00" "$2,060.15" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$3,100.32" "$17,417.50" "$17,417.50" "$4,181.12" "$4,181.12" "$13,425.41" "$2,060.15" "$3,630.00" "$17,417.50" "$6,967.00" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$13,063.13" "$17,417.50" "$17,417.50" "$17,417.50" "$8,708.75" "$8,708.75" "$13,794.66" "$17,417.50" "$13,934.00" "$11,321.38" "$17,417.50" N/A "$10,102.15" "$17,417.50" "$10,450.50" "$17,417.50" "$17,417.50" "$17,417.50" N/A N/A 116.408 SUP Custom 27203010 116.408 - SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$18,130.00" "$13,416.00" "$2,060.15" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$3,227.14" "$18,130.00" "$18,130.00" "$4,181.12" "$4,181.12" "$13,974.60" "$2,060.15" "$3,778.49" "$18,130.00" "$7,252.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$13,597.50" "$18,130.00" "$18,130.00" "$18,130.00" "$9,065.00" "$9,065.00" "$14,358.96" "$18,130.00" "$14,504.00" "$11,784.50" "$18,130.00" N/A "$10,515.40" "$18,130.00" "$10,878.00" "$18,130.00" "$18,130.00" "$18,130.00" N/A N/A 116.409 SUP Custom 27203010 116.409 - SPACER SPNL 0D 25MM MED LG 32X41MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$20,277.50" "$15,005.00" "$2,060.15" "$20,277.50" "$20,277.50" "$20,277.50" "$20,277.50" "$20,277.50" "$20,277.50" "$20,277.50" "$3,609.40" "$20,277.50" "$20,277.50" "$4,181.12" "$4,181.12" "$15,629.90" "$2,060.15" "$4,226.05" "$20,277.50" "$8,111.00" "$20,277.50" "$20,277.50" "$20,277.50" "$20,277.50" "$20,277.50" "$15,208.13" "$20,277.50" "$20,277.50" "$20,277.50" "$10,138.75" "$10,138.75" "$16,059.78" "$20,277.50" "$16,222.00" "$13,180.38" "$20,277.50" N/A "$11,760.95" "$20,277.50" "$12,166.50" "$20,277.50" "$20,277.50" "$20,277.50" N/A N/A 116.41 SUP Custom 27203010 116.410 - SPACER SPNL 0D 25MM MED LG 32X51MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$20,992.50" "$15,534.00" "$2,060.15" "$20,992.50" "$20,992.50" "$20,992.50" "$20,992.50" "$20,992.50" "$20,992.50" "$20,992.50" "$3,736.67" "$20,992.50" "$20,992.50" "$4,181.12" "$4,181.12" "$16,181.02" "$2,060.15" "$4,375.07" "$20,992.50" "$8,397.00" "$20,992.50" "$20,992.50" "$20,992.50" "$20,992.50" "$20,992.50" "$15,744.38" "$20,992.50" "$20,992.50" "$20,992.50" "$10,496.25" "$10,496.25" "$16,626.06" "$20,992.50" "$16,794.00" "$13,645.13" "$20,992.50" N/A "$12,175.65" "$20,992.50" "$12,595.50" "$20,992.50" "$20,992.50" "$20,992.50" N/A N/A 116.411 SUP Custom 27203010 116.411 - SPACER SPNL 0D 25MM MED LG 32X36MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$19,202.50" "$14,210.00" "$2,060.15" "$19,202.50" "$19,202.50" "$19,202.50" "$19,202.50" "$19,202.50" "$19,202.50" "$19,202.50" "$3,418.05" "$19,202.50" "$19,202.50" "$4,181.12" "$4,181.12" "$14,801.29" "$2,060.15" "$4,002.01" "$19,202.50" "$7,681.00" "$19,202.50" "$19,202.50" "$19,202.50" "$19,202.50" "$19,202.50" "$14,401.88" "$19,202.50" "$19,202.50" "$19,202.50" "$9,601.25" "$9,601.25" "$15,208.38" "$19,202.50" "$15,362.00" "$12,481.63" "$19,202.50" N/A "$11,137.45" "$19,202.50" "$11,521.50" "$19,202.50" "$19,202.50" "$19,202.50" N/A N/A 116.412 SUP Custom 27203010 116.412 - SPACER SPNL 0D 25MM MED LG 32X36MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$19,202.50" "$14,210.00" "$2,060.15" "$19,202.50" "$19,202.50" "$19,202.50" "$19,202.50" "$19,202.50" "$19,202.50" "$19,202.50" "$3,418.05" "$19,202.50" "$19,202.50" "$4,181.12" "$4,181.12" "$14,801.29" "$2,060.15" "$4,002.01" "$19,202.50" "$7,681.00" "$19,202.50" "$19,202.50" "$19,202.50" "$19,202.50" "$19,202.50" "$14,401.88" "$19,202.50" "$19,202.50" "$19,202.50" "$9,601.25" "$9,601.25" "$15,208.38" "$19,202.50" "$15,362.00" "$12,481.63" "$19,202.50" N/A "$11,137.45" "$19,202.50" "$11,521.50" "$19,202.50" "$19,202.50" "$19,202.50" N/A N/A 116.413 SUP Custom 27203010 116.413 - SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$17,417.50" "$12,889.00" "$2,060.15" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$3,100.32" "$17,417.50" "$17,417.50" "$4,181.12" "$4,181.12" "$13,425.41" "$2,060.15" "$3,630.00" "$17,417.50" "$6,967.00" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$13,063.13" "$17,417.50" "$17,417.50" "$17,417.50" "$8,708.75" "$8,708.75" "$13,794.66" "$17,417.50" "$13,934.00" "$11,321.38" "$17,417.50" N/A "$10,102.15" "$17,417.50" "$10,450.50" "$17,417.50" "$17,417.50" "$17,417.50" N/A N/A 116.414 SUP Custom 27203010 116.414 - SPACER SPNL 0D 25MM MED LG 32X26MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$17,417.50" "$12,889.00" "$2,060.15" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$3,100.32" "$17,417.50" "$17,417.50" "$4,181.12" "$4,181.12" "$13,425.41" "$2,060.15" "$3,630.00" "$17,417.50" "$6,967.00" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$17,417.50" "$13,063.13" "$17,417.50" "$17,417.50" "$17,417.50" "$8,708.75" "$8,708.75" "$13,794.66" "$17,417.50" "$13,934.00" "$11,321.38" "$17,417.50" N/A "$10,102.15" "$17,417.50" "$10,450.50" "$17,417.50" "$17,417.50" "$17,417.50" N/A N/A 116.415 SUP Custom 27203010 116.415 - SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$18,130.00" "$13,416.00" "$2,060.15" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$3,227.14" "$18,130.00" "$18,130.00" "$4,181.12" "$4,181.12" "$13,974.60" "$2,060.15" "$3,778.49" "$18,130.00" "$7,252.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$13,597.50" "$18,130.00" "$18,130.00" "$18,130.00" "$9,065.00" "$9,065.00" "$14,358.96" "$18,130.00" "$14,504.00" "$11,784.50" "$18,130.00" N/A "$10,515.40" "$18,130.00" "$10,878.00" "$18,130.00" "$18,130.00" "$18,130.00" N/A N/A 116.416 SUP Custom 27203010 116.416 - SPACER SPNL 0D 25MM MED LG 32X29MM NS LF XPAND SLF DSTRCT BOTH IP/OP "$18,130.00" "$13,416.00" "$2,060.15" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$3,227.14" "$18,130.00" "$18,130.00" "$4,181.12" "$4,181.12" "$13,974.60" "$2,060.15" "$3,778.49" "$18,130.00" "$7,252.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$18,130.00" "$13,597.50" "$18,130.00" "$18,130.00" "$18,130.00" "$9,065.00" "$9,065.00" "$14,358.96" "$18,130.00" "$14,504.00" "$11,784.50" "$18,130.00" N/A "$10,515.40" "$18,130.00" "$10,878.00" "$18,130.00" "$18,130.00" "$18,130.00" N/A N/A 117.112 SUP HCPCS C1713 "117.112 - ASSURE Translational Cervical Plate 1-Level, 12mm" BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 117.114 SUP HCPCS C1713 117.114 - PLATE BONE 14MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 117.116 SUP HCPCS C1713 117.116 - PLATE BONE 16MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 117.118 SUP HCPCS C1713 117.118 - PLATE BONE 18MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 117.12 SUP HCPCS C1713 117.120 - PLATE BONE 20MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 117.122 SUP HCPCS C1713 117.122 - PLATE BONE 22MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 117.124 SUP HCPCS C1713 117.124 - PLATE BONE 24MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 117.126 SUP HCPCS C1713 117.126 - PLATE BONE 26MM LEVEL 1 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 117.226 SUP HCPCS C1713 117.226 - PLATE BONE 26MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 117.228 SUP HCPCS C1713 117.228 - PLATE BONE 28MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 117.23 SUP HCPCS C1713 117.230 - PLATE BONE 30MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 117.232 SUP HCPCS C1713 117.232 - PLATE BONE 32MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 117.234 SUP HCPCS C1713 117.234 - PLATE BONE 34MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 117.236 SUP HCPCS C1713 117.236 - PLATE BONE 36MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 117.238 SUP HCPCS C1713 117.238 - PLATE BONE 38MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 117.24 SUP HCPCS C1713 117.240 - PLATE BONE 40MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 117.242 SUP HCPCS C1713 117.242 - PLATE BONE 42MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 117.244 SUP HCPCS C1713 117.244 - PLATE BONE 44MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 117.246 SUP HCPCS C1713 117.246 - PLATE BONE 46MM LEVEL 2 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 117.345 SUP HCPCS C1713 117.345 - PLATE BONE 45MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 117.348 SUP HCPCS C1713 117.348 - PLATE BONE 48MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 117.351 SUP HCPCS C1713 117.351 - PLATE BONE 51MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 117.354 SUP HCPCS C1713 117.354 - PLATE BONE 54MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 117.357 SUP HCPCS C1713 117.357 - PLATE BONE 57MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 117.36 SUP HCPCS C1713 117.360 - PLATE BN 60MM NS ASR LVL 3 TRANSLATIONAL SPNE CRV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 117.363 SUP HCPCS C1713 117.363 - PLATE BONE 63MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 117.366 SUP HCPCS C1713 117.366 - PLATE BONE 66MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 117.369 SUP HCPCS C1713 117.369 - PLATE BONE 69MM LEVEL 3 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 117.46 SUP HCPCS C1713 117.460 - PLATE BONE 60MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 117.464 SUP HCPCS C1713 117.464 - PLATE BONE 64MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 117.468 SUP HCPCS C1713 117.468 - PLATE BONE 68MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 117.472 SUP HCPCS C1713 117.472 - PLATE BONE 72MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 117.476 SUP HCPCS C1713 117.476 - PLATE BONE 76MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 117.48 SUP HCPCS C1713 117.480 - PLATE BONE 80MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 117.484 SUP HCPCS C1713 117.484 - PLATE BONE 84MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 117.488 SUP HCPCS C1713 117.488 - PLATE BONE 88MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 117.492 SUP HCPCS C1713 117.492 - PLATE BONE 92MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 117.496 SUP HCPCS C1713 117.496 - PLATE BONE 96MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 117.5 SUP HCPCS C1713 117.500 - PLATE BONE 100MM LEVEL 4 ASSURE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 124 SUP HCPCS C1713 124.000 - SCREW SET LOCKING NONTHREADED REVERE TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 124.001 SUP Custom 27803010 124.001 - ROD SPINAL 5.5MM 300MM STR REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.002 SUP Custom 27803010 124.002 - ROD SPINAL 5.5MM 400MM STR REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.003 SUP Custom 27803010 124.003 - ROD SPINAL 5.5MM 500MM STR REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.004 SUP Custom 27803010 124.004 - ROD SPINAL 5.5MM 300MM STR CP 2 BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.005 SUP Custom 27803010 124.005 - ROD SPINAL 5.5MM 400MM STR CP 2 BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.006 SUP Custom 27803010 124.006 - ROD SPINAL 5.5MM 500MM STR CP 2 BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.012 SUP Custom 27803010 124.012 - CONNECTOR ROD 24-25MM T LP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 124.013 SUP Custom 27803010 124.013 - CONNECTOR ROD 20-34MM T LP CROSSLINK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 124.014 SUP Custom 27803010 124.014 - CONNECTOR ROD 20MM-34MM TRNSVRS TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 124.051 SUP HCPCS C1713 124.051 - SCREW BONE 5MM 25MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.052 SUP HCPCS C1713 124.052 - SCREW BONE 5MM 30MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.053 SUP HCPCS C1713 124.053 - SCREW BONE 5MM 35MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.054 SUP HCPCS C1713 124.054 - SCREW BONE 5MM 40MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.055 SUP HCPCS C1713 124.055 - SCREW BONE 5MM 45MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.056 SUP HCPCS C1713 124.056 - SCREW BONE 5MM 50MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.057 SUP HCPCS C1713 124.057 - SCREW BONE 5MM 55MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.071 SUP HCPCS C1713 124.071 - SCREW BONE 7.5MM 70MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.072 SUP HCPCS C1713 124.072 - SCREW BONE 7.5MM 75MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.073 SUP HCPCS C1713 124.073 - SCREW BONE 7.5MM 80MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.074 SUP HCPCS C1713 124.074 - SCREW BONE 7.5MM 85MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.075 SUP HCPCS C1713 124.075 - SCREW BONE 7.5MM 90MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.081 SUP HCPCS C1713 124.081 - SCREW BONE 8.5MM 70MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.082 SUP HCPCS C1713 124.082 - SCREW BONE 8.5MM 75MM REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.083 SUP HCPCS C1713 124.083 - SCREW BONE 8.5MM 80MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.084 SUP HCPCS C1713 124.084 - SCREW BONE 8.5MM 85MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.085 SUP HCPCS C1713 124.085 - SCREW BONE 8.5MM 90MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.111 SUP HCPCS C1713 124.111 - SCREW BONE 5.5MM 27MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.112 SUP HCPCS C1713 124.112 - SCREW BONE 5.5MM 32MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.113 SUP HCPCS C1713 124.113 - SCREW BONE 5.5MM 37MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.114 SUP HCPCS C1713 124.114 - SCREW BONE 5.5MM 42MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.115 SUP HCPCS C1713 124.115 - SCREW BONE 5.5MM 47MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.121 SUP HCPCS C1713 124.121 - SCREW BONE 6.5MM 27MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.122 SUP HCPCS C1713 124.122 - SCREW BONE 6.5MM 32MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.123 SUP HCPCS C1713 124.123 - SCREW BONE 6.5MM 37MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.124 SUP HCPCS C1713 124.124 - SCREW BONE 6.5MM 42MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.125 SUP HCPCS C1713 124.125 - SCREW BONE 6.5MM 47MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.131 SUP HCPCS C1713 124.131 - SCREW BONE 7.5MM 27MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.132 SUP HCPCS C1713 124.132 - SCREW BONE 7.5MM 32MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.133 SUP HCPCS C1713 124.133 - SCREW BONE 7.5MM 37MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.134 SUP HCPCS C1713 124.134 - SCREW BONE 7.5MM 42MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.135 SUP HCPCS C1713 124.135 - SCREW BONE 7.5MM 47MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.171 SUP HCPCS C1713 124.171 - SCREW BONE 6.5MM 75MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.172 SUP HCPCS C1713 124.172 - SCREW BONE 6.5MM 80MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.173 SUP HCPCS C1713 124.173 - SCREW BONE 6.5MM 85MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.174 SUP HCPCS C1713 124.174 - SCREW BONE MEDIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.175 SUP HCPCS C1713 124.175 - SCREW BONE 6.5MM 95MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.176 SUP HCPCS C1713 124.176 - SCREW BONE 6.5MM 100MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.181 SUP HCPCS C1713 124.181 - SCREW BONE 7MM 75MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.182 SUP HCPCS C1713 124.182 - SCREW BONE 7MM 80MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.183 SUP HCPCS C1713 124.183 - SCREW BONE 7MM 85MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.184 SUP HCPCS C1713 124.184 - SCREW BONE 7MM 90MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.185 SUP HCPCS C1713 124.185 - SCREW BONE 7MM 95MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.186 SUP HCPCS C1713 124.186 - SCREW BONE 7MM 100MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.2 SUP HCPCS C1713 124.200 - SCREW BONE 4MM 20MM MULTIAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.201 SUP HCPCS C1713 124.201 - SCREW BONE 4MM 25MM MNOAX REVERE SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.202 SUP HCPCS C1713 124.202 - SCREW BONE 4MM 30MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.203 SUP HCPCS C1713 124.203 - SCREW BONE 4MM 35MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.204 SUP HCPCS C1713 124.204 - SCREW BONE 4MM 40MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.241 SUP HCPCS C1713 124.241 - SCREW BONE 4.5MM 25MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.242 SUP HCPCS C1713 124.242 - SCREW BONE 4.5MM 30MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.243 SUP HCPCS C1713 124.243 - SCREW BONE 4.5MM 35MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.244 SUP HCPCS C1713 124.244 - SCREW BONE 4.5MM 40MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.245 SUP HCPCS C1713 124.245 - SCREW BONE 4.5MM 45MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.251 SUP HCPCS C1713 124.251 - SCREW BONE 5.5MM 25MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.252 SUP HCPCS C1713 124.252 - SCREW BONE 5.5MM 30MM MNOAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.253 SUP HCPCS C1713 124.253 - SCREW BONE 5.5MM 35MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.254 SUP HCPCS C1713 124.254 - SCREW BONE 5.5MM 40MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.255 SUP HCPCS C1713 124.255 - SCREW BONE 5.5MM 45MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.256 SUP HCPCS C1713 124.256 - SCREW BONE 5.5MM 50MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.257 SUP HCPCS C1713 124.257 - SCREW BONE 5.5MM 55MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.258 SUP HCPCS C1713 124.258 - SCREW BONE 5.5MM 60MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.259 SUP HCPCS C1713 124.259 - SCREW BONE 5.5MM 65MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.261 SUP HCPCS C1713 124.261 - SCREW BONE 6.5MM 25MM MNOAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.262 SUP HCPCS C1713 124.262 - SCREW BONE 6.5MM 30MM MNOAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.263 SUP HCPCS C1713 124.263 - SCREW BONE 6.5MM 35MM MNOAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.264 SUP HCPCS C1713 124.264 - SCREW BONE 6.5MM 40MM MNOAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.265 SUP HCPCS C1713 124.265 - SCREW BONE 6.5MM 45MM MNOAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.266 SUP HCPCS C1713 124.266 - SCREW BONE 6.5MM 50MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.267 SUP HCPCS C1713 124.267 - SCREW BONE 6.5MM 55MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.268 SUP HCPCS C1713 124.268 - SCREW BONE 6.5MM 60MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.269 SUP HCPCS C1713 124.269 - SCREW BONE 6.5MM 65MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.271 SUP HCPCS C1713 124.271 - SCREW BONE 7.5MM 25MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.272 SUP HCPCS C1713 124.272 - SCREW BONE 7.5MM 30MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.273 SUP HCPCS C1713 124.273 - SCREW BONE 7.5MM 35MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.274 SUP HCPCS C1713 124.274 - SCREW BONE 7.5MM 40MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.275 SUP HCPCS C1713 124.275 - SCREW BONE 7.5MM 45MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.276 SUP HCPCS C1713 124.276 - SCREW BONE 7.5MM 50MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.277 SUP HCPCS C1713 124.277 - SCREW BONE 7.5MM 55MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.278 SUP HCPCS C1713 124.278 - SCREW BONE 7.5MM 60MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.279 SUP HCPCS C1713 124.279 - SCREW BONE 7.5MM 65MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.281 SUP HCPCS C1713 124.281 - SCREW BONE 8.5MM 25MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.282 SUP HCPCS C1713 124.282 - SCREW BONE 8.5MM 30MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.283 SUP HCPCS C1713 124.283 - SCREW BONE 8.5MM 35MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.284 SUP HCPCS C1713 124.284 - SCREW BONE 8.5MM 40MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.285 SUP HCPCS C1713 124.285 - SCREW BONE 8.5MM 45MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.286 SUP HCPCS C1713 124.286 - SCREW BONE 8.5MM 50MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.287 SUP HCPCS C1713 124.287 - SCREW BONE 8.5MM 55MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.288 SUP HCPCS C1713 124.288 - SCREW BONE 8.5MM 60MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.289 SUP HCPCS C1713 124.289 - SCREW BONE 8.5MM 65MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.351 SUP HCPCS C1713 124.351 - SCREW BONE 5.5MM 25MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.352 SUP HCPCS C1713 124.352 - SCREW BONE 5.5MM 30MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.353 SUP HCPCS C1713 124.353 - SCREW BONE 5.5MM 35MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.354 SUP HCPCS C1713 124.354 - SCREW BONE 5.5MM 40MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.355 SUP HCPCS C1713 124.355 - SCREW BONE 5.5MM 45MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.356 SUP HCPCS C1713 124.356 - SCREW BONE 5.5MM 50MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.357 SUP HCPCS C1713 124.357 - SCREW BONE 5.5MM 55MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.361 SUP HCPCS C1713 124.361 - SCREW BONE 6.5MM 25MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.362 SUP HCPCS C1713 124.362 - SCREW BONE 6.5MM 30MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.363 SUP HCPCS C1713 124.363 - SCREW BONE 6.5MM 35MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.364 SUP HCPCS C1713 124.364 - SCREW BONE 6.5MM 40MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.365 SUP HCPCS C1713 124.365 - SCREW BONE 6.5MM 45MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.366 SUP HCPCS C1713 124.366 - SCREW BONE 6.5MM 50MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.367 SUP HCPCS C1713 124.367 - SCREW BONE 6.5MM 55MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.368 SUP HCPCS C1713 124.368 - SCREW BONE 6.5MM 60MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.369 SUP HCPCS C1713 124.369 - SCREW BONE 6.5MM 65MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.371 SUP HCPCS C1713 124.371 - SCREW BONE 7.5MM 25MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.372 SUP HCPCS C1713 124.372 - SCREW BONE 7.5MM 30MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.373 SUP HCPCS C1713 124.373 - SCREW BONE 7.5MM 35MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.374 SUP HCPCS C1713 124.374 - SCREW BONE 7.5MM 40MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.375 SUP HCPCS C1713 124.375 - SCREW BONE 7.5MM 45MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.376 SUP HCPCS C1713 124.376 - SCREW BONE 7.5MM 50MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.377 SUP HCPCS C1713 124.377 - SCREW BONE 7.5MM 55MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.378 SUP HCPCS C1713 124.378 - SCREW BONE 7.5MM 60MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.379 SUP HCPCS C1713 124.379 - SCREW BONE 7.5MM 65MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.381 SUP HCPCS C1713 124.381 - SCREW BONE 8.5MM 25MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.382 SUP HCPCS C1713 124.382 - SCREW BONE 8.5MM 30MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.383 SUP HCPCS C1713 124.383 - SCREW BONE 8.5MM 35MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.384 SUP HCPCS C1713 124.384 - SCREW BONE 8.5MM 40MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.385 SUP HCPCS C1713 124.385 - SCREW BONE 8.5MM 45MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.386 SUP HCPCS C1713 124.386 - SCREW BONE 8.5MM 50MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.387 SUP HCPCS C1713 124.387 - SCREW BONE 8.5MM 55MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.388 SUP HCPCS C1713 124.388 - SCREW BONE 8.5MM 60MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.389 SUP HCPCS C1713 124.389 - SCREW BONE 8.5MM 65MM POLYAX CANN REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.441 SUP HCPCS C1713 124.441 - SCREW BONE 4.5MM 25MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.442 SUP HCPCS C1713 124.442 - SCREW BONE 4.5MM 30MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.443 SUP HCPCS C1713 124.443 - SCREW BONE 4.5MM 35MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.444 SUP HCPCS C1713 124.444 - SCREW BONE 4.5MM 40MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.445 SUP HCPCS C1713 124.445 - SCREW BONE 4.5MM 45MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.451 SUP HCPCS C1713 124.451 - SCREW BONE 5.5MM 25MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.452 SUP HCPCS C1713 124.452 - SCREW BONE 5.5MM 30MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.453 SUP HCPCS C1713 124.453 - SCREW BONE 5.5MM 35MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.454 SUP HCPCS C1713 124.454 - SCREW BONE 5.5MM 40MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.455 SUP HCPCS C1713 124.455 - SCREW BONE 5.5MM 45MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.456 SUP HCPCS C1713 124.456 - SCREW BONE 5.5MM 56MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.457 SUP HCPCS C1713 124.457 - SCREW BONE 5.5MM 55MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.461 SUP HCPCS C1713 124.461 - SCREW BONE 6.5MM 25MM REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.462 SUP HCPCS C1713 124.462 - SCREW BONE 6.5MM 30MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.463 SUP HCPCS C1713 124.463 - SCREW BONE 6.5MM 35MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.464 SUP HCPCS C1713 124.464 - SCREW BONE 6.5MM 40MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.465 SUP HCPCS C1713 124.465 - SCREW BONE 6.5MM 45MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.466 SUP HCPCS C1713 124.466 - SCREW BONE 6.5MM 50MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.467 SUP HCPCS C1713 124.467 - SCREW BONE 6.5MM 55MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.468 SUP HCPCS C1713 124.468 - SCREW BONE 6.5MM 60MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.469 SUP HCPCS C1713 124.469 - SCREW BONE 6.5MM 65MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.471 SUP HCPCS C1713 124.471 - SCREW BONE 7.5MM 25MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.472 SUP HCPCS C1713 124.472 - SCREW BONE 7.5MM 30MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.473 SUP HCPCS C1713 124.473 - SCREW BONE 7.5MM 35MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.474 SUP HCPCS C1713 124.474 - SCREW BONE 7.5MM 40MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.475 SUP HCPCS C1713 124.475 - SCREW BONE 7.5MM 45MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.476 SUP HCPCS C1713 124.476 - SCREW BONE 7.5MM 50MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.477 SUP HCPCS C1713 124.477 - SCREW BONE 7.5MM 55MM REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.478 SUP HCPCS C1713 124.478 - SCREW BONE 7.5MM 60MM REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.479 SUP HCPCS C1713 124.479 - SCREW BONE 7.5MM 65MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.481 SUP HCPCS C1713 124.481 - SCREW BONE 8.5MM 25MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.482 SUP HCPCS C1713 124.482 - SCREW BONE 8.5MM 30MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.483 SUP HCPCS C1713 124.483 - SCREW BONE 8.5MM 35MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.484 SUP HCPCS C1713 124.484 - SCREW BONE 8.5MM 40MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.485 SUP HCPCS C1713 124.485 - SCREW BONE 8.5MM 45MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.486 SUP HCPCS C1713 124.486 - SCREW BONE 8.5MM 50MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.487 SUP HCPCS C1713 124.487 - SCREW BONE 8.5MM 55MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.488 SUP HCPCS C1713 124.488 - SCREW BONE 8.5MM 60MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.489 SUP HCPCS C1713 124.489 - SCREW BONE 8.5MM 65MM POLYAX REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.51 SUP Custom 27803010 124.510 - ROD SPINAL 5.5MM 100MM STR REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.512 SUP Custom 27803010 124.512 - ROD SPINAL 5.5MM 125MM STR REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.515 SUP Custom 27803010 124.515 - ROD SPINAL 5.5MM 150MM STR REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.517 SUP Custom 27803010 124.517 - ROD SPINAL 5.5MM 200MM STR REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.519 SUP Custom 27803010 124.519 - ROD SPINAL 5.5MM 350MM STR REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.52 SUP Custom 27803010 124.520 - ROD SPINAL 5.5MM 400MM STR REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.521 SUP Custom 27803010 124.521 - ROD SPINAL 5.5MM 450MM STR REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.53 SUP Custom 27803010 124.530 - ROD SPINAL 5.5MM 30MM STR REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.535 SUP Custom 27803010 124.535 - ROD SPINAL 5.5MM 35MM STR REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.54 SUP Custom 27803010 124.540 - ROD SPINAL 5.5MM 40MM STR REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.545 SUP Custom 27803010 124.545 - ROD SPINAL 5.5MM 45MM STR REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.55 SUP Custom 27803010 124.550 - ROD SPINAL 5.5MM 50MM STR REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.555 SUP Custom 27803010 124.555 - ROD SPINAL 5.5MM 55MM STR REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.56 SUP Custom 27803010 124.560 - ROD SPINAL 5.5MM 60MM STR REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.565 SUP Custom 27803010 124.565 - ROD SPINAL STR 5.5MM 65MM REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.57 SUP Custom 27803010 124.570 - ROD SPINAL 5.5MM 70MM STR REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.575 SUP Custom 27803010 124.575 - ROD SPINAL 5.5MM 75MM STR REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.58 SUP Custom 27803010 124.580 - ROD SPINAL 5.5MM 80MM STR REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.585 SUP Custom 27803010 124.585 - ROD SPINAL 5.5MM 85MM STR REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.61 SUP Custom 27803010 124.610 - ROD SPINAL 5.5MM 100MM CVD REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.612 SUP Custom 27803010 124.612 - ROD SPINAL 5.5MM 125MM CVD REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.615 SUP Custom 27803010 124.615 - ROD SPINAL 5.5MM 150MM CVD REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.635 SUP Custom 27803010 124.635 - ROD SPINAL 5.5MM 35MM CVD REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.64 SUP Custom 27803010 124.640 - ROD SPINAL CURVE 5.5MM 40MM REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.645 SUP Custom 27803010 124.645 - ROD SPINAL 5.5MM 45MM CVD REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.65 SUP Custom 27803010 124.650 - ROD SPINAL CURVE 5.5MM 50MM REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.655 SUP Custom 27803010 124.655 - ROD SPINAL 5.5MM 55MM CVD REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.66 SUP Custom 27803010 124.660 - ROD SPINAL CURVE 5.5MM 60MM REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.665 SUP Custom 27803010 124.665 - ROD SPINAL 5.5MM 65MM CVD REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.67 SUP Custom 27803010 124.670 - ROD SPINAL 5.5MM 70MM CVD REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.675 SUP Custom 27803010 124.675 - ROD SPINAL 5.5MM 75MM CVD REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.68 SUP Custom 27803010 124.680 - ROD SPINAL 5.5MM 80MM CVD REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.685 SUP Custom 27803010 124.685 - ROD SPINAL 5.5MM 85MM CVD REVERE TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.69 SUP Custom 27803010 124.690 - ROD SPINAL 5.5MM 90MM CVD REVERE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.695 SUP Custom 27803010 124.695 - ROD SPINAL 5.5MM 95MM CVD TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 124.751 SUP HCPCS C1713 124.751 - SCREW BONE REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.752 SUP HCPCS C1713 124.752 - SCREW BONE 52MM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.753 SUP HCPCS C1713 124.753 - SCREW BONE 5.5MM 40MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.754 SUP HCPCS C1713 124.754 - SCREW BONE 5.5MM 45MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.755 SUP HCPCS C1713 124.755 - SCREW BONE 5.5MM 50MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.756 SUP HCPCS C1713 124.756 - SCREW BONE 5.5MM 55MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.757 SUP HCPCS C1713 124.757 - SCREW BONE 5.5MM 60MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.758 SUP HCPCS C1713 124.758 - SCREW BONE 5.5MM 65MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.761 SUP HCPCS C1713 124.761 - SCREW BONE 6MM 30MM 2 CORE POLYAX SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.762 SUP HCPCS C1713 124.762 - SCREW BONE 6/7.5MM 35MM REVERE TITANIUM SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.763 SUP HCPCS C1713 124.763 - SCREW BONE 6/7.5MM 40MM TITANIUM SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.764 SUP HCPCS C1713 124.764 - SCREW BONE 6/7.5MM 45MM TITANIUM SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.765 SUP HCPCS C1713 124.765 - SCREW BONE 6MM 50MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.766 SUP HCPCS C1713 124.766 - SCREW BONE 6MM 55MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.767 SUP HCPCS C1713 124.767 - SCREW BONE 6MM 60MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.768 SUP HCPCS C1713 124.768 - SCREW BONE 6MM 65MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.771 SUP HCPCS C1713 124.771 - SCREW BONE MEDIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.772 SUP HCPCS C1713 124.772 - SCREW BONE 6.5MM 8MM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.773 SUP HCPCS C1713 124.773 - SCREW BONE 4/6.5/8MM REVERE TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.774 SUP HCPCS C1713 124.774 - SCREW BONE 8MM 45MM TITANIUM SPN RIGHT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.775 SUP HCPCS C1713 124.775 - SCREW BONE 6.5MM 35MM 8MM DOD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.776 SUP HCPCS C1713 124.776 - 6.5mm REVERE Dual Outer Diameter Polyaxial Screw 55mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.777 SUP HCPCS C1713 124.777 - SCREW BONE 6.5MM 60MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.778 SUP HCPCS C1713 124.778 - SCREW BONE 6.5MM 65MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.779 SUP HCPCS C1713 124.779 - SCREW BONE 6.5MM 70MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.781 SUP HCPCS C1713 124.781 - SCREW BONE 7MM 30MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.782 SUP HCPCS C1713 124.782 - 7.0mm REVERE Dual Outer Diameter Polyaxial Screw 35mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.783 SUP HCPCS C1713 124.783 - SCREW BONE 7/8.5MM 40MM TITANIUM SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.784 SUP HCPCS C1713 124.784 - SCREW BONE MEDIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.785 SUP HCPCS C1713 124.785 - SCREW BN 7MM 50MM NS REVERE 2 DIA PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.786 SUP HCPCS C1713 124.786 - SCREW BONE 7MM 55MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.787 SUP HCPCS C1713 124.787 - SCREW BONE 7MM 60MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.788 SUP HCPCS C1713 124.788 - SCREW BONE 7MM 65MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.789 SUP HCPCS C1713 124.789 - SCREW BONE 7MM 70MM 2 DIAMETER POLYAX REVERE TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 124.851 SUP HCPCS C1713 124.851 - SCREW BONE 5MM 25MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.852 SUP HCPCS C1713 124.852 - SCREW BONE 5MM 30MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.853 SUP HCPCS C1713 124.853 - SCREW BONE 5MM 35MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.854 SUP HCPCS C1713 124.854 - SCREW BONE 5MM 40MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.855 SUP HCPCS C1713 124.855 - SCREW BONE 5MM 45MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.856 SUP HCPCS C1713 124.856 - SCREW BONE 5MM 50MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.857 SUP HCPCS C1713 124.857 - SCREW BONE 5MM 55MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.871 SUP HCPCS C1713 124.871 - SCREW BONE 7.5MM 70MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.872 SUP HCPCS C1713 124.872 - SCREW BONE 7.5MM 70MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.873 SUP HCPCS C1713 124.873 - SCREW BONE 7.5MM 80MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.874 SUP HCPCS C1713 124.874 - SCREW BONE 7.5MM 85MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.875 SUP HCPCS C1713 124.875 - SCREW BONE 7.5MM 90MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.881 SUP HCPCS C1713 124.881 - SCREW BONE 8.5MM 70MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.882 SUP HCPCS C1713 124.882 - SCREW BONE 8.5MM 75MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.883 SUP HCPCS C1713 124.883 - SCREW BONE 8.5MM 80MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.884 SUP HCPCS C1713 124.884 - SCREW BONE 8.5MM 85MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.885 SUP HCPCS C1713 124.885 - SCREW BONE 8.5MM 90MM MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 124.891 SUP Custom 27803010 124.891 - HOOK SPINAL LP REVERE PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.892 SUP Custom 27803010 124.892 - HOOK SPINAL LP REVERE PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.893 SUP Custom 27803010 124.893 - HOOK SPINAL LP REVERE PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.901 SUP Custom 27803010 124.901 - HOOK SPINAL SMALL NARROW BLADE REVERE LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.902 SUP Custom 27803010 124.902 - HOOK SPINAL MEDIUM NARROW BLADE REVERE LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.904 SUP Custom 27803010 124.904 - HOOK SPINAL SMALL REVERE LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.905 SUP Custom 27803010 124.905 - HOOK SPINAL MEDIUM REVERE LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.907 SUP Custom 27803010 124.907 - HOOK SPINAL MEDIUM REVERE LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.908 SUP Custom 27803010 124.908 - HOOK SPINAL LARGE REVERE LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.912 SUP Custom 27803010 124.912 - CONNECTOR ROD 29-33MM TRNSVRS ADJUSTABLE REVERE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 124.913 SUP Custom 27803010 124.913 - CONNECTOR ROD 33-41MM TRNSVRS ADJUSTABLE REVERE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 124.914 SUP Custom 27803010 124.914 - CONNECTOR ROD 38-51MM TRNSVRS ADJUSTABLE REVERE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 124.915 SUP Custom 27803010 124.915 - CONNECTOR ROD 48-68MM TRNSVRS ADJUSTABLE REVERE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 124.916 SUP Custom 27803010 124.916 - CONNECTOR ROD 58-71MM TRNSVRS ADJUSTABLE REVERE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 124.917 SUP Custom 27803010 124.917 - CONNECTOR ROD 68-81MM TRNSVRS ADJUSTABLE REVERE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 124.918 SUP Custom 27803010 124.918 - CONNECTOR ROD 78-91MM TRNSVRS ADJUSTABLE REVERE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 124.921 SUP Custom 27803010 124.921 - HOOK SPINAL RIGHT OFFST REVERE LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.922 SUP Custom 27803010 124.922 - HOOK SPINAL LEFT OFFST REVERE LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.924 SUP Custom 27803010 124.924 - HOOK SPINAL RIGHT OPENING TIP REVERE LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.925 SUP Custom 27803010 124.925 - HOOK SPINAL LEFT OPENING TRNSVRS PROCESS REVERE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.927 SUP Custom 27803010 124.927 - HOOK SPINAL SMALL REVERE PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.928 SUP Custom 27803010 124.928 - HOOK SPINAL MEDIUM REVERE PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.929 SUP Custom 27803010 124.929 - HOOK SPINAL LARGE REVERE PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.931 SUP Custom 27803010 124.931 - HOOK SPINAL SMALL TRNSVRS REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.932 SUP Custom 27803010 124.932 - HOOK SPINAL MEDIUM TRNSVRS REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.933 SUP Custom 27803010 124.933 - HOOK SPINAL LARGE TRNSVRS REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.935 SUP Custom 27803010 124.935 - HOOK SPINAL SMALL TRNSVRS REVERE PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.936 SUP Custom 27803010 124.936 - HOOK SPINAL MEDIUM TRNSVRS REVERE PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.937 SUP Custom 27803010 124.937 - HOOK SPINAL LARGE TRNSVRS REVERE PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.94 SUP Custom 27803010 124.940 - HOOK SPINAL SMALL NARROW BLADE REVERE TITANIUM LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.941 SUP Custom 27803010 124.941 - HOOK SPINAL MEDIUM NARROW BLADE REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.942 SUP Custom 27803010 124.942 - HOOK SPINAL LARGE NARROW BLADE REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.944 SUP Custom 27803010 124.944 - HOOK SPINAL SMALL REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.945 SUP Custom 27803010 124.945 - HOOK SPINAL MEDIUM REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.946 SUP Custom 27803010 124.946 - HOOK SPINAL LARGE REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.948 SUP Custom 27803010 124.948 - HOOK SPINAL SMALL WIDE BLADE REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.949 SUP Custom 27803010 124.949 - HOOK SPINAL MEDIUM WIDE BLADE REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.95 SUP Custom 27803010 124.950 - HOOK SPINAL LARGE WIDE BLADE REVERE TITANIUM LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.952 SUP Custom 27803010 124.952 - HOOK SPINAL SMALL TALL BODY REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.953 SUP Custom 27803010 124.953 - HOOK SPINAL MEDIUM TALL BODY REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.954 SUP Custom 27803010 124.954 - HOOK SPINAL LARGE TALL BODY REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.955 SUP Custom 27803010 124.955 - HOOK SPINAL SMALL ANGLED REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.956 SUP Custom 27803010 124.956 - HOOK SPINAL MEDIUM ANGLED REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.957 SUP Custom 27803010 124.957 - HOOK SPINAL LARGE ANGLED REVERE LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 124.96 SUP Custom 27803010 124.960 - CONNECTOR ROD 5.5/5.5MM TITANIUM SPN BOTH IP/OP "$1,272.50" $942.00 $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $265.20 "$1,272.50" $509.00 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $954.38 "$1,272.50" "$1,272.50" "$1,272.50" $636.25 $636.25 "$1,007.82" "$1,272.50" "$1,018.00" $572.63 "$1,272.50" N/A $738.05 "$1,272.50" $763.50 "$1,272.50" "$1,272.50" "$1,272.50" N/A N/A 124.961 SUP Custom 27803010 124.961 - CONNECTOR ROD 5.5/5.5MM WIDE BLADE PARALLEL SPN CLMP BOTH IP/OP "$1,272.50" $942.00 $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $265.20 "$1,272.50" $509.00 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $954.38 "$1,272.50" "$1,272.50" "$1,272.50" $636.25 $636.25 "$1,007.82" "$1,272.50" "$1,018.00" $572.63 "$1,272.50" N/A $738.05 "$1,272.50" $763.50 "$1,272.50" "$1,272.50" "$1,272.50" N/A N/A 124.962 SUP Custom 27803010 124.962 - CONNECTOR ROD 5.5MM CLMP SPN BOTH IP/OP "$1,287.50" $953.00 $229.18 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $229.18 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $268.33 "$1,287.50" $515.00 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $965.63 "$1,287.50" "$1,287.50" "$1,287.50" $643.75 $643.75 "$1,019.70" "$1,287.50" "$1,030.00" $579.38 "$1,287.50" N/A $746.75 "$1,287.50" $772.50 "$1,287.50" "$1,287.50" "$1,287.50" N/A N/A 124.963 SUP Custom 27803010 124.963 - CONNECTOR ROD 5.5/5.5MM WIDE BLADE SPN CLMP BOTH IP/OP "$1,287.50" $953.00 $229.18 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $229.18 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $268.33 "$1,287.50" $515.00 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $965.63 "$1,287.50" "$1,287.50" "$1,287.50" $643.75 $643.75 "$1,019.70" "$1,287.50" "$1,030.00" $579.38 "$1,287.50" N/A $746.75 "$1,287.50" $772.50 "$1,287.50" "$1,287.50" "$1,287.50" N/A N/A 124.964 SUP Custom 27803010 124.964 - CONNECTOR ROD 5.5/5.5MM ADJUSTABLE TRNSVRS BUTTRESSED SPN BOTH IP/OP "$1,287.50" $953.00 $229.18 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $229.18 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $268.33 "$1,287.50" $515.00 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $965.63 "$1,287.50" "$1,287.50" "$1,287.50" $643.75 $643.75 "$1,019.70" "$1,287.50" "$1,030.00" $579.38 "$1,287.50" N/A $746.75 "$1,287.50" $772.50 "$1,287.50" "$1,287.50" "$1,287.50" N/A N/A 124.965 SUP Custom 27803010 124.965 - CONNECTOR ROD 5.5MM WIDE BLADE PARALLEL CLMP SPN BOTH IP/OP "$1,287.50" $953.00 $229.18 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $229.18 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $268.33 "$1,287.50" $515.00 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $965.63 "$1,287.50" "$1,287.50" "$1,287.50" $643.75 $643.75 "$1,019.70" "$1,287.50" "$1,030.00" $579.38 "$1,287.50" N/A $746.75 "$1,287.50" $772.50 "$1,287.50" "$1,287.50" "$1,287.50" N/A N/A 124.97 SUP Custom 27803010 124.970 - CONNECTOR ROD 5.5MM 15MM TITANIUM SPN BOTH IP/OP "$1,145.00" $847.00 $203.81 "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" $203.81 "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" $238.63 "$1,145.00" $458.00 "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" $858.75 "$1,145.00" "$1,145.00" "$1,145.00" $572.50 $572.50 $906.84 "$1,145.00" $916.00 $515.25 "$1,145.00" N/A $664.10 "$1,145.00" $687.00 "$1,145.00" "$1,145.00" "$1,145.00" N/A N/A 124.971 SUP Custom 27803010 124.971 - CONNECTOR ROD 20MM SPN LATERAL BOTH IP/OP "$1,145.00" $847.00 $203.81 "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" $203.81 "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" $238.63 "$1,145.00" $458.00 "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" $858.75 "$1,145.00" "$1,145.00" "$1,145.00" $572.50 $572.50 $906.84 "$1,145.00" $916.00 $515.25 "$1,145.00" N/A $664.10 "$1,145.00" $687.00 "$1,145.00" "$1,145.00" "$1,145.00" N/A N/A 124.972 SUP Custom 27803010 124.972 - CONNECTOR ROD 25MM SPN LATERAL BOTH IP/OP "$1,145.00" $847.00 $203.81 "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" $203.81 "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" $238.63 "$1,145.00" $458.00 "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" "$1,145.00" $858.75 "$1,145.00" "$1,145.00" "$1,145.00" $572.50 $572.50 $906.84 "$1,145.00" $916.00 $515.25 "$1,145.00" N/A $664.10 "$1,145.00" $687.00 "$1,145.00" "$1,145.00" "$1,145.00" N/A N/A 124.973 SUP Custom 27803010 124.973 - CLAMP SPINAL 5.5MM 100MM ROD BOTH IP/OP "$1,362.50" "$1,008.00" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" $545.00 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 "$1,362.50" N/A $790.25 "$1,362.50" $817.50 "$1,362.50" "$1,362.50" "$1,362.50" N/A N/A 124.974 SUP Custom 27803010 124.974 - CLAMP SPINAL 120MM ADJUSTABLE TRNSVRS BUTTRESSED SPN 5.5MM BOTH IP/OP "$1,362.50" "$1,008.00" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" $545.00 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 "$1,362.50" N/A $790.25 "$1,362.50" $817.50 "$1,362.50" "$1,362.50" "$1,362.50" N/A N/A 124.975 SUP Custom 27803010 124.975 - CLAMP SPINAL 150MM 5.5MM ROD BOTH IP/OP "$1,362.50" "$1,008.00" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" $545.00 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 "$1,362.50" N/A $790.25 "$1,362.50" $817.50 "$1,362.50" "$1,362.50" "$1,362.50" N/A N/A 124.976 SUP Custom 27803010 124.976 - CONNECTOR ROD 5.5MM 30MM OFFST SPN BOTH IP/OP "$1,287.50" $953.00 $229.18 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $229.18 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $268.33 "$1,287.50" $515.00 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $965.63 "$1,287.50" "$1,287.50" "$1,287.50" $643.75 $643.75 "$1,019.70" "$1,287.50" "$1,030.00" $579.38 "$1,287.50" N/A $746.75 "$1,287.50" $772.50 "$1,287.50" "$1,287.50" "$1,287.50" N/A N/A 124.977 SUP Custom 27803010 124.977 - CONNECTOR ROD 5.5MM 35MM OFFST SPN BOTH IP/OP "$1,287.50" $953.00 $229.18 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $229.18 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $268.33 "$1,287.50" $515.00 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $965.63 "$1,287.50" "$1,287.50" "$1,287.50" $643.75 $643.75 "$1,019.70" "$1,287.50" "$1,030.00" $579.38 "$1,287.50" N/A $746.75 "$1,287.50" $772.50 "$1,287.50" "$1,287.50" "$1,287.50" N/A N/A 124.98 SUP Custom 27803010 124.980 - CONNECTOR ROD 5.5MM INLINE TITANIUM SPN BOTH IP/OP "$1,362.50" "$1,008.00" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" $545.00 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 "$1,362.50" N/A $790.25 "$1,362.50" $817.50 "$1,362.50" "$1,362.50" "$1,362.50" N/A N/A 124.99 SUP Custom 27803010 124.990 - CONNECTOR ROD 5.5MM 15MM TITANIUM SPN BOTH IP/OP "$1,362.50" "$1,008.00" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" $545.00 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 "$1,362.50" N/A $790.25 "$1,362.50" $817.50 "$1,362.50" "$1,362.50" "$1,362.50" N/A N/A 124.991 SUP Custom 27803010 124.991 - CONNECTOR ROD 5.5/5.5MM 20MM OFFST SPN BOTH IP/OP "$1,362.50" "$1,008.00" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" $545.00 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 "$1,362.50" N/A $790.25 "$1,362.50" $817.50 "$1,362.50" "$1,362.50" "$1,362.50" N/A N/A 124.992 SUP Custom 27803010 124.992 - CONNECTOR ROD 5.5MM 25MM OFFST SPN BOTH IP/OP "$1,362.50" "$1,008.00" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" $545.00 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 "$1,362.50" N/A $790.25 "$1,362.50" $817.50 "$1,362.50" "$1,362.50" "$1,362.50" N/A N/A 124.993 SUP Custom 27803010 124.993 - CONNECTOR ROD LARGE 5.5MM 30MM OFFST SPN BOTH IP/OP "$1,362.50" "$1,008.00" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" $545.00 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 "$1,362.50" N/A $790.25 "$1,362.50" $817.50 "$1,362.50" "$1,362.50" "$1,362.50" N/A N/A 124.994 SUP Custom 27803010 124.994 - CONNECTOR ROD 5.5/5.5MM 35MM OFFST SPN BOTH IP/OP "$1,362.50" "$1,008.00" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" $545.00 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 "$1,362.50" N/A $790.25 "$1,362.50" $817.50 "$1,362.50" "$1,362.50" "$1,362.50" N/A N/A 124.995 SUP Custom 27803010 124.995 - CONNECTOR ROD LARGE 5.5MM 100MM OFFST SPN BOTH IP/OP "$1,362.50" "$1,008.00" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" $545.00 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 "$1,362.50" N/A $790.25 "$1,362.50" $817.50 "$1,362.50" "$1,362.50" "$1,362.50" N/A N/A 124.996 SUP Custom 27803010 124.996 - CONNECTOR ROD LARGE 5.5MM 120MM OFFST SPN BOTH IP/OP "$1,362.50" "$1,008.00" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" $545.00 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 "$1,362.50" N/A $790.25 "$1,362.50" $817.50 "$1,362.50" "$1,362.50" "$1,362.50" N/A N/A 124.997 SUP Custom 27803010 124.997 - CONNECTOR ROD 5.5/5.5MM 150MM OFFST SPN BOTH IP/OP "$1,362.50" "$1,008.00" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $242.53 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" $545.00 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 "$1,362.50" N/A $790.25 "$1,362.50" $817.50 "$1,362.50" "$1,362.50" "$1,362.50" N/A N/A 129.436 SUP HCPCS C1713 129.436 - PLATE BONE 36MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$5,612.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$14,030.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.438 SUP HCPCS C1713 129.438 - PLATE BONE 38MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$14,030.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$8,418.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.44 SUP HCPCS C1713 129.440 - PLATE BONE 40MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$5,612.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$8,418.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.442 SUP HCPCS C1713 129.442 - PLATE BONE 42MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$14,030.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$8,418.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.444 SUP HCPCS C1713 129.444 - PLATE BONE 44MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$5,612.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$8,418.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.448 SUP HCPCS C1713 129.448 - PLATE BONE 48MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$14,030.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$8,418.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.452 SUP HCPCS C1713 129.452 - PLATE BONE 52MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$5,612.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$14,030.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.456 SUP HCPCS C1713 129.456 - PLATE BONE 56MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$14,030.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$14,030.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.46 SUP HCPCS C1713 129.460 - PLATE BONE 60MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$5,612.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$8,418.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.464 SUP HCPCS C1713 129.464 - PLATE BONE 64MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$14,030.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$8,418.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.468 SUP HCPCS C1713 129.468 - PLATE BONE 68MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$5,612.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$8,418.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.472 SUP HCPCS C1713 129.472 - PLATE BONE 72MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$5,612.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$8,418.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.476 SUP HCPCS C1713 129.476 - PLATE BONE 76MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$14,030.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$8,418.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.48 SUP HCPCS C1713 129.480 - PLATE BONE 80MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$5,612.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$14,030.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.484 SUP HCPCS C1713 129.484 - PLATE BONE 84MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$14,030.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$8,418.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.488 SUP HCPCS C1713 129.488 - PLATE BONE 88MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$5,612.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$8,418.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.492 SUP HCPCS C1713 129.492 - PLATE BONE 92MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$14,030.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$14,030.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.496 SUP HCPCS C1713 129.496 - PLATE BONE 96MM OPEN DOOR GATEWAY TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$5,612.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$14,030.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.5 SUP HCPCS C1713 129.500 - PLATE BONE 100MM OPEN DOOR GATEWAY TITANIUM SPN BOTH IP/OP "$14,030.00" "$10,382.00" "$2,784.60" "$14,030.00" "$6,313.50" "$6,313.50" "$6,313.50" "$6,313.50" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.20" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$2,924.01" "$14,030.00" "$14,030.00" "$6,916.79" "$14,030.00" "$14,030.00" "$14,030.00" "$14,030.00" "$10,522.50" "$14,030.00" "$14,030.00" "$14,030.00" "$7,015.00" "$7,015.00" "$11,111.76" "$14,030.00" "$11,224.00" "$6,313.50" "$2,784.60" N/A "$8,137.40" "$14,030.00" "$8,418.00" "$14,030.00" "$2,923.85" "$14,030.00" N/A N/A 129.65 SUP Custom 27203010 129.650 - STAPLE BONE 5MM REVERE TITANIUM SPN BOTH IP/OP "$1,772.50" "$1,312.00" $315.51 "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" $315.51 "$1,772.50" "$1,772.50" "$1,315.55" "$1,315.55" "$1,366.24" $923.47 $369.41 "$1,772.50" $709.00 "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,329.38" "$1,772.50" "$1,772.50" "$1,772.50" $886.25 $886.25 "$1,403.82" "$1,772.50" "$1,418.00" "$1,152.13" "$1,772.50" N/A "$1,028.05" "$1,772.50" "$1,063.50" "$1,772.50" "$1,772.50" "$1,772.50" N/A N/A 129.655 SUP Custom 27203010 129.655 - STAPLE BONE 5.5MM REVERE SPN BOTH IP/OP "$1,772.50" "$1,312.00" $315.51 "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" $315.51 "$1,772.50" "$1,772.50" "$1,315.55" "$1,315.55" "$1,366.24" $923.47 $369.41 "$1,772.50" $709.00 "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,329.38" "$1,772.50" "$1,772.50" "$1,772.50" $886.25 $886.25 "$1,403.82" "$1,772.50" "$1,418.00" "$1,152.13" "$1,772.50" N/A "$1,028.05" "$1,772.50" "$1,063.50" "$1,772.50" "$1,772.50" "$1,772.50" N/A N/A 129.665 SUP Custom 27203010 129.665 - STAPLE BONE 6.5MM REVERE SPN BOTH IP/OP "$1,772.50" "$1,312.00" $315.51 "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" $315.51 "$1,772.50" "$1,772.50" "$1,315.55" "$1,315.55" "$1,366.24" $923.47 $369.41 "$1,772.50" $709.00 "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,329.38" "$1,772.50" "$1,772.50" "$1,772.50" $886.25 $886.25 "$1,403.82" "$1,772.50" "$1,418.00" "$1,152.13" "$1,772.50" N/A "$1,028.05" "$1,772.50" "$1,063.50" "$1,772.50" "$1,772.50" "$1,772.50" N/A N/A 129.675 SUP Custom 27203010 129.675 - STAPLE BONE 7.5MM REVERE SPN BOTH IP/OP "$1,772.50" "$1,312.00" $315.51 "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" $315.51 "$1,772.50" "$1,772.50" "$1,315.55" "$1,315.55" "$1,366.24" $923.47 $369.41 "$1,772.50" $709.00 "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,329.38" "$1,772.50" "$1,772.50" "$1,772.50" $886.25 $886.25 "$1,403.82" "$1,772.50" "$1,418.00" "$1,152.13" "$1,772.50" N/A "$1,028.05" "$1,772.50" "$1,063.50" "$1,772.50" "$1,772.50" "$1,772.50" N/A N/A 129.685 SUP Custom 27203010 129.685 - STAPLE BONE 8.5MM REVERE SPN BOTH IP/OP "$1,772.50" "$1,312.00" $315.51 "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" $315.51 "$1,772.50" "$1,772.50" "$1,315.55" "$1,315.55" "$1,366.24" $923.47 $369.41 "$1,772.50" $709.00 "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,329.38" "$1,772.50" "$1,772.50" "$1,772.50" $886.25 $886.25 "$1,403.82" "$1,772.50" "$1,418.00" "$1,152.13" "$1,772.50" N/A "$1,028.05" "$1,772.50" "$1,063.50" "$1,772.50" "$1,772.50" "$1,772.50" N/A N/A 130.12 SUP HCPCS C1713 130.120 - PLATE BONE 20MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$11,635.00" "$8,610.00" "$2,309.26" "$11,635.00" "$5,235.75" "$5,235.75" "$5,235.75" "$5,235.75" "$11,635.00" "$11,635.00" "$11,635.00" "$2,425.02" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.86" "$11,635.00" "$11,635.00" "$5,736.06" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$8,726.25" "$11,635.00" "$11,635.00" "$11,635.00" "$5,817.50" "$5,817.50" "$9,214.92" "$11,635.00" "$9,308.00" "$5,235.75" "$2,309.26" N/A "$6,748.30" "$11,635.00" "$6,981.00" "$11,635.00" "$2,424.73" "$11,635.00" N/A N/A 130.122 SUP HCPCS C1713 130.122 - PLATE BONE 22MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$11,635.00" "$8,610.00" "$2,309.26" "$11,635.00" "$5,235.75" "$5,235.75" "$5,235.75" "$5,235.75" "$11,635.00" "$11,635.00" "$11,635.00" "$2,425.02" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.86" "$11,635.00" "$4,654.00" "$5,736.06" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$8,726.25" "$11,635.00" "$11,635.00" "$11,635.00" "$5,817.50" "$5,817.50" "$9,214.92" "$11,635.00" "$9,308.00" "$5,235.75" "$2,309.26" N/A "$6,748.30" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.73" "$11,635.00" N/A N/A 130.124 SUP HCPCS C1713 130.124 - PLATE BONE 24MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$11,635.00" "$8,610.00" "$2,309.26" "$11,635.00" "$5,235.75" "$5,235.75" "$5,235.75" "$5,235.75" "$11,635.00" "$11,635.00" "$11,635.00" "$2,425.02" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.86" "$11,635.00" "$11,635.00" "$5,736.06" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$8,726.25" "$11,635.00" "$11,635.00" "$11,635.00" "$5,817.50" "$5,817.50" "$9,214.92" "$11,635.00" "$9,308.00" "$5,235.75" "$2,309.26" N/A "$6,748.30" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.73" "$11,635.00" N/A N/A 130.126 SUP HCPCS C1713 130.126 - PLATE BONE 26MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$11,635.00" "$8,610.00" "$2,309.26" "$11,635.00" "$5,235.75" "$5,235.75" "$5,235.75" "$5,235.75" "$11,635.00" "$11,635.00" "$11,635.00" "$2,425.02" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.86" "$11,635.00" "$11,635.00" "$5,736.06" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$8,726.25" "$11,635.00" "$11,635.00" "$11,635.00" "$5,817.50" "$5,817.50" "$9,214.92" "$11,635.00" "$9,308.00" "$5,235.75" "$2,309.26" N/A "$6,748.30" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.73" "$11,635.00" N/A N/A 130.128 SUP HCPCS C1713 130.128 - PLATE BONE 28MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$11,635.00" "$8,610.00" "$2,309.26" "$11,635.00" "$5,235.75" "$5,235.75" "$5,235.75" "$5,235.75" "$11,635.00" "$11,635.00" "$11,635.00" "$2,425.02" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.86" "$11,635.00" "$11,635.00" "$5,736.06" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$8,726.25" "$11,635.00" "$11,635.00" "$11,635.00" "$5,817.50" "$5,817.50" "$9,214.92" "$11,635.00" "$9,308.00" "$5,235.75" "$2,309.26" N/A "$6,748.30" "$11,635.00" "$6,981.00" "$11,635.00" "$2,424.73" "$11,635.00" N/A N/A 130.13 SUP HCPCS C1713 130.130 - PLATE BONE 30MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$11,635.00" "$8,610.00" "$2,309.26" "$11,635.00" "$5,235.75" "$5,235.75" "$5,235.75" "$5,235.75" "$11,635.00" "$11,635.00" "$11,635.00" "$2,425.02" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.86" "$11,635.00" "$4,654.00" "$5,736.06" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$8,726.25" "$11,635.00" "$11,635.00" "$11,635.00" "$5,817.50" "$5,817.50" "$9,214.92" "$11,635.00" "$9,308.00" "$5,235.75" "$2,309.26" N/A "$6,748.30" "$11,635.00" "$6,981.00" "$11,635.00" "$2,424.73" "$11,635.00" N/A N/A 130.132 SUP HCPCS C1713 130.132 - PLATE BONE 32MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$11,635.00" "$8,610.00" "$2,309.26" "$11,635.00" "$5,235.75" "$5,235.75" "$5,235.75" "$5,235.75" "$11,635.00" "$11,635.00" "$11,635.00" "$2,425.02" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.86" "$11,635.00" "$11,635.00" "$5,736.06" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$8,726.25" "$11,635.00" "$11,635.00" "$11,635.00" "$5,817.50" "$5,817.50" "$9,214.92" "$11,635.00" "$9,308.00" "$5,235.75" "$2,309.26" N/A "$6,748.30" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.73" "$11,635.00" N/A N/A 130.134 SUP HCPCS C1713 130.134 - PLATE BONE 34MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$11,635.00" "$8,610.00" "$2,309.26" "$11,635.00" "$5,235.75" "$5,235.75" "$5,235.75" "$5,235.75" "$11,635.00" "$11,635.00" "$11,635.00" "$2,425.02" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.86" "$11,635.00" "$4,654.00" "$5,736.06" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$8,726.25" "$11,635.00" "$11,635.00" "$11,635.00" "$5,817.50" "$5,817.50" "$9,214.92" "$11,635.00" "$9,308.00" "$5,235.75" "$2,309.26" N/A "$6,748.30" "$11,635.00" "$6,981.00" "$11,635.00" "$2,424.73" "$11,635.00" N/A N/A 130.136 SUP HCPCS C1713 130.136 - PLATE BONE 36MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$11,635.00" "$8,610.00" "$2,309.26" "$11,635.00" "$5,235.75" "$5,235.75" "$5,235.75" "$5,235.75" "$11,635.00" "$11,635.00" "$11,635.00" "$2,425.02" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.86" "$11,635.00" "$11,635.00" "$5,736.06" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$8,726.25" "$11,635.00" "$11,635.00" "$11,635.00" "$5,817.50" "$5,817.50" "$9,214.92" "$11,635.00" "$9,308.00" "$5,235.75" "$2,309.26" N/A "$6,748.30" "$11,635.00" "$6,981.00" "$11,635.00" "$2,424.73" "$11,635.00" N/A N/A 130.138 SUP HCPCS C1713 130.138 - PLATE BONE 38MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$11,635.00" "$8,610.00" "$2,309.26" "$11,635.00" "$5,235.75" "$5,235.75" "$5,235.75" "$5,235.75" "$11,635.00" "$11,635.00" "$11,635.00" "$2,425.02" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.86" "$11,635.00" "$4,654.00" "$5,736.06" "$11,635.00" "$11,635.00" "$11,635.00" "$11,635.00" "$8,726.25" "$11,635.00" "$11,635.00" "$11,635.00" "$5,817.50" "$5,817.50" "$9,214.92" "$11,635.00" "$9,308.00" "$5,235.75" "$2,309.26" N/A "$6,748.30" "$11,635.00" "$11,635.00" "$11,635.00" "$2,424.73" "$11,635.00" N/A N/A 130.142 SUP HCPCS C1713 130.142 - PLATE BONE 42MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$12,925.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.148 SUP HCPCS C1713 130.148 - PLATE BONE 48MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$5,170.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$7,755.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.154 SUP HCPCS C1713 130.154 - PLATE BONE 54MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$12,925.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$7,755.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.16 SUP HCPCS C1713 130.160 - PLATE BONE 60MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$5,170.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.163 SUP HCPCS C1713 130.163 - PLATE BONE 63MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$12,925.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$7,755.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.166 SUP HCPCS C1713 130.166 - PLATE BONE 66MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$5,170.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$7,755.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.169 SUP HCPCS C1713 130.169 - PLATE BONE 69MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$5,170.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$7,755.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.172 SUP HCPCS C1713 130.172 - PLATE BONE 72MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$12,925.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.175 SUP HCPCS C1713 130.175 - PLATE BONE 75MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$12,925.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.178 SUP HCPCS C1713 130.178 - PLATE BONE 78MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$12,925.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$7,755.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.181 SUP HCPCS C1713 130.181 - PLATE BONE 81MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$12,925.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$7,755.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.184 SUP HCPCS C1713 130.184 - PLATE BONE 84MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$12,925.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$7,755.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.187 SUP HCPCS C1713 130.187 - PLATE BONE 87MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$12,925.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$7,755.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.19 SUP HCPCS C1713 130.190 - PLATE BONE 90MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$12,925.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.193 SUP HCPCS C1713 130.193 - PLATE BONE 93MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$5,170.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.196 SUP HCPCS C1713 130.196 - PLATE BONE 96MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$5,170.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.199 SUP HCPCS C1713 130.199 - PLATE BONE 99MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,925.00" "$9,565.00" "$2,565.29" "$12,925.00" "$5,816.25" "$5,816.25" "$5,816.25" "$5,816.25" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.89" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$2,693.71" "$12,925.00" "$5,170.00" "$6,372.03" "$12,925.00" "$12,925.00" "$12,925.00" "$12,925.00" "$9,693.75" "$12,925.00" "$12,925.00" "$12,925.00" "$6,462.50" "$6,462.50" "$10,236.60" "$12,925.00" "$10,340.00" "$5,816.25" "$2,565.29" N/A "$7,496.50" "$12,925.00" "$7,755.00" "$12,925.00" "$2,693.57" "$12,925.00" N/A N/A 130.22 SUP HCPCS C1713 130.220 - PLATE BONE 20MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,277.50" "$9,085.00" "$2,436.78" "$12,277.50" "$5,524.88" "$5,524.88" "$5,524.88" "$5,524.88" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.94" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.77" "$12,277.50" "$4,911.00" "$6,052.81" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$9,208.13" "$12,277.50" "$12,277.50" "$12,277.50" "$6,138.75" "$6,138.75" "$9,723.78" "$12,277.50" "$9,822.00" "$5,524.88" "$2,436.78" N/A "$7,120.95" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.63" "$12,277.50" N/A N/A 130.222 SUP HCPCS C1713 130.222 - PLATE BONE 22MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,277.50" "$9,085.00" "$2,436.78" "$12,277.50" "$5,524.88" "$5,524.88" "$5,524.88" "$5,524.88" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.94" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.77" "$12,277.50" "$4,911.00" "$6,052.81" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$9,208.13" "$12,277.50" "$12,277.50" "$12,277.50" "$6,138.75" "$6,138.75" "$9,723.78" "$12,277.50" "$9,822.00" "$5,524.88" "$2,436.78" N/A "$7,120.95" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.63" "$12,277.50" N/A N/A 130.224 SUP HCPCS C1713 130.224 - PLATE BONE 24MM LEVEL 1 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,277.50" "$9,085.00" "$2,436.78" "$12,277.50" "$5,524.88" "$5,524.88" "$5,524.88" "$5,524.88" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.94" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.77" "$12,277.50" "$4,911.00" "$6,052.81" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$9,208.13" "$12,277.50" "$12,277.50" "$12,277.50" "$6,138.75" "$6,138.75" "$9,723.78" "$12,277.50" "$9,822.00" "$5,524.88" "$2,436.78" N/A "$7,120.95" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.63" "$12,277.50" N/A N/A 130.226 SUP HCPCS C1713 130.226 - PLATE BONE 26MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,277.50" "$9,085.00" "$2,436.78" "$12,277.50" "$5,524.88" "$5,524.88" "$5,524.88" "$5,524.88" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.94" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.77" "$12,277.50" "$4,911.00" "$6,052.81" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$9,208.13" "$12,277.50" "$12,277.50" "$12,277.50" "$6,138.75" "$6,138.75" "$9,723.78" "$12,277.50" "$9,822.00" "$5,524.88" "$2,436.78" N/A "$7,120.95" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.63" "$12,277.50" N/A N/A 130.228 SUP HCPCS C1713 130.228 - PLATE BONE 28MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,277.50" "$9,085.00" "$2,436.78" "$12,277.50" "$5,524.88" "$5,524.88" "$5,524.88" "$5,524.88" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.94" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.77" "$12,277.50" "$4,911.00" "$6,052.81" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$9,208.13" "$12,277.50" "$12,277.50" "$12,277.50" "$6,138.75" "$6,138.75" "$9,723.78" "$12,277.50" "$9,822.00" "$5,524.88" "$2,436.78" N/A "$7,120.95" "$12,277.50" "$7,366.50" "$12,277.50" "$2,558.63" "$12,277.50" N/A N/A 130.23 SUP HCPCS C1713 130.230 - PLATE BN 30MM NS CITADEL LVL 1 SPNE LS ANT BOTH IP/OP "$12,277.50" "$9,085.00" "$2,436.78" "$12,277.50" "$5,524.88" "$5,524.88" "$5,524.88" "$5,524.88" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.94" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.77" "$12,277.50" "$4,911.00" "$6,052.81" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$9,208.13" "$12,277.50" "$12,277.50" "$12,277.50" "$6,138.75" "$6,138.75" "$9,723.78" "$12,277.50" "$9,822.00" "$5,524.88" "$2,436.78" N/A "$7,120.95" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.63" "$12,277.50" N/A N/A 130.232 SUP HCPCS C1713 130.232 - PLATE BN 32MM NS CITADEL LVL 1 SPNE LS ANT BOTH IP/OP "$12,277.50" "$9,085.00" "$2,436.78" "$12,277.50" "$5,524.88" "$5,524.88" "$5,524.88" "$5,524.88" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.94" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.77" "$12,277.50" "$4,911.00" "$6,052.81" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$9,208.13" "$12,277.50" "$12,277.50" "$12,277.50" "$6,138.75" "$6,138.75" "$9,723.78" "$12,277.50" "$9,822.00" "$5,524.88" "$2,436.78" N/A "$7,120.95" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.63" "$12,277.50" N/A N/A 130.234 SUP HCPCS C1713 130.234 - PLATE BN 34MM NS CITADEL LVL 1 SPNE LS ANT BOTH IP/OP "$12,277.50" "$9,085.00" "$2,436.78" "$12,277.50" "$5,524.88" "$5,524.88" "$5,524.88" "$5,524.88" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.94" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.77" "$12,277.50" "$12,277.50" "$6,052.81" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$9,208.13" "$12,277.50" "$12,277.50" "$12,277.50" "$6,138.75" "$6,138.75" "$9,723.78" "$12,277.50" "$9,822.00" "$5,524.88" "$2,436.78" N/A "$7,120.95" "$12,277.50" "$7,366.50" "$12,277.50" "$2,558.63" "$12,277.50" N/A N/A 130.236 SUP HCPCS C1713 130.236 - PLATE BONE 36MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$12,277.50" "$9,085.00" "$2,436.78" "$12,277.50" "$5,524.88" "$5,524.88" "$5,524.88" "$5,524.88" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.94" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.77" "$12,277.50" "$4,911.00" "$6,052.81" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$9,208.13" "$12,277.50" "$12,277.50" "$12,277.50" "$6,138.75" "$6,138.75" "$9,723.78" "$12,277.50" "$9,822.00" "$5,524.88" "$2,436.78" N/A "$7,120.95" "$12,277.50" "$7,366.50" "$12,277.50" "$2,558.63" "$12,277.50" N/A N/A 130.238 SUP HCPCS C1713 130.238 - PLATE BN 38MM NS CITADEL LVL 1 SPNE LS ANT BOTH IP/OP "$12,277.50" "$9,085.00" "$2,436.78" "$12,277.50" "$5,524.88" "$5,524.88" "$5,524.88" "$5,524.88" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.94" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$2,558.77" "$12,277.50" "$12,277.50" "$6,052.81" "$12,277.50" "$12,277.50" "$12,277.50" "$12,277.50" "$9,208.13" "$12,277.50" "$12,277.50" "$12,277.50" "$6,138.75" "$6,138.75" "$9,723.78" "$12,277.50" "$9,822.00" "$5,524.88" "$2,436.78" N/A "$7,120.95" "$12,277.50" "$7,366.50" "$12,277.50" "$2,558.63" "$12,277.50" N/A N/A 130.263 SUP HCPCS C1713 130.263 - PLATE BONE 63MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$13,572.50" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.266 SUP HCPCS C1713 130.266 - PLATE BONE 66MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$5,429.00" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.269 SUP HCPCS C1713 130.269 - PLATE BONE 69MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$13,572.50" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.272 SUP HCPCS C1713 130.272 - PLATE BONE 72MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$5,429.00" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.275 SUP HCPCS C1713 130.275 - PLATE BONE 75MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$13,572.50" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.278 SUP HCPCS C1713 130.278 - PLATE BONE 78MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$5,429.00" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.281 SUP HCPCS C1713 130.281 - PLATE BONE 81MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$13,572.50" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$8,143.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.284 SUP HCPCS C1713 130.284 - PLATE BONE 84MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$5,429.00" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$8,143.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.287 SUP HCPCS C1713 130.287 - PLATE BONE 87MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$13,572.50" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$8,143.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.29 SUP HCPCS C1713 130.290 - PLATE BONE 90MM LEVEL 2 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$5,429.00" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.501 SUP HCPCS C1713 "130.501 - Clamping Set Screw, 2.25mm" BOTH IP/OP $7.50 $6.00 $1.49 $7.50 $3.38 $3.38 $3.38 $3.38 $7.50 $7.50 $7.50 $1.56 $7.50 $7.50 $7.50 $7.50 $7.50 $1.56 $7.50 $7.50 $4.44 $7.50 $7.50 $7.50 $7.50 $5.63 $7.50 $7.50 $7.50 $3.75 $3.75 $5.94 $7.50 $6.00 $3.38 $1.49 N/A $4.35 $7.50 $4.50 $7.50 $1.56 $7.50 N/A N/A 130.542 SUP HCPCS C1713 130.542 - PLATE BONE 42MM LEVEL 5 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$5,429.00" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.548 SUP HCPCS C1713 130.548 - PLATE BONE 48MM LEVEL 5 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$13,572.50" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.554 SUP HCPCS C1713 130.554 - PLATE BONE 54MM LEVEL 5 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$5,429.00" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.56 SUP HCPCS C1713 130.560 - PLATE BONE 60MM LEVEL 5 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$13,572.50" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.566 SUP HCPCS C1713 130.566 - PLATE BONE 66MM LEVEL 5 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$5,429.00" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.572 SUP HCPCS C1713 130.572 - PLATE BONE 72MM LEVEL 5 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$13,572.50" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.578 SUP HCPCS C1713 130.578 - PLATE BONE 78MM LEVEL 5 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$5,429.00" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$8,143.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.584 SUP HCPCS C1713 130.584 - PLATE BONE 84MM LEVEL 5 CITADEL TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$13,572.50" "$10,044.00" "$2,693.80" "$13,572.50" "$6,107.63" "$6,107.63" "$6,107.63" "$6,107.63" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.85" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$2,828.66" "$13,572.50" "$13,572.50" "$6,691.24" "$13,572.50" "$13,572.50" "$13,572.50" "$13,572.50" "$10,179.38" "$13,572.50" "$13,572.50" "$13,572.50" "$6,786.25" "$6,786.25" "$10,749.42" "$13,572.50" "$10,858.00" "$6,107.63" "$2,693.80" N/A "$7,872.05" "$13,572.50" "$8,143.50" "$13,572.50" "$2,828.51" "$13,572.50" N/A N/A 130.622 SUP HCPCS C1713 130.622 - SCREW BONE 6.5MM 22MM SLFTAP VAR ANG SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" $776.00 "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,164.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.624 SUP HCPCS C1713 130.624 - SCREW BONE 6.5MM 24MM SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.626 SUP HCPCS C1713 130.626 - SCREW BONE 6.5MM 26MM SLFTAP VAR ANG SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,164.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.628 SUP HCPCS C1713 130.628 - SCREW BONE 6.5MM 28MM SLFTAP VAR ANG SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,164.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.63 SUP HCPCS C1713 130.630 - SCREW BONE 6.5MM 30MM SLFTAP VAR ANG TITANIUM SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.633 SUP HCPCS C1713 130.633 - SCREW BONE 33MM 65MM SLFTAP VAR ANG SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,164.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.636 SUP HCPCS C1713 130.636 - SCREW BONE 36MM 65MM SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,164.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.639 SUP HCPCS C1713 130.639 - SCREW BONE 6.5MM SLFTAP VARIABLE SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.642 SUP HCPCS C1713 130.642 - SCREW BONE 6.5MM SLFTAP VARIABLE BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.645 SUP HCPCS C1713 130.645 - SCREW BONE 6.5MM SLFTAP VARIABLE SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.648 SUP HCPCS C1713 130.648 - SCREW BONE 6.5MM SLFTAP VARIABLE BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" $776.00 "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,164.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.651 SUP HCPCS C1713 130.651 - SCREW BONE 6.5MM SLFTAP VARIABLE BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" $776.00 "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,164.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.654 SUP HCPCS C1713 130.654 - SCREW BONE 6.5MM SLFTAP VARIABLE BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" $776.00 "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,164.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.657 SUP HCPCS C1713 130.657 - SCREW BONE 6.5MM 57MM SLFTAP VAR ANG SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.822 SUP HCPCS C1713 130.822 - SCREW BONE 6.5MM 22MM FIX ANGLE SELF TAP SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.824 SUP HCPCS C1713 130.824 - SCREW BONE 6.5MM 24MM FIX ANGLE SELF TAP SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.826 SUP HCPCS C1713 130.826 - SCREW BONE 6.5MM 26MM SLFTAP FIXANG SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" $776.00 "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.828 SUP HCPCS C1713 130.828 - SCREW BONE 6.5MM 28MM FIX ANGLE SELF TAP SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" $776.00 "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.83 SUP HCPCS C1713 130.830 - SCREW BONE 6.5MM 30MM SLFTAP FIXANG TITANIUM SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" $776.00 "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.833 SUP HCPCS C1713 130.833 - SCREW BONE 6.5MM 33MM SLFTAP FIXANG SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.836 SUP HCPCS C1713 130.836 - SCREW BONE 6.5MM SLFTAP FIX BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" $776.00 "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.839 SUP HCPCS C1713 130.839 - SCREW BONE 6.5MM SLFTAP FIX BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" $776.00 "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.842 SUP HCPCS C1713 130.842 - SCREW BONE 6.5MM SLFTAP FIX SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" $776.00 "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.845 SUP HCPCS C1713 130.845 - SCREW BONE 6.5MM SLFTAP FIX SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" $776.00 "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.848 SUP HCPCS C1713 130.848 - SCREW BONE 6.5MM SLFTAP FIX SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" $776.00 "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.851 SUP HCPCS C1713 130.851 - SCREW BONE 6.5MM 51MM SLFTAP FIXANG SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" $776.00 "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.854 SUP HCPCS C1713 130.854 - SCREW BONE 6.5MM 54MM SLFTAP FIXANG SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,940.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 130.857 SUP HCPCS C1713 130.857 - SCREW BONE 6.5MM 57MM SLFTAP FIXANG SPN BOTH IP/OP "$1,940.00" "$1,436.00" $385.04 "$1,940.00" $873.00 $873.00 $873.00 $873.00 "$1,940.00" "$1,940.00" "$1,940.00" $404.34 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" "$1,940.00" "$1,147.51" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 $385.04 N/A "$1,125.20" "$1,940.00" "$1,164.00" "$1,940.00" $404.30 "$1,940.00" N/A N/A 131.001 SUP Custom 27203010 131.001 - STAPLE BONE SMALL 2 HOLE ROSTRAL SPN BOTH IP/OP "$2,712.50" "$2,007.00" $482.83 "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" $482.83 "$2,712.50" "$2,712.50" "$2,013.22" "$2,013.22" "$2,090.80" "$1,413.21" $565.31 "$2,712.50" "$1,085.00" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,034.38" "$2,712.50" "$2,712.50" "$2,712.50" "$1,356.25" "$1,356.25" "$2,148.30" "$2,712.50" "$2,170.00" "$1,763.13" "$2,712.50" N/A "$1,573.25" "$2,712.50" "$1,627.50" "$2,712.50" "$2,712.50" "$2,712.50" N/A N/A 131.002 SUP Custom 27203010 131.002 - STAPLE BONE SMALL 2 HOLE CAUDAL SPN BOTH IP/OP "$2,712.50" "$2,007.00" $482.83 "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" $482.83 "$2,712.50" "$2,712.50" "$2,013.22" "$2,013.22" "$2,090.80" "$1,413.21" $565.31 "$2,712.50" "$1,085.00" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,034.38" "$2,712.50" "$2,712.50" "$2,712.50" "$1,356.25" "$1,356.25" "$2,148.30" "$2,712.50" "$2,170.00" "$1,763.13" "$2,712.50" N/A "$1,573.25" "$2,712.50" "$1,627.50" "$2,712.50" "$2,712.50" "$2,712.50" N/A N/A 131.003 SUP Custom 27203010 131.003 - STAPLE BONE MEDIUM 2 HOLE ROSTRAL SPN BOTH IP/OP "$2,712.50" "$2,007.00" $482.83 "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" $482.83 "$2,712.50" "$2,712.50" "$2,013.22" "$2,013.22" "$2,090.80" "$1,413.21" $565.31 "$2,712.50" "$1,085.00" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,034.38" "$2,712.50" "$2,712.50" "$2,712.50" "$1,356.25" "$1,356.25" "$2,148.30" "$2,712.50" "$2,170.00" "$1,763.13" "$2,712.50" N/A "$1,573.25" "$2,712.50" "$1,627.50" "$2,712.50" "$2,712.50" "$2,712.50" N/A N/A 131.004 SUP Custom 27203010 131.004 - STAPLE BONE MEDIUM 2 HOLE CAUDAL SPN BOTH IP/OP "$2,712.50" "$2,007.00" $482.83 "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" $482.83 "$2,712.50" "$2,712.50" "$2,013.22" "$2,013.22" "$2,090.80" "$1,413.21" $565.31 "$2,712.50" "$1,085.00" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,034.38" "$2,712.50" "$2,712.50" "$2,712.50" "$1,356.25" "$1,356.25" "$2,148.30" "$2,712.50" "$2,170.00" "$1,763.13" "$2,712.50" N/A "$1,573.25" "$2,712.50" "$1,627.50" "$2,712.50" "$2,712.50" "$2,712.50" N/A N/A 131.005 SUP Custom 27203010 131.005 - STAPLE BONE LARGE 2 HOLE ROSTRAL SPN BOTH IP/OP "$2,712.50" "$2,007.00" $482.83 "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" $482.83 "$2,712.50" "$2,712.50" "$2,013.22" "$2,013.22" "$2,090.80" "$1,413.21" $565.31 "$2,712.50" "$1,085.00" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,034.38" "$2,712.50" "$2,712.50" "$2,712.50" "$1,356.25" "$1,356.25" "$2,148.30" "$2,712.50" "$2,170.00" "$1,763.13" "$2,712.50" N/A "$1,573.25" "$2,712.50" "$1,627.50" "$2,712.50" "$2,712.50" "$2,712.50" N/A N/A 131.006 SUP Custom 27203010 131.006 - STAPLE BONE LARGE 2 HOLE CAUDAL SPN BOTH IP/OP "$2,712.50" "$2,007.00" $482.83 "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" $482.83 "$2,712.50" "$2,712.50" "$2,013.22" "$2,013.22" "$2,090.80" "$1,413.21" $565.31 "$2,712.50" "$1,085.00" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,034.38" "$2,712.50" "$2,712.50" "$2,712.50" "$1,356.25" "$1,356.25" "$2,148.30" "$2,712.50" "$2,170.00" "$1,763.13" "$2,712.50" N/A "$1,573.25" "$2,712.50" "$1,627.50" "$2,712.50" "$2,712.50" "$2,712.50" N/A N/A 131.007 SUP Custom 27203010 131.007 - STAPLE BONE XL 2 HOLE ROSTRAL SPN BOTH IP/OP "$2,712.50" "$2,007.00" $482.83 "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" $482.83 "$2,712.50" "$2,712.50" "$2,013.22" "$2,013.22" "$2,090.80" "$1,413.21" $565.31 "$2,712.50" "$1,085.00" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,034.38" "$2,712.50" "$2,712.50" "$2,712.50" "$1,356.25" "$1,356.25" "$2,148.30" "$2,712.50" "$2,170.00" "$1,763.13" "$2,712.50" N/A "$1,573.25" "$2,712.50" "$1,627.50" "$2,712.50" "$2,712.50" "$2,712.50" N/A N/A 131.008 SUP Custom 27203010 131.008 - STAPLE BONE XL 2 HOLE CAUDAL SPN BOTH IP/OP "$2,712.50" "$2,007.00" $482.83 "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" $482.83 "$2,712.50" "$2,712.50" "$2,013.22" "$2,013.22" "$2,090.80" "$1,413.21" $565.31 "$2,712.50" "$1,085.00" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,712.50" "$2,034.38" "$2,712.50" "$2,712.50" "$2,712.50" "$1,356.25" "$1,356.25" "$2,148.30" "$2,712.50" "$2,170.00" "$1,763.13" "$2,712.50" N/A "$1,573.25" "$2,712.50" "$1,627.50" "$2,712.50" "$2,712.50" "$2,712.50" N/A N/A 131.011 SUP Custom 27203010 131.011 - SCREW BONE SMALL REINFORCED STAPLE SPN LATERAL BOTH IP/OP "$1,945.00" "$1,439.00" $346.21 "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" $346.21 "$1,945.00" "$1,945.00" "$1,443.58" "$1,443.58" "$1,499.21" "$1,013.35" $405.36 "$1,945.00" $778.00 "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,458.75" "$1,945.00" "$1,945.00" "$1,945.00" $972.50 $972.50 "$1,540.44" "$1,945.00" "$1,556.00" "$1,264.25" "$1,945.00" N/A "$1,128.10" "$1,945.00" "$1,167.00" "$1,945.00" "$1,945.00" "$1,945.00" N/A N/A 131.012 SUP Custom 27203010 131.012 - STAPLE BONE MEDIUM BOTH IP/OP "$1,945.00" "$1,439.00" $346.21 "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" $346.21 "$1,945.00" "$1,945.00" "$1,443.58" "$1,443.58" "$1,499.21" "$1,013.35" $405.36 "$1,945.00" $778.00 "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,458.75" "$1,945.00" "$1,945.00" "$1,945.00" $972.50 $972.50 "$1,540.44" "$1,945.00" "$1,556.00" "$1,264.25" "$1,945.00" N/A "$1,128.10" "$1,945.00" "$1,167.00" "$1,945.00" "$1,945.00" "$1,945.00" N/A N/A 131.013 SUP Custom 27203010 131.013 - STAPLE BONE LARGE BOTH IP/OP "$1,945.00" "$1,439.00" $346.21 "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" $346.21 "$1,945.00" "$1,945.00" "$1,443.58" "$1,443.58" "$1,499.21" "$1,013.35" $405.36 "$1,945.00" $778.00 "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,458.75" "$1,945.00" "$1,945.00" "$1,945.00" $972.50 $972.50 "$1,540.44" "$1,945.00" "$1,556.00" "$1,264.25" "$1,945.00" N/A "$1,128.10" "$1,945.00" "$1,167.00" "$1,945.00" "$1,945.00" "$1,945.00" N/A N/A 131.113 SUP Custom 27803010 131.113 - CONNECTOR ROD 13MM CROSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 131.114 SUP Custom 27803010 131.114 - CONNECTOR ROD 14MM CROSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 131.115 SUP Custom 27803010 131.115 - CONNECTOR ROD 15MM ADJUSTABLE TRNSVRS BUTTRESSED TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 131.116 SUP Custom 27803010 131.116 - LINK SURG 16MM CROSS TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 131.117 SUP Custom 27803010 131.117 - CONNECTOR ROD 17MM CROSSLINK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 131.118 SUP Custom 27803010 131.118 - CONNECTOR ROD 18MM CROSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 131.119 SUP Custom 27803010 131.119 - CONNECTOR ROD 19MM CROSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 131.12 SUP Custom 27803010 131.120 - CONNECTOR ROD 20MM LONG VERSION ANTERIOR CERV SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 131.121 SUP Custom 27803010 131.121 - CONNECTOR ROD 21MM CROSS SPN BOTH IP/OP "$2,545.00" "$1,883.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $530.41 "$2,545.00" "$1,018.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$1,908.75" "$2,545.00" "$2,545.00" "$2,545.00" "$1,272.50" "$1,272.50" "$2,015.64" "$2,545.00" "$2,036.00" "$1,145.25" "$2,545.00" N/A "$1,476.10" "$2,545.00" "$1,527.00" "$2,545.00" "$2,545.00" "$2,545.00" N/A N/A 131.122 SUP Custom 27803010 131.122 - CONNECTOR ROD 22MM CROSS SPN BOTH IP/OP "$2,545.00" "$1,883.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $530.41 "$2,545.00" "$1,018.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$1,908.75" "$2,545.00" "$2,545.00" "$2,545.00" "$1,272.50" "$1,272.50" "$2,015.64" "$2,545.00" "$2,036.00" "$1,145.25" "$2,545.00" N/A "$1,476.10" "$2,545.00" "$1,527.00" "$2,545.00" "$2,545.00" "$2,545.00" N/A N/A 131.123 SUP Custom 27803010 131.123 - CONNECTOR ROD 23MM CROSS SPN BOTH IP/OP "$2,545.00" "$1,883.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $530.41 "$2,545.00" "$1,018.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$1,908.75" "$2,545.00" "$2,545.00" "$2,545.00" "$1,272.50" "$1,272.50" "$2,015.64" "$2,545.00" "$2,036.00" "$1,145.25" "$2,545.00" N/A "$1,476.10" "$2,545.00" "$1,527.00" "$2,545.00" "$2,545.00" "$2,545.00" N/A N/A 131.124 SUP Custom 27803010 131.124 - CONNECTOR ROD 24MM CROSS SPN BOTH IP/OP "$2,545.00" "$1,883.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $530.41 "$2,545.00" "$1,018.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$1,908.75" "$2,545.00" "$2,545.00" "$2,545.00" "$1,272.50" "$1,272.50" "$2,015.64" "$2,545.00" "$2,036.00" "$1,145.25" "$2,545.00" N/A "$1,476.10" "$2,545.00" "$1,527.00" "$2,545.00" "$2,545.00" "$2,545.00" N/A N/A 131.125 SUP Custom 27803010 131.125 - CONNECTOR ROD 25MM CROSS SPN BOTH IP/OP "$2,545.00" "$1,883.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $530.41 "$2,545.00" "$1,018.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$1,908.75" "$2,545.00" "$2,545.00" "$2,545.00" "$1,272.50" "$1,272.50" "$2,015.64" "$2,545.00" "$2,036.00" "$1,145.25" "$2,545.00" N/A "$1,476.10" "$2,545.00" "$1,527.00" "$2,545.00" "$2,545.00" "$2,545.00" N/A N/A 131.126 SUP Custom 27803010 131.126 - CONNECTOR ROD 26MM CROSS SPN BOTH IP/OP "$2,545.00" "$1,883.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $530.41 "$2,545.00" "$1,018.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$1,908.75" "$2,545.00" "$2,545.00" "$2,545.00" "$1,272.50" "$1,272.50" "$2,015.64" "$2,545.00" "$2,036.00" "$1,145.25" "$2,545.00" N/A "$1,476.10" "$2,545.00" "$1,527.00" "$2,545.00" "$2,545.00" "$2,545.00" N/A N/A 131.127 SUP Custom 27803010 131.127 - CONNECTOR ROD 27MM CROSS SPN BOTH IP/OP "$2,545.00" "$1,883.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $530.41 "$2,545.00" "$1,018.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$1,908.75" "$2,545.00" "$2,545.00" "$2,545.00" "$1,272.50" "$1,272.50" "$2,015.64" "$2,545.00" "$2,036.00" "$1,145.25" "$2,545.00" N/A "$1,476.10" "$2,545.00" "$1,527.00" "$2,545.00" "$2,545.00" "$2,545.00" N/A N/A 131.128 SUP Custom 27803010 131.128 - CONNECTOR ROD 28MM CROSS SPN BOTH IP/OP "$2,545.00" "$1,883.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $453.01 "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" $530.41 "$2,545.00" "$1,018.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$2,545.00" "$1,908.75" "$2,545.00" "$2,545.00" "$2,545.00" "$1,272.50" "$1,272.50" "$2,015.64" "$2,545.00" "$2,036.00" "$1,145.25" "$2,545.00" N/A "$1,476.10" "$2,545.00" "$1,527.00" "$2,545.00" "$2,545.00" "$2,545.00" N/A N/A 131.201 SUP HCPCS C1713 131.201 - WASHER SPINAL SMALL STAPLE BOTH IP/OP $722.50 $535.00 $143.40 $722.50 $325.13 $325.13 $325.13 $325.13 $722.50 $722.50 $722.50 $150.59 $722.50 $722.50 $722.50 $722.50 $722.50 $150.58 $722.50 $722.50 $427.36 $722.50 $722.50 $722.50 $722.50 $541.88 $722.50 $722.50 $722.50 $361.25 $361.25 $572.22 $722.50 $578.00 $325.13 $143.40 N/A $419.05 $722.50 $722.50 $722.50 $150.57 $722.50 N/A N/A 131.202 SUP HCPCS C1713 131.202 - WASHER SPINAL MEDIUM REVERE BOTH IP/OP $797.50 $590.00 $158.28 $797.50 $358.88 $358.88 $358.88 $358.88 $797.50 $797.50 $797.50 $166.22 $797.50 $797.50 $797.50 $797.50 $797.50 $166.21 $797.50 $797.50 $471.72 $797.50 $797.50 $797.50 $797.50 $598.13 $797.50 $797.50 $797.50 $398.75 $398.75 $631.62 $797.50 $638.00 $358.88 $158.28 N/A $462.55 $797.50 $478.50 $797.50 $166.20 $797.50 N/A N/A 131.203 SUP HCPCS C1713 131.203 - WASHER SPINAL LARGE STAPLE BOTH IP/OP $840.00 $622.00 $166.72 $840.00 $378.00 $378.00 $378.00 $378.00 $840.00 $840.00 $840.00 $175.08 $840.00 $840.00 $840.00 $840.00 $840.00 $175.07 $840.00 $840.00 $496.86 $840.00 $840.00 $840.00 $840.00 $630.00 $840.00 $840.00 $840.00 $420.00 $420.00 $665.28 $840.00 $672.00 $378.00 $166.72 N/A $487.20 $840.00 $504.00 $840.00 $175.06 $840.00 N/A N/A 131.351 SUP HCPCS C1713 131.351 - SCREW BONE 5.5MM SPN ANTERIOR PLATE BOTH IP/OP "$1,910.00" "$1,413.00" $379.09 "$1,910.00" $859.50 $859.50 $859.50 $859.50 "$1,910.00" "$1,910.00" "$1,910.00" $398.09 "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" $398.07 "$1,910.00" $764.00 "$1,129.77" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,432.50" "$1,910.00" "$1,910.00" "$1,910.00" $955.00 $955.00 "$1,512.72" "$1,910.00" "$1,528.00" $859.50 $379.09 N/A "$1,107.80" "$1,910.00" "$1,146.00" "$1,910.00" $398.04 "$1,910.00" N/A N/A 131.352 SUP HCPCS C1713 131.352 - SCREW BONE 5.5MM SPN ANTERIOR PLATE BOTH IP/OP "$1,910.00" "$1,413.00" $379.09 "$1,910.00" $859.50 $859.50 $859.50 $859.50 "$1,910.00" "$1,910.00" "$1,910.00" $398.09 "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" $398.07 "$1,910.00" $764.00 "$1,129.77" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,432.50" "$1,910.00" "$1,910.00" "$1,910.00" $955.00 $955.00 "$1,512.72" "$1,910.00" "$1,528.00" $859.50 $379.09 N/A "$1,107.80" "$1,910.00" "$1,146.00" "$1,910.00" $398.04 "$1,910.00" N/A N/A 131.353 SUP HCPCS C1713 131.353 - SCREW BONE 5.5MM SPN ANTERIOR PLATE BOTH IP/OP "$1,910.00" "$1,413.00" $379.09 "$1,910.00" $859.50 $859.50 $859.50 $859.50 "$1,910.00" "$1,910.00" "$1,910.00" $398.09 "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" $398.07 "$1,910.00" $764.00 "$1,129.77" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,432.50" "$1,910.00" "$1,910.00" "$1,910.00" $955.00 $955.00 "$1,512.72" "$1,910.00" "$1,528.00" $859.50 $379.09 N/A "$1,107.80" "$1,910.00" "$1,910.00" "$1,910.00" $398.04 "$1,910.00" N/A N/A 131.354 SUP HCPCS C1713 131.354 - SCREW BONE 5.5MM SPN ANTERIOR PLATE BOTH IP/OP "$1,910.00" "$1,413.00" $379.09 "$1,910.00" $859.50 $859.50 $859.50 $859.50 "$1,910.00" "$1,910.00" "$1,910.00" $398.09 "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" $398.07 "$1,910.00" "$1,910.00" "$1,129.77" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,432.50" "$1,910.00" "$1,910.00" "$1,910.00" $955.00 $955.00 "$1,512.72" "$1,910.00" "$1,528.00" $859.50 $379.09 N/A "$1,107.80" "$1,910.00" "$1,146.00" "$1,910.00" $398.04 "$1,910.00" N/A N/A 131.355 SUP HCPCS C1713 131.355 - SCREW BONE 5.5MM SPN ANTERIOR PLATE BOTH IP/OP "$1,910.00" "$1,413.00" $379.09 "$1,910.00" $859.50 $859.50 $859.50 $859.50 "$1,910.00" "$1,910.00" "$1,910.00" $398.09 "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" $398.07 "$1,910.00" $764.00 "$1,129.77" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,432.50" "$1,910.00" "$1,910.00" "$1,910.00" $955.00 $955.00 "$1,512.72" "$1,910.00" "$1,528.00" $859.50 $379.09 N/A "$1,107.80" "$1,910.00" "$1,910.00" "$1,910.00" $398.04 "$1,910.00" N/A N/A 131.356 SUP HCPCS C1713 131.356 - SCREW BONE 5.5MM SPN ANTERIOR PLATE BOTH IP/OP "$1,910.00" "$1,413.00" $379.09 "$1,910.00" $859.50 $859.50 $859.50 $859.50 "$1,910.00" "$1,910.00" "$1,910.00" $398.09 "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" $398.07 "$1,910.00" $764.00 "$1,129.77" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,432.50" "$1,910.00" "$1,910.00" "$1,910.00" $955.00 $955.00 "$1,512.72" "$1,910.00" "$1,528.00" $859.50 $379.09 N/A "$1,107.80" "$1,910.00" "$1,910.00" "$1,910.00" $398.04 "$1,910.00" N/A N/A 131.361 SUP HCPCS C1713 131.361 - SCREW BONE 6.5MM SPN ANTERIOR PLATE BOTH IP/OP "$1,910.00" "$1,413.00" $379.09 "$1,910.00" $859.50 $859.50 $859.50 $859.50 "$1,910.00" "$1,910.00" "$1,910.00" $398.09 "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" $398.07 "$1,910.00" $764.00 "$1,129.77" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,432.50" "$1,910.00" "$1,910.00" "$1,910.00" $955.00 $955.00 "$1,512.72" "$1,910.00" "$1,528.00" $859.50 $379.09 N/A "$1,107.80" "$1,910.00" "$1,910.00" "$1,910.00" $398.04 "$1,910.00" N/A N/A 131.362 SUP HCPCS C1713 131.362 - SCREW BONE 6.5MM SPN ANTERIOR PLATE BOTH IP/OP "$1,910.00" "$1,413.00" $379.09 "$1,910.00" $859.50 $859.50 $859.50 $859.50 "$1,910.00" "$1,910.00" "$1,910.00" $398.09 "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" $398.07 "$1,910.00" "$1,910.00" "$1,129.77" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,432.50" "$1,910.00" "$1,910.00" "$1,910.00" $955.00 $955.00 "$1,512.72" "$1,910.00" "$1,528.00" $859.50 $379.09 N/A "$1,107.80" "$1,910.00" "$1,910.00" "$1,910.00" $398.04 "$1,910.00" N/A N/A 131.363 SUP HCPCS C1713 131.363 - SCREW BONE 6.5MM SPN ANTERIOR PLATE BOTH IP/OP "$1,910.00" "$1,413.00" $379.09 "$1,910.00" $859.50 $859.50 $859.50 $859.50 "$1,910.00" "$1,910.00" "$1,910.00" $398.09 "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" $398.07 "$1,910.00" "$1,910.00" "$1,129.77" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,432.50" "$1,910.00" "$1,910.00" "$1,910.00" $955.00 $955.00 "$1,512.72" "$1,910.00" "$1,528.00" $859.50 $379.09 N/A "$1,107.80" "$1,910.00" "$1,146.00" "$1,910.00" $398.04 "$1,910.00" N/A N/A 131.364 SUP HCPCS C1713 131.364 - SCREW BONE 6.5MM SPN ANTERIOR PLATE BOTH IP/OP "$1,910.00" "$1,413.00" $379.09 "$1,910.00" $859.50 $859.50 $859.50 $859.50 "$1,910.00" "$1,910.00" "$1,910.00" $398.09 "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" $398.07 "$1,910.00" "$1,910.00" "$1,129.77" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,432.50" "$1,910.00" "$1,910.00" "$1,910.00" $955.00 $955.00 "$1,512.72" "$1,910.00" "$1,528.00" $859.50 $379.09 N/A "$1,107.80" "$1,910.00" "$1,146.00" "$1,910.00" $398.04 "$1,910.00" N/A N/A 131.365 SUP HCPCS C1713 131.365 - SCREW BONE 6.5MM SPN ANTERIOR PLATE BOTH IP/OP "$1,910.00" "$1,413.00" $379.09 "$1,910.00" $859.50 $859.50 $859.50 $859.50 "$1,910.00" "$1,910.00" "$1,910.00" $398.09 "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" $398.07 "$1,910.00" $764.00 "$1,129.77" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,432.50" "$1,910.00" "$1,910.00" "$1,910.00" $955.00 $955.00 "$1,512.72" "$1,910.00" "$1,528.00" $859.50 $379.09 N/A "$1,107.80" "$1,910.00" "$1,146.00" "$1,910.00" $398.04 "$1,910.00" N/A N/A 131.366 SUP HCPCS C1713 131.366 - SCREW BONE 6.5MM SPN ANTERIOR PLATE BOTH IP/OP "$1,910.00" "$1,413.00" $379.09 "$1,910.00" $859.50 $859.50 $859.50 $859.50 "$1,910.00" "$1,910.00" "$1,910.00" $398.09 "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" $398.07 "$1,910.00" $764.00 "$1,129.77" "$1,910.00" "$1,910.00" "$1,910.00" "$1,910.00" "$1,432.50" "$1,910.00" "$1,910.00" "$1,910.00" $955.00 $955.00 "$1,512.72" "$1,910.00" "$1,528.00" $859.50 $379.09 N/A "$1,107.80" "$1,910.00" "$1,910.00" "$1,910.00" $398.04 "$1,910.00" N/A N/A 132.14 SUP Custom 27803010 132.140 - ROD SPINAL 40MM BLUNT TIP BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 132.145 SUP Custom 27803010 132.145 - ROD SPINAL 45MM CVD REVERE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 132.15 SUP Custom 27803010 132.150 - ROD SPINAL 5.5MM 50MM CVD PREBENT AUXILLARY MARS BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 132.155 SUP Custom 27803010 132.155 - ROD SPINAL 5.5MM 55MM PREBENT CVD AUXILLARY BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 132.16 SUP Custom 27803010 132.160 - ROD SPINAL 55MM REVOLVING PREBENT BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 132.165 SUP Custom 27803010 132.165 - ROD SPINAL 65MM REVOLVE PREBENT BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 132.17 SUP Custom 27803010 132.170 - ROD SPINAL 5.5MM 70MM CVD REVERE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 132.175 SUP Custom 27803010 132.175 - ROD SPINAL 75MM REVOLVE CVD BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 132.18 SUP Custom 27803010 132.180 - ROD SPINAL 80MM BLUNT TIP BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 132.185 SUP Custom 27803010 132.185 - ROD SPINAL 5.5MM 85MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 136.404 SUP HCPCS C1713 "136.404 - RELIEVE 2.2mm Screw, Self-Drilling, 4mm" BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $145.00 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $75.55 $362.50 N/A N/A 136.406 SUP HCPCS C1713 136.406 - SCREW BONE 2.2MM 6MM SLFDRILL BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $145.00 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $75.55 $362.50 N/A N/A 136.408 SUP HCPCS C1713 136.408 - SCREW BONE 2.2MM 8MM SLFDRILL BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $145.00 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $75.55 $362.50 N/A N/A 136.41 SUP HCPCS C1713 "136.410 - RELIEVE 2.2mm Screw, Self-Drilling, 10mm" BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $145.00 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $217.50 $362.50 $75.55 $362.50 N/A N/A 136.412 SUP HCPCS C1713 "136.412 - RELIEVE 2.2mm Screw, Self-Drilling, 12mm" BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $145.00 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $217.50 $362.50 $75.55 $362.50 N/A N/A 136.504 SUP HCPCS C1713 "136.504 - RELIEVE 2.2mm Screw, Self-Tapping, 4mm" BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $145.00 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $217.50 $362.50 $75.55 $362.50 N/A N/A 136.506 SUP HCPCS C1713 "136.506 - RELIEVE 2.2mm Screw, Self-Tapping, 6mm" BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $145.00 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $75.55 $362.50 N/A N/A 136.508 SUP HCPCS C1713 "136.508 - RELIEVE 2.2mm Screw, Self-Tapping, 8mm" BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $75.55 $362.50 N/A N/A 136.51 SUP HCPCS C1713 "136.510 - RELIEVE 2.2mm Screw, Self-Tapping, 10mm" BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $145.00 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $75.55 $362.50 N/A N/A 136.512 SUP HCPCS C1713 "136.512 - RELIEVE 2.2mm Screw, Self-Tapping, 12mm" BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $145.00 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $75.55 $362.50 N/A N/A 136.704 SUP HCPCS C1713 "136.704 - RELIEVE 2.6mm Screw, Self-Tapping, 4mm" BOTH IP/OP $527.50 $390.00 $104.70 $527.50 $237.38 $237.38 $237.38 $237.38 $527.50 $527.50 $527.50 $109.94 $527.50 $527.50 $527.50 $527.50 $527.50 $109.94 $527.50 $527.50 $312.02 $527.50 $527.50 $527.50 $527.50 $395.63 $527.50 $527.50 $527.50 $263.75 $263.75 $417.78 $527.50 $422.00 $237.38 $104.70 N/A $305.95 $527.50 $527.50 $527.50 $109.93 $527.50 N/A N/A 136.706 SUP HCPCS C1713 "136.706 - RELIEVE 2.6mm Screw, Self-Tapping, 6mm" BOTH IP/OP $527.50 $390.00 $104.70 $527.50 $237.38 $237.38 $237.38 $237.38 $527.50 $527.50 $527.50 $109.94 $527.50 $527.50 $527.50 $527.50 $527.50 $109.94 $527.50 $211.00 $312.02 $527.50 $527.50 $527.50 $527.50 $395.63 $527.50 $527.50 $527.50 $263.75 $263.75 $417.78 $527.50 $422.00 $237.38 $104.70 N/A $305.95 $527.50 $316.50 $527.50 $109.93 $527.50 N/A N/A 136.708 SUP HCPCS C1713 "136.708 - RELIEVE 2.6mm Screw, Self-Tapping, 8mm" BOTH IP/OP $527.50 $390.00 $104.70 $527.50 $237.38 $237.38 $237.38 $237.38 $527.50 $527.50 $527.50 $109.94 $527.50 $527.50 $527.50 $527.50 $527.50 $109.94 $527.50 $211.00 $312.02 $527.50 $527.50 $527.50 $527.50 $395.63 $527.50 $527.50 $527.50 $263.75 $263.75 $417.78 $527.50 $422.00 $237.38 $104.70 N/A $305.95 $527.50 $316.50 $527.50 $109.93 $527.50 N/A N/A 136.71 SUP HCPCS C1713 "136.710 - RELIEVE 2.6mm Screw, Self-Tapping, 10mm" BOTH IP/OP $527.50 $390.00 $104.70 $527.50 $237.38 $237.38 $237.38 $237.38 $527.50 $527.50 $527.50 $109.94 $527.50 $527.50 $527.50 $527.50 $527.50 $109.94 $527.50 $211.00 $312.02 $527.50 $527.50 $527.50 $527.50 $395.63 $527.50 $527.50 $527.50 $263.75 $263.75 $417.78 $527.50 $422.00 $237.38 $104.70 N/A $305.95 $527.50 $316.50 $527.50 $109.93 $527.50 N/A N/A 136.712 SUP HCPCS C1713 "136.712 - RELIEVE 2.6mm Screw, Self-Tapping, 12mm" BOTH IP/OP $527.50 $390.00 $104.70 $527.50 $237.38 $237.38 $237.38 $237.38 $527.50 $527.50 $527.50 $109.94 $527.50 $527.50 $527.50 $527.50 $527.50 $109.94 $527.50 $527.50 $312.02 $527.50 $527.50 $527.50 $527.50 $395.63 $527.50 $527.50 $527.50 $263.75 $263.75 $417.78 $527.50 $422.00 $237.38 $104.70 N/A $305.95 $527.50 $316.50 $527.50 $109.93 $527.50 N/A N/A 142 SUP HCPCS A4624 142 - CATHETER SCT 16FR 12FR STRL LF HALYARD DRCT O2 PORT ATRM TIP BOTH IP/OP $109.00 $81.00 $45.78 $81.75 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $45.78 N/A N/A N/A N/A N/A $81.75 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $63.22 N/A N/A N/A N/A N/A N/A N/A 150.01 SUP HCPCS C1713 150.010 - SCREW BONE 10MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.011 SUP HCPCS C1713 150.011 - SCREW BONE 4.2MM 11MM SLFDRILL FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.012 SUP HCPCS C1713 150.012 - SCREW BONE 4.2MM 12MM SLFDRILL FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.013 SUP HCPCS C1713 150.013 - SCREW BONE 4.2MM 13MM SLFDRILL FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.014 SUP HCPCS C1713 150.014 - SCREW BONE 4.2MM 14MM FIX ANGLE SELF DRILL PROTEX CT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.015 SUP HCPCS C1713 150.015 - SCREW BONE 4.2MM 15MM SLFDRILL FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.016 SUP HCPCS C1713 150.016 - SCREW BN 4.2MM 16MM NS PRTX CTTI SLF DRL FX ANG SPNE OCT PRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.03 SUP HCPCS C1713 150.030 - SCREW BONE 30MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.031 SUP HCPCS C1713 150.031 - SCREW BONE 4.2MM 11MM SLFTAP FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.032 SUP HCPCS C1713 150.032 - SCREW BONE 4.2MM 12MM SLFTAP FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.033 SUP HCPCS C1713 150.033 - SCREW BONE 4.2MM 13MM SLFTAP FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.034 SUP HCPCS C1713 150.034 - SCREW BONE 4.2MM 14MM SLFTAP FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.035 SUP HCPCS C1713 150.035 - SCREW BONE 4.2MM 15MM SLFTAP FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.036 SUP HCPCS C1713 150.036 - SCREW BONE 4.2MM 16MM SLFTAP FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.038 SUP HCPCS C1713 150.038 - SCREW BONE 4.2MM 18MM SLFTAP FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.04 SUP HCPCS C1713 150.040 - SCREW BONE 40MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.042 SUP HCPCS C1713 150.042 - PLATE BONE FIXANG PROVIDENCE SPN STERILE 4.2 MM SCREW BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.044 SUP HCPCS C1713 150.044 - PLATE BONE FIXANG PROVIDENCE SPN STERILE 4.2 MM SCREW BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.046 SUP HCPCS C1713 150.046 - PLATE BONE FIXANG PROVIDENCE SPN STERILE 4.2 MM SCREW BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.11 SUP HCPCS C1713 150.110 - PLATE BN 10MM NS PRV LVL 1 SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 150.112 SUP HCPCS C1713 150.112 - PLATE BN 12MM NS PRV LVL 1 SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 150.114 SUP HCPCS C1713 150.114 - PLATE BN 14MM NS PRV LVL 1 SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 150.116 SUP HCPCS C1713 150.116 - PLATE BN 16MM NS PRV LVL 1 SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 150.118 SUP HCPCS C1713 150.118 - PLATE BN 18MM NS PRV LVL 1 SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 150.12 SUP HCPCS C1713 150.120 - PLATE BONE 20MM LEVEL 1 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 150.122 SUP HCPCS C1713 150.122 - PLATE BONE 22MM LEVEL 1 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 150.124 SUP HCPCS C1713 150.124 - PLATE BN 24MM NS PRV LVL 1 SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 150.126 SUP HCPCS C1713 150.126 - PLATE BONE 26MM LEVEL 1 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 150.13 SUP HCPCS C1713 "150.130 - PROVIDENCE Anterior Cervical Plate 1-Level, Extra Lordotic," BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 150.132 SUP HCPCS C1713 150.132 - PLATE BONE 12MM PROVIDENCE SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 150.134 SUP HCPCS C1713 "150.134 - PROVIDENCE Anterior Cervical Plate 1-Level, Extra Lordotic," BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 150.224 SUP HCPCS C1713 150.224 - PLATE BN 24MM NS PRV LVL 2 SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 150.226 SUP HCPCS C1713 150.226 - PLATE BN 26MM NS PRV LVL 2 SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 150.228 SUP HCPCS C1713 150.228 - PLATE BN 28MM NS PRV LVL 2 SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 150.23 SUP HCPCS C1713 150.230 - PLATE BN 30MM NS PRV LVL 2 SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 150.232 SUP HCPCS C1713 150.232 - PLATE BN 32MM NS PRV 2 LVL TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 150.234 SUP HCPCS C1713 150.234 - PLATE BN 34MM NS PRV LVL 2 SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 150.236 SUP HCPCS C1713 150.236 - PLATE BN 36MM NS PRV LVL 2 SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 150.238 SUP HCPCS C1713 150.238 - PLATE BN 38MM NS PRV LVL 2 SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 150.24 SUP HCPCS C1713 150.240 - PLATE BN 40MM NS PRV LVL 2 SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 150.242 SUP HCPCS C1713 150.242 - PLATE BONE 42MM LEVEL 2 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 150.244 SUP HCPCS C1713 150.244 - PLATE BONE 44MM LEVEL 2 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 150.246 SUP HCPCS C1713 150.246 - PLATE BONE 46MM LEVEL 2 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 150.254 SUP HCPCS C1713 "150.254 - PROVIDENCE Anterior Cervical Plate 2-Level, Extra Lordotic," BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 150.256 SUP HCPCS C1713 "150.256 - PROVIDENCE Anterior Cervical Plate 2-Level, Extra Lordotic," BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 150.339 SUP HCPCS C1713 150.339 - PLATE BN 39MM NS PRV LVL 3 SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 150.342 SUP HCPCS C1713 150.342 - PLATE BN 42MM NS PRV LVL 3 SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 150.345 SUP HCPCS C1713 150.345 - PLATE BN 45MM NS PRV 3 LVL TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 150.348 SUP HCPCS C1713 150.348 - PLATE BN 48MM NS PRV LVL 3 SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 150.351 SUP HCPCS C1713 150.351 - PLATE BN 51MM NS PRV LVL 3 SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 150.354 SUP HCPCS C1713 150.354 - PLATE BN 54MM NS PRV LVL 3 SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 150.357 SUP HCPCS C1713 150.357 - PLATE BN 57MM NS PRV LVL 3 SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 150.36 SUP HCPCS C1713 150.360 - PLATE BONE 60MM LEVEL 3 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 150.363 SUP HCPCS C1713 150.363 - PLATE BONE 63MM LEVEL 3 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 150.366 SUP HCPCS C1713 150.366 - PLATE BN 66MM NS PRV LVL 3 SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 150.369 SUP HCPCS C1713 150.369 - PLATE BN 69MM NS PRV LVL 3 SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 150.379 SUP HCPCS C1713 "150.379 - PROVIDENCE Anterior Cervical Plate 3-Level, Extra Lordotic," BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 150.46 SUP HCPCS C1713 150.460 - PLATE BN 60MM NS PRV LVL 4 SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.463 SUP HCPCS C1713 150.463 - PLATE BN 63MM NS PRV LVL 4 SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.466 SUP HCPCS C1713 150.466 - PLATE BN 66MM NS PRV LVL 4 SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.469 SUP HCPCS C1713 150.469 - PLATE BONE 69MM LEVEL 4 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.472 SUP HCPCS C1713 150.472 - PLATE BONE 72MM LEVEL 4 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.475 SUP HCPCS C1713 150.475 - PLATE BONE 75MM LEVEL 4 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.478 SUP HCPCS C1713 150.478 - PLATE BN 78MM NS PRV LVL 4 SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.481 SUP HCPCS C1713 150.481 - PLATE BONE 81MM LEVEL 4 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.484 SUP HCPCS C1713 150.484 - PLATE BONE 84MM LEVEL 4 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.487 SUP HCPCS C1713 150.487 - PLATE BONE 87MM LEVEL 4 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.49 SUP HCPCS C1713 150.490 - PLATE BONE 90MM LEVEL 4 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.493 SUP HCPCS C1713 150.493 - PLATE BONE 93MM LEVEL 4 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.51 SUP HCPCS C1713 150.510 - SCREW BONE 10MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.511 SUP HCPCS C1713 150.511 - SCREW BONE 4.6MM 11MM SLFDRILL FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.512 SUP HCPCS C1713 150.512 - SCREW BONE 4.6MM 12MM SLFDRILL FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.513 SUP HCPCS C1713 150.513 - SCREW BONE 4.6MM 13MM SLFDRILL FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.514 SUP HCPCS C1713 150.514 - SCREW BONE 4.6MM 14MM FIX ANGLE SELF DRILL PROTEX CT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.515 SUP HCPCS C1713 150.515 - SCREW BONE 4.6MM 15MM SLFDRILL FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.516 SUP HCPCS C1713 150.516 - SCREW BN 4.6MM 16MM NS PRTX CTTI SLF DRL FX ANG SPNE OCT PRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.53 SUP HCPCS C1713 150.530 - SCREW BONE 30MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.531 SUP HCPCS C1713 150.531 - SCREW BONE 4.6MM 11MM SLFTAP FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.532 SUP HCPCS C1713 150.532 - SCREW BONE 4.6MM 12MM SLFTAP FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.533 SUP HCPCS C1713 150.533 - SCREW BONE 4.6MM 13MM SLFTAP FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.534 SUP HCPCS C1713 150.534 - SCREW BONE 4.6MM 14MM SLFTAP FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.535 SUP HCPCS C1713 150.535 - SCREW BONE 4.6MM 15MM SLFTAP FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.536 SUP HCPCS C1713 150.536 - SCREW BONE 4.6MM 16MM SLFTAP FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.538 SUP HCPCS C1713 150.538 - SCREW BONE 4.6MM 18MM SLFTAP FIXANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.54 SUP HCPCS C1713 150.540 - SCREW BONE 40MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.542 SUP HCPCS C1713 150.542 - PLATE BONE FIXANG PROVIDENCE SPN STERILE 4.6 MM SCREW BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.544 SUP HCPCS C1713 150.544 - PLATE BONE FIXANG PROVIDENCE SPN STERILE 4.6 MM SCREW BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.546 SUP HCPCS C1713 150.546 - PLATE BONE FIXANG PROVIDENCE SPN STERILE 4.6 MM SCREW BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.58 SUP HCPCS C1713 150.580 - PLATE BONE 80MM LEVEL 5 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.583 SUP HCPCS C1713 150.583 - PLATE BONE 83MM LEVEL 5 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.586 SUP HCPCS C1713 150.586 - PLATE BONE 86MM LEVEL 5 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.589 SUP HCPCS C1713 150.589 - PLATE BONE 89MM LEVEL 5 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.592 SUP HCPCS C1713 150.592 - PLATE BONE 92MM LEVEL 5 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.595 SUP HCPCS C1713 150.595 - PLATE BN 95MM NS PRV LVL 5 SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.598 SUP HCPCS C1713 150.598 - PLATE BONE 98MM LEVEL 5 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.601 SUP HCPCS C1713 150.601 - PLATE BONE 101MM LEVEL 5 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.604 SUP HCPCS C1713 150.604 - PLATE BONE 104MM LEVEL 5 PROTEX CT TITANIUM SPN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 150.61 SUP HCPCS C1713 150.610 - SCREW BONE 10MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.611 SUP HCPCS C1713 150.611 - SCREW BONE 4.2MM 11MM SLFDRILL VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.612 SUP HCPCS C1713 150.612 - SCREW BONE 4.2MM 12MM SLFDRILL VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.613 SUP HCPCS C1713 150.613 - SCREW BONE 4.2MM 13MM SLFDRILL VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.614 SUP HCPCS C1713 150.614 - SCREW BONE 4.2MM 14MM SELF DRILL PROTEX CT SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.615 SUP HCPCS C1713 150.615 - SCREW BONE 4.2MM 15MM SLFDRILL VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.616 SUP HCPCS C1713 150.616 - SCREW BN 4.2MM 16MM NS PRTX CTTI SLF DRL VA SPNE OCT PRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.618 SUP HCPCS C1713 150.618 - SCREW BONE 4.2MM 18MM SLFDRILL VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.71 SUP HCPCS C1713 150.710 - SCREW BONE 10MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.711 SUP HCPCS C1713 150.711 - SCREW BONE 4.6MM 11MM SLFDRILL VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.712 SUP HCPCS C1713 150.712 - SCREW BONE 4.6MM 12MM SLFDRILL VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.713 SUP HCPCS C1713 150.713 - SCREW BONE 4.6MM 13MM SLFDRILL VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.714 SUP HCPCS C1713 150.714 - SCREW BONE 4.6MM 14MM SLFDRILL VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.715 SUP HCPCS C1713 150.715 - SCREW BONE 4.6MM 15MM SLFDRILL VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.716 SUP HCPCS C1713 150.716 - SCREW BONE 4.6MM 16MM SLFDRILL VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.81 SUP HCPCS C1713 150.810 - SCREW BONE 10MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.811 SUP HCPCS C1713 150.811 - SCREW BONE 4.2MM 11MM SLFTAP VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.812 SUP HCPCS C1713 150.812 - SCREW BONE 4.2MM 12MM SLFTAP VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.813 SUP HCPCS C1713 150.813 - SCREW BONE 4.2MM 13MM SLFTAP VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.814 SUP HCPCS C1713 150.814 - SCREW BONE 4.2MM 14MM VAR ANG SELF TAP PROVIDENCE SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.815 SUP HCPCS C1713 150.815 - SCREW BONE 4.2MM 15MM SLFTAP VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.816 SUP HCPCS C1713 150.816 - SCREW BONE 4.2MM 16MM SLFTAP VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.818 SUP HCPCS C1713 150.818 - SCREW BONE 4.6MM 18MM SLFTAP VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.82 SUP HCPCS C1713 150.820 - SCREW BONE 20MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.822 SUP HCPCS C1713 150.822 - PLATE BONE VAR ANG PROVIDENCE SPN 4.2 MM SCREW BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.824 SUP HCPCS C1713 150.824 - PLATE BONE VAR ANG PROVIDENCE SPN 4.2 MM SCREW BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.826 SUP HCPCS C1713 150.826 - PLATE BONE VAR ANG PROVIDENCE SPN 4.2 MM SCREW BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.91 SUP HCPCS C1713 150.910 - SCREW BONE 10MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.911 SUP HCPCS C1713 150.911 - SCREW BONE 4.6MM 11MM SLFTAP VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.912 SUP HCPCS C1713 150.912 - SCREW BONE 4.6MM 12MM SLFTAP VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.913 SUP HCPCS C1713 150.913 - SCREW BONE 4.6MM 13MM SLFTAP VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.914 SUP HCPCS C1713 150.914 - SCREW BONE 4.6MM 14MM VAR ANG SELF TAP PROVIDENCE SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.915 SUP HCPCS C1713 150.915 - SCREW BONE 4.6MM 15MM SLFTAP VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.916 SUP HCPCS C1713 150.916 - SCREW BONE 4.6MM 16MM SLFTAP VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.918 SUP HCPCS C1713 150.918 - SCREW BONE 4.6MM 18MM SLFTAP VAR ANG PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.92 SUP HCPCS C1713 150.920 - SCREW BONE 20MM POLYAX SLFTAP PROTEX CT TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.922 SUP HCPCS C1713 150.922 - PLATE BONE VAR ANG PROVIDENCE SPN 4.6 MM SCREW BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 150.924 SUP HCPCS C1713 150.924 - PLATE BONE VAR ANG PROVIDENCE SPN 4.6 MM SCREW BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 150.926 SUP HCPCS C1713 150.926 - PLATE BONE VAR ANG PROVIDENCE SPN 4.6 MM SCREW BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 151.001 SUP Custom 27803010 151.001 - SPACER SPNL 0D 12MM 12X15MM NS LF FORTIFY NO SPK BOTH IP/OP "$16,080.00" "$11,899.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$3,351.25" "$16,080.00" "$6,432.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$12,060.00" "$16,080.00" "$16,080.00" "$16,080.00" "$8,040.00" "$8,040.00" "$12,735.36" "$16,080.00" "$12,864.00" "$7,236.00" "$16,080.00" N/A "$9,326.40" "$16,080.00" "$9,648.00" "$16,080.00" "$16,080.00" "$16,080.00" N/A N/A 151.002 SUP Custom 27803010 151.002 - SPACER SPNL 0D 12MM 12X16MM NS LF FORTIFY BOTH IP/OP "$16,080.00" "$11,899.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$3,351.25" "$16,080.00" "$6,432.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$12,060.00" "$16,080.00" "$16,080.00" "$16,080.00" "$8,040.00" "$8,040.00" "$12,735.36" "$16,080.00" "$12,864.00" "$7,236.00" "$16,080.00" N/A "$9,326.40" "$16,080.00" "$9,648.00" "$16,080.00" "$16,080.00" "$16,080.00" N/A N/A 151.003 SUP Custom 27803010 151.003 - SPACER SPNL 3.5D 12MM 12X16MM NS LF FORTIFY NO SPK BOTH IP/OP "$16,080.00" "$11,899.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$3,351.25" "$16,080.00" "$6,432.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$12,060.00" "$16,080.00" "$16,080.00" "$16,080.00" "$8,040.00" "$8,040.00" "$12,735.36" "$16,080.00" "$12,864.00" "$7,236.00" "$16,080.00" N/A "$9,326.40" "$16,080.00" "$9,648.00" "$16,080.00" "$16,080.00" "$16,080.00" N/A N/A 151.004 SUP Custom 27803010 151.004 - SPACER SPNL 3.5D 12MM 12X17MM NS LF FORTIFY BOTH IP/OP "$16,080.00" "$11,899.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$3,351.25" "$16,080.00" "$6,432.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$12,060.00" "$16,080.00" "$16,080.00" "$16,080.00" "$8,040.00" "$8,040.00" "$12,735.36" "$16,080.00" "$12,864.00" "$7,236.00" "$16,080.00" N/A "$9,326.40" "$16,080.00" "$9,648.00" "$16,080.00" "$16,080.00" "$16,080.00" N/A N/A 151.05 SUP Custom 27803010 151.050 - SPACER SPNL 12MM 12X18MM NS LF FORTIFY BOTH IP/OP "$16,080.00" "$11,899.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$3,351.25" "$16,080.00" "$6,432.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$12,060.00" "$16,080.00" "$16,080.00" "$16,080.00" "$8,040.00" "$8,040.00" "$12,735.36" "$16,080.00" "$12,864.00" "$7,236.00" "$16,080.00" N/A "$9,326.40" "$16,080.00" "$9,648.00" "$16,080.00" "$16,080.00" "$16,080.00" N/A N/A 151.051 SUP Custom 27803010 151.051 - SPACER SPNL 12MM 12X19MM NS LF FORTIFY BOTH IP/OP "$16,080.00" "$11,899.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$3,351.25" "$16,080.00" "$6,432.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$12,060.00" "$16,080.00" "$16,080.00" "$16,080.00" "$8,040.00" "$8,040.00" "$12,735.36" "$16,080.00" "$12,864.00" "$7,236.00" "$16,080.00" N/A "$9,326.40" "$16,080.00" "$9,648.00" "$16,080.00" "$16,080.00" "$16,080.00" N/A N/A 151.052 SUP Custom 27803010 151.052 - SPACER SPNL 12MM 12X21MM NS LF FORTIFY BOTH IP/OP "$16,080.00" "$11,899.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$3,351.25" "$16,080.00" "$6,432.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$12,060.00" "$16,080.00" "$16,080.00" "$16,080.00" "$8,040.00" "$8,040.00" "$12,735.36" "$16,080.00" "$12,864.00" "$7,236.00" "$16,080.00" N/A "$9,326.40" "$16,080.00" "$9,648.00" "$16,080.00" "$16,080.00" "$16,080.00" N/A N/A 151.053 SUP Custom 27803010 151.053 - SPACER SPNL 12MM 12X25MM NS LF FORTIFY BOTH IP/OP "$16,080.00" "$11,899.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$3,351.25" "$16,080.00" "$6,432.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$12,060.00" "$16,080.00" "$16,080.00" "$16,080.00" "$8,040.00" "$8,040.00" "$12,735.36" "$16,080.00" "$12,864.00" "$7,236.00" "$16,080.00" N/A "$9,326.40" "$16,080.00" "$9,648.00" "$16,080.00" "$16,080.00" "$16,080.00" N/A N/A 151.054 SUP Custom 27803010 151.054 - SPACER SPNL 12MM 12X33MM NS LF FORTIFY BOTH IP/OP "$16,080.00" "$11,899.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$3,351.25" "$16,080.00" "$6,432.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$12,060.00" "$16,080.00" "$16,080.00" "$16,080.00" "$8,040.00" "$8,040.00" "$12,735.36" "$16,080.00" "$12,864.00" "$7,236.00" "$16,080.00" N/A "$9,326.40" "$16,080.00" "$9,648.00" "$16,080.00" "$16,080.00" "$16,080.00" N/A N/A 151.055 SUP Custom 27803010 151.055 - SPACER SPNL 12MM 12X48MM NS LF FORTIFY BOTH IP/OP "$16,080.00" "$11,899.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$3,351.25" "$16,080.00" "$6,432.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$12,060.00" "$16,080.00" "$16,080.00" "$16,080.00" "$8,040.00" "$8,040.00" "$12,735.36" "$16,080.00" "$12,864.00" "$7,236.00" "$16,080.00" N/A "$9,326.40" "$16,080.00" "$9,648.00" "$16,080.00" "$16,080.00" "$16,080.00" N/A N/A 151.056 SUP Custom 27803010 151.056 - SPACER SPNL 12MM 12X67MM NS LF FORTIFY BOTH IP/OP "$16,080.00" "$11,899.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$2,862.24" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$3,351.25" "$16,080.00" "$6,432.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$16,080.00" "$12,060.00" "$16,080.00" "$16,080.00" "$16,080.00" "$8,040.00" "$8,040.00" "$12,735.36" "$16,080.00" "$12,864.00" "$7,236.00" "$16,080.00" N/A "$9,326.40" "$16,080.00" "$9,648.00" "$16,080.00" "$16,080.00" "$16,080.00" N/A N/A 151.15 SUP Custom 27803010 151.150 - SPACER SPNL 20MM 20X23MM NS LF FORTIFY BOTH IP/OP "$21,100.00" "$15,614.00" "$3,755.80" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$3,755.80" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$4,397.47" "$21,100.00" "$8,440.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$15,825.00" "$21,100.00" "$21,100.00" "$21,100.00" "$10,550.00" "$10,550.00" "$16,711.20" "$21,100.00" "$16,880.00" "$9,495.00" "$21,100.00" N/A "$12,238.00" "$21,100.00" "$12,660.00" "$21,100.00" "$21,100.00" "$21,100.00" N/A N/A 151.151 SUP Custom 27803010 151.151 - SPACER SPNL 20MM 20X26MM NS LF FORTIFY BOTH IP/OP "$21,100.00" "$15,614.00" "$3,755.80" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$3,755.80" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$4,397.47" "$21,100.00" "$8,440.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$15,825.00" "$21,100.00" "$21,100.00" "$21,100.00" "$10,550.00" "$10,550.00" "$16,711.20" "$21,100.00" "$16,880.00" "$9,495.00" "$21,100.00" N/A "$12,238.00" "$21,100.00" "$12,660.00" "$21,100.00" "$21,100.00" "$21,100.00" N/A N/A 151.152 SUP Custom 27803010 151.152 - SPACER SPNL 20MM 20X31MM NS LF FORTIFY BOTH IP/OP "$21,100.00" "$15,614.00" "$3,755.80" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$3,755.80" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$4,397.47" "$21,100.00" "$8,440.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$15,825.00" "$21,100.00" "$21,100.00" "$21,100.00" "$10,550.00" "$10,550.00" "$16,711.20" "$21,100.00" "$16,880.00" "$9,495.00" "$21,100.00" N/A "$12,238.00" "$21,100.00" "$12,660.00" "$21,100.00" "$21,100.00" "$21,100.00" N/A N/A 151.153 SUP Custom 27803010 151.153 - SPACER SPNL 20MM 20X41MM NS LF FORTIFY BOTH IP/OP "$21,100.00" "$15,614.00" "$3,755.80" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$3,755.80" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$4,397.47" "$21,100.00" "$8,440.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$15,825.00" "$21,100.00" "$21,100.00" "$21,100.00" "$10,550.00" "$10,550.00" "$16,711.20" "$21,100.00" "$16,880.00" "$9,495.00" "$21,100.00" N/A "$12,238.00" "$21,100.00" "$12,660.00" "$21,100.00" "$21,100.00" "$21,100.00" N/A N/A 151.154 SUP Custom 27803010 151.154 - SPACER SPNL 20MM 20X62MM NS LF FORTIFY BOTH IP/OP "$21,100.00" "$15,614.00" "$3,755.80" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$3,755.80" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$4,397.47" "$21,100.00" "$8,440.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$15,825.00" "$21,100.00" "$21,100.00" "$21,100.00" "$10,550.00" "$10,550.00" "$16,711.20" "$21,100.00" "$16,880.00" "$9,495.00" "$21,100.00" N/A "$12,238.00" "$21,100.00" "$12,660.00" "$21,100.00" "$21,100.00" "$21,100.00" N/A N/A 151.155 SUP Custom 27803010 151.155 - SPACER SPNL 20MM 20X90MM NS LF FORTIFY BOTH IP/OP "$21,100.00" "$15,614.00" "$3,755.80" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$3,755.80" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$4,397.47" "$21,100.00" "$8,440.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$21,100.00" "$15,825.00" "$21,100.00" "$21,100.00" "$21,100.00" "$10,550.00" "$10,550.00" "$16,711.20" "$21,100.00" "$16,880.00" "$9,495.00" "$21,100.00" N/A "$12,238.00" "$21,100.00" "$12,660.00" "$21,100.00" "$21,100.00" "$21,100.00" N/A N/A 151.32 SUP HCPCS C1713 151.320 - SPACER SPNL 0D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.321 SUP HCPCS C1713 151.321 - SPACER SPNL 0D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.322 SUP HCPCS C1713 151.322 - SPACER SPNL 3.5D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.323 SUP HCPCS C1713 151.323 - SPACER SPNL 3.5D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" "$1,335.00" $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" "$1,335.00" "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.324 SUP HCPCS C1713 151.324 - SPACER SPNL 7D 12MM 14X12MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" "$1,335.00" "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.331 SUP HCPCS C1713 151.331 - SPACER SPNL 0D 15MM 18X12MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.333 SUP HCPCS C1713 151.333 - SPACER SPNL 3.5D 15MM 18X12MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.334 SUP HCPCS C1713 151.334 - SPACER SPNL 7D 15MM 18X12MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.371 SUP HCPCS C1713 151.371 - SPACER SPNL 0D 12MM 14X12MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.373 SUP HCPCS C1713 151.373 - SPACER SPNL 3.5D 12MM 14X12MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.374 SUP HCPCS C1713 151.374 - SPACER SPNL 7D 12MM 14X12MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" "$1,335.00" $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" "$1,335.00" "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.381 SUP HCPCS C1713 151.381 - SPACER SPNL 0D 15MM 18X12MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.383 SUP HCPCS C1713 151.383 - SPACER SPNL 3.5D 15MM 18X12MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.384 SUP HCPCS C1713 151.384 - SPACER SPNL 7D 15MM 18X12MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.401 SUP HCPCS C1713 151.401 - SPACER SPNL 0D 20MM 20X20MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.403 SUP HCPCS C1713 151.403 - SPACER SPNL 4D 20MM 20X20MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" "$1,335.00" $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" "$1,335.00" "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.404 SUP HCPCS C1713 151.404 - SPACER SPNL 8D 20MM 20X20MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" "$1,335.00" $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" "$1,335.00" "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.411 SUP HCPCS C1713 151.411 - SPACER SPNL 0D 21MM 23X20MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.413 SUP HCPCS C1713 151.413 - SPACER SPNL 4D 21MM 23X20MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.414 SUP HCPCS C1713 151.414 - SPACER SPNL 8D 21MM 23X20MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.431 SUP HCPCS C1713 151.431 - SPACER SPNL 0D 25MM 30X20MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.433 SUP HCPCS C1713 151.433 - SPACER SPNL 4D 25MM 30X20MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.434 SUP HCPCS C1713 151.434 - SPACER SPNL 8D 25MM 30X20MM NS LF FORTIFY FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.451 SUP HCPCS C1713 151.451 - SPACER SPNL 0D 20MM 20X20MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" "$1,335.00" $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.453 SUP HCPCS C1713 151.453 - SPACER SPNL 4D 20MM 20X20MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.454 SUP HCPCS C1713 151.454 - SPACER SPNL 8D 20MM 20X20MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.461 SUP HCPCS C1713 151.461 - SPACER SPNL 0D 21MM 23X20MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.463 SUP HCPCS C1713 151.463 - SPACER SPNL 4D 21MM 23X20MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.464 SUP HCPCS C1713 151.464 - SPACER SPNL 8D 21MM 23X20MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.481 SUP HCPCS C1713 151.481 - SPACER SPNL 0D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.483 SUP HCPCS C1713 151.483 - SPACER SPNL 4D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.484 SUP HCPCS C1713 151.484 - SPACER SPNL 8D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.485 SUP HCPCS C1713 151.485 - SPACER SPNL 12D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.486 SUP HCPCS C1713 151.486 - SPACER SPNL 16D 25MM 30X20MM NS LF FORTIFY FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.601 SUP HCPCS C1713 151.601 - SPACER SPNL 0D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.603 SUP HCPCS C1713 151.603 - SPACER SPNL 4D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.604 SUP HCPCS C1713 151.604 - SPACER SPNL 8D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.605 SUP HCPCS C1713 151.605 - SPACER SPNL 12D 22MM 40X20MM NS LF FORTIFY UPR EPLT SGTL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.611 SUP HCPCS C1713 151.611 - SPACER SPNL 0D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.613 SUP HCPCS C1713 151.613 - SPACER SPNL 4D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.614 SUP HCPCS C1713 151.614 - SPACER SPNL 8D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.615 SUP HCPCS C1713 151.615 - SPACER SPNL 12D 22MM 45X20MM NS LF FORTIFY UPR EPLT SGTL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.621 SUP HCPCS C1713 151.621 - SPACER SPNL 0D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.623 SUP HCPCS C1713 151.623 - SPACER SPNL 4D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.624 SUP HCPCS C1713 151.624 - SPACER SPNL 8D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.625 SUP HCPCS C1713 151.625 - SPACER SPNL 12D 22MM 50X20MM NS LF FORTIFY UPR EPLT SGTL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.651 SUP HCPCS C1713 151.651 - SPACER SPNL 0D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.653 SUP HCPCS C1713 151.653 - SPACER SPNL 4D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.654 SUP HCPCS C1713 151.654 - SPACER SPNL 8D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.655 SUP HCPCS C1713 151.655 - SPACER SPNL 12D 22MM 40X20MM NS LF FORTIFY LWR EPLT SGTL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.661 SUP HCPCS C1713 151.661 - SPACER SPNL 0D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.663 SUP HCPCS C1713 151.663 - SPACER SPNL 4D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.664 SUP HCPCS C1713 151.664 - SPACER SPNL 8D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.665 SUP HCPCS C1713 151.665 - SPACER SPNL 12D 22MM 45X20MM NS LF FORTIFY LWR EPLT SGTL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.671 SUP HCPCS C1713 151.671 - SPACER SPNL 0D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.673 SUP HCPCS C1713 151.673 - SPACER SPNL 4D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.674 SUP HCPCS C1713 151.674 - SPACER SPNL 8D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL PRFL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.675 SUP HCPCS C1713 151.675 - SPACER SPNL 12D 22MM 50X20MM NS LF FORTIFY LWR EPLT SGTL BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 151.701 SUP HCPCS C1713 151.701 - SPACER SPNL 0D 14MM 16X12MM NS LF FORTIFY UPR EPLT SGTL PRFL BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" "$1,335.00" "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.703 SUP HCPCS C1713 151.703 - SPACER SPNL 3.5D 14MM 16X12MM NS LF FORTIFY UPR EPLT SGTL BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.704 SUP HCPCS C1713 151.704 - SPACER SPNL 7D 14MM 16X12MM NS LF FORTIFY UPR EPLT SGTL PRFL BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.751 SUP HCPCS C1713 151.751 - SPACER SPNL 0D 14MM 16X12MM NS LF FORTIFY LWR EPLT SGTL PRFL BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.753 SUP HCPCS C1713 151.753 - SPACER SPNL 3.5D 14MM 16X12MM NS LF FORTIFY LWR EPLT SGTL BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 151.754 SUP HCPCS C1713 151.754 - SPACER SPNL 7D 14MM 16X12MM NS LF FORTIFY LWR EPLT SGTL PRFL BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" "$1,335.00" "$1,335.00" $278.21 "$1,335.00" N/A N/A 152 SUP HCPCS L1830 152 - BRACE ORTH LNG SM 14-18IN 26IN LF QKFL BCKL PS VLCR STRAP BOTH IP/OP $174.00 $129.00 $36.18 $173.60 $173.60 $173.60 $173.60 $173.60 $173.60 $173.60 $48.84 $173.60 $173.60 $173.60 $173.60 $173.60 $173.60 $36.18 $173.60 $69.44 $173.60 $173.60 $173.60 $173.60 $173.60 $130.50 $173.60 $173.60 $173.60 $86.80 $86.80 $137.49 $173.60 $138.88 $78.12 $173.60 N/A $100.92 $173.60 $104.16 $173.60 $173.60 $173.60 N/A N/A 154.7 SUP Custom 27803010 154.700 - CONNECTOR ROD 5.5MM INLINE SPN BOTH IP/OP "$10,800.00" "$7,992.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$2,250.84" "$10,800.00" "$4,320.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$8,100.00" "$10,800.00" "$10,800.00" "$10,800.00" "$5,400.00" "$5,400.00" "$8,553.60" "$10,800.00" "$8,640.00" "$4,860.00" "$10,800.00" N/A "$6,264.00" "$10,800.00" "$6,480.00" "$10,800.00" "$10,800.00" "$10,800.00" N/A N/A 154.705 SUP Custom 27803010 154.705 - CLAMP SURG 5.5-6MM EXTN SPN LEFT BOTH IP/OP "$10,800.00" "$7,992.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$2,250.84" "$10,800.00" "$4,320.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$8,100.00" "$10,800.00" "$10,800.00" "$10,800.00" "$5,400.00" "$5,400.00" "$8,553.60" "$10,800.00" "$8,640.00" "$4,860.00" "$10,800.00" N/A "$6,264.00" "$10,800.00" "$6,480.00" "$10,800.00" "$10,800.00" "$10,800.00" N/A N/A 154.71 SUP Custom 27803010 154.710 - CONNECTOR ROD 10MM INLINE SPN GS BOTH IP/OP "$10,800.00" "$7,992.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$2,250.84" "$10,800.00" "$4,320.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$8,100.00" "$10,800.00" "$10,800.00" "$10,800.00" "$5,400.00" "$5,400.00" "$8,553.60" "$10,800.00" "$8,640.00" "$4,860.00" "$10,800.00" N/A "$6,264.00" "$10,800.00" "$6,480.00" "$10,800.00" "$10,800.00" "$10,800.00" N/A N/A 154.715 SUP Custom 27803010 154.715 - CONNECTOR ROD 15MM INLINE SPN BOTH IP/OP "$10,800.00" "$7,992.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$2,250.84" "$10,800.00" "$4,320.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$8,100.00" "$10,800.00" "$10,800.00" "$10,800.00" "$5,400.00" "$5,400.00" "$8,553.60" "$10,800.00" "$8,640.00" "$4,860.00" "$10,800.00" N/A "$6,264.00" "$10,800.00" "$6,480.00" "$10,800.00" "$10,800.00" "$10,800.00" N/A N/A 154.72 SUP Custom 27803010 154.720 - CONNECTOR ROD 5.5MM INLINE SPN LEFT BOTH IP/OP "$10,800.00" "$7,992.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$2,250.84" "$10,800.00" "$4,320.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$8,100.00" "$10,800.00" "$10,800.00" "$10,800.00" "$5,400.00" "$5,400.00" "$8,553.60" "$10,800.00" "$8,640.00" "$4,860.00" "$10,800.00" N/A "$6,264.00" "$10,800.00" "$6,480.00" "$10,800.00" "$10,800.00" "$10,800.00" N/A N/A 154.725 SUP Custom 27803010 154.725 - CONNECTOR ROD 5.5MM INLINE SPN BOTH IP/OP "$10,800.00" "$7,992.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$2,250.84" "$10,800.00" "$4,320.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$8,100.00" "$10,800.00" "$10,800.00" "$10,800.00" "$5,400.00" "$5,400.00" "$8,553.60" "$10,800.00" "$8,640.00" "$4,860.00" "$10,800.00" N/A "$6,264.00" "$10,800.00" "$6,480.00" "$10,800.00" "$10,800.00" "$10,800.00" N/A N/A 154.73 SUP Custom 27803010 154.730 - CLAMP SPINAL 6-6.5MM EXTN SPN RIGHT BOTH IP/OP "$10,800.00" "$7,992.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$2,250.84" "$10,800.00" "$4,320.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$8,100.00" "$10,800.00" "$10,800.00" "$10,800.00" "$5,400.00" "$5,400.00" "$8,553.60" "$10,800.00" "$8,640.00" "$4,860.00" "$10,800.00" N/A "$6,264.00" "$10,800.00" "$6,480.00" "$10,800.00" "$10,800.00" "$10,800.00" N/A N/A 154.735 SUP Custom 27803010 154.735 - CLAMP SURG 6-6.5MM EXTN SPN LEFT BOTH IP/OP "$10,800.00" "$7,992.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$1,922.40" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$2,250.84" "$10,800.00" "$4,320.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$10,800.00" "$8,100.00" "$10,800.00" "$10,800.00" "$10,800.00" "$5,400.00" "$5,400.00" "$8,553.60" "$10,800.00" "$8,640.00" "$4,860.00" "$10,800.00" N/A "$6,264.00" "$10,800.00" "$6,480.00" "$10,800.00" "$10,800.00" "$10,800.00" N/A N/A 154.74 SUP Custom 27803010 154.740 - CONNECTOR ROD CLMP OFFST ROD TO ROD Y SPN BOTH IP/OP "$2,620.00" "$1,939.00" $466.36 "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" $466.36 "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" $546.04 "$2,620.00" "$1,048.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$1,965.00" "$2,620.00" "$2,620.00" "$2,620.00" "$1,310.00" "$1,310.00" "$2,075.04" "$2,620.00" "$2,096.00" "$1,179.00" "$2,620.00" N/A "$1,519.60" "$2,620.00" "$1,572.00" "$2,620.00" "$2,620.00" "$2,620.00" N/A N/A 154.745 SUP Custom 27803010 154.745 - CONNECTOR ROD 6/6.5MM Y OFFST REVERE SPN BOTH IP/OP "$2,620.00" "$1,939.00" $466.36 "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" $466.36 "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" $546.04 "$2,620.00" "$1,048.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$2,620.00" "$1,965.00" "$2,620.00" "$2,620.00" "$2,620.00" "$1,310.00" "$1,310.00" "$2,075.04" "$2,620.00" "$2,096.00" "$1,179.00" "$2,620.00" N/A "$1,519.60" "$2,620.00" "$1,572.00" "$2,620.00" "$2,620.00" "$2,620.00" N/A N/A 154.754 SUP Custom 27803010 154.754 - CONNECTOR ROD 5.5-6.5MM PARALLEL CLMP WIDE SPN BOTH IP/OP "$1,310.00" $969.00 $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $273.02 "$1,310.00" $524.00 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $589.50 "$1,310.00" N/A $759.80 "$1,310.00" $786.00 "$1,310.00" "$1,310.00" "$1,310.00" N/A N/A 154.756 SUP Custom 27803010 154.756 - CONNECTOR ROD OPEN CLOSE SPN BOTH IP/OP "$1,310.00" $969.00 $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $273.02 "$1,310.00" $524.00 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $589.50 "$1,310.00" N/A $759.80 "$1,310.00" $786.00 "$1,310.00" "$1,310.00" "$1,310.00" N/A N/A 154.758 SUP Custom 27803010 154.758 - ROD SPINAL 5.5MM CONCTR BOTH IP/OP "$1,310.00" $969.00 $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $273.02 "$1,310.00" $524.00 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $589.50 "$1,310.00" N/A $759.80 "$1,310.00" $786.00 "$1,310.00" "$1,310.00" "$1,310.00" N/A N/A 154.76 SUP Custom 27803010 154.760 - CONNECTOR ROD WIDE 5.5/5.5MM PARALLEL CLMP SPN BOTH IP/OP "$1,310.00" $969.00 $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $273.02 "$1,310.00" $524.00 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $589.50 "$1,310.00" N/A $759.80 "$1,310.00" $786.00 "$1,310.00" "$1,310.00" "$1,310.00" N/A N/A 154.854 SUP Custom 27803010 154.854 - CONNECTOR ROD 6.5/6.5MM PARALLEL CLMP WIDE SPN SG BOTH IP/OP "$1,310.00" $969.00 $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $273.02 "$1,310.00" $524.00 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $589.50 "$1,310.00" N/A $759.80 "$1,310.00" $786.00 "$1,310.00" "$1,310.00" "$1,310.00" N/A N/A 154.856 SUP Custom 27803010 154.856 - CONNECTOR ROD 6.5MM PARALLEL CLMP WIDE SPN BOTH IP/OP "$1,310.00" $969.00 $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $273.02 "$1,310.00" $524.00 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $589.50 "$1,310.00" N/A $759.80 "$1,310.00" $786.00 "$1,310.00" "$1,310.00" "$1,310.00" N/A N/A 154.858 SUP Custom 27803010 154.858 - CLAMP SPINAL 6.5MM ROD TO ROD BOTH IP/OP "$1,310.00" $969.00 $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $273.02 "$1,310.00" $524.00 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $589.50 "$1,310.00" N/A $759.80 "$1,310.00" $786.00 "$1,310.00" "$1,310.00" "$1,310.00" N/A N/A 154.86 SUP Custom 27803010 154.860 - CLAMP EXFIX 5.5-6.5MM 18MM ROD TO ROD PARALLEL SPN BOTH IP/OP "$1,310.00" $969.00 $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $273.02 "$1,310.00" $524.00 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $589.50 "$1,310.00" N/A $759.80 "$1,310.00" $786.00 "$1,310.00" "$1,310.00" "$1,310.00" N/A N/A 154.862 SUP Custom 27803010 154.862 - CONNECTOR ROD 5.5-6.5MM ASMBLY CLMP SPN BOTH IP/OP "$1,310.00" $969.00 $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $273.02 "$1,310.00" $524.00 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $589.50 "$1,310.00" N/A $759.80 "$1,310.00" $786.00 "$1,310.00" "$1,310.00" "$1,310.00" N/A N/A 154.864 SUP Custom 27803010 154.864 - CONNECTOR ROD 5.5-6.5MM WIDE BLADE CLMP SPN BOTH IP/OP "$1,310.00" $969.00 $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $273.02 "$1,310.00" $524.00 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $589.50 "$1,310.00" N/A $759.80 "$1,310.00" $786.00 "$1,310.00" "$1,310.00" "$1,310.00" N/A N/A 154.865 SUP Custom 27803010 154.865 - CLAMP EXFIX 5.5-6.5MM 18MM ROD TO ROD PARALLEL ASMBLY SPN BOTH IP/OP "$1,445.00" "$1,069.00" $257.21 "$1,445.00" "$1,445.00" "$1,445.00" "$1,445.00" "$1,445.00" "$1,445.00" "$1,445.00" $257.21 "$1,445.00" "$1,445.00" "$1,445.00" "$1,445.00" "$1,445.00" "$1,445.00" $301.15 "$1,445.00" $578.00 "$1,445.00" "$1,445.00" "$1,445.00" "$1,445.00" "$1,445.00" "$1,083.75" "$1,445.00" "$1,445.00" "$1,445.00" $722.50 $722.50 "$1,144.44" "$1,445.00" "$1,156.00" $650.25 "$1,445.00" N/A $838.10 "$1,445.00" $867.00 "$1,445.00" "$1,445.00" "$1,445.00" N/A N/A 154.866 SUP Custom 27803010 154.866 - CONNECTOR ROD 6.5/6.5MM PARALLEL SPN CLMP BOTH IP/OP "$1,310.00" $969.00 $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $273.02 "$1,310.00" $524.00 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $589.50 "$1,310.00" N/A $759.80 "$1,310.00" $786.00 "$1,310.00" "$1,310.00" "$1,310.00" N/A N/A 154.868 SUP Custom 27803010 154.868 - CONNECTOR ROD 6.5MM PARALLEL SPN CLMP BOTH IP/OP "$1,310.00" $969.00 $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $273.02 "$1,310.00" $524.00 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $589.50 "$1,310.00" N/A $759.80 "$1,310.00" $786.00 "$1,310.00" "$1,310.00" "$1,310.00" N/A N/A 154.869 SUP Custom 27803010 154.869 - CONNECTOR ROD 6.5MM 18MM PARALLEL CLMP WIDE SPN BOTH IP/OP "$1,330.00" $984.00 $236.74 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $236.74 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" N/A $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 155.051 SUP HCPCS C1713 155.051 - SCREW BONE 5MM 25MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.052 SUP HCPCS C1713 155.052 - SCREW BONE 5MM 30MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.053 SUP HCPCS C1713 155.053 - SCREW BONE 5MM 30MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.054 SUP HCPCS C1713 155.054 - SCREW BONE 5MM 40MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.055 SUP HCPCS C1713 155.055 - SCREW BONE 5MM 45MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.056 SUP HCPCS C1713 155.056 - SCREW BONE 5MM 50MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.057 SUP HCPCS C1713 155.057 - SCREW BONE 5MM 55MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.071 SUP HCPCS C1713 155.071 - SCREW BONE 7.5MM 70MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.072 SUP HCPCS C1713 155.072 - SCREW BONE 7.5MM 75MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.073 SUP HCPCS C1713 155.073 - SCREW BONE 7.5MM 80MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.074 SUP HCPCS C1713 155.074 - SCREW BONE 7.5MM 85MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.075 SUP HCPCS C1713 155.075 - SCREW BONE 7.5MM 90MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.081 SUP HCPCS C1713 155.081 - SCREW BONE 8.5MM 70MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.082 SUP HCPCS C1713 155.082 - SCREW BONE 8.5MM 75MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.083 SUP HCPCS C1713 155.083 - SCREW BONE 8.5MM 80MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.084 SUP HCPCS C1713 155.084 - SCREW BONE 8.5MM 85MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.085 SUP HCPCS C1713 155.085 - SCREW BONE 8.5MM 90MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.091 SUP HCPCS C1713 155.091 - SCREW BONE 9.5MM 70MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.092 SUP HCPCS C1713 155.092 - SCREW BONE 9.5MM 75MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.093 SUP HCPCS C1713 155.093 - SCREW BONE 9.5MM 80MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.094 SUP HCPCS C1713 155.094 - SCREW BONE 9.5MM 85MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.095 SUP HCPCS C1713 155.095 - SCREW BONE 9.5MM 90MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.101 SUP Custom 27803010 155.101 - CLAMP SPINAL LARGE ADJUSTABLE TRNSVRS BUTTRESSED BEACON BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.102 SUP Custom 27803010 155.102 - CLAMP SPINAL MEDIUM BEACON TITANIUM BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.103 SUP Custom 27803010 155.103 - CONNECTOR ROD THIN OFFST SPN BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.104 SUP Custom 27803010 155.104 - CLAMP SPINAL 5.5MM OFFST BEACON LEFT BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.105 SUP Custom 27803010 155.105 - CLAMP SPINAL 5.5MM OFFST BEACON LEFT BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.106 SUP Custom 27803010 155.106 - CLAMP SPINAL 5.5MM OFFST BEACON LEFT BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.107 SUP Custom 27803010 155.107 - CLAMP EXFIX 5.5MM RIGHT OFFST BEACON SPN BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.108 SUP Custom 27803010 155.108 - CLAMP EXFIX 5.5MM RIGHT OFFST BEACON SPN BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.109 SUP Custom 27803010 155.109 - CLAMP EXFIX 5.5MM RIGHT OFFST BEACON SPN BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.111 SUP Custom 27803010 155.111 - CLAMP SPINAL LARGE 6.35MM STR BEACON BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.112 SUP Custom 27803010 155.112 - CLAMP SPINAL MEDIUM 6.35MM STR BEACON BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.113 SUP Custom 27803010 155.113 - CLAMP SPINAL SMALL 6.35MM STR BEACON BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.114 SUP Custom 27803010 155.114 - CLAMP SPINAL 6.35MM OFFST BEACON LEFT BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.115 SUP Custom 27803010 155.115 - CLAMP SPINAL 6.35MM OFFST BEACON LEFT BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.116 SUP Custom 27803010 155.116 - CLAMP SPINAL 6.35MM OFFST BEACON LEFT BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.117 SUP Custom 27803010 155.117 - CLAMP SPINAL 6.35MM OFFST BEACON RIGHT BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.118 SUP Custom 27803010 155.118 - CLAMP SPINAL 6.35MM OFFST BEACON RIGHT BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.119 SUP Custom 27803010 "155.119 - BEACON 6.35mm Right Offset Clamp, Small" BOTH IP/OP "$4,995.00" "$3,696.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" $889.11 "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$1,041.01" "$4,995.00" "$1,998.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$4,995.00" "$3,746.25" "$4,995.00" "$4,995.00" "$4,995.00" "$2,497.50" "$2,497.50" "$3,956.04" "$4,995.00" "$3,996.00" "$2,247.75" "$4,995.00" N/A "$2,897.10" "$4,995.00" "$2,997.00" "$4,995.00" "$4,995.00" "$4,995.00" N/A N/A 155.151 SUP HCPCS C1713 "155.151 - BEACON 5.0mm Reduction Screw, 25mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.152 SUP HCPCS C1713 "155.152 - BEACON 5.0mm Reduction Screw, 30mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.153 SUP HCPCS C1713 "155.153 - BEACON 5.0mm Reduction Screw, 35mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.154 SUP HCPCS C1713 "155.154 - BEACON 5.0mm Reduction Screw, 40mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.155 SUP HCPCS C1713 "155.155 - BEACON 5.0mm Reduction Screw, 45mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.156 SUP HCPCS C1713 "155.156 - BEACON 5.0mm Reduction Screw, 50mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.157 SUP HCPCS C1713 "155.157 - BEACON 5.0mm Reduction Screw, 55mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.171 SUP HCPCS C1713 "155.171 - BEACON 7.5mm Reduction Screw, 70mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.172 SUP HCPCS C1713 "155.172 - BEACON 7.5mm Reduction Screw, 75mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.173 SUP HCPCS C1713 "155.173 - BEACON 7.5mm Reduction Screw, 80mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.174 SUP HCPCS C1713 "155.174 - BEACON 7.5mm Reduction Screw, 85mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.175 SUP HCPCS C1713 "155.175 - BEACON 7.5mm Reduction Screw, 90mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.181 SUP HCPCS C1713 "155.181 - BEACON 8.5mm Reduction Screw, 70mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.182 SUP HCPCS C1713 "155.182 - BEACON 8.5mm Reduction Screw, 75mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.183 SUP HCPCS C1713 "155.183 - BEACON 8.5mm Reduction Screw, 80mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.184 SUP HCPCS C1713 "155.184 - BEACON 8.5mm Reduction Screw, 85mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.185 SUP HCPCS C1713 "155.185 - BEACON 8.5mm Reduction Screw, 90mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.341 SUP HCPCS C1713 "155.341 - BEACON 4.5mm Reduction Screw, 25mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.342 SUP HCPCS C1713 "155.342 - BEACON 4.5mm Reduction Screw, 30mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.343 SUP HCPCS C1713 "155.343 - BEACON 4.5mm Reduction Screw, 35mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.344 SUP HCPCS C1713 "155.344 - BEACON 4.5mm Reduction Screw, 40mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.345 SUP HCPCS C1713 "155.345 - BEACON 4.5mm Reduction Screw, 45mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.351 SUP HCPCS C1713 "155.351 - BEACON 5.5mm Reduction Screw, 25mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.352 SUP HCPCS C1713 "155.352 - BEACON 5.5mm Reduction Screw, 30mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.353 SUP HCPCS C1713 "155.353 - BEACON 5.5mm Reduction Screw, 35mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.354 SUP HCPCS C1713 "155.354 - BEACON 5.5mm Reduction Screw, 40mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.355 SUP HCPCS C1713 "155.355 - BEACON 5.5mm Reduction Screw, 45mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.356 SUP HCPCS C1713 "155.356 - BEACON 5.5mm Reduction Screw, 50mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.357 SUP HCPCS C1713 "155.357 - BEACON 5.5mm Reduction Screw, 55mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.361 SUP HCPCS C1713 "155.361 - BEACON 6.5mm Reduction Screw, 25mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.362 SUP HCPCS C1713 "155.362 - BEACON 6.5mm Reduction Screw, 30mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.363 SUP HCPCS C1713 "155.363 - BEACON 6.5mm Reduction Screw, 35mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.364 SUP HCPCS C1713 "155.364 - BEACON 6.5mm Reduction Screw, 40mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.365 SUP HCPCS C1713 "155.365 - BEACON 6.5mm Reduction Screw, 45mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.366 SUP HCPCS C1713 "155.366 - BEACON 6.5mm Reduction Screw, 50mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.367 SUP HCPCS C1713 "155.367 - BEACON 6.5mm Reduction Screw, 55mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.368 SUP HCPCS C1713 "155.368 - BEACON 6.5mm Reduction Screw, 60mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.369 SUP HCPCS C1713 "155.369 - BEACON 6.5mm Reduction Screw, 65mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.371 SUP HCPCS C1713 "155.371 - BEACON 7.5mm Reduction Screw, 25mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.372 SUP HCPCS C1713 "155.372 - BEACON 7.5mm Reduction Screw, 30mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.373 SUP HCPCS C1713 "155.373 - BEACON 7.5mm Reduction Screw, 35mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.374 SUP HCPCS C1713 "155.374 - BEACON 7.5mm Reduction Screw, 40mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.375 SUP HCPCS C1713 "155.375 - BEACON 7.5mm Reduction Screw, 45mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.376 SUP HCPCS C1713 "155.376 - BEACON 7.5mm Reduction Screw, 50mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.377 SUP HCPCS C1713 "155.377 - BEACON 7.5mm Reduction Screw, 55mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.378 SUP HCPCS C1713 "155.378 - BEACON 7.5mm Reduction Screw, 60mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.379 SUP HCPCS C1713 "155.379 - BEACON 7.5mm Reduction Screw, 65mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.381 SUP HCPCS C1713 "155.381 - BEACON 8.5mm Reduction Screw, 25mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.382 SUP HCPCS C1713 "155.382 - BEACON 8.5mm Reduction Screw, 30mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.383 SUP HCPCS C1713 "155.383 - BEACON 8.5mm Reduction Screw, 35mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.384 SUP HCPCS C1713 "155.384 - BEACON 8.5mm Reduction Screw, 40mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.385 SUP HCPCS C1713 "155.385 - BEACON 8.5mm Reduction Screw, 45mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.386 SUP HCPCS C1713 "155.386 - BEACON 8.5mm Reduction Screw, 50mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.387 SUP HCPCS C1713 "155.387 - BEACON 8.5mm Reduction Screw, 55mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.388 SUP HCPCS C1713 "155.388 - BEACON 8.5mm Reduction Screw, 60mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.389 SUP HCPCS C1713 "155.389 - BEACON 8.5mm Reduction Screw, 65mm" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 155.441 SUP HCPCS C1713 155.441 - SCREW BONE 4.5MM 25MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.442 SUP HCPCS C1713 155.442 - SCREW BONE 4.5MM 30MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.443 SUP HCPCS C1713 155.443 - SCREW BONE 4.5MM 35MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.444 SUP HCPCS C1713 155.444 - SCREW BONE 4.5MM 40MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.445 SUP HCPCS C1713 155.445 - SCREW BONE 4.5MM 45MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.451 SUP HCPCS C1713 155.451 - SCREW BONE 5.5MM 25MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.452 SUP HCPCS C1713 155.452 - SCREW BONE 5.5MM 30MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.453 SUP HCPCS C1713 155.453 - SCREW BONE 5.5MM 35MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.454 SUP HCPCS C1713 155.454 - SCREW BONE 5.5MM 40MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.455 SUP HCPCS C1713 155.455 - SCREW BONE 5.5MM 45MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.456 SUP HCPCS C1713 155.456 - SCREW BONE 5.5MM 50MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.457 SUP HCPCS C1713 155.457 - SCREW BONE 5.5MM 55MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.461 SUP HCPCS C1713 155.461 - SCREW BONE 6.5MM 25MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.462 SUP HCPCS C1713 155.462 - SCREW BONE 6.5MM 30MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.463 SUP HCPCS C1713 155.463 - SCREW BONE 6.5MM 35MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.464 SUP HCPCS C1713 155.464 - SCREW BONE 6.5MM 40MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.465 SUP HCPCS C1713 155.465 - SCREW BONE 6.5MM 45MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.466 SUP HCPCS C1713 155.466 - SCREW BONE 6.5MM 50MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.467 SUP HCPCS C1713 155.467 - SCREW BONE 6.5MM 55MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 155.468 SUP HCPCS C1713 155.468 - SCREW BONE 6.5MM 60MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.469 SUP HCPCS C1713 155.469 - SCREW BONE 6.5MM 65MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.471 SUP HCPCS C1713 155.471 - SCREW BONE 7.5MM 25MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.472 SUP HCPCS C1713 155.472 - SCREW BONE 7.5MM 30MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.473 SUP HCPCS C1713 155.473 - SCREW BONE 7.5MM 35MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.474 SUP HCPCS C1713 155.474 - SCREW BONE 7.5MM 40MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.475 SUP HCPCS C1713 155.475 - SCREW BONE 7.5MM 45MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.476 SUP HCPCS C1713 155.476 - SCREW BONE 7.5MM 50MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.477 SUP HCPCS C1713 155.477 - SCREW BONE 7.5MM 55MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.478 SUP HCPCS C1713 155.478 - SCREW BONE 7.5MM 60MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.479 SUP HCPCS C1713 155.479 - SCREW BONE 7.5MM 65MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.481 SUP HCPCS C1713 155.481 - SCREW BONE 8.5MM 25MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.482 SUP HCPCS C1713 155.482 - SCREW BONE 8.5MM 30MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.483 SUP HCPCS C1713 155.483 - SCREW BONE 8.5MM 35MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.484 SUP HCPCS C1713 155.484 - SCREW BONE 8.5MM 40MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.485 SUP HCPCS C1713 155.485 - SCREW BONE 8.5MM 45MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.486 SUP HCPCS C1713 155.486 - SCREW BONE 8.5MM 50MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.487 SUP HCPCS C1713 155.487 - SCREW BONE 8.5MM 55MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.488 SUP HCPCS C1713 155.488 - SCREW BONE 8.5MM 60MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.489 SUP HCPCS C1713 155.489 - SCREW BONE 8.5MM 65MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.491 SUP HCPCS C1713 155.491 - SCREW BONE 9.5MM 25MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.492 SUP HCPCS C1713 155.492 - SCREW BONE 9.5MM 30MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.493 SUP HCPCS C1713 155.493 - SCREW BONE 9.5MM 35MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.494 SUP HCPCS C1713 155.494 - SCREW BONE 9.5MM 40MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 155.495 SUP HCPCS C1713 155.495 - SCREW BONE 9.5MM 45MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 155.496 SUP HCPCS C1713 155.496 - SCREW BONE 9.5MM 50MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.497 SUP HCPCS C1713 155.497 - SCREW BONE 9.5MM 55MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.498 SUP HCPCS C1713 155.498 - SCREW BONE 9.5MM 60MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.499 SUP HCPCS C1713 155.499 - SCREW BONE 9.5MM 65MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.51 SUP Custom 27803010 155.510 - ROD SPINAL 6.35MM 100MM STR HEXAGONAL END BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.512 SUP Custom 27803010 155.512 - ROD SPINAL 6.35MM 125MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.515 SUP Custom 27803010 155.515 - ROD SPNL STRG 6.35MM 150MM BCN HEX END BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.517 SUP Custom 27803010 155.517 - ROD SPINAL 6.35MM 20MM STR HEXAGONAL END BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.519 SUP Custom 27803010 155.519 - ROD SPINAL 6.35MM 30MM STR HEXAGONAL END BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.52 SUP Custom 27803010 155.520 - ROD SPINAL 6.35MM 40MM STR HEXAGONAL END BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.521 SUP Custom 27803010 155.521 - ROD SPINAL 6.35MM 50MM STR HEXAGONAL END BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.53 SUP Custom 27803010 155.530 - ROD SPINAL 6.35MM 30MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.535 SUP Custom 27803010 155.535 - ROD SPINAL 6.35MM 35MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.54 SUP Custom 27803010 155.540 - ROD SPINAL 6.35MM 40MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.545 SUP Custom 27803010 155.545 - ROD SPINAL 6.35MM 45MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.55 SUP Custom 27803010 155.550 - ROD SPINAL 6.35MM 50MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.555 SUP Custom 27803010 155.555 - ROD SPINAL 6.35MM 55MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.56 SUP Custom 27803010 155.560 - ROD SPINAL 6.35MM 60MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.565 SUP Custom 27803010 155.565 - ROD SPINAL 6.35MM 65MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.57 SUP Custom 27803010 155.570 - ROD SPINAL 6.35MM 70MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.575 SUP Custom 27803010 155.575 - ROD SPINAL 6.35MM 75MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.58 SUP Custom 27803010 155.580 - ROD SPINAL 6.35MM 80MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.585 SUP Custom 27803010 155.585 - ROD SPINAL 6.35MM 85MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.61 SUP Custom 27803010 155.610 - ROD SPINAL 6.35MM 100MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.635 SUP Custom 27803010 155.635 - ROD SPINAL 6.35MM 35MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.64 SUP Custom 27803010 155.640 - ROD SPINAL 6.35MM 40MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.645 SUP Custom 27803010 155.645 - ROD SPINAL 6.35MM 45MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.65 SUP Custom 27803010 155.650 - ROD SPINAL 6.35MM 50MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.655 SUP Custom 27803010 155.655 - ROD SPINAL 6.35MM 55MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.66 SUP Custom 27803010 155.660 - ROD SPINAL 6.35MM 60MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.665 SUP Custom 27803010 155.665 - ROD SPINAL 6.35MM 65MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.67 SUP Custom 27803010 155.670 - ROD SPINAL 6.35MM 70MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.675 SUP Custom 27803010 155.675 - ROD SPINAL 6.35MM 75MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.68 SUP Custom 27803010 155.680 - ROD SPINAL 6.35MM 80MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.685 SUP Custom 27803010 155.685 - ROD SPINAL 6.35MM 85MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.69 SUP Custom 27803010 155.690 - ROD SPINAL 6.35MM 90MM CVD BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 155.695 SUP HCPCS C1713 155.695 - ROD SPINAL 6.35MM 95MM CVD BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 155.761 SUP HCPCS C1713 155.761 - SCREW BONE 6.5MM 17MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.762 SUP HCPCS C1713 155.762 - SCREW BONE 6.5MM 30MM 17MM BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.763 SUP HCPCS C1713 155.763 - SCREW BONE 6.5MM 35MM BEACON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.764 SUP HCPCS C1713 155.764 - SCREW BONE 3.5MM 40MM 17MM BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.765 SUP HCPCS C1713 155.765 - SCREW BONE 6.5MM 45MM BEACON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.766 SUP HCPCS C1713 155.766 - SCREW BONE 6.5MM 17MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.767 SUP HCPCS C1713 155.767 - SCREW BONE 6.5MM 17MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.768 SUP HCPCS C1713 155.768 - SCREW BONE 6.5MM 17MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.769 SUP HCPCS C1713 155.769 - SCREW BONE 6.5MM 17MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.771 SUP HCPCS C1713 155.771 - SCREW BONE 7.5MM 17MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.772 SUP HCPCS C1713 155.772 - SCREW BONE 7.5MM 17MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.773 SUP HCPCS C1713 155.773 - SCREW BONE 7.5MM 17MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.774 SUP HCPCS C1713 155.774 - SCREW BONE 7.5MM 17MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.775 SUP HCPCS C1713 155.775 - SCREW BONE 7.5MM 17MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.776 SUP HCPCS C1713 155.776 - SCREW BONE 7.5MM 17MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.777 SUP HCPCS C1713 155.777 - SCREW BONE 7.5MM 17MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.778 SUP HCPCS C1713 155.778 - SCREW BONE 7.5MM 17MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.779 SUP HCPCS C1713 155.779 - SCREW BONE 7.5MM 17MM POSTED BEACON SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 155.95 SUP Custom 27803010 155.950 - CONNECTOR ROD 5.5MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.951 SUP Custom 27803010 155.951 - CONNECTOR ROD 5.5MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.952 SUP Custom 27803010 155.952 - CONNECTOR ROD 5.5MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.953 SUP Custom 27803010 155.953 - CONNECTOR ROD 5.5MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.954 SUP Custom 27803010 155.954 - CONNECTOR ROD 5.5MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.96 SUP Custom 27803010 155.960 - CONNECTOR ROD 5.5MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.961 SUP Custom 27803010 155.961 - CONNECTOR ROD 5.5MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.962 SUP Custom 27803010 155.962 - CONNECTOR ROD 5.5MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.963 SUP Custom 27803010 155.963 - CONNECTOR ROD 5.5MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.964 SUP Custom 27803010 155.964 - CONNECTOR ROD 5.5MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.97 SUP Custom 27803010 155.970 - CONNECTOR ROD 6.35MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.971 SUP Custom 27803010 155.971 - CONNECTOR ROD 6.35MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.972 SUP Custom 27803010 155.972 - CONNECTOR ROD 6.35MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.973 SUP Custom 27803010 155.973 - CONNECTOR ROD 6.35MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.974 SUP Custom 27803010 155.974 - CONNECTOR ROD 6.35MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.98 SUP Custom 27803010 155.980 - CONNECTOR ROD 6.35MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.981 SUP Custom 27803010 155.981 - CONNECTOR ROD 6.35MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.982 SUP Custom 27803010 155.982 - CONNECTOR ROD 6.35MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.983 SUP Custom 27803010 155.983 - CONNECTOR ROD 6.35MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 155.984 SUP Custom 27803010 155.984 - CONNECTOR ROD 6.35MM OFFST BEACON SPN BOTH IP/OP "$1,410.00" "$1,043.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $250.98 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" $293.86 "$1,410.00" $564.00 "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,410.00" "$1,057.50" "$1,410.00" "$1,410.00" "$1,410.00" $705.00 $705.00 "$1,116.72" "$1,410.00" "$1,128.00" $634.50 "$1,410.00" N/A $817.80 "$1,410.00" $846.00 "$1,410.00" "$1,410.00" "$1,410.00" N/A N/A 170.051 SUP HCPCS C1713 170.051 - REVERE 5.0mm Uniplanar Fracture Reduction Screw 25mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.052 SUP HCPCS C1713 170.052 - REVERE 5.0mm Uniplanar Fracture Reduction Screw 30mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.053 SUP HCPCS C1713 170.053 - REVERE 5.0mm Uniplanar Fracture Reduction Screw 35mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.054 SUP HCPCS C1713 170.054 - REVERE 5.0mm Uniplanar Fracture Reduction Screw 40mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.055 SUP HCPCS C1713 170.055 - REVERE 5.0mm Uniplanar Fracture Reduction Screw 45mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.056 SUP HCPCS C1713 170.056 - REVERE 5.0mm Uniplanar Fracture Reduction Screw 50mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.057 SUP HCPCS C1713 170.057 - REVERE 5.0mm Uniplanar Fracture Reduction Screw 55mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.141 SUP HCPCS C1713 170.141 - REVERE 4.5mm Uniplanar Fracture Reduction Screw 25mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.142 SUP HCPCS C1713 170.142 - REVERE 4.5mm Uniplanar Fracture Reduction Screw 30mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.143 SUP HCPCS C1713 170.143 - REVERE 4.5mm Uniplanar Fracture Reduction Screw 35mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.144 SUP HCPCS C1713 170.144 - REVERE 4.5mm Uniplanar Fracture Reduction Screw 40mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.145 SUP HCPCS C1713 170.145 - REVERE 4.5mm Uniplanar Fracture Reduction Screw 45mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.146 SUP HCPCS C1713 170.146 - REVERE 4.5mm Uniplanar Fracture Reduction Screw 50mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.147 SUP HCPCS C1713 170.147 - REVERE 4.5mm Uniplanar Fracture Reduction Screw 55mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.151 SUP HCPCS C1713 170.151 - REVERE 5.5mm Uniplanar Fracture Reduction Screw 25mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.152 SUP HCPCS C1713 170.152 - REVERE 5.5mm Uniplanar Fracture Reduction Screw 30mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.153 SUP HCPCS C1713 170.153 - REVERE 5.5mm Uniplanar Fracture Reduction Screw 35mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.154 SUP HCPCS C1713 170.154 - REVERE 5.5mm Uniplanar Fracture Reduction Screw 40mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.155 SUP HCPCS C1713 170.155 - REVERE 5.5mm Uniplanar Fracture Reduction Screw 45mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.156 SUP HCPCS C1713 170.156 - REVERE 5.5mm Uniplanar Fracture Reduction Screw 50mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.157 SUP HCPCS C1713 170.157 - REVERE 5.5mm Uniplanar Fracture Reduction Screw 55mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.161 SUP HCPCS C1713 170.161 - REVERE 6.5mm Uniplanar Fracture Reduction Screw 25mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.162 SUP HCPCS C1713 170.162 - REVERE 6.5mm Uniplanar Fracture Reduction Screw 30mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.163 SUP HCPCS C1713 170.163 - REVERE 6.5mm Uniplanar Fracture Reduction Screw 35mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.164 SUP HCPCS C1713 170.164 - REVERE 6.5mm Uniplanar Fracture Reduction Screw 40mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.165 SUP HCPCS C1713 170.165 - REVERE 6.5mm Uniplanar Fracture Reduction Screw 45mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.166 SUP HCPCS C1713 170.166 - REVERE 6.5mm Uniplanar Fracture Reduction Screw 50mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 170.167 SUP HCPCS C1713 170.167 - REVERE 6.5mm Uniplanar Fracture Reduction Screw 55mm BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.012 SUP HCPCS C1713 171.012 - SCREW BONE 4.6MM VAR ANG VIP SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.014 SUP HCPCS C1713 171.014 - SCREW BONE 4.6MM VAR ANG VIP SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.016 SUP HCPCS C1713 171.016 - SCREW BONE 4.6MM VAR ANG VIP SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.113 SUP HCPCS C1713 171.113 - PLATE BONE LEVEL 1 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 171.115 SUP HCPCS C1713 171.115 - PLATE BONE LEVEL 1 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 171.117 SUP HCPCS C1713 171.117 - PLATE BONE LEVEL 1 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 171.119 SUP HCPCS C1713 171.119 - PLATE BONE LEVEL 1 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 171.121 SUP HCPCS C1713 171.121 - PLATE BONE LEVEL 1 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 171.123 SUP HCPCS C1713 171.123 - PLATE BONE LEVEL 1 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 171.125 SUP HCPCS C1713 171.125 - PLATE BONE LEVEL 1 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 171.163 SUP HCPCS C1713 171.163 - PLATE BONE LEVEL 1 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 171.165 SUP HCPCS C1713 171.165 - PLATE BONE LEVEL 1 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 171.167 SUP HCPCS C1713 171.167 - PLATE BONE LEVEL 1 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 171.169 SUP HCPCS C1713 171.169 - PLATE BONE LEVEL 1 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 171.226 SUP HCPCS C1713 171.226 - PLATE BONE 26MM LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.228 SUP HCPCS C1713 171.228 - PLATE BONE 28MM LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.23 SUP HCPCS C1713 171.230 - PLATE BONE 30MM LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.232 SUP HCPCS C1713 171.232 - PLATE BONE 32MM LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.234 SUP HCPCS C1713 171.234 - PLATE BONE 34MM LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.236 SUP HCPCS C1713 171.236 - PLATE BONE 36MM LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.238 SUP HCPCS C1713 171.238 - PLATE BONE 38MM LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.24 SUP HCPCS C1713 171.240 - PLATE BONE 40MM LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.242 SUP HCPCS C1713 171.242 - PLATE BONE 42MM LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.244 SUP HCPCS C1713 171.244 - PLATE BONE 44MM LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.246 SUP HCPCS C1713 171.246 - PLATE BONE 46MM LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.276 SUP HCPCS C1713 171.276 - PLATE BONE LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.278 SUP HCPCS C1713 171.278 - PLATE BONE LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.28 SUP HCPCS C1713 171.280 - PLATE BONE LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.282 SUP HCPCS C1713 171.282 - PLATE BONE LEVEL 2 VIP SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 171.312 SUP HCPCS C1713 171.312 - SCREW BONE 4.6MM 12MM VAR ANG SELF DRILL VIP SPN CERV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.314 SUP HCPCS C1713 171.314 - SCREW BONE 4.6MM 14MM VAR ANG SELF DRILL VIP SPN CERV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.316 SUP HCPCS C1713 171.316 - SCREW BONE 4.6MM VAR ANG VIP SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.318 SUP HCPCS C1713 171.318 - SCREW BONE 4.6MM VAR ANG VIP SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.32 SUP HCPCS C1713 171.320 - SCREW BONE 4.6MM 20MM VAR ANG VIP ANTERIOR CERV SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.322 SUP HCPCS C1713 171.322 - SCREW BONE 4.6MM 22MM VAR ANG VIP ANTERIOR CERV SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.324 SUP HCPCS C1713 171.324 - SCREW BONE 4.6MM 24MM VAR ANG VIP ANTERIOR CERV SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.326 SUP HCPCS C1713 171.326 - SCREW BONE 4.6MM 26MM VAR ANG VIP ANTERIOR CERV SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.412 SUP HCPCS C1713 171.412 - SCREW BONE 5.1MM VAR ANG VIP SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.414 SUP HCPCS C1713 171.414 - SCREW BONE 5.1MM VAR ANG VIP SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.416 SUP HCPCS C1713 171.416 - SCREW BONE 5.1MM VAR ANG VIP SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.512 SUP HCPCS C1713 171.512 - SCREW BONE 5.1MM VAR ANG VIP SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.514 SUP HCPCS C1713 171.514 - SCREW BONE 5.1MM VAR ANG VIP SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.516 SUP HCPCS C1713 171.516 - SCREW BONE 5.1MM VAR ANG VIP SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.518 SUP HCPCS C1713 171.518 - SCREW BONE 5.1MM 18MM VAR ANG VIP ANTERIOR CERV SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.52 SUP HCPCS C1713 171.520 - SCREW BONE 5.1MM 20MM VAR ANG VIP ANTERIOR CERV SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.522 SUP HCPCS C1713 171.522 - SCREW BONE 5.1MM 22MM VAR ANG VIP ANTERIOR CERV SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.524 SUP HCPCS C1713 171.524 - SCREW BONE 5.1MM 24MM VAR ANG VIP ANTERIOR CERV SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.526 SUP HCPCS C1713 171.526 - SCREW BONE 5.1MM 26MM VAR ANG VIP ANTERIOR CERV SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.612 SUP HCPCS C1713 171.612 - SCREW BONE 4.6MM 12MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.614 SUP HCPCS C1713 171.614 - SCREW BONE 4.6MM 14MM FIX ANGLE SELF DRILL VIP SPN CERV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.616 SUP HCPCS C1713 171.616 - SCREW BONE 4.6MM 16MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.712 SUP HCPCS C1713 171.712 - SCREW BONE 4.6MM 12MM FIX ANGLE SELF TAP VIP SPN CERV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.714 SUP HCPCS C1713 171.714 - SCREW BONE 4.6MM 14MM FIX ANGLE SELF TAP VIP SPN CERV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.716 SUP HCPCS C1713 171.716 - SCREW BONE 4.6MM 16MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.718 SUP HCPCS C1713 171.718 - SCREW BONE 4.6MM 18MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.72 SUP HCPCS C1713 171.720 - SCREW BONE 4.6MM 20MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.722 SUP HCPCS C1713 171.722 - SCREW BONE 4.6MM 22MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.724 SUP HCPCS C1713 171.724 - SCREW BONE 4.6MM 24MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.726 SUP HCPCS C1713 171.726 - SCREW BONE 4.6MM 26MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.812 SUP HCPCS C1713 171.812 - SCREW BONE 5.1MM 12MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.814 SUP HCPCS C1713 171.814 - SCREW BONE 5.1MM 14MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.816 SUP HCPCS C1713 171.816 - SCREW BONE 5.1MM 16MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.912 SUP HCPCS C1713 171.912 - SCREW BONE 5.1MM 12MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 171.914 SUP HCPCS C1713 171.914 - SCREW BONE 5.1MM 14MM FIX ANGLE SELF TAP VIP SPN CERV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.916 SUP HCPCS C1713 171.916 - SCREW BONE 5.1MM 16MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.918 SUP HCPCS C1713 171.918 - SCREW BONE 5.1MM 18MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.92 SUP HCPCS C1713 171.920 - SCREW BONE 5.1MM 20MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.922 SUP HCPCS C1713 171.922 - SCREW BONE 5.1MM 22MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.924 SUP HCPCS C1713 171.924 - SCREW BONE 5.1MM 24MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 171.926 SUP HCPCS C1713 171.926 - SCREW BONE 5.1MM 26MM FIXANG VIP ANTERIOR CERV SPN SE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 172.511 SUP Custom 27803010 172.511 - CONNECTOR ROD 40MM H LINK TITANIUM SPN BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.512 SUP Custom 27803010 172.512 - ROD SPINAL 5.5MM 48-61MM H-LINK TITANIUM BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.513 SUP Custom 27803010 172.513 - ROD SPINAL 4MM 58-71MM H-LINK BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.521 SUP Custom 27803010 172.521 - ROD SPINAL 51MM H-LINK TITANIUM BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.522 SUP Custom 27803010 172.522 - ROD SPINAL 48-61MM PREASSEMBLED H-LINK TITANIUM BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.523 SUP Custom 27803010 "172.523 - H-LINK 05.5mm Rod, 58mm-71mm x 45mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.531 SUP Custom 27803010 "172.531 - H-LINK 05.5mm Rod, 38mm-51mm x 35mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.532 SUP Custom 27803010 "172.532 - H-LINK 05.5mm Rod, 48mm-61mm x 35mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.533 SUP Custom 27803010 "172.533 - H-LINK 05.5mm Rod, 58mm-71mm x 35mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.581 SUP Custom 27803010 "172.581 - H-LINK 05.5mm Rod, 38mm-51mm x 100mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.582 SUP Custom 27803010 "172.582 - H-LINK 05.5mm Rod, 48mm-61mm x 100mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.583 SUP Custom 27803010 172.583 - ROD SPINAL 58-71MM 5.5MM 100MM HEALTHLINK BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.611 SUP Custom 27803010 "172.611 - H-LINK 06.35mm Rod, 38mm-51mm x 40mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.612 SUP Custom 27803010 "172.612 - H-LINK 06.35mm Rod, 48mm-61mm x 40mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.613 SUP Custom 27803010 "172.613 - H-LINK 06.35mm Rod, 58mm-71mm x 40mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.621 SUP Custom 27803010 "172.621 - H-LINK 06.35mm Rod, 38mm-51mm x 45mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.622 SUP Custom 27803010 "172.622 - H-LINK 06.35mm Rod, 48mm-61mm x 45mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.623 SUP Custom 27803010 "172.623 - H-LINK 06.35mm Rod, 58mm-71mm x 45mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.681 SUP Custom 27803010 "172.681 - H-LINK 06.35mm Rod, 38mm-51mm x 100mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.682 SUP Custom 27803010 "172.682 - H-LINK 06.35mm Rod, 48mm-61mm x 100mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 172.683 SUP Custom 27803010 "172.683 - H-LINK 06.35mm Rod, 58mm-71mm x 100mm" BOTH IP/OP "$5,527.50" "$4,090.00" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" $983.90 "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$1,151.99" "$5,527.50" "$2,211.00" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$5,527.50" "$4,145.63" "$5,527.50" "$5,527.50" "$5,527.50" "$2,763.75" "$2,763.75" "$4,377.78" "$5,527.50" "$4,422.00" "$2,487.38" "$5,527.50" N/A "$3,205.95" "$5,527.50" "$3,316.50" "$5,527.50" "$5,527.50" "$5,527.50" N/A N/A 176.12 SUP HCPCS C1713 "176.120 - Bone Screw, Fixed Angle 5.5mm, 20mm" BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" "$1,692.50" "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,015.50" "$1,692.50" $352.72 "$1,692.50" N/A N/A 176.125 SUP HCPCS C1713 176.125 - SCREW BONE 25MM FIXANG INDEPENDENCE SPN BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" "$1,692.50" "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,015.50" "$1,692.50" $352.72 "$1,692.50" N/A N/A 176.13 SUP HCPCS C1713 176.130 - SCREW BONE 5.5MM 30MM FIX SPN BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" "$1,692.50" "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,015.50" "$1,692.50" $352.72 "$1,692.50" N/A N/A 176.135 SUP HCPCS C1713 176.135 - SCREW BONE 5.5MM 13.5MM FIXANG INDEPENDENCE SPN BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" $677.00 "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,015.50" "$1,692.50" $352.72 "$1,692.50" N/A N/A 176.14 SUP HCPCS C1713 "176.140 - Bone Screw, Fixed Angle 5.5mm, 40mm" BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" "$1,692.50" "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,015.50" "$1,692.50" $352.72 "$1,692.50" N/A N/A 176.145 SUP HCPCS C1713 176.145 - SCREW BONE 5.5MM 14.5MM FIXANG INDEPENDENCE SPN BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" $677.00 "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,015.50" "$1,692.50" $352.72 "$1,692.50" N/A N/A 176.15 SUP HCPCS C1713 "176.150 - Bone Screw, Fixed Angle 5.5mm, 50mm" BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" "$1,692.50" "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,015.50" "$1,692.50" $352.72 "$1,692.50" N/A N/A 176.22 SUP HCPCS C1713 176.220 - SCREW BONE 5.5MM 20MM VAR ANG INDEPENDENCE SPN BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" "$1,692.50" "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,015.50" "$1,692.50" $352.72 "$1,692.50" N/A N/A 176.225 SUP HCPCS C1713 176.225 - SCREW BONE 5.5MM 25MM VAR ANG INDEPENDENCE SPN BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" "$1,692.50" "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,692.50" "$1,692.50" $352.72 "$1,692.50" N/A N/A 176.23 SUP HCPCS C1713 176.230 - SCREW BONE 30MM VAR ANG INDEPENDENCE SPN BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" "$1,692.50" "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,692.50" "$1,692.50" $352.72 "$1,692.50" N/A N/A 176.235 SUP HCPCS C1713 176.235 - SCREW BONE 5.5MM 35MM VAR ANG INDEPENDENCE SPN BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" $677.00 "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,692.50" "$1,692.50" $352.72 "$1,692.50" N/A N/A 176.24 SUP HCPCS C1713 "176.240 - Bone Screw, Variable Angle 5.5mm, 40mm" BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" $677.00 "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,692.50" "$1,692.50" $352.72 "$1,692.50" N/A N/A 176.245 SUP HCPCS C1713 176.245 - SCREW BONE 5.5MM 24.5MM VAR ANG INDEPENDENCE SPN BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" $677.00 "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,692.50" "$1,692.50" $352.72 "$1,692.50" N/A N/A 176.25 SUP HCPCS C1713 "176.250 - Bone Screw, Variable Angle 5.5mm, 50mm" BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" $677.00 "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,692.50" "$1,692.50" $352.72 "$1,692.50" N/A N/A 182.222 SUP HCPCS C1713 182.222 - SCREW BONE 3.5MM 22MM POLYAX ELLIPSE POSTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.224 SUP HCPCS C1713 182.224 - SCREW BONE 3.5MM 24MM POLYAX ELLIPSE POSTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.226 SUP HCPCS C1713 182.226 - SCREW BONE 3.5MM 26MM POLYAX ELLIPSE SPINAL SHOULDER BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.228 SUP HCPCS C1713 182.228 - SCREW BONE 3.5MM 28MM POLYAX ELLIPSE SPINAL SHOULDER BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.23 SUP HCPCS C1713 182.230 - SCREW BONE 3.5MM 30MM POLYAX ELLIPSE SPINAL SHOULDER BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.232 SUP HCPCS C1713 182.232 - SCREW BONE 3.5MM 32MM POLYAX ELLIPSE POSTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.234 SUP HCPCS C1713 182.234 - SCREW BONE 3.5MM 34MM POLYAX ELLIPSE TITANIUM SPINAL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.236 SUP HCPCS C1713 182.236 - SCREW BONE 3.5MM 36MM POLYAX ELLIPSE POSTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.308 SUP HCPCS C1713 182.308 - SCREW BONE 3.5MM 8MM POLYAX ELLIPSE TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.31 SUP HCPCS C1713 182.310 - SCREW BONE 3.5MM 10MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.312 SUP HCPCS C1713 182.312 - SCREW BONE 3.5MM 12MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.314 SUP HCPCS C1713 182.314 - SCREW BONE 3.5MM 14MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.316 SUP HCPCS C1713 182.316 - SCREW BONE 3.5MM 16MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.318 SUP HCPCS C1713 182.318 - SCREW BONE 3.5MM 18MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.32 SUP HCPCS C1713 182.320 - SCREW BONE 3.5MM 20MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.322 SUP HCPCS C1713 182.322 - SCREW BONE 3.5MM 22MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.324 SUP HCPCS C1713 182.324 - SCREW BONE 3.5MM 24MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.326 SUP HCPCS C1713 182.326 - SCREW BONE 3.5MM 26MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.328 SUP HCPCS C1713 182.328 - SCREW BONE 3.5MM 28MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.33 SUP HCPCS C1713 182.330 - SCREW BONE 3.5MM 30MM POLYAX ELLIPSE TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.332 SUP HCPCS C1713 182.332 - SCREW BONE 3.5MM 32MM POLYAX ELLIPSE TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.334 SUP HCPCS C1713 182.334 - SCREW BONE 3.5MM 34MM POLYAX ELLIPSE TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.336 SUP HCPCS C1713 182.336 - SCREW BONE 3.5MM 36MM POLYAX ELLIPSE TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.338 SUP HCPCS C1713 182.338 - SCREW BONE 3.5MM 38MM POLYAX ELLIPSE TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.34 SUP HCPCS C1713 182.340 - SCREW BONE 3.5MM 40MM POLYAX ELLIPSE TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.342 SUP HCPCS C1713 182.342 - SCREW BONE 3.5MM 42MM POLYAX ELLIPSE TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.344 SUP HCPCS C1713 182.344 - SCREW BONE 3.5MM 44MM POLYAX ELLIPSE TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.346 SUP HCPCS C1713 182.346 - SCREW BONE 3.5MM 46MM POLYAX ELLIPSE TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.348 SUP HCPCS C1713 182.348 - SCREW BONE 3.5MM 48MM POLYAX ELLIPSE TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.35 SUP HCPCS C1713 182.350 - SCREW BONE 3.5MM 50MM POLYAX ELLIPSE TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.41 SUP HCPCS C1713 182.410 - SCREW BONE 4MM 10MM POLYAX ELLIPSE TITANIUM POSTERIOR OCCPTL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.412 SUP HCPCS C1713 182.412 - SCREW BONE 4MM 12MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.414 SUP HCPCS C1713 182.414 - SCREW BONE 4MM 14MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.416 SUP HCPCS C1713 182.416 - SCREW BONE 4MM 16MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.418 SUP HCPCS C1713 182.418 - SCREW BONE 4MM 18MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.42 SUP HCPCS C1713 182.420 - SCREW BONE 4MM 20MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.422 SUP HCPCS C1713 182.422 - SCREW BONE 4MM 22MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.424 SUP HCPCS C1713 182.424 - SCREW BONE 4MM 24MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.426 SUP HCPCS C1713 182.426 - SCREW BONE 4MM 26MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.428 SUP HCPCS C1713 182.428 - SCREW BONE 4MM 28MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.43 SUP HCPCS C1713 182.430 - SCREW BONE 4MM 30MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.432 SUP HCPCS C1713 182.432 - SCREW BONE 4MM 32MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.434 SUP HCPCS C1713 182.434 - SCREW BONE 4MM 34MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.436 SUP HCPCS C1713 182.436 - SCREW BONE 4MM 36MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.438 SUP HCPCS C1713 182.438 - SCREW BONE 4MM 38MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.44 SUP HCPCS C1713 182.440 - SCREW BONE 4MM 40MM POLYAX ELLIPSE TITANIUM POSTERIOR OCCPTL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.442 SUP HCPCS C1713 182.442 - SCREW BONE 4MM 42MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.444 SUP HCPCS C1713 182.444 - SCREW BONE 4MM 44MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.446 SUP HCPCS C1713 182.446 - SCREW BONE 4MM 46MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.448 SUP HCPCS C1713 182.448 - SCREW BONE 4MM 48MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.45 SUP HCPCS C1713 182.450 - SCREW BONE 4MM 50MM POLYAX ELLIPSE TITANIUM POSTERIOR OCCPTL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.5 SUP HCPCS C1713 182.500 - SCREW SET LOCKING NONTHREADED ELLIPSE TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 182.501 SUP Custom 27803010 182.501 - HOOK SPINAL INLINE ELLIPSE TITANIUM NONSTRL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.503 SUP Custom 27803010 182.503 - HOOK SPINAL INLINE ELLIPSE TITANIUM RIGHT BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.504 SUP Custom 27803010 182.504 - HOOK SPINAL INLINE ELLIPSE TITANIUM LEFT BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.506 SUP Custom 27803010 182.506 - HOOK SPINAL 7MM LEFT OFFST ELLIPSE TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.507 SUP Custom 27803010 182.507 - HOOK SPINAL 5MM LEFT OFFST ELLIPSE TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.508 SUP Custom 27803010 182.508 - HOOK SPINAL 7MM RIGHT OFFST ELLIPSE TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.509 SUP Custom 27803010 182.509 - HOOK SPINAL 5MM RIGHT OFFST ELLIPSE TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.51 SUP HCPCS C1713 182.510 - SCREW BONE 4.5MM 10MM POLYAX ELLIPSE TITANIUM POSTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.512 SUP HCPCS C1713 182.512 - SCREW BONE 4.5MM 12MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.514 SUP HCPCS C1713 182.514 - SCREW BONE 4.5MM 14MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.516 SUP HCPCS C1713 182.516 - SCREW BONE 4.5MM 16MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.518 SUP HCPCS C1713 182.518 - SCREW BONE 4.5MM 18MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.52 SUP HCPCS C1713 182.520 - SCREW BONE 4.5MM 20MM POLYAX ELLIPSE TITANIUM POSTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.522 SUP HCPCS C1713 182.522 - SCREW BONE 4.5MM 22MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.524 SUP HCPCS C1713 182.524 - SCREW BONE 4.5MM 24MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.526 SUP HCPCS C1713 182.526 - SCREW BONE 4.5MM 26MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.528 SUP HCPCS C1713 182.528 - SCREW BONE 4.5MM 28MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.53 SUP HCPCS C1713 182.530 - SCREW BONE 4.5MM 30MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.532 SUP HCPCS C1713 182.532 - SCREW BONE 4.5MM 32MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.534 SUP HCPCS C1713 182.534 - SCREW BONE 4.5MM 34MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.536 SUP HCPCS C1713 182.536 - SCREW BONE 4.5MM 36MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.538 SUP HCPCS C1713 182.538 - SCREW BONE 4.5MM 38MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.54 SUP HCPCS C1713 182.540 - SCREW BONE 4.5MM 40MM POLYAX ELLIPSE TITANIUM POSTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.542 SUP HCPCS C1713 182.542 - SCREW BONE 4.5MM 42MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.544 SUP HCPCS C1713 182.544 - SCREW BONE 4.5MM 44MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.546 SUP HCPCS C1713 182.546 - SCREW BONE 4.5MM 46MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.548 SUP HCPCS C1713 182.548 - SCREW BONE 4.5MM 48MM POLYAX ELLIPSE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.55 SUP HCPCS C1713 182.550 - SCREW BONE 4.5MM 50MM POLYAX ELLIPSE TITANIUM POSTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 182.801 SUP Custom 27803010 182.801 - ROD SPINAL 3.5MM 80MM STR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 182.802 SUP Custom 27803010 182.802 - ROD SPINAL 3.5MM 120MM ELLIPSE TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 182.803 SUP Custom 27803010 182.803 - ROD SPINAL 3.5MM 240MM ELLIPSE TITANIUM NONSTRL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 182.804 SUP Custom 27803010 182.804 - ROD SPINAL 3.5MM 40MM ELLIPSE STERILE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 182.9 SUP Custom 27803010 182.900 - SCREW SET LOCKING NONTHREADED ELLIPSE TITANIUM SPN BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 182.901 SUP Custom 27803010 182.901 - NUT LOCK T HEAD TO HEAD ELLIPSE SPN BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 182.911 SUP Custom 27803010 182.911 - NUT LOCK 3.5MM 21-27MM T CONCTR ELLIPSE TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.912 SUP Custom 27803010 182.912 - CONNECTOR ROD 3.5MM 27-33MM T ELLIPSE TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.913 SUP Custom 27803010 182.913 - CONNECTOR ROD 3.5MM 33-39MM T ELLIPSE TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.914 SUP Custom 27803010 182.914 - CONNECTOR ROD 3.5MM 39-45MM T ELLIPSE TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.915 SUP Custom 27803010 182.915 - CONNECTOR ROD 3.5MM 45-51MM T ELLIPSE TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.916 SUP Custom 27803010 182.916 - CONNECTOR ROD 3.5MM 51-57MM T ELLIPSE TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.917 SUP Custom 27803010 182.917 - CONNECTOR ROD 3.5MM 57-63MM T ELLIPSE TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.923 SUP Custom 27803010 182.923 - CONNECTOR ROD 3.5MM 21-23MM STR ELLIPSE TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.924 SUP Custom 27803010 182.924 - CONNECTOR ROD 3.5MM 26-46MM CVD ELLIPSE TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.925 SUP Custom 27803010 182.925 - CONNECTOR ROD 3.5MM 26-46MM STR ELLIPSE TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.926 SUP Custom 27803010 182.926 - CONNECTOR ROD 3.5MM 36-56MM CVD ELLIPSE TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.927 SUP Custom 27803010 182.927 - CONNECTOR ROD 3.5MM 36-56MM STR ELLIPSE TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 182.95 SUP HCPCS C1713 182.950 - PLATE BONE SMALL ELLIPSE TITANIUM SPN OCCPTL BOTH IP/OP "$7,145.00" "$5,287.00" "$1,418.10" "$7,145.00" "$3,215.25" "$3,215.25" "$3,215.25" "$3,215.25" "$7,145.00" "$7,145.00" "$7,145.00" "$1,489.20" "$7,145.00" "$7,145.00" "$7,145.00" "$7,145.00" "$7,145.00" "$1,489.10" "$7,145.00" "$2,858.00" "$3,522.49" "$7,145.00" "$7,145.00" "$7,145.00" "$7,145.00" "$5,358.75" "$7,145.00" "$7,145.00" "$7,145.00" "$3,572.50" "$3,572.50" "$5,658.84" "$7,145.00" "$5,716.00" "$3,215.25" "$1,418.10" N/A "$4,144.10" "$7,145.00" "$4,287.00" "$7,145.00" "$1,489.02" "$7,145.00" N/A N/A 182.952 SUP HCPCS C1713 "182.952 - ELLIPSE Occipital Plate, Large" BOTH IP/OP "$7,145.00" "$5,287.00" "$1,418.10" "$7,145.00" "$3,215.25" "$3,215.25" "$3,215.25" "$3,215.25" "$7,145.00" "$7,145.00" "$7,145.00" "$1,489.20" "$7,145.00" "$7,145.00" "$7,145.00" "$7,145.00" "$7,145.00" "$1,489.10" "$7,145.00" "$2,858.00" "$3,522.49" "$7,145.00" "$7,145.00" "$7,145.00" "$7,145.00" "$5,358.75" "$7,145.00" "$7,145.00" "$7,145.00" "$3,572.50" "$3,572.50" "$5,658.84" "$7,145.00" "$5,716.00" "$3,215.25" "$1,418.10" N/A "$4,144.10" "$7,145.00" "$7,145.00" "$7,145.00" "$1,489.02" "$7,145.00" N/A N/A 182.953 SUP Custom 27803010 182.953 - ROD SPNL 100D 3.5MM 240MM ELLIPSE OCPTL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 182.954 SUP Custom 27803010 182.954 - ROD SPNL 115D 3.5MM 240MM ELLIPSE OCPTL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 182.955 SUP Custom 27803010 182.955 - ROD SPNL 130D 3.5MM 240MM ELLIPSE OCPTL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 182.96 SUP Custom 27803010 182.960 - CONNECTOR ROD 3.5MM ELLIPSE TITANIUM SPN BOTH IP/OP "$1,357.50" "$1,005.00" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $282.92 "$1,357.50" $543.00 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,018.13" "$1,357.50" "$1,357.50" "$1,357.50" $678.75 $678.75 "$1,075.14" "$1,357.50" "$1,086.00" $610.88 "$1,357.50" N/A $787.35 "$1,357.50" $814.50 "$1,357.50" "$1,357.50" "$1,357.50" N/A N/A 182.961 SUP Custom 27803010 182.961 - CONNECTOR ROD 3.5-4MM ELLIPSE TITANIUM SPN BOTH IP/OP "$1,357.50" "$1,005.00" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $282.92 "$1,357.50" $543.00 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,018.13" "$1,357.50" "$1,357.50" "$1,357.50" $678.75 $678.75 "$1,075.14" "$1,357.50" "$1,086.00" $610.88 "$1,357.50" N/A $787.35 "$1,357.50" $814.50 "$1,357.50" "$1,357.50" "$1,357.50" N/A N/A 182.962 SUP Custom 27803010 182.962 - CONNECTOR ROD 3.5/4.5MM ELLIPSE TITANIUM SPN BOTH IP/OP "$1,357.50" "$1,005.00" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $282.92 "$1,357.50" $543.00 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,018.13" "$1,357.50" "$1,357.50" "$1,357.50" $678.75 $678.75 "$1,075.14" "$1,357.50" "$1,086.00" $610.88 "$1,357.50" N/A $787.35 "$1,357.50" $814.50 "$1,357.50" "$1,357.50" "$1,357.50" N/A N/A 182.963 SUP Custom 27803010 182.963 - CONNECTOR ROD 3.5-5MM ELLIPSE TITANIUM SPN BOTH IP/OP "$1,357.50" "$1,005.00" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $282.92 "$1,357.50" $543.00 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,018.13" "$1,357.50" "$1,357.50" "$1,357.50" $678.75 $678.75 "$1,075.14" "$1,357.50" "$1,086.00" $610.88 "$1,357.50" N/A $787.35 "$1,357.50" $814.50 "$1,357.50" "$1,357.50" "$1,357.50" N/A N/A 182.964 SUP Custom 27803010 182.964 - CONNECTOR ROD 3.5-5.5MM ELLIPSE TITANIUM SPN BOTH IP/OP "$1,357.50" "$1,005.00" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $282.92 "$1,357.50" $543.00 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,018.13" "$1,357.50" "$1,357.50" "$1,357.50" $678.75 $678.75 "$1,075.14" "$1,357.50" "$1,086.00" $610.88 "$1,357.50" N/A $787.35 "$1,357.50" $814.50 "$1,357.50" "$1,357.50" "$1,357.50" N/A N/A 182.965 SUP Custom 27803010 182.965 - CONNECTOR ROD 3.5-6MM ELLIPSE TITANIUM SPN BOTH IP/OP "$1,357.50" "$1,005.00" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $282.92 "$1,357.50" $543.00 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,018.13" "$1,357.50" "$1,357.50" "$1,357.50" $678.75 $678.75 "$1,075.14" "$1,357.50" "$1,086.00" $610.88 "$1,357.50" N/A $787.35 "$1,357.50" $814.50 "$1,357.50" "$1,357.50" "$1,357.50" N/A N/A 182.966 SUP Custom 27803010 182.966 - CONNECTOR ROD 3.5-6.5MM ELLIPSE TITANIUM SPN BOTH IP/OP "$1,357.50" "$1,005.00" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $282.92 "$1,357.50" $543.00 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,018.13" "$1,357.50" "$1,357.50" "$1,357.50" $678.75 $678.75 "$1,075.14" "$1,357.50" "$1,086.00" $610.88 "$1,357.50" N/A $787.35 "$1,357.50" $814.50 "$1,357.50" "$1,357.50" "$1,357.50" N/A N/A 182.967 SUP Custom 27803010 182.967 - ELLIPSE Parallel Connector 3.5mm Rod to 6.5mm Rod BOTH IP/OP "$1,357.50" "$1,005.00" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $241.64 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" $282.92 "$1,357.50" $543.00 "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$1,018.13" "$1,357.50" "$1,357.50" "$1,357.50" $678.75 $678.75 "$1,075.14" "$1,357.50" "$1,086.00" $610.88 "$1,357.50" N/A $787.35 "$1,357.50" $814.50 "$1,357.50" "$1,357.50" "$1,357.50" N/A N/A 182.975 SUP Custom 27803010 182.975 - CONNECTOR ROD ELLIPSE TITANIUM SPN LATERAL NONSTRL BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $475.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A 182.98 SUP Custom 27803010 182.980 - ROD SPINAL 3.5-4MM 350MM TAPERED ELLIPSE TITANIUM BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $475.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A 182.981 SUP Custom 27803010 182.981 - ROD SPINAL 3.5-4.5MM 350MM TAPERED ELLIPSE TITANIUM BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $475.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A 182.982 SUP Custom 27803010 182.982 - ROD SPINAL 3.5-5MM 350MM TAPERED ELLIPSE TITANIUM BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $475.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A 182.983 SUP Custom 27803010 182.983 - ROD SPINAL 3.5-5.5MM 350MM TAPERED ELLIPSE BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $475.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A 182.984 SUP Custom 27803010 182.984 - ROD SPINAL 3.5-6MM 350MM TAPERED ELLIPSE TITANIUM BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $475.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A 182.985 SUP Custom 27803010 182.985 - ROD SPINAL 3.5-6.5MM 350MM TAPERED ELLIPSE TITANIUM BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $475.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A 182.986 SUP Custom 27803010 "182.986 - ELLIPSE Tapered Rod, 3.5mm to 6.5mm, 350mm" BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $475.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A 182.989 SUP Custom 27803010 182.989 - ROD SPINAL 3.5-5.5MM 500MM TAPERED ELLIPSE BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $475.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A 182.99 SUP Custom 27803010 "182.990 - ELLIPSE Lateral Connector, Long" BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $475.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A 182.991 SUP Custom 27803010 "182.991 - ELLIPSE Lateral Connector, Short" BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $475.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A 184.012 SUP HCPCS C1713 184.012 - SCREW BONE STANDARD 12MM COALITION SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.014 SUP HCPCS C1713 184.014 - SCREW BONE STANDARD 4.2MM 14MM SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.016 SUP HCPCS C1713 184.016 - SCREW BONE STANDARD 4.2MM 16MM COALITION BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.018 SUP HCPCS C1713 184.018 - SCREW BONE 4.2MM 18MM SLFTAP VAR ANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.02 SUP HCPCS C1713 184.020 - SCREW BN 4.2MM 20MM VA ST SPNE BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.032 SUP HCPCS C1713 184.032 - SCREW BONE 4.2MM 12MM SLFTAP FIXANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.034 SUP HCPCS C1713 184.034 - SCREW BONE 4.2MM 14MM SLFTAP FIXANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.036 SUP HCPCS C1713 184.036 - SCREW BONE STANDARD 4.2MM 16MM FIXANG SPN COALITION BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.038 SUP HCPCS C1713 184.038 - SCREW BONE 4.2MM 18MM SLFTAP FIXANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.04 SUP HCPCS C1713 184.040 - SCREW BN 4.2MM 20MM FX ANG ST SPNE BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.052 SUP HCPCS C1713 184.052 - SCREW BONE 4.2MM 12MM SLFDRILL VAR ANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.054 SUP HCPCS C1713 184.054 - SCREW BONE STANDARD 4.2MM 14MM VAR ANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.056 SUP HCPCS C1713 184.056 - SCREW BONE STANDARD 4.2MM 16MM COALITION BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.058 SUP HCPCS C1713 184.058 - SCREW BONE 4.2MM 18MM SLFDRILL VAR ANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.06 SUP HCPCS C1713 184.060 - SCREW BN 4.2MM 20MM VA SLF DRL SPNE BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.072 SUP HCPCS C1713 184.072 - SCREW BONE 4.2MM 12MM SLFDRILL FIXANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.074 SUP HCPCS C1713 184.074 - SCREW BONE 4.2MM 14MM SLFDRILL FIXANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.076 SUP HCPCS C1713 184.076 - SCREW BONE 4.2MM 16MM SLFDRILL FIXANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.078 SUP HCPCS C1713 184.078 - SCREW BONE 4.2MM 18MM SLFDRILL FIXANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.08 SUP HCPCS C1713 184.080 - SCREW BN 4.2MM 20MM FX ANG SLF DRL SPNE BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.112 SUP HCPCS C1713 184.112 - SCREW BONE 3.6MM 12MM SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.114 SUP HCPCS C1713 184.114 - SCREW BONE 3.6MM 14MM SLFDRILL SPN STERILE BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.116 SUP HCPCS C1713 184.116 - SCREW BONE 3.6MM 16MM SLFDRILL SPN STERILE BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.118 SUP HCPCS C1713 184.118 - SCREW BONE 3.6MM 18MM SLFTAP VAR ANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.12 SUP HCPCS C1713 184.120 - SCREW BN 3.6MM 20MM VA ST SPNE BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.132 SUP HCPCS C1713 184.132 - SCREW BONE 3.6MM 12MM SLFTAP FIXANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.134 SUP HCPCS C1713 184.134 - SCREW BONE 12MM SLFTAP SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.136 SUP HCPCS C1713 184.136 - SCREW BONE 3.6MM 16MM SLFTAP FIXANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.138 SUP HCPCS C1713 184.138 - SCREW BONE 3.6MM 18MM SLFTAP FIXANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.14 SUP HCPCS C1713 184.140 - SCREW BN 3.6MM 20MM FX ANG ST SPNE BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.152 SUP HCPCS C1713 184.152 - SCREW BONE STANDARD 3.6MM 12MM VAR ANG SELF DRILL SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.154 SUP HCPCS C1713 184.154 - SCREW BONE STANDARD 3.6MM 14MM VAR ANG SELF DRILL SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.156 SUP HCPCS C1713 184.156 - SCREW BONE 3.6MM 16MM SLFDRILL VAR ANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.158 SUP HCPCS C1713 184.158 - SCREW BONE 3.6MM 18MM SLFDRILL VAR ANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.16 SUP HCPCS C1713 184.160 - SCREW BN 3.6MM 20MM VA SLF DRL SPNE BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.172 SUP HCPCS C1713 184.172 - SCREW BONE 3.6MM 12MM SLFDRILL FIXANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.174 SUP HCPCS C1713 184.174 - SCREW BONE 3.6MM 14MM FIX SLFDRILL AUTOFIX SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.176 SUP HCPCS C1713 184.176 - SCREW BONE 3.6MM 16MM SLFDRILL SPN STERILE BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.178 SUP HCPCS C1713 184.178 - SCREW BONE 3.6MM 18MM SLFDRILL FIXANG SPN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A 184.18 SUP HCPCS C1713 184.180 - SCREW BN 3.6MM 20MM FX ANG SLF DRL SPNE BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A 185 SUP HCPCS C1713 185.000 - CAP LOCKING LOCK REVOLVE LUMBAR SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 185.081 SUP HCPCS C1713 185.081 - SCREW BONE 8.5MM 70MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.082 SUP HCPCS C1713 185.082 - SCREW BONE 8.5MM 75MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.083 SUP HCPCS C1713 185.083 - SCREW BONE 8.5MM 80MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.084 SUP HCPCS C1713 185.084 - SCREW BONE 8.5MM 85MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.085 SUP HCPCS C1713 185.085 - SCREW BONE 8.5MM 90MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.24 SUP Custom 27803010 185.240 - ROD SPINAL 5.5MM 40MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.245 SUP Custom 27803010 185.245 - ROD SPINAL 5.5MM 45MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.25 SUP Custom 27803010 185.250 - ROD SPINAL 5.5MM 50MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.255 SUP Custom 27803010 185.255 - ROD SPINAL 5.5MM 55MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.26 SUP Custom 27803010 185.260 - ROD SPINAL 5.5MM 60MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.265 SUP Custom 27803010 185.265 - ROD SPINAL 5.5MM 65MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.27 SUP Custom 27803010 185.270 - ROD SPINAL 5.5MM 70MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.275 SUP Custom 27803010 185.275 - ROD SPINAL 5.5MM 75MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.28 SUP Custom 27803010 185.280 - ROD SPINAL 5.5MM 80MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.29 SUP Custom 27803010 185.290 - ROD SPINAL 5.5MM 90MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.3 SUP Custom 27803010 185.300 - ROD SPINAL 5.5MM 100MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.31 SUP Custom 27803010 185.310 - ROD SPINAL 5.5MM 110MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.32 SUP Custom 27803010 185.320 - ROD SPINAL 5.5MM 120MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.33 SUP Custom 27803010 185.330 - ROD SPINAL 5.5MM 130MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.34 SUP Custom 27803010 185.340 - ROD SPINAL 5.5MM 140MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.35 SUP Custom 27803010 185.350 - ROD SPINAL 5.5MM 150MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.36 SUP Custom 27803010 185.360 - ROD SPINAL 5.5MM 160MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.37 SUP Custom 27803010 185.370 - ROD SPINAL 5.5MM 170MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.38 SUP Custom 27803010 185.380 - ROD SPINAL 5.5MM 180MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.39 SUP Custom 27803010 185.390 - ROD SPINAL 5.5MM 190MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.4 SUP Custom 27803010 185.400 - ROD SPINAL 5.5MM 200MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.41 SUP Custom 27803010 185.410 - ROD SPINAL 5.5MM 210MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.42 SUP Custom 27803010 185.420 - ROD SPINAL 5.5MM 220MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.43 SUP Custom 27803010 185.430 - ROD SPINAL 5.5MM 230MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.44 SUP Custom 27803010 185.440 - ROD SPINAL 5.5MM 240MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 185.451 SUP HCPCS C1713 185.451 - SCREW BONE 5.5MM 25MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.452 SUP HCPCS C1713 185.452 - SCREW BONE 5.5MM 30MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.453 SUP HCPCS C1713 185.453 - SCREW BONE 5.5MM 35MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.454 SUP HCPCS C1713 185.454 - SCREW BONE 5.5MM 40MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.455 SUP HCPCS C1713 185.455 - SCREW BONE 5.5MM 45MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.456 SUP HCPCS C1713 185.456 - SCREW BONE 5.5MM 50MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.457 SUP HCPCS C1713 185.457 - SCREW BONE 5.5MM 55MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.461 SUP HCPCS C1713 185.461 - SCREW BONE 6.5MM 25MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.462 SUP HCPCS C1713 185.462 - SCREW BONE 6.5MM 30MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.463 SUP HCPCS C1713 185.463 - SCREW BONE 6.5MM 35MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.464 SUP HCPCS C1713 185.464 - SCREW BONE 6.5MM 40MM REVOLVING SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.465 SUP HCPCS C1713 185.465 - SCREW BONE 6.5MM 45MM REVOLVING SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.466 SUP HCPCS C1713 185.466 - SCREW BONE 6.5MM 50MM REVOLVING SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.467 SUP HCPCS C1713 185.467 - SCREW BONE 6.5MM 55MM POLYAX REVOLVE TITANIUM SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.468 SUP HCPCS C1713 185.468 - SCREW BONE 6.5MM 60MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.469 SUP HCPCS C1713 185.469 - SCREW BONE 6.5MM 65MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.471 SUP HCPCS C1713 185.471 - SCREW BONE 7.5MM 25MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.472 SUP HCPCS C1713 185.472 - SCREW BONE 7.5MM 30MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.473 SUP HCPCS C1713 185.473 - SCREW BONE 7.5MM 60MM SYSTEM SPN ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.474 SUP HCPCS C1713 185.474 - SCREW BONE 7.5MM 40MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.475 SUP HCPCS C1713 185.475 - SCREW BONE 7.5MM 45MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.476 SUP HCPCS C1713 185.476 - SCREW BONE 7.5MM 50MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.477 SUP HCPCS C1713 185.477 - SCREW BONE 7.5MM 55MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.478 SUP HCPCS C1713 185.478 - SCREW BONE 7.5MM 60MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.479 SUP HCPCS C1713 185.479 - SCREW BONE 7.5MM 65MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.481 SUP HCPCS C1713 185.481 - SCREW BONE 8.5MM 25MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.482 SUP HCPCS C1713 185.482 - SCREW BONE 8.5MM 30MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.483 SUP HCPCS C1713 185.483 - SCREW BONE 8.5MM 35MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.484 SUP HCPCS C1713 185.484 - SCREW BONE 8.5MM 40MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.485 SUP HCPCS C1713 185.485 - SCREW BONE 8.5MM 45MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.486 SUP HCPCS C1713 185.486 - SCREW BONE 8.5MM 50MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.487 SUP HCPCS C1713 185.487 - SCREW BONE 8.5MM 55MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.488 SUP HCPCS C1713 185.488 - SCREW BONE 8.5MM 90MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.489 SUP HCPCS C1713 185.489 - SCREW BONE 8.5MM 65MM POLYAX REVOLVE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 185.5 SUP Custom 27803010 185.500 - ROD SPINAL 5.5MM 300MM REVOLVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 198 SUP Custom 27203010 198 - CATHETER SUCTION 8FR 2.6MM 12IN SOFT Y ADAPTER TACTILE BOTH IP/OP $32.50 $24.00 $5.76 $57.18 $32.35 $32.35 $32.35 $32.35 $32.35 $32.35 $5.76 $32.35 $32.35 $24.01 $24.01 $24.94 $16.85 $6.74 $32.35 $22.87 $32.35 $32.35 $57.18 $32.35 $32.35 $24.38 $32.35 $32.35 $32.35 $16.18 $16.18 $25.62 $32.35 $25.88 $21.03 $32.35 N/A $18.85 $32.35 $19.41 $32.35 $32.35 $32.35 N/A N/A 200.006 SUP HCPCS C1713 200.006 - SCREW BONE STANDARD 1.5MM 3MM 6MM CRCIFRM RECESS DCP BOTH IP/OP $54.50 $40.00 $10.81 $55.38 $24.50 $24.50 $24.50 $24.50 $54.45 $54.45 $54.45 $11.35 $54.45 $54.45 $54.45 $54.45 $54.45 $11.35 $54.45 $55.38 $32.21 $54.45 $55.38 $54.45 $54.45 $40.88 $54.45 $54.45 $54.45 $27.23 $27.23 $43.12 $54.45 $43.56 $24.50 $10.81 N/A $31.61 $54.45 $32.67 $54.45 $11.35 $54.45 N/A N/A 200.007 SUP HCPCS C1713 200.007 - SCREW BONE STANDARD 1.5MM 3MM 7MM CRCIFRM RECESS DCP BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $52.88 $52.88 $11.02 $52.88 N/A N/A 200.008 SUP HCPCS C1713 200.008 - SCREW BONE STANDARD 1.5MM 3MM 8MM CRCIFRM RECESS DCP BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $31.73 $52.88 $11.02 $52.88 N/A N/A 200.009 SUP HCPCS C1713 200.009 - SCREW BONE STANDARD 1.5MM 3MM 9MM CRCIFRM RECESS DCP BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $31.73 $52.88 $11.02 $52.88 N/A N/A 200.01 SUP HCPCS C1713 200.010 - SCREW BONE STANDARD 1.5MM 10MM CRCIFRM RECESS DCP STAINLESS BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $31.73 $52.88 $11.02 $52.88 N/A N/A 200.011 SUP HCPCS C1713 200.011 - SCREW BONE STANDARD 1.5MM 3MM 11MM CRCIFRM RECESS DCP BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $31.73 $52.88 $11.02 $52.88 N/A N/A 200.012 SUP HCPCS C1713 200.012 - SCREW BONE STANDARD 1.5MM 3MM 12MM CRCIFRM RECESS DCP BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $21.15 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $31.73 $52.88 $11.02 $52.88 N/A N/A 200.014 SUP HCPCS C1713 200.014 - SCREW BONE STANDARD 1.5MM 3MM 14MM CRCIFRM RECESS DCP BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $21.15 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $52.88 $52.88 $11.02 $52.88 N/A N/A 200.016 SUP HCPCS C1713 200.016 - SCREW BONE STANDARD 1.5MM 3MM 16MM CRCIFRM RECESS DCP BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $31.73 $52.88 $11.02 $52.88 N/A N/A 200.018 SUP HCPCS C1713 200.018 - SCREW BONE STANDARD 1.5MM 3MM 18MM CRCIFRM RECESS DCP BOTH IP/OP $51.50 $38.00 $10.19 $51.33 $23.10 $23.10 $23.10 $23.10 $51.33 $51.33 $51.33 $10.70 $51.33 $51.33 $51.33 $51.33 $51.33 $10.70 $51.33 $51.33 $30.36 $51.33 $51.33 $51.33 $51.33 $38.63 $51.33 $51.33 $51.33 $25.67 $25.67 $40.65 $51.33 $41.06 $23.10 $10.19 N/A $29.87 $51.33 $30.80 $51.33 $10.70 $51.33 N/A N/A 200.02 SUP HCPCS C1713 200.020 - SCREW BONE STANDARD 1.5MM 3MM 20MM CRCIFRM RECESS DCP BOTH IP/OP $51.50 $38.00 $10.19 $51.33 $23.10 $23.10 $23.10 $23.10 $51.33 $51.33 $51.33 $10.70 $51.33 $51.33 $51.33 $51.33 $51.33 $10.70 $51.33 $51.33 $30.36 $51.33 $51.33 $51.33 $51.33 $38.63 $51.33 $51.33 $51.33 $25.67 $25.67 $40.65 $51.33 $41.06 $23.10 $10.19 N/A $29.87 $51.33 $30.80 $51.33 $10.70 $51.33 N/A N/A 200.19 SUP Custom 27203010 200.190 - PIN FIX 1.8MM 12MM T8 STARDRIVE RECESS BUTTRESS LCP BOTH IP/OP $213.00 $158.00 $37.90 $223.03 $212.90 $212.90 $212.90 $212.90 $212.90 $212.90 $37.90 $212.90 $212.90 $158.01 $158.01 $164.10 $110.92 $44.37 $212.90 $89.21 $212.90 $212.90 $223.03 $212.90 $212.90 $159.75 $212.90 $212.90 $212.90 $106.45 $106.45 $168.62 $212.90 $170.32 $138.39 $212.90 N/A $123.54 $212.90 $127.74 $212.90 $212.90 $212.90 N/A N/A 200.191 SUP Custom 27203010 200.191 - PIN FIX 1.8MM 14MM T8 STARDRIVE RECESS BUTTRESS LCP BOTH IP/OP $219.50 $162.00 $39.04 $223.03 $219.30 $219.30 $219.30 $219.30 $219.30 $219.30 $39.04 $219.30 $219.30 $162.76 $162.76 $169.04 $114.26 $45.70 $219.30 $89.21 $219.30 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $142.55 $219.30 N/A $127.31 $219.30 $131.58 $219.30 $219.30 $219.30 N/A N/A 200.192 SUP Custom 27203010 200.192 - PIN FIX 1.8MM 16MM T8 STARDRIVE RECESS BUTTRESS LCP BOTH IP/OP $219.50 $162.00 $39.04 $223.03 $219.30 $219.30 $219.30 $219.30 $219.30 $219.30 $39.04 $219.30 $219.30 $162.76 $162.76 $169.04 $114.26 $45.70 $219.30 $89.21 $219.30 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $142.55 $219.30 N/A $127.31 $219.30 $131.58 $219.30 $219.30 $219.30 N/A N/A 200.193 SUP Custom 27203010 200.193 - PIN FIX 1.8MM 18MM T8 STARDRIVE RECESS BUTTRESS LCP BOTH IP/OP $219.50 $162.00 $39.04 $223.03 $219.30 $219.30 $219.30 $219.30 $219.30 $219.30 $39.04 $219.30 $219.30 $162.76 $162.76 $169.04 $114.26 $45.70 $219.30 $89.21 $219.30 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $142.55 $219.30 N/A $127.31 $219.30 $131.58 $219.30 $219.30 $219.30 N/A N/A 200.195 SUP Custom 27203010 200.195 - PIN FIX ROUND 1.8MM 22MM T8 STARDRIVE RECESS BUTTRESS SMOOTH BOTH IP/OP $219.50 $162.00 $39.04 $223.03 $219.30 $219.30 $219.30 $219.30 $219.30 $219.30 $39.04 $219.30 $219.30 $162.76 $162.76 $169.04 $114.26 $45.70 $219.30 $89.21 $219.30 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $142.55 $219.30 N/A $127.31 $219.30 $131.58 $219.30 $219.30 $219.30 N/A N/A 200.197 SUP Custom 27203010 200.197 - PIN FIX 1.8MM 24MM BUTTRESS STARDRIVE STAINLESS STEEL BOTH IP/OP $219.50 $162.00 $39.04 $223.03 $219.30 $219.30 $219.30 $219.30 $219.30 $219.30 $39.04 $219.30 $219.30 $162.76 $162.76 $169.04 $114.26 $45.70 $219.30 $89.21 $219.30 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $142.55 $219.30 N/A $127.31 $219.30 $131.58 $219.30 $219.30 $219.30 N/A N/A 200.198 SUP Custom 27203010 200.198 - PIN FIX 1.8MM 26MM BUTTRESS STARDRIVE STAINLESS STEEL BOTH IP/OP $219.50 $162.00 $39.04 $223.03 $219.30 $219.30 $219.30 $219.30 $219.30 $219.30 $39.04 $219.30 $219.30 $162.76 $162.76 $169.04 $114.26 $45.70 $219.30 $89.21 $219.30 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $142.55 $219.30 N/A $127.31 $219.30 $131.58 $219.30 $219.30 $219.30 N/A N/A 200.199 SUP Custom 27203010 200.199 - PIN FIX 1.8MM 28MM BUTTRESS STARDRIVE STAINLESS STEEL BOTH IP/OP $219.50 $162.00 $39.04 $223.03 $219.30 $219.30 $219.30 $219.30 $219.30 $219.30 $39.04 $219.30 $219.30 $162.76 $162.76 $169.04 $114.26 $45.70 $219.30 $89.21 $219.30 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $142.55 $219.30 N/A $127.31 $219.30 $131.58 $219.30 $219.30 $219.30 N/A N/A 200.526 SUP HCPCS C1713 200.526 - SCREW BONE 1MM 1.6MM 6MM SELF TAP CRCIFRM LP HEAD STAINLESS BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $55.75 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 200.527 SUP HCPCS C1713 200.527 - SCREW BONE LP 1MM 1.6MM 7MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $55.75 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 200.528 SUP HCPCS C1713 200.528 - SCREW BONE 1MM 1.6MM 8MM SELF TAP CRCIFRM LP HEAD STAINLESS BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $55.75 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 200.529 SUP HCPCS C1713 200.529 - SCREW BONE LP 1MM 1.6MM 9MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $55.75 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 200.53 SUP HCPCS C1713 200.530 - SCREW BONE LP 1MM 1.6MM 10MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $133.50 $99.00 $26.41 $139.38 $59.87 $59.87 $59.87 $59.87 $133.05 $133.05 $133.05 $27.73 $133.05 $133.05 $133.05 $133.05 $133.05 $27.73 $133.05 $55.75 $78.70 $133.05 $139.38 $133.05 $133.05 $100.13 $133.05 $133.05 $133.05 $66.53 $66.53 $105.38 $133.05 $106.44 $59.87 $26.41 N/A $77.43 $133.05 $79.83 $133.05 $133.05 $133.05 N/A N/A 200.531 SUP HCPCS C1713 200.531 - SCREW BONE LP 1MM 1.6MM 11MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $55.75 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $137.05 $137.05 N/A N/A 200.532 SUP HCPCS C1713 200.532 - SCREW BONE LP 1MM 1.6MM 12MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $55.75 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $137.05 $137.05 $28.56 $137.05 N/A N/A 200.533 SUP HCPCS C1713 200.533 - SCREW BONE 1MM 1.6MM 13MM SELF TAP CRCIFRM LP HEAD STAINLESS BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $55.75 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $137.05 $137.05 $28.56 $137.05 N/A N/A 200.534 SUP HCPCS C1713 200.534 - SCREW BONE LP 1MM 1.6MM 14MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $55.75 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 200.686 SUP HCPCS C1713 200.686 - SCREW BONE 1.3MM 2.4MM 6MM SELF TAP CRCIFRM RECESS LP HEAD BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $145.80 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $143.38 $143.38 N/A N/A 200.687 SUP HCPCS C1713 200.687 - SCREW BONE LP 1.3MM 2.4MM 7MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $58.32 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $143.38 $143.38 N/A N/A 200.688 SUP HCPCS C1713 200.688 - SCREW BONE LP 1.3MM 2.4MM 8MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $58.32 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $29.88 $143.38 N/A N/A 200.689 SUP HCPCS C1713 200.689 - SCREW BONE LP 1.3MM 2.4MM 9MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $58.32 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $143.38 $143.38 N/A N/A 200.69 SUP HCPCS C1713 200.690 - SCREW BONE 1.3MM 2.4MM 10MM SLFTAP CRCIFRM RECESS LP HEAD BOTH IP/OP $139.50 $103.00 $27.63 $145.80 $62.64 $62.64 $62.64 $62.64 $139.20 $139.20 $139.20 $29.01 $139.20 $139.20 $139.20 $139.20 $139.20 $29.01 $139.20 $58.32 $82.34 $139.20 $145.80 $139.20 $139.20 $104.63 $139.20 $139.20 $139.20 $69.60 $69.60 $110.25 $139.20 $111.36 $62.64 $27.63 N/A $80.91 $139.20 $83.52 $139.20 $139.20 $139.20 N/A N/A 200.691 SUP HCPCS C1713 200.691 - SCREW BONE LP 1.3MM 2.4MM 11MM SELF TAP CRCIFRM DCP BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $58.32 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $143.38 $143.38 N/A N/A 200.692 SUP HCPCS C1713 200.692 - SCREW BONE LP 1.3MM 2.4MM 12MM SELF TAP CRCIFRM DCP BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $58.32 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $143.38 $143.38 $29.88 $143.38 N/A N/A 200.693 SUP HCPCS C1713 200.693 - SCREW BONE 1.3MM 2.4MM 13MM SELF TAP CRCIFRM LP HEAD BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $145.80 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $29.88 $143.38 N/A N/A 200.694 SUP HCPCS C1713 200.694 - SCREW BONE LP 1.3MM 2.4MM 14MM SELF TAP CRCIFRM DCP BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $58.32 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $29.88 $143.38 N/A N/A 200.696 SUP HCPCS C1713 200.696 - SCREW BONE LP 1.3MM 2.4MM 16MM SELF TAP CRCIFRM DCP BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $58.32 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $143.38 $143.38 N/A N/A 200.698 SUP HCPCS C1713 200.698 - SCREW BONE LP 1.3MM 2.4MM 18MM SELF TAP CRCIFRM DCP BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $58.32 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $143.38 $143.38 N/A N/A 200.806 SUP HCPCS C1713 200.806 - SCREW BONE LP 1.5MM 3MM 6MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 200.807 SUP HCPCS C1713 200.807 - SCREW BONE LP 1.5MM 3MM 7MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 200.808 SUP HCPCS C1713 200.808 - SCREW BONE LP 1.5MM 3MM 8MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 200.809 SUP HCPCS C1713 200.809 - SCREW BONE LP 1.5MM 3MM 9MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 200.81 SUP HCPCS C1713 200.810 - SCREW BONE LP 1.5MM 3MM 10MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $59.50 $44.00 $11.72 $61.83 $26.56 $26.56 $26.56 $26.56 $59.03 $59.03 $59.03 $12.30 $59.03 $59.03 $59.03 $59.03 $59.03 $12.30 $59.03 $61.83 $34.92 $59.03 $61.83 $59.03 $59.03 $44.63 $59.03 $59.03 $59.03 $29.52 $29.52 $46.75 $59.03 $47.22 $26.56 $11.72 N/A $34.51 $59.03 $35.42 $59.03 $12.30 $59.03 N/A N/A 200.811 SUP HCPCS C1713 200.811 - SCREW BONE LP 1.5MM 3MM 11MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 200.812 SUP HCPCS C1713 200.812 - SCREW BONE LP 1.5MM 3MM 12MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 200.813 SUP HCPCS C1713 200.813 - SCREW BONE LP 1.5MM 3MM 13MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.73 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 200.814 SUP HCPCS C1713 200.814 - SCREW BONE LP 1.5MM 3MM 14MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 200.816 SUP HCPCS C1713 200.816 - SCREW BONE LP 1.5MM 3MM 16MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 200.818 SUP HCPCS C1713 200.818 - SCREW BONE LP 1.5MM 3MM 18MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 200.82 SUP HCPCS C1713 200.820 - SCREW BONE LP 1.5MM 3MM 20MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $59.50 $44.00 $11.72 $61.83 $26.56 $26.56 $26.56 $26.56 $59.03 $59.03 $59.03 $12.30 $59.03 $59.03 $59.03 $59.03 $59.03 $12.30 $59.03 $61.83 $34.92 $59.03 $61.83 $59.03 $59.03 $44.63 $59.03 $59.03 $59.03 $29.52 $29.52 $46.75 $59.03 $47.22 $26.56 $11.72 N/A $34.51 $59.03 $35.42 $59.03 $12.30 $59.03 N/A N/A 200.822 SUP HCPCS C1713 200.822 - SCREW BONE LP 1.5MM 3MM 22MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 200.824 SUP HCPCS C1713 200.824 - SCREW BONE LP 1.5MM 3MM 24MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.73 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 201.006 SUP HCPCS C1713 201.006 - SCREW BN STD 2MM 3.5MM 6MM NS CRFRM SS CORT MN FRAG SET MDLR BOTH IP/OP $54.00 $40.00 $10.67 $54.68 $24.19 $24.19 $24.19 $24.19 $53.75 $53.75 $53.75 $11.20 $53.75 $53.75 $53.75 $53.75 $53.75 $11.20 $53.75 $21.87 $31.79 $53.75 $54.68 $53.75 $53.75 $40.50 $53.75 $53.75 $53.75 $26.88 $26.88 $42.57 $53.75 $43.00 $24.19 $10.67 N/A $31.32 $53.75 $53.75 $53.75 $11.20 $53.75 N/A N/A 201.008 SUP HCPCS C1713 201.008 - SCREW BONE STANDARD 2MM 8MM CRCIFRM RECESS DCP STAINLESS BOTH IP/OP $54.00 $40.00 $10.67 $54.68 $24.19 $24.19 $24.19 $24.19 $53.75 $53.75 $53.75 $11.20 $53.75 $53.75 $53.75 $53.75 $53.75 $11.20 $53.75 $54.68 $31.79 $53.75 $54.68 $53.75 $53.75 $40.50 $53.75 $53.75 $53.75 $26.88 $26.88 $42.57 $53.75 $43.00 $24.19 $10.67 N/A $31.32 $53.75 $53.75 $53.75 $11.20 $53.75 N/A N/A 201.01 SUP HCPCS C1713 201.010 - SCREW BONE STANDARD 2MM 10MM CRCIFRM HEAD DCP STAINLESS BOTH IP/OP $52.50 $39.00 $10.36 $54.68 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $21.87 $30.88 $52.20 $54.68 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $31.32 $52.20 $10.88 $52.20 N/A N/A 201.012 SUP HCPCS C1713 201.012 - SCREW BONE STANDARD 2MM 3.5MM 12MM CRCIFRM RECESS DCP BOTH IP/OP $54.00 $40.00 $10.67 $54.68 $24.19 $24.19 $24.19 $24.19 $53.75 $53.75 $53.75 $11.20 $53.75 $53.75 $53.75 $53.75 $53.75 $11.20 $53.75 $21.87 $31.79 $53.75 $54.68 $53.75 $53.75 $40.50 $53.75 $53.75 $53.75 $26.88 $26.88 $42.57 $53.75 $43.00 $24.19 $10.67 N/A $31.32 $53.75 $32.25 $53.75 $11.20 $53.75 N/A N/A 201.014 SUP HCPCS C1713 201.014 - SCREW BONE STANDARD 2MM 3.5MM 14MM CRCIFRM DCP STAINLESS BOTH IP/OP $54.00 $40.00 $10.67 $54.68 $24.19 $24.19 $24.19 $24.19 $53.75 $53.75 $53.75 $11.20 $53.75 $53.75 $53.75 $53.75 $53.75 $11.20 $53.75 $54.68 $31.79 $53.75 $54.68 $53.75 $53.75 $40.50 $53.75 $53.75 $53.75 $26.88 $26.88 $42.57 $53.75 $43.00 $24.19 $10.67 N/A $31.32 $53.75 $32.25 $53.75 $11.20 $53.75 N/A N/A 201.016 SUP HCPCS C1713 201.016 - SCREW BONE STANDARD 2MM 3.5MM 16MM CRCIFRM RECESS DCP BOTH IP/OP $54.00 $40.00 $10.67 $54.68 $24.19 $24.19 $24.19 $24.19 $53.75 $53.75 $53.75 $11.20 $53.75 $53.75 $53.75 $53.75 $53.75 $11.20 $53.75 $54.68 $31.79 $53.75 $54.68 $53.75 $53.75 $40.50 $53.75 $53.75 $53.75 $26.88 $26.88 $42.57 $53.75 $43.00 $24.19 $10.67 N/A $31.32 $53.75 $32.25 $53.75 $11.20 $53.75 N/A N/A 201.018 SUP HCPCS C1713 201.018 - SCREW BONE STANDARD 2MM 18MM CRCIFRM RECESS DCP STAINLESS BOTH IP/OP $54.00 $40.00 $10.67 $54.68 $24.19 $24.19 $24.19 $24.19 $53.75 $53.75 $53.75 $11.20 $53.75 $53.75 $53.75 $53.75 $53.75 $11.20 $53.75 $54.68 $31.79 $53.75 $54.68 $53.75 $53.75 $40.50 $53.75 $53.75 $53.75 $26.88 $26.88 $42.57 $53.75 $43.00 $24.19 $10.67 N/A $31.32 $53.75 $32.25 $53.75 $11.20 $53.75 N/A N/A 201.02 SUP HCPCS C1713 201.020 - SCREW BONE STANDARD 2MM 20MM CRCIFRM RECESS DCP STAINLESS BOTH IP/OP $52.50 $39.00 $10.36 $54.68 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $21.87 $30.88 $52.20 $54.68 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $52.20 $52.20 $10.88 $52.20 N/A N/A 201.022 SUP HCPCS C1713 201.022 - SCREW BONE STANDARD 2MM 3.5MM 22MM CRCIFRM DCP STAINLESS BOTH IP/OP $51.00 $38.00 $10.06 $50.68 $22.81 $22.81 $22.81 $22.81 $50.68 $50.68 $50.68 $10.56 $50.68 $50.68 $50.68 $50.68 $50.68 $10.56 $50.68 $50.68 $29.98 $50.68 $50.68 $50.68 $50.68 $38.25 $50.68 $50.68 $50.68 $25.34 $25.34 $40.14 $50.68 $40.54 $22.81 $10.06 N/A $29.58 $50.68 $50.68 $50.68 $10.56 $50.68 N/A N/A 201.024 SUP HCPCS C1713 201.024 - SCREW BONE 2MM 24MM DCP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $51.00 $38.00 $10.06 $50.68 $22.81 $22.81 $22.81 $22.81 $50.68 $50.68 $50.68 $10.56 $50.68 $50.68 $50.68 $50.68 $50.68 $10.56 $50.68 $50.68 $29.98 $50.68 $50.68 $50.68 $50.68 $38.25 $50.68 $50.68 $50.68 $25.34 $25.34 $40.14 $50.68 $40.54 $22.81 $10.06 N/A $29.58 $50.68 $50.68 $50.68 $10.56 $50.68 N/A N/A 201.026 SUP HCPCS C1713 201.026 - SCREW BONE 2MM 26MM DCP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $52.20 $52.20 $10.88 $52.20 N/A N/A 201.028 SUP HCPCS C1713 201.028 - SCREW BONE 2MM 28MM DCP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $52.20 $52.20 $10.88 $52.20 N/A N/A 201.03 SUP HCPCS C1713 201.030 - SCREW BONE 2MM 30MM DCP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $31.32 $52.20 $10.88 $52.20 N/A N/A 201.032 SUP HCPCS C1713 201.032 - SCREW BONE 2MM 32MM DCP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $52.20 $52.20 $10.88 $52.20 N/A N/A 201.034 SUP HCPCS C1713 201.034 - SCREW BONE 2MM 34MM DCP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $52.20 $52.20 $10.88 $52.20 N/A N/A 201.036 SUP HCPCS C1713 201.036 - SCREW BONE 2MM 36MM DCP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $31.32 $52.20 $10.88 $52.20 N/A N/A 201.038 SUP HCPCS C1713 201.038 - SCREW BONE 2MM 38MM DCP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $31.32 $52.20 $10.88 $52.20 N/A N/A 201.04 SUP HCPCS C1713 201.040 - SCREW BONE 2MM 40MM DCP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $20.88 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $31.32 $52.20 $10.88 $52.20 N/A N/A 201.042 SUP HCPCS C1713 201.042 - SCREW BONE 2MM 42MM DCP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $54.00 $40.00 $10.67 $54.68 $24.19 $24.19 $24.19 $24.19 $53.75 $53.75 $53.75 $11.20 $53.75 $53.75 $53.75 $53.75 $53.75 $11.20 $53.75 $54.68 $31.79 $53.75 $54.68 $53.75 $53.75 $40.50 $53.75 $53.75 $53.75 $26.88 $26.88 $42.57 $53.75 $43.00 $24.19 $10.67 N/A $31.32 $53.75 $53.75 $53.75 $11.20 $53.75 N/A N/A 201.044 SUP HCPCS C1713 201.044 - SCREW BONE 2MM 44MM DCP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $54.00 $40.00 $10.67 $54.68 $24.19 $24.19 $24.19 $24.19 $53.75 $53.75 $53.75 $11.20 $53.75 $53.75 $53.75 $53.75 $53.75 $11.20 $53.75 $21.87 $31.79 $53.75 $54.68 $53.75 $53.75 $40.50 $53.75 $53.75 $53.75 $26.88 $26.88 $42.57 $53.75 $43.00 $24.19 $10.67 N/A $31.32 $53.75 $32.25 $53.75 $11.20 $53.75 N/A N/A 201.046 SUP HCPCS C1713 201.046 - SCREW BONE 2MM 46MM DCP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $54.00 $40.00 $10.67 $54.68 $24.19 $24.19 $24.19 $24.19 $53.75 $53.75 $53.75 $11.20 $53.75 $53.75 $53.75 $53.75 $53.75 $11.20 $53.75 $21.87 $31.79 $53.75 $54.68 $53.75 $53.75 $40.50 $53.75 $53.75 $53.75 $26.88 $26.88 $42.57 $53.75 $43.00 $24.19 $10.67 N/A $31.32 $53.75 $32.25 $53.75 $11.20 $53.75 N/A N/A 201.506 SUP HCPCS C1713 201.506 - SCREW BONE 2.4MM 3.5MM 6MM SLFTAP STAINLESS STEEL MAXILLA BOTH IP/OP $91.50 $68.00 $18.11 $91.25 $41.06 $41.06 $41.06 $41.06 $91.25 $91.25 $91.25 $19.02 $91.25 $91.25 $91.25 $91.25 $91.25 $19.02 $91.25 $36.50 $53.97 $91.25 $91.25 $91.25 $91.25 $68.63 $91.25 $91.25 $91.25 $45.63 $45.63 $72.27 $91.25 $73.00 $41.06 $18.11 N/A $53.07 $91.25 $91.25 $91.25 $19.02 $91.25 N/A N/A 201.508 SUP HCPCS C1713 201.508 - SCREW BONE 2.4MM 3.5MM 8MM SLFTAP STAINLESS STEEL MAXILLA BOTH IP/OP $91.50 $68.00 $18.11 $91.25 $41.06 $41.06 $41.06 $41.06 $91.25 $91.25 $91.25 $19.02 $91.25 $91.25 $91.25 $91.25 $91.25 $19.02 $91.25 $91.25 $53.97 $91.25 $91.25 $91.25 $91.25 $68.63 $91.25 $91.25 $91.25 $45.63 $45.63 $72.27 $91.25 $73.00 $41.06 $18.11 N/A $53.07 $91.25 $91.25 $91.25 $19.02 $91.25 N/A N/A 201.51 SUP HCPCS C1713 201.510 - SCREW BONE 2.4MM 3.5MM 10MM SLFTAP STAINLESS STEEL MAXILLA BOTH IP/OP $91.50 $68.00 $18.11 $91.25 $41.06 $41.06 $41.06 $41.06 $91.25 $91.25 $91.25 $19.02 $91.25 $91.25 $91.25 $91.25 $91.25 $19.02 $91.25 $91.25 $53.97 $91.25 $91.25 $91.25 $91.25 $68.63 $91.25 $91.25 $91.25 $45.63 $45.63 $72.27 $91.25 $73.00 $41.06 $18.11 N/A $53.07 $91.25 $91.25 $91.25 $19.02 $91.25 N/A N/A 201.512 SUP HCPCS C1713 201.512 - SCREW BONE 2.4MM 3.5MM 12MM SLFTAP STAINLESS STEEL MAXILLA BOTH IP/OP $75.50 $56.00 $14.96 $75.38 $33.92 $33.92 $33.92 $33.92 $75.38 $75.38 $75.38 $15.71 $75.38 $75.38 $75.38 $75.38 $75.38 $15.71 $75.38 $30.15 $44.59 $75.38 $75.38 $75.38 $75.38 $56.63 $75.38 $75.38 $75.38 $37.69 $37.69 $59.70 $75.38 $60.30 $33.92 $14.96 N/A $43.79 $75.38 $75.38 $75.38 $15.71 $75.38 N/A N/A 201.514 SUP HCPCS C1713 201.514 - SCREW BONE 2.4MM 14MM SLFTAP STAINLESS STEEL MAXILLA BOTH IP/OP $91.50 $68.00 $18.11 $91.25 $41.06 $41.06 $41.06 $41.06 $91.25 $91.25 $91.25 $19.02 $91.25 $91.25 $91.25 $91.25 $91.25 $19.02 $91.25 $36.50 $53.97 $91.25 $91.25 $91.25 $91.25 $68.63 $91.25 $91.25 $91.25 $45.63 $45.63 $72.27 $91.25 $73.00 $41.06 $18.11 N/A $53.07 $91.25 $91.25 $91.25 $19.02 $91.25 N/A N/A 201.612 SUP HCPCS C1713 201.612 - SCREW BONE 2.4MM 3.5MM 12MM SELF TAP CRCIFRM STAINLESS STEEL BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $36.60 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $89.98 $89.98 $18.75 $89.98 N/A N/A 201.614 SUP HCPCS C1713 201.614 - SCREW BONE 2.4MM 3.5MM 14MM SELF TAP STAINLESS STEEL CORTEX BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $36.60 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $53.99 $89.98 $18.75 $89.98 N/A N/A 201.616 SUP HCPCS C1713 201.616 - SCREW BONE 2.4MM 3.5MM 16MM SELF TAP CRCIFRM LCP STAINLESS BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $91.50 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $89.98 $89.98 $18.75 $89.98 N/A N/A 201.618 SUP HCPCS C1713 201.618 - SCREW BONE 2.4MM 3.5MM 18MM SELF TAP CRCIFRM STAINLESS STEEL BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $91.50 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $89.98 $89.98 $89.98 $89.98 N/A N/A 201.62 SUP HCPCS C1713 201.620 - SCREW BONE 2.4MM 20MM SLFTAP STAINLESS STEEL RAD CORTICAL BOTH IP/OP $87.50 $65.00 $17.34 $91.50 $39.31 $39.31 $39.31 $39.31 $87.35 $87.35 $87.35 $18.21 $87.35 $87.35 $87.35 $87.35 $87.35 $18.20 $87.35 $91.50 $51.67 $87.35 $91.50 $87.35 $87.35 $65.63 $87.35 $87.35 $87.35 $43.68 $43.68 $69.18 $87.35 $69.88 $39.31 $17.34 N/A $50.75 $87.35 $87.35 $87.35 $87.35 $87.35 N/A N/A 201.622 SUP HCPCS C1713 201.622 - SCREW BONE 2.4MM 3.5MM 22MM SELF TAP CRCIFRM STAINLESS STEEL BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $91.50 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $89.98 $89.98 $18.75 $89.98 N/A N/A 201.624 SUP HCPCS C1713 201.624 - SCREW BONE 2.4MM 3.5MM 24MM SELF TAP CRCIFRM STAINLESS STEEL BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $36.60 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $53.99 $89.98 $89.98 $89.98 N/A N/A 201.626 SUP HCPCS C1713 201.626 - SCREW BONE 2.4MM 3.5MM 26MM SELF TAP CRCIFRM STAINLESS STEEL BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $36.60 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $53.99 $89.98 $89.98 $89.98 N/A N/A 201.628 SUP HCPCS C1713 201.628 - SCREW BONE 2.4MM 28MM SLFTAP STAINLESS STEEL RAD CORTICAL BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $36.60 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $89.98 $89.98 $18.75 $89.98 N/A N/A 201.63 SUP HCPCS C1713 201.630 - SCREW BONE 2.4MM 3.5MM 30MM SLFTAP CRCIFRM RECESS STAINLESS BOTH IP/OP $87.50 $65.00 $17.34 $91.50 $39.31 $39.31 $39.31 $39.31 $87.35 $87.35 $87.35 $18.21 $87.35 $87.35 $87.35 $87.35 $87.35 $18.20 $87.35 $36.60 $51.67 $87.35 $91.50 $87.35 $87.35 $65.63 $87.35 $87.35 $87.35 $43.68 $43.68 $69.18 $87.35 $69.88 $39.31 $17.34 N/A $50.75 $87.35 $52.41 $87.35 $87.35 $87.35 N/A N/A 201.636 SUP HCPCS C1713 201.636 - SCREW BONE CONE LP 2.4MM 4.5MM 6MM SELF TAP THREAD CRCIFRM BOTH IP/OP $93.00 $69.00 $18.41 $94.35 $41.75 $41.75 $41.75 $41.75 $92.78 $92.78 $92.78 $19.34 $92.78 $92.78 $92.78 $92.78 $92.78 $19.34 $92.78 $37.74 $54.88 $92.78 $94.35 $92.78 $92.78 $69.75 $92.78 $92.78 $92.78 $46.39 $46.39 $73.48 $92.78 $74.22 $41.75 $18.41 N/A $53.94 $92.78 $55.67 $92.78 $19.34 $92.78 N/A N/A 201.637 SUP HCPCS C1713 201.637 - SCREW BONE CONE LP 2.4MM 4.5MM 7MM SELF TAP THREAD CRCIFRM BOTH IP/OP $93.00 $69.00 $18.41 $94.35 $41.75 $41.75 $41.75 $41.75 $92.78 $92.78 $92.78 $19.34 $92.78 $92.78 $92.78 $92.78 $92.78 $19.34 $92.78 $37.74 $54.88 $92.78 $94.35 $92.78 $92.78 $69.75 $92.78 $92.78 $92.78 $46.39 $46.39 $73.48 $92.78 $74.22 $41.75 $18.41 N/A $53.94 $92.78 $55.67 $92.78 $19.34 $92.78 N/A N/A 201.638 SUP HCPCS C1713 201.638 - SCREW BONE CONE LP 2.4MM 4.5MM 8MM SELF TAP THREAD CRCIFRM BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $91.50 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $89.98 $89.98 $18.75 $89.98 N/A N/A 201.639 SUP HCPCS C1713 201.639 - SCREW BONE CONE LP 2.4MM 4.5MM 9MM SELF TAP THREAD CRCIFRM BOTH IP/OP $93.00 $69.00 $18.41 $94.35 $41.75 $41.75 $41.75 $41.75 $92.78 $92.78 $92.78 $19.34 $92.78 $92.78 $92.78 $92.78 $92.78 $19.34 $92.78 $37.74 $54.88 $92.78 $94.35 $92.78 $92.78 $69.75 $92.78 $92.78 $92.78 $46.39 $46.39 $73.48 $92.78 $74.22 $41.75 $18.41 N/A $53.94 $92.78 $55.67 $92.78 $19.34 $92.78 N/A N/A 201.64 SUP HCPCS C1713 201.640 - SCREW BONE CONE LP 2.4MM 4.5MM 10MM SELF TAP THREAD CRCIFRM BOTH IP/OP $87.50 $65.00 $17.34 $91.50 $39.31 $39.31 $39.31 $39.31 $87.35 $87.35 $87.35 $18.21 $87.35 $87.35 $87.35 $87.35 $87.35 $18.20 $87.35 $36.60 $51.67 $87.35 $91.50 $87.35 $87.35 $65.63 $87.35 $87.35 $87.35 $43.68 $43.68 $69.18 $87.35 $69.88 $39.31 $17.34 N/A $50.75 $87.35 $52.41 $87.35 $18.20 $87.35 N/A N/A 201.641 SUP HCPCS C1713 201.641 - SCREW BONE CONE LP 2.4MM 4.5MM 11MM SELF TAP THREAD CRCIFRM BOTH IP/OP $93.00 $69.00 $18.41 $94.35 $41.75 $41.75 $41.75 $41.75 $92.78 $92.78 $92.78 $19.34 $92.78 $92.78 $92.78 $92.78 $92.78 $19.34 $92.78 $37.74 $54.88 $92.78 $94.35 $92.78 $92.78 $69.75 $92.78 $92.78 $92.78 $46.39 $46.39 $73.48 $92.78 $74.22 $41.75 $18.41 N/A $53.94 $92.78 $92.78 $92.78 $19.34 $92.78 N/A N/A 201.642 SUP HCPCS C1713 201.642 - SCREW BONE CONE LP 2.4MM 4.5MM 12MM SELF TAP THREAD CRCIFRM BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $36.60 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $53.99 $89.98 $18.75 $89.98 N/A N/A 201.643 SUP HCPCS C1713 201.643 - SCREW BONE CONE LP 2.4MM 4.5MM 13MM SELF TAP THREAD CRCIFRM BOTH IP/OP $93.00 $69.00 $18.41 $94.35 $41.75 $41.75 $41.75 $41.75 $92.78 $92.78 $92.78 $19.34 $92.78 $92.78 $92.78 $92.78 $92.78 $19.34 $92.78 $94.35 $54.88 $92.78 $94.35 $92.78 $92.78 $69.75 $92.78 $92.78 $92.78 $46.39 $46.39 $73.48 $92.78 $74.22 $41.75 $18.41 N/A $53.94 $92.78 $55.67 $92.78 $19.34 $92.78 N/A N/A 201.644 SUP HCPCS C1713 201.644 - SCREW BONE CONE LP 2.4MM 4.5MM 14MM SELF TAP THREAD CRCIFRM BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $91.50 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $53.99 $89.98 $89.98 $89.98 N/A N/A 201.646 SUP HCPCS C1713 201.646 - SCREW BONE CONE LP 2.4MM 4.5MM 16MM SELF TAP THREAD CRCIFRM BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $36.60 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $89.98 $89.98 $89.98 $89.98 N/A N/A 201.648 SUP HCPCS C1713 201.648 - SCREW BONE CONE LP 2.4MM 4.5MM 18MM SELF TAP THREAD CRCIFRM BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $36.60 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $53.99 $89.98 $18.75 $89.98 N/A N/A 201.65 SUP HCPCS C1713 201.650 - SCREW BONE CONE LP 2.4MM 4.5MM 20MM SELF TAP THREAD CRCIFRM BOTH IP/OP $87.50 $65.00 $17.34 $91.50 $39.31 $39.31 $39.31 $39.31 $87.35 $87.35 $87.35 $18.21 $87.35 $87.35 $87.35 $87.35 $87.35 $18.20 $87.35 $36.60 $51.67 $87.35 $91.50 $87.35 $87.35 $65.63 $87.35 $87.35 $87.35 $43.68 $43.68 $69.18 $87.35 $69.88 $39.31 $17.34 N/A $50.75 $87.35 $52.41 $87.35 $87.35 $87.35 N/A N/A 201.652 SUP HCPCS C1713 201.652 - SCREW BONE CONE LP 2.4MM 4.5MM 22MM SELF TAP THREAD CRCIFRM BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $36.60 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $53.99 $89.98 $89.98 $89.98 N/A N/A 201.654 SUP HCPCS C1713 201.654 - SCREW BONE CONE LP 2.4MM 4.5MM 24MM SELF TAP THREAD CRCIFRM BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $36.60 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $53.99 $89.98 $18.75 $89.98 N/A N/A 201.656 SUP HCPCS C1713 201.656 - SCREW BONE CONE LP 2.4MM 4.5MM 26MM SELF TAP THREAD CRCIFRM BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $36.60 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $53.99 $89.98 $18.75 $89.98 N/A N/A 201.658 SUP HCPCS C1713 201.658 - SCREW BONE CONE LP 2.4MM 4.5MM 28MM SELF TAP THREAD CRCIFRM BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $36.60 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $53.99 $89.98 $18.75 $89.98 N/A N/A 201.66 SUP HCPCS C1713 201.660 - SCREW BONE CONE LP 2.4MM 4.5MM 30MM SELF TAP THREAD CRCIFRM BOTH IP/OP $87.50 $65.00 $17.34 $91.50 $39.31 $39.31 $39.31 $39.31 $87.35 $87.35 $87.35 $18.21 $87.35 $87.35 $87.35 $87.35 $87.35 $18.20 $87.35 $36.60 $51.67 $87.35 $91.50 $87.35 $87.35 $65.63 $87.35 $87.35 $87.35 $43.68 $43.68 $69.18 $87.35 $69.88 $39.31 $17.34 N/A $50.75 $87.35 $52.41 $87.35 $18.20 $87.35 N/A N/A 201.662 SUP HCPCS C1713 201.662 - SCREW BONE CONE LP 2.4MM 4.5MM 32MM SELF TAP THREAD CRCIFRM BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $36.60 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $53.99 $89.98 $18.75 $89.98 N/A N/A 201.664 SUP HCPCS C1713 201.664 - SCREW BONE CONE LP 2.4MM 4.5MM 34MM SELF TAP THREAD CRCIFRM BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $91.50 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $53.99 $89.98 $18.75 $89.98 N/A N/A 201.666 SUP HCPCS C1713 201.666 - SCREW BONE 2.4MM 4MM 36MM SELF TAP STAINLESS STEEL SMALL BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $91.50 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $53.99 $89.98 $18.75 $89.98 N/A N/A 201.668 SUP HCPCS C1713 201.668 - SCREW BONE CONE LP 2.4MM 4.5MM 38MM SELF TAP THREAD CRCIFRM BOTH IP/OP $90.00 $67.00 $17.86 $91.50 $40.49 $40.49 $40.49 $40.49 $89.98 $89.98 $89.98 $18.75 $89.98 $89.98 $89.98 $89.98 $89.98 $18.75 $89.98 $91.50 $53.22 $89.98 $91.50 $89.98 $89.98 $67.50 $89.98 $89.98 $89.98 $44.99 $44.99 $71.26 $89.98 $71.98 $40.49 $17.86 N/A $52.20 $89.98 $53.99 $89.98 $18.75 $89.98 N/A N/A 201.67 SUP HCPCS C1713 201.670 - SCREW BONE CONE LP 2.4MM 4.5MM 40MM SELF TAP THREAD CRCIFRM BOTH IP/OP $87.50 $65.00 $17.34 $91.50 $39.31 $39.31 $39.31 $39.31 $87.35 $87.35 $87.35 $18.21 $87.35 $87.35 $87.35 $87.35 $87.35 $18.20 $87.35 $91.50 $51.67 $87.35 $91.50 $87.35 $87.35 $65.63 $87.35 $87.35 $87.35 $43.68 $43.68 $69.18 $87.35 $69.88 $39.31 $17.34 N/A $50.75 $87.35 $52.41 $87.35 $18.20 $87.35 N/A N/A 201.676 SUP HCPCS C1713 201.676 - SCREW BONE 3.5MM HEAD 2.4MM 6MM SLFTAP STAINLESS STEEL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $47.46 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $70.01 $116.68 $24.32 $116.68 N/A N/A 201.677 SUP HCPCS C1713 201.677 - SCREW BONE 2.3MM 3.5MM 7MM HEAD SLFTAP CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $47.46 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $70.01 $116.68 $24.32 $116.68 N/A N/A 201.678 SUP HCPCS C1713 201.678 - SCREW BONE 3.5MM HEAD 2.4MM 8MM SLFTAP STAINLESS STEEL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $47.46 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $116.68 $116.68 N/A N/A 201.679 SUP HCPCS C1713 201.679 - SCREW BONE 2.3MM 3.5MM 9MM HEAD SLFTAP CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $47.46 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $116.68 $116.68 N/A N/A 201.68 SUP HCPCS C1713 201.680 - CLIP ANEURYSM 10MM OPENING 20X1.88MM SUPER BAYONET LATEX BOTH IP/OP $113.50 $84.00 $22.48 $118.65 $50.98 $50.98 $50.98 $50.98 $113.28 $113.28 $113.28 $23.61 $113.28 $113.28 $113.28 $113.28 $113.28 $23.61 $113.28 $47.46 $67.01 $113.28 $118.65 $113.28 $113.28 $85.13 $113.28 $113.28 $113.28 $56.64 $56.64 $89.72 $113.28 $90.62 $50.98 $22.48 N/A $65.83 $113.28 $67.97 $113.28 $23.61 $113.28 N/A N/A 201.681 SUP HCPCS C1713 201.681 - SCREW BONE 2.3MM 3.5MM 11MM HEAD SLFTAP CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $47.46 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $24.32 $116.68 N/A N/A 201.683 SUP HCPCS C1713 201.683 - SCREW BONE 3.5MM HEAD 2.4MM 13MM SLFTAP STAINLESS STEEL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $47.46 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $70.01 $116.68 $24.32 $116.68 N/A N/A 201.685 SUP HCPCS C1713 201.685 - SCREW BONE 3.5MM HEAD 2.3MM 15MM SLFTAP CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $47.46 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $116.68 $116.68 N/A N/A 201.686 SUP HCPCS C1713 201.686 - SCREW BONE 2.3MM 3.5MM 32MM HEAD SLFTAP CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $118.65 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $116.68 $116.68 N/A N/A 201.687 SUP HCPCS C1713 201.687 - SCREW BONE 2.3MM 3.5MM 34MM HEAD SLFTAP CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $118.65 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $24.32 $116.68 N/A N/A 201.688 SUP HCPCS C1713 201.688 - SCREW BONE 2.3MM 3.5MM 36MM HEAD SLFTAP CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $118.65 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $24.32 $116.68 N/A N/A 201.689 SUP HCPCS C1713 201.689 - SCREW BONE 2.3MM 3.5MM 38MM HEAD SLFTAP CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $118.65 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $24.32 $116.68 N/A N/A 201.69 SUP HCPCS C1713 201.690 - SCREW BONE 3.5MM HEAD 2.3MM 40MM SLFTAP CORTICAL BOTH IP/OP $113.50 $84.00 $22.48 $118.65 $50.98 $50.98 $50.98 $50.98 $113.28 $113.28 $113.28 $23.61 $113.28 $113.28 $113.28 $113.28 $113.28 $23.61 $113.28 $47.46 $67.01 $113.28 $118.65 $113.28 $113.28 $85.13 $113.28 $113.28 $113.28 $56.64 $56.64 $89.72 $113.28 $90.62 $50.98 $22.48 N/A $65.83 $113.28 $113.28 $113.28 $113.28 $113.28 N/A N/A 201.691 SUP HCPCS C1713 201.691 - SCREW BONE 2.3MM 3.5MM 42MM HEAD SLFTAP CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $118.65 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $116.68 $116.68 N/A N/A 201.692 SUP HCPCS C1713 201.692 - SCREW BONE 2.4MM 44MM SLFTAP STAINLESS STEEL CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $47.46 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $24.32 $116.68 N/A N/A 201.693 SUP HCPCS C1713 201.693 - SCREW BONE 2.3MM 3.5MM 46MM HEAD SLFTAP CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $118.65 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $24.32 $116.68 N/A N/A 201.694 SUP HCPCS C1713 201.694 - SCREW BONE 2.3MM 3.5MM 48MM HEAD SLFTAP CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $47.46 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $24.32 $116.68 N/A N/A 201.695 SUP HCPCS C1713 201.695 - SCREW BONE 3.5MM HEAD 2.3MM 50MM SLFTAP CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $47.46 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $24.32 $116.68 N/A N/A 201.696 SUP HCPCS C1713 201.696 - SCREW BONE 3.5MM HEAD 2.4MM 52MM SLFTAP STAINLESS STEEL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $47.46 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $116.68 $116.68 N/A N/A 201.697 SUP HCPCS C1713 201.697 - SCREW BONE 2.3MM 3.5MM 54MM HEAD SLFTAP CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $47.46 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $116.68 $116.68 N/A N/A 201.698 SUP HCPCS C1713 201.698 - SCREW BONE 3.5MM HEAD 2.4MM 56MM SLFTAP STAINLESS STEEL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $47.46 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $24.32 $116.68 N/A N/A 201.699 SUP HCPCS C1713 201.699 - SCREW BONE 2.3MM 3.5MM 58MM HEAD SLFTAP CORTICAL BOTH IP/OP $117.00 $87.00 $23.16 $118.65 $52.51 $52.51 $52.51 $52.51 $116.68 $116.68 $116.68 $24.32 $116.68 $116.68 $116.68 $116.68 $116.68 $24.32 $116.68 $47.46 $69.02 $116.68 $118.65 $116.68 $116.68 $87.75 $116.68 $116.68 $116.68 $58.34 $58.34 $92.41 $116.68 $93.34 $52.51 $23.16 N/A $67.86 $116.68 $116.68 $116.68 $24.32 $116.68 N/A N/A 201.7 SUP HCPCS C1713 201.700 - SCREW BONE 2.4MM 3.5MM 60MM SLFTAP CRCIFRM RECESS STAINLESS BOTH IP/OP $113.50 $84.00 $22.48 $118.65 $50.98 $50.98 $50.98 $50.98 $113.28 $113.28 $113.28 $23.61 $113.28 $113.28 $113.28 $113.28 $113.28 $23.61 $113.28 $118.65 $67.01 $113.28 $118.65 $113.28 $113.28 $85.13 $113.28 $113.28 $113.28 $56.64 $56.64 $89.72 $113.28 $90.62 $50.98 $22.48 N/A $65.83 $113.28 $113.28 $113.28 $23.61 $113.28 N/A N/A 201.756 SUP HCPCS C1713 201.756 - SCREW BONE T8 LP 2.4MM 4MM 6MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $107.23 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $105.43 $105.43 $21.97 $105.43 N/A N/A 201.757 SUP HCPCS C1713 201.757 - SCREW BONE T8 LP 2.4MM 4MM 7MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $42.89 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.758 SUP HCPCS C1713 201.758 - SCREW BONE T8 LP 2.4MM 4MM 8MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $107.23 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.759 SUP HCPCS C1713 201.759 - SCREW BONE T8 LP 2.4MM 4MM 9MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $42.89 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.76 SUP HCPCS C1713 201.760 - SCREW BONE T8 LP 2.4MM 4MM 10MM SELF TAP STARDRIVE LCP BOTH IP/OP $102.50 $76.00 $20.31 $107.23 $46.06 $46.06 $46.06 $46.06 $102.35 $102.35 $102.35 $21.33 $102.35 $102.35 $102.35 $102.35 $102.35 $21.33 $102.35 $107.23 $60.54 $102.35 $107.23 $102.35 $102.35 $76.88 $102.35 $102.35 $102.35 $51.18 $51.18 $81.06 $102.35 $81.88 $46.06 $20.31 N/A $59.45 $102.35 $61.41 $102.35 $21.33 $102.35 N/A N/A 201.761 SUP HCPCS C1713 201.761 - SCREW BONE T8 LP 2.4MM 4MM 11MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $107.23 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.762 SUP HCPCS C1713 201.762 - SCREW BONE T8 LP 2.4MM 4MM 12MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $107.23 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $105.43 $105.43 $21.97 $105.43 N/A N/A 201.763 SUP HCPCS C1713 201.763 - SCREW BONE T8 LP 2.4MM 4MM 13MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $42.89 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.764 SUP HCPCS C1713 201.764 - SCREW BONE T8 LP 2.4MM 4MM 14MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $107.23 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.766 SUP HCPCS C1713 201.766 - SCREW BONE 2.4MM 4MM 16MM T8 STARDRIVE SELF TAP LP HEAD VAR BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $107.23 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $105.43 $105.43 $21.97 $105.43 N/A N/A 201.768 SUP HCPCS C1713 201.768 - SCREW BONE T8 LP 2.4MM 4MM 18MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $42.89 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.77 SUP HCPCS C1713 201.770 - SCREW BONE T8 LP 2.4MM 4MM 20MM SELF TAP STARDRIVE LCP BOTH IP/OP $102.50 $76.00 $20.31 $107.23 $46.06 $46.06 $46.06 $46.06 $102.35 $102.35 $102.35 $21.33 $102.35 $102.35 $102.35 $102.35 $102.35 $21.33 $102.35 $42.89 $60.54 $102.35 $107.23 $102.35 $102.35 $76.88 $102.35 $102.35 $102.35 $51.18 $51.18 $81.06 $102.35 $81.88 $46.06 $20.31 N/A $59.45 $102.35 $61.41 $102.35 $21.33 $102.35 N/A N/A 201.772 SUP HCPCS C1713 201.772 - SCREW BONE T8 LP 2.4MM 4MM 22MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $107.23 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.774 SUP HCPCS C1713 201.774 - SCREW BONE T8 LP 2.4MM 4MM 24MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $42.89 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.776 SUP HCPCS C1713 201.776 - SCREW BONE T8 LP 2.4MM 4MM 26MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $107.23 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.778 SUP HCPCS C1713 201.778 - SCREW BONE T8 LP 2.4MM 4MM 28MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $107.23 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.78 SUP HCPCS C1713 201.780 - SCREW BONE T8 LP 2.4MM 4MM 30MM SELF TAP STARDRIVE LCP BOTH IP/OP $102.50 $76.00 $20.31 $107.23 $46.06 $46.06 $46.06 $46.06 $102.35 $102.35 $102.35 $21.33 $102.35 $102.35 $102.35 $102.35 $102.35 $21.33 $102.35 $42.89 $60.54 $102.35 $107.23 $102.35 $102.35 $76.88 $102.35 $102.35 $102.35 $51.18 $51.18 $81.06 $102.35 $81.88 $46.06 $20.31 N/A $59.45 $102.35 $102.35 $102.35 $21.33 $102.35 N/A N/A 201.782 SUP HCPCS C1713 201.782 - SCREW BONE 2.4MM 3.5MM 32MM SELF TAP CRCIFRM T8 STARDRIVE BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $42.89 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.784 SUP HCPCS C1713 201.784 - SCREW BONE T8 LP 2.4MM 4MM 34MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $107.23 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.786 SUP HCPCS C1713 201.786 - SCREW BONE T8 LP 2.4MM 4MM 36MM SELF TAP STARDRIVE LCP BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $42.89 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.788 SUP HCPCS C1713 201.788 - SCREW BONE 2.4MM 4MM 38MM VARIABLESELF TAPPING T8 STARDRIVE BOTH IP/OP $105.50 $78.00 $20.93 $107.23 $47.44 $47.44 $47.44 $47.44 $105.43 $105.43 $105.43 $21.97 $105.43 $105.43 $105.43 $105.43 $105.43 $21.97 $105.43 $42.89 $62.36 $105.43 $107.23 $105.43 $105.43 $79.13 $105.43 $105.43 $105.43 $52.72 $52.72 $83.50 $105.43 $84.34 $47.44 $20.93 N/A $61.19 $105.43 $63.26 $105.43 $21.97 $105.43 N/A N/A 201.79 SUP HCPCS C1713 201.790 - SCREW BONE T8 LP 2.4MM 4MM 40MM SELF TAP STARDRIVE LCP BOTH IP/OP $102.50 $76.00 $20.31 $107.23 $46.06 $46.06 $46.06 $46.06 $102.35 $102.35 $102.35 $21.33 $102.35 $102.35 $102.35 $102.35 $102.35 $21.33 $102.35 $42.89 $60.54 $102.35 $107.23 $102.35 $102.35 $76.88 $102.35 $102.35 $102.35 $51.18 $51.18 $81.06 $102.35 $81.88 $46.06 $20.31 N/A $59.45 $102.35 $61.41 $102.35 $21.33 $102.35 N/A N/A 201.806 SUP HCPCS C1713 201.806 - SCREW BONE 2MM 3.5MM 6MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.73 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 201.807 SUP HCPCS C1713 201.807 - SCREW BONE 2MM 3.5MM 7MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.73 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 201.808 SUP HCPCS C1713 201.808 - SCREW BONE 2MM 3.5MM 8MM SELF TAP CRCIFRM STAINLESS STEEL FT BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 201.809 SUP HCPCS C1713 201.809 - SCREW BONE 2MM 3.5MM 9MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.73 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 201.81 SUP HCPCS C1713 201.810 - SCREW BONE 2MM 3.5MM 10MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $59.50 $44.00 $11.72 $61.83 $26.56 $26.56 $26.56 $26.56 $59.03 $59.03 $59.03 $12.30 $59.03 $59.03 $59.03 $59.03 $59.03 $12.30 $59.03 $24.73 $34.92 $59.03 $61.83 $59.03 $59.03 $44.63 $59.03 $59.03 $59.03 $29.52 $29.52 $46.75 $59.03 $47.22 $26.56 $11.72 N/A $34.51 $59.03 $59.03 $59.03 $12.30 $59.03 N/A N/A 201.811 SUP HCPCS C1713 201.811 - SCREW BONE 2MM 3.5MM 11MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.73 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $60.80 $60.80 N/A N/A 201.812 SUP HCPCS C1713 201.812 - SCREW BONE 2MM 3.5MM 12MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 201.813 SUP HCPCS C1713 201.813 - SCREW BN 2MM 13MM NS ST SS CORT MDLR HND SYS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.73 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 201.814 SUP HCPCS C1713 201.814 - SCREW BONE 2MM 3.5MM 14MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 201.816 SUP HCPCS C1713 201.816 - SCREW BONE 2MM 3.5MM 16MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.73 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 201.818 SUP HCPCS C1713 201.818 - SCREW BONE 2MM 3.5MM 18MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 201.82 SUP HCPCS C1713 201.820 - SCREW BONE 2MM 3.5MM 20MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $59.50 $44.00 $11.72 $61.83 $26.56 $26.56 $26.56 $26.56 $59.03 $59.03 $59.03 $12.30 $59.03 $59.03 $59.03 $59.03 $59.03 $12.30 $59.03 $61.83 $34.92 $59.03 $61.83 $59.03 $59.03 $44.63 $59.03 $59.03 $59.03 $29.52 $29.52 $46.75 $59.03 $47.22 $26.56 $11.72 N/A $34.51 $59.03 $59.03 $59.03 $12.30 $59.03 N/A N/A 201.822 SUP HCPCS C1713 201.822 - SCREW BONE 2MM 3.5MM 22MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 201.824 SUP HCPCS C1713 201.824 - SCREW BONE 2MM 3.5MM 24MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 201.826 SUP HCPCS C1713 201.826 - SCREW BONE 2MM 3.5MM 26MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $61.83 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 201.828 SUP HCPCS C1713 201.828 - SCREW BONE 2MM 3.5MM 28MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.73 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 201.83 SUP HCPCS C1713 201.830 - SCREW BONE 2MM 3.5MM 30MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $59.50 $44.00 $11.72 $61.83 $26.56 $26.56 $26.56 $26.56 $59.03 $59.03 $59.03 $12.30 $59.03 $59.03 $59.03 $59.03 $59.03 $12.30 $59.03 $24.73 $34.92 $59.03 $61.83 $59.03 $59.03 $44.63 $59.03 $59.03 $59.03 $29.52 $29.52 $46.75 $59.03 $47.22 $26.56 $11.72 N/A $34.51 $59.03 $59.03 $59.03 $12.30 $59.03 N/A N/A 201.832 SUP HCPCS C1713 201.832 - SCREW BONE 2MM 3.5MM 32MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.73 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 201.834 SUP HCPCS C1713 201.834 - SCREW BONE 2MM 3.5MM 34MM SELF TAP CRCIFRM LCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.73 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 201.836 SUP HCPCS C1713 201.836 - SCREW BONE 2MM 3.5MM 36MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.73 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $60.80 $60.80 N/A N/A 201.838 SUP HCPCS C1713 201.838 - SCREW BONE 2MM 3.5MM 38MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $61.83 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.73 $35.96 $60.80 $61.83 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $60.80 $60.80 N/A N/A 201.84 SUP HCPCS C1713 201.840 - SCREW BONE 2MM 3.5MM 40MM SELF TAP CRCIFRM LCP STAINLESS BOTH IP/OP $59.50 $44.00 $11.72 $61.83 $26.56 $26.56 $26.56 $26.56 $59.03 $59.03 $59.03 $12.30 $59.03 $59.03 $59.03 $59.03 $59.03 $12.30 $59.03 $24.73 $34.92 $59.03 $61.83 $59.03 $59.03 $44.63 $59.03 $59.03 $59.03 $29.52 $29.52 $46.75 $59.03 $47.22 $26.56 $11.72 N/A $34.51 $59.03 $59.03 $59.03 $59.03 $59.03 N/A N/A 201.876 SUP HCPCS C1713 201.876 - SCREW BONE T6 2MM 6MM SELF TAP STARDRIVE LCP STAINLESS STEEL BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 201.877 SUP HCPCS C1713 201.877 - SCREW BONE T6 2MM 7MM SELF TAP STARDRIVE LCP STAINLESS STEEL BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 201.878 SUP HCPCS C1713 201.878 - SCREW BONE T6 2MM 8MM SELF TAP STARDRIVE LCP STAINLESS STEEL BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 201.879 SUP HCPCS C1713 201.879 - SCREW BONE T6 2MM 9MM SELF TAP STARDRIVE LCP STAINLESS STEEL BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 201.88 SUP HCPCS C1713 201.880 - SCREW BONE T6 2MM 10MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $209.00 $155.00 $41.44 $218.73 $93.96 $93.96 $93.96 $93.96 $208.80 $208.80 $208.80 $43.52 $208.80 $208.80 $208.80 $208.80 $208.80 $43.52 $208.80 $218.73 $123.51 $208.80 $218.73 $208.80 $208.80 $156.75 $208.80 $208.80 $208.80 $104.40 $104.40 $165.37 $208.80 $167.04 $93.96 $41.44 N/A $121.22 $208.80 $208.80 $208.80 $43.51 $208.80 N/A N/A 201.881 SUP HCPCS C1713 201.881 - SCREW BONE T6 2MM 11MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 201.882 SUP HCPCS C1713 201.882 - SCREW BONE T6 2MM 12MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 201.883 SUP HCPCS C1713 201.883 - SCREW BONE T6 2MM 13MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 201.884 SUP HCPCS C1713 201.884 - SCREW BONE T6 2MM 14MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 201.886 SUP HCPCS C1713 201.886 - SCREW BONE T6 2MM 16MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 201.888 SUP HCPCS C1713 201.888 - SCREW BONE T6 2MM 18MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 201.89 SUP HCPCS C1713 201.890 - SCREW BONE T6 2MM 20MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $209.00 $155.00 $41.44 $218.73 $93.96 $93.96 $93.96 $93.96 $208.80 $208.80 $208.80 $43.52 $208.80 $208.80 $208.80 $208.80 $208.80 $43.52 $208.80 $218.73 $123.51 $208.80 $218.73 $208.80 $208.80 $156.75 $208.80 $208.80 $208.80 $104.40 $104.40 $165.37 $208.80 $167.04 $93.96 $41.44 N/A $121.22 $208.80 $125.28 $208.80 $43.51 $208.80 N/A N/A 201.892 SUP HCPCS C1713 201.892 - SCREW BONE T6 2MM 22MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 201.894 SUP HCPCS C1713 201.894 - SCREW BONE T6 2MM 24MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 201.896 SUP HCPCS C1713 201.896 - SCREW BONE T6 2MM 26MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $87.49 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 201.898 SUP HCPCS C1713 201.898 - SCREW BONE T6 2MM 28MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 201.9 SUP HCPCS C1713 201.900 - SCREW BONE 2MM 30MM T6 STAR DRIVE RECESS SLFTAP LCP BOTH IP/OP $209.00 $155.00 $41.44 $218.73 $93.96 $93.96 $93.96 $93.96 $208.80 $208.80 $208.80 $43.52 $208.80 $208.80 $208.80 $208.80 $208.80 $43.52 $208.80 $218.73 $123.51 $208.80 $218.73 $208.80 $208.80 $156.75 $208.80 $208.80 $208.80 $104.40 $104.40 $165.37 $208.80 $167.04 $93.96 $41.44 N/A $121.22 $208.80 $125.28 $208.80 $43.51 $208.80 N/A N/A 201.928 SUP HCPCS C1713 201.928 - SCREW BONE 8MM 2MM MAXFACL SS SLF DRILING IMF NONSTRL BOTH IP/OP $206.00 $152.00 $40.86 $205.88 $92.65 $92.65 $92.65 $92.65 $205.88 $205.88 $205.88 $42.91 $205.88 $205.88 $205.88 $205.88 $205.88 $42.91 $205.88 $205.88 $121.78 $205.88 $205.88 $205.88 $205.88 $154.50 $205.88 $205.88 $205.88 $102.94 $102.94 $163.06 $205.88 $164.70 $92.65 $40.86 N/A $119.48 $205.88 $205.88 $205.88 $42.91 $205.88 N/A N/A 201.962 SUP Custom 27203010 201.962 - PIN FIX 1.8MM 12MM BUTTRESS STAINLESS STEEL DISTAL RAD BOTH IP/OP $117.50 $87.00 $20.89 $119.35 $117.35 $117.35 $117.35 $117.35 $117.35 $117.35 $20.89 $117.35 $117.35 $87.10 $87.10 $90.45 $61.14 $24.46 $117.35 $47.74 $117.35 $117.35 $119.35 $117.35 $117.35 $88.13 $117.35 $117.35 $117.35 $58.68 $58.68 $92.94 $117.35 $93.88 $76.28 $117.35 N/A $68.15 $117.35 $70.41 $117.35 $117.35 $117.35 N/A N/A 201.964 SUP Custom 27203010 201.964 - PIN FIX 1.8MM 14MM BUTTRESS STAINLESS STEEL DISTAL RAD BOTH IP/OP $117.50 $87.00 $20.89 $119.35 $117.35 $117.35 $117.35 $117.35 $117.35 $117.35 $20.89 $117.35 $117.35 $87.10 $87.10 $90.45 $61.14 $24.46 $117.35 $47.74 $117.35 $117.35 $119.35 $117.35 $117.35 $88.13 $117.35 $117.35 $117.35 $58.68 $58.68 $92.94 $117.35 $93.88 $76.28 $117.35 N/A $68.15 $117.35 $70.41 $117.35 $117.35 $117.35 N/A N/A 201.966 SUP Custom 27203010 201.966 - PIN FIX 1.8MM 16MM BUTTRESS STAINLESS STEEL DISTAL RAD BOTH IP/OP $117.50 $87.00 $20.89 $119.35 $117.35 $117.35 $117.35 $117.35 $117.35 $117.35 $20.89 $117.35 $117.35 $87.10 $87.10 $90.45 $61.14 $24.46 $117.35 $47.74 $117.35 $117.35 $119.35 $117.35 $117.35 $88.13 $117.35 $117.35 $117.35 $58.68 $58.68 $92.94 $117.35 $93.88 $76.28 $117.35 N/A $68.15 $117.35 $70.41 $117.35 $117.35 $117.35 N/A N/A 201.968 SUP Custom 27203010 201.968 - PIN FIX 1.8MM 18MM BUTTRESS LCP STAINLESS STEEL DISTAL RAD BOTH IP/OP $117.50 $87.00 $20.89 $119.35 $117.35 $117.35 $117.35 $117.35 $117.35 $117.35 $20.89 $117.35 $117.35 $87.10 $87.10 $90.45 $61.14 $24.46 $117.35 $47.74 $117.35 $117.35 $119.35 $117.35 $117.35 $88.13 $117.35 $117.35 $117.35 $58.68 $58.68 $92.94 $117.35 $93.88 $76.28 $117.35 N/A $68.15 $117.35 $70.41 $117.35 $117.35 $117.35 N/A N/A 201.972 SUP Custom 27203010 201.972 - PIN FIX 1.8MM 22MM BUTTRESS STAINLESS STEEL DISTAL RAD BOTH IP/OP $117.50 $87.00 $20.89 $119.35 $117.35 $117.35 $117.35 $117.35 $117.35 $117.35 $20.89 $117.35 $117.35 $87.10 $87.10 $90.45 $61.14 $24.46 $117.35 $47.74 $117.35 $117.35 $119.35 $117.35 $117.35 $88.13 $117.35 $117.35 $117.35 $58.68 $58.68 $92.94 $117.35 $93.88 $76.28 $117.35 N/A $68.15 $117.35 $70.41 $117.35 $117.35 $117.35 N/A N/A 201.974 SUP Custom 27203010 201.974 - PIN FIX 1.8MM 24MM BUTTRESS STAINLESS STEEL DISTAL RAD BOTH IP/OP $117.50 $87.00 $20.89 $119.35 $117.35 $117.35 $117.35 $117.35 $117.35 $117.35 $20.89 $117.35 $117.35 $87.10 $87.10 $90.45 $61.14 $24.46 $117.35 $47.74 $117.35 $117.35 $119.35 $117.35 $117.35 $88.13 $117.35 $117.35 $117.35 $58.68 $58.68 $92.94 $117.35 $93.88 $76.28 $117.35 N/A $68.15 $117.35 $70.41 $117.35 $117.35 $117.35 N/A N/A 201.976 SUP Custom 27203010 201.976 - PIN FIX 1.8MM 26MM BUTTRESS STAINLESS STEEL DISTAL RAD BOTH IP/OP $117.50 $87.00 $20.89 $119.35 $117.35 $117.35 $117.35 $117.35 $117.35 $117.35 $20.89 $117.35 $117.35 $87.10 $87.10 $90.45 $61.14 $24.46 $117.35 $47.74 $117.35 $117.35 $119.35 $117.35 $117.35 $88.13 $117.35 $117.35 $117.35 $58.68 $58.68 $92.94 $117.35 $93.88 $76.28 $117.35 N/A $68.15 $117.35 $70.41 $117.35 $117.35 $117.35 N/A N/A 201.978 SUP Custom 27203010 201.978 - PIN FIX 1.8MM 28MM BUTTRESS STAINLESS STEEL DISTAL RAD BOTH IP/OP $117.50 $87.00 $20.89 $119.35 $117.35 $117.35 $117.35 $117.35 $117.35 $117.35 $20.89 $117.35 $117.35 $87.10 $87.10 $90.45 $61.14 $24.46 $117.35 $47.74 $117.35 $117.35 $119.35 $117.35 $117.35 $88.13 $117.35 $117.35 $117.35 $58.68 $58.68 $92.94 $117.35 $93.88 $76.28 $117.35 N/A $68.15 $117.35 $70.41 $117.35 $117.35 $117.35 N/A N/A 201.98 SUP Custom 27203010 201.980 - PIN FIX 1.8MM 30MM BUTTRESS STAINLESS STEEL DISTAL RAD BOTH IP/OP $114.00 $84.00 $20.28 $119.35 $113.95 $113.95 $113.95 $113.95 $113.95 $113.95 $20.28 $113.95 $113.95 $84.57 $84.57 $87.83 $59.37 $23.75 $113.95 $47.74 $113.95 $113.95 $119.35 $113.95 $113.95 $85.50 $113.95 $113.95 $113.95 $56.98 $56.98 $90.25 $113.95 $91.16 $74.07 $113.95 N/A $66.12 $113.95 $68.37 $113.95 $113.95 $113.95 N/A N/A 202.006 SUP HCPCS C1713 202.006 - SCREW BONE 2.5MM STANDARD 2.7MM 6MM SPHERICAL HEAD SMALL BOTH IP/OP $57.00 $42.00 $11.23 $57.53 $25.46 $25.46 $25.46 $25.46 $56.58 $56.58 $56.58 $11.79 $56.58 $56.58 $56.58 $56.58 $56.58 $11.79 $56.58 $23.01 $33.47 $56.58 $57.53 $56.58 $56.58 $42.75 $56.58 $56.58 $56.58 $28.29 $28.29 $44.81 $56.58 $45.26 $25.46 $11.23 N/A $33.06 $56.58 $56.58 $56.58 $11.79 $56.58 N/A N/A 202.008 SUP HCPCS C1713 202.008 - SCREW BONE STANDARD 2.7MM 5MM 8MM SPHERICAL HEAD SMALL BOTH IP/OP $57.00 $42.00 $11.23 $57.53 $25.46 $25.46 $25.46 $25.46 $56.58 $56.58 $56.58 $11.79 $56.58 $56.58 $56.58 $56.58 $56.58 $11.79 $56.58 $23.01 $33.47 $56.58 $57.53 $56.58 $56.58 $42.75 $56.58 $56.58 $56.58 $28.29 $28.29 $44.81 $56.58 $45.26 $25.46 $11.23 N/A $33.06 $56.58 $56.58 $56.58 $11.79 $56.58 N/A N/A 202.01 SUP HCPCS C1713 202.010 - SCREW BN STD FT 2.7MM 5MM 10MM NS 2.5MM SPHRCL HD SM HEX BOTH IP/OP $55.00 $41.00 $10.90 $57.53 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $23.01 $32.49 $54.93 $57.53 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $54.93 $54.93 $11.45 $54.93 N/A N/A 202.012 SUP HCPCS C1713 202.012 - SCREW BONE STANDARD 2.7MM 5MM 12MM SPHERICAL HEAD SMALL BOTH IP/OP $57.00 $42.00 $11.23 $57.53 $25.46 $25.46 $25.46 $25.46 $56.58 $56.58 $56.58 $11.79 $56.58 $56.58 $56.58 $56.58 $56.58 $11.79 $56.58 $57.53 $33.47 $56.58 $57.53 $56.58 $56.58 $42.75 $56.58 $56.58 $56.58 $28.29 $28.29 $44.81 $56.58 $45.26 $25.46 $11.23 N/A $33.06 $56.58 $56.58 $56.58 $56.58 $56.58 N/A N/A 202.014 SUP HCPCS C1713 202.014 - SCREW BONE STANDARD 2.7MM 5MM 14MM SPHERICAL HEAD SMALL BOTH IP/OP $57.00 $42.00 $11.23 $57.53 $25.46 $25.46 $25.46 $25.46 $56.58 $56.58 $56.58 $11.79 $56.58 $56.58 $56.58 $56.58 $56.58 $11.79 $56.58 $23.01 $33.47 $56.58 $57.53 $56.58 $56.58 $42.75 $56.58 $56.58 $56.58 $28.29 $28.29 $44.81 $56.58 $45.26 $25.46 $11.23 N/A $33.06 $56.58 $56.58 $56.58 $56.58 $56.58 N/A N/A 202.016 SUP HCPCS C1713 202.016 - SCREW BONE STANDARD 2.7MM 5MM 16MM SPHERICAL HEAD SMALL BOTH IP/OP $57.00 $42.00 $11.23 $57.53 $25.46 $25.46 $25.46 $25.46 $56.58 $56.58 $56.58 $11.79 $56.58 $56.58 $56.58 $56.58 $56.58 $11.79 $56.58 $23.01 $33.47 $56.58 $57.53 $56.58 $56.58 $42.75 $56.58 $56.58 $56.58 $28.29 $28.29 $44.81 $56.58 $45.26 $25.46 $11.23 N/A $33.06 $56.58 $56.58 $56.58 $11.79 $56.58 N/A N/A 202.018 SUP HCPCS C1713 202.018 - SCREW BONE STANDARD 2.7MM 5MM 18MM SPHERICAL HEAD SMALL BOTH IP/OP $57.00 $42.00 $11.23 $57.53 $25.46 $25.46 $25.46 $25.46 $56.58 $56.58 $56.58 $11.79 $56.58 $56.58 $56.58 $56.58 $56.58 $11.79 $56.58 $23.01 $33.47 $56.58 $57.53 $56.58 $56.58 $42.75 $56.58 $56.58 $56.58 $28.29 $28.29 $44.81 $56.58 $45.26 $25.46 $11.23 N/A $33.06 $56.58 $56.58 $56.58 $11.79 $56.58 N/A N/A 202.02 SUP HCPCS C1713 202.020 - SCREW BONE STANDARD 2.7MM 5MM 20MM SPHERICAL HEAD SMALL BOTH IP/OP $55.00 $41.00 $10.90 $57.53 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $57.53 $32.49 $54.93 $57.53 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $54.93 $54.93 $54.93 $54.93 N/A N/A 202.022 SUP HCPCS C1713 202.022 - SCREW BONE STANDARD 2.7MM 5MM 22MM SPHERICAL HEAD SMALL BOTH IP/OP $57.00 $42.00 $11.23 $57.53 $25.46 $25.46 $25.46 $25.46 $56.58 $56.58 $56.58 $11.79 $56.58 $56.58 $56.58 $56.58 $56.58 $11.79 $56.58 $57.53 $33.47 $56.58 $57.53 $56.58 $56.58 $42.75 $56.58 $56.58 $56.58 $28.29 $28.29 $44.81 $56.58 $45.26 $25.46 $11.23 N/A $33.06 $56.58 $56.58 $56.58 $56.58 $56.58 N/A N/A 202.024 SUP HCPCS C1713 202.024 - SCREW BONE STANDARD 2.7MM 5MM 24MM SPHERICAL HEAD SMALL BOTH IP/OP $57.00 $42.00 $11.23 $57.53 $25.46 $25.46 $25.46 $25.46 $56.58 $56.58 $56.58 $11.79 $56.58 $56.58 $56.58 $56.58 $56.58 $11.79 $56.58 $23.01 $33.47 $56.58 $57.53 $56.58 $56.58 $42.75 $56.58 $56.58 $56.58 $28.29 $28.29 $44.81 $56.58 $45.26 $25.46 $11.23 N/A $33.06 $56.58 $56.58 $56.58 $11.79 $56.58 N/A N/A 202.026 SUP HCPCS C1713 202.026 - SCREW BONE STANDARD 2.7MM 26MM DCP STAINLESS STEEL CORTICAL BOTH IP/OP $57.00 $42.00 $11.23 $57.53 $25.46 $25.46 $25.46 $25.46 $56.58 $56.58 $56.58 $11.79 $56.58 $56.58 $56.58 $56.58 $56.58 $11.79 $56.58 $23.01 $33.47 $56.58 $57.53 $56.58 $56.58 $42.75 $56.58 $56.58 $56.58 $28.29 $28.29 $44.81 $56.58 $45.26 $25.46 $11.23 N/A $33.06 $56.58 $56.58 $56.58 $56.58 $56.58 N/A N/A 202.028 SUP HCPCS C1713 202.028 - SCREW BONE STANDARD 2.7MM 5MM 28MM SPHERICAL HEAD SMALL BOTH IP/OP $43.00 $32.00 $8.46 $42.60 $19.17 $19.17 $19.17 $19.17 $42.60 $42.60 $42.60 $8.88 $42.60 $42.60 $42.60 $42.60 $42.60 $8.88 $42.60 $42.60 $25.20 $42.60 $42.60 $42.60 $42.60 $32.25 $42.60 $42.60 $42.60 $21.30 $21.30 $33.74 $42.60 $34.08 $19.17 $8.46 N/A $24.94 $42.60 $25.56 $42.60 $42.60 $42.60 N/A N/A 202.03 SUP HCPCS C1713 202.030 - SCREW BONE 2.7MM 30MM DCP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $54.93 $54.93 $11.45 $54.93 N/A N/A 202.032 SUP HCPCS C1713 202.032 - SCREW BONE 2.7MM 32MM DCP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $54.93 $54.93 $54.93 $54.93 N/A N/A 202.034 SUP HCPCS C1713 202.034 - SCREW BONE STANDARD 2.7MM 5MM 34MM 2.5MM SMALL HEXAGON BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $54.93 $54.93 N/A N/A 202.036 SUP HCPCS C1713 202.036 - SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 36MM BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $11.45 $54.93 N/A N/A 202.038 SUP HCPCS C1713 202.038 - SCREW BONE STANDARD 2.7MM 5MM 38MM 2.5MM SMALL HEXAGON BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $11.45 $54.93 N/A N/A 202.04 SUP HCPCS C1713 202.040 - SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 40MM BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $11.45 $54.93 N/A N/A 202.045 SUP HCPCS C1713 202.045 - SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 45MM BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $11.45 $54.93 N/A N/A 202.05 SUP HCPCS C1713 202.050 - SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 50MM BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $11.45 $54.93 N/A N/A 202.055 SUP HCPCS C1713 202.055 - SCREW BONE STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 55MM BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $11.45 $54.93 N/A N/A 202.208 SUP HCPCS C1713 202.208 - SCREW BONE T8 2.7MM 2.1MM 8MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 202.21 SUP HCPCS C1713 202.210 - SCREW BONE 2.7MM 10MM LOCKING SLFTAP T8 STARDRIVE RECESS LCP BOTH IP/OP $216.00 $160.00 $42.80 $225.88 $97.03 $97.03 $97.03 $97.03 $215.63 $215.63 $215.63 $44.94 $215.63 $215.63 $215.63 $215.63 $215.63 $44.94 $215.63 $90.35 $127.55 $215.63 $225.88 $215.63 $215.63 $162.00 $215.63 $215.63 $215.63 $107.82 $107.82 $170.78 $215.63 $172.50 $97.03 $42.80 N/A $125.28 $215.63 $129.38 $215.63 $44.94 $215.63 N/A N/A 202.212 SUP HCPCS C1713 202.212 - SCREW BONE T8 2.7MM 2.1MM 12MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 202.214 SUP HCPCS C1713 202.214 - SCREW BONE T8 2.7MM 2.1MM 14MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $222.10 $222.10 $46.29 $222.10 N/A N/A 202.216 SUP HCPCS C1713 202.216 - SCREW BONE 2.7MM 2.1MM 16MM T8 STARDRIVE RECESS SLFTAP BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 202.218 SUP HCPCS C1713 202.218 - SCREW BONE T8 2.7MM 2.1MM 18MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $222.10 $222.10 $46.29 $222.10 N/A N/A 202.22 SUP HCPCS C1713 202.220 - SCREW BONE T8 2.7MM 2.1MM 20MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $216.00 $160.00 $42.80 $225.88 $97.03 $97.03 $97.03 $97.03 $215.63 $215.63 $215.63 $44.94 $215.63 $215.63 $215.63 $215.63 $215.63 $44.94 $215.63 $225.88 $127.55 $215.63 $225.88 $215.63 $215.63 $162.00 $215.63 $215.63 $215.63 $107.82 $107.82 $170.78 $215.63 $172.50 $97.03 $42.80 N/A $125.28 $215.63 $129.38 $215.63 $44.94 $215.63 N/A N/A 202.222 SUP HCPCS C1713 202.222 - SCREW BONE T8 2.7MM 2.1MM 22MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 202.224 SUP HCPCS C1713 202.224 - SCREW BONE T8 2.7MM 2.1MM 24MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 202.226 SUP HCPCS C1713 202.226 - SCREW BONE 2.7MM 26MM LOCKING SLFTAP T8 STARDRIVE RECESS LCP BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 202.228 SUP HCPCS C1713 202.228 - SCREW BONE T8 2.7MM 2.1MM 28MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 202.23 SUP HCPCS C1713 202.230 - SCREW BONE T8 2.7MM 2.1MM 30MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $216.00 $160.00 $42.80 $225.88 $97.03 $97.03 $97.03 $97.03 $215.63 $215.63 $215.63 $44.94 $215.63 $215.63 $215.63 $215.63 $215.63 $44.94 $215.63 $225.88 $127.55 $215.63 $225.88 $215.63 $215.63 $162.00 $215.63 $215.63 $215.63 $107.82 $107.82 $170.78 $215.63 $172.50 $97.03 $42.80 N/A $125.28 $215.63 $129.38 $215.63 $44.94 $215.63 N/A N/A 202.232 SUP HCPCS C1713 202.232 - SCREW BONE T8 2.7MM 2.1MM 32MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $222.10 $222.10 $46.29 $222.10 N/A N/A 202.234 SUP HCPCS C1713 202.234 - SCREW BONE T8 2.7MM 2.1MM 34MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 202.236 SUP HCPCS C1713 202.236 - SCREW BONE T8 2.7MM 2.1MM 36MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 202.238 SUP HCPCS C1713 202.238 - SCREW BONE T8 2.7MM 2.1MM 38MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 202.24 SUP HCPCS C1713 202.240 - SCREW BONE T8 2.7MM 2.1MM 40MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $216.00 $160.00 $42.80 $225.88 $97.03 $97.03 $97.03 $97.03 $215.63 $215.63 $215.63 $44.94 $215.63 $215.63 $215.63 $215.63 $215.63 $44.94 $215.63 $90.35 $127.55 $215.63 $225.88 $215.63 $215.63 $162.00 $215.63 $215.63 $215.63 $107.82 $107.82 $170.78 $215.63 $172.50 $97.03 $42.80 N/A $125.28 $215.63 $129.38 $215.63 $44.94 $215.63 N/A N/A 202.242 SUP HCPCS C1713 202.242 - SCREW BONE 2.7MM 42MM T8 STARDRIVE RECESS SLFTAP LOCKING LCP BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $222.10 $222.10 $46.29 $222.10 N/A N/A 202.244 SUP HCPCS C1713 202.244 - SCREW BONE T8 2.7MM 2.1MM 44MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 202.246 SUP HCPCS C1713 202.246 - SCREW BONE T8 2.7MM 2.1MM 46MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 202.248 SUP HCPCS C1713 202.248 - SCREW BONE T8 2.7MM 2.1MM 48MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 202.25 SUP HCPCS C1713 202.250 - SCREW BONE T8 2.7MM 2.1MM 50MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $216.00 $160.00 $42.80 $225.88 $97.03 $97.03 $97.03 $97.03 $215.63 $215.63 $215.63 $44.94 $215.63 $215.63 $215.63 $215.63 $215.63 $44.94 $215.63 $90.35 $127.55 $215.63 $225.88 $215.63 $215.63 $162.00 $215.63 $215.63 $215.63 $107.82 $107.82 $170.78 $215.63 $172.50 $97.03 $42.80 N/A $125.28 $215.63 $129.38 $215.63 $44.94 $215.63 N/A N/A 202.255 SUP HCPCS C1713 202.255 - SCREW BONE T8 2.7MM 2.1MM 55MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 202.26 SUP HCPCS C1713 202.260 - SCREW BONE T8 2.7MM 2.1MM 60MM SELF TAP MODULAR STARDRIVE BOTH IP/OP $216.00 $160.00 $42.80 $225.88 $97.03 $97.03 $97.03 $97.03 $215.63 $215.63 $215.63 $44.94 $215.63 $215.63 $215.63 $215.63 $215.63 $44.94 $215.63 $225.88 $127.55 $215.63 $225.88 $215.63 $215.63 $162.00 $215.63 $215.63 $215.63 $107.82 $107.82 $170.78 $215.63 $172.50 $97.03 $42.80 N/A $125.28 $215.63 $215.63 $215.63 $44.94 $215.63 N/A N/A 202.608 SUP HCPCS C1713 202.608 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 8MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.609 SUP HCPCS C1713 202.609 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 9MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.61 SUP HCPCS C1713 202.610 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 10MM SELF DRILL SELF BOTH IP/OP $362.00 $268.00 $71.78 $378.83 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $151.53 $213.92 $361.65 $378.83 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $361.65 $361.65 $75.37 $361.65 N/A N/A 202.611 SUP HCPCS C1713 202.611 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 11MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.612 SUP HCPCS C1713 202.612 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 12MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.613 SUP HCPCS C1713 202.613 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 13MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.614 SUP HCPCS C1713 202.614 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 14MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.615 SUP HCPCS C1713 202.615 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 15MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.616 SUP HCPCS C1713 202.616 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 16MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.617 SUP HCPCS C1713 202.617 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 17MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.618 SUP HCPCS C1713 202.618 - SCREW BONE SHORT THREAD 3MM 18MM CANN STAINLESS STEEL WRIST BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.619 SUP HCPCS C1713 202.619 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 19MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.62 SUP HCPCS C1713 202.620 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 20MM SELF DRILL SELF BOTH IP/OP $362.00 $268.00 $71.78 $378.83 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $378.83 $213.92 $361.65 $378.83 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $361.65 $361.65 $75.37 $361.65 N/A N/A 202.621 SUP HCPCS C1713 202.621 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 21MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.622 SUP HCPCS C1713 202.622 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 22MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.623 SUP HCPCS C1713 202.623 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 23MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.624 SUP HCPCS C1713 202.624 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 24MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.625 SUP HCPCS C1713 202.625 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 25MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.626 SUP HCPCS C1713 202.626 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 26MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.627 SUP HCPCS C1713 202.627 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 27MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.628 SUP HCPCS C1713 202.628 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 28MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.629 SUP HCPCS C1713 202.629 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 29MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.63 SUP HCPCS C1713 202.630 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 30MM SELF DRILL SELF BOTH IP/OP $362.00 $268.00 $71.78 $378.83 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $151.53 $213.92 $361.65 $378.83 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $361.65 $361.65 $75.37 $361.65 N/A N/A 202.632 SUP HCPCS C1713 202.632 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 32MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.634 SUP HCPCS C1713 202.634 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 34MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.636 SUP HCPCS C1713 202.636 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 36MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.638 SUP HCPCS C1713 202.638 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 38MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.64 SUP HCPCS C1713 202.640 - SCREW BONE 1/3 THREAD LP 3MM 4MM 1.2MM 40MM SELF DRILL SELF BOTH IP/OP $362.00 $268.00 $71.78 $378.83 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $378.83 $213.92 $361.65 $378.83 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 202.714 SUP HCPCS C1713 202.714 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 14MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.715 SUP HCPCS C1713 202.715 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 15MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.716 SUP HCPCS C1713 202.716 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 16MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.717 SUP HCPCS C1713 202.717 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 17MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.718 SUP HCPCS C1713 202.718 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 18MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.719 SUP HCPCS C1713 202.719 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 19MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.72 SUP HCPCS C1713 202.720 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 20MM SELF DRILL SELF BOTH IP/OP $362.00 $268.00 $71.78 $378.83 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $378.83 $213.92 $361.65 $378.83 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 202.721 SUP HCPCS C1713 202.721 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 21MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.722 SUP HCPCS C1713 202.722 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 22MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.723 SUP HCPCS C1713 202.723 - SCREW BONE LNGTHRD 3MM 4MM 23MM CANN SLFDRILL SLFTAP BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.724 SUP HCPCS C1713 202.724 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 24MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.725 SUP HCPCS C1713 202.725 - SCREW BONE LNGTHRD 3MM 4MM 25MM CANN CRCIFRM RECESS SLFDRILL BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.726 SUP HCPCS C1713 202.726 - SCREW BONE LNGTHRD 3MM 26MM CANN STAINLESS STEEL WRIST HAND BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.727 SUP HCPCS C1713 202.727 - SCREW BONE LNGTHRD 3MM 27MM CANN STAINLESS STEEL WRIST HAND BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.728 SUP HCPCS C1713 202.728 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 28MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.729 SUP HCPCS C1713 202.729 - SCREW BONE LNGTHRD 3MM 29MM CANN STAINLESS STEEL WRIST HAND BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 202.73 SUP HCPCS C1713 202.730 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 30MM SELF DRILL SELF BOTH IP/OP $362.00 $268.00 $71.78 $378.83 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $151.53 $213.92 $361.65 $378.83 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 202.732 SUP HCPCS C1713 202.732 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 32MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.734 SUP HCPCS C1713 202.734 - SCREW BONE LNGTHRD 3MM 34MM CANN STAINLESS STEEL WRIST HAND BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.736 SUP HCPCS C1713 202.736 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 36MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.738 SUP HCPCS C1713 202.738 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 38MM SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 202.74 SUP HCPCS C1713 202.740 - SCREW BONE .5 THREAD LP 3MM 4MM 1.2MM 40MM SELF DRILL SELF BOTH IP/OP $362.00 $268.00 $71.78 $378.83 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $378.83 $213.92 $361.65 $378.83 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 202.806 SUP HCPCS C1713 202.806 - SCREW BONE 2.7MM 5MM 6MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.808 SUP HCPCS C1713 202.808 - SCREW BONE 2.7MM 5MM 8MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.81 SUP HCPCS C1713 202.810 - SCREW BONE 2.7MM 5MM 10MM SLFTAP SMALL HEXAGONAL SOCKET BOTH IP/OP $60.00 $44.00 $11.85 $62.53 $26.87 $26.87 $26.87 $26.87 $59.70 $59.70 $59.70 $12.44 $59.70 $59.70 $59.70 $59.70 $59.70 $12.44 $59.70 $62.53 $35.31 $59.70 $62.53 $59.70 $59.70 $45.00 $59.70 $59.70 $59.70 $29.85 $29.85 $47.28 $59.70 $47.76 $26.87 $11.85 N/A $34.80 $59.70 $35.82 $59.70 $12.44 $59.70 N/A N/A 202.812 SUP HCPCS C1713 202.812 - SCREW BONE SHORT THREAD 2.7MM 12MM SLFTAP DCP STAINLESS BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.814 SUP HCPCS C1713 202.814 - SCREW BONE 2.7MM 5MM 14MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.816 SUP HCPCS C1713 202.816 - SCREW BONE 2.7MM 16MM SLFTAP LC-DCP STAINLESS STEEL CORTICAL BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.818 SUP HCPCS C1713 202.818 - SCREW BN FT 2.7MM 5MM 18MM NS 2.5MM ST SPHRCL HD SM HEX SCKT BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.82 SUP HCPCS C1713 202.820 - SCREW BONE SHORT THREAD 2.7MM 20MM SLFTAP DCP STAINLESS BOTH IP/OP $60.00 $44.00 $11.85 $62.53 $26.87 $26.87 $26.87 $26.87 $59.70 $59.70 $59.70 $12.44 $59.70 $59.70 $59.70 $59.70 $59.70 $12.44 $59.70 $25.01 $35.31 $59.70 $62.53 $59.70 $59.70 $45.00 $59.70 $59.70 $59.70 $29.85 $29.85 $47.28 $59.70 $47.76 $26.87 $11.85 N/A $34.80 $59.70 $35.82 $59.70 $12.44 $59.70 N/A N/A 202.822 SUP HCPCS C1713 202.822 - SCREW BONE 2.7MM 22MM SLFTAP LCP DCP STAINLESS STEEL BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.824 SUP HCPCS C1713 202.824 - SCREW BN FT 2.7MM 5MM 24MM NS 2.5MM ST SPHRCL HD SM HEX SCKT BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $61.48 $61.48 $12.81 $61.48 N/A N/A 202.826 SUP HCPCS C1713 202.826 - SCREW BONE SHORT THREAD 2.7MM 26MM SLFTAP DCP STAINLESS BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.828 SUP HCPCS C1713 202.828 - SCREW BONE FULTHD 2.7MM 5MM 28MM SLFTAP SMALL HEXAGONAL BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.83 SUP HCPCS C1713 202.830 - SCREW BONE FULTHD SMALL HEXAGON SPHERE 2.7MM 5MM 30MM SELF BOTH IP/OP $60.00 $44.00 $11.85 $62.53 $26.87 $26.87 $26.87 $26.87 $59.70 $59.70 $59.70 $12.44 $59.70 $59.70 $59.70 $59.70 $59.70 $12.44 $59.70 $62.53 $35.31 $59.70 $62.53 $59.70 $59.70 $45.00 $59.70 $59.70 $59.70 $29.85 $29.85 $47.28 $59.70 $47.76 $26.87 $11.85 N/A $34.80 $59.70 $35.82 $59.70 $12.44 $59.70 N/A N/A 202.832 SUP HCPCS C1713 202.832 - SCREW BONE 2.7MM 5MM 32MM SLFTAP SPHERICAL HEAD SMALL BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.834 SUP HCPCS C1713 202.834 - SCREW BONE 2.7MM 5MM 34MM SLFTAP SPHERICAL HEAD SMALL BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.836 SUP HCPCS C1713 202.836 - SCREW BONE 2.7MM 5MM 36MM SLFTAP SPHERICAL HEAD SMALL BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $61.48 $61.48 $12.81 $61.48 N/A N/A 202.838 SUP HCPCS C1713 202.838 - SCREW BONE 2.7MM 5MM 38MM SLFTAP SPHERICAL HEAD SMALL BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.84 SUP HCPCS C1713 202.840 - SCREW BONE 2.7MM 40MM SLFTAP LCP DCP STAINLESS STEEL BOTH IP/OP $60.00 $44.00 $11.85 $62.53 $26.87 $26.87 $26.87 $26.87 $59.70 $59.70 $59.70 $12.44 $59.70 $59.70 $59.70 $59.70 $59.70 $12.44 $59.70 $62.53 $35.31 $59.70 $62.53 $59.70 $59.70 $45.00 $59.70 $59.70 $59.70 $29.85 $29.85 $47.28 $59.70 $47.76 $26.87 $11.85 N/A $34.80 $59.70 $35.82 $59.70 $12.44 $59.70 N/A N/A 202.842 SUP HCPCS C1713 202.842 - SCREW BONE 2.7MM 5MM 42MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.844 SUP HCPCS C1713 202.844 - SCREW BONE 2.7MM 5MM 44MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.845 SUP HCPCS C1713 202.845 - SCREW BONE 2.7MM 5MM 45MM SLFTAP SPHERICAL HEAD SMALL BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.846 SUP HCPCS C1713 202.846 - SCREW BONE 2.7MM 5MM 46MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $61.48 $61.48 $12.81 $61.48 N/A N/A 202.848 SUP HCPCS C1713 202.848 - SCREW BONE 2.7MM 5MM 48MM SELF TAP CRCIFRM DCP STAINLESS BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.85 SUP HCPCS C1713 202.850 - SCREW BONE SHORT THREAD 2.7MM 50MM SLFTAP DCP STAINLESS BOTH IP/OP $60.00 $44.00 $11.85 $62.53 $26.87 $26.87 $26.87 $26.87 $59.70 $59.70 $59.70 $12.44 $59.70 $59.70 $59.70 $59.70 $59.70 $12.44 $59.70 $62.53 $35.31 $59.70 $62.53 $59.70 $59.70 $45.00 $59.70 $59.70 $59.70 $29.85 $29.85 $47.28 $59.70 $47.76 $26.87 $11.85 N/A $34.80 $59.70 $35.82 $59.70 $12.44 $59.70 N/A N/A 202.855 SUP HCPCS C1713 202.855 - SCREW BONE 2.7MM 55MM SLFTAP LCP DCP STAINLESS STEEL BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 202.87 SUP HCPCS C1713 202.870 - SCREW BONE T8 2.7MM 5MM 10MM VAR ANG SELF TAP MODULAR BOTH IP/OP $70.00 $52.00 $13.81 $72.93 $31.32 $31.32 $31.32 $31.32 $69.60 $69.60 $69.60 $14.51 $69.60 $69.60 $69.60 $69.60 $69.60 $14.51 $69.60 $29.17 $41.17 $69.60 $72.93 $69.60 $69.60 $52.50 $69.60 $69.60 $69.60 $34.80 $34.80 $55.12 $69.60 $55.68 $31.32 $13.81 N/A $40.60 $69.60 $41.76 $69.60 $14.50 $69.60 N/A N/A 202.872 SUP HCPCS C1713 202.872 - SCREW BONE T8 2.7MM 5MM 12MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $29.17 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $71.70 $71.70 $14.94 $71.70 N/A N/A 202.874 SUP HCPCS C1713 202.874 - SCREW BONE 2.7MM 14MM T8 STARDRIVE SELF TAP LCP STAINLESS BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $72.93 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $71.70 $71.70 $14.94 $71.70 N/A N/A 202.876 SUP HCPCS C1713 202.876 - SCREW BONE 2.7MM 16MM T8 STARDRIVE RECESS SLFTAP LCP BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $29.17 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $43.02 $71.70 $14.94 $71.70 N/A N/A 202.878 SUP HCPCS C1713 202.878 - SCREW BONE T8 2.7MM 5MM 18MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $72.93 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $43.02 $71.70 $14.94 $71.70 N/A N/A 202.88 SUP HCPCS C1713 202.880 - SCREW BONE T8 2.7MM 5MM 20MM VAR ANG SELF TAP MODULAR BOTH IP/OP $70.00 $52.00 $13.81 $72.93 $31.32 $31.32 $31.32 $31.32 $69.60 $69.60 $69.60 $14.51 $69.60 $69.60 $69.60 $69.60 $69.60 $14.51 $69.60 $29.17 $41.17 $69.60 $72.93 $69.60 $69.60 $52.50 $69.60 $69.60 $69.60 $34.80 $34.80 $55.12 $69.60 $55.68 $31.32 $13.81 N/A $40.60 $69.60 $41.76 $69.60 $14.50 $69.60 N/A N/A 202.882 SUP HCPCS C1713 202.882 - SCREW BONE T8 2.7MM 5MM 22MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $29.17 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $71.70 $71.70 $14.94 $71.70 N/A N/A 202.884 SUP HCPCS C1713 202.884 - SCREW BONE T8 2.7MM 5MM 24MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $72.93 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $43.02 $71.70 $14.94 $71.70 N/A N/A 202.886 SUP HCPCS C1713 202.886 - SCREW BONE T8 2.7MM 5MM 26MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $72.93 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $71.70 $71.70 $14.94 $71.70 N/A N/A 202.888 SUP HCPCS C1713 202.888 - SCREW BONE T8 2.7MM 5MM 28MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $72.93 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $71.70 $71.70 $14.94 $71.70 N/A N/A 202.89 SUP HCPCS C1713 202.890 - SCREW BONE T8 2.7MM 5MM 30MM VAR ANG SELF TAP MODULAR BOTH IP/OP $70.00 $52.00 $13.81 $72.93 $31.32 $31.32 $31.32 $31.32 $69.60 $69.60 $69.60 $14.51 $69.60 $69.60 $69.60 $69.60 $69.60 $14.51 $69.60 $72.93 $41.17 $69.60 $72.93 $69.60 $69.60 $52.50 $69.60 $69.60 $69.60 $34.80 $34.80 $55.12 $69.60 $55.68 $31.32 $13.81 N/A $40.60 $69.60 $69.60 $69.60 $14.50 $69.60 N/A N/A 202.892 SUP HCPCS C1713 202.892 - SCREW BONE T8 2.7MM 5MM 32MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $72.93 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $71.70 $71.70 $14.94 $71.70 N/A N/A 202.894 SUP HCPCS C1713 202.894 - SCREW BONE T8 2.7MM 5MM 34MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $72.93 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $43.02 $71.70 $14.94 $71.70 N/A N/A 202.896 SUP HCPCS C1713 202.896 - SCREW BONE T8 2.7MM 5MM 36MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $72.93 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $43.02 $71.70 $14.94 $71.70 N/A N/A 202.898 SUP HCPCS C1713 202.898 - SCREW BONE T8 2.7MM 5MM 38MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $72.93 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $43.02 $71.70 $14.94 $71.70 N/A N/A 202.9 SUP HCPCS C1713 202.900 - SCREW BONE T8 2.7MM 5MM 40MM VAR ANG SELF TAP MODULAR BOTH IP/OP $70.00 $52.00 $13.81 $72.93 $31.32 $31.32 $31.32 $31.32 $69.60 $69.60 $69.60 $14.51 $69.60 $69.60 $69.60 $69.60 $69.60 $14.51 $69.60 $72.93 $41.17 $69.60 $72.93 $69.60 $69.60 $52.50 $69.60 $69.60 $69.60 $34.80 $34.80 $55.12 $69.60 $55.68 $31.32 $13.81 N/A $40.60 $69.60 $69.60 $69.60 $14.50 $69.60 N/A N/A 202.962 SUP HCPCS C1713 202.962 - SCREW BONE T8 2.7MM 5MM 42MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $72.93 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $71.70 $71.70 $14.94 $71.70 N/A N/A 202.963 SUP HCPCS C1713 202.963 - SCREW BONE T8 2.7MM 5MM 44MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $72.93 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $71.70 $71.70 $14.94 $71.70 N/A N/A 202.965 SUP HCPCS C1713 202.965 - SCREW BONE T8 2.7MM 5MM 46MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $72.93 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $71.70 $71.70 $14.94 $71.70 N/A N/A 202.966 SUP HCPCS C1713 202.966 - SCREW BONE T8 2.7MM 5MM 48MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $29.17 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $71.70 $71.70 $14.94 $71.70 N/A N/A 202.967 SUP HCPCS C1713 202.967 - SCREW BONE T8 2.7MM 5MM 50MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $29.17 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $43.02 $71.70 $14.94 $71.70 N/A N/A 202.968 SUP HCPCS C1713 202.968 - SCREW BONE T8 2.7MM 5MM 55MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $29.17 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $43.02 $71.70 $14.94 $71.70 N/A N/A 202.969 SUP HCPCS C1713 202.969 - SCREW BONE T8 2.7MM 5MM 60MM VAR ANG SELF TAP MODULAR BOTH IP/OP $72.00 $53.00 $14.23 $72.93 $32.27 $32.27 $32.27 $32.27 $71.70 $71.70 $71.70 $14.94 $71.70 $71.70 $71.70 $71.70 $71.70 $14.94 $71.70 $72.93 $42.41 $71.70 $72.93 $71.70 $71.70 $54.00 $71.70 $71.70 $71.70 $35.85 $35.85 $56.79 $71.70 $57.36 $32.27 $14.23 N/A $41.76 $71.70 $43.02 $71.70 $14.94 $71.70 N/A N/A 204.01 SUP HCPCS C1713 204.010 - SCREW BONE STANDARD 3.5MM 6MM 10MM SMALL HEXAGONAL SOCKET BOTH IP/OP $28.00 $21.00 $5.48 $28.93 $12.43 $12.43 $12.43 $12.43 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $27.63 $27.63 $27.63 $5.76 $27.63 $28.93 $16.34 $27.63 $28.93 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $12.43 $5.48 N/A $16.24 $27.63 $16.58 $27.63 $5.76 $27.63 N/A N/A 204.012 SUP HCPCS C1713 204.012 - SCREW BONE STANDARD 3.5MM 6MM 12MM SMALL HEXAGONAL SOCKET BOTH IP/OP $28.50 $21.00 $5.65 $28.93 $12.80 $12.80 $12.80 $12.80 $28.45 $28.45 $28.45 $5.93 $28.45 $28.45 $28.45 $28.45 $28.45 $5.93 $28.45 $11.57 $16.83 $28.45 $28.93 $28.45 $28.45 $21.38 $28.45 $28.45 $28.45 $14.23 $14.23 $22.53 $28.45 $22.76 $12.80 $5.65 N/A $16.53 $28.45 $17.07 $28.45 $5.93 $28.45 N/A N/A 204.014 SUP HCPCS C1713 204.014 - SCREW BONE 3.5MM 14MM SMALL HEXAGONAL SOCKET DCP LC-DCP BOTH IP/OP $28.50 $21.00 $5.65 $28.93 $12.80 $12.80 $12.80 $12.80 $28.45 $28.45 $28.45 $5.93 $28.45 $28.45 $28.45 $28.45 $28.45 $5.93 $28.45 $11.57 $16.83 $28.45 $28.93 $28.45 $28.45 $21.38 $28.45 $28.45 $28.45 $14.23 $14.23 $22.53 $28.45 $22.76 $12.80 $5.65 N/A $16.53 $28.45 $17.07 $28.45 $5.93 $28.45 N/A N/A 204.016 SUP HCPCS C1713 204.016 - SCREW BONE STANDARD 3.5MM 6MM 16MM HEXAGONAL SOCKET LC-DCP BOTH IP/OP $28.50 $21.00 $5.65 $28.93 $12.80 $12.80 $12.80 $12.80 $28.45 $28.45 $28.45 $5.93 $28.45 $28.45 $28.45 $28.45 $28.45 $5.93 $28.45 $11.57 $16.83 $28.45 $28.93 $28.45 $28.45 $21.38 $28.45 $28.45 $28.45 $14.23 $14.23 $22.53 $28.45 $22.76 $12.80 $5.65 N/A $16.53 $28.45 $17.07 $28.45 $5.93 $28.45 N/A N/A 204.018 SUP HCPCS C1713 204.018 - SCREW BONE STANDARD 3.5MM 6MM 18MM HEXAGONAL SOCKET LC-DCP BOTH IP/OP $28.50 $21.00 $5.65 $28.93 $12.80 $12.80 $12.80 $12.80 $28.45 $28.45 $28.45 $5.93 $28.45 $28.45 $28.45 $28.45 $28.45 $5.93 $28.45 $28.93 $16.83 $28.45 $28.93 $28.45 $28.45 $21.38 $28.45 $28.45 $28.45 $14.23 $14.23 $22.53 $28.45 $22.76 $12.80 $5.65 N/A $16.53 $28.45 $17.07 $28.45 $5.93 $28.45 N/A N/A 204.02 SUP HCPCS C1713 204.020 - SCREW BONE STANDARD 3.5MM 6MM 20MM SMALL HEXAGONAL SOCKET BOTH IP/OP $28.00 $21.00 $5.48 $28.93 $12.43 $12.43 $12.43 $12.43 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $27.63 $27.63 $27.63 $5.76 $27.63 $28.93 $16.34 $27.63 $28.93 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $12.43 $5.48 N/A $16.24 $27.63 $16.58 $27.63 $5.76 $27.63 N/A N/A 204.022 SUP HCPCS C1713 204.022 - SCREW BONE STANDARD SMALL HEXAGON 3.5MM 6MM 22MM SOCKET DCP BOTH IP/OP $28.50 $21.00 $5.65 $28.93 $12.80 $12.80 $12.80 $12.80 $28.45 $28.45 $28.45 $5.93 $28.45 $28.45 $28.45 $28.45 $28.45 $5.93 $28.45 $28.93 $16.83 $28.45 $28.93 $28.45 $28.45 $21.38 $28.45 $28.45 $28.45 $14.23 $14.23 $22.53 $28.45 $22.76 $12.80 $5.65 N/A $16.53 $28.45 $17.07 $28.45 $5.93 $28.45 N/A N/A 204.024 SUP HCPCS C1713 204.024 - SCREW BONE 2.5MM STANDARD 3.5MM 6MM 24MM SMALL HEXAGONAL BOTH IP/OP $28.50 $21.00 $5.65 $28.93 $12.80 $12.80 $12.80 $12.80 $28.45 $28.45 $28.45 $5.93 $28.45 $28.45 $28.45 $28.45 $28.45 $5.93 $28.45 $28.93 $16.83 $28.45 $28.93 $28.45 $28.45 $21.38 $28.45 $28.45 $28.45 $14.23 $14.23 $22.53 $28.45 $22.76 $12.80 $5.65 N/A $16.53 $28.45 $17.07 $28.45 $5.93 $28.45 N/A N/A 204.026 SUP HCPCS C1713 204.026 - SCREW BONE 4MM 26MM LOCKING SLFTAP STARDRIVE RECESS LCP BOTH IP/OP $28.50 $21.00 $5.65 $28.93 $12.80 $12.80 $12.80 $12.80 $28.45 $28.45 $28.45 $5.93 $28.45 $28.45 $28.45 $28.45 $28.45 $5.93 $28.45 $11.57 $16.83 $28.45 $28.93 $28.45 $28.45 $21.38 $28.45 $28.45 $28.45 $14.23 $14.23 $22.53 $28.45 $22.76 $12.80 $5.65 N/A $16.53 $28.45 $28.45 $28.45 $5.93 $28.45 N/A N/A 204.028 SUP HCPCS C1713 204.028 - SCREW BONE STANDARD 3.5MM 6MM 28MM SMALL HEXAGONAL SOCKET BOTH IP/OP $28.50 $21.00 $5.65 $28.93 $12.80 $12.80 $12.80 $12.80 $28.45 $28.45 $28.45 $5.93 $28.45 $28.45 $28.45 $28.45 $28.45 $5.93 $28.45 $11.57 $16.83 $28.45 $28.93 $28.45 $28.45 $21.38 $28.45 $28.45 $28.45 $14.23 $14.23 $22.53 $28.45 $22.76 $12.80 $5.65 N/A $16.53 $28.45 $17.07 $28.45 $5.93 $28.45 N/A N/A 204.03 SUP HCPCS C1713 204.030 - SCREW BONE SMALL STANDARD 3.5MM 6MM 30MM HEXAGONAL SOCKET BOTH IP/OP $28.00 $21.00 $5.48 $28.93 $12.43 $12.43 $12.43 $12.43 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $27.63 $27.63 $27.63 $5.76 $27.63 $28.93 $16.34 $27.63 $28.93 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $12.43 $5.48 N/A $16.24 $27.63 $16.58 $27.63 $5.76 $27.63 N/A N/A 204.032 SUP HCPCS C1713 204.032 - SCREW BONE STANDARD 3.5MM 6MM 32MM SLFTAP SMALL HEXAGON BOTH IP/OP $28.50 $21.00 $5.65 $28.93 $12.80 $12.80 $12.80 $12.80 $28.45 $28.45 $28.45 $5.93 $28.45 $28.45 $28.45 $28.45 $28.45 $5.93 $28.45 $28.93 $16.83 $28.45 $28.93 $28.45 $28.45 $21.38 $28.45 $28.45 $28.45 $14.23 $14.23 $22.53 $28.45 $22.76 $12.80 $5.65 N/A $16.53 $28.45 $17.07 $28.45 $5.93 $28.45 N/A N/A 204.034 SUP HCPCS C1713 204.034 - SCREW BONE T25 3.5MM 2.4MM 34MM LOCKING SLFTAP STARDRIVE BOTH IP/OP $28.50 $21.00 $5.65 $28.93 $12.80 $12.80 $12.80 $12.80 $28.45 $28.45 $28.45 $5.93 $28.45 $28.45 $28.45 $28.45 $28.45 $5.93 $28.45 $11.57 $16.83 $28.45 $28.93 $28.45 $28.45 $21.38 $28.45 $28.45 $28.45 $14.23 $14.23 $22.53 $28.45 $22.76 $12.80 $5.65 N/A $16.53 $28.45 $17.07 $28.45 $5.93 $28.45 N/A N/A 204.036 SUP HCPCS C1713 204.036 - SCREW BONE 3.5MM 36MM SMALL FRAGMENT LC-DCP STAINLESS STEEL BOTH IP/OP $28.50 $21.00 $5.65 $28.93 $12.80 $12.80 $12.80 $12.80 $28.45 $28.45 $28.45 $5.93 $28.45 $28.45 $28.45 $28.45 $28.45 $5.93 $28.45 $11.57 $16.83 $28.45 $28.93 $28.45 $28.45 $21.38 $28.45 $28.45 $28.45 $14.23 $14.23 $22.53 $28.45 $22.76 $12.80 $5.65 N/A $16.53 $28.45 $17.07 $28.45 $5.93 $28.45 N/A N/A 204.038 SUP HCPCS C1713 204.038 - SCREW BONE STANDARD 3.5MM 6MM 38MM SLFTAP SMALL HEXAGON BOTH IP/OP $28.50 $21.00 $5.65 $28.93 $12.80 $12.80 $12.80 $12.80 $28.45 $28.45 $28.45 $5.93 $28.45 $28.45 $28.45 $28.45 $28.45 $5.93 $28.45 $11.57 $16.83 $28.45 $28.93 $28.45 $28.45 $21.38 $28.45 $28.45 $28.45 $14.23 $14.23 $22.53 $28.45 $22.76 $12.80 $5.65 N/A $16.53 $28.45 $28.45 $28.45 $5.93 $28.45 N/A N/A 204.04 SUP HCPCS C1713 204.040 - SCREW BONE STANDARD 3.5MM 6MM 40MM SLFTAP SMALL HEXAGONAL BOTH IP/OP $28.00 $21.00 $5.48 $28.93 $12.43 $12.43 $12.43 $12.43 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $27.63 $27.63 $27.63 $5.76 $27.63 $28.93 $16.34 $27.63 $28.93 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $12.43 $5.48 N/A $16.24 $27.63 $16.58 $27.63 $5.76 $27.63 N/A N/A 204.045 SUP HCPCS C1713 204.045 - SCREW BONE 2.5MM SMALL STANDARD 3.5MM 45MM SMALL HEXAGONAL BOTH IP/OP $28.50 $21.00 $5.65 $28.93 $12.80 $12.80 $12.80 $12.80 $28.45 $28.45 $28.45 $5.93 $28.45 $28.45 $28.45 $28.45 $28.45 $5.93 $28.45 $11.57 $16.83 $28.45 $28.93 $28.45 $28.45 $21.38 $28.45 $28.45 $28.45 $14.23 $14.23 $22.53 $28.45 $22.76 $12.80 $5.65 N/A $16.53 $28.45 $17.07 $28.45 $5.93 $28.45 N/A N/A 204.05 SUP HCPCS C1713 204.050 - SCREW BONE STANDARD 3.5MM 6MM 50MM SLFTAP SMALL HEXAGON BOTH IP/OP $28.00 $21.00 $5.48 $28.93 $12.43 $12.43 $12.43 $12.43 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $27.63 $27.63 $27.63 $5.76 $27.63 $11.57 $16.34 $27.63 $28.93 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $12.43 $5.48 N/A $16.24 $27.63 $16.58 $27.63 $5.76 $27.63 N/A N/A 204.055 SUP HCPCS C1713 204.055 - SCREW BONE STANDARD 3.5MM 6MM 55MM HEXAGONAL SOCKET LC-DCP BOTH IP/OP $28.50 $21.00 $5.65 $28.93 $12.80 $12.80 $12.80 $12.80 $28.45 $28.45 $28.45 $5.93 $28.45 $28.45 $28.45 $28.45 $28.45 $5.93 $28.45 $11.57 $16.83 $28.45 $28.93 $28.45 $28.45 $21.38 $28.45 $28.45 $28.45 $14.23 $14.23 $22.53 $28.45 $22.76 $12.80 $5.65 N/A $16.53 $28.45 $28.45 $28.45 $5.93 $28.45 N/A N/A 204.06 SUP HCPCS C1713 204.060 - SCREW BONE STANDARD 3.5MM 6MM 60MM SELF TAP SMALL HEXAGONAL BOTH IP/OP $28.00 $21.00 $5.48 $28.93 $12.43 $12.43 $12.43 $12.43 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $27.63 $27.63 $27.63 $5.76 $27.63 $11.57 $16.34 $27.63 $28.93 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $12.43 $5.48 N/A $16.24 $27.63 $16.58 $27.63 $5.76 $27.63 N/A N/A 204.065 SUP HCPCS C1713 204.065 - SCREW BONE STANDARD 3.5MM 6MM 65MM SLFTAP SMALL HEXAGONAL BOTH IP/OP $46.50 $34.00 $9.14 $46.80 $20.71 $20.71 $20.71 $20.71 $46.03 $46.03 $46.03 $9.59 $46.03 $46.03 $46.03 $46.03 $46.03 $9.59 $46.03 $18.72 $27.23 $46.03 $46.80 $46.03 $46.03 $34.88 $46.03 $46.03 $46.03 $23.02 $23.02 $36.46 $46.03 $36.82 $20.71 $9.14 N/A $26.97 $46.03 $27.62 $46.03 $9.59 $46.03 N/A N/A 204.07 SUP HCPCS C1713 204.070 - SCREW BONE STANDARD 3.5MM 6MM 70MM SMALL HEXAGONAL SOCKET BOTH IP/OP $45.00 $33.00 $8.87 $46.80 $20.11 $20.11 $20.11 $20.11 $44.68 $44.68 $44.68 $9.31 $44.68 $44.68 $44.68 $44.68 $44.68 $9.31 $44.68 $18.72 $26.43 $44.68 $46.80 $44.68 $44.68 $33.75 $44.68 $44.68 $44.68 $22.34 $22.34 $35.39 $44.68 $35.74 $20.11 $8.87 N/A $26.10 $44.68 $26.81 $44.68 $9.31 $44.68 N/A N/A 204.075 SUP HCPCS C1713 204.075 - SCREW BONE STANDARD 3.5MM 6MM 75MM SLFTAP SMALL HEXAGON BOTH IP/OP $46.50 $34.00 $9.14 $46.80 $20.71 $20.71 $20.71 $20.71 $46.03 $46.03 $46.03 $9.59 $46.03 $46.03 $46.03 $46.03 $46.03 $9.59 $46.03 $18.72 $27.23 $46.03 $46.80 $46.03 $46.03 $34.88 $46.03 $46.03 $46.03 $23.02 $23.02 $36.46 $46.03 $36.82 $20.71 $9.14 N/A $26.97 $46.03 $46.03 $46.03 $9.59 $46.03 N/A N/A 204.08 SUP HCPCS C1713 204.080 - SCREW BONE STANDARD 3.5MM 6MM 80MM SMALL HEXAGONAL SOCKET BOTH IP/OP $45.00 $33.00 $8.87 $46.80 $20.11 $20.11 $20.11 $20.11 $44.68 $44.68 $44.68 $9.31 $44.68 $44.68 $44.68 $44.68 $44.68 $9.31 $44.68 $46.80 $26.43 $44.68 $46.80 $44.68 $44.68 $33.75 $44.68 $44.68 $44.68 $22.34 $22.34 $35.39 $44.68 $35.74 $20.11 $8.87 N/A $26.10 $44.68 $26.81 $44.68 $9.31 $44.68 N/A N/A 204.085 SUP HCPCS C1713 204.085 - SCREW BONE STANDARD 3.5MM 6MM 85MM SMALL HEXAGONAL SOCKET BOTH IP/OP $46.50 $34.00 $9.14 $46.80 $20.71 $20.71 $20.71 $20.71 $46.03 $46.03 $46.03 $9.59 $46.03 $46.03 $46.03 $46.03 $46.03 $9.59 $46.03 $46.80 $27.23 $46.03 $46.80 $46.03 $46.03 $34.88 $46.03 $46.03 $46.03 $23.02 $23.02 $36.46 $46.03 $36.82 $20.71 $9.14 N/A $26.97 $46.03 $27.62 $46.03 $9.59 $46.03 N/A N/A 204.09 SUP HCPCS C1713 204.090 - SCREW BONE STANDARD 3.5MM 6MM 90MM SMALL HEXAGONAL SOCKET BOTH IP/OP $45.00 $33.00 $8.87 $46.80 $20.11 $20.11 $20.11 $20.11 $44.68 $44.68 $44.68 $9.31 $44.68 $44.68 $44.68 $44.68 $44.68 $9.31 $44.68 $46.80 $26.43 $44.68 $46.80 $44.68 $44.68 $33.75 $44.68 $44.68 $44.68 $22.34 $22.34 $35.39 $44.68 $35.74 $20.11 $8.87 N/A $26.10 $44.68 $26.81 $44.68 $9.31 $44.68 N/A N/A 204.095 SUP HCPCS C1713 204.095 - SCREW BONE STANDARD 3.5MM 6MM 95MM SLFTAP SMALL HEXAGON BOTH IP/OP $46.50 $34.00 $9.14 $46.80 $20.71 $20.71 $20.71 $20.71 $46.03 $46.03 $46.03 $9.59 $46.03 $46.03 $46.03 $46.03 $46.03 $9.59 $46.03 $18.72 $27.23 $46.03 $46.80 $46.03 $46.03 $34.88 $46.03 $46.03 $46.03 $23.02 $23.02 $36.46 $46.03 $36.82 $20.71 $9.14 N/A $26.97 $46.03 $27.62 $46.03 $9.59 $46.03 N/A N/A 204.1 SUP HCPCS C1713 204.100 - SCREW BONE 3.5MM 100MM LC-DCP STAINLESS STEEL CORTICAL BOTH IP/OP $45.00 $33.00 $8.87 $46.80 $20.11 $20.11 $20.11 $20.11 $44.68 $44.68 $44.68 $9.31 $44.68 $44.68 $44.68 $44.68 $44.68 $9.31 $44.68 $18.72 $26.43 $44.68 $46.80 $44.68 $44.68 $33.75 $44.68 $44.68 $44.68 $22.34 $22.34 $35.39 $44.68 $35.74 $20.11 $8.87 N/A $26.10 $44.68 $26.81 $44.68 $9.31 $44.68 N/A N/A 204.105 SUP HCPCS C1713 204.105 - SCREW BONE STANDARD 3.5MM 6MM 105MM SLFTAP SMALL HEXAGON BOTH IP/OP $46.50 $34.00 $9.14 $46.80 $20.71 $20.71 $20.71 $20.71 $46.03 $46.03 $46.03 $9.59 $46.03 $46.03 $46.03 $46.03 $46.03 $9.59 $46.03 $46.80 $27.23 $46.03 $46.80 $46.03 $46.03 $34.88 $46.03 $46.03 $46.03 $23.02 $23.02 $36.46 $46.03 $36.82 $20.71 $9.14 N/A $26.97 $46.03 $27.62 $46.03 $9.59 $46.03 N/A N/A 204.11 SUP HCPCS C1713 204.110 - SCREW BONE STANDARD 3.5MM 6MM 110MM SLFTAP SMALL HEXAGON BOTH IP/OP $45.00 $33.00 $8.87 $46.80 $20.11 $20.11 $20.11 $20.11 $44.68 $44.68 $44.68 $9.31 $44.68 $44.68 $44.68 $44.68 $44.68 $9.31 $44.68 $46.80 $26.43 $44.68 $46.80 $44.68 $44.68 $33.75 $44.68 $44.68 $44.68 $22.34 $22.34 $35.39 $44.68 $35.74 $20.11 $8.87 N/A $26.10 $44.68 $26.81 $44.68 $9.31 $44.68 N/A N/A 204.115 SUP HCPCS C1713 204.115 - SCREW BONE 3.5MM 115MM LC-DCP STAINLESS STEEL CORTICAL BOTH IP/OP $46.50 $34.00 $9.14 $46.80 $20.71 $20.71 $20.71 $20.71 $46.03 $46.03 $46.03 $9.59 $46.03 $46.03 $46.03 $46.03 $46.03 $9.59 $46.03 $18.72 $27.23 $46.03 $46.80 $46.03 $46.03 $34.88 $46.03 $46.03 $46.03 $23.02 $23.02 $36.46 $46.03 $36.82 $20.71 $9.14 N/A $26.97 $46.03 $27.62 $46.03 $9.59 $46.03 N/A N/A 204.12 SUP HCPCS C1713 204.120 - SCREW BONE STANDARD 3.5MM 6MM 120MM SLFTAP SMALL HEXAGONAL BOTH IP/OP $45.00 $33.00 $8.87 $46.80 $20.11 $20.11 $20.11 $20.11 $44.68 $44.68 $44.68 $9.31 $44.68 $44.68 $44.68 $44.68 $44.68 $9.31 $44.68 $18.72 $26.43 $44.68 $46.80 $44.68 $44.68 $33.75 $44.68 $44.68 $44.68 $22.34 $22.34 $35.39 $44.68 $35.74 $20.11 $8.87 N/A $26.10 $44.68 $26.81 $44.68 $9.31 $44.68 N/A N/A 204.216 SUP HCPCS C1713 204.216 - SCREW BONE PTHRD 3.5MM 6MM 16MM 6MM SHAFT SMALL HEXAGONAL BOTH IP/OP $33.00 $24.00 $6.50 $32.75 $14.74 $14.74 $14.74 $14.74 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $32.75 $32.75 $32.75 $6.83 $32.75 $13.10 $19.37 $32.75 $32.75 $32.75 $32.75 $24.75 $32.75 $32.75 $32.75 $16.38 $16.38 $25.94 $32.75 $26.20 $14.74 $6.50 N/A $19.14 $32.75 $19.65 $32.75 $6.83 $32.75 N/A N/A 204.218 SUP HCPCS C1713 204.218 - SCREW BONE SMALL HEXAGON 3.5MM 6MM 18MM 6MM SELF TAP SOCKET BOTH IP/OP $33.00 $24.00 $6.50 $32.75 $14.74 $14.74 $14.74 $14.74 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $19.37 $32.75 $32.75 $32.75 $32.75 $24.75 $32.75 $32.75 $32.75 $16.38 $16.38 $25.94 $32.75 $26.20 $14.74 $6.50 N/A $19.14 $32.75 $19.65 $32.75 $6.83 $32.75 N/A N/A 204.22 SUP HCPCS C1713 204.220 - SCREW BONE PTHRD 3.5MM 6MM 20MM 6MM SHAFT SMALL HEXAGONAL BOTH IP/OP $33.00 $24.00 $6.50 $32.75 $14.74 $14.74 $14.74 $14.74 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $19.37 $32.75 $32.75 $32.75 $32.75 $24.75 $32.75 $32.75 $32.75 $16.38 $16.38 $25.94 $32.75 $26.20 $14.74 $6.50 N/A $19.14 $32.75 $19.65 $32.75 $6.83 $32.75 N/A N/A 204.222 SUP HCPCS C1713 204.222 - SCREW BONE SMALL HEXAGON 3.5MM 6MM 22MM 6MM SELF TAP SOCKET BOTH IP/OP $33.00 $24.00 $6.50 $32.75 $14.74 $14.74 $14.74 $14.74 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $19.37 $32.75 $32.75 $32.75 $32.75 $24.75 $32.75 $32.75 $32.75 $16.38 $16.38 $25.94 $32.75 $26.20 $14.74 $6.50 N/A $19.14 $32.75 $19.65 $32.75 $6.83 $32.75 N/A N/A 204.224 SUP HCPCS C1713 204.224 - SCREW BONE SMALL HEXAGON 3.5MM 6MM 24MM 10MM SELF TAP SOCKET BOTH IP/OP $33.00 $24.00 $6.50 $32.75 $14.74 $14.74 $14.74 $14.74 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $19.37 $32.75 $32.75 $32.75 $32.75 $24.75 $32.75 $32.75 $32.75 $16.38 $16.38 $25.94 $32.75 $26.20 $14.74 $6.50 N/A $19.14 $32.75 $19.65 $32.75 $6.83 $32.75 N/A N/A 204.226 SUP HCPCS C1713 204.226 - SCREW BONE PTHRD 3.5MM 6MM 26MM 10MM SHAFT SMALL HEXAGONAL BOTH IP/OP $33.00 $24.00 $6.50 $32.75 $14.74 $14.74 $14.74 $14.74 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $19.37 $32.75 $32.75 $32.75 $32.75 $24.75 $32.75 $32.75 $32.75 $16.38 $16.38 $25.94 $32.75 $26.20 $14.74 $6.50 N/A $19.14 $32.75 $19.65 $32.75 $32.75 $32.75 N/A N/A 204.228 SUP HCPCS C1713 204.228 - SCREW BONE SMALL HEXAGON 3.5MM 6MM 28MM 10MM SELF TAP SOCKET BOTH IP/OP $34.00 $25.00 $6.69 $34.30 $15.18 $15.18 $15.18 $15.18 $33.73 $33.73 $33.73 $7.03 $33.73 $33.73 $33.73 $33.73 $33.73 $7.03 $33.73 $34.30 $19.95 $33.73 $34.30 $33.73 $33.73 $25.50 $33.73 $33.73 $33.73 $16.87 $16.87 $26.71 $33.73 $26.98 $15.18 $6.69 N/A $19.72 $33.73 $20.24 $33.73 $33.73 $33.73 N/A N/A 204.23 SUP HCPCS C1713 204.230 - SCREW BONE SMALL HEXAGON 3.5MM 6MM 30MM 10MM SELF TAP SOCKET BOTH IP/OP $33.00 $24.00 $6.50 $34.30 $14.74 $14.74 $14.74 $14.74 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $32.75 $32.75 $32.75 $6.83 $32.75 $34.30 $19.37 $32.75 $34.30 $32.75 $32.75 $24.75 $32.75 $32.75 $32.75 $16.38 $16.38 $25.94 $32.75 $26.20 $14.74 $6.50 N/A $19.14 $32.75 $32.75 $32.75 $6.83 $32.75 N/A N/A 204.232 SUP HCPCS C1713 204.232 - SCREW BONE SMALL HEXAGON 3.5MM 6MM 32MM 12MM SELF TAP SOCKET BOTH IP/OP $34.00 $25.00 $6.69 $34.30 $15.18 $15.18 $15.18 $15.18 $33.73 $33.73 $33.73 $7.03 $33.73 $33.73 $33.73 $33.73 $33.73 $7.03 $33.73 $34.30 $19.95 $33.73 $34.30 $33.73 $33.73 $25.50 $33.73 $33.73 $33.73 $16.87 $16.87 $26.71 $33.73 $26.98 $15.18 $6.69 N/A $19.72 $33.73 $20.24 $33.73 $33.73 $33.73 N/A N/A 204.234 SUP HCPCS C1713 204.234 - SCREW BONE SMALL HEXAGON 3.5MM 6MM 34MM 12MM SELF TAP SOCKET BOTH IP/OP $34.00 $25.00 $6.69 $34.30 $15.18 $15.18 $15.18 $15.18 $33.73 $33.73 $33.73 $7.03 $33.73 $33.73 $33.73 $33.73 $33.73 $7.03 $33.73 $34.30 $19.95 $33.73 $34.30 $33.73 $33.73 $25.50 $33.73 $33.73 $33.73 $16.87 $16.87 $26.71 $33.73 $26.98 $15.18 $6.69 N/A $19.72 $33.73 $20.24 $33.73 $7.03 $33.73 N/A N/A 204.236 SUP HCPCS C1713 204.236 - SCREW BONE SMALL HEXAGON 3.5MM 6MM 36MM 12MM SELF TAP SOCKET BOTH IP/OP $34.00 $25.00 $6.69 $34.30 $15.18 $15.18 $15.18 $15.18 $33.73 $33.73 $33.73 $7.03 $33.73 $33.73 $33.73 $33.73 $33.73 $7.03 $33.73 $34.30 $19.95 $33.73 $34.30 $33.73 $33.73 $25.50 $33.73 $33.73 $33.73 $16.87 $16.87 $26.71 $33.73 $26.98 $15.18 $6.69 N/A $19.72 $33.73 $33.73 $33.73 $7.03 $33.73 N/A N/A 204.238 SUP HCPCS C1713 204.238 - SCREW BONE PTHRD 3.5MM 6MM 38MM 12MM SHAFT SMALL HEXAGONAL BOTH IP/OP $34.00 $25.00 $6.69 $34.30 $15.18 $15.18 $15.18 $15.18 $33.73 $33.73 $33.73 $7.03 $33.73 $33.73 $33.73 $33.73 $33.73 $7.03 $33.73 $34.30 $19.95 $33.73 $34.30 $33.73 $33.73 $25.50 $33.73 $33.73 $33.73 $16.87 $16.87 $26.71 $33.73 $26.98 $15.18 $6.69 N/A $19.72 $33.73 $20.24 $33.73 $7.03 $33.73 N/A N/A 204.24 SUP HCPCS C1713 204.240 - SCREW BONE SMALL HEXAGON 3.5MM 6MM 40MM 12MM SELF TAP SOCKET BOTH IP/OP $33.00 $24.00 $6.50 $34.30 $14.74 $14.74 $14.74 $14.74 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $32.75 $32.75 $32.75 $6.83 $32.75 $34.30 $19.37 $32.75 $34.30 $32.75 $32.75 $24.75 $32.75 $32.75 $32.75 $16.38 $16.38 $25.94 $32.75 $26.20 $14.74 $6.50 N/A $19.14 $32.75 $32.75 $32.75 $32.75 $32.75 N/A N/A 204.245 SUP HCPCS C1713 204.245 - SCREW BONE 3.5MM 45MM SHAFT LC-DCP STAINLESS STEEL TIBIA BOTH IP/OP $32.00 $24.00 $6.31 $31.80 $14.31 $14.31 $14.31 $14.31 $31.80 $31.80 $31.80 $6.63 $31.80 $31.80 $31.80 $31.80 $31.80 $6.63 $31.80 $31.80 $18.81 $31.80 $31.80 $31.80 $31.80 $24.00 $31.80 $31.80 $31.80 $15.90 $15.90 $25.19 $31.80 $25.44 $14.31 $6.31 N/A $18.56 $31.80 $19.08 $31.80 $6.63 $31.80 N/A N/A 204.25 SUP HCPCS C1713 204.250 - SCREW BONE 3.5MM 6MM 50MM SMALL HEXAGON SOCKET DCP LC-DCP BOTH IP/OP $32.00 $24.00 $6.31 $31.80 $14.31 $14.31 $14.31 $14.31 $31.80 $31.80 $31.80 $6.63 $31.80 $31.80 $31.80 $31.80 $31.80 $6.63 $31.80 $31.80 $18.81 $31.80 $31.80 $31.80 $31.80 $24.00 $31.80 $31.80 $31.80 $15.90 $15.90 $25.19 $31.80 $25.44 $14.31 $6.31 N/A $18.56 $31.80 $19.08 $31.80 $31.80 $31.80 N/A N/A 204.64 SUP HCPCS C1713 204.640 - SCREW BONE 3.5MM 6MM 40MM SELF TAP SMALL HEXAGONAL SOCKET BOTH IP/OP $52.00 $38.00 $10.29 $54.33 $23.33 $23.33 $23.33 $23.33 $51.85 $51.85 $51.85 $10.81 $51.85 $51.85 $51.85 $51.85 $51.85 $10.81 $51.85 $54.33 $30.67 $51.85 $54.33 $51.85 $51.85 $39.00 $51.85 $51.85 $51.85 $25.93 $25.93 $41.07 $51.85 $41.48 $23.33 $10.29 N/A $30.16 $51.85 $31.11 $51.85 $10.81 $51.85 N/A N/A 204.645 SUP HCPCS C1713 204.645 - SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 45MM SELF TAP SOCKET BOTH IP/OP $53.50 $40.00 $10.60 $54.33 $24.04 $24.04 $24.04 $24.04 $53.43 $53.43 $53.43 $11.14 $53.43 $53.43 $53.43 $53.43 $53.43 $11.14 $53.43 $54.33 $31.60 $53.43 $54.33 $53.43 $53.43 $40.13 $53.43 $53.43 $53.43 $26.72 $26.72 $42.32 $53.43 $42.74 $24.04 $10.60 N/A $31.03 $53.43 $32.06 $53.43 $11.13 $53.43 N/A N/A 204.65 SUP HCPCS C1713 204.650 - SCREW BONE 3.5MM 6MM 50MM SELF TAP SMALL HEXAGONAL SOCKET BOTH IP/OP $52.00 $38.00 $10.29 $54.33 $23.33 $23.33 $23.33 $23.33 $51.85 $51.85 $51.85 $10.81 $51.85 $51.85 $51.85 $51.85 $51.85 $10.81 $51.85 $54.33 $30.67 $51.85 $54.33 $51.85 $51.85 $39.00 $51.85 $51.85 $51.85 $25.93 $25.93 $41.07 $51.85 $41.48 $23.33 $10.29 N/A $30.16 $51.85 $31.11 $51.85 $10.81 $51.85 N/A N/A 204.655 SUP HCPCS C1713 204.655 - SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 55MM SELF TAP SOCKET BOTH IP/OP $53.50 $40.00 $10.60 $54.33 $24.04 $24.04 $24.04 $24.04 $53.43 $53.43 $53.43 $11.14 $53.43 $53.43 $53.43 $53.43 $53.43 $11.14 $53.43 $54.33 $31.60 $53.43 $54.33 $53.43 $53.43 $40.13 $53.43 $53.43 $53.43 $26.72 $26.72 $42.32 $53.43 $42.74 $24.04 $10.60 N/A $31.03 $53.43 $53.43 $53.43 $11.13 $53.43 N/A N/A 204.66 SUP HCPCS C1713 204.660 - SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 60MM SELF TAP SOCKET BOTH IP/OP $52.00 $38.00 $10.29 $54.33 $23.33 $23.33 $23.33 $23.33 $51.85 $51.85 $51.85 $10.81 $51.85 $51.85 $51.85 $51.85 $51.85 $10.81 $51.85 $54.33 $30.67 $51.85 $54.33 $51.85 $51.85 $39.00 $51.85 $51.85 $51.85 $25.93 $25.93 $41.07 $51.85 $41.48 $23.33 $10.29 N/A $30.16 $51.85 $31.11 $51.85 $51.85 $51.85 N/A N/A 204.665 SUP HCPCS C1713 204.665 - SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 65MM SELF TAP SOCKET BOTH IP/OP $53.50 $40.00 $10.60 $54.33 $24.04 $24.04 $24.04 $24.04 $53.43 $53.43 $53.43 $11.14 $53.43 $53.43 $53.43 $53.43 $53.43 $11.14 $53.43 $54.33 $31.60 $53.43 $54.33 $53.43 $53.43 $40.13 $53.43 $53.43 $53.43 $26.72 $26.72 $42.32 $53.43 $42.74 $24.04 $10.60 N/A $31.03 $53.43 $32.06 $53.43 $11.13 $53.43 N/A N/A 204.67 SUP HCPCS C1713 204.670 - SCREW BONE 3.5MM 6MM 70MM SELF TAP SMALL HEXAGONAL SOCKET BOTH IP/OP $52.00 $38.00 $10.29 $54.33 $23.33 $23.33 $23.33 $23.33 $51.85 $51.85 $51.85 $10.81 $51.85 $51.85 $51.85 $51.85 $51.85 $10.81 $51.85 $54.33 $30.67 $51.85 $54.33 $51.85 $51.85 $39.00 $51.85 $51.85 $51.85 $25.93 $25.93 $41.07 $51.85 $41.48 $23.33 $10.29 N/A $30.16 $51.85 $31.11 $51.85 $10.81 $51.85 N/A N/A 204.675 SUP HCPCS C1713 204.675 - SCREW BONE 3.5MM 6MM 75MM SELF TAP SMALL HEXAGONAL SOCKET BOTH IP/OP $53.50 $40.00 $10.60 $54.33 $24.04 $24.04 $24.04 $24.04 $53.43 $53.43 $53.43 $11.14 $53.43 $53.43 $53.43 $53.43 $53.43 $11.14 $53.43 $54.33 $31.60 $53.43 $54.33 $53.43 $53.43 $40.13 $53.43 $53.43 $53.43 $26.72 $26.72 $42.32 $53.43 $42.74 $24.04 $10.60 N/A $31.03 $53.43 $32.06 $53.43 $11.13 $53.43 N/A N/A 204.68 SUP HCPCS C1713 204.680 - SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 80MM SELF TAP SOCKET BOTH IP/OP $52.00 $38.00 $10.29 $54.33 $23.33 $23.33 $23.33 $23.33 $51.85 $51.85 $51.85 $10.81 $51.85 $51.85 $51.85 $51.85 $51.85 $10.81 $51.85 $54.33 $30.67 $51.85 $54.33 $51.85 $51.85 $39.00 $51.85 $51.85 $51.85 $25.93 $25.93 $41.07 $51.85 $41.48 $23.33 $10.29 N/A $30.16 $51.85 $31.11 $51.85 $10.81 $51.85 N/A N/A 204.685 SUP HCPCS C1713 204.685 - SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 85MM SELF TAP SOCKET BOTH IP/OP $53.50 $40.00 $10.60 $54.33 $24.04 $24.04 $24.04 $24.04 $53.43 $53.43 $53.43 $11.14 $53.43 $53.43 $53.43 $53.43 $53.43 $11.14 $53.43 $54.33 $31.60 $53.43 $54.33 $53.43 $53.43 $40.13 $53.43 $53.43 $53.43 $26.72 $26.72 $42.32 $53.43 $42.74 $24.04 $10.60 N/A $31.03 $53.43 $53.43 $53.43 $11.13 $53.43 N/A N/A 204.69 SUP HCPCS C1713 204.690 - SCREW BONE 3.5MM 6MM 90MM SELF TAP SMALL HEXAGONAL SOCKET BOTH IP/OP $52.00 $38.00 $10.29 $54.33 $23.33 $23.33 $23.33 $23.33 $51.85 $51.85 $51.85 $10.81 $51.85 $51.85 $51.85 $51.85 $51.85 $10.81 $51.85 $54.33 $30.67 $51.85 $54.33 $51.85 $51.85 $39.00 $51.85 $51.85 $51.85 $25.93 $25.93 $41.07 $51.85 $41.48 $23.33 $10.29 N/A $30.16 $51.85 $31.11 $51.85 $10.81 $51.85 N/A N/A 204.695 SUP HCPCS C1713 204.695 - SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 95MM SELF TAP SOCKET BOTH IP/OP $53.50 $40.00 $10.60 $54.33 $24.04 $24.04 $24.04 $24.04 $53.43 $53.43 $53.43 $11.14 $53.43 $53.43 $53.43 $53.43 $53.43 $11.14 $53.43 $54.33 $31.60 $53.43 $54.33 $53.43 $53.43 $40.13 $53.43 $53.43 $53.43 $26.72 $26.72 $42.32 $53.43 $42.74 $24.04 $10.60 N/A $31.03 $53.43 $32.06 $53.43 $11.13 $53.43 N/A N/A 204.7 SUP HCPCS C1713 204.700 - SCREW BONE 3.5MM 6MM 100MM SELF TAP SMALL HEXAGONAL SOCKET BOTH IP/OP $52.00 $38.00 $10.29 $54.33 $23.33 $23.33 $23.33 $23.33 $51.85 $51.85 $51.85 $10.81 $51.85 $51.85 $51.85 $51.85 $51.85 $10.81 $51.85 $54.33 $30.67 $51.85 $54.33 $51.85 $51.85 $39.00 $51.85 $51.85 $51.85 $25.93 $25.93 $41.07 $51.85 $41.48 $23.33 $10.29 N/A $30.16 $51.85 $51.85 $51.85 $10.81 $51.85 N/A N/A 204.705 SUP HCPCS C1713 204.705 - SCREW BONE 3.5MM 6MM 105MM SELF TAP SMALL HEXAGONAL SOCKET BOTH IP/OP $53.50 $40.00 $10.60 $54.33 $24.04 $24.04 $24.04 $24.04 $53.43 $53.43 $53.43 $11.14 $53.43 $53.43 $53.43 $53.43 $53.43 $11.14 $53.43 $54.33 $31.60 $53.43 $54.33 $53.43 $53.43 $40.13 $53.43 $53.43 $53.43 $26.72 $26.72 $42.32 $53.43 $42.74 $24.04 $10.60 N/A $31.03 $53.43 $53.43 $53.43 $11.13 $53.43 N/A N/A 204.71 SUP HCPCS C1713 204.710 - SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 110MM SELF TAP SOCKET BOTH IP/OP $52.00 $38.00 $10.29 $54.33 $23.33 $23.33 $23.33 $23.33 $51.85 $51.85 $51.85 $10.81 $51.85 $51.85 $51.85 $51.85 $51.85 $10.81 $51.85 $54.33 $30.67 $51.85 $54.33 $51.85 $51.85 $39.00 $51.85 $51.85 $51.85 $25.93 $25.93 $41.07 $51.85 $41.48 $23.33 $10.29 N/A $30.16 $51.85 $51.85 $51.85 $10.81 $51.85 N/A N/A 204.715 SUP HCPCS C1713 204.715 - SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 115MM SELF TAP SOCKET BOTH IP/OP $53.50 $40.00 $10.60 $54.33 $24.04 $24.04 $24.04 $24.04 $53.43 $53.43 $53.43 $11.14 $53.43 $53.43 $53.43 $53.43 $53.43 $11.14 $53.43 $54.33 $31.60 $53.43 $54.33 $53.43 $53.43 $40.13 $53.43 $53.43 $53.43 $26.72 $26.72 $42.32 $53.43 $42.74 $24.04 $10.60 N/A $31.03 $53.43 $32.06 $53.43 $11.13 $53.43 N/A N/A 204.72 SUP HCPCS C1713 204.720 - SCREW BONE 3.5MM 120MM SLFTAP LC-DCP STAINLESS STEEL CORTEX BOTH IP/OP $52.00 $38.00 $10.29 $54.33 $23.33 $23.33 $23.33 $23.33 $51.85 $51.85 $51.85 $10.81 $51.85 $51.85 $51.85 $51.85 $51.85 $10.81 $51.85 $54.33 $30.67 $51.85 $54.33 $51.85 $51.85 $39.00 $51.85 $51.85 $51.85 $25.93 $25.93 $41.07 $51.85 $41.48 $23.33 $10.29 N/A $30.16 $51.85 $31.11 $51.85 $10.81 $51.85 N/A N/A 204.725 SUP HCPCS C1713 204.725 - SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 125MM SELF TAP SOCKET BOTH IP/OP $53.50 $40.00 $10.60 $54.33 $24.04 $24.04 $24.04 $24.04 $53.43 $53.43 $53.43 $11.14 $53.43 $53.43 $53.43 $53.43 $53.43 $11.14 $53.43 $54.33 $31.60 $53.43 $54.33 $53.43 $53.43 $40.13 $53.43 $53.43 $53.43 $26.72 $26.72 $42.32 $53.43 $42.74 $24.04 $10.60 N/A $31.03 $53.43 $53.43 $53.43 $11.13 $53.43 N/A N/A 204.73 SUP HCPCS C1713 204.730 - SCREW BONE 3.5MM 6MM 130MM SLFTAP LP SMALL HEXAGONAL SOCKET BOTH IP/OP $165.50 $122.00 $32.77 $173.00 $74.31 $74.31 $74.31 $74.31 $165.13 $165.13 $165.13 $34.42 $165.13 $165.13 $165.13 $165.13 $165.13 $34.41 $165.13 $69.20 $97.67 $165.13 $173.00 $165.13 $165.13 $124.13 $165.13 $165.13 $165.13 $82.57 $82.57 $130.78 $165.13 $132.10 $74.31 $32.77 N/A $95.99 $165.13 $99.08 $165.13 $34.41 $165.13 N/A N/A 204.735 SUP HCPCS C1713 204.735 - SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 135MM SELF TAP SOCKET BOTH IP/OP $170.50 $126.00 $33.76 $173.00 $76.55 $76.55 $76.55 $76.55 $170.10 $170.10 $170.10 $35.45 $170.10 $170.10 $170.10 $170.10 $170.10 $35.45 $170.10 $69.20 $100.61 $170.10 $173.00 $170.10 $170.10 $127.88 $170.10 $170.10 $170.10 $85.05 $85.05 $134.72 $170.10 $136.08 $76.55 $33.76 N/A $98.89 $170.10 $102.06 $170.10 $35.45 $170.10 N/A N/A 204.74 SUP HCPCS C1713 204.740 - SCREW BONE 3.5MM 6MM 140MM SLFTAP LP SMALL HEXAGONAL SOCKET BOTH IP/OP $165.50 $122.00 $32.77 $173.00 $74.31 $74.31 $74.31 $74.31 $165.13 $165.13 $165.13 $34.42 $165.13 $165.13 $165.13 $165.13 $165.13 $34.41 $165.13 $69.20 $97.67 $165.13 $173.00 $165.13 $165.13 $124.13 $165.13 $165.13 $165.13 $82.57 $82.57 $130.78 $165.13 $132.10 $74.31 $32.77 N/A $95.99 $165.13 $99.08 $165.13 $34.41 $165.13 N/A N/A 204.745 SUP HCPCS C1713 204.745 - SCREW BONE SMALL HEXAGON LP 3.5MM 6MM 145MM SELF TAP SOCKET BOTH IP/OP $170.50 $126.00 $33.76 $173.00 $76.55 $76.55 $76.55 $76.55 $170.10 $170.10 $170.10 $35.45 $170.10 $170.10 $170.10 $170.10 $170.10 $35.45 $170.10 $173.00 $100.61 $170.10 $173.00 $170.10 $170.10 $127.88 $170.10 $170.10 $170.10 $85.05 $85.05 $134.72 $170.10 $136.08 $76.55 $33.76 N/A $98.89 $170.10 $102.06 $170.10 $35.45 $170.10 N/A N/A 204.75 SUP HCPCS C1713 204.750 - SCREW BONE 3.5MM 6MM 150MM SLFTAP LP SMALL HEXAGONAL SOCKET BOTH IP/OP $165.50 $122.00 $32.77 $173.00 $74.31 $74.31 $74.31 $74.31 $165.13 $165.13 $165.13 $34.42 $165.13 $165.13 $165.13 $165.13 $165.13 $34.41 $165.13 $173.00 $97.67 $165.13 $173.00 $165.13 $165.13 $124.13 $165.13 $165.13 $165.13 $82.57 $82.57 $130.78 $165.13 $132.10 $74.31 $32.77 N/A $95.99 $165.13 $99.08 $165.13 $34.41 $165.13 N/A N/A 204.81 SUP HCPCS C1713 204.810 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 10MM SELF TAP LC-DCP DCP BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $40.38 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $23.13 $38.55 $8.03 $38.55 N/A N/A 204.812 SUP HCPCS C1713 204.812 - SCREW BONE FULTHD 3.5MM 6MM 12MM SLFTAP SMALL HEXAGONAL BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.814 SUP HCPCS C1713 204.814 - SCREW BONE FULTHD 3.5MM 6MM 14MM SELF TAP SMALL HEXAGONAL BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.816 SUP HCPCS C1713 204.816 - SCREW BONE FULTHD 3.5MM 6MM 16MM SLFTAP SMALL HEXAGONAL BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.818 SUP HCPCS C1713 204.818 - SCREW BONE 3.5MM 18MM SLFTAP LCP STAINLESS STEEL CORTICAL BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.82 SUP HCPCS C1713 204.820 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 20MM SELF TAP LC-DCP DCP BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $40.38 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $23.13 $38.55 $8.03 $38.55 N/A N/A 204.822 SUP HCPCS C1713 204.822 - SCREW BONE 3.5MM 22MM SLFTAP LCP STAINLESS STEEL CORTICAL BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.824 SUP HCPCS C1713 204.824 - SCREW BONE 3.5MM 24MM SLFTAP LCP STAINLESS STEEL CORTICAL BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.826 SUP HCPCS C1713 204.826 - SCREW BONE 3.5MM 26MM SLFTAP LCP STAINLESS STEEL CORTICAL BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.828 SUP HCPCS C1713 204.828 - SCREW BONE 3.5MM 28MM SLFTAP HEXAGONAL RECESS DCP LC-DCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.83 SUP HCPCS C1713 204.830 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 30MM SELF TAP LC-DCP DCP BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $16.15 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $23.13 $38.55 $8.03 $38.55 N/A N/A 204.832 SUP HCPCS C1713 204.832 - SCREW BONE FULTHD 3.5MM 6MM 32MM SLFTAP SMALL HEXAGONAL BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.834 SUP HCPCS C1713 204.834 - SCREW BONE FULTHD 3.5MM 6MM 34MM SLFTAP SMALL HEXAGONAL BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.836 SUP HCPCS C1713 204.836 - SCREW BONE FULTHD 3.5MM 6MM 36MM SLFTAP SMALL HEXAGONAL BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.838 SUP HCPCS C1713 204.838 - SCREW BONE 3.5MM 38MM SLFTAP HEXAGONAL RECESS DCP LC-DCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.84 SUP HCPCS C1713 204.840 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 40MM SELF TAP LC-DCP DCP BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $40.38 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $23.13 $38.55 $8.03 $38.55 N/A N/A 204.842 SUP HCPCS C1713 204.842 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 42MM SELF TAP SOCKET DCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.844 SUP HCPCS C1713 204.844 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 44MM SELF TAP SOCKET DCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $8.27 $39.70 N/A N/A 204.845 SUP HCPCS C1713 204.845 - SCREW BONE 3.5MM 45MM SLFTAP LCP STAINLESS STEEL CORTICAL BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.846 SUP HCPCS C1713 204.846 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 46MM SELF TAP SOCKET DCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.848 SUP HCPCS C1713 204.848 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 48MM SELF TAP SOCKET DCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $16.15 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $8.27 $39.70 N/A N/A 204.85 SUP HCPCS C1713 204.850 - SCREW BONE FULTHD 3.5MM 6MM 50MM SLFTAP SMALL HEXAGONAL BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $40.38 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $38.55 $38.55 $8.03 $38.55 N/A N/A 204.855 SUP HCPCS C1713 204.855 - SCREW BONE 3.5MM 55MM SLFTAP HEXAGONAL RECESS DCP LC-DCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $8.27 $39.70 N/A N/A 204.86 SUP HCPCS C1713 204.860 - SCREW BONE FULTHD 3.5MM 6MM 60MM SLFTAP SMALL HEXAGONAL BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $16.15 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $38.55 $38.55 $8.03 $38.55 N/A N/A 204.865 SUP HCPCS C1713 204.865 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 65MM SELF TAP SOCKET DCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.87 SUP HCPCS C1713 204.870 - SCREW BONE FULTHD 3.5MM 6MM 70MM SLFTAP SMALL HEXAGONAL BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $16.15 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $23.13 $38.55 $8.03 $38.55 N/A N/A 204.875 SUP HCPCS C1713 204.875 - SCREW BONE FULTHD 3.5MM 6MM 75MM SLFTAP SMALL HEXAGONAL BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 204.88 SUP HCPCS C1713 204.880 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 80MM SELF TAP SOCKET DCP BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $16.15 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $23.13 $38.55 $8.03 $38.55 N/A N/A 204.885 SUP HCPCS C1713 204.885 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 85MM SELF TAP SOCKET DCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $8.27 $39.70 N/A N/A 204.89 SUP HCPCS C1713 204.890 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 90MM SELF TAP SOCKET DCP BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $40.38 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $23.13 $38.55 $8.03 $38.55 N/A N/A 204.895 SUP HCPCS C1713 204.895 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 95MM SELF TAP SOCKET DCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $8.27 $39.70 N/A N/A 204.9 SUP HCPCS C1713 204.900 - SCREW BONE 3.5MM 100MM SLFTAP LC-DCP STAINLESS STEEL TIBIA BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $40.38 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $23.13 $38.55 $8.03 $38.55 N/A N/A 204.905 SUP HCPCS C1713 204.905 - SCREW BONE 3.5MM 105MM SLFTAP LC-DCP STAINLESS STEEL TIBIA BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $8.27 $39.70 N/A N/A 204.91 SUP HCPCS C1713 204.910 - SCREW BONE 3.5MM 110MM SLFTAP LC-DCP STAINLESS STEEL TIBIA BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $40.38 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $23.13 $38.55 $8.03 $38.55 N/A N/A 205.01 SUP HCPCS C1713 205.010 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $344.00 $255.00 $68.26 $360.25 $154.77 $154.77 $154.77 $154.77 $343.93 $343.93 $343.93 $71.68 $343.93 $343.93 $343.93 $343.93 $343.93 $71.68 $343.93 $360.25 $203.43 $343.93 $360.25 $343.93 $343.93 $258.00 $343.93 $343.93 $343.93 $171.97 $171.97 $272.39 $343.93 $275.14 $154.77 $68.26 N/A $199.52 $343.93 $206.36 $343.93 $71.68 $343.93 N/A N/A 205.012 SUP HCPCS C1713 205.012 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $360.25 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $212.54 $354.23 $73.82 $354.23 N/A N/A 205.014 SUP HCPCS C1713 205.014 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $144.10 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $212.54 $354.23 $73.82 $354.23 N/A N/A 205.016 SUP HCPCS C1713 205.016 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $144.10 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $212.54 $354.23 $73.82 $354.23 N/A N/A 205.018 SUP HCPCS C1713 205.018 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $360.25 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $354.23 $354.23 $73.82 $354.23 N/A N/A 205.02 SUP HCPCS C1713 205.020 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $344.00 $255.00 $68.26 $360.25 $154.77 $154.77 $154.77 $154.77 $343.93 $343.93 $343.93 $71.68 $343.93 $343.93 $343.93 $343.93 $343.93 $71.68 $343.93 $360.25 $203.43 $343.93 $360.25 $343.93 $343.93 $258.00 $343.93 $343.93 $343.93 $171.97 $171.97 $272.39 $343.93 $275.14 $154.77 $68.26 N/A $199.52 $343.93 $343.93 $343.93 $71.68 $343.93 N/A N/A 205.022 SUP HCPCS C1713 205.022 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $360.25 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $354.23 $354.23 $73.82 $354.23 N/A N/A 205.024 SUP HCPCS C1713 205.024 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $360.25 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $354.23 $354.23 $73.82 $354.23 N/A N/A 205.026 SUP HCPCS C1713 205.026 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $360.25 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $354.23 $354.23 $73.82 $354.23 N/A N/A 205.028 SUP HCPCS C1713 205.028 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $360.25 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $354.23 $354.23 $73.82 $354.23 N/A N/A 205.03 SUP HCPCS C1713 205.030 - SCREW BONE PTHRD 3.5MM 30MM 10MM CANN HEMISPHERICAL HEAD BOTH IP/OP $344.00 $255.00 $68.26 $360.25 $154.77 $154.77 $154.77 $154.77 $343.93 $343.93 $343.93 $71.68 $343.93 $343.93 $343.93 $343.93 $343.93 $71.68 $343.93 $360.25 $203.43 $343.93 $360.25 $343.93 $343.93 $258.00 $343.93 $343.93 $343.93 $171.97 $171.97 $272.39 $343.93 $275.14 $154.77 $68.26 N/A $199.52 $343.93 $343.93 $343.93 $71.68 $343.93 N/A N/A 205.032 SUP HCPCS C1713 205.032 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $360.25 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $354.23 $354.23 $73.82 $354.23 N/A N/A 205.034 SUP HCPCS C1713 205.034 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $360.25 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $354.23 $354.23 $73.82 $354.23 N/A N/A 205.036 SUP HCPCS C1713 205.036 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $144.10 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $354.23 $354.23 $73.82 $354.23 N/A N/A 205.038 SUP HCPCS C1713 205.038 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $360.25 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $354.23 $354.23 $73.82 $354.23 N/A N/A 205.04 SUP HCPCS C1713 205.040 - SCREW BONE PTHRD 3.5MM 40MM 13MM CANN HEMISPHERICAL HEAD BOTH IP/OP $344.00 $255.00 $68.26 $360.25 $154.77 $154.77 $154.77 $154.77 $343.93 $343.93 $343.93 $71.68 $343.93 $343.93 $343.93 $343.93 $343.93 $71.68 $343.93 $360.25 $203.43 $343.93 $360.25 $343.93 $343.93 $258.00 $343.93 $343.93 $343.93 $171.97 $171.97 $272.39 $343.93 $275.14 $154.77 $68.26 N/A $199.52 $343.93 $206.36 $343.93 $71.68 $343.93 N/A N/A 205.042 SUP HCPCS C1713 205.042 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $360.25 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $212.54 $354.23 $73.82 $354.23 N/A N/A 205.044 SUP HCPCS C1713 205.044 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $360.25 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $212.54 $354.23 $73.82 $354.23 N/A N/A 205.046 SUP HCPCS C1713 205.046 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $360.25 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $354.23 $354.23 $73.82 $354.23 N/A N/A 205.048 SUP HCPCS C1713 205.048 - SCREW BONE SMALL HEXAGON SPHERE REVERSE CUT FLUTE LP 3.5MM 5 BOTH IP/OP $354.50 $262.00 $70.31 $360.25 $159.40 $159.40 $159.40 $159.40 $354.23 $354.23 $354.23 $73.83 $354.23 $354.23 $354.23 $354.23 $354.23 $73.83 $354.23 $360.25 $209.53 $354.23 $360.25 $354.23 $354.23 $265.88 $354.23 $354.23 $354.23 $177.12 $177.12 $280.55 $354.23 $283.38 $159.40 $70.31 N/A $205.61 $354.23 $212.54 $354.23 $73.82 $354.23 N/A N/A 205.05 SUP HCPCS C1713 205.050 - SCREW BONE PTHRD 3.5MM 50MM 16MM CANN HEMISPHERICAL HEAD BOTH IP/OP $344.00 $255.00 $68.26 $360.25 $154.77 $154.77 $154.77 $154.77 $343.93 $343.93 $343.93 $71.68 $343.93 $343.93 $343.93 $343.93 $343.93 $71.68 $343.93 $360.25 $203.43 $343.93 $360.25 $343.93 $343.93 $258.00 $343.93 $343.93 $343.93 $171.97 $171.97 $272.39 $343.93 $275.14 $154.77 $68.26 N/A $199.52 $343.93 $343.93 $343.93 $71.68 $343.93 N/A N/A 205.21 SUP HCPCS C1713 205.210 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $353.50 $262.00 $70.16 $370.28 $159.07 $159.07 $159.07 $159.07 $353.48 $353.48 $353.48 $73.67 $353.48 $353.48 $353.48 $353.48 $353.48 $73.67 $353.48 $370.28 $209.08 $353.48 $370.28 $353.48 $353.48 $265.13 $353.48 $353.48 $353.48 $176.74 $176.74 $279.96 $353.48 $282.78 $159.07 $70.16 N/A $205.03 $353.48 $212.09 $353.48 $73.67 $353.48 N/A N/A 205.212 SUP HCPCS C1713 205.212 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $370.28 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $218.45 $364.08 $75.87 $364.08 N/A N/A 205.214 SUP HCPCS C1713 205.214 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $370.28 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $218.45 $364.08 $75.87 $364.08 N/A N/A 205.216 SUP HCPCS C1713 205.216 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $370.28 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $218.45 $364.08 $75.87 $364.08 N/A N/A 205.218 SUP HCPCS C1713 205.218 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $370.28 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $218.45 $364.08 $75.87 $364.08 N/A N/A 205.22 SUP HCPCS C1713 205.220 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $353.50 $262.00 $70.16 $370.28 $159.07 $159.07 $159.07 $159.07 $353.48 $353.48 $353.48 $73.67 $353.48 $353.48 $353.48 $353.48 $353.48 $73.67 $353.48 $370.28 $209.08 $353.48 $370.28 $353.48 $353.48 $265.13 $353.48 $353.48 $353.48 $176.74 $176.74 $279.96 $353.48 $282.78 $159.07 $70.16 N/A $205.03 $353.48 $212.09 $353.48 $73.67 $353.48 N/A N/A 205.222 SUP HCPCS C1713 205.222 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $370.28 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $364.08 $364.08 $75.87 $364.08 N/A N/A 205.224 SUP HCPCS C1713 205.224 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $370.28 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $218.45 $364.08 $75.87 $364.08 N/A N/A 205.226 SUP HCPCS C1713 205.226 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $370.28 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $218.45 $364.08 $75.87 $364.08 N/A N/A 205.228 SUP HCPCS C1713 205.228 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $370.28 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $218.45 $364.08 $75.87 $364.08 N/A N/A 205.23 SUP HCPCS C1713 205.230 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $353.50 $262.00 $70.16 $370.28 $159.07 $159.07 $159.07 $159.07 $353.48 $353.48 $353.48 $73.67 $353.48 $353.48 $353.48 $353.48 $353.48 $73.67 $353.48 $370.28 $209.08 $353.48 $370.28 $353.48 $353.48 $265.13 $353.48 $353.48 $353.48 $176.74 $176.74 $279.96 $353.48 $282.78 $159.07 $70.16 N/A $205.03 $353.48 $212.09 $353.48 $73.67 $353.48 N/A N/A 205.232 SUP HCPCS C1713 205.232 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $370.28 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $218.45 $364.08 $75.87 $364.08 N/A N/A 205.234 SUP HCPCS C1713 205.234 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $370.28 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $218.45 $364.08 $75.87 $364.08 N/A N/A 205.236 SUP HCPCS C1713 205.236 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $370.28 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $218.45 $364.08 $75.87 $364.08 N/A N/A 205.238 SUP HCPCS C1713 205.238 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $370.28 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $218.45 $364.08 $75.87 $364.08 N/A N/A 205.24 SUP HCPCS C1713 205.240 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $353.50 $262.00 $70.16 $370.28 $159.07 $159.07 $159.07 $159.07 $353.48 $353.48 $353.48 $73.67 $353.48 $353.48 $353.48 $353.48 $353.48 $73.67 $353.48 $370.28 $209.08 $353.48 $370.28 $353.48 $353.48 $265.13 $353.48 $353.48 $353.48 $176.74 $176.74 $279.96 $353.48 $282.78 $159.07 $70.16 N/A $205.03 $353.48 $212.09 $353.48 $73.67 $353.48 N/A N/A 205.242 SUP HCPCS C1713 205.242 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $370.28 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $218.45 $364.08 $75.87 $364.08 N/A N/A 205.244 SUP HCPCS C1713 205.244 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $370.28 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $364.08 $364.08 $75.87 $364.08 N/A N/A 205.246 SUP HCPCS C1713 205.246 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $148.11 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $218.45 $364.08 $75.87 $364.08 N/A N/A 205.248 SUP HCPCS C1713 205.248 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $364.50 $270.00 $72.26 $370.28 $163.84 $163.84 $163.84 $163.84 $364.08 $364.08 $364.08 $75.88 $364.08 $364.08 $364.08 $364.08 $364.08 $75.88 $364.08 $148.11 $215.35 $364.08 $370.28 $364.08 $364.08 $273.38 $364.08 $364.08 $364.08 $182.04 $182.04 $288.35 $364.08 $291.26 $163.84 $72.26 N/A $211.41 $364.08 $218.45 $364.08 $75.87 $364.08 N/A N/A 205.25 SUP HCPCS C1713 205.250 - SCREW BONE FULTHD SMALL HEXAGON SPHERE REVERSE CUT FLUTE 3.5 BOTH IP/OP $353.50 $262.00 $70.16 $370.28 $159.07 $159.07 $159.07 $159.07 $353.48 $353.48 $353.48 $73.67 $353.48 $353.48 $353.48 $353.48 $353.48 $73.67 $353.48 $370.28 $209.08 $353.48 $370.28 $353.48 $353.48 $265.13 $353.48 $353.48 $353.48 $176.74 $176.74 $279.96 $353.48 $282.78 $159.07 $70.16 N/A $205.03 $353.48 $212.09 $353.48 $73.67 $353.48 N/A N/A 206.01 SUP HCPCS C1713 206.010 - SCREW BN FT 4MM 6MM 10MM NS SM HEX SCKT SS CANC SM FRAG SET BOTH IP/OP $32.00 $24.00 $6.30 $33.23 $14.28 $14.28 $14.28 $14.28 $31.73 $31.73 $31.73 $6.61 $31.73 $31.73 $31.73 $31.73 $31.73 $6.61 $31.73 $13.29 $18.77 $31.73 $33.23 $31.73 $31.73 $24.00 $31.73 $31.73 $31.73 $15.87 $15.87 $25.13 $31.73 $25.38 $14.28 $6.30 N/A $18.56 $31.73 $19.04 $31.73 $31.73 $31.73 N/A N/A 206.012 SUP HCPCS C1713 206.012 - SCREW BONE FULTHD 4MM 12MM FULTHRD LCP STAINLESS STEEL BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $33.23 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $32.68 $32.68 $6.81 $32.68 N/A N/A 206.014 SUP HCPCS C1713 206.014 - SCREW BONE PTHRD 4MM 6MM 14MM SMALL HEXAGONAL SOCKET LCP BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $33.23 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $32.68 $32.68 $6.81 $32.68 N/A N/A 206.016 SUP HCPCS C1713 206.016 - SCREW BONE PTHRD 4MM 6MM 16MM SMALL HEXAGONAL SOCKET LCP BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $33.23 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $32.68 $32.68 $6.81 $32.68 N/A N/A 206.018 SUP HCPCS C1713 206.018 - SCREW BONE PTHRD 4MM 6MM 18MM SMALL HEXAGONAL SOCKET LCP BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $33.23 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 206.02 SUP HCPCS C1713 206.020 - SCREW BONE PTHRD 4MM 6MM 20MM SMALL HEXAGONAL SOCKET LCP BOTH IP/OP $32.00 $24.00 $6.30 $33.23 $14.28 $14.28 $14.28 $14.28 $31.73 $31.73 $31.73 $6.61 $31.73 $31.73 $31.73 $31.73 $31.73 $6.61 $31.73 $13.29 $18.77 $31.73 $33.23 $31.73 $31.73 $24.00 $31.73 $31.73 $31.73 $15.87 $15.87 $25.13 $31.73 $25.38 $14.28 $6.30 N/A $18.56 $31.73 $19.04 $31.73 $31.73 $31.73 N/A N/A 206.022 SUP HCPCS C1713 206.022 - SCREW BONE FULTHD 4MM 22MM LOCKING SLFTAP LCP STAINLESS BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $33.23 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 206.024 SUP HCPCS C1713 206.024 - SCREW BONE PTHRD 4MM 6MM 24MM SMALL HEXAGONAL SOCKET LCP BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $33.23 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 206.026 SUP HCPCS C1713 206.026 - SCREW BONE 2.5MM FULTHD 4MM 26MM SELF TAP HEXAGONAL SHAFT BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $33.23 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 206.028 SUP HCPCS C1713 206.028 - SCREW BONE 2.5MM FULTHD 4MM 28MM SELF TAP HEXAGONAL SHAFT BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $33.23 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 206.03 SUP HCPCS C1713 206.030 - SCREW BONE FULTHD HEXAGON 4MM 6MM 30MM SELF TAP SOCKET LCP BOTH IP/OP $32.00 $24.00 $6.30 $33.23 $14.28 $14.28 $14.28 $14.28 $31.73 $31.73 $31.73 $6.61 $31.73 $31.73 $31.73 $31.73 $31.73 $6.61 $31.73 $13.29 $18.77 $31.73 $33.23 $31.73 $31.73 $24.00 $31.73 $31.73 $31.73 $15.87 $15.87 $25.13 $31.73 $25.38 $14.28 $6.30 N/A $18.56 $31.73 $19.04 $31.73 $6.61 $31.73 N/A N/A 206.032 SUP HCPCS C1713 206.032 - SCREW BONE FULTHD 4MM 32MM LOCK SELF TAP LCP STAINLESS STEEL BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $33.23 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $32.68 $32.68 $32.68 $32.68 N/A N/A 206.035 SUP HCPCS C1713 206.035 - SCREW BONE 2.5MM FULTHD 4MM 35MM SELF TAP HEXAGONAL SHAFT BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $33.23 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 206.036 SUP HCPCS C1713 206.036 - SCREW BONE 2.5MM FULTHD 4MM 36MM SELF TAP HEXAGONAL SHAFT BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $13.29 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 206.04 SUP HCPCS C1713 206.040 - SCREW BONE 2.5MM FULTHD 4MM 40MM LOCKING HEXAGONAL SOCKET BOTH IP/OP $32.00 $24.00 $6.30 $33.23 $14.28 $14.28 $14.28 $14.28 $31.73 $31.73 $31.73 $6.61 $31.73 $31.73 $31.73 $31.73 $31.73 $6.61 $31.73 $33.23 $18.77 $31.73 $33.23 $31.73 $31.73 $24.00 $31.73 $31.73 $31.73 $15.87 $15.87 $25.13 $31.73 $25.38 $14.28 $6.30 N/A $18.56 $31.73 $31.73 $31.73 $6.61 $31.73 N/A N/A 206.045 SUP HCPCS C1713 206.045 - SCREW BONE FULTHD 4MM 45MM LOCKING SLFTAP LCP STAINLESS BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $33.23 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 206.05 SUP HCPCS C1713 206.050 - SCREW BONE FULTHD 4MM 6MM 50MM 15MM SMALL HEXOGONAL SOCKET BOTH IP/OP $32.00 $24.00 $6.30 $33.23 $14.28 $14.28 $14.28 $14.28 $31.73 $31.73 $31.73 $6.61 $31.73 $31.73 $31.73 $31.73 $31.73 $6.61 $31.73 $33.23 $18.77 $31.73 $33.23 $31.73 $31.73 $24.00 $31.73 $31.73 $31.73 $15.87 $15.87 $25.13 $31.73 $25.38 $14.28 $6.30 N/A $18.56 $31.73 $31.73 $31.73 $6.61 $31.73 N/A N/A 206.055 SUP HCPCS C1713 206.055 - SCREW BONE PTHRD 4MM 6MM 55MM SMALL HEXAGONAL SOCKET LCP BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $33.23 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $32.68 $32.68 $6.81 $32.68 N/A N/A 206.06 SUP HCPCS C1713 206.060 - SCREW BONE FULTHD 4MM 60MM 15MM LOCKING SLFTAP LCP STAINLESS BOTH IP/OP $32.00 $24.00 $6.30 $33.23 $14.28 $14.28 $14.28 $14.28 $31.73 $31.73 $31.73 $6.61 $31.73 $31.73 $31.73 $31.73 $31.73 $6.61 $31.73 $13.29 $18.77 $31.73 $33.23 $31.73 $31.73 $24.00 $31.73 $31.73 $31.73 $15.87 $15.87 $25.13 $31.73 $25.38 $14.28 $6.30 N/A $18.56 $31.73 $19.04 $31.73 $6.61 $31.73 N/A N/A 206.065 SUP HCPCS C1713 206.065 - SCREW BONE FULTHD 4MM 65MM LOCKING SLFTAP LCP STAINLESS BOTH IP/OP $36.00 $27.00 $7.11 $36.43 $16.12 $16.12 $16.12 $16.12 $35.83 $35.83 $35.83 $7.47 $35.83 $35.83 $35.83 $35.83 $35.83 $7.47 $35.83 $14.57 $21.19 $35.83 $36.43 $35.83 $35.83 $27.00 $35.83 $35.83 $35.83 $17.92 $17.92 $28.38 $35.83 $28.66 $16.12 $7.11 N/A $20.88 $35.83 $35.83 $35.83 $7.47 $35.83 N/A N/A 206.07 SUP HCPCS C1713 206.070 - SCREW BONE FULTHD 4MM 70MM LOCKING SLFTAP LCP STAINLESS BOTH IP/OP $35.00 $26.00 $6.91 $36.43 $15.66 $15.66 $15.66 $15.66 $34.80 $34.80 $34.80 $7.25 $34.80 $34.80 $34.80 $34.80 $34.80 $7.25 $34.80 $14.57 $20.58 $34.80 $36.43 $34.80 $34.80 $26.25 $34.80 $34.80 $34.80 $17.40 $17.40 $27.56 $34.80 $27.84 $15.66 $6.91 N/A $20.30 $34.80 $34.80 $34.80 $7.25 $34.80 N/A N/A 206.08 SUP HCPCS C1713 206.080 - SCREW BONE FULTHD 4MM 80MM LOCKING SLFTAP LCP STAINLESS BOTH IP/OP $35.00 $26.00 $6.91 $36.43 $15.66 $15.66 $15.66 $15.66 $34.80 $34.80 $34.80 $7.25 $34.80 $34.80 $34.80 $34.80 $34.80 $7.25 $34.80 $36.43 $20.58 $34.80 $36.43 $34.80 $34.80 $26.25 $34.80 $34.80 $34.80 $17.40 $17.40 $27.56 $34.80 $27.84 $15.66 $6.91 N/A $20.30 $34.80 $34.80 $34.80 $7.25 $34.80 N/A N/A 206.085 SUP HCPCS C1713 206.085 - SCREW BONE FULTHD 4MM 85MM LOCKING SLFTAP LCP STAINLESS BOTH IP/OP $36.00 $27.00 $7.11 $36.43 $16.12 $16.12 $16.12 $16.12 $35.83 $35.83 $35.83 $7.47 $35.83 $35.83 $35.83 $35.83 $35.83 $7.47 $35.83 $36.43 $21.19 $35.83 $36.43 $35.83 $35.83 $27.00 $35.83 $35.83 $35.83 $17.92 $17.92 $28.38 $35.83 $28.66 $16.12 $7.11 N/A $20.88 $35.83 $21.50 $35.83 $7.47 $35.83 N/A N/A 206.09 SUP HCPCS C1713 206.090 - SCREW BONE FULTHD 4MM 90MM LOCKING SLFTAP LCP STAINLESS BOTH IP/OP $35.00 $26.00 $6.91 $36.43 $15.66 $15.66 $15.66 $15.66 $34.80 $34.80 $34.80 $7.25 $34.80 $34.80 $34.80 $34.80 $34.80 $7.25 $34.80 $36.43 $20.58 $34.80 $36.43 $34.80 $34.80 $26.25 $34.80 $34.80 $34.80 $17.40 $17.40 $27.56 $34.80 $27.84 $15.66 $6.91 N/A $20.30 $34.80 $20.88 $34.80 $7.25 $34.80 N/A N/A 206.095 SUP HCPCS C1713 206.095 - SCREW BONE FULTHD 4MM 95MM LOCKING SLFTAP LCP STAINLESS BOTH IP/OP $36.00 $27.00 $7.11 $36.43 $16.12 $16.12 $16.12 $16.12 $35.83 $35.83 $35.83 $7.47 $35.83 $35.83 $35.83 $35.83 $35.83 $7.47 $35.83 $36.43 $21.19 $35.83 $36.43 $35.83 $35.83 $27.00 $35.83 $35.83 $35.83 $17.92 $17.92 $28.38 $35.83 $28.66 $16.12 $7.11 N/A $20.88 $35.83 $21.50 $35.83 $7.47 $35.83 N/A N/A 206.1 SUP HCPCS C1713 206.100 - SCREW BONE FULTHD 4MM 100MM LOCKING SLFTAP LCP STAINLESS BOTH IP/OP $35.00 $26.00 $6.91 $36.43 $15.66 $15.66 $15.66 $15.66 $34.80 $34.80 $34.80 $7.25 $34.80 $34.80 $34.80 $34.80 $34.80 $7.25 $34.80 $36.43 $20.58 $34.80 $36.43 $34.80 $34.80 $26.25 $34.80 $34.80 $34.80 $17.40 $17.40 $27.56 $34.80 $27.84 $15.66 $6.91 N/A $20.30 $34.80 $34.80 $34.80 $7.25 $34.80 N/A N/A 206.414 SUP HCPCS C1713 206.414 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 14MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $50.03 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $10.25 $49.20 N/A N/A 206.416 SUP HCPCS C1713 206.416 - SCREW BONE 2.5MM SMALL FULTHD HEXAGON 4MM 6MM 16MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $20.01 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $49.20 $49.20 N/A N/A 206.418 SUP HCPCS C1713 206.418 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 18MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $20.01 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $49.20 $49.20 N/A N/A 206.42 SUP HCPCS C1713 206.420 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 20MM SELF TAP BOTH IP/OP $48.00 $36.00 $9.48 $50.03 $21.50 $21.50 $21.50 $21.50 $47.78 $47.78 $47.78 $9.96 $47.78 $47.78 $47.78 $47.78 $47.78 $9.96 $47.78 $50.03 $28.26 $47.78 $50.03 $47.78 $47.78 $36.00 $47.78 $47.78 $47.78 $23.89 $23.89 $37.84 $47.78 $38.22 $21.50 $9.48 N/A $27.84 $47.78 $47.78 $47.78 $9.96 $47.78 N/A N/A 206.422 SUP HCPCS C1713 206.422 - SCREW BONE 2.5MM SMALL FULTHD HEXAGON 4MM 6MM 22MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $20.01 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $49.20 $49.20 $10.25 $49.20 N/A N/A 206.424 SUP HCPCS C1713 206.424 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 24MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $50.03 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $10.25 $49.20 N/A N/A 206.426 SUP HCPCS C1713 206.426 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 26MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $20.01 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $49.20 $49.20 N/A N/A 206.428 SUP HCPCS C1713 206.428 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 28MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $50.03 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $49.20 $49.20 N/A N/A 206.43 SUP HCPCS C1713 206.430 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 30MM SELF TAP BOTH IP/OP $48.00 $36.00 $9.48 $50.03 $21.50 $21.50 $21.50 $21.50 $47.78 $47.78 $47.78 $9.96 $47.78 $47.78 $47.78 $47.78 $47.78 $9.96 $47.78 $20.01 $28.26 $47.78 $50.03 $47.78 $47.78 $36.00 $47.78 $47.78 $47.78 $23.89 $23.89 $37.84 $47.78 $38.22 $21.50 $9.48 N/A $27.84 $47.78 $28.67 $47.78 $9.96 $47.78 N/A N/A 206.432 SUP HCPCS C1713 206.432 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 32MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $50.03 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $10.25 $49.20 N/A N/A 206.434 SUP HCPCS C1713 206.434 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 34MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $20.01 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $49.20 $49.20 $10.25 $49.20 N/A N/A 206.436 SUP HCPCS C1713 206.436 - SCREW BONE 2.5MM SMALL FULTHD HEXAGON 4MM 6MM 36MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $50.03 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $10.25 $49.20 N/A N/A 206.438 SUP HCPCS C1713 206.438 - SCREW BONE FULTHD 4MM 6MM 38MM SLFTAP HEXAGON RECESS LCP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $20.01 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $10.25 $49.20 N/A N/A 206.44 SUP HCPCS C1713 206.440 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 40MM SELF TAP BOTH IP/OP $48.00 $36.00 $9.48 $50.03 $21.50 $21.50 $21.50 $21.50 $47.78 $47.78 $47.78 $9.96 $47.78 $47.78 $47.78 $47.78 $47.78 $9.96 $47.78 $50.03 $28.26 $47.78 $50.03 $47.78 $47.78 $36.00 $47.78 $47.78 $47.78 $23.89 $23.89 $37.84 $47.78 $38.22 $21.50 $9.48 N/A $27.84 $47.78 $28.67 $47.78 $9.96 $47.78 N/A N/A 206.442 SUP HCPCS C1713 206.442 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 42MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $20.01 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $49.20 $49.20 $10.25 $49.20 N/A N/A 206.444 SUP HCPCS C1713 206.444 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 44MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $50.03 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $10.25 $49.20 N/A N/A 206.446 SUP HCPCS C1713 206.446 - SCREW BONE 2.5MM FULTHD 4MM 6MM 46MM SELF TAP SMALL BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $20.01 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $49.20 $49.20 N/A N/A 206.448 SUP HCPCS C1713 206.448 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 48MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $20.01 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $49.20 $49.20 N/A N/A 206.45 SUP HCPCS C1713 206.450 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 50MM SELF TAP BOTH IP/OP $48.00 $36.00 $9.48 $50.03 $21.50 $21.50 $21.50 $21.50 $47.78 $47.78 $47.78 $9.96 $47.78 $47.78 $47.78 $47.78 $47.78 $9.96 $47.78 $50.03 $28.26 $47.78 $50.03 $47.78 $47.78 $36.00 $47.78 $47.78 $47.78 $23.89 $23.89 $37.84 $47.78 $38.22 $21.50 $9.48 N/A $27.84 $47.78 $28.67 $47.78 $9.96 $47.78 N/A N/A 206.452 SUP HCPCS C1713 206.452 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 52MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $50.03 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $49.20 $49.20 $10.25 $49.20 N/A N/A 206.454 SUP HCPCS C1713 206.454 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 54MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $20.01 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $10.25 $49.20 N/A N/A 206.456 SUP HCPCS C1713 206.456 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 56MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $20.01 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $10.25 $49.20 N/A N/A 206.458 SUP HCPCS C1713 206.458 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 58MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $50.03 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $10.25 $49.20 N/A N/A 206.46 SUP HCPCS C1713 206.460 - SCREW BONE FULTHD 4MM 6MM 60MM SLFTAP HEXAGON RECESS LCP BOTH IP/OP $48.00 $36.00 $9.48 $50.03 $21.50 $21.50 $21.50 $21.50 $47.78 $47.78 $47.78 $9.96 $47.78 $47.78 $47.78 $47.78 $47.78 $9.96 $47.78 $20.01 $28.26 $47.78 $50.03 $47.78 $47.78 $36.00 $47.78 $47.78 $47.78 $23.89 $23.89 $37.84 $47.78 $38.22 $21.50 $9.48 N/A $27.84 $47.78 $47.78 $47.78 $9.96 $47.78 N/A N/A 206.465 SUP HCPCS C1713 206.465 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 65MM SELF TAP BOTH IP/OP $49.50 $37.00 $9.76 $50.03 $22.14 $22.14 $22.14 $22.14 $49.20 $49.20 $49.20 $10.25 $49.20 $49.20 $49.20 $49.20 $49.20 $10.25 $49.20 $50.03 $29.10 $49.20 $50.03 $49.20 $49.20 $37.13 $49.20 $49.20 $49.20 $24.60 $24.60 $38.97 $49.20 $39.36 $22.14 $9.76 N/A $28.71 $49.20 $29.52 $49.20 $10.25 $49.20 N/A N/A 206.47 SUP HCPCS C1713 206.470 - SCREW BONE FULTHD 4MM 6MM 70MM SELF TAP SMALL HEXAGONAL BOTH IP/OP $48.00 $36.00 $9.48 $50.03 $21.50 $21.50 $21.50 $21.50 $47.78 $47.78 $47.78 $9.96 $47.78 $47.78 $47.78 $47.78 $47.78 $9.96 $47.78 $20.01 $28.26 $47.78 $50.03 $47.78 $47.78 $36.00 $47.78 $47.78 $47.78 $23.89 $23.89 $37.84 $47.78 $38.22 $21.50 $9.48 N/A $27.84 $47.78 $28.67 $47.78 $9.96 $47.78 N/A N/A 206.475 SUP HCPCS C1713 206.475 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 75MM SELF TAP BOTH IP/OP $88.00 $65.00 $17.44 $89.35 $39.53 $39.53 $39.53 $39.53 $87.85 $87.85 $87.85 $18.31 $87.85 $87.85 $87.85 $87.85 $87.85 $18.31 $87.85 $89.35 $51.96 $87.85 $89.35 $87.85 $87.85 $66.00 $87.85 $87.85 $87.85 $43.93 $43.93 $69.58 $87.85 $70.28 $39.53 $17.44 N/A $51.04 $87.85 $52.71 $87.85 $18.31 $87.85 N/A N/A 206.48 SUP HCPCS C1713 206.480 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 80MM SELF TAP BOTH IP/OP $85.50 $63.00 $16.93 $89.35 $38.38 $38.38 $38.38 $38.38 $85.28 $85.28 $85.28 $17.77 $85.28 $85.28 $85.28 $85.28 $85.28 $17.77 $85.28 $35.74 $50.44 $85.28 $89.35 $85.28 $85.28 $64.13 $85.28 $85.28 $85.28 $42.64 $42.64 $67.54 $85.28 $68.22 $38.38 $16.93 N/A $49.59 $85.28 $85.28 $85.28 $17.77 $85.28 N/A N/A 206.485 SUP HCPCS C1713 206.485 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 85MM SELF TAP BOTH IP/OP $88.00 $65.00 $17.44 $89.35 $39.53 $39.53 $39.53 $39.53 $87.85 $87.85 $87.85 $18.31 $87.85 $87.85 $87.85 $87.85 $87.85 $18.31 $87.85 $89.35 $51.96 $87.85 $89.35 $87.85 $87.85 $66.00 $87.85 $87.85 $87.85 $43.93 $43.93 $69.58 $87.85 $70.28 $39.53 $17.44 N/A $51.04 $87.85 $87.85 $87.85 $18.31 $87.85 N/A N/A 206.49 SUP HCPCS C1713 206.490 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 90MM SELF TAP BOTH IP/OP $85.50 $63.00 $16.93 $89.35 $38.38 $38.38 $38.38 $38.38 $85.28 $85.28 $85.28 $17.77 $85.28 $85.28 $85.28 $85.28 $85.28 $17.77 $85.28 $35.74 $50.44 $85.28 $89.35 $85.28 $85.28 $64.13 $85.28 $85.28 $85.28 $42.64 $42.64 $67.54 $85.28 $68.22 $38.38 $16.93 N/A $49.59 $85.28 $51.17 $85.28 $17.77 $85.28 N/A N/A 206.495 SUP HCPCS C1713 206.495 - SCREW BONE 2.5MM FULTHD SMALL HEXAGON 4MM 6MM 95MM SELF TAP BOTH IP/OP $88.00 $65.00 $17.44 $89.35 $39.53 $39.53 $39.53 $39.53 $87.85 $87.85 $87.85 $18.31 $87.85 $87.85 $87.85 $87.85 $87.85 $18.31 $87.85 $89.35 $51.96 $87.85 $89.35 $87.85 $87.85 $66.00 $87.85 $87.85 $87.85 $43.93 $43.93 $69.58 $87.85 $70.28 $39.53 $17.44 N/A $51.04 $87.85 $52.71 $87.85 $18.31 $87.85 N/A N/A 206.5 SUP HCPCS C1713 206.500 - SCREW BONE 4MM 100MM SLFTAP STAINLESS STEEL CORTICAL NONSTRL BOTH IP/OP $85.50 $63.00 $16.93 $89.35 $38.38 $38.38 $38.38 $38.38 $85.28 $85.28 $85.28 $17.77 $85.28 $85.28 $85.28 $85.28 $85.28 $17.77 $85.28 $35.74 $50.44 $85.28 $89.35 $85.28 $85.28 $64.13 $85.28 $85.28 $85.28 $42.64 $42.64 $67.54 $85.28 $68.22 $38.38 $16.93 N/A $49.59 $85.28 $51.17 $85.28 $17.77 $85.28 N/A N/A 207.01 SUP HCPCS C1713 207.010 - SCREW BONE PTHRD 4MM 2.5MM 10MM 7MM SMALL HEXAGONAL SOCKET BOTH IP/OP $30.50 $23.00 $5.96 $31.45 $13.51 $13.51 $13.51 $13.51 $30.03 $30.03 $30.03 $6.26 $30.03 $30.03 $30.03 $30.03 $30.03 $6.26 $30.03 $31.45 $17.76 $30.03 $31.45 $30.03 $30.03 $22.88 $30.03 $30.03 $30.03 $15.02 $15.02 $23.78 $30.03 $24.02 $13.51 $5.96 N/A $17.69 $30.03 $30.03 $30.03 $30.03 $30.03 N/A N/A 207.012 SUP HCPCS C1713 207.012 - SCREW BONE PTHRD 4MM 2.5MM 12MM 7MM SMALL HEXAGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $31.45 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $30.93 $30.93 $6.45 $30.93 N/A N/A 207.014 SUP HCPCS C1713 207.014 - SCREW BONE PTHRD 4MM 14MM 5MM SMALL HEXAGONAL SOCKET LCP BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $31.45 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $18.56 $30.93 $6.45 $30.93 N/A N/A 207.016 SUP HCPCS C1713 207.016 - SCREW BONE PTHRD 4MM 16MM 6MM SMALL HEXAGONAL SOCKET LCP BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $31.45 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $18.56 $30.93 $6.45 $30.93 N/A N/A 207.018 SUP HCPCS C1713 207.018 - SCREW BONE PTHRD 4MM 2.5MM 18MM 7MM SMALL HEXAGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $31.45 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $18.56 $30.93 $6.45 $30.93 N/A N/A 207.02 SUP HCPCS C1713 207.020 - SCREW BONE PTHRD 4MM 20MM LCP STAINLESS STEEL CANCELLOUS RAD BOTH IP/OP $30.50 $23.00 $5.96 $31.45 $13.51 $13.51 $13.51 $13.51 $30.03 $30.03 $30.03 $6.26 $30.03 $30.03 $30.03 $30.03 $30.03 $6.26 $30.03 $12.58 $17.76 $30.03 $31.45 $30.03 $30.03 $22.88 $30.03 $30.03 $30.03 $15.02 $15.02 $23.78 $30.03 $24.02 $13.51 $5.96 N/A $17.69 $30.03 $18.02 $30.03 $6.26 $30.03 N/A N/A 207.022 SUP HCPCS C1713 207.022 - SCREW BONE PTHRD 4MM 22MM 9MM SMALL HEXAGONAL SOCKET LCP BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $12.58 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $18.56 $30.93 $6.45 $30.93 N/A N/A 207.024 SUP HCPCS C1713 207.024 - SCREW BONE PTHRD 4MM 24MM 10MM SMALL HEXAGONAL SOCKET LCP BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $12.58 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $30.93 $30.93 $6.45 $30.93 N/A N/A 207.026 SUP HCPCS C1713 207.026 - SCREW BONE PTHRD 4MM 26MM 12MM SMALL HEXAGONAL SOCKET LCP BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $31.45 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $18.56 $30.93 $6.45 $30.93 N/A N/A 207.028 SUP HCPCS C1713 207.028 - SCREW BONE PTHRD 4MM 28MM 14MM SMALL HEXAGONAL SOCKET LCP BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $31.45 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $30.93 $30.93 $6.45 $30.93 N/A N/A 207.03 SUP HCPCS C1713 207.030 - SCREW BONE PTHRD 4MM 30MM 6MM SMALL HEXAGONAL SOCKET LCP BOTH IP/OP $30.50 $23.00 $5.96 $31.45 $13.51 $13.51 $13.51 $13.51 $30.03 $30.03 $30.03 $6.26 $30.03 $30.03 $30.03 $30.03 $30.03 $6.26 $30.03 $31.45 $17.76 $30.03 $31.45 $30.03 $30.03 $22.88 $30.03 $30.03 $30.03 $15.02 $15.02 $23.78 $30.03 $24.02 $13.51 $5.96 N/A $17.69 $30.03 $18.02 $30.03 $6.26 $30.03 N/A N/A 207.035 SUP HCPCS C1713 207.035 - SCREW BONE PTHRD 4MM 35MM LCP STAINLESS STEEL CANCELLOUS RAD BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $31.45 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $18.56 $30.93 $6.45 $30.93 N/A N/A 207.04 SUP HCPCS C1713 207.040 - SCREW BONE PTHRD 4MM 40MM 14MM SMALL HEXAGONAL SOCKET LCP BOTH IP/OP $30.50 $23.00 $5.96 $31.45 $13.51 $13.51 $13.51 $13.51 $30.03 $30.03 $30.03 $6.26 $30.03 $30.03 $30.03 $30.03 $30.03 $6.26 $30.03 $31.45 $17.76 $30.03 $31.45 $30.03 $30.03 $22.88 $30.03 $30.03 $30.03 $15.02 $15.02 $23.78 $30.03 $24.02 $13.51 $5.96 N/A $17.69 $30.03 $18.02 $30.03 $6.26 $30.03 N/A N/A 207.045 SUP HCPCS C1713 207.045 - SCREW BONE PTHRD 4MM 45MM SELF TAP HEXAGONAL SHAFT LC-DCP BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $31.45 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $18.56 $30.93 $6.45 $30.93 N/A N/A 207.05 SUP HCPCS C1713 207.050 - SCREW BONE 4MM 50MM LCP SS PTHRD CANC TIB NONSTRL SM FRAG BOTH IP/OP $30.50 $23.00 $5.96 $31.45 $13.51 $13.51 $13.51 $13.51 $30.03 $30.03 $30.03 $6.26 $30.03 $30.03 $30.03 $30.03 $30.03 $6.26 $30.03 $31.45 $17.76 $30.03 $31.45 $30.03 $30.03 $22.88 $30.03 $30.03 $30.03 $15.02 $15.02 $23.78 $30.03 $24.02 $13.51 $5.96 N/A $17.69 $30.03 $30.03 $30.03 $6.26 $30.03 N/A N/A 207.055 SUP HCPCS C1713 207.055 - SCREW BONE SMALL HEXAGON 4MM 6MM 55MM 15MM SOCKET LCP BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $31.45 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $30.93 $30.93 $6.45 $30.93 N/A N/A 207.06 SUP HCPCS C1713 207.060 - SCREW BONE SMALL HEXAGON 4MM 6MM 60MM 15MM SOCKET LCP BOTH IP/OP $30.50 $23.00 $5.96 $31.45 $13.51 $13.51 $13.51 $13.51 $30.03 $30.03 $30.03 $6.26 $30.03 $30.03 $30.03 $30.03 $30.03 $6.26 $30.03 $31.45 $17.76 $30.03 $31.45 $30.03 $30.03 $22.88 $30.03 $30.03 $30.03 $15.02 $15.02 $23.78 $30.03 $24.02 $13.51 $5.96 N/A $17.69 $30.03 $18.02 $30.03 $6.26 $30.03 N/A N/A 207.065 SUP HCPCS C1713 207.065 - SCREW BONE PTHRD 4MM 65MM PTHRD LCP STAINLESS STEEL BOTH IP/OP $35.50 $26.00 $6.98 $35.75 $15.82 $15.82 $15.82 $15.82 $35.15 $35.15 $35.15 $7.33 $35.15 $35.15 $35.15 $35.15 $35.15 $7.33 $35.15 $35.75 $20.79 $35.15 $35.75 $35.15 $35.15 $26.63 $35.15 $35.15 $35.15 $17.58 $17.58 $27.84 $35.15 $28.12 $15.82 $6.98 N/A $20.59 $35.15 $21.09 $35.15 $7.33 $35.15 N/A N/A 207.07 SUP HCPCS C1713 207.070 - SCREW BONE PTHRD 4MM 70MM PTTHRD LCP STAINLESS STEEL BOTH IP/OP $34.50 $26.00 $6.77 $35.75 $15.36 $15.36 $15.36 $15.36 $34.13 $34.13 $34.13 $7.11 $34.13 $34.13 $34.13 $34.13 $34.13 $7.11 $34.13 $35.75 $20.19 $34.13 $35.75 $34.13 $34.13 $25.88 $34.13 $34.13 $34.13 $17.07 $17.07 $27.03 $34.13 $27.30 $15.36 $6.77 N/A $20.01 $34.13 $20.48 $34.13 $7.11 $34.13 N/A N/A 207.075 SUP HCPCS C1713 207.075 - SCREW BONE PTHRD 4MM 75MM PTHRD LCP STAINLESS STEEL BOTH IP/OP $35.50 $26.00 $6.98 $35.75 $15.82 $15.82 $15.82 $15.82 $35.15 $35.15 $35.15 $7.33 $35.15 $35.15 $35.15 $35.15 $35.15 $7.33 $35.15 $35.75 $20.79 $35.15 $35.75 $35.15 $35.15 $26.63 $35.15 $35.15 $35.15 $17.58 $17.58 $27.84 $35.15 $28.12 $15.82 $6.98 N/A $20.59 $35.15 $21.09 $35.15 $7.33 $35.15 N/A N/A 207.08 SUP HCPCS C1713 207.080 - SCREW BONE PTHRD 4MM 80MM PTTHRD LCP STAINLESS STEEL BOTH IP/OP $34.50 $26.00 $6.77 $35.75 $15.36 $15.36 $15.36 $15.36 $34.13 $34.13 $34.13 $7.11 $34.13 $34.13 $34.13 $34.13 $34.13 $7.11 $34.13 $14.30 $20.19 $34.13 $35.75 $34.13 $34.13 $25.88 $34.13 $34.13 $34.13 $17.07 $17.07 $27.03 $34.13 $27.30 $15.36 $6.77 N/A $20.01 $34.13 $20.48 $34.13 $7.11 $34.13 N/A N/A 207.085 SUP HCPCS C1713 207.085 - SCREW BONE 4MM 85MM PTHRD LC-DCP DCP STAINLESS STEEL BOTH IP/OP $35.50 $26.00 $6.98 $35.75 $15.82 $15.82 $15.82 $15.82 $35.15 $35.15 $35.15 $7.33 $35.15 $35.15 $35.15 $35.15 $35.15 $7.33 $35.15 $14.30 $20.79 $35.15 $35.75 $35.15 $35.15 $26.63 $35.15 $35.15 $35.15 $17.58 $17.58 $27.84 $35.15 $28.12 $15.82 $6.98 N/A $20.59 $35.15 $21.09 $35.15 $7.33 $35.15 N/A N/A 207.09 SUP HCPCS C1713 207.090 - SCREW BONE PTHRD 4MM 90MM PTTHRD LCP STAINLESS STEEL BOTH IP/OP $34.50 $26.00 $6.77 $35.75 $15.36 $15.36 $15.36 $15.36 $34.13 $34.13 $34.13 $7.11 $34.13 $34.13 $34.13 $34.13 $34.13 $7.11 $34.13 $14.30 $20.19 $34.13 $35.75 $34.13 $34.13 $25.88 $34.13 $34.13 $34.13 $17.07 $17.07 $27.03 $34.13 $27.30 $15.36 $6.77 N/A $20.01 $34.13 $20.48 $34.13 $7.11 $34.13 N/A N/A 207.095 SUP HCPCS C1713 207.095 - SCREW BONE PTHRD 4MM 95MM PTHRD LCP STAINLESS STEEL BOTH IP/OP $35.50 $26.00 $6.98 $35.75 $15.82 $15.82 $15.82 $15.82 $35.15 $35.15 $35.15 $7.33 $35.15 $35.15 $35.15 $35.15 $35.15 $7.33 $35.15 $35.75 $20.79 $35.15 $35.75 $35.15 $35.15 $26.63 $35.15 $35.15 $35.15 $17.58 $17.58 $27.84 $35.15 $28.12 $15.82 $6.98 N/A $20.59 $35.15 $21.09 $35.15 $7.33 $35.15 N/A N/A 207.1 SUP HCPCS C1713 207.100 - SCREW BONE 4MM 100MM PTTHRD LC-DCP DCP STAINLESS STEEL BOTH IP/OP $34.50 $26.00 $6.77 $35.75 $15.36 $15.36 $15.36 $15.36 $34.13 $34.13 $34.13 $7.11 $34.13 $34.13 $34.13 $34.13 $34.13 $7.11 $34.13 $35.75 $20.19 $34.13 $35.75 $34.13 $34.13 $25.88 $34.13 $34.13 $34.13 $17.07 $17.07 $27.03 $34.13 $27.30 $15.36 $6.77 N/A $20.01 $34.13 $20.48 $34.13 $7.11 $34.13 N/A N/A 207.61 SUP HCPCS C1713 207.610 - SCREW BONE SHORT THREAD 4MM 10MM CANN LCP STAINLESS STEEL BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $149.82 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $357.58 $357.58 $74.52 $357.58 N/A N/A 207.612 SUP HCPCS C1713 207.612 - SCREW BONE SHORT THREAD 4MM 12MM CANN LCP STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.614 SUP HCPCS C1713 207.614 - SCREW BONE SHORT THREAD 4MM 14MM CANN LCP STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.616 SUP HCPCS C1713 207.616 - SCREW BONE SHORT THREAD 4MM 16MM 1/3MM CANN LCP STAINLESS BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.618 SUP HCPCS C1713 207.618 - SCREW BONE SHORT THREAD 4MM 18MM CANN LCP STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.622 SUP HCPCS C1713 207.622 - SCREW BONE SHORT THREAD 4MM 22MM CANN LCP STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.624 SUP HCPCS C1713 207.624 - SCREW BONE SHORT THREAD 4MM 24MM CANN LCP STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.626 SUP HCPCS C1713 207.626 - SCREW BONE SHORT THREAD 4MM 26MM CANN LCP STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.628 SUP HCPCS C1713 207.628 - SCREW BONE SHORT THREAD 4MM 28MM CANN LCP STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.63 SUP HCPCS C1713 207.630 - SCREW BONE SHORT THREAD 4MM 30MM CANN LCP STAINLESS STEEL BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $374.55 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $214.55 $357.58 $74.52 $357.58 N/A N/A 207.632 SUP HCPCS C1713 207.632 - SCREW BONE SHORT THREAD 4MM 32MM CANN LCP STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.634 SUP HCPCS C1713 207.634 - SCREW BONE SHORT THREAD 4MM 34MM 11MM CANN LCP STAINLESS BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.636 SUP HCPCS C1713 207.636 - SCREW BONE SHORT THREAD 4MM 36MM CANN LCP STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.638 SUP HCPCS C1713 207.638 - SCREW BONE SHORT THREAD 4MM 38MM CANN LCP STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.64 SUP HCPCS C1713 207.640 - SCREW BONE SHORT THREAD 4MM 40MM CANN LCP STAINLESS STEEL BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $374.55 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $214.55 $357.58 $74.52 $357.58 N/A N/A 207.642 SUP HCPCS C1713 207.642 - SCREW BONE SHORT THREAD 4MM 42MM CANN SHORT THREAD LCP BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.644 SUP HCPCS C1713 207.644 - SCREW BONE SHORT THREAD 4MM 44MM 1/3MM CANN LCP STAINLESS BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.646 SUP HCPCS C1713 207.646 - SCREW BONE SHORT THREAD 4MM 46MM CANN LCP STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.648 SUP HCPCS C1713 207.648 - SCREW BONE SHORT THREAD 4MM 48MM CANN LCP STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.65 SUP HCPCS C1713 207.650 - SCREW BONE SHORT THREAD HEXAGON LP 4MM 5MM 50MM SELF DRILL BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $374.55 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $357.58 $357.58 $74.52 $357.58 N/A N/A 207.652 SUP HCPCS C1713 207.652 - SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.654 SUP HCPCS C1713 207.654 - SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.656 SUP HCPCS C1713 207.656 - SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.658 SUP HCPCS C1713 207.658 - SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.66 SUP HCPCS C1713 207.660 - SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $374.55 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $357.58 $357.58 $74.52 $357.58 N/A N/A 207.664 SUP HCPCS C1713 207.664 - SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.668 SUP HCPCS C1713 207.668 - SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.672 SUP HCPCS C1713 207.672 - SCREW BONE 2.5MM SHORT THREAD SMALL HEXAGON 4MM 5MM 1.35MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.716 SUP HCPCS C1713 207.716 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.718 SUP HCPCS C1713 207.718 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.72 SUP HCPCS C1713 207.720 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $374.55 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $214.55 $357.58 $74.52 $357.58 N/A N/A 207.722 SUP HCPCS C1713 207.722 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.724 SUP HCPCS C1713 207.724 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.726 SUP HCPCS C1713 207.726 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.728 SUP HCPCS C1713 207.728 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.73 SUP HCPCS C1713 207.730 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $374.55 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $214.55 $357.58 $74.52 $357.58 N/A N/A 207.732 SUP HCPCS C1713 207.732 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.734 SUP HCPCS C1713 207.734 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.736 SUP HCPCS C1713 207.736 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.738 SUP HCPCS C1713 207.738 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.74 SUP HCPCS C1713 207.740 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $374.55 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $214.55 $357.58 $74.52 $357.58 N/A N/A 207.742 SUP HCPCS C1713 207.742 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.744 SUP HCPCS C1713 207.744 - SCREW BONE LNGTHRD 4MM 5MM 44MM CANN SLFDRILL SLFTAP SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.746 SUP HCPCS C1713 207.746 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.748 SUP HCPCS C1713 207.748 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.75 SUP HCPCS C1713 207.750 - SCREW BONE LNGTHRD 4MM 5MM 50MM CANN SLFDRILL SLFTAP SMALL BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $374.55 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $214.55 $357.58 $74.52 $357.58 N/A N/A 207.752 SUP HCPCS C1713 207.752 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.754 SUP HCPCS C1713 207.754 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.756 SUP HCPCS C1713 207.756 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.758 SUP HCPCS C1713 207.758 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.76 SUP HCPCS C1713 207.760 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $374.55 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $214.55 $357.58 $74.52 $357.58 N/A N/A 207.764 SUP HCPCS C1713 207.764 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.768 SUP HCPCS C1713 207.768 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 207.772 SUP HCPCS C1713 207.772 - SCREW BONE .5 THREAD SMALL HEXAGON REVERSE CUT FLUTE 4MM 5MM BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 207.916 SUP HCPCS C1713 207.916 - SCREW BONE 5MM 4MM 6MM 16MM 8MM DCP LC-DCP STAINLESS STEEL BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $37.18 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $21.93 $36.55 $7.62 $36.55 N/A N/A 207.918 SUP HCPCS C1713 207.918 - SCREW BONE 5MM 4MM 6MM 18MM 8MM DCP LC-DCP STAINLESS STEEL BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $14.87 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $36.55 $36.55 $7.62 $36.55 N/A N/A 207.92 SUP HCPCS C1713 207.920 - SCREW BONE 5MM 4MM 6MM 20MM 10MM DCP LC-DCP STAINLESS STEEL BOTH IP/OP $35.50 $26.00 $7.04 $37.18 $15.97 $15.97 $15.97 $15.97 $35.48 $35.48 $35.48 $7.39 $35.48 $35.48 $35.48 $35.48 $35.48 $7.39 $35.48 $14.87 $20.99 $35.48 $37.18 $35.48 $35.48 $26.63 $35.48 $35.48 $35.48 $17.74 $17.74 $28.10 $35.48 $28.38 $15.97 $7.04 N/A $20.59 $35.48 $21.29 $35.48 $7.39 $35.48 N/A N/A 207.922 SUP HCPCS C1713 207.922 - SCREW BONE 5MM 4MM 6MM 22MM 10MM DCP LC-DCP STAINLESS STEEL BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $14.87 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $21.93 $36.55 $7.62 $36.55 N/A N/A 207.924 SUP HCPCS C1713 207.924 - SCREW BONE 5MM 4MM 6MM 24MM 10MM DCP LC-DCP STAINLESS STEEL BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $14.87 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $21.93 $36.55 $7.62 $36.55 N/A N/A 207.926 SUP HCPCS C1713 207.926 - SCREW BONE 5MM 4MM 6MM 26MM 12MM DCP LC-DCP STAINLESS STEEL BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $14.87 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $21.93 $36.55 $7.62 $36.55 N/A N/A 207.928 SUP HCPCS C1713 207.928 - SCREW BONE 5MM 4MM 6MM 28MM 12MM DCP LC-DCP STAINLESS STEEL BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $14.87 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $21.93 $36.55 $7.62 $36.55 N/A N/A 207.93 SUP HCPCS C1713 207.930 - SCREW BONE 5MM 4MM 6MM 30MM 12MM DCP LC-DCP STAINLESS STEEL BOTH IP/OP $35.50 $26.00 $7.04 $37.18 $15.97 $15.97 $15.97 $15.97 $35.48 $35.48 $35.48 $7.39 $35.48 $35.48 $35.48 $35.48 $35.48 $7.39 $35.48 $14.87 $20.99 $35.48 $37.18 $35.48 $35.48 $26.63 $35.48 $35.48 $35.48 $17.74 $17.74 $28.10 $35.48 $28.38 $15.97 $7.04 N/A $20.59 $35.48 $21.29 $35.48 $7.39 $35.48 N/A N/A 207.932 SUP HCPCS C1713 207.932 - SCREW BONE 5MM 4MM 6MM 32MM 14MM DCP LC-DCP STAINLESS STEEL BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $14.87 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $21.93 $36.55 $7.62 $36.55 N/A N/A 207.934 SUP HCPCS C1713 207.934 - SCREW BONE 5MM 4MM 6MM 34MM 14MM DCP LC-DCP STAINLESS STEEL BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $14.87 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $21.93 $36.55 $7.62 $36.55 N/A N/A 207.936 SUP HCPCS C1713 207.936 - SCREW BONE 5MM 4MM 6MM 36MM 14MM DCP LC-DCP STAINLESS STEEL BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $14.87 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $21.93 $36.55 $7.62 $36.55 N/A N/A 207.938 SUP HCPCS C1713 207.938 - SCREW BONE 5MM HEAD 4MM 38MM PTHRD LC-DCP DCP STAINLESS BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $37.18 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $21.93 $36.55 $7.62 $36.55 N/A N/A 207.94 SUP HCPCS C1713 207.940 - SCREW BONE 5MM HEAD 4MM 40MM PTHRD LC-DCP STAINLESS STEEL BOTH IP/OP $35.50 $26.00 $7.04 $37.18 $15.97 $15.97 $15.97 $15.97 $35.48 $35.48 $35.48 $7.39 $35.48 $35.48 $35.48 $35.48 $35.48 $7.39 $35.48 $37.18 $20.99 $35.48 $37.18 $35.48 $35.48 $26.63 $35.48 $35.48 $35.48 $17.74 $17.74 $28.10 $35.48 $28.38 $15.97 $7.04 N/A $20.59 $35.48 $21.29 $35.48 $7.39 $35.48 N/A N/A 207.942 SUP HCPCS C1713 207.942 - SCREW BONE 5MM HEAD 4MM 42MM PTHRD LC-DCP DCP STAINLESS BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $37.18 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $21.93 $36.55 $7.62 $36.55 N/A N/A 207.944 SUP HCPCS C1713 207.944 - SCREW BONE 5MM HEAD 4MM 44MM PTHRD LC-DCP DCP STAINLESS BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $37.18 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $21.93 $36.55 $7.62 $36.55 N/A N/A 207.946 SUP HCPCS C1713 207.946 - SCREW BONE 5MM HEAD 4MM 46MM PTHRD LC-DCP STAINLESS STEEL BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $14.87 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $21.93 $36.55 $7.62 $36.55 N/A N/A 207.948 SUP HCPCS C1713 207.948 - SCREW BONE 5MM HEAD 4MM 48MM PTHRD LC-DCP DCP STAINLESS BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $14.87 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $36.55 $36.55 $7.62 $36.55 N/A N/A 207.95 SUP HCPCS C1713 207.950 - SCREW BONE 5MM HEAD 4MM 50MM PTHRD LC-DCP STAINLESS STEEL BOTH IP/OP $35.50 $26.00 $7.04 $37.18 $15.97 $15.97 $15.97 $15.97 $35.48 $35.48 $35.48 $7.39 $35.48 $35.48 $35.48 $35.48 $35.48 $7.39 $35.48 $14.87 $20.99 $35.48 $37.18 $35.48 $35.48 $26.63 $35.48 $35.48 $35.48 $17.74 $17.74 $28.10 $35.48 $28.38 $15.97 $7.04 N/A $20.59 $35.48 $21.29 $35.48 $7.39 $35.48 N/A N/A 207.952 SUP HCPCS C1713 207.952 - SCREW BONE 5MM HEAD 4MM 52MM PTHRD LC-DCP DCP STAINLESS BOTH IP/OP $37.00 $27.00 $7.25 $37.18 $16.45 $16.45 $16.45 $16.45 $36.55 $36.55 $36.55 $7.62 $36.55 $36.55 $36.55 $36.55 $36.55 $7.62 $36.55 $37.18 $21.62 $36.55 $37.18 $36.55 $36.55 $27.75 $36.55 $36.55 $36.55 $18.28 $18.28 $28.95 $36.55 $29.24 $16.45 $7.25 N/A $21.46 $36.55 $21.93 $36.55 $7.62 $36.55 N/A N/A 208.03 SUP HCPCS C1713 208.030 - SCREW BONE 7MM 8MM 30MM 16MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $201.85 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $289.05 $481.75 $100.40 $481.75 N/A N/A 208.035 SUP HCPCS C1713 208.035 - SCREW BONE 7MM 8MM 35MM 16MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $504.63 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $297.72 $496.20 $103.41 $496.20 N/A N/A 208.04 SUP HCPCS C1713 208.040 - SCREW BONE 7MM 8MM 40MM 16MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $201.85 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $289.05 $481.75 $100.40 $481.75 N/A N/A 208.045 SUP HCPCS C1713 208.045 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8 BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $504.63 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $496.20 $496.20 $103.41 $496.20 N/A N/A 208.05 SUP HCPCS C1713 208.050 - SCREW BONE 7MM 8MM 50MM 16MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $201.85 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $289.05 $481.75 $100.40 $481.75 N/A N/A 208.055 SUP HCPCS C1713 208.055 - SCREW BONE 7MM 8MM 55MM 16MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $504.63 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $297.72 $496.20 $103.41 $496.20 N/A N/A 208.06 SUP HCPCS C1713 208.060 - SCREW BONE 7MM 8MM 60MM 16MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $201.85 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $289.05 $481.75 $100.40 $481.75 N/A N/A 208.065 SUP HCPCS C1713 208.065 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8 BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $504.63 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $297.72 $496.20 $103.41 $496.20 N/A N/A 208.07 SUP HCPCS C1713 208.070 - SCREW BONE 7MM 8MM 70MM 16MM CANN LARGE HEXAGONAL SOCKET BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $201.85 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $289.05 $481.75 $100.40 $481.75 N/A N/A 208.075 SUP HCPCS C1713 208.075 - SCREW BONE 7MM 8MM 75MM 16MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $504.63 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $496.20 $496.20 $103.41 $496.20 N/A N/A 208.08 SUP HCPCS C1713 208.080 - SCREW BONE 3.5MM 7MM 8MM 80MM 16MM CANN LARGE HEXAGONAL BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $504.63 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $481.75 $481.75 $100.40 $481.75 N/A N/A 208.085 SUP HCPCS C1713 208.085 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8 BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $504.63 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $297.72 $496.20 $103.41 $496.20 N/A N/A 208.09 SUP HCPCS C1713 208.090 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8 BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $504.63 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $289.05 $481.75 $100.40 $481.75 N/A N/A 208.095 SUP HCPCS C1713 208.095 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8 BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $201.85 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $297.72 $496.20 $103.41 $496.20 N/A N/A 208.1 SUP HCPCS C1713 208.100 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8 BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $504.63 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $481.75 $481.75 $100.40 $481.75 N/A N/A 208.105 SUP HCPCS C1713 208.105 - SCREW BONE 7MM 8MM 105MM 16MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $201.85 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $496.20 $496.20 $103.41 $496.20 N/A N/A 208.11 SUP HCPCS C1713 208.110 - SCREW BONE 7MM 8MM 110MM 16MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $504.63 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $481.75 $481.75 $100.40 $481.75 N/A N/A 208.115 SUP HCPCS C1713 208.115 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8 BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $504.63 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $496.20 $496.20 $103.41 $496.20 N/A N/A 208.12 SUP HCPCS C1713 208.120 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8 BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $504.63 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $289.05 $481.75 $100.40 $481.75 N/A N/A 208.125 SUP HCPCS C1713 208.125 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8 BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $504.63 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $297.72 $496.20 $103.41 $496.20 N/A N/A 208.13 SUP HCPCS C1713 208.130 - SCREW BONE 7MM 8MM 130MM 16MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $504.63 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $289.05 $481.75 $100.40 $481.75 N/A N/A 208.135 SUP HCPCS C1713 208.135 - SCREW BONE 7MM 135MM 16MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $520.38 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $307.01 $511.68 $106.63 $511.68 N/A N/A 208.14 SUP HCPCS C1713 208.140 - SCREW BONE 7MM 140MM 16MM THREADED CANN STAINLESS STEEL BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $520.38 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $298.07 $496.78 $103.53 $496.78 N/A N/A 208.145 SUP HCPCS C1713 208.145 - SCREW BONE 7MM 145MM 16MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $520.38 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $511.68 $511.68 $106.63 $511.68 N/A N/A 208.15 SUP HCPCS C1713 208.150 - SCREW BONE 7MM 150MM 16MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $520.38 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $496.78 $496.78 $103.53 $496.78 N/A N/A 208.401 SUP HCPCS C1713 208.401 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 30 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.402 SUP HCPCS C1713 208.402 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 35 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.403 SUP HCPCS C1713 208.403 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 40 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.404 SUP HCPCS C1713 208.404 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 45 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.405 SUP HCPCS C1713 208.405 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 50 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.406 SUP HCPCS C1713 208.406 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 55 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.407 SUP HCPCS C1713 208.407 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 60 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.408 SUP HCPCS C1713 208.408 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 65 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.409 SUP HCPCS C1713 208.409 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 70 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.41 SUP HCPCS C1713 208.410 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 75 BOTH IP/OP $472.50 $350.00 $93.72 $494.65 $212.49 $212.49 $212.49 $212.49 $472.20 $472.20 $472.20 $98.42 $472.20 $472.20 $472.20 $472.20 $472.20 $98.41 $472.20 $494.65 $279.31 $472.20 $494.65 $472.20 $472.20 $354.38 $472.20 $472.20 $472.20 $236.10 $236.10 $373.98 $472.20 $377.76 $212.49 $93.72 N/A $274.05 $472.20 $283.32 $472.20 $98.41 $472.20 N/A N/A 208.411 SUP HCPCS C1713 208.411 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 80 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.412 SUP HCPCS C1713 208.412 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 85 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.413 SUP HCPCS C1713 208.413 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 90 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.414 SUP HCPCS C1713 208.414 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 95 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.415 SUP HCPCS C1713 208.415 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.416 SUP HCPCS C1713 208.416 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.417 SUP HCPCS C1713 208.417 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.418 SUP HCPCS C1713 208.418 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.419 SUP HCPCS C1713 208.419 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.42 SUP HCPCS C1713 208.420 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $472.50 $350.00 $93.72 $494.65 $212.49 $212.49 $212.49 $212.49 $472.20 $472.20 $472.20 $98.42 $472.20 $472.20 $472.20 $472.20 $472.20 $98.41 $472.20 $197.86 $279.31 $472.20 $494.65 $472.20 $472.20 $354.38 $472.20 $472.20 $472.20 $236.10 $236.10 $373.98 $472.20 $377.76 $212.49 $93.72 N/A $274.05 $472.20 $283.32 $472.20 $472.20 $472.20 N/A N/A 208.421 SUP HCPCS C1713 208.421 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.422 SUP HCPCS C1713 208.422 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.423 SUP HCPCS C1713 208.423 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.424 SUP HCPCS C1713 208.424 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.425 SUP HCPCS C1713 208.425 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.426 SUP HCPCS C1713 208.426 - SCREW BONE 6.5MM 160MM 16MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.427 SUP HCPCS C1713 208.427 - SCREW BONE 6.5MM 170MM 16MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.428 SUP HCPCS C1713 208.428 - SCREW BONE 6.5MM 180MM 16MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.431 SUP HCPCS C1713 208.431 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 45 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.432 SUP HCPCS C1713 208.432 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 50 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.433 SUP HCPCS C1713 208.433 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 55 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.434 SUP HCPCS C1713 208.434 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 60 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.435 SUP HCPCS C1713 208.435 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 65 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.436 SUP HCPCS C1713 208.436 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 70 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.437 SUP HCPCS C1713 208.437 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 75 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.438 SUP HCPCS C1713 208.438 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 80 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.439 SUP HCPCS C1713 208.439 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 85 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.44 SUP HCPCS C1713 208.440 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 90 BOTH IP/OP $472.50 $350.00 $93.72 $494.65 $212.49 $212.49 $212.49 $212.49 $472.20 $472.20 $472.20 $98.42 $472.20 $472.20 $472.20 $472.20 $472.20 $98.41 $472.20 $494.65 $279.31 $472.20 $494.65 $472.20 $472.20 $354.38 $472.20 $472.20 $472.20 $236.10 $236.10 $373.98 $472.20 $377.76 $212.49 $93.72 N/A $274.05 $472.20 $472.20 $472.20 $98.41 $472.20 N/A N/A 208.441 SUP HCPCS C1713 208.441 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM 95 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.442 SUP HCPCS C1713 208.442 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.443 SUP HCPCS C1713 208.443 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.444 SUP HCPCS C1713 208.444 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.445 SUP HCPCS C1713 208.445 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.446 SUP HCPCS C1713 208.446 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.447 SUP HCPCS C1713 208.447 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.448 SUP HCPCS C1713 208.448 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.449 SUP HCPCS C1713 208.449 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.45 SUP HCPCS C1713 208.450 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $472.50 $350.00 $93.72 $494.65 $212.49 $212.49 $212.49 $212.49 $472.20 $472.20 $472.20 $98.42 $472.20 $472.20 $472.20 $472.20 $472.20 $98.41 $472.20 $494.65 $279.31 $472.20 $494.65 $472.20 $472.20 $354.38 $472.20 $472.20 $472.20 $236.10 $236.10 $373.98 $472.20 $377.76 $212.49 $93.72 N/A $274.05 $472.20 $472.20 $472.20 $98.41 $472.20 N/A N/A 208.451 SUP HCPCS C1713 208.451 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.452 SUP HCPCS C1713 208.452 - SCREW BONE HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM 2.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.453 SUP HCPCS C1713 208.453 - SCREW BONE 6.5MM 160MM 32MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.454 SUP HCPCS C1713 208.454 - SCREW BONE 6.5MM 170MM 32MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.455 SUP HCPCS C1713 208.455 - SCREW BONE 6.5MM 180MM 32MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.46 SUP HCPCS C1713 208.460 - SCREW BONE FULTHD HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM BOTH IP/OP $472.50 $350.00 $93.72 $494.65 $212.49 $212.49 $212.49 $212.49 $472.20 $472.20 $472.20 $98.42 $472.20 $472.20 $472.20 $472.20 $472.20 $98.41 $472.20 $197.86 $279.31 $472.20 $494.65 $472.20 $472.20 $354.38 $472.20 $472.20 $472.20 $236.10 $236.10 $373.98 $472.20 $377.76 $212.49 $93.72 N/A $274.05 $472.20 $283.32 $472.20 $98.41 $472.20 N/A N/A 208.461 SUP HCPCS C1713 208.461 - SCREW BONE FULTHD HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.462 SUP HCPCS C1713 208.462 - SCREW BONE FULTHD HEMISPHERE REVERSE CUT FLUTE 6.5MM 7.9MM BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.463 SUP HCPCS C1713 208.463 - SCREW BONE 6.5MM 35MM FULTHRD STAINLESS STEEL CANN NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.464 SUP HCPCS C1713 208.464 - SCREW BONE 6.5MM 40MM FULTHRD STAINLESS STEEL CANN NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.465 SUP HCPCS C1713 208.465 - SCREW BONE FULTHD 6.5MM 45MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.466 SUP HCPCS C1713 208.466 - SCREW BONE FULTHD 6.5MM 50MM CANN STAINLESS STEEL FEMUR BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.467 SUP HCPCS C1713 208.467 - SCREW BONE FULTHD 6.5MM 55MM CANN STAINLESS STEEL FEMUR BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.468 SUP HCPCS C1713 208.468 - SCREW BONE FULTHD 6.5MM 60MM CANN STAINLESS STEEL FEMUR BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.469 SUP HCPCS C1713 208.469 - SCREW BONE FULTHD 6.5MM 65MM CANN STAINLESS STEEL FEMUR BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 208.47 SUP HCPCS C1713 208.470 - SCREW BONE FULTHD 6.5MM 70MM CANN STAINLESS STEEL FEMUR BOTH IP/OP $472.50 $350.00 $93.72 $494.65 $212.49 $212.49 $212.49 $212.49 $472.20 $472.20 $472.20 $98.42 $472.20 $472.20 $472.20 $472.20 $472.20 $98.41 $472.20 $197.86 $279.31 $472.20 $494.65 $472.20 $472.20 $354.38 $472.20 $472.20 $472.20 $236.10 $236.10 $373.98 $472.20 $377.76 $212.49 $93.72 N/A $274.05 $472.20 $283.32 $472.20 $98.41 $472.20 N/A N/A 208.471 SUP HCPCS C1713 208.471 - SCREW BONE FULTHD 6.5MM 75MM CANN STAINLESS STEEL FEMUR BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.472 SUP HCPCS C1713 208.472 - SCREW BONE FULTHD 6.5MM 80MM CANN STAINLESS STEEL FEMUR BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.473 SUP HCPCS C1713 208.473 - SCREW BONE FULTHD 6.5MM 85MM CANN STAINLESS STEEL FEMUR BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.474 SUP HCPCS C1713 208.474 - SCREW BONE FULTHD 6.5MM 90MM CANN STAINLESS STEEL FEMUR BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.475 SUP HCPCS C1713 208.475 - SCREW BONE FULTHD 6.5MM 95MM CANN STAINLESS STEEL FEMUR BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.476 SUP HCPCS C1713 208.476 - SCREW BONE FULTHD 6.5MM 100MM CANN STAINLESS STEEL FEMUR BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.477 SUP HCPCS C1713 208.477 - SCREW BONE FULTHD 6.5MM 105MM CANN FULTHRD STAINLESS STEEL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.478 SUP HCPCS C1713 208.478 - SCREW BONE FULTHD 6.5MM 110MM CANN FULTHRD STAINLESS STEEL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.479 SUP HCPCS C1713 208.479 - SCREW BONE 6.5MM 115MM CANN FULTHRD STAINLESS STEEL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.48 SUP HCPCS C1713 208.480 - SCREW BONE 6.5MM 120MM FULTHRD STAINLESS STEEL CANN NONSTRL BOTH IP/OP $472.50 $350.00 $93.72 $494.65 $212.49 $212.49 $212.49 $212.49 $472.20 $472.20 $472.20 $98.42 $472.20 $472.20 $472.20 $472.20 $472.20 $98.41 $472.20 $197.86 $279.31 $472.20 $494.65 $472.20 $472.20 $354.38 $472.20 $472.20 $472.20 $236.10 $236.10 $373.98 $472.20 $377.76 $212.49 $93.72 N/A $274.05 $472.20 $472.20 $472.20 $98.41 $472.20 N/A N/A 208.481 SUP HCPCS C1713 208.481 - SCREW BONE 6.5MM 125MM CANN FULTHRD STAINLESS STEEL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 208.482 SUP HCPCS C1713 208.482 - SCREW BONE 6.5MM 130MM CANN FULTHRD STAINLESS STEEL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $486.38 $486.38 N/A N/A 208.483 SUP HCPCS C1713 208.483 - SCREW BONE FULTHD 6.5MM 140MM CANN STAINLESS STEEL BOTH IP/OP $502.00 $371.00 $99.60 $510.35 $225.82 $225.82 $225.82 $225.82 $501.83 $501.83 $501.83 $104.59 $501.83 $501.83 $501.83 $501.83 $501.83 $104.59 $501.83 $204.14 $296.83 $501.83 $510.35 $501.83 $501.83 $376.50 $501.83 $501.83 $501.83 $250.92 $250.92 $397.45 $501.83 $401.46 $225.82 $99.60 N/A $291.16 $501.83 $501.83 $501.83 $501.83 $501.83 N/A N/A 208.484 SUP HCPCS C1713 208.484 - SCREW BONE FULTHD 6.5MM 150MM CANN STAINLESS STEEL BOTH IP/OP $502.00 $371.00 $99.60 $510.35 $225.82 $225.82 $225.82 $225.82 $501.83 $501.83 $501.83 $104.59 $501.83 $501.83 $501.83 $501.83 $501.83 $104.59 $501.83 $204.14 $296.83 $501.83 $510.35 $501.83 $501.83 $376.50 $501.83 $501.83 $501.83 $250.92 $250.92 $397.45 $501.83 $401.46 $225.82 $99.60 N/A $291.16 $501.83 $501.83 $501.83 $104.58 $501.83 N/A N/A 208.485 SUP HCPCS C1713 208.485 - SCREW BONE FULTHD 6.5MM 160MM CANN STAINLESS STEEL BOTH IP/OP $502.00 $371.00 $99.60 $510.35 $225.82 $225.82 $225.82 $225.82 $501.83 $501.83 $501.83 $104.59 $501.83 $501.83 $501.83 $501.83 $501.83 $104.59 $501.83 $204.14 $296.83 $501.83 $510.35 $501.83 $501.83 $376.50 $501.83 $501.83 $501.83 $250.92 $250.92 $397.45 $501.83 $401.46 $225.82 $99.60 N/A $291.16 $501.83 $501.83 $501.83 $104.58 $501.83 N/A N/A 208.486 SUP HCPCS C1713 208.486 - SCREW BONE FULTHD 6.5MM 170MM CANN STAINLESS STEEL BOTH IP/OP $502.00 $371.00 $99.60 $510.35 $225.82 $225.82 $225.82 $225.82 $501.83 $501.83 $501.83 $104.59 $501.83 $501.83 $501.83 $501.83 $501.83 $104.59 $501.83 $510.35 $296.83 $501.83 $510.35 $501.83 $501.83 $376.50 $501.83 $501.83 $501.83 $250.92 $250.92 $397.45 $501.83 $401.46 $225.82 $99.60 N/A $291.16 $501.83 $501.83 $501.83 $104.58 $501.83 N/A N/A 208.487 SUP HCPCS C1713 208.487 - SCREW BONE 6.5MM 180MM CANN FULTHD STAINLESS STEEL BOTH IP/OP $502.00 $371.00 $99.60 $510.35 $225.82 $225.82 $225.82 $225.82 $501.83 $501.83 $501.83 $104.59 $501.83 $501.83 $501.83 $501.83 $501.83 $104.59 $501.83 $204.14 $296.83 $501.83 $510.35 $501.83 $501.83 $376.50 $501.83 $501.83 $501.83 $250.92 $250.92 $397.45 $501.83 $401.46 $225.82 $99.60 N/A $291.16 $501.83 $501.83 $501.83 $104.58 $501.83 N/A N/A 208.83 SUP HCPCS C1713 208.830 - SCREW BONE PTHRD 7.3MM 30MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 208.835 SUP HCPCS C1713 208.835 - SCREW BONE PTHRD 7.3MM 35MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 208.84 SUP HCPCS C1713 208.840 - SCREW BONE 7.3MM 40MM 16MM CANN STAINLESS STEEL FEMUR BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 208.845 SUP HCPCS C1713 208.845 - SCREW BONE PTHRD 7.3MM 45MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 208.85 SUP HCPCS C1713 208.850 - SCREW BONE 7.3MM 50MM 16MM CANN STAINLESS STEEL CANCELLOUS BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 208.855 SUP HCPCS C1713 208.855 - SCREW BONE PTHRD 7.3MM 55MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 208.86 SUP HCPCS C1713 208.860 - SCREW BONE PTHRD 7.3MM 60MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 208.865 SUP HCPCS C1713 208.865 - SCREW BONE PTHRD 7.3MM 65MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 208.87 SUP HCPCS C1713 208.870 - SCREW BONE PTHRD 7.3MM 70MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 208.875 SUP HCPCS C1713 208.875 - SCREW BONE PTHRD 7.3MM 75MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 208.88 SUP HCPCS C1713 208.880 - SCREW BONE PTHRD 7.3MM 80MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 208.885 SUP HCPCS C1713 208.885 - SCREW BONE PTHRD 7.3MM 85MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 208.89 SUP HCPCS C1713 208.890 - SCREW BONE 7.3MM 90MM 16MM CANN STAINLESS STEEL CANN NONSTRL BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 208.895 SUP HCPCS C1713 208.895 - SCREW BONE PTHRD 7.3MM 95MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 208.9 SUP HCPCS C1713 208.900 - SCREW BONE PTHRD 7.3MM 100MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 208.905 SUP HCPCS C1713 208.905 - SCREW BONE PTHRD 7.3MM 105MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 208.91 SUP HCPCS C1713 208.910 - SCREW BONE PTHRD 7.3MM 110MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 208.915 SUP HCPCS C1713 208.915 - SCREW BONE PTHRD 7.3MM 115MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 208.92 SUP HCPCS C1713 208.920 - SCREW BONE PTHRD 7.3MM 120MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 208.925 SUP HCPCS C1713 208.925 - SCREW BONE PTHRD 7.3MM 125MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 208.93 SUP HCPCS C1713 208.930 - SCREW BONE PTHRD 7.3MM 130MM 16MM CANN SLFDRILL SLFTAP BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 208.935 SUP HCPCS C1713 208.935 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 208.94 SUP HCPCS C1713 208.940 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 208.945 SUP HCPCS C1713 208.945 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 208.95 SUP HCPCS C1713 208.950 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 208.955 SUP HCPCS C1713 208.955 - SCREW BONE 7.3MM 8.2MM 155MM 16X4MM CANNULARED SLFDRILL BOTH IP/OP $500.50 $370.00 $99.32 $508.93 $225.19 $225.19 $225.19 $225.19 $500.43 $500.43 $500.43 $104.30 $500.43 $500.43 $500.43 $500.43 $500.43 $104.30 $500.43 $203.57 $296.00 $500.43 $508.93 $500.43 $500.43 $375.38 $500.43 $500.43 $500.43 $250.22 $250.22 $396.34 $500.43 $400.34 $225.19 $99.32 N/A $290.29 $500.43 $500.43 $500.43 $104.29 $500.43 N/A N/A 208.96 SUP HCPCS C1713 208.960 - SCREW BONE 7.3MM 8.2MM 160MM 16X4MM CANNULARED SLFDRILL BOTH IP/OP $486.00 $360.00 $96.43 $508.93 $218.63 $218.63 $218.63 $218.63 $485.85 $485.85 $485.85 $101.26 $485.85 $485.85 $485.85 $485.85 $485.85 $101.26 $485.85 $203.57 $287.38 $485.85 $508.93 $485.85 $485.85 $364.50 $485.85 $485.85 $485.85 $242.93 $242.93 $384.79 $485.85 $388.68 $218.63 $96.43 N/A $281.88 $485.85 $485.85 $485.85 $101.25 $485.85 N/A N/A 208.965 SUP HCPCS C1713 208.965 - SCREW BONE 7.3MM 8.2MM 165MM 16X4MM CANNULARED SLFDRILL BOTH IP/OP $500.50 $370.00 $99.32 $508.93 $225.19 $225.19 $225.19 $225.19 $500.43 $500.43 $500.43 $104.30 $500.43 $500.43 $500.43 $500.43 $500.43 $104.30 $500.43 $203.57 $296.00 $500.43 $508.93 $500.43 $500.43 $375.38 $500.43 $500.43 $500.43 $250.22 $250.22 $396.34 $500.43 $400.34 $225.19 $99.32 N/A $290.29 $500.43 $500.43 $500.43 $104.29 $500.43 N/A N/A 208.97 SUP HCPCS C1713 208.970 - SCREW BONE 7.3MM 8.2MM 170MM 16X4MM CANNULARED SLFDRILL BOTH IP/OP $486.00 $360.00 $96.43 $508.93 $218.63 $218.63 $218.63 $218.63 $485.85 $485.85 $485.85 $101.26 $485.85 $485.85 $485.85 $485.85 $485.85 $101.26 $485.85 $508.93 $287.38 $485.85 $508.93 $485.85 $485.85 $364.50 $485.85 $485.85 $485.85 $242.93 $242.93 $384.79 $485.85 $388.68 $218.63 $96.43 N/A $281.88 $485.85 $485.85 $485.85 $101.25 $485.85 N/A N/A 208.975 SUP HCPCS C1713 208.975 - SCREW BONE 7.3MM 8.2MM 75MM 16X4MM L THREAD SLFDRILL SLFTAP BOTH IP/OP $500.50 $370.00 $99.32 $508.93 $225.19 $225.19 $225.19 $225.19 $500.43 $500.43 $500.43 $104.30 $500.43 $500.43 $500.43 $500.43 $500.43 $104.30 $500.43 $508.93 $296.00 $500.43 $508.93 $500.43 $500.43 $375.38 $500.43 $500.43 $500.43 $250.22 $250.22 $396.34 $500.43 $400.34 $225.19 $99.32 N/A $290.29 $500.43 $500.43 $500.43 $104.29 $500.43 N/A N/A 208.98 SUP HCPCS C1713 208.980 - SCREW BONE 7.3MM 8.2MM 80MM 16X4MM L THREAD SLFDRILL SLFTAP BOTH IP/OP $486.00 $360.00 $96.43 $508.93 $218.63 $218.63 $218.63 $218.63 $485.85 $485.85 $485.85 $101.26 $485.85 $485.85 $485.85 $485.85 $485.85 $101.26 $485.85 $203.57 $287.38 $485.85 $508.93 $485.85 $485.85 $364.50 $485.85 $485.85 $485.85 $242.93 $242.93 $384.79 $485.85 $388.68 $218.63 $96.43 N/A $281.88 $485.85 $485.85 $485.85 $101.25 $485.85 N/A N/A 209.045 SUP HCPCS C1713 209.045 - SCREW BONE 7MM 8MM 45MM 32MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $504.63 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $297.72 $496.20 $103.41 $496.20 N/A N/A 209.05 SUP HCPCS C1713 209.050 - SCREW BONE 7MM 8MM 50MM 32MM CANN LARGE HEXOGONAL SOCKET BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $201.85 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $289.05 $481.75 $100.40 $481.75 N/A N/A 209.055 SUP HCPCS C1713 209.055 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8 BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $504.63 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $496.20 $496.20 $103.41 $496.20 N/A N/A 209.06 SUP HCPCS C1713 209.060 - SCREW BONE REVERSE CUT FLUTE 7MM 8MM 60MM 32MM CANN LARGE BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $504.63 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $481.75 $481.75 $100.40 $481.75 N/A N/A 209.065 SUP HCPCS C1713 209.065 - SCREW BONE 7MM 8MM 65MM 32MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $201.85 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $496.20 $496.20 $103.41 $496.20 N/A N/A 209.07 SUP HCPCS C1713 209.070 - SCREW BONE 7MM 8MM 70MM 32MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $201.85 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $289.05 $481.75 $100.40 $481.75 N/A N/A 209.075 SUP HCPCS C1713 209.075 - SCREW BONE 7MM 8MM 75MM 32MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $201.85 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $297.72 $496.20 $103.41 $496.20 N/A N/A 209.08 SUP HCPCS C1713 209.080 - SCREW BONE LARGE 7MM 8MM 80MM 32MM CANN THREADED LARGE BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $201.85 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $481.75 $481.75 $100.40 $481.75 N/A N/A 209.085 SUP HCPCS C1713 209.085 - SCREW BONE 7MM 8MM 85MM 32MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $201.85 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $496.20 $496.20 $103.41 $496.20 N/A N/A 209.09 SUP HCPCS C1713 209.090 - SCREW BONE 7MM 8MM 90MM 32MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $504.63 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $481.75 $481.75 $100.40 $481.75 N/A N/A 209.095 SUP HCPCS C1713 209.095 - SCREW BONE 7MM 8MM 95MM 32MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $201.85 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $496.20 $496.20 $103.41 $496.20 N/A N/A 209.1 SUP HCPCS C1713 209.100 - SCREW BONE 7MM 8MM 100MM 32MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $201.85 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $289.05 $481.75 $100.40 $481.75 N/A N/A 209.105 SUP HCPCS C1713 209.105 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8 BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $201.85 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $297.72 $496.20 $103.41 $496.20 N/A N/A 209.11 SUP HCPCS C1713 209.110 - SCREW BONE 7MM 8MM 110MM 32MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $201.85 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $289.05 $481.75 $100.40 $481.75 N/A N/A 209.115 SUP HCPCS C1713 209.115 - SCREW BONE 7MM 8MM 115MM 32MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $201.85 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $496.20 $496.20 $103.41 $496.20 N/A N/A 209.12 SUP HCPCS C1713 209.120 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7MM 8 BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $201.85 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $289.05 $481.75 $100.40 $481.75 N/A N/A 209.125 SUP HCPCS C1713 209.125 - SCREW BONE 7MM 8MM 125MM 32MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $504.63 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $297.72 $496.20 $103.41 $496.20 N/A N/A 209.13 SUP HCPCS C1713 209.130 - SCREW BONE 7MM 8MM 130MM 32MM CANN THREADED LARGE HEXOGONAL BOTH IP/OP $482.00 $357.00 $95.62 $504.63 $216.79 $216.79 $216.79 $216.79 $481.75 $481.75 $481.75 $100.41 $481.75 $481.75 $481.75 $481.75 $481.75 $100.40 $481.75 $201.85 $284.96 $481.75 $504.63 $481.75 $481.75 $361.50 $481.75 $481.75 $481.75 $240.88 $240.88 $381.55 $481.75 $385.40 $216.79 $95.62 N/A $279.56 $481.75 $481.75 $481.75 $100.40 $481.75 N/A N/A 209.135 SUP HCPCS C1713 209.135 - SCREW BONE 7MM 135MM 32MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $520.38 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $307.01 $511.68 $106.63 $511.68 N/A N/A 209.14 SUP HCPCS C1713 209.140 - SCREW BONE 7MM 140MM 32MM CANN THREADED BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $520.38 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $298.07 $496.78 $103.53 $496.78 N/A N/A 209.145 SUP HCPCS C1713 209.145 - SCREW BONE 7MM 145MM 32MM CANN THREADED BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $208.15 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $307.01 $511.68 $106.63 $511.68 N/A N/A 209.15 SUP HCPCS C1713 209.150 - SCREW BONE 7MM 150MM 32MM CANN THREADED BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $520.38 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $298.07 $496.78 $103.53 $496.78 N/A N/A 209.42 SUP HCPCS C1713 209.420 - SCREW BONE 7MM 20MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $208.15 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $298.07 $496.78 $103.53 $496.78 N/A N/A 209.425 SUP HCPCS C1713 209.425 - SCREW BONE FULTHD 7MM 25MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $520.38 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $511.68 $511.68 $106.63 $511.68 N/A N/A 209.43 SUP HCPCS C1713 209.430 - SCREW ORTHOPEDIC 7MM 30MM CANN FULTHRD STAINLESS STEEL BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $208.15 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $298.07 $496.78 $103.53 $496.78 N/A N/A 209.435 SUP HCPCS C1713 209.435 - SCREW BONE FULTHD 7MM 35MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $520.38 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $307.01 $511.68 $106.63 $511.68 N/A N/A 209.44 SUP HCPCS C1713 209.440 - SCREW BONE 7MM 40MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $208.15 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $298.07 $496.78 $103.53 $496.78 N/A N/A 209.445 SUP HCPCS C1713 209.445 - SCREW BONE FULTHD 7MM 45MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $520.38 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $511.68 $511.68 $106.63 $511.68 N/A N/A 209.45 SUP HCPCS C1713 209.450 - SCREW BONE FULTHD 7MM 50MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $208.15 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $298.07 $496.78 $103.53 $496.78 N/A N/A 209.455 SUP HCPCS C1713 209.455 - SCREW BONE FULTHD 7MM 55MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $520.38 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $307.01 $511.68 $106.63 $511.68 N/A N/A 209.46 SUP HCPCS C1713 209.460 - SCREW BONE 7MM 60MM CANN FULTHRD STAINLESS STEEL NONSTRL BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $208.15 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $298.07 $496.78 $103.53 $496.78 N/A N/A 209.465 SUP HCPCS C1713 209.465 - SCREW BONE FULTHD 7MM 65MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $520.38 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $511.68 $511.68 $106.63 $511.68 N/A N/A 209.47 SUP HCPCS C1713 209.470 - SCREW BONE 7MM 70MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $208.15 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $298.07 $496.78 $103.53 $496.78 N/A N/A 209.475 SUP HCPCS C1713 209.475 - SCREW BONE FULTHD 7MM 75MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $520.38 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $307.01 $511.68 $106.63 $511.68 N/A N/A 209.48 SUP HCPCS C1713 209.480 - SCREW BONE 7MM 80MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $520.38 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $298.07 $496.78 $103.53 $496.78 N/A N/A 209.485 SUP HCPCS C1713 209.485 - SCREW BONE 7MM 85MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $520.38 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $307.01 $511.68 $106.63 $511.68 N/A N/A 209.49 SUP HCPCS C1713 209.490 - SCREW BONE 7MM 90MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $520.38 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $298.07 $496.78 $103.53 $496.78 N/A N/A 209.495 SUP HCPCS C1713 209.495 - SCREW BONE 7MM 95MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $208.15 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $511.68 $511.68 $511.68 $511.68 N/A N/A 209.5 SUP HCPCS C1713 209.500 - SCREW BONE 7MM 100MM CANN FULTHRD STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $520.38 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $298.07 $496.78 $103.53 $496.78 N/A N/A 209.505 SUP HCPCS C1713 209.505 - SCREW BONE FULTHD 7MM 105MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $208.15 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $307.01 $511.68 $106.63 $511.68 N/A N/A 209.51 SUP HCPCS C1713 209.510 - SCREW BONE FULTHD 7MM 8MM 110MM CANN LARGE HEXAGONAL SOCKET BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $520.38 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $298.07 $496.78 $103.53 $496.78 N/A N/A 209.515 SUP HCPCS C1713 209.515 - SCREW BONE FULTHD 7MM 115MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $208.15 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $307.01 $511.68 $106.63 $511.68 N/A N/A 209.52 SUP HCPCS C1713 209.520 - SCREW BONE 7MM 120MM CANN FULTHRD STAINLESS STEEL CORTICAL BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $520.38 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $298.07 $496.78 $103.53 $496.78 N/A N/A 209.525 SUP HCPCS C1713 209.525 - SCREW BONE FULTHD 7MM 125MM CANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $512.00 $379.00 $101.56 $520.38 $230.26 $230.26 $230.26 $230.26 $511.68 $511.68 $511.68 $106.65 $511.68 $511.68 $511.68 $511.68 $511.68 $106.64 $511.68 $208.15 $302.66 $511.68 $520.38 $511.68 $511.68 $384.00 $511.68 $511.68 $511.68 $255.84 $255.84 $405.25 $511.68 $409.34 $230.26 $101.56 N/A $296.96 $511.68 $511.68 $511.68 $106.63 $511.68 N/A N/A 209.53 SUP HCPCS C1713 209.530 - SCREW BONE 7MM 130MM FULTHRD STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $497.00 $368.00 $98.60 $520.38 $223.55 $223.55 $223.55 $223.55 $496.78 $496.78 $496.78 $103.54 $496.78 $496.78 $496.78 $496.78 $496.78 $103.53 $496.78 $520.38 $293.85 $496.78 $520.38 $496.78 $496.78 $372.75 $496.78 $496.78 $496.78 $248.39 $248.39 $393.45 $496.78 $397.42 $223.55 $98.60 N/A $288.26 $496.78 $496.78 $496.78 $103.53 $496.78 N/A N/A 209.62 SUP HCPCS C1713 209.620 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 209.625 SUP HCPCS C1713 209.625 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.63 SUP HCPCS C1713 209.630 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.635 SUP HCPCS C1713 209.635 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.64 SUP HCPCS C1713 209.640 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.645 SUP HCPCS C1713 209.645 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.65 SUP HCPCS C1713 209.650 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.655 SUP HCPCS C1713 209.655 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.66 SUP HCPCS C1713 209.660 - SCREW BONE FULLY THREAD LARGE HEXAGON 7.3MM 4MM 60MM CANN BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.665 SUP HCPCS C1713 209.665 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.67 SUP HCPCS C1713 209.670 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.675 SUP HCPCS C1713 209.675 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.68 SUP HCPCS C1713 209.680 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.685 SUP HCPCS C1713 209.685 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $483.55 $483.55 N/A N/A 209.69 SUP HCPCS C1713 209.690 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.695 SUP HCPCS C1713 209.695 - SCREW BONE FULTHD 7.3MM 8.2MM 95MM CANN SHAFT LP HEAD BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 209.7 SUP HCPCS C1713 209.700 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 209.705 SUP HCPCS C1713 209.705 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.71 SUP HCPCS C1713 209.710 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.715 SUP HCPCS C1713 209.715 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.72 SUP HCPCS C1713 209.720 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 209.725 SUP HCPCS C1713 209.725 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.73 SUP HCPCS C1713 209.730 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.735 SUP HCPCS C1713 209.735 - SCREW BONE FULTHD 7.3MM 8.2MM 135MM 4MM CANN SLFDRILL SLFTAP BOTH IP/OP $500.50 $370.00 $99.32 $508.93 $225.19 $225.19 $225.19 $225.19 $500.43 $500.43 $500.43 $104.30 $500.43 $500.43 $500.43 $500.43 $500.43 $104.30 $500.43 $508.93 $296.00 $500.43 $508.93 $500.43 $500.43 $375.38 $500.43 $500.43 $500.43 $250.22 $250.22 $396.34 $500.43 $400.34 $225.19 $99.32 N/A $290.29 $500.43 $500.43 $500.43 $104.29 $500.43 N/A N/A 209.74 SUP HCPCS C1713 209.740 - SCREW BONE 4MM FULTHD 7.3MM 8.2MM 140MM CANN SLFDRILL SLFTAP BOTH IP/OP $486.00 $360.00 $96.43 $508.93 $218.63 $218.63 $218.63 $218.63 $485.85 $485.85 $485.85 $101.26 $485.85 $485.85 $485.85 $485.85 $485.85 $101.26 $485.85 $508.93 $287.38 $485.85 $508.93 $485.85 $485.85 $364.50 $485.85 $485.85 $485.85 $242.93 $242.93 $384.79 $485.85 $388.68 $218.63 $96.43 N/A $281.88 $485.85 $485.85 $485.85 $101.25 $485.85 N/A N/A 209.745 SUP HCPCS C1713 209.745 - SCREW BONE FULTHD 7.3MM 8.2MM 145MM 4MM CANN SLFDRILL SLFTAP BOTH IP/OP $500.50 $370.00 $99.32 $508.93 $225.19 $225.19 $225.19 $225.19 $500.43 $500.43 $500.43 $104.30 $500.43 $500.43 $500.43 $500.43 $500.43 $104.30 $500.43 $508.93 $296.00 $500.43 $508.93 $500.43 $500.43 $375.38 $500.43 $500.43 $500.43 $250.22 $250.22 $396.34 $500.43 $400.34 $225.19 $99.32 N/A $290.29 $500.43 $500.43 $500.43 $104.29 $500.43 N/A N/A 209.75 SUP HCPCS C1713 209.750 - SCREW BONE FULTHD 7.3MM 50MM CANN NONSTRL BOTH IP/OP $486.00 $360.00 $96.43 $508.93 $218.63 $218.63 $218.63 $218.63 $485.85 $485.85 $485.85 $101.26 $485.85 $485.85 $485.85 $485.85 $485.85 $101.26 $485.85 $508.93 $287.38 $485.85 $508.93 $485.85 $485.85 $364.50 $485.85 $485.85 $485.85 $242.93 $242.93 $384.79 $485.85 $388.68 $218.63 $96.43 N/A $281.88 $485.85 $485.85 $485.85 $101.25 $485.85 N/A N/A 209.755 SUP HCPCS C1713 209.755 - SCREW BONE FULTHD 7.3MM 55MM CANN NONSTRL BOTH IP/OP $500.50 $370.00 $99.32 $508.93 $225.19 $225.19 $225.19 $225.19 $500.43 $500.43 $500.43 $104.30 $500.43 $500.43 $500.43 $500.43 $500.43 $104.30 $500.43 $508.93 $296.00 $500.43 $508.93 $500.43 $500.43 $375.38 $500.43 $500.43 $500.43 $250.22 $250.22 $396.34 $500.43 $400.34 $225.19 $99.32 N/A $290.29 $500.43 $500.43 $500.43 $104.29 $500.43 N/A N/A 209.76 SUP HCPCS C1713 209.760 - SCREW BONE 4MM FULTHD 7.3MM 8.2MM 160MM CANN SLFDRILL SLFTAP BOTH IP/OP $486.00 $360.00 $96.43 $508.93 $218.63 $218.63 $218.63 $218.63 $485.85 $485.85 $485.85 $101.26 $485.85 $485.85 $485.85 $485.85 $485.85 $101.26 $485.85 $508.93 $287.38 $485.85 $508.93 $485.85 $485.85 $364.50 $485.85 $485.85 $485.85 $242.93 $242.93 $384.79 $485.85 $388.68 $218.63 $96.43 N/A $281.88 $485.85 $485.85 $485.85 $485.85 $485.85 N/A N/A 209.765 SUP HCPCS C1713 209.765 - SCREW BONE FULTHD 7.3MM 8.2MM 165MM 4MM CANN SLFDRILL SLFTAP BOTH IP/OP $500.50 $370.00 $99.32 $508.93 $225.19 $225.19 $225.19 $225.19 $500.43 $500.43 $500.43 $104.30 $500.43 $500.43 $500.43 $500.43 $500.43 $104.30 $500.43 $508.93 $296.00 $500.43 $508.93 $500.43 $500.43 $375.38 $500.43 $500.43 $500.43 $250.22 $250.22 $396.34 $500.43 $400.34 $225.19 $99.32 N/A $290.29 $500.43 $500.43 $500.43 $500.43 $500.43 N/A N/A 209.77 SUP HCPCS C1713 209.770 - SCREW BONE FULTHD 7.3MM 8.2MM 170MM 4MM CANN SLFDRILL SLFTAP BOTH IP/OP $486.00 $360.00 $96.43 $508.93 $218.63 $218.63 $218.63 $218.63 $485.85 $485.85 $485.85 $101.26 $485.85 $485.85 $485.85 $485.85 $485.85 $101.26 $485.85 $508.93 $287.38 $485.85 $508.93 $485.85 $485.85 $364.50 $485.85 $485.85 $485.85 $242.93 $242.93 $384.79 $485.85 $388.68 $218.63 $96.43 N/A $281.88 $485.85 $485.85 $485.85 $101.25 $485.85 N/A N/A 209.775 SUP HCPCS C1713 209.775 - SCREW BONE FULTHD 7.3MM 75MM CANN STAINLESS STEEL BOTH IP/OP $500.50 $370.00 $99.32 $508.93 $225.19 $225.19 $225.19 $225.19 $500.43 $500.43 $500.43 $104.30 $500.43 $500.43 $500.43 $500.43 $500.43 $104.30 $500.43 $508.93 $296.00 $500.43 $508.93 $500.43 $500.43 $375.38 $500.43 $500.43 $500.43 $250.22 $250.22 $396.34 $500.43 $400.34 $225.19 $99.32 N/A $290.29 $500.43 $500.43 $500.43 $104.29 $500.43 N/A N/A 209.78 SUP HCPCS C1713 209.780 - SCREW BONE FULTHD 7.3MM 8.2MM 180MM 4MM CANN SLFDRILL SLFTAP BOTH IP/OP $486.00 $360.00 $96.43 $508.93 $218.63 $218.63 $218.63 $218.63 $485.85 $485.85 $485.85 $101.26 $485.85 $485.85 $485.85 $485.85 $485.85 $101.26 $485.85 $508.93 $287.38 $485.85 $508.93 $485.85 $485.85 $364.50 $485.85 $485.85 $485.85 $242.93 $242.93 $384.79 $485.85 $388.68 $218.63 $96.43 N/A $281.88 $485.85 $485.85 $485.85 $101.25 $485.85 N/A N/A 209.845 SUP HCPCS C1713 209.845 - SCREW BONE PTHRD 7.3MM 8.2MM 45MM 32MM CANN SHAFT LP HEAD BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 209.85 SUP HCPCS C1713 209.850 - SCREW BONE 7.3MM 8.2MM 50MM 32MM CANN SHAFT LP HEAD SLFDRILL BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.855 SUP HCPCS C1713 209.855 - SCREW BONE 4MM 7.3MM 8.2MM 55MM 32MM CANN SHAFT LP HEAD BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.86 SUP HCPCS C1713 209.860 - SCREW BONE PTHRD 7.3MM 8.2MM 60MM 32MM CANN SHAFT LP HEAD BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.865 SUP HCPCS C1713 209.865 - SCREW BONE 4MM 7.3MM 8.2MM 65MM 32MM CANN SHAFT LP HEAD BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.87 SUP HCPCS C1713 209.870 - SCREW BONE PTHRD 7.3MM 8.2MM 70MM 32MM CANN SHAFT LP HEAD BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.875 SUP HCPCS C1713 209.875 - SCREW BONE 4MM 7.3MM 8.2MM 75MM 32MM CANN SHAFT LP HEAD BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.88 SUP HCPCS C1713 209.880 - SCREW BONE PTHRD 7.3MM 8.2MM 80MM 32MM CANN SHAFT LP HEAD BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 209.885 SUP HCPCS C1713 209.885 - SCREW BONE 4MM PTHRD 7.3MM 8.2MM 85MM 32MM CANN SHAFT LP BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.89 SUP HCPCS C1713 209.890 - SCREW BONE 4MM PTHRD 7.3MM 8.2MM 90MM 32MM CANN SHAFT LP BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.895 SUP HCPCS C1713 209.895 - SCREW BONE 4MM PTHRD 7.3MM 8.2MM 95MM 32MM CANN SHAFT LP BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.9 SUP HCPCS C1713 209.900 - SCREW BONE 4MM PTHRD 7.3MM 8.2MM 100MM 32MM CANN SHAFT LP BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 209.905 SUP HCPCS C1713 209.905 - SCREW BONE 4MM 7.3MM 8.2MM 105MM 32MM CANN SHAFT LP HEAD BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.91 SUP HCPCS C1713 209.910 - SCREW BONE 4MM PTHRD 7.3MM 8.2MM 110MM 32MM CANN SHAFT LP BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 209.915 SUP HCPCS C1713 209.915 - SCREW BONE 7.3MM 8.2MM 115MM 32MM CANN SHAFT LP HEAD BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.92 SUP HCPCS C1713 209.920 - SCREW BONE 4MM 7.3MM 8.2MM 120MM 32MM CANN SHAFT LP HEAD BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.925 SUP HCPCS C1713 209.925 - SCREW BONE 4MM 7.3MM 8.2MM 125MM 32MM CANN SHAFT LP HEAD BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.93 SUP HCPCS C1713 209.930 - SCREW BONE 4MM PTHRD 7.3MM 8.2MM 130MM 32MM CANN SHAFT LP BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.935 SUP HCPCS C1713 209.935 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 209.94 SUP HCPCS C1713 209.940 - SCREW BONE HEXAGON 7.3MM 4MM 140MM 32MM CANN SELF DRILL SELF BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 209.945 SUP HCPCS C1713 209.945 - SCREW BONE LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE 7.3MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 209.95 SUP HCPCS C1713 209.950 - SCREW BONE HEXAGON 7.3MM 4MM 150MM 32MM CANN SELF DRILL SELF BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 209.955 SUP HCPCS C1713 209.955 - SCREW BONE 7.3MM 8.2MM 155MM 32X4MM CANN SLFDRILL SLFTAP BOTH IP/OP $500.50 $370.00 $99.32 $508.93 $225.19 $225.19 $225.19 $225.19 $500.43 $500.43 $500.43 $104.30 $500.43 $500.43 $500.43 $500.43 $500.43 $104.30 $500.43 $203.57 $296.00 $500.43 $508.93 $500.43 $500.43 $375.38 $500.43 $500.43 $500.43 $250.22 $250.22 $396.34 $500.43 $400.34 $225.19 $99.32 N/A $290.29 $500.43 $300.26 $500.43 $104.29 $500.43 N/A N/A 209.96 SUP HCPCS C1713 209.960 - SCREW BONE 7.3MM 160MM CANN THREADED STAINLESS STEEL NONSTRL BOTH IP/OP $486.00 $360.00 $96.43 $508.93 $218.63 $218.63 $218.63 $218.63 $485.85 $485.85 $485.85 $101.26 $485.85 $485.85 $485.85 $485.85 $485.85 $101.26 $485.85 $508.93 $287.38 $485.85 $508.93 $485.85 $485.85 $364.50 $485.85 $485.85 $485.85 $242.93 $242.93 $384.79 $485.85 $388.68 $218.63 $96.43 N/A $281.88 $485.85 $291.51 $485.85 $101.25 $485.85 N/A N/A 209.965 SUP HCPCS C1713 209.965 - SCREW BONE 7.3MM 8.2MM 165MM 32X4MM CANN SLFDRILL SLFTAP BOTH IP/OP $500.50 $370.00 $99.32 $508.93 $225.19 $225.19 $225.19 $225.19 $500.43 $500.43 $500.43 $104.30 $500.43 $500.43 $500.43 $500.43 $500.43 $104.30 $500.43 $508.93 $296.00 $500.43 $508.93 $500.43 $500.43 $375.38 $500.43 $500.43 $500.43 $250.22 $250.22 $396.34 $500.43 $400.34 $225.19 $99.32 N/A $290.29 $500.43 $500.43 $500.43 $104.29 $500.43 N/A N/A 209.97 SUP HCPCS C1713 209.970 - SCREW BONE 7.3MM 8.2MM 170MM 32X4MM CANN SLFDRILL SLFTAP BOTH IP/OP $486.00 $360.00 $96.43 $508.93 $218.63 $218.63 $218.63 $218.63 $485.85 $485.85 $485.85 $101.26 $485.85 $485.85 $485.85 $485.85 $485.85 $101.26 $485.85 $508.93 $287.38 $485.85 $508.93 $485.85 $485.85 $364.50 $485.85 $485.85 $485.85 $242.93 $242.93 $384.79 $485.85 $388.68 $218.63 $96.43 N/A $281.88 $485.85 $485.85 $485.85 $101.25 $485.85 N/A N/A 209.975 SUP HCPCS C1713 209.975 - SCREW BONE 7.3MM 8.2MM 175MM 32X4MM CANN SLFDRILL SLFTAP BOTH IP/OP $500.50 $370.00 $99.32 $508.93 $225.19 $225.19 $225.19 $225.19 $500.43 $500.43 $500.43 $104.30 $500.43 $500.43 $500.43 $500.43 $500.43 $104.30 $500.43 $508.93 $296.00 $500.43 $508.93 $500.43 $500.43 $375.38 $500.43 $500.43 $500.43 $250.22 $250.22 $396.34 $500.43 $400.34 $225.19 $99.32 N/A $290.29 $500.43 $500.43 $500.43 $104.29 $500.43 N/A N/A 209.98 SUP HCPCS C1713 209.980 - SCREW BONE 7.3MM 180MM CANN STAINLESS STEEL NONSTRL BOTH IP/OP $486.00 $360.00 $96.43 $508.93 $218.63 $218.63 $218.63 $218.63 $485.85 $485.85 $485.85 $101.26 $485.85 $485.85 $485.85 $485.85 $485.85 $101.26 $485.85 $508.93 $287.38 $485.85 $508.93 $485.85 $485.85 $364.50 $485.85 $485.85 $485.85 $242.93 $242.93 $384.79 $485.85 $388.68 $218.63 $96.43 N/A $281.88 $485.85 $485.85 $485.85 $101.25 $485.85 N/A N/A 211.81 SUP HCPCS C1713 211.810 - SCREW BONE .5 THREAD T8 2.4MM 3.5MM 10MM SELF DRILL SELF TAP BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $374.55 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $214.55 $357.58 $74.52 $357.58 N/A N/A 211.811 SUP HCPCS C1713 211.811 - SCREW BONE LNGTHRD 2.4MM 11MM 5MM CANN STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 211.812 SUP HCPCS C1713 211.812 - SCREW BONE .5 THREAD T8 2.4MM 3.5MM 12MM SELF DRILL SELF TAP BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 211.813 SUP HCPCS C1713 211.813 - SCREW BONE LNGTHRD 2.4MM 13MM 6MM CANN STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 211.814 SUP HCPCS C1713 211.814 - SCREW BONE .5 THREAD T8 2.4MM 3.5MM 14MM SELF DRILL SELF TAP BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 211.815 SUP HCPCS C1713 211.815 - SCREW BONE LNGTHRD 2.4MM 3.5MM 15MM 7MM CANN REVERSE CUTTING BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 211.816 SUP HCPCS C1713 211.816 - SCREW BONE .5 THREAD T8 2.4MM 3.5MM 16MM SELF DRILL SELF TAP BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 211.817 SUP HCPCS C1713 211.817 - SCREW BONE LNGTHRD 2.4MM 17MM 8MM CANN STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 211.818 SUP HCPCS C1713 211.818 - SCREW BONE LNGTHRD 2.4MM 35MM 18MM 8MM CANN T8 STARDRIVE BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 211.819 SUP HCPCS C1713 211.819 - SCREW BONE LNGTHRD 2.4MM 19MM 9MM CANN STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 211.82 SUP HCPCS C1713 211.820 - SCREW BONE LNGTHRD 2.4MM 3.5MM 20MM 9MM CANN REVERSE CUTTING BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $149.82 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $357.58 $357.58 $357.58 $357.58 N/A N/A 211.822 SUP HCPCS C1713 211.822 - SCREW BONE LNGTHRD 2.4MM 3.5MM 22MM 10MM CANN REVERSE BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $368.30 $368.30 N/A N/A 211.824 SUP HCPCS C1713 211.824 - SCREW BONE LNGTHRD 2.4MM 3.5MM 24MM 10MM CANN REVERSE BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 211.826 SUP HCPCS C1713 211.826 - SCREW BONE LNGTHRD 2.4MM 3.5MM 26MM 12MM CANN REVERSE BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 211.828 SUP HCPCS C1713 211.828 - SCREW BONE LNGTHRD 2.4MM 28MM 12MM CANN STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 211.83 SUP HCPCS C1713 211.830 - SCREW BONE LNGTHRD 2.4MM 3.5MM 30MM 14MM CANN REVERSE BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $149.82 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $214.55 $357.58 $357.58 $357.58 N/A N/A 211.841 SUP HCPCS C1713 211.841 - SCREW BONE SHORT THREAD 2.4MM 3.5MM 17MM 5MM CANN SLFDRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 211.842 SUP HCPCS C1713 211.842 - SCREW BONE SHORT THREAD 2.4MM 3.5MM 18MM 5MM CANN T8 BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $368.30 $368.30 N/A N/A 211.843 SUP HCPCS C1713 211.843 - SCREW BONE SHORT THREAD 2.4MM 19MM 5MM CANN STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 211.844 SUP HCPCS C1713 211.844 - SCREW BONE SHORT THREAD 20MM 204MM 5MM CANN STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 211.845 SUP HCPCS C1713 211.845 - SCREW BONE SHORT THREAD 2.4MM 22MM 5MM CANN STAINLESS STEEL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 211.846 SUP HCPCS C1713 211.846 - SCREW BONE SHORT THREAD 2.4MM 3.5MM 24MM 6MM CANN REVERSE BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 211.847 SUP HCPCS C1713 211.847 - SCREW BONE SHORT THREAD 2.4MM 3.5MM 26MM 6MM CANN REVERSE BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 211.848 SUP HCPCS C1713 211.848 - SCREW BONE SHORT THREAD 2.4MM 3.5MM 28MM 6MM CANN REVERSE BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 211.849 SUP HCPCS C1713 211.849 - SCREW BONE SHORT THREAD 2.4MM 3.5MM 30MM 6MM CANN REVERSE BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 211.89 SUP HCPCS C1713 211.890 - SCREW BONE 2.4MM 90MM COMPRESSION LCP DHHS STAINLESS STEEL BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $83.63 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $79.83 $79.83 $16.64 $79.83 N/A N/A 212.101 SUP HCPCS C1713 212.101 - SCREW BONE FULTHD 3.5MM 2.9MM 10MM T15 STARDRIVE RECESS BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 212.102 SUP HCPCS C1713 212.102 - SCREW BONE FULTHD 3.5MM 12MM STARDRIVE RECESS SLFTAP TIP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 212.103 SUP HCPCS C1713 212.103 - SCREW BONE FULTHD 3.5MM 14MM STARDRIVE RECESS SLFTAP TIP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.104 SUP HCPCS C1713 212.104 - SCREW BONE FULTHD 3.5MM 16MM STARDRIVE RECESS SLFTAP TIP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.105 SUP HCPCS C1713 212.105 - SCREW BONE 3.5MM 18MM LOCKING SLFTAP T15 STAR DRIVE RECESS BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 212.106 SUP HCPCS C1713 212.106 - SCREW BONE 3.5MM 20MM LOCKING SLFTAP STARDRIVE RECESS LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.107 SUP HCPCS C1713 212.107 - SCREW BONE T15 FULTHD CONE LP 3.5MM 22MM FIX ANGLE SELF TAP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.108 SUP HCPCS C1713 212.108 - SCREW BONE 3.5MM 24MM T15 STARDRIVE RECESS ANGULAR STABILITY BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.109 SUP HCPCS C1713 212.109 - SCREW BONE FULTHD 3.5MM 26MM STARDRIVE RECESS SLFTAP TIP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 212.11 SUP HCPCS C1713 212.110 - SCREW BONE 3.5MM 28MM LOCKING STARDRIVE SLFTAP LCP STAINLESS BOTH IP/OP $228.00 $169.00 $45.24 $238.75 $102.57 $102.57 $102.57 $102.57 $227.93 $227.93 $227.93 $47.51 $227.93 $227.93 $227.93 $227.93 $227.93 $47.50 $227.93 $238.75 $134.82 $227.93 $238.75 $227.93 $227.93 $171.00 $227.93 $227.93 $227.93 $113.97 $113.97 $180.52 $227.93 $182.34 $102.57 $45.24 N/A $132.24 $227.93 $227.93 $227.93 $47.50 $227.93 N/A N/A 212.111 SUP HCPCS C1713 212.111 - SCREW BONE 3.5MM 30MM LOCKING SLFTAP STARDRIVE RECESS LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.112 SUP HCPCS C1713 212.112 - SCREW BONE FULTHD 3.5MM 32MM STARDRIVE RECESS SLFTAP TIP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 212.113 SUP HCPCS C1713 212.113 - SCREW BONE 3.5MM 34MM T15 STARDRIVE RECESS ANGULAR STABILITY BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.114 SUP HCPCS C1713 212.114 - SCREW BONE T15 FULTHD CONE LP 3.5MM 35MM FIX ANGLE SELF TAP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 212.115 SUP HCPCS C1713 212.115 - SCREW BONE FULTHD 3.5MM 36MM T15 STARDRIVE SELF TAP FIX BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.116 SUP HCPCS C1713 212.116 - SCREW BONE FULTHD 3.5MM 38MM T15 STARDRIVE SELF TAP FIX BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.117 SUP HCPCS C1713 212.117 - SCREW BONE 3.5MM 40MM LOCKING STARDRIVE SLFTAP LCP STAINLESS BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 212.118 SUP HCPCS C1713 212.118 - SCREW BONE T15 FULTHD CONE LP 3.5MM 42MM FIX ANGLE SELF TAP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.119 SUP HCPCS C1713 212.119 - SCREW BONE FULTHD 3.5MM 45MM STARDRIVE SELF TAP LOCK LP LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.12 SUP HCPCS C1713 212.120 - SCREW BONE T15 FULTHD CONE LP 3.5MM 48MM FIX ANGLE SELF TAP BOTH IP/OP $228.00 $169.00 $45.24 $238.75 $102.57 $102.57 $102.57 $102.57 $227.93 $227.93 $227.93 $47.51 $227.93 $227.93 $227.93 $227.93 $227.93 $47.50 $227.93 $238.75 $134.82 $227.93 $238.75 $227.93 $227.93 $171.00 $227.93 $227.93 $227.93 $113.97 $113.97 $180.52 $227.93 $182.34 $102.57 $45.24 N/A $132.24 $227.93 $227.93 $227.93 $47.50 $227.93 N/A N/A 212.121 SUP HCPCS C1713 212.121 - SCREW BONE 3.5MM 50MM LOCKING SLFTAP T15 STAR DRIVE RECESS BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.122 SUP HCPCS C1713 212.122 - SCREW BONE T15 FULTHD CONE LP 3.5MM 52MM FIX ANGLE SELF TAP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 212.123 SUP HCPCS C1713 212.123 - SCREW BONE T15 FULTHD CONE LP 3.5MM 55MM FIX ANGLE SELF TAP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 212.124 SUP HCPCS C1713 212.124 - SCREW BONE FULTHD 3.5MM 60MM STARDRIVE RECESS SLFTAP TIP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.125 SUP HCPCS C1713 212.125 - SCREW BONE T15 FULTHD CONE LP 3.5MM 65MM FIX ANGLE SELF TAP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.126 SUP HCPCS C1713 212.126 - SCREW BONE T15 FULTHD CONE LP 3.5MM 70MM FIX ANGLE SELF TAP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.127 SUP HCPCS C1713 212.127 - SCREW BONE T15 FULTHD CONE LP 3.5MM 75MM FIX ANGLE SELF TAP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 212.128 SUP HCPCS C1713 212.128 - SCREW BONE T15 FULTHD CONE LP 3.5MM 80MM FIX ANGLE SELF TAP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.129 SUP HCPCS C1713 212.129 - SCREW BONE T15 FULTHD CONE LP 3.5MM 85MM FIX ANGLE SELF TAP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.13 SUP HCPCS C1713 212.130 - SCREW BONE T15 FULTHD CONE LP 3.5MM 90MM FIX ANGLE SELF TAP BOTH IP/OP $228.00 $169.00 $45.24 $238.75 $102.57 $102.57 $102.57 $102.57 $227.93 $227.93 $227.93 $47.51 $227.93 $227.93 $227.93 $227.93 $227.93 $47.50 $227.93 $238.75 $134.82 $227.93 $238.75 $227.93 $227.93 $171.00 $227.93 $227.93 $227.93 $113.97 $113.97 $180.52 $227.93 $182.34 $102.57 $45.24 N/A $132.24 $227.93 $136.76 $227.93 $47.50 $227.93 N/A N/A 212.131 SUP HCPCS C1713 212.131 - SCREW BONE T15 FULTHD CONE LP 3.5MM 95MM FIX ANGLE SELF TAP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 212.134 SUP HCPCS C1713 212.134 - SCREW BONE FULTHD CONE LP 3.5MM 44MM FIX ANGLE SELF TAP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 212.136 SUP HCPCS C1713 212.136 - SCREW BONE FULTHD CONE LP 3.5MM 46MM FIX ANGLE SELF TAP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 212.201 SUP HCPCS C1713 212.201 - SCREW BONE FULTHD 5MM 14MM T25 STARDRIVE RECESS SLFTAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 212.202 SUP HCPCS C1713 212.202 - SCREW BONE T25 FULTHD CONE 5MM 16MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 212.203 SUP HCPCS C1713 212.203 - SCREW BONE FULTHD 5MM 18MM T25 STARDRIVE RECESS SLFTAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 212.204 SUP HCPCS C1713 212.204 - SCREW BN T25 FT 5MM 4.4MM 20MM NS ST LCK STRDR CNCL HD SS BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 212.205 SUP HCPCS C1713 212.205 - SCREW BONE T25 FULTHD CONE 5MM 22MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 212.206 SUP HCPCS C1713 212.206 - SCREW BONE FULTHD 5MM 24MM SLFTAP TIP LOCKING FIXANG CONICAL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 212.207 SUP HCPCS C1713 212.207 - SCREW BONE FULTHD CONICAL 5MM 26MM SELF TAP LOCK FIX ANGLE T BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 212.208 SUP HCPCS C1713 212.208 - SCREW BONE T25 FULTHD CONE 5MM 28MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 212.209 SUP HCPCS C1713 212.209 - SCREW BONE T25 FULTHD CONE 5MM 30MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 212.21 SUP HCPCS C1713 212.210 - SCREW BONE FULTHD 5MM 32MM T25 STARDRIVE RECESS SLFTAP BOTH IP/OP $266.50 $197.00 $52.82 $278.75 $119.76 $119.76 $119.76 $119.76 $266.13 $266.13 $266.13 $55.47 $266.13 $266.13 $266.13 $266.13 $266.13 $55.46 $266.13 $278.75 $157.42 $266.13 $278.75 $266.13 $266.13 $199.88 $266.13 $266.13 $266.13 $133.07 $133.07 $210.77 $266.13 $212.90 $119.76 $52.82 N/A $154.57 $266.13 $159.68 $266.13 $55.46 $266.13 N/A N/A 212.211 SUP HCPCS C1713 212.211 - SCREW BONE T25 FULTHD CONE 5MM 34MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 212.212 SUP HCPCS C1713 212.212 - SCREW BONE T25 FULTHD CONE 5MM 36MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 212.213 SUP HCPCS C1713 212.213 - SCREW BONE T25 FULTHD CONE 5MM 38MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 212.214 SUP HCPCS C1713 212.214 - SCREW BONE T25 FULTHD CONE 5MM 40MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 212.215 SUP HCPCS C1713 212.215 - SCREW BONE T25 FULTHD CONE 5MM 42MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 212.216 SUP HCPCS C1713 212.216 - SCREW BONE FULTHD 5MM 44MM SLFTAP LOCKING FIXANG T25 BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 212.217 SUP HCPCS C1713 212.217 - SCREW BONE T25 FULTHD CONE 5MM 46MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 212.218 SUP HCPCS C1713 212.218 - SCREW BONE T25 FULTHD CONE 5MM 48MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 212.219 SUP HCPCS C1713 212.219 - SCREW BONE T25 FULTHD CONE 5MM 50MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 212.22 SUP HCPCS C1713 212.220 - SCREW BONE T25 FULTHD CONE 5MM 55MM FIX ANGLE SELF TAP BOTH IP/OP $266.50 $197.00 $52.82 $278.75 $119.76 $119.76 $119.76 $119.76 $266.13 $266.13 $266.13 $55.47 $266.13 $266.13 $266.13 $266.13 $266.13 $55.46 $266.13 $111.50 $157.42 $266.13 $278.75 $266.13 $266.13 $199.88 $266.13 $266.13 $266.13 $133.07 $133.07 $210.77 $266.13 $212.90 $119.76 $52.82 N/A $154.57 $266.13 $266.13 $266.13 $55.46 $266.13 N/A N/A 212.221 SUP HCPCS C1713 212.221 - SCREW BONE T25 FULTHD CONE 5MM 60MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 212.222 SUP HCPCS C1713 212.222 - SCREW BONE FULTHD 5MM 65MM T25 STARDRIVE RECESS SLFTAP TIP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 212.223 SUP HCPCS C1713 212.223 - SCREW BONE T25 FULTHD CONE 5MM 70MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 212.224 SUP HCPCS C1713 212.224 - SCREW BONE FULTHD 5MM 75MM SLFTAP TIP LOCKING FIXANG T25 BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 212.225 SUP HCPCS C1713 212.225 - SCREW BONE FULTHD 5MM 80MM T25 STARDRIVE SELF TAP LOCK FIX BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 212.226 SUP HCPCS C1713 212.226 - SCREW BONE T25 FULTHD CONE 5MM 85MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 212.227 SUP HCPCS C1713 212.227 - SCREW BONE T25 FULTHD CONE 5MM 90MM FIX ANGLE SELF TAP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 212.251 SUP HCPCS C1713 212.251 - SCREW BONE 5MM 51MM SLFDRILL LOCKING THREADED LCP STAINLESS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 212.252 SUP HCPCS C1713 212.252 - SCREW BONE 5MM 18MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 212.253 SUP HCPCS C1713 212.253 - SCREW BONE 5MM 22MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 212.254 SUP HCPCS C1713 212.254 - SCREW BONE 5MM 26MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $385.58 $385.58 N/A N/A 212.255 SUP HCPCS C1713 212.255 - SCREW BONE 5MM 30MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $231.35 $385.58 $385.58 $385.58 N/A N/A 212.256 SUP HCPCS C1713 212.256 - SCREW BONE 5MM 35MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 212.257 SUP HCPCS C1713 212.257 - SCREW BONE 5MM 40MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 212.258 SUP HCPCS C1713 212.258 - SCREW BONE 5MM 45MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 212.259 SUP HCPCS C1713 212.259 - SCREW BONE 5MM 50MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $385.58 $385.58 N/A N/A 212.26 SUP HCPCS C1713 212.260 - SCREW BONE 5MM 55MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $385.58 $385.58 N/A N/A 212.261 SUP HCPCS C1713 212.261 - SCREW BONE 5MM 60MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 212.262 SUP HCPCS C1713 212.262 - SCREW BONE 5MM 65MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 212.263 SUP HCPCS C1713 212.263 - SCREW BONE 5MM 70MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $385.58 $385.58 N/A N/A 212.264 SUP HCPCS C1713 212.264 - SCREW BONE 5MM 75MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 212.265 SUP HCPCS C1713 212.265 - SCREW BONE 5MM 80MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $385.58 $385.58 N/A N/A 212.266 SUP HCPCS C1713 212.266 - SCREW BONE 5MM 85MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 212.267 SUP HCPCS C1713 212.267 - SCREW BONE 5MM 90MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 212.317 SUP HCPCS C1713 212.317 - SCREW BONE FULTHD 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 212.319 SUP HCPCS C1713 212.319 - SCREW BONE FULTHD 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $268.78 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 212.321 SUP HCPCS C1713 212.321 - SCREW BONE FULTHD 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $268.78 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $264.28 $264.28 $55.08 $264.28 N/A N/A 212.323 SUP HCPCS C1713 212.323 - SCREW BONE FULTHD 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $268.78 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 212.324 SUP HCPCS C1713 212.324 - SCREW BONE FULTHD 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $268.78 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 212.325 SUP HCPCS C1713 212.325 - SCREW BONE FULTHD CONE 3.5MM 2.9MM 65MM SELF TAP SMOOTH BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $261.63 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 212.326 SUP HCPCS C1713 212.326 - SCREW BONE FULTHD CONE 3.5MM 2.9MM 70MM SELF TAP SMOOTH BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $104.65 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 212.327 SUP HCPCS C1713 212.327 - SCREW BONE FULTHD CONE 3.5MM 2.9MM 75MM SELF TAP SMOOTH BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $261.63 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 212.328 SUP HCPCS C1713 212.328 - SCREW BONE FULTHD CONE 3.5MM 2.9MM 80MM SELF TAP SMOOTH BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $261.63 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 212.329 SUP HCPCS C1713 212.329 - SCREW BONE FULTHD CONE 3.5MM 2.9MM 85MM SELF TAP SMOOTH BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $261.63 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 212.33 SUP HCPCS C1713 212.330 - SCREW BONE FULTHD 3.5MM 2.9MM 90MM SLFTAP STARDRIVE RECESS BOTH IP/OP $250.00 $185.00 $49.57 $261.63 $112.39 $112.39 $112.39 $112.39 $249.75 $249.75 $249.75 $52.05 $249.75 $249.75 $249.75 $249.75 $249.75 $52.05 $249.75 $261.63 $147.73 $249.75 $261.63 $249.75 $249.75 $187.50 $249.75 $249.75 $249.75 $124.88 $124.88 $197.80 $249.75 $199.80 $112.39 $49.57 N/A $145.00 $249.75 $249.75 $249.75 $52.05 $249.75 N/A N/A 212.331 SUP HCPCS C1713 212.331 - SCREW BONE FULTHD CONE 3.5MM 2.9MM 95MM SELF TAP SMOOTH BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $261.63 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 212.417 SUP HCPCS C1713 212.417 - SCREW BONE 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $268.78 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 212.419 SUP HCPCS C1713 212.419 - SCREW BONE 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $268.78 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 212.421 SUP HCPCS C1713 212.421 - SCREW BONE 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $264.28 $264.28 $55.08 $264.28 N/A N/A 212.423 SUP HCPCS C1713 212.423 - SCREW BONE 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $264.28 $264.28 $55.08 $264.28 N/A N/A 212.424 SUP HCPCS C1713 212.424 - SCREW BONE 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 212.425 SUP HCPCS C1713 212.425 - SCREW BONE PTHRD CONE 3.5MM 2.9MM 65MM SELF TAP SMOOTH BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $261.63 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 212.426 SUP HCPCS C1713 212.426 - SCREW BONE PTHRD CONE 3.5MM 2.9MM 70MM SELF TAP SMOOTH BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $261.63 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 212.427 SUP HCPCS C1713 212.427 - SCREW BONE PTHRD CONE 3.5MM 2.9MM 75MM SELF TAP SMOOTH BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $104.65 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 212.428 SUP HCPCS C1713 212.428 - SCREW BONE PTHRD CONE 3.5MM 2.9MM 80MM SELF TAP SMOOTH BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $261.63 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 212.429 SUP HCPCS C1713 212.429 - SCREW BONE PTHRD CONE 3.5MM 2.9MM 85MM SELF TAP SMOOTH BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $104.65 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 212.43 SUP HCPCS C1713 212.430 - SCREW BONE PTHRD CONE 3.5MM 2.9MM 90MM SELF TAP SMOOTH BOTH IP/OP $250.00 $185.00 $49.57 $261.63 $112.39 $112.39 $112.39 $112.39 $249.75 $249.75 $249.75 $52.05 $249.75 $249.75 $249.75 $249.75 $249.75 $52.05 $249.75 $104.65 $147.73 $249.75 $261.63 $249.75 $249.75 $187.50 $249.75 $249.75 $249.75 $124.88 $124.88 $197.80 $249.75 $199.80 $112.39 $49.57 N/A $145.00 $249.75 $149.85 $249.75 $52.05 $249.75 N/A N/A 212.431 SUP HCPCS C1713 212.431 - SCREW BONE PTHRD CONE 3.5MM 2.9MM 95MM SELF TAP SMOOTH BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $261.63 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 212.806 SUP HCPCS C1713 212.806 - SCREW BONE T8 CONE 2.4MM 1.9MM 6MM FIX ANGLE SELF TAP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 212.807 SUP HCPCS C1713 212.807 - SCREW BONE T8 CONE 2.4MM 1.9MM 7MM FIX ANGLE SELF TAP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $223.03 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 212.808 SUP HCPCS C1713 212.808 - SCREW BONE T8 CONE 2.4MM 1.9MM 8MM FIX ANGLE SELF TAP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $223.03 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $219.30 $219.30 $45.70 $219.30 N/A N/A 212.809 SUP HCPCS C1713 212.809 - SCREW BONE T8 CONE 2.4MM 1.9MM 9MM FIX ANGLE SELF TAP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $219.30 $219.30 $45.70 $219.30 N/A N/A 212.81 SUP HCPCS C1713 212.810 - SCREW BONE T8 CONE 2.4MM 1.9MM 10MM FIX ANGLE SELF TAP BOTH IP/OP $213.00 $158.00 $42.26 $223.03 $95.81 $95.81 $95.81 $95.81 $212.90 $212.90 $212.90 $44.37 $212.90 $212.90 $212.90 $212.90 $212.90 $44.37 $212.90 $89.21 $125.93 $212.90 $223.03 $212.90 $212.90 $159.75 $212.90 $212.90 $212.90 $106.45 $106.45 $168.62 $212.90 $170.32 $95.81 $42.26 N/A $123.54 $212.90 $127.74 $212.90 $44.37 $212.90 N/A N/A 212.811 SUP HCPCS C1713 212.811 - SCREW BONE T8 CONE 2.4MM 1.9MM 11MM FIX ANGLE SELF TAP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $223.03 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $219.30 $219.30 $45.70 $219.30 N/A N/A 212.812 SUP HCPCS C1713 212.812 - SCREW BONE T8 2.4MM 12MM SELF TAP LOCK STARDRIVE LCP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $223.03 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 212.813 SUP HCPCS C1713 212.813 - SCREW BONE T8 CONE 2.4MM 1.9MM 13MM FIX ANGLE SELF TAP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $223.03 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 212.814 SUP HCPCS C1713 212.814 - SCREW BONE T8 2.4MM 14MM SELF TAP LOCK STARDRIVE LCP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $223.03 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $219.30 $219.30 $45.70 $219.30 N/A N/A 212.816 SUP HCPCS C1713 212.816 - SCREW BONE T8 CONE 2.4MM 1.9MM 16MM FIX ANGLE SELF TAP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $223.03 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 212.818 SUP HCPCS C1713 212.818 - SCREW BONE 2.4MM 1.9MM 18MM T8 STARDRIVE RECESS SLFTAP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $223.03 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 212.82 SUP HCPCS C1713 212.820 - SCREW BONE 2.4MM 20MM T8 STARDRIVE RECESS SLFTAP LOCKING BOTH IP/OP $213.00 $158.00 $42.26 $223.03 $95.81 $95.81 $95.81 $95.81 $212.90 $212.90 $212.90 $44.37 $212.90 $212.90 $212.90 $212.90 $212.90 $44.37 $212.90 $89.21 $125.93 $212.90 $223.03 $212.90 $212.90 $159.75 $212.90 $212.90 $212.90 $106.45 $106.45 $168.62 $212.90 $170.32 $95.81 $42.26 N/A $123.54 $212.90 $127.74 $212.90 $44.37 $212.90 N/A N/A 212.822 SUP HCPCS C1713 212.822 - SCREW BONE 2.4MM 22MM T8 STARDRIVE RECESS SLFTAP LOCKING BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $219.30 $219.30 $45.70 $219.30 N/A N/A 212.824 SUP HCPCS C1713 212.824 - SCREW BONE T8 CONE 2.4MM 1.9MM 24MM FIX ANGLE SELF TAP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $219.30 $219.30 $45.70 $219.30 N/A N/A 212.826 SUP HCPCS C1713 212.826 - SCREW BONE 2.4MM 26MM T8 STARDRIVE RECESS SLFTAP LOCKING BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $223.03 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 212.828 SUP HCPCS C1713 212.828 - SCREW BONE 2.4MM 1.9MM 28MM FIX ANGLE SELF TAP T8 STARDRIVE BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $223.03 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 212.83 SUP HCPCS C1713 212.830 - SCREW BONE T8 CONE 2.4MM 1.9MM 30MM FIX ANGLE SELF TAP BOTH IP/OP $213.00 $158.00 $42.26 $223.03 $95.81 $95.81 $95.81 $95.81 $212.90 $212.90 $212.90 $44.37 $212.90 $212.90 $212.90 $212.90 $212.90 $44.37 $212.90 $223.03 $125.93 $212.90 $223.03 $212.90 $212.90 $159.75 $212.90 $212.90 $212.90 $106.45 $106.45 $168.62 $212.90 $170.32 $95.81 $42.26 N/A $123.54 $212.90 $127.74 $212.90 $44.37 $212.90 N/A N/A 213.018 SUP HCPCS C1713 213.018 - SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 18MM SELF TAP THREAD BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 213.02 SUP HCPCS C1713 213.020 - SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 20MM SELF TAP THREAD BOTH IP/OP $228.00 $169.00 $45.24 $238.75 $102.57 $102.57 $102.57 $102.57 $227.93 $227.93 $227.93 $47.51 $227.93 $227.93 $227.93 $227.93 $227.93 $47.50 $227.93 $95.50 $134.82 $227.93 $238.75 $227.93 $227.93 $171.00 $227.93 $227.93 $227.93 $113.97 $113.97 $180.52 $227.93 $182.34 $102.57 $45.24 N/A $132.24 $227.93 $227.93 $227.93 $227.93 $227.93 N/A N/A 213.022 SUP HCPCS C1713 213.022 - SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 22MM SELF TAP THREAD BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $234.75 $234.75 N/A N/A 213.024 SUP HCPCS C1713 213.024 - SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 24MM SELF TAP THREAD BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 213.026 SUP HCPCS C1713 213.026 - SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 26MM SELF TAP THREAD BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 213.028 SUP HCPCS C1713 213.028 - SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 28MM SELF TAP THREAD BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 213.03 SUP HCPCS C1713 213.030 - SCREW BONE 2.5MM 3.5MM 30MM SELF TAP LOCK SMALL HEXAGONAL BOTH IP/OP $228.00 $169.00 $45.24 $238.75 $102.57 $102.57 $102.57 $102.57 $227.93 $227.93 $227.93 $47.51 $227.93 $227.93 $227.93 $227.93 $227.93 $47.50 $227.93 $95.50 $134.82 $227.93 $238.75 $227.93 $227.93 $171.00 $227.93 $227.93 $227.93 $113.97 $113.97 $180.52 $227.93 $182.34 $102.57 $45.24 N/A $132.24 $227.93 $227.93 $227.93 $47.50 $227.93 N/A N/A 213.032 SUP HCPCS C1713 213.032 - SCREW BONE SMALL HEXAGON 3.5MM 2.9MM 32MM SELF TAP THREAD BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 213.034 SUP HCPCS C1713 213.034 - SCREW BONE 3.5MM 2.9MM 34MM SELF TAP LOCK SMALL HEXAGONAL BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 213.036 SUP HCPCS C1713 213.036 - SCREW BONE 3.5MM 2.9MM 36MM SELF TAP LOCK SMALL HEXAGONAL BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 213.038 SUP HCPCS C1713 213.038 - SCREW BONE 3.5MM 2.9MM 38MM SELF TAP LOCK SMALL HEXAGONAL BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 213.04 SUP HCPCS C1713 213.040 - SCREW BONE 2.5MM 3.5MM 40MM SELF TAP SMALL HEXAGONAL RECESS BOTH IP/OP $228.00 $169.00 $45.24 $238.75 $102.57 $102.57 $102.57 $102.57 $227.93 $227.93 $227.93 $47.51 $227.93 $227.93 $227.93 $227.93 $227.93 $47.50 $227.93 $95.50 $134.82 $227.93 $238.75 $227.93 $227.93 $171.00 $227.93 $227.93 $227.93 $113.97 $113.97 $180.52 $227.93 $182.34 $102.57 $45.24 N/A $132.24 $227.93 $227.93 $227.93 $47.50 $227.93 N/A N/A 213.045 SUP HCPCS C1713 213.045 - SCREW BONE 3.5MM 2.9MM 45MM SLFTAP LOCKING SMALL HEXAGONAL BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 213.05 SUP HCPCS C1713 213.050 - SCREW BONE 3.5MM 2.9MM 50MM SLFTAP LOCKING SMALL HEXAGONAL BOTH IP/OP $228.00 $169.00 $45.24 $238.75 $102.57 $102.57 $102.57 $102.57 $227.93 $227.93 $227.93 $47.51 $227.93 $227.93 $227.93 $227.93 $227.93 $47.50 $227.93 $95.50 $134.82 $227.93 $238.75 $227.93 $227.93 $171.00 $227.93 $227.93 $227.93 $113.97 $113.97 $180.52 $227.93 $182.34 $102.57 $45.24 N/A $132.24 $227.93 $227.93 $227.93 $47.50 $227.93 N/A N/A 213.414 SUP HCPCS C1713 213.414 - SCREW BONE 5MM 14MM SLFDRILL LOCKING LISS STAINLESS STEEL BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $378.95 $378.95 $78.97 $378.95 N/A N/A 213.418 SUP HCPCS C1713 213.418 - SCREW BONE 5MM 18MM SLFDRILL LOCKING LCP LISS STAINLESS BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $402.03 $402.03 $83.78 $402.03 N/A N/A 213.422 SUP HCPCS C1713 213.422 - SCREW BONE 5MM 22MM SLFDRILL LOCKING LISS STAINLESS STEEL BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $378.95 $378.95 $78.97 $378.95 N/A N/A 213.426 SUP HCPCS C1713 213.426 - SCREW BONE 5MM 26MM SLFDRILL LOCKING LCP LISS STAINLESS BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $402.03 $402.03 $83.78 $402.03 N/A N/A 213.43 SUP HCPCS C1713 213.430 - SCREW BONE 5MM 30MM SLFDRILL LOCKING LISS STAINLESS STEEL BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $378.95 $378.95 $78.97 $378.95 N/A N/A 213.435 SUP HCPCS C1713 213.435 - SCREW BONE 5MM 35MM SLFDRILL LOCKING STAINLESS STEEL BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $378.95 $378.95 $78.97 $378.95 N/A N/A 213.44 SUP HCPCS C1713 213.440 - SCREW BONE 5MM 40MM SLFDRILL LOCKING LCP LISS STAINLESS BOTH IP/OP $390.50 $289.00 $77.47 $408.85 $175.65 $175.65 $175.65 $175.65 $390.33 $390.33 $390.33 $81.35 $390.33 $390.33 $390.33 $390.33 $390.33 $81.35 $390.33 $163.54 $230.88 $390.33 $408.85 $390.33 $390.33 $292.88 $390.33 $390.33 $390.33 $195.17 $195.17 $309.14 $390.33 $312.26 $175.65 $77.47 N/A $226.49 $390.33 $390.33 $390.33 $81.34 $390.33 N/A N/A 213.445 SUP HCPCS C1713 213.445 - SCREW BONE 5MM 45MM SLFDRILL LOCKING STAINLESS STEEL BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $378.95 $378.95 $78.97 $378.95 N/A N/A 213.45 SUP HCPCS C1713 213.450 - SCREW BONE 5MM 50MM SLFDRILL LOCKING STAINLESS STEEL BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $378.95 $378.95 $78.97 $378.95 N/A N/A 213.455 SUP HCPCS C1713 213.455 - SCREW BONE 5MM 55MM SLFDRILL LOCKING LCP LISS STAINLESS BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $408.85 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $402.03 $402.03 $83.78 $402.03 N/A N/A 213.465 SUP HCPCS C1713 213.465 - SCREW BONE 5MM 65MM SLFDRILL LOCKING LCP LISS STAINLESS BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $402.03 $402.03 $83.78 $402.03 N/A N/A 213.47 SUP HCPCS C1713 213.470 - SCREW BONE 5MM 70MM SLFDRILL LOCKING STAINLESS STEEL BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $378.95 $378.95 $78.97 $378.95 N/A N/A 213.475 SUP HCPCS C1713 213.475 - SCREW BONE 5MM 75MM SLFDRILL LOCKING LCP LISS STAINLESS BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $402.03 $402.03 $83.78 $402.03 N/A N/A 213.48 SUP HCPCS C1713 213.480 - SCREW BONE 5MM 80MM SLFDRILL LOCKING STAINLESS STEEL BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $378.95 $378.95 $78.97 $378.95 N/A N/A 213.485 SUP HCPCS C1713 213.485 - SCREW BONE 5MM 85MM SLFDRILL LOCKING LCP LISS STAINLESS BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $402.03 $402.03 $83.78 $402.03 N/A N/A 213.49 SUP HCPCS C1713 213.490 - SCREW BONE 5MM 90MM SLFDRILL LOCKING STAINLESS STEEL BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $378.95 $378.95 $78.97 $378.95 N/A N/A 213.508 SUP HCPCS C1713 213.508 - SCREW BONE 4.5MM 8MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $236.25 $236.25 $49.23 $236.25 N/A N/A 213.509 SUP HCPCS C1713 213.509 - SCREW BONE 4.5MM 9MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $236.25 $236.25 $49.23 $236.25 N/A N/A 213.51 SUP HCPCS C1713 213.510 - SCREW BONE 4.5MM 10MM CANN MODULAR STAINLESS STEEL STERNUM BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $236.25 $236.25 $236.25 $236.25 N/A N/A 213.511 SUP HCPCS C1713 213.511 - SCREW BONE 4.5MM 11MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $236.25 $236.25 $49.23 $236.25 N/A N/A 213.512 SUP HCPCS C1713 213.512 - SCREW BONE 4.5MM 12MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $236.25 $236.25 $236.25 $236.25 N/A N/A 213.513 SUP HCPCS C1713 213.513 - SCREW BONE 4.5MM 13MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $236.25 $236.25 $236.25 $236.25 N/A N/A 213.514 SUP HCPCS C1713 213.514 - SCREW BONE 4.5MM 14MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $236.25 $236.25 $49.23 $236.25 N/A N/A 213.515 SUP HCPCS C1713 213.515 - SCREW BONE 4.5MM 15MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $236.25 $236.25 $49.23 $236.25 N/A N/A 213.516 SUP HCPCS C1713 213.516 - SCREW BONE 4.5MM 16MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $236.25 $236.25 $49.23 $236.25 N/A N/A 213.517 SUP HCPCS C1713 213.517 - SCREW BONE 4.5MM 17MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $141.75 $236.25 $236.25 $236.25 N/A N/A 213.518 SUP HCPCS C1713 213.518 - SCREW BONE 4.5MM 18MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $141.75 $236.25 $49.23 $236.25 N/A N/A 213.519 SUP HCPCS C1713 213.519 - SCREW BONE 4.5MM 19MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $141.75 $236.25 $49.23 $236.25 N/A N/A 213.52 SUP HCPCS C1713 213.520 - SCREW BONE 4.5MM 20MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $141.75 $236.25 $49.23 $236.25 N/A N/A 213.521 SUP HCPCS C1713 213.521 - SCREW BONE 4.5MM 21MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $236.25 $236.25 $49.23 $236.25 N/A N/A 213.522 SUP HCPCS C1713 213.522 - SCREW BONE 4.5MM 22MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $236.25 $236.25 $49.23 $236.25 N/A N/A 213.523 SUP HCPCS C1713 213.523 - SCREW BONE 4.5MM 23MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $141.75 $236.25 $49.23 $236.25 N/A N/A 213.524 SUP HCPCS C1713 213.524 - SCREW BONE 4.5MM 24MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $141.75 $236.25 $236.25 $236.25 N/A N/A 213.525 SUP HCPCS C1713 213.525 - SCREW BONE 4.5MM 25MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $141.75 $236.25 $236.25 $236.25 N/A N/A 213.526 SUP HCPCS C1713 213.526 - SCREW BONE 4.5MM 26MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $236.25 $236.25 $49.23 $236.25 N/A N/A 213.527 SUP HCPCS C1713 213.527 - SCREW BONE 4.5MM 27MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $94.50 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $236.25 $236.25 $49.23 $236.25 N/A N/A 213.528 SUP HCPCS C1713 213.528 - SCREW BONE 4.5MM 28MM CANN STAINLESS STEEL STERNUM NONSTRL BOTH IP/OP $236.50 $175.00 $46.89 $236.25 $106.31 $106.31 $106.31 $106.31 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $236.25 $236.25 $236.25 $49.24 $236.25 $236.25 $139.74 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $106.31 $46.89 N/A $137.17 $236.25 $236.25 $236.25 $49.23 $236.25 N/A N/A 214.014 SUP HCPCS C1713 214.014 - SCREW BONE STANDARD 4.5MM 8MM 14MM LARGE HEXGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $30.55 $30.55 $6.37 $30.55 N/A N/A 214.016 SUP HCPCS C1713 214.016 - SCREW BONE STANDARD 4.5MM 8MM 16MM LARGE HEXGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $30.55 $30.55 $6.37 $30.55 N/A N/A 214.018 SUP HCPCS C1713 214.018 - SCREW BONE 4.5MM 8MM 18MM HEXAGONAL SOCKET STAINLESS STEEL BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $30.55 $30.55 $6.37 $30.55 N/A N/A 214.02 SUP HCPCS C1713 214.020 - SCREW BONE STANDARD 4.5MM 8MM 20MM LARGE HEXAGONAL SOCKET BOTH IP/OP $30.00 $22.00 $5.89 $31.08 $13.36 $13.36 $13.36 $13.36 $29.68 $29.68 $29.68 $6.19 $29.68 $29.68 $29.68 $29.68 $29.68 $6.19 $29.68 $31.08 $17.56 $29.68 $31.08 $29.68 $29.68 $22.50 $29.68 $29.68 $29.68 $14.84 $14.84 $23.51 $29.68 $23.74 $13.36 $5.89 N/A $17.40 $29.68 $29.68 $29.68 $6.19 $29.68 N/A N/A 214.022 SUP HCPCS C1713 214.022 - SCREW BONE STANDARD 4.5MM 8MM 22MM LARGE HEXAGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.024 SUP HCPCS C1713 214.024 - SCREW BONE STANDARD 4.5MM 8MM 24MM LARGE HEXGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $30.55 $30.55 $6.37 $30.55 N/A N/A 214.026 SUP HCPCS C1713 214.026 - SCREW BONE STANDARD 4.5MM 8MM 26MM LARGE HEXGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.028 SUP HCPCS C1713 214.028 - SCREW BONE STANDARD 4.5MM 8MM 28MM LARGE HEXGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.03 SUP HCPCS C1713 214.030 - SCREW BONE STANDARD 4.5MM 8MM 30MM LARGE HEXGONAL SOCKET BOTH IP/OP $30.00 $22.00 $5.89 $31.08 $13.36 $13.36 $13.36 $13.36 $29.68 $29.68 $29.68 $6.19 $29.68 $29.68 $29.68 $29.68 $29.68 $6.19 $29.68 $31.08 $17.56 $29.68 $31.08 $29.68 $29.68 $22.50 $29.68 $29.68 $29.68 $14.84 $14.84 $23.51 $29.68 $23.74 $13.36 $5.89 N/A $17.40 $29.68 $17.81 $29.68 $6.19 $29.68 N/A N/A 214.032 SUP HCPCS C1713 214.032 - SCREW BONE STANDARD 4.5MM 8MM 32MM LARGE HEXGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.034 SUP HCPCS C1713 214.034 - SCREW BONE STANDARD 4.5MM 8MM 34MM LARGE HEXGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.036 SUP HCPCS C1713 214.036 - SCREW BONE STANDARD 4.5MM 8MM 36MM LARGE HEXGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $30.55 $30.55 $6.37 $30.55 N/A N/A 214.038 SUP HCPCS C1713 214.038 - SCREW BONE STANDARD 4.5MM 8MM 38MM LARGE HEXGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $30.55 $30.55 $6.37 $30.55 N/A N/A 214.04 SUP HCPCS C1713 214.040 - SCREW BONE STANDARD 4.5MM 8MM 40MM LARGE HEXGONAL SOCKET BOTH IP/OP $30.00 $22.00 $5.89 $31.08 $13.36 $13.36 $13.36 $13.36 $29.68 $29.68 $29.68 $6.19 $29.68 $29.68 $29.68 $29.68 $29.68 $6.19 $29.68 $31.08 $17.56 $29.68 $31.08 $29.68 $29.68 $22.50 $29.68 $29.68 $29.68 $14.84 $14.84 $23.51 $29.68 $23.74 $13.36 $5.89 N/A $17.40 $29.68 $17.81 $29.68 $6.19 $29.68 N/A N/A 214.042 SUP HCPCS C1713 214.042 - SCREW BONE 4.5MM 8MM 42MM HEXAGONAL SOCKET STAINLESS STEEL BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.044 SUP HCPCS C1713 214.044 - SCREW BONE STANDARD 4.5MM 8MM 44MM LARGE HEXGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.046 SUP HCPCS C1713 214.046 - SCREW BONE STANDARD 4.5MM 8MM 46MM LARGE HEXGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.048 SUP HCPCS C1713 214.048 - SCREW BONE STANDARD LARGE HEXAGON 4.5MM 8MM 48MM SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.05 SUP HCPCS C1713 214.050 - SCREW BONE STANDARD 4.5MM 8MM 50MM LARGE HEXGONAL SOCKET BOTH IP/OP $30.00 $22.00 $5.89 $31.08 $13.36 $13.36 $13.36 $13.36 $29.68 $29.68 $29.68 $6.19 $29.68 $29.68 $29.68 $29.68 $29.68 $6.19 $29.68 $31.08 $17.56 $29.68 $31.08 $29.68 $29.68 $22.50 $29.68 $29.68 $29.68 $14.84 $14.84 $23.51 $29.68 $23.74 $13.36 $5.89 N/A $17.40 $29.68 $17.81 $29.68 $6.19 $29.68 N/A N/A 214.052 SUP HCPCS C1713 214.052 - SCREW BONE STANDARD 4.5MM 8MM 52MM LARGE HEXGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.054 SUP HCPCS C1713 214.054 - SCREW BONE STANDARD 4.5MM 8MM 54MM LARGE HEXGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.056 SUP HCPCS C1713 214.056 - SCREW BONE 3.5MM STANDARD 4.5MM 8MM 56MM LARGE HEXAGONAL BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $30.55 $30.55 $6.37 $30.55 N/A N/A 214.058 SUP HCPCS C1713 214.058 - SCREW BONE STANDARD 4.5MM 8MM 58MM CORTEX PROXIMAL MEDIAL BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.06 SUP HCPCS C1713 214.060 - SCREW BONE STANDARD 4.5MM 8MM 60MM LARGE HEXAGONAL SOCKET BOTH IP/OP $30.00 $22.00 $5.89 $31.08 $13.36 $13.36 $13.36 $13.36 $29.68 $29.68 $29.68 $6.19 $29.68 $29.68 $29.68 $29.68 $29.68 $6.19 $29.68 $31.08 $17.56 $29.68 $31.08 $29.68 $29.68 $22.50 $29.68 $29.68 $29.68 $14.84 $14.84 $23.51 $29.68 $23.74 $13.36 $5.89 N/A $17.40 $29.68 $29.68 $29.68 $6.19 $29.68 N/A N/A 214.062 SUP HCPCS C1713 214.062 - SCREW BONE STANDARD 4.5MM 8MM 62MM NONSELF TAP LARGE HEXAGON BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.064 SUP HCPCS C1713 214.064 - SCREW BONE STANDARD 4.5MM 8MM 64MM LARGE HEXAGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.066 SUP HCPCS C1713 214.066 - SCREW BONE STANDARD 4.5MM 8MM 66MM NONSELF TAP LARGE HEXAGON BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $12.43 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $30.55 $30.55 $6.37 $30.55 N/A N/A 214.068 SUP HCPCS C1713 214.068 - SCREW BONE STANDARD 4.5MM 8MM 68MM NONSELF TAP LARGE HEXAGON BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $12.43 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $30.55 $30.55 $6.37 $30.55 N/A N/A 214.07 SUP HCPCS C1713 214.070 - SCREW BONE STANDARD 4.5MM 8MM 70MM NONSELF TAP LARGE HEXAGON BOTH IP/OP $30.00 $22.00 $5.89 $31.08 $13.36 $13.36 $13.36 $13.36 $29.68 $29.68 $29.68 $6.19 $29.68 $29.68 $29.68 $29.68 $29.68 $6.19 $29.68 $12.43 $17.56 $29.68 $31.08 $29.68 $29.68 $22.50 $29.68 $29.68 $29.68 $14.84 $14.84 $23.51 $29.68 $23.74 $13.36 $5.89 N/A $17.40 $29.68 $17.81 $29.68 $6.19 $29.68 N/A N/A 214.072 SUP HCPCS C1713 214.072 - SCREW BONE STANDARD 4.5MM 8MM 72MM NONSELF TAPPING LARGE BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 214.076 SUP HCPCS C1713 214.076 - SCREW BONE 4.5MM 76MM LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $51.50 $38.00 $10.18 $52.18 $23.09 $23.09 $23.09 $23.09 $51.30 $51.30 $51.30 $10.69 $51.30 $51.30 $51.30 $51.30 $51.30 $10.69 $51.30 $20.87 $30.34 $51.30 $52.18 $51.30 $51.30 $38.63 $51.30 $51.30 $51.30 $25.65 $25.65 $40.63 $51.30 $41.04 $23.09 $10.18 N/A $29.87 $51.30 $30.78 $51.30 $10.69 $51.30 N/A N/A 214.08 SUP HCPCS C1713 214.080 - SCREW BONE STANDARD 4.5MM 8MM 80MM NONSELF TAPPING LARGE BOTH IP/OP $50.00 $37.00 $9.88 $52.18 $22.41 $22.41 $22.41 $22.41 $49.80 $49.80 $49.80 $10.38 $49.80 $49.80 $49.80 $49.80 $49.80 $10.38 $49.80 $20.87 $29.46 $49.80 $52.18 $49.80 $49.80 $37.50 $49.80 $49.80 $49.80 $24.90 $24.90 $39.44 $49.80 $39.84 $22.41 $9.88 N/A $29.00 $49.80 $49.80 $49.80 $10.38 $49.80 N/A N/A 214.085 SUP HCPCS C1713 214.085 - SCREW BONE STANDARD 4.5MM 8MM 85MM LARGE HEXAGONAL SOCKET BOTH IP/OP $51.50 $38.00 $10.18 $52.18 $23.09 $23.09 $23.09 $23.09 $51.30 $51.30 $51.30 $10.69 $51.30 $51.30 $51.30 $51.30 $51.30 $10.69 $51.30 $20.87 $30.34 $51.30 $52.18 $51.30 $51.30 $38.63 $51.30 $51.30 $51.30 $25.65 $25.65 $40.63 $51.30 $41.04 $23.09 $10.18 N/A $29.87 $51.30 $51.30 $51.30 $10.69 $51.30 N/A N/A 214.09 SUP HCPCS C1713 214.090 - SCREW BONE 4.5MM 90MM LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $50.00 $37.00 $9.88 $52.18 $22.41 $22.41 $22.41 $22.41 $49.80 $49.80 $49.80 $10.38 $49.80 $49.80 $49.80 $49.80 $49.80 $10.38 $49.80 $52.18 $29.46 $49.80 $52.18 $49.80 $49.80 $37.50 $49.80 $49.80 $49.80 $24.90 $24.90 $39.44 $49.80 $39.84 $22.41 $9.88 N/A $29.00 $49.80 $29.88 $49.80 $10.38 $49.80 N/A N/A 214.095 SUP HCPCS C1713 214.095 - SCREW BONE STANDARD 4.5MM 8MM 95MM LARGE HEXAGONAL SOCKET BOTH IP/OP $51.50 $38.00 $10.18 $52.18 $23.09 $23.09 $23.09 $23.09 $51.30 $51.30 $51.30 $10.69 $51.30 $51.30 $51.30 $51.30 $51.30 $10.69 $51.30 $20.87 $30.34 $51.30 $52.18 $51.30 $51.30 $38.63 $51.30 $51.30 $51.30 $25.65 $25.65 $40.63 $51.30 $41.04 $23.09 $10.18 N/A $29.87 $51.30 $30.78 $51.30 $10.69 $51.30 N/A N/A 214.1 SUP HCPCS C1713 214.100 - SCREW BONE 4.5MM 100MM LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $50.00 $37.00 $9.88 $52.18 $22.41 $22.41 $22.41 $22.41 $49.80 $49.80 $49.80 $10.38 $49.80 $49.80 $49.80 $49.80 $49.80 $10.38 $49.80 $20.87 $29.46 $49.80 $52.18 $49.80 $49.80 $37.50 $49.80 $49.80 $49.80 $24.90 $24.90 $39.44 $49.80 $39.84 $22.41 $9.88 N/A $29.00 $49.80 $29.88 $49.80 $10.38 $49.80 N/A N/A 214.105 SUP HCPCS C1713 214.105 - SCREW BONE 4.5MM 105MM LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $51.50 $38.00 $10.18 $52.18 $23.09 $23.09 $23.09 $23.09 $51.30 $51.30 $51.30 $10.69 $51.30 $51.30 $51.30 $51.30 $51.30 $10.69 $51.30 $52.18 $30.34 $51.30 $52.18 $51.30 $51.30 $38.63 $51.30 $51.30 $51.30 $25.65 $25.65 $40.63 $51.30 $41.04 $23.09 $10.18 N/A $29.87 $51.30 $51.30 $51.30 $10.69 $51.30 N/A N/A 214.11 SUP HCPCS C1713 214.110 - SCREW BONE 4.5MM 110MM LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $50.00 $37.00 $9.88 $52.18 $22.41 $22.41 $22.41 $22.41 $49.80 $49.80 $49.80 $10.38 $49.80 $49.80 $49.80 $49.80 $49.80 $10.38 $49.80 $52.18 $29.46 $49.80 $52.18 $49.80 $49.80 $37.50 $49.80 $49.80 $49.80 $24.90 $24.90 $39.44 $49.80 $39.84 $22.41 $9.88 N/A $29.00 $49.80 $49.80 $49.80 $10.38 $49.80 N/A N/A 214.115 SUP HCPCS C1713 214.115 - SCREW BONE 4.5MM 115MM LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $51.50 $38.00 $10.18 $52.18 $23.09 $23.09 $23.09 $23.09 $51.30 $51.30 $51.30 $10.69 $51.30 $51.30 $51.30 $51.30 $51.30 $10.69 $51.30 $52.18 $30.34 $51.30 $52.18 $51.30 $51.30 $38.63 $51.30 $51.30 $51.30 $25.65 $25.65 $40.63 $51.30 $41.04 $23.09 $10.18 N/A $29.87 $51.30 $51.30 $51.30 $10.69 $51.30 N/A N/A 214.12 SUP HCPCS C1713 214.120 - SCREW BONE 3.5MM STANDARD 4.5MM 8MM 120MM LARGE HEXGONAL BOTH IP/OP $50.00 $37.00 $9.88 $52.18 $22.41 $22.41 $22.41 $22.41 $49.80 $49.80 $49.80 $10.38 $49.80 $49.80 $49.80 $49.80 $49.80 $10.38 $49.80 $52.18 $29.46 $49.80 $52.18 $49.80 $49.80 $37.50 $49.80 $49.80 $49.80 $24.90 $24.90 $39.44 $49.80 $39.84 $22.41 $9.88 N/A $29.00 $49.80 $49.80 $49.80 $10.38 $49.80 N/A N/A 214.125 SUP HCPCS C1713 214.125 - SCREW BONE 4.5MM 125MM LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $51.50 $38.00 $10.18 $52.18 $23.09 $23.09 $23.09 $23.09 $51.30 $51.30 $51.30 $10.69 $51.30 $51.30 $51.30 $51.30 $51.30 $10.69 $51.30 $52.18 $30.34 $51.30 $52.18 $51.30 $51.30 $38.63 $51.30 $51.30 $51.30 $25.65 $25.65 $40.63 $51.30 $41.04 $23.09 $10.18 N/A $29.87 $51.30 $51.30 $51.30 $10.69 $51.30 N/A N/A 214.13 SUP HCPCS C1713 214.130 - SCREW BONE 4.5MM 130MM DHS/DCP LC-DCP DCS STAINLESS STEEL BOTH IP/OP $50.00 $37.00 $9.88 $52.18 $22.41 $22.41 $22.41 $22.41 $49.80 $49.80 $49.80 $10.38 $49.80 $49.80 $49.80 $49.80 $49.80 $10.38 $49.80 $52.18 $29.46 $49.80 $52.18 $49.80 $49.80 $37.50 $49.80 $49.80 $49.80 $24.90 $24.90 $39.44 $49.80 $39.84 $22.41 $9.88 N/A $29.00 $49.80 $29.88 $49.80 $10.38 $49.80 N/A N/A 214.135 SUP HCPCS C1713 214.135 - SCREW BONE 4.5MM 135MM LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $51.50 $38.00 $10.18 $52.18 $23.09 $23.09 $23.09 $23.09 $51.30 $51.30 $51.30 $10.69 $51.30 $51.30 $51.30 $51.30 $51.30 $10.69 $51.30 $52.18 $30.34 $51.30 $52.18 $51.30 $51.30 $38.63 $51.30 $51.30 $51.30 $25.65 $25.65 $40.63 $51.30 $41.04 $23.09 $10.18 N/A $29.87 $51.30 $51.30 $51.30 $10.69 $51.30 N/A N/A 214.14 SUP HCPCS C1713 214.140 - SCREW BONE 4.5MM 140MM DHS/DCP LC-DCP DCS STAINLESS STEEL BOTH IP/OP $50.00 $37.00 $9.88 $52.18 $22.41 $22.41 $22.41 $22.41 $49.80 $49.80 $49.80 $10.38 $49.80 $49.80 $49.80 $49.80 $49.80 $10.38 $49.80 $52.18 $29.46 $49.80 $52.18 $49.80 $49.80 $37.50 $49.80 $49.80 $49.80 $24.90 $24.90 $39.44 $49.80 $39.84 $22.41 $9.88 N/A $29.00 $49.80 $49.80 $49.80 $10.38 $49.80 N/A N/A 214.145 SUP HCPCS C1713 214.145 - SCREW BONE 4.5MM 145MM LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $51.50 $38.00 $10.18 $52.18 $23.09 $23.09 $23.09 $23.09 $51.30 $51.30 $51.30 $10.69 $51.30 $51.30 $51.30 $51.30 $51.30 $10.69 $51.30 $20.87 $30.34 $51.30 $52.18 $51.30 $51.30 $38.63 $51.30 $51.30 $51.30 $25.65 $25.65 $40.63 $51.30 $41.04 $23.09 $10.18 N/A $29.87 $51.30 $51.30 $51.30 $10.69 $51.30 N/A N/A 214.15 SUP HCPCS C1713 214.150 - SCREW BONE 4.5MM 150MM LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $69.00 $51.00 $13.67 $72.18 $31.01 $31.01 $31.01 $31.01 $68.90 $68.90 $68.90 $14.36 $68.90 $68.90 $68.90 $68.90 $68.90 $14.36 $68.90 $28.87 $40.75 $68.90 $72.18 $68.90 $68.90 $51.75 $68.90 $68.90 $68.90 $34.45 $34.45 $54.57 $68.90 $55.12 $31.01 $13.67 N/A $40.02 $68.90 $68.90 $68.90 $14.36 $68.90 N/A N/A 214.155 SUP HCPCS C1713 214.155 - SCREW BONE 4.5MM 155MM LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $70.98 $70.98 $14.79 $70.98 N/A N/A 214.16 SUP HCPCS C1713 214.160 - SCREW BONE 4.5MM 160MM NON SLFTAP STAINLESS STEEL CORTICAL BOTH IP/OP $69.00 $51.00 $13.67 $72.18 $31.01 $31.01 $31.01 $31.01 $68.90 $68.90 $68.90 $14.36 $68.90 $68.90 $68.90 $68.90 $68.90 $14.36 $68.90 $28.87 $40.75 $68.90 $72.18 $68.90 $68.90 $51.75 $68.90 $68.90 $68.90 $34.45 $34.45 $54.57 $68.90 $55.12 $31.01 $13.67 N/A $40.02 $68.90 $68.90 $68.90 $14.36 $68.90 N/A N/A 214.222 SUP HCPCS C1713 214.222 - SCREW BONE 4.5MM 22MM SHAFT LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $30.50 $23.00 $5.98 $30.13 $13.56 $13.56 $13.56 $13.56 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $30.13 $30.13 $30.13 $6.28 $30.13 $12.05 $17.82 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $13.56 $5.98 N/A $17.69 $30.13 $30.13 $30.13 $6.28 $30.13 N/A N/A 214.224 SUP HCPCS C1713 214.224 - SCREW BONE 4.5MM 24MM SHAFT LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $30.50 $23.00 $5.98 $30.13 $13.56 $13.56 $13.56 $13.56 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $17.82 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $13.56 $5.98 N/A $17.69 $30.13 $30.13 $30.13 $6.28 $30.13 N/A N/A 214.226 SUP HCPCS C1713 214.226 - SCREW BONE 4.5MM 26MM SHAFT LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $30.50 $23.00 $5.98 $30.13 $13.56 $13.56 $13.56 $13.56 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $17.82 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $13.56 $5.98 N/A $17.69 $30.13 $18.08 $30.13 $6.28 $30.13 N/A N/A 214.228 SUP HCPCS C1713 214.228 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 28MM 12MM SOCKET DCP BOTH IP/OP $30.50 $23.00 $5.98 $30.13 $13.56 $13.56 $13.56 $13.56 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $30.13 $30.13 $30.13 $6.28 $30.13 $12.05 $17.82 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $13.56 $5.98 N/A $17.69 $30.13 $18.08 $30.13 $6.28 $30.13 N/A N/A 214.23 SUP HCPCS C1713 214.230 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 30MM 12MM SOCKET DCP BOTH IP/OP $30.50 $23.00 $5.98 $30.13 $13.56 $13.56 $13.56 $13.56 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $17.82 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $13.56 $5.98 N/A $17.69 $30.13 $18.08 $30.13 $6.28 $30.13 N/A N/A 214.232 SUP HCPCS C1713 214.232 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 32MM 12MM SOCKET DCP BOTH IP/OP $31.50 $23.00 $6.16 $31.03 $13.96 $13.96 $13.96 $13.96 $31.03 $31.03 $31.03 $6.47 $31.03 $31.03 $31.03 $31.03 $31.03 $6.47 $31.03 $31.03 $18.35 $31.03 $31.03 $31.03 $31.03 $23.63 $31.03 $31.03 $31.03 $15.52 $15.52 $24.58 $31.03 $24.82 $13.96 $6.16 N/A $18.27 $31.03 $18.62 $31.03 $6.47 $31.03 N/A N/A 214.234 SUP HCPCS C1713 214.234 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 34MM 12MM SOCKET DCP BOTH IP/OP $31.50 $23.00 $6.16 $31.03 $13.96 $13.96 $13.96 $13.96 $31.03 $31.03 $31.03 $6.47 $31.03 $31.03 $31.03 $31.03 $31.03 $6.47 $31.03 $12.41 $18.35 $31.03 $31.03 $31.03 $31.03 $23.63 $31.03 $31.03 $31.03 $15.52 $15.52 $24.58 $31.03 $24.82 $13.96 $6.16 N/A $18.27 $31.03 $31.03 $31.03 $6.47 $31.03 N/A N/A 214.236 SUP HCPCS C1713 214.236 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 36MM 12MM SOCKET DCP BOTH IP/OP $31.50 $23.00 $6.16 $31.03 $13.96 $13.96 $13.96 $13.96 $31.03 $31.03 $31.03 $6.47 $31.03 $31.03 $31.03 $31.03 $31.03 $6.47 $31.03 $31.03 $18.35 $31.03 $31.03 $31.03 $31.03 $23.63 $31.03 $31.03 $31.03 $15.52 $15.52 $24.58 $31.03 $24.82 $13.96 $6.16 N/A $18.27 $31.03 $31.03 $31.03 $6.47 $31.03 N/A N/A 214.238 SUP HCPCS C1713 214.238 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 38MM 12MM SOCKET DCP BOTH IP/OP $30.50 $23.00 $5.98 $30.13 $13.56 $13.56 $13.56 $13.56 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $17.82 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $13.56 $5.98 N/A $17.69 $30.13 $18.08 $30.13 $6.28 $30.13 N/A N/A 214.24 SUP HCPCS C1713 214.240 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 40MM 12MM SOCKET DCP BOTH IP/OP $30.50 $23.00 $5.98 $30.13 $13.56 $13.56 $13.56 $13.56 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $30.13 $30.13 $30.13 $6.28 $30.13 $12.05 $17.82 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $13.56 $5.98 N/A $17.69 $30.13 $18.08 $30.13 $6.28 $30.13 N/A N/A 214.242 SUP HCPCS C1713 214.242 - SCREW BONE PTHRD 4.5MM 8MM 42MM 12MM LCP STAINLESS STEEL BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $13.38 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $20.07 $33.45 $6.97 $33.45 N/A N/A 214.244 SUP HCPCS C1713 214.244 - SCREW BONE PTHRD 4.5MM 8MM 44MM 12MM LCP STAINLESS STEEL BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $13.38 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $33.45 $33.45 $6.97 $33.45 N/A N/A 214.246 SUP HCPCS C1713 214.246 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 46MM 12MM SOCKET DCP BOTH IP/OP $34.50 $26.00 $6.84 $34.45 $15.50 $15.50 $15.50 $15.50 $34.45 $34.45 $34.45 $7.18 $34.45 $34.45 $34.45 $34.45 $34.45 $7.18 $34.45 $13.78 $20.38 $34.45 $34.45 $34.45 $34.45 $25.88 $34.45 $34.45 $34.45 $17.23 $17.23 $27.28 $34.45 $27.56 $15.50 $6.84 N/A $20.01 $34.45 $34.45 $34.45 $7.18 $34.45 N/A N/A 214.248 SUP HCPCS C1713 214.248 - SCREW BONE PTHRD 4.5MM 8MM 50MM 12MM LCP STAINLESS STEEL BOTH IP/OP $34.50 $26.00 $6.84 $34.45 $15.50 $15.50 $15.50 $15.50 $34.45 $34.45 $34.45 $7.18 $34.45 $34.45 $34.45 $34.45 $34.45 $7.18 $34.45 $13.78 $20.38 $34.45 $34.45 $34.45 $34.45 $25.88 $34.45 $34.45 $34.45 $17.23 $17.23 $27.28 $34.45 $27.56 $15.50 $6.84 N/A $20.01 $34.45 $20.67 $34.45 $7.18 $34.45 N/A N/A 214.25 SUP HCPCS C1713 214.250 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 50MM 12MM SOCKET DCP BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $13.38 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $20.07 $33.45 $6.97 $33.45 N/A N/A 214.252 SUP HCPCS C1713 214.252 - SCREW BONE 4.5MM 52MM SHAFT LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $33.45 $33.45 $6.97 $33.45 N/A N/A 214.254 SUP HCPCS C1713 214.254 - SCREW BONE 4.5MM 54MM SHAFT LC-DCP STAINLESS STEEL CORTICAL BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $33.45 $33.45 $6.97 $33.45 N/A N/A 214.256 SUP HCPCS C1713 214.256 - SCREW BONE 4.5MM 8MM 56MM 15MM SHAFT LC-DCP DHS DCS BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $13.38 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $20.07 $33.45 $6.97 $33.45 N/A N/A 214.26 SUP HCPCS C1713 214.260 - SCREW BONE 4.5MM 60MM SHAFT LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $13.38 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $20.07 $33.45 $6.97 $33.45 N/A N/A 214.268 SUP HCPCS C1713 214.268 - SCREW BONE 4.5MM 68MM SHAFT LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $13.38 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $33.45 $33.45 $6.97 $33.45 N/A N/A 214.272 SUP HCPCS C1713 214.272 - SCREW BONE 4.5MM 8MM 72MM 18MM SHAFT LC-DCP DHS DCS BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $13.38 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $33.45 $33.45 $6.97 $33.45 N/A N/A 214.276 SUP HCPCS C1713 214.276 - SCREW BONE 4.5MM 76MM SHAFT LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $40.00 $30.00 $7.89 $39.75 $17.89 $17.89 $17.89 $17.89 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $39.75 $39.75 $39.75 $8.28 $39.75 $15.90 $23.51 $39.75 $39.75 $39.75 $39.75 $30.00 $39.75 $39.75 $39.75 $19.88 $19.88 $31.48 $39.75 $31.80 $17.89 $7.89 N/A $23.20 $39.75 $39.75 $39.75 $8.28 $39.75 N/A N/A 214.28 SUP HCPCS C1713 214.280 - SCREW BONE 4.5MM 80MM SHAFT DCP LC-DCP STAINLESS STEEL BOTH IP/OP $40.00 $30.00 $7.89 $39.75 $17.89 $17.89 $17.89 $17.89 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $39.75 $39.75 $39.75 $8.28 $39.75 $15.90 $23.51 $39.75 $39.75 $39.75 $39.75 $30.00 $39.75 $39.75 $39.75 $19.88 $19.88 $31.48 $39.75 $31.80 $17.89 $7.89 N/A $23.20 $39.75 $23.85 $39.75 $8.28 $39.75 N/A N/A 214.29 SUP HCPCS C1713 214.290 - SCREW BONE 4.5MM 90MM SHAFT LC-DCP STAINLESS STEEL BOTH IP/OP $40.00 $30.00 $7.89 $39.75 $17.89 $17.89 $17.89 $17.89 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $39.75 $39.75 $39.75 $8.28 $39.75 $15.90 $23.51 $39.75 $39.75 $39.75 $39.75 $30.00 $39.75 $39.75 $39.75 $19.88 $19.88 $31.48 $39.75 $31.80 $17.89 $7.89 N/A $23.20 $39.75 $23.85 $39.75 $8.28 $39.75 N/A N/A 214.295 SUP HCPCS C1713 214.295 - SCREW BONE 4.5MM 95MM SHAFT LC-DCP STAINLESS STEEL BOTH IP/OP $40.00 $30.00 $7.89 $39.75 $17.89 $17.89 $17.89 $17.89 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $39.75 $39.75 $39.75 $8.28 $39.75 $15.90 $23.51 $39.75 $39.75 $39.75 $39.75 $30.00 $39.75 $39.75 $39.75 $19.88 $19.88 $31.48 $39.75 $31.80 $17.89 $7.89 N/A $23.20 $39.75 $23.85 $39.75 $8.28 $39.75 N/A N/A 214.3 SUP HCPCS C1713 214.300 - SCREW BONE 4.5MM 100MM SHAFT LC-DCP DCP STAINLESS STEEL BOTH IP/OP $40.00 $30.00 $7.89 $39.75 $17.89 $17.89 $17.89 $17.89 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $39.75 $39.75 $39.75 $8.28 $39.75 $15.90 $23.51 $39.75 $39.75 $39.75 $39.75 $30.00 $39.75 $39.75 $39.75 $19.88 $19.88 $31.48 $39.75 $31.80 $17.89 $7.89 N/A $23.20 $39.75 $23.85 $39.75 $8.28 $39.75 N/A N/A 214.52 SUP HCPCS C1713 214.520 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $366.00 $271.00 $72.59 $383.13 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $153.25 $216.34 $365.75 $383.13 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $219.45 $365.75 $76.22 $365.75 N/A N/A 214.522 SUP HCPCS C1713 214.522 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 214.524 SUP HCPCS C1713 214.524 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 214.526 SUP HCPCS C1713 214.526 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 214.528 SUP HCPCS C1713 214.528 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 214.53 SUP HCPCS C1713 214.530 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $366.00 $271.00 $72.59 $383.13 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $153.25 $216.34 $365.75 $383.13 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $219.45 $365.75 $76.22 $365.75 N/A N/A 214.532 SUP HCPCS C1713 214.532 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 214.534 SUP HCPCS C1713 214.534 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 214.536 SUP HCPCS C1713 214.536 - SCREW BONE PTHRD 4.5MM 6.5MM 36MM CANN SLFTAP SLFDRILL LARGE BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 214.538 SUP HCPCS C1713 214.538 - SCREW BONE PTHRD 4.5MM 6.5MM 38MM CANN LARGE HEXAGONAL BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 214.54 SUP HCPCS C1713 214.540 - SCREW BONE PTHRD 4.5MM 6.5MM 40MM CANN REVERSE CUTTING FLUTE BOTH IP/OP $366.00 $271.00 $72.59 $383.13 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $383.13 $216.34 $365.75 $383.13 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $219.45 $365.75 $76.22 $365.75 N/A N/A 214.542 SUP HCPCS C1713 214.542 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 214.544 SUP HCPCS C1713 214.544 - SCREW BONE PTHRD 4.5MM 6.5MM 44MM CANN SLFTAP SLFDRILL LARGE BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 214.546 SUP HCPCS C1713 214.546 - SCREW BONE PTHRD 4.5MM 6.5MM 46MM CANN LP HEMISPHERICAL HEAD BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 214.548 SUP HCPCS C1713 214.548 - SCREW BONE PTHRD 4.5MM 6.5MM 48MM CANN SLFTAP SLFDRILL LARGE BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 214.55 SUP HCPCS C1713 214.550 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $366.00 $271.00 $72.59 $383.13 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $383.13 $216.34 $365.75 $383.13 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $219.45 $365.75 $76.22 $365.75 N/A N/A 214.552 SUP HCPCS C1713 214.552 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 214.554 SUP HCPCS C1713 214.554 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 214.556 SUP HCPCS C1713 214.556 - SCREW BONE PTHRD 4.5MM 6.5MM 56MM CANN SLFTAP SLFDRILL LARGE BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 214.56 SUP HCPCS C1713 214.560 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $366.00 $271.00 $72.59 $383.13 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $383.13 $216.34 $365.75 $383.13 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $219.45 $365.75 $76.22 $365.75 N/A N/A 214.564 SUP HCPCS C1713 214.564 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 214.568 SUP HCPCS C1713 214.568 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 214.572 SUP HCPCS C1713 214.572 - SCREW BONE 4.5MM 72MM 24MM CANN PTTHRD STAINLESS STEEL BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 214.576 SUP HCPCS C1713 214.576 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 214.58 SUP HCPCS C1713 214.580 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $377.00 $279.00 $74.76 $394.58 $169.51 $169.51 $169.51 $169.51 $376.68 $376.68 $376.68 $78.51 $376.68 $376.68 $376.68 $376.68 $376.68 $78.50 $376.68 $157.83 $222.81 $376.68 $394.58 $376.68 $376.68 $282.75 $376.68 $376.68 $376.68 $188.34 $188.34 $298.33 $376.68 $301.34 $169.51 $74.76 N/A $218.66 $376.68 $226.01 $376.68 $78.50 $376.68 N/A N/A 214.72 SUP HCPCS C1713 214.720 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $377.00 $279.00 $74.76 $394.58 $169.51 $169.51 $169.51 $169.51 $376.68 $376.68 $376.68 $78.51 $376.68 $376.68 $376.68 $376.68 $376.68 $78.50 $376.68 $157.83 $222.81 $376.68 $394.58 $376.68 $376.68 $282.75 $376.68 $376.68 $376.68 $188.34 $188.34 $298.33 $376.68 $301.34 $169.51 $74.76 N/A $218.66 $376.68 $376.68 $376.68 $78.50 $376.68 N/A N/A 214.722 SUP HCPCS C1713 214.722 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $157.83 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 214.724 SUP HCPCS C1713 214.724 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $157.83 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 214.726 SUP HCPCS C1713 214.726 - SCREW BONE HEMISPHERE FULTHD 4.5MM 6.5MM 1.75MM 26MM CANN BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $157.83 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 214.728 SUP HCPCS C1713 214.728 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $157.83 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 214.73 SUP HCPCS C1713 214.730 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $377.00 $279.00 $74.76 $394.58 $169.51 $169.51 $169.51 $169.51 $376.68 $376.68 $376.68 $78.51 $376.68 $376.68 $376.68 $376.68 $376.68 $78.50 $376.68 $157.83 $222.81 $376.68 $394.58 $376.68 $376.68 $282.75 $376.68 $376.68 $376.68 $188.34 $188.34 $298.33 $376.68 $301.34 $169.51 $74.76 N/A $218.66 $376.68 $226.01 $376.68 $78.50 $376.68 N/A N/A 214.732 SUP HCPCS C1713 214.732 - SCREW BONE HEMISPHERE FULTHD 4.5MM 6.5MM 1.75MM 32MM CANN BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $157.83 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 214.734 SUP HCPCS C1713 214.734 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $157.83 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 214.736 SUP HCPCS C1713 214.736 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $387.98 $387.98 $80.86 $387.98 N/A N/A 214.738 SUP HCPCS C1713 214.738 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $387.98 $387.98 $80.86 $387.98 N/A N/A 214.74 SUP HCPCS C1713 214.740 - SCREW BONE 3.5MM FULTHD 4.5MM 6.5MM 40MM CANN SELF DRILL BOTH IP/OP $377.00 $279.00 $74.76 $394.58 $169.51 $169.51 $169.51 $169.51 $376.68 $376.68 $376.68 $78.51 $376.68 $376.68 $376.68 $376.68 $376.68 $78.50 $376.68 $394.58 $222.81 $376.68 $394.58 $376.68 $376.68 $282.75 $376.68 $376.68 $376.68 $188.34 $188.34 $298.33 $376.68 $301.34 $169.51 $74.76 N/A $218.66 $376.68 $226.01 $376.68 $78.50 $376.68 N/A N/A 214.742 SUP HCPCS C1713 214.742 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $387.98 $387.98 $80.86 $387.98 N/A N/A 214.744 SUP HCPCS C1713 214.744 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $387.98 $387.98 $80.86 $387.98 N/A N/A 214.746 SUP HCPCS C1713 214.746 - SCREW BONE FULTHD 4.5MM 6.5MM 46MM CANN SELF TAP LARGE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $387.98 $387.98 $80.86 $387.98 N/A N/A 214.748 SUP HCPCS C1713 214.748 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $387.98 $387.98 $80.86 $387.98 N/A N/A 214.75 SUP HCPCS C1713 214.750 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $377.00 $279.00 $74.76 $394.58 $169.51 $169.51 $169.51 $169.51 $376.68 $376.68 $376.68 $78.51 $376.68 $376.68 $376.68 $376.68 $376.68 $78.50 $376.68 $394.58 $222.81 $376.68 $394.58 $376.68 $376.68 $282.75 $376.68 $376.68 $376.68 $188.34 $188.34 $298.33 $376.68 $301.34 $169.51 $74.76 N/A $218.66 $376.68 $376.68 $376.68 $78.50 $376.68 N/A N/A 214.752 SUP HCPCS C1713 214.752 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 214.754 SUP HCPCS C1713 214.754 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 214.756 SUP HCPCS C1713 214.756 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $387.98 $387.98 $80.86 $387.98 N/A N/A 214.76 SUP HCPCS C1713 214.760 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $377.00 $279.00 $74.76 $394.58 $169.51 $169.51 $169.51 $169.51 $376.68 $376.68 $376.68 $78.51 $376.68 $376.68 $376.68 $376.68 $376.68 $78.50 $376.68 $394.58 $222.81 $376.68 $394.58 $376.68 $376.68 $282.75 $376.68 $376.68 $376.68 $188.34 $188.34 $298.33 $376.68 $301.34 $169.51 $74.76 N/A $218.66 $376.68 $376.68 $376.68 $78.50 $376.68 N/A N/A 214.764 SUP HCPCS C1713 214.764 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $387.98 $387.98 $80.86 $387.98 N/A N/A 214.768 SUP HCPCS C1713 214.768 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $157.83 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $387.98 $387.98 $80.86 $387.98 N/A N/A 214.772 SUP HCPCS C1713 214.772 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $387.98 $387.98 $80.86 $387.98 N/A N/A 214.776 SUP HCPCS C1713 214.776 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $157.83 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 214.777 SUP HCPCS C1713 214.777 - SCREW BONE FULTHD LARGE HEXAGON HEMISPHERE REVERSE CUT FLUTE BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $157.83 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $387.98 $387.98 $80.86 $387.98 N/A N/A 214.814 SUP HCPCS C1713 214.814 - SCREW BONE 4.5MM 8MM 14MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.816 SUP HCPCS C1713 214.816 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 16MM SELF TAP SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 214.818 SUP HCPCS C1713 214.818 - SCREW BONE 4.5MM 8MM 18MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.82 SUP HCPCS C1713 214.820 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 20MM SELF TAP SOCKET LCP BOTH IP/OP $39.00 $29.00 $7.72 $40.73 $17.50 $17.50 $17.50 $17.50 $38.88 $38.88 $38.88 $8.10 $38.88 $38.88 $38.88 $38.88 $38.88 $8.10 $38.88 $40.73 $23.00 $38.88 $40.73 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $17.50 $7.72 N/A $22.62 $38.88 $23.33 $38.88 $8.10 $38.88 N/A N/A 214.822 SUP HCPCS C1713 214.822 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 22MM SELF TAP SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 214.824 SUP HCPCS C1713 214.824 - SCREW BONE 4.5MM 8MM 24MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.826 SUP HCPCS C1713 214.826 - SCREW BONE 4.5MM 8MM 26MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.828 SUP HCPCS C1713 214.828 - SCREW BONE 4.5MM 28MM SLFTAP LCP STAINLESS STEEL PEDIATRIC BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.83 SUP HCPCS C1713 214.830 - SCREW BONE 4.5MM 8MM 30MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $39.00 $29.00 $7.72 $40.73 $17.50 $17.50 $17.50 $17.50 $38.88 $38.88 $38.88 $8.10 $38.88 $38.88 $38.88 $38.88 $38.88 $8.10 $38.88 $40.73 $23.00 $38.88 $40.73 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $17.50 $7.72 N/A $22.62 $38.88 $23.33 $38.88 $8.10 $38.88 N/A N/A 214.83 SUP HCPCS C1713 214.83 - SCREW BONE 4.5MM 8MM 30MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.72 $40.73 $17.50 $17.50 $17.50 $17.50 $38.88 $38.88 $38.88 $8.10 $38.88 $38.88 $38.88 $38.88 $38.88 $8.10 $38.88 $40.73 $23.00 $38.88 $40.73 $38.88 $38.88 $30.38 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $17.50 $7.72 N/A $23.49 $38.88 $23.33 $38.88 $8.10 $38.88 N/A N/A 214.832 SUP HCPCS C1713 214.832 - SCREW BONE 4.5MM 8MM 32MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 214.834 SUP HCPCS C1713 214.834 - SCREW BONE 4.5MM 8MM 34MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.836 SUP HCPCS C1713 214.836 - SCREW BONE 4.5MM 8MM 36MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.838 SUP HCPCS C1713 214.838 - SCREW BONE 4.5MM 38MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 214.84 SUP HCPCS C1713 214.840 - SCREW BONE STANDARD 4.5MM 40MM SLFTAP TIP LCP STAINLESS BOTH IP/OP $39.00 $29.00 $7.95 $40.05 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.02 $23.69 $40.05 $40.05 $40.05 $40.05 $29.25 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $22.62 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.84 SUP HCPCS C1713 214.84 - SCREW BN 4.5MM 8MM 40MM NS ST LG HEX SCKT SS CORT LG FRAG BOTH IP/OP $40.50 $30.00 $7.95 $40.05 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.02 $23.69 $40.05 $40.05 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.842 SUP HCPCS C1713 214.842 - SCREW BONE 4.5MM 8MM 42MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 214.844 SUP HCPCS C1713 214.844 - SCREW BONE 4.5MM 8MM 44MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 214.846 SUP HCPCS C1713 214.846 - SCREW BONE 4.5MM 46MM SLFTAP TIP LCP STAINLESS STEEL BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 214.848 SUP HCPCS C1713 214.848 - SCREW BONE 4.5MM 48MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.85 SUP HCPCS C1713 214.850 - SCREW BONE 4.5MM 8MM 50MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $39.00 $29.00 $7.95 $40.05 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.02 $23.69 $40.05 $40.05 $40.05 $40.05 $29.25 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $22.62 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.85 SUP HCPCS C1713 214.85 - SCREW BONE 4.5MM 8MM 50MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.05 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.02 $23.69 $40.05 $40.05 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.852 SUP HCPCS C1713 214.852 - SCREW BONE 4.5MM 52MM SELF TAP LC-DCP DHS DCS STAINLESS BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.854 SUP HCPCS C1713 214.854 - SCREW BONE 4.5MM 54MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.856 SUP HCPCS C1713 214.856 - SCREW BONE 4.5MM 56MM SLFTAP LC-DCP DHS DCS STAINLESS STEEL BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 214.858 SUP HCPCS C1713 214.858 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 58MM SELF TAP SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.86 SUP HCPCS C1713 214.860 - SCREW BONE 4.5MM 8MM 60MM SELF TAP HEXAGONAL SOCKET LCP BOTH IP/OP $39.00 $29.00 $7.72 $40.73 $17.50 $17.50 $17.50 $17.50 $38.88 $38.88 $38.88 $8.10 $38.88 $38.88 $38.88 $38.88 $38.88 $8.10 $38.88 $40.73 $23.00 $38.88 $40.73 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $17.50 $7.72 N/A $22.62 $38.88 $23.33 $38.88 $8.10 $38.88 N/A N/A 214.86 SUP HCPCS C1713 214.86 - SCREW BONE 4.5MM 8MM 60MM SELF TAP HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.72 $40.73 $17.50 $17.50 $17.50 $17.50 $38.88 $38.88 $38.88 $8.10 $38.88 $38.88 $38.88 $38.88 $38.88 $8.10 $38.88 $40.73 $23.00 $38.88 $40.73 $38.88 $38.88 $30.38 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $17.50 $7.72 N/A $23.49 $38.88 $23.33 $38.88 $8.10 $38.88 N/A N/A 214.862 SUP HCPCS C1713 214.862 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 62MM SELF TAP SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 214.864 SUP HCPCS C1713 214.864 - SCREW BONE 4.5MM 8MM 64MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 214.866 SUP HCPCS C1713 214.866 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 66MM SELF TAP SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.868 SUP HCPCS C1713 214.868 - SCREW BONE 4.5MM 8MM 68MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 214.87 SUP HCPCS C1713 214.870 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 70MM SELF TAP SOCKET LCP BOTH IP/OP $39.00 $29.00 $7.95 $40.05 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.02 $23.69 $40.05 $40.05 $40.05 $40.05 $29.25 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $22.62 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.87 SUP HCPCS C1713 214.87 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 70MM SELF TAP SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.05 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.02 $23.69 $40.05 $40.05 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 214.872 SUP HCPCS C1713 214.872 - SCREW BONE 4.5MM 8MM 72MM SELF TAP HEXAGONAL SOCKET LCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 214.876 SUP HCPCS C1713 214.876 - SCREW BONE 4.5MM 8MM 76MM SELF TAP HEXAGONAL SOCKET LCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $67.20 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $39.65 $66.08 $13.77 $66.08 N/A N/A 214.88 SUP HCPCS C1713 214.880 - SCREW BONE 4.5MM 80MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $64.15 $64.15 $13.37 $64.15 N/A N/A 214.885 SUP HCPCS C1713 214.885 - SCREW BONE 4.5MM 8MM 85MM SELF TAP HEXAGONAL SOCKET LCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $66.08 $66.08 $13.77 $66.08 N/A N/A 214.89 SUP HCPCS C1713 214.890 - SCREW BONE 4.5MM 8MM 90MM SELF TAP HEXAGONAL SOCKET LCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $67.20 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $38.49 $64.15 $13.37 $64.15 N/A N/A 214.895 SUP HCPCS C1713 214.895 - SCREW BONE 4.5MM 8MM 95MM SELF TAP LARGE HEXAGONAL SOCKET BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $66.08 $66.08 $13.77 $66.08 N/A N/A 214.9 SUP HCPCS C1713 214.900 - SCREW BONE 4.5MM 8MM 100MM SELF TAP HEXAGONAL SOCKET LCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $64.15 $64.15 $13.37 $64.15 N/A N/A 214.905 SUP HCPCS C1713 214.905 - SCREW BONE 4.5MM 8MM 105MM SELF TAP HEXAGONAL SOCKET LCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $66.08 $66.08 $13.77 $66.08 N/A N/A 214.91 SUP HCPCS C1713 214.910 - SCREW BONE 4.5MM 8MM 110MM SELF TAP HEXAGONAL SOCKET LCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $64.15 $64.15 $13.37 $64.15 N/A N/A 214.915 SUP HCPCS C1713 214.915 - SCREW BONE 4.5MM 8MM 115MM SELF TAP HEXAGONAL SOCKET LCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $66.08 $66.08 $13.77 $66.08 N/A N/A 214.92 SUP HCPCS C1713 214.920 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 120MM SELF TAP SOCKET LCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $64.15 $64.15 $13.37 $64.15 N/A N/A 214.925 SUP HCPCS C1713 214.925 - SCREW BONE 4.5MM 8MM 125MM SELF TAP HEXAGONAL SOCKET LCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $66.08 $66.08 $13.77 $66.08 N/A N/A 214.93 SUP HCPCS C1713 214.930 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 130MM SELF TAP SOCKET LCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $64.15 $64.15 $13.37 $64.15 N/A N/A 214.935 SUP HCPCS C1713 214.935 - SCREW BONE 4.5MM 8MM 135MM SELF TAP HEXAGONAL SOCKET LCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $66.08 $66.08 $13.77 $66.08 N/A N/A 214.94 SUP HCPCS C1713 214.940 - SCREW BONE 4.5MM 8MM 140MM SLFTAP LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $64.15 $64.15 $13.37 $64.15 N/A N/A 214.945 SUP HCPCS C1713 214.945 - SCREW BONE 4.5MM 8MM 145MM SELF TAP HEXAGONAL SOCKET LCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $66.08 $66.08 $13.77 $66.08 N/A N/A 215.025 SUP HCPCS C1713 215.025 - SCREW BONE 3.5MM HEXAGON 4.5MM 8MM 25MM 12MM DCP LC-DCP BOTH IP/OP $56.50 $42.00 $11.17 $56.30 $25.34 $25.34 $25.34 $25.34 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $33.30 $56.30 $56.30 $56.30 $56.30 $42.38 $56.30 $56.30 $56.30 $28.15 $28.15 $44.59 $56.30 $45.04 $25.34 $11.17 N/A $32.77 $56.30 $33.78 $56.30 $11.73 $56.30 N/A N/A 215.03 SUP HCPCS C1713 215.030 - SCREW BONE PTHRD 4.5MM 8MM 30MM 15MM HEXAGONAL SOCKET LCP BOTH IP/OP $56.50 $42.00 $11.17 $56.30 $25.34 $25.34 $25.34 $25.34 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $33.30 $56.30 $56.30 $56.30 $56.30 $42.38 $56.30 $56.30 $56.30 $28.15 $28.15 $44.59 $56.30 $45.04 $25.34 $11.17 N/A $32.77 $56.30 $33.78 $56.30 $11.73 $56.30 N/A N/A 215.035 SUP HCPCS C1713 215.035 - SCREW BONE 4.5MM 35MM IMPLANT LC-DCP DCP MALLEOLAR LARGE BOTH IP/OP $56.50 $42.00 $11.17 $56.30 $25.34 $25.34 $25.34 $25.34 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $33.30 $56.30 $56.30 $56.30 $56.30 $42.38 $56.30 $56.30 $56.30 $28.15 $28.15 $44.59 $56.30 $45.04 $25.34 $11.17 N/A $32.77 $56.30 $33.78 $56.30 $11.73 $56.30 N/A N/A 215.04 SUP HCPCS C1713 215.040 - SCREW BONE 4.5MM 40MM DCP LC-DCP STAINLESS STEEL MALLEOLAR BOTH IP/OP $56.50 $42.00 $11.17 $56.30 $25.34 $25.34 $25.34 $25.34 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $56.30 $56.30 $56.30 $11.73 $56.30 $22.52 $33.30 $56.30 $56.30 $56.30 $56.30 $42.38 $56.30 $56.30 $56.30 $28.15 $28.15 $44.59 $56.30 $45.04 $25.34 $11.17 N/A $32.77 $56.30 $33.78 $56.30 $11.73 $56.30 N/A N/A 215.045 SUP HCPCS C1713 215.045 - SCREW BONE 3.5MM 4.5MM 8MM 45MM 22MM HEXAGONAL SOCKET LC-DCP BOTH IP/OP $56.50 $42.00 $11.17 $56.30 $25.34 $25.34 $25.34 $25.34 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $33.30 $56.30 $56.30 $56.30 $56.30 $42.38 $56.30 $56.30 $56.30 $28.15 $28.15 $44.59 $56.30 $45.04 $25.34 $11.17 N/A $32.77 $56.30 $33.78 $56.30 $11.73 $56.30 N/A N/A 215.05 SUP HCPCS C1713 215.050 - SCREW BONE PTHRD 4.5MM 8MM 50MM 24MM HEXAGONAL SOCKET LCP BOTH IP/OP $56.50 $42.00 $11.17 $56.30 $25.34 $25.34 $25.34 $25.34 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $56.30 $56.30 $56.30 $11.73 $56.30 $22.52 $33.30 $56.30 $56.30 $56.30 $56.30 $42.38 $56.30 $56.30 $56.30 $28.15 $28.15 $44.59 $56.30 $45.04 $25.34 $11.17 N/A $32.77 $56.30 $33.78 $56.30 $11.73 $56.30 N/A N/A 215.055 SUP HCPCS C1713 215.055 - SCREW BONE 3.5MM HEXAGON 4.5MM 8MM 55MM 26MM DCP LC-DCP BOTH IP/OP $56.50 $42.00 $11.17 $56.30 $25.34 $25.34 $25.34 $25.34 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $33.30 $56.30 $56.30 $56.30 $56.30 $42.38 $56.30 $56.30 $56.30 $28.15 $28.15 $44.59 $56.30 $45.04 $25.34 $11.17 N/A $32.77 $56.30 $33.78 $56.30 $11.73 $56.30 N/A N/A 215.06 SUP HCPCS C1713 215.060 - SCREW BONE 3.5MM 4.5MM 8MM 60MM 28MM HEXAGONAL SOCKET LCP BOTH IP/OP $56.50 $42.00 $11.17 $56.30 $25.34 $25.34 $25.34 $25.34 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $33.30 $56.30 $56.30 $56.30 $56.30 $42.38 $56.30 $56.30 $56.30 $28.15 $28.15 $44.59 $56.30 $45.04 $25.34 $11.17 N/A $32.77 $56.30 $56.30 $56.30 $11.73 $56.30 N/A N/A 215.065 SUP HCPCS C1713 215.065 - SCREW BONE 3.5MM 4.5MM 65MM 30MM HEXAGONAL SOCKET LCP BOTH IP/OP $56.50 $42.00 $11.17 $56.30 $25.34 $25.34 $25.34 $25.34 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $33.30 $56.30 $56.30 $56.30 $56.30 $42.38 $56.30 $56.30 $56.30 $28.15 $28.15 $44.59 $56.30 $45.04 $25.34 $11.17 N/A $32.77 $56.30 $33.78 $56.30 $11.73 $56.30 N/A N/A 215.07 SUP HCPCS C1713 215.070 - SCREW BONE 3.5MM 4.5MM 8MM 70MM 32MM HEXAGONAL SOCKET LCP BOTH IP/OP $56.50 $42.00 $11.17 $56.30 $25.34 $25.34 $25.34 $25.34 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $33.30 $56.30 $56.30 $56.30 $56.30 $42.38 $56.30 $56.30 $56.30 $28.15 $28.15 $44.59 $56.30 $45.04 $25.34 $11.17 N/A $32.77 $56.30 $33.78 $56.30 $11.73 $56.30 N/A N/A 215.075 SUP HCPCS C1713 215.075 - SCREW BONE 4.5MM 75MM LC-DCP STAINLESS STEEL MALLEOLAR BOTH IP/OP $56.50 $42.00 $11.17 $56.30 $25.34 $25.34 $25.34 $25.34 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $56.30 $56.30 $56.30 $11.73 $56.30 $22.52 $33.30 $56.30 $56.30 $56.30 $56.30 $42.38 $56.30 $56.30 $56.30 $28.15 $28.15 $44.59 $56.30 $45.04 $25.34 $11.17 N/A $32.77 $56.30 $56.30 $56.30 $11.73 $56.30 N/A N/A 215.08 SUP HCPCS C1713 215.080 - SCREW BONE 4.5MM 80MM LC-DCP STAINLESS STEEL MALLEOLAR BOTH IP/OP $56.50 $42.00 $11.17 $56.30 $25.34 $25.34 $25.34 $25.34 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $56.30 $56.30 $56.30 $11.73 $56.30 $56.30 $33.30 $56.30 $56.30 $56.30 $56.30 $42.38 $56.30 $56.30 $56.30 $28.15 $28.15 $44.59 $56.30 $45.04 $25.34 $11.17 N/A $32.77 $56.30 $56.30 $56.30 $11.73 $56.30 N/A N/A 215.222 SUP HCPCS C1713 "215.222 - 3.5mm SS PROTEX CT Polyaxail Shoulder Screw, 22mm" BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$1,600.00" "$1,972.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" $793.90 N/A "$2,320.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.60 "$4,000.00" N/A N/A 215.224 SUP HCPCS C1713 "215.224 - 3.5mm SS PROTEX CT Polyaxail Shoulder Screw, 24mm" BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$1,600.00" "$1,972.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" $793.90 N/A "$2,320.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.60 "$4,000.00" N/A N/A 215.226 SUP HCPCS C1713 "215.226 - 3.5mm SS PROTEX CT Polyaxail Shoulder Screw, 26mm" BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$1,600.00" "$1,972.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" $793.90 N/A "$2,320.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.60 "$4,000.00" N/A N/A 215.228 SUP HCPCS C1713 "215.228 - 3.5mm SS PROTEX CT Polyaxail Shoulder Screw, 28mm" BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$1,600.00" "$1,972.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" $793.90 N/A "$2,320.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.60 "$4,000.00" N/A N/A 215.23 SUP HCPCS C1713 "215.230 - 3.5mm SS PROTEX CT Polyaxail Shoulder Screw, 30mm" BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$1,600.00" "$1,972.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" $793.90 N/A "$2,320.00" "$4,000.00" "$2,400.00" "$4,000.00" $833.60 "$4,000.00" N/A N/A 215.232 SUP HCPCS C1713 "215.232 - 3.5mm SS PROTEX CT Polyaxail Shoulder Screw, 32mm" BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$1,600.00" "$1,972.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" $793.90 N/A "$2,320.00" "$4,000.00" "$2,400.00" "$4,000.00" $833.60 "$4,000.00" N/A N/A 215.234 SUP HCPCS C1713 "215.234 - 3.5mm SS PROTEX CT Polyaxail Shoulder Screw, 34mm" BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$1,600.00" "$1,972.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" $793.90 N/A "$2,320.00" "$4,000.00" "$2,400.00" "$4,000.00" $833.60 "$4,000.00" N/A N/A 215.236 SUP HCPCS C1713 "215.236 - 3.5mm SS PROTEX CT Polyaxail Shoulder Screw, 36mm" BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$1,600.00" "$1,972.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" $793.90 N/A "$2,320.00" "$4,000.00" "$2,400.00" "$4,000.00" $833.60 "$4,000.00" N/A N/A 215.308 SUP HCPCS C1713 "215.308 - 3.5mm SS PROTEX CT Polyaxial Screw, 8mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.31 SUP HCPCS C1713 "215.310 - 3.5mm SS PROTEX CT Polyaxial Screw, 10mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.312 SUP HCPCS C1713 "215.312 - 3.5mm SS PROTEX CT Polyaxial Screw, 12mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.314 SUP HCPCS C1713 "215.314 - 3.5mm SS PROTEX CT Polyaxial Screw, 14mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.316 SUP HCPCS C1713 "215.316 - 3.5mm SS PROTEX CT Polyaxial Screw, 16mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.318 SUP HCPCS C1713 "215.318 - 3.5mm SS PROTEX CT Polyaxial Screw, 18mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.32 SUP HCPCS C1713 "215.320 - 3.5mm SS PROTEX CT Polyaxial Screw, 20mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.322 SUP HCPCS C1713 "215.322 - 3.5mm SS PROTEX CT Polyaxial Screw, 22mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.324 SUP HCPCS C1713 "215.324 - 3.5mm SS PROTEX CT Polyaxial Screw, 24mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.326 SUP HCPCS C1713 "215.326 - 3.5mm SS PROTEX CT Polyaxial Screw, 26mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.328 SUP HCPCS C1713 "215.328 - 3.5mm SS PROTEX CT Polyaxial Screw, 28mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.33 SUP HCPCS C1713 "215.330 - 3.5mm SS PROTEX CT Polyaxial Screw, 30mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.335 SUP HCPCS C1713 "215.335 - 3.5mm SS PROTEX CT Polyaxial Screw, 35mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.34 SUP HCPCS C1713 "215.340 - 3.5mm SS PROTEX CT Polyaxial Screw, 40mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.345 SUP HCPCS C1713 "215.345 - 3.5mm SS PROTEX CT Polyaxial Screw, 45mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.35 SUP HCPCS C1713 "215.350 - 3.5mm SS PROTEX CT Polyaxial Screw, 50mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.41 SUP HCPCS C1713 "215.410 - 4.0mm SS PROTEX? CT Polyaxial Screw, 10mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.412 SUP HCPCS C1713 "215.412 - 4.0mm SS PROTEX CT Polyaxial Screw, 12mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.414 SUP HCPCS C1713 "215.414 - 4.0mm SS PROTEX CT Polyaxial Screw, 14mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.416 SUP HCPCS C1713 "215.416 - 4.0mm SS PROTEX CT Polyaxial Screw, 16mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.418 SUP HCPCS C1713 "215.418 - 4.0mm SS PROTEX CT Polyaxial Screw, 18mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.42 SUP HCPCS C1713 "215.420 - 4.0mm SS PROTEX CT Polyaxial Screw, 20mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.422 SUP HCPCS C1713 "215.422 - 4.0mm SS PROTEX CT Polyaxial Screw, 22mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.424 SUP HCPCS C1713 "215.424 - 4.0mm SS PROTEX CT Polyaxial Screw, 24mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.426 SUP HCPCS C1713 "215.426 - 4.0mm SS PROTEX CT Polyaxial Screw, 26mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.428 SUP HCPCS C1713 "215.428 - 4.0mm SS PROTEX CT Polyaxial Screw, 28mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.43 SUP HCPCS C1713 "215.430 - 4.0mm SS PROTEX CT Polyaxial Screw, 30mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.435 SUP HCPCS C1713 "215.435 - 4.0mm SS PROTEX CT Polyaxial Screw, 35mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.44 SUP HCPCS C1713 "215.440 - 4.0mm SS PROTEX CT Polyaxial Screw, 40mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.445 SUP HCPCS C1713 "215.445 - 4.0mm SS PROTEX CT Polyaxial Screw, 45mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.45 SUP HCPCS C1713 "215.450 - 4.0mm SS PROTEX CT Polyaxial Screw, 50mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.5 SUP HCPCS C1713 215.500 - SS PROTEX CT Locking Cap BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" $400.00 $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" $600.00 "$1,000.00" $208.40 "$1,000.00" N/A N/A 215.501 SUP HCPCS C1713 215.501 - SS PROTEX Hook BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 215.503 SUP Custom 27803010 "215.503 - SS PROTEX Hook, Right" BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 215.504 SUP Custom 27803010 "215.504 - SS PROTEX Hook, Left" BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 215.506 SUP Custom 27803010 "215.506 - SS PROTEX Hook, 7mm Offset, Left" BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 215.507 SUP Custom 27803010 "215.507 - SS PROTEX Hook, 5mm Offset, Left" BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 215.508 SUP Custom 27803010 "215.508 - SS PROTEX Hook, 7mm Offset, Right" BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 215.509 SUP Custom 27803010 "215.509 - SS PROTEX Hook, 5mm Offset, Right" BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 215.51 SUP HCPCS C1713 "215.510 - 4.5mm SS PROTEX CT Polyaxial Screw, 10mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.512 SUP HCPCS C1713 "215.512 - 4.5mm SS PROTEX CT Polyaxial Screw, 12mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.514 SUP HCPCS C1713 "215.514 - 4.5mm SS PROTEX CT Polyaxial Screw, 14mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.516 SUP HCPCS C1713 "215.516 - 4.5mm SS PROTEX CT Polyaxial Screw, 16mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.518 SUP HCPCS C1713 "215.518 - 4.5mm SS PROTEX CT Polyaxial Screw, 18mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.52 SUP HCPCS C1713 "215.520 - 4.5mm SS PROTEX CT Polyaxial Screw, 20mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.522 SUP HCPCS C1713 "215.522 - 4.5mm SS PROTEX CT Polyaxial Screw, 22mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.524 SUP HCPCS C1713 "215.524 - 4.5mm SS PROTEX CT Polyaxial Screw, 24mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.526 SUP HCPCS C1713 "215.526 - 4.5mm SS PROTEX CT Polyaxial Screw, 26mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.528 SUP HCPCS C1713 "215.528 - 4.5mm SS PROTEX CT Polyaxial Screw, 28mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.53 SUP HCPCS C1713 "215.530 - 4.5mm SS PROTEX CT Polyaxial Screw, 30mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.535 SUP HCPCS C1713 "215.535 - 4.5mm SS PROTEX CT Polyaxial Screw, 35mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.54 SUP HCPCS C1713 "215.540 - 4.5mm SS PROTEX CT Polyaxial Screw, 40mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.545 SUP HCPCS C1713 "215.545 - 4.5mm SS PROTEX CT Polyaxial Screw, 45mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.55 SUP HCPCS C1713 "215.550 - 4.5mm SS PROTEX CT Polyaxial Screw, 50mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.625 SUP HCPCS C1713 "215.625 - 5.0mm SS PROTEX CT Polyaxial Screw, 25mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.63 SUP HCPCS C1713 "215.630 - 5.0mm SS PROTEX CT Polyaxial Screw, 30mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.635 SUP HCPCS C1713 "215.635 - 5.0mm SS PROTEX CT Polyaxial Screw, 35mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.64 SUP HCPCS C1713 "215.640 - 5.0mm SS PROTEX CT Polyaxial Screw, 40mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.645 SUP HCPCS C1713 "215.645 - 5.0mm SS PROTEX CT Polyaxial Screw, 45mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.65 SUP HCPCS C1713 "215.650 - 5.0mm SS PROTEX CT Polyaxial Screw, 50mm" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 215.801 SUP Custom 27803010 "215.801 - 3.7mm SS Straight Rod, 80mm" BOTH IP/OP $825.00 $611.00 $146.85 $825.00 $825.00 $825.00 $825.00 $825.00 $825.00 $825.00 $146.85 $825.00 $825.00 $825.00 $825.00 $825.00 $825.00 $171.94 $825.00 $330.00 $825.00 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $371.25 $825.00 N/A $478.50 $825.00 $495.00 $825.00 $825.00 $825.00 N/A N/A 215.802 SUP Custom 27803010 "215.802 - 3.7mm SS Straight Rod, 120mm" BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" $400.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A 215.803 SUP Custom 27803010 "215.803 - 3.7mm SS Straight Rod, 240mm" BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $475.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A 215.804 SUP Custom 27803010 "215.804 - 3.7mm SS Straight Rod, 40mm" BOTH IP/OP $675.00 $500.00 $120.15 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $120.15 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $270.00 $675.00 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $675.00 N/A $391.50 $675.00 $405.00 $675.00 $675.00 $675.00 N/A N/A 215.806 SUP HCPCS C1713 "215.806 - 4.0mm SS PROTEX CT OC Standard Screw, Self-Tapping, 6mm" BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $425.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A 215.808 SUP HCPCS C1713 "215.808 - 4.0mm SS PROTEX CT OC Standard Screw, Self-Tapping, 8mm" BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $425.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A 215.81 SUP HCPCS C1713 "215.810 - 4.0mm SS PROTEX CT OC Standard Screw, Self-Tapping, 10mm" BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,062.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A 215.812 SUP HCPCS C1713 "215.812 - 4.0mm SS PROTEX CT OC Standard Screw, Self-Tapping, 12mm" BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,062.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A 215.814 SUP HCPCS C1713 "215.814 - 4.0mm SS PROTEX CT OC Standard Screw, Self-Tapping, 14mm" BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $425.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A 215.816 SUP HCPCS C1713 "215.816 - 4.0mm SS PROTEX CT OC Standard Screw, Self-Tapping, 16mm" BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $425.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" "$1,062.50" "$1,062.50" $221.43 "$1,062.50" N/A N/A 215.906 SUP HCPCS C1713 "215.906 - 4.5mm SS PROTEX CT OC Standard Screw, Self-Tapping, 6mm" BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $425.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A 215.908 SUP HCPCS C1713 "215.908 - 4.5mm SS PROTEX CT OC Standard Screw, Self-Tapping, 8mm" BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,062.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A 215.91 SUP HCPCS C1713 "215.910 - 4.5mm SS PROTEX CT OC Standard Screw, Self-Tapping, 10mm" BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $425.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A 215.912 SUP HCPCS C1713 "215.912 - 4.5mm SS PROTEX CT OC Standard Screw, Self-Tapping, 12mm" BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $425.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A 215.914 SUP HCPCS C1713 "215.914 - 4.5mm SS PROTEX CT OC Standard Screw, Self-Tapping, 14mm" BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $425.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A 215.916 SUP HCPCS C1713 "215.916 - 4.5mm SS PROTEX CT OC Standard Screw, Self-Tapping, 16mm" BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,062.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A 215.923 SUP Custom 27803010 "215.923 - SS Top Loading T-Connector for 3.7mm Rod, 21-33mm, Straight" BOTH IP/OP "$4,000.00" "$2,960.00" $712.00 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $712.00 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$1,600.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" "$4,000.00" N/A "$2,320.00" "$4,000.00" "$2,400.00" "$4,000.00" "$4,000.00" "$4,000.00" N/A N/A 215.925 SUP Custom 27803010 "215.925 - SS Top Loading T-Connector for 3.7mm Rod, 26-46mm, Straight" BOTH IP/OP "$4,000.00" "$2,960.00" $712.00 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $712.00 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$1,600.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" "$4,000.00" N/A "$2,320.00" "$4,000.00" "$2,400.00" "$4,000.00" "$4,000.00" "$4,000.00" N/A N/A 215.927 SUP Custom 27803010 "215.927 - SS Top Loading T-Connector for 3.7mm Rod, 36-56mm, Straight" BOTH IP/OP "$4,000.00" "$2,960.00" $712.00 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $712.00 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$1,600.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" "$4,000.00" N/A "$2,320.00" "$4,000.00" "$2,400.00" "$4,000.00" "$4,000.00" "$4,000.00" N/A N/A 215.949 SUP HCPCS C1713 "215.949 - SS Set Screw, M4.5 x 0.75, Round Tip, 2.5mm Hex" BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A 215.95 SUP Custom 27803010 "215.950 - SS Occipital Clamp, Single, Short" BOTH IP/OP "$1,050.00" $777.00 $186.90 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $186.90 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $218.83 "$1,050.00" $420.00 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $787.50 "$1,050.00" "$1,050.00" "$1,050.00" $525.00 $525.00 $831.60 "$1,050.00" $840.00 $472.50 "$1,050.00" N/A $609.00 "$1,050.00" $630.00 "$1,050.00" "$1,050.00" "$1,050.00" N/A N/A 215.951 SUP Custom 27803010 "215.951 - SS Occipital Clamp, Single, Long" BOTH IP/OP "$1,050.00" $777.00 $186.90 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $186.90 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $218.83 "$1,050.00" $420.00 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $787.50 "$1,050.00" "$1,050.00" "$1,050.00" $525.00 $525.00 $831.60 "$1,050.00" $840.00 $472.50 "$1,050.00" N/A $609.00 "$1,050.00" $630.00 "$1,050.00" "$1,050.00" "$1,050.00" N/A N/A 215.952 SUP HCPCS C1713 "215.952 - SS Set Screw, M4.5 x 0.75" BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A 215.953 SUP Custom 27803010 "215.953 - SS 3.7mm Occipital Rod, 240mm, 100deg" BOTH IP/OP "$1,575.00" "$1,166.00" $280.35 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $280.35 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 "$1,575.00" N/A $913.50 "$1,575.00" $945.00 "$1,575.00" "$1,575.00" "$1,575.00" N/A N/A 215.954 SUP Custom 27803010 "215.954 - SS 3.7mm Occipital Rod, 240mm, 115deg" BOTH IP/OP "$1,575.00" "$1,166.00" $280.35 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $280.35 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 "$1,575.00" N/A $913.50 "$1,575.00" $945.00 "$1,575.00" "$1,575.00" "$1,575.00" N/A N/A 215.955 SUP Custom 27803010 "215.955 - SS 3.7mm Occipital Rod, 240mm, 130deg" BOTH IP/OP "$1,575.00" "$1,166.00" $280.35 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $280.35 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 "$1,575.00" N/A $913.50 "$1,575.00" $945.00 "$1,575.00" "$1,575.00" "$1,575.00" N/A N/A 215.956 SUP Custom 27803010 "215.956 - SS Occipital Clamp, Triple, Short" BOTH IP/OP "$1,575.00" "$1,166.00" $280.35 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $280.35 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 "$1,575.00" N/A $913.50 "$1,575.00" $945.00 "$1,575.00" "$1,575.00" "$1,575.00" N/A N/A 215.957 SUP Custom 27803010 "215.957 - SS Occipital Clamp, Triple, Long" BOTH IP/OP "$1,575.00" "$1,166.00" $280.35 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $280.35 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 "$1,575.00" N/A $913.50 "$1,575.00" $945.00 "$1,575.00" "$1,575.00" "$1,575.00" N/A N/A 215.958 SUP Custom 27803010 "215.958 - SS Occipital Clamp, Double, Short" BOTH IP/OP "$1,312.50" $971.00 $233.63 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $233.63 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 "$1,312.50" N/A $761.25 "$1,312.50" $787.50 "$1,312.50" "$1,312.50" "$1,312.50" N/A N/A 215.959 SUP Custom 27803010 "215.959 - SS Occipital Clamp, Double, Long" BOTH IP/OP "$1,312.50" $971.00 $233.63 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $233.63 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 "$1,312.50" N/A $761.25 "$1,312.50" $787.50 "$1,312.50" "$1,312.50" "$1,312.50" N/A N/A 215.96 SUP Custom 27803010 "215.960 - SS Parallel Connector, 3.7mm Rod to 3.7mm Rod" BOTH IP/OP "$1,787.50" "$1,323.00" $318.18 "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" $318.18 "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" $372.53 "$1,787.50" $715.00 "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,340.63" "$1,787.50" "$1,787.50" "$1,787.50" $893.75 $893.75 "$1,415.70" "$1,787.50" "$1,430.00" $804.38 "$1,787.50" N/A "$1,036.75" "$1,787.50" "$1,072.50" "$1,787.50" "$1,787.50" "$1,787.50" N/A N/A 215.963 SUP Custom 27803010 "215.963 - SS Parallel Connector, 3.7mm Rod to 5.5mm Rod" BOTH IP/OP "$1,787.50" "$1,323.00" $318.18 "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" $318.18 "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" $372.53 "$1,787.50" $715.00 "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,340.63" "$1,787.50" "$1,787.50" "$1,787.50" $893.75 $893.75 "$1,415.70" "$1,787.50" "$1,430.00" $804.38 "$1,787.50" N/A "$1,036.75" "$1,787.50" "$1,072.50" "$1,787.50" "$1,787.50" "$1,787.50" N/A N/A 215.984 SUP Custom 27803010 "215.984 - SS Tapered Rod, 3.7mm to 5.5mm, 350mm" BOTH IP/OP "$1,625.00" "$1,203.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" $650.00 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 "$1,625.00" N/A $942.50 "$1,625.00" $975.00 "$1,625.00" "$1,625.00" "$1,625.00" N/A N/A 215.99 SUP Custom 27803010 215.990 - SS Lateral Connector BOTH IP/OP "$1,625.00" "$1,203.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" $650.00 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 "$1,625.00" N/A $942.50 "$1,625.00" $975.00 "$1,625.00" "$1,625.00" "$1,625.00" N/A N/A 215.991 SUP Custom 27803010 "215.991 - SS Lateral Connector, Short" BOTH IP/OP "$1,625.00" "$1,203.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" $650.00 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 "$1,625.00" N/A $942.50 "$1,625.00" $975.00 "$1,625.00" "$1,625.00" "$1,625.00" N/A N/A 216.03 SUP HCPCS C1713 216.030 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 30MM 16MM SOCKET LCP DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 216.035 SUP HCPCS C1713 216.035 - SCREW BONE PTHRD 6.5MM 8MM 35MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 216.04 SUP HCPCS C1713 216.040 - SCREW BONE PTHRD 6.5MM 8MM 40MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 216.045 SUP HCPCS C1713 216.045 - SCREW BONE PTHRD 6.5MM 8MM 45MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 216.05 SUP HCPCS C1713 216.050 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 50MM 16MM SOCKET LCP DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $62.18 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 216.055 SUP HCPCS C1713 216.055 - SCREW BONE PTHRD 6.5MM 8MM 55MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $62.18 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 216.06 SUP HCPCS C1713 216.060 - SCREW BONE PTHRD 6.5MM 8MM 60MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $62.18 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 216.065 SUP HCPCS C1713 216.065 - SCREW BONE PTHRD 6.5MM 8MM 65MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $62.18 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $61.13 $61.13 $12.74 $61.13 N/A N/A 216.07 SUP HCPCS C1713 216.070 - SCREW BONE PTHRD 6.5MM 8MM 70MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $62.18 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $59.35 $59.35 $12.37 $59.35 N/A N/A 216.075 SUP HCPCS C1713 216.075 - SCREW BONE PTHRD 6.5MM 8MM 75MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $62.18 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 216.08 SUP HCPCS C1713 216.080 - SCREW BONE PTHRD 6.5MM 8MM 80MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 216.085 SUP HCPCS C1713 216.085 - SCREW BONE PTHRD 6.5MM 8MM 85MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $67.20 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $39.65 $66.08 $13.77 $66.08 N/A N/A 216.09 SUP HCPCS C1713 216.090 - SCREW BONE PTHRD 6.5MM 8MM 90MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $38.49 $64.15 $13.37 $64.15 N/A N/A 216.095 SUP HCPCS C1713 216.095 - SCREW BONE PTHRD 6.5MM 8MM 95MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $67.20 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $39.65 $66.08 $13.77 $66.08 N/A N/A 216.1 SUP HCPCS C1713 216.100 - SCREW BONE PTHRD 6.5MM 8MM 100MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $38.49 $64.15 $13.37 $64.15 N/A N/A 216.105 SUP HCPCS C1713 216.105 - SCREW BONE PTHRD 6.5MM 8MM 105MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $39.65 $66.08 $13.77 $66.08 N/A N/A 216.11 SUP HCPCS C1713 216.110 - SCREW BONE PTHRD 6.5MM 110MM 16MM THREAD LCP STAINLESS STEEL BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $67.20 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $64.15 $64.15 $13.37 $64.15 N/A N/A 216.115 SUP HCPCS C1713 216.115 - SCREW BONE PTHRD 6.5MM 8MM 115MM 16MM HEXAGONAL SOCKET LCP BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $49.34 $82.23 $17.14 $82.23 N/A N/A 216.12 SUP HCPCS C1713 216.120 - SCREW BONE PTHRD 6.5MM 8MM 120MM 16MM HEXAGONAL SOCKET LCP BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $33.45 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $47.90 $79.83 $16.64 $79.83 N/A N/A 216.125 SUP HCPCS C1713 216.125 - SCREW BONE 6.5MM 125MM 16MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $49.34 $82.23 $17.14 $82.23 N/A N/A 216.13 SUP HCPCS C1713 216.130 - SCREW BONE PTHRD 6.5MM 8MM 130MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $83.63 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $47.90 $79.83 $16.64 $79.83 N/A N/A 216.135 SUP HCPCS C1713 216.135 - SCREW BONE 6.5MM 135MM 16MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $82.23 $82.23 $17.14 $82.23 N/A N/A 216.14 SUP HCPCS C1713 216.140 - SCREW BONE PTHRD 6.5MM 8MM 140MM 16MM LARGE HEXAGONAL SOCKET BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $33.45 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $47.90 $79.83 $16.64 $79.83 N/A N/A 216.145 SUP HCPCS C1713 216.145 - SCREW BONE 6.5MM 145MM 16MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $49.34 $82.23 $17.14 $82.23 N/A N/A 216.15 SUP HCPCS C1713 216.150 - SCREW BONE 6.5MM 150MM 16MM LOCKING THREADED LC-DCP BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $83.63 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $47.90 $79.83 $16.64 $79.83 N/A N/A 216.24 SUP HCPCS C1713 216.240 - SCREW BONE 6.5MM 40MM 24MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $58.00 $43.00 $11.44 $57.63 $25.93 $25.93 $25.93 $25.93 $57.63 $57.63 $57.63 $12.01 $57.63 $57.63 $57.63 $57.63 $57.63 $12.01 $57.63 $23.05 $34.09 $57.63 $57.63 $57.63 $57.63 $43.50 $57.63 $57.63 $57.63 $28.82 $28.82 $45.64 $57.63 $46.10 $25.93 $11.44 N/A $33.64 $57.63 $57.63 $57.63 $12.01 $57.63 N/A N/A 216.25 SUP HCPCS C1713 216.250 - SCREW BONE 6.5MM 8MM 50MM 24MM LARGE HEXAGONAL SOCKET DCP BOTH IP/OP $58.00 $43.00 $11.44 $57.63 $25.93 $25.93 $25.93 $25.93 $57.63 $57.63 $57.63 $12.01 $57.63 $57.63 $57.63 $57.63 $57.63 $12.01 $57.63 $23.05 $34.09 $57.63 $57.63 $57.63 $57.63 $43.50 $57.63 $57.63 $57.63 $28.82 $28.82 $45.64 $57.63 $46.10 $25.93 $11.44 N/A $33.64 $57.63 $57.63 $57.63 $12.01 $57.63 N/A N/A 216.26 SUP HCPCS C1713 216.260 - SCREW BONE 6.5MM 60MM 24MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $58.00 $43.00 $11.44 $57.63 $25.93 $25.93 $25.93 $25.93 $57.63 $57.63 $57.63 $12.01 $57.63 $57.63 $57.63 $57.63 $57.63 $12.01 $57.63 $23.05 $34.09 $57.63 $57.63 $57.63 $57.63 $43.50 $57.63 $57.63 $57.63 $28.82 $28.82 $45.64 $57.63 $46.10 $25.93 $11.44 N/A $33.64 $57.63 $57.63 $57.63 $12.01 $57.63 N/A N/A 216.27 SUP HCPCS C1713 216.270 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 70MM 24MM SOCKET LCP DCP BOTH IP/OP $58.00 $43.00 $11.44 $57.63 $25.93 $25.93 $25.93 $25.93 $57.63 $57.63 $57.63 $12.01 $57.63 $57.63 $57.63 $57.63 $57.63 $12.01 $57.63 $23.05 $34.09 $57.63 $57.63 $57.63 $57.63 $43.50 $57.63 $57.63 $57.63 $28.82 $28.82 $45.64 $57.63 $46.10 $25.93 $11.44 N/A $33.64 $57.63 $57.63 $57.63 $12.01 $57.63 N/A N/A 216.28 SUP HCPCS C1713 216.280 - SCREW BONE 6.5MM 80MM 24MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $58.00 $43.00 $11.44 $57.63 $25.93 $25.93 $25.93 $25.93 $57.63 $57.63 $57.63 $12.01 $57.63 $57.63 $57.63 $57.63 $57.63 $12.01 $57.63 $23.05 $34.09 $57.63 $57.63 $57.63 $57.63 $43.50 $57.63 $57.63 $57.63 $28.82 $28.82 $45.64 $57.63 $46.10 $25.93 $11.44 N/A $33.64 $57.63 $57.63 $57.63 $12.01 $57.63 N/A N/A 216.29 SUP HCPCS C1713 216.290 - SCREW BONE 6.5MM 90MM 24MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.36 $62.28 $28.03 $28.03 $28.03 $28.03 $62.28 $62.28 $62.28 $12.98 $62.28 $62.28 $62.28 $62.28 $62.28 $12.98 $62.28 $24.91 $36.84 $62.28 $62.28 $62.28 $62.28 $46.88 $62.28 $62.28 $62.28 $31.14 $31.14 $49.33 $62.28 $49.82 $28.03 $12.36 N/A $36.25 $62.28 $62.28 $62.28 $12.98 $62.28 N/A N/A 216.295 SUP HCPCS C1713 216.295 - SCREW BONE 6.5MM 95MM 24MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.36 $62.28 $28.03 $28.03 $28.03 $28.03 $62.28 $62.28 $62.28 $12.98 $62.28 $62.28 $62.28 $62.28 $62.28 $12.98 $62.28 $24.91 $36.84 $62.28 $62.28 $62.28 $62.28 $46.88 $62.28 $62.28 $62.28 $31.14 $31.14 $49.33 $62.28 $49.82 $28.03 $12.36 N/A $36.25 $62.28 $62.28 $62.28 $12.98 $62.28 N/A N/A 216.3 SUP HCPCS C1713 216.300 - SCREW BONE 6.5MM 100MM 24MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.36 $62.28 $28.03 $28.03 $28.03 $28.03 $62.28 $62.28 $62.28 $12.98 $62.28 $62.28 $62.28 $62.28 $62.28 $12.98 $62.28 $62.28 $36.84 $62.28 $62.28 $62.28 $62.28 $46.88 $62.28 $62.28 $62.28 $31.14 $31.14 $49.33 $62.28 $49.82 $28.03 $12.36 N/A $36.25 $62.28 $62.28 $62.28 $12.98 $62.28 N/A N/A 216.305 SUP HCPCS C1713 216.305 - SCREW BONE 6.5MM 105MM 24MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.36 $62.28 $28.03 $28.03 $28.03 $28.03 $62.28 $62.28 $62.28 $12.98 $62.28 $62.28 $62.28 $62.28 $62.28 $12.98 $62.28 $24.91 $36.84 $62.28 $62.28 $62.28 $62.28 $46.88 $62.28 $62.28 $62.28 $31.14 $31.14 $49.33 $62.28 $49.82 $28.03 $12.36 N/A $36.25 $62.28 $62.28 $62.28 $12.98 $62.28 N/A N/A 216.31 SUP HCPCS C1713 216.310 - SCREW BONE 6.5MM 110MM 24MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.36 $62.28 $28.03 $28.03 $28.03 $28.03 $62.28 $62.28 $62.28 $12.98 $62.28 $62.28 $62.28 $62.28 $62.28 $12.98 $62.28 $24.91 $36.84 $62.28 $62.28 $62.28 $62.28 $46.88 $62.28 $62.28 $62.28 $31.14 $31.14 $49.33 $62.28 $49.82 $28.03 $12.36 N/A $36.25 $62.28 $37.37 $62.28 $12.98 $62.28 N/A N/A 216.315 SUP HCPCS C1713 216.315 - SCREW BONE 6.5MM 115MM 24MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $77.50 $57.00 $15.38 $77.50 $34.88 $34.88 $34.88 $34.88 $77.50 $77.50 $77.50 $16.15 $77.50 $77.50 $77.50 $77.50 $77.50 $16.15 $77.50 $31.00 $45.84 $77.50 $77.50 $77.50 $77.50 $58.13 $77.50 $77.50 $77.50 $38.75 $38.75 $61.38 $77.50 $62.00 $34.88 $15.38 N/A $44.95 $77.50 $46.50 $77.50 $16.15 $77.50 N/A N/A 216.32 SUP HCPCS C1713 216.320 - SCREW BONE 6.5MM 120MM 24MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $77.50 $57.00 $15.38 $77.50 $34.88 $34.88 $34.88 $34.88 $77.50 $77.50 $77.50 $16.15 $77.50 $77.50 $77.50 $77.50 $77.50 $16.15 $77.50 $31.00 $45.84 $77.50 $77.50 $77.50 $77.50 $58.13 $77.50 $77.50 $77.50 $38.75 $38.75 $61.38 $77.50 $62.00 $34.88 $15.38 N/A $44.95 $77.50 $46.50 $77.50 $16.15 $77.50 N/A N/A 216.325 SUP HCPCS C1713 216.325 - SCREW BONE 6.5MM 125MM 24MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $77.50 $57.00 $15.38 $77.50 $34.88 $34.88 $34.88 $34.88 $77.50 $77.50 $77.50 $16.15 $77.50 $77.50 $77.50 $77.50 $77.50 $16.15 $77.50 $31.00 $45.84 $77.50 $77.50 $77.50 $77.50 $58.13 $77.50 $77.50 $77.50 $38.75 $38.75 $61.38 $77.50 $62.00 $34.88 $15.38 N/A $44.95 $77.50 $77.50 $77.50 $16.15 $77.50 N/A N/A 216.33 SUP HCPCS C1713 216.330 - SCREW BONE 6.5MM 130MM 24MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $77.50 $57.00 $15.38 $77.50 $34.88 $34.88 $34.88 $34.88 $77.50 $77.50 $77.50 $16.15 $77.50 $77.50 $77.50 $77.50 $77.50 $16.15 $77.50 $31.00 $45.84 $77.50 $77.50 $77.50 $77.50 $58.13 $77.50 $77.50 $77.50 $38.75 $38.75 $61.38 $77.50 $62.00 $34.88 $15.38 N/A $44.95 $77.50 $77.50 $77.50 $16.15 $77.50 N/A N/A 216.34 SUP HCPCS C1713 216.340 - SCREW BONE 6.5MM 140MM 24MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $77.50 $57.00 $15.38 $77.50 $34.88 $34.88 $34.88 $34.88 $77.50 $77.50 $77.50 $16.15 $77.50 $77.50 $77.50 $77.50 $77.50 $16.15 $77.50 $31.00 $45.84 $77.50 $77.50 $77.50 $77.50 $58.13 $77.50 $77.50 $77.50 $38.75 $38.75 $61.38 $77.50 $62.00 $34.88 $15.38 N/A $44.95 $77.50 $77.50 $77.50 $16.15 $77.50 N/A N/A 216.35 SUP HCPCS C1713 216.350 - SCREW BONE 6.5MM 150MM 24MM THREAD LC-DCP STAINLESS STEEL BOTH IP/OP $77.50 $57.00 $15.38 $77.50 $34.88 $34.88 $34.88 $34.88 $77.50 $77.50 $77.50 $16.15 $77.50 $77.50 $77.50 $77.50 $77.50 $16.15 $77.50 $31.00 $45.84 $77.50 $77.50 $77.50 $77.50 $58.13 $77.50 $77.50 $77.50 $38.75 $38.75 $61.38 $77.50 $62.00 $34.88 $15.38 N/A $44.95 $77.50 $77.50 $77.50 $16.15 $77.50 N/A N/A 217.045 SUP HCPCS C1713 217.045 - SCREW BONE PTHRD 6.5MM 8MM 45MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $62.18 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 217.05 SUP HCPCS C1713 217.050 - SCREW BONE PTHRD 6.5MM 8MM 50MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 217.055 SUP HCPCS C1713 217.055 - SCREW BONE PTHRD 6.5MM 55MM 32MM LCP STAINLESS STEEL HUMERUS BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $62.18 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 217.06 SUP HCPCS C1713 217.060 - SCREW BONE PTHRD 6.5MM 60MM 32MM LCP STAINLESS STEEL HUMERUS BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 217.065 SUP HCPCS C1713 217.065 - SCREW BONE PTHRD 6.5MM 8MM 65MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $62.18 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 217.07 SUP HCPCS C1713 217.070 - SCREW BONE PTHRD 6.5MM 8MM 70MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 217.075 SUP HCPCS C1713 217.075 - SCREW BONE PTHRD 6.5MM 8MM 75MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $62.18 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $61.13 $61.13 $12.74 $61.13 N/A N/A 217.08 SUP HCPCS C1713 217.080 - SCREW BONE PTHRD 6.5MM 80MM 32MM LCP STAINLESS STEEL HUMERUS BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 217.085 SUP HCPCS C1713 217.085 - SCREW BONE PTHRD 6.5MM 8MM 85MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $67.20 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $39.65 $66.08 $13.77 $66.08 N/A N/A 217.09 SUP HCPCS C1713 217.090 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 90MM 32MM SOCKET LCP DCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $38.49 $64.15 $13.37 $64.15 N/A N/A 217.095 SUP HCPCS C1713 217.095 - SCREW BONE PTHRD 6.5MM 8MM 95MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $67.20 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $39.65 $66.08 $13.77 $66.08 N/A N/A 217.1 SUP HCPCS C1713 217.100 - SCREW BONE PTHRD 6.5MM 8MM 100MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $38.49 $64.15 $13.37 $64.15 N/A N/A 217.105 SUP HCPCS C1713 217.105 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 105MM 32MM SOCKET LCP DCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $39.65 $66.08 $13.77 $66.08 N/A N/A 217.11 SUP HCPCS C1713 217.110 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 110MM 32MM SOCKET LCP DCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $38.49 $64.15 $13.37 $64.15 N/A N/A 217.115 SUP HCPCS C1713 217.115 - SCREW BONE 6.5MM 8MM 115MM 32MM HEXAGONAL SOCKET LC-DCP BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $49.34 $82.23 $17.14 $82.23 N/A N/A 217.12 SUP HCPCS C1713 217.120 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 120MM 32MM SOCKET LCP DCP BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $83.63 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $47.90 $79.83 $16.64 $79.83 N/A N/A 217.125 SUP HCPCS C1713 217.125 - SCREW BONE 6.5MM 8MM 125MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $49.34 $82.23 $17.14 $82.23 N/A N/A 217.13 SUP HCPCS C1713 217.130 - SCREW BONE 6.5MM 8MM 130MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $33.45 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $47.90 $79.83 $16.64 $79.83 N/A N/A 217.135 SUP HCPCS C1713 217.135 - SCREW BONE 6.5MM 8MM 135MM 32MM LARGE HEXAGONAL SOCKET DCP BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $83.63 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $82.23 $82.23 $17.14 $82.23 N/A N/A 217.14 SUP HCPCS C1713 217.140 - SCREW BONE 6.5MM 8MM 140MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $83.63 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $79.83 $79.83 $16.64 $79.83 N/A N/A 217.145 SUP HCPCS C1713 217.145 - SCREW BONE 6.5MM 8MM 145MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $82.23 $82.23 $17.14 $82.23 N/A N/A 217.15 SUP HCPCS C1713 217.150 - SCREW BONE 6.5MM 8MM 150MM 32MM LARGE HEXAGONAL SOCKET DCP BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $33.45 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $79.83 $79.83 $16.64 $79.83 N/A N/A 218.009 SUP HCPCS C1713 218.009 - SCREW BONE 6.5MM 60MM LCP STAINLESS STEEL CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 218.01 SUP HCPCS C1713 218.010 - CASE STERILIZATION 2IN 11X7IN CASTANEDA RETRACTOR KIT BOTH IP/OP $266.50 $197.00 $52.82 $278.75 $119.76 $119.76 $119.76 $119.76 $266.13 $266.13 $266.13 $55.47 $266.13 $266.13 $266.13 $266.13 $266.13 $55.46 $266.13 $111.50 $157.42 $266.13 $278.75 $266.13 $266.13 $199.88 $266.13 $266.13 $266.13 $133.07 $133.07 $210.77 $266.13 $212.90 $119.76 $52.82 N/A $154.57 $266.13 $266.13 $266.13 $55.46 $266.13 N/A N/A 218.011 SUP HCPCS C1713 218.011 - SCREW BONE 6.5MM 70MM LCP STAINLESS STEEL CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 218.012 SUP HCPCS C1713 218.012 - SCREW BONE 6.5MM 75MM LCP STAINLESS STEEL CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 218.013 SUP HCPCS C1713 218.013 - SCREW BONE 6.5MM 80MM LCP STAINLESS STEEL CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 218.014 SUP HCPCS C1713 218.014 - SCREW BONE 6.5MM 85MM LCP STAINLESS STEEL CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 218.015 SUP HCPCS C1713 218.015 - SCREW BONE 6.5MM 90MM LCP STAINLESS STEEL CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 218.016 SUP HCPCS C1713 218.016 - SCREW BONE 6.5MM 95MM LCP STAINLESS STEEL CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 218.017 SUP HCPCS C1713 218.017 - SCREW BONE 6.5MM 100MM LCP STAINLESS STEEL CANCELLOUS BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $274.10 $274.10 N/A N/A 218.018 SUP HCPCS C1713 218.018 - SCREW BONE 6.5MM 105MM LCP STAINLESS STEEL CANCELLOUS BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $274.10 $274.10 N/A N/A 218.019 SUP HCPCS C1713 218.019 - SCREW BONE 6.5MM 110MM LCP STAINLESS STEEL CANCELLOUS BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 218.02 SUP HCPCS C1713 218.020 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 20MM SOCKET LCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $59.35 $59.35 $12.37 $59.35 N/A N/A 218.025 SUP HCPCS C1713 218.025 - SCREW BONE 6.5MM 25MM FULTHD LC-DCP STAINLESS STEEL BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $62.18 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 218.03 SUP HCPCS C1713 218.030 - SCREW BONE FULTHD 6.5MM 8MM 30MM LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $59.35 $59.35 $12.37 $59.35 N/A N/A 218.035 SUP HCPCS C1713 218.035 - SCREW BONE FULTHD 6.5MM 8MM 35MM LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $62.18 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 218.04 SUP HCPCS C1713 218.040 - SCREW BONE FULTHD 6.5MM 8MM 40MM LARGE HEXAGONAL SOCKET LCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $59.35 $59.35 $12.37 $59.35 N/A N/A 218.045 SUP HCPCS C1713 218.045 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 45MM SOCKET LCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $61.13 $61.13 $12.74 $61.13 N/A N/A 218.05 SUP HCPCS C1713 218.050 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 50MM SOCKET LCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 218.055 SUP HCPCS C1713 218.055 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 55MM SOCKET LCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $62.18 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 218.06 SUP HCPCS C1713 218.060 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 60MM SOCKET LCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 218.065 SUP HCPCS C1713 218.065 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 65MM SOCKET LCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $62.18 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 218.07 SUP HCPCS C1713 218.070 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 70MM SOCKET LCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 218.075 SUP HCPCS C1713 218.075 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 75MM SOCKET LCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 218.08 SUP HCPCS C1713 218.080 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 80MM SOCKET LCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 218.085 SUP HCPCS C1713 218.085 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 85MM SOCKET LCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $39.65 $66.08 $13.77 $66.08 N/A N/A 218.09 SUP HCPCS C1713 218.090 - SCREW BONE FULTHD 6.5MM 8MM 90MM 3.5MM HEXAGONAL SOCKET DCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $38.49 $64.15 $13.37 $64.15 N/A N/A 218.095 SUP HCPCS C1713 218.095 - SCREW BONE FULTHD 6.5MM 8MM 95MM 3.5MM HEXAGONAL SOCKET DCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $39.65 $66.08 $13.77 $66.08 N/A N/A 218.1 SUP HCPCS C1713 218.100 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 100MM SOCKET LCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $64.15 $64.15 $64.15 $64.15 N/A N/A 218.105 SUP HCPCS C1713 218.105 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 105MM SOCKET LCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $39.65 $66.08 $66.08 $66.08 N/A N/A 218.11 SUP HCPCS C1713 218.110 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 110MM SOCKET LCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $67.20 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $64.15 $64.15 $13.37 $64.15 N/A N/A 218.115 SUP HCPCS C1713 218.115 - SCREW BONE FULTHD 6.5MM 8MM 115MM LARGE HEXAGONAL SOCKET BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $83.63 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $82.23 $82.23 $17.14 $82.23 N/A N/A 218.12 SUP HCPCS C1713 218.120 - SCREW BONE FULTHD 6.5MM 8MM 120MM LARGE HEXAGONAL SOCKET BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $33.45 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $79.83 $79.83 $16.64 $79.83 N/A N/A 218.125 SUP HCPCS C1713 218.125 - SCREW BONE FULTHD 6.5MM 8MM 125MM LARGE HEXAGONAL SOCKET BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $82.23 $82.23 $82.23 $82.23 N/A N/A 218.13 SUP HCPCS C1713 218.130 - SCREW BONE 6.5MM 130MM FULTHRD LC-DCP STAINLESS STEEL BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $33.45 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $79.83 $79.83 $79.83 $79.83 N/A N/A 218.135 SUP HCPCS C1713 218.135 - SCREW BONE FULTHD 6.5MM 8MM 135MM LARGE HEXAGONAL SOCKET BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $82.23 $82.23 $82.23 $82.23 N/A N/A 218.14 SUP HCPCS C1713 218.140 - SCREW BONE 6.5MM 140MM FULTHRD DCP LC-DCP STAINLESS STEEL BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $33.45 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $79.83 $79.83 $16.64 $79.83 N/A N/A 218.145 SUP HCPCS C1713 218.145 - SCREW BONE FULTHD 6.5MM 8MM 145MM LARGE HEXAGONAL SOCKET BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $49.34 $82.23 $17.14 $82.23 N/A N/A 218.15 SUP HCPCS C1713 218.150 - SCREW BONE 6.5MM 150MM FULTHRD DCP LC-DCP STAINLESS STEEL BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $83.63 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $47.90 $79.83 $16.64 $79.83 N/A N/A 218.215 SUP HCPCS C1713 218.215 - SCREW BONE FULTHD 6.5MM 115MM LCP STAINLESS STEEL CANCELLOUS BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $274.10 $274.10 N/A N/A 218.22 SUP HCPCS C1713 218.220 - SCREW BONE FULTHD LP 6.5MM 8MM 120MM HIGH BENDING STABILITY BOTH IP/OP $266.50 $197.00 $52.82 $278.75 $119.76 $119.76 $119.76 $119.76 $266.13 $266.13 $266.13 $55.47 $266.13 $266.13 $266.13 $266.13 $266.13 $55.46 $266.13 $278.75 $157.42 $266.13 $278.75 $266.13 $266.13 $199.88 $266.13 $266.13 $266.13 $133.07 $133.07 $210.77 $266.13 $212.90 $119.76 $52.82 N/A $154.57 $266.13 $159.68 $266.13 $266.13 $266.13 N/A N/A 218.225 SUP HCPCS C1713 218.225 - SCREW BONE FULTHD 6.5MM 125MM LCP STAINLESS STEEL CANCELLOUS BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 218.23 SUP HCPCS C1713 218.230 - SCREW BONE FULTHD LP 6.5MM 8MM 130MM HIGH BENDING STABILITY BOTH IP/OP $266.50 $197.00 $52.82 $278.75 $119.76 $119.76 $119.76 $119.76 $266.13 $266.13 $266.13 $55.47 $266.13 $266.13 $266.13 $266.13 $266.13 $55.46 $266.13 $111.50 $157.42 $266.13 $278.75 $266.13 $266.13 $199.88 $266.13 $266.13 $266.13 $133.07 $133.07 $210.77 $266.13 $212.90 $119.76 $52.82 N/A $154.57 $266.13 $266.13 $266.13 $55.46 $266.13 N/A N/A 219.89 SUP Custom 27803010 219.89 - WASHER ORTHOPEDIC THREAD LCP STAINLESS STEEL NONSTRL 3 MM BOTH IP/OP $259.00 $192.00 $46.04 $263.05 $258.65 $258.65 $258.65 $258.65 $258.65 $258.65 $46.04 $258.65 $258.65 $258.65 $258.65 $258.65 $258.65 $53.91 $258.65 $105.22 $258.65 $258.65 $263.05 $258.65 $258.65 $194.25 $258.65 $258.65 $258.65 $129.33 $129.33 $204.85 $258.65 $206.92 $116.39 $258.65 N/A $150.22 $258.65 $155.19 $258.65 $258.65 $258.65 N/A N/A 219.91 SUP Custom 27803010 219.91 - WASHER ORTHOPEDIC 10MM LCP STAINLESS STEEL NONSTRL 4.5MM BOTH IP/OP $50.00 $37.00 $8.88 $50.75 $49.90 $49.90 $49.90 $49.90 $49.90 $49.90 $8.88 $49.90 $49.90 $49.90 $49.90 $49.90 $49.90 $10.40 $49.90 $20.30 $49.90 $49.90 $50.75 $49.90 $49.90 $37.50 $49.90 $49.90 $49.90 $24.95 $24.95 $39.52 $49.90 $39.92 $22.46 $49.90 N/A $29.00 $49.90 $29.94 $49.90 $49.90 $49.90 N/A N/A 219.931 SUP Custom 27803010 219.931 - WASHER ORTHOPEDIC 8MM 3.2MM SPIKE LCP STAINLESS STEEL BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $61.03 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 219.941 SUP Custom 27803010 219.941 - WASHER ORTHOPEDIC 13.5MM 4MM SPIKE LCP STAINLESS STEEL BOTH IP/OP $229.50 $170.00 $40.79 $233.03 $229.13 $229.13 $229.13 $229.13 $229.13 $229.13 $40.79 $229.13 $229.13 $229.13 $229.13 $229.13 $229.13 $47.75 $229.13 $93.21 $229.13 $229.13 $233.03 $229.13 $229.13 $172.13 $229.13 $229.13 $229.13 $114.57 $114.57 $181.47 $229.13 $183.30 $103.11 $229.13 N/A $133.11 $229.13 $137.48 $229.13 $229.13 $229.13 N/A N/A 219.951 SUP Custom 27803010 219.951 - WASHER ORTHOPEDIC 13.5MM 5.5MM SPIKE LC-DCP PEEK-OPTIMA 6% BOTH IP/OP $226.50 $168.00 $40.29 $230.18 $226.33 $226.33 $226.33 $226.33 $226.33 $226.33 $40.29 $226.33 $226.33 $226.33 $226.33 $226.33 $226.33 $47.17 $226.33 $92.07 $226.33 $226.33 $230.18 $226.33 $226.33 $169.88 $226.33 $226.33 $226.33 $113.17 $113.17 $179.25 $226.33 $181.06 $101.85 $226.33 N/A $131.37 $226.33 $135.80 $226.33 $226.33 $226.33 N/A N/A 219.96 SUP Custom 27803010 219.96 - NUT ORTHOPEDIC LC-DCP STAINLESS STEEL NONSTRL 4.5 MM BOTH IP/OP $56.00 $41.00 $9.94 $56.80 $55.85 $55.85 $55.85 $55.85 $55.85 $55.85 $9.94 $55.85 $55.85 $55.85 $55.85 $55.85 $55.85 $11.64 $55.85 $22.72 $55.85 $55.85 $56.80 $55.85 $55.85 $42.00 $55.85 $55.85 $55.85 $27.93 $27.93 $44.23 $55.85 $44.68 $25.13 $55.85 N/A $32.48 $55.85 $33.51 $55.85 $55.85 $55.85 N/A N/A 219.97 SUP Custom 27803010 219.97 - WASHER ORTHOPEDIC 4.5MM FRAGMENT DCP STAINLESS STEEL NONSTRL BOTH IP/OP $43.00 $32.00 $7.63 $43.58 $42.85 $42.85 $42.85 $42.85 $42.85 $42.85 $7.63 $42.85 $42.85 $42.85 $42.85 $42.85 $42.85 $8.93 $42.85 $17.43 $42.85 $42.85 $43.58 $42.85 $42.85 $32.25 $42.85 $42.85 $42.85 $21.43 $21.43 $33.94 $42.85 $34.28 $19.28 $42.85 N/A $24.94 $42.85 $25.71 $42.85 $42.85 $42.85 N/A N/A 219.972 SUP Custom 27803010 219.972 - WASHER ORTHOPEDIC 6.5MM 3.3MM LCP STAINLESS STEEL NONSTRL 3 BOTH IP/OP $56.00 $41.00 $9.94 $56.80 $55.85 $55.85 $55.85 $55.85 $55.85 $55.85 $9.94 $55.85 $55.85 $55.85 $55.85 $55.85 $55.85 $11.64 $55.85 $22.72 $55.85 $55.85 $56.80 $55.85 $55.85 $42.00 $55.85 $55.85 $55.85 $27.93 $27.93 $44.23 $55.85 $44.68 $25.13 $55.85 N/A $32.48 $55.85 $33.51 $55.85 $55.85 $55.85 N/A N/A 219.98 SUP Custom 27803010 219.98 - WASHER ORTHOPEDIC SMALL 7MM 3.6MM LCP STAINLESS STEEL BOTH IP/OP $47.50 $35.00 $8.44 $48.23 $47.43 $47.43 $47.43 $47.43 $47.43 $47.43 $8.44 $47.43 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $47.43 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $47.43 N/A $27.55 $47.43 $28.46 $47.43 $47.43 $47.43 N/A N/A 219.99 SUP Custom 27803010 219.99 - WASHER ORTHOPEDIC 13MM 6.6MM LCP STAINLESS STEEL NONSTRL BOTH IP/OP $53.00 $39.00 $9.38 $53.60 $52.70 $52.70 $52.70 $52.70 $52.70 $52.70 $9.38 $52.70 $52.70 $52.70 $52.70 $52.70 $52.70 $10.98 $52.70 $21.44 $52.70 $52.70 $53.60 $52.70 $52.70 $39.75 $52.70 $52.70 $52.70 $26.35 $26.35 $41.74 $52.70 $42.16 $23.72 $52.70 N/A $30.74 $52.70 $31.62 $52.70 $52.70 $52.70 N/A N/A 221.306 SUP HCPCS C1713 221.306 - PLATE BONE STR 6 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $368.30 $368.30 N/A N/A 221.312 SUP HCPCS C1713 221.312 - PLATE BONE STR 12 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC BOTH IP/OP $465.50 $344.00 $92.35 $473.18 $209.38 $209.38 $209.38 $209.38 $465.28 $465.28 $465.28 $96.98 $465.28 $465.28 $465.28 $465.28 $465.28 $96.97 $465.28 $473.18 $275.21 $465.28 $473.18 $465.28 $465.28 $349.13 $465.28 $465.28 $465.28 $232.64 $232.64 $368.50 $465.28 $372.22 $209.38 $92.35 N/A $269.99 $465.28 $465.28 $465.28 $465.28 $465.28 N/A N/A 221.32 SUP HCPCS C1713 221.320 - PLATE BN H 19MMX.5MM NS 8 HL XTD LOPRFL PRECONTOUR SS HND RT BOTH IP/OP $431.50 $319.00 $85.59 $451.75 $194.06 $194.06 $194.06 $194.06 $431.25 $431.25 $431.25 $89.88 $431.25 $431.25 $431.25 $431.25 $431.25 $89.88 $431.25 $180.70 $255.08 $431.25 $451.75 $431.25 $431.25 $323.63 $431.25 $431.25 $431.25 $215.63 $215.63 $341.55 $431.25 $345.00 $194.06 $85.59 N/A $250.27 $431.25 $431.25 $431.25 $89.87 $431.25 N/A N/A 221.321 SUP HCPCS C1713 221.321 - PLATE BN H 19MMX.5MM NS 8 HL XTD LOPRFL PRECONTOUR SS HND LT BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $180.70 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $444.20 $444.20 $92.57 $444.20 N/A N/A 221.333 SUP HCPCS C1713 221.333 - SCREW BONE 4MM 46MM T25 STARDRIVE RECESS LOCK SELF TAP LCP BOTH IP/OP $426.00 $315.00 $84.54 $433.18 $191.67 $191.67 $191.67 $191.67 $425.93 $425.93 $425.93 $88.77 $425.93 $425.93 $425.93 $425.93 $425.93 $88.77 $425.93 $433.18 $251.94 $425.93 $433.18 $425.93 $425.93 $319.50 $425.93 $425.93 $425.93 $212.97 $212.97 $337.34 $425.93 $340.74 $191.67 $84.54 N/A $247.08 $425.93 $425.93 $425.93 $425.93 $425.93 N/A N/A 221.334 SUP HCPCS C1713 221.334 - PLATE BONE T 4X8 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $451.75 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $444.20 $444.20 $92.57 $444.20 N/A N/A 221.335 SUP HCPCS C1713 221.335 - PLATE BONE Y 3X8 HOLE LP PRECONTOUR RECONSTRUCTION ANATOMIC BOTH IP/OP $426.00 $315.00 $84.54 $433.18 $191.67 $191.67 $191.67 $191.67 $425.93 $425.93 $425.93 $88.77 $425.93 $425.93 $425.93 $425.93 $425.93 $88.77 $425.93 $173.27 $251.94 $425.93 $433.18 $425.93 $425.93 $319.50 $425.93 $425.93 $425.93 $212.97 $212.97 $337.34 $425.93 $340.74 $191.67 $84.54 N/A $247.08 $425.93 $425.93 $425.93 $88.76 $425.93 N/A N/A 222.02 SUP HCPCS C1713 222.02 - PLATE BN SMTB 39X12X1MM NS 2 HL SS 3.5/4.5MM SCR LG FRAG BOTH IP/OP $122.50 $91.00 $24.24 $122.13 $54.96 $54.96 $54.96 $54.96 $122.13 $122.13 $122.13 $25.45 $122.13 $122.13 $122.13 $122.13 $122.13 $25.45 $122.13 $122.13 $72.24 $122.13 $122.13 $122.13 $122.13 $91.88 $122.13 $122.13 $122.13 $61.07 $61.07 $96.73 $122.13 $97.70 $54.96 $24.24 N/A $71.05 $122.13 $122.13 $122.13 $25.45 $122.13 N/A N/A 222.03 SUP HCPCS C1713 222.03 - PLATE BN SMTB 55X12X1MM NS 3 HL SS 3.5/4.5MM SCR LG FRAG BOTH IP/OP $130.50 $97.00 $25.87 $130.33 $58.65 $58.65 $58.65 $58.65 $130.33 $130.33 $130.33 $27.16 $130.33 $130.33 $130.33 $130.33 $130.33 $27.16 $130.33 $130.33 $77.09 $130.33 $130.33 $130.33 $130.33 $97.88 $130.33 $130.33 $130.33 $65.17 $65.17 $103.22 $130.33 $104.26 $58.65 $25.87 N/A $75.69 $130.33 $78.20 $130.33 $27.16 $130.33 N/A N/A 222.04 SUP HCPCS C1713 222.04 - PLATE BONE SEMITUBULAR 71X12X1MM 4 HOLE SEMITUBULAR DCP BOTH IP/OP $141.00 $104.00 $27.90 $140.58 $63.26 $63.26 $63.26 $63.26 $140.58 $140.58 $140.58 $29.30 $140.58 $140.58 $140.58 $140.58 $140.58 $29.30 $140.58 $140.58 $83.15 $140.58 $140.58 $140.58 $140.58 $105.75 $140.58 $140.58 $140.58 $70.29 $70.29 $111.34 $140.58 $112.46 $63.26 $27.90 N/A $81.78 $140.58 $84.35 $140.58 $29.30 $140.58 N/A N/A 222.05 SUP HCPCS C1713 222.05 - PLATE BONE SEMITUBULAR 87X12X1MM 5 HOLE SEMITUBULAR DCP BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $89.25 $148.75 $31.00 $148.75 N/A N/A 222.06 SUP HCPCS C1713 222.06 - PLATE BONE SEMITUBULAR 103X12X1MM 6 HOLE SEMITUBULAR DCP BOTH IP/OP $158.50 $117.00 $31.42 $158.30 $71.24 $71.24 $71.24 $71.24 $158.30 $158.30 $158.30 $32.99 $158.30 $158.30 $158.30 $158.30 $158.30 $32.99 $158.30 $63.32 $93.63 $158.30 $158.30 $158.30 $158.30 $118.88 $158.30 $158.30 $158.30 $79.15 $79.15 $125.37 $158.30 $126.64 $71.24 $31.42 N/A $91.93 $158.30 $94.98 $158.30 $32.99 $158.30 N/A N/A 222.07 SUP HCPCS C1713 222.07 - PLATE BONE SEMITUBULAR 119X12X1MM 7 HOLE SEMITUBULAR DCP BOTH IP/OP $169.50 $125.00 $33.59 $169.23 $76.15 $76.15 $76.15 $76.15 $169.23 $169.23 $169.23 $35.27 $169.23 $169.23 $169.23 $169.23 $169.23 $35.27 $169.23 $67.69 $100.10 $169.23 $169.23 $169.23 $169.23 $127.13 $169.23 $169.23 $169.23 $84.62 $84.62 $134.03 $169.23 $135.38 $76.15 $33.59 N/A $98.31 $169.23 $101.54 $169.23 $35.27 $169.23 N/A N/A 222.08 SUP HCPCS C1713 222.08 - PLATE BONE SEMITUBULAR 135X12X1MM 8 HOLE SEMITUBULAR DCP BOTH IP/OP $184.50 $137.00 $36.57 $184.25 $82.91 $82.91 $82.91 $82.91 $184.25 $184.25 $184.25 $38.40 $184.25 $184.25 $184.25 $184.25 $184.25 $38.40 $184.25 $73.70 $108.98 $184.25 $184.25 $184.25 $184.25 $138.38 $184.25 $184.25 $184.25 $92.13 $92.13 $145.93 $184.25 $147.40 $82.91 $36.57 N/A $107.01 $184.25 $184.25 $184.25 $38.40 $184.25 N/A N/A 222.09 SUP HCPCS C1713 222.09 - PLATE BONE 151X12X1MM 9 HOLE SEMITUBULAR DCP LC-DCP BOTH IP/OP $206.50 $153.00 $40.90 $206.08 $92.74 $92.74 $92.74 $92.74 $206.08 $206.08 $206.08 $42.95 $206.08 $206.08 $206.08 $206.08 $206.08 $42.95 $206.08 $82.43 $121.90 $206.08 $206.08 $206.08 $206.08 $154.88 $206.08 $206.08 $206.08 $103.04 $103.04 $163.22 $206.08 $164.86 $92.74 $40.90 N/A $119.77 $206.08 $206.08 $206.08 $42.95 $206.08 N/A N/A 222.1 SUP HCPCS C1713 222.10 - PLATE BONE TUBE 167X12X1MM 10 HOLE LOCK LCP STAINLESS STEEL BOTH IP/OP $202.00 $149.00 $40.09 $211.58 $90.89 $90.89 $90.89 $90.89 $201.98 $201.98 $201.98 $42.10 $201.98 $201.98 $201.98 $201.98 $201.98 $42.09 $201.98 $84.63 $119.47 $201.98 $211.58 $201.98 $201.98 $151.50 $201.98 $201.98 $201.98 $100.99 $100.99 $159.97 $201.98 $161.58 $90.89 $40.09 N/A $117.16 $201.98 $121.19 $201.98 $42.09 $201.98 N/A N/A 222.11 SUP HCPCS C1713 222.11 - PLATE BONE 183X12X1MM 11 HOLE SEMITUBULAR LC-DCP STAINLESS BOTH IP/OP $229.50 $170.00 $45.48 $233.03 $103.11 $103.11 $103.11 $103.11 $229.13 $229.13 $229.13 $47.76 $229.13 $229.13 $229.13 $229.13 $229.13 $47.75 $229.13 $93.21 $135.53 $229.13 $233.03 $229.13 $229.13 $172.13 $229.13 $229.13 $229.13 $114.57 $114.57 $181.47 $229.13 $183.30 $103.11 $45.48 N/A $133.11 $229.13 $229.13 $229.13 $47.75 $229.13 N/A N/A 222.12 SUP HCPCS C1713 222.12 - PLATE BONE 199X12X1MM 12 HOLE SEMITUBULAR LC-DCP STAINLESS BOTH IP/OP $228.00 $169.00 $45.24 $227.93 $102.57 $102.57 $102.57 $102.57 $227.93 $227.93 $227.93 $47.51 $227.93 $227.93 $227.93 $227.93 $227.93 $47.50 $227.93 $227.93 $134.82 $227.93 $227.93 $227.93 $227.93 $171.00 $227.93 $227.93 $227.93 $113.97 $113.97 $180.52 $227.93 $182.34 $102.57 $45.24 N/A $132.24 $227.93 $227.93 $227.93 $47.50 $227.93 N/A N/A 222.22 SUP HCPCS C1713 222.220 - ANCHOR SUTURE 2MM 2 END THREAD TAB TACIT BOTH IP/OP "$2,764.00" "$2,045.00" $548.51 "$2,894.93" "$1,243.63" "$1,243.63" "$1,243.63" "$1,243.63" "$2,763.63" "$2,763.63" "$2,763.63" $576.01 "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" $575.97 "$2,763.63" "$1,157.97" "$1,362.47" "$2,763.63" "$2,894.93" "$2,763.63" "$2,763.63" "$2,073.00" "$2,763.63" "$2,763.63" "$2,763.63" "$1,381.82" "$1,381.82" "$2,188.79" "$2,763.63" "$2,210.90" "$1,243.63" $548.51 N/A "$1,603.12" "$2,763.63" "$1,658.18" "$2,763.63" $575.94 "$2,763.63" N/A N/A 222.221 SUP HCPCS C1713 222.221 - PLATE BONE 140MM 5 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$2,847.00" "$2,107.00" $564.97 "$2,894.93" "$1,280.94" "$1,280.94" "$1,280.94" "$1,280.94" "$2,846.53" "$2,846.53" "$2,846.53" $593.29 "$2,846.53" "$2,846.53" "$2,846.53" "$2,846.53" "$2,846.53" $593.25 "$2,846.53" "$2,894.93" "$1,403.34" "$2,846.53" "$2,894.93" "$2,846.53" "$2,846.53" "$2,135.25" "$2,846.53" "$2,846.53" "$2,846.53" "$1,423.27" "$1,423.27" "$2,254.45" "$2,846.53" "$2,277.22" "$1,280.94" $564.97 N/A "$1,651.26" "$2,846.53" "$2,846.53" "$2,846.53" $593.22 "$2,846.53" N/A N/A 222.222 SUP HCPCS C1713 222.222 - PLATE BONE 180MM 7 HOLE LCP STAINLESS STEEL TIBIA RIGHT BOTH IP/OP "$2,904.50" "$2,149.00" $576.40 "$2,953.53" "$1,306.87" "$1,306.87" "$1,306.87" "$1,306.87" "$2,904.15" "$2,904.15" "$2,904.15" $605.30 "$2,904.15" "$2,904.15" "$2,904.15" "$2,904.15" "$2,904.15" $605.26 "$2,904.15" "$1,181.41" "$1,431.75" "$2,904.15" "$2,953.53" "$2,904.15" "$2,904.15" "$2,178.38" "$2,904.15" "$2,904.15" "$2,904.15" "$1,452.08" "$1,452.08" "$2,300.09" "$2,904.15" "$2,323.32" "$1,306.87" $576.40 N/A "$1,684.61" "$2,904.15" "$2,904.15" "$2,904.15" $605.22 "$2,904.15" N/A N/A 222.223 SUP HCPCS C1713 222.223 - PLATE BONE 180MM 7 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$2,904.50" "$2,149.00" $576.40 "$2,953.53" "$1,306.87" "$1,306.87" "$1,306.87" "$1,306.87" "$2,904.15" "$2,904.15" "$2,904.15" $605.30 "$2,904.15" "$2,904.15" "$2,904.15" "$2,904.15" "$2,904.15" $605.26 "$2,904.15" "$2,953.53" "$1,431.75" "$2,904.15" "$2,953.53" "$2,904.15" "$2,904.15" "$2,178.38" "$2,904.15" "$2,904.15" "$2,904.15" "$1,452.08" "$1,452.08" "$2,300.09" "$2,904.15" "$2,323.32" "$1,306.87" $576.40 N/A "$1,684.61" "$2,904.15" "$2,904.15" "$2,904.15" $605.22 "$2,904.15" N/A N/A 222.224 SUP HCPCS C1713 222.224 - PLATE BONE 220MM 9 HOLE LCP STAINLESS STEEL TIBIA RIGHT BOTH IP/OP "$2,965.00" "$2,194.00" $588.40 "$3,015.00" "$1,334.07" "$1,334.07" "$1,334.07" "$1,334.07" "$2,964.60" "$2,964.60" "$2,964.60" $617.90 "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" $617.86 "$2,964.60" "$3,015.00" "$1,461.55" "$2,964.60" "$3,015.00" "$2,964.60" "$2,964.60" "$2,223.75" "$2,964.60" "$2,964.60" "$2,964.60" "$1,482.30" "$1,482.30" "$2,347.96" "$2,964.60" "$2,371.68" "$1,334.07" $588.40 N/A "$1,719.70" "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" N/A N/A 222.225 SUP HCPCS C1713 222.225 - PLATE BONE 220MM 9 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$2,965.00" "$2,194.00" $588.40 "$3,015.00" "$1,334.07" "$1,334.07" "$1,334.07" "$1,334.07" "$2,964.60" "$2,964.60" "$2,964.60" $617.90 "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" $617.86 "$2,964.60" "$1,206.00" "$1,461.55" "$2,964.60" "$3,015.00" "$2,964.60" "$2,964.60" "$2,223.75" "$2,964.60" "$2,964.60" "$2,964.60" "$1,482.30" "$1,482.30" "$2,347.96" "$2,964.60" "$2,371.68" "$1,334.07" $588.40 N/A "$1,719.70" "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" N/A N/A 222.226 SUP HCPCS C1713 222.226 - PLATE BONE 260MM 11 HOLE LCP STAINLESS STEEL TIBIA RIGHT BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,073.63" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,073.63" "$1,489.97" "$3,022.25" "$3,073.63" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 222.227 SUP HCPCS C1713 222.227 - PLATE BONE 260MM 11 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,073.63" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,229.45" "$1,489.97" "$3,022.25" "$3,073.63" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 222.228 SUP HCPCS C1713 222.228 - PLATE BONE 300MM 13 HOLE LCP STAINLESS STEEL TIBIA RIGHT BOTH IP/OP "$3,081.50" "$2,280.00" $611.56 "$3,133.65" "$1,386.58" "$1,386.58" "$1,386.58" "$1,386.58" "$3,081.28" "$3,081.28" "$3,081.28" $642.22 "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" $642.17 "$3,081.28" "$3,133.65" "$1,519.07" "$3,081.28" "$3,133.65" "$3,081.28" "$3,081.28" "$2,311.13" "$3,081.28" "$3,081.28" "$3,081.28" "$1,540.64" "$1,540.64" "$2,440.37" "$3,081.28" "$2,465.02" "$1,386.58" $611.56 N/A "$1,787.27" "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" N/A N/A 222.229 SUP HCPCS C1713 222.229 - PLATE BONE 300MM 13 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$3,081.50" "$2,280.00" $611.56 "$3,133.65" "$1,386.58" "$1,386.58" "$1,386.58" "$1,386.58" "$3,081.28" "$3,081.28" "$3,081.28" $642.22 "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" $642.17 "$3,081.28" "$1,253.46" "$1,519.07" "$3,081.28" "$3,133.65" "$3,081.28" "$3,081.28" "$2,311.13" "$3,081.28" "$3,081.28" "$3,081.28" "$1,540.64" "$1,540.64" "$2,440.37" "$3,081.28" "$2,465.02" "$1,386.58" $611.56 N/A "$1,787.27" "$3,081.28" "$3,081.28" "$3,081.28" $642.14 "$3,081.28" N/A N/A 222.25 SUP HCPCS C1713 222.250 - PLATE BONE 156MM 5 HOLE LCP STAINLESS STEEL FEMUR RIGHT BOTH IP/OP "$2,764.00" "$2,045.00" $548.51 "$2,894.93" "$1,243.63" "$1,243.63" "$1,243.63" "$1,243.63" "$2,763.63" "$2,763.63" "$2,763.63" $576.01 "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" $575.97 "$2,763.63" "$2,894.93" "$1,362.47" "$2,763.63" "$2,894.93" "$2,763.63" "$2,763.63" "$2,073.00" "$2,763.63" "$2,763.63" "$2,763.63" "$1,381.82" "$1,381.82" "$2,188.79" "$2,763.63" "$2,210.90" "$1,243.63" $548.51 N/A "$1,603.12" "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" N/A N/A 222.251 SUP HCPCS C1713 222.251 - PLATE BONE 156MM 5 HOLE LCP STAINLESS STEEL LEFT CNDYLR BOTH IP/OP "$2,847.00" "$2,107.00" $564.97 "$2,894.93" "$1,280.94" "$1,280.94" "$1,280.94" "$1,280.94" "$2,846.53" "$2,846.53" "$2,846.53" $593.29 "$2,846.53" "$2,846.53" "$2,846.53" "$2,846.53" "$2,846.53" $593.25 "$2,846.53" "$1,157.97" "$1,403.34" "$2,846.53" "$2,894.93" "$2,846.53" "$2,846.53" "$2,135.25" "$2,846.53" "$2,846.53" "$2,846.53" "$1,423.27" "$1,423.27" "$2,254.45" "$2,846.53" "$2,277.22" "$1,280.94" $564.97 N/A "$1,651.26" "$2,846.53" "$2,846.53" "$2,846.53" $593.22 "$2,846.53" N/A N/A 222.252 SUP HCPCS C1713 222.252 - PLATE BONE 196MM 7 HOLE LCP STAINLESS STEEL FEMUR RIGHT BOTH IP/OP "$2,904.50" "$2,149.00" $576.40 "$2,953.53" "$1,306.87" "$1,306.87" "$1,306.87" "$1,306.87" "$2,904.15" "$2,904.15" "$2,904.15" $605.30 "$2,904.15" "$2,904.15" "$2,904.15" "$2,904.15" "$2,904.15" $605.26 "$2,904.15" "$2,953.53" "$1,431.75" "$2,904.15" "$2,953.53" "$2,904.15" "$2,904.15" "$2,178.38" "$2,904.15" "$2,904.15" "$2,904.15" "$1,452.08" "$1,452.08" "$2,300.09" "$2,904.15" "$2,323.32" "$1,306.87" $576.40 N/A "$1,684.61" "$2,904.15" "$2,904.15" "$2,904.15" "$2,904.15" "$2,904.15" N/A N/A 222.253 SUP HCPCS C1713 222.253 - PLATE BONE 196MM 7 HOLE LCP STAINLESS STEEL FEMUR LEFT BOTH IP/OP "$2,904.50" "$2,149.00" $576.40 "$2,953.53" "$1,306.87" "$1,306.87" "$1,306.87" "$1,306.87" "$2,904.15" "$2,904.15" "$2,904.15" $605.30 "$2,904.15" "$2,904.15" "$2,904.15" "$2,904.15" "$2,904.15" $605.26 "$2,904.15" "$1,181.41" "$1,431.75" "$2,904.15" "$2,953.53" "$2,904.15" "$2,904.15" "$2,178.38" "$2,904.15" "$2,904.15" "$2,904.15" "$1,452.08" "$1,452.08" "$2,300.09" "$2,904.15" "$2,323.32" "$1,306.87" $576.40 N/A "$1,684.61" "$2,904.15" "$2,904.15" "$2,904.15" $605.22 "$2,904.15" N/A N/A 222.254 SUP HCPCS C1713 222.254 - PLATE BONE 236MM 9 HOLE LCP STAINLESS STEEL FEMUR RIGHT BOTH IP/OP "$2,965.00" "$2,194.00" $588.40 "$3,015.00" "$1,334.07" "$1,334.07" "$1,334.07" "$1,334.07" "$2,964.60" "$2,964.60" "$2,964.60" $617.90 "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" $617.86 "$2,964.60" "$3,015.00" "$1,461.55" "$2,964.60" "$3,015.00" "$2,964.60" "$2,964.60" "$2,223.75" "$2,964.60" "$2,964.60" "$2,964.60" "$1,482.30" "$1,482.30" "$2,347.96" "$2,964.60" "$2,371.68" "$1,334.07" $588.40 N/A "$1,719.70" "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" N/A N/A 222.255 SUP HCPCS C1713 222.255 - PLATE BONE 236MM 9 HOLE LCP STAINLESS STEEL FEMUR LEFT BOTH IP/OP "$2,965.00" "$2,194.00" $588.40 "$3,015.00" "$1,334.07" "$1,334.07" "$1,334.07" "$1,334.07" "$2,964.60" "$2,964.60" "$2,964.60" $617.90 "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" $617.86 "$2,964.60" "$1,206.00" "$1,461.55" "$2,964.60" "$3,015.00" "$2,964.60" "$2,964.60" "$2,223.75" "$2,964.60" "$2,964.60" "$2,964.60" "$1,482.30" "$1,482.30" "$2,347.96" "$2,964.60" "$2,371.68" "$1,334.07" $588.40 N/A "$1,719.70" "$2,964.60" "$2,964.60" "$2,964.60" $617.82 "$2,964.60" N/A N/A 222.256 SUP HCPCS C1713 222.256 - PLATE BONE 276MM 11 HOLE LCP STAINLESS STEEL FEMUR RIGHT BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,073.63" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,073.63" "$1,489.97" "$3,022.25" "$3,073.63" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 222.257 SUP HCPCS C1713 222.257 - PLATE BONE 276MM 11 HOLE LCP STAINLESS STEEL FEMUR LEFT BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,073.63" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,229.45" "$1,489.97" "$3,022.25" "$3,073.63" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" "$3,022.25" "$3,022.25" N/A N/A 222.258 SUP HCPCS C1713 222.258 - PLATE BONE 316MM 13 HOLE LCP STAINLESS STEEL FEMUR RIGHT BOTH IP/OP "$3,081.50" "$2,280.00" $611.56 "$3,133.65" "$1,386.58" "$1,386.58" "$1,386.58" "$1,386.58" "$3,081.28" "$3,081.28" "$3,081.28" $642.22 "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" $642.17 "$3,081.28" "$3,133.65" "$1,519.07" "$3,081.28" "$3,133.65" "$3,081.28" "$3,081.28" "$2,311.13" "$3,081.28" "$3,081.28" "$3,081.28" "$1,540.64" "$1,540.64" "$2,440.37" "$3,081.28" "$2,465.02" "$1,386.58" $611.56 N/A "$1,787.27" "$3,081.28" "$1,848.77" "$3,081.28" "$3,081.28" "$3,081.28" N/A N/A 222.259 SUP HCPCS C1713 222.259 - PLATE BONE 316MM 13 HOLE LCP STAINLESS STEEL FEMUR LEFT BOTH IP/OP "$3,081.50" "$2,280.00" $611.56 "$3,133.65" "$1,386.58" "$1,386.58" "$1,386.58" "$1,386.58" "$3,081.28" "$3,081.28" "$3,081.28" $642.22 "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" $642.17 "$3,081.28" "$1,253.46" "$1,519.07" "$3,081.28" "$3,133.65" "$3,081.28" "$3,081.28" "$2,311.13" "$3,081.28" "$3,081.28" "$3,081.28" "$1,540.64" "$1,540.64" "$2,440.37" "$3,081.28" "$2,465.02" "$1,386.58" $611.56 N/A "$1,787.27" "$3,081.28" "$1,848.77" "$3,081.28" "$3,081.28" "$3,081.28" N/A N/A 222.402 SUP HCPCS C1713 222.402 - SCREW BONE 5MM 14MM SLFTAP LOCKING LCP LISS STAINLESS STEEL BOTH IP/OP $405.00 $300.00 $80.35 $411.73 $182.18 $182.18 $182.18 $182.18 $404.85 $404.85 $404.85 $84.38 $404.85 $404.85 $404.85 $404.85 $404.85 $84.38 $404.85 $164.69 $239.47 $404.85 $411.73 $404.85 $404.85 $303.75 $404.85 $404.85 $404.85 $202.43 $202.43 $320.64 $404.85 $323.88 $182.18 $80.35 N/A $234.90 $404.85 $404.85 $404.85 $84.37 $404.85 N/A N/A 222.404 SUP HCPCS C1713 222.404 - SCREW BONE 5MM 18MM SLFTAP LOCKING LCP LISS STAINLESS STEEL BOTH IP/OP $398.00 $295.00 $78.95 $404.58 $179.01 $179.01 $179.01 $179.01 $397.80 $397.80 $397.80 $82.91 $397.80 $397.80 $397.80 $397.80 $397.80 $82.91 $397.80 $161.83 $235.30 $397.80 $404.58 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $179.01 $78.95 N/A $230.84 $397.80 $238.68 $397.80 $82.90 $397.80 N/A N/A 222.537 SUP HCPCS C1713 222.537 - SCREW BONE 5MM 35MM LCP SS PROX PERIART FEM/TIB CANN LCK BOTH IP/OP $444.50 $329.00 $88.14 $444.08 $199.84 $199.84 $199.84 $199.84 $444.08 $444.08 $444.08 $92.56 $444.08 $444.08 $444.08 $444.08 $444.08 $92.55 $444.08 $444.08 $262.67 $444.08 $444.08 $444.08 $444.08 $333.38 $444.08 $444.08 $444.08 $222.04 $222.04 $351.71 $444.08 $355.26 $199.84 $88.14 N/A $257.81 $444.08 $266.45 $444.08 $92.55 $444.08 N/A N/A 222.538 SUP HCPCS C1713 222.538 - SCREW BONE 5MM 40MM LCP TI PROX PERIART FEM/TIB CANN LCK BOTH IP/OP $444.50 $329.00 $88.14 $444.08 $199.84 $199.84 $199.84 $199.84 $444.08 $444.08 $444.08 $92.56 $444.08 $444.08 $444.08 $444.08 $444.08 $92.55 $444.08 $444.08 $262.67 $444.08 $444.08 $444.08 $444.08 $333.38 $444.08 $444.08 $444.08 $222.04 $222.04 $351.71 $444.08 $355.26 $199.84 $88.14 N/A $257.81 $444.08 $266.45 $444.08 $92.55 $444.08 N/A N/A 222.541 SUP HCPCS C1713 222.541 - SCREW BONE 5MM 55MM LCP SS PROX PERIART FEM/TIB CANN LCK BOTH IP/OP $444.50 $329.00 $88.14 $444.08 $199.84 $199.84 $199.84 $199.84 $444.08 $444.08 $444.08 $92.56 $444.08 $444.08 $444.08 $444.08 $444.08 $92.55 $444.08 $444.08 $262.67 $444.08 $444.08 $444.08 $444.08 $333.38 $444.08 $444.08 $444.08 $222.04 $222.04 $351.71 $444.08 $355.26 $199.84 $88.14 N/A $257.81 $444.08 $444.08 $444.08 $92.55 $444.08 N/A N/A 222.542 SUP HCPCS C1713 222.542 - SCREW BONE 5MM 60MM LCP SS PROX PERIART FEM/TIB CANN LCK BOTH IP/OP $444.50 $329.00 $88.14 $444.08 $199.84 $199.84 $199.84 $199.84 $444.08 $444.08 $444.08 $92.56 $444.08 $444.08 $444.08 $444.08 $444.08 $92.55 $444.08 $444.08 $262.67 $444.08 $444.08 $444.08 $444.08 $333.38 $444.08 $444.08 $444.08 $222.04 $222.04 $351.71 $444.08 $355.26 $199.84 $88.14 N/A $257.81 $444.08 $266.45 $444.08 $92.55 $444.08 N/A N/A 222.543 SUP HCPCS C1713 222.543 - SCREW BONE 5MM 65MM LCP SS PROX PERIART FEM/TIB CANN LCK BOTH IP/OP $388.00 $287.00 $76.96 $387.78 $174.50 $174.50 $174.50 $174.50 $387.78 $387.78 $387.78 $80.82 $387.78 $387.78 $387.78 $387.78 $387.78 $80.82 $387.78 $387.78 $229.37 $387.78 $387.78 $387.78 $387.78 $291.00 $387.78 $387.78 $387.78 $193.89 $193.89 $307.12 $387.78 $310.22 $174.50 $76.96 N/A $225.04 $387.78 $232.67 $387.78 $80.81 $387.78 N/A N/A 222.545 SUP HCPCS C1713 222.545 - SCREW BONE 5MM 75MM LCP SS PROX PERIART FEM/TIB CANN LCK BOTH IP/OP $444.50 $329.00 $88.14 $444.08 $199.84 $199.84 $199.84 $199.84 $444.08 $444.08 $444.08 $92.56 $444.08 $444.08 $444.08 $444.08 $444.08 $92.55 $444.08 $444.08 $262.67 $444.08 $444.08 $444.08 $444.08 $333.38 $444.08 $444.08 $444.08 $222.04 $222.04 $351.71 $444.08 $355.26 $199.84 $88.14 N/A $257.81 $444.08 $266.45 $444.08 $92.55 $444.08 N/A N/A 222.546 SUP HCPCS C1713 222.546 - SCREW BONE 5MM 80MM LCP SS PROX PERIART FEM/TIB CANN LCK BOTH IP/OP $444.50 $329.00 $88.14 $444.08 $199.84 $199.84 $199.84 $199.84 $444.08 $444.08 $444.08 $92.56 $444.08 $444.08 $444.08 $444.08 $444.08 $92.55 $444.08 $444.08 $262.67 $444.08 $444.08 $444.08 $444.08 $333.38 $444.08 $444.08 $444.08 $222.04 $222.04 $351.71 $444.08 $355.26 $199.84 $88.14 N/A $257.81 $444.08 $266.45 $444.08 $92.55 $444.08 N/A N/A 222.547 SUP HCPCS C1713 222.547 - SCREW BONE 5MM 85MM LCP SS PROX PERIART FEM/TIB CANN LCK BOTH IP/OP $444.50 $329.00 $88.14 $444.08 $199.84 $199.84 $199.84 $199.84 $444.08 $444.08 $444.08 $92.56 $444.08 $444.08 $444.08 $444.08 $444.08 $92.55 $444.08 $444.08 $262.67 $444.08 $444.08 $444.08 $444.08 $333.38 $444.08 $444.08 $444.08 $222.04 $222.04 $351.71 $444.08 $355.26 $199.84 $88.14 N/A $257.81 $444.08 $266.45 $444.08 $92.55 $444.08 N/A N/A 222.548 SUP HCPCS C1713 222.548 - SCREW BONE 5MM 90MM LCP SS PROX PERIART FEM/TIB CANN LCK BOTH IP/OP $444.50 $329.00 $88.14 $444.08 $199.84 $199.84 $199.84 $199.84 $444.08 $444.08 $444.08 $92.56 $444.08 $444.08 $444.08 $444.08 $444.08 $92.55 $444.08 $444.08 $262.67 $444.08 $444.08 $444.08 $444.08 $333.38 $444.08 $444.08 $444.08 $222.04 $222.04 $351.71 $444.08 $355.26 $199.84 $88.14 N/A $257.81 $444.08 $266.45 $444.08 $92.55 $444.08 N/A N/A 222.554 SUP HCPCS C1713 222.554 - SCREW BONE 5MM 40MM LCP SS PROX PERIART FEM/TIB CANN CONICAL BOTH IP/OP $341.00 $252.00 $67.63 $340.75 $153.34 $153.34 $153.34 $153.34 $340.75 $340.75 $340.75 $71.02 $340.75 $340.75 $340.75 $340.75 $340.75 $71.02 $340.75 $136.30 $201.55 $340.75 $340.75 $340.75 $340.75 $255.75 $340.75 $340.75 $340.75 $170.38 $170.38 $269.87 $340.75 $272.60 $153.34 $67.63 N/A $197.78 $340.75 $204.45 $340.75 $71.01 $340.75 N/A N/A 222.564 SUP HCPCS C1713 222.564 - SCREW BONE 5MM 90MM LCP SS PROX PERIART FEM/TIB CANN CONICAL BOTH IP/OP $391.00 $289.00 $77.52 $390.60 $175.77 $175.77 $175.77 $175.77 $390.60 $390.60 $390.60 $81.41 $390.60 $390.60 $390.60 $390.60 $390.60 $81.41 $390.60 $390.60 $231.04 $390.60 $390.60 $390.60 $390.60 $293.25 $390.60 $390.60 $390.60 $195.30 $195.30 $309.36 $390.60 $312.48 $175.77 $77.52 N/A $226.78 $390.60 $234.36 $390.60 $81.40 $390.60 N/A N/A 222.571 SUP HCPCS C1713 222.571 - SCREW BONE 7.3MM 70MM LCP SS PROX PERIART FEM/TIB CANN LCK BOTH IP/OP $658.00 $487.00 $130.59 $657.98 $296.09 $296.09 $296.09 $296.09 $657.98 $657.98 $657.98 $137.14 $657.98 $657.98 $657.98 $657.98 $657.98 $137.13 $657.98 $657.98 $389.20 $657.98 $657.98 $657.98 $657.98 $493.50 $657.98 $657.98 $657.98 $328.99 $328.99 $521.12 $657.98 $526.38 $296.09 $130.59 N/A $381.64 $657.98 $394.79 $657.98 $137.12 $657.98 N/A N/A 222.572 SUP HCPCS C1713 222.572 - SCREW BONE 7.3MM 75MM LCP SS PROX PERIART FEM/TIB CANN LCK BOTH IP/OP $658.00 $487.00 $130.59 $657.98 $296.09 $296.09 $296.09 $296.09 $657.98 $657.98 $657.98 $137.14 $657.98 $657.98 $657.98 $657.98 $657.98 $137.13 $657.98 $657.98 $389.20 $657.98 $657.98 $657.98 $657.98 $493.50 $657.98 $657.98 $657.98 $328.99 $328.99 $521.12 $657.98 $526.38 $296.09 $130.59 N/A $381.64 $657.98 $394.79 $657.98 $137.12 $657.98 N/A N/A 222.573 SUP HCPCS C1713 222.573 - SCREW BONE 7.3MM 80MM LCP SS PROX PERIART FEM/TIB CANN LCK BOTH IP/OP $658.00 $487.00 $130.59 $657.98 $296.09 $296.09 $296.09 $296.09 $657.98 $657.98 $657.98 $137.14 $657.98 $657.98 $657.98 $657.98 $657.98 $137.13 $657.98 $657.98 $389.20 $657.98 $657.98 $657.98 $657.98 $493.50 $657.98 $657.98 $657.98 $328.99 $328.99 $521.12 $657.98 $526.38 $296.09 $130.59 N/A $381.64 $657.98 $394.79 $657.98 $137.12 $657.98 N/A N/A 222.575 SUP HCPCS C1713 222.575 - SCREW BONE 7.3MM 90MM LCP SS PROX PERIART FEM/TIB CANN LCK BOTH IP/OP $658.00 $487.00 $130.59 $657.98 $296.09 $296.09 $296.09 $296.09 $657.98 $657.98 $657.98 $137.14 $657.98 $657.98 $657.98 $657.98 $657.98 $137.13 $657.98 $657.98 $389.20 $657.98 $657.98 $657.98 $657.98 $493.50 $657.98 $657.98 $657.98 $328.99 $328.99 $521.12 $657.98 $526.38 $296.09 $130.59 N/A $381.64 $657.98 $394.79 $657.98 $137.12 $657.98 N/A N/A 222.578 SUP Custom 27803010 222.578 - NUT ORTHOPEDIC 4MM 12MM SELF CUTTING SERRATED TIP LCP BOTH IP/OP $304.00 $225.00 $54.05 $308.78 $303.63 $303.63 $303.63 $303.63 $303.63 $303.63 $54.05 $303.63 $303.63 $303.63 $303.63 $303.63 $303.63 $63.28 $303.63 $123.51 $303.63 $303.63 $308.78 $303.63 $303.63 $228.00 $303.63 $303.63 $303.63 $151.82 $151.82 $240.47 $303.63 $242.90 $136.63 $303.63 N/A $176.32 $303.63 $182.18 $303.63 $303.63 $303.63 N/A N/A 222.58 SUP HCPCS C1713 222.580 - SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 14MM SELF TAP LCP BOTH IP/OP $262.50 $194.00 $52.01 $262.03 $117.91 $117.91 $117.91 $117.91 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $154.99 $262.03 $262.03 $262.03 $262.03 $196.88 $262.03 $262.03 $262.03 $131.02 $131.02 $207.53 $262.03 $209.62 $117.91 $52.01 N/A $152.25 $262.03 $157.22 $262.03 $54.61 $262.03 N/A N/A 222.581 SUP HCPCS C1713 222.581 - SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 16MM SELF TAP LCP BOTH IP/OP $262.50 $194.00 $52.01 $262.03 $117.91 $117.91 $117.91 $117.91 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $154.99 $262.03 $262.03 $262.03 $262.03 $196.88 $262.03 $262.03 $262.03 $131.02 $131.02 $207.53 $262.03 $209.62 $117.91 $52.01 N/A $152.25 $262.03 $157.22 $262.03 $54.61 $262.03 N/A N/A 222.582 SUP HCPCS C1713 222.582 - SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 18MM SELF TAP LCP BOTH IP/OP $262.50 $194.00 $52.01 $262.03 $117.91 $117.91 $117.91 $117.91 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $262.03 $262.03 $262.03 $54.61 $262.03 $104.81 $154.99 $262.03 $262.03 $262.03 $262.03 $196.88 $262.03 $262.03 $262.03 $131.02 $131.02 $207.53 $262.03 $209.62 $117.91 $52.01 N/A $152.25 $262.03 $157.22 $262.03 $54.61 $262.03 N/A N/A 222.583 SUP HCPCS C1713 222.583 - SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 22MM SELF TAP LCP BOTH IP/OP $262.50 $194.00 $52.01 $262.03 $117.91 $117.91 $117.91 $117.91 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $154.99 $262.03 $262.03 $262.03 $262.03 $196.88 $262.03 $262.03 $262.03 $131.02 $131.02 $207.53 $262.03 $209.62 $117.91 $52.01 N/A $152.25 $262.03 $157.22 $262.03 $54.61 $262.03 N/A N/A 222.584 SUP HCPCS C1713 222.584 - SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 26MM SELF TAP LCP BOTH IP/OP $262.50 $194.00 $52.01 $262.03 $117.91 $117.91 $117.91 $117.91 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $154.99 $262.03 $262.03 $262.03 $262.03 $196.88 $262.03 $262.03 $262.03 $131.02 $131.02 $207.53 $262.03 $209.62 $117.91 $52.01 N/A $152.25 $262.03 $262.03 $262.03 $54.61 $262.03 N/A N/A 222.585 SUP HCPCS C1713 222.585 - SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 30MM SELF TAP LCP BOTH IP/OP $262.50 $194.00 $52.01 $262.03 $117.91 $117.91 $117.91 $117.91 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $154.99 $262.03 $262.03 $262.03 $262.03 $196.88 $262.03 $262.03 $262.03 $131.02 $131.02 $207.53 $262.03 $209.62 $117.91 $52.01 N/A $152.25 $262.03 $262.03 $262.03 $54.61 $262.03 N/A N/A 222.586 SUP HCPCS C1713 222.586 - SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 34MM SELF TAP LCP BOTH IP/OP $262.50 $194.00 $52.01 $262.03 $117.91 $117.91 $117.91 $117.91 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $154.99 $262.03 $262.03 $262.03 $262.03 $196.88 $262.03 $262.03 $262.03 $131.02 $131.02 $207.53 $262.03 $209.62 $117.91 $52.01 N/A $152.25 $262.03 $157.22 $262.03 $54.61 $262.03 N/A N/A 222.587 SUP HCPCS C1713 222.587 - SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 38MM SELF TAP LCP BOTH IP/OP $262.50 $194.00 $52.01 $262.03 $117.91 $117.91 $117.91 $117.91 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $154.99 $262.03 $262.03 $262.03 $262.03 $196.88 $262.03 $262.03 $262.03 $131.02 $131.02 $207.53 $262.03 $209.62 $117.91 $52.01 N/A $152.25 $262.03 $157.22 $262.03 $54.61 $262.03 N/A N/A 222.588 SUP HCPCS C1713 222.588 - SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 42MM SELF TAP LCP BOTH IP/OP $262.50 $194.00 $52.01 $262.03 $117.91 $117.91 $117.91 $117.91 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $154.99 $262.03 $262.03 $262.03 $262.03 $196.88 $262.03 $262.03 $262.03 $131.02 $131.02 $207.53 $262.03 $209.62 $117.91 $52.01 N/A $152.25 $262.03 $262.03 $262.03 $54.61 $262.03 N/A N/A 222.589 SUP HCPCS C1713 222.589 - SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 46MM SELF TAP LCP BOTH IP/OP $262.50 $194.00 $52.01 $262.03 $117.91 $117.91 $117.91 $117.91 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $154.99 $262.03 $262.03 $262.03 $262.03 $196.88 $262.03 $262.03 $262.03 $131.02 $131.02 $207.53 $262.03 $209.62 $117.91 $52.01 N/A $152.25 $262.03 $157.22 $262.03 $54.61 $262.03 N/A N/A 222.59 SUP HCPCS C1713 222.590 - SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 50MM SELF TAP LCP BOTH IP/OP $262.50 $194.00 $52.01 $262.03 $117.91 $117.91 $117.91 $117.91 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $262.03 $262.03 $262.03 $54.61 $262.03 $104.81 $154.99 $262.03 $262.03 $262.03 $262.03 $196.88 $262.03 $262.03 $262.03 $131.02 $131.02 $207.53 $262.03 $209.62 $117.91 $52.01 N/A $152.25 $262.03 $157.22 $262.03 $54.61 $262.03 N/A N/A 222.591 SUP HCPCS C1713 222.591 - SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 54MM SELF TAP LCP BOTH IP/OP $262.50 $194.00 $52.01 $262.03 $117.91 $117.91 $117.91 $117.91 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $154.99 $262.03 $262.03 $262.03 $262.03 $196.88 $262.03 $262.03 $262.03 $131.02 $131.02 $207.53 $262.03 $209.62 $117.91 $52.01 N/A $152.25 $262.03 $157.22 $262.03 $54.61 $262.03 N/A N/A 222.592 SUP HCPCS C1713 222.592 - SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 58MM SELF TAP LCP BOTH IP/OP $262.50 $194.00 $52.01 $262.03 $117.91 $117.91 $117.91 $117.91 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $262.03 $262.03 $262.03 $54.61 $262.03 $104.81 $154.99 $262.03 $262.03 $262.03 $262.03 $196.88 $262.03 $262.03 $262.03 $131.02 $131.02 $207.53 $262.03 $209.62 $117.91 $52.01 N/A $152.25 $262.03 $157.22 $262.03 $54.61 $262.03 N/A N/A 222.593 SUP HCPCS C1713 222.593 - SCREW BONE LARGE CONE HEXAGON 4MM 3.4MM 62MM SELF TAP LCP BOTH IP/OP $262.50 $194.00 $52.01 $262.03 $117.91 $117.91 $117.91 $117.91 $262.03 $262.03 $262.03 $54.61 $262.03 $262.03 $262.03 $262.03 $262.03 $54.61 $262.03 $104.81 $154.99 $262.03 $262.03 $262.03 $262.03 $196.88 $262.03 $262.03 $262.03 $131.02 $131.02 $207.53 $262.03 $209.62 $117.91 $52.01 N/A $152.25 $262.03 $157.22 $262.03 $54.61 $262.03 N/A N/A 222.608 SUP HCPCS C1713 222.608 - SCREW BONE 7.3MM 85MM LCP SS FULTHD PROX PERIART FEM/TIB BOTH IP/OP $515.00 $381.00 $102.15 $514.65 $231.59 $231.59 $231.59 $231.59 $514.65 $514.65 $514.65 $107.27 $514.65 $514.65 $514.65 $514.65 $514.65 $107.26 $514.65 $205.86 $304.42 $514.65 $514.65 $514.65 $514.65 $386.25 $514.65 $514.65 $514.65 $257.33 $257.33 $407.60 $514.65 $411.72 $231.59 $102.15 N/A $298.70 $514.65 $308.79 $514.65 $107.25 $514.65 N/A N/A 222.609 SUP HCPCS C1713 222.609 - SCREW BONE 7.3MM 90MM LCP SS FULTHD PROX PERIART FEM/TIB BOTH IP/OP $534.50 $396.00 $106.03 $534.23 $240.40 $240.40 $240.40 $240.40 $534.23 $534.23 $534.23 $111.35 $534.23 $534.23 $534.23 $534.23 $534.23 $111.34 $534.23 $534.23 $316.00 $534.23 $534.23 $534.23 $534.23 $400.88 $534.23 $534.23 $534.23 $267.12 $267.12 $423.11 $534.23 $427.38 $240.40 $106.03 N/A $310.01 $534.23 $320.54 $534.23 $111.33 $534.23 N/A N/A 222.645 SUP HCPCS C1713 222.645 - SCREW BONE 7.3MM 75MM LCP SS PROX PERIART FEM/TIB CANN BOTH IP/OP $534.50 $396.00 $106.03 $534.23 $240.40 $240.40 $240.40 $240.40 $534.23 $534.23 $534.23 $111.35 $534.23 $534.23 $534.23 $534.23 $534.23 $111.34 $534.23 $534.23 $316.00 $534.23 $534.23 $534.23 $534.23 $400.88 $534.23 $534.23 $534.23 $267.12 $267.12 $423.11 $534.23 $427.38 $240.40 $106.03 N/A $310.01 $534.23 $320.54 $534.23 $111.33 $534.23 N/A N/A 222.646 SUP HCPCS C1713 222.646 - SCREW BONE 7.3MM 80MM LCP SS PROX PERIART FEM/TIB CANN BOTH IP/OP $588.50 $435.00 $116.75 $588.23 $264.70 $264.70 $264.70 $264.70 $588.23 $588.23 $588.23 $122.60 $588.23 $588.23 $588.23 $588.23 $588.23 $122.59 $588.23 $588.23 $347.94 $588.23 $588.23 $588.23 $588.23 $441.38 $588.23 $588.23 $588.23 $294.12 $294.12 $465.88 $588.23 $470.58 $264.70 $116.75 N/A $341.33 $588.23 $352.94 $588.23 $122.59 $588.23 N/A N/A 222.656 SUP HCPCS C1713 222.656 - PLATE BN 170X17.5X5.2MM NS LCP CMBN 6 HL LOPRFL LMT CNTCT BOTH IP/OP "$2,887.50" "$2,137.00" $573.06 "$2,936.38" "$1,299.29" "$1,299.29" "$1,299.29" "$1,299.29" "$2,887.30" "$2,887.30" "$2,887.30" $601.79 "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" $601.75 "$2,887.30" "$2,936.38" "$1,423.44" "$2,887.30" "$2,936.38" "$2,887.30" "$2,887.30" "$2,165.63" "$2,887.30" "$2,887.30" "$2,887.30" "$1,443.65" "$1,443.65" "$2,286.74" "$2,887.30" "$2,309.84" "$1,299.29" $573.06 N/A "$1,674.75" "$2,887.30" "$1,732.38" "$2,887.30" $601.71 "$2,887.30" N/A N/A 222.657 SUP HCPCS C1713 222.657 - PLATE BN 170X17.5X5.2MM NS LCP CMBN 6 HL LOPRFL LMT CNTCT BOTH IP/OP "$2,887.50" "$2,137.00" $573.06 "$2,936.38" "$1,299.29" "$1,299.29" "$1,299.29" "$1,299.29" "$2,887.30" "$2,887.30" "$2,887.30" $601.79 "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" $601.75 "$2,887.30" "$2,936.38" "$1,423.44" "$2,887.30" "$2,936.38" "$2,887.30" "$2,887.30" "$2,165.63" "$2,887.30" "$2,887.30" "$2,887.30" "$1,443.65" "$1,443.65" "$2,286.74" "$2,887.30" "$2,309.84" "$1,299.29" $573.06 N/A "$1,674.75" "$2,887.30" "$1,732.38" "$2,887.30" $601.71 "$2,887.30" N/A N/A 222.658 SUP HCPCS C1713 222.658 - PLATE BN 206X17.5X5.2MM NS LCP CMBN 8 HL LOPRFL LMT CNTCT BOTH IP/OP "$2,941.00" "$2,176.00" $583.66 "$2,990.70" "$1,323.32" "$1,323.32" "$1,323.32" "$1,323.32" "$2,940.70" "$2,940.70" "$2,940.70" $612.92 "$2,940.70" "$2,940.70" "$2,940.70" "$2,940.70" "$2,940.70" $612.87 "$2,940.70" "$2,990.70" "$1,449.77" "$2,940.70" "$2,990.70" "$2,940.70" "$2,940.70" "$2,205.75" "$2,940.70" "$2,940.70" "$2,940.70" "$1,470.35" "$1,470.35" "$2,329.03" "$2,940.70" "$2,352.56" "$1,323.32" $583.66 N/A "$1,705.78" "$2,940.70" "$2,940.70" "$2,940.70" $612.84 "$2,940.70" N/A N/A 222.659 SUP HCPCS C1713 222.659 - PLATE BN 206X17.5X5.2MM NS LCP CMBN 8 HL LOPRFL LMT CNTCT BOTH IP/OP "$2,941.00" "$2,176.00" $583.66 "$2,990.70" "$1,323.32" "$1,323.32" "$1,323.32" "$1,323.32" "$2,940.70" "$2,940.70" "$2,940.70" $612.92 "$2,940.70" "$2,940.70" "$2,940.70" "$2,940.70" "$2,940.70" $612.87 "$2,940.70" "$2,990.70" "$1,449.77" "$2,940.70" "$2,990.70" "$2,940.70" "$2,940.70" "$2,205.75" "$2,940.70" "$2,940.70" "$2,940.70" "$1,470.35" "$1,470.35" "$2,329.03" "$2,940.70" "$2,352.56" "$1,323.32" $583.66 N/A "$1,705.78" "$2,940.70" "$1,764.42" "$2,940.70" $612.84 "$2,940.70" N/A N/A 222.66 SUP HCPCS C1713 222.660 - PLATE BN 242X17.5X5.2MM NS LCP CMBN 10 HL LOPRFL LMT CNTCT BOTH IP/OP "$2,961.50" "$2,192.00" $587.78 "$3,102.20" "$1,332.68" "$1,332.68" "$1,332.68" "$1,332.68" "$2,961.50" "$2,961.50" "$2,961.50" $617.25 "$2,961.50" "$2,961.50" "$2,961.50" "$2,961.50" "$2,961.50" $617.21 "$2,961.50" "$3,102.20" "$1,460.02" "$2,961.50" "$3,102.20" "$2,961.50" "$2,961.50" "$2,221.13" "$2,961.50" "$2,961.50" "$2,961.50" "$1,480.75" "$1,480.75" "$2,345.51" "$2,961.50" "$2,369.20" "$1,332.68" $587.78 N/A "$1,717.67" "$2,961.50" "$1,776.90" "$2,961.50" $617.18 "$2,961.50" N/A N/A 222.661 SUP HCPCS C1713 222.661 - PLATE BN 242X17.5X5.2MM NS LCP CMBN 10 HL LOPRFL LMT CNTCT BOTH IP/OP "$3,050.50" "$2,257.00" $605.42 "$3,102.20" "$1,372.66" "$1,372.66" "$1,372.66" "$1,372.66" "$3,050.35" "$3,050.35" "$3,050.35" $635.77 "$3,050.35" "$3,050.35" "$3,050.35" "$3,050.35" "$3,050.35" $635.73 "$3,050.35" "$3,102.20" "$1,503.82" "$3,050.35" "$3,102.20" "$3,050.35" "$3,050.35" "$2,287.88" "$3,050.35" "$3,050.35" "$3,050.35" "$1,525.18" "$1,525.18" "$2,415.88" "$3,050.35" "$2,440.28" "$1,372.66" $605.42 N/A "$1,769.29" "$3,050.35" "$1,830.21" "$3,050.35" $635.69 "$3,050.35" N/A N/A 222.662 SUP HCPCS C1713 222.662 - PLATE BN 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL LMT CNTCT BOTH IP/OP "$3,112.50" "$2,303.00" $617.69 "$3,165.10" "$1,400.49" "$1,400.49" "$1,400.49" "$1,400.49" "$3,112.20" "$3,112.20" "$3,112.20" $648.66 "$3,112.20" "$3,112.20" "$3,112.20" "$3,112.20" "$3,112.20" $648.62 "$3,112.20" "$3,165.10" "$1,534.31" "$3,112.20" "$3,165.10" "$3,112.20" "$3,112.20" "$2,334.38" "$3,112.20" "$3,112.20" "$3,112.20" "$1,556.10" "$1,556.10" "$2,464.86" "$3,112.20" "$2,489.76" "$1,400.49" $617.69 N/A "$1,805.25" "$3,112.20" "$1,867.32" "$3,112.20" $648.58 "$3,112.20" N/A N/A 222.663 SUP HCPCS C1713 222.663 - PLATE BN 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL LMT CNTCT BOTH IP/OP "$3,112.50" "$2,303.00" $617.69 "$3,165.10" "$1,400.49" "$1,400.49" "$1,400.49" "$1,400.49" "$3,112.20" "$3,112.20" "$3,112.20" $648.66 "$3,112.20" "$3,112.20" "$3,112.20" "$3,112.20" "$3,112.20" $648.62 "$3,112.20" "$3,165.10" "$1,534.31" "$3,112.20" "$3,165.10" "$3,112.20" "$3,112.20" "$2,334.38" "$3,112.20" "$3,112.20" "$3,112.20" "$1,556.10" "$1,556.10" "$2,464.86" "$3,112.20" "$2,489.76" "$1,400.49" $617.69 N/A "$1,805.25" "$3,112.20" "$3,112.20" "$3,112.20" $648.58 "$3,112.20" N/A N/A 222.664 SUP HCPCS C1713 222.664 - PLATE BN 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL LMT CNTCT BOTH IP/OP "$3,281.00" "$2,428.00" $651.17 "$3,336.65" "$1,476.40" "$1,476.40" "$1,476.40" "$1,476.40" "$3,280.88" "$3,280.88" "$3,280.88" $683.82 "$3,280.88" "$3,280.88" "$3,280.88" "$3,280.88" "$3,280.88" $683.77 "$3,280.88" "$1,334.66" "$1,617.47" "$3,280.88" "$3,336.65" "$3,280.88" "$3,280.88" "$2,460.75" "$3,280.88" "$3,280.88" "$3,280.88" "$1,640.44" "$1,640.44" "$2,598.46" "$3,280.88" "$2,624.70" "$1,476.40" $651.17 N/A "$1,902.98" "$3,280.88" "$1,968.53" "$3,280.88" $683.74 "$3,280.88" N/A N/A 222.665 SUP HCPCS C1713 222.665 - PLATE BN 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL LMT CNTCT BOTH IP/OP "$3,281.00" "$2,428.00" $651.17 "$3,336.65" "$1,476.40" "$1,476.40" "$1,476.40" "$1,476.40" "$3,280.88" "$3,280.88" "$3,280.88" $683.82 "$3,280.88" "$3,280.88" "$3,280.88" "$3,280.88" "$3,280.88" $683.77 "$3,280.88" "$1,334.66" "$1,617.47" "$3,280.88" "$3,336.65" "$3,280.88" "$3,280.88" "$2,460.75" "$3,280.88" "$3,280.88" "$3,280.88" "$1,640.44" "$1,640.44" "$2,598.46" "$3,280.88" "$2,624.70" "$1,476.40" $651.17 N/A "$1,902.98" "$3,280.88" "$1,968.53" "$3,280.88" $683.74 "$3,280.88" N/A N/A 222.666 SUP HCPCS C1713 222.666 - PLATE BONE CURVE 350X17.5X5.2MM 16 HOLE LP ANATOMIC HEAD BOTH IP/OP "$3,249.50" "$2,405.00" $644.94 "$3,249.48" "$1,462.27" "$1,462.27" "$1,462.27" "$1,462.27" "$3,249.48" "$3,249.48" "$3,249.48" $677.27 "$3,249.48" "$3,249.48" "$3,249.48" "$3,249.48" "$3,249.48" $677.23 "$3,249.48" "$3,249.48" "$1,601.99" "$3,249.48" "$3,249.48" "$3,249.48" "$3,249.48" "$2,437.13" "$3,249.48" "$3,249.48" "$3,249.48" "$1,624.74" "$1,624.74" "$2,573.59" "$3,249.48" "$2,599.58" "$1,462.27" $644.94 N/A "$1,884.71" "$3,249.48" "$1,949.69" "$3,249.48" $677.19 "$3,249.48" N/A N/A 222.667 SUP HCPCS C1713 222.667 - PLATE BONE CURVE 350X17.5X5.2MM 16 HOLE LP ANATOMIC HEAD BOTH IP/OP "$3,249.50" "$2,405.00" $644.94 "$3,249.48" "$1,462.27" "$1,462.27" "$1,462.27" "$1,462.27" "$3,249.48" "$3,249.48" "$3,249.48" $677.27 "$3,249.48" "$3,249.48" "$3,249.48" "$3,249.48" "$3,249.48" $677.23 "$3,249.48" "$1,299.79" "$1,601.99" "$3,249.48" "$3,249.48" "$3,249.48" "$3,249.48" "$2,437.13" "$3,249.48" "$3,249.48" "$3,249.48" "$1,624.74" "$1,624.74" "$2,573.59" "$3,249.48" "$2,599.58" "$1,462.27" $644.94 N/A "$1,884.71" "$3,249.48" "$1,949.69" "$3,249.48" $677.19 "$3,249.48" N/A N/A 222.668 SUP HCPCS C1713 222.668 - PLATE BONE CURVE 386X17.5X5.2MM 18 HOLE LP ANATOMIC HEAD BOTH IP/OP "$3,315.00" "$2,453.00" $657.94 "$3,314.98" "$1,491.74" "$1,491.74" "$1,491.74" "$1,491.74" "$3,314.98" "$3,314.98" "$3,314.98" $690.92 "$3,314.98" "$3,314.98" "$3,314.98" "$3,314.98" "$3,314.98" $690.88 "$3,314.98" "$1,325.99" "$1,634.29" "$3,314.98" "$3,314.98" "$3,314.98" "$3,314.98" "$2,486.25" "$3,314.98" "$3,314.98" "$3,314.98" "$1,657.49" "$1,657.49" "$2,625.46" "$3,314.98" "$2,651.98" "$1,491.74" $657.94 N/A "$1,922.70" "$3,314.98" "$3,314.98" "$3,314.98" $690.84 "$3,314.98" N/A N/A 222.669 SUP HCPCS C1713 222.669 - PLATE BONE CURVE 386X17.5X5.2MM 18 HOLE LP ANATOMIC HEAD BOTH IP/OP "$3,315.00" "$2,453.00" $657.94 "$3,314.98" "$1,491.74" "$1,491.74" "$1,491.74" "$1,491.74" "$3,314.98" "$3,314.98" "$3,314.98" $690.92 "$3,314.98" "$3,314.98" "$3,314.98" "$3,314.98" "$3,314.98" $690.88 "$3,314.98" "$3,314.98" "$1,634.29" "$3,314.98" "$3,314.98" "$3,314.98" "$3,314.98" "$2,486.25" "$3,314.98" "$3,314.98" "$3,314.98" "$1,657.49" "$1,657.49" "$2,625.46" "$3,314.98" "$2,651.98" "$1,491.74" $657.94 N/A "$1,922.70" "$3,314.98" "$1,988.99" "$3,314.98" $690.84 "$3,314.98" N/A N/A 222.675 SUP HCPCS C1713 222.675 - SCREW BONE 4MM 30MM LCP SS PROX PERIART FEM/TIB CANN LCK BOTH IP/OP $319.00 $236.00 $63.22 $318.53 $143.34 $143.34 $143.34 $143.34 $318.53 $318.53 $318.53 $66.39 $318.53 $318.53 $318.53 $318.53 $318.53 $66.39 $318.53 $318.53 $188.41 $318.53 $318.53 $318.53 $318.53 $239.25 $318.53 $318.53 $318.53 $159.27 $159.27 $252.28 $318.53 $254.82 $143.34 $63.22 N/A $185.02 $318.53 $318.53 $318.53 $66.38 $318.53 N/A N/A 222.676 SUP HCPCS C1713 222.676 - SCREW BONE 4MM 34MM LCP SS PROX MDL TIB LCK SLFTAP STARDRIVE BOTH IP/OP $444.50 $329.00 $88.14 $444.08 $199.84 $199.84 $199.84 $199.84 $444.08 $444.08 $444.08 $92.56 $444.08 $444.08 $444.08 $444.08 $444.08 $92.55 $444.08 $444.08 $262.67 $444.08 $444.08 $444.08 $444.08 $333.38 $444.08 $444.08 $444.08 $222.04 $222.04 $351.71 $444.08 $355.26 $199.84 $88.14 N/A $257.81 $444.08 $266.45 $444.08 $92.55 $444.08 N/A N/A 222.677 SUP HCPCS C1713 222.677 - SCREW BONE 4MM 38MM LCP SS PROX MDL TIB LCK SLFTAP NONSTRL BOTH IP/OP $319.00 $236.00 $63.22 $318.53 $143.34 $143.34 $143.34 $143.34 $318.53 $318.53 $318.53 $66.39 $318.53 $318.53 $318.53 $318.53 $318.53 $66.39 $318.53 $318.53 $188.41 $318.53 $318.53 $318.53 $318.53 $239.25 $318.53 $318.53 $318.53 $159.27 $159.27 $252.28 $318.53 $254.82 $143.34 $63.22 N/A $185.02 $318.53 $191.12 $318.53 $66.38 $318.53 N/A N/A 223.406 SUP HCPCS C1713 223.406 - PLATE BONE 86X11X3.3MM 6 HOLE LOCKING TAPERED ROUNDED TIP BOTH IP/OP "$1,673.00" "$1,238.00" $332.01 "$1,701.20" $752.75 $752.75 $752.75 $752.75 "$1,672.78" "$1,672.78" "$1,672.78" $348.65 "$1,672.78" "$1,672.78" "$1,672.78" "$1,672.78" "$1,672.78" $348.63 "$1,672.78" "$1,701.20" $989.45 "$1,672.78" "$1,701.20" "$1,672.78" "$1,672.78" "$1,254.75" "$1,672.78" "$1,672.78" "$1,672.78" $836.39 $836.39 "$1,324.84" "$1,672.78" "$1,338.22" $752.75 $332.01 N/A $970.34 "$1,672.78" "$1,003.67" "$1,672.78" $348.61 "$1,672.78" N/A N/A 223.407 SUP HCPCS C1713 223.407 - PLATE BONE 99X11X3.3MM 7 HOLE LOCKING TAPERED ROUNDED TIP BOTH IP/OP "$1,705.50" "$1,262.00" $338.42 "$1,734.08" $767.30 $767.30 $767.30 $767.30 "$1,705.10" "$1,705.10" "$1,705.10" $355.39 "$1,705.10" "$1,705.10" "$1,705.10" "$1,705.10" "$1,705.10" $355.36 "$1,705.10" "$1,734.08" "$1,008.57" "$1,705.10" "$1,734.08" "$1,705.10" "$1,705.10" "$1,279.13" "$1,705.10" "$1,705.10" "$1,705.10" $852.55 $852.55 "$1,350.44" "$1,705.10" "$1,364.08" $767.30 $338.42 N/A $989.19 "$1,705.10" "$1,023.06" "$1,705.10" $355.34 "$1,705.10" N/A N/A 223.408 SUP HCPCS C1713 223.408 - PLATE BONE 112X11X3.3MM 8 HOLE LCP STAINLESS STEEL BOTH IP/OP "$1,730.50" "$1,281.00" $343.44 "$1,759.83" $778.68 $778.68 $778.68 $778.68 "$1,730.40" "$1,730.40" "$1,730.40" $360.66 "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" $360.63 "$1,730.40" "$1,759.83" "$1,023.53" "$1,730.40" "$1,759.83" "$1,730.40" "$1,730.40" "$1,297.88" "$1,730.40" "$1,730.40" "$1,730.40" $865.20 $865.20 "$1,370.48" "$1,730.40" "$1,384.32" $778.68 $343.44 N/A "$1,003.69" "$1,730.40" "$1,038.24" "$1,730.40" $360.62 "$1,730.40" N/A N/A 223.409 SUP HCPCS C1713 223.409 - PLATE BONE 125MM 9 HOLE LOCKING LCP STAINLESS STEEL BOTH IP/OP "$1,759.00" "$1,302.00" $349.02 "$1,788.43" $791.34 $791.34 $791.34 $791.34 "$1,758.53" "$1,758.53" "$1,758.53" $366.52 "$1,758.53" "$1,758.53" "$1,758.53" "$1,758.53" "$1,758.53" $366.50 "$1,758.53" "$1,788.43" "$1,040.17" "$1,758.53" "$1,788.43" "$1,758.53" "$1,758.53" "$1,319.25" "$1,758.53" "$1,758.53" "$1,758.53" $879.27 $879.27 "$1,392.76" "$1,758.53" "$1,406.82" $791.34 $349.02 N/A "$1,020.22" "$1,758.53" "$1,055.12" "$1,758.53" $366.48 "$1,758.53" N/A N/A 223.41 SUP HCPCS C1713 223.410 - PLATE BN TPR 138X11X3.3MM NS LCP CMBN 10 HL RND TIP THN PRFL BOTH IP/OP "$1,736.00" "$1,285.00" $344.54 "$1,818.45" $781.18 $781.18 $781.18 $781.18 "$1,735.95" "$1,735.95" "$1,735.95" $361.82 "$1,735.95" "$1,735.95" "$1,735.95" "$1,735.95" "$1,735.95" $361.79 "$1,735.95" "$1,818.45" "$1,026.81" "$1,735.95" "$1,818.45" "$1,735.95" "$1,735.95" "$1,302.00" "$1,735.95" "$1,735.95" "$1,735.95" $867.98 $867.98 "$1,374.87" "$1,735.95" "$1,388.76" $781.18 $344.54 N/A "$1,006.88" "$1,735.95" "$1,041.57" "$1,735.95" $361.77 "$1,735.95" N/A N/A 223.411 SUP HCPCS C1713 223.411 - PLATE BONE 151MM 11 HOLE LOCKING LCP STAINLESS STEEL BOTH IP/OP "$1,818.00" "$1,345.00" $360.74 "$1,848.45" $817.90 $817.90 $817.90 $817.90 "$1,817.55" "$1,817.55" "$1,817.55" $378.82 "$1,817.55" "$1,817.55" "$1,817.55" "$1,817.55" "$1,817.55" $378.80 "$1,817.55" "$1,848.45" "$1,075.08" "$1,817.55" "$1,848.45" "$1,817.55" "$1,817.55" "$1,363.50" "$1,817.55" "$1,817.55" "$1,817.55" $908.78 $908.78 "$1,439.50" "$1,817.55" "$1,454.04" $817.90 $360.74 N/A "$1,054.44" "$1,817.55" "$1,817.55" "$1,817.55" $378.78 "$1,817.55" N/A N/A 223.412 SUP HCPCS C1713 223.412 - PLATE BONE 164MM 12 HOLE LOCKING LCP STAINLESS STEEL BOTH IP/OP "$2,346.50" "$1,736.00" $465.64 "$2,385.98" "$1,055.75" "$1,055.75" "$1,055.75" "$1,055.75" "$2,346.10" "$2,346.10" "$2,346.10" $488.99 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" "$2,385.98" "$1,387.72" "$2,346.10" "$2,385.98" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" $465.64 N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" $488.93 "$2,346.10" N/A N/A 223.414 SUP HCPCS C1713 223.414 - PLATE BONE 190MM 14 HOLE LOCKING LCP STAINLESS STEEL BOTH IP/OP "$2,422.00" "$1,792.00" $480.71 "$2,463.18" "$1,089.90" "$1,089.90" "$1,089.90" "$1,089.90" "$2,422.00" "$2,422.00" "$2,422.00" $504.81 "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" $504.77 "$2,422.00" "$2,463.18" "$1,432.61" "$2,422.00" "$2,463.18" "$2,422.00" "$2,422.00" "$1,816.50" "$2,422.00" "$2,422.00" "$2,422.00" "$1,211.00" "$1,211.00" "$1,918.22" "$2,422.00" "$1,937.60" "$1,089.90" $480.71 N/A "$1,404.76" "$2,422.00" "$1,453.20" "$2,422.00" $504.74 "$2,422.00" N/A N/A 223.416 SUP HCPCS C1713 223.416 - PLATE BONE 216MM 16 HOLE LOCKING LCP STAINLESS STEEL BOTH IP/OP "$2,474.50" "$1,831.00" $491.03 "$2,516.08" "$1,113.31" "$1,113.31" "$1,113.31" "$1,113.31" "$2,474.03" "$2,474.03" "$2,474.03" $515.65 "$2,474.03" "$2,474.03" "$2,474.03" "$2,474.03" "$2,474.03" $515.62 "$2,474.03" "$2,516.08" "$1,463.39" "$2,474.03" "$2,516.08" "$2,474.03" "$2,474.03" "$1,855.88" "$2,474.03" "$2,474.03" "$2,474.03" "$1,237.02" "$1,237.02" "$1,959.43" "$2,474.03" "$1,979.22" "$1,113.31" $491.03 N/A "$1,435.21" "$2,474.03" "$1,484.42" "$2,474.03" $515.59 "$2,474.03" N/A N/A 223.418 SUP HCPCS C1713 223.418 - PLATE BONE 242MM 18 HOLE LOCKING LCP STAINLESS STEEL BOTH IP/OP "$2,422.00" "$1,792.00" $480.71 "$2,463.18" "$1,089.90" "$1,089.90" "$1,089.90" "$1,089.90" "$2,422.00" "$2,422.00" "$2,422.00" $504.81 "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" $504.77 "$2,422.00" $985.27 "$1,432.61" "$2,422.00" "$2,463.18" "$2,422.00" "$2,422.00" "$1,816.50" "$2,422.00" "$2,422.00" "$2,422.00" "$1,211.00" "$1,211.00" "$1,918.22" "$2,422.00" "$1,937.60" "$1,089.90" $480.71 N/A "$1,404.76" "$2,422.00" "$2,422.00" "$2,422.00" $504.74 "$2,422.00" N/A N/A 223.506 SUP HCPCS C1713 223.506 - PLATE BN 95MM 6 HL SS TIB RT DIST MDL 3.5MM SCR BOTH IP/OP "$1,021.00" $756.00 $202.55 "$1,037.88" $459.24 $459.24 $459.24 $459.24 "$1,020.53" "$1,020.53" "$1,020.53" $212.70 "$1,020.53" "$1,020.53" "$1,020.53" "$1,020.53" "$1,020.53" $212.69 "$1,020.53" "$1,037.88" $603.64 "$1,020.53" "$1,037.88" "$1,020.53" "$1,020.53" $765.75 "$1,020.53" "$1,020.53" "$1,020.53" $510.27 $510.27 $808.26 "$1,020.53" $816.42 $459.24 $202.55 N/A $592.18 "$1,020.53" $612.32 "$1,020.53" $212.68 "$1,020.53" N/A N/A 223.507 SUP HCPCS C1713 223.507 - PLATE BN 95MM 6 HL SS TIB LT DIST MDL 3.5MM SCR BOTH IP/OP "$1,021.00" $756.00 $202.55 "$1,037.88" $459.24 $459.24 $459.24 $459.24 "$1,020.53" "$1,020.53" "$1,020.53" $212.70 "$1,020.53" "$1,020.53" "$1,020.53" "$1,020.53" "$1,020.53" $212.69 "$1,020.53" "$1,037.88" $603.64 "$1,020.53" "$1,037.88" "$1,020.53" "$1,020.53" $765.75 "$1,020.53" "$1,020.53" "$1,020.53" $510.27 $510.27 $808.26 "$1,020.53" $816.42 $459.24 $202.55 N/A $592.18 "$1,020.53" $612.32 "$1,020.53" $212.68 "$1,020.53" N/A N/A 223.508 SUP HCPCS C1713 223.508 - PLATE BN 121MM 8 HL SS TIB RT DIST MDL 3.5MM SCR BOTH IP/OP "$1,186.50" $878.00 $235.47 "$1,206.58" $533.88 $533.88 $533.88 $533.88 "$1,186.40" "$1,186.40" "$1,186.40" $247.28 "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" $247.26 "$1,186.40" "$1,206.58" $701.76 "$1,186.40" "$1,206.58" "$1,186.40" "$1,186.40" $889.88 "$1,186.40" "$1,186.40" "$1,186.40" $593.20 $593.20 $939.63 "$1,186.40" $949.12 $533.88 $235.47 N/A $688.17 "$1,186.40" $711.84 "$1,186.40" $247.25 "$1,186.40" N/A N/A 223.509 SUP HCPCS C1713 223.509 - PLATE BN 121MM 8 HL SS TIB LT DIST MDL 3.5MM SCR BOTH IP/OP "$1,186.50" $878.00 $235.47 "$1,206.58" $533.88 $533.88 $533.88 $533.88 "$1,186.40" "$1,186.40" "$1,186.40" $247.28 "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" $247.26 "$1,186.40" $482.63 $701.76 "$1,186.40" "$1,206.58" "$1,186.40" "$1,186.40" $889.88 "$1,186.40" "$1,186.40" "$1,186.40" $593.20 $593.20 $939.63 "$1,186.40" $949.12 $533.88 $235.47 N/A $688.17 "$1,186.40" $711.84 "$1,186.40" $247.25 "$1,186.40" N/A N/A 223.51 SUP HCPCS C1713 223.510 - PLATE BONE 147X10.2X2.2MM 10 HOLE LCP STAINLESS STEEL RIGHT BOTH IP/OP "$1,316.00" $974.00 $261.12 "$1,378.13" $592.03 $592.03 $592.03 $592.03 "$1,315.63" "$1,315.63" "$1,315.63" $274.21 "$1,315.63" "$1,315.63" "$1,315.63" "$1,315.63" "$1,315.63" $274.19 "$1,315.63" $551.25 $778.20 "$1,315.63" "$1,378.13" "$1,315.63" "$1,315.63" $987.00 "$1,315.63" "$1,315.63" "$1,315.63" $657.82 $657.82 "$1,041.98" "$1,315.63" "$1,052.50" $592.03 $261.12 N/A $763.28 "$1,315.63" $789.38 "$1,315.63" $274.18 "$1,315.63" N/A N/A 223.511 SUP HCPCS C1713 223.511 - PLATE BN 147MM 10 HL SS TIB LT DIST MDL 3.5MM SCR BOTH IP/OP "$1,355.50" "$1,003.00" $268.95 "$1,378.13" $609.80 $609.80 $609.80 $609.80 "$1,355.10" "$1,355.10" "$1,355.10" $282.44 "$1,355.10" "$1,355.10" "$1,355.10" "$1,355.10" "$1,355.10" $282.42 "$1,355.10" "$1,378.13" $801.54 "$1,355.10" "$1,378.13" "$1,355.10" "$1,355.10" "$1,016.63" "$1,355.10" "$1,355.10" "$1,355.10" $677.55 $677.55 "$1,073.24" "$1,355.10" "$1,084.08" $609.80 $268.95 N/A $786.19 "$1,355.10" $813.06 "$1,355.10" $282.40 "$1,355.10" N/A N/A 223.512 SUP HCPCS C1713 223.512 - PLATE BONE 173X10.2X2.2MM 11X3.3MM 12 HOLE LCP STAINLESS BOTH IP/OP "$1,513.00" "$1,120.00" $300.20 "$1,538.25" $680.64 $680.64 $680.64 $680.64 "$1,512.53" "$1,512.53" "$1,512.53" $315.25 "$1,512.53" "$1,512.53" "$1,512.53" "$1,512.53" "$1,512.53" $315.23 "$1,512.53" "$1,538.25" $894.66 "$1,512.53" "$1,538.25" "$1,512.53" "$1,512.53" "$1,134.75" "$1,512.53" "$1,512.53" "$1,512.53" $756.27 $756.27 "$1,197.92" "$1,512.53" "$1,210.02" $680.64 $300.20 N/A $877.54 "$1,512.53" $907.52 "$1,512.53" $315.21 "$1,512.53" N/A N/A 223.513 SUP HCPCS C1713 223.513 - PLATE BONE 173X10.2X2.2MM 11X3.3MM 12 HOLE LCP STAINLESS BOTH IP/OP "$1,513.00" "$1,120.00" $300.20 "$1,538.25" $680.64 $680.64 $680.64 $680.64 "$1,512.53" "$1,512.53" "$1,512.53" $315.25 "$1,512.53" "$1,512.53" "$1,512.53" "$1,512.53" "$1,512.53" $315.23 "$1,512.53" "$1,538.25" $894.66 "$1,512.53" "$1,538.25" "$1,512.53" "$1,512.53" "$1,134.75" "$1,512.53" "$1,512.53" "$1,512.53" $756.27 $756.27 "$1,197.92" "$1,512.53" "$1,210.02" $680.64 $300.20 N/A $877.54 "$1,512.53" $907.52 "$1,512.53" $315.21 "$1,512.53" N/A N/A 223.514 SUP HCPCS C1713 223.514 - PLATE BONE 199X10.2X2.2MM 11X3.3MM 14 HOLE LCP STAINLESS BOTH IP/OP "$1,688.50" "$1,249.00" $335.07 "$1,716.93" $759.70 $759.70 $759.70 $759.70 "$1,688.23" "$1,688.23" "$1,688.23" $351.87 "$1,688.23" "$1,688.23" "$1,688.23" "$1,688.23" "$1,688.23" $351.85 "$1,688.23" "$1,716.93" $998.59 "$1,688.23" "$1,716.93" "$1,688.23" "$1,688.23" "$1,266.38" "$1,688.23" "$1,688.23" "$1,688.23" $844.12 $844.12 "$1,337.08" "$1,688.23" "$1,350.58" $759.70 $335.07 N/A $979.33 "$1,688.23" "$1,688.23" "$1,688.23" $351.83 "$1,688.23" N/A N/A 223.515 SUP HCPCS C1713 223.515 - PLATE BONE 199X10.2X2.2MM 11X3.3MM 14 HOLE LCP STAINLESS BOTH IP/OP "$1,688.50" "$1,249.00" $335.07 "$1,716.93" $759.70 $759.70 $759.70 $759.70 "$1,688.23" "$1,688.23" "$1,688.23" $351.87 "$1,688.23" "$1,688.23" "$1,688.23" "$1,688.23" "$1,688.23" $351.85 "$1,688.23" "$1,716.93" $998.59 "$1,688.23" "$1,716.93" "$1,688.23" "$1,688.23" "$1,266.38" "$1,688.23" "$1,688.23" "$1,688.23" $844.12 $844.12 "$1,337.08" "$1,688.23" "$1,350.58" $759.70 $335.07 N/A $979.33 "$1,688.23" "$1,012.94" "$1,688.23" $351.83 "$1,688.23" N/A N/A 223.516 SUP HCPCS C1713 223.516 - PLATE BONE 225MM 16 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL BOTH IP/OP "$1,912.00" "$1,415.00" $379.43 "$1,944.25" $860.29 $860.29 $860.29 $860.29 "$1,911.75" "$1,911.75" "$1,911.75" $398.46 "$1,911.75" "$1,911.75" "$1,911.75" "$1,911.75" "$1,911.75" $398.43 "$1,911.75" $777.70 "$1,130.80" "$1,911.75" "$1,944.25" "$1,911.75" "$1,911.75" "$1,434.00" "$1,911.75" "$1,911.75" "$1,911.75" $955.88 $955.88 "$1,514.11" "$1,911.75" "$1,529.40" $860.29 $379.43 N/A "$1,108.96" "$1,911.75" "$1,147.05" "$1,911.75" $398.41 "$1,911.75" N/A N/A 223.517 SUP HCPCS C1713 223.517 - PLATE BONE 225MM 16 HOLE STAINLESS STEEL TIBIA LEFT DISTAL BOTH IP/OP "$1,912.00" "$1,415.00" $379.43 "$1,944.25" $860.29 $860.29 $860.29 $860.29 "$1,911.75" "$1,911.75" "$1,911.75" $398.46 "$1,911.75" "$1,911.75" "$1,911.75" "$1,911.75" "$1,911.75" $398.43 "$1,911.75" "$1,944.25" "$1,130.80" "$1,911.75" "$1,944.25" "$1,911.75" "$1,911.75" "$1,434.00" "$1,911.75" "$1,911.75" "$1,911.75" $955.88 $955.88 "$1,514.11" "$1,911.75" "$1,529.40" $860.29 $379.43 N/A "$1,108.96" "$1,911.75" "$1,147.05" "$1,911.75" $398.41 "$1,911.75" N/A N/A 223.518 SUP HCPCS C1713 223.518 - PLATE BONE 251MM 18 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL BOTH IP/OP "$2,087.50" "$1,545.00" $414.31 "$2,122.93" $939.35 $939.35 $939.35 $939.35 "$2,087.45" "$2,087.45" "$2,087.45" $435.08 "$2,087.45" "$2,087.45" "$2,087.45" "$2,087.45" "$2,087.45" $435.05 "$2,087.45" $849.17 "$1,234.73" "$2,087.45" "$2,122.93" "$2,087.45" "$2,087.45" "$1,565.63" "$2,087.45" "$2,087.45" "$2,087.45" "$1,043.73" "$1,043.73" "$1,653.26" "$2,087.45" "$1,669.96" $939.35 $414.31 N/A "$1,210.75" "$2,087.45" "$1,252.47" "$2,087.45" $435.02 "$2,087.45" N/A N/A 223.519 SUP HCPCS C1713 223.519 - PLATE BONE 251MM 18 HOLE STAINLESS STEEL TIBIA LEFT DISTAL BOTH IP/OP "$2,087.50" "$1,545.00" $414.31 "$2,122.93" $939.35 $939.35 $939.35 $939.35 "$2,087.45" "$2,087.45" "$2,087.45" $435.08 "$2,087.45" "$2,087.45" "$2,087.45" "$2,087.45" "$2,087.45" $435.05 "$2,087.45" "$2,122.93" "$1,234.73" "$2,087.45" "$2,122.93" "$2,087.45" "$2,087.45" "$1,565.63" "$2,087.45" "$2,087.45" "$2,087.45" "$1,043.73" "$1,043.73" "$1,653.26" "$2,087.45" "$1,669.96" $939.35 $414.31 N/A "$1,210.75" "$2,087.45" "$1,252.47" "$2,087.45" $435.02 "$2,087.45" N/A N/A 223.52 SUP HCPCS C1713 223.52 - PLATE BONE 25X11X3.3MM 2 HOLE LC-DCP STAINLESS STEEL DISTAL BOTH IP/OP $232.00 $172.00 $46.04 $235.90 $104.38 $104.38 $104.38 $104.38 $231.95 $231.95 $231.95 $48.34 $231.95 $231.95 $231.95 $231.95 $231.95 $48.34 $231.95 $235.90 $137.20 $231.95 $235.90 $231.95 $231.95 $174.00 $231.95 $231.95 $231.95 $115.98 $115.98 $183.70 $231.95 $185.56 $104.38 $46.04 N/A $134.56 $231.95 $231.95 $231.95 $48.34 $231.95 N/A N/A 223.521 SUP HCPCS C1713 223.521 - PLATE BN 33MM NS LCP CMBN 2 HL LMT CNTCT TPR END SS 3.5MM BOTH IP/OP $491.00 $363.00 $97.37 $498.93 $220.76 $220.76 $220.76 $220.76 $490.58 $490.58 $490.58 $102.25 $490.58 $490.58 $490.58 $490.58 $490.58 $102.24 $490.58 $498.93 $290.18 $490.58 $498.93 $490.58 $490.58 $368.25 $490.58 $490.58 $490.58 $245.29 $245.29 $388.54 $490.58 $392.46 $220.76 $97.37 N/A $284.78 $490.58 $294.35 $490.58 $102.24 $490.58 N/A N/A 223.53 SUP HCPCS C1713 223.53 - PLATE BONE 38X11X3.3MM 3 HOLE LC-DCP STAINLESS STEEL DISTAL BOTH IP/OP $236.50 $175.00 $46.87 $240.18 $106.27 $106.27 $106.27 $106.27 $236.15 $236.15 $236.15 $49.22 $236.15 $236.15 $236.15 $236.15 $236.15 $49.22 $236.15 $240.18 $139.68 $236.15 $240.18 $236.15 $236.15 $177.38 $236.15 $236.15 $236.15 $118.08 $118.08 $187.03 $236.15 $188.92 $106.27 $46.87 N/A $137.17 $236.15 $236.15 $236.15 $49.21 $236.15 N/A N/A 223.531 SUP HCPCS C1713 223.531 - PLATE BN 46X11X3.4MM NS LCP CMBN 3 HL LMT CNTCT TPR END SS BOTH IP/OP $510.50 $378.00 $101.28 $518.95 $229.63 $229.63 $229.63 $229.63 $510.28 $510.28 $510.28 $106.36 $510.28 $510.28 $510.28 $510.28 $510.28 $106.35 $510.28 $518.95 $301.83 $510.28 $518.95 $510.28 $510.28 $382.88 $510.28 $510.28 $510.28 $255.14 $255.14 $404.14 $510.28 $408.22 $229.63 $101.28 N/A $296.09 $510.28 $510.28 $510.28 $106.34 $510.28 N/A N/A 223.54 SUP HCPCS C1713 223.54 - PLATE BN 51MM NS LC DCP 4 HL SS 3.5MM SCR BOTH IP/OP $243.50 $180.00 $48.27 $247.30 $109.43 $109.43 $109.43 $109.43 $243.18 $243.18 $243.18 $50.68 $243.18 $243.18 $243.18 $243.18 $243.18 $50.68 $243.18 $247.30 $143.84 $243.18 $247.30 $243.18 $243.18 $182.63 $243.18 $243.18 $243.18 $121.59 $121.59 $192.60 $243.18 $194.54 $109.43 $48.27 N/A $141.23 $243.18 $145.91 $243.18 $50.68 $243.18 N/A N/A 223.541 SUP HCPCS C1713 223.541 - PLATE BN 59MM NS LCP CMBN 4 HL SS 3.5MM SCR SM FRAG BOTH IP/OP $533.00 $394.00 $105.74 $541.80 $239.74 $239.74 $239.74 $239.74 $532.75 $532.75 $532.75 $111.04 $532.75 $532.75 $532.75 $532.75 $532.75 $111.03 $532.75 $541.80 $315.12 $532.75 $541.80 $532.75 $532.75 $399.75 $532.75 $532.75 $532.75 $266.38 $266.38 $421.94 $532.75 $426.20 $239.74 $105.74 N/A $309.14 $532.75 $532.75 $532.75 $111.03 $532.75 N/A N/A 223.55 SUP HCPCS C1713 223.55 - PLATE BONE 64X11X3.3MM 5 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $268.78 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 223.551 SUP HCPCS C1713 223.551 - PLATE BN 72X11X3.4MM NS LCP CMBN 5 HL LMT CNTCT TPR END SS BOTH IP/OP $550.00 $407.00 $109.09 $558.98 $247.33 $247.33 $247.33 $247.33 $549.63 $549.63 $549.63 $114.56 $549.63 $549.63 $549.63 $549.63 $549.63 $114.55 $549.63 $558.98 $325.11 $549.63 $558.98 $549.63 $549.63 $412.50 $549.63 $549.63 $549.63 $274.82 $274.82 $435.31 $549.63 $439.70 $247.33 $109.09 N/A $319.00 $549.63 $549.63 $549.63 $114.54 $549.63 N/A N/A 223.56 SUP HCPCS C1713 223.56 - PLATE BONE 77X11X3.3MM 6 HOLE LC-DCP STAINLESS STEEL DISTAL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 223.561 SUP HCPCS C1713 223.561 - PLATE BN 85X11X3.4MM NS LCP CMBN 6 HL LMT CNTCT TPR END SS BOTH IP/OP $585.00 $433.00 $116.06 $594.73 $263.15 $263.15 $263.15 $263.15 $584.78 $584.78 $584.78 $121.88 $584.78 $584.78 $584.78 $584.78 $584.78 $121.87 $584.78 $594.73 $345.90 $584.78 $594.73 $584.78 $584.78 $438.75 $584.78 $584.78 $584.78 $292.39 $292.39 $463.15 $584.78 $467.82 $263.15 $116.06 N/A $339.30 $584.78 $350.87 $584.78 $121.87 $584.78 N/A N/A 223.57 SUP HCPCS C1713 223.57 - PLATE BONE 90X11X3.3MM 7 HOLE LC-DCP STAINLESS STEEL DISTAL BOTH IP/OP $284.00 $210.00 $56.36 $288.78 $127.78 $127.78 $127.78 $127.78 $283.95 $283.95 $283.95 $59.18 $283.95 $283.95 $283.95 $283.95 $283.95 $59.18 $283.95 $288.78 $167.96 $283.95 $288.78 $283.95 $283.95 $213.00 $283.95 $283.95 $283.95 $141.98 $141.98 $224.89 $283.95 $227.16 $127.78 $56.36 N/A $164.72 $283.95 $170.37 $283.95 $59.18 $283.95 N/A N/A 223.571 SUP HCPCS C1713 223.571 - PLATE BN 98X11X3.4MM NS LCP CMBN 7 HL LMT CNTCT TPR END SS BOTH IP/OP $609.00 $451.00 $120.81 $619.03 $273.91 $273.91 $273.91 $273.91 $608.68 $608.68 $608.68 $126.86 $608.68 $608.68 $608.68 $608.68 $608.68 $126.86 $608.68 $247.61 $360.03 $608.68 $619.03 $608.68 $608.68 $456.75 $608.68 $608.68 $608.68 $304.34 $304.34 $482.07 $608.68 $486.94 $273.91 $120.81 N/A $353.22 $608.68 $365.21 $608.68 $126.85 $608.68 N/A N/A 223.58 SUP HCPCS C1713 223.58 - PLATE BONE 103X11X3.3MM 8 HOLE LC-DCP STAINLESS STEEL DISTAL BOTH IP/OP $299.50 $222.00 $59.43 $304.53 $134.74 $134.74 $134.74 $134.74 $299.43 $299.43 $299.43 $62.41 $299.43 $299.43 $299.43 $299.43 $299.43 $62.40 $299.43 $304.53 $177.11 $299.43 $304.53 $299.43 $299.43 $224.63 $299.43 $299.43 $299.43 $149.72 $149.72 $237.15 $299.43 $239.54 $134.74 $59.43 N/A $173.71 $299.43 $299.43 $299.43 $62.40 $299.43 N/A N/A 223.581 SUP HCPCS C1713 223.581 - PLATE BN 111X11X3.4MM NS LCP CMBN 8 HL LMT CNTCT TPR END SS BOTH IP/OP $640.00 $474.00 $126.94 $650.48 $287.82 $287.82 $287.82 $287.82 $639.60 $639.60 $639.60 $133.31 $639.60 $639.60 $639.60 $639.60 $639.60 $133.30 $639.60 $650.48 $378.32 $639.60 $650.48 $639.60 $639.60 $480.00 $639.60 $639.60 $639.60 $319.80 $319.80 $506.56 $639.60 $511.68 $287.82 $126.94 N/A $371.20 $639.60 $639.60 $639.60 $133.29 $639.60 N/A N/A 223.59 SUP HCPCS C1713 223.59 - PLATE BONE 116X11X3.3MM 9 HOLE LC-DCP STAINLESS STEEL DISTAL BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $65.33 $313.48 N/A N/A 223.591 SUP HCPCS C1713 223.591 - PLATE BN 124X11X3.4MM NS LCP CMBN 9 HL LMT CNTCT TPR END SS BOTH IP/OP $665.00 $492.00 $131.97 $676.20 $299.21 $299.21 $299.21 $299.21 $664.90 $664.90 $664.90 $138.58 $664.90 $664.90 $664.90 $664.90 $664.90 $138.57 $664.90 $676.20 $393.29 $664.90 $676.20 $664.90 $664.90 $498.75 $664.90 $664.90 $664.90 $332.45 $332.45 $526.60 $664.90 $531.92 $299.21 $131.97 N/A $385.70 $664.90 $398.94 $664.90 $138.57 $664.90 N/A N/A 223.6 SUP HCPCS C1713 223.60 - PLATE BONE 129X11X3.3MM 10 HOLE LOCK LC-DCP STAINLESS STEEL BOTH IP/OP $308.50 $228.00 $61.22 $323.08 $138.79 $138.79 $138.79 $138.79 $308.43 $308.43 $308.43 $64.28 $308.43 $308.43 $308.43 $308.43 $308.43 $64.28 $308.43 $129.23 $182.44 $308.43 $323.08 $308.43 $308.43 $231.38 $308.43 $308.43 $308.43 $154.22 $154.22 $244.28 $308.43 $246.74 $138.79 $61.22 N/A $178.93 $308.43 $308.43 $308.43 $64.28 $308.43 N/A N/A 223.601 SUP HCPCS C1713 223.601 - PLATE BN 137X11X3.4MM NS LCP CMBN 10 HL LMT CNTCT TPR END SS BOTH IP/OP $686.00 $508.00 $136.15 $697.63 $308.69 $308.69 $308.69 $308.69 $685.98 $685.98 $685.98 $142.98 $685.98 $685.98 $685.98 $685.98 $685.98 $142.97 $685.98 $697.63 $405.76 $685.98 $697.63 $685.98 $685.98 $514.50 $685.98 $685.98 $685.98 $342.99 $342.99 $543.30 $685.98 $548.78 $308.69 $136.15 N/A $397.88 $685.98 $411.59 $685.98 $142.96 $685.98 N/A N/A 223.61 SUP HCPCS C1713 223.61 - PLATE BN 142X11X3.3MM NS LC DCP 11 HL SS 3.5MM SCR SM FRAG BOTH IP/OP $344.50 $255.00 $68.35 $350.25 $154.98 $154.98 $154.98 $154.98 $344.40 $344.40 $344.40 $71.78 $344.40 $344.40 $344.40 $344.40 $344.40 $71.78 $344.40 $140.10 $203.71 $344.40 $350.25 $344.40 $344.40 $258.38 $344.40 $344.40 $344.40 $172.20 $172.20 $272.76 $344.40 $275.52 $154.98 $68.35 N/A $199.81 $344.40 $344.40 $344.40 $71.77 $344.40 N/A N/A 223.611 SUP HCPCS C1713 223.611 - PLATE BN 150MM NS LCP CMBN 11 HL LMT CNTCT TPR END SS 3.5MM BOTH IP/OP $715.50 $529.00 $142.01 $727.68 $321.98 $321.98 $321.98 $321.98 $715.50 $715.50 $715.50 $149.13 $715.50 $715.50 $715.50 $715.50 $715.50 $149.12 $715.50 $727.68 $423.22 $715.50 $727.68 $715.50 $715.50 $536.63 $715.50 $715.50 $715.50 $357.75 $357.75 $566.68 $715.50 $572.40 $321.98 $142.01 N/A $414.99 $715.50 $715.50 $715.50 $149.11 $715.50 N/A N/A 223.62 SUP HCPCS C1713 223.62 - PLATE BN 155X11X3.3MM NS LC DCP 12 HL SS 3.5MM SCR SM FRAG BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 223.621 SUP HCPCS C1713 223.621 - PLATE BN 163X11X3.4MM NS LCP CMBN 12 HL LMT CNTCT TPR END SS BOTH IP/OP $756.50 $560.00 $150.10 $769.13 $340.33 $340.33 $340.33 $340.33 $756.28 $756.28 $756.28 $157.63 $756.28 $756.28 $756.28 $756.28 $756.28 $157.62 $756.28 $769.13 $447.34 $756.28 $769.13 $756.28 $756.28 $567.38 $756.28 $756.28 $756.28 $378.14 $378.14 $598.97 $756.28 $605.02 $340.33 $150.10 N/A $438.77 $756.28 $453.77 $756.28 $157.61 $756.28 N/A N/A 223.631 SUP HCPCS C1713 223.631 - PLATE BN 176X11X3.4MM NS LCP CMBN 13 HL SS 3.5MM SCR BOTH IP/OP $872.00 $645.00 $172.98 $886.35 $392.19 $392.19 $392.19 $392.19 $871.53 $871.53 $871.53 $181.65 $871.53 $871.53 $871.53 $871.53 $871.53 $181.64 $871.53 $886.35 $515.51 $871.53 $886.35 $871.53 $871.53 $654.00 $871.53 $871.53 $871.53 $435.77 $435.77 $690.25 $871.53 $697.22 $392.19 $172.98 N/A $505.76 $871.53 $522.92 $871.53 $181.63 $871.53 N/A N/A 223.64 SUP HCPCS C1713 223.64 - PLATE BN 181X11X3.3MM NS LC DCP 14 HL SS 3.5MM SCR SM FRAG BOTH IP/OP $682.00 $505.00 $135.31 $693.35 $306.79 $306.79 $306.79 $306.79 $681.75 $681.75 $681.75 $142.09 $681.75 $681.75 $681.75 $681.75 $681.75 $142.08 $681.75 $693.35 $403.26 $681.75 $693.35 $681.75 $681.75 $511.50 $681.75 $681.75 $681.75 $340.88 $340.88 $539.95 $681.75 $545.40 $306.79 $135.31 N/A $395.56 $681.75 $681.75 $681.75 $142.08 $681.75 N/A N/A 223.641 SUP HCPCS C1713 223.641 - PLATE BN 189X11X3.4MM NS LCP CMBN 14 HL LMT CNTCT TPR END SS BOTH IP/OP "$1,134.50" $840.00 $225.15 "$1,153.68" $510.48 $510.48 $510.48 $510.48 "$1,134.40" "$1,134.40" "$1,134.40" $236.44 "$1,134.40" "$1,134.40" "$1,134.40" "$1,134.40" "$1,134.40" $236.42 "$1,134.40" "$1,153.68" $671.00 "$1,134.40" "$1,153.68" "$1,134.40" "$1,134.40" $850.88 "$1,134.40" "$1,134.40" "$1,134.40" $567.20 $567.20 $898.44 "$1,134.40" $907.52 $510.48 $225.15 N/A $658.01 "$1,134.40" $680.64 "$1,134.40" $236.41 "$1,134.40" N/A N/A 223.65 SUP HCPCS C1713 223.65 - PLATE BONE 195X11X3.3MM 15 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP $714.50 $529.00 $141.73 $726.25 $321.35 $321.35 $321.35 $321.35 $714.10 $714.10 $714.10 $148.84 $714.10 $714.10 $714.10 $714.10 $714.10 $148.83 $714.10 $290.50 $422.39 $714.10 $726.25 $714.10 $714.10 $535.88 $714.10 $714.10 $714.10 $357.05 $357.05 $565.57 $714.10 $571.28 $321.35 $141.73 N/A $414.41 $714.10 $714.10 $714.10 $148.82 $714.10 N/A N/A 223.651 SUP HCPCS C1713 223.651 - PLATE BONE 202X11X3.4MM 15 HOLE LCP STAINLESS STEEL PROXIMAL BOTH IP/OP "$1,215.00" $899.00 $241.05 "$1,235.18" $546.54 $546.54 $546.54 $546.54 "$1,214.53" "$1,214.53" "$1,214.53" $253.14 "$1,214.53" "$1,214.53" "$1,214.53" "$1,214.53" "$1,214.53" $253.12 "$1,214.53" $494.07 $718.39 "$1,214.53" "$1,235.18" "$1,214.53" "$1,214.53" $911.25 "$1,214.53" "$1,214.53" "$1,214.53" $607.27 $607.27 $961.91 "$1,214.53" $971.62 $546.54 $241.05 N/A $704.70 "$1,214.53" $728.72 "$1,214.53" $253.11 "$1,214.53" N/A N/A 223.66 SUP HCPCS C1713 223.66 - PLATE BONE 208X11X3.3MM 16 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP $783.00 $579.00 $155.40 $796.28 $352.34 $352.34 $352.34 $352.34 $782.98 $782.98 $782.98 $163.19 $782.98 $782.98 $782.98 $782.98 $782.98 $163.18 $782.98 $318.51 $463.13 $782.98 $796.28 $782.98 $782.98 $587.25 $782.98 $782.98 $782.98 $391.49 $391.49 $620.12 $782.98 $626.38 $352.34 $155.40 N/A $454.14 $782.98 $782.98 $782.98 $163.17 $782.98 N/A N/A 223.661 SUP HCPCS C1713 223.661 - PLATE BN 215X11X3.4MM NS LCP CMBN 16 HL LMT CNTCT TPR END SS BOTH IP/OP "$1,271.00" $941.00 $252.21 "$1,292.35" $571.84 $571.84 $571.84 $571.84 "$1,270.75" "$1,270.75" "$1,270.75" $264.86 "$1,270.75" "$1,270.75" "$1,270.75" "$1,270.75" "$1,270.75" $264.84 "$1,270.75" "$1,292.35" $751.65 "$1,270.75" "$1,292.35" "$1,270.75" "$1,270.75" $953.25 "$1,270.75" "$1,270.75" "$1,270.75" $635.38 $635.38 "$1,006.43" "$1,270.75" "$1,016.60" $571.84 $252.21 N/A $737.18 "$1,270.75" $762.45 "$1,270.75" $264.82 "$1,270.75" N/A N/A 223.671 SUP HCPCS C1713 223.671 - PLATE BN 241X11X3.4MM NS LCP CMBN 18 HL LMT CNTCT TPR END SS BOTH IP/OP "$1,425.50" "$1,055.00" $282.90 "$1,449.60" $641.42 $641.42 $641.42 $641.42 "$1,425.38" "$1,425.38" "$1,425.38" $297.08 "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" $297.06 "$1,425.38" "$1,449.60" $843.11 "$1,425.38" "$1,449.60" "$1,425.38" "$1,425.38" "$1,069.13" "$1,425.38" "$1,425.38" "$1,425.38" $712.69 $712.69 "$1,128.90" "$1,425.38" "$1,140.30" $641.42 $282.90 N/A $826.79 "$1,425.38" "$1,425.38" "$1,425.38" $297.05 "$1,425.38" N/A N/A 223.68 SUP HCPCS C1713 223.68 - PLATE BONE 233X11X3.3MM 18 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP $876.00 $648.00 $173.81 $890.65 $394.09 $394.09 $394.09 $394.09 $875.75 $875.75 $875.75 $182.53 $875.75 $875.75 $875.75 $875.75 $875.75 $182.52 $875.75 $356.26 $518.01 $875.75 $890.65 $875.75 $875.75 $657.00 $875.75 $875.75 $875.75 $437.88 $437.88 $693.59 $875.75 $700.60 $394.09 $173.81 N/A $508.08 $875.75 $875.75 $875.75 $182.51 $875.75 N/A N/A 223.681 SUP HCPCS C1713 223.681 - PLATE BN 267X11X3.4MM NS LCP CMBN 20 HL LMT CNTCT TPR END SS BOTH IP/OP "$1,583.00" "$1,171.00" $314.15 "$1,609.70" $712.26 $712.26 $712.26 $712.26 "$1,582.80" "$1,582.80" "$1,582.80" $329.90 "$1,582.80" "$1,582.80" "$1,582.80" "$1,582.80" "$1,582.80" $329.87 "$1,582.80" "$1,609.70" $936.23 "$1,582.80" "$1,609.70" "$1,582.80" "$1,582.80" "$1,187.25" "$1,582.80" "$1,582.80" "$1,582.80" $791.40 $791.40 "$1,253.58" "$1,582.80" "$1,266.24" $712.26 $314.15 N/A $918.14 "$1,582.80" $949.68 "$1,582.80" $329.86 "$1,582.80" N/A N/A 223.691 SUP HCPCS C1713 223.691 - PLATE BONE 293X11X3.4MM 22 HOLE LCP STAINLESS STEEL PROXIMAL BOTH IP/OP "$1,584.50" "$1,173.00" $314.43 "$1,611.15" $712.90 $712.90 $712.90 $712.90 "$1,584.23" "$1,584.23" "$1,584.23" $330.19 "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" $330.17 "$1,584.23" "$1,611.15" $937.07 "$1,584.23" "$1,611.15" "$1,584.23" "$1,584.23" "$1,188.38" "$1,584.23" "$1,584.23" "$1,584.23" $792.12 $792.12 "$1,254.71" "$1,584.23" "$1,267.38" $712.90 $314.43 N/A $919.01 "$1,584.23" $950.54 "$1,584.23" $330.15 "$1,584.23" N/A N/A 223.7 SUP HCPCS C1713 223.70 - PLATE BONE 259X11X3.3MM 20 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP $942.00 $697.00 $186.90 $986.43 $423.76 $423.76 $423.76 $423.76 $941.68 $941.68 $941.68 $196.27 $941.68 $941.68 $941.68 $941.68 $941.68 $196.26 $941.68 $394.57 $557.00 $941.68 $986.43 $941.68 $941.68 $706.50 $941.68 $941.68 $941.68 $470.84 $470.84 $745.81 $941.68 $753.34 $423.76 $186.90 N/A $546.36 $941.68 $941.68 $941.68 $196.25 $941.68 N/A N/A 224 SUP Custom 27803010 224.000 - CAP LOCKING REVERE STAINLESS STEEL SPN BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 224.001 SUP Custom 27803010 224.001 - ROD SPINAL 5.5MM 300MM STR STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.002 SUP Custom 27803010 224.002 - ROD SPINAL 5.5MM 400MM STR STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.003 SUP Custom 27803010 224.003 - ROD SPINAL 5.5MM 500MM STR STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.012 SUP Custom 27803010 224.012 - SCREW BONE LP STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 224.013 SUP Custom 27803010 224.013 - CONNECTOR ROD 26-28MM ADJUSTABLE LP STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 224.014 SUP Custom 27803010 224.014 - CONNECTOR ROD 29-34MM ADJUSTABLE LP STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 224.02 SUP HCPCS C1713 224.02 - PLATE BN NAR 39X12X3.8MM NS DCP 2 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 224.04 SUP HCPCS C1713 224.04 - PLATE BN NAR 71X12X3.8MM NS DCP 4 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $266.50 $197.00 $52.82 $266.13 $119.76 $119.76 $119.76 $119.76 $266.13 $266.13 $266.13 $55.47 $266.13 $266.13 $266.13 $266.13 $266.13 $55.46 $266.13 $266.13 $157.42 $266.13 $266.13 $266.13 $266.13 $199.88 $266.13 $266.13 $266.13 $133.07 $133.07 $210.77 $266.13 $212.90 $119.76 $52.82 N/A $154.57 $266.13 $266.13 $266.13 $55.46 $266.13 N/A N/A 224.041 SUP HCPCS C1713 224.041 - PLATE BONE 61MM 4 HOLE DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $828.50 $613.00 $164.42 $828.40 $372.78 $372.78 $372.78 $372.78 $828.40 $828.40 $828.40 $172.66 $828.40 $828.40 $828.40 $828.40 $828.40 $172.65 $828.40 $828.40 $490.00 $828.40 $828.40 $828.40 $828.40 $621.38 $828.40 $828.40 $828.40 $414.20 $414.20 $656.09 $828.40 $662.72 $372.78 $164.42 N/A $480.53 $828.40 $497.04 $828.40 $172.64 $828.40 N/A N/A 224.05 SUP HCPCS C1713 224.05 - PLATE BN NAR 87X12X3.8MM NS DCP 5 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 224.051 SUP HCPCS C1713 224.051 - SCREW BONE 5MM 25MM POLYAX SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.052 SUP HCPCS C1713 224.052 - SCREW BONE 5MM 30MM POLYAX SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.053 SUP HCPCS C1713 224.053 - SCREW BONE 5MM 35MM POLYAX SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.054 SUP HCPCS C1713 224.054 - SCREW BONE 5MM 40MM POLYAX SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.055 SUP HCPCS C1713 224.055 - SCREW BONE 5MM 45MM POLYAX SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.056 SUP HCPCS C1713 224.056 - SCREW BONE 5MM 50MM POLYAX SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.057 SUP HCPCS C1713 224.057 - SCREW BONE 5MM 55MM POLYAX SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.06 SUP HCPCS C1713 224.06 - PLATE BN NAR 103X12X3.8MM NS DCP 6 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $312.50 $231.00 $61.94 $317.38 $140.44 $140.44 $140.44 $140.44 $312.08 $312.08 $312.08 $65.05 $312.08 $312.08 $312.08 $312.08 $312.08 $65.04 $312.08 $317.38 $184.60 $312.08 $317.38 $312.08 $312.08 $234.38 $312.08 $312.08 $312.08 $156.04 $156.04 $247.17 $312.08 $249.66 $140.44 $61.94 N/A $181.25 $312.08 $312.08 $312.08 $65.04 $312.08 N/A N/A 224.061 SUP HCPCS C1713 224.061 - SCREW BONE 7.5MM 70MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.062 SUP HCPCS C1713 224.062 - SCREW BONE 7.5MM 75MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.063 SUP HCPCS C1713 224.063 - SCREW BONE 7.5MM 80MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.064 SUP HCPCS C1713 224.064 - SCREW BONE 7.5MM 85MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.065 SUP HCPCS C1713 224.065 - SCREW BONE 7.5MM 90MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.07 SUP HCPCS C1713 224.07 - PLATE BN NAR 119X12X3.8MM NS DCP 7 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $312.50 $231.00 $61.94 $317.38 $140.44 $140.44 $140.44 $140.44 $312.08 $312.08 $312.08 $65.05 $312.08 $312.08 $312.08 $312.08 $312.08 $65.04 $312.08 $126.95 $184.60 $312.08 $317.38 $312.08 $312.08 $234.38 $312.08 $312.08 $312.08 $156.04 $156.04 $247.17 $312.08 $249.66 $140.44 $61.94 N/A $181.25 $312.08 $312.08 $312.08 $65.04 $312.08 N/A N/A 224.071 SUP HCPCS C1713 224.071 - SCREW BONE 7.5MM 70MM POLYAX SOLID REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.072 SUP HCPCS C1713 224.072 - SCREW BONE 7.5MM 75MM POLYAX SOLID REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.073 SUP HCPCS C1713 224.073 - SCREW BONE 7.5MM 80MM POLYAX SOLID REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.074 SUP HCPCS C1713 224.074 - SCREW BONE 7.5MM 85MM POLYAX SOLID REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.075 SUP HCPCS C1713 224.075 - SCREW BONE 7.5MM 90MM POLYAX SOLID REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.08 SUP HCPCS C1713 224.08 - PLATE BN NAR 135X12X3.8MM NS DCP 8 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $303.00 $224.00 $60.13 $302.98 $136.34 $136.34 $136.34 $136.34 $302.98 $302.98 $302.98 $63.15 $302.98 $302.98 $302.98 $302.98 $302.98 $63.14 $302.98 $121.19 $179.21 $302.98 $302.98 $302.98 $302.98 $227.25 $302.98 $302.98 $302.98 $151.49 $151.49 $239.96 $302.98 $242.38 $136.34 $60.13 N/A $175.74 $302.98 $302.98 $302.98 $63.14 $302.98 N/A N/A 224.081 SUP HCPCS C1713 224.081 - SCREW BONE 8.5MM 70MM POLYAX SOLID REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.082 SUP HCPCS C1713 224.082 - SCREW BONE 8.5MM 75MM POLYAX SOLID REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.083 SUP HCPCS C1713 224.083 - SCREW BONE 8.5MM 80MM POLYAX SOLID REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.084 SUP HCPCS C1713 224.084 - SCREW BONE 8.5MM 85MM POLYAX SOLID REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.085 SUP HCPCS C1713 224.085 - SCREW BONE 8.5MM 90MM POLYAX SOLID REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.09 SUP HCPCS C1713 224.09 - PLATE BN NAR 151X12X3.8MM NS DCP 9 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $312.50 $231.00 $61.94 $317.38 $140.44 $140.44 $140.44 $140.44 $312.08 $312.08 $312.08 $65.05 $312.08 $312.08 $312.08 $312.08 $312.08 $65.04 $312.08 $126.95 $184.60 $312.08 $317.38 $312.08 $312.08 $234.38 $312.08 $312.08 $312.08 $156.04 $156.04 $247.17 $312.08 $249.66 $140.44 $61.94 N/A $181.25 $312.08 $312.08 $312.08 $65.04 $312.08 N/A N/A 224.1 SUP HCPCS C1713 224.10 - PLATE BN NAR 167X12X3.8MM NS DCP 10 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $400.00 $296.00 $79.37 $399.88 $179.95 $179.95 $179.95 $179.95 $399.88 $399.88 $399.88 $83.34 $399.88 $399.88 $399.88 $399.88 $399.88 $83.34 $399.88 $159.95 $236.53 $399.88 $399.88 $399.88 $399.88 $300.00 $399.88 $399.88 $399.88 $199.94 $199.94 $316.70 $399.88 $319.90 $179.95 $79.37 N/A $232.00 $399.88 $399.88 $399.88 $83.33 $399.88 N/A N/A 224.11 SUP HCPCS C1713 224.11 - PLATE BONE NARROW 183X12X3.8MM 11 HOLE DCP STAINLESS STEEL BOTH IP/OP $399.00 $295.00 $79.16 $398.83 $179.47 $179.47 $179.47 $179.47 $398.83 $398.83 $398.83 $83.13 $398.83 $398.83 $398.83 $398.83 $398.83 $83.12 $398.83 $159.53 $235.91 $398.83 $398.83 $398.83 $398.83 $299.25 $398.83 $398.83 $398.83 $199.42 $199.42 $315.87 $398.83 $319.06 $179.47 $79.16 N/A $231.42 $398.83 $398.83 $398.83 $83.12 $398.83 N/A N/A 224.111 SUP HCPCS C1713 224.111 - SCREW BN 5.5MM 27MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.112 SUP HCPCS C1713 224.112 - SCREW BN 5.5MM 32MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.113 SUP HCPCS C1713 224.113 - SCREW BN 5.5MM 37MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.114 SUP HCPCS C1713 224.114 - SCREW BN 5.5MM 42MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.115 SUP HCPCS C1713 224.115 - SCREW BN 5.5MM 47MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.12 SUP HCPCS C1713 224.12 - PLATE BN NAR 199X12X3.8MM NS DCP 12 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $400.00 $296.00 $79.37 $399.88 $179.95 $179.95 $179.95 $179.95 $399.88 $399.88 $399.88 $83.34 $399.88 $399.88 $399.88 $399.88 $399.88 $83.34 $399.88 $159.95 $236.53 $399.88 $399.88 $399.88 $399.88 $300.00 $399.88 $399.88 $399.88 $199.94 $199.94 $316.70 $399.88 $319.90 $179.95 $79.37 N/A $232.00 $399.88 $399.88 $399.88 $83.33 $399.88 N/A N/A 224.121 SUP HCPCS C1713 224.121 - SCREW BN 6.5MM 27MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.122 SUP HCPCS C1713 224.122 - SCREW BN 6.5MM 32MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.123 SUP HCPCS C1713 224.123 - SCREW BN 6.5MM 37MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.124 SUP HCPCS C1713 224.124 - SCREW BN 6.5MM 42MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.125 SUP HCPCS C1713 224.125 - SCREW BN 6.5MM 47MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.131 SUP HCPCS C1713 224.131 - SCREW BN 7.5MM 27MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.132 SUP HCPCS C1713 224.132 - SCREW BN 7.5MM 32MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.133 SUP HCPCS C1713 224.133 - SCREW BN 7.5MM 37MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.134 SUP HCPCS C1713 224.134 - SCREW BN 7.5MM 42MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.135 SUP HCPCS C1713 224.135 - SCREW BN 7.5MM 47MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.14 SUP HCPCS C1713 224.14 - PLATE BONE NARROW 14 HOLE DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $561.50 $416.00 $111.44 $561.50 $252.68 $252.68 $252.68 $252.68 $561.50 $561.50 $561.50 $117.03 $561.50 $561.50 $561.50 $561.50 $561.50 $117.02 $561.50 $561.50 $332.13 $561.50 $561.50 $561.50 $561.50 $421.13 $561.50 $561.50 $561.50 $280.75 $280.75 $444.71 $561.50 $449.20 $252.68 $111.44 N/A $325.67 $561.50 $561.50 $561.50 $117.02 $561.50 N/A N/A 224.141 SUP HCPCS C1713 224.141 - SCREW BONE 5.5MM 25MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.142 SUP HCPCS C1713 224.142 - SCREW BONE 5.5MM 30MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.143 SUP HCPCS C1713 224.143 - SCREW BONE 5.5MM 35MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.144 SUP HCPCS C1713 224.144 - SCREW BONE 5.5MM 40MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.145 SUP HCPCS C1713 224.145 - SCREW BONE 5.5MM 45MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.146 SUP HCPCS C1713 224.146 - SCREW BONE 5.5MM 50MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.147 SUP HCPCS C1713 224.147 - SCREW BONE 5.5MM 55MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 224.151 SUP HCPCS C1713 224.151 - SCREW BONE 6.5MM 25MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.152 SUP HCPCS C1713 224.152 - SCREW BONE 6.5MM 30MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.153 SUP HCPCS C1713 224.153 - SCREW BONE 6.5MM 35MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.154 SUP HCPCS C1713 224.154 - SCREW BONE 6.5MM 40MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.155 SUP HCPCS C1713 224.155 - SCREW BONE 6.5MM 45MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.156 SUP HCPCS C1713 224.156 - SCREW BONE 6.5MM 50MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.157 SUP HCPCS C1713 224.157 - SCREW BONE 6.5MM 55MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.158 SUP HCPCS C1713 224.158 - SCREW BONE 6.5MM 60MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.159 SUP HCPCS C1713 224.159 - SCREW BONE 6.5MM 65MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.161 SUP HCPCS C1713 224.161 - SCREW BONE 7.5MM 25MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.162 SUP HCPCS C1713 224.162 - SCREW BONE 7.5MM 30MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.163 SUP HCPCS C1713 224.163 - SCREW BONE 7.5MM 35MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.164 SUP HCPCS C1713 224.164 - SCREW BONE 7.5MM 40MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.165 SUP HCPCS C1713 224.165 - SCREW BONE 7.5MM 45MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.166 SUP HCPCS C1713 224.166 - SCREW BONE 7.5MM 50MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.167 SUP HCPCS C1713 224.167 - SCREW BONE 7.5MM 55MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.168 SUP HCPCS C1713 224.168 - SCREW BONE 7.5MM 60MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.169 SUP HCPCS C1713 224.169 - SCREW BONE 7.5MM 65MM REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.2 SUP HCPCS C1713 224.20 - PLATE BN NAR 326X12X3.8MM NS DCP 20 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $816.50 $604.00 $161.98 $816.13 $367.26 $367.26 $367.26 $367.26 $816.13 $816.13 $816.13 $170.10 $816.13 $816.13 $816.13 $816.13 $816.13 $170.09 $816.13 $326.45 $482.74 $816.13 $816.13 $816.13 $816.13 $612.38 $816.13 $816.13 $816.13 $408.07 $408.07 $646.37 $816.13 $652.90 $367.26 $161.98 N/A $473.57 $816.13 $816.13 $816.13 $170.08 $816.13 N/A N/A 224.2 SUP HCPCS C1713 224.200 - SCREW BONE 4MM 20MM MNOAX REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $161.98 "$1,500.00" $367.26 $367.26 $367.26 $367.26 $816.13 $816.13 $816.13 $170.10 $816.13 $816.13 $816.13 $816.13 $816.13 $170.09 $816.13 $326.45 $482.74 $816.13 $816.13 $816.13 $816.13 "$1,500.00" $816.13 $816.13 $816.13 $408.07 $408.07 $646.37 $816.13 $652.90 $367.26 $161.98 N/A "$1,160.00" $816.13 $816.13 $816.13 $170.08 $816.13 N/A N/A 224.201 SUP HCPCS C1713 224.201 - SCREW BONE 4MM 25MM MNOAX REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.202 SUP HCPCS C1713 224.202 - SCREW BONE 4MM 30MM MNOAX REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.203 SUP HCPCS C1713 224.203 - SCREW BONE 4MM 35MM MNOAX REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.204 SUP HCPCS C1713 224.204 - SCREW BONE 4MM 40MM MNOAX REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.241 SUP HCPCS C1713 224.241 - SCREW BONE 4.5MM 25MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.242 SUP HCPCS C1713 224.242 - SCREW BONE 4MM 30MM MNOAX REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.243 SUP HCPCS C1713 224.243 - SCREW BONE 4.5MM 35MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.244 SUP HCPCS C1713 224.244 - SCREW BONE 4.5MM 40MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.245 SUP HCPCS C1713 224.245 - SCREW BONE 4.5MM 45MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.251 SUP HCPCS C1713 224.251 - SCREW BN 5.5MM 25MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.252 SUP HCPCS C1713 224.252 - SCREW BONE 5.5MM 30MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.253 SUP HCPCS C1713 224.253 - SCREW BONE 5.5MM 35MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.254 SUP HCPCS C1713 224.254 - SCREW BONE 5.5MM 40MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.255 SUP HCPCS C1713 224.255 - SCREW BONE 5.5MM 45MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.256 SUP HCPCS C1713 224.256 - SCREW BONE 5.5MM 50MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.257 SUP HCPCS C1713 224.257 - SCREW BONE 5.5MM 55MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.258 SUP HCPCS C1713 224.258 - SCREW BONE 5.5MM 60MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.259 SUP HCPCS C1713 224.259 - SCREW BONE 5.5MM 65MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.262 SUP HCPCS C1713 224.262 - SCREW BONE 30MM 30MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.263 SUP HCPCS C1713 224.263 - SCREW BONE 6.5MM 35MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.264 SUP HCPCS C1713 224.264 - SCREW BONE 6.5MM 40MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.265 SUP HCPCS C1713 224.265 - SCREW BONE 6.5MM 45MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.266 SUP HCPCS C1713 224.266 - SCREW BONE 6.5MM 50MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.267 SUP HCPCS C1713 224.267 - SCREW BONE 6.5MM 55MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.268 SUP HCPCS C1713 224.268 - SCREW BONE 6.5MM 60MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.269 SUP HCPCS C1713 224.269 - SCREW BONE 6.5MM 65MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.271 SUP HCPCS C1713 224.271 - SCREW BONE 7.5MM MNOAX REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.272 SUP HCPCS C1713 224.272 - SCREW BONE 7.5MM 30MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.273 SUP HCPCS C1713 224.273 - SCREW BONE 7.5MM 35MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.274 SUP HCPCS C1713 224.274 - SCREW BONE 7.5MM 40MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.275 SUP HCPCS C1713 224.275 - SCREW BONE 7.5MM 45MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.276 SUP HCPCS C1713 224.276 - SCREW BONE 7.5MM 50MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.277 SUP HCPCS C1713 224.277 - SCREW BONE 7.5MM 55MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.278 SUP HCPCS C1713 224.278 - SCREW BONE 7.5MM 60MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.279 SUP HCPCS C1713 224.279 - SCREW BONE 7.5MM 65MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.281 SUP HCPCS C1713 224.281 - SCREW BN 8.5MM 25MM REVERE MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.282 SUP HCPCS C1713 224.282 - SCREW BONE 8.5MM 30MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.283 SUP HCPCS C1713 224.283 - SCREW BONE 8.5MM 35MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.284 SUP HCPCS C1713 224.284 - SCREW BONE 8.5MM 40MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.285 SUP HCPCS C1713 224.285 - SCREW BONE 8.5MM 45MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.286 SUP HCPCS C1713 224.286 - SCREW BONE 8.5MM 50MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.287 SUP HCPCS C1713 224.287 - SCREW BONE 8.5MM 55MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.288 SUP HCPCS C1713 224.288 - SCREW BONE 8.5MM 60MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.289 SUP HCPCS C1713 224.289 - SCREW BONE 8.5MM 65MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.351 SUP HCPCS C1713 224.351 - SCREW BONE 5.5MM 25MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.352 SUP HCPCS C1713 224.352 - SCREW BONE 5.5MM 30MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.353 SUP HCPCS C1713 224.353 - SCREW BONE 5.5MM 35MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.354 SUP HCPCS C1713 224.354 - SCREW BONE 5.5MM 40MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.355 SUP HCPCS C1713 224.355 - SCREW BONE 5.5MM 45MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.356 SUP HCPCS C1713 224.356 - SCREW BONE 5.5MM 50MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.357 SUP HCPCS C1713 224.357 - SCREW BONE 5.5MM 55MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.361 SUP HCPCS C1713 224.361 - SCREW BONE 6.5MM 25MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.362 SUP HCPCS C1713 224.362 - SCREW BONE 6.5MM 30MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.363 SUP HCPCS C1713 224.363 - SCREW BONE 6.5MM 35MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.364 SUP HCPCS C1713 224.364 - SCREW BONE 6.5MM 40MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.365 SUP HCPCS C1713 224.365 - SCREW BONE 6.5MM 45MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.366 SUP HCPCS C1713 224.366 - SCREW BONE 6.5MM 50MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.367 SUP HCPCS C1713 224.367 - SCREW BONE 6.5MM 55MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.368 SUP HCPCS C1713 224.368 - SCREW BONE 6.5MM 60MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.369 SUP HCPCS C1713 224.369 - SCREW BONE 6.5MM 65MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.371 SUP HCPCS C1713 224.371 - SCREW BONE 7.5MM 25MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.372 SUP HCPCS C1713 224.372 - SCREW BONE 7.5MM 30MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.373 SUP HCPCS C1713 224.373 - SCREW BONE 7.5MM 35MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.374 SUP HCPCS C1713 224.374 - SCREW BONE 7.5MM 40MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.375 SUP HCPCS C1713 224.375 - SCREW BONE 7.5MM 45MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.376 SUP HCPCS C1713 224.376 - SCREW BONE 7.5MM 50MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.377 SUP HCPCS C1713 224.377 - SCREW BONE 7.5MM 55MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.378 SUP HCPCS C1713 224.378 - SCREW BONE 7.5MM 60MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.379 SUP HCPCS C1713 224.379 - SCREW BONE 7.5MM 65MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.381 SUP HCPCS C1713 224.381 - SCREW BONE 8.5MM 25MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.382 SUP HCPCS C1713 224.382 - SCREW BONE 8.5MM 30MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.383 SUP HCPCS C1713 224.383 - SCREW BONE 8.5MM 35MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.384 SUP HCPCS C1713 224.384 - SCREW BONE 8.5MM 40MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.385 SUP HCPCS C1713 224.385 - SCREW BONE 8.5MM 45MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.386 SUP HCPCS C1713 224.386 - SCREW BONE 8.5MM 50MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.387 SUP HCPCS C1713 224.387 - SCREW BONE 8.5MM 55MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.388 SUP HCPCS C1713 224.388 - SCREW BONE 8.5MM 60MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$5,262.50" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.389 SUP HCPCS C1713 224.389 - SCREW BONE 8.5MM 65MM POLYAX CANN REVERE STAINLESS STEEL SPN BOTH IP/OP "$5,262.50" "$3,894.00" "$1,044.47" "$5,262.50" "$2,368.13" "$2,368.13" "$2,368.13" "$2,368.13" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.84" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$1,096.76" "$5,262.50" "$2,105.00" "$2,594.41" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$2,368.13" "$1,044.47" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$1,096.71" "$5,262.50" N/A N/A 224.441 SUP HCPCS C1713 224.441 - SCREW BONE 4.5MM 25MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.442 SUP HCPCS C1713 224.442 - SCREW BONE 4.5MM 30MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.443 SUP HCPCS C1713 224.443 - SCREW BONE 4.5MM 55MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.444 SUP HCPCS C1713 224.444 - SCREW BONE 4.5MM 40MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.445 SUP HCPCS C1713 224.445 - SCREW BONE 4.5MM 45MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.451 SUP HCPCS C1713 224.451 - SCREW BONE 5.5MM 25MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.452 SUP HCPCS C1713 224.452 - SCREW BONE 5.5MM 30MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.453 SUP HCPCS C1713 224.453 - SCREW BONE 5.5MM 35MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.454 SUP HCPCS C1713 224.454 - SCREW BONE 5.5MM 40MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.455 SUP HCPCS C1713 224.455 - SCREW BONE 5.5MM 45MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.456 SUP HCPCS C1713 224.456 - SCREW BONE 5.5MM 50MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.457 SUP HCPCS C1713 224.457 - SCREW BONE 5.5MM 55MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.461 SUP HCPCS C1713 224.461 - SCREW BONE 6.5MM 25MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.462 SUP HCPCS C1713 224.462 - SCREW BONE 6.5MM 30MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.463 SUP HCPCS C1713 224.463 - SCREW BONE 6.5MM 35MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.464 SUP HCPCS C1713 224.464 - SCREW BONE 6.5MM 40MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.465 SUP HCPCS C1713 224.465 - SCREW BONE 6.5MM 45MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.466 SUP HCPCS C1713 224.466 - SCREW BONE 6.5MM 50MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.467 SUP HCPCS C1713 224.467 - SCREW BONE 6.5MM 55MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.468 SUP HCPCS C1713 224.468 - SCREW BONE 6.5MM 60MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.469 SUP HCPCS C1713 224.469 - SCREW BONE 6.5MM 65MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.471 SUP HCPCS C1713 224.471 - SCREW BONE 7.5MM 25MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.472 SUP HCPCS C1713 224.472 - SCREW BONE 7.5MM 30MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.473 SUP HCPCS C1713 224.473 - SCREW BONE 7.5MM 35MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.474 SUP HCPCS C1713 224.474 - SCREW BONE 7.5MM 40MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.475 SUP HCPCS C1713 224.475 - SCREW BONE 7.5MM 45MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.476 SUP HCPCS C1713 224.476 - SCREW BONE 7.5MM 50MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.477 SUP HCPCS C1713 224.477 - SCREW BONE 7.5MM 55MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.478 SUP HCPCS C1713 224.478 - SCREW BONE 7.5MM 60MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.479 SUP HCPCS C1713 224.479 - SCREW BONE 7.5MM 65MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.481 SUP HCPCS C1713 224.481 - SCREW BONE 8.5MM 25MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.482 SUP HCPCS C1713 224.482 - SCREW BONE 8.5MM 30MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.483 SUP HCPCS C1713 224.483 - SCREW BONE 8.5MM 35MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.484 SUP HCPCS C1713 224.484 - SCREW BONE 8.5MM 40MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.485 SUP HCPCS C1713 224.485 - SCREW BONE 8.5MM 45MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.486 SUP HCPCS C1713 224.486 - SCREW BONE 8.5MM 50MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.487 SUP HCPCS C1713 224.487 - SCREW BONE 8.5MM 55MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.488 SUP HCPCS C1713 224.488 - SCREW BONE 8.5MM 60MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.489 SUP HCPCS C1713 224.489 - SCREW BONE 8.5MM 65MM SOLID REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.506 SUP HCPCS C1713 224.506 - PLATE BONE 125MM 6 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL BOTH IP/OP "$1,150.00" $851.00 $228.22 "$1,169.40" $517.43 $517.43 $517.43 $517.43 "$1,149.85" "$1,149.85" "$1,149.85" $239.66 "$1,149.85" "$1,149.85" "$1,149.85" "$1,149.85" "$1,149.85" $239.64 "$1,149.85" $467.76 $680.14 "$1,149.85" "$1,169.40" "$1,149.85" "$1,149.85" $862.50 "$1,149.85" "$1,149.85" "$1,149.85" $574.93 $574.93 $910.68 "$1,149.85" $919.88 $517.43 $228.22 N/A $667.00 "$1,149.85" "$1,149.85" "$1,149.85" $239.63 "$1,149.85" N/A N/A 224.507 SUP HCPCS C1713 224.507 - PLATE BONE 125MM 6 HOLE STAINLESS STEEL TIBIA LEFT DISTAL BOTH IP/OP "$1,150.00" $851.00 $228.22 "$1,169.40" $517.43 $517.43 $517.43 $517.43 "$1,149.85" "$1,149.85" "$1,149.85" $239.66 "$1,149.85" "$1,149.85" "$1,149.85" "$1,149.85" "$1,149.85" $239.64 "$1,149.85" $467.76 $680.14 "$1,149.85" "$1,169.40" "$1,149.85" "$1,149.85" $862.50 "$1,149.85" "$1,149.85" "$1,149.85" $574.93 $574.93 $910.68 "$1,149.85" $919.88 $517.43 $228.22 N/A $667.00 "$1,149.85" $689.91 "$1,149.85" $239.63 "$1,149.85" N/A N/A 224.508 SUP HCPCS C1713 224.508 - PLATE BONE 161MM 8 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL BOTH IP/OP "$1,296.50" $959.00 $257.23 "$1,318.08" $583.22 $583.22 $583.22 $583.22 "$1,296.05" "$1,296.05" "$1,296.05" $270.13 "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" $270.11 "$1,296.05" $527.23 $766.61 "$1,296.05" "$1,318.08" "$1,296.05" "$1,296.05" $972.38 "$1,296.05" "$1,296.05" "$1,296.05" $648.03 $648.03 "$1,026.47" "$1,296.05" "$1,036.84" $583.22 $257.23 N/A $751.97 "$1,296.05" $777.63 "$1,296.05" $270.10 "$1,296.05" N/A N/A 224.509 SUP HCPCS C1713 224.509 - PLATE BONE 161MM 8 HOLE STAINLESS STEEL TIBIA LEFT DISTAL BOTH IP/OP "$1,296.50" $959.00 $257.23 "$1,318.08" $583.22 $583.22 $583.22 $583.22 "$1,296.05" "$1,296.05" "$1,296.05" $270.13 "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" $270.11 "$1,296.05" $527.23 $766.61 "$1,296.05" "$1,318.08" "$1,296.05" "$1,296.05" $972.38 "$1,296.05" "$1,296.05" "$1,296.05" $648.03 $648.03 "$1,026.47" "$1,296.05" "$1,036.84" $583.22 $257.23 N/A $751.97 "$1,296.05" $777.63 "$1,296.05" $270.10 "$1,296.05" N/A N/A 224.51 SUP HCPCS C1713 224.510 - PLATE BONE 197X14X3.8MM 10 HOLE DCP STAINLESS STEEL RIGHT BOTH IP/OP "$1,434.50" "$1,062.00" $284.68 "$1,502.50" $645.46 $645.46 $645.46 $645.46 "$1,434.35" "$1,434.35" "$1,434.35" $298.95 "$1,434.35" "$1,434.35" "$1,434.35" "$1,434.35" "$1,434.35" $298.93 "$1,434.35" "$1,502.50" $848.42 "$1,434.35" "$1,502.50" "$1,434.35" "$1,434.35" "$1,075.88" "$1,434.35" "$1,434.35" "$1,434.35" $717.18 $717.18 "$1,136.01" "$1,434.35" "$1,147.48" $645.46 $284.68 N/A $832.01 "$1,434.35" "$1,434.35" "$1,434.35" $298.92 "$1,434.35" N/A N/A 224.511 SUP HCPCS C1713 224.511 - PLATE BONE 197X14X3.8MM 10 HOLE STAINLESS STEEL LEFT MEDIAL BOTH IP/OP "$1,477.50" "$1,093.00" $293.22 "$1,502.50" $664.82 $664.82 $664.82 $664.82 "$1,477.38" "$1,477.38" "$1,477.38" $307.92 "$1,477.38" "$1,477.38" "$1,477.38" "$1,477.38" "$1,477.38" $307.90 "$1,477.38" $601.00 $873.87 "$1,477.38" "$1,502.50" "$1,477.38" "$1,477.38" "$1,108.13" "$1,477.38" "$1,477.38" "$1,477.38" $738.69 $738.69 "$1,170.08" "$1,477.38" "$1,181.90" $664.82 $293.22 N/A $856.95 "$1,477.38" $886.43 "$1,477.38" $307.89 "$1,477.38" N/A N/A 224.512 SUP Custom 27803010 224.512 - ROD SPINAL 5.5MM 125MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $290.00 "$1,678.33" "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" $293.75 "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" $343.94 "$1,650.28" $671.33 "$1,650.28" "$1,650.28" "$1,678.33" "$1,650.28" "$1,650.28" $375.00 "$1,650.28" "$1,650.28" "$1,650.28" $825.14 $825.14 "$1,307.02" "$1,650.28" "$1,320.22" $742.63 "$1,650.28" N/A $290.00 "$1,650.28" $990.17 "$1,650.28" "$1,650.28" "$1,650.28" N/A N/A 224.512 SUP Custom 27803010 224.512 - PLATE BONE 233X14X3.8MM 12 HOLE STAINLESS STEEL RIGHT MEDIAL BOTH IP/OP "$1,650.50" "$1,221.00" $293.75 "$1,678.33" "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" $293.75 "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" $343.94 "$1,650.28" $671.33 "$1,650.28" "$1,650.28" "$1,678.33" "$1,650.28" "$1,650.28" "$1,237.88" "$1,650.28" "$1,650.28" "$1,650.28" $825.14 $825.14 "$1,307.02" "$1,650.28" "$1,320.22" $742.63 "$1,650.28" N/A $957.29 "$1,650.28" $990.17 "$1,650.28" "$1,650.28" "$1,650.28" N/A N/A 224.513 SUP HCPCS C1713 224.513 - PLATE BONE 233X14X3.8MM 12 HOLE STAINLESS STEEL LEFT MEDIAL BOTH IP/OP "$1,650.50" "$1,221.00" $327.54 "$1,678.33" $742.63 $742.63 $742.63 $742.63 "$1,650.28" "$1,650.28" "$1,650.28" $343.96 "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" $343.94 "$1,650.28" $671.33 $976.14 "$1,650.28" "$1,678.33" "$1,650.28" "$1,650.28" "$1,237.88" "$1,650.28" "$1,650.28" "$1,650.28" $825.14 $825.14 "$1,307.02" "$1,650.28" "$1,320.22" $742.63 $327.54 N/A $957.29 "$1,650.28" "$1,650.28" "$1,650.28" $343.92 "$1,650.28" N/A N/A 224.514 SUP HCPCS C1713 224.514 - PLATE BONE 269X14X3.8MM 14 HOLE STAINLESS STEEL RIGHT MEDIAL BOTH IP/OP "$1,840.50" "$1,362.00" $365.20 "$1,871.33" $828.02 $828.02 $828.02 $828.02 "$1,840.05" "$1,840.05" "$1,840.05" $383.51 "$1,840.05" "$1,840.05" "$1,840.05" "$1,840.05" "$1,840.05" $383.49 "$1,840.05" "$1,871.33" "$1,088.39" "$1,840.05" "$1,871.33" "$1,840.05" "$1,840.05" "$1,380.38" "$1,840.05" "$1,840.05" "$1,840.05" $920.03 $920.03 "$1,457.32" "$1,840.05" "$1,472.04" $828.02 $365.20 N/A "$1,067.49" "$1,840.05" "$1,840.05" "$1,840.05" $383.47 "$1,840.05" N/A N/A 224.515 SUP Custom 27803010 224.515 - ROD SPINAL 5.5MM 150MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $290.00 "$1,871.33" "$1,840.05" "$1,840.05" "$1,840.05" "$1,840.05" "$1,840.05" "$1,840.05" $327.53 "$1,840.05" "$1,840.05" "$1,840.05" "$1,840.05" "$1,840.05" "$1,840.05" $383.49 "$1,840.05" $748.53 "$1,840.05" "$1,840.05" "$1,871.33" "$1,840.05" "$1,840.05" $375.00 "$1,840.05" "$1,840.05" "$1,840.05" $920.03 $920.03 "$1,457.32" "$1,840.05" "$1,472.04" $828.02 "$1,840.05" N/A $290.00 "$1,840.05" "$1,104.03" "$1,840.05" "$1,840.05" "$1,840.05" N/A N/A 224.515 SUP Custom 27803010 224.515 - PLATE BONE 269X14X3.8MM 14 HOLE STAINLESS STEEL LEFT MEDIAL BOTH IP/OP "$1,840.50" "$1,362.00" $327.53 "$1,871.33" "$1,840.05" "$1,840.05" "$1,840.05" "$1,840.05" "$1,840.05" "$1,840.05" $327.53 "$1,840.05" "$1,840.05" "$1,840.05" "$1,840.05" "$1,840.05" "$1,840.05" $383.49 "$1,840.05" $748.53 "$1,840.05" "$1,840.05" "$1,871.33" "$1,840.05" "$1,840.05" "$1,380.38" "$1,840.05" "$1,840.05" "$1,840.05" $920.03 $920.03 "$1,457.32" "$1,840.05" "$1,472.04" $828.02 "$1,840.05" N/A "$1,067.49" "$1,840.05" "$1,104.03" "$1,840.05" "$1,840.05" "$1,840.05" N/A N/A 224.517 SUP Custom 27803010 224.517 - ROD EXFIX 5.5MM 200MM STR SPN BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.52 SUP HCPCS C1713 224.52 - PLATE BONE NARROW 34X13.5X4.2MM 2 HOLE LCP STAINLESS STEEL BOTH IP/OP $301.00 $223.00 $59.70 $300.78 $135.35 $135.35 $135.35 $135.35 $300.78 $300.78 $300.78 $62.69 $300.78 $300.78 $300.78 $300.78 $300.78 $62.69 $300.78 $120.31 $177.91 $300.78 $300.78 $300.78 $300.78 $225.75 $300.78 $300.78 $300.78 $150.39 $150.39 $238.22 $300.78 $240.62 $135.35 $59.70 N/A $174.58 $300.78 $300.78 $300.78 $62.68 $300.78 N/A N/A 224.52 SUP Custom 27803010 224.520 - ROD SPNL 5.5MM 400MM REVERE STRG SS BOTH IP/OP $500.00 $370.00 $59.70 $375.00 $135.35 $135.35 $135.35 $135.35 $300.78 $300.78 $300.78 $62.69 $300.78 $300.78 $300.78 $300.78 $300.78 $62.69 $300.78 $120.31 $177.91 $300.78 $300.78 $300.78 $300.78 $375.00 $300.78 $300.78 $300.78 $150.39 $150.39 $238.22 $300.78 $240.62 $135.35 $59.70 N/A $290.00 $300.78 $300.78 $300.78 $62.68 $300.78 N/A N/A 224.521 SUP Custom 27803010 224.521 - ROD SPNL 500MM 5.5MM REVERE SS STR BOTH IP/OP $500.00 $370.00 $108.35 $619.03 $608.68 $608.68 $608.68 $608.68 $608.68 $608.68 $108.35 $608.68 $608.68 $608.68 $608.68 $608.68 $608.68 $126.86 $608.68 $619.03 $608.68 $608.68 $619.03 $608.68 $608.68 $375.00 $608.68 $608.68 $608.68 $304.34 $304.34 $482.07 $608.68 $486.94 $273.91 $608.68 N/A $290.00 $608.68 $365.21 $608.68 $608.68 $608.68 N/A N/A 224.521 SUP Custom 27803010 224.521 - PLATE BN NAR 44X13.5X4.2MM NS LCP CMBN 2 HL LMT CNTCT TPR BOTH IP/OP $609.00 $451.00 $108.35 $619.03 $608.68 $608.68 $608.68 $608.68 $608.68 $608.68 $108.35 $608.68 $608.68 $608.68 $608.68 $608.68 $608.68 $126.86 $608.68 $619.03 $608.68 $608.68 $619.03 $608.68 $608.68 $456.75 $608.68 $608.68 $608.68 $304.34 $304.34 $482.07 $608.68 $486.94 $273.91 $608.68 N/A $353.22 $608.68 $365.21 $608.68 $608.68 $608.68 N/A N/A 224.53 SUP HCPCS C1713 224.53 - PLATE BONE NARROW 62X13.5X4.2MM 3 HOLE LC-DCP STAINLESS BOTH IP/OP $310.50 $230.00 $61.54 $310.05 $139.52 $139.52 $139.52 $139.52 $310.05 $310.05 $310.05 $64.62 $310.05 $310.05 $310.05 $310.05 $310.05 $64.62 $310.05 $124.02 $183.39 $310.05 $310.05 $310.05 $310.05 $232.88 $310.05 $310.05 $310.05 $155.03 $155.03 $245.56 $310.05 $248.04 $139.52 $61.54 N/A $180.09 $310.05 $310.05 $310.05 $64.61 $310.05 N/A N/A 224.53 SUP Custom 27803010 224.530 - ROD SPINAL 5.5MM 30MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $61.54 $375.00 $139.52 $139.52 $139.52 $139.52 $310.05 $310.05 $310.05 $64.62 $310.05 $310.05 $310.05 $310.05 $310.05 $64.62 $310.05 $124.02 $183.39 $310.05 $310.05 $310.05 $310.05 $375.00 $310.05 $310.05 $310.05 $155.03 $155.03 $245.56 $310.05 $248.04 $139.52 $61.54 N/A $290.00 $310.05 $310.05 $310.05 $64.61 $310.05 N/A N/A 224.531 SUP HCPCS C1713 224.531 - PLATE BN NAR 62X13.5X4.2MM NS LCP CMBN 3 HL LMT CNTCT TPR BOTH IP/OP $616.00 $456.00 $122.20 $626.18 $277.07 $277.07 $277.07 $277.07 $615.70 $615.70 $615.70 $128.33 $615.70 $615.70 $615.70 $615.70 $615.70 $128.32 $615.70 $250.47 $364.19 $615.70 $626.18 $615.70 $615.70 $462.00 $615.70 $615.70 $615.70 $307.85 $307.85 $487.63 $615.70 $492.56 $277.07 $122.20 N/A $357.28 $615.70 $615.70 $615.70 $128.31 $615.70 N/A N/A 224.535 SUP Custom 27803010 224.535 - ROD SPINAL 5.5MM 35MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.54 SUP HCPCS C1713 224.54 - PLATE BN NAR 70X13.5X4.2MM NS LC DCP 4 HL SS 4.5MM SCR LG BOTH IP/OP $319.50 $236.00 $63.33 $324.53 $143.60 $143.60 $143.60 $143.60 $319.10 $319.10 $319.10 $66.51 $319.10 $319.10 $319.10 $319.10 $319.10 $66.50 $319.10 $129.81 $188.75 $319.10 $324.53 $319.10 $319.10 $239.63 $319.10 $319.10 $319.10 $159.55 $159.55 $252.73 $319.10 $255.28 $143.60 $63.33 N/A $185.31 $319.10 $319.10 $319.10 $66.50 $319.10 N/A N/A 224.54 SUP Custom 27803010 224.540 - ROD SPINAL 5.5MM 40MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $63.33 $375.00 $143.60 $143.60 $143.60 $143.60 $319.10 $319.10 $319.10 $66.51 $319.10 $319.10 $319.10 $319.10 $319.10 $66.50 $319.10 $129.81 $188.75 $319.10 $324.53 $319.10 $319.10 $375.00 $319.10 $319.10 $319.10 $159.55 $159.55 $252.73 $319.10 $255.28 $143.60 $63.33 N/A $290.00 $319.10 $319.10 $319.10 $66.50 $319.10 N/A N/A 224.541 SUP HCPCS C1713 224.541 - PLATE BN NAR 80X13.5X4.2MM NS LCP CMBN 4 HL LMT CNTCT TPR BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 224.545 SUP Custom 27803010 224.545 - ROD SPINAL 5.5MM 45MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.55 SUP HCPCS C1713 224.55 - PLATE BN NAR 88X13.5X4.2MM NS LC DCP 5 HL SS 4.5MM SCR LG BOTH IP/OP $319.50 $236.00 $63.33 $324.53 $143.60 $143.60 $143.60 $143.60 $319.10 $319.10 $319.10 $66.51 $319.10 $319.10 $319.10 $319.10 $319.10 $66.50 $319.10 $129.81 $188.75 $319.10 $324.53 $319.10 $319.10 $239.63 $319.10 $319.10 $319.10 $159.55 $159.55 $252.73 $319.10 $255.28 $143.60 $63.33 N/A $185.31 $319.10 $319.10 $319.10 $66.50 $319.10 N/A N/A 224.55 SUP Custom 27803010 224.550 - ROD SPINAL 5.5MM 50MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $63.33 $375.00 $143.60 $143.60 $143.60 $143.60 $319.10 $319.10 $319.10 $66.51 $319.10 $319.10 $319.10 $319.10 $319.10 $66.50 $319.10 $129.81 $188.75 $319.10 $324.53 $319.10 $319.10 $375.00 $319.10 $319.10 $319.10 $159.55 $159.55 $252.73 $319.10 $255.28 $143.60 $63.33 N/A $290.00 $319.10 $319.10 $319.10 $66.50 $319.10 N/A N/A 224.551 SUP HCPCS C1713 224.551 - PLATE BN NAR 98X13.5X4.2MM NS LCP CMBN 5 HL LMT CNTCT TPR BOTH IP/OP $694.50 $514.00 $137.82 $706.20 $312.48 $312.48 $312.48 $312.48 $694.40 $694.40 $694.40 $144.73 $694.40 $694.40 $694.40 $694.40 $694.40 $144.72 $694.40 $282.48 $410.74 $694.40 $706.20 $694.40 $694.40 $520.88 $694.40 $694.40 $694.40 $347.20 $347.20 $549.96 $694.40 $555.52 $312.48 $137.82 N/A $402.81 $694.40 $694.40 $694.40 $144.71 $694.40 N/A N/A 224.555 SUP Custom 27803010 224.555 - ROD SPINAL 5.5MM 55MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.56 SUP HCPCS C1713 224.56 - PLATE BN NAR 106X13.5X4.2MM NS LC DCP 6 HL SS 4.5MM SCR LG BOTH IP/OP $360.00 $266.00 $71.42 $365.98 $161.93 $161.93 $161.93 $161.93 $359.85 $359.85 $359.85 $75.00 $359.85 $359.85 $359.85 $359.85 $359.85 $75.00 $359.85 $365.98 $212.85 $359.85 $365.98 $359.85 $359.85 $270.00 $359.85 $359.85 $359.85 $179.93 $179.93 $285.00 $359.85 $287.88 $161.93 $71.42 N/A $208.80 $359.85 $215.91 $359.85 $74.99 $359.85 N/A N/A 224.56 SUP Custom 27803010 224.560 - ROD SPINAL 5.5MM 60MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $71.42 $375.00 $161.93 $161.93 $161.93 $161.93 $359.85 $359.85 $359.85 $75.00 $359.85 $359.85 $359.85 $359.85 $359.85 $75.00 $359.85 $365.98 $212.85 $359.85 $365.98 $359.85 $359.85 $375.00 $359.85 $359.85 $359.85 $179.93 $179.93 $285.00 $359.85 $287.88 $161.93 $71.42 N/A $290.00 $359.85 $215.91 $359.85 $74.99 $359.85 N/A N/A 224.561 SUP HCPCS C1713 224.561 - PLATE BN NAR 116MM NS LCP CMBN 6 HL SS 4.5MM SCR LG FRAG SET BOTH IP/OP $735.50 $544.00 $145.91 $747.68 $330.83 $330.83 $330.83 $330.83 $735.18 $735.18 $735.18 $153.23 $735.18 $735.18 $735.18 $735.18 $735.18 $153.22 $735.18 $747.68 $434.86 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $330.83 $145.91 N/A $426.59 $735.18 $735.18 $735.18 $153.21 $735.18 N/A N/A 224.565 SUP Custom 27803010 224.565 - ROD SPINAL 5.5MM 65MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.57 SUP HCPCS C1713 224.57 - PLATE BN NAR 124X13.5X4.2MM NS LC DCP 7 HL SS 4.5MM SCR LG BOTH IP/OP $360.00 $266.00 $71.42 $365.98 $161.93 $161.93 $161.93 $161.93 $359.85 $359.85 $359.85 $75.00 $359.85 $359.85 $359.85 $359.85 $359.85 $75.00 $359.85 $365.98 $212.85 $359.85 $365.98 $359.85 $359.85 $270.00 $359.85 $359.85 $359.85 $179.93 $179.93 $285.00 $359.85 $287.88 $161.93 $71.42 N/A $208.80 $359.85 $215.91 $359.85 $74.99 $359.85 N/A N/A 224.57 SUP Custom 27803010 224.570 - ROD SPINAL 5.5MM 70MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $71.42 $375.00 $161.93 $161.93 $161.93 $161.93 $359.85 $359.85 $359.85 $75.00 $359.85 $359.85 $359.85 $359.85 $359.85 $75.00 $359.85 $365.98 $212.85 $359.85 $365.98 $359.85 $359.85 $375.00 $359.85 $359.85 $359.85 $179.93 $179.93 $285.00 $359.85 $287.88 $161.93 $71.42 N/A $290.00 $359.85 $215.91 $359.85 $74.99 $359.85 N/A N/A 224.571 SUP HCPCS C1713 224.571 - PLATE BN NAR 134X13.5X4.2MM NS LCP CMBN 7 HL LMT CNTCT TPR BOTH IP/OP $850.50 $629.00 $168.79 $864.90 $382.70 $382.70 $382.70 $382.70 $850.45 $850.45 $850.45 $177.26 $850.45 $850.45 $850.45 $850.45 $850.45 $177.24 $850.45 $345.96 $503.04 $850.45 $864.90 $850.45 $850.45 $637.88 $850.45 $850.45 $850.45 $425.23 $425.23 $673.56 $850.45 $680.36 $382.70 $168.79 N/A $493.29 $850.45 $850.45 $850.45 $177.23 $850.45 N/A N/A 224.575 SUP Custom 27803010 224.575 - ROD SPINAL 5.5MM 75MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.58 SUP HCPCS C1713 224.58 - PLATE BN NAR 142X13.5X4.2MM NS LC DCP 8 HL SS 4.5MM SCR LG BOTH IP/OP $360.00 $266.00 $71.42 $365.98 $161.93 $161.93 $161.93 $161.93 $359.85 $359.85 $359.85 $75.00 $359.85 $359.85 $359.85 $359.85 $359.85 $75.00 $359.85 $365.98 $212.85 $359.85 $365.98 $359.85 $359.85 $270.00 $359.85 $359.85 $359.85 $179.93 $179.93 $285.00 $359.85 $287.88 $161.93 $71.42 N/A $208.80 $359.85 $215.91 $359.85 $74.99 $359.85 N/A N/A 224.58 SUP Custom 27803010 224.580 - ROD SPINAL 5.5MM 80MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $71.42 $375.00 $161.93 $161.93 $161.93 $161.93 $359.85 $359.85 $359.85 $75.00 $359.85 $359.85 $359.85 $359.85 $359.85 $75.00 $359.85 $365.98 $212.85 $359.85 $365.98 $359.85 $359.85 $375.00 $359.85 $359.85 $359.85 $179.93 $179.93 $285.00 $359.85 $287.88 $161.93 $71.42 N/A $290.00 $359.85 $215.91 $359.85 $74.99 $359.85 N/A N/A 224.581 SUP HCPCS C1713 224.581 - PLATE BN NAR 152X13.5X4.2MM NS LCP CMBN 8 HL LMT CNTCT TPR BOTH IP/OP $900.00 $666.00 $178.56 $914.95 $404.84 $404.84 $404.84 $404.84 $899.65 $899.65 $899.65 $187.51 $899.65 $899.65 $899.65 $899.65 $899.65 $187.50 $899.65 $914.95 $532.14 $899.65 $914.95 $899.65 $899.65 $675.00 $899.65 $899.65 $899.65 $449.83 $449.83 $712.52 $899.65 $719.72 $404.84 $178.56 N/A $522.00 $899.65 $539.79 $899.65 $187.49 $899.65 N/A N/A 224.585 SUP Custom 27803010 224.585 - ROD SPINAL 5.5MM 85MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.59 SUP HCPCS C1713 224.59 - PLATE BN NAR 160X13.5X4.2MM NS LC DCP 9 HL SS 4.5MM SCR LG BOTH IP/OP $360.00 $266.00 $71.42 $365.98 $161.93 $161.93 $161.93 $161.93 $359.85 $359.85 $359.85 $75.00 $359.85 $359.85 $359.85 $359.85 $359.85 $75.00 $359.85 $365.98 $212.85 $359.85 $365.98 $359.85 $359.85 $270.00 $359.85 $359.85 $359.85 $179.93 $179.93 $285.00 $359.85 $287.88 $161.93 $71.42 N/A $208.80 $359.85 $215.91 $359.85 $74.99 $359.85 N/A N/A 224.591 SUP HCPCS C1713 224.591 - PLATE BN NAR 170X13.5X4.2MM NS LCP CMBN 9 HL LMT CNTCT TPR BOTH IP/OP $942.00 $697.00 $186.93 $957.83 $423.82 $423.82 $423.82 $423.82 $941.83 $941.83 $941.83 $196.30 $941.83 $941.83 $941.83 $941.83 $941.83 $196.29 $941.83 $957.83 $557.09 $941.83 $957.83 $941.83 $941.83 $706.50 $941.83 $941.83 $941.83 $470.92 $470.92 $745.93 $941.83 $753.46 $423.82 $186.93 N/A $546.36 $941.83 $941.83 $941.83 $196.28 $941.83 N/A N/A 224.6 SUP HCPCS C1713 224.60 - PLATE BN NAR 178X13.5X4.2MM NS LC DCP 10 HL SS 4.5MM SCR LG BOTH IP/OP $454.50 $336.00 $90.20 $476.05 $204.50 $204.50 $204.50 $204.50 $454.45 $454.45 $454.45 $94.72 $454.45 $454.45 $454.45 $454.45 $454.45 $94.71 $454.45 $190.42 $268.81 $454.45 $476.05 $454.45 $454.45 $340.88 $454.45 $454.45 $454.45 $227.23 $227.23 $359.92 $454.45 $363.56 $204.50 $90.20 N/A $263.61 $454.45 $454.45 $454.45 $94.71 $454.45 N/A N/A 224.601 SUP HCPCS C1713 224.601 - PLATE BN NAR 188X13.5X4.2MM NS LCP CMBN 10 HL LMT CNTCT TPR BOTH IP/OP "$1,023.50" $757.00 $203.11 "$1,040.75" $460.51 $460.51 $460.51 $460.51 "$1,023.35" "$1,023.35" "$1,023.35" $213.29 "$1,023.35" "$1,023.35" "$1,023.35" "$1,023.35" "$1,023.35" $213.28 "$1,023.35" "$1,040.75" $605.31 "$1,023.35" "$1,040.75" "$1,023.35" "$1,023.35" $767.63 "$1,023.35" "$1,023.35" "$1,023.35" $511.68 $511.68 $810.49 "$1,023.35" $818.68 $460.51 $203.11 N/A $593.63 "$1,023.35" "$1,023.35" "$1,023.35" $213.27 "$1,023.35" N/A N/A 224.61 SUP HCPCS C1713 224.61 - PLATE BN NAR 196X13.5X4.2MM NS LC DCP 11 HL SS 4.5MM SCR LG BOTH IP/OP $468.50 $347.00 $92.91 $476.05 $210.65 $210.65 $210.65 $210.65 $468.10 $468.10 $468.10 $97.56 $468.10 $468.10 $468.10 $468.10 $468.10 $97.56 $468.10 $476.05 $276.88 $468.10 $476.05 $468.10 $468.10 $351.38 $468.10 $468.10 $468.10 $234.05 $234.05 $370.74 $468.10 $374.48 $210.65 $92.91 N/A $271.73 $468.10 $468.10 $468.10 $97.55 $468.10 N/A N/A 224.61 SUP Custom 27803010 224.610 - ROD SPINAL 5.5MM 100MM CVD REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $92.91 $476.05 $210.65 $210.65 $210.65 $210.65 $468.10 $468.10 $468.10 $97.56 $468.10 $468.10 $468.10 $468.10 $468.10 $97.56 $468.10 $476.05 $276.88 $468.10 $476.05 $468.10 $468.10 $375.00 $468.10 $468.10 $468.10 $234.05 $234.05 $370.74 $468.10 $374.48 $210.65 $92.91 N/A $290.00 $468.10 $468.10 $468.10 $97.55 $468.10 N/A N/A 224.611 SUP HCPCS C1713 224.611 - PLATE BN NAR 206X13.5X4.2MM NS LCP CMBN 11 HL LMT CNTCT TPR BOTH IP/OP "$1,102.50" $816.00 $218.74 "$1,120.80" $495.94 $495.94 $495.94 $495.94 "$1,102.08" "$1,102.08" "$1,102.08" $229.70 "$1,102.08" "$1,102.08" "$1,102.08" "$1,102.08" "$1,102.08" $229.69 "$1,102.08" $448.32 $651.88 "$1,102.08" "$1,120.80" "$1,102.08" "$1,102.08" $826.88 "$1,102.08" "$1,102.08" "$1,102.08" $551.04 $551.04 $872.85 "$1,102.08" $881.66 $495.94 $218.74 N/A $639.45 "$1,102.08" "$1,102.08" "$1,102.08" $229.67 "$1,102.08" N/A N/A 224.612 SUP Custom 27803010 224.612 - ROD SPINAL 5.5MM 125MM CVD REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.615 SUP Custom 27803010 224.615 - ROD SPINAL 5.5MM 150MM CVD REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.62 SUP HCPCS C1713 224.62 - PLATE BN NAR 214X13.5X4.2MM NS LC DCP 12 HL SS 4.5MM SCR LG BOTH IP/OP $468.50 $347.00 $92.91 $476.05 $210.65 $210.65 $210.65 $210.65 $468.10 $468.10 $468.10 $97.56 $468.10 $468.10 $468.10 $468.10 $468.10 $97.56 $468.10 $476.05 $276.88 $468.10 $476.05 $468.10 $468.10 $351.38 $468.10 $468.10 $468.10 $234.05 $234.05 $370.74 $468.10 $374.48 $210.65 $92.91 N/A $271.73 $468.10 $468.10 $468.10 $97.55 $468.10 N/A N/A 224.621 SUP HCPCS C1713 224.621 - PLATE BN NAR 224X13.5X4.2MM NS LCP CMBN 12 HL LMT CNTCT TPR BOTH IP/OP "$1,185.00" $877.00 $235.19 "$1,205.15" $533.25 $533.25 $533.25 $533.25 "$1,185.00" "$1,185.00" "$1,185.00" $246.98 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" "$1,205.15" $700.93 "$1,185.00" "$1,205.15" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 $235.19 N/A $687.30 "$1,185.00" "$1,185.00" "$1,185.00" $246.95 "$1,185.00" N/A N/A 224.635 SUP Custom 27803010 224.635 - ROD SPINAL 5.5MM 35MM CVD REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.64 SUP HCPCS C1713 224.64 - PLATE BONE NARROW 250X13.5X4.2MM 14 HOLE LC-DCP STAINLESS BOTH IP/OP $441.50 $327.00 $87.57 $441.23 $198.55 $198.55 $198.55 $198.55 $441.23 $441.23 $441.23 $91.96 $441.23 $441.23 $441.23 $441.23 $441.23 $91.96 $441.23 $176.49 $260.99 $441.23 $441.23 $441.23 $441.23 $331.13 $441.23 $441.23 $441.23 $220.62 $220.62 $349.45 $441.23 $352.98 $198.55 $87.57 N/A $256.07 $441.23 $441.23 $441.23 $91.95 $441.23 N/A N/A 224.64 SUP Custom 27803010 224.640 - ROD SPINAL 5.5MM 40MM CVD REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $87.57 $441.23 $198.55 $198.55 $198.55 $198.55 $441.23 $441.23 $441.23 $91.96 $441.23 $441.23 $441.23 $441.23 $441.23 $91.96 $441.23 $176.49 $260.99 $441.23 $441.23 $441.23 $441.23 $375.00 $441.23 $441.23 $441.23 $220.62 $220.62 $349.45 $441.23 $352.98 $198.55 $87.57 N/A $290.00 $441.23 $441.23 $441.23 $91.95 $441.23 N/A N/A 224.641 SUP HCPCS C1713 224.641 - PLATE BN NAR 260X13.5X4.2MM NS LCP CMBN 14 HL LMT CNTCT TPR BOTH IP/OP "$1,328.50" $983.00 $263.65 "$1,350.95" $597.77 $597.77 $597.77 $597.77 "$1,328.38" "$1,328.38" "$1,328.38" $276.87 "$1,328.38" "$1,328.38" "$1,328.38" "$1,328.38" "$1,328.38" $276.85 "$1,328.38" "$1,350.95" $785.74 "$1,328.38" "$1,350.95" "$1,328.38" "$1,328.38" $996.38 "$1,328.38" "$1,328.38" "$1,328.38" $664.19 $664.19 "$1,052.08" "$1,328.38" "$1,062.70" $597.77 $263.65 N/A $770.53 "$1,328.38" $797.03 "$1,328.38" $276.83 "$1,328.38" N/A N/A 224.645 SUP Custom 27803010 224.645 - ROD SPINAL 5.5MM 45MM CVD REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.65 SUP Custom 27803010 224.650 - ROD SPINAL 5.5MM 50MM CVD REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.655 SUP Custom 27803010 224.655 - ROD SPINAL 5.5MM 55MM CVD REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.66 SUP Custom 27803010 224.660 - ROD SPINAL 5.5MM 60MM CVD REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $111.60 $571.83 $253.03 $253.03 $253.03 $253.03 $562.28 $562.28 $562.28 $117.19 $562.28 $562.28 $562.28 $562.28 $562.28 $117.19 $562.28 $571.83 $332.59 $562.28 $571.83 $562.28 $562.28 $375.00 $562.28 $562.28 $562.28 $281.14 $281.14 $445.33 $562.28 $449.82 $253.03 $111.60 N/A $290.00 $562.28 $562.28 $562.28 $117.18 $562.28 N/A N/A 224.66 SUP HCPCS C1713 224.66 - PLATE BONE NARROW 286X13.5X4.2MM 16 HOLE LC-DCP STAINLESS BOTH IP/OP $562.50 $416.00 $111.60 $571.83 $253.03 $253.03 $253.03 $253.03 $562.28 $562.28 $562.28 $117.19 $562.28 $562.28 $562.28 $562.28 $562.28 $117.19 $562.28 $571.83 $332.59 $562.28 $571.83 $562.28 $562.28 $421.88 $562.28 $562.28 $562.28 $281.14 $281.14 $445.33 $562.28 $449.82 $253.03 $111.60 N/A $326.25 $562.28 $562.28 $562.28 $117.18 $562.28 N/A N/A 224.661 SUP HCPCS C1713 224.661 - PLATE BN NAR 296X13.5X4.2MM NS LCP CMBN 16 HL LMT CNTCT TPR BOTH IP/OP "$1,553.50" "$1,150.00" $308.29 "$1,579.70" $698.99 $698.99 $698.99 $698.99 "$1,553.30" "$1,553.30" "$1,553.30" $323.75 "$1,553.30" "$1,553.30" "$1,553.30" "$1,553.30" "$1,553.30" $323.72 "$1,553.30" "$1,579.70" $918.78 "$1,553.30" "$1,579.70" "$1,553.30" "$1,553.30" "$1,165.13" "$1,553.30" "$1,553.30" "$1,553.30" $776.65 $776.65 "$1,230.21" "$1,553.30" "$1,242.64" $698.99 $308.29 N/A $901.03 "$1,553.30" "$1,553.30" "$1,553.30" "$1,553.30" "$1,553.30" N/A N/A 224.665 SUP Custom 27803010 224.665 - ROD SPINAL 5.5MM 65MM CVD REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.67 SUP Custom 27803010 224.670 - ROD SPINAL 5.5MM 70MM CVD REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.675 SUP Custom 27803010 224.675 - ROD SPINAL 5.5MM 75MM CVD REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.68 SUP Custom 27803010 224.680 - ROD SPINAL 5.5MM 80MM CVD REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.681 SUP HCPCS C1713 224.681 - PLATE BONE NARROW 332MM 18 HOLE LCP STAINLESS STEEL BOTH IP/OP "$1,886.50" "$1,396.00" $374.41 "$1,918.53" $848.90 $848.90 $848.90 $848.90 "$1,886.45" "$1,886.45" "$1,886.45" $393.18 "$1,886.45" "$1,886.45" "$1,886.45" "$1,886.45" "$1,886.45" $393.16 "$1,886.45" $767.41 "$1,115.84" "$1,886.45" "$1,918.53" "$1,886.45" "$1,886.45" "$1,414.88" "$1,886.45" "$1,886.45" "$1,886.45" $943.23 $943.23 "$1,494.07" "$1,886.45" "$1,509.16" $848.90 $374.41 N/A "$1,094.17" "$1,886.45" "$1,886.45" "$1,886.45" "$1,886.45" "$1,886.45" N/A N/A 224.685 SUP Custom 27803010 224.685 - ROD SPINAL 5.5MM 85MM CVD REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 224.7 SUP HCPCS C1713 224.70 - PLATE BONE NARROW 358MM 20 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP "$1,156.00" $855.00 $229.43 "$1,210.88" $520.18 $520.18 $520.18 $520.18 "$1,155.95" "$1,155.95" "$1,155.95" $240.93 "$1,155.95" "$1,155.95" "$1,155.95" "$1,155.95" "$1,155.95" $240.91 "$1,155.95" $484.35 $683.74 "$1,155.95" "$1,210.88" "$1,155.95" "$1,155.95" $867.00 "$1,155.95" "$1,155.95" "$1,155.95" $577.98 $577.98 $915.51 "$1,155.95" $924.76 $520.18 $229.43 N/A $670.48 "$1,155.95" "$1,155.95" "$1,155.95" $240.90 "$1,155.95" N/A N/A 224.701 SUP HCPCS C1713 224.701 - SCREW BONE 4.5MM 25MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $475.96 "$2,438.88" "$1,079.15" "$1,079.15" "$1,079.15" "$1,079.15" "$2,398.10" "$2,398.10" "$2,398.10" $499.82 "$2,398.10" "$2,398.10" "$2,398.10" "$2,398.10" "$2,398.10" $499.79 "$2,398.10" "$2,438.88" "$1,418.48" "$2,398.10" "$2,438.88" "$2,398.10" "$2,398.10" "$1,687.50" "$2,398.10" "$2,398.10" "$2,398.10" "$1,199.05" "$1,199.05" "$1,899.30" "$2,398.10" "$1,918.48" "$1,079.15" $475.96 N/A "$1,305.00" "$2,398.10" "$2,398.10" "$2,398.10" $499.76 "$2,398.10" N/A N/A 224.701 SUP HCPCS C1713 224.701 - PLATE BONE NARROW 368MM 20 HOLE LCP STAINLESS STEEL BOTH IP/OP "$2,398.50" "$1,775.00" $475.96 "$2,438.88" "$1,079.15" "$1,079.15" "$1,079.15" "$1,079.15" "$2,398.10" "$2,398.10" "$2,398.10" $499.82 "$2,398.10" "$2,398.10" "$2,398.10" "$2,398.10" "$2,398.10" $499.79 "$2,398.10" "$2,438.88" "$1,418.48" "$2,398.10" "$2,438.88" "$2,398.10" "$2,398.10" "$1,798.88" "$2,398.10" "$2,398.10" "$2,398.10" "$1,199.05" "$1,199.05" "$1,899.30" "$2,398.10" "$1,918.48" "$1,079.15" $475.96 N/A "$1,391.13" "$2,398.10" "$2,398.10" "$2,398.10" $499.76 "$2,398.10" N/A N/A 224.702 SUP HCPCS C1713 224.702 - SCREW BONE 4.5MM 30MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.703 SUP HCPCS C1713 224.703 - SCREW BONE 4.5MM 35MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.704 SUP HCPCS C1713 224.704 - SCREW BONE 4.5MM 40MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.705 SUP HCPCS C1713 224.705 - SCREW BONE 4.5MM 45MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.706 SUP HCPCS C1713 224.706 - SCREW BONE 4.5MM 50MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.707 SUP HCPCS C1713 224.707 - SCREW BONE 4.5MM 55MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.711 SUP HCPCS C1713 224.711 - SCREW BONE 5MM 25MM UNIPLNR REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.712 SUP HCPCS C1713 224.712 - SCREW BONE 5MM 30MM UNIPLNR REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.713 SUP HCPCS C1713 224.713 - SCREW BONE 5MM 35MM UNIPLNR REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.714 SUP HCPCS C1713 224.714 - SCREW BONE 5MM 40MM UNIPLNR REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.715 SUP HCPCS C1713 224.715 - SCREW BONE 5MM 45MM UNIPLNR REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.716 SUP HCPCS C1713 224.716 - SCREW BONE 5MM 50MM UNIPLNR REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.717 SUP HCPCS C1713 224.717 - SCREW BONE 5MM 55MM UNIPLNR REDX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.721 SUP HCPCS C1713 224.721 - SCREW BONE 5.5MM 25MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $519.77 "$2,663.33" "$1,178.46" "$1,178.46" "$1,178.46" "$1,178.46" "$2,618.80" "$2,618.80" "$2,618.80" $545.82 "$2,618.80" "$2,618.80" "$2,618.80" "$2,618.80" "$2,618.80" $545.79 "$2,618.80" "$2,663.33" "$1,291.07" "$2,618.80" "$2,663.33" "$2,618.80" "$2,618.80" "$1,687.50" "$2,618.80" "$2,618.80" "$2,618.80" "$1,309.40" "$1,309.40" "$2,074.09" "$2,618.80" "$2,095.04" "$1,178.46" $519.77 N/A "$1,305.00" "$2,618.80" "$2,618.80" "$2,618.80" $545.76 "$2,618.80" N/A N/A 224.721 SUP HCPCS C1713 224.721 - PLATE BONE NARROW 404MM 22 HOLE LCP STAINLESS STEEL BOTH IP/OP "$2,619.00" "$1,938.00" $519.77 "$2,663.33" "$1,178.46" "$1,178.46" "$1,178.46" "$1,178.46" "$2,618.80" "$2,618.80" "$2,618.80" $545.82 "$2,618.80" "$2,618.80" "$2,618.80" "$2,618.80" "$2,618.80" $545.79 "$2,618.80" "$2,663.33" "$1,291.07" "$2,618.80" "$2,663.33" "$2,618.80" "$2,618.80" "$1,964.25" "$2,618.80" "$2,618.80" "$2,618.80" "$1,309.40" "$1,309.40" "$2,074.09" "$2,618.80" "$2,095.04" "$1,178.46" $519.77 N/A "$1,519.02" "$2,618.80" "$2,618.80" "$2,618.80" $545.76 "$2,618.80" N/A N/A 224.722 SUP HCPCS C1713 224.722 - SCREW BONE 5.5MM 30MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.723 SUP HCPCS C1713 224.723 - SCREW BONE 5.5MM 35MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.724 SUP HCPCS C1713 224.724 - SCREW BONE 5.5MM 40MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.725 SUP HCPCS C1713 224.725 - SCREW BONE 5.5MM 45MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.726 SUP HCPCS C1713 224.726 - SCREW BONE 5.5MM 50MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.727 SUP HCPCS C1713 224.727 - SCREW BONE 5.5MM 55MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.731 SUP HCPCS C1713 224.731 - SCREW BONE 6.5MM 25MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.732 SUP HCPCS C1713 224.732 - SCREW BONE 6.5MM 30MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.733 SUP HCPCS C1713 224.733 - SCREW BONE 6.5MM 35MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.734 SUP HCPCS C1713 224.734 - SCREW BONE 6.5MM 40MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.735 SUP HCPCS C1713 224.735 - SCREW BONE 6.5MM 45MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.736 SUP HCPCS C1713 224.736 - SCREW BONE 6.5MM 50MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.737 SUP HCPCS C1713 224.737 - SCREW BONE 6.5MM 55MM UNIPLNR REDX REVERE STAINLESS STEEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.753 SUP HCPCS C1713 224.753 - PLATE BN 118X11X4.2MM NS LCP CMBN 8 HL LMT CNTCT TPR END SS BOTH IP/OP "$1,730.50" "$1,281.00" $343.44 "$1,759.83" $778.68 $778.68 $778.68 $778.68 "$1,730.40" "$1,730.40" "$1,730.40" $360.66 "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" $360.63 "$1,730.40" "$1,759.83" "$1,023.53" "$1,730.40" "$1,759.83" "$1,730.40" "$1,730.40" "$1,297.88" "$1,730.40" "$1,730.40" "$1,730.40" $865.20 $865.20 "$1,370.48" "$1,730.40" "$1,384.32" $778.68 $343.44 N/A "$1,003.69" "$1,730.40" "$1,730.40" "$1,730.40" $360.62 "$1,730.40" N/A N/A 224.754 SUP HCPCS C1713 224.754 - PLATE BN 136X11X4.2MM NS LCP CMBN 9 HL LMT CNTCT TPR END SS BOTH IP/OP "$1,759.00" "$1,302.00" $349.02 "$1,788.43" $791.34 $791.34 $791.34 $791.34 "$1,758.53" "$1,758.53" "$1,758.53" $366.52 "$1,758.53" "$1,758.53" "$1,758.53" "$1,758.53" "$1,758.53" $366.50 "$1,758.53" "$1,788.43" "$1,040.17" "$1,758.53" "$1,788.43" "$1,758.53" "$1,758.53" "$1,319.25" "$1,758.53" "$1,758.53" "$1,758.53" $879.27 $879.27 "$1,392.76" "$1,758.53" "$1,406.82" $791.34 $349.02 N/A "$1,020.22" "$1,758.53" "$1,055.12" "$1,758.53" $366.48 "$1,758.53" N/A N/A 224.755 SUP HCPCS C1713 224.755 - PLATE BN 154X11X4.2MM NS LCP CMBN 10 HL LMT CNTCT TPR END SS BOTH IP/OP "$1,788.50" "$1,323.00" $354.88 "$1,818.45" $804.62 $804.62 $804.62 $804.62 "$1,788.05" "$1,788.05" "$1,788.05" $372.67 "$1,788.05" "$1,788.05" "$1,788.05" "$1,788.05" "$1,788.05" $372.65 "$1,788.05" $727.38 "$1,057.63" "$1,788.05" "$1,818.45" "$1,788.05" "$1,788.05" "$1,341.38" "$1,788.05" "$1,788.05" "$1,788.05" $894.03 $894.03 "$1,416.14" "$1,788.05" "$1,430.44" $804.62 $354.88 N/A "$1,037.33" "$1,788.05" "$1,072.83" "$1,788.05" $372.63 "$1,788.05" N/A N/A 224.756 SUP HCPCS C1713 224.756 - PLATE BONE 172MM 11 HOLE LCP STAINLESS STEEL METAPHYSEAL BOTH IP/OP "$1,818.00" "$1,345.00" $360.74 "$1,848.45" $817.90 $817.90 $817.90 $817.90 "$1,817.55" "$1,817.55" "$1,817.55" $378.82 "$1,817.55" "$1,817.55" "$1,817.55" "$1,817.55" "$1,817.55" $378.80 "$1,817.55" "$1,848.45" "$1,075.08" "$1,817.55" "$1,848.45" "$1,817.55" "$1,817.55" "$1,363.50" "$1,817.55" "$1,817.55" "$1,817.55" $908.78 $908.78 "$1,439.50" "$1,817.55" "$1,454.04" $817.90 $360.74 N/A "$1,054.44" "$1,817.55" "$1,090.53" "$1,817.55" "$1,817.55" "$1,817.55" N/A N/A 224.757 SUP HCPCS C1713 224.757 - PLATE BONE 190MM 12 HOLE LCP STAINLESS STEEL METAPHYSEAL BOTH IP/OP "$2,346.50" "$1,736.00" $465.64 "$2,385.98" "$1,055.75" "$1,055.75" "$1,055.75" "$1,055.75" "$2,346.10" "$2,346.10" "$2,346.10" $488.99 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $954.39 "$1,387.72" "$2,346.10" "$2,385.98" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" $465.64 N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 224.758 SUP HCPCS C1713 224.758 - PLATE BONE 208MM 8X5 HOLE LCP STAINLESS STEEL METAPHYSEAL BOTH IP/OP "$2,370.00" "$1,754.00" $470.39 "$2,410.30" "$1,066.50" "$1,066.50" "$1,066.50" "$1,066.50" "$2,370.00" "$2,370.00" "$2,370.00" $493.97 "$2,370.00" "$2,370.00" "$2,370.00" "$2,370.00" "$2,370.00" $493.93 "$2,370.00" "$2,410.30" "$1,401.86" "$2,370.00" "$2,410.30" "$2,370.00" "$2,370.00" "$1,777.50" "$2,370.00" "$2,370.00" "$2,370.00" "$1,185.00" "$1,185.00" "$1,877.04" "$2,370.00" "$1,896.00" "$1,066.50" $470.39 N/A "$1,374.60" "$2,370.00" "$2,370.00" "$2,370.00" $493.91 "$2,370.00" N/A N/A 224.759 SUP HCPCS C1713 224.759 - PLATE BONE 226MM 9X5 HOLE LCP STAINLESS STEEL METAPHYSEAL BOTH IP/OP "$2,422.00" "$1,792.00" $480.71 "$2,463.18" "$1,089.90" "$1,089.90" "$1,089.90" "$1,089.90" "$2,422.00" "$2,422.00" "$2,422.00" $504.81 "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" "$2,422.00" $504.77 "$2,422.00" $985.27 "$1,432.61" "$2,422.00" "$2,463.18" "$2,422.00" "$2,422.00" "$1,816.50" "$2,422.00" "$2,422.00" "$2,422.00" "$1,211.00" "$1,211.00" "$1,918.22" "$2,422.00" "$1,937.60" "$1,089.90" $480.71 N/A "$1,404.76" "$2,422.00" "$2,422.00" "$2,422.00" $504.74 "$2,422.00" N/A N/A 224.761 SUP HCPCS C1713 224.761 - PLATE BONE 262MM 11X5 HOLE LCP STAINLESS STEEL METAPHYSEAL BOTH IP/OP "$2,543.00" "$1,882.00" $504.70 "$2,586.13" "$1,144.31" "$1,144.31" "$1,144.31" "$1,144.31" "$2,542.90" "$2,542.90" "$2,542.90" $530.00 "$2,542.90" "$2,542.90" "$2,542.90" "$2,542.90" "$2,542.90" $529.97 "$2,542.90" "$2,586.13" "$1,253.65" "$2,542.90" "$2,586.13" "$2,542.90" "$2,542.90" "$1,907.25" "$2,542.90" "$2,542.90" "$2,542.90" "$1,271.45" "$1,271.45" "$2,013.98" "$2,542.90" "$2,034.32" "$1,144.31" $504.70 N/A "$1,474.94" "$2,542.90" "$2,542.90" "$2,542.90" $529.94 "$2,542.90" N/A N/A 224.763 SUP HCPCS C1713 224.763 - PLATE BONE 298MM 13X5 HOLE LCP STAINLESS STEEL METAPHYSEAL BOTH IP/OP "$2,591.00" "$1,917.00" $514.19 "$2,634.75" "$1,165.82" "$1,165.82" "$1,165.82" "$1,165.82" "$2,590.70" "$2,590.70" "$2,590.70" $539.97 "$2,590.70" "$2,590.70" "$2,590.70" "$2,590.70" "$2,590.70" $539.93 "$2,590.70" "$1,053.90" "$1,277.22" "$2,590.70" "$2,634.75" "$2,590.70" "$2,590.70" "$1,943.25" "$2,590.70" "$2,590.70" "$2,590.70" "$1,295.35" "$1,295.35" "$2,051.83" "$2,590.70" "$2,072.56" "$1,165.82" $514.19 N/A "$1,502.78" "$2,590.70" "$2,590.70" "$2,590.70" $539.90 "$2,590.70" N/A N/A 224.765 SUP HCPCS C1713 224.765 - PLATE BONE 334MM 20 HOLE LCP STAINLESS STEEL METAPHYSEAL BOTH IP/OP "$2,709.00" "$2,005.00" $537.63 "$2,754.83" "$1,218.95" "$1,218.95" "$1,218.95" "$1,218.95" "$2,708.78" "$2,708.78" "$2,708.78" $564.58 "$2,708.78" "$2,708.78" "$2,708.78" "$2,708.78" "$2,708.78" $564.54 "$2,708.78" "$2,754.83" "$1,335.43" "$2,708.78" "$2,754.83" "$2,708.78" "$2,708.78" "$2,031.75" "$2,708.78" "$2,708.78" "$2,708.78" "$1,354.39" "$1,354.39" "$2,145.35" "$2,708.78" "$2,167.02" "$1,218.95" $537.63 N/A "$1,571.22" "$2,708.78" "$2,708.78" "$2,708.78" $564.51 "$2,708.78" N/A N/A 224.801 SUP HCPCS C1713 224.801 - SCREW BONE 4.5MM 25MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.802 SUP HCPCS C1713 224.802 - SCREW BONE 4.5MM 30MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.803 SUP HCPCS C1713 224.803 - SCREW BONE 4.5MM 35MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.804 SUP HCPCS C1713 224.804 - SCREW BONE 4.5MM 40MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.805 SUP HCPCS C1713 224.805 - SCREW BONE 4.5MM 45MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.806 SUP HCPCS C1713 224.806 - SCREW BONE 4.5MM 50MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.807 SUP HCPCS C1713 224.807 - SCREW BONE 4.5MM 55MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.811 SUP HCPCS C1713 224.811 - SCREW BONE 5MM 25MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.812 SUP HCPCS C1713 224.812 - SCREW BONE 5MM 30MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.813 SUP HCPCS C1713 224.813 - SCREW BONE 5MM 35MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.814 SUP HCPCS C1713 224.814 - SCREW BONE 5MM 40MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.815 SUP HCPCS C1713 224.815 - SCREW BONE 5MM 45MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.816 SUP HCPCS C1713 224.816 - SCREW BONE 5MM 50MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.817 SUP HCPCS C1713 224.817 - SCREW BONE 5MM 55MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.821 SUP HCPCS C1713 224.821 - SCREW BONE 5.5MM 25MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.822 SUP HCPCS C1713 224.822 - SCREW BONE 5.5MM 30MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.823 SUP HCPCS C1713 224.823 - SCREW BONE 5.5MM 35MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.824 SUP HCPCS C1713 224.824 - SCREW BONE 5.5MM 40MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.825 SUP HCPCS C1713 224.825 - SCREW BONE 5.5MM 45MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.826 SUP HCPCS C1713 224.826 - SCREW BONE 5.5MM 50MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.827 SUP HCPCS C1713 224.827 - SCREW BONE 5.5MM 55MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.831 SUP HCPCS C1713 224.831 - SCREW BONE 6.5MM 25MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.832 SUP HCPCS C1713 224.832 - SCREW BONE 6.5MM 30MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.833 SUP HCPCS C1713 224.833 - SCREW BONE 6.5MM 35MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.834 SUP HCPCS C1713 224.834 - SCREW BONE 6.5MM 40MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.835 SUP HCPCS C1713 224.835 - SCREW BONE 6.5MM 45MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.836 SUP HCPCS C1713 224.836 - SCREW BONE 6.5MM 50MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.837 SUP HCPCS C1713 224.837 - SCREW BONE 6.5MM 55MM UNIPLNR REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 224.851 SUP HCPCS C1713 224.851 - SCREW BONE 5MM 25MM MNOAX REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.852 SUP HCPCS C1713 224.852 - SCREW BONE 5MM 30MM MNOAX REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.853 SUP HCPCS C1713 224.853 - SCREW BONE 5MM 35MM MNOAX REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.854 SUP HCPCS C1713 224.854 - SCREW BONE 5MM 40MM MNOAX REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.855 SUP HCPCS C1713 224.855 - SCREW BONE 5MM 45MM MNOAX REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.856 SUP HCPCS C1713 224.856 - SCREW BONE 5MM 50MM MNOAX REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.857 SUP HCPCS C1713 224.857 - SCREW BONE 5MM 55MM MNOAX REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.871 SUP HCPCS C1713 224.871 - SCREW BONE 7.5MM 70MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.872 SUP HCPCS C1713 224.872 - SCREW BONE 7.5MM 75MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.873 SUP HCPCS C1713 224.873 - SCREW BONE 7.5MM 80MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.874 SUP HCPCS C1713 224.874 - SCREW BONE 7.5MM 85MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.875 SUP HCPCS C1713 224.875 - SCREW BONE 7.5MM 90MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.881 SUP HCPCS C1713 224.881 - SCREW BONE 8.5MM 70MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.882 SUP HCPCS C1713 224.882 - SCREW BONE 8.5MM 75MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.883 SUP HCPCS C1713 224.883 - SCREW BONE 8.5MM 80MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.884 SUP HCPCS C1713 224.884 - SCREW BONE 8.5MM 85MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.885 SUP HCPCS C1713 224.885 - SCREW BONE 8.5MM 90MM MNOAX REVERE STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 224.891 SUP Custom 27803010 224.891 - SCREW BONE LP REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.892 SUP Custom 27803010 224.892 - SCREW BONE LP REVERE STAINLESS STEEL SPN PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.893 SUP Custom 27803010 224.893 - HOOK SPINAL LP REVERE STAINLESS STEEL PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.901 SUP Custom 27803010 224.901 - HOOK SPINAL SMALL NARROW BLADE REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.902 SUP Custom 27803010 224.902 - HOOK SPINAL MEDIUM NARROW BLADE REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.904 SUP Custom 27803010 224.904 - HOOK SPINAL SMALL REVERE STAINLESS STEEL LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.905 SUP Custom 27803010 224.905 - HOOK SPINAL MEDIUM REVERE STAINLESS STEEL LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.907 SUP Custom 27803010 224.907 - HOOK SPINAL MEDIUM UPGOING REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.908 SUP Custom 27803010 224.908 - HOOK SPINAL LARGE UPGOING REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.912 SUP Custom 27803010 224.912 - CONNECTOR ROD 29-33MM TRNSVRS ADJUSTABLE REVERE STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 224.913 SUP Custom 27803010 224.913 - CONNECTOR ROD 33-41MM TRNSVRS ADJUSTABLE REVERE STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 224.914 SUP Custom 27803010 224.914 - CONNECTOR ROD 38-51MM TRNSVRS ADJUSTABLE REVERE STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 224.915 SUP Custom 27803010 224.915 - CONNECTOR ROD 48-61MM TRNSVRS ADJUSTABLE REVERE STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 224.916 SUP Custom 27803010 224.916 - CONNECTOR ROD 58-71MM TRNSVRS ADJUSTABLE REVERE STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 224.917 SUP Custom 27803010 224.917 - CONNECTOR ROD 68-81MM TRNSVRS ADJUSTABLE REVERE STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 224.918 SUP Custom 27803010 224.918 - CONNECTOR ROD 78-91MM TRNSVRS ADJUSTABLE REVERE STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 224.921 SUP Custom 27803010 224.921 - HOOK SPINAL RIGHT OFFST REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.922 SUP Custom 27803010 224.922 - HOOK SPINAL LEFT OFFST REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.924 SUP Custom 27803010 224.924 - HOOK SPINAL RIGHT OPENING TRNSVRS REVERE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.925 SUP Custom 27803010 224.925 - HOOK SPINAL LEFT OPENING TRNSVRS REVERE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.927 SUP Custom 27803010 224.927 - HOOK SPINAL SMALL REVERE STAINLESS STEEL PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.928 SUP Custom 27803010 224.928 - HOOK SPINAL MEDIUM REVERE STAINLESS STEEL PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.929 SUP Custom 27803010 224.929 - HOOK SPINAL LARGE REVERE STAINLESS STEEL PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.931 SUP Custom 27803010 224.931 - HOOK SPINAL SMALL TRNSVRS PROCESS REVERE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.932 SUP Custom 27803010 224.932 - HOOK SPINAL MEDIUM TRNSVRS PROCESS REVERE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.933 SUP Custom 27803010 224.933 - HOOK SPINAL LARGE TRNSVRS PROCESS REVERE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.935 SUP Custom 27803010 224.935 - HOOK SPINAL SMALL TRNSVRS PROCESS REVERE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.936 SUP Custom 27803010 224.936 - HOOK SPINAL MEDIUM TRNSVRS PROCESS REVERE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.937 SUP Custom 27803010 224.937 - HOOK SPINAL LARGE TRNSVRS PROCESS REVERE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.94 SUP Custom 27803010 224.940 - HOOK SPINAL SMALL NARROW BLADE REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.941 SUP Custom 27803010 224.941 - HOOK SPINAL MEDIUM NARROW BLADE REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.942 SUP Custom 27803010 224.942 - HOOK SPINAL LARGE NARROW BLADE REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.944 SUP Custom 27803010 224.944 - HOOK SPINAL SMALL REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.945 SUP Custom 27803010 224.945 - HOOK SPINAL MEDIUM REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.946 SUP Custom 27803010 224.946 - HOOK SPINAL LARGE REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.948 SUP Custom 27803010 224.948 - HOOK SPINAL SMALL WIDE BLADE REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.949 SUP Custom 27803010 224.949 - HOOK SPINAL MEDIUM WIDE BLADE REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.95 SUP Custom 27803010 224.950 - HOOK SPINAL LARGE WIDE BLADE REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.952 SUP Custom 27803010 224.952 - HOOK SPINAL SMALL TALL BODY REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.953 SUP Custom 27803010 224.953 - HOOK SPINAL MEDIUM TALL BODY REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.954 SUP Custom 27803010 224.954 - HOOK SPINAL LARGE TALL BODY REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.955 SUP Custom 27803010 224.955 - HOOK SPINAL SMALL ANGLED REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.956 SUP Custom 27803010 224.956 - HOOK SPINAL MEDIUM ANGLED REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.957 SUP Custom 27803010 224.957 - HOOK SPINAL LARGE ANGLED REVERE STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 224.96 SUP Custom 27803010 224.960 - CONNECTOR ROD 5.5/5.5MM REVERE STAINLESS STEEL THORACOLUMBAR BOTH IP/OP "$1,142.50" $845.00 $203.37 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $203.37 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $238.11 "$1,142.50" $457.00 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $856.88 "$1,142.50" "$1,142.50" "$1,142.50" $571.25 $571.25 $904.86 "$1,142.50" $914.00 $514.13 "$1,142.50" N/A $662.65 "$1,142.50" $685.50 "$1,142.50" "$1,142.50" "$1,142.50" N/A N/A 224.961 SUP Custom 27803010 224.961 - CONNECTOR ROD 5.5/5.5MM WIDE BLADE PARALLEL REVERE STAINLESS BOTH IP/OP "$1,142.50" $845.00 $203.37 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $203.37 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $238.11 "$1,142.50" $457.00 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $856.88 "$1,142.50" "$1,142.50" "$1,142.50" $571.25 $571.25 $904.86 "$1,142.50" $914.00 $514.13 "$1,142.50" N/A $662.65 "$1,142.50" $685.50 "$1,142.50" "$1,142.50" "$1,142.50" N/A N/A 224.962 SUP Custom 27803010 224.962 - CONNECTOR ROD 5.5/5.5MM REVERE STAINLESS STEEL SPN CLMP BOTH IP/OP "$1,142.50" $845.00 $203.37 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $203.37 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $238.11 "$1,142.50" $457.00 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $856.88 "$1,142.50" "$1,142.50" "$1,142.50" $571.25 $571.25 $904.86 "$1,142.50" $914.00 $514.13 "$1,142.50" N/A $662.65 "$1,142.50" $685.50 "$1,142.50" "$1,142.50" "$1,142.50" N/A N/A 224.963 SUP Custom 27803010 224.963 - CONNECTOR ROD 5.5/5.5MM WIDE BLADE REVERE STAINLESS STEEL BOTH IP/OP "$1,142.50" $845.00 $203.37 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $203.37 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $238.11 "$1,142.50" $457.00 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $856.88 "$1,142.50" "$1,142.50" "$1,142.50" $571.25 $571.25 $904.86 "$1,142.50" $914.00 $514.13 "$1,142.50" N/A $662.65 "$1,142.50" $685.50 "$1,142.50" "$1,142.50" "$1,142.50" N/A N/A 224.964 SUP Custom 27803010 224.964 - CONNECTOR ROD 5.5/5.5MM PARALLEL REVERE STAINLESS STEEL SPN BOTH IP/OP "$1,142.50" $845.00 $203.37 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $203.37 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $238.11 "$1,142.50" $457.00 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $856.88 "$1,142.50" "$1,142.50" "$1,142.50" $571.25 $571.25 $904.86 "$1,142.50" $914.00 $514.13 "$1,142.50" N/A $662.65 "$1,142.50" $685.50 "$1,142.50" "$1,142.50" "$1,142.50" N/A N/A 224.965 SUP Custom 27803010 224.965 - CONNECTOR ROD 5.5/5.5MM WIDE BLADE REVERE STAINLESS STEEL BOTH IP/OP "$1,142.50" $845.00 $203.37 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $203.37 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $238.11 "$1,142.50" $457.00 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $856.88 "$1,142.50" "$1,142.50" "$1,142.50" $571.25 $571.25 $904.86 "$1,142.50" $914.00 $514.13 "$1,142.50" N/A $662.65 "$1,142.50" $685.50 "$1,142.50" "$1,142.50" "$1,142.50" N/A N/A 224.97 SUP Custom 27803010 224.970 - CONNECTOR ROD 5.5MM 15MM REVERE STAINLESS STEEL BOTH IP/OP "$1,025.00" $759.00 $182.45 "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" $182.45 "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" $213.62 "$1,025.00" $410.00 "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" $768.75 "$1,025.00" "$1,025.00" "$1,025.00" $512.50 $512.50 $811.80 "$1,025.00" $820.00 $461.25 "$1,025.00" N/A $594.50 "$1,025.00" $615.00 "$1,025.00" "$1,025.00" "$1,025.00" N/A N/A 224.971 SUP Custom 27803010 224.971 - CONNECTOR ROD 5.5MM 20MM OFFST REVERE STAINLESS STEEL SPN BOTH IP/OP "$1,025.00" $759.00 $182.45 "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" $182.45 "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" $213.62 "$1,025.00" $410.00 "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" $768.75 "$1,025.00" "$1,025.00" "$1,025.00" $512.50 $512.50 $811.80 "$1,025.00" $820.00 $461.25 "$1,025.00" N/A $594.50 "$1,025.00" $615.00 "$1,025.00" "$1,025.00" "$1,025.00" N/A N/A 224.972 SUP Custom 27803010 224.972 - CONNECTOR ROD 5.5MM 25MM OFFST REVERE STAINLESS STEEL SPN BOTH IP/OP "$1,025.00" $759.00 $182.45 "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" $182.45 "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" $213.62 "$1,025.00" $410.00 "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" $768.75 "$1,025.00" "$1,025.00" "$1,025.00" $512.50 $512.50 $811.80 "$1,025.00" $820.00 $461.25 "$1,025.00" N/A $594.50 "$1,025.00" $615.00 "$1,025.00" "$1,025.00" "$1,025.00" N/A N/A 224.973 SUP Custom 27803010 224.973 - CLAMP SPINAL 100MM REVERE STAINLESS STEEL 5.5MM ROD BOTH IP/OP "$1,217.50" $901.00 $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $487.00 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 "$1,217.50" N/A $706.15 "$1,217.50" $730.50 "$1,217.50" "$1,217.50" "$1,217.50" N/A N/A 224.974 SUP Custom 27803010 224.974 - CLAMP SPINAL 120MM REVERE STAINLESS STEEL 5.5MM ROD BOTH IP/OP "$1,217.50" $901.00 $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $487.00 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 "$1,217.50" N/A $706.15 "$1,217.50" $730.50 "$1,217.50" "$1,217.50" "$1,217.50" N/A N/A 224.975 SUP Custom 27803010 224.975 - CLAMP SPINAL 150MM REVERE STAINLESS STEEL 5.5MM ROD BOTH IP/OP "$1,217.50" $901.00 $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $487.00 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 "$1,217.50" N/A $706.15 "$1,217.50" $730.50 "$1,217.50" "$1,217.50" "$1,217.50" N/A N/A 224.976 SUP Custom 27803010 224.976 - CONNECTOR ROD 5.5MM 30MM OFFST REVERE STAINLESS STEEL SPN BOTH IP/OP "$1,132.50" $838.00 $201.59 "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" $201.59 "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" $236.03 "$1,132.50" $453.00 "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" $849.38 "$1,132.50" "$1,132.50" "$1,132.50" $566.25 $566.25 $896.94 "$1,132.50" $906.00 $509.63 "$1,132.50" N/A $656.85 "$1,132.50" $679.50 "$1,132.50" "$1,132.50" "$1,132.50" N/A N/A 224.977 SUP Custom 27803010 224.977 - CONNECTOR ROD 5.5MM 35MM OFFST REVERE STAINLESS STEEL SPN BOTH IP/OP "$1,132.50" $838.00 $201.59 "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" $201.59 "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" $236.03 "$1,132.50" $453.00 "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" "$1,132.50" $849.38 "$1,132.50" "$1,132.50" "$1,132.50" $566.25 $566.25 $896.94 "$1,132.50" $906.00 $509.63 "$1,132.50" N/A $656.85 "$1,132.50" $679.50 "$1,132.50" "$1,132.50" "$1,132.50" N/A N/A 224.98 SUP Custom 27803010 224.980 - CONNECTOR ROD 5.5MM REVERE STAINLESS STEEL THORACOLUMBAR SPN BOTH IP/OP "$1,217.50" $901.00 $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $487.00 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 "$1,217.50" N/A $706.15 "$1,217.50" $730.50 "$1,217.50" "$1,217.50" "$1,217.50" N/A N/A 224.99 SUP Custom 27803010 224.990 - CONNECTOR ROD 5.5MM CLOSE OFFST STAINLESS STEEL SPN BOTH IP/OP "$1,300.00" $962.00 $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 "$1,300.00" N/A $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A 224.991 SUP Custom 27803010 224.991 - CONNECTOR ROD 5.5MM CLOSE OFFST STAINLESS STEEL SPN BOTH IP/OP "$1,300.00" $962.00 $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 "$1,300.00" N/A $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A 224.992 SUP Custom 27803010 224.992 - CONNECTOR ROD 5.5MM CLOSE OFFST STAINLESS STEEL SPN BOTH IP/OP "$1,300.00" $962.00 $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 "$1,300.00" N/A $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A 224.993 SUP Custom 27803010 224.993 - CONNECTOR ROD 5.5MM CLOSE OFFST STAINLESS STEEL SPN BOTH IP/OP "$1,300.00" $962.00 $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 "$1,300.00" N/A $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A 224.994 SUP Custom 27803010 224.994 - CONNECTOR ROD 5.5MM CLOSE OFFST STAINLESS STEEL SPN BOTH IP/OP "$1,300.00" $962.00 $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 "$1,300.00" N/A $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A 224.995 SUP Custom 27803010 224.995 - CONNECTOR ROD 5.5MM CLOSE OFFST STAINLESS STEEL SPN BOTH IP/OP "$1,450.00" "$1,073.00" $258.10 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" $258.10 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" $302.20 "$1,450.00" $580.00 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,087.50" "$1,450.00" "$1,450.00" "$1,450.00" $725.00 $725.00 "$1,148.40" "$1,450.00" "$1,160.00" $652.50 "$1,450.00" N/A $841.00 "$1,450.00" $870.00 "$1,450.00" "$1,450.00" "$1,450.00" N/A N/A 224.996 SUP Custom 27803010 224.996 - CONNECTOR ROD 5.5MM CLOSE OFFST STAINLESS STEEL SPN BOTH IP/OP "$1,450.00" "$1,073.00" $258.10 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" $258.10 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" $302.20 "$1,450.00" $580.00 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,087.50" "$1,450.00" "$1,450.00" "$1,450.00" $725.00 $725.00 "$1,148.40" "$1,450.00" "$1,160.00" $652.50 "$1,450.00" N/A $841.00 "$1,450.00" $870.00 "$1,450.00" "$1,450.00" "$1,450.00" N/A N/A 224.997 SUP Custom 27803010 224.997 - CONNECTOR ROD 5.5MM CLOSE OFFST STAINLESS STEEL SPN BOTH IP/OP "$1,450.00" "$1,073.00" $258.10 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" $258.10 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" $302.20 "$1,450.00" $580.00 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,087.50" "$1,450.00" "$1,450.00" "$1,450.00" $725.00 $725.00 "$1,148.40" "$1,450.00" "$1,160.00" $652.50 "$1,450.00" N/A $841.00 "$1,450.00" $870.00 "$1,450.00" "$1,450.00" "$1,450.00" N/A N/A 225.007 SUP HCPCS C1713 225.007 - PLATE BONE BROAD 90MM 7 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP $377.50 $279.00 $74.91 $377.43 $169.84 $169.84 $169.84 $169.84 $377.43 $377.43 $377.43 $78.67 $377.43 $377.43 $377.43 $377.43 $377.43 $78.66 $377.43 $150.97 $223.25 $377.43 $377.43 $377.43 $377.43 $283.13 $377.43 $377.43 $377.43 $188.72 $188.72 $298.92 $377.43 $301.94 $169.84 $74.91 N/A $218.95 $377.43 $377.43 $377.43 $78.66 $377.43 N/A N/A 225.008 SUP HCPCS C1713 225.008 - PLATE BONE BROAD 103MM 8 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP $394.00 $292.00 $78.15 $393.73 $177.18 $177.18 $177.18 $177.18 $393.73 $393.73 $393.73 $82.06 $393.73 $393.73 $393.73 $393.73 $393.73 $82.06 $393.73 $393.73 $232.89 $393.73 $393.73 $393.73 $393.73 $295.50 $393.73 $393.73 $393.73 $196.87 $196.87 $311.83 $393.73 $314.98 $177.18 $78.15 N/A $228.52 $393.73 $393.73 $393.73 $82.05 $393.73 N/A N/A 225.009 SUP HCPCS C1713 225.009 - PLATE BONE BROAD 9 HOLE LCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $412.50 $305.00 $81.85 $412.38 $185.57 $185.57 $185.57 $185.57 $412.38 $412.38 $412.38 $85.95 $412.38 $412.38 $412.38 $412.38 $412.38 $85.94 $412.38 $164.95 $243.92 $412.38 $412.38 $412.38 $412.38 $309.38 $412.38 $412.38 $412.38 $206.19 $206.19 $326.60 $412.38 $329.90 $185.57 $81.85 N/A $239.25 $412.38 $412.38 $412.38 $85.94 $412.38 N/A N/A 225.01 SUP HCPCS C1713 225.010 - MALLET SURG 7IN 1.5LB BOTH IP/OP $417.50 $309.00 $82.77 $417.05 $187.67 $187.67 $187.67 $187.67 $417.05 $417.05 $417.05 $86.92 $417.05 $417.05 $417.05 $417.05 $417.05 $86.92 $417.05 $417.05 $246.69 $417.05 $417.05 $417.05 $417.05 $313.13 $417.05 $417.05 $417.05 $208.53 $208.53 $330.30 $417.05 $333.64 $187.67 $82.77 N/A $242.15 $417.05 $250.23 $417.05 $417.05 $417.05 N/A N/A 225.011 SUP HCPCS C1713 225.011 - PLATE BONE BROAD 142MM 11 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP $436.00 $323.00 $86.48 $435.70 $196.07 $196.07 $196.07 $196.07 $435.70 $435.70 $435.70 $90.81 $435.70 $435.70 $435.70 $435.70 $435.70 $90.80 $435.70 $174.28 $257.72 $435.70 $435.70 $435.70 $435.70 $327.00 $435.70 $435.70 $435.70 $217.85 $217.85 $345.07 $435.70 $348.56 $196.07 $86.48 N/A $252.88 $435.70 $261.42 $435.70 $435.70 $435.70 N/A N/A 225.012 SUP HCPCS C1713 225.012 - PLATE BONE BROAD 155MM 12 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP $466.00 $345.00 $92.48 $465.95 $209.68 $209.68 $209.68 $209.68 $465.95 $465.95 $465.95 $97.12 $465.95 $465.95 $465.95 $465.95 $465.95 $97.11 $465.95 $186.38 $275.61 $465.95 $465.95 $465.95 $465.95 $349.50 $465.95 $465.95 $465.95 $232.98 $232.98 $369.03 $465.95 $372.76 $209.68 $92.48 N/A $270.28 $465.95 $279.57 $465.95 $97.10 $465.95 N/A N/A 225.013 SUP HCPCS C1713 225.013 - PLATE BONE BROAD 168MM 13 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP $628.50 $465.00 $124.65 $628.05 $282.62 $282.62 $282.62 $282.62 $628.05 $628.05 $628.05 $130.90 $628.05 $628.05 $628.05 $628.05 $628.05 $130.89 $628.05 $628.05 $371.49 $628.05 $628.05 $628.05 $628.05 $471.38 $628.05 $628.05 $628.05 $314.03 $314.03 $497.42 $628.05 $502.44 $282.62 $124.65 N/A $364.53 $628.05 $376.83 $628.05 $130.89 $628.05 N/A N/A 225.014 SUP HCPCS C1713 225.014 - PLATE BONE BROAD 181X13.5X4.2MM 14 HOLE LC-DCP STAINLESS BOTH IP/OP $709.50 $525.00 $140.77 $709.28 $319.18 $319.18 $319.18 $319.18 $709.28 $709.28 $709.28 $147.83 $709.28 $709.28 $709.28 $709.28 $709.28 $147.82 $709.28 $283.71 $419.54 $709.28 $709.28 $709.28 $709.28 $532.13 $709.28 $709.28 $709.28 $354.64 $354.64 $561.75 $709.28 $567.42 $319.18 $140.77 N/A $411.51 $709.28 $425.57 $709.28 $147.81 $709.28 N/A N/A 225.015 SUP HCPCS C1713 225.015 - PLATE BONE BROAD 194MM 15 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP $788.50 $583.00 $156.47 $788.35 $354.76 $354.76 $354.76 $354.76 $788.35 $788.35 $788.35 $164.31 $788.35 $788.35 $788.35 $788.35 $788.35 $164.30 $788.35 $788.35 $466.31 $788.35 $788.35 $788.35 $788.35 $591.38 $788.35 $788.35 $788.35 $394.18 $394.18 $624.37 $788.35 $630.68 $354.76 $156.47 N/A $457.33 $788.35 $473.01 $788.35 $164.29 $788.35 N/A N/A 225.016 SUP HCPCS C1713 225.016 - PLATE BONE BROAD 207MM 16 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP $870.00 $644.00 $172.59 $869.60 $391.32 $391.32 $391.32 $391.32 $869.60 $869.60 $869.60 $181.25 $869.60 $869.60 $869.60 $869.60 $869.60 $181.23 $869.60 $347.84 $514.37 $869.60 $869.60 $869.60 $869.60 $652.50 $869.60 $869.60 $869.60 $434.80 $434.80 $688.72 $869.60 $695.68 $391.32 $172.59 N/A $504.60 $869.60 $521.76 $869.60 $181.22 $869.60 N/A N/A 225.017 SUP HCPCS C1713 225.017 - PLATE BONE BROAD 220MM 17 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP $949.00 $702.00 $188.28 $948.65 $426.89 $426.89 $426.89 $426.89 $948.65 $948.65 $948.65 $197.72 $948.65 $948.65 $948.65 $948.65 $948.65 $197.71 $948.65 $948.65 $561.13 $948.65 $948.65 $948.65 $948.65 $711.75 $948.65 $948.65 $948.65 $474.33 $474.33 $751.33 $948.65 $758.92 $426.89 $188.28 N/A $550.42 $948.65 $569.19 $948.65 $197.70 $948.65 N/A N/A 225.018 SUP HCPCS C1713 225.018 - PLATE BONE BROAD 233MM 18 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP "$1,030.00" $762.00 $204.41 "$1,029.90" $463.46 $463.46 $463.46 $463.46 "$1,029.90" "$1,029.90" "$1,029.90" $214.66 "$1,029.90" "$1,029.90" "$1,029.90" "$1,029.90" "$1,029.90" $214.64 "$1,029.90" "$1,029.90" $609.19 "$1,029.90" "$1,029.90" "$1,029.90" "$1,029.90" $772.50 "$1,029.90" "$1,029.90" "$1,029.90" $514.95 $514.95 $815.68 "$1,029.90" $823.92 $463.46 $204.41 N/A $597.40 "$1,029.90" "$1,029.90" "$1,029.90" $214.63 "$1,029.90" N/A N/A 225.02 SUP HCPCS C1713 225.020 - PLATE BONE BROAD 259X13.5X4.2MM 20 HOLE LC-DCP STAINLESS BOTH IP/OP "$1,170.00" $866.00 $232.12 "$1,169.53" $526.29 $526.29 $526.29 $526.29 "$1,169.53" "$1,169.53" "$1,169.53" $243.76 "$1,169.53" "$1,169.53" "$1,169.53" "$1,169.53" "$1,169.53" $243.74 "$1,169.53" "$1,169.53" $691.78 "$1,169.53" "$1,169.53" "$1,169.53" "$1,169.53" $877.50 "$1,169.53" "$1,169.53" "$1,169.53" $584.77 $584.77 $926.27 "$1,169.53" $935.62 $526.29 $232.12 N/A $678.60 "$1,169.53" "$1,169.53" "$1,169.53" $243.73 "$1,169.53" N/A N/A 225.022 SUP HCPCS C1713 225.022 - PLATE BONE BROAD 285MM 22 HOLE LC-DCP STAINLESS STEEL BOTH IP/OP "$1,279.00" $946.00 $253.85 "$1,279.00" $575.55 $575.55 $575.55 $575.55 "$1,279.00" "$1,279.00" "$1,279.00" $266.58 "$1,279.00" "$1,279.00" "$1,279.00" "$1,279.00" "$1,279.00" $266.56 "$1,279.00" "$1,279.00" $756.53 "$1,279.00" "$1,279.00" "$1,279.00" "$1,279.00" $959.25 "$1,279.00" "$1,279.00" "$1,279.00" $639.50 $639.50 "$1,012.97" "$1,279.00" "$1,023.20" $575.55 $253.85 N/A $741.82 "$1,279.00" "$1,279.00" "$1,279.00" $266.54 "$1,279.00" N/A N/A 226.06 SUP HCPCS C1713 226.06 - PLATE BN BRD 103X16X4.8MM NS DCP 6 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $416.50 $308.00 $82.58 $423.15 $187.24 $187.24 $187.24 $187.24 $416.08 $416.08 $416.08 $86.72 $416.08 $416.08 $416.08 $416.08 $416.08 $86.72 $416.08 $423.15 $246.11 $416.08 $423.15 $416.08 $416.08 $312.38 $416.08 $416.08 $416.08 $208.04 $208.04 $329.54 $416.08 $332.86 $187.24 $82.58 N/A $241.57 $416.08 $416.08 $416.08 $86.71 $416.08 N/A N/A 226.07 SUP HCPCS C1713 226.07 - PLATE BN BRD 119X16X4.8MM NS DCP 7 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $427.50 $316.00 $84.81 $434.60 $192.30 $192.30 $192.30 $192.30 $427.33 $427.33 $427.33 $89.07 $427.33 $427.33 $427.33 $427.33 $427.33 $89.06 $427.33 $434.60 $252.77 $427.33 $434.60 $427.33 $427.33 $320.63 $427.33 $427.33 $427.33 $213.67 $213.67 $338.45 $427.33 $341.86 $192.30 $84.81 N/A $247.95 $427.33 $256.40 $427.33 $89.06 $427.33 N/A N/A 226.08 SUP HCPCS C1713 226.08 - PLATE BONE BROAD 135X16X4.8MM 8 HOLE DCP STAINLESS STEEL BOTH IP/OP $504.00 $373.00 $99.95 $503.60 $226.62 $226.62 $226.62 $226.62 $503.60 $503.60 $503.60 $104.96 $503.60 $503.60 $503.60 $503.60 $503.60 $104.96 $503.60 $503.60 $297.88 $503.60 $503.60 $503.60 $503.60 $378.00 $503.60 $503.60 $503.60 $251.80 $251.80 $398.85 $503.60 $402.88 $226.62 $99.95 N/A $292.32 $503.60 $302.16 $503.60 $503.60 $503.60 N/A N/A 226.09 SUP HCPCS C1713 226.09 - PLATE BN BRD 151X16X4.8MM NS DCP 9 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $519.00 $384.00 $102.95 $527.53 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $527.53 $306.81 $518.70 $527.53 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $518.70 $518.70 N/A N/A 226.1 SUP HCPCS C1713 226.10 - PLATE BN BRD 167X16X4.8MM NS DCP 10 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $504.00 $373.00 $99.95 $503.60 $226.62 $226.62 $226.62 $226.62 $503.60 $503.60 $503.60 $104.96 $503.60 $503.60 $503.60 $503.60 $503.60 $104.96 $503.60 $503.60 $297.88 $503.60 $503.60 $503.60 $503.60 $378.00 $503.60 $503.60 $503.60 $251.80 $251.80 $398.85 $503.60 $402.88 $226.62 $99.95 N/A $292.32 $503.60 $503.60 $503.60 $104.95 $503.60 N/A N/A 226.12 SUP HCPCS C1713 226.12 - PLATE BN BRD 199X16X4.8MM NS DCP 12 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $556.13 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $328.10 $546.83 $113.96 $546.83 N/A N/A 226.14 SUP HCPCS C1713 226.14 - PLATE BONE BROAD 231X16X4.8MM 14 HOLE DCP STAINLESS STEEL BOTH IP/OP $531.00 $393.00 $105.37 $530.90 $238.91 $238.91 $238.91 $238.91 $530.90 $530.90 $530.90 $110.65 $530.90 $530.90 $530.90 $530.90 $530.90 $110.65 $530.90 $530.90 $314.03 $530.90 $530.90 $530.90 $530.90 $398.25 $530.90 $530.90 $530.90 $265.45 $265.45 $420.47 $530.90 $424.72 $238.91 $105.37 N/A $307.98 $530.90 $318.54 $530.90 $110.64 $530.90 N/A N/A 226.16 SUP HCPCS C1713 226.16 - PLATE BONE BROAD 4.5MM 263X16X4.8MM 16 HOLE DCP STAINLESS BOTH IP/OP $563.50 $417.00 $111.77 $563.13 $253.41 $253.41 $253.41 $253.41 $563.13 $563.13 $563.13 $117.37 $563.13 $563.13 $563.13 $563.13 $563.13 $117.36 $563.13 $225.25 $333.09 $563.13 $563.13 $563.13 $563.13 $422.63 $563.13 $563.13 $563.13 $281.57 $281.57 $446.00 $563.13 $450.50 $253.41 $111.77 N/A $326.83 $563.13 $337.88 $563.13 $117.36 $563.13 N/A N/A 226.2 SUP HCPCS C1713 226.20 - PLATE BN BRD 326X16X4.8MM NS DCP 20 HL SS 4.5MM SCR LG FRAG BOTH IP/OP $918.50 $680.00 $182.30 $918.48 $413.32 $413.32 $413.32 $413.32 $918.48 $918.48 $918.48 $191.43 $918.48 $918.48 $918.48 $918.48 $918.48 $191.42 $918.48 $918.48 $543.28 $918.48 $918.48 $918.48 $918.48 $688.88 $918.48 $918.48 $918.48 $459.24 $459.24 $727.44 $918.48 $734.78 $413.32 $182.30 N/A $532.73 $918.48 $551.09 $918.48 $191.41 $918.48 N/A N/A 226.22 SUP HCPCS C1713 226.22 - PLATE BONE BROAD 358MM 22 HOLE DCP STAINLESS STEEL BOTH IP/OP $969.00 $717.00 $192.24 $968.58 $435.86 $435.86 $435.86 $435.86 $968.58 $968.58 $968.58 $201.88 $968.58 $968.58 $968.58 $968.58 $968.58 $201.86 $968.58 $387.43 $572.92 $968.58 $968.58 $968.58 $968.58 $726.75 $968.58 $968.58 $968.58 $484.29 $484.29 $767.12 $968.58 $774.86 $435.86 $192.24 N/A $562.02 $968.58 $968.58 $968.58 $201.85 $968.58 N/A N/A 226.24 SUP HCPCS C1713 226.24 - PLATE BONE BROAD 390MM 24 HOLE DCP STAINLESS STEEL BOTH IP/OP "$1,037.50" $768.00 $205.91 "$1,037.48" $466.87 $466.87 $466.87 $466.87 "$1,037.48" "$1,037.48" "$1,037.48" $216.24 "$1,037.48" "$1,037.48" "$1,037.48" "$1,037.48" "$1,037.48" $216.22 "$1,037.48" "$1,037.48" $613.67 "$1,037.48" "$1,037.48" "$1,037.48" "$1,037.48" $778.13 "$1,037.48" "$1,037.48" "$1,037.48" $518.74 $518.74 $821.68 "$1,037.48" $829.98 $466.87 $205.91 N/A $601.75 "$1,037.48" $622.49 "$1,037.48" $216.21 "$1,037.48" N/A N/A 226.56 SUP HCPCS C1713 226.56 - PLATE BN BRD 106X17.5X5.2MM NS LC DCP 6 HL SS 4.5MM SCR LG BOTH IP/OP $489.50 $362.00 $97.09 $497.50 $220.13 $220.13 $220.13 $220.13 $489.18 $489.18 $489.18 $101.96 $489.18 $489.18 $489.18 $489.18 $489.18 $101.95 $489.18 $199.00 $289.35 $489.18 $497.50 $489.18 $489.18 $367.13 $489.18 $489.18 $489.18 $244.59 $244.59 $387.43 $489.18 $391.34 $220.13 $97.09 N/A $283.91 $489.18 $293.51 $489.18 $489.18 $489.18 N/A N/A 226.561 SUP HCPCS C1713 226.561 - PLATE BN BRD 116X17.5X5.2MM NS LCP CMBN 6 HL LMT CNTCT TPR BOTH IP/OP $784.50 $581.00 $155.68 $797.70 $352.97 $352.97 $352.97 $352.97 $784.38 $784.38 $784.38 $163.48 $784.38 $784.38 $784.38 $784.38 $784.38 $163.47 $784.38 $319.08 $463.96 $784.38 $797.70 $784.38 $784.38 $588.38 $784.38 $784.38 $784.38 $392.19 $392.19 $621.23 $784.38 $627.50 $352.97 $155.68 N/A $455.01 $784.38 $470.63 $784.38 $163.46 $784.38 N/A N/A 226.57 SUP HCPCS C1713 226.57 - PLATE BN BRD 124X17.5X5.2MM NS LC DCP 7 HL SS 4.5MM SCR LG BOTH IP/OP $530.00 $392.00 $105.18 $538.95 $238.48 $238.48 $238.48 $238.48 $529.95 $529.95 $529.95 $110.45 $529.95 $529.95 $529.95 $529.95 $529.95 $110.45 $529.95 $538.95 $313.47 $529.95 $538.95 $529.95 $529.95 $397.50 $529.95 $529.95 $529.95 $264.98 $264.98 $419.72 $529.95 $423.96 $238.48 $105.18 N/A $307.40 $529.95 $317.97 $529.95 $110.44 $529.95 N/A N/A 226.571 SUP HCPCS C1713 226.571 - PLATE BN BRD 134MM NS LCP CMBN 7 HL SS 4.5MM SCR LG FRAG SET BOTH IP/OP $834.00 $617.00 $165.44 $847.75 $375.11 $375.11 $375.11 $375.11 $833.58 $833.58 $833.58 $173.74 $833.58 $833.58 $833.58 $833.58 $833.58 $173.73 $833.58 $339.10 $493.06 $833.58 $847.75 $833.58 $833.58 $625.50 $833.58 $833.58 $833.58 $416.79 $416.79 $660.20 $833.58 $666.86 $375.11 $165.44 N/A $483.72 $833.58 $500.15 $833.58 $173.72 $833.58 N/A N/A 226.58 SUP HCPCS C1713 226.58 - PLATE BN BRD 142X17.5X5.2MM NS LC DCP 8 HL SS 4.5MM SCR LG BOTH IP/OP $589.00 $436.00 $116.90 $599.00 $265.04 $265.04 $265.04 $265.04 $588.98 $588.98 $588.98 $122.76 $588.98 $588.98 $588.98 $588.98 $588.98 $122.75 $588.98 $599.00 $348.38 $588.98 $599.00 $588.98 $588.98 $441.75 $588.98 $588.98 $588.98 $294.49 $294.49 $466.47 $588.98 $471.18 $265.04 $116.90 N/A $341.62 $588.98 $588.98 $588.98 $588.98 $588.98 N/A N/A 226.581 SUP HCPCS C1713 226.581 - PLATE BN BRD 152MM NS LCP CMBN 8 HL SS 4.5MM SCR LG FRAG SET BOTH IP/OP "$1,019.50" $754.00 $202.27 "$1,036.45" $458.61 $458.61 $458.61 $458.61 "$1,019.13" "$1,019.13" "$1,019.13" $212.41 "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" $212.40 "$1,019.13" "$1,036.45" $602.82 "$1,019.13" "$1,036.45" "$1,019.13" "$1,019.13" $764.63 "$1,019.13" "$1,019.13" "$1,019.13" $509.57 $509.57 $807.15 "$1,019.13" $815.30 $458.61 $202.27 N/A $591.31 "$1,019.13" "$1,019.13" "$1,019.13" $212.39 "$1,019.13" N/A N/A 226.59 SUP HCPCS C1713 226.59 - PLATE BN BRD 160X17.5X5.2MM NS LC DCP 9 HL SS 4.5MM SCR LG BOTH IP/OP $589.00 $436.00 $116.90 $599.00 $265.04 $265.04 $265.04 $265.04 $588.98 $588.98 $588.98 $122.76 $588.98 $588.98 $588.98 $588.98 $588.98 $122.75 $588.98 $599.00 $348.38 $588.98 $599.00 $588.98 $588.98 $441.75 $588.98 $588.98 $588.98 $294.49 $294.49 $466.47 $588.98 $471.18 $265.04 $116.90 N/A $341.62 $588.98 $353.39 $588.98 $122.74 $588.98 N/A N/A 226.591 SUP HCPCS C1713 226.591 - PLATE BN BRD 170X17.5X5.2MM NS LCP CMBN 9 HL LMT CNTCT TPR BOTH IP/OP "$1,102.50" $816.00 $218.74 "$1,120.80" $495.94 $495.94 $495.94 $495.94 "$1,102.08" "$1,102.08" "$1,102.08" $229.70 "$1,102.08" "$1,102.08" "$1,102.08" "$1,102.08" "$1,102.08" $229.69 "$1,102.08" $448.32 $651.88 "$1,102.08" "$1,120.80" "$1,102.08" "$1,102.08" $826.88 "$1,102.08" "$1,102.08" "$1,102.08" $551.04 $551.04 $872.85 "$1,102.08" $881.66 $495.94 $218.74 N/A $639.45 "$1,102.08" $661.25 "$1,102.08" $229.67 "$1,102.08" N/A N/A 226.6 SUP HCPCS C1713 226.60 - PLATE BN BRD 178X17.5X5.2MM NS LC DCP 10 HL SS 4.5MM SCR LG BOTH IP/OP $572.00 $423.00 $113.49 $599.00 $257.32 $257.32 $257.32 $257.32 $571.83 $571.83 $571.83 $119.18 $571.83 $571.83 $571.83 $571.83 $571.83 $119.18 $571.83 $239.60 $338.24 $571.83 $599.00 $571.83 $571.83 $429.00 $571.83 $571.83 $571.83 $285.92 $285.92 $452.89 $571.83 $457.46 $257.32 $113.49 N/A $331.76 $571.83 $343.10 $571.83 $119.17 $571.83 N/A N/A 226.601 SUP HCPCS C1713 226.601 - PLATE BN BRD 188X17.5X5.2MM NS LCP CMBN 10 HL LMT CNTCT TPR BOTH IP/OP "$1,185.00" $877.00 $235.19 "$1,205.15" $533.25 $533.25 $533.25 $533.25 "$1,185.00" "$1,185.00" "$1,185.00" $246.98 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" "$1,205.15" $700.93 "$1,185.00" "$1,205.15" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 $235.19 N/A $687.30 "$1,185.00" "$1,185.00" "$1,185.00" $246.95 "$1,185.00" N/A N/A 226.61 SUP HCPCS C1713 226.61 - PLATE BN BRD 196X17.5X5.2MM NS LC DCP 11 HL SS 4.5MM SCR LG BOTH IP/OP $633.00 $468.00 $125.55 $643.30 $284.65 $284.65 $284.65 $284.65 $632.55 $632.55 $632.55 $131.84 $632.55 $632.55 $632.55 $632.55 $632.55 $131.83 $632.55 $257.32 $374.15 $632.55 $643.30 $632.55 $632.55 $474.75 $632.55 $632.55 $632.55 $316.28 $316.28 $500.98 $632.55 $506.04 $284.65 $125.55 N/A $367.14 $632.55 $379.53 $632.55 $131.82 $632.55 N/A N/A 226.611 SUP HCPCS C1713 226.611 - PLATE BN BRD 206X17.5X5.2MM NS LCP CMBN 11 HL LMT CNTCT TPR BOTH IP/OP "$1,262.50" $934.00 $250.53 "$1,283.75" $568.04 $568.04 $568.04 $568.04 "$1,262.30" "$1,262.30" "$1,262.30" $263.09 "$1,262.30" "$1,262.30" "$1,262.30" "$1,262.30" "$1,262.30" $263.08 "$1,262.30" $513.50 $746.65 "$1,262.30" "$1,283.75" "$1,262.30" "$1,262.30" $946.88 "$1,262.30" "$1,262.30" "$1,262.30" $631.15 $631.15 $999.74 "$1,262.30" "$1,009.84" $568.04 $250.53 N/A $732.25 "$1,262.30" $757.38 "$1,262.30" $263.06 "$1,262.30" N/A N/A 226.62 SUP HCPCS C1713 226.62 - PLATE BN BRD 214X17.5X5.2MM NS LC DCP 12 HL SS 4.5MM SCR LG BOTH IP/OP $633.00 $468.00 $125.55 $643.30 $284.65 $284.65 $284.65 $284.65 $632.55 $632.55 $632.55 $131.84 $632.55 $632.55 $632.55 $632.55 $632.55 $131.83 $632.55 $643.30 $374.15 $632.55 $643.30 $632.55 $632.55 $474.75 $632.55 $632.55 $632.55 $316.28 $316.28 $500.98 $632.55 $506.04 $284.65 $125.55 N/A $367.14 $632.55 $632.55 $632.55 $131.82 $632.55 N/A N/A 226.621 SUP HCPCS C1713 226.621 - PLATE BN BRD 224X17.5X5.2MM NS LCP CMBN 12 HL LMT CNTCT TPR BOTH IP/OP "$1,340.00" $992.00 $265.88 "$1,362.40" $602.83 $602.83 $602.83 $602.83 "$1,339.63" "$1,339.63" "$1,339.63" $279.21 "$1,339.63" "$1,339.63" "$1,339.63" "$1,339.63" "$1,339.63" $279.19 "$1,339.63" "$1,362.40" $792.39 "$1,339.63" "$1,362.40" "$1,339.63" "$1,339.63" "$1,005.00" "$1,339.63" "$1,339.63" "$1,339.63" $669.82 $669.82 "$1,060.99" "$1,339.63" "$1,071.70" $602.83 $265.88 N/A $777.20 "$1,339.63" $803.78 "$1,339.63" $279.18 "$1,339.63" N/A N/A 226.622 SUP HCPCS C1713 226.622 - PLATE BN BRD CRV 229X17.5X5.2MM NS LCP CMBN 12 HL LMT CNTCT BOTH IP/OP "$1,340.00" $992.00 $265.88 "$1,362.40" $602.83 $602.83 $602.83 $602.83 "$1,339.63" "$1,339.63" "$1,339.63" $279.21 "$1,339.63" "$1,339.63" "$1,339.63" "$1,339.63" "$1,339.63" $279.19 "$1,339.63" $544.96 $792.39 "$1,339.63" "$1,362.40" "$1,339.63" "$1,339.63" "$1,005.00" "$1,339.63" "$1,339.63" "$1,339.63" $669.82 $669.82 "$1,060.99" "$1,339.63" "$1,071.70" $602.83 $265.88 N/A $777.20 "$1,339.63" $803.78 "$1,339.63" $279.18 "$1,339.63" N/A N/A 226.632 SUP HCPCS C1713 226.632 - PLATE BONE BROAD CURVE 247MM 13 HOLE LCP STAINLESS STEEL BOTH IP/OP "$1,420.00" "$1,051.00" $281.78 "$1,443.88" $638.89 $638.89 $638.89 $638.89 "$1,419.75" "$1,419.75" "$1,419.75" $295.91 "$1,419.75" "$1,419.75" "$1,419.75" "$1,419.75" "$1,419.75" $295.89 "$1,419.75" "$1,443.88" $839.78 "$1,419.75" "$1,443.88" "$1,419.75" "$1,419.75" "$1,065.00" "$1,419.75" "$1,419.75" "$1,419.75" $709.88 $709.88 "$1,124.44" "$1,419.75" "$1,135.80" $638.89 $281.78 N/A $823.60 "$1,419.75" $851.85 "$1,419.75" $295.88 "$1,419.75" N/A N/A 226.64 SUP HCPCS C1713 226.64 - PLATE BN BRD 250X17.5X5.2MM NS LC DCP 14 HL SS 4.5MM SCR LG BOTH IP/OP $633.00 $468.00 $125.55 $643.30 $284.65 $284.65 $284.65 $284.65 $632.55 $632.55 $632.55 $131.84 $632.55 $632.55 $632.55 $632.55 $632.55 $131.83 $632.55 $257.32 $374.15 $632.55 $643.30 $632.55 $632.55 $474.75 $632.55 $632.55 $632.55 $316.28 $316.28 $500.98 $632.55 $506.04 $284.65 $125.55 N/A $367.14 $632.55 $379.53 $632.55 $131.82 $632.55 N/A N/A 226.641 SUP HCPCS C1713 226.641 - PLATE BN BRD 260X17.5X5.2MM NS LCP CMBN 14 HL LMT CNTCT TPR BOTH IP/OP "$1,491.50" "$1,104.00" $296.02 "$1,516.80" $671.15 $671.15 $671.15 $671.15 "$1,491.45" "$1,491.45" "$1,491.45" $310.86 "$1,491.45" "$1,491.45" "$1,491.45" "$1,491.45" "$1,491.45" $310.83 "$1,491.45" "$1,516.80" $882.19 "$1,491.45" "$1,516.80" "$1,491.45" "$1,491.45" "$1,118.63" "$1,491.45" "$1,491.45" "$1,491.45" $745.73 $745.73 "$1,181.23" "$1,491.45" "$1,193.16" $671.15 $296.02 N/A $865.07 "$1,491.45" "$1,491.45" "$1,491.45" $310.82 "$1,491.45" N/A N/A 226.642 SUP HCPCS C1713 226.642 - PLATE BN BRD CRV 265X17.5X5.2MM NS LCP CMBN 14 HL LMT CNTCT BOTH IP/OP "$1,491.50" "$1,104.00" $296.02 "$1,516.80" $671.15 $671.15 $671.15 $671.15 "$1,491.45" "$1,491.45" "$1,491.45" $310.86 "$1,491.45" "$1,491.45" "$1,491.45" "$1,491.45" "$1,491.45" $310.83 "$1,491.45" "$1,516.80" $882.19 "$1,491.45" "$1,516.80" "$1,491.45" "$1,491.45" "$1,118.63" "$1,491.45" "$1,491.45" "$1,491.45" $745.73 $745.73 "$1,181.23" "$1,491.45" "$1,193.16" $671.15 $296.02 N/A $865.07 "$1,491.45" $894.87 "$1,491.45" $310.82 "$1,491.45" N/A N/A 226.652 SUP HCPCS C1713 226.652 - PLATE BONE BROAD CURVE 282MM 15 HOLE LCP STAINLESS STEEL BOTH IP/OP "$1,656.00" "$1,225.00" $328.65 "$1,684.05" $745.16 $745.16 $745.16 $745.16 "$1,655.90" "$1,655.90" "$1,655.90" $345.13 "$1,655.90" "$1,655.90" "$1,655.90" "$1,655.90" "$1,655.90" $345.11 "$1,655.90" "$1,684.05" $979.46 "$1,655.90" "$1,684.05" "$1,655.90" "$1,655.90" "$1,242.00" "$1,655.90" "$1,655.90" "$1,655.90" $827.95 $827.95 "$1,311.47" "$1,655.90" "$1,324.72" $745.16 $328.65 N/A $960.48 "$1,655.90" $993.54 "$1,655.90" $345.09 "$1,655.90" N/A N/A 226.66 SUP HCPCS C1713 226.66 - PLATE BN BRD 286X17.5X5.2MM NS LC DCP 16 HL SS 4.5MM SCR LG BOTH IP/OP $718.50 $532.00 $142.56 $730.50 $323.24 $323.24 $323.24 $323.24 $718.30 $718.30 $718.30 $149.71 $718.30 $718.30 $718.30 $718.30 $718.30 $149.70 $718.30 $730.50 $424.87 $718.30 $730.50 $718.30 $718.30 $538.88 $718.30 $718.30 $718.30 $359.15 $359.15 $568.89 $718.30 $574.64 $323.24 $142.56 N/A $416.73 $718.30 $430.98 $718.30 $149.69 $718.30 N/A N/A 226.661 SUP HCPCS C1713 226.661 - PLATE BN BRD 296X17.5X5.2MM NS LCP CMBN 16 HL LMT CNTCT TPR BOTH IP/OP "$1,812.00" "$1,341.00" $359.63 "$1,842.75" $815.38 $815.38 $815.38 $815.38 "$1,811.95" "$1,811.95" "$1,811.95" $377.66 "$1,811.95" "$1,811.95" "$1,811.95" "$1,811.95" "$1,811.95" $377.63 "$1,811.95" "$1,842.75" "$1,071.77" "$1,811.95" "$1,842.75" "$1,811.95" "$1,811.95" "$1,359.00" "$1,811.95" "$1,811.95" "$1,811.95" $905.98 $905.98 "$1,435.06" "$1,811.95" "$1,449.56" $815.38 $359.63 N/A "$1,050.96" "$1,811.95" "$1,811.95" "$1,811.95" $377.61 "$1,811.95" N/A N/A 226.662 SUP HCPCS C1713 226.662 - PLATE BN BRD CRV 300X17.5X5.2MM NS LCP CMBN 16 HL LMT CNTCT BOTH IP/OP "$1,812.00" "$1,341.00" $359.63 "$1,842.75" $815.38 $815.38 $815.38 $815.38 "$1,811.95" "$1,811.95" "$1,811.95" $377.66 "$1,811.95" "$1,811.95" "$1,811.95" "$1,811.95" "$1,811.95" $377.63 "$1,811.95" "$1,842.75" "$1,071.77" "$1,811.95" "$1,842.75" "$1,811.95" "$1,811.95" "$1,359.00" "$1,811.95" "$1,811.95" "$1,811.95" $905.98 $905.98 "$1,435.06" "$1,811.95" "$1,449.56" $815.38 $359.63 N/A "$1,050.96" "$1,811.95" "$1,811.95" "$1,811.95" $377.61 "$1,811.95" N/A N/A 226.672 SUP HCPCS C1713 226.672 - PLATE BONE BROAD CURVE 318MM 17 HOLE LCP STAINLESS STEEL BOTH IP/OP "$1,898.00" "$1,405.00" $376.64 "$1,929.93" $853.96 $853.96 $853.96 $853.96 "$1,897.68" "$1,897.68" "$1,897.68" $395.52 "$1,897.68" "$1,897.68" "$1,897.68" "$1,897.68" "$1,897.68" $395.50 "$1,897.68" "$1,929.93" "$1,122.48" "$1,897.68" "$1,929.93" "$1,897.68" "$1,897.68" "$1,423.50" "$1,897.68" "$1,897.68" "$1,897.68" $948.84 $948.84 "$1,502.96" "$1,897.68" "$1,518.14" $853.96 $376.64 N/A "$1,100.84" "$1,897.68" "$1,897.68" "$1,897.68" $395.48 "$1,897.68" N/A N/A 226.68 SUP HCPCS C1713 226.68 - PLATE BN BRD 332X17.5X5.2MM NS LC DCP 18 HL SS 4.5MM SCR LG BOTH IP/OP $789.00 $584.00 $156.56 $788.83 $354.97 $354.97 $354.97 $354.97 $788.83 $788.83 $788.83 $164.41 $788.83 $788.83 $788.83 $788.83 $788.83 $164.40 $788.83 $788.83 $466.59 $788.83 $788.83 $788.83 $788.83 $591.75 $788.83 $788.83 $788.83 $394.42 $394.42 $624.75 $788.83 $631.06 $354.97 $156.56 N/A $457.62 $788.83 $788.83 $788.83 $164.39 $788.83 N/A N/A 226.681 SUP HCPCS C1713 226.681 - PLATE BONE BROAD 332X17.5X5.2MM 18 HOLE LCP STAINLESS STEEL BOTH IP/OP "$2,204.50" "$1,631.00" $437.46 "$2,241.60" $991.86 $991.86 $991.86 $991.86 "$2,204.13" "$2,204.13" "$2,204.13" $459.40 "$2,204.13" "$2,204.13" "$2,204.13" "$2,204.13" "$2,204.13" $459.36 "$2,204.13" "$2,241.60" "$1,303.74" "$2,204.13" "$2,241.60" "$2,204.13" "$2,204.13" "$1,653.38" "$2,204.13" "$2,204.13" "$2,204.13" "$1,102.07" "$1,102.07" "$1,745.67" "$2,204.13" "$1,763.30" $991.86 $437.46 N/A "$1,278.61" "$2,204.13" "$1,322.48" "$2,204.13" $459.34 "$2,204.13" N/A N/A 226.682 SUP HCPCS C1713 226.682 - PLATE BN BRD CRV 336X17.5X5.2MM NS LCP CMBN 18 HL LMT CNTCT BOTH IP/OP "$2,068.00" "$1,530.00" $410.40 "$2,102.93" $930.50 $930.50 $930.50 $930.50 "$2,067.78" "$2,067.78" "$2,067.78" $430.98 "$2,067.78" "$2,067.78" "$2,067.78" "$2,067.78" "$2,067.78" $430.95 "$2,067.78" "$2,102.93" "$1,223.09" "$2,067.78" "$2,102.93" "$2,067.78" "$2,067.78" "$1,551.00" "$2,067.78" "$2,067.78" "$2,067.78" "$1,033.89" "$1,033.89" "$1,637.68" "$2,067.78" "$1,654.22" $930.50 $410.40 N/A "$1,199.44" "$2,067.78" "$2,067.78" "$2,067.78" $430.93 "$2,067.78" N/A N/A 226.7 SUP HCPCS C1713 226.70 - PLATE BONE BROAD 358X17.5X5.2MM 20 HOLE LC-DCP STAINLESS BOTH IP/OP "$1,156.00" $855.00 $229.43 "$1,155.95" $520.18 $520.18 $520.18 $520.18 "$1,155.95" "$1,155.95" "$1,155.95" $240.93 "$1,155.95" "$1,155.95" "$1,155.95" "$1,155.95" "$1,155.95" $240.91 "$1,155.95" "$1,155.95" $683.74 "$1,155.95" "$1,155.95" "$1,155.95" "$1,155.95" $867.00 "$1,155.95" "$1,155.95" "$1,155.95" $577.98 $577.98 $915.51 "$1,155.95" $924.76 $520.18 $229.43 N/A $670.48 "$1,155.95" $693.57 "$1,155.95" $240.90 "$1,155.95" N/A N/A 226.701 SUP HCPCS C1713 226.701 - PLATE BONE BROAD 368MM 20 HOLE LCP STAINLESS STEEL BOTH IP/OP "$2,436.50" "$1,803.00" $483.50 "$2,477.50" "$1,096.24" "$1,096.24" "$1,096.24" "$1,096.24" "$2,436.08" "$2,436.08" "$2,436.08" $507.74 "$2,436.08" "$2,436.08" "$2,436.08" "$2,436.08" "$2,436.08" $507.71 "$2,436.08" $991.00 "$1,440.94" "$2,436.08" "$2,477.50" "$2,436.08" "$2,436.08" "$1,827.38" "$2,436.08" "$2,436.08" "$2,436.08" "$1,218.04" "$1,218.04" "$1,929.38" "$2,436.08" "$1,948.86" "$1,096.24" $483.50 N/A "$1,413.17" "$2,436.08" "$1,461.65" "$2,436.08" $507.68 "$2,436.08" N/A N/A 226.72 SUP HCPCS C1713 226.72 - PLATE BONE BROAD 394X17.5X5.2MM 22 HOLE LC-DCP STAINLESS BOTH IP/OP "$1,210.00" $895.00 $240.10 "$1,209.73" $544.38 $544.38 $544.38 $544.38 "$1,209.73" "$1,209.73" "$1,209.73" $252.14 "$1,209.73" "$1,209.73" "$1,209.73" "$1,209.73" "$1,209.73" $252.12 "$1,209.73" $483.89 $715.56 "$1,209.73" "$1,209.73" "$1,209.73" "$1,209.73" $907.50 "$1,209.73" "$1,209.73" "$1,209.73" $604.87 $604.87 $958.11 "$1,209.73" $967.78 $544.38 $240.10 N/A $701.80 "$1,209.73" $725.84 "$1,209.73" $252.11 "$1,209.73" N/A N/A 226.721 SUP HCPCS C1713 226.721 - PLATE BONE BROAD 404MM 22 HOLE LCP STAINLESS STEEL BOTH IP/OP "$2,669.50" "$1,975.00" $529.81 "$2,714.78" "$1,201.23" "$1,201.23" "$1,201.23" "$1,201.23" "$2,669.40" "$2,669.40" "$2,669.40" $556.37 "$2,669.40" "$2,669.40" "$2,669.40" "$2,669.40" "$2,669.40" $556.33 "$2,669.40" "$1,085.91" "$1,316.01" "$2,669.40" "$2,714.78" "$2,669.40" "$2,669.40" "$2,002.13" "$2,669.40" "$2,669.40" "$2,669.40" "$1,334.70" "$1,334.70" "$2,114.16" "$2,669.40" "$2,135.52" "$1,201.23" $529.81 N/A "$1,548.31" "$2,669.40" "$1,601.64" "$2,669.40" $556.30 "$2,669.40" N/A N/A 227.11 SUP HCPCS C1713 227.11 - PLATE BONE BROAD 179MM 10 HOLE STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $696.00 $515.00 $138.07 $695.63 $313.03 $313.03 $313.03 $313.03 $695.63 $695.63 $695.63 $144.99 $695.63 $695.63 $695.63 $695.63 $695.63 $144.98 $695.63 $695.63 $411.47 $695.63 $695.63 $695.63 $695.63 $522.00 $695.63 $695.63 $695.63 $347.82 $347.82 $550.94 $695.63 $556.50 $313.03 $138.07 N/A $403.68 $695.63 $695.63 $695.63 $144.97 $695.63 N/A N/A 227.13 SUP HCPCS C1713 227.13 - PLATE BONE BROAD 199MM 10 HOLE STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $778.00 $576.00 $154.37 $777.78 $350.00 $350.00 $350.00 $350.00 $777.78 $777.78 $777.78 $162.11 $777.78 $777.78 $777.78 $777.78 $777.78 $162.10 $777.78 $777.78 $460.06 $777.78 $777.78 $777.78 $777.78 $583.50 $777.78 $777.78 $777.78 $388.89 $388.89 $616.00 $777.78 $622.22 $350.00 $154.37 N/A $451.24 $777.78 $777.78 $777.78 $162.09 $777.78 N/A N/A 227.14 SUP HCPCS C1713 227.14 - PLATE BONE BROAD 209MM 10 HOLE STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $778.00 $576.00 $154.37 $777.78 $350.00 $350.00 $350.00 $350.00 $777.78 $777.78 $777.78 $162.11 $777.78 $777.78 $777.78 $777.78 $777.78 $162.10 $777.78 $777.78 $460.06 $777.78 $777.78 $777.78 $777.78 $583.50 $777.78 $777.78 $777.78 $388.89 $388.89 $616.00 $777.78 $622.22 $350.00 $154.37 N/A $451.24 $777.78 $466.67 $777.78 $162.09 $777.78 N/A N/A 227.18 SUP HCPCS C1713 227.18 - PLATE BONE BROAD 249MM 10 HOLE STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $810.00 $599.00 $160.68 $809.58 $364.31 $364.31 $364.31 $364.31 $809.58 $809.58 $809.58 $168.74 $809.58 $809.58 $809.58 $809.58 $809.58 $168.73 $809.58 $323.83 $478.87 $809.58 $809.58 $809.58 $809.58 $607.50 $809.58 $809.58 $809.58 $404.79 $404.79 $641.19 $809.58 $647.66 $364.31 $160.68 N/A $469.80 $809.58 $485.75 $809.58 $168.72 $809.58 N/A N/A 227.81 SUP HCPCS C1713 227.81 - PLATE BONE BROAD 135MM 8 HOLE STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $674.50 $499.00 $133.86 $674.43 $303.49 $303.49 $303.49 $303.49 $674.43 $674.43 $674.43 $140.57 $674.43 $674.43 $674.43 $674.43 $674.43 $140.56 $674.43 $269.77 $398.93 $674.43 $674.43 $674.43 $674.43 $505.88 $674.43 $674.43 $674.43 $337.22 $337.22 $534.15 $674.43 $539.54 $303.49 $133.86 N/A $391.21 $674.43 $674.43 $674.43 $140.55 $674.43 N/A N/A 227.83 SUP HCPCS C1713 227.83 - PLATE BONE BROAD 155MM 8 HOLE STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $674.50 $499.00 $133.86 $674.43 $303.49 $303.49 $303.49 $303.49 $674.43 $674.43 $674.43 $140.57 $674.43 $674.43 $674.43 $674.43 $674.43 $140.56 $674.43 $269.77 $398.93 $674.43 $674.43 $674.43 $674.43 $505.88 $674.43 $674.43 $674.43 $337.22 $337.22 $534.15 $674.43 $539.54 $303.49 $133.86 N/A $391.21 $674.43 $674.43 $674.43 $674.43 $674.43 N/A N/A 227.84 SUP HCPCS C1713 227.84 - PLATE BONE BROAD 185MM 8 HOLE STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $674.50 $499.00 $133.86 $674.43 $303.49 $303.49 $303.49 $303.49 $674.43 $674.43 $674.43 $140.57 $674.43 $674.43 $674.43 $674.43 $674.43 $140.56 $674.43 $269.77 $398.93 $674.43 $674.43 $674.43 $674.43 $505.88 $674.43 $674.43 $674.43 $337.22 $337.22 $534.15 $674.43 $539.54 $303.49 $133.86 N/A $391.21 $674.43 $404.66 $674.43 $674.43 $674.43 N/A N/A 228.85 SUP HCPCS C1713 228.85 - PLATE BONE NARROW 175MM 8 HOLE STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $502.50 $372.00 $99.67 $502.18 $225.98 $225.98 $225.98 $225.98 $502.18 $502.18 $502.18 $104.67 $502.18 $502.18 $502.18 $502.18 $502.18 $104.66 $502.18 $200.87 $297.04 $502.18 $502.18 $502.18 $502.18 $376.88 $502.18 $502.18 $502.18 $251.09 $251.09 $397.73 $502.18 $401.74 $225.98 $99.67 N/A $291.45 $502.18 $301.31 $502.18 $104.65 $502.18 N/A N/A 229.33 SUP HCPCS C1713 229.33 - PLATE BN STRG 45X12X3MM NS LC DCP 3 HL RECON SS 4.5MM CORT BOTH IP/OP $672.00 $497.00 $133.36 $683.35 $302.37 $302.37 $302.37 $302.37 $671.93 $671.93 $671.93 $140.05 $671.93 $671.93 $671.93 $671.93 $671.93 $140.04 $671.93 $683.35 $397.45 $671.93 $683.35 $671.93 $671.93 $504.00 $671.93 $671.93 $671.93 $335.97 $335.97 $532.17 $671.93 $537.54 $302.37 $133.36 N/A $389.76 $671.93 $403.16 $671.93 $140.03 $671.93 N/A N/A 229.331 SUP HCPCS C1713 229.331 - PLATE BONE 56MM 3 HOLE STR RECONSTRUCTION LCP STAINLESS BOTH IP/OP $803.00 $594.00 $159.31 $816.30 $361.19 $361.19 $361.19 $361.19 $802.65 $802.65 $802.65 $167.29 $802.65 $802.65 $802.65 $802.65 $802.65 $167.28 $802.65 $326.52 $474.77 $802.65 $816.30 $802.65 $802.65 $602.25 $802.65 $802.65 $802.65 $401.33 $401.33 $635.70 $802.65 $642.12 $361.19 $159.31 N/A $465.74 $802.65 $802.65 $802.65 $167.27 $802.65 N/A N/A 229.34 SUP HCPCS C1713 229.34 - PLATE BN STRG 61X12X3MM NS LC DCP 4 HL RECON SS 4.5MM CORT BOTH IP/OP $700.50 $518.00 $138.94 $711.93 $315.01 $315.01 $315.01 $315.01 $700.03 $700.03 $700.03 $145.90 $700.03 $700.03 $700.03 $700.03 $700.03 $145.89 $700.03 $711.93 $414.07 $700.03 $711.93 $700.03 $700.03 $525.38 $700.03 $700.03 $700.03 $350.02 $350.02 $554.42 $700.03 $560.02 $315.01 $138.94 N/A $406.29 $700.03 $700.03 $700.03 $145.89 $700.03 N/A N/A 229.341 SUP HCPCS C1713 229.341 - PLATE BONE 75MM 4 HOLE STR RECONSTRUCTION LCP STAINLESS BOTH IP/OP $841.00 $622.00 $166.84 $854.90 $378.27 $378.27 $378.27 $378.27 $840.60 $840.60 $840.60 $175.20 $840.60 $840.60 $840.60 $840.60 $840.60 $175.19 $840.60 $341.96 $497.21 $840.60 $854.90 $840.60 $840.60 $630.75 $840.60 $840.60 $840.60 $420.30 $420.30 $665.76 $840.60 $672.48 $378.27 $166.84 N/A $487.78 $840.60 $840.60 $840.60 $175.18 $840.60 N/A N/A 229.35 SUP HCPCS C1713 229.35 - PLATE BONE STR 77X12X3MM 5 HOLE RECONSTRUCTION LC-DCP BOTH IP/OP $762.00 $564.00 $151.21 $774.83 $342.85 $342.85 $342.85 $342.85 $761.88 $761.88 $761.88 $158.79 $761.88 $761.88 $761.88 $761.88 $761.88 $158.78 $761.88 $309.93 $450.65 $761.88 $774.83 $761.88 $761.88 $571.50 $761.88 $761.88 $761.88 $380.94 $380.94 $603.41 $761.88 $609.50 $342.85 $151.21 N/A $441.96 $761.88 $761.88 $761.88 $158.78 $761.88 N/A N/A 229.351 SUP HCPCS C1713 229.351 - PLATE BONE 94MM 5 HOLE STR RECONSTRUCTION LCP STAINLESS BOTH IP/OP $908.50 $672.00 $180.23 $923.50 $408.64 $408.64 $408.64 $408.64 $908.08 $908.08 $908.08 $189.27 $908.08 $908.08 $908.08 $908.08 $908.08 $189.25 $908.08 $369.40 $537.13 $908.08 $923.50 $908.08 $908.08 $681.38 $908.08 $908.08 $908.08 $454.04 $454.04 $719.20 $908.08 $726.46 $408.64 $180.23 N/A $526.93 $908.08 $544.85 $908.08 $189.24 $908.08 N/A N/A 229.36 SUP HCPCS C1713 229.36 - PLATE BN 93X12X3MM NS LC DCP 6 HL RECON SS 4.5MM SCR BOTH IP/OP $808.50 $598.00 $160.42 $822.03 $363.73 $363.73 $363.73 $363.73 $808.28 $808.28 $808.28 $168.47 $808.28 $808.28 $808.28 $808.28 $808.28 $168.45 $808.28 $328.81 $478.10 $808.28 $822.03 $808.28 $808.28 $606.38 $808.28 $808.28 $808.28 $404.14 $404.14 $640.16 $808.28 $646.62 $363.73 $160.42 N/A $468.93 $808.28 $808.28 $808.28 $168.45 $808.28 N/A N/A 229.361 SUP HCPCS C1713 229.361 - PLATE BONE 113MM 6 HOLE STR RECONSTRUCTION LCP STAINLESS BOTH IP/OP $970.00 $718.00 $192.51 $986.43 $436.47 $436.47 $436.47 $436.47 $969.93 $969.93 $969.93 $202.16 $969.93 $969.93 $969.93 $969.93 $969.93 $202.14 $969.93 $394.57 $573.71 $969.93 $986.43 $969.93 $969.93 $727.50 $969.93 $969.93 $969.93 $484.97 $484.97 $768.18 $969.93 $775.94 $436.47 $192.51 N/A $562.60 $969.93 $581.96 $969.93 $969.93 $969.93 N/A N/A 229.37 SUP HCPCS C1713 229.37 - PLATE BONE STR 109X12X3MM 7 HOLE RECONSTRUCTION LC-DCP BOTH IP/OP $845.00 $625.00 $167.68 $859.18 $380.17 $380.17 $380.17 $380.17 $844.83 $844.83 $844.83 $176.08 $844.83 $844.83 $844.83 $844.83 $844.83 $176.07 $844.83 $343.67 $499.72 $844.83 $859.18 $844.83 $844.83 $633.75 $844.83 $844.83 $844.83 $422.42 $422.42 $669.11 $844.83 $675.86 $380.17 $167.68 N/A $490.10 $844.83 $844.83 $844.83 $176.06 $844.83 N/A N/A 229.371 SUP HCPCS C1713 229.371 - PLATE BONE 132MM 7 HOLE STR RECONSTRUCTION LCP STAINLESS BOTH IP/OP "$1,015.00" $751.00 $201.43 "$1,032.15" $456.71 $456.71 $456.71 $456.71 "$1,014.90" "$1,014.90" "$1,014.90" $211.53 "$1,014.90" "$1,014.90" "$1,014.90" "$1,014.90" "$1,014.90" $211.52 "$1,014.90" "$1,032.15" $600.31 "$1,014.90" "$1,032.15" "$1,014.90" "$1,014.90" $761.25 "$1,014.90" "$1,014.90" "$1,014.90" $507.45 $507.45 $803.80 "$1,014.90" $811.92 $456.71 $201.43 N/A $588.70 "$1,014.90" "$1,014.90" "$1,014.90" $211.51 "$1,014.90" N/A N/A 229.38 SUP HCPCS C1713 229.38 - PLATE BN STRG 125X12X3MM NS LC DCP 8 HL RECON SS 4.5MM CORT BOTH IP/OP $890.00 $659.00 $176.60 $904.93 $400.41 $400.41 $400.41 $400.41 $889.80 $889.80 $889.80 $185.46 $889.80 $889.80 $889.80 $889.80 $889.80 $185.44 $889.80 $904.93 $526.32 $889.80 $904.93 $889.80 $889.80 $667.50 $889.80 $889.80 $889.80 $444.90 $444.90 $704.72 $889.80 $711.84 $400.41 $176.60 N/A $516.20 $889.80 $889.80 $889.80 $185.43 $889.80 N/A N/A 229.381 SUP HCPCS C1713 229.381 - PLATE BONE 151MM 8 HOLE STR RECONSTRUCTION LCP STAINLESS BOTH IP/OP "$1,067.00" $790.00 $211.76 "$1,085.08" $480.12 $480.12 $480.12 $480.12 "$1,066.93" "$1,066.93" "$1,066.93" $222.37 "$1,066.93" "$1,066.93" "$1,066.93" "$1,066.93" "$1,066.93" $222.36 "$1,066.93" "$1,085.08" $631.09 "$1,066.93" "$1,085.08" "$1,066.93" "$1,066.93" $800.25 "$1,066.93" "$1,066.93" "$1,066.93" $533.47 $533.47 $845.01 "$1,066.93" $853.54 $480.12 $211.76 N/A $618.86 "$1,066.93" "$1,066.93" "$1,066.93" $222.35 "$1,066.93" N/A N/A 229.39 SUP HCPCS C1713 229.39 - PLATE BONE STR 141X12X3MM 9 HOLE RECONSTRUCTION LC-DCP BOTH IP/OP $954.50 $706.00 $189.44 $970.70 $429.52 $429.52 $429.52 $429.52 $954.48 $954.48 $954.48 $198.94 $954.48 $954.48 $954.48 $954.48 $954.48 $198.92 $954.48 $388.28 $564.57 $954.48 $970.70 $954.48 $954.48 $715.88 $954.48 $954.48 $954.48 $477.24 $477.24 $755.95 $954.48 $763.58 $429.52 $189.44 N/A $553.61 $954.48 $954.48 $954.48 $198.91 $954.48 N/A N/A 229.391 SUP HCPCS C1713 229.391 - PLATE BONE 170MM 9 HOLE STR RECONSTRUCTION LCP STAINLESS BOTH IP/OP "$1,143.00" $846.00 $226.82 "$1,162.25" $514.27 $514.27 $514.27 $514.27 "$1,142.83" "$1,142.83" "$1,142.83" $238.19 "$1,142.83" "$1,142.83" "$1,142.83" "$1,142.83" "$1,142.83" $238.18 "$1,142.83" "$1,162.25" $675.98 "$1,142.83" "$1,162.25" "$1,142.83" "$1,142.83" $857.25 "$1,142.83" "$1,142.83" "$1,142.83" $571.42 $571.42 $905.12 "$1,142.83" $914.26 $514.27 $226.82 N/A $662.94 "$1,142.83" "$1,142.83" "$1,142.83" $238.17 "$1,142.83" N/A N/A 229.4 SUP HCPCS C1713 229.40 - PLATE BN 157MM NS LC DCP 10 HL RECON 4.5MM SCR BOTH IP/OP $970.50 $718.00 $192.59 "$1,016.45" $436.65 $436.65 $436.65 $436.65 $970.33 $970.33 $970.33 $202.24 $970.33 $970.33 $970.33 $970.33 $970.33 $202.23 $970.33 $406.58 $573.95 $970.33 "$1,016.45" $970.33 $970.33 $727.88 $970.33 $970.33 $970.33 $485.17 $485.17 $768.50 $970.33 $776.26 $436.65 $192.59 N/A $562.89 $970.33 $582.20 $970.33 $202.22 $970.33 N/A N/A 229.401 SUP HCPCS C1713 229.401 - PLATE BONE 189MM 10 HOLE STR RECONSTRUCTION LCP STAINLESS BOTH IP/OP "$1,198.00" $887.00 $237.70 "$1,218.00" $538.94 $538.94 $538.94 $538.94 "$1,197.65" "$1,197.65" "$1,197.65" $249.62 "$1,197.65" "$1,197.65" "$1,197.65" "$1,197.65" "$1,197.65" $249.60 "$1,197.65" "$1,218.00" $708.41 "$1,197.65" "$1,218.00" "$1,197.65" "$1,197.65" $898.50 "$1,197.65" "$1,197.65" "$1,197.65" $598.83 $598.83 $948.54 "$1,197.65" $958.12 $538.94 $237.70 N/A $694.84 "$1,197.65" "$1,197.65" "$1,197.65" $249.59 "$1,197.65" N/A N/A 229.41 SUP HCPCS C1713 229.41 - PLATE BONE 173MM 11 HOLE STR RECONSTRUCTION LC-DCP DCP BOTH IP/OP "$1,035.00" $766.00 $205.34 "$1,052.20" $465.57 $465.57 $465.57 $465.57 "$1,034.60" "$1,034.60" "$1,034.60" $215.64 "$1,034.60" "$1,034.60" "$1,034.60" "$1,034.60" "$1,034.60" $215.62 "$1,034.60" $420.88 $611.97 "$1,034.60" "$1,052.20" "$1,034.60" "$1,034.60" $776.25 "$1,034.60" "$1,034.60" "$1,034.60" $517.30 $517.30 $819.40 "$1,034.60" $827.68 $465.57 $205.34 N/A $600.30 "$1,034.60" $620.76 "$1,034.60" $215.61 "$1,034.60" N/A N/A 229.411 SUP HCPCS C1713 229.411 - PLATE BONE 208MM 11 HOLE STR RECONSTRUCTION LCP STAINLESS BOTH IP/OP "$1,237.00" $915.00 $245.51 "$1,258.03" $556.65 $556.65 $556.65 $556.65 "$1,237.00" "$1,237.00" "$1,237.00" $257.82 "$1,237.00" "$1,237.00" "$1,237.00" "$1,237.00" "$1,237.00" $257.80 "$1,237.00" "$1,258.03" $731.69 "$1,237.00" "$1,258.03" "$1,237.00" "$1,237.00" $927.75 "$1,237.00" "$1,237.00" "$1,237.00" $618.50 $618.50 $979.70 "$1,237.00" $989.60 $556.65 $245.51 N/A $717.46 "$1,237.00" $742.20 "$1,237.00" $257.79 "$1,237.00" N/A N/A 229.42 SUP HCPCS C1713 229.42 - PLATE BONE STR 189X12X3MM 12 HOLE RECONSTRUCTION LC-DCP BOTH IP/OP "$1,082.50" $801.00 $214.83 "$1,100.78" $487.07 $487.07 $487.07 $487.07 "$1,082.38" "$1,082.38" "$1,082.38" $225.60 "$1,082.38" "$1,082.38" "$1,082.38" "$1,082.38" "$1,082.38" $225.58 "$1,082.38" $440.31 $640.23 "$1,082.38" "$1,100.78" "$1,082.38" "$1,082.38" $811.88 "$1,082.38" "$1,082.38" "$1,082.38" $541.19 $541.19 $857.24 "$1,082.38" $865.90 $487.07 $214.83 N/A $627.85 "$1,082.38" $649.43 "$1,082.38" $225.57 "$1,082.38" N/A N/A 229.421 SUP HCPCS C1713 229.421 - PLATE BONE 227MM 12 HOLE STR RECONSTRUCTION LCP STAINLESS BOTH IP/OP "$1,296.50" $959.00 $257.23 "$1,318.08" $583.22 $583.22 $583.22 $583.22 "$1,296.05" "$1,296.05" "$1,296.05" $270.13 "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" $270.11 "$1,296.05" $527.23 $766.61 "$1,296.05" "$1,318.08" "$1,296.05" "$1,296.05" $972.38 "$1,296.05" "$1,296.05" "$1,296.05" $648.03 $648.03 "$1,026.47" "$1,296.05" "$1,036.84" $583.22 $257.23 N/A $751.97 "$1,296.05" "$1,296.05" "$1,296.05" $270.10 "$1,296.05" N/A N/A 229.43 SUP HCPCS C1713 229.43 - PLATE BONE STR 205X12X3MM 13 HOLE RECONSTRUCTION LC-DCP BOTH IP/OP "$1,153.00" $853.00 $228.78 "$1,172.28" $518.71 $518.71 $518.71 $518.71 "$1,152.68" "$1,152.68" "$1,152.68" $240.25 "$1,152.68" "$1,152.68" "$1,152.68" "$1,152.68" "$1,152.68" $240.23 "$1,152.68" $468.91 $681.81 "$1,152.68" "$1,172.28" "$1,152.68" "$1,152.68" $864.75 "$1,152.68" "$1,152.68" "$1,152.68" $576.34 $576.34 $912.92 "$1,152.68" $922.14 $518.71 $228.78 N/A $668.74 "$1,152.68" "$1,152.68" "$1,152.68" $240.22 "$1,152.68" N/A N/A 229.431 SUP HCPCS C1713 229.431 - PLATE BONE 246MM 13 HOLE STR RECONSTRUCTION LCP STAINLESS BOTH IP/OP "$1,379.00" "$1,020.00" $273.69 "$1,402.43" $620.54 $620.54 $620.54 $620.54 "$1,378.98" "$1,378.98" "$1,378.98" $287.41 "$1,378.98" "$1,378.98" "$1,378.98" "$1,378.98" "$1,378.98" $287.39 "$1,378.98" "$1,402.43" $815.67 "$1,378.98" "$1,402.43" "$1,378.98" "$1,378.98" "$1,034.25" "$1,378.98" "$1,378.98" "$1,378.98" $689.49 $689.49 "$1,092.15" "$1,378.98" "$1,103.18" $620.54 $273.69 N/A $799.82 "$1,378.98" "$1,378.98" "$1,378.98" $287.38 "$1,378.98" N/A N/A 229.44 SUP HCPCS C1713 229.44 - PLATE BONE 221MM 14 HOLE RECONSTRUCTION DCP LC-DCP STAINLESS BOTH IP/OP "$1,185.00" $877.00 $235.19 "$1,205.15" $533.25 $533.25 $533.25 $533.25 "$1,185.00" "$1,185.00" "$1,185.00" $246.98 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" "$1,205.15" $700.93 "$1,185.00" "$1,205.15" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 $235.19 N/A $687.30 "$1,185.00" $711.00 "$1,185.00" $246.95 "$1,185.00" N/A N/A 229.441 SUP HCPCS C1713 229.441 - PLATE BONE 265MM 14 HOLE STR RECONSTRUCTION LCP STAINLESS BOTH IP/OP "$1,417.00" "$1,049.00" $281.23 "$1,441.05" $637.63 $637.63 $637.63 $637.63 "$1,416.95" "$1,416.95" "$1,416.95" $295.33 "$1,416.95" "$1,416.95" "$1,416.95" "$1,416.95" "$1,416.95" $295.31 "$1,416.95" $576.42 $838.13 "$1,416.95" "$1,441.05" "$1,416.95" "$1,416.95" "$1,062.75" "$1,416.95" "$1,416.95" "$1,416.95" $708.48 $708.48 "$1,122.22" "$1,416.95" "$1,133.56" $637.63 $281.23 N/A $821.86 "$1,416.95" "$1,416.95" "$1,416.95" $295.29 "$1,416.95" N/A N/A 229.451 SUP HCPCS C1713 229.451 - PLATE BONE 284MM 15 HOLE STR RECONSTRUCTION LCP STAINLESS BOTH IP/OP "$1,476.00" "$1,092.00" $292.95 "$1,501.08" $664.19 $664.19 $664.19 $664.19 "$1,475.98" "$1,475.98" "$1,475.98" $307.63 "$1,475.98" "$1,475.98" "$1,475.98" "$1,475.98" "$1,475.98" $307.61 "$1,475.98" "$1,501.08" $873.04 "$1,475.98" "$1,501.08" "$1,475.98" "$1,475.98" "$1,107.00" "$1,475.98" "$1,475.98" "$1,475.98" $737.99 $737.99 "$1,168.98" "$1,475.98" "$1,180.78" $664.19 $292.95 N/A $856.08 "$1,475.98" "$1,475.98" "$1,475.98" $307.59 "$1,475.98" N/A N/A 229.461 SUP HCPCS C1713 229.461 - PLATE BONE 303MM 16 HOLE STR RECONSTRUCTION LCP STAINLESS BOTH IP/OP "$1,515.50" "$1,121.00" $300.76 "$1,541.08" $681.90 $681.90 $681.90 $681.90 "$1,515.33" "$1,515.33" "$1,515.33" $315.83 "$1,515.33" "$1,515.33" "$1,515.33" "$1,515.33" "$1,515.33" $315.81 "$1,515.33" $616.43 $896.32 "$1,515.33" "$1,541.08" "$1,515.33" "$1,515.33" "$1,136.63" "$1,515.33" "$1,515.33" "$1,515.33" $757.67 $757.67 "$1,200.14" "$1,515.33" "$1,212.26" $681.90 $300.76 N/A $878.99 "$1,515.33" "$1,515.33" "$1,515.33" $315.79 "$1,515.33" N/A N/A 231.001 SUP Custom 27203010 231.001 - STAPLE BONE SMALL 2 STAINLESS STEEL BOTH IP/OP "$2,522.50" "$1,867.00" $449.01 "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" $449.01 "$2,522.50" "$2,522.50" "$1,872.20" "$1,872.20" "$1,944.34" "$1,314.22" $525.72 "$2,522.50" "$1,009.00" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$1,891.88" "$2,522.50" "$2,522.50" "$2,522.50" "$1,261.25" "$1,261.25" "$1,997.82" "$2,522.50" "$2,018.00" "$1,639.63" "$2,522.50" N/A "$1,463.05" "$2,522.50" "$1,513.50" "$2,522.50" "$2,522.50" "$2,522.50" N/A N/A 231.002 SUP Custom 27203010 231.002 - STAPLE BONE SMALL 2 STAINLESS STEEL BOTH IP/OP "$2,522.50" "$1,867.00" $449.01 "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" $449.01 "$2,522.50" "$2,522.50" "$1,872.20" "$1,872.20" "$1,944.34" "$1,314.22" $525.72 "$2,522.50" "$1,009.00" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$1,891.88" "$2,522.50" "$2,522.50" "$2,522.50" "$1,261.25" "$1,261.25" "$1,997.82" "$2,522.50" "$2,018.00" "$1,639.63" "$2,522.50" N/A "$1,463.05" "$2,522.50" "$1,513.50" "$2,522.50" "$2,522.50" "$2,522.50" N/A N/A 231.003 SUP Custom 27203010 231.003 - STAPLE BONE MEDIUM 2 STAINLESS STEEL BOTH IP/OP "$2,522.50" "$1,867.00" $449.01 "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" $449.01 "$2,522.50" "$2,522.50" "$1,872.20" "$1,872.20" "$1,944.34" "$1,314.22" $525.72 "$2,522.50" "$1,009.00" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$1,891.88" "$2,522.50" "$2,522.50" "$2,522.50" "$1,261.25" "$1,261.25" "$1,997.82" "$2,522.50" "$2,018.00" "$1,639.63" "$2,522.50" N/A "$1,463.05" "$2,522.50" "$1,513.50" "$2,522.50" "$2,522.50" "$2,522.50" N/A N/A 231.004 SUP Custom 27203010 231.004 - STAPLE BONE MEDIUM 2 STAINLESS STEEL BOTH IP/OP "$2,522.50" "$1,867.00" $449.01 "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" $449.01 "$2,522.50" "$2,522.50" "$1,872.20" "$1,872.20" "$1,944.34" "$1,314.22" $525.72 "$2,522.50" "$1,009.00" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$1,891.88" "$2,522.50" "$2,522.50" "$2,522.50" "$1,261.25" "$1,261.25" "$1,997.82" "$2,522.50" "$2,018.00" "$1,639.63" "$2,522.50" N/A "$1,463.05" "$2,522.50" "$1,513.50" "$2,522.50" "$2,522.50" "$2,522.50" N/A N/A 231.005 SUP Custom 27203010 231.005 - STAPLE BONE LARGE 2 STAINLESS STEEL BOTH IP/OP "$2,522.50" "$1,867.00" $449.01 "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" $449.01 "$2,522.50" "$2,522.50" "$1,872.20" "$1,872.20" "$1,944.34" "$1,314.22" $525.72 "$2,522.50" "$1,009.00" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$1,891.88" "$2,522.50" "$2,522.50" "$2,522.50" "$1,261.25" "$1,261.25" "$1,997.82" "$2,522.50" "$2,018.00" "$1,639.63" "$2,522.50" N/A "$1,463.05" "$2,522.50" "$1,513.50" "$2,522.50" "$2,522.50" "$2,522.50" N/A N/A 231.006 SUP Custom 27203010 231.006 - STAPLE BONE LARGE 2 STAINLESS STEEL BOTH IP/OP "$2,522.50" "$1,867.00" $449.01 "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" $449.01 "$2,522.50" "$2,522.50" "$1,872.20" "$1,872.20" "$1,944.34" "$1,314.22" $525.72 "$2,522.50" "$1,009.00" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$1,891.88" "$2,522.50" "$2,522.50" "$2,522.50" "$1,261.25" "$1,261.25" "$1,997.82" "$2,522.50" "$2,018.00" "$1,639.63" "$2,522.50" N/A "$1,463.05" "$2,522.50" "$1,513.50" "$2,522.50" "$2,522.50" "$2,522.50" N/A N/A 231.007 SUP Custom 27203010 231.007 - STAPLE BONE 2 STAINLESS STEEL X BOTH IP/OP "$2,522.50" "$1,867.00" $449.01 "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" $449.01 "$2,522.50" "$2,522.50" "$1,872.20" "$1,872.20" "$1,944.34" "$1,314.22" $525.72 "$2,522.50" "$1,009.00" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$1,891.88" "$2,522.50" "$2,522.50" "$2,522.50" "$1,261.25" "$1,261.25" "$1,997.82" "$2,522.50" "$2,018.00" "$1,639.63" "$2,522.50" N/A "$1,463.05" "$2,522.50" "$1,513.50" "$2,522.50" "$2,522.50" "$2,522.50" N/A N/A 231.008 SUP Custom 27203010 231.008 - SPACER SPINAL LARGE CONVEX ANTERIOR CERV DISCECTOMY AND BOTH IP/OP "$2,522.50" "$1,867.00" $449.01 "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" $449.01 "$2,522.50" "$2,522.50" "$1,872.20" "$1,872.20" "$1,944.34" "$1,314.22" $525.72 "$2,522.50" "$1,009.00" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$2,522.50" "$1,891.88" "$2,522.50" "$2,522.50" "$2,522.50" "$1,261.25" "$1,261.25" "$1,997.82" "$2,522.50" "$2,018.00" "$1,639.63" "$2,522.50" N/A "$1,463.05" "$2,522.50" "$1,513.50" "$2,522.50" "$2,522.50" "$2,522.50" N/A N/A 231.011 SUP Custom 27203010 231.011 - STAPLE BONE STAINLESS STEEL BOTH IP/OP "$1,822.50" "$1,349.00" $324.41 "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" $324.41 "$1,822.50" "$1,822.50" "$1,352.66" "$1,352.66" "$1,404.78" $949.52 $379.83 "$1,822.50" $729.00 "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,366.88" "$1,822.50" "$1,822.50" "$1,822.50" $911.25 $911.25 "$1,443.42" "$1,822.50" "$1,458.00" "$1,184.63" "$1,822.50" N/A "$1,057.05" "$1,822.50" "$1,093.50" "$1,822.50" "$1,822.50" "$1,822.50" N/A N/A 231.012 SUP Custom 27203010 231.012 - STAPLE BONE STAINLESS STEEL BOTH IP/OP "$1,822.50" "$1,349.00" $324.41 "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" $324.41 "$1,822.50" "$1,822.50" "$1,352.66" "$1,352.66" "$1,404.78" $949.52 $379.83 "$1,822.50" $729.00 "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,366.88" "$1,822.50" "$1,822.50" "$1,822.50" $911.25 $911.25 "$1,443.42" "$1,822.50" "$1,458.00" "$1,184.63" "$1,822.50" N/A "$1,057.05" "$1,822.50" "$1,093.50" "$1,822.50" "$1,822.50" "$1,822.50" N/A N/A 231.013 SUP Custom 27203010 231.013 - STAPLE BONE STAINLESS STEEL BOTH IP/OP "$1,822.50" "$1,349.00" $324.41 "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" $324.41 "$1,822.50" "$1,822.50" "$1,352.66" "$1,352.66" "$1,404.78" $949.52 $379.83 "$1,822.50" $729.00 "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$1,366.88" "$1,822.50" "$1,822.50" "$1,822.50" $911.25 $911.25 "$1,443.42" "$1,822.50" "$1,458.00" "$1,184.63" "$1,822.50" N/A "$1,057.05" "$1,822.50" "$1,093.50" "$1,822.50" "$1,822.50" "$1,822.50" N/A N/A 231.113 SUP Custom 27803010 231.113 - CONNECTOR ROD CROSS STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 231.114 SUP Custom 27803010 231.114 - CONNECTOR ROD CROSS STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 231.115 SUP Custom 27803010 231.115 - CONNECTOR ROD CROSS STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 231.116 SUP Custom 27803010 231.116 - CONNECTOR ROD CROSS STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 231.117 SUP Custom 27803010 231.117 - CONNECTOR ROD CROSS STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 231.118 SUP Custom 27803010 231.118 - CONNECTOR ROD CROSS STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 231.119 SUP Custom 27803010 231.119 - CONNECTOR ROD CROSS STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 231.12 SUP Custom 27803010 231.120 - CONNECTOR ROD CROSS STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 231.201 SUP HCPCS C1713 231.201 - WASHER SPINAL SMALL STAINLESS STEEL BOTH IP/OP $700.00 $518.00 $138.93 $700.00 $315.00 $315.00 $315.00 $315.00 $700.00 $700.00 $700.00 $145.90 $700.00 $700.00 $700.00 $700.00 $700.00 $145.89 $700.00 $280.00 $414.05 $700.00 $700.00 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $350.00 $350.00 $554.40 $700.00 $560.00 $315.00 $138.93 N/A $406.00 $700.00 $420.00 $700.00 $145.88 $700.00 N/A N/A 231.202 SUP HCPCS C1713 231.202 - WASHER SPINAL MEDIUM STAINLESS STEEL BOTH IP/OP $700.00 $518.00 $138.93 $700.00 $315.00 $315.00 $315.00 $315.00 $700.00 $700.00 $700.00 $145.90 $700.00 $700.00 $700.00 $700.00 $700.00 $145.89 $700.00 $700.00 $414.05 $700.00 $700.00 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $350.00 $350.00 $554.40 $700.00 $560.00 $315.00 $138.93 N/A $406.00 $700.00 $700.00 $700.00 $145.88 $700.00 N/A N/A 231.203 SUP HCPCS C1713 231.203 - WASHER SPINAL LARGE STAINLESS STEEL BOTH IP/OP $700.00 $518.00 $138.93 $700.00 $315.00 $315.00 $315.00 $315.00 $700.00 $700.00 $700.00 $145.90 $700.00 $700.00 $700.00 $700.00 $700.00 $145.89 $700.00 $700.00 $414.05 $700.00 $700.00 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $350.00 $350.00 $554.40 $700.00 $560.00 $315.00 $138.93 N/A $406.00 $700.00 $700.00 $700.00 $145.88 $700.00 N/A N/A 232.006 SUP HCPCS C1713 232.006 - PLATE BONE 90D 132MM 30X9.2MM 10 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,876.50" "$1,389.00" $372.38 "$1,876.20" $844.29 $844.29 $844.29 $844.29 "$1,876.20" "$1,876.20" "$1,876.20" $391.05 "$1,876.20" "$1,876.20" "$1,876.20" "$1,876.20" "$1,876.20" $391.02 "$1,876.20" "$1,876.20" "$1,109.77" "$1,876.20" "$1,876.20" "$1,876.20" "$1,876.20" "$1,407.38" "$1,876.20" "$1,876.20" "$1,876.20" $938.10 $938.10 "$1,485.95" "$1,876.20" "$1,500.96" $844.29 $372.38 N/A "$1,088.37" "$1,876.20" "$1,876.20" "$1,876.20" $391.00 "$1,876.20" N/A N/A 232.007 SUP HCPCS C1713 232.007 - PLATE BONE 90D 132MM 35X9.2MM 10 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,876.50" "$1,389.00" $372.38 "$1,876.20" $844.29 $844.29 $844.29 $844.29 "$1,876.20" "$1,876.20" "$1,876.20" $391.05 "$1,876.20" "$1,876.20" "$1,876.20" "$1,876.20" "$1,876.20" $391.02 "$1,876.20" $750.48 "$1,109.77" "$1,876.20" "$1,876.20" "$1,876.20" "$1,876.20" "$1,407.38" "$1,876.20" "$1,876.20" "$1,876.20" $938.10 $938.10 "$1,485.95" "$1,876.20" "$1,500.96" $844.29 $372.38 N/A "$1,088.37" "$1,876.20" "$1,125.72" "$1,876.20" $391.00 "$1,876.20" N/A N/A 232.008 SUP HCPCS C1713 232.008 - PLATE BONE 90D 132MM 40X9.2MM 10 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,876.50" "$1,389.00" $372.38 "$1,876.20" $844.29 $844.29 $844.29 $844.29 "$1,876.20" "$1,876.20" "$1,876.20" $391.05 "$1,876.20" "$1,876.20" "$1,876.20" "$1,876.20" "$1,876.20" $391.02 "$1,876.20" "$1,876.20" "$1,109.77" "$1,876.20" "$1,876.20" "$1,876.20" "$1,876.20" "$1,407.38" "$1,876.20" "$1,876.20" "$1,876.20" $938.10 $938.10 "$1,485.95" "$1,876.20" "$1,500.96" $844.29 $372.38 N/A "$1,088.37" "$1,876.20" "$1,125.72" "$1,876.20" $391.00 "$1,876.20" N/A N/A 232.009 SUP HCPCS C1713 232.009 - PLATE BONE 90D 132MM 45X9.2MM 10 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,876.50" "$1,389.00" $372.38 "$1,876.20" $844.29 $844.29 $844.29 $844.29 "$1,876.20" "$1,876.20" "$1,876.20" $391.05 "$1,876.20" "$1,876.20" "$1,876.20" "$1,876.20" "$1,876.20" $391.02 "$1,876.20" $750.48 "$1,109.77" "$1,876.20" "$1,876.20" "$1,876.20" "$1,876.20" "$1,407.38" "$1,876.20" "$1,876.20" "$1,876.20" $938.10 $938.10 "$1,485.95" "$1,876.20" "$1,500.96" $844.29 $372.38 N/A "$1,088.37" "$1,876.20" "$1,125.72" "$1,876.20" $391.00 "$1,876.20" N/A N/A 232.046 SUP HCPCS C1713 232.046 - PLATE BONE 90D 54MM 30X9.2MM 4 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,496.00" "$1,107.00" $296.90 "$1,495.93" $673.17 $673.17 $673.17 $673.17 "$1,495.93" "$1,495.93" "$1,495.93" $311.79 "$1,495.93" "$1,495.93" "$1,495.93" "$1,495.93" "$1,495.93" $311.77 "$1,495.93" "$1,495.93" $884.84 "$1,495.93" "$1,495.93" "$1,495.93" "$1,495.93" "$1,122.00" "$1,495.93" "$1,495.93" "$1,495.93" $747.97 $747.97 "$1,184.78" "$1,495.93" "$1,196.74" $673.17 $296.90 N/A $867.68 "$1,495.93" "$1,495.93" "$1,495.93" "$1,495.93" "$1,495.93" N/A N/A 232.047 SUP HCPCS C1713 232.047 - PLATE BONE 90D 54MM 35X9.2MM 4 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,496.00" "$1,107.00" $296.90 "$1,495.93" $673.17 $673.17 $673.17 $673.17 "$1,495.93" "$1,495.93" "$1,495.93" $311.79 "$1,495.93" "$1,495.93" "$1,495.93" "$1,495.93" "$1,495.93" $311.77 "$1,495.93" $598.37 $884.84 "$1,495.93" "$1,495.93" "$1,495.93" "$1,495.93" "$1,122.00" "$1,495.93" "$1,495.93" "$1,495.93" $747.97 $747.97 "$1,184.78" "$1,495.93" "$1,196.74" $673.17 $296.90 N/A $867.68 "$1,495.93" $897.56 "$1,495.93" "$1,495.93" "$1,495.93" N/A N/A 232.048 SUP HCPCS C1713 232.048 - PLATE BN 90D 40X9.2MM NS 4 HL LMT CNTCT ANG BLDE CNN SS 3.5 BOTH IP/OP "$1,496.00" "$1,107.00" $296.90 "$1,495.93" $673.17 $673.17 $673.17 $673.17 "$1,495.93" "$1,495.93" "$1,495.93" $311.79 "$1,495.93" "$1,495.93" "$1,495.93" "$1,495.93" "$1,495.93" $311.77 "$1,495.93" "$1,495.93" $884.84 "$1,495.93" "$1,495.93" "$1,495.93" "$1,495.93" "$1,122.00" "$1,495.93" "$1,495.93" "$1,495.93" $747.97 $747.97 "$1,184.78" "$1,495.93" "$1,196.74" $673.17 $296.90 N/A $867.68 "$1,495.93" $897.56 "$1,495.93" $311.75 "$1,495.93" N/A N/A 232.049 SUP HCPCS C1713 232.049 - PLATE BONE 90D 54MM 45X9.2MM 4 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,496.00" "$1,107.00" $296.90 "$1,495.93" $673.17 $673.17 $673.17 $673.17 "$1,495.93" "$1,495.93" "$1,495.93" $311.79 "$1,495.93" "$1,495.93" "$1,495.93" "$1,495.93" "$1,495.93" $311.77 "$1,495.93" $598.37 $884.84 "$1,495.93" "$1,495.93" "$1,495.93" "$1,495.93" "$1,122.00" "$1,495.93" "$1,495.93" "$1,495.93" $747.97 $747.97 "$1,184.78" "$1,495.93" "$1,196.74" $673.17 $296.90 N/A $867.68 "$1,495.93" $897.56 "$1,495.93" $311.75 "$1,495.93" N/A N/A 232.056 SUP HCPCS C1713 232.056 - PLATE BONE 90D 67MM 30X9.2MM 5 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,582.50" "$1,171.00" $314.00 "$1,582.05" $711.92 $711.92 $711.92 $711.92 "$1,582.05" "$1,582.05" "$1,582.05" $329.74 "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" $329.72 "$1,582.05" "$1,582.05" $935.78 "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" "$1,186.88" "$1,582.05" "$1,582.05" "$1,582.05" $791.03 $791.03 "$1,252.98" "$1,582.05" "$1,265.64" $711.92 $314.00 N/A $917.85 "$1,582.05" $949.23 "$1,582.05" $329.70 "$1,582.05" N/A N/A 232.057 SUP HCPCS C1713 232.057 - PLATE BONE 90D 67MM 35X9.2MM 5 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,582.50" "$1,171.00" $314.00 "$1,582.05" $711.92 $711.92 $711.92 $711.92 "$1,582.05" "$1,582.05" "$1,582.05" $329.74 "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" $329.72 "$1,582.05" $632.82 $935.78 "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" "$1,186.88" "$1,582.05" "$1,582.05" "$1,582.05" $791.03 $791.03 "$1,252.98" "$1,582.05" "$1,265.64" $711.92 $314.00 N/A $917.85 "$1,582.05" "$1,582.05" "$1,582.05" $329.70 "$1,582.05" N/A N/A 232.058 SUP HCPCS C1713 232.058 - PLATE BONE 90D 67MM 40X9.2MM 5 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,582.50" "$1,171.00" $314.00 "$1,582.05" $711.92 $711.92 $711.92 $711.92 "$1,582.05" "$1,582.05" "$1,582.05" $329.74 "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" $329.72 "$1,582.05" $632.82 $935.78 "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" "$1,186.88" "$1,582.05" "$1,582.05" "$1,582.05" $791.03 $791.03 "$1,252.98" "$1,582.05" "$1,265.64" $711.92 $314.00 N/A $917.85 "$1,582.05" $949.23 "$1,582.05" $329.70 "$1,582.05" N/A N/A 232.059 SUP HCPCS C1713 232.059 - PLATE BONE 90D 67MM 45X9.2MM 5 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,582.50" "$1,171.00" $314.00 "$1,582.05" $711.92 $711.92 $711.92 $711.92 "$1,582.05" "$1,582.05" "$1,582.05" $329.74 "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" $329.72 "$1,582.05" $632.82 $935.78 "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" "$1,186.88" "$1,582.05" "$1,582.05" "$1,582.05" $791.03 $791.03 "$1,252.98" "$1,582.05" "$1,265.64" $711.92 $314.00 N/A $917.85 "$1,582.05" $949.23 "$1,582.05" $329.70 "$1,582.05" N/A N/A 232.066 SUP HCPCS C1713 232.066 - PLATE BONE 90D 80MM 30X9.2MM 6 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,650.00" "$1,221.00" $327.41 "$1,649.63" $742.33 $742.33 $742.33 $742.33 "$1,649.63" "$1,649.63" "$1,649.63" $343.82 "$1,649.63" "$1,649.63" "$1,649.63" "$1,649.63" "$1,649.63" $343.80 "$1,649.63" $659.85 $975.76 "$1,649.63" "$1,649.63" "$1,649.63" "$1,649.63" "$1,237.50" "$1,649.63" "$1,649.63" "$1,649.63" $824.82 $824.82 "$1,306.51" "$1,649.63" "$1,319.70" $742.33 $327.41 N/A $957.00 "$1,649.63" $989.78 "$1,649.63" $343.78 "$1,649.63" N/A N/A 232.067 SUP HCPCS C1713 232.067 - PLATE BONE 90D 80MM 35X9.2MM 6 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,650.00" "$1,221.00" $327.41 "$1,649.63" $742.33 $742.33 $742.33 $742.33 "$1,649.63" "$1,649.63" "$1,649.63" $343.82 "$1,649.63" "$1,649.63" "$1,649.63" "$1,649.63" "$1,649.63" $343.80 "$1,649.63" $659.85 $975.76 "$1,649.63" "$1,649.63" "$1,649.63" "$1,649.63" "$1,237.50" "$1,649.63" "$1,649.63" "$1,649.63" $824.82 $824.82 "$1,306.51" "$1,649.63" "$1,319.70" $742.33 $327.41 N/A $957.00 "$1,649.63" "$1,649.63" "$1,649.63" $343.78 "$1,649.63" N/A N/A 232.068 SUP HCPCS C1713 232.068 - PLATE BONE 90D 80MM 40X9.2MM 6 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,650.00" "$1,221.00" $327.41 "$1,649.63" $742.33 $742.33 $742.33 $742.33 "$1,649.63" "$1,649.63" "$1,649.63" $343.82 "$1,649.63" "$1,649.63" "$1,649.63" "$1,649.63" "$1,649.63" $343.80 "$1,649.63" $659.85 $975.76 "$1,649.63" "$1,649.63" "$1,649.63" "$1,649.63" "$1,237.50" "$1,649.63" "$1,649.63" "$1,649.63" $824.82 $824.82 "$1,306.51" "$1,649.63" "$1,319.70" $742.33 $327.41 N/A $957.00 "$1,649.63" "$1,649.63" "$1,649.63" $343.78 "$1,649.63" N/A N/A 232.069 SUP HCPCS C1713 232.069 - PLATE BONE 90D 80MM 45X9.2MM 6 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,650.00" "$1,221.00" $327.41 "$1,649.63" $742.33 $742.33 $742.33 $742.33 "$1,649.63" "$1,649.63" "$1,649.63" $343.82 "$1,649.63" "$1,649.63" "$1,649.63" "$1,649.63" "$1,649.63" $343.80 "$1,649.63" "$1,649.63" $975.76 "$1,649.63" "$1,649.63" "$1,649.63" "$1,649.63" "$1,237.50" "$1,649.63" "$1,649.63" "$1,649.63" $824.82 $824.82 "$1,306.51" "$1,649.63" "$1,319.70" $742.33 $327.41 N/A $957.00 "$1,649.63" $989.78 "$1,649.63" $343.78 "$1,649.63" N/A N/A 232.086 SUP HCPCS C1713 232.086 - PLATE BONE 90D 106MM 30X9.2MM 8 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,770.50" "$1,310.00" $351.34 "$1,770.20" $796.59 $796.59 $796.59 $796.59 "$1,770.20" "$1,770.20" "$1,770.20" $368.95 "$1,770.20" "$1,770.20" "$1,770.20" "$1,770.20" "$1,770.20" $368.93 "$1,770.20" "$1,770.20" "$1,047.07" "$1,770.20" "$1,770.20" "$1,770.20" "$1,770.20" "$1,327.88" "$1,770.20" "$1,770.20" "$1,770.20" $885.10 $885.10 "$1,402.00" "$1,770.20" "$1,416.16" $796.59 $351.34 N/A "$1,026.89" "$1,770.20" "$1,062.12" "$1,770.20" $368.91 "$1,770.20" N/A N/A 232.087 SUP HCPCS C1713 232.087 - PLATE BN 90D 35X9.2MM NS 8 HL LMT CNTCT ANG BLDE CNN SS 3.5 BOTH IP/OP "$1,770.50" "$1,310.00" $351.34 "$1,770.20" $796.59 $796.59 $796.59 $796.59 "$1,770.20" "$1,770.20" "$1,770.20" $368.95 "$1,770.20" "$1,770.20" "$1,770.20" "$1,770.20" "$1,770.20" $368.93 "$1,770.20" "$1,770.20" "$1,047.07" "$1,770.20" "$1,770.20" "$1,770.20" "$1,770.20" "$1,327.88" "$1,770.20" "$1,770.20" "$1,770.20" $885.10 $885.10 "$1,402.00" "$1,770.20" "$1,416.16" $796.59 $351.34 N/A "$1,026.89" "$1,770.20" "$1,062.12" "$1,770.20" $368.91 "$1,770.20" N/A N/A 232.088 SUP HCPCS C1713 232.088 - PLATE BONE 90D 106MM 40X9.2MM 8 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,770.50" "$1,310.00" $351.34 "$1,770.20" $796.59 $796.59 $796.59 $796.59 "$1,770.20" "$1,770.20" "$1,770.20" $368.95 "$1,770.20" "$1,770.20" "$1,770.20" "$1,770.20" "$1,770.20" $368.93 "$1,770.20" "$1,770.20" "$1,047.07" "$1,770.20" "$1,770.20" "$1,770.20" "$1,770.20" "$1,327.88" "$1,770.20" "$1,770.20" "$1,770.20" $885.10 $885.10 "$1,402.00" "$1,770.20" "$1,416.16" $796.59 $351.34 N/A "$1,026.89" "$1,770.20" "$1,062.12" "$1,770.20" $368.91 "$1,770.20" N/A N/A 232.089 SUP HCPCS C1713 232.089 - PLATE BONE 90D 106MM 45X9.2MM 8 HOLE LIMITED CONTACT ANGLED BOTH IP/OP "$1,770.50" "$1,310.00" $351.34 "$1,770.20" $796.59 $796.59 $796.59 $796.59 "$1,770.20" "$1,770.20" "$1,770.20" $368.95 "$1,770.20" "$1,770.20" "$1,770.20" "$1,770.20" "$1,770.20" $368.93 "$1,770.20" "$1,770.20" "$1,047.07" "$1,770.20" "$1,770.20" "$1,770.20" "$1,770.20" "$1,327.88" "$1,770.20" "$1,770.20" "$1,770.20" $885.10 $885.10 "$1,402.00" "$1,770.20" "$1,416.16" $796.59 $351.34 N/A "$1,026.89" "$1,770.20" "$1,062.12" "$1,770.20" $368.91 "$1,770.20" N/A N/A 235 SUP Custom 27803010 235 - PLATE BONE STANDARD 128X79X.6MM NONCHAMFERED HOLE MESH PANEL BOTH IP/OP "$1,623.50" "$1,201.00" $288.98 "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" $288.98 "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" $338.36 "$1,623.50" $649.40 "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" "$1,217.63" "$1,623.50" "$1,623.50" "$1,623.50" $811.75 $811.75 "$1,285.81" "$1,623.50" "$1,298.80" $730.58 "$1,623.50" N/A $941.63 "$1,623.50" $974.10 "$1,623.50" "$1,623.50" "$1,623.50" N/A N/A 235.17 SUP HCPCS C1713 235.170 - PLATE BONE 80D 8MM DISPLACEMENT 35MM DCP CAPOS STAINLESS BOTH IP/OP $938.00 $694.00 $186.09 $982.13 $421.91 $421.91 $421.91 $421.91 $937.58 $937.58 $937.58 $195.42 $937.58 $937.58 $937.58 $937.58 $937.58 $195.40 $937.58 $392.85 $554.58 $937.58 $982.13 $937.58 $937.58 $703.50 $937.58 $937.58 $937.58 $468.79 $468.79 $742.56 $937.58 $750.06 $421.91 $186.09 N/A $544.04 $937.58 $562.55 $937.58 $195.39 $937.58 N/A N/A 235.19 SUP HCPCS C1713 235.190 - PLATE BONE 80D 8MM DISPLACEMENT 45MM ANGLED DCP CAPOS BOTH IP/OP $938.00 $694.00 $186.09 $982.13 $421.91 $421.91 $421.91 $421.91 $937.58 $937.58 $937.58 $195.42 $937.58 $937.58 $937.58 $937.58 $937.58 $195.40 $937.58 $392.85 $554.58 $937.58 $982.13 $937.58 $937.58 $703.50 $937.58 $937.58 $937.58 $468.79 $468.79 $742.56 $937.58 $750.06 $421.91 $186.09 N/A $544.04 $937.58 $937.58 $937.58 $195.39 $937.58 N/A N/A 235.27 SUP HCPCS C1713 235.270 - PLATE BN 90D 8MM DSPL 35MMX74.5MM NS DCP CAPOS 3 HL T PRFL BOTH IP/OP $938.00 $694.00 $186.09 $982.13 $421.91 $421.91 $421.91 $421.91 $937.58 $937.58 $937.58 $195.42 $937.58 $937.58 $937.58 $937.58 $937.58 $195.40 $937.58 $392.85 $554.58 $937.58 $982.13 $937.58 $937.58 $703.50 $937.58 $937.58 $937.58 $468.79 $468.79 $742.56 $937.58 $750.06 $421.91 $186.09 N/A $544.04 $937.58 $562.55 $937.58 $195.39 $937.58 N/A N/A 235.29 SUP HCPCS C1713 235.290 - PLATE BN 90D 8MM DSPL 45MMX74.5MM NS DCP CAPOS 3 HL T PRFL BOTH IP/OP $938.00 $694.00 $186.09 $982.13 $421.91 $421.91 $421.91 $421.91 $937.58 $937.58 $937.58 $195.42 $937.58 $937.58 $937.58 $937.58 $937.58 $195.40 $937.58 $392.85 $554.58 $937.58 $982.13 $937.58 $937.58 $703.50 $937.58 $937.58 $937.58 $468.79 $468.79 $742.56 $937.58 $750.06 $421.91 $186.09 N/A $544.04 $937.58 $562.55 $937.58 $195.39 $937.58 N/A N/A 235.37 SUP HCPCS C1713 235.370 - PLATE BONE 100D 8MM DISPLACEMENT 35MM DCP CAPOS STAINLESS BOTH IP/OP $938.00 $694.00 $186.09 $982.13 $421.91 $421.91 $421.91 $421.91 $937.58 $937.58 $937.58 $195.42 $937.58 $937.58 $937.58 $937.58 $937.58 $195.40 $937.58 $392.85 $554.58 $937.58 $982.13 $937.58 $937.58 $703.50 $937.58 $937.58 $937.58 $468.79 $468.79 $742.56 $937.58 $750.06 $421.91 $186.09 N/A $544.04 $937.58 $562.55 $937.58 $195.39 $937.58 N/A N/A 235.39 SUP HCPCS C1713 235.390 - PLATE BONE 100D 45MM 8MM DCP CAPOS STAINLESS STEEL PEDIATRIC BOTH IP/OP $938.00 $694.00 $186.09 $982.13 $421.91 $421.91 $421.91 $421.91 $937.58 $937.58 $937.58 $195.42 $937.58 $937.58 $937.58 $937.58 $937.58 $195.40 $937.58 $392.85 $554.58 $937.58 $982.13 $937.58 $937.58 $703.50 $937.58 $937.58 $937.58 $468.79 $468.79 $742.56 $937.58 $750.06 $421.91 $186.09 N/A $544.04 $937.58 $937.58 $937.58 $195.39 $937.58 N/A N/A 235.6 SUP HCPCS C1713 235.600 - PLATE BN 90D 10MM DSPL 50MMX78MM NS DCP CAPOS 3 HL T PRFL BOTH IP/OP $938.00 $694.00 $186.09 $982.13 $421.91 $421.91 $421.91 $421.91 $937.58 $937.58 $937.58 $195.42 $937.58 $937.58 $937.58 $937.58 $937.58 $195.40 $937.58 $982.13 $554.58 $937.58 $982.13 $937.58 $937.58 $703.50 $937.58 $937.58 $937.58 $468.79 $468.79 $742.56 $937.58 $750.06 $421.91 $186.09 N/A $544.04 $937.58 $937.58 $937.58 $195.39 $937.58 N/A N/A 235.601 SUP HCPCS C1713 235.601 - PLATE BONE 100D 10MM DISPLACEMENT 50MM DCP CAPOS STAINLESS BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $965.70 $965.70 $201.25 $965.70 N/A N/A 235.68 SUP HCPCS C1713 235.680 - PLATE BN 90D 10MM DSPL 40MMX78MM NS DCP CAPOS 3 HL T PRFL BOTH IP/OP $938.00 $694.00 $186.09 $982.13 $421.91 $421.91 $421.91 $421.91 $937.58 $937.58 $937.58 $195.42 $937.58 $937.58 $937.58 $937.58 $937.58 $195.40 $937.58 $982.13 $554.58 $937.58 $982.13 $937.58 $937.58 $703.50 $937.58 $937.58 $937.58 $468.79 $468.79 $742.56 $937.58 $750.06 $421.91 $186.09 N/A $544.04 $937.58 $937.58 $937.58 $195.39 $937.58 N/A N/A 235.681 SUP HCPCS C1713 235.681 - PLATE BONE 100D 10MM DISPLACEMENT 40MM DCP CAPOS STAINLESS BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $579.42 $965.70 $201.25 $965.70 N/A N/A 235.7 SUP HCPCS C1713 235.700 - PLATE BN 90D 15MM DSPL 50MMX78MM NS DCP CAPOS 3 HL T PRFL BOTH IP/OP $938.00 $694.00 $186.09 $982.13 $421.91 $421.91 $421.91 $421.91 $937.58 $937.58 $937.58 $195.42 $937.58 $937.58 $937.58 $937.58 $937.58 $195.40 $937.58 $982.13 $554.58 $937.58 $982.13 $937.58 $937.58 $703.50 $937.58 $937.58 $937.58 $468.79 $468.79 $742.56 $937.58 $750.06 $421.91 $186.09 N/A $544.04 $937.58 $562.55 $937.58 $195.39 $937.58 N/A N/A 235.701 SUP HCPCS C1713 235.701 - PLATE BONE 100D 10MM DISPLACEMENT 50MM DCP CAPOS STAINLESS BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $579.42 $965.70 $201.25 $965.70 N/A N/A 235.72 SUP HCPCS C1713 235.720 - PLATE BN 90D 15MM DSPL 60MMX78MM NS DCP CAPOS 3 HL T PRFL BOTH IP/OP $938.00 $694.00 $186.09 $982.13 $421.91 $421.91 $421.91 $421.91 $937.58 $937.58 $937.58 $195.42 $937.58 $937.58 $937.58 $937.58 $937.58 $195.40 $937.58 $982.13 $554.58 $937.58 $982.13 $937.58 $937.58 $703.50 $937.58 $937.58 $937.58 $468.79 $468.79 $742.56 $937.58 $750.06 $421.91 $186.09 N/A $544.04 $937.58 $937.58 $937.58 $195.39 $937.58 N/A N/A 235.721 SUP HCPCS C1713 235.721 - PLATE BONE 100D 15MM DISPLACEMENT 60MM DCP CAPOS STAINLESS BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $392.85 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $579.42 $965.70 $201.25 $965.70 N/A N/A 235.78 SUP HCPCS C1713 235.780 - PLATE BN 90D 15MM DSPL 40MMX78MM NS DCP CAPOS 3 HL T PRFL BOTH IP/OP $938.00 $694.00 $186.09 $982.13 $421.91 $421.91 $421.91 $421.91 $937.58 $937.58 $937.58 $195.42 $937.58 $937.58 $937.58 $937.58 $937.58 $195.40 $937.58 $392.85 $554.58 $937.58 $982.13 $937.58 $937.58 $703.50 $937.58 $937.58 $937.58 $468.79 $468.79 $742.56 $937.58 $750.06 $421.91 $186.09 N/A $544.04 $937.58 $562.55 $937.58 $195.39 $937.58 N/A N/A 235.781 SUP HCPCS C1713 235.781 - PLATE BONE 100D 10MM DISPLACEMENT 40MM DCP CAPOS STAINLESS BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $579.42 $965.70 $201.25 $965.70 N/A N/A 236.001 SUP HCPCS C1713 236.001 - PLATE BONE 90D 4MM DISPLACEMENT 26MM ANGLED DCP CAPOS BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $392.85 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $965.70 $965.70 $201.25 $965.70 N/A N/A 236.002 SUP HCPCS C1713 236.002 - PLATE BN 90D 4MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $392.85 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $579.42 $965.70 $201.25 $965.70 N/A N/A 236.003 SUP HCPCS C1713 236.003 - PLATE BONE 90D 4MM DISPLACEMENT 38MM DCP CAPOS STAINLESS BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $392.85 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $579.42 $965.70 $201.25 $965.70 N/A N/A 236.011 SUP HCPCS C1713 236.011 - PLATE BONE 90D 8MM DISPLACEMENT ANGLED 26MM DCP CAPOS BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $579.42 $965.70 $201.25 $965.70 N/A N/A 236.012 SUP HCPCS C1713 236.012 - PLATE BN 90D 8MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $579.42 $965.70 $201.25 $965.70 N/A N/A 236.013 SUP HCPCS C1713 236.013 - PLATE BN 90D 8MM DSPL 38MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $579.42 $965.70 $201.25 $965.70 N/A N/A 236.101 SUP HCPCS C1713 236.101 - PLATE BONE 100D 4MM DISPLACEMENT 26MM ANGLED DCP CAPOS BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $579.42 $965.70 $201.25 $965.70 N/A N/A 236.102 SUP HCPCS C1713 236.102 - PLATE BN 100D 4MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $579.42 $965.70 $201.25 $965.70 N/A N/A 236.103 SUP HCPCS C1713 236.103 - PLATE BN 100D 4MM DSPL 38MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $965.70 $965.70 $201.25 $965.70 N/A N/A 236.104 SUP HCPCS C1713 236.104 - PLATE BN 100D 4MM DSPL 44MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $965.70 $965.70 $201.25 $965.70 N/A N/A 236.111 SUP HCPCS C1713 236.111 - PLATE BONE 100D 8MM DISPLACEMENT 26MM CANN ANGLED BLADE DCP BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $965.70 $965.70 $965.70 $965.70 N/A N/A 236.112 SUP HCPCS C1713 236.112 - PLATE BN 100D 8MM DSPL 32MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $579.42 $965.70 $965.70 $965.70 N/A N/A 236.113 SUP HCPCS C1713 236.113 - PLATE BN 100D 8MM DSPL 38MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $965.70 $965.70 $965.70 $965.70 N/A N/A 236.114 SUP HCPCS C1713 236.114 - PLATE BN 100D 8MM DSPL 44MMX67MM NS 9.5X3.2MM DCP CAPOS 3 HL BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $965.70 $965.70 $201.25 $965.70 N/A N/A 236.25 SUP HCPCS C1713 236.250 - PLATE BN 90D 7MM DSPL 25MMX46MM NS 8X2MM DCP CAPOS 3 HL T BOTH IP/OP $805.50 $596.00 $159.81 $843.45 $362.34 $362.34 $362.34 $362.34 $805.20 $805.20 $805.20 $167.82 $805.20 $805.20 $805.20 $805.20 $805.20 $167.81 $805.20 $843.45 $476.28 $805.20 $843.45 $805.20 $805.20 $604.13 $805.20 $805.20 $805.20 $402.60 $402.60 $637.72 $805.20 $644.16 $362.34 $159.81 N/A $467.19 $805.20 $805.20 $805.20 $167.80 $805.20 N/A N/A 236.26 SUP HCPCS C1713 236.260 - PLATE BN 90D 7MM DSPL 32MMX46MM NS 8X2MM DCP CAPOS 3 HL T BOTH IP/OP $805.50 $596.00 $159.81 $843.45 $362.34 $362.34 $362.34 $362.34 $805.20 $805.20 $805.20 $167.82 $805.20 $805.20 $805.20 $805.20 $805.20 $167.81 $805.20 $843.45 $476.28 $805.20 $843.45 $805.20 $805.20 $604.13 $805.20 $805.20 $805.20 $402.60 $402.60 $637.72 $805.20 $644.16 $362.34 $159.81 N/A $467.19 $805.20 $483.12 $805.20 $167.80 $805.20 N/A N/A 236.35 SUP HCPCS C1713 236.350 - PLATE BN 90D 12MM DSPL 25MMX46MM NS 8X2MM DCP CAPOS SS INF BOTH IP/OP $805.50 $596.00 $159.81 $843.45 $362.34 $362.34 $362.34 $362.34 $805.20 $805.20 $805.20 $167.82 $805.20 $805.20 $805.20 $805.20 $805.20 $167.81 $805.20 $843.45 $476.28 $805.20 $843.45 $805.20 $805.20 $604.13 $805.20 $805.20 $805.20 $402.60 $402.60 $637.72 $805.20 $644.16 $362.34 $159.81 N/A $467.19 $805.20 $483.12 $805.20 $167.80 $805.20 N/A N/A 236.36 SUP HCPCS C1713 236.360 - PLATE BN 90D 12MM DSPL 32MMX46MM NS 8X2MM DCP CAPOS 3 HL T BOTH IP/OP $805.50 $596.00 $159.81 $843.45 $362.34 $362.34 $362.34 $362.34 $805.20 $805.20 $805.20 $167.82 $805.20 $805.20 $805.20 $805.20 $805.20 $167.81 $805.20 $843.45 $476.28 $805.20 $843.45 $805.20 $805.20 $604.13 $805.20 $805.20 $805.20 $402.60 $402.60 $637.72 $805.20 $644.16 $362.34 $159.81 N/A $467.19 $805.20 $483.12 $805.20 $805.20 $805.20 N/A N/A 236.4 SUP HCPCS C1713 236.400 - PLATE BN 115D 5MM DSPL 2 BRCH 30MM NS DCP CAPOS 2 HL SS BOTH IP/OP $538.00 $398.00 $106.72 $563.28 $241.97 $241.97 $241.97 $241.97 $537.70 $537.70 $537.70 $112.07 $537.70 $537.70 $537.70 $537.70 $537.70 $112.06 $537.70 $563.28 $318.05 $537.70 $563.28 $537.70 $537.70 $403.50 $537.70 $537.70 $537.70 $268.85 $268.85 $425.86 $537.70 $430.16 $241.97 $106.72 N/A $312.04 $537.70 $322.62 $537.70 $537.70 $537.70 N/A N/A 236.43 SUP HCPCS C1713 236.430 - PLATE BN 115D 5MM DSPL 2 BRCH 35MM NS DCP CAPOS 2 HL SS BOTH IP/OP $538.00 $398.00 $106.72 $563.28 $241.97 $241.97 $241.97 $241.97 $537.70 $537.70 $537.70 $112.07 $537.70 $537.70 $537.70 $537.70 $537.70 $112.06 $537.70 $563.28 $318.05 $537.70 $563.28 $537.70 $537.70 $403.50 $537.70 $537.70 $537.70 $268.85 $268.85 $425.86 $537.70 $430.16 $241.97 $106.72 N/A $312.04 $537.70 $537.70 $537.70 $112.06 $537.70 N/A N/A 236.502 SUP HCPCS C1713 236.502 - PLATE BONE 86MM 2 HOLE LCP STAINLESS STEEL RIGHT OLECRANON BOTH IP/OP "$1,645.00" "$1,217.00" $326.42 "$1,672.60" $740.09 $740.09 $740.09 $740.09 "$1,644.65" "$1,644.65" "$1,644.65" $342.79 "$1,644.65" "$1,644.65" "$1,644.65" "$1,644.65" "$1,644.65" $342.76 "$1,644.65" "$1,672.60" $972.81 "$1,644.65" "$1,672.60" "$1,644.65" "$1,644.65" "$1,233.75" "$1,644.65" "$1,644.65" "$1,644.65" $822.33 $822.33 "$1,302.56" "$1,644.65" "$1,315.72" $740.09 $326.42 N/A $954.10 "$1,644.65" "$1,644.65" "$1,644.65" $342.75 "$1,644.65" N/A N/A 236.503 SUP HCPCS C1713 236.503 - PLATE BONE 86MM 2 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT BOTH IP/OP "$1,645.00" "$1,217.00" $326.42 "$1,672.60" $740.09 $740.09 $740.09 $740.09 "$1,644.65" "$1,644.65" "$1,644.65" $342.79 "$1,644.65" "$1,644.65" "$1,644.65" "$1,644.65" "$1,644.65" $342.76 "$1,644.65" "$1,672.60" $972.81 "$1,644.65" "$1,672.60" "$1,644.65" "$1,644.65" "$1,233.75" "$1,644.65" "$1,644.65" "$1,644.65" $822.33 $822.33 "$1,302.56" "$1,644.65" "$1,315.72" $740.09 $326.42 N/A $954.10 "$1,644.65" $986.79 "$1,644.65" $342.75 "$1,644.65" N/A N/A 236.504 SUP HCPCS C1713 236.504 - PLATE BONE 112MM 4 HOLE PRECONTOUR LCP STAINLESS STEEL RIGHT BOTH IP/OP "$1,716.50" "$1,270.00" $340.65 "$1,745.53" $772.36 $772.36 $772.36 $772.36 "$1,716.35" "$1,716.35" "$1,716.35" $357.73 "$1,716.35" "$1,716.35" "$1,716.35" "$1,716.35" "$1,716.35" $357.71 "$1,716.35" "$1,745.53" "$1,015.22" "$1,716.35" "$1,745.53" "$1,716.35" "$1,716.35" "$1,287.38" "$1,716.35" "$1,716.35" "$1,716.35" $858.18 $858.18 "$1,359.35" "$1,716.35" "$1,373.08" $772.36 $340.65 N/A $995.57 "$1,716.35" "$1,029.81" "$1,716.35" $357.69 "$1,716.35" N/A N/A 236.505 SUP HCPCS C1713 236.505 - PLATE BONE 112MM 4 HOLE LCP STAINLESS STEEL LEFT OLECRANON BOTH IP/OP "$1,716.50" "$1,270.00" $340.65 "$1,745.53" $772.36 $772.36 $772.36 $772.36 "$1,716.35" "$1,716.35" "$1,716.35" $357.73 "$1,716.35" "$1,716.35" "$1,716.35" "$1,716.35" "$1,716.35" $357.71 "$1,716.35" "$1,745.53" "$1,015.22" "$1,716.35" "$1,745.53" "$1,716.35" "$1,716.35" "$1,287.38" "$1,716.35" "$1,716.35" "$1,716.35" $858.18 $858.18 "$1,359.35" "$1,716.35" "$1,373.08" $772.36 $340.65 N/A $995.57 "$1,716.35" "$1,029.81" "$1,716.35" $357.69 "$1,716.35" N/A N/A 236.506 SUP HCPCS C1713 236.506 - PLATE BONE 3.5MM 138MM 6 HOLE LCP STAINLESS STEEL RIGHT BOTH IP/OP "$1,771.50" "$1,311.00" $351.53 "$1,801.28" $797.03 $797.03 $797.03 $797.03 "$1,771.18" "$1,771.18" "$1,771.18" $369.16 "$1,771.18" "$1,771.18" "$1,771.18" "$1,771.18" "$1,771.18" $369.13 "$1,771.18" $720.51 "$1,047.65" "$1,771.18" "$1,801.28" "$1,771.18" "$1,771.18" "$1,328.63" "$1,771.18" "$1,771.18" "$1,771.18" $885.59 $885.59 "$1,402.77" "$1,771.18" "$1,416.94" $797.03 $351.53 N/A "$1,027.47" "$1,771.18" "$1,062.71" "$1,771.18" "$1,771.18" "$1,771.18" N/A N/A 236.507 SUP HCPCS C1713 236.507 - PLATE BONE 138MM 6 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT BOTH IP/OP "$1,771.50" "$1,311.00" $351.53 "$1,801.28" $797.03 $797.03 $797.03 $797.03 "$1,771.18" "$1,771.18" "$1,771.18" $369.16 "$1,771.18" "$1,771.18" "$1,771.18" "$1,771.18" "$1,771.18" $369.13 "$1,771.18" "$1,801.28" "$1,047.65" "$1,771.18" "$1,801.28" "$1,771.18" "$1,771.18" "$1,328.63" "$1,771.18" "$1,771.18" "$1,771.18" $885.59 $885.59 "$1,402.77" "$1,771.18" "$1,416.94" $797.03 $351.53 N/A "$1,027.47" "$1,771.18" "$1,062.71" "$1,771.18" "$1,771.18" "$1,771.18" N/A N/A 236.508 SUP HCPCS C1713 236.508 - PLATE BONE 164MM 8 HOLE LCP STAINLESS STEEL RIGHT OLECRANON BOTH IP/OP "$1,826.00" "$1,351.00" $362.42 "$1,857.05" $821.70 $821.70 $821.70 $821.70 "$1,826.00" "$1,826.00" "$1,826.00" $380.58 "$1,826.00" "$1,826.00" "$1,826.00" "$1,826.00" "$1,826.00" $380.56 "$1,826.00" $742.82 "$1,080.08" "$1,826.00" "$1,857.05" "$1,826.00" "$1,826.00" "$1,369.50" "$1,826.00" "$1,826.00" "$1,826.00" $913.00 $913.00 "$1,446.19" "$1,826.00" "$1,460.80" $821.70 $362.42 N/A "$1,059.08" "$1,826.00" "$1,826.00" "$1,826.00" $380.54 "$1,826.00" N/A N/A 236.509 SUP HCPCS C1713 236.509 - PLATE BONE 164MM 8 HOLE LCP STAINLESS STEEL LEFT OLECRANON BOTH IP/OP "$1,826.00" "$1,351.00" $362.42 "$1,857.05" $821.70 $821.70 $821.70 $821.70 "$1,826.00" "$1,826.00" "$1,826.00" $380.58 "$1,826.00" "$1,826.00" "$1,826.00" "$1,826.00" "$1,826.00" $380.56 "$1,826.00" "$1,857.05" "$1,080.08" "$1,826.00" "$1,857.05" "$1,826.00" "$1,826.00" "$1,369.50" "$1,826.00" "$1,826.00" "$1,826.00" $913.00 $913.00 "$1,446.19" "$1,826.00" "$1,460.80" $821.70 $362.42 N/A "$1,059.08" "$1,826.00" "$1,826.00" "$1,826.00" $380.54 "$1,826.00" N/A N/A 236.51 SUP HCPCS C1713 236.510 - PLATE BONE 190MM 10 HOLE LCP STAINLESS STEEL RIGHT OLECRANON BOTH IP/OP "$1,822.00" "$1,348.00" $361.61 "$1,908.50" $819.88 $819.88 $819.88 $819.88 "$1,821.95" "$1,821.95" "$1,821.95" $379.74 "$1,821.95" "$1,821.95" "$1,821.95" "$1,821.95" "$1,821.95" $379.71 "$1,821.95" $763.40 "$1,077.68" "$1,821.95" "$1,908.50" "$1,821.95" "$1,821.95" "$1,366.50" "$1,821.95" "$1,821.95" "$1,821.95" $910.98 $910.98 "$1,442.98" "$1,821.95" "$1,457.56" $819.88 $361.61 N/A "$1,056.76" "$1,821.95" "$1,821.95" "$1,821.95" "$1,821.95" "$1,821.95" N/A N/A 236.511 SUP HCPCS C1713 236.511 - PLATE BONE 190MM 10 HOLE LCP STAINLESS STEEL LEFT OLECRANON BOTH IP/OP "$1,877.00" "$1,389.00" $372.46 "$1,908.50" $844.47 $844.47 $844.47 $844.47 "$1,876.60" "$1,876.60" "$1,876.60" $391.13 "$1,876.60" "$1,876.60" "$1,876.60" "$1,876.60" "$1,876.60" $391.10 "$1,876.60" "$1,908.50" "$1,110.01" "$1,876.60" "$1,908.50" "$1,876.60" "$1,876.60" "$1,407.75" "$1,876.60" "$1,876.60" "$1,876.60" $938.30 $938.30 "$1,486.27" "$1,876.60" "$1,501.28" $844.47 $372.46 N/A "$1,088.66" "$1,876.60" "$1,876.60" "$1,876.60" $391.08 "$1,876.60" N/A N/A 236.512 SUP HCPCS C1713 236.512 - PLATE BONE 216MM 12 HOLE LCP STAINLESS STEEL RIGHT OLECRANON BOTH IP/OP "$1,910.50" "$1,414.00" $379.15 "$1,942.80" $859.65 $859.65 $859.65 $859.65 "$1,910.33" "$1,910.33" "$1,910.33" $398.16 "$1,910.33" "$1,910.33" "$1,910.33" "$1,910.33" "$1,910.33" $398.13 "$1,910.33" $777.12 "$1,129.96" "$1,910.33" "$1,942.80" "$1,910.33" "$1,910.33" "$1,432.88" "$1,910.33" "$1,910.33" "$1,910.33" $955.17 $955.17 "$1,512.98" "$1,910.33" "$1,528.26" $859.65 $379.15 N/A "$1,108.09" "$1,910.33" "$1,910.33" "$1,910.33" $398.11 "$1,910.33" N/A N/A 236.513 SUP HCPCS C1713 236.513 - PLATE BONE 215MM 12 HOLE LCP STAINLESS STEEL LEFT OLECRANON BOTH IP/OP "$1,910.50" "$1,414.00" $379.15 "$1,942.80" $859.65 $859.65 $859.65 $859.65 "$1,910.33" "$1,910.33" "$1,910.33" $398.16 "$1,910.33" "$1,910.33" "$1,910.33" "$1,910.33" "$1,910.33" $398.13 "$1,910.33" "$1,942.80" "$1,129.96" "$1,910.33" "$1,942.80" "$1,910.33" "$1,910.33" "$1,432.88" "$1,910.33" "$1,910.33" "$1,910.33" $955.17 $955.17 "$1,512.98" "$1,910.33" "$1,528.26" $859.65 $379.15 N/A "$1,108.09" "$1,910.33" "$1,910.33" "$1,910.33" $398.11 "$1,910.33" N/A N/A 237.2 SUP HCPCS C1713 237.20 - PLATE BONE 95D 50MM 12 HOLE ANGLED BLADE DCP STAINLESS STEEL BOTH IP/OP "$1,178.00" $872.00 $233.76 "$1,233.75" $530.00 $530.00 $530.00 $530.00 "$1,177.78" "$1,177.78" "$1,177.78" $245.48 "$1,177.78" "$1,177.78" "$1,177.78" "$1,177.78" "$1,177.78" $245.46 "$1,177.78" $493.50 $696.66 "$1,177.78" "$1,233.75" "$1,177.78" "$1,177.78" $883.50 "$1,177.78" "$1,177.78" "$1,177.78" $588.89 $588.89 $932.80 "$1,177.78" $942.22 $530.00 $233.76 N/A $683.24 "$1,177.78" $706.67 "$1,177.78" $245.45 "$1,177.78" N/A N/A 237.22 SUP HCPCS C1713 237.22 - PLATE BN 95D 60MM NS 204MM DCP 12 HL SS HIP CNDRL BOTH IP/OP "$1,213.50" $898.00 $240.78 "$1,233.75" $545.91 $545.91 $545.91 $545.91 "$1,213.13" "$1,213.13" "$1,213.13" $252.85 "$1,213.13" "$1,213.13" "$1,213.13" "$1,213.13" "$1,213.13" $252.83 "$1,213.13" $493.50 $717.57 "$1,213.13" "$1,233.75" "$1,213.13" "$1,213.13" $910.13 "$1,213.13" "$1,213.13" "$1,213.13" $606.57 $606.57 $960.80 "$1,213.13" $970.50 $545.91 $240.78 N/A $703.83 "$1,213.13" $727.88 "$1,213.13" $252.82 "$1,213.13" N/A N/A 237.24 SUP HCPCS C1713 237.24 - PLATE BN 95D 70MM NS 240MM DCP 12 HL SS HIP CNDRL BOTH IP/OP "$1,213.50" $898.00 $240.78 "$1,233.75" $545.91 $545.91 $545.91 $545.91 "$1,213.13" "$1,213.13" "$1,213.13" $252.85 "$1,213.13" "$1,213.13" "$1,213.13" "$1,213.13" "$1,213.13" $252.83 "$1,213.13" $493.50 $717.57 "$1,213.13" "$1,233.75" "$1,213.13" "$1,213.13" $910.13 "$1,213.13" "$1,213.13" "$1,213.13" $606.57 $606.57 $960.80 "$1,213.13" $970.50 $545.91 $240.78 N/A $703.83 "$1,213.13" $727.88 "$1,213.13" $252.82 "$1,213.13" N/A N/A 237.26 SUP HCPCS C1713 237.26 - PLATE BN 95D 70MM NS 204MM DCP 12 HL SS HIP CNDRL BOTH IP/OP "$1,213.50" $898.00 $240.78 "$1,233.75" $545.91 $545.91 $545.91 $545.91 "$1,213.13" "$1,213.13" "$1,213.13" $252.85 "$1,213.13" "$1,213.13" "$1,213.13" "$1,213.13" "$1,213.13" $252.83 "$1,213.13" "$1,233.75" $717.57 "$1,213.13" "$1,233.75" "$1,213.13" "$1,213.13" $910.13 "$1,213.13" "$1,213.13" "$1,213.13" $606.57 $606.57 $960.80 "$1,213.13" $970.50 $545.91 $240.78 N/A $703.83 "$1,213.13" "$1,213.13" "$1,213.13" $252.82 "$1,213.13" N/A N/A 237.261 SUP HCPCS C1713 237.261 - PLATE BONE 95D 60MM 26 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP "$2,690.00" "$1,991.00" $533.89 "$2,689.95" "$1,210.48" "$1,210.48" "$1,210.48" "$1,210.48" "$2,689.95" "$2,689.95" "$2,689.95" $560.65 "$2,689.95" "$2,689.95" "$2,689.95" "$2,689.95" "$2,689.95" $560.62 "$2,689.95" "$2,689.95" "$1,326.15" "$2,689.95" "$2,689.95" "$2,689.95" "$2,689.95" "$2,017.50" "$2,689.95" "$2,689.95" "$2,689.95" "$1,344.98" "$1,344.98" "$2,130.44" "$2,689.95" "$2,151.96" "$1,210.48" $533.89 N/A "$1,560.20" "$2,689.95" "$1,613.97" "$2,689.95" $560.59 "$2,689.95" N/A N/A 237.262 SUP HCPCS C1713 237.262 - PLATE BONE 95D 70MM 26 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP "$2,536.00" "$1,877.00" $503.24 "$2,535.53" "$1,140.99" "$1,140.99" "$1,140.99" "$1,140.99" "$2,535.53" "$2,535.53" "$2,535.53" $528.47 "$2,535.53" "$2,535.53" "$2,535.53" "$2,535.53" "$2,535.53" $528.43 "$2,535.53" "$2,535.53" "$1,250.02" "$2,535.53" "$2,535.53" "$2,535.53" "$2,535.53" "$1,902.00" "$2,535.53" "$2,535.53" "$2,535.53" "$1,267.77" "$1,267.77" "$2,008.14" "$2,535.53" "$2,028.42" "$1,140.99" $503.24 N/A "$1,470.88" "$2,535.53" "$1,521.32" "$2,535.53" "$2,535.53" "$2,535.53" N/A N/A 237.4 SUP HCPCS C1713 237.40 - PLATE BONE 95D 50MM 235MM 14 HOLE DCP STAINLESS STEEL BOTH IP/OP "$1,765.00" "$1,306.00" $350.23 "$1,848.45" $794.08 $794.08 $794.08 $794.08 "$1,764.63" "$1,764.63" "$1,764.63" $367.79 "$1,764.63" "$1,764.63" "$1,764.63" "$1,764.63" "$1,764.63" $367.77 "$1,764.63" "$1,848.45" "$1,043.78" "$1,764.63" "$1,848.45" "$1,764.63" "$1,764.63" "$1,323.75" "$1,764.63" "$1,764.63" "$1,764.63" $882.32 $882.32 "$1,397.59" "$1,764.63" "$1,411.70" $794.08 $350.23 N/A "$1,023.70" "$1,764.63" "$1,058.78" "$1,764.63" $367.75 "$1,764.63" N/A N/A 237.42 SUP HCPCS C1713 237.42 - PLATE BONE 95D 60MM 235MM 14 HOLE DCP STAINLESS STEEL BOTH IP/OP "$1,818.00" "$1,345.00" $360.74 "$1,848.45" $817.90 $817.90 $817.90 $817.90 "$1,817.55" "$1,817.55" "$1,817.55" $378.82 "$1,817.55" "$1,817.55" "$1,817.55" "$1,817.55" "$1,817.55" $378.80 "$1,817.55" "$1,848.45" "$1,075.08" "$1,817.55" "$1,848.45" "$1,817.55" "$1,817.55" "$1,363.50" "$1,817.55" "$1,817.55" "$1,817.55" $908.78 $908.78 "$1,439.50" "$1,817.55" "$1,454.04" $817.90 $360.74 N/A "$1,054.44" "$1,817.55" "$1,090.53" "$1,817.55" $378.78 "$1,817.55" N/A N/A 237.44 SUP HCPCS C1713 237.44 - PLATE BN 95D 70MM NS 235MM DCP 14 HL SS HIP CNDRL BOTH IP/OP "$1,818.00" "$1,345.00" $360.74 "$1,848.45" $817.90 $817.90 $817.90 $817.90 "$1,817.55" "$1,817.55" "$1,817.55" $378.82 "$1,817.55" "$1,817.55" "$1,817.55" "$1,817.55" "$1,817.55" $378.80 "$1,817.55" "$1,848.45" "$1,075.08" "$1,817.55" "$1,848.45" "$1,817.55" "$1,817.55" "$1,363.50" "$1,817.55" "$1,817.55" "$1,817.55" $908.78 $908.78 "$1,439.50" "$1,817.55" "$1,454.04" $817.90 $360.74 N/A "$1,054.44" "$1,817.55" "$1,817.55" "$1,817.55" "$1,817.55" "$1,817.55" N/A N/A 237.46 SUP HCPCS C1713 237.46 - PLATE BONE 95D 80MM 235MM 14 HOLE DCP STAINLESS STEEL BOTH IP/OP "$1,818.00" "$1,345.00" $360.74 "$1,848.45" $817.90 $817.90 $817.90 $817.90 "$1,817.55" "$1,817.55" "$1,817.55" $378.82 "$1,817.55" "$1,817.55" "$1,817.55" "$1,817.55" "$1,817.55" $378.80 "$1,817.55" "$1,848.45" "$1,075.08" "$1,817.55" "$1,848.45" "$1,817.55" "$1,817.55" "$1,363.50" "$1,817.55" "$1,817.55" "$1,817.55" $908.78 $908.78 "$1,439.50" "$1,817.55" "$1,454.04" $817.90 $360.74 N/A "$1,054.44" "$1,817.55" "$1,090.53" "$1,817.55" "$1,817.55" "$1,817.55" N/A N/A 237.5 SUP HCPCS C1713 237.50 - PLATE BN 95D 50MM NS 92MM DCP 5 HL SS HIP CNDRL BOTH IP/OP $979.00 $724.00 $194.21 "$1,025.00" $440.34 $440.34 $440.34 $440.34 $978.53 $978.53 $978.53 $203.95 $978.53 $978.53 $978.53 $978.53 $978.53 $203.94 $978.53 "$1,025.00" $578.80 $978.53 "$1,025.00" $978.53 $978.53 $734.25 $978.53 $978.53 $978.53 $489.27 $489.27 $775.00 $978.53 $782.82 $440.34 $194.21 N/A $567.82 $978.53 $587.12 $978.53 $203.93 $978.53 N/A N/A 237.52 SUP HCPCS C1713 237.52 - PLATE BONE 95D 60MM 92MM 5 HOLE DCP STAINLESS STEEL CONDYLE BOTH IP/OP "$1,008.00" $746.00 $200.04 "$1,025.00" $453.55 $453.55 $453.55 $453.55 "$1,007.88" "$1,007.88" "$1,007.88" $210.07 "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" $210.05 "$1,007.88" "$1,025.00" $596.16 "$1,007.88" "$1,025.00" "$1,007.88" "$1,007.88" $756.00 "$1,007.88" "$1,007.88" "$1,007.88" $503.94 $503.94 $798.24 "$1,007.88" $806.30 $453.55 $200.04 N/A $584.64 "$1,007.88" $604.73 "$1,007.88" "$1,007.88" "$1,007.88" N/A N/A 237.54 SUP HCPCS C1713 237.54 - PLATE BN 95D 70MM NS 92MM DCP 5 HL SS HIP CNDRL BOTH IP/OP "$1,008.00" $746.00 $200.04 "$1,025.00" $453.55 $453.55 $453.55 $453.55 "$1,007.88" "$1,007.88" "$1,007.88" $210.07 "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" $210.05 "$1,007.88" "$1,025.00" $596.16 "$1,007.88" "$1,025.00" "$1,007.88" "$1,007.88" $756.00 "$1,007.88" "$1,007.88" "$1,007.88" $503.94 $503.94 $798.24 "$1,007.88" $806.30 $453.55 $200.04 N/A $584.64 "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" N/A N/A 237.56 SUP HCPCS C1713 237.56 - PLATE BONE 95D 80MM 92MM 5 HOLE DCP STAINLESS STEEL CONDYLE BOTH IP/OP "$1,008.00" $746.00 $200.04 "$1,025.00" $453.55 $453.55 $453.55 $453.55 "$1,007.88" "$1,007.88" "$1,007.88" $210.07 "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" $210.05 "$1,007.88" "$1,025.00" $596.16 "$1,007.88" "$1,025.00" "$1,007.88" "$1,007.88" $756.00 "$1,007.88" "$1,007.88" "$1,007.88" $503.94 $503.94 $798.24 "$1,007.88" $806.30 $453.55 $200.04 N/A $584.64 "$1,007.88" $604.73 "$1,007.88" $210.04 "$1,007.88" N/A N/A 237.62 SUP HCPCS C1713 237.62 - PLATE BONE 95D 60MM 267MM 16 HOLE DCP STAINLESS STEEL BOTH IP/OP "$1,922.00" "$1,422.00" $381.39 "$1,954.25" $864.71 $864.71 $864.71 $864.71 "$1,921.58" "$1,921.58" "$1,921.58" $400.51 "$1,921.58" "$1,921.58" "$1,921.58" "$1,921.58" "$1,921.58" $400.48 "$1,921.58" "$1,954.25" "$1,136.61" "$1,921.58" "$1,954.25" "$1,921.58" "$1,921.58" "$1,441.50" "$1,921.58" "$1,921.58" "$1,921.58" $960.79 $960.79 "$1,521.89" "$1,921.58" "$1,537.26" $864.71 $381.39 N/A "$1,114.76" "$1,921.58" "$1,152.95" "$1,921.58" $400.46 "$1,921.58" N/A N/A 237.64 SUP HCPCS C1713 237.64 - PLATE BN 95D 70MM NS 267MM DCP 16 HL SS HIP CNDRL BOTH IP/OP "$1,922.00" "$1,422.00" $381.39 "$1,954.25" $864.71 $864.71 $864.71 $864.71 "$1,921.58" "$1,921.58" "$1,921.58" $400.51 "$1,921.58" "$1,921.58" "$1,921.58" "$1,921.58" "$1,921.58" $400.48 "$1,921.58" $781.70 "$1,136.61" "$1,921.58" "$1,954.25" "$1,921.58" "$1,921.58" "$1,441.50" "$1,921.58" "$1,921.58" "$1,921.58" $960.79 $960.79 "$1,521.89" "$1,921.58" "$1,537.26" $864.71 $381.39 N/A "$1,114.76" "$1,921.58" "$1,152.95" "$1,921.58" $400.46 "$1,921.58" N/A N/A 237.66 SUP HCPCS C1713 237.66 - PLATE BN 95D 80MM NS 267MM DCP 16 HL SS HIP CNDRL BOTH IP/OP "$1,922.00" "$1,422.00" $381.39 "$1,954.25" $864.71 $864.71 $864.71 $864.71 "$1,921.58" "$1,921.58" "$1,921.58" $400.51 "$1,921.58" "$1,921.58" "$1,921.58" "$1,921.58" "$1,921.58" $400.48 "$1,921.58" $781.70 "$1,136.61" "$1,921.58" "$1,954.25" "$1,921.58" "$1,921.58" "$1,441.50" "$1,921.58" "$1,921.58" "$1,921.58" $960.79 $960.79 "$1,521.89" "$1,921.58" "$1,537.26" $864.71 $381.39 N/A "$1,114.76" "$1,921.58" "$1,152.95" "$1,921.58" $400.46 "$1,921.58" N/A N/A 237.7 SUP HCPCS C1713 237.70 - PLATE BONE 95D 124MM 50MM 7 HOLE BLADE DCP STAINLESS STEEL BOTH IP/OP "$1,032.00" $764.00 $204.78 "$1,080.78" $464.29 $464.29 $464.29 $464.29 "$1,031.75" "$1,031.75" "$1,031.75" $215.04 "$1,031.75" "$1,031.75" "$1,031.75" "$1,031.75" "$1,031.75" $215.03 "$1,031.75" $432.31 $610.28 "$1,031.75" "$1,080.78" "$1,031.75" "$1,031.75" $774.00 "$1,031.75" "$1,031.75" "$1,031.75" $515.88 $515.88 $817.15 "$1,031.75" $825.40 $464.29 $204.78 N/A $598.56 "$1,031.75" $619.05 "$1,031.75" $215.02 "$1,031.75" N/A N/A 237.72 SUP HCPCS C1713 237.72 - PLATE BN 95D 60MM NS 124MM DCP 7 HL SS HIP CNDRL BOTH IP/OP "$1,063.00" $787.00 $210.92 "$1,080.78" $478.22 $478.22 $478.22 $478.22 "$1,062.70" "$1,062.70" "$1,062.70" $221.49 "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" $221.48 "$1,062.70" $432.31 $628.59 "$1,062.70" "$1,080.78" "$1,062.70" "$1,062.70" $797.25 "$1,062.70" "$1,062.70" "$1,062.70" $531.35 $531.35 $841.66 "$1,062.70" $850.16 $478.22 $210.92 N/A $616.54 "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" N/A N/A 237.74 SUP HCPCS C1713 237.74 - PLATE BN 95D 70MM NS 124MM DCP 7 HL SS HIP CNDRL BOTH IP/OP "$1,063.00" $787.00 $210.92 "$1,080.78" $478.22 $478.22 $478.22 $478.22 "$1,062.70" "$1,062.70" "$1,062.70" $221.49 "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" $221.48 "$1,062.70" $432.31 $628.59 "$1,062.70" "$1,080.78" "$1,062.70" "$1,062.70" $797.25 "$1,062.70" "$1,062.70" "$1,062.70" $531.35 $531.35 $841.66 "$1,062.70" $850.16 $478.22 $210.92 N/A $616.54 "$1,062.70" "$1,062.70" "$1,062.70" $221.47 "$1,062.70" N/A N/A 237.76 SUP HCPCS C1713 237.76 - PLATE BN 95D 80MM NS 124MM DCP 7 HL SS HIP CNDRL BOTH IP/OP "$1,063.00" $787.00 $210.92 "$1,080.78" $478.22 $478.22 $478.22 $478.22 "$1,062.70" "$1,062.70" "$1,062.70" $221.49 "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" $221.48 "$1,062.70" "$1,080.78" $628.59 "$1,062.70" "$1,080.78" "$1,062.70" "$1,062.70" $797.25 "$1,062.70" "$1,062.70" "$1,062.70" $531.35 $531.35 $841.66 "$1,062.70" $850.16 $478.22 $210.92 N/A $616.54 "$1,062.70" $637.62 "$1,062.70" "$1,062.70" "$1,062.70" N/A N/A 237.82 SUP HCPCS C1713 237.82 - PLATE BONE 95D 299MM 60MM 18 HOLE DCP STAINLESS STEEL BOTH IP/OP "$2,127.00" "$1,574.00" $422.12 "$2,162.98" $957.07 $957.07 $957.07 $957.07 "$2,126.83" "$2,126.83" "$2,126.83" $443.28 "$2,126.83" "$2,126.83" "$2,126.83" "$2,126.83" "$2,126.83" $443.25 "$2,126.83" $865.19 "$1,258.02" "$2,126.83" "$2,162.98" "$2,126.83" "$2,126.83" "$1,595.25" "$2,126.83" "$2,126.83" "$2,126.83" "$1,063.42" "$1,063.42" "$1,684.45" "$2,126.83" "$1,701.46" $957.07 $422.12 N/A "$1,233.66" "$2,126.83" "$1,276.10" "$2,126.83" $443.23 "$2,126.83" N/A N/A 237.84 SUP HCPCS C1713 237.84 - PLATE BN 95D 80MM NS 299MM DCP 18 HL SS HIP CNDRL BOTH IP/OP "$2,127.00" "$1,574.00" $422.12 "$2,162.98" $957.07 $957.07 $957.07 $957.07 "$2,126.83" "$2,126.83" "$2,126.83" $443.28 "$2,126.83" "$2,126.83" "$2,126.83" "$2,126.83" "$2,126.83" $443.25 "$2,126.83" $865.19 "$1,258.02" "$2,126.83" "$2,162.98" "$2,126.83" "$2,126.83" "$1,595.25" "$2,126.83" "$2,126.83" "$2,126.83" "$1,063.42" "$1,063.42" "$1,684.45" "$2,126.83" "$1,701.46" $957.07 $422.12 N/A "$1,233.66" "$2,126.83" "$1,276.10" "$2,126.83" $443.23 "$2,126.83" N/A N/A 237.86 SUP HCPCS C1713 237.86 - PLATE BN 95D 80MM NS 299MM DCP 18 HL SS HIP CNDRL BOTH IP/OP "$2,127.00" "$1,574.00" $422.12 "$2,162.98" $957.07 $957.07 $957.07 $957.07 "$2,126.83" "$2,126.83" "$2,126.83" $443.28 "$2,126.83" "$2,126.83" "$2,126.83" "$2,126.83" "$2,126.83" $443.25 "$2,126.83" $865.19 "$1,258.02" "$2,126.83" "$2,162.98" "$2,126.83" "$2,126.83" "$1,595.25" "$2,126.83" "$2,126.83" "$2,126.83" "$1,063.42" "$1,063.42" "$1,684.45" "$2,126.83" "$1,701.46" $957.07 $422.12 N/A "$1,233.66" "$2,126.83" "$1,276.10" "$2,126.83" "$2,126.83" "$2,126.83" N/A N/A 237.9 SUP HCPCS C1713 237.90 - PLATE BN 95D 50MM NS 156MM DCP 9 HL SS HIP CNDRL BOTH IP/OP "$1,081.00" $800.00 $214.53 "$1,132.23" $486.40 $486.40 $486.40 $486.40 "$1,080.88" "$1,080.88" "$1,080.88" $225.28 "$1,080.88" "$1,080.88" "$1,080.88" "$1,080.88" "$1,080.88" $225.27 "$1,080.88" $452.89 $639.34 "$1,080.88" "$1,132.23" "$1,080.88" "$1,080.88" $810.75 "$1,080.88" "$1,080.88" "$1,080.88" $540.44 $540.44 $856.06 "$1,080.88" $864.70 $486.40 $214.53 N/A $626.98 "$1,080.88" $648.53 "$1,080.88" "$1,080.88" "$1,080.88" N/A N/A 237.92 SUP HCPCS C1713 237.92 - PLATE BN 95D 60MM NS 156MM DCP 9 HL SS HIP CNDRL BOTH IP/OP "$1,113.50" $824.00 $220.96 "$1,132.23" $500.99 $500.99 $500.99 $500.99 "$1,113.30" "$1,113.30" "$1,113.30" $232.04 "$1,113.30" "$1,113.30" "$1,113.30" "$1,113.30" "$1,113.30" $232.02 "$1,113.30" "$1,132.23" $658.52 "$1,113.30" "$1,132.23" "$1,113.30" "$1,113.30" $835.13 "$1,113.30" "$1,113.30" "$1,113.30" $556.65 $556.65 $881.73 "$1,113.30" $890.64 $500.99 $220.96 N/A $645.83 "$1,113.30" $667.98 "$1,113.30" $232.01 "$1,113.30" N/A N/A 237.94 SUP HCPCS C1713 237.94 - PLATE BN 95D 70MM NS 156MM DCP 9 HL SS HIP CNDRL BOTH IP/OP "$1,113.50" $824.00 $220.96 "$1,132.23" $500.99 $500.99 $500.99 $500.99 "$1,113.30" "$1,113.30" "$1,113.30" $232.04 "$1,113.30" "$1,113.30" "$1,113.30" "$1,113.30" "$1,113.30" $232.02 "$1,113.30" "$1,132.23" $658.52 "$1,113.30" "$1,132.23" "$1,113.30" "$1,113.30" $835.13 "$1,113.30" "$1,113.30" "$1,113.30" $556.65 $556.65 $881.73 "$1,113.30" $890.64 $500.99 $220.96 N/A $645.83 "$1,113.30" $667.98 "$1,113.30" $232.01 "$1,113.30" N/A N/A 237.96 SUP HCPCS C1713 237.96 - PLATE BN 95D 80MM NS 156MM DCP 9 HL SS HIP CNDRL BOTH IP/OP "$1,113.50" $824.00 $220.96 "$1,132.23" $500.99 $500.99 $500.99 $500.99 "$1,113.30" "$1,113.30" "$1,113.30" $232.04 "$1,113.30" "$1,113.30" "$1,113.30" "$1,113.30" "$1,113.30" $232.02 "$1,113.30" "$1,132.23" $658.52 "$1,113.30" "$1,132.23" "$1,113.30" "$1,113.30" $835.13 "$1,113.30" "$1,113.30" "$1,113.30" $556.65 $556.65 $881.73 "$1,113.30" $890.64 $500.99 $220.96 N/A $645.83 "$1,113.30" "$1,113.30" "$1,113.30" $232.01 "$1,113.30" N/A N/A 237.995 SUP HCPCS C1713 237.995 - PLATE BONE 90D 35MM 5 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP "$1,394.00" "$1,032.00" $276.65 "$1,393.90" $627.26 $627.26 $627.26 $627.26 "$1,393.90" "$1,393.90" "$1,393.90" $290.52 "$1,393.90" "$1,393.90" "$1,393.90" "$1,393.90" "$1,393.90" $290.50 "$1,393.90" "$1,393.90" $824.49 "$1,393.90" "$1,393.90" "$1,393.90" "$1,393.90" "$1,045.50" "$1,393.90" "$1,393.90" "$1,393.90" $696.95 $696.95 "$1,103.97" "$1,393.90" "$1,115.12" $627.26 $276.65 N/A $808.52 "$1,393.90" $836.34 "$1,393.90" $290.49 "$1,393.90" N/A N/A 237.997 SUP HCPCS C1713 237.997 - PLATE BONE 90D 35MM 7 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP "$1,394.00" "$1,032.00" $276.65 "$1,393.90" $627.26 $627.26 $627.26 $627.26 "$1,393.90" "$1,393.90" "$1,393.90" $290.52 "$1,393.90" "$1,393.90" "$1,393.90" "$1,393.90" "$1,393.90" $290.50 "$1,393.90" "$1,393.90" $824.49 "$1,393.90" "$1,393.90" "$1,393.90" "$1,393.90" "$1,045.50" "$1,393.90" "$1,393.90" "$1,393.90" $696.95 $696.95 "$1,103.97" "$1,393.90" "$1,115.12" $627.26 $276.65 N/A $808.52 "$1,393.90" $836.34 "$1,393.90" $290.49 "$1,393.90" N/A N/A 238.24 SUP HCPCS C1713 238.24 - PLATE BONE 130D 70MM 12 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP "$1,193.50" $883.00 $236.87 "$1,213.73" $537.04 $537.04 $537.04 $537.04 "$1,193.43" "$1,193.43" "$1,193.43" $248.74 "$1,193.43" "$1,193.43" "$1,193.43" "$1,193.43" "$1,193.43" $248.72 "$1,193.43" "$1,213.73" $705.91 "$1,193.43" "$1,213.73" "$1,193.43" "$1,193.43" $895.13 "$1,193.43" "$1,193.43" "$1,193.43" $596.72 $596.72 $945.20 "$1,193.43" $954.74 $537.04 $236.87 N/A $692.23 "$1,193.43" $716.06 "$1,193.43" "$1,193.43" "$1,193.43" N/A N/A 238.26 SUP HCPCS C1713 238.26 - PLATE BONE 130D 80MM 12 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP "$1,193.50" $883.00 $236.87 "$1,213.73" $537.04 $537.04 $537.04 $537.04 "$1,193.43" "$1,193.43" "$1,193.43" $248.74 "$1,193.43" "$1,193.43" "$1,193.43" "$1,193.43" "$1,193.43" $248.72 "$1,193.43" "$1,213.73" $705.91 "$1,193.43" "$1,213.73" "$1,193.43" "$1,193.43" $895.13 "$1,193.43" "$1,193.43" "$1,193.43" $596.72 $596.72 $945.20 "$1,193.43" $954.74 $537.04 $236.87 N/A $692.23 "$1,193.43" "$1,193.43" "$1,193.43" "$1,193.43" "$1,193.43" N/A N/A 238.28 SUP HCPCS C1713 238.28 - PLATE BONE 130D 90MM 12 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP "$1,193.50" $883.00 $236.87 "$1,213.73" $537.04 $537.04 $537.04 $537.04 "$1,193.43" "$1,193.43" "$1,193.43" $248.74 "$1,193.43" "$1,193.43" "$1,193.43" "$1,193.43" "$1,193.43" $248.72 "$1,193.43" "$1,213.73" $705.91 "$1,193.43" "$1,213.73" "$1,193.43" "$1,193.43" $895.13 "$1,193.43" "$1,193.43" "$1,193.43" $596.72 $596.72 $945.20 "$1,193.43" $954.74 $537.04 $236.87 N/A $692.23 "$1,193.43" $716.06 "$1,193.43" $248.71 "$1,193.43" N/A N/A 238.36 SUP HCPCS C1713 238.36 - PLATE BONE 130D 50MM 4 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP $876.00 $648.00 $173.81 $890.65 $394.09 $394.09 $394.09 $394.09 $875.75 $875.75 $875.75 $182.53 $875.75 $875.75 $875.75 $875.75 $875.75 $182.52 $875.75 $890.65 $518.01 $875.75 $890.65 $875.75 $875.75 $657.00 $875.75 $875.75 $875.75 $437.88 $437.88 $693.59 $875.75 $700.60 $394.09 $173.81 N/A $508.08 $875.75 $525.45 $875.75 $875.75 $875.75 N/A N/A 238.38 SUP HCPCS C1713 238.38 - PLATE BONE 130D 60MM 4 HOLE ANGLED BLADE DCP STAINLESS STEEL BOTH IP/OP $876.00 $648.00 $173.81 $890.65 $394.09 $394.09 $394.09 $394.09 $875.75 $875.75 $875.75 $182.53 $875.75 $875.75 $875.75 $875.75 $875.75 $182.52 $875.75 $890.65 $518.01 $875.75 $890.65 $875.75 $875.75 $657.00 $875.75 $875.75 $875.75 $437.88 $437.88 $693.59 $875.75 $700.60 $394.09 $173.81 N/A $508.08 $875.75 $525.45 $875.75 $875.75 $875.75 N/A N/A 238.4 SUP HCPCS C1713 238.40 - PLATE BONE 130D 100MM 60MM 4 HOLE DCP STAINLESS STEEL SMALL BOTH IP/OP $850.50 $629.00 $168.75 $890.65 $382.61 $382.61 $382.61 $382.61 $850.25 $850.25 $850.25 $177.21 $850.25 $850.25 $850.25 $850.25 $850.25 $177.20 $850.25 $890.65 $502.92 $850.25 $890.65 $850.25 $850.25 $637.88 $850.25 $850.25 $850.25 $425.13 $425.13 $673.40 $850.25 $680.20 $382.61 $168.75 N/A $493.29 $850.25 $510.15 $850.25 $850.25 $850.25 N/A N/A 238.41 SUP HCPCS C1713 238.41 - PLATE BONE 130D 105MM 4 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP $876.00 $648.00 $173.81 $890.65 $394.09 $394.09 $394.09 $394.09 $875.75 $875.75 $875.75 $182.53 $875.75 $875.75 $875.75 $875.75 $875.75 $182.52 $875.75 $890.65 $518.01 $875.75 $890.65 $875.75 $875.75 $657.00 $875.75 $875.75 $875.75 $437.88 $437.88 $693.59 $875.75 $700.60 $394.09 $173.81 N/A $508.08 $875.75 $525.45 $875.75 $182.51 $875.75 N/A N/A 238.42 SUP HCPCS C1713 238.42 - PLATE BONE 130D 110MM 4 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP $876.00 $648.00 $173.81 $890.65 $394.09 $394.09 $394.09 $394.09 $875.75 $875.75 $875.75 $182.53 $875.75 $875.75 $875.75 $875.75 $875.75 $182.52 $875.75 $890.65 $518.01 $875.75 $890.65 $875.75 $875.75 $657.00 $875.75 $875.75 $875.75 $437.88 $437.88 $693.59 $875.75 $700.60 $394.09 $173.81 N/A $508.08 $875.75 $525.45 $875.75 $875.75 $875.75 N/A N/A 238.44 SUP HCPCS C1713 238.44 - PLATE BONE 130D 70MM 4 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP $876.00 $648.00 $173.81 $890.65 $394.09 $394.09 $394.09 $394.09 $875.75 $875.75 $875.75 $182.53 $875.75 $875.75 $875.75 $875.75 $875.75 $182.52 $875.75 $356.26 $518.01 $875.75 $890.65 $875.75 $875.75 $657.00 $875.75 $875.75 $875.75 $437.88 $437.88 $693.59 $875.75 $700.60 $394.09 $173.81 N/A $508.08 $875.75 $525.45 $875.75 $875.75 $875.75 N/A N/A 238.45 SUP HCPCS C1713 238.45 - PLATE BONE 130D 75MM 4 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP $876.00 $648.00 $173.81 $890.65 $394.09 $394.09 $394.09 $394.09 $875.75 $875.75 $875.75 $182.53 $875.75 $875.75 $875.75 $875.75 $875.75 $182.52 $875.75 $356.26 $518.01 $875.75 $890.65 $875.75 $875.75 $657.00 $875.75 $875.75 $875.75 $437.88 $437.88 $693.59 $875.75 $700.60 $394.09 $173.81 N/A $508.08 $875.75 $875.75 $875.75 $182.51 $875.75 N/A N/A 238.46 SUP HCPCS C1713 238.46 - PLATE BONE 130D 80MM 4 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP $876.00 $648.00 $173.81 $890.65 $394.09 $394.09 $394.09 $394.09 $875.75 $875.75 $875.75 $182.53 $875.75 $875.75 $875.75 $875.75 $875.75 $182.52 $875.75 $890.65 $518.01 $875.75 $890.65 $875.75 $875.75 $657.00 $875.75 $875.75 $875.75 $437.88 $437.88 $693.59 $875.75 $700.60 $394.09 $173.81 N/A $508.08 $875.75 $525.45 $875.75 $182.51 $875.75 N/A N/A 238.47 SUP HCPCS C1713 238.47 - PLATE BONE 130D 85MM 4 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP $876.00 $648.00 $173.81 $890.65 $394.09 $394.09 $394.09 $394.09 $875.75 $875.75 $875.75 $182.53 $875.75 $875.75 $875.75 $875.75 $875.75 $182.52 $875.75 $890.65 $518.01 $875.75 $890.65 $875.75 $875.75 $657.00 $875.75 $875.75 $875.75 $437.88 $437.88 $693.59 $875.75 $700.60 $394.09 $173.81 N/A $508.08 $875.75 $525.45 $875.75 $182.51 $875.75 N/A N/A 238.48 SUP HCPCS C1713 238.48 - PLATE BONE 130D 90MM 4 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP $876.00 $648.00 $173.81 $890.65 $394.09 $394.09 $394.09 $394.09 $875.75 $875.75 $875.75 $182.53 $875.75 $875.75 $875.75 $875.75 $875.75 $182.52 $875.75 $890.65 $518.01 $875.75 $890.65 $875.75 $875.75 $657.00 $875.75 $875.75 $875.75 $437.88 $437.88 $693.59 $875.75 $700.60 $394.09 $173.81 N/A $508.08 $875.75 $525.45 $875.75 $182.51 $875.75 N/A N/A 238.49 SUP HCPCS C1713 238.49 - PLATE BONE 130D 95MM 4 HOLE ANGLED DCP STAINLESS STEEL BOTH IP/OP $876.00 $648.00 $173.81 $890.65 $394.09 $394.09 $394.09 $394.09 $875.75 $875.75 $875.75 $182.53 $875.75 $875.75 $875.75 $875.75 $875.75 $182.52 $875.75 $356.26 $518.01 $875.75 $890.65 $875.75 $875.75 $657.00 $875.75 $875.75 $875.75 $437.88 $437.88 $693.59 $875.75 $700.60 $394.09 $173.81 N/A $508.08 $875.75 $875.75 $875.75 $182.51 $875.75 N/A N/A 238.6 SUP HCPCS C1713 238.60 - PLATE BONE 130D 104MM 50MM 6 HOLE DCP STAINLESS STEEL SMALL BOTH IP/OP $913.50 $676.00 $181.21 $956.38 $410.86 $410.86 $410.86 $410.86 $913.03 $913.03 $913.03 $190.30 $913.03 $913.03 $913.03 $913.03 $913.03 $190.29 $913.03 $956.38 $540.06 $913.03 $956.38 $913.03 $913.03 $685.13 $913.03 $913.03 $913.03 $456.52 $456.52 $723.12 $913.03 $730.42 $410.86 $181.21 N/A $529.83 $913.03 $547.82 $913.03 $190.28 $913.03 N/A N/A 238.62 SUP HCPCS C1713 238.62 - PLATE BONE 130D 104MM 60MM 6 HOLE DCP STAINLESS STEEL BOTH IP/OP $940.50 $696.00 $186.65 $956.38 $423.18 $423.18 $423.18 $423.18 $940.40 $940.40 $940.40 $196.00 $940.40 $940.40 $940.40 $940.40 $940.40 $195.99 $940.40 $956.38 $556.25 $940.40 $956.38 $940.40 $940.40 $705.38 $940.40 $940.40 $940.40 $470.20 $470.20 $744.80 $940.40 $752.32 $423.18 $186.65 N/A $545.49 $940.40 $564.24 $940.40 $195.98 $940.40 N/A N/A 238.64 SUP HCPCS C1713 238.64 - PLATE BN 130D 70MM NS 104MM DCP 6 HL SS HIP CNDRL BOTH IP/OP $940.50 $696.00 $186.65 $956.38 $423.18 $423.18 $423.18 $423.18 $940.40 $940.40 $940.40 $196.00 $940.40 $940.40 $940.40 $940.40 $940.40 $195.99 $940.40 $956.38 $556.25 $940.40 $956.38 $940.40 $940.40 $705.38 $940.40 $940.40 $940.40 $470.20 $470.20 $744.80 $940.40 $752.32 $423.18 $186.65 N/A $545.49 $940.40 $564.24 $940.40 $195.98 $940.40 N/A N/A 238.66 SUP HCPCS C1713 238.66 - PLATE BONE 130D 104MM 80MM 6 HOLE DCP STAINLESS STEEL BOTH IP/OP $940.50 $696.00 $186.65 $956.38 $423.18 $423.18 $423.18 $423.18 $940.40 $940.40 $940.40 $196.00 $940.40 $940.40 $940.40 $940.40 $940.40 $195.99 $940.40 $382.55 $556.25 $940.40 $956.38 $940.40 $940.40 $705.38 $940.40 $940.40 $940.40 $470.20 $470.20 $744.80 $940.40 $752.32 $423.18 $186.65 N/A $545.49 $940.40 $564.24 $940.40 $195.98 $940.40 N/A N/A 238.68 SUP HCPCS C1713 238.68 - PLATE BN 130D 90MM NS 104MM DCP 6 HL SS HIP CNDRL BOTH IP/OP $940.50 $696.00 $186.65 $956.38 $423.18 $423.18 $423.18 $423.18 $940.40 $940.40 $940.40 $196.00 $940.40 $940.40 $940.40 $940.40 $940.40 $195.99 $940.40 $956.38 $556.25 $940.40 $956.38 $940.40 $940.40 $705.38 $940.40 $940.40 $940.40 $470.20 $470.20 $744.80 $940.40 $752.32 $423.18 $186.65 N/A $545.49 $940.40 $564.24 $940.40 $195.98 $940.40 N/A N/A 238.7 SUP HCPCS C1713 238.700 - PLATE BONE 116MM 13.5X3.7MM 4 HOLE LCP STAINLESS STEEL RIGHT BOTH IP/OP "$2,607.00" "$1,929.00" $517.36 "$2,730.53" "$1,173.01" "$1,173.01" "$1,173.01" "$1,173.01" "$2,606.68" "$2,606.68" "$2,606.68" $543.30 "$2,606.68" "$2,606.68" "$2,606.68" "$2,606.68" "$2,606.68" $543.26 "$2,606.68" "$2,730.53" "$1,285.09" "$2,606.68" "$2,730.53" "$2,606.68" "$2,606.68" "$1,955.25" "$2,606.68" "$2,606.68" "$2,606.68" "$1,303.34" "$1,303.34" "$2,064.49" "$2,606.68" "$2,085.34" "$1,173.01" $517.36 N/A "$1,512.06" "$2,606.68" "$1,564.01" "$2,606.68" $543.23 "$2,606.68" N/A N/A 238.701 SUP HCPCS C1713 238.701 - PLATE BONE 116MM 13.5X3.7MM 4 HOLE LCP STAINLESS STEEL LEFT BOTH IP/OP "$2,685.00" "$1,987.00" $532.88 "$2,730.53" "$1,208.20" "$1,208.20" "$1,208.20" "$1,208.20" "$2,684.88" "$2,684.88" "$2,684.88" $559.60 "$2,684.88" "$2,684.88" "$2,684.88" "$2,684.88" "$2,684.88" $559.56 "$2,684.88" "$1,092.21" "$1,323.65" "$2,684.88" "$2,730.53" "$2,684.88" "$2,684.88" "$2,013.75" "$2,684.88" "$2,684.88" "$2,684.88" "$1,342.44" "$1,342.44" "$2,126.42" "$2,684.88" "$2,147.90" "$1,208.20" $532.88 N/A "$1,557.30" "$2,684.88" "$2,684.88" "$2,684.88" $559.53 "$2,684.88" N/A N/A 238.702 SUP HCPCS C1713 238.702 - PLATE BONE 142MM 6 HOLE LCP STAINLESS STEEL RIGHT DISTAL BOTH IP/OP "$2,716.00" "$2,010.00" $539.02 "$2,761.98" "$1,222.11" "$1,222.11" "$1,222.11" "$1,222.11" "$2,715.80" "$2,715.80" "$2,715.80" $566.04 "$2,715.80" "$2,715.80" "$2,715.80" "$2,715.80" "$2,715.80" $566.00 "$2,715.80" "$2,761.98" "$1,338.89" "$2,715.80" "$2,761.98" "$2,715.80" "$2,715.80" "$2,037.00" "$2,715.80" "$2,715.80" "$2,715.80" "$1,357.90" "$1,357.90" "$2,150.91" "$2,715.80" "$2,172.64" "$1,222.11" $539.02 N/A "$1,575.28" "$2,715.80" "$1,629.48" "$2,715.80" $565.97 "$2,715.80" N/A N/A 238.703 SUP HCPCS C1713 238.703 - PLATE BONE 142MM 13.5X3.7MM 6 HOLE LCP STAINLESS STEEL LEFT BOTH IP/OP "$2,716.00" "$2,010.00" $539.02 "$2,761.98" "$1,222.11" "$1,222.11" "$1,222.11" "$1,222.11" "$2,715.80" "$2,715.80" "$2,715.80" $566.04 "$2,715.80" "$2,715.80" "$2,715.80" "$2,715.80" "$2,715.80" $566.00 "$2,715.80" "$1,104.79" "$1,338.89" "$2,715.80" "$2,761.98" "$2,715.80" "$2,715.80" "$2,037.00" "$2,715.80" "$2,715.80" "$2,715.80" "$1,357.90" "$1,357.90" "$2,150.91" "$2,715.80" "$2,172.64" "$1,222.11" $539.02 N/A "$1,575.28" "$2,715.80" "$2,715.80" "$2,715.80" $565.97 "$2,715.80" N/A N/A 238.704 SUP HCPCS C1713 238.704 - PLATE BONE 168MM 13.5X3.7MM 8 HOLE LCP STAINLESS STEEL RIGHT BOTH IP/OP "$2,742.50" "$2,029.00" $544.32 "$2,789.13" "$1,234.13" "$1,234.13" "$1,234.13" "$1,234.13" "$2,742.50" "$2,742.50" "$2,742.50" $571.61 "$2,742.50" "$2,742.50" "$2,742.50" "$2,742.50" "$2,742.50" $571.57 "$2,742.50" "$2,789.13" "$1,352.05" "$2,742.50" "$2,789.13" "$2,742.50" "$2,742.50" "$2,056.88" "$2,742.50" "$2,742.50" "$2,742.50" "$1,371.25" "$1,371.25" "$2,172.06" "$2,742.50" "$2,194.00" "$1,234.13" $544.32 N/A "$1,590.65" "$2,742.50" "$2,742.50" "$2,742.50" $571.54 "$2,742.50" N/A N/A 238.705 SUP HCPCS C1713 238.705 - PLATE BONE 168MM 13.5X3.7MM 8 HOLE LCP STAINLESS STEEL LEFT BOTH IP/OP "$2,742.50" "$2,029.00" $544.32 "$2,789.13" "$1,234.13" "$1,234.13" "$1,234.13" "$1,234.13" "$2,742.50" "$2,742.50" "$2,742.50" $571.61 "$2,742.50" "$2,742.50" "$2,742.50" "$2,742.50" "$2,742.50" $571.57 "$2,742.50" "$1,115.65" "$1,352.05" "$2,742.50" "$2,789.13" "$2,742.50" "$2,742.50" "$2,056.88" "$2,742.50" "$2,742.50" "$2,742.50" "$1,371.25" "$1,371.25" "$2,172.06" "$2,742.50" "$2,194.00" "$1,234.13" $544.32 N/A "$1,590.65" "$2,742.50" "$2,742.50" "$2,742.50" $571.54 "$2,742.50" N/A N/A 238.706 SUP HCPCS C1713 238.706 - PLATE BONE 194MM 13.5X3.7MM 10 HOLE LCP STAINLESS STEEL BOTH IP/OP "$2,771.00" "$2,051.00" $549.90 "$2,817.73" "$1,246.78" "$1,246.78" "$1,246.78" "$1,246.78" "$2,770.63" "$2,770.63" "$2,770.63" $577.47 "$2,770.63" "$2,770.63" "$2,770.63" "$2,770.63" "$2,770.63" $577.43 "$2,770.63" "$1,127.09" "$1,365.92" "$2,770.63" "$2,817.73" "$2,770.63" "$2,770.63" "$2,078.25" "$2,770.63" "$2,770.63" "$2,770.63" "$1,385.32" "$1,385.32" "$2,194.34" "$2,770.63" "$2,216.50" "$1,246.78" $549.90 N/A "$1,607.18" "$2,770.63" "$2,770.63" "$2,770.63" $577.40 "$2,770.63" N/A N/A 238.707 SUP HCPCS C1713 238.707 - PLATE BONE 194MM 13.5X3.7MM 10 HOLE LCP STAINLESS STEEL LEFT BOTH IP/OP "$2,771.00" "$2,051.00" $549.90 "$2,817.73" "$1,246.78" "$1,246.78" "$1,246.78" "$1,246.78" "$2,770.63" "$2,770.63" "$2,770.63" $577.47 "$2,770.63" "$2,770.63" "$2,770.63" "$2,770.63" "$2,770.63" $577.43 "$2,770.63" "$1,127.09" "$1,365.92" "$2,770.63" "$2,817.73" "$2,770.63" "$2,770.63" "$2,078.25" "$2,770.63" "$2,770.63" "$2,770.63" "$1,385.32" "$1,385.32" "$2,194.34" "$2,770.63" "$2,216.50" "$1,246.78" $549.90 N/A "$1,607.18" "$2,770.63" "$2,770.63" "$2,770.63" $577.40 "$2,770.63" N/A N/A 238.708 SUP HCPCS C1713 238.708 - PLATE BONE 220MM 13.5X3.7MM 12 HOLE LCP STAINLESS STEEL BOTH IP/OP "$2,802.00" "$2,073.00" $556.04 "$2,849.18" "$1,260.70" "$1,260.70" "$1,260.70" "$1,260.70" "$2,801.55" "$2,801.55" "$2,801.55" $583.91 "$2,801.55" "$2,801.55" "$2,801.55" "$2,801.55" "$2,801.55" $583.87 "$2,801.55" "$2,849.18" "$1,381.16" "$2,801.55" "$2,849.18" "$2,801.55" "$2,801.55" "$2,101.50" "$2,801.55" "$2,801.55" "$2,801.55" "$1,400.78" "$1,400.78" "$2,218.83" "$2,801.55" "$2,241.24" "$1,260.70" $556.04 N/A "$1,625.16" "$2,801.55" "$2,801.55" "$2,801.55" $583.84 "$2,801.55" N/A N/A 238.709 SUP HCPCS C1713 238.709 - PLATE BONE 220MM 13.5X3.7MM 12 HOLE LCP STAINLESS STEEL LEFT BOTH IP/OP "$2,802.00" "$2,073.00" $556.04 "$2,849.18" "$1,260.70" "$1,260.70" "$1,260.70" "$1,260.70" "$2,801.55" "$2,801.55" "$2,801.55" $583.91 "$2,801.55" "$2,801.55" "$2,801.55" "$2,801.55" "$2,801.55" $583.87 "$2,801.55" "$1,139.67" "$1,381.16" "$2,801.55" "$2,849.18" "$2,801.55" "$2,801.55" "$2,101.50" "$2,801.55" "$2,801.55" "$2,801.55" "$1,400.78" "$1,400.78" "$2,218.83" "$2,801.55" "$2,241.24" "$1,260.70" $556.04 N/A "$1,625.16" "$2,801.55" "$2,801.55" "$2,801.55" $583.84 "$2,801.55" N/A N/A 238.71 SUP HCPCS C1713 238.710 - PLATE BONE 246MM 14 HOLE LCP STAINLESS STEEL RIGHT DISTAL BOTH IP/OP "$2,755.50" "$2,039.00" $546.88 "$2,886.35" "$1,239.94" "$1,239.94" "$1,239.94" "$1,239.94" "$2,755.43" "$2,755.43" "$2,755.43" $574.30 "$2,755.43" "$2,755.43" "$2,755.43" "$2,755.43" "$2,755.43" $574.26 "$2,755.43" "$1,154.54" "$1,358.43" "$2,755.43" "$2,886.35" "$2,755.43" "$2,755.43" "$2,066.63" "$2,755.43" "$2,755.43" "$2,755.43" "$1,377.72" "$1,377.72" "$2,182.30" "$2,755.43" "$2,204.34" "$1,239.94" $546.88 N/A "$1,598.19" "$2,755.43" "$2,755.43" "$2,755.43" $574.23 "$2,755.43" N/A N/A 238.711 SUP HCPCS C1713 238.711 - PLATE BONE 246MM 13.5X3.7MM 14 HOLE LCP STAINLESS STEEL LEFT BOTH IP/OP "$2,838.50" "$2,100.00" $563.29 "$2,886.35" "$1,277.15" "$1,277.15" "$1,277.15" "$1,277.15" "$2,838.10" "$2,838.10" "$2,838.10" $591.53 "$2,838.10" "$2,838.10" "$2,838.10" "$2,838.10" "$2,838.10" $591.49 "$2,838.10" "$2,886.35" "$1,399.18" "$2,838.10" "$2,886.35" "$2,838.10" "$2,838.10" "$2,128.88" "$2,838.10" "$2,838.10" "$2,838.10" "$1,419.05" "$1,419.05" "$2,247.78" "$2,838.10" "$2,270.48" "$1,277.15" $563.29 N/A "$1,646.33" "$2,838.10" "$1,702.86" "$2,838.10" $591.46 "$2,838.10" N/A N/A 238.94 SUP HCPCS C1713 238.94 - PLATE BONE 130D 152MM 70MM 9 HOLE DCP STAINLESS STEEL BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 238.96 SUP HCPCS C1713 238.96 - PLATE BONE 130D 152MM 80MM 9 HOLE DCP STAINLESS STEEL BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 238.98 SUP HCPCS C1713 238.98 - PLATE BONE 130D 154MM 90MM 9 HOLE DCP STAINLESS STEEL BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" $422.01 $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" "$1,037.40" "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.2 SUP HCPCS C1713 239.20 - PLATE BN 90D 10MM DSPL 50MM NS DCP SS ADLT OSTM BOTH IP/OP "$1,007.50" $746.00 $199.90 "$1,055.03" $453.23 $453.23 $453.23 $453.23 "$1,007.18" "$1,007.18" "$1,007.18" $209.92 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $209.91 "$1,007.18" $422.01 $595.75 "$1,007.18" "$1,055.03" "$1,007.18" "$1,007.18" $755.63 "$1,007.18" "$1,007.18" "$1,007.18" $503.59 $503.59 $797.69 "$1,007.18" $805.74 $453.23 $199.90 N/A $584.35 "$1,007.18" $604.31 "$1,007.18" "$1,007.18" "$1,007.18" N/A N/A 239.21 SUP HCPCS C1713 239.21 - PLATE BN 90D 10MM DSPL 55MM NS DCP SS ADLT OSTM BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" $422.01 $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" "$1,037.40" "$1,037.40" N/A N/A 239.22 SUP HCPCS C1713 239.22 - PLATE BONE 90D 10MM 60MMX94MM 4X1 HOLE BLADE DCP STAINLESS BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" $422.01 $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.23 SUP HCPCS C1713 239.23 - PLATE BONE 90D 10MM 65MMX94MM 4X1 HOLE BLADE DCP STAINLESS BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" $422.01 $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" "$1,037.40" "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.24 SUP HCPCS C1713 239.24 - PLATE BONE 90D 10MM 70MMX94MM 4X1 HOLE BLADE DCP STAINLESS BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" $422.01 $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" "$1,037.40" "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.28 SUP HCPCS C1713 239.28 - PLATE BN 90D 10MM DSPL 40MM NS DCP SS ADLT OSTM BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" $422.01 $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" N/A N/A 239.3 SUP HCPCS C1713 239.30 - PLATE BONE 100D 10MM 50MMX94MM 4X1 HOLE BLADE DCP STAINLESS BOTH IP/OP "$1,007.50" $746.00 $199.90 "$1,055.03" $453.23 $453.23 $453.23 $453.23 "$1,007.18" "$1,007.18" "$1,007.18" $209.92 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $209.91 "$1,007.18" $422.01 $595.75 "$1,007.18" "$1,055.03" "$1,007.18" "$1,007.18" $755.63 "$1,007.18" "$1,007.18" "$1,007.18" $503.59 $503.59 $797.69 "$1,007.18" $805.74 $453.23 $199.90 N/A $584.35 "$1,007.18" $604.31 "$1,007.18" $209.90 "$1,007.18" N/A N/A 239.32 SUP HCPCS C1713 239.32 - PLATE BONE 100D 10MM 60MMX94MM 4X1 HOLE BLADE DCP STAINLESS BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" $422.01 $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" "$1,037.40" "$1,037.40" N/A N/A 239.43 SUP HCPCS C1713 239.43 - PLATE BONE 110D 65MMX94MM 4X1 HOLE ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" N/A N/A 239.45 SUP HCPCS C1713 239.45 - PLATE BONE 110D 75MMX94MM 4X1 HOLE ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.47 SUP HCPCS C1713 239.47 - PLATE BONE 110D 85MMX94MM 4X1 HOLE ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.53 SUP HCPCS C1713 239.53 - PLATE BONE 120D 65MMX94MM 4X1 HOLE ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.55 SUP HCPCS C1713 239.55 - PLATE BONE 120D 75MMX94MM 4X1 HOLE ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.57 SUP HCPCS C1713 239.57 - PLATE BONE 120D 85MMX94MM 4X1 HOLE ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" "$1,037.40" "$1,037.40" N/A N/A 239.6 SUP HCPCS C1713 239.60 - PLATE BONE 90D 10MM 50MMX94MM 4X1 HOLE ANGLED BLADE DCP BOTH IP/OP "$1,007.50" $746.00 $199.90 "$1,055.03" $453.23 $453.23 $453.23 $453.23 "$1,007.18" "$1,007.18" "$1,007.18" $209.92 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $209.91 "$1,007.18" "$1,055.03" $595.75 "$1,007.18" "$1,055.03" "$1,007.18" "$1,007.18" $755.63 "$1,007.18" "$1,007.18" "$1,007.18" $503.59 $503.59 $797.69 "$1,007.18" $805.74 $453.23 $199.90 N/A $584.35 "$1,007.18" $604.31 "$1,007.18" "$1,007.18" "$1,007.18" N/A N/A 239.62 SUP HCPCS C1713 239.62 - PLATE BONE 90D 20MM 60MMX94MM 4X1 HOLE BLADE DCP STAINLESS BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" "$1,037.40" "$1,037.40" N/A N/A 239.64 SUP HCPCS C1713 239.64 - PLATE BONE 90D 20MM 70MMX94MM 4X1 HOLE BLADE DCP STAINLESS BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" "$1,037.40" "$1,037.40" N/A N/A 239.7 SUP HCPCS C1713 239.70 - PLATE BONE 90D 15MM 50MMX94MM 4X1 HOLE ANGLED BLADE DCP BOTH IP/OP "$1,007.50" $746.00 $199.90 "$1,055.03" $453.23 $453.23 $453.23 $453.23 "$1,007.18" "$1,007.18" "$1,007.18" $209.92 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $209.91 "$1,007.18" "$1,055.03" $595.75 "$1,007.18" "$1,055.03" "$1,007.18" "$1,007.18" $755.63 "$1,007.18" "$1,007.18" "$1,007.18" $503.59 $503.59 $797.69 "$1,007.18" $805.74 $453.23 $199.90 N/A $584.35 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" N/A N/A 239.71 SUP HCPCS C1713 239.71 - PLATE BONE 90D 15MM 55MMX94MM 4X1 HOLE ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.72 SUP HCPCS C1713 239.72 - PLATE BONE 90D 15MM 60MMX94MM 4X1 HOLE ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.73 SUP HCPCS C1713 239.73 - PLATE BONE 90D 15MM 65MMX94MM 4X1 HOLE ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.74 SUP HCPCS C1713 239.74 - PLATE BONE 90D 15MM 70MMX94MM 4X1 HOLE ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.78 SUP HCPCS C1713 239.78 - PLATE BONE 90D 15MM 40MMX94MM 4X1 HOLE BLADE DCP STAINLESS BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" "$1,037.40" "$1,037.40" N/A N/A 239.8 SUP HCPCS C1713 239.80 - PLATE BONE 130D 100MMX94MM 4X1 HOLE: ANGLED BLADE DCP BOTH IP/OP "$1,007.50" $746.00 $199.90 "$1,055.03" $453.23 $453.23 $453.23 $453.23 "$1,007.18" "$1,007.18" "$1,007.18" $209.92 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $209.91 "$1,007.18" "$1,055.03" $595.75 "$1,007.18" "$1,055.03" "$1,007.18" "$1,007.18" $755.63 "$1,007.18" "$1,007.18" "$1,007.18" $503.59 $503.59 $797.69 "$1,007.18" $805.74 $453.23 $199.90 N/A $584.35 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" N/A N/A 239.81 SUP HCPCS C1713 239.81 - PLATE BONE 130D 105MMX94MM 4X1 HOLE: ANGLED BLADE DCP BOTH IP/OP $978.00 $724.00 $194.08 $977.85 $440.03 $440.03 $440.03 $440.03 $977.85 $977.85 $977.85 $203.81 $977.85 $977.85 $977.85 $977.85 $977.85 $203.79 $977.85 $977.85 $578.40 $977.85 $977.85 $977.85 $977.85 $733.50 $977.85 $977.85 $977.85 $488.93 $488.93 $774.46 $977.85 $782.28 $440.03 $194.08 N/A $567.24 $977.85 $586.71 $977.85 $203.78 $977.85 N/A N/A 239.83 SUP HCPCS C1713 239.83 - PLATE BONE 130D 65MMX94MM 4X1 HOLE: ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.84 SUP HCPCS C1713 239.84 - PLATE BONE 130D 65MM 70MM 4X1 HOLE: ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.85 SUP HCPCS C1713 239.85 - PLATE BONE 130D 75MMX94MM 4X1 HOLE: ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.86 SUP HCPCS C1713 239.86 - PLATE BONE 130D 80MMX94MM 4X1 HOLE: ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.87 SUP HCPCS C1713 239.87 - PLATE BONE 130D 85MMX94MM 4X1 HOLE: ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.88 SUP HCPCS C1713 239.88 - PLATE BONE 130D 90MMX94MM 4X1 HOLE: ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.89 SUP HCPCS C1713 239.89 - PLATE BONE 130D 95MMX94MM 4X1 HOLE: ANGLED BLADE DCP BOTH IP/OP "$1,037.50" $768.00 $205.90 "$1,055.03" $466.83 $466.83 $466.83 $466.83 "$1,037.40" "$1,037.40" "$1,037.40" $216.22 "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" "$1,037.40" $216.21 "$1,037.40" "$1,055.03" $613.62 "$1,037.40" "$1,055.03" "$1,037.40" "$1,037.40" $778.13 "$1,037.40" "$1,037.40" "$1,037.40" $518.70 $518.70 $821.62 "$1,037.40" $829.92 $466.83 $205.90 N/A $601.75 "$1,037.40" $622.44 "$1,037.40" $216.19 "$1,037.40" N/A N/A 239.9 SUP HCPCS C1713 239.900 - PLATE BONE 116X11X3.7MM 4 HOLE PRECONTOUR LCP STAINLESS BOTH IP/OP "$2,735.00" "$2,024.00" $542.82 "$2,864.90" "$1,230.73" "$1,230.73" "$1,230.73" "$1,230.73" "$2,734.95" "$2,734.95" "$2,734.95" $570.03 "$2,734.95" "$2,734.95" "$2,734.95" "$2,734.95" "$2,734.95" $569.99 "$2,734.95" "$1,145.96" "$1,348.33" "$2,734.95" "$2,864.90" "$2,734.95" "$2,734.95" "$2,051.25" "$2,734.95" "$2,734.95" "$2,734.95" "$1,367.48" "$1,367.48" "$2,166.08" "$2,734.95" "$2,187.96" "$1,230.73" $542.82 N/A "$1,586.30" "$2,734.95" "$1,640.97" "$2,734.95" $569.96 "$2,734.95" N/A N/A 239.901 SUP HCPCS C1713 239.901 - PLATE BONE 116X11X3.7MM 4 HOLE PRECONTOUR LCP STAINLESS BOTH IP/OP "$2,735.00" "$2,024.00" $542.82 "$2,734.95" "$1,230.73" "$1,230.73" "$1,230.73" "$1,230.73" "$2,734.95" "$2,734.95" "$2,734.95" $570.03 "$2,734.95" "$2,734.95" "$2,734.95" "$2,734.95" "$2,734.95" $569.99 "$2,734.95" "$1,093.98" "$1,348.33" "$2,734.95" "$2,734.95" "$2,734.95" "$2,734.95" "$2,051.25" "$2,734.95" "$2,734.95" "$2,734.95" "$1,367.48" "$1,367.48" "$2,166.08" "$2,734.95" "$2,187.96" "$1,230.73" $542.82 N/A "$1,586.30" "$2,734.95" "$1,640.97" "$2,734.95" $569.96 "$2,734.95" N/A N/A 239.904 SUP HCPCS C1713 239.904 - PLATE BONE 142X11X3.7MM 6 HOLE PRECONTOUR LCP STAINLESS BOTH IP/OP "$2,764.00" "$2,045.00" $548.51 "$2,763.63" "$1,243.63" "$1,243.63" "$1,243.63" "$1,243.63" "$2,763.63" "$2,763.63" "$2,763.63" $576.01 "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" $575.97 "$2,763.63" "$1,105.45" "$1,362.47" "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" "$2,073.00" "$2,763.63" "$2,763.63" "$2,763.63" "$1,381.82" "$1,381.82" "$2,188.79" "$2,763.63" "$2,210.90" "$1,243.63" $548.51 N/A "$1,603.12" "$2,763.63" "$2,763.63" "$2,763.63" $575.94 "$2,763.63" N/A N/A 239.905 SUP HCPCS C1713 239.905 - PLATE BONE 142X11X3.7MM 6 HOLE PRECONTOUR LCP STAINLESS BOTH IP/OP "$2,764.00" "$2,045.00" $548.51 "$2,763.63" "$1,243.63" "$1,243.63" "$1,243.63" "$1,243.63" "$2,763.63" "$2,763.63" "$2,763.63" $576.01 "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" $575.97 "$2,763.63" "$2,763.63" "$1,362.47" "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" "$2,073.00" "$2,763.63" "$2,763.63" "$2,763.63" "$1,381.82" "$1,381.82" "$2,188.79" "$2,763.63" "$2,210.90" "$1,243.63" $548.51 N/A "$1,603.12" "$2,763.63" "$1,658.18" "$2,763.63" $575.94 "$2,763.63" N/A N/A 239.908 SUP HCPCS C1713 239.908 - PLATE BONE 168X11X3.7MM 8 HOLE PRECONTOURED LCP STAINLESS BOTH IP/OP "$2,790.00" "$2,065.00" $553.66 "$2,789.55" "$1,255.30" "$1,255.30" "$1,255.30" "$1,255.30" "$2,789.55" "$2,789.55" "$2,789.55" $581.41 "$2,789.55" "$2,789.55" "$2,789.55" "$2,789.55" "$2,789.55" $581.37 "$2,789.55" "$1,115.82" "$1,375.25" "$2,789.55" "$2,789.55" "$2,789.55" "$2,789.55" "$2,092.50" "$2,789.55" "$2,789.55" "$2,789.55" "$1,394.78" "$1,394.78" "$2,209.32" "$2,789.55" "$2,231.64" "$1,255.30" $553.66 N/A "$1,618.20" "$2,789.55" "$1,673.73" "$2,789.55" $581.34 "$2,789.55" N/A N/A 239.909 SUP HCPCS C1713 239.909 - PLATE BONE 168X11X3.7MM 8 HOLE PRECONTOURED LCP STAINLESS BOTH IP/OP "$2,790.00" "$2,065.00" $553.66 "$2,789.55" "$1,255.30" "$1,255.30" "$1,255.30" "$1,255.30" "$2,789.55" "$2,789.55" "$2,789.55" $581.41 "$2,789.55" "$2,789.55" "$2,789.55" "$2,789.55" "$2,789.55" $581.37 "$2,789.55" "$1,115.82" "$1,375.25" "$2,789.55" "$2,789.55" "$2,789.55" "$2,789.55" "$2,092.50" "$2,789.55" "$2,789.55" "$2,789.55" "$1,394.78" "$1,394.78" "$2,209.32" "$2,789.55" "$2,231.64" "$1,255.30" $553.66 N/A "$1,618.20" "$2,789.55" "$1,673.73" "$2,789.55" $581.34 "$2,789.55" N/A N/A 239.912 SUP HCPCS C1713 239.912 - PLATE BONE 194X11X3.7MM 10 HOLE PRECONTOUR LCP STAINLESS BOTH IP/OP "$2,821.00" "$2,088.00" $559.89 "$2,820.95" "$1,269.43" "$1,269.43" "$1,269.43" "$1,269.43" "$2,820.95" "$2,820.95" "$2,820.95" $587.96 "$2,820.95" "$2,820.95" "$2,820.95" "$2,820.95" "$2,820.95" $587.92 "$2,820.95" "$1,128.38" "$1,390.73" "$2,820.95" "$2,820.95" "$2,820.95" "$2,820.95" "$2,115.75" "$2,820.95" "$2,820.95" "$2,820.95" "$1,410.48" "$1,410.48" "$2,234.19" "$2,820.95" "$2,256.76" "$1,269.43" $559.89 N/A "$1,636.18" "$2,820.95" "$1,692.57" "$2,820.95" $587.89 "$2,820.95" N/A N/A 239.913 SUP HCPCS C1713 239.913 - PLATE BONE 194X11X3.7MM 10 HOLE PRECONTOUR LCP STAINLESS BOTH IP/OP "$2,821.00" "$2,088.00" $559.89 "$2,820.95" "$1,269.43" "$1,269.43" "$1,269.43" "$1,269.43" "$2,820.95" "$2,820.95" "$2,820.95" $587.96 "$2,820.95" "$2,820.95" "$2,820.95" "$2,820.95" "$2,820.95" $587.92 "$2,820.95" "$1,128.38" "$1,390.73" "$2,820.95" "$2,820.95" "$2,820.95" "$2,820.95" "$2,115.75" "$2,820.95" "$2,820.95" "$2,820.95" "$1,410.48" "$1,410.48" "$2,234.19" "$2,820.95" "$2,256.76" "$1,269.43" $559.89 N/A "$1,636.18" "$2,820.95" "$1,692.57" "$2,820.95" $587.89 "$2,820.95" N/A N/A 239.916 SUP HCPCS C1713 239.916 - PLATE BONE 220X11X3.7MM 12 HOLE PRECONTOUR LCP STAINLESS BOTH IP/OP "$2,851.00" "$2,110.00" $565.85 "$2,850.98" "$1,282.94" "$1,282.94" "$1,282.94" "$1,282.94" "$2,850.98" "$2,850.98" "$2,850.98" $594.22 "$2,850.98" "$2,850.98" "$2,850.98" "$2,850.98" "$2,850.98" $594.18 "$2,850.98" "$1,140.39" "$1,405.53" "$2,850.98" "$2,850.98" "$2,850.98" "$2,850.98" "$2,138.25" "$2,850.98" "$2,850.98" "$2,850.98" "$1,425.49" "$1,425.49" "$2,257.98" "$2,850.98" "$2,280.78" "$1,282.94" $565.85 N/A "$1,653.58" "$2,850.98" "$2,850.98" "$2,850.98" $594.14 "$2,850.98" N/A N/A 239.917 SUP HCPCS C1713 239.917 - PLATE BONE 220X11X3.7MM 12 HOLE PRECONTOUR LCP STAINLESS BOTH IP/OP "$2,851.00" "$2,110.00" $565.85 "$2,850.98" "$1,282.94" "$1,282.94" "$1,282.94" "$1,282.94" "$2,850.98" "$2,850.98" "$2,850.98" $594.22 "$2,850.98" "$2,850.98" "$2,850.98" "$2,850.98" "$2,850.98" $594.18 "$2,850.98" "$1,140.39" "$1,405.53" "$2,850.98" "$2,850.98" "$2,850.98" "$2,850.98" "$2,138.25" "$2,850.98" "$2,850.98" "$2,850.98" "$1,425.49" "$1,425.49" "$2,257.98" "$2,850.98" "$2,280.78" "$1,282.94" $565.85 N/A "$1,653.58" "$2,850.98" "$2,850.98" "$2,850.98" $594.14 "$2,850.98" N/A N/A 239.92 SUP HCPCS C1713 239.920 - PLATE BONE 246X11X3.7MM 14 HOLE PRECONTOUR LCP STAINLESS BOTH IP/OP "$2,886.50" "$2,136.00" $572.89 "$3,023.60" "$1,298.90" "$1,298.90" "$1,298.90" "$1,298.90" "$2,886.45" "$2,886.45" "$2,886.45" $601.61 "$2,886.45" "$2,886.45" "$2,886.45" "$2,886.45" "$2,886.45" $601.57 "$2,886.45" "$1,209.44" "$1,423.02" "$2,886.45" "$3,023.60" "$2,886.45" "$2,886.45" "$2,164.88" "$2,886.45" "$2,886.45" "$2,886.45" "$1,443.23" "$1,443.23" "$2,286.07" "$2,886.45" "$2,309.16" "$1,298.90" $572.89 N/A "$1,674.17" "$2,886.45" "$1,731.87" "$2,886.45" $601.54 "$2,886.45" N/A N/A 239.921 SUP HCPCS C1713 239.921 - PLATE BONE 246X11X3.7MM 14 HOLE PRECONTOUR LCP STAINLESS BOTH IP/OP "$2,886.50" "$2,136.00" $572.89 "$2,886.45" "$1,298.90" "$1,298.90" "$1,298.90" "$1,298.90" "$2,886.45" "$2,886.45" "$2,886.45" $601.61 "$2,886.45" "$2,886.45" "$2,886.45" "$2,886.45" "$2,886.45" $601.57 "$2,886.45" "$1,154.58" "$1,423.02" "$2,886.45" "$2,886.45" "$2,886.45" "$2,886.45" "$2,164.88" "$2,886.45" "$2,886.45" "$2,886.45" "$1,443.23" "$1,443.23" "$2,286.07" "$2,886.45" "$2,309.16" "$1,298.90" $572.89 N/A "$1,674.17" "$2,886.45" "$1,731.87" "$2,886.45" $601.54 "$2,886.45" N/A N/A 239.934 SUP HCPCS C1713 239.934 - PLATE BN CNTR 81MM NS LCP CMBN 4 HL LMT CNTCT SS TIB RT PROX BOTH IP/OP "$2,664.00" "$1,971.00" $528.69 "$2,709.05" "$1,198.70" "$1,198.70" "$1,198.70" "$1,198.70" "$2,663.78" "$2,663.78" "$2,663.78" $555.20 "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" $555.16 "$2,663.78" "$2,709.05" "$1,313.24" "$2,663.78" "$2,709.05" "$2,663.78" "$2,663.78" "$1,998.00" "$2,663.78" "$2,663.78" "$2,663.78" "$1,331.89" "$1,331.89" "$2,109.71" "$2,663.78" "$2,131.02" "$1,198.70" $528.69 N/A "$1,545.12" "$2,663.78" "$2,663.78" "$2,663.78" $555.13 "$2,663.78" N/A N/A 239.935 SUP HCPCS C1713 239.935 - PLATE BN CNTR 81MM NS LCP CMBN 4 HL LMT CNTCT SS TIB LT PROX BOTH IP/OP "$2,664.00" "$1,971.00" $528.69 "$2,709.05" "$1,198.70" "$1,198.70" "$1,198.70" "$1,198.70" "$2,663.78" "$2,663.78" "$2,663.78" $555.20 "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" $555.16 "$2,663.78" "$2,709.05" "$1,313.24" "$2,663.78" "$2,709.05" "$2,663.78" "$2,663.78" "$1,998.00" "$2,663.78" "$2,663.78" "$2,663.78" "$1,331.89" "$1,331.89" "$2,109.71" "$2,663.78" "$2,131.02" "$1,198.70" $528.69 N/A "$1,545.12" "$2,663.78" "$1,598.27" "$2,663.78" $555.13 "$2,663.78" N/A N/A 239.936 SUP HCPCS C1713 239.936 - PLATE BN CNTR 107MM NS LCP CMBN 6 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,696.50" "$1,995.00" $535.11 "$2,741.95" "$1,213.26" "$1,213.26" "$1,213.26" "$1,213.26" "$2,696.13" "$2,696.13" "$2,696.13" $561.94 "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" $561.90 "$2,696.13" "$1,096.78" "$1,329.19" "$2,696.13" "$2,741.95" "$2,696.13" "$2,696.13" "$2,022.38" "$2,696.13" "$2,696.13" "$2,696.13" "$1,348.07" "$1,348.07" "$2,135.33" "$2,696.13" "$2,156.90" "$1,213.26" $535.11 N/A "$1,563.97" "$2,696.13" "$1,617.68" "$2,696.13" $561.87 "$2,696.13" N/A N/A 239.937 SUP HCPCS C1713 239.937 - PLATE BN CNTR 107MM NS LCP CMBN 6 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,696.50" "$1,995.00" $535.11 "$2,741.95" "$1,213.26" "$1,213.26" "$1,213.26" "$1,213.26" "$2,696.13" "$2,696.13" "$2,696.13" $561.94 "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" $561.90 "$2,696.13" "$1,096.78" "$1,329.19" "$2,696.13" "$2,741.95" "$2,696.13" "$2,696.13" "$2,022.38" "$2,696.13" "$2,696.13" "$2,696.13" "$1,348.07" "$1,348.07" "$2,135.33" "$2,696.13" "$2,156.90" "$1,213.26" $535.11 N/A "$1,563.97" "$2,696.13" "$2,696.13" "$2,696.13" $561.87 "$2,696.13" N/A N/A 239.938 SUP HCPCS C1713 239.938 - PLATE BN CNTR 133MM NS LCP CMBN 8 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,727.50" "$2,018.00" $541.25 "$2,773.40" "$1,227.17" "$1,227.17" "$1,227.17" "$1,227.17" "$2,727.05" "$2,727.05" "$2,727.05" $568.39 "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" $568.35 "$2,727.05" "$2,773.40" "$1,344.44" "$2,727.05" "$2,773.40" "$2,727.05" "$2,727.05" "$2,045.63" "$2,727.05" "$2,727.05" "$2,727.05" "$1,363.53" "$1,363.53" "$2,159.82" "$2,727.05" "$2,181.64" "$1,227.17" $541.25 N/A "$1,581.95" "$2,727.05" "$1,636.23" "$2,727.05" $568.32 "$2,727.05" N/A N/A 239.939 SUP HCPCS C1713 239.939 - PLATE BN CNTR 133MM NS LCP CMBN 8 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,727.50" "$2,018.00" $541.25 "$2,773.40" "$1,227.17" "$1,227.17" "$1,227.17" "$1,227.17" "$2,727.05" "$2,727.05" "$2,727.05" $568.39 "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" $568.35 "$2,727.05" "$2,773.40" "$1,344.44" "$2,727.05" "$2,773.40" "$2,727.05" "$2,727.05" "$2,045.63" "$2,727.05" "$2,727.05" "$2,727.05" "$1,363.53" "$1,363.53" "$2,159.82" "$2,727.05" "$2,181.64" "$1,227.17" $541.25 N/A "$1,581.95" "$2,727.05" "$1,636.23" "$2,727.05" $568.32 "$2,727.05" N/A N/A 239.94 SUP HCPCS C1713 239.940 - PLATE BN CNTR 159MM NS LCP CMBN 10 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,676.50" "$1,981.00" $531.17 "$2,803.43" "$1,204.33" "$1,204.33" "$1,204.33" "$1,204.33" "$2,676.28" "$2,676.28" "$2,676.28" $557.80 "$2,676.28" "$2,676.28" "$2,676.28" "$2,676.28" "$2,676.28" $557.77 "$2,676.28" "$2,803.43" "$1,319.41" "$2,676.28" "$2,803.43" "$2,676.28" "$2,676.28" "$2,007.38" "$2,676.28" "$2,676.28" "$2,676.28" "$1,338.14" "$1,338.14" "$2,119.61" "$2,676.28" "$2,141.02" "$1,204.33" $531.17 N/A "$1,552.37" "$2,676.28" "$2,676.28" "$2,676.28" $557.74 "$2,676.28" N/A N/A 239.941 SUP HCPCS C1713 239.941 - PLATE BN CNTR 159MM NS LCP CMBN 10 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,757.00" "$2,040.00" $547.11 "$2,803.43" "$1,240.46" "$1,240.46" "$1,240.46" "$1,240.46" "$2,756.58" "$2,756.58" "$2,756.58" $574.54 "$2,756.58" "$2,756.58" "$2,756.58" "$2,756.58" "$2,756.58" $574.50 "$2,756.58" "$1,121.37" "$1,358.99" "$2,756.58" "$2,803.43" "$2,756.58" "$2,756.58" "$2,067.75" "$2,756.58" "$2,756.58" "$2,756.58" "$1,378.29" "$1,378.29" "$2,183.21" "$2,756.58" "$2,205.26" "$1,240.46" $547.11 N/A "$1,599.06" "$2,756.58" "$2,756.58" "$2,756.58" $574.47 "$2,756.58" N/A N/A 239.942 SUP HCPCS C1713 239.942 - PLATE BN CNTR 185MM NS LCP CMBN 12 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,793.50" "$2,067.00" $554.36 "$2,840.58" "$1,256.90" "$1,256.90" "$1,256.90" "$1,256.90" "$2,793.10" "$2,793.10" "$2,793.10" $582.15 "$2,793.10" "$2,793.10" "$2,793.10" "$2,793.10" "$2,793.10" $582.11 "$2,793.10" "$2,840.58" "$1,377.00" "$2,793.10" "$2,840.58" "$2,793.10" "$2,793.10" "$2,095.13" "$2,793.10" "$2,793.10" "$2,793.10" "$1,396.55" "$1,396.55" "$2,212.14" "$2,793.10" "$2,234.48" "$1,256.90" $554.36 N/A "$1,620.23" "$2,793.10" "$1,675.86" "$2,793.10" $582.08 "$2,793.10" N/A N/A 239.943 SUP HCPCS C1713 239.943 - PLATE BN CNTR 185MM NS LCP CMBN 12 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,793.50" "$2,067.00" $554.36 "$2,840.58" "$1,256.90" "$1,256.90" "$1,256.90" "$1,256.90" "$2,793.10" "$2,793.10" "$2,793.10" $582.15 "$2,793.10" "$2,793.10" "$2,793.10" "$2,793.10" "$2,793.10" $582.11 "$2,793.10" "$2,840.58" "$1,377.00" "$2,793.10" "$2,840.58" "$2,793.10" "$2,793.10" "$2,095.13" "$2,793.10" "$2,793.10" "$2,793.10" "$1,396.55" "$1,396.55" "$2,212.14" "$2,793.10" "$2,234.48" "$1,256.90" $554.36 N/A "$1,620.23" "$2,793.10" "$2,793.10" "$2,793.10" $582.08 "$2,793.10" N/A N/A 239.944 SUP HCPCS C1713 239.944 - PLATE BN CNTR 211MM NS LCP CMBN 14 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,823.00" "$2,089.00" $560.22 "$2,870.60" "$1,270.18" "$1,270.18" "$1,270.18" "$1,270.18" "$2,822.63" "$2,822.63" "$2,822.63" $588.31 "$2,822.63" "$2,822.63" "$2,822.63" "$2,822.63" "$2,822.63" $588.27 "$2,822.63" "$2,870.60" "$1,391.56" "$2,822.63" "$2,870.60" "$2,822.63" "$2,822.63" "$2,117.25" "$2,822.63" "$2,822.63" "$2,822.63" "$1,411.32" "$1,411.32" "$2,235.52" "$2,822.63" "$2,258.10" "$1,270.18" $560.22 N/A "$1,637.34" "$2,822.63" "$1,693.58" "$2,822.63" $588.24 "$2,822.63" N/A N/A 239.945 SUP HCPCS C1713 239.945 - PLATE BN CNTR 211MM NS LCP CMBN 14 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,918.50" "$2,160.00" $579.20 "$2,967.83" "$1,313.20" "$1,313.20" "$1,313.20" "$1,313.20" "$2,918.23" "$2,918.23" "$2,918.23" $608.23 "$2,918.23" "$2,918.23" "$2,918.23" "$2,918.23" "$2,918.23" $608.19 "$2,918.23" "$2,967.83" "$1,438.69" "$2,918.23" "$2,967.83" "$2,918.23" "$2,918.23" "$2,188.88" "$2,918.23" "$2,918.23" "$2,918.23" "$1,459.12" "$1,459.12" "$2,311.24" "$2,918.23" "$2,334.58" "$1,313.20" $579.20 N/A "$1,692.73" "$2,918.23" "$2,918.23" "$2,918.23" $608.16 "$2,918.23" N/A N/A 239.946 SUP HCPCS C1713 239.946 - PLATE BN CNTR 237MM NS LCP CMBN 16 HL LMT CNTCT SS TIB RT BOTH IP/OP "$3,021.00" "$2,236.00" $599.56 "$3,072.18" "$1,359.37" "$1,359.37" "$1,359.37" "$1,359.37" "$3,020.83" "$3,020.83" "$3,020.83" $629.62 "$3,020.83" "$3,020.83" "$3,020.83" "$3,020.83" "$3,020.83" $629.57 "$3,020.83" "$3,072.18" "$1,489.27" "$3,020.83" "$3,072.18" "$3,020.83" "$3,020.83" "$2,265.75" "$3,020.83" "$3,020.83" "$3,020.83" "$1,510.42" "$1,510.42" "$2,392.50" "$3,020.83" "$2,416.66" "$1,359.37" $599.56 N/A "$1,752.18" "$3,020.83" "$1,812.50" "$3,020.83" $629.54 "$3,020.83" N/A N/A 239.947 SUP HCPCS C1713 239.947 - PLATE BN CNTR 237MM NS LCP CMBN 16 HL LMT CNTCT SS TIB LT BOTH IP/OP "$3,021.00" "$2,236.00" $599.56 "$3,072.18" "$1,359.37" "$1,359.37" "$1,359.37" "$1,359.37" "$3,020.83" "$3,020.83" "$3,020.83" $629.62 "$3,020.83" "$3,020.83" "$3,020.83" "$3,020.83" "$3,020.83" $629.57 "$3,020.83" "$3,072.18" "$1,489.27" "$3,020.83" "$3,072.18" "$3,020.83" "$3,020.83" "$2,265.75" "$3,020.83" "$3,020.83" "$3,020.83" "$1,510.42" "$1,510.42" "$2,392.50" "$3,020.83" "$2,416.66" "$1,359.37" $599.56 N/A "$1,752.18" "$3,020.83" "$3,020.83" "$3,020.83" $629.54 "$3,020.83" N/A N/A 239.954 SUP HCPCS C1713 239.954 - PLATE BONE CNTOUR 93MM 4 HOLE FIXANG LIMITED CONTACT LCP BOTH IP/OP "$2,655.50" "$1,965.00" $527.02 "$2,700.50" "$1,194.91" "$1,194.91" "$1,194.91" "$1,194.91" "$2,655.35" "$2,655.35" "$2,655.35" $553.44 "$2,655.35" "$2,655.35" "$2,655.35" "$2,655.35" "$2,655.35" $553.40 "$2,655.35" "$2,700.50" "$1,309.09" "$2,655.35" "$2,700.50" "$2,655.35" "$2,655.35" "$1,991.63" "$2,655.35" "$2,655.35" "$2,655.35" "$1,327.68" "$1,327.68" "$2,103.04" "$2,655.35" "$2,124.28" "$1,194.91" $527.02 N/A "$1,540.19" "$2,655.35" "$1,593.21" "$2,655.35" $553.37 "$2,655.35" N/A N/A 239.955 SUP HCPCS C1713 239.955 - PLATE BN CNTR 93MM NS LCP CMBN 4 HL LMT CNTCT SS TIB LT PROX BOTH IP/OP "$2,503.00" "$1,852.00" $496.77 "$2,502.93" "$1,126.32" "$1,126.32" "$1,126.32" "$1,126.32" "$2,502.93" "$2,502.93" "$2,502.93" $521.67 "$2,502.93" "$2,502.93" "$2,502.93" "$2,502.93" "$2,502.93" $521.64 "$2,502.93" "$2,502.93" "$1,233.94" "$2,502.93" "$2,502.93" "$2,502.93" "$2,502.93" "$1,877.25" "$2,502.93" "$2,502.93" "$2,502.93" "$1,251.47" "$1,251.47" "$1,982.32" "$2,502.93" "$2,002.34" "$1,126.32" $496.77 N/A "$1,451.74" "$2,502.93" "$1,501.76" "$2,502.93" $521.61 "$2,502.93" N/A N/A 239.956 SUP HCPCS C1713 239.956 - PLATE BONE 119MM 6 HOLE LCP STAINLESS STEEL TIBIA RIGHT BOTH IP/OP "$2,690.50" "$1,991.00" $534.00 "$2,736.25" "$1,210.73" "$1,210.73" "$1,210.73" "$1,210.73" "$2,690.50" "$2,690.50" "$2,690.50" $560.77 "$2,690.50" "$2,690.50" "$2,690.50" "$2,690.50" "$2,690.50" $560.73 "$2,690.50" "$2,736.25" "$1,326.42" "$2,690.50" "$2,736.25" "$2,690.50" "$2,690.50" "$2,017.88" "$2,690.50" "$2,690.50" "$2,690.50" "$1,345.25" "$1,345.25" "$2,130.88" "$2,690.50" "$2,152.40" "$1,210.73" $534.00 N/A "$1,560.49" "$2,690.50" "$1,614.30" "$2,690.50" $560.70 "$2,690.50" N/A N/A 239.957 SUP HCPCS C1713 239.957 - PLATE BN CNTR 119MM NS LCP CMBN 6 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,690.50" "$1,991.00" $534.00 "$2,736.25" "$1,210.73" "$1,210.73" "$1,210.73" "$1,210.73" "$2,690.50" "$2,690.50" "$2,690.50" $560.77 "$2,690.50" "$2,690.50" "$2,690.50" "$2,690.50" "$2,690.50" $560.73 "$2,690.50" "$2,736.25" "$1,326.42" "$2,690.50" "$2,736.25" "$2,690.50" "$2,690.50" "$2,017.88" "$2,690.50" "$2,690.50" "$2,690.50" "$1,345.25" "$1,345.25" "$2,130.88" "$2,690.50" "$2,152.40" "$1,210.73" $534.00 N/A "$1,560.49" "$2,690.50" "$1,614.30" "$2,690.50" $560.70 "$2,690.50" N/A N/A 239.958 SUP HCPCS C1713 239.958 - PLATE BN CNTR 145MM NS LCP CMBN 8 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,723.00" "$2,015.00" $540.41 "$2,769.13" "$1,225.27" "$1,225.27" "$1,225.27" "$1,225.27" "$2,722.83" "$2,722.83" "$2,722.83" $567.51 "$2,722.83" "$2,722.83" "$2,722.83" "$2,722.83" "$2,722.83" $567.47 "$2,722.83" "$2,769.13" "$1,342.36" "$2,722.83" "$2,769.13" "$2,722.83" "$2,722.83" "$2,042.25" "$2,722.83" "$2,722.83" "$2,722.83" "$1,361.42" "$1,361.42" "$2,156.48" "$2,722.83" "$2,178.26" "$1,225.27" $540.41 N/A "$1,579.34" "$2,722.83" "$1,633.70" "$2,722.83" $567.44 "$2,722.83" N/A N/A 239.959 SUP HCPCS C1713 239.959 - PLATE BN CNTR 145MM NS LCP CMBN 8 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,723.00" "$2,015.00" $540.41 "$2,769.13" "$1,225.27" "$1,225.27" "$1,225.27" "$1,225.27" "$2,722.83" "$2,722.83" "$2,722.83" $567.51 "$2,722.83" "$2,722.83" "$2,722.83" "$2,722.83" "$2,722.83" $567.47 "$2,722.83" "$2,769.13" "$1,342.36" "$2,722.83" "$2,769.13" "$2,722.83" "$2,722.83" "$2,042.25" "$2,722.83" "$2,722.83" "$2,722.83" "$1,361.42" "$1,361.42" "$2,156.48" "$2,722.83" "$2,178.26" "$1,225.27" $540.41 N/A "$1,579.34" "$2,722.83" "$2,722.83" "$2,722.83" $567.44 "$2,722.83" N/A N/A 239.96 SUP HCPCS C1713 239.960 - PLATE BN CNTR 171MM NS LCP CMBN 10 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,674.00" "$1,979.00" $530.63 "$2,800.58" "$1,203.10" "$1,203.10" "$1,203.10" "$1,203.10" "$2,673.55" "$2,673.55" "$2,673.55" $557.23 "$2,673.55" "$2,673.55" "$2,673.55" "$2,673.55" "$2,673.55" $557.20 "$2,673.55" "$2,800.58" "$1,318.06" "$2,673.55" "$2,800.58" "$2,673.55" "$2,673.55" "$2,005.50" "$2,673.55" "$2,673.55" "$2,673.55" "$1,336.78" "$1,336.78" "$2,117.45" "$2,673.55" "$2,138.84" "$1,203.10" $530.63 N/A "$1,550.92" "$2,673.55" "$1,604.13" "$2,673.55" $557.17 "$2,673.55" N/A N/A 239.961 SUP HCPCS C1713 239.961 - PLATE BN CNTR 171MM NS LCP CMBN 10 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,754.00" "$2,038.00" $546.55 "$2,800.58" "$1,239.19" "$1,239.19" "$1,239.19" "$1,239.19" "$2,753.75" "$2,753.75" "$2,753.75" $573.95 "$2,753.75" "$2,753.75" "$2,753.75" "$2,753.75" "$2,753.75" $573.91 "$2,753.75" "$2,800.58" "$1,357.60" "$2,753.75" "$2,800.58" "$2,753.75" "$2,753.75" "$2,065.50" "$2,753.75" "$2,753.75" "$2,753.75" "$1,376.88" "$1,376.88" "$2,180.97" "$2,753.75" "$2,203.00" "$1,239.19" $546.55 N/A "$1,597.32" "$2,753.75" "$1,652.25" "$2,753.75" $573.88 "$2,753.75" N/A N/A 239.962 SUP HCPCS C1713 239.962 - PLATE BN CNTR 197MM NS LCP CMBN 12 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,783.50" "$2,060.00" $552.41 "$2,830.60" "$1,252.48" "$1,252.48" "$1,252.48" "$1,252.48" "$2,783.28" "$2,783.28" "$2,783.28" $580.11 "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" $580.07 "$2,783.28" "$2,830.60" "$1,372.16" "$2,783.28" "$2,830.60" "$2,783.28" "$2,783.28" "$2,087.63" "$2,783.28" "$2,783.28" "$2,783.28" "$1,391.64" "$1,391.64" "$2,204.36" "$2,783.28" "$2,226.62" "$1,252.48" $552.41 N/A "$1,614.43" "$2,783.28" "$1,669.97" "$2,783.28" $580.04 "$2,783.28" N/A N/A 239.963 SUP HCPCS C1713 239.963 - PLATE BN CNTR 197MM NS LCP CMBN 12 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,783.50" "$2,060.00" $552.41 "$2,830.60" "$1,252.48" "$1,252.48" "$1,252.48" "$1,252.48" "$2,783.28" "$2,783.28" "$2,783.28" $580.11 "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" $580.07 "$2,783.28" "$2,830.60" "$1,372.16" "$2,783.28" "$2,830.60" "$2,783.28" "$2,783.28" "$2,087.63" "$2,783.28" "$2,783.28" "$2,783.28" "$1,391.64" "$1,391.64" "$2,204.36" "$2,783.28" "$2,226.62" "$1,252.48" $552.41 N/A "$1,614.43" "$2,783.28" "$1,669.97" "$2,783.28" $580.04 "$2,783.28" N/A N/A 239.964 SUP HCPCS C1713 239.964 - PLATE BN CNTR 223MM NS LCP CMBN 4 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,817.00" "$2,085.00" $559.10 "$2,864.90" "$1,267.65" "$1,267.65" "$1,267.65" "$1,267.65" "$2,817.00" "$2,817.00" "$2,817.00" $587.13 "$2,817.00" "$2,817.00" "$2,817.00" "$2,817.00" "$2,817.00" $587.09 "$2,817.00" "$2,864.90" "$1,388.78" "$2,817.00" "$2,864.90" "$2,817.00" "$2,817.00" "$2,112.75" "$2,817.00" "$2,817.00" "$2,817.00" "$1,408.50" "$1,408.50" "$2,231.06" "$2,817.00" "$2,253.60" "$1,267.65" $559.10 N/A "$1,633.86" "$2,817.00" "$2,817.00" "$2,817.00" "$2,817.00" "$2,817.00" N/A N/A 239.965 SUP HCPCS C1713 239.965 - PLATE BN CNTR 223MM NS LCP CMBN 4 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,817.00" "$2,085.00" $559.10 "$2,864.90" "$1,267.65" "$1,267.65" "$1,267.65" "$1,267.65" "$2,817.00" "$2,817.00" "$2,817.00" $587.13 "$2,817.00" "$2,817.00" "$2,817.00" "$2,817.00" "$2,817.00" $587.09 "$2,817.00" "$2,864.90" "$1,388.78" "$2,817.00" "$2,864.90" "$2,817.00" "$2,817.00" "$2,112.75" "$2,817.00" "$2,817.00" "$2,817.00" "$1,408.50" "$1,408.50" "$2,231.06" "$2,817.00" "$2,253.60" "$1,267.65" $559.10 N/A "$1,633.86" "$2,817.00" "$1,690.20" "$2,817.00" "$2,817.00" "$2,817.00" N/A N/A 239.966 SUP HCPCS C1713 239.966 - PLATE BN CNTR 249MM NS LCP CMBN 16 HL LMT CNTCT SS TIB RT BOTH IP/OP "$3,014.00" "$2,230.00" $598.16 "$3,065.03" "$1,356.21" "$1,356.21" "$1,356.21" "$1,356.21" "$3,013.80" "$3,013.80" "$3,013.80" $628.15 "$3,013.80" "$3,013.80" "$3,013.80" "$3,013.80" "$3,013.80" $628.11 "$3,013.80" "$3,065.03" "$1,485.80" "$3,013.80" "$3,065.03" "$3,013.80" "$3,013.80" "$2,260.50" "$3,013.80" "$3,013.80" "$3,013.80" "$1,506.90" "$1,506.90" "$2,386.93" "$3,013.80" "$2,411.04" "$1,356.21" $598.16 N/A "$1,748.12" "$3,013.80" "$1,808.28" "$3,013.80" $628.08 "$3,013.80" N/A N/A 239.967 SUP HCPCS C1713 239.967 - PLATE BN CNTR 249MM NS LCP CMBN 16 HL LMT CNTCT SS TIB LT BOTH IP/OP "$3,014.00" "$2,230.00" $598.16 "$3,065.03" "$1,356.21" "$1,356.21" "$1,356.21" "$1,356.21" "$3,013.80" "$3,013.80" "$3,013.80" $628.15 "$3,013.80" "$3,013.80" "$3,013.80" "$3,013.80" "$3,013.80" $628.11 "$3,013.80" "$3,065.03" "$1,485.80" "$3,013.80" "$3,065.03" "$3,013.80" "$3,013.80" "$2,260.50" "$3,013.80" "$3,013.80" "$3,013.80" "$1,506.90" "$1,506.90" "$2,386.93" "$3,013.80" "$2,411.04" "$1,356.21" $598.16 N/A "$1,748.12" "$3,013.80" "$3,013.80" "$3,013.80" $628.08 "$3,013.80" N/A N/A 239.968 SUP HCPCS C1713 239.968 - PLATE BN CNTR 275MM NS LCP CMBN 18 HL LMT CNTCT SS TIB RT BOTH IP/OP "$3,122.50" "$2,311.00" $619.65 "$3,175.13" "$1,404.92" "$1,404.92" "$1,404.92" "$1,404.92" "$3,122.05" "$3,122.05" "$3,122.05" $650.71 "$3,122.05" "$3,122.05" "$3,122.05" "$3,122.05" "$3,122.05" $650.67 "$3,122.05" "$3,175.13" "$1,539.17" "$3,122.05" "$3,175.13" "$3,122.05" "$3,122.05" "$2,341.88" "$3,122.05" "$3,122.05" "$3,122.05" "$1,561.03" "$1,561.03" "$2,472.66" "$3,122.05" "$2,497.64" "$1,404.92" $619.65 N/A "$1,811.05" "$3,122.05" "$1,873.23" "$3,122.05" $650.64 "$3,122.05" N/A N/A 239.969 SUP HCPCS C1713 239.969 - PLATE BN CNTR 275MM NS LCP CMBN 18 HL LMT CNTCT SS TIB LT BOTH IP/OP "$3,122.50" "$2,311.00" $619.65 "$3,175.13" "$1,404.92" "$1,404.92" "$1,404.92" "$1,404.92" "$3,122.05" "$3,122.05" "$3,122.05" $650.71 "$3,122.05" "$3,122.05" "$3,122.05" "$3,122.05" "$3,122.05" $650.67 "$3,122.05" "$3,175.13" "$1,539.17" "$3,122.05" "$3,175.13" "$3,122.05" "$3,122.05" "$2,341.88" "$3,122.05" "$3,122.05" "$3,122.05" "$1,561.03" "$1,561.03" "$2,472.66" "$3,122.05" "$2,497.64" "$1,404.92" $619.65 N/A "$1,811.05" "$3,122.05" "$1,873.23" "$3,122.05" $650.64 "$3,122.05" N/A N/A 239.97 SUP HCPCS C1713 239.970 - PLATE BN CNTR 301MM NS LCP CMBN 20 HL LMT CNTCT SS TIB RT BOTH IP/OP "$3,131.00" "$2,317.00" $621.37 "$3,279.48" "$1,408.83" "$1,408.83" "$1,408.83" "$1,408.83" "$3,130.73" "$3,130.73" "$3,130.73" $652.52 "$3,130.73" "$3,130.73" "$3,130.73" "$3,130.73" "$3,130.73" $652.48 "$3,130.73" "$3,279.48" "$1,543.45" "$3,130.73" "$3,279.48" "$3,130.73" "$3,130.73" "$2,348.25" "$3,130.73" "$3,130.73" "$3,130.73" "$1,565.37" "$1,565.37" "$2,479.54" "$3,130.73" "$2,504.58" "$1,408.83" $621.37 N/A "$1,815.98" "$3,130.73" "$3,130.73" "$3,130.73" $652.44 "$3,130.73" N/A N/A 239.971 SUP HCPCS C1713 239.971 - PLATE BN CNTR 301MM NS LCP CMBN 20 HL LMT CNTCT SS TIB LT BOTH IP/OP "$3,225.00" "$2,387.00" $640.01 "$3,279.48" "$1,451.09" "$1,451.09" "$1,451.09" "$1,451.09" "$3,224.65" "$3,224.65" "$3,224.65" $672.10 "$3,224.65" "$3,224.65" "$3,224.65" "$3,224.65" "$3,224.65" $672.05 "$3,224.65" "$3,279.48" "$1,589.75" "$3,224.65" "$3,279.48" "$3,224.65" "$3,224.65" "$2,418.75" "$3,224.65" "$3,224.65" "$3,224.65" "$1,612.33" "$1,612.33" "$2,553.92" "$3,224.65" "$2,579.72" "$1,451.09" $640.01 N/A "$1,870.50" "$3,224.65" "$1,934.79" "$3,224.65" $672.02 "$3,224.65" N/A N/A 239.984 SUP HCPCS C1713 239.984 - PLATE BONE 106MM 4 HOLE PRECONTOUR LCP STAINLESS STEEL RIGHT BOTH IP/OP "$2,665.50" "$1,972.00" $528.98 "$2,710.50" "$1,199.34" "$1,199.34" "$1,199.34" "$1,199.34" "$2,665.20" "$2,665.20" "$2,665.20" $555.49 "$2,665.20" "$2,665.20" "$2,665.20" "$2,665.20" "$2,665.20" $555.46 "$2,665.20" "$2,710.50" "$1,313.94" "$2,665.20" "$2,710.50" "$2,665.20" "$2,665.20" "$1,999.13" "$2,665.20" "$2,665.20" "$2,665.20" "$1,332.60" "$1,332.60" "$2,110.84" "$2,665.20" "$2,132.16" "$1,199.34" $528.98 N/A "$1,545.99" "$2,665.20" "$2,665.20" "$2,665.20" $555.43 "$2,665.20" N/A N/A 239.985 SUP HCPCS C1713 239.985 - PLATE BONE 106MM 4 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT BOTH IP/OP "$2,665.50" "$1,972.00" $528.98 "$2,710.50" "$1,199.34" "$1,199.34" "$1,199.34" "$1,199.34" "$2,665.20" "$2,665.20" "$2,665.20" $555.49 "$2,665.20" "$2,665.20" "$2,665.20" "$2,665.20" "$2,665.20" $555.46 "$2,665.20" "$2,710.50" "$1,313.94" "$2,665.20" "$2,710.50" "$2,665.20" "$2,665.20" "$1,999.13" "$2,665.20" "$2,665.20" "$2,665.20" "$1,332.60" "$1,332.60" "$2,110.84" "$2,665.20" "$2,132.16" "$1,199.34" $528.98 N/A "$1,545.99" "$2,665.20" "$1,599.12" "$2,665.20" $555.43 "$2,665.20" N/A N/A 239.986 SUP HCPCS C1713 239.986 - PLATE BONE 142MM 6 HOLE PRECONTOUR LCP STAINLESS STEEL RIGHT BOTH IP/OP "$2,698.00" "$1,997.00" $535.39 "$2,743.38" "$1,213.89" "$1,213.89" "$1,213.89" "$1,213.89" "$2,697.53" "$2,697.53" "$2,697.53" $562.23 "$2,697.53" "$2,697.53" "$2,697.53" "$2,697.53" "$2,697.53" $562.19 "$2,697.53" "$2,743.38" "$1,329.88" "$2,697.53" "$2,743.38" "$2,697.53" "$2,697.53" "$2,023.50" "$2,697.53" "$2,697.53" "$2,697.53" "$1,348.77" "$1,348.77" "$2,136.44" "$2,697.53" "$2,158.02" "$1,213.89" $535.39 N/A "$1,564.84" "$2,697.53" "$2,697.53" "$2,697.53" $562.17 "$2,697.53" N/A N/A 239.987 SUP HCPCS C1713 239.987 - PLATE BONE 142MM 6 HOLE PRECONTOUR LCP STAINLESS STEEL LEFT BOTH IP/OP "$2,698.00" "$1,997.00" $535.39 "$2,743.38" "$1,213.89" "$1,213.89" "$1,213.89" "$1,213.89" "$2,697.53" "$2,697.53" "$2,697.53" $562.23 "$2,697.53" "$2,697.53" "$2,697.53" "$2,697.53" "$2,697.53" $562.19 "$2,697.53" "$1,097.35" "$1,329.88" "$2,697.53" "$2,743.38" "$2,697.53" "$2,697.53" "$2,023.50" "$2,697.53" "$2,697.53" "$2,697.53" "$1,348.77" "$1,348.77" "$2,136.44" "$2,697.53" "$2,158.02" "$1,213.89" $535.39 N/A "$1,564.84" "$2,697.53" "$2,697.53" "$2,697.53" $562.17 "$2,697.53" N/A N/A 239.988 SUP HCPCS C1713 239.988 - PLATE BONE 178MM 8 HOLE LIMITED CONTACT PROFILE LCP BOTH IP/OP "$2,728.50" "$2,019.00" $541.53 "$2,774.83" "$1,227.80" "$1,227.80" "$1,227.80" "$1,227.80" "$2,728.45" "$2,728.45" "$2,728.45" $568.68 "$2,728.45" "$2,728.45" "$2,728.45" "$2,728.45" "$2,728.45" $568.64 "$2,728.45" "$1,109.93" "$1,345.13" "$2,728.45" "$2,774.83" "$2,728.45" "$2,728.45" "$2,046.38" "$2,728.45" "$2,728.45" "$2,728.45" "$1,364.23" "$1,364.23" "$2,160.93" "$2,728.45" "$2,182.76" "$1,227.80" $541.53 N/A "$1,582.53" "$2,728.45" "$1,637.07" "$2,728.45" $568.61 "$2,728.45" N/A N/A 239.989 SUP HCPCS C1713 239.989 - PLATE BONE 178MM 8 HOLE LIMITED CONTACT PROFILE LCP BOTH IP/OP "$2,728.50" "$2,019.00" $541.53 "$2,774.83" "$1,227.80" "$1,227.80" "$1,227.80" "$1,227.80" "$2,728.45" "$2,728.45" "$2,728.45" $568.68 "$2,728.45" "$2,728.45" "$2,728.45" "$2,728.45" "$2,728.45" $568.64 "$2,728.45" "$1,109.93" "$1,345.13" "$2,728.45" "$2,774.83" "$2,728.45" "$2,728.45" "$2,046.38" "$2,728.45" "$2,728.45" "$2,728.45" "$1,364.23" "$1,364.23" "$2,160.93" "$2,728.45" "$2,182.76" "$1,227.80" $541.53 N/A "$1,582.53" "$2,728.45" "$1,637.07" "$2,728.45" $568.61 "$2,728.45" N/A N/A 239.99 SUP HCPCS C1713 239.990 - PLATE BONE 214MM 10 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL BOTH IP/OP "$2,678.00" "$1,982.00" $531.45 "$2,804.85" "$1,204.94" "$1,204.94" "$1,204.94" "$1,204.94" "$2,677.65" "$2,677.65" "$2,677.65" $558.09 "$2,677.65" "$2,677.65" "$2,677.65" "$2,677.65" "$2,677.65" $558.05 "$2,677.65" "$1,121.94" "$1,320.08" "$2,677.65" "$2,804.85" "$2,677.65" "$2,677.65" "$2,008.50" "$2,677.65" "$2,677.65" "$2,677.65" "$1,338.83" "$1,338.83" "$2,120.70" "$2,677.65" "$2,142.12" "$1,204.94" $531.45 N/A "$1,553.24" "$2,677.65" "$2,677.65" "$2,677.65" $558.02 "$2,677.65" N/A N/A 239.991 SUP HCPCS C1713 239.991 - PLATE BONE 214MM 10 HOLE LOCKING LCP STAINLESS STEEL BOTH IP/OP "$2,758.00" "$2,041.00" $547.39 "$2,804.85" "$1,241.09" "$1,241.09" "$1,241.09" "$1,241.09" "$2,757.98" "$2,757.98" "$2,757.98" $574.83 "$2,757.98" "$2,757.98" "$2,757.98" "$2,757.98" "$2,757.98" $574.79 "$2,757.98" "$1,121.94" "$1,359.68" "$2,757.98" "$2,804.85" "$2,757.98" "$2,757.98" "$2,068.50" "$2,757.98" "$2,757.98" "$2,757.98" "$1,378.99" "$1,378.99" "$2,184.32" "$2,757.98" "$2,206.38" "$1,241.09" $547.39 N/A "$1,599.64" "$2,757.98" "$2,757.98" "$2,757.98" $574.76 "$2,757.98" N/A N/A 239.992 SUP HCPCS C1713 239.992 - PLATE BONE 250MM 12 HOLE LCP STAINLESS STEEL TIBIA RIGHT BOTH IP/OP "$2,887.50" "$2,137.00" $573.06 "$2,936.38" "$1,299.29" "$1,299.29" "$1,299.29" "$1,299.29" "$2,887.30" "$2,887.30" "$2,887.30" $601.79 "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" $601.75 "$2,887.30" "$1,174.55" "$1,423.44" "$2,887.30" "$2,936.38" "$2,887.30" "$2,887.30" "$2,165.63" "$2,887.30" "$2,887.30" "$2,887.30" "$1,443.65" "$1,443.65" "$2,286.74" "$2,887.30" "$2,309.84" "$1,299.29" $573.06 N/A "$1,674.75" "$2,887.30" "$1,732.38" "$2,887.30" $601.71 "$2,887.30" N/A N/A 239.993 SUP HCPCS C1713 239.993 - PLATE BONE 250MM 12 HOLE LIMITED CONTACT PROFILE LCP BOTH IP/OP "$2,887.50" "$2,137.00" $573.06 "$2,936.38" "$1,299.29" "$1,299.29" "$1,299.29" "$1,299.29" "$2,887.30" "$2,887.30" "$2,887.30" $601.79 "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" $601.75 "$2,887.30" "$2,936.38" "$1,423.44" "$2,887.30" "$2,936.38" "$2,887.30" "$2,887.30" "$2,165.63" "$2,887.30" "$2,887.30" "$2,887.30" "$1,443.65" "$1,443.65" "$2,286.74" "$2,887.30" "$2,309.84" "$1,299.29" $573.06 N/A "$1,674.75" "$2,887.30" "$1,732.38" "$2,887.30" $601.71 "$2,887.30" N/A N/A 239.994 SUP HCPCS C1713 239.994 - PLATE BONE 286MM 14 HOLE LOCKING LCP STAINLESS STEEL BOTH IP/OP "$2,918.50" "$2,160.00" $579.20 "$2,967.83" "$1,313.20" "$1,313.20" "$1,313.20" "$1,313.20" "$2,918.23" "$2,918.23" "$2,918.23" $608.23 "$2,918.23" "$2,918.23" "$2,918.23" "$2,918.23" "$2,918.23" $608.19 "$2,918.23" "$2,967.83" "$1,438.69" "$2,918.23" "$2,967.83" "$2,918.23" "$2,918.23" "$2,188.88" "$2,918.23" "$2,918.23" "$2,918.23" "$1,459.12" "$1,459.12" "$2,311.24" "$2,918.23" "$2,334.58" "$1,313.20" $579.20 N/A "$1,692.73" "$2,918.23" "$2,918.23" "$2,918.23" $608.16 "$2,918.23" N/A N/A 239.995 SUP HCPCS C1713 239.995 - PLATE BONE 286MM 14 HOLE LOCKING LCP STAINLESS STEEL BOTH IP/OP "$2,918.50" "$2,160.00" $579.20 "$2,967.83" "$1,313.20" "$1,313.20" "$1,313.20" "$1,313.20" "$2,918.23" "$2,918.23" "$2,918.23" $608.23 "$2,918.23" "$2,918.23" "$2,918.23" "$2,918.23" "$2,918.23" $608.19 "$2,918.23" "$1,187.13" "$1,438.69" "$2,918.23" "$2,967.83" "$2,918.23" "$2,918.23" "$2,188.88" "$2,918.23" "$2,918.23" "$2,918.23" "$1,459.12" "$1,459.12" "$2,311.24" "$2,918.23" "$2,334.58" "$1,313.20" $579.20 N/A "$1,692.73" "$2,918.23" "$1,750.94" "$2,918.23" $608.16 "$2,918.23" N/A N/A 239.996 SUP HCPCS C1713 239.996 - PLATE BONE 322MM 16 HOLE LOCKING LCP STAINLESS STEEL BOTH IP/OP "$2,948.00" "$2,182.00" $585.05 "$2,997.83" "$1,326.48" "$1,326.48" "$1,326.48" "$1,326.48" "$2,947.73" "$2,947.73" "$2,947.73" $614.38 "$2,947.73" "$2,947.73" "$2,947.73" "$2,947.73" "$2,947.73" $614.34 "$2,947.73" "$1,199.13" "$1,453.23" "$2,947.73" "$2,997.83" "$2,947.73" "$2,947.73" "$2,211.00" "$2,947.73" "$2,947.73" "$2,947.73" "$1,473.87" "$1,473.87" "$2,334.60" "$2,947.73" "$2,358.18" "$1,326.48" $585.05 N/A "$1,709.84" "$2,947.73" "$1,768.64" "$2,947.73" $614.31 "$2,947.73" N/A N/A 239.997 SUP HCPCS C1713 239.997 - PLATE BONE 322MM 16 HOLE LCP STAINLESS STEEL LEFT PROXIMAL BOTH IP/OP "$2,948.00" "$2,182.00" $585.05 "$2,997.83" "$1,326.48" "$1,326.48" "$1,326.48" "$1,326.48" "$2,947.73" "$2,947.73" "$2,947.73" $614.38 "$2,947.73" "$2,947.73" "$2,947.73" "$2,947.73" "$2,947.73" $614.34 "$2,947.73" "$1,199.13" "$1,453.23" "$2,947.73" "$2,997.83" "$2,947.73" "$2,947.73" "$2,211.00" "$2,947.73" "$2,947.73" "$2,947.73" "$1,473.87" "$1,473.87" "$2,334.60" "$2,947.73" "$2,358.18" "$1,326.48" $585.05 N/A "$1,709.84" "$2,947.73" "$1,768.64" "$2,947.73" $614.31 "$2,947.73" N/A N/A 240.002 SUP HCPCS C1713 240.002 - PLATE BONE 41MM 2 HOLE LCP STAINLESS STEEL TIBIA RIGHT BOTH IP/OP "$2,155.00" "$1,595.00" $427.70 "$2,191.55" $969.72 $969.72 $969.72 $969.72 "$2,154.93" "$2,154.93" "$2,154.93" $449.14 "$2,154.93" "$2,154.93" "$2,154.93" "$2,154.93" "$2,154.93" $449.11 "$2,154.93" $876.62 "$1,274.64" "$2,154.93" "$2,191.55" "$2,154.93" "$2,154.93" "$1,616.25" "$2,154.93" "$2,154.93" "$2,154.93" "$1,077.47" "$1,077.47" "$1,706.70" "$2,154.93" "$1,723.94" $969.72 $427.70 N/A "$1,249.90" "$2,154.93" "$2,154.93" "$2,154.93" $449.09 "$2,154.93" N/A N/A 240.003 SUP HCPCS C1713 240.003 - PLATE BONE 41MM 2 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$2,155.00" "$1,595.00" $427.70 "$2,191.55" $969.72 $969.72 $969.72 $969.72 "$2,154.93" "$2,154.93" "$2,154.93" $449.14 "$2,154.93" "$2,154.93" "$2,154.93" "$2,154.93" "$2,154.93" $449.11 "$2,154.93" $876.62 "$1,274.64" "$2,154.93" "$2,191.55" "$2,154.93" "$2,154.93" "$1,616.25" "$2,154.93" "$2,154.93" "$2,154.93" "$1,077.47" "$1,077.47" "$1,706.70" "$2,154.93" "$1,723.94" $969.72 $427.70 N/A "$1,249.90" "$2,154.93" "$1,292.96" "$2,154.93" $449.09 "$2,154.93" N/A N/A 240.004 SUP HCPCS C1713 240.004 - PLATE BONE 73MM 4 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL BOTH IP/OP "$2,161.00" "$1,599.00" $428.82 "$2,197.28" $972.25 $972.25 $972.25 $972.25 "$2,160.55" "$2,160.55" "$2,160.55" $450.31 "$2,160.55" "$2,160.55" "$2,160.55" "$2,160.55" "$2,160.55" $450.28 "$2,160.55" "$2,197.28" "$1,277.97" "$2,160.55" "$2,197.28" "$2,160.55" "$2,160.55" "$1,620.75" "$2,160.55" "$2,160.55" "$2,160.55" "$1,080.28" "$1,080.28" "$1,711.16" "$2,160.55" "$1,728.44" $972.25 $428.82 N/A "$1,253.38" "$2,160.55" "$1,296.33" "$2,160.55" $450.26 "$2,160.55" N/A N/A 240.005 SUP HCPCS C1713 240.005 - PLATE BONE 73MM 4 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$2,161.00" "$1,599.00" $428.82 "$2,197.28" $972.25 $972.25 $972.25 $972.25 "$2,160.55" "$2,160.55" "$2,160.55" $450.31 "$2,160.55" "$2,160.55" "$2,160.55" "$2,160.55" "$2,160.55" $450.28 "$2,160.55" "$2,197.28" "$1,277.97" "$2,160.55" "$2,197.28" "$2,160.55" "$2,160.55" "$1,620.75" "$2,160.55" "$2,160.55" "$2,160.55" "$1,080.28" "$1,080.28" "$1,711.16" "$2,160.55" "$1,728.44" $972.25 $428.82 N/A "$1,253.38" "$2,160.55" "$2,160.55" "$2,160.55" $450.26 "$2,160.55" N/A N/A 240.006 SUP HCPCS C1713 240.006 - PLATE BONE 109MM 6 HOLE LCP STAINLESS STEEL TIBIA RIGHT BOTH IP/OP "$2,165.00" "$1,602.00" $429.65 "$2,201.58" $974.15 $974.15 $974.15 $974.15 "$2,164.78" "$2,164.78" "$2,164.78" $451.19 "$2,164.78" "$2,164.78" "$2,164.78" "$2,164.78" "$2,164.78" $451.16 "$2,164.78" "$2,201.58" "$1,280.47" "$2,164.78" "$2,201.58" "$2,164.78" "$2,164.78" "$1,623.75" "$2,164.78" "$2,164.78" "$2,164.78" "$1,082.39" "$1,082.39" "$1,714.51" "$2,164.78" "$1,731.82" $974.15 $429.65 N/A "$1,255.70" "$2,164.78" "$1,298.87" "$2,164.78" $451.14 "$2,164.78" N/A N/A 240.007 SUP HCPCS C1713 240.007 - PLATE BONE 109MM 6 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$2,165.00" "$1,602.00" $429.65 "$2,201.58" $974.15 $974.15 $974.15 $974.15 "$2,164.78" "$2,164.78" "$2,164.78" $451.19 "$2,164.78" "$2,164.78" "$2,164.78" "$2,164.78" "$2,164.78" $451.16 "$2,164.78" $880.63 "$1,280.47" "$2,164.78" "$2,201.58" "$2,164.78" "$2,164.78" "$1,623.75" "$2,164.78" "$2,164.78" "$2,164.78" "$1,082.39" "$1,082.39" "$1,714.51" "$2,164.78" "$1,731.82" $974.15 $429.65 N/A "$1,255.70" "$2,164.78" "$1,298.87" "$2,164.78" $451.14 "$2,164.78" N/A N/A 240.008 SUP HCPCS C1713 240.008 - PLATE BONE 145MM 8 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL BOTH IP/OP "$2,241.00" "$1,658.00" $444.72 "$2,278.78" "$1,008.31" "$1,008.31" "$1,008.31" "$1,008.31" "$2,240.68" "$2,240.68" "$2,240.68" $467.01 "$2,240.68" "$2,240.68" "$2,240.68" "$2,240.68" "$2,240.68" $466.98 "$2,240.68" $911.51 "$1,325.36" "$2,240.68" "$2,278.78" "$2,240.68" "$2,240.68" "$1,680.75" "$2,240.68" "$2,240.68" "$2,240.68" "$1,120.34" "$1,120.34" "$1,774.62" "$2,240.68" "$1,792.54" "$1,008.31" $444.72 N/A "$1,299.78" "$2,240.68" "$1,344.41" "$2,240.68" $466.96 "$2,240.68" N/A N/A 240.009 SUP HCPCS C1713 240.009 - PLATE BONE 145MM 8 HOLE LCP STAINLESS STEEL LEFT PROXIMAL BOTH IP/OP "$2,241.00" "$1,658.00" $444.72 "$2,278.78" "$1,008.31" "$1,008.31" "$1,008.31" "$1,008.31" "$2,240.68" "$2,240.68" "$2,240.68" $467.01 "$2,240.68" "$2,240.68" "$2,240.68" "$2,240.68" "$2,240.68" $466.98 "$2,240.68" $911.51 "$1,325.36" "$2,240.68" "$2,278.78" "$2,240.68" "$2,240.68" "$1,680.75" "$2,240.68" "$2,240.68" "$2,240.68" "$1,120.34" "$1,120.34" "$1,774.62" "$2,240.68" "$1,792.54" "$1,008.31" $444.72 N/A "$1,299.78" "$2,240.68" "$2,240.68" "$2,240.68" $466.96 "$2,240.68" N/A N/A 240.01 SUP HCPCS C1713 240.010 - PLATE BONE 181MM 10 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL BOTH IP/OP "$2,181.00" "$1,614.00" $432.85 "$2,284.48" $981.40 $981.40 $981.40 $981.40 "$2,180.88" "$2,180.88" "$2,180.88" $454.55 "$2,180.88" "$2,180.88" "$2,180.88" "$2,180.88" "$2,180.88" $454.52 "$2,180.88" "$2,284.48" "$1,289.99" "$2,180.88" "$2,284.48" "$2,180.88" "$2,180.88" "$1,635.75" "$2,180.88" "$2,180.88" "$2,180.88" "$1,090.44" "$1,090.44" "$1,727.26" "$2,180.88" "$1,744.70" $981.40 $432.85 N/A "$1,264.98" "$2,180.88" "$2,180.88" "$2,180.88" $454.50 "$2,180.88" N/A N/A 240.011 SUP HCPCS C1713 240.011 - PLATE BONE 181MM 10 HOLE LCP STAINLESS STEEL LEFT PROXIMAL BOTH IP/OP "$2,246.50" "$1,662.00" $445.83 "$2,284.48" "$1,010.84" "$1,010.84" "$1,010.84" "$1,010.84" "$2,246.30" "$2,246.30" "$2,246.30" $468.19 "$2,246.30" "$2,246.30" "$2,246.30" "$2,246.30" "$2,246.30" $468.15 "$2,246.30" $913.79 "$1,328.69" "$2,246.30" "$2,284.48" "$2,246.30" "$2,246.30" "$1,684.88" "$2,246.30" "$2,246.30" "$2,246.30" "$1,123.15" "$1,123.15" "$1,779.07" "$2,246.30" "$1,797.04" "$1,010.84" $445.83 N/A "$1,302.97" "$2,246.30" "$1,347.78" "$2,246.30" $468.13 "$2,246.30" N/A N/A 240.012 SUP HCPCS C1713 240.012 - PLATE BONE 217MM 12 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL BOTH IP/OP "$2,402.50" "$1,778.00" $476.80 "$2,443.18" "$1,081.05" "$1,081.05" "$1,081.05" "$1,081.05" "$2,402.33" "$2,402.33" "$2,402.33" $500.71 "$2,402.33" "$2,402.33" "$2,402.33" "$2,402.33" "$2,402.33" $500.67 "$2,402.33" $977.27 "$1,420.98" "$2,402.33" "$2,443.18" "$2,402.33" "$2,402.33" "$1,801.88" "$2,402.33" "$2,402.33" "$2,402.33" "$1,201.17" "$1,201.17" "$1,902.65" "$2,402.33" "$1,921.86" "$1,081.05" $476.80 N/A "$1,393.45" "$2,402.33" "$1,441.40" "$2,402.33" $500.65 "$2,402.33" N/A N/A 240.013 SUP HCPCS C1713 240.013 - PLATE BONE 217MM 12 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$2,336.50" "$1,729.00" $463.69 "$2,375.98" "$1,051.31" "$1,051.31" "$1,051.31" "$1,051.31" "$2,336.25" "$2,336.25" "$2,336.25" $486.93 "$2,336.25" "$2,336.25" "$2,336.25" "$2,336.25" "$2,336.25" $486.90 "$2,336.25" $950.39 "$1,381.89" "$2,336.25" "$2,375.98" "$2,336.25" "$2,336.25" "$1,752.38" "$2,336.25" "$2,336.25" "$2,336.25" "$1,168.13" "$1,168.13" "$1,850.31" "$2,336.25" "$1,869.00" "$1,051.31" $463.69 N/A "$1,355.17" "$2,336.25" "$1,401.75" "$2,336.25" $486.87 "$2,336.25" N/A N/A 240.014 SUP HCPCS C1713 240.014 - PLATE BONE 4.5MM 14 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL BOTH IP/OP "$2,387.00" "$1,766.00" $473.74 "$2,427.45" "$1,074.10" "$1,074.10" "$1,074.10" "$1,074.10" "$2,386.88" "$2,386.88" "$2,386.88" $497.49 "$2,386.88" "$2,386.88" "$2,386.88" "$2,386.88" "$2,386.88" $497.45 "$2,386.88" $970.98 "$1,411.84" "$2,386.88" "$2,427.45" "$2,386.88" "$2,386.88" "$1,790.25" "$2,386.88" "$2,386.88" "$2,386.88" "$1,193.44" "$1,193.44" "$1,890.41" "$2,386.88" "$1,909.50" "$1,074.10" $473.74 N/A "$1,384.46" "$2,386.88" "$2,386.88" "$2,386.88" $497.43 "$2,386.88" N/A N/A 240.015 SUP HCPCS C1713 240.015 - PLATE BONE 4.5MM 14 HOLE LCP STAINLESS STEEL LEFT PROXIMAL BOTH IP/OP "$2,387.00" "$1,766.00" $473.74 "$2,427.45" "$1,074.10" "$1,074.10" "$1,074.10" "$1,074.10" "$2,386.88" "$2,386.88" "$2,386.88" $497.49 "$2,386.88" "$2,386.88" "$2,386.88" "$2,386.88" "$2,386.88" $497.45 "$2,386.88" $970.98 "$1,411.84" "$2,386.88" "$2,427.45" "$2,386.88" "$2,386.88" "$1,790.25" "$2,386.88" "$2,386.88" "$2,386.88" "$1,193.44" "$1,193.44" "$1,890.41" "$2,386.88" "$1,909.50" "$1,074.10" $473.74 N/A "$1,384.46" "$2,386.88" "$2,386.88" "$2,386.88" $497.43 "$2,386.88" N/A N/A 240.019 SUP Custom 27803010 240.019 - WASHER ORTHOPEDIC 4.5MM 3.5MM LCP STAINLESS STEEL NONSTRL BOTH IP/OP $99.50 $74.00 $17.64 $100.78 $99.10 $99.10 $99.10 $99.10 $99.10 $99.10 $17.64 $99.10 $99.10 $99.10 $99.10 $99.10 $99.10 $20.65 $99.10 $40.31 $99.10 $99.10 $100.78 $99.10 $99.10 $74.63 $99.10 $99.10 $99.10 $49.55 $49.55 $78.49 $99.10 $79.28 $44.60 $99.10 N/A $57.71 $99.10 $59.46 $99.10 $99.10 $99.10 N/A N/A 240.036 SUP HCPCS C1713 240.036 - PLATE BN CNTR 82MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS TIB BOTH IP/OP "$2,667.00" "$1,974.00" $529.25 "$2,711.93" "$1,199.97" "$1,199.97" "$1,199.97" "$1,199.97" "$2,666.60" "$2,666.60" "$2,666.60" $555.79 "$2,666.60" "$2,666.60" "$2,666.60" "$2,666.60" "$2,666.60" $555.75 "$2,666.60" "$1,084.77" "$1,314.63" "$2,666.60" "$2,711.93" "$2,666.60" "$2,666.60" "$2,000.25" "$2,666.60" "$2,666.60" "$2,666.60" "$1,333.30" "$1,333.30" "$2,111.95" "$2,666.60" "$2,133.28" "$1,199.97" $529.25 N/A "$1,546.86" "$2,666.60" "$2,666.60" "$2,666.60" $555.72 "$2,666.60" N/A N/A 240.037 SUP HCPCS C1713 240.037 - PLATE BN CNTR 82MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS TIB BOTH IP/OP "$2,667.00" "$1,974.00" $529.25 "$2,711.93" "$1,199.97" "$1,199.97" "$1,199.97" "$1,199.97" "$2,666.60" "$2,666.60" "$2,666.60" $555.79 "$2,666.60" "$2,666.60" "$2,666.60" "$2,666.60" "$2,666.60" $555.75 "$2,666.60" "$2,711.93" "$1,314.63" "$2,666.60" "$2,711.93" "$2,666.60" "$2,666.60" "$2,000.25" "$2,666.60" "$2,666.60" "$2,666.60" "$1,333.30" "$1,333.30" "$2,111.95" "$2,666.60" "$2,133.28" "$1,199.97" $529.25 N/A "$1,546.86" "$2,666.60" "$1,599.96" "$2,666.60" $555.72 "$2,666.60" N/A N/A 240.038 SUP HCPCS C1713 240.038 - PLATE BN CNTR 118MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS BOTH IP/OP "$2,699.00" "$1,997.00" $535.67 "$2,744.80" "$1,214.52" "$1,214.52" "$1,214.52" "$1,214.52" "$2,698.93" "$2,698.93" "$2,698.93" $562.52 "$2,698.93" "$2,698.93" "$2,698.93" "$2,698.93" "$2,698.93" $562.49 "$2,698.93" "$2,744.80" "$1,330.57" "$2,698.93" "$2,744.80" "$2,698.93" "$2,698.93" "$2,024.25" "$2,698.93" "$2,698.93" "$2,698.93" "$1,349.47" "$1,349.47" "$2,137.55" "$2,698.93" "$2,159.14" "$1,214.52" $535.67 N/A "$1,565.42" "$2,698.93" "$1,619.36" "$2,698.93" $562.46 "$2,698.93" N/A N/A 240.039 SUP HCPCS C1713 240.039 - PLATE BN CNTR 118MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS BOTH IP/OP "$2,699.00" "$1,997.00" $535.67 "$2,744.80" "$1,214.52" "$1,214.52" "$1,214.52" "$1,214.52" "$2,698.93" "$2,698.93" "$2,698.93" $562.52 "$2,698.93" "$2,698.93" "$2,698.93" "$2,698.93" "$2,698.93" $562.49 "$2,698.93" "$1,097.92" "$1,330.57" "$2,698.93" "$2,744.80" "$2,698.93" "$2,698.93" "$2,024.25" "$2,698.93" "$2,698.93" "$2,698.93" "$1,349.47" "$1,349.47" "$2,137.55" "$2,698.93" "$2,159.14" "$1,214.52" $535.67 N/A "$1,565.42" "$2,698.93" "$2,698.93" "$2,698.93" $562.46 "$2,698.93" N/A N/A 240.04 SUP HCPCS C1713 240.040 - PLATE BN CNTR 154MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS BOTH IP/OP "$2,650.50" "$1,961.00" $526.03 "$2,776.25" "$1,192.66" "$1,192.66" "$1,192.66" "$1,192.66" "$2,650.35" "$2,650.35" "$2,650.35" $552.40 "$2,650.35" "$2,650.35" "$2,650.35" "$2,650.35" "$2,650.35" $552.36 "$2,650.35" "$2,776.25" "$1,306.62" "$2,650.35" "$2,776.25" "$2,650.35" "$2,650.35" "$1,987.88" "$2,650.35" "$2,650.35" "$2,650.35" "$1,325.18" "$1,325.18" "$2,099.08" "$2,650.35" "$2,120.28" "$1,192.66" $526.03 N/A "$1,537.29" "$2,650.35" "$1,590.21" "$2,650.35" $552.33 "$2,650.35" N/A N/A 240.041 SUP HCPCS C1713 240.041 - PLATE BN CNTR 154MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS BOTH IP/OP "$2,730.00" "$2,020.00" $541.81 "$2,776.25" "$1,228.43" "$1,228.43" "$1,228.43" "$1,228.43" "$2,729.85" "$2,729.85" "$2,729.85" $568.97 "$2,729.85" "$2,729.85" "$2,729.85" "$2,729.85" "$2,729.85" $568.93 "$2,729.85" "$2,776.25" "$1,345.82" "$2,729.85" "$2,776.25" "$2,729.85" "$2,729.85" "$2,047.50" "$2,729.85" "$2,729.85" "$2,729.85" "$1,364.93" "$1,364.93" "$2,162.04" "$2,729.85" "$2,183.88" "$1,228.43" $541.81 N/A "$1,583.40" "$2,729.85" "$1,637.91" "$2,729.85" $568.90 "$2,729.85" N/A N/A 240.042 SUP HCPCS C1713 240.042 - PLATE BN CNTR 190MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS BOTH IP/OP "$2,759.50" "$2,042.00" $547.67 "$2,806.28" "$1,241.72" "$1,241.72" "$1,241.72" "$1,241.72" "$2,759.38" "$2,759.38" "$2,759.38" $575.12 "$2,759.38" "$2,759.38" "$2,759.38" "$2,759.38" "$2,759.38" $575.09 "$2,759.38" "$2,806.28" "$1,360.37" "$2,759.38" "$2,806.28" "$2,759.38" "$2,759.38" "$2,069.63" "$2,759.38" "$2,759.38" "$2,759.38" "$1,379.69" "$1,379.69" "$2,185.43" "$2,759.38" "$2,207.50" "$1,241.72" $547.67 N/A "$1,600.51" "$2,759.38" "$2,759.38" "$2,759.38" $575.05 "$2,759.38" N/A N/A 240.043 SUP HCPCS C1713 240.043 - PLATE BN CNTR 190MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS BOTH IP/OP "$2,759.50" "$2,042.00" $547.67 "$2,806.28" "$1,241.72" "$1,241.72" "$1,241.72" "$1,241.72" "$2,759.38" "$2,759.38" "$2,759.38" $575.12 "$2,759.38" "$2,759.38" "$2,759.38" "$2,759.38" "$2,759.38" $575.09 "$2,759.38" "$2,806.28" "$1,360.37" "$2,759.38" "$2,806.28" "$2,759.38" "$2,759.38" "$2,069.63" "$2,759.38" "$2,759.38" "$2,759.38" "$1,379.69" "$1,379.69" "$2,185.43" "$2,759.38" "$2,207.50" "$1,241.72" $547.67 N/A "$1,600.51" "$2,759.38" "$1,655.63" "$2,759.38" $575.05 "$2,759.38" N/A N/A 240.044 SUP HCPCS C1713 240.044 - PLATE BN CNTR 226MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS BOTH IP/OP "$2,792.00" "$2,066.00" $554.08 "$2,839.15" "$1,256.27" "$1,256.27" "$1,256.27" "$1,256.27" "$2,791.70" "$2,791.70" "$2,791.70" $581.86 "$2,791.70" "$2,791.70" "$2,791.70" "$2,791.70" "$2,791.70" $581.82 "$2,791.70" "$2,839.15" "$1,376.31" "$2,791.70" "$2,839.15" "$2,791.70" "$2,791.70" "$2,094.00" "$2,791.70" "$2,791.70" "$2,791.70" "$1,395.85" "$1,395.85" "$2,211.03" "$2,791.70" "$2,233.36" "$1,256.27" $554.08 N/A "$1,619.36" "$2,791.70" "$2,791.70" "$2,791.70" $581.79 "$2,791.70" N/A N/A 240.045 SUP HCPCS C1713 240.045 - PLATE BN CNTR 226MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS BOTH IP/OP "$2,792.00" "$2,066.00" $554.08 "$2,839.15" "$1,256.27" "$1,256.27" "$1,256.27" "$1,256.27" "$2,791.70" "$2,791.70" "$2,791.70" $581.86 "$2,791.70" "$2,791.70" "$2,791.70" "$2,791.70" "$2,791.70" $581.82 "$2,791.70" "$2,839.15" "$1,376.31" "$2,791.70" "$2,839.15" "$2,791.70" "$2,791.70" "$2,094.00" "$2,791.70" "$2,791.70" "$2,791.70" "$1,395.85" "$1,395.85" "$2,211.03" "$2,791.70" "$2,233.36" "$1,256.27" $554.08 N/A "$1,619.36" "$2,791.70" "$1,675.02" "$2,791.70" $581.79 "$2,791.70" N/A N/A 240.046 SUP HCPCS C1713 240.046 - PLATE BN CNTR 262MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS BOTH IP/OP "$2,821.50" "$2,088.00" $559.94 "$2,869.18" "$1,269.55" "$1,269.55" "$1,269.55" "$1,269.55" "$2,821.23" "$2,821.23" "$2,821.23" $588.01 "$2,821.23" "$2,821.23" "$2,821.23" "$2,821.23" "$2,821.23" $587.98 "$2,821.23" "$1,147.67" "$1,390.87" "$2,821.23" "$2,869.18" "$2,821.23" "$2,821.23" "$2,116.13" "$2,821.23" "$2,821.23" "$2,821.23" "$1,410.62" "$1,410.62" "$2,234.41" "$2,821.23" "$2,256.98" "$1,269.55" $559.94 N/A "$1,636.47" "$2,821.23" "$1,692.74" "$2,821.23" $587.94 "$2,821.23" N/A N/A 240.047 SUP HCPCS C1713 240.047 - PLATE BN CNTR 262MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS BOTH IP/OP "$2,821.50" "$2,088.00" $559.94 "$2,869.18" "$1,269.55" "$1,269.55" "$1,269.55" "$1,269.55" "$2,821.23" "$2,821.23" "$2,821.23" $588.01 "$2,821.23" "$2,821.23" "$2,821.23" "$2,821.23" "$2,821.23" $587.98 "$2,821.23" "$2,869.18" "$1,390.87" "$2,821.23" "$2,869.18" "$2,821.23" "$2,821.23" "$2,116.13" "$2,821.23" "$2,821.23" "$2,821.23" "$1,410.62" "$1,410.62" "$2,234.41" "$2,821.23" "$2,256.98" "$1,269.55" $559.94 N/A "$1,636.47" "$2,821.23" "$1,692.74" "$2,821.23" $587.94 "$2,821.23" N/A N/A 240.064 SUP HCPCS C1713 240.064 - PLATE BONE 4 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL BOTH IP/OP $482.50 $357.00 $95.72 $482.30 $217.04 $217.04 $217.04 $217.04 $482.30 $482.30 $482.30 $100.52 $482.30 $482.30 $482.30 $482.30 $482.30 $100.52 $482.30 $192.92 $285.28 $482.30 $482.30 $482.30 $482.30 $361.88 $482.30 $482.30 $482.30 $241.15 $241.15 $381.98 $482.30 $385.84 $217.04 $95.72 N/A $279.85 $482.30 $289.38 $482.30 $100.51 $482.30 N/A N/A 240.065 SUP HCPCS C1713 240.065 - PLATE BONE 5 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL BOTH IP/OP $514.50 $381.00 $102.04 $514.10 $231.35 $231.35 $231.35 $231.35 $514.10 $514.10 $514.10 $107.15 $514.10 $514.10 $514.10 $514.10 $514.10 $107.14 $514.10 $514.10 $304.09 $514.10 $514.10 $514.10 $514.10 $385.88 $514.10 $514.10 $514.10 $257.05 $257.05 $407.17 $514.10 $411.28 $231.35 $102.04 N/A $298.41 $514.10 $308.46 $514.10 $107.14 $514.10 N/A N/A 240.066 SUP HCPCS C1713 240.066 - PLATE BONE 6 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL BOTH IP/OP $545.00 $403.00 $108.09 $544.58 $245.06 $245.06 $245.06 $245.06 $544.58 $544.58 $544.58 $113.50 $544.58 $544.58 $544.58 $544.58 $544.58 $113.50 $544.58 $544.58 $322.12 $544.58 $544.58 $544.58 $544.58 $408.75 $544.58 $544.58 $544.58 $272.29 $272.29 $431.31 $544.58 $435.66 $245.06 $108.09 N/A $316.10 $544.58 $544.58 $544.58 $113.49 $544.58 N/A N/A 240.067 SUP HCPCS C1713 240.067 - PLATE BONE 7 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL BOTH IP/OP $580.50 $430.00 $115.18 $580.35 $261.16 $261.16 $261.16 $261.16 $580.35 $580.35 $580.35 $120.96 $580.35 $580.35 $580.35 $580.35 $580.35 $120.95 $580.35 $580.35 $343.28 $580.35 $580.35 $580.35 $580.35 $435.38 $580.35 $580.35 $580.35 $290.18 $290.18 $459.64 $580.35 $464.28 $261.16 $115.18 N/A $336.69 $580.35 $348.21 $580.35 $120.94 $580.35 N/A N/A 240.068 SUP HCPCS C1713 240.068 - PLATE BONE 8 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL BOTH IP/OP $615.00 $455.00 $122.02 $614.80 $276.66 $276.66 $276.66 $276.66 $614.80 $614.80 $614.80 $128.14 $614.80 $614.80 $614.80 $614.80 $614.80 $128.13 $614.80 $614.80 $363.65 $614.80 $614.80 $614.80 $614.80 $461.25 $614.80 $614.80 $614.80 $307.40 $307.40 $486.92 $614.80 $491.84 $276.66 $122.02 N/A $356.70 $614.80 $368.88 $614.80 $128.12 $614.80 N/A N/A 240.069 SUP HCPCS C1713 240.069 - PLATE BONE 9 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL BOTH IP/OP $644.00 $477.00 $127.81 $643.95 $289.78 $289.78 $289.78 $289.78 $643.95 $643.95 $643.95 $134.22 $643.95 $643.95 $643.95 $643.95 $643.95 $134.21 $643.95 $643.95 $380.90 $643.95 $643.95 $643.95 $643.95 $483.00 $643.95 $643.95 $643.95 $321.98 $321.98 $510.01 $643.95 $515.16 $289.78 $127.81 N/A $373.52 $643.95 $386.37 $643.95 $134.20 $643.95 N/A N/A 240.07 SUP HCPCS C1713 240.070 - LASER SURG 20 BACKSTOP BOTH IP/OP $677.50 $501.00 $134.38 $677.08 $304.69 $304.69 $304.69 $304.69 $677.08 $677.08 $677.08 $141.12 $677.08 $677.08 $677.08 $677.08 $677.08 $141.11 $677.08 $677.08 $400.49 $677.08 $677.08 $677.08 $677.08 $508.13 $677.08 $677.08 $677.08 $338.54 $338.54 $536.25 $677.08 $541.66 $304.69 $134.38 N/A $392.95 $677.08 $406.25 $677.08 $141.10 $677.08 N/A N/A 240.071 SUP HCPCS C1713 240.071 - PLATE BONE 11 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL BOTH IP/OP $734.50 $544.00 $145.69 $734.05 $330.32 $330.32 $330.32 $330.32 $734.05 $734.05 $734.05 $152.99 $734.05 $734.05 $734.05 $734.05 $734.05 $152.98 $734.05 $293.62 $434.19 $734.05 $734.05 $734.05 $734.05 $550.88 $734.05 $734.05 $734.05 $367.03 $367.03 $581.37 $734.05 $587.24 $330.32 $145.69 N/A $426.01 $734.05 $440.43 $734.05 $152.98 $734.05 N/A N/A 240.072 SUP HCPCS C1713 240.072 - PLATE BONE 12 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL BOTH IP/OP $761.00 $563.00 $150.95 $760.55 $342.25 $342.25 $342.25 $342.25 $760.55 $760.55 $760.55 $158.52 $760.55 $760.55 $760.55 $760.55 $760.55 $158.51 $760.55 $304.22 $449.87 $760.55 $760.55 $760.55 $760.55 $570.75 $760.55 $760.55 $760.55 $380.28 $380.28 $602.36 $760.55 $608.44 $342.25 $150.95 N/A $441.38 $760.55 $456.33 $760.55 $158.50 $760.55 N/A N/A 240.073 SUP HCPCS C1713 240.073 - PLATE BONE 13 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL BOTH IP/OP $812.50 $601.00 $161.21 $812.23 $365.50 $365.50 $365.50 $365.50 $812.23 $812.23 $812.23 $169.29 $812.23 $812.23 $812.23 $812.23 $812.23 $169.28 $812.23 $324.89 $480.43 $812.23 $812.23 $812.23 $812.23 $609.38 $812.23 $812.23 $812.23 $406.12 $406.12 $643.29 $812.23 $649.78 $365.50 $161.21 N/A $471.25 $812.23 $487.34 $812.23 $169.27 $812.23 N/A N/A 240.074 SUP HCPCS C1713 240.074 - PLATE BONE 14 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL BOTH IP/OP $857.50 $635.00 $170.15 $857.28 $385.78 $385.78 $385.78 $385.78 $857.28 $857.28 $857.28 $178.68 $857.28 $857.28 $857.28 $857.28 $857.28 $178.67 $857.28 $857.28 $507.08 $857.28 $857.28 $857.28 $857.28 $643.13 $857.28 $857.28 $857.28 $428.64 $428.64 $678.97 $857.28 $685.82 $385.78 $170.15 N/A $497.35 $857.28 $514.37 $857.28 $178.66 $857.28 N/A N/A 240.075 SUP HCPCS C1713 240.075 - PLATE BONE 15 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL BOTH IP/OP $913.00 $676.00 $181.19 $912.93 $410.82 $410.82 $410.82 $410.82 $912.93 $912.93 $912.93 $190.28 $912.93 $912.93 $912.93 $912.93 $912.93 $190.26 $912.93 $912.93 $540.00 $912.93 $912.93 $912.93 $912.93 $684.75 $912.93 $912.93 $912.93 $456.47 $456.47 $723.04 $912.93 $730.34 $410.82 $181.19 N/A $529.54 $912.93 $547.76 $912.93 $190.25 $912.93 N/A N/A 240.076 SUP HCPCS C1713 240.076 - PLATE BONE 16 HOLE SCALLOPED STAINLESS STEEL TIBIA DISTAL BOTH IP/OP $995.50 $737.00 $197.50 $995.08 $447.79 $447.79 $447.79 $447.79 $995.08 $995.08 $995.08 $207.40 $995.08 $995.08 $995.08 $995.08 $995.08 $207.39 $995.08 $995.08 $588.59 $995.08 $995.08 $995.08 $995.08 $746.63 $995.08 $995.08 $995.08 $497.54 $497.54 $788.10 $995.08 $796.06 $447.79 $197.50 N/A $577.39 $995.08 $995.08 $995.08 $207.37 $995.08 N/A N/A 240.082 SUP HCPCS C1713 240.082 - PLATE BONE 173MM 7 HOLE PILON LCP STAINLESS STEEL DISTAL BOTH IP/OP "$3,212.00" "$2,377.00" $637.50 "$3,266.60" "$1,445.40" "$1,445.40" "$1,445.40" "$1,445.40" "$3,212.00" "$3,212.00" "$3,212.00" $669.46 "$3,212.00" "$3,212.00" "$3,212.00" "$3,212.00" "$3,212.00" $669.42 "$3,212.00" "$3,266.60" "$1,583.52" "$3,212.00" "$3,266.60" "$3,212.00" "$3,212.00" "$2,409.00" "$3,212.00" "$3,212.00" "$3,212.00" "$1,606.00" "$1,606.00" "$2,543.90" "$3,212.00" "$2,569.60" "$1,445.40" $637.50 N/A "$1,862.96" "$3,212.00" "$1,927.20" "$3,212.00" $669.38 "$3,212.00" N/A N/A 240.083 SUP HCPCS C1713 240.083 - PLATE BONE 173MM 9 HOLE PILON CNTOUR LCP STAINLESS STEEL BOTH IP/OP "$3,381.00" "$2,502.00" $670.98 "$3,438.18" "$1,521.32" "$1,521.32" "$1,521.32" "$1,521.32" "$3,380.70" "$3,380.70" "$3,380.70" $704.62 "$3,380.70" "$3,380.70" "$3,380.70" "$3,380.70" "$3,380.70" $704.58 "$3,380.70" "$3,438.18" "$1,666.69" "$3,380.70" "$3,438.18" "$3,380.70" "$3,380.70" "$2,535.75" "$3,380.70" "$3,380.70" "$3,380.70" "$1,690.35" "$1,690.35" "$2,677.51" "$3,380.70" "$2,704.56" "$1,521.32" $670.98 N/A "$1,960.98" "$3,380.70" "$2,028.42" "$3,380.70" $704.54 "$3,380.70" N/A N/A 240.13 SUP HCPCS C1713 240.13 - PLATE BONE T 68MM 3 HOLE DCP LC-DCP STAINLESS STEEL FT BOTH IP/OP $490.50 $363.00 $97.30 $490.25 $220.61 $220.61 $220.61 $220.61 $490.25 $490.25 $490.25 $102.18 $490.25 $490.25 $490.25 $490.25 $490.25 $102.17 $490.25 $490.25 $289.98 $490.25 $490.25 $490.25 $490.25 $367.88 $490.25 $490.25 $490.25 $245.13 $245.13 $388.28 $490.25 $392.20 $220.61 $97.30 N/A $284.49 $490.25 $294.15 $490.25 $102.17 $490.25 N/A N/A 240.14 SUP HCPCS C1713 240.14 - PLATE BN T 84MM NS 4 HL SHFT SS 4.5MM SCR LG FRAG SET BOTH IP/OP $551.50 $408.00 $109.37 $560.40 $247.96 $247.96 $247.96 $247.96 $551.03 $551.03 $551.03 $114.85 $551.03 $551.03 $551.03 $551.03 $551.03 $114.84 $551.03 $560.40 $325.93 $551.03 $560.40 $551.03 $551.03 $413.63 $551.03 $551.03 $551.03 $275.52 $275.52 $436.42 $551.03 $440.82 $247.96 $109.37 N/A $319.87 $551.03 $551.03 $551.03 $114.83 $551.03 N/A N/A 240.141 SUP HCPCS C1713 240.141 - PLATE BN T 83MM NS LCP CMBN 4 HL LMT CNTCT TPR END SS 4.5/5 BOTH IP/OP "$1,137.50" $842.00 $225.71 "$1,156.53" $511.74 $511.74 $511.74 $511.74 "$1,137.20" "$1,137.20" "$1,137.20" $237.02 "$1,137.20" "$1,137.20" "$1,137.20" "$1,137.20" "$1,137.20" $237.00 "$1,137.20" "$1,156.53" $672.65 "$1,137.20" "$1,156.53" "$1,137.20" "$1,137.20" $853.13 "$1,137.20" "$1,137.20" "$1,137.20" $568.60 $568.60 $900.66 "$1,137.20" $909.76 $511.74 $225.71 N/A $659.75 "$1,137.20" $682.32 "$1,137.20" $236.99 "$1,137.20" N/A N/A 240.15 SUP HCPCS C1713 240.15 - PLATE BONE 100MM 5 HOLE T DCP LC-DCP STAINLESS STEEL FT BOTH IP/OP $560.50 $415.00 $111.24 $560.48 $252.22 $252.22 $252.22 $252.22 $560.48 $560.48 $560.48 $116.82 $560.48 $560.48 $560.48 $560.48 $560.48 $116.81 $560.48 $224.19 $331.52 $560.48 $560.48 $560.48 $560.48 $420.38 $560.48 $560.48 $560.48 $280.24 $280.24 $443.90 $560.48 $448.38 $252.22 $111.24 N/A $325.09 $560.48 $336.29 $560.48 $116.80 $560.48 N/A N/A 240.16 SUP HCPCS C1713 240.16 - PLATE BN T 116MM NS 6 HL SHFT SS 4.5MM SCR LG FRAG SET BOTH IP/OP $639.00 $473.00 $126.77 $638.70 $287.42 $287.42 $287.42 $287.42 $638.70 $638.70 $638.70 $133.12 $638.70 $638.70 $638.70 $638.70 $638.70 $133.11 $638.70 $255.48 $377.79 $638.70 $638.70 $638.70 $638.70 $479.25 $638.70 $638.70 $638.70 $319.35 $319.35 $505.85 $638.70 $510.96 $287.42 $126.77 N/A $370.62 $638.70 $383.22 $638.70 $133.11 $638.70 N/A N/A 240.161 SUP HCPCS C1713 240.161 - PLATE BN T 115MM NS LCP CMBN 6 HL LMT CNTCT TPR END SS 4.5/5 BOTH IP/OP "$1,304.50" $965.00 $258.91 "$1,326.65" $587.02 $587.02 $587.02 $587.02 "$1,304.48" "$1,304.48" "$1,304.48" $271.89 "$1,304.48" "$1,304.48" "$1,304.48" "$1,304.48" "$1,304.48" $271.87 "$1,304.48" $530.66 $771.60 "$1,304.48" "$1,326.65" "$1,304.48" "$1,304.48" $978.38 "$1,304.48" "$1,304.48" "$1,304.48" $652.24 $652.24 "$1,033.15" "$1,304.48" "$1,043.58" $587.02 $258.91 N/A $756.61 "$1,304.48" $782.69 "$1,304.48" $271.85 "$1,304.48" N/A N/A 240.18 SUP HCPCS C1713 240.18 - PLATE BN T 148MM NS 8 HL SHFT SS 4.5MM SCR LG FRAG SET BOTH IP/OP $865.50 $640.00 $171.73 $865.25 $389.36 $389.36 $389.36 $389.36 $865.25 $865.25 $865.25 $180.34 $865.25 $865.25 $865.25 $865.25 $865.25 $180.33 $865.25 $865.25 $511.80 $865.25 $865.25 $865.25 $865.25 $649.13 $865.25 $865.25 $865.25 $432.63 $432.63 $685.28 $865.25 $692.20 $389.36 $171.73 N/A $501.99 $865.25 $519.15 $865.25 $180.32 $865.25 N/A N/A 240.181 SUP HCPCS C1713 240.181 - PLATE BN T 147MM NS LCP CMBN 8 HL LMT CNTCT TPR END SS 4.5/5 BOTH IP/OP "$1,505.50" "$1,114.00" $298.80 "$1,531.10" $677.48 $677.48 $677.48 $677.48 "$1,505.50" "$1,505.50" "$1,505.50" $313.78 "$1,505.50" "$1,505.50" "$1,505.50" "$1,505.50" "$1,505.50" $313.76 "$1,505.50" "$1,531.10" $890.50 "$1,505.50" "$1,531.10" "$1,505.50" "$1,505.50" "$1,129.13" "$1,505.50" "$1,505.50" "$1,505.50" $752.75 $752.75 "$1,192.36" "$1,505.50" "$1,204.40" $677.48 $298.80 N/A $873.19 "$1,505.50" "$1,505.50" "$1,505.50" $313.75 "$1,505.50" N/A N/A 240.34 SUP HCPCS C1713 240.34 - PLATE BN TBTRS 80MM NS DCP 4 HL SHFT SS 4.5MM SCR LG FRAG BOTH IP/OP $815.00 $603.00 $161.73 $814.88 $366.70 $366.70 $366.70 $366.70 $814.88 $814.88 $814.88 $169.84 $814.88 $814.88 $814.88 $814.88 $814.88 $169.83 $814.88 $814.88 $482.00 $814.88 $814.88 $814.88 $814.88 $611.25 $814.88 $814.88 $814.88 $407.44 $407.44 $645.38 $814.88 $651.90 $366.70 $161.73 N/A $472.70 $814.88 $488.93 $814.88 $169.82 $814.88 N/A N/A 240.35 SUP HCPCS C1713 240.35 - PLATE BONE T 96MM 5 HOLE BUTTRESS DCP LC-DCP STAINLESS STEEL BOTH IP/OP $857.50 $635.00 $170.15 $857.28 $385.78 $385.78 $385.78 $385.78 $857.28 $857.28 $857.28 $178.68 $857.28 $857.28 $857.28 $857.28 $857.28 $178.67 $857.28 $857.28 $507.08 $857.28 $857.28 $857.28 $857.28 $643.13 $857.28 $857.28 $857.28 $428.64 $428.64 $678.97 $857.28 $685.82 $385.78 $170.15 N/A $497.35 $857.28 $514.37 $857.28 $178.66 $857.28 N/A N/A 240.36 SUP HCPCS C1713 240.36 - PLATE BONE T 112MM 6 HOLE BUTTRESS DCP STAINLESS STEEL FT BOTH IP/OP $940.50 $696.00 $186.65 $956.38 $423.18 $423.18 $423.18 $423.18 $940.40 $940.40 $940.40 $196.00 $940.40 $940.40 $940.40 $940.40 $940.40 $195.99 $940.40 $956.38 $556.25 $940.40 $956.38 $940.40 $940.40 $705.38 $940.40 $940.40 $940.40 $470.20 $470.20 $744.80 $940.40 $752.32 $423.18 $186.65 N/A $545.49 $940.40 $564.24 $940.40 $195.98 $940.40 N/A N/A 240.403 SUP HCPCS C1713 240.403 - PLATE BONE 87MM 3 HOLE BUTTRESS DCP STAINLESS STEEL TIBIAL BOTH IP/OP "$1,057.50" $783.00 $209.86 "$1,057.35" $475.81 $475.81 $475.81 $475.81 "$1,057.35" "$1,057.35" "$1,057.35" $220.38 "$1,057.35" "$1,057.35" "$1,057.35" "$1,057.35" "$1,057.35" $220.36 "$1,057.35" $422.94 $625.42 "$1,057.35" "$1,057.35" "$1,057.35" "$1,057.35" $793.13 "$1,057.35" "$1,057.35" "$1,057.35" $528.68 $528.68 $837.42 "$1,057.35" $845.88 $475.81 $209.86 N/A $613.35 "$1,057.35" $634.41 "$1,057.35" $220.35 "$1,057.35" N/A N/A 240.406 SUP HCPCS C1713 240.406 - PLATE BONE LEFT ANGLE L 115MM 6 HOLE BUTTRESS LC-DCP BOTH IP/OP "$1,018.50" $754.00 $202.07 "$1,018.10" $458.15 $458.15 $458.15 $458.15 "$1,018.10" "$1,018.10" "$1,018.10" $212.20 "$1,018.10" "$1,018.10" "$1,018.10" "$1,018.10" "$1,018.10" $212.18 "$1,018.10" $407.24 $602.21 "$1,018.10" "$1,018.10" "$1,018.10" "$1,018.10" $763.88 "$1,018.10" "$1,018.10" "$1,018.10" $509.05 $509.05 $806.34 "$1,018.10" $814.48 $458.15 $202.07 N/A $590.73 "$1,018.10" $610.86 "$1,018.10" $212.17 "$1,018.10" N/A N/A 240.407 SUP HCPCS C1713 240.407 - PLATE BONE LEFT ANGLE L 132MM 7 HOLE BUTTRESS LC-DCP BOTH IP/OP "$1,076.00" $796.00 $213.54 "$1,075.90" $484.16 $484.16 $484.16 $484.16 "$1,075.90" "$1,075.90" "$1,075.90" $224.24 "$1,075.90" "$1,075.90" "$1,075.90" "$1,075.90" "$1,075.90" $224.23 "$1,075.90" $430.36 $636.39 "$1,075.90" "$1,075.90" "$1,075.90" "$1,075.90" $807.00 "$1,075.90" "$1,075.90" "$1,075.90" $537.95 $537.95 $852.11 "$1,075.90" $860.72 $484.16 $213.54 N/A $624.08 "$1,075.90" $645.54 "$1,075.90" $224.22 "$1,075.90" N/A N/A 240.408 SUP HCPCS C1713 240.408 - PLATE BONE LEFT ANGLE L 148MM 8 HOLE BUTTRESS LC-DCP BOTH IP/OP "$1,163.00" $861.00 $230.78 "$1,162.78" $523.25 $523.25 $523.25 $523.25 "$1,162.78" "$1,162.78" "$1,162.78" $242.35 "$1,162.78" "$1,162.78" "$1,162.78" "$1,162.78" "$1,162.78" $242.34 "$1,162.78" "$1,162.78" $687.78 "$1,162.78" "$1,162.78" "$1,162.78" "$1,162.78" $872.25 "$1,162.78" "$1,162.78" "$1,162.78" $581.39 $581.39 $920.92 "$1,162.78" $930.22 $523.25 $230.78 N/A $674.54 "$1,162.78" "$1,162.78" "$1,162.78" $242.32 "$1,162.78" N/A N/A 240.44 SUP HCPCS C1713 240.44 - PLATE BN ANG LT L BTRS 86X14X3.8MM NS DCP 4 HL SHFT SS TIB BOTH IP/OP $734.50 $544.00 $145.73 $734.23 $330.40 $330.40 $330.40 $330.40 $734.23 $734.23 $734.23 $153.03 $734.23 $734.23 $734.23 $734.23 $734.23 $153.02 $734.23 $293.69 $434.30 $734.23 $734.23 $734.23 $734.23 $550.88 $734.23 $734.23 $734.23 $367.12 $367.12 $581.51 $734.23 $587.38 $330.40 $145.73 N/A $426.01 $734.23 $440.54 $734.23 $153.01 $734.23 N/A N/A 240.46 SUP HCPCS C1713 240.46 - PLATE BN BTRS 118X14X3.8MM NS DCP 5 HL SHFT SS TIBHD RL LG BOTH IP/OP "$1,266.50" $937.00 $251.37 "$1,266.50" $569.93 $569.93 $569.93 $569.93 "$1,266.50" "$1,266.50" "$1,266.50" $263.97 "$1,266.50" "$1,266.50" "$1,266.50" "$1,266.50" "$1,266.50" $263.95 "$1,266.50" $506.60 $749.13 "$1,266.50" "$1,266.50" "$1,266.50" "$1,266.50" $949.88 "$1,266.50" "$1,266.50" "$1,266.50" $633.25 $633.25 "$1,003.07" "$1,266.50" "$1,013.20" $569.93 $251.37 N/A $734.57 "$1,266.50" $759.90 "$1,266.50" $263.94 "$1,266.50" N/A N/A 240.47 SUP HCPCS C1713 240.47 - PLATE BN BTRS 149X14X3.8MM NS DCP 7 HL SHFT SS TIBHD RL LG BOTH IP/OP "$1,401.50" "$1,037.00" $278.16 "$1,425.30" $630.67 $630.67 $630.67 $630.67 "$1,401.48" "$1,401.48" "$1,401.48" $292.10 "$1,401.48" "$1,401.48" "$1,401.48" "$1,401.48" "$1,401.48" $292.08 "$1,401.48" $570.12 $828.98 "$1,401.48" "$1,425.30" "$1,401.48" "$1,401.48" "$1,051.13" "$1,401.48" "$1,401.48" "$1,401.48" $700.74 $700.74 "$1,109.97" "$1,401.48" "$1,121.18" $630.67 $278.16 N/A $812.87 "$1,401.48" $840.89 "$1,401.48" $292.07 "$1,401.48" N/A N/A 240.48 SUP HCPCS C1713 240.48 - PLATE BN BTRS 181X14X3.8MM NS DCP 9 HL SHFT SS TIBHD RL LG BOTH IP/OP "$1,496.00" "$1,107.00" $296.85 "$1,521.08" $673.04 $673.04 $673.04 $673.04 "$1,495.65" "$1,495.65" "$1,495.65" $311.73 "$1,495.65" "$1,495.65" "$1,495.65" "$1,495.65" "$1,495.65" $311.71 "$1,495.65" $608.43 $884.68 "$1,495.65" "$1,521.08" "$1,495.65" "$1,495.65" "$1,122.00" "$1,495.65" "$1,495.65" "$1,495.65" $747.83 $747.83 "$1,184.55" "$1,495.65" "$1,196.52" $673.04 $296.85 N/A $867.68 "$1,495.65" $897.39 "$1,495.65" $311.69 "$1,495.65" N/A N/A 240.5 SUP HCPCS C1713 240.50 - PLATE BONE 240MM 13 HOLE BUTTRESS DCP STAINLESS STEEL TIBIA BOTH IP/OP "$1,605.00" "$1,188.00" $318.54 "$1,681.20" $722.23 $722.23 $722.23 $722.23 "$1,604.95" "$1,604.95" "$1,604.95" $334.51 "$1,604.95" "$1,604.95" "$1,604.95" "$1,604.95" "$1,604.95" $334.49 "$1,604.95" $672.48 $949.33 "$1,604.95" "$1,681.20" "$1,604.95" "$1,604.95" "$1,203.75" "$1,604.95" "$1,604.95" "$1,604.95" $802.48 $802.48 "$1,271.12" "$1,604.95" "$1,283.96" $722.23 $318.54 N/A $930.90 "$1,604.95" $962.97 "$1,604.95" $334.47 "$1,604.95" N/A N/A 240.505 SUP HCPCS C1713 240.505 - PLATE BONE RIGHT ANG L 101MM 5 HOLE BUTTRESS LC-DCP BOTH IP/OP $983.50 $728.00 $195.13 $983.15 $442.42 $442.42 $442.42 $442.42 $983.15 $983.15 $983.15 $204.91 $983.15 $983.15 $983.15 $983.15 $983.15 $204.90 $983.15 $393.26 $581.53 $983.15 $983.15 $983.15 $983.15 $737.63 $983.15 $983.15 $983.15 $491.58 $491.58 $778.65 $983.15 $786.52 $442.42 $195.13 N/A $570.43 $983.15 $589.89 $983.15 $204.89 $983.15 N/A N/A 240.506 SUP HCPCS C1713 240.506 - PLATE BONE RIGHT ANG L 115MM 6 HOLE BUTTRESS LC-DCP BOTH IP/OP "$1,018.50" $754.00 $202.07 "$1,018.10" $458.15 $458.15 $458.15 $458.15 "$1,018.10" "$1,018.10" "$1,018.10" $212.20 "$1,018.10" "$1,018.10" "$1,018.10" "$1,018.10" "$1,018.10" $212.18 "$1,018.10" "$1,018.10" $602.21 "$1,018.10" "$1,018.10" "$1,018.10" "$1,018.10" $763.88 "$1,018.10" "$1,018.10" "$1,018.10" $509.05 $509.05 $806.34 "$1,018.10" $814.48 $458.15 $202.07 N/A $590.73 "$1,018.10" $610.86 "$1,018.10" $212.17 "$1,018.10" N/A N/A 240.508 SUP HCPCS C1713 240.508 - PLATE BONE RIGHT ANG L 148MM 8 HOLE BUTTRESS LC-DCP BOTH IP/OP "$1,163.00" $861.00 $230.78 "$1,162.78" $523.25 $523.25 $523.25 $523.25 "$1,162.78" "$1,162.78" "$1,162.78" $242.35 "$1,162.78" "$1,162.78" "$1,162.78" "$1,162.78" "$1,162.78" $242.34 "$1,162.78" "$1,162.78" $687.78 "$1,162.78" "$1,162.78" "$1,162.78" "$1,162.78" $872.25 "$1,162.78" "$1,162.78" "$1,162.78" $581.39 $581.39 $920.92 "$1,162.78" $930.22 $523.25 $230.78 N/A $674.54 "$1,162.78" $697.67 "$1,162.78" $242.32 "$1,162.78" N/A N/A 240.509 SUP HCPCS C1713 240.509 - PLATE BONE 162MM BUTTRESS L 9 HOLE LC-DCP TITANIUM LEFT BOTH IP/OP "$1,175.50" $870.00 $233.26 "$1,175.28" $528.88 $528.88 $528.88 $528.88 "$1,175.28" "$1,175.28" "$1,175.28" $244.96 "$1,175.28" "$1,175.28" "$1,175.28" "$1,175.28" "$1,175.28" $244.94 "$1,175.28" "$1,175.28" $695.18 "$1,175.28" "$1,175.28" "$1,175.28" "$1,175.28" $881.63 "$1,175.28" "$1,175.28" "$1,175.28" $587.64 $587.64 $930.82 "$1,175.28" $940.22 $528.88 $233.26 N/A $681.79 "$1,175.28" $705.17 "$1,175.28" $244.93 "$1,175.28" N/A N/A 240.54 SUP HCPCS C1713 240.54 - PLATE BN ANG RT L BTRS 86X14X3.8MM NS DCP 4 HL SHFT SS TIB BOTH IP/OP $734.50 $544.00 $145.73 $734.23 $330.40 $330.40 $330.40 $330.40 $734.23 $734.23 $734.23 $153.03 $734.23 $734.23 $734.23 $734.23 $734.23 $153.02 $734.23 $734.23 $434.30 $734.23 $734.23 $734.23 $734.23 $550.88 $734.23 $734.23 $734.23 $367.12 $367.12 $581.51 $734.23 $587.38 $330.40 $145.73 N/A $426.01 $734.23 $440.54 $734.23 $153.01 $734.23 N/A N/A 240.56 SUP HCPCS C1713 240.56 - PLATE BN BTRS 118X14X3.8MM NS DCP 5 HL SHFT SS TIBHD L/L 4.5 BOTH IP/OP "$1,304.50" $965.00 $258.91 "$1,326.65" $587.02 $587.02 $587.02 $587.02 "$1,304.48" "$1,304.48" "$1,304.48" $271.89 "$1,304.48" "$1,304.48" "$1,304.48" "$1,304.48" "$1,304.48" $271.87 "$1,304.48" "$1,326.65" $771.60 "$1,304.48" "$1,326.65" "$1,304.48" "$1,304.48" $978.38 "$1,304.48" "$1,304.48" "$1,304.48" $652.24 $652.24 "$1,033.15" "$1,304.48" "$1,043.58" $587.02 $258.91 N/A $756.61 "$1,304.48" $782.69 "$1,304.48" $271.85 "$1,304.48" N/A N/A 240.57 SUP HCPCS C1713 240.57 - PLATE BN BTRS 149X14X3.8MM NS DCP 7 HL SHFT SS TIBHD L/L LG BOTH IP/OP "$1,401.50" "$1,037.00" $278.16 "$1,425.30" $630.67 $630.67 $630.67 $630.67 "$1,401.48" "$1,401.48" "$1,401.48" $292.10 "$1,401.48" "$1,401.48" "$1,401.48" "$1,401.48" "$1,401.48" $292.08 "$1,401.48" $570.12 $828.98 "$1,401.48" "$1,425.30" "$1,401.48" "$1,401.48" "$1,051.13" "$1,401.48" "$1,401.48" "$1,401.48" $700.74 $700.74 "$1,109.97" "$1,401.48" "$1,121.18" $630.67 $278.16 N/A $812.87 "$1,401.48" $840.89 "$1,401.48" $292.07 "$1,401.48" N/A N/A 240.58 SUP HCPCS C1713 240.58 - PLATE BN BTRS 181X14X3.8MM NS DCP 9 HL SHFT SS TIBHD L/L LG BOTH IP/OP "$1,496.00" "$1,107.00" $296.85 "$1,521.08" $673.04 $673.04 $673.04 $673.04 "$1,495.65" "$1,495.65" "$1,495.65" $311.73 "$1,495.65" "$1,495.65" "$1,495.65" "$1,495.65" "$1,495.65" $311.71 "$1,495.65" $608.43 $884.68 "$1,495.65" "$1,521.08" "$1,495.65" "$1,495.65" "$1,122.00" "$1,495.65" "$1,495.65" "$1,495.65" $747.83 $747.83 "$1,184.55" "$1,495.65" "$1,196.52" $673.04 $296.85 N/A $867.68 "$1,495.65" "$1,495.65" "$1,495.65" $311.69 "$1,495.65" N/A N/A 240.6 SUP HCPCS C1713 240.60 - PLATE BONE 240X14X3.8MM 13 HOLE SHAFT BUTTRESS DCP STAINLESS BOTH IP/OP "$1,605.00" "$1,188.00" $318.54 "$1,681.20" $722.23 $722.23 $722.23 $722.23 "$1,604.95" "$1,604.95" "$1,604.95" $334.51 "$1,604.95" "$1,604.95" "$1,604.95" "$1,604.95" "$1,604.95" $334.49 "$1,604.95" $672.48 $949.33 "$1,604.95" "$1,681.20" "$1,604.95" "$1,604.95" "$1,203.75" "$1,604.95" "$1,604.95" "$1,604.95" $802.48 $802.48 "$1,271.12" "$1,604.95" "$1,283.96" $722.23 $318.54 N/A $930.90 "$1,604.95" $962.97 "$1,604.95" $334.47 "$1,604.95" N/A N/A 240.7 SUP HCPCS C1713 240.70 - PLATE BONE BUTTRESS 221X16X5MM 11 HOLE SHAFT DCP STAINLESS BOTH IP/OP "$1,539.50" "$1,139.00" $305.54 "$1,539.45" $692.75 $692.75 $692.75 $692.75 "$1,539.45" "$1,539.45" "$1,539.45" $320.86 "$1,539.45" "$1,539.45" "$1,539.45" "$1,539.45" "$1,539.45" $320.84 "$1,539.45" $615.78 $910.58 "$1,539.45" "$1,539.45" "$1,539.45" "$1,539.45" "$1,154.63" "$1,539.45" "$1,539.45" "$1,539.45" $769.73 $769.73 "$1,219.24" "$1,539.45" "$1,231.56" $692.75 $305.54 N/A $892.91 "$1,539.45" $923.67 "$1,539.45" $320.82 "$1,539.45" N/A N/A 240.71 SUP HCPCS C1713 240.71 - PLATE BONE BUTTRESS 253X16X5MM 11 HOLE SHAFT DCP STAINLESS BOTH IP/OP "$1,582.50" "$1,171.00" $314.00 "$1,582.05" $711.92 $711.92 $711.92 $711.92 "$1,582.05" "$1,582.05" "$1,582.05" $329.74 "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" $329.72 "$1,582.05" $632.82 $935.78 "$1,582.05" "$1,582.05" "$1,582.05" "$1,582.05" "$1,186.88" "$1,582.05" "$1,582.05" "$1,582.05" $791.03 $791.03 "$1,252.98" "$1,582.05" "$1,265.64" $711.92 $314.00 N/A $917.85 "$1,582.05" $949.23 "$1,582.05" $329.70 "$1,582.05" N/A N/A 240.72 SUP HCPCS C1713 240.72 - PLATE BONE 285MM BUTTRESS 15 HOLE DCP STAINLESS STEEL BOTH IP/OP "$1,624.50" "$1,202.00" $322.41 "$1,624.45" $731.00 $731.00 $731.00 $731.00 "$1,624.45" "$1,624.45" "$1,624.45" $338.58 "$1,624.45" "$1,624.45" "$1,624.45" "$1,624.45" "$1,624.45" $338.55 "$1,624.45" $649.78 $960.86 "$1,624.45" "$1,624.45" "$1,624.45" "$1,624.45" "$1,218.38" "$1,624.45" "$1,624.45" "$1,624.45" $812.23 $812.23 "$1,286.56" "$1,624.45" "$1,299.56" $731.00 $322.41 N/A $942.21 "$1,624.45" $974.67 "$1,624.45" $338.54 "$1,624.45" N/A N/A 240.73 SUP HCPCS C1713 240.73 - PLATE BONE BUTTRESS 221X16X5MM 11 HOLE SHAFT DCP STAINLESS BOTH IP/OP "$1,537.00" "$1,137.00" $305.06 "$1,537.00" $691.65 $691.65 $691.65 $691.65 "$1,537.00" "$1,537.00" "$1,537.00" $320.35 "$1,537.00" "$1,537.00" "$1,537.00" "$1,537.00" "$1,537.00" $320.33 "$1,537.00" "$1,537.00" $909.14 "$1,537.00" "$1,537.00" "$1,537.00" "$1,537.00" "$1,152.75" "$1,537.00" "$1,537.00" "$1,537.00" $768.50 $768.50 "$1,217.30" "$1,537.00" "$1,229.60" $691.65 $305.06 N/A $891.46 "$1,537.00" $922.20 "$1,537.00" $320.31 "$1,537.00" N/A N/A 240.75 SUP HCPCS C1713 240.75 - PLATE BONE 285MM 15 HOLE BUTTRESS DCP STAINLESS STEEL BOTH IP/OP "$1,624.50" "$1,202.00" $322.41 "$1,624.45" $731.00 $731.00 $731.00 $731.00 "$1,624.45" "$1,624.45" "$1,624.45" $338.58 "$1,624.45" "$1,624.45" "$1,624.45" "$1,624.45" "$1,624.45" $338.55 "$1,624.45" "$1,624.45" $960.86 "$1,624.45" "$1,624.45" "$1,624.45" "$1,624.45" "$1,218.38" "$1,624.45" "$1,624.45" "$1,624.45" $812.23 $812.23 "$1,286.56" "$1,624.45" "$1,299.56" $731.00 $322.41 N/A $942.21 "$1,624.45" "$1,624.45" "$1,624.45" $338.54 "$1,624.45" N/A N/A 240.8 SUP HCPCS C1713 240.80 - PLATE BONE 128MM 4 HOLE HOOK BUTTRESS DCP STAINLESS STEEL BOTH IP/OP "$1,257.50" $931.00 $249.57 "$1,257.43" $565.84 $565.84 $565.84 $565.84 "$1,257.43" "$1,257.43" "$1,257.43" $262.08 "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $262.06 "$1,257.43" "$1,257.43" $743.77 "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $943.13 "$1,257.43" "$1,257.43" "$1,257.43" $628.72 $628.72 $995.88 "$1,257.43" "$1,005.94" $565.84 $249.57 N/A $729.35 "$1,257.43" $754.46 "$1,257.43" $262.05 "$1,257.43" N/A N/A 240.9 SUP HCPCS C1713 240.90 - PLATE 202MM SS LG FRAG SET 10 HOLE CBR HEAD DCP BONE ORTH BOTH IP/OP "$1,158.50" $857.00 $229.84 "$1,158.05" $521.12 $521.12 $521.12 $521.12 "$1,158.05" "$1,158.05" "$1,158.05" $241.37 "$1,158.05" "$1,158.05" "$1,158.05" "$1,158.05" "$1,158.05" $241.35 "$1,158.05" "$1,158.05" $684.99 "$1,158.05" "$1,158.05" "$1,158.05" "$1,158.05" $868.88 "$1,158.05" "$1,158.05" "$1,158.05" $579.03 $579.03 $917.18 "$1,158.05" $926.44 $521.12 $229.84 N/A $671.93 "$1,158.05" $694.83 "$1,158.05" $241.34 "$1,158.05" N/A N/A 240.91 SUP HCPCS C1713 240.91 - PLATE BONE 218MM 11 HOLE COBRA HEAD LC-DCP STAINLESS STEEL BOTH IP/OP "$1,220.50" $903.00 $242.20 "$1,220.33" $549.15 $549.15 $549.15 $549.15 "$1,220.33" "$1,220.33" "$1,220.33" $254.35 "$1,220.33" "$1,220.33" "$1,220.33" "$1,220.33" "$1,220.33" $254.33 "$1,220.33" "$1,220.33" $721.83 "$1,220.33" "$1,220.33" "$1,220.33" "$1,220.33" $915.38 "$1,220.33" "$1,220.33" "$1,220.33" $610.17 $610.17 $966.50 "$1,220.33" $976.26 $549.15 $242.20 N/A $707.89 "$1,220.33" "$1,220.33" "$1,220.33" $254.32 "$1,220.33" N/A N/A 240.92 SUP HCPCS C1713 240.92 - PLATE BN BTRS 158X16X5MM NS DCP 7 HL SHFT SS FEM LT CNDRL BOTH IP/OP "$1,357.00" "$1,004.00" $269.24 "$1,356.55" $610.45 $610.45 $610.45 $610.45 "$1,356.55" "$1,356.55" "$1,356.55" $282.74 "$1,356.55" "$1,356.55" "$1,356.55" "$1,356.55" "$1,356.55" $282.72 "$1,356.55" $542.62 $802.40 "$1,356.55" "$1,356.55" "$1,356.55" "$1,356.55" "$1,017.75" "$1,356.55" "$1,356.55" "$1,356.55" $678.28 $678.28 "$1,074.39" "$1,356.55" "$1,085.24" $610.45 $269.24 N/A $787.06 "$1,356.55" $813.93 "$1,356.55" $282.71 "$1,356.55" N/A N/A 240.93 SUP HCPCS C1713 240.93 - PLATE BN BTRS 190X16X5MM NS DCP 9 HL SHFT SS FEM LT CNDRL BOTH IP/OP "$1,467.50" "$1,086.00" $291.18 "$1,467.10" $660.20 $660.20 $660.20 $660.20 "$1,467.10" "$1,467.10" "$1,467.10" $305.78 "$1,467.10" "$1,467.10" "$1,467.10" "$1,467.10" "$1,467.10" $305.76 "$1,467.10" $586.84 $867.79 "$1,467.10" "$1,467.10" "$1,467.10" "$1,467.10" "$1,100.63" "$1,467.10" "$1,467.10" "$1,467.10" $733.55 $733.55 "$1,161.94" "$1,467.10" "$1,173.68" $660.20 $291.18 N/A $851.15 "$1,467.10" $880.26 "$1,467.10" $305.74 "$1,467.10" N/A N/A 240.94 SUP HCPCS C1713 240.94 - PLATE BN BTRS 158X16X5MM NS DCP 7 HL SHFT SS FEM RT CNDRL BOTH IP/OP "$1,357.00" "$1,004.00" $269.24 "$1,356.55" $610.45 $610.45 $610.45 $610.45 "$1,356.55" "$1,356.55" "$1,356.55" $282.74 "$1,356.55" "$1,356.55" "$1,356.55" "$1,356.55" "$1,356.55" $282.72 "$1,356.55" $542.62 $802.40 "$1,356.55" "$1,356.55" "$1,356.55" "$1,356.55" "$1,017.75" "$1,356.55" "$1,356.55" "$1,356.55" $678.28 $678.28 "$1,074.39" "$1,356.55" "$1,085.24" $610.45 $269.24 N/A $787.06 "$1,356.55" "$1,356.55" "$1,356.55" $282.71 "$1,356.55" N/A N/A 240.95 SUP HCPCS C1713 240.95 - PLATE BN BTRS 190X16X5MM NS DCP 9 HL SHFT SS FEM RT CNDRL BOTH IP/OP "$1,467.50" "$1,086.00" $291.18 "$1,467.10" $660.20 $660.20 $660.20 $660.20 "$1,467.10" "$1,467.10" "$1,467.10" $305.78 "$1,467.10" "$1,467.10" "$1,467.10" "$1,467.10" "$1,467.10" $305.76 "$1,467.10" $586.84 $867.79 "$1,467.10" "$1,467.10" "$1,467.10" "$1,467.10" "$1,100.63" "$1,467.10" "$1,467.10" "$1,467.10" $733.55 $733.55 "$1,161.94" "$1,467.10" "$1,173.68" $660.20 $291.18 N/A $851.15 "$1,467.10" $880.26 "$1,467.10" $305.74 "$1,467.10" N/A N/A 240.98 SUP HCPCS C1713 240.98 - PLATE BONE 170MM 8 HOLE COBRA HEAD DCP STAINLESS STEEL BOTH IP/OP "$1,031.00" $763.00 $204.60 "$1,030.85" $463.88 $463.88 $463.88 $463.88 "$1,030.85" "$1,030.85" "$1,030.85" $214.85 "$1,030.85" "$1,030.85" "$1,030.85" "$1,030.85" "$1,030.85" $214.84 "$1,030.85" $412.34 $609.75 "$1,030.85" "$1,030.85" "$1,030.85" "$1,030.85" $773.25 "$1,030.85" "$1,030.85" "$1,030.85" $515.43 $515.43 $816.43 "$1,030.85" $824.68 $463.88 $204.60 N/A $597.98 "$1,030.85" "$1,030.85" "$1,030.85" $214.83 "$1,030.85" N/A N/A 240.99 SUP HCPCS C1713 240.99 - PLATE BONE 186MM 9 HOLE COBRA HEAD DCP STAINLESS STEEL BOTH IP/OP "$1,098.50" $813.00 $218.01 "$1,098.43" $494.29 $494.29 $494.29 $494.29 "$1,098.43" "$1,098.43" "$1,098.43" $228.94 "$1,098.43" "$1,098.43" "$1,098.43" "$1,098.43" "$1,098.43" $228.92 "$1,098.43" $439.37 $649.72 "$1,098.43" "$1,098.43" "$1,098.43" "$1,098.43" $823.88 "$1,098.43" "$1,098.43" "$1,098.43" $549.22 $549.22 $869.96 "$1,098.43" $878.74 $494.29 $218.01 N/A $637.13 "$1,098.43" $659.06 "$1,098.43" $228.91 "$1,098.43" N/A N/A 241.004 SUP HCPCS C1713 241.004 - PLATE BN 60MM NS 4 HL SHFT SS TIB RT PROX 3.5MM SCR SM FRAG BOTH IP/OP "$2,172.00" "$1,607.00" $431.05 "$2,208.73" $977.31 $977.31 $977.31 $977.31 "$2,171.80" "$2,171.80" "$2,171.80" $452.66 "$2,171.80" "$2,171.80" "$2,171.80" "$2,171.80" "$2,171.80" $452.63 "$2,171.80" "$2,208.73" "$1,284.62" "$2,171.80" "$2,208.73" "$2,171.80" "$2,171.80" "$1,629.00" "$2,171.80" "$2,171.80" "$2,171.80" "$1,085.90" "$1,085.90" "$1,720.07" "$2,171.80" "$1,737.44" $977.31 $431.05 N/A "$1,259.76" "$2,171.80" "$1,303.08" "$2,171.80" $452.60 "$2,171.80" N/A N/A 241.005 SUP HCPCS C1713 241.005 - PLATE BONE 60MM 4 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL BOTH IP/OP "$2,172.00" "$1,607.00" $431.05 "$2,208.73" $977.31 $977.31 $977.31 $977.31 "$2,171.80" "$2,171.80" "$2,171.80" $452.66 "$2,171.80" "$2,171.80" "$2,171.80" "$2,171.80" "$2,171.80" $452.63 "$2,171.80" "$2,208.73" "$1,284.62" "$2,171.80" "$2,208.73" "$2,171.80" "$2,171.80" "$1,629.00" "$2,171.80" "$2,171.80" "$2,171.80" "$1,085.90" "$1,085.90" "$1,720.07" "$2,171.80" "$1,737.44" $977.31 $431.05 N/A "$1,259.76" "$2,171.80" "$1,303.08" "$2,171.80" $452.60 "$2,171.80" N/A N/A 241.006 SUP HCPCS C1713 241.006 - PLATE BONE 85MM 6 HOLE STAINLESS STEEL TIBIA RIGHT PROXIMAL BOTH IP/OP "$2,180.50" "$1,614.00" $432.72 "$2,217.30" $981.10 $981.10 $981.10 $981.10 "$2,180.23" "$2,180.23" "$2,180.23" $454.41 "$2,180.23" "$2,180.23" "$2,180.23" "$2,180.23" "$2,180.23" $454.38 "$2,180.23" "$2,217.30" "$1,289.61" "$2,180.23" "$2,217.30" "$2,180.23" "$2,180.23" "$1,635.38" "$2,180.23" "$2,180.23" "$2,180.23" "$1,090.12" "$1,090.12" "$1,726.74" "$2,180.23" "$1,744.18" $981.10 $432.72 N/A "$1,264.69" "$2,180.23" "$1,308.14" "$2,180.23" $454.36 "$2,180.23" N/A N/A 241.007 SUP HCPCS C1713 241.007 - PLATE BONE 85MM 6 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL BOTH IP/OP "$2,180.50" "$1,614.00" $432.72 "$2,217.30" $981.10 $981.10 $981.10 $981.10 "$2,180.23" "$2,180.23" "$2,180.23" $454.41 "$2,180.23" "$2,180.23" "$2,180.23" "$2,180.23" "$2,180.23" $454.38 "$2,180.23" "$2,217.30" "$1,289.61" "$2,180.23" "$2,217.30" "$2,180.23" "$2,180.23" "$1,635.38" "$2,180.23" "$2,180.23" "$2,180.23" "$1,090.12" "$1,090.12" "$1,726.74" "$2,180.23" "$1,744.18" $981.10 $432.72 N/A "$1,264.69" "$2,180.23" "$1,308.14" "$2,180.23" $454.36 "$2,180.23" N/A N/A 241.008 SUP HCPCS C1713 241.008 - PLATE BN 111MM NS 8 HL SHFT SS TIB RT PROX 3.5MM SCR SM FRAG BOTH IP/OP "$2,251.00" "$1,666.00" $446.67 "$2,288.78" "$1,012.74" "$1,012.74" "$1,012.74" "$1,012.74" "$2,250.53" "$2,250.53" "$2,250.53" $469.07 "$2,250.53" "$2,250.53" "$2,250.53" "$2,250.53" "$2,250.53" $469.04 "$2,250.53" "$2,288.78" "$1,331.19" "$2,250.53" "$2,288.78" "$2,250.53" "$2,250.53" "$1,688.25" "$2,250.53" "$2,250.53" "$2,250.53" "$1,125.27" "$1,125.27" "$1,782.42" "$2,250.53" "$1,800.42" "$1,012.74" $446.67 N/A "$1,305.58" "$2,250.53" "$1,350.32" "$2,250.53" $469.01 "$2,250.53" N/A N/A 241.009 SUP HCPCS C1713 241.009 - PLATE BN 111MM NS 8 HL SHFT SS TIB LT PROX 3.5MM SCR SM FRAG BOTH IP/OP "$2,251.00" "$1,666.00" $446.67 "$2,288.78" "$1,012.74" "$1,012.74" "$1,012.74" "$1,012.74" "$2,250.53" "$2,250.53" "$2,250.53" $469.07 "$2,250.53" "$2,250.53" "$2,250.53" "$2,250.53" "$2,250.53" $469.04 "$2,250.53" "$2,288.78" "$1,331.19" "$2,250.53" "$2,288.78" "$2,250.53" "$2,250.53" "$1,688.25" "$2,250.53" "$2,250.53" "$2,250.53" "$1,125.27" "$1,125.27" "$1,782.42" "$2,250.53" "$1,800.42" "$1,012.74" $446.67 N/A "$1,305.58" "$2,250.53" "$1,350.32" "$2,250.53" $469.01 "$2,250.53" N/A N/A 241.01 SUP HCPCS C1713 241.010 - PLATE BONE 137MM 10 HOLE STAINLESS STEEL TIBIA RIGHT BOTH IP/OP "$2,197.50" "$1,626.00" $436.10 "$2,301.65" $988.76 $988.76 $988.76 $988.76 "$2,197.25" "$2,197.25" "$2,197.25" $457.96 "$2,197.25" "$2,197.25" "$2,197.25" "$2,197.25" "$2,197.25" $457.93 "$2,197.25" $920.66 "$1,299.67" "$2,197.25" "$2,301.65" "$2,197.25" "$2,197.25" "$1,648.13" "$2,197.25" "$2,197.25" "$2,197.25" "$1,098.63" "$1,098.63" "$1,740.22" "$2,197.25" "$1,757.80" $988.76 $436.10 N/A "$1,274.55" "$2,197.25" "$2,197.25" "$2,197.25" $457.91 "$2,197.25" N/A N/A 241.011 SUP HCPCS C1713 241.011 - PLATE BN 137MM NS 10 HL SHFT SS TIB LT PROX 3.5MM SCR SM BOTH IP/OP "$2,263.50" "$1,675.00" $449.18 "$2,301.65" "$1,018.43" "$1,018.43" "$1,018.43" "$1,018.43" "$2,263.18" "$2,263.18" "$2,263.18" $471.70 "$2,263.18" "$2,263.18" "$2,263.18" "$2,263.18" "$2,263.18" $471.67 "$2,263.18" $920.66 "$1,338.67" "$2,263.18" "$2,301.65" "$2,263.18" "$2,263.18" "$1,697.63" "$2,263.18" "$2,263.18" "$2,263.18" "$1,131.59" "$1,131.59" "$1,792.44" "$2,263.18" "$1,810.54" "$1,018.43" $449.18 N/A "$1,312.83" "$2,263.18" "$2,263.18" "$2,263.18" $471.65 "$2,263.18" N/A N/A 241.012 SUP HCPCS C1713 241.012 - PLATE BN 137MM NS 12 HL SHFT SS TIB RT PROX 3.5MM SCR SM BOTH IP/OP "$2,347.50" "$1,737.00" $465.92 "$2,387.40" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$2,347.50" "$2,347.50" "$2,347.50" $489.28 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $954.96 "$1,388.55" "$2,347.50" "$2,387.40" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" $465.92 N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" $489.22 "$2,347.50" N/A N/A 241.013 SUP HCPCS C1713 241.013 - PLATE BN 163MM NS 12 HL SHFT SS TIB LT PROX 3.5MM SCR SM BOTH IP/OP "$2,347.50" "$1,737.00" $465.92 "$2,387.40" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$2,347.50" "$2,347.50" "$2,347.50" $489.28 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $954.96 "$1,388.55" "$2,347.50" "$2,387.40" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" $465.92 N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" $489.22 "$2,347.50" N/A N/A 241.014 SUP HCPCS C1713 241.014 - PLATE BONE 163MM 14 HOLE STAINLESS STEEL TIBIA RIGHT BOTH IP/OP "$2,398.50" "$1,775.00" $475.96 "$2,438.88" "$1,079.15" "$1,079.15" "$1,079.15" "$1,079.15" "$2,398.10" "$2,398.10" "$2,398.10" $499.82 "$2,398.10" "$2,398.10" "$2,398.10" "$2,398.10" "$2,398.10" $499.79 "$2,398.10" "$2,438.88" "$1,418.48" "$2,398.10" "$2,438.88" "$2,398.10" "$2,398.10" "$1,798.88" "$2,398.10" "$2,398.10" "$2,398.10" "$1,199.05" "$1,199.05" "$1,899.30" "$2,398.10" "$1,918.48" "$1,079.15" $475.96 N/A "$1,391.13" "$2,398.10" "$1,438.86" "$2,398.10" $499.76 "$2,398.10" N/A N/A 241.015 SUP HCPCS C1713 241.015 - PLATE BONE 189MM 14 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL BOTH IP/OP "$2,398.50" "$1,775.00" $475.96 "$2,438.88" "$1,079.15" "$1,079.15" "$1,079.15" "$1,079.15" "$2,398.10" "$2,398.10" "$2,398.10" $499.82 "$2,398.10" "$2,398.10" "$2,398.10" "$2,398.10" "$2,398.10" $499.79 "$2,398.10" "$2,438.88" "$1,418.48" "$2,398.10" "$2,438.88" "$2,398.10" "$2,398.10" "$1,798.88" "$2,398.10" "$2,398.10" "$2,398.10" "$1,199.05" "$1,199.05" "$1,899.30" "$2,398.10" "$1,918.48" "$1,079.15" $475.96 N/A "$1,391.13" "$2,398.10" "$1,438.86" "$2,398.10" $499.76 "$2,398.10" N/A N/A 241.016 SUP HCPCS C1713 241.016 - PLATE BN 215MM NS 16 HL SHFT SS TIB RT PROX 3.5MM SCR SM BOTH IP/OP "$2,447.50" "$1,811.00" $485.73 "$2,488.90" "$1,101.29" "$1,101.29" "$1,101.29" "$1,101.29" "$2,447.30" "$2,447.30" "$2,447.30" $510.08 "$2,447.30" "$2,447.30" "$2,447.30" "$2,447.30" "$2,447.30" $510.04 "$2,447.30" $995.56 "$1,447.58" "$2,447.30" "$2,488.90" "$2,447.30" "$2,447.30" "$1,835.63" "$2,447.30" "$2,447.30" "$2,447.30" "$1,223.65" "$1,223.65" "$1,938.26" "$2,447.30" "$1,957.84" "$1,101.29" $485.73 N/A "$1,419.55" "$2,447.30" "$1,468.38" "$2,447.30" $510.02 "$2,447.30" N/A N/A 241.017 SUP HCPCS C1713 241.017 - PLATE BONE 215MM 16 HOLE STAINLESS STEEL TIBIA LEFT PROXIMAL BOTH IP/OP "$2,447.50" "$1,811.00" $485.73 "$2,488.90" "$1,101.29" "$1,101.29" "$1,101.29" "$1,101.29" "$2,447.30" "$2,447.30" "$2,447.30" $510.08 "$2,447.30" "$2,447.30" "$2,447.30" "$2,447.30" "$2,447.30" $510.04 "$2,447.30" $995.56 "$1,447.58" "$2,447.30" "$2,488.90" "$2,447.30" "$2,447.30" "$1,835.63" "$2,447.30" "$2,447.30" "$2,447.30" "$1,223.65" "$1,223.65" "$1,938.26" "$2,447.30" "$1,957.84" "$1,101.29" $485.73 N/A "$1,419.55" "$2,447.30" "$1,468.38" "$2,447.30" $510.02 "$2,447.30" N/A N/A 241.031 SUP HCPCS C1713 241.031 - PLATE BN OB R T 52X10X1.5MM NS LCP CMBN 3 HLE/HD 3 HL SHFT BOTH IP/OP $662.50 $490.00 $131.41 $673.33 $297.94 $297.94 $297.94 $297.94 $662.08 $662.08 $662.08 $137.99 $662.08 $662.08 $662.08 $662.08 $662.08 $137.98 $662.08 $673.33 $391.62 $662.08 $673.33 $662.08 $662.08 $496.88 $662.08 $662.08 $662.08 $331.04 $331.04 $524.37 $662.08 $529.66 $297.94 $131.41 N/A $384.25 $662.08 $397.25 $662.08 $137.98 $662.08 N/A N/A 241.041 SUP HCPCS C1713 241.041 - PLATE BN OB R T 63X10X1.5MM NS LCP CMBN 3 HLE/HD 4 HL SHFT BOTH IP/OP $693.00 $513.00 $137.54 $704.78 $311.85 $311.85 $311.85 $311.85 $693.00 $693.00 $693.00 $144.44 $693.00 $693.00 $693.00 $693.00 $693.00 $144.43 $693.00 $281.91 $409.91 $693.00 $704.78 $693.00 $693.00 $519.75 $693.00 $693.00 $693.00 $346.50 $346.50 $548.86 $693.00 $554.40 $311.85 $137.54 N/A $401.94 $693.00 $415.80 $693.00 $144.42 $693.00 N/A N/A 241.051 SUP HCPCS C1713 241.051 - PLATE BN OB R T 74X10X1.5MM NS LCP CMBN 3 HLE/HD 5 HL SHFT BOTH IP/OP $724.00 $536.00 $143.68 $736.23 $325.77 $325.77 $325.77 $325.77 $723.93 $723.93 $723.93 $150.89 $723.93 $723.93 $723.93 $723.93 $723.93 $150.87 $723.93 $736.23 $428.20 $723.93 $736.23 $723.93 $723.93 $543.00 $723.93 $723.93 $723.93 $361.97 $361.97 $573.35 $723.93 $579.14 $325.77 $143.68 N/A $419.92 $723.93 $434.36 $723.93 $150.87 $723.93 N/A N/A 241.061 SUP HCPCS C1713 241.061 - PLATE BONE T 85X10X1.5MM 3X6 HOLE OBLIQUE RIGHT LCP BOTH IP/OP $776.00 $574.00 $154.01 $789.15 $349.18 $349.18 $349.18 $349.18 $775.95 $775.95 $775.95 $161.73 $775.95 $775.95 $775.95 $775.95 $775.95 $161.72 $775.95 $789.15 $458.97 $775.95 $789.15 $775.95 $775.95 $582.00 $775.95 $775.95 $775.95 $387.98 $387.98 $614.55 $775.95 $620.76 $349.18 $154.01 N/A $450.08 $775.95 $775.95 $775.95 $161.71 $775.95 N/A N/A 241.062 SUP HCPCS C1713 241.062 - PLATE BONE 15MM 6 HOLE HOOK LC-DCP DCP STAINLESS STEEL RIGHT BOTH IP/OP "$1,272.00" $941.00 $252.46 "$1,272.00" $572.40 $572.40 $572.40 $572.40 "$1,272.00" "$1,272.00" "$1,272.00" $265.12 "$1,272.00" "$1,272.00" "$1,272.00" "$1,272.00" "$1,272.00" $265.10 "$1,272.00" "$1,272.00" $752.39 "$1,272.00" "$1,272.00" "$1,272.00" "$1,272.00" $954.00 "$1,272.00" "$1,272.00" "$1,272.00" $636.00 $636.00 "$1,007.42" "$1,272.00" "$1,017.60" $572.40 $252.46 N/A $737.76 "$1,272.00" $763.20 "$1,272.00" $265.08 "$1,272.00" N/A N/A 241.063 SUP HCPCS C1713 241.063 - PLATE BONE 15MM 6 HOLE HOOK LC-DCP STAINLESS STEEL LEFT BOTH IP/OP "$1,272.00" $941.00 $252.46 "$1,272.00" $572.40 $572.40 $572.40 $572.40 "$1,272.00" "$1,272.00" "$1,272.00" $265.12 "$1,272.00" "$1,272.00" "$1,272.00" "$1,272.00" "$1,272.00" $265.10 "$1,272.00" $508.80 $752.39 "$1,272.00" "$1,272.00" "$1,272.00" "$1,272.00" $954.00 "$1,272.00" "$1,272.00" "$1,272.00" $636.00 $636.00 "$1,007.42" "$1,272.00" "$1,017.60" $572.40 $252.46 N/A $737.76 "$1,272.00" $763.20 "$1,272.00" $265.08 "$1,272.00" N/A N/A 241.064 SUP HCPCS C1713 241.064 - PLATE BONE 18MM 6 HOLE HOOK LC-DCP DCP STAINLESS STEEL RIGHT BOTH IP/OP "$1,272.00" $941.00 $252.46 "$1,272.00" $572.40 $572.40 $572.40 $572.40 "$1,272.00" "$1,272.00" "$1,272.00" $265.12 "$1,272.00" "$1,272.00" "$1,272.00" "$1,272.00" "$1,272.00" $265.10 "$1,272.00" $508.80 $752.39 "$1,272.00" "$1,272.00" "$1,272.00" "$1,272.00" $954.00 "$1,272.00" "$1,272.00" "$1,272.00" $636.00 $636.00 "$1,007.42" "$1,272.00" "$1,017.60" $572.40 $252.46 N/A $737.76 "$1,272.00" "$1,272.00" "$1,272.00" $265.08 "$1,272.00" N/A N/A 241.065 SUP HCPCS C1713 241.065 - PLATE BONE 18MM 6 HOLE HOOK LC-DCP STAINLESS STEEL LEFT BOTH IP/OP "$1,272.00" $941.00 $252.46 "$1,272.00" $572.40 $572.40 $572.40 $572.40 "$1,272.00" "$1,272.00" "$1,272.00" $265.12 "$1,272.00" "$1,272.00" "$1,272.00" "$1,272.00" "$1,272.00" $265.10 "$1,272.00" $508.80 $752.39 "$1,272.00" "$1,272.00" "$1,272.00" "$1,272.00" $954.00 "$1,272.00" "$1,272.00" "$1,272.00" $636.00 $636.00 "$1,007.42" "$1,272.00" "$1,017.60" $572.40 $252.46 N/A $737.76 "$1,272.00" $763.20 "$1,272.00" $265.08 "$1,272.00" N/A N/A 241.066 SUP HCPCS C1713 241.066 - PLATE BONE 15MM 8 HOLE HOOK LC-DCP STAINLESS STEEL RIGHT BOTH IP/OP "$1,365.00" "$1,010.00" $270.87 "$1,364.75" $614.14 $614.14 $614.14 $614.14 "$1,364.75" "$1,364.75" "$1,364.75" $284.45 "$1,364.75" "$1,364.75" "$1,364.75" "$1,364.75" "$1,364.75" $284.43 "$1,364.75" $545.90 $807.25 "$1,364.75" "$1,364.75" "$1,364.75" "$1,364.75" "$1,023.75" "$1,364.75" "$1,364.75" "$1,364.75" $682.38 $682.38 "$1,080.88" "$1,364.75" "$1,091.80" $614.14 $270.87 N/A $791.70 "$1,364.75" $818.85 "$1,364.75" $284.41 "$1,364.75" N/A N/A 241.067 SUP HCPCS C1713 241.067 - PLATE BONE 15MM 8 HOLE HOOK LC-DCP STAINLESS STEEL LEFT BOTH IP/OP "$1,365.00" "$1,010.00" $270.87 "$1,364.75" $614.14 $614.14 $614.14 $614.14 "$1,364.75" "$1,364.75" "$1,364.75" $284.45 "$1,364.75" "$1,364.75" "$1,364.75" "$1,364.75" "$1,364.75" $284.43 "$1,364.75" "$1,364.75" $807.25 "$1,364.75" "$1,364.75" "$1,364.75" "$1,364.75" "$1,023.75" "$1,364.75" "$1,364.75" "$1,364.75" $682.38 $682.38 "$1,080.88" "$1,364.75" "$1,091.80" $614.14 $270.87 N/A $791.70 "$1,364.75" "$1,364.75" "$1,364.75" $284.41 "$1,364.75" N/A N/A 241.068 SUP HCPCS C1713 241.068 - PLATE BONE 18MM 8 HOLE HOOK LC-DCP STAINLESS STEEL RIGHT BOTH IP/OP "$1,365.00" "$1,010.00" $270.87 "$1,364.75" $614.14 $614.14 $614.14 $614.14 "$1,364.75" "$1,364.75" "$1,364.75" $284.45 "$1,364.75" "$1,364.75" "$1,364.75" "$1,364.75" "$1,364.75" $284.43 "$1,364.75" $545.90 $807.25 "$1,364.75" "$1,364.75" "$1,364.75" "$1,364.75" "$1,023.75" "$1,364.75" "$1,364.75" "$1,364.75" $682.38 $682.38 "$1,080.88" "$1,364.75" "$1,091.80" $614.14 $270.87 N/A $791.70 "$1,364.75" "$1,364.75" "$1,364.75" $284.41 "$1,364.75" N/A N/A 241.069 SUP HCPCS C1713 241.069 - PLATE BN 18MM 77X10X3.3MM NS LC DCP 8 HL HK PRECONTOUR SS BOTH IP/OP "$1,365.00" "$1,010.00" $270.87 "$1,364.75" $614.14 $614.14 $614.14 $614.14 "$1,364.75" "$1,364.75" "$1,364.75" $284.45 "$1,364.75" "$1,364.75" "$1,364.75" "$1,364.75" "$1,364.75" $284.43 "$1,364.75" $545.90 $807.25 "$1,364.75" "$1,364.75" "$1,364.75" "$1,364.75" "$1,023.75" "$1,364.75" "$1,364.75" "$1,364.75" $682.38 $682.38 "$1,080.88" "$1,364.75" "$1,091.80" $614.14 $270.87 N/A $791.70 "$1,364.75" $818.85 "$1,364.75" $284.41 "$1,364.75" N/A N/A 241.071 SUP HCPCS C1713 241.071 - PLATE BN OB R T 96X10X1.5MM NS LCP CMBN 3 HLE/HD 7 HL SHFT BOTH IP/OP $786.00 $582.00 $155.96 $799.13 $353.60 $353.60 $353.60 $353.60 $785.78 $785.78 $785.78 $163.78 $785.78 $785.78 $785.78 $785.78 $785.78 $163.77 $785.78 $799.13 $464.79 $785.78 $799.13 $785.78 $785.78 $589.50 $785.78 $785.78 $785.78 $392.89 $392.89 $622.34 $785.78 $628.62 $353.60 $155.96 N/A $455.88 $785.78 $471.47 $785.78 $163.76 $785.78 N/A N/A 241.081 SUP HCPCS C1713 241.081 - PLATE BONE T 107X10X1.5MM 3X8 HOLE OBLIQUE RIGHT LCP BOTH IP/OP $853.50 $632.00 $169.35 $867.75 $383.96 $383.96 $383.96 $383.96 $853.25 $853.25 $853.25 $177.84 $853.25 $853.25 $853.25 $853.25 $853.25 $177.83 $853.25 $867.75 $504.70 $853.25 $867.75 $853.25 $853.25 $640.13 $853.25 $853.25 $853.25 $426.63 $426.63 $675.77 $853.25 $682.60 $383.96 $169.35 N/A $495.03 $853.25 $511.95 $853.25 $177.82 $853.25 N/A N/A 241.13 SUP HCPCS C1713 241.13 - PLATE BN RT ANG T 50X10X1.2MM NS LC DCP 3 HLE/HD 3 HL SHFT BOTH IP/OP $233.50 $173.00 $46.32 $233.38 $105.02 $105.02 $105.02 $105.02 $233.38 $233.38 $233.38 $48.64 $233.38 $233.38 $233.38 $233.38 $233.38 $48.64 $233.38 $93.35 $138.04 $233.38 $233.38 $233.38 $233.38 $175.13 $233.38 $233.38 $233.38 $116.69 $116.69 $184.84 $233.38 $186.70 $105.02 $46.32 N/A $135.43 $233.38 $140.03 $233.38 $48.64 $233.38 N/A N/A 241.131 SUP HCPCS C1713 241.131 - PLATE BONE T RIGHT ANG 50X10X1.5MM 3X3 HOLE LCP STAINLESS BOTH IP/OP $592.00 $438.00 $117.46 $601.85 $266.31 $266.31 $266.31 $266.31 $591.80 $591.80 $591.80 $123.35 $591.80 $591.80 $591.80 $591.80 $591.80 $123.34 $591.80 $601.85 $350.05 $591.80 $601.85 $591.80 $591.80 $444.00 $591.80 $591.80 $591.80 $295.90 $295.90 $468.71 $591.80 $473.44 $266.31 $117.46 N/A $343.36 $591.80 $355.08 $591.80 $123.33 $591.80 N/A N/A 241.132 SUP HCPCS C1713 241.132 - PLATE BONE T RIGHT ANG 50X11X1.5MM 4X3 HOLE LCP STAINLESS BOTH IP/OP $607.50 $450.00 $120.52 $617.58 $273.26 $273.26 $273.26 $273.26 $607.25 $607.25 $607.25 $126.57 $607.25 $607.25 $607.25 $607.25 $607.25 $126.56 $607.25 $617.58 $359.19 $607.25 $617.58 $607.25 $607.25 $455.63 $607.25 $607.25 $607.25 $303.63 $303.63 $480.94 $607.25 $485.80 $273.26 $120.52 N/A $352.35 $607.25 $607.25 $607.25 $126.55 $607.25 N/A N/A 241.14 SUP HCPCS C1713 241.14 - PLATE BN RT ANG T 56X10X1.2MM NS LC DCP 4 HLE/HD 4 HL SHFT BOTH IP/OP $249.00 $184.00 $49.38 $253.03 $111.96 $111.96 $111.96 $111.96 $248.80 $248.80 $248.80 $51.86 $248.80 $248.80 $248.80 $248.80 $248.80 $51.85 $248.80 $253.03 $147.17 $248.80 $253.03 $248.80 $248.80 $186.75 $248.80 $248.80 $248.80 $124.40 $124.40 $197.05 $248.80 $199.04 $111.96 $49.38 N/A $144.42 $248.80 $149.28 $248.80 $51.85 $248.80 N/A N/A 241.141 SUP HCPCS C1713 241.141 - PLATE BN RT ANG T 56X11X1.5MM NS LCP CMBN 4 HLE/HD 4 HL SHFT BOTH IP/OP $610.50 $452.00 $121.09 $620.45 $274.54 $274.54 $274.54 $274.54 $610.08 $610.08 $610.08 $127.16 $610.08 $610.08 $610.08 $610.08 $610.08 $127.15 $610.08 $248.18 $360.86 $610.08 $620.45 $610.08 $610.08 $457.88 $610.08 $610.08 $610.08 $305.04 $305.04 $483.18 $610.08 $488.06 $274.54 $121.09 N/A $354.09 $610.08 $610.08 $610.08 $127.14 $610.08 N/A N/A 241.142 SUP HCPCS C1713 241.142 - PLATE BN RT ANG T 57X10X1.5MM NS LCP CMBN 3 HLE/HD 4 HL SHFT BOTH IP/OP $630.00 $466.00 $124.99 $640.45 $283.39 $283.39 $283.39 $283.39 $629.75 $629.75 $629.75 $131.26 $629.75 $629.75 $629.75 $629.75 $629.75 $131.25 $629.75 $640.45 $372.50 $629.75 $640.45 $629.75 $629.75 $472.50 $629.75 $629.75 $629.75 $314.88 $314.88 $498.76 $629.75 $503.80 $283.39 $124.99 N/A $365.40 $629.75 $629.75 $629.75 $131.24 $629.75 N/A N/A 241.15 SUP HCPCS C1713 241.15 - PLATE BN RT ANG T 67X10X1.2MM NS LC DCP 3 HLE/HD 5 HL SHFT BOTH IP/OP $267.50 $198.00 $53.09 $267.50 $120.38 $120.38 $120.38 $120.38 $267.50 $267.50 $267.50 $55.75 $267.50 $267.50 $267.50 $267.50 $267.50 $55.75 $267.50 $267.50 $158.23 $267.50 $267.50 $267.50 $267.50 $200.63 $267.50 $267.50 $267.50 $133.75 $133.75 $211.86 $267.50 $214.00 $120.38 $53.09 N/A $155.15 $267.50 $267.50 $267.50 $55.75 $267.50 N/A N/A 241.151 SUP HCPCS C1713 241.151 - PLATE BN RT ANG T 67X10X1.5MM NS LCP CMBN 3 HLE/HD 5 HL SHFT BOTH IP/OP $672.00 $497.00 $133.36 $683.35 $302.37 $302.37 $302.37 $302.37 $671.93 $671.93 $671.93 $140.05 $671.93 $671.93 $671.93 $671.93 $671.93 $140.04 $671.93 $683.35 $397.45 $671.93 $683.35 $671.93 $671.93 $504.00 $671.93 $671.93 $671.93 $335.97 $335.97 $532.17 $671.93 $537.54 $302.37 $133.36 N/A $389.76 $671.93 $403.16 $671.93 $140.03 $671.93 N/A N/A 241.152 SUP HCPCS C1713 241.152 - PLATE BONE 67MM 3X5 HOLE T RIGHT ANG LCP STAINLESS STEEL BOTH IP/OP $692.00 $512.00 $137.27 $703.35 $311.22 $311.22 $311.22 $311.22 $691.60 $691.60 $691.60 $144.15 $691.60 $691.60 $691.60 $691.60 $691.60 $144.14 $691.60 $703.35 $409.08 $691.60 $703.35 $691.60 $691.60 $519.00 $691.60 $691.60 $691.60 $345.80 $345.80 $547.75 $691.60 $553.28 $311.22 $137.27 N/A $401.36 $691.60 $414.96 $691.60 $144.13 $691.60 N/A N/A 241.16 SUP HCPCS C1713 241.16 - PLATE BONE ANGLE RIGHT T 75X10X1.2MM 4X6 HOLE LCP STAINLESS BOTH IP/OP $311.50 $231.00 $61.76 $311.18 $140.03 $140.03 $140.03 $140.03 $311.18 $311.18 $311.18 $64.86 $311.18 $311.18 $311.18 $311.18 $311.18 $64.85 $311.18 $124.47 $184.06 $311.18 $311.18 $311.18 $311.18 $233.63 $311.18 $311.18 $311.18 $155.59 $155.59 $246.45 $311.18 $248.94 $140.03 $61.76 N/A $180.67 $311.18 $311.18 $311.18 $64.85 $311.18 N/A N/A 241.161 SUP HCPCS C1713 241.161 - PLATE BN RT ANG T 78X11X1.5MM NS LCP CMBN 4 HLE/HD 6 HL SHFT BOTH IP/OP $783.00 $579.00 $155.40 $796.28 $352.34 $352.34 $352.34 $352.34 $782.98 $782.98 $782.98 $163.19 $782.98 $782.98 $782.98 $782.98 $782.98 $163.18 $782.98 $796.28 $463.13 $782.98 $796.28 $782.98 $782.98 $587.25 $782.98 $782.98 $782.98 $391.49 $391.49 $620.12 $782.98 $626.38 $352.34 $155.40 N/A $454.14 $782.98 $469.79 $782.98 $163.17 $782.98 N/A N/A 241.162 SUP HCPCS C1713 241.162 - PLATE BONE T RIGHT ANG 77X10X1.5MM 3X6 HOLE LCP STAINLESS BOTH IP/OP $804.50 $595.00 $159.58 $817.73 $361.82 $361.82 $361.82 $361.82 $804.05 $804.05 $804.05 $167.58 $804.05 $804.05 $804.05 $804.05 $804.05 $167.57 $804.05 $817.73 $475.60 $804.05 $817.73 $804.05 $804.05 $603.38 $804.05 $804.05 $804.05 $402.03 $402.03 $636.81 $804.05 $643.24 $361.82 $159.58 N/A $466.61 $804.05 $482.43 $804.05 $167.56 $804.05 N/A N/A 241.17 SUP HCPCS C1713 241.17 - PLATE BONE T RIGHT ANG 90X10X1.2MM 4X7 HOLE LCP STAINLESS BOTH IP/OP $400.00 $296.00 $79.37 $399.88 $179.95 $179.95 $179.95 $179.95 $399.88 $399.88 $399.88 $83.34 $399.88 $399.88 $399.88 $399.88 $399.88 $83.34 $399.88 $159.95 $236.53 $399.88 $399.88 $399.88 $399.88 $300.00 $399.88 $399.88 $399.88 $199.94 $199.94 $316.70 $399.88 $319.90 $179.95 $79.37 N/A $232.00 $399.88 $399.88 $399.88 $83.33 $399.88 N/A N/A 241.171 SUP HCPCS C1713 241.171 - PLATE BN RT ANG T 87X10X1.5MM NS LCP CMBN 3 HLE/HD 7 HL SHFT BOTH IP/OP $981.50 $726.00 $194.74 $997.85 $441.53 $441.53 $441.53 $441.53 $981.18 $981.18 $981.18 $204.50 $981.18 $981.18 $981.18 $981.18 $981.18 $204.49 $981.18 $997.85 $580.37 $981.18 $997.85 $981.18 $981.18 $736.13 $981.18 $981.18 $981.18 $490.59 $490.59 $777.09 $981.18 $784.94 $441.53 $194.74 N/A $569.27 $981.18 $981.18 $981.18 $204.48 $981.18 N/A N/A 241.172 SUP HCPCS C1713 241.172 - PLATE BONE T RIGHT ANG 89X11X1.5MM 4X7 HOLE LCP STAINLESS BOTH IP/OP $977.00 $723.00 $193.90 $993.55 $439.63 $439.63 $439.63 $439.63 $976.95 $976.95 $976.95 $203.62 $976.95 $976.95 $976.95 $976.95 $976.95 $203.61 $976.95 $993.55 $577.87 $976.95 $993.55 $976.95 $976.95 $732.75 $976.95 $976.95 $976.95 $488.48 $488.48 $773.74 $976.95 $781.56 $439.63 $193.90 N/A $566.66 $976.95 $586.17 $976.95 $203.60 $976.95 N/A N/A 241.18 SUP HCPCS C1713 241.18 - PLATE BONE 100MM 4 HOLE HEAD 8 HOLE SHAFT T RIGHT ANG LC-DCP BOTH IP/OP $464.50 $344.00 $92.10 $464.03 $208.81 $208.81 $208.81 $208.81 $464.03 $464.03 $464.03 $96.72 $464.03 $464.03 $464.03 $464.03 $464.03 $96.71 $464.03 $185.61 $274.47 $464.03 $464.03 $464.03 $464.03 $348.38 $464.03 $464.03 $464.03 $232.02 $232.02 $367.51 $464.03 $371.22 $208.81 $92.10 N/A $269.41 $464.03 $464.03 $464.03 $96.70 $464.03 N/A N/A 241.181 SUP HCPCS C1713 241.181 - PLATE BONE T RIGHT ANG 97X10X1.5MM 3X8 HOLE LCP STAINLESS BOTH IP/OP "$1,175.50" $870.00 $233.24 "$1,195.13" $528.82 $528.82 $528.82 $528.82 "$1,175.15" "$1,175.15" "$1,175.15" $244.93 "$1,175.15" "$1,175.15" "$1,175.15" "$1,175.15" "$1,175.15" $244.91 "$1,175.15" $478.05 $695.10 "$1,175.15" "$1,195.13" "$1,175.15" "$1,175.15" $881.63 "$1,175.15" "$1,175.15" "$1,175.15" $587.58 $587.58 $930.72 "$1,175.15" $940.12 $528.82 $233.24 N/A $681.79 "$1,175.15" $705.09 "$1,175.15" $244.90 "$1,175.15" N/A N/A 241.182 SUP HCPCS C1713 241.182 - PLATE BONE T RIGHT ANG 100X10X1.5MM 4X8 HOLE LCP STAINLESS BOTH IP/OP "$1,171.00" $867.00 $232.40 "$1,190.85" $526.93 $526.93 $526.93 $526.93 "$1,170.95" "$1,170.95" "$1,170.95" $244.06 "$1,170.95" "$1,170.95" "$1,170.95" "$1,170.95" "$1,170.95" $244.04 "$1,170.95" "$1,190.85" $692.62 "$1,170.95" "$1,190.85" "$1,170.95" "$1,170.95" $878.25 "$1,170.95" "$1,170.95" "$1,170.95" $585.48 $585.48 $927.39 "$1,170.95" $936.76 $526.93 $232.40 N/A $679.18 "$1,170.95" $702.57 "$1,170.95" $244.03 "$1,170.95" N/A N/A 241.189 SUP HCPCS C1713 241.189 - PLATE BONE 112MM 4 HOLE HEAD 9 HOLE SHAFT T RIGHT ANG LC-DCP BOTH IP/OP $517.50 $383.00 $102.67 $526.10 $232.79 $232.79 $232.79 $232.79 $517.30 $517.30 $517.30 $107.82 $517.30 $517.30 $517.30 $517.30 $517.30 $107.81 $517.30 $526.10 $305.98 $517.30 $526.10 $517.30 $517.30 $388.13 $517.30 $517.30 $517.30 $258.65 $258.65 $409.70 $517.30 $413.84 $232.79 $102.67 N/A $300.15 $517.30 $310.38 $517.30 $107.81 $517.30 N/A N/A 241.23 SUP HCPCS C1713 241.23 - PLATE BN OBLQ T 53X10X1.5MM NS LC DCP 3 HLE/HD 3 HL SHFT SS BOTH IP/OP $401.50 $297.00 $79.63 $401.23 $180.55 $180.55 $180.55 $180.55 $401.23 $401.23 $401.23 $83.63 $401.23 $401.23 $401.23 $401.23 $401.23 $83.62 $401.23 $401.23 $237.33 $401.23 $401.23 $401.23 $401.23 $301.13 $401.23 $401.23 $401.23 $200.62 $200.62 $317.77 $401.23 $320.98 $180.55 $79.63 N/A $232.87 $401.23 $240.74 $401.23 $83.62 $401.23 N/A N/A 241.231 SUP HCPCS C1713 241.231 - PLATE BONE 53MM 3X3 HOLE T OBLIQUE ANGLE LCP STAINLESS STEEL BOTH IP/OP $428.00 $317.00 $84.94 $427.98 $192.59 $192.59 $192.59 $192.59 $427.98 $427.98 $427.98 $89.20 $427.98 $427.98 $427.98 $427.98 $427.98 $89.20 $427.98 $171.19 $253.15 $427.98 $427.98 $427.98 $427.98 $321.00 $427.98 $427.98 $427.98 $213.99 $213.99 $338.96 $427.98 $342.38 $192.59 $84.94 N/A $248.24 $427.98 $256.79 $427.98 $89.19 $427.98 N/A N/A 241.24 SUP HCPCS C1713 241.24 - PLATE BN OBLQ T 63X10X1.5MM NS LC DCP 3 HLE/HD 4 HL SHFT SS BOTH IP/OP $424.50 $314.00 $84.24 $424.43 $190.99 $190.99 $190.99 $190.99 $424.43 $424.43 $424.43 $88.46 $424.43 $424.43 $424.43 $424.43 $424.43 $88.46 $424.43 $169.77 $251.05 $424.43 $424.43 $424.43 $424.43 $318.38 $424.43 $424.43 $424.43 $212.22 $212.22 $336.15 $424.43 $339.54 $190.99 $84.24 N/A $246.21 $424.43 $424.43 $424.43 $88.45 $424.43 N/A N/A 241.241 SUP HCPCS C1713 241.241 - PLATE BONE 63MM 3 HOLE HEAD 3 HOLE SHAFT T OBLIQUE STAINLESS BOTH IP/OP $449.50 $333.00 $89.15 $449.18 $202.13 $202.13 $202.13 $202.13 $449.18 $449.18 $449.18 $93.62 $449.18 $449.18 $449.18 $449.18 $449.18 $93.61 $449.18 $179.67 $265.69 $449.18 $449.18 $449.18 $449.18 $337.13 $449.18 $449.18 $449.18 $224.59 $224.59 $355.75 $449.18 $359.34 $202.13 $89.15 N/A $260.71 $449.18 $269.51 $449.18 $93.61 $449.18 N/A N/A 241.25 SUP HCPCS C1713 241.25 - PLATE BN OBLQ T 75X10X1.5MM NS LC DCP 3 HLE/HD 5 HL SHFT SS BOTH IP/OP $437.00 $323.00 $86.68 $436.73 $196.53 $196.53 $196.53 $196.53 $436.73 $436.73 $436.73 $91.03 $436.73 $436.73 $436.73 $436.73 $436.73 $91.02 $436.73 $174.69 $258.33 $436.73 $436.73 $436.73 $436.73 $327.75 $436.73 $436.73 $436.73 $218.37 $218.37 $345.89 $436.73 $349.38 $196.53 $86.68 N/A $253.46 $436.73 $436.73 $436.73 $91.01 $436.73 N/A N/A 241.252 SUP HCPCS C1713 241.252 - PLATE BONE 75MM 3 HOLE HEAD 3 HOLE SHAFT T OBLIQUE STAINLESS BOTH IP/OP $460.00 $340.00 $91.25 $459.78 $206.90 $206.90 $206.90 $206.90 $459.78 $459.78 $459.78 $95.83 $459.78 $459.78 $459.78 $459.78 $459.78 $95.82 $459.78 $183.91 $271.96 $459.78 $459.78 $459.78 $459.78 $345.00 $459.78 $459.78 $459.78 $229.89 $229.89 $364.15 $459.78 $367.82 $206.90 $91.25 N/A $266.80 $459.78 $275.87 $459.78 $95.82 $459.78 N/A N/A 241.262 SUP HCPCS C1713 241.262 - PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$1,732.00" "$1,282.00" $343.72 "$1,761.28" $779.32 $779.32 $779.32 $779.32 "$1,731.83" "$1,731.83" "$1,731.83" $360.96 "$1,731.83" "$1,731.83" "$1,731.83" "$1,731.83" "$1,731.83" $360.93 "$1,731.83" $704.51 "$1,024.38" "$1,731.83" "$1,761.28" "$1,731.83" "$1,731.83" "$1,299.00" "$1,731.83" "$1,731.83" "$1,731.83" $865.92 $865.92 "$1,371.61" "$1,731.83" "$1,385.46" $779.32 $343.72 N/A "$1,004.56" "$1,731.83" "$1,731.83" "$1,731.83" $360.91 "$1,731.83" N/A N/A 241.263 SUP HCPCS C1713 241.263 - PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$1,732.00" "$1,282.00" $343.72 "$1,761.28" $779.32 $779.32 $779.32 $779.32 "$1,731.83" "$1,731.83" "$1,731.83" $360.96 "$1,731.83" "$1,731.83" "$1,731.83" "$1,731.83" "$1,731.83" $360.93 "$1,731.83" "$1,761.28" "$1,024.38" "$1,731.83" "$1,761.28" "$1,731.83" "$1,731.83" "$1,299.00" "$1,731.83" "$1,731.83" "$1,731.83" $865.92 $865.92 "$1,371.61" "$1,731.83" "$1,385.46" $779.32 $343.72 N/A "$1,004.56" "$1,731.83" "$1,039.10" "$1,731.83" $360.91 "$1,731.83" N/A N/A 241.264 SUP HCPCS C1713 241.264 - PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$1,922.00" "$1,422.00" $381.39 "$1,954.25" $864.71 $864.71 $864.71 $864.71 "$1,921.58" "$1,921.58" "$1,921.58" $400.51 "$1,921.58" "$1,921.58" "$1,921.58" "$1,921.58" "$1,921.58" $400.48 "$1,921.58" $781.70 "$1,136.61" "$1,921.58" "$1,954.25" "$1,921.58" "$1,921.58" "$1,441.50" "$1,921.58" "$1,921.58" "$1,921.58" $960.79 $960.79 "$1,521.89" "$1,921.58" "$1,537.26" $864.71 $381.39 N/A "$1,114.76" "$1,921.58" "$1,152.95" "$1,921.58" $400.46 "$1,921.58" N/A N/A 241.265 SUP HCPCS C1713 241.265 - PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$1,922.00" "$1,422.00" $381.39 "$1,954.25" $864.71 $864.71 $864.71 $864.71 "$1,921.58" "$1,921.58" "$1,921.58" $400.51 "$1,921.58" "$1,921.58" "$1,921.58" "$1,921.58" "$1,921.58" $400.48 "$1,921.58" "$1,954.25" "$1,136.61" "$1,921.58" "$1,954.25" "$1,921.58" "$1,921.58" "$1,441.50" "$1,921.58" "$1,921.58" "$1,921.58" $960.79 $960.79 "$1,521.89" "$1,921.58" "$1,537.26" $864.71 $381.39 N/A "$1,114.76" "$1,921.58" "$1,152.95" "$1,921.58" $400.46 "$1,921.58" N/A N/A 241.266 SUP HCPCS C1713 241.266 - PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,113.00" "$1,564.00" $419.33 "$2,148.68" $950.74 $950.74 $950.74 $950.74 "$2,112.75" "$2,112.75" "$2,112.75" $440.35 "$2,112.75" "$2,112.75" "$2,112.75" "$2,112.75" "$2,112.75" $440.32 "$2,112.75" "$2,148.68" "$1,249.69" "$2,112.75" "$2,148.68" "$2,112.75" "$2,112.75" "$1,584.75" "$2,112.75" "$2,112.75" "$2,112.75" "$1,056.38" "$1,056.38" "$1,673.30" "$2,112.75" "$1,690.20" $950.74 $419.33 N/A "$1,225.54" "$2,112.75" "$1,267.65" "$2,112.75" $440.30 "$2,112.75" N/A N/A 241.267 SUP HCPCS C1713 241.267 - PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,113.00" "$1,564.00" $419.33 "$2,148.68" $950.74 $950.74 $950.74 $950.74 "$2,112.75" "$2,112.75" "$2,112.75" $440.35 "$2,112.75" "$2,112.75" "$2,112.75" "$2,112.75" "$2,112.75" $440.32 "$2,112.75" "$2,148.68" "$1,249.69" "$2,112.75" "$2,148.68" "$2,112.75" "$2,112.75" "$1,584.75" "$2,112.75" "$2,112.75" "$2,112.75" "$1,056.38" "$1,056.38" "$1,673.30" "$2,112.75" "$1,690.20" $950.74 $419.33 N/A "$1,225.54" "$2,112.75" "$1,267.65" "$2,112.75" $440.30 "$2,112.75" N/A N/A 241.268 SUP HCPCS C1713 241.268 - PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,281.50" "$1,688.00" $452.81 "$2,320.23" "$1,026.65" "$1,026.65" "$1,026.65" "$1,026.65" "$2,281.45" "$2,281.45" "$2,281.45" $475.51 "$2,281.45" "$2,281.45" "$2,281.45" "$2,281.45" "$2,281.45" $475.48 "$2,281.45" $928.09 "$1,349.48" "$2,281.45" "$2,320.23" "$2,281.45" "$2,281.45" "$1,711.13" "$2,281.45" "$2,281.45" "$2,281.45" "$1,140.73" "$1,140.73" "$1,806.91" "$2,281.45" "$1,825.16" "$1,026.65" $452.81 N/A "$1,323.27" "$2,281.45" "$1,368.87" "$2,281.45" $475.45 "$2,281.45" N/A N/A 241.269 SUP HCPCS C1713 241.269 - PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,281.50" "$1,688.00" $452.81 "$2,320.23" "$1,026.65" "$1,026.65" "$1,026.65" "$1,026.65" "$2,281.45" "$2,281.45" "$2,281.45" $475.51 "$2,281.45" "$2,281.45" "$2,281.45" "$2,281.45" "$2,281.45" $475.48 "$2,281.45" $928.09 "$1,349.48" "$2,281.45" "$2,320.23" "$2,281.45" "$2,281.45" "$1,711.13" "$2,281.45" "$2,281.45" "$2,281.45" "$1,140.73" "$1,140.73" "$1,806.91" "$2,281.45" "$1,825.16" "$1,026.65" $452.81 N/A "$1,323.27" "$2,281.45" "$2,281.45" "$2,281.45" $475.45 "$2,281.45" N/A N/A 241.272 SUP HCPCS C1713 241.272 - PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$1,986.50" "$1,470.00" $394.22 "$2,020.03" $893.81 $893.81 $893.81 $893.81 "$1,986.25" "$1,986.25" "$1,986.25" $413.98 "$1,986.25" "$1,986.25" "$1,986.25" "$1,986.25" "$1,986.25" $413.96 "$1,986.25" "$2,020.03" "$1,174.87" "$1,986.25" "$2,020.03" "$1,986.25" "$1,986.25" "$1,489.88" "$1,986.25" "$1,986.25" "$1,986.25" $993.13 $993.13 "$1,573.11" "$1,986.25" "$1,589.00" $893.81 $394.22 N/A "$1,152.17" "$1,986.25" "$1,191.75" "$1,986.25" $413.93 "$1,986.25" N/A N/A 241.273 SUP HCPCS C1713 241.273 - PLATE BN 65X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$1,986.50" "$1,470.00" $394.22 "$2,020.03" $893.81 $893.81 $893.81 $893.81 "$1,986.25" "$1,986.25" "$1,986.25" $413.98 "$1,986.25" "$1,986.25" "$1,986.25" "$1,986.25" "$1,986.25" $413.96 "$1,986.25" "$2,020.03" "$1,174.87" "$1,986.25" "$2,020.03" "$1,986.25" "$1,986.25" "$1,489.88" "$1,986.25" "$1,986.25" "$1,986.25" $993.13 $993.13 "$1,573.11" "$1,986.25" "$1,589.00" $893.81 $394.22 N/A "$1,152.17" "$1,986.25" "$1,191.75" "$1,986.25" $413.93 "$1,986.25" N/A N/A 241.274 SUP HCPCS C1713 241.274 - PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,166.50" "$1,603.00" $429.93 "$2,203.00" $974.78 $974.78 $974.78 $974.78 "$2,166.18" "$2,166.18" "$2,166.18" $451.49 "$2,166.18" "$2,166.18" "$2,166.18" "$2,166.18" "$2,166.18" $451.46 "$2,166.18" $881.20 "$1,281.30" "$2,166.18" "$2,203.00" "$2,166.18" "$2,166.18" "$1,624.88" "$2,166.18" "$2,166.18" "$2,166.18" "$1,083.09" "$1,083.09" "$1,715.61" "$2,166.18" "$1,732.94" $974.78 $429.93 N/A "$1,256.57" "$2,166.18" "$1,299.71" "$2,166.18" $451.43 "$2,166.18" N/A N/A 241.275 SUP HCPCS C1713 241.275 - PLATE BN 90X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,166.50" "$1,603.00" $429.93 "$2,203.00" $974.78 $974.78 $974.78 $974.78 "$2,166.18" "$2,166.18" "$2,166.18" $451.49 "$2,166.18" "$2,166.18" "$2,166.18" "$2,166.18" "$2,166.18" $451.46 "$2,166.18" "$2,203.00" "$1,281.30" "$2,166.18" "$2,203.00" "$2,166.18" "$2,166.18" "$1,624.88" "$2,166.18" "$2,166.18" "$2,166.18" "$1,083.09" "$1,083.09" "$1,715.61" "$2,166.18" "$1,732.94" $974.78 $429.93 N/A "$1,256.57" "$2,166.18" "$1,299.71" "$2,166.18" $451.43 "$2,166.18" N/A N/A 241.276 SUP HCPCS C1713 241.276 - PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,347.50" "$1,737.00" $465.92 "$2,387.40" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$2,347.50" "$2,347.50" "$2,347.50" $489.28 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" "$2,387.40" "$1,388.55" "$2,347.50" "$2,387.40" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" $465.92 N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" $489.22 "$2,347.50" N/A N/A 241.277 SUP HCPCS C1713 241.277 - PLATE BN 116X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,347.50" "$1,737.00" $465.92 "$2,387.40" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$2,347.50" "$2,347.50" "$2,347.50" $489.28 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" "$2,387.40" "$1,388.55" "$2,347.50" "$2,387.40" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" $465.92 N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" $489.22 "$2,347.50" N/A N/A 241.278 SUP HCPCS C1713 241.278 - PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,547.50" "$1,885.00" $505.54 "$2,590.43" "$1,146.21" "$1,146.21" "$1,146.21" "$1,146.21" "$2,547.13" "$2,547.13" "$2,547.13" $530.89 "$2,547.13" "$2,547.13" "$2,547.13" "$2,547.13" "$2,547.13" $530.85 "$2,547.13" "$1,036.17" "$1,255.74" "$2,547.13" "$2,590.43" "$2,547.13" "$2,547.13" "$1,910.63" "$2,547.13" "$2,547.13" "$2,547.13" "$1,273.57" "$1,273.57" "$2,017.33" "$2,547.13" "$2,037.70" "$1,146.21" $505.54 N/A "$1,477.55" "$2,547.13" "$2,547.13" "$2,547.13" $530.82 "$2,547.13" N/A N/A 241.279 SUP HCPCS C1713 241.279 - PLATE BN 142X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,547.50" "$1,885.00" $505.54 "$2,590.43" "$1,146.21" "$1,146.21" "$1,146.21" "$1,146.21" "$2,547.13" "$2,547.13" "$2,547.13" $530.89 "$2,547.13" "$2,547.13" "$2,547.13" "$2,547.13" "$2,547.13" $530.85 "$2,547.13" "$1,036.17" "$1,255.74" "$2,547.13" "$2,590.43" "$2,547.13" "$2,547.13" "$1,910.63" "$2,547.13" "$2,547.13" "$2,547.13" "$1,273.57" "$1,273.57" "$2,017.33" "$2,547.13" "$2,037.70" "$1,146.21" $505.54 N/A "$1,477.55" "$2,547.13" "$2,547.13" "$2,547.13" $530.82 "$2,547.13" N/A N/A 241.282 SUP HCPCS C1713 241.282 - PLATE BN 58X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$1,732.00" "$1,282.00" $343.72 "$1,761.28" $779.32 $779.32 $779.32 $779.32 "$1,731.83" "$1,731.83" "$1,731.83" $360.96 "$1,731.83" "$1,731.83" "$1,731.83" "$1,731.83" "$1,731.83" $360.93 "$1,731.83" $704.51 "$1,024.38" "$1,731.83" "$1,761.28" "$1,731.83" "$1,731.83" "$1,299.00" "$1,731.83" "$1,731.83" "$1,731.83" $865.92 $865.92 "$1,371.61" "$1,731.83" "$1,385.46" $779.32 $343.72 N/A "$1,004.56" "$1,731.83" "$1,731.83" "$1,731.83" $360.91 "$1,731.83" N/A N/A 241.283 SUP HCPCS C1713 241.283 - PLATE BN 58X11X2.5MM NS LCP CMBN 3 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$1,732.00" "$1,282.00" $343.72 "$1,761.28" $779.32 $779.32 $779.32 $779.32 "$1,731.83" "$1,731.83" "$1,731.83" $360.96 "$1,731.83" "$1,731.83" "$1,731.83" "$1,731.83" "$1,731.83" $360.93 "$1,731.83" "$1,761.28" "$1,024.38" "$1,731.83" "$1,761.28" "$1,731.83" "$1,731.83" "$1,299.00" "$1,731.83" "$1,731.83" "$1,731.83" $865.92 $865.92 "$1,371.61" "$1,731.83" "$1,385.46" $779.32 $343.72 N/A "$1,004.56" "$1,731.83" "$1,731.83" "$1,731.83" $360.91 "$1,731.83" N/A N/A 241.284 SUP HCPCS C1713 241.284 - PLATE BN 83X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$1,922.00" "$1,422.00" $381.39 "$1,954.25" $864.71 $864.71 $864.71 $864.71 "$1,921.58" "$1,921.58" "$1,921.58" $400.51 "$1,921.58" "$1,921.58" "$1,921.58" "$1,921.58" "$1,921.58" $400.48 "$1,921.58" $781.70 "$1,136.61" "$1,921.58" "$1,954.25" "$1,921.58" "$1,921.58" "$1,441.50" "$1,921.58" "$1,921.58" "$1,921.58" $960.79 $960.79 "$1,521.89" "$1,921.58" "$1,537.26" $864.71 $381.39 N/A "$1,114.76" "$1,921.58" "$1,921.58" "$1,921.58" $400.46 "$1,921.58" N/A N/A 241.285 SUP HCPCS C1713 241.285 - PLATE BN 83X11X2.5MM NS LCP CMBN 5 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$1,922.00" "$1,422.00" $381.39 "$1,954.25" $864.71 $864.71 $864.71 $864.71 "$1,921.58" "$1,921.58" "$1,921.58" $400.51 "$1,921.58" "$1,921.58" "$1,921.58" "$1,921.58" "$1,921.58" $400.48 "$1,921.58" "$1,954.25" "$1,136.61" "$1,921.58" "$1,954.25" "$1,921.58" "$1,921.58" "$1,441.50" "$1,921.58" "$1,921.58" "$1,921.58" $960.79 $960.79 "$1,521.89" "$1,921.58" "$1,537.26" $864.71 $381.39 N/A "$1,114.76" "$1,921.58" "$1,152.95" "$1,921.58" $400.46 "$1,921.58" N/A N/A 241.286 SUP HCPCS C1713 241.286 - PLATE BN 110X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,113.00" "$1,564.00" $419.33 "$2,148.68" $950.74 $950.74 $950.74 $950.74 "$2,112.75" "$2,112.75" "$2,112.75" $440.35 "$2,112.75" "$2,112.75" "$2,112.75" "$2,112.75" "$2,112.75" $440.32 "$2,112.75" "$2,148.68" "$1,249.69" "$2,112.75" "$2,148.68" "$2,112.75" "$2,112.75" "$1,584.75" "$2,112.75" "$2,112.75" "$2,112.75" "$1,056.38" "$1,056.38" "$1,673.30" "$2,112.75" "$1,690.20" $950.74 $419.33 N/A "$1,225.54" "$2,112.75" "$1,267.65" "$2,112.75" $440.30 "$2,112.75" N/A N/A 241.287 SUP HCPCS C1713 241.287 - PLATE BN 110X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,113.00" "$1,564.00" $419.33 "$2,148.68" $950.74 $950.74 $950.74 $950.74 "$2,112.75" "$2,112.75" "$2,112.75" $440.35 "$2,112.75" "$2,112.75" "$2,112.75" "$2,112.75" "$2,112.75" $440.32 "$2,112.75" "$2,148.68" "$1,249.69" "$2,112.75" "$2,148.68" "$2,112.75" "$2,112.75" "$1,584.75" "$2,112.75" "$2,112.75" "$2,112.75" "$1,056.38" "$1,056.38" "$1,673.30" "$2,112.75" "$1,690.20" $950.74 $419.33 N/A "$1,225.54" "$2,112.75" "$2,112.75" "$2,112.75" $440.30 "$2,112.75" N/A N/A 241.288 SUP HCPCS C1713 241.288 - PLATE BN 136X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,281.50" "$1,688.00" $452.81 "$2,320.23" "$1,026.65" "$1,026.65" "$1,026.65" "$1,026.65" "$2,281.45" "$2,281.45" "$2,281.45" $475.51 "$2,281.45" "$2,281.45" "$2,281.45" "$2,281.45" "$2,281.45" $475.48 "$2,281.45" "$2,320.23" "$1,349.48" "$2,281.45" "$2,320.23" "$2,281.45" "$2,281.45" "$1,711.13" "$2,281.45" "$2,281.45" "$2,281.45" "$1,140.73" "$1,140.73" "$1,806.91" "$2,281.45" "$1,825.16" "$1,026.65" $452.81 N/A "$1,323.27" "$2,281.45" "$1,368.87" "$2,281.45" $475.45 "$2,281.45" N/A N/A 241.289 SUP HCPCS C1713 241.289 - PLATE BN 136X11X2.5MM NS LCP CMBN 9 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,281.50" "$1,688.00" $452.81 "$2,320.23" "$1,026.65" "$1,026.65" "$1,026.65" "$1,026.65" "$2,281.45" "$2,281.45" "$2,281.45" $475.51 "$2,281.45" "$2,281.45" "$2,281.45" "$2,281.45" "$2,281.45" $475.48 "$2,281.45" "$2,320.23" "$1,349.48" "$2,281.45" "$2,320.23" "$2,281.45" "$2,281.45" "$1,711.13" "$2,281.45" "$2,281.45" "$2,281.45" "$1,140.73" "$1,140.73" "$1,806.91" "$2,281.45" "$1,825.16" "$1,026.65" $452.81 N/A "$1,323.27" "$2,281.45" "$2,281.45" "$2,281.45" $475.45 "$2,281.45" N/A N/A 241.3 SUP HCPCS C1713 241.300 - PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,279.50" "$1,687.00" $452.35 "$2,387.40" "$1,025.61" "$1,025.61" "$1,025.61" "$1,025.61" "$2,279.13" "$2,279.13" "$2,279.13" $475.03 "$2,279.13" "$2,279.13" "$2,279.13" "$2,279.13" "$2,279.13" $475.00 "$2,279.13" "$2,387.40" "$1,348.11" "$2,279.13" "$2,387.40" "$2,279.13" "$2,279.13" "$1,709.63" "$2,279.13" "$2,279.13" "$2,279.13" "$1,139.57" "$1,139.57" "$1,805.07" "$2,279.13" "$1,823.30" "$1,025.61" $452.35 N/A "$1,322.11" "$2,279.13" "$2,279.13" "$2,279.13" $474.97 "$2,279.13" N/A N/A 241.301 SUP HCPCS C1713 241.301 - PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,347.50" "$1,737.00" $465.92 "$2,387.40" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$2,347.50" "$2,347.50" "$2,347.50" $489.28 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $954.96 "$1,388.55" "$2,347.50" "$2,387.40" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" $465.92 N/A "$1,361.55" "$2,347.50" "$2,347.50" "$2,347.50" $489.22 "$2,347.50" N/A N/A 241.302 SUP HCPCS C1713 241.302 - PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,481.50" "$1,836.00" $492.43 "$2,523.23" "$1,116.47" "$1,116.47" "$1,116.47" "$1,116.47" "$2,481.05" "$2,481.05" "$2,481.05" $517.11 "$2,481.05" "$2,481.05" "$2,481.05" "$2,481.05" "$2,481.05" $517.08 "$2,481.05" "$1,009.29" "$1,467.54" "$2,481.05" "$2,523.23" "$2,481.05" "$2,481.05" "$1,861.13" "$2,481.05" "$2,481.05" "$2,481.05" "$1,240.53" "$1,240.53" "$1,964.99" "$2,481.05" "$1,984.84" "$1,116.47" $492.43 N/A "$1,439.27" "$2,481.05" "$1,488.63" "$2,481.05" $517.05 "$2,481.05" N/A N/A 241.303 SUP HCPCS C1713 241.303 - PLATE BN 208X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,481.50" "$1,836.00" $492.43 "$2,523.23" "$1,116.47" "$1,116.47" "$1,116.47" "$1,116.47" "$2,481.05" "$2,481.05" "$2,481.05" $517.11 "$2,481.05" "$2,481.05" "$2,481.05" "$2,481.05" "$2,481.05" $517.08 "$2,481.05" "$1,009.29" "$1,467.54" "$2,481.05" "$2,523.23" "$2,481.05" "$2,481.05" "$1,861.13" "$2,481.05" "$2,481.05" "$2,481.05" "$1,240.53" "$1,240.53" "$1,964.99" "$2,481.05" "$1,984.84" "$1,116.47" $492.43 N/A "$1,439.27" "$2,481.05" "$2,481.05" "$2,481.05" $517.05 "$2,481.05" N/A N/A 241.304 SUP HCPCS C1713 241.304 - PLATE BN 201X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,347.50" "$1,737.00" $465.92 "$2,387.40" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$2,347.50" "$2,347.50" "$2,347.50" $489.28 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $954.96 "$1,388.55" "$2,347.50" "$2,387.40" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" $465.92 N/A "$1,361.55" "$2,347.50" "$2,347.50" "$2,347.50" $489.22 "$2,347.50" N/A N/A 241.305 SUP HCPCS C1713 241.305 - PLATE BN 201X11X2.5MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,347.50" "$1,737.00" $465.92 "$2,387.40" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$2,347.50" "$2,347.50" "$2,347.50" $489.28 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $954.96 "$1,388.55" "$2,347.50" "$2,387.40" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" $465.92 N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" $489.22 "$2,347.50" N/A N/A 241.32 SUP HCPCS C1713 241.32 - PLATE BN 1/3 TBLR 12MM 25X9X1MM NS .5MM 2 HL COLR SS 3.5MM BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 241.33 SUP HCPCS C1713 241.33 - PLATE BN 1/3 TBLR 12MM 37X9X1MM NS .5MM 3 HL COLR SS 3.5MM BOTH IP/OP $108.00 $80.00 $21.34 $109.35 $48.39 $48.39 $48.39 $48.39 $107.53 $107.53 $107.53 $22.41 $107.53 $107.53 $107.53 $107.53 $107.53 $22.41 $107.53 $43.74 $63.60 $107.53 $109.35 $107.53 $107.53 $81.00 $107.53 $107.53 $107.53 $53.77 $53.77 $85.16 $107.53 $86.02 $48.39 $21.34 N/A $62.64 $107.53 $107.53 $107.53 $22.41 $107.53 N/A N/A 241.331 SUP HCPCS C1713 241.331 - PLATE BONE 33X9X1MM .7MM 1/3 TUBULAR 3 HOLE COLLAR LCP BOTH IP/OP $283.00 $209.00 $56.08 $287.35 $127.15 $127.15 $127.15 $127.15 $282.55 $282.55 $282.55 $58.89 $282.55 $282.55 $282.55 $282.55 $282.55 $58.89 $282.55 $287.35 $167.13 $282.55 $287.35 $282.55 $282.55 $212.25 $282.55 $282.55 $282.55 $141.28 $141.28 $223.78 $282.55 $226.04 $127.15 $56.08 N/A $164.14 $282.55 $169.53 $282.55 $58.88 $282.55 N/A N/A 241.34 SUP HCPCS C1713 241.34 - PLATE BN 1/3 TBLR 12MM 49X9X1MM NS .5MM 4 HL COLR SS 3.5MM BOTH IP/OP $124.00 $92.00 $24.55 $125.80 $55.67 $55.67 $55.67 $55.67 $123.70 $123.70 $123.70 $25.78 $123.70 $123.70 $123.70 $123.70 $123.70 $25.78 $123.70 $50.32 $73.17 $123.70 $125.80 $123.70 $123.70 $93.00 $123.70 $123.70 $123.70 $61.85 $61.85 $97.97 $123.70 $98.96 $55.67 $24.55 N/A $71.92 $123.70 $74.22 $123.70 $25.78 $123.70 N/A N/A 241.341 SUP HCPCS C1713 241.341 - PLATE BN 1/3 TBLR 12MM 45X9X1MM NS .7MM LCP 4 HL COLR SS BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $195.68 $326.13 $67.97 $326.13 N/A N/A 241.35 SUP HCPCS C1713 241.35 - PLATE BN 1/3 TBLR 12MM 61X9X1MM NS .5MM 5 HL COLR SS 3.5MM BOTH IP/OP $124.00 $92.00 $24.55 $125.80 $55.67 $55.67 $55.67 $55.67 $123.70 $123.70 $123.70 $25.78 $123.70 $123.70 $123.70 $123.70 $123.70 $25.78 $123.70 $125.80 $73.17 $123.70 $125.80 $123.70 $123.70 $93.00 $123.70 $123.70 $123.70 $61.85 $61.85 $97.97 $123.70 $98.96 $55.67 $24.55 N/A $71.92 $123.70 $74.22 $123.70 $25.78 $123.70 N/A N/A 241.351 SUP HCPCS C1713 241.351 - PLATE BN 1/3 TBLR 12MM 57X9X1MM NS .7MM LCP 5 HL COLR SS BOTH IP/OP $316.50 $234.00 $62.77 $321.65 $142.33 $142.33 $142.33 $142.33 $316.28 $316.28 $316.28 $65.92 $316.28 $316.28 $316.28 $316.28 $316.28 $65.92 $316.28 $321.65 $187.08 $316.28 $321.65 $316.28 $316.28 $237.38 $316.28 $316.28 $316.28 $158.14 $158.14 $250.49 $316.28 $253.02 $142.33 $62.77 N/A $183.57 $316.28 $316.28 $316.28 $65.91 $316.28 N/A N/A 241.36 SUP HCPCS C1713 241.36 - PLATE BN 1/3 TBLR 12MM 73X9X1MM NS .5MM 6 HL COLR SS 3.5MM BOTH IP/OP $129.00 $95.00 $25.52 $130.78 $57.87 $57.87 $57.87 $57.87 $128.60 $128.60 $128.60 $26.80 $128.60 $128.60 $128.60 $128.60 $128.60 $26.80 $128.60 $130.78 $76.07 $128.60 $130.78 $128.60 $128.60 $96.75 $128.60 $128.60 $128.60 $64.30 $64.30 $101.85 $128.60 $102.88 $57.87 $25.52 N/A $74.82 $128.60 $77.16 $128.60 $26.80 $128.60 N/A N/A 241.361 SUP HCPCS C1713 241.361 - PLATE BN 1/3 TBLR 12MM 69X9X1MM NS .7MM LCP 6 HL COLR SS BOTH IP/OP $316.50 $234.00 $62.77 $321.65 $142.33 $142.33 $142.33 $142.33 $316.28 $316.28 $316.28 $65.92 $316.28 $316.28 $316.28 $316.28 $316.28 $65.92 $316.28 $321.65 $187.08 $316.28 $321.65 $316.28 $316.28 $237.38 $316.28 $316.28 $316.28 $158.14 $158.14 $250.49 $316.28 $253.02 $142.33 $62.77 N/A $183.57 $316.28 $316.28 $316.28 $65.91 $316.28 N/A N/A 241.37 SUP HCPCS C1713 241.37 - PLATE BN 1/3 TBLR 12MM 85X9X1MM NS .5MM 7 HL COLR SS 3.5MM BOTH IP/OP $129.00 $95.00 $25.52 $130.78 $57.87 $57.87 $57.87 $57.87 $128.60 $128.60 $128.60 $26.80 $128.60 $128.60 $128.60 $128.60 $128.60 $26.80 $128.60 $130.78 $76.07 $128.60 $130.78 $128.60 $128.60 $96.75 $128.60 $128.60 $128.60 $64.30 $64.30 $101.85 $128.60 $102.88 $57.87 $25.52 N/A $74.82 $128.60 $77.16 $128.60 $26.80 $128.60 N/A N/A 241.371 SUP HCPCS C1713 241.371 - PLATE BN 1/3 TBLR 12MM 81X9X1MM NS .7MM LCP 7 HL COLR SS BOTH IP/OP $323.50 $239.00 $64.17 $328.80 $145.49 $145.49 $145.49 $145.49 $323.30 $323.30 $323.30 $67.38 $323.30 $323.30 $323.30 $323.30 $323.30 $67.38 $323.30 $328.80 $191.23 $323.30 $328.80 $323.30 $323.30 $242.63 $323.30 $323.30 $323.30 $161.65 $161.65 $256.05 $323.30 $258.64 $145.49 $64.17 N/A $187.63 $323.30 $193.98 $323.30 $67.38 $323.30 N/A N/A 241.38 SUP HCPCS C1713 241.38 - PLATE BN 1/3 TBLR 12MM 97X9X1MM NS .5MM 8 HL COLR SS 3.5MM BOTH IP/OP $134.00 $99.00 $26.51 $135.83 $60.10 $60.10 $60.10 $60.10 $133.55 $133.55 $133.55 $27.84 $133.55 $133.55 $133.55 $133.55 $133.55 $27.83 $133.55 $135.83 $78.99 $133.55 $135.83 $133.55 $133.55 $100.50 $133.55 $133.55 $133.55 $66.78 $66.78 $105.77 $133.55 $106.84 $60.10 $26.51 N/A $77.72 $133.55 $80.13 $133.55 $27.83 $133.55 N/A N/A 241.381 SUP HCPCS C1713 241.381 - PLATE BN 1/3 TBLR 12MM 93X9X1MM NS .7MM LCP 8 HL COLR SS BOTH IP/OP $340.50 $252.00 $67.52 $345.95 $153.08 $153.08 $153.08 $153.08 $340.18 $340.18 $340.18 $70.90 $340.18 $340.18 $340.18 $340.18 $340.18 $70.90 $340.18 $345.95 $201.22 $340.18 $345.95 $340.18 $340.18 $255.38 $340.18 $340.18 $340.18 $170.09 $170.09 $269.42 $340.18 $272.14 $153.08 $67.52 N/A $197.49 $340.18 $204.11 $340.18 $70.89 $340.18 N/A N/A 241.39 SUP HCPCS C1713 241.39 - PLATE BONE 1/3 TUBE 109X9X1MM .5MM 9 HOLE COLLAR DCP LC-DCP BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $55.75 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 241.391 SUP HCPCS C1713 241.391 - PLATE BN 1/3 TBLR 12MM 105X9X1MM NS .7MM LCP 9 HL COLR SS BOTH IP/OP $340.50 $252.00 $67.52 $345.95 $153.08 $153.08 $153.08 $153.08 $340.18 $340.18 $340.18 $70.90 $340.18 $340.18 $340.18 $340.18 $340.18 $70.90 $340.18 $138.38 $201.22 $340.18 $345.95 $340.18 $340.18 $255.38 $340.18 $340.18 $340.18 $170.09 $170.09 $269.42 $340.18 $272.14 $153.08 $67.52 N/A $197.49 $340.18 $204.11 $340.18 $70.89 $340.18 N/A N/A 241.4 SUP HCPCS C1713 241.40 - PLATE BN 1/3 TBLR 12MM 121X9X1MM NS .5MM 10 HL COLR SS 3.5MM BOTH IP/OP $133.50 $99.00 $26.41 $139.38 $59.87 $59.87 $59.87 $59.87 $133.05 $133.05 $133.05 $27.73 $133.05 $133.05 $133.05 $133.05 $133.05 $27.73 $133.05 $139.38 $78.70 $133.05 $139.38 $133.05 $133.05 $100.13 $133.05 $133.05 $133.05 $66.53 $66.53 $105.38 $133.05 $106.44 $59.87 $26.41 N/A $77.43 $133.05 $133.05 $133.05 $27.73 $133.05 N/A N/A 241.401 SUP HCPCS C1713 241.401 - PLATE BN 1/3 TBLR 12MM 117X9X1MM NS .7MM LCP 10 HL COLR SS BOTH IP/OP $340.50 $252.00 $67.52 $345.95 $153.08 $153.08 $153.08 $153.08 $340.18 $340.18 $340.18 $70.90 $340.18 $340.18 $340.18 $340.18 $340.18 $70.90 $340.18 $345.95 $201.22 $340.18 $345.95 $340.18 $340.18 $255.38 $340.18 $340.18 $340.18 $170.09 $170.09 $269.42 $340.18 $272.14 $153.08 $67.52 N/A $197.49 $340.18 $204.11 $340.18 $70.89 $340.18 N/A N/A 241.42 SUP HCPCS C1713 241.42 - PLATE BN 1/3 TBLR 12MM 145X9X1MM NS .5MM 12 HL COLR SS 3.5MM BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $145.80 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $29.88 $143.38 N/A N/A 241.421 SUP HCPCS C1713 241.421 - PLATE BN 1/3 TBLR 12MM 141X9X1MM NS .7MM LCP 12 HL COLR SS BOTH IP/OP $351.50 $260.00 $69.75 $357.40 $158.14 $158.14 $158.14 $158.14 $351.43 $351.43 $351.43 $73.25 $351.43 $351.43 $351.43 $351.43 $351.43 $73.24 $351.43 $357.40 $207.87 $351.43 $357.40 $351.43 $351.43 $263.63 $351.43 $351.43 $351.43 $175.72 $175.72 $278.33 $351.43 $281.14 $158.14 $69.75 N/A $203.87 $351.43 $210.86 $351.43 $73.24 $351.43 N/A N/A 241.44 SUP HCPCS C1713 241.440 - PLATE BONE 80MM 5 HOLE LCP STAINLESS STEEL RIGHT DISTAL BOTH IP/OP "$2,775.00" "$2,054.00" $550.67 "$2,906.35" "$1,248.54" "$1,248.54" "$1,248.54" "$1,248.54" "$2,774.53" "$2,774.53" "$2,774.53" $578.28 "$2,774.53" "$2,774.53" "$2,774.53" "$2,774.53" "$2,774.53" $578.24 "$2,774.53" "$1,162.54" "$1,367.84" "$2,774.53" "$2,906.35" "$2,774.53" "$2,774.53" "$2,081.25" "$2,774.53" "$2,774.53" "$2,774.53" "$1,387.27" "$1,387.27" "$2,197.43" "$2,774.53" "$2,219.62" "$1,248.54" $550.67 N/A "$1,609.50" "$2,774.53" "$1,664.72" "$2,774.53" $578.21 "$2,774.53" N/A N/A 241.441 SUP HCPCS C1713 241.441 - PLATE BONE 80MM 5 HOLE ANATOMIC TAPERED TIP LCP STAINLESS BOTH IP/OP "$2,858.00" "$2,115.00" $567.20 "$2,906.35" "$1,286.00" "$1,286.00" "$1,286.00" "$1,286.00" "$2,857.78" "$2,857.78" "$2,857.78" $595.63 "$2,857.78" "$2,857.78" "$2,857.78" "$2,857.78" "$2,857.78" $595.59 "$2,857.78" "$1,162.54" "$1,408.89" "$2,857.78" "$2,906.35" "$2,857.78" "$2,857.78" "$2,143.50" "$2,857.78" "$2,857.78" "$2,857.78" "$1,428.89" "$1,428.89" "$2,263.36" "$2,857.78" "$2,286.22" "$1,286.00" $567.20 N/A "$1,657.64" "$2,857.78" "$2,857.78" "$2,857.78" $595.56 "$2,857.78" N/A N/A 241.442 SUP HCPCS C1713 241.442 - PLATE BONE 106MM 7 HOLE ANATOMIC TAPERED TIP LCP STAINLESS BOTH IP/OP "$2,796.00" "$2,069.00" $554.92 "$2,843.45" "$1,258.17" "$1,258.17" "$1,258.17" "$1,258.17" "$2,795.93" "$2,795.93" "$2,795.93" $582.74 "$2,795.93" "$2,795.93" "$2,795.93" "$2,795.93" "$2,795.93" $582.70 "$2,795.93" "$2,843.45" "$1,378.39" "$2,795.93" "$2,843.45" "$2,795.93" "$2,795.93" "$2,097.00" "$2,795.93" "$2,795.93" "$2,795.93" "$1,397.97" "$1,397.97" "$2,214.38" "$2,795.93" "$2,236.74" "$1,258.17" $554.92 N/A "$1,621.68" "$2,795.93" "$2,795.93" "$2,795.93" $582.67 "$2,795.93" N/A N/A 241.443 SUP HCPCS C1713 241.443 - PLATE BONE 106MM 7 HOLE ANATOMIC TAPERED TIP LCP STAINLESS BOTH IP/OP "$2,796.00" "$2,069.00" $554.92 "$2,843.45" "$1,258.17" "$1,258.17" "$1,258.17" "$1,258.17" "$2,795.93" "$2,795.93" "$2,795.93" $582.74 "$2,795.93" "$2,795.93" "$2,795.93" "$2,795.93" "$2,795.93" $582.70 "$2,795.93" "$2,843.45" "$1,378.39" "$2,795.93" "$2,843.45" "$2,795.93" "$2,795.93" "$2,097.00" "$2,795.93" "$2,795.93" "$2,795.93" "$1,397.97" "$1,397.97" "$2,214.38" "$2,795.93" "$2,236.74" "$1,258.17" $554.92 N/A "$1,621.68" "$2,795.93" "$2,795.93" "$2,795.93" "$2,795.93" "$2,795.93" N/A N/A 241.444 SUP HCPCS C1713 241.444 - PLATE BONE 132MM 9 HOLE ANATOMIC TAPERED TIP LCP STAINLESS BOTH IP/OP "$2,824.50" "$2,090.00" $560.50 "$2,872.03" "$1,270.81" "$1,270.81" "$1,270.81" "$1,270.81" "$2,824.03" "$2,824.03" "$2,824.03" $588.60 "$2,824.03" "$2,824.03" "$2,824.03" "$2,824.03" "$2,824.03" $588.56 "$2,824.03" "$1,148.81" "$1,392.25" "$2,824.03" "$2,872.03" "$2,824.03" "$2,824.03" "$2,118.38" "$2,824.03" "$2,824.03" "$2,824.03" "$1,412.02" "$1,412.02" "$2,236.63" "$2,824.03" "$2,259.22" "$1,270.81" $560.50 N/A "$1,638.21" "$2,824.03" "$2,824.03" "$2,824.03" "$2,824.03" "$2,824.03" N/A N/A 241.445 SUP HCPCS C1713 241.445 - PLATE BONE 132MM 9 HOLE ANATOMIC TAPERED TIP LCP STAINLESS BOTH IP/OP "$2,824.50" "$2,090.00" $560.50 "$2,872.03" "$1,270.81" "$1,270.81" "$1,270.81" "$1,270.81" "$2,824.03" "$2,824.03" "$2,824.03" $588.60 "$2,824.03" "$2,824.03" "$2,824.03" "$2,824.03" "$2,824.03" $588.56 "$2,824.03" "$2,872.03" "$1,392.25" "$2,824.03" "$2,872.03" "$2,824.03" "$2,824.03" "$2,118.38" "$2,824.03" "$2,824.03" "$2,824.03" "$1,412.02" "$1,412.02" "$2,236.63" "$2,824.03" "$2,259.22" "$1,270.81" $560.50 N/A "$1,638.21" "$2,824.03" "$2,824.03" "$2,824.03" $588.53 "$2,824.03" N/A N/A 241.446 SUP HCPCS C1713 241.446 - PLATE BONE 158MM 11 HOLE ANATOMIC TAPERED TIP LCP STAINLESS BOTH IP/OP "$2,851.00" "$2,110.00" $565.80 "$2,899.23" "$1,282.84" "$1,282.84" "$1,282.84" "$1,282.84" "$2,850.75" "$2,850.75" "$2,850.75" $594.17 "$2,850.75" "$2,850.75" "$2,850.75" "$2,850.75" "$2,850.75" $594.13 "$2,850.75" "$2,899.23" "$1,405.42" "$2,850.75" "$2,899.23" "$2,850.75" "$2,850.75" "$2,138.25" "$2,850.75" "$2,850.75" "$2,850.75" "$1,425.38" "$1,425.38" "$2,257.79" "$2,850.75" "$2,280.60" "$1,282.84" $565.80 N/A "$1,653.58" "$2,850.75" "$2,850.75" "$2,850.75" $594.10 "$2,850.75" N/A N/A 241.447 SUP HCPCS C1713 241.447 - PLATE BONE 158MM 11 HOLE LCP STAINLESS STEEL LEFT DISTAL BOTH IP/OP "$2,851.00" "$2,110.00" $565.80 "$2,899.23" "$1,282.84" "$1,282.84" "$1,282.84" "$1,282.84" "$2,850.75" "$2,850.75" "$2,850.75" $594.17 "$2,850.75" "$2,850.75" "$2,850.75" "$2,850.75" "$2,850.75" $594.13 "$2,850.75" "$1,159.69" "$1,405.42" "$2,850.75" "$2,899.23" "$2,850.75" "$2,850.75" "$2,138.25" "$2,850.75" "$2,850.75" "$2,850.75" "$1,425.38" "$1,425.38" "$2,257.79" "$2,850.75" "$2,280.60" "$1,282.84" $565.80 N/A "$1,653.58" "$2,850.75" "$2,850.75" "$2,850.75" $594.10 "$2,850.75" N/A N/A 241.448 SUP HCPCS C1713 241.448 - PLATE BONE 184MM 13 HOLE ANATOMIC TAPERED TIP LCP STAINLESS BOTH IP/OP "$2,883.50" "$2,134.00" $572.22 "$2,932.08" "$1,297.39" "$1,297.39" "$1,297.39" "$1,297.39" "$2,883.08" "$2,883.08" "$2,883.08" $600.91 "$2,883.08" "$2,883.08" "$2,883.08" "$2,883.08" "$2,883.08" $600.87 "$2,883.08" "$1,172.83" "$1,421.36" "$2,883.08" "$2,932.08" "$2,883.08" "$2,883.08" "$2,162.63" "$2,883.08" "$2,883.08" "$2,883.08" "$1,441.54" "$1,441.54" "$2,283.40" "$2,883.08" "$2,306.46" "$1,297.39" $572.22 N/A "$1,672.43" "$2,883.08" "$1,729.85" "$2,883.08" $600.83 "$2,883.08" N/A N/A 241.449 SUP HCPCS C1713 241.449 - PLATE BONE 184MM 13 HOLE ANATOMIC TAPERED TIP LCP STAINLESS BOTH IP/OP "$2,883.50" "$2,134.00" $572.22 "$2,932.08" "$1,297.39" "$1,297.39" "$1,297.39" "$1,297.39" "$2,883.08" "$2,883.08" "$2,883.08" $600.91 "$2,883.08" "$2,883.08" "$2,883.08" "$2,883.08" "$2,883.08" $600.87 "$2,883.08" "$1,172.83" "$1,421.36" "$2,883.08" "$2,932.08" "$2,883.08" "$2,883.08" "$2,162.63" "$2,883.08" "$2,883.08" "$2,883.08" "$1,441.54" "$1,441.54" "$2,283.40" "$2,883.08" "$2,306.46" "$1,297.39" $572.22 N/A "$1,672.43" "$2,883.08" "$1,729.85" "$2,883.08" "$2,883.08" "$2,883.08" N/A N/A 241.45 SUP HCPCS C1713 241.450 - PLATE BONE 210MM 15 HOLE LCP STAINLESS STEEL RIGHT DISTAL BOTH IP/OP "$2,836.00" "$2,099.00" $562.87 "$2,970.68" "$1,276.18" "$1,276.18" "$1,276.18" "$1,276.18" "$2,835.95" "$2,835.95" "$2,835.95" $591.08 "$2,835.95" "$2,835.95" "$2,835.95" "$2,835.95" "$2,835.95" $591.04 "$2,835.95" "$2,970.68" "$1,398.12" "$2,835.95" "$2,970.68" "$2,835.95" "$2,835.95" "$2,127.00" "$2,835.95" "$2,835.95" "$2,835.95" "$1,417.98" "$1,417.98" "$2,246.07" "$2,835.95" "$2,268.76" "$1,276.18" $562.87 N/A "$1,644.88" "$2,835.95" "$1,701.57" "$2,835.95" $591.01 "$2,835.95" N/A N/A 241.451 SUP HCPCS C1713 241.451 - PLATE BONE 210MM 15 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$2,921.50" "$2,162.00" $579.75 "$2,970.68" "$1,314.46" "$1,314.46" "$1,314.46" "$1,314.46" "$2,921.03" "$2,921.03" "$2,921.03" $608.82 "$2,921.03" "$2,921.03" "$2,921.03" "$2,921.03" "$2,921.03" $608.77 "$2,921.03" "$1,188.27" "$1,440.07" "$2,921.03" "$2,970.68" "$2,921.03" "$2,921.03" "$2,191.13" "$2,921.03" "$2,921.03" "$2,921.03" "$1,460.52" "$1,460.52" "$2,313.46" "$2,921.03" "$2,336.82" "$1,314.46" $579.75 N/A "$1,694.47" "$2,921.03" "$1,752.62" "$2,921.03" $608.74 "$2,921.03" N/A N/A 241.452 SUP HCPCS C1713 241.452 - PLATE BONE 236MM 17 HOLE LCP STAINLESS STEEL TIBIA RIGHT BOTH IP/OP "$3,048.00" "$2,256.00" $604.86 "$3,099.35" "$1,371.40" "$1,371.40" "$1,371.40" "$1,371.40" "$3,047.55" "$3,047.55" "$3,047.55" $635.19 "$3,047.55" "$3,047.55" "$3,047.55" "$3,047.55" "$3,047.55" $635.14 "$3,047.55" "$1,239.74" "$1,502.44" "$3,047.55" "$3,099.35" "$3,047.55" "$3,047.55" "$2,286.00" "$3,047.55" "$3,047.55" "$3,047.55" "$1,523.78" "$1,523.78" "$2,413.66" "$3,047.55" "$2,438.04" "$1,371.40" $604.86 N/A "$1,767.84" "$3,047.55" "$3,047.55" "$3,047.55" "$3,047.55" "$3,047.55" N/A N/A 241.453 SUP HCPCS C1713 241.453 - PLATE BONE 236MM 17 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$3,048.00" "$2,256.00" $604.86 "$3,099.35" "$1,371.40" "$1,371.40" "$1,371.40" "$1,371.40" "$3,047.55" "$3,047.55" "$3,047.55" $635.19 "$3,047.55" "$3,047.55" "$3,047.55" "$3,047.55" "$3,047.55" $635.14 "$3,047.55" "$3,099.35" "$1,502.44" "$3,047.55" "$3,099.35" "$3,047.55" "$3,047.55" "$2,286.00" "$3,047.55" "$3,047.55" "$3,047.55" "$1,523.78" "$1,523.78" "$2,413.66" "$3,047.55" "$2,438.04" "$1,371.40" $604.86 N/A "$1,767.84" "$3,047.55" "$3,047.55" "$3,047.55" $635.11 "$3,047.55" N/A N/A 241.454 SUP HCPCS C1713 241.454 - PLATE BONE 262MM 19 HOLE LCP STAINLESS STEEL TIBIA RIGHT BOTH IP/OP "$3,071.50" "$2,273.00" $609.61 "$3,123.68" "$1,382.15" "$1,382.15" "$1,382.15" "$1,382.15" "$3,071.45" "$3,071.45" "$3,071.45" $640.17 "$3,071.45" "$3,071.45" "$3,071.45" "$3,071.45" "$3,071.45" $640.12 "$3,071.45" "$1,249.47" "$1,514.22" "$3,071.45" "$3,123.68" "$3,071.45" "$3,071.45" "$2,303.63" "$3,071.45" "$3,071.45" "$3,071.45" "$1,535.73" "$1,535.73" "$2,432.59" "$3,071.45" "$2,457.16" "$1,382.15" $609.61 N/A "$1,781.47" "$3,071.45" "$3,071.45" "$3,071.45" "$3,071.45" "$3,071.45" N/A N/A 241.455 SUP HCPCS C1713 241.455 - PLATE BONE 262MM 19 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$3,071.50" "$2,273.00" $609.61 "$3,123.68" "$1,382.15" "$1,382.15" "$1,382.15" "$1,382.15" "$3,071.45" "$3,071.45" "$3,071.45" $640.17 "$3,071.45" "$3,071.45" "$3,071.45" "$3,071.45" "$3,071.45" $640.12 "$3,071.45" "$1,249.47" "$1,514.22" "$3,071.45" "$3,123.68" "$3,071.45" "$3,071.45" "$2,303.63" "$3,071.45" "$3,071.45" "$3,071.45" "$1,535.73" "$1,535.73" "$2,432.59" "$3,071.45" "$2,457.16" "$1,382.15" $609.61 N/A "$1,781.47" "$3,071.45" "$3,071.45" "$3,071.45" "$3,071.45" "$3,071.45" N/A N/A 241.456 SUP HCPCS C1713 241.456 - PLATE BONE 288MM 21 HOLE LCP STAINLESS STEEL TIBIA RIGHT BOTH IP/OP "$3,101.00" "$2,295.00" $615.46 "$3,153.68" "$1,395.43" "$1,395.43" "$1,395.43" "$1,395.43" "$3,100.95" "$3,100.95" "$3,100.95" $646.32 "$3,100.95" "$3,100.95" "$3,100.95" "$3,100.95" "$3,100.95" $646.27 "$3,100.95" "$1,261.47" "$1,528.77" "$3,100.95" "$3,153.68" "$3,100.95" "$3,100.95" "$2,325.75" "$3,100.95" "$3,100.95" "$3,100.95" "$1,550.48" "$1,550.48" "$2,455.95" "$3,100.95" "$2,480.76" "$1,395.43" $615.46 N/A "$1,798.58" "$3,100.95" "$3,100.95" "$3,100.95" $646.24 "$3,100.95" N/A N/A 241.457 SUP HCPCS C1713 241.457 - PLATE BONE 288MM 21 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$3,101.00" "$2,295.00" $615.46 "$3,153.68" "$1,395.43" "$1,395.43" "$1,395.43" "$1,395.43" "$3,100.95" "$3,100.95" "$3,100.95" $646.32 "$3,100.95" "$3,100.95" "$3,100.95" "$3,100.95" "$3,100.95" $646.27 "$3,100.95" "$1,261.47" "$1,528.77" "$3,100.95" "$3,153.68" "$3,100.95" "$3,100.95" "$2,325.75" "$3,100.95" "$3,100.95" "$3,100.95" "$1,550.48" "$1,550.48" "$2,455.95" "$3,100.95" "$2,480.76" "$1,395.43" $615.46 N/A "$1,798.58" "$3,100.95" "$3,100.95" "$3,100.95" $646.24 "$3,100.95" N/A N/A 241.61 SUP HCPCS C1713 241.61 - PLATE BN 60MMX1.2MM NS LCP SS CALC 3.5MM CORT 4MM CANC 3.5MM BOTH IP/OP $974.50 $721.00 $193.34 $990.70 $438.37 $438.37 $438.37 $438.37 $974.15 $974.15 $974.15 $203.04 $974.15 $974.15 $974.15 $974.15 $974.15 $203.02 $974.15 $990.70 $576.21 $974.15 $990.70 $974.15 $974.15 $730.88 $974.15 $974.15 $974.15 $487.08 $487.08 $771.53 $974.15 $779.32 $438.37 $193.34 N/A $565.21 $974.15 $584.49 $974.15 $203.01 $974.15 N/A N/A 241.618 SUP HCPCS C1713 241.618 - PLATE BONE MINI 64MM LOCK LCP STAINLESS STEEL RIGHT BOTH IP/OP "$1,153.00" $853.00 $228.78 "$1,172.28" $518.71 $518.71 $518.71 $518.71 "$1,152.68" "$1,152.68" "$1,152.68" $240.25 "$1,152.68" "$1,152.68" "$1,152.68" "$1,152.68" "$1,152.68" $240.23 "$1,152.68" $468.91 $681.81 "$1,152.68" "$1,172.28" "$1,152.68" "$1,152.68" $864.75 "$1,152.68" "$1,152.68" "$1,152.68" $576.34 $576.34 $912.92 "$1,152.68" $922.14 $518.71 $228.78 N/A $668.74 "$1,152.68" "$1,152.68" "$1,152.68" $240.22 "$1,152.68" N/A N/A 241.619 SUP HCPCS C1713 241.619 - PLATE BONE MINI 64MM LOCK LCP STAINLESS STEEL LEFT CALCANEAL BOTH IP/OP "$1,153.00" $853.00 $228.78 "$1,172.28" $518.71 $518.71 $518.71 $518.71 "$1,152.68" "$1,152.68" "$1,152.68" $240.25 "$1,152.68" "$1,152.68" "$1,152.68" "$1,152.68" "$1,152.68" $240.23 "$1,152.68" $468.91 $681.81 "$1,152.68" "$1,172.28" "$1,152.68" "$1,152.68" $864.75 "$1,152.68" "$1,152.68" "$1,152.68" $576.34 $576.34 $912.92 "$1,152.68" $922.14 $518.71 $228.78 N/A $668.74 "$1,152.68" "$1,152.68" "$1,152.68" $240.22 "$1,152.68" N/A N/A 241.62 SUP HCPCS C1713 241.62 - PLATE BN 70MMX1.2MM NS LCP SS CALC 3.5MM CORT 4MM CANC 3.5MM BOTH IP/OP $994.00 $736.00 $197.25 "$1,010.73" $447.22 $447.22 $447.22 $447.22 $993.83 $993.83 $993.83 $207.14 $993.83 $993.83 $993.83 $993.83 $993.83 $207.13 $993.83 "$1,010.73" $587.85 $993.83 "$1,010.73" $993.83 $993.83 $745.50 $993.83 $993.83 $993.83 $496.92 $496.92 $787.11 $993.83 $795.06 $447.22 $197.25 N/A $576.52 $993.83 $596.30 $993.83 $207.11 $993.83 N/A N/A 241.622 SUP HCPCS C1713 241.622 - PLATE BN SHRT 69MMX2MM NS LCP LCK SS CALC RT 2.7/3.5MM CORT BOTH IP/OP "$1,292.00" $956.00 $256.40 "$1,313.78" $581.32 $581.32 $581.32 $581.32 "$1,291.83" "$1,291.83" "$1,291.83" $269.25 "$1,291.83" "$1,291.83" "$1,291.83" "$1,291.83" "$1,291.83" $269.23 "$1,291.83" "$1,313.78" $764.12 "$1,291.83" "$1,313.78" "$1,291.83" "$1,291.83" $969.00 "$1,291.83" "$1,291.83" "$1,291.83" $645.92 $645.92 "$1,023.13" "$1,291.83" "$1,033.46" $581.32 $256.40 N/A $749.36 "$1,291.83" $775.10 "$1,291.83" $269.22 "$1,291.83" N/A N/A 241.623 SUP HCPCS C1713 241.623 - PLATE BN SHRT 69MMX2MM NS LCP LCK SS CALC LT 2.7/3.5MM CORT BOTH IP/OP "$1,292.00" $956.00 $256.40 "$1,313.78" $581.32 $581.32 $581.32 $581.32 "$1,291.83" "$1,291.83" "$1,291.83" $269.25 "$1,291.83" "$1,291.83" "$1,291.83" "$1,291.83" "$1,291.83" $269.23 "$1,291.83" $525.51 $764.12 "$1,291.83" "$1,313.78" "$1,291.83" "$1,291.83" $969.00 "$1,291.83" "$1,291.83" "$1,291.83" $645.92 $645.92 "$1,023.13" "$1,291.83" "$1,033.46" $581.32 $256.40 N/A $749.36 "$1,291.83" "$1,291.83" "$1,291.83" $269.22 "$1,291.83" N/A N/A 241.624 SUP HCPCS C1713 241.624 - PLATE BN LNG 76MMX2MM NS LCP LCK SS CALC RT 2.7/3.5MM CORT BOTH IP/OP "$1,378.00" "$1,020.00" $273.42 "$1,401.00" $619.91 $619.91 $619.91 $619.91 "$1,377.58" "$1,377.58" "$1,377.58" $287.12 "$1,377.58" "$1,377.58" "$1,377.58" "$1,377.58" "$1,377.58" $287.10 "$1,377.58" $560.40 $814.84 "$1,377.58" "$1,401.00" "$1,377.58" "$1,377.58" "$1,033.50" "$1,377.58" "$1,377.58" "$1,377.58" $688.79 $688.79 "$1,091.04" "$1,377.58" "$1,102.06" $619.91 $273.42 N/A $799.24 "$1,377.58" "$1,377.58" "$1,377.58" $287.09 "$1,377.58" N/A N/A 241.625 SUP HCPCS C1713 241.625 - PLATE BONE LONG 76MM LOCKING BENDABLE TAB LCP STAINLESS BOTH IP/OP "$1,378.00" "$1,020.00" $273.42 "$1,401.00" $619.91 $619.91 $619.91 $619.91 "$1,377.58" "$1,377.58" "$1,377.58" $287.12 "$1,377.58" "$1,377.58" "$1,377.58" "$1,377.58" "$1,377.58" $287.10 "$1,377.58" $560.40 $814.84 "$1,377.58" "$1,401.00" "$1,377.58" "$1,377.58" "$1,033.50" "$1,377.58" "$1,377.58" "$1,377.58" $688.79 $688.79 "$1,091.04" "$1,377.58" "$1,102.06" $619.91 $273.42 N/A $799.24 "$1,377.58" "$1,377.58" "$1,377.58" $287.09 "$1,377.58" N/A N/A 241.626 SUP HCPCS C1713 241.626 - PLATE BN XLNG 81MMX2MM NS LCP LCK SS CALC RT 2.7/3.5MM CORT BOTH IP/OP "$1,424.00" "$1,054.00" $282.62 "$1,448.18" $640.79 $640.79 $640.79 $640.79 "$1,423.98" "$1,423.98" "$1,423.98" $296.79 "$1,423.98" "$1,423.98" "$1,423.98" "$1,423.98" "$1,423.98" $296.77 "$1,423.98" $579.27 $842.28 "$1,423.98" "$1,448.18" "$1,423.98" "$1,423.98" "$1,068.00" "$1,423.98" "$1,423.98" "$1,423.98" $711.99 $711.99 "$1,127.79" "$1,423.98" "$1,139.18" $640.79 $282.62 N/A $825.92 "$1,423.98" "$1,423.98" "$1,423.98" $296.76 "$1,423.98" N/A N/A 241.627 SUP HCPCS C1713 241.627 - PLATE BN XLNG 81MMX2MM NS LCP LCK SS CALC LT 2.7/3.5MM CORT BOTH IP/OP "$1,424.00" "$1,054.00" $282.62 "$1,448.18" $640.79 $640.79 $640.79 $640.79 "$1,423.98" "$1,423.98" "$1,423.98" $296.79 "$1,423.98" "$1,423.98" "$1,423.98" "$1,423.98" "$1,423.98" $296.77 "$1,423.98" $579.27 $842.28 "$1,423.98" "$1,448.18" "$1,423.98" "$1,423.98" "$1,068.00" "$1,423.98" "$1,423.98" "$1,423.98" $711.99 $711.99 "$1,127.79" "$1,423.98" "$1,139.18" $640.79 $282.62 N/A $825.92 "$1,423.98" "$1,423.98" "$1,423.98" "$1,423.98" "$1,423.98" N/A N/A 241.65 SUP HCPCS C1713 241.65 - PLATE BN Y 87MMX2MM NS LCP SS CALC 3.5MM CORT 4MM CANC 3.5MM BOTH IP/OP $994.00 $736.00 $197.25 "$1,010.73" $447.22 $447.22 $447.22 $447.22 $993.83 $993.83 $993.83 $207.14 $993.83 $993.83 $993.83 $993.83 $993.83 $207.13 $993.83 "$1,010.73" $587.85 $993.83 "$1,010.73" $993.83 $993.83 $745.50 $993.83 $993.83 $993.83 $496.92 $496.92 $787.11 $993.83 $795.06 $447.22 $197.25 N/A $576.52 $993.83 $596.30 $993.83 $207.11 $993.83 N/A N/A 241.68 SUP HCPCS C1713 241.680 - PLATE BONE 34MM 2 HOLE LCP STAINLESS STEEL RIGHT RADIAL HEAD BOTH IP/OP "$1,112.50" $823.00 $220.76 "$1,165.13" $500.53 $500.53 $500.53 $500.53 "$1,112.28" "$1,112.28" "$1,112.28" $231.83 "$1,112.28" "$1,112.28" "$1,112.28" "$1,112.28" "$1,112.28" $231.81 "$1,112.28" "$1,165.13" $657.91 "$1,112.28" "$1,165.13" "$1,112.28" "$1,112.28" $834.38 "$1,112.28" "$1,112.28" "$1,112.28" $556.14 $556.14 $880.93 "$1,112.28" $889.82 $500.53 $220.76 N/A $645.25 "$1,112.28" $667.37 "$1,112.28" "$1,112.28" "$1,112.28" N/A N/A 241.681 SUP HCPCS C1713 241.681 - PLATE BN 34MM NS LCP CMBN 2 HL RIM PRECONTOUR LMT CNTCT SS BOTH IP/OP "$1,146.00" $848.00 $227.38 "$1,165.13" $515.54 $515.54 $515.54 $515.54 "$1,145.65" "$1,145.65" "$1,145.65" $238.78 "$1,145.65" "$1,145.65" "$1,145.65" "$1,145.65" "$1,145.65" $238.77 "$1,145.65" $466.05 $677.65 "$1,145.65" "$1,165.13" "$1,145.65" "$1,145.65" $859.50 "$1,145.65" "$1,145.65" "$1,145.65" $572.83 $572.83 $907.35 "$1,145.65" $916.52 $515.54 $227.38 N/A $664.68 "$1,145.65" $687.39 "$1,145.65" $238.75 "$1,145.65" N/A N/A 241.682 SUP HCPCS C1713 241.682 - PLATE BONE 46MM 3 HOLE HEAD LCP STAINLESS STEEL RIGHT RADIAL BOTH IP/OP "$1,178.00" $872.00 $233.80 "$1,198.00" $530.09 $530.09 $530.09 $530.09 "$1,177.98" "$1,177.98" "$1,177.98" $245.52 "$1,177.98" "$1,177.98" "$1,177.98" "$1,177.98" "$1,177.98" $245.50 "$1,177.98" "$1,198.00" $696.78 "$1,177.98" "$1,198.00" "$1,177.98" "$1,177.98" $883.50 "$1,177.98" "$1,177.98" "$1,177.98" $588.99 $588.99 $932.96 "$1,177.98" $942.38 $530.09 $233.80 N/A $683.24 "$1,177.98" "$1,177.98" "$1,177.98" $245.49 "$1,177.98" N/A N/A 241.683 SUP HCPCS C1713 241.683 - PLATE BONE 46MM 3 HOLE RIM LCP STAINLESS STEEL LEFT RADIAL BOTH IP/OP "$1,178.00" $872.00 $233.80 "$1,198.00" $530.09 $530.09 $530.09 $530.09 "$1,177.98" "$1,177.98" "$1,177.98" $245.52 "$1,177.98" "$1,177.98" "$1,177.98" "$1,177.98" "$1,177.98" $245.50 "$1,177.98" $479.20 $696.78 "$1,177.98" "$1,198.00" "$1,177.98" "$1,177.98" $883.50 "$1,177.98" "$1,177.98" "$1,177.98" $588.99 $588.99 $932.96 "$1,177.98" $942.38 $530.09 $233.80 N/A $683.24 "$1,177.98" "$1,177.98" "$1,177.98" $245.49 "$1,177.98" N/A N/A 241.684 SUP HCPCS C1713 241.684 - PLATE BONE 56MM 4 HOLE RIM LCP STAINLESS STEEL RIGHT RADIAL BOTH IP/OP "$1,199.50" $888.00 $237.98 "$1,219.43" $539.57 $539.57 $539.57 $539.57 "$1,199.05" "$1,199.05" "$1,199.05" $249.91 "$1,199.05" "$1,199.05" "$1,199.05" "$1,199.05" "$1,199.05" $249.90 "$1,199.05" $487.77 $709.24 "$1,199.05" "$1,219.43" "$1,199.05" "$1,199.05" $899.63 "$1,199.05" "$1,199.05" "$1,199.05" $599.53 $599.53 $949.65 "$1,199.05" $959.24 $539.57 $237.98 N/A $695.71 "$1,199.05" "$1,199.05" "$1,199.05" "$1,199.05" "$1,199.05" N/A N/A 241.685 SUP HCPCS C1713 241.685 - PLATE BONE 56MM 4 HOLE RIM LCP STAINLESS STEEL LEFT RADIAL BOTH IP/OP "$1,199.50" $888.00 $237.98 "$1,219.43" $539.57 $539.57 $539.57 $539.57 "$1,199.05" "$1,199.05" "$1,199.05" $249.91 "$1,199.05" "$1,199.05" "$1,199.05" "$1,199.05" "$1,199.05" $249.90 "$1,199.05" "$1,219.43" $709.24 "$1,199.05" "$1,219.43" "$1,199.05" "$1,199.05" $899.63 "$1,199.05" "$1,199.05" "$1,199.05" $599.53 $599.53 $949.65 "$1,199.05" $959.24 $539.57 $237.98 N/A $695.71 "$1,199.05" $719.43 "$1,199.05" $249.88 "$1,199.05" N/A N/A 241.69 SUP HCPCS C1713 241.690 - PLATE BN 28MM NS LCP CMBN 2 HL NK PRECONTOUR LMT CNTCT SS BOTH IP/OP "$1,112.50" $823.00 $220.76 "$1,165.13" $500.53 $500.53 $500.53 $500.53 "$1,112.28" "$1,112.28" "$1,112.28" $231.83 "$1,112.28" "$1,112.28" "$1,112.28" "$1,112.28" "$1,112.28" $231.81 "$1,112.28" "$1,165.13" $657.91 "$1,112.28" "$1,165.13" "$1,112.28" "$1,112.28" $834.38 "$1,112.28" "$1,112.28" "$1,112.28" $556.14 $556.14 $880.93 "$1,112.28" $889.82 $500.53 $220.76 N/A $645.25 "$1,112.28" $667.37 "$1,112.28" "$1,112.28" "$1,112.28" N/A N/A 241.691 SUP HCPCS C1713 241.691 - PLATE BN 40MM NS LCP CMBN 3 HL NK PRECONTOUR LMT CNTCT SS BOTH IP/OP "$1,178.00" $872.00 $233.80 "$1,198.00" $530.09 $530.09 $530.09 $530.09 "$1,177.98" "$1,177.98" "$1,177.98" $245.52 "$1,177.98" "$1,177.98" "$1,177.98" "$1,177.98" "$1,177.98" $245.50 "$1,177.98" $479.20 $696.78 "$1,177.98" "$1,198.00" "$1,177.98" "$1,177.98" $883.50 "$1,177.98" "$1,177.98" "$1,177.98" $588.99 $588.99 $932.96 "$1,177.98" $942.38 $530.09 $233.80 N/A $683.24 "$1,177.98" $706.79 "$1,177.98" "$1,177.98" "$1,177.98" N/A N/A 241.692 SUP HCPCS C1713 241.692 - PLATE BONE 50MM 4 HOLE LCP STAINLESS STEEL RADIAL HEAD BOTH IP/OP "$1,200.50" $888.00 $238.26 "$1,220.85" $540.20 $540.20 $540.20 $540.20 "$1,200.45" "$1,200.45" "$1,200.45" $250.20 "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" $250.19 "$1,200.45" $488.34 $710.07 "$1,200.45" "$1,220.85" "$1,200.45" "$1,200.45" $900.38 "$1,200.45" "$1,200.45" "$1,200.45" $600.23 $600.23 $950.76 "$1,200.45" $960.36 $540.20 $238.26 N/A $696.29 "$1,200.45" $720.27 "$1,200.45" "$1,200.45" "$1,200.45" N/A N/A 241.83 SUP HCPCS C1713 241.83 - PLATE BN CLVRLF 88X15X2MM NS 1.2MM LC DCP 3 HL THN BLDE BOTH IP/OP $553.00 $409.00 $109.70 $552.73 $248.73 $248.73 $248.73 $248.73 $552.73 $552.73 $552.73 $115.20 $552.73 $552.73 $552.73 $552.73 $552.73 $115.20 $552.73 $221.09 $326.94 $552.73 $552.73 $552.73 $552.73 $414.75 $552.73 $552.73 $552.73 $276.37 $276.37 $437.76 $552.73 $442.18 $248.73 $109.70 N/A $320.74 $552.73 $552.73 $552.73 $115.19 $552.73 N/A N/A 241.84 SUP HCPCS C1713 241.84 - PLATE BN CLVRLF 104X15X2MM NS 1.2MM LC DCP 4 HL THN BLDE BOTH IP/OP $591.00 $437.00 $117.28 $590.93 $265.92 $265.92 $265.92 $265.92 $590.93 $590.93 $590.93 $123.16 $590.93 $590.93 $590.93 $590.93 $590.93 $123.16 $590.93 $236.37 $349.54 $590.93 $590.93 $590.93 $590.93 $443.25 $590.93 $590.93 $590.93 $295.47 $295.47 $468.02 $590.93 $472.74 $265.92 $117.28 N/A $342.78 $590.93 $590.93 $590.93 $123.15 $590.93 N/A N/A 241.85 SUP HCPCS C1713 241.85 - PLATE BN CLVRLF 120X15X2MM NS 5 HL THN BLDE SS 3.5MM SCR BOTH IP/OP $768.50 $569.00 $152.50 $768.35 $345.76 $345.76 $345.76 $345.76 $768.35 $768.35 $768.35 $160.14 $768.35 $768.35 $768.35 $768.35 $768.35 $160.13 $768.35 $768.35 $454.48 $768.35 $768.35 $768.35 $768.35 $576.38 $768.35 $768.35 $768.35 $384.18 $384.18 $608.53 $768.35 $614.68 $345.76 $152.50 N/A $445.73 $768.35 $768.35 $768.35 $160.12 $768.35 N/A N/A 241.86 SUP HCPCS C1713 241.86 - PLATE BONE THIN CLOVERLEAF 136MM 6 HOLE LC-DCP STAINLESS BOTH IP/OP $834.00 $617.00 $165.50 $833.85 $375.23 $375.23 $375.23 $375.23 $833.85 $833.85 $833.85 $173.80 $833.85 $833.85 $833.85 $833.85 $833.85 $173.78 $833.85 $833.85 $493.22 $833.85 $833.85 $833.85 $833.85 $625.50 $833.85 $833.85 $833.85 $416.93 $416.93 $660.41 $833.85 $667.08 $375.23 $165.50 N/A $483.72 $833.85 $833.85 $833.85 $173.77 $833.85 N/A N/A 241.87 SUP HCPCS C1713 241.87 - PLATE BN CLVRLF 152X15X2MM NS 1.2MM LC DCP 7 HL THN BLDE BOTH IP/OP $898.00 $665.00 $178.23 $898.00 $404.10 $404.10 $404.10 $404.10 $898.00 $898.00 $898.00 $187.17 $898.00 $898.00 $898.00 $898.00 $898.00 $187.15 $898.00 $359.20 $531.17 $898.00 $898.00 $898.00 $898.00 $673.50 $898.00 $898.00 $898.00 $449.00 $449.00 $711.22 $898.00 $718.40 $404.10 $178.23 N/A $520.84 $898.00 $898.00 $898.00 $187.14 $898.00 N/A N/A 241.88 SUP HCPCS C1713 241.88 - PLATE BN CLVRLF 168X15X2MM NS 1.2MM LC DCP 8 HL THN BLDE BOTH IP/OP $954.00 $706.00 $189.34 $953.95 $429.28 $429.28 $429.28 $429.28 $953.95 $953.95 $953.95 $198.83 $953.95 $953.95 $953.95 $953.95 $953.95 $198.81 $953.95 $381.58 $564.26 $953.95 $953.95 $953.95 $953.95 $715.50 $953.95 $953.95 $953.95 $476.98 $476.98 $755.53 $953.95 $763.16 $429.28 $189.34 N/A $553.32 $953.95 $953.95 $953.95 $198.80 $953.95 N/A N/A 241.89 SUP HCPCS C1713 241.89 - PLATE BONE THIN 200X15X1.2MM 10 HOLE CLOVERLEAF THIN BLADE BOTH IP/OP "$1,061.50" $786.00 $210.64 "$1,079.35" $477.59 $477.59 $477.59 $477.59 "$1,061.30" "$1,061.30" "$1,061.30" $221.20 "$1,061.30" "$1,061.30" "$1,061.30" "$1,061.30" "$1,061.30" $221.19 "$1,061.30" $431.74 $627.76 "$1,061.30" "$1,079.35" "$1,061.30" "$1,061.30" $796.13 "$1,061.30" "$1,061.30" "$1,061.30" $530.65 $530.65 $840.55 "$1,061.30" $849.04 $477.59 $210.64 N/A $615.67 "$1,061.30" "$1,061.30" "$1,061.30" $221.17 "$1,061.30" N/A N/A 241.901 SUP HCPCS C1713 241.901 - PLATE BN STD 90X12X2.5MM NS LCP CMBN PHLS 3 HL SHFT LCK CMPR BOTH IP/OP "$2,858.00" "$2,115.00" $567.20 "$2,906.35" "$1,286.00" "$1,286.00" "$1,286.00" "$1,286.00" "$2,857.78" "$2,857.78" "$2,857.78" $595.63 "$2,857.78" "$2,857.78" "$2,857.78" "$2,857.78" "$2,857.78" $595.59 "$2,857.78" "$2,906.35" "$1,408.89" "$2,857.78" "$2,906.35" "$2,857.78" "$2,857.78" "$2,143.50" "$2,857.78" "$2,857.78" "$2,857.78" "$1,428.89" "$1,428.89" "$2,263.36" "$2,857.78" "$2,286.22" "$1,286.00" $567.20 N/A "$1,657.64" "$2,857.78" "$1,714.67" "$2,857.78" $595.56 "$2,857.78" N/A N/A 241.903 SUP HCPCS C1713 241.903 - PLATE BN STD 114X12X2.5MM NS LCP CMBN PHLS 5 HL SHFT LCK BOTH IP/OP "$2,948.00" "$2,182.00" $585.05 "$2,997.83" "$1,326.48" "$1,326.48" "$1,326.48" "$1,326.48" "$2,947.73" "$2,947.73" "$2,947.73" $614.38 "$2,947.73" "$2,947.73" "$2,947.73" "$2,947.73" "$2,947.73" $614.34 "$2,947.73" "$2,997.83" "$1,453.23" "$2,947.73" "$2,997.83" "$2,947.73" "$2,947.73" "$2,211.00" "$2,947.73" "$2,947.73" "$2,947.73" "$1,473.87" "$1,473.87" "$2,334.60" "$2,947.73" "$2,358.18" "$1,326.48" $585.05 N/A "$1,709.84" "$2,947.73" "$1,768.64" "$2,947.73" $614.31 "$2,947.73" N/A N/A 241.918 SUP HCPCS C1713 241.918 - PLATE BN 142X12X3.7MM NS LCP CMBN PHLS LNG 5 HL SHFT LCK BOTH IP/OP "$2,976.00" "$2,202.00" $590.63 "$3,026.45" "$1,339.13" "$1,339.13" "$1,339.13" "$1,339.13" "$2,975.85" "$2,975.85" "$2,975.85" $620.24 "$2,975.85" "$2,975.85" "$2,975.85" "$2,975.85" "$2,975.85" $620.20 "$2,975.85" "$3,026.45" "$1,467.09" "$2,975.85" "$3,026.45" "$2,975.85" "$2,975.85" "$2,232.00" "$2,975.85" "$2,975.85" "$2,975.85" "$1,487.93" "$1,487.93" "$2,356.87" "$2,975.85" "$2,380.68" "$1,339.13" $590.63 N/A "$1,726.08" "$2,975.85" "$1,785.51" "$2,975.85" $620.17 "$2,975.85" N/A N/A 241.919 SUP HCPCS C1713 241.919 - PLATE LNG 160MM SS 3.5MM SCR SM FRAG SET 6 HOLE LCP BONE BOTH IP/OP "$3,583.00" "$2,651.00" $711.09 "$3,582.78" "$1,612.25" "$1,612.25" "$1,612.25" "$1,612.25" "$3,582.78" "$3,582.78" "$3,582.78" $746.74 "$3,582.78" "$3,582.78" "$3,582.78" "$3,582.78" "$3,582.78" $746.69 "$3,582.78" "$3,582.78" "$1,766.31" "$3,582.78" "$3,582.78" "$3,582.78" "$3,582.78" "$2,687.25" "$3,582.78" "$3,582.78" "$3,582.78" "$1,791.39" "$1,791.39" "$2,837.56" "$3,582.78" "$2,866.22" "$1,612.25" $711.09 N/A "$2,078.14" "$3,582.78" "$2,149.67" "$3,582.78" $746.65 "$3,582.78" N/A N/A 241.921 SUP HCPCS C1713 241.921 - PLATE BN 196X12X3.7MM NS LCP CMBN PHLS LNG 8 HL SHFT LCK BOTH IP/OP "$3,213.50" "$2,378.00" $637.79 "$3,268.05" "$1,446.04" "$1,446.04" "$1,446.04" "$1,446.04" "$3,213.43" "$3,213.43" "$3,213.43" $669.76 "$3,213.43" "$3,213.43" "$3,213.43" "$3,213.43" "$3,213.43" $669.71 "$3,213.43" "$1,307.22" "$1,584.22" "$3,213.43" "$3,268.05" "$3,213.43" "$3,213.43" "$2,410.13" "$3,213.43" "$3,213.43" "$3,213.43" "$1,606.72" "$1,606.72" "$2,545.04" "$3,213.43" "$2,570.74" "$1,446.04" $637.79 N/A "$1,863.83" "$3,213.43" "$1,928.06" "$3,213.43" $669.68 "$3,213.43" N/A N/A 241.923 SUP HCPCS C1713 241.923 - PLATE BN 232X12X3.7MM NS LCP CMBN PHLS LNG 10 HL SHFT LCK BOTH IP/OP "$3,333.00" "$2,466.00" $661.50 "$3,389.55" "$1,499.81" "$1,499.81" "$1,499.81" "$1,499.81" "$3,332.90" "$3,332.90" "$3,332.90" $694.66 "$3,332.90" "$3,332.90" "$3,332.90" "$3,332.90" "$3,332.90" $694.61 "$3,332.90" "$3,389.55" "$1,643.12" "$3,332.90" "$3,389.55" "$3,332.90" "$3,332.90" "$2,499.75" "$3,332.90" "$3,332.90" "$3,332.90" "$1,666.45" "$1,666.45" "$2,639.66" "$3,332.90" "$2,666.32" "$1,499.81" $661.50 N/A "$1,933.14" "$3,332.90" "$3,332.90" "$3,332.90" $694.58 "$3,332.90" N/A N/A 241.925 SUP HCPCS C1713 241.925 - PLATE BN 268X12X3.7MM NS LCP CMBN PHLS LNG 12 HL SHFT LCK BOTH IP/OP "$3,448.50" "$2,552.00" $684.38 "$3,506.80" "$1,551.68" "$1,551.68" "$1,551.68" "$1,551.68" "$3,448.18" "$3,448.18" "$3,448.18" $718.69 "$3,448.18" "$3,448.18" "$3,448.18" "$3,448.18" "$3,448.18" $718.64 "$3,448.18" "$1,402.72" "$1,699.95" "$3,448.18" "$3,506.80" "$3,448.18" "$3,448.18" "$2,586.38" "$3,448.18" "$3,448.18" "$3,448.18" "$1,724.09" "$1,724.09" "$2,730.96" "$3,448.18" "$2,758.54" "$1,551.68" $684.38 N/A "$2,000.13" "$3,448.18" "$3,448.18" "$3,448.18" $718.60 "$3,448.18" N/A N/A 241.931 SUP HCPCS C1713 241.931 - PLATE BN OB L T 52X10X1.5MM NS LCP CMBN 3 HLE/HD 3 HL SHFT BOTH IP/OP $663.50 $491.00 $131.68 $674.75 $298.57 $298.57 $298.57 $298.57 $663.48 $663.48 $663.48 $138.29 $663.48 $663.48 $663.48 $663.48 $663.48 $138.28 $663.48 $269.90 $392.45 $663.48 $674.75 $663.48 $663.48 $497.63 $663.48 $663.48 $663.48 $331.74 $331.74 $525.48 $663.48 $530.78 $298.57 $131.68 N/A $384.83 $663.48 $398.09 $663.48 $138.27 $663.48 N/A N/A 241.941 SUP HCPCS C1713 241.941 - PLATE BN OB L T 63X10X1.5MM NS LCP CMBN 3 HLE/HD 4 HL SHFT BOTH IP/OP $696.00 $515.00 $138.10 $707.65 $313.12 $313.12 $313.12 $313.12 $695.83 $695.83 $695.83 $145.03 $695.83 $695.83 $695.83 $695.83 $695.83 $145.02 $695.83 $707.65 $411.58 $695.83 $707.65 $695.83 $695.83 $522.00 $695.83 $695.83 $695.83 $347.92 $347.92 $551.10 $695.83 $556.66 $313.12 $138.10 N/A $403.68 $695.83 $417.50 $695.83 $145.01 $695.83 N/A N/A 241.951 SUP HCPCS C1713 241.951 - PLATE BN OB L T 74X10X1.5MM NS LCP CMBN 3 HLE/HD 5 HL SHFT BOTH IP/OP $727.00 $538.00 $144.24 $739.10 $327.04 $327.04 $327.04 $327.04 $726.75 $726.75 $726.75 $151.47 $726.75 $726.75 $726.75 $726.75 $726.75 $151.46 $726.75 $739.10 $429.87 $726.75 $739.10 $726.75 $726.75 $545.25 $726.75 $726.75 $726.75 $363.38 $363.38 $575.59 $726.75 $581.40 $327.04 $144.24 N/A $421.66 $726.75 $436.05 $726.75 $151.45 $726.75 N/A N/A 241.961 SUP HCPCS C1713 241.961 - PLATE BONE T THK1.5MM 85X10MM 3X6 HOLE LEFT OBLIQUE LOCKING BOTH IP/OP $779.00 $576.00 $154.56 $792.00 $350.44 $350.44 $350.44 $350.44 $778.75 $778.75 $778.75 $162.31 $778.75 $778.75 $778.75 $778.75 $778.75 $162.30 $778.75 $792.00 $460.63 $778.75 $792.00 $778.75 $778.75 $584.25 $778.75 $778.75 $778.75 $389.38 $389.38 $616.77 $778.75 $623.00 $350.44 $154.56 N/A $451.82 $778.75 $467.25 $778.75 $162.29 $778.75 N/A N/A 241.971 SUP HCPCS C1713 241.971 - PLATE BN OB L T 96X10X1.5MM NS LCP CMBN 3 HLE/HD 7 HL SHFT BOTH IP/OP $787.50 $583.00 $156.24 $800.58 $354.24 $354.24 $354.24 $354.24 $787.20 $787.20 $787.20 $164.07 $787.20 $787.20 $787.20 $787.20 $787.20 $164.06 $787.20 $800.58 $465.63 $787.20 $800.58 $787.20 $787.20 $590.63 $787.20 $787.20 $787.20 $393.60 $393.60 $623.46 $787.20 $629.76 $354.24 $156.24 N/A $456.75 $787.20 $787.20 $787.20 $164.05 $787.20 N/A N/A 241.981 SUP HCPCS C1713 241.981 - PLATE BONE T THK1.5MM 107X10MM 3X8 HOLE LEFT OBLIQUE LOCKING BOTH IP/OP $856.50 $634.00 $169.91 $870.63 $385.24 $385.24 $385.24 $385.24 $856.08 $856.08 $856.08 $178.43 $856.08 $856.08 $856.08 $856.08 $856.08 $178.42 $856.08 $870.63 $506.37 $856.08 $870.63 $856.08 $856.08 $642.38 $856.08 $856.08 $856.08 $428.04 $428.04 $678.02 $856.08 $684.86 $385.24 $169.91 N/A $496.77 $856.08 $513.65 $856.08 $178.41 $856.08 N/A N/A 242.03 SUP HCPCS C1713 242.03 - PLATE BN .25 TBLR 23X7X1MM NS .3MM 3 HL COLR SS 2.7MM SCR MN BOTH IP/OP $146.50 $108.00 $29.02 $148.68 $65.79 $65.79 $65.79 $65.79 $146.20 $146.20 $146.20 $30.47 $146.20 $146.20 $146.20 $146.20 $146.20 $30.47 $146.20 $148.68 $86.48 $146.20 $148.68 $146.20 $146.20 $109.88 $146.20 $146.20 $146.20 $73.10 $73.10 $115.79 $146.20 $116.96 $65.79 $29.02 N/A $84.97 $146.20 $87.72 $146.20 $30.47 $146.20 N/A N/A 242.04 SUP HCPCS C1713 242.04 - PLATE BONE .25 TUBE LP 31X7X1MM .3MM 4 HOLE COLLAR STAINLESS BOTH IP/OP $156.50 $116.00 $30.97 $158.68 $70.21 $70.21 $70.21 $70.21 $156.03 $156.03 $156.03 $32.52 $156.03 $156.03 $156.03 $156.03 $156.03 $32.52 $156.03 $158.68 $92.29 $156.03 $158.68 $156.03 $156.03 $117.38 $156.03 $156.03 $156.03 $78.02 $78.02 $123.58 $156.03 $124.82 $70.21 $30.97 N/A $90.77 $156.03 $156.03 $156.03 $32.52 $156.03 N/A N/A 242.05 SUP HCPCS C1713 242.05 - PLATE BONE 39X7X1MM .3MM 5 HOLE QUARTER TUBULAR COLLAR LCP BOTH IP/OP $166.00 $123.00 $32.92 $168.70 $74.65 $74.65 $74.65 $74.65 $165.88 $165.88 $165.88 $34.57 $165.88 $165.88 $165.88 $165.88 $165.88 $34.57 $165.88 $168.70 $98.12 $165.88 $168.70 $165.88 $165.88 $124.50 $165.88 $165.88 $165.88 $82.94 $82.94 $131.38 $165.88 $132.70 $74.65 $32.92 N/A $96.28 $165.88 $99.53 $165.88 $34.57 $165.88 N/A N/A 242.06 SUP HCPCS C1713 242.06 - PLATE BONE .25 TUBULAR 47X7X1MM .3MM 6 HOLE COLLAR DCP BOTH IP/OP $180.00 $133.00 $35.71 $182.98 $80.97 $80.97 $80.97 $80.97 $179.93 $179.93 $179.93 $37.50 $179.93 $179.93 $179.93 $179.93 $179.93 $37.50 $179.93 $182.98 $106.43 $179.93 $182.98 $179.93 $179.93 $135.00 $179.93 $179.93 $179.93 $89.97 $89.97 $142.50 $179.93 $143.94 $80.97 $35.71 N/A $104.40 $179.93 $107.96 $179.93 $37.50 $179.93 N/A N/A 242.07 SUP HCPCS C1713 242.07 - PLATE BONE .75 TUBE 55X7X1MM .3MM 7 HOLE COLLAR STAINLESS BOTH IP/OP $191.50 $142.00 $37.94 $194.43 $86.03 $86.03 $86.03 $86.03 $191.18 $191.18 $191.18 $39.85 $191.18 $191.18 $191.18 $191.18 $191.18 $39.84 $191.18 $194.43 $113.08 $191.18 $194.43 $191.18 $191.18 $143.63 $191.18 $191.18 $191.18 $95.59 $95.59 $151.41 $191.18 $152.94 $86.03 $37.94 N/A $111.07 $191.18 $114.71 $191.18 $39.84 $191.18 N/A N/A 242.08 SUP HCPCS C1713 242.08 - PLATE BONE .25 TUBE 63MM .3MM 8 HOLE COLLAR DCP STAINLESS BOTH IP/OP $197.00 $146.00 $39.06 $200.15 $88.56 $88.56 $88.56 $88.56 $196.80 $196.80 $196.80 $41.02 $196.80 $196.80 $196.80 $196.80 $196.80 $41.02 $196.80 $80.06 $116.41 $196.80 $200.15 $196.80 $196.80 $147.75 $196.80 $196.80 $196.80 $98.40 $98.40 $155.87 $196.80 $157.44 $88.56 $39.06 N/A $114.26 $196.80 $118.08 $196.80 $41.01 $196.80 N/A N/A 242.102 SUP HCPCS C1713 242.102 - PLATE BONE 139MM 2 HOLE LCP STAINLESS STEEL FEMUR LEFT BOTH IP/OP "$2,615.00" "$1,935.00" $518.93 "$2,659.05" "$1,176.57" "$1,176.57" "$1,176.57" "$1,176.57" "$2,614.60" "$2,614.60" "$2,614.60" $544.95 "$2,614.60" "$2,614.60" "$2,614.60" "$2,614.60" "$2,614.60" $544.91 "$2,614.60" "$1,063.62" "$1,289.00" "$2,614.60" "$2,659.05" "$2,614.60" "$2,614.60" "$1,961.25" "$2,614.60" "$2,614.60" "$2,614.60" "$1,307.30" "$1,307.30" "$2,070.76" "$2,614.60" "$2,091.68" "$1,176.57" $518.93 N/A "$1,516.70" "$2,614.60" "$1,568.76" "$2,614.60" $544.88 "$2,614.60" N/A N/A 242.104 SUP HCPCS C1713 242.104 - PLATE BN 175MM NS LCP CMBN 4 HL LMT CNTCT SS FEM LT PROX 4.5 BOTH IP/OP "$2,667.00" "$1,974.00" $529.25 "$2,711.93" "$1,199.97" "$1,199.97" "$1,199.97" "$1,199.97" "$2,666.60" "$2,666.60" "$2,666.60" $555.79 "$2,666.60" "$2,666.60" "$2,666.60" "$2,666.60" "$2,666.60" $555.75 "$2,666.60" "$1,084.77" "$1,314.63" "$2,666.60" "$2,711.93" "$2,666.60" "$2,666.60" "$2,000.25" "$2,666.60" "$2,666.60" "$2,666.60" "$1,333.30" "$1,333.30" "$2,111.95" "$2,666.60" "$2,133.28" "$1,199.97" $529.25 N/A "$1,546.86" "$2,666.60" "$1,599.96" "$2,666.60" $555.72 "$2,666.60" N/A N/A 242.106 SUP HCPCS C1713 242.106 - PLATE BN 211MM NS LCP CMBN 6 HL LMT CNTCT SS FEM LT PROX 4.5 BOTH IP/OP "$2,719.00" "$2,012.00" $539.57 "$2,764.83" "$1,223.37" "$1,223.37" "$1,223.37" "$1,223.37" "$2,718.60" "$2,718.60" "$2,718.60" $566.62 "$2,718.60" "$2,718.60" "$2,718.60" "$2,718.60" "$2,718.60" $566.59 "$2,718.60" "$1,105.93" "$1,340.27" "$2,718.60" "$2,764.83" "$2,718.60" "$2,718.60" "$2,039.25" "$2,718.60" "$2,718.60" "$2,718.60" "$1,359.30" "$1,359.30" "$2,153.13" "$2,718.60" "$2,174.88" "$1,223.37" $539.57 N/A "$1,577.02" "$2,718.60" "$2,718.60" "$2,718.60" $566.56 "$2,718.60" N/A N/A 242.108 SUP HCPCS C1713 242.108 - PLATE BN 247MM NS LCP CMBN 8 HL LMT CNTCT SS FEM LT PROX 4.5 BOTH IP/OP "$2,852.50" "$2,111.00" $566.08 "$2,900.63" "$1,283.47" "$1,283.47" "$1,283.47" "$1,283.47" "$2,852.15" "$2,852.15" "$2,852.15" $594.46 "$2,852.15" "$2,852.15" "$2,852.15" "$2,852.15" "$2,852.15" $594.42 "$2,852.15" "$1,160.25" "$1,406.11" "$2,852.15" "$2,900.63" "$2,852.15" "$2,852.15" "$2,139.38" "$2,852.15" "$2,852.15" "$2,852.15" "$1,426.08" "$1,426.08" "$2,258.90" "$2,852.15" "$2,281.72" "$1,283.47" $566.08 N/A "$1,654.45" "$2,852.15" "$1,711.29" "$2,852.15" $594.39 "$2,852.15" N/A N/A 242.11 SUP HCPCS C1713 242.110 - PLATE BN 283MM NS LCP CMBN 10 HL LMT CNTCT SS FEM LT PROX BOTH IP/OP "$2,967.00" "$2,196.00" $588.87 "$3,107.93" "$1,335.14" "$1,335.14" "$1,335.14" "$1,335.14" "$2,966.98" "$2,966.98" "$2,966.98" $618.39 "$2,966.98" "$2,966.98" "$2,966.98" "$2,966.98" "$2,966.98" $618.35 "$2,966.98" "$1,243.17" "$1,462.72" "$2,966.98" "$3,107.93" "$2,966.98" "$2,966.98" "$2,225.25" "$2,966.98" "$2,966.98" "$2,966.98" "$1,483.49" "$1,483.49" "$2,349.85" "$2,966.98" "$2,373.58" "$1,335.14" $588.87 N/A "$1,720.86" "$2,966.98" "$1,780.19" "$2,966.98" $618.32 "$2,966.98" N/A N/A 242.112 SUP HCPCS C1713 242.112 - PLATE BN 319MM NS LCP CMBN 12 HL LMT CNTCT SS FEM LT PROX BOTH IP/OP "$3,236.00" "$2,395.00" $642.25 "$3,290.90" "$1,456.16" "$1,456.16" "$1,456.16" "$1,456.16" "$3,235.90" "$3,235.90" "$3,235.90" $674.44 "$3,235.90" "$3,235.90" "$3,235.90" "$3,235.90" "$3,235.90" $674.40 "$3,235.90" "$1,316.36" "$1,595.30" "$3,235.90" "$3,290.90" "$3,235.90" "$3,235.90" "$2,427.00" "$3,235.90" "$3,235.90" "$3,235.90" "$1,617.95" "$1,617.95" "$2,562.83" "$3,235.90" "$2,588.72" "$1,456.16" $642.25 N/A "$1,876.88" "$3,235.90" "$1,941.54" "$3,235.90" $674.36 "$3,235.90" N/A N/A 242.114 SUP HCPCS C1713 242.114 - PLATE BN 355MM NS LCP CMBN 14 HL LMT CNTCT SS FEM LT PROX BOTH IP/OP "$3,496.00" "$2,587.00" $693.86 "$3,555.38" "$1,573.18" "$1,573.18" "$1,573.18" "$1,573.18" "$3,495.95" "$3,495.95" "$3,495.95" $728.64 "$3,495.95" "$3,495.95" "$3,495.95" "$3,495.95" "$3,495.95" $728.59 "$3,495.95" "$1,422.15" "$1,723.50" "$3,495.95" "$3,555.38" "$3,495.95" "$3,495.95" "$2,622.00" "$3,495.95" "$3,495.95" "$3,495.95" "$1,747.98" "$1,747.98" "$2,768.79" "$3,495.95" "$2,796.76" "$1,573.18" $693.86 N/A "$2,027.68" "$3,495.95" "$2,097.57" "$3,495.95" $728.56 "$3,495.95" N/A N/A 242.116 SUP HCPCS C1713 242.116 - PLATE BN 391MM NS LCP CMBN 16 HL LMT CNTCT SS FEM LT PROX BOTH IP/OP "$3,601.50" "$2,665.00" $714.78 "$3,662.60" "$1,620.62" "$1,620.62" "$1,620.62" "$1,620.62" "$3,601.38" "$3,601.38" "$3,601.38" $750.62 "$3,601.38" "$3,601.38" "$3,601.38" "$3,601.38" "$3,601.38" $750.57 "$3,601.38" "$3,662.60" "$1,775.48" "$3,601.38" "$3,662.60" "$3,601.38" "$3,601.38" "$2,701.13" "$3,601.38" "$3,601.38" "$3,601.38" "$1,800.69" "$1,800.69" "$2,852.29" "$3,601.38" "$2,881.10" "$1,620.62" $714.78 N/A "$2,088.87" "$3,601.38" "$2,160.83" "$3,601.38" $750.53 "$3,601.38" N/A N/A 242.12 SUP HCPCS C1713 242.120 - PLATE BONE 133MM 2 HOLE HOOK LCP STAINLESS STEEL PROXIMAL BOTH IP/OP "$2,941.50" "$2,177.00" $583.72 "$3,080.78" "$1,323.46" "$1,323.46" "$1,323.46" "$1,323.46" "$2,941.03" "$2,941.03" "$2,941.03" $612.98 "$2,941.03" "$2,941.03" "$2,941.03" "$2,941.03" "$2,941.03" $612.94 "$2,941.03" "$1,232.31" "$1,449.93" "$2,941.03" "$3,080.78" "$2,941.03" "$2,941.03" "$2,206.13" "$2,941.03" "$2,941.03" "$2,941.03" "$1,470.52" "$1,470.52" "$2,329.30" "$2,941.03" "$2,352.82" "$1,323.46" $583.72 N/A "$1,706.07" "$2,941.03" "$1,764.62" "$2,941.03" $612.91 "$2,941.03" N/A N/A 242.121 SUP HCPCS C1713 242.121 - PLATE BONE 169MM 4 HOLE HOOK LCP STAINLESS STEEL FEMUR BOTH IP/OP "$3,071.50" "$2,273.00" $609.61 "$3,123.68" "$1,382.15" "$1,382.15" "$1,382.15" "$1,382.15" "$3,071.45" "$3,071.45" "$3,071.45" $640.17 "$3,071.45" "$3,071.45" "$3,071.45" "$3,071.45" "$3,071.45" $640.12 "$3,071.45" "$1,249.47" "$1,514.22" "$3,071.45" "$3,123.68" "$3,071.45" "$3,071.45" "$2,303.63" "$3,071.45" "$3,071.45" "$3,071.45" "$1,535.73" "$1,535.73" "$2,432.59" "$3,071.45" "$2,457.16" "$1,382.15" $609.61 N/A "$1,781.47" "$3,071.45" "$1,842.87" "$3,071.45" $640.09 "$3,071.45" N/A N/A 242.122 SUP HCPCS C1713 242.122 - PLATE BONE 205MM 6 HOLE HOOK LCP STAINLESS STEEL FEMUR BOTH IP/OP "$3,119.50" "$2,308.00" $619.09 "$3,172.25" "$1,403.65" "$1,403.65" "$1,403.65" "$1,403.65" "$3,119.23" "$3,119.23" "$3,119.23" $650.13 "$3,119.23" "$3,119.23" "$3,119.23" "$3,119.23" "$3,119.23" $650.08 "$3,119.23" "$3,172.25" "$1,537.78" "$3,119.23" "$3,172.25" "$3,119.23" "$3,119.23" "$2,339.63" "$3,119.23" "$3,119.23" "$3,119.23" "$1,559.62" "$1,559.62" "$2,470.43" "$3,119.23" "$2,495.38" "$1,403.65" $619.09 N/A "$1,809.31" "$3,119.23" "$3,119.23" "$3,119.23" $650.05 "$3,119.23" N/A N/A 242.123 SUP HCPCS C1713 242.123 - PLATE BONE 241MM 8 HOLE HOOK LCP STAINLESS STEEL FEMUR BOTH IP/OP "$3,234.50" "$2,394.00" $641.97 "$3,289.48" "$1,455.53" "$1,455.53" "$1,455.53" "$1,455.53" "$3,234.50" "$3,234.50" "$3,234.50" $674.15 "$3,234.50" "$3,234.50" "$3,234.50" "$3,234.50" "$3,234.50" $674.11 "$3,234.50" "$1,315.79" "$1,594.61" "$3,234.50" "$3,289.48" "$3,234.50" "$3,234.50" "$2,425.88" "$3,234.50" "$3,234.50" "$3,234.50" "$1,617.25" "$1,617.25" "$2,561.72" "$3,234.50" "$2,587.60" "$1,455.53" $641.97 N/A "$1,876.01" "$3,234.50" "$1,940.70" "$3,234.50" $674.07 "$3,234.50" N/A N/A 242.124 SUP HCPCS C1713 242.124 - PLATE BONE 277MM 10 HOLE HOOK LCP STAINLESS STEEL PROXIMAL BOTH IP/OP "$3,400.50" "$2,516.00" $674.89 "$3,458.18" "$1,530.17" "$1,530.17" "$1,530.17" "$1,530.17" "$3,400.38" "$3,400.38" "$3,400.38" $708.72 "$3,400.38" "$3,400.38" "$3,400.38" "$3,400.38" "$3,400.38" $708.68 "$3,400.38" "$3,458.18" "$1,676.39" "$3,400.38" "$3,458.18" "$3,400.38" "$3,400.38" "$2,550.38" "$3,400.38" "$3,400.38" "$3,400.38" "$1,700.19" "$1,700.19" "$2,693.10" "$3,400.38" "$2,720.30" "$1,530.17" $674.89 N/A "$1,972.29" "$3,400.38" "$2,040.23" "$3,400.38" $708.64 "$3,400.38" N/A N/A 242.125 SUP HCPCS C1713 242.125 - PLATE BONE 313MM 12 HOLE HOOK LCP STAINLESS STEEL FEMUR BOTH IP/OP "$3,511.50" "$2,599.00" $696.93 "$3,571.13" "$1,580.14" "$1,580.14" "$1,580.14" "$1,580.14" "$3,511.43" "$3,511.43" "$3,511.43" $731.87 "$3,511.43" "$3,511.43" "$3,511.43" "$3,511.43" "$3,511.43" $731.82 "$3,511.43" "$3,571.13" "$1,731.13" "$3,511.43" "$3,571.13" "$3,511.43" "$3,511.43" "$2,633.63" "$3,511.43" "$3,511.43" "$3,511.43" "$1,755.72" "$1,755.72" "$2,781.05" "$3,511.43" "$2,809.14" "$1,580.14" $696.93 N/A "$2,036.67" "$3,511.43" "$2,106.86" "$3,511.43" $731.78 "$3,511.43" N/A N/A 242.126 SUP HCPCS C1713 242.126 - PLATE BONE 349MM 14 HOLE HOOK LCP STAINLESS STEEL FEMUR BOTH IP/OP "$3,552.50" "$2,629.00" $705.02 "$3,612.55" "$1,598.48" "$1,598.48" "$1,598.48" "$1,598.48" "$3,552.18" "$3,552.18" "$3,552.18" $740.36 "$3,552.18" "$3,552.18" "$3,552.18" "$3,552.18" "$3,552.18" $740.31 "$3,552.18" "$3,612.55" "$1,751.22" "$3,552.18" "$3,612.55" "$3,552.18" "$3,552.18" "$2,664.38" "$3,552.18" "$3,552.18" "$3,552.18" "$1,776.09" "$1,776.09" "$2,813.33" "$3,552.18" "$2,841.74" "$1,598.48" $705.02 N/A "$2,060.45" "$3,552.18" "$2,131.31" "$3,552.18" $740.27 "$3,552.18" N/A N/A 242.127 SUP HCPCS C1713 242.127 - PLATE BONE 385MM 16 HOLE HOOK LCP STAINLESS STEEL FEMUR BOTH IP/OP "$3,670.50" "$2,716.00" $728.46 "$3,732.68" "$1,651.63" "$1,651.63" "$1,651.63" "$1,651.63" "$3,670.28" "$3,670.28" "$3,670.28" $764.98 "$3,670.28" "$3,670.28" "$3,670.28" "$3,670.28" "$3,670.28" $764.93 "$3,670.28" "$3,732.68" "$1,809.45" "$3,670.28" "$3,732.68" "$3,670.28" "$3,670.28" "$2,752.88" "$3,670.28" "$3,670.28" "$3,670.28" "$1,835.14" "$1,835.14" "$2,906.86" "$3,670.28" "$2,936.22" "$1,651.63" $728.46 N/A "$2,128.89" "$3,670.28" "$2,202.17" "$3,670.28" $764.89 "$3,670.28" N/A N/A 242.128 SUP HCPCS C1713 242.128 - PLATE BONE 421MM 18 HOLE HOOK LCP STAINLESS STEEL FEMUR BOTH IP/OP "$3,788.50" "$2,803.00" $751.89 "$3,852.75" "$1,704.76" "$1,704.76" "$1,704.76" "$1,704.76" "$3,788.35" "$3,788.35" "$3,788.35" $789.59 "$3,788.35" "$3,788.35" "$3,788.35" "$3,788.35" "$3,788.35" $789.53 "$3,788.35" "$3,852.75" "$1,867.66" "$3,788.35" "$3,852.75" "$3,788.35" "$3,788.35" "$2,841.38" "$3,788.35" "$3,788.35" "$3,788.35" "$1,894.18" "$1,894.18" "$3,000.37" "$3,788.35" "$3,030.68" "$1,704.76" $751.89 N/A "$2,197.33" "$3,788.35" "$2,273.01" "$3,788.35" $789.49 "$3,788.35" N/A N/A 242.204 SUP HCPCS C1713 242.204 - PLATE BONE 41MMX2.6MM 4 HOLE LC-DCP STAINLESS STEEL FT BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $251.60 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $148.44 $247.40 $51.56 $247.40 N/A N/A 242.205 SUP HCPCS C1713 242.205 - PLATE BONE 50MM 5 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $104.65 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $257.25 $257.25 N/A N/A 242.206 SUP HCPCS C1713 242.206 - PLATE BONE 59MM 6 HOLE LC-DCP STAINLESS STEEL FT NONSTRL 2.7 BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $109.80 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $161.94 $269.90 $269.90 $269.90 N/A N/A 242.207 SUP HCPCS C1713 242.207 - PLATE BONE 68MM 7 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $281.50 $208.00 $55.80 $285.93 $126.52 $126.52 $126.52 $126.52 $281.15 $281.15 $281.15 $58.60 $281.15 $281.15 $281.15 $281.15 $281.15 $58.59 $281.15 $114.37 $166.30 $281.15 $285.93 $281.15 $281.15 $211.13 $281.15 $281.15 $281.15 $140.58 $140.58 $222.67 $281.15 $224.92 $126.52 $55.80 N/A $163.27 $281.15 $168.69 $281.15 $58.59 $281.15 N/A N/A 242.208 SUP HCPCS C1713 242.208 - PLATE BONE 77MM 8 HOLE LC-DCP STAINLESS STEEL FT NONSTRL 2.7 BOTH IP/OP $294.00 $218.00 $58.31 $298.80 $132.21 $132.21 $132.21 $132.21 $293.80 $293.80 $293.80 $61.24 $293.80 $293.80 $293.80 $293.80 $293.80 $61.23 $293.80 $298.80 $173.78 $293.80 $298.80 $293.80 $293.80 $220.50 $293.80 $293.80 $293.80 $146.90 $146.90 $232.69 $293.80 $235.04 $132.21 $58.31 N/A $170.52 $293.80 $176.28 $293.80 $61.23 $293.80 N/A N/A 242.209 SUP HCPCS C1713 242.209 - PLATE BONE 86MM 9 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $301.00 $223.00 $59.71 $305.95 $135.37 $135.37 $135.37 $135.37 $300.83 $300.83 $300.83 $62.70 $300.83 $300.83 $300.83 $300.83 $300.83 $62.70 $300.83 $305.95 $177.94 $300.83 $305.95 $300.83 $300.83 $225.75 $300.83 $300.83 $300.83 $150.42 $150.42 $238.26 $300.83 $240.66 $135.37 $59.71 N/A $174.58 $300.83 $180.50 $300.83 $62.69 $300.83 N/A N/A 242.21 SUP HCPCS C1713 242.21 - PLATE BONE 44MM 7 HOLE MULTIPLE FRAGMENT DCP STAINLESS STEEL BOTH IP/OP $127.00 $94.00 $25.19 $126.93 $57.12 $57.12 $57.12 $57.12 $126.93 $126.93 $126.93 $26.46 $126.93 $126.93 $126.93 $126.93 $126.93 $26.45 $126.93 $126.93 $75.08 $126.93 $126.93 $126.93 $126.93 $95.25 $126.93 $126.93 $126.93 $63.47 $63.47 $100.53 $126.93 $101.54 $57.12 $25.19 N/A $73.66 $126.93 $76.16 $126.93 $26.45 $126.93 N/A N/A 242.22 SUP HCPCS C1713 242.220 - PLATE BONE 95MM 10 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $308.50 $228.00 $61.22 $323.08 $138.79 $138.79 $138.79 $138.79 $308.43 $308.43 $308.43 $64.28 $308.43 $308.43 $308.43 $308.43 $308.43 $64.28 $308.43 $129.23 $182.44 $308.43 $323.08 $308.43 $308.43 $231.38 $308.43 $308.43 $308.43 $154.22 $154.22 $244.28 $308.43 $246.74 $138.79 $61.22 N/A $178.93 $308.43 $185.06 $308.43 $308.43 $308.43 N/A N/A 242.221 SUP HCPCS C1713 242.221 - PLATE BONE 104MM 11 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $332.00 $246.00 $65.84 $337.40 $149.29 $149.29 $149.29 $149.29 $331.75 $331.75 $331.75 $69.14 $331.75 $331.75 $331.75 $331.75 $331.75 $69.14 $331.75 $134.96 $196.23 $331.75 $337.40 $331.75 $331.75 $249.00 $331.75 $331.75 $331.75 $165.88 $165.88 $262.75 $331.75 $265.40 $149.29 $65.84 N/A $192.56 $331.75 $199.05 $331.75 $331.75 $331.75 N/A N/A 242.222 SUP HCPCS C1713 242.222 - PLATE BONE 113MM 12 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $344.50 $255.00 $68.35 $350.25 $154.98 $154.98 $154.98 $154.98 $344.40 $344.40 $344.40 $71.78 $344.40 $344.40 $344.40 $344.40 $344.40 $71.78 $344.40 $140.10 $203.71 $344.40 $350.25 $344.40 $344.40 $258.38 $344.40 $344.40 $344.40 $172.20 $172.20 $272.76 $344.40 $275.52 $154.98 $68.35 N/A $199.81 $344.40 $206.64 $344.40 $71.77 $344.40 N/A N/A 242.31 SUP HCPCS C1713 242.31 - PLATE BN L 32MM NS DCP 3 HLE/HD 2 HL SHFT SS FT LT 2.7MM SCR BOTH IP/OP $103.50 $77.00 $20.50 $105.05 $46.49 $46.49 $46.49 $46.49 $103.30 $103.30 $103.30 $21.53 $103.30 $103.30 $103.30 $103.30 $103.30 $21.53 $103.30 $42.02 $61.10 $103.30 $105.05 $103.30 $103.30 $77.63 $103.30 $103.30 $103.30 $51.65 $51.65 $81.81 $103.30 $82.64 $46.49 $20.50 N/A $60.03 $103.30 $61.98 $103.30 $21.53 $103.30 N/A N/A 242.32 SUP HCPCS C1713 242.32 - PLATE BONE L 32MM 2X3 HOLE DCP STAINLESS STEEL FT RIGHT BOTH IP/OP $103.50 $77.00 $20.50 $105.05 $46.49 $46.49 $46.49 $46.49 $103.30 $103.30 $103.30 $21.53 $103.30 $103.30 $103.30 $103.30 $103.30 $21.53 $103.30 $42.02 $61.10 $103.30 $105.05 $103.30 $103.30 $77.63 $103.30 $103.30 $103.30 $51.65 $51.65 $81.81 $103.30 $82.64 $46.49 $20.50 N/A $60.03 $103.30 $61.98 $103.30 $21.53 $103.30 N/A N/A 242.33 SUP HCPCS C1713 242.33 - PLATE BN OB L L 34X7X1MM NS DCP 3 HL SS 2.7MM SCR MN FRAG BOTH IP/OP $115.00 $85.00 $22.74 $116.50 $51.55 $51.55 $51.55 $51.55 $114.55 $114.55 $114.55 $23.88 $114.55 $114.55 $114.55 $114.55 $114.55 $23.87 $114.55 $116.50 $67.76 $114.55 $116.50 $114.55 $114.55 $86.25 $114.55 $114.55 $114.55 $57.28 $57.28 $90.72 $114.55 $91.64 $51.55 $22.74 N/A $66.70 $114.55 $68.73 $114.55 $23.87 $114.55 N/A N/A 242.34 SUP HCPCS C1713 242.34 - PLATE BN OB R L 34X7X1MM NS DCP 3 HL SS 2.7MM SCR MN FRAG BOTH IP/OP $115.00 $85.00 $22.74 $116.50 $51.55 $51.55 $51.55 $51.55 $114.55 $114.55 $114.55 $23.88 $114.55 $114.55 $114.55 $114.55 $114.55 $23.87 $114.55 $46.60 $67.76 $114.55 $116.50 $114.55 $114.55 $86.25 $114.55 $114.55 $114.55 $57.28 $57.28 $90.72 $114.55 $91.64 $51.55 $22.74 N/A $66.70 $114.55 $114.55 $114.55 $23.87 $114.55 N/A N/A 242.41 SUP HCPCS C1713 242.41 - PLATE BN T 32X7X1.2MM NS 3 HL SS 2.7MM SCR MN FRAG SET BOTH IP/OP $115.00 $85.00 $22.74 $116.50 $51.55 $51.55 $51.55 $51.55 $114.55 $114.55 $114.55 $23.88 $114.55 $114.55 $114.55 $114.55 $114.55 $23.87 $114.55 $116.50 $67.76 $114.55 $116.50 $114.55 $114.55 $86.25 $114.55 $114.55 $114.55 $57.28 $57.28 $90.72 $114.55 $91.64 $51.55 $22.74 N/A $66.70 $114.55 $68.73 $114.55 $23.87 $114.55 N/A N/A 242.458 SUP HCPCS C1713 242.458 - PLATE BN 48X6.3X1.6MM NS LCP 5 HLE/HD 3 HL SHFT PRECONTOUR BOTH IP/OP "$1,536.50" "$1,137.00" $304.94 "$1,562.55" $691.39 $691.39 $691.39 $691.39 "$1,536.43" "$1,536.43" "$1,536.43" $320.23 "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" $320.21 "$1,536.43" "$1,562.55" $908.80 "$1,536.43" "$1,562.55" "$1,536.43" "$1,536.43" "$1,152.38" "$1,536.43" "$1,536.43" "$1,536.43" $768.22 $768.22 "$1,216.85" "$1,536.43" "$1,229.14" $691.39 $304.94 N/A $891.17 "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" N/A N/A 242.459 SUP HCPCS C1713 242.459 - PLATE BN 66X6.3X1.6MM NS LCP 5 HLE/HD 5 HL SHFT PRECONTOUR BOTH IP/OP "$1,626.50" "$1,204.00" $322.80 "$1,654.03" $731.87 $731.87 $731.87 $731.87 "$1,626.38" "$1,626.38" "$1,626.38" $338.98 "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" $338.96 "$1,626.38" $661.61 $962.00 "$1,626.38" "$1,654.03" "$1,626.38" "$1,626.38" "$1,219.88" "$1,626.38" "$1,626.38" "$1,626.38" $813.19 $813.19 "$1,288.09" "$1,626.38" "$1,301.10" $731.87 $322.80 N/A $943.37 "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" N/A N/A 242.461 SUP HCPCS C1713 242.461 - PLATE BN 48X6.3X1.6MM NS LCP 5 HLE/HD 3 HL SHFT PRECONTOUR BOTH IP/OP "$1,536.50" "$1,137.00" $304.94 "$1,562.55" $691.39 $691.39 $691.39 $691.39 "$1,536.43" "$1,536.43" "$1,536.43" $320.23 "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" $320.21 "$1,536.43" $625.02 $908.80 "$1,536.43" "$1,562.55" "$1,536.43" "$1,536.43" "$1,152.38" "$1,536.43" "$1,536.43" "$1,536.43" $768.22 $768.22 "$1,216.85" "$1,536.43" "$1,229.14" $691.39 $304.94 N/A $891.17 "$1,536.43" $921.86 "$1,536.43" $320.19 "$1,536.43" N/A N/A 242.462 SUP HCPCS C1713 242.462 - PLATE BN 66X6.3X1.6MM NS LCP 5 HLE/HD 5 HL SHFT PRECONTOUR BOTH IP/OP "$1,626.50" "$1,204.00" $322.80 "$1,654.03" $731.87 $731.87 $731.87 $731.87 "$1,626.38" "$1,626.38" "$1,626.38" $338.98 "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" $338.96 "$1,626.38" $661.61 $962.00 "$1,626.38" "$1,654.03" "$1,626.38" "$1,626.38" "$1,219.88" "$1,626.38" "$1,626.38" "$1,626.38" $813.19 $813.19 "$1,288.09" "$1,626.38" "$1,301.10" $731.87 $322.80 N/A $943.37 "$1,626.38" $975.83 "$1,626.38" $338.94 "$1,626.38" N/A N/A 242.464 SUP HCPCS C1713 242.464 - PLATE BN 47X6.3X1.6MM NS LCP 4 HLE/HD 3 HL SHFT PRECONTOUR BOTH IP/OP "$1,536.50" "$1,137.00" $304.94 "$1,562.55" $691.39 $691.39 $691.39 $691.39 "$1,536.43" "$1,536.43" "$1,536.43" $320.23 "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" $320.21 "$1,536.43" $625.02 $908.80 "$1,536.43" "$1,562.55" "$1,536.43" "$1,536.43" "$1,152.38" "$1,536.43" "$1,536.43" "$1,536.43" $768.22 $768.22 "$1,216.85" "$1,536.43" "$1,229.14" $691.39 $304.94 N/A $891.17 "$1,536.43" "$1,536.43" "$1,536.43" $320.19 "$1,536.43" N/A N/A 242.465 SUP HCPCS C1713 242.465 - PLATE BN 65X6.3X1.6MM NS LCP 4 HLE/HD 5 HL SHFT PRECONTOUR BOTH IP/OP "$1,626.50" "$1,204.00" $322.80 "$1,654.03" $731.87 $731.87 $731.87 $731.87 "$1,626.38" "$1,626.38" "$1,626.38" $338.98 "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" $338.96 "$1,626.38" $661.61 $962.00 "$1,626.38" "$1,654.03" "$1,626.38" "$1,626.38" "$1,219.88" "$1,626.38" "$1,626.38" "$1,626.38" $813.19 $813.19 "$1,288.09" "$1,626.38" "$1,301.10" $731.87 $322.80 N/A $943.37 "$1,626.38" "$1,626.38" "$1,626.38" $338.94 "$1,626.38" N/A N/A 242.467 SUP HCPCS C1713 242.467 - PLATE BN 47X6.3X1.6MM NS LCP 4 HLE/HD 3 HL SHFT PRECONTOUR BOTH IP/OP "$1,536.50" "$1,137.00" $304.94 "$1,562.55" $691.39 $691.39 $691.39 $691.39 "$1,536.43" "$1,536.43" "$1,536.43" $320.23 "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" $320.21 "$1,536.43" $625.02 $908.80 "$1,536.43" "$1,562.55" "$1,536.43" "$1,536.43" "$1,152.38" "$1,536.43" "$1,536.43" "$1,536.43" $768.22 $768.22 "$1,216.85" "$1,536.43" "$1,229.14" $691.39 $304.94 N/A $891.17 "$1,536.43" "$1,536.43" "$1,536.43" $320.19 "$1,536.43" N/A N/A 242.468 SUP HCPCS C1713 242.468 - PLATE BN 65X6.3X1.6MM NS LCP 4 HLE/HD 5 HL SHFT PRECONTOUR BOTH IP/OP "$1,626.50" "$1,204.00" $322.80 "$1,654.03" $731.87 $731.87 $731.87 $731.87 "$1,626.38" "$1,626.38" "$1,626.38" $338.98 "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" $338.96 "$1,626.38" $661.61 $962.00 "$1,626.38" "$1,654.03" "$1,626.38" "$1,626.38" "$1,219.88" "$1,626.38" "$1,626.38" "$1,626.38" $813.19 $813.19 "$1,288.09" "$1,626.38" "$1,301.10" $731.87 $322.80 N/A $943.37 "$1,626.38" "$1,626.38" "$1,626.38" $338.94 "$1,626.38" N/A N/A 242.472 SUP HCPCS C1713 242.472 - PLATE BONE STAINLESS STEEL RIGHT DISTAL DORSAL RAD NONSTRL BOTH IP/OP "$1,868.50" "$1,383.00" $370.84 "$1,868.43" $840.79 $840.79 $840.79 $840.79 "$1,868.43" "$1,868.43" "$1,868.43" $389.43 "$1,868.43" "$1,868.43" "$1,868.43" "$1,868.43" "$1,868.43" $389.40 "$1,868.43" $747.37 "$1,105.18" "$1,868.43" "$1,868.43" "$1,868.43" "$1,868.43" "$1,401.38" "$1,868.43" "$1,868.43" "$1,868.43" $934.22 $934.22 "$1,479.80" "$1,868.43" "$1,494.74" $840.79 $370.84 N/A "$1,083.73" "$1,868.43" "$1,868.43" "$1,868.43" $389.38 "$1,868.43" N/A N/A 242.473 SUP HCPCS C1713 242.473 - PLATE BONE LCP STAINLESS STEEL RIGHT DISTAL DORSAL VOLAR RAD BOTH IP/OP "$1,542.50" "$1,141.00" $306.10 "$1,542.28" $694.03 $694.03 $694.03 $694.03 "$1,542.28" "$1,542.28" "$1,542.28" $321.45 "$1,542.28" "$1,542.28" "$1,542.28" "$1,542.28" "$1,542.28" $321.43 "$1,542.28" $616.91 $912.26 "$1,542.28" "$1,542.28" "$1,542.28" "$1,542.28" "$1,156.88" "$1,542.28" "$1,542.28" "$1,542.28" $771.14 $771.14 "$1,221.49" "$1,542.28" "$1,233.82" $694.03 $306.10 N/A $894.65 "$1,542.28" "$1,542.28" "$1,542.28" $321.41 "$1,542.28" N/A N/A 242.477 SUP HCPCS C1713 242.477 - PLATE BN T 40X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT BOTH IP/OP $877.50 $649.00 $174.09 $892.05 $394.72 $394.72 $394.72 $394.72 $877.15 $877.15 $877.15 $182.82 $877.15 $877.15 $877.15 $877.15 $877.15 $182.81 $877.15 $356.82 $518.83 $877.15 $892.05 $877.15 $877.15 $658.13 $877.15 $877.15 $877.15 $438.58 $438.58 $694.70 $877.15 $701.72 $394.72 $174.09 N/A $508.95 $877.15 $877.15 $877.15 $182.80 $877.15 N/A N/A 242.478 SUP HCPCS C1713 242.478 - PLATE BN T 49X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT BOTH IP/OP $914.00 $676.00 $181.35 $929.23 $411.17 $411.17 $411.17 $411.17 $913.70 $913.70 $913.70 $190.44 $913.70 $913.70 $913.70 $913.70 $913.70 $190.43 $913.70 $371.69 $540.45 $913.70 $929.23 $913.70 $913.70 $685.50 $913.70 $913.70 $913.70 $456.85 $456.85 $723.65 $913.70 $730.96 $411.17 $181.35 N/A $530.12 $913.70 $913.70 $913.70 $190.42 $913.70 N/A N/A 242.479 SUP HCPCS C1713 242.479 - PLATE BN STRG 48X6.3X1.6MM NS LCP CMBN 5 HL LOPRFL RND EDG BOTH IP/OP $832.50 $616.00 $165.17 $846.33 $374.48 $374.48 $374.48 $374.48 $832.18 $832.18 $832.18 $173.45 $832.18 $832.18 $832.18 $832.18 $832.18 $173.44 $832.18 $338.53 $492.23 $832.18 $846.33 $832.18 $832.18 $624.38 $832.18 $832.18 $832.18 $416.09 $416.09 $659.09 $832.18 $665.74 $374.48 $165.17 N/A $482.85 $832.18 $832.18 $832.18 $173.43 $832.18 N/A N/A 242.482 SUP HCPCS C1713 242.482 - PLATE BONE LCP STAINLESS STEEL LEFT DISTAL DORSAL VOLAR RAD BOTH IP/OP "$1,868.50" "$1,383.00" $370.84 "$1,868.43" $840.79 $840.79 $840.79 $840.79 "$1,868.43" "$1,868.43" "$1,868.43" $389.43 "$1,868.43" "$1,868.43" "$1,868.43" "$1,868.43" "$1,868.43" $389.40 "$1,868.43" $747.37 "$1,105.18" "$1,868.43" "$1,868.43" "$1,868.43" "$1,868.43" "$1,401.38" "$1,868.43" "$1,868.43" "$1,868.43" $934.22 $934.22 "$1,479.80" "$1,868.43" "$1,494.74" $840.79 $370.84 N/A "$1,083.73" "$1,868.43" "$1,868.43" "$1,868.43" $389.38 "$1,868.43" N/A N/A 242.483 SUP HCPCS C1713 242.483 - PLATE BONE LCP STAINLESS STEEL LEFT DISTAL DORSAL VOLAR RAD BOTH IP/OP "$1,542.50" "$1,141.00" $306.10 "$1,542.28" $694.03 $694.03 $694.03 $694.03 "$1,542.28" "$1,542.28" "$1,542.28" $321.45 "$1,542.28" "$1,542.28" "$1,542.28" "$1,542.28" "$1,542.28" $321.43 "$1,542.28" "$1,542.28" $912.26 "$1,542.28" "$1,542.28" "$1,542.28" "$1,542.28" "$1,156.88" "$1,542.28" "$1,542.28" "$1,542.28" $771.14 $771.14 "$1,221.49" "$1,542.28" "$1,233.82" $694.03 $306.10 N/A $894.65 "$1,542.28" "$1,542.28" "$1,542.28" $321.41 "$1,542.28" N/A N/A 242.49 SUP HCPCS C1713 242.490 - PLATE BN STRG 57X6.3X1.6MM NS LCP CMBN 6 HL LOPRFL RND EDG BOTH IP/OP $852.00 $630.00 $169.02 $892.05 $383.22 $383.22 $383.22 $383.22 $851.60 $851.60 $851.60 $177.49 $851.60 $851.60 $851.60 $851.60 $851.60 $177.48 $851.60 $892.05 $503.72 $851.60 $892.05 $851.60 $851.60 $639.00 $851.60 $851.60 $851.60 $425.80 $425.80 $674.47 $851.60 $681.28 $383.22 $169.02 N/A $494.16 $851.60 $851.60 $851.60 $177.47 $851.60 N/A N/A 242.491 SUP HCPCS C1713 242.491 - PLATE BN 43X7.5X1.6MM NS LCP CMBN 5 HLE/HD 3 HL SHFT BOTH IP/OP "$1,536.50" "$1,137.00" $304.94 "$1,562.55" $691.39 $691.39 $691.39 $691.39 "$1,536.43" "$1,536.43" "$1,536.43" $320.23 "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" $320.21 "$1,536.43" "$1,562.55" $908.80 "$1,536.43" "$1,562.55" "$1,536.43" "$1,536.43" "$1,152.38" "$1,536.43" "$1,536.43" "$1,536.43" $768.22 $768.22 "$1,216.85" "$1,536.43" "$1,229.14" $691.39 $304.94 N/A $891.17 "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" N/A N/A 242.492 SUP HCPCS C1713 242.492 - PLATE BN 61X7.5X1.6MM NS LCP CMBN 5 HLE/HD 5 HL SHFT BOTH IP/OP "$1,626.50" "$1,204.00" $322.80 "$1,654.03" $731.87 $731.87 $731.87 $731.87 "$1,626.38" "$1,626.38" "$1,626.38" $338.98 "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" $338.96 "$1,626.38" "$1,654.03" $962.00 "$1,626.38" "$1,654.03" "$1,626.38" "$1,626.38" "$1,219.88" "$1,626.38" "$1,626.38" "$1,626.38" $813.19 $813.19 "$1,288.09" "$1,626.38" "$1,301.10" $731.87 $322.80 N/A $943.37 "$1,626.38" $975.83 "$1,626.38" "$1,626.38" "$1,626.38" N/A N/A 242.493 SUP HCPCS C1713 242.493 - PLATE BN 43X7.5X1.6MM NS LCP CMBN 5 HLE/HD 3 HL SHFT BOTH IP/OP "$1,536.50" "$1,137.00" $304.94 "$1,562.55" $691.39 $691.39 $691.39 $691.39 "$1,536.43" "$1,536.43" "$1,536.43" $320.23 "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" $320.21 "$1,536.43" "$1,562.55" $908.80 "$1,536.43" "$1,562.55" "$1,536.43" "$1,536.43" "$1,152.38" "$1,536.43" "$1,536.43" "$1,536.43" $768.22 $768.22 "$1,216.85" "$1,536.43" "$1,229.14" $691.39 $304.94 N/A $891.17 "$1,536.43" $921.86 "$1,536.43" "$1,536.43" "$1,536.43" N/A N/A 242.494 SUP HCPCS C1713 242.494 - PLATE BN 61X7.5X1.6MM NS LCP CMBN 5 HLE/HD 5 HL SHFT BOTH IP/OP "$1,626.50" "$1,204.00" $322.80 "$1,654.03" $731.87 $731.87 $731.87 $731.87 "$1,626.38" "$1,626.38" "$1,626.38" $338.98 "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" $338.96 "$1,626.38" "$1,654.03" $962.00 "$1,626.38" "$1,654.03" "$1,626.38" "$1,626.38" "$1,219.88" "$1,626.38" "$1,626.38" "$1,626.38" $813.19 $813.19 "$1,288.09" "$1,626.38" "$1,301.10" $731.87 $322.80 N/A $943.37 "$1,626.38" $975.83 "$1,626.38" $338.94 "$1,626.38" N/A N/A 242.5 SUP HCPCS C1713 242.500 - PLATE BN -90D L 40X6.3X1.6MM NS LCP CMBN 2 HLE/HD 3 HL SHFT BOTH IP/OP $823.00 $609.00 $163.34 $862.03 $370.33 $370.33 $370.33 $370.33 $822.95 $822.95 $822.95 $171.52 $822.95 $822.95 $822.95 $822.95 $822.95 $171.51 $822.95 $344.81 $486.77 $822.95 $862.03 $822.95 $822.95 $617.25 $822.95 $822.95 $822.95 $411.48 $411.48 $651.78 $822.95 $658.36 $370.33 $163.34 N/A $477.34 $822.95 $822.95 $822.95 $171.50 $822.95 N/A N/A 242.501 SUP HCPCS C1713 242.501 - PLATE BN -90D L 49X6.3X1.6MM NS LCP CMBN 2 HLE/HD 4 HL SHFT BOTH IP/OP $890.00 $659.00 $176.60 $904.93 $400.41 $400.41 $400.41 $400.41 $889.80 $889.80 $889.80 $185.46 $889.80 $889.80 $889.80 $889.80 $889.80 $185.44 $889.80 $904.93 $526.32 $889.80 $904.93 $889.80 $889.80 $667.50 $889.80 $889.80 $889.80 $444.90 $444.90 $704.72 $889.80 $711.84 $400.41 $176.60 N/A $516.20 $889.80 $889.80 $889.80 $185.43 $889.80 N/A N/A 242.502 SUP HCPCS C1713 242.502 - PLATE BN +90D L 40X6.3X1.6MM NS LCP CMBN 2 HLE/HD 3 HL SHFT BOTH IP/OP $848.00 $628.00 $168.23 $862.03 $381.43 $381.43 $381.43 $381.43 $847.63 $847.63 $847.63 $176.67 $847.63 $847.63 $847.63 $847.63 $847.63 $176.66 $847.63 $344.81 $501.37 $847.63 $862.03 $847.63 $847.63 $636.00 $847.63 $847.63 $847.63 $423.82 $423.82 $671.32 $847.63 $678.10 $381.43 $168.23 N/A $491.84 $847.63 $508.58 $847.63 $176.65 $847.63 N/A N/A 242.503 SUP HCPCS C1713 242.503 - PLATE BN +90D L 49X6.3X1.6MM NS LCP CMBN 2 HLE/HD 4 HL SHFT BOTH IP/OP $890.00 $659.00 $176.60 $904.93 $400.41 $400.41 $400.41 $400.41 $889.80 $889.80 $889.80 $185.46 $889.80 $889.80 $889.80 $889.80 $889.80 $185.44 $889.80 $904.93 $526.32 $889.80 $904.93 $889.80 $889.80 $667.50 $889.80 $889.80 $889.80 $444.90 $444.90 $704.72 $889.80 $711.84 $400.41 $176.60 N/A $516.20 $889.80 $533.88 $889.80 $185.43 $889.80 N/A N/A 242.504 SUP HCPCS C1713 242.504 - PLATE BN +90D L 40X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT BOTH IP/OP $848.00 $628.00 $168.23 $862.03 $381.43 $381.43 $381.43 $381.43 $847.63 $847.63 $847.63 $176.67 $847.63 $847.63 $847.63 $847.63 $847.63 $176.66 $847.63 $344.81 $501.37 $847.63 $862.03 $847.63 $847.63 $636.00 $847.63 $847.63 $847.63 $423.82 $423.82 $671.32 $847.63 $678.10 $381.43 $168.23 N/A $491.84 $847.63 $508.58 $847.63 $176.65 $847.63 N/A N/A 242.505 SUP HCPCS C1713 242.505 - PLATE BN +90D L 49X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT BOTH IP/OP $890.00 $659.00 $176.60 $904.93 $400.41 $400.41 $400.41 $400.41 $889.80 $889.80 $889.80 $185.46 $889.80 $889.80 $889.80 $889.80 $889.80 $185.44 $889.80 $904.93 $526.32 $889.80 $904.93 $889.80 $889.80 $667.50 $889.80 $889.80 $889.80 $444.90 $444.90 $704.72 $889.80 $711.84 $400.41 $176.60 N/A $516.20 $889.80 $533.88 $889.80 $185.43 $889.80 N/A N/A 242.506 SUP HCPCS C1713 242.506 - PLATE BN -90D L 40X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT BOTH IP/OP $848.00 $628.00 $168.23 $862.03 $381.43 $381.43 $381.43 $381.43 $847.63 $847.63 $847.63 $176.67 $847.63 $847.63 $847.63 $847.63 $847.63 $176.66 $847.63 $344.81 $501.37 $847.63 $862.03 $847.63 $847.63 $636.00 $847.63 $847.63 $847.63 $423.82 $423.82 $671.32 $847.63 $678.10 $381.43 $168.23 N/A $491.84 $847.63 $508.58 $847.63 $176.65 $847.63 N/A N/A 242.507 SUP HCPCS C1713 242.507 - PLATE BN -90D L 49X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT BOTH IP/OP $890.00 $659.00 $176.60 $904.93 $400.41 $400.41 $400.41 $400.41 $889.80 $889.80 $889.80 $185.46 $889.80 $889.80 $889.80 $889.80 $889.80 $185.44 $889.80 $904.93 $526.32 $889.80 $904.93 $889.80 $889.80 $667.50 $889.80 $889.80 $889.80 $444.90 $444.90 $704.72 $889.80 $711.84 $400.41 $176.60 N/A $516.20 $889.80 $533.88 $889.80 $185.43 $889.80 N/A N/A 242.508 SUP HCPCS C1713 242.508 - PLATE BN +20D L 43X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT BOTH IP/OP $848.00 $628.00 $168.23 $862.03 $381.43 $381.43 $381.43 $381.43 $847.63 $847.63 $847.63 $176.67 $847.63 $847.63 $847.63 $847.63 $847.63 $176.66 $847.63 $344.81 $501.37 $847.63 $862.03 $847.63 $847.63 $636.00 $847.63 $847.63 $847.63 $423.82 $423.82 $671.32 $847.63 $678.10 $381.43 $168.23 N/A $491.84 $847.63 $508.58 $847.63 $176.65 $847.63 N/A N/A 242.509 SUP HCPCS C1713 242.509 - PLATE BN +20D L 52X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT BOTH IP/OP $890.00 $659.00 $176.60 $904.93 $400.41 $400.41 $400.41 $400.41 $889.80 $889.80 $889.80 $185.46 $889.80 $889.80 $889.80 $889.80 $889.80 $185.44 $889.80 $904.93 $526.32 $889.80 $904.93 $889.80 $889.80 $667.50 $889.80 $889.80 $889.80 $444.90 $444.90 $704.72 $889.80 $711.84 $400.41 $176.60 N/A $516.20 $889.80 $533.88 $889.80 $185.43 $889.80 N/A N/A 242.51 SUP HCPCS C1713 242.510 - PLATE BONE STANDARD BEND 8 HOLE FUSION LCP STAINLESS STEEL BOTH IP/OP "$1,973.50" "$1,460.00" $391.68 "$2,067.18" $888.04 $888.04 $888.04 $888.04 "$1,973.43" "$1,973.43" "$1,973.43" $411.31 "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" $411.28 "$1,973.43" $826.87 "$1,167.28" "$1,973.43" "$2,067.18" "$1,973.43" "$1,973.43" "$1,480.13" "$1,973.43" "$1,973.43" "$1,973.43" $986.72 $986.72 "$1,562.96" "$1,973.43" "$1,578.74" $888.04 $391.68 N/A "$1,144.63" "$1,973.43" "$1,184.06" "$1,973.43" $411.26 "$1,973.43" N/A N/A 242.511 SUP HCPCS C1713 242.511 - PLATE BN -20D L 43X6.3X1.6MM NS LCP CMBN 3 HLE/HD 3 HL SHFT BOTH IP/OP $848.00 $628.00 $168.23 $862.03 $381.43 $381.43 $381.43 $381.43 $847.63 $847.63 $847.63 $176.67 $847.63 $847.63 $847.63 $847.63 $847.63 $176.66 $847.63 $862.03 $501.37 $847.63 $862.03 $847.63 $847.63 $636.00 $847.63 $847.63 $847.63 $423.82 $423.82 $671.32 $847.63 $678.10 $381.43 $168.23 N/A $491.84 $847.63 $508.58 $847.63 $176.65 $847.63 N/A N/A 242.512 SUP HCPCS C1713 242.512 - PLATE BN -20D L 52X6.3X1.6MM NS LCP CMBN 3 HLE/HD 4 HL SHFT BOTH IP/OP $890.00 $659.00 $176.60 $904.93 $400.41 $400.41 $400.41 $400.41 $889.80 $889.80 $889.80 $185.46 $889.80 $889.80 $889.80 $889.80 $889.80 $185.44 $889.80 $361.97 $526.32 $889.80 $904.93 $889.80 $889.80 $667.50 $889.80 $889.80 $889.80 $444.90 $444.90 $704.72 $889.80 $711.84 $400.41 $176.60 N/A $516.20 $889.80 $533.88 $889.80 $185.43 $889.80 N/A N/A 242.52 SUP HCPCS C1713 242.520 - PLATE BONE SHORT BEND 8 HOLE STAINLESS STEEL WRIST NONSTRL BOTH IP/OP "$1,973.50" "$1,460.00" $391.68 "$2,067.18" $888.04 $888.04 $888.04 $888.04 "$1,973.43" "$1,973.43" "$1,973.43" $411.31 "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" $411.28 "$1,973.43" "$2,067.18" "$1,167.28" "$1,973.43" "$2,067.18" "$1,973.43" "$1,973.43" "$1,480.13" "$1,973.43" "$1,973.43" "$1,973.43" $986.72 $986.72 "$1,562.96" "$1,973.43" "$1,578.74" $888.04 $391.68 N/A "$1,144.63" "$1,973.43" "$1,184.06" "$1,973.43" $411.26 "$1,973.43" N/A N/A 242.53 SUP HCPCS C1713 242.530 - PLATE BONE 9 HOLE STR FUSION STAINLESS STEEL WRIST NONSTRL BOTH IP/OP "$1,973.50" "$1,460.00" $391.68 "$2,067.18" $888.04 $888.04 $888.04 $888.04 "$1,973.43" "$1,973.43" "$1,973.43" $411.31 "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" $411.28 "$1,973.43" $826.87 "$1,167.28" "$1,973.43" "$2,067.18" "$1,973.43" "$1,973.43" "$1,480.13" "$1,973.43" "$1,973.43" "$1,973.43" $986.72 $986.72 "$1,562.96" "$1,973.43" "$1,578.74" $888.04 $391.68 N/A "$1,144.63" "$1,973.43" "$1,184.06" "$1,973.43" $411.26 "$1,973.43" N/A N/A 242.535 SUP HCPCS C1713 242.535 - PLATE BN 31MMX1.2MM NS 5 HL MDLR SS HND/MDFT 2.7MM SCR BOTH IP/OP $450.00 $333.00 $89.28 $457.48 $202.42 $202.42 $202.42 $202.42 $449.83 $449.83 $449.83 $93.76 $449.83 $449.83 $449.83 $449.83 $449.83 $93.75 $449.83 $182.99 $266.07 $449.83 $457.48 $449.83 $449.83 $337.50 $449.83 $449.83 $449.83 $224.92 $224.92 $356.27 $449.83 $359.86 $202.42 $89.28 N/A $261.00 $449.83 $449.83 $449.83 $93.74 $449.83 N/A N/A 242.536 SUP HCPCS C1713 242.536 - PLATE BN 45MMX1.2MM NS 8 HL MDLR SS HND/MDFT 2.7MM SCR BOTH IP/OP $465.50 $344.00 $92.35 $473.18 $209.38 $209.38 $209.38 $209.38 $465.28 $465.28 $465.28 $96.98 $465.28 $465.28 $465.28 $465.28 $465.28 $96.97 $465.28 $473.18 $275.21 $465.28 $473.18 $465.28 $465.28 $349.13 $465.28 $465.28 $465.28 $232.64 $232.64 $368.50 $465.28 $372.22 $209.38 $92.35 N/A $269.99 $465.28 $279.17 $465.28 $96.96 $465.28 N/A N/A 242.61 SUP HCPCS C1713 242.61 - PLATE BONE 57MM 7 HOLE DCP STAINLESS STEEL CONDYLE LEFT BOTH IP/OP $533.00 $394.00 $105.74 $541.80 $239.74 $239.74 $239.74 $239.74 $532.75 $532.75 $532.75 $111.04 $532.75 $532.75 $532.75 $532.75 $532.75 $111.03 $532.75 $216.72 $315.12 $532.75 $541.80 $532.75 $532.75 $399.75 $532.75 $532.75 $532.75 $266.38 $266.38 $421.94 $532.75 $426.20 $239.74 $105.74 N/A $309.14 $532.75 $319.65 $532.75 $111.03 $532.75 N/A N/A 242.62 SUP HCPCS C1713 242.62 - PLATE BONE 57MM 7 HOLE DCP STAINLESS STEEL CONDYLE RIGHT BOTH IP/OP $533.00 $394.00 $105.74 $541.80 $239.74 $239.74 $239.74 $239.74 $532.75 $532.75 $532.75 $111.04 $532.75 $532.75 $532.75 $532.75 $532.75 $111.03 $532.75 $541.80 $315.12 $532.75 $541.80 $532.75 $532.75 $399.75 $532.75 $532.75 $532.75 $266.38 $266.38 $421.94 $532.75 $426.20 $239.74 $105.74 N/A $309.14 $532.75 $319.65 $532.75 $111.03 $532.75 N/A N/A 242.802 SUP HCPCS C1713 242.802 - PLATE BONE 139MM 2 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL BOTH IP/OP "$2,615.00" "$1,935.00" $518.93 "$2,659.05" "$1,176.57" "$1,176.57" "$1,176.57" "$1,176.57" "$2,614.60" "$2,614.60" "$2,614.60" $544.95 "$2,614.60" "$2,614.60" "$2,614.60" "$2,614.60" "$2,614.60" $544.91 "$2,614.60" "$1,063.62" "$1,289.00" "$2,614.60" "$2,659.05" "$2,614.60" "$2,614.60" "$1,961.25" "$2,614.60" "$2,614.60" "$2,614.60" "$1,307.30" "$1,307.30" "$2,070.76" "$2,614.60" "$2,091.68" "$1,176.57" $518.93 N/A "$1,516.70" "$2,614.60" "$1,568.76" "$2,614.60" $544.88 "$2,614.60" N/A N/A 242.804 SUP HCPCS C1713 242.804 - PLATE BN 175MM NS LCP CMBN 4 HL LMT CNTCT SS FEM RT PROX 4.5 BOTH IP/OP "$2,667.00" "$1,974.00" $529.25 "$2,711.93" "$1,199.97" "$1,199.97" "$1,199.97" "$1,199.97" "$2,666.60" "$2,666.60" "$2,666.60" $555.79 "$2,666.60" "$2,666.60" "$2,666.60" "$2,666.60" "$2,666.60" $555.75 "$2,666.60" "$1,084.77" "$1,314.63" "$2,666.60" "$2,711.93" "$2,666.60" "$2,666.60" "$2,000.25" "$2,666.60" "$2,666.60" "$2,666.60" "$1,333.30" "$1,333.30" "$2,111.95" "$2,666.60" "$2,133.28" "$1,199.97" $529.25 N/A "$1,546.86" "$2,666.60" "$1,599.96" "$2,666.60" $555.72 "$2,666.60" N/A N/A 242.806 SUP HCPCS C1713 242.806 - PLATE BN 211MM NS LCP CMBN 6 HL LMT CNTCT SS FEM RT PROX 4.5 BOTH IP/OP "$2,719.00" "$2,012.00" $539.57 "$2,764.83" "$1,223.37" "$1,223.37" "$1,223.37" "$1,223.37" "$2,718.60" "$2,718.60" "$2,718.60" $566.62 "$2,718.60" "$2,718.60" "$2,718.60" "$2,718.60" "$2,718.60" $566.59 "$2,718.60" "$1,105.93" "$1,340.27" "$2,718.60" "$2,764.83" "$2,718.60" "$2,718.60" "$2,039.25" "$2,718.60" "$2,718.60" "$2,718.60" "$1,359.30" "$1,359.30" "$2,153.13" "$2,718.60" "$2,174.88" "$1,223.37" $539.57 N/A "$1,577.02" "$2,718.60" "$1,631.16" "$2,718.60" $566.56 "$2,718.60" N/A N/A 242.808 SUP HCPCS C1713 242.808 - PLATE BN 247MM NS LCP CMBN 8 HL LMT CNTCT SS FEM RT PROX 4.5 BOTH IP/OP "$2,852.50" "$2,111.00" $566.08 "$2,900.63" "$1,283.47" "$1,283.47" "$1,283.47" "$1,283.47" "$2,852.15" "$2,852.15" "$2,852.15" $594.46 "$2,852.15" "$2,852.15" "$2,852.15" "$2,852.15" "$2,852.15" $594.42 "$2,852.15" "$1,160.25" "$1,406.11" "$2,852.15" "$2,900.63" "$2,852.15" "$2,852.15" "$2,139.38" "$2,852.15" "$2,852.15" "$2,852.15" "$1,426.08" "$1,426.08" "$2,258.90" "$2,852.15" "$2,281.72" "$1,283.47" $566.08 N/A "$1,654.45" "$2,852.15" "$1,711.29" "$2,852.15" $594.39 "$2,852.15" N/A N/A 242.81 SUP HCPCS C1713 242.810 - PLATE BONE 283MM 10 HOLE LCP STAINLESS STEEL FEMUR RIGHT BOTH IP/OP "$2,967.00" "$2,196.00" $588.87 "$3,107.93" "$1,335.14" "$1,335.14" "$1,335.14" "$1,335.14" "$2,966.98" "$2,966.98" "$2,966.98" $618.39 "$2,966.98" "$2,966.98" "$2,966.98" "$2,966.98" "$2,966.98" $618.35 "$2,966.98" "$1,243.17" "$1,462.72" "$2,966.98" "$3,107.93" "$2,966.98" "$2,966.98" "$2,225.25" "$2,966.98" "$2,966.98" "$2,966.98" "$1,483.49" "$1,483.49" "$2,349.85" "$2,966.98" "$2,373.58" "$1,335.14" $588.87 N/A "$1,720.86" "$2,966.98" "$2,966.98" "$2,966.98" $618.32 "$2,966.98" N/A N/A 242.812 SUP HCPCS C1713 242.812 - PLATE BN 319MM NS LCP CMBN 12 HL LMT CNTCT SS FEM RT PROX BOTH IP/OP "$3,236.00" "$2,395.00" $642.25 "$3,290.90" "$1,456.16" "$1,456.16" "$1,456.16" "$1,456.16" "$3,235.90" "$3,235.90" "$3,235.90" $674.44 "$3,235.90" "$3,235.90" "$3,235.90" "$3,235.90" "$3,235.90" $674.40 "$3,235.90" "$1,316.36" "$1,595.30" "$3,235.90" "$3,290.90" "$3,235.90" "$3,235.90" "$2,427.00" "$3,235.90" "$3,235.90" "$3,235.90" "$1,617.95" "$1,617.95" "$2,562.83" "$3,235.90" "$2,588.72" "$1,456.16" $642.25 N/A "$1,876.88" "$3,235.90" "$1,941.54" "$3,235.90" $674.36 "$3,235.90" N/A N/A 242.814 SUP HCPCS C1713 242.814 - PLATE BN 355MM NS LCP CMBN 14 HL LMT CNTCT SS FEM RT PROX BOTH IP/OP "$3,496.00" "$2,587.00" $693.86 "$3,555.38" "$1,573.18" "$1,573.18" "$1,573.18" "$1,573.18" "$3,495.95" "$3,495.95" "$3,495.95" $728.64 "$3,495.95" "$3,495.95" "$3,495.95" "$3,495.95" "$3,495.95" $728.59 "$3,495.95" "$1,422.15" "$1,723.50" "$3,495.95" "$3,555.38" "$3,495.95" "$3,495.95" "$2,622.00" "$3,495.95" "$3,495.95" "$3,495.95" "$1,747.98" "$1,747.98" "$2,768.79" "$3,495.95" "$2,796.76" "$1,573.18" $693.86 N/A "$2,027.68" "$3,495.95" "$2,097.57" "$3,495.95" $728.56 "$3,495.95" N/A N/A 242.816 SUP HCPCS C1713 242.816 - PLATE BN 391MM NS LCP CMBN 16 HL LMT CNTCT SS FEM RT PROX BOTH IP/OP "$3,601.50" "$2,665.00" $714.78 "$3,662.60" "$1,620.62" "$1,620.62" "$1,620.62" "$1,620.62" "$3,601.38" "$3,601.38" "$3,601.38" $750.62 "$3,601.38" "$3,601.38" "$3,601.38" "$3,601.38" "$3,601.38" $750.57 "$3,601.38" "$1,465.04" "$1,775.48" "$3,601.38" "$3,662.60" "$3,601.38" "$3,601.38" "$2,701.13" "$3,601.38" "$3,601.38" "$3,601.38" "$1,800.69" "$1,800.69" "$2,852.29" "$3,601.38" "$2,881.10" "$1,620.62" $714.78 N/A "$2,088.87" "$3,601.38" "$2,160.83" "$3,601.38" $750.53 "$3,601.38" N/A N/A 243.091 SUP HCPCS C1713 243.091 - PLATE BONE STR 12 HOLE ADAPTION STAINLESS STEEL HAND NONSTRL BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 243.13 SUP HCPCS C1713 243.13 - PLATE BONE STR 17X5X1MM 3 HOLE DCP STAINLESS STEEL FT BOTH IP/OP $103.50 $77.00 $20.50 $105.05 $46.49 $46.49 $46.49 $46.49 $103.30 $103.30 $103.30 $21.53 $103.30 $103.30 $103.30 $103.30 $103.30 $21.53 $103.30 $105.05 $61.10 $103.30 $105.05 $103.30 $103.30 $77.63 $103.30 $103.30 $103.30 $51.65 $51.65 $81.81 $103.30 $82.64 $46.49 $20.50 N/A $60.03 $103.30 $103.30 $103.30 $21.53 $103.30 N/A N/A 243.14 SUP HCPCS C1713 243.14 - PLATE BONE STR 23X5X1MM 4 HOLE DCP STAINLESS STEEL FT BOTH IP/OP $114.00 $84.00 $22.60 $115.78 $51.23 $51.23 $51.23 $51.23 $113.85 $113.85 $113.85 $23.73 $113.85 $113.85 $113.85 $113.85 $113.85 $23.73 $113.85 $115.78 $67.34 $113.85 $115.78 $113.85 $113.85 $85.50 $113.85 $113.85 $113.85 $56.93 $56.93 $90.17 $113.85 $91.08 $51.23 $22.60 N/A $66.12 $113.85 $68.31 $113.85 $23.73 $113.85 N/A N/A 243.15 SUP HCPCS C1713 243.15 - PLATE BONE STR 29X5X1MM 5 HOLE DCP STAINLESS STEEL FT BOTH IP/OP $122.00 $90.00 $24.13 $123.65 $54.71 $54.71 $54.71 $54.71 $121.58 $121.58 $121.58 $25.34 $121.58 $121.58 $121.58 $121.58 $121.58 $25.34 $121.58 $123.65 $71.91 $121.58 $123.65 $121.58 $121.58 $91.50 $121.58 $121.58 $121.58 $60.79 $60.79 $96.29 $121.58 $97.26 $54.71 $24.13 N/A $70.76 $121.58 $72.95 $121.58 $25.34 $121.58 N/A N/A 243.16 SUP HCPCS C1713 243.16 - PLATE BN STRG 35X5X1MM NS 6 HL SS 2MM SCR MN FRAG SET BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $139.38 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 243.19 SUP HCPCS C1713 243.19 - PLATE BONE 2MM 100MM 20 HOLE DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $420.50 $311.00 $83.42 $427.45 $189.14 $189.14 $189.14 $189.14 $420.30 $420.30 $420.30 $87.60 $420.30 $420.30 $420.30 $420.30 $420.30 $87.60 $420.30 $170.98 $248.61 $420.30 $427.45 $420.30 $420.30 $315.38 $420.30 $420.30 $420.30 $210.15 $210.15 $332.88 $420.30 $336.24 $189.14 $83.42 N/A $243.89 $420.30 $420.30 $420.30 $87.59 $420.30 N/A N/A 243.23 SUP HCPCS C1713 243.23 - PLATE BONE 2MM 12 HOLE T DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $166.95 $166.95 $166.95 $166.95 $371.00 $371.00 $371.00 $77.33 $371.00 $371.00 $371.00 $371.00 $371.00 $77.32 $371.00 $148.40 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $166.95 $73.63 N/A $215.18 $371.00 $222.60 $371.00 $77.32 $371.00 N/A N/A 243.234 SUP HCPCS C1713 243.234 - PLATE BN T 65MMX1.2MM NS DCP 3 HLE/HD 10 HL SHFT SS FT 2MM BOTH IP/OP $462.50 $342.00 $91.79 $470.33 $208.12 $208.12 $208.12 $208.12 $462.48 $462.48 $462.48 $96.39 $462.48 $462.48 $462.48 $462.48 $462.48 $96.39 $462.48 $470.33 $273.56 $462.48 $470.33 $462.48 $462.48 $346.88 $462.48 $462.48 $462.48 $231.24 $231.24 $366.28 $462.48 $369.98 $208.12 $91.79 N/A $268.25 $462.48 $277.49 $462.48 $96.38 $462.48 N/A N/A 243.24 SUP HCPCS C1713 243.24 - PLATE BONE 2MM 50MM T 4 HOLE HEAD 9 HOLE SHAFT DCP STAINLESS BOTH IP/OP $394.00 $292.00 $78.12 $400.30 $177.12 $177.12 $177.12 $177.12 $393.60 $393.60 $393.60 $82.04 $393.60 $393.60 $393.60 $393.60 $393.60 $82.03 $393.60 $160.12 $232.81 $393.60 $400.30 $393.60 $393.60 $295.50 $393.60 $393.60 $393.60 $196.80 $196.80 $311.73 $393.60 $314.88 $177.12 $78.12 N/A $228.52 $393.60 $236.16 $393.60 $82.03 $393.60 N/A N/A 243.31 SUP HCPCS C1713 243.31 - PLATE BONE L 17X5X1MM 2 HOLE OBLIQUE DCP STAINLESS STEEL BOTH IP/OP $104.00 $77.00 $20.59 $103.73 $46.68 $46.68 $46.68 $46.68 $103.73 $103.73 $103.73 $21.62 $103.73 $103.73 $103.73 $103.73 $103.73 $21.62 $103.73 $103.73 $61.36 $103.73 $103.73 $103.73 $103.73 $78.00 $103.73 $103.73 $103.73 $51.87 $51.87 $82.15 $103.73 $82.98 $46.68 $20.59 N/A $60.32 $103.73 $103.73 $103.73 $21.62 $103.73 N/A N/A 243.32 SUP HCPCS C1713 243.32 - PLATE BONE L 17X5X1MM 2 HOLE OBLIQUE DCP STAINLESS STEEL BOTH IP/OP $104.00 $77.00 $20.59 $103.73 $46.68 $46.68 $46.68 $46.68 $103.73 $103.73 $103.73 $21.62 $103.73 $103.73 $103.73 $103.73 $103.73 $21.62 $103.73 $41.49 $61.36 $103.73 $103.73 $103.73 $103.73 $78.00 $103.73 $103.73 $103.73 $51.87 $51.87 $82.15 $103.73 $82.98 $46.68 $20.59 N/A $60.32 $103.73 $103.73 $103.73 $21.62 $103.73 N/A N/A 243.33 SUP HCPCS C1713 243.33 - PLATE BN OB L L 19X5X1MM NS DCP 2 HL SS 2MM SCR MN FRAG SET BOTH IP/OP $103.50 $77.00 $20.50 $105.05 $46.49 $46.49 $46.49 $46.49 $103.30 $103.30 $103.30 $21.53 $103.30 $103.30 $103.30 $103.30 $103.30 $21.53 $103.30 $105.05 $61.10 $103.30 $105.05 $103.30 $103.30 $77.63 $103.30 $103.30 $103.30 $51.65 $51.65 $81.81 $103.30 $82.64 $46.49 $20.50 N/A $60.03 $103.30 $103.30 $103.30 $21.53 $103.30 N/A N/A 243.34 SUP HCPCS C1713 243.34 - PLATE BN OB R L 19X5X1MM NS DCP 2 HL SS 2MM SCR MN FRAG SET BOTH IP/OP $103.50 $77.00 $20.50 $105.05 $46.49 $46.49 $46.49 $46.49 $103.30 $103.30 $103.30 $21.53 $103.30 $103.30 $103.30 $103.30 $103.30 $21.53 $103.30 $42.02 $61.10 $103.30 $105.05 $103.30 $103.30 $77.63 $103.30 $103.30 $103.30 $51.65 $51.65 $81.81 $103.30 $82.64 $46.49 $20.50 N/A $60.03 $103.30 $103.30 $103.30 $21.53 $103.30 N/A N/A 243.41 SUP HCPCS C1713 243.41 - PLATE BONE T 18MM 2X2 HOLE DCP STAINLESS STEEL FT NONSTRL BOTH IP/OP $103.50 $77.00 $20.50 $105.05 $46.49 $46.49 $46.49 $46.49 $103.30 $103.30 $103.30 $21.53 $103.30 $103.30 $103.30 $103.30 $103.30 $21.53 $103.30 $105.05 $61.10 $103.30 $105.05 $103.30 $103.30 $77.63 $103.30 $103.30 $103.30 $51.65 $51.65 $81.81 $103.30 $82.64 $46.49 $20.50 N/A $60.03 $103.30 $61.98 $103.30 $21.53 $103.30 N/A N/A 243.48 SUP HCPCS C1713 243.48 - PLATE BONE H 6MM 4 HOLE DCP STAINLESS STEEL FT NONSTRL MINI BOTH IP/OP $302.00 $223.00 $59.86 $301.60 $135.72 $135.72 $135.72 $135.72 $301.60 $301.60 $301.60 $62.86 $301.60 $301.60 $301.60 $301.60 $301.60 $62.86 $301.60 $120.64 $178.40 $301.60 $301.60 $301.60 $301.60 $226.50 $301.60 $301.60 $301.60 $150.80 $150.80 $238.87 $301.60 $241.28 $135.72 $59.86 N/A $175.16 $301.60 $301.60 $301.60 $62.85 $301.60 N/A N/A 243.54 SUP HCPCS C1713 243.54 - PLATE BONE 2MM 22MM 4 HOLE DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $306.00 $226.00 $60.67 $305.70 $137.57 $137.57 $137.57 $137.57 $305.70 $305.70 $305.70 $63.72 $305.70 $305.70 $305.70 $305.70 $305.70 $63.71 $305.70 $305.70 $180.82 $305.70 $305.70 $305.70 $305.70 $229.50 $305.70 $305.70 $305.70 $152.85 $152.85 $242.11 $305.70 $244.56 $137.57 $60.67 N/A $177.48 $305.70 $183.42 $305.70 $63.71 $305.70 N/A N/A 243.55 SUP HCPCS C1713 243.55 - PLATE BONE 27X5MM 5 HOLE DCP STAINLESS STEEL NONSTRL 2MM BOTH IP/OP $317.00 $235.00 $62.84 $316.63 $142.48 $142.48 $142.48 $142.48 $316.63 $316.63 $316.63 $65.99 $316.63 $316.63 $316.63 $316.63 $316.63 $65.99 $316.63 $316.63 $187.29 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $142.48 $62.84 N/A $183.86 $316.63 $189.98 $316.63 $65.99 $316.63 N/A N/A 243.56 SUP HCPCS C1713 243.56 - PLATE BONE 32MM 2MM 6 HOLE DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $330.50 $245.00 $65.55 $330.28 $148.63 $148.63 $148.63 $148.63 $330.28 $330.28 $330.28 $68.84 $330.28 $330.28 $330.28 $330.28 $330.28 $68.83 $330.28 $330.28 $195.36 $330.28 $330.28 $330.28 $330.28 $247.88 $330.28 $330.28 $330.28 $165.14 $165.14 $261.58 $330.28 $264.22 $148.63 $65.55 N/A $191.69 $330.28 $198.17 $330.28 $68.83 $330.28 N/A N/A 243.57 SUP HCPCS C1713 243.57 - PLATE BONE 2MM 37MM 7 HOLE RECONSTRUCTION DCP STAINLESS BOTH IP/OP $348.00 $258.00 $69.07 $348.00 $156.60 $156.60 $156.60 $156.60 $348.00 $348.00 $348.00 $72.53 $348.00 $348.00 $348.00 $348.00 $348.00 $72.53 $348.00 $348.00 $205.84 $348.00 $348.00 $348.00 $348.00 $261.00 $348.00 $348.00 $348.00 $174.00 $174.00 $275.62 $348.00 $278.40 $156.60 $69.07 N/A $201.84 $348.00 $208.80 $348.00 $72.52 $348.00 N/A N/A 243.58 SUP HCPCS C1713 243.58 - PLATE BONE 2MM 42MM 8 HOLE DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $358.00 $265.00 $70.97 $357.58 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $357.58 $211.51 $357.58 $357.58 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $357.58 $357.58 $74.52 $357.58 N/A N/A 243.584 SUP HCPCS C1713 243.584 - PLATE BN 27MMX1.2MM NS LC DCP 4 HL SS 2MM SCR MDLR HND SYS BOTH IP/OP $395.00 $292.00 $78.40 $401.73 $177.75 $177.75 $177.75 $177.75 $395.00 $395.00 $395.00 $82.33 $395.00 $395.00 $395.00 $395.00 $395.00 $82.32 $395.00 $160.69 $233.64 $395.00 $401.73 $395.00 $395.00 $296.25 $395.00 $395.00 $395.00 $197.50 $197.50 $312.84 $395.00 $316.00 $177.75 $78.40 N/A $229.10 $395.00 $395.00 $395.00 $82.32 $395.00 N/A N/A 243.585 SUP HCPCS C1713 243.585 - PLATE BONE 33MM 5 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $420.50 $311.00 $83.42 $427.45 $189.14 $189.14 $189.14 $189.14 $420.30 $420.30 $420.30 $87.60 $420.30 $420.30 $420.30 $420.30 $420.30 $87.60 $420.30 $427.45 $248.61 $420.30 $427.45 $420.30 $420.30 $315.38 $420.30 $420.30 $420.30 $210.15 $210.15 $332.88 $420.30 $336.24 $189.14 $83.42 N/A $243.89 $420.30 $252.18 $420.30 $87.59 $420.30 N/A N/A 243.586 SUP HCPCS C1713 243.586 - PLATE BN 39MMX1.2MM NS LC DCP 6 HL SS 2MM SCR MDLR HND SYS BOTH IP/OP $464.00 $343.00 $92.07 $471.75 $208.75 $208.75 $208.75 $208.75 $463.88 $463.88 $463.88 $96.68 $463.88 $463.88 $463.88 $463.88 $463.88 $96.68 $463.88 $188.70 $274.39 $463.88 $471.75 $463.88 $463.88 $348.00 $463.88 $463.88 $463.88 $231.94 $231.94 $367.39 $463.88 $371.10 $208.75 $92.07 N/A $269.12 $463.88 $278.33 $463.88 $96.67 $463.88 N/A N/A 243.587 SUP HCPCS C1713 243.587 - PLATE BONE 45MM 7 HOLE LC-DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $496.50 $367.00 $98.48 $504.63 $223.29 $223.29 $223.29 $223.29 $496.20 $496.20 $496.20 $103.42 $496.20 $496.20 $496.20 $496.20 $496.20 $103.41 $496.20 $504.63 $293.50 $496.20 $504.63 $496.20 $496.20 $372.38 $496.20 $496.20 $496.20 $248.10 $248.10 $392.99 $496.20 $396.96 $223.29 $98.48 N/A $287.97 $496.20 $297.72 $496.20 $103.41 $496.20 N/A N/A 243.588 SUP HCPCS C1713 243.588 - PLATE BN 51MMX1.2MM NS LC DCP 8 HL SS 2MM SCR MDLR HND SYS BOTH IP/OP $531.50 $393.00 $105.46 $540.38 $239.11 $239.11 $239.11 $239.11 $531.35 $531.35 $531.35 $110.75 $531.35 $531.35 $531.35 $531.35 $531.35 $110.74 $531.35 $540.38 $314.29 $531.35 $540.38 $531.35 $531.35 $398.63 $531.35 $531.35 $531.35 $265.68 $265.68 $420.83 $531.35 $425.08 $239.11 $105.46 N/A $308.27 $531.35 $318.81 $531.35 $110.73 $531.35 N/A N/A 243.61 SUP HCPCS C1713 243.61 - PLATE BN 39X5X1.2MM NS DCP 7 HL SS CNDYL LT 2MM SCR BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 243.62 SUP HCPCS C1713 243.62 - PLATE BN 39X5X1.2MM NS DCP 7 HL SS CNDYL RT 2MM SCR BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 244.02 SUP HCPCS C1713 244.02 - PLATE BONE 20MM 2 HOLE DCP STAINLESS STEEL NONSTRL 2.7MM BOTH IP/OP $218.50 $162.00 $43.34 $218.35 $98.26 $98.26 $98.26 $98.26 $218.35 $218.35 $218.35 $45.51 $218.35 $218.35 $218.35 $218.35 $218.35 $45.51 $218.35 $218.35 $129.15 $218.35 $218.35 $218.35 $218.35 $163.88 $218.35 $218.35 $218.35 $109.18 $109.18 $172.93 $218.35 $174.68 $98.26 $43.34 N/A $126.73 $218.35 $131.01 $218.35 $45.50 $218.35 N/A N/A 244.04 SUP HCPCS C1713 244.04 - PLATE BN 36X8X2MM NS DCP 4 HL SS 2.7MM SCR MN FRAG SET BOTH IP/OP $246.00 $182.00 $48.76 $245.65 $110.54 $110.54 $110.54 $110.54 $245.65 $245.65 $245.65 $51.20 $245.65 $245.65 $245.65 $245.65 $245.65 $51.20 $245.65 $245.65 $145.30 $245.65 $245.65 $245.65 $245.65 $184.50 $245.65 $245.65 $245.65 $122.83 $122.83 $194.55 $245.65 $196.52 $110.54 $48.76 N/A $142.68 $245.65 $147.39 $245.65 $51.19 $245.65 N/A N/A 244.05 SUP HCPCS C1713 244.05 - PLATE BONE 44X8X2MM 5 HOLE DCP STAINLESS STEEL NONSTRL 2.7MM BOTH IP/OP $280.00 $207.00 $55.53 $279.78 $125.90 $125.90 $125.90 $125.90 $279.78 $279.78 $279.78 $58.31 $279.78 $279.78 $279.78 $279.78 $279.78 $58.31 $279.78 $279.78 $165.49 $279.78 $279.78 $279.78 $279.78 $210.00 $279.78 $279.78 $279.78 $139.89 $139.89 $221.59 $279.78 $223.82 $125.90 $55.53 N/A $162.40 $279.78 $167.87 $279.78 $58.31 $279.78 N/A N/A 244.06 SUP HCPCS C1713 244.06 - PLATE BONE 52X8X2MM 6 HOLE DCP STAINLESS STEEL NONSTRL 2.7MM BOTH IP/OP $303.00 $224.00 $60.13 $302.98 $136.34 $136.34 $136.34 $136.34 $302.98 $302.98 $302.98 $63.15 $302.98 $302.98 $302.98 $302.98 $302.98 $63.14 $302.98 $302.98 $179.21 $302.98 $302.98 $302.98 $302.98 $227.25 $302.98 $302.98 $302.98 $151.49 $151.49 $239.96 $302.98 $242.38 $136.34 $60.13 N/A $175.74 $302.98 $181.79 $302.98 $63.14 $302.98 N/A N/A 244.07 SUP HCPCS C1713 244.07 - PLATE BN 60X8X2.5MM NS DCP 7 HL SS 2.7MM SCR MN FRAG SET BOTH IP/OP $347.00 $257.00 $68.80 $346.65 $155.99 $155.99 $155.99 $155.99 $346.65 $346.65 $346.65 $72.25 $346.65 $346.65 $346.65 $346.65 $346.65 $72.25 $346.65 $138.66 $205.04 $346.65 $346.65 $346.65 $346.65 $260.25 $346.65 $346.65 $346.65 $173.33 $173.33 $274.55 $346.65 $277.32 $155.99 $68.80 N/A $201.26 $346.65 $207.99 $346.65 $72.24 $346.65 N/A N/A 244.08 SUP HCPCS C1713 244.08 - PLATE BONE 68X8X2.5MM 8 HOLE DCP STAINLESS STEEL NONSTRL 2.7 BOTH IP/OP $385.00 $285.00 $76.38 $384.85 $173.18 $173.18 $173.18 $173.18 $384.85 $384.85 $384.85 $80.21 $384.85 $384.85 $384.85 $384.85 $384.85 $80.21 $384.85 $384.85 $227.64 $384.85 $384.85 $384.85 $384.85 $288.75 $384.85 $384.85 $384.85 $192.43 $192.43 $304.80 $384.85 $307.88 $173.18 $76.38 N/A $223.30 $384.85 $230.91 $384.85 $80.20 $384.85 N/A N/A 244.09 SUP HCPCS C1713 244.09 - PLATE BN 76X8X2.5MM NS DCP 9 HL SS 2.7MM SCR MN FRAG SET BOTH IP/OP $400.00 $296.00 $79.37 $399.88 $179.95 $179.95 $179.95 $179.95 $399.88 $399.88 $399.88 $83.34 $399.88 $399.88 $399.88 $399.88 $399.88 $83.34 $399.88 $399.88 $236.53 $399.88 $399.88 $399.88 $399.88 $300.00 $399.88 $399.88 $399.88 $199.94 $199.94 $316.70 $399.88 $319.90 $179.95 $79.37 N/A $232.00 $399.88 $239.93 $399.88 $83.33 $399.88 N/A N/A 244.1 SUP HCPCS C1713 244.10 - PLATE BONE 84X8X2.5MM 10 HOLE DCP STAINLESS STEEL FT NONSTRL BOTH IP/OP $444.00 $329.00 $88.03 $443.55 $199.60 $199.60 $199.60 $199.60 $443.55 $443.55 $443.55 $92.45 $443.55 $443.55 $443.55 $443.55 $443.55 $92.44 $443.55 $443.55 $262.36 $443.55 $443.55 $443.55 $443.55 $333.00 $443.55 $443.55 $443.55 $221.78 $221.78 $351.29 $443.55 $354.84 $199.60 $88.03 N/A $257.52 $443.55 $443.55 $443.55 $92.44 $443.55 N/A N/A 244.12 SUP HCPCS C1713 244.12 - PLATE BONE 100X8X2.5MM 12MM 12 HOLE DCP STAINLESS STEEL BOTH IP/OP $499.50 $370.00 $99.14 $499.50 $224.78 $224.78 $224.78 $224.78 $499.50 $499.50 $499.50 $104.11 $499.50 $499.50 $499.50 $499.50 $499.50 $104.10 $499.50 $499.50 $295.45 $499.50 $499.50 $499.50 $499.50 $374.63 $499.50 $499.50 $499.50 $249.75 $249.75 $395.60 $499.50 $399.60 $224.78 $99.14 N/A $289.71 $499.50 $299.70 $499.50 $104.10 $499.50 N/A N/A 244.22 SUP HCPCS C1713 244.22 - PLATE BONE 2.7MM 26MM 2 HOLE DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $259.50 $192.00 $51.46 $259.30 $116.69 $116.69 $116.69 $116.69 $259.30 $259.30 $259.30 $54.04 $259.30 $259.30 $259.30 $259.30 $259.30 $54.04 $259.30 $259.30 $153.38 $259.30 $259.30 $259.30 $259.30 $194.63 $259.30 $259.30 $259.30 $129.65 $129.65 $205.37 $259.30 $207.44 $116.69 $51.46 N/A $150.51 $259.30 $155.58 $259.30 $54.04 $259.30 N/A N/A 245 SUP HCPCS C1713 245.00 - PLATE BONE STR 118MM 10 HOLE RECONSTRUCTION LC-DCP STAINLESS BOTH IP/OP $813.50 $602.00 $161.44 $852.05 $366.03 $366.03 $366.03 $366.03 $813.40 $813.40 $813.40 $169.53 $813.40 $813.40 $813.40 $813.40 $813.40 $169.52 $813.40 $852.05 $481.13 $813.40 $852.05 $813.40 $813.40 $610.13 $813.40 $813.40 $813.40 $406.70 $406.70 $644.21 $813.40 $650.72 $366.03 $161.44 N/A $471.83 $813.40 $813.40 $813.40 $169.51 $813.40 N/A N/A 245.01 SUP HCPCS C1713 245.01 - PLATE BONE 130MM 11 HOLE RECONSTRUCTION LC-DCP STAINLESS BOTH IP/OP $880.00 $651.00 $174.65 $894.93 $395.99 $395.99 $395.99 $395.99 $879.98 $879.98 $879.98 $183.41 $879.98 $879.98 $879.98 $879.98 $879.98 $183.40 $879.98 $357.97 $520.51 $879.98 $894.93 $879.98 $879.98 $660.00 $879.98 $879.98 $879.98 $439.99 $439.99 $696.94 $879.98 $703.98 $395.99 $174.65 N/A $510.40 $879.98 $527.99 $879.98 $183.39 $879.98 N/A N/A 245.02 SUP HCPCS C1713 245.02 - PLATE BONE STR 142MM 12 HOLE RECONSTRUCTION LC-DCP STAINLESS BOTH IP/OP $918.00 $679.00 $182.19 $933.53 $413.07 $413.07 $413.07 $413.07 $917.93 $917.93 $917.93 $191.32 $917.93 $917.93 $917.93 $917.93 $917.93 $191.31 $917.93 $933.53 $542.96 $917.93 $933.53 $917.93 $917.93 $688.50 $917.93 $917.93 $917.93 $458.97 $458.97 $727.00 $917.93 $734.34 $413.07 $182.19 N/A $532.44 $917.93 $550.76 $917.93 $191.30 $917.93 N/A N/A 245.023 SUP HCPCS C1713 245.023 - PLATE BN STRG 39X10.2X2.7MM NS LC DCP 3 HL LOPRFL RECON SS BOTH IP/OP $607.50 $450.00 $120.52 $617.58 $273.26 $273.26 $273.26 $273.26 $607.25 $607.25 $607.25 $126.57 $607.25 $607.25 $607.25 $607.25 $607.25 $126.56 $607.25 $247.03 $359.19 $607.25 $617.58 $607.25 $607.25 $455.63 $607.25 $607.25 $607.25 $303.63 $303.63 $480.94 $607.25 $485.80 $273.26 $120.52 N/A $352.35 $607.25 $364.35 $607.25 $126.55 $607.25 N/A N/A 245.024 SUP HCPCS C1713 245.024 - PLATE BONE 52X10.2X2.7MM 4 HOLE LP STAINLESS STEEL CALCANEUS BOTH IP/OP $635.50 $470.00 $126.11 $646.18 $285.92 $285.92 $285.92 $285.92 $635.38 $635.38 $635.38 $132.43 $635.38 $635.38 $635.38 $635.38 $635.38 $132.42 $635.38 $646.18 $375.83 $635.38 $646.18 $635.38 $635.38 $476.63 $635.38 $635.38 $635.38 $317.69 $317.69 $503.22 $635.38 $508.30 $285.92 $126.11 N/A $368.59 $635.38 $381.23 $635.38 $132.41 $635.38 N/A N/A 245.025 SUP HCPCS C1713 245.025 - PLATE BN STRG 65X10.2X2.7MM NS LC DCP 5 HL LOPRFL RECON SS BOTH IP/OP $662.50 $490.00 $131.41 $673.33 $297.94 $297.94 $297.94 $297.94 $662.08 $662.08 $662.08 $137.99 $662.08 $662.08 $662.08 $662.08 $662.08 $137.98 $662.08 $673.33 $391.62 $662.08 $673.33 $662.08 $662.08 $496.88 $662.08 $662.08 $662.08 $331.04 $331.04 $524.37 $662.08 $529.66 $297.94 $131.41 N/A $384.25 $662.08 $397.25 $662.08 $137.98 $662.08 N/A N/A 245.026 SUP HCPCS C1713 245.026 - PLATE BONE 78X10.2X2.7MM 6 HOLE LP RECONSTRUCTION STAINLESS BOTH IP/OP $734.00 $543.00 $145.64 $746.25 $330.20 $330.20 $330.20 $330.20 $733.78 $733.78 $733.78 $152.94 $733.78 $733.78 $733.78 $733.78 $733.78 $152.93 $733.78 $746.25 $434.03 $733.78 $746.25 $733.78 $733.78 $550.50 $733.78 $733.78 $733.78 $366.89 $366.89 $581.15 $733.78 $587.02 $330.20 $145.64 N/A $425.72 $733.78 $440.27 $733.78 $152.92 $733.78 N/A N/A 245.027 SUP HCPCS C1713 245.027 - PLATE BONE 91X10.2X2.7MM 7 HOLE LP RECONSTRUCTION STAINLESS BOTH IP/OP $770.50 $570.00 $152.89 $783.43 $346.65 $346.65 $346.65 $346.65 $770.33 $770.33 $770.33 $160.56 $770.33 $770.33 $770.33 $770.33 $770.33 $160.55 $770.33 $313.37 $455.65 $770.33 $783.43 $770.33 $770.33 $577.88 $770.33 $770.33 $770.33 $385.17 $385.17 $610.10 $770.33 $616.26 $346.65 $152.89 N/A $446.89 $770.33 $462.20 $770.33 $160.54 $770.33 N/A N/A 245.028 SUP HCPCS C1713 245.028 - PLATE BN STRG 104X10.2X2.7MM NS LC DCP 8 HL LOPRFL RECON SS BOTH IP/OP $801.50 $593.00 $159.03 $814.88 $360.56 $360.56 $360.56 $360.56 $801.25 $801.25 $801.25 $167.00 $801.25 $801.25 $801.25 $801.25 $801.25 $166.99 $801.25 $814.88 $473.94 $801.25 $814.88 $801.25 $801.25 $601.13 $801.25 $801.25 $801.25 $400.63 $400.63 $634.59 $801.25 $641.00 $360.56 $159.03 N/A $464.87 $801.25 $480.75 $801.25 $166.98 $801.25 N/A N/A 245.029 SUP HCPCS C1713 245.029 - PLATE BONE 11.7X1.02X.27CM 9 HOLE LP RECONSTRUCTION BOTH IP/OP $822.50 $609.00 $163.21 $836.30 $370.05 $370.05 $370.05 $370.05 $822.33 $822.33 $822.33 $171.39 $822.33 $822.33 $822.33 $822.33 $822.33 $171.38 $822.33 $334.52 $486.41 $822.33 $836.30 $822.33 $822.33 $616.88 $822.33 $822.33 $822.33 $411.17 $411.17 $651.29 $822.33 $657.86 $370.05 $163.21 N/A $477.05 $822.33 $822.33 $822.33 $171.37 $822.33 N/A N/A 245.03 SUP HCPCS C1713 245.030 - PLATE BONE 130MM 10 HOLE LP STAINLESS STEEL PELVIC NONSTRL BOTH IP/OP $827.00 $612.00 $164.05 $840.60 $371.95 $371.95 $371.95 $371.95 $826.55 $826.55 $826.55 $172.27 $826.55 $826.55 $826.55 $826.55 $826.55 $172.26 $826.55 $840.60 $488.90 $826.55 $840.60 $826.55 $826.55 $620.25 $826.55 $826.55 $826.55 $413.28 $413.28 $654.63 $826.55 $661.24 $371.95 $164.05 N/A $479.66 $826.55 $495.93 $826.55 $172.25 $826.55 N/A N/A 245.03 SUP HCPCS C1713 245.03 - PLATE BN 154MM NS LC DCP 13 HL RECON SS 3.5MM SCR SM FRAG BOTH IP/OP $960.50 $711.00 $164.05 $840.60 $371.95 $371.95 $371.95 $371.95 $826.55 $826.55 $826.55 $172.27 $826.55 $826.55 $826.55 $826.55 $826.55 $172.26 $826.55 $840.60 $488.90 $826.55 $840.60 $826.55 $826.55 $720.38 $826.55 $826.55 $826.55 $413.28 $413.28 $654.63 $826.55 $661.24 $371.95 $164.05 N/A $557.09 $826.55 $495.93 $826.55 $172.25 $826.55 N/A N/A 245.031 SUP HCPCS C1713 245.031 - PLATE BONE 143MM 11 HOLE LP RECONSTRUCTION STAINLESS STEEL BOTH IP/OP $873.00 $646.00 $173.25 $887.78 $392.82 $392.82 $392.82 $392.82 $872.93 $872.93 $872.93 $181.94 $872.93 $872.93 $872.93 $872.93 $872.93 $181.93 $872.93 $887.78 $516.34 $872.93 $887.78 $872.93 $872.93 $654.75 $872.93 $872.93 $872.93 $436.47 $436.47 $691.36 $872.93 $698.34 $392.82 $173.25 N/A $506.34 $872.93 $872.93 $872.93 $181.92 $872.93 N/A N/A 245.032 SUP HCPCS C1713 245.032 - PLATE BN STRG 156X10.2X2.7MM NS LC DCP 12 HL LOPRFL RECON SS BOTH IP/OP $907.00 $671.00 $179.95 $922.10 $408.01 $408.01 $408.01 $408.01 $906.68 $906.68 $906.68 $188.97 $906.68 $906.68 $906.68 $906.68 $906.68 $188.96 $906.68 $368.84 $536.30 $906.68 $922.10 $906.68 $906.68 $680.25 $906.68 $906.68 $906.68 $453.34 $453.34 $718.09 $906.68 $725.34 $408.01 $179.95 N/A $526.06 $906.68 $544.01 $906.68 $188.95 $906.68 N/A N/A 245.033 SUP HCPCS C1713 245.033 - PLATE BONE 169MM 13 HOLE LP RECONSTRUCTION STAINLESS STEEL BOTH IP/OP $950.50 $703.00 $188.60 $966.40 $427.61 $427.61 $427.61 $427.61 $950.25 $950.25 $950.25 $198.06 $950.25 $950.25 $950.25 $950.25 $950.25 $198.04 $950.25 $966.40 $562.07 $950.25 $966.40 $950.25 $950.25 $712.88 $950.25 $950.25 $950.25 $475.13 $475.13 $752.60 $950.25 $760.20 $427.61 $188.60 N/A $551.29 $950.25 $570.15 $950.25 $198.03 $950.25 N/A N/A 245.034 SUP HCPCS C1713 245.034 - PLATE BONE 182MM 14 HOLE LP RECONSTRUCTION STAINLESS STEEL BOTH IP/OP $985.50 $729.00 $195.58 "$1,002.15" $443.43 $443.43 $443.43 $443.43 $985.40 $985.40 $985.40 $205.38 $985.40 $985.40 $985.40 $985.40 $985.40 $205.37 $985.40 $400.86 $582.86 $985.40 "$1,002.15" $985.40 $985.40 $739.13 $985.40 $985.40 $985.40 $492.70 $492.70 $780.44 $985.40 $788.32 $443.43 $195.58 N/A $571.59 $985.40 $591.24 $985.40 $985.40 $985.40 N/A N/A 245.035 SUP HCPCS C1713 245.035 - PLATE BONE 195MM 15 HOLE LP RECONSTRUCTION STAINLESS STEEL BOTH IP/OP "$1,035.00" $766.00 $205.34 "$1,052.20" $465.57 $465.57 $465.57 $465.57 "$1,034.60" "$1,034.60" "$1,034.60" $215.64 "$1,034.60" "$1,034.60" "$1,034.60" "$1,034.60" "$1,034.60" $215.62 "$1,034.60" "$1,052.20" $611.97 "$1,034.60" "$1,052.20" "$1,034.60" "$1,034.60" $776.25 "$1,034.60" "$1,034.60" "$1,034.60" $517.30 $517.30 $819.40 "$1,034.60" $827.68 $465.57 $205.34 N/A $600.30 "$1,034.60" $620.76 "$1,034.60" $215.61 "$1,034.60" N/A N/A 245.036 SUP HCPCS C1713 245.036 - PLATE BONE 208MM 16 HOLE LP RECONSTRUCTION STAINLESS STEEL BOTH IP/OP "$1,081.00" $800.00 $214.55 "$1,099.35" $486.44 $486.44 $486.44 $486.44 "$1,080.98" "$1,080.98" "$1,080.98" $225.30 "$1,080.98" "$1,080.98" "$1,080.98" "$1,080.98" "$1,080.98" $225.29 "$1,080.98" $439.74 $639.40 "$1,080.98" "$1,099.35" "$1,080.98" "$1,080.98" $810.75 "$1,080.98" "$1,080.98" "$1,080.98" $540.49 $540.49 $856.14 "$1,080.98" $864.78 $486.44 $214.55 N/A $626.98 "$1,080.98" $648.59 "$1,080.98" $225.28 "$1,080.98" N/A N/A 245.038 SUP HCPCS C1713 245.038 - PLATE BONE 234MM 18 HOLE LP RECONSTRUCTION STAINLESS STEEL BOTH IP/OP "$1,127.50" $834.00 $223.76 "$1,146.55" $507.32 $507.32 $507.32 $507.32 "$1,127.38" "$1,127.38" "$1,127.38" $234.97 "$1,127.38" "$1,127.38" "$1,127.38" "$1,127.38" "$1,127.38" $234.96 "$1,127.38" "$1,146.55" $666.85 "$1,127.38" "$1,146.55" "$1,127.38" "$1,127.38" $845.63 "$1,127.38" "$1,127.38" "$1,127.38" $563.69 $563.69 $892.88 "$1,127.38" $901.90 $507.32 $223.76 N/A $653.95 "$1,127.38" $676.43 "$1,127.38" $234.95 "$1,127.38" N/A N/A 245.039 SUP HCPCS C1713 245.039 - PLATE BONE 260MM 20 HOLE LP RECONSTRUCTION STAINLESS STEEL BOTH IP/OP "$1,354.00" "$1,002.00" $268.67 "$1,376.68" $609.16 $609.16 $609.16 $609.16 "$1,353.68" "$1,353.68" "$1,353.68" $282.14 "$1,353.68" "$1,353.68" "$1,353.68" "$1,353.68" "$1,353.68" $282.12 "$1,353.68" "$1,376.68" $800.70 "$1,353.68" "$1,376.68" "$1,353.68" "$1,353.68" "$1,015.50" "$1,353.68" "$1,353.68" "$1,353.68" $676.84 $676.84 "$1,072.11" "$1,353.68" "$1,082.94" $609.16 $268.67 N/A $785.32 "$1,353.68" $812.21 "$1,353.68" $282.11 "$1,353.68" N/A N/A 245.04 SUP HCPCS C1713 245.04 - PLATE BONE 3.5MM 166MM 14 HOLE RECONSTRUCTION LC-DCP BOTH IP/OP $997.00 $738.00 $197.81 "$1,013.58" $448.48 $448.48 $448.48 $448.48 $996.63 $996.63 $996.63 $207.72 $996.63 $996.63 $996.63 $996.63 $996.63 $207.71 $996.63 "$1,013.58" $589.51 $996.63 "$1,013.58" $996.63 $996.63 $747.75 $996.63 $996.63 $996.63 $498.32 $498.32 $789.33 $996.63 $797.30 $448.48 $197.81 N/A $578.26 $996.63 $597.98 $996.63 $207.70 $996.63 N/A N/A 245.041 SUP HCPCS C1713 245.041 - PLATE BN 56MM NS LCP 4 HL RECON SS 3.5MM SCR SM FRAG SYS BOTH IP/OP $828.00 $613.00 $164.33 $842.03 $372.58 $372.58 $372.58 $372.58 $827.95 $827.95 $827.95 $172.57 $827.95 $827.95 $827.95 $827.95 $827.95 $172.55 $827.95 $842.03 $489.73 $827.95 $842.03 $827.95 $827.95 $621.00 $827.95 $827.95 $827.95 $413.98 $413.98 $655.74 $827.95 $662.36 $372.58 $164.33 N/A $480.24 $827.95 $827.95 $827.95 $172.54 $827.95 N/A N/A 245.05 SUP HCPCS C1713 245.05 - PLATE BONE 3.5MM 178MM 15 HOLE RECONSTRUCTION DCP LC-DCP BOTH IP/OP "$1,035.00" $766.00 $205.34 "$1,052.20" $465.57 $465.57 $465.57 $465.57 "$1,034.60" "$1,034.60" "$1,034.60" $215.64 "$1,034.60" "$1,034.60" "$1,034.60" "$1,034.60" "$1,034.60" $215.62 "$1,034.60" $420.88 $611.97 "$1,034.60" "$1,052.20" "$1,034.60" "$1,034.60" $776.25 "$1,034.60" "$1,034.60" "$1,034.60" $517.30 $517.30 $819.40 "$1,034.60" $827.68 $465.57 $205.34 N/A $600.30 "$1,034.60" $620.76 "$1,034.60" $215.61 "$1,034.60" N/A N/A 245.051 SUP HCPCS C1713 245.051 - PLATE BONE STR 70X10.1X3.5MM 5 HOLE RECONSTRUCTION LCP BOTH IP/OP $810.00 $599.00 $160.70 $823.45 $364.36 $364.36 $364.36 $364.36 $809.68 $809.68 $809.68 $168.76 $809.68 $809.68 $809.68 $809.68 $809.68 $168.75 $809.68 $823.45 $478.93 $809.68 $823.45 $809.68 $809.68 $607.50 $809.68 $809.68 $809.68 $404.84 $404.84 $641.27 $809.68 $647.74 $364.36 $160.70 N/A $469.80 $809.68 $485.81 $809.68 $168.74 $809.68 N/A N/A 245.06 SUP HCPCS C1713 245.06 - PLATE BN 190MM NS LC DCP 16 HL RECON SS 3.5MM SCR SM FRAG BOTH IP/OP "$1,080.00" $799.00 $214.27 "$1,097.93" $485.81 $485.81 $485.81 $485.81 "$1,079.58" "$1,079.58" "$1,079.58" $225.01 "$1,079.58" "$1,079.58" "$1,079.58" "$1,079.58" "$1,079.58" $225.00 "$1,079.58" "$1,097.93" $638.57 "$1,079.58" "$1,097.93" "$1,079.58" "$1,079.58" $810.00 "$1,079.58" "$1,079.58" "$1,079.58" $539.79 $539.79 $855.03 "$1,079.58" $863.66 $485.81 $214.27 N/A $626.40 "$1,079.58" $647.75 "$1,079.58" $224.98 "$1,079.58" N/A N/A 245.061 SUP HCPCS C1713 245.061 - PLATE BONE STR 84X10.1X3.5MM 6 HOLE RECONSTRUCTION LCP BOTH IP/OP $936.50 $693.00 $185.81 $952.13 $421.29 $421.29 $421.29 $421.29 $936.20 $936.20 $936.20 $195.13 $936.20 $936.20 $936.20 $936.20 $936.20 $195.11 $936.20 $952.13 $553.76 $936.20 $952.13 $936.20 $936.20 $702.38 $936.20 $936.20 $936.20 $468.10 $468.10 $741.47 $936.20 $748.96 $421.29 $185.81 N/A $543.17 $936.20 $936.20 $936.20 $195.10 $936.20 N/A N/A 245.071 SUP HCPCS C1713 245.071 - PLATE BONE STR 98X10.1X3.5MM 7 HOLE RECONSTRUCTION LCP BOTH IP/OP $983.00 $727.00 $195.02 $999.28 $442.16 $442.16 $442.16 $442.16 $982.58 $982.58 $982.58 $204.79 $982.58 $982.58 $982.58 $982.58 $982.58 $204.78 $982.58 $999.28 $581.20 $982.58 $999.28 $982.58 $982.58 $737.25 $982.58 $982.58 $982.58 $491.29 $491.29 $778.20 $982.58 $786.06 $442.16 $195.02 N/A $570.14 $982.58 $589.55 $982.58 $204.77 $982.58 N/A N/A 245.08 SUP HCPCS C1713 245.08 - PLATE BONE STR 214MM 18 HOLE RECONSTRUCTION LC-DCP STAINLESS BOTH IP/OP "$1,129.00" $835.00 $224.03 "$1,147.98" $507.95 $507.95 $507.95 $507.95 "$1,128.78" "$1,128.78" "$1,128.78" $235.27 "$1,128.78" "$1,128.78" "$1,128.78" "$1,128.78" "$1,128.78" $235.25 "$1,128.78" $459.19 $667.67 "$1,128.78" "$1,147.98" "$1,128.78" "$1,128.78" $846.75 "$1,128.78" "$1,128.78" "$1,128.78" $564.39 $564.39 $893.99 "$1,128.78" $903.02 $507.95 $224.03 N/A $654.82 "$1,128.78" $677.27 "$1,128.78" $235.24 "$1,128.78" N/A N/A 245.081 SUP HCPCS C1713 245.081 - PLATE BONE STR 112X10.1X3.5MM 8 HOLE RECONSTRUCTION LCP BOTH IP/OP "$1,025.00" $759.00 $203.39 "$1,042.18" $461.14 $461.14 $461.14 $461.14 "$1,024.75" "$1,024.75" "$1,024.75" $213.58 "$1,024.75" "$1,024.75" "$1,024.75" "$1,024.75" "$1,024.75" $213.57 "$1,024.75" "$1,042.18" $606.14 "$1,024.75" "$1,042.18" "$1,024.75" "$1,024.75" $768.75 "$1,024.75" "$1,024.75" "$1,024.75" $512.38 $512.38 $811.60 "$1,024.75" $819.80 $461.14 $203.39 N/A $594.50 "$1,024.75" $614.85 "$1,024.75" $213.56 "$1,024.75" N/A N/A 245.091 SUP HCPCS C1713 245.091 - PLATE BN 126X10.1X3.5MM NS LCP CMBN 9 HL RECON SS 3.5MM SCR BOTH IP/OP "$1,080.00" $799.00 $214.27 "$1,097.93" $485.81 $485.81 $485.81 $485.81 "$1,079.58" "$1,079.58" "$1,079.58" $225.01 "$1,079.58" "$1,079.58" "$1,079.58" "$1,079.58" "$1,079.58" $225.00 "$1,079.58" "$1,097.93" $638.57 "$1,079.58" "$1,097.93" "$1,079.58" "$1,079.58" $810.00 "$1,079.58" "$1,079.58" "$1,079.58" $539.79 $539.79 $855.03 "$1,079.58" $863.66 $485.81 $214.27 N/A $626.40 "$1,079.58" "$1,079.58" "$1,079.58" $224.98 "$1,079.58" N/A N/A 245.1 SUP HCPCS C1713 245.10 - PLATE BN 238MM NS LC DCP 20 HL RECON SS 3.5MM SCR SM FRAG BOTH IP/OP "$1,329.50" $984.00 $263.83 "$1,392.43" $598.18 $598.18 $598.18 $598.18 "$1,329.28" "$1,329.28" "$1,329.28" $277.06 "$1,329.28" "$1,329.28" "$1,329.28" "$1,329.28" "$1,329.28" $277.04 "$1,329.28" $556.97 $786.27 "$1,329.28" "$1,392.43" "$1,329.28" "$1,329.28" $997.13 "$1,329.28" "$1,329.28" "$1,329.28" $664.64 $664.64 "$1,052.79" "$1,329.28" "$1,063.42" $598.18 $263.83 N/A $771.11 "$1,329.28" $797.57 "$1,329.28" $277.02 "$1,329.28" N/A N/A 245.101 SUP HCPCS C1713 245.101 - PLATE BONE STR 140X10.1X3.5MM 10 HOLE RECONSTRUCTION LCP BOTH IP/OP "$1,063.00" $787.00 $210.92 "$1,080.78" $478.22 $478.22 $478.22 $478.22 "$1,062.70" "$1,062.70" "$1,062.70" $221.49 "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" $221.48 "$1,062.70" $432.31 $628.59 "$1,062.70" "$1,080.78" "$1,062.70" "$1,062.70" $797.25 "$1,062.70" "$1,062.70" "$1,062.70" $531.35 $531.35 $841.66 "$1,062.70" $850.16 $478.22 $210.92 N/A $616.54 "$1,062.70" $637.62 "$1,062.70" $221.47 "$1,062.70" N/A N/A 245.111 SUP HCPCS C1713 245.111 - PLATE BN 154X10.1X3.5MM NS LCP CMBN 11 HL SHFT RECON SS 3.5 BOTH IP/OP "$1,150.00" $851.00 $228.22 "$1,169.40" $517.43 $517.43 $517.43 $517.43 "$1,149.85" "$1,149.85" "$1,149.85" $239.66 "$1,149.85" "$1,149.85" "$1,149.85" "$1,149.85" "$1,149.85" $239.64 "$1,149.85" "$1,169.40" $680.14 "$1,149.85" "$1,169.40" "$1,149.85" "$1,149.85" $862.50 "$1,149.85" "$1,149.85" "$1,149.85" $574.93 $574.93 $910.68 "$1,149.85" $919.88 $517.43 $228.22 N/A $667.00 "$1,149.85" $689.91 "$1,149.85" $239.63 "$1,149.85" N/A N/A 245.12 SUP HCPCS C1713 245.12 - PLATE BONE STR 3.5MM 263MM 22 HOLE RECONSTRUCTION LC-DCP BOTH IP/OP "$1,425.50" "$1,055.00" $282.90 "$1,449.60" $641.42 $641.42 $641.42 $641.42 "$1,425.38" "$1,425.38" "$1,425.38" $297.08 "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" $297.06 "$1,425.38" $579.84 $843.11 "$1,425.38" "$1,449.60" "$1,425.38" "$1,425.38" "$1,069.13" "$1,425.38" "$1,425.38" "$1,425.38" $712.69 $712.69 "$1,128.90" "$1,425.38" "$1,140.30" $641.42 $282.90 N/A $826.79 "$1,425.38" $855.23 "$1,425.38" $297.05 "$1,425.38" N/A N/A 245.121 SUP HCPCS C1713 245.121 - PLATE BONE STR 168X10.1X3.5MM 12 HOLE RECONSTRUCTION LCP BOTH IP/OP "$1,177.00" $871.00 $233.52 "$1,196.58" $529.46 $529.46 $529.46 $529.46 "$1,176.58" "$1,176.58" "$1,176.58" $245.23 "$1,176.58" "$1,176.58" "$1,176.58" "$1,176.58" "$1,176.58" $245.21 "$1,176.58" "$1,196.58" $695.95 "$1,176.58" "$1,196.58" "$1,176.58" "$1,176.58" $882.75 "$1,176.58" "$1,176.58" "$1,176.58" $588.29 $588.29 $931.85 "$1,176.58" $941.26 $529.46 $233.52 N/A $682.66 "$1,176.58" $705.95 "$1,176.58" $245.20 "$1,176.58" N/A N/A 245.131 SUP HCPCS C1713 245.131 - PLATE BONE STR 182X10.1X3.5MM 13 HOLE RECONSTRUCTION LCP BOTH IP/OP "$1,274.00" $943.00 $252.77 "$1,295.20" $573.10 $573.10 $573.10 $573.10 "$1,273.55" "$1,273.55" "$1,273.55" $265.44 "$1,273.55" "$1,273.55" "$1,273.55" "$1,273.55" "$1,273.55" $265.42 "$1,273.55" "$1,295.20" $753.30 "$1,273.55" "$1,295.20" "$1,273.55" "$1,273.55" $955.50 "$1,273.55" "$1,273.55" "$1,273.55" $636.78 $636.78 "$1,008.65" "$1,273.55" "$1,018.84" $573.10 $252.77 N/A $738.92 "$1,273.55" $764.13 "$1,273.55" $265.41 "$1,273.55" N/A N/A 245.14 SUP HCPCS C1713 245.14 - PLATE BONE STR 46X10.1X3.5MM 4 HOLE RECONSTRUCTION LC-DCP BOTH IP/OP $635.50 $470.00 $126.11 $646.18 $285.92 $285.92 $285.92 $285.92 $635.38 $635.38 $635.38 $132.43 $635.38 $635.38 $635.38 $635.38 $635.38 $132.42 $635.38 $646.18 $375.83 $635.38 $646.18 $635.38 $635.38 $476.63 $635.38 $635.38 $635.38 $317.69 $317.69 $503.22 $635.38 $508.30 $285.92 $126.11 N/A $368.59 $635.38 $381.23 $635.38 $132.41 $635.38 N/A N/A 245.141 SUP HCPCS C1713 245.141 - PLATE BONE STR 196X10.1X3.5MM 14 HOLE RECONSTRUCTION LCP BOTH IP/OP "$1,323.00" $979.00 $262.53 "$1,345.23" $595.24 $595.24 $595.24 $595.24 "$1,322.75" "$1,322.75" "$1,322.75" $275.69 "$1,322.75" "$1,322.75" "$1,322.75" "$1,322.75" "$1,322.75" $275.68 "$1,322.75" "$1,345.23" $782.41 "$1,322.75" "$1,345.23" "$1,322.75" "$1,322.75" $992.25 "$1,322.75" "$1,322.75" "$1,322.75" $661.38 $661.38 "$1,047.62" "$1,322.75" "$1,058.20" $595.24 $262.53 N/A $767.34 "$1,322.75" $793.65 "$1,322.75" $275.66 "$1,322.75" N/A N/A 245.15 SUP HCPCS C1713 245.15 - PLATE BONE STR 58MM 5 HOLE RECONSTRUCTION LC-DCP STAINLESS BOTH IP/OP $647.00 $479.00 $128.34 $657.63 $290.98 $290.98 $290.98 $290.98 $646.63 $646.63 $646.63 $134.77 $646.63 $646.63 $646.63 $646.63 $646.63 $134.76 $646.63 $657.63 $382.48 $646.63 $657.63 $646.63 $646.63 $485.25 $646.63 $646.63 $646.63 $323.32 $323.32 $512.13 $646.63 $517.30 $290.98 $128.34 N/A $375.26 $646.63 $387.98 $646.63 $134.76 $646.63 N/A N/A 245.16 SUP HCPCS C1713 245.16 - PLATE BONE STR 70MM 6 HOLE RECONSTRUCTION LC-DCP STAINLESS BOTH IP/OP $742.50 $549.00 $147.31 $754.83 $333.99 $333.99 $333.99 $333.99 $742.20 $742.20 $742.20 $154.69 $742.20 $742.20 $742.20 $742.20 $742.20 $154.68 $742.20 $754.83 $439.01 $742.20 $754.83 $742.20 $742.20 $556.88 $742.20 $742.20 $742.20 $371.10 $371.10 $587.82 $742.20 $593.76 $333.99 $147.31 N/A $430.65 $742.20 $445.32 $742.20 $154.67 $742.20 N/A N/A 245.161 SUP HCPCS C1713 245.161 - PLATE BONE STR 224X10.1X3.5MM 16 HOLE RECONSTRUCTION LCP BOTH IP/OP "$1,434.00" "$1,061.00" $284.57 "$1,458.18" $645.21 $645.21 $645.21 $645.21 "$1,433.80" "$1,433.80" "$1,433.80" $298.84 "$1,433.80" "$1,433.80" "$1,433.80" "$1,433.80" "$1,433.80" $298.82 "$1,433.80" "$1,458.18" $848.09 "$1,433.80" "$1,458.18" "$1,433.80" "$1,433.80" "$1,075.50" "$1,433.80" "$1,433.80" "$1,433.80" $716.90 $716.90 "$1,135.57" "$1,433.80" "$1,147.04" $645.21 $284.57 N/A $831.72 "$1,433.80" $860.28 "$1,433.80" $298.80 "$1,433.80" N/A N/A 245.17 SUP HCPCS C1713 245.17 - PLATE BONE STR 82MM 7 HOLE RECONSTRUCTION LC-DCP STAINLESS BOTH IP/OP $779.00 $576.00 $154.56 $792.00 $350.44 $350.44 $350.44 $350.44 $778.75 $778.75 $778.75 $162.31 $778.75 $778.75 $778.75 $778.75 $778.75 $162.30 $778.75 $792.00 $460.63 $778.75 $792.00 $778.75 $778.75 $584.25 $778.75 $778.75 $778.75 $389.38 $389.38 $616.77 $778.75 $623.00 $350.44 $154.56 N/A $451.82 $778.75 $467.25 $778.75 $162.29 $778.75 N/A N/A 245.18 SUP HCPCS C1713 245.18 - PLATE BONE STR 94MM 8 HOLE RECONSTRUCTION LC-DCP STAINLESS BOTH IP/OP $811.50 $601.00 $160.98 $824.88 $364.99 $364.99 $364.99 $364.99 $811.08 $811.08 $811.08 $169.05 $811.08 $811.08 $811.08 $811.08 $811.08 $169.04 $811.08 $824.88 $479.75 $811.08 $824.88 $811.08 $811.08 $608.63 $811.08 $811.08 $811.08 $405.54 $405.54 $642.38 $811.08 $648.86 $364.99 $160.98 N/A $470.67 $811.08 $486.65 $811.08 $169.03 $811.08 N/A N/A 245.181 SUP HCPCS C1713 245.181 - PLATE BONE STR 252X10.1X3.5MM 18 HOLE RECONSTRUCTION LCP BOTH IP/OP "$1,501.50" "$1,111.00" $297.97 "$1,526.80" $675.58 $675.58 $675.58 $675.58 "$1,501.28" "$1,501.28" "$1,501.28" $312.90 "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" $312.88 "$1,501.28" $610.72 $888.01 "$1,501.28" "$1,526.80" "$1,501.28" "$1,501.28" "$1,126.13" "$1,501.28" "$1,501.28" "$1,501.28" $750.64 $750.64 "$1,189.01" "$1,501.28" "$1,201.02" $675.58 $297.97 N/A $870.87 "$1,501.28" $900.77 "$1,501.28" $312.87 "$1,501.28" N/A N/A 245.19 SUP HCPCS C1713 245.19 - PLATE BN 106MM NS LC DCP 9 HL RECON SS 3.5MM SCR SM FRAG SET BOTH IP/OP $831.00 $615.00 $164.89 $844.90 $373.85 $373.85 $373.85 $373.85 $830.78 $830.78 $830.78 $173.16 $830.78 $830.78 $830.78 $830.78 $830.78 $173.14 $830.78 $844.90 $491.41 $830.78 $844.90 $830.78 $830.78 $623.25 $830.78 $830.78 $830.78 $415.39 $415.39 $657.98 $830.78 $664.62 $373.85 $164.89 N/A $481.98 $830.78 $830.78 $830.78 $173.13 $830.78 N/A N/A 245.2 SUP HCPCS C1713 245.20 - PLATE BN 48X8X3.3MM NS 6 HL RECON 2.7MM SCR BOTH IP/OP $560.00 $414.00 $111.06 $586.13 $251.80 $251.80 $251.80 $251.80 $559.55 $559.55 $559.55 $116.62 $559.55 $559.55 $559.55 $559.55 $559.55 $116.62 $559.55 $586.13 $330.97 $559.55 $586.13 $559.55 $559.55 $420.00 $559.55 $559.55 $559.55 $279.78 $279.78 $443.16 $559.55 $447.64 $251.80 $111.06 N/A $324.80 $559.55 $559.55 $559.55 $116.61 $559.55 N/A N/A 245.201 SUP HCPCS C1713 245.201 - PLATE BONE STR 280X10.1X3.5MM 20 HOLE RECONSTRUCTION LCP BOTH IP/OP "$1,823.50" "$1,349.00" $361.86 "$1,854.18" $820.43 $820.43 $820.43 $820.43 "$1,823.18" "$1,823.18" "$1,823.18" $380.00 "$1,823.18" "$1,823.18" "$1,823.18" "$1,823.18" "$1,823.18" $379.97 "$1,823.18" "$1,854.18" "$1,078.41" "$1,823.18" "$1,854.18" "$1,823.18" "$1,823.18" "$1,367.63" "$1,823.18" "$1,823.18" "$1,823.18" $911.59 $911.59 "$1,443.96" "$1,823.18" "$1,458.54" $820.43 $361.86 N/A "$1,057.63" "$1,823.18" "$1,093.91" "$1,823.18" $379.95 "$1,823.18" N/A N/A 245.21 SUP HCPCS C1713 245.21 - PLATE BN 64X8X3.3MM NS 8 HL RECON 2.7MM SCR BOTH IP/OP $597.50 $442.00 $118.57 $607.58 $268.84 $268.84 $268.84 $268.84 $597.43 $597.43 $597.43 $124.52 $597.43 $597.43 $597.43 $597.43 $597.43 $124.51 $597.43 $607.58 $353.38 $597.43 $607.58 $597.43 $597.43 $448.13 $597.43 $597.43 $597.43 $298.72 $298.72 $473.16 $597.43 $477.94 $268.84 $118.57 N/A $346.55 $597.43 $358.46 $597.43 $124.50 $597.43 N/A N/A 245.22 SUP HCPCS C1713 245.22 - PLATE BN 80X8X3.3MM NS 10 HL RECON 2.7MM SCR BOTH IP/OP $638.50 $472.00 $126.66 $649.03 $287.18 $287.18 $287.18 $287.18 $638.18 $638.18 $638.18 $133.01 $638.18 $638.18 $638.18 $638.18 $638.18 $133.00 $638.18 $649.03 $377.48 $638.18 $649.03 $638.18 $638.18 $478.88 $638.18 $638.18 $638.18 $319.09 $319.09 $505.44 $638.18 $510.54 $287.18 $126.66 N/A $370.33 $638.18 $382.91 $638.18 $133.00 $638.18 N/A N/A 245.221 SUP HCPCS C1713 245.221 - PLATE BN 308X10.1X3.5MM NS LCP CMBN 22 HL RECON SS 3.5MM SCR BOTH IP/OP "$1,893.50" "$1,401.00" $375.81 "$1,925.68" $852.07 $852.07 $852.07 $852.07 "$1,893.48" "$1,893.48" "$1,893.48" $394.65 "$1,893.48" "$1,893.48" "$1,893.48" "$1,893.48" "$1,893.48" $394.62 "$1,893.48" "$1,925.68" "$1,119.99" "$1,893.48" "$1,925.68" "$1,893.48" "$1,893.48" "$1,420.13" "$1,893.48" "$1,893.48" "$1,893.48" $946.74 $946.74 "$1,499.64" "$1,893.48" "$1,514.78" $852.07 $375.81 N/A "$1,098.23" "$1,893.48" "$1,136.09" "$1,893.48" $394.60 "$1,893.48" N/A N/A 245.23 SUP HCPCS C1713 245.23 - PLATE BONE STR 96MM 12 HOLE RECONSTRUCTION LCP STAINLESS BOTH IP/OP $762.00 $564.00 $151.21 $774.83 $342.85 $342.85 $342.85 $342.85 $761.88 $761.88 $761.88 $158.79 $761.88 $761.88 $761.88 $761.88 $761.88 $158.78 $761.88 $774.83 $450.65 $761.88 $774.83 $761.88 $761.88 $571.50 $761.88 $761.88 $761.88 $380.94 $380.94 $603.41 $761.88 $609.50 $342.85 $151.21 N/A $441.96 $761.88 $457.13 $761.88 $158.78 $761.88 N/A N/A 245.24 SUP HCPCS C1713 245.24 - PLATE BN 112X8X3.3MM NS 14 HL RECON 2.7MM SCR BOTH IP/OP $811.50 $601.00 $160.98 $824.88 $364.99 $364.99 $364.99 $364.99 $811.08 $811.08 $811.08 $169.05 $811.08 $811.08 $811.08 $811.08 $811.08 $169.04 $811.08 $824.88 $479.75 $811.08 $824.88 $811.08 $811.08 $608.63 $811.08 $811.08 $811.08 $405.54 $405.54 $642.38 $811.08 $648.86 $364.99 $160.98 N/A $470.67 $811.08 $486.65 $811.08 $169.03 $811.08 N/A N/A 245.25 SUP HCPCS C1713 245.25 - PLATE BONE STR 128X8X3.3MM 16 HOLE RECONSTRUCTION LCP BOTH IP/OP $883.00 $653.00 $175.21 $897.78 $397.25 $397.25 $397.25 $397.25 $882.78 $882.78 $882.78 $183.99 $882.78 $882.78 $882.78 $882.78 $882.78 $183.98 $882.78 $897.78 $522.16 $882.78 $897.78 $882.78 $882.78 $662.25 $882.78 $882.78 $882.78 $441.39 $441.39 $699.16 $882.78 $706.22 $397.25 $175.21 N/A $512.14 $882.78 $529.67 $882.78 $183.97 $882.78 N/A N/A 245.26 SUP HCPCS C1713 245.26 - PLATE BONE 144MM 18 HOLE RECONSTRUCTION LC-DCP STAINLESS BOTH IP/OP "$1,066.00" $789.00 $211.55 "$1,065.88" $479.65 $479.65 $479.65 $479.65 "$1,065.88" "$1,065.88" "$1,065.88" $222.16 "$1,065.88" "$1,065.88" "$1,065.88" "$1,065.88" "$1,065.88" $222.14 "$1,065.88" "$1,065.88" $630.47 "$1,065.88" "$1,065.88" "$1,065.88" "$1,065.88" $799.50 "$1,065.88" "$1,065.88" "$1,065.88" $532.94 $532.94 $844.18 "$1,065.88" $852.70 $479.65 $211.55 N/A $618.28 "$1,065.88" $639.53 "$1,065.88" $222.13 "$1,065.88" N/A N/A 245.27 SUP HCPCS C1713 245.27 - PLATE BONE 160MM 20 HOLE RECONSTRUCTION DCP STAINLESS STEEL BOTH IP/OP "$1,109.50" $821.00 $220.11 "$1,109.03" $499.06 $499.06 $499.06 $499.06 "$1,109.03" "$1,109.03" "$1,109.03" $231.15 "$1,109.03" "$1,109.03" "$1,109.03" "$1,109.03" "$1,109.03" $231.13 "$1,109.03" "$1,109.03" $655.99 "$1,109.03" "$1,109.03" "$1,109.03" "$1,109.03" $832.13 "$1,109.03" "$1,109.03" "$1,109.03" $554.52 $554.52 $878.35 "$1,109.03" $887.22 $499.06 $220.11 N/A $643.51 "$1,109.03" $665.42 "$1,109.03" $231.12 "$1,109.03" N/A N/A 245.28 SUP HCPCS C1713 245.28 - PLATE BONE 176MM 22 HOLE RECONSTRUCTION DCP STAINLESS STEEL BOTH IP/OP "$1,329.50" $984.00 $263.83 "$1,329.28" $598.18 $598.18 $598.18 $598.18 "$1,329.28" "$1,329.28" "$1,329.28" $277.06 "$1,329.28" "$1,329.28" "$1,329.28" "$1,329.28" "$1,329.28" $277.04 "$1,329.28" "$1,329.28" $786.27 "$1,329.28" "$1,329.28" "$1,329.28" "$1,329.28" $997.13 "$1,329.28" "$1,329.28" "$1,329.28" $664.64 $664.64 "$1,052.79" "$1,329.28" "$1,063.42" $598.18 $263.83 N/A $771.11 "$1,329.28" "$1,329.28" "$1,329.28" $277.02 "$1,329.28" N/A N/A 245.29 SUP HCPCS C1713 245.29 - PLATE BONE 192MM 24 HOLE RECONSTRUCTION DCP STAINLESS STEEL BOTH IP/OP "$1,497.50" "$1,108.00" $297.14 "$1,497.13" $673.71 $673.71 $673.71 $673.71 "$1,497.13" "$1,497.13" "$1,497.13" $312.04 "$1,497.13" "$1,497.13" "$1,497.13" "$1,497.13" "$1,497.13" $312.02 "$1,497.13" "$1,497.13" $885.55 "$1,497.13" "$1,497.13" "$1,497.13" "$1,497.13" "$1,123.13" "$1,497.13" "$1,497.13" "$1,497.13" $748.57 $748.57 "$1,185.73" "$1,497.13" "$1,197.70" $673.71 $297.14 N/A $868.55 "$1,497.13" $898.28 "$1,497.13" $312.00 "$1,497.13" N/A N/A 245.3 SUP HCPCS C1713 245.30 - PLATE BONE CURVE 70X10X3.6MM 6 HOLE RECONSTRUCTION LC-DCP BOTH IP/OP $781.00 $578.00 $154.94 $817.73 $351.28 $351.28 $351.28 $351.28 $780.63 $780.63 $780.63 $162.70 $780.63 $780.63 $780.63 $780.63 $780.63 $162.69 $780.63 $327.09 $461.74 $780.63 $817.73 $780.63 $780.63 $585.75 $780.63 $780.63 $780.63 $390.32 $390.32 $618.26 $780.63 $624.50 $351.28 $154.94 N/A $452.98 $780.63 $780.63 $780.63 $162.68 $780.63 N/A N/A 245.31 SUP HCPCS C1713 245.31 - PLATE BN CRV 94X10X3.6MM NS LC DCP 8 HL RECON SS 3.5MM CORT BOTH IP/OP $873.00 $646.00 $173.25 $887.78 $392.82 $392.82 $392.82 $392.82 $872.93 $872.93 $872.93 $181.94 $872.93 $872.93 $872.93 $872.93 $872.93 $181.93 $872.93 $887.78 $516.34 $872.93 $887.78 $872.93 $872.93 $654.75 $872.93 $872.93 $872.93 $436.47 $436.47 $691.36 $872.93 $698.34 $392.82 $173.25 N/A $506.34 $872.93 $872.93 $872.93 $181.92 $872.93 N/A N/A 245.32 SUP HCPCS C1713 245.32 - PLATE BN CRV 118X10X3.6MM NS LC DCP 10 HL RECON SS 3.5MM BOTH IP/OP $918.00 $679.00 $182.19 $933.53 $413.07 $413.07 $413.07 $413.07 $917.93 $917.93 $917.93 $191.32 $917.93 $917.93 $917.93 $917.93 $917.93 $191.31 $917.93 $373.41 $542.96 $917.93 $933.53 $917.93 $917.93 $688.50 $917.93 $917.93 $917.93 $458.97 $458.97 $727.00 $917.93 $734.34 $413.07 $182.19 N/A $532.44 $917.93 $550.76 $917.93 $191.30 $917.93 N/A N/A 245.33 SUP HCPCS C1713 245.33 - PLATE BONE CURVE 142X10X3.6MM 12 HOLE RECONSTRUCTION LC-DCP BOTH IP/OP $956.00 $707.00 $189.72 $972.13 $430.15 $430.15 $430.15 $430.15 $955.88 $955.88 $955.88 $199.23 $955.88 $955.88 $955.88 $955.88 $955.88 $199.22 $955.88 $388.85 $565.40 $955.88 $972.13 $955.88 $955.88 $717.00 $955.88 $955.88 $955.88 $477.94 $477.94 $757.06 $955.88 $764.70 $430.15 $189.72 N/A $554.48 $955.88 $573.53 $955.88 $199.21 $955.88 N/A N/A 245.34 SUP HCPCS C1713 245.34 - PLATE BONE CURVE 166X10X3.6MM 14 HOLE RECONSTRUCTION LC-DCP BOTH IP/OP "$1,073.00" $794.00 $212.87 "$1,090.78" $482.65 $482.65 $482.65 $482.65 "$1,072.55" "$1,072.55" "$1,072.55" $223.55 "$1,072.55" "$1,072.55" "$1,072.55" "$1,072.55" "$1,072.55" $223.53 "$1,072.55" "$1,090.78" $634.41 "$1,072.55" "$1,090.78" "$1,072.55" "$1,072.55" $804.75 "$1,072.55" "$1,072.55" "$1,072.55" $536.28 $536.28 $849.46 "$1,072.55" $858.04 $482.65 $212.87 N/A $622.34 "$1,072.55" $643.53 "$1,072.55" $223.52 "$1,072.55" N/A N/A 245.341 SUP HCPCS C1713 245.341 - PLATE BONE 55MM 4 HOLE SHAFT CVD RECONSTRUCTION LCP BOTH IP/OP "$1,292.00" $956.00 $256.40 "$1,313.78" $581.32 $581.32 $581.32 $581.32 "$1,291.83" "$1,291.83" "$1,291.83" $269.25 "$1,291.83" "$1,291.83" "$1,291.83" "$1,291.83" "$1,291.83" $269.23 "$1,291.83" $525.51 $764.12 "$1,291.83" "$1,313.78" "$1,291.83" "$1,291.83" $969.00 "$1,291.83" "$1,291.83" "$1,291.83" $645.92 $645.92 "$1,023.13" "$1,291.83" "$1,033.46" $581.32 $256.40 N/A $749.36 "$1,291.83" $775.10 "$1,291.83" $269.22 "$1,291.83" N/A N/A 245.35 SUP HCPCS C1713 245.35 - PLATE BN CRV 190X10X3.6MM NS LC DCP 16 HL RECON SS 3.5MM BOTH IP/OP "$1,141.50" $845.00 $226.55 "$1,160.83" $513.64 $513.64 $513.64 $513.64 "$1,141.43" "$1,141.43" "$1,141.43" $237.90 "$1,141.43" "$1,141.43" "$1,141.43" "$1,141.43" "$1,141.43" $237.89 "$1,141.43" "$1,160.83" $675.16 "$1,141.43" "$1,160.83" "$1,141.43" "$1,141.43" $856.13 "$1,141.43" "$1,141.43" "$1,141.43" $570.72 $570.72 $904.01 "$1,141.43" $913.14 $513.64 $226.55 N/A $662.07 "$1,141.43" $684.86 "$1,141.43" $237.87 "$1,141.43" N/A N/A 245.36 SUP HCPCS C1713 245.36 - PLATE BONE CURVE 214X10X3.6MM 18 HOLE RECONSTRUCTION LC-DCP BOTH IP/OP "$1,230.00" $910.00 $244.12 "$1,250.88" $553.49 $553.49 $553.49 $553.49 "$1,229.98" "$1,229.98" "$1,229.98" $256.36 "$1,229.98" "$1,229.98" "$1,229.98" "$1,229.98" "$1,229.98" $256.34 "$1,229.98" $500.35 $727.53 "$1,229.98" "$1,250.88" "$1,229.98" "$1,229.98" $922.50 "$1,229.98" "$1,229.98" "$1,229.98" $614.99 $614.99 $974.14 "$1,229.98" $983.98 $553.49 $244.12 N/A $713.40 "$1,229.98" $737.99 "$1,229.98" $256.33 "$1,229.98" N/A N/A 245.361 SUP HCPCS C1713 245.361 - PLATE BONE 82MM 6 HOLE SHAFT CVD RECONSTRUCTION LCP BOTH IP/OP "$1,399.00" "$1,035.00" $277.60 "$1,422.45" $629.41 $629.41 $629.41 $629.41 "$1,398.68" "$1,398.68" "$1,398.68" $291.52 "$1,398.68" "$1,398.68" "$1,398.68" "$1,398.68" "$1,398.68" $291.50 "$1,398.68" $568.98 $827.32 "$1,398.68" "$1,422.45" "$1,398.68" "$1,398.68" "$1,049.25" "$1,398.68" "$1,398.68" "$1,398.68" $699.34 $699.34 "$1,107.75" "$1,398.68" "$1,118.94" $629.41 $277.60 N/A $811.42 "$1,398.68" $839.21 "$1,398.68" $291.48 "$1,398.68" N/A N/A 245.381 SUP HCPCS C1713 245.381 - PLATE BN CRV 106X10.1X3.5MM NS LCP 8 HL SHFT RECON SS 3.5MM BOTH IP/OP "$1,517.00" "$1,123.00" $301.04 "$1,542.53" $682.54 $682.54 $682.54 $682.54 "$1,516.75" "$1,516.75" "$1,516.75" $316.13 "$1,516.75" "$1,516.75" "$1,516.75" "$1,516.75" "$1,516.75" $316.11 "$1,516.75" $617.01 $897.16 "$1,516.75" "$1,542.53" "$1,516.75" "$1,516.75" "$1,137.75" "$1,516.75" "$1,516.75" "$1,516.75" $758.38 $758.38 "$1,201.27" "$1,516.75" "$1,213.40" $682.54 $301.04 N/A $879.86 "$1,516.75" $910.05 "$1,516.75" $316.09 "$1,516.75" N/A N/A 245.401 SUP HCPCS C1713 245.401 - PLATE BONE 140MM 10 HOLE CVD RECONSTRUCTION LCP STAINLESS BOTH IP/OP "$1,588.50" "$1,175.00" $315.26 "$1,615.43" $714.79 $714.79 $714.79 $714.79 "$1,588.43" "$1,588.43" "$1,588.43" $331.07 "$1,588.43" "$1,588.43" "$1,588.43" "$1,588.43" "$1,588.43" $331.05 "$1,588.43" "$1,615.43" $939.56 "$1,588.43" "$1,615.43" "$1,588.43" "$1,588.43" "$1,191.38" "$1,588.43" "$1,588.43" "$1,588.43" $794.22 $794.22 "$1,258.04" "$1,588.43" "$1,270.74" $714.79 $315.26 N/A $921.33 "$1,588.43" $953.06 "$1,588.43" $331.03 "$1,588.43" N/A N/A 245.421 SUP HCPCS C1713 245.421 - PLATE BONE 149MM 12 HOLE SHAFT CVD RECONSTRUCTION LCP BOTH IP/OP "$1,663.00" "$1,231.00" $330.05 "$1,691.20" $748.32 $748.32 $748.32 $748.32 "$1,662.93" "$1,662.93" "$1,662.93" $346.60 "$1,662.93" "$1,662.93" "$1,662.93" "$1,662.93" "$1,662.93" $346.57 "$1,662.93" "$1,691.20" $983.62 "$1,662.93" "$1,691.20" "$1,662.93" "$1,662.93" "$1,247.25" "$1,662.93" "$1,662.93" "$1,662.93" $831.47 $831.47 "$1,317.04" "$1,662.93" "$1,330.34" $748.32 $330.05 N/A $964.54 "$1,662.93" $997.76 "$1,662.93" $346.55 "$1,662.93" N/A N/A 245.441 SUP HCPCS C1713 245.441 - PLATE BONE 166MM 14 HOLE SHAFT CVD RECONSTRUCTION LCP BOTH IP/OP "$1,868.50" "$1,383.00" $370.79 "$1,899.93" $840.68 $840.68 $840.68 $840.68 "$1,868.18" "$1,868.18" "$1,868.18" $389.38 "$1,868.18" "$1,868.18" "$1,868.18" "$1,868.18" "$1,868.18" $389.35 "$1,868.18" "$1,899.93" "$1,105.03" "$1,868.18" "$1,899.93" "$1,868.18" "$1,868.18" "$1,401.38" "$1,868.18" "$1,868.18" "$1,868.18" $934.09 $934.09 "$1,479.60" "$1,868.18" "$1,494.54" $840.68 $370.79 N/A "$1,083.73" "$1,868.18" "$1,120.91" "$1,868.18" $389.33 "$1,868.18" N/A N/A 245.461 SUP HCPCS C1713 245.461 - PLATE BONE 180MM 16 HOLE SHAFT CVD RECONSTRUCTION LCP BOTH IP/OP "$1,996.50" "$1,477.00" $396.17 "$2,030.00" $898.24 $898.24 $898.24 $898.24 "$1,996.08" "$1,996.08" "$1,996.08" $416.03 "$1,996.08" "$1,996.08" "$1,996.08" "$1,996.08" "$1,996.08" $416.01 "$1,996.08" "$2,030.00" "$1,180.68" "$1,996.08" "$2,030.00" "$1,996.08" "$1,996.08" "$1,497.38" "$1,996.08" "$1,996.08" "$1,996.08" $998.04 $998.04 "$1,580.90" "$1,996.08" "$1,596.86" $898.24 $396.17 N/A "$1,157.97" "$1,996.08" "$1,197.65" "$1,996.08" $415.98 "$1,996.08" N/A N/A 245.481 SUP HCPCS C1713 245.481 - PLATE BONE 190MM 18 HOLE SHAFT CVD RECONSTRUCTION LCP BOTH IP/OP "$2,152.50" "$1,593.00" $427.14 "$2,188.70" $968.46 $968.46 $968.46 $968.46 "$2,152.13" "$2,152.13" "$2,152.13" $448.56 "$2,152.13" "$2,152.13" "$2,152.13" "$2,152.13" "$2,152.13" $448.53 "$2,152.13" $875.48 "$1,272.98" "$2,152.13" "$2,188.70" "$2,152.13" "$2,152.13" "$1,614.38" "$2,152.13" "$2,152.13" "$2,152.13" "$1,076.07" "$1,076.07" "$1,704.49" "$2,152.13" "$1,721.70" $968.46 $427.14 N/A "$1,248.45" "$2,152.13" "$1,291.28" "$2,152.13" $448.50 "$2,152.13" N/A N/A 245.876 SUP HCPCS C1713 245.876 - PLATE BONE 108MM RAD 78MM 6 HOLE LP CVD RECONSTRUCTION BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $827.73 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $488.34 $813.90 $813.90 $813.90 N/A N/A 245.878 SUP HCPCS C1713 245.878 - PLATE BN 108MM RDS CRV 104X10.2X2.7MM NS 8 HL LOPRFL RECON BOTH IP/OP $884.50 $655.00 $175.49 $899.20 $397.88 $397.88 $397.88 $397.88 $884.18 $884.18 $884.18 $184.29 $884.18 $884.18 $884.18 $884.18 $884.18 $184.27 $884.18 $359.68 $522.99 $884.18 $899.20 $884.18 $884.18 $663.38 $884.18 $884.18 $884.18 $442.09 $442.09 $700.27 $884.18 $707.34 $397.88 $175.49 N/A $513.01 $884.18 $530.51 $884.18 $884.18 $884.18 N/A N/A 245.88 SUP HCPCS C1713 245.880 - PLATE BONE 108MM RAD CVD 130MM 8 HOLE LP RECONSTRUCTION BOTH IP/OP $927.00 $686.00 $183.92 $970.70 $417.01 $417.01 $417.01 $417.01 $926.68 $926.68 $926.68 $193.14 $926.68 $926.68 $926.68 $926.68 $926.68 $193.13 $926.68 $388.28 $548.13 $926.68 $970.70 $926.68 $926.68 $695.25 $926.68 $926.68 $926.68 $463.34 $463.34 $733.93 $926.68 $741.34 $417.01 $183.92 N/A $537.66 $926.68 $556.01 $926.68 $193.12 $926.68 N/A N/A 245.882 SUP HCPCS C1713 245.882 - PLATE BN 108MM RDS CRV 156MMX10.2MMX2.7M NS 12 HL LOPRFL BOTH IP/OP "$1,030.50" $763.00 $204.50 "$1,047.90" $463.67 $463.67 $463.67 $463.67 "$1,030.38" "$1,030.38" "$1,030.38" $214.76 "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" $214.74 "$1,030.38" $419.16 $609.47 "$1,030.38" "$1,047.90" "$1,030.38" "$1,030.38" $772.88 "$1,030.38" "$1,030.38" "$1,030.38" $515.19 $515.19 $816.06 "$1,030.38" $824.30 $463.67 $204.50 N/A $597.69 "$1,030.38" $618.23 "$1,030.38" "$1,030.38" "$1,030.38" N/A N/A 245.884 SUP HCPCS C1713 245.884 - PLATE BONE 108MM RAD 182MM 14 HOLE LP CVD RECONSTRUCTION BOTH IP/OP "$1,108.00" $820.00 $219.85 "$1,126.50" $498.46 $498.46 $498.46 $498.46 "$1,107.68" "$1,107.68" "$1,107.68" $230.87 "$1,107.68" "$1,107.68" "$1,107.68" "$1,107.68" "$1,107.68" $230.85 "$1,107.68" $450.60 $655.19 "$1,107.68" "$1,126.50" "$1,107.68" "$1,107.68" $831.00 "$1,107.68" "$1,107.68" "$1,107.68" $553.84 $553.84 $877.28 "$1,107.68" $886.14 $498.46 $219.85 N/A $642.64 "$1,107.68" "$1,107.68" "$1,107.68" "$1,107.68" "$1,107.68" N/A N/A 245.886 SUP HCPCS C1713 245.886 - PLATE BONE 108MM RAD 208MM 16 HOLE LP CVD RECONSTRUCTION BOTH IP/OP "$1,185.00" $877.00 $235.19 "$1,205.15" $533.25 $533.25 $533.25 $533.25 "$1,185.00" "$1,185.00" "$1,185.00" $246.98 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $482.06 $700.93 "$1,185.00" "$1,205.15" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 $235.19 N/A $687.30 "$1,185.00" "$1,185.00" "$1,185.00" $246.95 "$1,185.00" N/A N/A 245.906 SUP HCPCS C1713 245.906 - PLATE BONE 88MM RAD 78MM 6 HOLE LP CVD RECONSTRUCTION BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $331.09 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $488.34 $813.90 $813.90 $813.90 N/A N/A 245.908 SUP HCPCS C1713 245.908 - PLATE BN 88MM RDS CRV 104MMX10.2MMX2.7M NS 8 HL LOPRFL RECON BOTH IP/OP $884.50 $655.00 $175.49 $899.20 $397.88 $397.88 $397.88 $397.88 $884.18 $884.18 $884.18 $184.29 $884.18 $884.18 $884.18 $884.18 $884.18 $184.27 $884.18 $359.68 $522.99 $884.18 $899.20 $884.18 $884.18 $663.38 $884.18 $884.18 $884.18 $442.09 $442.09 $700.27 $884.18 $707.34 $397.88 $175.49 N/A $513.01 $884.18 $530.51 $884.18 $184.26 $884.18 N/A N/A 245.91 SUP HCPCS C1713 245.910 - PLATE BONE 88MM RAD LP CURVE 130MM 10 HOLE RECONSTRUCTION BOTH IP/OP $927.00 $686.00 $183.92 $970.70 $417.01 $417.01 $417.01 $417.01 $926.68 $926.68 $926.68 $193.14 $926.68 $926.68 $926.68 $926.68 $926.68 $193.13 $926.68 $388.28 $548.13 $926.68 $970.70 $926.68 $926.68 $695.25 $926.68 $926.68 $926.68 $463.34 $463.34 $733.93 $926.68 $741.34 $417.01 $183.92 N/A $537.66 $926.68 $556.01 $926.68 $193.12 $926.68 N/A N/A 245.912 SUP HCPCS C1713 245.912 - PLATE BN 88MM RDS CRV 156MMX10.2MMX2.7M NS 12 HL LOPRFL BOTH IP/OP "$1,030.50" $763.00 $204.50 "$1,047.90" $463.67 $463.67 $463.67 $463.67 "$1,030.38" "$1,030.38" "$1,030.38" $214.76 "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" $214.74 "$1,030.38" "$1,047.90" $609.47 "$1,030.38" "$1,047.90" "$1,030.38" "$1,030.38" $772.88 "$1,030.38" "$1,030.38" "$1,030.38" $515.19 $515.19 $816.06 "$1,030.38" $824.30 $463.67 $204.50 N/A $597.69 "$1,030.38" "$1,030.38" "$1,030.38" $214.73 "$1,030.38" N/A N/A 245.914 SUP HCPCS C1713 245.914 - PLATE BONE 88MM RAD 182MM 14 HOLE LP CVD RECONSTRUCTION BOTH IP/OP "$1,108.00" $820.00 $219.85 "$1,126.50" $498.46 $498.46 $498.46 $498.46 "$1,107.68" "$1,107.68" "$1,107.68" $230.87 "$1,107.68" "$1,107.68" "$1,107.68" "$1,107.68" "$1,107.68" $230.85 "$1,107.68" "$1,126.50" $655.19 "$1,107.68" "$1,126.50" "$1,107.68" "$1,107.68" $831.00 "$1,107.68" "$1,107.68" "$1,107.68" $553.84 $553.84 $877.28 "$1,107.68" $886.14 $498.46 $219.85 N/A $642.64 "$1,107.68" $664.61 "$1,107.68" $230.84 "$1,107.68" N/A N/A 245.916 SUP HCPCS C1713 245.916 - PLATE BONE 88MM RAD 208MM 16 HOLE LP CVD RECONSTRUCTION BOTH IP/OP "$1,185.00" $877.00 $235.19 "$1,205.15" $533.25 $533.25 $533.25 $533.25 "$1,185.00" "$1,185.00" "$1,185.00" $246.98 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" "$1,205.15" $700.93 "$1,185.00" "$1,205.15" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 $235.19 N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 245.92 SUP HCPCS C1713 245.920 - PLATE BONE J RIGHT 130X10X3.4MM 3.5MM 10 HOLE RECONSTRUCTION BOTH IP/OP $927.00 $686.00 $183.92 $970.70 $417.01 $417.01 $417.01 $417.01 $926.68 $926.68 $926.68 $193.14 $926.68 $926.68 $926.68 $926.68 $926.68 $193.13 $926.68 $970.70 $548.13 $926.68 $970.70 $926.68 $926.68 $695.25 $926.68 $926.68 $926.68 $463.34 $463.34 $733.93 $926.68 $741.34 $417.01 $183.92 N/A $537.66 $926.68 $556.01 $926.68 $926.68 $926.68 N/A N/A 245.922 SUP HCPCS C1713 245.922 - PLATE BONE 88MM RAD 156MM 12 HOLE J LP RECONSTRUCTION BOTH IP/OP "$1,030.50" $763.00 $204.50 "$1,047.90" $463.67 $463.67 $463.67 $463.67 "$1,030.38" "$1,030.38" "$1,030.38" $214.76 "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" $214.74 "$1,030.38" "$1,047.90" $609.47 "$1,030.38" "$1,047.90" "$1,030.38" "$1,030.38" $772.88 "$1,030.38" "$1,030.38" "$1,030.38" $515.19 $515.19 $816.06 "$1,030.38" $824.30 $463.67 $204.50 N/A $597.69 "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" N/A N/A 245.924 SUP HCPCS C1713 245.924 - PLATE BONE 88MM RAD 182MM 14 HOLE J LP RECONSTRUCTION BOTH IP/OP "$1,108.00" $820.00 $219.85 "$1,126.50" $498.46 $498.46 $498.46 $498.46 "$1,107.68" "$1,107.68" "$1,107.68" $230.87 "$1,107.68" "$1,107.68" "$1,107.68" "$1,107.68" "$1,107.68" $230.85 "$1,107.68" $450.60 $655.19 "$1,107.68" "$1,126.50" "$1,107.68" "$1,107.68" $831.00 "$1,107.68" "$1,107.68" "$1,107.68" $553.84 $553.84 $877.28 "$1,107.68" $886.14 $498.46 $219.85 N/A $642.64 "$1,107.68" $664.61 "$1,107.68" $230.84 "$1,107.68" N/A N/A 245.926 SUP HCPCS C1713 245.926 - PLATE BN 88MM RDS J 208X10.2X2.7MM NS 16 HL LOPRFL RECON SS BOTH IP/OP "$1,185.00" $877.00 $235.19 "$1,205.15" $533.25 $533.25 $533.25 $533.25 "$1,185.00" "$1,185.00" "$1,185.00" $246.98 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $482.06 $700.93 "$1,185.00" "$1,205.15" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 $235.19 N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 245.93 SUP HCPCS C1713 245.930 - PLATE BONE 88MM RAD J 130X10.2X2.7MM 10 HOLE LP BOTH IP/OP $927.00 $686.00 $183.92 $970.70 $417.01 $417.01 $417.01 $417.01 $926.68 $926.68 $926.68 $193.14 $926.68 $926.68 $926.68 $926.68 $926.68 $193.13 $926.68 $388.28 $548.13 $926.68 $970.70 $926.68 $926.68 $695.25 $926.68 $926.68 $926.68 $463.34 $463.34 $733.93 $926.68 $741.34 $417.01 $183.92 N/A $537.66 $926.68 $556.01 $926.68 $926.68 $926.68 N/A N/A 245.932 SUP HCPCS C1713 245.932 - PLATE BONE 88MM RAD 156MM 12 HOLE J LP RECONSTRUCTION BOTH IP/OP "$1,030.50" $763.00 $204.50 "$1,047.90" $463.67 $463.67 $463.67 $463.67 "$1,030.38" "$1,030.38" "$1,030.38" $214.76 "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" $214.74 "$1,030.38" $419.16 $609.47 "$1,030.38" "$1,047.90" "$1,030.38" "$1,030.38" $772.88 "$1,030.38" "$1,030.38" "$1,030.38" $515.19 $515.19 $816.06 "$1,030.38" $824.30 $463.67 $204.50 N/A $597.69 "$1,030.38" $618.23 "$1,030.38" $214.73 "$1,030.38" N/A N/A 245.934 SUP HCPCS C1713 245.934 - PLATE BONE 88MM RAD 182MM 14 HOLE J LP RECONSTRUCTION BOTH IP/OP "$1,108.00" $820.00 $219.85 "$1,126.50" $498.46 $498.46 $498.46 $498.46 "$1,107.68" "$1,107.68" "$1,107.68" $230.87 "$1,107.68" "$1,107.68" "$1,107.68" "$1,107.68" "$1,107.68" $230.85 "$1,107.68" $450.60 $655.19 "$1,107.68" "$1,126.50" "$1,107.68" "$1,107.68" $831.00 "$1,107.68" "$1,107.68" "$1,107.68" $553.84 $553.84 $877.28 "$1,107.68" $886.14 $498.46 $219.85 N/A $642.64 "$1,107.68" $664.61 "$1,107.68" $230.84 "$1,107.68" N/A N/A 245.936 SUP HCPCS C1713 245.936 - PLATE BN 88MM RDS J 208X10.2X2.7MM NS 16 HL LOPRFL RECON SS BOTH IP/OP "$1,185.00" $877.00 $235.19 "$1,205.15" $533.25 $533.25 $533.25 $533.25 "$1,185.00" "$1,185.00" "$1,185.00" $246.98 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $482.06 $700.93 "$1,185.00" "$1,205.15" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 $235.19 N/A $687.30 "$1,185.00" $711.00 "$1,185.00" $246.95 "$1,185.00" N/A N/A 245.98 SUP HCPCS C1713 245.98 - PLATE BN 64X8X2.5MM NS 8 HL RECON SS CALC 2.7MM SCR BOTH IP/OP $665.00 $492.00 $131.97 $676.20 $299.21 $299.21 $299.21 $299.21 $664.90 $664.90 $664.90 $138.58 $664.90 $664.90 $664.90 $664.90 $664.90 $138.57 $664.90 $270.48 $393.29 $664.90 $676.20 $664.90 $664.90 $498.75 $664.90 $664.90 $664.90 $332.45 $332.45 $526.60 $664.90 $531.92 $299.21 $131.97 N/A $385.70 $664.90 $398.94 $664.90 $664.90 $664.90 N/A N/A 245.99 SUP HCPCS C1713 245.99 - PLATE BN 72X8X2.5MM NS 9 HL RECON SS CALC 2.7MM SCR BOTH IP/OP $689.00 $510.00 $136.71 $700.50 $309.96 $309.96 $309.96 $309.96 $688.80 $688.80 $688.80 $143.56 $688.80 $688.80 $688.80 $688.80 $688.80 $143.55 $688.80 $280.20 $407.43 $688.80 $700.50 $688.80 $688.80 $516.75 $688.80 $688.80 $688.80 $344.40 $344.40 $545.53 $688.80 $551.04 $309.96 $136.71 N/A $399.62 $688.80 $413.28 $688.80 $688.80 $688.80 N/A N/A 246.031 SUP HCPCS C1713 246.031 - PLATE BN STRG 29X3.8X.8MM NS PRO-PK 6 HL LOPRFL PRECONTOUR BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 246.19 SUP HCPCS C1713 246.19 - PLATE BONE 100MM 20 HOLE STR DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $478.00 $354.00 $94.86 $486.05 $215.07 $215.07 $215.07 $215.07 $477.93 $477.93 $477.93 $99.61 $477.93 $477.93 $477.93 $477.93 $477.93 $99.61 $477.93 $194.42 $282.70 $477.93 $486.05 $477.93 $477.93 $358.50 $477.93 $477.93 $477.93 $238.97 $238.97 $378.52 $477.93 $382.34 $215.07 $94.86 N/A $277.24 $477.93 $286.76 $477.93 $99.60 $477.93 N/A N/A 246.191 SUP HCPCS C1713 246.191 - PLATE BN STRG 59X3.8X.8MM NS PRO-PK 12 HL LOPRFL PRECONTOUR BOTH IP/OP $465.50 $344.00 $92.35 $473.18 $209.38 $209.38 $209.38 $209.38 $465.28 $465.28 $465.28 $96.98 $465.28 $465.28 $465.28 $465.28 $465.28 $96.97 $465.28 $473.18 $275.21 $465.28 $473.18 $465.28 $465.28 $349.13 $465.28 $465.28 $465.28 $232.64 $232.64 $368.50 $465.28 $372.22 $209.38 $92.35 N/A $269.99 $465.28 $279.17 $465.28 $465.28 $465.28 N/A N/A 246.23 SUP HCPCS C1713 246.23 - PLATE BN T 50MM NS DCP 3 HLE/HD 9 HL SHFT SS 1.5MM SCR BOTH IP/OP $417.50 $309.00 $82.86 $424.60 $187.88 $187.88 $187.88 $187.88 $417.50 $417.50 $417.50 $87.02 $417.50 $417.50 $417.50 $417.50 $417.50 $87.01 $417.50 $424.60 $246.95 $417.50 $424.60 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $187.88 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A 246.233 SUP HCPCS C1713 246.233 - PLATE BN T 44X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $426.00 $315.00 $84.54 $433.18 $191.67 $191.67 $191.67 $191.67 $425.93 $425.93 $425.93 $88.77 $425.93 $425.93 $425.93 $425.93 $425.93 $88.77 $425.93 $433.18 $251.94 $425.93 $433.18 $425.93 $425.93 $319.50 $425.93 $425.93 $425.93 $212.97 $212.97 $337.34 $425.93 $340.74 $191.67 $84.54 N/A $247.08 $425.93 $255.56 $425.93 $88.76 $425.93 N/A N/A 246.234 SUP HCPCS C1713 246.234 - PLATE BN T 44X4X1MM NS PRO-PK 4 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $451.75 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $266.52 $444.20 $92.57 $444.20 N/A N/A 246.24 SUP HCPCS C1713 246.24 - PLATE BONE 50MM 4 HOLE HEAD 9 HOLE SHAFT T DCP STAINLESS BOTH IP/OP $450.00 $333.00 $89.28 $457.48 $202.42 $202.42 $202.42 $202.42 $449.83 $449.83 $449.83 $93.76 $449.83 $449.83 $449.83 $449.83 $449.83 $93.75 $449.83 $182.99 $266.07 $449.83 $457.48 $449.83 $449.83 $337.50 $449.83 $449.83 $449.83 $224.92 $224.92 $356.27 $449.83 $359.86 $202.42 $89.28 N/A $261.00 $449.83 $449.83 $449.83 $93.74 $449.83 N/A N/A 246.48 SUP HCPCS C1713 246.48 - PLATE BONE 4 HOLE H LCP STAINLESS STEEL ORTHOPEDIC NONSTRL BOTH IP/OP $412.00 $305.00 $81.75 $418.88 $185.35 $185.35 $185.35 $185.35 $411.88 $411.88 $411.88 $85.85 $411.88 $411.88 $411.88 $411.88 $411.88 $85.84 $411.88 $418.88 $243.63 $411.88 $418.88 $411.88 $411.88 $309.00 $411.88 $411.88 $411.88 $205.94 $205.94 $326.21 $411.88 $329.50 $185.35 $81.75 N/A $238.96 $411.88 $247.13 $411.88 $85.84 $411.88 N/A N/A 246.482 SUP HCPCS C1713 246.482 - PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR SS RT BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $451.75 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $266.52 $444.20 $92.57 $444.20 N/A N/A 246.483 SUP HCPCS C1713 246.483 - PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR SS LT BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $180.70 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $266.52 $444.20 $92.57 $444.20 N/A N/A 246.61 SUP HCPCS C1713 246.61 - PLATE BN 36X3.5X.9MM NS 7 HL SS CNDYL LT 1.5MM SCR MDLR HND BOTH IP/OP $530.00 $392.00 $105.18 $538.95 $238.48 $238.48 $238.48 $238.48 $529.95 $529.95 $529.95 $110.45 $529.95 $529.95 $529.95 $529.95 $529.95 $110.45 $529.95 $215.58 $313.47 $529.95 $538.95 $529.95 $529.95 $397.50 $529.95 $529.95 $529.95 $264.98 $264.98 $419.72 $529.95 $423.96 $238.48 $105.18 N/A $307.40 $529.95 $317.97 $529.95 $110.44 $529.95 N/A N/A 246.612 SUP HCPCS C1713 246.612 - PLATE BN Y 46X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $426.00 $315.00 $84.54 $433.18 $191.67 $191.67 $191.67 $191.67 $425.93 $425.93 $425.93 $88.77 $425.93 $425.93 $425.93 $425.93 $425.93 $88.77 $425.93 $173.27 $251.94 $425.93 $433.18 $425.93 $425.93 $319.50 $425.93 $425.93 $425.93 $212.97 $212.97 $337.34 $425.93 $340.74 $191.67 $84.54 N/A $247.08 $425.93 $255.56 $425.93 $88.76 $425.93 N/A N/A 246.62 SUP HCPCS C1713 246.62 - PLATE BN 36X3.5X.9MM NS 7 HL SS CNDYL RT 1.5MM SCR MDLR HND BOTH IP/OP $530.00 $392.00 $105.18 $538.95 $238.48 $238.48 $238.48 $238.48 $529.95 $529.95 $529.95 $110.45 $529.95 $529.95 $529.95 $529.95 $529.95 $110.45 $529.95 $538.95 $313.47 $529.95 $538.95 $529.95 $529.95 $397.50 $529.95 $529.95 $529.95 $264.98 $264.98 $419.72 $529.95 $423.96 $238.48 $105.18 N/A $307.40 $529.95 $317.97 $529.95 $110.44 $529.95 N/A N/A 247.031 SUP HCPCS C1713 247.031 - PLATE BN STRG 35X5X1.2MM NS PRO-PK 6 HL LOPRFL PRECONTOUR BOTH IP/OP $405.00 $300.00 $80.35 $411.73 $182.18 $182.18 $182.18 $182.18 $404.85 $404.85 $404.85 $84.38 $404.85 $404.85 $404.85 $404.85 $404.85 $84.38 $404.85 $164.69 $239.47 $404.85 $411.73 $404.85 $404.85 $303.75 $404.85 $404.85 $404.85 $202.43 $202.43 $320.64 $404.85 $323.88 $182.18 $80.35 N/A $234.90 $404.85 $404.85 $404.85 $84.37 $404.85 N/A N/A 247.232 SUP HCPCS C1713 247.232 - PLATE BN T 53X5X1.2MM NS PRO-PK 2 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $451.75 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $444.20 $444.20 $92.57 $444.20 N/A N/A 247.233 SUP HCPCS C1713 247.233 - PLATE BN T 53X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 247.344 SUP HCPCS C1713 247.344 - PLATE BN 31MM NS LCP PRO-PK 4 HL LOPRFL CUT TO LGTH SS 2MM BOTH IP/OP $460.00 $340.00 $91.23 $467.48 $206.84 $206.84 $206.84 $206.84 $459.65 $459.65 $459.65 $95.80 $459.65 $459.65 $459.65 $459.65 $459.65 $95.80 $459.65 $186.99 $271.88 $459.65 $467.48 $459.65 $459.65 $345.00 $459.65 $459.65 $459.65 $229.83 $229.83 $364.04 $459.65 $367.72 $206.84 $91.23 N/A $266.80 $459.65 $275.79 $459.65 $95.79 $459.65 N/A N/A 247.345 SUP HCPCS C1713 247.345 - PLATE BN 38MM NS LCP PRO-PK 5 HL LOPRFL CUT TO LGTH SS 2MM BOTH IP/OP $460.00 $340.00 $91.23 $467.48 $206.84 $206.84 $206.84 $206.84 $459.65 $459.65 $459.65 $95.80 $459.65 $459.65 $459.65 $459.65 $459.65 $95.80 $459.65 $467.48 $271.88 $459.65 $467.48 $459.65 $459.65 $345.00 $459.65 $459.65 $459.65 $229.83 $229.83 $364.04 $459.65 $367.72 $206.84 $91.23 N/A $266.80 $459.65 $275.79 $459.65 $95.79 $459.65 N/A N/A 247.346 SUP HCPCS C1713 247.346 - PLATE BN 45MM NS LCP PRO-PK 6 HL LOPRFL CUT TO LGTH SS 2MM BOTH IP/OP $460.00 $340.00 $91.23 $467.48 $206.84 $206.84 $206.84 $206.84 $459.65 $459.65 $459.65 $95.80 $459.65 $459.65 $459.65 $459.65 $459.65 $95.80 $459.65 $186.99 $271.88 $459.65 $467.48 $459.65 $459.65 $345.00 $459.65 $459.65 $459.65 $229.83 $229.83 $364.04 $459.65 $367.72 $206.84 $91.23 N/A $266.80 $459.65 $275.79 $459.65 $95.79 $459.65 N/A N/A 247.347 SUP HCPCS C1713 247.347 - PLATE BN 52MM NS LCP PRO-PK 7 HL LOPRFL CUT TO LGTH SS 2MM BOTH IP/OP $460.00 $340.00 $91.23 $467.48 $206.84 $206.84 $206.84 $206.84 $459.65 $459.65 $459.65 $95.80 $459.65 $459.65 $459.65 $459.65 $459.65 $95.80 $459.65 $467.48 $271.88 $459.65 $467.48 $459.65 $459.65 $345.00 $459.65 $459.65 $459.65 $229.83 $229.83 $364.04 $459.65 $367.72 $206.84 $91.23 N/A $266.80 $459.65 $275.79 $459.65 $95.79 $459.65 N/A N/A 247.348 SUP HCPCS C1713 247.348 - PLATE BN 59MM NS LCP PRO-PK 8 HL LOPRFL CUT TO LGTH SS 2MM BOTH IP/OP $460.00 $340.00 $91.23 $467.48 $206.84 $206.84 $206.84 $206.84 $459.65 $459.65 $459.65 $95.80 $459.65 $459.65 $459.65 $459.65 $459.65 $95.80 $459.65 $186.99 $271.88 $459.65 $467.48 $459.65 $459.65 $345.00 $459.65 $459.65 $459.65 $229.83 $229.83 $364.04 $459.65 $367.72 $206.84 $91.23 N/A $266.80 $459.65 $275.79 $459.65 $95.79 $459.65 N/A N/A 247.349 SUP HCPCS C1713 247.349 - PLATE BN 54MM NS LCP PRO-PK 7 HL SHFT LOPRFL CUT TO LGTH SS BOTH IP/OP "$1,446.50" "$1,070.00" $287.08 "$1,471.05" $650.90 $650.90 $650.90 $650.90 "$1,446.45" "$1,446.45" "$1,446.45" $301.48 "$1,446.45" "$1,446.45" "$1,446.45" "$1,446.45" "$1,446.45" $301.46 "$1,446.45" $588.42 $855.58 "$1,446.45" "$1,471.05" "$1,446.45" "$1,446.45" "$1,084.88" "$1,446.45" "$1,446.45" "$1,446.45" $723.23 $723.23 "$1,145.59" "$1,446.45" "$1,157.16" $650.90 $287.08 N/A $838.97 "$1,446.45" "$1,446.45" "$1,446.45" $301.44 "$1,446.45" N/A N/A 247.35 SUP HCPCS C1713 247.350 - PLATE BN Y 55MM NS LCP PRO-PK 3 HLE/HD 7 HL SHFT LOPRFL CUT BOTH IP/OP $789.00 $584.00 $156.56 $826.33 $354.97 $354.97 $354.97 $354.97 $788.83 $788.83 $788.83 $164.41 $788.83 $788.83 $788.83 $788.83 $788.83 $164.40 $788.83 $826.33 $466.59 $788.83 $826.33 $788.83 $788.83 $591.75 $788.83 $788.83 $788.83 $394.42 $394.42 $624.75 $788.83 $631.06 $354.97 $156.56 N/A $457.62 $788.83 $473.30 $788.83 $164.39 $788.83 N/A N/A 247.351 SUP HCPCS C1713 247.351 - PLATE BN T 53MM NS LCP PRO-PK 2 HLE/HD 7 HL SHFT LOPRFL CUT BOTH IP/OP $812.50 $601.00 $161.26 $826.33 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $330.53 $480.59 $812.50 $826.33 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 247.36 SUP HCPCS C1713 247.360 - PLATE BN 73MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH SS 2MM BOTH IP/OP $446.50 $330.00 $88.58 $467.48 $200.83 $200.83 $200.83 $200.83 $446.28 $446.28 $446.28 $93.02 $446.28 $446.28 $446.28 $446.28 $446.28 $93.01 $446.28 $467.48 $263.97 $446.28 $467.48 $446.28 $446.28 $334.88 $446.28 $446.28 $446.28 $223.14 $223.14 $353.45 $446.28 $357.02 $200.83 $88.58 N/A $258.97 $446.28 $267.77 $446.28 $93.00 $446.28 N/A N/A 247.362 SUP HCPCS C1713 247.362 - PLATE BN 81MM NS LCP PRO-PK 12 HL ADP LOPRFL CUT TO LGTH SS BOTH IP/OP $777.50 $575.00 $154.28 $790.58 $349.81 $349.81 $349.81 $349.81 $777.35 $777.35 $777.35 $162.02 $777.35 $777.35 $777.35 $777.35 $777.35 $162.01 $777.35 $316.23 $459.80 $777.35 $790.58 $777.35 $777.35 $583.13 $777.35 $777.35 $777.35 $388.68 $388.68 $615.66 $777.35 $621.88 $349.81 $154.28 N/A $450.95 $777.35 $466.41 $777.35 $162.00 $777.35 N/A N/A 247.364 SUP HCPCS C1713 247.364 - PLATE BN 84MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH SS 2.4 BOTH IP/OP $735.50 $544.00 $145.91 $747.68 $330.83 $330.83 $330.83 $330.83 $735.18 $735.18 $735.18 $153.23 $735.18 $735.18 $735.18 $735.18 $735.18 $153.22 $735.18 $747.68 $434.86 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $330.83 $145.91 N/A $426.59 $735.18 $441.11 $735.18 $153.21 $735.18 N/A N/A 247.366 SUP HCPCS C1713 247.366 - PLATE BN 88MM NS LCP PRO-PK 12 HL ADP LOPRFL CUT TO LGTH SS BOTH IP/OP $856.50 $634.00 $169.91 $870.63 $385.24 $385.24 $385.24 $385.24 $856.08 $856.08 $856.08 $178.43 $856.08 $856.08 $856.08 $856.08 $856.08 $178.42 $856.08 $870.63 $506.37 $856.08 $870.63 $856.08 $856.08 $642.38 $856.08 $856.08 $856.08 $428.04 $428.04 $678.02 $856.08 $684.86 $385.24 $169.91 N/A $496.77 $856.08 $513.65 $856.08 $178.41 $856.08 N/A N/A 247.37 SUP HCPCS C1713 247.370 - PLATE BN 97MM NS LCP PRO-PK 12 HL ADP LOPRFL CUT TO LGTH SS BOTH IP/OP $831.50 $615.00 $164.96 $870.63 $374.01 $374.01 $374.01 $374.01 $831.13 $831.13 $831.13 $173.23 $831.13 $831.13 $831.13 $831.13 $831.13 $173.22 $831.13 $870.63 $491.61 $831.13 $870.63 $831.13 $831.13 $623.63 $831.13 $831.13 $831.13 $415.57 $415.57 $658.25 $831.13 $664.90 $374.01 $164.96 N/A $482.27 $831.13 $498.68 $831.13 $173.21 $831.13 N/A N/A 247.372 SUP HCPCS C1713 247.372 - PLATE BN 76MM NS LCP PRO-PK 8 HL LOPRFL CUT TO LGTH SS 2.7MM BOTH IP/OP $776.00 $574.00 $154.01 $789.15 $349.18 $349.18 $349.18 $349.18 $775.95 $775.95 $775.95 $161.73 $775.95 $775.95 $775.95 $775.95 $775.95 $161.72 $775.95 $789.15 $458.97 $775.95 $789.15 $775.95 $775.95 $582.00 $775.95 $775.95 $775.95 $387.98 $387.98 $614.55 $775.95 $620.76 $349.18 $154.01 N/A $450.08 $775.95 $465.57 $775.95 $161.71 $775.95 N/A N/A 247.374 SUP HCPCS C1713 247.374 - PLATE BN 94MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH SS 2.7 BOTH IP/OP $776.00 $574.00 $154.01 $789.15 $349.18 $349.18 $349.18 $349.18 $775.95 $775.95 $775.95 $161.73 $775.95 $775.95 $775.95 $775.95 $775.95 $161.72 $775.95 $315.66 $458.97 $775.95 $789.15 $775.95 $775.95 $582.00 $775.95 $775.95 $775.95 $387.98 $387.98 $614.55 $775.95 $620.76 $349.18 $154.01 N/A $450.08 $775.95 $465.57 $775.95 $161.71 $775.95 N/A N/A 247.375 SUP HCPCS C1713 247.375 - PLATE BN 44MM NS LCP PRO-PK 5 HL LOPRFL CUT TO LGTH SS 2.4MM BOTH IP/OP $735.50 $544.00 $145.91 $747.68 $330.83 $330.83 $330.83 $330.83 $735.18 $735.18 $735.18 $153.23 $735.18 $735.18 $735.18 $735.18 $735.18 $153.22 $735.18 $299.07 $434.86 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $330.83 $145.91 N/A $426.59 $735.18 $441.11 $735.18 $153.21 $735.18 N/A N/A 247.377 SUP HCPCS C1713 247.377 - PLATE BN 60MM NS LCP PRO-PK 7 HL LOPRFL CUT TO LGTH SS 2.4MM BOTH IP/OP $735.50 $544.00 $145.91 $747.68 $330.83 $330.83 $330.83 $330.83 $735.18 $735.18 $735.18 $153.23 $735.18 $735.18 $735.18 $735.18 $735.18 $153.22 $735.18 $299.07 $434.86 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $330.83 $145.91 N/A $426.59 $735.18 $735.18 $735.18 $153.21 $735.18 N/A N/A 247.612 SUP HCPCS C1713 247.612 - PLATE BN Y 48X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $483.55 $483.55 N/A N/A 247.615 SUP HCPCS C1713 247.615 - PLATE BN T 53MM NS LCP PRO-PK 3 HLE/HD 7 HL SHFT LOPRFL CUT BOTH IP/OP $812.50 $601.00 $161.26 $826.33 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $826.33 $480.59 $812.50 $826.33 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 247.702 SUP HCPCS C1713 247.702 - PLATE BONE X SMALL 24X18MM LOCK STAINLESS STEEL ANKLE FT BOTH IP/OP "$1,439.50" "$1,065.00" $285.69 "$1,463.90" $647.74 $647.74 $647.74 $647.74 "$1,439.43" "$1,439.43" "$1,439.43" $300.01 "$1,439.43" "$1,439.43" "$1,439.43" "$1,439.43" "$1,439.43" $299.99 "$1,439.43" "$1,463.90" $851.42 "$1,439.43" "$1,463.90" "$1,439.43" "$1,439.43" "$1,079.63" "$1,439.43" "$1,439.43" "$1,439.43" $719.72 $719.72 "$1,140.03" "$1,439.43" "$1,151.54" $647.74 $285.69 N/A $834.91 "$1,439.43" $863.66 "$1,439.43" "$1,439.43" "$1,439.43" N/A N/A 247.704 SUP HCPCS C1713 247.704 - PLATE BN MED X 30X20MM NS LCK RND THRD HL SS FT/ANKL 2.4/2.7 BOTH IP/OP "$1,458.00" "$1,079.00" $289.32 "$1,482.48" $655.97 $655.97 $655.97 $655.97 "$1,457.70" "$1,457.70" "$1,457.70" $303.82 "$1,457.70" "$1,457.70" "$1,457.70" "$1,457.70" "$1,457.70" $303.80 "$1,457.70" "$1,482.48" $862.23 "$1,457.70" "$1,482.48" "$1,457.70" "$1,457.70" "$1,093.50" "$1,457.70" "$1,457.70" "$1,457.70" $728.85 $728.85 "$1,154.50" "$1,457.70" "$1,166.16" $655.97 $289.32 N/A $845.64 "$1,457.70" $874.62 "$1,457.70" $303.78 "$1,457.70" N/A N/A 247.706 SUP HCPCS C1713 247.706 - PLATE BONE LARGE 36MM LOCK STAINLESS STEEL ORTHOPEDIC BOTH IP/OP "$1,477.50" "$1,093.00" $293.22 "$1,502.50" $664.82 $664.82 $664.82 $664.82 "$1,477.38" "$1,477.38" "$1,477.38" $307.92 "$1,477.38" "$1,477.38" "$1,477.38" "$1,477.38" "$1,477.38" $307.90 "$1,477.38" "$1,502.50" $873.87 "$1,477.38" "$1,502.50" "$1,477.38" "$1,477.38" "$1,108.13" "$1,477.38" "$1,477.38" "$1,477.38" $738.69 $738.69 "$1,170.08" "$1,477.38" "$1,181.90" $664.82 $293.22 N/A $856.95 "$1,477.38" $886.43 "$1,477.38" $307.89 "$1,477.38" N/A N/A 247.71 SUP HCPCS C1713 247.710 - PLATE BONE 18MM 2 HOLE LOCKING STAINLESS STEEL ANKLE FT BOTH IP/OP $681.00 $504.00 $135.16 $713.38 $306.45 $306.45 $306.45 $306.45 $681.00 $681.00 $681.00 $141.94 $681.00 $681.00 $681.00 $681.00 $681.00 $141.93 $681.00 $713.38 $402.81 $681.00 $713.38 $681.00 $681.00 $510.75 $681.00 $681.00 $681.00 $340.50 $340.50 $539.35 $681.00 $544.80 $306.45 $135.16 N/A $394.98 $681.00 $408.60 $681.00 $141.92 $681.00 N/A N/A 247.711 SUP HCPCS C1713 247.711 - PLATE BONE XS 2.4MM 4MM BOTH IP/OP "$1,461.00" "$1,081.00" $289.88 "$1,485.35" $657.24 $657.24 $657.24 $657.24 "$1,460.53" "$1,460.53" "$1,460.53" $304.41 "$1,460.53" "$1,460.53" "$1,460.53" "$1,460.53" "$1,460.53" $304.39 "$1,460.53" "$1,485.35" $863.90 "$1,460.53" "$1,485.35" "$1,460.53" "$1,460.53" "$1,095.75" "$1,460.53" "$1,460.53" "$1,460.53" $730.27 $730.27 "$1,156.74" "$1,460.53" "$1,168.42" $657.24 $289.88 N/A $847.38 "$1,460.53" $876.32 "$1,460.53" $304.37 "$1,460.53" N/A N/A 248.02 SUP HCPCS C1713 248.02 - PLATE BONE 25MM 2 HOLE DCP STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $239.00 $177.00 $47.40 $238.83 $107.47 $107.47 $107.47 $107.47 $238.83 $238.83 $238.83 $49.78 $238.83 $238.83 $238.83 $238.83 $238.83 $49.77 $238.83 $238.83 $141.27 $238.83 $238.83 $238.83 $238.83 $179.25 $238.83 $238.83 $238.83 $119.42 $119.42 $189.15 $238.83 $191.06 $107.47 $47.40 N/A $138.62 $238.83 $143.30 $238.83 $49.77 $238.83 N/A N/A 248.03 SUP HCPCS C1713 248.03 - PLATE BONE 3.5MM 37X10X3.3MM 3 HOLE DCP STAINLESS STEEL BOTH IP/OP $246.00 $182.00 $48.76 $245.65 $110.54 $110.54 $110.54 $110.54 $245.65 $245.65 $245.65 $51.20 $245.65 $245.65 $245.65 $245.65 $245.65 $51.20 $245.65 $245.65 $145.30 $245.65 $245.65 $245.65 $245.65 $184.50 $245.65 $245.65 $245.65 $122.83 $122.83 $194.55 $245.65 $196.52 $110.54 $48.76 N/A $142.68 $245.65 $147.39 $245.65 $51.19 $245.65 N/A N/A 248.04 SUP HCPCS C1713 248.04 - PLATE BN 49X10X3.3MM NS DCP 4 HL SS PLV 3.5MM CORT SCR SM BOTH IP/OP $261.50 $194.00 $51.89 $265.90 $117.65 $117.65 $117.65 $117.65 $261.45 $261.45 $261.45 $54.49 $261.45 $261.45 $261.45 $261.45 $261.45 $54.49 $261.45 $106.36 $154.65 $261.45 $265.90 $261.45 $261.45 $196.13 $261.45 $261.45 $261.45 $130.73 $130.73 $207.07 $261.45 $209.16 $117.65 $51.89 N/A $151.67 $261.45 $156.87 $261.45 $54.49 $261.45 N/A N/A 248.05 SUP HCPCS C1713 248.05 - PLATE BONE 61X10X3.3MM 5 HOLE DCP STAINLESS STEEL PELVIS BOTH IP/OP $273.00 $202.00 $54.17 $272.95 $122.83 $122.83 $122.83 $122.83 $272.95 $272.95 $272.95 $56.89 $272.95 $272.95 $272.95 $272.95 $272.95 $56.89 $272.95 $109.18 $161.45 $272.95 $272.95 $272.95 $272.95 $204.75 $272.95 $272.95 $272.95 $136.48 $136.48 $216.18 $272.95 $218.36 $122.83 $54.17 N/A $158.34 $272.95 $163.77 $272.95 $56.88 $272.95 N/A N/A 248.06 SUP HCPCS C1713 248.06 - PLATE BN 73X10X3.3MM NS DCP 6 HL SS PLV 3.5MM CORT SCR SM BOTH IP/OP $292.50 $216.00 $58.03 $297.35 $131.57 $131.57 $131.57 $131.57 $292.38 $292.38 $292.38 $60.94 $292.38 $292.38 $292.38 $292.38 $292.38 $60.94 $292.38 $118.94 $172.94 $292.38 $297.35 $292.38 $292.38 $219.38 $292.38 $292.38 $292.38 $146.19 $146.19 $231.56 $292.38 $233.90 $131.57 $58.03 N/A $169.65 $292.38 $175.43 $292.38 $60.93 $292.38 N/A N/A 248.07 SUP HCPCS C1713 248.07 - PLATE BONE 85X10X3.3MM 7 HOLE DCP STAINLESS STEEL PELVIS BOTH IP/OP $304.00 $225.00 $60.26 $308.78 $136.63 $136.63 $136.63 $136.63 $303.63 $303.63 $303.63 $63.28 $303.63 $303.63 $303.63 $303.63 $303.63 $63.28 $303.63 $308.78 $179.60 $303.63 $308.78 $303.63 $303.63 $228.00 $303.63 $303.63 $303.63 $151.82 $151.82 $240.47 $303.63 $242.90 $136.63 $60.26 N/A $176.32 $303.63 $182.18 $303.63 $63.28 $303.63 N/A N/A 248.08 SUP HCPCS C1713 248.08 - PLATE BN 97X10X3.3MM NS DCP 8 HL SS PLV 3.5MM CORT SCR SM BOTH IP/OP $316.50 $234.00 $62.77 $321.65 $142.33 $142.33 $142.33 $142.33 $316.28 $316.28 $316.28 $65.92 $316.28 $316.28 $316.28 $316.28 $316.28 $65.92 $316.28 $128.66 $187.08 $316.28 $321.65 $316.28 $316.28 $237.38 $316.28 $316.28 $316.28 $158.14 $158.14 $250.49 $316.28 $253.02 $142.33 $62.77 N/A $183.57 $316.28 $189.77 $316.28 $65.91 $316.28 N/A N/A 248.09 SUP HCPCS C1713 248.09 - PLATE BN 109X10X3.3MM NS DCP 9 HL SS PLV 3.5MM CORT SCR SM BOTH IP/OP $336.00 $249.00 $66.68 $341.65 $151.18 $151.18 $151.18 $151.18 $335.95 $335.95 $335.95 $70.02 $335.95 $335.95 $335.95 $335.95 $335.95 $70.02 $335.95 $136.66 $198.71 $335.95 $341.65 $335.95 $335.95 $252.00 $335.95 $335.95 $335.95 $167.98 $167.98 $266.07 $335.95 $268.76 $151.18 $66.68 N/A $194.88 $335.95 $335.95 $335.95 $70.01 $335.95 N/A N/A 248.1 SUP HCPCS C1713 248.10 - PLATE BONE 121X10X3.3MM 10 HOLE DCP STAINLESS STEEL PELVIS BOTH IP/OP $329.00 $243.00 $65.28 $344.53 $148.01 $148.01 $148.01 $148.01 $328.90 $328.90 $328.90 $68.55 $328.90 $328.90 $328.90 $328.90 $328.90 $68.55 $328.90 $137.81 $194.54 $328.90 $344.53 $328.90 $328.90 $246.75 $328.90 $328.90 $328.90 $164.45 $164.45 $260.49 $328.90 $263.12 $148.01 $65.28 N/A $190.82 $328.90 $197.34 $328.90 $68.54 $328.90 N/A N/A 248.12 SUP HCPCS C1713 248.12 - PLATE BONE 145X10X3.3MM 12 HOLE DCP STAINLESS STEEL PELVIS BOTH IP/OP $394.00 $292.00 $78.12 $400.30 $177.12 $177.12 $177.12 $177.12 $393.60 $393.60 $393.60 $82.04 $393.60 $393.60 $393.60 $393.60 $393.60 $82.03 $393.60 $400.30 $232.81 $393.60 $400.30 $393.60 $393.60 $295.50 $393.60 $393.60 $393.60 $196.80 $196.80 $311.73 $393.60 $314.88 $177.12 $78.12 N/A $228.52 $393.60 $236.16 $393.60 $82.03 $393.60 N/A N/A 248.14 SUP HCPCS C1713 248.14 - PLATE BONE 169X10X3.3MM 14 HOLE DCP STAINLESS STEEL PELVIS BOTH IP/OP $724.00 $536.00 $143.68 $736.23 $325.77 $325.77 $325.77 $325.77 $723.93 $723.93 $723.93 $150.89 $723.93 $723.93 $723.93 $723.93 $723.93 $150.87 $723.93 $294.49 $428.20 $723.93 $736.23 $723.93 $723.93 $543.00 $723.93 $723.93 $723.93 $361.97 $361.97 $573.35 $723.93 $579.14 $325.77 $143.68 N/A $419.92 $723.93 $723.93 $723.93 $150.87 $723.93 N/A N/A 248.16 SUP HCPCS C1713 248.16 - PLATE BONE 194X10X3.3MM 16 HOLE DCP STAINLESS STEEL PELVIS BOTH IP/OP $834.00 $617.00 $165.44 $847.75 $375.11 $375.11 $375.11 $375.11 $833.58 $833.58 $833.58 $173.74 $833.58 $833.58 $833.58 $833.58 $833.58 $173.73 $833.58 $339.10 $493.06 $833.58 $847.75 $833.58 $833.58 $625.50 $833.58 $833.58 $833.58 $416.79 $416.79 $660.20 $833.58 $666.86 $375.11 $165.44 N/A $483.72 $833.58 $833.58 $833.58 $173.72 $833.58 N/A N/A 248.18 SUP HCPCS C1713 248.18 - PLATE BONE 217X10X3.3MM 18 HOLE DCP STAINLESS STEEL PELVIS BOTH IP/OP $933.50 $691.00 $185.25 $949.25 $420.02 $420.02 $420.02 $420.02 $933.38 $933.38 $933.38 $194.54 $933.38 $933.38 $933.38 $933.38 $933.38 $194.53 $933.38 $949.25 $552.09 $933.38 $949.25 $933.38 $933.38 $700.13 $933.38 $933.38 $933.38 $466.69 $466.69 $739.24 $933.38 $746.70 $420.02 $185.25 N/A $541.43 $933.38 $560.03 $933.38 $194.52 $933.38 N/A N/A 248.2 SUP HCPCS C1713 248.20 - PLATE BONE 3.5MM 242X10X3.3MM 20 HOLE DCP STAINLESS STEEL BOTH IP/OP $999.00 $739.00 $198.28 $999.00 $449.55 $449.55 $449.55 $449.55 $999.00 $999.00 $999.00 $208.22 $999.00 $999.00 $999.00 $999.00 $999.00 $208.20 $999.00 $999.00 $590.91 $999.00 $999.00 $999.00 $999.00 $749.25 $999.00 $999.00 $999.00 $499.50 $499.50 $791.21 $999.00 $799.20 $449.55 $198.28 N/A $579.42 $999.00 $599.40 $999.00 $208.19 $999.00 N/A N/A 248.22 SUP HCPCS C1713 248.22 - PLATE BONE 3.5MM 265X10X3.3MM 22 HOLE DCP STAINLESS STEEL BOTH IP/OP "$1,090.50" $807.00 $216.42 "$1,090.43" $490.69 $490.69 $490.69 $490.69 "$1,090.43" "$1,090.43" "$1,090.43" $227.27 "$1,090.43" "$1,090.43" "$1,090.43" "$1,090.43" "$1,090.43" $227.26 "$1,090.43" "$1,090.43" $644.99 "$1,090.43" "$1,090.43" "$1,090.43" "$1,090.43" $817.88 "$1,090.43" "$1,090.43" "$1,090.43" $545.22 $545.22 $863.62 "$1,090.43" $872.34 $490.69 $216.42 N/A $632.49 "$1,090.43" $654.26 "$1,090.43" $227.25 "$1,090.43" N/A N/A 249.615 SUP HCPCS C1713 249.615 - PLATE BONE T 58MM 7X3 HOLE LCP STAINLESS STEEL SMALL BONE BOTH IP/OP "$1,351.00" "$1,000.00" $268.12 "$1,373.85" $607.90 $607.90 $607.90 $607.90 "$1,350.88" "$1,350.88" "$1,350.88" $281.56 "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" $281.54 "$1,350.88" $549.54 $799.05 "$1,350.88" "$1,373.85" "$1,350.88" "$1,350.88" "$1,013.25" "$1,350.88" "$1,350.88" "$1,350.88" $675.44 $675.44 "$1,069.90" "$1,350.88" "$1,080.70" $607.90 $268.12 N/A $783.58 "$1,350.88" $810.53 "$1,350.88" $281.52 "$1,350.88" N/A N/A 249.669 SUP HCPCS C1713 249.669 - PLATE BONE Y 60MM 3X7 HOLE LCP STAINLESS STEEL ANKLE FT BOTH IP/OP "$1,351.00" "$1,000.00" $268.12 "$1,373.85" $607.90 $607.90 $607.90 $607.90 "$1,350.88" "$1,350.88" "$1,350.88" $281.56 "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" $281.54 "$1,350.88" $549.54 $799.05 "$1,350.88" "$1,373.85" "$1,350.88" "$1,350.88" "$1,013.25" "$1,350.88" "$1,350.88" "$1,350.88" $675.44 $675.44 "$1,069.90" "$1,350.88" "$1,080.70" $607.90 $268.12 N/A $783.58 "$1,350.88" "$1,350.88" "$1,350.88" $281.52 "$1,350.88" N/A N/A 249.67 SUP HCPCS C1713 249.670 - PLATE BONE T 58MM 2X7 HOLE LCP STAINLESS STEEL ANKLE FT BOTH IP/OP "$1,312.00" $971.00 $260.31 "$1,373.85" $590.19 $590.19 $590.19 $590.19 "$1,311.53" "$1,311.53" "$1,311.53" $273.36 "$1,311.53" "$1,311.53" "$1,311.53" "$1,311.53" "$1,311.53" $273.34 "$1,311.53" "$1,373.85" $775.77 "$1,311.53" "$1,373.85" "$1,311.53" "$1,311.53" $984.00 "$1,311.53" "$1,311.53" "$1,311.53" $655.77 $655.77 "$1,038.73" "$1,311.53" "$1,049.22" $590.19 $260.31 N/A $760.96 "$1,311.53" $786.92 "$1,311.53" $273.32 "$1,311.53" N/A N/A 249.674 SUP HCPCS C1713 249.674 - PLATE BONE 36MM 4 HOLE LCP STAINLESS STEEL ANKLE FT NONSTRL BOTH IP/OP $735.50 $544.00 $145.91 $747.68 $330.83 $330.83 $330.83 $330.83 $735.18 $735.18 $735.18 $153.23 $735.18 $735.18 $735.18 $735.18 $735.18 $153.22 $735.18 $747.68 $434.86 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $330.83 $145.91 N/A $426.59 $735.18 $441.11 $735.18 $153.21 $735.18 N/A N/A 249.676 SUP HCPCS C1713 249.676 - PLATE BONE 52MM 6 HOLE LP LCP STAINLESS STEEL SMALL BONE BOTH IP/OP $735.50 $544.00 $145.91 $747.68 $330.83 $330.83 $330.83 $330.83 $735.18 $735.18 $735.18 $153.23 $735.18 $735.18 $735.18 $735.18 $735.18 $153.22 $735.18 $747.68 $434.86 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $330.83 $145.91 N/A $426.59 $735.18 $441.11 $735.18 $153.21 $735.18 N/A N/A 249.678 SUP HCPCS C1713 249.678 - PLATE BONE 68MM 8 HOLE LCP STAINLESS STEEL SMALL BONE BOTH IP/OP $735.50 $544.00 $145.91 $747.68 $330.83 $330.83 $330.83 $330.83 $735.18 $735.18 $735.18 $153.23 $735.18 $735.18 $735.18 $735.18 $735.18 $153.22 $735.18 $299.07 $434.86 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $330.83 $145.91 N/A $426.59 $735.18 $441.11 $735.18 $153.21 $735.18 N/A N/A 249.679 SUP HCPCS C1713 249.679 - PLATE BONE 59MM 7 SHAFT HOLE LCP STAINLESS STEEL CONDYLE BOTH IP/OP "$1,103.50" $817.00 $219.01 "$1,122.23" $496.57 $496.57 $496.57 $496.57 "$1,103.48" "$1,103.48" "$1,103.48" $229.99 "$1,103.48" "$1,103.48" "$1,103.48" "$1,103.48" "$1,103.48" $229.98 "$1,103.48" $448.89 $652.71 "$1,103.48" "$1,122.23" "$1,103.48" "$1,103.48" $827.63 "$1,103.48" "$1,103.48" "$1,103.48" $551.74 $551.74 $873.96 "$1,103.48" $882.78 $496.57 $219.01 N/A $640.03 "$1,103.48" $662.09 "$1,103.48" $229.97 "$1,103.48" N/A N/A 249.68 SUP HCPCS C1713 249.680 - PLATE BN 40MM NS LCP 4 HL LOPRFL CUT TO LGTH SS 2.7MM SCR BOTH IP/OP $753.50 $558.00 $149.52 $789.15 $339.01 $339.01 $339.01 $339.01 $753.35 $753.35 $753.35 $157.02 $753.35 $753.35 $753.35 $753.35 $753.35 $157.01 $753.35 $789.15 $445.61 $753.35 $789.15 $753.35 $753.35 $565.13 $753.35 $753.35 $753.35 $376.68 $376.68 $596.65 $753.35 $602.68 $339.01 $149.52 N/A $437.03 $753.35 $452.01 $753.35 $157.00 $753.35 N/A N/A 249.681 SUP HCPCS C1713 249.681 - PLATE BONE 49MM 5 HOLE LCP STAINLESS STEEL ANKLE FT NONSTRL BOTH IP/OP $776.00 $574.00 $154.01 $789.15 $349.18 $349.18 $349.18 $349.18 $775.95 $775.95 $775.95 $161.73 $775.95 $775.95 $775.95 $775.95 $775.95 $161.72 $775.95 $315.66 $458.97 $775.95 $789.15 $775.95 $775.95 $582.00 $775.95 $775.95 $775.95 $387.98 $387.98 $614.55 $775.95 $620.76 $349.18 $154.01 N/A $450.08 $775.95 $465.57 $775.95 $161.71 $775.95 N/A N/A 249.682 SUP HCPCS C1713 249.682 - PLATE BONE LP 58MM 6 HOLE CUT TO LENGTH LCP STAINLESS STEEL BOTH IP/OP $776.00 $574.00 $154.01 $789.15 $349.18 $349.18 $349.18 $349.18 $775.95 $775.95 $775.95 $161.73 $775.95 $775.95 $775.95 $775.95 $775.95 $161.72 $775.95 $789.15 $458.97 $775.95 $789.15 $775.95 $775.95 $582.00 $775.95 $775.95 $775.95 $387.98 $387.98 $614.55 $775.95 $620.76 $349.18 $154.01 N/A $450.08 $775.95 $465.57 $775.95 $161.71 $775.95 N/A N/A 249.683 SUP HCPCS C1713 249.683 - PLATE BONE 6.7CM 7 HOLE LCP STAINLESS STEEL SMALL BONE BOTH IP/OP $776.00 $574.00 $154.01 $789.15 $349.18 $349.18 $349.18 $349.18 $775.95 $775.95 $775.95 $161.73 $775.95 $775.95 $775.95 $775.95 $775.95 $161.72 $775.95 $315.66 $458.97 $775.95 $789.15 $775.95 $775.95 $582.00 $775.95 $775.95 $775.95 $387.98 $387.98 $614.55 $775.95 $620.76 $349.18 $154.01 N/A $450.08 $775.95 $465.57 $775.95 $161.71 $775.95 N/A N/A 249.684 SUP HCPCS C1713 249.684 - PLATE BONE 66MM 7 HOLE LCP STAINLESS STEEL CONDYLE NONSTRL BOTH IP/OP "$1,203.50" $891.00 $238.82 "$1,223.73" $541.48 $541.48 $541.48 $541.48 "$1,203.28" "$1,203.28" "$1,203.28" $250.79 "$1,203.28" "$1,203.28" "$1,203.28" "$1,203.28" "$1,203.28" $250.78 "$1,203.28" "$1,223.73" $711.74 "$1,203.28" "$1,223.73" "$1,203.28" "$1,203.28" $902.63 "$1,203.28" "$1,203.28" "$1,203.28" $601.64 $601.64 $953.00 "$1,203.28" $962.62 $541.48 $238.82 N/A $698.03 "$1,203.28" "$1,203.28" "$1,203.28" $250.76 "$1,203.28" N/A N/A 249.685 SUP HCPCS C1713 249.685 - PLATE BONE T 32MM 2X3 HOLE LCP STAINLESS STEEL ANKLE FT BOTH IP/OP "$1,351.00" "$1,000.00" $268.12 "$1,373.85" $607.90 $607.90 $607.90 $607.90 "$1,350.88" "$1,350.88" "$1,350.88" $281.56 "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" $281.54 "$1,350.88" "$1,373.85" $799.05 "$1,350.88" "$1,373.85" "$1,350.88" "$1,350.88" "$1,013.25" "$1,350.88" "$1,350.88" "$1,350.88" $675.44 $675.44 "$1,069.90" "$1,350.88" "$1,080.70" $607.90 $268.12 N/A $783.58 "$1,350.88" $810.53 "$1,350.88" "$1,350.88" "$1,350.88" N/A N/A 249.686 SUP HCPCS C1713 249.686 - PLATE BN OB R L 35MM NS LCP 2 HLE/HD 3 HL SHFT LOPRFL CUT TO BOTH IP/OP $737.00 $545.00 $146.19 $749.10 $331.46 $331.46 $331.46 $331.46 $736.58 $736.58 $736.58 $153.52 $736.58 $736.58 $736.58 $736.58 $736.58 $153.51 $736.58 $749.10 $435.69 $736.58 $749.10 $736.58 $736.58 $552.75 $736.58 $736.58 $736.58 $368.29 $368.29 $583.37 $736.58 $589.26 $331.46 $146.19 N/A $427.46 $736.58 $441.95 $736.58 $153.50 $736.58 N/A N/A 249.687 SUP HCPCS C1713 249.687 - PLATE BN OB L L 35MM NS LCP 2 HLE/HD 3 HL SHFT LOPRFL CUT TO BOTH IP/OP $737.00 $545.00 $146.19 $749.10 $331.46 $331.46 $331.46 $331.46 $736.58 $736.58 $736.58 $153.52 $736.58 $736.58 $736.58 $736.58 $736.58 $153.51 $736.58 $749.10 $435.69 $736.58 $749.10 $736.58 $736.58 $552.75 $736.58 $736.58 $736.58 $368.29 $368.29 $583.37 $736.58 $589.26 $331.46 $146.19 N/A $427.46 $736.58 $441.95 $736.58 $153.50 $736.58 N/A N/A 249.688 SUP HCPCS C1713 249.688 - PLATE BONE L 32MM 2X3 HOLE RIGHT OBLIQUE LCP STAINLESS STEEL BOTH IP/OP $737.00 $545.00 $146.19 $749.10 $331.46 $331.46 $331.46 $331.46 $736.58 $736.58 $736.58 $153.52 $736.58 $736.58 $736.58 $736.58 $736.58 $153.51 $736.58 $299.64 $435.69 $736.58 $749.10 $736.58 $736.58 $552.75 $736.58 $736.58 $736.58 $368.29 $368.29 $583.37 $736.58 $589.26 $331.46 $146.19 N/A $427.46 $736.58 $441.95 $736.58 $153.50 $736.58 N/A N/A 249.689 SUP HCPCS C1713 249.689 - PLATE BN L 32MM NS LCP 2 HLE/HD 3 HL SHFT LOPRFL CUT TO LGTH BOTH IP/OP $737.00 $545.00 $146.19 $749.10 $331.46 $331.46 $331.46 $331.46 $736.58 $736.58 $736.58 $153.52 $736.58 $736.58 $736.58 $736.58 $736.58 $153.51 $736.58 $299.64 $435.69 $736.58 $749.10 $736.58 $736.58 $552.75 $736.58 $736.58 $736.58 $368.29 $368.29 $583.37 $736.58 $589.26 $331.46 $146.19 N/A $427.46 $736.58 $441.95 $736.58 $153.50 $736.58 N/A N/A 249.69 SUP HCPCS C1713 249.690 - PLATE BONE 31MM 5 HOLE LOCKING HIND MIDFT NONSTRL 2.4-2.7MM BOTH IP/OP "$1,455.00" "$1,077.00" $288.75 "$1,523.95" $654.67 $654.67 $654.67 $654.67 "$1,454.83" "$1,454.83" "$1,454.83" $303.22 "$1,454.83" "$1,454.83" "$1,454.83" "$1,454.83" "$1,454.83" $303.20 "$1,454.83" "$1,523.95" $860.53 "$1,454.83" "$1,523.95" "$1,454.83" "$1,454.83" "$1,091.25" "$1,454.83" "$1,454.83" "$1,454.83" $727.42 $727.42 "$1,152.23" "$1,454.83" "$1,163.86" $654.67 $288.75 N/A $843.90 "$1,454.83" $872.90 "$1,454.83" "$1,454.83" "$1,454.83" N/A N/A 249.691 SUP HCPCS C1713 249.691 - PLATE BN 45MM NS 8 HL LCK SS HND/MDFT 2.4/2.7MM SCR BOTH IP/OP "$1,529.50" "$1,132.00" $303.55 "$1,555.40" $688.23 $688.23 $688.23 $688.23 "$1,529.40" "$1,529.40" "$1,529.40" $318.77 "$1,529.40" "$1,529.40" "$1,529.40" "$1,529.40" "$1,529.40" $318.74 "$1,529.40" "$1,555.40" $904.64 "$1,529.40" "$1,555.40" "$1,529.40" "$1,529.40" "$1,147.13" "$1,529.40" "$1,529.40" "$1,529.40" $764.70 $764.70 "$1,211.28" "$1,529.40" "$1,223.52" $688.23 $303.55 N/A $887.11 "$1,529.40" $917.64 "$1,529.40" $318.73 "$1,529.40" N/A N/A 249.697 SUP HCPCS C1713 249.697 - PLATE BONE 32MM 2X4 HOLE T LCP STAINLESS STEEL CONDYLE BOTH IP/OP "$1,351.00" "$1,000.00" $268.12 "$1,373.85" $607.90 $607.90 $607.90 $607.90 "$1,350.88" "$1,350.88" "$1,350.88" $281.56 "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" $281.54 "$1,350.88" "$1,373.85" $799.05 "$1,350.88" "$1,373.85" "$1,350.88" "$1,350.88" "$1,013.25" "$1,350.88" "$1,350.88" "$1,350.88" $675.44 $675.44 "$1,069.90" "$1,350.88" "$1,080.70" $607.90 $268.12 N/A $783.58 "$1,350.88" "$1,350.88" "$1,350.88" $281.52 "$1,350.88" N/A N/A 249.698 SUP HCPCS C1713 249.698 - PLATE BONE 42MM 2 HOLE HEAD 4 HOLE SHAFT L RIGHT OBLIQUE LCP BOTH IP/OP $745.50 $552.00 $147.87 $757.70 $335.26 $335.26 $335.26 $335.26 $745.03 $745.03 $745.03 $155.28 $745.03 $745.03 $745.03 $745.03 $745.03 $155.27 $745.03 $303.08 $440.69 $745.03 $757.70 $745.03 $745.03 $559.13 $745.03 $745.03 $745.03 $372.52 $372.52 $590.06 $745.03 $596.02 $335.26 $147.87 N/A $432.39 $745.03 $745.03 $745.03 $155.26 $745.03 N/A N/A 249.699 SUP HCPCS C1713 249.699 - PLATE BONE T 42MM 2 HOLE HEAD 4 HOLE SHAFT LEFT OBLIQUE LCP BOTH IP/OP $745.50 $552.00 $147.87 $757.70 $335.26 $335.26 $335.26 $335.26 $745.03 $745.03 $745.03 $155.28 $745.03 $745.03 $745.03 $745.03 $745.03 $155.27 $745.03 $757.70 $440.69 $745.03 $757.70 $745.03 $745.03 $559.13 $745.03 $745.03 $745.03 $372.52 $372.52 $590.06 $745.03 $596.02 $335.26 $147.87 N/A $432.39 $745.03 $447.02 $745.03 $155.26 $745.03 N/A N/A 249.701 SUP HCPCS C1713 249.701 - PLATE BONE 40MM 2 HOLE HEAD 4 HOLE SHAFT L LCP STAINLESS BOTH IP/OP $745.50 $552.00 $147.87 $757.70 $335.26 $335.26 $335.26 $335.26 $745.03 $745.03 $745.03 $155.28 $745.03 $745.03 $745.03 $745.03 $745.03 $155.27 $745.03 $757.70 $440.69 $745.03 $757.70 $745.03 $745.03 $559.13 $745.03 $745.03 $745.03 $372.52 $372.52 $590.06 $745.03 $596.02 $335.26 $147.87 N/A $432.39 $745.03 $447.02 $745.03 $155.26 $745.03 N/A N/A 249.702 SUP HCPCS C1713 249.702 - PLATE BONE L 40MM 2X4 HOLE LCP STAINLESS STEEL LEFT SMALL BOTH IP/OP $745.50 $552.00 $147.87 $757.70 $335.26 $335.26 $335.26 $335.26 $745.03 $745.03 $745.03 $155.28 $745.03 $745.03 $745.03 $745.03 $745.03 $155.27 $745.03 $757.70 $440.69 $745.03 $757.70 $745.03 $745.03 $559.13 $745.03 $745.03 $745.03 $372.52 $372.52 $590.06 $745.03 $596.02 $335.26 $147.87 N/A $432.39 $745.03 $447.02 $745.03 $155.26 $745.03 N/A N/A 249.906 SUP HCPCS C1713 249.906 - PLATE BN STRG 36X6.3X1.25MM NS 6 HL LOPRFL PRECONTOUR CUT TO BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $451.75 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $266.52 $444.20 $92.57 $444.20 N/A N/A 249.912 SUP HCPCS C1713 249.912 - PLATE BN STRG 72X6.3X1.25MM NS 12 HL LOPRFL PRECONTOUR CUT BOTH IP/OP $523.00 $387.00 $103.79 $531.83 $235.32 $235.32 $235.32 $235.32 $522.93 $522.93 $522.93 $108.99 $522.93 $522.93 $522.93 $522.93 $522.93 $108.98 $522.93 $212.73 $309.31 $522.93 $531.83 $522.93 $522.93 $392.25 $522.93 $522.93 $522.93 $261.47 $261.47 $414.16 $522.93 $418.34 $235.32 $103.79 N/A $303.34 $522.93 $313.76 $522.93 $108.98 $522.93 N/A N/A 249.913 SUP HCPCS C1713 249.913 - PLATE BN T 54X6.3X1.25MM NS 2 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $486.38 $486.38 N/A N/A 249.914 SUP HCPCS C1713 249.914 - PLATE BN T 54X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $517.50 $383.00 $102.67 $526.10 $232.79 $232.79 $232.79 $232.79 $517.30 $517.30 $517.30 $107.82 $517.30 $517.30 $517.30 $517.30 $517.30 $107.81 $517.30 $210.44 $305.98 $517.30 $526.10 $517.30 $517.30 $388.13 $517.30 $517.30 $517.30 $258.65 $258.65 $409.70 $517.30 $413.84 $232.79 $102.67 N/A $300.15 $517.30 $310.38 $517.30 $107.81 $517.30 N/A N/A 249.915 SUP HCPCS C1713 249.915 - PLATE BN Y 56X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $514.50 $381.00 $102.11 $523.23 $231.52 $231.52 $231.52 $231.52 $514.48 $514.48 $514.48 $107.23 $514.48 $514.48 $514.48 $514.48 $514.48 $107.22 $514.48 $209.29 $304.31 $514.48 $523.23 $514.48 $514.48 $385.88 $514.48 $514.48 $514.48 $257.24 $257.24 $407.47 $514.48 $411.58 $231.52 $102.11 N/A $298.41 $514.48 $308.69 $514.48 $107.22 $514.48 N/A N/A 249.916 SUP HCPCS C1713 249.916 - PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH BOTH IP/OP $516.00 $382.00 $102.39 $524.68 $232.16 $232.16 $232.16 $232.16 $515.90 $515.90 $515.90 $107.53 $515.90 $515.90 $515.90 $515.90 $515.90 $107.52 $515.90 $524.68 $305.15 $515.90 $524.68 $515.90 $515.90 $387.00 $515.90 $515.90 $515.90 $257.95 $257.95 $408.59 $515.90 $412.72 $232.16 $102.39 N/A $299.28 $515.90 $309.54 $515.90 $515.90 $515.90 N/A N/A 249.917 SUP HCPCS C1713 249.917 - PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH BOTH IP/OP $516.00 $382.00 $102.39 $524.68 $232.16 $232.16 $232.16 $232.16 $515.90 $515.90 $515.90 $107.53 $515.90 $515.90 $515.90 $515.90 $515.90 $107.52 $515.90 $524.68 $305.15 $515.90 $524.68 $515.90 $515.90 $387.00 $515.90 $515.90 $515.90 $257.95 $257.95 $408.59 $515.90 $412.72 $232.16 $102.39 N/A $299.28 $515.90 $309.54 $515.90 $107.51 $515.90 N/A N/A 249.919 SUP HCPCS C1713 249.919 - PLATE BN T 66MM NS 3 HLE/HD 10 HL SHFT LOPRFL CUT TO LGTH SS BOTH IP/OP $472.50 $350.00 $93.75 $480.35 $212.55 $212.55 $212.55 $212.55 $472.33 $472.33 $472.33 $98.45 $472.33 $472.33 $472.33 $472.33 $472.33 $98.44 $472.33 $192.14 $279.38 $472.33 $480.35 $472.33 $472.33 $354.38 $472.33 $472.33 $472.33 $236.17 $236.17 $374.09 $472.33 $377.86 $212.55 $93.75 N/A $274.05 $472.33 $283.40 $472.33 $98.43 $472.33 N/A N/A 249.921 SUP HCPCS C1713 249.921 - PLATE BN NS LOPRFL CUT TO LGTH SS CUBOID 2.4 MM SCR MODFT BOTH IP/OP $689.00 $510.00 $136.71 $700.50 $309.96 $309.96 $309.96 $309.96 $688.80 $688.80 $688.80 $143.56 $688.80 $688.80 $688.80 $688.80 $688.80 $143.55 $688.80 $280.20 $407.43 $688.80 $700.50 $688.80 $688.80 $516.75 $688.80 $688.80 $688.80 $344.40 $344.40 $545.53 $688.80 $551.04 $309.96 $136.71 N/A $399.62 $688.80 $413.28 $688.80 $143.55 $688.80 N/A N/A 249.924 SUP HCPCS C1713 249.924 - PLATE BN 31X6.5X1.6MM NS LC DCP 4 HL LOPRFL PRECONTOUR CUT BOTH IP/OP $548.50 $406.00 $108.81 $557.55 $246.70 $246.70 $246.70 $246.70 $548.23 $548.23 $548.23 $114.26 $548.23 $548.23 $548.23 $548.23 $548.23 $114.26 $548.23 $223.02 $324.28 $548.23 $557.55 $548.23 $548.23 $411.38 $548.23 $548.23 $548.23 $274.12 $274.12 $434.20 $548.23 $438.58 $246.70 $108.81 N/A $318.13 $548.23 $548.23 $548.23 $114.25 $548.23 N/A N/A 249.926 SUP HCPCS C1713 249.926 - PLATE BN 47X6.5X1.6MM NS LC DCP 6 HL LOPRFL PRECONTOUR CUT BOTH IP/OP $618.50 $458.00 $122.76 $629.03 $278.33 $278.33 $278.33 $278.33 $618.50 $618.50 $618.50 $128.91 $618.50 $618.50 $618.50 $618.50 $618.50 $128.90 $618.50 $251.61 $365.84 $618.50 $629.03 $618.50 $618.50 $463.88 $618.50 $618.50 $618.50 $309.25 $309.25 $489.85 $618.50 $494.80 $278.33 $122.76 N/A $358.73 $618.50 $371.10 $618.50 $128.90 $618.50 N/A N/A 249.928 SUP HCPCS C1713 249.928 - PLATE BN 63X6.5X1.6MM NS LC DCP 8 HL LOPRFL PRECONTOUR CUT BOTH IP/OP $668.00 $494.00 $132.52 $679.05 $300.47 $300.47 $300.47 $300.47 $667.70 $667.70 $667.70 $139.17 $667.70 $667.70 $667.70 $667.70 $667.70 $139.16 $667.70 $271.62 $394.94 $667.70 $679.05 $667.70 $667.70 $501.00 $667.70 $667.70 $667.70 $333.85 $333.85 $528.82 $667.70 $534.16 $300.47 $132.52 N/A $387.44 $667.70 $400.62 $667.70 $139.15 $667.70 N/A N/A 254.862 SUP Custom 27803010 254.862 - CLAMP EXFIX SMALL ROD TO ROD PARALLEL SPN BOTH IP/OP "$1,217.50" $901.00 $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $487.00 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 "$1,217.50" N/A $706.15 "$1,217.50" $730.50 "$1,217.50" "$1,217.50" "$1,217.50" N/A N/A 254.864 SUP Custom 27803010 254.864 - CLAMP EXFIX LARGE ROD TO ROD PARALLEL SPN BOTH IP/OP "$1,217.50" $901.00 $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $487.00 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 "$1,217.50" N/A $706.15 "$1,217.50" $730.50 "$1,217.50" "$1,217.50" "$1,217.50" N/A N/A 254.866 SUP Custom 27803010 254.866 - CONNECTOR ROD 6MM PARALLEL CLMP STAINLESS STEEL SPN BOTH IP/OP "$1,217.50" $901.00 $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $487.00 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 "$1,217.50" N/A $706.15 "$1,217.50" $730.50 "$1,217.50" "$1,217.50" "$1,217.50" N/A N/A 254.868 SUP Custom 27803010 254.868 - CONNECTOR ROD 6MM PARALLEL CLMP STAINLESS STEEL SPN BOTH IP/OP "$1,217.50" $901.00 $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $216.72 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $487.00 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 "$1,217.50" N/A $706.15 "$1,217.50" $730.50 "$1,217.50" "$1,217.50" "$1,217.50" N/A N/A 260.06 SUP HCPCS C1713 260.060 - PLATE BONE 80MM 10 HOLE RECONSTRUCTION STAINLESS STEEL BOTH IP/OP "$2,682.50" "$1,985.00" $532.41 "$2,682.50" "$1,207.13" "$1,207.13" "$1,207.13" "$1,207.13" "$2,682.50" "$2,682.50" "$2,682.50" $559.10 "$2,682.50" "$2,682.50" "$2,682.50" "$2,682.50" "$2,682.50" $559.06 "$2,682.50" "$1,073.00" "$1,322.47" "$2,682.50" "$2,682.50" "$2,682.50" "$2,682.50" "$2,011.88" "$2,682.50" "$2,682.50" "$2,682.50" "$1,341.25" "$1,341.25" "$2,124.54" "$2,682.50" "$2,146.00" "$1,207.13" $532.41 N/A "$1,555.85" "$2,682.50" "$1,609.50" "$2,682.50" $559.03 "$2,682.50" N/A N/A 260.062 SUP HCPCS C1713 260.062 - PLATE BONE 96MM 12 HOLE RECONSTRUCTION STAINLESS STEEL BOTH IP/OP "$2,760.00" "$2,042.00" $547.79 "$2,760.00" "$1,242.00" "$1,242.00" "$1,242.00" "$1,242.00" "$2,760.00" "$2,760.00" "$2,760.00" $575.25 "$2,760.00" "$2,760.00" "$2,760.00" "$2,760.00" "$2,760.00" $575.21 "$2,760.00" "$1,104.00" "$1,360.68" "$2,760.00" "$2,760.00" "$2,760.00" "$2,760.00" "$2,070.00" "$2,760.00" "$2,760.00" "$2,760.00" "$1,380.00" "$1,380.00" "$2,185.92" "$2,760.00" "$2,208.00" "$1,242.00" $547.79 N/A "$1,600.80" "$2,760.00" "$2,760.00" "$2,760.00" $575.18 "$2,760.00" N/A N/A 260.064 SUP HCPCS C1713 260.064 - PLATE BONE 112MM 14 HOLE RECONSTRUCTION STAINLESS STEEL BOTH IP/OP "$2,835.00" "$2,098.00" $562.68 "$2,835.00" "$1,275.75" "$1,275.75" "$1,275.75" "$1,275.75" "$2,835.00" "$2,835.00" "$2,835.00" $590.88 "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" $590.85 "$2,835.00" "$1,134.00" "$1,397.66" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,126.25" "$2,835.00" "$2,835.00" "$2,835.00" "$1,417.50" "$1,417.50" "$2,245.32" "$2,835.00" "$2,268.00" "$1,275.75" $562.68 N/A "$1,644.30" "$2,835.00" "$1,701.00" "$2,835.00" $590.81 "$2,835.00" N/A N/A 260.066 SUP HCPCS C1713 260.066 - PLATE BONE 128MM 16 HOLE RECONSTRUCTION STAINLESS STEEL BOTH IP/OP "$2,912.50" "$2,155.00" $578.06 "$2,912.50" "$1,310.63" "$1,310.63" "$1,310.63" "$1,310.63" "$2,912.50" "$2,912.50" "$2,912.50" $607.04 "$2,912.50" "$2,912.50" "$2,912.50" "$2,912.50" "$2,912.50" $607.00 "$2,912.50" "$1,165.00" "$1,435.86" "$2,912.50" "$2,912.50" "$2,912.50" "$2,912.50" "$2,184.38" "$2,912.50" "$2,912.50" "$2,912.50" "$1,456.25" "$1,456.25" "$2,306.70" "$2,912.50" "$2,330.00" "$1,310.63" $578.06 N/A "$1,689.25" "$2,912.50" "$2,912.50" "$2,912.50" $606.97 "$2,912.50" N/A N/A 260.068 SUP HCPCS C1713 260.068 - PLATE BONE 144MM 18 HOLE RECONSTRUCTION STAINLESS STEEL BOTH IP/OP "$2,990.00" "$2,213.00" $593.44 "$2,990.00" "$1,345.50" "$1,345.50" "$1,345.50" "$1,345.50" "$2,990.00" "$2,990.00" "$2,990.00" $623.19 "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" $623.15 "$2,990.00" "$1,196.00" "$1,474.07" "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" "$2,242.50" "$2,990.00" "$2,990.00" "$2,990.00" "$1,495.00" "$1,495.00" "$2,368.08" "$2,990.00" "$2,392.00" "$1,345.50" $593.44 N/A "$1,734.20" "$2,990.00" "$1,794.00" "$2,990.00" $623.12 "$2,990.00" N/A N/A 260.07 SUP HCPCS C1713 260.070 - PLATE BONE 160MM 20 HOLE RECONSTRUCTION STAINLESS STEEL BOTH IP/OP "$3,067.50" "$2,270.00" $608.82 "$3,067.50" "$1,380.38" "$1,380.38" "$1,380.38" "$1,380.38" "$3,067.50" "$3,067.50" "$3,067.50" $639.34 "$3,067.50" "$3,067.50" "$3,067.50" "$3,067.50" "$3,067.50" $639.30 "$3,067.50" "$3,067.50" "$1,512.28" "$3,067.50" "$3,067.50" "$3,067.50" "$3,067.50" "$2,300.63" "$3,067.50" "$3,067.50" "$3,067.50" "$1,533.75" "$1,533.75" "$2,429.46" "$3,067.50" "$2,454.00" "$1,380.38" $608.82 N/A "$1,779.15" "$3,067.50" "$1,840.50" "$3,067.50" $639.27 "$3,067.50" N/A N/A 260.072 SUP HCPCS C1713 260.072 - PLATE BONE 176MM 22 HOLE RECONSTRUCTION STAINLESS STEEL BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$1,255.00" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$1,882.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 260.074 SUP HCPCS C1713 260.074 - PLATE BONE 192MM 24 HOLE RECONSTRUCTION STAINLESS STEEL BOTH IP/OP "$3,217.50" "$2,381.00" $638.59 "$3,217.50" "$1,447.88" "$1,447.88" "$1,447.88" "$1,447.88" "$3,217.50" "$3,217.50" "$3,217.50" $670.61 "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" $670.56 "$3,217.50" "$3,217.50" "$1,586.23" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$2,413.13" "$3,217.50" "$3,217.50" "$3,217.50" "$1,608.75" "$1,608.75" "$2,548.26" "$3,217.50" "$2,574.00" "$1,447.88" $638.59 N/A "$1,866.15" "$3,217.50" "$1,930.50" "$3,217.50" $670.53 "$3,217.50" N/A N/A 275.9 SUP Custom 27803010 275.900 - CAP END 3-4MM STAINLESS STEEL ORTHOPEDIC ELSTIC NAIL BOTH IP/OP $151.50 $112.00 $26.96 $158.68 $151.48 $151.48 $151.48 $151.48 $151.48 $151.48 $26.96 $151.48 $151.48 $151.48 $151.48 $151.48 $151.48 $31.57 $151.48 $63.47 $151.48 $151.48 $158.68 $151.48 $151.48 $113.63 $151.48 $151.48 $151.48 $75.74 $75.74 $119.97 $151.48 $121.18 $68.17 $151.48 N/A $87.87 $151.48 $90.89 $151.48 $151.48 $151.48 N/A N/A 275.905 SUP Custom 27803010 275.905 - CAP END STAINLESS STEEL NONSTRL 1.5-2.5 MM ELAST NAIL BOTH IP/OP $156.50 $116.00 $27.77 $158.68 $156.03 $156.03 $156.03 $156.03 $156.03 $156.03 $27.77 $156.03 $156.03 $156.03 $156.03 $156.03 $156.03 $32.52 $156.03 $63.47 $156.03 $156.03 $158.68 $156.03 $156.03 $117.38 $156.03 $156.03 $156.03 $78.02 $78.02 $123.58 $156.03 $124.82 $70.21 $156.03 N/A $90.77 $156.03 $93.62 $156.03 $156.03 $156.03 N/A N/A 275.915 SUP HCPCS C1713 275.915 - NAIL INTRAMEDULLARY 1.5MM 300MM ELAST STAINLESS STEEL BOTH IP/OP $493.50 $365.00 $97.93 $501.80 $222.03 $222.03 $222.03 $222.03 $493.40 $493.40 $493.40 $102.84 $493.40 $493.40 $493.40 $493.40 $493.40 $102.83 $493.40 $501.80 $291.85 $493.40 $501.80 $493.40 $493.40 $370.13 $493.40 $493.40 $493.40 $246.70 $246.70 $390.77 $493.40 $394.72 $222.03 $97.93 N/A $286.23 $493.40 $296.04 $493.40 $102.82 $493.40 N/A N/A 275.92 SUP HCPCS C1713 275.920 - NAIL INTRAMEDULLARY 2MM 440MM ELAST STAINLESS STEEL BOTH IP/OP $513.50 $380.00 $101.85 $537.53 $230.92 $230.92 $230.92 $230.92 $513.15 $513.15 $513.15 $106.95 $513.15 $513.15 $513.15 $513.15 $513.15 $106.95 $513.15 $215.01 $303.53 $513.15 $537.53 $513.15 $513.15 $385.13 $513.15 $513.15 $513.15 $256.58 $256.58 $406.41 $513.15 $410.52 $230.92 $101.85 N/A $297.83 $513.15 $307.89 $513.15 $106.94 $513.15 N/A N/A 275.925 SUP HCPCS C1713 275.925 - NAIL INTRAMEDULLARY 2.5MM 440MM ELAST STAINLESS STEEL BOTH IP/OP $568.00 $420.00 $112.71 $577.55 $255.56 $255.56 $255.56 $255.56 $567.90 $567.90 $567.90 $118.36 $567.90 $567.90 $567.90 $567.90 $567.90 $118.36 $567.90 $231.02 $335.91 $567.90 $577.55 $567.90 $567.90 $426.00 $567.90 $567.90 $567.90 $283.95 $283.95 $449.78 $567.90 $454.32 $255.56 $112.71 N/A $329.44 $567.90 $340.74 $567.90 $118.35 $567.90 N/A N/A 275.93 SUP HCPCS C1713 275.930 - NAIL INTRAMEDULLARY 3MM 440MM ELAST STAINLESS STEEL BOTH IP/OP $583.00 $431.00 $115.66 $610.43 $262.24 $262.24 $262.24 $262.24 $582.75 $582.75 $582.75 $121.46 $582.75 $582.75 $582.75 $582.75 $582.75 $121.45 $582.75 $244.17 $344.70 $582.75 $610.43 $582.75 $582.75 $437.25 $582.75 $582.75 $582.75 $291.38 $291.38 $461.54 $582.75 $466.20 $262.24 $115.66 N/A $338.14 $582.75 $349.65 $582.75 $582.75 $582.75 N/A N/A 275.935 SUP HCPCS C1713 275.935 - NAIL INTRAMEDULLARY 3.5MM 440MM ELAST STAINLESS STEEL BOTH IP/OP $635.50 $470.00 $126.11 $646.18 $285.92 $285.92 $285.92 $285.92 $635.38 $635.38 $635.38 $132.43 $635.38 $635.38 $635.38 $635.38 $635.38 $132.42 $635.38 $646.18 $375.83 $635.38 $646.18 $635.38 $635.38 $476.63 $635.38 $635.38 $635.38 $317.69 $317.69 $503.22 $635.38 $508.30 $285.92 $126.11 N/A $368.59 $635.38 $381.23 $635.38 $132.41 $635.38 N/A N/A 275.94 SUP HCPCS C1713 275.940 - NAIL INTRAMEDULLARY 4MM 440MM ELAST STAINLESS STEEL BOTH IP/OP $662.00 $490.00 $131.37 $693.35 $297.86 $297.86 $297.86 $297.86 $661.90 $661.90 $661.90 $137.96 $661.90 $661.90 $661.90 $661.90 $661.90 $137.95 $661.90 $277.34 $391.51 $661.90 $693.35 $661.90 $661.90 $496.50 $661.90 $661.90 $661.90 $330.95 $330.95 $524.22 $661.90 $529.52 $297.86 $131.37 N/A $383.96 $661.90 $397.14 $661.90 $137.94 $661.90 N/A N/A 280 SUP HCPCS C1713 280.000 - SCREW BONE 12.7MM 8.2MM 2.7MM 100MM 22MM CANN LAG DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $651.90 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $129.69 $622.33 N/A N/A 280.05 SUP HCPCS C1713 280.050 - SCREW BONE 12.7MM 8.2MM 2.7MM 105MM 22MM CANN LAG DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $651.90 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $129.69 $622.33 N/A N/A 280.1 SUP HCPCS C1713 280.100 - SCREW BONE 12.7MM 8.2MM 2.7MM 110MM 22MM CANN LAG DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $651.90 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $129.69 $622.33 N/A N/A 280.15 SUP HCPCS C1713 280.150 - SCREW BONE 12.7MM 8.2MM 115MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $651.90 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $129.69 $622.33 N/A N/A 280.2 SUP HCPCS C1713 280.200 - SCREW BONE 12.7MM 8.2MM 120MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $651.90 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $622.33 $622.33 $129.69 $622.33 N/A N/A 280.25 SUP HCPCS C1713 280.250 - SCREW BONE 12.7MM 8.2MM 125MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $622.33 $622.33 $622.33 $622.33 N/A N/A 280.251 SUP HCPCS C1713 280.251 - SCREW BONE 12.7MM 50MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 280.255 SUP HCPCS C1713 280.255 - SCREW BONE 12.7MM 55MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 280.26 SUP HCPCS C1713 280.260 - SCREW BONE 12.7MM 60MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $651.90 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $129.69 $622.33 N/A N/A 280.265 SUP HCPCS C1713 280.265 - SCREW BONE 12.7MM 65MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 280.27 SUP HCPCS C1713 280.270 - SCREW BONE 12.7MM 70MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $651.90 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $129.69 $622.33 N/A N/A 280.275 SUP HCPCS C1713 280.275 - SCREW BONE 12.7MM 75MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 280.28 SUP HCPCS C1713 280.280 - SCREW BONE 12.7MM 80MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $622.33 $622.33 $129.69 $622.33 N/A N/A 280.285 SUP HCPCS C1713 280.285 - SCREW BN 12MM 8MM 2.7MM 85MM NS 22MM DHS DCS LG CNN SS HIP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 280.29 SUP HCPCS C1713 280.290 - SCREW BONE 12.7MM 90MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $622.33 $622.33 $622.33 $622.33 N/A N/A 280.295 SUP HCPCS C1713 280.295 - SCREW BONE 12.7MM 95MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 280.3 SUP HCPCS C1713 280.300 - SCREW BONE 12.7MM 130MM 22MM DHS/DCS SS CNDYLR HIP LAG CANN BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $622.33 $622.33 $129.69 $622.33 N/A N/A 280.301 SUP HCPCS C1713 280.301 - SCREW BONE 12.7MM 100MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 280.305 SUP HCPCS C1713 280.305 - SCREW BONE 12.7MM 105MM 22MM LAG CANN DHS/DCS STAINLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 280.31 SUP HCPCS C1713 280.310 - SCREW BONE 12.7MM 110MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $622.33 $622.33 N/A N/A 280.315 SUP HCPCS C1713 280.315 - SCREW BONE 12.7MM 115MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 280.32 SUP HCPCS C1713 280.320 - SCREW BONE 12.7MM 120MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $622.33 $622.33 $129.69 $622.33 N/A N/A 280.325 SUP HCPCS C1713 280.325 - SCREW BONE 12.7MM 125MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 280.33 SUP HCPCS C1713 280.330 - SCREW BONE 12.7MM 130MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $129.69 $622.33 N/A N/A 280.335 SUP HCPCS C1713 280.335 - SCREW BONE 13MM 135MM 22MM LAG CANN OCTAGONAL DHS/DCS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 280.34 SUP HCPCS C1713 280.340 - SCREW BONE 12MM 8MM 2.7MM 140MM 22MM 1 STEP LAG CANN DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $651.90 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $622.33 $622.33 N/A N/A 280.345 SUP HCPCS C1713 280.345 - SCREW BONE 12MM 8MM 2.7MM 145MM 22MM 1 STEP LAG CANN DHS/DCS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 280.35 SUP HCPCS C1713 280.350 - SCREW BONE 12.7MM 8.2MM 135MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $129.69 $622.33 N/A N/A 280.4 SUP HCPCS C1713 280.400 - SCREW BONE 12.7MM 140MM 22MM 1 STEP LAG THREADED DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $622.33 $622.33 N/A N/A 280.451 SUP HCPCS C1713 280.451 - SCREW BONE 12.7MM 8.2MM 2.7MM 145MM 22MM CANN LAG DHS/DCS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 280.454 SUP HCPCS C1713 280.454 - SCREW BONE 14MM 2.7MM 50MM 22MM LAG CANN DHS/DCS STAINLESS BOTH IP/OP $723.00 $535.00 $143.40 $734.80 $325.14 $325.14 $325.14 $325.14 $722.53 $722.53 $722.53 $150.59 $722.53 $722.53 $722.53 $722.53 $722.53 $150.58 $722.53 $293.92 $427.38 $722.53 $734.80 $722.53 $722.53 $542.25 $722.53 $722.53 $722.53 $361.27 $361.27 $572.24 $722.53 $578.02 $325.14 $143.40 N/A $419.34 $722.53 $433.52 $722.53 $150.58 $722.53 N/A N/A 280.455 SUP HCPCS C1713 280.455 - SCREW BONE 14MM 8.2MM 55MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $723.00 $535.00 $143.40 $734.80 $325.14 $325.14 $325.14 $325.14 $722.53 $722.53 $722.53 $150.59 $722.53 $722.53 $722.53 $722.53 $722.53 $150.58 $722.53 $734.80 $427.38 $722.53 $734.80 $722.53 $722.53 $542.25 $722.53 $722.53 $722.53 $361.27 $361.27 $572.24 $722.53 $578.02 $325.14 $143.40 N/A $419.34 $722.53 $433.52 $722.53 $722.53 $722.53 N/A N/A 280.46 SUP HCPCS C1713 280.460 - SCREW BONE 14MM 8.2MM 60MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $734.80 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $420.89 $701.48 $146.19 $701.48 N/A N/A 280.465 SUP HCPCS C1713 280.465 - SCREW BONE LARGE 14MM 65MM 14MM THREAD DHS/DCS STAINLESS BOTH IP/OP $723.00 $535.00 $143.40 $734.80 $325.14 $325.14 $325.14 $325.14 $722.53 $722.53 $722.53 $150.59 $722.53 $722.53 $722.53 $722.53 $722.53 $150.58 $722.53 $293.92 $427.38 $722.53 $734.80 $722.53 $722.53 $542.25 $722.53 $722.53 $722.53 $361.27 $361.27 $572.24 $722.53 $578.02 $325.14 $143.40 N/A $419.34 $722.53 $722.53 $722.53 $150.58 $722.53 N/A N/A 280.47 SUP HCPCS C1713 280.470 - SCREW BONE 14MM 8.2MM 70MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $293.92 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $420.89 $701.48 $146.19 $701.48 N/A N/A 280.475 SUP HCPCS C1713 280.475 - SCREW BONE 14MM 8.2MM 75MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $723.00 $535.00 $143.40 $734.80 $325.14 $325.14 $325.14 $325.14 $722.53 $722.53 $722.53 $150.59 $722.53 $722.53 $722.53 $722.53 $722.53 $150.58 $722.53 $293.92 $427.38 $722.53 $734.80 $722.53 $722.53 $542.25 $722.53 $722.53 $722.53 $361.27 $361.27 $572.24 $722.53 $578.02 $325.14 $143.40 N/A $419.34 $722.53 $433.52 $722.53 $150.58 $722.53 N/A N/A 280.48 SUP HCPCS C1713 280.480 - SCREW BONE 14MM 8.2MM 80MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $293.92 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $701.48 $701.48 $146.19 $701.48 N/A N/A 280.485 SUP HCPCS C1713 280.485 - SCREW BONE 14MM 8.2MM 85MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $723.00 $535.00 $143.40 $734.80 $325.14 $325.14 $325.14 $325.14 $722.53 $722.53 $722.53 $150.59 $722.53 $722.53 $722.53 $722.53 $722.53 $150.58 $722.53 $293.92 $427.38 $722.53 $734.80 $722.53 $722.53 $542.25 $722.53 $722.53 $722.53 $361.27 $361.27 $572.24 $722.53 $578.02 $325.14 $143.40 N/A $419.34 $722.53 $722.53 $722.53 $150.58 $722.53 N/A N/A 280.49 SUP HCPCS C1713 280.490 - SCREW BONE 14MM 8.2MM 90MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $734.80 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $420.89 $701.48 $701.48 $701.48 N/A N/A 280.495 SUP HCPCS C1713 280.495 - SCREW BONE 14MM 8.2MM 95MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $723.00 $535.00 $143.40 $734.80 $325.14 $325.14 $325.14 $325.14 $722.53 $722.53 $722.53 $150.59 $722.53 $722.53 $722.53 $722.53 $722.53 $150.58 $722.53 $293.92 $427.38 $722.53 $734.80 $722.53 $722.53 $542.25 $722.53 $722.53 $722.53 $361.27 $361.27 $572.24 $722.53 $578.02 $325.14 $143.40 N/A $419.34 $722.53 $433.52 $722.53 $722.53 $722.53 N/A N/A 280.501 SUP HCPCS C1713 280.501 - SCREW BONE 12.7MM 8.2MM 50MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $703.00 $520.00 $139.50 $714.80 $316.28 $316.28 $316.28 $316.28 $702.85 $702.85 $702.85 $146.49 $702.85 $702.85 $702.85 $702.85 $702.85 $146.48 $702.85 $714.80 $415.74 $702.85 $714.80 $702.85 $702.85 $527.25 $702.85 $702.85 $702.85 $351.43 $351.43 $556.66 $702.85 $562.28 $316.28 $139.50 N/A $407.74 $702.85 $702.85 $702.85 $146.47 $702.85 N/A N/A 280.504 SUP HCPCS C1713 280.504 - SCREW BONE 14MM 8MM 2.7MM 100MM 22MM LAG CANN DHS/DCS BOTH IP/OP $723.00 $535.00 $143.40 $734.80 $325.14 $325.14 $325.14 $325.14 $722.53 $722.53 $722.53 $150.59 $722.53 $722.53 $722.53 $722.53 $722.53 $150.58 $722.53 $293.92 $427.38 $722.53 $734.80 $722.53 $722.53 $542.25 $722.53 $722.53 $722.53 $361.27 $361.27 $572.24 $722.53 $578.02 $325.14 $143.40 N/A $419.34 $722.53 $722.53 $722.53 $150.58 $722.53 N/A N/A 280.505 SUP HCPCS C1713 280.505 - SCREW BONE 14MM 8.2MM 105MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $723.00 $535.00 $143.40 $734.80 $325.14 $325.14 $325.14 $325.14 $722.53 $722.53 $722.53 $150.59 $722.53 $722.53 $722.53 $722.53 $722.53 $150.58 $722.53 $734.80 $427.38 $722.53 $734.80 $722.53 $722.53 $542.25 $722.53 $722.53 $722.53 $361.27 $361.27 $572.24 $722.53 $578.02 $325.14 $143.40 N/A $419.34 $722.53 $722.53 $722.53 $150.58 $722.53 N/A N/A 280.51 SUP HCPCS C1713 280.510 - SCREW BONE 14MM 8.2MM 110MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $293.92 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $701.48 $701.48 $146.19 $701.48 N/A N/A 280.515 SUP HCPCS C1713 280.515 - SCREW BONE 14MM 8.2MM 115MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $723.00 $535.00 $143.40 $734.80 $325.14 $325.14 $325.14 $325.14 $722.53 $722.53 $722.53 $150.59 $722.53 $722.53 $722.53 $722.53 $722.53 $150.58 $722.53 $734.80 $427.38 $722.53 $734.80 $722.53 $722.53 $542.25 $722.53 $722.53 $722.53 $361.27 $361.27 $572.24 $722.53 $578.02 $325.14 $143.40 N/A $419.34 $722.53 $722.53 $722.53 $150.58 $722.53 N/A N/A 280.52 SUP HCPCS C1713 280.520 - SCREW BONE 14MM 8.2MM 120MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $293.92 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $701.48 $701.48 $146.19 $701.48 N/A N/A 280.525 SUP HCPCS C1713 280.525 - SCREW BONE 14MM 8.2MM 125MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $723.00 $535.00 $143.40 $734.80 $325.14 $325.14 $325.14 $325.14 $722.53 $722.53 $722.53 $150.59 $722.53 $722.53 $722.53 $722.53 $722.53 $150.58 $722.53 $734.80 $427.38 $722.53 $734.80 $722.53 $722.53 $542.25 $722.53 $722.53 $722.53 $361.27 $361.27 $572.24 $722.53 $578.02 $325.14 $143.40 N/A $419.34 $722.53 $722.53 $722.53 $150.58 $722.53 N/A N/A 280.53 SUP HCPCS C1713 280.530 - SCREW BONE 14MM 8.2MM 130MM 22MM CANN LAG DHS/DCS STAINLESS BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $293.92 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $420.89 $701.48 $146.19 $701.48 N/A N/A 280.535 SUP HCPCS C1713 280.535 - SCREW BONE 14MM 135MM 22MM LAG THREAD DHS/DCS STAINLESS BOTH IP/OP $723.00 $535.00 $143.40 $734.80 $325.14 $325.14 $325.14 $325.14 $722.53 $722.53 $722.53 $150.59 $722.53 $722.53 $722.53 $722.53 $722.53 $150.58 $722.53 $734.80 $427.38 $722.53 $734.80 $722.53 $722.53 $542.25 $722.53 $722.53 $722.53 $361.27 $361.27 $572.24 $722.53 $578.02 $325.14 $143.40 N/A $419.34 $722.53 $433.52 $722.53 $150.58 $722.53 N/A N/A 280.54 SUP HCPCS C1713 280.540 - SCREW BONE 14MM 8.2MM 130MM 22MM CANN LAG DHS/DCS STAINLESS BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $293.92 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $701.48 $701.48 $146.19 $701.48 N/A N/A 280.545 SUP HCPCS C1713 280.545 - SCREW BONE 14MM 145MM 22MM LAG THREAD DHS/DCS STAINLESS BOTH IP/OP $723.00 $535.00 $143.40 $734.80 $325.14 $325.14 $325.14 $325.14 $722.53 $722.53 $722.53 $150.59 $722.53 $722.53 $722.53 $722.53 $722.53 $150.58 $722.53 $734.80 $427.38 $722.53 $734.80 $722.53 $722.53 $542.25 $722.53 $722.53 $722.53 $361.27 $361.27 $572.24 $722.53 $578.02 $325.14 $143.40 N/A $419.34 $722.53 $433.52 $722.53 $722.53 $722.53 N/A N/A 280.55 SUP HCPCS C1713 280.550 - SCREW BONE 8MM 55MM 22MM CANN THREADED LAG DHS/DCS STAINLESS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $129.69 $622.33 N/A N/A 280.6 SUP HCPCS C1713 280.600 - SCREW BONE 12.7MM 8.2MM 2.7MM 60MM 22MM CANN LAG DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $651.90 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $129.69 $622.33 N/A N/A 280.65 SUP HCPCS C1713 280.650 - SCREW BONE 12.7MM 8.2MM 65MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $622.33 $622.33 $129.69 $622.33 N/A N/A 280.66 SUP HCPCS C1713 280.660 - SCREW BONE 14MM 8.2MM 60MM 22MM 1 STEP LAG CANN DHS/DCS BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $293.92 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $420.89 $701.48 $146.19 $701.48 N/A N/A 280.67 SUP HCPCS C1713 280.670 - SCREW BONE 14MM 70MM 22MM 1 STEP LAG THREAD DHS/DCS BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $293.92 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $420.89 $701.48 $146.19 $701.48 N/A N/A 280.68 SUP HCPCS C1713 280.680 - SCREW BONE 14MM 80MM 22MM LAG CANN DHS/DCS STAINLESS STEEL BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $293.92 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $420.89 $701.48 $701.48 $701.48 N/A N/A 280.69 SUP HCPCS C1713 280.690 - SCREW BONE 14MM 90MM 22MM LAG CANN DHS/DCS STAINLESS STEEL BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $293.92 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $701.48 $701.48 $146.19 $701.48 N/A N/A 280.7 SUP HCPCS C1713 280.700 - SCREW BN 12.7MM 8MM 2.7MM 70MM NS 22MM DHS DCS LG CNN SS HIP BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $622.33 $622.33 $622.33 $622.33 N/A N/A 280.71 SUP HCPCS C1713 280.710 - SCREW BONE 14MM 8.2MM 110MM 22MM 1 STEP LAG CANN DHS/DCS BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $293.92 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $701.48 $701.48 $146.19 $701.48 N/A N/A 280.72 SUP HCPCS C1713 280.720 - SCREW BONE 14MM 8.2MM 120MM 22MM 1 STEP LAG CANN DHS/DCS BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $293.92 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $701.48 $701.48 $701.48 $701.48 N/A N/A 280.73 SUP HCPCS C1713 280.730 - SCREW BONE 14MM 8.2MM 60MM 22MM 1 STEP LAG CANN DHS/DCS BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $293.92 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $420.89 $701.48 $146.19 $701.48 N/A N/A 280.74 SUP HCPCS C1713 280.740 - SCREW BONE 14MM 8.2MM 140MM 22MM 1 STEP LAG CANN DHS/DCS BOTH IP/OP $701.50 $519.00 $139.23 $734.80 $315.67 $315.67 $315.67 $315.67 $701.48 $701.48 $701.48 $146.21 $701.48 $701.48 $701.48 $701.48 $701.48 $146.20 $701.48 $293.92 $414.93 $701.48 $734.80 $701.48 $701.48 $526.13 $701.48 $701.48 $701.48 $350.74 $350.74 $555.57 $701.48 $561.18 $315.67 $139.23 N/A $406.87 $701.48 $701.48 $701.48 $146.19 $701.48 N/A N/A 280.75 SUP HCPCS C1713 280.750 - SCREW BONE 12.7MM 8.2MM 75MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $622.33 $622.33 $129.69 $622.33 N/A N/A 280.8 SUP HCPCS C1713 280.800 - SCREW BONE 12.7MM 8.2MM 80MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $651.90 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $129.69 $622.33 N/A N/A 280.85 SUP HCPCS C1713 280.850 - SCREW BONE 12.7MM 8.2MM 85MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $129.69 $622.33 N/A N/A 280.9 SUP HCPCS C1713 280.900 - SCREW BONE 12.7MM 8MM 2.7MM 90MM 22MM LAG DHS/DCS STAINLESS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $651.90 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $129.69 $622.33 N/A N/A 280.95 SUP HCPCS C1713 280.950 - SCREW BONE 12.7MM 8.2MM 95MM 22MM CANN THREADED LAG DHS/DCS BOTH IP/OP $622.50 $461.00 $123.52 $651.90 $280.05 $280.05 $280.05 $280.05 $622.33 $622.33 $622.33 $129.71 $622.33 $622.33 $622.33 $622.33 $622.33 $129.70 $622.33 $260.76 $368.11 $622.33 $651.90 $622.33 $622.33 $466.88 $622.33 $622.33 $622.33 $311.17 $311.17 $492.89 $622.33 $497.86 $280.05 $123.52 N/A $361.05 $622.33 $373.40 $622.33 $129.69 $622.33 N/A N/A 280.99 SUP HCPCS C1713 280.990 - SCREW BONE 12.7MM 36MM 22MM COMPRESSION DHS/DCS STAINLESS BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $83.63 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $47.90 $79.83 $16.64 $79.83 N/A N/A 281.01 SUP HCPCS C1713 281.010 - PLATE BONE 130D STANDARD BARREL 174MM 38MM 10 HOLE DHS/DCP BOTH IP/OP "$1,295.50" $959.00 $257.05 "$1,356.68" $582.82 $582.82 $582.82 $582.82 "$1,295.15" "$1,295.15" "$1,295.15" $269.94 "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" $269.92 "$1,295.15" $542.67 $766.08 "$1,295.15" "$1,356.68" "$1,295.15" "$1,295.15" $971.63 "$1,295.15" "$1,295.15" "$1,295.15" $647.58 $647.58 "$1,025.76" "$1,295.15" "$1,036.12" $582.82 $257.05 N/A $751.39 "$1,295.15" $777.09 "$1,295.15" $269.91 "$1,295.15" N/A N/A 281.012 SUP HCPCS C1713 281.012 - PLATE BN 130D STD BRL 206MM NS 38MM DHS 12 HL SS HIP 4.5MM BOTH IP/OP "$1,334.00" $987.00 $264.77 "$1,356.68" $600.30 $600.30 $600.30 $600.30 "$1,334.00" "$1,334.00" "$1,334.00" $278.04 "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" $278.02 "$1,334.00" "$1,356.68" $789.06 "$1,334.00" "$1,356.68" "$1,334.00" "$1,334.00" "$1,000.50" "$1,334.00" "$1,334.00" "$1,334.00" $667.00 $667.00 "$1,056.53" "$1,334.00" "$1,067.20" $600.30 $264.77 N/A $773.72 "$1,334.00" $800.40 "$1,334.00" $278.01 "$1,334.00" N/A N/A 281.014 SUP HCPCS C1713 281.014 - PLATE BN 130D STD BRL 238MM NS 38MM DHS 14 HL SS HIP 4.5MM BOTH IP/OP "$1,773.00" "$1,312.00" $351.81 "$1,802.70" $797.66 $797.66 $797.66 $797.66 "$1,772.58" "$1,772.58" "$1,772.58" $369.45 "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" $369.43 "$1,772.58" "$1,802.70" "$1,048.48" "$1,772.58" "$1,802.70" "$1,772.58" "$1,772.58" "$1,329.75" "$1,772.58" "$1,772.58" "$1,772.58" $886.29 $886.29 "$1,403.88" "$1,772.58" "$1,418.06" $797.66 $351.81 N/A "$1,028.34" "$1,772.58" "$1,063.55" "$1,772.58" $369.41 "$1,772.58" N/A N/A 281.02 SUP HCPCS C1713 281.020 - PLATE BONE 135D STANDARD BARREL 333X19X5.8MM 38MM 20 HOLE BOTH IP/OP "$1,771.50" "$1,311.00" $351.59 "$1,855.63" $797.15 $797.15 $797.15 $797.15 "$1,771.45" "$1,771.45" "$1,771.45" $369.21 "$1,771.45" "$1,771.45" "$1,771.45" "$1,771.45" "$1,771.45" $369.19 "$1,771.45" $742.25 "$1,047.81" "$1,771.45" "$1,855.63" "$1,771.45" "$1,771.45" "$1,328.63" "$1,771.45" "$1,771.45" "$1,771.45" $885.73 $885.73 "$1,402.99" "$1,771.45" "$1,417.16" $797.15 $351.59 N/A "$1,027.47" "$1,771.45" "$1,062.87" "$1,771.45" $369.17 "$1,771.45" N/A N/A 281.021 SUP HCPCS C1713 281.021 - PLATE BN 130D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM BOTH IP/OP "$1,004.00" $743.00 $199.21 "$1,020.73" $451.66 $451.66 $451.66 $451.66 "$1,003.68" "$1,003.68" "$1,003.68" $209.19 "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" $209.18 "$1,003.68" $408.29 $593.68 "$1,003.68" "$1,020.73" "$1,003.68" "$1,003.68" $753.00 "$1,003.68" "$1,003.68" "$1,003.68" $501.84 $501.84 $794.91 "$1,003.68" $802.94 $451.66 $199.21 N/A $582.32 "$1,003.68" $602.21 "$1,003.68" $209.17 "$1,003.68" N/A N/A 281.031 SUP HCPCS C1713 281.031 - PLATE BONE 130D STANDARD BARREL 62MM 38MM 3 HOLE DHS/DCS BOTH IP/OP "$1,004.00" $743.00 $199.21 "$1,020.73" $451.66 $451.66 $451.66 $451.66 "$1,003.68" "$1,003.68" "$1,003.68" $209.19 "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" $209.18 "$1,003.68" $408.29 $593.68 "$1,003.68" "$1,020.73" "$1,003.68" "$1,003.68" $753.00 "$1,003.68" "$1,003.68" "$1,003.68" $501.84 $501.84 $794.91 "$1,003.68" $802.94 $451.66 $199.21 N/A $582.32 "$1,003.68" $602.21 "$1,003.68" $209.17 "$1,003.68" N/A N/A 281.04 SUP HCPCS C1713 281.040 - PLATE BN 130D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.05 SUP HCPCS C1713 281.050 - PLATE BN 130D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $974.43 $974.43 $203.07 $974.43 N/A N/A 281.06 SUP HCPCS C1713 281.060 - PLATE BN 130D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.081 SUP HCPCS C1713 281.081 - PLATE BONE 130D STANDARD BARREL 142MM 38MM 8 HOLE BOTH IP/OP "$1,334.00" $987.00 $264.77 "$1,356.68" $600.30 $600.30 $600.30 $600.30 "$1,334.00" "$1,334.00" "$1,334.00" $278.04 "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" $278.02 "$1,334.00" $542.67 $789.06 "$1,334.00" "$1,356.68" "$1,334.00" "$1,334.00" "$1,000.50" "$1,334.00" "$1,334.00" "$1,334.00" $667.00 $667.00 "$1,056.53" "$1,334.00" "$1,067.20" $600.30 $264.77 N/A $773.72 "$1,334.00" $800.40 "$1,334.00" "$1,334.00" "$1,334.00" N/A N/A 281.1 SUP HCPCS C1713 281.100 - PLATE BN 135D STD BRL 12.6MM 174X19X5.8MM NS 38MM DHS DCP 10 BOTH IP/OP "$1,295.50" $959.00 $257.05 "$1,356.68" $582.82 $582.82 $582.82 $582.82 "$1,295.15" "$1,295.15" "$1,295.15" $269.94 "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" $269.92 "$1,295.15" $542.67 $766.08 "$1,295.15" "$1,356.68" "$1,295.15" "$1,295.15" $971.63 "$1,295.15" "$1,295.15" "$1,295.15" $647.58 $647.58 "$1,025.76" "$1,295.15" "$1,036.12" $582.82 $257.05 N/A $751.39 "$1,295.15" $777.09 "$1,295.15" "$1,295.15" "$1,295.15" N/A N/A 281.102 SUP HCPCS C1713 281.102 - PLATE BN 135D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM BOTH IP/OP "$1,004.00" $743.00 $199.21 "$1,020.73" $451.66 $451.66 $451.66 $451.66 "$1,003.68" "$1,003.68" "$1,003.68" $209.19 "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" $209.18 "$1,003.68" $408.29 $593.68 "$1,003.68" "$1,020.73" "$1,003.68" "$1,003.68" $753.00 "$1,003.68" "$1,003.68" "$1,003.68" $501.84 $501.84 $794.91 "$1,003.68" $802.94 $451.66 $199.21 N/A $582.32 "$1,003.68" $602.21 "$1,003.68" $209.17 "$1,003.68" N/A N/A 281.11 SUP HCPCS C1713 281.110 - PLATE BN 135D STD BRL 12.6MM 206X19X5.8MM NS 38MM DHS DCP 12 BOTH IP/OP "$1,295.50" $959.00 $257.05 "$1,356.68" $582.82 $582.82 $582.82 $582.82 "$1,295.15" "$1,295.15" "$1,295.15" $269.94 "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" $269.92 "$1,295.15" $542.67 $766.08 "$1,295.15" "$1,356.68" "$1,295.15" "$1,295.15" $971.63 "$1,295.15" "$1,295.15" "$1,295.15" $647.58 $647.58 "$1,025.76" "$1,295.15" "$1,036.12" $582.82 $257.05 N/A $751.39 "$1,295.15" $777.09 "$1,295.15" $269.91 "$1,295.15" N/A N/A 281.13 SUP HCPCS C1713 281.130 - PLATE BN 135D STD BRL 12.6MM 238X19X5.8MM NS 38MM DHS DCP 14 BOTH IP/OP "$1,721.00" "$1,274.00" $341.57 "$1,802.70" $774.43 $774.43 $774.43 $774.43 "$1,720.95" "$1,720.95" "$1,720.95" $358.69 "$1,720.95" "$1,720.95" "$1,720.95" "$1,720.95" "$1,720.95" $358.66 "$1,720.95" $721.08 "$1,017.94" "$1,720.95" "$1,802.70" "$1,720.95" "$1,720.95" "$1,290.75" "$1,720.95" "$1,720.95" "$1,720.95" $860.48 $860.48 "$1,362.99" "$1,720.95" "$1,376.76" $774.43 $341.57 N/A $998.18 "$1,720.95" "$1,032.57" "$1,720.95" "$1,720.95" "$1,720.95" N/A N/A 281.131 SUP HCPCS C1713 281.131 - PLATE BN 135D STD BRL 12.6MM 62X19X5.8MM NS 38MM DHS DCP 3 BOTH IP/OP "$1,004.00" $743.00 $199.21 "$1,020.73" $451.66 $451.66 $451.66 $451.66 "$1,003.68" "$1,003.68" "$1,003.68" $209.19 "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" $209.18 "$1,003.68" $408.29 $593.68 "$1,003.68" "$1,020.73" "$1,003.68" "$1,003.68" $753.00 "$1,003.68" "$1,003.68" "$1,003.68" $501.84 $501.84 $794.91 "$1,003.68" $802.94 $451.66 $199.21 N/A $582.32 "$1,003.68" $602.21 "$1,003.68" "$1,003.68" "$1,003.68" N/A N/A 281.14 SUP HCPCS C1713 281.140 - PLATE BN 135D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.15 SUP HCPCS C1713 281.150 - PLATE BN 135D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.16 SUP HCPCS C1713 281.160 - PLATE BN 135D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.17 SUP HCPCS C1713 281.170 - PLATE BN 135D STD BRL 12.6MM 270X19X5.8MM NS 38MM DHS DCP 16 BOTH IP/OP "$1,721.00" "$1,274.00" $341.57 "$1,802.70" $774.43 $774.43 $774.43 $774.43 "$1,720.95" "$1,720.95" "$1,720.95" $358.69 "$1,720.95" "$1,720.95" "$1,720.95" "$1,720.95" "$1,720.95" $358.66 "$1,720.95" "$1,802.70" "$1,017.94" "$1,720.95" "$1,802.70" "$1,720.95" "$1,720.95" "$1,290.75" "$1,720.95" "$1,720.95" "$1,720.95" $860.48 $860.48 "$1,362.99" "$1,720.95" "$1,376.76" $774.43 $341.57 N/A $998.18 "$1,720.95" "$1,032.57" "$1,720.95" $358.65 "$1,720.95" N/A N/A 281.18 SUP HCPCS C1713 281.180 - PLATE BN 135D STD BRL 12.6MM 142X19X5.8MM NS 38MM DHS DCP 8 BOTH IP/OP "$1,295.50" $959.00 $257.05 "$1,356.68" $582.82 $582.82 $582.82 $582.82 "$1,295.15" "$1,295.15" "$1,295.15" $269.94 "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" $269.92 "$1,295.15" $542.67 $766.08 "$1,295.15" "$1,356.68" "$1,295.15" "$1,295.15" $971.63 "$1,295.15" "$1,295.15" "$1,295.15" $647.58 $647.58 "$1,025.76" "$1,295.15" "$1,036.12" $582.82 $257.05 N/A $751.39 "$1,295.15" $777.09 "$1,295.15" "$1,295.15" "$1,295.15" N/A N/A 281.19 SUP HCPCS C1713 281.190 - PLATE BONE 135D STANDARD BARREL 302X19X5.8MM 38MM 18 HOLE BOTH IP/OP "$1,771.50" "$1,311.00" $351.59 "$1,855.63" $797.15 $797.15 $797.15 $797.15 "$1,771.45" "$1,771.45" "$1,771.45" $369.21 "$1,771.45" "$1,771.45" "$1,771.45" "$1,771.45" "$1,771.45" $369.19 "$1,771.45" $742.25 "$1,047.81" "$1,771.45" "$1,855.63" "$1,771.45" "$1,771.45" "$1,328.63" "$1,771.45" "$1,771.45" "$1,771.45" $885.73 $885.73 "$1,402.99" "$1,771.45" "$1,417.16" $797.15 $351.59 N/A "$1,027.47" "$1,771.45" "$1,062.87" "$1,771.45" "$1,771.45" "$1,771.45" N/A N/A 281.2 SUP HCPCS C1713 281.200 - PLATE BN 140D STD BRL 174MM NS 38MM DHS 10 HL SS HIP 4.5MM BOTH IP/OP "$1,295.50" $959.00 $257.05 "$1,356.68" $582.82 $582.82 $582.82 $582.82 "$1,295.15" "$1,295.15" "$1,295.15" $269.94 "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" $269.92 "$1,295.15" $542.67 $766.08 "$1,295.15" "$1,356.68" "$1,295.15" "$1,295.15" $971.63 "$1,295.15" "$1,295.15" "$1,295.15" $647.58 $647.58 "$1,025.76" "$1,295.15" "$1,036.12" $582.82 $257.05 N/A $751.39 "$1,295.15" $777.09 "$1,295.15" $269.91 "$1,295.15" N/A N/A 281.212 SUP HCPCS C1713 281.212 - PLATE BONE STANDARD BARREL 140D 206MM 38MM 12 HOLE DHS BOTH IP/OP "$1,334.00" $987.00 $264.77 "$1,356.68" $600.30 $600.30 $600.30 $600.30 "$1,334.00" "$1,334.00" "$1,334.00" $278.04 "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" $278.02 "$1,334.00" "$1,356.68" $789.06 "$1,334.00" "$1,356.68" "$1,334.00" "$1,334.00" "$1,000.50" "$1,334.00" "$1,334.00" "$1,334.00" $667.00 $667.00 "$1,056.53" "$1,334.00" "$1,067.20" $600.30 $264.77 N/A $773.72 "$1,334.00" $800.40 "$1,334.00" "$1,334.00" "$1,334.00" N/A N/A 281.214 SUP HCPCS C1713 281.214 - PLATE BN 140D STD BRL 238MM NS 38MM DHS 14 HL SS HIP 4.5MM BOTH IP/OP "$1,773.00" "$1,312.00" $351.81 "$1,802.70" $797.66 $797.66 $797.66 $797.66 "$1,772.58" "$1,772.58" "$1,772.58" $369.45 "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" $369.43 "$1,772.58" $721.08 "$1,048.48" "$1,772.58" "$1,802.70" "$1,772.58" "$1,772.58" "$1,329.75" "$1,772.58" "$1,772.58" "$1,772.58" $886.29 $886.29 "$1,403.88" "$1,772.58" "$1,418.06" $797.66 $351.81 N/A "$1,028.34" "$1,772.58" "$1,063.55" "$1,772.58" "$1,772.58" "$1,772.58" N/A N/A 281.216 SUP HCPCS C1713 281.216 - PLATE BONE 140D STANDARD BARREL 12.6MM 270MM 38MM 16 HOLE BOTH IP/OP "$1,773.00" "$1,312.00" $351.81 "$1,802.70" $797.66 $797.66 $797.66 $797.66 "$1,772.58" "$1,772.58" "$1,772.58" $369.45 "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" $369.43 "$1,772.58" $721.08 "$1,048.48" "$1,772.58" "$1,802.70" "$1,772.58" "$1,772.58" "$1,329.75" "$1,772.58" "$1,772.58" "$1,772.58" $886.29 $886.29 "$1,403.88" "$1,772.58" "$1,418.06" $797.66 $351.81 N/A "$1,028.34" "$1,772.58" "$1,063.55" "$1,772.58" $369.41 "$1,772.58" N/A N/A 281.22 SUP HCPCS C1713 281.220 - PLATE BN 140D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.23 SUP HCPCS C1713 281.230 - PLATE BONE 140D STANDARD BARREL 62MM 38MM 3 HOLE COMPRESSION BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.24 SUP HCPCS C1713 281.240 - PLATE BN 140D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $974.43 $974.43 N/A N/A 281.25 SUP HCPCS C1713 281.250 - PLATE BN 140D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $974.43 $974.43 N/A N/A 281.26 SUP HCPCS C1713 281.260 - PLATE BN 140D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.28 SUP HCPCS C1713 281.280 - PLATE BN 140D STD BRL 142MM NS 38MM DHS 8 HL SS HIP 4.5MM BOTH IP/OP "$1,295.50" $959.00 $257.05 "$1,356.68" $582.82 $582.82 $582.82 $582.82 "$1,295.15" "$1,295.15" "$1,295.15" $269.94 "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" $269.92 "$1,295.15" "$1,356.68" $766.08 "$1,295.15" "$1,356.68" "$1,295.15" "$1,295.15" $971.63 "$1,295.15" "$1,295.15" "$1,295.15" $647.58 $647.58 "$1,025.76" "$1,295.15" "$1,036.12" $582.82 $257.05 N/A $751.39 "$1,295.15" $777.09 "$1,295.15" "$1,295.15" "$1,295.15" N/A N/A 281.308 SUP HCPCS C1713 281.308 - PLATE BN 145D STD BRL 142MM NS 38MM DHS 8 HL SS HIP 4.5MM BOTH IP/OP "$1,334.00" $987.00 $264.77 "$1,356.68" $600.30 $600.30 $600.30 $600.30 "$1,334.00" "$1,334.00" "$1,334.00" $278.04 "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" $278.02 "$1,334.00" $542.67 $789.06 "$1,334.00" "$1,356.68" "$1,334.00" "$1,334.00" "$1,000.50" "$1,334.00" "$1,334.00" "$1,334.00" $667.00 $667.00 "$1,056.53" "$1,334.00" "$1,067.20" $600.30 $264.77 N/A $773.72 "$1,334.00" $800.40 "$1,334.00" "$1,334.00" "$1,334.00" N/A N/A 281.31 SUP HCPCS C1713 281.310 - PLATE BN 145D STD BRL 174MM NS 38MM DHS 10 HL SS HIP 4.5MM BOTH IP/OP "$1,295.50" $959.00 $257.05 "$1,356.68" $582.82 $582.82 $582.82 $582.82 "$1,295.15" "$1,295.15" "$1,295.15" $269.94 "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" $269.92 "$1,295.15" $542.67 $766.08 "$1,295.15" "$1,356.68" "$1,295.15" "$1,295.15" $971.63 "$1,295.15" "$1,295.15" "$1,295.15" $647.58 $647.58 "$1,025.76" "$1,295.15" "$1,036.12" $582.82 $257.05 N/A $751.39 "$1,295.15" $777.09 "$1,295.15" $269.91 "$1,295.15" N/A N/A 281.312 SUP HCPCS C1713 281.312 - PLATE BONE 145D 206MM 38MM 12 HOLE ANGLED STANDARD BARREL BOTH IP/OP "$1,334.00" $987.00 $264.77 "$1,356.68" $600.30 $600.30 $600.30 $600.30 "$1,334.00" "$1,334.00" "$1,334.00" $278.04 "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" $278.02 "$1,334.00" $542.67 $789.06 "$1,334.00" "$1,356.68" "$1,334.00" "$1,334.00" "$1,000.50" "$1,334.00" "$1,334.00" "$1,334.00" $667.00 $667.00 "$1,056.53" "$1,334.00" "$1,067.20" $600.30 $264.77 N/A $773.72 "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" N/A N/A 281.314 SUP HCPCS C1713 281.314 - PLATE BONE 145D STANDARD BARREL 238MM 38MM 14 HOLE DHS BOTH IP/OP "$1,773.00" "$1,312.00" $351.81 "$1,802.70" $797.66 $797.66 $797.66 $797.66 "$1,772.58" "$1,772.58" "$1,772.58" $369.45 "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" $369.43 "$1,772.58" $721.08 "$1,048.48" "$1,772.58" "$1,802.70" "$1,772.58" "$1,772.58" "$1,329.75" "$1,772.58" "$1,772.58" "$1,772.58" $886.29 $886.29 "$1,403.88" "$1,772.58" "$1,418.06" $797.66 $351.81 N/A "$1,028.34" "$1,772.58" "$1,063.55" "$1,772.58" "$1,772.58" "$1,772.58" N/A N/A 281.316 SUP HCPCS C1713 281.316 - PLATE BONE 145D STANDARD BARREL 270MM 38MM 16 HOLE DHS BOTH IP/OP "$1,773.00" "$1,312.00" $351.81 "$1,802.70" $797.66 $797.66 $797.66 $797.66 "$1,772.58" "$1,772.58" "$1,772.58" $369.45 "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" $369.43 "$1,772.58" $721.08 "$1,048.48" "$1,772.58" "$1,802.70" "$1,772.58" "$1,772.58" "$1,329.75" "$1,772.58" "$1,772.58" "$1,772.58" $886.29 $886.29 "$1,403.88" "$1,772.58" "$1,418.06" $797.66 $351.81 N/A "$1,028.34" "$1,772.58" "$1,063.55" "$1,772.58" $369.41 "$1,772.58" N/A N/A 281.32 SUP HCPCS C1713 281.320 - PLATE BN 145D STD BRL 46MM NS 38MM DHS 2 HL SS HIP 4.5MM BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.33 SUP HCPCS C1713 281.330 - PLATE BONE 145D STANDARD BARREL 62MM 38MM 3 HOLE COMPRESSION BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $974.43 $974.43 $203.07 $974.43 N/A N/A 281.34 SUP HCPCS C1713 281.340 - PLATE BN 145D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $974.43 $974.43 N/A N/A 281.35 SUP HCPCS C1713 281.350 - PLATE BN 145D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.36 SUP HCPCS C1713 281.360 - PLATE BN 145D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $974.43 $974.43 N/A N/A 281.4 SUP HCPCS C1713 281.400 - PLATE BN 150D STD BRL 174MM NS 38MM DHS 10 HL SS HIP 4.5MM BOTH IP/OP "$1,295.50" $959.00 $257.05 "$1,356.68" $582.82 $582.82 $582.82 $582.82 "$1,295.15" "$1,295.15" "$1,295.15" $269.94 "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" $269.92 "$1,295.15" $542.67 $766.08 "$1,295.15" "$1,356.68" "$1,295.15" "$1,295.15" $971.63 "$1,295.15" "$1,295.15" "$1,295.15" $647.58 $647.58 "$1,025.76" "$1,295.15" "$1,036.12" $582.82 $257.05 N/A $751.39 "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" N/A N/A 281.402 SUP HCPCS C1713 281.402 - PLATE BONE 150D STANDARD BARREL 46X19X5.8MM 38MM 2 HOLE BOTH IP/OP "$1,004.00" $743.00 $199.21 "$1,020.73" $451.66 $451.66 $451.66 $451.66 "$1,003.68" "$1,003.68" "$1,003.68" $209.19 "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" $209.18 "$1,003.68" $408.29 $593.68 "$1,003.68" "$1,020.73" "$1,003.68" "$1,003.68" $753.00 "$1,003.68" "$1,003.68" "$1,003.68" $501.84 $501.84 $794.91 "$1,003.68" $802.94 $451.66 $199.21 N/A $582.32 "$1,003.68" $602.21 "$1,003.68" "$1,003.68" "$1,003.68" N/A N/A 281.41 SUP HCPCS C1713 281.410 - PLATE BONE 150D STANDARD BARREL 12.6MM 206MM 38MM 12 HOLE BOTH IP/OP "$1,295.50" $959.00 $257.05 "$1,356.68" $582.82 $582.82 $582.82 $582.82 "$1,295.15" "$1,295.15" "$1,295.15" $269.94 "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" $269.92 "$1,295.15" $542.67 $766.08 "$1,295.15" "$1,356.68" "$1,295.15" "$1,295.15" $971.63 "$1,295.15" "$1,295.15" "$1,295.15" $647.58 $647.58 "$1,025.76" "$1,295.15" "$1,036.12" $582.82 $257.05 N/A $751.39 "$1,295.15" $777.09 "$1,295.15" $269.91 "$1,295.15" N/A N/A 281.414 SUP HCPCS C1713 281.414 - PLATE BONE 150D STANDARD BARREL 238MM 38MM 14 HOLE DHS BOTH IP/OP "$1,773.00" "$1,312.00" $351.81 "$1,802.70" $797.66 $797.66 $797.66 $797.66 "$1,772.58" "$1,772.58" "$1,772.58" $369.45 "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" $369.43 "$1,772.58" $721.08 "$1,048.48" "$1,772.58" "$1,802.70" "$1,772.58" "$1,772.58" "$1,329.75" "$1,772.58" "$1,772.58" "$1,772.58" $886.29 $886.29 "$1,403.88" "$1,772.58" "$1,418.06" $797.66 $351.81 N/A "$1,028.34" "$1,772.58" "$1,063.55" "$1,772.58" $369.41 "$1,772.58" N/A N/A 281.416 SUP HCPCS C1713 281.416 - PLATE BONE 150D STANDARD BARREL 270MM 38MM 16 HOLE DHS BOTH IP/OP "$1,773.00" "$1,312.00" $351.81 "$1,802.70" $797.66 $797.66 $797.66 $797.66 "$1,772.58" "$1,772.58" "$1,772.58" $369.45 "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" $369.43 "$1,772.58" "$1,802.70" "$1,048.48" "$1,772.58" "$1,802.70" "$1,772.58" "$1,772.58" "$1,329.75" "$1,772.58" "$1,772.58" "$1,772.58" $886.29 $886.29 "$1,403.88" "$1,772.58" "$1,418.06" $797.66 $351.81 N/A "$1,028.34" "$1,772.58" "$1,772.58" "$1,772.58" $369.41 "$1,772.58" N/A N/A 281.418 SUP HCPCS C1713 281.418 - PLATE BONE 150D STANDARD BARRAL 302MM 38MM 18 HOLE DHS/DCP BOTH IP/OP "$1,825.00" "$1,351.00" $362.14 "$1,855.63" $821.07 $821.07 $821.07 $821.07 "$1,824.60" "$1,824.60" "$1,824.60" $380.29 "$1,824.60" "$1,824.60" "$1,824.60" "$1,824.60" "$1,824.60" $380.27 "$1,824.60" $742.25 "$1,079.25" "$1,824.60" "$1,855.63" "$1,824.60" "$1,824.60" "$1,368.75" "$1,824.60" "$1,824.60" "$1,824.60" $912.30 $912.30 "$1,445.08" "$1,824.60" "$1,459.68" $821.07 $362.14 N/A "$1,058.50" "$1,824.60" "$1,094.76" "$1,824.60" $380.25 "$1,824.60" N/A N/A 281.421 SUP HCPCS C1713 281.421 - PLATE BONE 150D STANDARD BARREL 333MM 38MM 20 HOLE DHS/DCP BOTH IP/OP "$1,825.00" "$1,351.00" $362.14 "$1,855.63" $821.07 $821.07 $821.07 $821.07 "$1,824.60" "$1,824.60" "$1,824.60" $380.29 "$1,824.60" "$1,824.60" "$1,824.60" "$1,824.60" "$1,824.60" $380.27 "$1,824.60" $742.25 "$1,079.25" "$1,824.60" "$1,855.63" "$1,824.60" "$1,824.60" "$1,368.75" "$1,824.60" "$1,824.60" "$1,824.60" $912.30 $912.30 "$1,445.08" "$1,824.60" "$1,459.68" $821.07 $362.14 N/A "$1,058.50" "$1,824.60" "$1,094.76" "$1,824.60" $380.25 "$1,824.60" N/A N/A 281.43 SUP HCPCS C1713 281.430 - PLATE BONE 150D STANDARD BARREL 62MM 38MM 3 HOLE DHS/DCP BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $974.43 $974.43 N/A N/A 281.44 SUP HCPCS C1713 281.440 - PLATE BN 150D STD BRL 12.6MM 78X19X5.8MM NS 38MM DHS DCP 4 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.45 SUP HCPCS C1713 281.450 - PLATE BN 150D STD BRL 12.6MM 94X19X5.8MM NS 38MM DHS DCP 5 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.46 SUP HCPCS C1713 281.460 - PLATE BN 150D STD BRL 12.6MM 110X19X5.8MM NS 38MM DHS DCP 6 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $974.43 $974.43 $203.07 $974.43 N/A N/A 281.48 SUP HCPCS C1713 281.480 - PLATE BN 150D STD BRL 142MM NS 38MM DHS 8 HL SS HIP 4.5MM BOTH IP/OP "$1,295.50" $959.00 $257.05 "$1,356.68" $582.82 $582.82 $582.82 $582.82 "$1,295.15" "$1,295.15" "$1,295.15" $269.94 "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" $269.92 "$1,295.15" $542.67 $766.08 "$1,295.15" "$1,356.68" "$1,295.15" "$1,295.15" $971.63 "$1,295.15" "$1,295.15" "$1,295.15" $647.58 $647.58 "$1,025.76" "$1,295.15" "$1,036.12" $582.82 $257.05 N/A $751.39 "$1,295.15" "$1,295.15" "$1,295.15" $269.91 "$1,295.15" N/A N/A 281.502 SUP HCPCS C1713 281.502 - PLATE BONE 130D SHORT BARREL 46MM 25MM 2 HOLE DHS/DCP BOTH IP/OP "$1,004.00" $743.00 $199.21 "$1,020.73" $451.66 $451.66 $451.66 $451.66 "$1,003.68" "$1,003.68" "$1,003.68" $209.19 "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" $209.18 "$1,003.68" "$1,020.73" $593.68 "$1,003.68" "$1,020.73" "$1,003.68" "$1,003.68" $753.00 "$1,003.68" "$1,003.68" "$1,003.68" $501.84 $501.84 $794.91 "$1,003.68" $802.94 $451.66 $199.21 N/A $582.32 "$1,003.68" "$1,003.68" "$1,003.68" $209.17 "$1,003.68" N/A N/A 281.503 SUP HCPCS C1713 281.503 - PLATE BONE 130D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP BOTH IP/OP "$1,004.00" $743.00 $199.21 "$1,020.73" $451.66 $451.66 $451.66 $451.66 "$1,003.68" "$1,003.68" "$1,003.68" $209.19 "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" $209.18 "$1,003.68" $408.29 $593.68 "$1,003.68" "$1,020.73" "$1,003.68" "$1,003.68" $753.00 "$1,003.68" "$1,003.68" "$1,003.68" $501.84 $501.84 $794.91 "$1,003.68" $802.94 $451.66 $199.21 N/A $582.32 "$1,003.68" "$1,003.68" "$1,003.68" $209.17 "$1,003.68" N/A N/A 281.504 SUP HCPCS C1713 281.504 - PLATE BONE 130D SHORT BARREL 78MM 25MM 4 HOLE DHS/DCP BOTH IP/OP "$1,004.00" $743.00 $199.21 "$1,020.73" $451.66 $451.66 $451.66 $451.66 "$1,003.68" "$1,003.68" "$1,003.68" $209.19 "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" $209.18 "$1,003.68" $408.29 $593.68 "$1,003.68" "$1,020.73" "$1,003.68" "$1,003.68" $753.00 "$1,003.68" "$1,003.68" "$1,003.68" $501.84 $501.84 $794.91 "$1,003.68" $802.94 $451.66 $199.21 N/A $582.32 "$1,003.68" $602.21 "$1,003.68" $209.17 "$1,003.68" N/A N/A 281.505 SUP HCPCS C1713 281.505 - PLATE BONE 130D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP BOTH IP/OP "$1,004.00" $743.00 $199.21 "$1,020.73" $451.66 $451.66 $451.66 $451.66 "$1,003.68" "$1,003.68" "$1,003.68" $209.19 "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" $209.18 "$1,003.68" $408.29 $593.68 "$1,003.68" "$1,020.73" "$1,003.68" "$1,003.68" $753.00 "$1,003.68" "$1,003.68" "$1,003.68" $501.84 $501.84 $794.91 "$1,003.68" $802.94 $451.66 $199.21 N/A $582.32 "$1,003.68" $602.21 "$1,003.68" $209.17 "$1,003.68" N/A N/A 281.506 SUP HCPCS C1713 281.506 - PLATE BONE 130D SHORT BARREL 110MM 25MM 6 HOLE DHS/DCP BOTH IP/OP "$1,004.00" $743.00 $199.21 "$1,020.73" $451.66 $451.66 $451.66 $451.66 "$1,003.68" "$1,003.68" "$1,003.68" $209.19 "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" "$1,003.68" $209.18 "$1,003.68" "$1,020.73" $593.68 "$1,003.68" "$1,020.73" "$1,003.68" "$1,003.68" $753.00 "$1,003.68" "$1,003.68" "$1,003.68" $501.84 $501.84 $794.91 "$1,003.68" $802.94 $451.66 $199.21 N/A $582.32 "$1,003.68" $602.21 "$1,003.68" $209.17 "$1,003.68" N/A N/A 281.52 SUP HCPCS C1713 281.520 - PLATE BN 135D SHRT BRL 46MM NS 25MM DHS 2 HL SS HIP 4.5MM BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.53 SUP HCPCS C1713 281.530 - PLATE BONE 135D SHORT BARREL 62MM 25MM 3 HOLE COMPRESSION BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.54 SUP HCPCS C1713 281.540 - PLATE BN 135D SHRT BRL 12.6MM 78X19X5.8MM NS 25MM DHS DCP 4 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.55 SUP HCPCS C1713 281.550 - PLATE BONE 135D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.56 SUP HCPCS C1713 281.560 - PLATE BONE 135D SHORT BARREL 110MM 6 HOLE DHS STAINLESS BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.62 SUP HCPCS C1713 281.620 - PLATE BN 140D SHRT BRL 46MM NS 25MM DHS 2 HL SS HIP 4.5MM BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.63 SUP HCPCS C1713 281.630 - PLATE BONE 140D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $974.43 $974.43 N/A N/A 281.64 SUP HCPCS C1713 281.640 - PLATE BONE 140D SHORT BARREL 78MM 25MM 4 HOLE DHS/DCP BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $974.43 $974.43 N/A N/A 281.65 SUP HCPCS C1713 281.650 - PLATE BONE 140D SHORT BARREL 94MM 25MM 5 HOLE DHS STAINLESS BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.66 SUP HCPCS C1713 281.660 - PLATE BONE 140D SHORT BARREL 110MM 25MM 6 HOLE DHS/DCP BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $974.43 $974.43 $203.07 $974.43 N/A N/A 281.72 SUP HCPCS C1713 281.720 - PLATE BN 145D SHRT BRL 46MM NS 25MM DHS 2 HL SS HIP 4.5MM BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $974.43 $974.43 $974.43 $974.43 N/A N/A 281.73 SUP HCPCS C1713 281.730 - PLATE BONE 145D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $974.43 $974.43 N/A N/A 281.74 SUP HCPCS C1713 281.740 - PLATE BONE 145D SHORT BARREL 78MM 25MM 4 HOLE DHS/DCP BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.75 SUP HCPCS C1713 281.750 - PLATE BONE 145D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.76 SUP HCPCS C1713 281.760 - PLATE BONE 145D SHORT BARREL 110MM 25MM 6 HOLE DHS/DCP BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.82 SUP HCPCS C1713 281.820 - PLATE BONE 150D 2 FLAT LP SHORT BARREL 12.6MM 46X19X5.8MM 25 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $974.43 $974.43 N/A N/A 281.83 SUP HCPCS C1713 281.830 - PLATE BONE 150D SHORT BARREL 62MM 25MM 3 HOLE DHS/DCP BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.84 SUP HCPCS C1713 281.840 - PLATE BN 150D SHRT BRL 12.6MM 78X19X5.8MM NS 25MM DHS DCP 4 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 $408.29 $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $203.07 $974.43 N/A N/A 281.85 SUP HCPCS C1713 281.850 - PLATE BONE 150D SHORT BARREL 94MM 25MM 5 HOLE DHS/DCP BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $974.43 $974.43 N/A N/A 281.86 SUP HCPCS C1713 281.860 - PLATE BN 150D SHRT BRL 12.6MM 110X19X5.8MM NS 25MM DHS DCP 6 BOTH IP/OP $974.50 $721.00 $193.40 "$1,020.73" $438.49 $438.49 $438.49 $438.49 $974.43 $974.43 $974.43 $203.10 $974.43 $974.43 $974.43 $974.43 $974.43 $203.08 $974.43 "$1,020.73" $576.38 $974.43 "$1,020.73" $974.43 $974.43 $730.88 $974.43 $974.43 $974.43 $487.22 $487.22 $771.75 $974.43 $779.54 $438.49 $193.40 N/A $565.21 $974.43 $584.66 $974.43 $974.43 $974.43 N/A N/A 281.869 SUP HCPCS C1713 281.869 - PLATE BN SHRT 138MM NS SS DHS TROCH STAB BOTH IP/OP "$1,074.00" $795.00 $213.15 "$1,092.20" $483.28 $483.28 $483.28 $483.28 "$1,073.95" "$1,073.95" "$1,073.95" $223.84 "$1,073.95" "$1,073.95" "$1,073.95" "$1,073.95" "$1,073.95" $223.82 "$1,073.95" "$1,092.20" $635.24 "$1,073.95" "$1,092.20" "$1,073.95" "$1,073.95" $805.50 "$1,073.95" "$1,073.95" "$1,073.95" $536.98 $536.98 $850.57 "$1,073.95" $859.16 $483.28 $213.15 N/A $622.92 "$1,073.95" "$1,073.95" "$1,073.95" $223.81 "$1,073.95" N/A N/A 281.87 SUP HCPCS C1713 281.870 - PLATE BN LNG 148MM NS SS DHS TROCH STAB BOTH IP/OP "$1,043.00" $772.00 $206.95 "$1,092.20" $469.21 $469.21 $469.21 $469.21 "$1,042.68" "$1,042.68" "$1,042.68" $217.32 "$1,042.68" "$1,042.68" "$1,042.68" "$1,042.68" "$1,042.68" $217.31 "$1,042.68" "$1,092.20" $616.75 "$1,042.68" "$1,092.20" "$1,042.68" "$1,042.68" $782.25 "$1,042.68" "$1,042.68" "$1,042.68" $521.34 $521.34 $825.80 "$1,042.68" $834.14 $469.21 $206.95 N/A $604.94 "$1,042.68" "$1,042.68" "$1,042.68" $217.29 "$1,042.68" N/A N/A 281.9 SUP HCPCS C1713 281.900 - PLATE BN 95D SHRT BRL 12.6MM 178X16X5.4MM NS 25MM DCS DCP 10 BOTH IP/OP "$1,685.50" "$1,247.00" $334.53 "$1,765.53" $758.47 $758.47 $758.47 $758.47 "$1,685.48" "$1,685.48" "$1,685.48" $351.30 "$1,685.48" "$1,685.48" "$1,685.48" "$1,685.48" "$1,685.48" $351.27 "$1,685.48" "$1,765.53" $996.96 "$1,685.48" "$1,765.53" "$1,685.48" "$1,685.48" "$1,264.13" "$1,685.48" "$1,685.48" "$1,685.48" $842.74 $842.74 "$1,334.90" "$1,685.48" "$1,348.38" $758.47 $334.53 N/A $977.59 "$1,685.48" "$1,011.29" "$1,685.48" $351.25 "$1,685.48" N/A N/A 281.925 SUP HCPCS C1713 281.925 - PLATE BN 95D SHRT BRL 210MM NS 25MM DCS 12 HL SS CNDRL 4.5MM BOTH IP/OP "$1,962.50" "$1,452.00" $389.48 "$1,995.70" $883.06 $883.06 $883.06 $883.06 "$1,962.35" "$1,962.35" "$1,962.35" $409.00 "$1,962.35" "$1,962.35" "$1,962.35" "$1,962.35" "$1,962.35" $408.98 "$1,962.35" "$1,995.70" "$1,160.73" "$1,962.35" "$1,995.70" "$1,962.35" "$1,962.35" "$1,471.88" "$1,962.35" "$1,962.35" "$1,962.35" $981.18 $981.18 "$1,554.18" "$1,962.35" "$1,569.88" $883.06 $389.48 N/A "$1,138.25" "$1,962.35" "$1,177.41" "$1,962.35" "$1,962.35" "$1,962.35" N/A N/A 281.93 SUP HCPCS C1713 281.930 - PLATE BN 95D SHRT BRL 12.6MM 242X16X5.4MM NS 25MM DCS DCP 14 BOTH IP/OP "$1,905.50" "$1,410.00" $378.13 "$1,995.70" $857.34 $857.34 $857.34 $857.34 "$1,905.20" "$1,905.20" "$1,905.20" $397.09 "$1,905.20" "$1,905.20" "$1,905.20" "$1,905.20" "$1,905.20" $397.06 "$1,905.20" "$1,995.70" "$1,126.93" "$1,905.20" "$1,995.70" "$1,905.20" "$1,905.20" "$1,429.13" "$1,905.20" "$1,905.20" "$1,905.20" $952.60 $952.60 "$1,508.92" "$1,905.20" "$1,524.16" $857.34 $378.13 N/A "$1,105.19" "$1,905.20" "$1,143.12" "$1,905.20" "$1,905.20" "$1,905.20" N/A N/A 281.94 SUP HCPCS C1713 281.940 - PLATE BN 95D SHRT BRL 12.6MM 274X16X5.4MM NS 25MM DCS DCP 16 BOTH IP/OP "$2,031.00" "$1,503.00" $403.05 "$2,127.23" $913.84 $913.84 $913.84 $913.84 "$2,030.75" "$2,030.75" "$2,030.75" $423.26 "$2,030.75" "$2,030.75" "$2,030.75" "$2,030.75" "$2,030.75" $423.23 "$2,030.75" $850.89 "$1,201.19" "$2,030.75" "$2,127.23" "$2,030.75" "$2,030.75" "$1,523.25" "$2,030.75" "$2,030.75" "$2,030.75" "$1,015.38" "$1,015.38" "$1,608.35" "$2,030.75" "$1,624.60" $913.84 $403.05 N/A "$1,177.98" "$2,030.75" "$2,030.75" "$2,030.75" $423.21 "$2,030.75" N/A N/A 281.95 SUP HCPCS C1713 281.950 - PLATE BONE 95D 306MM 25MM 18 HOLE DCS STAINLESS STEEL BOTH IP/OP "$2,590.50" "$1,917.00" $514.11 "$2,713.35" "$1,165.64" "$1,165.64" "$1,165.64" "$1,165.64" "$2,590.30" "$2,590.30" "$2,590.30" $539.88 "$2,590.30" "$2,590.30" "$2,590.30" "$2,590.30" "$2,590.30" $539.85 "$2,590.30" "$1,085.34" "$1,277.02" "$2,590.30" "$2,713.35" "$2,590.30" "$2,590.30" "$1,942.88" "$2,590.30" "$2,590.30" "$2,590.30" "$1,295.15" "$1,295.15" "$2,051.52" "$2,590.30" "$2,072.24" "$1,165.64" $514.11 N/A "$1,502.49" "$2,590.30" "$2,590.30" "$2,590.30" "$2,590.30" "$2,590.30" N/A N/A 281.96 SUP HCPCS C1713 281.960 - PLATE BN 95D SHRT BRL 12.6MM 114X16X5.4MM NS 25MM DCS DCP 6 BOTH IP/OP "$1,685.50" "$1,247.00" $334.53 "$1,765.53" $758.47 $758.47 $758.47 $758.47 "$1,685.48" "$1,685.48" "$1,685.48" $351.30 "$1,685.48" "$1,685.48" "$1,685.48" "$1,685.48" "$1,685.48" $351.27 "$1,685.48" $706.21 $996.96 "$1,685.48" "$1,765.53" "$1,685.48" "$1,685.48" "$1,264.13" "$1,685.48" "$1,685.48" "$1,685.48" $842.74 $842.74 "$1,334.90" "$1,685.48" "$1,348.38" $758.47 $334.53 N/A $977.59 "$1,685.48" "$1,685.48" "$1,685.48" $351.25 "$1,685.48" N/A N/A 281.97 SUP HCPCS C1713 281.970 - PLATE BONE 95D 338MM 25MM 20 HOLE DCS DCP STAINLESS STEEL BOTH IP/OP "$2,676.50" "$1,981.00" $531.17 "$2,803.43" "$1,204.33" "$1,204.33" "$1,204.33" "$1,204.33" "$2,676.28" "$2,676.28" "$2,676.28" $557.80 "$2,676.28" "$2,676.28" "$2,676.28" "$2,676.28" "$2,676.28" $557.77 "$2,676.28" "$2,803.43" "$1,319.41" "$2,676.28" "$2,803.43" "$2,676.28" "$2,676.28" "$2,007.38" "$2,676.28" "$2,676.28" "$2,676.28" "$1,338.14" "$1,338.14" "$2,119.61" "$2,676.28" "$2,141.02" "$1,204.33" $531.17 N/A "$1,552.37" "$2,676.28" "$1,605.77" "$2,676.28" $557.74 "$2,676.28" N/A N/A 281.98 SUP HCPCS C1713 281.980 - PLATE BN 95D SHRT BRL 12.6MM 146X16X5.4MM NS 25MM DCS DCP 8 BOTH IP/OP "$1,685.50" "$1,247.00" $334.53 "$1,765.53" $758.47 $758.47 $758.47 $758.47 "$1,685.48" "$1,685.48" "$1,685.48" $351.30 "$1,685.48" "$1,685.48" "$1,685.48" "$1,685.48" "$1,685.48" $351.27 "$1,685.48" "$1,765.53" $996.96 "$1,685.48" "$1,765.53" "$1,685.48" "$1,685.48" "$1,264.13" "$1,685.48" "$1,685.48" "$1,685.48" $842.74 $842.74 "$1,334.90" "$1,685.48" "$1,348.38" $758.47 $334.53 N/A $977.59 "$1,685.48" "$1,011.29" "$1,685.48" "$1,685.48" "$1,685.48" N/A N/A 281.99 SUP HCPCS C1713 281.990 - PLATE BONE 95D BARREL 370MM 22 HOLE DCS STAINLESS STEEL BOTH IP/OP "$2,795.00" "$2,068.00" $554.74 "$2,927.80" "$1,257.75" "$1,257.75" "$1,257.75" "$1,257.75" "$2,795.00" "$2,795.00" "$2,795.00" $582.55 "$2,795.00" "$2,795.00" "$2,795.00" "$2,795.00" "$2,795.00" $582.51 "$2,795.00" "$2,927.80" "$1,377.94" "$2,795.00" "$2,927.80" "$2,795.00" "$2,795.00" "$2,096.25" "$2,795.00" "$2,795.00" "$2,795.00" "$1,397.50" "$1,397.50" "$2,213.64" "$2,795.00" "$2,236.00" "$1,257.75" $554.74 N/A "$1,621.10" "$2,795.00" "$1,677.00" "$2,795.00" $582.48 "$2,795.00" N/A N/A 282.235 SUP HCPCS C1713 282.235 - BLADE IM NAIL 80MM LCP DHHS HIP SS CMPR PLT NONSTRL BOTH IP/OP $688.00 $509.00 $136.47 $687.60 $309.42 $309.42 $309.42 $309.42 $687.60 $687.60 $687.60 $143.31 $687.60 $687.60 $687.60 $687.60 $687.60 $143.30 $687.60 $275.04 $406.72 $687.60 $687.60 $687.60 $687.60 $516.00 $687.60 $687.60 $687.60 $343.80 $343.80 $544.58 $687.60 $550.08 $309.42 $136.47 N/A $399.04 $687.60 $412.56 $687.60 $143.30 $687.60 N/A N/A 282.236 SUP HCPCS C1713 282.236 - BLADE IM NAIL 85MM LCP DHHS HIP SS CMPR PLT NONSTRL BOTH IP/OP $688.00 $509.00 $136.47 $687.60 $309.42 $309.42 $309.42 $309.42 $687.60 $687.60 $687.60 $143.31 $687.60 $687.60 $687.60 $687.60 $687.60 $143.30 $687.60 $275.04 $406.72 $687.60 $687.60 $687.60 $687.60 $516.00 $687.60 $687.60 $687.60 $343.80 $343.80 $544.58 $687.60 $550.08 $309.42 $136.47 N/A $399.04 $687.60 $412.56 $687.60 $143.30 $687.60 N/A N/A 282.24 SUP HCPCS C1713 282.240 - BLADE 105MM HLX LCP DHHS SS ORTH SURG NONSTRL BOTH IP/OP $742.00 $549.00 $147.24 $741.88 $333.85 $333.85 $333.85 $333.85 $741.88 $741.88 $741.88 $154.63 $741.88 $741.88 $741.88 $741.88 $741.88 $154.62 $741.88 $741.88 $438.82 $741.88 $741.88 $741.88 $741.88 $556.50 $741.88 $741.88 $741.88 $370.94 $370.94 $587.57 $741.88 $593.50 $333.85 $147.24 N/A $430.36 $741.88 $445.13 $741.88 $154.61 $741.88 N/A N/A 282.241 SUP HCPCS C1713 282.241 - BLADE FIX 110MM LCP DHHS SS HLCL STRL BOTH IP/OP $742.00 $549.00 $147.24 $741.88 $333.85 $333.85 $333.85 $333.85 $741.88 $741.88 $741.88 $154.63 $741.88 $741.88 $741.88 $741.88 $741.88 $154.62 $741.88 $296.75 $438.82 $741.88 $741.88 $741.88 $741.88 $556.50 $741.88 $741.88 $741.88 $370.94 $370.94 $587.57 $741.88 $593.50 $333.85 $147.24 N/A $430.36 $741.88 $445.13 $741.88 $154.61 $741.88 N/A N/A 282.242 SUP HCPCS C1713 282.242 - BLADE FIX 115MM LCP DHHS SS HLCL STRL BOTH IP/OP $742.00 $549.00 $147.24 $741.88 $333.85 $333.85 $333.85 $333.85 $741.88 $741.88 $741.88 $154.63 $741.88 $741.88 $741.88 $741.88 $741.88 $154.62 $741.88 $296.75 $438.82 $741.88 $741.88 $741.88 $741.88 $556.50 $741.88 $741.88 $741.88 $370.94 $370.94 $587.57 $741.88 $593.50 $333.85 $147.24 N/A $430.36 $741.88 $741.88 $741.88 $154.61 $741.88 N/A N/A 282.5 SUP HCPCS C1713 282.50 - PLATE 95D 92 MMX 50MM SS 5 HOLE DCP BONE SM ADLT/YTH 50MM BOTH IP/OP $935.00 $692.00 $185.54 $979.28 $420.68 $420.68 $420.68 $420.68 $934.85 $934.85 $934.85 $194.85 $934.85 $934.85 $934.85 $934.85 $934.85 $194.83 $934.85 $979.28 $552.96 $934.85 $979.28 $934.85 $934.85 $701.25 $934.85 $934.85 $934.85 $467.43 $467.43 $740.40 $934.85 $747.88 $420.68 $185.54 N/A $542.30 $934.85 $934.85 $934.85 $194.82 $934.85 N/A N/A 282.52 SUP HCPCS C1713 282.52 - PLATE BONE 95D SMALL STATURE 92MM 60MM 5 HOLE DCP STAINLESS BOTH IP/OP $963.00 $713.00 $191.11 $979.28 $433.31 $433.31 $433.31 $433.31 $962.90 $962.90 $962.90 $200.69 $962.90 $962.90 $962.90 $962.90 $962.90 $200.68 $962.90 $391.71 $569.56 $962.90 $979.28 $962.90 $962.90 $722.25 $962.90 $962.90 $962.90 $481.45 $481.45 $762.62 $962.90 $770.32 $433.31 $191.11 N/A $558.54 $962.90 $962.90 $962.90 $200.67 $962.90 N/A N/A 282.54 SUP HCPCS C1713 282.54 - PLATE BONE 95D SMALL STATURE 92MM 70MM 5 HOLE DCP LC-DCP BOTH IP/OP $963.00 $713.00 $191.11 $979.28 $433.31 $433.31 $433.31 $433.31 $962.90 $962.90 $962.90 $200.69 $962.90 $962.90 $962.90 $962.90 $962.90 $200.68 $962.90 $391.71 $569.56 $962.90 $979.28 $962.90 $962.90 $722.25 $962.90 $962.90 $962.90 $481.45 $481.45 $762.62 $962.90 $770.32 $433.31 $191.11 N/A $558.54 $962.90 $962.90 $962.90 $962.90 $962.90 N/A N/A 282.58 SUP HCPCS C1713 282.58 - PLATE BONE 95D SMALL STATURE 40MM 92MM 5 HOLE DCP STAINLESS BOTH IP/OP $963.00 $713.00 $191.11 $979.28 $433.31 $433.31 $433.31 $433.31 $962.90 $962.90 $962.90 $200.69 $962.90 $962.90 $962.90 $962.90 $962.90 $200.68 $962.90 $391.71 $569.56 $962.90 $979.28 $962.90 $962.90 $722.25 $962.90 $962.90 $962.90 $481.45 $481.45 $762.62 $962.90 $770.32 $433.31 $191.11 N/A $558.54 $962.90 $577.74 $962.90 $962.90 $962.90 N/A N/A 282.6 SUP HCPCS C1713 282.600 - SIDEPLATE BONE 130D STANDARD BARREL 54MM 38MM 2 HOLE LCP BOTH IP/OP "$1,056.50" $782.00 $209.66 "$1,106.50" $475.35 $475.35 $475.35 $475.35 "$1,056.33" "$1,056.33" "$1,056.33" $220.17 "$1,056.33" "$1,056.33" "$1,056.33" "$1,056.33" "$1,056.33" $220.15 "$1,056.33" "$1,106.50" $624.82 "$1,056.33" "$1,106.50" "$1,056.33" "$1,056.33" $792.38 "$1,056.33" "$1,056.33" "$1,056.33" $528.17 $528.17 $836.61 "$1,056.33" $845.06 $475.35 $209.66 N/A $612.77 "$1,056.33" $633.80 "$1,056.33" "$1,056.33" "$1,056.33" N/A N/A 282.601 SUP HCPCS C1713 282.601 - SIDEPLATE BONE 130D STANDARD BARREL 72MM 38MM 3 HOLE LCP BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" "$1,106.50" $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" $652.80 "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.602 SUP HCPCS C1713 282.602 - SIDEPLATE BONE 130D STANDARD BARREL 90MM 4 HOLE LCP DHHS BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" "$1,106.50" $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" $652.80 "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.603 SUP HCPCS C1713 282.603 - SIDEPLATE BONE 130D STANDARD BARREL 108MM 5 HOLE LCP DHHS BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" "$1,106.50" $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.604 SUP HCPCS C1713 282.604 - SIDEPLATE BONE 130D STANDARD BARREL 126MM 38MM 6 HOLE LCP BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" $652.80 "$1,088.00" "$1,088.00" "$1,088.00" N/A N/A 282.61 SUP HCPCS C1713 282.610 - SIDEPLATE BONE 135D STANDARD BARREL 54MM 38MM 2 HOLE LCP BOTH IP/OP "$1,056.50" $782.00 $209.66 "$1,106.50" $475.35 $475.35 $475.35 $475.35 "$1,056.33" "$1,056.33" "$1,056.33" $220.17 "$1,056.33" "$1,056.33" "$1,056.33" "$1,056.33" "$1,056.33" $220.15 "$1,056.33" "$1,106.50" $624.82 "$1,056.33" "$1,106.50" "$1,056.33" "$1,056.33" $792.38 "$1,056.33" "$1,056.33" "$1,056.33" $528.17 $528.17 $836.61 "$1,056.33" $845.06 $475.35 $209.66 N/A $612.77 "$1,056.33" $633.80 "$1,056.33" $220.14 "$1,056.33" N/A N/A 282.611 SUP HCPCS C1713 282.611 - SIDEPLATE BONE 135D STANDARD BARREL 72MM 38MM 3 HOLE LCP BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" $652.80 "$1,088.00" "$1,088.00" "$1,088.00" N/A N/A 282.612 SUP HCPCS C1713 282.612 - SIDEPLATE BONE 135D STANDARD BARREL 90MM 38MM 4 HOLE LCP BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.613 SUP HCPCS C1713 282.613 - SIDEPLATE BONE 135D STANDARD BARREL 108MM 38MM 5 HOLE LCP BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" "$1,106.50" $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" $652.80 "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.614 SUP HCPCS C1713 282.614 - SIDEPLATE BONE 135D STANDARD BARREL 126MM 38MM 6 HOLE LCP BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" "$1,106.50" $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" $652.80 "$1,088.00" "$1,088.00" "$1,088.00" N/A N/A 282.63 SUP HCPCS C1713 282.630 - SIDEPLATE BONE 140D STANDARD BARREL LP 54MM 38MM 2 HOLE LCP BOTH IP/OP "$1,056.50" $782.00 $209.66 "$1,106.50" $475.35 $475.35 $475.35 $475.35 "$1,056.33" "$1,056.33" "$1,056.33" $220.17 "$1,056.33" "$1,056.33" "$1,056.33" "$1,056.33" "$1,056.33" $220.15 "$1,056.33" "$1,106.50" $624.82 "$1,056.33" "$1,106.50" "$1,056.33" "$1,056.33" $792.38 "$1,056.33" "$1,056.33" "$1,056.33" $528.17 $528.17 $836.61 "$1,056.33" $845.06 $475.35 $209.66 N/A $612.77 "$1,056.33" "$1,056.33" "$1,056.33" $220.14 "$1,056.33" N/A N/A 282.631 SUP HCPCS C1713 282.631 - SIDEPLATE BONE 140D STANDARD BARREL 72MM 38MM 3 HOLE BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" "$1,106.50" $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.632 SUP HCPCS C1713 282.632 - SIDEPLATE BONE 140D STANDARD BARREL 90MM 38MM 4 HOLE BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" "$1,106.50" $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" $652.80 "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.633 SUP HCPCS C1713 282.633 - SIDEPLATE BONE 140D STANDARD BARREL 108MM 38MM 5 HOLE BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" "$1,106.50" $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" $652.80 "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.634 SUP HCPCS C1713 282.634 - SIDEPLATE BONE 140D STANDARD BARREL 126MM 38MM 6 HOLE BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" $652.80 "$1,088.00" "$1,088.00" "$1,088.00" N/A N/A 282.64 SUP HCPCS C1713 282.640 - SIDEPLATE BONE 145D STANDARD BARREL LP 54MM 38MM 2 HOLE LCP BOTH IP/OP "$1,056.50" $782.00 $209.66 "$1,106.50" $475.35 $475.35 $475.35 $475.35 "$1,056.33" "$1,056.33" "$1,056.33" $220.17 "$1,056.33" "$1,056.33" "$1,056.33" "$1,056.33" "$1,056.33" $220.15 "$1,056.33" $442.60 $624.82 "$1,056.33" "$1,106.50" "$1,056.33" "$1,056.33" $792.38 "$1,056.33" "$1,056.33" "$1,056.33" $528.17 $528.17 $836.61 "$1,056.33" $845.06 $475.35 $209.66 N/A $612.77 "$1,056.33" "$1,056.33" "$1,056.33" "$1,056.33" "$1,056.33" N/A N/A 282.641 SUP HCPCS C1713 282.641 - SIDEPLATE BONE 145D STANDARD BARREL 72MM 38MM 3 HOLE BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" N/A N/A 282.642 SUP HCPCS C1713 282.642 - SIDEPLATE BONE 145D STANDARD BARREL 90MM 38MM 4 HOLE BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" "$1,106.50" $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.643 SUP HCPCS C1713 282.643 - SIDEPLATE BONE 145D STANDARD BARREL 108MM 38MM 5 HOLE BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" N/A N/A 282.644 SUP HCPCS C1713 282.644 - SIDEPLATE BONE 145D STANDARD BARREL 126MM 38MM 6 HOLE BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" N/A N/A 282.65 SUP HCPCS C1713 282.650 - SIDEPLATE BONE 150D STANDARD BARREL LP 54MM 38MM 2 HOLE LCP BOTH IP/OP "$1,056.50" $782.00 $209.66 "$1,106.50" $475.35 $475.35 $475.35 $475.35 "$1,056.33" "$1,056.33" "$1,056.33" $220.17 "$1,056.33" "$1,056.33" "$1,056.33" "$1,056.33" "$1,056.33" $220.15 "$1,056.33" "$1,106.50" $624.82 "$1,056.33" "$1,106.50" "$1,056.33" "$1,056.33" $792.38 "$1,056.33" "$1,056.33" "$1,056.33" $528.17 $528.17 $836.61 "$1,056.33" $845.06 $475.35 $209.66 N/A $612.77 "$1,056.33" "$1,056.33" "$1,056.33" $220.14 "$1,056.33" N/A N/A 282.651 SUP HCPCS C1713 282.651 - SIDEPLATE BONE 150D STANDARD BARREL 72MM 38MM 3 HOLE LCP BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.652 SUP HCPCS C1713 282.652 - SIDEPLATE BONE 150D STANDARD BARREL 90MM 38MM 4 HOLE LCP BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" "$1,106.50" $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.653 SUP HCPCS C1713 282.653 - SIDEPLATE BONE 150D STANDARD BARREL 108MM 38MM 5 HOLE LCP BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.654 SUP HCPCS C1713 282.654 - SIDEPLATE BONE 150D STANDARD BARREL 126MM 38MM 6 HOLE LCP BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" "$1,106.50" $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.67 SUP HCPCS C1713 282.670 - SIDEPLATE BONE 130D SHORT BARREL LP 54MM 25MM 2 HOLE LCP BOTH IP/OP "$1,056.50" $782.00 $209.66 "$1,106.50" $475.35 $475.35 $475.35 $475.35 "$1,056.33" "$1,056.33" "$1,056.33" $220.17 "$1,056.33" "$1,056.33" "$1,056.33" "$1,056.33" "$1,056.33" $220.15 "$1,056.33" $442.60 $624.82 "$1,056.33" "$1,106.50" "$1,056.33" "$1,056.33" $792.38 "$1,056.33" "$1,056.33" "$1,056.33" $528.17 $528.17 $836.61 "$1,056.33" $845.06 $475.35 $209.66 N/A $612.77 "$1,056.33" "$1,056.33" "$1,056.33" $220.14 "$1,056.33" N/A N/A 282.672 SUP HCPCS C1713 282.672 - SIDEPLATE BONE 130D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.676 SUP HCPCS C1713 282.676 - SIDEPLATE BONE 135D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.678 SUP HCPCS C1713 282.678 - SIDEPLATE BONE 135D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.683 SUP HCPCS C1713 282.683 - SIDEPLATE BONE 140D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.688 SUP HCPCS C1713 282.688 - SIDEPLATE BONE 145D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" N/A N/A 282.691 SUP HCPCS C1713 282.691 - SIDEPLATE BONE 150D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" "$1,106.50" $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.693 SUP HCPCS C1713 282.693 - SIDEPLATE BONE 150D SHORT BARREL 90MM 25MM 4 HOLE LCP DHHS BOTH IP/OP "$1,088.00" $805.00 $215.94 "$1,106.50" $489.60 $489.60 $489.60 $489.60 "$1,088.00" "$1,088.00" "$1,088.00" $226.77 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $226.75 "$1,088.00" $442.60 $643.55 "$1,088.00" "$1,106.50" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $489.60 $215.94 N/A $631.04 "$1,088.00" "$1,088.00" "$1,088.00" $226.74 "$1,088.00" N/A N/A 282.7 SUP HCPCS C1713 282.70 - PLATE BONE 95D SMALL STATURE T PROFILE 124MM 50MM 7 HOLE DCP BOTH IP/OP $979.00 $724.00 $194.21 "$1,025.00" $440.34 $440.34 $440.34 $440.34 $978.53 $978.53 $978.53 $203.95 $978.53 $978.53 $978.53 $978.53 $978.53 $203.94 $978.53 "$1,025.00" $578.80 $978.53 "$1,025.00" $978.53 $978.53 $734.25 $978.53 $978.53 $978.53 $489.27 $489.27 $775.00 $978.53 $782.82 $440.34 $194.21 N/A $567.82 $978.53 $978.53 $978.53 $203.93 $978.53 N/A N/A 282.72 SUP HCPCS C1713 282.72 - PLATE BONE 95D SMALL STATURE 124MM 60MM 7 HOLE ANGLED DCP BOTH IP/OP "$1,008.00" $746.00 $200.04 "$1,025.00" $453.55 $453.55 $453.55 $453.55 "$1,007.88" "$1,007.88" "$1,007.88" $210.07 "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" $210.05 "$1,007.88" "$1,025.00" $596.16 "$1,007.88" "$1,025.00" "$1,007.88" "$1,007.88" $756.00 "$1,007.88" "$1,007.88" "$1,007.88" $503.94 $503.94 $798.24 "$1,007.88" $806.30 $453.55 $200.04 N/A $584.64 "$1,007.88" $604.73 "$1,007.88" $210.04 "$1,007.88" N/A N/A 282.74 SUP HCPCS C1713 282.74 - PLATE BONE 95D SMALL STATURE 124MM 70MM 7 HOLE CNDYLR DCP BOTH IP/OP "$1,008.00" $746.00 $200.04 "$1,025.00" $453.55 $453.55 $453.55 $453.55 "$1,007.88" "$1,007.88" "$1,007.88" $210.07 "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" $210.05 "$1,007.88" $410.00 $596.16 "$1,007.88" "$1,025.00" "$1,007.88" "$1,007.88" $756.00 "$1,007.88" "$1,007.88" "$1,007.88" $503.94 $503.94 $798.24 "$1,007.88" $806.30 $453.55 $200.04 N/A $584.64 "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" N/A N/A 282.78 SUP HCPCS C1713 282.78 - PLATE BONE 95D SMALL STATURE 124MM 40MM 7 HOLE DCP CAPOS BOTH IP/OP "$1,008.00" $746.00 $200.04 "$1,025.00" $453.55 $453.55 $453.55 $453.55 "$1,007.88" "$1,007.88" "$1,007.88" $210.07 "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" $210.05 "$1,007.88" $410.00 $596.16 "$1,007.88" "$1,025.00" "$1,007.88" "$1,007.88" $756.00 "$1,007.88" "$1,007.88" "$1,007.88" $503.94 $503.94 $798.24 "$1,007.88" $806.30 $453.55 $200.04 N/A $584.64 "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" "$1,007.88" N/A N/A 282.8 SUP Custom 27803010 282.80 - STAPLE BONE 23X20X3MM STAINLESS STEEL NONSTRL BOTH IP/OP $252.00 $186.00 $44.81 $251.75 $251.75 $251.75 $251.75 $251.75 $251.75 $251.75 $44.81 $251.75 $251.75 $251.75 $251.75 $251.75 $251.75 $52.47 $251.75 $100.70 $251.75 $251.75 $251.75 $251.75 $251.75 $189.00 $251.75 $251.75 $251.75 $125.88 $125.88 $199.39 $251.75 $201.40 $113.29 $251.75 N/A $146.16 $251.75 $151.05 $251.75 $251.75 $251.75 N/A N/A 282.82 SUP Custom 27803010 282.82 - STAPLE BONE 24MM STAINLESS STEEL ORTHOPEDIC NONSTRL BOTH IP/OP $252.00 $186.00 $44.81 $251.75 $251.75 $251.75 $251.75 $251.75 $251.75 $251.75 $44.81 $251.75 $251.75 $251.75 $251.75 $251.75 $251.75 $52.47 $251.75 $100.70 $251.75 $251.75 $251.75 $251.75 $251.75 $189.00 $251.75 $251.75 $251.75 $125.88 $125.88 $199.39 $251.75 $201.40 $113.29 $251.75 N/A $146.16 $251.75 $151.05 $251.75 $251.75 $251.75 N/A N/A 282.9 SUP HCPCS C1713 282.90 - PLATE BONE 95D SMALL STATURE T PROFILE 156MM 50MM 9 HOLE DCP BOTH IP/OP "$1,047.00" $775.00 $207.76 "$1,096.50" $471.05 $471.05 $471.05 $471.05 "$1,046.78" "$1,046.78" "$1,046.78" $218.18 "$1,046.78" "$1,046.78" "$1,046.78" "$1,046.78" "$1,046.78" $218.16 "$1,046.78" $438.60 $619.17 "$1,046.78" "$1,096.50" "$1,046.78" "$1,046.78" $785.25 "$1,046.78" "$1,046.78" "$1,046.78" $523.39 $523.39 $829.05 "$1,046.78" $837.42 $471.05 $207.76 N/A $607.26 "$1,046.78" "$1,046.78" "$1,046.78" $218.15 "$1,046.78" N/A N/A 282.92 SUP HCPCS C1713 282.92 - PLATE BONE 95D SMALL STATURE 156MM 60MM 9 HOLE ANGLED BLADE BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" "$1,096.50" $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" "$1,078.18" "$1,078.18" $224.69 "$1,078.18" N/A N/A 282.94 SUP HCPCS C1713 282.94 - PLATE BONE 95D SMALL STATURE 156MM 70MM 9 HOLE DCP STAINLESS BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" "$1,096.50" $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" N/A N/A 282.98 SUP HCPCS C1713 282.98 - PLATE BONE 95D SMALL STATURE 156X40MM 40MM 9 HOLE CNDYLR DCP BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" "$1,096.50" $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" N/A N/A 283.4 SUP HCPCS C1713 283.40 - PLATE BONE 130D SMALL STATURE 50MM 60MM 4 HOLE ANGLED BLADE BOTH IP/OP $938.00 $694.00 $186.09 $982.13 $421.91 $421.91 $421.91 $421.91 $937.58 $937.58 $937.58 $195.42 $937.58 $937.58 $937.58 $937.58 $937.58 $195.40 $937.58 $982.13 $554.58 $937.58 $982.13 $937.58 $937.58 $703.50 $937.58 $937.58 $937.58 $468.79 $468.79 $742.56 $937.58 $750.06 $421.91 $186.09 N/A $544.04 $937.58 $937.58 $937.58 $195.39 $937.58 N/A N/A 283.42 SUP HCPCS C1713 283.42 - PLATE BONE 130D SMALL STATURE 60MM 4 HOLE ANGLED BLADE DCP BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $965.70 $965.70 $965.70 $965.70 N/A N/A 283.44 SUP HCPCS C1713 283.44 - PLATE BONE 130D SMALL STATURE 70MM 60MM ANGLED BLADE DCP BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $965.70 $965.70 $965.70 $965.70 N/A N/A 283.46 SUP HCPCS C1713 283.46 - PLATE BONE 130D SMALL STATURE 80MM 60MM 4 HOLE ANGLED BLADE BOTH IP/OP $966.00 $715.00 $191.67 $982.13 $434.57 $434.57 $434.57 $434.57 $965.70 $965.70 $965.70 $201.28 $965.70 $965.70 $965.70 $965.70 $965.70 $201.26 $965.70 $982.13 $571.21 $965.70 $982.13 $965.70 $965.70 $724.50 $965.70 $965.70 $965.70 $482.85 $482.85 $764.83 $965.70 $772.56 $434.57 $191.67 N/A $560.28 $965.70 $965.70 $965.70 $201.25 $965.70 N/A N/A 283.6 SUP HCPCS C1713 283.60 - PLATE BONE 130D 104MM 50MM 6 HOLE ANGLED BLADE DCP STAINLESS BOTH IP/OP $994.00 $736.00 $197.19 "$1,040.75" $447.10 $447.10 $447.10 $447.10 $993.55 $993.55 $993.55 $207.08 $993.55 $993.55 $993.55 $993.55 $993.55 $207.07 $993.55 "$1,040.75" $587.68 $993.55 "$1,040.75" $993.55 $993.55 $745.50 $993.55 $993.55 $993.55 $496.78 $496.78 $786.89 $993.55 $794.84 $447.10 $197.19 N/A $576.52 $993.55 $993.55 $993.55 $993.55 $993.55 N/A N/A 283.62 SUP HCPCS C1713 283.62 - PLATE BONE 130D 104MM 60MM 6 HOLE ANGLED BLADE DCP STAINLESS BOTH IP/OP "$1,023.50" $757.00 $203.11 "$1,040.75" $460.51 $460.51 $460.51 $460.51 "$1,023.35" "$1,023.35" "$1,023.35" $213.29 "$1,023.35" "$1,023.35" "$1,023.35" "$1,023.35" "$1,023.35" $213.28 "$1,023.35" "$1,040.75" $605.31 "$1,023.35" "$1,040.75" "$1,023.35" "$1,023.35" $767.63 "$1,023.35" "$1,023.35" "$1,023.35" $511.68 $511.68 $810.49 "$1,023.35" $818.68 $460.51 $203.11 N/A $593.63 "$1,023.35" "$1,023.35" "$1,023.35" "$1,023.35" "$1,023.35" N/A N/A 283.64 SUP HCPCS C1713 283.64 - PLATE BLADE 130D 104MM 70MM 6 HOLE ANGLED DCP STAINLESS BOTH IP/OP "$1,023.50" $757.00 $203.11 "$1,040.75" $460.51 $460.51 $460.51 $460.51 "$1,023.35" "$1,023.35" "$1,023.35" $213.29 "$1,023.35" "$1,023.35" "$1,023.35" "$1,023.35" "$1,023.35" $213.28 "$1,023.35" $416.30 $605.31 "$1,023.35" "$1,040.75" "$1,023.35" "$1,023.35" $767.63 "$1,023.35" "$1,023.35" "$1,023.35" $511.68 $511.68 $810.49 "$1,023.35" $818.68 $460.51 $203.11 N/A $593.63 "$1,023.35" "$1,023.35" "$1,023.35" "$1,023.35" "$1,023.35" N/A N/A 283.66 SUP HCPCS C1713 283.66 - SCREW BONE 130D 104MM 80MM 6 HOLE ANGLED BLADE DCP STAINLESS BOTH IP/OP "$1,023.50" $757.00 $203.11 "$1,040.75" $460.51 $460.51 $460.51 $460.51 "$1,023.35" "$1,023.35" "$1,023.35" $213.29 "$1,023.35" "$1,023.35" "$1,023.35" "$1,023.35" "$1,023.35" $213.28 "$1,023.35" $416.30 $605.31 "$1,023.35" "$1,040.75" "$1,023.35" "$1,023.35" $767.63 "$1,023.35" "$1,023.35" "$1,023.35" $511.68 $511.68 $810.49 "$1,023.35" $818.68 $460.51 $203.11 N/A $593.63 "$1,023.35" "$1,023.35" "$1,023.35" $213.27 "$1,023.35" N/A N/A 283.9 SUP HCPCS C1713 283.90 - PLATE BONE 130D SMALL STATURE 152MM 50MM 9 HOLE DCP CAPOS BOTH IP/OP "$1,073.00" $794.00 $212.90 "$1,123.65" $482.72 $482.72 $482.72 $482.72 "$1,072.70" "$1,072.70" "$1,072.70" $223.58 "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" $223.56 "$1,072.70" $449.46 $634.50 "$1,072.70" "$1,123.65" "$1,072.70" "$1,072.70" $804.75 "$1,072.70" "$1,072.70" "$1,072.70" $536.35 $536.35 $849.58 "$1,072.70" $858.16 $482.72 $212.90 N/A $622.34 "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" N/A N/A 283.92 SUP HCPCS C1713 283.92 - PLATE BONE 130D 4.5MM 152MM 60MM 9 HOLE BLADE ANGLED DCP BOTH IP/OP "$1,105.00" $818.00 $219.29 "$1,123.65" $497.20 $497.20 $497.20 $497.20 "$1,104.88" "$1,104.88" "$1,104.88" $230.28 "$1,104.88" "$1,104.88" "$1,104.88" "$1,104.88" "$1,104.88" $230.27 "$1,104.88" $449.46 $653.54 "$1,104.88" "$1,123.65" "$1,104.88" "$1,104.88" $828.75 "$1,104.88" "$1,104.88" "$1,104.88" $552.44 $552.44 $875.06 "$1,104.88" $883.90 $497.20 $219.29 N/A $640.90 "$1,104.88" "$1,104.88" "$1,104.88" "$1,104.88" "$1,104.88" N/A N/A 283.94 SUP HCPCS C1713 283.94 - PLATE BONE 130D 152MM 70MM 9 HOLE BLADE DCP STAINLESS STEEL BOTH IP/OP "$1,105.00" $818.00 $219.29 "$1,123.65" $497.20 $497.20 $497.20 $497.20 "$1,104.88" "$1,104.88" "$1,104.88" $230.28 "$1,104.88" "$1,104.88" "$1,104.88" "$1,104.88" "$1,104.88" $230.27 "$1,104.88" $449.46 $653.54 "$1,104.88" "$1,123.65" "$1,104.88" "$1,104.88" $828.75 "$1,104.88" "$1,104.88" "$1,104.88" $552.44 $552.44 $875.06 "$1,104.88" $883.90 $497.20 $219.29 N/A $640.90 "$1,104.88" "$1,104.88" "$1,104.88" $230.26 "$1,104.88" N/A N/A 283.96 SUP HCPCS C1713 283.96 - PLATE BONE 130D 80MM 152MM 80MM 9 HOLE ANGLED BLADE DCP BOTH IP/OP "$1,105.00" $818.00 $219.29 "$1,123.65" $497.20 $497.20 $497.20 $497.20 "$1,104.88" "$1,104.88" "$1,104.88" $230.28 "$1,104.88" "$1,104.88" "$1,104.88" "$1,104.88" "$1,104.88" $230.27 "$1,104.88" $449.46 $653.54 "$1,104.88" "$1,123.65" "$1,104.88" "$1,104.88" $828.75 "$1,104.88" "$1,104.88" "$1,104.88" $552.44 $552.44 $875.06 "$1,104.88" $883.90 $497.20 $219.29 N/A $640.90 "$1,104.88" "$1,104.88" "$1,104.88" $230.26 "$1,104.88" N/A N/A 288.025 SUP Custom 27803010 288.025 - DISTRACTOR SURG 10MM BODY STAINLESS STEEL NONSTRL BOTH IP/OP "$11,697.50" "$8,656.00" "$2,082.16" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$2,082.16" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$2,437.89" "$11,697.50" "$4,679.00" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$8,773.13" "$11,697.50" "$11,697.50" "$11,697.50" "$5,848.75" "$5,848.75" "$9,264.42" "$11,697.50" "$9,358.00" "$5,263.88" "$11,697.50" N/A "$6,784.55" "$11,697.50" "$7,018.50" "$11,697.50" "$11,697.50" "$11,697.50" N/A N/A 288.026 SUP Custom 27803010 288.026 - DISTRACTOR SURG 15MM BODY STAINLESS STEEL NONSTRL BOTH IP/OP "$11,697.50" "$8,656.00" "$2,082.16" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$2,082.16" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$2,437.89" "$11,697.50" "$4,679.00" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$8,773.13" "$11,697.50" "$11,697.50" "$11,697.50" "$5,848.75" "$5,848.75" "$9,264.42" "$11,697.50" "$9,358.00" "$5,263.88" "$11,697.50" N/A "$6,784.55" "$11,697.50" "$7,018.50" "$11,697.50" "$11,697.50" "$11,697.50" N/A N/A 288.027 SUP Custom 27803010 288.027 - DISTRACTOR SURG 20MM BODY STAINLESS STEEL NONSTRL BOTH IP/OP "$11,697.50" "$8,656.00" "$2,082.16" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$2,082.16" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$2,437.89" "$11,697.50" "$4,679.00" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$8,773.13" "$11,697.50" "$11,697.50" "$11,697.50" "$5,848.75" "$5,848.75" "$9,264.42" "$11,697.50" "$9,358.00" "$5,263.88" "$11,697.50" N/A "$6,784.55" "$11,697.50" "$7,018.50" "$11,697.50" "$11,697.50" "$11,697.50" N/A N/A 288.028 SUP Custom 27803010 288.028 - DISTRACTOR SURG 25MM BODY STAINLESS STEEL NONSTRL BOTH IP/OP "$11,697.50" "$8,656.00" "$2,082.16" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$2,082.16" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$2,437.89" "$11,697.50" "$4,679.00" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$11,697.50" "$8,773.13" "$11,697.50" "$11,697.50" "$11,697.50" "$5,848.75" "$5,848.75" "$9,264.42" "$11,697.50" "$9,358.00" "$5,263.88" "$11,697.50" N/A "$6,784.55" "$11,697.50" "$7,018.50" "$11,697.50" "$11,697.50" "$11,697.50" N/A N/A 288.038 SUP Custom 27803010 288.038 - FOOTPLATE BONE 6MM SPLINT STAINLESS STEEL RIGHT ANTERIOR BOTH IP/OP "$1,485.00" "$1,099.00" $264.33 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $264.33 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" $594.00 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 "$1,485.00" N/A $861.30 "$1,485.00" $891.00 "$1,485.00" "$1,485.00" "$1,485.00" N/A N/A 288.039 SUP Custom 27803010 288.039 - FOOTPLATE BONE 10MM SPLINT STAINLESS STEEL RIGHT ANTERIOR BOTH IP/OP "$1,485.00" "$1,099.00" $264.33 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $264.33 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" $594.00 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 "$1,485.00" N/A $861.30 "$1,485.00" $891.00 "$1,485.00" "$1,485.00" "$1,485.00" N/A N/A 288.04 SUP Custom 27803010 288.040 - FOOTPLATE BONE 14MM SPLINT STAINLESS STEEL RIGHT ANTERIOR BOTH IP/OP "$1,485.00" "$1,099.00" $264.33 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $264.33 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" $594.00 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 "$1,485.00" N/A $861.30 "$1,485.00" $891.00 "$1,485.00" "$1,485.00" "$1,485.00" N/A N/A 288.042 SUP Custom 27803010 288.042 - FOOTPLATE BONE 6MM SPLINT STAINLESS STEEL LEFT ANTERIOR MAXL BOTH IP/OP "$1,485.00" "$1,099.00" $264.33 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $264.33 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" $594.00 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 "$1,485.00" N/A $861.30 "$1,485.00" $891.00 "$1,485.00" "$1,485.00" "$1,485.00" N/A N/A 288.043 SUP Custom 27803010 288.043 - FOOTPLATE BONE 10MM SPLINT STAINLESS STEEL LEFT ANTERIOR BOTH IP/OP "$1,485.00" "$1,099.00" $264.33 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $264.33 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" $594.00 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 "$1,485.00" N/A $861.30 "$1,485.00" $891.00 "$1,485.00" "$1,485.00" "$1,485.00" N/A N/A 288.044 SUP Custom 27803010 288.044 - FOOTPLATE BONE 14MM SPLINT STAINLESS STEEL LEFT ANTERIOR BOTH IP/OP "$1,485.00" "$1,099.00" $264.33 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $264.33 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" $594.00 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 "$1,485.00" N/A $861.30 "$1,485.00" $891.00 "$1,485.00" "$1,485.00" "$1,485.00" N/A N/A 288.052 SUP Custom 27803010 288.052 - FOOTPLATE BONE SHORT 7MM OFFST STAINLESS STEEL POSTERIOR BOTH IP/OP "$2,952.50" "$2,185.00" $525.55 "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" $525.55 "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" $615.33 "$2,952.50" "$1,181.00" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,214.38" "$2,952.50" "$2,952.50" "$2,952.50" "$1,476.25" "$1,476.25" "$2,338.38" "$2,952.50" "$2,362.00" "$1,328.63" "$2,952.50" N/A "$1,712.45" "$2,952.50" "$1,771.50" "$2,952.50" "$2,952.50" "$2,952.50" N/A N/A 288.053 SUP Custom 27803010 288.053 - FOOTPLATE BONE SHORT 12MM OFFST STAINLESS STEEL POSTERIOR BOTH IP/OP "$2,952.50" "$2,185.00" $525.55 "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" $525.55 "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" $615.33 "$2,952.50" "$1,181.00" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,214.38" "$2,952.50" "$2,952.50" "$2,952.50" "$1,476.25" "$1,476.25" "$2,338.38" "$2,952.50" "$2,362.00" "$1,328.63" "$2,952.50" N/A "$1,712.45" "$2,952.50" "$1,771.50" "$2,952.50" "$2,952.50" "$2,952.50" N/A N/A 288.055 SUP Custom 27803010 288.055 - FOOTPLATE BONE MEDIUM 7MM OFFST STAINLESS STEEL POSTERIOR BOTH IP/OP "$2,952.50" "$2,185.00" $525.55 "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" $525.55 "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" $615.33 "$2,952.50" "$1,181.00" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,214.38" "$2,952.50" "$2,952.50" "$2,952.50" "$1,476.25" "$1,476.25" "$2,338.38" "$2,952.50" "$2,362.00" "$1,328.63" "$2,952.50" N/A "$1,712.45" "$2,952.50" "$1,771.50" "$2,952.50" "$2,952.50" "$2,952.50" N/A N/A 288.056 SUP Custom 27803010 288.056 - FOOTPLATE BONE MEDIUM 12MM OFFST STAINLESS STEEL POSTERIOR BOTH IP/OP "$2,952.50" "$2,185.00" $525.55 "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" $525.55 "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" $615.33 "$2,952.50" "$1,181.00" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,214.38" "$2,952.50" "$2,952.50" "$2,952.50" "$1,476.25" "$1,476.25" "$2,338.38" "$2,952.50" "$2,362.00" "$1,328.63" "$2,952.50" N/A "$1,712.45" "$2,952.50" "$1,771.50" "$2,952.50" "$2,952.50" "$2,952.50" N/A N/A 288.058 SUP Custom 27803010 288.058 - FOOTPLATE BONE TALL 7MM OFFST STAINLESS STEEL POSTERIOR MAXL BOTH IP/OP "$2,952.50" "$2,185.00" $525.55 "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" $525.55 "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" $615.33 "$2,952.50" "$1,181.00" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,214.38" "$2,952.50" "$2,952.50" "$2,952.50" "$1,476.25" "$1,476.25" "$2,338.38" "$2,952.50" "$2,362.00" "$1,328.63" "$2,952.50" N/A "$1,712.45" "$2,952.50" "$1,771.50" "$2,952.50" "$2,952.50" "$2,952.50" N/A N/A 288.059 SUP Custom 27803010 288.059 - FOOTPLATE BONE TALL 12MM OFFST STAINLESS STEEL POSTERIOR BOTH IP/OP "$2,952.50" "$2,185.00" $525.55 "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" $525.55 "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" $615.33 "$2,952.50" "$1,181.00" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,952.50" "$2,214.38" "$2,952.50" "$2,952.50" "$2,952.50" "$1,476.25" "$1,476.25" "$2,338.38" "$2,952.50" "$2,362.00" "$1,328.63" "$2,952.50" N/A "$1,712.45" "$2,952.50" "$1,771.50" "$2,952.50" "$2,952.50" "$2,952.50" N/A N/A 288.065 SUP HCPCS C1713 288.065 - SCREW EXTERNAL DISTRCT 3.5MM STAINLESS STEEL NONSTRL BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $63.04 $302.50 N/A N/A 291.01 SUP Custom 27803010 291.01 - WIRE CERCLAGE 1MM 280MM EYE KWIRE STAINLESS STEEL NONSTRL BOTH IP/OP $15.50 $11.00 $2.70 $15.44 $15.18 $15.18 $15.18 $15.18 $15.18 $15.18 $2.70 $15.18 $15.18 $15.18 $15.18 $15.18 $15.18 $3.16 $15.18 $6.18 $15.18 $15.18 $15.44 $15.18 $15.18 $11.63 $15.18 $15.18 $15.18 $7.59 $7.59 $12.02 $15.18 $12.14 $6.83 $15.18 N/A $8.99 $15.18 $9.11 $15.18 $15.18 $15.18 N/A N/A 291.02 SUP Custom 27203010 291.02 - WIRE CERCLAGE 1.25MM 280MM EYE STAINLESS STEEL NONSTRL BOTH IP/OP $15.50 $11.00 $2.70 $15.44 $15.18 $15.18 $15.18 $15.18 $15.18 $15.18 $2.70 $15.18 $15.18 $11.27 $11.27 $11.70 $7.91 $3.16 $15.18 $6.18 $15.18 $15.18 $15.44 $15.18 $15.18 $11.63 $15.18 $15.18 $15.18 $7.59 $7.59 $12.02 $15.18 $12.14 $9.87 $15.18 N/A $8.99 $15.18 $9.11 $15.18 $15.18 $15.18 N/A N/A 291.03 SUP Custom 27803010 291.03 - WIRE CERCLAGE 1MM 600MM EYE STAINLESS STEEL NONSTRL BOTH IP/OP $23.00 $17.00 $4.08 $23.30 $22.91 $22.91 $22.91 $22.91 $22.91 $22.91 $4.08 $22.91 $22.91 $22.91 $22.91 $22.91 $22.91 $4.77 $22.91 $9.32 $22.91 $22.91 $23.30 $22.91 $22.91 $17.25 $22.91 $22.91 $22.91 $11.46 $11.46 $18.14 $22.91 $18.33 $10.31 $22.91 N/A $13.34 $22.91 $13.75 $22.91 $22.91 $22.91 N/A N/A 291.04 SUP Custom 27203010 291.04 - WIRE FIX 1.25MM 600MM CERCLAGE EYE STAINLESS STEEL BOTH IP/OP $23.00 $17.00 $4.08 $23.30 $22.91 $22.91 $22.91 $22.91 $22.91 $22.91 $4.08 $22.91 $22.91 $17.00 $17.00 $17.66 $11.94 $4.77 $22.91 $9.32 $22.91 $22.91 $23.30 $22.91 $22.91 $17.25 $22.91 $22.91 $22.91 $11.46 $11.46 $18.14 $22.91 $18.33 $14.89 $22.91 N/A $13.34 $22.91 $13.75 $22.91 $22.91 $22.91 N/A N/A 291.05 SUP Custom 27203010 291.05 - WIRE CERCLAGE 1MM 10MR COIL STAINLESS STEEL NONSTRL BOTH IP/OP $129.00 $95.00 $22.89 $130.78 $128.60 $128.60 $128.60 $128.60 $128.60 $128.60 $22.89 $128.60 $128.60 $95.45 $95.45 $99.12 $67.00 $26.80 $128.60 $52.31 $128.60 $128.60 $130.78 $128.60 $128.60 $96.75 $128.60 $128.60 $128.60 $64.30 $64.30 $101.85 $128.60 $102.88 $83.59 $128.60 N/A $74.82 $128.60 $77.16 $128.60 $128.60 $128.60 N/A N/A 291.06 SUP Custom 27803010 291.06 - WIRE CERCLAGE 1.25MM 1MM COIL STAINLESS STEEL NONSTRL BOTH IP/OP $129.00 $95.00 $22.89 $130.78 $128.60 $128.60 $128.60 $128.60 $128.60 $128.60 $22.89 $128.60 $128.60 $128.60 $128.60 $128.60 $128.60 $26.80 $128.60 $52.31 $128.60 $128.60 $130.78 $128.60 $128.60 $96.75 $128.60 $128.60 $128.60 $64.30 $64.30 $101.85 $128.60 $102.88 $57.87 $128.60 N/A $74.82 $128.60 $77.16 $128.60 $128.60 $128.60 N/A N/A 291.08 SUP Custom 27803010 291.08 - WIRE CERCLAGE .8MM 280MM EYE STAINLESS STEEL NONSTRL BOTH IP/OP $11.00 $8.00 $1.89 $10.79 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $1.89 $10.61 $10.61 $10.61 $10.61 $10.61 $10.61 $2.21 $10.61 $4.32 $10.61 $10.61 $10.79 $10.61 $10.61 $8.25 $10.61 $10.61 $10.61 $5.31 $5.31 $8.40 $10.61 $8.49 $4.77 $10.61 N/A $6.38 $10.61 $6.37 $10.61 $10.61 $10.61 N/A N/A 291.09 SUP Custom 27203010 291.09 - WIRE CERCLAGE .8MM 10MR COIL STAINLESS STEEL NONSTRL BOTH IP/OP $129.00 $95.00 $22.89 $130.78 $128.60 $128.60 $128.60 $128.60 $128.60 $128.60 $22.89 $128.60 $128.60 $95.45 $95.45 $99.12 $67.00 $26.80 $128.60 $52.31 $128.60 $128.60 $130.78 $128.60 $128.60 $96.75 $128.60 $128.60 $128.60 $64.30 $64.30 $101.85 $128.60 $102.88 $83.59 $128.60 N/A $74.82 $128.60 $77.16 $128.60 $128.60 $128.60 N/A N/A 291.11 SUP Custom 27803010 291.11 - WIRE CERCLAGE 1.5MM 280MM EYE STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $15.50 $11.00 $2.70 $15.44 $15.18 $15.18 $15.18 $15.18 $15.18 $15.18 $2.70 $15.18 $15.18 $15.18 $15.18 $15.18 $15.18 $3.16 $15.18 $6.18 $15.18 $15.18 $15.44 $15.18 $15.18 $11.63 $15.18 $15.18 $15.18 $7.59 $7.59 $12.02 $15.18 $12.14 $6.83 $15.18 N/A $8.99 $15.18 $9.11 $15.18 $15.18 $15.18 N/A N/A 291.12 SUP Custom 27203010 291.12 - WIRE CERCLAGE 1.5MM 600MM EYE STAINLESS STEEL NONSTRL BOTH IP/OP $23.00 $17.00 $4.08 $23.30 $22.91 $22.91 $22.91 $22.91 $22.91 $22.91 $4.08 $22.91 $22.91 $17.00 $17.00 $17.66 $11.94 $4.77 $22.91 $9.32 $22.91 $22.91 $23.30 $22.91 $22.91 $17.25 $22.91 $22.91 $22.91 $11.46 $11.46 $18.14 $22.91 $18.33 $14.89 $22.91 N/A $13.34 $22.91 $13.75 $22.91 $22.91 $22.91 N/A N/A 291.13 SUP Custom 27203010 291.13 - WIRE CERCLAGE 1.5MM 10MM COIL STAINLESS STEEL NONSTRL BOTH IP/OP $129.00 $95.00 $22.89 $130.78 $128.60 $128.60 $128.60 $128.60 $128.60 $128.60 $22.89 $128.60 $128.60 $95.45 $95.45 $99.12 $67.00 $26.80 $128.60 $52.31 $128.60 $128.60 $130.78 $128.60 $128.60 $96.75 $128.60 $128.60 $128.60 $64.30 $64.30 $101.85 $128.60 $102.88 $83.59 $128.60 N/A $74.82 $128.60 $77.16 $128.60 $128.60 $128.60 N/A N/A 291.22 SUP Custom 27203010 291.22 - WIRE FX .4MM 150MM NS CRLGE SFT PCUT SS BOTH IP/OP $14.50 $11.00 $2.55 $14.58 $14.34 $14.34 $14.34 $14.34 $14.34 $14.34 $2.55 $14.34 $14.34 $10.64 $10.64 $11.05 $7.47 $2.99 $14.34 $5.83 $14.34 $14.34 $14.58 $14.34 $14.34 $10.88 $14.34 $14.34 $14.34 $7.17 $7.17 $11.36 $14.34 $11.47 $9.32 $14.34 N/A $8.41 $14.34 $8.60 $14.34 $14.34 $14.34 N/A N/A 291.24 SUP Custom 27203010 291.24 - WIRE CERCLAGE .6MM 175MM SOFT PRECUT STAINLESS STEEL NONSTRL BOTH IP/OP $15.50 $11.00 $2.70 $15.44 $15.18 $15.18 $15.18 $15.18 $15.18 $15.18 $2.70 $15.18 $15.18 $11.27 $11.27 $11.70 $7.91 $3.16 $15.18 $6.18 $15.18 $15.18 $15.44 $15.18 $15.18 $11.63 $15.18 $15.18 $15.18 $7.59 $7.59 $12.02 $15.18 $12.14 $9.87 $15.18 N/A $8.99 $15.18 $9.11 $15.18 $15.18 $15.18 N/A N/A 291.26 SUP Custom 27203010 291.26 - WIRE CERCLAGE .8MM 200MM SOFT PRECUT STAINLESS STEEL NONSTRL BOTH IP/OP $17.50 $13.00 $3.08 $17.59 $17.29 $17.29 $17.29 $17.29 $17.29 $17.29 $3.08 $17.29 $17.29 $12.83 $12.83 $13.33 $9.01 $3.60 $17.29 $7.04 $17.29 $17.29 $17.59 $17.29 $17.29 $13.13 $17.29 $17.29 $17.29 $8.65 $8.65 $13.69 $17.29 $13.83 $11.24 $17.29 N/A $10.15 $17.29 $10.37 $17.29 $17.29 $17.29 N/A N/A 291.27 SUP Custom 27203010 291.27 - WIRE CRLGE 1MM 250MM NS PCUT SFT SS BOTH IP/OP $19.00 $14.00 $3.35 $19.16 $18.84 $18.84 $18.84 $18.84 $18.84 $18.84 $3.35 $18.84 $18.84 $13.98 $13.98 $14.52 $9.82 $3.93 $18.84 $7.66 $18.84 $18.84 $19.16 $18.84 $18.84 $14.25 $18.84 $18.84 $18.84 $9.42 $9.42 $14.92 $18.84 $15.07 $12.25 $18.84 N/A $11.02 $18.84 $11.30 $18.84 $18.84 $18.84 N/A N/A 291.28 SUP Custom 27203010 291.28 - WIRE CRLGE 1.25MM 300MM NS PCUT SFT SS BOTH IP/OP $22.00 $16.00 $3.83 $21.87 $21.51 $21.51 $21.51 $21.51 $21.51 $21.51 $3.83 $21.51 $21.51 $15.96 $15.96 $16.58 $11.21 $4.48 $21.51 $8.75 $21.51 $21.51 $21.87 $21.51 $21.51 $16.50 $21.51 $21.51 $21.51 $10.76 $10.76 $17.04 $21.51 $17.21 $13.98 $21.51 N/A $12.76 $21.51 $12.91 $21.51 $21.51 $21.51 N/A N/A 292.02 SUP HCPCS C1713 292.020 - GUIDEWIRE ORTHOPEDIC 1.25MM 200MM BOTH IP/OP $25.00 $19.00 $4.90 $24.68 $11.11 $11.11 $11.11 $11.11 $24.68 $24.68 $24.68 $5.14 $24.68 $24.68 $24.68 $24.68 $24.68 $5.14 $24.68 $9.87 $14.60 $24.68 $24.68 $24.68 $24.68 $18.75 $24.68 $24.68 $24.68 $12.34 $12.34 $19.55 $24.68 $19.74 $11.11 $4.90 N/A $14.50 $24.68 $14.81 $24.68 $5.14 $24.68 N/A N/A 292.06 SUP Custom 27203010 292.06 - WIRE FIX .6MM 70MM TROCAR POINT KWIRE STAINLESS STEEL BOTH IP/OP $14.50 $11.00 $2.55 $14.58 $14.34 $14.34 $14.34 $14.34 $14.34 $14.34 $2.55 $14.34 $14.34 $10.64 $10.64 $11.05 $7.47 $2.99 $14.34 $5.83 $14.34 $14.34 $14.58 $14.34 $14.34 $10.88 $14.34 $14.34 $14.34 $7.17 $7.17 $11.36 $14.34 $11.47 $9.32 $14.34 N/A $8.41 $14.34 $8.60 $14.34 $14.34 $14.34 N/A N/A 292.08 SUP Custom 27203010 292.08 - WIRE FIX .8MM 70MM TROCAR POINT KWIRE STAINLESS STEEL BOTH IP/OP $14.50 $11.00 $2.55 $14.58 $14.34 $14.34 $14.34 $14.34 $14.34 $14.34 $2.55 $14.34 $14.34 $10.64 $10.64 $11.05 $7.47 $2.99 $14.34 $5.83 $14.34 $14.34 $14.58 $14.34 $14.34 $10.88 $14.34 $14.34 $14.34 $7.17 $7.17 $11.36 $14.34 $11.47 $9.32 $14.34 N/A $8.41 $14.34 $8.60 $14.34 $14.34 $14.34 N/A N/A 292.1 SUP Custom 27203010 292.10 - WIRE FIX 1MM 150MM TROCAR POINT KWIRE STAINLESS STEEL BOTH IP/OP $16.00 $12.00 $2.78 $16.87 $15.64 $15.64 $15.64 $15.64 $15.64 $15.64 $2.78 $15.64 $15.64 $11.61 $11.61 $12.06 $8.15 $3.26 $15.64 $6.75 $15.64 $15.64 $16.87 $15.64 $15.64 $12.00 $15.64 $15.64 $15.64 $7.82 $7.82 $12.39 $15.64 $12.51 $10.17 $15.64 N/A $9.28 $15.64 $9.38 $15.64 $15.64 $15.64 N/A N/A 292.11 SUP Custom 27203010 292.11 - WIRE FIX 1MM 285MM TROCAR POINT KWIRE STAINLESS STEEL BOTH IP/OP $21.00 $16.00 $3.68 $21.02 $20.66 $20.66 $20.66 $20.66 $20.66 $20.66 $3.68 $20.66 $20.66 $15.33 $15.33 $15.92 $10.76 $4.31 $20.66 $8.41 $20.66 $20.66 $21.02 $20.66 $20.66 $15.75 $20.66 $20.66 $20.66 $10.33 $10.33 $16.36 $20.66 $16.53 $13.43 $20.66 N/A $12.18 $20.66 $12.40 $20.66 $20.66 $20.66 N/A N/A 292.12 SUP HCPCS C1713 292.12 - WIRE FX 1.25MM 150MM NS KRSH TROC PNT SS BOTH IP/OP $16.00 $12.00 $3.10 $15.64 $7.04 $7.04 $7.04 $7.04 $15.64 $15.64 $15.64 $3.26 $15.64 $15.64 $15.64 $15.64 $15.64 $3.26 $15.64 $15.64 $9.25 $15.64 $15.64 $15.64 $15.64 $12.00 $15.64 $15.64 $15.64 $7.82 $7.82 $12.39 $15.64 $12.51 $7.04 $3.10 N/A $9.28 $15.64 $9.38 $15.64 $3.26 $15.64 N/A N/A 292.13 SUP Custom 27203010 292.13 - WIRE FX 1.25MM 285MM NS KRSH TROC PNT SS BOTH IP/OP $21.00 $16.00 $3.68 $21.02 $20.66 $20.66 $20.66 $20.66 $20.66 $20.66 $3.68 $20.66 $20.66 $15.33 $15.33 $15.92 $10.76 $4.31 $20.66 $8.41 $20.66 $20.66 $21.02 $20.66 $20.66 $15.75 $20.66 $20.66 $20.66 $10.33 $10.33 $16.36 $20.66 $16.53 $13.43 $20.66 N/A $12.18 $20.66 $12.40 $20.66 $20.66 $20.66 N/A N/A 292.16 SUP HCPCS C1713 292.16 - WIRE FX 1.6MM 150MM NS KRSH TROC PNT SS BOTH IP/OP $16.00 $12.00 $3.10 $15.64 $7.04 $7.04 $7.04 $7.04 $15.64 $15.64 $15.64 $3.26 $15.64 $15.64 $15.64 $15.64 $15.64 $3.26 $15.64 $15.64 $9.25 $15.64 $15.64 $15.64 $15.64 $12.00 $15.64 $15.64 $15.64 $7.82 $7.82 $12.39 $15.64 $12.51 $7.04 $3.10 N/A $9.28 $15.64 $15.64 $15.64 $3.26 $15.64 N/A N/A 292.18 SUP Custom 27203010 292.18 - WIRE FIX 1.6MM 285MM 5MM THREADED TROCAR POINT KWIRE BOTH IP/OP $21.00 $16.00 $3.68 $21.02 $20.66 $20.66 $20.66 $20.66 $20.66 $20.66 $3.68 $20.66 $20.66 $15.33 $15.33 $15.92 $10.76 $4.31 $20.66 $8.41 $20.66 $20.66 $21.02 $20.66 $20.66 $15.75 $20.66 $20.66 $20.66 $10.33 $10.33 $16.36 $20.66 $16.53 $13.43 $20.66 N/A $12.18 $20.66 $12.40 $20.66 $20.66 $20.66 N/A N/A 292.2 SUP HCPCS C1713 292.2 - WIRE FX 2MM 150MM NS KRSH TROC PNT SS BOTH IP/OP $16.50 $12.00 $3.20 $16.11 $7.25 $7.25 $7.25 $7.25 $16.11 $16.11 $16.11 $3.36 $16.11 $16.11 $16.11 $16.11 $16.11 $3.36 $16.11 $6.44 $9.53 $16.11 $16.11 $16.11 $16.11 $12.38 $16.11 $16.11 $16.11 $8.06 $8.06 $12.76 $16.11 $12.89 $7.25 $3.20 N/A $9.57 $16.11 $9.67 $16.11 $3.36 $16.11 N/A N/A 292.21 SUP Custom 27203010 292.21 - WIRE FIX 2MM 285MM TROCAR POINT KWIRE STAINLESS STEEL BOTH IP/OP $23.50 $17.00 $4.15 $23.30 $23.30 $23.30 $23.30 $23.30 $23.30 $23.30 $4.15 $23.30 $23.30 $17.29 $17.29 $17.96 $12.14 $4.86 $23.30 $9.32 $23.30 $23.30 $23.30 $23.30 $23.30 $17.63 $23.30 $23.30 $23.30 $11.65 $11.65 $18.45 $23.30 $18.64 $15.15 $23.30 N/A $13.63 $23.30 $13.98 $23.30 $23.30 $23.30 N/A N/A 292.25 SUP Custom 27203010 292.25 - WIRE FIX 2.5MM 150MM TROCAR POINT KWIRE STAINLESS STEEL BOTH IP/OP $17.00 $13.00 $2.95 $16.87 $16.59 $16.59 $16.59 $16.59 $16.59 $16.59 $2.95 $16.59 $16.59 $12.31 $12.31 $12.79 $8.64 $3.46 $16.59 $6.75 $16.59 $16.59 $16.87 $16.59 $16.59 $12.75 $16.59 $16.59 $16.59 $8.30 $8.30 $13.14 $16.59 $13.27 $10.78 $16.59 N/A $9.86 $16.59 $9.95 $16.59 $16.59 $16.59 N/A N/A 292.26 SUP Custom 27203010 292.26 - WIRE FIX 2.5MM 285MM TROCAR KWIRE STAINLESS STEEL NONSTRL BOTH IP/OP $21.00 $16.00 $3.68 $21.02 $20.66 $20.66 $20.66 $20.66 $20.66 $20.66 $3.68 $20.66 $20.66 $15.33 $15.33 $15.92 $10.76 $4.31 $20.66 $8.41 $20.66 $20.66 $21.02 $20.66 $20.66 $15.75 $20.66 $20.66 $20.66 $10.33 $10.33 $16.36 $20.66 $16.53 $13.43 $20.66 N/A $12.18 $20.66 $12.40 $20.66 $20.66 $20.66 N/A N/A 292.3 SUP Custom 27203010 292.30 - WIRE FIX TROCAR 3MM 150MM KWIRE STAINLESS STEEL NONSTRL BOTH IP/OP $16.50 $12.00 $2.87 $16.87 $16.11 $16.11 $16.11 $16.11 $16.11 $16.11 $2.87 $16.11 $16.11 $11.96 $11.96 $12.42 $8.39 $3.36 $16.11 $6.75 $16.11 $16.11 $16.87 $16.11 $16.11 $12.38 $16.11 $16.11 $16.11 $8.06 $8.06 $12.76 $16.11 $12.89 $10.47 $16.11 N/A $9.57 $16.11 $9.67 $16.11 $16.11 $16.11 N/A N/A 292.31 SUP Custom 27203010 292.31 - WIRE FIX 3MM 285MM TROCAR POINT KWIRE STAINLESS STEEL BOTH IP/OP $21.00 $16.00 $3.68 $21.02 $20.66 $20.66 $20.66 $20.66 $20.66 $20.66 $3.68 $20.66 $20.66 $15.33 $15.33 $15.92 $10.76 $4.31 $20.66 $8.41 $20.66 $20.66 $21.02 $20.66 $20.66 $15.75 $20.66 $20.66 $20.66 $10.33 $10.33 $16.36 $20.66 $16.53 $13.43 $20.66 N/A $12.18 $20.66 $12.40 $20.66 $20.66 $20.66 N/A N/A 292.38 SUP Custom 27203010 292.38 - WIRE FIX 1.8MM 350MM SPADE POINT KWIRE STAINLESS STEEL BOTH IP/OP $119.50 $88.00 $21.22 $121.23 $119.20 $119.20 $119.20 $119.20 $119.20 $119.20 $21.22 $119.20 $119.20 $88.47 $88.47 $91.88 $62.10 $24.84 $119.20 $48.49 $119.20 $119.20 $121.23 $119.20 $119.20 $89.63 $119.20 $119.20 $119.20 $59.60 $59.60 $94.41 $119.20 $95.36 $77.48 $119.20 N/A $69.31 $119.20 $71.52 $119.20 $119.20 $119.20 N/A N/A 292.39 SUP Custom 27203010 292.39 - WIRE FIX 1.8MM 400MM SPADE POINT REDX KWIRE STAINLESS STEEL BOTH IP/OP $371.00 $275.00 $66.03 $377.25 $370.95 $370.95 $370.95 $370.95 $370.95 $370.95 $66.03 $370.95 $370.95 $275.32 $275.32 $285.93 $193.26 $77.31 $370.95 $150.90 $370.95 $370.95 $377.25 $370.95 $370.95 $278.25 $370.95 $370.95 $370.95 $185.48 $185.48 $293.79 $370.95 $296.76 $241.12 $370.95 N/A $215.18 $370.95 $222.57 $370.95 $370.95 $370.95 N/A N/A 292.4 SUP Custom 27203010 292.40 - WIRE FIX 2MM 350MM SPADE POINT KWIRE STAINLESS STEEL NONSTRL BOTH IP/OP $116.00 $86.00 $20.60 $121.23 $115.73 $115.73 $115.73 $115.73 $115.73 $115.73 $20.60 $115.73 $115.73 $85.89 $85.89 $89.20 $60.30 $24.12 $115.73 $48.49 $115.73 $115.73 $121.23 $115.73 $115.73 $87.00 $115.73 $115.73 $115.73 $57.87 $57.87 $91.66 $115.73 $92.58 $75.22 $115.73 N/A $67.28 $115.73 $69.44 $115.73 $115.73 $115.73 N/A N/A 292.41 SUP Custom 27203010 292.41 - WIRE FIX 2MM 400MM SPADE POINT REDX KWIRE STAINLESS STEEL BOTH IP/OP $371.00 $275.00 $66.03 $377.25 $370.95 $370.95 $370.95 $370.95 $370.95 $370.95 $66.03 $370.95 $370.95 $275.32 $275.32 $285.93 $193.26 $77.31 $370.95 $150.90 $370.95 $370.95 $377.25 $370.95 $370.95 $278.25 $370.95 $370.95 $370.95 $185.48 $185.48 $293.79 $370.95 $296.76 $241.12 $370.95 N/A $215.18 $370.95 $222.57 $370.95 $370.95 $370.95 N/A N/A 292.46 SUP Custom 27203010 292.46 - WIRE FX .6MM 70MM NS KRSH 2 END TROC PNT SS BOTH IP/OP $17.50 $13.00 $3.08 $17.59 $17.29 $17.29 $17.29 $17.29 $17.29 $17.29 $3.08 $17.29 $17.29 $12.83 $12.83 $13.33 $9.01 $3.60 $17.29 $7.04 $17.29 $17.29 $17.59 $17.29 $17.29 $13.13 $17.29 $17.29 $17.29 $8.65 $8.65 $13.69 $17.29 $13.83 $11.24 $17.29 N/A $10.15 $17.29 $10.37 $17.29 $17.29 $17.29 N/A N/A 292.48 SUP Custom 27203010 292.48 - WIRE FX .8MM 70MM NS KRSH 2 END TROC PNT SS BOTH IP/OP $17.50 $13.00 $3.08 $17.59 $17.29 $17.29 $17.29 $17.29 $17.29 $17.29 $3.08 $17.29 $17.29 $12.83 $12.83 $13.33 $9.01 $3.60 $17.29 $7.04 $17.29 $17.29 $17.59 $17.29 $17.29 $13.13 $17.29 $17.29 $17.29 $8.65 $8.65 $13.69 $17.29 $13.83 $11.24 $17.29 N/A $10.15 $17.29 $10.37 $17.29 $17.29 $17.29 N/A N/A 292.5 SUP Custom 27203010 292.50 - WIRE FIX 1MM 150MM 2 END TROCAR POINT KWIRE STAINLESS STEEL BOTH IP/OP $19.00 $14.00 $3.38 $19.87 $18.97 $18.97 $18.97 $18.97 $18.97 $18.97 $3.38 $18.97 $18.97 $14.08 $14.08 $14.62 $9.88 $3.95 $18.97 $7.95 $18.97 $18.97 $19.87 $18.97 $18.97 $14.25 $18.97 $18.97 $18.97 $9.49 $9.49 $15.02 $18.97 $15.18 $12.33 $18.97 N/A $11.02 $18.97 $11.38 $18.97 $18.97 $18.97 N/A N/A 292.52 SUP Custom 27203010 292.52 - WIRE FIX TROCAR 1.25MM 150MM KWIRE STAINLESS STEEL NONSTRL BOTH IP/OP $20.00 $15.00 $3.48 $19.87 $19.54 $19.54 $19.54 $19.54 $19.54 $19.54 $3.48 $19.54 $19.54 $14.50 $14.50 $15.06 $10.18 $4.07 $19.54 $7.95 $19.54 $19.54 $19.87 $19.54 $19.54 $15.00 $19.54 $19.54 $19.54 $9.77 $9.77 $15.48 $19.54 $15.63 $12.70 $19.54 N/A $11.60 $19.54 $11.72 $19.54 $19.54 $19.54 N/A N/A 292.56 SUP Custom 27203010 292.56 - WIRE FIX TROCAR 1.6MM 150MM 2 END KWIRE STAINLESS STEEL BOTH IP/OP $20.00 $15.00 $3.48 $19.87 $19.54 $19.54 $19.54 $19.54 $19.54 $19.54 $3.48 $19.54 $19.54 $14.50 $14.50 $15.06 $10.18 $4.07 $19.54 $7.95 $19.54 $19.54 $19.87 $19.54 $19.54 $15.00 $19.54 $19.54 $19.54 $9.77 $9.77 $15.48 $19.54 $15.63 $12.70 $19.54 N/A $11.60 $19.54 $11.72 $19.54 $19.54 $19.54 N/A N/A 292.58 SUP Custom 27203010 292.58 - WIRE FX 2MM 150MM NS KRSH 2 END TROC PNT SS BOTH IP/OP $20.00 $15.00 $3.48 $19.87 $19.54 $19.54 $19.54 $19.54 $19.54 $19.54 $3.48 $19.54 $19.54 $14.50 $14.50 $15.06 $10.18 $4.07 $19.54 $7.95 $19.54 $19.54 $19.87 $19.54 $19.54 $15.00 $19.54 $19.54 $19.54 $9.77 $9.77 $15.48 $19.54 $15.63 $12.70 $19.54 N/A $11.60 $19.54 $11.72 $19.54 $19.54 $19.54 N/A N/A 292.6 SUP Custom 27203010 292.600 - WIRE FX 1.25MM 100MM NS KRSH THRD TIP SS MN XTRNFXTR BOTH IP/OP $81.50 $60.00 $14.46 $87.64 $81.22 $81.22 $81.22 $81.22 $81.22 $81.22 $14.46 $81.22 $81.22 $60.28 $60.28 $62.60 $42.32 $16.93 $81.22 $35.06 $81.22 $81.22 $87.64 $81.22 $81.22 $61.13 $81.22 $81.22 $81.22 $40.61 $40.61 $64.33 $81.22 $64.98 $52.79 $81.22 N/A $47.27 $81.22 $48.73 $81.22 $81.22 $81.22 N/A N/A 292.619 SUP HCPCS C1769 292.619 - GUIDEWIRE ORTHOPEDIC .8MM 100MM SPADE POINT STAINLESS STEEL BOTH IP/OP $28.50 $21.00 $5.61 $28.74 $15.35 $15.35 $15.35 $15.35 $28.26 $28.26 $28.26 $5.89 $28.26 $20.97 $20.97 $21.78 $14.72 $5.89 $28.26 $28.74 $16.72 $28.26 $28.74 $28.26 $28.26 $21.38 $28.26 $28.26 $28.26 $14.13 $14.13 $22.38 $28.26 $22.61 $18.37 $5.61 N/A $16.53 $28.26 $28.26 $28.26 $5.89 $28.26 N/A N/A 292.62 SUP HCPCS C1769 292.62 - GWIRE ORTH 150MM 1.25MM SS THRD BOTH IP/OP $59.50 $44.00 $11.74 $59.13 $32.11 $32.11 $32.11 $32.11 $59.13 $59.13 $59.13 $12.32 $59.13 $43.89 $43.89 $45.58 $30.81 $12.32 $59.13 $59.13 $34.98 $59.13 $59.13 $59.13 $59.13 $44.63 $59.13 $59.13 $59.13 $29.57 $29.57 $46.83 $59.13 $47.30 $38.43 $11.74 N/A $34.51 $59.13 $59.13 $59.13 $12.32 $59.13 N/A N/A 292.621 SUP HCPCS C1713 292.621 - GUIDEWIRE ORTHOPEDIC 1.25MM 150MM THREADED SPADE POINT ON 2 BOTH IP/OP $53.50 $40.00 $10.53 $53.95 $23.87 $23.87 $23.87 $23.87 $53.05 $53.05 $53.05 $11.06 $53.05 $53.05 $53.05 $53.05 $53.05 $11.06 $53.05 $21.58 $31.38 $53.05 $53.95 $53.05 $53.05 $40.13 $53.05 $53.05 $53.05 $26.53 $26.53 $42.02 $53.05 $42.44 $23.87 $10.53 N/A $31.03 $53.05 $53.05 $53.05 $11.06 $53.05 N/A N/A 292.622 SUP HCPCS C1713 292.622 - GUIDEWIRE ORTHOPEDIC 1.1MM 150MM THREAD STAINLESS STEEL BOTH IP/OP $55.50 $41.00 $11.02 $56.45 $24.98 $24.98 $24.98 $24.98 $55.50 $55.50 $55.50 $11.57 $55.50 $55.50 $55.50 $55.50 $55.50 $11.57 $55.50 $22.58 $32.83 $55.50 $56.45 $55.50 $55.50 $41.63 $55.50 $55.50 $55.50 $27.75 $27.75 $43.96 $55.50 $44.40 $24.98 $11.02 N/A $32.19 $55.50 $33.30 $55.50 $11.57 $55.50 N/A N/A 292.623 SUP HCPCS C1713 292.623 - GUIDEWIRE ORTHOPEDIC 1.1MM 150MM NONTHREADED STAINLESS STEEL BOTH IP/OP $53.00 $39.00 $10.46 $53.60 $23.72 $23.72 $23.72 $23.72 $52.70 $52.70 $52.70 $10.98 $52.70 $52.70 $52.70 $52.70 $52.70 $10.98 $52.70 $53.60 $31.17 $52.70 $53.60 $52.70 $52.70 $39.75 $52.70 $52.70 $52.70 $26.35 $26.35 $41.74 $52.70 $42.16 $23.72 $10.46 N/A $30.74 $52.70 $52.70 $52.70 $10.98 $52.70 N/A N/A 292.626 SUP HCPCS C1769 292.626 - GUIDEWIRE ORTHOPEDIC 1.25MM 150MM 1 END SPADE PONT STAINLESS BOTH IP/OP $62.50 $46.00 $12.38 $62.40 $33.88 $33.88 $33.88 $33.88 $62.40 $62.40 $62.40 $13.01 $62.40 $46.31 $46.31 $48.10 $32.51 $13.00 $62.40 $62.40 $36.91 $62.40 $62.40 $62.40 $62.40 $46.88 $62.40 $62.40 $62.40 $31.20 $31.20 $49.42 $62.40 $49.92 $40.56 $12.38 N/A $36.25 $62.40 $62.40 $62.40 $13.00 $62.40 N/A N/A 292.65 SUP HCPCS C1769 292.65 - GUIDEWIRE ORTHOPEDIC SPADE 2MM 230MM THREAD BLACK STAINLESS BOTH IP/OP $75.50 $56.00 $14.93 $76.48 $40.83 $40.83 $40.83 $40.83 $75.20 $75.20 $75.20 $15.67 $75.20 $55.81 $55.81 $57.96 $39.18 $15.67 $75.20 $76.48 $44.48 $75.20 $76.48 $75.20 $75.20 $56.63 $75.20 $75.20 $75.20 $37.60 $37.60 $59.56 $75.20 $60.16 $48.88 $14.93 N/A $43.79 $75.20 $75.20 $75.20 $15.67 $75.20 N/A N/A 292.651 SUP HCPCS C1713 292.651 - GUIDEWIRE ORTHOPEDIC 2MM 230MM THREADED SPADE POINT BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $87.20 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $85.75 $85.75 $17.87 $85.75 N/A N/A 292.652 SUP HCPCS C1713 292.652 - GUIDEWIRE ORTHOPEDIC 2MM 230MM THREADED SPADE POINT BOTH IP/OP $74.00 $55.00 $14.64 $75.03 $33.20 $33.20 $33.20 $33.20 $73.78 $73.78 $73.78 $15.38 $73.78 $73.78 $73.78 $73.78 $73.78 $15.38 $73.78 $75.03 $43.64 $73.78 $75.03 $73.78 $73.78 $55.50 $73.78 $73.78 $73.78 $36.89 $36.89 $58.43 $73.78 $59.02 $33.20 $14.64 N/A $42.92 $73.78 $73.78 $73.78 $15.38 $73.78 N/A N/A 292.653 SUP Custom 27203010 292.653 - GUIDEWIRE ORTHOPEDIC 2MM 330MM TROCAR THREAD STAINLESS STEEL BOTH IP/OP $111.50 $83.00 $19.77 $112.95 $111.05 $111.05 $111.05 $111.05 $111.05 $111.05 $19.77 $111.05 $111.05 $82.42 $82.42 $85.60 $57.86 $23.14 $111.05 $45.18 $111.05 $111.05 $112.95 $111.05 $111.05 $83.63 $111.05 $111.05 $111.05 $55.53 $55.53 $87.95 $111.05 $88.84 $72.18 $111.05 N/A $64.67 $111.05 $66.63 $111.05 $111.05 $111.05 N/A N/A 292.655 SUP Custom 27203010 292.655 - GUIDEWIRE ORTHOPEDIC 1.6MM 410MM BOTH IP/OP $102.00 $75.00 $18.14 $103.63 $101.90 $101.90 $101.90 $101.90 $101.90 $101.90 $18.14 $101.90 $101.90 $75.63 $75.63 $78.54 $53.09 $21.24 $101.90 $41.45 $101.90 $101.90 $103.63 $101.90 $101.90 $76.50 $101.90 $101.90 $101.90 $50.95 $50.95 $80.70 $101.90 $81.52 $66.24 $101.90 N/A $59.16 $101.90 $61.14 $101.90 $101.90 $101.90 N/A N/A 292.656 SUP HCPCS C1713 292.656 - GUIDEWIRE ORTHOPEDIC 2MM 230MM NONTHREADED STAINLESS STEEL BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $70.98 $70.98 $14.79 $70.98 N/A N/A 292.68 SUP HCPCS C1713 292.68 - GUIDEWIRE ORTHOPEDIC 2.8MM 300MM TROCAR THREAD STAINLESS BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $87.20 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 292.69 SUP Custom 27203010 292.69 - GUIDEWIRE ORTHOPEDIC 3.2MM 300MM CALIBRATE STAINLESS STEEL BOTH IP/OP $232.00 $172.00 $41.29 $235.90 $231.95 $231.95 $231.95 $231.95 $231.95 $231.95 $41.29 $231.95 $231.95 $172.15 $172.15 $178.79 $120.85 $48.34 $231.95 $94.36 $231.95 $231.95 $235.90 $231.95 $231.95 $174.00 $231.95 $231.95 $231.95 $115.98 $115.98 $183.70 $231.95 $185.56 $150.77 $231.95 N/A $134.56 $231.95 $139.17 $231.95 $231.95 $231.95 N/A N/A 292.699 SUP Custom 27203010 292.699 - WIRE FX 2MM 280MM NS KRSH THRD SPD PNT TIP SS BOTH IP/OP $77.00 $57.00 $13.63 $77.90 $76.60 $76.60 $76.60 $76.60 $76.60 $76.60 $13.63 $76.60 $76.60 $56.85 $56.85 $59.04 $39.91 $15.96 $76.60 $31.16 $76.60 $76.60 $77.90 $76.60 $76.60 $57.75 $76.60 $76.60 $76.60 $38.30 $38.30 $60.67 $76.60 $61.28 $49.79 $76.60 N/A $44.66 $76.60 $45.96 $76.60 $76.60 $76.60 N/A N/A 292.708 SUP Custom 27203010 292.708 - WIRE FX 1.6MM 100MM NS KRSH THRD TIP SS MN XTRNFXTR BOTH IP/OP $837.00 $619.00 $35.06 $836.60 $836.60 $836.60 $836.60 $836.60 $836.60 $836.60 $148.91 $836.60 $836.60 $620.92 $620.92 $644.85 $435.87 $174.36 $836.60 $35.06 $836.60 $836.60 $87.64 $836.60 $836.60 $627.75 $836.60 $836.60 $836.60 $418.30 $418.30 $662.59 $836.60 $669.28 $543.79 $836.60 N/A $485.46 $836.60 $501.96 $836.60 $836.60 $836.60 N/A N/A 292.71 SUP Custom 27203010 292.71 - WIRE FIX 1.6MM 15CM 5MM THREADED TROCAR POINT KWIRE BOTH IP/OP $294.50 $218.00 $52.36 $317.38 $294.15 $294.15 $294.15 $294.15 $294.15 $294.15 $52.36 $294.15 $294.15 $218.32 $218.32 $226.73 $153.25 $61.30 $294.15 $126.95 $294.15 $294.15 $317.38 $294.15 $294.15 $220.88 $294.15 $294.15 $294.15 $147.08 $147.08 $232.97 $294.15 $235.32 $191.20 $294.15 N/A $170.81 $294.15 $176.49 $294.15 $294.15 $294.15 N/A N/A 292.72 SUP HCPCS C1713 292.72 - GUIDEWIRE ORTHOPEDIC 1.6MM 150MM THREAD STAINLESS STEEL BOTH IP/OP $63.50 $47.00 $12.55 $64.33 $28.46 $28.46 $28.46 $28.46 $63.25 $63.25 $63.25 $13.18 $63.25 $63.25 $63.25 $63.25 $63.25 $13.18 $63.25 $64.33 $37.41 $63.25 $64.33 $63.25 $63.25 $47.63 $63.25 $63.25 $63.25 $31.63 $31.63 $50.09 $63.25 $50.60 $28.46 $12.55 N/A $36.83 $63.25 $63.25 $63.25 $13.18 $63.25 N/A N/A 292.721 SUP HCPCS C1713 292.721 - GUIDEWIRE ORTHOPEDIC 1.6MM 150MM THREADED SPADE POINT BOTH IP/OP $74.00 $55.00 $14.64 $75.03 $33.20 $33.20 $33.20 $33.20 $73.78 $73.78 $73.78 $15.38 $73.78 $73.78 $73.78 $73.78 $73.78 $15.38 $73.78 $75.03 $43.64 $73.78 $75.03 $73.78 $73.78 $55.50 $73.78 $73.78 $73.78 $36.89 $36.89 $58.43 $73.78 $59.02 $33.20 $14.64 N/A $42.92 $73.78 $73.78 $73.78 $15.38 $73.78 N/A N/A 292.722 SUP HCPCS C1713 292.722 - GUIDEWIRE ORTHOPEDIC 1.6MM 150MM THREADED SPADE POINT BOTH IP/OP $55.50 $41.00 $10.95 $56.13 $24.83 $24.83 $24.83 $24.83 $55.18 $55.18 $55.18 $11.50 $55.18 $55.18 $55.18 $55.18 $55.18 $11.50 $55.18 $56.13 $32.64 $55.18 $56.13 $55.18 $55.18 $41.63 $55.18 $55.18 $55.18 $27.59 $27.59 $43.70 $55.18 $44.14 $24.83 $10.95 N/A $32.19 $55.18 $33.11 $55.18 $11.50 $55.18 N/A N/A 292.727 SUP HCPCS C1713 292.727 - GUIDEWIRE ORTHOPEDIC 1.6MM 150MM NONTHREADED SPADE POINT BOTH IP/OP $53.50 $40.00 $10.53 $53.95 $23.87 $23.87 $23.87 $23.87 $53.05 $53.05 $53.05 $11.06 $53.05 $53.05 $53.05 $53.05 $53.05 $11.06 $53.05 $53.95 $31.38 $53.05 $53.95 $53.05 $53.05 $40.13 $53.05 $53.05 $53.05 $26.53 $26.53 $42.02 $53.05 $42.44 $23.87 $10.53 N/A $31.03 $53.05 $31.83 $53.05 $11.06 $53.05 N/A N/A 292.73 SUP Custom 27203010 292.73 - WIRE FX 1.6MM 150MM NS 15MM KRSH TROC PNT THRD SS BOTH IP/OP $29.50 $22.00 $5.24 $31.74 $29.42 $29.42 $29.42 $29.42 $29.42 $29.42 $5.24 $29.42 $29.42 $21.84 $21.84 $22.68 $15.33 $6.13 $29.42 $12.70 $29.42 $29.42 $31.74 $29.42 $29.42 $22.13 $29.42 $29.42 $29.42 $14.71 $14.71 $23.30 $29.42 $23.54 $19.12 $29.42 N/A $17.11 $29.42 $17.65 $29.42 $29.42 $29.42 N/A N/A 292.75 SUP Custom 27203010 292.75 - WIRE FX 2.5MM 150MM NS 15MM KRSH TROC PNT THRD SS BOTH IP/OP $34.50 $26.00 $6.11 $34.88 $34.30 $34.30 $34.30 $34.30 $34.30 $34.30 $6.11 $34.30 $34.30 $25.46 $25.46 $26.44 $17.87 $7.15 $34.30 $13.95 $34.30 $34.30 $34.88 $34.30 $34.30 $25.88 $34.30 $34.30 $34.30 $17.15 $17.15 $27.17 $34.30 $27.44 $22.30 $34.30 N/A $20.01 $34.30 $20.58 $34.30 $34.30 $34.30 N/A N/A 292.76 SUP Custom 27203010 292.76 - WIRE FIX 2.5MM 200MM 15MM THREADED TROCAR POINT KWIRE BOTH IP/OP $36.00 $27.00 $6.33 $36.17 $35.57 $35.57 $35.57 $35.57 $35.57 $35.57 $6.33 $35.57 $35.57 $26.40 $26.40 $27.42 $18.53 $7.41 $35.57 $14.47 $35.57 $35.57 $36.17 $35.57 $35.57 $27.00 $35.57 $35.57 $35.57 $17.79 $17.79 $28.17 $35.57 $28.46 $23.12 $35.57 N/A $20.88 $35.57 $21.34 $35.57 $35.57 $35.57 N/A N/A 292.79 SUP Custom 27203010 292.79 - WIRE FX 2MM 150MM NS 15MM KRSH TROC PNT THRD SS BOTH IP/OP $32.50 $24.00 $5.73 $32.74 $32.19 $32.19 $32.19 $32.19 $32.19 $32.19 $5.73 $32.19 $32.19 $23.89 $23.89 $24.81 $16.77 $6.71 $32.19 $13.10 $32.19 $32.19 $32.74 $32.19 $32.19 $24.38 $32.19 $32.19 $32.19 $16.10 $16.10 $25.49 $32.19 $25.75 $20.92 $32.19 N/A $18.85 $32.19 $19.31 $32.19 $32.19 $32.19 N/A N/A 292.801 SUP Custom 27203010 292.801 - WIRE FX 2MM 150MM NS 15MM KRSH CLBRT THRD TROC PNT SS BOTH IP/OP $83.50 $62.00 $14.82 $83.25 $83.25 $83.25 $83.25 $83.25 $83.25 $83.25 $14.82 $83.25 $83.25 $61.79 $61.79 $64.17 $43.37 $17.35 $83.25 $33.30 $83.25 $83.25 $83.25 $83.25 $83.25 $62.63 $83.25 $83.25 $83.25 $41.63 $41.63 $65.93 $83.25 $66.60 $54.11 $83.25 N/A $48.43 $83.25 $49.95 $83.25 $83.25 $83.25 N/A N/A 292.81 SUP HCPCS C1713 292.81 - GUIDEWIRE ORTHOPEDIC 2.8MM 300MM 150MM NONTHREADED STAINLESS BOTH IP/OP $190.00 $141.00 $37.67 $193.00 $85.40 $85.40 $85.40 $85.40 $189.78 $189.78 $189.78 $39.55 $189.78 $189.78 $189.78 $189.78 $189.78 $39.55 $189.78 $77.20 $112.25 $189.78 $193.00 $189.78 $189.78 $142.50 $189.78 $189.78 $189.78 $94.89 $94.89 $150.31 $189.78 $151.82 $85.40 $37.67 N/A $110.20 $189.78 $113.87 $189.78 $39.55 $189.78 N/A N/A 293.35 SUP Custom 27203010 293.35 - PIN FIX 3.5MM 120MM STEINMANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $68.00 $50.00 $12.10 $69.10 $67.95 $67.95 $67.95 $67.95 $67.95 $67.95 $12.10 $67.95 $67.95 $50.43 $50.43 $52.38 $35.40 $14.16 $67.95 $27.64 $67.95 $67.95 $69.10 $67.95 $67.95 $51.00 $67.95 $67.95 $67.95 $33.98 $33.98 $53.82 $67.95 $54.36 $44.17 $67.95 N/A $39.44 $67.95 $40.77 $67.95 $67.95 $67.95 N/A N/A 293.36 SUP Custom 27203010 293.36 - PIN FIX 3.5MM 150MM TRACTION STEINMANN STAINLESS STEEL BOTH IP/OP $68.00 $50.00 $12.10 $69.10 $67.95 $67.95 $67.95 $67.95 $67.95 $67.95 $12.10 $67.95 $67.95 $50.43 $50.43 $52.38 $35.40 $14.16 $67.95 $27.64 $67.95 $67.95 $69.10 $67.95 $67.95 $51.00 $67.95 $67.95 $67.95 $33.98 $33.98 $53.82 $67.95 $54.36 $44.17 $67.95 N/A $39.44 $67.95 $40.77 $67.95 $67.95 $67.95 N/A N/A 293.4 SUP Custom 27203010 293.40 - PIN FIX 4MM 150MM STEINMANN STAINLESS STEEL NONSTRL TRACTION BOTH IP/OP $66.00 $49.00 $11.74 $69.10 $65.98 $65.98 $65.98 $65.98 $65.98 $65.98 $11.74 $65.98 $65.98 $48.97 $48.97 $50.86 $34.38 $13.75 $65.98 $27.64 $65.98 $65.98 $69.10 $65.98 $65.98 $49.50 $65.98 $65.98 $65.98 $32.99 $32.99 $52.26 $65.98 $52.78 $42.89 $65.98 N/A $38.28 $65.98 $39.59 $65.98 $65.98 $65.98 N/A N/A 293.41 SUP Custom 27203010 293.41 - PIN FIX LARGE 4MM 180MM EXTERNAL IMPLANT TRACTION STEINMANN BOTH IP/OP $68.00 $50.00 $12.10 $69.10 $67.95 $67.95 $67.95 $67.95 $67.95 $67.95 $12.10 $67.95 $67.95 $50.43 $50.43 $52.38 $35.40 $14.16 $67.95 $27.64 $67.95 $67.95 $69.10 $67.95 $67.95 $51.00 $67.95 $67.95 $67.95 $33.98 $33.98 $53.82 $67.95 $54.36 $44.17 $67.95 N/A $39.44 $67.95 $40.77 $67.95 $67.95 $67.95 N/A N/A 293.42 SUP Custom 27203010 293.42 - PIN FIX 4MM 200MM STEINMANN STAINLESS STEEL NONSTRL LARGE BOTH IP/OP $68.00 $50.00 $12.10 $69.10 $67.95 $67.95 $67.95 $67.95 $67.95 $67.95 $12.10 $67.95 $67.95 $50.43 $50.43 $52.38 $35.40 $14.16 $67.95 $27.64 $67.95 $67.95 $69.10 $67.95 $67.95 $51.00 $67.95 $67.95 $67.95 $33.98 $33.98 $53.82 $67.95 $54.36 $44.17 $67.95 N/A $39.44 $67.95 $40.77 $67.95 $67.95 $67.95 N/A N/A 293.44 SUP Custom 27203010 293.44 - PIN FIX 4.5MM 120MM STEINMANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $126.00 $93.00 $22.41 $128.03 $125.88 $125.88 $125.88 $125.88 $125.88 $125.88 $22.41 $125.88 $125.88 $93.43 $93.43 $97.03 $65.58 $26.23 $125.88 $51.21 $125.88 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $81.82 $125.88 N/A $73.08 $125.88 $75.53 $125.88 $125.88 $125.88 N/A N/A 293.45 SUP Custom 27203010 293.45 - PIN FIX 4.5MM 150MM STEINMANN STAINLESS STEEL NONSTRL LARGE BOTH IP/OP $126.00 $93.00 $22.41 $128.03 $125.88 $125.88 $125.88 $125.88 $125.88 $125.88 $22.41 $125.88 $125.88 $93.43 $93.43 $97.03 $65.58 $26.23 $125.88 $51.21 $125.88 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $81.82 $125.88 N/A $73.08 $125.88 $75.53 $125.88 $125.88 $125.88 N/A N/A 293.46 SUP Custom 27203010 293.46 - PIN FIX 4.5MM 180MM STEINMANN STAINLESS STEEL NONSTRL LARGE BOTH IP/OP $126.00 $93.00 $22.41 $128.03 $125.88 $125.88 $125.88 $125.88 $125.88 $125.88 $22.41 $125.88 $125.88 $93.43 $93.43 $97.03 $65.58 $26.23 $125.88 $51.21 $125.88 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $81.82 $125.88 N/A $73.08 $125.88 $75.53 $125.88 $125.88 $125.88 N/A N/A 293.47 SUP Custom 27203010 293.47 - PIN FIX 4.5MM 200MM STEINMANN STAINLESS STEEL NONSTRL LARGE BOTH IP/OP $126.00 $93.00 $22.41 $128.03 $125.88 $125.88 $125.88 $125.88 $125.88 $125.88 $22.41 $125.88 $125.88 $93.43 $93.43 $97.03 $65.58 $26.23 $125.88 $51.21 $125.88 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $81.82 $125.88 N/A $73.08 $125.88 $75.53 $125.88 $125.88 $125.88 N/A N/A 293.48 SUP Custom 27203010 293.48 - PIN FIX 4.5MM 250MM STEINMANN STAINLESS STEEL NONSTRL LARGE BOTH IP/OP $126.00 $93.00 $22.41 $128.03 $125.88 $125.88 $125.88 $125.88 $125.88 $125.88 $22.41 $125.88 $125.88 $93.43 $93.43 $97.03 $65.58 $26.23 $125.88 $51.21 $125.88 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $81.82 $125.88 N/A $73.08 $125.88 $75.53 $125.88 $125.88 $125.88 N/A N/A 293.49 SUP Custom 27203010 293.49 - PIN FIX 4.5MM 225MM STEINMANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $126.00 $93.00 $22.41 $128.03 $125.88 $125.88 $125.88 $125.88 $125.88 $125.88 $22.41 $125.88 $125.88 $93.43 $93.43 $97.03 $65.58 $26.23 $125.88 $51.21 $125.88 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $81.82 $125.88 N/A $73.08 $125.88 $75.53 $125.88 $125.88 $125.88 N/A N/A 293.5 SUP Custom 27203010 293.50 - PIN FIX 5MM 150MM STEINMANN STAINLESS STEEL NONSTRL LARGE BOTH IP/OP $122.50 $91.00 $21.75 $128.03 $122.20 $122.20 $122.20 $122.20 $122.20 $122.20 $21.75 $122.20 $122.20 $90.70 $90.70 $94.19 $63.67 $25.47 $122.20 $51.21 $122.20 $122.20 $128.03 $122.20 $122.20 $91.88 $122.20 $122.20 $122.20 $61.10 $61.10 $96.78 $122.20 $97.76 $79.43 $122.20 N/A $71.05 $122.20 $73.32 $122.20 $122.20 $122.20 N/A N/A 293.51 SUP Custom 27203010 293.51 - PIN FIX 5MM 180MM STEINMANN STAINLESS STEEL NONSTRL LARGE BOTH IP/OP $126.00 $93.00 $22.41 $128.03 $125.88 $125.88 $125.88 $125.88 $125.88 $125.88 $22.41 $125.88 $125.88 $93.43 $93.43 $97.03 $65.58 $26.23 $125.88 $51.21 $125.88 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $81.82 $125.88 N/A $73.08 $125.88 $75.53 $125.88 $125.88 $125.88 N/A N/A 293.52 SUP Custom 27203010 293.52 - PIN FIX 5MM 200MM STEINMANN STAINLESS STEEL NONSTRL LARGE BOTH IP/OP $126.00 $93.00 $22.41 $128.03 $125.88 $125.88 $125.88 $125.88 $125.88 $125.88 $22.41 $125.88 $125.88 $93.43 $93.43 $97.03 $65.58 $26.23 $125.88 $51.21 $125.88 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $81.82 $125.88 N/A $73.08 $125.88 $75.53 $125.88 $125.88 $125.88 N/A N/A 293.53 SUP Custom 27203010 293.53 - PIN FIX 5MM 250MM STEINMANN STAINLESS STEEL NONSTRL LARGE BOTH IP/OP $126.00 $93.00 $22.41 $128.03 $125.88 $125.88 $125.88 $125.88 $125.88 $125.88 $22.41 $125.88 $125.88 $93.43 $93.43 $97.03 $65.58 $26.23 $125.88 $51.21 $125.88 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $81.82 $125.88 N/A $73.08 $125.88 $75.53 $125.88 $125.88 $125.88 N/A N/A 293.54 SUP Custom 27203010 293.54 - PIN FIX 5MM 300MM STEINMANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $126.00 $93.00 $22.41 $128.03 $125.88 $125.88 $125.88 $125.88 $125.88 $125.88 $22.41 $125.88 $125.88 $93.43 $93.43 $97.03 $65.58 $26.23 $125.88 $51.21 $125.88 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $81.82 $125.88 N/A $73.08 $125.88 $75.53 $125.88 $125.88 $125.88 N/A N/A 293.58 SUP Custom 27203010 293.58 - PIN FIX 5MM 225MM STEINMANN STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $126.00 $93.00 $22.41 $128.03 $125.88 $125.88 $125.88 $125.88 $125.88 $125.88 $22.41 $125.88 $125.88 $93.43 $93.43 $97.03 $65.58 $26.23 $125.88 $51.21 $125.88 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $81.82 $125.88 N/A $73.08 $125.88 $75.53 $125.88 $125.88 $125.88 N/A N/A 293.59 SUP Custom 27203010 293.59 - PIN FIX 5MM 275MM STEINMANN ORTHOPEDIC NONSTRL LARGE EXFIX BOTH IP/OP $126.00 $93.00 $22.41 $128.03 $125.88 $125.88 $125.88 $125.88 $125.88 $125.88 $22.41 $125.88 $125.88 $93.43 $93.43 $97.03 $65.58 $26.23 $125.88 $51.21 $125.88 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $81.82 $125.88 N/A $73.08 $125.88 $75.53 $125.88 $125.88 $125.88 N/A N/A 293.62 SUP Custom 27203010 293.62 - PIN FIX 4MM 150MM CENTRL THREAD STEINMANN STAINLESS STEEL BOTH IP/OP $190.50 $141.00 $33.91 $193.73 $190.48 $190.48 $190.48 $190.48 $190.48 $190.48 $33.91 $190.48 $190.48 $141.37 $141.37 $146.82 $99.24 $39.70 $190.48 $77.49 $190.48 $190.48 $193.73 $190.48 $190.48 $142.88 $190.48 $190.48 $190.48 $95.24 $95.24 $150.86 $190.48 $152.38 $123.81 $190.48 N/A $110.49 $190.48 $114.29 $190.48 $190.48 $190.48 N/A N/A 293.63 SUP Custom 27203010 293.63 - PIN FIX 4.5MM 5MM 150MM CENTRL THREAD STEINMANN STAINLESS BOTH IP/OP $190.50 $141.00 $33.91 $193.73 $190.48 $190.48 $190.48 $190.48 $190.48 $190.48 $33.91 $190.48 $190.48 $141.37 $141.37 $146.82 $99.24 $39.70 $190.48 $77.49 $190.48 $190.48 $193.73 $190.48 $190.48 $142.88 $190.48 $190.48 $190.48 $95.24 $95.24 $150.86 $190.48 $152.38 $123.81 $190.48 N/A $110.49 $190.48 $114.29 $190.48 $190.48 $190.48 N/A N/A 293.67 SUP Custom 27203010 293.67 - PIN FIX 4MM 180MM CENTRL THREAD STEINMANN STAINLESS STEEL BOTH IP/OP $190.50 $141.00 $33.91 $193.73 $190.48 $190.48 $190.48 $190.48 $190.48 $190.48 $33.91 $190.48 $190.48 $141.37 $141.37 $146.82 $99.24 $39.70 $190.48 $77.49 $190.48 $190.48 $193.73 $190.48 $190.48 $142.88 $190.48 $190.48 $190.48 $95.24 $95.24 $150.86 $190.48 $152.38 $123.81 $190.48 N/A $110.49 $190.48 $114.29 $190.48 $190.48 $190.48 N/A N/A 293.68 SUP Custom 27203010 293.68 - PIN FX CNTR THRD 4.5MM 5MM 180MM NS STNM SS LG XTRNFXTR BOTH IP/OP $214.00 $158.00 $38.07 $217.50 $213.88 $213.88 $213.88 $213.88 $213.88 $213.88 $38.07 $213.88 $213.88 $158.74 $158.74 $164.86 $111.43 $44.57 $213.88 $87.00 $213.88 $213.88 $217.50 $213.88 $213.88 $160.50 $213.88 $213.88 $213.88 $106.94 $106.94 $169.39 $213.88 $171.10 $139.02 $213.88 N/A $124.12 $213.88 $128.33 $213.88 $213.88 $213.88 N/A N/A 293.69 SUP Custom 27203010 293.69 - PIN FIX 5MM 5.5MM 175MM CENTRL THREAD STEINMANN STAINLESS BOTH IP/OP $214.00 $158.00 $38.07 $217.50 $213.88 $213.88 $213.88 $213.88 $213.88 $213.88 $38.07 $213.88 $213.88 $158.74 $158.74 $164.86 $111.43 $44.57 $213.88 $87.00 $213.88 $213.88 $217.50 $213.88 $213.88 $160.50 $213.88 $213.88 $213.88 $106.94 $106.94 $169.39 $213.88 $171.10 $139.02 $213.88 N/A $124.12 $213.88 $128.33 $213.88 $213.88 $213.88 N/A N/A 293.72 SUP Custom 27203010 293.72 - PIN FIX 4MM 4.5MM 200MM CENTRL THREAD STEINMANN STAINLESS BOTH IP/OP $190.50 $141.00 $33.91 $193.73 $190.48 $190.48 $190.48 $190.48 $190.48 $190.48 $33.91 $190.48 $190.48 $141.37 $141.37 $146.82 $99.24 $39.70 $190.48 $77.49 $190.48 $190.48 $193.73 $190.48 $190.48 $142.88 $190.48 $190.48 $190.48 $95.24 $95.24 $150.86 $190.48 $152.38 $123.81 $190.48 N/A $110.49 $190.48 $114.29 $190.48 $190.48 $190.48 N/A N/A 293.73 SUP Custom 27203010 293.73 - PIN FIX 4.5MM 200MM CENTRL THREAD STEINMANN STAINLESS STEEL BOTH IP/OP $214.00 $158.00 $38.07 $217.50 $213.88 $213.88 $213.88 $213.88 $213.88 $213.88 $38.07 $213.88 $213.88 $158.74 $158.74 $164.86 $111.43 $44.57 $213.88 $87.00 $213.88 $213.88 $217.50 $213.88 $213.88 $160.50 $213.88 $213.88 $213.88 $106.94 $106.94 $169.39 $213.88 $171.10 $139.02 $213.88 N/A $124.12 $213.88 $128.33 $213.88 $213.88 $213.88 N/A N/A 293.74 SUP Custom 27203010 293.74 - PIN FX CNTR THRD 5MM 5.5MM 200MM NS STNM SS LG XTRNFXTR BOTH IP/OP $214.00 $158.00 $38.07 $217.50 $213.88 $213.88 $213.88 $213.88 $213.88 $213.88 $38.07 $213.88 $213.88 $158.74 $158.74 $164.86 $111.43 $44.57 $213.88 $87.00 $213.88 $213.88 $217.50 $213.88 $213.88 $160.50 $213.88 $213.88 $213.88 $106.94 $106.94 $169.39 $213.88 $171.10 $139.02 $213.88 N/A $124.12 $213.88 $128.33 $213.88 $213.88 $213.88 N/A N/A 293.78 SUP Custom 27203010 293.78 - PIN FX CNTR THRD 4.5MM 5MM 225MM NS STNM SS LG XTRNFXTR BOTH IP/OP $214.00 $158.00 $38.07 $217.50 $213.88 $213.88 $213.88 $213.88 $213.88 $213.88 $38.07 $213.88 $213.88 $158.74 $158.74 $164.86 $111.43 $44.57 $213.88 $87.00 $213.88 $213.88 $217.50 $213.88 $213.88 $160.50 $213.88 $213.88 $213.88 $106.94 $106.94 $169.39 $213.88 $171.10 $139.02 $213.88 N/A $124.12 $213.88 $128.33 $213.88 $213.88 $213.88 N/A N/A 293.79 SUP Custom 27203010 293.790 - PIN FIX CENTRL THREAD 5MM 5.5MM 225MM STEINMANN STAINLESS BOTH IP/OP $208.00 $154.00 $36.96 $217.50 $207.65 $207.65 $207.65 $207.65 $207.65 $207.65 $36.96 $207.65 $207.65 $154.12 $154.12 $160.06 $108.19 $43.28 $207.65 $87.00 $207.65 $207.65 $217.50 $207.65 $207.65 $156.00 $207.65 $207.65 $207.65 $103.83 $103.83 $164.46 $207.65 $166.12 $134.97 $207.65 N/A $120.64 $207.65 $124.59 $207.65 $207.65 $207.65 N/A N/A 293.83 SUP Custom 27203010 293.83 - PIN FIX 4.5MM 250MM CENTRL THREAD STEINMANN STAINLESS STEEL BOTH IP/OP $214.00 $158.00 $38.07 $217.50 $213.88 $213.88 $213.88 $213.88 $213.88 $213.88 $38.07 $213.88 $213.88 $158.74 $158.74 $164.86 $111.43 $44.57 $213.88 $87.00 $213.88 $213.88 $217.50 $213.88 $213.88 $160.50 $213.88 $213.88 $213.88 $106.94 $106.94 $169.39 $213.88 $171.10 $139.02 $213.88 N/A $124.12 $213.88 $128.33 $213.88 $213.88 $213.88 N/A N/A 293.84 SUP Custom 27203010 293.840 - PIN FIX 5MM 5.5MM 250MM 3 FLAT END CENTRL THREAD ROUND BOTH IP/OP $208.00 $154.00 $36.96 $217.50 $207.65 $207.65 $207.65 $207.65 $207.65 $207.65 $36.96 $207.65 $207.65 $154.12 $154.12 $160.06 $108.19 $43.28 $207.65 $87.00 $207.65 $207.65 $217.50 $207.65 $207.65 $156.00 $207.65 $207.65 $207.65 $103.83 $103.83 $164.46 $207.65 $166.12 $134.97 $207.65 N/A $120.64 $207.65 $124.59 $207.65 $207.65 $207.65 N/A N/A 293.88 SUP Custom 27203010 293.88 - PIN FX CNTR THRD 4.5MM 5MM 275MM NS STNM SS LG XTRNFXTR BOTH IP/OP $214.00 $158.00 $38.07 $217.50 $213.88 $213.88 $213.88 $213.88 $213.88 $213.88 $38.07 $213.88 $213.88 $158.74 $158.74 $164.86 $111.43 $44.57 $213.88 $87.00 $213.88 $213.88 $217.50 $213.88 $213.88 $160.50 $213.88 $213.88 $213.88 $106.94 $106.94 $169.39 $213.88 $171.10 $139.02 $213.88 N/A $124.12 $213.88 $128.33 $213.88 $213.88 $213.88 N/A N/A 293.89 SUP Custom 27203010 293.890 - PIN FIX 5MM 275MM CENTRL THREAD STEINMANN STAINLESS STEEL BOTH IP/OP $208.00 $154.00 $36.96 $217.50 $207.65 $207.65 $207.65 $207.65 $207.65 $207.65 $36.96 $207.65 $207.65 $154.12 $154.12 $160.06 $108.19 $43.28 $207.65 $87.00 $207.65 $207.65 $217.50 $207.65 $207.65 $156.00 $207.65 $207.65 $207.65 $103.83 $103.83 $164.46 $207.65 $166.12 $134.97 $207.65 N/A $120.64 $207.65 $124.59 $207.65 $207.65 $207.65 N/A N/A 293.93 SUP Custom 27203010 293.93 - PIN FIX 4.5MM 300MM CENTRL THREAD STEINMANN STAINLESS STEEL BOTH IP/OP $214.00 $158.00 $38.07 $217.50 $213.88 $213.88 $213.88 $213.88 $213.88 $213.88 $38.07 $213.88 $213.88 $158.74 $158.74 $164.86 $111.43 $44.57 $213.88 $87.00 $213.88 $213.88 $217.50 $213.88 $213.88 $160.50 $213.88 $213.88 $213.88 $106.94 $106.94 $169.39 $213.88 $171.10 $139.02 $213.88 N/A $124.12 $213.88 $128.33 $213.88 $213.88 $213.88 N/A N/A 293.94 SUP HCPCS C1713 293.940 - PIN FIX 5MM 300MM CENTRL THREAD STEINMANN STAINLESS STEEL BOTH IP/OP $208.00 $154.00 $41.21 $217.50 $93.44 $93.44 $93.44 $93.44 $207.65 $207.65 $207.65 $43.28 $207.65 $207.65 $207.65 $207.65 $207.65 $43.28 $207.65 $217.50 $122.82 $207.65 $217.50 $207.65 $207.65 $156.00 $207.65 $207.65 $207.65 $103.83 $103.83 $164.46 $207.65 $166.12 $93.44 $41.21 N/A $120.64 $207.65 $124.59 $207.65 $43.27 $207.65 N/A N/A 294.3 SUP HCPCS C1713 294.30 - SCREW XTRNFX 4MM 3MM 80MM NS 20MM SCHNZ TROC PNT MR BOTH IP/OP $124.50 $92.00 $24.69 $130.28 $55.97 $55.97 $55.97 $55.97 $124.38 $124.38 $124.38 $25.92 $124.38 $124.38 $124.38 $124.38 $124.38 $25.92 $124.38 $52.11 $73.57 $124.38 $130.28 $124.38 $124.38 $93.38 $124.38 $124.38 $124.38 $62.19 $62.19 $98.51 $124.38 $99.50 $55.97 $24.69 N/A $72.21 $124.38 $74.63 $124.38 $25.92 $124.38 N/A N/A 294.43 SUP HCPCS C1713 294.43 - SCREW XTRNFX 4MM 60MM NS SCHNZ SPD PNT SS LG XTRNFXTR BOTH IP/OP $128.50 $95.00 $25.42 $130.28 $57.65 $57.65 $57.65 $57.65 $128.10 $128.10 $128.10 $26.70 $128.10 $128.10 $128.10 $128.10 $128.10 $26.70 $128.10 $52.11 $75.77 $128.10 $130.28 $128.10 $128.10 $96.38 $128.10 $128.10 $128.10 $64.05 $64.05 $101.46 $128.10 $102.48 $57.65 $25.42 N/A $74.53 $128.10 $128.10 $128.10 $26.70 $128.10 N/A N/A 294.44 SUP HCPCS C1713 294.44 - SCREW XTRNFX 4MM 80MM NS SCHNZ SPD PNT MR CONDITIONAL SS LG BOTH IP/OP $128.50 $95.00 $25.42 $130.28 $57.65 $57.65 $57.65 $57.65 $128.10 $128.10 $128.10 $26.70 $128.10 $128.10 $128.10 $128.10 $128.10 $26.70 $128.10 $52.11 $75.77 $128.10 $130.28 $128.10 $128.10 $96.38 $128.10 $128.10 $128.10 $64.05 $64.05 $101.46 $128.10 $102.48 $57.65 $25.42 N/A $74.53 $128.10 $76.86 $128.10 $26.70 $128.10 N/A N/A 294.45 SUP HCPCS C1713 294.45 - SCREW XTRNFX 4MM 100MM NS 25MM SCHNZ SPD PNT SS PLVC LG BOTH IP/OP $128.50 $95.00 $25.42 $130.28 $57.65 $57.65 $57.65 $57.65 $128.10 $128.10 $128.10 $26.70 $128.10 $128.10 $128.10 $128.10 $128.10 $26.70 $128.10 $130.28 $75.77 $128.10 $130.28 $128.10 $128.10 $96.38 $128.10 $128.10 $128.10 $64.05 $64.05 $101.46 $128.10 $102.48 $57.65 $25.42 N/A $74.53 $128.10 $76.86 $128.10 $26.70 $128.10 N/A N/A 294.455 SUP HCPCS C1713 294.455 - SCREW BONE 4MM 100MM 38IN SPADE POINT PTHRD SCHANZ BOTH IP/OP $128.50 $95.00 $25.42 $130.28 $57.65 $57.65 $57.65 $57.65 $128.10 $128.10 $128.10 $26.70 $128.10 $128.10 $128.10 $128.10 $128.10 $26.70 $128.10 $130.28 $75.77 $128.10 $130.28 $128.10 $128.10 $96.38 $128.10 $128.10 $128.10 $64.05 $64.05 $101.46 $128.10 $102.48 $57.65 $25.42 N/A $74.53 $128.10 $76.86 $128.10 $26.70 $128.10 N/A N/A 294.46 SUP HCPCS C1713 294.46 - SCREW XTRNFX 4MM 120MM NS SCHNZ SPD PNT MR CONDITIONAL SS BOTH IP/OP $128.50 $95.00 $25.42 $130.28 $57.65 $57.65 $57.65 $57.65 $128.10 $128.10 $128.10 $26.70 $128.10 $128.10 $128.10 $128.10 $128.10 $26.70 $128.10 $130.28 $75.77 $128.10 $130.28 $128.10 $128.10 $96.38 $128.10 $128.10 $128.10 $64.05 $64.05 $101.46 $128.10 $102.48 $57.65 $25.42 N/A $74.53 $128.10 $76.86 $128.10 $26.70 $128.10 N/A N/A 294.48 SUP HCPCS C1713 294.48 - SCREW XTRNFX 4MM 150MM NS 25MM SCHNZ SPD PNT SS PLVC LG BOTH IP/OP $128.50 $95.00 $25.42 $130.28 $57.65 $57.65 $57.65 $57.65 $128.10 $128.10 $128.10 $26.70 $128.10 $128.10 $128.10 $128.10 $128.10 $26.70 $128.10 $130.28 $75.77 $128.10 $130.28 $128.10 $128.10 $96.38 $128.10 $128.10 $128.10 $64.05 $64.05 $101.46 $128.10 $102.48 $57.65 $25.42 N/A $74.53 $128.10 $128.10 $128.10 $26.70 $128.10 N/A N/A 294.52 SUP HCPCS C1713 294.52 - SCREW XTRNFX XLNG 5MM 100MM NS SCHNZ BLNT TROC PNT MR BOTH IP/OP $141.50 $105.00 $28.08 $143.88 $63.67 $63.67 $63.67 $63.67 $141.48 $141.48 $141.48 $29.49 $141.48 $141.48 $141.48 $141.48 $141.48 $29.49 $141.48 $143.88 $83.69 $141.48 $143.88 $141.48 $141.48 $106.13 $141.48 $141.48 $141.48 $70.74 $70.74 $112.05 $141.48 $113.18 $63.67 $28.08 N/A $82.07 $141.48 $141.48 $141.48 $29.48 $141.48 N/A N/A 294.53 SUP HCPCS C1713 294.53 - SCREW XTRNFX 5MM 125MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL BOTH IP/OP $141.50 $105.00 $28.08 $143.88 $63.67 $63.67 $63.67 $63.67 $141.48 $141.48 $141.48 $29.49 $141.48 $141.48 $141.48 $141.48 $141.48 $29.49 $141.48 $57.55 $83.69 $141.48 $143.88 $141.48 $141.48 $106.13 $141.48 $141.48 $141.48 $70.74 $70.74 $112.05 $141.48 $113.18 $63.67 $28.08 N/A $82.07 $141.48 $141.48 $141.48 $29.48 $141.48 N/A N/A 294.54 SUP HCPCS C1713 294.54 - SCREW XTRNFX 5MM 150MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL BOTH IP/OP $141.50 $105.00 $28.08 $143.88 $63.67 $63.67 $63.67 $63.67 $141.48 $141.48 $141.48 $29.49 $141.48 $141.48 $141.48 $141.48 $141.48 $29.49 $141.48 $143.88 $83.69 $141.48 $143.88 $141.48 $141.48 $106.13 $141.48 $141.48 $141.48 $70.74 $70.74 $112.05 $141.48 $113.18 $63.67 $28.08 N/A $82.07 $141.48 $141.48 $141.48 $29.48 $141.48 N/A N/A 294.55 SUP HCPCS C1713 294.55 - SCREW XTRNFX XLNG 5MM 170MM NS 50MM SCHNZ BLNT TROC PNT SS BOTH IP/OP $164.00 $121.00 $32.50 $166.53 $73.69 $73.69 $73.69 $73.69 $163.75 $163.75 $163.75 $34.13 $163.75 $163.75 $163.75 $163.75 $163.75 $34.13 $163.75 $166.53 $96.86 $163.75 $166.53 $163.75 $163.75 $123.00 $163.75 $163.75 $163.75 $81.88 $81.88 $129.69 $163.75 $131.00 $73.69 $32.50 N/A $95.12 $163.75 $98.25 $163.75 $163.75 $163.75 N/A N/A 294.56 SUP HCPCS C1713 294.56 - SCREW XTRNFX 5MM 200MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL BOTH IP/OP $164.00 $121.00 $32.50 $166.53 $73.69 $73.69 $73.69 $73.69 $163.75 $163.75 $163.75 $34.13 $163.75 $163.75 $163.75 $163.75 $163.75 $34.13 $163.75 $166.53 $96.86 $163.75 $166.53 $163.75 $163.75 $123.00 $163.75 $163.75 $163.75 $81.88 $81.88 $129.69 $163.75 $131.00 $73.69 $32.50 N/A $95.12 $163.75 $98.25 $163.75 $163.75 $163.75 N/A N/A 294.57 SUP HCPCS C1713 294.57 - SCREW XTRNFX 5MM 250MM NS SCHNZ BLNT TROC PNT MR CONDITIONAL BOTH IP/OP $164.00 $121.00 $32.50 $166.53 $73.69 $73.69 $73.69 $73.69 $163.75 $163.75 $163.75 $34.13 $163.75 $163.75 $163.75 $163.75 $163.75 $34.13 $163.75 $166.53 $96.86 $163.75 $166.53 $163.75 $163.75 $123.00 $163.75 $163.75 $163.75 $81.88 $81.88 $129.69 $163.75 $131.00 $73.69 $32.50 N/A $95.12 $163.75 $98.25 $163.75 $34.13 $163.75 N/A N/A 294.65 SUP HCPCS C1713 294.65 - SCREW XTRNFX 6MM 100MM NS 50MM SCHNZ SPD PNT SS LG XTRNFXTR BOTH IP/OP $141.50 $105.00 $28.08 $143.88 $63.67 $63.67 $63.67 $63.67 $141.48 $141.48 $141.48 $29.49 $141.48 $141.48 $141.48 $141.48 $141.48 $29.49 $141.48 $57.55 $83.69 $141.48 $143.88 $141.48 $141.48 $106.13 $141.48 $141.48 $141.48 $70.74 $70.74 $112.05 $141.48 $113.18 $63.67 $28.08 N/A $82.07 $141.48 $84.89 $141.48 $29.48 $141.48 N/A N/A 294.66 SUP HCPCS C1713 294.66 - SCREW EXFIX BLUNT SPADE 6MM 130MM 50MM TROCAR SCHANZ BOTH IP/OP $141.50 $105.00 $28.08 $143.88 $63.67 $63.67 $63.67 $63.67 $141.48 $141.48 $141.48 $29.49 $141.48 $141.48 $141.48 $141.48 $141.48 $29.49 $141.48 $57.55 $83.69 $141.48 $143.88 $141.48 $141.48 $106.13 $141.48 $141.48 $141.48 $70.74 $70.74 $112.05 $141.48 $113.18 $63.67 $28.08 N/A $82.07 $141.48 $84.89 $141.48 $29.48 $141.48 N/A N/A 294.67 SUP HCPCS C1713 294.67 - SCREW XTRNFX 6MM 160MM NS 50MM SCHNZ SPD PNT SS LG XTRNFXTR BOTH IP/OP $147.50 $109.00 $29.19 $149.55 $66.17 $66.17 $66.17 $66.17 $147.05 $147.05 $147.05 $30.65 $147.05 $147.05 $147.05 $147.05 $147.05 $30.65 $147.05 $59.82 $86.98 $147.05 $149.55 $147.05 $147.05 $110.63 $147.05 $147.05 $147.05 $73.53 $73.53 $116.46 $147.05 $117.64 $66.17 $29.19 N/A $85.55 $147.05 $88.23 $147.05 $30.65 $147.05 N/A N/A 294.68 SUP HCPCS C1713 294.68 - SCREW XTRNFX 6MM 190MM NS 50MM SCHNZ SPD PNT SS LG XTRNFXTR BOTH IP/OP $147.50 $109.00 $29.19 $149.55 $66.17 $66.17 $66.17 $66.17 $147.05 $147.05 $147.05 $30.65 $147.05 $147.05 $147.05 $147.05 $147.05 $30.65 $147.05 $149.55 $86.98 $147.05 $149.55 $147.05 $147.05 $110.63 $147.05 $147.05 $147.05 $73.53 $73.53 $116.46 $147.05 $117.64 $66.17 $29.19 N/A $85.55 $147.05 $147.05 $147.05 $30.65 $147.05 N/A N/A 294.71 SUP HCPCS C1713 294.71 - SCREW EXFIX BLUNT SPADE 4.5MM 80MM 18MM TROCAR SCHANZ BOTH IP/OP $125.00 $93.00 $24.76 $126.88 $56.14 $56.14 $56.14 $56.14 $124.75 $124.75 $124.75 $26.00 $124.75 $124.75 $124.75 $124.75 $124.75 $26.00 $124.75 $50.75 $73.79 $124.75 $126.88 $124.75 $124.75 $93.75 $124.75 $124.75 $124.75 $62.38 $62.38 $98.80 $124.75 $99.80 $56.14 $24.76 N/A $72.50 $124.75 $124.75 $124.75 $26.00 $124.75 N/A N/A 294.72 SUP HCPCS C1713 294.72 - SCREW XTRNFX ST 4.5MM 100MM NS 18MM SCHNZ BLNT TROC PNT SS BOTH IP/OP $125.00 $93.00 $24.76 $126.88 $56.14 $56.14 $56.14 $56.14 $124.75 $124.75 $124.75 $26.00 $124.75 $124.75 $124.75 $124.75 $124.75 $26.00 $124.75 $50.75 $73.79 $124.75 $126.88 $124.75 $124.75 $93.75 $124.75 $124.75 $124.75 $62.38 $62.38 $98.80 $124.75 $99.80 $56.14 $24.76 N/A $72.50 $124.75 $74.85 $124.75 $26.00 $124.75 N/A N/A 294.73 SUP HCPCS C1713 294.73 - SCREW XTRNFX ST 4.5MM 125MM NS 18MM SCHNZ BLNT TROC PNT SS BOTH IP/OP $125.00 $93.00 $24.76 $126.88 $56.14 $56.14 $56.14 $56.14 $124.75 $124.75 $124.75 $26.00 $124.75 $124.75 $124.75 $124.75 $124.75 $26.00 $124.75 $50.75 $73.79 $124.75 $126.88 $124.75 $124.75 $93.75 $124.75 $124.75 $124.75 $62.38 $62.38 $98.80 $124.75 $99.80 $56.14 $24.76 N/A $72.50 $124.75 $74.85 $124.75 $26.00 $124.75 N/A N/A 294.74 SUP HCPCS C1713 294.74 - SCREW XTRNFX ST 4.5MM 150MM NS 18MM SCHNZ BLNT TROC PNT SS BOTH IP/OP $125.00 $93.00 $24.76 $126.88 $56.14 $56.14 $56.14 $56.14 $124.75 $124.75 $124.75 $26.00 $124.75 $124.75 $124.75 $124.75 $124.75 $26.00 $124.75 $126.88 $73.79 $124.75 $126.88 $124.75 $124.75 $93.75 $124.75 $124.75 $124.75 $62.38 $62.38 $98.80 $124.75 $99.80 $56.14 $24.76 N/A $72.50 $124.75 $74.85 $124.75 $124.75 $124.75 N/A N/A 294.75 SUP HCPCS C1713 294.75 - SCREW XTRNFX ST 4.5MM 175MM NS 18MM SCHNZ BLNT TROC PNT SS BOTH IP/OP $147.50 $109.00 $29.19 $149.55 $66.17 $66.17 $66.17 $66.17 $147.05 $147.05 $147.05 $30.65 $147.05 $147.05 $147.05 $147.05 $147.05 $30.65 $147.05 $59.82 $86.98 $147.05 $149.55 $147.05 $147.05 $110.63 $147.05 $147.05 $147.05 $73.53 $73.53 $116.46 $147.05 $117.64 $66.17 $29.19 N/A $85.55 $147.05 $147.05 $147.05 $30.65 $147.05 N/A N/A 294.76 SUP HCPCS C1713 294.76 - SCREW XTRNFX 4.5MM 200MM NS SCHNZ BLNT TROC PNT MR BOTH IP/OP $147.50 $109.00 $29.19 $149.55 $66.17 $66.17 $66.17 $66.17 $147.05 $147.05 $147.05 $30.65 $147.05 $147.05 $147.05 $147.05 $147.05 $30.65 $147.05 $59.82 $86.98 $147.05 $149.55 $147.05 $147.05 $110.63 $147.05 $147.05 $147.05 $73.53 $73.53 $116.46 $147.05 $117.64 $66.17 $29.19 N/A $85.55 $147.05 $147.05 $147.05 $147.05 $147.05 N/A N/A 294.767 SUP HCPCS C1713 294.767 - SCREW BONE 4MM 2.5MM 65MM 18MM SLFDRILL TROCAR POINT SCHANZ BOTH IP/OP $222.00 $164.00 $44.00 $225.45 $99.76 $99.76 $99.76 $99.76 $221.68 $221.68 $221.68 $46.20 $221.68 $221.68 $221.68 $221.68 $221.68 $46.20 $221.68 $225.45 $131.12 $221.68 $225.45 $221.68 $221.68 $166.50 $221.68 $221.68 $221.68 $110.84 $110.84 $175.57 $221.68 $177.34 $99.76 $44.00 N/A $128.76 $221.68 $133.01 $221.68 $221.68 $221.68 N/A N/A 294.768 SUP HCPCS C1713 294.768 - SCREW BONE 4MM 2.5MM 80MM 20MM SLFDRILL TROCAR POINT SCHANZ BOTH IP/OP $222.00 $164.00 $44.00 $225.45 $99.76 $99.76 $99.76 $99.76 $221.68 $221.68 $221.68 $46.20 $221.68 $221.68 $221.68 $221.68 $221.68 $46.20 $221.68 $90.18 $131.12 $221.68 $225.45 $221.68 $221.68 $166.50 $221.68 $221.68 $221.68 $110.84 $110.84 $175.57 $221.68 $177.34 $99.76 $44.00 N/A $128.76 $221.68 $133.01 $221.68 $221.68 $221.68 N/A N/A 294.769 SUP HCPCS C1713 294.769 - SCREW XTRNFX 4MM 2.5MM 80MM NS 20MM SCHNZ SLF DRL MR BOTH IP/OP $250.00 $185.00 $49.53 $253.78 $112.29 $112.29 $112.29 $112.29 $249.53 $249.53 $249.53 $52.01 $249.53 $249.53 $249.53 $249.53 $249.53 $52.00 $249.53 $253.78 $147.60 $249.53 $253.78 $249.53 $249.53 $187.50 $249.53 $249.53 $249.53 $124.77 $124.77 $197.63 $249.53 $199.62 $112.29 $49.53 N/A $145.00 $249.53 $149.72 $249.53 $52.00 $249.53 N/A N/A 294.771 SUP HCPCS C1713 294.771 - SCREW XTRNFX 4MM 3MM 80MM NS 20MM SCHNZ SLF DRL MR BOTH IP/OP $250.00 $185.00 $49.53 $253.78 $112.29 $112.29 $112.29 $112.29 $249.53 $249.53 $249.53 $52.01 $249.53 $249.53 $249.53 $249.53 $249.53 $52.00 $249.53 $253.78 $147.60 $249.53 $253.78 $249.53 $249.53 $187.50 $249.53 $249.53 $249.53 $124.77 $124.77 $197.63 $249.53 $199.62 $112.29 $49.53 N/A $145.00 $249.53 $249.53 $249.53 $52.00 $249.53 N/A N/A 294.772 SUP HCPCS C1713 294.772 - SCREW BONE 4/3MM 100MM 20MM SLFDRILL SCHANZ STAINLESS STEEL BOTH IP/OP $250.00 $185.00 $49.53 $253.78 $112.29 $112.29 $112.29 $112.29 $249.53 $249.53 $249.53 $52.01 $249.53 $249.53 $249.53 $249.53 $249.53 $52.00 $249.53 $253.78 $147.60 $249.53 $253.78 $249.53 $249.53 $187.50 $249.53 $249.53 $249.53 $124.77 $124.77 $197.63 $249.53 $199.62 $112.29 $49.53 N/A $145.00 $249.53 $149.72 $249.53 $249.53 $249.53 N/A N/A 294.773 SUP HCPCS C1713 294.773 - SCREW BONE 4MM 3MM 65MM 18MM SELF DRILL SCHANZ STAINLESS BOTH IP/OP $250.00 $185.00 $49.53 $253.78 $112.29 $112.29 $112.29 $112.29 $249.53 $249.53 $249.53 $52.01 $249.53 $249.53 $249.53 $249.53 $249.53 $52.00 $249.53 $253.78 $147.60 $249.53 $253.78 $249.53 $249.53 $187.50 $249.53 $249.53 $249.53 $124.77 $124.77 $197.63 $249.53 $199.62 $112.29 $49.53 N/A $145.00 $249.53 $149.72 $249.53 $52.00 $249.53 N/A N/A 294.774 SUP HCPCS C1713 294.774 - SCREW BONE 4MM 60MM 20MM SELF DRILL SCHANZ STAINLESS STEEL BOTH IP/OP $250.00 $185.00 $49.53 $253.78 $112.29 $112.29 $112.29 $112.29 $249.53 $249.53 $249.53 $52.01 $249.53 $249.53 $249.53 $249.53 $249.53 $52.00 $249.53 $101.51 $147.60 $249.53 $253.78 $249.53 $249.53 $187.50 $249.53 $249.53 $249.53 $124.77 $124.77 $197.63 $249.53 $199.62 $112.29 $49.53 N/A $145.00 $249.53 $149.72 $249.53 $52.00 $249.53 N/A N/A 294.775 SUP HCPCS C1713 294.775 - SCREW XTRNFX 4MM 80MM NS 20MM SCHNZ SLF DRL MR CONDITIONAL BOTH IP/OP $250.00 $185.00 $49.53 $253.78 $112.29 $112.29 $112.29 $112.29 $249.53 $249.53 $249.53 $52.01 $249.53 $249.53 $249.53 $249.53 $249.53 $52.00 $249.53 $253.78 $147.60 $249.53 $253.78 $249.53 $249.53 $187.50 $249.53 $249.53 $249.53 $124.77 $124.77 $197.63 $249.53 $199.62 $112.29 $49.53 N/A $145.00 $249.53 $249.53 $249.53 $52.00 $249.53 N/A N/A 294.776 SUP HCPCS C1713 294.776 - SCREW XTRNFX 4MM 100MM NS 30MM SCHNZ SLF DRL MR CONDITIONAL BOTH IP/OP $250.00 $185.00 $49.53 $253.78 $112.29 $112.29 $112.29 $112.29 $249.53 $249.53 $249.53 $52.01 $249.53 $249.53 $249.53 $249.53 $249.53 $52.00 $249.53 $253.78 $147.60 $249.53 $253.78 $249.53 $249.53 $187.50 $249.53 $249.53 $249.53 $124.77 $124.77 $197.63 $249.53 $199.62 $112.29 $49.53 N/A $145.00 $249.53 $249.53 $249.53 $52.00 $249.53 N/A N/A 294.777 SUP HCPCS C1713 294.777 - SCREW XTRNFX 4MM 125MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL BOTH IP/OP $250.00 $185.00 $49.53 $253.78 $112.29 $112.29 $112.29 $112.29 $249.53 $249.53 $249.53 $52.01 $249.53 $249.53 $249.53 $249.53 $249.53 $52.00 $249.53 $253.78 $147.60 $249.53 $253.78 $249.53 $249.53 $187.50 $249.53 $249.53 $249.53 $124.77 $124.77 $197.63 $249.53 $199.62 $112.29 $49.53 N/A $145.00 $249.53 $149.72 $249.53 $52.00 $249.53 N/A N/A 294.778 SUP HCPCS C1713 294.778 - SCREW XTRNFX 4MM 150MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL BOTH IP/OP $250.00 $185.00 $49.53 $253.78 $112.29 $112.29 $112.29 $112.29 $249.53 $249.53 $249.53 $52.01 $249.53 $249.53 $249.53 $249.53 $249.53 $52.00 $249.53 $253.78 $147.60 $249.53 $253.78 $249.53 $249.53 $187.50 $249.53 $249.53 $249.53 $124.77 $124.77 $197.63 $249.53 $199.62 $112.29 $49.53 N/A $145.00 $249.53 $149.72 $249.53 $52.00 $249.53 N/A N/A 294.779 SUP HCPCS C1713 294.779 - SCREW XTRNFX 4MM 175MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL BOTH IP/OP $250.00 $185.00 $49.53 $253.78 $112.29 $112.29 $112.29 $112.29 $249.53 $249.53 $249.53 $52.01 $249.53 $249.53 $249.53 $249.53 $249.53 $52.00 $249.53 $101.51 $147.60 $249.53 $253.78 $249.53 $249.53 $187.50 $249.53 $249.53 $249.53 $124.77 $124.77 $197.63 $249.53 $199.62 $112.29 $49.53 N/A $145.00 $249.53 $149.72 $249.53 $52.00 $249.53 N/A N/A 294.782 SUP HCPCS C1713 294.782 - SCREW XTRNFX 5MM 100MM NS 30MM SCHNZ SLF DRL MR CONDITIONAL BOTH IP/OP $282.00 $209.00 $55.94 $286.63 $126.82 $126.82 $126.82 $126.82 $281.83 $281.83 $281.83 $58.74 $281.83 $281.83 $281.83 $281.83 $281.83 $58.74 $281.83 $114.65 $166.70 $281.83 $286.63 $281.83 $281.83 $211.50 $281.83 $281.83 $281.83 $140.92 $140.92 $223.21 $281.83 $225.46 $126.82 $55.94 N/A $163.56 $281.83 $281.83 $281.83 $58.73 $281.83 N/A N/A 294.783 SUP HCPCS C1713 294.783 - SCREW XTRNFX 5MM 125MM NS 40MM SCHNZ SLF DRL SS HIP CNDYL LG BOTH IP/OP $282.00 $209.00 $55.94 $286.63 $126.82 $126.82 $126.82 $126.82 $281.83 $281.83 $281.83 $58.74 $281.83 $281.83 $281.83 $281.83 $281.83 $58.74 $281.83 $114.65 $166.70 $281.83 $286.63 $281.83 $281.83 $211.50 $281.83 $281.83 $281.83 $140.92 $140.92 $223.21 $281.83 $225.46 $126.82 $55.94 N/A $163.56 $281.83 $281.83 $281.83 $281.83 $281.83 N/A N/A 294.784 SUP HCPCS C1713 294.784 - SCREW XTRNFX 5MM 150MM NS 60MM SCHNZ SLF DRL MR CONDITIONAL BOTH IP/OP $282.00 $209.00 $55.94 $286.63 $126.82 $126.82 $126.82 $126.82 $281.83 $281.83 $281.83 $58.74 $281.83 $281.83 $281.83 $281.83 $281.83 $58.74 $281.83 $286.63 $166.70 $281.83 $286.63 $281.83 $281.83 $211.50 $281.83 $281.83 $281.83 $140.92 $140.92 $223.21 $281.83 $225.46 $126.82 $55.94 N/A $163.56 $281.83 $169.10 $281.83 $58.73 $281.83 N/A N/A 294.785 SUP HCPCS C1713 294.785 - SCREW XTRNFX 5MM 175MM NS 60MM SCHNZ SLF DRL MR CONDITIONAL BOTH IP/OP $282.00 $209.00 $55.94 $286.63 $126.82 $126.82 $126.82 $126.82 $281.83 $281.83 $281.83 $58.74 $281.83 $281.83 $281.83 $281.83 $281.83 $58.74 $281.83 $286.63 $166.70 $281.83 $286.63 $281.83 $281.83 $211.50 $281.83 $281.83 $281.83 $140.92 $140.92 $223.21 $281.83 $225.46 $126.82 $55.94 N/A $163.56 $281.83 $169.10 $281.83 $58.73 $281.83 N/A N/A 294.786 SUP HCPCS C1713 294.786 - SCREW XTRNFX 5MM 200MM NS 80MM SCHNZ SLF DRL MR CONDITIONAL BOTH IP/OP $282.00 $209.00 $55.94 $286.63 $126.82 $126.82 $126.82 $126.82 $281.83 $281.83 $281.83 $58.74 $281.83 $281.83 $281.83 $281.83 $281.83 $58.74 $281.83 $286.63 $166.70 $281.83 $286.63 $281.83 $281.83 $211.50 $281.83 $281.83 $281.83 $140.92 $140.92 $223.21 $281.83 $225.46 $126.82 $55.94 N/A $163.56 $281.83 $169.10 $281.83 $58.73 $281.83 N/A N/A 294.788 SUP HCPCS C1713 294.788 - SCREW XTRNFX 5MM 250MM NS 80MM SCHNZ SLF DRL MR CONDITIONAL BOTH IP/OP $282.00 $209.00 $55.94 $286.63 $126.82 $126.82 $126.82 $126.82 $281.83 $281.83 $281.83 $58.74 $281.83 $281.83 $281.83 $281.83 $281.83 $58.74 $281.83 $286.63 $166.70 $281.83 $286.63 $281.83 $281.83 $211.50 $281.83 $281.83 $281.83 $140.92 $140.92 $223.21 $281.83 $225.46 $126.82 $55.94 N/A $163.56 $281.83 $169.10 $281.83 $58.73 $281.83 N/A N/A 294.792 SUP HCPCS C1713 294.792 - SCREW BONE 6MM 100MM 30MM SLFDRILL SCHANZ STAINLESS STEEL BOTH IP/OP $301.00 $223.00 $59.70 $305.90 $135.35 $135.35 $135.35 $135.35 $300.78 $300.78 $300.78 $62.69 $300.78 $300.78 $300.78 $300.78 $300.78 $62.69 $300.78 $305.90 $177.91 $300.78 $305.90 $300.78 $300.78 $225.75 $300.78 $300.78 $300.78 $150.39 $150.39 $238.22 $300.78 $240.62 $135.35 $59.70 N/A $174.58 $300.78 $180.47 $300.78 $300.78 $300.78 N/A N/A 294.793 SUP HCPCS C1713 294.793 - SCREW BONE 6MM 125MM 40MM SLFDRILL SCHANZ STAINLESS STEEL BOTH IP/OP $301.00 $223.00 $59.70 $305.90 $135.35 $135.35 $135.35 $135.35 $300.78 $300.78 $300.78 $62.69 $300.78 $300.78 $300.78 $300.78 $300.78 $62.69 $300.78 $305.90 $177.91 $300.78 $305.90 $300.78 $300.78 $225.75 $300.78 $300.78 $300.78 $150.39 $150.39 $238.22 $300.78 $240.62 $135.35 $59.70 N/A $174.58 $300.78 $180.47 $300.78 $62.68 $300.78 N/A N/A 294.794 SUP HCPCS C1713 294.794 - SCREW BONE 6MM 150MM 60MM SELF DRILL SCHANZ STAINLESS STEEL BOTH IP/OP $301.00 $223.00 $59.70 $305.90 $135.35 $135.35 $135.35 $135.35 $300.78 $300.78 $300.78 $62.69 $300.78 $300.78 $300.78 $300.78 $300.78 $62.69 $300.78 $122.36 $177.91 $300.78 $305.90 $300.78 $300.78 $225.75 $300.78 $300.78 $300.78 $150.39 $150.39 $238.22 $300.78 $240.62 $135.35 $59.70 N/A $174.58 $300.78 $180.47 $300.78 $62.68 $300.78 N/A N/A 294.795 SUP HCPCS C1713 294.795 - SCREW BONE 6MM 175MM 60MM SLFDRILL SCHANZ STAINLESS STEEL BOTH IP/OP $301.00 $223.00 $59.70 $305.90 $135.35 $135.35 $135.35 $135.35 $300.78 $300.78 $300.78 $62.69 $300.78 $300.78 $300.78 $300.78 $300.78 $62.69 $300.78 $122.36 $177.91 $300.78 $305.90 $300.78 $300.78 $225.75 $300.78 $300.78 $300.78 $150.39 $150.39 $238.22 $300.78 $240.62 $135.35 $59.70 N/A $174.58 $300.78 $180.47 $300.78 $300.78 $300.78 N/A N/A 294.796 SUP HCPCS C1713 294.796 - SCREW BONE 6MM 200MM 80MM SELF DRILL SCHANZ STAINLESS STEEL BOTH IP/OP $301.00 $223.00 $59.70 $305.90 $135.35 $135.35 $135.35 $135.35 $300.78 $300.78 $300.78 $62.69 $300.78 $300.78 $300.78 $300.78 $300.78 $62.69 $300.78 $122.36 $177.91 $300.78 $305.90 $300.78 $300.78 $225.75 $300.78 $300.78 $300.78 $150.39 $150.39 $238.22 $300.78 $240.62 $135.35 $59.70 N/A $174.58 $300.78 $180.47 $300.78 $300.78 $300.78 N/A N/A 294.798 SUP HCPCS C1713 294.798 - SCREW XTRNFX 4MM 175MM NS 40MM SCHNZ SLF DRL MR CONDITIONAL BOTH IP/OP $301.00 $223.00 $59.70 $305.90 $135.35 $135.35 $135.35 $135.35 $300.78 $300.78 $300.78 $62.69 $300.78 $300.78 $300.78 $300.78 $300.78 $62.69 $300.78 $122.36 $177.91 $300.78 $305.90 $300.78 $300.78 $225.75 $300.78 $300.78 $300.78 $150.39 $150.39 $238.22 $300.78 $240.62 $135.35 $59.70 N/A $174.58 $300.78 $180.47 $300.78 $300.78 $300.78 N/A N/A 294.95 SUP Custom 27203010 294.950 - PIN FIX 6MM 225MM TRANSFIXATION STEINMANN STAINLESS STEEL BOTH IP/OP $209.00 $155.00 $37.15 $218.65 $208.73 $208.73 $208.73 $208.73 $208.73 $208.73 $37.15 $208.73 $208.73 $154.92 $154.92 $160.89 $108.75 $43.50 $208.73 $87.46 $208.73 $208.73 $218.65 $208.73 $208.73 $156.75 $208.73 $208.73 $208.73 $104.37 $104.37 $165.31 $208.73 $166.98 $135.67 $208.73 N/A $121.22 $208.73 $125.24 $208.73 $208.73 $208.73 N/A N/A 296.757 SUP Custom 27803010 296.757 - NUT ORTHOPEDIC 6MM ROUNDED STAINLESS STEEL SACRAL NONSTRL BOTH IP/OP $264.00 $195.00 $46.32 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $46.99 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $55.02 $264.00 $46.32 $264.00 $264.00 $115.80 $264.00 $264.00 $198.00 $264.00 $264.00 $264.00 $132.00 $132.00 $209.09 $264.00 $211.20 $118.80 $264.00 N/A $153.12 $264.00 $158.40 $264.00 $264.00 $264.00 N/A N/A 296.758 SUP Custom 27803010 296.758 - WASHER SPINAL 6MM STAINLESS STEEL SACRAL NONSTRL BOTH IP/OP $264.00 $195.00 $46.32 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $46.99 $264.00 $264.00 $264.00 $264.00 $264.00 $264.00 $55.02 $264.00 $46.32 $264.00 $264.00 $115.80 $264.00 $264.00 $198.00 $264.00 $264.00 $264.00 $132.00 $132.00 $209.09 $264.00 $211.20 $118.80 $264.00 N/A $153.12 $264.00 $158.40 $264.00 $264.00 $264.00 N/A N/A 296.759 SUP Custom 27803010 296.759 - NUT ORTHOPEDIC 6MM HEXAGON STAINLESS STEEL SACRAL NONSTRL BOTH IP/OP $245.00 $181.00 $43.46 $244.75 $244.75 $244.75 $244.75 $244.75 $244.75 $244.75 $43.57 $244.75 $244.75 $244.75 $244.75 $244.75 $244.75 $51.01 $244.75 $43.46 $244.75 $244.75 $108.65 $244.75 $244.75 $183.75 $244.75 $244.75 $244.75 $122.38 $122.38 $193.84 $244.75 $195.80 $110.14 $244.75 N/A $142.10 $244.75 $146.85 $244.75 $244.75 $244.75 N/A N/A 296.761 SUP HCPCS C1713 296.761 - BAR SPINAL 6MM 160MM THREAD STAINLESS STEEL SACRAL SPN BOTH IP/OP "$1,334.50" $988.00 $264.86 "$1,334.50" $600.53 $600.53 $600.53 $600.53 "$1,334.50" "$1,334.50" "$1,334.50" $278.14 "$1,334.50" "$1,334.50" "$1,334.50" "$1,334.50" "$1,334.50" $278.12 "$1,334.50" $533.80 $789.36 "$1,334.50" "$1,334.50" "$1,334.50" "$1,334.50" "$1,000.88" "$1,334.50" "$1,334.50" "$1,334.50" $667.25 $667.25 "$1,056.92" "$1,334.50" "$1,067.60" $600.53 $264.86 N/A $774.01 "$1,334.50" "$1,334.50" "$1,334.50" $278.11 "$1,334.50" N/A N/A 296.763 SUP HCPCS C1713 296.763 - BAR SPINAL 6MM 200MM THREADED KIT SACRAL NONSTRL BOTH IP/OP "$1,210.50" $896.00 $240.21 "$1,230.88" $544.64 $544.64 $544.64 $544.64 "$1,210.30" "$1,210.30" "$1,210.30" $252.26 "$1,210.30" "$1,210.30" "$1,210.30" "$1,210.30" "$1,210.30" $252.24 "$1,210.30" $492.35 $715.89 "$1,210.30" "$1,230.88" "$1,210.30" "$1,210.30" $907.88 "$1,210.30" "$1,210.30" "$1,210.30" $605.15 $605.15 $958.56 "$1,210.30" $968.24 $544.64 $240.21 N/A $702.09 "$1,210.30" "$1,210.30" "$1,210.30" $252.23 "$1,210.30" N/A N/A 296.765 SUP HCPCS C1713 296.765 - BAR SPINAL 6MM 240MM THREAD STAINLESS STEEL SACRAL SPN BOTH IP/OP "$1,416.00" "$1,048.00" $280.99 "$1,415.75" $637.09 $637.09 $637.09 $637.09 "$1,415.75" "$1,415.75" "$1,415.75" $295.08 "$1,415.75" "$1,415.75" "$1,415.75" "$1,415.75" "$1,415.75" $295.06 "$1,415.75" $566.30 $837.42 "$1,415.75" "$1,415.75" "$1,415.75" "$1,415.75" "$1,062.00" "$1,415.75" "$1,415.75" "$1,415.75" $707.88 $707.88 "$1,121.27" "$1,415.75" "$1,132.60" $637.09 $280.99 N/A $821.28 "$1,415.75" $849.45 "$1,415.75" $295.04 "$1,415.75" N/A N/A 296.766 SUP HCPCS C1713 296.766 - BAR SPINAL 6MM 260MM THREAD STAINLESS STEEL SACRAL SPN BOTH IP/OP "$1,210.50" $896.00 $240.21 "$1,230.88" $544.64 $544.64 $544.64 $544.64 "$1,210.30" "$1,210.30" "$1,210.30" $252.26 "$1,210.30" "$1,210.30" "$1,210.30" "$1,210.30" "$1,210.30" $252.24 "$1,210.30" $492.35 $715.89 "$1,210.30" "$1,230.88" "$1,210.30" "$1,210.30" $907.88 "$1,210.30" "$1,210.30" "$1,210.30" $605.15 $605.15 $958.56 "$1,210.30" $968.24 $544.64 $240.21 N/A $702.09 "$1,210.30" $726.18 "$1,210.30" $252.23 "$1,210.30" N/A N/A 304 SUP HCPCS C1778 304 - LEAD NEUROSTIMULATOR 3MM 43CM BIPOL PERENNIAFLEX SILICONE BOTH IP/OP "$17,070.00" "$12,632.00" "$3,557.58" "$17,070.00" "$17,070.00" "$17,070.00" "$17,070.00" "$17,070.00" "$17,070.00" "$17,070.00" "$17,070.00" "$17,070.00" "$17,070.00" "$17,070.00" "$17,070.00" "$17,070.00" "$17,070.00" "$3,557.58" "$17,070.00" "$6,828.00" "$17,070.00" "$17,070.00" "$17,070.00" "$17,070.00" "$17,070.00" "$12,802.50" "$17,070.00" "$17,070.00" "$17,070.00" "$8,535.00" "$8,535.00" "$13,519.44" "$17,070.00" "$13,656.00" "$7,681.50" "$17,070.00" N/A "$9,900.60" "$17,070.00" "$10,242.00" "$17,070.00" "$17,070.00" "$17,070.00" N/A N/A 304.008 SUP Custom 27803010 304.008 - SPACER SPNL OBLQ 26X10X8MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.009 SUP Custom 27803010 304.009 - SPACER SPNL OBLQ 26X10X9MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.01 SUP Custom 27803010 304.010 - SPACER SPNL OBLQ 26X10X10MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.011 SUP Custom 27803010 304.011 - SPACER SPNL OBLQ 26X10X11MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.012 SUP Custom 27803010 304.012 - SPACER SPNL OBLQ 26X10X12MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.013 SUP Custom 27803010 304.013 - SPACER SPNL OBLQ 26X10X13MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.014 SUP Custom 27803010 304.014 - SPACER SPNL OBLQ 26X10X14MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.015 SUP Custom 27803010 304.015 - SPACER SPNL OBLQ 26X10X15MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.017 SUP Custom 27803010 304.017 - SPACER SPNL OBLQ 26X10X17MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.065 SUP Custom 27803010 304.065 - SPACER SPNL 13MM MED CNVX 14X5MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.066 SUP Custom 27803010 304.066 - SPACER SPNL 13MM MED CNVX 14X6MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.067 SUP Custom 27803010 304.067 - SPACER SPNL 13MM MED CNVX 14X7MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.068 SUP Custom 27803010 304.068 - SPACER SPNL 13MM MED CNVX 14X8MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.069 SUP Custom 27803010 304.069 - SPACER SPNL 13MM MED CNVX 14X9MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.07 SUP Custom 27803010 304.070 - SPACER SPNL 13MM MED CNVX 14X10MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.071 SUP Custom 27803010 304.071 - SPACER SPNL 13MM MED CNVX 14X11MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.072 SUP Custom 27803010 304.072 - SPACER SPNL 13MM MED CNVX 14X12MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.078 SUP Custom 27803010 304.078 - SPACER SPNL SM OBLQ 22X8X8MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.079 SUP Custom 27803010 304.079 - SPACER SPNL SM OBLQ 22X8X9MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.08 SUP Custom 27803010 304.080 - SPACER SPNL SM OBLQ 22X8X10MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.081 SUP Custom 27803010 304.081 - SPACER SPNL SM OBLQ 22X8X11MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.082 SUP Custom 27803010 304.082 - SPACER SPNL SM OBLQ 22X8X12MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.083 SUP Custom 27803010 304.083 - SPACER SPNL SM OBLQ 22X8X13MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.085 SUP Custom 27803010 304.085 - SPACER SPNL SM OBLQ 22X8X15MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.087 SUP Custom 27803010 304.087 - SPACER SPNL SM OBLQ 22X8X17MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.088 SUP Custom 27803010 304.088 - SPACER SPNL SM OBLQ 22X10X8MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.089 SUP Custom 27803010 304.089 - SPACER SPNL SM OBLQ 22X10X9MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.09 SUP Custom 27803010 304.090 - SPACER SPNL SM OBLQ 22X10X10MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.091 SUP Custom 27803010 304.091 - SPACER SPNL SM OBLQ 22X10X11MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.092 SUP Custom 27803010 304.092 - SPACER SPNL SM OBLQ 22X10X12MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.093 SUP Custom 27803010 304.093 - SPACER SPNL SM OBLQ 22X10X13MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.095 SUP Custom 27803010 304.095 - SPACER SPNL SM OBLQ 22X10X15MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.097 SUP Custom 27803010 304.097 - SPACER SPNL SM OBLQ 22X10X17MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.104 SUP Custom 27803010 304.104 - MARKER SRG 4MM WHT SCR LGTH SLFDRL SCR BOTH IP/OP $107.00 $79.00 $19.02 $106.88 $106.88 $106.88 $106.88 $106.88 $106.88 $106.88 $19.02 $106.88 $106.88 $106.88 $106.88 $106.88 $106.88 $22.27 $106.88 $42.75 $106.88 $106.88 $106.88 $106.88 $106.88 $80.25 $106.88 $106.88 $106.88 $53.44 $53.44 $84.65 $106.88 $85.50 $48.10 $106.88 N/A $62.06 $106.88 $64.13 $106.88 $106.88 $106.88 N/A N/A 304.105 SUP Custom 27803010 304.105 - MARKER SRG 5MM WHT SCR LGTH SLF DRL SCR BOTH IP/OP $107.00 $79.00 $19.02 $106.88 $106.88 $106.88 $106.88 $106.88 $106.88 $106.88 $19.02 $106.88 $106.88 $106.88 $106.88 $106.88 $106.88 $22.27 $106.88 $42.75 $106.88 $106.88 $106.88 $106.88 $106.88 $80.25 $106.88 $106.88 $106.88 $53.44 $53.44 $84.65 $106.88 $85.50 $48.10 $106.88 N/A $62.06 $106.88 $64.13 $106.88 $106.88 $106.88 N/A N/A 304.107 SUP Custom 27803010 304.107 - SPACER SPNL SM 22X10X7MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.109 SUP Custom 27803010 304.109 - SPACER SPNL SM 22X10X9MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.111 SUP Custom 27803010 304.111 - SPACER SPNL SM 22X10X11MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.113 SUP Custom 27803010 304.113 - SPACER SPNL SM 22X10X13MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.115 SUP Custom 27803010 304.115 - SPACER SPNL SM 22X10X15MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.117 SUP Custom 27803010 304.117 - SPACER SPNL SM 22X10X17MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.119 SUP Custom 27803010 304.119 - SPACER SPNL SM 22X10X19MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.121 SUP Custom 27803010 304.121 - SPACER SPNL SM 22X10X21MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.159 SUP Custom 27803010 304.159 - SPACER SPNL SM 18X10X9MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.161 SUP Custom 27803010 304.161 - SPACER SPNL SM 18X10X11MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.163 SUP Custom 27803010 304.163 - SPACER SPNL SM 18X10X13MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.165 SUP Custom 27803010 304.165 - SPACER SPNL SM 18X10X15MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.167 SUP Custom 27803010 304.167 - SPACER SPNL SM 18X10X17MM NS LF SUST O RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.205 SUP Custom 27803010 304.205 - SPACER SPNL 13MM MED PRLL 14X5MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.206 SUP Custom 27803010 304.206 - SPACER SPNL 13MM MED PRLL 14X6MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.207 SUP Custom 27803010 304.207 - SPACER SPNL 13MM MED PRLL 14X7MM NS LF SUST R RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.208 SUP Custom 27803010 304.208 - SPACER SPNL 13MM MED PRLL 14X8MM NS LF SUST R RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.209 SUP Custom 27803010 304.209 - SPACER SPNL 13MM MED PRLL 14X9MM NS LF SUST R RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.21 SUP Custom 27803010 304.210 - SPACER SPNL 13MM MED PRLL 14X10MM NS LF SUST R RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.211 SUP Custom 27803010 304.211 - SPACER SPNL 13MM MED PRLL 14X11MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.212 SUP Custom 27803010 304.212 - SPACER SPNL 13MM MED PRLL 14X12MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.225 SUP Custom 27803010 304.225 - SPACER SPNL 7D LRDTC 13MM MED 14X5MM NS LF SUST R RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.226 SUP Custom 27803010 304.226 - SPACER SPNL 7D LRDTC 13MM MED 14X6MM NS LF SUST R RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.227 SUP Custom 27803010 304.227 - SPACER SPNL 7D LRDTC 13MM MED 14X7MM NS LF SUST R RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.228 SUP Custom 27803010 304.228 - SPACER SPNL 7D LRDTC 13MM MED 14X8MM NS LF SUST R RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.229 SUP Custom 27803010 304.229 - SPACER SPNL 7D LRDTC 13MM MED 14X9MM NS LF SUST R RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.23 SUP Custom 27803010 304.230 - SPACER SPNL 7D LRDTC 13MM MED 14X10MM NS LF SUST R RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.231 SUP Custom 27803010 304.231 - SPACER SPNL 7D LRDTC 13MM MED 14X11MM NS LF SUST O RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.232 SUP Custom 27803010 304.232 - SPACER SPNL 7D LRDTC 13MM MED 14X12MM NS LF SUST O RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.245 SUP Custom 27803010 304.245 - SPACER SPNL 13MM MED CNVX 14X5MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.246 SUP Custom 27803010 304.246 - SPACER SPNL 13MM MED CNVX 14X6MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.247 SUP Custom 27803010 304.247 - SPACER SPNL 13MM MED CNVX 14X7MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.248 SUP Custom 27803010 304.248 - SPACER SPNL 13MM MED CNVX 14X8MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.249 SUP Custom 27803010 304.249 - SPACER SPNL 13MM MED CNVX 14X9MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.25 SUP Custom 27803010 304.250 - SPACER SPNL 13MM MED CNVX 14X10MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.251 SUP Custom 27803010 304.251 - SPACER SPNL 13MM MED CNVX 14X11MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.252 SUP Custom 27803010 304.252 - SPACER SPNL 13MM MED CNVX 14X12MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.265 SUP Custom 27803010 304.265 - SPACER SPNL 13MM MED PRLL 14X5MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.266 SUP Custom 27803010 304.266 - SPACER SPNL 13MM MED PRLL 14X6MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.267 SUP Custom 27803010 304.267 - SPACER SPNL 13MM MED PRLL 14X7MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.268 SUP Custom 27803010 304.268 - SPACER SPNL 13MM MED PRLL 14X8MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.269 SUP Custom 27803010 304.269 - SPACER SPNL 13MM MED PRLL 14X9MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.27 SUP Custom 27803010 304.270 - SPACER SPNL 13MM MED PRLL 14X10MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.271 SUP Custom 27803010 304.271 - SPACER SPNL 13MM MED PRLL 14X11MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.272 SUP Custom 27803010 304.272 - SPACER SPNL 13MM MED PRLL 14X12MM NS LF SUST O RDLCNT BEAD BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.275 SUP Custom 27803010 304.275 - SPACER SPNL 7D LRDTC 13MM MED 14X5MM NS LF SUST O RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.276 SUP Custom 27803010 304.276 - SPACER SPNL 7D LRDTC 13MM MED 14X6MM NS LF SUST O RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.277 SUP Custom 27803010 304.277 - SPACER SPNL 7D LRDTC 13MM MED 14X7MM NS LF SUST O RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.278 SUP Custom 27803010 304.278 - SPACER SPNL 7D LRDTC 13MM MED 14X8MM NS LF SUST O RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.279 SUP Custom 27803010 304.279 - SPACER SPNL 7D LRDTC 13MM MED 14X9MM NS LF SUST O RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.28 SUP Custom 27803010 304.280 - SPACER SPNL 7D LRDTC 13MM MED 14X10MM NS LF SUST O RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.281 SUP Custom 27803010 304.281 - SPACER SPNL 7D LRDTC 13MM MED 14X11MM NS LF SUST O RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.282 SUP Custom 27803010 304.282 - SPACER SPNL 7D LRDTC 13MM MED 14X12MM NS LF SUST O RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.309 SUP Custom 27803010 304.309 - SPACER SPNL 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK THORLMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.311 SUP Custom 27803010 304.311 - SPACER SPNL 31MM LG 25X11MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.313 SUP Custom 27803010 304.313 - SPACER SPNL 31MM LG 25X13MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.315 SUP Custom 27803010 304.315 - SPACER SPNL 31MM LG 25X15MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.317 SUP Custom 27803010 304.317 - SPACER SPNL 31MM LG 25X17MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.319 SUP Custom 27803010 304.319 - SPACER SPNL 31MM LG 25X19MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.321 SUP Custom 27803010 304.321 - SPACER SPNL 31MM LG 25X21MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.351 SUP Custom 27803010 304.351 - SPACER SPNL 15D LRDTC 31MM LG 25X11MM NS LF SUST O RDLCNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.352 SUP Custom 27803010 304.352 - SPACER SPNL 15D LRDTC 31MM LG 25X13MM NS LF SUST O RDLCNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.353 SUP Custom 27803010 304.353 - SPACER SPNL 15D LRDTC 31MM LG 25X15MM NS LF SUST O RDLCNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.354 SUP Custom 27803010 304.354 - SPACER SPNL 15D LRDTC 31MM LG 25X17MM NS LF SUST O RDLCNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.355 SUP Custom 27803010 304.355 - SPACER SPNL 15D LRDTC 31MM LG 25X19MM NS LF SUST O RDLCNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.356 SUP Custom 27803010 304.356 - SPACER SPNL 15D LRDTC 31MM LG 25X21MM NS LF SUST O RDLCNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.359 SUP Custom 27803010 304.359 - SPACER SPNL 42MM XL 28X9MM NS LF SUST O RDLCNT PEEK THORLMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.361 SUP Custom 27803010 304.361 - SPACER SPNL 42MM XL 28X11MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.363 SUP Custom 27803010 304.363 - SPACER SPNL 42MM XL 28X13MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.365 SUP Custom 27803010 304.365 - SPACER SPNL 42MM XL 28X15MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.367 SUP Custom 27803010 304.367 - SPACER SPNL 42MM XL 28X17MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.369 SUP Custom 27803010 304.369 - SPACER SPNL 42MM XL 28X19MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.371 SUP Custom 27803010 304.371 - SPACER SPNL 42MM XL 28X21MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.379 SUP Custom 27803010 304.379 - SPACER SPNL 42MM XL 28X9MM NS LF SUST O RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.381 SUP Custom 27803010 304.381 - SPACER SPNL 42MM XL 28X11MM NS LF SUST O RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.383 SUP Custom 27803010 304.383 - SPACER SPNL 42MM XL 28X13MM NS LF SUST O RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.385 SUP Custom 27803010 304.385 - SPACER SPNL 42MM XL 28X15MM NS LF SUST O RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.387 SUP Custom 27803010 304.387 - SPACER SPNL 42MM XL 28X17MM NS LF SUST O RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.389 SUP Custom 27803010 304.389 - SPACER SPNL 42MM XL 28X19MM NS LF SUST O RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.391 SUP Custom 27803010 304.391 - SPACER SPNL 42MM XL 28X21MM NS LF SUST O RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.409 SUP Custom 27803010 304.409 - SPACER SPNL 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK LAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.411 SUP Custom 27803010 304.411 - SPACER SPNL 31MM LG 25X11MM NS LF SUST O RDLCNT PEEK LAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.413 SUP Custom 27803010 304.413 - SPACER SPNL 31MM LG 25X13MM NS LF SUST O RDLCNT PEEK LAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.415 SUP Custom 27803010 304.415 - SPACER SPNL 31MM LG 25X15MM NS LF SUST O RDLCNT PEEK LAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.417 SUP Custom 27803010 304.417 - SPACER SPNL 31MM LG 25X17MM NS LF SUST O RDLCNT PEEK LAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.419 SUP Custom 27803010 304.419 - SPACER SPNL 31MM LG 25X19MM NS LF SUST O RDLCNT PEEK LAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.421 SUP Custom 27803010 304.421 - SPACER SPNL 31MM LG 25X21MM NS LF SUST O RDLCNT PEEK LAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.45 SUP Custom 27803010 304.450 - SPACER SPNL 4D LRDTC 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.451 SUP Custom 27803010 304.451 - SPACER SPNL 4D LRDTC 31MM LG 25X11MM NS LF SUST O RDLCNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.452 SUP Custom 27803010 304.452 - SPACER SPNL 4D LRDTC 31MM LG 25X13MM NS LF SUST O RDLCNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.453 SUP Custom 27803010 304.453 - SPACER SPNL 4D LRDTC 31MM LG 25X15MM NS LF SUST O RDLCNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.454 SUP Custom 27803010 304.454 - SPACER SPNL 4D LRDTC 31MM LG 25X17MM NS LF SUST O RDLCNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.455 SUP Custom 27803010 304.455 - SPACER SPNL 4D LRDTC 31MM LG 25X19MM NS LF SUST O RDLCNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.456 SUP Custom 27803010 304.456 - SPACER SPNL 4D LRDTC 31MM LG 25X21MM NS LF SUST O RDLCNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.509 SUP Custom 27803010 304.509 - SPACER SPNL 31MM LG 25X9MM NS LF SUST O RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.511 SUP Custom 27803010 304.511 - SPACER SPNL 31MM LG 25X11MM NS LF SUST O RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.513 SUP Custom 27803010 304.513 - SPACER SPNL 31MM LG 25X13MM NS LF SUST O RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.515 SUP Custom 27803010 304.515 - SPACER SPNL 31MM LG 25X15MM NS LF SUST O RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.517 SUP Custom 27803010 304.517 - SPACER SPNL 31MM LG 25X17MM NS LF SUST O RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.519 SUP Custom 27803010 304.519 - SPACER SPNL 31MM LG 25X19MM NS LF SUST O RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.521 SUP Custom 27803010 304.521 - SPACER SPNL 31MM LG 25X21MM NS LF SUST O RDLCNT PEEK ALAT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 304.607 SUP Custom 27803010 304.607 - SPACER SPNL SM ARCH 27X9.5X7MM NS LF SUST RDLCNT PEEK TLIF BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.609 SUP Custom 27803010 304.609 - SPACER SPNL SM ARCH 27X9.5X9MM NS LF SUST RDLCNT PEEK TLIF BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.611 SUP Custom 27803010 304.611 - SPACER SPNL SM ARCH 27X9.5X11MM NS LF SUST RDLCNT PEEK TLIF BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.613 SUP Custom 27803010 304.613 - SPACER SPNL SM ARCH 27X9.5X13MM NS LF SUST RDLCNT PEEK TLIF BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.615 SUP Custom 27803010 304.615 - SPACER SPNL SM ARCH 27X9.5X15MM NS LF SUST RDLCNT PEEK TLIF BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.617 SUP Custom 27803010 304.617 - SPACER SPNL SM ARCH 27X9.5X17MM NS LF SUST RDLCNT PEEK TLIF BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.707 SUP Custom 27803010 304.707 - SPACER SPNL SM NAR 22X8X7MM NS LF SUST R RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.709 SUP Custom 27803010 304.709 - SPACER SPNL SM NAR 22X8X9MM NS LF SUST R RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.711 SUP Custom 27803010 304.711 - SPACER SPNL SM NAR 22X8X11MM NS LF SUST R RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.713 SUP Custom 27803010 304.713 - SPACER SPNL SM NAR 22X8X13MM NS LF SUST R RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.715 SUP Custom 27803010 304.715 - SPACER SPNL SM NAR 22X8X15MM NS LF SUST R RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.717 SUP Custom 27803010 304.717 - SPACER SPNL SM NAR 22X8X17MM NS LF SUST R RDLCNT PEEK LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 304.808 SUP Custom 27803010 304.808 - SPACER SPNL OBLQ 30X10X8MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.809 SUP Custom 27803010 304.809 - SPACER SPNL OBLQ 30X10X9MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.81 SUP Custom 27803010 304.810 - SPACER SPNL OBLQ 30X10X10MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.811 SUP Custom 27803010 304.811 - SPACER SPNL OBLQ 30X10X11MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.812 SUP Custom 27803010 304.812 - SPACER SPNL OBLQ 30X10X12MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.813 SUP Custom 27803010 304.813 - SPACER SPNL OBLQ 30X10X13MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.814 SUP Custom 27803010 304.814 - SPACER SPNL OBLQ 30X10X14MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.815 SUP Custom 27803010 304.815 - SPACER SPNL OBLQ 30X10X15MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.817 SUP Custom 27803010 304.817 - SPACER SPNL OBLQ 30X10X17MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.868 SUP Custom 27803010 304.868 - SPACER SPNL OBLQ 30X12X8MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.869 SUP Custom 27803010 304.869 - SPACER SPNL OBLQ 30X12X9MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.87 SUP Custom 27803010 304.870 - SPACER SPNL OBLQ 30X12X10MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.871 SUP Custom 27803010 304.871 - SPACER SPNL OBLQ 30X12X11MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.872 SUP Custom 27803010 304.872 - SPACER SPNL OBLQ 30X12X12MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.873 SUP Custom 27803010 304.873 - SPACER SPNL OBLQ 30X12X13MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.874 SUP Custom 27803010 304.874 - SPACER SPNL OBLQ 30X12X14MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.875 SUP Custom 27803010 304.875 - SPACER SPNL OBLQ 30X12X15MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.877 SUP Custom 27803010 304.877 - SPACER SPNL OBLQ 30X12X17MM NS LF SUST RDLCNT PEEK LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.905 SUP Custom 27803010 304.905 - SPACER SPNL 11MM MED NAR PRLL 12X5MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.906 SUP Custom 27803010 304.906 - SPACER SPNL 11MM MED NAR PRLL 12X6MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.907 SUP Custom 27803010 304.907 - SPACER SPNL 11MM MED NAR PRLL 12X7MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.908 SUP Custom 27803010 304.908 - SPACER SPNL 11MM MED NAR PRLL 12X8MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.909 SUP Custom 27803010 304.909 - SPACER SPNL 11MM MED NAR PRLL 12X9MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.91 SUP Custom 27803010 304.910 - SPACER SPNL 11MM MED NAR PRLL 12X10MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.911 SUP Custom 27803010 304.911 - SPACER SPNL 11MM MED NAR PRLL 12X11MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.912 SUP Custom 27803010 304.912 - SPACER SPNL 11MM MED NAR PRLL 12X12MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.925 SUP Custom 27803010 304.925 - SPACER SPNL 11MM LRDTC MED NAR 12X5MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.926 SUP Custom 27803010 304.926 - SPACER SPNL 11MM LRDTC MED NAR 12X6MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.927 SUP Custom 27803010 304.927 - SPACER SPNL 11MM LRDTC MED NAR 12X7MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.928 SUP Custom 27803010 304.928 - SPACER SPNL 11MM LRDTC MED NAR 12X8MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.929 SUP Custom 27803010 304.929 - SPACER SPNL 11MM LRDTC MED NAR 12X9MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.93 SUP Custom 27803010 304.930 - SPACER SPNL 11MM LRDTC MED NAR 12X10MM NS LF SUST RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.931 SUP Custom 27803010 304.931 - SPACER SPNL 11MM LRDTC MED NAR 12X11MM NS LF SUST RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.932 SUP Custom 27803010 304.932 - SPACER SPNL 11MM LRDTC MED NAR 12X12MM NS LF SUST RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.945 SUP Custom 27803010 304.945 - SPACER SPNL 11MM MED CNVX NAR 12X5MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.946 SUP Custom 27803010 304.946 - SPACER SPNL 11MM MED CNVX NAR 12X6MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.947 SUP Custom 27803010 304.947 - SPACER SPNL 11MM MED CNVX NAR 12X7MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.948 SUP Custom 27803010 304.948 - SPACER SPNL 11MM MED CNVX NAR 12X8MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.949 SUP Custom 27803010 304.949 - SPACER SPNL 11MM MED CNVX NAR 12X9MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.95 SUP Custom 27803010 304.950 - SPACER SPNL 11MM MED CNVX NAR 12X10MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.951 SUP Custom 27803010 304.951 - SPACER SPNL 11MM MED CNVX NAR 12X11MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.952 SUP Custom 27803010 304.952 - SPACER SPNL 11MM MED CNVX NAR 12X12MM NS LF SUST RDLCNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 304.968 SUP Custom 27803010 304.968 - SPACER SPNL OBLQ 26X12X8MM NS LF SUST RDLCNT PEEK INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.969 SUP Custom 27803010 304.969 - SPACER SPNL OBLQ 26X12X9MM NS LF SUST RDLCNT PEEK INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.97 SUP Custom 27803010 304.970 - SPACER SPNL OBLQ 26X12X10MM NS LF SUST RDLCNT PEEK INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.971 SUP Custom 27803010 304.971 - SPACER SPNL OBLQ 26X12X11MM NS LF SUST RDLCNT PEEK INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.972 SUP Custom 27803010 304.972 - SPACER SPNL OBLQ 26X12X12MM NS LF SUST RDLCNT PEEK INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.973 SUP Custom 27803010 304.973 - SPACER SPNL OBLQ 26X12X13MM NS LF SUST RDLCNT PEEK INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.974 SUP Custom 27803010 304.974 - SPACER SPNL OBLQ 26X12X14MM NS LF SUST RDLCNT PEEK INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.975 SUP Custom 27803010 304.975 - SPACER SPNL OBLQ 26X12X15MM NS LF SUST RDLCNT PEEK INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 304.977 SUP Custom 27803010 304.977 - SPACER SPNL OBLQ 26X12X17MM NS LF SUST RDLCNT PEEK INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 308 SUP HCPCS C1879 308 - MARKER BREAST BIOP 10MM CHARM MARGINMAP STERILE BOTH IP/OP $37.50 $28.00 $6.68 $37.50 $37.50 $37.50 $37.50 $37.50 $37.50 $37.50 $6.68 $37.50 $37.50 $37.50 $37.50 $37.50 $37.50 $7.82 $37.50 $15.00 $37.50 $37.50 $37.50 $37.50 $37.50 $28.13 $37.50 $37.50 $37.50 $18.75 $18.75 $29.70 $37.50 $30.00 $16.88 $37.50 N/A $21.75 $37.50 $22.50 $37.50 $37.50 $37.50 N/A N/A 309.521 SUP HCPCS C1713 309.521 - SCREW BONE 3.5MM 21MM EXTRACTION FIBULA DISTAL NONSTRL BOTH IP/OP $125.50 $93.00 $24.83 $127.23 $56.30 $56.30 $56.30 $56.30 $125.10 $125.10 $125.10 $26.07 $125.10 $125.10 $125.10 $125.10 $125.10 $26.07 $125.10 $127.23 $74.00 $125.10 $127.23 $125.10 $125.10 $94.13 $125.10 $125.10 $125.10 $62.55 $62.55 $99.08 $125.10 $100.08 $56.30 $24.83 N/A $72.79 $125.10 $125.10 $125.10 $26.07 $125.10 N/A N/A 310.02 SUP Custom 27203010 310.02 - BIT DRL 3.2MM 225MM NS QC UNV NL SYS BOTH IP/OP $287.00 $212.00 $51.04 $291.63 $286.75 $286.75 $286.75 $286.75 $286.75 $286.75 $51.04 $286.75 $286.75 $212.83 $212.83 $221.03 $149.40 $59.76 $286.75 $116.65 $286.75 $286.75 $291.63 $286.75 $286.75 $215.25 $286.75 $286.75 $286.75 $143.38 $143.38 $227.11 $286.75 $229.40 $186.39 $286.75 N/A $166.46 $286.75 $172.05 $286.75 $286.75 $286.75 N/A N/A 310.1 SUP Custom 27203010 310.10 - BIT DRILL 1.1MM 45MM JACOBS CHUCK NONSTRL MINI FRAGMENT BOTH IP/OP $124.50 $92.00 $22.11 $130.10 $124.20 $124.20 $124.20 $124.20 $124.20 $124.20 $22.11 $124.20 $124.20 $92.18 $92.18 $95.73 $64.71 $25.88 $124.20 $52.04 $124.20 $124.20 $130.10 $124.20 $124.20 $93.38 $124.20 $124.20 $124.20 $62.10 $62.10 $98.37 $124.20 $99.36 $80.73 $124.20 N/A $72.21 $124.20 $74.52 $124.20 $124.20 $124.20 N/A N/A 310.11 SUP Custom 27203010 310.11 - BIT DRL 1.1MM 60MM NS QC MN FRAG SYS BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $100.66 $100.66 $104.54 $70.66 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $88.16 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 310.111 SUP Custom 27203010 310.111 - BIT DRL 1.1MM 55MM NS MNQK CPLNG 1.5/2MM ROT CRRT PLT BOTH IP/OP $139.50 $103.00 $24.77 $141.55 $139.18 $139.18 $139.18 $139.18 $139.18 $139.18 $24.77 $139.18 $139.18 $103.30 $103.30 $107.28 $72.51 $29.01 $139.18 $56.62 $139.18 $139.18 $141.55 $139.18 $139.18 $104.63 $139.18 $139.18 $139.18 $69.59 $69.59 $110.23 $139.18 $111.34 $90.47 $139.18 N/A $80.91 $139.18 $83.51 $139.18 $139.18 $139.18 N/A N/A 310.113 SUP Custom 27203010 310.113 - BIT DRL 1.1MM 65MM NS JLTCH CPLNG CPLNG STRYK BOTH IP/OP $139.50 $103.00 $24.77 $141.55 $139.18 $139.18 $139.18 $139.18 $139.18 $139.18 $24.77 $139.18 $139.18 $103.30 $103.30 $107.28 $72.51 $29.01 $139.18 $56.62 $139.18 $139.18 $141.55 $139.18 $139.18 $104.63 $139.18 $139.18 $139.18 $69.59 $69.59 $110.23 $139.18 $111.34 $90.47 $139.18 N/A $80.91 $139.18 $83.51 $139.18 $139.18 $139.18 N/A N/A 310.133 SUP Custom 27203010 310.133 - BIT DRILL 3MM STOP 1.3MM 44.5MM 3MM J LATCH COUPLING SELF BOTH IP/OP $326.50 $242.00 $58.07 $326.25 $326.25 $326.25 $326.25 $326.25 $326.25 $326.25 $58.07 $326.25 $326.25 $242.14 $242.14 $251.47 $169.98 $67.99 $326.25 $130.50 $326.25 $326.25 $326.25 $326.25 $326.25 $244.88 $326.25 $326.25 $326.25 $163.13 $163.13 $258.39 $326.25 $261.00 $212.06 $326.25 N/A $189.37 $326.25 $195.75 $326.25 $326.25 $326.25 N/A N/A 310.134 SUP Custom 27203010 310.134 - BIT DRILL 3MM STOP 1.3MM 52MM 3MM J LATCH HEXAGONAL COUPLING BOTH IP/OP $326.50 $242.00 $58.07 $326.25 $326.25 $326.25 $326.25 $326.25 $326.25 $326.25 $58.07 $326.25 $326.25 $242.14 $242.14 $251.47 $169.98 $67.99 $326.25 $130.50 $326.25 $326.25 $326.25 $326.25 $326.25 $244.88 $326.25 $326.25 $326.25 $163.13 $163.13 $258.39 $326.25 $261.00 $212.06 $326.25 N/A $189.37 $326.25 $195.75 $326.25 $326.25 $326.25 N/A N/A 310.136 SUP Custom 27203010 310.136 - BIT DRL 4MM 1.3MM 45MM NS JLTCH CPLNG CPLNG SLF STP STRYK BOTH IP/OP $326.50 $242.00 $58.07 $326.25 $326.25 $326.25 $326.25 $326.25 $326.25 $326.25 $58.07 $326.25 $326.25 $242.14 $242.14 $251.47 $169.98 $67.99 $326.25 $130.50 $326.25 $326.25 $326.25 $326.25 $326.25 $244.88 $326.25 $326.25 $326.25 $163.13 $163.13 $258.39 $326.25 $261.00 $212.06 $326.25 N/A $189.37 $326.25 $195.75 $326.25 $326.25 $326.25 N/A N/A 310.137 SUP Custom 27203010 310.137 - BIT DRILL 6MM STOP 1.3MM 45MM 6MM J LATCH COUPLING SELF STOP BOTH IP/OP $326.50 $242.00 $58.07 $326.25 $326.25 $326.25 $326.25 $326.25 $326.25 $326.25 $58.07 $326.25 $326.25 $242.14 $242.14 $251.47 $169.98 $67.99 $326.25 $130.50 $326.25 $326.25 $326.25 $326.25 $326.25 $244.88 $326.25 $326.25 $326.25 $163.13 $163.13 $258.39 $326.25 $261.00 $212.06 $326.25 N/A $189.37 $326.25 $195.75 $326.25 $326.25 $326.25 N/A N/A 310.138 SUP Custom 27203010 310.138 - BIT DRILL 1.3MM 52MM 4MM J LATCH HEXAGONAL COUPLING SELF BOTH IP/OP $326.50 $242.00 $58.07 $326.25 $326.25 $326.25 $326.25 $326.25 $326.25 $326.25 $58.07 $326.25 $326.25 $242.14 $242.14 $251.47 $169.98 $67.99 $326.25 $130.50 $326.25 $326.25 $326.25 $326.25 $326.25 $244.88 $326.25 $326.25 $326.25 $163.13 $163.13 $258.39 $326.25 $261.00 $212.06 $326.25 N/A $189.37 $326.25 $195.75 $326.25 $326.25 $326.25 N/A N/A 310.139 SUP Custom 27203010 310.139 - BIT DRILL 6MM STOP 1.3MM 52MM 6MM J LATCH HEXAGONAL COUPLING BOTH IP/OP $326.50 $242.00 $58.07 $326.25 $326.25 $326.25 $326.25 $326.25 $326.25 $326.25 $58.07 $326.25 $326.25 $242.14 $242.14 $251.47 $169.98 $67.99 $326.25 $130.50 $326.25 $326.25 $326.25 $326.25 $326.25 $244.88 $326.25 $326.25 $326.25 $163.13 $163.13 $258.39 $326.25 $261.00 $212.06 $326.25 N/A $189.37 $326.25 $195.75 $326.25 $326.25 $326.25 N/A N/A 310.14 SUP Custom 27203010 310.14 - BIT DRL 1.5MM 70MM NS JCHK MN FRAG SYS BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $100.66 $100.66 $104.54 $70.66 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $88.16 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 310.141 SUP Custom 27203010 310.141 - BIT DRL 1.5MM 65MM NS MNQK CPLNG 1.5/2MM ROT CRRT PLT BOTH IP/OP $139.50 $103.00 $24.77 $141.55 $139.18 $139.18 $139.18 $139.18 $139.18 $139.18 $24.77 $139.18 $139.18 $103.30 $103.30 $107.28 $72.51 $29.01 $139.18 $56.62 $139.18 $139.18 $141.55 $139.18 $139.18 $104.63 $139.18 $139.18 $139.18 $69.59 $69.59 $110.23 $139.18 $111.34 $90.47 $139.18 N/A $80.91 $139.18 $83.51 $139.18 $139.18 $139.18 N/A N/A 310.143 SUP Custom 27203010 310.143 - BIT DRL 1.5MM 75MM NS JLTCH CPLNG CPLNG STRYK BOTH IP/OP $139.50 $103.00 $24.77 $141.55 $139.18 $139.18 $139.18 $139.18 $139.18 $139.18 $24.77 $139.18 $139.18 $103.30 $103.30 $107.28 $72.51 $29.01 $139.18 $56.62 $139.18 $139.18 $141.55 $139.18 $139.18 $104.63 $139.18 $139.18 $139.18 $69.59 $69.59 $110.23 $139.18 $111.34 $90.47 $139.18 N/A $80.91 $139.18 $83.51 $139.18 $139.18 $139.18 N/A N/A 310.15 SUP Custom 27203010 310.15 - BIT DRL 1.5MM 85MM NS QC BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $100.66 $100.66 $104.54 $70.66 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $88.16 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 310.153 SUP Custom 27203010 310.153 - BIT DRILL 1.5MM 75MM J LATCH COUPLING W/O SELF STOP NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.16 SUP Custom 27203010 310.16 - BIT DRILL 1.5MM 110MM QUICK COUPLING STAINLESS STEEL NONSTRL BOTH IP/OP $136.00 $101.00 $78.88 $102.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $92.34 N/A N/A N/A N/A N/A $102.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $78.88 N/A N/A N/A N/A N/A N/A N/A 310.161 SUP Custom 27203010 310.161 - BIT DRILL 1.5MM 110MM J LATCH DEPTH MARK NONSTRL BOTH IP/OP $280.00 $207.00 $49.79 $284.48 $279.73 $279.73 $279.73 $279.73 $279.73 $279.73 $49.79 $279.73 $279.73 $207.62 $207.62 $215.62 $145.74 $58.30 $279.73 $113.79 $279.73 $279.73 $284.48 $279.73 $279.73 $210.00 $279.73 $279.73 $279.73 $139.87 $139.87 $221.55 $279.73 $223.78 $181.82 $279.73 N/A $162.40 $279.73 $167.84 $279.73 $279.73 $279.73 N/A N/A 310.162 SUP Custom 27203010 310.162 - BIT DRILL 1.8MM 110MM J LATCH DEPTH MARK NONSTRL BOTH IP/OP $280.00 $207.00 $49.79 $284.48 $279.73 $279.73 $279.73 $279.73 $279.73 $279.73 $49.79 $279.73 $279.73 $207.62 $207.62 $215.62 $145.74 $58.30 $279.73 $113.79 $279.73 $279.73 $284.48 $279.73 $279.73 $210.00 $279.73 $279.73 $279.73 $139.87 $139.87 $221.55 $279.73 $223.78 $181.82 $279.73 N/A $162.40 $279.73 $167.84 $279.73 $279.73 $279.73 N/A N/A 310.17 SUP Custom 27203010 310.170 - BIT DRILL 8MM STOP 1.5MM 125MM 8MM J LATCH QUICK COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.171 SUP Custom 27203010 310.171 - BIT DRILL 8MM STOP UNIVERSAL 1.5MM 125MM 8MM UNIVERSAL HALL BOTH IP/OP $342.00 $253.00 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 310.172 SUP Custom 27203010 310.172 - BIT DRILL 8MM STOP 1.5MM 125MM 8MM J LATCH COUPLING SELF BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.173 SUP Custom 27203010 310.173 - BIT DRILL 8MM STOP MINI 1.5MM 125MM 8MM MINI QUICK COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.177 SUP Custom 27203010 310.177 - BIT DRILL 4MM STOP 1.5MM 45MM 4MM J LATCH STOP NONSTRL BOTH IP/OP $346.50 $256.00 $61.68 $346.50 $346.50 $346.50 $346.50 $346.50 $346.50 $346.50 $61.68 $346.50 $346.50 $257.17 $257.17 $267.08 $180.53 $72.21 $346.50 $138.60 $346.50 $346.50 $346.50 $346.50 $346.50 $259.88 $346.50 $346.50 $346.50 $173.25 $173.25 $274.43 $346.50 $277.20 $225.23 $346.50 N/A $200.97 $346.50 $207.90 $346.50 $346.50 $346.50 N/A N/A 310.182 SUP Custom 27203010 310.182 - BIT DRILL 4MM STOP 1.5MM 52MM 4MM HEXAGONAL COUPLING STOP BOTH IP/OP $346.50 $256.00 $61.68 $346.50 $346.50 $346.50 $346.50 $346.50 $346.50 $346.50 $61.68 $346.50 $346.50 $257.17 $257.17 $267.08 $180.53 $72.21 $346.50 $138.60 $346.50 $346.50 $346.50 $346.50 $346.50 $259.88 $346.50 $346.50 $346.50 $173.25 $173.25 $274.43 $346.50 $277.20 $225.23 $346.50 N/A $200.97 $346.50 $207.90 $346.50 $346.50 $346.50 N/A N/A 310.19 SUP Custom 27203010 310.19 - BIT DRL 2MM 100MM NS QC BOTH IP/OP $143.50 $106.00 $25.52 $145.80 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $25.52 $143.38 $143.38 $106.42 $106.42 $110.52 $74.70 $29.88 $143.38 $58.32 $143.38 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $93.20 $143.38 N/A $83.23 $143.38 $86.03 $143.38 $143.38 $143.38 N/A N/A 310.2 SUP Custom 27203010 310.20 - BIT DRILL STANDARD 2MM 85MM SET BASIC ARTICULATE TENSION BOTH IP/OP $132.00 $98.00 $23.44 $137.93 $131.68 $131.68 $131.68 $131.68 $131.68 $131.68 $23.44 $131.68 $131.68 $97.73 $97.73 $101.50 $68.61 $27.44 $131.68 $55.17 $131.68 $131.68 $137.93 $131.68 $131.68 $99.00 $131.68 $131.68 $131.68 $65.84 $65.84 $104.29 $131.68 $105.34 $85.59 $131.68 N/A $76.56 $131.68 $79.01 $131.68 $131.68 $131.68 N/A N/A 310.201 SUP Custom 27203010 310.201 - BIT DRL 2MM 65MM NS MNQK CPLNG BOTH IP/OP $139.50 $103.00 $24.77 $141.55 $139.18 $139.18 $139.18 $139.18 $139.18 $139.18 $24.77 $139.18 $139.18 $103.30 $103.30 $107.28 $72.51 $29.01 $139.18 $56.62 $139.18 $139.18 $141.55 $139.18 $139.18 $104.63 $139.18 $139.18 $139.18 $69.59 $69.59 $110.23 $139.18 $111.34 $90.47 $139.18 N/A $80.91 $139.18 $83.51 $139.18 $139.18 $139.18 N/A N/A 310.203 SUP Custom 27203010 310.203 - BIT DRL 2MM 75MM NS JLTCH CPLNG STRYK BOTH IP/OP $139.50 $103.00 $24.77 $141.55 $139.18 $139.18 $139.18 $139.18 $139.18 $139.18 $24.77 $139.18 $139.18 $103.30 $103.30 $107.28 $72.51 $29.01 $139.18 $56.62 $139.18 $139.18 $141.55 $139.18 $139.18 $104.63 $139.18 $139.18 $139.18 $69.59 $69.59 $110.23 $139.18 $111.34 $90.47 $139.18 N/A $80.91 $139.18 $83.51 $139.18 $139.18 $139.18 N/A N/A 310.21 SUP Custom 27203010 310.21 - BIT DRL 2MM 125MM NS QC BOTH IP/OP $152.00 $112.00 $27.03 $154.40 $151.83 $151.83 $151.83 $151.83 $151.83 $151.83 $27.03 $151.83 $151.83 $112.69 $112.69 $117.03 $79.10 $31.64 $151.83 $61.76 $151.83 $151.83 $154.40 $151.83 $151.83 $114.00 $151.83 $151.83 $151.83 $75.92 $75.92 $120.25 $151.83 $121.46 $98.69 $151.83 N/A $88.16 $151.83 $91.10 $151.83 $151.83 $151.83 N/A N/A 310.215 SUP Custom 27203010 310.215 - BIT DRILL 1.7MM .9MM 100MM 2.4MM QUICK COUPLING CANN NONSTRL BOTH IP/OP $850.50 $629.00 $151.38 $864.90 $850.45 $850.45 $850.45 $850.45 $850.45 $850.45 $151.38 $850.45 $850.45 $631.20 $631.20 $655.53 $443.08 $177.24 $850.45 $345.96 $850.45 $850.45 $864.90 $850.45 $850.45 $637.88 $850.45 $850.45 $850.45 $425.23 $425.23 $673.56 $850.45 $680.36 $552.79 $850.45 N/A $493.29 $850.45 $510.27 $850.45 $850.45 $850.45 N/A N/A 310.221 SUP Custom 27203010 310.221 - BIT DRL 2MM 150MM NS CNN QC BOTH IP/OP $789.00 $584.00 $140.37 $802.00 $788.60 $788.60 $788.60 $788.60 $788.60 $788.60 $140.37 $788.60 $788.60 $585.30 $585.30 $607.85 $410.86 $164.35 $788.60 $320.80 $788.60 $788.60 $802.00 $788.60 $788.60 $591.75 $788.60 $788.60 $788.60 $394.30 $394.30 $624.57 $788.60 $630.88 $512.59 $788.60 N/A $457.62 $788.60 $473.16 $788.60 $788.60 $788.60 N/A N/A 310.229 SUP Custom 27203010 310.229 - BIT DRL 2.9MM 150MM NS QC 4MM CORT SCR BOTH IP/OP $169.00 $125.00 $30.03 $171.55 $168.68 $168.68 $168.68 $168.68 $168.68 $168.68 $30.03 $168.68 $168.68 $125.19 $125.19 $130.02 $87.88 $35.15 $168.68 $68.62 $168.68 $168.68 $171.55 $168.68 $168.68 $126.75 $168.68 $168.68 $168.68 $84.34 $84.34 $133.59 $168.68 $134.94 $109.64 $168.68 N/A $98.02 $168.68 $101.21 $168.68 $168.68 $168.68 N/A N/A 310.23 SUP Custom 27203010 310.23 - BIT DRILL 2.5MM 180MM QUICK COUPLING GOLD STAINLESS STEEL BOTH IP/OP $152.00 $112.00 $27.03 $154.40 $151.83 $151.83 $151.83 $151.83 $151.83 $151.83 $27.03 $151.83 $151.83 $112.69 $112.69 $117.03 $79.10 $31.64 $151.83 $61.76 $151.83 $151.83 $154.40 $151.83 $151.83 $114.00 $151.83 $151.83 $151.83 $75.92 $75.92 $120.25 $151.83 $121.46 $98.69 $151.83 N/A $88.16 $151.83 $91.10 $151.83 $151.83 $151.83 N/A N/A 310.24 SUP Custom 27203010 310.24 - BIT DRILL 2.5MM 95MM JACOBS CHUCK GOLD STAINLESS STEEL BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $100.66 $100.66 $104.54 $70.66 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $88.16 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 310.243 SUP Custom 27203010 310.243 - GUIDEWIRE ORTHOPEDIC 2.5MM 200MM DRILL TIP LCP STAINLESS BOTH IP/OP $122.00 $90.00 $21.64 $123.65 $121.58 $121.58 $121.58 $121.58 $121.58 $121.58 $21.64 $121.58 $121.58 $90.24 $90.24 $93.71 $63.34 $25.34 $121.58 $49.46 $121.58 $121.58 $123.65 $121.58 $121.58 $91.50 $121.58 $121.58 $121.58 $60.79 $60.79 $96.29 $121.58 $97.26 $79.03 $121.58 N/A $70.76 $121.58 $72.95 $121.58 $121.58 $121.58 N/A N/A 310.25 SUP Custom 27203010 310.25 - BIT DRL 2.5MM 110MM AU NS QC BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $100.66 $100.66 $104.54 $70.66 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $88.16 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 310.26 SUP Custom 27203010 310.26 - BIT DRL 2.7MM 100MM NS QC BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $100.66 $100.66 $104.54 $70.66 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $88.16 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 310.27 SUP Custom 27203010 310.27 - BIT DRL 2.7MM 85MM NS JCHK BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $100.66 $100.66 $104.54 $70.66 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $88.16 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 310.28 SUP Custom 27203010 310.28 - BIT DRL 2.7MM 125MM NS QC BOTH IP/OP $152.00 $112.00 $27.03 $154.40 $151.83 $151.83 $151.83 $151.83 $151.83 $151.83 $27.03 $151.83 $151.83 $112.69 $112.69 $117.03 $79.10 $31.64 $151.83 $61.76 $151.83 $151.83 $154.40 $151.83 $151.83 $114.00 $151.83 $151.83 $151.83 $75.92 $75.92 $120.25 $151.83 $121.46 $98.69 $151.83 N/A $88.16 $151.83 $91.10 $151.83 $151.83 $151.83 N/A N/A 310.284 SUP Custom 27203010 310.284 - BIT DRILL 2.8MM 165MM 2 FLUTE QUICK COUPLING LCP NONSTRL BOTH IP/OP $169.00 $125.00 $30.03 $171.55 $168.68 $168.68 $168.68 $168.68 $168.68 $168.68 $30.03 $168.68 $168.68 $125.19 $125.19 $130.02 $87.88 $35.15 $168.68 $68.62 $168.68 $168.68 $171.55 $168.68 $168.68 $126.75 $168.68 $168.68 $168.68 $84.34 $84.34 $133.59 $168.68 $134.94 $109.64 $168.68 N/A $98.02 $168.68 $101.21 $168.68 $168.68 $168.68 N/A N/A 310.288 SUP Custom 27203010 310.288 - BIT DRL 2.8MM 165MM NS QC BOTH IP/OP $169.00 $125.00 $30.03 $171.55 $168.68 $168.68 $168.68 $168.68 $168.68 $168.68 $30.03 $168.68 $168.68 $125.19 $125.19 $130.02 $87.88 $35.15 $168.68 $68.62 $168.68 $168.68 $171.55 $168.68 $168.68 $126.75 $168.68 $168.68 $168.68 $84.34 $84.34 $133.59 $168.68 $134.94 $109.64 $168.68 N/A $98.02 $168.68 $101.21 $168.68 $168.68 $168.68 N/A N/A 310.29 SUP Custom 27203010 310.29 - BIT DRILL 3.2MM 195MM QUICK COUPLING STAINLESS STEEL NONSTRL BOTH IP/OP $222.50 $165.00 $39.53 $225.88 $222.10 $222.10 $222.10 $222.10 $222.10 $222.10 $39.53 $222.10 $222.10 $164.84 $164.84 $171.19 $115.71 $46.29 $222.10 $90.35 $222.10 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $144.37 $222.10 N/A $129.05 $222.10 $133.26 $222.10 $222.10 $222.10 N/A N/A 310.3 SUP Custom 27203010 310.30 - BIT DRL 3.2MM 180MM NS JCHK BOTH IP/OP $165.50 $122.00 $29.39 $173.00 $165.13 $165.13 $165.13 $165.13 $165.13 $165.13 $29.39 $165.13 $165.13 $122.56 $122.56 $127.28 $86.03 $34.41 $165.13 $69.20 $165.13 $165.13 $173.00 $165.13 $165.13 $124.13 $165.13 $165.13 $165.13 $82.57 $82.57 $130.78 $165.13 $132.10 $107.33 $165.13 N/A $95.99 $165.13 $99.08 $165.13 $165.13 $165.13 N/A N/A 310.31 SUP Custom 27203010 310.31 - BIT DRL 3.2MM 145MM NS QC BOTH IP/OP $134.00 $99.00 $23.77 $135.83 $133.55 $133.55 $133.55 $133.55 $133.55 $133.55 $23.77 $133.55 $133.55 $99.12 $99.12 $102.94 $69.58 $27.83 $133.55 $54.33 $133.55 $133.55 $135.83 $133.55 $133.55 $100.50 $133.55 $133.55 $133.55 $66.78 $66.78 $105.77 $133.55 $106.84 $86.81 $133.55 N/A $77.72 $133.55 $80.13 $133.55 $133.55 $133.55 N/A N/A 310.32 SUP Custom 27203010 310.32 - BIT DRL 3.2MM 130MM NS JCHK BOTH IP/OP $131.50 $97.00 $23.39 $133.65 $131.43 $131.43 $131.43 $131.43 $131.43 $131.43 $23.39 $131.43 $131.43 $97.55 $97.55 $101.31 $68.48 $27.39 $131.43 $53.46 $131.43 $131.43 $133.65 $131.43 $131.43 $98.63 $131.43 $131.43 $131.43 $65.72 $65.72 $104.09 $131.43 $105.14 $85.43 $131.43 N/A $76.27 $131.43 $78.86 $131.43 $131.43 $131.43 N/A N/A 310.35 SUP Custom 27203010 310.35 - BIT DRL 3.5MM 110MM NS QC BOTH IP/OP $143.50 $106.00 $25.52 $145.80 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $25.52 $143.38 $143.38 $106.42 $106.42 $110.52 $74.70 $29.88 $143.38 $58.32 $143.38 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $93.20 $143.38 N/A $83.23 $143.38 $86.03 $143.38 $143.38 $143.38 N/A N/A 310.36 SUP Custom 27203010 310.36 - BIT DRL 3.5MM 95MM NS JCHK BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $100.66 $100.66 $104.54 $70.66 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $88.16 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 310.37 SUP Custom 27203010 310.37 - BIT DRL 3.5MM 195MM NS QC BOTH IP/OP $152.00 $112.00 $27.03 $154.40 $151.83 $151.83 $151.83 $151.83 $151.83 $151.83 $27.03 $151.83 $151.83 $112.69 $112.69 $117.03 $79.10 $31.64 $151.83 $61.76 $151.83 $151.83 $154.40 $151.83 $151.83 $114.00 $151.83 $151.83 $151.83 $75.92 $75.92 $120.25 $151.83 $121.46 $98.69 $151.83 N/A $88.16 $151.83 $91.10 $151.83 $151.83 $151.83 N/A N/A 310.38 SUP Custom 27203010 310.38 - BIT DRL 3.5MM 180MM NS JCHK BOTH IP/OP $152.00 $112.00 $27.03 $154.40 $151.83 $151.83 $151.83 $151.83 $151.83 $151.83 $27.03 $151.83 $151.83 $112.69 $112.69 $117.03 $79.10 $31.64 $151.83 $61.76 $151.83 $151.83 $154.40 $151.83 $151.83 $114.00 $151.83 $151.83 $151.83 $75.92 $75.92 $120.25 $151.83 $121.46 $98.69 $151.83 N/A $88.16 $151.83 $91.10 $151.83 $151.83 $151.83 N/A N/A 310.4 SUP Custom 27203010 310.40 - BIT DRILL 4MM 197MM QUICK COUPLING NONSTRL BOTH IP/OP $158.50 $117.00 $28.18 $158.30 $158.30 $158.30 $158.30 $158.30 $158.30 $158.30 $28.18 $158.30 $158.30 $117.49 $117.49 $122.02 $82.47 $32.99 $158.30 $63.32 $158.30 $158.30 $158.30 $158.30 $158.30 $118.88 $158.30 $158.30 $158.30 $79.15 $79.15 $125.37 $158.30 $126.64 $102.90 $158.30 N/A $91.93 $158.30 $94.98 $158.30 $158.30 $158.30 N/A N/A 310.401 SUP Custom 27203010 310.401 - BIT DRL 4MM 160MM NS QC BOTH IP/OP $160.50 $119.00 $28.52 $162.98 $160.25 $160.25 $160.25 $160.25 $160.25 $160.25 $28.52 $160.25 $160.25 $118.94 $118.94 $123.52 $83.49 $33.40 $160.25 $65.19 $160.25 $160.25 $162.98 $160.25 $160.25 $120.38 $160.25 $160.25 $160.25 $80.13 $80.13 $126.92 $160.25 $128.20 $104.16 $160.25 N/A $93.09 $160.25 $96.15 $160.25 $160.25 $160.25 N/A N/A 310.423 SUP Custom 27203010 310.423 - BIT DRL 4.3MM 280MM NS QC BOTH IP/OP $708.50 $524.00 $126.11 $720.53 $708.48 $708.48 $708.48 $708.48 $708.48 $708.48 $126.11 $708.48 $708.48 $525.83 $525.83 $546.10 $369.12 $147.66 $708.48 $288.21 $708.48 $708.48 $720.53 $708.48 $708.48 $531.38 $708.48 $708.48 $708.48 $354.24 $354.24 $561.12 $708.48 $566.78 $460.51 $708.48 N/A $410.93 $708.48 $425.09 $708.48 $708.48 $708.48 N/A N/A 310.43 SUP Custom 27203010 310.430 - BIT DRILL 4.3MM 221MM QUICK COUPLING CANN NONSTRL BOTH IP/OP $400.00 $296.00 $71.18 $418.88 $399.88 $399.88 $399.88 $399.88 $399.88 $399.88 $71.18 $399.88 $399.88 $296.79 $296.79 $308.23 $208.34 $83.34 $399.88 $167.55 $399.88 $399.88 $418.88 $399.88 $399.88 $300.00 $399.88 $399.88 $399.88 $199.94 $199.94 $316.70 $399.88 $319.90 $259.92 $399.88 N/A $232.00 $399.88 $239.93 $399.88 $399.88 $399.88 N/A N/A 310.431 SUP Custom 27203010 310.431 - DRILL 4.3MM BIT QC 180MM BOTH IP/OP $59.50 $44.00 $34.51 $93.78 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $93.78 N/A N/A N/A N/A N/A $44.63 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $34.51 N/A N/A N/A N/A N/A N/A N/A 310.44 SUP Custom 27203010 310.44 - BIT DRL 4.5MM 145MM NS QC BOTH IP/OP $134.00 $99.00 $23.77 $135.83 $133.55 $133.55 $133.55 $133.55 $133.55 $133.55 $23.77 $133.55 $133.55 $99.12 $99.12 $102.94 $69.58 $27.83 $133.55 $54.33 $133.55 $133.55 $135.83 $133.55 $133.55 $100.50 $133.55 $133.55 $133.55 $66.78 $66.78 $105.77 $133.55 $106.84 $86.81 $133.55 N/A $77.72 $133.55 $80.13 $133.55 $133.55 $133.55 N/A N/A 310.45 SUP Custom 27203010 310.45 - BIT DRILL 4.5MM 130MM JACOBS CHUCK COUPLING STAINLESS STEEL BOTH IP/OP $131.50 $97.00 $23.39 $133.65 $131.43 $131.43 $131.43 $131.43 $131.43 $131.43 $23.39 $131.43 $131.43 $97.55 $97.55 $101.31 $68.48 $27.39 $131.43 $53.46 $131.43 $131.43 $133.65 $131.43 $131.43 $98.63 $131.43 $131.43 $131.43 $65.72 $65.72 $104.09 $131.43 $105.14 $85.43 $131.43 N/A $76.27 $131.43 $78.86 $131.43 $131.43 $131.43 N/A N/A 310.48 SUP Custom 27203010 310.48 - BIT DRILL 4.5MM 195MM QUICK COUPLING STAINLESS STEEL NONSTRL BOTH IP/OP $222.50 $165.00 $39.53 $225.88 $222.10 $222.10 $222.10 $222.10 $222.10 $222.10 $39.53 $222.10 $222.10 $164.84 $164.84 $171.19 $115.71 $46.29 $222.10 $90.35 $222.10 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $144.37 $222.10 N/A $129.05 $222.10 $133.26 $222.10 $222.10 $222.10 N/A N/A 310.49 SUP Custom 27203010 310.49 - BIT DRILL 4.5MM 180MM JACOBS CHUCK STAINLESS STEEL NONSTRL BOTH IP/OP $170.50 $126.00 $30.28 $173.00 $170.10 $170.10 $170.10 $170.10 $170.10 $170.10 $30.28 $170.10 $170.10 $126.25 $126.25 $131.11 $88.62 $35.45 $170.10 $69.20 $170.10 $170.10 $173.00 $170.10 $170.10 $127.88 $170.10 $170.10 $170.10 $85.05 $85.05 $134.72 $170.10 $136.08 $110.57 $170.10 N/A $98.89 $170.10 $102.06 $170.10 $170.10 $170.10 N/A N/A 310.495 SUP Custom 27203010 310.495 - BIT DRL 7.3MM 2.9MM 300MM NS CNN LG QC BOTH IP/OP $835.00 $618.00 $148.63 $849.18 $834.98 $834.98 $834.98 $834.98 $834.98 $834.98 $148.63 $834.98 $834.98 $619.72 $619.72 $643.60 $435.02 $174.02 $834.98 $339.67 $834.98 $834.98 $849.18 $834.98 $834.98 $626.25 $834.98 $834.98 $834.98 $417.49 $417.49 $661.30 $834.98 $667.98 $542.74 $834.98 N/A $484.30 $834.98 $500.99 $834.98 $834.98 $834.98 N/A N/A 310.507 SUP Custom 27203010 310.507 - BIT DRL 1.5MM 96MM NS MNQK CPLNG D MRK BOTH IP/OP $280.00 $207.00 $49.79 $284.48 $279.73 $279.73 $279.73 $279.73 $279.73 $279.73 $49.79 $279.73 $279.73 $207.62 $207.62 $215.62 $145.74 $58.30 $279.73 $113.79 $279.73 $279.73 $284.48 $279.73 $279.73 $210.00 $279.73 $279.73 $279.73 $139.87 $139.87 $221.55 $279.73 $223.78 $181.82 $279.73 N/A $162.40 $279.73 $167.84 $279.73 $279.73 $279.73 N/A N/A 310.509 SUP Custom 27203010 310.509 - BIT DRL 1.8MM 110MM NS QC D MRK BOTH IP/OP $280.00 $207.00 $49.79 $284.48 $279.73 $279.73 $279.73 $279.73 $279.73 $279.73 $49.79 $279.73 $279.73 $207.62 $207.62 $215.62 $145.74 $58.30 $279.73 $113.79 $279.73 $279.73 $284.48 $279.73 $279.73 $210.00 $279.73 $279.73 $279.73 $139.87 $139.87 $221.55 $279.73 $223.78 $181.82 $279.73 N/A $162.40 $279.73 $167.84 $279.73 $279.73 $279.73 N/A N/A 310.51 SUP Custom 27203010 310.510 - BIT DRL 1.8MM 100MM NS QC D MRK BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.511 SUP Custom 27203010 310.511 - BIT DRILL UNIVERSAL 1.8MM 100MM 64MM HALL COUPLING NONSTRL BOTH IP/OP $342.00 $253.00 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 310.512 SUP Custom 27203010 310.512 - BIT DRL 1.8MM 100MM NS JLTCH CPLNG STRYK BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.513 SUP Custom 27203010 310.513 - BIT DRILL MINI 1.8MM 100MM MINI QUICK COUPLING MANDIB BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.52 SUP Custom 27203010 310.520 - BIT DRL 1.8MM 125MM NS QC BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.521 SUP Custom 27203010 310.521 - BIT DRILL UNIVERSAL 1.8MM 125MM 100MM 2 FLUTE UNIVERSAL HALL BOTH IP/OP $342.00 $253.00 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 310.522 SUP Custom 27203010 310.522 - BIT DRL 1.8MM 125MM NS JLTCH CPLNG STRYK BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.523 SUP Custom 27203010 310.523 - BIT DRILL MINI 1.8MM 125MM MINI QUICK COUPLING NONSTRL 2.4MM BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.53 SUP Custom 27203010 310.530 - BIT DRL 2.4MM 100MM NS QC D MRK BOTH IP/OP $371.50 $275.00 $66.08 $652.50 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $261.00 $371.25 $371.25 $652.50 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.531 SUP Custom 27203010 310.531 - BIT DRILL UNIVERSAL 2.4MM 100MM 64MM 2 FLUTE UNIVERSAL HALL BOTH IP/OP $342.00 $253.00 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 310.532 SUP Custom 27203010 310.532 - BIT DRL 2.4MM 100MM NS JLTCH CPLNG STRYK BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.533 SUP Custom 27203010 310.533 - BIT DRILL MINI 2.4MM 100MM MINI QUICK COUPLING NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.534 SUP Custom 27203010 310.534 - BIT DRL 2MM 110MM NS 85MM LCP 2 FLUT D MRK QC BOTH IP/OP $194.00 $144.00 $34.53 $197.28 $193.98 $193.98 $193.98 $193.98 $193.98 $193.98 $34.53 $193.98 $193.98 $143.97 $143.97 $149.52 $101.06 $40.43 $193.98 $78.91 $193.98 $193.98 $197.28 $193.98 $193.98 $145.50 $193.98 $193.98 $193.98 $96.99 $96.99 $153.63 $193.98 $155.18 $126.09 $193.98 N/A $112.52 $193.98 $116.39 $193.98 $193.98 $193.98 N/A N/A 310.54 SUP Custom 27203010 310.540 - BIT DRL 2.4MM 125MM NS QC BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.541 SUP Custom 27203010 310.541 - BIT DRILL UNIVERSAL 2.4MM 125MM 100MM 2 FLUTE UNIVERSAL HALL BOTH IP/OP $342.00 $253.00 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 310.542 SUP Custom 27203010 310.542 - BIT DRILL 2.4MM 125MM J LATCH NONSTRL STRYKER BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.543 SUP Custom 27203010 310.543 - BIT DRILL MINI 1.8MM 125MM MINI QUICK COUPLING NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.562 SUP Custom 27203010 310.562 - BIT DRILL 1.8MM 75MM J LATCH NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.572 SUP Custom 27203010 310.572 - BIT DRL 2.4MM 75MM NS JLTCH CPLNG STRYK BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.582 SUP Custom 27203010 310.582 - BIT DRILL 1.5MM 50MM J LATCH STAINLESS STEEL NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.592 SUP Custom 27203010 310.592 - BIT DRILL 1.8MM 50MM J LATCH NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 310.6 SUP Custom 27203010 310.60 - BIT DRILL 6MM 195MM QUICK COUPLING NONSTRL BOTH IP/OP $303.00 $224.00 $53.93 $317.38 $302.98 $302.98 $302.98 $302.98 $302.98 $302.98 $53.93 $302.98 $302.98 $224.87 $224.87 $233.54 $157.85 $63.14 $302.98 $126.95 $302.98 $302.98 $317.38 $302.98 $302.98 $227.25 $302.98 $302.98 $302.98 $151.49 $151.49 $239.96 $302.98 $242.38 $196.94 $302.98 N/A $175.74 $302.98 $181.79 $302.98 $302.98 $302.98 N/A N/A 310.63 SUP Custom 27203010 310.63 - BIT DRL 5MM 2.9MM 300MM NS CNN LG QC BOTH IP/OP $822.50 $609.00 $146.37 $836.30 $822.33 $822.33 $822.33 $822.33 $822.33 $822.33 $146.37 $822.33 $822.33 $610.33 $610.33 $633.85 $428.43 $171.38 $822.33 $334.52 $822.33 $822.33 $836.30 $822.33 $822.33 $616.88 $822.33 $822.33 $822.33 $411.17 $411.17 $651.29 $822.33 $657.86 $534.51 $822.33 N/A $477.05 $822.33 $493.40 $822.33 $822.33 $822.33 N/A N/A 310.632 SUP Custom 27203010 310.632 - BIT DRL SHRT FLUT 5MM 200MM NS CNN QC 7.3MM SCR BOTH IP/OP $656.50 $486.00 $116.85 $667.60 $656.45 $656.45 $656.45 $656.45 $656.45 $656.45 $116.85 $656.45 $656.45 $487.22 $487.22 $505.99 $342.01 $136.81 $656.45 $267.04 $656.45 $656.45 $667.60 $656.45 $656.45 $492.38 $656.45 $656.45 $656.45 $328.23 $328.23 $519.91 $656.45 $525.16 $426.69 $656.45 N/A $380.77 $656.45 $393.87 $656.45 $656.45 $656.45 N/A N/A 310.634 SUP Custom 27203010 310.634 - BIT DRL LNG FLUT 4.3MM 200MM NS CNN QC 5MM SCR BOTH IP/OP $656.50 $486.00 $116.85 $667.60 $656.45 $656.45 $656.45 $656.45 $656.45 $656.45 $116.85 $656.45 $656.45 $487.22 $487.22 $505.99 $342.01 $136.81 $656.45 $267.04 $656.45 $656.45 $667.60 $656.45 $656.45 $492.38 $656.45 $656.45 $656.45 $328.23 $328.23 $519.91 $656.45 $525.16 $426.69 $656.45 N/A $380.77 $656.45 $393.87 $656.45 $656.45 $656.45 N/A N/A 310.65 SUP Custom 27203010 310.65 - BIT DRL 3.2MM 1.7MM 170MM NS CNN QC BOTH IP/OP $818.50 $606.00 $145.63 $832.03 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $145.63 $818.13 $818.13 $607.22 $607.22 $630.61 $426.25 $170.51 $818.13 $332.81 $818.13 $818.13 $832.03 $818.13 $818.13 $613.88 $818.13 $818.13 $818.13 $409.07 $409.07 $647.96 $818.13 $654.50 $531.78 $818.13 N/A $474.73 $818.13 $490.88 $818.13 $818.13 $818.13 N/A N/A 310.66 SUP Custom 27203010 310.66 - BIT DRL 4.5MM 1.7MM 170MM NS CNN QC BOTH IP/OP $818.50 $606.00 $145.63 $832.03 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $145.63 $818.13 $818.13 $607.22 $607.22 $630.61 $426.25 $170.51 $818.13 $332.81 $818.13 $818.13 $832.03 $818.13 $818.13 $613.88 $818.13 $818.13 $818.13 $409.07 $409.07 $647.96 $818.13 $654.50 $531.78 $818.13 N/A $474.73 $818.13 $490.88 $818.13 $818.13 $818.13 N/A N/A 310.67 SUP Custom 27203010 310.67 - BIT DRL 2.7MM 160MM NS CNN QC BOTH IP/OP $834.00 $617.00 $148.38 $847.75 $833.58 $833.58 $833.58 $833.58 $833.58 $833.58 $148.38 $833.58 $833.58 $618.68 $618.68 $642.52 $434.30 $173.73 $833.58 $339.10 $833.58 $833.58 $847.75 $833.58 $833.58 $625.50 $833.58 $833.58 $833.58 $416.79 $416.79 $660.20 $833.58 $666.86 $541.83 $833.58 N/A $483.72 $833.58 $500.15 $833.58 $833.58 $833.58 N/A N/A 310.68 SUP Custom 27203010 310.68 - BIT DRL 3.5MM 160MM NS CNN QC BOTH IP/OP $834.00 $617.00 $148.38 $847.75 $833.58 $833.58 $833.58 $833.58 $833.58 $833.58 $148.38 $833.58 $833.58 $618.68 $618.68 $642.52 $434.30 $173.73 $833.58 $339.10 $833.58 $833.58 $847.75 $833.58 $833.58 $625.50 $833.58 $833.58 $833.58 $416.79 $416.79 $660.20 $833.58 $666.86 $541.83 $833.58 N/A $483.72 $833.58 $500.15 $833.58 $833.58 $833.58 N/A N/A 310.69 SUP Custom 27203010 310.69 - BIT DRL 4.5MM 233MM NS CNN JCHK BOTH IP/OP $818.50 $606.00 $145.63 $832.03 $818.13 $818.13 $818.13 $818.13 $818.13 $818.13 $145.63 $818.13 $818.13 $607.22 $607.22 $630.61 $426.25 $170.51 $818.13 $332.81 $818.13 $818.13 $832.03 $818.13 $818.13 $613.88 $818.13 $818.13 $818.13 $409.07 $409.07 $647.96 $818.13 $654.50 $531.78 $818.13 N/A $474.73 $818.13 $490.88 $818.13 $818.13 $818.13 N/A N/A 310.8 SUP Custom 27203010 310.80 - COUNTERSINK DRILL CENTERING PIN NONSTRL 2.4 MM CORTICAL BOTH IP/OP "$1,460.50" "$1,081.00" $259.92 "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" $259.92 "$1,460.25" "$1,460.25" "$1,083.80" "$1,083.80" "$1,125.56" $760.79 $304.33 "$1,460.25" $584.10 "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" "$1,095.38" "$1,460.25" "$1,460.25" "$1,460.25" $730.13 $730.13 "$1,156.52" "$1,460.25" "$1,168.20" $949.16 "$1,460.25" N/A $847.09 "$1,460.25" $876.15 "$1,460.25" "$1,460.25" "$1,460.25" N/A N/A 310.805 SUP Custom 27203010 310.805 - REAMER SURG CENTERING PIN HEXAGONAL COUPLING 2.4 MM SCREW BOTH IP/OP "$1,519.00" "$1,124.00" $270.34 "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" $270.34 "$1,518.75" "$1,518.75" "$1,127.22" "$1,127.22" "$1,170.65" $791.27 $316.52 "$1,518.75" $607.50 "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,139.25" "$1,518.75" "$1,518.75" "$1,518.75" $759.38 $759.38 "$1,202.85" "$1,518.75" "$1,215.00" $987.19 "$1,518.75" N/A $881.02 "$1,518.75" $911.25 "$1,518.75" "$1,518.75" "$1,518.75" N/A N/A 310.81 SUP Custom 27203010 310.81 - COUNTERSINK DRILL QUICK COUPLING CENTERING PIN NONSTRL 1.5 BOTH IP/OP "$1,519.00" "$1,124.00" $270.34 "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" $270.34 "$1,518.75" "$1,518.75" "$1,127.22" "$1,127.22" "$1,170.65" $791.27 $316.52 "$1,518.75" $607.50 "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,139.25" "$1,518.75" "$1,518.75" "$1,518.75" $759.38 $759.38 "$1,202.85" "$1,518.75" "$1,215.00" $987.19 "$1,518.75" N/A $881.02 "$1,518.75" $911.25 "$1,518.75" "$1,518.75" "$1,518.75" N/A N/A 310.811 SUP Custom 27203010 310.811 - COUNTERSINK DRILL CENTERING PIN HEXAGONAL COUPLING NONSTRL 2 BOTH IP/OP "$1,584.00" "$1,172.00" $281.95 "$1,584.00" "$1,584.00" "$1,584.00" "$1,584.00" "$1,584.00" "$1,584.00" "$1,584.00" $281.95 "$1,584.00" "$1,584.00" "$1,175.64" "$1,175.64" "$1,220.95" $825.26 $330.12 "$1,584.00" $633.60 "$1,584.00" "$1,584.00" "$1,584.00" "$1,584.00" "$1,584.00" "$1,188.00" "$1,584.00" "$1,584.00" "$1,584.00" $792.00 $792.00 "$1,254.53" "$1,584.00" "$1,267.20" "$1,029.60" "$1,584.00" N/A $918.72 "$1,584.00" $950.40 "$1,584.00" "$1,584.00" "$1,584.00" N/A N/A 310.883 SUP Custom 27203010 310.883 - COUNTERSINK DRILL HEX COUPLING 2 MM 2.4 MM SCREWS BOTH IP/OP "$1,471.50" "$1,089.00" $261.93 "$1,471.50" "$1,471.50" "$1,471.50" "$1,471.50" "$1,471.50" "$1,471.50" "$1,471.50" $261.93 "$1,471.50" "$1,471.50" "$1,092.15" "$1,092.15" "$1,134.23" $766.65 $306.68 "$1,471.50" $588.60 "$1,471.50" "$1,471.50" "$1,471.50" "$1,471.50" "$1,471.50" "$1,103.63" "$1,471.50" "$1,471.50" "$1,471.50" $735.75 $735.75 "$1,165.43" "$1,471.50" "$1,177.20" $956.48 "$1,471.50" N/A $853.47 "$1,471.50" $882.90 "$1,471.50" "$1,471.50" "$1,471.50" N/A N/A 311.014 SUP Custom 27203010 311.014 - SCREWDRIVER SURG SMALL NONSTRL RATCHETING BOTH IP/OP "$3,096.00" "$2,291.00" $551.09 "$3,096.00" "$3,096.00" "$3,096.00" "$3,096.00" "$3,096.00" "$3,096.00" "$3,096.00" $551.09 "$3,096.00" "$3,096.00" "$2,297.85" "$2,297.85" "$2,386.40" "$1,613.02" $645.24 "$3,096.00" "$1,238.40" "$3,096.00" "$3,096.00" "$3,096.00" "$3,096.00" "$3,096.00" "$2,322.00" "$3,096.00" "$3,096.00" "$3,096.00" "$1,548.00" "$1,548.00" "$2,452.03" "$3,096.00" "$2,476.80" "$2,012.40" "$3,096.00" N/A "$1,795.68" "$3,096.00" "$1,857.60" "$3,096.00" "$3,096.00" "$3,096.00" N/A N/A 311.12 SUP HCPCS C1713 311.120 - TAP SURG MINI QUICK COUPLING 1.3 MM CORTEX SCREWS BOTH IP/OP $326.50 $242.00 $64.75 $326.25 $146.81 $146.81 $146.81 $146.81 $326.25 $326.25 $326.25 $68.00 $326.25 $326.25 $326.25 $326.25 $326.25 $67.99 $326.25 $326.25 $192.98 $326.25 $326.25 $326.25 $326.25 $244.88 $326.25 $326.25 $326.25 $163.13 $163.13 $258.39 $326.25 $261.00 $146.81 $64.75 N/A $189.37 $326.25 $326.25 $326.25 $67.99 $326.25 N/A N/A 311.15 SUP HCPCS C1713 311.15 - TAP SURG 50MM MINI QUICK COUPLING NONSTRL 1.5MM CORTICAL BOTH IP/OP $184.50 $137.00 $36.55 $187.28 $82.87 $82.87 $82.87 $82.87 $184.15 $184.15 $184.15 $38.38 $184.15 $184.15 $184.15 $184.15 $184.15 $38.38 $184.15 $187.28 $108.92 $184.15 $187.28 $184.15 $184.15 $138.38 $184.15 $184.15 $184.15 $92.08 $92.08 $145.85 $184.15 $147.32 $82.87 $36.55 N/A $107.01 $184.15 $110.49 $184.15 $38.38 $184.15 N/A N/A 311.204 SUP HCPCS C1713 311.204 - TAP SURG 100MM 2MM MANDIB LOCKING SCREWS BOTH IP/OP $243.00 $180.00 $48.23 $243.00 $109.35 $109.35 $109.35 $109.35 $243.00 $243.00 $243.00 $50.65 $243.00 $243.00 $243.00 $243.00 $243.00 $50.64 $243.00 $243.00 $143.73 $243.00 $243.00 $243.00 $243.00 $182.25 $243.00 $243.00 $243.00 $121.50 $121.50 $192.46 $243.00 $194.40 $109.35 $48.23 N/A $140.94 $243.00 $145.80 $243.00 $50.64 $243.00 N/A N/A 311.209 SUP HCPCS C1713 311.209 - TAP SURG HEXAGONAL COUPLING 2 MM COARSE PITCH SCREWS BOTH IP/OP $324.00 $240.00 $64.31 $324.00 $145.80 $145.80 $145.80 $145.80 $324.00 $324.00 $324.00 $67.53 $324.00 $324.00 $324.00 $324.00 $324.00 $67.53 $324.00 $324.00 $191.65 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $145.80 $64.31 N/A $187.92 $324.00 $194.40 $324.00 $67.52 $324.00 N/A N/A 311.211 SUP HCPCS C1713 311.211 - TAP SURG HEXAGONAL COUPLING 2 MM CORTEX SCREWS BOTH IP/OP $290.50 $215.00 $57.61 $290.25 $130.61 $130.61 $130.61 $130.61 $290.25 $290.25 $290.25 $60.50 $290.25 $290.25 $290.25 $290.25 $290.25 $60.49 $290.25 $290.25 $171.68 $290.25 $290.25 $290.25 $290.25 $217.88 $290.25 $290.25 $290.25 $145.13 $145.13 $229.88 $290.25 $232.20 $130.61 $57.61 N/A $168.49 $290.25 $174.15 $290.25 $60.49 $290.25 N/A N/A 311.23 SUP HCPCS C1713 311.23 - TAP SURG QUICK COUPLING NONSTRL 2.4 MM CORTICAL SCREW BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $244.35 $407.25 $84.87 $407.25 N/A N/A 311.24 SUP HCPCS C1713 311.24 - TAP SURG LONG QUICK COUPLING 2.4MM CORTEX SCREWS BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $244.35 $407.25 $407.25 $407.25 N/A N/A 311.241 SUP HCPCS C1713 311.241 - TAP SURG HEXAGONAL COUPLING 2.4 MM CORTEX SCREWS BOTH IP/OP $423.00 $313.00 $83.95 $423.00 $190.35 $190.35 $190.35 $190.35 $423.00 $423.00 $423.00 $88.16 $423.00 $423.00 $423.00 $423.00 $423.00 $88.16 $423.00 $423.00 $250.20 $423.00 $423.00 $423.00 $423.00 $317.25 $423.00 $423.00 $423.00 $211.50 $211.50 $335.02 $423.00 $338.40 $190.35 $83.95 N/A $245.34 $423.00 $253.80 $423.00 $423.00 $423.00 N/A N/A 311.26 SUP Custom 27203010 311.26 - TAP SURG LONG 100MM QUICK COUPLING NONSTRL 2.7MM CORTICAL BOTH IP/OP $216.50 $160.00 $38.53 $220.15 $216.48 $216.48 $216.48 $216.48 $216.48 $216.48 $38.53 $216.48 $216.48 $160.67 $160.67 $166.86 $112.79 $45.12 $216.48 $88.06 $216.48 $216.48 $220.15 $216.48 $216.48 $162.38 $216.48 $216.48 $216.48 $108.24 $108.24 $171.45 $216.48 $173.18 $140.71 $216.48 N/A $125.57 $216.48 $129.89 $216.48 $216.48 $216.48 N/A N/A 311.32 SUP HCPCS C1713 311.32 - TAP SURG LONG 110MM QUICK COUPLING GOLD NONSTRL 3.5MM BOTH IP/OP $216.50 $160.00 $42.97 $220.15 $97.42 $97.42 $97.42 $97.42 $216.48 $216.48 $216.48 $45.12 $216.48 $216.48 $216.48 $216.48 $216.48 $45.12 $216.48 $220.15 $128.05 $216.48 $220.15 $216.48 $216.48 $162.38 $216.48 $216.48 $216.48 $108.24 $108.24 $171.45 $216.48 $173.18 $97.42 $42.97 N/A $125.57 $216.48 $216.48 $216.48 $45.11 $216.48 N/A N/A 311.33 SUP HCPCS C1713 TAP 180MM SURG 3.5MM CORT TI SHAFT SCR 180MM BOTH IP/OP $256.00 $189.00 $50.73 $255.58 $115.01 $115.01 $115.01 $115.01 $255.58 $255.58 $255.58 $53.27 $255.58 $255.58 $255.58 $255.58 $255.58 $53.27 $255.58 $255.58 $151.18 $255.58 $255.58 $255.58 $255.58 $192.00 $255.58 $255.58 $255.58 $127.79 $127.79 $202.42 $255.58 $204.46 $115.01 $50.73 $255.58 $148.48 $255.58 $153.35 $255.58 $53.26 $255.58 N/A N/A 311.34 SUP HCPCS C1713 311.34 - TAP SURG 110MM NONSTRL 4MM CANCELLOUS SCREW BOTH IP/OP $216.50 $160.00 $50.73 $255.58 $115.01 $115.01 $115.01 $115.01 $255.58 $255.58 $255.58 $53.27 $255.58 $255.58 $255.58 $255.58 $255.58 $53.27 $255.58 $255.58 $151.18 $255.58 $255.58 $255.58 $255.58 $162.38 $255.58 $255.58 $255.58 $127.79 $127.79 $202.42 $255.58 $204.46 $115.01 $50.73 $255.58 $125.57 $255.58 $255.58 $255.58 $53.26 $255.58 N/A N/A 311.34 SUP HCPCS C1713 SCREW TAP FOR 4.0MM CANCELLOUS BONE SCREWS 110MM BOTH IP/OP $256.00 $189.00 $50.73 $255.58 $115.01 $115.01 $115.01 $115.01 $255.58 $255.58 $255.58 $53.27 $255.58 $255.58 $255.58 $255.58 $255.58 $53.27 $255.58 $255.58 $151.18 $255.58 $255.58 $255.58 $255.58 $192.00 $255.58 $255.58 $255.58 $127.79 $127.79 $202.42 $255.58 $204.46 $115.01 $50.73 $255.58 $148.48 $255.58 $255.58 $255.58 $53.26 $255.58 N/A N/A 311.349 SUP HCPCS C1713 311.349 - TAP SURG 50MM CALIBRATE SPN CANCELLOUS NONSTRL 3.5MM BOTH IP/OP $324.00 $240.00 $64.26 $323.75 $145.69 $145.69 $145.69 $145.69 $323.75 $323.75 $323.75 $67.48 $323.75 $323.75 $323.75 $323.75 $323.75 $67.47 $323.75 $129.50 $191.50 $323.75 $323.75 $323.75 $323.75 $243.00 $323.75 $323.75 $323.75 $161.88 $161.88 $256.41 $323.75 $259.00 $145.69 $64.26 N/A $187.92 $323.75 $323.75 $323.75 $67.47 $323.75 N/A N/A 311.449 SUP Custom 27203010 311.449 - DEVICE TARGET 4.5MM PUSH PULL REDX LCP NONSTRL 4.5MM LCP BOTH IP/OP $485.00 $359.00 $86.33 $493.23 $484.98 $484.98 $484.98 $484.98 $484.98 $484.98 $86.33 $484.98 $484.98 $359.95 $359.95 $373.82 $252.67 $101.08 $484.98 $197.29 $484.98 $484.98 $493.23 $484.98 $484.98 $363.75 $484.98 $484.98 $484.98 $242.49 $242.49 $384.10 $484.98 $387.98 $315.24 $484.98 N/A $281.30 $484.98 $290.99 $484.98 $484.98 $484.98 N/A N/A 311.63 SUP Custom 27203010 311.63 - TAP SURG 147MM CANN NONSTRL 4MM SCREW BOTH IP/OP $853.50 $632.00 $175.14 $983.93 $983.93 $983.93 $983.93 $983.93 $983.93 $983.93 $175.14 $983.93 $983.93 $730.27 $730.27 $758.41 $512.63 $205.06 $983.93 $393.57 $983.93 $983.93 $983.93 $983.93 $983.93 $640.13 $983.93 $983.93 $983.93 $491.97 $491.97 $779.27 $983.93 $787.14 $639.55 $983.93 $983.93 $495.03 $983.93 $590.36 $983.93 $983.93 $983.93 N/A N/A 311.63 SUP Custom 27203010 TAP CANNULATED FOR 4.0MM CANNULATED SCREWS 147MM BOTH IP/OP $984.00 $728.00 $175.14 $983.93 $983.93 $983.93 $983.93 $983.93 $983.93 $983.93 $175.14 $983.93 $983.93 $730.27 $730.27 $758.41 $512.63 $205.06 $983.93 $393.57 $983.93 $983.93 $983.93 $983.93 $983.93 $738.00 $983.93 $983.93 $983.93 $491.97 $491.97 $779.27 $983.93 $787.14 $639.55 $983.93 $983.93 $570.72 $983.93 $590.36 $983.93 $983.93 $983.93 N/A N/A 312.3 SUP Custom 27203010 312.30 - SLEEVE DRILL 3.5MM 2.5MM INSERT LCP NONSTRL BOTH IP/OP $205.00 $152.00 $36.44 $214.43 $204.73 $204.73 $204.73 $204.73 $204.73 $204.73 $36.44 $204.73 $204.73 $151.95 $151.95 $157.81 $106.66 $42.67 $204.73 $85.77 $204.73 $204.73 $214.43 $204.73 $204.73 $153.75 $204.73 $204.73 $204.73 $102.37 $102.37 $162.15 $204.73 $163.78 $133.07 $204.73 N/A $118.90 $204.73 $122.84 $204.73 $204.73 $204.73 N/A N/A 312.35 SUP Custom 27203010 312.35 - SLEEVE DRILL 2.7MM 1.25MM 2 END NONSTRL BOTH IP/OP $779.00 $576.00 $138.62 $792.00 $778.75 $778.75 $778.75 $778.75 $778.75 $778.75 $138.62 $778.75 $778.75 $577.99 $577.99 $600.26 $405.73 $162.30 $778.75 $316.80 $778.75 $778.75 $792.00 $778.75 $778.75 $584.25 $778.75 $778.75 $778.75 $389.38 $389.38 $616.77 $778.75 $623.00 $506.19 $778.75 N/A $451.82 $778.75 $467.25 $778.75 $778.75 $778.75 N/A N/A 312.648 SUP Custom 27203010 312.648 - GUIDE DRL 2.8MM 2.8MM NS LCP THRD 3.5 LCK SCR BOTH IP/OP $197.00 $146.00 $35.03 $200.15 $196.80 $196.80 $196.80 $196.80 $196.80 $196.80 $35.03 $196.80 $196.80 $146.06 $146.06 $151.69 $102.53 $41.02 $196.80 $80.06 $196.80 $196.80 $200.15 $196.80 $196.80 $147.75 $196.80 $196.80 $196.80 $98.40 $98.40 $155.87 $196.80 $157.44 $127.92 $196.80 N/A $114.26 $196.80 $118.08 $196.80 $196.80 $196.80 N/A N/A 313.25 SUP Custom 27203010 313.250 - BIT DRILL MINI 4MM STOP 44.5MM QUICK COUPLING NONSTRL BOTH IP/OP $281.50 $208.00 $50.06 $281.25 $281.25 $281.25 $281.25 $281.25 $281.25 $281.25 $50.06 $281.25 $281.25 $208.74 $208.74 $216.79 $146.53 $58.62 $281.25 $112.50 $281.25 $281.25 $281.25 $281.25 $281.25 $211.13 $281.25 $281.25 $281.25 $140.63 $140.63 $222.75 $281.25 $225.00 $182.81 $281.25 N/A $163.27 $281.25 $168.75 $281.25 $281.25 $281.25 N/A N/A 314.03 SUP Custom 27203010 314.03 - SHAFT SCREWDRIVER 2.5MM SMALL HEXAGON NONSTRL BOTH IP/OP $102.00 $75.00 $18.14 $103.63 $101.90 $101.90 $101.90 $101.90 $101.90 $101.90 $18.14 $101.90 $101.90 $75.63 $75.63 $78.54 $53.09 $21.24 $101.90 $41.45 $101.90 $101.90 $103.63 $101.90 $101.90 $76.50 $101.90 $101.90 $101.90 $50.95 $50.95 $80.70 $101.90 $81.52 $66.24 $101.90 N/A $59.16 $101.90 $61.14 $101.90 $101.90 $101.90 N/A N/A 314.23 SUP Custom 27203010 314.23 - SHAFT SCREWDRIVER 4MM HEXAGONAL CANN QUICK COUPLING BOTH IP/OP $602.00 $445.00 $107.09 $611.85 $601.63 $601.63 $601.63 $601.63 $601.63 $601.63 $107.09 $601.63 $601.63 $446.53 $446.53 $463.74 $313.45 $125.39 $601.63 $244.74 $601.63 $601.63 $611.85 $601.63 $601.63 $451.50 $601.63 $601.63 $601.63 $300.82 $300.82 $476.49 $601.63 $481.30 $391.06 $601.63 N/A $349.16 $601.63 $360.98 $601.63 $601.63 $601.63 N/A N/A 314.467 SUP Custom 27203010 314.467 - SHAFT SCREWDRIVER T8 105MM SELF RETAINING QUICK COUPLING BOTH IP/OP $557.00 $412.00 $99.08 $566.13 $556.65 $556.65 $556.65 $556.65 $556.65 $556.65 $99.08 $556.65 $556.65 $413.15 $413.15 $429.07 $290.01 $116.01 $556.65 $226.45 $556.65 $556.65 $566.13 $556.65 $556.65 $417.75 $556.65 $556.65 $556.65 $278.33 $278.33 $440.87 $556.65 $445.32 $361.82 $556.65 N/A $323.06 $556.65 $333.99 $556.65 $556.65 $556.65 N/A N/A 314.57 SUP Custom 27203010 314.57 - SCREWDRIVER SURG LONG SMALL HEXAGONAL 3.5MM CORTEX 4MM BOTH IP/OP $423.50 $313.00 $75.32 $430.33 $423.13 $423.13 $423.13 $423.13 $423.13 $423.13 $75.32 $423.13 $423.13 $314.05 $314.05 $326.15 $220.45 $88.18 $423.13 $172.13 $423.13 $423.13 $430.33 $423.13 $423.13 $317.63 $423.13 $423.13 $423.13 $211.57 $211.57 $335.12 $423.13 $338.50 $275.03 $423.13 N/A $245.63 $423.13 $253.88 $423.13 $423.13 $423.13 N/A N/A 314.743 SUP Custom 27203010 314.743 - REAMER SURG 520MM DRIVE SHAFT NONSTRL RIA BOTH IP/OP "$8,876.50" "$6,569.00" "$1,580.00" "$9,027.33" "$8,876.43" "$8,876.43" "$8,876.43" "$8,876.43" "$8,876.43" "$8,876.43" "$1,580.00" "$8,876.43" "$8,876.43" "$4,181.12" "$4,181.12" "$6,841.95" "$2,060.15" "$1,849.95" "$8,876.43" "$3,610.93" "$8,876.43" "$8,876.43" "$9,027.33" "$8,876.43" "$8,876.43" "$6,657.38" "$8,876.43" "$8,876.43" "$8,876.43" "$4,438.22" "$4,438.22" "$7,030.13" "$8,876.43" "$7,101.14" "$5,769.68" "$8,876.43" N/A "$5,148.37" "$8,876.43" "$5,325.86" "$8,876.43" "$8,876.43" "$8,876.43" N/A N/A 315.05 SUP Custom 27203010 315.05 - BIT DRILL 3.5MM 225MM 3 FLUTED QUICK COUPLING NONSTRL BOTH IP/OP $225.00 $167.00 $40.03 $228.73 $224.90 $224.90 $224.90 $224.90 $224.90 $224.90 $40.03 $224.90 $224.90 $166.92 $166.92 $173.35 $117.17 $46.87 $224.90 $91.49 $224.90 $224.90 $228.73 $224.90 $224.90 $168.75 $224.90 $224.90 $224.90 $112.45 $112.45 $178.12 $224.90 $179.92 $146.19 $224.90 N/A $130.50 $224.90 $134.94 $224.90 $224.90 $224.90 N/A N/A 315.19 SUP Custom 27203010 315.19 - BIT DRILL 2MM 100MM 3 FLUTED QUICK COUPLING NONSTRL BOTH IP/OP $193.00 $143.00 $34.28 $195.85 $192.58 $192.58 $192.58 $192.58 $192.58 $192.58 $34.28 $192.58 $192.58 $142.93 $142.93 $148.44 $100.33 $40.14 $192.58 $78.34 $192.58 $192.58 $195.85 $192.58 $192.58 $144.75 $192.58 $192.58 $192.58 $96.29 $96.29 $152.52 $192.58 $154.06 $125.18 $192.58 N/A $111.94 $192.58 $115.55 $192.58 $192.58 $192.58 N/A N/A 315.21 SUP Custom 27203010 315.21 - BIT DRILL 2MM 125MM 3 FLUTED QUICK COUPLING NONSTRL BOTH IP/OP $193.00 $143.00 $34.28 $195.85 $192.58 $192.58 $192.58 $192.58 $192.58 $192.58 $34.28 $192.58 $192.58 $142.93 $142.93 $148.44 $100.33 $40.14 $192.58 $78.34 $192.58 $192.58 $195.85 $192.58 $192.58 $144.75 $192.58 $192.58 $192.58 $96.29 $96.29 $152.52 $192.58 $154.06 $125.18 $192.58 N/A $111.94 $192.58 $115.55 $192.58 $192.58 $192.58 N/A N/A 315.23 SUP Custom 27203010 315.23 - BIT DRILL 2.5MM 180MM 3 FLUTED NONSTRL BOTH IP/OP $209.50 $155.00 $37.28 $213.00 $209.45 $209.45 $209.45 $209.45 $209.45 $209.45 $37.28 $209.45 $209.45 $155.45 $155.45 $161.44 $109.12 $43.65 $209.45 $85.20 $209.45 $209.45 $213.00 $209.45 $209.45 $157.13 $209.45 $209.45 $209.45 $104.73 $104.73 $165.88 $209.45 $167.56 $136.14 $209.45 N/A $121.51 $209.45 $125.67 $209.45 $209.45 $209.45 N/A N/A 315.25 SUP Custom 27203010 315.25 - BIT DRILL 2.5MM 110MM 3 FLUTED QUICK COUPLING NONSTRL BOTH IP/OP $209.50 $155.00 $37.28 $213.00 $209.45 $209.45 $209.45 $209.45 $209.45 $209.45 $37.28 $209.45 $209.45 $155.45 $155.45 $161.44 $109.12 $43.65 $209.45 $85.20 $209.45 $209.45 $213.00 $209.45 $209.45 $157.13 $209.45 $209.45 $209.45 $104.73 $104.73 $165.88 $209.45 $167.56 $136.14 $209.45 N/A $121.51 $209.45 $125.67 $209.45 $209.45 $209.45 N/A N/A 315.26 SUP Custom 27203010 315.26 - BIT DRILL 3 FLUTED 2.7MM 110MM QUICK COUPLING NONSTRL BOTH IP/OP $216.50 $160.00 $38.53 $220.15 $216.48 $216.48 $216.48 $216.48 $216.48 $216.48 $38.53 $216.48 $216.48 $160.67 $160.67 $166.86 $112.79 $45.12 $216.48 $88.06 $216.48 $216.48 $220.15 $216.48 $216.48 $162.38 $216.48 $216.48 $216.48 $108.24 $108.24 $171.45 $216.48 $173.18 $140.71 $216.48 N/A $125.57 $216.48 $129.89 $216.48 $216.48 $216.48 N/A N/A 315.28 SUP Custom 27203010 315.28 - BIT DRL 3 FLUT 2.7MM 125MM NS QC BOTH IP/OP $216.50 $160.00 $38.53 $220.15 $216.48 $216.48 $216.48 $216.48 $216.48 $216.48 $38.53 $216.48 $216.48 $160.67 $160.67 $166.86 $112.79 $45.12 $216.48 $88.06 $216.48 $216.48 $220.15 $216.48 $216.48 $162.38 $216.48 $216.48 $216.48 $108.24 $108.24 $171.45 $216.48 $173.18 $140.71 $216.48 N/A $125.57 $216.48 $129.89 $216.48 $216.48 $216.48 N/A N/A 315.29 SUP Custom 27203010 315.29 - BIT DRL 3 FLUT 3.2MM 195MM NS QC BOTH IP/OP $259.00 $192.00 $46.04 $263.05 $258.65 $258.65 $258.65 $258.65 $258.65 $258.65 $46.04 $258.65 $258.65 $191.97 $191.97 $199.37 $134.76 $53.91 $258.65 $105.22 $258.65 $258.65 $263.05 $258.65 $258.65 $194.25 $258.65 $258.65 $258.65 $129.33 $129.33 $204.85 $258.65 $206.92 $168.12 $258.65 N/A $150.22 $258.65 $155.19 $258.65 $258.65 $258.65 N/A N/A 315.31 SUP Custom 27203010 315.31 - BIT DRILL 3.2MM 145MM 3 FLUTED QUICK COUPLING NONSTRL BOTH IP/OP $174.50 $129.00 $31.03 $177.28 $174.30 $174.30 $174.30 $174.30 $174.30 $174.30 $31.03 $174.30 $174.30 $129.37 $129.37 $134.35 $90.81 $36.33 $174.30 $70.91 $174.30 $174.30 $177.28 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $113.30 $174.30 N/A $101.21 $174.30 $104.58 $174.30 $174.30 $174.30 N/A N/A 315.33 SUP Custom 27203010 315.330 - BIT DRILL 3.2MM 210MM 68MM 3 FLUTED QUICK COUPLING BOTH IP/OP $303.00 $224.00 $53.93 $317.38 $302.98 $302.98 $302.98 $302.98 $302.98 $302.98 $53.93 $302.98 $302.98 $224.87 $224.87 $233.54 $157.85 $63.14 $302.98 $126.95 $302.98 $302.98 $317.38 $302.98 $302.98 $227.25 $302.98 $302.98 $302.98 $151.49 $151.49 $239.96 $302.98 $242.38 $196.94 $302.98 N/A $175.74 $302.98 $181.79 $302.98 $302.98 $302.98 N/A N/A 315.35 SUP Custom 27203010 315.35 - BIT DRILL 3.5MM 110MM 3 FLUTED QUICK COUPLING CANN NONSTRL BOTH IP/OP $191.50 $142.00 $34.02 $194.35 $191.10 $191.10 $191.10 $191.10 $191.10 $191.10 $34.02 $191.10 $191.10 $141.83 $141.83 $147.30 $99.56 $39.83 $191.10 $77.74 $191.10 $191.10 $194.35 $191.10 $191.10 $143.63 $191.10 $191.10 $191.10 $95.55 $95.55 $151.35 $191.10 $152.88 $124.22 $191.10 N/A $111.07 $191.10 $114.66 $191.10 $191.10 $191.10 N/A N/A 315.37 SUP Custom 27203010 315.37 - BIT DRILL 3.5MM 195MM 3 FLUTE QUICK COUPLING CANN NONSTRL BOTH IP/OP $286.00 $212.00 $50.90 $290.78 $285.93 $285.93 $285.93 $285.93 $285.93 $285.93 $50.90 $285.93 $285.93 $212.22 $212.22 $220.39 $148.97 $59.59 $285.93 $116.31 $285.93 $285.93 $290.78 $285.93 $285.93 $214.50 $285.93 $285.93 $285.93 $142.97 $142.97 $226.46 $285.93 $228.74 $185.85 $285.93 N/A $165.88 $285.93 $171.56 $285.93 $285.93 $285.93 N/A N/A 315.4 SUP Custom 27203010 315.40 - BIT DRILL 3 FLUTE 4MM 195MM QUICK COUPLING NONSTRL BOTH IP/OP $278.00 $206.00 $49.41 $290.78 $277.58 $277.58 $277.58 $277.58 $277.58 $277.58 $49.41 $277.58 $277.58 $206.02 $206.02 $213.96 $144.62 $57.85 $277.58 $116.31 $277.58 $277.58 $290.78 $277.58 $277.58 $208.50 $277.58 $277.58 $277.58 $138.79 $138.79 $219.84 $277.58 $222.06 $180.43 $277.58 N/A $161.24 $277.58 $166.55 $277.58 $277.58 $277.58 N/A N/A 315.44 SUP Custom 27203010 315.44 - BIT DRILL 4.5MM 145MM QUICK COUPLING 3 FLUTE NONSTRL BOTH IP/OP $174.50 $129.00 $31.03 $177.28 $174.30 $174.30 $174.30 $174.30 $174.30 $174.30 $31.03 $174.30 $174.30 $129.37 $129.37 $134.35 $90.81 $36.33 $174.30 $70.91 $174.30 $174.30 $177.28 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $113.30 $174.30 N/A $101.21 $174.30 $104.58 $174.30 $174.30 $174.30 N/A N/A 315.48 SUP Custom 27203010 315.48 - BIT DRL 3 FLUT 4.5MM 195MM NS QC BOTH IP/OP $259.00 $192.00 $46.04 $263.05 $258.65 $258.65 $258.65 $258.65 $258.65 $258.65 $46.04 $258.65 $258.65 $191.97 $191.97 $199.37 $134.76 $53.91 $258.65 $105.22 $258.65 $258.65 $263.05 $258.65 $258.65 $194.25 $258.65 $258.65 $258.65 $129.33 $129.33 $204.85 $258.65 $206.92 $168.12 $258.65 N/A $150.22 $258.65 $155.19 $258.65 $258.65 $258.65 N/A N/A 315.6 SUP Custom 27203010 315.60 - BIT DRILL 6MM 195MM QUICK COUPLING 3 FLUTED NONSTRL BOTH IP/OP $325.00 $241.00 $57.81 $340.23 $324.80 $324.80 $324.80 $324.80 $324.80 $324.80 $57.81 $324.80 $324.80 $241.07 $241.07 $250.36 $169.22 $67.69 $324.80 $136.09 $324.80 $324.80 $340.23 $324.80 $324.80 $243.75 $324.80 $324.80 $324.80 $162.40 $162.40 $257.24 $324.80 $259.84 $211.12 $324.80 N/A $188.50 $324.80 $194.88 $324.80 $324.80 $324.80 N/A N/A 315.92 SUP Custom 27203010 315.92 - BIT DRL 3 FLUT 2.5MM 230MM NS 200MM QC CLBRT BOTH IP/OP $350.50 $259.00 $62.31 $355.98 $350.03 $350.03 $350.03 $350.03 $350.03 $350.03 $62.31 $350.03 $350.03 $259.79 $259.79 $269.80 $182.37 $72.95 $350.03 $142.39 $350.03 $350.03 $355.98 $350.03 $350.03 $262.88 $350.03 $350.03 $350.03 $175.02 $175.02 $277.22 $350.03 $280.02 $227.52 $350.03 N/A $203.29 $350.03 $210.02 $350.03 $350.03 $350.03 N/A N/A 315.93 SUP Custom 27203010 315.93 - BIT DRILL 200MM 3.2MM 230MM 3 FLUTED QUICK COUPLING BOTH IP/OP $433.00 $320.00 $77.07 $440.30 $432.95 $432.95 $432.95 $432.95 $432.95 $432.95 $77.07 $432.95 $432.95 $321.34 $321.34 $333.72 $225.57 $90.23 $432.95 $176.12 $432.95 $432.95 $440.30 $432.95 $432.95 $324.75 $432.95 $432.95 $432.95 $216.48 $216.48 $342.90 $432.95 $346.36 $281.42 $432.95 N/A $251.14 $432.95 $259.77 $432.95 $432.95 $432.95 N/A N/A 316 SUP Custom 27203010 316 - FORCEPS INTUBATION 9.75IN CATHETER MAGILL STAINLESS STEEL BOTH IP/OP $26.50 $20.00 $4.66 $26.20 $26.20 $26.20 $26.20 $26.20 $26.20 $26.20 $4.66 $26.20 $26.20 $19.45 $19.45 $20.19 $13.65 $5.46 $26.20 $10.48 $26.20 $26.20 $26.20 $26.20 $26.20 $19.88 $26.20 $26.20 $26.20 $13.10 $13.10 $20.75 $26.20 $20.96 $17.03 $26.20 N/A $15.37 $26.20 $15.72 $26.20 $26.20 $26.20 N/A N/A 316.001 SUP Custom 27203010 316.001 - SPACER SPNL 0D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$2,060.15" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$4,181.12" "$4,181.12" "$15,724.32" "$2,060.15" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$13,260.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.002 SUP Custom 27203010 316.002 - SPACER SPNL 0D 25MM LG 30X41MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$2,060.15" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$4,181.12" "$4,181.12" "$15,724.32" "$2,060.15" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$13,260.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.003 SUP Custom 27203010 316.003 - SPACER SPNL 0D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$2,060.15" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$4,181.12" "$4,181.12" "$15,724.32" "$2,060.15" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$13,260.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.004 SUP Custom 27803010 316.004 - SPACER SPNL 0D 25MM LG 30X53MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.005 SUP Custom 27803010 316.005 - SPACER SPNL 0D 25MM LG 30X69MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$22,190.00" "$16,421.00" "$3,949.82" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$3,949.82" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$4,624.64" "$22,190.00" "$8,876.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$16,642.50" "$22,190.00" "$22,190.00" "$22,190.00" "$11,095.00" "$11,095.00" "$17,574.48" "$22,190.00" "$17,752.00" "$9,985.50" "$22,190.00" N/A "$12,870.20" "$22,190.00" "$13,314.00" "$22,190.00" "$22,190.00" "$22,190.00" N/A N/A 316.006 SUP Custom 27803010 316.006 - SPACER SPNL 8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.007 SUP Custom 27803010 316.007 - SPACER SPNL 8D 25MM LG 30X41MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.008 SUP Custom 27803010 316.008 - SPACER SPNL 8D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.009 SUP Custom 27803010 316.009 - SPACER SPNL 8D 25MM LG 30X53MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.01 SUP Custom 27803010 316.010 - SPACER SPNL 8D 25MM LG 30X69MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$22,190.00" "$16,421.00" "$3,949.82" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$3,949.82" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$4,624.64" "$22,190.00" "$8,876.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$16,642.50" "$22,190.00" "$22,190.00" "$22,190.00" "$11,095.00" "$11,095.00" "$17,574.48" "$22,190.00" "$17,752.00" "$9,985.50" "$22,190.00" N/A "$12,870.20" "$22,190.00" "$13,314.00" "$22,190.00" "$22,190.00" "$22,190.00" N/A N/A 316.011 SUP Custom 27803010 316.011 - SPACER SPNL 8D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.012 SUP Custom 27803010 316.012 - SPACER SPNL 16D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.013 SUP Custom 27803010 316.013 - SPACER SPNL 16D 25MM LG 30X63MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$22,190.00" "$16,421.00" "$3,949.82" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$3,949.82" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$4,624.64" "$22,190.00" "$8,876.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$16,642.50" "$22,190.00" "$22,190.00" "$22,190.00" "$11,095.00" "$11,095.00" "$17,574.48" "$22,190.00" "$17,752.00" "$9,985.50" "$22,190.00" N/A "$12,870.20" "$22,190.00" "$13,314.00" "$22,190.00" "$22,190.00" "$22,190.00" N/A N/A 316.014 SUP Custom 27803010 316.014 - BIT DRILL 14MM STOP UNIVERSAL .76MM 44.5MM 14MM UNIVERSAL BOTH IP/OP $371.50 $275.00 $215.47 "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" $278.63 "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$20,400.00" N/A $215.47 "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.014 SUP Custom 27803010 316.014 - SPACER SPNL 16D 25MM LG 30X39MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.015 SUP Custom 27803010 316.015 - SPACER SPNL 16D 25MM LG 30X48MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.016 SUP Custom 27803010 316.016 - SPACER SPNL 16D 25MM LG 30X57MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.017 SUP Custom 27803010 316.017 - SPACER SPNL 16D 25MM LG 30X74MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$23,740.00" "$17,568.00" "$4,225.72" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$4,225.72" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$4,947.68" "$23,740.00" "$9,496.00" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$17,805.00" "$23,740.00" "$23,740.00" "$23,740.00" "$11,870.00" "$11,870.00" "$18,802.08" "$23,740.00" "$18,992.00" "$10,683.00" "$23,740.00" N/A "$13,769.20" "$23,740.00" "$14,244.00" "$23,740.00" "$23,740.00" "$23,740.00" N/A N/A 316.018 SUP Custom 27803010 316.018 - SPACER SPNL 16D 25MM LG 30X91MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$23,740.00" "$17,568.00" "$4,225.72" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$4,225.72" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$4,947.68" "$23,740.00" "$9,496.00" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$23,740.00" "$17,805.00" "$23,740.00" "$23,740.00" "$23,740.00" "$11,870.00" "$11,870.00" "$18,802.08" "$23,740.00" "$18,992.00" "$10,683.00" "$23,740.00" N/A "$13,769.20" "$23,740.00" "$14,244.00" "$23,740.00" "$23,740.00" "$23,740.00" N/A N/A 316.019 SUP Custom 27803010 316.019 - SPACER SPNL -8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.02 SUP Custom 27803010 316.020 - SPACER SPNL -8D 25MM LG 30X41MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.021 SUP Custom 27803010 316.021 - SPACER SPNL -8D 25MM LG 30X45MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.022 SUP Custom 27803010 316.022 - SPACER SPNL -8D 25MM LG 30X53MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.023 SUP Custom 27803010 316.023 - SPACER SPNL -8D 25MM LG 30X69MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$22,190.00" "$16,421.00" "$3,949.82" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$3,949.82" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$4,624.64" "$22,190.00" "$8,876.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$22,190.00" "$16,642.50" "$22,190.00" "$22,190.00" "$22,190.00" "$11,095.00" "$11,095.00" "$17,574.48" "$22,190.00" "$17,752.00" "$9,985.50" "$22,190.00" N/A "$12,870.20" "$22,190.00" "$13,314.00" "$22,190.00" "$22,190.00" "$22,190.00" N/A N/A 316.024 SUP Custom 27803010 316.024 - SPACER SPNL 0D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.025 SUP Custom 27803010 316.025 - SPACER SPNL 8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.026 SUP Custom 27803010 316.026 - SPACER SPNL -8D 25MM LG 30X33MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.027 SUP Custom 27803010 316.027 - SPACER SPNL 16D 25MM LG 30X39MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$20,400.00" "$15,096.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$3,631.20" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$4,251.58" "$20,400.00" "$8,160.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$20,400.00" "$15,300.00" "$20,400.00" "$20,400.00" "$20,400.00" "$10,200.00" "$10,200.00" "$16,156.80" "$20,400.00" "$16,320.00" "$9,180.00" "$20,400.00" N/A "$11,832.00" "$20,400.00" "$12,240.00" "$20,400.00" "$20,400.00" "$20,400.00" N/A N/A 316.03 SUP Custom 27203010 316.03 - BIT DRILL 3MM STOP UNIVERSAL .7MM 44.5MM 3MM UNIVERSAL HALL BOTH IP/OP $342.00 $253.00 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 316.05 SUP Custom 27203010 316.05 - BIT DRILL UNIVERSAL .76MM 44.5MM 5MM SELF STOP HALL COUPLING BOTH IP/OP $342.00 $253.00 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 316.08 SUP Custom 27203010 316.08 - BIT DRILL 8MM STOP UNIVERSAL .76MM 44.5MM 8MM UNIVERSAL HALL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.101 SUP Custom 27803010 316.101 - SPACER SPNL 0D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.102 SUP Custom 27803010 316.102 - SPACER SPNL 0D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.103 SUP Custom 27803010 316.103 - SPACER SPNL 0D 13MM SM 15X28MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.104 SUP Custom 27803010 316.104 - SPACER SPNL 0D 13MM SM 15X30MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.105 SUP Custom 27803010 316.105 - SPACER SPNL 0D 13MM SM 15X32MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.106 SUP Custom 27803010 316.106 - SPACER SPNL 0D 13MM SM 15X38MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.107 SUP Custom 27803010 316.107 - SPACER SPNL 0D 13MM SM 15X44MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.108 SUP Custom 27803010 316.108 - SPACER SPNL 0D 13MM SM 15X52MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$17,540.00" "$12,980.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,655.53" "$17,540.00" "$7,016.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$13,155.00" "$17,540.00" "$17,540.00" "$17,540.00" "$8,770.00" "$8,770.00" "$13,891.68" "$17,540.00" "$14,032.00" "$7,893.00" "$17,540.00" N/A "$10,173.20" "$17,540.00" "$10,524.00" "$17,540.00" "$17,540.00" "$17,540.00" N/A N/A 316.109 SUP Custom 27803010 316.109 - SPACER SPNL 0D 13MM SM 15X58MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$17,540.00" "$12,980.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,655.53" "$17,540.00" "$7,016.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$13,155.00" "$17,540.00" "$17,540.00" "$17,540.00" "$8,770.00" "$8,770.00" "$13,891.68" "$17,540.00" "$14,032.00" "$7,893.00" "$17,540.00" N/A "$10,173.20" "$17,540.00" "$10,524.00" "$17,540.00" "$17,540.00" "$17,540.00" N/A N/A 316.11 SUP Custom 27803010 316.110 - SPACER SPNL 0D 13MM SM 15X64MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$17,540.00" "$12,980.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,655.53" "$17,540.00" "$7,016.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$13,155.00" "$17,540.00" "$17,540.00" "$17,540.00" "$8,770.00" "$8,770.00" "$13,891.68" "$17,540.00" "$14,032.00" "$7,893.00" "$17,540.00" N/A "$10,173.20" "$17,540.00" "$10,524.00" "$17,540.00" "$17,540.00" "$17,540.00" N/A N/A 316.111 SUP Custom 27803010 316.111 - SPACER SPNL 0D 13MM SM 15X72MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$18,972.50" "$14,040.00" "$3,377.11" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$3,377.11" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$3,954.08" "$18,972.50" "$7,589.00" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$14,229.38" "$18,972.50" "$18,972.50" "$18,972.50" "$9,486.25" "$9,486.25" "$15,026.22" "$18,972.50" "$15,178.00" "$8,537.63" "$18,972.50" N/A "$11,004.05" "$18,972.50" "$11,383.50" "$18,972.50" "$18,972.50" "$18,972.50" N/A N/A 316.112 SUP Custom 27803010 316.112 - SPACER SPNL 0D 13MM SM 15X80MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$18,972.50" "$14,040.00" "$3,377.11" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$3,377.11" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$3,954.08" "$18,972.50" "$7,589.00" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$14,229.38" "$18,972.50" "$18,972.50" "$18,972.50" "$9,486.25" "$9,486.25" "$15,026.22" "$18,972.50" "$15,178.00" "$8,537.63" "$18,972.50" N/A "$11,004.05" "$18,972.50" "$11,383.50" "$18,972.50" "$18,972.50" "$18,972.50" N/A N/A 316.113 SUP Custom 27803010 316.113 - SPACER SPNL 7D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.114 SUP Custom 27803010 316.114 - BIT DRL 14MM .76MM 44.5MM NS JLTCH CPLNG SLF STP STRYK BOTH IP/OP $371.50 $275.00 $215.47 "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" $278.63 "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A $215.47 "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.114 SUP Custom 27803010 316.114 - SPACER SPNL 7D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.115 SUP Custom 27803010 316.115 - SPACER SPNL 7D 13MM SM 15X28MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.116 SUP Custom 27803010 316.116 - SPACER SPNL 7D 13MM SM 15X30MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.117 SUP Custom 27803010 316.117 - SPACER SPNL 7D 13MM SM 15X32MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.118 SUP Custom 27803010 316.118 - SPACER SPNL 7D 13MM SM 15X38MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.119 SUP Custom 27803010 316.119 - SPACER SPNL 7D 13MM SM 15X44MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.12 SUP Custom 27803010 316.120 - SPACER SPNL 7D 13MM SM 15X52MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$17,540.00" "$12,980.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,655.53" "$17,540.00" "$7,016.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$13,155.00" "$17,540.00" "$17,540.00" "$17,540.00" "$8,770.00" "$8,770.00" "$13,891.68" "$17,540.00" "$14,032.00" "$7,893.00" "$17,540.00" N/A "$10,173.20" "$17,540.00" "$10,524.00" "$17,540.00" "$17,540.00" "$17,540.00" N/A N/A 316.121 SUP Custom 27803010 316.121 - SPACER SPNL 7D 13MM SM 15X58MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$17,540.00" "$12,980.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,655.53" "$17,540.00" "$7,016.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$13,155.00" "$17,540.00" "$17,540.00" "$17,540.00" "$8,770.00" "$8,770.00" "$13,891.68" "$17,540.00" "$14,032.00" "$7,893.00" "$17,540.00" N/A "$10,173.20" "$17,540.00" "$10,524.00" "$17,540.00" "$17,540.00" "$17,540.00" N/A N/A 316.122 SUP Custom 27803010 316.122 - SPACER SPNL 7D 13MM SM 15X64MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$17,540.00" "$12,980.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,655.53" "$17,540.00" "$7,016.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$13,155.00" "$17,540.00" "$17,540.00" "$17,540.00" "$8,770.00" "$8,770.00" "$13,891.68" "$17,540.00" "$14,032.00" "$7,893.00" "$17,540.00" N/A "$10,173.20" "$17,540.00" "$10,524.00" "$17,540.00" "$17,540.00" "$17,540.00" N/A N/A 316.123 SUP Custom 27803010 316.123 - SPACER SPNL 7D 13MM SM 15X72MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$18,972.50" "$14,040.00" "$3,377.11" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$3,377.11" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$3,954.08" "$18,972.50" "$7,589.00" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$14,229.38" "$18,972.50" "$18,972.50" "$18,972.50" "$9,486.25" "$9,486.25" "$15,026.22" "$18,972.50" "$15,178.00" "$8,537.63" "$18,972.50" N/A "$11,004.05" "$18,972.50" "$11,383.50" "$18,972.50" "$18,972.50" "$18,972.50" N/A N/A 316.124 SUP Custom 27803010 316.124 - SPACER SPNL 7D 13MM SM 15X80MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$18,972.50" "$14,040.00" "$3,377.11" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$3,377.11" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$3,954.08" "$18,972.50" "$7,589.00" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$14,229.38" "$18,972.50" "$18,972.50" "$18,972.50" "$9,486.25" "$9,486.25" "$15,026.22" "$18,972.50" "$15,178.00" "$8,537.63" "$18,972.50" N/A "$11,004.05" "$18,972.50" "$11,383.50" "$18,972.50" "$18,972.50" "$18,972.50" N/A N/A 316.125 SUP Custom 27803010 316.125 - SPACER SPNL 16D 13MM SM 15X56MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$17,540.00" "$12,980.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,655.53" "$17,540.00" "$7,016.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$13,155.00" "$17,540.00" "$17,540.00" "$17,540.00" "$8,770.00" "$8,770.00" "$13,891.68" "$17,540.00" "$14,032.00" "$7,893.00" "$17,540.00" N/A "$10,173.20" "$17,540.00" "$10,524.00" "$17,540.00" "$17,540.00" "$17,540.00" N/A N/A 316.126 SUP Custom 27803010 316.126 - SPACER SPNL 16D 13MM SM 15X64MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$17,540.00" "$12,980.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,122.12" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$3,655.53" "$17,540.00" "$7,016.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$17,540.00" "$13,155.00" "$17,540.00" "$17,540.00" "$17,540.00" "$8,770.00" "$8,770.00" "$13,891.68" "$17,540.00" "$14,032.00" "$7,893.00" "$17,540.00" N/A "$10,173.20" "$17,540.00" "$10,524.00" "$17,540.00" "$17,540.00" "$17,540.00" N/A N/A 316.127 SUP Custom 27803010 316.127 - SPACER SPNL 16D 13MM SM 15X72MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$18,972.50" "$14,040.00" "$3,377.11" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$3,377.11" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$3,954.08" "$18,972.50" "$7,589.00" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$14,229.38" "$18,972.50" "$18,972.50" "$18,972.50" "$9,486.25" "$9,486.25" "$15,026.22" "$18,972.50" "$15,178.00" "$8,537.63" "$18,972.50" N/A "$11,004.05" "$18,972.50" "$11,383.50" "$18,972.50" "$18,972.50" "$18,972.50" N/A N/A 316.128 SUP Custom 27803010 316.128 - SPACER SPNL 16D 13MM SM 15X80MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$18,972.50" "$14,040.00" "$3,377.11" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$3,377.11" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$3,954.08" "$18,972.50" "$7,589.00" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$18,972.50" "$14,229.38" "$18,972.50" "$18,972.50" "$18,972.50" "$9,486.25" "$9,486.25" "$15,026.22" "$18,972.50" "$15,178.00" "$8,537.63" "$18,972.50" N/A "$11,004.05" "$18,972.50" "$11,383.50" "$18,972.50" "$18,972.50" "$18,972.50" N/A N/A 316.129 SUP Custom 27803010 316.129 - SPACER SPNL 0D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.13 SUP Custom 27203010 316.13 - BIT DRL 3MM .7MM 44.5MM NS JLTCH CPLNG SLF STP STRYK BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.13 SUP Custom 27803010 316.130 - SPACER SPNL 7D 13MM SM 15X20MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" $66.08 "$12,078.75" $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 "$12,078.75" $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A "$9,340.90" $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.131 SUP Custom 27803010 316.131 - SPACER SPNL 0D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.132 SUP Custom 27803010 316.132 - SPACER SPNL 7D 13MM SM 15X22MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$16,105.00" "$11,918.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$2,866.69" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$6,442.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$16,105.00" N/A "$9,340.90" "$16,105.00" "$9,663.00" "$16,105.00" "$16,105.00" "$16,105.00" N/A N/A 316.15 SUP Custom 27203010 316.15 - BIT DRILL .76MM 44.5MM 5MM J LATCH STOP COUPLING NONSTRL 1MM BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.18 SUP Custom 27203010 316.18 - BIT DRILL .76MM 44.5MM 8MM J LATCH STOP NONSTRL 1MM SCREW BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.201 SUP Custom 27803010 316.201 - SPACER SPNL 6D 21MM MED 23X32MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$18,017.50" "$13,333.00" "$3,207.12" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,207.12" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,755.05" "$18,017.50" "$7,207.00" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$13,513.13" "$18,017.50" "$18,017.50" "$18,017.50" "$9,008.75" "$9,008.75" "$14,269.86" "$18,017.50" "$14,414.00" "$8,107.88" "$18,017.50" N/A "$10,450.15" "$18,017.50" "$10,810.50" "$18,017.50" "$18,017.50" "$18,017.50" N/A N/A 316.202 SUP Custom 27803010 316.202 - SPACER SPNL 6D 21MM MED 23X34MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$18,017.50" "$13,333.00" "$3,207.12" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,207.12" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,755.05" "$18,017.50" "$7,207.00" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$13,513.13" "$18,017.50" "$18,017.50" "$18,017.50" "$9,008.75" "$9,008.75" "$14,269.86" "$18,017.50" "$14,414.00" "$8,107.88" "$18,017.50" N/A "$10,450.15" "$18,017.50" "$10,810.50" "$18,017.50" "$18,017.50" "$18,017.50" N/A N/A 316.203 SUP Custom 27803010 316.203 - SPACER SPNL 6D 21MM MED 23X38MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$19,447.50" "$14,391.00" "$3,461.66" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$3,461.66" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$4,053.07" "$19,447.50" "$7,779.00" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$14,585.63" "$19,447.50" "$19,447.50" "$19,447.50" "$9,723.75" "$9,723.75" "$15,402.42" "$19,447.50" "$15,558.00" "$8,751.38" "$19,447.50" N/A "$11,279.55" "$19,447.50" "$11,668.50" "$19,447.50" "$19,447.50" "$19,447.50" N/A N/A 316.204 SUP Custom 27803010 316.204 - SPACER SPNL -6D 21MM MED 23X46MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$19,807.50" "$14,658.00" "$3,525.74" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$3,525.74" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$4,128.10" "$19,807.50" "$7,923.00" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$14,855.63" "$19,807.50" "$19,807.50" "$19,807.50" "$9,903.75" "$9,903.75" "$15,687.54" "$19,807.50" "$15,846.00" "$8,913.38" "$19,807.50" N/A "$11,488.35" "$19,807.50" "$11,884.50" "$19,807.50" "$19,807.50" "$19,807.50" N/A N/A 316.205 SUP Custom 27803010 316.205 - SPACER SPNL 6D 21MM MED 23X56MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.206 SUP Custom 27803010 316.206 - SPACER SPNL -6D 21MM MED 23X64MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.207 SUP Custom 27803010 316.207 - SPACER SPNL 0D 21MM MED 23X32MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$18,017.50" "$13,333.00" "$3,207.12" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,207.12" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,755.05" "$18,017.50" "$7,207.00" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$13,513.13" "$18,017.50" "$18,017.50" "$18,017.50" "$9,008.75" "$9,008.75" "$14,269.86" "$18,017.50" "$14,414.00" "$8,107.88" "$18,017.50" N/A "$10,450.15" "$18,017.50" "$10,810.50" "$18,017.50" "$18,017.50" "$18,017.50" N/A N/A 316.208 SUP Custom 27803010 316.208 - SPACER SPNL 0D 21MM MED 23X34MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$18,017.50" "$13,333.00" "$3,207.12" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,207.12" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,755.05" "$18,017.50" "$7,207.00" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$13,513.13" "$18,017.50" "$18,017.50" "$18,017.50" "$9,008.75" "$9,008.75" "$14,269.86" "$18,017.50" "$14,414.00" "$8,107.88" "$18,017.50" N/A "$10,450.15" "$18,017.50" "$10,810.50" "$18,017.50" "$18,017.50" "$18,017.50" N/A N/A 316.209 SUP Custom 27803010 316.209 - SPACER SPNL 0D 21MM MED 23X38MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$19,447.50" "$14,391.00" "$3,461.66" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$3,461.66" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$4,053.07" "$19,447.50" "$7,779.00" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$14,585.63" "$19,447.50" "$19,447.50" "$19,447.50" "$9,723.75" "$9,723.75" "$15,402.42" "$19,447.50" "$15,558.00" "$8,751.38" "$19,447.50" N/A "$11,279.55" "$19,447.50" "$11,668.50" "$19,447.50" "$19,447.50" "$19,447.50" N/A N/A 316.21 SUP Custom 27803010 316.210 - SPACER SPNL 0D 21MM MED 23X46MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$19,807.50" "$14,658.00" "$3,525.74" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$3,525.74" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$4,128.10" "$19,807.50" "$7,923.00" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$14,855.63" "$19,807.50" "$19,807.50" "$19,807.50" "$9,903.75" "$9,903.75" "$15,687.54" "$19,807.50" "$15,846.00" "$8,913.38" "$19,807.50" N/A "$11,488.35" "$19,807.50" "$11,884.50" "$19,807.50" "$19,807.50" "$19,807.50" N/A N/A 316.211 SUP Custom 27803010 316.211 - SPACER SPNL 0D 21MM MED 23X56MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.212 SUP Custom 27803010 316.212 - SPACER SPNL 0D 21MM MED 23X64MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.213 SUP Custom 27803010 316.213 - SPACER SPNL 8D 21MM MED 23X32MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$18,017.50" "$13,333.00" "$3,207.12" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,207.12" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,755.05" "$18,017.50" "$7,207.00" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$13,513.13" "$18,017.50" "$18,017.50" "$18,017.50" "$9,008.75" "$9,008.75" "$14,269.86" "$18,017.50" "$14,414.00" "$8,107.88" "$18,017.50" N/A "$10,450.15" "$18,017.50" "$10,810.50" "$18,017.50" "$18,017.50" "$18,017.50" N/A N/A 316.214 SUP Custom 27803010 316.214 - BIT DRILL 14MM STOP MINI .76MM 44.5MM 14MM MINI QUICK BOTH IP/OP $371.50 $275.00 $215.47 "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,207.12" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,755.05" "$18,017.50" "$7,207.00" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" $278.63 "$18,017.50" "$18,017.50" "$18,017.50" "$9,008.75" "$9,008.75" "$14,269.86" "$18,017.50" "$14,414.00" "$8,107.88" "$18,017.50" N/A $215.47 "$18,017.50" "$10,810.50" "$18,017.50" "$18,017.50" "$18,017.50" N/A N/A 316.214 SUP Custom 27803010 316.214 - SPACER SPNL 8D 21MM MED 23X34MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$18,017.50" "$13,333.00" "$3,207.12" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,207.12" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$3,755.05" "$18,017.50" "$7,207.00" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$18,017.50" "$13,513.13" "$18,017.50" "$18,017.50" "$18,017.50" "$9,008.75" "$9,008.75" "$14,269.86" "$18,017.50" "$14,414.00" "$8,107.88" "$18,017.50" N/A "$10,450.15" "$18,017.50" "$10,810.50" "$18,017.50" "$18,017.50" "$18,017.50" N/A N/A 316.215 SUP Custom 27803010 316.215 - SPACER SPNL 8D 21MM MED 23X38MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$19,447.50" "$14,391.00" "$3,461.66" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$3,461.66" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$4,053.07" "$19,447.50" "$7,779.00" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$19,447.50" "$14,585.63" "$19,447.50" "$19,447.50" "$19,447.50" "$9,723.75" "$9,723.75" "$15,402.42" "$19,447.50" "$15,558.00" "$8,751.38" "$19,447.50" N/A "$11,279.55" "$19,447.50" "$11,668.50" "$19,447.50" "$19,447.50" "$19,447.50" N/A N/A 316.216 SUP Custom 27803010 316.216 - SPACER SPNL 8D 21MM MED 23X46MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$19,807.50" "$14,658.00" "$3,525.74" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$3,525.74" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$4,128.10" "$19,807.50" "$7,923.00" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$19,807.50" "$14,855.63" "$19,807.50" "$19,807.50" "$19,807.50" "$9,903.75" "$9,903.75" "$15,687.54" "$19,807.50" "$15,846.00" "$8,913.38" "$19,807.50" N/A "$11,488.35" "$19,807.50" "$11,884.50" "$19,807.50" "$19,807.50" "$19,807.50" N/A N/A 316.217 SUP Custom 27803010 316.217 - SPACER SPNL 8D 21MM MED 23X56MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.218 SUP Custom 27803010 316.218 - SPACER SPNL 8D 21MM MED 23X64MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.219 SUP Custom 27803010 316.219 - SPACER SPNL 8D 21MM MED 23X73MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.22 SUP Custom 27803010 316.220 - SPACER SPNL 8D 21MM MED 23X42MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.221 SUP Custom 27803010 316.221 - SPACER SPNL 0D 21MM MED 23X73MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.222 SUP Custom 27803010 316.222 - SPACER SPNL 0D 21MM MED 23X82MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$21,832.50" "$16,156.00" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$3,886.19" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$4,550.13" "$21,832.50" "$8,733.00" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$21,832.50" "$16,374.38" "$21,832.50" "$21,832.50" "$21,832.50" "$10,916.25" "$10,916.25" "$17,291.34" "$21,832.50" "$17,466.00" "$9,824.63" "$21,832.50" N/A "$12,662.85" "$21,832.50" "$13,099.50" "$21,832.50" "$21,832.50" "$21,832.50" N/A N/A 316.23 SUP Custom 27203010 316.23 - BIT DRILL 3MM STOP .7MM 44.5MM 3MM MINI QUICK COUPLING SELF BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.232 SUP Custom 27203010 316.232 - BIT DRILL UNIVERSAL 1MM 60MM UNIVERSAL HALL COUPLING NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.235 SUP Custom 27203010 316.235 - BIT DRL 1MM 60MM NS JLTCH CPLNG WO SLF STP STRYK BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.236 SUP Custom 27203010 316.236 - BIT DRL 1MM 60MM NS JLTCH CPLNG STRYK MDLR HND SYS BOTH IP/OP $126.00 $93.00 $22.39 $127.95 $125.80 $125.80 $125.80 $125.80 $125.80 $125.80 $22.39 $125.80 $125.80 $93.37 $93.37 $96.97 $65.54 $26.22 $125.80 $51.18 $125.80 $125.80 $127.95 $125.80 $125.80 $94.50 $125.80 $125.80 $125.80 $62.90 $62.90 $99.63 $125.80 $100.64 $81.77 $125.80 N/A $73.08 $125.80 $75.48 $125.80 $125.80 $125.80 N/A N/A 316.238 SUP Custom 27203010 316.238 - BIT DRILL MINI 1MM 50MM MINI QUICK COUPLING NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.25 SUP Custom 27203010 316.25 - BIT DRILL 5MM STOP MINI .76MM 44.5MM 5MM MINI QUICK COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.28 SUP Custom 27203010 316.28 - BIT DRILL 8MM STOP QUICK COUPLING NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.286 SUP Custom 27203010 316.286 - BIT DRILL MINI .76MM 44.5MM 6MM MINI QUICK COUPLING STOP BOTH IP/OP $278.50 $206.00 $49.54 $283.05 $278.33 $278.33 $278.33 $278.33 $278.33 $278.33 $49.54 $278.33 $278.33 $206.58 $206.58 $214.54 $145.01 $58.01 $278.33 $113.22 $278.33 $278.33 $283.05 $278.33 $278.33 $208.88 $278.33 $278.33 $278.33 $139.17 $139.17 $220.44 $278.33 $222.66 $180.91 $278.33 N/A $161.53 $278.33 $167.00 $278.33 $278.33 $278.33 N/A N/A 316.288 SUP Custom 27203010 316.288 - BIT DRILL MINI .76MM 44.5MM 8MM QUICK COUPLING STOP LCP BOTH IP/OP $278.50 $206.00 $49.54 $283.05 $278.33 $278.33 $278.33 $278.33 $278.33 $278.33 $49.54 $278.33 $278.33 $206.58 $206.58 $214.54 $145.01 $58.01 $278.33 $113.22 $278.33 $278.33 $283.05 $278.33 $278.33 $208.88 $278.33 $278.33 $278.33 $139.17 $139.17 $220.44 $278.33 $222.66 $180.91 $278.33 N/A $161.53 $278.33 $167.00 $278.33 $278.33 $278.33 N/A N/A 316.29 SUP Custom 27203010 316.290 - BIT DRILL MINI .76MM 10MM QUICK COUPLING STAINLESS STEEL BOTH IP/OP $270.50 $200.00 $48.10 $283.05 $270.23 $270.23 $270.23 $270.23 $270.23 $270.23 $48.10 $270.23 $270.23 $200.56 $200.56 $208.29 $140.79 $56.32 $270.23 $113.22 $270.23 $270.23 $283.05 $270.23 $270.23 $202.88 $270.23 $270.23 $270.23 $135.12 $135.12 $214.02 $270.23 $216.18 $175.65 $270.23 N/A $156.89 $270.23 $162.14 $270.23 $270.23 $270.23 N/A N/A 316.292 SUP Custom 27203010 316.292 - BIT DRILL MINI .76MM 44.5MM 12MM MINI QUICK COUPLING STOP BOTH IP/OP $278.50 $206.00 $49.54 $283.05 $278.33 $278.33 $278.33 $278.33 $278.33 $278.33 $49.54 $278.33 $278.33 $206.58 $206.58 $214.54 $145.01 $58.01 $278.33 $113.22 $278.33 $278.33 $283.05 $278.33 $278.33 $208.88 $278.33 $278.33 $278.33 $139.17 $139.17 $220.44 $278.33 $222.66 $180.91 $278.33 N/A $161.53 $278.33 $167.00 $278.33 $278.33 $278.33 N/A N/A 316.294 SUP Custom 27203010 316.294 - BIT DRILL .76MM 44.5MM 14MM MINI QUICK COULPING STOP NONSTRL BOTH IP/OP $278.50 $206.00 $49.54 $283.05 $278.33 $278.33 $278.33 $278.33 $278.33 $278.33 $49.54 $278.33 $278.33 $206.58 $206.58 $214.54 $145.01 $58.01 $278.33 $113.22 $278.33 $278.33 $283.05 $278.33 $278.33 $208.88 $278.33 $278.33 $278.33 $139.17 $139.17 $220.44 $278.33 $222.66 $180.91 $278.33 N/A $161.53 $278.33 $167.00 $278.33 $278.33 $278.33 N/A N/A 316.301 SUP Custom 27803010 316.301 - SPACER SPNL 0D 21MM S/MED 23X23MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$17,062.50" "$12,626.00" "$3,037.13" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$3,037.13" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$3,556.01" "$17,062.50" "$6,825.00" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$12,796.88" "$17,062.50" "$17,062.50" "$17,062.50" "$8,531.25" "$8,531.25" "$13,513.50" "$17,062.50" "$13,650.00" "$7,678.13" "$17,062.50" N/A "$9,896.25" "$17,062.50" "$10,237.50" "$17,062.50" "$17,062.50" "$17,062.50" N/A N/A 316.302 SUP Custom 27803010 316.302 - SPACER SPNL 0D 21MM S/MED 23X24MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$17,062.50" "$12,626.00" "$3,037.13" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$3,037.13" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$3,556.01" "$17,062.50" "$6,825.00" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$12,796.88" "$17,062.50" "$17,062.50" "$17,062.50" "$8,531.25" "$8,531.25" "$13,513.50" "$17,062.50" "$13,650.00" "$7,678.13" "$17,062.50" N/A "$9,896.25" "$17,062.50" "$10,237.50" "$17,062.50" "$17,062.50" "$17,062.50" N/A N/A 316.303 SUP Custom 27803010 316.303 - SPACER SPNL 0D 21MM S/MED 23X30MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$17,062.50" "$12,626.00" "$3,037.13" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$3,037.13" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$3,556.01" "$17,062.50" "$6,825.00" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$12,796.88" "$17,062.50" "$17,062.50" "$17,062.50" "$8,531.25" "$8,531.25" "$13,513.50" "$17,062.50" "$13,650.00" "$7,678.13" "$17,062.50" N/A "$9,896.25" "$17,062.50" "$10,237.50" "$17,062.50" "$17,062.50" "$17,062.50" N/A N/A 316.304 SUP Custom 27803010 316.304 - SPACER SPNL 0D 21MM S/MED 23X23MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$17,062.50" "$12,626.00" "$3,037.13" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$3,037.13" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$3,556.01" "$17,062.50" "$6,825.00" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$12,796.88" "$17,062.50" "$17,062.50" "$17,062.50" "$8,531.25" "$8,531.25" "$13,513.50" "$17,062.50" "$13,650.00" "$7,678.13" "$17,062.50" N/A "$9,896.25" "$17,062.50" "$10,237.50" "$17,062.50" "$17,062.50" "$17,062.50" N/A N/A 316.305 SUP Custom 27803010 316.305 - SPACER SPNL 0D 21MM S/MED 23X24MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$17,062.50" "$12,626.00" "$3,037.13" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$3,037.13" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$3,556.01" "$17,062.50" "$6,825.00" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$17,062.50" "$12,796.88" "$17,062.50" "$17,062.50" "$17,062.50" "$8,531.25" "$8,531.25" "$13,513.50" "$17,062.50" "$13,650.00" "$7,678.13" "$17,062.50" N/A "$9,896.25" "$17,062.50" "$10,237.50" "$17,062.50" "$17,062.50" "$17,062.50" N/A N/A 316.306 SUP Custom 27203010 316.306 - BIT DRL 6MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR MDLR BOTH IP/OP $278.50 $206.00 $49.54 $283.05 $278.33 $278.33 $278.33 $278.33 $278.33 $278.33 $49.54 $278.33 $278.33 $206.58 $206.58 $214.54 $145.01 $58.01 $278.33 $113.22 $278.33 $278.33 $283.05 $278.33 $278.33 $208.88 $278.33 $278.33 $278.33 $139.17 $139.17 $220.44 $278.33 $222.66 $180.91 $278.33 N/A $161.53 $278.33 $167.00 $278.33 $278.33 $278.33 N/A N/A 316.308 SUP Custom 27203010 316.308 - BIT DRILL 8MM STOP .76MM 44.5MM J LATCH NONSTRL BOTH IP/OP $278.50 $206.00 $49.54 $283.05 $278.33 $278.33 $278.33 $278.33 $278.33 $278.33 $49.54 $278.33 $278.33 $206.58 $206.58 $214.54 $145.01 $58.01 $278.33 $113.22 $278.33 $278.33 $283.05 $278.33 $278.33 $208.88 $278.33 $278.33 $278.33 $139.17 $139.17 $220.44 $278.33 $222.66 $180.91 $278.33 N/A $161.53 $278.33 $167.00 $278.33 $278.33 $278.33 N/A N/A 316.31 SUP Custom 27203010 316.310 - BIT DRL 10MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR BOTH IP/OP $270.50 $200.00 $48.10 $283.05 $270.23 $270.23 $270.23 $270.23 $270.23 $270.23 $48.10 $270.23 $270.23 $200.56 $200.56 $208.29 $140.79 $56.32 $270.23 $113.22 $270.23 $270.23 $283.05 $270.23 $270.23 $202.88 $270.23 $270.23 $270.23 $135.12 $135.12 $214.02 $270.23 $216.18 $175.65 $270.23 N/A $156.89 $270.23 $162.14 $270.23 $270.23 $270.23 N/A N/A 316.312 SUP Custom 27203010 316.312 - BIT DRL 12MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR BOTH IP/OP $278.50 $206.00 $49.54 $283.05 $278.33 $278.33 $278.33 $278.33 $278.33 $278.33 $49.54 $278.33 $278.33 $206.58 $206.58 $214.54 $145.01 $58.01 $278.33 $113.22 $278.33 $278.33 $283.05 $278.33 $278.33 $208.88 $278.33 $278.33 $278.33 $139.17 $139.17 $220.44 $278.33 $222.66 $180.91 $278.33 N/A $161.53 $278.33 $167.00 $278.33 $278.33 $278.33 N/A N/A 316.314 SUP Custom 27203010 316.314 - BIT DRL 14MM .76MM 44.5MM NS JLTCH CPLNG SLF STP 1MM SCR BOTH IP/OP $278.50 $206.00 $49.54 $283.05 $278.33 $278.33 $278.33 $278.33 $278.33 $278.33 $49.54 $278.33 $278.33 $206.58 $206.58 $214.54 $145.01 $58.01 $278.33 $113.22 $278.33 $278.33 $283.05 $278.33 $278.33 $208.88 $278.33 $278.33 $278.33 $139.17 $139.17 $220.44 $278.33 $222.66 $180.91 $278.33 N/A $161.53 $278.33 $167.00 $278.33 $278.33 $278.33 N/A N/A 316.33 SUP Custom 27203010 316.33 - BIT DRILL 3MM STOP MINI .7MM 17MM 3MM MINI QUICK COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.332 SUP Custom 27203010 316.332 - BIT DRILL UNIVERSAL 1.3MM 65MM UNIVERSAL HALL COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.335 SUP Custom 27203010 316.335 - BIT DRILL 1.3MM 65MM J LATCH COUPLING NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.338 SUP Custom 27203010 316.338 - BIT DRILL MINI 1.3MM 55MM MINI QUICK COUPLING NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.35 SUP Custom 27203010 316.35 - BIT DRILL 5MM STOP MINI .76MM 19MM 5MM MINI QUICK COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.38 SUP Custom 27203010 316.38 - BIT DRILL 8MM STOP MINI .76MM 22MM 8MM MINI QUICK COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.396 SUP Custom 27203010 316.396 - BIT DRILL MINI 1MM 50MM QUICK COUPLING STAINLESS STEEL BOTH IP/OP $139.50 $103.00 $24.77 $141.55 $139.18 $139.18 $139.18 $139.18 $139.18 $139.18 $24.77 $139.18 $139.18 $103.30 $103.30 $107.28 $72.51 $29.01 $139.18 $56.62 $139.18 $139.18 $141.55 $139.18 $139.18 $104.63 $139.18 $139.18 $139.18 $69.59 $69.59 $110.23 $139.18 $111.34 $90.47 $139.18 N/A $80.91 $139.18 $83.51 $139.18 $139.18 $139.18 N/A N/A 316.401 SUP Custom 27803010 316.401 - SPACER SPNL 0D 25MM MED LG 30X28MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$19,922.50" "$14,743.00" "$3,546.21" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$3,546.21" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$4,152.07" "$19,922.50" "$7,969.00" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$14,941.88" "$19,922.50" "$19,922.50" "$19,922.50" "$9,961.25" "$9,961.25" "$15,778.62" "$19,922.50" "$15,938.00" "$8,965.13" "$19,922.50" N/A "$11,555.05" "$19,922.50" "$11,953.50" "$19,922.50" "$19,922.50" "$19,922.50" N/A N/A 316.402 SUP Custom 27803010 316.402 - BIT DRILL MINI 1.3MM 55MM QUICK COUPLING STAINLESS STEEL BOTH IP/OP $139.50 $103.00 $80.91 "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$3,546.21" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$4,152.07" "$19,922.50" "$7,969.00" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" $104.63 "$19,922.50" "$19,922.50" "$19,922.50" "$9,961.25" "$9,961.25" "$15,778.62" "$19,922.50" "$15,938.00" "$8,965.13" "$19,922.50" N/A $80.91 "$19,922.50" "$11,953.50" "$19,922.50" "$19,922.50" "$19,922.50" N/A N/A 316.402 SUP Custom 27803010 316.402 - SPACER SPNL 0D 25MM MED LG 30X35MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$19,922.50" "$14,743.00" "$3,546.21" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$3,546.21" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$4,152.07" "$19,922.50" "$7,969.00" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$14,941.88" "$19,922.50" "$19,922.50" "$19,922.50" "$9,961.25" "$9,961.25" "$15,778.62" "$19,922.50" "$15,938.00" "$8,965.13" "$19,922.50" N/A "$11,555.05" "$19,922.50" "$11,953.50" "$19,922.50" "$19,922.50" "$19,922.50" N/A N/A 316.403 SUP Custom 27803010 316.403 - BIT DRILL 1.3MM 65MM J LATCH NONSTRL BOTH IP/OP $139.50 $103.00 $24.77 $141.55 $139.18 $139.18 $139.18 $139.18 $139.18 $139.18 $24.77 $139.18 $139.18 $139.18 $139.18 $139.18 $139.18 $29.01 $139.18 $56.62 $139.18 $139.18 $141.55 $139.18 $139.18 $104.63 $139.18 $139.18 $139.18 $69.59 $69.59 $110.23 $139.18 $111.34 $62.63 $139.18 N/A $80.91 $139.18 $83.51 $139.18 $139.18 $139.18 N/A N/A 316.403 SUP Custom 27803010 316.403 - SPACER SPNL 0D 25MM MED LG 30X39MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$22,070.00" "$16,332.00" $24.77 "$16,552.50" $139.18 $139.18 $139.18 $139.18 $139.18 $139.18 $24.77 $139.18 $139.18 $139.18 $139.18 $139.18 $139.18 $29.01 $139.18 $56.62 $139.18 $139.18 $141.55 $139.18 $139.18 "$16,552.50" $139.18 $139.18 $139.18 $69.59 $69.59 $110.23 $139.18 $111.34 $62.63 $139.18 N/A "$12,800.60" $139.18 $83.51 $139.18 $139.18 $139.18 N/A N/A 316.404 SUP Custom 27803010 316.404 - SPACER SPNL 0D 25MM MED LG 30X45MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$22,070.00" "$16,332.00" "$3,928.46" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$3,928.46" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$4,599.63" "$22,070.00" "$8,828.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$16,552.50" "$22,070.00" "$22,070.00" "$22,070.00" "$11,035.00" "$11,035.00" "$17,479.44" "$22,070.00" "$17,656.00" "$9,931.50" "$22,070.00" N/A "$12,800.60" "$22,070.00" "$13,242.00" "$22,070.00" "$22,070.00" "$22,070.00" N/A N/A 316.405 SUP Custom 27803010 316.405 - SPACER SPNL 0D 25MM MED LG 30X55MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$22,785.00" "$16,861.00" "$4,055.73" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$4,055.73" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$4,748.64" "$22,785.00" "$9,114.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$17,088.75" "$22,785.00" "$22,785.00" "$22,785.00" "$11,392.50" "$11,392.50" "$18,045.72" "$22,785.00" "$18,228.00" "$10,253.25" "$22,785.00" N/A "$13,215.30" "$22,785.00" "$13,671.00" "$22,785.00" "$22,785.00" "$22,785.00" N/A N/A 316.406 SUP Custom 27803010 316.406 - SPACER SPNL 0D 25MM MED LG 30X61MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$22,785.00" "$16,861.00" "$4,055.73" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$4,055.73" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$4,748.64" "$22,785.00" "$9,114.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$17,088.75" "$22,785.00" "$22,785.00" "$22,785.00" "$11,392.50" "$11,392.50" "$18,045.72" "$22,785.00" "$18,228.00" "$10,253.25" "$22,785.00" N/A "$13,215.30" "$22,785.00" "$13,671.00" "$22,785.00" "$22,785.00" "$22,785.00" N/A N/A 316.407 SUP Custom 27803010 316.407 - SPACER SPNL 3D 25MM MED LG 30X28MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$19,922.50" "$14,743.00" "$3,546.21" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$3,546.21" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$4,152.07" "$19,922.50" "$7,969.00" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$14,941.88" "$19,922.50" "$19,922.50" "$19,922.50" "$9,961.25" "$9,961.25" "$15,778.62" "$19,922.50" "$15,938.00" "$8,965.13" "$19,922.50" N/A "$11,555.05" "$19,922.50" "$11,953.50" "$19,922.50" "$19,922.50" "$19,922.50" N/A N/A 316.408 SUP Custom 27803010 316.408 - SPACER SPNL 3D 25MM MED LG 30X35MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$19,922.50" "$14,743.00" "$3,546.21" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$3,546.21" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$4,152.07" "$19,922.50" "$7,969.00" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$14,941.88" "$19,922.50" "$19,922.50" "$19,922.50" "$9,961.25" "$9,961.25" "$15,778.62" "$19,922.50" "$15,938.00" "$8,965.13" "$19,922.50" N/A "$11,555.05" "$19,922.50" "$11,953.50" "$19,922.50" "$19,922.50" "$19,922.50" N/A N/A 316.409 SUP Custom 27803010 316.409 - SPACER SPNL 3D 25MM MED LG 30X39MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$22,070.00" "$16,332.00" "$3,928.46" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$3,928.46" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$4,599.63" "$22,070.00" "$8,828.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$16,552.50" "$22,070.00" "$22,070.00" "$22,070.00" "$11,035.00" "$11,035.00" "$17,479.44" "$22,070.00" "$17,656.00" "$9,931.50" "$22,070.00" N/A "$12,800.60" "$22,070.00" "$13,242.00" "$22,070.00" "$22,070.00" "$22,070.00" N/A N/A 316.41 SUP Custom 27803010 316.410 - SPACER SPNL 3D 25MM MED LG 30X45MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$22,070.00" "$16,332.00" "$3,928.46" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$3,928.46" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$4,599.63" "$22,070.00" "$8,828.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$22,070.00" "$16,552.50" "$22,070.00" "$22,070.00" "$22,070.00" "$11,035.00" "$11,035.00" "$17,479.44" "$22,070.00" "$17,656.00" "$9,931.50" "$22,070.00" N/A "$12,800.60" "$22,070.00" "$13,242.00" "$22,070.00" "$22,070.00" "$22,070.00" N/A N/A 316.411 SUP Custom 27803010 316.411 - SPACER SPNL 3D 25MM MED LG 30X55MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$22,785.00" "$16,861.00" "$4,055.73" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$4,055.73" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$4,748.64" "$22,785.00" "$9,114.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$17,088.75" "$22,785.00" "$22,785.00" "$22,785.00" "$11,392.50" "$11,392.50" "$18,045.72" "$22,785.00" "$18,228.00" "$10,253.25" "$22,785.00" N/A "$13,215.30" "$22,785.00" "$13,671.00" "$22,785.00" "$22,785.00" "$22,785.00" N/A N/A 316.412 SUP Custom 27803010 316.412 - SPACER SPNL 3D 25MM MED LG 30X61MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$22,785.00" "$16,861.00" "$4,055.73" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$4,055.73" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$4,748.64" "$22,785.00" "$9,114.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$22,785.00" "$17,088.75" "$22,785.00" "$22,785.00" "$22,785.00" "$11,392.50" "$11,392.50" "$18,045.72" "$22,785.00" "$18,228.00" "$10,253.25" "$22,785.00" N/A "$13,215.30" "$22,785.00" "$13,671.00" "$22,785.00" "$22,785.00" "$22,785.00" N/A N/A 316.413 SUP Custom 27803010 316.413 - SPACER SPNL 3D 25MM MED LG 30X28MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$19,922.50" "$14,743.00" "$3,546.21" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$3,546.21" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$4,152.07" "$19,922.50" "$7,969.00" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$14,941.88" "$19,922.50" "$19,922.50" "$19,922.50" "$9,961.25" "$9,961.25" "$15,778.62" "$19,922.50" "$15,938.00" "$8,965.13" "$19,922.50" N/A "$11,555.05" "$19,922.50" "$11,953.50" "$19,922.50" "$19,922.50" "$19,922.50" N/A N/A 316.414 SUP Custom 27803010 316.414 - SPACER SPNL 3D 25MM MED LG 30X34MM NS LF XPAND-R RDLCNT SLF BOTH IP/OP "$19,922.50" "$14,743.00" "$3,546.21" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$3,546.21" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$4,152.07" "$19,922.50" "$7,969.00" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$19,922.50" "$14,941.88" "$19,922.50" "$19,922.50" "$19,922.50" "$9,961.25" "$9,961.25" "$15,778.62" "$19,922.50" "$15,938.00" "$8,965.13" "$19,922.50" N/A "$11,555.05" "$19,922.50" "$11,953.50" "$19,922.50" "$19,922.50" "$19,922.50" N/A N/A 316.441 SUP Custom 27203010 316.441 - BIT DRL 4MM 1MM 44.5MM NS U HL CPLNG SLF STP .5MM SCR BOTH IP/OP $342.00 $253.00 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 316.442 SUP Custom 27203010 316.442 - BIT DRL 6MM 1MM 44.5MM NS U HL CPLNG SLF STP .5MM SCR BOTH IP/OP $342.00 $253.00 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 316.443 SUP Custom 27203010 316.443 - BIT DRL 8MM 1MM 44.5MM NS U HL CPLNG SLF STP .5MM SCR BOTH IP/OP $342.00 $253.00 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 316.446 SUP Custom 27203010 316.446 - BIT DRILL 1MM 44.5MM 4MM J LATCH STOP STAINLESS STEEL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.447 SUP Custom 27203010 316.447 - BIT DRILL 1MM 44.5MM 6MM STOP J LATCH END NONSTRL 1.3MM BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.448 SUP Custom 27203010 316.448 - BIT DRILL 1MM 44.5MM 8MM J LATCH STOP NONSTRL 1.3MM SCREW BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.451 SUP Custom 27203010 316.451 - BIT DRILL 4MM STOP MINI 1MM 44.5MM 4MM MINI QUICK COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.452 SUP Custom 27203010 316.452 - BIT DRILL 6MM STOP MINI 1MM 44.5MM 6MM MINI QUICK COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.453 SUP Custom 27203010 316.453 - BIT DRILL 8MM STOP MINI 1MM 44.5MM 8MM MINI QUICK COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.605 SUP Custom 27203010 316.605 - BIT DRILL 5MM STOP .76MM 52MM 5MM HEXAGONAL COULPLING STOP BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.608 SUP Custom 27203010 316.608 - BIT DRILL 8MM STOP .76MM 52MM 8MM HEXAGONAL COULPLING STOP BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.614 SUP Custom 27203010 316.614 - BIT DRILL 4MM STOP 1MM 52MM 4MM HEX COUPLING STOP NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.616 SUP Custom 27203010 316.616 - BIT DRILL 6MM STOP 1MM 52MM 6MM HEX COUPLING STOP NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.618 SUP Custom 27203010 316.618 - BIT DRILL 8MM STOP 1MM 52MM 8MM HEX COUPLING STOP NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.624 SUP Custom 27203010 316.624 - BIT DRILL 1.1MM 52MM 4MM HEX COUPLING STOP NONSTRL 1.5MM BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.626 SUP Custom 27203010 316.626 - BIT DRILL 1.1MM 52MM 6MM HEX COUPLING STOP NONSTRL 1.5MM BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.628 SUP Custom 27203010 316.628 - BIT DRILL 1.1MM 52MM 8MM HEX COUPLING STOP NONSTRL 1.5MM BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.632 SUP Custom 27203010 316.632 - BIT DRILL 1.1MM 52MM 12MM HEX COUPLING STOP NONSTRL 1.5MM BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.644 SUP Custom 27203010 316.644 - BIT DRILL 4MM STOP 1.5MM 52MM 4MM HEX COUPLING STOP NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.646 SUP Custom 27203010 316.646 - BIT DRILL 6MM STOP 1.5MM 52MM 6MM HEX COUPLING STOP NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.648 SUP Custom 27203010 316.648 - BIT DRILL 8MM STOP 1.5MM 52MM 8MM HEX COUPLING STOP NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 316.652 SUP Custom 27203010 316.652 - BIT DRILL 12MM STOP 1.5MM 52MM 12MM HEX COUPLING STOP BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.04 SUP Custom 27203010 317.04 - BIT DRILL UNIVERSAL 1.1MM 44.5MM 4MM UNIVERSAL HALL COUPLING BOTH IP/OP $342.00 $253.00 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 317.06 SUP Custom 27203010 317.06 - BIT DRILL UNIVERSAL 1.1MM 44.5MM 6MM UNIVERSAL HALL COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.08 SUP Custom 27203010 317.08 - BIT DRILL 8MM STOP UNIVERSAL 1.1MM 44.5MM HALL COUPLING BOTH IP/OP $342.00 $253.00 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 317.106 SUP Custom 27203010 317.106 - BIT DRILL 6MM STOP MINI 1.1MM 20MM 6MM STOP MINI QUICK BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 N/A $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A 317.112 SUP Custom 27203010 317.112 - BIT DRILL 12MM STOP MINI 1.1MM 26MM 12MM STOP MINI QUICK BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 N/A $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A 317.118 SUP Custom 27203010 317.118 - BIT DRILL 18MM STOP MINI 1.1MM 32MM 18MM STOP MINI QUICK BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 N/A $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A 317.12 SUP Custom 27203010 317.12 - BIT DRILL UNIVERSAL 1.1MM 44.5MM 12MM HALL COUPLING SELF BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.14 SUP Custom 27203010 317.14 - BIT DRL 4MM 1.1MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.16 SUP Custom 27203010 317.16 - BIT DRL 6MM 1.1MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.18 SUP Custom 27203010 317.18 - BIT DRL 8MM 1.1MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.22 SUP Custom 27203010 317.22 - BIT DRL 12MM 1.1MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.232 SUP Custom 27203010 317.232 - BIT DRILL UNIVERSAL 1.1MM 65MM UNIVERSAL HALL COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.235 SUP Custom 27203010 317.235 - BIT DRILL 1.1MM 65MM 40MM J LATCH COUPLING STAINLESS STEEL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.238 SUP Custom 27203010 317.238 - BIT DRILL MINI 1.1MM 55MM MINI QUICK COUPLING NONSTRL 1.5MM BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.24 SUP Custom 27203010 317.24 - BIT DRILL 4MM STOP MINI 1.1MM 44.5MM 4MM SELF STOP MINI BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.26 SUP Custom 27203010 317.26 - BIT DRILL 6MM STOP MINI 1.1MM 44.5MM 6MM SELF STOP MINI BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.28 SUP Custom 27203010 317.28 - BIT DRILL 8MM STOP MINI 1.1MM 44.5MM 8MM SELF STOP MINI BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.32 SUP Custom 27203010 317.32 - BIT DRILL 12MM STOP MINI 1.1MM 44.5MM 12MM SELF STOP MINI BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.332 SUP Custom 27203010 317.332 - BIT DRILL UNIVERSAL 1.1MM 110MM UNIVERSAL HALL COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.335 SUP Custom 27203010 317.335 - BIT DRILL 1.1MM 110MM J LATCH COUPLING NONSTRL 1/1.5MM SCREW BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.338 SUP Custom 27203010 317.338 - BIT DRILL MINI 1.1MM 110MM MINI QUICK COUPLING NONSTRL 1.5MM BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.432 SUP Custom 27203010 317.432 - BIT DRILL UNIVERSAL 1.5MM 85MM UNIVERSAL HALL COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.435 SUP Custom 27203010 317.435 - BIT DRL 1.5MM 85MM NS JLTCH CPLNG WO SLF STP 1/1.5MM SCR BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.438 SUP Custom 27203010 317.438 - BIT DRILL MINI 1.5MM 75MM MINI QUICK COUPLING NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.452 SUP Custom 27203010 317.452 - BIT DRILL UNIVERSAL 2MM 100MM UNIVERSAL HALL COUPLING BOTH IP/OP $342.00 $253.00 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 317.458 SUP Custom 27203010 317.458 - BIT DRILL MINI 2MM 90MM MINI QUICK COUPLING NONSTRL BOTH IP/OP $342.00 $253.00 $60.88 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $342.00 $60.88 $342.00 $342.00 $253.83 $253.83 $263.61 $178.18 $71.28 $342.00 $136.80 $342.00 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $222.30 $342.00 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 317.506 SUP Custom 27203010 317.506 - BIT DRILL 6MM STOP MINI 1.5MM 20MM 6MM STOP MINI QUICK BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 N/A $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A 317.512 SUP Custom 27203010 317.512 - BIT DRILL 12MM STOP MINI 1.5MM 26MM 12MM STOP MINI QUICK BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 N/A $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A 317.518 SUP Custom 27203010 317.518 - BIT DRILL 18MM STOP MINI 1.5MM 32MM 18MM STOP MINI QUICK BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 N/A $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A 317.54 SUP Custom 27203010 317.54 - BIT DRILL UNIVERSAL 1MM 44.5MM 4MM HALL COUPLING STOP BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.56 SUP Custom 27203010 317.56 - BIT DRILL UNIVERSAL 1.5MM 44.5MM 6MM SELF STOP HALL COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.58 SUP Custom 27203010 317.58 - BIT DRILL 8MM STOP UNIVERSAL 1.5MM 44.5MM 8MM SELF STOP BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.62 SUP Custom 27203010 317.62 - BIT DRILL 12MM STOP UNIVERSAL 1.5MM 44.5MM 12MM SELF STOP BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.64 SUP Custom 27203010 317.64 - BIT DRL 4MM 1.5MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.66 SUP Custom 27203010 317.66 - BIT DRL 6MM 1.5MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.68 SUP Custom 27203010 317.68 - BIT DRL 8MM 1.5MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.72 SUP Custom 27203010 317.72 - BIT DRL 12MM 1.5MM 44.5MM NS JLTCH CPLNG SLF STP 1/1.5MM SCR BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.74 SUP Custom 27203010 317.74 - BIT DRILL 4MM STOP MINI 1.5MM 44.5MM 4MM SELF STOP MINI BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.76 SUP Custom 27203010 317.76 - BIT DRILL 6MM STOP MINI 1.5MM 44.5MM 6MM SELF STOP MINI BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.78 SUP Custom 27203010 317.78 - BIT DRILL UNIVERSAL 1.5MM 44.5MM 8MM SELF STOP HALL COUPLING BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.781 SUP Custom 27203010 317.781 - BIT DRILL 4MM STOP 1.5MM 91MM GUIDE NONSTRL BOTH IP/OP $224.00 $166.00 $39.87 $224.00 $224.00 $224.00 $224.00 $224.00 $224.00 $224.00 $39.87 $224.00 $224.00 $166.25 $166.25 $172.66 $116.70 $46.68 $224.00 $89.60 $224.00 $224.00 $224.00 $224.00 $224.00 $168.00 $224.00 $224.00 $224.00 $112.00 $112.00 $177.41 $224.00 $179.20 $145.60 $224.00 N/A $129.92 $224.00 $134.40 $224.00 $224.00 $224.00 N/A N/A 317.782 SUP Custom 27203010 317.782 - BIT DRILL 6MM STOP 1.5MM 91MM GUIDE NONSTRL BOTH IP/OP $224.00 $166.00 $39.87 $224.00 $224.00 $224.00 $224.00 $224.00 $224.00 $224.00 $39.87 $224.00 $224.00 $166.25 $166.25 $172.66 $116.70 $46.68 $224.00 $89.60 $224.00 $224.00 $224.00 $224.00 $224.00 $168.00 $224.00 $224.00 $224.00 $112.00 $112.00 $177.41 $224.00 $179.20 $145.60 $224.00 N/A $129.92 $224.00 $134.40 $224.00 $224.00 $224.00 N/A N/A 317.806 SUP Custom 27203010 317.806 - BIT DRILL MINI 1.8MM 20MM MINI QUICK COUPLING NONSTRL BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 N/A $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A 317.812 SUP Custom 27203010 317.812 - BIT DRILL MINI 1.8MM 26MM MINI QUICK COUPLING NONSTRL BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 N/A $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A 317.818 SUP Custom 27203010 317.818 - BIT DRILL MINI 18MM 32MM QUICK COUPLING BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 N/A $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A 317.82 SUP Custom 27203010 317.82 - BIT DRILL 12MM STOP MINI 1.5MM 44.5MM QUICK COUPLING NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.832 SUP Custom 27203010 317.832 - BIT DRILL 1.5MM 110MM HEX COUPLING NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.835 SUP Custom 27203010 317.835 - BIT DRILL 1.5MM 110MM J LATCH NO STOP STAINLESS STEEL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.836 SUP Custom 27203010 317.836 - BIT DRILL 1.5MM 125MM J LATCH NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.838 SUP Custom 27203010 317.838 - BIT DRILL MINI 1.5MM 110MM MINI QUICK COUPLING NONSTRL 1/1.5 BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.852 SUP Custom 27203010 317.852 - BIT DRILL UNIVERSAL 2MM 110MM HALL COUPLING NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.855 SUP Custom 27203010 317.855 - BIT DRL 2MM 110MM NS JLTCH CPLNG WO SLF STP STRYK BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.856 SUP Custom 27203010 317.856 - BIT DRILL 2MM 125MM J LATCH BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.858 SUP Custom 27203010 317.858 - BIT DRILL MINI 2MM 110MM QUICK COUPLING NONSTRL BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 317.861 SUP Custom 27203010 317.861 - BIT DRL 1.8MM 80MM NS MNQK CPLNG D MRK BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $100.66 $100.66 $104.54 $70.66 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $88.16 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 317.867 SUP Custom 27203010 317.867 - BIT DRL 1.8MM 90MM NS JLTCH CPLNG 2.4MM SCR MDLR HND SYS BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $100.66 $100.66 $104.54 $70.66 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $88.16 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 317.871 SUP Custom 27203010 317.871 - BIT DRL 2.4MM 80MM NS MNQK CPLNG 2.4MM SCR MDLR HND SYS BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $100.66 $100.66 $104.54 $70.66 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $88.16 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 317.872 SUP Custom 27203010 317.872 - BIT DRL 2.4MM 90MM NS JLTCH CPLNG STRYK BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $100.66 $100.66 $104.54 $70.66 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $88.16 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 317.875 SUP Custom 27203010 317.875 - BIT DRL 6MM 1.5MM 100MM NS QC TROC STP BOTH IP/OP $380.50 $282.00 $67.68 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $67.68 $380.25 $380.25 $282.22 $282.22 $293.10 $198.11 $79.25 $380.25 $152.10 $380.25 $380.25 $380.25 $380.25 $380.25 $285.38 $380.25 $380.25 $380.25 $190.13 $190.13 $301.16 $380.25 $304.20 $247.16 $380.25 N/A $220.69 $380.25 $228.15 $380.25 $380.25 $380.25 N/A N/A 317.876 SUP Custom 27203010 317.876 - BIT DRL 8-18MM 1.5MM 100MM NS QC TROC CLBRT BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 317.877 SUP Custom 27203010 317.877 - BIT DRL 6MM 1.8MM 100MM NS QC TROC STP BOTH IP/OP $380.50 $282.00 $67.68 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $67.68 $380.25 $380.25 $282.22 $282.22 $293.10 $198.11 $79.25 $380.25 $152.10 $380.25 $380.25 $380.25 $380.25 $380.25 $285.38 $380.25 $380.25 $380.25 $190.13 $190.13 $301.16 $380.25 $304.20 $247.16 $380.25 N/A $220.69 $380.25 $228.15 $380.25 $380.25 $380.25 N/A N/A 317.878 SUP Custom 27203010 317.878 - BIT DRL 8-18MM 1.8MM 100MM NS QC TROC CLBRT BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 319.006 SUP Custom 27203010 319.006 - GAUGE DEPTH 2 MM 2.4 MM SCREW BOTH IP/OP "$1,084.00" $802.00 $192.92 "$1,102.23" "$1,083.80" "$1,083.80" "$1,083.80" "$1,083.80" "$1,083.80" "$1,083.80" $192.92 "$1,083.80" "$1,083.80" $804.40 $804.40 $835.39 $564.66 $225.88 "$1,083.80" $440.89 "$1,083.80" "$1,083.80" "$1,102.23" "$1,083.80" "$1,083.80" $813.00 "$1,083.80" "$1,083.80" "$1,083.80" $541.90 $541.90 $858.37 "$1,083.80" $867.04 $704.47 "$1,083.80" N/A $628.72 "$1,083.80" $650.28 "$1,083.80" "$1,083.80" "$1,083.80" N/A N/A 319.01 SUP Custom 27203010 319.01 - GAUGE DEPTH MEASURE LCP NONSTRL 2.7/3.5/4 MM SCREW BOTH IP/OP $762.00 $564.00 $135.61 $774.83 $761.88 $761.88 $761.88 $761.88 $761.88 $761.88 $135.61 $761.88 $761.88 $565.47 $565.47 $587.26 $396.94 $158.78 $761.88 $309.93 $761.88 $761.88 $774.83 $761.88 $761.88 $571.50 $761.88 $761.88 $761.88 $380.94 $380.94 $603.41 $761.88 $609.50 $495.22 $761.88 N/A $441.96 $761.88 $457.13 $761.88 $761.88 $761.88 N/A N/A 323.062 SUP Custom 27203010 323.062 - BIT DRL 2MM 140MM NS QC D MRK BOTH IP/OP $280.00 $207.00 $49.79 $284.48 $279.73 $279.73 $279.73 $279.73 $279.73 $279.73 $49.79 $279.73 $279.73 $207.62 $207.62 $215.62 $145.74 $58.30 $279.73 $113.79 $279.73 $279.73 $284.48 $279.73 $279.73 $210.00 $279.73 $279.73 $279.73 $139.87 $139.87 $221.55 $279.73 $223.78 $181.82 $279.73 N/A $162.40 $279.73 $167.84 $279.73 $279.73 $279.73 N/A N/A 323.36 SUP Custom 27203010 323.36 - GUIDE DRL UNV 3.5MM NS BOTH IP/OP $815.50 $603.00 $145.12 $829.15 $815.30 $815.30 $815.30 $815.30 $815.30 $815.30 $145.12 $815.30 $815.30 $605.12 $605.12 $628.43 $424.77 $169.92 $815.30 $331.66 $815.30 $815.30 $829.15 $815.30 $815.30 $611.63 $815.30 $815.30 $815.30 $407.65 $407.65 $645.72 $815.30 $652.24 $529.95 $815.30 N/A $472.99 $815.30 $489.18 $815.30 $815.30 $815.30 N/A N/A 323.46 SUP Custom 27203010 323.46 - GUIDE DRILL UNIVERSAL 4.5MM LC-DCP BOTH IP/OP $775.00 $574.00 $137.87 $787.70 $774.53 $774.53 $774.53 $774.53 $774.53 $774.53 $137.87 $774.53 $774.53 $574.86 $574.86 $597.01 $403.53 $161.42 $774.53 $315.08 $774.53 $774.53 $787.70 $774.53 $774.53 $581.25 $774.53 $774.53 $774.53 $387.27 $387.27 $613.43 $774.53 $619.62 $503.44 $774.53 N/A $449.50 $774.53 $464.72 $774.53 $774.53 $774.53 N/A N/A 324.101 SUP Custom 27203010 324.101 - HOLDER IMPLANT TEMPORARY INSERT SELF RETAINING HOLDING BOTH IP/OP $264.50 $196.00 $47.04 $264.25 $264.25 $264.25 $264.25 $264.25 $264.25 $264.25 $47.04 $264.25 $264.25 $196.13 $196.13 $203.68 $137.67 $55.07 $264.25 $105.70 $264.25 $264.25 $264.25 $264.25 $264.25 $198.38 $264.25 $264.25 $264.25 $132.13 $132.13 $209.29 $264.25 $211.40 $171.76 $264.25 N/A $153.41 $264.25 $158.55 $264.25 $264.25 $264.25 N/A N/A 324.153 SUP Custom 27203010 324.153 - BIT DRL 2.5MM 14MM NS STP BOTH IP/OP $516.50 $382.00 $91.89 $516.25 $516.25 $516.25 $516.25 $516.25 $516.25 $516.25 $91.89 $516.25 $516.25 $383.16 $383.16 $397.93 $268.97 $107.59 $516.25 $206.50 $516.25 $516.25 $516.25 $516.25 $516.25 $387.38 $516.25 $516.25 $516.25 $258.13 $258.13 $408.87 $516.25 $413.00 $335.56 $516.25 N/A $299.57 $516.25 $309.75 $516.25 $516.25 $516.25 N/A N/A 324.155 SUP Custom 27203010 324.155 - BIT DRL 2.5MM 16MM NS STP BOTH IP/OP $516.50 $382.00 $91.89 $516.25 $516.25 $516.25 $516.25 $516.25 $516.25 $516.25 $91.89 $516.25 $516.25 $383.16 $383.16 $397.93 $268.97 $107.59 $516.25 $206.50 $516.25 $516.25 $516.25 $516.25 $516.25 $387.38 $516.25 $516.25 $516.25 $258.13 $258.13 $408.87 $516.25 $413.00 $335.56 $516.25 N/A $299.57 $516.25 $309.75 $516.25 $516.25 $516.25 N/A N/A 324.174 SUP HCPCS C1769 324.174 - GUIDEWIRE ORTHOPEDIC 2.5MM NONSTRL 5MM SCREW BOTH IP/OP $276.00 $204.00 $54.69 $280.20 $149.61 $149.61 $149.61 $149.61 $275.53 $275.53 $275.53 $57.43 $275.53 $204.50 $204.50 $212.38 $143.55 $57.42 $275.53 $280.20 $162.98 $275.53 $280.20 $275.53 $275.53 $207.00 $275.53 $275.53 $275.53 $137.77 $137.77 $218.22 $275.53 $220.42 $179.09 $54.69 N/A $160.08 $275.53 $275.53 $275.53 $57.42 $275.53 N/A N/A 324.203 SUP Custom 27203010 324.203 - GUIDE DRILL 4.3MM THREAD PERCUTANEOUS BOTH IP/OP $718.50 $532.00 $127.86 $730.50 $718.30 $718.30 $718.30 $718.30 $718.30 $718.30 $127.86 $718.30 $718.30 $533.12 $533.12 $553.67 $374.23 $149.70 $718.30 $292.20 $718.30 $718.30 $730.50 $718.30 $718.30 $538.88 $718.30 $718.30 $718.30 $359.15 $359.15 $568.89 $718.30 $574.64 $466.90 $718.30 N/A $416.73 $718.30 $430.98 $718.30 $718.30 $718.30 N/A N/A 324.21 SUP Custom 27203010 324.210 - BIT DRL 2.5MM 300MM NS 200MM QC CLBRT BOTH IP/OP $341.50 $253.00 $60.73 $357.40 $341.20 $341.20 $341.20 $341.20 $341.20 $341.20 $60.73 $341.20 $341.20 $253.24 $253.24 $263.00 $177.77 $71.11 $341.20 $142.96 $341.20 $341.20 $357.40 $341.20 $341.20 $256.13 $341.20 $341.20 $341.20 $170.60 $170.60 $270.23 $341.20 $272.96 $221.78 $341.20 N/A $198.07 $341.20 $204.72 $341.20 $341.20 $341.20 N/A N/A 324.211 SUP Custom 27203010 324.211 - BIT DRL 2.8MM 300MM NS 200MM QC CLBRT BOTH IP/OP $351.50 $260.00 $62.55 $357.40 $351.43 $351.43 $351.43 $351.43 $351.43 $351.43 $62.55 $351.43 $351.43 $260.83 $260.83 $270.88 $183.10 $73.24 $351.43 $142.96 $351.43 $351.43 $357.40 $351.43 $351.43 $263.63 $351.43 $351.43 $351.43 $175.72 $175.72 $278.33 $351.43 $281.14 $228.43 $351.43 N/A $203.87 $351.43 $210.86 $351.43 $351.43 $351.43 N/A N/A 324.212 SUP Custom 27203010 324.212 - BIT DRL 3.2MM 300MM NS QC CLBRT PERC BOTH IP/OP $351.50 $260.00 $62.55 $357.40 $351.43 $351.43 $351.43 $351.43 $351.43 $351.43 $62.55 $351.43 $351.43 $260.83 $260.83 $270.88 $183.10 $73.24 $351.43 $142.96 $351.43 $351.43 $357.40 $351.43 $351.43 $263.63 $351.43 $351.43 $351.43 $175.72 $175.72 $278.33 $351.43 $281.14 $228.43 $351.43 N/A $203.87 $351.43 $210.86 $351.43 $351.43 $351.43 N/A N/A 324.213 SUP Custom 27203010 324.213 - BIT DRL 4.3MM 300MM NS QC CLBRT PERC BOTH IP/OP $351.50 $260.00 $62.55 $357.40 $351.43 $351.43 $351.43 $351.43 $351.43 $351.43 $62.55 $351.43 $351.43 $260.83 $260.83 $270.88 $183.10 $73.24 $351.43 $142.96 $351.43 $351.43 $357.40 $351.43 $351.43 $263.63 $351.43 $351.43 $351.43 $175.72 $175.72 $278.33 $351.43 $281.14 $228.43 $351.43 N/A $203.87 $351.43 $210.86 $351.43 $351.43 $351.43 N/A N/A 324.214 SUP Custom 27203010 324.214 - BIT DRL 2.8MM 200MM NS QC CLBRT BOTH IP/OP $325.00 $241.00 $57.80 $330.25 $324.73 $324.73 $324.73 $324.73 $324.73 $324.73 $57.80 $324.73 $324.73 $241.01 $241.01 $250.30 $169.18 $67.68 $324.73 $132.10 $324.73 $324.73 $330.25 $324.73 $324.73 $243.75 $324.73 $324.73 $324.73 $162.37 $162.37 $257.19 $324.73 $259.78 $211.07 $324.73 N/A $188.50 $324.73 $194.84 $324.73 $324.73 $324.73 N/A N/A 325.16 SUP Custom 27203010 325.160 - ROD EXFIX 3MM 270MM THREAD SELF DRILL NONSTRL BOTH IP/OP $460.00 $340.00 $81.87 $481.78 $459.93 $459.93 $459.93 $459.93 $459.93 $459.93 $81.87 $459.93 $459.93 $341.36 $341.36 $354.51 $239.62 $95.85 $459.93 $192.71 $459.93 $459.93 $481.78 $459.93 $459.93 $345.00 $459.93 $459.93 $459.93 $229.97 $229.97 $364.26 $459.93 $367.94 $298.95 $459.93 N/A $266.80 $459.93 $275.96 $459.93 $459.93 $459.93 N/A N/A 328.16 SUP Custom 27203010 328.160 - ROD EXFIX 5MM 380MM THREADED SLFDRILL TIP NONSTRL BOTH IP/OP $557.00 $412.00 $99.12 $583.28 $556.83 $556.83 $556.83 $556.83 $556.83 $556.83 $99.12 $556.83 $556.83 $413.28 $413.28 $429.20 $290.11 $116.05 $556.83 $233.31 $556.83 $556.83 $583.28 $556.83 $556.83 $417.75 $556.83 $556.83 $556.83 $278.42 $278.42 $441.01 $556.83 $445.46 $361.94 $556.83 N/A $323.06 $556.83 $334.10 $556.83 $556.83 $556.83 N/A N/A 328.17 SUP Custom 27203010 328.170 - ROD EXFIX BLUNT 5MM 1.6MM 335MM THREAD CANN NONSTRL BOTH IP/OP $557.00 $412.00 $99.12 $583.28 $556.83 $556.83 $556.83 $556.83 $556.83 $556.83 $99.12 $556.83 $556.83 $413.28 $413.28 $429.20 $290.11 $116.05 $556.83 $233.31 $556.83 $556.83 $583.28 $556.83 $556.83 $417.75 $556.83 $556.83 $556.83 $278.42 $278.42 $441.01 $556.83 $445.46 $361.94 $556.83 N/A $323.06 $556.83 $334.10 $556.83 $556.83 $556.83 N/A N/A 329.08 SUP Custom 27203010 329.08 - IRON BENDING NONSTRL 3.5/4.5 MM RECONSTRUCTION PLATE BOTH IP/OP $603.50 $447.00 $107.34 $613.30 $603.05 $603.05 $603.05 $603.05 $603.05 $603.05 $107.34 $603.05 $603.05 $447.58 $447.58 $464.83 $314.19 $125.68 $603.05 $245.32 $603.05 $603.05 $613.30 $603.05 $603.05 $452.63 $603.05 $603.05 $603.05 $301.53 $301.53 $477.62 $603.05 $482.44 $391.98 $603.05 N/A $350.03 $603.05 $361.83 $603.05 $603.05 $603.05 N/A N/A 336.105 SUP HCPCS C1713 336.105 - PLATE BONE 5MM RELIEVE SPN LAMINOPLASTY BOTH IP/OP "$4,877.50" "$3,609.00" $968.06 "$4,877.50" "$2,194.88" "$2,194.88" "$2,194.88" "$2,194.88" "$4,877.50" "$4,877.50" "$4,877.50" "$1,016.59" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$1,016.52" "$4,877.50" "$1,951.00" "$2,404.61" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$3,658.13" "$4,877.50" "$4,877.50" "$4,877.50" "$2,438.75" "$2,438.75" "$3,862.98" "$4,877.50" "$3,902.00" "$2,194.88" $968.06 N/A "$2,828.95" "$4,877.50" "$4,877.50" "$4,877.50" "$1,016.47" "$4,877.50" N/A N/A 336.107 SUP HCPCS C1713 336.107 - PLATE BONE 7MM RELIEVE SPN LAMINOPLASTY BOTH IP/OP "$4,877.50" "$3,609.00" $968.06 "$4,877.50" "$2,194.88" "$2,194.88" "$2,194.88" "$2,194.88" "$4,877.50" "$4,877.50" "$4,877.50" "$1,016.59" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$1,016.52" "$4,877.50" "$4,877.50" "$2,404.61" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$3,658.13" "$4,877.50" "$4,877.50" "$4,877.50" "$2,438.75" "$2,438.75" "$3,862.98" "$4,877.50" "$3,902.00" "$2,194.88" $968.06 N/A "$2,828.95" "$4,877.50" "$4,877.50" "$4,877.50" "$1,016.47" "$4,877.50" N/A N/A 336.109 SUP HCPCS C1713 "336.109 - RELIEVE Radiolucent Plate, Open Door, 9mm" BOTH IP/OP "$4,877.50" "$3,609.00" $968.06 "$4,877.50" "$2,194.88" "$2,194.88" "$2,194.88" "$2,194.88" "$4,877.50" "$4,877.50" "$4,877.50" "$1,016.59" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$1,016.52" "$4,877.50" "$4,877.50" "$2,404.61" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$3,658.13" "$4,877.50" "$4,877.50" "$4,877.50" "$2,438.75" "$2,438.75" "$3,862.98" "$4,877.50" "$3,902.00" "$2,194.88" $968.06 N/A "$2,828.95" "$4,877.50" "$4,877.50" "$4,877.50" "$1,016.47" "$4,877.50" N/A N/A 336.111 SUP HCPCS C1713 "336.111 - RELIEVE Radiolucent Plate, Open Door, 11mm" BOTH IP/OP "$4,877.50" "$3,609.00" $968.06 "$4,877.50" "$2,194.88" "$2,194.88" "$2,194.88" "$2,194.88" "$4,877.50" "$4,877.50" "$4,877.50" "$1,016.59" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$1,016.52" "$4,877.50" "$1,951.00" "$2,404.61" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$3,658.13" "$4,877.50" "$4,877.50" "$4,877.50" "$2,438.75" "$2,438.75" "$3,862.98" "$4,877.50" "$3,902.00" "$2,194.88" $968.06 N/A "$2,828.95" "$4,877.50" "$2,926.50" "$4,877.50" "$1,016.47" "$4,877.50" N/A N/A 336.113 SUP HCPCS C1713 "336.113 - RELIEVE Radiolucent Plate, Open Door, 13mm" BOTH IP/OP "$4,877.50" "$3,609.00" $968.06 "$4,877.50" "$2,194.88" "$2,194.88" "$2,194.88" "$2,194.88" "$4,877.50" "$4,877.50" "$4,877.50" "$1,016.59" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$1,016.52" "$4,877.50" "$4,877.50" "$2,404.61" "$4,877.50" "$4,877.50" "$4,877.50" "$4,877.50" "$3,658.13" "$4,877.50" "$4,877.50" "$4,877.50" "$2,438.75" "$2,438.75" "$3,862.98" "$4,877.50" "$3,902.00" "$2,194.88" $968.06 N/A "$2,828.95" "$4,877.50" "$2,926.50" "$4,877.50" "$1,016.47" "$4,877.50" N/A N/A 337.92 SUP Custom 27203010 337.92 - CANNULA OPHTHALMIC 45D 25GA GRIESHABER DSP STERILE BOTH IP/OP $541.00 $400.00 $96.25 $540.75 $540.75 $540.75 $540.75 $540.75 $540.75 $540.75 $96.25 $540.75 $540.75 $401.34 $401.34 $416.81 $281.73 $112.70 $540.75 $216.30 $540.75 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $351.49 $540.75 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 338.002 SUP Custom 27203010 338.002 - GUIDEWIRE ORTHOPEDIC 2.5MM 300MM 12MM DRILL TIP THEADED BOTH IP/OP $132.50 $98.00 $23.52 $134.38 $132.13 $132.13 $132.13 $132.13 $132.13 $132.13 $23.52 $132.13 $132.13 $98.07 $98.07 $101.85 $68.84 $27.54 $132.13 $53.75 $132.13 $132.13 $134.38 $132.13 $132.13 $99.38 $132.13 $132.13 $132.13 $66.07 $66.07 $104.65 $132.13 $105.70 $85.88 $132.13 N/A $76.85 $132.13 $79.28 $132.13 $132.13 $132.13 N/A N/A 338.13 SUP Custom 27203010 338.13 - REAMER SURG 3 COMPLETE DHS NONSTRL BOTH IP/OP "$2,685.00" "$1,987.00" $477.91 "$2,730.53" "$2,684.88" "$2,684.88" "$2,684.88" "$2,684.88" "$2,684.88" "$2,684.88" $477.91 "$2,684.88" "$2,684.88" "$1,992.72" "$1,992.72" "$2,069.51" "$1,398.82" $559.56 "$2,684.88" "$1,092.21" "$2,684.88" "$2,684.88" "$2,730.53" "$2,684.88" "$2,684.88" "$2,013.75" "$2,684.88" "$2,684.88" "$2,684.88" "$1,342.44" "$1,342.44" "$2,126.42" "$2,684.88" "$2,147.90" "$1,745.17" "$2,684.88" N/A "$1,557.30" "$2,684.88" "$1,610.93" "$2,684.88" "$2,684.88" "$2,684.88" N/A N/A 338.17 SUP Custom 27203010 338.17 - TAP SURG 220MM DHS/DCS 12.5MM SCREWS BOTH IP/OP $656.50 $486.00 $116.85 $667.60 $656.45 $656.45 $656.45 $656.45 $656.45 $656.45 $116.85 $656.45 $656.45 $487.22 $487.22 $505.99 $342.01 $136.81 $656.45 $267.04 $656.45 $656.45 $667.60 $656.45 $656.45 $492.38 $656.45 $656.45 $656.45 $328.23 $328.23 $519.91 $656.45 $525.16 $426.69 $656.45 N/A $380.77 $656.45 $393.87 $656.45 $656.45 $656.45 N/A N/A 338.31 SUP Custom 27203010 338.31 - GUIDE SURG COUPLING SCREW SOLID LATEX FREE DHS/DCS STAINLESS BOTH IP/OP $746.50 $552.00 $132.86 $759.13 $746.43 $746.43 $746.43 $746.43 $746.43 $746.43 $132.86 $746.43 $746.43 $554.00 $554.00 $575.35 $388.89 $155.56 $746.43 $303.65 $746.43 $746.43 $759.13 $746.43 $746.43 $559.88 $746.43 $746.43 $746.43 $373.22 $373.22 $591.17 $746.43 $597.14 $485.18 $746.43 N/A $432.97 $746.43 $447.86 $746.43 $746.43 $746.43 N/A N/A 338.333 SUP Custom 27203010 338.333 - REAMER SURG HEAD DHS BOTH IP/OP "$1,536.50" "$1,137.00" $273.48 "$1,562.55" "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" $273.48 "$1,536.43" "$1,536.43" "$1,140.34" "$1,140.34" "$1,184.28" $800.48 $320.21 "$1,536.43" $625.02 "$1,536.43" "$1,536.43" "$1,562.55" "$1,536.43" "$1,536.43" "$1,152.38" "$1,536.43" "$1,536.43" "$1,536.43" $768.22 $768.22 "$1,216.85" "$1,536.43" "$1,229.14" $998.68 "$1,536.43" N/A $891.17 "$1,536.43" $921.86 "$1,536.43" "$1,536.43" "$1,536.43" N/A N/A 338.348 SUP HCPCS C1713 338.348 - IMPACTOR SURG CAP LCP DHHS BOTH IP/OP $271.50 $201.00 $53.85 $275.90 $122.09 $122.09 $122.09 $122.09 $271.30 $271.30 $271.30 $56.55 $271.30 $271.30 $271.30 $271.30 $271.30 $56.54 $271.30 $110.36 $160.47 $271.30 $275.90 $271.30 $271.30 $203.63 $271.30 $271.30 $271.30 $135.65 $135.65 $214.87 $271.30 $217.04 $122.09 $53.85 N/A $157.47 $271.30 $271.30 $271.30 $56.54 $271.30 N/A N/A 339.21 SUP Custom 27203010 339.21 - PROBE VITRECTOMY 30D 25GA DSP POINTED TIP DIATHERMY BOTH IP/OP $695.50 $515.00 $123.75 $695.25 $695.25 $695.25 $695.25 $695.25 $695.25 $695.25 $123.75 $695.25 $695.25 $516.01 $516.01 $535.90 $362.23 $144.90 $695.25 $278.10 $695.25 $695.25 $695.25 $695.25 $695.25 $521.63 $695.25 $695.25 $695.25 $347.63 $347.63 $550.64 $695.25 $556.20 $451.91 $695.25 N/A $403.39 $695.25 $417.15 $695.25 $695.25 $695.25 N/A N/A 342.715 SUP Custom 27803010 342.715 - SPACER SPNL 0D 12MM SM 14X15MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.717 SUP Custom 27803010 342.717 - SPACER SPNL 0D 12MM SM 14X17MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.719 SUP Custom 27803010 342.719 - SPACER SPNL 0D 12MM SM 14X19MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.721 SUP Custom 27803010 342.721 - SPACER SPNL 0D 12MM SM 14X21MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.723 SUP Custom 27803010 342.723 - SPACER SPNL 0D 12MM SM 14X23MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.725 SUP Custom 27803010 342.725 - SPACER SPNL 0D 12MM SM 14X25MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.727 SUP Custom 27803010 342.727 - SPACER SPNL 0D 12MM SM 14X27MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.729 SUP Custom 27803010 342.729 - SPACER SPNL 0D 12MM SM 14X29MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.731 SUP Custom 27803010 342.731 - SPACER SPNL 0D 12MM SM 14X31MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.733 SUP Custom 27803010 342.733 - SPACER SPNL 0D 12MM SM 14X33MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.815 SUP Custom 27803010 342.815 - SPACER SPNL 7D 12MM SM 14X15MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.817 SUP Custom 27803010 342.817 - SPACER SPNL 7D 12MM SM 14X17MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.819 SUP Custom 27803010 342.819 - SPACER SPNL 7D 12MM SM 14X19MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.821 SUP Custom 27803010 342.821 - SPACER SPNL 7D 12MM SM 14X21MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.823 SUP Custom 27803010 342.823 - SPACER SPNL 7D 12MM SM 14X23MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.825 SUP Custom 27803010 342.825 - SPACER SPNL 7D 12MM SM 14X25MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.827 SUP Custom 27803010 342.827 - SPACER SPNL 7D 12MM SM 14X27MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.829 SUP Custom 27803010 342.829 - SPACER SPNL 7D 12MM SM 14X29MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.831 SUP Custom 27803010 342.831 - SPACER SPNL 7D 12MM SM 14X31MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.833 SUP Custom 27803010 342.833 - SPACER SPNL 7D 12MM SM 14X33MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.915 SUP Custom 27803010 342.915 - SPACER SPNL 5D 12MM SM 14X15MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.917 SUP Custom 27803010 342.917 - SPACER SPNL 5D 12MM SM 14X17MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.919 SUP Custom 27803010 342.919 - SPACER SPNL 5D 12MM SM 14X19MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.921 SUP Custom 27803010 342.921 - SPACER SPNL 5D 12MM SM 14X21MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.923 SUP Custom 27803010 342.923 - SPACER SPNL 5D 12MM SM 14X23MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.925 SUP Custom 27803010 342.925 - SPACER SPNL 5D 12MM SM 14X25MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.927 SUP Custom 27803010 342.927 - SPACER SPNL 5D 12MM SM 14X27MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.929 SUP Custom 27803010 342.929 - SPACER SPNL 5D 12MM SM 14X29MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.931 SUP Custom 27803010 342.931 - SPACER SPNL 5D 12MM SM 14X31MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 342.933 SUP Custom 27803010 342.933 - SPACER SPNL 5D 12MM SM 14X33MM NS LF NIKO PEEK-OPTM BOTH IP/OP "$7,635.00" "$5,650.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,359.03" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$1,591.22" "$7,635.00" "$3,054.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$7,635.00" "$5,726.25" "$7,635.00" "$7,635.00" "$7,635.00" "$3,817.50" "$3,817.50" "$6,046.92" "$7,635.00" "$6,108.00" "$3,435.75" "$7,635.00" N/A "$4,428.30" "$7,635.00" "$4,581.00" "$7,635.00" "$7,635.00" "$7,635.00" N/A N/A 351.001 SUP Custom 27803010 351.001 - ENDPLATE SPNL 0D 14MM 14X15MM NS LF FORTIFY-R FTPRNT NO SPK BOTH IP/OP "$19,050.00" "$14,097.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,970.23" "$19,050.00" "$7,620.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$14,287.50" "$19,050.00" "$19,050.00" "$19,050.00" "$9,525.00" "$9,525.00" "$15,087.60" "$19,050.00" "$15,240.00" "$8,572.50" "$19,050.00" N/A "$11,049.00" "$19,050.00" "$11,430.00" "$19,050.00" "$19,050.00" "$19,050.00" N/A N/A 351.002 SUP Custom 27803010 351.002 - ENDPLATE SPNL 0D 14MM 14X17MM NS LF FORTIFY-R FTPRNT BOTH IP/OP "$19,050.00" "$14,097.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,970.23" "$19,050.00" "$7,620.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$14,287.50" "$19,050.00" "$19,050.00" "$19,050.00" "$9,525.00" "$9,525.00" "$15,087.60" "$19,050.00" "$15,240.00" "$8,572.50" "$19,050.00" N/A "$11,049.00" "$19,050.00" "$11,430.00" "$19,050.00" "$19,050.00" "$19,050.00" N/A N/A 351.003 SUP Custom 27803010 351.003 - ENDPLATE SPNL 3.5D 14MM 14X17MM NS LF FORTIFY-R FTPRNT NO BOTH IP/OP "$19,050.00" "$14,097.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,970.23" "$19,050.00" "$7,620.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$14,287.50" "$19,050.00" "$19,050.00" "$19,050.00" "$9,525.00" "$9,525.00" "$15,087.60" "$19,050.00" "$15,240.00" "$8,572.50" "$19,050.00" N/A "$11,049.00" "$19,050.00" "$11,430.00" "$19,050.00" "$19,050.00" "$19,050.00" N/A N/A 351.004 SUP Custom 27803010 351.004 - ENDPLATE SPNL 3.5D 14MM 14X19MM NS LF FORTIFY-R FTPRNT BOTH IP/OP "$19,050.00" "$14,097.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,970.23" "$19,050.00" "$7,620.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$14,287.50" "$19,050.00" "$19,050.00" "$19,050.00" "$9,525.00" "$9,525.00" "$15,087.60" "$19,050.00" "$15,240.00" "$8,572.50" "$19,050.00" N/A "$11,049.00" "$19,050.00" "$11,430.00" "$19,050.00" "$19,050.00" "$19,050.00" N/A N/A 351.005 SUP Custom 27803010 351.005 - ENDPLATE SPNL 0D 14MM 14X16MM NS LF FORTIFY-R FTPRNT NO SPK BOTH IP/OP "$19,050.00" "$14,097.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,970.23" "$19,050.00" "$7,620.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$14,287.50" "$19,050.00" "$19,050.00" "$19,050.00" "$9,525.00" "$9,525.00" "$15,087.60" "$19,050.00" "$15,240.00" "$8,572.50" "$19,050.00" N/A "$11,049.00" "$19,050.00" "$11,430.00" "$19,050.00" "$19,050.00" "$19,050.00" N/A N/A 351.006 SUP Custom 27803010 351.006 - ENDPLATE SPNL 0D 14MM 14X18MM NS LF FORTIFY-R FTPRNT BOTH IP/OP "$19,050.00" "$14,097.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,970.23" "$19,050.00" "$7,620.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$14,287.50" "$19,050.00" "$19,050.00" "$19,050.00" "$9,525.00" "$9,525.00" "$15,087.60" "$19,050.00" "$15,240.00" "$8,572.50" "$19,050.00" N/A "$11,049.00" "$19,050.00" "$11,430.00" "$19,050.00" "$19,050.00" "$19,050.00" N/A N/A 351.007 SUP Custom 27803010 351.007 - ENDPLATE SPNL 3.5D 14MM 14X18MM NS LF FORTIFY-R FTPRNT NO BOTH IP/OP "$19,050.00" "$14,097.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,970.23" "$19,050.00" "$7,620.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$14,287.50" "$19,050.00" "$19,050.00" "$19,050.00" "$9,525.00" "$9,525.00" "$15,087.60" "$19,050.00" "$15,240.00" "$8,572.50" "$19,050.00" N/A "$11,049.00" "$19,050.00" "$11,430.00" "$19,050.00" "$19,050.00" "$19,050.00" N/A N/A 351.008 SUP Custom 27803010 351.008 - ENDPLATE SPNL 3.5D 14MM 14X20MM NS LF FORTIFY-R FTPRNT BOTH IP/OP "$19,050.00" "$14,097.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,970.23" "$19,050.00" "$7,620.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$14,287.50" "$19,050.00" "$19,050.00" "$19,050.00" "$9,525.00" "$9,525.00" "$15,087.60" "$19,050.00" "$15,240.00" "$8,572.50" "$19,050.00" N/A "$11,049.00" "$19,050.00" "$11,430.00" "$19,050.00" "$19,050.00" "$19,050.00" N/A N/A 351.009 SUP Custom 27803010 351.009 - ENDPLATE SPNL 0D 14MM 14X18MM NS LF FORTIFY-R FTPRNT NO SPK BOTH IP/OP "$19,050.00" "$14,097.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,970.23" "$19,050.00" "$7,620.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$14,287.50" "$19,050.00" "$19,050.00" "$19,050.00" "$9,525.00" "$9,525.00" "$15,087.60" "$19,050.00" "$15,240.00" "$8,572.50" "$19,050.00" N/A "$11,049.00" "$19,050.00" "$11,430.00" "$19,050.00" "$19,050.00" "$19,050.00" N/A N/A 351.01 SUP Custom 27803010 351.010 - ENDPLATE SPNL 0D 14MM 14X20MM NS LF FORTIFY-R FTPRNT BOTH IP/OP "$19,050.00" "$14,097.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,970.23" "$19,050.00" "$7,620.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$14,287.50" "$19,050.00" "$19,050.00" "$19,050.00" "$9,525.00" "$9,525.00" "$15,087.60" "$19,050.00" "$15,240.00" "$8,572.50" "$19,050.00" N/A "$11,049.00" "$19,050.00" "$11,430.00" "$19,050.00" "$19,050.00" "$19,050.00" N/A N/A 351.011 SUP Custom 27803010 351.011 - ENDPLATE SPNL 3.5D 14MM 14X20MM NS LF FORTIFY-R FTPRNT NO BOTH IP/OP "$19,050.00" "$14,097.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,970.23" "$19,050.00" "$7,620.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$14,287.50" "$19,050.00" "$19,050.00" "$19,050.00" "$9,525.00" "$9,525.00" "$15,087.60" "$19,050.00" "$15,240.00" "$8,572.50" "$19,050.00" N/A "$11,049.00" "$19,050.00" "$11,430.00" "$19,050.00" "$19,050.00" "$19,050.00" N/A N/A 351.012 SUP Custom 27803010 351.012 - ENDPLATE SPNL 3.5D 14MM 14X22MM NS LF FORTIFY-R FTPRNT BOTH IP/OP "$19,050.00" "$14,097.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,390.90" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$3,970.23" "$19,050.00" "$7,620.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$19,050.00" "$14,287.50" "$19,050.00" "$19,050.00" "$19,050.00" "$9,525.00" "$9,525.00" "$15,087.60" "$19,050.00" "$15,240.00" "$8,572.50" "$19,050.00" N/A "$11,049.00" "$19,050.00" "$11,430.00" "$19,050.00" "$19,050.00" "$19,050.00" N/A N/A 351.05 SUP Custom 27803010 351.050 - ENDPLATE SPNL 14MM 14X24MM NS LF FORTIFY-R BOTH IP/OP "$18,600.00" "$13,764.00" "$3,310.80" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$3,310.80" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$3,876.44" "$18,600.00" "$7,440.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$13,950.00" "$18,600.00" "$18,600.00" "$18,600.00" "$9,300.00" "$9,300.00" "$14,731.20" "$18,600.00" "$14,880.00" "$8,370.00" "$18,600.00" N/A "$10,788.00" "$18,600.00" "$11,160.00" "$18,600.00" "$18,600.00" "$18,600.00" N/A N/A 351.051 SUP Custom 27803010 351.051 - ENDPLATE SPNL 14MM 14X28MM NS LF FORTIFY-R BOTH IP/OP "$18,600.00" "$13,764.00" "$3,310.80" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$3,310.80" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$3,876.44" "$18,600.00" "$7,440.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$13,950.00" "$18,600.00" "$18,600.00" "$18,600.00" "$9,300.00" "$9,300.00" "$14,731.20" "$18,600.00" "$14,880.00" "$8,370.00" "$18,600.00" N/A "$10,788.00" "$18,600.00" "$11,160.00" "$18,600.00" "$18,600.00" "$18,600.00" N/A N/A 351.052 SUP Custom 27803010 351.052 - ENDPLATE SPNL 14MM 14X35MM NS LF FORTIFY-R BOTH IP/OP "$18,600.00" "$13,764.00" "$3,310.80" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$3,310.80" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$3,876.44" "$18,600.00" "$7,440.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$13,950.00" "$18,600.00" "$18,600.00" "$18,600.00" "$9,300.00" "$9,300.00" "$14,731.20" "$18,600.00" "$14,880.00" "$8,370.00" "$18,600.00" N/A "$10,788.00" "$18,600.00" "$11,160.00" "$18,600.00" "$18,600.00" "$18,600.00" N/A N/A 351.053 SUP Custom 27803010 351.053 - ENDPLATE SPNL 14MM 14X49MM NS LF FORTIFY-R BOTH IP/OP "$18,600.00" "$13,764.00" "$3,310.80" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$3,310.80" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$3,876.44" "$18,600.00" "$7,440.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$13,950.00" "$18,600.00" "$18,600.00" "$18,600.00" "$9,300.00" "$9,300.00" "$14,731.20" "$18,600.00" "$14,880.00" "$8,370.00" "$18,600.00" N/A "$10,788.00" "$18,600.00" "$11,160.00" "$18,600.00" "$18,600.00" "$18,600.00" N/A N/A 351.054 SUP Custom 27803010 351.054 - ENDPLATE SPNL 14MM 14X66MM NS LF FORTIFY-R BOTH IP/OP "$18,600.00" "$13,764.00" "$3,310.80" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$3,310.80" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$3,876.44" "$18,600.00" "$7,440.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$18,600.00" "$13,950.00" "$18,600.00" "$18,600.00" "$18,600.00" "$9,300.00" "$9,300.00" "$14,731.20" "$18,600.00" "$14,880.00" "$8,370.00" "$18,600.00" N/A "$10,788.00" "$18,600.00" "$11,160.00" "$18,600.00" "$18,600.00" "$18,600.00" N/A N/A 351.15 SUP Custom 27803010 351.150 - ENDPLATE SPNL 14MM 20X26MM NS LF FORTIFY-R BOTH IP/OP "$23,600.00" "$17,464.00" "$4,200.80" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$4,200.80" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$4,918.50" "$23,600.00" "$9,440.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$17,700.00" "$23,600.00" "$23,600.00" "$23,600.00" "$11,800.00" "$11,800.00" "$18,691.20" "$23,600.00" "$18,880.00" "$10,620.00" "$23,600.00" N/A "$13,688.00" "$23,600.00" "$14,160.00" "$23,600.00" "$23,600.00" "$23,600.00" N/A N/A 351.151 SUP Custom 27803010 351.151 - ENDPLATE SPNL 20MM 20X28MM NS LF FORTIFY-R BOTH IP/OP "$23,600.00" "$17,464.00" "$4,200.80" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$4,200.80" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$4,918.50" "$23,600.00" "$9,440.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$17,700.00" "$23,600.00" "$23,600.00" "$23,600.00" "$11,800.00" "$11,800.00" "$18,691.20" "$23,600.00" "$18,880.00" "$10,620.00" "$23,600.00" N/A "$13,688.00" "$23,600.00" "$14,160.00" "$23,600.00" "$23,600.00" "$23,600.00" N/A N/A 351.152 SUP Custom 27803010 351.152 - ENDPLATE SPNL 20MM 20X33MM NS LF FORTIFY-R BOTH IP/OP "$23,600.00" "$17,464.00" "$4,200.80" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$4,200.80" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$4,918.50" "$23,600.00" "$9,440.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$17,700.00" "$23,600.00" "$23,600.00" "$23,600.00" "$11,800.00" "$11,800.00" "$18,691.20" "$23,600.00" "$18,880.00" "$10,620.00" "$23,600.00" N/A "$13,688.00" "$23,600.00" "$14,160.00" "$23,600.00" "$23,600.00" "$23,600.00" N/A N/A 351.153 SUP Custom 27803010 351.153 - ENDPLATE SPNL 20MM 20X43MM NS LF FORTIFY-R BOTH IP/OP "$23,600.00" "$17,464.00" "$4,200.80" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$4,200.80" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$4,918.50" "$23,600.00" "$9,440.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$17,700.00" "$23,600.00" "$23,600.00" "$23,600.00" "$11,800.00" "$11,800.00" "$18,691.20" "$23,600.00" "$18,880.00" "$10,620.00" "$23,600.00" N/A "$13,688.00" "$23,600.00" "$14,160.00" "$23,600.00" "$23,600.00" "$23,600.00" N/A N/A 351.154 SUP Custom 27803010 351.154 - ENDPLATE SPNL 20MM 20X61MM NS LF FORTIFY-R BOTH IP/OP "$23,600.00" "$17,464.00" "$4,200.80" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$4,200.80" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$4,918.50" "$23,600.00" "$9,440.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$17,700.00" "$23,600.00" "$23,600.00" "$23,600.00" "$11,800.00" "$11,800.00" "$18,691.20" "$23,600.00" "$18,880.00" "$10,620.00" "$23,600.00" N/A "$13,688.00" "$23,600.00" "$14,160.00" "$23,600.00" "$23,600.00" "$23,600.00" N/A N/A 351.155 SUP Custom 27803010 351.155 - ENDPLATE SPNL 20MM 20X80MM NS LF FORTIFY-R BOTH IP/OP "$23,600.00" "$17,464.00" "$4,200.80" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$4,200.80" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$4,918.50" "$23,600.00" "$9,440.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$17,700.00" "$23,600.00" "$23,600.00" "$23,600.00" "$11,800.00" "$11,800.00" "$18,691.20" "$23,600.00" "$18,880.00" "$10,620.00" "$23,600.00" N/A "$13,688.00" "$23,600.00" "$14,160.00" "$23,600.00" "$23,600.00" "$23,600.00" N/A N/A 351.156 SUP Custom 27803010 351.156 - ENDPLATE SPNL 20MM 20X99MM NS LF FORTIFY-R BOTH IP/OP "$23,600.00" "$17,464.00" "$4,200.80" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$4,200.80" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$4,918.50" "$23,600.00" "$9,440.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$23,600.00" "$17,700.00" "$23,600.00" "$23,600.00" "$23,600.00" "$11,800.00" "$11,800.00" "$18,691.20" "$23,600.00" "$18,880.00" "$10,620.00" "$23,600.00" N/A "$13,688.00" "$23,600.00" "$14,160.00" "$23,600.00" "$23,600.00" "$23,600.00" N/A N/A 351.27 SUP Custom 27203010 351.27 - BIT DRILL 13MM 300MM CANN NONSTRL BOTH IP/OP "$1,117.50" $827.00 $198.90 "$1,136.40" "$1,117.40" "$1,117.40" "$1,117.40" "$1,117.40" "$1,117.40" "$1,117.40" $198.90 "$1,117.40" "$1,117.40" $829.33 $829.33 $861.29 $582.17 $232.88 "$1,117.40" $454.56 "$1,117.40" "$1,117.40" "$1,136.40" "$1,117.40" "$1,117.40" $838.13 "$1,117.40" "$1,117.40" "$1,117.40" $558.70 $558.70 $884.98 "$1,117.40" $893.92 $726.31 "$1,117.40" N/A $648.15 "$1,117.40" $670.44 "$1,117.40" "$1,117.40" "$1,117.40" N/A N/A 351.3 SUP HCPCS C1713 351.300 - SPACER SPNL 0D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT NO BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.301 SUP HCPCS C1713 351.301 - SPACER SPNL 0D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.302 SUP HCPCS C1713 351.302 - SPACER SPNL 3.5D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.303 SUP HCPCS C1713 351.303 - SPACER SPNL 3.5D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.304 SUP HCPCS C1713 351.304 - SPACER SPNL 7D 14MM 14MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.311 SUP HCPCS C1713 351.311 - SPACER SPNL 0D 14MM 16MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.313 SUP HCPCS C1713 351.313 - SPACER SPNL 3.5D 14MM 16MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.314 SUP HCPCS C1713 351.314 - SPACER SPNL 7D 14MM 16MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.321 SUP HCPCS C1713 351.321 - SPACER SPNL 0D 15MM 18MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,815.00" "$1,343.00" $360.23 "$1,815.00" $816.75 $816.75 $816.75 $816.75 "$1,815.00" "$1,815.00" "$1,815.00" $378.29 "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" $378.27 "$1,815.00" "$1,815.00" "$1,073.57" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,361.25" "$1,815.00" "$1,815.00" "$1,815.00" $907.50 $907.50 "$1,437.48" "$1,815.00" "$1,452.00" $816.75 $360.23 N/A "$1,052.70" "$1,815.00" "$1,815.00" "$1,815.00" $378.25 "$1,815.00" N/A N/A 351.323 SUP HCPCS C1713 351.323 - SPACER SPNL 3.5D 15MM 18MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,815.00" "$1,343.00" $360.23 "$1,815.00" $816.75 $816.75 $816.75 $816.75 "$1,815.00" "$1,815.00" "$1,815.00" $378.29 "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" $378.27 "$1,815.00" $726.00 "$1,073.57" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,361.25" "$1,815.00" "$1,815.00" "$1,815.00" $907.50 $907.50 "$1,437.48" "$1,815.00" "$1,452.00" $816.75 $360.23 N/A "$1,052.70" "$1,815.00" "$1,815.00" "$1,815.00" $378.25 "$1,815.00" N/A N/A 351.324 SUP HCPCS C1713 351.324 - SPACER SPNL 7D 15MM 18MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,815.00" "$1,343.00" $360.23 "$1,815.00" $816.75 $816.75 $816.75 $816.75 "$1,815.00" "$1,815.00" "$1,815.00" $378.29 "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" $378.27 "$1,815.00" "$1,815.00" "$1,073.57" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,361.25" "$1,815.00" "$1,815.00" "$1,815.00" $907.50 $907.50 "$1,437.48" "$1,815.00" "$1,452.00" $816.75 $360.23 N/A "$1,052.70" "$1,815.00" "$1,815.00" "$1,815.00" $378.25 "$1,815.00" N/A N/A 351.351 SUP HCPCS C1713 351.351 - SPACER SPNL 0D 14MM 14MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.353 SUP HCPCS C1713 351.353 - SPACER SPNL 3.5D 14MM 14MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.354 SUP HCPCS C1713 351.354 - SPACER SPNL 7D 14MM 14MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.361 SUP HCPCS C1713 351.361 - SPACER SPNL 0D 14MM 16MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.363 SUP HCPCS C1713 351.363 - SPACER SPNL 3.5D 14MM 16MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.364 SUP HCPCS C1713 351.364 - SPACER SPNL 7D 14MM 16MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.371 SUP HCPCS C1713 351.371 - SPACER SPNL 0D 15MM 18MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,815.00" "$1,343.00" $360.23 "$1,815.00" $816.75 $816.75 $816.75 $816.75 "$1,815.00" "$1,815.00" "$1,815.00" $378.29 "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" $378.27 "$1,815.00" "$1,815.00" "$1,073.57" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,361.25" "$1,815.00" "$1,815.00" "$1,815.00" $907.50 $907.50 "$1,437.48" "$1,815.00" "$1,452.00" $816.75 $360.23 N/A "$1,052.70" "$1,815.00" "$1,089.00" "$1,815.00" $378.25 "$1,815.00" N/A N/A 351.373 SUP HCPCS C1713 351.373 - SPACER SPNL 3.5D 15MM 18MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,815.00" "$1,343.00" $360.23 "$1,815.00" $816.75 $816.75 $816.75 $816.75 "$1,815.00" "$1,815.00" "$1,815.00" $378.29 "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" $378.27 "$1,815.00" "$1,815.00" "$1,073.57" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,361.25" "$1,815.00" "$1,815.00" "$1,815.00" $907.50 $907.50 "$1,437.48" "$1,815.00" "$1,452.00" $816.75 $360.23 N/A "$1,052.70" "$1,815.00" "$1,089.00" "$1,815.00" $378.25 "$1,815.00" N/A N/A 351.374 SUP HCPCS C1713 351.374 - SPACER SPNL 7D 15MM 18MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,815.00" "$1,343.00" $360.23 "$1,815.00" $816.75 $816.75 $816.75 $816.75 "$1,815.00" "$1,815.00" "$1,815.00" $378.29 "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" $378.27 "$1,815.00" $726.00 "$1,073.57" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,361.25" "$1,815.00" "$1,815.00" "$1,815.00" $907.50 $907.50 "$1,437.48" "$1,815.00" "$1,452.00" $816.75 $360.23 N/A "$1,052.70" "$1,815.00" "$1,089.00" "$1,815.00" $378.25 "$1,815.00" N/A N/A 351.401 SUP HCPCS C1713 351.401 - SPACER SPNL 0D 20MM 20MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" "$1,335.00" $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 351.403 SUP HCPCS C1713 351.403 - SPACER SPNL 4D 20MM 20MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" $534.00 $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" "$1,335.00" "$1,335.00" $278.21 "$1,335.00" N/A N/A 351.404 SUP HCPCS C1713 351.404 - SPACER SPNL 8D 20MM 20MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" "$1,335.00" $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 351.411 SUP HCPCS C1713 351.411 - SPACER SPNL 0D 21MM 23MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.413 SUP HCPCS C1713 351.413 - SPACER SPNL 4D 21MM 23MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.414 SUP HCPCS C1713 351.414 - SPACER SPNL 8D 21MM 23MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.431 SUP HCPCS C1713 351.431 - SPACER SPNL 0D 25MM 30MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.433 SUP HCPCS C1713 351.433 - SPACER SPNL 4D 25MM 30MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.434 SUP HCPCS C1713 351.434 - SPACER SPNL 8D 25MM 30MM NS LF FORTIFY-R FTPRNT UPR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.451 SUP HCPCS C1713 351.451 - SPACER SPNL 0D 20MM 20MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" "$1,335.00" $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" "$1,335.00" "$1,335.00" $278.21 "$1,335.00" N/A N/A 351.453 SUP HCPCS C1713 351.453 - SPACER SPNL 4D 20MM 20MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" "$1,335.00" $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 351.454 SUP HCPCS C1713 351.454 - SPACER SPNL 8D 20MM 20MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,335.00" $988.00 $264.96 "$1,335.00" $600.75 $600.75 $600.75 $600.75 "$1,335.00" "$1,335.00" "$1,335.00" $278.25 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" $278.23 "$1,335.00" "$1,335.00" $789.65 "$1,335.00" "$1,335.00" "$1,335.00" "$1,335.00" "$1,001.25" "$1,335.00" "$1,335.00" "$1,335.00" $667.50 $667.50 "$1,057.32" "$1,335.00" "$1,068.00" $600.75 $264.96 N/A $774.30 "$1,335.00" $801.00 "$1,335.00" $278.21 "$1,335.00" N/A N/A 351.461 SUP HCPCS C1713 351.461 - SPACER SPNL 0D 21MM 23MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.463 SUP HCPCS C1713 351.463 - SPACER SPNL 4D 21MM 23MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.464 SUP HCPCS C1713 351.464 - SPACER SPNL 8D 21MM 23MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.481 SUP HCPCS C1713 351.481 - SPACER SPNL 0D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.483 SUP HCPCS C1713 351.483 - SPACER SPNL 4D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.485 SUP HCPCS C1713 351.485 - SPACER SPNL 12D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" "$1,575.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.486 SUP HCPCS C1713 351.486 - SPACER SPNL 16D 25MM 30MM NS LF FORTIFY-R FTPRNT LWR EPLT BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $630.00 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 351.92 SUP Custom 27203010 351.92 - REAMER HAND 6MM 450MM NONSTRL BOTH IP/OP $548.50 $406.00 $97.63 $557.80 $548.48 $548.48 $548.48 $548.48 $548.48 $548.48 $97.63 $548.48 $548.48 $407.08 $407.08 $422.77 $285.76 $114.31 $548.48 $223.12 $548.48 $548.48 $557.80 $548.48 $548.48 $411.38 $548.48 $548.48 $548.48 $274.24 $274.24 $434.40 $548.48 $438.78 $356.51 $548.48 N/A $318.13 $548.48 $329.09 $548.48 $548.48 $548.48 N/A N/A 351.95 SUP Custom 27203010 351.95 - REAMER HAND 9MM 450MM NONSTRL BOTH IP/OP $567.50 $420.00 $101.01 $577.10 $567.45 $567.45 $567.45 $567.45 $567.45 $567.45 $101.01 $567.45 $567.45 $421.16 $421.16 $437.39 $295.64 $118.26 $567.45 $230.84 $567.45 $567.45 $577.10 $567.45 $567.45 $425.63 $567.45 $567.45 $567.45 $283.73 $283.73 $449.42 $567.45 $453.96 $368.84 $567.45 N/A $329.15 $567.45 $340.47 $567.45 $567.45 $567.45 N/A N/A 352.04 SUP Custom 27203010 352.04 - MANIPULATOR SURG 5MM FLEXIBLE STEM BOTH IP/OP "$4,753.00" "$3,517.00" $845.96 "$4,752.58" "$4,752.58" "$4,752.58" "$4,752.58" "$4,752.58" "$4,752.58" "$4,752.58" $845.96 "$4,752.58" "$4,752.58" "$3,527.36" "$3,527.36" "$3,663.29" "$2,060.15" $990.49 "$4,752.58" "$1,901.03" "$4,752.58" "$4,752.58" "$4,752.58" "$4,752.58" "$4,752.58" "$3,564.75" "$4,752.58" "$4,752.58" "$4,752.58" "$2,376.29" "$2,376.29" "$3,764.04" "$4,752.58" "$3,802.06" "$3,089.18" "$4,752.58" N/A "$2,756.74" "$4,752.58" "$2,851.55" "$4,752.58" "$4,752.58" "$4,752.58" N/A N/A 352.085 SUP Custom 27203010 352.085 - HEAD RMR 8.5MM MDLRY BOTH IP/OP $588.00 $435.00 $104.64 $597.88 $587.88 $587.88 $587.88 $587.88 $587.88 $587.88 $104.64 $587.88 $587.88 $436.32 $436.32 $453.14 $306.29 $122.52 $587.88 $239.15 $587.88 $587.88 $597.88 $587.88 $587.88 $441.00 $587.88 $587.88 $587.88 $293.94 $293.94 $465.60 $587.88 $470.30 $382.12 $587.88 N/A $341.04 $587.88 $352.73 $587.88 $587.88 $587.88 N/A N/A 352.165 SUP Custom 27203010 352.165 - REAMER SURG 16.5MM HEAD SIDE CUT MEDULLARY NONSTRL BOTH IP/OP $720.00 $533.00 $128.14 $719.88 $719.88 $719.88 $719.88 $719.88 $719.88 $719.88 $128.14 $719.88 $719.88 $534.29 $534.29 $554.88 $375.06 $150.03 $719.88 $287.95 $719.88 $719.88 $719.88 $719.88 $719.88 $540.00 $719.88 $719.88 $719.88 $359.94 $359.94 $570.14 $719.88 $575.90 $467.92 $719.88 N/A $417.60 $719.88 $431.93 $719.88 $719.88 $719.88 N/A N/A 355.9 SUP Custom 27203010 355.90 - BIT DRILL 4.5MM 4MM 225MM QUICK COUPLING NONSTRL BOTH IP/OP $363.00 $269.00 $64.53 $362.55 $362.55 $362.55 $362.55 $362.55 $362.55 $362.55 $64.53 $362.55 $362.55 $269.08 $269.08 $279.45 $188.89 $75.56 $362.55 $145.02 $362.55 $362.55 $362.55 $362.55 $362.55 $272.25 $362.55 $362.55 $362.55 $181.28 $181.28 $287.14 $362.55 $290.04 $235.66 $362.55 N/A $210.54 $362.55 $217.53 $362.55 $362.55 $362.55 N/A N/A 356.95 SUP Custom 27203010 356.95 - BIT DRILL 4MM 4.5MM 225MM QUICK COUPLING 3 FLUTED NONSTRL BOTH IP/OP $446.50 $330.00 $79.44 $446.28 $446.28 $446.28 $446.28 $446.28 $446.28 $446.28 $79.44 $446.28 $446.28 $331.23 $331.23 $343.99 $232.51 $93.01 $446.28 $178.51 $446.28 $446.28 $446.28 $446.28 $446.28 $334.88 $446.28 $446.28 $446.28 $223.14 $223.14 $353.45 $446.28 $357.02 $290.08 $446.28 N/A $258.97 $446.28 $267.77 $446.28 $446.28 $446.28 N/A N/A 356.97 SUP Custom 27203010 356.97 - BIT DRILL 3.2MM 215MM 80MM 3 FLUTED CALIBRATED QUICK BOTH IP/OP $408.50 $302.00 $72.70 $415.40 $408.45 $408.45 $408.45 $408.45 $408.45 $408.45 $72.70 $408.45 $408.45 $303.15 $303.15 $314.83 $212.80 $85.13 $408.45 $166.16 $408.45 $408.45 $415.40 $408.45 $408.45 $306.38 $408.45 $408.45 $408.45 $204.23 $204.23 $323.49 $408.45 $326.76 $265.49 $408.45 N/A $236.93 $408.45 $245.07 $408.45 $408.45 $408.45 N/A N/A 356.972 SUP Custom 27203010 356.972 - BIT DRILL 82MM CALIBRATION 3.2MM 215MM QUICK COUPLING 3 BOTH IP/OP $404.50 $299.00 $71.93 $410.95 $404.08 $404.08 $404.08 $404.08 $404.08 $404.08 $71.93 $404.08 $404.08 $299.91 $299.91 $311.46 $210.53 $84.21 $404.08 $164.38 $404.08 $404.08 $410.95 $404.08 $404.08 $303.38 $404.08 $404.08 $404.08 $202.04 $202.04 $320.03 $404.08 $323.26 $262.65 $404.08 N/A $234.61 $404.08 $242.45 $404.08 $404.08 $404.08 N/A N/A 356.98 SUP Custom 27203010 356.98 - BIT DRILL 4MM 270MM 95MM 3 FLUTED CALIBRATED QUICK COUPLING BOTH IP/OP $477.00 $353.00 $84.91 $485.10 $477.00 $477.00 $477.00 $477.00 $477.00 $477.00 $84.91 $477.00 $477.00 $354.03 $354.03 $367.67 $248.52 $99.41 $477.00 $194.04 $477.00 $477.00 $485.10 $477.00 $477.00 $357.75 $477.00 $477.00 $477.00 $238.50 $238.50 $377.78 $477.00 $381.60 $310.05 $477.00 N/A $276.66 $477.00 $286.20 $477.00 $477.00 $477.00 N/A N/A 356.982 SUP Custom 27203010 356.982 - BIT DRILL 4MM 215MM 80MM 3 FLUTED CALIBRATED QUICK COUPLING BOTH IP/OP $462.50 $342.00 $82.31 $470.28 $462.43 $462.43 $462.43 $462.43 $462.43 $462.43 $82.31 $462.43 $462.43 $343.22 $343.22 $356.44 $240.93 $96.38 $462.43 $188.11 $462.43 $462.43 $470.28 $462.43 $462.43 $346.88 $462.43 $462.43 $462.43 $231.22 $231.22 $366.24 $462.43 $369.94 $300.58 $462.43 N/A $268.25 $462.43 $277.46 $462.43 $462.43 $462.43 N/A N/A 357.039 SUP Custom 27203010 357.039 - GUIDEWIRE ORTHOPEDIC 2.8MM 350MM THREADED TROCAR POINT BOTH IP/OP $93.00 $69.00 $16.51 $94.35 $92.78 $92.78 $92.78 $92.78 $92.78 $92.78 $16.51 $92.78 $92.78 $68.86 $68.86 $71.51 $48.34 $19.34 $92.78 $37.74 $92.78 $92.78 $94.35 $92.78 $92.78 $69.75 $92.78 $92.78 $92.78 $46.39 $46.39 $73.48 $92.78 $74.22 $60.31 $92.78 N/A $53.94 $92.78 $55.67 $92.78 $92.78 $92.78 N/A N/A 357.047 SUP Custom 27203010 357.047 - BIT DRILL 6.5MM 330MM QUICK COUPLING CANN BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,205.15" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" $879.51 $879.51 $913.40 $617.39 $246.97 "$1,185.00" $482.06 "$1,185.00" "$1,185.00" "$1,205.15" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $770.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 357.099 SUP Custom 27203010 357.099 - BIT DRILL 5MM 330MM 100MM 3 FLUTED CALIBRATED QUICK COUPLING BOTH IP/OP $568.00 $420.00 $101.09 $567.93 $567.93 $567.93 $567.93 $567.93 $567.93 $567.93 $101.09 $567.93 $567.93 $421.52 $421.52 $437.76 $295.89 $118.36 $567.93 $227.17 $567.93 $567.93 $567.93 $567.93 $567.93 $426.00 $567.93 $567.93 $567.93 $283.97 $283.97 $449.80 $567.93 $454.34 $369.15 $567.93 N/A $329.44 $567.93 $340.76 $567.93 $567.93 $567.93 N/A N/A 357.394 SUP Custom 27203010 357.394 - BIT DRL 17MM 300MM NS CNN LG QC BOTH IP/OP "$1,514.50" "$1,121.00" $269.52 "$1,539.93" "$1,514.18" "$1,514.18" "$1,514.18" "$1,514.18" "$1,514.18" "$1,514.18" $269.52 "$1,514.18" "$1,514.18" "$1,123.82" "$1,123.82" "$1,167.13" $788.89 $315.57 "$1,514.18" $615.97 "$1,514.18" "$1,514.18" "$1,539.93" "$1,514.18" "$1,514.18" "$1,135.88" "$1,514.18" "$1,514.18" "$1,514.18" $757.09 $757.09 "$1,199.23" "$1,514.18" "$1,211.34" $984.22 "$1,514.18" N/A $878.41 "$1,514.18" $908.51 "$1,514.18" "$1,514.18" "$1,514.18" N/A N/A 357.399 SUP Custom 27203010 357.399 - GUIDEWIRE ORTHOPEDIC 3.2MM 400MM THREAD TIBIA NONSTRL BOTH IP/OP $187.00 $138.00 $33.24 $189.90 $186.73 $186.73 $186.73 $186.73 $186.73 $186.73 $33.24 $186.73 $186.73 $138.59 $138.59 $143.93 $97.29 $38.92 $186.73 $75.96 $186.73 $186.73 $189.90 $186.73 $186.73 $140.25 $186.73 $186.73 $186.73 $93.37 $93.37 $147.89 $186.73 $149.38 $121.37 $186.73 N/A $108.46 $186.73 $112.04 $186.73 $186.73 $186.73 N/A N/A 357.403 SUP Custom 27203010 357.403 - BIT DRILL 6/10MM 435MM LARGE QUICK COUPLING CANN TAPERED BOTH IP/OP "$1,088.50" $805.00 $193.70 "$1,106.73" "$1,088.23" "$1,088.23" "$1,088.23" "$1,088.23" "$1,088.23" "$1,088.23" $193.70 "$1,088.23" "$1,088.23" $807.68 $807.68 $838.81 $566.97 $226.80 "$1,088.23" $442.69 "$1,088.23" "$1,088.23" "$1,106.73" "$1,088.23" "$1,088.23" $816.38 "$1,088.23" "$1,088.23" "$1,088.23" $544.12 $544.12 $861.88 "$1,088.23" $870.58 $707.35 "$1,088.23" N/A $631.33 "$1,088.23" $652.94 "$1,088.23" "$1,088.23" "$1,088.23" N/A N/A 357.404 SUP Custom 27203010 357.404 - BIT DRILL LARGE 11MM 280MM LARGE QUICK COUPLING CANN TAPERED BOTH IP/OP $960.00 $710.00 $170.85 $976.18 $959.85 $959.85 $959.85 $959.85 $959.85 $959.85 $170.85 $959.85 $959.85 $712.40 $712.40 $739.85 $500.08 $200.04 $959.85 $390.47 $959.85 $959.85 $976.18 $959.85 $959.85 $720.00 $959.85 $959.85 $959.85 $479.93 $479.93 $760.20 $959.85 $767.88 $623.90 $959.85 N/A $556.80 $959.85 $575.91 $959.85 $959.85 $959.85 N/A N/A 357.407 SUP Custom 27203010 357.407 - BIT DRL 65MM 3 FLUT 4MM 260MM NS QC CLBRT BOTH IP/OP $392.50 $290.00 $69.85 $399.08 $392.40 $392.40 $392.40 $392.40 $392.40 $392.40 $69.85 $392.40 $392.40 $291.24 $291.24 $302.46 $204.44 $81.78 $392.40 $159.63 $392.40 $392.40 $399.08 $392.40 $392.40 $294.38 $392.40 $392.40 $392.40 $196.20 $196.20 $310.78 $392.40 $313.92 $255.06 $392.40 N/A $227.65 $392.40 $235.44 $392.40 $392.40 $392.40 N/A N/A 358.691 SUP Custom 27203010 358.691 - BIT DRILL 102MM STOP 4.5MM 170MM 102MM JACOBS CHUCK CANN BOTH IP/OP $694.00 $514.00 $123.53 $693.98 $693.98 $693.98 $693.98 $693.98 $693.98 $693.98 $123.53 $693.98 $693.98 $515.07 $515.07 $534.92 $361.56 $144.63 $693.98 $277.59 $693.98 $693.98 $693.98 $693.98 $693.98 $520.50 $693.98 $693.98 $693.98 $346.99 $346.99 $549.63 $693.98 $555.18 $451.09 $693.98 N/A $402.52 $693.98 $416.39 $693.98 $693.98 $693.98 N/A N/A 359.079 SUP Custom 27203010 359.079 - BIT DRILL LARGE 10.5MM 250MM QUICK COUPLING CANN FLEXIBLE BOTH IP/OP $921.50 $682.00 $163.97 $921.20 $921.20 $921.20 $921.20 $921.20 $921.20 $921.20 $163.97 $921.20 $921.20 $683.71 $683.71 $710.06 $479.95 $191.99 $921.20 $368.48 $921.20 $921.20 $921.20 $921.20 $921.20 $691.13 $921.20 $921.20 $921.20 $460.60 $460.60 $729.59 $921.20 $736.96 $598.78 $921.20 N/A $534.47 $921.20 $552.72 $921.20 $921.20 $921.20 N/A N/A 359.081 SUP Custom 27203010 359.081 - BIT DRILL LARGE 8MM 250MM QUICK COUPLING CANN FLEXIBLE BOTH IP/OP $921.50 $682.00 $163.97 $921.20 $921.20 $921.20 $921.20 $921.20 $921.20 $921.20 $163.97 $921.20 $921.20 $683.71 $683.71 $710.06 $479.95 $191.99 $921.20 $368.48 $921.20 $921.20 $921.20 $921.20 $921.20 $691.13 $921.20 $921.20 $921.20 $460.60 $460.60 $729.59 $921.20 $736.96 $598.78 $921.20 N/A $534.47 $921.20 $552.72 $921.20 $921.20 $921.20 N/A N/A 360.01 SUP Custom 27203010 360.01 - BIT DRILL LARGE 6MM 190MM QUICK COUPLING CANN NONSTRL BOTH IP/OP "$1,098.00" $813.00 $195.42 "$1,116.53" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" $195.42 "$1,097.85" "$1,097.85" $814.82 $814.82 $846.22 $571.98 $228.80 "$1,097.85" $446.61 "$1,097.85" "$1,097.85" "$1,116.53" "$1,097.85" "$1,097.85" $823.50 "$1,097.85" "$1,097.85" "$1,097.85" $548.93 $548.93 $869.50 "$1,097.85" $878.28 $713.60 "$1,097.85" N/A $636.84 "$1,097.85" $658.71 "$1,097.85" "$1,097.85" "$1,097.85" N/A N/A 360.02 SUP Custom 27203010 360.02 - BIT DRILL LARGE 7MM 190MM QUICK COUPLING CANN NONSTRL BOTH IP/OP "$1,098.00" $813.00 $195.42 "$1,116.53" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" $195.42 "$1,097.85" "$1,097.85" $814.82 $814.82 $846.22 $571.98 $228.80 "$1,097.85" $446.61 "$1,097.85" "$1,097.85" "$1,116.53" "$1,097.85" "$1,097.85" $823.50 "$1,097.85" "$1,097.85" "$1,097.85" $548.93 $548.93 $869.50 "$1,097.85" $878.28 $713.60 "$1,097.85" N/A $636.84 "$1,097.85" $658.71 "$1,097.85" "$1,097.85" "$1,097.85" N/A N/A 360.03 SUP Custom 27203010 360.03 - BIT DRILL LARGE 8MM 190MM QUICK COUPLING CANN NONSTRL BOTH IP/OP "$1,098.00" $813.00 $195.42 "$1,116.53" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" $195.42 "$1,097.85" "$1,097.85" $814.82 $814.82 $846.22 $571.98 $228.80 "$1,097.85" $446.61 "$1,097.85" "$1,097.85" "$1,116.53" "$1,097.85" "$1,097.85" $823.50 "$1,097.85" "$1,097.85" "$1,097.85" $548.93 $548.93 $869.50 "$1,097.85" $878.28 $713.60 "$1,097.85" N/A $636.84 "$1,097.85" $658.71 "$1,097.85" "$1,097.85" "$1,097.85" N/A N/A 360.04 SUP Custom 27203010 360.04 - BIT DRILL LARGE 9MM 190MM QUICK COUPLING CANN NONSTRL BOTH IP/OP "$1,098.00" $813.00 $195.42 "$1,116.53" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" $195.42 "$1,097.85" "$1,097.85" $814.82 $814.82 $846.22 $571.98 $228.80 "$1,097.85" $446.61 "$1,097.85" "$1,097.85" "$1,116.53" "$1,097.85" "$1,097.85" $823.50 "$1,097.85" "$1,097.85" "$1,097.85" $548.93 $548.93 $869.50 "$1,097.85" $878.28 $713.60 "$1,097.85" N/A $636.84 "$1,097.85" $658.71 "$1,097.85" "$1,097.85" "$1,097.85" N/A N/A 360.05 SUP Custom 27203010 360.05 - BIT DRILL LARGE 10MM 190MM QUICK COUPLING CANN NONSTRL BOTH IP/OP "$1,098.00" $813.00 $195.42 "$1,116.53" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" "$1,097.85" $195.42 "$1,097.85" "$1,097.85" $814.82 $814.82 $846.22 $571.98 $228.80 "$1,097.85" $446.61 "$1,097.85" "$1,097.85" "$1,116.53" "$1,097.85" "$1,097.85" $823.50 "$1,097.85" "$1,097.85" "$1,097.85" $548.93 $548.93 $869.50 "$1,097.85" $878.28 $713.60 "$1,097.85" N/A $636.84 "$1,097.85" $658.71 "$1,097.85" "$1,097.85" "$1,097.85" N/A N/A 360.06 SUP Custom 27203010 360.06 - BIT DRILL LARGE 11MM 190MM QUICK COUPLING CANN NONSTRL BOTH IP/OP "$1,153.00" $853.00 $205.18 "$1,172.28" "$1,152.68" "$1,152.68" "$1,152.68" "$1,152.68" "$1,152.68" "$1,152.68" $205.18 "$1,152.68" "$1,152.68" $855.52 $855.52 $888.49 $600.55 $240.23 "$1,152.68" $468.91 "$1,152.68" "$1,152.68" "$1,172.28" "$1,152.68" "$1,152.68" $864.75 "$1,152.68" "$1,152.68" "$1,152.68" $576.34 $576.34 $912.92 "$1,152.68" $922.14 $749.24 "$1,152.68" N/A $668.74 "$1,152.68" $691.61 "$1,152.68" "$1,152.68" "$1,152.68" N/A N/A 360.07 SUP Custom 27203010 360.07 - BIT DRILL LARGE 12MM 190MM QUICK COUPLING CANN NONSTRL BOTH IP/OP "$1,153.00" $853.00 $205.18 "$1,172.28" "$1,152.68" "$1,152.68" "$1,152.68" "$1,152.68" "$1,152.68" "$1,152.68" $205.18 "$1,152.68" "$1,152.68" $855.52 $855.52 $888.49 $600.55 $240.23 "$1,152.68" $468.91 "$1,152.68" "$1,152.68" "$1,172.28" "$1,152.68" "$1,152.68" $864.75 "$1,152.68" "$1,152.68" "$1,152.68" $576.34 $576.34 $912.92 "$1,152.68" $922.14 $749.24 "$1,152.68" N/A $668.74 "$1,152.68" $691.61 "$1,152.68" "$1,152.68" "$1,152.68" N/A N/A 360.257 SUP Custom 27203010 360.257 - BIT DRL 13MM 385MM NS LG QC FLXB BOTH IP/OP $794.50 $588.00 $141.37 $807.73 $794.23 $794.23 $794.23 $794.23 $794.23 $794.23 $141.37 $794.23 $794.23 $589.48 $589.48 $612.19 $413.79 $165.53 $794.23 $323.09 $794.23 $794.23 $807.73 $794.23 $794.23 $595.88 $794.23 $794.23 $794.23 $397.12 $397.12 $629.03 $794.23 $635.38 $516.25 $794.23 N/A $460.81 $794.23 $476.54 $794.23 $794.23 $794.23 N/A N/A 360.258 SUP Custom 27203010 360.258 - BIT DRL 15.5MM 385MM NS LG QC FLXB BOTH IP/OP $794.50 $588.00 $141.37 $807.73 $794.23 $794.23 $794.23 $794.23 $794.23 $794.23 $141.37 $794.23 $794.23 $589.48 $589.48 $612.19 $413.79 $165.53 $794.23 $323.09 $794.23 $794.23 $807.73 $794.23 $794.23 $595.88 $794.23 $794.23 $794.23 $397.12 $397.12 $629.03 $794.23 $635.38 $516.25 $794.23 N/A $460.81 $794.23 $476.54 $794.23 $794.23 $794.23 N/A N/A 364.009 SUP Custom 27803010 364.009 - SPACER SPNL 0D 20MM XS 25X9MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.011 SUP Custom 27803010 364.011 - SPACER SPNL 0D 20MM XS 25X11MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.013 SUP Custom 27803010 364.013 - SPACER SPNL 0D 20MM XS 25X13MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.015 SUP Custom 27803010 364.015 - SPACER SPNL 0D 20MM XS 25X15MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.017 SUP Custom 27803010 364.017 - SPACER SPNL 0D 20MM XS 25X17MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.109 SUP Custom 27803010 364.109 - SPACER SPNL 0D 22MM SM 29X9MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.111 SUP Custom 27803010 364.111 - SPACER SPNL 0D 22MM SM 29X11MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.113 SUP Custom 27803010 364.113 - SPACER SPNL 0D 22MM SM 29X13MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.115 SUP Custom 27803010 364.115 - SPACER SPNL 0D 22MM SM 29X15MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.117 SUP Custom 27803010 364.117 - SPACER SPNL 0D 22MM SM 29X17MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.209 SUP Custom 27803010 364.209 - SPACER SPNL 8D LRDTC 22MM SM 29X9MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.211 SUP Custom 27803010 364.211 - SPACER SPNL 8D LRDTC 22MM SM 29X11MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.213 SUP Custom 27803010 364.213 - SPACER SPNL 8D LRDTC 22MM SM 29X13MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.215 SUP Custom 27803010 364.215 - SPACER SPNL 8D LRDTC 22MM SM 29X15MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.217 SUP Custom 27803010 364.217 - SPACER SPNL 8D LRDTC 22MM SM 29X17MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.311 SUP Custom 27803010 364.311 - SPACER SPNL 15D LRDTC 22MM SM 29X11MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.313 SUP Custom 27803010 364.313 - SPACER SPNL 15D LRDTC 22MM SM 29X13MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.315 SUP Custom 27803010 364.315 - SPACER SPNL 15D LRDTC 22MM SM 29X15MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.317 SUP Custom 27803010 364.317 - SPACER SPNL 15D LRDTC 22MM SM 29X17MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.409 SUP Custom 27803010 364.409 - SPACER SPNL 0D 24MM MED 35X9MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.411 SUP Custom 27803010 364.411 - SPACER SPNL 0D 24MM MED 35X11MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.413 SUP Custom 27803010 364.413 - SPACER SPNL 0D 24MM MED 35X13MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.415 SUP Custom 27803010 364.415 - SPACER SPNL 0D 24MM MED 35X15MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.417 SUP Custom 27803010 364.417 - SPACER SPNL 0D 24MM MED 35X17MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.419 SUP Custom 27803010 364.419 - SPACER SPNL 0D 24MM MED 35X19MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.421 SUP Custom 27803010 364.421 - SPACER SPNL 0D 24MM MED 35X21MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.509 SUP Custom 27803010 364.509 - SPACER SPNL 8D LRDTC 24MM MED 35X9MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.511 SUP Custom 27803010 364.511 - SPACER SPNL 8D LRDTC 24MM MED 35X11MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.513 SUP Custom 27803010 364.513 - SPACER SPNL 8D LRDTC 24MM MED 35X13MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.515 SUP Custom 27803010 364.515 - SPACER SPNL 8D LRDTC 24MM MED 35X15MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.517 SUP Custom 27803010 364.517 - SPACER SPNL 8D LRDTC 24MM MED 35X17MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.519 SUP Custom 27803010 364.519 - SPACER SPNL 8D LRDTC 24MM MED 35X19MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.521 SUP Custom 27803010 364.521 - SPACER SPNL 8D LRDTC 24MM MED 35X21MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.611 SUP Custom 27803010 364.611 - SPACER SPNL 15D LRDTC 24MM MED 35X11MM NS LF CNTNTL PEEK BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.613 SUP Custom 27803010 364.613 - SPACER SPNL 15D LRDTC 24MM MED 35X13MM NS LF CNTNTL PEEK BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.615 SUP Custom 27803010 364.615 - SPACER SPNL 15D LRDTC 24MM MED 35X15MM NS LF CNTNTL PEEK BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.617 SUP Custom 27803010 364.617 - SPACER SPNL 15D LRDTC 24MM MED 35X17MM NS LF CNTNTL PEEK BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.619 SUP Custom 27803010 364.619 - SPACER SPNL 15D LRDTC 24MM MED 35X19MM NS LF CNTNTL PEEK BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.621 SUP Custom 27803010 364.621 - SPACER SPNL 15D LRDTC 24MM MED 35X21MM NS LF CNTNTL PEEK BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.711 SUP Custom 27803010 364.711 - SPACER SPNL 8D LRDTC 28MM LG 39X11MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.713 SUP Custom 27803010 364.713 - SPACER SPNL 8D LRDTC 28MM LG 39X13MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.715 SUP Custom 27803010 364.715 - SPACER SPNL 8D LRDTC 28MM LG 39X15MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.717 SUP Custom 27803010 364.717 - SPACER SPNL 8D LRDTC 28MM LG 39X17MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.719 SUP Custom 27803010 364.719 - SPACER SPNL 8D LRDTC 28MM LG 39X19MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.721 SUP Custom 27803010 364.721 - SPACER SPNL 8D LRDTC 28MM LG 39X21MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.759 SUP Custom 27803010 "364.759 - Continental ALIF Spacer, Large 5 deg, 9mm" BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.813 SUP Custom 27803010 364.813 - SPACER SPNL 15D LRDTC 28MM LG 39X13MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.815 SUP Custom 27803010 364.815 - SPACER SPNL 15D LRDTC 28MM LG 39X15MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.817 SUP Custom 27803010 364.817 - SPACER SPNL 15D LRDTC 28MM LG 39X17MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.819 SUP Custom 27803010 364.819 - SPACER SPNL 15D LRDTC 28MM LG 39X19MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 364.821 SUP Custom 27803010 364.821 - SPACER SPNL 15D LRDTC 28MM LG 39X21MM NS LF CNTNTL PEEK ALIF BOTH IP/OP "$13,642.50" "$10,095.00" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,428.37" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$2,843.25" "$13,642.50" "$5,457.00" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$13,642.50" "$10,231.88" "$13,642.50" "$13,642.50" "$13,642.50" "$6,821.25" "$6,821.25" "$10,804.86" "$13,642.50" "$10,914.00" "$6,139.13" "$13,642.50" N/A "$7,912.65" "$13,642.50" "$8,185.50" "$13,642.50" "$13,642.50" "$13,642.50" N/A N/A 365.005 SUP Custom 27803010 365.005 - SPACER SPNL 11MM SM PRLL 12X5MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.006 SUP Custom 27803010 365.006 - SPACER SPNL 11MM SM PRLL 12X6MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.007 SUP Custom 27803010 365.007 - SPACER SPNL 11MM SM PRLL 12X7MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.008 SUP Custom 27803010 365.008 - SPACER SPNL 11MM SM PRLL 12X8MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.009 SUP Custom 27803010 365.009 - SPACER SPNL 11MM SM PRLL 12X9MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.01 SUP Custom 27803010 365.010 - SPACER SPNL 11MM SM PRLL 12X10MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.011 SUP Custom 27803010 365.011 - SPACER SPNL 11MM SM PRLL 12X11MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.012 SUP Custom 27803010 365.012 - SPACER SPNL 11MM SM PRLL 12X12MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.045 SUP Custom 27803010 365.045 - SPACER SPNL 15MM 2XL PRLL 18X5MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.046 SUP Custom 27803010 365.046 - SPACER SPNL 15MM 2XL PRLL 18X6MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.047 SUP Custom 27803010 365.047 - SPACER SPNL 15MM 2XL PRLL 18X7MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.048 SUP Custom 27803010 365.048 - SPACER SPNL 15MM 2XL PRLL 18X8MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.049 SUP Custom 27803010 365.049 - SPACER SPNL 15MM 2XL PRLL 18X9MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.05 SUP Custom 27803010 365.050 - SPACER SPNL 15MM 2XL PRLL 18X10MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.051 SUP Custom 27803010 365.051 - SPACER SPNL 15MM 2XL PRLL 18X11MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.052 SUP Custom 27803010 365.052 - SPACER SPNL 15MM 2XL PRLL 18X12MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.065 SUP Custom 27803010 365.065 - SPACER SPNL 7D LRDTC 15MM 2XL 18X5MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.066 SUP Custom 27803010 365.066 - SPACER SPNL 7D LRDTC 15MM 2XL 18X6MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.067 SUP Custom 27803010 365.067 - SPACER SPNL 7D LRDTC 15MM 2XL 18X7MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.068 SUP Custom 27803010 365.068 - SPACER SPNL 7D LRDTC 15MM 2XL 18X8MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.069 SUP Custom 27803010 365.069 - SPACER SPNL 7D LRDTC 15MM 2XL 18X9MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.07 SUP Custom 27803010 365.070 - SPACER SPNL 7D LRDTC 15MM 2XL 18X10MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.071 SUP Custom 27803010 365.071 - SPACER SPNL 7D LRDTC 15MM 2XL 18X11MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.072 SUP Custom 27803010 365.072 - SPACER SPNL 7D LRDTC 15MM 2XL 18X12MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.105 SUP Custom 27803010 365.105 - SPACER SPNL 7D LRDTC 11MM SM 12X5MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.106 SUP Custom 27803010 365.106 - SPACER SPNL 7D LRDTC 11MM SM 12X6MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.107 SUP Custom 27803010 365.107 - SPACER SPNL 7D LRDTC 11MM SM 12X7MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.108 SUP Custom 27803010 365.108 - SPACER SPNL 7D LRDTC 11MM SM 12X8MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.109 SUP Custom 27803010 365.109 - SPACER SPNL 7D LRDTC 11MM SM 12X9MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.11 SUP Custom 27803010 365.110 - SPACER SPNL 7D LRDTC 11MM SM 12X10MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.111 SUP Custom 27803010 365.111 - SPACER SPNL 7D LRDTC 11MM SM 12X11MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.112 SUP Custom 27803010 365.112 - SPACER SPNL 7D LRDTC 11MM SM 12X12MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.305 SUP Custom 27803010 365.305 - SPACER SPNL 12MM LG PRLL 14X5MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.306 SUP Custom 27803010 365.306 - SPACER SPNL 12MM LG PRLL 14X6MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.307 SUP Custom 27803010 365.307 - SPACER SPNL 12MM LG PRLL 14X7MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.308 SUP Custom 27803010 365.308 - SPACER SPNL 12MM LG PRLL 14X8MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.309 SUP Custom 27803010 365.309 - SPACER SPNL 12MM LG PRLL 14X9MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.31 SUP Custom 27803010 365.310 - SPACER SPNL 12MM LG PRLL 14X10MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.311 SUP Custom 27803010 365.311 - SPACER SPNL 12MM LG PRLL 14X11MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.312 SUP Custom 27803010 365.312 - SPACER SPNL 12MM LG PRLL 14X12MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.405 SUP Custom 27803010 365.405 - SPACER SPNL 7D LRDTC 12MM LG 14X5MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.406 SUP Custom 27803010 365.406 - SPACER SPNL 7D LRDTC 12MM LG 14X6MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.407 SUP Custom 27803010 365.407 - SPACER SPNL 7D LRDTC 12MM LG 14X7MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.408 SUP Custom 27803010 365.408 - SPACER SPNL 7D LRDTC 12MM LG 14X8MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.409 SUP Custom 27803010 365.409 - SPACER SPNL 7D LRDTC 12MM LG 14X9MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.41 SUP Custom 27803010 365.410 - SPACER SPNL 7D LRDTC 12MM LG 14X10MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.411 SUP Custom 27803010 365.411 - SPACER SPNL 7D LRDTC 12MM LG 14X11MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.412 SUP Custom 27803010 365.412 - SPACER SPNL 7D LRDTC 12MM LG 14X12MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.705 SUP Custom 27803010 365.705 - SPACER SPNL 7D LRDTC 14MM XL 16X5MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.706 SUP Custom 27803010 365.706 - SPACER SPNL 7D LRDTC 14MM XL 16X6MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.707 SUP Custom 27803010 365.707 - SPACER SPNL 7D LRDTC 14MM XL 16X7MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.708 SUP Custom 27803010 365.708 - SPACER SPNL 7D LRDTC 14MM XL 16X8MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.709 SUP Custom 27803010 365.709 - SPACER SPNL 7D LRDTC 14MM XL 16X9MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.71 SUP Custom 27803010 365.710 - SPACER SPNL 7D LRDTC 14MM XL 16X10MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.711 SUP Custom 27803010 365.711 - SPACER SPNL 7D LRDTC 14MM XL 16X11MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.712 SUP Custom 27803010 365.712 - SPACER SPNL 7D LRDTC 14MM XL 16X12MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.805 SUP Custom 27803010 365.805 - SPACER SPNL 7D LRDTC 14MM XL 16X5MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.806 SUP Custom 27803010 365.806 - SPACER SPNL 7D LRDTC 14MM XL 16X6MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.807 SUP Custom 27803010 365.807 - SPACER SPNL 7D LRDTC 14MM XL 16X7MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.808 SUP Custom 27803010 365.808 - SPACER SPNL 7D LRDTC 14MM XL 16X8MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.809 SUP Custom 27803010 365.809 - SPACER SPNL 7D LRDTC 14MM XL 16X9MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.81 SUP Custom 27803010 365.810 - SPACER SPNL 7D LRDTC 14MM XL 16X10MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.811 SUP Custom 27803010 365.811 - SPACER SPNL 7D LRDTC 14MM XL 16X11MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 365.812 SUP Custom 27803010 365.812 - SPACER SPNL 7D LRDTC 14MM XL 16X12MM NS LF CLN PEEK ACDF BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 368.207 SUP Custom 27803010 368.207 - SPACER SPNL SM 28X10X7MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.208 SUP Custom 27803010 368.208 - SPACER SPNL SM 28X10X8MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.209 SUP Custom 27803010 368.209 - SPACER SPNL SM 28X10X9MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.21 SUP Custom 27803010 368.210 - SPACER SPNL SM 28X10X10MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.211 SUP Custom 27803010 368.211 - SPACER SPNL SM 28X10X11MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.212 SUP Custom 27803010 368.212 - SPACER SPNL SM 28X10X12MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.213 SUP Custom 27803010 368.213 - SPACER SPNL SM 28X10X13MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.215 SUP Custom 27803010 368.215 - SPACER SPNL SM 28X10X15MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.217 SUP Custom 27803010 368.217 - SPACER SPNL SM 28X10X17MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.307 SUP Custom 27803010 368.307 - SPACER SPNL LG 33X11X7MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.308 SUP Custom 27803010 368.308 - SPACER SPNL LG 33X11X8MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.309 SUP Custom 27803010 368.309 - SPACER SPNL LG 33X11X9MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.31 SUP Custom 27803010 368.310 - SPACER SPNL LG 33X11X10MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.311 SUP Custom 27803010 368.311 - SPACER SPNL LG 33X11X11MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.312 SUP Custom 27803010 368.312 - SPACER SPNL LG 33X11X12MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.313 SUP Custom 27803010 368.313 - SPACER SPNL LG 33X11X13MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.315 SUP Custom 27803010 368.315 - SPACER SPNL LG 33X11X15MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 368.317 SUP Custom 27803010 368.317 - SPACER SPNL LG 33X11X17MM NS SGNTR PEEK TLIF BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.008 SUP Custom 27803010 "375.008 - TransContinental LLIF Spacer, Small, 0 deg, 8mm" BOTH IP/OP "$19,642.50" "$14,535.00" "$3,496.37" "$19,642.50" "$19,642.50" "$19,642.50" "$19,642.50" "$19,642.50" "$19,642.50" "$19,642.50" "$3,496.37" "$19,642.50" "$19,642.50" "$19,642.50" "$19,642.50" "$19,642.50" "$19,642.50" "$4,093.71" "$19,642.50" "$7,857.00" "$19,642.50" "$19,642.50" "$19,642.50" "$19,642.50" "$19,642.50" "$14,731.88" "$19,642.50" "$19,642.50" "$19,642.50" "$9,821.25" "$9,821.25" "$15,556.86" "$19,642.50" "$15,714.00" "$8,839.13" "$19,642.50" N/A "$11,392.65" "$19,642.50" "$11,785.50" "$19,642.50" "$19,642.50" "$19,642.50" N/A N/A 375.009 SUP Custom 27803010 375.009 - SPACER SPNL 0D SM 45X18X9MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.011 SUP Custom 27803010 375.011 - SPACER SPNL 0D SM 45X18X11MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.013 SUP Custom 27803010 375.013 - SPACER SPNL 0D SM 45X18X13MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.015 SUP Custom 27803010 375.015 - SPACER SPNL 0D SM 45X18X15MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.017 SUP Custom 27803010 375.017 - SPACER SPNL 0D SM 45X18X17MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.019 SUP Custom 27803010 375.019 - SPACER SPNL 0D SM 45X18X19MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.021 SUP Custom 27803010 375.021 - SPACER SPNL 0D SM 45X18X21MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.109 SUP Custom 27803010 375.109 - SPACER SPNL 6D LRDTC SM 45X18X9MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.111 SUP Custom 27803010 375.111 - SPACER SPNL 6D LRDTC SM 45X18X11MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.113 SUP Custom 27803010 375.113 - SPACER SPNL 6D LRDTC SM 45X18X13MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.115 SUP Custom 27803010 375.115 - SPACER SPNL 6D LRDTC SM 45X18X15MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.117 SUP Custom 27803010 375.117 - SPACER SPNL 6D LRDTC SM 45X18X17MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.119 SUP Custom 27803010 375.119 - SPACER SPNL 6D LRDTC SM 45X18X19MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.121 SUP Custom 27803010 375.121 - SPACER SPNL 6D LRDTC SM 45X18X21MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.209 SUP Custom 27803010 375.209 - SPACER SPNL 0D MED 50X18X9MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.211 SUP Custom 27803010 375.211 - SPACER SPNL 0D MED 50X18X11MM NS LF TRANSCONTINENTAL PEEK BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.213 SUP Custom 27803010 375.213 - SPACER SPNL 0D MED 50X18X13MM NS LF TRANSCONTINENTAL PEEK BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.215 SUP Custom 27803010 375.215 - SPACER SPNL 0D MED 50X18X15MM NS LF TRANSCONTINENTAL PEEK BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.217 SUP Custom 27803010 375.217 - SPACER SPNL 0D MED 50X18X17MM NS LF TRANSCONTINENTAL PEEK BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.219 SUP Custom 27803010 375.219 - SPACER SPNL 0D MED 50X18X19MM NS LF TRANSCONTINENTAL PEEK BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.221 SUP Custom 27803010 375.221 - SPACER SPNL 0D MED 50X18X21MM NS LF TRANSCONTINENTAL PEEK BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.309 SUP Custom 27803010 375.309 - SPACER SPNL 6D LRDTC MED 50X18X9MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.311 SUP Custom 27803010 375.311 - SPACER SPNL 6D LRDTC MED 50X18X11MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.313 SUP Custom 27803010 375.313 - SPACER SPNL 6D LRDTC MED 50X18X13MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.315 SUP Custom 27803010 375.315 - SPACER SPNL 6D LRDTC MED 50X18X15MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.317 SUP Custom 27803010 375.317 - SPACER SPNL 6D LRDTC MED 50X18X17MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.319 SUP Custom 27803010 375.319 - SPACER SPNL 6D LRDTC MED 50X18X19MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.321 SUP Custom 27803010 375.321 - SPACER SPNL 6D LRDTC MED 50X18X21MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.409 SUP Custom 27803010 375.409 - SPACER SPNL 0D LG 55X18X9MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.411 SUP Custom 27803010 375.411 - SPACER SPNL 0D LG 55X18X11MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.413 SUP Custom 27803010 375.413 - SPACER SPNL 0D LG 55X18X13MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.415 SUP Custom 27803010 375.415 - SPACER SPNL 0D LG 55X18X15MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.417 SUP Custom 27803010 375.417 - SPACER SPNL 0D LG 55X18X17MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.419 SUP Custom 27803010 375.419 - SPACER SPNL 0D LG 55X18X19MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.421 SUP Custom 27803010 375.421 - SPACER SPNL 0D LG 55X18X21MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.509 SUP Custom 27803010 375.509 - SPACER SPNL 6D LRDTC LG 55X18X9MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.511 SUP Custom 27803010 375.511 - SPACER SPNL 6D LRDTC LG 55X18X11MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.513 SUP Custom 27803010 375.513 - SPACER SPNL 6D LRDTC LG 55X18X13MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.515 SUP Custom 27803010 375.515 - SPACER SPNL 6D LRDTC LG 55X18X15MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.517 SUP Custom 27803010 375.517 - SPACER SPNL 6D LRDTC LG 55X18X17MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.519 SUP Custom 27803010 375.519 - SPACER SPNL 6D LRDTC LG 55X18X19MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.521 SUP Custom 27803010 375.521 - SPACER SPNL 6D LRDTC LG 55X18X21MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.609 SUP Custom 27803010 375.609 - SPACER SPNL 0D XL 60X18X9MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.611 SUP Custom 27803010 375.611 - SPACER SPNL 0D XL 60X18X11MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.613 SUP Custom 27803010 375.613 - SPACER SPNL 0D XL 60X18X13MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.615 SUP Custom 27803010 375.615 - SPACER SPNL 0D XL 60X18X15MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.617 SUP Custom 27803010 375.617 - SPACER SPNL 0D XL 60X18X17MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.619 SUP Custom 27803010 375.619 - SPACER SPNL 0D XL 60X18X19MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.621 SUP Custom 27803010 375.621 - SPACER SPNL 0D XL 60X18X21MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.709 SUP Custom 27803010 375.709 - SPACER SPNL 6D LRDTC XL 60X18X9MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.711 SUP Custom 27803010 375.711 - SPACER SPNL 6D LRDTC XL 60X18X11MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.713 SUP Custom 27803010 375.713 - SPACER SPNL 6D LRDTC XL 60X18X13MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.715 SUP Custom 27803010 375.715 - SPACER SPNL 6D LRDTC XL 60X18X15MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.717 SUP Custom 27803010 375.717 - SPACER SPNL 6D LRDTC XL 60X18X17MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.719 SUP Custom 27803010 375.719 - SPACER SPNL 6D LRDTC XL 60X18X19MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.721 SUP Custom 27803010 375.721 - SPACER SPNL 6D LRDTC XL 60X18X21MM NS LF TRANSCONTINENTAL BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.809 SUP Custom 27803010 375.809 - SPACER SPNL 0D XS 40X18X9MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.811 SUP Custom 27803010 375.811 - SPACER SPNL 0D XS 40X18X11MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.813 SUP Custom 27803010 375.813 - SPACER SPNL 0D XS 40X18X13MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.815 SUP Custom 27803010 375.815 - SPACER SPNL 0D XS 40X18X15MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 375.817 SUP Custom 27803010 375.817 - SPACER SPNL 0D XS 40X18X17MM NS LF TRANSCONTINENTAL PEEK LAT BOTH IP/OP "$21,065.00" "$15,588.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$3,749.57" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$4,390.18" "$21,065.00" "$8,426.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$21,065.00" "$15,798.75" "$21,065.00" "$21,065.00" "$21,065.00" "$10,532.50" "$10,532.50" "$16,683.48" "$21,065.00" "$16,852.00" "$9,479.25" "$21,065.00" N/A "$12,217.70" "$21,065.00" "$12,639.00" "$21,065.00" "$21,065.00" "$21,065.00" N/A N/A 376.111 SUP Custom 27803010 376.111 - SPACER ORTHOPEDIC SMALL 11MM INDEPENDENCE PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.113 SUP Custom 27803010 376.113 - SPACER SPNL 8D LRDTC 24MM SM 30X13MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.115 SUP Custom 27803010 376.115 - SPACER SPNL 8D LRDTC 24MM SM 30X15MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.117 SUP Custom 27803010 376.117 - SPACER SPNL 8D LRDTC 24MM SM 30X17MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.211 SUP Custom 27803010 376.211 - SPACER SPNL 15D LRDTC 24MM SM 30X11MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.213 SUP Custom 27803010 376.213 - SPACER SPNL 15D LRDTC 24MM SM 30X13MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.215 SUP Custom 27803010 376.215 - SPACER SPNL 15D LRDTC 24MM SM 30X15MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.217 SUP Custom 27803010 376.217 - SPACER SPNL 15D LRDTC 24MM SM 30X17MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.411 SUP Custom 27803010 376.411 - SPACER ORTHOPEDIC 11MM INDEPENDENCE BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.413 SUP Custom 27803010 376.413 - SPACER SPNL 8D LRDTC 26MM MED 34X13MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.415 SUP Custom 27803010 376.415 - SPACER ORTHOPEDIC 8D 15MM INDEPENDENT INDEPENDENCE GS BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.417 SUP Custom 27803010 376.417 - SPACER SPNL 8D LRDTC 26MM MED 34X17MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.419 SUP Custom 27803010 376.419 - SPACER SPNL 8D LRDTC 26MM MED 34X19MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.421 SUP Custom 27803010 376.421 - SPACER SPNL 8D LRDTC 26MM MED 34X21MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.511 SUP Custom 27803010 376.511 - SPACER SPNL 15D LRDTC 26MM MED 24X11MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.513 SUP Custom 27803010 376.513 - SPACER SPNL 15D LRDTC 26MM MED 34X13MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.515 SUP Custom 27803010 376.515 - SPACER SPNL 15D LRDTC 26MM MED 34X15MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.517 SUP Custom 27803010 376.517 - SPACER SPNL 15D LRDTC 26MM MED 34X17MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.519 SUP Custom 27803010 376.519 - SPACER SPNL 15D LRDTC 26MM MED 34X19MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.521 SUP Custom 27803010 376.521 - SPACER SPNL 15D LRDTC 26MM MED 34X21MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.711 SUP Custom 27803010 376.711 - SPACER SPNL 8D LRDTC 29MM LG 39X11MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.713 SUP Custom 27803010 376.713 - SPACER SPNL 8D LRDTC 29MM LG 39X13MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.715 SUP Custom 27803010 376.715 - SPACER SPNL 8D LRDTC 29MM LG 39X15MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.717 SUP Custom 27803010 376.717 - SPACER SPNL 8D LRDTC 29MM LG 39X17MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.719 SUP Custom 27803010 376.719 - SPACER SPNL 8D LRDTC 29MM LG 39X19MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.721 SUP Custom 27803010 376.721 - SPACER SPNL 8D LRDTC 29MM LG 39X21MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.813 SUP Custom 27803010 376.813 - SPACER SPNL 15D LRDTC 29MM LG 39X13MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.815 SUP Custom 27803010 376.815 - SPACER ORTHOPEDIC 15D 15MM INDEPENDENCE SPN BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.817 SUP Custom 27803010 376.817 - SPACER SPNL 15D LRDTC 29MM LG 39X17MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.819 SUP Custom 27803010 376.819 - SPACER SPNL 15D LRDTC 29MM LG 39X19MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 376.821 SUP Custom 27803010 376.821 - SPACER SPNL 15D LRDTC 29MM LG 39X21MM NS LF INDPD PLT PEEK BOTH IP/OP "$25,250.00" "$18,685.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$4,494.50" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$5,262.38" "$25,250.00" "$10,100.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$25,250.00" "$18,937.50" "$25,250.00" "$25,250.00" "$25,250.00" "$12,625.00" "$12,625.00" "$19,998.00" "$25,250.00" "$20,200.00" "$11,362.50" "$25,250.00" N/A "$14,645.00" "$25,250.00" "$15,150.00" "$25,250.00" "$25,250.00" "$25,250.00" N/A N/A 384.006 SUP Custom 27803010 384.006 - SPACER SPNL 0D 12MM 14X6MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.007 SUP Custom 27803010 384.007 - SPACER SPNL 0D 12MM 14X7MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.008 SUP Custom 27803010 384.008 - SPACER SPNL 0D 12MM 14X8MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.009 SUP Custom 27803010 384.009 - SPACER SPNL 0D 12MM 14X9MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.01 SUP Custom 27803010 384.010 - SPACER SPNL 0D 12MM 14X10MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.011 SUP Custom 27803010 384.011 - SPACER SPNL 0D 12MM 14X11MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.012 SUP Custom 27803010 384.012 - SPACER SPNL 0D 12MM 14X12MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.106 SUP Custom 27803010 384.106 - SPACER SPNL 7D LRDTC 12MM 14X6MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.107 SUP Custom 27803010 384.107 - SPACER SPNL 7D LRDTC 12MM 14X7MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.108 SUP Custom 27803010 384.108 - SPACER SPNL 7D LRDTC 12MM 14X8MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.109 SUP Custom 27803010 384.109 - SPACER SPNL 7D LRDTC 12MM 14X9MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.11 SUP Custom 27803010 384.110 - SPACER SPNL 7D LRDTC 12MM 14X10MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.111 SUP Custom 27803010 384.111 - SPACER SPNL 7D LRDTC 12MM 14X11MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.112 SUP Custom 27803010 384.112 - SPACER SPNL 7D LRDTC 12MM 14X12MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.206 SUP Custom 27803010 384.206 - SPACER SPNL 0D 14MM 16X6MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.207 SUP Custom 27803010 384.207 - SPACER SPNL 0D 14MM 16X7MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.208 SUP Custom 27803010 384.208 - SPACER SPNL 0D 14MM 16X8MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.209 SUP Custom 27803010 384.209 - SPACER SPNL 0D 14MM 16X9MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.21 SUP Custom 27803010 384.210 - SPACER SPNL 0D 14MM 16X10MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.211 SUP Custom 27803010 384.211 - SPACER SPNL 0D 14MM 16X14MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.212 SUP Custom 27803010 384.212 - SPACER SPNL 0D 14MM 16X12MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.306 SUP Custom 27803010 384.306 - SPACER SPNL 7D LRDTC 14MM 16X6MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.307 SUP Custom 27803010 384.307 - SPACER SPNL 7D LRDTC 14MM 16X7MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.308 SUP Custom 27803010 384.308 - SPACER SPNL 7D LRDTC 14MM 16X8MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.309 SUP Custom 27803010 384.309 - SPACER SPNL 7D LRDTC 14MM 16X9MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.31 SUP Custom 27803010 384.310 - SPACER SPNL 7D LRDTC 14MM 16X10MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.311 SUP Custom 27803010 384.311 - SPACER SPNL 7D LRDTC 14MM 16X11MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.312 SUP Custom 27803010 384.312 - SPACER SPNL 7D LRDTC 14MM 16X12MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.406 SUP Custom 27803010 384.406 - SPACER SPNL 0D 15MM 18X6MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.407 SUP Custom 27803010 384.407 - SPACER SPNL 0D 15MM 18X7MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.408 SUP Custom 27803010 384.408 - SPACER SPNL 0D 15MM 18X8MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.409 SUP Custom 27803010 384.409 - SPACER SPNL 0D 15MM 18X9MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.41 SUP Custom 27803010 384.410 - SPACER SPNL 0D 15MM 18X10MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.411 SUP Custom 27803010 384.411 - SPACER SPNL 0D 15MM 18X11MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.412 SUP Custom 27803010 384.412 - SPACER SPNL 0D 15MM 18X12MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.506 SUP Custom 27803010 384.506 - SPACER SPNL 7D LRDTC 15MM 18X6MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.507 SUP Custom 27803010 384.507 - SPACER SPNL 7D LRDTC 15MM 18X7MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.508 SUP Custom 27803010 384.508 - SPACER SPNL 7D LRDTC 15MM 18X8MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.509 SUP Custom 27803010 384.509 - SPACER SPNL 7D LRDTC 15MM 18X9MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.51 SUP Custom 27803010 384.510 - SPACER SPNL 7D LRDTC 15MM 18X10MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.511 SUP Custom 27803010 384.511 - SPACER SPNL 7D LRDTC 15MM 18X11MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 384.512 SUP Custom 27803010 384.512 - SPACER SPNL 7D LRDTC 15MM 18X12MM NS LF COALITION PEEK ACDF BOTH IP/OP "$12,052.50" "$8,919.00" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,145.35" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$2,511.87" "$12,052.50" "$4,821.00" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$12,052.50" "$9,039.38" "$12,052.50" "$12,052.50" "$12,052.50" "$6,026.25" "$6,026.25" "$9,545.58" "$12,052.50" "$9,642.00" "$5,423.63" "$12,052.50" N/A "$6,990.45" "$12,052.50" "$7,231.50" "$12,052.50" "$12,052.50" "$12,052.50" N/A N/A 387.21 SUP Custom 27203010 387.21 - BIT DRILL THORPE BOTH IP/OP $376.00 $278.00 $66.88 $375.75 $375.75 $375.75 $375.75 $375.75 $375.75 $375.75 $66.88 $375.75 $375.75 $278.88 $278.88 $289.63 $195.77 $78.31 $375.75 $150.30 $375.75 $375.75 $375.75 $375.75 $375.75 $282.00 $375.75 $375.75 $375.75 $187.88 $187.88 $297.59 $375.75 $300.60 $244.24 $375.75 N/A $218.08 $375.75 $225.45 $375.75 $375.75 $375.75 N/A N/A 387.604 SUP Custom 27203010 387.604 - BIT DRILL 3MM QUICK COUPLING STOP BOTH IP/OP $444.50 $329.00 $79.12 $444.50 $444.50 $444.50 $444.50 $444.50 $444.50 $444.50 $79.12 $444.50 $444.50 $329.91 $329.91 $342.62 $231.58 $92.64 $444.50 $177.80 $444.50 $444.50 $444.50 $444.50 $444.50 $333.38 $444.50 $444.50 $444.50 $222.25 $222.25 $352.04 $444.50 $355.60 $288.93 $444.50 N/A $257.81 $444.50 $266.70 $444.50 $444.50 $444.50 N/A N/A 388.174 SUP Custom 27203010 388.174 - BIT DRILL 1.5MM 4MM 4-12MM 2 FLUTE STOP ARCH NONSTRL QUICK BOTH IP/OP $224.00 $166.00 $39.87 $224.00 $224.00 $224.00 $224.00 $224.00 $224.00 $224.00 $39.87 $224.00 $224.00 $166.25 $166.25 $172.66 $116.70 $46.68 $224.00 $89.60 $224.00 $224.00 $224.00 $224.00 $224.00 $168.00 $224.00 $224.00 $224.00 $112.00 $112.00 $177.41 $224.00 $179.20 $145.60 $224.00 N/A $129.92 $224.00 $134.40 $224.00 $224.00 $224.00 N/A N/A 388.175 SUP Custom 27203010 388.175 - BIT DRILL 1.5MM 91MM STOP ARCH NONSTRL QUICK COUPLING BOTH IP/OP $217.50 $161.00 $38.72 $217.50 $217.50 $217.50 $217.50 $217.50 $217.50 $217.50 $38.72 $217.50 $217.50 $161.43 $161.43 $167.65 $113.32 $45.33 $217.50 $87.00 $217.50 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $141.38 $217.50 N/A $126.15 $217.50 $130.50 $217.50 $217.50 $217.50 N/A N/A 388.177 SUP Custom 27203010 388.177 - BIT DRILL 10MM STOP 1.5MM 91MM NONSTRL BOTH IP/OP $217.50 $161.00 $38.72 $217.50 $217.50 $217.50 $217.50 $217.50 $217.50 $217.50 $38.72 $217.50 $217.50 $161.43 $161.43 $167.65 $113.32 $45.33 $217.50 $87.00 $217.50 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $141.38 $217.50 N/A $126.15 $217.50 $130.50 $217.50 $217.50 $217.50 N/A N/A 388.178 SUP Custom 27203010 388.178 - BIT DRILL 12MM STOP 1.5MM 12MM 2 FLUTE STOP ARCH NONSTRL BOTH IP/OP $224.00 $166.00 $39.87 $224.00 $224.00 $224.00 $224.00 $224.00 $224.00 $224.00 $39.87 $224.00 $224.00 $166.25 $166.25 $172.66 $116.70 $46.68 $224.00 $89.60 $224.00 $224.00 $224.00 $224.00 $224.00 $168.00 $224.00 $224.00 $224.00 $112.00 $112.00 $177.41 $224.00 $179.20 $145.60 $224.00 N/A $129.92 $224.00 $134.40 $224.00 $224.00 $224.00 N/A N/A 388.394 SUP Custom 27203010 388.394 - BIT DRL 65MM 2.4MM NS QC STP BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 388.868 SUP HCPCS C1713 388.868 - TRIAL SPNL 3.5MM ROD BOTH IP/OP $470.00 $348.00 $93.28 $470.00 $211.50 $211.50 $211.50 $211.50 $470.00 $470.00 $470.00 $97.96 $470.00 $470.00 $470.00 $470.00 $470.00 $97.95 $470.00 $188.00 $278.01 $470.00 $470.00 $470.00 $470.00 $352.50 $470.00 $470.00 $470.00 $235.00 $235.00 $372.24 $470.00 $376.00 $211.50 $93.28 N/A $272.60 $470.00 $282.00 $470.00 $97.95 $470.00 N/A N/A 388.906 SUP HCPCS C1713 388.906 - TEMPLATE ROD 150MM NS COAT 5.5MM ROD BOTH IP/OP $447.50 $331.00 $88.82 $447.50 $201.38 $201.38 $201.38 $201.38 $447.50 $447.50 $447.50 $93.27 $447.50 $447.50 $447.50 $447.50 $447.50 $93.26 $447.50 $179.00 $264.70 $447.50 $447.50 $447.50 $447.50 $335.63 $447.50 $447.50 $447.50 $223.75 $223.75 $354.42 $447.50 $358.00 $201.38 $88.82 N/A $259.55 $447.50 $268.50 $447.50 $93.26 $447.50 N/A N/A 388.907 SUP Custom 27203010 388.907 - TEMPLATE ROD 500MM NS COAT 5/5.5MM ROD BOTH IP/OP $740.00 $548.00 $131.72 $740.00 $740.00 $740.00 $740.00 $740.00 $740.00 $740.00 $131.72 $740.00 $740.00 $549.23 $549.23 $570.39 $385.54 $154.22 $740.00 $296.00 $740.00 $740.00 $740.00 $740.00 $740.00 $555.00 $740.00 $740.00 $740.00 $370.00 $370.00 $586.08 $740.00 $592.00 $481.00 $740.00 N/A $429.20 $740.00 $444.00 $740.00 $740.00 $740.00 N/A N/A 390.002 SUP Custom 27203010 390.002 - CLAMP EXFIX LARGE 6 POSITION MULTIPIN MR CONDITIONAL NONSTRL BOTH IP/OP "$1,205.50" $892.00 $214.54 "$1,225.80" "$1,205.30" "$1,205.30" "$1,205.30" "$1,205.30" "$1,205.30" "$1,205.30" $214.54 "$1,205.30" "$1,205.30" $894.57 $894.57 $929.05 $627.96 $251.20 "$1,205.30" $490.32 "$1,205.30" "$1,205.30" "$1,225.80" "$1,205.30" "$1,205.30" $904.13 "$1,205.30" "$1,205.30" "$1,205.30" $602.65 $602.65 $954.60 "$1,205.30" $964.24 $783.45 "$1,205.30" N/A $699.19 "$1,205.30" $723.18 "$1,205.30" "$1,205.30" "$1,205.30" N/A N/A 390.003 SUP HCPCS C1713 390.003 - ROD EXFIX ATTCH NONSTRL LARGE MULTIPIN CLMP BOTH IP/OP $675.50 $500.00 $133.98 $686.53 $303.77 $303.77 $303.77 $303.77 $675.05 $675.05 $675.05 $140.70 $675.05 $675.05 $675.05 $675.05 $675.05 $140.69 $675.05 $686.53 $399.29 $675.05 $686.53 $675.05 $675.05 $506.63 $675.05 $675.05 $675.05 $337.53 $337.53 $534.64 $675.05 $540.04 $303.77 $133.98 N/A $391.79 $675.05 $675.05 $675.05 $140.68 $675.05 N/A N/A 390.004 SUP Custom 27203010 390.004 - CLAMP EXFIX LARGE 4 POSITION MULTIPIN MR CONDITIONAL NONSTRL BOTH IP/OP "$1,128.50" $835.00 $200.86 "$1,147.60" "$1,128.43" "$1,128.43" "$1,128.43" "$1,128.43" "$1,128.43" "$1,128.43" $200.86 "$1,128.43" "$1,128.43" $837.52 $837.52 $869.79 $587.91 $235.18 "$1,128.43" $459.04 "$1,128.43" "$1,128.43" "$1,147.60" "$1,128.43" "$1,128.43" $846.38 "$1,128.43" "$1,128.43" "$1,128.43" $564.22 $564.22 $893.72 "$1,128.43" $902.74 $733.48 "$1,128.43" N/A $654.53 "$1,128.43" $677.06 "$1,128.43" "$1,128.43" "$1,128.43" N/A N/A 390.005 SUP Custom 27203010 390.005 - CLAMP EXFIX LARGE COMBO NONSTRL BOTH IP/OP "$1,054.00" $780.00 $187.58 "$1,071.73" "$1,053.80" "$1,053.80" "$1,053.80" "$1,053.80" "$1,053.80" "$1,053.80" $187.58 "$1,053.80" "$1,053.80" $782.13 $782.13 $812.27 $549.03 $219.62 "$1,053.80" $428.69 "$1,053.80" "$1,053.80" "$1,071.73" "$1,053.80" "$1,053.80" $790.50 "$1,053.80" "$1,053.80" "$1,053.80" $526.90 $526.90 $834.61 "$1,053.80" $843.04 $684.97 "$1,053.80" N/A $611.32 "$1,053.80" $632.28 "$1,053.80" "$1,053.80" "$1,053.80" N/A N/A 390.006 SUP Custom 27203010 390.006 - CLIP XTRNFX NS DYN MR CONDITIONAL LG CMBN CLP BOTH IP/OP $167.50 $124.00 $29.74 $169.95 $167.10 $167.10 $167.10 $167.10 $167.10 $167.10 $29.74 $167.10 $167.10 $124.02 $124.02 $128.80 $87.06 $34.83 $167.10 $67.98 $167.10 $167.10 $169.95 $167.10 $167.10 $125.63 $167.10 $167.10 $167.10 $83.55 $83.55 $132.34 $167.10 $133.68 $108.62 $167.10 N/A $97.15 $167.10 $100.26 $167.10 $167.10 $167.10 N/A N/A 390.007 SUP Custom 27203010 390.007 - CLAMP EXFIX TUBE TO TUBE MR CONDITIONAL NONSTRL BOTH IP/OP "$1,088.50" $805.00 $193.72 "$1,106.83" "$1,088.33" "$1,088.33" "$1,088.33" "$1,088.33" "$1,088.33" "$1,088.33" $193.72 "$1,088.33" "$1,088.33" $807.76 $807.76 $838.88 $567.02 $226.82 "$1,088.33" $442.73 "$1,088.33" "$1,088.33" "$1,106.83" "$1,088.33" "$1,088.33" $816.38 "$1,088.33" "$1,088.33" "$1,088.33" $544.17 $544.17 $861.96 "$1,088.33" $870.66 $707.41 "$1,088.33" N/A $631.33 "$1,088.33" $653.00 "$1,088.33" "$1,088.33" "$1,088.33" N/A N/A 390.008 SUP Custom 27203010 390.008 - CLAMP EXFIX LARGE OPEN ADJUSTABLE NONSTRL BOTH IP/OP $873.50 $646.00 $155.45 $888.18 $873.33 $873.33 $873.33 $873.33 $873.33 $873.33 $155.45 $873.33 $873.33 $648.19 $648.19 $673.16 $455.00 $182.01 $873.33 $355.27 $873.33 $873.33 $888.18 $873.33 $873.33 $655.13 $873.33 $873.33 $873.33 $436.67 $436.67 $691.68 $873.33 $698.66 $567.66 $873.33 N/A $506.63 $873.33 $524.00 $873.33 $873.33 $873.33 N/A N/A 390.009 SUP Custom 27203010 390.009 - CLAMP EXFIX LARGE 4 POSITION PIN NONSTRL LARGE EXFIX BOTH IP/OP $730.00 $540.00 $129.87 $742.03 $729.63 $729.63 $729.63 $729.63 $729.63 $729.63 $129.87 $729.63 $729.63 $541.53 $541.53 $562.40 $380.14 $152.06 $729.63 $296.81 $729.63 $729.63 $742.03 $729.63 $729.63 $547.50 $729.63 $729.63 $729.63 $364.82 $364.82 $577.87 $729.63 $583.70 $474.26 $729.63 N/A $423.40 $729.63 $437.78 $729.63 $729.63 $729.63 N/A N/A 390.01 SUP Custom 27203010 390.010 - CLAMP EXFIX LARGE 6 POSITION PIN NONSTRL BOTH IP/OP $728.00 $539.00 $129.56 $762.43 $727.85 $727.85 $727.85 $727.85 $727.85 $727.85 $129.56 $727.85 $727.85 $540.21 $540.21 $561.03 $379.21 $151.69 $727.85 $304.97 $727.85 $727.85 $762.43 $727.85 $727.85 $546.00 $727.85 $727.85 $727.85 $363.93 $363.93 $576.46 $727.85 $582.28 $473.10 $727.85 N/A $422.24 $727.85 $436.71 $727.85 $727.85 $727.85 N/A N/A 390.011 SUP Custom 27203010 390.011 - POST EXFIX STR 11MM OUTRIGGER NONSTRL BOTH IP/OP $197.50 $146.00 $35.10 $200.53 $197.18 $197.18 $197.18 $197.18 $197.18 $197.18 $35.10 $197.18 $197.18 $146.35 $146.35 $151.99 $102.73 $41.09 $197.18 $80.21 $197.18 $197.18 $200.53 $197.18 $197.18 $148.13 $197.18 $197.18 $197.18 $98.59 $98.59 $156.17 $197.18 $157.74 $128.17 $197.18 N/A $114.55 $197.18 $118.31 $197.18 $197.18 $197.18 N/A N/A 390.012 SUP Custom 27203010 390.012 - POST EXFIX 30D 11MM OUTRIGGER MR SAFE NONSTRL BOTH IP/OP $197.50 $146.00 $35.10 $200.53 $197.18 $197.18 $197.18 $197.18 $197.18 $197.18 $35.10 $197.18 $197.18 $146.35 $146.35 $151.99 $102.73 $41.09 $197.18 $80.21 $197.18 $197.18 $200.53 $197.18 $197.18 $148.13 $197.18 $197.18 $197.18 $98.59 $98.59 $156.17 $197.18 $157.74 $128.17 $197.18 N/A $114.55 $197.18 $118.31 $197.18 $197.18 $197.18 N/A N/A 390.013 SUP Custom 27203010 390.013 - POST EXFIX 90D 11MM OUTRIGGER NONSTRL BOTH IP/OP $217.50 $161.00 $38.67 $220.93 $217.23 $217.23 $217.23 $217.23 $217.23 $217.23 $38.67 $217.23 $217.23 $161.23 $161.23 $167.44 $113.18 $45.27 $217.23 $88.37 $217.23 $217.23 $220.93 $217.23 $217.23 $163.13 $217.23 $217.23 $217.23 $108.62 $108.62 $172.05 $217.23 $173.78 $141.20 $217.23 N/A $126.15 $217.23 $130.34 $217.23 $217.23 $217.23 N/A N/A 390.026 SUP Custom 27203010 390.026 - CLAMP EXFIX MEDIUM 4 POSISTION PIN MR SAFE NONSTRL BOTH IP/OP $690.00 $511.00 $122.74 $701.25 $689.53 $689.53 $689.53 $689.53 $689.53 $689.53 $122.74 $689.53 $689.53 $511.77 $511.77 $531.49 $359.25 $143.71 $689.53 $280.50 $689.53 $689.53 $701.25 $689.53 $689.53 $517.50 $689.53 $689.53 $689.53 $344.77 $344.77 $546.11 $689.53 $551.62 $448.19 $689.53 N/A $400.20 $689.53 $413.72 $689.53 $689.53 $689.53 N/A N/A 390.027 SUP Custom 27203010 390.027 - CLAMP EXFIX MEDIUM 6 POSISTION PIN MR SAFE NONSTRL BOTH IP/OP $707.50 $524.00 $125.91 $719.38 $707.35 $707.35 $707.35 $707.35 $707.35 $707.35 $125.91 $707.35 $707.35 $525.00 $525.00 $545.23 $368.53 $147.42 $707.35 $287.75 $707.35 $707.35 $719.38 $707.35 $707.35 $530.63 $707.35 $707.35 $707.35 $353.68 $353.68 $560.22 $707.35 $565.88 $459.78 $707.35 N/A $410.35 $707.35 $424.41 $707.35 $707.35 $707.35 N/A N/A 390.028 SUP Custom 27203010 390.028 - POST XTRNFX STRG 8MM NS OTRGR MR CONDITIONAL BOTH IP/OP $187.50 $139.00 $33.31 $190.33 $187.15 $187.15 $187.15 $187.15 $187.15 $187.15 $33.31 $187.15 $187.15 $138.90 $138.90 $144.26 $97.51 $39.00 $187.15 $76.13 $187.15 $187.15 $190.33 $187.15 $187.15 $140.63 $187.15 $187.15 $187.15 $93.58 $93.58 $148.22 $187.15 $149.72 $121.65 $187.15 N/A $108.75 $187.15 $112.29 $187.15 $187.15 $187.15 N/A N/A 390.029 SUP Custom 27203010 390.029 - POST XTRNFX 30D 8MM NS OTRGR MR CONDITIONAL BOTH IP/OP $187.50 $139.00 $33.31 $190.33 $187.15 $187.15 $187.15 $187.15 $187.15 $187.15 $33.31 $187.15 $187.15 $138.90 $138.90 $144.26 $97.51 $39.00 $187.15 $76.13 $187.15 $187.15 $190.33 $187.15 $187.15 $140.63 $187.15 $187.15 $187.15 $93.58 $93.58 $148.22 $187.15 $149.72 $121.65 $187.15 N/A $108.75 $187.15 $112.29 $187.15 $187.15 $187.15 N/A N/A 390.03 SUP Custom 27203010 390.030 - POST XTRNFX 90D 8MM NS OTRGR MR CONDITIONAL BOTH IP/OP $199.00 $147.00 $35.42 $208.45 $199.00 $199.00 $199.00 $199.00 $199.00 $199.00 $35.42 $199.00 $199.00 $147.70 $147.70 $153.39 $103.68 $41.47 $199.00 $83.38 $199.00 $199.00 $208.45 $199.00 $199.00 $149.25 $199.00 $199.00 $199.00 $99.50 $99.50 $157.61 $199.00 $159.20 $129.35 $199.00 N/A $115.42 $199.00 $119.40 $199.00 $199.00 $199.00 N/A N/A 390.031 SUP Custom 27203010 390.031 - CLAMP EXFIX MEDIUM COMBO SELF HOLDING CLIP ON NONSTRL BOTH IP/OP $858.00 $635.00 $152.68 $872.33 $857.75 $857.75 $857.75 $857.75 $857.75 $857.75 $152.68 $857.75 $857.75 $636.62 $636.62 $661.15 $446.89 $178.76 $857.75 $348.93 $857.75 $857.75 $872.33 $857.75 $857.75 $643.50 $857.75 $857.75 $857.75 $428.88 $428.88 $679.34 $857.75 $686.20 $557.54 $857.75 N/A $497.64 $857.75 $514.65 $857.75 $857.75 $857.75 N/A N/A 390.032 SUP Custom 27203010 390.032 - CLIP XTRNFX NS DYN MR CONDITIONAL MED CMBN CLP BOTH IP/OP $186.50 $138.00 $33.11 $189.18 $186.03 $186.03 $186.03 $186.03 $186.03 $186.03 $33.11 $186.03 $186.03 $138.07 $138.07 $143.39 $96.92 $38.77 $186.03 $75.67 $186.03 $186.03 $189.18 $186.03 $186.03 $139.88 $186.03 $186.03 $186.03 $93.02 $93.02 $147.34 $186.03 $148.82 $120.92 $186.03 N/A $108.17 $186.03 $111.62 $186.03 $186.03 $186.03 N/A N/A 390.033 SUP Custom 27203010 390.033 - CLAMP EXFIX MEDIUM 4 POSISTION MULTIPIN MR SAFE NONSTRL BOTH IP/OP "$1,038.50" $768.00 $184.80 "$1,055.85" "$1,038.20" "$1,038.20" "$1,038.20" "$1,038.20" "$1,038.20" "$1,038.20" $184.80 "$1,038.20" "$1,038.20" $770.55 $770.55 $800.24 $540.90 $216.37 "$1,038.20" $422.34 "$1,038.20" "$1,038.20" "$1,055.85" "$1,038.20" "$1,038.20" $778.88 "$1,038.20" "$1,038.20" "$1,038.20" $519.10 $519.10 $822.25 "$1,038.20" $830.56 $674.83 "$1,038.20" N/A $602.33 "$1,038.20" $622.92 "$1,038.20" "$1,038.20" "$1,038.20" N/A N/A 390.034 SUP Custom 27203010 390.034 - CLAMP EXFIX MEDIUM MULTIPIN ROD ATTCH MRI SAFE NONSTRL BOTH IP/OP $596.00 $441.00 $106.08 $606.08 $595.95 $595.95 $595.95 $595.95 $595.95 $595.95 $106.08 $595.95 $595.95 $442.31 $442.31 $459.36 $310.49 $124.20 $595.95 $242.43 $595.95 $595.95 $606.08 $595.95 $595.95 $447.00 $595.95 $595.95 $595.95 $297.98 $297.98 $471.99 $595.95 $476.76 $387.37 $595.95 N/A $345.68 $595.95 $357.57 $595.95 $595.95 $595.95 N/A N/A 390.035 SUP Custom 27203010 390.035 - CLAMP EXFIX MEDIUM OPEN ADJUSTABLE NONSTRL BOTH IP/OP $707.50 $524.00 $125.91 $719.38 $707.35 $707.35 $707.35 $707.35 $707.35 $707.35 $125.91 $707.35 $707.35 $525.00 $525.00 $545.23 $368.53 $147.42 $707.35 $287.75 $707.35 $707.35 $719.38 $707.35 $707.35 $530.63 $707.35 $707.35 $707.35 $353.68 $353.68 $560.22 $707.35 $565.88 $459.78 $707.35 N/A $410.35 $707.35 $424.41 $707.35 $707.35 $707.35 N/A N/A 390.036 SUP Custom 27203010 390.036 - CLAMP EXFIX MEDIUM 6 POSISTION MULTIPIN MR SAFE NONSTRL BOTH IP/OP "$1,130.00" $836.00 $201.06 "$1,148.75" "$1,129.55" "$1,129.55" "$1,129.55" "$1,129.55" "$1,129.55" "$1,129.55" $201.06 "$1,129.55" "$1,129.55" $838.35 $838.35 $870.66 $588.50 $235.41 "$1,129.55" $459.50 "$1,129.55" "$1,129.55" "$1,148.75" "$1,129.55" "$1,129.55" $847.50 "$1,129.55" "$1,129.55" "$1,129.55" $564.78 $564.78 $894.60 "$1,129.55" $903.64 $734.21 "$1,129.55" N/A $655.40 "$1,129.55" $677.73 "$1,129.55" "$1,129.55" "$1,129.55" N/A N/A 390.037 SUP Custom 27203010 390.037 - CLAMP EXFIX MEDIUM 8-11MM COMBO MR SAFE NONSTRL BOTH IP/OP $987.00 $730.00 $175.68 "$1,003.73" $986.95 $986.95 $986.95 $986.95 $986.95 $986.95 $175.68 $986.95 $986.95 $732.51 $732.51 $760.74 $514.20 $205.69 $986.95 $401.49 $986.95 $986.95 "$1,003.73" $986.95 $986.95 $740.25 $986.95 $986.95 $986.95 $493.48 $493.48 $781.66 $986.95 $789.56 $641.52 $986.95 N/A $572.46 $986.95 $592.17 $986.95 $986.95 $986.95 N/A N/A 390.041 SUP Custom 27203010 390.041 - CLAMP EXFIX SMALL COMBO NONSTRL BOTH IP/OP $554.00 $410.00 $98.55 $563.03 $553.63 $553.63 $553.63 $553.63 $553.63 $553.63 $98.55 $553.63 $553.63 $410.90 $410.90 $426.74 $288.44 $115.38 $553.63 $225.21 $553.63 $553.63 $563.03 $553.63 $553.63 $415.50 $553.63 $553.63 $553.63 $276.82 $276.82 $438.47 $553.63 $442.90 $359.86 $553.63 N/A $321.32 $553.63 $332.18 $553.63 $553.63 $553.63 N/A N/A 390.042 SUP Custom 27203010 390.042 - CLAMP EXFIX SMALL ADJUSTABLE NONSPANNING NONSTRL BOTH IP/OP $955.50 $707.00 $170.05 $955.33 $955.33 $955.33 $955.33 $955.33 $955.33 $955.33 $170.05 $955.33 $955.33 $709.05 $709.05 $736.37 $497.73 $199.10 $955.33 $382.13 $955.33 $955.33 $955.33 $955.33 $955.33 $716.63 $955.33 $955.33 $955.33 $477.67 $477.67 $756.62 $955.33 $764.26 $620.96 $955.33 N/A $554.19 $955.33 $573.20 $955.33 $955.33 $955.33 N/A N/A 390.12 SUP HCPCS C1713 390.120 - PIN POSITIONING 40MM TITANIUM CRANIAL NONSTRL EXTERNAL BOTH IP/OP $390.00 $289.00 $77.41 $390.00 $175.50 $175.50 $175.50 $175.50 $390.00 $390.00 $390.00 $81.29 $390.00 $390.00 $390.00 $390.00 $390.00 $81.28 $390.00 $390.00 $230.69 $390.00 $390.00 $390.00 $390.00 $292.50 $390.00 $390.00 $390.00 $195.00 $195.00 $308.88 $390.00 $312.00 $175.50 $77.41 N/A $226.20 $390.00 $390.00 $390.00 $390.00 $390.00 N/A N/A 390.122 SUP Custom 27203010 390.122 - HOLDER IMPLANT 40MM MOUNT PIN TITANIUM CRANIAL NONSTRL BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $445.32 $445.32 $462.48 $312.60 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $390.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 390.124 SUP Custom 27803010 390.124 - PIN FIX 50MM MOUNT MIDFAC NONSTRL EXTERNAL MIDFAC DISTRCT BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 390.126 SUP Custom 27203010 390.126 - HOLDER IMPLANT 40MM MOUNT PIN TITANIUM MIDFAC BOTH IP/OP $677.50 $501.00 $120.60 $677.50 $677.50 $677.50 $677.50 $677.50 $677.50 $677.50 $120.60 $677.50 $677.50 $502.84 $502.84 $522.22 $352.98 $141.20 $677.50 $271.00 $677.50 $677.50 $677.50 $677.50 $677.50 $508.13 $677.50 $677.50 $677.50 $338.75 $338.75 $536.58 $677.50 $542.00 $440.38 $677.50 N/A $392.95 $677.50 $406.50 $677.50 $677.50 $677.50 N/A N/A 390.128 SUP Custom 27203010 390.128 - PIN SKULL 50MM SLFDRILL CRANIUM NONSTRL BOTH IP/OP $677.50 $501.00 $120.60 $677.50 $677.50 $677.50 $677.50 $677.50 $677.50 $677.50 $120.60 $677.50 $677.50 $502.84 $502.84 $522.22 $352.98 $141.20 $677.50 $271.00 $677.50 $677.50 $677.50 $677.50 $677.50 $508.13 $677.50 $677.50 $677.50 $338.75 $338.75 $536.58 $677.50 $542.00 $440.38 $677.50 N/A $392.95 $677.50 $406.50 $677.50 $677.50 $677.50 N/A N/A 392.177 SUP Custom 27203010 392.177 - CAP PROTECTIVE CLEAR NONSTRL 1MM 1.25MM K WIRES BOTH IP/OP $5.00 $4.00 $0.86 $4.90 $4.82 $4.82 $4.82 $4.82 $4.82 $4.82 $0.86 $4.82 $4.82 $3.58 $3.58 $3.72 $2.51 $1.00 $4.82 $1.96 $4.82 $4.82 $4.90 $4.82 $4.82 $3.75 $4.82 $4.82 $4.82 $2.41 $2.41 $3.82 $4.82 $3.86 $3.13 $4.82 N/A $2.90 $4.82 $2.89 $4.82 $4.82 $4.82 N/A N/A 392.178 SUP Custom 27203010 392.178 - CAP PROTECTIVE NONSTRL 1.6 MM KWIRE WIRE BOTH IP/OP $5.00 $4.00 $0.86 $4.90 $4.82 $4.82 $4.82 $4.82 $4.82 $4.82 $0.86 $4.82 $4.82 $3.58 $3.58 $3.72 $2.51 $1.00 $4.82 $1.96 $4.82 $4.82 $4.90 $4.82 $4.82 $3.75 $4.82 $4.82 $4.82 $2.41 $2.41 $3.82 $4.82 $3.86 $3.13 $4.82 N/A $2.90 $4.82 $2.89 $4.82 $4.82 $4.82 N/A N/A 392.179 SUP Custom 27203010 392.179 - CAP PROTECTIVE NONSTRL 2 MM KWIRE WIRE BOTH IP/OP $5.00 $4.00 $0.81 $4.90 $4.54 $4.54 $4.54 $4.54 $4.54 $4.54 $0.81 $4.54 $4.54 $3.37 $3.37 $3.50 $2.37 $0.95 $4.54 $1.96 $4.54 $4.54 $4.90 $4.54 $4.54 $3.75 $4.54 $4.54 $4.54 $2.27 $2.27 $3.60 $4.54 $3.63 $2.95 $4.54 N/A $2.90 $4.54 $2.72 $4.54 $4.54 $4.54 N/A N/A 392.18 SUP Custom 27203010 392.18 - CAP PROTECTIVE NONSTRL 1.8-2 MM KWIRE WIRE BOTH IP/OP $4.00 $3.00 $0.70 $3.99 $3.93 $3.93 $3.93 $3.93 $3.93 $3.93 $0.70 $3.93 $3.93 $2.92 $2.92 $3.03 $2.05 $0.82 $3.93 $1.60 $3.93 $3.93 $3.99 $3.93 $3.93 $3.00 $3.93 $3.93 $3.93 $1.97 $1.97 $3.11 $3.93 $3.14 $2.55 $3.93 N/A $2.32 $3.93 $2.36 $3.93 $3.93 $3.93 N/A N/A 392.24 SUP Custom 27203010 392.24 - CAP PROTECTIVE NONSTRL 2.5 MM KWIRE WIRE BOTH IP/OP $5.00 $4.00 $0.86 $4.90 $4.82 $4.82 $4.82 $4.82 $4.82 $4.82 $0.86 $4.82 $4.82 $3.58 $3.58 $3.72 $2.51 $1.00 $4.82 $1.96 $4.82 $4.82 $4.90 $4.82 $4.82 $3.75 $4.82 $4.82 $4.82 $2.41 $2.41 $3.82 $4.82 $3.86 $3.13 $4.82 N/A $2.90 $4.82 $2.89 $4.82 $4.82 $4.82 N/A N/A 392.961 SUP HCPCS C1713 392.961 - FIXATOR XTRNFX LG ADJ RADL DIST BOTH IP/OP "$6,189.50" "$4,580.00" "$1,228.38" "$6,294.30" "$2,785.09" "$2,785.09" "$2,785.09" "$2,785.09" "$6,189.08" "$6,189.08" "$6,189.08" "$1,289.96" "$6,189.08" "$6,189.08" "$6,189.08" "$6,189.08" "$6,189.08" "$1,289.87" "$6,189.08" "$2,517.72" "$3,051.22" "$6,189.08" "$6,294.30" "$6,189.08" "$6,189.08" "$4,642.13" "$6,189.08" "$6,189.08" "$6,189.08" "$3,094.54" "$3,094.54" "$4,901.75" "$6,189.08" "$4,951.26" "$2,785.09" "$1,228.38" N/A "$3,589.91" "$6,189.08" "$6,189.08" "$6,189.08" "$1,289.80" "$6,189.08" N/A N/A 393.43 SUP Custom 27203010 393.43 - NUT XTRNFX NS RING TO ROD SPRG LD LG XTRNFXTR BOTH IP/OP $76.00 $56.00 $13.48 $77.05 $75.75 $75.75 $75.75 $75.75 $75.75 $75.75 $13.48 $75.75 $75.75 $56.22 $56.22 $58.39 $39.47 $15.79 $75.75 $30.82 $75.75 $75.75 $77.05 $75.75 $75.75 $57.00 $75.75 $75.75 $75.75 $37.88 $37.88 $59.99 $75.75 $60.60 $49.24 $75.75 N/A $44.08 $75.75 $45.45 $75.75 $75.75 $75.75 N/A N/A 393.436 SUP Custom 27203010 393.436 - CLAMP EXFIX RING TO ROD NONSTRL HYBRID EXFIX BOTH IP/OP "$1,445.00" "$1,069.00" $257.17 "$1,469.33" "$1,444.78" "$1,444.78" "$1,444.78" "$1,444.78" "$1,444.78" "$1,444.78" $257.17 "$1,444.78" "$1,444.78" "$1,072.32" "$1,072.32" "$1,113.64" $752.73 $301.11 "$1,444.78" $587.73 "$1,444.78" "$1,444.78" "$1,469.33" "$1,444.78" "$1,444.78" "$1,083.75" "$1,444.78" "$1,444.78" "$1,444.78" $722.39 $722.39 "$1,144.27" "$1,444.78" "$1,155.82" $939.11 "$1,444.78" N/A $838.10 "$1,444.78" $866.87 "$1,444.78" "$1,444.78" "$1,444.78" N/A N/A 393.464 SUP Custom 27203010 393.464 - CLAMP EXFIX ADJUSTABLE WIRE PIN NONSTRL HYBRID EXFIX BOTH IP/OP "$1,290.00" $955.00 $229.61 "$1,311.88" "$1,289.95" "$1,289.95" "$1,289.95" "$1,289.95" "$1,289.95" "$1,289.95" $229.61 "$1,289.95" "$1,289.95" $957.40 $957.40 $994.29 $672.06 $268.84 "$1,289.95" $524.75 "$1,289.95" "$1,289.95" "$1,311.88" "$1,289.95" "$1,289.95" $967.50 "$1,289.95" "$1,289.95" "$1,289.95" $644.98 $644.98 "$1,021.64" "$1,289.95" "$1,031.96" $838.47 "$1,289.95" N/A $748.20 "$1,289.95" $773.97 "$1,289.95" "$1,289.95" "$1,289.95" N/A N/A 393.64 SUP Custom 27203010 393.64 - CLAMP EXFIX ADJUSTABLE NONSTRL 4/6 MM SCHANZ SCREW LARGE BOTH IP/OP $651.00 $482.00 $115.80 $661.60 $650.55 $650.55 $650.55 $650.55 $650.55 $650.55 $115.80 $650.55 $650.55 $482.84 $482.84 $501.44 $338.94 $135.58 $650.55 $264.64 $650.55 $650.55 $661.60 $650.55 $650.55 $488.25 $650.55 $650.55 $650.55 $325.28 $325.28 $515.24 $650.55 $520.44 $422.86 $650.55 N/A $377.58 $650.55 $390.33 $650.55 $650.55 $650.55 N/A N/A 393.66 SUP Custom 27203010 393.66 - CLAMP EXFIX TRNSVRS NONSTRL 4-6 MM SCHANZ SCREW LARGE EXFIX BOTH IP/OP "$1,088.50" $805.00 $193.72 "$1,106.83" "$1,088.33" "$1,088.33" "$1,088.33" "$1,088.33" "$1,088.33" "$1,088.33" $193.72 "$1,088.33" "$1,088.33" $807.76 $807.76 $838.88 $567.02 $226.82 "$1,088.33" $442.73 "$1,088.33" "$1,088.33" "$1,106.83" "$1,088.33" "$1,088.33" $816.38 "$1,088.33" "$1,088.33" "$1,088.33" $544.17 $544.17 $861.96 "$1,088.33" $870.66 $707.41 "$1,088.33" N/A $631.33 "$1,088.33" $653.00 "$1,088.33" "$1,088.33" "$1,088.33" N/A N/A 393.69 SUP Custom 27203010 393.69 - CLAMP EXFIX OPEN NONSTRL PIN INSERTION CONNECT BOTH IP/OP $388.00 $287.00 $69.00 $394.25 $387.65 $387.65 $387.65 $387.65 $387.65 $387.65 $69.00 $387.65 $387.65 $287.71 $287.71 $298.80 $201.97 $80.79 $387.65 $157.70 $387.65 $387.65 $394.25 $387.65 $387.65 $291.00 $387.65 $387.65 $387.65 $193.83 $193.83 $307.02 $387.65 $310.12 $251.97 $387.65 N/A $225.04 $387.65 $232.59 $387.65 $387.65 $387.65 N/A N/A 393.721 SUP Custom 27203010 393.721 - RING EXFIX FULL 205MM FULL RING NONSTRL HYBRID FIXATOR BOTH IP/OP $969.50 $717.00 $172.51 $985.60 $969.13 $969.13 $969.13 $969.13 $969.13 $969.13 $172.51 $969.13 $969.13 $719.29 $719.29 $747.01 $504.92 $201.98 $969.13 $394.24 $969.13 $969.13 $985.60 $969.13 $969.13 $727.13 $969.13 $969.13 $969.13 $484.57 $484.57 $767.55 $969.13 $775.30 $629.93 $969.13 N/A $562.31 $969.13 $581.48 $969.13 $969.13 $969.13 N/A N/A 393.722 SUP Custom 27203010 393.722 - RING EXFIX .75 205MM .75 RING NONSTRL HYBRID FIXATOR BOTH IP/OP $894.50 $662.00 $159.22 $909.70 $894.50 $894.50 $894.50 $894.50 $894.50 $894.50 $159.22 $894.50 $894.50 $663.90 $663.90 $689.48 $466.03 $186.42 $894.50 $363.88 $894.50 $894.50 $909.70 $894.50 $894.50 $670.88 $894.50 $894.50 $894.50 $447.25 $447.25 $708.44 $894.50 $715.60 $581.43 $894.50 N/A $518.81 $894.50 $536.70 $894.50 $894.50 $894.50 N/A N/A 393.731 SUP Custom 27203010 393.731 - RING EXFIX FULL 115MM FULL RING NONSTRL HYBRID FIXATOR BOTH IP/OP $733.00 $542.00 $130.47 $745.43 $732.98 $732.98 $732.98 $732.98 $732.98 $732.98 $130.47 $732.98 $732.98 $544.02 $544.02 $564.98 $381.88 $152.76 $732.98 $298.17 $732.98 $732.98 $745.43 $732.98 $732.98 $549.75 $732.98 $732.98 $732.98 $366.49 $366.49 $580.52 $732.98 $586.38 $476.44 $732.98 N/A $425.14 $732.98 $439.79 $732.98 $732.98 $732.98 N/A N/A 393.732 SUP Custom 27203010 393.732 - RING EXFIX .75 115MM .75 RING NONSTRL HYBRID FIXATOR BOTH IP/OP $658.50 $487.00 $117.19 $669.55 $658.35 $658.35 $658.35 $658.35 $658.35 $658.35 $117.19 $658.35 $658.35 $488.63 $488.63 $507.46 $343.00 $137.21 $658.35 $267.82 $658.35 $658.35 $669.55 $658.35 $658.35 $493.88 $658.35 $658.35 $658.35 $329.18 $329.18 $521.41 $658.35 $526.68 $427.93 $658.35 N/A $381.93 $658.35 $395.01 $658.35 $658.35 $658.35 N/A N/A 393.734 SUP Custom 27203010 393.734 - RING EXFIX .75 140MM NONSTRL HYBRID FIXATOR BOTH IP/OP $720.00 $533.00 $128.09 $731.83 $719.60 $719.60 $719.60 $719.60 $719.60 $719.60 $128.09 $719.60 $719.60 $534.09 $534.09 $554.67 $374.91 $149.97 $719.60 $292.73 $719.60 $719.60 $731.83 $719.60 $719.60 $540.00 $719.60 $719.60 $719.60 $359.80 $359.80 $569.92 $719.60 $575.68 $467.74 $719.60 N/A $417.60 $719.60 $431.76 $719.60 $719.60 $719.60 N/A N/A 393.735 SUP Custom 27203010 393.735 - RING EXFIX FULL 165MM FULL RING NONSTRL HYBRID FIXATOR BOTH IP/OP $831.00 $615.00 $147.92 $845.13 $831.00 $831.00 $831.00 $831.00 $831.00 $831.00 $147.92 $831.00 $831.00 $616.77 $616.77 $640.53 $432.95 $173.19 $831.00 $338.05 $831.00 $831.00 $845.13 $831.00 $831.00 $623.25 $831.00 $831.00 $831.00 $415.50 $415.50 $658.15 $831.00 $664.80 $540.15 $831.00 N/A $481.98 $831.00 $498.60 $831.00 $831.00 $831.00 N/A N/A 393.736 SUP Custom 27203010 393.736 - RING EXFIX .75 165MM .75 RING NONSTRL HYBRID FIXATOR BOTH IP/OP $755.50 $559.00 $134.43 $768.10 $755.25 $755.25 $755.25 $755.25 $755.25 $755.25 $134.43 $755.25 $755.25 $560.55 $560.55 $582.15 $393.49 $157.40 $755.25 $307.24 $755.25 $755.25 $768.10 $755.25 $755.25 $566.63 $755.25 $755.25 $755.25 $377.63 $377.63 $598.16 $755.25 $604.20 $490.91 $755.25 N/A $438.19 $755.25 $453.15 $755.25 $755.25 $755.25 N/A N/A 393.737 SUP Custom 27203010 393.737 - RING EXFIX .25 165MM .25 RING NONSTRL HYBRID FIXATOR BOTH IP/OP $607.50 $450.00 $108.06 $617.43 $607.10 $607.10 $607.10 $607.10 $607.10 $607.10 $108.06 $607.10 $607.10 $450.59 $450.59 $467.95 $316.30 $126.53 $607.10 $246.97 $607.10 $607.10 $617.43 $607.10 $607.10 $455.63 $607.10 $607.10 $607.10 $303.55 $303.55 $480.82 $607.10 $485.68 $394.62 $607.10 N/A $352.35 $607.10 $364.26 $607.10 $607.10 $607.10 N/A N/A 393.75 SUP Custom 27203010 393.75 - CLAMP EXFIX LARGE UNIVERSAL ADJUSTABLE NONSTRL LARGE EXFIX BOTH IP/OP "$1,034.00" $765.00 $184.04 "$1,033.93" "$1,033.93" "$1,033.93" "$1,033.93" "$1,033.93" "$1,033.93" "$1,033.93" $184.04 "$1,033.93" "$1,033.93" $767.38 $767.38 $796.95 $538.68 $215.48 "$1,033.93" $413.57 "$1,033.93" "$1,033.93" "$1,033.93" "$1,033.93" "$1,033.93" $775.50 "$1,033.93" "$1,033.93" "$1,033.93" $516.97 $516.97 $818.87 "$1,033.93" $827.14 $672.05 "$1,033.93" N/A $599.72 "$1,033.93" $620.36 "$1,033.93" "$1,033.93" "$1,033.93" N/A N/A 394.05 SUP Custom 27203010 394.050 - FIXATOR XTRNFX NS ADJ RADL DIST BOTH IP/OP "$2,949.50" "$2,183.00" $524.97 "$3,089.38" "$2,949.25" "$2,949.25" "$2,949.25" "$2,949.25" "$2,949.25" "$2,949.25" $524.97 "$2,949.25" "$2,949.25" "$2,188.93" "$2,188.93" "$2,273.28" "$1,536.56" $614.66 "$2,949.25" "$1,235.75" "$2,949.25" "$2,949.25" "$3,089.38" "$2,949.25" "$2,949.25" "$2,212.13" "$2,949.25" "$2,949.25" "$2,949.25" "$1,474.63" "$1,474.63" "$2,335.81" "$2,949.25" "$2,359.40" "$1,917.01" "$2,949.25" N/A "$1,710.71" "$2,949.25" "$1,769.55" "$2,949.25" "$2,949.25" "$2,949.25" N/A N/A 394.055 SUP Custom 27203010 394.055 - FIXATOR XTRNFX HNG ELB UNSTBL FX BOTH IP/OP "$2,316.00" "$1,714.00" $412.23 "$2,355.28" "$2,315.90" "$2,315.90" "$2,315.90" "$2,315.90" "$2,315.90" "$2,315.90" $412.23 "$2,315.90" "$2,315.90" "$1,718.86" "$1,718.86" "$1,785.10" "$1,206.58" $482.66 "$2,315.90" $942.11 "$2,315.90" "$2,315.90" "$2,355.28" "$2,315.90" "$2,315.90" "$1,737.00" "$2,315.90" "$2,315.90" "$2,315.90" "$1,157.95" "$1,157.95" "$1,834.19" "$2,315.90" "$1,852.72" "$1,505.34" "$2,315.90" N/A "$1,343.28" "$2,315.90" "$1,389.54" "$2,315.90" "$2,315.90" "$2,315.90" N/A N/A 394.46 SUP Custom 27203010 394.46 - SLEEVE DISTRCT 105MM HOLD BOTH IP/OP $518.00 $383.00 $92.20 $526.78 $517.98 $517.98 $517.98 $517.98 $517.98 $517.98 $92.20 $517.98 $517.98 $384.44 $384.44 $399.26 $269.87 $107.95 $517.98 $210.71 $517.98 $517.98 $526.78 $517.98 $517.98 $388.50 $517.98 $517.98 $517.98 $258.99 $258.99 $410.24 $517.98 $414.38 $336.69 $517.98 N/A $300.44 $517.98 $310.79 $517.98 $517.98 $517.98 N/A N/A 394.79 SUP Custom 27203010 394.79 - ROD EXFIX 180D CURVE 11MM 850MM CARFBR NONSTRL LARGE EXFIX BOTH IP/OP "$1,231.00" $911.00 $219.10 "$1,251.83" "$1,230.90" "$1,230.90" "$1,230.90" "$1,230.90" "$1,230.90" "$1,230.90" $219.10 "$1,230.90" "$1,230.90" $913.57 $913.57 $948.78 $641.30 $256.53 "$1,230.90" $500.73 "$1,230.90" "$1,230.90" "$1,251.83" "$1,230.90" "$1,230.90" $923.25 "$1,230.90" "$1,230.90" "$1,230.90" $615.45 $615.45 $974.87 "$1,230.90" $984.72 $800.09 "$1,230.90" N/A $713.98 "$1,230.90" $738.54 "$1,230.90" "$1,230.90" "$1,230.90" N/A N/A 394.791 SUP Custom 27203010 394.791 - ROD EXFIX 45D 11MM 207MM CVD SPAN ANGLED CARFBR NONSTRL BOTH IP/OP $950.50 $703.00 $169.14 $966.35 $950.20 $950.20 $950.20 $950.20 $950.20 $950.20 $169.14 $950.20 $950.20 $705.24 $705.24 $732.41 $495.05 $198.03 $950.20 $386.54 $950.20 $950.20 $966.35 $950.20 $950.20 $712.88 $950.20 $950.20 $950.20 $475.10 $475.10 $752.56 $950.20 $760.16 $617.63 $950.20 N/A $551.29 $950.20 $570.12 $950.20 $950.20 $950.20 N/A N/A 394.792 SUP Custom 27203010 394.792 - ROD EXFIX 90D 11MM 382MM CVD SPAN ANGLED CARFBR NONSTRL BOTH IP/OP "$1,045.00" $773.00 $185.99 "$1,062.65" "$1,044.88" "$1,044.88" "$1,044.88" "$1,044.88" "$1,044.88" "$1,044.88" $185.99 "$1,044.88" "$1,044.88" $775.51 $775.51 $805.39 $544.38 $217.76 "$1,044.88" $425.06 "$1,044.88" "$1,044.88" "$1,062.65" "$1,044.88" "$1,044.88" $783.75 "$1,044.88" "$1,044.88" "$1,044.88" $522.44 $522.44 $827.54 "$1,044.88" $835.90 $679.17 "$1,044.88" N/A $606.10 "$1,044.88" $626.93 "$1,044.88" "$1,044.88" "$1,044.88" N/A N/A 394.793 SUP Custom 27203010 394.793 - ROD EXFIX 135D 11MM 499MM CVD SPAN ANGLED CARFBR NONSTRL BOTH IP/OP "$1,141.00" $844.00 $203.04 "$1,160.08" "$1,140.68" "$1,140.68" "$1,140.68" "$1,140.68" "$1,140.68" "$1,140.68" $203.04 "$1,140.68" "$1,140.68" $846.61 $846.61 $879.24 $594.29 $237.73 "$1,140.68" $464.03 "$1,140.68" "$1,140.68" "$1,160.08" "$1,140.68" "$1,140.68" $855.75 "$1,140.68" "$1,140.68" "$1,140.68" $570.34 $570.34 $903.42 "$1,140.68" $912.54 $741.44 "$1,140.68" N/A $661.78 "$1,140.68" $684.41 "$1,140.68" "$1,140.68" "$1,140.68" N/A N/A 394.8 SUP Custom 27203010 394.8 - ROD XTRNFX 11MM 100MM NS SLFDRL MR CONDITIONAL SET CFBR LG BOTH IP/OP $361.00 $267.00 $64.25 $360.93 $360.93 $360.93 $360.93 $360.93 $360.93 $360.93 $64.25 $360.93 $360.93 $267.88 $267.88 $278.20 $188.04 $75.22 $360.93 $144.37 $360.93 $360.93 $360.93 $360.93 $360.93 $270.75 $360.93 $360.93 $360.93 $180.47 $180.47 $285.86 $360.93 $288.74 $234.60 $360.93 N/A $209.38 $360.93 $216.56 $360.93 $360.93 $360.93 N/A N/A 394.81 SUP Custom 27203010 394.81 - ROD EXFIX 11MM 125MM MR CONDITIONAL CARFBR NONSTRL BOTH IP/OP $361.00 $267.00 $64.25 $367.05 $360.93 $360.93 $360.93 $360.93 $360.93 $360.93 $64.25 $360.93 $360.93 $267.88 $267.88 $278.20 $188.04 $75.22 $360.93 $146.82 $360.93 $360.93 $367.05 $360.93 $360.93 $270.75 $360.93 $360.93 $360.93 $180.47 $180.47 $285.86 $360.93 $288.74 $234.60 $360.93 N/A $209.38 $360.93 $216.56 $360.93 $360.93 $360.93 N/A N/A 394.82 SUP Custom 27203010 394.82 - ROD EXFIX 11MM 150MM RADIOLUCENT MR CONDITIONAL CARFBR BOTH IP/OP $361.00 $267.00 $64.25 $367.05 $360.93 $360.93 $360.93 $360.93 $360.93 $360.93 $64.25 $360.93 $360.93 $267.88 $267.88 $278.20 $188.04 $75.22 $360.93 $146.82 $360.93 $360.93 $367.05 $360.93 $360.93 $270.75 $360.93 $360.93 $360.93 $180.47 $180.47 $285.86 $360.93 $288.74 $234.60 $360.93 N/A $209.38 $360.93 $216.56 $360.93 $360.93 $360.93 N/A N/A 394.83 SUP Custom 27203010 394.83 - ROD EXFIX 11MM 200MM RADIOLUCENT MR CONDITIONAL CARFBR BOTH IP/OP $361.00 $267.00 $64.25 $367.05 $360.93 $360.93 $360.93 $360.93 $360.93 $360.93 $64.25 $360.93 $360.93 $267.88 $267.88 $278.20 $188.04 $75.22 $360.93 $146.82 $360.93 $360.93 $367.05 $360.93 $360.93 $270.75 $360.93 $360.93 $360.93 $180.47 $180.47 $285.86 $360.93 $288.74 $234.60 $360.93 N/A $209.38 $360.93 $216.56 $360.93 $360.93 $360.93 N/A N/A 394.84 SUP Custom 27203010 394.84 - ROD EXFIX 11MM 250MM CARFBR NONSTRL BOTH IP/OP $388.00 $287.00 $69.00 $394.25 $387.65 $387.65 $387.65 $387.65 $387.65 $387.65 $69.00 $387.65 $387.65 $287.71 $287.71 $298.80 $201.97 $80.79 $387.65 $157.70 $387.65 $387.65 $394.25 $387.65 $387.65 $291.00 $387.65 $387.65 $387.65 $193.83 $193.83 $307.02 $387.65 $310.12 $251.97 $387.65 N/A $225.04 $387.65 $232.59 $387.65 $387.65 $387.65 N/A N/A 394.85 SUP Custom 27203010 394.85 - ROD EXFIX 11MM 300MM MR CONDITIONAL CARFBR NONSTRL BOTH IP/OP $388.00 $287.00 $69.00 $394.25 $387.65 $387.65 $387.65 $387.65 $387.65 $387.65 $69.00 $387.65 $387.65 $287.71 $287.71 $298.80 $201.97 $80.79 $387.65 $157.70 $387.65 $387.65 $394.25 $387.65 $387.65 $291.00 $387.65 $387.65 $387.65 $193.83 $193.83 $307.02 $387.65 $310.12 $251.97 $387.65 N/A $225.04 $387.65 $232.59 $387.65 $387.65 $387.65 N/A N/A 394.86 SUP Custom 27203010 394.86 - ROD EXFIX 11MM 350MM RADIOLUCENT MR CONDITIONAL CARFBR BOTH IP/OP $388.00 $287.00 $69.00 $394.25 $387.65 $387.65 $387.65 $387.65 $387.65 $387.65 $69.00 $387.65 $387.65 $287.71 $287.71 $298.80 $201.97 $80.79 $387.65 $157.70 $387.65 $387.65 $394.25 $387.65 $387.65 $291.00 $387.65 $387.65 $387.65 $193.83 $193.83 $307.02 $387.65 $310.12 $251.97 $387.65 N/A $225.04 $387.65 $232.59 $387.65 $387.65 $387.65 N/A N/A 394.87 SUP Custom 27203010 394.87 - ROD EXFIX 11MM 400MM MR CONDITIONAL CARFBR NONSTRL BOTH IP/OP $426.00 $315.00 $75.74 $432.75 $425.53 $425.53 $425.53 $425.53 $425.53 $425.53 $75.74 $425.53 $425.53 $315.83 $315.83 $328.00 $221.70 $88.69 $425.53 $173.10 $425.53 $425.53 $432.75 $425.53 $425.53 $319.50 $425.53 $425.53 $425.53 $212.77 $212.77 $337.02 $425.53 $340.42 $276.59 $425.53 N/A $247.08 $425.53 $255.32 $425.53 $425.53 $425.53 N/A N/A 394.88 SUP Custom 27203010 394.88 - ROD EXFIX 11MM 450MM MR CONDITIONAL CARFBR NONSTRL BOTH IP/OP $426.00 $315.00 $75.74 $432.75 $425.53 $425.53 $425.53 $425.53 $425.53 $425.53 $75.74 $425.53 $425.53 $315.83 $315.83 $328.00 $221.70 $88.69 $425.53 $173.10 $425.53 $425.53 $432.75 $425.53 $425.53 $319.50 $425.53 $425.53 $425.53 $212.77 $212.77 $337.02 $425.53 $340.42 $276.59 $425.53 N/A $247.08 $425.53 $255.32 $425.53 $425.53 $425.53 N/A N/A 394.89 SUP Custom 27203010 394.89 - ROD EXFIX 11MM 500MM CARFBR NONSTRL LARGE EXFIX BOTH IP/OP $426.00 $315.00 $75.74 $432.75 $425.53 $425.53 $425.53 $425.53 $425.53 $425.53 $75.74 $425.53 $425.53 $315.83 $315.83 $328.00 $221.70 $88.69 $425.53 $173.10 $425.53 $425.53 $432.75 $425.53 $425.53 $319.50 $425.53 $425.53 $425.53 $212.77 $212.77 $337.02 $425.53 $340.42 $276.59 $425.53 N/A $247.08 $425.53 $255.32 $425.53 $425.53 $425.53 N/A N/A 394.9 SUP Custom 27203010 394.90 - ROD EXFIX 11MM 550MM RADIOLUCENT CARFBR NONSTRL BOTH IP/OP $447.00 $331.00 $79.50 $467.88 $446.65 $446.65 $446.65 $446.65 $446.65 $446.65 $79.50 $446.65 $446.65 $331.50 $331.50 $344.28 $232.70 $93.09 $446.65 $187.15 $446.65 $446.65 $467.88 $446.65 $446.65 $335.25 $446.65 $446.65 $446.65 $223.33 $223.33 $353.75 $446.65 $357.32 $290.32 $446.65 N/A $259.26 $446.65 $267.99 $446.65 $446.65 $446.65 N/A N/A 394.91 SUP Custom 27203010 394.91 - ROD EXFIX 11MM 600MM CARFBR NONSTRL LARGE EXFIX BOTH IP/OP $460.50 $341.00 $81.89 $467.88 $460.05 $460.05 $460.05 $460.05 $460.05 $460.05 $81.89 $460.05 $460.05 $341.45 $341.45 $354.61 $239.69 $95.88 $460.05 $187.15 $460.05 $460.05 $467.88 $460.05 $460.05 $345.38 $460.05 $460.05 $460.05 $230.03 $230.03 $364.36 $460.05 $368.04 $299.03 $460.05 N/A $267.09 $460.05 $276.03 $460.05 $460.05 $460.05 N/A N/A 394.92 SUP Custom 27203010 394.92 - ROD EXFIX 11MM 650MM CARFBR NONSTRL LARGE EXFIX BOTH IP/OP $460.50 $341.00 $81.89 $467.88 $460.05 $460.05 $460.05 $460.05 $460.05 $460.05 $81.89 $460.05 $460.05 $341.45 $341.45 $354.61 $239.69 $95.88 $460.05 $187.15 $460.05 $460.05 $467.88 $460.05 $460.05 $345.38 $460.05 $460.05 $460.05 $230.03 $230.03 $364.36 $460.05 $368.04 $299.03 $460.05 N/A $267.09 $460.05 $276.03 $460.05 $460.05 $460.05 N/A N/A 394.97 SUP Custom 27203010 394.97 - CAP PROTECTIVE NONSTRL 11 MM CARFBR ROD BOTH IP/OP $2.50 $2.00 $0.43 $2.58 $2.39 $2.39 $2.39 $2.39 $2.39 $2.39 $0.43 $2.39 $2.39 $1.77 $1.77 $1.84 $1.25 $0.50 $2.39 $1.03 $2.39 $2.39 $2.58 $2.39 $2.39 $1.88 $2.39 $2.39 $2.39 $1.20 $1.20 $1.89 $2.39 $1.91 $1.55 $2.39 N/A $1.45 $2.39 $1.43 $2.39 $2.39 $2.39 N/A N/A 394.99 SUP Custom 27203010 394.99 - CAP PROTECTIVE BLACK NONSTRL 4MM CARFBR ROD BOTH IP/OP $5.00 $4.00 $0.86 $4.90 $4.82 $4.82 $4.82 $4.82 $4.82 $4.82 $0.86 $4.82 $4.82 $3.58 $3.58 $3.72 $2.51 $1.00 $4.82 $1.96 $4.82 $4.82 $4.90 $4.82 $4.82 $3.75 $4.82 $4.82 $4.82 $2.41 $2.41 $3.82 $4.82 $3.86 $3.13 $4.82 N/A $2.90 $4.82 $2.89 $4.82 $4.82 $4.82 N/A N/A 394.991 SUP Custom 27203010 394.991 - CAP PROTECTIVE YELLOW NONSTRL 4MM FIX PIN BOTH IP/OP $58.00 $43.00 $2.42 $57.85 $57.85 $57.85 $57.85 $57.85 $57.85 $57.85 $10.30 $57.85 $57.85 $42.94 $42.94 $44.59 $30.14 $12.06 $57.85 $2.42 $57.85 $57.85 $6.06 $57.85 $57.85 $43.50 $57.85 $57.85 $57.85 $28.93 $28.93 $45.82 $57.85 $46.28 $37.60 $57.85 N/A $33.64 $57.85 $34.71 $57.85 $57.85 $57.85 N/A N/A 394.992 SUP Custom 27203010 394.992 - CAP PROTECTIVE WHITE NONSTRL 4.5MM FIX PIN BOTH IP/OP $6.00 $4.00 $1.06 $6.06 $5.96 $5.96 $5.96 $5.96 $5.96 $5.96 $1.06 $5.96 $5.96 $4.42 $4.42 $4.59 $3.11 $1.24 $5.96 $2.42 $5.96 $5.96 $6.06 $5.96 $5.96 $4.50 $5.96 $5.96 $5.96 $2.98 $2.98 $4.72 $5.96 $4.77 $3.87 $5.96 N/A $3.48 $5.96 $3.58 $5.96 $5.96 $5.96 N/A N/A 394.994 SUP Custom 27203010 394.994 - CAP PROTECTIVE GREEN NONSTRL 6MM FIX PIN BOTH IP/OP $6.00 $4.00 $1.06 $6.06 $5.96 $5.96 $5.96 $5.96 $5.96 $5.96 $1.06 $5.96 $5.96 $4.42 $4.42 $4.59 $3.11 $1.24 $5.96 $2.42 $5.96 $5.96 $6.06 $5.96 $5.96 $4.50 $5.96 $5.96 $5.96 $2.98 $2.98 $4.72 $5.96 $4.77 $3.87 $5.96 N/A $3.48 $5.96 $3.58 $5.96 $5.96 $5.96 N/A N/A 395.103 SUP Custom 27203010 395.103 - BAR EXFIX ANGLED 3MM CONNCTNG ROD STAINLESS STEEL NONSTRL BOTH IP/OP $84.00 $62.00 $14.87 $84.98 $83.55 $83.55 $83.55 $83.55 $83.55 $83.55 $14.87 $83.55 $83.55 $62.01 $62.01 $64.40 $43.53 $17.41 $83.55 $33.99 $83.55 $83.55 $84.98 $83.55 $83.55 $63.00 $83.55 $83.55 $83.55 $41.78 $41.78 $66.17 $83.55 $66.84 $54.31 $83.55 N/A $48.72 $83.55 $50.13 $83.55 $83.55 $83.55 N/A N/A 395.105 SUP Custom 27203010 395.105 - ROD EXFIX 3MM 25MM CONNCTNG RADIOLUCENT CARFBR NONSTRL MINI BOTH IP/OP $65.50 $48.00 $11.60 $66.28 $65.18 $65.18 $65.18 $65.18 $65.18 $65.18 $11.60 $65.18 $65.18 $48.38 $48.38 $50.24 $33.96 $13.58 $65.18 $26.51 $65.18 $65.18 $66.28 $65.18 $65.18 $49.13 $65.18 $65.18 $65.18 $32.59 $32.59 $51.62 $65.18 $52.14 $42.37 $65.18 N/A $37.99 $65.18 $39.11 $65.18 $65.18 $65.18 N/A N/A 395.107 SUP Custom 27203010 395.107 - ROD EXFIX 3MM 45MM CARFBR NONSTRL MINI EXFIX BOTH IP/OP $65.50 $48.00 $11.60 $66.28 $65.18 $65.18 $65.18 $65.18 $65.18 $65.18 $11.60 $65.18 $65.18 $48.38 $48.38 $50.24 $33.96 $13.58 $65.18 $26.51 $65.18 $65.18 $66.28 $65.18 $65.18 $49.13 $65.18 $65.18 $65.18 $32.59 $32.59 $51.62 $65.18 $52.14 $42.37 $65.18 N/A $37.99 $65.18 $39.11 $65.18 $65.18 $65.18 N/A N/A 395.109 SUP Custom 27203010 395.109 - ROD EXFIX 3MM 60MM CARFBR NONSTRL MINI EXFIX BOTH IP/OP $65.50 $48.00 $11.60 $66.28 $65.18 $65.18 $65.18 $65.18 $65.18 $65.18 $11.60 $65.18 $65.18 $48.38 $48.38 $50.24 $33.96 $13.58 $65.18 $26.51 $65.18 $65.18 $66.28 $65.18 $65.18 $49.13 $65.18 $65.18 $65.18 $32.59 $32.59 $51.62 $65.18 $52.14 $42.37 $65.18 N/A $37.99 $65.18 $39.11 $65.18 $65.18 $65.18 N/A N/A 395.111 SUP Custom 27203010 395.111 - ROD EXFIX 3MM 75MM CONNCTNG RADIOLUCENT CARFBR NONSTRL MINI BOTH IP/OP $65.50 $48.00 $11.60 $66.28 $65.18 $65.18 $65.18 $65.18 $65.18 $65.18 $11.60 $65.18 $65.18 $48.38 $48.38 $50.24 $33.96 $13.58 $65.18 $26.51 $65.18 $65.18 $66.28 $65.18 $65.18 $49.13 $65.18 $65.18 $65.18 $32.59 $32.59 $51.62 $65.18 $52.14 $42.37 $65.18 N/A $37.99 $65.18 $39.11 $65.18 $65.18 $65.18 N/A N/A 395.125 SUP Custom 27203010 395.125 - CLAMP EXFIX 1.25MM HOLD NONSTRL MINI EXFIX BOTH IP/OP "$1,143.00" $846.00 $203.44 "$1,162.33" "$1,142.90" "$1,142.90" "$1,142.90" "$1,142.90" "$1,142.90" "$1,142.90" $203.44 "$1,142.90" "$1,142.90" $848.26 $848.26 $880.95 $595.45 $238.19 "$1,142.90" $464.93 "$1,142.90" "$1,142.90" "$1,162.33" "$1,142.90" "$1,142.90" $857.25 "$1,142.90" "$1,142.90" "$1,142.90" $571.45 $571.45 $905.18 "$1,142.90" $914.32 $742.89 "$1,142.90" N/A $662.94 "$1,142.90" $685.74 "$1,142.90" "$1,142.90" "$1,142.90" N/A N/A 395.126 SUP Custom 27203010 395.126 - CLAMP EXFIX 1.6MM HOLD NONSTRL 1.6MM K WIRE MINI EXFIX BOTH IP/OP "$1,143.00" $846.00 $203.44 "$1,162.33" "$1,142.90" "$1,142.90" "$1,142.90" "$1,142.90" "$1,142.90" "$1,142.90" $203.44 "$1,142.90" "$1,142.90" $848.26 $848.26 $880.95 $595.45 $238.19 "$1,142.90" $464.93 "$1,142.90" "$1,142.90" "$1,162.33" "$1,142.90" "$1,142.90" $857.25 "$1,142.90" "$1,142.90" "$1,142.90" $571.45 $571.45 $905.18 "$1,142.90" $914.32 $742.89 "$1,142.90" N/A $662.94 "$1,142.90" $685.74 "$1,142.90" "$1,142.90" "$1,142.90" N/A N/A 395.133 SUP Custom 27203010 395.133 - CLAMP EXFIX 3MM CONNCTNG NONSTRL MINI EXFIX BOTH IP/OP "$1,063.00" $787.00 $189.16 "$1,080.78" "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" $189.16 "$1,062.70" "$1,062.70" $788.74 $788.74 $819.13 $553.67 $221.48 "$1,062.70" $432.31 "$1,062.70" "$1,062.70" "$1,080.78" "$1,062.70" "$1,062.70" $797.25 "$1,062.70" "$1,062.70" "$1,062.70" $531.35 $531.35 $841.66 "$1,062.70" $850.16 $690.76 "$1,062.70" N/A $616.54 "$1,062.70" $637.62 "$1,062.70" "$1,062.70" "$1,062.70" N/A N/A 395.134 SUP Custom 27203010 395.134 - CLAMP EXFIX 3X4MM CONNCTNG NONSTRL MINI EXFIX SMALL EXFIX BOTH IP/OP "$1,063.00" $787.00 $189.16 "$1,080.78" "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" "$1,062.70" $189.16 "$1,062.70" "$1,062.70" $788.74 $788.74 $819.13 $553.67 $221.48 "$1,062.70" $432.31 "$1,062.70" "$1,062.70" "$1,080.78" "$1,062.70" "$1,062.70" $797.25 "$1,062.70" "$1,062.70" "$1,062.70" $531.35 $531.35 $841.66 "$1,062.70" $850.16 $690.76 "$1,062.70" N/A $616.54 "$1,062.70" $637.62 "$1,062.70" "$1,062.70" "$1,062.70" N/A N/A 395.54 SUP Custom 27803010 395.54 - CLAMP XTRNFX 4MM 2.5MM NS OPN SEF BOTH IP/OP $521.50 $386.00 $92.80 $530.20 $521.33 $521.33 $521.33 $521.33 $521.33 $521.33 $92.80 $521.33 $521.33 $521.33 $521.33 $521.33 $521.33 $108.65 $521.33 $212.08 $521.33 $521.33 $530.20 $521.33 $521.33 $391.13 $521.33 $521.33 $521.33 $260.67 $260.67 $412.89 $521.33 $417.06 $234.60 $521.33 N/A $302.47 $521.33 $312.80 $521.33 $521.33 $521.33 N/A N/A 395.55 SUP Custom 27803010 395.55 - CLAMP XTRNFX 4MM NS OPN SEF 4MM SCHNZ SCR BOTH IP/OP $521.50 $386.00 $92.80 $530.20 $521.33 $521.33 $521.33 $521.33 $521.33 $521.33 $92.80 $521.33 $521.33 $521.33 $521.33 $521.33 $521.33 $108.65 $521.33 $212.08 $521.33 $521.33 $530.20 $521.33 $521.33 $391.13 $521.33 $521.33 $521.33 $260.67 $260.67 $412.89 $521.33 $417.06 $234.60 $521.33 N/A $302.47 $521.33 $312.80 $521.33 $521.33 $521.33 N/A N/A 395.56 SUP Custom 27203010 395.56 - CLAMP EXFIX SMALL 2.5MM 4MM NONSTRL SMALL EXFIX BOTH IP/OP $487.00 $360.00 $86.65 $495.08 $486.80 $486.80 $486.80 $486.80 $486.80 $486.80 $86.65 $486.80 $486.80 $361.30 $361.30 $375.23 $253.62 $101.45 $486.80 $198.03 $486.80 $486.80 $495.08 $486.80 $486.80 $365.25 $486.80 $486.80 $486.80 $243.40 $243.40 $385.55 $486.80 $389.44 $316.42 $486.80 N/A $282.46 $486.80 $292.08 $486.80 $486.80 $486.80 N/A N/A 395.57 SUP Custom 27203010 395.57 - CLAMP EXFIX 4MM 4MM NONSTRL 4MM SCHANZ SCREW CONNECT BOTH IP/OP $487.00 $360.00 $86.65 $495.08 $486.80 $486.80 $486.80 $486.80 $486.80 $486.80 $86.65 $486.80 $486.80 $361.30 $361.30 $375.23 $253.62 $101.45 $486.80 $198.03 $486.80 $486.80 $495.08 $486.80 $486.80 $365.25 $486.80 $486.80 $486.80 $243.40 $243.40 $385.55 $486.80 $389.44 $316.42 $486.80 N/A $282.46 $486.80 $292.08 $486.80 $486.80 $486.80 N/A N/A 395.575 SUP Custom 27203010 395.575 - CLAMP EXFIX MULTIVECTOR TITANIUM CARFBR RODS BOTH IP/OP "$2,157.50" "$1,597.00" $384.04 "$2,157.50" "$2,157.50" "$2,157.50" "$2,157.50" "$2,157.50" "$2,157.50" "$2,157.50" $384.04 "$2,157.50" "$2,157.50" "$1,601.30" "$1,601.30" "$1,663.00" "$1,124.06" $449.65 "$2,157.50" $863.00 "$2,157.50" "$2,157.50" "$2,157.50" "$2,157.50" "$2,157.50" "$1,618.13" "$2,157.50" "$2,157.50" "$2,157.50" "$1,078.75" "$1,078.75" "$1,708.74" "$2,157.50" "$1,726.00" "$1,402.38" "$2,157.50" N/A "$1,251.35" "$2,157.50" "$1,294.50" "$2,157.50" "$2,157.50" "$2,157.50" N/A N/A 395.58 SUP Custom 27203010 395.58 - NUT XTRNFX NS SPRG LD BOTH IP/OP $55.00 $41.00 $9.76 $55.78 $54.85 $54.85 $54.85 $54.85 $54.85 $54.85 $9.76 $54.85 $54.85 $40.71 $40.71 $42.28 $28.58 $11.43 $54.85 $22.31 $54.85 $54.85 $55.78 $54.85 $54.85 $41.25 $54.85 $54.85 $54.85 $27.43 $27.43 $43.44 $54.85 $43.88 $35.65 $54.85 N/A $31.90 $54.85 $32.91 $54.85 $54.85 $54.85 N/A N/A 395.6 SUP Custom 27203010 395.60 - ROD EXFIX 4MM 60MM CARFBR NONSTRL BOTH IP/OP $59.50 $44.00 $10.59 $62.33 $59.48 $59.48 $59.48 $59.48 $59.48 $59.48 $10.59 $59.48 $59.48 $44.15 $44.15 $45.85 $30.99 $12.40 $59.48 $24.93 $59.48 $59.48 $62.33 $59.48 $59.48 $44.63 $59.48 $59.48 $59.48 $29.74 $29.74 $47.11 $59.48 $47.58 $38.66 $59.48 N/A $34.51 $59.48 $35.69 $59.48 $59.48 $59.48 N/A N/A 395.61 SUP Custom 27203010 395.61 - ROD EXFIX 4MM 80MM CARFBR NONSTRL SMALL EXFIX BOTH IP/OP $61.50 $46.00 $10.91 $62.33 $61.28 $61.28 $61.28 $61.28 $61.28 $61.28 $10.91 $61.28 $61.28 $45.48 $45.48 $47.23 $31.93 $12.77 $61.28 $24.93 $61.28 $61.28 $62.33 $61.28 $61.28 $46.13 $61.28 $61.28 $61.28 $30.64 $30.64 $48.53 $61.28 $49.02 $39.83 $61.28 N/A $35.67 $61.28 $36.77 $61.28 $61.28 $61.28 N/A N/A 395.62 SUP Custom 27203010 395.62 - ROD EXFIX 4MM 100MM CARFBR NONSTRL SMALL EXFIX BOTH IP/OP $61.50 $46.00 $10.91 $62.33 $61.28 $61.28 $61.28 $61.28 $61.28 $61.28 $10.91 $61.28 $61.28 $45.48 $45.48 $47.23 $31.93 $12.77 $61.28 $24.93 $61.28 $61.28 $62.33 $61.28 $61.28 $46.13 $61.28 $61.28 $61.28 $30.64 $30.64 $48.53 $61.28 $49.02 $39.83 $61.28 N/A $35.67 $61.28 $36.77 $61.28 $61.28 $61.28 N/A N/A 395.63 SUP Custom 27203010 395.63 - ROD EXFIX 4MM 120MM CARFBR NONSTRL SMALL EXFIX BOTH IP/OP $61.50 $46.00 $10.91 $62.33 $61.28 $61.28 $61.28 $61.28 $61.28 $61.28 $10.91 $61.28 $61.28 $45.48 $45.48 $47.23 $31.93 $12.77 $61.28 $24.93 $61.28 $61.28 $62.33 $61.28 $61.28 $46.13 $61.28 $61.28 $61.28 $30.64 $30.64 $48.53 $61.28 $49.02 $39.83 $61.28 N/A $35.67 $61.28 $36.77 $61.28 $61.28 $61.28 N/A N/A 395.64 SUP Custom 27203010 395.64 - ROD EXFIX 4MM 140MM CARFBR NONSTRL SMALL EXFIX BOTH IP/OP $85.00 $63.00 $15.07 $86.10 $84.65 $84.65 $84.65 $84.65 $84.65 $84.65 $15.07 $84.65 $84.65 $62.83 $62.83 $65.25 $44.10 $17.64 $84.65 $34.44 $84.65 $84.65 $86.10 $84.65 $84.65 $63.75 $84.65 $84.65 $84.65 $42.33 $42.33 $67.04 $84.65 $67.72 $55.02 $84.65 N/A $49.30 $84.65 $50.79 $84.65 $84.65 $84.65 N/A N/A 395.65 SUP Custom 27203010 395.65 - ROD EXFIX 4MM 160MM CARFBR NONSTRL SMALL EXFIX BOTH IP/OP $85.00 $63.00 $15.07 $86.10 $84.65 $84.65 $84.65 $84.65 $84.65 $84.65 $15.07 $84.65 $84.65 $62.83 $62.83 $65.25 $44.10 $17.64 $84.65 $34.44 $84.65 $84.65 $86.10 $84.65 $84.65 $63.75 $84.65 $84.65 $84.65 $42.33 $42.33 $67.04 $84.65 $67.72 $55.02 $84.65 N/A $49.30 $84.65 $50.79 $84.65 $84.65 $84.65 N/A N/A 395.66 SUP Custom 27203010 395.66 - ROD EXFIX 4MM 180MM CARFBR NONSTRL SMALL EXFIX BOTH IP/OP $85.00 $63.00 $15.07 $86.10 $84.65 $84.65 $84.65 $84.65 $84.65 $84.65 $15.07 $84.65 $84.65 $62.83 $62.83 $65.25 $44.10 $17.64 $84.65 $34.44 $84.65 $84.65 $86.10 $84.65 $84.65 $63.75 $84.65 $84.65 $84.65 $42.33 $42.33 $67.04 $84.65 $67.72 $55.02 $84.65 N/A $49.30 $84.65 $50.79 $84.65 $84.65 $84.65 N/A N/A 395.67 SUP Custom 27203010 395.67 - ROD EXFIX 4MM 200MM CARFBR NONSTRL BOTH IP/OP $85.00 $63.00 $15.07 $86.10 $84.65 $84.65 $84.65 $84.65 $84.65 $84.65 $15.07 $84.65 $84.65 $62.83 $62.83 $65.25 $44.10 $17.64 $84.65 $34.44 $84.65 $84.65 $86.10 $84.65 $84.65 $63.75 $84.65 $84.65 $84.65 $42.33 $42.33 $67.04 $84.65 $67.72 $55.02 $84.65 N/A $49.30 $84.65 $50.79 $84.65 $84.65 $84.65 N/A N/A 395.68 SUP Custom 27203010 395.680 - ROD EXFIX 60D CVD 4MM 78MM CARFBR NONSTRL BOTH IP/OP $275.00 $204.00 $48.90 $287.75 $274.70 $274.70 $274.70 $274.70 $274.70 $274.70 $48.90 $274.70 $274.70 $203.88 $203.88 $211.74 $143.12 $57.25 $274.70 $115.10 $274.70 $274.70 $287.75 $274.70 $274.70 $206.25 $274.70 $274.70 $274.70 $137.35 $137.35 $217.56 $274.70 $219.76 $178.56 $274.70 N/A $159.50 $274.70 $164.82 $274.70 $274.70 $274.70 N/A N/A 395.681 SUP Custom 27203010 395.681 - ROD EXFIX 90D 4MM 117MM CVD SPAN ANGLED CARFBR NONSTRL BOTH IP/OP $303.00 $224.00 $53.93 $308.15 $303.00 $303.00 $303.00 $303.00 $303.00 $303.00 $53.93 $303.00 $303.00 $224.89 $224.89 $233.55 $157.86 $63.15 $303.00 $123.26 $303.00 $303.00 $308.15 $303.00 $303.00 $227.25 $303.00 $303.00 $303.00 $151.50 $151.50 $239.98 $303.00 $242.40 $196.95 $303.00 N/A $175.74 $303.00 $181.80 $303.00 $303.00 $303.00 N/A N/A 395.682 SUP Custom 27203010 395.682 - ROD EXFIX 120D 4MM 156MM CVD SPAN ANGLED CARFBR NONSTRL BOTH IP/OP $324.50 $240.00 $57.70 $329.65 $324.15 $324.15 $324.15 $324.15 $324.15 $324.15 $57.70 $324.15 $324.15 $240.58 $240.58 $249.85 $168.88 $67.56 $324.15 $131.86 $324.15 $324.15 $329.65 $324.15 $324.15 $243.38 $324.15 $324.15 $324.15 $162.08 $162.08 $256.73 $324.15 $259.32 $210.70 $324.15 N/A $188.21 $324.15 $194.49 $324.15 $324.15 $324.15 N/A N/A 395.685 SUP Custom 27203010 395.685 - ROD EXFIX ANGLE 4MM 50X80MM T BAR RECYCLED CARFBR NONSTRL BOTH IP/OP $583.00 $431.00 $103.70 $592.50 $582.60 $582.60 $582.60 $582.60 $582.60 $582.60 $103.70 $582.60 $582.60 $432.41 $432.41 $449.07 $303.53 $121.42 $582.60 $237.00 $582.60 $582.60 $592.50 $582.60 $582.60 $437.25 $582.60 $582.60 $582.60 $291.30 $291.30 $461.42 $582.60 $466.08 $378.69 $582.60 N/A $338.14 $582.60 $349.56 $582.60 $582.60 $582.60 N/A N/A 395.686 SUP Custom 27203010 395.686 - ROD EXFIX ANGLE 4MM 120X80MM T BAR CARFBR NONSTRL BOTH IP/OP $583.00 $431.00 $103.70 $592.50 $582.60 $582.60 $582.60 $582.60 $582.60 $582.60 $103.70 $582.60 $582.60 $432.41 $432.41 $449.07 $303.53 $121.42 $582.60 $237.00 $582.60 $582.60 $592.50 $582.60 $582.60 $437.25 $582.60 $582.60 $582.60 $291.30 $291.30 $461.42 $582.60 $466.08 $378.69 $582.60 N/A $338.14 $582.60 $349.56 $582.60 $582.60 $582.60 N/A N/A 395.687 SUP Custom 27203010 395.687 - ROD EXFIX ANGLED 4MM 50X110MM T BAR ANGLED CARFBR NONSTRL BOTH IP/OP $583.00 $431.00 $103.70 $592.50 $582.60 $582.60 $582.60 $582.60 $582.60 $582.60 $103.70 $582.60 $582.60 $432.41 $432.41 $449.07 $303.53 $121.42 $582.60 $237.00 $582.60 $582.60 $592.50 $582.60 $582.60 $437.25 $582.60 $582.60 $582.60 $291.30 $291.30 $461.42 $582.60 $466.08 $378.69 $582.60 N/A $338.14 $582.60 $349.56 $582.60 $582.60 $582.60 N/A N/A 395.688 SUP Custom 27203010 395.688 - ROD EXFIX ANGLED 4MM 120X110MM T BAR ANGLED CARFBR NONSTRL BOTH IP/OP $583.00 $431.00 $103.70 $592.50 $582.60 $582.60 $582.60 $582.60 $582.60 $582.60 $103.70 $582.60 $582.60 $432.41 $432.41 $449.07 $303.53 $121.42 $582.60 $237.00 $582.60 $582.60 $592.50 $582.60 $582.60 $437.25 $582.60 $582.60 $582.60 $291.30 $291.30 $461.42 $582.60 $466.08 $378.69 $582.60 N/A $338.14 $582.60 $349.56 $582.60 $582.60 $582.60 N/A N/A 395.69 SUP Custom 27203010 395.690 - ROD EXFIX 45D 8MM 214MM CVD CARFBR NONSTRL BOTH IP/OP $597.00 $442.00 $106.27 $625.35 $597.00 $597.00 $597.00 $597.00 $597.00 $597.00 $106.27 $597.00 $597.00 $443.09 $443.09 $460.17 $311.04 $124.42 $597.00 $250.14 $597.00 $597.00 $625.35 $597.00 $597.00 $447.75 $597.00 $597.00 $597.00 $298.50 $298.50 $472.82 $597.00 $477.60 $388.05 $597.00 N/A $346.26 $597.00 $358.20 $597.00 $597.00 $597.00 N/A N/A 395.691 SUP Custom 27203010 395.691 - ROD EXFIX 90D 8MM 382MM CVD CARFBR NONSTRL BOTH IP/OP $615.00 $455.00 $109.45 $625.35 $614.90 $614.90 $614.90 $614.90 $614.90 $614.90 $109.45 $614.90 $614.90 $456.38 $456.38 $473.96 $320.36 $128.15 $614.90 $250.14 $614.90 $614.90 $625.35 $614.90 $614.90 $461.25 $614.90 $614.90 $614.90 $307.45 $307.45 $487.00 $614.90 $491.92 $399.69 $614.90 N/A $356.70 $614.90 $368.94 $614.90 $614.90 $614.90 N/A N/A 395.692 SUP Custom 27203010 395.692 - ROD EXFIX 135D 8MM 499MM CVD CARFBR NONSTRL BOTH IP/OP $580.00 $429.00 $103.17 $579.60 $579.60 $579.60 $579.60 $579.60 $579.60 $579.60 $103.17 $579.60 $579.60 $430.18 $430.18 $446.76 $301.97 $120.80 $579.60 $231.84 $579.60 $579.60 $579.60 $579.60 $579.60 $435.00 $579.60 $579.60 $579.60 $289.80 $289.80 $459.04 $579.60 $463.68 $376.74 $579.60 N/A $336.40 $579.60 $347.76 $579.60 $579.60 $579.60 N/A N/A 395.693 SUP Custom 27203010 395.693 - ROD EXFIX 180D 8MM 540MM CVD SPAN ANGLED CARFBR NONSTRL BOTH IP/OP $580.00 $429.00 $103.17 $579.60 $579.60 $579.60 $579.60 $579.60 $579.60 $579.60 $103.17 $579.60 $579.60 $430.18 $430.18 $446.76 $301.97 $120.80 $579.60 $231.84 $579.60 $579.60 $579.60 $579.60 $579.60 $435.00 $579.60 $579.60 $579.60 $289.80 $289.80 $459.04 $579.60 $463.68 $376.74 $579.60 N/A $336.40 $579.60 $347.76 $579.60 $579.60 $579.60 N/A N/A 395.7 SUP Custom 27203010 395.70 - BAR XTRNFX 4MM 60MM NS CNCT MRI SAFE SS METACARPUS PHALANX BOTH IP/OP $47.50 $35.00 $8.37 $47.05 $47.05 $47.05 $47.05 $47.05 $47.05 $47.05 $8.37 $47.05 $47.05 $34.92 $34.92 $36.27 $24.51 $9.81 $47.05 $18.82 $47.05 $47.05 $47.05 $47.05 $47.05 $35.63 $47.05 $47.05 $47.05 $23.53 $23.53 $37.26 $47.05 $37.64 $30.58 $47.05 N/A $27.55 $47.05 $28.23 $47.05 $47.05 $47.05 N/A N/A 395.71 SUP Custom 27203010 395.71 - BAR XTRNFX 4MM 80MM NS CNCT MRI SAFE SS METACARPUS PHALANX BOTH IP/OP $47.50 $35.00 $8.37 $47.05 $47.05 $47.05 $47.05 $47.05 $47.05 $47.05 $8.37 $47.05 $47.05 $34.92 $34.92 $36.27 $24.51 $9.81 $47.05 $18.82 $47.05 $47.05 $47.05 $47.05 $47.05 $35.63 $47.05 $47.05 $47.05 $23.53 $23.53 $37.26 $47.05 $37.64 $30.58 $47.05 N/A $27.55 $47.05 $28.23 $47.05 $47.05 $47.05 N/A N/A 395.72 SUP Custom 27203010 395.72 - BAR XTRNFX 4MM 100MM NS CNCT MRI SAFE SS METACARPUS PHALANX BOTH IP/OP $47.50 $35.00 $8.37 $47.05 $47.05 $47.05 $47.05 $47.05 $47.05 $47.05 $8.37 $47.05 $47.05 $34.92 $34.92 $36.27 $24.51 $9.81 $47.05 $18.82 $47.05 $47.05 $47.05 $47.05 $47.05 $35.63 $47.05 $47.05 $47.05 $23.53 $23.53 $37.26 $47.05 $37.64 $30.58 $47.05 N/A $27.55 $47.05 $28.23 $47.05 $47.05 $47.05 N/A N/A 395.73 SUP Custom 27203010 395.73 - BAR XTRNFX 4MM 120MM NS CNCT MRI SAFE SS METACARPUS PHALANX BOTH IP/OP $47.50 $35.00 $8.37 $47.05 $47.05 $47.05 $47.05 $47.05 $47.05 $47.05 $8.37 $47.05 $47.05 $34.92 $34.92 $36.27 $24.51 $9.81 $47.05 $18.82 $47.05 $47.05 $47.05 $47.05 $47.05 $35.63 $47.05 $47.05 $47.05 $23.53 $23.53 $37.26 $47.05 $37.64 $30.58 $47.05 N/A $27.55 $47.05 $28.23 $47.05 $47.05 $47.05 N/A N/A 395.74 SUP Custom 27203010 395.74 - BAR XTRNFX 4MM 140MM NS CNCT MRI SAFE SS METACARPUS PHALANX BOTH IP/OP $62.00 $46.00 $10.97 $61.65 $61.65 $61.65 $61.65 $61.65 $61.65 $61.65 $10.97 $61.65 $61.65 $45.76 $45.76 $47.52 $32.12 $12.85 $61.65 $24.66 $61.65 $61.65 $61.65 $61.65 $61.65 $46.50 $61.65 $61.65 $61.65 $30.83 $30.83 $48.83 $61.65 $49.32 $40.07 $61.65 N/A $35.96 $61.65 $36.99 $61.65 $61.65 $61.65 N/A N/A 395.75 SUP Custom 27203010 395.75 - BAR XTRNFX 4MM 160MM NS CNCT MRI SAFE SS METACARPUS PHALANX BOTH IP/OP $62.00 $46.00 $10.97 $61.65 $61.65 $61.65 $61.65 $61.65 $61.65 $61.65 $10.97 $61.65 $61.65 $45.76 $45.76 $47.52 $32.12 $12.85 $61.65 $24.66 $61.65 $61.65 $61.65 $61.65 $61.65 $46.50 $61.65 $61.65 $61.65 $30.83 $30.83 $48.83 $61.65 $49.32 $40.07 $61.65 N/A $35.96 $61.65 $36.99 $61.65 $61.65 $61.65 N/A N/A 395.76 SUP Custom 27203010 395.76 - BAR XTRNFX 4MM 180MM NS CNCT MRI SAFE SS METACARPUS PHALANX BOTH IP/OP $62.00 $46.00 $10.97 $61.65 $61.65 $61.65 $61.65 $61.65 $61.65 $61.65 $10.97 $61.65 $61.65 $45.76 $45.76 $47.52 $32.12 $12.85 $61.65 $24.66 $61.65 $61.65 $61.65 $61.65 $61.65 $46.50 $61.65 $61.65 $61.65 $30.83 $30.83 $48.83 $61.65 $49.32 $40.07 $61.65 N/A $35.96 $61.65 $36.99 $61.65 $61.65 $61.65 N/A N/A 395.77 SUP Custom 27203010 395.77 - BAR XTRNFX 4MM 200MM NS CNCT MRI SAFE SS METACARPUS PHALANX BOTH IP/OP $62.00 $46.00 $10.97 $61.65 $61.65 $61.65 $61.65 $61.65 $61.65 $61.65 $10.97 $61.65 $61.65 $45.76 $45.76 $47.52 $32.12 $12.85 $61.65 $24.66 $61.65 $61.65 $61.65 $61.65 $61.65 $46.50 $61.65 $61.65 $61.65 $30.83 $30.83 $48.83 $61.65 $49.32 $40.07 $61.65 N/A $35.96 $61.65 $36.99 $61.65 $61.65 $61.65 N/A N/A 395.779 SUP Custom 27203010 395.779 - ROD EXFIX MEDIUM 8MM 160MM CARFBR NONSTRL BOTH IP/OP $246.50 $182.00 $43.82 $250.35 $246.18 $246.18 $246.18 $246.18 $246.18 $246.18 $43.82 $246.18 $246.18 $182.71 $182.71 $189.76 $128.26 $51.31 $246.18 $100.14 $246.18 $246.18 $250.35 $246.18 $246.18 $184.88 $246.18 $246.18 $246.18 $123.09 $123.09 $194.97 $246.18 $196.94 $160.02 $246.18 N/A $142.97 $246.18 $147.71 $246.18 $246.18 $246.18 N/A N/A 395.78 SUP HCPCS C1713 395.780 - ROD EXFIX 120MM 8MM MED CARFBR MED EXFIX NONSTRL BOTH IP/OP $239.00 $177.00 $43.82 $246.18 $246.18 $246.18 $246.18 $246.18 $246.18 $246.18 $43.82 $246.18 $246.18 $182.71 $182.71 $189.76 $128.26 $51.31 $246.18 $98.47 $246.18 $246.18 $246.18 $246.18 $246.18 $179.25 $246.18 $246.18 $246.18 $123.09 $123.09 $194.97 $246.18 $196.94 $160.02 $246.18 N/A $138.62 $246.18 $147.71 $246.18 $246.18 $246.18 N/A N/A 395.78 SUP Custom 27203010 395.78 - BAR XTRNFX 4MM 220MM NS CNCT MRI SAFE SS METACARPUS PHALANX BOTH IP/OP $246.50 $182.00 $43.82 $246.18 $246.18 $246.18 $246.18 $246.18 $246.18 $246.18 $43.82 $246.18 $246.18 $182.71 $182.71 $189.76 $128.26 $51.31 $246.18 $98.47 $246.18 $246.18 $246.18 $246.18 $246.18 $184.88 $246.18 $246.18 $246.18 $123.09 $123.09 $194.97 $246.18 $196.94 $160.02 $246.18 N/A $142.97 $246.18 $147.71 $246.18 $246.18 $246.18 N/A N/A 395.782 SUP Custom 27203010 395.782 - ROD EXFIX 8MM 200MM CARFBR DISTAL RAD NONSTRL BOTH IP/OP $244.00 $181.00 $43.42 $248.10 $243.95 $243.95 $243.95 $243.95 $243.95 $243.95 $43.42 $243.95 $243.95 $181.06 $181.06 $188.04 $127.10 $50.84 $243.95 $99.24 $243.95 $243.95 $248.10 $243.95 $243.95 $183.00 $243.95 $243.95 $243.95 $121.98 $121.98 $193.21 $243.95 $195.16 $158.57 $243.95 N/A $141.52 $243.95 $146.37 $243.95 $243.95 $243.95 N/A N/A 395.784 SUP Custom 27203010 395.784 - ROD EXFIX 8MM 220MM CARFBR DISTAL RAD NONSTRL BOTH IP/OP $244.00 $181.00 $43.42 $248.10 $243.95 $243.95 $243.95 $243.95 $243.95 $243.95 $43.42 $243.95 $243.95 $181.06 $181.06 $188.04 $127.10 $50.84 $243.95 $99.24 $243.95 $243.95 $248.10 $243.95 $243.95 $183.00 $243.95 $243.95 $243.95 $121.98 $121.98 $193.21 $243.95 $195.16 $158.57 $243.95 N/A $141.52 $243.95 $146.37 $243.95 $243.95 $243.95 N/A N/A 395.786 SUP Custom 27203010 395.786 - ROD EXFIX 8MM 240MM CARFBR DISTAL RAD NONSTRL BOTH IP/OP $244.00 $181.00 $43.42 $248.10 $243.95 $243.95 $243.95 $243.95 $243.95 $243.95 $43.42 $243.95 $243.95 $181.06 $181.06 $188.04 $127.10 $50.84 $243.95 $99.24 $243.95 $243.95 $248.10 $243.95 $243.95 $183.00 $243.95 $243.95 $243.95 $121.98 $121.98 $193.21 $243.95 $195.16 $158.57 $243.95 N/A $141.52 $243.95 $146.37 $243.95 $243.95 $243.95 N/A N/A 395.788 SUP Custom 27203010 395.788 - ROD EXFIX 8MM 280MM CARFBR DISTAL RAD NONSTRL BOTH IP/OP $246.50 $182.00 $43.82 $250.35 $246.18 $246.18 $246.18 $246.18 $246.18 $246.18 $43.82 $246.18 $246.18 $182.71 $182.71 $189.76 $128.26 $51.31 $246.18 $100.14 $246.18 $246.18 $250.35 $246.18 $246.18 $184.88 $246.18 $246.18 $246.18 $123.09 $123.09 $194.97 $246.18 $196.94 $160.02 $246.18 N/A $142.97 $246.18 $147.71 $246.18 $246.18 $246.18 N/A N/A 395.79 SUP Custom 27203010 395.79 - BAR XTRNFX 4MM 240MM NS CNCT MRI SAFE SS METACARPUS PHALANX BOTH IP/OP $76.50 $57.00 $13.55 $76.13 $76.13 $76.13 $76.13 $76.13 $76.13 $76.13 $13.55 $76.13 $76.13 $56.50 $56.50 $58.68 $39.66 $15.87 $76.13 $30.45 $76.13 $76.13 $76.13 $76.13 $76.13 $57.38 $76.13 $76.13 $76.13 $38.07 $38.07 $60.29 $76.13 $60.90 $49.48 $76.13 N/A $44.37 $76.13 $45.68 $76.13 $76.13 $76.13 N/A N/A 395.792 SUP Custom 27203010 395.792 - ROD EXFIX MEDIUM 8MM 320MM CARFBR NONSTRL BOTH IP/OP $246.50 $182.00 $43.82 $250.35 $246.18 $246.18 $246.18 $246.18 $246.18 $246.18 $43.82 $246.18 $246.18 $182.71 $182.71 $189.76 $128.26 $51.31 $246.18 $100.14 $246.18 $246.18 $250.35 $246.18 $246.18 $184.88 $246.18 $246.18 $246.18 $123.09 $123.09 $194.97 $246.18 $196.94 $160.02 $246.18 N/A $142.97 $246.18 $147.71 $246.18 $246.18 $246.18 N/A N/A 395.796 SUP Custom 27203010 395.796 - ROD EXFIX 8MM 360MM CARFBR NONSTRL BOTH IP/OP $265.50 $196.00 $47.19 $269.63 $265.13 $265.13 $265.13 $265.13 $265.13 $265.13 $47.19 $265.13 $265.13 $196.78 $196.78 $204.36 $138.13 $55.26 $265.13 $107.85 $265.13 $265.13 $269.63 $265.13 $265.13 $199.13 $265.13 $265.13 $265.13 $132.57 $132.57 $209.98 $265.13 $212.10 $172.33 $265.13 N/A $153.99 $265.13 $159.08 $265.13 $265.13 $265.13 N/A N/A 395.797 SUP Custom 27203010 395.797 - ROD EXFIX MEDIUM 8MM 400MM CARFBR NONSTRL BOTH IP/OP $265.50 $196.00 $47.19 $269.63 $265.13 $265.13 $265.13 $265.13 $265.13 $265.13 $47.19 $265.13 $265.13 $196.78 $196.78 $204.36 $138.13 $55.26 $265.13 $107.85 $265.13 $265.13 $269.63 $265.13 $265.13 $199.13 $265.13 $265.13 $265.13 $132.57 $132.57 $209.98 $265.13 $212.10 $172.33 $265.13 N/A $153.99 $265.13 $159.08 $265.13 $265.13 $265.13 N/A N/A 395.798 SUP Custom 27203010 395.798 - ROD EXFIX 8MM 460MM CARFBR NONSTRL BOTH IP/OP $265.50 $196.00 $47.19 $269.63 $265.13 $265.13 $265.13 $265.13 $265.13 $265.13 $47.19 $265.13 $265.13 $196.78 $196.78 $204.36 $138.13 $55.26 $265.13 $107.85 $265.13 $265.13 $269.63 $265.13 $265.13 $199.13 $265.13 $265.13 $265.13 $132.57 $132.57 $209.98 $265.13 $212.10 $172.33 $265.13 N/A $153.99 $265.13 $159.08 $265.13 $265.13 $265.13 N/A N/A 395.8 SUP Custom 27203010 395.80 - BAR XTRNFX 4MM 250MM NS CNCT SS MN XTRNFXTR BOTH IP/OP $76.50 $57.00 $13.55 $76.13 $76.13 $76.13 $76.13 $76.13 $76.13 $76.13 $13.55 $76.13 $76.13 $56.50 $56.50 $58.68 $39.66 $15.87 $76.13 $30.45 $76.13 $76.13 $76.13 $76.13 $76.13 $57.38 $76.13 $76.13 $76.13 $38.07 $38.07 $60.29 $76.13 $60.90 $49.48 $76.13 N/A $44.37 $76.13 $45.68 $76.13 $76.13 $76.13 N/A N/A 395.81 SUP Custom 27203010 395.81 - BAR EXFIX 4MM 260MM CONNECT NONSTRL BOTH IP/OP $76.50 $57.00 $13.55 $76.13 $76.13 $76.13 $76.13 $76.13 $76.13 $76.13 $13.55 $76.13 $76.13 $56.50 $56.50 $58.68 $39.66 $15.87 $76.13 $30.45 $76.13 $76.13 $76.13 $76.13 $76.13 $57.38 $76.13 $76.13 $76.13 $38.07 $38.07 $60.29 $76.13 $60.90 $49.48 $76.13 N/A $44.37 $76.13 $45.68 $76.13 $76.13 $76.13 N/A N/A 395.82 SUP Custom 27203010 395.82 - BAR EXFIX 4MM 280MM CONNECT NONSTRL BOTH IP/OP $76.50 $57.00 $13.55 $76.13 $76.13 $76.13 $76.13 $76.13 $76.13 $76.13 $13.55 $76.13 $76.13 $56.50 $56.50 $58.68 $39.66 $15.87 $76.13 $30.45 $76.13 $76.13 $76.13 $76.13 $76.13 $57.38 $76.13 $76.13 $76.13 $38.07 $38.07 $60.29 $76.13 $60.90 $49.48 $76.13 N/A $44.37 $76.13 $45.68 $76.13 $76.13 $76.13 N/A N/A 395.83 SUP Custom 27203010 395.83 - BAR EXFIX 4MM 300MM CONNECT NONSTRL BOTH IP/OP $76.50 $57.00 $13.55 $76.13 $76.13 $76.13 $76.13 $76.13 $76.13 $76.13 $13.55 $76.13 $76.13 $56.50 $56.50 $58.68 $39.66 $15.87 $76.13 $30.45 $76.13 $76.13 $76.13 $76.13 $76.13 $57.38 $76.13 $76.13 $76.13 $38.07 $38.07 $60.29 $76.13 $60.90 $49.48 $76.13 N/A $44.37 $76.13 $45.68 $76.13 $76.13 $76.13 N/A N/A 397.283 SUP Custom 27203010 397.283 - BIT DRILL 1.8MM J LATCH NONSTRL BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 397.284 SUP Custom 27203010 397.284 - BIT DRILL 2.4MM J LATCH NONSTRL BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 397.342 SUP Custom 27203010 397.342 - BIT DRL 140MM 2.5MM 400MM NS JCHK CLBRT BOTH IP/OP $970.00 $718.00 $172.65 $986.43 $969.93 $969.93 $969.93 $969.93 $969.93 $969.93 $172.65 $969.93 $969.93 $719.88 $719.88 $747.62 $505.33 $202.14 $969.93 $394.57 $969.93 $969.93 $986.43 $969.93 $969.93 $727.50 $969.93 $969.93 $969.93 $484.97 $484.97 $768.18 $969.93 $775.94 $630.45 $969.93 N/A $562.60 $969.93 $581.96 $969.93 $969.93 $969.93 N/A N/A 397.343 SUP Custom 27203010 397.343 - BIT DRL 3.5MM 380MM NS JCHK BOTH IP/OP "$1,018.00" $753.00 $181.16 "$1,035.03" "$1,017.73" "$1,017.73" "$1,017.73" "$1,017.73" "$1,017.73" "$1,017.73" $181.16 "$1,017.73" "$1,017.73" $755.36 $755.36 $784.47 $530.24 $212.11 "$1,017.73" $414.01 "$1,017.73" "$1,017.73" "$1,035.03" "$1,017.73" "$1,017.73" $763.50 "$1,017.73" "$1,017.73" "$1,017.73" $508.87 $508.87 $806.04 "$1,017.73" $814.18 $661.52 "$1,017.73" N/A $590.44 "$1,017.73" $610.64 "$1,017.73" "$1,017.73" "$1,017.73" N/A N/A 398.756 SUP Custom 27203010 398.756 - CLAMP SURG 206MM HOOK ARM BONE BOTH IP/OP "$5,084.50" "$3,763.00" $905.02 "$5,170.83" "$5,084.40" "$5,084.40" "$5,084.40" "$5,084.40" "$5,084.40" "$5,084.40" $905.02 "$5,084.40" "$5,084.40" "$3,773.64" "$3,773.64" "$3,919.06" "$2,060.15" "$1,059.64" "$5,084.40" "$2,068.33" "$5,084.40" "$5,084.40" "$5,170.83" "$5,084.40" "$5,084.40" "$3,813.38" "$5,084.40" "$5,084.40" "$5,084.40" "$2,542.20" "$2,542.20" "$4,026.84" "$5,084.40" "$4,067.52" "$3,304.86" "$5,084.40" N/A "$2,949.01" "$5,084.40" "$3,050.64" "$5,084.40" "$5,084.40" "$5,084.40" N/A N/A 400.006 SUP HCPCS C1713 400.006 - SCREW BONE STANDARD 1.5MM 3MM 6MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $21.15 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $31.73 $52.88 $11.02 $52.88 N/A N/A 400.007 SUP HCPCS C1713 400.007 - SCREW BONE STANDARD 1.5MM 3MM 7MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $21.15 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $31.73 $52.88 $11.02 $52.88 N/A N/A 400.008 SUP HCPCS C1713 400.008 - SCREW BONE STANDARD 1.5MM 3MM 8MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $31.73 $52.88 $11.02 $52.88 N/A N/A 400.009 SUP HCPCS C1713 400.009 - SCREW BONE STANDARD 1.5MM 3MM 9MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $31.73 $52.88 $11.02 $52.88 N/A N/A 400.01 SUP HCPCS C1713 400.010 - SCREW BONE STANDARD 1.5MM 3MM 10MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $52.88 $52.88 $11.02 $52.88 N/A N/A 400.011 SUP HCPCS C1713 400.011 - SCREW BONE STANDARD 1.5MM 3MM 11MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $52.88 $52.88 $11.02 $52.88 N/A N/A 400.012 SUP HCPCS C1713 400.012 - SCREW BONE STANDARD 1.5MM 3MM 12MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $31.73 $52.88 $52.88 $52.88 N/A N/A 400.014 SUP HCPCS C1713 400.014 - SCREW BONE STANDARD 1.5MM 3MM 14MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $21.15 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $31.73 $52.88 $11.02 $52.88 N/A N/A 400.016 SUP HCPCS C1713 400.016 - SCREW BONE STANDARD 1.5MM 3MM 16MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $21.15 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $31.73 $52.88 $11.02 $52.88 N/A N/A 400.018 SUP HCPCS C1713 400.018 - SCREW BONE STANDARD 1.5MM 3MM 18MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $21.15 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $52.88 $52.88 $52.88 $52.88 N/A N/A 400.02 SUP HCPCS C1713 400.020 - SCREW BONE STANDARD 1.5MM 3MM 20MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $21.15 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $52.88 $52.88 $11.02 $52.88 N/A N/A 400.022 SUP HCPCS C1713 400.022 - SCREW BONE 1.5MM 22MM TITANIUM CORTICAL NONSTRL MINI BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $21.15 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $52.88 $52.88 $52.88 $52.88 N/A N/A 400.024 SUP HCPCS C1713 400.024 - SCREW BONE STANDARD CRCIFRM 1.5MM 3MM 24MM TITANIUM CORTICAL BOTH IP/OP $53.00 $39.00 $10.50 $52.88 $23.80 $23.80 $23.80 $23.80 $52.88 $52.88 $52.88 $11.02 $52.88 $52.88 $52.88 $52.88 $52.88 $11.02 $52.88 $21.15 $31.28 $52.88 $52.88 $52.88 $52.88 $39.75 $52.88 $52.88 $52.88 $26.44 $26.44 $41.88 $52.88 $42.30 $23.80 $10.50 N/A $30.74 $52.88 $31.73 $52.88 $52.88 $52.88 N/A N/A 400.19 SUP HCPCS C1713 400.190 - PIN FIX 1.8MM 12MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $213.00 $158.00 $42.26 $223.03 $95.81 $95.81 $95.81 $95.81 $212.90 $212.90 $212.90 $44.37 $212.90 $212.90 $212.90 $212.90 $212.90 $44.37 $212.90 $89.21 $125.93 $212.90 $223.03 $212.90 $212.90 $159.75 $212.90 $212.90 $212.90 $106.45 $106.45 $168.62 $212.90 $170.32 $95.81 $42.26 N/A $123.54 $212.90 $127.74 $212.90 $44.37 $212.90 N/A N/A 400.191 SUP Custom 27203010 400.191 - PIN FIX 1.8MM 14MM T8 STARDRIVE RECESS BUTTRESS LCP TITANIUM BOTH IP/OP $219.50 $162.00 $39.04 $223.03 $219.30 $219.30 $219.30 $219.30 $219.30 $219.30 $39.04 $219.30 $219.30 $162.76 $162.76 $169.04 $114.26 $45.70 $219.30 $89.21 $219.30 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $142.55 $219.30 N/A $127.31 $219.30 $131.58 $219.30 $219.30 $219.30 N/A N/A 400.192 SUP Custom 27203010 400.192 - PIN FIX 1.8MM 16MM T8 STARDRIVE RECESS BUTTRESS LCP TITANIUM BOTH IP/OP $219.50 $162.00 $39.04 $223.03 $219.30 $219.30 $219.30 $219.30 $219.30 $219.30 $39.04 $219.30 $219.30 $162.76 $162.76 $169.04 $114.26 $45.70 $219.30 $89.21 $219.30 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $142.55 $219.30 N/A $127.31 $219.30 $131.58 $219.30 $219.30 $219.30 N/A N/A 400.193 SUP Custom 27203010 400.193 - PIN FIX 1.8MM 18MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $219.50 $162.00 $39.04 $223.03 $219.30 $219.30 $219.30 $219.30 $219.30 $219.30 $39.04 $219.30 $219.30 $162.76 $162.76 $169.04 $114.26 $45.70 $219.30 $89.21 $219.30 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $142.55 $219.30 N/A $127.31 $219.30 $131.58 $219.30 $219.30 $219.30 N/A N/A 400.194 SUP HCPCS C1713 400.194 - PIN FIX 1.8MM 20MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 400.195 SUP Custom 27203010 400.195 - PIN FIX 1.8MM 22MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $219.50 $162.00 $39.04 $223.03 $219.30 $219.30 $219.30 $219.30 $219.30 $219.30 $39.04 $219.30 $219.30 $162.76 $162.76 $169.04 $114.26 $45.70 $219.30 $89.21 $219.30 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $142.55 $219.30 N/A $127.31 $219.30 $131.58 $219.30 $219.30 $219.30 N/A N/A 400.196 SUP HCPCS C1713 400.196 - PIN FIX 1.8MM 24MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $219.30 $219.30 $45.70 $219.30 N/A N/A 400.197 SUP Custom 27203010 400.197 - PIN FIX 1.8MM 26MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $219.50 $162.00 $39.04 $223.03 $219.30 $219.30 $219.30 $219.30 $219.30 $219.30 $39.04 $219.30 $219.30 $162.76 $162.76 $169.04 $114.26 $45.70 $219.30 $89.21 $219.30 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $142.55 $219.30 N/A $127.31 $219.30 $131.58 $219.30 $219.30 $219.30 N/A N/A 400.198 SUP HCPCS C1713 400.198 - PIN FIX 1.8MM 28MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $223.03 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 400.199 SUP Custom 27203010 400.199 - PIN FIX 1.8MM 30MM BUTTRESS T8 STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $219.50 $162.00 $39.04 $223.03 $219.30 $219.30 $219.30 $219.30 $219.30 $219.30 $39.04 $219.30 $219.30 $162.76 $162.76 $169.04 $114.26 $45.70 $219.30 $89.21 $219.30 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $142.55 $219.30 N/A $127.31 $219.30 $131.58 $219.30 $219.30 $219.30 N/A N/A 400.406 SUP HCPCS C1713 400.406 - SCREW BONE GOLD 6MM 1MM CORT CRANFCL TI SLFTAP +DR RECESS BOTH IP/OP $157.50 $117.00 $31.26 $157.50 $70.88 $70.88 $70.88 $70.88 $157.50 $157.50 $157.50 $32.83 $157.50 $157.50 $157.50 $157.50 $157.50 $32.82 $157.50 $63.00 $93.16 $157.50 $157.50 $157.50 $157.50 $118.13 $157.50 $157.50 $157.50 $78.75 $78.75 $124.74 $157.50 $126.00 $70.88 $31.26 N/A $91.35 $157.50 $94.50 $157.50 $32.82 $157.50 N/A N/A 400.526 SUP HCPCS C1713 400.526 - SCREW BONE 1MM 1.6MM 6MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $139.38 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 400.527 SUP HCPCS C1713 400.527 - SCREW BONE 1MM 1.6MM 7MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $139.38 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 400.528 SUP HCPCS C1713 400.528 - SCREW BONE 1MM 1.6MM 8MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $139.38 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 400.529 SUP HCPCS C1713 400.529 - SCREW BONE 1MM 1.6MM 9MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $139.38 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 400.53 SUP HCPCS C1713 400.530 - SCREW BONE 1MM 1.6MM 10MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $133.50 $99.00 $26.41 $139.38 $59.87 $59.87 $59.87 $59.87 $133.05 $133.05 $133.05 $27.73 $133.05 $133.05 $133.05 $133.05 $133.05 $27.73 $133.05 $139.38 $78.70 $133.05 $139.38 $133.05 $133.05 $100.13 $133.05 $133.05 $133.05 $66.53 $66.53 $105.38 $133.05 $106.44 $59.87 $26.41 N/A $77.43 $133.05 $133.05 $133.05 $27.73 $133.05 N/A N/A 400.531 SUP HCPCS C1713 400.531 - SCREW BONE 1MM 1.6MM 11MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $139.38 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 400.532 SUP HCPCS C1713 400.532 - SCREW BONE 1MM 1.6MM 12MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $139.38 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 400.533 SUP HCPCS C1713 400.533 - SCREW BONE 1MM 1.6MM 13MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $139.38 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 400.534 SUP HCPCS C1713 400.534 - SCREW BONE 1MM 1.6MM 14MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $137.50 $102.00 $27.20 $139.38 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $139.38 $81.07 $137.05 $139.38 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $82.23 $137.05 $28.56 $137.05 N/A N/A 400.686 SUP HCPCS C1713 400.686 - SCREW BONE 1.3MM 2.4MM 6MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $145.80 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $29.88 $143.38 N/A N/A 400.687 SUP HCPCS C1713 400.687 - SCREW BONE 1.3MM 2.4MM 7MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $145.80 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $29.88 $143.38 N/A N/A 400.688 SUP HCPCS C1713 400.688 - SCREW BONE 1.3MM 2.4MM 8MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $145.80 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $29.88 $143.38 N/A N/A 400.689 SUP HCPCS C1713 400.689 - SCREW BONE 1.3MM 2.4MM 9MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $145.80 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $29.88 $143.38 N/A N/A 400.69 SUP HCPCS C1713 400.690 - SCREW BONE 1.3MM 2.4MM 10MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $139.50 $103.00 $27.63 $145.80 $62.64 $62.64 $62.64 $62.64 $139.20 $139.20 $139.20 $29.01 $139.20 $139.20 $139.20 $139.20 $139.20 $29.01 $139.20 $145.80 $82.34 $139.20 $145.80 $139.20 $139.20 $104.63 $139.20 $139.20 $139.20 $69.60 $69.60 $110.25 $139.20 $111.36 $62.64 $27.63 N/A $80.91 $139.20 $83.52 $139.20 $29.01 $139.20 N/A N/A 400.691 SUP HCPCS C1713 400.691 - SCREW BONE 1.3MM 2.4MM 11MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $145.80 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $29.88 $143.38 N/A N/A 400.692 SUP HCPCS C1713 400.692 - SCREW BONE 1.3MM 2.4MM 12MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $145.80 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $29.88 $143.38 N/A N/A 400.693 SUP HCPCS C1713 400.693 - SCREW BONE 1.3MM 2.4MM 13MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $145.80 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $29.88 $143.38 N/A N/A 400.694 SUP HCPCS C1713 400.694 - SCREW BONE 1.3MM 2.4MM 14MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $145.80 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $29.88 $143.38 N/A N/A 400.696 SUP HCPCS C1713 400.696 - SCREW BONE 1.3MM 2.4MM 16MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $145.80 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $143.38 $143.38 $29.88 $143.38 N/A N/A 400.698 SUP HCPCS C1713 400.698 - SCREW BONE 1.3MM 2.4MM 18MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $143.50 $106.00 $28.46 $145.80 $64.52 $64.52 $64.52 $64.52 $143.38 $143.38 $143.38 $29.88 $143.38 $143.38 $143.38 $143.38 $143.38 $29.88 $143.38 $145.80 $84.81 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $64.52 $28.46 N/A $83.23 $143.38 $86.03 $143.38 $29.88 $143.38 N/A N/A 400.806 SUP HCPCS C1713 400.806 - SCREW BONE 1.5MM 3MM 6MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $26.58 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $65.35 $65.35 N/A N/A 400.807 SUP HCPCS C1713 400.807 - SCREW BONE 1.5MM 3MM 7MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $26.58 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $13.62 $65.35 N/A N/A 400.808 SUP HCPCS C1713 400.808 - SCREW BONE 1.5MM 3MM 8MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $26.58 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $13.62 $65.35 N/A N/A 400.809 SUP HCPCS C1713 400.809 - SCREW BONE 1.5MM 3MM 9MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $66.45 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $65.35 $65.35 N/A N/A 400.81 SUP HCPCS C1713 400.810 - SCREW BONE 1.5MM 3MM 10MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $63.50 $47.00 $12.59 $66.45 $28.55 $28.55 $28.55 $28.55 $63.45 $63.45 $63.45 $13.22 $63.45 $63.45 $63.45 $63.45 $63.45 $13.22 $63.45 $66.45 $37.53 $63.45 $66.45 $63.45 $63.45 $47.63 $63.45 $63.45 $63.45 $31.73 $31.73 $50.25 $63.45 $50.76 $28.55 $12.59 N/A $36.83 $63.45 $38.07 $63.45 $13.22 $63.45 N/A N/A 400.811 SUP HCPCS C1713 400.811 - SCREW BONE 1.5MM 3MM 11MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $66.45 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $13.62 $65.35 N/A N/A 400.812 SUP HCPCS C1713 400.812 - SCREW BONE 1.5MM 3MM 12MM SELF TAP CRCIFRM RECESS TITANIUM BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $66.45 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $65.35 $65.35 $13.62 $65.35 N/A N/A 400.814 SUP HCPCS C1713 400.814 - SCREW BONE 1.5MM 3MM 14MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $66.45 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $65.35 $65.35 $13.62 $65.35 N/A N/A 400.816 SUP HCPCS C1713 400.816 - SCREW BONE 1.5MM 3MM 16MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $66.45 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $65.35 $65.35 $13.62 $65.35 N/A N/A 400.818 SUP HCPCS C1713 400.818 - SCREW BONE 1.5MM 3MM 18MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $66.45 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $13.62 $65.35 N/A N/A 400.82 SUP HCPCS C1713 400.820 - SCREW BONE 1.5MM 3MM 20MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $63.50 $47.00 $12.59 $66.45 $28.55 $28.55 $28.55 $28.55 $63.45 $63.45 $63.45 $13.22 $63.45 $63.45 $63.45 $63.45 $63.45 $13.22 $63.45 $66.45 $37.53 $63.45 $66.45 $63.45 $63.45 $47.63 $63.45 $63.45 $63.45 $31.73 $31.73 $50.25 $63.45 $50.76 $28.55 $12.59 N/A $36.83 $63.45 $38.07 $63.45 $13.22 $63.45 N/A N/A 400.822 SUP HCPCS C1713 400.822 - SCREW BONE 1.5MM 3MM 22MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $66.45 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $65.35 $65.35 $13.62 $65.35 N/A N/A 400.824 SUP HCPCS C1713 400.824 - SCREW BONE 1.5MM 3MM 24MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $66.45 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $65.35 $65.35 $13.62 $65.35 N/A N/A 400.834 SUP HCPCS C1713 400.834 - SCREW BONE 4MM 1.5MM CORT CRANFCL TI SLFDRILL LP NONSTRL BOTH IP/OP $151.50 $112.00 $30.05 $151.38 $68.12 $68.12 $68.12 $68.12 $151.38 $151.38 $151.38 $31.55 $151.38 $151.38 $151.38 $151.38 $151.38 $31.55 $151.38 $151.38 $89.54 $151.38 $151.38 $151.38 $151.38 $113.63 $151.38 $151.38 $151.38 $75.69 $75.69 $119.89 $151.38 $121.10 $68.12 $30.05 N/A $87.87 $151.38 $90.83 $151.38 $31.55 $151.38 N/A N/A 400.835 SUP HCPCS C1713 400.835 - SCREW BONE 5MM 1.5MM CORT CRANFCL TI SLFDRILL LP NONSTRL BOTH IP/OP $151.50 $112.00 $30.05 $151.38 $68.12 $68.12 $68.12 $68.12 $151.38 $151.38 $151.38 $31.55 $151.38 $151.38 $151.38 $151.38 $151.38 $31.55 $151.38 $60.55 $89.54 $151.38 $151.38 $151.38 $151.38 $113.63 $151.38 $151.38 $151.38 $75.69 $75.69 $119.89 $151.38 $121.10 $68.12 $30.05 N/A $87.87 $151.38 $151.38 $151.38 $31.55 $151.38 N/A N/A 400.996 SUP HCPCS C1713 400.996 - SCREW BONE 1.4MM 15MM SLFDRILL WIRE FIX TITANIUM MIDFAC BOTH IP/OP $347.50 $257.00 $68.97 $347.50 $156.38 $156.38 $156.38 $156.38 $347.50 $347.50 $347.50 $72.43 $347.50 $347.50 $347.50 $347.50 $347.50 $72.42 $347.50 $139.00 $205.55 $347.50 $347.50 $347.50 $347.50 $260.63 $347.50 $347.50 $347.50 $173.75 $173.75 $275.22 $347.50 $278.00 $156.38 $68.97 N/A $201.55 $347.50 $347.50 $347.50 $72.42 $347.50 N/A N/A 400.997 SUP HCPCS C1713 400.997 - SCREW BONE 1.4MM 21MM SLFDRILL WIRE FIX TITANIUM MIDFAC BOTH IP/OP $347.50 $257.00 $68.97 $347.50 $156.38 $156.38 $156.38 $156.38 $347.50 $347.50 $347.50 $72.43 $347.50 $347.50 $347.50 $347.50 $347.50 $72.42 $347.50 $347.50 $205.55 $347.50 $347.50 $347.50 $347.50 $260.63 $347.50 $347.50 $347.50 $173.75 $173.75 $275.22 $347.50 $278.00 $156.38 $68.97 N/A $201.55 $347.50 $347.50 $347.50 $72.42 $347.50 N/A N/A 401.006 SUP HCPCS C1713 401.006 - SCREW BONE STANDARD 2MM 3.5MM 6MM CRCIFRM TITANIUM CORTICAL BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $20.88 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $31.32 $52.20 $10.88 $52.20 N/A N/A 401.008 SUP HCPCS C1713 401.008 - SCREW BONE STANDARD 2MM 3.5MM 8MM CRCIFRM TITANIUM CORTICAL BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $20.88 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $52.20 $52.20 $52.20 $52.20 N/A N/A 401.012 SUP HCPCS C1713 401.012 - SCREW BONE STANDARD 2MM 3.5MM 12MM CRCIFRM TITANIUM CORTICAL BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $52.20 $52.20 $10.88 $52.20 N/A N/A 401.02 SUP HCPCS C1713 401.020 - SCREW BONE STANDARD 2MM 3.5MM 20MM CRCIFRM TITANIUM CORTICAL BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $31.32 $52.20 $10.88 $52.20 N/A N/A 401.022 SUP HCPCS C1713 401.022 - SCREW BONE STANDARD 2MM 3.5MM 22MM CRCIFRM TITANIUM CORTICAL BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $31.32 $52.20 $10.88 $52.20 N/A N/A 401.024 SUP HCPCS C1713 401.024 - SCREW BONE STANDARD 2MM 3.5MM 24MM SLFTAP CRCIFRM RECESS BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $20.88 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $31.32 $52.20 $10.88 $52.20 N/A N/A 401.026 SUP HCPCS C1713 401.026 - SCREW BONE 2MM 26MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $20.88 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $52.20 $52.20 $10.88 $52.20 N/A N/A 401.028 SUP HCPCS C1713 401.028 - SCREW BONE 2MM 28MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $20.88 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $52.20 $52.20 $10.88 $52.20 N/A N/A 401.03 SUP HCPCS C1713 401.030 - SCREW BONE 2MM 30MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $20.88 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $52.20 $52.20 $10.88 $52.20 N/A N/A 401.032 SUP HCPCS C1713 401.032 - SCREW BONE 2MM 32MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $20.88 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $31.32 $52.20 $10.88 $52.20 N/A N/A 401.034 SUP HCPCS C1713 401.034 - SCREW BONE 2MM 34MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $20.88 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $31.32 $52.20 $52.20 $52.20 N/A N/A 401.036 SUP HCPCS C1713 401.036 - SCREW BONE 2MM 36MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $20.88 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $31.32 $52.20 $10.88 $52.20 N/A N/A 401.038 SUP HCPCS C1713 401.038 - SCREW BONE 2MM 38MM TITANIUM CORTICAL NONSTRL MINI FRAGMENT BOTH IP/OP $52.50 $39.00 $10.36 $52.20 $23.49 $23.49 $23.49 $23.49 $52.20 $52.20 $52.20 $10.88 $52.20 $52.20 $52.20 $52.20 $52.20 $10.88 $52.20 $20.88 $30.88 $52.20 $52.20 $52.20 $52.20 $39.38 $52.20 $52.20 $52.20 $26.10 $26.10 $41.34 $52.20 $41.76 $23.49 $10.36 N/A $30.45 $52.20 $31.32 $52.20 $10.88 $52.20 N/A N/A 401.158 SUP HCPCS C1713 401.158 - SCREW BONE 8MM 2MM CORT CRANFCL TI SLFTAP FLUT TIP NONSTRL BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 401.292 SUP HCPCS C1713 401.292 - SCREW BONE BLUE 6MM 2MM CRANFCL TI SLFTAP +DR RECESS LCK BOTH IP/OP "$1,091.50" $808.00 $216.59 "$1,091.25" $491.06 $491.06 $491.06 $491.06 "$1,091.25" "$1,091.25" "$1,091.25" $227.44 "$1,091.25" "$1,091.25" "$1,091.25" "$1,091.25" "$1,091.25" $227.43 "$1,091.25" $436.50 $645.47 "$1,091.25" "$1,091.25" "$1,091.25" "$1,091.25" $818.63 "$1,091.25" "$1,091.25" "$1,091.25" $545.63 $545.63 $864.27 "$1,091.25" $873.00 $491.06 $216.59 N/A $633.07 "$1,091.25" $654.75 "$1,091.25" $227.42 "$1,091.25" N/A N/A 401.295 SUP HCPCS C1713 401.295 - SCREW BONE BLUE 10MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $218.25 $218.25 $45.48 $218.25 N/A N/A 401.296 SUP HCPCS C1713 401.296 - SCREW BONE BLUE 12MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 401.297 SUP HCPCS C1713 401.297 - SCREW BONE BLUE 14MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 401.298 SUP HCPCS C1713 401.298 - SCREW BONE BLUE 16MM 2MM CRNMXF TI SLFTAP LCK +DR RECESS BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 401.305 SUP HCPCS C1713 401.305 - SCREW BONE 5MM 2.4MM CRNMXF TI ER CRCIFRM RECESS NONSTRL BOTH IP/OP $119.50 $88.00 $23.67 $119.25 $53.66 $53.66 $53.66 $53.66 $119.25 $119.25 $119.25 $24.85 $119.25 $119.25 $119.25 $119.25 $119.25 $24.85 $119.25 $119.25 $70.54 $119.25 $119.25 $119.25 $119.25 $89.63 $119.25 $119.25 $119.25 $59.63 $59.63 $94.45 $119.25 $95.40 $53.66 $23.67 N/A $69.31 $119.25 $71.55 $119.25 $24.85 $119.25 N/A N/A 401.508 SUP HCPCS C1713 401.508 - SCREW BONE 2.4MM 8MM TI CORT CRNMXF SLFTAP STRL GOLD BOTH IP/OP $170.00 $126.00 $33.72 $169.88 $76.45 $76.45 $76.45 $76.45 $169.88 $169.88 $169.88 $35.41 $169.88 $169.88 $169.88 $169.88 $169.88 $35.40 $169.88 $67.95 $100.48 $169.88 $169.88 $169.88 $169.88 $127.50 $169.88 $169.88 $169.88 $84.94 $84.94 $134.54 $169.88 $135.90 $76.45 $33.72 N/A $98.60 $169.88 $101.93 $169.88 $35.40 $169.88 N/A N/A 401.51 SUP HCPCS C1713 401.510 - SCREW BONE 2.4MM 10MM TI CORT CRNMXF MANDIB SLFTAP NONSTRL BOTH IP/OP $170.00 $126.00 $33.72 $169.88 $76.45 $76.45 $76.45 $76.45 $169.88 $169.88 $169.88 $35.41 $169.88 $169.88 $169.88 $169.88 $169.88 $35.40 $169.88 $169.88 $100.48 $169.88 $169.88 $169.88 $169.88 $127.50 $169.88 $169.88 $169.88 $84.94 $84.94 $134.54 $169.88 $135.90 $76.45 $33.72 N/A $98.60 $169.88 $101.93 $169.88 $35.40 $169.88 N/A N/A 401.516 SUP HCPCS C1713 401.516 - SCREW BONE 2.4MM 16MM TI CORT CRNMXF SLFTAP STRL GOLD BOTH IP/OP $170.00 $126.00 $33.72 $169.88 $76.45 $76.45 $76.45 $76.45 $169.88 $169.88 $169.88 $35.41 $169.88 $169.88 $169.88 $169.88 $169.88 $35.40 $169.88 $169.88 $100.48 $169.88 $169.88 $169.88 $169.88 $127.50 $169.88 $169.88 $169.88 $84.94 $84.94 $134.54 $169.88 $135.90 $76.45 $33.72 N/A $98.60 $169.88 $169.88 $169.88 $35.40 $169.88 N/A N/A 401.518 SUP HCPCS C1713 401.518 - SCREW BONE 2.4MM 18MM TI CORT CRNMXF MANDIB SLFTAP NONSTRL BOTH IP/OP $170.00 $126.00 $33.72 $169.88 $76.45 $76.45 $76.45 $76.45 $169.88 $169.88 $169.88 $35.41 $169.88 $169.88 $169.88 $169.88 $169.88 $35.40 $169.88 $169.88 $100.48 $169.88 $169.88 $169.88 $169.88 $127.50 $169.88 $169.88 $169.88 $84.94 $84.94 $134.54 $169.88 $135.90 $76.45 $33.72 N/A $98.60 $169.88 $169.88 $169.88 $35.40 $169.88 N/A N/A 401.612 SUP HCPCS C1713 401.612 - SCREW BONE 2.4MM 3.5MM 12MM SELF TAP SMALL CRCIFRM RECESS BOTH IP/OP $116.00 $86.00 $23.01 $115.93 $52.17 $52.17 $52.17 $52.17 $115.93 $115.93 $115.93 $24.16 $115.93 $115.93 $115.93 $115.93 $115.93 $24.16 $115.93 $46.37 $68.57 $115.93 $115.93 $115.93 $115.93 $87.00 $115.93 $115.93 $115.93 $57.97 $57.97 $91.82 $115.93 $92.74 $52.17 $23.01 N/A $67.28 $115.93 $115.93 $115.93 $115.93 $115.93 N/A N/A 401.614 SUP HCPCS C1713 401.614 - SCREW BONE SMALL 2.4MM 3.5MM 14MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $116.00 $86.00 $23.01 $115.93 $52.17 $52.17 $52.17 $52.17 $115.93 $115.93 $115.93 $24.16 $115.93 $115.93 $115.93 $115.93 $115.93 $24.16 $115.93 $115.93 $68.57 $115.93 $115.93 $115.93 $115.93 $87.00 $115.93 $115.93 $115.93 $57.97 $57.97 $91.82 $115.93 $92.74 $52.17 $23.01 N/A $67.28 $115.93 $115.93 $115.93 $115.93 $115.93 N/A N/A 401.616 SUP HCPCS C1713 401.616 - SCREW BONE SMALL 2.4MM 3.5MM 16MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $116.00 $86.00 $23.01 $115.93 $52.17 $52.17 $52.17 $52.17 $115.93 $115.93 $115.93 $24.16 $115.93 $115.93 $115.93 $115.93 $115.93 $24.16 $115.93 $46.37 $68.57 $115.93 $115.93 $115.93 $115.93 $87.00 $115.93 $115.93 $115.93 $57.97 $57.97 $91.82 $115.93 $92.74 $52.17 $23.01 N/A $67.28 $115.93 $115.93 $115.93 $24.16 $115.93 N/A N/A 401.618 SUP HCPCS C1713 401.618 - SCREW BONE SMALL 2.4MM 3.5MM 18MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $116.00 $86.00 $23.01 $115.93 $52.17 $52.17 $52.17 $52.17 $115.93 $115.93 $115.93 $24.16 $115.93 $115.93 $115.93 $115.93 $115.93 $24.16 $115.93 $46.37 $68.57 $115.93 $115.93 $115.93 $115.93 $87.00 $115.93 $115.93 $115.93 $57.97 $57.97 $91.82 $115.93 $92.74 $52.17 $23.01 N/A $67.28 $115.93 $115.93 $115.93 $24.16 $115.93 N/A N/A 401.62 SUP HCPCS C1713 401.620 - SCREW BONE 2.4MM 3.5MM 20MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $116.00 $86.00 $23.01 $115.93 $52.17 $52.17 $52.17 $52.17 $115.93 $115.93 $115.93 $24.16 $115.93 $115.93 $115.93 $115.93 $115.93 $24.16 $115.93 $46.37 $68.57 $115.93 $115.93 $115.93 $115.93 $87.00 $115.93 $115.93 $115.93 $57.97 $57.97 $91.82 $115.93 $92.74 $52.17 $23.01 N/A $67.28 $115.93 $115.93 $115.93 $24.16 $115.93 N/A N/A 401.622 SUP HCPCS C1713 401.622 - SCREW BONE SMALL 2.4MM 3.5MM 22MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $116.00 $86.00 $23.01 $115.93 $52.17 $52.17 $52.17 $52.17 $115.93 $115.93 $115.93 $24.16 $115.93 $115.93 $115.93 $115.93 $115.93 $24.16 $115.93 $115.93 $68.57 $115.93 $115.93 $115.93 $115.93 $87.00 $115.93 $115.93 $115.93 $57.97 $57.97 $91.82 $115.93 $92.74 $52.17 $23.01 N/A $67.28 $115.93 $69.56 $115.93 $24.16 $115.93 N/A N/A 401.624 SUP HCPCS C1713 401.624 - SCREW BONE SMALL 2.4MM 3.5MM 24MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $116.00 $86.00 $23.01 $115.93 $52.17 $52.17 $52.17 $52.17 $115.93 $115.93 $115.93 $24.16 $115.93 $115.93 $115.93 $115.93 $115.93 $24.16 $115.93 $115.93 $68.57 $115.93 $115.93 $115.93 $115.93 $87.00 $115.93 $115.93 $115.93 $57.97 $57.97 $91.82 $115.93 $92.74 $52.17 $23.01 N/A $67.28 $115.93 $115.93 $115.93 $24.16 $115.93 N/A N/A 401.626 SUP HCPCS C1713 401.626 - SCREW BONE SMALL 2.4MM 3.5MM 26MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $116.00 $86.00 $23.01 $115.93 $52.17 $52.17 $52.17 $52.17 $115.93 $115.93 $115.93 $24.16 $115.93 $115.93 $115.93 $115.93 $115.93 $24.16 $115.93 $46.37 $68.57 $115.93 $115.93 $115.93 $115.93 $87.00 $115.93 $115.93 $115.93 $57.97 $57.97 $91.82 $115.93 $92.74 $52.17 $23.01 N/A $67.28 $115.93 $69.56 $115.93 $24.16 $115.93 N/A N/A 401.628 SUP HCPCS C1713 401.628 - SCREW BONE SMALL 2.4MM 3.5MM 28MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $116.00 $86.00 $23.01 $115.93 $52.17 $52.17 $52.17 $52.17 $115.93 $115.93 $115.93 $24.16 $115.93 $115.93 $115.93 $115.93 $115.93 $24.16 $115.93 $46.37 $68.57 $115.93 $115.93 $115.93 $115.93 $87.00 $115.93 $115.93 $115.93 $57.97 $57.97 $91.82 $115.93 $92.74 $52.17 $23.01 N/A $67.28 $115.93 $69.56 $115.93 $24.16 $115.93 N/A N/A 401.63 SUP HCPCS C1713 401.630 - SCREW BONE SMALL 2.4MM 3.5MM 30MM SELF TAP CRCIFRM TITANIUM BOTH IP/OP $116.00 $86.00 $23.01 $115.93 $52.17 $52.17 $52.17 $52.17 $115.93 $115.93 $115.93 $24.16 $115.93 $115.93 $115.93 $115.93 $115.93 $24.16 $115.93 $46.37 $68.57 $115.93 $115.93 $115.93 $115.93 $87.00 $115.93 $115.93 $115.93 $57.97 $57.97 $91.82 $115.93 $92.74 $52.17 $23.01 N/A $67.28 $115.93 $69.56 $115.93 $115.93 $115.93 N/A N/A 401.756 SUP HCPCS C1713 401.756 - SCREW BONE 2.4MM 6MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 401.757 SUP HCPCS C1713 401.757 - SCREW BONE 2.4MM 7MM SLFTAP LCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 401.758 SUP HCPCS C1713 401.758 - SCREW BONE 2.4MM 8MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $104.70 $104.70 N/A N/A 401.759 SUP HCPCS C1713 401.759 - SCREW BONE 2.4MM 9MM SLFTAP LCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $104.70 $104.70 N/A N/A 401.76 SUP HCPCS C1713 401.760 - SCREW BONE 2.4MM 4MM 10MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $102.00 $75.00 $20.17 $106.48 $45.74 $45.74 $45.74 $45.74 $101.65 $101.65 $101.65 $21.19 $101.65 $101.65 $101.65 $101.65 $101.65 $21.18 $101.65 $42.59 $60.13 $101.65 $106.48 $101.65 $101.65 $76.50 $101.65 $101.65 $101.65 $50.83 $50.83 $80.51 $101.65 $81.32 $45.74 $20.17 N/A $59.16 $101.65 $101.65 $101.65 $21.18 $101.65 N/A N/A 401.761 SUP HCPCS C1713 401.761 - SCREW BONE 2.4MM 11MM SLFTAP LCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $104.70 $104.70 N/A N/A 401.762 SUP HCPCS C1713 401.762 - SCREW BONE 2.4MM 4MM 12MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 401.763 SUP HCPCS C1713 401.763 - SCREW BONE 2.4MM 13MM SLFTAP LCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 401.764 SUP HCPCS C1713 401.764 - SCREW BONE 2.4MM 4MM 14MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 401.766 SUP HCPCS C1713 401.766 - SCREW BONE 2.4MM 4MM 16MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 401.768 SUP HCPCS C1713 401.768 - SCREW BONE 2.4MM 4MM 18MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 401.77 SUP HCPCS C1713 401.770 - SCREW BONE 2.4MM 20MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $102.00 $75.00 $20.17 $106.48 $45.74 $45.74 $45.74 $45.74 $101.65 $101.65 $101.65 $21.19 $101.65 $101.65 $101.65 $101.65 $101.65 $21.18 $101.65 $42.59 $60.13 $101.65 $106.48 $101.65 $101.65 $76.50 $101.65 $101.65 $101.65 $50.83 $50.83 $80.51 $101.65 $81.32 $45.74 $20.17 N/A $59.16 $101.65 $101.65 $101.65 $101.65 $101.65 N/A N/A 401.772 SUP HCPCS C1713 401.772 - SCREW BONE 2.4MM 4MM 22MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $104.70 $104.70 N/A N/A 401.774 SUP HCPCS C1713 401.774 - SCREW BONE 2.4MM 4MM 24MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 401.776 SUP HCPCS C1713 401.776 - SCREW BONE 2.4MM 26MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 401.778 SUP HCPCS C1713 401.778 - SCREW BONE 2.4MM 28MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 401.78 SUP HCPCS C1713 401.780 - SCREW BONE 2.4MM 30MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $102.00 $75.00 $20.17 $106.48 $45.74 $45.74 $45.74 $45.74 $101.65 $101.65 $101.65 $21.19 $101.65 $101.65 $101.65 $101.65 $101.65 $21.18 $101.65 $42.59 $60.13 $101.65 $106.48 $101.65 $101.65 $76.50 $101.65 $101.65 $101.65 $50.83 $50.83 $80.51 $101.65 $81.32 $45.74 $20.17 N/A $59.16 $101.65 $101.65 $101.65 $101.65 $101.65 N/A N/A 401.782 SUP HCPCS C1713 401.782 - SCREW BONE 2.4MM 4MM 32MM T8 STARDRIVE RECESS SELF TAP SELF BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 401.784 SUP HCPCS C1713 401.784 - SCREW BONE 2.4MM 4MM 34MM T8 STARDRIVE RECESS SELF TAP BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 401.786 SUP HCPCS C1713 401.786 - SCREW BONE 2.4MM 36MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 401.788 SUP HCPCS C1713 401.788 - SCREW BONE 2.4MM 4MM 38MM T8 STARDRIVE RECESS SELF TAP LCP BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 401.79 SUP HCPCS C1713 401.790 - SCREW BONE 2.4MM 40MM T8 STARDRIVE RECESS SLFTAP TITANIUM BOTH IP/OP $102.00 $75.00 $20.17 $106.48 $45.74 $45.74 $45.74 $45.74 $101.65 $101.65 $101.65 $21.19 $101.65 $101.65 $101.65 $101.65 $101.65 $21.18 $101.65 $42.59 $60.13 $101.65 $106.48 $101.65 $101.65 $76.50 $101.65 $101.65 $101.65 $50.83 $50.83 $80.51 $101.65 $81.32 $45.74 $20.17 N/A $59.16 $101.65 $101.65 $101.65 $21.18 $101.65 N/A N/A 401.806 SUP HCPCS C1713 401.806 - SCREW BONE 2MM 3.5MM 6MM SELF TAP CRCIFRM RECESS TITANIUM BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.808 SUP HCPCS C1713 401.808 - SCREW BONE 2MM 3.5MM 8MM SELF TAP CRCIFRM RECESS TITANIUM BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.81 SUP HCPCS C1713 401.810 - SCREW BONE 2MM 3.5MM 10MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $63.50 $47.00 $12.53 $66.10 $28.41 $28.41 $28.41 $28.41 $63.13 $63.13 $63.13 $13.16 $63.13 $63.13 $63.13 $63.13 $63.13 $13.16 $63.13 $26.44 $37.34 $63.13 $66.10 $63.13 $63.13 $47.63 $63.13 $63.13 $63.13 $31.57 $31.57 $50.00 $63.13 $50.50 $28.41 $12.53 N/A $36.83 $63.13 $37.88 $63.13 $13.16 $63.13 N/A N/A 401.812 SUP HCPCS C1713 401.812 - SCREW BONE 2MM 3.5MM 12MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.814 SUP HCPCS C1713 401.814 - SCREW BONE 2MM 3.5MM 14MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.816 SUP HCPCS C1713 401.816 - SCREW BONE 2MM 3.5MM 16MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 401.818 SUP HCPCS C1713 401.818 - SCREW BONE 2MM 3.5MM 18MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.82 SUP HCPCS C1713 401.820 - SCREW BONE 2MM 3.5MM 22MM SELF TAP CRCIFRM RECESS TITANIUM BOTH IP/OP $63.50 $47.00 $12.53 $66.10 $28.41 $28.41 $28.41 $28.41 $63.13 $63.13 $63.13 $13.16 $63.13 $63.13 $63.13 $63.13 $63.13 $13.16 $63.13 $66.10 $37.34 $63.13 $66.10 $63.13 $63.13 $47.63 $63.13 $63.13 $63.13 $31.57 $31.57 $50.00 $63.13 $50.50 $28.41 $12.53 N/A $36.83 $63.13 $37.88 $63.13 $13.16 $63.13 N/A N/A 401.822 SUP HCPCS C1713 401.822 - SCREW BONE 2MM 3.5MM 22MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.824 SUP HCPCS C1713 401.824 - SCREW BONE 2MM 3.5MM 24MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.826 SUP HCPCS C1713 401.826 - SCREW BONE 2MM 3.5MM 26MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.828 SUP HCPCS C1713 401.828 - SCREW BONE 2MM 3.5MM 28MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.83 SUP HCPCS C1713 401.830 - SCREW BONE 2MM 3.5MM 30MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $63.50 $47.00 $12.53 $66.10 $28.41 $28.41 $28.41 $28.41 $63.13 $63.13 $63.13 $13.16 $63.13 $63.13 $63.13 $63.13 $63.13 $13.16 $63.13 $66.10 $37.34 $63.13 $66.10 $63.13 $63.13 $47.63 $63.13 $63.13 $63.13 $31.57 $31.57 $50.00 $63.13 $50.50 $28.41 $12.53 N/A $36.83 $63.13 $37.88 $63.13 $13.16 $63.13 N/A N/A 401.832 SUP HCPCS C1713 401.832 - SCREW BONE 2MM 3.5MM 32MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.834 SUP HCPCS C1713 401.834 - SCREW BONE 2MM 3.5MM 34MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 401.836 SUP HCPCS C1713 401.836 - SCREW BONE 2MM 3.5MM 36MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.838 SUP HCPCS C1713 401.838 - SCREW BONE 2MM 3.5MM 38MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 401.876 SUP HCPCS C1713 401.876 - SCREW BONE 2MM 6MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $87.49 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 401.877 SUP HCPCS C1713 401.877 - SCREW BONE 2MM 7MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 401.878 SUP HCPCS C1713 401.878 - SCREW BONE 2MM 8MM SLFTAP LOCKING LCP TITANIUM CORTICAL BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 401.879 SUP HCPCS C1713 401.879 - SCREW BONE 2MM 9MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 401.88 SUP HCPCS C1713 401.880 - SCREW BONE 2MM 10MM SELF TAP STARDRIVE LCP TITANIUM SMALL BOTH IP/OP $209.00 $155.00 $41.44 $218.73 $93.96 $93.96 $93.96 $93.96 $208.80 $208.80 $208.80 $43.52 $208.80 $208.80 $208.80 $208.80 $208.80 $43.52 $208.80 $218.73 $123.51 $208.80 $218.73 $208.80 $208.80 $156.75 $208.80 $208.80 $208.80 $104.40 $104.40 $165.37 $208.80 $167.04 $93.96 $41.44 N/A $121.22 $208.80 $208.80 $208.80 $43.51 $208.80 N/A N/A 401.881 SUP HCPCS C1713 401.881 - SCREW BONE 2MM 11MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $87.49 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 401.882 SUP HCPCS C1713 401.882 - SCREW BONE 2MM 12MM SELF TAP STARDRIVE LCP TITANIUM SMALL BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $87.49 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $215.08 $215.08 N/A N/A 401.883 SUP HCPCS C1713 401.883 - SCREW BONE 2MM 13MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $87.49 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 401.884 SUP HCPCS C1713 401.884 - SCREW BONE 2MM 14MM SELF TAP STARDRIVE LCP TITANIUM SMALL BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $215.08 $215.08 N/A N/A 401.886 SUP HCPCS C1713 401.886 - SCREW BONE 2MM 16MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 401.888 SUP HCPCS C1713 401.888 - SCREW BONE 2MM 18MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $87.49 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 401.89 SUP HCPCS C1713 401.890 - SCREW BONE T6 2MM 20MM SELF TAP LOCK LCP TITANIUM CORTICAL BOTH IP/OP $209.00 $155.00 $41.44 $218.73 $93.96 $93.96 $93.96 $93.96 $208.80 $208.80 $208.80 $43.52 $208.80 $208.80 $208.80 $208.80 $208.80 $43.52 $208.80 $87.49 $123.51 $208.80 $218.73 $208.80 $208.80 $156.75 $208.80 $208.80 $208.80 $104.40 $104.40 $165.37 $208.80 $167.04 $93.96 $41.44 N/A $121.22 $208.80 $208.80 $208.80 $208.80 $208.80 N/A N/A 401.892 SUP HCPCS C1713 401.892 - SCREW BONE 2MM 22MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $87.49 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $215.08 $215.08 N/A N/A 401.894 SUP HCPCS C1713 401.894 - SCREW BONE 2MM 24MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $87.49 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $215.08 $215.08 N/A N/A 401.896 SUP HCPCS C1713 401.896 - SCREW BONE 2MM 26MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $87.49 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $215.08 $215.08 N/A N/A 401.898 SUP HCPCS C1713 401.898 - SCREW BONE 2MM 28MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $87.49 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $215.08 $215.08 N/A N/A 401.9 SUP HCPCS C1713 401.900 - SCREW BONE 2MM 30MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP BOTH IP/OP $209.00 $155.00 $41.44 $218.73 $93.96 $93.96 $93.96 $93.96 $208.80 $208.80 $208.80 $43.52 $208.80 $208.80 $208.80 $208.80 $208.80 $43.52 $208.80 $87.49 $123.51 $208.80 $218.73 $208.80 $208.80 $156.75 $208.80 $208.80 $208.80 $104.40 $104.40 $165.37 $208.80 $167.04 $93.96 $41.44 N/A $121.22 $208.80 $208.80 $208.80 $208.80 $208.80 N/A N/A 401.962 SUP Custom 27203010 401.962 - PIN FIX 1.8MM 12MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL BOTH IP/OP $115.00 $85.00 $20.39 $116.50 $114.55 $114.55 $114.55 $114.55 $114.55 $114.55 $20.39 $114.55 $114.55 $85.02 $85.02 $88.30 $59.68 $23.87 $114.55 $46.60 $114.55 $114.55 $116.50 $114.55 $114.55 $86.25 $114.55 $114.55 $114.55 $57.28 $57.28 $90.72 $114.55 $91.64 $74.46 $114.55 N/A $66.70 $114.55 $68.73 $114.55 $114.55 $114.55 N/A N/A 401.964 SUP Custom 27203010 401.964 - PIN FIX 1.8MM 14MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL BOTH IP/OP $115.00 $85.00 $20.39 $116.50 $114.55 $114.55 $114.55 $114.55 $114.55 $114.55 $20.39 $114.55 $114.55 $85.02 $85.02 $88.30 $59.68 $23.87 $114.55 $46.60 $114.55 $114.55 $116.50 $114.55 $114.55 $86.25 $114.55 $114.55 $114.55 $57.28 $57.28 $90.72 $114.55 $91.64 $74.46 $114.55 N/A $66.70 $114.55 $68.73 $114.55 $114.55 $114.55 N/A N/A 401.966 SUP Custom 27203010 401.966 - PIN FIX 1.8MM 16MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL BOTH IP/OP $115.00 $85.00 $20.39 $116.50 $114.55 $114.55 $114.55 $114.55 $114.55 $114.55 $20.39 $114.55 $114.55 $85.02 $85.02 $88.30 $59.68 $23.87 $114.55 $46.60 $114.55 $114.55 $116.50 $114.55 $114.55 $86.25 $114.55 $114.55 $114.55 $57.28 $57.28 $90.72 $114.55 $91.64 $74.46 $114.55 N/A $66.70 $114.55 $68.73 $114.55 $114.55 $114.55 N/A N/A 401.968 SUP Custom 27203010 401.968 - PIN FIX 1.8MM 18MM BUTTRESS TITANIUM NONSTRL BOTH IP/OP $115.00 $85.00 $20.39 $116.50 $114.55 $114.55 $114.55 $114.55 $114.55 $114.55 $20.39 $114.55 $114.55 $85.02 $85.02 $88.30 $59.68 $23.87 $114.55 $46.60 $114.55 $114.55 $116.50 $114.55 $114.55 $86.25 $114.55 $114.55 $114.55 $57.28 $57.28 $90.72 $114.55 $91.64 $74.46 $114.55 N/A $66.70 $114.55 $68.73 $114.55 $114.55 $114.55 N/A N/A 401.97 SUP Custom 27203010 401.970 - PIN FIX 1.8MM 20MM BUTTRESS TITANIUM DISTAL RAD NONSTRL BOTH IP/OP $111.50 $83.00 $19.80 $116.50 $111.23 $111.23 $111.23 $111.23 $111.23 $111.23 $19.80 $111.23 $111.23 $82.55 $82.55 $85.74 $57.95 $23.18 $111.23 $46.60 $111.23 $111.23 $116.50 $111.23 $111.23 $83.63 $111.23 $111.23 $111.23 $55.62 $55.62 $88.09 $111.23 $88.98 $72.30 $111.23 N/A $64.67 $111.23 $66.74 $111.23 $111.23 $111.23 N/A N/A 401.972 SUP Custom 27203010 401.972 - PIN FIX 1.8MM 22MM BUTTRESS TITANIUM DISTAL RAD NONSTRL BOTH IP/OP $115.00 $85.00 $20.39 $116.50 $114.55 $114.55 $114.55 $114.55 $114.55 $114.55 $20.39 $114.55 $114.55 $85.02 $85.02 $88.30 $59.68 $23.87 $114.55 $46.60 $114.55 $114.55 $116.50 $114.55 $114.55 $86.25 $114.55 $114.55 $114.55 $57.28 $57.28 $90.72 $114.55 $91.64 $74.46 $114.55 N/A $66.70 $114.55 $68.73 $114.55 $114.55 $114.55 N/A N/A 401.974 SUP Custom 27203010 401.974 - PIN FIX 1.8MM 24MM BUTTRESS TITANIUM DISTAL RAD NONSTRL BOTH IP/OP $115.00 $85.00 $20.39 $116.50 $114.55 $114.55 $114.55 $114.55 $114.55 $114.55 $20.39 $114.55 $114.55 $85.02 $85.02 $88.30 $59.68 $23.87 $114.55 $46.60 $114.55 $114.55 $116.50 $114.55 $114.55 $86.25 $114.55 $114.55 $114.55 $57.28 $57.28 $90.72 $114.55 $91.64 $74.46 $114.55 N/A $66.70 $114.55 $68.73 $114.55 $114.55 $114.55 N/A N/A 401.976 SUP Custom 27203010 401.976 - PIN FIX 1.8MM 26MM BUTTRESS TITANIUM DISTAL RAD NONSTRL BOTH IP/OP $115.00 $85.00 $20.39 $116.50 $114.55 $114.55 $114.55 $114.55 $114.55 $114.55 $20.39 $114.55 $114.55 $85.02 $85.02 $88.30 $59.68 $23.87 $114.55 $46.60 $114.55 $114.55 $116.50 $114.55 $114.55 $86.25 $114.55 $114.55 $114.55 $57.28 $57.28 $90.72 $114.55 $91.64 $74.46 $114.55 N/A $66.70 $114.55 $68.73 $114.55 $114.55 $114.55 N/A N/A 401.978 SUP Custom 27203010 401.978 - PIN FIX 1.8MM 28MM BUTTRESS TITANIUM DISTAL RAD NONSTRL BOTH IP/OP $115.00 $85.00 $20.39 $116.50 $114.55 $114.55 $114.55 $114.55 $114.55 $114.55 $20.39 $114.55 $114.55 $85.02 $85.02 $88.30 $59.68 $23.87 $114.55 $46.60 $114.55 $114.55 $116.50 $114.55 $114.55 $86.25 $114.55 $114.55 $114.55 $57.28 $57.28 $90.72 $114.55 $91.64 $74.46 $114.55 N/A $66.70 $114.55 $68.73 $114.55 $114.55 $114.55 N/A N/A 401.98 SUP Custom 27203010 401.980 - PIN FIX 1.8MM 30MM BUTTRESS TITANIUM DISTAL RADIAL NONSTRL BOTH IP/OP $111.50 $83.00 $19.80 $116.50 $111.23 $111.23 $111.23 $111.23 $111.23 $111.23 $19.80 $111.23 $111.23 $82.55 $82.55 $85.74 $57.95 $23.18 $111.23 $46.60 $111.23 $111.23 $116.50 $111.23 $111.23 $83.63 $111.23 $111.23 $111.23 $55.62 $55.62 $88.09 $111.23 $88.98 $72.30 $111.23 N/A $64.67 $111.23 $66.74 $111.23 $111.23 $111.23 N/A N/A 402 SUP Custom 27204646 402 - TUNNELER SURG 2 SLEEVE DISPOSABLE BOTH IP/OP "$1,080.00" $799.00 $192.24 "$1,080.00" "$1,080.00" "$1,080.00" "$1,080.00" "$1,080.00" "$1,080.00" "$1,080.00" $192.24 "$1,080.00" "$1,080.00" $801.58 $801.58 $832.46 $562.68 $225.08 "$1,080.00" $432.00 "$1,080.00" "$1,080.00" "$1,080.00" "$1,080.00" "$1,080.00" $810.00 "$1,080.00" "$1,080.00" "$1,080.00" $540.00 $540.00 $855.36 "$1,080.00" $864.00 $702.00 "$1,080.00" N/A $626.40 "$1,080.00" $648.00 "$1,080.00" "$1,080.00" "$1,080.00" N/A N/A 402.006 SUP HCPCS C1713 402.006 - SCREW BONE 2.5MM STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 6MM BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $11.45 $54.93 N/A N/A 402.008 SUP HCPCS C1713 402.008 - SCREW BONE STANDARD 2.7MM 5MM 8MM SMALL HEXAGONAL SOCKET BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $54.93 $54.93 N/A N/A 402.01 SUP HCPCS C1713 402.010 - SCREW BONE STANDARD 4MM 2.7MM 10MM T8 STARDRIVE SLFTAP BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $54.93 $54.93 N/A N/A 402.012 SUP HCPCS C1713 402.012 - SCREW BONE 2.5MM STANDARD 2.7MM 5MM 12MM SPHERICAL HEAD BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $11.45 $54.93 N/A N/A 402.014 SUP HCPCS C1713 402.014 - SCREW BONE 2.5MM STANDARD 2.7MM 5MM 14MM SPHERICAL HEAD BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $54.93 $54.93 N/A N/A 402.016 SUP HCPCS C1713 402.016 - SCREW BONE 2.5MM STANDARD 2.7MM 5MM 16MM SMALL HEXAGONAL BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $54.93 $54.93 N/A N/A 402.018 SUP HCPCS C1713 402.018 - SCREW BONE 2.7MM 18MM TITANIUM CORTICAL NONSTRL MINI BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $54.93 $54.93 $11.45 $54.93 N/A N/A 402.02 SUP HCPCS C1713 402.020 - SCREW BONE 2.5MM STANDARD 2.7MM 5MM 20MM SPHERICAL HEAD BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $54.93 $54.93 $11.45 $54.93 N/A N/A 402.022 SUP HCPCS C1713 402.022 - SCREW BONE 2.5MM STANDARD SMALL HEXAGON SPHERE 2.7MM 5MM 22 BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $54.93 $54.93 $11.45 $54.93 N/A N/A 402.024 SUP HCPCS C1713 402.024 - SCREW BONE 2.5MM STANDARD 2.7MM 5MM 24MM SPHERICAL HEAD BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $54.93 $54.93 $11.45 $54.93 N/A N/A 402.026 SUP HCPCS C1713 402.026 - SCREW BONE 2.7MM 26MM TITANIUM CORTICAL NONSTRL MINI BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $54.93 $54.93 N/A N/A 402.028 SUP HCPCS C1713 402.028 - SCREW BONE STANDARD 2.7MM 5MM 28MM SMALL HEXAGONAL SOCKET BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $54.93 $54.93 $54.93 $54.93 N/A N/A 402.03 SUP HCPCS C1713 402.030 - SCREW BONE STANDARD 2.7MM 5MM 30MM SMALL HEXAGONAL SOCKET BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $54.93 $54.93 $11.45 $54.93 N/A N/A 402.032 SUP HCPCS C1713 402.032 - SCREW BONE STANDARD 2.7MM 5MM 32MM SMALL HEXAGONAL SOCKET BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $54.93 $54.93 $11.45 $54.93 N/A N/A 402.034 SUP HCPCS C1713 402.034 - SCREW BONE 2.7MM 34MM TITANIUM CORTICAL NONSTRL MINI BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $54.93 $54.93 $11.45 $54.93 N/A N/A 402.036 SUP HCPCS C1713 402.036 - SCREW BONE 2.7MM 36MM TITANIUM CORTICAL NONSTRL MINI BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $54.93 $54.93 $11.45 $54.93 N/A N/A 402.038 SUP HCPCS C1713 402.038 - SCREW BONE 2.5MM 38MM TITANIUM CORTICAL NONSTRL MINI BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $11.45 $54.93 N/A N/A 402.04 SUP HCPCS C1713 402.040 - SCREW BONE 2.7MM 40MM TITANIUM CORTICAL NONSTRL MINI BOTH IP/OP $55.00 $41.00 $10.90 $54.93 $24.72 $24.72 $24.72 $24.72 $54.93 $54.93 $54.93 $11.45 $54.93 $54.93 $54.93 $54.93 $54.93 $11.45 $54.93 $21.97 $32.49 $54.93 $54.93 $54.93 $54.93 $41.25 $54.93 $54.93 $54.93 $27.47 $27.47 $43.50 $54.93 $43.94 $24.72 $10.90 N/A $31.90 $54.93 $32.96 $54.93 $11.45 $54.93 N/A N/A 402.208 SUP HCPCS C1713 402.208 - SCREW BONE 2.7MM 8MM SLFTAP T8 STARDRIVE RECESS LOCKING LCP BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 402.21 SUP HCPCS C1713 402.210 - SCREW BONE 2.7MM 10MM T8 STARDRIVE RECESS SLFTAP LOCKING LCP BOTH IP/OP $216.00 $160.00 $42.80 $225.88 $97.03 $97.03 $97.03 $97.03 $215.63 $215.63 $215.63 $44.94 $215.63 $215.63 $215.63 $215.63 $215.63 $44.94 $215.63 $90.35 $127.55 $215.63 $225.88 $215.63 $215.63 $162.00 $215.63 $215.63 $215.63 $107.82 $107.82 $170.78 $215.63 $172.50 $97.03 $42.80 N/A $125.28 $215.63 $129.38 $215.63 $44.94 $215.63 N/A N/A 402.212 SUP HCPCS C1713 402.212 - SCREW BONE 2.7MM 12MM T8 STARDRIVE RECESS SELF TAP LOCK BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 402.214 SUP HCPCS C1713 402.214 - SCREW BONE 2.7MM 14MM T8 STARDRIVE RECESS SELF TAP LOCK LCP BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 402.216 SUP HCPCS C1713 402.216 - SCREW BONE T8 2.7MM 16MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $222.10 $222.10 $46.29 $222.10 N/A N/A 402.218 SUP HCPCS C1713 402.218 - SCREW BONE T8 2.7MM 18MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $222.10 $222.10 $46.29 $222.10 N/A N/A 402.22 SUP HCPCS C1713 402.220 - SCREW BONE T8 2.7MM 20MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $216.00 $160.00 $42.80 $225.88 $97.03 $97.03 $97.03 $97.03 $215.63 $215.63 $215.63 $44.94 $215.63 $215.63 $215.63 $215.63 $215.63 $44.94 $215.63 $90.35 $127.55 $215.63 $225.88 $215.63 $215.63 $162.00 $215.63 $215.63 $215.63 $107.82 $107.82 $170.78 $215.63 $172.50 $97.03 $42.80 N/A $125.28 $215.63 $215.63 $215.63 $44.94 $215.63 N/A N/A 402.222 SUP HCPCS C1713 402.222 - SCREW BONE 2.7MM 22MM T8 STARDRIVE RECESS SELF TAP LOCK LCP BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $222.10 $222.10 $46.29 $222.10 N/A N/A 402.224 SUP HCPCS C1713 402.224 - SCREW BONE 2.7MM 24MM CANN SELF TAP LOCK STARDRIVE RECESS BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 402.226 SUP HCPCS C1713 402.226 - SCREW BONE 2.7MM 26MM CANN SELF TAP LOCK STARDRIVE RECESS BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 402.228 SUP HCPCS C1713 402.228 - SCREW BONE 2.7MM 28MM CANN SELF TAP LOCK STARDRIVE RECESS BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 402.23 SUP HCPCS C1713 402.230 - SCREW BONE 2.7MM 30MM SELF TAP LOCK T8 LCP STARDRIVE BOTH IP/OP $216.00 $160.00 $42.80 $225.88 $97.03 $97.03 $97.03 $97.03 $215.63 $215.63 $215.63 $44.94 $215.63 $215.63 $215.63 $215.63 $215.63 $44.94 $215.63 $225.88 $127.55 $215.63 $225.88 $215.63 $215.63 $162.00 $215.63 $215.63 $215.63 $107.82 $107.82 $170.78 $215.63 $172.50 $97.03 $42.80 N/A $125.28 $215.63 $129.38 $215.63 $44.94 $215.63 N/A N/A 402.232 SUP HCPCS C1713 402.232 - SCREW BONE 2.7MM 32MM CANN SELF TAP LOCK STARDRIVE RECESS BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 402.234 SUP HCPCS C1713 402.234 - SCREW BONE 2.7MM 34MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 402.236 SUP HCPCS C1713 402.236 - SCREW BONE 2.7MM 36MM CANN SELF TAP LOCK STARDRIVE RECESS BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $222.10 $222.10 $46.29 $222.10 N/A N/A 402.238 SUP HCPCS C1713 402.238 - SCREW BONE 2.7MM 38MM SLFTAP LOCKING T8 STARDRIVE RECESS LCP BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 402.24 SUP HCPCS C1713 402.240 - SCREW BONE 2.7MM 40MM SELF TAP LOCK T8 LCP STARDRIVE BOTH IP/OP $216.00 $160.00 $42.80 $225.88 $97.03 $97.03 $97.03 $97.03 $215.63 $215.63 $215.63 $44.94 $215.63 $215.63 $215.63 $215.63 $215.63 $44.94 $215.63 $90.35 $127.55 $215.63 $225.88 $215.63 $215.63 $162.00 $215.63 $215.63 $215.63 $107.82 $107.82 $170.78 $215.63 $172.50 $97.03 $42.80 N/A $125.28 $215.63 $215.63 $215.63 $44.94 $215.63 N/A N/A 402.242 SUP HCPCS C1713 402.242 - SCREW BONE 2.7MM 42MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $222.10 $222.10 $46.29 $222.10 N/A N/A 402.244 SUP HCPCS C1713 402.244 - SCREW BONE 2.7MM 44MM SLFTAP LOCKING T8 STARDRIVE RECESS LCP BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $225.88 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $222.10 $222.10 $46.29 $222.10 N/A N/A 402.246 SUP HCPCS C1713 402.246 - SCREW BONE 2.7MM 46MM SLFTAP LOCKING T8 STARDRIVE RECESS LCP BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $222.10 $222.10 $46.29 $222.10 N/A N/A 402.248 SUP HCPCS C1713 402.248 - SCREW BONE 2.7MM 48MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $222.10 $222.10 $46.29 $222.10 N/A N/A 402.25 SUP HCPCS C1713 402.250 - SCREW BONE 2MM 50MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP BOTH IP/OP $216.00 $160.00 $42.80 $225.88 $97.03 $97.03 $97.03 $97.03 $215.63 $215.63 $215.63 $44.94 $215.63 $215.63 $215.63 $215.63 $215.63 $44.94 $215.63 $90.35 $127.55 $215.63 $225.88 $215.63 $215.63 $162.00 $215.63 $215.63 $215.63 $107.82 $107.82 $170.78 $215.63 $172.50 $97.03 $42.80 N/A $125.28 $215.63 $215.63 $215.63 $44.94 $215.63 N/A N/A 402.255 SUP HCPCS C1713 402.255 - SCREW BONE 2.7MM 55MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $222.50 $165.00 $44.08 $225.88 $99.95 $99.95 $99.95 $99.95 $222.10 $222.10 $222.10 $46.29 $222.10 $222.10 $222.10 $222.10 $222.10 $46.29 $222.10 $90.35 $131.37 $222.10 $225.88 $222.10 $222.10 $166.88 $222.10 $222.10 $222.10 $111.05 $111.05 $175.90 $222.10 $177.68 $99.95 $44.08 N/A $129.05 $222.10 $133.26 $222.10 $46.29 $222.10 N/A N/A 402.26 SUP HCPCS C1713 402.260 - SCREW BONE 2MM 60MM T6 STARDRIVE RECESS SLFTAP LOCKING LCP BOTH IP/OP $216.00 $160.00 $42.80 $225.88 $97.03 $97.03 $97.03 $97.03 $215.63 $215.63 $215.63 $44.94 $215.63 $215.63 $215.63 $215.63 $215.63 $44.94 $215.63 $90.35 $127.55 $215.63 $225.88 $215.63 $215.63 $162.00 $215.63 $215.63 $215.63 $107.82 $107.82 $170.78 $215.63 $172.50 $97.03 $42.80 N/A $125.28 $215.63 $215.63 $215.63 $215.63 $215.63 N/A N/A 402.608 SUP HCPCS C1713 402.608 - SCREW BONE 3MM 4MM 1.2MM 8MM 4MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $372.50 $372.50 N/A N/A 402.609 SUP HCPCS C1713 402.609 - SCREW BONE 3MM 4MM 1.2MM 9MM 4MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.61 SUP HCPCS C1713 402.610 - SCREW BONE 3MM 4MM 1.2MM 10MM 4MM CANN TITANIUM SMALL BONE BOTH IP/OP $362.00 $268.00 $71.78 $378.83 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $151.53 $213.92 $361.65 $378.83 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $361.65 $361.65 $361.65 $361.65 N/A N/A 402.611 SUP HCPCS C1713 402.611 - SCREW BONE 3MM 4MM 1.2MM 11MM 4MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $372.50 $372.50 N/A N/A 402.612 SUP HCPCS C1713 402.612 - SCREW BONE 3MM 4MM 1.2MM 12MM 4MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 402.613 SUP HCPCS C1713 402.613 - SCREW BONE 3MM 4MM 1.2MM 13MM 4MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 402.614 SUP HCPCS C1713 402.614 - SCREW BONE SHORT THREAD 3MM 14MM 4MM CANN SELF DRILL SELF BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.615 SUP HCPCS C1713 402.615 - SCREW BONE 3MM 4MM 1.2MM 15MM 4MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.616 SUP HCPCS C1713 402.616 - SCREW BONE 3MM 4MM 1.2MM 16MM 4MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.617 SUP HCPCS C1713 402.617 - SCREW BONE 3MM 4MM 1.2MM 17MM 4MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.618 SUP HCPCS C1713 402.618 - SCREW BONE 3MM 4MM 1.2MM 18MM 5MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.619 SUP HCPCS C1713 402.619 - SCREW BONE 3MM 4MM 1.2MM 19MM 5MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.62 SUP HCPCS C1713 402.620 - SCREW BONE 3MM 4MM 1.2MM 20MM 5MM CANN TITANIUM SMALL BONE BOTH IP/OP $362.00 $268.00 $71.78 $378.83 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $378.83 $213.92 $361.65 $378.83 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $361.65 $361.65 $75.37 $361.65 N/A N/A 402.621 SUP HCPCS C1713 402.621 - SCREW BONE 3MM 4MM 1.2MM 21MM 5MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.622 SUP HCPCS C1713 402.622 - SCREW BONE 3MM 4MM 1.2MM 22MM 5MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.623 SUP HCPCS C1713 402.623 - SCREW BONE 3MM 4MM 1.2MM 23MM 5MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.624 SUP HCPCS C1713 402.624 - SCREW BONE 3MM 4MM 1.2MM 24MM 6MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 402.625 SUP HCPCS C1713 402.625 - SCREW BONE 3MM 4MM 1.2MM 25MM 6MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 402.626 SUP HCPCS C1713 402.626 - SCREW BONE 3MM 4MM 1.2MM 26MM 6MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.627 SUP HCPCS C1713 402.627 - SCREW BONE 3MM 4MM 1.2MM 27MM 6MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.628 SUP HCPCS C1713 402.628 - SCREW BONE 3MM 4MM 1.2MM 28MM 6MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.629 SUP HCPCS C1713 402.629 - SCREW BONE 3MM 4MM 1.2MM 29MM 6MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.63 SUP HCPCS C1713 402.630 - SCREW BONE 3MM 4MM 1.2MM 30MM 6MM CANN TITANIUM SMALL BONE BOTH IP/OP $362.00 $268.00 $71.78 $378.83 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $378.83 $213.92 $361.65 $378.83 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $361.65 $361.65 $75.37 $361.65 N/A N/A 402.632 SUP HCPCS C1713 402.632 - SCREW BONE 3MM 4MM 1.2MM 32MM 6MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.634 SUP HCPCS C1713 402.634 - SCREW BONE 3MM 4MM 1.2MM 34MM 7MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.636 SUP HCPCS C1713 402.636 - SCREW BONE 3MM 4MM 1.2MM 36MM 7MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.638 SUP HCPCS C1713 402.638 - SCREW BONE 3MM 4MM 1.2MM 38MM 8MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.64 SUP HCPCS C1713 402.640 - SCREW BONE 3MM 4MM 1.2MM 40MM 8MM CANN TITANIUM SMALL BONE BOTH IP/OP $362.00 $268.00 $71.78 $378.83 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $151.53 $213.92 $361.65 $378.83 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $361.65 $361.65 $75.37 $361.65 N/A N/A 402.714 SUP HCPCS C1713 402.714 - SCREW BONE 3MM 4MM 1.2MM 14MM 6MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.715 SUP HCPCS C1713 402.715 - SCREW BONE LNGTHRD 3MM 15MM CANN LOCK STARDRIVE RECESS BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.716 SUP HCPCS C1713 402.716 - SCREW BONE 3MM 4MM 1.2MM 16MM 7MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 402.717 SUP HCPCS C1713 402.717 - SCREW BONE 3MM 4MM 1.2MM 17MM 8MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.718 SUP HCPCS C1713 402.718 - SCREW BONE 3MM 4MM 1.2MM 18MM 8MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $372.50 $372.50 N/A N/A 402.719 SUP HCPCS C1713 402.719 - SCREW BONE 3MM 4MM 1.2MM 19MM 9MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $372.50 $372.50 N/A N/A 402.72 SUP HCPCS C1713 402.720 - SCREW BONE 3MM 4MM 1.2MM 20MM 9MM CANN TITANIUM SMALL BONE BOTH IP/OP $362.00 $268.00 $71.78 $378.83 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $151.53 $213.92 $361.65 $378.83 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $361.65 $361.65 $75.37 $361.65 N/A N/A 402.721 SUP HCPCS C1713 402.721 - SCREW BONE 3MM 4MM 1.2MM 21MM 9MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 402.722 SUP HCPCS C1713 402.722 - SCREW BONE 3MM 4MM 1.2MM 22MM 10MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.723 SUP HCPCS C1713 402.723 - SCREW BONE 3MM 4MM 1.2MM 23MM 10MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.724 SUP HCPCS C1713 402.724 - SCREW BONE 3MM 4MM 1.2MM 24MM 10MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.725 SUP HCPCS C1713 402.725 - SCREW BONE 3MM 4MM 1.2MM 25MM 10MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.726 SUP HCPCS C1713 402.726 - SCREW BONE 3MM 4MM 1.2MM 26MM 12MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.727 SUP HCPCS C1713 402.727 - SCREW BONE 3MM 4MM 1.2MM 27MM 12MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.728 SUP HCPCS C1713 402.728 - SCREW BONE 3MM 4MM 1.2MM 28MM 12MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.729 SUP HCPCS C1713 402.729 - SCREW BONE 3MM 4MM 1.2MM 29MM 12MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.73 SUP HCPCS C1713 402.730 - SCREW BONE 3MM 4MM 1.2MM 30MM 14MM CANN TITANIUM SMALL BONE BOTH IP/OP $362.00 $268.00 $71.78 $378.83 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $378.83 $213.92 $361.65 $378.83 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 402.732 SUP HCPCS C1713 402.732 - SCREW BONE 3MM 4MM 1.2MM 32MM 14MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $378.83 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 402.734 SUP HCPCS C1713 402.734 - SCREW BONE 3MM 4MM 1.2MM 34MM 16MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 402.736 SUP HCPCS C1713 402.736 - SCREW BONE 3MM 4MM 1.2MM 36MM 16MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 402.738 SUP HCPCS C1713 402.738 - SCREW BONE 3MM 4MM 1.2MM 38MM 18MM CANN TITANIUM SMALL BONE BOTH IP/OP $372.50 $276.00 $73.93 $378.83 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $151.53 $220.33 $372.50 $378.83 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $223.50 $372.50 $77.63 $372.50 N/A N/A 402.74 SUP HCPCS C1713 402.740 - SCREW BONE 3MM 4MM 1.2MM 40MM 18MM CANN TITANIUM SMALL BONE BOTH IP/OP $362.00 $268.00 $71.78 $378.83 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $378.83 $213.92 $361.65 $378.83 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 402.806 SUP HCPCS C1713 402.806 - SCREW BONE FULTHD 2.7MM 5MM 6MM SELF TAP SPHERICAL HEAD BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $25.01 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 402.808 SUP HCPCS C1713 402.808 - SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 8MM SELF TAP BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $25.01 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $61.48 $61.48 $61.48 $61.48 N/A N/A 402.81 SUP HCPCS C1713 402.810 - SCREW BONE 2.7MM 5MM 10MM SELF TAP SPHERICAL HEAD SMALL BOTH IP/OP $60.00 $44.00 $11.85 $62.53 $26.87 $26.87 $26.87 $26.87 $59.70 $59.70 $59.70 $12.44 $59.70 $59.70 $59.70 $59.70 $59.70 $12.44 $59.70 $25.01 $35.31 $59.70 $62.53 $59.70 $59.70 $45.00 $59.70 $59.70 $59.70 $29.85 $29.85 $47.28 $59.70 $47.76 $26.87 $11.85 N/A $34.80 $59.70 $59.70 $59.70 $59.70 $59.70 N/A N/A 402.812 SUP HCPCS C1713 402.812 - SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 12MM SELF TAP BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $25.01 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $61.48 $61.48 $12.81 $61.48 N/A N/A 402.814 SUP HCPCS C1713 402.814 - SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 14MM SELF TAP BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $25.01 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $61.48 $61.48 $12.81 $61.48 N/A N/A 402.816 SUP HCPCS C1713 402.816 - SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 16MM SELF TAP BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $61.48 $61.48 N/A N/A 402.818 SUP HCPCS C1713 402.818 - SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 18MM SELF TAP BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $25.01 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $61.48 $61.48 N/A N/A 402.82 SUP HCPCS C1713 402.820 - SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 20MM SELF TAP BOTH IP/OP $60.00 $44.00 $11.85 $62.53 $26.87 $26.87 $26.87 $26.87 $59.70 $59.70 $59.70 $12.44 $59.70 $59.70 $59.70 $59.70 $59.70 $12.44 $59.70 $25.01 $35.31 $59.70 $62.53 $59.70 $59.70 $45.00 $59.70 $59.70 $59.70 $29.85 $29.85 $47.28 $59.70 $47.76 $26.87 $11.85 N/A $34.80 $59.70 $35.82 $59.70 $12.44 $59.70 N/A N/A 402.822 SUP HCPCS C1713 402.822 - SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 22MM SELF TAP BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $25.01 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 402.824 SUP HCPCS C1713 402.824 - SCREW BONE FULTHD 2.7MM 5MM 24MM SELF TAP SPHERICAL HEAD BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $61.48 $61.48 $12.81 $61.48 N/A N/A 402.826 SUP HCPCS C1713 402.826 - SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 26MM SELF TAP BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $25.01 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $61.48 $61.48 $12.81 $61.48 N/A N/A 402.828 SUP HCPCS C1713 402.828 - SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 28MM SELF TAP BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $25.01 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $12.81 $61.48 N/A N/A 402.83 SUP HCPCS C1713 402.830 - SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 30MM SELF TAP BOTH IP/OP $60.00 $44.00 $11.85 $62.53 $26.87 $26.87 $26.87 $26.87 $59.70 $59.70 $59.70 $12.44 $59.70 $59.70 $59.70 $59.70 $59.70 $12.44 $59.70 $25.01 $35.31 $59.70 $62.53 $59.70 $59.70 $45.00 $59.70 $59.70 $59.70 $29.85 $29.85 $47.28 $59.70 $47.76 $26.87 $11.85 N/A $34.80 $59.70 $35.82 $59.70 $12.44 $59.70 N/A N/A 402.832 SUP HCPCS C1713 402.832 - SCREW BONE FULTHD 2.7MM 5MM 32MM SELF TAP HEXAGONAL SOCKET BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $25.01 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $61.48 $61.48 N/A N/A 402.834 SUP HCPCS C1713 402.834 - SCREW BONE FULTHD 2.7MM 5MM 34MM SELF TAP SPHERICAL HEAD BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $25.01 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $61.48 $61.48 N/A N/A 402.836 SUP HCPCS C1713 402.836 - SCREW BONE FULTHD 2.7MM 5MM 36MM SELF TAP SPHERICAL HEAD BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $61.48 $61.48 N/A N/A 402.838 SUP HCPCS C1713 402.838 - SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 38MM SELF TAP BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $62.53 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $36.89 $61.48 $61.48 $61.48 N/A N/A 402.84 SUP HCPCS C1713 402.840 - SCREW BONE 2.7MM 40MM SLFTAP LCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $60.00 $44.00 $11.85 $62.53 $26.87 $26.87 $26.87 $26.87 $59.70 $59.70 $59.70 $12.44 $59.70 $59.70 $59.70 $59.70 $59.70 $12.44 $59.70 $25.01 $35.31 $59.70 $62.53 $59.70 $59.70 $45.00 $59.70 $59.70 $59.70 $29.85 $29.85 $47.28 $59.70 $47.76 $26.87 $11.85 N/A $34.80 $59.70 $35.82 $59.70 $59.70 $59.70 N/A N/A 402.845 SUP HCPCS C1713 402.845 - SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 45MM SELF TAP BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $25.01 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $61.48 $61.48 $12.81 $61.48 N/A N/A 402.85 SUP HCPCS C1713 402.850 - SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 50MM SELF TAP BOTH IP/OP $60.00 $44.00 $11.85 $62.53 $26.87 $26.87 $26.87 $26.87 $59.70 $59.70 $59.70 $12.44 $59.70 $59.70 $59.70 $59.70 $59.70 $12.44 $59.70 $25.01 $35.31 $59.70 $62.53 $59.70 $59.70 $45.00 $59.70 $59.70 $59.70 $29.85 $29.85 $47.28 $59.70 $47.76 $26.87 $11.85 N/A $34.80 $59.70 $59.70 $59.70 $12.44 $59.70 N/A N/A 402.855 SUP HCPCS C1713 402.855 - SCREW BONE FULTHD HEXAGON SPHERE 2.7MM 5MM 55MM SELF TAP BOTH IP/OP $61.50 $46.00 $12.20 $62.53 $27.67 $27.67 $27.67 $27.67 $61.48 $61.48 $61.48 $12.81 $61.48 $61.48 $61.48 $61.48 $61.48 $12.81 $61.48 $25.01 $36.37 $61.48 $62.53 $61.48 $61.48 $46.13 $61.48 $61.48 $61.48 $30.74 $30.74 $48.69 $61.48 $49.18 $27.67 $12.20 N/A $35.67 $61.48 $61.48 $61.48 $12.81 $61.48 N/A N/A 402.87 SUP HCPCS C1713 402.870 - SCREW BONE T8 2.7MM 10MM SELF TAP STARDRIVE LCP TITANIUM RAD BOTH IP/OP $69.00 $51.00 $13.67 $72.18 $31.01 $31.01 $31.01 $31.01 $68.90 $68.90 $68.90 $14.36 $68.90 $68.90 $68.90 $68.90 $68.90 $14.36 $68.90 $28.87 $40.75 $68.90 $72.18 $68.90 $68.90 $51.75 $68.90 $68.90 $68.90 $34.45 $34.45 $54.57 $68.90 $55.12 $31.01 $13.67 N/A $40.02 $68.90 $41.34 $68.90 $14.36 $68.90 N/A N/A 402.872 SUP HCPCS C1713 402.872 - SCREW BONE T8 2.7MM 12MM SELF TAP STARDRIVE LCP TITANIUM RAD BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $42.59 $70.98 $14.79 $70.98 N/A N/A 402.874 SUP HCPCS C1713 402.874 - SCREW BONE T8 2.7MM 14MM SELF TAP STARDRIVE LCP TITANIUM RAD BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $72.18 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $42.59 $70.98 $14.79 $70.98 N/A N/A 402.876 SUP HCPCS C1713 402.876 - SCREW BONE T8 2.7MM 16MM SELF TAP STARDRIVE LCP TITANIUM RAD BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $70.98 $70.98 $70.98 $70.98 N/A N/A 402.878 SUP HCPCS C1713 402.878 - SCREW BONE T8 2.7MM 18MM SELF TAP STARDRIVE LCP TITANIUM RAD BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $42.59 $70.98 $70.98 $70.98 N/A N/A 402.88 SUP HCPCS C1713 402.880 - SCREW BONE T8 2.7MM 20MM SELF TAP STARDRIVE LCP TITANIUM RAD BOTH IP/OP $69.00 $51.00 $13.67 $72.18 $31.01 $31.01 $31.01 $31.01 $68.90 $68.90 $68.90 $14.36 $68.90 $68.90 $68.90 $68.90 $68.90 $14.36 $68.90 $72.18 $40.75 $68.90 $72.18 $68.90 $68.90 $51.75 $68.90 $68.90 $68.90 $34.45 $34.45 $54.57 $68.90 $55.12 $31.01 $13.67 N/A $40.02 $68.90 $41.34 $68.90 $14.36 $68.90 N/A N/A 402.882 SUP HCPCS C1713 402.882 - SCREW BONE 2.7MM 22MM T8 STARDRIVE RECESS SLFTAP LCP BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $72.18 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $42.59 $70.98 $14.79 $70.98 N/A N/A 402.884 SUP HCPCS C1713 402.884 - SCREW BONE 2.7MM 24MM T8 STARDRIVE RECESS SLFTAP LCP BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $42.59 $70.98 $14.79 $70.98 N/A N/A 402.886 SUP HCPCS C1713 402.886 - SCREW BONE 2.7MM 26MM T8 STARDRIVE RECESS SLFTAP LCP BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $42.59 $70.98 $14.79 $70.98 N/A N/A 402.888 SUP HCPCS C1713 402.888 - SCREW BONE 2.7MM 28MM T8 STARDRIVE RECESS SLFTAP LCP BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $70.98 $70.98 $14.79 $70.98 N/A N/A 402.89 SUP HCPCS C1713 402.890 - SCREW BONE 2.7MM 30MM T8 STARDRIVE SELF TAP LCP TITANIUM RAD BOTH IP/OP $69.00 $51.00 $13.67 $72.18 $31.01 $31.01 $31.01 $31.01 $68.90 $68.90 $68.90 $14.36 $68.90 $68.90 $68.90 $68.90 $68.90 $14.36 $68.90 $28.87 $40.75 $68.90 $72.18 $68.90 $68.90 $51.75 $68.90 $68.90 $68.90 $34.45 $34.45 $54.57 $68.90 $55.12 $31.01 $13.67 N/A $40.02 $68.90 $41.34 $68.90 $14.36 $68.90 N/A N/A 402.892 SUP HCPCS C1713 402.892 - SCREW BONE 2.7MM 32MM SLFTAP LCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $42.59 $70.98 $14.79 $70.98 N/A N/A 402.894 SUP HCPCS C1713 402.894 - SCREW BONE 2.7MM 34MM SLFTAP LCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $70.98 $70.98 $70.98 $70.98 N/A N/A 402.896 SUP HCPCS C1713 402.896 - SCREW BONE 2.7MM 36MM SLFTAP LCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $70.98 $70.98 $70.98 $70.98 N/A N/A 402.898 SUP HCPCS C1713 402.898 - SCREW BONE 2.7MM 38MM SLFTAP LCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $42.59 $70.98 $14.79 $70.98 N/A N/A 402.9 SUP HCPCS C1713 402.900 - SCREW BONE 2.7MM 5MM 40MM SLFTAP T8 STARDRIVE RECESS LCP BOTH IP/OP $69.00 $51.00 $13.67 $72.18 $31.01 $31.01 $31.01 $31.01 $68.90 $68.90 $68.90 $14.36 $68.90 $68.90 $68.90 $68.90 $68.90 $14.36 $68.90 $28.87 $40.75 $68.90 $72.18 $68.90 $68.90 $51.75 $68.90 $68.90 $68.90 $34.45 $34.45 $54.57 $68.90 $55.12 $31.01 $13.67 N/A $40.02 $68.90 $41.34 $68.90 $14.36 $68.90 N/A N/A 402.962 SUP HCPCS C1713 402.962 - SCREW BONE 2.7MM 42MM SLFTAP LCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $42.59 $70.98 $14.79 $70.98 N/A N/A 402.963 SUP HCPCS C1713 402.963 - SCREW BONE 2.7MM 44MM SLFTAP LCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $70.98 $70.98 $70.98 $70.98 N/A N/A 402.965 SUP HCPCS C1713 402.965 - SCREW BONE T8 2.7MM 46MM SELF TAP STARDRIVE LCP TITANIUM RAD BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $72.18 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $70.98 $70.98 $14.79 $70.98 N/A N/A 402.966 SUP HCPCS C1713 402.966 - SCREW BONE T8 2.7MM 48MM SELF TAP STARDRIVE LCP TITANIUM RAD BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $28.87 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $42.59 $70.98 $14.79 $70.98 N/A N/A 402.967 SUP HCPCS C1713 402.967 - SCREW BONE 2.7MM 50MM SLFTAP LCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $72.18 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $42.59 $70.98 $14.79 $70.98 N/A N/A 402.968 SUP HCPCS C1713 402.968 - SCREW BONE 2.7MM 55MM SLFTAP LCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $72.18 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $42.59 $70.98 $14.79 $70.98 N/A N/A 402.969 SUP HCPCS C1713 402.969 - SCREW BONE 2.7MM 60MM SLFTAP LCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $72.18 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $70.98 $70.98 $14.79 $70.98 N/A N/A 404.01 SUP HCPCS C1713 404.010 - SCREW BONE STANDARD 3.5MM 6MM 10MM SMALL HEXAGONAL SOCKET BOTH IP/OP $27.00 $20.00 $5.33 $26.83 $12.07 $12.07 $12.07 $12.07 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $15.87 $26.83 $26.83 $26.83 $26.83 $20.25 $26.83 $26.83 $26.83 $13.42 $13.42 $21.25 $26.83 $21.46 $12.07 $5.33 N/A $15.66 $26.83 $26.83 $26.83 $5.59 $26.83 N/A N/A 404.012 SUP HCPCS C1713 404.012 - SCREW BONE STANDARD HEXAGON 3.5MM 6MM 12MM SELF TAP SOCKET BOTH IP/OP $27.00 $20.00 $5.33 $26.83 $12.07 $12.07 $12.07 $12.07 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $15.87 $26.83 $26.83 $26.83 $26.83 $20.25 $26.83 $26.83 $26.83 $13.42 $13.42 $21.25 $26.83 $21.46 $12.07 $5.33 N/A $15.66 $26.83 $26.83 $26.83 $5.59 $26.83 N/A N/A 404.014 SUP HCPCS C1713 404.014 - SCREW BONE STANDARD HEXAGON 3.5MM 6MM 14MM SELF TAP SOCKET BOTH IP/OP $27.00 $20.00 $5.33 $26.83 $12.07 $12.07 $12.07 $12.07 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $15.87 $26.83 $26.83 $26.83 $26.83 $20.25 $26.83 $26.83 $26.83 $13.42 $13.42 $21.25 $26.83 $21.46 $12.07 $5.33 N/A $15.66 $26.83 $26.83 $26.83 $5.59 $26.83 N/A N/A 404.016 SUP HCPCS C1713 404.016 - SCREW BONE STANDARD HEXAGON 3.5MM 6MM 16MM SELF TAP SOCKET BOTH IP/OP $27.00 $20.00 $5.33 $26.83 $12.07 $12.07 $12.07 $12.07 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $15.87 $26.83 $26.83 $26.83 $26.83 $20.25 $26.83 $26.83 $26.83 $13.42 $13.42 $21.25 $26.83 $21.46 $12.07 $5.33 N/A $15.66 $26.83 $16.10 $26.83 $5.59 $26.83 N/A N/A 404.018 SUP HCPCS C1713 404.018 - SCREW BONE STANDARD HEXAGON 3.5MM 6MM 18MM SELF TAP SOCKET BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $12.43 $12.43 $12.43 $12.43 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $12.43 $5.48 N/A $16.24 $27.63 $16.58 $27.63 $5.76 $27.63 N/A N/A 404.02 SUP HCPCS C1713 404.020 - SCREW BONE STANDARD HEXAGON 3.5MM 6MM 20MM SELF TAP SOCKET BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $12.43 $12.43 $12.43 $12.43 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $12.43 $5.48 N/A $16.24 $27.63 $16.58 $27.63 $27.63 $27.63 N/A N/A 404.022 SUP HCPCS C1713 404.022 - SCREW BONE STANDARD HEXAGON 3.5MM 6MM 22MM SELF TAP SOCKET BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $12.43 $12.43 $12.43 $12.43 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $12.43 $5.48 N/A $16.24 $27.63 $27.63 $27.63 $5.76 $27.63 N/A N/A 404.024 SUP HCPCS C1713 404.024 - SCREW BONE STANDARD HEXAGON 3.5MM 6MM 24MM SELF TAP SOCKET BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $12.43 $12.43 $12.43 $12.43 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $27.63 $27.63 $27.63 $5.76 $27.63 $11.05 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $12.43 $5.48 N/A $16.24 $27.63 $27.63 $27.63 $27.63 $27.63 N/A N/A 404.026 SUP HCPCS C1713 404.026 - SCREW BONE STANDARD HEXAGON 3.5MM 6MM 26MM SELF TAP SOCKET BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $12.43 $12.43 $12.43 $12.43 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $27.63 $27.63 $27.63 $5.76 $27.63 $11.05 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $12.43 $5.48 N/A $16.24 $27.63 $16.58 $27.63 $5.76 $27.63 N/A N/A 404.028 SUP HCPCS C1713 404.028 - SCREW BONE STANDARD HEXAGON 3.5MM 6MM 28MM SELF TAP SOCKET BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $12.43 $12.43 $12.43 $12.43 $27.63 $27.63 $27.63 $5.76 $27.63 $27.63 $27.63 $27.63 $27.63 $5.76 $27.63 $11.05 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $12.43 $5.48 N/A $16.24 $27.63 $16.58 $27.63 $5.76 $27.63 N/A N/A 404.03 SUP HCPCS C1713 404.030 - SCREW BONE STANDARD SMALL HEXAGON 3.5MM 6MM 30MM SOCKET BOTH IP/OP $27.00 $20.00 $5.33 $26.83 $12.07 $12.07 $12.07 $12.07 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $15.87 $26.83 $26.83 $26.83 $26.83 $20.25 $26.83 $26.83 $26.83 $13.42 $13.42 $21.25 $26.83 $21.46 $12.07 $5.33 N/A $15.66 $26.83 $16.10 $26.83 $26.83 $26.83 N/A N/A 404.032 SUP HCPCS C1713 404.032 - SCREW BONE STANDARD HEXAGON 3.5MM 6MM 32MM SELF TAP SOCKET BOTH IP/OP $27.00 $20.00 $5.33 $26.83 $12.07 $12.07 $12.07 $12.07 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $15.87 $26.83 $26.83 $26.83 $26.83 $20.25 $26.83 $26.83 $26.83 $13.42 $13.42 $21.25 $26.83 $21.46 $12.07 $5.33 N/A $15.66 $26.83 $26.83 $26.83 $5.59 $26.83 N/A N/A 404.034 SUP HCPCS C1713 404.034 - SCREW BONE STANDARD HEXAGON 3.5MM 6MM 34MM SELF TAP SOCKET BOTH IP/OP $27.00 $20.00 $5.33 $26.83 $12.07 $12.07 $12.07 $12.07 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $26.83 $26.83 $26.83 $5.59 $26.83 $10.73 $15.87 $26.83 $26.83 $26.83 $26.83 $20.25 $26.83 $26.83 $26.83 $13.42 $13.42 $21.25 $26.83 $21.46 $12.07 $5.33 N/A $15.66 $26.83 $26.83 $26.83 $26.83 $26.83 N/A N/A 404.036 SUP HCPCS C1713 404.036 - SCREW BONE STANDARD HEXAGON 3.5MM 6MM 36MM SELF TAP SOCKET BOTH IP/OP $27.00 $20.00 $5.33 $26.83 $12.07 $12.07 $12.07 $12.07 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $26.83 $26.83 $26.83 $5.59 $26.83 $10.73 $15.87 $26.83 $26.83 $26.83 $26.83 $20.25 $26.83 $26.83 $26.83 $13.42 $13.42 $21.25 $26.83 $21.46 $12.07 $5.33 N/A $15.66 $26.83 $26.83 $26.83 $5.59 $26.83 N/A N/A 404.038 SUP HCPCS C1713 404.038 - SCREW BONE STANDARD 3.5MM 6MM 38MM SMALL HEXAGONAL SOCKET BOTH IP/OP $27.00 $20.00 $5.33 $26.83 $12.07 $12.07 $12.07 $12.07 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $26.83 $26.83 $26.83 $5.59 $26.83 $10.73 $15.87 $26.83 $26.83 $26.83 $26.83 $20.25 $26.83 $26.83 $26.83 $13.42 $13.42 $21.25 $26.83 $21.46 $12.07 $5.33 N/A $15.66 $26.83 $26.83 $26.83 $5.59 $26.83 N/A N/A 404.04 SUP HCPCS C1713 404.040 - SCREW BONE STANDARD 3.5MM 6MM 40MM SMALL HEXAGONAL SOCKET BOTH IP/OP $27.00 $20.00 $5.33 $26.83 $12.07 $12.07 $12.07 $12.07 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $15.87 $26.83 $26.83 $26.83 $26.83 $20.25 $26.83 $26.83 $26.83 $13.42 $13.42 $21.25 $26.83 $21.46 $12.07 $5.33 N/A $15.66 $26.83 $26.83 $26.83 $5.59 $26.83 N/A N/A 404.045 SUP HCPCS C1713 404.045 - SCREW BONE STANDARD HEXAGON 3.5MM 6MM 45MM SELF TAP SOCKET BOTH IP/OP $27.00 $20.00 $5.33 $26.83 $12.07 $12.07 $12.07 $12.07 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $26.83 $26.83 $26.83 $5.59 $26.83 $10.73 $15.87 $26.83 $26.83 $26.83 $26.83 $20.25 $26.83 $26.83 $26.83 $13.42 $13.42 $21.25 $26.83 $21.46 $12.07 $5.33 N/A $15.66 $26.83 $26.83 $26.83 $5.59 $26.83 N/A N/A 404.05 SUP HCPCS C1713 404.050 - SCREW BONE STANDARD 3.5MM 6MM 50MM SMALL HEXAGONAL SOCKET BOTH IP/OP $27.00 $20.00 $5.33 $26.83 $12.07 $12.07 $12.07 $12.07 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $26.83 $26.83 $26.83 $5.59 $26.83 $10.73 $15.87 $26.83 $26.83 $26.83 $26.83 $20.25 $26.83 $26.83 $26.83 $13.42 $13.42 $21.25 $26.83 $21.46 $12.07 $5.33 N/A $15.66 $26.83 $16.10 $26.83 $26.83 $26.83 N/A N/A 404.055 SUP HCPCS C1713 404.055 - SCREW BONE 2.5MM STANDARD 3.5MM 6MM 55MM SMALL HEXAGONAL BOTH IP/OP $27.00 $20.00 $5.33 $26.83 $12.07 $12.07 $12.07 $12.07 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $26.83 $26.83 $26.83 $5.59 $26.83 $10.73 $15.87 $26.83 $26.83 $26.83 $26.83 $20.25 $26.83 $26.83 $26.83 $13.42 $13.42 $21.25 $26.83 $21.46 $12.07 $5.33 N/A $15.66 $26.83 $16.10 $26.83 $5.59 $26.83 N/A N/A 404.06 SUP HCPCS C1713 404.060 - SCREW BONE 2.5MM STANDARD 3.5MM 6MM 60MM SMALL HEXAGONAL BOTH IP/OP $27.00 $20.00 $5.33 $26.83 $12.07 $12.07 $12.07 $12.07 $26.83 $26.83 $26.83 $5.59 $26.83 $26.83 $26.83 $26.83 $26.83 $5.59 $26.83 $10.73 $15.87 $26.83 $26.83 $26.83 $26.83 $20.25 $26.83 $26.83 $26.83 $13.42 $13.42 $21.25 $26.83 $21.46 $12.07 $5.33 N/A $15.66 $26.83 $16.10 $26.83 $5.59 $26.83 N/A N/A 404.216 SUP HCPCS C1713 404.216 - SCREW BONE HEXAGON SPHERE 3.5MM 16MM SELF TAP SOCKET LC-DCP BOTH IP/OP $34.00 $25.00 $6.69 $34.30 $15.18 $15.18 $15.18 $15.18 $33.73 $33.73 $33.73 $7.03 $33.73 $33.73 $33.73 $33.73 $33.73 $7.03 $33.73 $13.72 $19.95 $33.73 $34.30 $33.73 $33.73 $25.50 $33.73 $33.73 $33.73 $16.87 $16.87 $26.71 $33.73 $26.98 $15.18 $6.69 N/A $19.72 $33.73 $20.24 $33.73 $33.73 $33.73 N/A N/A 404.218 SUP HCPCS C1713 404.218 - SCREW BONE HEXAGON SPHERE 3.5MM 18MM SELF TAP SOCKET LC-DCP BOTH IP/OP $34.00 $25.00 $6.69 $34.30 $15.18 $15.18 $15.18 $15.18 $33.73 $33.73 $33.73 $7.03 $33.73 $33.73 $33.73 $33.73 $33.73 $7.03 $33.73 $13.72 $19.95 $33.73 $34.30 $33.73 $33.73 $25.50 $33.73 $33.73 $33.73 $16.87 $16.87 $26.71 $33.73 $26.98 $15.18 $6.69 N/A $19.72 $33.73 $33.73 $33.73 $7.03 $33.73 N/A N/A 404.22 SUP HCPCS C1713 404.220 - SCREW BONE HEXAGON SPHERE 3.5MM 20MM SELF TAP SOCKET LC-DCP BOTH IP/OP $33.00 $24.00 $6.50 $32.75 $14.74 $14.74 $14.74 $14.74 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $19.37 $32.75 $32.75 $32.75 $32.75 $24.75 $32.75 $32.75 $32.75 $16.38 $16.38 $25.94 $32.75 $26.20 $14.74 $6.50 N/A $19.14 $32.75 $32.75 $32.75 $6.83 $32.75 N/A N/A 404.222 SUP HCPCS C1713 404.222 - SCREW BONE HEXAGON SPHERE 3.5MM 22MM SELF TAP SOCKET LC-DCP BOTH IP/OP $33.00 $24.00 $6.50 $32.75 $14.74 $14.74 $14.74 $14.74 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $19.37 $32.75 $32.75 $32.75 $32.75 $24.75 $32.75 $32.75 $32.75 $16.38 $16.38 $25.94 $32.75 $26.20 $14.74 $6.50 N/A $19.14 $32.75 $32.75 $32.75 $32.75 $32.75 N/A N/A 404.224 SUP HCPCS C1713 404.224 - SCREW BONE HEXAGON SPHERE 3.5MM 24MM SELF TAP SOCKET LC-DCP BOTH IP/OP $33.00 $24.00 $6.50 $32.75 $14.74 $14.74 $14.74 $14.74 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $32.75 $32.75 $32.75 $6.83 $32.75 $13.10 $19.37 $32.75 $32.75 $32.75 $32.75 $24.75 $32.75 $32.75 $32.75 $16.38 $16.38 $25.94 $32.75 $26.20 $14.74 $6.50 N/A $19.14 $32.75 $19.65 $32.75 $6.83 $32.75 N/A N/A 404.226 SUP HCPCS C1713 404.226 - SCREW BONE HEXAGON SPHERE 3.5MM 26MM SELF TAP SOCKET LC-DCP BOTH IP/OP $33.00 $24.00 $6.50 $32.75 $14.74 $14.74 $14.74 $14.74 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $32.75 $32.75 $32.75 $6.83 $32.75 $13.10 $19.37 $32.75 $32.75 $32.75 $32.75 $24.75 $32.75 $32.75 $32.75 $16.38 $16.38 $25.94 $32.75 $26.20 $14.74 $6.50 N/A $19.14 $32.75 $19.65 $32.75 $6.83 $32.75 N/A N/A 404.228 SUP HCPCS C1713 404.228 - SCREW BONE HEXAGON SPHERE 3.5MM 28MM SELF TAP SOCKET LC-DCP BOTH IP/OP $34.00 $25.00 $6.69 $34.30 $15.18 $15.18 $15.18 $15.18 $33.73 $33.73 $33.73 $7.03 $33.73 $33.73 $33.73 $33.73 $33.73 $7.03 $33.73 $34.30 $19.95 $33.73 $34.30 $33.73 $33.73 $25.50 $33.73 $33.73 $33.73 $16.87 $16.87 $26.71 $33.73 $26.98 $15.18 $6.69 N/A $19.72 $33.73 $20.24 $33.73 $33.73 $33.73 N/A N/A 404.23 SUP HCPCS C1713 404.230 - SCREW BONE PTHRD 3.5MM 6MM 30MM 10MM SMALL HEXAGONAL SOCKET BOTH IP/OP $33.00 $24.00 $6.50 $34.30 $14.74 $14.74 $14.74 $14.74 $32.75 $32.75 $32.75 $6.83 $32.75 $32.75 $32.75 $32.75 $32.75 $6.83 $32.75 $13.72 $19.37 $32.75 $34.30 $32.75 $32.75 $24.75 $32.75 $32.75 $32.75 $16.38 $16.38 $25.94 $32.75 $26.20 $14.74 $6.50 N/A $19.14 $32.75 $19.65 $32.75 $6.83 $32.75 N/A N/A 404.232 SUP HCPCS C1713 404.232 - SCREW BONE HEXAGON SPHERE 3.5MM 32MM SELF TAP SOCKET LC-DCP BOTH IP/OP $34.00 $25.00 $6.69 $34.30 $15.18 $15.18 $15.18 $15.18 $33.73 $33.73 $33.73 $7.03 $33.73 $33.73 $33.73 $33.73 $33.73 $7.03 $33.73 $13.72 $19.95 $33.73 $34.30 $33.73 $33.73 $25.50 $33.73 $33.73 $33.73 $16.87 $16.87 $26.71 $33.73 $26.98 $15.18 $6.69 N/A $19.72 $33.73 $33.73 $33.73 $7.03 $33.73 N/A N/A 404.234 SUP HCPCS C1713 404.234 - SCREW BONE HEXAGON SPHERE 3.5MM 34MM SELF TAP SOCKET LC-DCP BOTH IP/OP $32.00 $24.00 $6.31 $31.80 $14.31 $14.31 $14.31 $14.31 $31.80 $31.80 $31.80 $6.63 $31.80 $31.80 $31.80 $31.80 $31.80 $6.63 $31.80 $31.80 $18.81 $31.80 $31.80 $31.80 $31.80 $24.00 $31.80 $31.80 $31.80 $15.90 $15.90 $25.19 $31.80 $25.44 $14.31 $6.31 N/A $18.56 $31.80 $19.08 $31.80 $31.80 $31.80 N/A N/A 404.236 SUP HCPCS C1713 404.236 - SCREW BONE HEXAGON SPHERE 3.5MM 36MM SELF TAP SOCKET LC-DCP BOTH IP/OP $32.00 $24.00 $6.31 $31.80 $14.31 $14.31 $14.31 $14.31 $31.80 $31.80 $31.80 $6.63 $31.80 $31.80 $31.80 $31.80 $31.80 $6.63 $31.80 $12.72 $18.81 $31.80 $31.80 $31.80 $31.80 $24.00 $31.80 $31.80 $31.80 $15.90 $15.90 $25.19 $31.80 $25.44 $14.31 $6.31 N/A $18.56 $31.80 $19.08 $31.80 $6.63 $31.80 N/A N/A 404.238 SUP HCPCS C1713 404.238 - SCREW BONE HEXAGON SPHERE 3.5MM 38MM SELF TAP SOCKET LC-DCP BOTH IP/OP $32.00 $24.00 $6.31 $31.80 $14.31 $14.31 $14.31 $14.31 $31.80 $31.80 $31.80 $6.63 $31.80 $31.80 $31.80 $31.80 $31.80 $6.63 $31.80 $12.72 $18.81 $31.80 $31.80 $31.80 $31.80 $24.00 $31.80 $31.80 $31.80 $15.90 $15.90 $25.19 $31.80 $25.44 $14.31 $6.31 N/A $18.56 $31.80 $19.08 $31.80 $31.80 $31.80 N/A N/A 404.24 SUP HCPCS C1713 404.240 - SCREW BONE HEXAGON SPHERE 3.5MM 40MM SELF TAP SOCKET LC-DCP BOTH IP/OP $32.00 $24.00 $6.31 $31.80 $14.31 $14.31 $14.31 $14.31 $31.80 $31.80 $31.80 $6.63 $31.80 $31.80 $31.80 $31.80 $31.80 $6.63 $31.80 $12.72 $18.81 $31.80 $31.80 $31.80 $31.80 $24.00 $31.80 $31.80 $31.80 $15.90 $15.90 $25.19 $31.80 $25.44 $14.31 $6.31 N/A $18.56 $31.80 $31.80 $31.80 $6.63 $31.80 N/A N/A 404.245 SUP HCPCS C1713 404.245 - SCREW BONE HEXAGON SPHERE 3.5MM 45MM SELF TAP SOCKET LC-DCP BOTH IP/OP $32.00 $24.00 $6.31 $31.80 $14.31 $14.31 $14.31 $14.31 $31.80 $31.80 $31.80 $6.63 $31.80 $31.80 $31.80 $31.80 $31.80 $6.63 $31.80 $31.80 $18.81 $31.80 $31.80 $31.80 $31.80 $24.00 $31.80 $31.80 $31.80 $15.90 $15.90 $25.19 $31.80 $25.44 $14.31 $6.31 N/A $18.56 $31.80 $19.08 $31.80 $6.63 $31.80 N/A N/A 404.25 SUP HCPCS C1713 404.250 - SCREW BONE HEXAGON SPHERE 3.5MM 50MM SELF TAP SOCKET LC-DCP BOTH IP/OP $32.00 $24.00 $6.31 $31.80 $14.31 $14.31 $14.31 $14.31 $31.80 $31.80 $31.80 $6.63 $31.80 $31.80 $31.80 $31.80 $31.80 $6.63 $31.80 $31.80 $18.81 $31.80 $31.80 $31.80 $31.80 $24.00 $31.80 $31.80 $31.80 $15.90 $15.90 $25.19 $31.80 $25.44 $14.31 $6.31 N/A $18.56 $31.80 $19.08 $31.80 $31.80 $31.80 N/A N/A 404.81 SUP HCPCS C1713 404.810 - SCREW BONE FULTHD 3.5MM 6MM 10MM SLFTAP HEXAGONAL RECESS LCP BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $16.15 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $38.55 $38.55 $8.03 $38.55 N/A N/A 404.812 SUP HCPCS C1713 404.812 - SCREW BONE FULTHD 3.5MM 6MM 12MM SELF TAP HEXAGONAL RECESS BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $16.15 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $39.70 $39.70 N/A N/A 404.814 SUP HCPCS C1713 404.814 - SCREW BONE FULTHD 3.5MM 6MM 14MM SELF TAP HEXAGONAL RECESS BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $16.15 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $39.70 $39.70 N/A N/A 404.816 SUP HCPCS C1713 404.816 - SCREW BONE FULTHD 3.5MM 6MM 16MM SELF TAP HEXAGONAL RECESS BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $39.70 $39.70 N/A N/A 404.818 SUP HCPCS C1713 404.818 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 18MM SELF TAP SOCKET LCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $16.15 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 404.82 SUP HCPCS C1713 404.820 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 20MM SELF TAP SOCKET LCP BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $16.15 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $23.13 $38.55 $38.55 $38.55 N/A N/A 404.822 SUP HCPCS C1713 404.822 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 22MM SELF TAP SOCKET LCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $16.15 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $39.70 $39.70 N/A N/A 404.824 SUP HCPCS C1713 404.824 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 24MM SELF TAP SOCKET LCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $39.70 $39.70 N/A N/A 404.826 SUP HCPCS C1713 404.826 - SCREW BONE FULTHD 3.5MM 6MM 26MM SELF TAP HEXAGONAL RECESS BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $16.15 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $8.27 $39.70 N/A N/A 404.828 SUP HCPCS C1713 404.828 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 28MM SELF TAP SOCKET LCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $16.15 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $8.27 $39.70 N/A N/A 404.83 SUP HCPCS C1713 404.830 - SCREW BONE FULTHD 3.5MM 6MM 30MM SLFTAP HEXAGONAL RECESS LCP BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $40.38 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $23.13 $38.55 $8.03 $38.55 N/A N/A 404.832 SUP HCPCS C1713 404.832 - SCREW BONE FULTHD 3.5MM 6MM 32MM SELF TAP HEXAGONAL RECESS BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $39.70 $39.70 N/A N/A 404.834 SUP HCPCS C1713 404.834 - SCREW BONE FULTHD 3.5MM 6MM 34MM SELF TAP HEXAGONAL RECESS BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $16.15 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $39.70 $39.70 N/A N/A 404.836 SUP HCPCS C1713 404.836 - SCREW BONE FULTHD 3.5MM 6MM 36MM SELF TAP HEXAGONAL RECESS BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $16.15 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $8.27 $39.70 N/A N/A 404.838 SUP HCPCS C1713 404.838 - SCREW BONE FULTHD 3.5MM 6MM 38MM SELF TAP HEXAGONAL RECESS BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $16.15 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $8.27 $39.70 N/A N/A 404.84 SUP HCPCS C1713 404.840 - SCREW BONE HEXAGON 3.5MM 40MM SLFTAP SMALL RECESS LCP BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $16.15 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $23.13 $38.55 $8.03 $38.55 N/A N/A 404.845 SUP HCPCS C1713 404.845 - SCREW BONE FULTHD HEXAGON 3.5MM 6MM 45MM SELF TAP SOCKET LCP BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $16.15 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $23.82 $39.70 $39.70 $39.70 N/A N/A 404.85 SUP HCPCS C1713 404.850 - SCREW BONE FULTHD 3.5MM 6MM 50MM SELF TAP HEXAGONAL RECESS BOTH IP/OP $39.00 $29.00 $7.65 $40.38 $17.35 $17.35 $17.35 $17.35 $38.55 $38.55 $38.55 $8.03 $38.55 $38.55 $38.55 $38.55 $38.55 $8.03 $38.55 $16.15 $22.80 $38.55 $40.38 $38.55 $38.55 $29.25 $38.55 $38.55 $38.55 $19.28 $19.28 $30.53 $38.55 $30.84 $17.35 $7.65 N/A $22.62 $38.55 $23.13 $38.55 $38.55 $38.55 N/A N/A 404.855 SUP HCPCS C1713 404.855 - SCREW BONE FULTHD 3.5MM 6MM 55MM SELF TAP HEXAGONAL RECESS BOTH IP/OP $40.00 $30.00 $7.88 $40.38 $17.87 $17.87 $17.87 $17.87 $39.70 $39.70 $39.70 $8.27 $39.70 $39.70 $39.70 $39.70 $39.70 $8.27 $39.70 $40.38 $23.48 $39.70 $40.38 $39.70 $39.70 $30.00 $39.70 $39.70 $39.70 $19.85 $19.85 $31.44 $39.70 $31.76 $17.87 $7.88 N/A $23.20 $39.70 $39.70 $39.70 $8.27 $39.70 N/A N/A 406.01 SUP HCPCS C1713 406.010 - SCREW BONE FULTHD 4MM 10MM LCP TITANIUM CANCELLOUS CLAVICLE BOTH IP/OP $32.00 $24.00 $6.30 $33.23 $14.28 $14.28 $14.28 $14.28 $31.73 $31.73 $31.73 $6.61 $31.73 $31.73 $31.73 $31.73 $31.73 $6.61 $31.73 $13.29 $18.77 $31.73 $33.23 $31.73 $31.73 $24.00 $31.73 $31.73 $31.73 $15.87 $15.87 $25.13 $31.73 $25.38 $14.28 $6.30 N/A $18.56 $31.73 $19.04 $31.73 $6.61 $31.73 N/A N/A 406.012 SUP HCPCS C1713 406.012 - SCREW BONE FULTHD HEXAGON 4MM 12MM SOCKET LC-DCP TITANIUM BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $13.29 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 406.014 SUP HCPCS C1713 406.014 - SCREW BONE FULTHD HEXAGON 4MM 14MM SOCKET LC-DCP TITANIUM BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $13.29 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $32.68 $32.68 $6.81 $32.68 N/A N/A 406.016 SUP HCPCS C1713 406.016 - SCREW BONE FULTHD HEXAGON 4MM 16MM SOCKET LC-DCP TITANIUM BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $13.29 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $32.68 $32.68 $6.81 $32.68 N/A N/A 406.018 SUP HCPCS C1713 406.018 - SCREW BONE FULTHD HEXAGON 4MM 18MM SOCKET LC-DCP TITANIUM BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $13.29 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 406.02 SUP HCPCS C1713 406.020 - SCREW BONE FULTHD HEXAGON 4MM 20MM SOCKET LC-DCP TITANIUM BOTH IP/OP $32.00 $24.00 $6.30 $33.23 $14.28 $14.28 $14.28 $14.28 $31.73 $31.73 $31.73 $6.61 $31.73 $31.73 $31.73 $31.73 $31.73 $6.61 $31.73 $13.29 $18.77 $31.73 $33.23 $31.73 $31.73 $24.00 $31.73 $31.73 $31.73 $15.87 $15.87 $25.13 $31.73 $25.38 $14.28 $6.30 N/A $18.56 $31.73 $19.04 $31.73 $6.61 $31.73 N/A N/A 406.022 SUP HCPCS C1713 406.022 - SCREW BONE FULTHD 4MM 6MM 22MM 9MM SMALL HEXAGONAL SOCKET BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $33.23 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 406.024 SUP HCPCS C1713 406.024 - SCREW BONE FULTHD 4MM 6MM 24MM 10MM SMALL HEXAGONAL SOCKET BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $13.29 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $32.68 $32.68 $6.81 $32.68 N/A N/A 406.026 SUP HCPCS C1713 406.026 - SCREW BONE FULTHD HEXAGON 4MM 26MM SOCKET LC-DCP TITANIUM BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $13.29 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 406.028 SUP HCPCS C1713 406.028 - SCREW BONE FULTHD HEXAGON 4MM 28MM SOCKET LC-DCP TITANIUM BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $13.29 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $32.68 $32.68 N/A N/A 406.03 SUP HCPCS C1713 406.030 - SCREW BONE FULTHD 4MM 6MM 30MM LC-DCP TITANIUM TIBIA BOTH IP/OP $32.00 $24.00 $6.30 $33.23 $14.28 $14.28 $14.28 $14.28 $31.73 $31.73 $31.73 $6.61 $31.73 $31.73 $31.73 $31.73 $31.73 $6.61 $31.73 $13.29 $18.77 $31.73 $33.23 $31.73 $31.73 $24.00 $31.73 $31.73 $31.73 $15.87 $15.87 $25.13 $31.73 $25.38 $14.28 $6.30 N/A $18.56 $31.73 $19.04 $31.73 $31.73 $31.73 N/A N/A 406.032 SUP HCPCS C1713 406.032 - SCREW BONE FULTHD HEXAGON 4MM 32MM SOCKET LC-DCP TITANIUM BOTH IP/OP $31.00 $23.00 $6.11 $30.80 $13.86 $13.86 $13.86 $13.86 $30.80 $30.80 $30.80 $6.42 $30.80 $30.80 $30.80 $30.80 $30.80 $6.42 $30.80 $12.32 $18.22 $30.80 $30.80 $30.80 $30.80 $23.25 $30.80 $30.80 $30.80 $15.40 $15.40 $24.39 $30.80 $24.64 $13.86 $6.11 N/A $17.98 $30.80 $30.80 $30.80 $6.42 $30.80 N/A N/A 406.035 SUP HCPCS C1713 406.035 - SCREW BONE FULTHD HEXAGON 4MM 35MM SOCKET LC-DCP TITANIUM BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $33.23 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 406.04 SUP HCPCS C1713 406.040 - SCREW BONE FULTHD SMALL HEXAGON 4MM 6MM 40MM SOCKET TITANIUM BOTH IP/OP $32.00 $24.00 $6.30 $33.23 $14.28 $14.28 $14.28 $14.28 $31.73 $31.73 $31.73 $6.61 $31.73 $31.73 $31.73 $31.73 $31.73 $6.61 $31.73 $13.29 $18.77 $31.73 $33.23 $31.73 $31.73 $24.00 $31.73 $31.73 $31.73 $15.87 $15.87 $25.13 $31.73 $25.38 $14.28 $6.30 N/A $18.56 $31.73 $19.04 $31.73 $6.61 $31.73 N/A N/A 406.045 SUP HCPCS C1713 406.045 - SCREW BONE FULTHD 4MM 6MM 45MM 15MM SMALL HEXAGONAL SOCKET BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $13.29 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 406.05 SUP HCPCS C1713 406.050 - SCREW BONE FULTHD HEXAGON 4MM 50MM SOCKET LC-DCP TITANIUM BOTH IP/OP $32.00 $24.00 $6.30 $33.23 $14.28 $14.28 $14.28 $14.28 $31.73 $31.73 $31.73 $6.61 $31.73 $31.73 $31.73 $31.73 $31.73 $6.61 $31.73 $13.29 $18.77 $31.73 $33.23 $31.73 $31.73 $24.00 $31.73 $31.73 $31.73 $15.87 $15.87 $25.13 $31.73 $25.38 $14.28 $6.30 N/A $18.56 $31.73 $19.04 $31.73 $6.61 $31.73 N/A N/A 406.055 SUP HCPCS C1713 406.055 - SCREW BONE FULTHD 4MM 6MM 55MM 15MM SMALL HEXAGONAL SOCKET BOTH IP/OP $33.00 $24.00 $6.49 $33.23 $14.71 $14.71 $14.71 $14.71 $32.68 $32.68 $32.68 $6.81 $32.68 $32.68 $32.68 $32.68 $32.68 $6.81 $32.68 $13.29 $19.33 $32.68 $33.23 $32.68 $32.68 $24.75 $32.68 $32.68 $32.68 $16.34 $16.34 $25.88 $32.68 $26.14 $14.71 $6.49 N/A $19.14 $32.68 $19.61 $32.68 $6.81 $32.68 N/A N/A 406.06 SUP HCPCS C1713 406.060 - SCREW BONE FULTHD 4MM 6MM 60MM 15MM SMALL HEXAGONAL SOCKET BOTH IP/OP $32.00 $24.00 $6.30 $33.23 $14.28 $14.28 $14.28 $14.28 $31.73 $31.73 $31.73 $6.61 $31.73 $31.73 $31.73 $31.73 $31.73 $6.61 $31.73 $13.29 $18.77 $31.73 $33.23 $31.73 $31.73 $24.00 $31.73 $31.73 $31.73 $15.87 $15.87 $25.13 $31.73 $25.38 $14.28 $6.30 N/A $18.56 $31.73 $19.04 $31.73 $6.61 $31.73 N/A N/A 406.065 SUP HCPCS C1713 406.065 - SCREW BONE FULTHD 4MM 65MM LC-DCP TITANIUM TIBIA CANCELLOUS BOTH IP/OP $36.00 $27.00 $7.11 $36.43 $16.12 $16.12 $16.12 $16.12 $35.83 $35.83 $35.83 $7.47 $35.83 $35.83 $35.83 $35.83 $35.83 $7.47 $35.83 $14.57 $21.19 $35.83 $36.43 $35.83 $35.83 $27.00 $35.83 $35.83 $35.83 $17.92 $17.92 $28.38 $35.83 $28.66 $16.12 $7.11 N/A $20.88 $35.83 $21.50 $35.83 $7.47 $35.83 N/A N/A 406.07 SUP HCPCS C1713 406.070 - SCREW BONE FULTHD 4MM 70MM LCP TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $35.00 $26.00 $6.91 $36.43 $15.66 $15.66 $15.66 $15.66 $34.80 $34.80 $34.80 $7.25 $34.80 $34.80 $34.80 $34.80 $34.80 $7.25 $34.80 $36.43 $20.58 $34.80 $36.43 $34.80 $34.80 $26.25 $34.80 $34.80 $34.80 $17.40 $17.40 $27.56 $34.80 $27.84 $15.66 $6.91 N/A $20.30 $34.80 $20.88 $34.80 $7.25 $34.80 N/A N/A 406.075 SUP HCPCS C1713 406.075 - SCREW BONE FULTHD 4MM 75MM LC-DCP TITANIUM TIBIA CANCELLOUS BOTH IP/OP $36.00 $27.00 $7.11 $36.43 $16.12 $16.12 $16.12 $16.12 $35.83 $35.83 $35.83 $7.47 $35.83 $35.83 $35.83 $35.83 $35.83 $7.47 $35.83 $36.43 $21.19 $35.83 $36.43 $35.83 $35.83 $27.00 $35.83 $35.83 $35.83 $17.92 $17.92 $28.38 $35.83 $28.66 $16.12 $7.11 N/A $20.88 $35.83 $21.50 $35.83 $7.47 $35.83 N/A N/A 406.08 SUP HCPCS C1713 406.080 - SCREW BONE FULTHD 4MM 80MM LCP TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $35.00 $26.00 $6.91 $36.43 $15.66 $15.66 $15.66 $15.66 $34.80 $34.80 $34.80 $7.25 $34.80 $34.80 $34.80 $34.80 $34.80 $7.25 $34.80 $14.57 $20.58 $34.80 $36.43 $34.80 $34.80 $26.25 $34.80 $34.80 $34.80 $17.40 $17.40 $27.56 $34.80 $27.84 $15.66 $6.91 N/A $20.30 $34.80 $34.80 $34.80 $7.25 $34.80 N/A N/A 406.085 SUP HCPCS C1713 406.085 - SCREW BONE FULTHD 4MM 85MM LC-DCP TITANIUM TIBIA CANCELLOUS BOTH IP/OP $36.00 $27.00 $7.11 $36.43 $16.12 $16.12 $16.12 $16.12 $35.83 $35.83 $35.83 $7.47 $35.83 $35.83 $35.83 $35.83 $35.83 $7.47 $35.83 $14.57 $21.19 $35.83 $36.43 $35.83 $35.83 $27.00 $35.83 $35.83 $35.83 $17.92 $17.92 $28.38 $35.83 $28.66 $16.12 $7.11 N/A $20.88 $35.83 $21.50 $35.83 $7.47 $35.83 N/A N/A 406.09 SUP HCPCS C1713 406.090 - SCREW BONE FULTHD 4MM 90MM LCP TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $35.00 $26.00 $6.91 $36.43 $15.66 $15.66 $15.66 $15.66 $34.80 $34.80 $34.80 $7.25 $34.80 $34.80 $34.80 $34.80 $34.80 $7.25 $34.80 $14.57 $20.58 $34.80 $36.43 $34.80 $34.80 $26.25 $34.80 $34.80 $34.80 $17.40 $17.40 $27.56 $34.80 $27.84 $15.66 $6.91 N/A $20.30 $34.80 $20.88 $34.80 $7.25 $34.80 N/A N/A 406.095 SUP HCPCS C1713 406.095 - SCREW BONE FULTHD 4MM 95MM LC-DCP TITANIUM TIBIA CANCELLOUS BOTH IP/OP $36.00 $27.00 $7.11 $36.43 $16.12 $16.12 $16.12 $16.12 $35.83 $35.83 $35.83 $7.47 $35.83 $35.83 $35.83 $35.83 $35.83 $7.47 $35.83 $14.57 $21.19 $35.83 $36.43 $35.83 $35.83 $27.00 $35.83 $35.83 $35.83 $17.92 $17.92 $28.38 $35.83 $28.66 $16.12 $7.11 N/A $20.88 $35.83 $21.50 $35.83 $7.47 $35.83 N/A N/A 406.1 SUP HCPCS C1713 406.100 - SCREW BONE FULTHD 4MM 100MM LC-DCP TITANIUM TIBIA CANCELLOUS BOTH IP/OP $35.00 $26.00 $6.91 $36.43 $15.66 $15.66 $15.66 $15.66 $34.80 $34.80 $34.80 $7.25 $34.80 $34.80 $34.80 $34.80 $34.80 $7.25 $34.80 $14.57 $20.58 $34.80 $36.43 $34.80 $34.80 $26.25 $34.80 $34.80 $34.80 $17.40 $17.40 $27.56 $34.80 $27.84 $15.66 $6.91 N/A $20.30 $34.80 $20.88 $34.80 $7.25 $34.80 N/A N/A 406.104 SUP HCPCS C1713 406.104 - SCREW BONE LOCK STARDRIVE AXON TITANIUM SPN NONSTRL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 407.01 SUP HCPCS C1713 407.010 - SCREW BONE PTHRD HEXAGON 4MM 10MM SOCKET LC-DCP TITANIUM BOTH IP/OP $30.50 $23.00 $5.96 $31.45 $13.51 $13.51 $13.51 $13.51 $30.03 $30.03 $30.03 $6.26 $30.03 $30.03 $30.03 $30.03 $30.03 $6.26 $30.03 $12.58 $17.76 $30.03 $31.45 $30.03 $30.03 $22.88 $30.03 $30.03 $30.03 $15.02 $15.02 $23.78 $30.03 $24.02 $13.51 $5.96 N/A $17.69 $30.03 $18.02 $30.03 $6.26 $30.03 N/A N/A 407.012 SUP HCPCS C1713 407.012 - SCREW BONE PTHRD HEXAGON 4MM 12MM SOCKET LC-DCP TITANIUM BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $31.45 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $18.56 $30.93 $6.45 $30.93 N/A N/A 407.014 SUP HCPCS C1713 407.014 - SCREW BONE PTHRD HEXAGON 4MM 14MM SOCKET LC-DCP TITANIUM BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $31.45 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $30.93 $30.93 $6.45 $30.93 N/A N/A 407.016 SUP HCPCS C1713 407.016 - SCREW BONE PTHRD 4MM 6MM 16MM 6MM SMALL HEXAGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $31.45 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $30.93 $30.93 $6.45 $30.93 N/A N/A 407.018 SUP HCPCS C1713 407.018 - SCREW BONE PTHRD 4MM 6MM 18MM 7MM SMALL HEXAGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $12.58 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $18.56 $30.93 $6.45 $30.93 N/A N/A 407.02 SUP HCPCS C1713 407.020 - SCREW BONE PTHRD HEXAGON 4MM 20MM SOCKET LC-DCP TITANIUM BOTH IP/OP $30.50 $23.00 $5.96 $31.45 $13.51 $13.51 $13.51 $13.51 $30.03 $30.03 $30.03 $6.26 $30.03 $30.03 $30.03 $30.03 $30.03 $6.26 $30.03 $12.58 $17.76 $30.03 $31.45 $30.03 $30.03 $22.88 $30.03 $30.03 $30.03 $15.02 $15.02 $23.78 $30.03 $24.02 $13.51 $5.96 N/A $17.69 $30.03 $18.02 $30.03 $6.26 $30.03 N/A N/A 407.022 SUP HCPCS C1713 407.022 - SCREW BONE PTHRD 4MM 6MM 22MM 9MM SMALL HEXAGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $31.45 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $30.93 $30.93 $6.45 $30.93 N/A N/A 407.024 SUP HCPCS C1713 407.024 - SCREW BONE PTHRD 4MM 6MM 24MM 10MM SMALL HEXAGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $12.58 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $18.56 $30.93 $6.45 $30.93 N/A N/A 407.026 SUP HCPCS C1713 407.026 - SCREW BONE PTHRD 4MM 6MM 26MM 12MM SMALL HEXAGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $12.58 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $18.56 $30.93 $6.45 $30.93 N/A N/A 407.028 SUP HCPCS C1713 407.028 - SCREW BONE PTHRD 4MM 6MM 28MM 14MM HEXAGONAL SOCKET LC-DCP BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $12.58 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $18.56 $30.93 $6.45 $30.93 N/A N/A 407.03 SUP HCPCS C1713 407.030 - SCREW BONE PTHRD HEXAGON 4MM 30MM SOCKET LC-DCP TITANIUM BOTH IP/OP $30.50 $23.00 $5.96 $31.45 $13.51 $13.51 $13.51 $13.51 $30.03 $30.03 $30.03 $6.26 $30.03 $30.03 $30.03 $30.03 $30.03 $6.26 $30.03 $12.58 $17.76 $30.03 $31.45 $30.03 $30.03 $22.88 $30.03 $30.03 $30.03 $15.02 $15.02 $23.78 $30.03 $24.02 $13.51 $5.96 N/A $17.69 $30.03 $18.02 $30.03 $6.26 $30.03 N/A N/A 407.035 SUP HCPCS C1713 407.035 - SCREW BONE PTHRD HEXAGON 4MM 35MM SOCKET LC-DCP TITANIUM BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $12.58 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $30.93 $30.93 $6.45 $30.93 N/A N/A 407.04 SUP HCPCS C1713 407.040 - SCREW BONE PTHRD HEXAGON 4MM 40MM SOCKET LC-DCP TITANIUM BOTH IP/OP $30.50 $23.00 $5.96 $31.45 $13.51 $13.51 $13.51 $13.51 $30.03 $30.03 $30.03 $6.26 $30.03 $30.03 $30.03 $30.03 $30.03 $6.26 $30.03 $31.45 $17.76 $30.03 $31.45 $30.03 $30.03 $22.88 $30.03 $30.03 $30.03 $15.02 $15.02 $23.78 $30.03 $24.02 $13.51 $5.96 N/A $17.69 $30.03 $18.02 $30.03 $6.26 $30.03 N/A N/A 407.045 SUP HCPCS C1713 407.045 - SCREW BONE PTHRD HEXAGON 4MM 45MM SOCKET LC-DCP TITANIUM BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $31.45 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $18.56 $30.93 $6.45 $30.93 N/A N/A 407.05 SUP HCPCS C1713 407.050 - SCREW BONE PTHRD HEXAGON 4MM 50MM SOCKET LC-DCP TITANIUM BOTH IP/OP $30.50 $23.00 $5.96 $31.45 $13.51 $13.51 $13.51 $13.51 $30.03 $30.03 $30.03 $6.26 $30.03 $30.03 $30.03 $30.03 $30.03 $6.26 $30.03 $12.58 $17.76 $30.03 $31.45 $30.03 $30.03 $22.88 $30.03 $30.03 $30.03 $15.02 $15.02 $23.78 $30.03 $24.02 $13.51 $5.96 N/A $17.69 $30.03 $18.02 $30.03 $6.26 $30.03 N/A N/A 407.055 SUP HCPCS C1713 407.055 - SCREW BONE PTHRD HEXAGON 4MM 55MM SOCKET LC-DCP TITANIUM BOTH IP/OP $31.00 $23.00 $6.14 $31.45 $13.92 $13.92 $13.92 $13.92 $30.93 $30.93 $30.93 $6.45 $30.93 $30.93 $30.93 $30.93 $30.93 $6.45 $30.93 $12.58 $18.30 $30.93 $31.45 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $13.92 $6.14 N/A $17.98 $30.93 $18.56 $30.93 $6.45 $30.93 N/A N/A 407.06 SUP HCPCS C1713 407.060 - SCREW BONE 4MM 60MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS BOTH IP/OP $30.50 $23.00 $5.96 $31.45 $13.51 $13.51 $13.51 $13.51 $30.03 $30.03 $30.03 $6.26 $30.03 $30.03 $30.03 $30.03 $30.03 $6.26 $30.03 $12.58 $17.76 $30.03 $31.45 $30.03 $30.03 $22.88 $30.03 $30.03 $30.03 $15.02 $15.02 $23.78 $30.03 $24.02 $13.51 $5.96 N/A $17.69 $30.03 $18.02 $30.03 $6.26 $30.03 N/A N/A 407.065 SUP HCPCS C1713 407.065 - SCREW BONE 4MM 65MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS BOTH IP/OP $35.50 $26.00 $6.98 $35.75 $15.82 $15.82 $15.82 $15.82 $35.15 $35.15 $35.15 $7.33 $35.15 $35.15 $35.15 $35.15 $35.15 $7.33 $35.15 $14.30 $20.79 $35.15 $35.75 $35.15 $35.15 $26.63 $35.15 $35.15 $35.15 $17.58 $17.58 $27.84 $35.15 $28.12 $15.82 $6.98 N/A $20.59 $35.15 $21.09 $35.15 $7.33 $35.15 N/A N/A 407.07 SUP HCPCS C1713 407.070 - SCREW BONE PTHRD 4MM 70MM LCP TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $34.50 $26.00 $6.77 $35.75 $15.36 $15.36 $15.36 $15.36 $34.13 $34.13 $34.13 $7.11 $34.13 $34.13 $34.13 $34.13 $34.13 $7.11 $34.13 $14.30 $20.19 $34.13 $35.75 $34.13 $34.13 $25.88 $34.13 $34.13 $34.13 $17.07 $17.07 $27.03 $34.13 $27.30 $15.36 $6.77 N/A $20.01 $34.13 $20.48 $34.13 $7.11 $34.13 N/A N/A 407.075 SUP HCPCS C1713 407.075 - SCREW BONE 4MM 75MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS BOTH IP/OP $35.50 $26.00 $6.98 $35.75 $15.82 $15.82 $15.82 $15.82 $35.15 $35.15 $35.15 $7.33 $35.15 $35.15 $35.15 $35.15 $35.15 $7.33 $35.15 $14.30 $20.79 $35.15 $35.75 $35.15 $35.15 $26.63 $35.15 $35.15 $35.15 $17.58 $17.58 $27.84 $35.15 $28.12 $15.82 $6.98 N/A $20.59 $35.15 $21.09 $35.15 $7.33 $35.15 N/A N/A 407.08 SUP HCPCS C1713 407.080 - SCREW BONE PTHRD 4MM 80MM LCP TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $34.50 $26.00 $6.77 $35.75 $15.36 $15.36 $15.36 $15.36 $34.13 $34.13 $34.13 $7.11 $34.13 $34.13 $34.13 $34.13 $34.13 $7.11 $34.13 $35.75 $20.19 $34.13 $35.75 $34.13 $34.13 $25.88 $34.13 $34.13 $34.13 $17.07 $17.07 $27.03 $34.13 $27.30 $15.36 $6.77 N/A $20.01 $34.13 $20.48 $34.13 $7.11 $34.13 N/A N/A 407.085 SUP HCPCS C1713 407.085 - SCREW BONE 4MM 85MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS BOTH IP/OP $35.50 $26.00 $6.98 $35.75 $15.82 $15.82 $15.82 $15.82 $35.15 $35.15 $35.15 $7.33 $35.15 $35.15 $35.15 $35.15 $35.15 $7.33 $35.15 $14.30 $20.79 $35.15 $35.75 $35.15 $35.15 $26.63 $35.15 $35.15 $35.15 $17.58 $17.58 $27.84 $35.15 $28.12 $15.82 $6.98 N/A $20.59 $35.15 $21.09 $35.15 $7.33 $35.15 N/A N/A 407.09 SUP HCPCS C1713 407.090 - SCREW BONE PTHRD 4MM 90MM LCP TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $34.50 $26.00 $6.77 $35.75 $15.36 $15.36 $15.36 $15.36 $34.13 $34.13 $34.13 $7.11 $34.13 $34.13 $34.13 $34.13 $34.13 $7.11 $34.13 $14.30 $20.19 $34.13 $35.75 $34.13 $34.13 $25.88 $34.13 $34.13 $34.13 $17.07 $17.07 $27.03 $34.13 $27.30 $15.36 $6.77 N/A $20.01 $34.13 $20.48 $34.13 $7.11 $34.13 N/A N/A 407.095 SUP HCPCS C1713 407.095 - SCREW BONE 4MM 95MM PTHRD LC-DCP TITANIUM TIBIA CANCELLOUS BOTH IP/OP $35.50 $26.00 $6.98 $35.75 $15.82 $15.82 $15.82 $15.82 $35.15 $35.15 $35.15 $7.33 $35.15 $35.15 $35.15 $35.15 $35.15 $7.33 $35.15 $35.75 $20.79 $35.15 $35.75 $35.15 $35.15 $26.63 $35.15 $35.15 $35.15 $17.58 $17.58 $27.84 $35.15 $28.12 $15.82 $6.98 N/A $20.59 $35.15 $21.09 $35.15 $7.33 $35.15 N/A N/A 407.1 SUP HCPCS C1713 407.100 - SCREW BONE PTHRD 4MM 100MM LCP TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $34.50 $26.00 $6.77 $35.75 $15.36 $15.36 $15.36 $15.36 $34.13 $34.13 $34.13 $7.11 $34.13 $34.13 $34.13 $34.13 $34.13 $7.11 $34.13 $35.75 $20.19 $34.13 $35.75 $34.13 $34.13 $25.88 $34.13 $34.13 $34.13 $17.07 $17.07 $27.03 $34.13 $27.30 $15.36 $6.77 N/A $20.01 $34.13 $34.13 $34.13 $7.11 $34.13 N/A N/A 407.61 SUP HCPCS C1713 407.610 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 10MM SELF DRILL BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $149.82 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $357.58 $357.58 $74.52 $357.58 N/A N/A 407.612 SUP HCPCS C1713 407.612 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 12MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 407.614 SUP HCPCS C1713 407.614 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 14MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 407.616 SUP HCPCS C1713 407.616 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 16MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 407.618 SUP HCPCS C1713 407.618 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 18MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.62 SUP HCPCS C1713 407.620 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 20MM SELF DRILL BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $149.82 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $214.55 $357.58 $74.52 $357.58 N/A N/A 407.622 SUP HCPCS C1713 407.622 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 22MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.624 SUP HCPCS C1713 407.624 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 24MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.626 SUP HCPCS C1713 407.626 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 26MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.628 SUP HCPCS C1713 407.628 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 28MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.63 SUP HCPCS C1713 407.630 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 30MM SELF DRILL BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $149.82 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $214.55 $357.58 $74.52 $357.58 N/A N/A 407.632 SUP HCPCS C1713 407.632 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 32MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.634 SUP HCPCS C1713 407.634 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 34MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.636 SUP HCPCS C1713 407.636 - SCREW BONE SHORT THREAD 4MM 5MM 36MM CANN HEXAGONAL SOCKET BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.638 SUP HCPCS C1713 407.638 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 38MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.64 SUP HCPCS C1713 407.640 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 40MM SELF DRILL BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $149.82 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $214.55 $357.58 $74.52 $357.58 N/A N/A 407.642 SUP HCPCS C1713 407.642 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 42MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.644 SUP HCPCS C1713 407.644 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 44MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.646 SUP HCPCS C1713 407.646 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 46MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.648 SUP HCPCS C1713 407.648 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 48MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 407.65 SUP HCPCS C1713 407.650 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 50MM SELF DRILL BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $149.82 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $357.58 $357.58 $74.52 $357.58 N/A N/A 407.652 SUP HCPCS C1713 407.652 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 52MM SELF DRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 407.654 SUP HCPCS C1713 407.654 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 54MM SELF DRILL BOTH IP/OP $381.00 $282.00 $75.61 $387.43 $171.43 $171.43 $171.43 $171.43 $380.95 $380.95 $380.95 $79.40 $380.95 $380.95 $380.95 $380.95 $380.95 $79.39 $380.95 $154.97 $225.33 $380.95 $387.43 $380.95 $380.95 $285.75 $380.95 $380.95 $380.95 $190.48 $190.48 $301.71 $380.95 $304.76 $171.43 $75.61 N/A $220.98 $380.95 $228.57 $380.95 $79.39 $380.95 N/A N/A 407.656 SUP HCPCS C1713 407.656 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 56MM SELF DRILL BOTH IP/OP $381.00 $282.00 $75.61 $387.43 $171.43 $171.43 $171.43 $171.43 $380.95 $380.95 $380.95 $79.40 $380.95 $380.95 $380.95 $380.95 $380.95 $79.39 $380.95 $154.97 $225.33 $380.95 $387.43 $380.95 $380.95 $285.75 $380.95 $380.95 $380.95 $190.48 $190.48 $301.71 $380.95 $304.76 $171.43 $75.61 N/A $220.98 $380.95 $380.95 $380.95 $79.39 $380.95 N/A N/A 407.658 SUP HCPCS C1713 407.658 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 58MM SELF DRILL BOTH IP/OP $381.00 $282.00 $75.61 $387.43 $171.43 $171.43 $171.43 $171.43 $380.95 $380.95 $380.95 $79.40 $380.95 $380.95 $380.95 $380.95 $380.95 $79.39 $380.95 $154.97 $225.33 $380.95 $387.43 $380.95 $380.95 $285.75 $380.95 $380.95 $380.95 $190.48 $190.48 $301.71 $380.95 $304.76 $171.43 $75.61 N/A $220.98 $380.95 $380.95 $380.95 $79.39 $380.95 N/A N/A 407.66 SUP HCPCS C1713 407.660 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 60MM SELF DRILL BOTH IP/OP $370.00 $274.00 $73.41 $387.43 $166.43 $166.43 $166.43 $166.43 $369.85 $369.85 $369.85 $77.09 $369.85 $369.85 $369.85 $369.85 $369.85 $77.08 $369.85 $154.97 $218.77 $369.85 $387.43 $369.85 $369.85 $277.50 $369.85 $369.85 $369.85 $184.93 $184.93 $292.92 $369.85 $295.88 $166.43 $73.41 N/A $214.60 $369.85 $369.85 $369.85 $77.08 $369.85 N/A N/A 407.664 SUP HCPCS C1713 407.664 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 64MM SELF DRILL BOTH IP/OP $381.00 $282.00 $75.61 $387.43 $171.43 $171.43 $171.43 $171.43 $380.95 $380.95 $380.95 $79.40 $380.95 $380.95 $380.95 $380.95 $380.95 $79.39 $380.95 $154.97 $225.33 $380.95 $387.43 $380.95 $380.95 $285.75 $380.95 $380.95 $380.95 $190.48 $190.48 $301.71 $380.95 $304.76 $171.43 $75.61 N/A $220.98 $380.95 $380.95 $380.95 $79.39 $380.95 N/A N/A 407.668 SUP HCPCS C1713 407.668 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 68MM SELF DRILL BOTH IP/OP $381.00 $282.00 $75.61 $387.43 $171.43 $171.43 $171.43 $171.43 $380.95 $380.95 $380.95 $79.40 $380.95 $380.95 $380.95 $380.95 $380.95 $79.39 $380.95 $154.97 $225.33 $380.95 $387.43 $380.95 $380.95 $285.75 $380.95 $380.95 $380.95 $190.48 $190.48 $301.71 $380.95 $304.76 $171.43 $75.61 N/A $220.98 $380.95 $380.95 $380.95 $79.39 $380.95 N/A N/A 407.672 SUP HCPCS C1713 407.672 - SCREW BONE 1/3 THREAD HEXAGON 4MM 5MM 1.35MM 72MM SELF DRILL BOTH IP/OP $381.00 $282.00 $75.61 $387.43 $171.43 $171.43 $171.43 $171.43 $380.95 $380.95 $380.95 $79.40 $380.95 $380.95 $380.95 $380.95 $380.95 $79.39 $380.95 $387.43 $225.33 $380.95 $387.43 $380.95 $380.95 $285.75 $380.95 $380.95 $380.95 $190.48 $190.48 $301.71 $380.95 $304.76 $171.43 $75.61 N/A $220.98 $380.95 $228.57 $380.95 $79.39 $380.95 N/A N/A 407.716 SUP HCPCS C1713 407.716 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 16MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.718 SUP HCPCS C1713 407.718 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 18MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.72 SUP HCPCS C1713 407.720 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 20MM CANN TITANIUM SMALL BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $374.55 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $214.55 $357.58 $74.52 $357.58 N/A N/A 407.722 SUP HCPCS C1713 407.722 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 22MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.724 SUP HCPCS C1713 407.724 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 24MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.726 SUP HCPCS C1713 407.726 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 26MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 407.728 SUP HCPCS C1713 407.728 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 28MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.73 SUP HCPCS C1713 407.730 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 30MM CANN TITANIUM SMALL BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $374.55 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $357.58 $357.58 $74.52 $357.58 N/A N/A 407.732 SUP HCPCS C1713 407.732 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 32MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 407.734 SUP HCPCS C1713 407.734 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 34MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 407.736 SUP HCPCS C1713 407.736 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 36MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 407.738 SUP HCPCS C1713 407.738 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 38MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 407.74 SUP HCPCS C1713 407.740 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 40MM CANN TITANIUM SMALL BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $149.82 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $357.58 $357.58 $74.52 $357.58 N/A N/A 407.742 SUP HCPCS C1713 407.742 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 42MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 407.744 SUP HCPCS C1713 407.744 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 44MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 407.746 SUP HCPCS C1713 407.746 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 46MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 407.748 SUP HCPCS C1713 407.748 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 48MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 407.75 SUP HCPCS C1713 407.750 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 50MM CANN TITANIUM SMALL BOTH IP/OP $358.00 $265.00 $70.97 $374.55 $160.91 $160.91 $160.91 $160.91 $357.58 $357.58 $357.58 $74.53 $357.58 $357.58 $357.58 $357.58 $357.58 $74.52 $357.58 $374.55 $211.51 $357.58 $374.55 $357.58 $357.58 $268.50 $357.58 $357.58 $357.58 $178.79 $178.79 $283.20 $357.58 $286.06 $160.91 $70.97 N/A $207.64 $357.58 $357.58 $357.58 $74.52 $357.58 N/A N/A 407.752 SUP HCPCS C1713 407.752 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 52MM CANN TITANIUM SMALL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 407.754 SUP HCPCS C1713 407.754 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 54MM CANN TITANIUM SMALL BOTH IP/OP $381.00 $282.00 $75.61 $387.43 $171.43 $171.43 $171.43 $171.43 $380.95 $380.95 $380.95 $79.40 $380.95 $380.95 $380.95 $380.95 $380.95 $79.39 $380.95 $154.97 $225.33 $380.95 $387.43 $380.95 $380.95 $285.75 $380.95 $380.95 $380.95 $190.48 $190.48 $301.71 $380.95 $304.76 $171.43 $75.61 N/A $220.98 $380.95 $380.95 $380.95 $79.39 $380.95 N/A N/A 407.756 SUP HCPCS C1713 407.756 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 56MM CANN TITANIUM SMALL BOTH IP/OP $381.00 $282.00 $75.61 $387.43 $171.43 $171.43 $171.43 $171.43 $380.95 $380.95 $380.95 $79.40 $380.95 $380.95 $380.95 $380.95 $380.95 $79.39 $380.95 $154.97 $225.33 $380.95 $387.43 $380.95 $380.95 $285.75 $380.95 $380.95 $380.95 $190.48 $190.48 $301.71 $380.95 $304.76 $171.43 $75.61 N/A $220.98 $380.95 $228.57 $380.95 $79.39 $380.95 N/A N/A 407.758 SUP HCPCS C1713 407.758 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 58MM CANN TITANIUM SMALL BOTH IP/OP $381.00 $282.00 $75.61 $387.43 $171.43 $171.43 $171.43 $171.43 $380.95 $380.95 $380.95 $79.40 $380.95 $380.95 $380.95 $380.95 $380.95 $79.39 $380.95 $154.97 $225.33 $380.95 $387.43 $380.95 $380.95 $285.75 $380.95 $380.95 $380.95 $190.48 $190.48 $301.71 $380.95 $304.76 $171.43 $75.61 N/A $220.98 $380.95 $228.57 $380.95 $79.39 $380.95 N/A N/A 407.76 SUP HCPCS C1713 407.760 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 60MM CANN TITANIUM SMALL BOTH IP/OP $370.00 $274.00 $73.41 $387.43 $166.43 $166.43 $166.43 $166.43 $369.85 $369.85 $369.85 $77.09 $369.85 $369.85 $369.85 $369.85 $369.85 $77.08 $369.85 $154.97 $218.77 $369.85 $387.43 $369.85 $369.85 $277.50 $369.85 $369.85 $369.85 $184.93 $184.93 $292.92 $369.85 $295.88 $166.43 $73.41 N/A $214.60 $369.85 $369.85 $369.85 $77.08 $369.85 N/A N/A 407.764 SUP HCPCS C1713 407.764 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 64MM CANN TITANIUM SMALL BOTH IP/OP $381.00 $282.00 $75.61 $387.43 $171.43 $171.43 $171.43 $171.43 $380.95 $380.95 $380.95 $79.40 $380.95 $380.95 $380.95 $380.95 $380.95 $79.39 $380.95 $154.97 $225.33 $380.95 $387.43 $380.95 $380.95 $285.75 $380.95 $380.95 $380.95 $190.48 $190.48 $301.71 $380.95 $304.76 $171.43 $75.61 N/A $220.98 $380.95 $228.57 $380.95 $79.39 $380.95 N/A N/A 407.768 SUP HCPCS C1713 407.768 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 68MM CANN TITANIUM SMALL BOTH IP/OP $381.00 $282.00 $75.61 $387.43 $171.43 $171.43 $171.43 $171.43 $380.95 $380.95 $380.95 $79.40 $380.95 $380.95 $380.95 $380.95 $380.95 $79.39 $380.95 $387.43 $225.33 $380.95 $387.43 $380.95 $380.95 $285.75 $380.95 $380.95 $380.95 $190.48 $190.48 $301.71 $380.95 $304.76 $171.43 $75.61 N/A $220.98 $380.95 $228.57 $380.95 $79.39 $380.95 N/A N/A 407.772 SUP HCPCS C1713 407.772 - SCREW BONE .5 THREAD 4MM 5MM 1.35MM 72MM CANN TITANIUM SMALL BOTH IP/OP $381.00 $282.00 $75.61 $387.43 $171.43 $171.43 $171.43 $171.43 $380.95 $380.95 $380.95 $79.40 $380.95 $380.95 $380.95 $380.95 $380.95 $79.39 $380.95 $387.43 $225.33 $380.95 $387.43 $380.95 $380.95 $285.75 $380.95 $380.95 $380.95 $190.48 $190.48 $301.71 $380.95 $304.76 $171.43 $75.61 N/A $220.98 $380.95 $228.57 $380.95 $79.39 $380.95 N/A N/A 408.401 SUP HCPCS C1713 408.401 - SCREW BONE 6.5MM 30MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.402 SUP HCPCS C1713 408.402 - SCREW BONE 6.5MM 35MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.403 SUP HCPCS C1713 408.403 - SCREW BONE 6.5MM 40MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.404 SUP HCPCS C1713 408.404 - SCREW BONE 6.5MM 45MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.405 SUP HCPCS C1713 408.405 - SCREW BONE 6.5MM 50MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.406 SUP HCPCS C1713 408.406 - SCREW BONE 6.5MM 55MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.407 SUP HCPCS C1713 408.407 - SCREW BONE 6.5MM 7.9MM 2.9MM 60MM 16MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.408 SUP HCPCS C1713 408.408 - SCREW BONE 6.5MM 7.9MM 2.9MM 65MM 16MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.409 SUP HCPCS C1713 408.409 - SCREW BONE 6.5MM 7.9MM 2.9MM 70MM 16MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.41 SUP HCPCS C1713 408.410 - SCREW BONE 6.5MM 7.9MM 2.9MM 75MM 16MM CANN TITANIUM LARGE BOTH IP/OP $472.50 $350.00 $93.72 $494.65 $212.49 $212.49 $212.49 $212.49 $472.20 $472.20 $472.20 $98.42 $472.20 $472.20 $472.20 $472.20 $472.20 $98.41 $472.20 $197.86 $279.31 $472.20 $494.65 $472.20 $472.20 $354.38 $472.20 $472.20 $472.20 $236.10 $236.10 $373.98 $472.20 $377.76 $212.49 $93.72 N/A $274.05 $472.20 $283.32 $472.20 $98.41 $472.20 N/A N/A 408.411 SUP HCPCS C1713 408.411 - SCREW BONE 6.5MM 7.9MM 2.9MM 80MM 16MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.412 SUP HCPCS C1713 408.412 - SCREW BONE 6.5MM 7.9MM 2.9MM 85MM 16MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.413 SUP HCPCS C1713 408.413 - SCREW BONE 6.5MM 7.9MM 2.9MM 90MM 16MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.414 SUP HCPCS C1713 408.414 - SCREW BONE 6.5MM 7.9MM 2.9MM 95MM 16MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.415 SUP HCPCS C1713 408.415 - SCREW BONE 6.5MM 7.9MM 2.9MM 100MM 16MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.416 SUP HCPCS C1713 408.416 - SCREW BONE 6.5MM 7.9MM 2.9MM 105MM 16MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.417 SUP HCPCS C1713 408.417 - SCREW BONE 6.5MM 7.9MM 2.9MM 110MM 16MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $486.38 $486.38 N/A N/A 408.418 SUP HCPCS C1713 408.418 - SCREW BONE 6.5MM 7.9MM 2.9MM 115MM 16MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $486.38 $486.38 N/A N/A 408.419 SUP HCPCS C1713 408.419 - SCREW BONE 6.5MM 7.9MM 2.9MM 120MM 16MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.42 SUP HCPCS C1713 408.420 - SCREW BONE 6.5MM 7.9MM 2.9MM 125MM 16MM CANN TITANIUM LARGE BOTH IP/OP $472.50 $350.00 $93.72 $494.65 $212.49 $212.49 $212.49 $212.49 $472.20 $472.20 $472.20 $98.42 $472.20 $472.20 $472.20 $472.20 $472.20 $98.41 $472.20 $197.86 $279.31 $472.20 $494.65 $472.20 $472.20 $354.38 $472.20 $472.20 $472.20 $236.10 $236.10 $373.98 $472.20 $377.76 $212.49 $93.72 N/A $274.05 $472.20 $283.32 $472.20 $98.41 $472.20 N/A N/A 408.421 SUP HCPCS C1713 408.421 - SCREW BONE 6.5MM 7.9MM 2.9MM 130MM 16MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.422 SUP HCPCS C1713 408.422 - SCREW BONE 6.5MM 7.9MM 2.9MM 135MM 16MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.423 SUP HCPCS C1713 408.423 - SCREW BONE 6.5MM 140MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.424 SUP HCPCS C1713 408.424 - SCREW BONE 6.5MM 145MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.425 SUP HCPCS C1713 408.425 - SCREW BONE 6.5MM 150MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $486.38 $486.38 N/A N/A 408.426 SUP HCPCS C1713 408.426 - SCREW BONE 6.5MM 160MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $486.38 $486.38 N/A N/A 408.427 SUP HCPCS C1713 408.427 - SCREW BONE 6.5MM 170MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.428 SUP HCPCS C1713 408.428 - SCREW BONE 6.5MM 180MM 16MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $486.38 $486.38 N/A N/A 408.431 SUP HCPCS C1713 408.431 - SCREW BONE 6.5MM 45MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $486.38 $486.38 N/A N/A 408.432 SUP HCPCS C1713 408.432 - SCREW BONE 6.5MM 50MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $486.38 $486.38 N/A N/A 408.433 SUP HCPCS C1713 408.433 - SCREW BONE 6.5MM 55MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.434 SUP HCPCS C1713 408.434 - SCREW BONE 6.5MM 7.9MM 2.9MM 60MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.435 SUP HCPCS C1713 408.435 - SCREW BONE 6.5MM 7.9MM 2.9MM 65MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $486.38 $486.38 N/A N/A 408.436 SUP HCPCS C1713 408.436 - SCREW BONE 6.5MM 7.9MM 2.9MM 70MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $486.38 $486.38 N/A N/A 408.437 SUP HCPCS C1713 408.437 - SCREW BONE 6.5MM 7.9MM 2.9MM 75MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.438 SUP HCPCS C1713 408.438 - SCREW BONE 6.5MM 7.9MM 2.9MM 80MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.439 SUP HCPCS C1713 408.439 - SCREW BONE 6.5MM 7.9MM 2.9MM 85MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.44 SUP HCPCS C1713 408.440 - SCREW BONE 6.5MM 7.9MM 2.9MM 90MM 32MM CANN TITANIUM LARGE BOTH IP/OP $472.50 $350.00 $93.72 $494.65 $212.49 $212.49 $212.49 $212.49 $472.20 $472.20 $472.20 $98.42 $472.20 $472.20 $472.20 $472.20 $472.20 $98.41 $472.20 $494.65 $279.31 $472.20 $494.65 $472.20 $472.20 $354.38 $472.20 $472.20 $472.20 $236.10 $236.10 $373.98 $472.20 $377.76 $212.49 $93.72 N/A $274.05 $472.20 $283.32 $472.20 $98.41 $472.20 N/A N/A 408.441 SUP HCPCS C1713 408.441 - SCREW BONE 6.5MM 7.9MM 2.9MM 95MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.442 SUP HCPCS C1713 408.442 - SCREW BONE 6.5MM 7.9MM 2.9MM 100MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.443 SUP HCPCS C1713 408.443 - SCREW BONE 6.5MM 7.9MM 2.9MM 105MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.444 SUP HCPCS C1713 408.444 - SCREW BONE 6.5MM 7.9MM 2.9MM 110MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.445 SUP HCPCS C1713 408.445 - SCREW BONE 6.5MM 7.9MM 2.9MM 115MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.446 SUP HCPCS C1713 408.446 - SCREW BONE 6.5MM 7.9MM 2.9MM 120MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.447 SUP HCPCS C1713 408.447 - SCREW BONE 6.5MM 7.9MM 2.9MM 125MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.448 SUP HCPCS C1713 408.448 - SCREW BONE 6.5MM 7.9MM 2.9MM 130MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.449 SUP HCPCS C1713 408.449 - SCREW BONE 6.5MM 7.9MM 2.9MM 135MM 32MM CANN TITANIUM LARGE BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.45 SUP HCPCS C1713 408.450 - SCREW BONE 6.5MM 140MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $472.50 $350.00 $93.72 $494.65 $212.49 $212.49 $212.49 $212.49 $472.20 $472.20 $472.20 $98.42 $472.20 $472.20 $472.20 $472.20 $472.20 $98.41 $472.20 $197.86 $279.31 $472.20 $494.65 $472.20 $472.20 $354.38 $472.20 $472.20 $472.20 $236.10 $236.10 $373.98 $472.20 $377.76 $212.49 $93.72 N/A $274.05 $472.20 $472.20 $472.20 $98.41 $472.20 N/A N/A 408.451 SUP HCPCS C1713 408.451 - SCREW BONE 6.5MM 145MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.452 SUP HCPCS C1713 408.452 - SCREW BONE 6.5MM 150MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.453 SUP HCPCS C1713 408.453 - SCREW BONE 6.5MM 160MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.454 SUP HCPCS C1713 408.454 - SCREW BONE 6.5MM 170MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.455 SUP HCPCS C1713 408.455 - SCREW BONE 6.5MM 180MM 32MM CANN TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.46 SUP HCPCS C1713 408.460 - SCREW BONE FULTHD 6.5MM 20MM CANN TITANIUM FEMUR TIBIA ANKLE BOTH IP/OP $472.50 $350.00 $93.72 $494.65 $212.49 $212.49 $212.49 $212.49 $472.20 $472.20 $472.20 $98.42 $472.20 $472.20 $472.20 $472.20 $472.20 $98.41 $472.20 $494.65 $279.31 $472.20 $494.65 $472.20 $472.20 $354.38 $472.20 $472.20 $472.20 $236.10 $236.10 $373.98 $472.20 $377.76 $212.49 $93.72 N/A $274.05 $472.20 $283.32 $472.20 $98.41 $472.20 N/A N/A 408.461 SUP HCPCS C1713 408.461 - SCREW BONE FULTHD 6.5MM 25MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.462 SUP HCPCS C1713 408.462 - SCREW BONE FULTHD 6.5MM 30MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.463 SUP HCPCS C1713 408.463 - SCREW BONE FULTHD 6.5MM 35MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.464 SUP HCPCS C1713 408.464 - SCREW BONE FULTHD 6.5MM 40MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.465 SUP HCPCS C1713 408.465 - SCREW BONE 6.5MM 45MM FULTHRD TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.466 SUP HCPCS C1713 408.466 - SCREW BONE FULTHD 6.5MM 50MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.467 SUP HCPCS C1713 408.467 - SCREW BONE FULTHD 6.5MM 55MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.468 SUP HCPCS C1713 408.468 - SCREW BONE FULTHD 6.5MM 60MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.469 SUP HCPCS C1713 408.469 - SCREW BONE FULTHD 6.5MM 65MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.47 SUP HCPCS C1713 408.470 - SCREW BONE FULTHD 6.5MM 70MM CANN TITANIUM FEMUR TIBIA ANKLE BOTH IP/OP $472.50 $350.00 $93.72 $494.65 $212.49 $212.49 $212.49 $212.49 $472.20 $472.20 $472.20 $98.42 $472.20 $472.20 $472.20 $472.20 $472.20 $98.41 $472.20 $197.86 $279.31 $472.20 $494.65 $472.20 $472.20 $354.38 $472.20 $472.20 $472.20 $236.10 $236.10 $373.98 $472.20 $377.76 $212.49 $93.72 N/A $274.05 $472.20 $472.20 $472.20 $98.41 $472.20 N/A N/A 408.471 SUP HCPCS C1713 408.471 - SCREW BONE FULTHD 6.5MM 75MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.472 SUP HCPCS C1713 408.472 - SCREW BONE FULTHD 6.5MM 80MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.473 SUP HCPCS C1713 408.473 - SCREW BONE FULTHD 6.5MM 85MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.474 SUP HCPCS C1713 408.474 - SCREW BONE FULTHD 6.5MM 90MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.475 SUP HCPCS C1713 408.475 - SCREW BONE FULTHD 6.5MM 95MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 408.476 SUP HCPCS C1713 408.476 - SCREW BONE FULTHD 6.5MM 100MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.477 SUP HCPCS C1713 408.477 - SCREW BONE FULTHD 6.5MM 105MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.478 SUP HCPCS C1713 408.478 - SCREW BONE FULTHD 6.5MM 110MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.479 SUP HCPCS C1713 408.479 - SCREW BONE FULTHD 6.5MM 115MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 408.48 SUP HCPCS C1713 408.480 - SCREW BONE FULTHD 6.5MM 120MM CANN TITANIUM FEMUR TIBIA BOTH IP/OP $472.50 $350.00 $93.72 $494.65 $212.49 $212.49 $212.49 $212.49 $472.20 $472.20 $472.20 $98.42 $472.20 $472.20 $472.20 $472.20 $472.20 $98.41 $472.20 $197.86 $279.31 $472.20 $494.65 $472.20 $472.20 $354.38 $472.20 $472.20 $472.20 $236.10 $236.10 $373.98 $472.20 $377.76 $212.49 $93.72 N/A $274.05 $472.20 $472.20 $472.20 $98.41 $472.20 N/A N/A 408.481 SUP HCPCS C1713 408.481 - SCREW BONE FULTHD 6.5MM 125MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $486.38 $486.38 N/A N/A 408.482 SUP HCPCS C1713 408.482 - SCREW BONE FULTHD 6.5MM 130MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $486.38 $486.38 N/A N/A 408.483 SUP HCPCS C1713 408.483 - SCREW BONE 6.5MM 140MM CANN FULTHD TITANIUM ORTHOPEDIC BOTH IP/OP $502.00 $371.00 $99.60 $510.35 $225.82 $225.82 $225.82 $225.82 $501.83 $501.83 $501.83 $104.59 $501.83 $501.83 $501.83 $501.83 $501.83 $104.59 $501.83 $204.14 $296.83 $501.83 $510.35 $501.83 $501.83 $376.50 $501.83 $501.83 $501.83 $250.92 $250.92 $397.45 $501.83 $401.46 $225.82 $99.60 N/A $291.16 $501.83 $301.10 $501.83 $104.58 $501.83 N/A N/A 408.484 SUP HCPCS C1713 408.484 - SCREW BONE FULTHD 6.5MM 150MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $502.00 $371.00 $99.60 $510.35 $225.82 $225.82 $225.82 $225.82 $501.83 $501.83 $501.83 $104.59 $501.83 $501.83 $501.83 $501.83 $501.83 $104.59 $501.83 $204.14 $296.83 $501.83 $510.35 $501.83 $501.83 $376.50 $501.83 $501.83 $501.83 $250.92 $250.92 $397.45 $501.83 $401.46 $225.82 $99.60 N/A $291.16 $501.83 $301.10 $501.83 $104.58 $501.83 N/A N/A 408.485 SUP HCPCS C1713 408.485 - SCREW BONE FULTHD 6.5MM 160MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $502.00 $371.00 $99.60 $510.35 $225.82 $225.82 $225.82 $225.82 $501.83 $501.83 $501.83 $104.59 $501.83 $501.83 $501.83 $501.83 $501.83 $104.59 $501.83 $204.14 $296.83 $501.83 $510.35 $501.83 $501.83 $376.50 $501.83 $501.83 $501.83 $250.92 $250.92 $397.45 $501.83 $401.46 $225.82 $99.60 N/A $291.16 $501.83 $301.10 $501.83 $104.58 $501.83 N/A N/A 408.486 SUP HCPCS C1713 408.486 - SCREW BONE FULTHD 6.5MM 170MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $502.00 $371.00 $99.60 $510.35 $225.82 $225.82 $225.82 $225.82 $501.83 $501.83 $501.83 $104.59 $501.83 $501.83 $501.83 $501.83 $501.83 $104.59 $501.83 $510.35 $296.83 $501.83 $510.35 $501.83 $501.83 $376.50 $501.83 $501.83 $501.83 $250.92 $250.92 $397.45 $501.83 $401.46 $225.82 $99.60 N/A $291.16 $501.83 $501.83 $501.83 $104.58 $501.83 N/A N/A 408.487 SUP HCPCS C1713 408.487 - SCREW BONE FULTHD 6.5MM 180MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $502.00 $371.00 $99.60 $510.35 $225.82 $225.82 $225.82 $225.82 $501.83 $501.83 $501.83 $104.59 $501.83 $501.83 $501.83 $501.83 $501.83 $104.59 $501.83 $510.35 $296.83 $501.83 $510.35 $501.83 $501.83 $376.50 $501.83 $501.83 $501.83 $250.92 $250.92 $397.45 $501.83 $401.46 $225.82 $99.60 N/A $291.16 $501.83 $301.10 $501.83 $104.58 $501.83 N/A N/A 408.83 SUP HCPCS C1713 408.830 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 30MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 408.835 SUP HCPCS C1713 408.835 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 35MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 408.84 SUP HCPCS C1713 408.840 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 40MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 408.845 SUP HCPCS C1713 408.845 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 45MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 408.85 SUP HCPCS C1713 408.850 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 50MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 408.855 SUP HCPCS C1713 408.855 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 55MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 408.86 SUP HCPCS C1713 408.860 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 60MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 408.865 SUP HCPCS C1713 408.865 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 65MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 408.87 SUP HCPCS C1713 408.870 - SCREW BONE 7.3MM 8.2MM 2.9MM 70MM 16MM CANN SELF TAP SELF BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 408.875 SUP HCPCS C1713 408.875 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 75MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 408.88 SUP HCPCS C1713 408.880 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 80MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 408.885 SUP HCPCS C1713 408.885 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 85MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 408.89 SUP HCPCS C1713 408.890 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 90MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 408.895 SUP HCPCS C1713 408.895 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 95MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 408.9 SUP HCPCS C1713 408.900 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 100MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 408.905 SUP HCPCS C1713 408.905 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 105MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 408.91 SUP HCPCS C1713 408.910 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 110MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 408.915 SUP HCPCS C1713 408.915 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 115MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 408.92 SUP HCPCS C1713 408.920 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 120MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 408.925 SUP HCPCS C1713 408.925 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 125MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 408.93 SUP HCPCS C1713 408.930 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 130MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 408.935 SUP HCPCS C1713 408.935 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 135MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 408.94 SUP HCPCS C1713 408.940 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 140MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 408.945 SUP HCPCS C1713 408.945 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 145MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 408.95 SUP HCPCS C1713 408.950 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 150MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 409.62 SUP HCPCS C1713 409.620 - SCREW BONE FULTHD 7.3MM 20MM CANN TITANIUM FEMUR TIBIA ANKLE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 409.625 SUP HCPCS C1713 409.625 - SCREW BONE FULTHD 7.3MM 25MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 409.63 SUP HCPCS C1713 409.630 - SCREW BONE FULTHD 7.3MM 30MM CANN TITANIUM FEMUR TIBIA ANKLE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 409.635 SUP HCPCS C1713 409.635 - SCREW BONE FULTHD 7.3MM 35MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 409.64 SUP HCPCS C1713 409.640 - SCREW BONE FULTHD 7.3MM 40MM CANN TITANIUM FEMUR TIBIA ANKLE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 409.645 SUP HCPCS C1713 409.645 - SCREW BONE FULTHD 7.3MM 45MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 409.65 SUP HCPCS C1713 409.650 - SCREW BONE FULTHD 7.3MM 50MM CANN TITANIUM FEMUR TIBIA ANKLE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 409.655 SUP HCPCS C1713 409.655 - SCREW BONE FULTHD 7.3MM 55MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 409.66 SUP HCPCS C1713 409.660 - SCREW BONE FULTHD 7.3MM 60MM CANN TITANIUM FEMUR TIBIA ANKLE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 409.665 SUP HCPCS C1713 409.665 - SCREW BONE FULTHD 7.3MM 65MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 409.67 SUP HCPCS C1713 409.670 - SCREW BONE FULTHD 7.3MM 70MM CANN TITANIUM FEMUR TIBIA ANKLE BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 409.675 SUP HCPCS C1713 409.675 - SCREW BONE FULTHD 7.3MM 8MM 2.9MM 75MM CANN SELF DRILL GOLD BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 409.68 SUP HCPCS C1713 409.680 - SCREW BONE FULTHD 7.3MM 8.2MM 80MM CANN SLFDRILL SLFTAP BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $469.48 $469.48 N/A N/A 409.685 SUP HCPCS C1713 409.685 - SCREW BONE FULTHD 7.3MM 85MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 409.69 SUP HCPCS C1713 409.690 - SCREW BONE FULTHD 7.3MM 8MM 2.9MM 90MM CANN SELF DRILL GOLD BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 409.695 SUP HCPCS C1713 409.695 - SCREW BONE FULTHD 7.3MM 8MM 2.9MM 95MM CANN SELF DRILL GOLD BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 409.7 SUP HCPCS C1713 409.700 - SCREW BONE FULTHD 7.3MM 100MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 409.705 SUP HCPCS C1713 409.705 - SCREW BONE FULTHD 7.3MM 105MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 409.71 SUP HCPCS C1713 409.710 - SCREW BONE FULTHD 7.3MM 110MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 409.715 SUP HCPCS C1713 409.715 - SCREW BONE FULTHD 7.3MM 115MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 409.72 SUP HCPCS C1713 409.720 - SCREW BONE FULTHD 7.3MM 120MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 409.725 SUP HCPCS C1713 409.725 - SCREW BONE FULTHD 7.3MM 125MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 409.73 SUP HCPCS C1713 409.730 - SCREW BONE FULTHD 7.3MM 130MM CANN TITANIUM ORTHOPEDIC BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $469.48 $469.48 N/A N/A 409.845 SUP HCPCS C1713 409.845 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 45MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $483.55 $483.55 N/A N/A 409.85 SUP HCPCS C1713 409.850 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 50MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 409.855 SUP HCPCS C1713 409.855 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 55MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 409.86 SUP HCPCS C1713 409.860 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 60MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $196.71 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $469.48 $469.48 N/A N/A 409.865 SUP HCPCS C1713 409.865 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 65MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $483.55 $483.55 N/A N/A 409.87 SUP HCPCS C1713 409.870 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 70MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 409.875 SUP HCPCS C1713 409.875 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 75MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 409.88 SUP HCPCS C1713 409.880 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 80MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 409.885 SUP HCPCS C1713 409.885 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 85MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $483.55 $483.55 N/A N/A 409.89 SUP HCPCS C1713 409.890 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 90MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 409.895 SUP HCPCS C1713 409.895 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 95MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $483.55 $483.55 N/A N/A 409.9 SUP HCPCS C1713 409.900 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 100MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 409.905 SUP HCPCS C1713 409.905 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 105MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 409.91 SUP HCPCS C1713 409.910 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 110MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $469.48 $469.48 N/A N/A 409.915 SUP HCPCS C1713 409.915 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 115MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 409.92 SUP HCPCS C1713 409.920 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 120MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 409.925 SUP HCPCS C1713 409.925 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 125MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 409.93 SUP HCPCS C1713 409.930 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 130MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $469.48 $469.48 N/A N/A 409.935 SUP HCPCS C1713 409.935 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 135MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 409.94 SUP HCPCS C1713 409.940 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 140MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $469.48 $469.48 $97.84 $469.48 N/A N/A 409.945 SUP HCPCS C1713 409.945 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 145MM BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $483.55 $483.55 N/A N/A 409.95 SUP HCPCS C1713 409.950 - SCREW BONE LARGE HEXAGON HEMISPHERE 7.3MM 8.2MM 2.9MM 150MM BOTH IP/OP $469.50 $347.00 $93.18 $491.78 $211.27 $211.27 $211.27 $211.27 $469.48 $469.48 $469.48 $97.85 $469.48 $469.48 $469.48 $469.48 $469.48 $97.84 $469.48 $491.78 $277.70 $469.48 $491.78 $469.48 $469.48 $352.13 $469.48 $469.48 $469.48 $234.74 $234.74 $371.83 $469.48 $375.58 $211.27 $93.18 N/A $272.31 $469.48 $281.69 $469.48 $97.84 $469.48 N/A N/A 412.101 SUP HCPCS C1713 412.101 - SCREW BONE T15 FULTHD 3.5MM 10MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $234.75 $234.75 N/A N/A 412.102 SUP HCPCS C1713 412.102 - SCREW BONE T15 FULTHD 3.5MM 12MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $234.75 $234.75 N/A N/A 412.103 SUP HCPCS C1713 412.103 - SCREW BONE T15 FULTHD 3.5MM 14MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $234.75 $234.75 N/A N/A 412.104 SUP HCPCS C1713 412.104 - SCREW BONE T15 FULTHD 3.5MM 16MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 412.105 SUP HCPCS C1713 412.105 - SCREW BONE 3.5MM 5MM 18MM SELF TAP LOCK T15 STARDRIVE RECESS BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 412.106 SUP HCPCS C1713 412.106 - SCREW BONE T15 FULTHD 3.5MM 20MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $234.75 $234.75 N/A N/A 412.107 SUP HCPCS C1713 412.107 - SCREW BONE T15 FULTHD 3.5MM 22MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 412.108 SUP HCPCS C1713 412.108 - SCREW BONE 3.5MM 24MM SELF TAP LOCK STARDRIVE CONICAL HEAD BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 412.109 SUP HCPCS C1713 412.109 - SCREW BONE T15 FULTHD 3.5MM 26MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 412.11 SUP HCPCS C1713 412.110 - SCREW BONE T15 FULTHD 3.5MM 28MM SELF TAP STARDRIVE LCP BOTH IP/OP $228.00 $169.00 $45.24 $238.75 $102.57 $102.57 $102.57 $102.57 $227.93 $227.93 $227.93 $47.51 $227.93 $227.93 $227.93 $227.93 $227.93 $47.50 $227.93 $95.50 $134.82 $227.93 $238.75 $227.93 $227.93 $171.00 $227.93 $227.93 $227.93 $113.97 $113.97 $180.52 $227.93 $182.34 $102.57 $45.24 N/A $132.24 $227.93 $136.76 $227.93 $47.50 $227.93 N/A N/A 412.111 SUP HCPCS C1713 412.111 - SCREW BONE T15 FULTHD 3.5MM 30MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 412.112 SUP HCPCS C1713 412.112 - SCREW BONE T15 FULTHD 3.5MM 32MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 412.113 SUP HCPCS C1713 412.113 - SCREW BONE T15 FULTHD 3.5MM 34MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 412.114 SUP HCPCS C1713 412.114 - SCREW BONE T15 FULTHD 3.5MM 35MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.115 SUP HCPCS C1713 412.115 - SCREW BONE T15 FULTHD 3.5MM 36MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.116 SUP HCPCS C1713 412.116 - SCREW BONE T15 FULTHD 3.5MM 38MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.117 SUP HCPCS C1713 412.117 - SCREW BONE T15 FULTHD 3.5MM 40MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.118 SUP HCPCS C1713 412.118 - SCREW BONE T15 FULTHD 3.5MM 42MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.119 SUP HCPCS C1713 412.119 - SCREW BONE T15 FULTHD 3.5MM 45MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.12 SUP HCPCS C1713 412.120 - SCREW BONE T15 FULTHD 3.5MM 48MM SELF TAP STARDRIVE LCP BOTH IP/OP $228.00 $169.00 $45.24 $238.75 $102.57 $102.57 $102.57 $102.57 $227.93 $227.93 $227.93 $47.51 $227.93 $227.93 $227.93 $227.93 $227.93 $47.50 $227.93 $238.75 $134.82 $227.93 $238.75 $227.93 $227.93 $171.00 $227.93 $227.93 $227.93 $113.97 $113.97 $180.52 $227.93 $182.34 $102.57 $45.24 N/A $132.24 $227.93 $227.93 $227.93 $47.50 $227.93 N/A N/A 412.121 SUP HCPCS C1713 412.121 - SCREW BONE T15 FULTHD 3.5MM 50MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.122 SUP HCPCS C1713 412.122 - SCREW BONE T15 FULTHD 3.5MM 52MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.123 SUP HCPCS C1713 412.123 - SCREW BONE T15 FULTHD 3.5MM 55MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.124 SUP HCPCS C1713 412.124 - SCREW BONE T15 FULTHD 3.5MM 60MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.125 SUP HCPCS C1713 412.125 - SCREW BONE 3.5MM 65MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.126 SUP HCPCS C1713 412.126 - SCREW BONE T15 FULTHD 3.5MM 70MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 412.127 SUP HCPCS C1713 412.127 - SCREW BONE T15 FULTHD 3.5MM 75MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.128 SUP HCPCS C1713 412.128 - SCREW BONE T15 FULTHD 3.5MM 80MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.129 SUP HCPCS C1713 412.129 - SCREW BONE 3.5MM 85MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.13 SUP HCPCS C1713 412.130 - SCREW BONE 3.5MM 90MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $228.00 $169.00 $45.24 $238.75 $102.57 $102.57 $102.57 $102.57 $227.93 $227.93 $227.93 $47.51 $227.93 $227.93 $227.93 $227.93 $227.93 $47.50 $227.93 $238.75 $134.82 $227.93 $238.75 $227.93 $227.93 $171.00 $227.93 $227.93 $227.93 $113.97 $113.97 $180.52 $227.93 $182.34 $102.57 $45.24 N/A $132.24 $227.93 $227.93 $227.93 $47.50 $227.93 N/A N/A 412.131 SUP HCPCS C1713 412.131 - SCREW BONE 3.5MM 95MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.134 SUP HCPCS C1713 412.134 - SCREW BONE T15 FULTHD 3.5MM 44MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.136 SUP HCPCS C1713 412.136 - SCREW BONE T15 FULTHD 3.5MM 46MM SELF TAP STARDRIVE LCP BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 412.201 SUP HCPCS C1713 412.201 - SCREW BONE T25 5MM 14MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.202 SUP HCPCS C1713 412.202 - SCREW BONE T25 5MM 16MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.203 SUP HCPCS C1713 412.203 - SCREW BONE T25 5MM 18MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.204 SUP HCPCS C1713 412.204 - SCREW BONE T25 5MM 20MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.205 SUP HCPCS C1713 412.205 - SCREW BONE T25 5MM 22MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.206 SUP HCPCS C1713 412.206 - SCREW BONE T25 5MM 24MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 412.207 SUP HCPCS C1713 412.207 - SCREW BONE T25 5MM 26MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 412.208 SUP HCPCS C1713 412.208 - SCREW BONE T25 5MM 28MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.209 SUP HCPCS C1713 412.209 - SCREW BONE T25 5MM 30MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.21 SUP HCPCS C1713 412.210 - SCREW BONE T25 5MM 32MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $266.50 $197.00 $52.82 $278.75 $119.76 $119.76 $119.76 $119.76 $266.13 $266.13 $266.13 $55.47 $266.13 $266.13 $266.13 $266.13 $266.13 $55.46 $266.13 $278.75 $157.42 $266.13 $278.75 $266.13 $266.13 $199.88 $266.13 $266.13 $266.13 $133.07 $133.07 $210.77 $266.13 $212.90 $119.76 $52.82 N/A $154.57 $266.13 $266.13 $266.13 $55.46 $266.13 N/A N/A 412.211 SUP HCPCS C1713 412.211 - SCREW BONE T25 5MM 34MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.212 SUP HCPCS C1713 412.212 - SCREW BONE T25 5MM 36MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.213 SUP HCPCS C1713 412.213 - SCREW BONE T25 5MM 38MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.214 SUP HCPCS C1713 412.214 - SCREW BONE T25 5MM 40MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.215 SUP HCPCS C1713 412.215 - SCREW BONE 5MM 6.6MM 42MM LOCK T25 STARDRIVE RECESS LCP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.216 SUP HCPCS C1713 412.216 - SCREW BONE 5MM 44MM LOCKING SLFTAP T25 STARDRIVE RECESS LCP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.217 SUP HCPCS C1713 412.217 - SCREW BONE T25 5MM 46MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.218 SUP HCPCS C1713 412.218 - SCREW BONE 5MM 6.6MM 48MM LOCK SELF TAP T25 STARDRIVE LCP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.219 SUP HCPCS C1713 412.219 - SCREW BONE T25 5MM 50MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.22 SUP HCPCS C1713 412.220 - SCREW BONE T25 5MM 55MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $266.50 $197.00 $52.82 $278.75 $119.76 $119.76 $119.76 $119.76 $266.13 $266.13 $266.13 $55.47 $266.13 $266.13 $266.13 $266.13 $266.13 $55.46 $266.13 $111.50 $157.42 $266.13 $278.75 $266.13 $266.13 $199.88 $266.13 $266.13 $266.13 $133.07 $133.07 $210.77 $266.13 $212.90 $119.76 $52.82 N/A $154.57 $266.13 $266.13 $266.13 $55.46 $266.13 N/A N/A 412.221 SUP HCPCS C1713 412.221 - SCREW BONE 5MM 60MM LOCKING SLFTAP T25 STARDRIVE RECESS LCP BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.222 SUP HCPCS C1713 412.222 - SCREW BONE T25 5MM 65MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.223 SUP HCPCS C1713 412.223 - SCREW BONE T25 5MM 70MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 412.224 SUP HCPCS C1713 412.224 - SCREW BONE T25 5MM 75MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 412.225 SUP HCPCS C1713 412.225 - SCREW BONE T25 5MM 80MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 412.226 SUP HCPCS C1713 412.226 - SCREW BONE T25 5MM 85MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.227 SUP HCPCS C1713 412.227 - SCREW BONE T25 5MM 90MM SELF TAP STARDRIVE LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 412.251 SUP HCPCS C1713 412.251 - SCREW BONE 5MM 51MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 412.252 SUP HCPCS C1713 412.252 - SCREW BONE 5MM 52MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 412.253 SUP HCPCS C1713 412.253 - SCREW BONE 5MM 53MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 412.254 SUP HCPCS C1713 412.254 - SCREW BONE 5MM 54MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $231.35 $385.58 $80.35 $385.58 N/A N/A 412.255 SUP HCPCS C1713 412.255 - SCREW BONE 5MM 55MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $231.35 $385.58 $80.35 $385.58 N/A N/A 412.256 SUP HCPCS C1713 412.256 - SCREW BONE 5MM 56MM SLFDRILL LOCKING TITANIUM ORTHOPEDIC BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $231.35 $385.58 $80.35 $385.58 N/A N/A 412.257 SUP HCPCS C1713 412.257 - SCREW BONE 5MM 40MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 412.258 SUP HCPCS C1713 412.258 - SCREW BONE 5MM 45MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 412.259 SUP HCPCS C1713 412.259 - SCREW BONE 5MM 50MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $231.35 $385.58 $80.35 $385.58 N/A N/A 412.26 SUP HCPCS C1713 412.260 - SCREW BONE 5MM 55MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $231.35 $385.58 $80.35 $385.58 N/A N/A 412.261 SUP HCPCS C1713 412.261 - SCREW BONE 5MM 60MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $231.35 $385.58 $80.35 $385.58 N/A N/A 412.262 SUP HCPCS C1713 412.262 - SCREW BONE 5MM 65MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 412.263 SUP HCPCS C1713 412.263 - SCREW BONE 5MM 70MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 412.264 SUP HCPCS C1713 412.264 - SCREW BONE 5MM 75MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $231.35 $385.58 $80.35 $385.58 N/A N/A 412.265 SUP HCPCS C1713 412.265 - SCREW BONE 5MM 80MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $231.35 $385.58 $80.35 $385.58 N/A N/A 412.266 SUP HCPCS C1713 412.266 - SCREW BONE 5MM 85MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $385.58 $385.58 $80.35 $385.58 N/A N/A 412.267 SUP HCPCS C1713 412.267 - SCREW BONE 5MM 90MM SLFDRILL LOCKING STARDRIVE RECESS LISS BOTH IP/OP $386.00 $286.00 $76.53 $385.58 $173.51 $173.51 $173.51 $173.51 $385.58 $385.58 $385.58 $80.36 $385.58 $385.58 $385.58 $385.58 $385.58 $80.36 $385.58 $154.23 $228.07 $385.58 $385.58 $385.58 $385.58 $289.50 $385.58 $385.58 $385.58 $192.79 $192.79 $305.38 $385.58 $308.46 $173.51 $76.53 N/A $223.88 $385.58 $231.35 $385.58 $80.35 $385.58 N/A N/A 412.317 SUP HCPCS C1713 412.317 - SCREW BONE FULTHD 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 412.319 SUP HCPCS C1713 412.319 - SCREW BONE FULTHD 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $268.78 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 412.321 SUP HCPCS C1713 412.321 - SCREW BONE FULTHD 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $264.28 $264.28 $55.08 $264.28 N/A N/A 412.323 SUP HCPCS C1713 412.323 - SCREW BONE FULTHD 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $264.28 $264.28 $55.08 $264.28 N/A N/A 412.324 SUP HCPCS C1713 412.324 - SCREW BONE FULTHD 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 412.325 SUP HCPCS C1713 412.325 - SCREW BONE FULTHD 3.5MM 65MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $268.78 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 412.326 SUP HCPCS C1713 412.326 - SCREW BONE FULTHD 3.5MM 70MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 412.327 SUP HCPCS C1713 412.327 - SCREW BONE FULTHD 3.5MM 75MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 412.328 SUP HCPCS C1713 412.328 - SCREW BONE FULTHD 3.5MM 80MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $104.65 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 412.329 SUP HCPCS C1713 412.329 - SCREW BONE FULTHD 3.5MM 85MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $104.65 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 412.33 SUP HCPCS C1713 412.330 - SCREW BONE FULTHD 3.5MM 90MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $250.00 $185.00 $49.57 $261.63 $112.39 $112.39 $112.39 $112.39 $249.75 $249.75 $249.75 $52.05 $249.75 $249.75 $249.75 $249.75 $249.75 $52.05 $249.75 $104.65 $147.73 $249.75 $261.63 $249.75 $249.75 $187.50 $249.75 $249.75 $249.75 $124.88 $124.88 $197.80 $249.75 $199.80 $112.39 $49.57 N/A $145.00 $249.75 $149.85 $249.75 $52.05 $249.75 N/A N/A 412.331 SUP HCPCS C1713 412.331 - SCREW BONE FULTHD 3.5MM 95MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $104.65 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $257.25 $257.25 $53.61 $257.25 N/A N/A 412.417 SUP HCPCS C1713 412.417 - SCREW BONE 3.5MM 40MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 412.419 SUP HCPCS C1713 412.419 - SCREW BONE 3.5MM 45MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 412.421 SUP HCPCS C1713 412.421 - SCREW BONE 3.5MM 50MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $264.28 $264.28 $55.08 $264.28 N/A N/A 412.423 SUP HCPCS C1713 412.423 - SCREW BONE 3.5MM 55MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $264.28 $264.28 $55.08 $264.28 N/A N/A 412.424 SUP HCPCS C1713 412.424 - SCREW BONE 3.5MM 60MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $264.50 $196.00 $52.45 $268.78 $118.93 $118.93 $118.93 $118.93 $264.28 $264.28 $264.28 $55.08 $264.28 $264.28 $264.28 $264.28 $264.28 $55.08 $264.28 $107.51 $156.32 $264.28 $268.78 $264.28 $264.28 $198.38 $264.28 $264.28 $264.28 $132.14 $132.14 $209.31 $264.28 $211.42 $118.93 $52.45 N/A $153.41 $264.28 $158.57 $264.28 $55.08 $264.28 N/A N/A 412.425 SUP HCPCS C1713 412.425 - SCREW BONE 3.5MM 65MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $104.65 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 412.426 SUP HCPCS C1713 412.426 - SCREW BONE 3.5MM 70MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $104.65 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 412.427 SUP HCPCS C1713 412.427 - SCREW BONE 3.5MM 75MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $104.65 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 412.428 SUP HCPCS C1713 412.428 - SCREW BONE 3.5MM 80MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $104.65 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 412.429 SUP HCPCS C1713 412.429 - SCREW BONE 3.5MM 85MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $104.65 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 412.43 SUP HCPCS C1713 412.430 - SCREW BONE PTHRD 3.5MM 90MM SLFTAP CONICAL STARDRIVE RECESS BOTH IP/OP $250.00 $185.00 $49.57 $261.63 $112.39 $112.39 $112.39 $112.39 $249.75 $249.75 $249.75 $52.05 $249.75 $249.75 $249.75 $249.75 $249.75 $52.05 $249.75 $104.65 $147.73 $249.75 $261.63 $249.75 $249.75 $187.50 $249.75 $249.75 $249.75 $124.88 $124.88 $197.80 $249.75 $199.80 $112.39 $49.57 N/A $145.00 $249.75 $149.85 $249.75 $52.05 $249.75 N/A N/A 412.431 SUP HCPCS C1713 412.431 - SCREW BONE 3.5MM 95MM SLFTAP CONICAL STARDRIVE RECESS PTHRD BOTH IP/OP $257.50 $191.00 $51.06 $261.63 $115.76 $115.76 $115.76 $115.76 $257.25 $257.25 $257.25 $53.62 $257.25 $257.25 $257.25 $257.25 $257.25 $53.61 $257.25 $104.65 $152.16 $257.25 $261.63 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $115.76 $51.06 N/A $149.35 $257.25 $154.35 $257.25 $53.61 $257.25 N/A N/A 412.806 SUP HCPCS C1713 412.806 - SCREW BONE 2.4MM 6MM T8 STARDRIVE RECESS SLFTAP LOCKING BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 412.807 SUP HCPCS C1713 412.807 - SCREW BONE 2.4MM 7MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 412.808 SUP HCPCS C1713 412.808 - SCREW BONE 2.4MM 8MM T8 STARDRIVE RECESS SLFTAP LOCKING BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 412.809 SUP HCPCS C1713 412.809 - SCREW BONE 2.4MM 9MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 412.81 SUP HCPCS C1713 412.810 - SCREW BONE T8 CONE 2.4MM 10MM SELF TAP THREAD STARDRIVE LCP BOTH IP/OP $213.00 $158.00 $42.26 $223.03 $95.81 $95.81 $95.81 $95.81 $212.90 $212.90 $212.90 $44.37 $212.90 $212.90 $212.90 $212.90 $212.90 $44.37 $212.90 $89.21 $125.93 $212.90 $223.03 $212.90 $212.90 $159.75 $212.90 $212.90 $212.90 $106.45 $106.45 $168.62 $212.90 $170.32 $95.81 $42.26 N/A $123.54 $212.90 $127.74 $212.90 $44.37 $212.90 N/A N/A 412.811 SUP HCPCS C1713 412.811 - SCREW BONE T8 CONE 2.4MM 11MM SELF TAP THREAD STARDRIVE LCP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $219.30 $219.30 $45.70 $219.30 N/A N/A 412.812 SUP HCPCS C1713 412.812 - SCREW BONE T8 CONE 2.4MM 12MM SELF TAP THREAD STARDRIVE LCP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $219.30 $219.30 $45.70 $219.30 N/A N/A 412.813 SUP HCPCS C1713 412.813 - SCREW BONE 2.4MM 13MM SLFTAP LOCKING LCP TITANIUM ORTHOPEDIC BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $219.30 $219.30 $45.70 $219.30 N/A N/A 412.814 SUP HCPCS C1713 412.814 - SCREW BONE T8 CONE 2.4MM 14MM SELF TAP THREAD STARDRIVE LCP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $219.30 $219.30 $45.70 $219.30 N/A N/A 412.816 SUP HCPCS C1713 412.816 - SCREW BONE T8 CONE 2.4MM 16MM SELF TAP THREAD STARDRIVE LCP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 412.818 SUP HCPCS C1713 412.818 - SCREW BONE T8 CONE 2.4MM 18MM SELF TAP THREAD STARDRIVE LCP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 412.82 SUP HCPCS C1713 412.820 - SCREW BONE T8 CONE 2.4MM 20MM SELF TAP THREAD STARDRIVE LCP BOTH IP/OP $213.00 $158.00 $42.26 $223.03 $95.81 $95.81 $95.81 $95.81 $212.90 $212.90 $212.90 $44.37 $212.90 $212.90 $212.90 $212.90 $212.90 $44.37 $212.90 $89.21 $125.93 $212.90 $223.03 $212.90 $212.90 $159.75 $212.90 $212.90 $212.90 $106.45 $106.45 $168.62 $212.90 $170.32 $95.81 $42.26 N/A $123.54 $212.90 $127.74 $212.90 $44.37 $212.90 N/A N/A 412.822 SUP HCPCS C1713 412.822 - SCREW BONE T8 CONE 2.4MM 22MM SELF TAP THREAD STARDRIVE LCP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 412.824 SUP HCPCS C1713 412.824 - SCREW BONE T8 CONE 2.4MM 24MM SELF TAP THREAD STARDRIVE LCP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $223.03 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 412.826 SUP HCPCS C1713 412.826 - SCREW BONE 2.4MM 1.9MM 26MM T8 STARDRIVE RECESS SLFTAP BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 412.828 SUP HCPCS C1713 412.828 - SCREW BONE 2.4MM 28MM T8 STARDRIVE RECESS SLFTAP LOCKING BOTH IP/OP $219.50 $162.00 $43.53 $223.03 $98.69 $98.69 $98.69 $98.69 $219.30 $219.30 $219.30 $45.71 $219.30 $219.30 $219.30 $219.30 $219.30 $45.70 $219.30 $89.21 $129.72 $219.30 $223.03 $219.30 $219.30 $164.63 $219.30 $219.30 $219.30 $109.65 $109.65 $173.69 $219.30 $175.44 $98.69 $43.53 N/A $127.31 $219.30 $131.58 $219.30 $45.70 $219.30 N/A N/A 412.83 SUP HCPCS C1713 412.830 - SCREW BONE 2.4MM 30MM T8 STARDRIVE RECESS SLFTAP LOCKING BOTH IP/OP $213.00 $158.00 $42.26 $223.03 $95.81 $95.81 $95.81 $95.81 $212.90 $212.90 $212.90 $44.37 $212.90 $212.90 $212.90 $212.90 $212.90 $44.37 $212.90 $89.21 $125.93 $212.90 $223.03 $212.90 $212.90 $159.75 $212.90 $212.90 $212.90 $106.45 $106.45 $168.62 $212.90 $170.32 $95.81 $42.26 N/A $123.54 $212.90 $212.90 $212.90 $44.37 $212.90 N/A N/A 413.309 SUP HCPCS C1776 413.309 - SPACER TIBIAL 2MM 5MM 5MM TOMOFIX CHRONOS TITANIUM KNEE BOTH IP/OP $183.00 $135.00 $36.27 $185.85 $82.24 $82.24 $82.24 $82.24 $182.75 $182.75 $182.75 $38.09 $182.75 $182.75 $182.75 $182.75 $182.75 $38.09 $182.75 $74.34 $108.10 $182.75 $185.85 $182.75 $182.75 $137.25 $182.75 $182.75 $182.75 $91.38 $91.38 $144.74 $182.75 $146.20 $82.24 $36.27 N/A $106.14 $182.75 $182.75 $182.75 $38.09 $182.75 N/A N/A 413.324 SUP HCPCS C1713 413.324 - SCREW BONE 5MM 24MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $241.22 $402.03 $83.78 $402.03 N/A N/A 413.326 SUP HCPCS C1713 413.326 - SCREW BONE 5MM 26MM SLFTAP LOCKING HEAD TITANIUM NONSTRL BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $408.85 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $402.03 $402.03 $83.78 $402.03 N/A N/A 413.328 SUP HCPCS C1713 413.328 - SCREW BONE 5MM 28MM LOCKING SLFTAP HEX DRIVE TITANIUM FEMUR BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $402.03 $402.03 $83.78 $402.03 N/A N/A 413.33 SUP HCPCS C1713 413.330 - SCREW BONE 5MM 30MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM BOTH IP/OP $390.50 $289.00 $77.47 $408.85 $175.65 $175.65 $175.65 $175.65 $390.33 $390.33 $390.33 $81.35 $390.33 $390.33 $390.33 $390.33 $390.33 $81.35 $390.33 $163.54 $230.88 $390.33 $408.85 $390.33 $390.33 $292.88 $390.33 $390.33 $390.33 $195.17 $195.17 $309.14 $390.33 $312.26 $175.65 $77.47 N/A $226.49 $390.33 $234.20 $390.33 $81.34 $390.33 N/A N/A 413.332 SUP HCPCS C1713 413.332 - SCREW BONE 5MM 32MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $408.85 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $241.22 $402.03 $83.78 $402.03 N/A N/A 413.334 SUP HCPCS C1713 413.334 - SCREW BONE 5MM 34MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $402.03 $402.03 $83.78 $402.03 N/A N/A 413.336 SUP HCPCS C1713 413.336 - SCREW BONE 5MM 36MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $402.03 $402.03 $83.78 $402.03 N/A N/A 413.338 SUP HCPCS C1713 413.338 - SCREW BONE 5MM 38MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM SPN BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $241.22 $402.03 $83.78 $402.03 N/A N/A 413.34 SUP HCPCS C1713 413.340 - SCREW BONE 5MM 40MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $390.50 $289.00 $77.47 $408.85 $175.65 $175.65 $175.65 $175.65 $390.33 $390.33 $390.33 $81.35 $390.33 $390.33 $390.33 $390.33 $390.33 $81.35 $390.33 $408.85 $230.88 $390.33 $408.85 $390.33 $390.33 $292.88 $390.33 $390.33 $390.33 $195.17 $195.17 $309.14 $390.33 $312.26 $175.65 $77.47 N/A $226.49 $390.33 $234.20 $390.33 $81.34 $390.33 N/A N/A 413.342 SUP HCPCS C1713 413.342 - SCREW BONE 5MM 42MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $408.85 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $241.22 $402.03 $83.78 $402.03 N/A N/A 413.344 SUP HCPCS C1713 413.344 - SCREW BONE 5MM 44MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $241.22 $402.03 $83.78 $402.03 N/A N/A 413.346 SUP HCPCS C1713 413.346 - SCREW BONE 5MM 46MM SLFTAP LOCKING HEAD TOMOFIX TITANIUM BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $241.22 $402.03 $83.78 $402.03 N/A N/A 413.348 SUP HCPCS C1713 413.348 - SCREW BONE 5MM 48MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $408.85 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $241.22 $402.03 $83.78 $402.03 N/A N/A 413.35 SUP HCPCS C1713 413.350 - SCREW BONE 5MM 50MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $390.50 $289.00 $77.47 $408.85 $175.65 $175.65 $175.65 $175.65 $390.33 $390.33 $390.33 $81.35 $390.33 $390.33 $390.33 $390.33 $390.33 $81.35 $390.33 $408.85 $230.88 $390.33 $408.85 $390.33 $390.33 $292.88 $390.33 $390.33 $390.33 $195.17 $195.17 $309.14 $390.33 $312.26 $175.65 $77.47 N/A $226.49 $390.33 $390.33 $390.33 $81.34 $390.33 N/A N/A 413.355 SUP HCPCS C1713 413.355 - SCREW BONE 5MM 55MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $408.85 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $402.03 $402.03 $83.78 $402.03 N/A N/A 413.36 SUP HCPCS C1713 413.360 - SCREW BONE 5MM 60MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $390.50 $289.00 $77.47 $408.85 $175.65 $175.65 $175.65 $175.65 $390.33 $390.33 $390.33 $81.35 $390.33 $390.33 $390.33 $390.33 $390.33 $81.35 $390.33 $408.85 $230.88 $390.33 $408.85 $390.33 $390.33 $292.88 $390.33 $390.33 $390.33 $195.17 $195.17 $309.14 $390.33 $312.26 $175.65 $77.47 N/A $226.49 $390.33 $390.33 $390.33 $81.34 $390.33 N/A N/A 413.365 SUP HCPCS C1713 413.365 - SCREW BONE 5MM 65MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $241.22 $402.03 $83.78 $402.03 N/A N/A 413.37 SUP HCPCS C1713 413.370 - SCREW BONE 5MM 70MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $390.50 $289.00 $77.47 $408.85 $175.65 $175.65 $175.65 $175.65 $390.33 $390.33 $390.33 $81.35 $390.33 $390.33 $390.33 $390.33 $390.33 $81.35 $390.33 $163.54 $230.88 $390.33 $408.85 $390.33 $390.33 $292.88 $390.33 $390.33 $390.33 $195.17 $195.17 $309.14 $390.33 $312.26 $175.65 $77.47 N/A $226.49 $390.33 $234.20 $390.33 $81.34 $390.33 N/A N/A 413.375 SUP HCPCS C1713 413.375 - SCREW BONE 5MM 75MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $402.03 $402.03 $83.78 $402.03 N/A N/A 413.38 SUP HCPCS C1713 413.380 - SCREW BONE 5MM 80MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $390.50 $289.00 $77.47 $408.85 $175.65 $175.65 $175.65 $175.65 $390.33 $390.33 $390.33 $81.35 $390.33 $390.33 $390.33 $390.33 $390.33 $81.35 $390.33 $163.54 $230.88 $390.33 $408.85 $390.33 $390.33 $292.88 $390.33 $390.33 $390.33 $195.17 $195.17 $309.14 $390.33 $312.26 $175.65 $77.47 N/A $226.49 $390.33 $234.20 $390.33 $81.34 $390.33 N/A N/A 413.385 SUP HCPCS C1713 413.385 - SCREW BONE 5MM 85MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $241.22 $402.03 $83.78 $402.03 N/A N/A 413.39 SUP HCPCS C1713 413.390 - SCREW BONE 5MM 90MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $390.50 $289.00 $77.47 $408.85 $175.65 $175.65 $175.65 $175.65 $390.33 $390.33 $390.33 $81.35 $390.33 $390.33 $390.33 $390.33 $390.33 $81.35 $390.33 $163.54 $230.88 $390.33 $408.85 $390.33 $390.33 $292.88 $390.33 $390.33 $390.33 $195.17 $195.17 $309.14 $390.33 $312.26 $175.65 $77.47 N/A $226.49 $390.33 $234.20 $390.33 $81.34 $390.33 N/A N/A 413.414 SUP HCPCS C1713 413.414 - SCREW BONE 5MM 14MM SLFDRILL LOCKING LISS TITANIUM FEMUR BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $227.37 $378.95 $78.97 $378.95 N/A N/A 413.418 SUP HCPCS C1713 413.418 - SCREW BONE 5MM 18MM SLFDRILL LOCKING LISS TITANIUM FEMUR BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $227.37 $378.95 $78.97 $378.95 N/A N/A 413.422 SUP HCPCS C1713 413.422 - SCREW BONE 5MM 22MM SLFDRILL LOCKING LISS TITANIUM FEMUR BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $227.37 $378.95 $78.97 $378.95 N/A N/A 413.426 SUP HCPCS C1713 413.426 - SCREW BONE 5MM 26MM SELF TAP LOCK HEAD TOMOFIX TITANIUM BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $408.85 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $241.22 $402.03 $83.78 $402.03 N/A N/A 413.43 SUP HCPCS C1713 413.430 - SCREW BONE 5MM 30MM SLFDRILL LOCKING LISS TITANIUM FEMUR BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $227.37 $378.95 $78.97 $378.95 N/A N/A 413.435 SUP HCPCS C1713 413.435 - SCREW BONE 5MM 35MM SLFDRILL LOCKING LISS TITANIUM FEMUR BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $227.37 $378.95 $78.97 $378.95 N/A N/A 413.44 SUP HCPCS C1713 413.440 - SCREW BONE 5MM 40MM SLFDRILL LOCKING LISS TITANIUM FEMUR BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $227.37 $378.95 $78.97 $378.95 N/A N/A 413.445 SUP HCPCS C1713 413.445 - SCREW BONE 5MM 45MM SLFDRILL LOCKING LISS TITANIUM FEMUR BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $378.95 $378.95 $78.97 $378.95 N/A N/A 413.45 SUP HCPCS C1713 413.450 - SCREW BONE 5MM 50MM SLFDRILL LOCKING LISS TITANIUM FEMUR BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $227.37 $378.95 $78.97 $378.95 N/A N/A 413.455 SUP HCPCS C1713 413.455 - SCREW BONE 5MM 55MM SLFDRILL LOCKING LISS TITANIUM FEMUR BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $227.37 $378.95 $78.97 $378.95 N/A N/A 413.46 SUP HCPCS C1713 413.460 - SCREW BONE 5MM 60MM SLFDRILL LOCKING LISS TITANIUM FEMUR BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $227.37 $378.95 $78.97 $378.95 N/A N/A 413.465 SUP HCPCS C1713 413.465 - SCREW BONE 5MM 65MM SLFDRILL LOCKING LISS TITANIUM FEMUR BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $378.95 $378.95 $78.97 $378.95 N/A N/A 413.47 SUP HCPCS C1713 413.470 - SCREW BONE 5MM 70MM SLFDRILL LOCKING LISS TITANIUM FEMUR BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $227.37 $378.95 $78.97 $378.95 N/A N/A 413.475 SUP HCPCS C1713 413.475 - SCREW BONE 5MM 75MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $227.37 $378.95 $78.97 $378.95 N/A N/A 413.48 SUP HCPCS C1713 413.480 - SCREW BONE 5MM 80MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $378.95 $378.95 $78.97 $378.95 N/A N/A 413.485 SUP HCPCS C1713 413.485 - SCREW BONE 5MM 85MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $378.95 $378.95 $78.97 $378.95 N/A N/A 413.49 SUP HCPCS C1713 413.490 - SCREW BONE 5MM 90MM SLFDRILL LOCKING TITANIUM FEMUR DISTAL BOTH IP/OP $379.00 $280.00 $75.21 $378.95 $170.53 $170.53 $170.53 $170.53 $378.95 $378.95 $378.95 $78.98 $378.95 $378.95 $378.95 $378.95 $378.95 $78.98 $378.95 $151.58 $224.15 $378.95 $378.95 $378.95 $378.95 $284.25 $378.95 $378.95 $378.95 $189.48 $189.48 $300.13 $378.95 $303.16 $170.53 $75.21 N/A $219.82 $378.95 $227.37 $378.95 $78.97 $378.95 N/A N/A 414.014 SUP HCPCS C1713 414.014 - SCREW BONE 4.5MM 14MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 414.016 SUP HCPCS C1713 414.016 - SCREW BONE 4.5MM 8MM 16MM HEXAGONAL SOCKET LC-DCP TITANIUM BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $12.43 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $30.55 $30.55 $6.37 $30.55 N/A N/A 414.018 SUP HCPCS C1713 414.018 - SCREW BONE 4.5MM 18MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $29.00 $21.00 $5.72 $28.80 $12.96 $12.96 $12.96 $12.96 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $28.80 $28.80 $28.80 $6.00 $28.80 $11.52 $17.04 $28.80 $28.80 $28.80 $28.80 $21.75 $28.80 $28.80 $28.80 $14.40 $14.40 $22.81 $28.80 $23.04 $12.96 $5.72 N/A $16.82 $28.80 $17.28 $28.80 $6.00 $28.80 N/A N/A 414.02 SUP HCPCS C1713 414.020 - SCREW BONE STANDARD 4.5MM 8MM 20MM LARGE HEXAGONAL SOCKET BOTH IP/OP $29.00 $21.00 $5.72 $28.80 $12.96 $12.96 $12.96 $12.96 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $17.04 $28.80 $28.80 $28.80 $28.80 $21.75 $28.80 $28.80 $28.80 $14.40 $14.40 $22.81 $28.80 $23.04 $12.96 $5.72 N/A $16.82 $28.80 $17.28 $28.80 $6.00 $28.80 N/A N/A 414.022 SUP HCPCS C1713 414.022 - SCREW BONE 4.5MM 8MM 22MM HEXAGONAL SOCKET LC-DCP TITANIUM BOTH IP/OP $29.00 $21.00 $5.72 $28.80 $12.96 $12.96 $12.96 $12.96 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $17.04 $28.80 $28.80 $28.80 $28.80 $21.75 $28.80 $28.80 $28.80 $14.40 $14.40 $22.81 $28.80 $23.04 $12.96 $5.72 N/A $16.82 $28.80 $17.28 $28.80 $6.00 $28.80 N/A N/A 414.024 SUP HCPCS C1713 414.024 - SCREW BONE 4.5MM 24MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $29.00 $21.00 $5.72 $28.80 $12.96 $12.96 $12.96 $12.96 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $28.80 $28.80 $28.80 $6.00 $28.80 $11.52 $17.04 $28.80 $28.80 $28.80 $28.80 $21.75 $28.80 $28.80 $28.80 $14.40 $14.40 $22.81 $28.80 $23.04 $12.96 $5.72 N/A $16.82 $28.80 $28.80 $28.80 $6.00 $28.80 N/A N/A 414.026 SUP HCPCS C1713 414.026 - SCREW BONE 4.5MM 26MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $29.00 $21.00 $5.72 $28.80 $12.96 $12.96 $12.96 $12.96 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $28.80 $28.80 $28.80 $6.00 $28.80 $11.52 $17.04 $28.80 $28.80 $28.80 $28.80 $21.75 $28.80 $28.80 $28.80 $14.40 $14.40 $22.81 $28.80 $23.04 $12.96 $5.72 N/A $16.82 $28.80 $17.28 $28.80 $6.00 $28.80 N/A N/A 414.028 SUP HCPCS C1713 414.028 - SCREW BONE 4.5MM 28MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $29.00 $21.00 $5.72 $28.80 $12.96 $12.96 $12.96 $12.96 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $28.80 $28.80 $28.80 $6.00 $28.80 $11.52 $17.04 $28.80 $28.80 $28.80 $28.80 $21.75 $28.80 $28.80 $28.80 $14.40 $14.40 $22.81 $28.80 $23.04 $12.96 $5.72 N/A $16.82 $28.80 $17.28 $28.80 $6.00 $28.80 N/A N/A 414.03 SUP HCPCS C1713 414.030 - SCREW BONE 4.5MM 30MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $30.00 $22.00 $5.89 $31.08 $13.36 $13.36 $13.36 $13.36 $29.68 $29.68 $29.68 $6.19 $29.68 $29.68 $29.68 $29.68 $29.68 $6.19 $29.68 $31.08 $17.56 $29.68 $31.08 $29.68 $29.68 $22.50 $29.68 $29.68 $29.68 $14.84 $14.84 $23.51 $29.68 $23.74 $13.36 $5.89 N/A $17.40 $29.68 $17.81 $29.68 $6.19 $29.68 N/A N/A 414.032 SUP HCPCS C1713 414.032 - SCREW BONE 3.5MM STANDARD 4.5MM 8MM 32MM LARGE HEXAGONAL BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $12.43 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 414.034 SUP HCPCS C1713 414.034 - SCREW BONE 4.5MM 34MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $12.43 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $30.55 $30.55 $6.37 $30.55 N/A N/A 414.036 SUP HCPCS C1713 414.036 - SCREW BONE STANDARD 4.5MM 8MM 14MM LARGE HEXAGONAL SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 414.038 SUP HCPCS C1713 414.038 - SCREW BONE 4.5MM 38MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $29.00 $21.00 $5.72 $28.80 $12.96 $12.96 $12.96 $12.96 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $28.80 $28.80 $28.80 $6.00 $28.80 $11.52 $17.04 $28.80 $28.80 $28.80 $28.80 $21.75 $28.80 $28.80 $28.80 $14.40 $14.40 $22.81 $28.80 $23.04 $12.96 $5.72 N/A $16.82 $28.80 $17.28 $28.80 $6.00 $28.80 N/A N/A 414.04 SUP HCPCS C1713 414.040 - SCREW BONE 3.5MM STANDARD 4.5MM 8MM 26MM LARGE HEXAGONAL BOTH IP/OP $29.00 $21.00 $5.72 $28.80 $12.96 $12.96 $12.96 $12.96 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $28.80 $28.80 $28.80 $6.00 $28.80 $11.52 $17.04 $28.80 $28.80 $28.80 $28.80 $21.75 $28.80 $28.80 $28.80 $14.40 $14.40 $22.81 $28.80 $23.04 $12.96 $5.72 N/A $16.82 $28.80 $17.28 $28.80 $6.00 $28.80 N/A N/A 414.042 SUP HCPCS C1713 414.042 - SCREW BONE 3.5MM STANDARD 4.5MM 8MM 42MM LARGE HEXAGONAL BOTH IP/OP $29.00 $21.00 $5.72 $28.80 $12.96 $12.96 $12.96 $12.96 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $28.80 $28.80 $28.80 $6.00 $28.80 $11.52 $17.04 $28.80 $28.80 $28.80 $28.80 $21.75 $28.80 $28.80 $28.80 $14.40 $14.40 $22.81 $28.80 $23.04 $12.96 $5.72 N/A $16.82 $28.80 $17.28 $28.80 $6.00 $28.80 N/A N/A 414.044 SUP HCPCS C1713 414.044 - SCREW BONE 3MM STANDARD 4.5MM 8MM 44X3.5MM HEXAGONAL SOCKET BOTH IP/OP $29.00 $21.00 $5.72 $28.80 $12.96 $12.96 $12.96 $12.96 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $17.04 $28.80 $28.80 $28.80 $28.80 $21.75 $28.80 $28.80 $28.80 $14.40 $14.40 $22.81 $28.80 $23.04 $12.96 $5.72 N/A $16.82 $28.80 $17.28 $28.80 $6.00 $28.80 N/A N/A 414.046 SUP HCPCS C1713 414.046 - SCREW BONE 4.5MM 46MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $12.43 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 414.048 SUP HCPCS C1713 414.048 - SCREW BONE 4.5MM 48MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $29.00 $21.00 $5.72 $28.80 $12.96 $12.96 $12.96 $12.96 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $28.80 $28.80 $28.80 $6.00 $28.80 $11.52 $17.04 $28.80 $28.80 $28.80 $28.80 $21.75 $28.80 $28.80 $28.80 $14.40 $14.40 $22.81 $28.80 $23.04 $12.96 $5.72 N/A $16.82 $28.80 $17.28 $28.80 $6.00 $28.80 N/A N/A 414.05 SUP HCPCS C1713 414.050 - SCREW BONE 3.5MM STANDARD 4.5MM 8MM 50MM LARGE HEXAGONAL BOTH IP/OP $30.00 $22.00 $5.89 $31.08 $13.36 $13.36 $13.36 $13.36 $29.68 $29.68 $29.68 $6.19 $29.68 $29.68 $29.68 $29.68 $29.68 $6.19 $29.68 $31.08 $17.56 $29.68 $31.08 $29.68 $29.68 $22.50 $29.68 $29.68 $29.68 $14.84 $14.84 $23.51 $29.68 $23.74 $13.36 $5.89 N/A $17.40 $29.68 $17.81 $29.68 $6.19 $29.68 N/A N/A 414.052 SUP HCPCS C1713 414.052 - SCREW BONE 3.5MM STANDARD 4.5MM 8MM 52MM LARGE HEXAGONAL BOTH IP/OP $29.00 $21.00 $5.72 $28.80 $12.96 $12.96 $12.96 $12.96 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $17.04 $28.80 $28.80 $28.80 $28.80 $21.75 $28.80 $28.80 $28.80 $14.40 $14.40 $22.81 $28.80 $23.04 $12.96 $5.72 N/A $16.82 $28.80 $28.80 $28.80 $6.00 $28.80 N/A N/A 414.054 SUP HCPCS C1713 414.054 - SCREW BONE 4.5MM 54MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 414.056 SUP HCPCS C1713 414.056 - SCREW BONE 4.5MM 56MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $12.43 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 414.058 SUP HCPCS C1713 414.058 - SCREW BONE STANDARD LARGE HEXAGON 4.5MM 8MM 14MM SOCKET BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $12.43 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 414.06 SUP HCPCS C1713 414.060 - SCREW BONE 4.5MM 60MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $30.00 $22.00 $5.89 $31.08 $13.36 $13.36 $13.36 $13.36 $29.68 $29.68 $29.68 $6.19 $29.68 $29.68 $29.68 $29.68 $29.68 $6.19 $29.68 $12.43 $17.56 $29.68 $31.08 $29.68 $29.68 $22.50 $29.68 $29.68 $29.68 $14.84 $14.84 $23.51 $29.68 $23.74 $13.36 $5.89 N/A $17.40 $29.68 $29.68 $29.68 $6.19 $29.68 N/A N/A 414.062 SUP HCPCS C1713 414.062 - SCREW BONE 4.5MM 62MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 414.064 SUP HCPCS C1713 414.064 - SCREW BONE 4.5MM 64MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 414.066 SUP HCPCS C1713 414.066 - SCREW BONE 4.5MM 66MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 414.068 SUP HCPCS C1713 414.068 - SCREW BONE 4.5MM 68MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $31.00 $23.00 $6.06 $31.08 $13.75 $13.75 $13.75 $13.75 $30.55 $30.55 $30.55 $6.37 $30.55 $30.55 $30.55 $30.55 $30.55 $6.37 $30.55 $31.08 $18.07 $30.55 $31.08 $30.55 $30.55 $23.25 $30.55 $30.55 $30.55 $15.28 $15.28 $24.20 $30.55 $24.44 $13.75 $6.06 N/A $17.98 $30.55 $18.33 $30.55 $6.37 $30.55 N/A N/A 414.07 SUP HCPCS C1713 414.070 - SCREW BONE STANDARD 4.5MM 8MM 70MM LARGE HEXAGONAL SOCKET BOTH IP/OP $30.00 $22.00 $5.89 $31.08 $13.36 $13.36 $13.36 $13.36 $29.68 $29.68 $29.68 $6.19 $29.68 $29.68 $29.68 $29.68 $29.68 $6.19 $29.68 $31.08 $17.56 $29.68 $31.08 $29.68 $29.68 $22.50 $29.68 $29.68 $29.68 $14.84 $14.84 $23.51 $29.68 $23.74 $13.36 $5.89 N/A $17.40 $29.68 $29.68 $29.68 $6.19 $29.68 N/A N/A 414.072 SUP HCPCS C1713 414.072 - SCREW BONE 4.5MM 72MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $29.00 $21.00 $5.72 $28.80 $12.96 $12.96 $12.96 $12.96 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $28.80 $28.80 $28.80 $6.00 $28.80 $28.80 $17.04 $28.80 $28.80 $28.80 $28.80 $21.75 $28.80 $28.80 $28.80 $14.40 $14.40 $22.81 $28.80 $23.04 $12.96 $5.72 N/A $16.82 $28.80 $28.80 $28.80 $6.00 $28.80 N/A N/A 414.076 SUP HCPCS C1713 414.076 - SCREW BONE 4.5MM 76MM SLFTAP LC-DCP TITANIUM CORTICAL BOTH IP/OP $47.00 $35.00 $9.27 $46.70 $21.02 $21.02 $21.02 $21.02 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $27.62 $46.70 $46.70 $46.70 $46.70 $35.25 $46.70 $46.70 $46.70 $23.35 $23.35 $36.99 $46.70 $37.36 $21.02 $9.27 N/A $27.26 $46.70 $46.70 $46.70 $9.73 $46.70 N/A N/A 414.08 SUP HCPCS C1713 414.080 - SCREW BONE 4.5MM 80MM LC DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $47.00 $35.00 $9.27 $46.70 $21.02 $21.02 $21.02 $21.02 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $27.62 $46.70 $46.70 $46.70 $46.70 $35.25 $46.70 $46.70 $46.70 $23.35 $23.35 $36.99 $46.70 $37.36 $21.02 $9.27 N/A $27.26 $46.70 $46.70 $46.70 $9.73 $46.70 N/A N/A 414.085 SUP HCPCS C1713 414.085 - SCREW BONE 3.5MM 85MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $47.00 $35.00 $9.27 $46.70 $21.02 $21.02 $21.02 $21.02 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $27.62 $46.70 $46.70 $46.70 $46.70 $35.25 $46.70 $46.70 $46.70 $23.35 $23.35 $36.99 $46.70 $37.36 $21.02 $9.27 N/A $27.26 $46.70 $28.02 $46.70 $9.73 $46.70 N/A N/A 414.09 SUP HCPCS C1713 414.090 - SCREW BONE 4.5MM 90MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $47.00 $35.00 $9.27 $46.70 $21.02 $21.02 $21.02 $21.02 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $46.70 $46.70 $46.70 $9.73 $46.70 $18.68 $27.62 $46.70 $46.70 $46.70 $46.70 $35.25 $46.70 $46.70 $46.70 $23.35 $23.35 $36.99 $46.70 $37.36 $21.02 $9.27 N/A $27.26 $46.70 $28.02 $46.70 $9.73 $46.70 N/A N/A 414.095 SUP HCPCS C1713 414.095 - SCREW BONE 4.5MM 95MM LC-DCP TITANIUM CORTICAL NONSTRL LARGE BOTH IP/OP $47.00 $35.00 $9.27 $46.70 $21.02 $21.02 $21.02 $21.02 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $46.70 $46.70 $46.70 $9.73 $46.70 $18.68 $27.62 $46.70 $46.70 $46.70 $46.70 $35.25 $46.70 $46.70 $46.70 $23.35 $23.35 $36.99 $46.70 $37.36 $21.02 $9.27 N/A $27.26 $46.70 $46.70 $46.70 $9.73 $46.70 N/A N/A 414.1 SUP HCPCS C1713 414.100 - SCREW BONE 4.5MM 100MM LC-DCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $47.00 $35.00 $9.27 $46.70 $21.02 $21.02 $21.02 $21.02 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $46.70 $46.70 $46.70 $9.73 $46.70 $18.68 $27.62 $46.70 $46.70 $46.70 $46.70 $35.25 $46.70 $46.70 $46.70 $23.35 $23.35 $36.99 $46.70 $37.36 $21.02 $9.27 N/A $27.26 $46.70 $28.02 $46.70 $9.73 $46.70 N/A N/A 414.105 SUP HCPCS C1713 414.105 - SCREW BONE 4.5MM 105MM LC-DCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $47.00 $35.00 $9.27 $46.70 $21.02 $21.02 $21.02 $21.02 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $27.62 $46.70 $46.70 $46.70 $46.70 $35.25 $46.70 $46.70 $46.70 $23.35 $23.35 $36.99 $46.70 $37.36 $21.02 $9.27 N/A $27.26 $46.70 $28.02 $46.70 $9.73 $46.70 N/A N/A 414.11 SUP HCPCS C1713 414.110 - SCREW BONE 4.5MM 110MM LC-DCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $47.00 $35.00 $9.27 $46.70 $21.02 $21.02 $21.02 $21.02 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $46.70 $46.70 $46.70 $9.73 $46.70 $18.68 $27.62 $46.70 $46.70 $46.70 $46.70 $35.25 $46.70 $46.70 $46.70 $23.35 $23.35 $36.99 $46.70 $37.36 $21.02 $9.27 N/A $27.26 $46.70 $28.02 $46.70 $9.73 $46.70 N/A N/A 414.115 SUP HCPCS C1713 414.115 - SCREW BONE 4.5MM 115MM LC-DCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $47.00 $35.00 $9.27 $46.70 $21.02 $21.02 $21.02 $21.02 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $46.70 $46.70 $46.70 $9.73 $46.70 $18.68 $27.62 $46.70 $46.70 $46.70 $46.70 $35.25 $46.70 $46.70 $46.70 $23.35 $23.35 $36.99 $46.70 $37.36 $21.02 $9.27 N/A $27.26 $46.70 $28.02 $46.70 $9.73 $46.70 N/A N/A 414.12 SUP HCPCS C1713 414.120 - SCREW BONE 4.5MM 120MM LC-DCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $47.00 $35.00 $9.27 $46.70 $21.02 $21.02 $21.02 $21.02 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $46.70 $46.70 $46.70 $9.73 $46.70 $18.68 $27.62 $46.70 $46.70 $46.70 $46.70 $35.25 $46.70 $46.70 $46.70 $23.35 $23.35 $36.99 $46.70 $37.36 $21.02 $9.27 N/A $27.26 $46.70 $46.70 $46.70 $9.73 $46.70 N/A N/A 414.125 SUP HCPCS C1713 414.125 - SCREW BONE 4.5MM 125MM LC-DCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $47.00 $35.00 $9.27 $46.70 $21.02 $21.02 $21.02 $21.02 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $46.70 $46.70 $46.70 $9.73 $46.70 $18.68 $27.62 $46.70 $46.70 $46.70 $46.70 $35.25 $46.70 $46.70 $46.70 $23.35 $23.35 $36.99 $46.70 $37.36 $21.02 $9.27 N/A $27.26 $46.70 $28.02 $46.70 $9.73 $46.70 N/A N/A 414.13 SUP HCPCS C1713 414.130 - SCREW BONE 4.5MM 130MM LC-DCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $47.00 $35.00 $9.27 $46.70 $21.02 $21.02 $21.02 $21.02 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $46.70 $46.70 $46.70 $9.73 $46.70 $18.68 $27.62 $46.70 $46.70 $46.70 $46.70 $35.25 $46.70 $46.70 $46.70 $23.35 $23.35 $36.99 $46.70 $37.36 $21.02 $9.27 N/A $27.26 $46.70 $28.02 $46.70 $9.73 $46.70 N/A N/A 414.135 SUP HCPCS C1713 414.135 - SCREW BONE 4.5MM 135MM LC-DCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $47.00 $35.00 $9.27 $46.70 $21.02 $21.02 $21.02 $21.02 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $46.70 $46.70 $46.70 $9.73 $46.70 $18.68 $27.62 $46.70 $46.70 $46.70 $46.70 $35.25 $46.70 $46.70 $46.70 $23.35 $23.35 $36.99 $46.70 $37.36 $21.02 $9.27 N/A $27.26 $46.70 $46.70 $46.70 $9.73 $46.70 N/A N/A 414.14 SUP HCPCS C1713 414.140 - SCREW BONE 4.5MM 140MM LC-DCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $47.00 $35.00 $9.27 $46.70 $21.02 $21.02 $21.02 $21.02 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $46.70 $46.70 $46.70 $9.73 $46.70 $46.70 $27.62 $46.70 $46.70 $46.70 $46.70 $35.25 $46.70 $46.70 $46.70 $23.35 $23.35 $36.99 $46.70 $37.36 $21.02 $9.27 N/A $27.26 $46.70 $28.02 $46.70 $9.73 $46.70 N/A N/A 414.222 SUP HCPCS C1713 414.222 - SCREW BONE 4.5MM 22MM SHAFT LC-DCP TITANIUM ORTHOPEDIC BOTH IP/OP $30.50 $23.00 $5.98 $30.13 $13.56 $13.56 $13.56 $13.56 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $30.13 $30.13 $30.13 $6.28 $30.13 $12.05 $17.82 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $13.56 $5.98 N/A $17.69 $30.13 $18.08 $30.13 $6.28 $30.13 N/A N/A 414.224 SUP HCPCS C1713 414.224 - SCREW BONE 4.5MM 24CM SHAFT LC-DCP TITANIUM ORTHOPEDIC BOTH IP/OP $30.50 $23.00 $5.98 $30.13 $13.56 $13.56 $13.56 $13.56 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $30.13 $30.13 $30.13 $6.28 $30.13 $12.05 $17.82 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $13.56 $5.98 N/A $17.69 $30.13 $18.08 $30.13 $6.28 $30.13 N/A N/A 414.226 SUP HCPCS C1713 414.226 - SCREW BONE 4.5MM 26MM SHAFT LC-DCP TITANIUM ORTHOPEDIC BOTH IP/OP $30.50 $23.00 $5.98 $30.13 $13.56 $13.56 $13.56 $13.56 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $30.13 $30.13 $30.13 $6.28 $30.13 $12.05 $17.82 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $13.56 $5.98 N/A $17.69 $30.13 $18.08 $30.13 $6.28 $30.13 N/A N/A 414.228 SUP HCPCS C1713 414.228 - SCREW BONE 4.5MM 28MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL BOTH IP/OP $30.50 $23.00 $5.98 $30.13 $13.56 $13.56 $13.56 $13.56 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $17.82 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $13.56 $5.98 N/A $17.69 $30.13 $18.08 $30.13 $6.28 $30.13 N/A N/A 414.23 SUP HCPCS C1713 414.230 - SCREW BONE 4.5MM 30MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL BOTH IP/OP $30.50 $23.00 $5.98 $30.13 $13.56 $13.56 $13.56 $13.56 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $30.13 $30.13 $30.13 $6.28 $30.13 $12.05 $17.82 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $13.56 $5.98 N/A $17.69 $30.13 $30.13 $30.13 $6.28 $30.13 N/A N/A 414.232 SUP HCPCS C1713 414.232 - SCREW BONE 4.5MM 32MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL BOTH IP/OP $31.50 $23.00 $6.16 $31.03 $13.96 $13.96 $13.96 $13.96 $31.03 $31.03 $31.03 $6.47 $31.03 $31.03 $31.03 $31.03 $31.03 $6.47 $31.03 $12.41 $18.35 $31.03 $31.03 $31.03 $31.03 $23.63 $31.03 $31.03 $31.03 $15.52 $15.52 $24.58 $31.03 $24.82 $13.96 $6.16 N/A $18.27 $31.03 $31.03 $31.03 $6.47 $31.03 N/A N/A 414.234 SUP HCPCS C1713 414.234 - SCREW BONE 4.5MM 34MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL BOTH IP/OP $31.50 $23.00 $6.16 $31.03 $13.96 $13.96 $13.96 $13.96 $31.03 $31.03 $31.03 $6.47 $31.03 $31.03 $31.03 $31.03 $31.03 $6.47 $31.03 $12.41 $18.35 $31.03 $31.03 $31.03 $31.03 $23.63 $31.03 $31.03 $31.03 $15.52 $15.52 $24.58 $31.03 $24.82 $13.96 $6.16 N/A $18.27 $31.03 $18.62 $31.03 $6.47 $31.03 N/A N/A 414.236 SUP HCPCS C1713 414.236 - SCREW BONE 4.5MM 36MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL BOTH IP/OP $31.50 $23.00 $6.16 $31.03 $13.96 $13.96 $13.96 $13.96 $31.03 $31.03 $31.03 $6.47 $31.03 $31.03 $31.03 $31.03 $31.03 $6.47 $31.03 $31.03 $18.35 $31.03 $31.03 $31.03 $31.03 $23.63 $31.03 $31.03 $31.03 $15.52 $15.52 $24.58 $31.03 $24.82 $13.96 $6.16 N/A $18.27 $31.03 $18.62 $31.03 $6.47 $31.03 N/A N/A 414.238 SUP HCPCS C1713 414.238 - SCREW BONE 4.5MM 38MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL BOTH IP/OP $30.50 $23.00 $5.98 $30.13 $13.56 $13.56 $13.56 $13.56 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $30.13 $30.13 $30.13 $6.28 $30.13 $12.05 $17.82 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $13.56 $5.98 N/A $17.69 $30.13 $18.08 $30.13 $6.28 $30.13 N/A N/A 414.24 SUP HCPCS C1713 414.240 - SCREW BONE 3.5MM 40MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL BOTH IP/OP $30.50 $23.00 $5.98 $30.13 $13.56 $13.56 $13.56 $13.56 $30.13 $30.13 $30.13 $6.28 $30.13 $30.13 $30.13 $30.13 $30.13 $6.28 $30.13 $12.05 $17.82 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $13.56 $5.98 N/A $17.69 $30.13 $18.08 $30.13 $6.28 $30.13 N/A N/A 414.242 SUP HCPCS C1713 414.242 - SCREW BONE 4.5MM 42MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $13.38 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $33.45 $33.45 $6.97 $33.45 N/A N/A 414.244 SUP HCPCS C1713 414.244 - SCREW BONE 4.5MM 44MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $13.38 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $20.07 $33.45 $6.97 $33.45 N/A N/A 414.246 SUP HCPCS C1713 414.246 - SCREW BONE 4.5MM 46MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL BOTH IP/OP $34.50 $26.00 $6.84 $34.45 $15.50 $15.50 $15.50 $15.50 $34.45 $34.45 $34.45 $7.18 $34.45 $34.45 $34.45 $34.45 $34.45 $7.18 $34.45 $34.45 $20.38 $34.45 $34.45 $34.45 $34.45 $25.88 $34.45 $34.45 $34.45 $17.23 $17.23 $27.28 $34.45 $27.56 $15.50 $6.84 N/A $20.01 $34.45 $20.67 $34.45 $7.18 $34.45 N/A N/A 414.248 SUP HCPCS C1713 414.248 - SCREW BONE 4.5MM 48MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL BOTH IP/OP $34.50 $26.00 $6.84 $34.45 $15.50 $15.50 $15.50 $15.50 $34.45 $34.45 $34.45 $7.18 $34.45 $34.45 $34.45 $34.45 $34.45 $7.18 $34.45 $34.45 $20.38 $34.45 $34.45 $34.45 $34.45 $25.88 $34.45 $34.45 $34.45 $17.23 $17.23 $27.28 $34.45 $27.56 $15.50 $6.84 N/A $20.01 $34.45 $20.67 $34.45 $7.18 $34.45 N/A N/A 414.25 SUP HCPCS C1713 414.250 - SCREW BONE 4.5MM 50MM LC-DCP TITANIUM FEMUR MEDIAL PROXIMAL BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $20.07 $33.45 $6.97 $33.45 N/A N/A 414.252 SUP HCPCS C1713 414.252 - SCREW BONE 4.5MM 52MM SHAFT LC-DCP TITANIUM ORTHOPEDIC BOTH IP/OP $34.50 $26.00 $6.84 $34.45 $15.50 $15.50 $15.50 $15.50 $34.45 $34.45 $34.45 $7.18 $34.45 $34.45 $34.45 $34.45 $34.45 $7.18 $34.45 $34.45 $20.38 $34.45 $34.45 $34.45 $34.45 $25.88 $34.45 $34.45 $34.45 $17.23 $17.23 $27.28 $34.45 $27.56 $15.50 $6.84 N/A $20.01 $34.45 $20.67 $34.45 $7.18 $34.45 N/A N/A 414.254 SUP HCPCS C1713 414.254 - SCREW BONE 4.5MM 54MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $33.45 $33.45 $6.97 $33.45 N/A N/A 414.256 SUP HCPCS C1713 414.256 - SCREW BONE 4.5MM 56MM SHAFT LC-DCP TITANIUM ORTHOPEDIC BOTH IP/OP $34.50 $26.00 $6.84 $34.45 $15.50 $15.50 $15.50 $15.50 $34.45 $34.45 $34.45 $7.18 $34.45 $34.45 $34.45 $34.45 $34.45 $7.18 $34.45 $34.45 $20.38 $34.45 $34.45 $34.45 $34.45 $25.88 $34.45 $34.45 $34.45 $17.23 $17.23 $27.28 $34.45 $27.56 $15.50 $6.84 N/A $20.01 $34.45 $34.45 $34.45 $7.18 $34.45 N/A N/A 414.258 SUP HCPCS C1713 414.258 - SCREW BONE 4.5MM 58MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $20.07 $33.45 $6.97 $33.45 N/A N/A 414.26 SUP HCPCS C1713 414.260 - SCREW BONE 4.5MM 60MM SHAFT LC-DCP TITANIUM ORTHOPEDIC BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $20.07 $33.45 $6.97 $33.45 N/A N/A 414.264 SUP HCPCS C1713 414.264 - SCREW BONE 4.5MM 64MM 20MM PTTHRD SHAFT LC-DCP TITANIUM BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $20.07 $33.45 $6.97 $33.45 N/A N/A 414.268 SUP HCPCS C1713 414.268 - SCREW BONE 4.5MM 68MM SHAFT LC-DCP TITANIUM ORTHOPEDIC BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $13.38 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $20.07 $33.45 $6.97 $33.45 N/A N/A 414.272 SUP HCPCS C1713 414.272 - SCREW BONE 4.5MM 72MM SHAFT LCP TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $33.50 $25.00 $6.64 $33.45 $15.05 $15.05 $15.05 $15.05 $33.45 $33.45 $33.45 $6.97 $33.45 $33.45 $33.45 $33.45 $33.45 $6.97 $33.45 $13.38 $19.79 $33.45 $33.45 $33.45 $33.45 $25.13 $33.45 $33.45 $33.45 $16.73 $16.73 $26.49 $33.45 $26.76 $15.05 $6.64 N/A $19.43 $33.45 $33.45 $33.45 $6.97 $33.45 N/A N/A 414.276 SUP HCPCS C1713 414.276 - SCREW BONE 4.5MM 76MM SHAFT LC-DCP TITANIUM ORTHOPEDIC BOTH IP/OP $40.00 $30.00 $7.89 $39.75 $17.89 $17.89 $17.89 $17.89 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $39.75 $39.75 $39.75 $8.28 $39.75 $15.90 $23.51 $39.75 $39.75 $39.75 $39.75 $30.00 $39.75 $39.75 $39.75 $19.88 $19.88 $31.48 $39.75 $31.80 $17.89 $7.89 N/A $23.20 $39.75 $23.85 $39.75 $8.28 $39.75 N/A N/A 414.28 SUP HCPCS C1713 414.280 - SCREW BONE 4.5MM 80MM SHAFT LC-DCP TITANIUM ORTHOPEDIC BOTH IP/OP $40.00 $30.00 $7.89 $39.75 $17.89 $17.89 $17.89 $17.89 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $23.51 $39.75 $39.75 $39.75 $39.75 $30.00 $39.75 $39.75 $39.75 $19.88 $19.88 $31.48 $39.75 $31.80 $17.89 $7.89 N/A $23.20 $39.75 $23.85 $39.75 $8.28 $39.75 N/A N/A 414.285 SUP HCPCS C1713 414.285 - SCREW BONE 4.5MM 85MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $40.00 $30.00 $7.89 $39.75 $17.89 $17.89 $17.89 $17.89 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $23.51 $39.75 $39.75 $39.75 $39.75 $30.00 $39.75 $39.75 $39.75 $19.88 $19.88 $31.48 $39.75 $31.80 $17.89 $7.89 N/A $23.20 $39.75 $39.75 $39.75 $8.28 $39.75 N/A N/A 414.29 SUP HCPCS C1713 414.290 - SCREW BONE 4.5MM 90MM SHAFT LC-DCP TITANIUM CORTICAL NONSTRL BOTH IP/OP $40.00 $30.00 $7.89 $39.75 $17.89 $17.89 $17.89 $17.89 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $23.51 $39.75 $39.75 $39.75 $39.75 $30.00 $39.75 $39.75 $39.75 $19.88 $19.88 $31.48 $39.75 $31.80 $17.89 $7.89 N/A $23.20 $39.75 $39.75 $39.75 $8.28 $39.75 N/A N/A 414.295 SUP HCPCS C1713 414.295 - SCREW BONE 4.5MM 95MM SHAFT LC-DCP TITANIUM ORTHOPEDIC BOTH IP/OP $40.00 $30.00 $7.89 $39.75 $17.89 $17.89 $17.89 $17.89 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $23.51 $39.75 $39.75 $39.75 $39.75 $30.00 $39.75 $39.75 $39.75 $19.88 $19.88 $31.48 $39.75 $31.80 $17.89 $7.89 N/A $23.20 $39.75 $39.75 $39.75 $8.28 $39.75 N/A N/A 414.3 SUP HCPCS C1713 414.300 - SCREW BONE 4.5MM 100MM SHAFT LC-DCP TITANIUM ORTHOPEDIC BOTH IP/OP $40.00 $30.00 $7.89 $39.75 $17.89 $17.89 $17.89 $17.89 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $23.51 $39.75 $39.75 $39.75 $39.75 $30.00 $39.75 $39.75 $39.75 $19.88 $19.88 $31.48 $39.75 $31.80 $17.89 $7.89 N/A $23.20 $39.75 $23.85 $39.75 $8.28 $39.75 N/A N/A 414.305 SUP HCPCS C1713 414.305 - SCREW BONE 4.5MM 105MM SHAFT LC-DCP TITANIUM SHAFT NONSTRL BOTH IP/OP $40.00 $30.00 $7.89 $39.75 $17.89 $17.89 $17.89 $17.89 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $39.75 $39.75 $39.75 $8.28 $39.75 $15.90 $23.51 $39.75 $39.75 $39.75 $39.75 $30.00 $39.75 $39.75 $39.75 $19.88 $19.88 $31.48 $39.75 $31.80 $17.89 $7.89 N/A $23.20 $39.75 $23.85 $39.75 $8.28 $39.75 N/A N/A 414.31 SUP HCPCS C1713 414.310 - SCREW BONE 4.5MM 110MM SHAAFT LC-DCP TITANIUM CORTICAL BOTH IP/OP $40.00 $30.00 $7.89 $39.75 $17.89 $17.89 $17.89 $17.89 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $39.75 $39.75 $39.75 $8.28 $39.75 $39.75 $23.51 $39.75 $39.75 $39.75 $39.75 $30.00 $39.75 $39.75 $39.75 $19.88 $19.88 $31.48 $39.75 $31.80 $17.89 $7.89 N/A $23.20 $39.75 $39.75 $39.75 $8.28 $39.75 N/A N/A 414.52 SUP HCPCS C1713 414.520 - SCREW BONE 1/3 THREAD LARGE HEXAGON HEMISPHERE REVERSE CUT BOTH IP/OP $366.00 $271.00 $72.59 $383.13 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $153.25 $216.34 $365.75 $383.13 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $219.45 $365.75 $76.22 $365.75 N/A N/A 414.522 SUP HCPCS C1713 414.522 - SCREW BONE 1/3 THREAD 4.5MM 6.5MM 22MM CANN LARGE HEXAGONAL BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 414.524 SUP HCPCS C1713 414.524 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 414.526 SUP HCPCS C1713 414.526 - SCREW BONE 1/3 THREAD 4.5MM 6.5MM 26MM CANN LARGE HEXAGONAL BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 414.528 SUP HCPCS C1713 414.528 - SCREW BONE 1/3 THREAD 4.5MM 6.5MM 28MM CANN LARGE HEXAGONAL BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 414.53 SUP HCPCS C1713 414.530 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $366.00 $271.00 $72.59 $383.13 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $383.13 $216.34 $365.75 $383.13 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $219.45 $365.75 $76.22 $365.75 N/A N/A 414.532 SUP HCPCS C1713 414.532 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 414.534 SUP HCPCS C1713 414.534 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 414.536 SUP HCPCS C1713 414.536 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 414.538 SUP HCPCS C1713 414.538 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 414.54 SUP HCPCS C1713 414.540 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $366.00 $271.00 $72.59 $383.13 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $153.25 $216.34 $365.75 $383.13 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $365.75 $365.75 $76.22 $365.75 N/A N/A 414.542 SUP HCPCS C1713 414.542 - SCREW BONE 1/3 THREAD 4.5MM 6.5MM 42MM CANN LARGE HEXAGONAL BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 414.544 SUP HCPCS C1713 414.544 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 414.546 SUP HCPCS C1713 414.546 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 414.548 SUP HCPCS C1713 414.548 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 414.55 SUP HCPCS C1713 414.550 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $366.00 $271.00 $72.59 $383.13 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $153.25 $216.34 $365.75 $383.13 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $365.75 $365.75 $76.22 $365.75 N/A N/A 414.552 SUP HCPCS C1713 414.552 - SCREW BONE 1/3 THREAD 4.5MM 6.5MM 52MM CANN LARGE HEXAGONAL BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 414.554 SUP HCPCS C1713 414.554 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 414.556 SUP HCPCS C1713 414.556 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $153.25 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $226.04 $376.73 $78.51 $376.73 N/A N/A 414.56 SUP HCPCS C1713 414.560 - SCREW BONE 1/3 THREAD 4.5MM 6.5MM 60MM CANN LARGE HEXAGONAL BOTH IP/OP $366.00 $271.00 $72.59 $383.13 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $153.25 $216.34 $365.75 $383.13 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $365.75 $365.75 $76.22 $365.75 N/A N/A 414.564 SUP HCPCS C1713 414.564 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 414.568 SUP HCPCS C1713 414.568 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 414.572 SUP HCPCS C1713 414.572 - SCREW BONE SHORT THREAD REVERSE CUT FLUTE 4.5MM 6.5MM 1.7MM BOTH IP/OP $377.00 $279.00 $74.77 $383.13 $169.53 $169.53 $169.53 $169.53 $376.73 $376.73 $376.73 $78.52 $376.73 $376.73 $376.73 $376.73 $376.73 $78.51 $376.73 $383.13 $222.84 $376.73 $383.13 $376.73 $376.73 $282.75 $376.73 $376.73 $376.73 $188.37 $188.37 $298.37 $376.73 $301.38 $169.53 $74.77 N/A $218.66 $376.73 $376.73 $376.73 $78.51 $376.73 N/A N/A 414.576 SUP HCPCS C1713 414.576 - SCREW BONE PTHRD 4.5MM 76MM CANN TITANIUM NONSTRL BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $387.98 $387.98 $80.86 $387.98 N/A N/A 414.58 SUP HCPCS C1713 414.580 - SCREW BONE PTHRD 4.5MM 80MM CANN TITANIUM NONSTRL BOTH IP/OP $377.00 $279.00 $74.76 $394.58 $169.51 $169.51 $169.51 $169.51 $376.68 $376.68 $376.68 $78.51 $376.68 $376.68 $376.68 $376.68 $376.68 $78.50 $376.68 $394.58 $222.81 $376.68 $394.58 $376.68 $376.68 $282.75 $376.68 $376.68 $376.68 $188.34 $188.34 $298.33 $376.68 $301.34 $169.51 $74.76 N/A $218.66 $376.68 $226.01 $376.68 $78.50 $376.68 N/A N/A 414.72 SUP HCPCS C1713 414.720 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 20MM CANN TITANIUM BOTH IP/OP $377.00 $279.00 $74.76 $394.58 $169.51 $169.51 $169.51 $169.51 $376.68 $376.68 $376.68 $78.51 $376.68 $376.68 $376.68 $376.68 $376.68 $78.50 $376.68 $394.58 $222.81 $376.68 $394.58 $376.68 $376.68 $282.75 $376.68 $376.68 $376.68 $188.34 $188.34 $298.33 $376.68 $301.34 $169.51 $74.76 N/A $218.66 $376.68 $226.01 $376.68 $78.50 $376.68 N/A N/A 414.722 SUP HCPCS C1713 414.722 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 22MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.724 SUP HCPCS C1713 414.724 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 24MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.726 SUP HCPCS C1713 414.726 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 26MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.728 SUP HCPCS C1713 414.728 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 28MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.73 SUP HCPCS C1713 414.730 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 30MM CANN TITANIUM BOTH IP/OP $377.00 $279.00 $74.76 $394.58 $169.51 $169.51 $169.51 $169.51 $376.68 $376.68 $376.68 $78.51 $376.68 $376.68 $376.68 $376.68 $376.68 $78.50 $376.68 $394.58 $222.81 $376.68 $394.58 $376.68 $376.68 $282.75 $376.68 $376.68 $376.68 $188.34 $188.34 $298.33 $376.68 $301.34 $169.51 $74.76 N/A $218.66 $376.68 $226.01 $376.68 $78.50 $376.68 N/A N/A 414.732 SUP HCPCS C1713 414.732 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 32MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.734 SUP HCPCS C1713 414.734 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 34MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.736 SUP HCPCS C1713 414.736 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 36MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.738 SUP HCPCS C1713 414.738 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 38MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.74 SUP HCPCS C1713 414.740 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 40MM CANN TITANIUM BOTH IP/OP $377.00 $279.00 $74.76 $394.58 $169.51 $169.51 $169.51 $169.51 $376.68 $376.68 $376.68 $78.51 $376.68 $376.68 $376.68 $376.68 $376.68 $78.50 $376.68 $394.58 $222.81 $376.68 $394.58 $376.68 $376.68 $282.75 $376.68 $376.68 $376.68 $188.34 $188.34 $298.33 $376.68 $301.34 $169.51 $74.76 N/A $218.66 $376.68 $226.01 $376.68 $78.50 $376.68 N/A N/A 414.742 SUP HCPCS C1713 414.742 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 42MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.744 SUP HCPCS C1713 414.744 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 44MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.746 SUP HCPCS C1713 414.746 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 46MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.748 SUP HCPCS C1713 414.748 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 48MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.75 SUP HCPCS C1713 414.750 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 50MM CANN TITANIUM BOTH IP/OP $377.00 $279.00 $74.76 $394.58 $169.51 $169.51 $169.51 $169.51 $376.68 $376.68 $376.68 $78.51 $376.68 $376.68 $376.68 $376.68 $376.68 $78.50 $376.68 $394.58 $222.81 $376.68 $394.58 $376.68 $376.68 $282.75 $376.68 $376.68 $376.68 $188.34 $188.34 $298.33 $376.68 $301.34 $169.51 $74.76 N/A $218.66 $376.68 $226.01 $376.68 $78.50 $376.68 N/A N/A 414.752 SUP HCPCS C1713 414.752 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 52MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.754 SUP HCPCS C1713 414.754 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 54MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $157.83 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.756 SUP HCPCS C1713 414.756 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 56MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $157.83 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.76 SUP HCPCS C1713 414.760 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 60MM CANN TITANIUM BOTH IP/OP $377.00 $279.00 $74.76 $394.58 $169.51 $169.51 $169.51 $169.51 $376.68 $376.68 $376.68 $78.51 $376.68 $376.68 $376.68 $376.68 $376.68 $78.50 $376.68 $157.83 $222.81 $376.68 $394.58 $376.68 $376.68 $282.75 $376.68 $376.68 $376.68 $188.34 $188.34 $298.33 $376.68 $301.34 $169.51 $74.76 N/A $218.66 $376.68 $226.01 $376.68 $78.50 $376.68 N/A N/A 414.764 SUP HCPCS C1713 414.764 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 64MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.768 SUP HCPCS C1713 414.768 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 68MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $157.83 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $387.98 $387.98 $80.86 $387.98 N/A N/A 414.772 SUP HCPCS C1713 414.772 - SCREW BONE FULTHD 4.5MM 6.5MM 1.75MM 72MM CANN TITANIUM BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $157.83 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $387.98 $387.98 $80.86 $387.98 N/A N/A 414.776 SUP HCPCS C1713 414.776 - SCREW BONE FULTHD 4.5MM 76MM CANN TITANIUM NONSTRL BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $157.83 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.777 SUP HCPCS C1713 414.777 - SCREW BONE FULTHD 4.5MM 77MM CANN TITANIUM NONSTRL BOTH IP/OP $388.00 $287.00 $77.00 $394.58 $174.59 $174.59 $174.59 $174.59 $387.98 $387.98 $387.98 $80.86 $387.98 $387.98 $387.98 $387.98 $387.98 $80.86 $387.98 $394.58 $229.49 $387.98 $394.58 $387.98 $387.98 $291.00 $387.98 $387.98 $387.98 $193.99 $193.99 $307.28 $387.98 $310.38 $174.59 $77.00 N/A $225.04 $387.98 $232.79 $387.98 $80.86 $387.98 N/A N/A 414.814 SUP HCPCS C1713 414.814 - SCREW BONE 4.5MM 8MM 14MM LARGE HEXAGONAL SOCKET SELF TAP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 414.816 SUP HCPCS C1713 414.816 - SCREW BONE 4.5MM 8MM 16MM LARGE HEXAGONAL SOCKET SELF TAP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.818 SUP HCPCS C1713 414.818 - SCREW BONE 4.5MM 8MM 18MM HEXAGONAL SOCKET SELF TAP TIP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.82 SUP HCPCS C1713 414.820 - SCREW BONE 4.5MM 8MM 20MM LARGE HEXAGONAL SOCKET SELF TAP BOTH IP/OP $39.00 $29.00 $7.72 $40.73 $17.50 $17.50 $17.50 $17.50 $38.88 $38.88 $38.88 $8.10 $38.88 $38.88 $38.88 $38.88 $38.88 $8.10 $38.88 $16.29 $23.00 $38.88 $40.73 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $17.50 $7.72 N/A $22.62 $38.88 $23.33 $38.88 $8.10 $38.88 N/A N/A 414.822 SUP HCPCS C1713 414.822 - SCREW BONE 4.5MM 8MM 22MM HEXAGONAL SOCKET SELF TAP TIP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.29 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 414.824 SUP HCPCS C1713 414.824 - SCREW BONE 4.5MM 8MM 24MM HEXAGONAL SOCKET SELF TAP TIP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.29 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 414.826 SUP HCPCS C1713 414.826 - SCREW BONE 4.5MM 8MM 26MM HEXAGONAL SOCKET SELF TAP LC-DCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.828 SUP HCPCS C1713 414.828 - SCREW BONE 4.5MM 8MM 28MM HEXAGONAL SOCKET SELF TAP LC-DCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.29 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.83 SUP HCPCS C1713 414.830 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 30MM SELF TAP SOCKET BOTH IP/OP $39.00 $29.00 $7.72 $40.73 $17.50 $17.50 $17.50 $17.50 $38.88 $38.88 $38.88 $8.10 $38.88 $38.88 $38.88 $38.88 $38.88 $8.10 $38.88 $16.29 $23.00 $38.88 $40.73 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $17.50 $7.72 N/A $22.62 $38.88 $23.33 $38.88 $8.10 $38.88 N/A N/A 414.832 SUP HCPCS C1713 414.832 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 32MM SELF TAP SOCKET BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.29 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.834 SUP HCPCS C1713 414.834 - SCREW BONE 4.5MM 8MM 34MM HEXAGONAL SOCKET SELF TAP LC-DCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 414.836 SUP HCPCS C1713 414.836 - SCREW BONE LARGE HEXAGON 4.5MM 8MM 36MM SELF TAP SOCKET BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.838 SUP HCPCS C1713 414.838 - SCREW BONE 4.5MM 8MM 38MM HEXAGONAL SOCKET SELF TAP LC-DCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.29 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.84 SUP HCPCS C1713 414.840 - SCREW BONE 4.5MM 8MM 40MM HEXAGONAL SOCKET SELF TAP LC-DCP BOTH IP/OP $39.00 $29.00 $7.72 $40.73 $17.50 $17.50 $17.50 $17.50 $38.88 $38.88 $38.88 $8.10 $38.88 $38.88 $38.88 $38.88 $38.88 $8.10 $38.88 $16.29 $23.00 $38.88 $40.73 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $17.50 $7.72 N/A $22.62 $38.88 $38.88 $38.88 $8.10 $38.88 N/A N/A 414.842 SUP HCPCS C1713 414.842 - SCREW BONE 4.5MM 8MM 42MM HEXAGONAL SOCKET SELF TAP LC-DCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.844 SUP HCPCS C1713 414.844 - SCREW BONE 4.5MM 8MM 44MM HEXAGONAL SOCKET SELF TAP LC-DCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.29 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.846 SUP HCPCS C1713 414.846 - SCREW BONE 4.5MM 8MM 46MM HEXAGONAL SOCKET SELF TAP LC-DCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.29 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 414.848 SUP HCPCS C1713 414.848 - SCREW BONE 4.5MM 48MM SELF TAP LCP TITANIUM CORTEX LARGE BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.29 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 414.85 SUP HCPCS C1713 414.850 - SCREW BONE 4.5MM 50MM SELF TAP LCP TITANIUM CORTEX LARGE BOTH IP/OP $39.00 $29.00 $7.72 $40.73 $17.50 $17.50 $17.50 $17.50 $38.88 $38.88 $38.88 $8.10 $38.88 $38.88 $38.88 $38.88 $38.88 $8.10 $38.88 $40.73 $23.00 $38.88 $40.73 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $17.50 $7.72 N/A $22.62 $38.88 $23.33 $38.88 $8.10 $38.88 N/A N/A 414.852 SUP HCPCS C1713 414.852 - SCREW BONE 4.5MM 52MM SELF TAP LCP TITANIUM CORTEX LARGE BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.854 SUP HCPCS C1713 414.854 - SCREW BONE 4.5MM 54MM SELF TAP LCP TITANIUM CORTEX LARGE BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.856 SUP HCPCS C1713 414.856 - SCREW BONE 4.5MM 56MM SELF TAP LCP TITANIUM CORTEX LARGE BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 414.858 SUP HCPCS C1713 414.858 - SCREW BONE 4.5MM 58MM SELF TAP LCP TITANIUM CORTEX LARGE BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.86 SUP HCPCS C1713 414.860 - SCREW BONE 4.5MM 8MM 60MM HEXAGONAL SOCKET SELF TAP LC-DCP BOTH IP/OP $39.00 $29.00 $7.72 $40.73 $17.50 $17.50 $17.50 $17.50 $38.88 $38.88 $38.88 $8.10 $38.88 $38.88 $38.88 $38.88 $38.88 $8.10 $38.88 $40.73 $23.00 $38.88 $40.73 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $17.50 $7.72 N/A $22.62 $38.88 $23.33 $38.88 $8.10 $38.88 N/A N/A 414.862 SUP HCPCS C1713 414.862 - SCREW BONE 4.5MM 62MM SELF TAP LCP TITANIUM CORTEX LARGE BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.29 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.864 SUP HCPCS C1713 414.864 - SCREW BONE 4.5MM 64MM SELF TAP LCP TITANIUM CORTEX LARGE BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.29 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 414.866 SUP HCPCS C1713 414.866 - SCREW BONE 4.5MM 8MM 66MM HEXAGONAL SOCKET SELF TAP LC-DCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.29 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $40.05 $40.05 $8.35 $40.05 N/A N/A 414.868 SUP HCPCS C1713 414.868 - SCREW BONE 4.5MM 8MM 68MM HEXAGONAL SOCKET SELF TAP LC-DCP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $40.73 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.87 SUP HCPCS C1713 414.870 - SCREW BONE 4.5MM 70MM SELF TAP LCP TITANIUM CORTEX LARGE BOTH IP/OP $39.00 $29.00 $7.72 $40.73 $17.50 $17.50 $17.50 $17.50 $38.88 $38.88 $38.88 $8.10 $38.88 $38.88 $38.88 $38.88 $38.88 $8.10 $38.88 $16.29 $23.00 $38.88 $40.73 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $17.50 $7.72 N/A $22.62 $38.88 $23.33 $38.88 $8.10 $38.88 N/A N/A 414.872 SUP HCPCS C1713 414.872 - SCREW BONE 4.5MM 8MM 72MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $40.50 $30.00 $7.95 $40.73 $18.02 $18.02 $18.02 $18.02 $40.05 $40.05 $40.05 $8.35 $40.05 $40.05 $40.05 $40.05 $40.05 $8.35 $40.05 $16.29 $23.69 $40.05 $40.73 $40.05 $40.05 $30.38 $40.05 $40.05 $40.05 $20.03 $20.03 $31.72 $40.05 $32.04 $18.02 $7.95 N/A $23.49 $40.05 $24.03 $40.05 $8.35 $40.05 N/A N/A 414.876 SUP HCPCS C1713 414.876 - SCREW BONE 4.5MM 8MM 76MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $64.00 $47.00 $12.69 $65.03 $28.78 $28.78 $28.78 $28.78 $63.95 $63.95 $63.95 $13.33 $63.95 $63.95 $63.95 $63.95 $63.95 $13.33 $63.95 $26.01 $37.83 $63.95 $65.03 $63.95 $63.95 $48.00 $63.95 $63.95 $63.95 $31.98 $31.98 $50.65 $63.95 $51.16 $28.78 $12.69 N/A $37.12 $63.95 $38.37 $63.95 $13.33 $63.95 N/A N/A 414.88 SUP HCPCS C1713 414.880 - SCREW BONE 4.5MM 8MM 80MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $62.50 $46.00 $12.32 $65.03 $27.94 $27.94 $27.94 $27.94 $62.08 $62.08 $62.08 $12.94 $62.08 $62.08 $62.08 $62.08 $62.08 $12.94 $62.08 $65.03 $36.72 $62.08 $65.03 $62.08 $62.08 $46.88 $62.08 $62.08 $62.08 $31.04 $31.04 $49.17 $62.08 $49.66 $27.94 $12.32 N/A $36.25 $62.08 $37.25 $62.08 $12.94 $62.08 N/A N/A 414.885 SUP HCPCS C1713 414.885 - SCREW BONE 4.5MM 8MM 85MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $64.00 $47.00 $12.69 $65.03 $28.78 $28.78 $28.78 $28.78 $63.95 $63.95 $63.95 $13.33 $63.95 $63.95 $63.95 $63.95 $63.95 $13.33 $63.95 $26.01 $37.83 $63.95 $65.03 $63.95 $63.95 $48.00 $63.95 $63.95 $63.95 $31.98 $31.98 $50.65 $63.95 $51.16 $28.78 $12.69 N/A $37.12 $63.95 $38.37 $63.95 $13.33 $63.95 N/A N/A 414.89 SUP HCPCS C1713 414.890 - SCREW BONE 4.5MM 8MM 90MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $62.50 $46.00 $12.32 $65.03 $27.94 $27.94 $27.94 $27.94 $62.08 $62.08 $62.08 $12.94 $62.08 $62.08 $62.08 $62.08 $62.08 $12.94 $62.08 $26.01 $36.72 $62.08 $65.03 $62.08 $62.08 $46.88 $62.08 $62.08 $62.08 $31.04 $31.04 $49.17 $62.08 $49.66 $27.94 $12.32 N/A $36.25 $62.08 $62.08 $62.08 $12.94 $62.08 N/A N/A 414.895 SUP HCPCS C1713 414.895 - SCREW BONE 4.5MM 8MM 95MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $64.00 $47.00 $12.69 $65.03 $28.78 $28.78 $28.78 $28.78 $63.95 $63.95 $63.95 $13.33 $63.95 $63.95 $63.95 $63.95 $63.95 $13.33 $63.95 $26.01 $37.83 $63.95 $65.03 $63.95 $63.95 $48.00 $63.95 $63.95 $63.95 $31.98 $31.98 $50.65 $63.95 $51.16 $28.78 $12.69 N/A $37.12 $63.95 $63.95 $63.95 $13.33 $63.95 N/A N/A 414.9 SUP HCPCS C1713 414.900 - SCREW BONE 4.5MM 8MM 100MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $62.50 $46.00 $12.32 $65.03 $27.94 $27.94 $27.94 $27.94 $62.08 $62.08 $62.08 $12.94 $62.08 $62.08 $62.08 $62.08 $62.08 $12.94 $62.08 $65.03 $36.72 $62.08 $65.03 $62.08 $62.08 $46.88 $62.08 $62.08 $62.08 $31.04 $31.04 $49.17 $62.08 $49.66 $27.94 $12.32 N/A $36.25 $62.08 $37.25 $62.08 $12.94 $62.08 N/A N/A 414.905 SUP HCPCS C1713 414.905 - SCREW BONE 4.5MM 8MM 105MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $64.00 $47.00 $12.69 $65.03 $28.78 $28.78 $28.78 $28.78 $63.95 $63.95 $63.95 $13.33 $63.95 $63.95 $63.95 $63.95 $63.95 $13.33 $63.95 $26.01 $37.83 $63.95 $65.03 $63.95 $63.95 $48.00 $63.95 $63.95 $63.95 $31.98 $31.98 $50.65 $63.95 $51.16 $28.78 $12.69 N/A $37.12 $63.95 $38.37 $63.95 $13.33 $63.95 N/A N/A 414.91 SUP HCPCS C1713 414.910 - SCREW BONE 4.5MM 8MM 110MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $62.50 $46.00 $12.32 $65.03 $27.94 $27.94 $27.94 $27.94 $62.08 $62.08 $62.08 $12.94 $62.08 $62.08 $62.08 $62.08 $62.08 $12.94 $62.08 $65.03 $36.72 $62.08 $65.03 $62.08 $62.08 $46.88 $62.08 $62.08 $62.08 $31.04 $31.04 $49.17 $62.08 $49.66 $27.94 $12.32 N/A $36.25 $62.08 $37.25 $62.08 $12.94 $62.08 N/A N/A 414.915 SUP HCPCS C1713 414.915 - SCREW BONE 4.5MM 8MM 115MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $64.00 $47.00 $12.69 $65.03 $28.78 $28.78 $28.78 $28.78 $63.95 $63.95 $63.95 $13.33 $63.95 $63.95 $63.95 $63.95 $63.95 $13.33 $63.95 $26.01 $37.83 $63.95 $65.03 $63.95 $63.95 $48.00 $63.95 $63.95 $63.95 $31.98 $31.98 $50.65 $63.95 $51.16 $28.78 $12.69 N/A $37.12 $63.95 $38.37 $63.95 $13.33 $63.95 N/A N/A 414.92 SUP HCPCS C1713 414.920 - SCREW BONE 4.5MM 8MM 120MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $62.50 $46.00 $12.32 $65.03 $27.94 $27.94 $27.94 $27.94 $62.08 $62.08 $62.08 $12.94 $62.08 $62.08 $62.08 $62.08 $62.08 $12.94 $62.08 $65.03 $36.72 $62.08 $65.03 $62.08 $62.08 $46.88 $62.08 $62.08 $62.08 $31.04 $31.04 $49.17 $62.08 $49.66 $27.94 $12.32 N/A $36.25 $62.08 $62.08 $62.08 $12.94 $62.08 N/A N/A 414.925 SUP HCPCS C1713 414.925 - SCREW BONE 4.5MM 8MM 125MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $64.00 $47.00 $12.69 $65.03 $28.78 $28.78 $28.78 $28.78 $63.95 $63.95 $63.95 $13.33 $63.95 $63.95 $63.95 $63.95 $63.95 $13.33 $63.95 $26.01 $37.83 $63.95 $65.03 $63.95 $63.95 $48.00 $63.95 $63.95 $63.95 $31.98 $31.98 $50.65 $63.95 $51.16 $28.78 $12.69 N/A $37.12 $63.95 $63.95 $63.95 $13.33 $63.95 N/A N/A 414.93 SUP HCPCS C1713 414.930 - SCREW BONE 4.5MM 8MM 130MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $62.50 $46.00 $12.32 $65.03 $27.94 $27.94 $27.94 $27.94 $62.08 $62.08 $62.08 $12.94 $62.08 $62.08 $62.08 $62.08 $62.08 $12.94 $62.08 $65.03 $36.72 $62.08 $65.03 $62.08 $62.08 $46.88 $62.08 $62.08 $62.08 $31.04 $31.04 $49.17 $62.08 $49.66 $27.94 $12.32 N/A $36.25 $62.08 $62.08 $62.08 $12.94 $62.08 N/A N/A 414.935 SUP HCPCS C1713 414.935 - SCREW BONE 4.5MM 8MM 135MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $64.00 $47.00 $12.69 $65.03 $28.78 $28.78 $28.78 $28.78 $63.95 $63.95 $63.95 $13.33 $63.95 $63.95 $63.95 $63.95 $63.95 $13.33 $63.95 $26.01 $37.83 $63.95 $65.03 $63.95 $63.95 $48.00 $63.95 $63.95 $63.95 $31.98 $31.98 $50.65 $63.95 $51.16 $28.78 $12.69 N/A $37.12 $63.95 $38.37 $63.95 $13.33 $63.95 N/A N/A 414.94 SUP HCPCS C1713 414.940 - SCREW BONE 4.5MM 8MM 140MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $62.50 $46.00 $12.32 $65.03 $27.94 $27.94 $27.94 $27.94 $62.08 $62.08 $62.08 $12.94 $62.08 $62.08 $62.08 $62.08 $62.08 $12.94 $62.08 $65.03 $36.72 $62.08 $65.03 $62.08 $62.08 $46.88 $62.08 $62.08 $62.08 $31.04 $31.04 $49.17 $62.08 $49.66 $27.94 $12.32 N/A $36.25 $62.08 $37.25 $62.08 $12.94 $62.08 N/A N/A 414.945 SUP HCPCS C1713 414.945 - SCREW BONE 4.5MM 8MM 145MM LARGE HEXAGONAL SOCKET SLFTAP BOTH IP/OP $64.00 $47.00 $12.69 $65.03 $28.78 $28.78 $28.78 $28.78 $63.95 $63.95 $63.95 $13.33 $63.95 $63.95 $63.95 $63.95 $63.95 $13.33 $63.95 $26.01 $37.83 $63.95 $65.03 $63.95 $63.95 $48.00 $63.95 $63.95 $63.95 $31.98 $31.98 $50.65 $63.95 $51.16 $28.78 $12.69 N/A $37.12 $63.95 $38.37 $63.95 $13.33 $63.95 N/A N/A 416.03 SUP HCPCS C1713 416.030 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 30MM 16MM SOCKET LC-DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $62.18 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 416.035 SUP HCPCS C1713 416.035 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 35MM 16MM SOCKET LC-DCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 416.04 SUP HCPCS C1713 416.040 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 40MM 16MM SOCKET LC-DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $62.18 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 416.045 SUP HCPCS C1713 416.045 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 45MM 16MM SOCKET LC-DCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 416.05 SUP HCPCS C1713 416.050 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 50MM 16MM SOCKET LC-DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $59.35 $59.35 $12.37 $59.35 N/A N/A 416.055 SUP HCPCS C1713 416.055 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 55MM 16MM SOCKET LC-DCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $62.18 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 416.06 SUP HCPCS C1713 416.060 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 60MM 16MM SOCKET LC-DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 416.065 SUP HCPCS C1713 416.065 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 65MM 16MM SOCKET LC-DCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 416.07 SUP HCPCS C1713 416.070 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 70MM 16MM SOCKET LC-DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $62.18 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $59.35 $59.35 $12.37 $59.35 N/A N/A 416.075 SUP HCPCS C1713 416.075 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 75MM 16MM SOCKET LC-DCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $61.13 $61.13 $12.74 $61.13 N/A N/A 416.08 SUP HCPCS C1713 416.080 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 80MM 16MM SOCKET LC-DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $59.35 $59.35 $12.37 $59.35 N/A N/A 416.085 SUP HCPCS C1713 416.085 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 85MM 16MM SOCKET LC-DCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $66.08 $66.08 $13.77 $66.08 N/A N/A 416.09 SUP HCPCS C1713 416.090 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 90MM 16MM SOCKET LC-DCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $64.15 $64.15 $13.37 $64.15 N/A N/A 416.095 SUP HCPCS C1713 416.095 - SCREW BONE 6.5MM 8MM 95MM 16MM THREAD LARGE HEXAGONAL SOCKET BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $67.20 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $66.08 $66.08 $13.77 $66.08 N/A N/A 416.1 SUP HCPCS C1713 416.100 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 100MM 16MM SOCKET LC-DCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $64.15 $64.15 $13.37 $64.15 N/A N/A 416.105 SUP HCPCS C1713 416.105 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 105MM 16MM SOCKET LC-DCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $66.08 $66.08 $13.77 $66.08 N/A N/A 416.11 SUP HCPCS C1713 416.110 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 110MM 16MM SOCKET LC-DCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $38.49 $64.15 $13.37 $64.15 N/A N/A 416.115 SUP HCPCS C1713 416.115 - SCREW BONE 6.5MM 115MM 16MM LC-DCP TITANIUM CANCELLOUS BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $49.34 $82.23 $17.14 $82.23 N/A N/A 416.12 SUP HCPCS C1713 416.120 - SCREW BONE 6.5MM 120MM 16MM THREAD LC-DCP TITANIUM BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $33.45 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $79.83 $79.83 $16.64 $79.83 N/A N/A 417.045 SUP HCPCS C1713 417.045 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 45MM 32MM SOCKET LC-DCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $61.13 $61.13 $12.74 $61.13 N/A N/A 417.05 SUP HCPCS C1713 417.050 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 50MM 32MM SOCKET LC-DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $59.35 $59.35 $12.37 $59.35 N/A N/A 417.055 SUP HCPCS C1713 417.055 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 55MM 32MM SOCKET LC-DCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 417.06 SUP HCPCS C1713 417.060 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 60MM 32MM SOCKET LC-DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 417.065 SUP HCPCS C1713 417.065 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 65MM 32MM SOCKET LC-DCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 417.07 SUP HCPCS C1713 417.070 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 70MM 32MM SOCKET LC-DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 417.075 SUP HCPCS C1713 417.075 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 75MM 32MM SOCKET LC-DCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 417.08 SUP HCPCS C1713 417.080 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 80MM 32MM SOCKET LC-DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 417.085 SUP HCPCS C1713 417.085 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 85MM 32MM SOCKET LC-DCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $66.08 $66.08 $13.77 $66.08 N/A N/A 417.09 SUP HCPCS C1713 417.090 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 90MM 32MM SOCKET LC-DCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $67.20 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $64.15 $64.15 $13.37 $64.15 N/A N/A 417.095 SUP HCPCS C1713 417.095 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 95MM 32MM SOCKET LC-DCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $66.08 $66.08 $13.77 $66.08 N/A N/A 417.1 SUP HCPCS C1713 417.100 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 100MM 32MM SOCKET LC-DCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $38.49 $64.15 $13.37 $64.15 N/A N/A 417.105 SUP HCPCS C1713 417.105 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 105MM 32MM SOCKET LC-DCP BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $39.65 $66.08 $13.77 $66.08 N/A N/A 417.11 SUP HCPCS C1713 417.110 - SCREW BONE LARGE HEXAGON 6.5MM 8MM 110MM 32MM SOCKET LC-DCP BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $67.20 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $38.49 $64.15 $13.37 $64.15 N/A N/A 417.115 SUP HCPCS C1713 417.115 - SCREW BONE PTHRD 6.5MM 8MM 115MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $49.34 $82.23 $17.14 $82.23 N/A N/A 417.12 SUP HCPCS C1713 417.120 - SCREW BONE PTHRD 6.5MM 8MM 120MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $33.45 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $47.90 $79.83 $16.64 $79.83 N/A N/A 417.125 SUP HCPCS C1713 417.125 - SCREW BONE PTHRD 6.5MM 8MM 125MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $49.34 $82.23 $17.14 $82.23 N/A N/A 417.13 SUP HCPCS C1713 417.130 - SCREW BONE PTHRD 6.5MM 8MM 130MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $33.45 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $47.90 $79.83 $16.64 $79.83 N/A N/A 417.135 SUP HCPCS C1713 417.135 - SCREW BONE PTHRD 6.5MM 8MM 135MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $49.34 $82.23 $17.14 $82.23 N/A N/A 417.14 SUP HCPCS C1713 417.140 - SCREW BONE PTHRD 6.5MM 8MM 140MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $33.45 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $47.90 $79.83 $16.64 $79.83 N/A N/A 417.145 SUP HCPCS C1713 417.145 - SCREW BONE PTHRD 6.5MM 8MM 145MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $82.50 $61.00 $16.32 $83.63 $37.00 $37.00 $37.00 $37.00 $82.23 $82.23 $82.23 $17.14 $82.23 $82.23 $82.23 $82.23 $82.23 $17.14 $82.23 $33.45 $48.64 $82.23 $83.63 $82.23 $82.23 $61.88 $82.23 $82.23 $82.23 $41.12 $41.12 $65.13 $82.23 $65.78 $37.00 $16.32 N/A $47.85 $82.23 $49.34 $82.23 $17.14 $82.23 N/A N/A 417.15 SUP HCPCS C1713 417.150 - SCREW BONE PTHRD 6.5MM 8MM 150MM 32MM LARGE HEXAGONAL SOCKET BOTH IP/OP $80.00 $59.00 $15.84 $83.63 $35.92 $35.92 $35.92 $35.92 $79.83 $79.83 $79.83 $16.64 $79.83 $79.83 $79.83 $79.83 $79.83 $16.64 $79.83 $33.45 $47.22 $79.83 $83.63 $79.83 $79.83 $60.00 $79.83 $79.83 $79.83 $39.92 $39.92 $63.23 $79.83 $63.86 $35.92 $15.84 N/A $46.40 $79.83 $47.90 $79.83 $16.64 $79.83 N/A N/A 418.009 SUP HCPCS C1713 418.009 - SCREW BONE 6.5MM 60MM TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 418.01 SUP HCPCS C1713 418.010 - SCREW BONE FULTHD 6.5MM 4MM 65MM TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $266.50 $197.00 $52.82 $278.75 $119.76 $119.76 $119.76 $119.76 $266.13 $266.13 $266.13 $55.47 $266.13 $266.13 $266.13 $266.13 $266.13 $55.46 $266.13 $278.75 $157.42 $266.13 $278.75 $266.13 $266.13 $199.88 $266.13 $266.13 $266.13 $133.07 $133.07 $210.77 $266.13 $212.90 $119.76 $52.82 N/A $154.57 $266.13 $159.68 $266.13 $55.46 $266.13 N/A N/A 418.011 SUP HCPCS C1713 418.011 - SCREW BONE 6.5MM 70MM TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 418.012 SUP HCPCS C1713 418.012 - SCREW BONE 6.5MM 75MM TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 418.013 SUP HCPCS C1713 418.013 - SCREW BONE 6.5MM 80MM TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 418.014 SUP HCPCS C1713 418.014 - SCREW BONE 6.5MM 85MM TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 418.015 SUP HCPCS C1713 418.015 - SCREW BONE 6.5MM 90MM TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 418.016 SUP HCPCS C1713 418.016 - SCREW BONE 6.5MM 95MM TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 418.017 SUP HCPCS C1713 418.017 - SCREW BONE 6.5MM 100MM TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 418.018 SUP HCPCS C1713 418.018 - SCREW BONE 6.5MM 105MM TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 418.019 SUP HCPCS C1713 418.019 - SCREW BONE 6.5MM 110MM TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 418.025 SUP HCPCS C1713 418.025 - SCREW BONE 6.5MM 8MM 25MM HEXAGONAL SOCKET LC-DCP TITANIUM BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 418.03 SUP HCPCS C1713 418.030 - SCREW BONE 6.5MM 8MM 30MM HEXAGONAL SOCKET LC-DCP TITANIUM BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 418.035 SUP HCPCS C1713 418.035 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 35MM SOCKET LC-DCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $61.13 $61.13 $12.74 $61.13 N/A N/A 418.04 SUP HCPCS C1713 418.040 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 40MM SOCKET LC-DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $62.18 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 418.045 SUP HCPCS C1713 418.045 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 45MM SOCKET LC-DCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 418.05 SUP HCPCS C1713 418.050 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 50MM SOCKET LC-DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 418.055 SUP HCPCS C1713 418.055 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 55MM SOCKET LC-DCP BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $36.68 $61.13 $12.74 $61.13 N/A N/A 418.06 SUP HCPCS C1713 418.060 - SCREW BONE FULTHD LARGE HEXAGON 6.5MM 8MM 60MM SOCKET LC-DCP BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $35.61 $59.35 $12.37 $59.35 N/A N/A 418.065 SUP HCPCS C1713 418.065 - SCREW BONE FULTHD 6.5MM 8MM 65MM LARGE HEXAGONAL SOCKET BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $24.87 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $61.13 $61.13 $12.74 $61.13 N/A N/A 418.07 SUP HCPCS C1713 418.070 - SCREW BONE FULTHD 6.5MM 8MM 70MM LARGE HEXAGONAL SOCKET BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $24.87 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $59.35 $59.35 $12.37 $59.35 N/A N/A 418.075 SUP HCPCS C1713 418.075 - SCREW BONE FULTHD 6.5MM 8MM 75MM LARGE HEXAGONAL SOCKET BOTH IP/OP $61.50 $46.00 $12.13 $62.18 $27.51 $27.51 $27.51 $27.51 $61.13 $61.13 $61.13 $12.74 $61.13 $61.13 $61.13 $61.13 $61.13 $12.74 $61.13 $62.18 $36.16 $61.13 $62.18 $61.13 $61.13 $46.13 $61.13 $61.13 $61.13 $30.57 $30.57 $48.41 $61.13 $48.90 $27.51 $12.13 N/A $35.67 $61.13 $61.13 $61.13 $12.74 $61.13 N/A N/A 418.08 SUP HCPCS C1713 418.080 - SCREW BONE FULTHD 6.5MM 8MM 80MM LARGE HEXAGONAL SOCKET BOTH IP/OP $59.50 $44.00 $11.78 $62.18 $26.71 $26.71 $26.71 $26.71 $59.35 $59.35 $59.35 $12.37 $59.35 $59.35 $59.35 $59.35 $59.35 $12.37 $59.35 $62.18 $35.11 $59.35 $62.18 $59.35 $59.35 $44.63 $59.35 $59.35 $59.35 $29.68 $29.68 $47.01 $59.35 $47.48 $26.71 $11.78 N/A $34.51 $59.35 $59.35 $59.35 $12.37 $59.35 N/A N/A 418.085 SUP HCPCS C1713 418.085 - SCREW BONE FULTHD 6.5MM 8MM 85MM LARGE HEXAGONAL SOCKET BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $66.08 $66.08 $13.77 $66.08 N/A N/A 418.09 SUP HCPCS C1713 418.090 - SCREW BONE FULTHD 6.5MM 8MM 90MM LARGE HEXAGONAL SOCKET BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $26.88 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $64.15 $64.15 $13.37 $64.15 N/A N/A 418.095 SUP HCPCS C1713 418.095 - SCREW BONE FULTHD 6.5MM 8MM 95MM LARGE HEXAGONAL SOCKET BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $26.88 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $39.65 $66.08 $13.77 $66.08 N/A N/A 418.1 SUP HCPCS C1713 418.100 - SCREW BONE FULTHD 6.5MM 8MM 100MM LARGE HEXAGONAL SOCKET BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $67.20 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $38.49 $64.15 $13.37 $64.15 N/A N/A 418.105 SUP HCPCS C1713 418.105 - SCREW BONE FULTHD 6.5MM 8MM 105MM LARGE HEXAGONAL SOCKET BOTH IP/OP $66.50 $49.00 $13.12 $67.20 $29.74 $29.74 $29.74 $29.74 $66.08 $66.08 $66.08 $13.77 $66.08 $66.08 $66.08 $66.08 $66.08 $13.77 $66.08 $67.20 $39.09 $66.08 $67.20 $66.08 $66.08 $49.88 $66.08 $66.08 $66.08 $33.04 $33.04 $52.34 $66.08 $52.86 $29.74 $13.12 N/A $38.57 $66.08 $66.08 $66.08 $13.77 $66.08 N/A N/A 418.11 SUP HCPCS C1713 418.110 - SCREW BONE FULTHD 6.5MM 8MM 110MM LARGE HEXAGONAL SOCKET BOTH IP/OP $64.50 $48.00 $12.73 $67.20 $28.87 $28.87 $28.87 $28.87 $64.15 $64.15 $64.15 $13.37 $64.15 $64.15 $64.15 $64.15 $64.15 $13.37 $64.15 $67.20 $37.94 $64.15 $67.20 $64.15 $64.15 $48.38 $64.15 $64.15 $64.15 $32.08 $32.08 $50.81 $64.15 $51.32 $28.87 $12.73 N/A $37.41 $64.15 $64.15 $64.15 $13.37 $64.15 N/A N/A 418.215 SUP HCPCS C1713 418.215 - SCREW BONE FULTHD 6.5MM 115MM TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 418.22 SUP HCPCS C1713 418.220 - SCREW BONE FULTHD 6.5MM 4MM 120MM TITANIUM CANCELLOUS BOTH IP/OP $266.50 $197.00 $52.82 $278.75 $119.76 $119.76 $119.76 $119.76 $266.13 $266.13 $266.13 $55.47 $266.13 $266.13 $266.13 $266.13 $266.13 $55.46 $266.13 $278.75 $157.42 $266.13 $278.75 $266.13 $266.13 $199.88 $266.13 $266.13 $266.13 $133.07 $133.07 $210.77 $266.13 $212.90 $119.76 $52.82 N/A $154.57 $266.13 $159.68 $266.13 $55.46 $266.13 N/A N/A 418.225 SUP HCPCS C1713 418.225 - SCREW BONE FULTHD 6.5MM 125MM TITANIUM CANCELLOUS NONSTRL BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $278.75 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $164.46 $274.10 $57.12 $274.10 N/A N/A 418.23 SUP HCPCS C1713 418.230 - SCREW BONE FULTHD 6.5MM 4MM 130MM TITANIUM CANCELLOUS BOTH IP/OP $266.50 $197.00 $52.82 $278.75 $119.76 $119.76 $119.76 $119.76 $266.13 $266.13 $266.13 $55.47 $266.13 $266.13 $266.13 $266.13 $266.13 $55.46 $266.13 $278.75 $157.42 $266.13 $278.75 $266.13 $266.13 $199.88 $266.13 $266.13 $266.13 $133.07 $133.07 $210.77 $266.13 $212.90 $119.76 $52.82 N/A $154.57 $266.13 $266.13 $266.13 $55.46 $266.13 N/A N/A 419.89 SUP Custom 27803010 419.89 - WASHER ORTHOPEDIC THREAD TITANIUM NONSTRL 3 MM CANN SCREWS BOTH IP/OP $259.00 $192.00 $46.04 $263.05 $258.65 $258.65 $258.65 $258.65 $258.65 $258.65 $46.04 $258.65 $258.65 $258.65 $258.65 $258.65 $258.65 $53.91 $258.65 $105.22 $258.65 $258.65 $263.05 $258.65 $258.65 $194.25 $258.65 $258.65 $258.65 $129.33 $129.33 $204.85 $258.65 $206.92 $116.39 $258.65 N/A $150.22 $258.65 $155.19 $258.65 $258.65 $258.65 N/A N/A 419.91 SUP Custom 27803010 419.91 - WASHER ORTHOPEDIC 10MM TITANIUM NONSTRL 4.5MM CANN SCREW BOTH IP/OP $56.00 $41.00 $9.94 $56.80 $55.85 $55.85 $55.85 $55.85 $55.85 $55.85 $9.94 $55.85 $55.85 $55.85 $55.85 $55.85 $55.85 $11.64 $55.85 $22.72 $55.85 $55.85 $56.80 $55.85 $55.85 $42.00 $55.85 $55.85 $55.85 $27.93 $27.93 $44.23 $55.85 $44.68 $25.13 $55.85 N/A $32.48 $55.85 $33.51 $55.85 $55.85 $55.85 N/A N/A 419.96 SUP Custom 27803010 419.96 - NUT ORTHOPEDIC LC-DCP TITANIUM NONSTRL 4.5 MM CORTICAL SCREW BOTH IP/OP $56.00 $41.00 $9.94 $56.80 $55.85 $55.85 $55.85 $55.85 $55.85 $55.85 $9.94 $55.85 $55.85 $55.85 $55.85 $55.85 $55.85 $11.64 $55.85 $22.72 $55.85 $55.85 $56.80 $55.85 $55.85 $42.00 $55.85 $55.85 $55.85 $27.93 $27.93 $44.23 $55.85 $44.68 $25.13 $55.85 N/A $32.48 $55.85 $33.51 $55.85 $55.85 $55.85 N/A N/A 419.972 SUP Custom 27803010 419.972 - WASHER ORTHOPEDIC 6.5MM CANN TITANIUM NONSTRL 3MM SCREWS BOTH IP/OP $55.00 $41.00 $9.76 $55.75 $54.83 $54.83 $54.83 $54.83 $54.83 $54.83 $9.76 $54.83 $54.83 $54.83 $54.83 $54.83 $54.83 $11.43 $54.83 $22.30 $54.83 $54.83 $55.75 $54.83 $54.83 $41.25 $54.83 $54.83 $54.83 $27.42 $27.42 $43.43 $54.83 $43.86 $24.67 $54.83 N/A $31.90 $54.83 $32.90 $54.83 $54.83 $54.83 N/A N/A 419.98 SUP Custom 27803010 419.98 - WASHER ORTHOPEDIC 7MM TITANIUM PROXIMAL TIBIA NONSTRL 4MM BOTH IP/OP $47.50 $35.00 $8.44 $48.23 $47.43 $47.43 $47.43 $47.43 $47.43 $47.43 $8.44 $47.43 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $47.43 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $47.43 N/A $27.55 $47.43 $28.46 $47.43 $47.43 $47.43 N/A N/A 419.99 SUP Custom 27803010 419.99 - WASHER ORTHOPEDIC 13MM TITANIUM FEMUR NONSTRL 6.5/7.3MM CANN BOTH IP/OP $53.00 $39.00 $9.38 $53.60 $52.70 $52.70 $52.70 $52.70 $52.70 $52.70 $9.38 $52.70 $52.70 $52.70 $52.70 $52.70 $52.70 $10.98 $52.70 $21.44 $52.70 $52.70 $53.60 $52.70 $52.70 $39.75 $52.70 $52.70 $52.70 $26.35 $26.35 $41.74 $52.70 $42.16 $23.72 $52.70 N/A $30.74 $52.70 $31.62 $52.70 $52.70 $52.70 N/A N/A 420 SUP HCPCS C1713 420.00 - PLATE BONE 40X29X.5MM 7X8 HOLE MESH TITANIUM CRANFCL NONSTRL BOTH IP/OP "$2,608.00" "$1,930.00" $517.57 "$2,607.75" "$1,173.49" "$1,173.49" "$1,173.49" "$1,173.49" "$2,607.75" "$2,607.75" "$2,607.75" $543.52 "$2,607.75" "$2,607.75" "$2,607.75" "$2,607.75" "$2,607.75" $543.48 "$2,607.75" "$1,043.10" "$1,285.62" "$2,607.75" "$2,607.75" "$2,607.75" "$2,607.75" "$1,956.00" "$2,607.75" "$2,607.75" "$2,607.75" "$1,303.88" "$1,303.88" "$2,065.34" "$2,607.75" "$2,086.20" "$1,173.49" $517.57 N/A "$1,512.64" "$2,607.75" "$2,607.75" "$2,607.75" $543.46 "$2,607.75" N/A N/A 420.01 SUP HCPCS C1713 420.01 - PLATE BONE 30X6MM 16 HOLE STRUT TITANIUM CRANFCL NONSTRL 1MM BOTH IP/OP "$1,132.00" $838.00 $224.62 "$1,131.75" $509.29 $509.29 $509.29 $509.29 "$1,131.75" "$1,131.75" "$1,131.75" $235.88 "$1,131.75" "$1,131.75" "$1,131.75" "$1,131.75" "$1,131.75" $235.87 "$1,131.75" $452.70 $669.43 "$1,131.75" "$1,131.75" "$1,131.75" "$1,131.75" $849.00 "$1,131.75" "$1,131.75" "$1,131.75" $565.88 $565.88 $896.35 "$1,131.75" $905.40 $509.29 $224.62 N/A $656.56 "$1,131.75" "$1,131.75" "$1,131.75" "$1,131.75" "$1,131.75" N/A N/A 420.02 SUP HCPCS C1713 420.02 - PLATE BONE 42X38X.4MM MESH TITANIUM CRANFCL NONSTRL 1MM BOTH IP/OP "$3,145.50" "$2,328.00" $624.30 "$3,145.50" "$1,415.48" "$1,415.48" "$1,415.48" "$1,415.48" "$3,145.50" "$3,145.50" "$3,145.50" $655.60 "$3,145.50" "$3,145.50" "$3,145.50" "$3,145.50" "$3,145.50" $655.56 "$3,145.50" "$1,258.20" "$1,550.73" "$3,145.50" "$3,145.50" "$3,145.50" "$3,145.50" "$2,359.13" "$3,145.50" "$3,145.50" "$3,145.50" "$1,572.75" "$1,572.75" "$2,491.24" "$3,145.50" "$2,516.40" "$1,415.48" $624.30 N/A "$1,824.39" "$3,145.50" "$3,145.50" "$3,145.50" "$3,145.50" "$3,145.50" N/A N/A 420.031 SUP HCPCS C1713 420.031 - PLATE BONE MICRO 50X50X.4MM 17X17 HOLE MESH TITANIUM CRANFCL BOTH IP/OP "$3,746.50" "$2,772.00" $743.54 "$3,746.25" "$1,685.81" "$1,685.81" "$1,685.81" "$1,685.81" "$3,746.25" "$3,746.25" "$3,746.25" $780.81 "$3,746.25" "$3,746.25" "$3,746.25" "$3,746.25" "$3,746.25" $780.76 "$3,746.25" "$1,498.50" "$1,846.90" "$3,746.25" "$3,746.25" "$3,746.25" "$3,746.25" "$2,809.88" "$3,746.25" "$3,746.25" "$3,746.25" "$1,873.13" "$1,873.13" "$2,967.03" "$3,746.25" "$2,997.00" "$1,685.81" $743.54 N/A "$2,172.97" "$3,746.25" "$3,746.25" "$3,746.25" $780.72 "$3,746.25" N/A N/A 420.04 SUP HCPCS C1713 420.04 - PLATE BONE 42X6X.5MM 2X11 HOLE STRUT TITANIUM BOTH IP/OP "$1,271.50" $941.00 $252.31 "$1,271.25" $572.06 $572.06 $572.06 $572.06 "$1,271.25" "$1,271.25" "$1,271.25" $264.96 "$1,271.25" "$1,271.25" "$1,271.25" "$1,271.25" "$1,271.25" $264.94 "$1,271.25" $508.50 $751.94 "$1,271.25" "$1,271.25" "$1,271.25" "$1,271.25" $953.63 "$1,271.25" "$1,271.25" "$1,271.25" $635.63 $635.63 "$1,006.83" "$1,271.25" "$1,017.00" $572.06 $252.31 N/A $737.47 "$1,271.25" "$1,271.25" "$1,271.25" $264.93 "$1,271.25" N/A N/A 420.05 SUP HCPCS C1713 420.05 - PLATE BONE 100X50X.4MM 13X26 HOLE MESH TITANIUM CRANFCL BOTH IP/OP "$3,746.50" "$2,772.00" $743.54 "$3,746.25" "$1,685.81" "$1,685.81" "$1,685.81" "$1,685.81" "$3,746.25" "$3,746.25" "$3,746.25" $780.81 "$3,746.25" "$3,746.25" "$3,746.25" "$3,746.25" "$3,746.25" $780.76 "$3,746.25" "$1,498.50" "$1,846.90" "$3,746.25" "$3,746.25" "$3,746.25" "$3,746.25" "$2,809.88" "$3,746.25" "$3,746.25" "$3,746.25" "$1,873.13" "$1,873.13" "$2,967.03" "$3,746.25" "$2,997.00" "$1,685.81" $743.54 N/A "$2,172.97" "$3,746.25" "$3,746.25" "$3,746.25" $780.72 "$3,746.25" N/A N/A 420.06 SUP HCPCS C1713 420.06 - PLATE BONE 100X100X.4MM MESH TITANIUM CRANFCL NONSTRL 1MM BOTH IP/OP "$5,346.00" "$3,956.00" "$1,061.05" "$5,346.00" "$2,405.70" "$2,405.70" "$2,405.70" "$2,405.70" "$5,346.00" "$5,346.00" "$5,346.00" "$1,114.24" "$5,346.00" "$5,346.00" "$5,346.00" "$5,346.00" "$5,346.00" "$1,114.17" "$5,346.00" "$2,138.40" "$2,635.58" "$5,346.00" "$5,346.00" "$5,346.00" "$5,346.00" "$4,009.50" "$5,346.00" "$5,346.00" "$5,346.00" "$2,673.00" "$2,673.00" "$4,234.03" "$5,346.00" "$4,276.80" "$2,405.70" "$1,061.05" N/A "$3,100.68" "$5,346.00" "$5,346.00" "$5,346.00" "$1,114.11" "$5,346.00" N/A N/A 420.07 SUP HCPCS C1713 420.070 - PLATE BONE 100X100X.1MM MESH SCREEN TITANIUM CRANFCL NONSTRL BOTH IP/OP "$2,691.00" "$1,991.00" $534.10 "$2,691.00" "$1,210.95" "$1,210.95" "$1,210.95" "$1,210.95" "$2,691.00" "$2,691.00" "$2,691.00" $560.87 "$2,691.00" "$2,691.00" "$2,691.00" "$2,691.00" "$2,691.00" $560.83 "$2,691.00" "$1,076.40" "$1,326.66" "$2,691.00" "$2,691.00" "$2,691.00" "$2,691.00" "$2,018.25" "$2,691.00" "$2,691.00" "$2,691.00" "$1,345.50" "$1,345.50" "$2,131.27" "$2,691.00" "$2,152.80" "$1,210.95" $534.10 N/A "$1,560.78" "$2,691.00" "$1,614.60" "$2,691.00" $560.80 "$2,691.00" N/A N/A 420.071 SUP HCPCS C1713 420.071 - PLATE BONE 100X100MM MESH TITANIUM CRANFCL NONSTRL 1/1.5MM BOTH IP/OP "$4,603.50" "$3,407.00" $913.68 "$4,603.50" "$2,071.58" "$2,071.58" "$2,071.58" "$2,071.58" "$4,603.50" "$4,603.50" "$4,603.50" $959.48 "$4,603.50" "$4,603.50" "$4,603.50" "$4,603.50" "$4,603.50" $959.42 "$4,603.50" "$1,841.40" "$2,269.53" "$4,603.50" "$4,603.50" "$4,603.50" "$4,603.50" "$3,452.63" "$4,603.50" "$4,603.50" "$4,603.50" "$2,301.75" "$2,301.75" "$3,645.97" "$4,603.50" "$3,682.80" "$2,071.58" $913.68 N/A "$2,670.03" "$4,603.50" "$2,762.10" "$4,603.50" $959.37 "$4,603.50" N/A N/A 420.1 SUP HCPCS C1713 420.10 - PLATE BONE 100MM 34 HOLE ADAPTION TITANIUM CRANFCL NONSTRL 1 BOTH IP/OP "$1,395.00" "$1,032.00" $276.87 "$1,395.00" $627.75 $627.75 $627.75 $627.75 "$1,395.00" "$1,395.00" "$1,395.00" $290.75 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $290.73 "$1,395.00" $558.00 $825.14 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $627.75 $276.87 N/A $809.10 "$1,395.00" $837.00 "$1,395.00" $290.72 "$1,395.00" N/A N/A 420.21 SUP HCPCS C1713 420.21 - PLATE BONE 11 HOLE TITANIUM ORBTL RIM NONSTRL 1 MM SCREW BOTH IP/OP $616.50 $456.00 $122.36 $616.50 $277.43 $277.43 $277.43 $277.43 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $616.50 $616.50 $616.50 $128.49 $616.50 $246.60 $364.66 $616.50 $616.50 $616.50 $616.50 $462.38 $616.50 $616.50 $616.50 $308.25 $308.25 $488.27 $616.50 $493.20 $277.43 $122.36 N/A $357.57 $616.50 $369.90 $616.50 $128.48 $616.50 N/A N/A 420.302 SUP HCPCS C1713 420.302 - PLATE BONE .2MM MESH PURPLE TITANIUM ORBTL FLOOR NONSTRL 1MM BOTH IP/OP "$2,889.00" "$2,138.00" $573.39 "$2,889.00" "$1,300.05" "$1,300.05" "$1,300.05" "$1,300.05" "$2,889.00" "$2,889.00" "$2,889.00" $602.14 "$2,889.00" "$2,889.00" "$2,889.00" "$2,889.00" "$2,889.00" $602.10 "$2,889.00" "$1,155.60" "$1,424.28" "$2,889.00" "$2,889.00" "$2,889.00" "$2,889.00" "$2,166.75" "$2,889.00" "$2,889.00" "$2,889.00" "$1,444.50" "$1,444.50" "$2,288.09" "$2,889.00" "$2,311.20" "$1,300.05" $573.39 N/A "$1,675.62" "$2,889.00" "$1,733.40" "$2,889.00" $602.07 "$2,889.00" N/A N/A 420.303 SUP HCPCS C1713 420.303 - PLATE BONE .3MM MESH TEAL TITANIUM ORBTL FLOOR NONSTRL 1MM BOTH IP/OP "$2,889.00" "$2,138.00" $573.39 "$2,889.00" "$1,300.05" "$1,300.05" "$1,300.05" "$1,300.05" "$2,889.00" "$2,889.00" "$2,889.00" $602.14 "$2,889.00" "$2,889.00" "$2,889.00" "$2,889.00" "$2,889.00" $602.10 "$2,889.00" "$1,155.60" "$1,424.28" "$2,889.00" "$2,889.00" "$2,889.00" "$2,889.00" "$2,166.75" "$2,889.00" "$2,889.00" "$2,889.00" "$1,444.50" "$1,444.50" "$2,288.09" "$2,889.00" "$2,311.20" "$1,300.05" $573.39 N/A "$1,675.62" "$2,889.00" "$1,733.40" "$2,889.00" $602.07 "$2,889.00" N/A N/A 420.304 SUP HCPCS C1713 420.304 - PLATE BONE .4MM MESH GOLD TITANIUM ORBTL FLOOR NONSTRL 1MM BOTH IP/OP "$2,889.00" "$2,138.00" $573.39 "$2,889.00" "$1,300.05" "$1,300.05" "$1,300.05" "$1,300.05" "$2,889.00" "$2,889.00" "$2,889.00" $602.14 "$2,889.00" "$2,889.00" "$2,889.00" "$2,889.00" "$2,889.00" $602.10 "$2,889.00" "$1,155.60" "$1,424.28" "$2,889.00" "$2,889.00" "$2,889.00" "$2,889.00" "$2,166.75" "$2,889.00" "$2,889.00" "$2,889.00" "$1,444.50" "$1,444.50" "$2,288.09" "$2,889.00" "$2,311.20" "$1,300.05" $573.39 N/A "$1,675.62" "$2,889.00" "$1,733.40" "$2,889.00" $602.07 "$2,889.00" N/A N/A 420.4 SUP HCPCS C1713 420.40 - PLATE BONE UNIVERSAL 50X50X.4MM TITANIUM ORBTL FLOOR CRANFCL BOTH IP/OP "$2,772.00" "$2,051.00" $550.17 "$2,772.00" "$1,247.40" "$1,247.40" "$1,247.40" "$1,247.40" "$2,772.00" "$2,772.00" "$2,772.00" $577.75 "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" $577.72 "$2,772.00" "$1,108.80" "$1,366.60" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,079.00" "$2,772.00" "$2,772.00" "$2,772.00" "$1,386.00" "$1,386.00" "$2,195.42" "$2,772.00" "$2,217.60" "$1,247.40" $550.17 N/A "$1,607.76" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" N/A N/A 420.401 SUP HCPCS C1713 420.401 - PLATE BONE SMALL .3MM ANATOMIC TEAL TITANIUM ORBTL FLOOR BOTH IP/OP "$2,772.00" "$2,051.00" $550.17 "$2,772.00" "$1,247.40" "$1,247.40" "$1,247.40" "$1,247.40" "$2,772.00" "$2,772.00" "$2,772.00" $577.75 "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" $577.72 "$2,772.00" "$1,108.80" "$1,366.60" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,079.00" "$2,772.00" "$2,772.00" "$2,772.00" "$1,386.00" "$1,386.00" "$2,195.42" "$2,772.00" "$2,217.60" "$1,247.40" $550.17 N/A "$1,607.76" "$2,772.00" "$1,663.20" "$2,772.00" "$2,772.00" "$2,772.00" N/A N/A 420.402 SUP HCPCS C1713 420.402 - PLATE BONE LARGE .3MM ANATOMIC TEAL TITANIUM ORBTL FLOOR BOTH IP/OP "$2,772.00" "$2,051.00" $550.17 "$2,772.00" "$1,247.40" "$1,247.40" "$1,247.40" "$1,247.40" "$2,772.00" "$2,772.00" "$2,772.00" $577.75 "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" $577.72 "$2,772.00" "$1,108.80" "$1,366.60" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,079.00" "$2,772.00" "$2,772.00" "$2,772.00" "$1,386.00" "$1,386.00" "$2,195.42" "$2,772.00" "$2,217.60" "$1,247.40" $550.17 N/A "$1,607.76" "$2,772.00" "$1,663.20" "$2,772.00" $577.68 "$2,772.00" N/A N/A 420.403 SUP HCPCS C1713 420.403 - PLATE BONE MEDIUM .3MM ANATOMIC TEAL TITANIUM ORBTL FLOOR BOTH IP/OP "$2,772.00" "$2,051.00" $550.17 "$2,772.00" "$1,247.40" "$1,247.40" "$1,247.40" "$1,247.40" "$2,772.00" "$2,772.00" "$2,772.00" $577.75 "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" $577.72 "$2,772.00" "$1,108.80" "$1,366.60" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,079.00" "$2,772.00" "$2,772.00" "$2,772.00" "$1,386.00" "$1,386.00" "$2,195.42" "$2,772.00" "$2,217.60" "$1,247.40" $550.17 N/A "$1,607.76" "$2,772.00" "$1,663.20" "$2,772.00" $577.68 "$2,772.00" N/A N/A 420.44 SUP HCPCS C1713 420.44 - PLATE BONE MICRO 36X32X.5MM 10 HOLE GOLD TITANIUM CRANFCL BOTH IP/OP "$2,772.00" "$2,051.00" $550.17 "$2,772.00" "$1,247.40" "$1,247.40" "$1,247.40" "$1,247.40" "$2,772.00" "$2,772.00" "$2,772.00" $577.75 "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" $577.72 "$2,772.00" "$1,108.80" "$1,366.60" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,079.00" "$2,772.00" "$2,772.00" "$2,772.00" "$1,386.00" "$1,386.00" "$2,195.42" "$2,772.00" "$2,217.60" "$1,247.40" $550.17 N/A "$1,607.76" "$2,772.00" "$1,663.20" "$2,772.00" $577.68 "$2,772.00" N/A N/A 420.45 SUP HCPCS C1713 420.45 - PLATE BONE MICRO 36X32X.5MM 10 HOLE TITANIUM CRANFCL RIGHT BOTH IP/OP "$2,772.00" "$2,051.00" $550.17 "$2,772.00" "$1,247.40" "$1,247.40" "$1,247.40" "$1,247.40" "$2,772.00" "$2,772.00" "$2,772.00" $577.75 "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" $577.72 "$2,772.00" "$1,108.80" "$1,366.60" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,079.00" "$2,772.00" "$2,772.00" "$2,772.00" "$1,386.00" "$1,386.00" "$2,195.42" "$2,772.00" "$2,217.60" "$1,247.40" $550.17 N/A "$1,607.76" "$2,772.00" "$1,663.20" "$2,772.00" "$2,772.00" "$2,772.00" N/A N/A 420.54 SUP HCPCS C1713 420.54 - PLATE BONE L 9 HOLE TITANIUM LEFT CRANIOMAXILLOFACIAL BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $222.30 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $555.75 $555.75 N/A N/A 420.55 SUP HCPCS C1713 420.55 - PLATE BONE L 4X5 HOLE TITANIUM RIGHT CRANIOMAXILLOFACIAL BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $222.30 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 420.62 SUP HCPCS C1713 420.62 - PLATE BONE 9 HOLE Y TITANIUM CRANFCL NONSTRL 1 MM SCREW BOTH IP/OP $558.00 $413.00 $110.75 $558.00 $251.10 $251.10 $251.10 $251.10 $558.00 $558.00 $558.00 $116.30 $558.00 $558.00 $558.00 $558.00 $558.00 $116.29 $558.00 $223.20 $330.06 $558.00 $558.00 $558.00 $558.00 $418.50 $558.00 $558.00 $558.00 $279.00 $279.00 $441.94 $558.00 $446.40 $251.10 $110.75 N/A $323.64 $558.00 $558.00 $558.00 $116.29 $558.00 N/A N/A 420.63 SUP HCPCS C1713 420.63 - PLATE BONE Y 27X15X.5MM 3X7 HOLE TITANIUM CRANFCL NONSTRL 1 BOTH IP/OP $558.00 $413.00 $110.75 $558.00 $251.10 $251.10 $251.10 $251.10 $558.00 $558.00 $558.00 $116.30 $558.00 $558.00 $558.00 $558.00 $558.00 $116.29 $558.00 $223.20 $330.06 $558.00 $558.00 $558.00 $558.00 $418.50 $558.00 $558.00 $558.00 $279.00 $279.00 $441.94 $558.00 $446.40 $251.10 $110.75 N/A $323.64 $558.00 $334.80 $558.00 $116.29 $558.00 N/A N/A 420.631 SUP HCPCS C1713 420.631 - PLATE BONE Y 38X19X.5MM 10 HOLE TITANIUM CRANFCL NONSTRL 1MM BOTH IP/OP $515.50 $381.00 $102.26 $515.25 $231.86 $231.86 $231.86 $231.86 $515.25 $515.25 $515.25 $107.39 $515.25 $515.25 $515.25 $515.25 $515.25 $107.38 $515.25 $206.10 $304.77 $515.25 $515.25 $515.25 $515.25 $386.63 $515.25 $515.25 $515.25 $257.63 $257.63 $408.08 $515.25 $412.20 $231.86 $102.26 N/A $298.99 $515.25 $309.15 $515.25 $107.38 $515.25 N/A N/A 420.68 SUP HCPCS C1713 420.68 - PLATE BONE 2Y 14X10X.5MM 1X2 HOLE TITANIUM CRANFCL NONSTRL 1 BOTH IP/OP $592.00 $438.00 $117.45 $591.75 $266.29 $266.29 $266.29 $266.29 $591.75 $591.75 $591.75 $123.34 $591.75 $591.75 $591.75 $591.75 $591.75 $123.33 $591.75 $236.70 $350.02 $591.75 $591.75 $591.75 $591.75 $444.00 $591.75 $591.75 $591.75 $295.88 $295.88 $468.67 $591.75 $473.40 $266.29 $117.45 N/A $343.36 $591.75 $355.05 $591.75 $591.75 $591.75 N/A N/A 420.7 SUP HCPCS C1713 420.70 - PLATE BONE 5X5 HOLE T TITANIUM ORTHOPEDIC NONSTRL 1 MM BOTH IP/OP $558.00 $413.00 $110.75 $558.00 $251.10 $251.10 $251.10 $251.10 $558.00 $558.00 $558.00 $116.30 $558.00 $558.00 $558.00 $558.00 $558.00 $116.29 $558.00 $223.20 $330.06 $558.00 $558.00 $558.00 $558.00 $418.50 $558.00 $558.00 $558.00 $279.00 $279.00 $441.94 $558.00 $446.40 $251.10 $110.75 N/A $323.64 $558.00 $334.80 $558.00 $116.29 $558.00 N/A N/A 420.71 SUP HCPCS C1713 420.71 - PLATE BONE 12 HOLE T TITANIUM CRANFCL NONSTRL 1 MM SCREW BOTH IP/OP $592.00 $438.00 $117.45 $591.75 $266.29 $266.29 $266.29 $266.29 $591.75 $591.75 $591.75 $123.34 $591.75 $591.75 $591.75 $591.75 $591.75 $123.33 $591.75 $591.75 $350.02 $591.75 $591.75 $591.75 $591.75 $444.00 $591.75 $591.75 $591.75 $295.88 $295.88 $468.67 $591.75 $473.40 $266.29 $117.45 N/A $343.36 $591.75 $355.05 $591.75 $591.75 $591.75 N/A N/A 420.81 SUP HCPCS C1713 420.81 - PLATE BONE X 10X7X.5MM 5 HOLE TITANIUM CRANFCL NONSTRL 1MM BOTH IP/OP $499.50 $370.00 $99.14 $499.50 $224.78 $224.78 $224.78 $224.78 $499.50 $499.50 $499.50 $104.11 $499.50 $499.50 $499.50 $499.50 $499.50 $104.10 $499.50 $199.80 $295.45 $499.50 $499.50 $499.50 $499.50 $374.63 $499.50 $499.50 $499.50 $249.75 $249.75 $395.60 $499.50 $399.60 $224.78 $99.14 N/A $289.71 $499.50 $299.70 $499.50 $104.10 $499.50 N/A N/A 420.84 SUP HCPCS C1713 420.84 - PLATE BONE 6 HOLE H TITANIUM CRANFCL NONSTRL 1 MM SCREW BOTH IP/OP $529.00 $391.00 $104.94 $528.75 $237.94 $237.94 $237.94 $237.94 $528.75 $528.75 $528.75 $110.20 $528.75 $528.75 $528.75 $528.75 $528.75 $110.20 $528.75 $211.50 $312.76 $528.75 $528.75 $528.75 $528.75 $396.75 $528.75 $528.75 $528.75 $264.38 $264.38 $418.77 $528.75 $423.00 $237.94 $104.94 N/A $306.82 $528.75 $528.75 $528.75 $110.19 $528.75 N/A N/A 420.85 SUP HCPCS C1713 420.85 - PLATE BONE 11 HOLE H TITANIUM CRANFCL NONSTRL 1 MM SCREW BOTH IP/OP $592.00 $438.00 $117.45 $591.75 $266.29 $266.29 $266.29 $266.29 $591.75 $591.75 $591.75 $123.34 $591.75 $591.75 $591.75 $591.75 $591.75 $123.33 $591.75 $591.75 $350.02 $591.75 $591.75 $591.75 $591.75 $444.00 $591.75 $591.75 $591.75 $295.88 $295.88 $468.67 $591.75 $473.40 $266.29 $117.45 N/A $343.36 $591.75 $355.05 $591.75 $123.32 $591.75 N/A N/A 420.9 SUP Custom 27803010 420.900 - BURR SURG 12MM HOLE COVER BOTH IP/OP $504.00 $373.00 $89.71 $504.00 $504.00 $504.00 $504.00 $504.00 $504.00 $504.00 $89.71 $504.00 $504.00 $504.00 $504.00 $504.00 $504.00 $105.04 $504.00 $201.60 $504.00 $504.00 $504.00 $504.00 $504.00 $378.00 $504.00 $504.00 $504.00 $252.00 $252.00 $399.17 $504.00 $403.20 $226.80 $504.00 N/A $292.32 $504.00 $302.40 $504.00 $504.00 $504.00 N/A N/A 420.91 SUP Custom 27803010 420.91 - COVER BURR HOLE 17MM 6 HOLE TITANIUM CRANFCL NONSTRL 1MM BOTH IP/OP $504.00 $373.00 $89.71 $504.00 $504.00 $504.00 $504.00 $504.00 $504.00 $504.00 $89.71 $504.00 $504.00 $504.00 $504.00 $504.00 $504.00 $105.04 $504.00 $201.60 $504.00 $504.00 $504.00 $504.00 $504.00 $378.00 $504.00 $504.00 $504.00 $252.00 $252.00 $399.17 $504.00 $403.20 $226.80 $504.00 N/A $292.32 $504.00 $302.40 $504.00 $504.00 $504.00 N/A N/A 421.001 SUP HCPCS C1713 421.001 - PLATE BONE 53X38X.4MM 8X11 HOLE MESH MALBLE TITANIUM CRANFCL BOTH IP/OP "$3,467.50" "$2,566.00" $688.16 "$3,467.25" "$1,560.26" "$1,560.26" "$1,560.26" "$1,560.26" "$3,467.25" "$3,467.25" "$3,467.25" $722.66 "$3,467.25" "$3,467.25" "$3,467.25" "$3,467.25" "$3,467.25" $722.61 "$3,467.25" "$1,386.90" "$1,709.35" "$3,467.25" "$3,467.25" "$3,467.25" "$3,467.25" "$2,600.63" "$3,467.25" "$3,467.25" "$3,467.25" "$1,733.63" "$1,733.63" "$2,746.06" "$3,467.25" "$2,773.80" "$1,560.26" $688.16 N/A "$2,011.15" "$3,467.25" "$2,080.35" "$3,467.25" $722.57 "$3,467.25" N/A N/A 421.002 SUP HCPCS C1713 421.002 - PLATE BONE MEDIUM MESH MALBLE TITANIUM TEMPORAL NONSTRL 1.3 BOTH IP/OP "$1,852.00" "$1,370.00" $367.53 "$1,851.75" $833.29 $833.29 $833.29 $833.29 "$1,851.75" "$1,851.75" "$1,851.75" $385.95 "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" $385.93 "$1,851.75" $740.70 "$1,095.31" "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" "$1,389.00" "$1,851.75" "$1,851.75" "$1,851.75" $925.88 $925.88 "$1,466.59" "$1,851.75" "$1,481.40" $833.29 $367.53 N/A "$1,074.16" "$1,851.75" "$1,111.05" "$1,851.75" $385.90 "$1,851.75" N/A N/A 421.003 SUP HCPCS C1713 421.003 - PLATE BONE 8 HOLE CONTUR STRUT TITANIUM CRANIUM NONSTRL 1.3 BOTH IP/OP "$1,366.00" "$1,011.00" $271.07 "$1,365.75" $614.59 $614.59 $614.59 $614.59 "$1,365.75" "$1,365.75" "$1,365.75" $284.66 "$1,365.75" "$1,365.75" "$1,365.75" "$1,365.75" "$1,365.75" $284.64 "$1,365.75" $546.30 $807.84 "$1,365.75" "$1,365.75" "$1,365.75" "$1,365.75" "$1,024.50" "$1,365.75" "$1,365.75" "$1,365.75" $682.88 $682.88 "$1,081.67" "$1,365.75" "$1,092.60" $614.59 $271.07 N/A $792.28 "$1,365.75" $819.45 "$1,365.75" $284.62 "$1,365.75" N/A N/A 421.004 SUP HCPCS C1713 421.004 - PLATE BONE 45X38X.4MM CONTUR MESH MALBLE TEAL TITANIUM BOTH IP/OP "$3,584.50" "$2,653.00" $711.38 "$3,584.25" "$1,612.91" "$1,612.91" "$1,612.91" "$1,612.91" "$3,584.25" "$3,584.25" "$3,584.25" $747.05 "$3,584.25" "$3,584.25" "$3,584.25" "$3,584.25" "$3,584.25" $747.00 "$3,584.25" "$1,433.70" "$1,767.04" "$3,584.25" "$3,584.25" "$3,584.25" "$3,584.25" "$2,688.38" "$3,584.25" "$3,584.25" "$3,584.25" "$1,792.13" "$1,792.13" "$2,838.73" "$3,584.25" "$2,867.40" "$1,612.91" $711.38 N/A "$2,079.01" "$3,584.25" "$2,150.55" "$3,584.25" $746.96 "$3,584.25" N/A N/A 421.005 SUP HCPCS C1713 421.005 - PLATE BN RECT 45X38X.6MM NS CNTR MESH RGD TI CRNFCL 1.3MM BOTH IP/OP "$3,584.50" "$2,653.00" $711.38 "$3,584.25" "$1,612.91" "$1,612.91" "$1,612.91" "$1,612.91" "$3,584.25" "$3,584.25" "$3,584.25" $747.05 "$3,584.25" "$3,584.25" "$3,584.25" "$3,584.25" "$3,584.25" $747.00 "$3,584.25" "$1,433.70" "$1,767.04" "$3,584.25" "$3,584.25" "$3,584.25" "$3,584.25" "$2,688.38" "$3,584.25" "$3,584.25" "$3,584.25" "$1,792.13" "$1,792.13" "$2,838.73" "$3,584.25" "$2,867.40" "$1,612.91" $711.38 N/A "$2,079.01" "$3,584.25" "$2,150.55" "$3,584.25" $746.96 "$3,584.25" N/A N/A 421.006 SUP HCPCS C1713 421.006 - PLATE BONE 100X100X.4MM 21X21 HOLE MESH MALBLE TITANIUM BOTH IP/OP "$5,380.00" "$3,981.00" "$1,067.75" "$5,379.75" "$2,420.89" "$2,420.89" "$2,420.89" "$2,420.89" "$5,379.75" "$5,379.75" "$5,379.75" "$1,121.27" "$5,379.75" "$5,379.75" "$5,379.75" "$5,379.75" "$5,379.75" "$1,121.20" "$5,379.75" "$2,151.90" "$2,652.22" "$5,379.75" "$5,379.75" "$5,379.75" "$5,379.75" "$4,035.00" "$5,379.75" "$5,379.75" "$5,379.75" "$2,689.88" "$2,689.88" "$4,260.76" "$5,379.75" "$4,303.80" "$2,420.89" "$1,067.75" N/A "$3,120.40" "$5,379.75" "$3,227.85" "$5,379.75" "$1,121.14" "$5,379.75" N/A N/A 421.007 SUP HCPCS C1713 421.007 - PLATE BONE 1.3MM 100X100X.6MM CONTUR MESH MALBLE GRADE 1 BOTH IP/OP "$5,596.00" "$4,141.00" "$1,110.62" "$5,595.75" "$2,518.09" "$2,518.09" "$2,518.09" "$2,518.09" "$5,595.75" "$5,595.75" "$5,595.75" "$1,166.29" "$5,595.75" "$5,595.75" "$5,595.75" "$5,595.75" "$5,595.75" "$1,166.22" "$5,595.75" "$5,595.75" "$2,758.70" "$5,595.75" "$5,595.75" "$5,595.75" "$5,595.75" "$4,197.00" "$5,595.75" "$5,595.75" "$5,595.75" "$2,797.88" "$2,797.88" "$4,431.83" "$5,595.75" "$4,476.60" "$2,518.09" "$1,110.62" N/A "$3,245.68" "$5,595.75" "$5,595.75" "$5,595.75" "$1,166.15" "$5,595.75" N/A N/A 421.008 SUP HCPCS C1713 421.008 - PLATE BN RECT 100X100X.6MM NS CNTR MESH RGD TI CRNFCL 1.3MM BOTH IP/OP "$5,596.00" "$4,141.00" "$1,110.62" "$5,595.75" "$2,518.09" "$2,518.09" "$2,518.09" "$2,518.09" "$5,595.75" "$5,595.75" "$5,595.75" "$1,166.29" "$5,595.75" "$5,595.75" "$5,595.75" "$5,595.75" "$5,595.75" "$1,166.22" "$5,595.75" "$2,238.30" "$2,758.70" "$5,595.75" "$5,595.75" "$5,595.75" "$5,595.75" "$4,197.00" "$5,595.75" "$5,595.75" "$5,595.75" "$2,797.88" "$2,797.88" "$4,431.83" "$5,595.75" "$4,476.60" "$2,518.09" "$1,110.62" N/A "$3,245.68" "$5,595.75" "$3,357.45" "$5,595.75" "$1,166.15" "$5,595.75" N/A N/A 421.009 SUP HCPCS C1713 421.009 - PLATE BONE RECTANGLE 200X200X.6MM CONTUR MESH RIGID TEAL BOTH IP/OP "$22,304.50" "$16,505.00" "$4,426.84" "$22,304.25" "$10,036.91" "$10,036.91" "$10,036.91" "$10,036.91" "$22,304.25" "$22,304.25" "$22,304.25" "$4,648.76" "$22,304.25" "$22,304.25" "$22,304.25" "$22,304.25" "$22,304.25" "$4,648.45" "$22,304.25" "$8,921.70" "$10,996.00" "$22,304.25" "$22,304.25" "$22,304.25" "$22,304.25" "$16,728.38" "$22,304.25" "$22,304.25" "$22,304.25" "$11,152.13" "$11,152.13" "$17,664.97" "$22,304.25" "$17,843.40" "$10,036.91" "$4,426.84" N/A "$12,936.61" "$22,304.25" "$13,382.55" "$22,304.25" "$22,304.25" "$22,304.25" N/A N/A 421.01 SUP HCPCS C1713 421.010 - PLATE BN 95X3.3X.5MM NS 24 HL ADP TI CRNFCL 1.3MM CORT SCR BOTH IP/OP "$1,447.00" "$1,071.00" $287.14 "$1,446.75" $651.04 $651.04 $651.04 $651.04 "$1,446.75" "$1,446.75" "$1,446.75" $301.54 "$1,446.75" "$1,446.75" "$1,446.75" "$1,446.75" "$1,446.75" $301.52 "$1,446.75" $578.70 $855.75 "$1,446.75" "$1,446.75" "$1,446.75" "$1,446.75" "$1,085.25" "$1,446.75" "$1,446.75" "$1,446.75" $723.38 $723.38 "$1,145.83" "$1,446.75" "$1,157.40" $651.04 $287.14 N/A $839.26 "$1,446.75" "$1,446.75" "$1,446.75" $301.50 "$1,446.75" N/A N/A 421.011 SUP HCPCS C1713 421.011 - PLATE BONE SMALL ARC .4MM CONTUR MESH MALBLE TEAL TITANIUM BOTH IP/OP "$1,852.00" "$1,370.00" $367.53 "$1,851.75" $833.29 $833.29 $833.29 $833.29 "$1,851.75" "$1,851.75" "$1,851.75" $385.95 "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" $385.93 "$1,851.75" "$1,851.75" "$1,095.31" "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" "$1,389.00" "$1,851.75" "$1,851.75" "$1,851.75" $925.88 $925.88 "$1,466.59" "$1,851.75" "$1,481.40" $833.29 $367.53 N/A "$1,074.16" "$1,851.75" "$1,851.75" "$1,851.75" $385.90 "$1,851.75" N/A N/A 421.012 SUP HCPCS C1713 421.012 - PLATE BONE LARGE ARC .4MM CONTUR MESH MALBLE TEAL TITANIUM BOTH IP/OP "$2,893.50" "$2,141.00" $574.29 "$2,893.50" "$1,302.08" "$1,302.08" "$1,302.08" "$1,302.08" "$2,893.50" "$2,893.50" "$2,893.50" $603.08 "$2,893.50" "$2,893.50" "$2,893.50" "$2,893.50" "$2,893.50" $603.04 "$2,893.50" "$1,157.40" "$1,426.50" "$2,893.50" "$2,893.50" "$2,893.50" "$2,893.50" "$2,170.13" "$2,893.50" "$2,893.50" "$2,893.50" "$1,446.75" "$1,446.75" "$2,291.65" "$2,893.50" "$2,314.80" "$1,302.08" $574.29 N/A "$1,678.23" "$2,893.50" "$1,736.10" "$2,893.50" "$2,893.50" "$2,893.50" N/A N/A 421.013 SUP HCPCS C1713 421.013 - PLATE BONE SMALL ARC .6MM CONTUR MESH RIGID GOLD TITANIUM BOTH IP/OP "$1,852.00" "$1,370.00" $367.53 "$1,851.75" $833.29 $833.29 $833.29 $833.29 "$1,851.75" "$1,851.75" "$1,851.75" $385.95 "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" $385.93 "$1,851.75" $740.70 "$1,095.31" "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" "$1,389.00" "$1,851.75" "$1,851.75" "$1,851.75" $925.88 $925.88 "$1,466.59" "$1,851.75" "$1,481.40" $833.29 $367.53 N/A "$1,074.16" "$1,851.75" "$1,111.05" "$1,851.75" "$1,851.75" "$1,851.75" N/A N/A 421.014 SUP HCPCS C1713 421.014 - PLATE BONE LARGE ARC .6MM CONTUR MESH RIGID GOLD TITANIUM BOTH IP/OP "$2,893.50" "$2,141.00" $574.29 "$2,893.50" "$1,302.08" "$1,302.08" "$1,302.08" "$1,302.08" "$2,893.50" "$2,893.50" "$2,893.50" $603.08 "$2,893.50" "$2,893.50" "$2,893.50" "$2,893.50" "$2,893.50" $603.04 "$2,893.50" "$2,893.50" "$1,426.50" "$2,893.50" "$2,893.50" "$2,893.50" "$2,893.50" "$2,170.13" "$2,893.50" "$2,893.50" "$2,893.50" "$1,446.75" "$1,446.75" "$2,291.65" "$2,893.50" "$2,314.80" "$1,302.08" $574.29 N/A "$1,678.23" "$2,893.50" "$1,736.10" "$2,893.50" $603.01 "$2,893.50" N/A N/A 421.015 SUP HCPCS C1713 421.015 - PLATE BONE ROUND 30MM .4MM CONTUR MESH MALBLE TEAL TITANIUM BOTH IP/OP "$1,852.00" "$1,370.00" $367.53 "$1,851.75" $833.29 $833.29 $833.29 $833.29 "$1,851.75" "$1,851.75" "$1,851.75" $385.95 "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" $385.93 "$1,851.75" "$1,851.75" "$1,095.31" "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" "$1,389.00" "$1,851.75" "$1,851.75" "$1,851.75" $925.88 $925.88 "$1,466.59" "$1,851.75" "$1,481.40" $833.29 $367.53 N/A "$1,074.16" "$1,851.75" "$1,111.05" "$1,851.75" $385.90 "$1,851.75" N/A N/A 421.016 SUP HCPCS C1713 421.016 - PLATE BONE ROUND 70MM .4MM CONTUR MESH MALBLE TEAL TITANIUM BOTH IP/OP "$3,845.50" "$2,846.00" $763.19 "$3,845.25" "$1,730.36" "$1,730.36" "$1,730.36" "$1,730.36" "$3,845.25" "$3,845.25" "$3,845.25" $801.45 "$3,845.25" "$3,845.25" "$3,845.25" "$3,845.25" "$3,845.25" $801.39 "$3,845.25" "$1,538.10" "$1,895.71" "$3,845.25" "$3,845.25" "$3,845.25" "$3,845.25" "$2,884.13" "$3,845.25" "$3,845.25" "$3,845.25" "$1,922.63" "$1,922.63" "$3,045.44" "$3,845.25" "$3,076.20" "$1,730.36" $763.19 N/A "$2,230.39" "$3,845.25" "$2,307.15" "$3,845.25" $801.35 "$3,845.25" N/A N/A 421.017 SUP HCPCS C1713 421.017 - PLATE BONE ROUND 100MM .4MM CONTUR MESH MALBLE TEAL TITANIUM BOTH IP/OP "$5,335.00" "$3,948.00" "$1,058.81" "$5,334.75" "$2,400.64" "$2,400.64" "$2,400.64" "$2,400.64" "$5,334.75" "$5,334.75" "$5,334.75" "$1,111.90" "$5,334.75" "$5,334.75" "$5,334.75" "$5,334.75" "$5,334.75" "$1,111.82" "$5,334.75" "$2,133.90" "$2,630.03" "$5,334.75" "$5,334.75" "$5,334.75" "$5,334.75" "$4,001.25" "$5,334.75" "$5,334.75" "$5,334.75" "$2,667.38" "$2,667.38" "$4,225.12" "$5,334.75" "$4,267.80" "$2,400.64" "$1,058.81" N/A "$3,094.30" "$5,334.75" "$5,334.75" "$5,334.75" "$1,111.76" "$5,334.75" N/A N/A 421.018 SUP HCPCS C1713 421.018 - PLATE BONE ROUND 30MM .6MM CONTUR MESH RIGID GOLD TITANIUM BOTH IP/OP "$1,852.00" "$1,370.00" $367.53 "$1,851.75" $833.29 $833.29 $833.29 $833.29 "$1,851.75" "$1,851.75" "$1,851.75" $385.95 "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" $385.93 "$1,851.75" "$1,851.75" "$1,095.31" "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" "$1,389.00" "$1,851.75" "$1,851.75" "$1,851.75" $925.88 $925.88 "$1,466.59" "$1,851.75" "$1,481.40" $833.29 $367.53 N/A "$1,074.16" "$1,851.75" "$1,851.75" "$1,851.75" $385.90 "$1,851.75" N/A N/A 421.019 SUP HCPCS C1713 421.019 - PLATE BONE ROUND 70MM .6MM CONTUR MESH RIGID GOLD TITANIUM BOTH IP/OP "$3,845.50" "$2,846.00" $763.19 "$3,845.25" "$1,730.36" "$1,730.36" "$1,730.36" "$1,730.36" "$3,845.25" "$3,845.25" "$3,845.25" $801.45 "$3,845.25" "$3,845.25" "$3,845.25" "$3,845.25" "$3,845.25" $801.39 "$3,845.25" "$1,538.10" "$1,895.71" "$3,845.25" "$3,845.25" "$3,845.25" "$3,845.25" "$2,884.13" "$3,845.25" "$3,845.25" "$3,845.25" "$1,922.63" "$1,922.63" "$3,045.44" "$3,845.25" "$3,076.20" "$1,730.36" $763.19 N/A "$2,230.39" "$3,845.25" "$2,307.15" "$3,845.25" "$3,845.25" "$3,845.25" N/A N/A 421.02 SUP HCPCS C1713 421.020 - PLATE BONE ROUND 100MM .6MM CONTUR MESH RIGID GOLD TITANIUM BOTH IP/OP "$5,335.00" "$3,948.00" "$1,058.81" "$5,334.75" "$2,400.64" "$2,400.64" "$2,400.64" "$2,400.64" "$5,334.75" "$5,334.75" "$5,334.75" "$1,111.90" "$5,334.75" "$5,334.75" "$5,334.75" "$5,334.75" "$5,334.75" "$1,111.82" "$5,334.75" "$2,133.90" "$2,630.03" "$5,334.75" "$5,334.75" "$5,334.75" "$5,334.75" "$4,001.25" "$5,334.75" "$5,334.75" "$5,334.75" "$2,667.38" "$2,667.38" "$4,225.12" "$5,334.75" "$4,267.80" "$2,400.64" "$1,058.81" N/A "$3,094.30" "$5,334.75" "$3,200.85" "$5,334.75" "$5,334.75" "$5,334.75" N/A N/A 421.021 SUP HCPCS C1713 421.021 - PLATE BN 35X3.3X.5MM NS 9 HL TI CRNFCL ORBT RIM 1.3MM CORT BOTH IP/OP $576.00 $426.00 $114.32 $576.00 $259.20 $259.20 $259.20 $259.20 $576.00 $576.00 $576.00 $120.05 $576.00 $576.00 $576.00 $576.00 $576.00 $120.04 $576.00 $230.40 $340.70 $576.00 $576.00 $576.00 $576.00 $432.00 $576.00 $576.00 $576.00 $288.00 $288.00 $456.19 $576.00 $460.80 $259.20 $114.32 N/A $334.08 $576.00 $576.00 $576.00 $120.04 $576.00 N/A N/A 421.022 SUP HCPCS C1713 421.022 - PLATE BONE STR .4MM 2 HOLE TITANIUM CRANFCL NONSTRL 1.3MM BOTH IP/OP $101.50 $75.00 $20.10 $101.25 $45.56 $45.56 $45.56 $45.56 $101.25 $101.25 $101.25 $21.10 $101.25 $101.25 $101.25 $101.25 $101.25 $21.10 $101.25 $40.50 $59.89 $101.25 $101.25 $101.25 $101.25 $76.13 $101.25 $101.25 $101.25 $50.63 $50.63 $80.19 $101.25 $81.00 $45.56 $20.10 N/A $58.87 $101.25 $60.75 $101.25 $101.25 $101.25 N/A N/A 421.024 SUP HCPCS C1713 421.024 - PLATE BONE STR .4MM 4 HOLE TITANIUM CRANFCL NONSTRL 1.3MM BOTH IP/OP $139.50 $103.00 $27.69 $139.50 $62.78 $62.78 $62.78 $62.78 $139.50 $139.50 $139.50 $29.08 $139.50 $139.50 $139.50 $139.50 $139.50 $29.07 $139.50 $55.80 $82.51 $139.50 $139.50 $139.50 $139.50 $104.63 $139.50 $139.50 $139.50 $69.75 $69.75 $110.48 $139.50 $111.60 $62.78 $27.69 N/A $80.91 $139.50 $83.70 $139.50 $139.50 $139.50 N/A N/A 421.034 SUP Custom 27803010 421.034 - COVER BURR HOLE 17MM 5 HOLE SHUNT TITANIUM CRANIUM NONSTRL BOTH IP/OP $567.00 $420.00 $100.93 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $100.93 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $226.80 $567.00 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $567.00 N/A $328.86 $567.00 $340.20 $567.00 $567.00 $567.00 N/A N/A 421.04 SUP HCPCS C1713 421.040 - PLATE BONE UNIVERSAL 50X50X.4MM TITANIUM ORBTL FLOOR CRANFCL BOTH IP/OP "$2,531.50" "$1,873.00" $502.39 "$2,531.25" "$1,139.06" "$1,139.06" "$1,139.06" "$1,139.06" "$2,531.25" "$2,531.25" "$2,531.25" $527.58 "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" $527.54 "$2,531.25" "$1,012.50" "$1,247.91" "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" "$1,898.63" "$2,531.25" "$2,531.25" "$2,531.25" "$1,265.63" "$1,265.63" "$2,004.75" "$2,531.25" "$2,025.00" "$1,139.06" $502.39 N/A "$1,468.27" "$2,531.25" "$2,531.25" "$2,531.25" $527.51 "$2,531.25" N/A N/A 421.043 SUP HCPCS C1713 421.043 - PLATE BONE MEDIUM .3MM ANATOMIC TITANIUM ORBTL FLOOR NONSTRL BOTH IP/OP "$2,554.00" "$1,890.00" $506.86 "$2,553.75" "$1,149.19" "$1,149.19" "$1,149.19" "$1,149.19" "$2,553.75" "$2,553.75" "$2,553.75" $532.27 "$2,553.75" "$2,553.75" "$2,553.75" "$2,553.75" "$2,553.75" $532.23 "$2,553.75" "$1,021.50" "$1,259.00" "$2,553.75" "$2,553.75" "$2,553.75" "$2,553.75" "$1,915.50" "$2,553.75" "$2,553.75" "$2,553.75" "$1,276.88" "$1,276.88" "$2,022.57" "$2,553.75" "$2,043.00" "$1,149.19" $506.86 N/A "$1,481.32" "$2,553.75" "$1,532.25" "$2,553.75" "$2,553.75" "$2,553.75" N/A N/A 421.044 SUP HCPCS C1713 421.044 - PLATE BONE 36X32X.5MM 7 HOLE GOLD TITANIUM LEFT MEDIAL WALL BOTH IP/OP "$2,531.50" "$1,873.00" $502.39 "$2,531.25" "$1,139.06" "$1,139.06" "$1,139.06" "$1,139.06" "$2,531.25" "$2,531.25" "$2,531.25" $527.58 "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" $527.54 "$2,531.25" "$1,012.50" "$1,247.91" "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" "$1,898.63" "$2,531.25" "$2,531.25" "$2,531.25" "$1,265.63" "$1,265.63" "$2,004.75" "$2,531.25" "$2,025.00" "$1,139.06" $502.39 N/A "$1,468.27" "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" N/A N/A 421.045 SUP HCPCS C1713 421.045 - PLATE BONE 36X32X.5MM 7 HOLE GOLD TITANIUM RIGHT MEDIAL WALL BOTH IP/OP "$2,531.50" "$1,873.00" $502.39 "$2,531.25" "$1,139.06" "$1,139.06" "$1,139.06" "$1,139.06" "$2,531.25" "$2,531.25" "$2,531.25" $527.58 "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" $527.54 "$2,531.25" "$1,012.50" "$1,247.91" "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" "$1,898.63" "$2,531.25" "$2,531.25" "$2,531.25" "$1,265.63" "$1,265.63" "$2,004.75" "$2,531.25" "$2,025.00" "$1,139.06" $502.39 N/A "$1,468.27" "$2,531.25" "$1,518.75" "$2,531.25" $527.51 "$2,531.25" N/A N/A 421.048 SUP HCPCS C1713 421.048 - PLATE BN SM .3MM NS ANTM TI ORBT FLR 1.3MM CORT SCR BOTH IP/OP "$2,554.00" "$1,890.00" $506.86 "$2,553.75" "$1,149.19" "$1,149.19" "$1,149.19" "$1,149.19" "$2,553.75" "$2,553.75" "$2,553.75" $532.27 "$2,553.75" "$2,553.75" "$2,553.75" "$2,553.75" "$2,553.75" $532.23 "$2,553.75" "$1,021.50" "$1,259.00" "$2,553.75" "$2,553.75" "$2,553.75" "$2,553.75" "$1,915.50" "$2,553.75" "$2,553.75" "$2,553.75" "$1,276.88" "$1,276.88" "$2,022.57" "$2,553.75" "$2,043.00" "$1,149.19" $506.86 N/A "$1,481.32" "$2,553.75" "$1,532.25" "$2,553.75" "$2,553.75" "$2,553.75" N/A N/A 421.049 SUP HCPCS C1713 421.049 - PLATE BN LG .3MM NS ANTM TI ORBT FLR 1.3MM CORT SCR BOTH IP/OP "$2,554.00" "$1,890.00" $506.86 "$2,553.75" "$1,149.19" "$1,149.19" "$1,149.19" "$1,149.19" "$2,553.75" "$2,553.75" "$2,553.75" $532.27 "$2,553.75" "$2,553.75" "$2,553.75" "$2,553.75" "$2,553.75" $532.23 "$2,553.75" "$1,021.50" "$1,259.00" "$2,553.75" "$2,553.75" "$2,553.75" "$2,553.75" "$1,915.50" "$2,553.75" "$2,553.75" "$2,553.75" "$1,276.88" "$1,276.88" "$2,022.57" "$2,553.75" "$2,043.00" "$1,149.19" $506.86 N/A "$1,481.32" "$2,553.75" "$1,532.25" "$2,553.75" "$2,553.75" "$2,553.75" N/A N/A 421.05 SUP HCPCS C1713 421.050 - PLATE BN 100D 9MM SPC L OB L 20X11X.5MM NS 3 HL BS 3 HL SHFT BOTH IP/OP $576.00 $426.00 $114.32 $576.00 $259.20 $259.20 $259.20 $259.20 $576.00 $576.00 $576.00 $120.05 $576.00 $576.00 $576.00 $576.00 $576.00 $120.04 $576.00 $230.40 $340.70 $576.00 $576.00 $576.00 $576.00 $432.00 $576.00 $576.00 $576.00 $288.00 $288.00 $456.19 $576.00 $460.80 $259.20 $114.32 N/A $334.08 $576.00 $345.60 $576.00 $576.00 $576.00 N/A N/A 421.051 SUP HCPCS C1713 421.051 - PLATE BN 100D 9MM SPC L OB R 20X11X.5MM NS 3 HL BS 3 HL SHFT BOTH IP/OP $576.00 $426.00 $114.32 $576.00 $259.20 $259.20 $259.20 $259.20 $576.00 $576.00 $576.00 $120.05 $576.00 $576.00 $576.00 $576.00 $576.00 $120.04 $576.00 $230.40 $340.70 $576.00 $576.00 $576.00 $576.00 $432.00 $576.00 $576.00 $576.00 $288.00 $288.00 $456.19 $576.00 $460.80 $259.20 $114.32 N/A $334.08 $576.00 $345.60 $576.00 $120.04 $576.00 N/A N/A 421.052 SUP HCPCS C1713 421.052 - PLATE BN 100D 5MM SPC L OB L 20X11X.5MM NS 3 HL BS 4 HL SHFT BOTH IP/OP $576.00 $426.00 $114.32 $576.00 $259.20 $259.20 $259.20 $259.20 $576.00 $576.00 $576.00 $120.05 $576.00 $576.00 $576.00 $576.00 $576.00 $120.04 $576.00 $230.40 $340.70 $576.00 $576.00 $576.00 $576.00 $432.00 $576.00 $576.00 $576.00 $288.00 $288.00 $456.19 $576.00 $460.80 $259.20 $114.32 N/A $334.08 $576.00 $345.60 $576.00 $576.00 $576.00 N/A N/A 421.053 SUP HCPCS C1713 421.053 - PLATE BN 100D 5MM SPC L OB R 20X11X.5MM NS 3 HL BS 4 HL SHFT BOTH IP/OP $576.00 $426.00 $114.32 $576.00 $259.20 $259.20 $259.20 $259.20 $576.00 $576.00 $576.00 $120.05 $576.00 $576.00 $576.00 $576.00 $576.00 $120.04 $576.00 $230.40 $340.70 $576.00 $576.00 $576.00 $576.00 $432.00 $576.00 $576.00 $576.00 $288.00 $288.00 $456.19 $576.00 $460.80 $259.20 $114.32 N/A $334.08 $576.00 $345.60 $576.00 $120.04 $576.00 N/A N/A 421.061 SUP HCPCS C1713 421.061 - PLATE BN Y 20X10X.5MM NS 5 HL TI CRNFCL 1.3MM CORT SCR BOTH IP/OP $522.00 $386.00 $103.60 $522.00 $234.90 $234.90 $234.90 $234.90 $522.00 $522.00 $522.00 $108.80 $522.00 $522.00 $522.00 $522.00 $522.00 $108.79 $522.00 $522.00 $308.76 $522.00 $522.00 $522.00 $522.00 $391.50 $522.00 $522.00 $522.00 $261.00 $261.00 $413.42 $522.00 $417.60 $234.90 $103.60 N/A $302.76 $522.00 $313.20 $522.00 $108.78 $522.00 N/A N/A 421.067 SUP HCPCS C1713 421.067 - PLATE BONE 2Y 22X3.3MM 9MM 6 HOLE TITANIUM CRANFCL NONSTRL BOTH IP/OP $571.50 $423.00 $113.43 $571.50 $257.18 $257.18 $257.18 $257.18 $571.50 $571.50 $571.50 $119.11 $571.50 $571.50 $571.50 $571.50 $571.50 $119.11 $571.50 $571.50 $338.04 $571.50 $571.50 $571.50 $571.50 $428.63 $571.50 $571.50 $571.50 $285.75 $285.75 $452.63 $571.50 $457.20 $257.18 $113.43 N/A $331.47 $571.50 $342.90 $571.50 $119.10 $571.50 N/A N/A 421.068 SUP HCPCS C1713 421.068 - PLATE BN 6MM SPC 2Y 15X9X.5MM NS 2 HL SHFT 1 HL ARM TI BOTH IP/OP $571.50 $423.00 $113.43 $571.50 $257.18 $257.18 $257.18 $257.18 $571.50 $571.50 $571.50 $119.11 $571.50 $571.50 $571.50 $571.50 $571.50 $119.11 $571.50 $571.50 $338.04 $571.50 $571.50 $571.50 $571.50 $428.63 $571.50 $571.50 $571.50 $285.75 $285.75 $452.63 $571.50 $457.20 $257.18 $113.43 N/A $331.47 $571.50 $342.90 $571.50 $119.10 $571.50 N/A N/A 421.069 SUP HCPCS C1713 421.069 - PLATE BONE 2Y 18X9X.5MM 1 HOLE ARM 2 HOLE SHAFT TITANIUM BOTH IP/OP $571.50 $423.00 $113.43 $571.50 $257.18 $257.18 $257.18 $257.18 $571.50 $571.50 $571.50 $119.11 $571.50 $571.50 $571.50 $571.50 $571.50 $119.11 $571.50 $228.60 $338.04 $571.50 $571.50 $571.50 $571.50 $428.63 $571.50 $571.50 $571.50 $285.75 $285.75 $452.63 $571.50 $457.20 $257.18 $113.43 N/A $331.47 $571.50 $342.90 $571.50 $119.10 $571.50 N/A N/A 421.071 SUP HCPCS C1713 421.071 - PLATE BONE T 20X11X.5MM 3X4 HOLE TITANIUM BOTH IP/OP $576.00 $426.00 $114.32 $576.00 $259.20 $259.20 $259.20 $259.20 $576.00 $576.00 $576.00 $120.05 $576.00 $576.00 $576.00 $576.00 $576.00 $120.04 $576.00 $230.40 $340.70 $576.00 $576.00 $576.00 $576.00 $432.00 $576.00 $576.00 $576.00 $288.00 $288.00 $456.19 $576.00 $460.80 $259.20 $114.32 N/A $334.08 $576.00 $576.00 $576.00 $576.00 $576.00 N/A N/A 421.072 SUP HCPCS C1713 421.072 - PLATE BONE 14MM T TITANIUM RIGHT MAXL NONSTRL 1.3MM SCREWS BOTH IP/OP $729.00 $539.00 $144.69 $729.00 $328.05 $328.05 $328.05 $328.05 $729.00 $729.00 $729.00 $151.94 $729.00 $729.00 $729.00 $729.00 $729.00 $151.93 $729.00 $291.60 $431.20 $729.00 $729.00 $729.00 $729.00 $546.75 $729.00 $729.00 $729.00 $364.50 $364.50 $577.37 $729.00 $583.20 $328.05 $144.69 N/A $422.82 $729.00 $437.40 $729.00 $151.92 $729.00 N/A N/A 421.073 SUP HCPCS C1713 421.073 - PLATE BONE 14MM T TITANIUM LEFT MAXL NONSTRL 1.3MM SCREWS BOTH IP/OP $729.00 $539.00 $144.69 $729.00 $328.05 $328.05 $328.05 $328.05 $729.00 $729.00 $729.00 $151.94 $729.00 $729.00 $729.00 $729.00 $729.00 $151.93 $729.00 $291.60 $431.20 $729.00 $729.00 $729.00 $729.00 $546.75 $729.00 $729.00 $729.00 $364.50 $364.50 $577.37 $729.00 $583.20 $328.05 $144.69 N/A $422.82 $729.00 $437.40 $729.00 $151.92 $729.00 N/A N/A 421.074 SUP HCPCS C1713 421.074 - PLATE BONE 8MM T TITANIUM RIGHT MAXL NONSTRL 1.3MM SCREWS BOTH IP/OP $729.00 $539.00 $144.69 $729.00 $328.05 $328.05 $328.05 $328.05 $729.00 $729.00 $729.00 $151.94 $729.00 $729.00 $729.00 $729.00 $729.00 $151.93 $729.00 $729.00 $431.20 $729.00 $729.00 $729.00 $729.00 $546.75 $729.00 $729.00 $729.00 $364.50 $364.50 $577.37 $729.00 $583.20 $328.05 $144.69 N/A $422.82 $729.00 $437.40 $729.00 $151.92 $729.00 N/A N/A 421.075 SUP HCPCS C1713 421.075 - PLATE BONE 8MM T TITANIUM LEFT MAXL NONSTRL 1.3MM SCREWS BOTH IP/OP $729.00 $539.00 $144.69 $729.00 $328.05 $328.05 $328.05 $328.05 $729.00 $729.00 $729.00 $151.94 $729.00 $729.00 $729.00 $729.00 $729.00 $151.93 $729.00 $291.60 $431.20 $729.00 $729.00 $729.00 $729.00 $546.75 $729.00 $729.00 $729.00 $364.50 $364.50 $577.37 $729.00 $583.20 $328.05 $144.69 N/A $422.82 $729.00 $437.40 $729.00 $151.92 $729.00 N/A N/A 421.076 SUP HCPCS C1713 421.076 - PLATE BONE 10MM T TITANIUM RIGHT MAXL NONSTRL 1.3MM SCREWS BOTH IP/OP $729.00 $539.00 $144.69 $729.00 $328.05 $328.05 $328.05 $328.05 $729.00 $729.00 $729.00 $151.94 $729.00 $729.00 $729.00 $729.00 $729.00 $151.93 $729.00 $291.60 $431.20 $729.00 $729.00 $729.00 $729.00 $546.75 $729.00 $729.00 $729.00 $364.50 $364.50 $577.37 $729.00 $583.20 $328.05 $144.69 N/A $422.82 $729.00 $437.40 $729.00 $151.92 $729.00 N/A N/A 421.077 SUP HCPCS C1713 421.077 - PLATE BONE 10MM T TITANIUM LEFT MAXL NONSTRL 1.3MM SCREWS BOTH IP/OP $729.00 $539.00 $144.69 $729.00 $328.05 $328.05 $328.05 $328.05 $729.00 $729.00 $729.00 $151.94 $729.00 $729.00 $729.00 $729.00 $729.00 $151.93 $729.00 $291.60 $431.20 $729.00 $729.00 $729.00 $729.00 $546.75 $729.00 $729.00 $729.00 $364.50 $364.50 $577.37 $729.00 $583.20 $328.05 $144.69 N/A $422.82 $729.00 $437.40 $729.00 $151.92 $729.00 N/A N/A 421.078 SUP HCPCS C1713 421.078 - PLATE BONE 12MM T TITANIUM RIGHT MAXL NONSTRL 1.3MM SCREWS BOTH IP/OP $729.00 $539.00 $144.69 $729.00 $328.05 $328.05 $328.05 $328.05 $729.00 $729.00 $729.00 $151.94 $729.00 $729.00 $729.00 $729.00 $729.00 $151.93 $729.00 $291.60 $431.20 $729.00 $729.00 $729.00 $729.00 $546.75 $729.00 $729.00 $729.00 $364.50 $364.50 $577.37 $729.00 $583.20 $328.05 $144.69 N/A $422.82 $729.00 $437.40 $729.00 $151.92 $729.00 N/A N/A 421.079 SUP HCPCS C1713 421.079 - PLATE BONE 12MM T TITANIUM LEFT MAXL NONSTRL 1.3MM SCREWS BOTH IP/OP $729.00 $539.00 $144.69 $729.00 $328.05 $328.05 $328.05 $328.05 $729.00 $729.00 $729.00 $151.94 $729.00 $729.00 $729.00 $729.00 $729.00 $151.93 $729.00 $291.60 $431.20 $729.00 $729.00 $729.00 $729.00 $546.75 $729.00 $729.00 $729.00 $364.50 $364.50 $577.37 $729.00 $583.20 $328.05 $144.69 N/A $422.82 $729.00 $437.40 $729.00 $151.92 $729.00 N/A N/A 421.08 SUP HCPCS C1713 421.080 - PLATE BN T 43X8X.5MM NS 2X9 HL STRUT TI CRNFCL 1.3MM CORT BOTH IP/OP "$1,190.50" $881.00 $236.23 "$1,190.25" $535.61 $535.61 $535.61 $535.61 "$1,190.25" "$1,190.25" "$1,190.25" $248.08 "$1,190.25" "$1,190.25" "$1,190.25" "$1,190.25" "$1,190.25" $248.06 "$1,190.25" $476.10 $704.03 "$1,190.25" "$1,190.25" "$1,190.25" "$1,190.25" $892.88 "$1,190.25" "$1,190.25" "$1,190.25" $595.13 $595.13 $942.68 "$1,190.25" $952.20 $535.61 $236.23 N/A $690.49 "$1,190.25" $714.15 "$1,190.25" $248.05 "$1,190.25" N/A N/A 421.081 SUP HCPCS C1713 421.081 - PLATE BONE X 4 HOLE TITANIUM CRANIUM NONSTRL 1.3MM SCREW BOTH IP/OP $522.00 $386.00 $103.60 $522.00 $234.90 $234.90 $234.90 $234.90 $522.00 $522.00 $522.00 $108.80 $522.00 $522.00 $522.00 $522.00 $522.00 $108.79 $522.00 $208.80 $308.76 $522.00 $522.00 $522.00 $522.00 $391.50 $522.00 $522.00 $522.00 $261.00 $261.00 $413.42 $522.00 $417.60 $234.90 $103.60 N/A $302.76 $522.00 $522.00 $522.00 $108.78 $522.00 N/A N/A 421.082 SUP HCPCS C1713 421.082 - PLATE BONE 8MM T STR TITANIUM MAXL NONSTRL 1.3MM SCREWS BOTH IP/OP $729.00 $539.00 $144.69 $729.00 $328.05 $328.05 $328.05 $328.05 $729.00 $729.00 $729.00 $151.94 $729.00 $729.00 $729.00 $729.00 $729.00 $151.93 $729.00 $291.60 $431.20 $729.00 $729.00 $729.00 $729.00 $546.75 $729.00 $729.00 $729.00 $364.50 $364.50 $577.37 $729.00 $583.20 $328.05 $144.69 N/A $422.82 $729.00 $729.00 $729.00 $151.92 $729.00 N/A N/A 421.083 SUP HCPCS C1713 421.083 - PLATE BONE 10MM T STR TITANIUM MAXL NONSTRL 1.3MM SCREWS BOTH IP/OP $729.00 $539.00 $144.69 $729.00 $328.05 $328.05 $328.05 $328.05 $729.00 $729.00 $729.00 $151.94 $729.00 $729.00 $729.00 $729.00 $729.00 $151.93 $729.00 $291.60 $431.20 $729.00 $729.00 $729.00 $729.00 $546.75 $729.00 $729.00 $729.00 $364.50 $364.50 $577.37 $729.00 $583.20 $328.05 $144.69 N/A $422.82 $729.00 $437.40 $729.00 $151.92 $729.00 N/A N/A 421.084 SUP HCPCS C1713 421.084 - PLATE BONE 12MM T STR TITANIUM MAXL NONSTRL 1.3MM SCREWS BOTH IP/OP $729.00 $539.00 $144.69 $729.00 $328.05 $328.05 $328.05 $328.05 $729.00 $729.00 $729.00 $151.94 $729.00 $729.00 $729.00 $729.00 $729.00 $151.93 $729.00 $291.60 $431.20 $729.00 $729.00 $729.00 $729.00 $546.75 $729.00 $729.00 $729.00 $364.50 $364.50 $577.37 $729.00 $583.20 $328.05 $144.69 N/A $422.82 $729.00 $729.00 $729.00 $151.92 $729.00 N/A N/A 421.085 SUP HCPCS C1713 421.085 - PLATE BONE H 19X13X.5MM 11 HOLE TITANIUM CRANFCL NONSTRL 1.3 BOTH IP/OP $610.00 $451.00 $121.02 $609.75 $274.39 $274.39 $274.39 $274.39 $609.75 $609.75 $609.75 $127.09 $609.75 $609.75 $609.75 $609.75 $609.75 $127.08 $609.75 $243.90 $360.67 $609.75 $609.75 $609.75 $609.75 $457.50 $609.75 $609.75 $609.75 $304.88 $304.88 $482.92 $609.75 $487.80 $274.39 $121.02 N/A $353.80 $609.75 $365.85 $609.75 $127.07 $609.75 N/A N/A 421.086 SUP HCPCS C1713 421.086 - PLATE BONE 14MM T STR TITANIUM MAXL NONSTRL 1.3MM SCREWS BOTH IP/OP $729.00 $539.00 $144.69 $729.00 $328.05 $328.05 $328.05 $328.05 $729.00 $729.00 $729.00 $151.94 $729.00 $729.00 $729.00 $729.00 $729.00 $151.93 $729.00 $291.60 $431.20 $729.00 $729.00 $729.00 $729.00 $546.75 $729.00 $729.00 $729.00 $364.50 $364.50 $577.37 $729.00 $583.20 $328.05 $144.69 N/A $422.82 $729.00 $437.40 $729.00 $151.92 $729.00 N/A N/A 421.09 SUP Custom 27803010 421.090 - COVER BURR HOLE 12MM 6 HOLE TITANIUM CRANFCL NONSTRL 1.3MM BOTH IP/OP $632.50 $468.00 $112.54 $632.25 $632.25 $632.25 $632.25 $632.25 $632.25 $632.25 $112.54 $632.25 $632.25 $632.25 $632.25 $632.25 $632.25 $131.77 $632.25 $252.90 $632.25 $632.25 $632.25 $632.25 $632.25 $474.38 $632.25 $632.25 $632.25 $316.13 $316.13 $500.74 $632.25 $505.80 $284.51 $632.25 N/A $366.85 $632.25 $379.35 $632.25 $632.25 $632.25 N/A N/A 421.091 SUP Custom 27803010 421.091 - COVER BURR HOLE 17MM 6 HOLE TITANIUM CRANFCL NONSTRL 1.3MM BOTH IP/OP $632.50 $468.00 $112.54 $632.25 $632.25 $632.25 $632.25 $632.25 $632.25 $632.25 $112.54 $632.25 $632.25 $632.25 $632.25 $632.25 $632.25 $131.77 $632.25 $252.90 $632.25 $632.25 $632.25 $632.25 $632.25 $474.38 $632.25 $632.25 $632.25 $316.13 $316.13 $500.74 $632.25 $505.80 $284.51 $632.25 N/A $366.85 $632.25 $379.35 $632.25 $632.25 $632.25 N/A N/A 421.092 SUP Custom 27803010 421.092 - COVER BURR HOLE 15MM 6 HOLE TITANIUM CRANFCL NONSTRL 1.3MM BOTH IP/OP $567.00 $420.00 $100.93 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $100.93 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $226.80 $567.00 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $567.00 N/A $328.86 $567.00 $340.20 $567.00 $567.00 $567.00 N/A N/A 421.093 SUP Custom 27803010 421.093 - COVER BURR HOLE 24MM 6 HOLE TITANIUM CRANFCL NONSTRL 1.3MM BOTH IP/OP $567.00 $420.00 $100.93 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $100.93 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $226.80 $567.00 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $567.00 N/A $328.86 $567.00 $340.20 $567.00 $567.00 $567.00 N/A N/A 421.095 SUP HCPCS C1713 421.095 - PLATE BN BX 13X8MM NS 4 HL TI CRNFCL 1.3MM SCR BOTH IP/OP $511.00 $378.00 $101.37 $510.75 $229.84 $229.84 $229.84 $229.84 $510.75 $510.75 $510.75 $106.45 $510.75 $510.75 $510.75 $510.75 $510.75 $106.45 $510.75 $204.30 $302.11 $510.75 $510.75 $510.75 $510.75 $383.25 $510.75 $510.75 $510.75 $255.38 $255.38 $404.51 $510.75 $408.60 $229.84 $101.37 N/A $296.38 $510.75 $306.45 $510.75 $106.44 $510.75 N/A N/A 421.096 SUP HCPCS C1713 421.096 - PLATE BONE BOX 13X13MM 4 HOLE TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $511.00 $378.00 $101.37 $510.75 $229.84 $229.84 $229.84 $229.84 $510.75 $510.75 $510.75 $106.45 $510.75 $510.75 $510.75 $510.75 $510.75 $106.45 $510.75 $510.75 $302.11 $510.75 $510.75 $510.75 $510.75 $383.25 $510.75 $510.75 $510.75 $255.38 $255.38 $404.51 $510.75 $408.60 $229.84 $101.37 N/A $296.38 $510.75 $306.45 $510.75 $106.44 $510.75 N/A N/A 421.099 SUP HCPCS C1713 421.099 - PLATE BONE 100X100X.2MM CONTUR MESH SCREEN TITANIUM BOTH IP/OP "$2,819.50" "$2,086.00" $559.55 "$2,819.25" "$1,268.66" "$1,268.66" "$1,268.66" "$1,268.66" "$2,819.25" "$2,819.25" "$2,819.25" $587.60 "$2,819.25" "$2,819.25" "$2,819.25" "$2,819.25" "$2,819.25" $587.56 "$2,819.25" "$1,127.70" "$1,389.89" "$2,819.25" "$2,819.25" "$2,819.25" "$2,819.25" "$2,114.63" "$2,819.25" "$2,819.25" "$2,819.25" "$1,409.63" "$1,409.63" "$2,232.85" "$2,819.25" "$2,255.40" "$1,268.66" $559.55 N/A "$1,635.31" "$2,819.25" "$2,819.25" "$2,819.25" $587.53 "$2,819.25" N/A N/A 421.302 SUP HCPCS C1713 421.302 - PLATE BONE UNIVERSAL .2MM 3 ROW SCREW HOLE MESH MALBLE BOTH IP/OP "$2,668.50" "$1,975.00" $529.63 "$2,668.50" "$1,200.83" "$1,200.83" "$1,200.83" "$1,200.83" "$2,668.50" "$2,668.50" "$2,668.50" $556.18 "$2,668.50" "$2,668.50" "$2,668.50" "$2,668.50" "$2,668.50" $556.14 "$2,668.50" "$1,067.40" "$1,315.57" "$2,668.50" "$2,668.50" "$2,668.50" "$2,668.50" "$2,001.38" "$2,668.50" "$2,668.50" "$2,668.50" "$1,334.25" "$1,334.25" "$2,113.45" "$2,668.50" "$2,134.80" "$1,200.83" $529.63 N/A "$1,547.73" "$2,668.50" "$2,668.50" "$2,668.50" $556.12 "$2,668.50" N/A N/A 421.303 SUP HCPCS C1713 421.303 - PLATE BONE UNIVERSAL .3MM 3 ROW SCREW HOLE MESH MALBLE TEAL BOTH IP/OP "$2,668.50" "$1,975.00" $529.63 "$2,668.50" "$1,200.83" "$1,200.83" "$1,200.83" "$1,200.83" "$2,668.50" "$2,668.50" "$2,668.50" $556.18 "$2,668.50" "$2,668.50" "$2,668.50" "$2,668.50" "$2,668.50" $556.14 "$2,668.50" "$2,668.50" "$1,315.57" "$2,668.50" "$2,668.50" "$2,668.50" "$2,668.50" "$2,001.38" "$2,668.50" "$2,668.50" "$2,668.50" "$1,334.25" "$1,334.25" "$2,113.45" "$2,668.50" "$2,134.80" "$1,200.83" $529.63 N/A "$1,547.73" "$2,668.50" "$1,601.10" "$2,668.50" $556.12 "$2,668.50" N/A N/A 421.304 SUP HCPCS C1713 421.304 - PLATE BN .4MM AU NS 3 ROW SCR HL MESH MLBL TI ORBT 1.3MM SCR BOTH IP/OP "$2,668.50" "$1,975.00" $529.63 "$2,668.50" "$1,200.83" "$1,200.83" "$1,200.83" "$1,200.83" "$2,668.50" "$2,668.50" "$2,668.50" $556.18 "$2,668.50" "$2,668.50" "$2,668.50" "$2,668.50" "$2,668.50" $556.14 "$2,668.50" "$2,668.50" "$1,315.57" "$2,668.50" "$2,668.50" "$2,668.50" "$2,668.50" "$2,001.38" "$2,668.50" "$2,668.50" "$2,668.50" "$1,334.25" "$1,334.25" "$2,113.45" "$2,668.50" "$2,134.80" "$1,200.83" $529.63 N/A "$1,547.73" "$2,668.50" "$1,601.10" "$2,668.50" $556.12 "$2,668.50" N/A N/A 421.306 SUP HCPCS C1713 421.306 - PLATE BN STRG 23MM NS 6 HL LOPRFL PRECONTOUR RECON TI HND BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $368.30 $368.30 N/A N/A 421.312 SUP HCPCS C1713 421.312 - PLATE BN STRG 47MM NS 12 HL LOPRFL PRECONTOUR RECON TI HND BOTH IP/OP $465.50 $344.00 $92.35 $473.18 $209.38 $209.38 $209.38 $209.38 $465.28 $465.28 $465.28 $96.98 $465.28 $465.28 $465.28 $465.28 $465.28 $96.97 $465.28 $473.18 $275.21 $465.28 $473.18 $465.28 $465.28 $349.13 $465.28 $465.28 $465.28 $232.64 $232.64 $368.50 $465.28 $372.22 $209.38 $92.35 N/A $269.99 $465.28 $279.17 $465.28 $465.28 $465.28 N/A N/A 421.32 SUP HCPCS C1713 421.320 - PLATE BONE H 19MMX.5MM 8 HOLE EXTENDED TITANIUM RIGHT HAND BOTH IP/OP $431.50 $319.00 $85.59 $451.75 $194.06 $194.06 $194.06 $194.06 $431.25 $431.25 $431.25 $89.88 $431.25 $431.25 $431.25 $431.25 $431.25 $89.88 $431.25 $451.75 $255.08 $431.25 $451.75 $431.25 $431.25 $323.63 $431.25 $431.25 $431.25 $215.63 $215.63 $341.55 $431.25 $345.00 $194.06 $85.59 N/A $250.27 $431.25 $258.75 $431.25 $89.87 $431.25 N/A N/A 421.321 SUP HCPCS C1713 421.321 - PLATE BONE H 8 HOLE EXTEND PRECONTOUR LP TITANIUM HAND LEFT BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $451.75 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $444.20 $444.20 $444.20 $444.20 N/A N/A 421.333 SUP HCPCS C1713 421.333 - PLATE BONE T 32MM 3X8 HOLE PRECONTOUR LP TITANIUM HAND BOTH IP/OP $426.00 $315.00 $84.54 $433.18 $191.67 $191.67 $191.67 $191.67 $425.93 $425.93 $425.93 $88.77 $425.93 $425.93 $425.93 $425.93 $425.93 $88.77 $425.93 $433.18 $251.94 $425.93 $433.18 $425.93 $425.93 $319.50 $425.93 $425.93 $425.93 $212.97 $212.97 $337.34 $425.93 $340.74 $191.67 $84.54 N/A $247.08 $425.93 $255.56 $425.93 $425.93 $425.93 N/A N/A 421.334 SUP HCPCS C1713 421.334 - PLATE BONE T 32MM 4X8 HOLE PRECONTOUR LP TITANIUM HAND BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $451.75 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $266.52 $444.20 $92.57 $444.20 N/A N/A 421.335 SUP HCPCS C1713 421.335 - PLATE BONE Y 3X8 HOLE PRECONTOUR LP TITANIUM HAND NONSTRL BOTH IP/OP $426.00 $315.00 $84.54 $433.18 $191.67 $191.67 $191.67 $191.67 $425.93 $425.93 $425.93 $88.77 $425.93 $425.93 $425.93 $425.93 $425.93 $88.77 $425.93 $173.27 $251.94 $425.93 $433.18 $425.93 $425.93 $319.50 $425.93 $425.93 $425.93 $212.97 $212.97 $337.34 $425.93 $340.74 $191.67 $84.54 N/A $247.08 $425.93 $255.56 $425.93 $88.76 $425.93 N/A N/A 421.5 SUP HCPCS C1713 421.500 - PLATE BONE MEDIUM .4MM CONTUR MESH MALBLE LP TITANIUM BOTH IP/OP "$2,083.50" "$1,542.00" $413.52 "$2,083.50" $937.58 $937.58 $937.58 $937.58 "$2,083.50" "$2,083.50" "$2,083.50" $434.25 "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" $434.22 "$2,083.50" "$2,083.50" "$1,232.39" "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" "$1,562.63" "$2,083.50" "$2,083.50" "$2,083.50" "$1,041.75" "$1,041.75" "$1,650.13" "$2,083.50" "$1,666.80" $937.58 $413.52 N/A "$1,208.43" "$2,083.50" "$1,250.10" "$2,083.50" $434.20 "$2,083.50" N/A N/A 421.501 SUP HCPCS C1713 421.501 - PLATE BONE .4MM 8 HOLE CONTUR STRUT LP TITANIUM BOTH IP/OP "$1,573.00" "$1,164.00" $312.15 "$1,572.75" $707.74 $707.74 $707.74 $707.74 "$1,572.75" "$1,572.75" "$1,572.75" $327.80 "$1,572.75" "$1,572.75" "$1,572.75" "$1,572.75" "$1,572.75" $327.78 "$1,572.75" "$1,572.75" $930.28 "$1,572.75" "$1,572.75" "$1,572.75" "$1,572.75" "$1,179.75" "$1,572.75" "$1,572.75" "$1,572.75" $786.38 $786.38 "$1,245.62" "$1,572.75" "$1,258.20" $707.74 $312.15 N/A $912.34 "$1,572.75" "$1,572.75" "$1,572.75" $327.76 "$1,572.75" N/A N/A 421.502 SUP HCPCS C1713 421.502 - PLATE BONE STR 12MMX.5MM 2 HOLE CENTRE SPACE LP TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 421.503 SUP HCPCS C1713 421.503 - PLATE BONE STR 9MMX.5MM 2 HOLE LP TITANIUM CRANFCL NONSTRL BOTH IP/OP $125.00 $93.00 $24.79 $124.88 $56.20 $56.20 $56.20 $56.20 $124.88 $124.88 $124.88 $26.03 $124.88 $124.88 $124.88 $124.88 $124.88 $26.03 $124.88 $49.95 $73.87 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $56.20 $24.79 N/A $72.50 $124.88 $124.88 $124.88 $124.88 $124.88 N/A N/A 421.504 SUP HCPCS C1713 421.504 - PLATE BONE STR .5MM 4 HOLE CENTRE SPACE LP TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 421.505 SUP HCPCS C1713 421.505 - PLATE BONE CURVE 12 HOLE LP OBLIQUE TITANIUM ORBTL RIM BOTH IP/OP $783.00 $579.00 $155.41 $783.00 $352.35 $352.35 $352.35 $352.35 $783.00 $783.00 $783.00 $163.20 $783.00 $783.00 $783.00 $783.00 $783.00 $163.19 $783.00 $783.00 $463.14 $783.00 $783.00 $783.00 $783.00 $587.25 $783.00 $783.00 $783.00 $391.50 $391.50 $620.14 $783.00 $626.40 $352.35 $155.41 N/A $454.14 $783.00 $783.00 $783.00 $783.00 $783.00 N/A N/A 421.506 SUP HCPCS C1713 421.506 - PLATE BONE L RIGHT OBLIQUE 2X3 HOLE LP TITANIUM CRANFCL BOTH IP/OP $655.00 $485.00 $129.95 $654.75 $294.64 $294.64 $294.64 $294.64 $654.75 $654.75 $654.75 $136.47 $654.75 $654.75 $654.75 $654.75 $654.75 $136.46 $654.75 $261.90 $387.28 $654.75 $654.75 $654.75 $654.75 $491.25 $654.75 $654.75 $654.75 $327.38 $327.38 $518.56 $654.75 $523.80 $294.64 $129.95 N/A $379.90 $654.75 $654.75 $654.75 $136.45 $654.75 N/A N/A 421.507 SUP HCPCS C1713 421.507 - PLATE BONE L LEFT OBLIQUE 2X3 HOLE LP TITANIUM CRANFCL BOTH IP/OP $655.00 $485.00 $129.95 $654.75 $294.64 $294.64 $294.64 $294.64 $654.75 $654.75 $654.75 $136.47 $654.75 $654.75 $654.75 $654.75 $654.75 $136.46 $654.75 $261.90 $387.28 $654.75 $654.75 $654.75 $654.75 $491.25 $654.75 $654.75 $654.75 $327.38 $327.38 $518.56 $654.75 $523.80 $294.64 $129.95 N/A $379.90 $654.75 $392.85 $654.75 $136.45 $654.75 N/A N/A 421.508 SUP HCPCS C1713 421.508 - PLATE BONE L RIGHT OBLIQUE 3X4 HOLE LP TITANIUM CRANFCL BOTH IP/OP $655.00 $485.00 $129.95 $654.75 $294.64 $294.64 $294.64 $294.64 $654.75 $654.75 $654.75 $136.47 $654.75 $654.75 $654.75 $654.75 $654.75 $136.46 $654.75 $261.90 $387.28 $654.75 $654.75 $654.75 $654.75 $491.25 $654.75 $654.75 $654.75 $327.38 $327.38 $518.56 $654.75 $523.80 $294.64 $129.95 N/A $379.90 $654.75 $392.85 $654.75 $136.45 $654.75 N/A N/A 421.509 SUP HCPCS C1713 421.509 - PLATE BONE L LEFT OBLIQUE 3X4 HOLE LP TITANIUM CRANFCL BOTH IP/OP $655.00 $485.00 $129.95 $654.75 $294.64 $294.64 $294.64 $294.64 $654.75 $654.75 $654.75 $136.47 $654.75 $654.75 $654.75 $654.75 $654.75 $136.46 $654.75 $261.90 $387.28 $654.75 $654.75 $654.75 $654.75 $491.25 $654.75 $654.75 $654.75 $327.38 $327.38 $518.56 $654.75 $523.80 $294.64 $129.95 N/A $379.90 $654.75 $392.85 $654.75 $136.45 $654.75 N/A N/A 421.51 SUP HCPCS C1713 421.510 - PLATE BN X .5MM NS 4 HL LOPRFL TI CRNMXF NEURO SYS BOTH IP/OP $637.00 $471.00 $126.38 $636.75 $286.54 $286.54 $286.54 $286.54 $636.75 $636.75 $636.75 $132.71 $636.75 $636.75 $636.75 $636.75 $636.75 $132.71 $636.75 $254.70 $376.64 $636.75 $636.75 $636.75 $636.75 $477.75 $636.75 $636.75 $636.75 $318.38 $318.38 $504.31 $636.75 $509.40 $286.54 $126.38 N/A $369.46 $636.75 $382.05 $636.75 $132.70 $636.75 N/A N/A 421.511 SUP HCPCS C1713 421.511 - PLATE BONE BOX 14X14X.5MM 4 HOLE LP TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 421.512 SUP HCPCS C1713 421.512 - PLATE BONE BOX 16X16X.5MM 4 HOLE HIGH STRENGTH LP TITANIUM BOTH IP/OP $637.00 $471.00 $126.38 $636.75 $286.54 $286.54 $286.54 $286.54 $636.75 $636.75 $636.75 $132.71 $636.75 $636.75 $636.75 $636.75 $636.75 $132.71 $636.75 $636.75 $376.64 $636.75 $636.75 $636.75 $636.75 $477.75 $636.75 $636.75 $636.75 $318.38 $318.38 $504.31 $636.75 $509.40 $286.54 $126.38 N/A $369.46 $636.75 $382.05 $636.75 $132.70 $636.75 N/A N/A 421.515 SUP HCPCS C1713 421.515 - PLATE BONE Y .5MM 5 HOLE LP TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $637.00 $471.00 $126.38 $636.75 $286.54 $286.54 $286.54 $286.54 $636.75 $636.75 $636.75 $132.71 $636.75 $636.75 $636.75 $636.75 $636.75 $132.71 $636.75 $254.70 $376.64 $636.75 $636.75 $636.75 $636.75 $477.75 $636.75 $636.75 $636.75 $318.38 $318.38 $504.31 $636.75 $509.40 $286.54 $126.38 N/A $369.46 $636.75 $382.05 $636.75 $132.70 $636.75 N/A N/A 421.516 SUP HCPCS C1713 421.516 - PLATE BONE 2Y LP 18MMX.5MM 6 HOLE TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 421.517 SUP HCPCS C1713 421.517 - PLATE BONE 2Y 21MMX.5MM 6 HOLE LP TITANIUM BOTH IP/OP $637.00 $471.00 $126.38 $636.75 $286.54 $286.54 $286.54 $286.54 $636.75 $636.75 $636.75 $132.71 $636.75 $636.75 $636.75 $636.75 $636.75 $132.71 $636.75 $636.75 $376.64 $636.75 $636.75 $636.75 $636.75 $477.75 $636.75 $636.75 $636.75 $318.38 $318.38 $504.31 $636.75 $509.40 $286.54 $126.38 N/A $369.46 $636.75 $636.75 $636.75 $132.70 $636.75 N/A N/A 421.518 SUP HCPCS C1713 421.518 - PLATE BN .5MM NS 5 HL LOPRFL ADP TI CRNMXF NEURO SYS BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 421.519 SUP HCPCS C1713 421.519 - PLATE BN .5MM NS 7 HL LOPRFL ADP TI CRNMXF NEURO SYS BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 421.52 SUP HCPCS C1713 421.520 - PLATE BN .5MM NS 20 HL LOPRFL ADP TI CRNMXF NEURO SYS BOTH IP/OP "$1,413.00" "$1,046.00" $280.45 "$1,413.00" $635.85 $635.85 $635.85 $635.85 "$1,413.00" "$1,413.00" "$1,413.00" $294.50 "$1,413.00" "$1,413.00" "$1,413.00" "$1,413.00" "$1,413.00" $294.48 "$1,413.00" $565.20 $835.79 "$1,413.00" "$1,413.00" "$1,413.00" "$1,413.00" "$1,059.75" "$1,413.00" "$1,413.00" "$1,413.00" $706.50 $706.50 "$1,119.10" "$1,413.00" "$1,130.40" $635.85 $280.45 N/A $819.54 "$1,413.00" $847.80 "$1,413.00" $294.47 "$1,413.00" N/A N/A 421.521 SUP HCPCS C1713 421.521 - PLATE BONE RECTANGLE 16X10X.5MM 4 HOLE LP FRAME TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 421.522 SUP HCPCS C1713 421.522 - PLATE BN .5MM NS 6 HL LOPRFL STRUT TI CRNMXF NEURO SYS BOTH IP/OP "$1,109.50" $821.00 $220.16 "$1,109.25" $499.16 $499.16 $499.16 $499.16 "$1,109.25" "$1,109.25" "$1,109.25" $231.20 "$1,109.25" "$1,109.25" "$1,109.25" "$1,109.25" "$1,109.25" $231.18 "$1,109.25" "$1,109.25" $656.12 "$1,109.25" "$1,109.25" "$1,109.25" "$1,109.25" $832.13 "$1,109.25" "$1,109.25" "$1,109.25" $554.63 $554.63 $878.53 "$1,109.25" $887.40 $499.16 $220.16 N/A $643.51 "$1,109.25" $665.55 "$1,109.25" $231.17 "$1,109.25" N/A N/A 421.523 SUP HCPCS C1713 421.523 - PLATE BN .5MM NS 8 HL LOPRFL STRUT TI CRNMXF NEURO SYS BOTH IP/OP "$1,573.00" "$1,164.00" $312.15 "$1,572.75" $707.74 $707.74 $707.74 $707.74 "$1,572.75" "$1,572.75" "$1,572.75" $327.80 "$1,572.75" "$1,572.75" "$1,572.75" "$1,572.75" "$1,572.75" $327.78 "$1,572.75" "$1,572.75" $930.28 "$1,572.75" "$1,572.75" "$1,572.75" "$1,572.75" "$1,179.75" "$1,572.75" "$1,572.75" "$1,572.75" $786.38 $786.38 "$1,245.62" "$1,572.75" "$1,258.20" $707.74 $312.15 N/A $912.34 "$1,572.75" "$1,572.75" "$1,572.75" $327.76 "$1,572.75" N/A N/A 421.525 SUP Custom 27803010 421.525 - COVER BURR HOLE 12MM .5MM LP TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $1.00 $1.00 $0.18 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.18 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $1.00 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $1.00 N/A $0.58 $1.00 $0.60 $1.00 $1.00 $1.00 N/A N/A 421.526 SUP Custom 27803010 421.526 - COVER BURR HOLE 15MM .5MM 6 HOLE LP TITANIUM CRANFCL NONSTRL BOTH IP/OP $661.50 $490.00 $117.75 $661.50 $661.50 $661.50 $661.50 $661.50 $661.50 $661.50 $117.75 $661.50 $661.50 $661.50 $661.50 $661.50 $661.50 $137.86 $661.50 $264.60 $661.50 $661.50 $661.50 $661.50 $661.50 $496.13 $661.50 $661.50 $661.50 $330.75 $330.75 $523.91 $661.50 $529.20 $297.68 $661.50 N/A $383.67 $661.50 $396.90 $661.50 $661.50 $661.50 N/A N/A 421.527 SUP Custom 27803010 421.527 - COVER BURR HOLE 17MM .5MM LP TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $1.00 $1.00 $0.18 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.18 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $1.00 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $1.00 N/A $0.58 $1.00 $0.60 $1.00 $1.00 $1.00 N/A N/A 421.528 SUP Custom 27803010 421.528 - COVER BURR HOLE 24MM .5MM 6 HOLE LP TITANIUM CRANFCL NONSTRL BOTH IP/OP $661.50 $490.00 $117.75 $661.50 $661.50 $661.50 $661.50 $661.50 $661.50 $661.50 $117.75 $661.50 $661.50 $661.50 $661.50 $661.50 $661.50 $137.86 $661.50 $264.60 $661.50 $661.50 $661.50 $661.50 $661.50 $496.13 $661.50 $661.50 $661.50 $330.75 $330.75 $523.91 $661.50 $529.20 $297.68 $661.50 N/A $383.67 $661.50 $396.90 $661.50 $661.50 $661.50 N/A N/A 421.531 SUP HCPCS C1713 421.531 - PLATE BONE 45X38X.4MM CONTUR MESH MALBLE NEURO LP BLUE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 421.532 SUP HCPCS C1713 421.532 - PLATE BONE THK.6MM 45X38MM CONTUR MESH RIGID SILVER TITANIUM BOTH IP/OP "$3,620.50" "$2,679.00" $718.53 "$3,620.25" "$1,629.11" "$1,629.11" "$1,629.11" "$1,629.11" "$3,620.25" "$3,620.25" "$3,620.25" $754.55 "$3,620.25" "$3,620.25" "$3,620.25" "$3,620.25" "$3,620.25" $754.50 "$3,620.25" "$3,620.25" "$1,784.78" "$3,620.25" "$3,620.25" "$3,620.25" "$3,620.25" "$2,715.38" "$3,620.25" "$3,620.25" "$3,620.25" "$1,810.13" "$1,810.13" "$2,867.24" "$3,620.25" "$2,896.20" "$1,629.11" $718.53 N/A "$2,099.89" "$3,620.25" "$2,172.15" "$3,620.25" "$3,620.25" "$3,620.25" N/A N/A 421.533 SUP HCPCS C1713 421.533 - MESH DYNAMIC 100X100X.4MM CONTUR MALBLE LP BLUE TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 421.534 SUP HCPCS C1713 421.534 - MESH DYNAMIC 100X100X.6MM CONTUR MALBLE MESH LP SILVER BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 421.535 SUP HCPCS C1713 421.535 - PLATE BONE 200X200X.6MM CONTUR MESH RIGID NEURO LP SILVER BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 421.536 SUP HCPCS C1713 421.536 - PLATE BONE SMALL ARC .4MM CONTUR MESH MALBLE NEURO LP BLUE BOTH IP/OP "$2,083.50" "$1,542.00" $413.52 "$2,083.50" $937.58 $937.58 $937.58 $937.58 "$2,083.50" "$2,083.50" "$2,083.50" $434.25 "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" $434.22 "$2,083.50" "$2,083.50" "$1,232.39" "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" "$1,562.63" "$2,083.50" "$2,083.50" "$2,083.50" "$1,041.75" "$1,041.75" "$1,650.13" "$2,083.50" "$1,666.80" $937.58 $413.52 N/A "$1,208.43" "$2,083.50" "$1,250.10" "$2,083.50" $434.20 "$2,083.50" N/A N/A 421.537 SUP HCPCS C1713 421.537 - PLATE BONE LARGE ARC .4MM CONTUR MESH MALBLE NEURO LP BLUE BOTH IP/OP "$3,244.50" "$2,401.00" $643.95 "$3,244.50" "$1,460.03" "$1,460.03" "$1,460.03" "$1,460.03" "$3,244.50" "$3,244.50" "$3,244.50" $676.23 "$3,244.50" "$3,244.50" "$3,244.50" "$3,244.50" "$3,244.50" $676.19 "$3,244.50" "$3,244.50" "$1,599.54" "$3,244.50" "$3,244.50" "$3,244.50" "$3,244.50" "$2,433.38" "$3,244.50" "$3,244.50" "$3,244.50" "$1,622.25" "$1,622.25" "$2,569.64" "$3,244.50" "$2,595.60" "$1,460.03" $643.95 N/A "$1,881.81" "$3,244.50" "$1,946.70" "$3,244.50" "$3,244.50" "$3,244.50" N/A N/A 421.538 SUP HCPCS C1713 421.538 - PLATE BONE SMALL ARC .6MM CONTUR MESH RIGID NEURO LP SILVER BOTH IP/OP "$2,083.50" "$1,542.00" $413.52 "$2,083.50" $937.58 $937.58 $937.58 $937.58 "$2,083.50" "$2,083.50" "$2,083.50" $434.25 "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" $434.22 "$2,083.50" "$2,083.50" "$1,232.39" "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" "$1,562.63" "$2,083.50" "$2,083.50" "$2,083.50" "$1,041.75" "$1,041.75" "$1,650.13" "$2,083.50" "$1,666.80" $937.58 $413.52 N/A "$1,208.43" "$2,083.50" "$1,250.10" "$2,083.50" "$2,083.50" "$2,083.50" N/A N/A 421.539 SUP HCPCS C1713 421.539 - PLATE BONE LARGE ARC .6MM CONTUR MESH RIGID NEURO LP SILVER BOTH IP/OP "$3,244.50" "$2,401.00" $643.95 "$3,244.50" "$1,460.03" "$1,460.03" "$1,460.03" "$1,460.03" "$3,244.50" "$3,244.50" "$3,244.50" $676.23 "$3,244.50" "$3,244.50" "$3,244.50" "$3,244.50" "$3,244.50" $676.19 "$3,244.50" "$3,244.50" "$1,599.54" "$3,244.50" "$3,244.50" "$3,244.50" "$3,244.50" "$2,433.38" "$3,244.50" "$3,244.50" "$3,244.50" "$1,622.25" "$1,622.25" "$2,569.64" "$3,244.50" "$2,595.60" "$1,460.03" $643.95 N/A "$1,881.81" "$3,244.50" "$3,244.50" "$3,244.50" $676.15 "$3,244.50" N/A N/A 421.54 SUP HCPCS C1713 421.540 - PLATE BONE 30MM .4MM CONTUR MESH MALBLE LP BLUE TITANIUM BOTH IP/OP "$2,083.50" "$1,542.00" $413.52 "$2,083.50" $937.58 $937.58 $937.58 $937.58 "$2,083.50" "$2,083.50" "$2,083.50" $434.25 "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" $434.22 "$2,083.50" "$2,083.50" "$1,232.39" "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" "$1,562.63" "$2,083.50" "$2,083.50" "$2,083.50" "$1,041.75" "$1,041.75" "$1,650.13" "$2,083.50" "$1,666.80" $937.58 $413.52 N/A "$1,208.43" "$2,083.50" "$1,250.10" "$2,083.50" "$2,083.50" "$2,083.50" N/A N/A 421.541 SUP HCPCS C1713 421.541 - PLATE BONE ROUND 70MM .4MM CONTUR MESH MALBLE NEURO LP BLUE BOTH IP/OP "$4,311.00" "$3,190.00" $855.63 "$4,311.00" "$1,939.95" "$1,939.95" "$1,939.95" "$1,939.95" "$4,311.00" "$4,311.00" "$4,311.00" $898.52 "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" $898.46 "$4,311.00" "$4,311.00" "$2,125.32" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" "$3,233.25" "$4,311.00" "$4,311.00" "$4,311.00" "$2,155.50" "$2,155.50" "$3,414.31" "$4,311.00" "$3,448.80" "$1,939.95" $855.63 N/A "$2,500.38" "$4,311.00" "$2,586.60" "$4,311.00" "$4,311.00" "$4,311.00" N/A N/A 421.542 SUP HCPCS C1713 421.542 - PLATE BONE 100MM .4MM CONTUR MESH MALBLE LP BLUE TITANIUM BOTH IP/OP "$5,373.00" "$3,976.00" "$1,066.41" "$5,373.00" "$2,417.85" "$2,417.85" "$2,417.85" "$2,417.85" "$5,373.00" "$5,373.00" "$5,373.00" "$1,119.87" "$5,373.00" "$5,373.00" "$5,373.00" "$5,373.00" "$5,373.00" "$1,119.79" "$5,373.00" "$5,373.00" "$2,648.89" "$5,373.00" "$5,373.00" "$5,373.00" "$5,373.00" "$4,029.75" "$5,373.00" "$5,373.00" "$5,373.00" "$2,686.50" "$2,686.50" "$4,255.42" "$5,373.00" "$4,298.40" "$2,417.85" "$1,066.41" N/A "$3,116.34" "$5,373.00" "$3,223.80" "$5,373.00" "$1,119.73" "$5,373.00" N/A N/A 421.543 SUP HCPCS C1713 421.543 - PLATE BONE ROUND 30MM .6MM CONTUR MESH RIGID NEURO LP SILVER BOTH IP/OP "$2,083.50" "$1,542.00" $413.52 "$2,083.50" $937.58 $937.58 $937.58 $937.58 "$2,083.50" "$2,083.50" "$2,083.50" $434.25 "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" $434.22 "$2,083.50" "$2,083.50" "$1,232.39" "$2,083.50" "$2,083.50" "$2,083.50" "$2,083.50" "$1,562.63" "$2,083.50" "$2,083.50" "$2,083.50" "$1,041.75" "$1,041.75" "$1,650.13" "$2,083.50" "$1,666.80" $937.58 $413.52 N/A "$1,208.43" "$2,083.50" "$2,083.50" "$2,083.50" $434.20 "$2,083.50" N/A N/A 421.544 SUP HCPCS C1713 421.544 - PLATE BONE ROUND 70MM .6MM CONTUR MESH RIGID NEURO LP SILVER BOTH IP/OP "$4,311.00" "$3,190.00" $855.63 "$4,311.00" "$1,939.95" "$1,939.95" "$1,939.95" "$1,939.95" "$4,311.00" "$4,311.00" "$4,311.00" $898.52 "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" $898.46 "$4,311.00" "$4,311.00" "$2,125.32" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" "$3,233.25" "$4,311.00" "$4,311.00" "$4,311.00" "$2,155.50" "$2,155.50" "$3,414.31" "$4,311.00" "$3,448.80" "$1,939.95" $855.63 N/A "$2,500.38" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" N/A N/A 421.545 SUP HCPCS C1713 421.545 - PLATE BONE ROUND 100MM .6MM CONTUR MESH RIGID NEURO LP BOTH IP/OP "$5,373.00" "$3,976.00" "$1,066.41" "$5,373.00" "$2,417.85" "$2,417.85" "$2,417.85" "$2,417.85" "$5,373.00" "$5,373.00" "$5,373.00" "$1,119.87" "$5,373.00" "$5,373.00" "$5,373.00" "$5,373.00" "$5,373.00" "$1,119.79" "$5,373.00" "$5,373.00" "$2,648.89" "$5,373.00" "$5,373.00" "$5,373.00" "$5,373.00" "$4,029.75" "$5,373.00" "$5,373.00" "$5,373.00" "$2,686.50" "$2,686.50" "$4,255.42" "$5,373.00" "$4,298.40" "$2,417.85" "$1,066.41" N/A "$3,116.34" "$5,373.00" "$5,373.00" "$5,373.00" "$1,119.73" "$5,373.00" N/A N/A 421.546 SUP HCPCS C1713 421.546 - PLATE BN THK.4MM LG BLU NS CNTR MESH LOPRFL TI CRNL MSTD BOTH IP/OP "$2,522.50" "$1,867.00" $500.60 "$2,522.25" "$1,135.01" "$1,135.01" "$1,135.01" "$1,135.01" "$2,522.25" "$2,522.25" "$2,522.25" $525.70 "$2,522.25" "$2,522.25" "$2,522.25" "$2,522.25" "$2,522.25" $525.66 "$2,522.25" "$2,522.25" "$1,243.47" "$2,522.25" "$2,522.25" "$2,522.25" "$2,522.25" "$1,891.88" "$2,522.25" "$2,522.25" "$2,522.25" "$1,261.13" "$1,261.13" "$1,997.62" "$2,522.25" "$2,017.80" "$1,135.01" $500.60 N/A "$1,463.05" "$2,522.25" "$2,522.25" "$2,522.25" "$2,522.25" "$2,522.25" N/A N/A 421.547 SUP HCPCS C1713 421.547 - PLATE BONE MEDIUM .4MM CONTUR MESH MALBLE LP TITANIUM BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" N/A N/A 421.553 SUP Custom 27803010 421.553 - COVER BURR HOLE 24MM .5MM 6 HOLE LP TITANIUM NONSTRL BOTH IP/OP $661.50 $490.00 $117.75 $661.50 $661.50 $661.50 $661.50 $661.50 $661.50 $661.50 $117.75 $661.50 $661.50 $661.50 $661.50 $661.50 $661.50 $137.86 $661.50 $264.60 $661.50 $661.50 $661.50 $661.50 $661.50 $496.13 $661.50 $661.50 $661.50 $330.75 $330.75 $523.91 $661.50 $529.20 $297.68 $661.50 N/A $383.67 $661.50 $396.90 $661.50 $661.50 $661.50 N/A N/A 421.554 SUP Custom 27803010 421.554 - COVER BURR HOLE 17MM .5MM LP TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $661.50 $490.00 $117.75 $661.50 $661.50 $661.50 $661.50 $661.50 $661.50 $661.50 $117.75 $661.50 $661.50 $661.50 $661.50 $661.50 $661.50 $137.86 $661.50 $264.60 $661.50 $661.50 $661.50 $661.50 $661.50 $496.13 $661.50 $661.50 $661.50 $330.75 $330.75 $523.91 $661.50 $529.20 $297.68 $661.50 N/A $383.67 $661.50 $396.90 $661.50 $661.50 $661.50 N/A N/A 422.02 SUP HCPCS C1713 422.02 - PLATE BONE 39X12X1MM 2 HOLE SEMITUBULAR LC-DCP TITANIUM BOTH IP/OP $126.00 $93.00 $24.92 $125.55 $56.50 $56.50 $56.50 $56.50 $125.55 $125.55 $125.55 $26.17 $125.55 $125.55 $125.55 $125.55 $125.55 $26.17 $125.55 $50.22 $74.26 $125.55 $125.55 $125.55 $125.55 $94.50 $125.55 $125.55 $125.55 $62.78 $62.78 $99.44 $125.55 $100.44 $56.50 $24.92 N/A $73.08 $125.55 $125.55 $125.55 $26.16 $125.55 N/A N/A 422.03 SUP HCPCS C1713 422.03 - PLATE BONE 55X12X1MM 3 HOLE SEMITUBULAR LC-DCP TITANIUM BOTH IP/OP $134.00 $99.00 $26.55 $133.75 $60.19 $60.19 $60.19 $60.19 $133.75 $133.75 $133.75 $27.88 $133.75 $133.75 $133.75 $133.75 $133.75 $27.87 $133.75 $53.50 $79.11 $133.75 $133.75 $133.75 $133.75 $100.50 $133.75 $133.75 $133.75 $66.88 $66.88 $105.93 $133.75 $107.00 $60.19 $26.55 N/A $77.72 $133.75 $133.75 $133.75 $133.75 $133.75 N/A N/A 422.04 SUP HCPCS C1713 422.04 - PLATE BONE 71X12X1MM 4 HOLE SEMITUBULAR LC-DCP TITANIUM BOTH IP/OP $145.00 $107.00 $28.72 $144.68 $65.11 $65.11 $65.11 $65.11 $144.68 $144.68 $144.68 $30.15 $144.68 $144.68 $144.68 $144.68 $144.68 $30.15 $144.68 $57.87 $85.58 $144.68 $144.68 $144.68 $144.68 $108.75 $144.68 $144.68 $144.68 $72.34 $72.34 $114.59 $144.68 $115.74 $65.11 $28.72 N/A $84.10 $144.68 $144.68 $144.68 $30.15 $144.68 N/A N/A 422.05 SUP HCPCS C1713 422.05 - PLATE BONE 87X12X1MM 5 HOLE SEMITUBULAR LC-DCP TITANIUM BOTH IP/OP $153.00 $113.00 $30.34 $152.85 $68.78 $68.78 $68.78 $68.78 $152.85 $152.85 $152.85 $31.86 $152.85 $152.85 $152.85 $152.85 $152.85 $31.86 $152.85 $61.14 $90.41 $152.85 $152.85 $152.85 $152.85 $114.75 $152.85 $152.85 $152.85 $76.43 $76.43 $121.06 $152.85 $122.28 $68.78 $30.34 N/A $88.74 $152.85 $152.85 $152.85 $152.85 $152.85 N/A N/A 422.06 SUP HCPCS C1713 422.06 - PLATE BONE 103X12X1MM 6 HOLE SEMITUBULAR LC-DCP TITANIUM BOTH IP/OP $162.50 $120.00 $32.23 $162.40 $73.08 $73.08 $73.08 $73.08 $162.40 $162.40 $162.40 $33.85 $162.40 $162.40 $162.40 $162.40 $162.40 $33.85 $162.40 $64.96 $96.06 $162.40 $162.40 $162.40 $162.40 $121.88 $162.40 $162.40 $162.40 $81.20 $81.20 $128.62 $162.40 $129.92 $73.08 $32.23 N/A $94.25 $162.40 $97.44 $162.40 $33.84 $162.40 N/A N/A 422.07 SUP HCPCS C1713 422.07 - PLATE BONE 119X12X1MM 7 HOLE SEMITUBULAR LC-DCP TITANIUM BOTH IP/OP $174.50 $129.00 $34.59 $177.28 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $177.28 $103.10 $174.30 $177.28 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $36.32 $174.30 N/A N/A 422.08 SUP HCPCS C1713 422.08 - PLATE BONE 135X12X1MM 8 HOLE SEMITUBULAR LC-DCP TITANIUM BOTH IP/OP $184.50 $137.00 $36.57 $184.25 $82.91 $82.91 $82.91 $82.91 $184.25 $184.25 $184.25 $38.40 $184.25 $184.25 $184.25 $184.25 $184.25 $38.40 $184.25 $73.70 $108.98 $184.25 $184.25 $184.25 $184.25 $138.38 $184.25 $184.25 $184.25 $92.13 $92.13 $145.93 $184.25 $147.40 $82.91 $36.57 N/A $107.01 $184.25 $110.55 $184.25 $38.40 $184.25 N/A N/A 422.09 SUP HCPCS C1713 422.09 - PLATE BONE 151X12X1MM 9 HOLE SEMITUBULAR LC-DCP TITANIUM BOTH IP/OP $206.50 $153.00 $40.90 $206.08 $92.74 $92.74 $92.74 $92.74 $206.08 $206.08 $206.08 $42.95 $206.08 $206.08 $206.08 $206.08 $206.08 $42.95 $206.08 $82.43 $121.90 $206.08 $206.08 $206.08 $206.08 $154.88 $206.08 $206.08 $206.08 $103.04 $103.04 $163.22 $206.08 $164.86 $92.74 $40.90 N/A $119.77 $206.08 $123.65 $206.08 $206.08 $206.08 N/A N/A 422.1 SUP HCPCS C1713 422.10 - PLATE BONE 167X12X1MM 10 HOLE SEMITUBULAR LC-DCP TITANIUM BOTH IP/OP $207.50 $154.00 $41.17 $207.45 $93.35 $93.35 $93.35 $93.35 $207.45 $207.45 $207.45 $43.24 $207.45 $207.45 $207.45 $207.45 $207.45 $43.23 $207.45 $82.98 $122.71 $207.45 $207.45 $207.45 $207.45 $155.63 $207.45 $207.45 $207.45 $103.73 $103.73 $164.30 $207.45 $165.96 $93.35 $41.17 N/A $120.35 $207.45 $124.47 $207.45 $207.45 $207.45 N/A N/A 422.11 SUP HCPCS C1713 422.11 - PLATE BONE 183X12X1MM 11 HOLE SEMITUBULAR LC-DCP TITANIUM BOTH IP/OP $222.50 $165.00 $44.15 $222.45 $100.10 $100.10 $100.10 $100.10 $222.45 $222.45 $222.45 $46.36 $222.45 $222.45 $222.45 $222.45 $222.45 $46.36 $222.45 $88.98 $131.58 $222.45 $222.45 $222.45 $222.45 $166.88 $222.45 $222.45 $222.45 $111.23 $111.23 $176.18 $222.45 $177.96 $100.10 $44.15 N/A $129.05 $222.45 $133.47 $222.45 $46.36 $222.45 N/A N/A 422.12 SUP HCPCS C1713 422.12 - PLATE BONE LARGE 183MM 12 HOLE SEMITUBULAR LC-DCP TITANIUM BOTH IP/OP $228.00 $169.00 $45.24 $227.93 $102.57 $102.57 $102.57 $102.57 $227.93 $227.93 $227.93 $47.51 $227.93 $227.93 $227.93 $227.93 $227.93 $47.50 $227.93 $91.17 $134.82 $227.93 $227.93 $227.93 $227.93 $171.00 $227.93 $227.93 $227.93 $113.97 $113.97 $180.52 $227.93 $182.34 $102.57 $45.24 N/A $132.24 $227.93 $136.76 $227.93 $227.93 $227.93 N/A N/A 422.22 SUP HCPCS C1713 422.220 - PLATE BONE 140MM 5 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$2,914.00" "$2,156.00" $578.31 "$3,052.18" "$1,311.19" "$1,311.19" "$1,311.19" "$1,311.19" "$2,913.75" "$2,913.75" "$2,913.75" $607.30 "$2,913.75" "$2,913.75" "$2,913.75" "$2,913.75" "$2,913.75" $607.26 "$2,913.75" "$1,220.87" "$1,436.48" "$2,913.75" "$3,052.18" "$2,913.75" "$2,913.75" "$2,185.50" "$2,913.75" "$2,913.75" "$2,913.75" "$1,456.88" "$1,456.88" "$2,307.69" "$2,913.75" "$2,331.00" "$1,311.19" $578.31 N/A "$1,690.12" "$2,913.75" "$1,748.25" "$2,913.75" "$2,913.75" "$2,913.75" N/A N/A 422.221 SUP HCPCS C1713 422.221 - PLATE BONE 140MM 5 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$3,001.50" "$2,221.00" $595.65 "$3,052.18" "$1,350.52" "$1,350.52" "$1,350.52" "$1,350.52" "$3,001.15" "$3,001.15" "$3,001.15" $625.51 "$3,001.15" "$3,001.15" "$3,001.15" "$3,001.15" "$3,001.15" $625.47 "$3,001.15" "$1,220.87" "$1,479.57" "$3,001.15" "$3,052.18" "$3,001.15" "$3,001.15" "$2,251.13" "$3,001.15" "$3,001.15" "$3,001.15" "$1,500.58" "$1,500.58" "$2,376.91" "$3,001.15" "$2,400.92" "$1,350.52" $595.65 N/A "$1,740.87" "$3,001.15" "$1,800.69" "$3,001.15" $625.44 "$3,001.15" N/A N/A 422.222 SUP HCPCS C1713 422.222 - PLATE BONE 180MM 7 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$3,062.00" "$2,266.00" $607.65 "$3,113.65" "$1,377.72" "$1,377.72" "$1,377.72" "$1,377.72" "$3,061.60" "$3,061.60" "$3,061.60" $638.11 "$3,061.60" "$3,061.60" "$3,061.60" "$3,061.60" "$3,061.60" $638.07 "$3,061.60" "$1,245.46" "$1,509.37" "$3,061.60" "$3,113.65" "$3,061.60" "$3,061.60" "$2,296.50" "$3,061.60" "$3,061.60" "$3,061.60" "$1,530.80" "$1,530.80" "$2,424.79" "$3,061.60" "$2,449.28" "$1,377.72" $607.65 N/A "$1,775.96" "$3,061.60" "$1,836.96" "$3,061.60" "$3,061.60" "$3,061.60" N/A N/A 422.223 SUP HCPCS C1713 422.223 - PLATE BONE 180MM 7 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$3,062.00" "$2,266.00" $607.65 "$3,113.65" "$1,377.72" "$1,377.72" "$1,377.72" "$1,377.72" "$3,061.60" "$3,061.60" "$3,061.60" $638.11 "$3,061.60" "$3,061.60" "$3,061.60" "$3,061.60" "$3,061.60" $638.07 "$3,061.60" "$1,245.46" "$1,509.37" "$3,061.60" "$3,113.65" "$3,061.60" "$3,061.60" "$2,296.50" "$3,061.60" "$3,061.60" "$3,061.60" "$1,530.80" "$1,530.80" "$2,424.79" "$3,061.60" "$2,449.28" "$1,377.72" $607.65 N/A "$1,775.96" "$3,061.60" "$1,836.96" "$3,061.60" "$3,061.60" "$3,061.60" N/A N/A 422.224 SUP HCPCS C1713 422.224 - PLATE BONE 220MM 9 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$3,125.00" "$2,313.00" $620.20 "$3,177.98" "$1,406.18" "$1,406.18" "$1,406.18" "$1,406.18" "$3,124.85" "$3,124.85" "$3,124.85" $651.30 "$3,124.85" "$3,124.85" "$3,124.85" "$3,124.85" "$3,124.85" $651.25 "$3,124.85" "$1,271.19" "$1,540.55" "$3,124.85" "$3,177.98" "$3,124.85" "$3,124.85" "$2,343.75" "$3,124.85" "$3,124.85" "$3,124.85" "$1,562.43" "$1,562.43" "$2,474.88" "$3,124.85" "$2,499.88" "$1,406.18" $620.20 N/A "$1,812.50" "$3,124.85" "$3,124.85" "$3,124.85" "$3,124.85" "$3,124.85" N/A N/A 422.225 SUP HCPCS C1713 422.225 - PLATE BONE 220MM 9 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$3,125.00" "$2,313.00" $620.20 "$3,177.98" "$1,406.18" "$1,406.18" "$1,406.18" "$1,406.18" "$3,124.85" "$3,124.85" "$3,124.85" $651.30 "$3,124.85" "$3,124.85" "$3,124.85" "$3,124.85" "$3,124.85" $651.25 "$3,124.85" "$1,271.19" "$1,540.55" "$3,124.85" "$3,177.98" "$3,124.85" "$3,124.85" "$2,343.75" "$3,124.85" "$3,124.85" "$3,124.85" "$1,562.43" "$1,562.43" "$2,474.88" "$3,124.85" "$2,499.88" "$1,406.18" $620.20 N/A "$1,812.50" "$3,124.85" "$3,124.85" "$3,124.85" $651.22 "$3,124.85" N/A N/A 422.226 SUP HCPCS C1713 422.226 - PLATE BONE 260MM 11 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$3,185.50" "$2,357.00" $632.20 "$3,239.45" "$1,433.39" "$1,433.39" "$1,433.39" "$1,433.39" "$3,185.30" "$3,185.30" "$3,185.30" $663.90 "$3,185.30" "$3,185.30" "$3,185.30" "$3,185.30" "$3,185.30" $663.85 "$3,185.30" "$1,295.78" "$1,570.35" "$3,185.30" "$3,239.45" "$3,185.30" "$3,185.30" "$2,389.13" "$3,185.30" "$3,185.30" "$3,185.30" "$1,592.65" "$1,592.65" "$2,522.76" "$3,185.30" "$2,548.24" "$1,433.39" $632.20 N/A "$1,847.59" "$3,185.30" "$3,185.30" "$3,185.30" $663.82 "$3,185.30" N/A N/A 422.227 SUP HCPCS C1713 422.227 - PLATE BONE 260MM 11 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$3,185.50" "$2,357.00" $632.20 "$3,239.45" "$1,433.39" "$1,433.39" "$1,433.39" "$1,433.39" "$3,185.30" "$3,185.30" "$3,185.30" $663.90 "$3,185.30" "$3,185.30" "$3,185.30" "$3,185.30" "$3,185.30" $663.85 "$3,185.30" "$1,295.78" "$1,570.35" "$3,185.30" "$3,239.45" "$3,185.30" "$3,185.30" "$2,389.13" "$3,185.30" "$3,185.30" "$3,185.30" "$1,592.65" "$1,592.65" "$2,522.76" "$3,185.30" "$2,548.24" "$1,433.39" $632.20 N/A "$1,847.59" "$3,185.30" "$3,185.30" "$3,185.30" "$3,185.30" "$3,185.30" N/A N/A 422.228 SUP HCPCS C1713 422.228 - PLATE BONE 300MM 13 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$3,249.00" "$2,404.00" $644.76 "$3,303.78" "$1,461.85" "$1,461.85" "$1,461.85" "$1,461.85" "$3,248.55" "$3,248.55" "$3,248.55" $677.08 "$3,248.55" "$3,248.55" "$3,248.55" "$3,248.55" "$3,248.55" $677.03 "$3,248.55" "$3,303.78" "$1,601.54" "$3,248.55" "$3,303.78" "$3,248.55" "$3,248.55" "$2,436.75" "$3,248.55" "$3,248.55" "$3,248.55" "$1,624.28" "$1,624.28" "$2,572.85" "$3,248.55" "$2,598.84" "$1,461.85" $644.76 N/A "$1,884.42" "$3,248.55" "$3,248.55" "$3,248.55" $677.00 "$3,248.55" N/A N/A 422.229 SUP HCPCS C1713 422.229 - PLATE BONE 300MM 13 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$3,249.00" "$2,404.00" $644.76 "$3,303.78" "$1,461.85" "$1,461.85" "$1,461.85" "$1,461.85" "$3,248.55" "$3,248.55" "$3,248.55" $677.08 "$3,248.55" "$3,248.55" "$3,248.55" "$3,248.55" "$3,248.55" $677.03 "$3,248.55" "$1,321.51" "$1,601.54" "$3,248.55" "$3,303.78" "$3,248.55" "$3,248.55" "$2,436.75" "$3,248.55" "$3,248.55" "$3,248.55" "$1,624.28" "$1,624.28" "$2,572.85" "$3,248.55" "$2,598.84" "$1,461.85" $644.76 N/A "$1,884.42" "$3,248.55" "$3,248.55" "$3,248.55" $677.00 "$3,248.55" N/A N/A 422.25 SUP HCPCS C1713 422.250 - PLATE BONE 156MM 5 HOLE LCP TITANIUM FEMUR RIGHT DISTAL BOTH IP/OP "$2,764.00" "$2,045.00" $548.51 "$2,894.93" "$1,243.63" "$1,243.63" "$1,243.63" "$1,243.63" "$2,763.63" "$2,763.63" "$2,763.63" $576.01 "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" $575.97 "$2,763.63" "$1,157.97" "$1,362.47" "$2,763.63" "$2,894.93" "$2,763.63" "$2,763.63" "$2,073.00" "$2,763.63" "$2,763.63" "$2,763.63" "$1,381.82" "$1,381.82" "$2,188.79" "$2,763.63" "$2,210.90" "$1,243.63" $548.51 N/A "$1,603.12" "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" "$2,763.63" N/A N/A 422.251 SUP HCPCS C1713 422.251 - PLATE BONE 156MM 5 HOLE LCP TITANIUM FEMUR LEFT DISTAL BOTH IP/OP "$2,847.00" "$2,107.00" $564.97 "$2,894.93" "$1,280.94" "$1,280.94" "$1,280.94" "$1,280.94" "$2,846.53" "$2,846.53" "$2,846.53" $593.29 "$2,846.53" "$2,846.53" "$2,846.53" "$2,846.53" "$2,846.53" $593.25 "$2,846.53" "$1,157.97" "$1,403.34" "$2,846.53" "$2,894.93" "$2,846.53" "$2,846.53" "$2,135.25" "$2,846.53" "$2,846.53" "$2,846.53" "$1,423.27" "$1,423.27" "$2,254.45" "$2,846.53" "$2,277.22" "$1,280.94" $564.97 N/A "$1,651.26" "$2,846.53" "$2,846.53" "$2,846.53" $593.22 "$2,846.53" N/A N/A 422.252 SUP HCPCS C1713 422.252 - PLATE BONE 196MM 7 HOLE LCP TITANIUM FEMUR RIGHT DISTAL BOTH IP/OP "$2,904.50" "$2,149.00" $576.40 "$2,953.53" "$1,306.87" "$1,306.87" "$1,306.87" "$1,306.87" "$2,904.15" "$2,904.15" "$2,904.15" $605.30 "$2,904.15" "$2,904.15" "$2,904.15" "$2,904.15" "$2,904.15" $605.26 "$2,904.15" "$1,181.41" "$1,431.75" "$2,904.15" "$2,953.53" "$2,904.15" "$2,904.15" "$2,178.38" "$2,904.15" "$2,904.15" "$2,904.15" "$1,452.08" "$1,452.08" "$2,300.09" "$2,904.15" "$2,323.32" "$1,306.87" $576.40 N/A "$1,684.61" "$2,904.15" "$2,904.15" "$2,904.15" $605.22 "$2,904.15" N/A N/A 422.253 SUP HCPCS C1713 422.253 - PLATE BONE 196MM 7 HOLE LCP TITANIUM FEMUR LEFT DISTAL BOTH IP/OP "$2,904.50" "$2,149.00" $576.40 "$2,953.53" "$1,306.87" "$1,306.87" "$1,306.87" "$1,306.87" "$2,904.15" "$2,904.15" "$2,904.15" $605.30 "$2,904.15" "$2,904.15" "$2,904.15" "$2,904.15" "$2,904.15" $605.26 "$2,904.15" "$1,181.41" "$1,431.75" "$2,904.15" "$2,953.53" "$2,904.15" "$2,904.15" "$2,178.38" "$2,904.15" "$2,904.15" "$2,904.15" "$1,452.08" "$1,452.08" "$2,300.09" "$2,904.15" "$2,323.32" "$1,306.87" $576.40 N/A "$1,684.61" "$2,904.15" "$2,904.15" "$2,904.15" $605.22 "$2,904.15" N/A N/A 422.254 SUP HCPCS C1713 422.254 - PLATE BONE 236MM 9 HOLE LCP TITANIUM FEMUR RIGHT DISTAL BOTH IP/OP "$2,965.00" "$2,194.00" $588.40 "$3,015.00" "$1,334.07" "$1,334.07" "$1,334.07" "$1,334.07" "$2,964.60" "$2,964.60" "$2,964.60" $617.90 "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" $617.86 "$2,964.60" "$1,206.00" "$1,461.55" "$2,964.60" "$3,015.00" "$2,964.60" "$2,964.60" "$2,223.75" "$2,964.60" "$2,964.60" "$2,964.60" "$1,482.30" "$1,482.30" "$2,347.96" "$2,964.60" "$2,371.68" "$1,334.07" $588.40 N/A "$1,719.70" "$2,964.60" "$2,964.60" "$2,964.60" $617.82 "$2,964.60" N/A N/A 422.255 SUP HCPCS C1713 422.255 - PLATE BONE 236MM 9 HOLE LCP TITANIUM FEMUR LEFT DISTAL BOTH IP/OP "$2,965.00" "$2,194.00" $588.40 "$3,015.00" "$1,334.07" "$1,334.07" "$1,334.07" "$1,334.07" "$2,964.60" "$2,964.60" "$2,964.60" $617.90 "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" "$2,964.60" $617.86 "$2,964.60" "$3,015.00" "$1,461.55" "$2,964.60" "$3,015.00" "$2,964.60" "$2,964.60" "$2,223.75" "$2,964.60" "$2,964.60" "$2,964.60" "$1,482.30" "$1,482.30" "$2,347.96" "$2,964.60" "$2,371.68" "$1,334.07" $588.40 N/A "$1,719.70" "$2,964.60" "$2,964.60" "$2,964.60" $617.82 "$2,964.60" N/A N/A 422.256 SUP HCPCS C1713 422.256 - PLATE BONE 276MM 11 HOLE LCP TITANIUM FEMUR RIGHT DISTAL BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,073.63" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,229.45" "$1,489.97" "$3,022.25" "$3,073.63" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 422.257 SUP HCPCS C1713 422.257 - PLATE BONE 276MM 11 HOLE LCP TITANIUM FEMUR LEFT DISTAL BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,073.63" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,229.45" "$1,489.97" "$3,022.25" "$3,073.63" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 422.258 SUP HCPCS C1713 422.258 - PLATE BONE 316MM 13 HOLE LCP TITANIUM FEMUR RIGHT DISTAL BOTH IP/OP "$3,081.50" "$2,280.00" $611.56 "$3,133.65" "$1,386.58" "$1,386.58" "$1,386.58" "$1,386.58" "$3,081.28" "$3,081.28" "$3,081.28" $642.22 "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" $642.17 "$3,081.28" "$1,253.46" "$1,519.07" "$3,081.28" "$3,133.65" "$3,081.28" "$3,081.28" "$2,311.13" "$3,081.28" "$3,081.28" "$3,081.28" "$1,540.64" "$1,540.64" "$2,440.37" "$3,081.28" "$2,465.02" "$1,386.58" $611.56 N/A "$1,787.27" "$3,081.28" "$3,081.28" "$3,081.28" $642.14 "$3,081.28" N/A N/A 422.259 SUP HCPCS C1713 422.259 - PLATE BONE 316MM 13 HOLE LCP TITANIUM FEMUR LEFT DISTAL BOTH IP/OP "$3,081.50" "$2,280.00" $611.56 "$3,133.65" "$1,386.58" "$1,386.58" "$1,386.58" "$1,386.58" "$3,081.28" "$3,081.28" "$3,081.28" $642.22 "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" $642.17 "$3,081.28" "$1,253.46" "$1,519.07" "$3,081.28" "$3,133.65" "$3,081.28" "$3,081.28" "$2,311.13" "$3,081.28" "$3,081.28" "$3,081.28" "$1,540.64" "$1,540.64" "$2,440.37" "$3,081.28" "$2,465.02" "$1,386.58" $611.56 N/A "$1,787.27" "$3,081.28" "$3,081.28" "$3,081.28" $642.14 "$3,081.28" N/A N/A 422.3 SUP HCPCS C1713 422.300 - PLATE BONE 140MM 5 HOLE LISS TITANIUM RIGHT PROXIMAL TIBIA BOTH IP/OP "$3,004.00" "$2,223.00" $596.19 "$3,146.53" "$1,351.72" "$1,351.72" "$1,351.72" "$1,351.72" "$3,003.83" "$3,003.83" "$3,003.83" $626.07 "$3,003.83" "$3,003.83" "$3,003.83" "$3,003.83" "$3,003.83" $626.03 "$3,003.83" "$1,258.61" "$1,480.89" "$3,003.83" "$3,146.53" "$3,003.83" "$3,003.83" "$2,253.00" "$3,003.83" "$3,003.83" "$3,003.83" "$1,501.92" "$1,501.92" "$2,379.03" "$3,003.83" "$2,403.06" "$1,351.72" $596.19 N/A "$1,742.32" "$3,003.83" "$3,003.83" "$3,003.83" $626.00 "$3,003.83" N/A N/A 422.301 SUP HCPCS C1713 422.301 - PLATE BONE 140MM 5 HOLE LISS TITANIUM LEFT PROXIMAL TIBIA BOTH IP/OP "$3,094.00" "$2,290.00" $614.07 "$3,146.53" "$1,392.27" "$1,392.27" "$1,392.27" "$1,392.27" "$3,093.93" "$3,093.93" "$3,093.93" $644.85 "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" $644.81 "$3,093.93" "$1,258.61" "$1,525.31" "$3,093.93" "$3,146.53" "$3,093.93" "$3,093.93" "$2,320.50" "$3,093.93" "$3,093.93" "$3,093.93" "$1,546.97" "$1,546.97" "$2,450.39" "$3,093.93" "$2,475.14" "$1,392.27" $614.07 N/A "$1,794.52" "$3,093.93" "$3,093.93" "$3,093.93" $644.78 "$3,093.93" N/A N/A 422.304 SUP HCPCS C1713 422.304 - PLATE BONE 3.5MM 220MM 9 HOLE LISS TITANIUM RIGHT PROXIMAL BOTH IP/OP "$3,094.00" "$2,290.00" $614.07 "$3,146.53" "$1,392.27" "$1,392.27" "$1,392.27" "$1,392.27" "$3,093.93" "$3,093.93" "$3,093.93" $644.85 "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" $644.81 "$3,093.93" "$3,146.53" "$1,525.31" "$3,093.93" "$3,146.53" "$3,093.93" "$3,093.93" "$2,320.50" "$3,093.93" "$3,093.93" "$3,093.93" "$1,546.97" "$1,546.97" "$2,450.39" "$3,093.93" "$2,475.14" "$1,392.27" $614.07 N/A "$1,794.52" "$3,093.93" "$1,856.36" "$3,093.93" $644.78 "$3,093.93" N/A N/A 422.305 SUP HCPCS C1713 422.305 - PLATE BONE 220MM 9 HOLE LISS TITANIUM LEFT PROXIMAL TIBIA BOTH IP/OP "$3,094.00" "$2,290.00" $614.07 "$3,146.53" "$1,392.27" "$1,392.27" "$1,392.27" "$1,392.27" "$3,093.93" "$3,093.93" "$3,093.93" $644.85 "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" $644.81 "$3,093.93" "$3,146.53" "$1,525.31" "$3,093.93" "$3,146.53" "$3,093.93" "$3,093.93" "$2,320.50" "$3,093.93" "$3,093.93" "$3,093.93" "$1,546.97" "$1,546.97" "$2,450.39" "$3,093.93" "$2,475.14" "$1,392.27" $614.07 N/A "$1,794.52" "$3,093.93" "$3,093.93" "$3,093.93" $644.78 "$3,093.93" N/A N/A 422.308 SUP HCPCS C1713 422.308 - PLATE BONE 300MM 13 HOLE LISS TITANIUM RIGHT PROXIMAL TIBIA BOTH IP/OP "$3,094.00" "$2,290.00" $614.07 "$3,146.53" "$1,392.27" "$1,392.27" "$1,392.27" "$1,392.27" "$3,093.93" "$3,093.93" "$3,093.93" $644.85 "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" $644.81 "$3,093.93" "$1,258.61" "$1,525.31" "$3,093.93" "$3,146.53" "$3,093.93" "$3,093.93" "$2,320.50" "$3,093.93" "$3,093.93" "$3,093.93" "$1,546.97" "$1,546.97" "$2,450.39" "$3,093.93" "$2,475.14" "$1,392.27" $614.07 N/A "$1,794.52" "$3,093.93" "$3,093.93" "$3,093.93" $644.78 "$3,093.93" N/A N/A 422.309 SUP HCPCS C1713 422.309 - PLATE BONE 300MM 13 HOLE LISS TITANIUM LEFT PROXIMAL TIBIA BOTH IP/OP "$3,094.00" "$2,290.00" $614.07 "$3,146.53" "$1,392.27" "$1,392.27" "$1,392.27" "$1,392.27" "$3,093.93" "$3,093.93" "$3,093.93" $644.85 "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" $644.81 "$3,093.93" "$1,258.61" "$1,525.31" "$3,093.93" "$3,146.53" "$3,093.93" "$3,093.93" "$2,320.50" "$3,093.93" "$3,093.93" "$3,093.93" "$1,546.97" "$1,546.97" "$2,450.39" "$3,093.93" "$2,475.14" "$1,392.27" $614.07 N/A "$1,794.52" "$3,093.93" "$3,093.93" "$3,093.93" $644.78 "$3,093.93" N/A N/A 422.34 SUP HCPCS C1713 422.340 - PLATE BONE 156MM 5 HOLE LISS TITANIUM FEMUR RIGHT DISTAL BOTH IP/OP "$3,004.00" "$2,223.00" $596.19 "$3,146.53" "$1,351.72" "$1,351.72" "$1,351.72" "$1,351.72" "$3,003.83" "$3,003.83" "$3,003.83" $626.07 "$3,003.83" "$3,003.83" "$3,003.83" "$3,003.83" "$3,003.83" $626.03 "$3,003.83" "$1,258.61" "$1,480.89" "$3,003.83" "$3,146.53" "$3,003.83" "$3,003.83" "$2,253.00" "$3,003.83" "$3,003.83" "$3,003.83" "$1,501.92" "$1,501.92" "$2,379.03" "$3,003.83" "$2,403.06" "$1,351.72" $596.19 N/A "$1,742.32" "$3,003.83" "$3,003.83" "$3,003.83" $626.00 "$3,003.83" N/A N/A 422.341 SUP HCPCS C1713 422.341 - PLATE BN 156MM NS LISS 5 HL TI FEM LT DIST 5MM LCK SCR BOTH IP/OP "$3,094.00" "$2,290.00" $614.07 "$3,146.53" "$1,392.27" "$1,392.27" "$1,392.27" "$1,392.27" "$3,093.93" "$3,093.93" "$3,093.93" $644.85 "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" $644.81 "$3,093.93" "$3,146.53" "$1,525.31" "$3,093.93" "$3,146.53" "$3,093.93" "$3,093.93" "$2,320.50" "$3,093.93" "$3,093.93" "$3,093.93" "$1,546.97" "$1,546.97" "$2,450.39" "$3,093.93" "$2,475.14" "$1,392.27" $614.07 N/A "$1,794.52" "$3,093.93" "$3,093.93" "$3,093.93" $644.78 "$3,093.93" N/A N/A 422.344 SUP HCPCS C1713 422.344 - PLATE BN 236MM NS LISS 9 HL TI FEM RT DIST 5MM LCK SCR BOTH IP/OP "$3,094.00" "$2,290.00" $614.07 "$3,146.53" "$1,392.27" "$1,392.27" "$1,392.27" "$1,392.27" "$3,093.93" "$3,093.93" "$3,093.93" $644.85 "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" $644.81 "$3,093.93" "$3,146.53" "$1,525.31" "$3,093.93" "$3,146.53" "$3,093.93" "$3,093.93" "$2,320.50" "$3,093.93" "$3,093.93" "$3,093.93" "$1,546.97" "$1,546.97" "$2,450.39" "$3,093.93" "$2,475.14" "$1,392.27" $614.07 N/A "$1,794.52" "$3,093.93" "$3,093.93" "$3,093.93" $644.78 "$3,093.93" N/A N/A 422.345 SUP HCPCS C1713 422.345 - PLATE BN 236MM NS LISS 9 HL TI FEM LT DIST 5MM LCK SCR BOTH IP/OP "$3,094.00" "$2,290.00" $614.07 "$3,146.53" "$1,392.27" "$1,392.27" "$1,392.27" "$1,392.27" "$3,093.93" "$3,093.93" "$3,093.93" $644.85 "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" $644.81 "$3,093.93" "$3,146.53" "$1,525.31" "$3,093.93" "$3,146.53" "$3,093.93" "$3,093.93" "$2,320.50" "$3,093.93" "$3,093.93" "$3,093.93" "$1,546.97" "$1,546.97" "$2,450.39" "$3,093.93" "$2,475.14" "$1,392.27" $614.07 N/A "$1,794.52" "$3,093.93" "$1,856.36" "$3,093.93" $644.78 "$3,093.93" N/A N/A 422.348 SUP HCPCS C1713 422.348 - PLATE BN 316MM NS LISS 13 HL TI FEM RT DIST 5MM LCK SCR BOTH IP/OP "$3,094.00" "$2,290.00" $614.07 "$3,146.53" "$1,392.27" "$1,392.27" "$1,392.27" "$1,392.27" "$3,093.93" "$3,093.93" "$3,093.93" $644.85 "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" $644.81 "$3,093.93" "$3,146.53" "$1,525.31" "$3,093.93" "$3,146.53" "$3,093.93" "$3,093.93" "$2,320.50" "$3,093.93" "$3,093.93" "$3,093.93" "$1,546.97" "$1,546.97" "$2,450.39" "$3,093.93" "$2,475.14" "$1,392.27" $614.07 N/A "$1,794.52" "$3,093.93" "$3,093.93" "$3,093.93" $644.78 "$3,093.93" N/A N/A 422.349 SUP HCPCS C1713 422.349 - PLATE BN 316MM NS LISS 13 HL TI FEM LT DIST 5MM LCK SCR BOTH IP/OP "$3,094.00" "$2,290.00" $614.07 "$3,146.53" "$1,392.27" "$1,392.27" "$1,392.27" "$1,392.27" "$3,093.93" "$3,093.93" "$3,093.93" $644.85 "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" "$3,093.93" $644.81 "$3,093.93" "$3,146.53" "$1,525.31" "$3,093.93" "$3,146.53" "$3,093.93" "$3,093.93" "$2,320.50" "$3,093.93" "$3,093.93" "$3,093.93" "$1,546.97" "$1,546.97" "$2,450.39" "$3,093.93" "$2,475.14" "$1,392.27" $614.07 N/A "$1,794.52" "$3,093.93" "$3,093.93" "$3,093.93" $644.78 "$3,093.93" N/A N/A 422.39 SUP Custom 27203010 422.390 - INSERT SCR HL 5MM LISS TI FEM BOTH IP/OP $176.50 $131.00 $31.34 $184.40 $176.05 $176.05 $176.05 $176.05 $176.05 $176.05 $31.34 $176.05 $176.05 $130.66 $130.66 $135.70 $91.72 $36.69 $176.05 $73.76 $176.05 $176.05 $184.40 $176.05 $176.05 $132.38 $176.05 $176.05 $176.05 $88.03 $88.03 $139.43 $176.05 $140.84 $114.43 $176.05 N/A $102.37 $176.05 $105.63 $176.05 $176.05 $176.05 N/A N/A 422.391 SUP HCPCS C1713 422.391 - SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 18MM SELF DRILL BOTH IP/OP $395.00 $292.00 $78.40 $401.73 $177.75 $177.75 $177.75 $177.75 $395.00 $395.00 $395.00 $82.33 $395.00 $395.00 $395.00 $395.00 $395.00 $82.32 $395.00 $401.73 $233.64 $395.00 $401.73 $395.00 $395.00 $296.25 $395.00 $395.00 $395.00 $197.50 $197.50 $312.84 $395.00 $316.00 $177.75 $78.40 N/A $229.10 $395.00 $395.00 $395.00 $82.32 $395.00 N/A N/A 422.392 SUP HCPCS C1713 422.392 - SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 26MM SELF DRILL BOTH IP/OP $395.00 $292.00 $78.40 $401.73 $177.75 $177.75 $177.75 $177.75 $395.00 $395.00 $395.00 $82.33 $395.00 $395.00 $395.00 $395.00 $395.00 $82.32 $395.00 $401.73 $233.64 $395.00 $401.73 $395.00 $395.00 $296.25 $395.00 $395.00 $395.00 $197.50 $197.50 $312.84 $395.00 $316.00 $177.75 $78.40 N/A $229.10 $395.00 $395.00 $395.00 $82.32 $395.00 N/A N/A 422.393 SUP HCPCS C1713 422.393 - SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 40MM SELF DRILL BOTH IP/OP $395.00 $292.00 $78.40 $401.73 $177.75 $177.75 $177.75 $177.75 $395.00 $395.00 $395.00 $82.33 $395.00 $395.00 $395.00 $395.00 $395.00 $82.32 $395.00 $401.73 $233.64 $395.00 $401.73 $395.00 $395.00 $296.25 $395.00 $395.00 $395.00 $197.50 $197.50 $312.84 $395.00 $316.00 $177.75 $78.40 N/A $229.10 $395.00 $237.00 $395.00 $82.32 $395.00 N/A N/A 422.394 SUP HCPCS C1713 422.394 - SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 55MM SELF DRILL BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $408.85 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $241.22 $402.03 $83.78 $402.03 N/A N/A 422.395 SUP HCPCS C1713 422.395 - SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 65MM SELF DRILL BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $241.22 $402.03 $83.78 $402.03 N/A N/A 422.396 SUP HCPCS C1713 422.396 - SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 75MM SELF DRILL BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $163.54 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $241.22 $402.03 $83.78 $402.03 N/A N/A 422.397 SUP HCPCS C1713 422.397 - SCREW BONE 3.5MM 5MM 4.4MM 85MM SLFDRILL LOCKING THREADED BOTH IP/OP $402.50 $298.00 $79.79 $408.85 $180.91 $180.91 $180.91 $180.91 $402.03 $402.03 $402.03 $83.79 $402.03 $402.03 $402.03 $402.03 $402.03 $83.79 $402.03 $408.85 $237.80 $402.03 $408.85 $402.03 $402.03 $301.88 $402.03 $402.03 $402.03 $201.02 $201.02 $318.41 $402.03 $321.62 $180.91 $79.79 N/A $233.45 $402.03 $402.03 $402.03 $83.78 $402.03 N/A N/A 422.402 SUP HCPCS C1713 422.402 - SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 14MM SELF DRILL LCP BOTH IP/OP $409.50 $303.00 $81.19 $416.00 $184.07 $184.07 $184.07 $184.07 $409.05 $409.05 $409.05 $85.26 $409.05 $409.05 $409.05 $409.05 $409.05 $85.25 $409.05 $166.40 $241.95 $409.05 $416.00 $409.05 $409.05 $307.13 $409.05 $409.05 $409.05 $204.53 $204.53 $323.97 $409.05 $327.24 $184.07 $81.19 N/A $237.51 $409.05 $245.43 $409.05 $85.25 $409.05 N/A N/A 422.404 SUP HCPCS C1713 422.404 - SCREW BONE 3.5MM CONE HEXAGON 5MM 4.4MM 18MM SELF DRILL LCP BOTH IP/OP $409.50 $303.00 $81.19 $416.00 $184.07 $184.07 $184.07 $184.07 $409.05 $409.05 $409.05 $85.26 $409.05 $409.05 $409.05 $409.05 $409.05 $85.25 $409.05 $166.40 $241.95 $409.05 $416.00 $409.05 $409.05 $307.13 $409.05 $409.05 $409.05 $204.53 $204.53 $323.97 $409.05 $327.24 $184.07 $81.19 N/A $237.51 $409.05 $245.43 $409.05 $85.25 $409.05 N/A N/A 422.578 SUP Custom 27803010 422.578 - NUT ORTHOPEDIC 5MM TITANIUM TIBIA PROXIMAL MEDIAL NONSTRL BOTH IP/OP $304.00 $225.00 $54.05 $308.78 $303.63 $303.63 $303.63 $303.63 $303.63 $303.63 $54.05 $303.63 $303.63 $303.63 $303.63 $303.63 $303.63 $63.28 $303.63 $123.51 $303.63 $303.63 $308.78 $303.63 $303.63 $228.00 $303.63 $303.63 $303.63 $151.82 $151.82 $240.47 $303.63 $242.90 $136.63 $303.63 N/A $176.32 $303.63 $182.18 $303.63 $303.63 $303.63 N/A N/A 423.406 SUP HCPCS C1713 423.406 - PLATE BONE 86MM 6 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5 BOTH IP/OP "$1,721.00" "$1,274.00" $341.49 "$1,749.83" $774.26 $774.26 $774.26 $774.26 "$1,720.58" "$1,720.58" "$1,720.58" $358.61 "$1,720.58" "$1,720.58" "$1,720.58" "$1,720.58" "$1,720.58" $358.59 "$1,720.58" "$1,749.83" "$1,017.72" "$1,720.58" "$1,749.83" "$1,720.58" "$1,720.58" "$1,290.75" "$1,720.58" "$1,720.58" "$1,720.58" $860.29 $860.29 "$1,362.70" "$1,720.58" "$1,376.46" $774.26 $341.49 N/A $998.18 "$1,720.58" "$1,720.58" "$1,720.58" $358.57 "$1,720.58" N/A N/A 423.407 SUP HCPCS C1713 423.407 - PLATE BONE 99MM 7 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5 BOTH IP/OP "$1,753.00" "$1,297.00" $347.91 "$1,782.70" $788.81 $788.81 $788.81 $788.81 "$1,752.90" "$1,752.90" "$1,752.90" $365.35 "$1,752.90" "$1,752.90" "$1,752.90" "$1,752.90" "$1,752.90" $365.32 "$1,752.90" "$1,782.70" "$1,036.84" "$1,752.90" "$1,782.70" "$1,752.90" "$1,752.90" "$1,314.75" "$1,752.90" "$1,752.90" "$1,752.90" $876.45 $876.45 "$1,388.30" "$1,752.90" "$1,402.32" $788.81 $347.91 N/A "$1,016.74" "$1,752.90" "$1,752.90" "$1,752.90" $365.30 "$1,752.90" N/A N/A 423.408 SUP HCPCS C1713 423.408 - PLATE BONE 112MM 8 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5 BOTH IP/OP "$1,778.50" "$1,316.00" $352.93 "$1,808.43" $800.19 $800.19 $800.19 $800.19 "$1,778.20" "$1,778.20" "$1,778.20" $370.62 "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" $370.60 "$1,778.20" "$1,808.43" "$1,051.81" "$1,778.20" "$1,808.43" "$1,778.20" "$1,778.20" "$1,333.88" "$1,778.20" "$1,778.20" "$1,778.20" $889.10 $889.10 "$1,408.33" "$1,778.20" "$1,422.56" $800.19 $352.93 N/A "$1,031.53" "$1,778.20" "$1,778.20" "$1,778.20" $370.58 "$1,778.20" N/A N/A 423.409 SUP HCPCS C1713 423.409 - PLATE BONE 125MM 9 HOLE LCP TITANIUM METAPHYSEAL NONSTRL 3.5 BOTH IP/OP "$1,808.00" "$1,338.00" $358.79 "$1,838.45" $813.48 $813.48 $813.48 $813.48 "$1,807.73" "$1,807.73" "$1,807.73" $376.78 "$1,807.73" "$1,807.73" "$1,807.73" "$1,807.73" "$1,807.73" $376.75 "$1,807.73" "$1,838.45" "$1,069.27" "$1,807.73" "$1,838.45" "$1,807.73" "$1,807.73" "$1,356.00" "$1,807.73" "$1,807.73" "$1,807.73" $903.87 $903.87 "$1,431.72" "$1,807.73" "$1,446.18" $813.48 $358.79 N/A "$1,048.64" "$1,807.73" "$1,807.73" "$1,807.73" $376.73 "$1,807.73" N/A N/A 423.41 SUP HCPCS C1713 423.410 - PLATE BONE 138MM 10 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$1,784.00" "$1,320.00" $354.03 "$1,868.48" $802.68 $802.68 $802.68 $802.68 "$1,783.73" "$1,783.73" "$1,783.73" $371.77 "$1,783.73" "$1,783.73" "$1,783.73" "$1,783.73" "$1,783.73" $371.75 "$1,783.73" "$1,868.48" "$1,055.08" "$1,783.73" "$1,868.48" "$1,783.73" "$1,783.73" "$1,338.00" "$1,783.73" "$1,783.73" "$1,783.73" $891.87 $891.87 "$1,412.71" "$1,783.73" "$1,426.98" $802.68 $354.03 N/A "$1,034.72" "$1,783.73" "$1,783.73" "$1,783.73" $371.73 "$1,783.73" N/A N/A 423.411 SUP HCPCS C1713 423.411 - PLATE BONE 151MM 11 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$1,868.50" "$1,383.00" $370.79 "$1,899.93" $840.68 $840.68 $840.68 $840.68 "$1,868.18" "$1,868.18" "$1,868.18" $389.38 "$1,868.18" "$1,868.18" "$1,868.18" "$1,868.18" "$1,868.18" $389.35 "$1,868.18" "$1,899.93" "$1,105.03" "$1,868.18" "$1,899.93" "$1,868.18" "$1,868.18" "$1,401.38" "$1,868.18" "$1,868.18" "$1,868.18" $934.09 $934.09 "$1,479.60" "$1,868.18" "$1,494.54" $840.68 $370.79 N/A "$1,083.73" "$1,868.18" "$1,868.18" "$1,868.18" $389.33 "$1,868.18" N/A N/A 423.412 SUP HCPCS C1713 423.412 - PLATE BONE 164MM 12 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$2,411.00" "$1,784.00" $478.48 "$2,451.75" "$1,084.85" "$1,084.85" "$1,084.85" "$1,084.85" "$2,410.78" "$2,410.78" "$2,410.78" $502.47 "$2,410.78" "$2,410.78" "$2,410.78" "$2,410.78" "$2,410.78" $502.43 "$2,410.78" "$2,451.75" "$1,425.98" "$2,410.78" "$2,451.75" "$2,410.78" "$2,410.78" "$1,808.25" "$2,410.78" "$2,410.78" "$2,410.78" "$1,205.39" "$1,205.39" "$1,909.34" "$2,410.78" "$1,928.62" "$1,084.85" $478.48 N/A "$1,398.38" "$2,410.78" "$2,410.78" "$2,410.78" $502.41 "$2,410.78" N/A N/A 423.414 SUP HCPCS C1713 423.414 - PLATE BONE 190MM 14 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$2,489.50" "$1,842.00" $494.10 "$2,531.80" "$1,120.27" "$1,120.27" "$1,120.27" "$1,120.27" "$2,489.48" "$2,489.48" "$2,489.48" $518.87 "$2,489.48" "$2,489.48" "$2,489.48" "$2,489.48" "$2,489.48" $518.84 "$2,489.48" "$2,531.80" "$1,472.53" "$2,489.48" "$2,531.80" "$2,489.48" "$2,489.48" "$1,867.13" "$2,489.48" "$2,489.48" "$2,489.48" "$1,244.74" "$1,244.74" "$1,971.67" "$2,489.48" "$1,991.58" "$1,120.27" $494.10 N/A "$1,443.91" "$2,489.48" "$2,489.48" "$2,489.48" $518.81 "$2,489.48" N/A N/A 423.416 SUP HCPCS C1713 423.416 - PLATE BONE 216MM 16 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$2,543.00" "$1,882.00" $504.70 "$2,586.13" "$1,144.31" "$1,144.31" "$1,144.31" "$1,144.31" "$2,542.90" "$2,542.90" "$2,542.90" $530.00 "$2,542.90" "$2,542.90" "$2,542.90" "$2,542.90" "$2,542.90" $529.97 "$2,542.90" "$2,586.13" "$1,253.65" "$2,542.90" "$2,586.13" "$2,542.90" "$2,542.90" "$1,907.25" "$2,542.90" "$2,542.90" "$2,542.90" "$1,271.45" "$1,271.45" "$2,013.98" "$2,542.90" "$2,034.32" "$1,144.31" $504.70 N/A "$1,474.94" "$2,542.90" "$2,542.90" "$2,542.90" $529.94 "$2,542.90" N/A N/A 423.418 SUP HCPCS C1713 423.418 - PLATE BONE 242MM 18 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$2,489.50" "$1,842.00" $494.10 "$2,531.80" "$1,120.27" "$1,120.27" "$1,120.27" "$1,120.27" "$2,489.48" "$2,489.48" "$2,489.48" $518.87 "$2,489.48" "$2,489.48" "$2,489.48" "$2,489.48" "$2,489.48" $518.84 "$2,489.48" "$1,012.72" "$1,472.53" "$2,489.48" "$2,531.80" "$2,489.48" "$2,489.48" "$1,867.13" "$2,489.48" "$2,489.48" "$2,489.48" "$1,244.74" "$1,244.74" "$1,971.67" "$2,489.48" "$1,991.58" "$1,120.27" $494.10 N/A "$1,443.91" "$2,489.48" "$2,489.48" "$2,489.48" $518.81 "$2,489.48" N/A N/A 423.52 SUP HCPCS C1713 423.52 - PLATE BONE 25X11X3.3MM 2 HOLE LC-DCP TITANIUM CLAVICLE BOTH IP/OP $219.00 $162.00 $43.39 $218.63 $98.38 $98.38 $98.38 $98.38 $218.63 $218.63 $218.63 $45.57 $218.63 $218.63 $218.63 $218.63 $218.63 $45.56 $218.63 $87.45 $129.32 $218.63 $218.63 $218.63 $218.63 $164.25 $218.63 $218.63 $218.63 $109.32 $109.32 $173.15 $218.63 $174.90 $98.38 $43.39 N/A $127.02 $218.63 $218.63 $218.63 $45.56 $218.63 N/A N/A 423.521 SUP HCPCS C1713 423.521 - PLATE BONE 33MM 2 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5MM BOTH IP/OP $491.00 $363.00 $97.37 $498.93 $220.76 $220.76 $220.76 $220.76 $490.58 $490.58 $490.58 $102.25 $490.58 $490.58 $490.58 $490.58 $490.58 $102.24 $490.58 $199.57 $290.18 $490.58 $498.93 $490.58 $490.58 $368.25 $490.58 $490.58 $490.58 $245.29 $245.29 $388.54 $490.58 $392.46 $220.76 $97.37 N/A $284.78 $490.58 $490.58 $490.58 $490.58 $490.58 N/A N/A 423.53 SUP HCPCS C1713 423.53 - PLATE BONE 38X11X3.3MM 3 HOLE LC-DCP TITANIUM CLAVICLE BOTH IP/OP $223.00 $165.00 $44.18 $222.60 $100.17 $100.17 $100.17 $100.17 $222.60 $222.60 $222.60 $46.40 $222.60 $222.60 $222.60 $222.60 $222.60 $46.39 $222.60 $222.60 $131.67 $222.60 $222.60 $222.60 $222.60 $167.25 $222.60 $222.60 $222.60 $111.30 $111.30 $176.30 $222.60 $178.08 $100.17 $44.18 N/A $129.34 $222.60 $222.60 $222.60 $222.60 $222.60 N/A N/A 423.531 SUP HCPCS C1713 423.531 - PLATE BONE 46MM 3 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5MM BOTH IP/OP $510.50 $378.00 $101.28 $518.95 $229.63 $229.63 $229.63 $229.63 $510.28 $510.28 $510.28 $106.36 $510.28 $510.28 $510.28 $510.28 $510.28 $106.35 $510.28 $518.95 $301.83 $510.28 $518.95 $510.28 $510.28 $382.88 $510.28 $510.28 $510.28 $255.14 $255.14 $404.14 $510.28 $408.22 $229.63 $101.28 N/A $296.09 $510.28 $510.28 $510.28 $106.34 $510.28 N/A N/A 423.54 SUP HCPCS C1713 423.54 - PLATE BONE 3.5MM 51X11X3.3MM 4 HOLE LC-DCP TITANIUM CLAVICLE BOTH IP/OP $229.50 $170.00 $45.50 $229.23 $103.15 $103.15 $103.15 $103.15 $229.23 $229.23 $229.23 $47.78 $229.23 $229.23 $229.23 $229.23 $229.23 $47.77 $229.23 $229.23 $135.59 $229.23 $229.23 $229.23 $229.23 $172.13 $229.23 $229.23 $229.23 $114.62 $114.62 $181.55 $229.23 $183.38 $103.15 $45.50 N/A $133.11 $229.23 $229.23 $229.23 $229.23 $229.23 N/A N/A 423.541 SUP HCPCS C1713 423.541 - PLATE BONE 59MM 4 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5MM BOTH IP/OP $533.00 $394.00 $105.74 $541.80 $239.74 $239.74 $239.74 $239.74 $532.75 $532.75 $532.75 $111.04 $532.75 $532.75 $532.75 $532.75 $532.75 $111.03 $532.75 $541.80 $315.12 $532.75 $541.80 $532.75 $532.75 $399.75 $532.75 $532.75 $532.75 $266.38 $266.38 $421.94 $532.75 $426.20 $239.74 $105.74 N/A $309.14 $532.75 $532.75 $532.75 $111.03 $532.75 N/A N/A 423.55 SUP HCPCS C1713 423.55 - PLATE BONE 64X11X3.3MM 5 HOLE LC-DCP TITANIUM CLAVICLE BOTH IP/OP $241.50 $179.00 $47.86 $241.15 $108.52 $108.52 $108.52 $108.52 $241.15 $241.15 $241.15 $50.26 $241.15 $241.15 $241.15 $241.15 $241.15 $50.26 $241.15 $241.15 $142.64 $241.15 $241.15 $241.15 $241.15 $181.13 $241.15 $241.15 $241.15 $120.58 $120.58 $190.99 $241.15 $192.92 $108.52 $47.86 N/A $140.07 $241.15 $241.15 $241.15 $50.26 $241.15 N/A N/A 423.551 SUP HCPCS C1713 423.551 - PLATE BONE 72X11X3.4MM 5 HOLE LCP TITANIUM HUMERUS RAD ULNA BOTH IP/OP $550.00 $407.00 $109.09 $558.98 $247.33 $247.33 $247.33 $247.33 $549.63 $549.63 $549.63 $114.56 $549.63 $549.63 $549.63 $549.63 $549.63 $114.55 $549.63 $558.98 $325.11 $549.63 $558.98 $549.63 $549.63 $412.50 $549.63 $549.63 $549.63 $274.82 $274.82 $435.31 $549.63 $439.70 $247.33 $109.09 N/A $319.00 $549.63 $549.63 $549.63 $114.54 $549.63 N/A N/A 423.56 SUP HCPCS C1713 423.56 - PLATE BONE 77X11X3.3MM 6 HOLE LC-DCP TITANIUM CLAVICLE BOTH IP/OP $258.50 $191.00 $51.28 $258.38 $116.27 $116.27 $116.27 $116.27 $258.38 $258.38 $258.38 $53.85 $258.38 $258.38 $258.38 $258.38 $258.38 $53.85 $258.38 $258.38 $152.83 $258.38 $258.38 $258.38 $258.38 $193.88 $258.38 $258.38 $258.38 $129.19 $129.19 $204.64 $258.38 $206.70 $116.27 $51.28 N/A $149.93 $258.38 $258.38 $258.38 $53.85 $258.38 N/A N/A 423.561 SUP HCPCS C1713 423.561 - PLATE BONE 85X11X3.4MM 6 HOLE LCP TITANIUM HUMERUS RAD ULNA BOTH IP/OP $585.00 $433.00 $116.06 $594.73 $263.15 $263.15 $263.15 $263.15 $584.78 $584.78 $584.78 $121.88 $584.78 $584.78 $584.78 $584.78 $584.78 $121.87 $584.78 $594.73 $345.90 $584.78 $594.73 $584.78 $584.78 $438.75 $584.78 $584.78 $584.78 $292.39 $292.39 $463.15 $584.78 $467.82 $263.15 $116.06 N/A $339.30 $584.78 $350.87 $584.78 $121.87 $584.78 N/A N/A 423.57 SUP HCPCS C1713 423.57 - PLATE BN 90X11X3.3MM NS LC DCP 7 HL TI 3.5MM SCR SM FRAG SET BOTH IP/OP $268.00 $198.00 $53.12 $267.65 $120.44 $120.44 $120.44 $120.44 $267.65 $267.65 $267.65 $55.78 $267.65 $267.65 $267.65 $267.65 $267.65 $55.78 $267.65 $107.06 $158.31 $267.65 $267.65 $267.65 $267.65 $201.00 $267.65 $267.65 $267.65 $133.83 $133.83 $211.98 $267.65 $214.12 $120.44 $53.12 N/A $155.44 $267.65 $160.59 $267.65 $55.78 $267.65 N/A N/A 423.571 SUP HCPCS C1713 423.571 - PLATE BN 98X11X3.4MM NS LCP CMBN 7 HL LMT CNTCT TPR END TI BOTH IP/OP $609.00 $451.00 $120.81 $619.03 $273.91 $273.91 $273.91 $273.91 $608.68 $608.68 $608.68 $126.86 $608.68 $608.68 $608.68 $608.68 $608.68 $126.86 $608.68 $247.61 $360.03 $608.68 $619.03 $608.68 $608.68 $456.75 $608.68 $608.68 $608.68 $304.34 $304.34 $482.07 $608.68 $486.94 $273.91 $120.81 N/A $353.22 $608.68 $365.21 $608.68 $126.85 $608.68 N/A N/A 423.58 SUP HCPCS C1713 423.58 - PLATE BONE SMALL 103X11X3.3MM 8 HOLE LC-DCP TITANIUM BOTH IP/OP $282.50 $209.00 $56.02 $282.23 $127.00 $127.00 $127.00 $127.00 $282.23 $282.23 $282.23 $58.82 $282.23 $282.23 $282.23 $282.23 $282.23 $58.82 $282.23 $112.89 $166.94 $282.23 $282.23 $282.23 $282.23 $211.88 $282.23 $282.23 $282.23 $141.12 $141.12 $223.53 $282.23 $225.78 $127.00 $56.02 N/A $163.85 $282.23 $169.34 $282.23 $58.82 $282.23 N/A N/A 423.581 SUP HCPCS C1713 423.581 - PLATE BN 111X11X3.4MM NS LCP CMBN 8 HL LMT CNTCT TPR END TI BOTH IP/OP $640.00 $474.00 $126.94 $650.48 $287.82 $287.82 $287.82 $287.82 $639.60 $639.60 $639.60 $133.31 $639.60 $639.60 $639.60 $639.60 $639.60 $133.30 $639.60 $260.19 $378.32 $639.60 $650.48 $639.60 $639.60 $480.00 $639.60 $639.60 $639.60 $319.80 $319.80 $506.56 $639.60 $511.68 $287.82 $126.94 N/A $371.20 $639.60 $383.76 $639.60 $133.29 $639.60 N/A N/A 423.59 SUP HCPCS C1713 423.59 - PLATE BN 116X11X3.3MM NS LC DCP 9 HL TI 3.5MM SCR SM FRAG BOTH IP/OP $305.00 $226.00 $60.49 $304.75 $137.14 $137.14 $137.14 $137.14 $304.75 $304.75 $304.75 $63.52 $304.75 $304.75 $304.75 $304.75 $304.75 $63.51 $304.75 $121.90 $180.26 $304.75 $304.75 $304.75 $304.75 $228.75 $304.75 $304.75 $304.75 $152.38 $152.38 $241.36 $304.75 $243.80 $137.14 $60.49 N/A $176.90 $304.75 $182.85 $304.75 $63.51 $304.75 N/A N/A 423.591 SUP HCPCS C1713 423.591 - PLATE BONE 124X11X3.4MM 9 HOLE LCP TITANIUM HUMERUS RAD ULNA BOTH IP/OP $665.00 $492.00 $131.97 $676.20 $299.21 $299.21 $299.21 $299.21 $664.90 $664.90 $664.90 $138.58 $664.90 $664.90 $664.90 $664.90 $664.90 $138.57 $664.90 $270.48 $393.29 $664.90 $676.20 $664.90 $664.90 $498.75 $664.90 $664.90 $664.90 $332.45 $332.45 $526.60 $664.90 $531.92 $299.21 $131.97 N/A $385.70 $664.90 $398.94 $664.90 $138.57 $664.90 N/A N/A 423.6 SUP HCPCS C1713 423.60 - PLATE BONE 129X11X3.3MM 10 HOLE LC-DCP TITANIUM DISTAL TIBIA BOTH IP/OP $309.00 $229.00 $61.28 $308.73 $138.93 $138.93 $138.93 $138.93 $308.73 $308.73 $308.73 $64.35 $308.73 $308.73 $308.73 $308.73 $308.73 $64.34 $308.73 $123.49 $182.61 $308.73 $308.73 $308.73 $308.73 $231.75 $308.73 $308.73 $308.73 $154.37 $154.37 $244.51 $308.73 $246.98 $138.93 $61.28 N/A $179.22 $308.73 $308.73 $308.73 $308.73 $308.73 N/A N/A 423.601 SUP HCPCS C1713 423.601 - PLATE BONE 137X11X3.4MM 10 HOLE LCP TITANIUM HUMERUS RAD BOTH IP/OP $686.00 $508.00 $136.15 $697.63 $308.69 $308.69 $308.69 $308.69 $685.98 $685.98 $685.98 $142.98 $685.98 $685.98 $685.98 $685.98 $685.98 $142.97 $685.98 $279.05 $405.76 $685.98 $697.63 $685.98 $685.98 $514.50 $685.98 $685.98 $685.98 $342.99 $342.99 $543.30 $685.98 $548.78 $308.69 $136.15 N/A $397.88 $685.98 $685.98 $685.98 $685.98 $685.98 N/A N/A 423.61 SUP HCPCS C1713 423.61 - PLATE BONE 142X11X3.3MM 11 HOLE LC-DCP TITANIUM CLAVICLE BOTH IP/OP $325.00 $241.00 $64.43 $324.63 $146.08 $146.08 $146.08 $146.08 $324.63 $324.63 $324.63 $67.66 $324.63 $324.63 $324.63 $324.63 $324.63 $67.66 $324.63 $324.63 $192.02 $324.63 $324.63 $324.63 $324.63 $243.75 $324.63 $324.63 $324.63 $162.32 $162.32 $257.11 $324.63 $259.70 $146.08 $64.43 N/A $188.50 $324.63 $194.78 $324.63 $67.65 $324.63 N/A N/A 423.611 SUP HCPCS C1713 423.611 - PLATE BONE 150MM 11 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5 BOTH IP/OP $737.00 $545.00 $146.19 $749.10 $331.46 $331.46 $331.46 $331.46 $736.58 $736.58 $736.58 $153.52 $736.58 $736.58 $736.58 $736.58 $736.58 $153.51 $736.58 $749.10 $435.69 $736.58 $749.10 $736.58 $736.58 $552.75 $736.58 $736.58 $736.58 $368.29 $368.29 $583.37 $736.58 $589.26 $331.46 $146.19 N/A $427.46 $736.58 $441.95 $736.58 $736.58 $736.58 N/A N/A 423.62 SUP HCPCS C1713 423.62 - PLATE BONE 3.5MM 155X11X3.3MM 12 HOLE LC-DCP TITANIUM BOTH IP/OP $347.50 $257.00 $68.90 $347.15 $156.22 $156.22 $156.22 $156.22 $347.15 $347.15 $347.15 $72.35 $347.15 $347.15 $347.15 $347.15 $347.15 $72.35 $347.15 $138.86 $205.34 $347.15 $347.15 $347.15 $347.15 $260.63 $347.15 $347.15 $347.15 $173.58 $173.58 $274.94 $347.15 $277.72 $156.22 $68.90 N/A $201.55 $347.15 $208.29 $347.15 $347.15 $347.15 N/A N/A 423.621 SUP HCPCS C1713 423.621 - PLATE BONE 163X11X3.4MM 12 HOLE LCP TITANIUM HUMERUS RAD BOTH IP/OP $756.50 $560.00 $150.10 $769.13 $340.33 $340.33 $340.33 $340.33 $756.28 $756.28 $756.28 $157.63 $756.28 $756.28 $756.28 $756.28 $756.28 $157.62 $756.28 $307.65 $447.34 $756.28 $769.13 $756.28 $756.28 $567.38 $756.28 $756.28 $756.28 $378.14 $378.14 $598.97 $756.28 $605.02 $340.33 $150.10 N/A $438.77 $756.28 $756.28 $756.28 $157.61 $756.28 N/A N/A 423.631 SUP HCPCS C1713 423.631 - PLATE BONE 176MM 13 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5 BOTH IP/OP $898.50 $665.00 $178.28 $913.53 $404.21 $404.21 $404.21 $404.21 $898.25 $898.25 $898.25 $187.22 $898.25 $898.25 $898.25 $898.25 $898.25 $187.21 $898.25 $365.41 $531.31 $898.25 $913.53 $898.25 $898.25 $673.88 $898.25 $898.25 $898.25 $449.13 $449.13 $711.41 $898.25 $718.60 $404.21 $178.28 N/A $521.13 $898.25 $538.95 $898.25 $898.25 $898.25 N/A N/A 423.64 SUP HCPCS C1713 423.64 - PLATE BONE 181X11X3.3MM 14 HOLE LC-DCP TITANIUM CLAVICLE BOTH IP/OP $643.00 $476.00 $127.55 $642.63 $289.18 $289.18 $289.18 $289.18 $642.63 $642.63 $642.63 $133.94 $642.63 $642.63 $642.63 $642.63 $642.63 $133.93 $642.63 $642.63 $380.12 $642.63 $642.63 $642.63 $642.63 $482.25 $642.63 $642.63 $642.63 $321.32 $321.32 $508.96 $642.63 $514.10 $289.18 $127.55 N/A $372.94 $642.63 $385.58 $642.63 $642.63 $642.63 N/A N/A 423.641 SUP HCPCS C1713 423.641 - PLATE BONE 189X11X3.4MM 14 HOLE LCP TITANIUM HUMERUS RAD BOTH IP/OP "$1,134.50" $840.00 $225.15 "$1,153.68" $510.48 $510.48 $510.48 $510.48 "$1,134.40" "$1,134.40" "$1,134.40" $236.44 "$1,134.40" "$1,134.40" "$1,134.40" "$1,134.40" "$1,134.40" $236.42 "$1,134.40" $461.47 $671.00 "$1,134.40" "$1,153.68" "$1,134.40" "$1,134.40" $850.88 "$1,134.40" "$1,134.40" "$1,134.40" $567.20 $567.20 $898.44 "$1,134.40" $907.52 $510.48 $225.15 N/A $658.01 "$1,134.40" $680.64 "$1,134.40" $236.41 "$1,134.40" N/A N/A 423.65 SUP HCPCS C1713 423.65 - PLATE BONE 195X11X3.3MM 15 HOLE LC-DCP TITANIUM CLAVICLE BOTH IP/OP $673.50 $498.00 $133.59 $673.10 $302.90 $302.90 $302.90 $302.90 $673.10 $673.10 $673.10 $140.29 $673.10 $673.10 $673.10 $673.10 $673.10 $140.28 $673.10 $269.24 $398.14 $673.10 $673.10 $673.10 $673.10 $505.13 $673.10 $673.10 $673.10 $336.55 $336.55 $533.10 $673.10 $538.48 $302.90 $133.59 N/A $390.63 $673.10 $403.86 $673.10 $140.27 $673.10 N/A N/A 423.651 SUP HCPCS C1713 423.651 - PLATE BONE 202MM 15 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5 BOTH IP/OP "$1,215.00" $899.00 $241.05 "$1,235.18" $546.54 $546.54 $546.54 $546.54 "$1,214.53" "$1,214.53" "$1,214.53" $253.14 "$1,214.53" "$1,214.53" "$1,214.53" "$1,214.53" "$1,214.53" $253.12 "$1,214.53" $494.07 $718.39 "$1,214.53" "$1,235.18" "$1,214.53" "$1,214.53" $911.25 "$1,214.53" "$1,214.53" "$1,214.53" $607.27 $607.27 $961.91 "$1,214.53" $971.62 $546.54 $241.05 N/A $704.70 "$1,214.53" $728.72 "$1,214.53" $253.11 "$1,214.53" N/A N/A 423.66 SUP HCPCS C1713 423.66 - PLATE BONE 207X11X3.3MM 16 HOLE LC-DCP TITANIUM CLAVICLE BOTH IP/OP $738.50 $546.00 $146.48 $738.03 $332.11 $332.11 $332.11 $332.11 $738.03 $738.03 $738.03 $153.82 $738.03 $738.03 $738.03 $738.03 $738.03 $153.81 $738.03 $295.21 $436.54 $738.03 $738.03 $738.03 $738.03 $553.88 $738.03 $738.03 $738.03 $369.02 $369.02 $584.52 $738.03 $590.42 $332.11 $146.48 N/A $428.33 $738.03 $442.82 $738.03 $153.81 $738.03 N/A N/A 423.661 SUP HCPCS C1713 423.661 - PLATE BONE 215MM 16 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5 BOTH IP/OP "$1,271.00" $941.00 $252.21 "$1,292.35" $571.84 $571.84 $571.84 $571.84 "$1,270.75" "$1,270.75" "$1,270.75" $264.86 "$1,270.75" "$1,270.75" "$1,270.75" "$1,270.75" "$1,270.75" $264.84 "$1,270.75" $516.94 $751.65 "$1,270.75" "$1,292.35" "$1,270.75" "$1,270.75" $953.25 "$1,270.75" "$1,270.75" "$1,270.75" $635.38 $635.38 "$1,006.43" "$1,270.75" "$1,016.60" $571.84 $252.21 N/A $737.18 "$1,270.75" $762.45 "$1,270.75" $264.82 "$1,270.75" N/A N/A 423.671 SUP HCPCS C1713 423.671 - PLATE BONE 241MM 18 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5 BOTH IP/OP "$1,425.50" "$1,055.00" $282.90 "$1,449.60" $641.42 $641.42 $641.42 $641.42 "$1,425.38" "$1,425.38" "$1,425.38" $297.08 "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" $297.06 "$1,425.38" $579.84 $843.11 "$1,425.38" "$1,449.60" "$1,425.38" "$1,425.38" "$1,069.13" "$1,425.38" "$1,425.38" "$1,425.38" $712.69 $712.69 "$1,128.90" "$1,425.38" "$1,140.30" $641.42 $282.90 N/A $826.79 "$1,425.38" $855.23 "$1,425.38" $297.05 "$1,425.38" N/A N/A 423.68 SUP HCPCS C1713 423.68 - PLATE BONE 233X11X3.3MM 18 HOLE LC-DCP TITANIUM CLAVICLE BOTH IP/OP $825.50 $611.00 $163.84 $825.48 $371.47 $371.47 $371.47 $371.47 $825.48 $825.48 $825.48 $172.05 $825.48 $825.48 $825.48 $825.48 $825.48 $172.04 $825.48 $825.48 $488.27 $825.48 $825.48 $825.48 $825.48 $619.13 $825.48 $825.48 $825.48 $412.74 $412.74 $653.78 $825.48 $660.38 $371.47 $163.84 N/A $478.79 $825.48 $495.29 $825.48 $172.03 $825.48 N/A N/A 423.681 SUP HCPCS C1713 423.681 - PLATE BONE 267MM 20 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5 BOTH IP/OP "$1,583.00" "$1,171.00" $314.15 "$1,609.70" $712.26 $712.26 $712.26 $712.26 "$1,582.80" "$1,582.80" "$1,582.80" $329.90 "$1,582.80" "$1,582.80" "$1,582.80" "$1,582.80" "$1,582.80" $329.87 "$1,582.80" $643.88 $936.23 "$1,582.80" "$1,609.70" "$1,582.80" "$1,582.80" "$1,187.25" "$1,582.80" "$1,582.80" "$1,582.80" $791.40 $791.40 "$1,253.58" "$1,582.80" "$1,266.24" $712.26 $314.15 N/A $918.14 "$1,582.80" $949.68 "$1,582.80" "$1,582.80" "$1,582.80" N/A N/A 423.691 SUP HCPCS C1713 423.691 - PLATE BONE 293MM 22 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 3.5 BOTH IP/OP "$1,584.50" "$1,173.00" $314.43 "$1,611.15" $712.90 $712.90 $712.90 $712.90 "$1,584.23" "$1,584.23" "$1,584.23" $330.19 "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" $330.17 "$1,584.23" $644.46 $937.07 "$1,584.23" "$1,611.15" "$1,584.23" "$1,584.23" "$1,188.38" "$1,584.23" "$1,584.23" "$1,584.23" $792.12 $792.12 "$1,254.71" "$1,584.23" "$1,267.38" $712.90 $314.43 N/A $919.01 "$1,584.23" $950.54 "$1,584.23" "$1,584.23" "$1,584.23" N/A N/A 423.7 SUP HCPCS C1713 423.70 - PLATE BONE 259X11X3.3MM 20 HOLE LC-DCP TITANIUM CLAVICLE BOTH IP/OP $914.50 $677.00 $181.46 $914.25 $411.41 $411.41 $411.41 $411.41 $914.25 $914.25 $914.25 $190.55 $914.25 $914.25 $914.25 $914.25 $914.25 $190.54 $914.25 $365.70 $540.78 $914.25 $914.25 $914.25 $914.25 $685.88 $914.25 $914.25 $914.25 $457.13 $457.13 $724.09 $914.25 $731.40 $411.41 $181.46 N/A $530.41 $914.25 $914.25 $914.25 $190.53 $914.25 N/A N/A 424.519 SUP Custom 27803010 424.519 - ROD SPINAL 5.5MM STR HEXAGONAL END STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 424.52 SUP HCPCS C1713 424.52 - PLATE BONE NARROW 34X13.5X4.2MM 2 HOLE LC-DCP TITANIUM LONG BOTH IP/OP $321.00 $238.00 $63.66 $320.73 $144.33 $144.33 $144.33 $144.33 $320.73 $320.73 $320.73 $66.85 $320.73 $320.73 $320.73 $320.73 $320.73 $66.84 $320.73 $128.29 $189.71 $320.73 $320.73 $320.73 $320.73 $240.75 $320.73 $320.73 $320.73 $160.37 $160.37 $254.02 $320.73 $256.58 $144.33 $63.66 N/A $186.18 $320.73 $192.44 $320.73 $66.84 $320.73 N/A N/A 424.52 SUP Custom 27803010 424.520 - ROD SPINAL 5.5MM STR HEXAGONAL END STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $63.66 $375.00 $144.33 $144.33 $144.33 $144.33 $320.73 $320.73 $320.73 $66.85 $320.73 $320.73 $320.73 $320.73 $320.73 $66.84 $320.73 $128.29 $189.71 $320.73 $320.73 $320.73 $320.73 $375.00 $320.73 $320.73 $320.73 $160.37 $160.37 $254.02 $320.73 $256.58 $144.33 $63.66 N/A $290.00 $320.73 $192.44 $320.73 $66.84 $320.73 N/A N/A 424.521 SUP Custom 27803010 424.521 - ROD SPINAL 5.5MM STR HEXAGONAL END STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $104.84 $599.00 $588.98 $588.98 $588.98 $588.98 $588.98 $588.98 $104.84 $588.98 $588.98 $588.98 $588.98 $588.98 $588.98 $122.75 $588.98 $239.60 $588.98 $588.98 $599.00 $588.98 $588.98 $375.00 $588.98 $588.98 $588.98 $294.49 $294.49 $466.47 $588.98 $471.18 $265.04 $588.98 N/A $290.00 $588.98 $353.39 $588.98 $588.98 $588.98 N/A N/A 424.521 SUP Custom 27803010 424.521 - PLATE BONE NARROW 44MM 2 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP $589.00 $436.00 $104.84 $599.00 $588.98 $588.98 $588.98 $588.98 $588.98 $588.98 $104.84 $588.98 $588.98 $588.98 $588.98 $588.98 $588.98 $122.75 $588.98 $239.60 $588.98 $588.98 $599.00 $588.98 $588.98 $441.75 $588.98 $588.98 $588.98 $294.49 $294.49 $466.47 $588.98 $471.18 $265.04 $588.98 N/A $341.62 $588.98 $353.39 $588.98 $588.98 $588.98 N/A N/A 424.53 SUP HCPCS C1713 424.53 - PLATE BONE NARROW 52X13.5X4.2MM 3 HOLE LC-DCP TITANIUM LONG BOTH IP/OP $321.00 $238.00 $63.66 $320.73 $144.33 $144.33 $144.33 $144.33 $320.73 $320.73 $320.73 $66.85 $320.73 $320.73 $320.73 $320.73 $320.73 $66.84 $320.73 $128.29 $189.71 $320.73 $320.73 $320.73 $320.73 $240.75 $320.73 $320.73 $320.73 $160.37 $160.37 $254.02 $320.73 $256.58 $144.33 $63.66 N/A $186.18 $320.73 $192.44 $320.73 $66.84 $320.73 N/A N/A 424.531 SUP HCPCS C1713 424.531 - PLATE BONE NARROW 62MM 3 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP $596.50 $441.00 $118.30 $606.15 $268.21 $268.21 $268.21 $268.21 $596.03 $596.03 $596.03 $124.23 $596.03 $596.03 $596.03 $596.03 $596.03 $124.22 $596.03 $242.46 $352.55 $596.03 $606.15 $596.03 $596.03 $447.38 $596.03 $596.03 $596.03 $298.02 $298.02 $472.06 $596.03 $476.82 $268.21 $118.30 N/A $345.97 $596.03 $596.03 $596.03 $124.21 $596.03 N/A N/A 424.54 SUP HCPCS C1713 424.54 - PLATE BONE NARROW 70X13.5X4.2MM 4 HOLE LC-DCP TITANIUM LONG BOTH IP/OP $321.00 $238.00 $63.66 $320.73 $144.33 $144.33 $144.33 $144.33 $320.73 $320.73 $320.73 $66.85 $320.73 $320.73 $320.73 $320.73 $320.73 $66.84 $320.73 $128.29 $189.71 $320.73 $320.73 $320.73 $320.73 $240.75 $320.73 $320.73 $320.73 $160.37 $160.37 $254.02 $320.73 $256.58 $144.33 $63.66 N/A $186.18 $320.73 $192.44 $320.73 $66.84 $320.73 N/A N/A 424.541 SUP HCPCS C1713 424.541 - PLATE BONE NARROW 80MM 4 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 424.55 SUP HCPCS C1713 424.55 - PLATE BONE NARROW 88X13.5X4.2MM 5 HOLE LC-DCP TITANIUM LONG BOTH IP/OP $321.00 $238.00 $63.66 $320.73 $144.33 $144.33 $144.33 $144.33 $320.73 $320.73 $320.73 $66.85 $320.73 $320.73 $320.73 $320.73 $320.73 $66.84 $320.73 $128.29 $189.71 $320.73 $320.73 $320.73 $320.73 $240.75 $320.73 $320.73 $320.73 $160.37 $160.37 $254.02 $320.73 $256.58 $144.33 $63.66 N/A $186.18 $320.73 $320.73 $320.73 $66.84 $320.73 N/A N/A 424.551 SUP HCPCS C1713 424.551 - PLATE BONE NARROW 98MM 5 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP $694.50 $514.00 $137.82 $706.20 $312.48 $312.48 $312.48 $312.48 $694.40 $694.40 $694.40 $144.73 $694.40 $694.40 $694.40 $694.40 $694.40 $144.72 $694.40 $282.48 $410.74 $694.40 $706.20 $694.40 $694.40 $520.88 $694.40 $694.40 $694.40 $347.20 $347.20 $549.96 $694.40 $555.52 $312.48 $137.82 N/A $402.81 $694.40 $416.64 $694.40 $144.71 $694.40 N/A N/A 424.56 SUP HCPCS C1713 424.56 - PLATE BONE NARROW 106X13.5X4.2MM 6 HOLE LC-DCP TITANIUM LONG BOTH IP/OP $360.50 $267.00 $71.51 $360.30 $162.14 $162.14 $162.14 $162.14 $360.30 $360.30 $360.30 $75.10 $360.30 $360.30 $360.30 $360.30 $360.30 $75.09 $360.30 $144.12 $213.12 $360.30 $360.30 $360.30 $360.30 $270.38 $360.30 $360.30 $360.30 $180.15 $180.15 $285.36 $360.30 $288.24 $162.14 $71.51 N/A $209.09 $360.30 $216.18 $360.30 $75.09 $360.30 N/A N/A 424.561 SUP HCPCS C1713 424.561 - PLATE BONE NARROW 116MM 6 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP $735.50 $544.00 $145.91 $747.68 $330.83 $330.83 $330.83 $330.83 $735.18 $735.18 $735.18 $153.23 $735.18 $735.18 $735.18 $735.18 $735.18 $153.22 $735.18 $299.07 $434.86 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $330.83 $145.91 N/A $426.59 $735.18 $441.11 $735.18 $153.21 $735.18 N/A N/A 424.57 SUP HCPCS C1713 424.57 - PLATE BONE NARROW 124X13.5X4.2MM 7 HOLE LC-DCP TITANIUM LONG BOTH IP/OP $350.00 $259.00 $69.43 $349.80 $157.41 $157.41 $157.41 $157.41 $349.80 $349.80 $349.80 $72.91 $349.80 $349.80 $349.80 $349.80 $349.80 $72.90 $349.80 $139.92 $206.91 $349.80 $349.80 $349.80 $349.80 $262.50 $349.80 $349.80 $349.80 $174.90 $174.90 $277.04 $349.80 $279.84 $157.41 $69.43 N/A $203.00 $349.80 $349.80 $349.80 $349.80 $349.80 N/A N/A 424.571 SUP HCPCS C1713 424.571 - PLATE BONE NARROW 134MM 7 HOLE LCP TITANIUM ORTHOPEDIC 4.5MM BOTH IP/OP $850.50 $629.00 $168.79 $864.90 $382.70 $382.70 $382.70 $382.70 $850.45 $850.45 $850.45 $177.26 $850.45 $850.45 $850.45 $850.45 $850.45 $177.24 $850.45 $345.96 $503.04 $850.45 $864.90 $850.45 $850.45 $637.88 $850.45 $850.45 $850.45 $425.23 $425.23 $673.56 $850.45 $680.36 $382.70 $168.79 N/A $493.29 $850.45 $850.45 $850.45 $177.23 $850.45 N/A N/A 424.58 SUP HCPCS C1713 424.58 - PLATE BONE NARROW 4.5MM 142X13.5X4.2MM 8 HOLE LC-DCP BOTH IP/OP $371.50 $275.00 $73.65 $377.40 $167.00 $167.00 $167.00 $167.00 $371.10 $371.10 $371.10 $77.35 $371.10 $371.10 $371.10 $371.10 $371.10 $77.34 $371.10 $150.96 $219.51 $371.10 $377.40 $371.10 $371.10 $278.63 $371.10 $371.10 $371.10 $185.55 $185.55 $293.91 $371.10 $296.88 $167.00 $73.65 N/A $215.47 $371.10 $222.66 $371.10 $77.34 $371.10 N/A N/A 424.581 SUP HCPCS C1713 424.581 - PLATE BONE NARROW 152MM 8 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP $900.00 $666.00 $178.56 $914.95 $404.84 $404.84 $404.84 $404.84 $899.65 $899.65 $899.65 $187.51 $899.65 $899.65 $899.65 $899.65 $899.65 $187.50 $899.65 $365.98 $532.14 $899.65 $914.95 $899.65 $899.65 $675.00 $899.65 $899.65 $899.65 $449.83 $449.83 $712.52 $899.65 $719.72 $404.84 $178.56 N/A $522.00 $899.65 $539.79 $899.65 $187.49 $899.65 N/A N/A 424.59 SUP HCPCS C1713 424.59 - PLATE BONE NARROW 160X13.5X4.2MM 9 HOLE LC-DCP TITANIUM LONG BOTH IP/OP $351.00 $260.00 $69.62 $350.75 $157.84 $157.84 $157.84 $157.84 $350.75 $350.75 $350.75 $73.11 $350.75 $350.75 $350.75 $350.75 $350.75 $73.10 $350.75 $140.30 $207.47 $350.75 $350.75 $350.75 $350.75 $263.25 $350.75 $350.75 $350.75 $175.38 $175.38 $277.79 $350.75 $280.60 $157.84 $69.62 N/A $203.58 $350.75 $210.45 $350.75 $73.10 $350.75 N/A N/A 424.591 SUP HCPCS C1713 424.591 - PLATE BONE NARROW 170MM 9 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP $942.00 $697.00 $186.93 $957.83 $423.82 $423.82 $423.82 $423.82 $941.83 $941.83 $941.83 $196.30 $941.83 $941.83 $941.83 $941.83 $941.83 $196.29 $941.83 $383.13 $557.09 $941.83 $957.83 $941.83 $941.83 $706.50 $941.83 $941.83 $941.83 $470.92 $470.92 $745.93 $941.83 $753.46 $423.82 $186.93 N/A $546.36 $941.83 $565.10 $941.83 $196.28 $941.83 N/A N/A 424.6 SUP HCPCS C1713 424.60 - PLATE BONE NARROW 4.5MM 178X13.5X4.2MM 10 HOLE LC-DCP BOTH IP/OP $454.50 $336.00 $90.20 $454.45 $204.50 $204.50 $204.50 $204.50 $454.45 $454.45 $454.45 $94.72 $454.45 $454.45 $454.45 $454.45 $454.45 $94.71 $454.45 $454.45 $268.81 $454.45 $454.45 $454.45 $454.45 $340.88 $454.45 $454.45 $454.45 $227.23 $227.23 $359.92 $454.45 $363.56 $204.50 $90.20 N/A $263.61 $454.45 $272.67 $454.45 $94.71 $454.45 N/A N/A 424.601 SUP HCPCS C1713 424.601 - PLATE BONE NARROW 188MM 10 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,023.50" $757.00 $203.11 "$1,040.75" $460.51 $460.51 $460.51 $460.51 "$1,023.35" "$1,023.35" "$1,023.35" $213.29 "$1,023.35" "$1,023.35" "$1,023.35" "$1,023.35" "$1,023.35" $213.28 "$1,023.35" $416.30 $605.31 "$1,023.35" "$1,040.75" "$1,023.35" "$1,023.35" $767.63 "$1,023.35" "$1,023.35" "$1,023.35" $511.68 $511.68 $810.49 "$1,023.35" $818.68 $460.51 $203.11 N/A $593.63 "$1,023.35" $614.01 "$1,023.35" $213.27 "$1,023.35" N/A N/A 424.61 SUP HCPCS C1713 424.61 - PLATE BONE NARROW 4.5MM 206MM 11 HOLE LCP TITANIUM NONSTRL BOTH IP/OP $468.50 $347.00 $92.91 $468.10 $210.65 $210.65 $210.65 $210.65 $468.10 $468.10 $468.10 $97.56 $468.10 $468.10 $468.10 $468.10 $468.10 $97.56 $468.10 $187.24 $276.88 $468.10 $468.10 $468.10 $468.10 $351.38 $468.10 $468.10 $468.10 $234.05 $234.05 $370.74 $468.10 $374.48 $210.65 $92.91 N/A $271.73 $468.10 $468.10 $468.10 $468.10 $468.10 N/A N/A 424.611 SUP HCPCS C1713 424.611 - PLATE BONE NARROW 206MM 11 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,102.50" $816.00 $218.74 "$1,120.80" $495.94 $495.94 $495.94 $495.94 "$1,102.08" "$1,102.08" "$1,102.08" $229.70 "$1,102.08" "$1,102.08" "$1,102.08" "$1,102.08" "$1,102.08" $229.69 "$1,102.08" $448.32 $651.88 "$1,102.08" "$1,120.80" "$1,102.08" "$1,102.08" $826.88 "$1,102.08" "$1,102.08" "$1,102.08" $551.04 $551.04 $872.85 "$1,102.08" $881.66 $495.94 $218.74 N/A $639.45 "$1,102.08" $661.25 "$1,102.08" "$1,102.08" "$1,102.08" N/A N/A 424.62 SUP HCPCS C1713 424.62 - PLATE BONE NARROW 214X13.5X4.2MM 12 HOLE LC-DCP TITANIUM BOTH IP/OP $441.50 $327.00 $87.57 $441.23 $198.55 $198.55 $198.55 $198.55 $441.23 $441.23 $441.23 $91.96 $441.23 $441.23 $441.23 $441.23 $441.23 $91.96 $441.23 $176.49 $260.99 $441.23 $441.23 $441.23 $441.23 $331.13 $441.23 $441.23 $441.23 $220.62 $220.62 $349.45 $441.23 $352.98 $198.55 $87.57 N/A $256.07 $441.23 $264.74 $441.23 $91.95 $441.23 N/A N/A 424.621 SUP HCPCS C1713 424.621 - PLATE BONE NARROW 224MM 12 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,185.00" $877.00 $235.19 "$1,205.15" $533.25 $533.25 $533.25 $533.25 "$1,185.00" "$1,185.00" "$1,185.00" $246.98 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $482.06 $700.93 "$1,185.00" "$1,205.15" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 $235.19 N/A $687.30 "$1,185.00" $711.00 "$1,185.00" $246.95 "$1,185.00" N/A N/A 424.63 SUP HCPCS C1713 424.63 - PLATE BONE NARROW 232X13.5X4.2MM 13 HOLE LC-DCP TITANIUM BOTH IP/OP $545.00 $403.00 $108.08 $544.53 $245.04 $245.04 $245.04 $245.04 $544.53 $544.53 $544.53 $113.49 $544.53 $544.53 $544.53 $544.53 $544.53 $113.49 $544.53 $217.81 $322.09 $544.53 $544.53 $544.53 $544.53 $408.75 $544.53 $544.53 $544.53 $272.27 $272.27 $431.27 $544.53 $435.62 $245.04 $108.08 N/A $316.10 $544.53 $326.72 $544.53 $113.48 $544.53 N/A N/A 424.631 SUP HCPCS C1713 424.631 - PLATE BONE NARROW 242MM 13 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,265.50" $936.00 $251.10 "$1,286.63" $569.31 $569.31 $569.31 $569.31 "$1,265.13" "$1,265.13" "$1,265.13" $263.68 "$1,265.13" "$1,265.13" "$1,265.13" "$1,265.13" "$1,265.13" $263.67 "$1,265.13" $514.65 $748.32 "$1,265.13" "$1,286.63" "$1,265.13" "$1,265.13" $949.13 "$1,265.13" "$1,265.13" "$1,265.13" $632.57 $632.57 "$1,001.98" "$1,265.13" "$1,012.10" $569.31 $251.10 N/A $733.99 "$1,265.13" "$1,265.13" "$1,265.13" "$1,265.13" "$1,265.13" N/A N/A 424.64 SUP HCPCS C1713 424.64 - PLATE BONE NARROW 4.5MM 250X13.5X4.2MM 14 HOLE LC-DCP BOTH IP/OP $545.50 $404.00 $108.25 $554.68 $245.43 $245.43 $245.43 $245.43 $545.40 $545.40 $545.40 $113.67 $545.40 $545.40 $545.40 $545.40 $545.40 $113.67 $545.40 $221.87 $322.60 $545.40 $554.68 $545.40 $545.40 $409.13 $545.40 $545.40 $545.40 $272.70 $272.70 $431.96 $545.40 $436.32 $245.43 $108.25 N/A $316.39 $545.40 $545.40 $545.40 $545.40 $545.40 N/A N/A 424.641 SUP HCPCS C1713 424.641 - PLATE BONE NARROW 260MM 14 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,328.50" $983.00 $263.65 "$1,350.95" $597.77 $597.77 $597.77 $597.77 "$1,328.38" "$1,328.38" "$1,328.38" $276.87 "$1,328.38" "$1,328.38" "$1,328.38" "$1,328.38" "$1,328.38" $276.85 "$1,328.38" "$1,350.95" $785.74 "$1,328.38" "$1,350.95" "$1,328.38" "$1,328.38" $996.38 "$1,328.38" "$1,328.38" "$1,328.38" $664.19 $664.19 "$1,052.08" "$1,328.38" "$1,062.70" $597.77 $263.65 N/A $770.53 "$1,328.38" $797.03 "$1,328.38" $276.83 "$1,328.38" N/A N/A 424.65 SUP HCPCS C1713 424.65 - PLATE BONE NARROW 4.5MM 268MM 15 HOLE LC-DCP TITANIUM BOTH IP/OP $545.00 $403.00 $108.08 $544.53 $245.04 $245.04 $245.04 $245.04 $544.53 $544.53 $544.53 $113.49 $544.53 $544.53 $544.53 $544.53 $544.53 $113.49 $544.53 $217.81 $322.09 $544.53 $544.53 $544.53 $544.53 $408.75 $544.53 $544.53 $544.53 $272.27 $272.27 $431.27 $544.53 $435.62 $245.04 $108.08 N/A $316.10 $544.53 $326.72 $544.53 $113.48 $544.53 N/A N/A 424.651 SUP HCPCS C1713 424.651 - PLATE BONE NARROW 278MM 15 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,445.50" "$1,070.00" $286.81 "$1,469.63" $650.27 $650.27 $650.27 $650.27 "$1,445.05" "$1,445.05" "$1,445.05" $301.18 "$1,445.05" "$1,445.05" "$1,445.05" "$1,445.05" "$1,445.05" $301.16 "$1,445.05" $587.85 $854.75 "$1,445.05" "$1,469.63" "$1,445.05" "$1,445.05" "$1,084.13" "$1,445.05" "$1,445.05" "$1,445.05" $722.53 $722.53 "$1,144.48" "$1,445.05" "$1,156.04" $650.27 $286.81 N/A $838.39 "$1,445.05" $867.03 "$1,445.05" $301.15 "$1,445.05" N/A N/A 424.66 SUP HCPCS C1713 424.66 - PLATE BONE NARROW 4.5MM 286MM 16 HOLE LC-DCP TITANIUM BOTH IP/OP $545.00 $403.00 $108.08 $544.53 $245.04 $245.04 $245.04 $245.04 $544.53 $544.53 $544.53 $113.49 $544.53 $544.53 $544.53 $544.53 $544.53 $113.49 $544.53 $217.81 $322.09 $544.53 $544.53 $544.53 $544.53 $408.75 $544.53 $544.53 $544.53 $272.27 $272.27 $431.27 $544.53 $435.62 $245.04 $108.08 N/A $316.10 $544.53 $326.72 $544.53 $113.48 $544.53 N/A N/A 424.661 SUP HCPCS C1713 424.661 - PLATE BONE NARROW 296MM 16 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,553.50" "$1,150.00" $308.29 "$1,579.70" $698.99 $698.99 $698.99 $698.99 "$1,553.30" "$1,553.30" "$1,553.30" $323.75 "$1,553.30" "$1,553.30" "$1,553.30" "$1,553.30" "$1,553.30" $323.72 "$1,553.30" "$1,579.70" $918.78 "$1,553.30" "$1,579.70" "$1,553.30" "$1,553.30" "$1,165.13" "$1,553.30" "$1,553.30" "$1,553.30" $776.65 $776.65 "$1,230.21" "$1,553.30" "$1,242.64" $698.99 $308.29 N/A $901.03 "$1,553.30" $931.98 "$1,553.30" $323.71 "$1,553.30" N/A N/A 424.67 SUP HCPCS C1713 424.67 - PLATE BONE NARROW 4.5MM 305MM 17 HOLE LC-DCP TITANIUM BOTH IP/OP $800.00 $592.00 $158.73 $799.75 $359.89 $359.89 $359.89 $359.89 $799.75 $799.75 $799.75 $166.69 $799.75 $799.75 $799.75 $799.75 $799.75 $166.68 $799.75 $319.90 $473.05 $799.75 $799.75 $799.75 $799.75 $600.00 $799.75 $799.75 $799.75 $399.88 $399.88 $633.40 $799.75 $639.80 $359.89 $158.73 N/A $464.00 $799.75 $799.75 $799.75 $166.67 $799.75 N/A N/A 424.68 SUP HCPCS C1713 424.68 - PLATE BONE NARROW 4.5MM 323MM 18 HOLE LC-DCP TITANIUM BOTH IP/OP $800.00 $592.00 $158.73 $799.75 $359.89 $359.89 $359.89 $359.89 $799.75 $799.75 $799.75 $166.69 $799.75 $799.75 $799.75 $799.75 $799.75 $166.68 $799.75 $799.75 $473.05 $799.75 $799.75 $799.75 $799.75 $600.00 $799.75 $799.75 $799.75 $399.88 $399.88 $633.40 $799.75 $639.80 $359.89 $158.73 N/A $464.00 $799.75 $799.75 $799.75 $166.67 $799.75 N/A N/A 424.681 SUP HCPCS C1713 424.681 - PLATE BONE NARROW 332MM 18 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,825.00" "$1,351.00" $362.14 "$1,855.63" $821.07 $821.07 $821.07 $821.07 "$1,824.60" "$1,824.60" "$1,824.60" $380.29 "$1,824.60" "$1,824.60" "$1,824.60" "$1,824.60" "$1,824.60" $380.27 "$1,824.60" $742.25 "$1,079.25" "$1,824.60" "$1,855.63" "$1,824.60" "$1,824.60" "$1,368.75" "$1,824.60" "$1,824.60" "$1,824.60" $912.30 $912.30 "$1,445.08" "$1,824.60" "$1,459.68" $821.07 $362.14 N/A "$1,058.50" "$1,824.60" "$1,094.76" "$1,824.60" $380.25 "$1,824.60" N/A N/A 424.7 SUP HCPCS C1713 424.70 - PLATE BONE NARROW 358X13.5X4.2MM 20 HOLE LC-DCP TITANIUM BOTH IP/OP "$1,123.50" $831.00 $222.93 "$1,123.20" $505.44 $505.44 $505.44 $505.44 "$1,123.20" "$1,123.20" "$1,123.20" $234.10 "$1,123.20" "$1,123.20" "$1,123.20" "$1,123.20" "$1,123.20" $234.09 "$1,123.20" $449.28 $664.37 "$1,123.20" "$1,123.20" "$1,123.20" "$1,123.20" $842.63 "$1,123.20" "$1,123.20" "$1,123.20" $561.60 $561.60 $889.57 "$1,123.20" $898.56 $505.44 $222.93 N/A $651.63 "$1,123.20" $673.92 "$1,123.20" "$1,123.20" "$1,123.20" N/A N/A 424.701 SUP HCPCS C1713 424.701 - PLATE BONE NARROW 368MM 20 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$2,319.50" "$1,716.00" $460.34 "$2,358.83" "$1,043.73" "$1,043.73" "$1,043.73" "$1,043.73" "$2,319.40" "$2,319.40" "$2,319.40" $483.42 "$2,319.40" "$2,319.40" "$2,319.40" "$2,319.40" "$2,319.40" $483.39 "$2,319.40" "$2,358.83" "$1,371.93" "$2,319.40" "$2,358.83" "$2,319.40" "$2,319.40" "$1,739.63" "$2,319.40" "$2,319.40" "$2,319.40" "$1,159.70" "$1,159.70" "$1,836.96" "$2,319.40" "$1,855.52" "$1,043.73" $460.34 N/A "$1,345.31" "$2,319.40" "$1,391.64" "$2,319.40" "$2,319.40" "$2,319.40" N/A N/A 424.72 SUP HCPCS C1713 424.72 - PLATE BONE NARROW 394MM 22 HOLE LC-DCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,209.50" $895.00 $239.99 "$1,209.18" $544.13 $544.13 $544.13 $544.13 "$1,209.18" "$1,209.18" "$1,209.18" $252.02 "$1,209.18" "$1,209.18" "$1,209.18" "$1,209.18" "$1,209.18" $252.01 "$1,209.18" "$1,209.18" $715.23 "$1,209.18" "$1,209.18" "$1,209.18" "$1,209.18" $907.13 "$1,209.18" "$1,209.18" "$1,209.18" $604.59 $604.59 $957.67 "$1,209.18" $967.34 $544.13 $239.99 N/A $701.51 "$1,209.18" "$1,209.18" "$1,209.18" $251.99 "$1,209.18" N/A N/A 424.721 SUP HCPCS C1713 424.721 - PLATE BONE NARROW 404MM 22 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$2,533.50" "$1,875.00" $502.75 "$2,576.10" "$1,139.87" "$1,139.87" "$1,139.87" "$1,139.87" "$2,533.05" "$2,533.05" "$2,533.05" $527.95 "$2,533.05" "$2,533.05" "$2,533.05" "$2,533.05" "$2,533.05" $527.92 "$2,533.05" "$1,030.44" "$1,248.79" "$2,533.05" "$2,576.10" "$2,533.05" "$2,533.05" "$1,900.13" "$2,533.05" "$2,533.05" "$2,533.05" "$1,266.53" "$1,266.53" "$2,006.18" "$2,533.05" "$2,026.44" "$1,139.87" $502.75 N/A "$1,469.43" "$2,533.05" "$2,533.05" "$2,533.05" "$2,533.05" "$2,533.05" N/A N/A 424.753 SUP HCPCS C1713 424.753 - PLATE BONE 118MM 3/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$1,778.50" "$1,316.00" $352.93 "$1,808.43" $800.19 $800.19 $800.19 $800.19 "$1,778.20" "$1,778.20" "$1,778.20" $370.62 "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" $370.60 "$1,778.20" $723.37 "$1,051.81" "$1,778.20" "$1,808.43" "$1,778.20" "$1,778.20" "$1,333.88" "$1,778.20" "$1,778.20" "$1,778.20" $889.10 $889.10 "$1,408.33" "$1,778.20" "$1,422.56" $800.19 $352.93 N/A "$1,031.53" "$1,778.20" "$1,066.92" "$1,778.20" "$1,778.20" "$1,778.20" N/A N/A 424.754 SUP HCPCS C1713 424.754 - PLATE BONE 136MM 4/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$1,808.00" "$1,338.00" $358.79 "$1,838.45" $813.48 $813.48 $813.48 $813.48 "$1,807.73" "$1,807.73" "$1,807.73" $376.78 "$1,807.73" "$1,807.73" "$1,807.73" "$1,807.73" "$1,807.73" $376.75 "$1,807.73" $735.38 "$1,069.27" "$1,807.73" "$1,838.45" "$1,807.73" "$1,807.73" "$1,356.00" "$1,807.73" "$1,807.73" "$1,807.73" $903.87 $903.87 "$1,431.72" "$1,807.73" "$1,446.18" $813.48 $358.79 N/A "$1,048.64" "$1,807.73" "$1,084.64" "$1,807.73" "$1,807.73" "$1,807.73" N/A N/A 424.755 SUP HCPCS C1713 424.755 - PLATE BONE 154MM 5/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$1,837.50" "$1,360.00" $364.65 "$1,868.48" $826.76 $826.76 $826.76 $826.76 "$1,837.25" "$1,837.25" "$1,837.25" $382.93 "$1,837.25" "$1,837.25" "$1,837.25" "$1,837.25" "$1,837.25" $382.90 "$1,837.25" $747.39 "$1,086.73" "$1,837.25" "$1,868.48" "$1,837.25" "$1,837.25" "$1,378.13" "$1,837.25" "$1,837.25" "$1,837.25" $918.63 $918.63 "$1,455.10" "$1,837.25" "$1,469.80" $826.76 $364.65 N/A "$1,065.75" "$1,837.25" "$1,102.35" "$1,837.25" $382.88 "$1,837.25" N/A N/A 424.756 SUP HCPCS C1713 424.756 - PLATE BONE 172MM 6/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$1,868.50" "$1,383.00" $370.79 "$1,899.93" $840.68 $840.68 $840.68 $840.68 "$1,868.18" "$1,868.18" "$1,868.18" $389.38 "$1,868.18" "$1,868.18" "$1,868.18" "$1,868.18" "$1,868.18" $389.35 "$1,868.18" $759.97 "$1,105.03" "$1,868.18" "$1,899.93" "$1,868.18" "$1,868.18" "$1,401.38" "$1,868.18" "$1,868.18" "$1,868.18" $934.09 $934.09 "$1,479.60" "$1,868.18" "$1,494.54" $840.68 $370.79 N/A "$1,083.73" "$1,868.18" "$1,120.91" "$1,868.18" $389.33 "$1,868.18" N/A N/A 424.757 SUP HCPCS C1713 424.757 - PLATE BONE 190MM 7/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$2,411.00" "$1,784.00" $478.48 "$2,451.75" "$1,084.85" "$1,084.85" "$1,084.85" "$1,084.85" "$2,410.78" "$2,410.78" "$2,410.78" $502.47 "$2,410.78" "$2,410.78" "$2,410.78" "$2,410.78" "$2,410.78" $502.43 "$2,410.78" $980.70 "$1,425.98" "$2,410.78" "$2,451.75" "$2,410.78" "$2,410.78" "$1,808.25" "$2,410.78" "$2,410.78" "$2,410.78" "$1,205.39" "$1,205.39" "$1,909.34" "$2,410.78" "$1,928.62" "$1,084.85" $478.48 N/A "$1,398.38" "$2,410.78" "$1,446.47" "$2,410.78" $502.41 "$2,410.78" N/A N/A 424.758 SUP HCPCS C1713 424.758 - PLATE BONE 208MM 8/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$2,436.50" "$1,803.00" $483.50 "$2,477.50" "$1,096.24" "$1,096.24" "$1,096.24" "$1,096.24" "$2,436.08" "$2,436.08" "$2,436.08" $507.74 "$2,436.08" "$2,436.08" "$2,436.08" "$2,436.08" "$2,436.08" $507.71 "$2,436.08" $991.00 "$1,440.94" "$2,436.08" "$2,477.50" "$2,436.08" "$2,436.08" "$1,827.38" "$2,436.08" "$2,436.08" "$2,436.08" "$1,218.04" "$1,218.04" "$1,929.38" "$2,436.08" "$1,948.86" "$1,096.24" $483.50 N/A "$1,413.17" "$2,436.08" "$1,461.65" "$2,436.08" $507.68 "$2,436.08" N/A N/A 424.759 SUP HCPCS C1713 424.759 - PLATE BONE 226MM 9/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$2,489.50" "$1,842.00" $494.10 "$2,531.80" "$1,120.27" "$1,120.27" "$1,120.27" "$1,120.27" "$2,489.48" "$2,489.48" "$2,489.48" $518.87 "$2,489.48" "$2,489.48" "$2,489.48" "$2,489.48" "$2,489.48" $518.84 "$2,489.48" "$1,012.72" "$1,472.53" "$2,489.48" "$2,531.80" "$2,489.48" "$2,489.48" "$1,867.13" "$2,489.48" "$2,489.48" "$2,489.48" "$1,244.74" "$1,244.74" "$1,971.67" "$2,489.48" "$1,991.58" "$1,120.27" $494.10 N/A "$1,443.91" "$2,489.48" "$1,493.69" "$2,489.48" $518.81 "$2,489.48" N/A N/A 424.761 SUP HCPCS C1713 424.761 - PLATE BONE 262MM 11/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$2,543.00" "$1,882.00" $504.70 "$2,586.13" "$1,144.31" "$1,144.31" "$1,144.31" "$1,144.31" "$2,542.90" "$2,542.90" "$2,542.90" $530.00 "$2,542.90" "$2,542.90" "$2,542.90" "$2,542.90" "$2,542.90" $529.97 "$2,542.90" "$1,034.45" "$1,253.65" "$2,542.90" "$2,586.13" "$2,542.90" "$2,542.90" "$1,907.25" "$2,542.90" "$2,542.90" "$2,542.90" "$1,271.45" "$1,271.45" "$2,013.98" "$2,542.90" "$2,034.32" "$1,144.31" $504.70 N/A "$1,474.94" "$2,542.90" "$1,525.74" "$2,542.90" "$2,542.90" "$2,542.90" N/A N/A 424.763 SUP HCPCS C1713 424.763 - PLATE BONE 298MM 13/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$2,591.00" "$1,917.00" $514.19 "$2,634.75" "$1,165.82" "$1,165.82" "$1,165.82" "$1,165.82" "$2,590.70" "$2,590.70" "$2,590.70" $539.97 "$2,590.70" "$2,590.70" "$2,590.70" "$2,590.70" "$2,590.70" $539.93 "$2,590.70" "$1,053.90" "$1,277.22" "$2,590.70" "$2,634.75" "$2,590.70" "$2,590.70" "$1,943.25" "$2,590.70" "$2,590.70" "$2,590.70" "$1,295.35" "$1,295.35" "$2,051.83" "$2,590.70" "$2,072.56" "$1,165.82" $514.19 N/A "$1,502.78" "$2,590.70" "$2,590.70" "$2,590.70" "$2,590.70" "$2,590.70" N/A N/A 424.765 SUP HCPCS C1713 424.765 - PLATE BONE 334MM 15/5 HOLE LCP TITANIUM METAPHYSEAL NONSTRL BOTH IP/OP "$2,709.00" "$2,005.00" $537.63 "$2,754.83" "$1,218.95" "$1,218.95" "$1,218.95" "$1,218.95" "$2,708.78" "$2,708.78" "$2,708.78" $564.58 "$2,708.78" "$2,708.78" "$2,708.78" "$2,708.78" "$2,708.78" $564.54 "$2,708.78" "$2,754.83" "$1,335.43" "$2,708.78" "$2,754.83" "$2,708.78" "$2,708.78" "$2,031.75" "$2,708.78" "$2,708.78" "$2,708.78" "$1,354.39" "$1,354.39" "$2,145.35" "$2,708.78" "$2,167.02" "$1,218.95" $537.63 N/A "$1,571.22" "$2,708.78" "$1,625.27" "$2,708.78" "$2,708.78" "$2,708.78" N/A N/A 426.56 SUP HCPCS C1713 426.56 - PLATE BONE BROAD 106X17.5X5.2MM 6 HOLE LC-DCP TITANIUM LONG BOTH IP/OP $489.00 $362.00 $96.97 $488.58 $219.86 $219.86 $219.86 $219.86 $488.58 $488.58 $488.58 $101.83 $488.58 $488.58 $488.58 $488.58 $488.58 $101.83 $488.58 $488.58 $289.00 $488.58 $488.58 $488.58 $488.58 $366.75 $488.58 $488.58 $488.58 $244.29 $244.29 $386.96 $488.58 $390.86 $219.86 $96.97 N/A $283.62 $488.58 $488.58 $488.58 $101.82 $488.58 N/A N/A 426.561 SUP HCPCS C1713 426.561 - PLATE BONE BROAD 116MM 6 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP $784.50 $581.00 $155.68 $797.70 $352.97 $352.97 $352.97 $352.97 $784.38 $784.38 $784.38 $163.48 $784.38 $784.38 $784.38 $784.38 $784.38 $163.47 $784.38 $797.70 $463.96 $784.38 $797.70 $784.38 $784.38 $588.38 $784.38 $784.38 $784.38 $392.19 $392.19 $621.23 $784.38 $627.50 $352.97 $155.68 N/A $455.01 $784.38 $784.38 $784.38 $163.46 $784.38 N/A N/A 426.57 SUP HCPCS C1713 426.57 - PLATE BONE BROAD 124X17.5X5.2MM 7 HOLE LC-DCP TITANIUM LONG BOTH IP/OP $530.00 $392.00 $105.10 $529.53 $238.29 $238.29 $238.29 $238.29 $529.53 $529.53 $529.53 $110.37 $529.53 $529.53 $529.53 $529.53 $529.53 $110.36 $529.53 $529.53 $313.22 $529.53 $529.53 $529.53 $529.53 $397.50 $529.53 $529.53 $529.53 $264.77 $264.77 $419.39 $529.53 $423.62 $238.29 $105.10 N/A $307.40 $529.53 $529.53 $529.53 $529.53 $529.53 N/A N/A 426.571 SUP HCPCS C1713 426.571 - PLATE BONE BROAD 134MM 7 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP $834.00 $617.00 $165.44 $847.75 $375.11 $375.11 $375.11 $375.11 $833.58 $833.58 $833.58 $173.74 $833.58 $833.58 $833.58 $833.58 $833.58 $173.73 $833.58 $847.75 $493.06 $833.58 $847.75 $833.58 $833.58 $625.50 $833.58 $833.58 $833.58 $416.79 $416.79 $660.20 $833.58 $666.86 $375.11 $165.44 N/A $483.72 $833.58 $833.58 $833.58 $173.72 $833.58 N/A N/A 426.58 SUP HCPCS C1713 426.58 - PLATE BONE BROAD 3.5MM 142X17.5X5.2MM 8 HOLE LC-DCP TITANIUM BOTH IP/OP $588.50 $435.00 $116.74 $588.20 $264.69 $264.69 $264.69 $264.69 $588.20 $588.20 $588.20 $122.60 $588.20 $588.20 $588.20 $588.20 $588.20 $122.59 $588.20 $588.20 $347.92 $588.20 $588.20 $588.20 $588.20 $441.38 $588.20 $588.20 $588.20 $294.10 $294.10 $465.85 $588.20 $470.56 $264.69 $116.74 N/A $341.33 $588.20 $352.92 $588.20 $122.58 $588.20 N/A N/A 426.581 SUP HCPCS C1713 426.581 - PLATE BONE BROAD 152MM 8 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,019.50" $754.00 $202.27 "$1,036.45" $458.61 $458.61 $458.61 $458.61 "$1,019.13" "$1,019.13" "$1,019.13" $212.41 "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" $212.40 "$1,019.13" "$1,036.45" $602.82 "$1,019.13" "$1,036.45" "$1,019.13" "$1,019.13" $764.63 "$1,019.13" "$1,019.13" "$1,019.13" $509.57 $509.57 $807.15 "$1,019.13" $815.30 $458.61 $202.27 N/A $591.31 "$1,019.13" $611.48 "$1,019.13" $212.39 "$1,019.13" N/A N/A 426.59 SUP HCPCS C1713 426.59 - PLATE BONE BROAD 160X17.5X5.2MM 9 HOLE LC-DCP TITANIUM LONG BOTH IP/OP $606.00 $448.00 $120.25 $616.15 $272.63 $272.63 $272.63 $272.63 $605.85 $605.85 $605.85 $126.27 $605.85 $605.85 $605.85 $605.85 $605.85 $126.27 $605.85 $246.46 $358.36 $605.85 $616.15 $605.85 $605.85 $454.50 $605.85 $605.85 $605.85 $302.93 $302.93 $479.83 $605.85 $484.68 $272.63 $120.25 N/A $351.48 $605.85 $363.51 $605.85 $126.26 $605.85 N/A N/A 426.591 SUP HCPCS C1713 426.591 - PLATE BONE BROAD 170MM 9 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,102.50" $816.00 $218.74 "$1,120.80" $495.94 $495.94 $495.94 $495.94 "$1,102.08" "$1,102.08" "$1,102.08" $229.70 "$1,102.08" "$1,102.08" "$1,102.08" "$1,102.08" "$1,102.08" $229.69 "$1,102.08" $448.32 $651.88 "$1,102.08" "$1,120.80" "$1,102.08" "$1,102.08" $826.88 "$1,102.08" "$1,102.08" "$1,102.08" $551.04 $551.04 $872.85 "$1,102.08" $881.66 $495.94 $218.74 N/A $639.45 "$1,102.08" $661.25 "$1,102.08" $229.67 "$1,102.08" N/A N/A 426.6 SUP HCPCS C1713 426.60 - PLATE BONE BROAD 178X17.5X5.2MM 10 HOLE LC-DCP TITANIUM LONG BOTH IP/OP $588.50 $435.00 $116.74 $588.20 $264.69 $264.69 $264.69 $264.69 $588.20 $588.20 $588.20 $122.60 $588.20 $588.20 $588.20 $588.20 $588.20 $122.59 $588.20 $235.28 $347.92 $588.20 $588.20 $588.20 $588.20 $441.38 $588.20 $588.20 $588.20 $294.10 $294.10 $465.85 $588.20 $470.56 $264.69 $116.74 N/A $341.33 $588.20 $352.92 $588.20 $588.20 $588.20 N/A N/A 426.601 SUP HCPCS C1713 426.601 - PLATE BONE BROAD 188MM 10 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,185.00" $877.00 $235.19 "$1,205.15" $533.25 $533.25 $533.25 $533.25 "$1,185.00" "$1,185.00" "$1,185.00" $246.98 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $482.06 $700.93 "$1,185.00" "$1,205.15" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 $235.19 N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 426.61 SUP HCPCS C1713 426.61 - PLATE BONE BROAD 196X17.5X5.2MM 11 HOLE LC-DCP TITANIUM LONG BOTH IP/OP $615.50 $455.00 $122.16 $615.50 $276.98 $276.98 $276.98 $276.98 $615.50 $615.50 $615.50 $128.29 $615.50 $615.50 $615.50 $615.50 $615.50 $128.28 $615.50 $615.50 $364.07 $615.50 $615.50 $615.50 $615.50 $461.63 $615.50 $615.50 $615.50 $307.75 $307.75 $487.48 $615.50 $492.40 $276.98 $122.16 N/A $356.99 $615.50 $369.30 $615.50 $128.27 $615.50 N/A N/A 426.611 SUP HCPCS C1713 426.611 - PLATE BONE BROAD 206MM 11 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,262.50" $934.00 $250.53 "$1,283.75" $568.04 $568.04 $568.04 $568.04 "$1,262.30" "$1,262.30" "$1,262.30" $263.09 "$1,262.30" "$1,262.30" "$1,262.30" "$1,262.30" "$1,262.30" $263.08 "$1,262.30" $513.50 $746.65 "$1,262.30" "$1,283.75" "$1,262.30" "$1,262.30" $946.88 "$1,262.30" "$1,262.30" "$1,262.30" $631.15 $631.15 $999.74 "$1,262.30" "$1,009.84" $568.04 $250.53 N/A $732.25 "$1,262.30" "$1,262.30" "$1,262.30" $263.06 "$1,262.30" N/A N/A 426.62 SUP HCPCS C1713 426.62 - PLATE BONE BROAD 214X17.5X5.2MM 12 HOLE LC-DCP TITANIUM LONG BOTH IP/OP $634.00 $469.00 $125.83 $644.75 $285.29 $285.29 $285.29 $285.29 $633.98 $633.98 $633.98 $132.14 $633.98 $633.98 $633.98 $633.98 $633.98 $132.13 $633.98 $257.90 $375.00 $633.98 $644.75 $633.98 $633.98 $475.50 $633.98 $633.98 $633.98 $316.99 $316.99 $502.11 $633.98 $507.18 $285.29 $125.83 N/A $367.72 $633.98 $633.98 $633.98 $132.12 $633.98 N/A N/A 426.621 SUP HCPCS C1713 426.621 - PLATE BONE BROAD 224MM 12 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,340.00" $992.00 $265.88 "$1,362.40" $602.83 $602.83 $602.83 $602.83 "$1,339.63" "$1,339.63" "$1,339.63" $279.21 "$1,339.63" "$1,339.63" "$1,339.63" "$1,339.63" "$1,339.63" $279.19 "$1,339.63" $544.96 $792.39 "$1,339.63" "$1,362.40" "$1,339.63" "$1,339.63" "$1,005.00" "$1,339.63" "$1,339.63" "$1,339.63" $669.82 $669.82 "$1,060.99" "$1,339.63" "$1,071.70" $602.83 $265.88 N/A $777.20 "$1,339.63" "$1,339.63" "$1,339.63" "$1,339.63" "$1,339.63" N/A N/A 426.622 SUP HCPCS C1713 426.622 - PLATE BONE BROAD 229MM 12 HOLE CVD LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,340.00" $992.00 $265.88 "$1,362.40" $602.83 $602.83 $602.83 $602.83 "$1,339.63" "$1,339.63" "$1,339.63" $279.21 "$1,339.63" "$1,339.63" "$1,339.63" "$1,339.63" "$1,339.63" $279.19 "$1,339.63" $544.96 $792.39 "$1,339.63" "$1,362.40" "$1,339.63" "$1,339.63" "$1,005.00" "$1,339.63" "$1,339.63" "$1,339.63" $669.82 $669.82 "$1,060.99" "$1,339.63" "$1,071.70" $602.83 $265.88 N/A $777.20 "$1,339.63" "$1,339.63" "$1,339.63" "$1,339.63" "$1,339.63" N/A N/A 426.632 SUP HCPCS C1713 426.632 - PLATE BONE BROAD 247MM 13 HOLE CVD LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,420.00" "$1,051.00" $281.78 "$1,443.88" $638.89 $638.89 $638.89 $638.89 "$1,419.75" "$1,419.75" "$1,419.75" $295.91 "$1,419.75" "$1,419.75" "$1,419.75" "$1,419.75" "$1,419.75" $295.89 "$1,419.75" $577.55 $839.78 "$1,419.75" "$1,443.88" "$1,419.75" "$1,419.75" "$1,065.00" "$1,419.75" "$1,419.75" "$1,419.75" $709.88 $709.88 "$1,124.44" "$1,419.75" "$1,135.80" $638.89 $281.78 N/A $823.60 "$1,419.75" "$1,419.75" "$1,419.75" $295.88 "$1,419.75" N/A N/A 426.64 SUP HCPCS C1713 426.64 - PLATE BONE BROAD 4.5MM 250X17.5X5.2MM 14 HOLE LC-DCP BOTH IP/OP $615.00 $455.00 $122.02 $614.80 $276.66 $276.66 $276.66 $276.66 $614.80 $614.80 $614.80 $128.14 $614.80 $614.80 $614.80 $614.80 $614.80 $128.13 $614.80 $245.92 $363.65 $614.80 $614.80 $614.80 $614.80 $461.25 $614.80 $614.80 $614.80 $307.40 $307.40 $486.92 $614.80 $491.84 $276.66 $122.02 N/A $356.70 $614.80 $368.88 $614.80 $128.12 $614.80 N/A N/A 426.641 SUP HCPCS C1713 426.641 - PLATE BONE BROAD 260MM 14 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,491.50" "$1,104.00" $296.02 "$1,516.80" $671.15 $671.15 $671.15 $671.15 "$1,491.45" "$1,491.45" "$1,491.45" $310.86 "$1,491.45" "$1,491.45" "$1,491.45" "$1,491.45" "$1,491.45" $310.83 "$1,491.45" $606.72 $882.19 "$1,491.45" "$1,516.80" "$1,491.45" "$1,491.45" "$1,118.63" "$1,491.45" "$1,491.45" "$1,491.45" $745.73 $745.73 "$1,181.23" "$1,491.45" "$1,193.16" $671.15 $296.02 N/A $865.07 "$1,491.45" $894.87 "$1,491.45" $310.82 "$1,491.45" N/A N/A 426.642 SUP HCPCS C1713 426.642 - PLATE BONE BROAD CVD 265MM 14 HOLE LCP TITANIUM ANKLE BOTH IP/OP "$1,491.50" "$1,104.00" $296.02 "$1,516.80" $671.15 $671.15 $671.15 $671.15 "$1,491.45" "$1,491.45" "$1,491.45" $310.86 "$1,491.45" "$1,491.45" "$1,491.45" "$1,491.45" "$1,491.45" $310.83 "$1,491.45" "$1,516.80" $882.19 "$1,491.45" "$1,516.80" "$1,491.45" "$1,491.45" "$1,118.63" "$1,491.45" "$1,491.45" "$1,491.45" $745.73 $745.73 "$1,181.23" "$1,491.45" "$1,193.16" $671.15 $296.02 N/A $865.07 "$1,491.45" $894.87 "$1,491.45" "$1,491.45" "$1,491.45" N/A N/A 426.652 SUP HCPCS C1713 426.652 - PLATE BONE BROAD 282MM 15 HOLE CVD LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,656.00" "$1,225.00" $328.65 "$1,684.05" $745.16 $745.16 $745.16 $745.16 "$1,655.90" "$1,655.90" "$1,655.90" $345.13 "$1,655.90" "$1,655.90" "$1,655.90" "$1,655.90" "$1,655.90" $345.11 "$1,655.90" $673.62 $979.46 "$1,655.90" "$1,684.05" "$1,655.90" "$1,655.90" "$1,242.00" "$1,655.90" "$1,655.90" "$1,655.90" $827.95 $827.95 "$1,311.47" "$1,655.90" "$1,324.72" $745.16 $328.65 N/A $960.48 "$1,655.90" "$1,655.90" "$1,655.90" "$1,655.90" "$1,655.90" N/A N/A 426.66 SUP HCPCS C1713 426.66 - PLATE BONE BROAD 286X17.5X5.2MM 16 HOLE LC-DCP TITANIUM LONG BOTH IP/OP $696.50 $515.00 $138.14 $696.03 $313.21 $313.21 $313.21 $313.21 $696.03 $696.03 $696.03 $145.07 $696.03 $696.03 $696.03 $696.03 $696.03 $145.06 $696.03 $278.41 $411.70 $696.03 $696.03 $696.03 $696.03 $522.38 $696.03 $696.03 $696.03 $348.02 $348.02 $551.26 $696.03 $556.82 $313.21 $138.14 N/A $403.97 $696.03 $696.03 $696.03 $696.03 $696.03 N/A N/A 426.661 SUP HCPCS C1713 426.661 - PLATE BONE BROAD 296MM 16 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,812.00" "$1,341.00" $359.63 "$1,842.75" $815.38 $815.38 $815.38 $815.38 "$1,811.95" "$1,811.95" "$1,811.95" $377.66 "$1,811.95" "$1,811.95" "$1,811.95" "$1,811.95" "$1,811.95" $377.63 "$1,811.95" $737.10 "$1,071.77" "$1,811.95" "$1,842.75" "$1,811.95" "$1,811.95" "$1,359.00" "$1,811.95" "$1,811.95" "$1,811.95" $905.98 $905.98 "$1,435.06" "$1,811.95" "$1,449.56" $815.38 $359.63 N/A "$1,050.96" "$1,811.95" "$1,811.95" "$1,811.95" "$1,811.95" "$1,811.95" N/A N/A 426.662 SUP HCPCS C1713 426.662 - PLATE BONE BROAD 300MM 16 HOLE CVD LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,812.00" "$1,341.00" $359.63 "$1,842.75" $815.38 $815.38 $815.38 $815.38 "$1,811.95" "$1,811.95" "$1,811.95" $377.66 "$1,811.95" "$1,811.95" "$1,811.95" "$1,811.95" "$1,811.95" $377.63 "$1,811.95" "$1,842.75" "$1,071.77" "$1,811.95" "$1,842.75" "$1,811.95" "$1,811.95" "$1,359.00" "$1,811.95" "$1,811.95" "$1,811.95" $905.98 $905.98 "$1,435.06" "$1,811.95" "$1,449.56" $815.38 $359.63 N/A "$1,050.96" "$1,811.95" "$1,811.95" "$1,811.95" "$1,811.95" "$1,811.95" N/A N/A 426.672 SUP HCPCS C1713 426.672 - PLATE BONE BROAD 318MM 17 HOLE CVD LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,898.00" "$1,405.00" $376.64 "$1,929.93" $853.96 $853.96 $853.96 $853.96 "$1,897.68" "$1,897.68" "$1,897.68" $395.52 "$1,897.68" "$1,897.68" "$1,897.68" "$1,897.68" "$1,897.68" $395.50 "$1,897.68" "$1,929.93" "$1,122.48" "$1,897.68" "$1,929.93" "$1,897.68" "$1,897.68" "$1,423.50" "$1,897.68" "$1,897.68" "$1,897.68" $948.84 $948.84 "$1,502.96" "$1,897.68" "$1,518.14" $853.96 $376.64 N/A "$1,100.84" "$1,897.68" "$1,897.68" "$1,897.68" $395.48 "$1,897.68" N/A N/A 426.68 SUP HCPCS C1713 426.68 - PLATE BONE BROAD 4.5MM 322X17.5X5.2MM 18 HOLE LC-DCP BOTH IP/OP $789.00 $584.00 $156.52 $802.00 $354.87 $354.87 $354.87 $354.87 $788.60 $788.60 $788.60 $164.36 $788.60 $788.60 $788.60 $788.60 $788.60 $164.35 $788.60 $802.00 $466.46 $788.60 $802.00 $788.60 $788.60 $591.75 $788.60 $788.60 $788.60 $394.30 $394.30 $624.57 $788.60 $630.88 $354.87 $156.52 N/A $457.62 $788.60 $788.60 $788.60 $788.60 $788.60 N/A N/A 426.681 SUP HCPCS C1713 426.681 - PLATE BONE BROAD 332MM 18 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$2,132.50" "$1,578.00" $423.23 "$2,168.68" $959.59 $959.59 $959.59 $959.59 "$2,132.43" "$2,132.43" "$2,132.43" $444.45 "$2,132.43" "$2,132.43" "$2,132.43" "$2,132.43" "$2,132.43" $444.42 "$2,132.43" "$2,168.68" "$1,261.33" "$2,132.43" "$2,168.68" "$2,132.43" "$2,132.43" "$1,599.38" "$2,132.43" "$2,132.43" "$2,132.43" "$1,066.22" "$1,066.22" "$1,688.88" "$2,132.43" "$1,705.94" $959.59 $423.23 N/A "$1,236.85" "$2,132.43" "$2,132.43" "$2,132.43" "$2,132.43" "$2,132.43" N/A N/A 426.682 SUP HCPCS C1713 426.682 - PLATE BONE BROAD 336MM 18 HOLE CVD LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$2,068.00" "$1,530.00" $410.40 "$2,102.93" $930.50 $930.50 $930.50 $930.50 "$2,067.78" "$2,067.78" "$2,067.78" $430.98 "$2,067.78" "$2,067.78" "$2,067.78" "$2,067.78" "$2,067.78" $430.95 "$2,067.78" $841.17 "$1,223.09" "$2,067.78" "$2,102.93" "$2,067.78" "$2,067.78" "$1,551.00" "$2,067.78" "$2,067.78" "$2,067.78" "$1,033.89" "$1,033.89" "$1,637.68" "$2,067.78" "$1,654.22" $930.50 $410.40 N/A "$1,199.44" "$2,067.78" "$2,067.78" "$2,067.78" "$2,067.78" "$2,067.78" N/A N/A 426.7 SUP HCPCS C1713 426.70 - PLATE BONE BROAD 358X17.5X5.2MM 20 HOLE LC-DCP TITANIUM LONG BOTH IP/OP "$1,123.50" $831.00 $222.93 "$1,123.20" $505.44 $505.44 $505.44 $505.44 "$1,123.20" "$1,123.20" "$1,123.20" $234.10 "$1,123.20" "$1,123.20" "$1,123.20" "$1,123.20" "$1,123.20" $234.09 "$1,123.20" $449.28 $664.37 "$1,123.20" "$1,123.20" "$1,123.20" "$1,123.20" $842.63 "$1,123.20" "$1,123.20" "$1,123.20" $561.60 $561.60 $889.57 "$1,123.20" $898.56 $505.44 $222.93 N/A $651.63 "$1,123.20" "$1,123.20" "$1,123.20" $234.07 "$1,123.20" N/A N/A 426.701 SUP HCPCS C1713 426.701 - PLATE BONE BROAD 368MM 20 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$2,356.00" "$1,743.00" $467.60 "$2,396.00" "$1,060.18" "$1,060.18" "$1,060.18" "$1,060.18" "$2,355.95" "$2,355.95" "$2,355.95" $491.04 "$2,355.95" "$2,355.95" "$2,355.95" "$2,355.95" "$2,355.95" $491.01 "$2,355.95" $958.40 "$1,393.54" "$2,355.95" "$2,396.00" "$2,355.95" "$2,355.95" "$1,767.00" "$2,355.95" "$2,355.95" "$2,355.95" "$1,177.98" "$1,177.98" "$1,865.91" "$2,355.95" "$1,884.76" "$1,060.18" $467.60 N/A "$1,366.48" "$2,355.95" "$2,355.95" "$2,355.95" "$2,355.95" "$2,355.95" N/A N/A 426.72 SUP HCPCS C1713 426.72 - PLATE BONE BROAD 394X17.5X5.2MM 22 HOLE LC-DCP TITANIUM LONG BOTH IP/OP "$1,209.50" $895.00 $239.99 "$1,209.18" $544.13 $544.13 $544.13 $544.13 "$1,209.18" "$1,209.18" "$1,209.18" $252.02 "$1,209.18" "$1,209.18" "$1,209.18" "$1,209.18" "$1,209.18" $252.01 "$1,209.18" $483.67 $715.23 "$1,209.18" "$1,209.18" "$1,209.18" "$1,209.18" $907.13 "$1,209.18" "$1,209.18" "$1,209.18" $604.59 $604.59 $957.67 "$1,209.18" $967.34 $544.13 $239.99 N/A $701.51 "$1,209.18" $725.51 "$1,209.18" $251.99 "$1,209.18" N/A N/A 426.721 SUP HCPCS C1713 426.721 - PLATE BONE BROAD 404MM 22 HOLE LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$2,582.50" "$1,911.00" $512.51 "$2,626.15" "$1,162.01" "$1,162.01" "$1,162.01" "$1,162.01" "$2,582.25" "$2,582.25" "$2,582.25" $538.21 "$2,582.25" "$2,582.25" "$2,582.25" "$2,582.25" "$2,582.25" $538.17 "$2,582.25" "$1,050.46" "$1,273.05" "$2,582.25" "$2,626.15" "$2,582.25" "$2,582.25" "$1,936.88" "$2,582.25" "$2,582.25" "$2,582.25" "$1,291.13" "$1,291.13" "$2,045.14" "$2,582.25" "$2,065.80" "$1,162.01" $512.51 N/A "$1,497.85" "$2,582.25" "$1,549.35" "$2,582.25" "$2,582.25" "$2,582.25" N/A N/A 426.74 SUP HCPCS C1713 426.74 - PLATE BONE BROAD 430X17.5X5.2MM 24 HOLE LC-DCP TITANIUM LONG BOTH IP/OP "$1,295.50" $959.00 $257.05 "$1,295.15" $582.82 $582.82 $582.82 $582.82 "$1,295.15" "$1,295.15" "$1,295.15" $269.94 "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" $269.92 "$1,295.15" $518.06 $766.08 "$1,295.15" "$1,295.15" "$1,295.15" "$1,295.15" $971.63 "$1,295.15" "$1,295.15" "$1,295.15" $647.58 $647.58 "$1,025.76" "$1,295.15" "$1,036.12" $582.82 $257.05 N/A $751.39 "$1,295.15" $777.09 "$1,295.15" $269.91 "$1,295.15" N/A N/A 429 SUP Custom 27203010 000429 - BLOCK BITE LARGE 20MM 27MM MOUTHPIECE STRAP RETENTION RIM BOTH IP/OP $156.50 $116.00 $27.81 $156.25 $156.25 $156.25 $156.25 $156.25 $156.25 $156.25 $27.81 $156.25 $156.25 $115.97 $115.97 $120.44 $81.41 $32.56 $156.25 $62.50 $156.25 $156.25 $156.25 $156.25 $156.25 $117.38 $156.25 $156.25 $156.25 $78.13 $78.13 $123.75 $156.25 $125.00 $101.56 $156.25 N/A $90.77 $156.25 $93.75 $156.25 $156.25 $156.25 N/A N/A 429.331 SUP HCPCS C1713 429.331 - PLATE BONE 56MM 3 HOLE STR RECONSTRUCTION LCP TITANIUM BOTH IP/OP $776.00 $574.00 $154.01 $789.15 $349.18 $349.18 $349.18 $349.18 $775.95 $775.95 $775.95 $161.73 $775.95 $775.95 $775.95 $775.95 $775.95 $161.72 $775.95 $789.15 $458.97 $775.95 $789.15 $775.95 $775.95 $582.00 $775.95 $775.95 $775.95 $387.98 $387.98 $614.55 $775.95 $620.76 $349.18 $154.01 N/A $450.08 $775.95 $775.95 $775.95 $161.71 $775.95 N/A N/A 429.341 SUP HCPCS C1713 429.341 - PLATE BONE 75MM 4 HOLE STR RECONSTRUCTION LCP TITANIUM BOTH IP/OP $812.50 $601.00 $161.26 $826.33 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $330.53 $480.59 $812.50 $826.33 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $812.50 $812.50 N/A N/A 429.351 SUP HCPCS C1713 429.351 - PLATE BONE 94MM 5 HOLE STR RECONSTRUCTION LCP TITANIUM BOTH IP/OP $879.00 $650.00 $174.37 $893.48 $395.35 $395.35 $395.35 $395.35 $878.55 $878.55 $878.55 $183.11 $878.55 $878.55 $878.55 $878.55 $878.55 $183.10 $878.55 $357.39 $519.66 $878.55 $893.48 $878.55 $878.55 $659.25 $878.55 $878.55 $878.55 $439.28 $439.28 $695.81 $878.55 $702.84 $395.35 $174.37 N/A $509.82 $878.55 $527.13 $878.55 $878.55 $878.55 N/A N/A 429.361 SUP HCPCS C1713 429.361 - PLATE BONE 113MM 6 HOLE STR RECONSTRUCTION LCP TITANIUM BOTH IP/OP $938.00 $694.00 $186.09 $953.55 $421.92 $421.92 $421.92 $421.92 $937.60 $937.60 $937.60 $195.42 $937.60 $937.60 $937.60 $937.60 $937.60 $195.41 $937.60 $381.42 $554.59 $937.60 $953.55 $937.60 $937.60 $703.50 $937.60 $937.60 $937.60 $468.80 $468.80 $742.58 $937.60 $750.08 $421.92 $186.09 N/A $544.04 $937.60 $562.56 $937.60 $195.40 $937.60 N/A N/A 429.371 SUP HCPCS C1713 429.371 - PLATE BONE 132MM 7 HOLE STR RECONSTRUCTION LCP TITANIUM BOTH IP/OP $981.50 $726.00 $194.74 $997.85 $441.53 $441.53 $441.53 $441.53 $981.18 $981.18 $981.18 $204.50 $981.18 $981.18 $981.18 $981.18 $981.18 $204.49 $981.18 $399.14 $580.37 $981.18 $997.85 $981.18 $981.18 $736.13 $981.18 $981.18 $981.18 $490.59 $490.59 $777.09 $981.18 $784.94 $441.53 $194.74 N/A $569.27 $981.18 $588.71 $981.18 $204.48 $981.18 N/A N/A 429.381 SUP HCPCS C1713 429.381 - PLATE BONE 151MM 8 HOLE STR RECONSTRUCTION LCP TITANIUM BOTH IP/OP "$1,032.00" $764.00 $204.78 "$1,049.33" $464.30 $464.30 $464.30 $464.30 "$1,031.78" "$1,031.78" "$1,031.78" $215.05 "$1,031.78" "$1,031.78" "$1,031.78" "$1,031.78" "$1,031.78" $215.03 "$1,031.78" "$1,049.33" $610.30 "$1,031.78" "$1,049.33" "$1,031.78" "$1,031.78" $774.00 "$1,031.78" "$1,031.78" "$1,031.78" $515.89 $515.89 $817.17 "$1,031.78" $825.42 $464.30 $204.78 N/A $598.56 "$1,031.78" $619.07 "$1,031.78" $215.02 "$1,031.78" N/A N/A 429.391 SUP HCPCS C1713 429.391 - PLATE BONE 170MM 9 HOLE STR RECONSTRUCTION LCP TITANIUM BOTH IP/OP "$1,105.00" $818.00 $219.29 "$1,123.65" $497.20 $497.20 $497.20 $497.20 "$1,104.88" "$1,104.88" "$1,104.88" $230.28 "$1,104.88" "$1,104.88" "$1,104.88" "$1,104.88" "$1,104.88" $230.27 "$1,104.88" $449.46 $653.54 "$1,104.88" "$1,123.65" "$1,104.88" "$1,104.88" $828.75 "$1,104.88" "$1,104.88" "$1,104.88" $552.44 $552.44 $875.06 "$1,104.88" $883.90 $497.20 $219.29 N/A $640.90 "$1,104.88" $662.93 "$1,104.88" $230.26 "$1,104.88" N/A N/A 429.401 SUP HCPCS C1713 429.401 - PLATE BONE 189MM 10 HOLE STR RECONSTRUCTION LCP TITANIUM BOTH IP/OP "$1,158.50" $857.00 $229.89 "$1,178.00" $521.24 $521.24 $521.24 $521.24 "$1,158.30" "$1,158.30" "$1,158.30" $241.42 "$1,158.30" "$1,158.30" "$1,158.30" "$1,158.30" "$1,158.30" $241.40 "$1,158.30" $471.20 $685.13 "$1,158.30" "$1,178.00" "$1,158.30" "$1,158.30" $868.88 "$1,158.30" "$1,158.30" "$1,158.30" $579.15 $579.15 $917.37 "$1,158.30" $926.64 $521.24 $229.89 N/A $671.93 "$1,158.30" $694.98 "$1,158.30" $241.39 "$1,158.30" N/A N/A 429.411 SUP HCPCS C1713 429.411 - PLATE BONE 208MM 11 HOLE STR RECONSTRUCTION LCP TITANIUM BOTH IP/OP "$1,196.50" $885.00 $237.43 "$1,216.58" $538.31 $538.31 $538.31 $538.31 "$1,196.25" "$1,196.25" "$1,196.25" $249.33 "$1,196.25" "$1,196.25" "$1,196.25" "$1,196.25" "$1,196.25" $249.31 "$1,196.25" $486.63 $707.58 "$1,196.25" "$1,216.58" "$1,196.25" "$1,196.25" $897.38 "$1,196.25" "$1,196.25" "$1,196.25" $598.13 $598.13 $947.43 "$1,196.25" $957.00 $538.31 $237.43 N/A $693.97 "$1,196.25" "$1,196.25" "$1,196.25" "$1,196.25" "$1,196.25" N/A N/A 429.421 SUP HCPCS C1713 429.421 - PLATE BONE 227MM 12 HOLE STR RECONSTRUCTION LCP TITANIUM BOTH IP/OP "$1,254.00" $928.00 $248.86 "$1,275.20" $564.25 $564.25 $564.25 $564.25 "$1,253.88" "$1,253.88" "$1,253.88" $261.34 "$1,253.88" "$1,253.88" "$1,253.88" "$1,253.88" "$1,253.88" $261.32 "$1,253.88" $510.08 $741.67 "$1,253.88" "$1,275.20" "$1,253.88" "$1,253.88" $940.50 "$1,253.88" "$1,253.88" "$1,253.88" $626.94 $626.94 $993.07 "$1,253.88" "$1,003.10" $564.25 $248.86 N/A $727.32 "$1,253.88" "$1,253.88" "$1,253.88" "$1,253.88" "$1,253.88" N/A N/A 429.431 SUP HCPCS C1713 429.431 - PLATE BONE 246MM 13 HOLE STR RECONSTRUCTION LCP TITANIUM BOTH IP/OP "$1,334.00" $987.00 $264.77 "$1,356.68" $600.30 $600.30 $600.30 $600.30 "$1,334.00" "$1,334.00" "$1,334.00" $278.04 "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" "$1,334.00" $278.02 "$1,334.00" $542.67 $789.06 "$1,334.00" "$1,356.68" "$1,334.00" "$1,334.00" "$1,000.50" "$1,334.00" "$1,334.00" "$1,334.00" $667.00 $667.00 "$1,056.53" "$1,334.00" "$1,067.20" $600.30 $264.77 N/A $773.72 "$1,334.00" "$1,334.00" "$1,334.00" $278.01 "$1,334.00" N/A N/A 429.441 SUP HCPCS C1713 429.441 - PLATE BONE 265MM 14 HOLE STR RECONSTRUCTION LCP TITANIUM BOTH IP/OP "$1,371.00" "$1,015.00" $272.02 "$1,393.85" $616.75 $616.75 $616.75 $616.75 "$1,370.55" "$1,370.55" "$1,370.55" $285.66 "$1,370.55" "$1,370.55" "$1,370.55" "$1,370.55" "$1,370.55" $285.64 "$1,370.55" $557.54 $810.68 "$1,370.55" "$1,393.85" "$1,370.55" "$1,370.55" "$1,028.25" "$1,370.55" "$1,370.55" "$1,370.55" $685.28 $685.28 "$1,085.48" "$1,370.55" "$1,096.44" $616.75 $272.02 N/A $795.18 "$1,370.55" "$1,370.55" "$1,370.55" $285.62 "$1,370.55" N/A N/A 429.451 SUP HCPCS C1713 429.451 - PLATE BONE 284MM 15 HOLE STR RECONSTRUCTION LCP TITANIUM BOTH IP/OP "$1,428.50" "$1,057.00" $283.46 "$1,452.45" $642.68 $642.68 $642.68 $642.68 "$1,428.18" "$1,428.18" "$1,428.18" $297.67 "$1,428.18" "$1,428.18" "$1,428.18" "$1,428.18" "$1,428.18" $297.65 "$1,428.18" $580.98 $844.77 "$1,428.18" "$1,452.45" "$1,428.18" "$1,428.18" "$1,071.38" "$1,428.18" "$1,428.18" "$1,428.18" $714.09 $714.09 "$1,131.12" "$1,428.18" "$1,142.54" $642.68 $283.46 N/A $828.53 "$1,428.18" "$1,428.18" "$1,428.18" $297.63 "$1,428.18" N/A N/A 429.461 SUP HCPCS C1713 429.461 - PLATE BONE 303MM 16 HOLE STR RECONSTRUCTION LCP TITANIUM BOTH IP/OP "$1,466.50" "$1,085.00" $290.99 "$1,491.05" $659.76 $659.76 $659.76 $659.76 "$1,466.13" "$1,466.13" "$1,466.13" $305.58 "$1,466.13" "$1,466.13" "$1,466.13" "$1,466.13" "$1,466.13" $305.56 "$1,466.13" "$1,491.05" $867.22 "$1,466.13" "$1,491.05" "$1,466.13" "$1,466.13" "$1,099.88" "$1,466.13" "$1,466.13" "$1,466.13" $733.07 $733.07 "$1,161.17" "$1,466.13" "$1,172.90" $659.76 $290.99 N/A $850.57 "$1,466.13" "$1,466.13" "$1,466.13" $305.54 "$1,466.13" N/A N/A 432.006 SUP HCPCS C1713 432.006 - PLATE BONE 90D 30MM 10 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,929.50" "$1,428.00" $382.90 "$1,929.20" $868.14 $868.14 $868.14 $868.14 "$1,929.20" "$1,929.20" "$1,929.20" $402.09 "$1,929.20" "$1,929.20" "$1,929.20" "$1,929.20" "$1,929.20" $402.07 "$1,929.20" $771.68 "$1,141.12" "$1,929.20" "$1,929.20" "$1,929.20" "$1,929.20" "$1,447.13" "$1,929.20" "$1,929.20" "$1,929.20" $964.60 $964.60 "$1,527.93" "$1,929.20" "$1,543.36" $868.14 $382.90 N/A "$1,119.11" "$1,929.20" "$1,929.20" "$1,929.20" $402.05 "$1,929.20" N/A N/A 432.007 SUP HCPCS C1713 432.007 - PLATE BONE 90D 35MM 10 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,929.50" "$1,428.00" $382.90 "$1,929.20" $868.14 $868.14 $868.14 $868.14 "$1,929.20" "$1,929.20" "$1,929.20" $402.09 "$1,929.20" "$1,929.20" "$1,929.20" "$1,929.20" "$1,929.20" $402.07 "$1,929.20" $771.68 "$1,141.12" "$1,929.20" "$1,929.20" "$1,929.20" "$1,929.20" "$1,447.13" "$1,929.20" "$1,929.20" "$1,929.20" $964.60 $964.60 "$1,527.93" "$1,929.20" "$1,543.36" $868.14 $382.90 N/A "$1,119.11" "$1,929.20" "$1,929.20" "$1,929.20" $402.05 "$1,929.20" N/A N/A 432.008 SUP HCPCS C1713 432.008 - PLATE BONE 90D 40MM 10 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,929.50" "$1,428.00" $382.90 "$1,929.20" $868.14 $868.14 $868.14 $868.14 "$1,929.20" "$1,929.20" "$1,929.20" $402.09 "$1,929.20" "$1,929.20" "$1,929.20" "$1,929.20" "$1,929.20" $402.07 "$1,929.20" $771.68 "$1,141.12" "$1,929.20" "$1,929.20" "$1,929.20" "$1,929.20" "$1,447.13" "$1,929.20" "$1,929.20" "$1,929.20" $964.60 $964.60 "$1,527.93" "$1,929.20" "$1,543.36" $868.14 $382.90 N/A "$1,119.11" "$1,929.20" "$1,929.20" "$1,929.20" $402.05 "$1,929.20" N/A N/A 432.009 SUP HCPCS C1713 432.009 - PLATE BONE 90D 45MM 10 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,929.50" "$1,428.00" $382.90 "$1,929.20" $868.14 $868.14 $868.14 $868.14 "$1,929.20" "$1,929.20" "$1,929.20" $402.09 "$1,929.20" "$1,929.20" "$1,929.20" "$1,929.20" "$1,929.20" $402.07 "$1,929.20" $771.68 "$1,141.12" "$1,929.20" "$1,929.20" "$1,929.20" "$1,929.20" "$1,447.13" "$1,929.20" "$1,929.20" "$1,929.20" $964.60 $964.60 "$1,527.93" "$1,929.20" "$1,543.36" $868.14 $382.90 N/A "$1,119.11" "$1,929.20" "$1,929.20" "$1,929.20" $402.05 "$1,929.20" N/A N/A 432.046 SUP HCPCS C1713 432.046 - PLATE BONE 90D 30MM 4 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,538.50" "$1,138.00" $305.32 "$1,538.33" $692.25 $692.25 $692.25 $692.25 "$1,538.33" "$1,538.33" "$1,538.33" $320.63 "$1,538.33" "$1,538.33" "$1,538.33" "$1,538.33" "$1,538.33" $320.60 "$1,538.33" $615.33 $909.92 "$1,538.33" "$1,538.33" "$1,538.33" "$1,538.33" "$1,153.88" "$1,538.33" "$1,538.33" "$1,538.33" $769.17 $769.17 "$1,218.36" "$1,538.33" "$1,230.66" $692.25 $305.32 N/A $892.33 "$1,538.33" "$1,538.33" "$1,538.33" $320.59 "$1,538.33" N/A N/A 432.047 SUP HCPCS C1713 432.047 - PLATE BONE 90D 35MM 4 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,538.50" "$1,138.00" $305.32 "$1,538.33" $692.25 $692.25 $692.25 $692.25 "$1,538.33" "$1,538.33" "$1,538.33" $320.63 "$1,538.33" "$1,538.33" "$1,538.33" "$1,538.33" "$1,538.33" $320.60 "$1,538.33" $615.33 $909.92 "$1,538.33" "$1,538.33" "$1,538.33" "$1,538.33" "$1,153.88" "$1,538.33" "$1,538.33" "$1,538.33" $769.17 $769.17 "$1,218.36" "$1,538.33" "$1,230.66" $692.25 $305.32 N/A $892.33 "$1,538.33" "$1,538.33" "$1,538.33" $320.59 "$1,538.33" N/A N/A 432.048 SUP HCPCS C1713 432.048 - PLATE BONE 90D 40MM 4 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,538.50" "$1,138.00" $305.32 "$1,538.33" $692.25 $692.25 $692.25 $692.25 "$1,538.33" "$1,538.33" "$1,538.33" $320.63 "$1,538.33" "$1,538.33" "$1,538.33" "$1,538.33" "$1,538.33" $320.60 "$1,538.33" $615.33 $909.92 "$1,538.33" "$1,538.33" "$1,538.33" "$1,538.33" "$1,153.88" "$1,538.33" "$1,538.33" "$1,538.33" $769.17 $769.17 "$1,218.36" "$1,538.33" "$1,230.66" $692.25 $305.32 N/A $892.33 "$1,538.33" "$1,538.33" "$1,538.33" $320.59 "$1,538.33" N/A N/A 432.049 SUP HCPCS C1713 432.049 - PLATE BONE 90D 45MM 4 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,538.50" "$1,138.00" $305.32 "$1,538.33" $692.25 $692.25 $692.25 $692.25 "$1,538.33" "$1,538.33" "$1,538.33" $320.63 "$1,538.33" "$1,538.33" "$1,538.33" "$1,538.33" "$1,538.33" $320.60 "$1,538.33" $615.33 $909.92 "$1,538.33" "$1,538.33" "$1,538.33" "$1,538.33" "$1,153.88" "$1,538.33" "$1,538.33" "$1,538.33" $769.17 $769.17 "$1,218.36" "$1,538.33" "$1,230.66" $692.25 $305.32 N/A $892.33 "$1,538.33" "$1,538.33" "$1,538.33" $320.59 "$1,538.33" N/A N/A 432.056 SUP HCPCS C1713 432.056 - PLATE BONE 90D 30MM 5 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,626.00" "$1,203.00" $322.68 "$1,625.78" $731.60 $731.60 $731.60 $731.60 "$1,625.78" "$1,625.78" "$1,625.78" $338.85 "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" $338.83 "$1,625.78" $650.31 $961.65 "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" "$1,219.50" "$1,625.78" "$1,625.78" "$1,625.78" $812.89 $812.89 "$1,287.62" "$1,625.78" "$1,300.62" $731.60 $322.68 N/A $943.08 "$1,625.78" "$1,625.78" "$1,625.78" $338.81 "$1,625.78" N/A N/A 432.057 SUP HCPCS C1713 432.057 - PLATE BONE 90D 35MM 5 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,626.00" "$1,203.00" $322.68 "$1,625.78" $731.60 $731.60 $731.60 $731.60 "$1,625.78" "$1,625.78" "$1,625.78" $338.85 "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" $338.83 "$1,625.78" $650.31 $961.65 "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" "$1,219.50" "$1,625.78" "$1,625.78" "$1,625.78" $812.89 $812.89 "$1,287.62" "$1,625.78" "$1,300.62" $731.60 $322.68 N/A $943.08 "$1,625.78" "$1,625.78" "$1,625.78" $338.81 "$1,625.78" N/A N/A 432.058 SUP HCPCS C1713 432.058 - PLATE BONE 90D 40MM 5 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,626.00" "$1,203.00" $322.68 "$1,625.78" $731.60 $731.60 $731.60 $731.60 "$1,625.78" "$1,625.78" "$1,625.78" $338.85 "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" $338.83 "$1,625.78" "$1,625.78" $961.65 "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" "$1,219.50" "$1,625.78" "$1,625.78" "$1,625.78" $812.89 $812.89 "$1,287.62" "$1,625.78" "$1,300.62" $731.60 $322.68 N/A $943.08 "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" N/A N/A 432.059 SUP HCPCS C1713 432.059 - PLATE BONE 90D 45MM 5 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,626.00" "$1,203.00" $322.68 "$1,625.78" $731.60 $731.60 $731.60 $731.60 "$1,625.78" "$1,625.78" "$1,625.78" $338.85 "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" $338.83 "$1,625.78" "$1,625.78" $961.65 "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" "$1,219.50" "$1,625.78" "$1,625.78" "$1,625.78" $812.89 $812.89 "$1,287.62" "$1,625.78" "$1,300.62" $731.60 $322.68 N/A $943.08 "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" "$1,625.78" N/A N/A 432.066 SUP HCPCS C1713 432.066 - PLATE BONE 90D 30MM 6 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,696.00" "$1,255.00" $336.61 "$1,696.00" $763.20 $763.20 $763.20 $763.20 "$1,696.00" "$1,696.00" "$1,696.00" $353.49 "$1,696.00" "$1,696.00" "$1,696.00" "$1,696.00" "$1,696.00" $353.47 "$1,696.00" $678.40 "$1,003.18" "$1,696.00" "$1,696.00" "$1,696.00" "$1,696.00" "$1,272.00" "$1,696.00" "$1,696.00" "$1,696.00" $848.00 $848.00 "$1,343.23" "$1,696.00" "$1,356.80" $763.20 $336.61 N/A $983.68 "$1,696.00" "$1,696.00" "$1,696.00" $353.45 "$1,696.00" N/A N/A 432.067 SUP HCPCS C1713 432.067 - PLATE BONE 90D 35MM 6 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,696.00" "$1,255.00" $336.61 "$1,696.00" $763.20 $763.20 $763.20 $763.20 "$1,696.00" "$1,696.00" "$1,696.00" $353.49 "$1,696.00" "$1,696.00" "$1,696.00" "$1,696.00" "$1,696.00" $353.47 "$1,696.00" $678.40 "$1,003.18" "$1,696.00" "$1,696.00" "$1,696.00" "$1,696.00" "$1,272.00" "$1,696.00" "$1,696.00" "$1,696.00" $848.00 $848.00 "$1,343.23" "$1,696.00" "$1,356.80" $763.20 $336.61 N/A $983.68 "$1,696.00" "$1,696.00" "$1,696.00" $353.45 "$1,696.00" N/A N/A 432.068 SUP HCPCS C1713 432.068 - PLATE BONE 90D 40MM 6 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,696.00" "$1,255.00" $336.61 "$1,696.00" $763.20 $763.20 $763.20 $763.20 "$1,696.00" "$1,696.00" "$1,696.00" $353.49 "$1,696.00" "$1,696.00" "$1,696.00" "$1,696.00" "$1,696.00" $353.47 "$1,696.00" $678.40 "$1,003.18" "$1,696.00" "$1,696.00" "$1,696.00" "$1,696.00" "$1,272.00" "$1,696.00" "$1,696.00" "$1,696.00" $848.00 $848.00 "$1,343.23" "$1,696.00" "$1,356.80" $763.20 $336.61 N/A $983.68 "$1,696.00" "$1,696.00" "$1,696.00" $353.45 "$1,696.00" N/A N/A 432.069 SUP HCPCS C1713 432.069 - PLATE BONE 90D 45MM 6 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,696.00" "$1,255.00" $336.61 "$1,696.00" $763.20 $763.20 $763.20 $763.20 "$1,696.00" "$1,696.00" "$1,696.00" $353.49 "$1,696.00" "$1,696.00" "$1,696.00" "$1,696.00" "$1,696.00" $353.47 "$1,696.00" "$1,696.00" "$1,003.18" "$1,696.00" "$1,696.00" "$1,696.00" "$1,696.00" "$1,272.00" "$1,696.00" "$1,696.00" "$1,696.00" $848.00 $848.00 "$1,343.23" "$1,696.00" "$1,356.80" $763.20 $336.61 N/A $983.68 "$1,696.00" "$1,696.00" "$1,696.00" "$1,696.00" "$1,696.00" N/A N/A 432.086 SUP HCPCS C1713 432.086 - PLATE BONE 90D 30MM 8 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,819.50" "$1,346.00" $361.07 "$1,819.23" $818.65 $818.65 $818.65 $818.65 "$1,819.23" "$1,819.23" "$1,819.23" $379.17 "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" $379.15 "$1,819.23" $727.69 "$1,076.07" "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" "$1,364.63" "$1,819.23" "$1,819.23" "$1,819.23" $909.62 $909.62 "$1,440.83" "$1,819.23" "$1,455.38" $818.65 $361.07 N/A "$1,055.31" "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" N/A N/A 432.087 SUP HCPCS C1713 432.087 - PLATE BONE 90D 106MM 35MM 8 HOLE CANN ANGLED TITANIUM BOTH IP/OP "$1,819.50" "$1,346.00" $361.07 "$1,819.23" $818.65 $818.65 $818.65 $818.65 "$1,819.23" "$1,819.23" "$1,819.23" $379.17 "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" $379.15 "$1,819.23" $727.69 "$1,076.07" "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" "$1,364.63" "$1,819.23" "$1,819.23" "$1,819.23" $909.62 $909.62 "$1,440.83" "$1,819.23" "$1,455.38" $818.65 $361.07 N/A "$1,055.31" "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" N/A N/A 432.088 SUP HCPCS C1713 432.088 - PLATE BONE 90D 40MM 8 HOLE CANN LC ANGLE BLADE TITANIUM BOTH IP/OP "$1,819.50" "$1,346.00" $361.07 "$1,819.23" $818.65 $818.65 $818.65 $818.65 "$1,819.23" "$1,819.23" "$1,819.23" $379.17 "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" $379.15 "$1,819.23" $727.69 "$1,076.07" "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" "$1,364.63" "$1,819.23" "$1,819.23" "$1,819.23" $909.62 $909.62 "$1,440.83" "$1,819.23" "$1,455.38" $818.65 $361.07 N/A "$1,055.31" "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" N/A N/A 432.089 SUP HCPCS C1713 432.089 - PLATE BONE 90D 45MM 8 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,819.50" "$1,346.00" $361.07 "$1,819.23" $818.65 $818.65 $818.65 $818.65 "$1,819.23" "$1,819.23" "$1,819.23" $379.17 "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" $379.15 "$1,819.23" "$1,819.23" "$1,076.07" "$1,819.23" "$1,819.23" "$1,819.23" "$1,819.23" "$1,364.63" "$1,819.23" "$1,819.23" "$1,819.23" $909.62 $909.62 "$1,440.83" "$1,819.23" "$1,455.38" $818.65 $361.07 N/A "$1,055.31" "$1,819.23" "$1,819.23" "$1,819.23" $379.13 "$1,819.23" N/A N/A 433 SUP Custom 27203010 433 - CUTTER WIRE MODIFY CARBIDE BOTH IP/OP "$1,126.50" $834.00 $200.47 "$1,126.25" "$1,126.25" "$1,126.25" "$1,126.25" "$1,126.25" "$1,126.25" "$1,126.25" $200.47 "$1,126.25" "$1,126.25" $835.90 $835.90 $868.11 $586.78 $234.72 "$1,126.25" $450.50 "$1,126.25" "$1,126.25" "$1,126.25" "$1,126.25" "$1,126.25" $844.88 "$1,126.25" "$1,126.25" "$1,126.25" $563.13 $563.13 $891.99 "$1,126.25" $901.00 $732.06 "$1,126.25" N/A $653.37 "$1,126.25" $675.75 "$1,126.25" "$1,126.25" "$1,126.25" N/A N/A 436.502 SUP HCPCS C1713 436.502 - PLATE BONE 86MM 2 HOLE LCP TITANIUM RIGHT OLECRANON NONSTRL BOTH IP/OP "$1,701.00" "$1,259.00" $337.59 "$1,729.83" $765.41 $765.41 $765.41 $765.41 "$1,700.90" "$1,700.90" "$1,700.90" $354.51 "$1,700.90" "$1,700.90" "$1,700.90" "$1,700.90" "$1,700.90" $354.49 "$1,700.90" "$1,729.83" "$1,006.08" "$1,700.90" "$1,729.83" "$1,700.90" "$1,700.90" "$1,275.75" "$1,700.90" "$1,700.90" "$1,700.90" $850.45 $850.45 "$1,347.11" "$1,700.90" "$1,360.72" $765.41 $337.59 N/A $986.58 "$1,700.90" "$1,700.90" "$1,700.90" $354.47 "$1,700.90" N/A N/A 436.503 SUP HCPCS C1713 436.503 - PLATE BONE 86MM 2 HOLE LCP TITANIUM LEFT OLECRANON NONSTRL BOTH IP/OP "$1,701.00" "$1,259.00" $337.59 "$1,729.83" $765.41 $765.41 $765.41 $765.41 "$1,700.90" "$1,700.90" "$1,700.90" $354.51 "$1,700.90" "$1,700.90" "$1,700.90" "$1,700.90" "$1,700.90" $354.49 "$1,700.90" "$1,729.83" "$1,006.08" "$1,700.90" "$1,729.83" "$1,700.90" "$1,700.90" "$1,275.75" "$1,700.90" "$1,700.90" "$1,700.90" $850.45 $850.45 "$1,347.11" "$1,700.90" "$1,360.72" $765.41 $337.59 N/A $986.58 "$1,700.90" "$1,700.90" "$1,700.90" $354.47 "$1,700.90" N/A N/A 436.506 SUP HCPCS C1713 436.506 - PLATE BONE 138MM 6 HOLE LCP TITANIUM RIGHT OLECRANON NONSTRL BOTH IP/OP "$1,832.00" "$1,356.00" $363.53 "$1,862.78" $824.23 $824.23 $824.23 $824.23 "$1,831.63" "$1,831.63" "$1,831.63" $381.76 "$1,831.63" "$1,831.63" "$1,831.63" "$1,831.63" "$1,831.63" $381.73 "$1,831.63" $745.11 "$1,083.41" "$1,831.63" "$1,862.78" "$1,831.63" "$1,831.63" "$1,374.00" "$1,831.63" "$1,831.63" "$1,831.63" $915.82 $915.82 "$1,450.65" "$1,831.63" "$1,465.30" $824.23 $363.53 N/A "$1,062.56" "$1,831.63" "$1,831.63" "$1,831.63" $381.71 "$1,831.63" N/A N/A 436.507 SUP HCPCS C1713 436.507 - PLATE BONE 138MM 6 HOLE LCP TITANIUM LEFT OLECRANON NONSTRL BOTH IP/OP "$1,865.50" "$1,380.00" $370.23 "$1,897.05" $839.41 $839.41 $839.41 $839.41 "$1,865.35" "$1,865.35" "$1,865.35" $388.79 "$1,865.35" "$1,865.35" "$1,865.35" "$1,865.35" "$1,865.35" $388.76 "$1,865.35" "$1,897.05" "$1,103.35" "$1,865.35" "$1,897.05" "$1,865.35" "$1,865.35" "$1,399.13" "$1,865.35" "$1,865.35" "$1,865.35" $932.68 $932.68 "$1,477.36" "$1,865.35" "$1,492.28" $839.41 $370.23 N/A "$1,081.99" "$1,865.35" "$1,865.35" "$1,865.35" $388.74 "$1,865.35" N/A N/A 436.51 SUP HCPCS C1713 436.510 - PLATE BONE 189MM 10 HOLE LCP TITANIUM RIGHT OLECRANON ELBOW BOTH IP/OP "$1,919.00" "$1,420.00" $380.84 "$2,010.00" $863.48 $863.48 $863.48 $863.48 "$1,918.85" "$1,918.85" "$1,918.85" $399.94 "$1,918.85" "$1,918.85" "$1,918.85" "$1,918.85" "$1,918.85" $399.91 "$1,918.85" $804.00 "$1,135.00" "$1,918.85" "$2,010.00" "$1,918.85" "$1,918.85" "$1,439.25" "$1,918.85" "$1,918.85" "$1,918.85" $959.43 $959.43 "$1,519.73" "$1,918.85" "$1,535.08" $863.48 $380.84 N/A "$1,113.02" "$1,918.85" "$1,918.85" "$1,918.85" $399.89 "$1,918.85" N/A N/A 436.511 SUP HCPCS C1713 436.511 - PLATE BONE 189MM 10 HOLE LCP TITANIUM LEFT OLECRANON ELBOW BOTH IP/OP "$1,976.50" "$1,463.00" $392.27 "$2,010.00" $889.38 $889.38 $889.38 $889.38 "$1,976.40" "$1,976.40" "$1,976.40" $411.93 "$1,976.40" "$1,976.40" "$1,976.40" "$1,976.40" "$1,976.40" $411.90 "$1,976.40" "$2,010.00" "$1,169.04" "$1,976.40" "$2,010.00" "$1,976.40" "$1,976.40" "$1,482.38" "$1,976.40" "$1,976.40" "$1,976.40" $988.20 $988.20 "$1,565.31" "$1,976.40" "$1,581.12" $889.38 $392.27 N/A "$1,146.37" "$1,976.40" "$1,976.40" "$1,976.40" "$1,976.40" "$1,976.40" N/A N/A 436.512 SUP HCPCS C1713 436.512 - PLATE BONE 215MM 12 HOLE LCP TITANIUM RIGHT OLECRANON ELBOW BOTH IP/OP "$2,013.00" "$1,490.00" $399.52 "$2,047.18" $905.83 $905.83 $905.83 $905.83 "$2,012.95" "$2,012.95" "$2,012.95" $419.55 "$2,012.95" "$2,012.95" "$2,012.95" "$2,012.95" "$2,012.95" $419.52 "$2,012.95" "$2,047.18" "$1,190.66" "$2,012.95" "$2,047.18" "$2,012.95" "$2,012.95" "$1,509.75" "$2,012.95" "$2,012.95" "$2,012.95" "$1,006.48" "$1,006.48" "$1,594.26" "$2,012.95" "$1,610.36" $905.83 $399.52 N/A "$1,167.54" "$2,012.95" "$2,012.95" "$2,012.95" $419.50 "$2,012.95" N/A N/A 436.513 SUP HCPCS C1713 436.513 - PLATE BONE 215MM 13 HOLE LCP TITANIUM LEFT OLECRANON ELBOW BOTH IP/OP "$2,013.00" "$1,490.00" $399.52 "$2,047.18" $905.83 $905.83 $905.83 $905.83 "$2,012.95" "$2,012.95" "$2,012.95" $419.55 "$2,012.95" "$2,012.95" "$2,012.95" "$2,012.95" "$2,012.95" $419.52 "$2,012.95" "$2,047.18" "$1,190.66" "$2,012.95" "$2,047.18" "$2,012.95" "$2,012.95" "$1,509.75" "$2,012.95" "$2,012.95" "$2,012.95" "$1,006.48" "$1,006.48" "$1,594.26" "$2,012.95" "$1,610.36" $905.83 $399.52 N/A "$1,167.54" "$2,012.95" "$2,012.95" "$2,012.95" $419.50 "$2,012.95" N/A N/A 437.2 SUP HCPCS C1713 437.20 - PLATE BONE 95D 50MM 12 HOLE DCP TITANIUM CONDYLE NONSTRL BOTH IP/OP "$1,268.50" $939.00 $251.67 "$1,268.03" $570.61 $570.61 $570.61 $570.61 "$1,268.03" "$1,268.03" "$1,268.03" $264.29 "$1,268.03" "$1,268.03" "$1,268.03" "$1,268.03" "$1,268.03" $264.27 "$1,268.03" $507.21 $750.04 "$1,268.03" "$1,268.03" "$1,268.03" "$1,268.03" $951.38 "$1,268.03" "$1,268.03" "$1,268.03" $634.02 $634.02 "$1,004.28" "$1,268.03" "$1,014.42" $570.61 $251.67 N/A $735.73 "$1,268.03" "$1,268.03" "$1,268.03" $264.26 "$1,268.03" N/A N/A 437.22 SUP HCPCS C1713 437.22 - PLATE BONE 95D 204MM 60MM 12 HOLE DCP TITANIUM CONDYLE BOTH IP/OP "$1,268.50" $939.00 $251.67 "$1,268.03" $570.61 $570.61 $570.61 $570.61 "$1,268.03" "$1,268.03" "$1,268.03" $264.29 "$1,268.03" "$1,268.03" "$1,268.03" "$1,268.03" "$1,268.03" $264.27 "$1,268.03" "$1,268.03" $750.04 "$1,268.03" "$1,268.03" "$1,268.03" "$1,268.03" $951.38 "$1,268.03" "$1,268.03" "$1,268.03" $634.02 $634.02 "$1,004.28" "$1,268.03" "$1,014.42" $570.61 $251.67 N/A $735.73 "$1,268.03" "$1,268.03" "$1,268.03" "$1,268.03" "$1,268.03" N/A N/A 437.24 SUP HCPCS C1713 437.24 - PLATE BONE 95D 70MM 12 HOLE DCP TITANIUM CONDYLE NONSTRL BOTH IP/OP "$1,268.50" $939.00 $251.67 "$1,268.03" $570.61 $570.61 $570.61 $570.61 "$1,268.03" "$1,268.03" "$1,268.03" $264.29 "$1,268.03" "$1,268.03" "$1,268.03" "$1,268.03" "$1,268.03" $264.27 "$1,268.03" $507.21 $750.04 "$1,268.03" "$1,268.03" "$1,268.03" "$1,268.03" $951.38 "$1,268.03" "$1,268.03" "$1,268.03" $634.02 $634.02 "$1,004.28" "$1,268.03" "$1,014.42" $570.61 $251.67 N/A $735.73 "$1,268.03" "$1,268.03" "$1,268.03" $264.26 "$1,268.03" N/A N/A 437.26 SUP HCPCS C1713 437.26 - PLATE BONE 95D 204MM 80MM 12 HOLE DCP TITANIUM CONDYLE BOTH IP/OP "$1,268.50" $939.00 $251.67 "$1,268.03" $570.61 $570.61 $570.61 $570.61 "$1,268.03" "$1,268.03" "$1,268.03" $264.29 "$1,268.03" "$1,268.03" "$1,268.03" "$1,268.03" "$1,268.03" $264.27 "$1,268.03" $507.21 $750.04 "$1,268.03" "$1,268.03" "$1,268.03" "$1,268.03" $951.38 "$1,268.03" "$1,268.03" "$1,268.03" $634.02 $634.02 "$1,004.28" "$1,268.03" "$1,014.42" $570.61 $251.67 N/A $735.73 "$1,268.03" "$1,268.03" "$1,268.03" $264.26 "$1,268.03" N/A N/A 437.5 SUP HCPCS C1713 437.50 - PLATE BONE 95D 50MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL BOTH IP/OP "$1,045.50" $774.00 $207.49 "$1,045.43" $470.44 $470.44 $470.44 $470.44 "$1,045.43" "$1,045.43" "$1,045.43" $217.89 "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" $217.88 "$1,045.43" $418.17 $618.37 "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" $784.13 "$1,045.43" "$1,045.43" "$1,045.43" $522.72 $522.72 $827.98 "$1,045.43" $836.34 $470.44 $207.49 N/A $606.39 "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" N/A N/A 437.52 SUP HCPCS C1713 437.52 - PLATE BONE 95D 60MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL BOTH IP/OP "$1,045.50" $774.00 $207.49 "$1,045.43" $470.44 $470.44 $470.44 $470.44 "$1,045.43" "$1,045.43" "$1,045.43" $217.89 "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" $217.88 "$1,045.43" $418.17 $618.37 "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" $784.13 "$1,045.43" "$1,045.43" "$1,045.43" $522.72 $522.72 $827.98 "$1,045.43" $836.34 $470.44 $207.49 N/A $606.39 "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" N/A N/A 437.54 SUP HCPCS C1713 437.54 - PLATE BONE 95D 70MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL BOTH IP/OP "$1,045.50" $774.00 $207.49 "$1,045.43" $470.44 $470.44 $470.44 $470.44 "$1,045.43" "$1,045.43" "$1,045.43" $217.89 "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" $217.88 "$1,045.43" $418.17 $618.37 "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" $784.13 "$1,045.43" "$1,045.43" "$1,045.43" $522.72 $522.72 $827.98 "$1,045.43" $836.34 $470.44 $207.49 N/A $606.39 "$1,045.43" "$1,045.43" "$1,045.43" $217.87 "$1,045.43" N/A N/A 437.56 SUP HCPCS C1713 437.56 - PLATE BONE 95D 80MM 5 HOLE DCP TITANIUM CONDYLE NONSTRL BOTH IP/OP "$1,045.50" $774.00 $207.49 "$1,045.43" $470.44 $470.44 $470.44 $470.44 "$1,045.43" "$1,045.43" "$1,045.43" $217.89 "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" $217.88 "$1,045.43" $418.17 $618.37 "$1,045.43" "$1,045.43" "$1,045.43" "$1,045.43" $784.13 "$1,045.43" "$1,045.43" "$1,045.43" $522.72 $522.72 $827.98 "$1,045.43" $836.34 $470.44 $207.49 N/A $606.39 "$1,045.43" "$1,045.43" "$1,045.43" $217.87 "$1,045.43" N/A N/A 437.7 SUP HCPCS C1713 437.70 - PLATE BONE 95D 50MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL BOTH IP/OP "$1,093.50" $809.00 $216.96 "$1,093.13" $491.91 $491.91 $491.91 $491.91 "$1,093.13" "$1,093.13" "$1,093.13" $227.84 "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" $227.82 "$1,093.13" $437.25 $646.59 "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" $820.13 "$1,093.13" "$1,093.13" "$1,093.13" $546.57 $546.57 $865.76 "$1,093.13" $874.50 $491.91 $216.96 N/A $634.23 "$1,093.13" "$1,093.13" "$1,093.13" $227.81 "$1,093.13" N/A N/A 437.72 SUP HCPCS C1713 437.72 - PLATE BONE 95D 60MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL BOTH IP/OP "$1,093.50" $809.00 $216.96 "$1,093.13" $491.91 $491.91 $491.91 $491.91 "$1,093.13" "$1,093.13" "$1,093.13" $227.84 "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" $227.82 "$1,093.13" $437.25 $646.59 "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" $820.13 "$1,093.13" "$1,093.13" "$1,093.13" $546.57 $546.57 $865.76 "$1,093.13" $874.50 $491.91 $216.96 N/A $634.23 "$1,093.13" "$1,093.13" "$1,093.13" $227.81 "$1,093.13" N/A N/A 437.74 SUP HCPCS C1713 437.74 - PLATE BONE 95D 70MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL BOTH IP/OP "$1,093.50" $809.00 $216.96 "$1,093.13" $491.91 $491.91 $491.91 $491.91 "$1,093.13" "$1,093.13" "$1,093.13" $227.84 "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" $227.82 "$1,093.13" $437.25 $646.59 "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" $820.13 "$1,093.13" "$1,093.13" "$1,093.13" $546.57 $546.57 $865.76 "$1,093.13" $874.50 $491.91 $216.96 N/A $634.23 "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" N/A N/A 437.76 SUP HCPCS C1713 437.76 - PLATE BONE 95D 80MM 7 HOLE DCP TITANIUM CONDYLE NONSTRL BOTH IP/OP "$1,093.50" $809.00 $216.96 "$1,093.13" $491.91 $491.91 $491.91 $491.91 "$1,093.13" "$1,093.13" "$1,093.13" $227.84 "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" $227.82 "$1,093.13" $437.25 $646.59 "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" $820.13 "$1,093.13" "$1,093.13" "$1,093.13" $546.57 $546.57 $865.76 "$1,093.13" $874.50 $491.91 $216.96 N/A $634.23 "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" "$1,093.13" N/A N/A 437.9 SUP HCPCS C1713 437.90 - PLATE BONE 95D 50MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL BOTH IP/OP "$1,147.50" $849.00 $227.74 "$1,147.45" $516.35 $516.35 $516.35 $516.35 "$1,147.45" "$1,147.45" "$1,147.45" $239.16 "$1,147.45" "$1,147.45" "$1,147.45" "$1,147.45" "$1,147.45" $239.14 "$1,147.45" $458.98 $678.72 "$1,147.45" "$1,147.45" "$1,147.45" "$1,147.45" $860.63 "$1,147.45" "$1,147.45" "$1,147.45" $573.73 $573.73 $908.78 "$1,147.45" $917.96 $516.35 $227.74 N/A $665.55 "$1,147.45" $688.47 "$1,147.45" $239.13 "$1,147.45" N/A N/A 437.92 SUP HCPCS C1713 437.92 - PLATE BONE 95D 60MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL BOTH IP/OP "$1,147.50" $849.00 $227.74 "$1,147.45" $516.35 $516.35 $516.35 $516.35 "$1,147.45" "$1,147.45" "$1,147.45" $239.16 "$1,147.45" "$1,147.45" "$1,147.45" "$1,147.45" "$1,147.45" $239.14 "$1,147.45" $458.98 $678.72 "$1,147.45" "$1,147.45" "$1,147.45" "$1,147.45" $860.63 "$1,147.45" "$1,147.45" "$1,147.45" $573.73 $573.73 $908.78 "$1,147.45" $917.96 $516.35 $227.74 N/A $665.55 "$1,147.45" $688.47 "$1,147.45" $239.13 "$1,147.45" N/A N/A 437.94 SUP HCPCS C1713 437.94 - PLATE BONE 95D 70MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL BOTH IP/OP "$1,165.00" $862.00 $231.16 "$1,164.68" $524.11 $524.11 $524.11 $524.11 "$1,164.68" "$1,164.68" "$1,164.68" $242.75 "$1,164.68" "$1,164.68" "$1,164.68" "$1,164.68" "$1,164.68" $242.73 "$1,164.68" $465.87 $688.91 "$1,164.68" "$1,164.68" "$1,164.68" "$1,164.68" $873.75 "$1,164.68" "$1,164.68" "$1,164.68" $582.34 $582.34 $922.43 "$1,164.68" $931.74 $524.11 $231.16 N/A $675.70 "$1,164.68" "$1,164.68" "$1,164.68" "$1,164.68" "$1,164.68" N/A N/A 437.96 SUP HCPCS C1713 437.96 - PLATE BONE 95D 80MM 9 HOLE DCP TITANIUM CONDYLE NONSTRL BOTH IP/OP "$1,165.00" $862.00 $231.16 "$1,164.68" $524.11 $524.11 $524.11 $524.11 "$1,164.68" "$1,164.68" "$1,164.68" $242.75 "$1,164.68" "$1,164.68" "$1,164.68" "$1,164.68" "$1,164.68" $242.73 "$1,164.68" $465.87 $688.91 "$1,164.68" "$1,164.68" "$1,164.68" "$1,164.68" $873.75 "$1,164.68" "$1,164.68" "$1,164.68" $582.34 $582.34 $922.43 "$1,164.68" $931.74 $524.11 $231.16 N/A $675.70 "$1,164.68" $698.81 "$1,164.68" "$1,164.68" "$1,164.68" N/A N/A 438.24 SUP HCPCS C1713 438.24 - PLATE BONE 130D 70MM 12 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,276.50" $945.00 $253.26 "$1,276.05" $574.22 $574.22 $574.22 $574.22 "$1,276.05" "$1,276.05" "$1,276.05" $265.96 "$1,276.05" "$1,276.05" "$1,276.05" "$1,276.05" "$1,276.05" $265.94 "$1,276.05" "$1,276.05" $754.78 "$1,276.05" "$1,276.05" "$1,276.05" "$1,276.05" $957.38 "$1,276.05" "$1,276.05" "$1,276.05" $638.03 $638.03 "$1,010.63" "$1,276.05" "$1,020.84" $574.22 $253.26 N/A $740.37 "$1,276.05" "$1,276.05" "$1,276.05" $265.93 "$1,276.05" N/A N/A 438.26 SUP HCPCS C1713 438.26 - PLATE BONE 130D 80MM 12 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,276.50" $945.00 $253.26 "$1,276.05" $574.22 $574.22 $574.22 $574.22 "$1,276.05" "$1,276.05" "$1,276.05" $265.96 "$1,276.05" "$1,276.05" "$1,276.05" "$1,276.05" "$1,276.05" $265.94 "$1,276.05" $510.42 $754.78 "$1,276.05" "$1,276.05" "$1,276.05" "$1,276.05" $957.38 "$1,276.05" "$1,276.05" "$1,276.05" $638.03 $638.03 "$1,010.63" "$1,276.05" "$1,020.84" $574.22 $253.26 N/A $740.37 "$1,276.05" $765.63 "$1,276.05" $265.93 "$1,276.05" N/A N/A 438.28 SUP HCPCS C1713 438.28 - PLATE BONE 130D 90MM 12 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,276.50" $945.00 $253.26 "$1,276.05" $574.22 $574.22 $574.22 $574.22 "$1,276.05" "$1,276.05" "$1,276.05" $265.96 "$1,276.05" "$1,276.05" "$1,276.05" "$1,276.05" "$1,276.05" $265.94 "$1,276.05" "$1,276.05" $754.78 "$1,276.05" "$1,276.05" "$1,276.05" "$1,276.05" $957.38 "$1,276.05" "$1,276.05" "$1,276.05" $638.03 $638.03 "$1,010.63" "$1,276.05" "$1,020.84" $574.22 $253.26 N/A $740.37 "$1,276.05" "$1,276.05" "$1,276.05" $265.93 "$1,276.05" N/A N/A 438.36 SUP HCPCS C1713 438.36 - PLATE BONE 130D 50MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP $943.50 $698.00 $187.17 $943.05 $424.37 $424.37 $424.37 $424.37 $943.05 $943.05 $943.05 $196.56 $943.05 $943.05 $943.05 $943.05 $943.05 $196.54 $943.05 $377.22 $557.81 $943.05 $943.05 $943.05 $943.05 $707.63 $943.05 $943.05 $943.05 $471.53 $471.53 $746.90 $943.05 $754.44 $424.37 $187.17 N/A $547.23 $943.05 $565.83 $943.05 $196.53 $943.05 N/A N/A 438.38 SUP HCPCS C1713 438.38 - PLATE BONE 130D 60MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP $943.50 $698.00 $187.17 $943.05 $424.37 $424.37 $424.37 $424.37 $943.05 $943.05 $943.05 $196.56 $943.05 $943.05 $943.05 $943.05 $943.05 $196.54 $943.05 $943.05 $557.81 $943.05 $943.05 $943.05 $943.05 $707.63 $943.05 $943.05 $943.05 $471.53 $471.53 $746.90 $943.05 $754.44 $424.37 $187.17 N/A $547.23 $943.05 $943.05 $943.05 $196.53 $943.05 N/A N/A 438.4 SUP HCPCS C1713 438.40 - PLATE BONE 130D 100MM 4 HOLE ANGLE BLADE DCP TITANIUM BOTH IP/OP $943.50 $698.00 $187.17 $943.05 $424.37 $424.37 $424.37 $424.37 $943.05 $943.05 $943.05 $196.56 $943.05 $943.05 $943.05 $943.05 $943.05 $196.54 $943.05 $377.22 $557.81 $943.05 $943.05 $943.05 $943.05 $707.63 $943.05 $943.05 $943.05 $471.53 $471.53 $746.90 $943.05 $754.44 $424.37 $187.17 N/A $547.23 $943.05 $565.83 $943.05 $196.53 $943.05 N/A N/A 438.41 SUP HCPCS C1713 438.41 - PLATE BONE 130D 105MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP $943.50 $698.00 $187.17 $943.05 $424.37 $424.37 $424.37 $424.37 $943.05 $943.05 $943.05 $196.56 $943.05 $943.05 $943.05 $943.05 $943.05 $196.54 $943.05 $943.05 $557.81 $943.05 $943.05 $943.05 $943.05 $707.63 $943.05 $943.05 $943.05 $471.53 $471.53 $746.90 $943.05 $754.44 $424.37 $187.17 N/A $547.23 $943.05 $565.83 $943.05 $196.53 $943.05 N/A N/A 438.42 SUP HCPCS C1713 438.42 - PLATE BONE 130D 110MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP $943.50 $698.00 $187.17 $943.05 $424.37 $424.37 $424.37 $424.37 $943.05 $943.05 $943.05 $196.56 $943.05 $943.05 $943.05 $943.05 $943.05 $196.54 $943.05 $943.05 $557.81 $943.05 $943.05 $943.05 $943.05 $707.63 $943.05 $943.05 $943.05 $471.53 $471.53 $746.90 $943.05 $754.44 $424.37 $187.17 N/A $547.23 $943.05 $565.83 $943.05 $196.53 $943.05 N/A N/A 438.44 SUP HCPCS C1713 438.44 - PLATE BONE 130D 70MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP $943.50 $698.00 $187.17 $943.05 $424.37 $424.37 $424.37 $424.37 $943.05 $943.05 $943.05 $196.56 $943.05 $943.05 $943.05 $943.05 $943.05 $196.54 $943.05 $377.22 $557.81 $943.05 $943.05 $943.05 $943.05 $707.63 $943.05 $943.05 $943.05 $471.53 $471.53 $746.90 $943.05 $754.44 $424.37 $187.17 N/A $547.23 $943.05 $943.05 $943.05 $943.05 $943.05 N/A N/A 438.45 SUP HCPCS C1713 438.45 - PLATE BONE 130D 75MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP $943.50 $698.00 $187.17 $943.05 $424.37 $424.37 $424.37 $424.37 $943.05 $943.05 $943.05 $196.56 $943.05 $943.05 $943.05 $943.05 $943.05 $196.54 $943.05 $943.05 $557.81 $943.05 $943.05 $943.05 $943.05 $707.63 $943.05 $943.05 $943.05 $471.53 $471.53 $746.90 $943.05 $754.44 $424.37 $187.17 N/A $547.23 $943.05 $943.05 $943.05 $943.05 $943.05 N/A N/A 438.46 SUP HCPCS C1713 438.46 - PLATE BONE 130D 80MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP $943.50 $698.00 $187.17 $943.05 $424.37 $424.37 $424.37 $424.37 $943.05 $943.05 $943.05 $196.56 $943.05 $943.05 $943.05 $943.05 $943.05 $196.54 $943.05 $377.22 $557.81 $943.05 $943.05 $943.05 $943.05 $707.63 $943.05 $943.05 $943.05 $471.53 $471.53 $746.90 $943.05 $754.44 $424.37 $187.17 N/A $547.23 $943.05 $943.05 $943.05 $196.53 $943.05 N/A N/A 438.47 SUP HCPCS C1713 438.47 - PLATE BONE 130D 85MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP $943.50 $698.00 $187.17 $943.05 $424.37 $424.37 $424.37 $424.37 $943.05 $943.05 $943.05 $196.56 $943.05 $943.05 $943.05 $943.05 $943.05 $196.54 $943.05 $943.05 $557.81 $943.05 $943.05 $943.05 $943.05 $707.63 $943.05 $943.05 $943.05 $471.53 $471.53 $746.90 $943.05 $754.44 $424.37 $187.17 N/A $547.23 $943.05 $565.83 $943.05 $196.53 $943.05 N/A N/A 438.48 SUP HCPCS C1713 438.48 - PLATE BONE 130D 90MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP $943.50 $698.00 $187.17 $943.05 $424.37 $424.37 $424.37 $424.37 $943.05 $943.05 $943.05 $196.56 $943.05 $943.05 $943.05 $943.05 $943.05 $196.54 $943.05 $377.22 $557.81 $943.05 $943.05 $943.05 $943.05 $707.63 $943.05 $943.05 $943.05 $471.53 $471.53 $746.90 $943.05 $754.44 $424.37 $187.17 N/A $547.23 $943.05 $565.83 $943.05 $196.53 $943.05 N/A N/A 438.49 SUP HCPCS C1713 438.49 - PLATE BONE 130D 95MM 4 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP $943.50 $698.00 $187.17 $943.05 $424.37 $424.37 $424.37 $424.37 $943.05 $943.05 $943.05 $196.56 $943.05 $943.05 $943.05 $943.05 $943.05 $196.54 $943.05 $943.05 $557.81 $943.05 $943.05 $943.05 $943.05 $707.63 $943.05 $943.05 $943.05 $471.53 $471.53 $746.90 $943.05 $754.44 $424.37 $187.17 N/A $547.23 $943.05 $565.83 $943.05 $196.53 $943.05 N/A N/A 438.6 SUP HCPCS C1713 438.60 - PLATE BONE 130D 50MM 6 HOLE ANGLE BLADE DCP TITANIUM NONSTRL BOTH IP/OP "$1,007.50" $746.00 $199.90 "$1,007.18" $453.23 $453.23 $453.23 $453.23 "$1,007.18" "$1,007.18" "$1,007.18" $209.92 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $209.91 "$1,007.18" $402.87 $595.75 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $755.63 "$1,007.18" "$1,007.18" "$1,007.18" $503.59 $503.59 $797.69 "$1,007.18" $805.74 $453.23 $199.90 N/A $584.35 "$1,007.18" $604.31 "$1,007.18" $209.90 "$1,007.18" N/A N/A 438.62 SUP HCPCS C1713 438.62 - PLATE BONE 130D 60MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,007.50" $746.00 $199.90 "$1,007.18" $453.23 $453.23 $453.23 $453.23 "$1,007.18" "$1,007.18" "$1,007.18" $209.92 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $209.91 "$1,007.18" "$1,007.18" $595.75 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $755.63 "$1,007.18" "$1,007.18" "$1,007.18" $503.59 $503.59 $797.69 "$1,007.18" $805.74 $453.23 $199.90 N/A $584.35 "$1,007.18" "$1,007.18" "$1,007.18" $209.90 "$1,007.18" N/A N/A 438.64 SUP HCPCS C1713 438.64 - PLATE BONE 130D 70MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,007.50" $746.00 $199.90 "$1,007.18" $453.23 $453.23 $453.23 $453.23 "$1,007.18" "$1,007.18" "$1,007.18" $209.92 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $209.91 "$1,007.18" $402.87 $595.75 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $755.63 "$1,007.18" "$1,007.18" "$1,007.18" $503.59 $503.59 $797.69 "$1,007.18" $805.74 $453.23 $199.90 N/A $584.35 "$1,007.18" "$1,007.18" "$1,007.18" $209.90 "$1,007.18" N/A N/A 438.66 SUP HCPCS C1713 438.66 - PLATE BONE 130D 80MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,007.50" $746.00 $199.90 "$1,007.18" $453.23 $453.23 $453.23 $453.23 "$1,007.18" "$1,007.18" "$1,007.18" $209.92 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $209.91 "$1,007.18" "$1,007.18" $595.75 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $755.63 "$1,007.18" "$1,007.18" "$1,007.18" $503.59 $503.59 $797.69 "$1,007.18" $805.74 $453.23 $199.90 N/A $584.35 "$1,007.18" $604.31 "$1,007.18" $209.90 "$1,007.18" N/A N/A 438.68 SUP HCPCS C1713 438.68 - PLATE BLADE 130D 90MM 6 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,007.50" $746.00 $199.90 "$1,007.18" $453.23 $453.23 $453.23 $453.23 "$1,007.18" "$1,007.18" "$1,007.18" $209.92 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $209.91 "$1,007.18" $402.87 $595.75 "$1,007.18" "$1,007.18" "$1,007.18" "$1,007.18" $755.63 "$1,007.18" "$1,007.18" "$1,007.18" $503.59 $503.59 $797.69 "$1,007.18" $805.74 $453.23 $199.90 N/A $584.35 "$1,007.18" $604.31 "$1,007.18" "$1,007.18" "$1,007.18" N/A N/A 438.7 SUP HCPCS C1713 438.700 - PLATE BONE 116MM 4 HOLE W/O TAB LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$2,531.00" "$1,873.00" $502.29 "$2,530.75" "$1,138.84" "$1,138.84" "$1,138.84" "$1,138.84" "$2,530.75" "$2,530.75" "$2,530.75" $527.47 "$2,530.75" "$2,530.75" "$2,530.75" "$2,530.75" "$2,530.75" $527.44 "$2,530.75" "$2,530.75" "$1,247.66" "$2,530.75" "$2,530.75" "$2,530.75" "$2,530.75" "$1,898.25" "$2,530.75" "$2,530.75" "$2,530.75" "$1,265.38" "$1,265.38" "$2,004.35" "$2,530.75" "$2,024.60" "$1,138.84" $502.29 N/A "$1,467.98" "$2,530.75" "$1,518.45" "$2,530.75" $527.41 "$2,530.75" N/A N/A 438.701 SUP HCPCS C1713 438.701 - PLATE BONE 116MM 4 HOLE W/O TAB LCP TITANIUM TIBIA LEFT BOTH IP/OP "$3,294.50" "$2,438.00" $653.82 "$3,294.20" "$1,482.39" "$1,482.39" "$1,482.39" "$1,482.39" "$3,294.20" "$3,294.20" "$3,294.20" $686.59 "$3,294.20" "$3,294.20" "$3,294.20" "$3,294.20" "$3,294.20" $686.55 "$3,294.20" "$1,317.68" "$1,624.04" "$3,294.20" "$3,294.20" "$3,294.20" "$3,294.20" "$2,470.88" "$3,294.20" "$3,294.20" "$3,294.20" "$1,647.10" "$1,647.10" "$2,609.01" "$3,294.20" "$2,635.36" "$1,482.39" $653.82 N/A "$1,910.81" "$3,294.20" "$1,976.52" "$3,294.20" $686.51 "$3,294.20" N/A N/A 438.703 SUP HCPCS C1713 438.703 - PLATE BONE 142MM 6 HOLE W/O TAB LCP TITANIUM TIBIA LEFT BOTH IP/OP "$3,234.50" "$2,394.00" $641.95 "$3,234.43" "$1,455.49" "$1,455.49" "$1,455.49" "$1,455.49" "$3,234.43" "$3,234.43" "$3,234.43" $674.14 "$3,234.43" "$3,234.43" "$3,234.43" "$3,234.43" "$3,234.43" $674.09 "$3,234.43" "$3,234.43" "$1,594.57" "$3,234.43" "$3,234.43" "$3,234.43" "$3,234.43" "$2,425.88" "$3,234.43" "$3,234.43" "$3,234.43" "$1,617.22" "$1,617.22" "$2,561.67" "$3,234.43" "$2,587.54" "$1,455.49" $641.95 N/A "$1,876.01" "$3,234.43" "$1,940.66" "$3,234.43" $674.06 "$3,234.43" N/A N/A 438.705 SUP HCPCS C1713 438.705 - PLATE 168MM TI 3.5MM SCR 8 HOLE W/O TAB LCP BONE LEFT DISTAL BOTH IP/OP "$3,266.50" "$2,417.00" $648.25 "$3,266.13" "$1,469.76" "$1,469.76" "$1,469.76" "$1,469.76" "$3,266.13" "$3,266.13" "$3,266.13" $680.74 "$3,266.13" "$3,266.13" "$3,266.13" "$3,266.13" "$3,266.13" $680.70 "$3,266.13" "$3,266.13" "$1,610.20" "$3,266.13" "$3,266.13" "$3,266.13" "$3,266.13" "$2,449.88" "$3,266.13" "$3,266.13" "$3,266.13" "$1,633.07" "$1,633.07" "$2,586.77" "$3,266.13" "$2,612.90" "$1,469.76" $648.25 N/A "$1,894.57" "$3,266.13" "$3,266.13" "$3,266.13" $680.66 "$3,266.13" N/A N/A 438.706 SUP HCPCS C1713 438.706 - PLATE BONE 194MM 10 HOLE W/O TAB LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$3,399.50" "$2,516.00" $674.63 "$3,399.05" "$1,529.57" "$1,529.57" "$1,529.57" "$1,529.57" "$3,399.05" "$3,399.05" "$3,399.05" $708.45 "$3,399.05" "$3,399.05" "$3,399.05" "$3,399.05" "$3,399.05" $708.40 "$3,399.05" "$3,399.05" "$1,675.73" "$3,399.05" "$3,399.05" "$3,399.05" "$3,399.05" "$2,549.63" "$3,399.05" "$3,399.05" "$3,399.05" "$1,699.53" "$1,699.53" "$2,692.05" "$3,399.05" "$2,719.24" "$1,529.57" $674.63 N/A "$1,971.71" "$3,399.05" "$3,399.05" "$3,399.05" $708.36 "$3,399.05" N/A N/A 438.708 SUP HCPCS C1713 438.708 - PLATE BONE 220MM 12 HOLE W/O TAB LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$2,641.00" "$1,954.00" $524.12 "$2,640.73" "$1,188.33" "$1,188.33" "$1,188.33" "$1,188.33" "$2,640.73" "$2,640.73" "$2,640.73" $550.39 "$2,640.73" "$2,640.73" "$2,640.73" "$2,640.73" "$2,640.73" $550.36 "$2,640.73" "$2,640.73" "$1,301.88" "$2,640.73" "$2,640.73" "$2,640.73" "$2,640.73" "$1,980.75" "$2,640.73" "$2,640.73" "$2,640.73" "$1,320.37" "$1,320.37" "$2,091.46" "$2,640.73" "$2,112.58" "$1,188.33" $524.12 N/A "$1,531.78" "$2,640.73" "$2,640.73" "$2,640.73" $550.33 "$2,640.73" N/A N/A 438.71 SUP HCPCS C1713 438.710 - PLATE BONE 246MM 14 HOLE W/O TAB LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$2,675.50" "$1,980.00" $530.96 "$2,675.18" "$1,203.83" "$1,203.83" "$1,203.83" "$1,203.83" "$2,675.18" "$2,675.18" "$2,675.18" $557.57 "$2,675.18" "$2,675.18" "$2,675.18" "$2,675.18" "$2,675.18" $557.54 "$2,675.18" "$2,675.18" "$1,318.86" "$2,675.18" "$2,675.18" "$2,675.18" "$2,675.18" "$2,006.63" "$2,675.18" "$2,675.18" "$2,675.18" "$1,337.59" "$1,337.59" "$2,118.74" "$2,675.18" "$2,140.14" "$1,203.83" $530.96 N/A "$1,551.79" "$2,675.18" "$2,675.18" "$2,675.18" $557.51 "$2,675.18" N/A N/A 438.711 SUP HCPCS C1713 438.711 - PLATE BONE 246MM 14 HOLE W/O TAB LCP TITANIUM TIBIA LEFT BOTH IP/OP "$2,756.00" "$2,039.00" $547.00 "$2,756.00" "$1,240.20" "$1,240.20" "$1,240.20" "$1,240.20" "$2,756.00" "$2,756.00" "$2,756.00" $574.42 "$2,756.00" "$2,756.00" "$2,756.00" "$2,756.00" "$2,756.00" $574.38 "$2,756.00" "$2,756.00" "$1,358.71" "$2,756.00" "$2,756.00" "$2,756.00" "$2,756.00" "$2,067.00" "$2,756.00" "$2,756.00" "$2,756.00" "$1,378.00" "$1,378.00" "$2,182.75" "$2,756.00" "$2,204.80" "$1,240.20" $547.00 N/A "$1,598.48" "$2,756.00" "$2,756.00" "$2,756.00" $574.35 "$2,756.00" N/A N/A 438.94 SUP HCPCS C1713 438.94 - PLATE BONE 130D 70MM 9 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,111.00" $822.00 $220.49 "$1,110.90" $499.91 $499.91 $499.91 $499.91 "$1,110.90" "$1,110.90" "$1,110.90" $231.54 "$1,110.90" "$1,110.90" "$1,110.90" "$1,110.90" "$1,110.90" $231.52 "$1,110.90" "$1,110.90" $657.10 "$1,110.90" "$1,110.90" "$1,110.90" "$1,110.90" $833.25 "$1,110.90" "$1,110.90" "$1,110.90" $555.45 $555.45 $879.83 "$1,110.90" $888.72 $499.91 $220.49 N/A $644.38 "$1,110.90" $666.54 "$1,110.90" "$1,110.90" "$1,110.90" N/A N/A 438.96 SUP HCPCS C1713 438.96 - PLATE BONE 130D 80MM 9 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" "$1,078.55" "$1,078.55" $224.77 "$1,078.55" N/A N/A 438.98 SUP HCPCS C1713 438.98 - PLATE BONE 130D 90MM 9 HOLE ANGLED DCP TITANIUM ORTHOPEDIC BOTH IP/OP "$1,111.00" $822.00 $220.49 "$1,110.90" $499.91 $499.91 $499.91 $499.91 "$1,110.90" "$1,110.90" "$1,110.90" $231.54 "$1,110.90" "$1,110.90" "$1,110.90" "$1,110.90" "$1,110.90" $231.52 "$1,110.90" $444.36 $657.10 "$1,110.90" "$1,110.90" "$1,110.90" "$1,110.90" $833.25 "$1,110.90" "$1,110.90" "$1,110.90" $555.45 $555.45 $879.83 "$1,110.90" $888.72 $499.91 $220.49 N/A $644.38 "$1,110.90" "$1,110.90" "$1,110.90" $231.51 "$1,110.90" N/A N/A 439.2 SUP HCPCS C1713 439.20 - PLATE BONE 90D 10MM DISPLACEMENT 50MM DCP TITANIUM ADULT BOTH IP/OP "$1,291.00" $955.00 $256.23 "$1,290.98" $580.94 $580.94 $580.94 $580.94 "$1,290.98" "$1,290.98" "$1,290.98" $269.07 "$1,290.98" "$1,290.98" "$1,290.98" "$1,290.98" "$1,290.98" $269.05 "$1,290.98" $516.39 $763.61 "$1,290.98" "$1,290.98" "$1,290.98" "$1,290.98" $968.25 "$1,290.98" "$1,290.98" "$1,290.98" $645.49 $645.49 "$1,022.46" "$1,290.98" "$1,032.78" $580.94 $256.23 N/A $748.78 "$1,290.98" $774.59 "$1,290.98" $269.04 "$1,290.98" N/A N/A 439.21 SUP HCPCS C1713 439.21 - PLATE BONE 90D 10MM DISPLACEMENT 55MM ANGLED DCP TITANIUM BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.22 SUP HCPCS C1713 439.22 - PLATE BONE 90D 10MM DISPLACEMENT 60MM DCP TITANIUM ADULT BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.23 SUP HCPCS C1713 439.23 - PLATE BONE 90D 10MM DISPLACEMENT 65MM ANGLED DCP TITANIUM BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.24 SUP HCPCS C1713 439.24 - PLATE BONE 90D 10MM DISPLACEMENT 70MM DCP TITANIUM ADULT BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.25 SUP HCPCS C1713 439.25 - PLATE BONE 90D 10MM DISPLACEMENT 75MM DCP TITANIUM ADULT BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" "$1,078.55" "$1,078.55" N/A N/A 439.28 SUP HCPCS C1713 439.28 - PLATE BONE 90D 10MM DISPLACEMENT 40MM DCP TITANIUM ADULT BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" "$1,078.55" "$1,078.55" N/A N/A 439.32 SUP HCPCS C1713 439.32 - PLATE BONE 100D 10MM DISPLACEMENT 60MM DCP TITANIUM ADULT BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.43 SUP HCPCS C1713 439.43 - PLATE BONE 110D 65MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" "$1,078.55" $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.45 SUP HCPCS C1713 439.45 - PLATE BONE 110D 75MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL BOTH IP/OP "$1,111.00" $822.00 $220.49 "$1,110.90" $499.91 $499.91 $499.91 $499.91 "$1,110.90" "$1,110.90" "$1,110.90" $231.54 "$1,110.90" "$1,110.90" "$1,110.90" "$1,110.90" "$1,110.90" $231.52 "$1,110.90" $444.36 $657.10 "$1,110.90" "$1,110.90" "$1,110.90" "$1,110.90" $833.25 "$1,110.90" "$1,110.90" "$1,110.90" $555.45 $555.45 $879.83 "$1,110.90" $888.72 $499.91 $220.49 N/A $644.38 "$1,110.90" $666.54 "$1,110.90" $231.51 "$1,110.90" N/A N/A 439.47 SUP HCPCS C1713 439.47 - PLATE BONE 110D 85MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" N/A N/A 439.53 SUP HCPCS C1713 439.53 - PLATE BONE 120D 65MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" "$1,078.55" "$1,078.55" N/A N/A 439.55 SUP HCPCS C1713 439.55 - PLATE BONE 120D 75MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.57 SUP HCPCS C1713 439.57 - PLATE BONE 120D 85MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.6 SUP HCPCS C1713 439.60 - PLATE BONE 90D 20MM DISPLACEMENT 50MM 20MM DCP TITANIUM BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" "$1,078.55" "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.61 SUP HCPCS C1713 439.61 - PLATE BONE 90D 20MM 55MM DCP TITANIUM ADULT ORTHOPEDIC BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" "$1,078.55" $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.62 SUP HCPCS C1713 439.62 - PLATE BN 90D 20MM DSPL 60MM NS DCP TI ADLT OSTM BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.63 SUP HCPCS C1713 439.63 - PLATE BONE 90D 20MM DISPLACEMENT 65MM DCP TITANIUM ADULT BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.64 SUP HCPCS C1713 439.64 - PLATE BONE 90D 20MM DISPLACEMENT 70MM DCP TITANIUM ADULT BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.65 SUP HCPCS C1713 439.65 - PLATE BONE 90D 20MM 75MM ANGLED DCP STAINLESS STEEL ADULT BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.7 SUP HCPCS C1713 439.70 - PLATE BONE 90D 15MM DISPLACEMENT 50MM DCP TITANIUM ADULT BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.71 SUP HCPCS C1713 439.71 - PLATE BONE 90D 15MM DISPLACEMENT 55MM ANGLED DCP TITANIUM BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" "$1,078.55" "$1,078.55" N/A N/A 439.72 SUP HCPCS C1713 439.72 - PLATE BONE 90D 15MM DISPLACEMENT 60MM DCP TITANIUM ADULT BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" N/A N/A 439.73 SUP HCPCS C1713 439.73 - PLATE BONE 90D 15MM DISPLACEMENT 65MM DCP TITANIUM ADULT BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.74 SUP HCPCS C1713 439.74 - PLATE BONE 90D 15MM 70MM DCP TITANIUM ADULT ORTHOPEDIC BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" "$1,078.55" "$1,078.55" N/A N/A 439.76 SUP HCPCS C1713 439.76 - PLATE BONE 90D 15MM DISPLACEMENT 80MM DCP TITANIUM ADULT BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" N/A N/A 439.78 SUP HCPCS C1713 439.78 - PLATE BONE 90D 15MM DISPLACEMENT 40MM DCP TITANIUM ADULT BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" "$1,078.55" "$1,078.55" N/A N/A 439.8 SUP HCPCS C1713 439.80 - PLATE BONE 130D 100MM DCP TITANIUM ADULT NONSTRL OSTMY BOTH IP/OP "$1,111.00" $822.00 $220.49 "$1,110.90" $499.91 $499.91 $499.91 $499.91 "$1,110.90" "$1,110.90" "$1,110.90" $231.54 "$1,110.90" "$1,110.90" "$1,110.90" "$1,110.90" "$1,110.90" $231.52 "$1,110.90" $444.36 $657.10 "$1,110.90" "$1,110.90" "$1,110.90" "$1,110.90" $833.25 "$1,110.90" "$1,110.90" "$1,110.90" $555.45 $555.45 $879.83 "$1,110.90" $888.72 $499.91 $220.49 N/A $644.38 "$1,110.90" $666.54 "$1,110.90" $231.51 "$1,110.90" N/A N/A 439.81 SUP HCPCS C1713 439.81 - PLATE BONE 130D 105MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" "$1,078.55" "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.82 SUP HCPCS C1713 439.82 - PLATE BONE 130D 110MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" "$1,078.55" "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.83 SUP HCPCS C1713 439.83 - PLATE BONE 130D 65MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" N/A N/A 439.84 SUP HCPCS C1713 439.84 - PLATE BONE 130D 70MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" $431.42 $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" N/A N/A 439.85 SUP HCPCS C1713 439.85 - PLATE BONE 130D 75MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" "$1,078.55" $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" "$1,078.55" "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.86 SUP HCPCS C1713 439.86 - PLATE BONE 130D 80MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" "$1,078.55" $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" "$1,078.55" "$1,078.55" N/A N/A 439.87 SUP HCPCS C1713 439.87 - PLATE BONE 130D 85MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" "$1,078.55" $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" "$1,078.55" "$1,078.55" N/A N/A 439.88 SUP HCPCS C1713 439.88 - PLATE BONE 130D 90MM ANGLED DCP TITANIUM ADULT ORTHOPEDIC BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" "$1,078.55" $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" N/A N/A 439.89 SUP HCPCS C1713 439.89 - PLATE BONE 130D 95MM DCP TITANIUM ADULT ORTHOPEDIC NONSTRL BOTH IP/OP "$1,079.00" $798.00 $214.07 "$1,078.55" $485.35 $485.35 $485.35 $485.35 "$1,078.55" "$1,078.55" "$1,078.55" $224.80 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $224.78 "$1,078.55" "$1,078.55" $637.96 "$1,078.55" "$1,078.55" "$1,078.55" "$1,078.55" $809.25 "$1,078.55" "$1,078.55" "$1,078.55" $539.28 $539.28 $854.21 "$1,078.55" $862.84 $485.35 $214.07 N/A $625.82 "$1,078.55" $647.13 "$1,078.55" $224.77 "$1,078.55" N/A N/A 439.934 SUP HCPCS C1713 439.934 - PLATE BONE 81MM 4 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$2,664.00" "$1,971.00" $528.69 "$2,709.05" "$1,198.70" "$1,198.70" "$1,198.70" "$1,198.70" "$2,663.78" "$2,663.78" "$2,663.78" $555.20 "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" $555.16 "$2,663.78" "$2,709.05" "$1,313.24" "$2,663.78" "$2,709.05" "$2,663.78" "$2,663.78" "$1,998.00" "$2,663.78" "$2,663.78" "$2,663.78" "$1,331.89" "$1,331.89" "$2,109.71" "$2,663.78" "$2,131.02" "$1,198.70" $528.69 N/A "$1,545.12" "$2,663.78" "$1,598.27" "$2,663.78" $555.13 "$2,663.78" N/A N/A 439.935 SUP HCPCS C1713 439.935 - PLATE BONE 81MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,664.00" "$1,971.00" $528.69 "$2,709.05" "$1,198.70" "$1,198.70" "$1,198.70" "$1,198.70" "$2,663.78" "$2,663.78" "$2,663.78" $555.20 "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" $555.16 "$2,663.78" "$2,709.05" "$1,313.24" "$2,663.78" "$2,709.05" "$2,663.78" "$2,663.78" "$1,998.00" "$2,663.78" "$2,663.78" "$2,663.78" "$1,331.89" "$1,331.89" "$2,109.71" "$2,663.78" "$2,131.02" "$1,198.70" $528.69 N/A "$1,545.12" "$2,663.78" "$1,598.27" "$2,663.78" $555.13 "$2,663.78" N/A N/A 439.936 SUP HCPCS C1713 439.936 - PLATE BONE 107MM 6 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$2,696.50" "$1,995.00" $535.11 "$2,741.95" "$1,213.26" "$1,213.26" "$1,213.26" "$1,213.26" "$2,696.13" "$2,696.13" "$2,696.13" $561.94 "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" $561.90 "$2,696.13" "$2,741.95" "$1,329.19" "$2,696.13" "$2,741.95" "$2,696.13" "$2,696.13" "$2,022.38" "$2,696.13" "$2,696.13" "$2,696.13" "$1,348.07" "$1,348.07" "$2,135.33" "$2,696.13" "$2,156.90" "$1,213.26" $535.11 N/A "$1,563.97" "$2,696.13" "$1,617.68" "$2,696.13" $561.87 "$2,696.13" N/A N/A 439.937 SUP HCPCS C1713 439.937 - PLATE BONE 107MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,696.50" "$1,995.00" $535.11 "$2,741.95" "$1,213.26" "$1,213.26" "$1,213.26" "$1,213.26" "$2,696.13" "$2,696.13" "$2,696.13" $561.94 "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" $561.90 "$2,696.13" "$2,741.95" "$1,329.19" "$2,696.13" "$2,741.95" "$2,696.13" "$2,696.13" "$2,022.38" "$2,696.13" "$2,696.13" "$2,696.13" "$1,348.07" "$1,348.07" "$2,135.33" "$2,696.13" "$2,156.90" "$1,213.26" $535.11 N/A "$1,563.97" "$2,696.13" "$1,617.68" "$2,696.13" "$2,696.13" "$2,696.13" N/A N/A 439.938 SUP HCPCS C1713 439.938 - PLATE BONE 133MM 8 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$2,727.50" "$2,018.00" $541.25 "$2,773.40" "$1,227.17" "$1,227.17" "$1,227.17" "$1,227.17" "$2,727.05" "$2,727.05" "$2,727.05" $568.39 "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" $568.35 "$2,727.05" "$2,773.40" "$1,344.44" "$2,727.05" "$2,773.40" "$2,727.05" "$2,727.05" "$2,045.63" "$2,727.05" "$2,727.05" "$2,727.05" "$1,363.53" "$1,363.53" "$2,159.82" "$2,727.05" "$2,181.64" "$1,227.17" $541.25 N/A "$1,581.95" "$2,727.05" "$1,636.23" "$2,727.05" "$2,727.05" "$2,727.05" N/A N/A 439.939 SUP HCPCS C1713 439.939 - PLATE BONE 133MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,727.50" "$2,018.00" $541.25 "$2,773.40" "$1,227.17" "$1,227.17" "$1,227.17" "$1,227.17" "$2,727.05" "$2,727.05" "$2,727.05" $568.39 "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" $568.35 "$2,727.05" "$2,773.40" "$1,344.44" "$2,727.05" "$2,773.40" "$2,727.05" "$2,727.05" "$2,045.63" "$2,727.05" "$2,727.05" "$2,727.05" "$1,363.53" "$1,363.53" "$2,159.82" "$2,727.05" "$2,181.64" "$1,227.17" $541.25 N/A "$1,581.95" "$2,727.05" "$1,636.23" "$2,727.05" $568.32 "$2,727.05" N/A N/A 439.94 SUP HCPCS C1713 439.940 - PLATE BONE 159MM 10 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$2,676.50" "$1,981.00" $531.17 "$2,803.43" "$1,204.33" "$1,204.33" "$1,204.33" "$1,204.33" "$2,676.28" "$2,676.28" "$2,676.28" $557.80 "$2,676.28" "$2,676.28" "$2,676.28" "$2,676.28" "$2,676.28" $557.77 "$2,676.28" "$1,121.37" "$1,319.41" "$2,676.28" "$2,803.43" "$2,676.28" "$2,676.28" "$2,007.38" "$2,676.28" "$2,676.28" "$2,676.28" "$1,338.14" "$1,338.14" "$2,119.61" "$2,676.28" "$2,141.02" "$1,204.33" $531.17 N/A "$1,552.37" "$2,676.28" "$2,676.28" "$2,676.28" $557.74 "$2,676.28" N/A N/A 439.941 SUP HCPCS C1713 439.941 - PLATE BONE 159MM 10 HOLE TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,757.00" "$2,040.00" $547.11 "$2,803.43" "$1,240.46" "$1,240.46" "$1,240.46" "$1,240.46" "$2,756.58" "$2,756.58" "$2,756.58" $574.54 "$2,756.58" "$2,756.58" "$2,756.58" "$2,756.58" "$2,756.58" $574.50 "$2,756.58" "$1,121.37" "$1,358.99" "$2,756.58" "$2,803.43" "$2,756.58" "$2,756.58" "$2,067.75" "$2,756.58" "$2,756.58" "$2,756.58" "$1,378.29" "$1,378.29" "$2,183.21" "$2,756.58" "$2,205.26" "$1,240.46" $547.11 N/A "$1,599.06" "$2,756.58" "$2,756.58" "$2,756.58" $574.47 "$2,756.58" N/A N/A 439.942 SUP HCPCS C1713 439.942 - PLATE BONE 185MM 12 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$2,793.50" "$2,067.00" $554.36 "$2,840.58" "$1,256.90" "$1,256.90" "$1,256.90" "$1,256.90" "$2,793.10" "$2,793.10" "$2,793.10" $582.15 "$2,793.10" "$2,793.10" "$2,793.10" "$2,793.10" "$2,793.10" $582.11 "$2,793.10" "$1,136.23" "$1,377.00" "$2,793.10" "$2,840.58" "$2,793.10" "$2,793.10" "$2,095.13" "$2,793.10" "$2,793.10" "$2,793.10" "$1,396.55" "$1,396.55" "$2,212.14" "$2,793.10" "$2,234.48" "$1,256.90" $554.36 N/A "$1,620.23" "$2,793.10" "$2,793.10" "$2,793.10" $582.08 "$2,793.10" N/A N/A 439.943 SUP HCPCS C1713 439.943 - PLATE BONE 185MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,793.50" "$2,067.00" $554.36 "$2,840.58" "$1,256.90" "$1,256.90" "$1,256.90" "$1,256.90" "$2,793.10" "$2,793.10" "$2,793.10" $582.15 "$2,793.10" "$2,793.10" "$2,793.10" "$2,793.10" "$2,793.10" $582.11 "$2,793.10" "$2,840.58" "$1,377.00" "$2,793.10" "$2,840.58" "$2,793.10" "$2,793.10" "$2,095.13" "$2,793.10" "$2,793.10" "$2,793.10" "$1,396.55" "$1,396.55" "$2,212.14" "$2,793.10" "$2,234.48" "$1,256.90" $554.36 N/A "$1,620.23" "$2,793.10" "$1,675.86" "$2,793.10" $582.08 "$2,793.10" N/A N/A 439.944 SUP HCPCS C1713 439.944 - PLATE BONE 211MM 14 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$2,823.00" "$2,089.00" $560.22 "$2,870.60" "$1,270.18" "$1,270.18" "$1,270.18" "$1,270.18" "$2,822.63" "$2,822.63" "$2,822.63" $588.31 "$2,822.63" "$2,822.63" "$2,822.63" "$2,822.63" "$2,822.63" $588.27 "$2,822.63" "$1,148.24" "$1,391.56" "$2,822.63" "$2,870.60" "$2,822.63" "$2,822.63" "$2,117.25" "$2,822.63" "$2,822.63" "$2,822.63" "$1,411.32" "$1,411.32" "$2,235.52" "$2,822.63" "$2,258.10" "$1,270.18" $560.22 N/A "$1,637.34" "$2,822.63" "$1,693.58" "$2,822.63" "$2,822.63" "$2,822.63" N/A N/A 439.945 SUP HCPCS C1713 439.945 - PLATE BONE 211MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,823.00" "$2,089.00" $560.22 "$2,870.60" "$1,270.18" "$1,270.18" "$1,270.18" "$1,270.18" "$2,822.63" "$2,822.63" "$2,822.63" $588.31 "$2,822.63" "$2,822.63" "$2,822.63" "$2,822.63" "$2,822.63" $588.27 "$2,822.63" "$1,148.24" "$1,391.56" "$2,822.63" "$2,870.60" "$2,822.63" "$2,822.63" "$2,117.25" "$2,822.63" "$2,822.63" "$2,822.63" "$1,411.32" "$1,411.32" "$2,235.52" "$2,822.63" "$2,258.10" "$1,270.18" $560.22 N/A "$1,637.34" "$2,822.63" "$2,822.63" "$2,822.63" $588.24 "$2,822.63" N/A N/A 439.946 SUP HCPCS C1713 439.946 - PLATE BONE 237MM 16 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$2,922.50" "$2,163.00" $580.03 "$2,972.10" "$1,315.09" "$1,315.09" "$1,315.09" "$1,315.09" "$2,922.43" "$2,922.43" "$2,922.43" $609.11 "$2,922.43" "$2,922.43" "$2,922.43" "$2,922.43" "$2,922.43" $609.07 "$2,922.43" "$1,188.84" "$1,440.76" "$2,922.43" "$2,972.10" "$2,922.43" "$2,922.43" "$2,191.88" "$2,922.43" "$2,922.43" "$2,922.43" "$1,461.22" "$1,461.22" "$2,314.56" "$2,922.43" "$2,337.94" "$1,315.09" $580.03 N/A "$1,695.05" "$2,922.43" "$1,753.46" "$2,922.43" "$2,922.43" "$2,922.43" N/A N/A 439.947 SUP HCPCS C1713 439.947 - PLATE BONE 237MM 16 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,922.50" "$2,163.00" $580.03 "$2,972.10" "$1,315.09" "$1,315.09" "$1,315.09" "$1,315.09" "$2,922.43" "$2,922.43" "$2,922.43" $609.11 "$2,922.43" "$2,922.43" "$2,922.43" "$2,922.43" "$2,922.43" $609.07 "$2,922.43" "$2,972.10" "$1,440.76" "$2,922.43" "$2,972.10" "$2,922.43" "$2,922.43" "$2,191.88" "$2,922.43" "$2,922.43" "$2,922.43" "$1,461.22" "$1,461.22" "$2,314.56" "$2,922.43" "$2,337.94" "$1,315.09" $580.03 N/A "$1,695.05" "$2,922.43" "$1,753.46" "$2,922.43" $609.03 "$2,922.43" N/A N/A 439.954 SUP HCPCS C1713 439.954 - PLATE BONE 94MM 4 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$2,655.50" "$1,965.00" $527.02 "$2,700.50" "$1,194.91" "$1,194.91" "$1,194.91" "$1,194.91" "$2,655.35" "$2,655.35" "$2,655.35" $553.44 "$2,655.35" "$2,655.35" "$2,655.35" "$2,655.35" "$2,655.35" $553.40 "$2,655.35" "$2,700.50" "$1,309.09" "$2,655.35" "$2,700.50" "$2,655.35" "$2,655.35" "$1,991.63" "$2,655.35" "$2,655.35" "$2,655.35" "$1,327.68" "$1,327.68" "$2,103.04" "$2,655.35" "$2,124.28" "$1,194.91" $527.02 N/A "$1,540.19" "$2,655.35" "$1,593.21" "$2,655.35" $553.37 "$2,655.35" N/A N/A 439.955 SUP HCPCS C1713 439.955 - PLATE BONE 94MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,655.50" "$1,965.00" $527.02 "$2,700.50" "$1,194.91" "$1,194.91" "$1,194.91" "$1,194.91" "$2,655.35" "$2,655.35" "$2,655.35" $553.44 "$2,655.35" "$2,655.35" "$2,655.35" "$2,655.35" "$2,655.35" $553.40 "$2,655.35" "$2,700.50" "$1,309.09" "$2,655.35" "$2,700.50" "$2,655.35" "$2,655.35" "$1,991.63" "$2,655.35" "$2,655.35" "$2,655.35" "$1,327.68" "$1,327.68" "$2,103.04" "$2,655.35" "$2,124.28" "$1,194.91" $527.02 N/A "$1,540.19" "$2,655.35" "$2,655.35" "$2,655.35" "$2,655.35" "$2,655.35" N/A N/A 439.956 SUP HCPCS C1713 439.956 - PLATE BONE 119MM 6 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$2,690.50" "$1,991.00" $534.00 "$2,736.25" "$1,210.73" "$1,210.73" "$1,210.73" "$1,210.73" "$2,690.50" "$2,690.50" "$2,690.50" $560.77 "$2,690.50" "$2,690.50" "$2,690.50" "$2,690.50" "$2,690.50" $560.73 "$2,690.50" "$2,736.25" "$1,326.42" "$2,690.50" "$2,736.25" "$2,690.50" "$2,690.50" "$2,017.88" "$2,690.50" "$2,690.50" "$2,690.50" "$1,345.25" "$1,345.25" "$2,130.88" "$2,690.50" "$2,152.40" "$1,210.73" $534.00 N/A "$1,560.49" "$2,690.50" "$2,690.50" "$2,690.50" $560.70 "$2,690.50" N/A N/A 439.957 SUP HCPCS C1713 439.957 - PLATE BONE 119MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,690.50" "$1,991.00" $534.00 "$2,736.25" "$1,210.73" "$1,210.73" "$1,210.73" "$1,210.73" "$2,690.50" "$2,690.50" "$2,690.50" $560.77 "$2,690.50" "$2,690.50" "$2,690.50" "$2,690.50" "$2,690.50" $560.73 "$2,690.50" "$2,736.25" "$1,326.42" "$2,690.50" "$2,736.25" "$2,690.50" "$2,690.50" "$2,017.88" "$2,690.50" "$2,690.50" "$2,690.50" "$1,345.25" "$1,345.25" "$2,130.88" "$2,690.50" "$2,152.40" "$1,210.73" $534.00 N/A "$1,560.49" "$2,690.50" "$2,690.50" "$2,690.50" $560.70 "$2,690.50" N/A N/A 439.958 SUP HCPCS C1713 439.958 - PLATE BONE 145MM 8 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$2,723.00" "$2,015.00" $540.41 "$2,769.13" "$1,225.27" "$1,225.27" "$1,225.27" "$1,225.27" "$2,722.83" "$2,722.83" "$2,722.83" $567.51 "$2,722.83" "$2,722.83" "$2,722.83" "$2,722.83" "$2,722.83" $567.47 "$2,722.83" "$2,769.13" "$1,342.36" "$2,722.83" "$2,769.13" "$2,722.83" "$2,722.83" "$2,042.25" "$2,722.83" "$2,722.83" "$2,722.83" "$1,361.42" "$1,361.42" "$2,156.48" "$2,722.83" "$2,178.26" "$1,225.27" $540.41 N/A "$1,579.34" "$2,722.83" "$2,722.83" "$2,722.83" $567.44 "$2,722.83" N/A N/A 439.959 SUP HCPCS C1713 439.959 - PLATE BONE 145MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,723.00" "$2,015.00" $540.41 "$2,769.13" "$1,225.27" "$1,225.27" "$1,225.27" "$1,225.27" "$2,722.83" "$2,722.83" "$2,722.83" $567.51 "$2,722.83" "$2,722.83" "$2,722.83" "$2,722.83" "$2,722.83" $567.47 "$2,722.83" "$2,769.13" "$1,342.36" "$2,722.83" "$2,769.13" "$2,722.83" "$2,722.83" "$2,042.25" "$2,722.83" "$2,722.83" "$2,722.83" "$1,361.42" "$1,361.42" "$2,156.48" "$2,722.83" "$2,178.26" "$1,225.27" $540.41 N/A "$1,579.34" "$2,722.83" "$2,722.83" "$2,722.83" $567.44 "$2,722.83" N/A N/A 439.96 SUP HCPCS C1713 439.960 - PLATE BONE 171MM 10 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$2,674.00" "$1,979.00" $530.63 "$2,800.58" "$1,203.10" "$1,203.10" "$1,203.10" "$1,203.10" "$2,673.55" "$2,673.55" "$2,673.55" $557.23 "$2,673.55" "$2,673.55" "$2,673.55" "$2,673.55" "$2,673.55" $557.20 "$2,673.55" "$2,800.58" "$1,318.06" "$2,673.55" "$2,800.58" "$2,673.55" "$2,673.55" "$2,005.50" "$2,673.55" "$2,673.55" "$2,673.55" "$1,336.78" "$1,336.78" "$2,117.45" "$2,673.55" "$2,138.84" "$1,203.10" $530.63 N/A "$1,550.92" "$2,673.55" "$2,673.55" "$2,673.55" $557.17 "$2,673.55" N/A N/A 439.961 SUP HCPCS C1713 439.961 - PLATE BONE 171MM 10 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,754.00" "$2,038.00" $546.55 "$2,800.58" "$1,239.19" "$1,239.19" "$1,239.19" "$1,239.19" "$2,753.75" "$2,753.75" "$2,753.75" $573.95 "$2,753.75" "$2,753.75" "$2,753.75" "$2,753.75" "$2,753.75" $573.91 "$2,753.75" "$2,800.58" "$1,357.60" "$2,753.75" "$2,800.58" "$2,753.75" "$2,753.75" "$2,065.50" "$2,753.75" "$2,753.75" "$2,753.75" "$1,376.88" "$1,376.88" "$2,180.97" "$2,753.75" "$2,203.00" "$1,239.19" $546.55 N/A "$1,597.32" "$2,753.75" "$2,753.75" "$2,753.75" $573.88 "$2,753.75" N/A N/A 439.962 SUP HCPCS C1713 439.962 - PLATE BONE 197MM 12 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$2,783.50" "$2,060.00" $552.41 "$2,830.60" "$1,252.48" "$1,252.48" "$1,252.48" "$1,252.48" "$2,783.28" "$2,783.28" "$2,783.28" $580.11 "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" $580.07 "$2,783.28" "$2,830.60" "$1,372.16" "$2,783.28" "$2,830.60" "$2,783.28" "$2,783.28" "$2,087.63" "$2,783.28" "$2,783.28" "$2,783.28" "$1,391.64" "$1,391.64" "$2,204.36" "$2,783.28" "$2,226.62" "$1,252.48" $552.41 N/A "$1,614.43" "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" N/A N/A 439.963 SUP HCPCS C1713 439.963 - PLATE BONE 197MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,783.50" "$2,060.00" $552.41 "$2,830.60" "$1,252.48" "$1,252.48" "$1,252.48" "$1,252.48" "$2,783.28" "$2,783.28" "$2,783.28" $580.11 "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" $580.07 "$2,783.28" "$2,830.60" "$1,372.16" "$2,783.28" "$2,830.60" "$2,783.28" "$2,783.28" "$2,087.63" "$2,783.28" "$2,783.28" "$2,783.28" "$1,391.64" "$1,391.64" "$2,204.36" "$2,783.28" "$2,226.62" "$1,252.48" $552.41 N/A "$1,614.43" "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" N/A N/A 439.964 SUP HCPCS C1713 439.964 - PLATE BONE 223MM 14 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$2,817.00" "$2,085.00" $559.10 "$2,864.90" "$1,267.65" "$1,267.65" "$1,267.65" "$1,267.65" "$2,817.00" "$2,817.00" "$2,817.00" $587.13 "$2,817.00" "$2,817.00" "$2,817.00" "$2,817.00" "$2,817.00" $587.09 "$2,817.00" "$2,864.90" "$1,388.78" "$2,817.00" "$2,864.90" "$2,817.00" "$2,817.00" "$2,112.75" "$2,817.00" "$2,817.00" "$2,817.00" "$1,408.50" "$1,408.50" "$2,231.06" "$2,817.00" "$2,253.60" "$1,267.65" $559.10 N/A "$1,633.86" "$2,817.00" "$2,817.00" "$2,817.00" $587.06 "$2,817.00" N/A N/A 439.965 SUP HCPCS C1713 439.965 - PLATE BONE 223MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,817.00" "$2,085.00" $559.10 "$2,864.90" "$1,267.65" "$1,267.65" "$1,267.65" "$1,267.65" "$2,817.00" "$2,817.00" "$2,817.00" $587.13 "$2,817.00" "$2,817.00" "$2,817.00" "$2,817.00" "$2,817.00" $587.09 "$2,817.00" "$2,864.90" "$1,388.78" "$2,817.00" "$2,864.90" "$2,817.00" "$2,817.00" "$2,112.75" "$2,817.00" "$2,817.00" "$2,817.00" "$1,408.50" "$1,408.50" "$2,231.06" "$2,817.00" "$2,253.60" "$1,267.65" $559.10 N/A "$1,633.86" "$2,817.00" "$2,817.00" "$2,817.00" $587.06 "$2,817.00" N/A N/A 439.966 SUP HCPCS C1713 439.966 - PLATE BONE 249MM 16 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$2,915.50" "$2,157.00" $578.63 "$2,964.95" "$1,311.93" "$1,311.93" "$1,311.93" "$1,311.93" "$2,915.40" "$2,915.40" "$2,915.40" $607.64 "$2,915.40" "$2,915.40" "$2,915.40" "$2,915.40" "$2,915.40" $607.60 "$2,915.40" "$2,964.95" "$1,437.29" "$2,915.40" "$2,964.95" "$2,915.40" "$2,915.40" "$2,186.63" "$2,915.40" "$2,915.40" "$2,915.40" "$1,457.70" "$1,457.70" "$2,309.00" "$2,915.40" "$2,332.32" "$1,311.93" $578.63 N/A "$1,690.99" "$2,915.40" "$2,915.40" "$2,915.40" $607.57 "$2,915.40" N/A N/A 439.967 SUP HCPCS C1713 439.967 - PLATE BONE 249MM 16 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,915.50" "$2,157.00" $578.63 "$2,964.95" "$1,311.93" "$1,311.93" "$1,311.93" "$1,311.93" "$2,915.40" "$2,915.40" "$2,915.40" $607.64 "$2,915.40" "$2,915.40" "$2,915.40" "$2,915.40" "$2,915.40" $607.60 "$2,915.40" "$2,964.95" "$1,437.29" "$2,915.40" "$2,964.95" "$2,915.40" "$2,915.40" "$2,186.63" "$2,915.40" "$2,915.40" "$2,915.40" "$1,457.70" "$1,457.70" "$2,309.00" "$2,915.40" "$2,332.32" "$1,311.93" $578.63 N/A "$1,690.99" "$2,915.40" "$2,915.40" "$2,915.40" "$2,915.40" "$2,915.40" N/A N/A 439.968 SUP HCPCS C1713 439.968 - PLATE BONE 275MM 18 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$3,019.50" "$2,234.00" $599.28 "$3,070.75" "$1,358.74" "$1,358.74" "$1,358.74" "$1,358.74" "$3,019.43" "$3,019.43" "$3,019.43" $629.32 "$3,019.43" "$3,019.43" "$3,019.43" "$3,019.43" "$3,019.43" $629.28 "$3,019.43" "$3,070.75" "$1,488.58" "$3,019.43" "$3,070.75" "$3,019.43" "$3,019.43" "$2,264.63" "$3,019.43" "$3,019.43" "$3,019.43" "$1,509.72" "$1,509.72" "$2,391.39" "$3,019.43" "$2,415.54" "$1,358.74" $599.28 N/A "$1,751.31" "$3,019.43" "$3,019.43" "$3,019.43" "$3,019.43" "$3,019.43" N/A N/A 439.969 SUP HCPCS C1713 439.969 - PLATE BONE 275MM 18 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$3,111.00" "$2,302.00" $617.42 "$3,163.68" "$1,399.86" "$1,399.86" "$1,399.86" "$1,399.86" "$3,110.80" "$3,110.80" "$3,110.80" $648.37 "$3,110.80" "$3,110.80" "$3,110.80" "$3,110.80" "$3,110.80" $648.32 "$3,110.80" "$3,163.68" "$1,533.62" "$3,110.80" "$3,163.68" "$3,110.80" "$3,110.80" "$2,333.25" "$3,110.80" "$3,110.80" "$3,110.80" "$1,555.40" "$1,555.40" "$2,463.75" "$3,110.80" "$2,488.64" "$1,399.86" $617.42 N/A "$1,804.38" "$3,110.80" "$3,110.80" "$3,110.80" $648.29 "$3,110.80" N/A N/A 439.97 SUP HCPCS C1713 439.970 - PLATE BONE 301MM 20 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$3,028.50" "$2,241.00" $601.06 "$3,172.25" "$1,362.77" "$1,362.77" "$1,362.77" "$1,362.77" "$3,028.38" "$3,028.38" "$3,028.38" $631.19 "$3,028.38" "$3,028.38" "$3,028.38" "$3,028.38" "$3,028.38" $631.15 "$3,028.38" "$1,268.90" "$1,492.99" "$3,028.38" "$3,172.25" "$3,028.38" "$3,028.38" "$2,271.38" "$3,028.38" "$3,028.38" "$3,028.38" "$1,514.19" "$1,514.19" "$2,398.48" "$3,028.38" "$2,422.70" "$1,362.77" $601.06 N/A "$1,756.53" "$3,028.38" "$3,028.38" "$3,028.38" "$3,028.38" "$3,028.38" N/A N/A 439.971 SUP HCPCS C1713 439.971 - PLATE BONE 301MM 20 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$3,119.50" "$2,308.00" $619.09 "$3,172.25" "$1,403.65" "$1,403.65" "$1,403.65" "$1,403.65" "$3,119.23" "$3,119.23" "$3,119.23" $650.13 "$3,119.23" "$3,119.23" "$3,119.23" "$3,119.23" "$3,119.23" $650.08 "$3,119.23" "$1,268.90" "$1,537.78" "$3,119.23" "$3,172.25" "$3,119.23" "$3,119.23" "$2,339.63" "$3,119.23" "$3,119.23" "$3,119.23" "$1,559.62" "$1,559.62" "$2,470.43" "$3,119.23" "$2,495.38" "$1,403.65" $619.09 N/A "$1,809.31" "$3,119.23" "$3,119.23" "$3,119.23" "$3,119.23" "$3,119.23" N/A N/A 439.984 SUP HCPCS C1713 439.984 - PLATE BONE 106MM 4 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$2,665.50" "$1,972.00" $528.98 "$2,710.50" "$1,199.34" "$1,199.34" "$1,199.34" "$1,199.34" "$2,665.20" "$2,665.20" "$2,665.20" $555.49 "$2,665.20" "$2,665.20" "$2,665.20" "$2,665.20" "$2,665.20" $555.46 "$2,665.20" "$1,084.20" "$1,313.94" "$2,665.20" "$2,710.50" "$2,665.20" "$2,665.20" "$1,999.13" "$2,665.20" "$2,665.20" "$2,665.20" "$1,332.60" "$1,332.60" "$2,110.84" "$2,665.20" "$2,132.16" "$1,199.34" $528.98 N/A "$1,545.99" "$2,665.20" "$2,665.20" "$2,665.20" $555.43 "$2,665.20" N/A N/A 439.985 SUP HCPCS C1713 439.985 - PLATE BONE 106MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,665.50" "$1,972.00" $528.98 "$2,710.50" "$1,199.34" "$1,199.34" "$1,199.34" "$1,199.34" "$2,665.20" "$2,665.20" "$2,665.20" $555.49 "$2,665.20" "$2,665.20" "$2,665.20" "$2,665.20" "$2,665.20" $555.46 "$2,665.20" "$2,710.50" "$1,313.94" "$2,665.20" "$2,710.50" "$2,665.20" "$2,665.20" "$1,999.13" "$2,665.20" "$2,665.20" "$2,665.20" "$1,332.60" "$1,332.60" "$2,110.84" "$2,665.20" "$2,132.16" "$1,199.34" $528.98 N/A "$1,545.99" "$2,665.20" "$2,665.20" "$2,665.20" $555.43 "$2,665.20" N/A N/A 439.986 SUP HCPCS C1713 439.986 - PLATE BONE 142MM 6 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$2,698.00" "$1,997.00" $535.39 "$2,743.38" "$1,213.89" "$1,213.89" "$1,213.89" "$1,213.89" "$2,697.53" "$2,697.53" "$2,697.53" $562.23 "$2,697.53" "$2,697.53" "$2,697.53" "$2,697.53" "$2,697.53" $562.19 "$2,697.53" "$1,097.35" "$1,329.88" "$2,697.53" "$2,743.38" "$2,697.53" "$2,697.53" "$2,023.50" "$2,697.53" "$2,697.53" "$2,697.53" "$1,348.77" "$1,348.77" "$2,136.44" "$2,697.53" "$2,158.02" "$1,213.89" $535.39 N/A "$1,564.84" "$2,697.53" "$2,697.53" "$2,697.53" $562.17 "$2,697.53" N/A N/A 439.987 SUP HCPCS C1713 439.987 - PLATE BONE 142MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,698.00" "$1,997.00" $535.39 "$2,743.38" "$1,213.89" "$1,213.89" "$1,213.89" "$1,213.89" "$2,697.53" "$2,697.53" "$2,697.53" $562.23 "$2,697.53" "$2,697.53" "$2,697.53" "$2,697.53" "$2,697.53" $562.19 "$2,697.53" "$1,097.35" "$1,329.88" "$2,697.53" "$2,743.38" "$2,697.53" "$2,697.53" "$2,023.50" "$2,697.53" "$2,697.53" "$2,697.53" "$1,348.77" "$1,348.77" "$2,136.44" "$2,697.53" "$2,158.02" "$1,213.89" $535.39 N/A "$1,564.84" "$2,697.53" "$2,697.53" "$2,697.53" $562.17 "$2,697.53" N/A N/A 439.988 SUP HCPCS C1713 439.988 - PLATE BONE 178MM 8 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$2,728.50" "$2,019.00" $541.53 "$2,774.83" "$1,227.80" "$1,227.80" "$1,227.80" "$1,227.80" "$2,728.45" "$2,728.45" "$2,728.45" $568.68 "$2,728.45" "$2,728.45" "$2,728.45" "$2,728.45" "$2,728.45" $568.64 "$2,728.45" "$1,109.93" "$1,345.13" "$2,728.45" "$2,774.83" "$2,728.45" "$2,728.45" "$2,046.38" "$2,728.45" "$2,728.45" "$2,728.45" "$1,364.23" "$1,364.23" "$2,160.93" "$2,728.45" "$2,182.76" "$1,227.80" $541.53 N/A "$1,582.53" "$2,728.45" "$1,637.07" "$2,728.45" $568.61 "$2,728.45" N/A N/A 439.989 SUP HCPCS C1713 439.989 - PLATE BONE 178MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,728.50" "$2,019.00" $541.53 "$2,774.83" "$1,227.80" "$1,227.80" "$1,227.80" "$1,227.80" "$2,728.45" "$2,728.45" "$2,728.45" $568.68 "$2,728.45" "$2,728.45" "$2,728.45" "$2,728.45" "$2,728.45" $568.64 "$2,728.45" "$1,109.93" "$1,345.13" "$2,728.45" "$2,774.83" "$2,728.45" "$2,728.45" "$2,046.38" "$2,728.45" "$2,728.45" "$2,728.45" "$1,364.23" "$1,364.23" "$2,160.93" "$2,728.45" "$2,182.76" "$1,227.80" $541.53 N/A "$1,582.53" "$2,728.45" "$1,637.07" "$2,728.45" $568.61 "$2,728.45" N/A N/A 439.99 SUP HCPCS C1713 439.990 - PLATE BONE 214MM 10 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$2,678.00" "$1,982.00" $531.45 "$2,804.85" "$1,204.94" "$1,204.94" "$1,204.94" "$1,204.94" "$2,677.65" "$2,677.65" "$2,677.65" $558.09 "$2,677.65" "$2,677.65" "$2,677.65" "$2,677.65" "$2,677.65" $558.05 "$2,677.65" "$1,121.94" "$1,320.08" "$2,677.65" "$2,804.85" "$2,677.65" "$2,677.65" "$2,008.50" "$2,677.65" "$2,677.65" "$2,677.65" "$1,338.83" "$1,338.83" "$2,120.70" "$2,677.65" "$2,142.12" "$1,204.94" $531.45 N/A "$1,553.24" "$2,677.65" "$1,606.59" "$2,677.65" $558.02 "$2,677.65" N/A N/A 439.991 SUP HCPCS C1713 439.991 - PLATE BONE 214MM 10 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,758.00" "$2,041.00" $547.39 "$2,804.85" "$1,241.09" "$1,241.09" "$1,241.09" "$1,241.09" "$2,757.98" "$2,757.98" "$2,757.98" $574.83 "$2,757.98" "$2,757.98" "$2,757.98" "$2,757.98" "$2,757.98" $574.79 "$2,757.98" "$1,121.94" "$1,359.68" "$2,757.98" "$2,804.85" "$2,757.98" "$2,757.98" "$2,068.50" "$2,757.98" "$2,757.98" "$2,757.98" "$1,378.99" "$1,378.99" "$2,184.32" "$2,757.98" "$2,206.38" "$1,241.09" $547.39 N/A "$1,599.64" "$2,757.98" "$2,757.98" "$2,757.98" $574.76 "$2,757.98" N/A N/A 439.992 SUP HCPCS C1713 439.992 - PLATE BONE 250MM 12 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$2,793.50" "$2,067.00" $554.36 "$2,840.58" "$1,256.90" "$1,256.90" "$1,256.90" "$1,256.90" "$2,793.10" "$2,793.10" "$2,793.10" $582.15 "$2,793.10" "$2,793.10" "$2,793.10" "$2,793.10" "$2,793.10" $582.11 "$2,793.10" "$1,136.23" "$1,377.00" "$2,793.10" "$2,840.58" "$2,793.10" "$2,793.10" "$2,095.13" "$2,793.10" "$2,793.10" "$2,793.10" "$1,396.55" "$1,396.55" "$2,212.14" "$2,793.10" "$2,234.48" "$1,256.90" $554.36 N/A "$1,620.23" "$2,793.10" "$2,793.10" "$2,793.10" $582.08 "$2,793.10" N/A N/A 439.993 SUP HCPCS C1713 439.993 - PLATE BONE 250MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,793.50" "$2,067.00" $554.36 "$2,840.58" "$1,256.90" "$1,256.90" "$1,256.90" "$1,256.90" "$2,793.10" "$2,793.10" "$2,793.10" $582.15 "$2,793.10" "$2,793.10" "$2,793.10" "$2,793.10" "$2,793.10" $582.11 "$2,793.10" "$1,136.23" "$1,377.00" "$2,793.10" "$2,840.58" "$2,793.10" "$2,793.10" "$2,095.13" "$2,793.10" "$2,793.10" "$2,793.10" "$1,396.55" "$1,396.55" "$2,212.14" "$2,793.10" "$2,234.48" "$1,256.90" $554.36 N/A "$1,620.23" "$2,793.10" "$2,793.10" "$2,793.10" "$2,793.10" "$2,793.10" N/A N/A 439.994 SUP HCPCS C1713 439.994 - PLATE BONE 286MM 14 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$2,823.00" "$2,089.00" $560.22 "$2,870.60" "$1,270.18" "$1,270.18" "$1,270.18" "$1,270.18" "$2,822.63" "$2,822.63" "$2,822.63" $588.31 "$2,822.63" "$2,822.63" "$2,822.63" "$2,822.63" "$2,822.63" $588.27 "$2,822.63" "$1,148.24" "$1,391.56" "$2,822.63" "$2,870.60" "$2,822.63" "$2,822.63" "$2,117.25" "$2,822.63" "$2,822.63" "$2,822.63" "$1,411.32" "$1,411.32" "$2,235.52" "$2,822.63" "$2,258.10" "$1,270.18" $560.22 N/A "$1,637.34" "$2,822.63" "$2,822.63" "$2,822.63" "$2,822.63" "$2,822.63" N/A N/A 439.995 SUP HCPCS C1713 439.995 - PLATE BONE 286MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,823.00" "$2,089.00" $560.22 "$2,870.60" "$1,270.18" "$1,270.18" "$1,270.18" "$1,270.18" "$2,822.63" "$2,822.63" "$2,822.63" $588.31 "$2,822.63" "$2,822.63" "$2,822.63" "$2,822.63" "$2,822.63" $588.27 "$2,822.63" "$1,148.24" "$1,391.56" "$2,822.63" "$2,870.60" "$2,822.63" "$2,822.63" "$2,117.25" "$2,822.63" "$2,822.63" "$2,822.63" "$1,411.32" "$1,411.32" "$2,235.52" "$2,822.63" "$2,258.10" "$1,270.18" $560.22 N/A "$1,637.34" "$2,822.63" "$1,693.58" "$2,822.63" $588.24 "$2,822.63" N/A N/A 439.996 SUP HCPCS C1713 439.996 - PLATE BONE 322MM 16 HOLE LCP TITANIUM TIBIA RIGHT MEDIAL BOTH IP/OP "$2,851.00" "$2,110.00" $565.80 "$2,899.23" "$1,282.84" "$1,282.84" "$1,282.84" "$1,282.84" "$2,850.75" "$2,850.75" "$2,850.75" $594.17 "$2,850.75" "$2,850.75" "$2,850.75" "$2,850.75" "$2,850.75" $594.13 "$2,850.75" "$1,159.69" "$1,405.42" "$2,850.75" "$2,899.23" "$2,850.75" "$2,850.75" "$2,138.25" "$2,850.75" "$2,850.75" "$2,850.75" "$1,425.38" "$1,425.38" "$2,257.79" "$2,850.75" "$2,280.60" "$1,282.84" $565.80 N/A "$1,653.58" "$2,850.75" "$1,710.45" "$2,850.75" $594.10 "$2,850.75" N/A N/A 439.997 SUP HCPCS C1713 439.997 - PLATE BONE 322MM 16 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,851.00" "$2,110.00" $565.80 "$2,899.23" "$1,282.84" "$1,282.84" "$1,282.84" "$1,282.84" "$2,850.75" "$2,850.75" "$2,850.75" $594.17 "$2,850.75" "$2,850.75" "$2,850.75" "$2,850.75" "$2,850.75" $594.13 "$2,850.75" "$1,159.69" "$1,405.42" "$2,850.75" "$2,899.23" "$2,850.75" "$2,850.75" "$2,138.25" "$2,850.75" "$2,850.75" "$2,850.75" "$1,425.38" "$1,425.38" "$2,257.79" "$2,850.75" "$2,280.60" "$1,282.84" $565.80 N/A "$1,653.58" "$2,850.75" "$1,710.45" "$2,850.75" $594.10 "$2,850.75" N/A N/A 440.036 SUP HCPCS C1713 440.036 - PLATE BONE 82MM 4 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$2,667.00" "$1,974.00" $529.25 "$2,711.93" "$1,199.97" "$1,199.97" "$1,199.97" "$1,199.97" "$2,666.60" "$2,666.60" "$2,666.60" $555.79 "$2,666.60" "$2,666.60" "$2,666.60" "$2,666.60" "$2,666.60" $555.75 "$2,666.60" "$1,084.77" "$1,314.63" "$2,666.60" "$2,711.93" "$2,666.60" "$2,666.60" "$2,000.25" "$2,666.60" "$2,666.60" "$2,666.60" "$1,333.30" "$1,333.30" "$2,111.95" "$2,666.60" "$2,133.28" "$1,199.97" $529.25 N/A "$1,546.86" "$2,666.60" "$1,599.96" "$2,666.60" $555.72 "$2,666.60" N/A N/A 440.037 SUP HCPCS C1713 440.037 - PLATE BONE 82MM 4 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,667.00" "$1,974.00" $529.25 "$2,711.93" "$1,199.97" "$1,199.97" "$1,199.97" "$1,199.97" "$2,666.60" "$2,666.60" "$2,666.60" $555.79 "$2,666.60" "$2,666.60" "$2,666.60" "$2,666.60" "$2,666.60" $555.75 "$2,666.60" "$1,084.77" "$1,314.63" "$2,666.60" "$2,711.93" "$2,666.60" "$2,666.60" "$2,000.25" "$2,666.60" "$2,666.60" "$2,666.60" "$1,333.30" "$1,333.30" "$2,111.95" "$2,666.60" "$2,133.28" "$1,199.97" $529.25 N/A "$1,546.86" "$2,666.60" "$1,599.96" "$2,666.60" $555.72 "$2,666.60" N/A N/A 440.038 SUP HCPCS C1713 440.038 - PLATE BONE 118MM 6 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$2,699.00" "$1,997.00" $535.67 "$2,744.80" "$1,214.52" "$1,214.52" "$1,214.52" "$1,214.52" "$2,698.93" "$2,698.93" "$2,698.93" $562.52 "$2,698.93" "$2,698.93" "$2,698.93" "$2,698.93" "$2,698.93" $562.49 "$2,698.93" "$1,097.92" "$1,330.57" "$2,698.93" "$2,744.80" "$2,698.93" "$2,698.93" "$2,024.25" "$2,698.93" "$2,698.93" "$2,698.93" "$1,349.47" "$1,349.47" "$2,137.55" "$2,698.93" "$2,159.14" "$1,214.52" $535.67 N/A "$1,565.42" "$2,698.93" "$1,619.36" "$2,698.93" $562.46 "$2,698.93" N/A N/A 440.039 SUP HCPCS C1713 440.039 - PLATE BONE 118MM 6 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,699.00" "$1,997.00" $535.67 "$2,744.80" "$1,214.52" "$1,214.52" "$1,214.52" "$1,214.52" "$2,698.93" "$2,698.93" "$2,698.93" $562.52 "$2,698.93" "$2,698.93" "$2,698.93" "$2,698.93" "$2,698.93" $562.49 "$2,698.93" "$1,097.92" "$1,330.57" "$2,698.93" "$2,744.80" "$2,698.93" "$2,698.93" "$2,024.25" "$2,698.93" "$2,698.93" "$2,698.93" "$1,349.47" "$1,349.47" "$2,137.55" "$2,698.93" "$2,159.14" "$1,214.52" $535.67 N/A "$1,565.42" "$2,698.93" "$1,619.36" "$2,698.93" $562.46 "$2,698.93" N/A N/A 440.04 SUP HCPCS C1713 440.040 - PLATE BONE 154MM 8 HOLE LCP TITANIUM RIGHT PROXIMAL TIBIA BOTH IP/OP "$2,650.50" "$1,961.00" $526.03 "$2,776.25" "$1,192.66" "$1,192.66" "$1,192.66" "$1,192.66" "$2,650.35" "$2,650.35" "$2,650.35" $552.40 "$2,650.35" "$2,650.35" "$2,650.35" "$2,650.35" "$2,650.35" $552.36 "$2,650.35" "$1,110.50" "$1,306.62" "$2,650.35" "$2,776.25" "$2,650.35" "$2,650.35" "$1,987.88" "$2,650.35" "$2,650.35" "$2,650.35" "$1,325.18" "$1,325.18" "$2,099.08" "$2,650.35" "$2,120.28" "$1,192.66" $526.03 N/A "$1,537.29" "$2,650.35" "$2,650.35" "$2,650.35" $552.33 "$2,650.35" N/A N/A 440.041 SUP HCPCS C1713 440.041 - PLATE BONE 154MM 8 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,730.00" "$2,020.00" $541.81 "$2,776.25" "$1,228.43" "$1,228.43" "$1,228.43" "$1,228.43" "$2,729.85" "$2,729.85" "$2,729.85" $568.97 "$2,729.85" "$2,729.85" "$2,729.85" "$2,729.85" "$2,729.85" $568.93 "$2,729.85" "$1,110.50" "$1,345.82" "$2,729.85" "$2,776.25" "$2,729.85" "$2,729.85" "$2,047.50" "$2,729.85" "$2,729.85" "$2,729.85" "$1,364.93" "$1,364.93" "$2,162.04" "$2,729.85" "$2,183.88" "$1,228.43" $541.81 N/A "$1,583.40" "$2,729.85" "$1,637.91" "$2,729.85" $568.90 "$2,729.85" N/A N/A 440.042 SUP HCPCS C1713 440.042 - PLATE BONE 190MM 10 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$2,759.50" "$2,042.00" $547.67 "$2,806.28" "$1,241.72" "$1,241.72" "$1,241.72" "$1,241.72" "$2,759.38" "$2,759.38" "$2,759.38" $575.12 "$2,759.38" "$2,759.38" "$2,759.38" "$2,759.38" "$2,759.38" $575.09 "$2,759.38" "$1,122.51" "$1,360.37" "$2,759.38" "$2,806.28" "$2,759.38" "$2,759.38" "$2,069.63" "$2,759.38" "$2,759.38" "$2,759.38" "$1,379.69" "$1,379.69" "$2,185.43" "$2,759.38" "$2,207.50" "$1,241.72" $547.67 N/A "$1,600.51" "$2,759.38" "$1,655.63" "$2,759.38" $575.05 "$2,759.38" N/A N/A 440.043 SUP HCPCS C1713 440.043 - PLATE BONE 190MM 10 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,759.50" "$2,042.00" $547.67 "$2,806.28" "$1,241.72" "$1,241.72" "$1,241.72" "$1,241.72" "$2,759.38" "$2,759.38" "$2,759.38" $575.12 "$2,759.38" "$2,759.38" "$2,759.38" "$2,759.38" "$2,759.38" $575.09 "$2,759.38" "$1,122.51" "$1,360.37" "$2,759.38" "$2,806.28" "$2,759.38" "$2,759.38" "$2,069.63" "$2,759.38" "$2,759.38" "$2,759.38" "$1,379.69" "$1,379.69" "$2,185.43" "$2,759.38" "$2,207.50" "$1,241.72" $547.67 N/A "$1,600.51" "$2,759.38" "$1,655.63" "$2,759.38" $575.05 "$2,759.38" N/A N/A 440.044 SUP HCPCS C1713 440.044 - PLATE BONE 226MM 12 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$2,792.00" "$2,066.00" $554.08 "$2,839.15" "$1,256.27" "$1,256.27" "$1,256.27" "$1,256.27" "$2,791.70" "$2,791.70" "$2,791.70" $581.86 "$2,791.70" "$2,791.70" "$2,791.70" "$2,791.70" "$2,791.70" $581.82 "$2,791.70" "$2,839.15" "$1,376.31" "$2,791.70" "$2,839.15" "$2,791.70" "$2,791.70" "$2,094.00" "$2,791.70" "$2,791.70" "$2,791.70" "$1,395.85" "$1,395.85" "$2,211.03" "$2,791.70" "$2,233.36" "$1,256.27" $554.08 N/A "$1,619.36" "$2,791.70" "$2,791.70" "$2,791.70" $581.79 "$2,791.70" N/A N/A 440.045 SUP HCPCS C1713 440.045 - PLATE BONE 226MM 12 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,792.00" "$2,066.00" $554.08 "$2,839.15" "$1,256.27" "$1,256.27" "$1,256.27" "$1,256.27" "$2,791.70" "$2,791.70" "$2,791.70" $581.86 "$2,791.70" "$2,791.70" "$2,791.70" "$2,791.70" "$2,791.70" $581.82 "$2,791.70" "$2,839.15" "$1,376.31" "$2,791.70" "$2,839.15" "$2,791.70" "$2,791.70" "$2,094.00" "$2,791.70" "$2,791.70" "$2,791.70" "$1,395.85" "$1,395.85" "$2,211.03" "$2,791.70" "$2,233.36" "$1,256.27" $554.08 N/A "$1,619.36" "$2,791.70" "$2,791.70" "$2,791.70" $581.79 "$2,791.70" N/A N/A 440.046 SUP HCPCS C1713 440.046 - PLATE BONE 262MM 14 HOLE LCP TITANIUM TIBIA RIGHT PROXIMAL BOTH IP/OP "$2,821.50" "$2,088.00" $559.94 "$2,869.18" "$1,269.55" "$1,269.55" "$1,269.55" "$1,269.55" "$2,821.23" "$2,821.23" "$2,821.23" $588.01 "$2,821.23" "$2,821.23" "$2,821.23" "$2,821.23" "$2,821.23" $587.98 "$2,821.23" "$2,869.18" "$1,390.87" "$2,821.23" "$2,869.18" "$2,821.23" "$2,821.23" "$2,116.13" "$2,821.23" "$2,821.23" "$2,821.23" "$1,410.62" "$1,410.62" "$2,234.41" "$2,821.23" "$2,256.98" "$1,269.55" $559.94 N/A "$1,636.47" "$2,821.23" "$1,692.74" "$2,821.23" $587.94 "$2,821.23" N/A N/A 440.047 SUP HCPCS C1713 440.047 - PLATE BONE 262MM 14 HOLE LCP TITANIUM TIBIA LEFT PROXIMAL BOTH IP/OP "$2,821.50" "$2,088.00" $559.94 "$2,869.18" "$1,269.55" "$1,269.55" "$1,269.55" "$1,269.55" "$2,821.23" "$2,821.23" "$2,821.23" $588.01 "$2,821.23" "$2,821.23" "$2,821.23" "$2,821.23" "$2,821.23" $587.98 "$2,821.23" "$1,147.67" "$1,390.87" "$2,821.23" "$2,869.18" "$2,821.23" "$2,821.23" "$2,116.13" "$2,821.23" "$2,821.23" "$2,821.23" "$1,410.62" "$1,410.62" "$2,234.41" "$2,821.23" "$2,256.98" "$1,269.55" $559.94 N/A "$1,636.47" "$2,821.23" "$1,692.74" "$2,821.23" $587.94 "$2,821.23" N/A N/A 440.05 SUP HCPCS C1713 440.05 - PLATE BONE 5 HOLE SPOON LC-DCP TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $626.50 $464.00 $124.33 $626.43 $281.89 $281.89 $281.89 $281.89 $626.43 $626.43 $626.43 $130.56 $626.43 $626.43 $626.43 $626.43 $626.43 $130.55 $626.43 $250.57 $370.53 $626.43 $626.43 $626.43 $626.43 $469.88 $626.43 $626.43 $626.43 $313.22 $313.22 $496.13 $626.43 $501.14 $281.89 $124.33 N/A $363.37 $626.43 $375.86 $626.43 $130.55 $626.43 N/A N/A 440.06 SUP HCPCS C1713 440.06 - PLATE BONE SPOON 6 HOLE LC DCP TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $669.00 $495.00 $132.73 $668.73 $300.93 $300.93 $300.93 $300.93 $668.73 $668.73 $668.73 $139.38 $668.73 $668.73 $668.73 $668.73 $668.73 $139.37 $668.73 $267.49 $395.55 $668.73 $668.73 $668.73 $668.73 $501.75 $668.73 $668.73 $668.73 $334.37 $334.37 $529.63 $668.73 $534.98 $300.93 $132.73 N/A $388.02 $668.73 $401.24 $668.73 $139.36 $668.73 N/A N/A 440.13 SUP HCPCS C1713 440.13 - PLATE BONE T 68MM 3 HOLE LC-DCP TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $505.00 $374.00 $100.22 $504.95 $227.23 $227.23 $227.23 $227.23 $504.95 $504.95 $504.95 $105.24 $504.95 $504.95 $504.95 $504.95 $504.95 $105.24 $504.95 $504.95 $298.68 $504.95 $504.95 $504.95 $504.95 $378.75 $504.95 $504.95 $504.95 $252.48 $252.48 $399.92 $504.95 $403.96 $227.23 $100.22 N/A $292.90 $504.95 $302.97 $504.95 $105.23 $504.95 N/A N/A 440.14 SUP HCPCS C1713 440.14 - PLATE BONE T 84MM 4 HOLE LC-DCP TITANIUM HUMERUS TIBIAL BOTH IP/OP $550.00 $407.00 $109.16 $550.00 $247.50 $247.50 $247.50 $247.50 $550.00 $550.00 $550.00 $114.63 $550.00 $550.00 $550.00 $550.00 $550.00 $114.63 $550.00 $550.00 $325.33 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $247.50 $109.16 N/A $319.00 $550.00 $330.00 $550.00 $114.62 $550.00 N/A N/A 440.141 SUP HCPCS C1713 440.141 - PLATE BONE 83MM 4 HOLE T LCP TITANIUM ORTHOPEDIC NONSTRL 4.5 BOTH IP/OP "$1,137.50" $842.00 $225.71 "$1,156.53" $511.74 $511.74 $511.74 $511.74 "$1,137.20" "$1,137.20" "$1,137.20" $237.02 "$1,137.20" "$1,137.20" "$1,137.20" "$1,137.20" "$1,137.20" $237.00 "$1,137.20" "$1,156.53" $672.65 "$1,137.20" "$1,156.53" "$1,137.20" "$1,137.20" $853.13 "$1,137.20" "$1,137.20" "$1,137.20" $568.60 $568.60 $900.66 "$1,137.20" $909.76 $511.74 $225.71 N/A $659.75 "$1,137.20" "$1,137.20" "$1,137.20" $236.99 "$1,137.20" N/A N/A 440.15 SUP HCPCS C1713 440.15 - PLATE BONE T 100MM 5 HOLE LC-DCP TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $577.50 $427.00 $114.58 $577.30 $259.79 $259.79 $259.79 $259.79 $577.30 $577.30 $577.30 $120.32 $577.30 $577.30 $577.30 $577.30 $577.30 $120.32 $577.30 $577.30 $341.47 $577.30 $577.30 $577.30 $577.30 $433.13 $577.30 $577.30 $577.30 $288.65 $288.65 $457.22 $577.30 $461.84 $259.79 $114.58 N/A $334.95 $577.30 $577.30 $577.30 $120.31 $577.30 N/A N/A 440.16 SUP HCPCS C1713 440.16 - PLATE BONE T 116MM 6 HOLE LC-DCP TITANIUM HUMERUS TIBIAL BOTH IP/OP $656.50 $486.00 $130.29 $656.45 $295.40 $295.40 $295.40 $295.40 $656.45 $656.45 $656.45 $136.82 $656.45 $656.45 $656.45 $656.45 $656.45 $136.81 $656.45 $656.45 $388.29 $656.45 $656.45 $656.45 $656.45 $492.38 $656.45 $656.45 $656.45 $328.23 $328.23 $519.91 $656.45 $525.16 $295.40 $130.29 N/A $380.77 $656.45 $393.87 $656.45 $136.80 $656.45 N/A N/A 440.161 SUP HCPCS C1713 440.161 - PLATE BONE 115MM 6 HOLE T LCP TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP "$1,304.50" $965.00 $258.91 "$1,326.65" $587.02 $587.02 $587.02 $587.02 "$1,304.48" "$1,304.48" "$1,304.48" $271.89 "$1,304.48" "$1,304.48" "$1,304.48" "$1,304.48" "$1,304.48" $271.87 "$1,304.48" "$1,326.65" $771.60 "$1,304.48" "$1,326.65" "$1,304.48" "$1,304.48" $978.38 "$1,304.48" "$1,304.48" "$1,304.48" $652.24 $652.24 "$1,033.15" "$1,304.48" "$1,043.58" $587.02 $258.91 N/A $756.61 "$1,304.48" $782.69 "$1,304.48" $271.85 "$1,304.48" N/A N/A 440.18 SUP HCPCS C1713 440.18 - PLATE BONE T 148MM 8 HOLE LC-DCP TITANIUM HUMERUS TIBIAL BOTH IP/OP $865.50 $640.00 $171.73 $865.25 $389.36 $389.36 $389.36 $389.36 $865.25 $865.25 $865.25 $180.34 $865.25 $865.25 $865.25 $865.25 $865.25 $180.33 $865.25 $865.25 $511.80 $865.25 $865.25 $865.25 $865.25 $649.13 $865.25 $865.25 $865.25 $432.63 $432.63 $685.28 $865.25 $692.20 $389.36 $171.73 N/A $501.99 $865.25 $519.15 $865.25 $180.32 $865.25 N/A N/A 440.181 SUP HCPCS C1713 440.181 - PLATE BONE 147MM 8 HOLE T LCP TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP "$1,505.50" "$1,114.00" $298.80 "$1,531.10" $677.48 $677.48 $677.48 $677.48 "$1,505.50" "$1,505.50" "$1,505.50" $313.78 "$1,505.50" "$1,505.50" "$1,505.50" "$1,505.50" "$1,505.50" $313.76 "$1,505.50" "$1,531.10" $890.50 "$1,505.50" "$1,531.10" "$1,505.50" "$1,505.50" "$1,129.13" "$1,505.50" "$1,505.50" "$1,505.50" $752.75 $752.75 "$1,192.36" "$1,505.50" "$1,204.40" $677.48 $298.80 N/A $873.19 "$1,505.50" "$1,505.50" "$1,505.50" "$1,505.50" "$1,505.50" N/A N/A 440.34 SUP HCPCS C1713 440.34 - PLATE BONE T BUTTRESS 80MM 4 HOLE LC-DCP TITANIUM ORTHOPEDIC BOTH IP/OP $839.50 $621.00 $166.59 $839.33 $377.70 $377.70 $377.70 $377.70 $839.33 $839.33 $839.33 $174.94 $839.33 $839.33 $839.33 $839.33 $839.33 $174.93 $839.33 $839.33 $496.46 $839.33 $839.33 $839.33 $839.33 $629.63 $839.33 $839.33 $839.33 $419.67 $419.67 $664.75 $839.33 $671.46 $377.70 $166.59 N/A $486.91 $839.33 $839.33 $839.33 $174.92 $839.33 N/A N/A 440.35 SUP HCPCS C1713 440.35 - PLATE BONE T BUTTRESS 96MM 5 HOLE LC-DCP TITANIUM ORTHOPEDIC BOTH IP/OP $883.00 $653.00 $175.25 $883.00 $397.35 $397.35 $397.35 $397.35 $883.00 $883.00 $883.00 $184.04 $883.00 $883.00 $883.00 $883.00 $883.00 $184.03 $883.00 $883.00 $522.29 $883.00 $883.00 $883.00 $883.00 $662.25 $883.00 $883.00 $883.00 $441.50 $441.50 $699.34 $883.00 $706.40 $397.35 $175.25 N/A $512.14 $883.00 $529.80 $883.00 $184.02 $883.00 N/A N/A 440.36 SUP HCPCS C1713 440.36 - PLATE BONE T BUTTRESS 112MM 6 HOLE LC-DCP TITANIUM BOTH IP/OP $913.50 $676.00 $181.21 $913.03 $410.86 $410.86 $410.86 $410.86 $913.03 $913.03 $913.03 $190.30 $913.03 $913.03 $913.03 $913.03 $913.03 $190.29 $913.03 $913.03 $540.06 $913.03 $913.03 $913.03 $913.03 $685.13 $913.03 $913.03 $913.03 $456.52 $456.52 $723.12 $913.03 $730.42 $410.86 $181.21 N/A $529.83 $913.03 $547.82 $913.03 $190.28 $913.03 N/A N/A 440.44 SUP HCPCS C1713 440.44 - PLATE BN ANG LT L BTRS 86X14X3.8MM NS LC DCP 4 HL SHFT TI BOTH IP/OP $756.50 $560.00 $150.10 $769.13 $340.33 $340.33 $340.33 $340.33 $756.28 $756.28 $756.28 $157.63 $756.28 $756.28 $756.28 $756.28 $756.28 $157.62 $756.28 $769.13 $447.34 $756.28 $769.13 $756.28 $756.28 $567.38 $756.28 $756.28 $756.28 $378.14 $378.14 $598.97 $756.28 $605.02 $340.33 $150.10 N/A $438.77 $756.28 $756.28 $756.28 $157.61 $756.28 N/A N/A 440.515 SUP HCPCS C1713 440.515 - PLATE BONE 130MM 5 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD BOTH IP/OP "$1,396.50" "$1,033.00" $277.10 "$1,396.15" $628.27 $628.27 $628.27 $628.27 "$1,396.15" "$1,396.15" "$1,396.15" $290.99 "$1,396.15" "$1,396.15" "$1,396.15" "$1,396.15" "$1,396.15" $290.97 "$1,396.15" "$1,396.15" $825.82 "$1,396.15" "$1,396.15" "$1,396.15" "$1,396.15" "$1,047.38" "$1,396.15" "$1,396.15" "$1,396.15" $698.08 $698.08 "$1,105.75" "$1,396.15" "$1,116.92" $628.27 $277.10 N/A $809.97 "$1,396.15" "$1,396.15" "$1,396.15" $290.96 "$1,396.15" N/A N/A 440.517 SUP HCPCS C1713 440.517 - PLATE BONE 166MM 7 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD BOTH IP/OP "$1,496.00" "$1,107.00" $296.87 "$1,495.78" $673.10 $673.10 $673.10 $673.10 "$1,495.78" "$1,495.78" "$1,495.78" $311.76 "$1,495.78" "$1,495.78" "$1,495.78" "$1,495.78" "$1,495.78" $311.74 "$1,495.78" "$1,495.78" $884.75 "$1,495.78" "$1,495.78" "$1,495.78" "$1,495.78" "$1,122.00" "$1,495.78" "$1,495.78" "$1,495.78" $747.89 $747.89 "$1,184.66" "$1,495.78" "$1,196.62" $673.10 $296.87 N/A $867.68 "$1,495.78" "$1,495.78" "$1,495.78" $311.72 "$1,495.78" N/A N/A 440.519 SUP HCPCS C1713 440.519 - PLATE BONE 202MM 9 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD BOTH IP/OP "$1,605.00" "$1,188.00" $318.54 "$1,604.95" $722.23 $722.23 $722.23 $722.23 "$1,604.95" "$1,604.95" "$1,604.95" $334.51 "$1,604.95" "$1,604.95" "$1,604.95" "$1,604.95" "$1,604.95" $334.49 "$1,604.95" $641.98 $949.33 "$1,604.95" "$1,604.95" "$1,604.95" "$1,604.95" "$1,203.75" "$1,604.95" "$1,604.95" "$1,604.95" $802.48 $802.48 "$1,271.12" "$1,604.95" "$1,283.96" $722.23 $318.54 N/A $930.90 "$1,604.95" "$1,604.95" "$1,604.95" $334.47 "$1,604.95" N/A N/A 440.521 SUP HCPCS C1713 440.521 - PLATE BONE 238MM 11 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL BOTH IP/OP "$1,709.00" "$1,265.00" $339.13 "$1,708.68" $768.91 $768.91 $768.91 $768.91 "$1,708.68" "$1,708.68" "$1,708.68" $356.13 "$1,708.68" "$1,708.68" "$1,708.68" "$1,708.68" "$1,708.68" $356.11 "$1,708.68" "$1,708.68" "$1,010.68" "$1,708.68" "$1,708.68" "$1,708.68" "$1,708.68" "$1,281.75" "$1,708.68" "$1,708.68" "$1,708.68" $854.34 $854.34 "$1,353.27" "$1,708.68" "$1,366.94" $768.91 $339.13 N/A $991.22 "$1,708.68" "$1,708.68" "$1,708.68" $356.09 "$1,708.68" N/A N/A 440.523 SUP HCPCS C1713 440.523 - PLATE BONE 274MM 13 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL BOTH IP/OP "$1,777.00" "$1,315.00" $352.67 "$1,776.90" $799.61 $799.61 $799.61 $799.61 "$1,776.90" "$1,776.90" "$1,776.90" $370.35 "$1,776.90" "$1,776.90" "$1,776.90" "$1,776.90" "$1,776.90" $370.33 "$1,776.90" "$1,776.90" "$1,051.04" "$1,776.90" "$1,776.90" "$1,776.90" "$1,776.90" "$1,332.75" "$1,776.90" "$1,776.90" "$1,776.90" $888.45 $888.45 "$1,407.30" "$1,776.90" "$1,421.52" $799.61 $352.67 N/A "$1,030.66" "$1,776.90" "$1,776.90" "$1,776.90" $370.31 "$1,776.90" N/A N/A 440.525 SUP HCPCS C1713 440.525 - PLATE BONE 130MM 5 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD BOTH IP/OP "$1,396.50" "$1,033.00" $277.10 "$1,396.15" $628.27 $628.27 $628.27 $628.27 "$1,396.15" "$1,396.15" "$1,396.15" $290.99 "$1,396.15" "$1,396.15" "$1,396.15" "$1,396.15" "$1,396.15" $290.97 "$1,396.15" $558.46 $825.82 "$1,396.15" "$1,396.15" "$1,396.15" "$1,396.15" "$1,047.38" "$1,396.15" "$1,396.15" "$1,396.15" $698.08 $698.08 "$1,105.75" "$1,396.15" "$1,116.92" $628.27 $277.10 N/A $809.97 "$1,396.15" "$1,396.15" "$1,396.15" "$1,396.15" "$1,396.15" N/A N/A 440.527 SUP HCPCS C1713 440.527 - PLATE BONE 166MM 7 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD BOTH IP/OP "$1,496.00" "$1,107.00" $296.87 "$1,495.78" $673.10 $673.10 $673.10 $673.10 "$1,495.78" "$1,495.78" "$1,495.78" $311.76 "$1,495.78" "$1,495.78" "$1,495.78" "$1,495.78" "$1,495.78" $311.74 "$1,495.78" $598.31 $884.75 "$1,495.78" "$1,495.78" "$1,495.78" "$1,495.78" "$1,122.00" "$1,495.78" "$1,495.78" "$1,495.78" $747.89 $747.89 "$1,184.66" "$1,495.78" "$1,196.62" $673.10 $296.87 N/A $867.68 "$1,495.78" "$1,495.78" "$1,495.78" "$1,495.78" "$1,495.78" N/A N/A 440.529 SUP HCPCS C1713 440.529 - PLATE BONE 202MM 9 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL HEAD BOTH IP/OP "$1,605.00" "$1,188.00" $318.54 "$1,604.95" $722.23 $722.23 $722.23 $722.23 "$1,604.95" "$1,604.95" "$1,604.95" $334.51 "$1,604.95" "$1,604.95" "$1,604.95" "$1,604.95" "$1,604.95" $334.49 "$1,604.95" $641.98 $949.33 "$1,604.95" "$1,604.95" "$1,604.95" "$1,604.95" "$1,203.75" "$1,604.95" "$1,604.95" "$1,604.95" $802.48 $802.48 "$1,271.12" "$1,604.95" "$1,283.96" $722.23 $318.54 N/A $930.90 "$1,604.95" "$1,604.95" "$1,604.95" $334.47 "$1,604.95" N/A N/A 440.531 SUP HCPCS C1713 440.531 - PLATE BONE 238MM 11 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL BOTH IP/OP "$1,709.00" "$1,265.00" $339.13 "$1,708.68" $768.91 $768.91 $768.91 $768.91 "$1,708.68" "$1,708.68" "$1,708.68" $356.13 "$1,708.68" "$1,708.68" "$1,708.68" "$1,708.68" "$1,708.68" $356.11 "$1,708.68" $683.47 "$1,010.68" "$1,708.68" "$1,708.68" "$1,708.68" "$1,708.68" "$1,281.75" "$1,708.68" "$1,708.68" "$1,708.68" $854.34 $854.34 "$1,353.27" "$1,708.68" "$1,366.94" $768.91 $339.13 N/A $991.22 "$1,708.68" "$1,708.68" "$1,708.68" $356.09 "$1,708.68" N/A N/A 440.533 SUP HCPCS C1713 440.533 - PLATE BONE 274MM 13 HOLE BUTTRESS LC-DCP TITANIUM TIBIAL BOTH IP/OP "$1,777.00" "$1,315.00" $352.67 "$1,776.90" $799.61 $799.61 $799.61 $799.61 "$1,776.90" "$1,776.90" "$1,776.90" $370.35 "$1,776.90" "$1,776.90" "$1,776.90" "$1,776.90" "$1,776.90" $370.33 "$1,776.90" $710.76 "$1,051.04" "$1,776.90" "$1,776.90" "$1,776.90" "$1,776.90" "$1,332.75" "$1,776.90" "$1,776.90" "$1,776.90" $888.45 $888.45 "$1,407.30" "$1,776.90" "$1,421.52" $799.61 $352.67 N/A "$1,030.66" "$1,776.90" "$1,066.14" "$1,776.90" $370.31 "$1,776.90" N/A N/A 440.54 SUP HCPCS C1713 440.54 - PLATE BN ANG RT L BTRS 86X14X3.8MM NS LC DCP 4 HL SHFT TI BOTH IP/OP $755.00 $559.00 $149.79 $754.70 $339.62 $339.62 $339.62 $339.62 $754.70 $754.70 $754.70 $157.30 $754.70 $754.70 $754.70 $754.70 $754.70 $157.29 $754.70 $301.88 $446.41 $754.70 $754.70 $754.70 $754.70 $566.25 $754.70 $754.70 $754.70 $377.35 $377.35 $597.72 $754.70 $603.76 $339.62 $149.79 N/A $437.90 $754.70 $452.82 $754.70 $157.28 $754.70 N/A N/A 440.547 SUP HCPCS C1713 440.547 - PLATE BONE 177MM 7 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE BOTH IP/OP "$1,695.50" "$1,255.00" $336.42 "$1,695.03" $762.76 $762.76 $762.76 $762.76 "$1,695.03" "$1,695.03" "$1,695.03" $353.29 "$1,695.03" "$1,695.03" "$1,695.03" "$1,695.03" "$1,695.03" $353.26 "$1,695.03" "$1,695.03" "$1,002.61" "$1,695.03" "$1,695.03" "$1,695.03" "$1,695.03" "$1,271.63" "$1,695.03" "$1,695.03" "$1,695.03" $847.52 $847.52 "$1,342.46" "$1,695.03" "$1,356.02" $762.76 $336.42 N/A $983.39 "$1,695.03" "$1,017.02" "$1,695.03" $353.24 "$1,695.03" N/A N/A 440.549 SUP HCPCS C1713 440.549 - PLATE BONE 213MM 9 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE BOTH IP/OP "$1,744.50" "$1,291.00" $346.17 "$1,744.15" $784.87 $784.87 $784.87 $784.87 "$1,744.15" "$1,744.15" "$1,744.15" $363.52 "$1,744.15" "$1,744.15" "$1,744.15" "$1,744.15" "$1,744.15" $363.50 "$1,744.15" $697.66 "$1,031.66" "$1,744.15" "$1,744.15" "$1,744.15" "$1,744.15" "$1,308.38" "$1,744.15" "$1,744.15" "$1,744.15" $872.08 $872.08 "$1,381.37" "$1,744.15" "$1,395.32" $784.87 $346.17 N/A "$1,011.81" "$1,744.15" "$1,046.49" "$1,744.15" $363.48 "$1,744.15" N/A N/A 440.551 SUP HCPCS C1713 440.551 - PLATE BONE 249MM 11 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE BOTH IP/OP "$1,786.50" "$1,322.00" $354.57 "$1,786.45" $803.90 $803.90 $803.90 $803.90 "$1,786.45" "$1,786.45" "$1,786.45" $372.34 "$1,786.45" "$1,786.45" "$1,786.45" "$1,786.45" "$1,786.45" $372.32 "$1,786.45" $714.58 "$1,056.69" "$1,786.45" "$1,786.45" "$1,786.45" "$1,786.45" "$1,339.88" "$1,786.45" "$1,786.45" "$1,786.45" $893.23 $893.23 "$1,414.87" "$1,786.45" "$1,429.16" $803.90 $354.57 N/A "$1,036.17" "$1,786.45" "$1,786.45" "$1,786.45" $372.30 "$1,786.45" N/A N/A 440.553 SUP HCPCS C1713 440.553 - PLATE BONE 285MM 13 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE BOTH IP/OP "$1,845.50" "$1,366.00" $366.22 "$1,845.15" $830.32 $830.32 $830.32 $830.32 "$1,845.15" "$1,845.15" "$1,845.15" $384.58 "$1,845.15" "$1,845.15" "$1,845.15" "$1,845.15" "$1,845.15" $384.55 "$1,845.15" $738.06 "$1,091.41" "$1,845.15" "$1,845.15" "$1,845.15" "$1,845.15" "$1,384.13" "$1,845.15" "$1,845.15" "$1,845.15" $922.58 $922.58 "$1,461.36" "$1,845.15" "$1,476.12" $830.32 $366.22 N/A "$1,070.39" "$1,845.15" "$1,107.09" "$1,845.15" $384.53 "$1,845.15" N/A N/A 440.555 SUP HCPCS C1713 440.555 - PLATE BONE 321MM 11 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE BOTH IP/OP "$1,919.00" "$1,420.00" $380.84 "$1,918.85" $863.48 $863.48 $863.48 $863.48 "$1,918.85" "$1,918.85" "$1,918.85" $399.94 "$1,918.85" "$1,918.85" "$1,918.85" "$1,918.85" "$1,918.85" $399.91 "$1,918.85" "$1,918.85" "$1,135.00" "$1,918.85" "$1,918.85" "$1,918.85" "$1,918.85" "$1,439.25" "$1,918.85" "$1,918.85" "$1,918.85" $959.43 $959.43 "$1,519.73" "$1,918.85" "$1,535.08" $863.48 $380.84 N/A "$1,113.02" "$1,918.85" "$1,151.31" "$1,918.85" $399.89 "$1,918.85" N/A N/A 440.567 SUP HCPCS C1713 440.567 - PLATE BONE 177MM 7 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE BOTH IP/OP "$1,695.50" "$1,255.00" $336.42 "$1,695.03" $762.76 $762.76 $762.76 $762.76 "$1,695.03" "$1,695.03" "$1,695.03" $353.29 "$1,695.03" "$1,695.03" "$1,695.03" "$1,695.03" "$1,695.03" $353.26 "$1,695.03" "$1,695.03" "$1,002.61" "$1,695.03" "$1,695.03" "$1,695.03" "$1,695.03" "$1,271.63" "$1,695.03" "$1,695.03" "$1,695.03" $847.52 $847.52 "$1,342.46" "$1,695.03" "$1,356.02" $762.76 $336.42 N/A $983.39 "$1,695.03" "$1,017.02" "$1,695.03" $353.24 "$1,695.03" N/A N/A 440.569 SUP HCPCS C1713 440.569 - PLATE BONE 213MM 9 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE BOTH IP/OP "$1,696.50" "$1,255.00" $336.69 "$1,696.38" $763.37 $763.37 $763.37 $763.37 "$1,696.38" "$1,696.38" "$1,696.38" $353.57 "$1,696.38" "$1,696.38" "$1,696.38" "$1,696.38" "$1,696.38" $353.54 "$1,696.38" "$1,696.38" "$1,003.41" "$1,696.38" "$1,696.38" "$1,696.38" "$1,696.38" "$1,272.38" "$1,696.38" "$1,696.38" "$1,696.38" $848.19 $848.19 "$1,343.53" "$1,696.38" "$1,357.10" $763.37 $336.69 N/A $983.97 "$1,696.38" "$1,696.38" "$1,696.38" $353.53 "$1,696.38" N/A N/A 440.571 SUP HCPCS C1713 440.571 - PLATE BONE 249MM 11 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE BOTH IP/OP "$1,786.50" "$1,322.00" $354.57 "$1,786.45" $803.90 $803.90 $803.90 $803.90 "$1,786.45" "$1,786.45" "$1,786.45" $372.34 "$1,786.45" "$1,786.45" "$1,786.45" "$1,786.45" "$1,786.45" $372.32 "$1,786.45" $714.58 "$1,056.69" "$1,786.45" "$1,786.45" "$1,786.45" "$1,786.45" "$1,339.88" "$1,786.45" "$1,786.45" "$1,786.45" $893.23 $893.23 "$1,414.87" "$1,786.45" "$1,429.16" $803.90 $354.57 N/A "$1,036.17" "$1,786.45" "$1,786.45" "$1,786.45" $372.30 "$1,786.45" N/A N/A 440.573 SUP HCPCS C1713 440.573 - PLATE BONE 285MM 13 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE BOTH IP/OP "$1,791.50" "$1,326.00" $355.55 "$1,791.40" $806.13 $806.13 $806.13 $806.13 "$1,791.40" "$1,791.40" "$1,791.40" $373.37 "$1,791.40" "$1,791.40" "$1,791.40" "$1,791.40" "$1,791.40" $373.35 "$1,791.40" $716.56 "$1,059.61" "$1,791.40" "$1,791.40" "$1,791.40" "$1,791.40" "$1,343.63" "$1,791.40" "$1,791.40" "$1,791.40" $895.70 $895.70 "$1,418.79" "$1,791.40" "$1,433.12" $806.13 $355.55 N/A "$1,039.07" "$1,791.40" "$1,791.40" "$1,791.40" $373.33 "$1,791.40" N/A N/A 440.575 SUP HCPCS C1713 440.575 - PLATE BONE 321MM 15 HOLE BUTTRESS LC-DCP TITANIUM CONDYLE BOTH IP/OP "$1,863.00" "$1,379.00" $369.75 "$1,862.95" $838.33 $838.33 $838.33 $838.33 "$1,862.95" "$1,862.95" "$1,862.95" $388.29 "$1,862.95" "$1,862.95" "$1,862.95" "$1,862.95" "$1,862.95" $388.26 "$1,862.95" "$1,862.95" "$1,101.93" "$1,862.95" "$1,862.95" "$1,862.95" "$1,862.95" "$1,397.25" "$1,862.95" "$1,862.95" "$1,862.95" $931.48 $931.48 "$1,475.46" "$1,862.95" "$1,490.36" $838.33 $369.75 N/A "$1,080.54" "$1,862.95" "$1,117.77" "$1,862.95" $388.24 "$1,862.95" N/A N/A 440.831 SUP HCPCS C1713 440.831 - PLATE BONE SMALL 4 HOLE HIGH TOMOFIX TITANIUM TIBIAL MEDIAL BOTH IP/OP "$2,446.00" "$1,810.00" $485.45 "$2,487.48" "$1,100.66" "$1,100.66" "$1,100.66" "$1,100.66" "$2,445.90" "$2,445.90" "$2,445.90" $509.79 "$2,445.90" "$2,445.90" "$2,445.90" "$2,445.90" "$2,445.90" $509.75 "$2,445.90" "$2,487.48" "$1,446.75" "$2,445.90" "$2,487.48" "$2,445.90" "$2,445.90" "$1,834.50" "$2,445.90" "$2,445.90" "$2,445.90" "$1,222.95" "$1,222.95" "$1,937.15" "$2,445.90" "$1,956.72" "$1,100.66" $485.45 N/A "$1,418.68" "$2,445.90" "$1,467.54" "$2,445.90" $509.73 "$2,445.90" N/A N/A 440.834 SUP HCPCS C1713 440.834 - PLATE BONE 4 HOLE HIGH TOMOFIX TITANIUM TIBIAL MEDIAL BOTH IP/OP "$2,446.00" "$1,810.00" $485.45 "$2,487.48" "$1,100.66" "$1,100.66" "$1,100.66" "$1,100.66" "$2,445.90" "$2,445.90" "$2,445.90" $509.79 "$2,445.90" "$2,445.90" "$2,445.90" "$2,445.90" "$2,445.90" $509.75 "$2,445.90" $994.99 "$1,446.75" "$2,445.90" "$2,487.48" "$2,445.90" "$2,445.90" "$1,834.50" "$2,445.90" "$2,445.90" "$2,445.90" "$1,222.95" "$1,222.95" "$1,937.15" "$2,445.90" "$1,956.72" "$1,100.66" $485.45 N/A "$1,418.68" "$2,445.90" "$1,467.54" "$2,445.90" $509.73 "$2,445.90" N/A N/A 440.843 SUP HCPCS C1713 440.843 - PLATE BONE 3 HOLE TOMOFIX TITANIUM TIBIA RIGHT LATERAL BOTH IP/OP "$2,446.00" "$1,810.00" $485.45 "$2,487.48" "$1,100.66" "$1,100.66" "$1,100.66" "$1,100.66" "$2,445.90" "$2,445.90" "$2,445.90" $509.79 "$2,445.90" "$2,445.90" "$2,445.90" "$2,445.90" "$2,445.90" $509.75 "$2,445.90" $994.99 "$1,446.75" "$2,445.90" "$2,487.48" "$2,445.90" "$2,445.90" "$1,834.50" "$2,445.90" "$2,445.90" "$2,445.90" "$1,222.95" "$1,222.95" "$1,937.15" "$2,445.90" "$1,956.72" "$1,100.66" $485.45 N/A "$1,418.68" "$2,445.90" "$1,467.54" "$2,445.90" $509.73 "$2,445.90" N/A N/A 440.853 SUP HCPCS C1713 440.853 - PLATE BONE 3 HOLE TOMOFIX TITANIUM TIBIA LEFT LATERAL BOTH IP/OP "$2,446.00" "$1,810.00" $485.45 "$2,487.48" "$1,100.66" "$1,100.66" "$1,100.66" "$1,100.66" "$2,445.90" "$2,445.90" "$2,445.90" $509.79 "$2,445.90" "$2,445.90" "$2,445.90" "$2,445.90" "$2,445.90" $509.75 "$2,445.90" $994.99 "$1,446.75" "$2,445.90" "$2,487.48" "$2,445.90" "$2,445.90" "$1,834.50" "$2,445.90" "$2,445.90" "$2,445.90" "$1,222.95" "$1,222.95" "$1,937.15" "$2,445.90" "$1,956.72" "$1,100.66" $485.45 N/A "$1,418.68" "$2,445.90" "$2,445.90" "$2,445.90" $509.73 "$2,445.90" N/A N/A 440.864 SUP HCPCS C1713 440.864 - PLATE BONE 4 HOLE TOMOFIX TITANIUM FEMUR RIGHT DISTAL BOTH IP/OP "$2,446.00" "$1,810.00" $485.45 "$2,487.48" "$1,100.66" "$1,100.66" "$1,100.66" "$1,100.66" "$2,445.90" "$2,445.90" "$2,445.90" $509.79 "$2,445.90" "$2,445.90" "$2,445.90" "$2,445.90" "$2,445.90" $509.75 "$2,445.90" "$2,487.48" "$1,446.75" "$2,445.90" "$2,487.48" "$2,445.90" "$2,445.90" "$1,834.50" "$2,445.90" "$2,445.90" "$2,445.90" "$1,222.95" "$1,222.95" "$1,937.15" "$2,445.90" "$1,956.72" "$1,100.66" $485.45 N/A "$1,418.68" "$2,445.90" "$2,445.90" "$2,445.90" $509.73 "$2,445.90" N/A N/A 440.874 SUP HCPCS C1713 440.874 - PLATE BONE 4 HOLE TOMOFIX TITANIUM FEMUR LEFT DISTAL LATERAL BOTH IP/OP "$2,446.00" "$1,810.00" $485.45 "$2,487.48" "$1,100.66" "$1,100.66" "$1,100.66" "$1,100.66" "$2,445.90" "$2,445.90" "$2,445.90" $509.79 "$2,445.90" "$2,445.90" "$2,445.90" "$2,445.90" "$2,445.90" $509.75 "$2,445.90" "$2,487.48" "$1,446.75" "$2,445.90" "$2,487.48" "$2,445.90" "$2,445.90" "$1,834.50" "$2,445.90" "$2,445.90" "$2,445.90" "$1,222.95" "$1,222.95" "$1,937.15" "$2,445.90" "$1,956.72" "$1,100.66" $485.45 N/A "$1,418.68" "$2,445.90" "$2,445.90" "$2,445.90" $509.73 "$2,445.90" N/A N/A 440.885 SUP HCPCS C1713 440.885 - PLATE BONE 121MM 4 HOLE TOMOFIX TITANIUM RIGHT MEDIAL DISTAL BOTH IP/OP "$2,305.50" "$1,706.00" $457.58 "$2,305.50" "$1,037.48" "$1,037.48" "$1,037.48" "$1,037.48" "$2,305.50" "$2,305.50" "$2,305.50" $480.52 "$2,305.50" "$2,305.50" "$2,305.50" "$2,305.50" "$2,305.50" $480.49 "$2,305.50" "$2,305.50" "$1,363.70" "$2,305.50" "$2,305.50" "$2,305.50" "$2,305.50" "$1,729.13" "$2,305.50" "$2,305.50" "$2,305.50" "$1,152.75" "$1,152.75" "$1,825.96" "$2,305.50" "$1,844.40" "$1,037.48" $457.58 N/A "$1,337.19" "$2,305.50" "$2,305.50" "$2,305.50" $480.47 "$2,305.50" N/A N/A 440.895 SUP HCPCS C1713 440.895 - PLATE BONE 121MM 4 HOLE TOMOFIX TITANIUM LEFT MEDIAL DISTAL BOTH IP/OP "$2,305.50" "$1,706.00" $457.58 "$2,305.50" "$1,037.48" "$1,037.48" "$1,037.48" "$1,037.48" "$2,305.50" "$2,305.50" "$2,305.50" $480.52 "$2,305.50" "$2,305.50" "$2,305.50" "$2,305.50" "$2,305.50" $480.49 "$2,305.50" "$2,305.50" "$1,363.70" "$2,305.50" "$2,305.50" "$2,305.50" "$2,305.50" "$1,729.13" "$2,305.50" "$2,305.50" "$2,305.50" "$1,152.75" "$1,152.75" "$1,825.96" "$2,305.50" "$1,844.40" "$1,037.48" $457.58 N/A "$1,337.19" "$2,305.50" "$1,383.30" "$2,305.50" $480.47 "$2,305.50" N/A N/A 441.031 SUP HCPCS C1713 441.031 - PLATE BONE T OBLIQUE RIGHT 52X10X1.5MM 3 HOLE HEAD 3 HOLE BOTH IP/OP $685.00 $507.00 $135.87 $696.23 $308.06 $308.06 $308.06 $308.06 $684.58 $684.58 $684.58 $142.68 $684.58 $684.58 $684.58 $684.58 $684.58 $142.67 $684.58 $278.49 $404.93 $684.58 $696.23 $684.58 $684.58 $513.75 $684.58 $684.58 $684.58 $342.29 $342.29 $542.19 $684.58 $547.66 $308.06 $135.87 N/A $397.30 $684.58 $684.58 $684.58 $142.67 $684.58 N/A N/A 441.041 SUP HCPCS C1713 441.041 - PLATE BONE T OBLIQUE RIGHT 63X10X1.5MM 3 HOLE HEAD 4 HOLE BOTH IP/OP $717.00 $531.00 $142.29 $729.08 $322.61 $322.61 $322.61 $322.61 $716.90 $716.90 $716.90 $149.42 $716.90 $716.90 $716.90 $716.90 $716.90 $149.41 $716.90 $291.63 $424.05 $716.90 $729.08 $716.90 $716.90 $537.75 $716.90 $716.90 $716.90 $358.45 $358.45 $567.78 $716.90 $573.52 $322.61 $142.29 N/A $415.86 $716.90 $430.14 $716.90 $149.40 $716.90 N/A N/A 441.051 SUP HCPCS C1713 441.051 - PLATE BONE T OBLIQUE RIGHT 74X10X1.5MM 3 HOLE HEAD 5 HOLE BOTH IP/OP $748.00 $554.00 $148.43 $760.55 $336.52 $336.52 $336.52 $336.52 $747.83 $747.83 $747.83 $155.87 $747.83 $747.83 $747.83 $747.83 $747.83 $155.86 $747.83 $304.22 $442.34 $747.83 $760.55 $747.83 $747.83 $561.00 $747.83 $747.83 $747.83 $373.92 $373.92 $592.28 $747.83 $598.26 $336.52 $148.43 N/A $433.84 $747.83 $747.83 $747.83 $155.85 $747.83 N/A N/A 441.061 SUP HCPCS C1713 441.061 - PLATE BONE 85MM 3 HOLE HEAD 6 HOLE SHAFT T OBLIQUE RIGHT LCP BOTH IP/OP $803.00 $594.00 $159.31 $816.30 $361.19 $361.19 $361.19 $361.19 $802.65 $802.65 $802.65 $167.29 $802.65 $802.65 $802.65 $802.65 $802.65 $167.28 $802.65 $816.30 $474.77 $802.65 $816.30 $802.65 $802.65 $602.25 $802.65 $802.65 $802.65 $401.33 $401.33 $635.70 $802.65 $642.12 $361.19 $159.31 N/A $465.74 $802.65 $802.65 $802.65 $167.27 $802.65 N/A N/A 441.062 SUP HCPCS C1713 441.062 - PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE BOTH IP/OP "$1,308.00" $968.00 $259.56 "$1,307.78" $588.50 $588.50 $588.50 $588.50 "$1,307.78" "$1,307.78" "$1,307.78" $272.57 "$1,307.78" "$1,307.78" "$1,307.78" "$1,307.78" "$1,307.78" $272.56 "$1,307.78" "$1,307.78" $773.55 "$1,307.78" "$1,307.78" "$1,307.78" "$1,307.78" $981.00 "$1,307.78" "$1,307.78" "$1,307.78" $653.89 $653.89 "$1,035.76" "$1,307.78" "$1,046.22" $588.50 $259.56 N/A $758.64 "$1,307.78" "$1,307.78" "$1,307.78" $272.54 "$1,307.78" N/A N/A 441.063 SUP HCPCS C1713 441.063 - PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,308.00" $968.00 $259.56 "$1,307.78" $588.50 $588.50 $588.50 $588.50 "$1,307.78" "$1,307.78" "$1,307.78" $272.57 "$1,307.78" "$1,307.78" "$1,307.78" "$1,307.78" "$1,307.78" $272.56 "$1,307.78" $523.11 $773.55 "$1,307.78" "$1,307.78" "$1,307.78" "$1,307.78" $981.00 "$1,307.78" "$1,307.78" "$1,307.78" $653.89 $653.89 "$1,035.76" "$1,307.78" "$1,046.22" $588.50 $259.56 N/A $758.64 "$1,307.78" "$1,307.78" "$1,307.78" $272.54 "$1,307.78" N/A N/A 441.064 SUP HCPCS C1713 441.064 - PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE BOTH IP/OP "$1,308.00" $968.00 $259.56 "$1,307.78" $588.50 $588.50 $588.50 $588.50 "$1,307.78" "$1,307.78" "$1,307.78" $272.57 "$1,307.78" "$1,307.78" "$1,307.78" "$1,307.78" "$1,307.78" $272.56 "$1,307.78" $523.11 $773.55 "$1,307.78" "$1,307.78" "$1,307.78" "$1,307.78" $981.00 "$1,307.78" "$1,307.78" "$1,307.78" $653.89 $653.89 "$1,035.76" "$1,307.78" "$1,046.22" $588.50 $259.56 N/A $758.64 "$1,307.78" "$1,307.78" "$1,307.78" "$1,307.78" "$1,307.78" N/A N/A 441.065 SUP HCPCS C1713 441.065 - PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,308.00" $968.00 $259.56 "$1,307.78" $588.50 $588.50 $588.50 $588.50 "$1,307.78" "$1,307.78" "$1,307.78" $272.57 "$1,307.78" "$1,307.78" "$1,307.78" "$1,307.78" "$1,307.78" $272.56 "$1,307.78" $523.11 $773.55 "$1,307.78" "$1,307.78" "$1,307.78" "$1,307.78" $981.00 "$1,307.78" "$1,307.78" "$1,307.78" $653.89 $653.89 "$1,035.76" "$1,307.78" "$1,046.22" $588.50 $259.56 N/A $758.64 "$1,307.78" $784.67 "$1,307.78" "$1,307.78" "$1,307.78" N/A N/A 441.066 SUP HCPCS C1713 441.066 - PLATE BONE 15MM 8 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE BOTH IP/OP "$1,403.50" "$1,039.00" $278.50 "$1,403.18" $631.43 $631.43 $631.43 $631.43 "$1,403.18" "$1,403.18" "$1,403.18" $292.46 "$1,403.18" "$1,403.18" "$1,403.18" "$1,403.18" "$1,403.18" $292.44 "$1,403.18" "$1,403.18" $829.98 "$1,403.18" "$1,403.18" "$1,403.18" "$1,403.18" "$1,052.63" "$1,403.18" "$1,403.18" "$1,403.18" $701.59 $701.59 "$1,111.32" "$1,403.18" "$1,122.54" $631.43 $278.50 N/A $814.03 "$1,403.18" $841.91 "$1,403.18" $292.42 "$1,403.18" N/A N/A 441.067 SUP HCPCS C1713 441.067 - PLATE BONE 15MM 8 HOLE HOOK LCP TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,403.50" "$1,039.00" $278.50 "$1,403.18" $631.43 $631.43 $631.43 $631.43 "$1,403.18" "$1,403.18" "$1,403.18" $292.46 "$1,403.18" "$1,403.18" "$1,403.18" "$1,403.18" "$1,403.18" $292.44 "$1,403.18" $561.27 $829.98 "$1,403.18" "$1,403.18" "$1,403.18" "$1,403.18" "$1,052.63" "$1,403.18" "$1,403.18" "$1,403.18" $701.59 $701.59 "$1,111.32" "$1,403.18" "$1,122.54" $631.43 $278.50 N/A $814.03 "$1,403.18" $841.91 "$1,403.18" $292.42 "$1,403.18" N/A N/A 441.068 SUP HCPCS C1713 441.068 - PLATE BN 18MM 3.5MM 77MM NS 8 HL HK TI CLVCL RT 3.5MM 4MM BOTH IP/OP "$1,403.50" "$1,039.00" $278.50 "$1,403.18" $631.43 $631.43 $631.43 $631.43 "$1,403.18" "$1,403.18" "$1,403.18" $292.46 "$1,403.18" "$1,403.18" "$1,403.18" "$1,403.18" "$1,403.18" $292.44 "$1,403.18" $561.27 $829.98 "$1,403.18" "$1,403.18" "$1,403.18" "$1,403.18" "$1,052.63" "$1,403.18" "$1,403.18" "$1,403.18" $701.59 $701.59 "$1,111.32" "$1,403.18" "$1,122.54" $631.43 $278.50 N/A $814.03 "$1,403.18" $841.91 "$1,403.18" $292.42 "$1,403.18" N/A N/A 441.069 SUP HCPCS C1713 441.069 - PLATE BONE 18MM 77MM 8 HOLE HOOK TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,403.50" "$1,039.00" $278.50 "$1,403.18" $631.43 $631.43 $631.43 $631.43 "$1,403.18" "$1,403.18" "$1,403.18" $292.46 "$1,403.18" "$1,403.18" "$1,403.18" "$1,403.18" "$1,403.18" $292.44 "$1,403.18" $561.27 $829.98 "$1,403.18" "$1,403.18" "$1,403.18" "$1,403.18" "$1,052.63" "$1,403.18" "$1,403.18" "$1,403.18" $701.59 $701.59 "$1,111.32" "$1,403.18" "$1,122.54" $631.43 $278.50 N/A $814.03 "$1,403.18" $841.91 "$1,403.18" $292.42 "$1,403.18" N/A N/A 441.071 SUP HCPCS C1713 441.071 - PLATE BONE T RIGHT OBLIQUE 96MM 7 HOLE SHAFT 3 HOLE HEAD LCP BOTH IP/OP $812.50 $601.00 $161.26 $826.33 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $826.33 $480.59 $812.50 $826.33 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 441.081 SUP HCPCS C1713 441.081 - PLATE BONE 107MM 3X8 HOLE T OBLIQUE RIGHT LCP TITANIUM BOTH IP/OP $883.00 $653.00 $175.21 $897.78 $397.25 $397.25 $397.25 $397.25 $882.78 $882.78 $882.78 $183.99 $882.78 $882.78 $882.78 $882.78 $882.78 $183.98 $882.78 $897.78 $522.16 $882.78 $897.78 $882.78 $882.78 $662.25 $882.78 $882.78 $882.78 $441.39 $441.39 $699.16 $882.78 $706.22 $397.25 $175.21 N/A $512.14 $882.78 $882.78 $882.78 $882.78 $882.78 N/A N/A 441.13 SUP HCPCS C1713 441.13 - PLATE BONE T RIGHT ANG 50X10X1.2MM 3X3 HOLE LC-DCP TITANIUM BOTH IP/OP $232.00 $172.00 $46.05 $232.00 $104.40 $104.40 $104.40 $104.40 $232.00 $232.00 $232.00 $48.35 $232.00 $232.00 $232.00 $232.00 $232.00 $48.35 $232.00 $92.80 $137.23 $232.00 $232.00 $232.00 $232.00 $174.00 $232.00 $232.00 $232.00 $116.00 $116.00 $183.74 $232.00 $185.60 $104.40 $46.05 N/A $134.56 $232.00 $232.00 $232.00 $48.35 $232.00 N/A N/A 441.131 SUP HCPCS C1713 441.131 - PLATE BONE T RIGHT ANG 50X10X1.5MM 3 HOLE HEAD 3 HOLE SHAFT BOTH IP/OP $611.50 $453.00 $121.36 $621.88 $275.17 $275.17 $275.17 $275.17 $611.48 $611.48 $611.48 $127.45 $611.48 $611.48 $611.48 $611.48 $611.48 $127.44 $611.48 $248.75 $361.69 $611.48 $621.88 $611.48 $611.48 $458.63 $611.48 $611.48 $611.48 $305.74 $305.74 $484.29 $611.48 $489.18 $275.17 $121.36 N/A $354.67 $611.48 $366.89 $611.48 $611.48 $611.48 N/A N/A 441.132 SUP HCPCS C1713 441.132 - PLATE BONE 50MM 4 HEAD HOLE 3 SHAFT HOLE T RIGHT ANG LCP BOTH IP/OP $630.00 $466.00 $124.99 $640.45 $283.39 $283.39 $283.39 $283.39 $629.75 $629.75 $629.75 $131.26 $629.75 $629.75 $629.75 $629.75 $629.75 $131.25 $629.75 $256.18 $372.50 $629.75 $640.45 $629.75 $629.75 $472.50 $629.75 $629.75 $629.75 $314.88 $314.88 $498.76 $629.75 $503.80 $283.39 $124.99 N/A $365.40 $629.75 $377.85 $629.75 $629.75 $629.75 N/A N/A 441.14 SUP HCPCS C1713 441.14 - PLATE BONE 3.5MM 56MM T 4 HEAD HOLE 4 SHAFT HOLE RIGHT ANG BOTH IP/OP $240.50 $178.00 $47.67 $240.20 $108.09 $108.09 $108.09 $108.09 $240.20 $240.20 $240.20 $50.06 $240.20 $240.20 $240.20 $240.20 $240.20 $50.06 $240.20 $96.08 $142.08 $240.20 $240.20 $240.20 $240.20 $180.38 $240.20 $240.20 $240.20 $120.10 $120.10 $190.24 $240.20 $192.16 $108.09 $47.67 N/A $139.49 $240.20 $144.12 $240.20 $50.06 $240.20 N/A N/A 441.141 SUP HCPCS C1713 441.141 - PLATE BONE T RIGHT ANG 56X11X1.5MM 4 HOLE HEAD 4 HOLE SHAFT BOTH IP/OP $631.50 $467.00 $125.27 $641.88 $284.02 $284.02 $284.02 $284.02 $631.15 $631.15 $631.15 $131.55 $631.15 $631.15 $631.15 $631.15 $631.15 $131.54 $631.15 $256.75 $373.33 $631.15 $641.88 $631.15 $631.15 $473.63 $631.15 $631.15 $631.15 $315.58 $315.58 $499.87 $631.15 $504.92 $284.02 $125.27 N/A $366.27 $631.15 $631.15 $631.15 $131.53 $631.15 N/A N/A 441.142 SUP HCPCS C1713 441.142 - PLATE BONE 57MM 3 HOLE HEAD 4 HOLE SHAFT T RIGHT ANG LCP BOTH IP/OP $651.00 $482.00 $129.17 $661.90 $292.87 $292.87 $292.87 $292.87 $650.83 $650.83 $650.83 $135.65 $650.83 $650.83 $650.83 $650.83 $650.83 $135.64 $650.83 $264.76 $384.97 $650.83 $661.90 $650.83 $650.83 $488.25 $650.83 $650.83 $650.83 $325.42 $325.42 $515.46 $650.83 $520.66 $292.87 $129.17 N/A $377.58 $650.83 $390.50 $650.83 $135.63 $650.83 N/A N/A 441.15 SUP HCPCS C1713 441.15 - PLATE BONE T RIGHT ANG 67X10X1.2MM 3X5 HOLE LC-DCP TITANIUM BOTH IP/OP $266.50 $197.00 $52.82 $266.13 $119.76 $119.76 $119.76 $119.76 $266.13 $266.13 $266.13 $55.47 $266.13 $266.13 $266.13 $266.13 $266.13 $55.46 $266.13 $106.45 $157.42 $266.13 $266.13 $266.13 $266.13 $199.88 $266.13 $266.13 $266.13 $133.07 $133.07 $210.77 $266.13 $212.90 $119.76 $52.82 N/A $154.57 $266.13 $159.68 $266.13 $55.46 $266.13 N/A N/A 441.151 SUP HCPCS C1713 441.151 - PLATE BONE T RIGHT ANG 67X10X1.5MM 3 HOLE HEAD 5 HOLE SHAFT BOTH IP/OP $694.50 $514.00 $137.82 $706.20 $312.48 $312.48 $312.48 $312.48 $694.40 $694.40 $694.40 $144.73 $694.40 $694.40 $694.40 $694.40 $694.40 $144.72 $694.40 $282.48 $410.74 $694.40 $706.20 $694.40 $694.40 $520.88 $694.40 $694.40 $694.40 $347.20 $347.20 $549.96 $694.40 $555.52 $312.48 $137.82 N/A $402.81 $694.40 $416.64 $694.40 $144.71 $694.40 N/A N/A 441.152 SUP HCPCS C1713 441.152 - PLATE BONE 67MM 4 HEAD HOLE 5 SHAFT HOLE T RIGHT ANG LCP BOTH IP/OP $715.50 $529.00 $142.01 $727.68 $321.98 $321.98 $321.98 $321.98 $715.50 $715.50 $715.50 $149.13 $715.50 $715.50 $715.50 $715.50 $715.50 $149.12 $715.50 $291.07 $423.22 $715.50 $727.68 $715.50 $715.50 $536.63 $715.50 $715.50 $715.50 $357.75 $357.75 $566.68 $715.50 $572.40 $321.98 $142.01 N/A $414.99 $715.50 $715.50 $715.50 $149.11 $715.50 N/A N/A 441.16 SUP HCPCS C1713 441.16 - PLATE BONE T RIGHT ANG 78X10X1.2MM 4X6 HOLE LC-DCP TITANIUM BOTH IP/OP $302.50 $224.00 $59.96 $302.10 $135.95 $135.95 $135.95 $135.95 $302.10 $302.10 $302.10 $62.97 $302.10 $302.10 $302.10 $302.10 $302.10 $62.96 $302.10 $120.84 $178.69 $302.10 $302.10 $302.10 $302.10 $226.88 $302.10 $302.10 $302.10 $151.05 $151.05 $239.26 $302.10 $241.68 $135.95 $59.96 N/A $175.45 $302.10 $302.10 $302.10 $62.96 $302.10 N/A N/A 441.161 SUP HCPCS C1713 441.161 - PLATE BONE T RIGHT ANG 78X11X1.5MM 4 HOLE HEAD 6 HOLE SHAFT BOTH IP/OP $810.00 $599.00 $160.70 $823.45 $364.36 $364.36 $364.36 $364.36 $809.68 $809.68 $809.68 $168.76 $809.68 $809.68 $809.68 $809.68 $809.68 $168.75 $809.68 $329.38 $478.93 $809.68 $823.45 $809.68 $809.68 $607.50 $809.68 $809.68 $809.68 $404.84 $404.84 $641.27 $809.68 $647.74 $364.36 $160.70 N/A $469.80 $809.68 $809.68 $809.68 $168.74 $809.68 N/A N/A 441.162 SUP HCPCS C1713 441.162 - PLATE BONE 77MM 3 HOLE HEAD 6 HOLE SHAFT T RIGHT ANG LCP BOTH IP/OP $831.00 $615.00 $164.89 $844.90 $373.85 $373.85 $373.85 $373.85 $830.78 $830.78 $830.78 $173.16 $830.78 $830.78 $830.78 $830.78 $830.78 $173.14 $830.78 $337.96 $491.41 $830.78 $844.90 $830.78 $830.78 $623.25 $830.78 $830.78 $830.78 $415.39 $415.39 $657.98 $830.78 $664.62 $373.85 $164.89 N/A $481.98 $830.78 $830.78 $830.78 $173.13 $830.78 N/A N/A 441.171 SUP HCPCS C1713 441.171 - PLATE BONE T RIGHT ANG 87X10X1.5MM 3 HOLE HEAD 7 HOLE SHAFT BOTH IP/OP "$1,015.00" $751.00 $201.43 "$1,032.15" $456.71 $456.71 $456.71 $456.71 "$1,014.90" "$1,014.90" "$1,014.90" $211.53 "$1,014.90" "$1,014.90" "$1,014.90" "$1,014.90" "$1,014.90" $211.52 "$1,014.90" $412.86 $600.31 "$1,014.90" "$1,032.15" "$1,014.90" "$1,014.90" $761.25 "$1,014.90" "$1,014.90" "$1,014.90" $507.45 $507.45 $803.80 "$1,014.90" $811.92 $456.71 $201.43 N/A $588.70 "$1,014.90" "$1,014.90" "$1,014.90" $211.51 "$1,014.90" N/A N/A 441.172 SUP HCPCS C1713 441.172 - PLATE BONE 89MM 4 HOLE HEAD 7 HOLE SHAFT T RIGHT ANG LCP BOTH IP/OP "$1,042.00" $771.00 $206.74 "$1,059.33" $468.73 $468.73 $468.73 $468.73 "$1,041.63" "$1,041.63" "$1,041.63" $217.10 "$1,041.63" "$1,041.63" "$1,041.63" "$1,041.63" "$1,041.63" $217.09 "$1,041.63" $423.73 $616.12 "$1,041.63" "$1,059.33" "$1,041.63" "$1,041.63" $781.50 "$1,041.63" "$1,041.63" "$1,041.63" $520.82 $520.82 $824.97 "$1,041.63" $833.30 $468.73 $206.74 N/A $604.36 "$1,041.63" "$1,041.63" "$1,041.63" "$1,041.63" "$1,041.63" N/A N/A 441.181 SUP HCPCS C1713 441.181 - PLATE BONE 97MM 3 HOLE HEAD 8 HOLE SHAFT T RIGHT ANG LCP BOTH IP/OP "$1,215.00" $899.00 $241.05 "$1,235.18" $546.54 $546.54 $546.54 $546.54 "$1,214.53" "$1,214.53" "$1,214.53" $253.14 "$1,214.53" "$1,214.53" "$1,214.53" "$1,214.53" "$1,214.53" $253.12 "$1,214.53" $494.07 $718.39 "$1,214.53" "$1,235.18" "$1,214.53" "$1,214.53" $911.25 "$1,214.53" "$1,214.53" "$1,214.53" $607.27 $607.27 $961.91 "$1,214.53" $971.62 $546.54 $241.05 N/A $704.70 "$1,214.53" "$1,214.53" "$1,214.53" "$1,214.53" "$1,214.53" N/A N/A 441.182 SUP HCPCS C1713 441.182 - PLATE BONE 100MM 4 HOLE HEAD 8 HOLE SHAFT T RIGHT ANG LCP BOTH IP/OP "$1,210.50" $896.00 $240.21 "$1,230.88" $544.64 $544.64 $544.64 $544.64 "$1,210.30" "$1,210.30" "$1,210.30" $252.26 "$1,210.30" "$1,210.30" "$1,210.30" "$1,210.30" "$1,210.30" $252.24 "$1,210.30" $492.35 $715.89 "$1,210.30" "$1,230.88" "$1,210.30" "$1,210.30" $907.88 "$1,210.30" "$1,210.30" "$1,210.30" $605.15 $605.15 $958.56 "$1,210.30" $968.24 $544.64 $240.21 N/A $702.09 "$1,210.30" "$1,210.30" "$1,210.30" $252.23 "$1,210.30" N/A N/A 441.23 SUP HCPCS C1713 441.23 - PLATE BONE T OBLIQUE 53X10X1.2MM 3X3 HOLE LC-DCP TITANIUM BOTH IP/OP $398.50 $295.00 $79.09 $398.50 $179.33 $179.33 $179.33 $179.33 $398.50 $398.50 $398.50 $83.06 $398.50 $398.50 $398.50 $398.50 $398.50 $83.05 $398.50 $159.40 $235.71 $398.50 $398.50 $398.50 $398.50 $298.88 $398.50 $398.50 $398.50 $199.25 $199.25 $315.61 $398.50 $318.80 $179.33 $79.09 N/A $231.13 $398.50 $239.10 $398.50 $83.05 $398.50 N/A N/A 441.24 SUP HCPCS C1713 441.24 - PLATE BONE T OBLIQUE 63X10X1.2MM 3X4 HOLE LC-DCP TITANIUM BOTH IP/OP $423.50 $313.00 $83.97 $423.08 $190.39 $190.39 $190.39 $190.39 $423.08 $423.08 $423.08 $88.18 $423.08 $423.08 $423.08 $423.08 $423.08 $88.17 $423.08 $169.23 $250.25 $423.08 $423.08 $423.08 $423.08 $317.63 $423.08 $423.08 $423.08 $211.54 $211.54 $335.08 $423.08 $338.46 $190.39 $83.97 N/A $245.63 $423.08 $253.85 $423.08 $88.17 $423.08 N/A N/A 441.25 SUP HCPCS C1713 441.25 - PLATE BN T OBLQ 75X10X1.5MM LC DCP 3 HLE/HD 5 HL SHFT TI 3.5 BOTH IP/OP $435.50 $322.00 $86.41 $435.35 $195.91 $195.91 $195.91 $195.91 $435.35 $435.35 $435.35 $90.74 $435.35 $435.35 $435.35 $435.35 $435.35 $90.73 $435.35 $174.14 $257.51 $435.35 $435.35 $435.35 $435.35 $326.63 $435.35 $435.35 $435.35 $217.68 $217.68 $344.80 $435.35 $348.28 $195.91 $86.41 N/A $252.59 $435.35 $261.21 $435.35 $90.73 $435.35 N/A N/A 441.262 SUP HCPCS C1713 441.262 - PLATE BONE 55MM 3 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT BOTH IP/OP "$1,791.00" "$1,325.00" $355.44 "$1,821.30" $805.88 $805.88 $805.88 $805.88 "$1,790.85" "$1,790.85" "$1,790.85" $373.26 "$1,790.85" "$1,790.85" "$1,790.85" "$1,790.85" "$1,790.85" $373.23 "$1,790.85" $728.52 "$1,059.29" "$1,790.85" "$1,821.30" "$1,790.85" "$1,790.85" "$1,343.25" "$1,790.85" "$1,790.85" "$1,790.85" $895.43 $895.43 "$1,418.35" "$1,790.85" "$1,432.68" $805.88 $355.44 N/A "$1,038.78" "$1,790.85" "$1,074.51" "$1,790.85" "$1,790.85" "$1,790.85" N/A N/A 441.263 SUP HCPCS C1713 441.263 - PLATE BONE 55MM 3 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT BOTH IP/OP "$1,791.00" "$1,325.00" $355.44 "$1,821.30" $805.88 $805.88 $805.88 $805.88 "$1,790.85" "$1,790.85" "$1,790.85" $373.26 "$1,790.85" "$1,790.85" "$1,790.85" "$1,790.85" "$1,790.85" $373.23 "$1,790.85" $728.52 "$1,059.29" "$1,790.85" "$1,821.30" "$1,790.85" "$1,790.85" "$1,343.25" "$1,790.85" "$1,790.85" "$1,790.85" $895.43 $895.43 "$1,418.35" "$1,790.85" "$1,432.68" $805.88 $355.44 N/A "$1,038.78" "$1,790.85" "$1,074.51" "$1,790.85" "$1,790.85" "$1,790.85" N/A N/A 441.264 SUP HCPCS C1713 441.264 - PLATE BONE 5 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT DISTAL BOTH IP/OP "$1,986.50" "$1,470.00" $394.22 "$2,020.03" $893.81 $893.81 $893.81 $893.81 "$1,986.25" "$1,986.25" "$1,986.25" $413.98 "$1,986.25" "$1,986.25" "$1,986.25" "$1,986.25" "$1,986.25" $413.96 "$1,986.25" $808.01 "$1,174.87" "$1,986.25" "$2,020.03" "$1,986.25" "$1,986.25" "$1,489.88" "$1,986.25" "$1,986.25" "$1,986.25" $993.13 $993.13 "$1,573.11" "$1,986.25" "$1,589.00" $893.81 $394.22 N/A "$1,152.17" "$1,986.25" "$1,191.75" "$1,986.25" "$1,986.25" "$1,986.25" N/A N/A 441.265 SUP HCPCS C1713 441.265 - PLATE BONE 5 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT DISTAL BOTH IP/OP "$1,986.50" "$1,470.00" $394.22 "$2,020.03" $893.81 $893.81 $893.81 $893.81 "$1,986.25" "$1,986.25" "$1,986.25" $413.98 "$1,986.25" "$1,986.25" "$1,986.25" "$1,986.25" "$1,986.25" $413.96 "$1,986.25" $808.01 "$1,174.87" "$1,986.25" "$2,020.03" "$1,986.25" "$1,986.25" "$1,489.88" "$1,986.25" "$1,986.25" "$1,986.25" $993.13 $993.13 "$1,573.11" "$1,986.25" "$1,589.00" $893.81 $394.22 N/A "$1,152.17" "$1,986.25" "$1,986.25" "$1,986.25" "$1,986.25" "$1,986.25" N/A N/A 441.266 SUP HCPCS C1713 441.266 - PLATE BONE 116MM 7 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT BOTH IP/OP "$2,184.50" "$1,617.00" $433.56 "$2,221.58" $983.00 $983.00 $983.00 $983.00 "$2,184.45" "$2,184.45" "$2,184.45" $455.29 "$2,184.45" "$2,184.45" "$2,184.45" "$2,184.45" "$2,184.45" $455.26 "$2,184.45" $888.63 "$1,292.10" "$2,184.45" "$2,221.58" "$2,184.45" "$2,184.45" "$1,638.38" "$2,184.45" "$2,184.45" "$2,184.45" "$1,092.23" "$1,092.23" "$1,730.08" "$2,184.45" "$1,747.56" $983.00 $433.56 N/A "$1,267.01" "$2,184.45" "$2,184.45" "$2,184.45" "$2,184.45" "$2,184.45" N/A N/A 441.267 SUP HCPCS C1713 441.267 - PLATE BONE 116MM 7 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT BOTH IP/OP "$2,184.50" "$1,617.00" $433.56 "$2,221.58" $983.00 $983.00 $983.00 $983.00 "$2,184.45" "$2,184.45" "$2,184.45" $455.29 "$2,184.45" "$2,184.45" "$2,184.45" "$2,184.45" "$2,184.45" $455.26 "$2,184.45" $888.63 "$1,292.10" "$2,184.45" "$2,221.58" "$2,184.45" "$2,184.45" "$1,638.38" "$2,184.45" "$2,184.45" "$2,184.45" "$1,092.23" "$1,092.23" "$1,730.08" "$2,184.45" "$1,747.56" $983.00 $433.56 N/A "$1,267.01" "$2,184.45" "$1,310.67" "$2,184.45" $455.24 "$2,184.45" N/A N/A 441.268 SUP HCPCS C1713 441.268 - PLATE BONE 9 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT DISTAL BOTH IP/OP "$2,359.00" "$1,746.00" $468.15 "$2,398.85" "$1,061.44" "$1,061.44" "$1,061.44" "$1,061.44" "$2,358.75" "$2,358.75" "$2,358.75" $491.62 "$2,358.75" "$2,358.75" "$2,358.75" "$2,358.75" "$2,358.75" $491.59 "$2,358.75" "$2,398.85" "$1,395.20" "$2,358.75" "$2,398.85" "$2,358.75" "$2,358.75" "$1,769.25" "$2,358.75" "$2,358.75" "$2,358.75" "$1,179.38" "$1,179.38" "$1,868.13" "$2,358.75" "$1,887.00" "$1,061.44" $468.15 N/A "$1,368.22" "$2,358.75" "$1,415.25" "$2,358.75" "$2,358.75" "$2,358.75" N/A N/A 441.269 SUP HCPCS C1713 441.269 - PLATE BONE 9 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT DISTAL BOTH IP/OP "$2,359.00" "$1,746.00" $468.15 "$2,398.85" "$1,061.44" "$1,061.44" "$1,061.44" "$1,061.44" "$2,358.75" "$2,358.75" "$2,358.75" $491.62 "$2,358.75" "$2,358.75" "$2,358.75" "$2,358.75" "$2,358.75" $491.59 "$2,358.75" "$2,398.85" "$1,395.20" "$2,358.75" "$2,398.85" "$2,358.75" "$2,358.75" "$1,769.25" "$2,358.75" "$2,358.75" "$2,358.75" "$1,179.38" "$1,179.38" "$1,868.13" "$2,358.75" "$1,887.00" "$1,061.44" $468.15 N/A "$1,368.22" "$2,358.75" "$1,415.25" "$2,358.75" $491.56 "$2,358.75" N/A N/A 441.272 SUP HCPCS C1713 441.272 - PLATE BONE 55MM 3 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS BOTH IP/OP "$2,054.00" "$1,520.00" $407.61 "$2,088.65" $924.18 $924.18 $924.18 $924.18 "$2,053.73" "$2,053.73" "$2,053.73" $428.05 "$2,053.73" "$2,053.73" "$2,053.73" "$2,053.73" "$2,053.73" $428.02 "$2,053.73" "$2,088.65" "$1,214.78" "$2,053.73" "$2,088.65" "$2,053.73" "$2,053.73" "$1,540.50" "$2,053.73" "$2,053.73" "$2,053.73" "$1,026.87" "$1,026.87" "$1,626.55" "$2,053.73" "$1,642.98" $924.18 $407.61 N/A "$1,191.32" "$2,053.73" "$1,232.24" "$2,053.73" $428.00 "$2,053.73" N/A N/A 441.273 SUP HCPCS C1713 441.273 - PLATE BONE 3 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT BOTH IP/OP "$2,054.00" "$1,520.00" $407.61 "$2,088.65" $924.18 $924.18 $924.18 $924.18 "$2,053.73" "$2,053.73" "$2,053.73" $428.05 "$2,053.73" "$2,053.73" "$2,053.73" "$2,053.73" "$2,053.73" $428.02 "$2,053.73" $835.46 "$1,214.78" "$2,053.73" "$2,088.65" "$2,053.73" "$2,053.73" "$1,540.50" "$2,053.73" "$2,053.73" "$2,053.73" "$1,026.87" "$1,026.87" "$1,626.55" "$2,053.73" "$1,642.98" $924.18 $407.61 N/A "$1,191.32" "$2,053.73" "$1,232.24" "$2,053.73" $428.00 "$2,053.73" N/A N/A 441.274 SUP HCPCS C1713 441.274 - PLATE BONE 5 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS RIGHT BOTH IP/OP "$2,239.50" "$1,657.00" $444.44 "$2,277.35" "$1,007.68" "$1,007.68" "$1,007.68" "$1,007.68" "$2,239.28" "$2,239.28" "$2,239.28" $466.72 "$2,239.28" "$2,239.28" "$2,239.28" "$2,239.28" "$2,239.28" $466.69 "$2,239.28" $910.94 "$1,324.53" "$2,239.28" "$2,277.35" "$2,239.28" "$2,239.28" "$1,679.63" "$2,239.28" "$2,239.28" "$2,239.28" "$1,119.64" "$1,119.64" "$1,773.51" "$2,239.28" "$1,791.42" "$1,007.68" $444.44 N/A "$1,298.91" "$2,239.28" "$1,343.57" "$2,239.28" "$2,239.28" "$2,239.28" N/A N/A 441.275 SUP HCPCS C1713 441.275 - PLATE BONE 5 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT BOTH IP/OP "$2,239.50" "$1,657.00" $444.44 "$2,277.35" "$1,007.68" "$1,007.68" "$1,007.68" "$1,007.68" "$2,239.28" "$2,239.28" "$2,239.28" $466.72 "$2,239.28" "$2,239.28" "$2,239.28" "$2,239.28" "$2,239.28" $466.69 "$2,239.28" $910.94 "$1,324.53" "$2,239.28" "$2,277.35" "$2,239.28" "$2,239.28" "$1,679.63" "$2,239.28" "$2,239.28" "$2,239.28" "$1,119.64" "$1,119.64" "$1,773.51" "$2,239.28" "$1,791.42" "$1,007.68" $444.44 N/A "$1,298.91" "$2,239.28" "$1,343.57" "$2,239.28" $466.67 "$2,239.28" N/A N/A 441.276 SUP HCPCS C1713 441.276 - PLATE BONE 116MM 7 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS BOTH IP/OP "$2,426.50" "$1,796.00" $481.55 "$2,467.48" "$1,091.80" "$1,091.80" "$1,091.80" "$1,091.80" "$2,426.23" "$2,426.23" "$2,426.23" $505.69 "$2,426.23" "$2,426.23" "$2,426.23" "$2,426.23" "$2,426.23" $505.65 "$2,426.23" "$2,467.48" "$1,435.12" "$2,426.23" "$2,467.48" "$2,426.23" "$2,426.23" "$1,819.88" "$2,426.23" "$2,426.23" "$2,426.23" "$1,213.12" "$1,213.12" "$1,921.57" "$2,426.23" "$1,940.98" "$1,091.80" $481.55 N/A "$1,407.37" "$2,426.23" "$2,426.23" "$2,426.23" $505.63 "$2,426.23" N/A N/A 441.277 SUP HCPCS C1713 441.277 - PLATE BONE 7 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT BOTH IP/OP "$2,426.50" "$1,796.00" $481.55 "$2,467.48" "$1,091.80" "$1,091.80" "$1,091.80" "$1,091.80" "$2,426.23" "$2,426.23" "$2,426.23" $505.69 "$2,426.23" "$2,426.23" "$2,426.23" "$2,426.23" "$2,426.23" $505.65 "$2,426.23" "$2,467.48" "$1,435.12" "$2,426.23" "$2,467.48" "$2,426.23" "$2,426.23" "$1,819.88" "$2,426.23" "$2,426.23" "$2,426.23" "$1,213.12" "$1,213.12" "$1,921.57" "$2,426.23" "$1,940.98" "$1,091.80" $481.55 N/A "$1,407.37" "$2,426.23" "$2,426.23" "$2,426.23" $505.63 "$2,426.23" N/A N/A 441.278 SUP HCPCS C1713 441.278 - PLATE BONE 9 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS RIGHT BOTH IP/OP "$2,633.00" "$1,948.00" $522.55 "$2,677.60" "$1,184.78" "$1,184.78" "$1,184.78" "$1,184.78" "$2,632.85" "$2,632.85" "$2,632.85" $548.75 "$2,632.85" "$2,632.85" "$2,632.85" "$2,632.85" "$2,632.85" $548.71 "$2,632.85" "$2,677.60" "$1,298.00" "$2,632.85" "$2,677.60" "$2,632.85" "$2,632.85" "$1,974.75" "$2,632.85" "$2,632.85" "$2,632.85" "$1,316.43" "$1,316.43" "$2,085.22" "$2,632.85" "$2,106.28" "$1,184.78" $522.55 N/A "$1,527.14" "$2,632.85" "$2,632.85" "$2,632.85" "$2,632.85" "$2,632.85" N/A N/A 441.279 SUP HCPCS C1713 441.279 - PLATE BONE 9 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT BOTH IP/OP "$2,633.00" "$1,948.00" $522.55 "$2,677.60" "$1,184.78" "$1,184.78" "$1,184.78" "$1,184.78" "$2,632.85" "$2,632.85" "$2,632.85" $548.75 "$2,632.85" "$2,632.85" "$2,632.85" "$2,632.85" "$2,632.85" $548.71 "$2,632.85" "$1,071.04" "$1,298.00" "$2,632.85" "$2,677.60" "$2,632.85" "$2,632.85" "$1,974.75" "$2,632.85" "$2,632.85" "$2,632.85" "$1,316.43" "$1,316.43" "$2,085.22" "$2,632.85" "$2,106.28" "$1,184.78" $522.55 N/A "$1,527.14" "$2,632.85" "$1,579.71" "$2,632.85" $548.69 "$2,632.85" N/A N/A 441.282 SUP HCPCS C1713 441.282 - PLATE BONE 3 HOLE LCP TITANIUM HUMERUS RIGHT MEDIAL DISTAL BOTH IP/OP "$1,791.00" "$1,325.00" $355.44 "$1,821.30" $805.88 $805.88 $805.88 $805.88 "$1,790.85" "$1,790.85" "$1,790.85" $373.26 "$1,790.85" "$1,790.85" "$1,790.85" "$1,790.85" "$1,790.85" $373.23 "$1,790.85" "$1,821.30" "$1,059.29" "$1,790.85" "$1,821.30" "$1,790.85" "$1,790.85" "$1,343.25" "$1,790.85" "$1,790.85" "$1,790.85" $895.43 $895.43 "$1,418.35" "$1,790.85" "$1,432.68" $805.88 $355.44 N/A "$1,038.78" "$1,790.85" "$1,074.51" "$1,790.85" $373.21 "$1,790.85" N/A N/A 441.283 SUP HCPCS C1713 441.283 - PLATE BONE 58MM 3 HOLE LCP TITANIUM HUMERUS LEFT DISTAL BOTH IP/OP "$1,791.00" "$1,325.00" $355.44 "$1,821.30" $805.88 $805.88 $805.88 $805.88 "$1,790.85" "$1,790.85" "$1,790.85" $373.26 "$1,790.85" "$1,790.85" "$1,790.85" "$1,790.85" "$1,790.85" $373.23 "$1,790.85" $728.52 "$1,059.29" "$1,790.85" "$1,821.30" "$1,790.85" "$1,790.85" "$1,343.25" "$1,790.85" "$1,790.85" "$1,790.85" $895.43 $895.43 "$1,418.35" "$1,790.85" "$1,432.68" $805.88 $355.44 N/A "$1,038.78" "$1,790.85" "$1,074.51" "$1,790.85" $373.21 "$1,790.85" N/A N/A 441.284 SUP HCPCS C1713 441.284 - PLATE BONE 5 HOLE LCP TITANIUM HUMERUS RIGHT DISTAL MEDIAL BOTH IP/OP "$1,986.50" "$1,470.00" $394.22 "$2,020.03" $893.81 $893.81 $893.81 $893.81 "$1,986.25" "$1,986.25" "$1,986.25" $413.98 "$1,986.25" "$1,986.25" "$1,986.25" "$1,986.25" "$1,986.25" $413.96 "$1,986.25" "$2,020.03" "$1,174.87" "$1,986.25" "$2,020.03" "$1,986.25" "$1,986.25" "$1,489.88" "$1,986.25" "$1,986.25" "$1,986.25" $993.13 $993.13 "$1,573.11" "$1,986.25" "$1,589.00" $893.81 $394.22 N/A "$1,152.17" "$1,986.25" "$1,191.75" "$1,986.25" $413.93 "$1,986.25" N/A N/A 441.285 SUP HCPCS C1713 441.285 - PLATE BONE 83MM 5 HOLE LCP TITANIUM HUMERUS LEFT DISTAL BOTH IP/OP "$1,986.50" "$1,470.00" $394.22 "$2,020.03" $893.81 $893.81 $893.81 $893.81 "$1,986.25" "$1,986.25" "$1,986.25" $413.98 "$1,986.25" "$1,986.25" "$1,986.25" "$1,986.25" "$1,986.25" $413.96 "$1,986.25" $808.01 "$1,174.87" "$1,986.25" "$2,020.03" "$1,986.25" "$1,986.25" "$1,489.88" "$1,986.25" "$1,986.25" "$1,986.25" $993.13 $993.13 "$1,573.11" "$1,986.25" "$1,589.00" $893.81 $394.22 N/A "$1,152.17" "$1,986.25" "$1,986.25" "$1,986.25" $413.93 "$1,986.25" N/A N/A 441.286 SUP HCPCS C1713 441.286 - PLATE BONE 110MM 7 HOLE LCP TITANIUM HUMERUS RIGHT DISTAL BOTH IP/OP "$2,184.50" "$1,617.00" $433.56 "$2,221.58" $983.00 $983.00 $983.00 $983.00 "$2,184.45" "$2,184.45" "$2,184.45" $455.29 "$2,184.45" "$2,184.45" "$2,184.45" "$2,184.45" "$2,184.45" $455.26 "$2,184.45" $888.63 "$1,292.10" "$2,184.45" "$2,221.58" "$2,184.45" "$2,184.45" "$1,638.38" "$2,184.45" "$2,184.45" "$2,184.45" "$1,092.23" "$1,092.23" "$1,730.08" "$2,184.45" "$1,747.56" $983.00 $433.56 N/A "$1,267.01" "$2,184.45" "$2,184.45" "$2,184.45" $455.24 "$2,184.45" N/A N/A 441.287 SUP HCPCS C1713 441.287 - PLATE BN 110X11X2.5MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT BOTH IP/OP "$2,184.50" "$1,617.00" $433.56 "$2,221.58" $983.00 $983.00 $983.00 $983.00 "$2,184.45" "$2,184.45" "$2,184.45" $455.29 "$2,184.45" "$2,184.45" "$2,184.45" "$2,184.45" "$2,184.45" $455.26 "$2,184.45" $888.63 "$1,292.10" "$2,184.45" "$2,221.58" "$2,184.45" "$2,184.45" "$1,638.38" "$2,184.45" "$2,184.45" "$2,184.45" "$1,092.23" "$1,092.23" "$1,730.08" "$2,184.45" "$1,747.56" $983.00 $433.56 N/A "$1,267.01" "$2,184.45" "$2,184.45" "$2,184.45" $455.24 "$2,184.45" N/A N/A 441.288 SUP HCPCS C1713 441.288 - PLATE BONE 9 HOLE LCP TITANIUM HUMERUS RIGHT MEDIAL DISTAL BOTH IP/OP "$2,359.00" "$1,746.00" $468.15 "$2,398.85" "$1,061.44" "$1,061.44" "$1,061.44" "$1,061.44" "$2,358.75" "$2,358.75" "$2,358.75" $491.62 "$2,358.75" "$2,358.75" "$2,358.75" "$2,358.75" "$2,358.75" $491.59 "$2,358.75" $959.54 "$1,395.20" "$2,358.75" "$2,398.85" "$2,358.75" "$2,358.75" "$1,769.25" "$2,358.75" "$2,358.75" "$2,358.75" "$1,179.38" "$1,179.38" "$1,868.13" "$2,358.75" "$1,887.00" "$1,061.44" $468.15 N/A "$1,368.22" "$2,358.75" "$2,358.75" "$2,358.75" $491.56 "$2,358.75" N/A N/A 441.289 SUP HCPCS C1713 441.289 - PLATE BONE 136MM 9 HOLE LCP TITANIUM HUMERUS LEFT DISTAL BOTH IP/OP "$2,359.00" "$1,746.00" $468.15 "$2,398.85" "$1,061.44" "$1,061.44" "$1,061.44" "$1,061.44" "$2,358.75" "$2,358.75" "$2,358.75" $491.62 "$2,358.75" "$2,358.75" "$2,358.75" "$2,358.75" "$2,358.75" $491.59 "$2,358.75" $959.54 "$1,395.20" "$2,358.75" "$2,398.85" "$2,358.75" "$2,358.75" "$1,769.25" "$2,358.75" "$2,358.75" "$2,358.75" "$1,179.38" "$1,179.38" "$1,868.13" "$2,358.75" "$1,887.00" "$1,061.44" $468.15 N/A "$1,368.22" "$2,358.75" "$2,358.75" "$2,358.75" $491.56 "$2,358.75" N/A N/A 441.3 SUP HCPCS C1713 441.300 - PLATE BONE 14 HOLE LCP TITANIUM HUMERUS RIGHT POSTLAT DISTAL BOTH IP/OP "$2,356.00" "$1,743.00" $467.52 "$2,467.48" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$2,355.55" "$2,355.55" "$2,355.55" $490.96 "$2,355.55" "$2,355.55" "$2,355.55" "$2,355.55" "$2,355.55" $490.92 "$2,355.55" $986.99 "$1,393.31" "$2,355.55" "$2,467.48" "$2,355.55" "$2,355.55" "$1,767.00" "$2,355.55" "$2,355.55" "$2,355.55" "$1,177.78" "$1,177.78" "$1,865.60" "$2,355.55" "$1,884.44" "$1,060.00" $467.52 N/A "$1,366.48" "$2,355.55" "$2,355.55" "$2,355.55" "$2,355.55" "$2,355.55" N/A N/A 441.301 SUP HCPCS C1713 441.301 - PLATE BONE 14 HOLE LCP TITANIUM HUMERUS LEFT POSTLAT DISTAL BOTH IP/OP "$2,426.50" "$1,796.00" $481.55 "$2,467.48" "$1,091.80" "$1,091.80" "$1,091.80" "$1,091.80" "$2,426.23" "$2,426.23" "$2,426.23" $505.69 "$2,426.23" "$2,426.23" "$2,426.23" "$2,426.23" "$2,426.23" $505.65 "$2,426.23" $986.99 "$1,435.12" "$2,426.23" "$2,467.48" "$2,426.23" "$2,426.23" "$1,819.88" "$2,426.23" "$2,426.23" "$2,426.23" "$1,213.12" "$1,213.12" "$1,921.57" "$2,426.23" "$1,940.98" "$1,091.80" $481.55 N/A "$1,407.37" "$2,426.23" "$1,455.74" "$2,426.23" "$2,426.23" "$2,426.23" N/A N/A 441.302 SUP HCPCS C1713 441.302 - PLATE BONE 14 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS BOTH IP/OP "$2,565.50" "$1,898.00" $509.17 "$2,609.00" "$1,154.43" "$1,154.43" "$1,154.43" "$1,154.43" "$2,565.40" "$2,565.40" "$2,565.40" $534.69 "$2,565.40" "$2,565.40" "$2,565.40" "$2,565.40" "$2,565.40" $534.66 "$2,565.40" "$2,609.00" "$1,264.74" "$2,565.40" "$2,609.00" "$2,565.40" "$2,565.40" "$1,924.13" "$2,565.40" "$2,565.40" "$2,565.40" "$1,282.70" "$1,282.70" "$2,031.80" "$2,565.40" "$2,052.32" "$1,154.43" $509.17 N/A "$1,487.99" "$2,565.40" "$1,539.24" "$2,565.40" $534.63 "$2,565.40" N/A N/A 441.303 SUP HCPCS C1713 441.303 - PLATE BONE 14 HOLE LATERAL SUPPORT LCP TITANIUM HUMERUS LEFT BOTH IP/OP "$2,565.50" "$1,898.00" $509.17 "$2,609.00" "$1,154.43" "$1,154.43" "$1,154.43" "$1,154.43" "$2,565.40" "$2,565.40" "$2,565.40" $534.69 "$2,565.40" "$2,565.40" "$2,565.40" "$2,565.40" "$2,565.40" $534.66 "$2,565.40" "$1,043.60" "$1,264.74" "$2,565.40" "$2,609.00" "$2,565.40" "$2,565.40" "$1,924.13" "$2,565.40" "$2,565.40" "$2,565.40" "$1,282.70" "$1,282.70" "$2,031.80" "$2,565.40" "$2,052.32" "$1,154.43" $509.17 N/A "$1,487.99" "$2,565.40" "$1,539.24" "$2,565.40" "$2,565.40" "$2,565.40" N/A N/A 441.304 SUP HCPCS C1713 441.304 - PLATE BONE 14 HOLE LCP TITANIUM HUMERUS RIGHT MEDIAL DISTAL BOTH IP/OP "$2,426.50" "$1,796.00" $481.55 "$2,467.48" "$1,091.80" "$1,091.80" "$1,091.80" "$1,091.80" "$2,426.23" "$2,426.23" "$2,426.23" $505.69 "$2,426.23" "$2,426.23" "$2,426.23" "$2,426.23" "$2,426.23" $505.65 "$2,426.23" $986.99 "$1,435.12" "$2,426.23" "$2,467.48" "$2,426.23" "$2,426.23" "$1,819.88" "$2,426.23" "$2,426.23" "$2,426.23" "$1,213.12" "$1,213.12" "$1,921.57" "$2,426.23" "$1,940.98" "$1,091.80" $481.55 N/A "$1,407.37" "$2,426.23" "$2,426.23" "$2,426.23" "$2,426.23" "$2,426.23" N/A N/A 441.305 SUP HCPCS C1713 441.305 - PLATE BONE 14 HOLE LCP TITANIUM HUMERUS LEFT DISTAL MEDIAL BOTH IP/OP "$2,426.50" "$1,796.00" $481.55 "$2,467.48" "$1,091.80" "$1,091.80" "$1,091.80" "$1,091.80" "$2,426.23" "$2,426.23" "$2,426.23" $505.69 "$2,426.23" "$2,426.23" "$2,426.23" "$2,426.23" "$2,426.23" $505.65 "$2,426.23" $986.99 "$1,435.12" "$2,426.23" "$2,467.48" "$2,426.23" "$2,426.23" "$1,819.88" "$2,426.23" "$2,426.23" "$2,426.23" "$1,213.12" "$1,213.12" "$1,921.57" "$2,426.23" "$1,940.98" "$1,091.80" $481.55 N/A "$1,407.37" "$2,426.23" "$1,455.74" "$2,426.23" $505.63 "$2,426.23" N/A N/A 441.32 SUP HCPCS C1713 441.32 - PLATE BONE 25X9X1MM 2 HOLE 1/3 TUBULAR COLLAR LC-DCP BOTH IP/OP $108.50 $80.00 $21.48 $110.10 $48.71 $48.71 $48.71 $48.71 $108.25 $108.25 $108.25 $22.56 $108.25 $108.25 $108.25 $108.25 $108.25 $22.56 $108.25 $44.04 $64.03 $108.25 $110.10 $108.25 $108.25 $81.38 $108.25 $108.25 $108.25 $54.13 $54.13 $85.73 $108.25 $86.60 $48.71 $21.48 N/A $62.93 $108.25 $64.95 $108.25 $108.25 $108.25 N/A N/A 441.33 SUP HCPCS C1713 441.33 - PLATE BONE 1/3 TUBULAR 37X9X1MM .5MM 3 HOLE COLLAR LC-DCP BOTH IP/OP $111.50 $83.00 $22.04 $112.95 $49.97 $49.97 $49.97 $49.97 $111.05 $111.05 $111.05 $23.15 $111.05 $111.05 $111.05 $111.05 $111.05 $23.14 $111.05 $45.18 $65.69 $111.05 $112.95 $111.05 $111.05 $83.63 $111.05 $111.05 $111.05 $55.53 $55.53 $87.95 $111.05 $88.84 $49.97 $22.04 N/A $64.67 $111.05 $66.63 $111.05 $111.05 $111.05 N/A N/A 441.331 SUP HCPCS C1713 441.331 - PLATE BONE 33MM 3 HOLE 1/3 TUBULAR COLLAR LCP TITANIUM BOTH IP/OP $274.50 $203.00 $54.40 $278.75 $123.35 $123.35 $123.35 $123.35 $274.10 $274.10 $274.10 $57.13 $274.10 $274.10 $274.10 $274.10 $274.10 $57.13 $274.10 $111.50 $162.13 $274.10 $278.75 $274.10 $274.10 $205.88 $274.10 $274.10 $274.10 $137.05 $137.05 $217.09 $274.10 $219.28 $123.35 $54.40 N/A $159.21 $274.10 $274.10 $274.10 $57.12 $274.10 N/A N/A 441.34 SUP HCPCS C1713 441.34 - PLATE BONE 1/3 TUBULAR 49X9X1MM .5MM 4 HOLE COLLAR LC-DCP BOTH IP/OP $131.00 $97.00 $25.95 $132.95 $58.83 $58.83 $58.83 $58.83 $130.73 $130.73 $130.73 $27.25 $130.73 $130.73 $130.73 $130.73 $130.73 $27.25 $130.73 $132.95 $77.33 $130.73 $132.95 $130.73 $130.73 $98.25 $130.73 $130.73 $130.73 $65.37 $65.37 $103.54 $130.73 $104.58 $58.83 $25.95 N/A $75.98 $130.73 $78.44 $130.73 $130.73 $130.73 N/A N/A 441.341 SUP HCPCS C1713 441.341 - PLATE BONE 45MM 4 HOLE 1/3 TUBULAR COLLAR LCP TITANIUM BOTH IP/OP $316.50 $234.00 $62.77 $321.65 $142.33 $142.33 $142.33 $142.33 $316.28 $316.28 $316.28 $65.92 $316.28 $316.28 $316.28 $316.28 $316.28 $65.92 $316.28 $321.65 $187.08 $316.28 $321.65 $316.28 $316.28 $237.38 $316.28 $316.28 $316.28 $158.14 $158.14 $250.49 $316.28 $253.02 $142.33 $62.77 N/A $183.57 $316.28 $189.77 $316.28 $316.28 $316.28 N/A N/A 441.35 SUP HCPCS C1713 441.35 - PLATE BONE 61X9X1MM 5 HOLE 1/3 TUBULAR COLLAR LC-DCP BOTH IP/OP $131.00 $97.00 $25.95 $132.95 $58.83 $58.83 $58.83 $58.83 $130.73 $130.73 $130.73 $27.25 $130.73 $130.73 $130.73 $130.73 $130.73 $27.25 $130.73 $132.95 $77.33 $130.73 $132.95 $130.73 $130.73 $98.25 $130.73 $130.73 $130.73 $65.37 $65.37 $103.54 $130.73 $104.58 $58.83 $25.95 N/A $75.98 $130.73 $78.44 $130.73 $27.24 $130.73 N/A N/A 441.351 SUP HCPCS C1713 441.351 - PLATE BONE 1/3 TUBULAR 57X9X1MM 5 HOLE COLLAR LCP TITANIUM BOTH IP/OP $316.50 $234.00 $62.77 $321.65 $142.33 $142.33 $142.33 $142.33 $316.28 $316.28 $316.28 $65.92 $316.28 $316.28 $316.28 $316.28 $316.28 $65.92 $316.28 $321.65 $187.08 $316.28 $321.65 $316.28 $316.28 $237.38 $316.28 $316.28 $316.28 $158.14 $158.14 $250.49 $316.28 $253.02 $142.33 $62.77 N/A $183.57 $316.28 $189.77 $316.28 $65.91 $316.28 N/A N/A 441.36 SUP HCPCS C1713 441.36 - PLATE BN 1/3 TBLR 12MM 73X9X1MM NS .5MM 6 HL COLR TI 3.5MM BOTH IP/OP $136.00 $101.00 $26.92 $137.93 $61.03 $61.03 $61.03 $61.03 $135.63 $135.63 $135.63 $28.27 $135.63 $135.63 $135.63 $135.63 $135.63 $28.27 $135.63 $137.93 $80.23 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $61.03 $26.92 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 441.361 SUP HCPCS C1713 441.361 - PLATE BN 1/3 TBLR 12MM 69X9X1MM NS .7MM LCP 6 HL COLR TI BOTH IP/OP $316.50 $234.00 $62.77 $321.65 $142.33 $142.33 $142.33 $142.33 $316.28 $316.28 $316.28 $65.92 $316.28 $316.28 $316.28 $316.28 $316.28 $65.92 $316.28 $128.66 $187.08 $316.28 $321.65 $316.28 $316.28 $237.38 $316.28 $316.28 $316.28 $158.14 $158.14 $250.49 $316.28 $253.02 $142.33 $62.77 N/A $183.57 $316.28 $189.77 $316.28 $316.28 $316.28 N/A N/A 441.37 SUP HCPCS C1713 441.37 - PLATE BN 1/3 TBLR 12MM 85X9X1MM NS .5MM 7 HL COLR TI 3.5MM BOTH IP/OP $136.00 $101.00 $26.92 $137.93 $61.03 $61.03 $61.03 $61.03 $135.63 $135.63 $135.63 $28.27 $135.63 $135.63 $135.63 $135.63 $135.63 $28.27 $135.63 $137.93 $80.23 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $61.03 $26.92 N/A $78.88 $135.63 $81.38 $135.63 $28.27 $135.63 N/A N/A 441.371 SUP HCPCS C1713 441.371 - PLATE BN 1/3 TBLR 12MM 81X9X1MM NS .7MM LCP 7 HL COLR TI BOTH IP/OP $323.50 $239.00 $64.17 $328.80 $145.49 $145.49 $145.49 $145.49 $323.30 $323.30 $323.30 $67.38 $323.30 $323.30 $323.30 $323.30 $323.30 $67.38 $323.30 $131.52 $191.23 $323.30 $328.80 $323.30 $323.30 $242.63 $323.30 $323.30 $323.30 $161.65 $161.65 $256.05 $323.30 $258.64 $145.49 $64.17 N/A $187.63 $323.30 $193.98 $323.30 $67.38 $323.30 N/A N/A 441.38 SUP HCPCS C1713 441.38 - PLATE BN 1/3 TBLR 12MM 97X9X1MM NS .5MM 8 HL COLR TI 3.5MM BOTH IP/OP $141.00 $104.00 $27.90 $142.98 $63.26 $63.26 $63.26 $63.26 $140.58 $140.58 $140.58 $29.30 $140.58 $140.58 $140.58 $140.58 $140.58 $29.30 $140.58 $142.98 $83.15 $140.58 $142.98 $140.58 $140.58 $105.75 $140.58 $140.58 $140.58 $70.29 $70.29 $111.34 $140.58 $112.46 $63.26 $27.90 N/A $81.78 $140.58 $84.35 $140.58 $29.30 $140.58 N/A N/A 441.381 SUP HCPCS C1713 441.381 - PLATE BN 1/3 TBLR 12MM 93X9X1MM NS .7MM LCP 8 HL COLR TI BOTH IP/OP $340.50 $252.00 $67.52 $345.95 $153.08 $153.08 $153.08 $153.08 $340.18 $340.18 $340.18 $70.90 $340.18 $340.18 $340.18 $340.18 $340.18 $70.90 $340.18 $138.38 $201.22 $340.18 $345.95 $340.18 $340.18 $255.38 $340.18 $340.18 $340.18 $170.09 $170.09 $269.42 $340.18 $272.14 $153.08 $67.52 N/A $197.49 $340.18 $204.11 $340.18 $70.89 $340.18 N/A N/A 441.39 SUP HCPCS C1713 441.39 - PLATE BONE 109X9X1MM 9 HOLE 1/3 TUBULAR COLLAR LC-DCP BOTH IP/OP $141.00 $104.00 $27.90 $142.98 $63.26 $63.26 $63.26 $63.26 $140.58 $140.58 $140.58 $29.30 $140.58 $140.58 $140.58 $140.58 $140.58 $29.30 $140.58 $57.19 $83.15 $140.58 $142.98 $140.58 $140.58 $105.75 $140.58 $140.58 $140.58 $70.29 $70.29 $111.34 $140.58 $112.46 $63.26 $27.90 N/A $81.78 $140.58 $84.35 $140.58 $29.30 $140.58 N/A N/A 441.391 SUP HCPCS C1713 441.391 - PLATE BONE 105MM 9 HOLE 1/3 TUBULAR COLLAR LCP TITANIUM BOTH IP/OP $357.50 $265.00 $70.87 $363.13 $160.67 $160.67 $160.67 $160.67 $357.05 $357.05 $357.05 $74.42 $357.05 $357.05 $357.05 $357.05 $357.05 $74.41 $357.05 $145.25 $211.20 $357.05 $363.13 $357.05 $357.05 $268.13 $357.05 $357.05 $357.05 $178.53 $178.53 $282.78 $357.05 $285.64 $160.67 $70.87 N/A $207.35 $357.05 $214.23 $357.05 $74.41 $357.05 N/A N/A 441.4 SUP HCPCS C1713 441.40 - PLATE BONE 121X9X1MM 10 HOLE 1/3 TUBULAR COLLAR LC-DCP BOTH IP/OP $136.50 $101.00 $27.09 $142.98 $61.42 $61.42 $61.42 $61.42 $136.48 $136.48 $136.48 $28.45 $136.48 $136.48 $136.48 $136.48 $136.48 $28.44 $136.48 $142.98 $80.73 $136.48 $142.98 $136.48 $136.48 $102.38 $136.48 $136.48 $136.48 $68.24 $68.24 $108.09 $136.48 $109.18 $61.42 $27.09 N/A $79.17 $136.48 $81.89 $136.48 $28.44 $136.48 N/A N/A 441.401 SUP HCPCS C1713 441.401 - PLATE BONE 1/3 TUBULAR 12MM 117X9X1MM 10 HOLE COLLAR LCP BOTH IP/OP $346.00 $256.00 $68.63 $351.68 $155.61 $155.61 $155.61 $155.61 $345.80 $345.80 $345.80 $72.07 $345.80 $345.80 $345.80 $345.80 $345.80 $72.07 $345.80 $351.68 $204.54 $345.80 $351.68 $345.80 $345.80 $259.50 $345.80 $345.80 $345.80 $172.90 $172.90 $273.87 $345.80 $276.64 $155.61 $68.63 N/A $200.68 $345.80 $345.80 $345.80 $72.06 $345.80 N/A N/A 441.42 SUP HCPCS C1713 441.42 - PLATE BONE 145X9X1MM 12 HOLE 1/3 TUBULAR COLLAR TITANIUM RAD BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $152.95 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $90.24 $150.40 $31.34 $150.40 N/A N/A 441.421 SUP HCPCS C1713 441.421 - PLATE BONE 1/3 TUBULAR 12MM 141X9X1MM 12 HOLE COLLAR LCP BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $215.07 $358.45 $74.70 $358.45 N/A N/A 441.44 SUP HCPCS C1713 441.440 - PLATE BONE 80MM 5 HOLE LCP TITANIUM TIBIA RIGHT DISTAL BOTH IP/OP "$2,775.00" "$2,054.00" $550.67 "$2,906.35" "$1,248.54" "$1,248.54" "$1,248.54" "$1,248.54" "$2,774.53" "$2,774.53" "$2,774.53" $578.28 "$2,774.53" "$2,774.53" "$2,774.53" "$2,774.53" "$2,774.53" $578.24 "$2,774.53" "$2,906.35" "$1,367.84" "$2,774.53" "$2,906.35" "$2,774.53" "$2,774.53" "$2,081.25" "$2,774.53" "$2,774.53" "$2,774.53" "$1,387.27" "$1,387.27" "$2,197.43" "$2,774.53" "$2,219.62" "$1,248.54" $550.67 N/A "$1,609.50" "$2,774.53" "$1,664.72" "$2,774.53" $578.21 "$2,774.53" N/A N/A 441.441 SUP HCPCS C1713 441.441 - PLATE BONE 80MM 5 HOLE LCP TITANIUM TIBIA LEFT DISTAL ANTLAT BOTH IP/OP "$2,858.00" "$2,115.00" $567.20 "$2,906.35" "$1,286.00" "$1,286.00" "$1,286.00" "$1,286.00" "$2,857.78" "$2,857.78" "$2,857.78" $595.63 "$2,857.78" "$2,857.78" "$2,857.78" "$2,857.78" "$2,857.78" $595.59 "$2,857.78" "$2,906.35" "$1,408.89" "$2,857.78" "$2,906.35" "$2,857.78" "$2,857.78" "$2,143.50" "$2,857.78" "$2,857.78" "$2,857.78" "$1,428.89" "$1,428.89" "$2,263.36" "$2,857.78" "$2,286.22" "$1,286.00" $567.20 N/A "$1,657.64" "$2,857.78" "$1,714.67" "$2,857.78" $595.56 "$2,857.78" N/A N/A 441.442 SUP HCPCS C1713 441.442 - PLATE BONE 106MM 7 HOLE LCP TITANIUM TIBIA RIGHT DISTAL BOTH IP/OP "$2,890.50" "$2,139.00" $573.61 "$2,939.23" "$1,300.55" "$1,300.55" "$1,300.55" "$1,300.55" "$2,890.10" "$2,890.10" "$2,890.10" $602.37 "$2,890.10" "$2,890.10" "$2,890.10" "$2,890.10" "$2,890.10" $602.33 "$2,890.10" "$2,939.23" "$1,424.82" "$2,890.10" "$2,939.23" "$2,890.10" "$2,890.10" "$2,167.88" "$2,890.10" "$2,890.10" "$2,890.10" "$1,445.05" "$1,445.05" "$2,288.96" "$2,890.10" "$2,312.08" "$1,300.55" $573.61 N/A "$1,676.49" "$2,890.10" "$1,734.06" "$2,890.10" $602.30 "$2,890.10" N/A N/A 441.443 SUP HCPCS C1713 441.443 - PLATE BONE 106MM 7 HOLE LCP TITANIUM TIBIA LEFT DISTAL BOTH IP/OP "$2,890.50" "$2,139.00" $573.61 "$2,939.23" "$1,300.55" "$1,300.55" "$1,300.55" "$1,300.55" "$2,890.10" "$2,890.10" "$2,890.10" $602.37 "$2,890.10" "$2,890.10" "$2,890.10" "$2,890.10" "$2,890.10" $602.33 "$2,890.10" "$2,939.23" "$1,424.82" "$2,890.10" "$2,939.23" "$2,890.10" "$2,890.10" "$2,167.88" "$2,890.10" "$2,890.10" "$2,890.10" "$1,445.05" "$1,445.05" "$2,288.96" "$2,890.10" "$2,312.08" "$1,300.55" $573.61 N/A "$1,676.49" "$2,890.10" "$1,734.06" "$2,890.10" $602.30 "$2,890.10" N/A N/A 441.444 SUP HCPCS C1713 441.444 - PLATE BONE 132MM 9 HOLE LCP TITANIUM TIBIA RIGHT DISTAL BOTH IP/OP "$2,920.00" "$2,161.00" $579.47 "$2,969.25" "$1,313.83" "$1,313.83" "$1,313.83" "$1,313.83" "$2,919.63" "$2,919.63" "$2,919.63" $608.52 "$2,919.63" "$2,919.63" "$2,919.63" "$2,919.63" "$2,919.63" $608.48 "$2,919.63" "$2,969.25" "$1,439.38" "$2,919.63" "$2,969.25" "$2,919.63" "$2,919.63" "$2,190.00" "$2,919.63" "$2,919.63" "$2,919.63" "$1,459.82" "$1,459.82" "$2,312.35" "$2,919.63" "$2,335.70" "$1,313.83" $579.47 N/A "$1,693.60" "$2,919.63" "$1,751.78" "$2,919.63" $608.45 "$2,919.63" N/A N/A 441.445 SUP HCPCS C1713 441.445 - PLATE BONE 132MM 9 HOLE LCP TITANIUM TIBIA LEFT DISTAL BOTH IP/OP "$2,920.00" "$2,161.00" $579.47 "$2,969.25" "$1,313.83" "$1,313.83" "$1,313.83" "$1,313.83" "$2,919.63" "$2,919.63" "$2,919.63" $608.52 "$2,919.63" "$2,919.63" "$2,919.63" "$2,919.63" "$2,919.63" $608.48 "$2,919.63" "$2,969.25" "$1,439.38" "$2,919.63" "$2,969.25" "$2,919.63" "$2,919.63" "$2,190.00" "$2,919.63" "$2,919.63" "$2,919.63" "$1,459.82" "$1,459.82" "$2,312.35" "$2,919.63" "$2,335.70" "$1,313.83" $579.47 N/A "$1,693.60" "$2,919.63" "$2,919.63" "$2,919.63" $608.45 "$2,919.63" N/A N/A 441.446 SUP HCPCS C1713 441.446 - PLATE BONE 158MM 11 HOLE LCP TITANIUM TIBIA RIGHT DISTAL BOTH IP/OP "$2,948.00" "$2,182.00" $585.05 "$2,997.83" "$1,326.48" "$1,326.48" "$1,326.48" "$1,326.48" "$2,947.73" "$2,947.73" "$2,947.73" $614.38 "$2,947.73" "$2,947.73" "$2,947.73" "$2,947.73" "$2,947.73" $614.34 "$2,947.73" "$2,997.83" "$1,453.23" "$2,947.73" "$2,997.83" "$2,947.73" "$2,947.73" "$2,211.00" "$2,947.73" "$2,947.73" "$2,947.73" "$1,473.87" "$1,473.87" "$2,334.60" "$2,947.73" "$2,358.18" "$1,326.48" $585.05 N/A "$1,709.84" "$2,947.73" "$2,947.73" "$2,947.73" $614.31 "$2,947.73" N/A N/A 441.447 SUP HCPCS C1713 441.447 - PLATE BONE 158MM 11 HOLE LCP TITANIUM TIBIA LEFT DISTAL BOTH IP/OP "$2,948.00" "$2,182.00" $585.05 "$2,997.83" "$1,326.48" "$1,326.48" "$1,326.48" "$1,326.48" "$2,947.73" "$2,947.73" "$2,947.73" $614.38 "$2,947.73" "$2,947.73" "$2,947.73" "$2,947.73" "$2,947.73" $614.34 "$2,947.73" "$2,997.83" "$1,453.23" "$2,947.73" "$2,997.83" "$2,947.73" "$2,947.73" "$2,211.00" "$2,947.73" "$2,947.73" "$2,947.73" "$1,473.87" "$1,473.87" "$2,334.60" "$2,947.73" "$2,358.18" "$1,326.48" $585.05 N/A "$1,709.84" "$2,947.73" "$1,768.64" "$2,947.73" $614.31 "$2,947.73" N/A N/A 441.448 SUP HCPCS C1713 441.448 - PLATE BONE 184MM 13 HOLE LCP TITANIUM TIBIA RIGHT DISTAL BOTH IP/OP "$2,980.50" "$2,206.00" $591.47 "$3,030.73" "$1,341.04" "$1,341.04" "$1,341.04" "$1,341.04" "$2,980.08" "$2,980.08" "$2,980.08" $621.12 "$2,980.08" "$2,980.08" "$2,980.08" "$2,980.08" "$2,980.08" $621.08 "$2,980.08" "$3,030.73" "$1,469.18" "$2,980.08" "$3,030.73" "$2,980.08" "$2,980.08" "$2,235.38" "$2,980.08" "$2,980.08" "$2,980.08" "$1,490.04" "$1,490.04" "$2,360.22" "$2,980.08" "$2,384.06" "$1,341.04" $591.47 N/A "$1,728.69" "$2,980.08" "$1,788.05" "$2,980.08" "$2,980.08" "$2,980.08" N/A N/A 441.449 SUP HCPCS C1713 441.449 - PLATE BONE 184MM 13 HOLE LCP TITANIUM TIBIA LEFT DISTAL BOTH IP/OP "$2,980.50" "$2,206.00" $591.47 "$3,030.73" "$1,341.04" "$1,341.04" "$1,341.04" "$1,341.04" "$2,980.08" "$2,980.08" "$2,980.08" $621.12 "$2,980.08" "$2,980.08" "$2,980.08" "$2,980.08" "$2,980.08" $621.08 "$2,980.08" "$3,030.73" "$1,469.18" "$2,980.08" "$3,030.73" "$2,980.08" "$2,980.08" "$2,235.38" "$2,980.08" "$2,980.08" "$2,980.08" "$1,490.04" "$1,490.04" "$2,360.22" "$2,980.08" "$2,384.06" "$1,341.04" $591.47 N/A "$1,728.69" "$2,980.08" "$1,788.05" "$2,980.08" "$2,980.08" "$2,980.08" N/A N/A 441.45 SUP HCPCS C1713 441.450 - PLATE BONE 210MM 15 HOLE LCP TITANIUM TIBIA RIGHT DISTAL BOTH IP/OP "$2,931.50" "$2,169.00" $581.83 "$3,070.75" "$1,319.17" "$1,319.17" "$1,319.17" "$1,319.17" "$2,931.48" "$2,931.48" "$2,931.48" $610.99 "$2,931.48" "$2,931.48" "$2,931.48" "$2,931.48" "$2,931.48" $610.95 "$2,931.48" "$3,070.75" "$1,445.22" "$2,931.48" "$3,070.75" "$2,931.48" "$2,931.48" "$2,198.63" "$2,931.48" "$2,931.48" "$2,931.48" "$1,465.74" "$1,465.74" "$2,321.73" "$2,931.48" "$2,345.18" "$1,319.17" $581.83 N/A "$1,700.27" "$2,931.48" "$2,931.48" "$2,931.48" $610.92 "$2,931.48" N/A N/A 441.451 SUP HCPCS C1713 441.451 - PLATE BONE 210MM 15 HOLE LCP TITANIUM TIBIA LEFT DISTAL BOTH IP/OP "$3,019.50" "$2,234.00" $599.28 "$3,070.75" "$1,358.74" "$1,358.74" "$1,358.74" "$1,358.74" "$3,019.43" "$3,019.43" "$3,019.43" $629.32 "$3,019.43" "$3,019.43" "$3,019.43" "$3,019.43" "$3,019.43" $629.28 "$3,019.43" "$3,070.75" "$1,488.58" "$3,019.43" "$3,070.75" "$3,019.43" "$3,019.43" "$2,264.63" "$3,019.43" "$3,019.43" "$3,019.43" "$1,509.72" "$1,509.72" "$2,391.39" "$3,019.43" "$2,415.54" "$1,358.74" $599.28 N/A "$1,751.31" "$3,019.43" "$3,019.43" "$3,019.43" $629.25 "$3,019.43" N/A N/A 441.452 SUP HCPCS C1713 441.452 - PLATE BONE 236MM 17 HOLE LCP TITANIUM TIBIA RIGHT DISTAL BOTH IP/OP "$3,048.00" "$2,256.00" $604.86 "$3,099.35" "$1,371.40" "$1,371.40" "$1,371.40" "$1,371.40" "$3,047.55" "$3,047.55" "$3,047.55" $635.19 "$3,047.55" "$3,047.55" "$3,047.55" "$3,047.55" "$3,047.55" $635.14 "$3,047.55" "$1,239.74" "$1,502.44" "$3,047.55" "$3,099.35" "$3,047.55" "$3,047.55" "$2,286.00" "$3,047.55" "$3,047.55" "$3,047.55" "$1,523.78" "$1,523.78" "$2,413.66" "$3,047.55" "$2,438.04" "$1,371.40" $604.86 N/A "$1,767.84" "$3,047.55" "$1,828.53" "$3,047.55" $635.11 "$3,047.55" N/A N/A 441.453 SUP HCPCS C1713 441.453 - PLATE BONE 236MM 17 HOLE LCP TITANIUM TIBIA LEFT DISTAL BOTH IP/OP "$3,048.00" "$2,256.00" $604.86 "$3,099.35" "$1,371.40" "$1,371.40" "$1,371.40" "$1,371.40" "$3,047.55" "$3,047.55" "$3,047.55" $635.19 "$3,047.55" "$3,047.55" "$3,047.55" "$3,047.55" "$3,047.55" $635.14 "$3,047.55" "$3,099.35" "$1,502.44" "$3,047.55" "$3,099.35" "$3,047.55" "$3,047.55" "$2,286.00" "$3,047.55" "$3,047.55" "$3,047.55" "$1,523.78" "$1,523.78" "$2,413.66" "$3,047.55" "$2,438.04" "$1,371.40" $604.86 N/A "$1,767.84" "$3,047.55" "$1,828.53" "$3,047.55" $635.11 "$3,047.55" N/A N/A 441.454 SUP HCPCS C1713 441.454 - PLATE BONE 262MM 19 HOLE LCP TITANIUM TIBIA RIGHT DISTAL BOTH IP/OP "$3,071.50" "$2,273.00" $609.61 "$3,123.68" "$1,382.15" "$1,382.15" "$1,382.15" "$1,382.15" "$3,071.45" "$3,071.45" "$3,071.45" $640.17 "$3,071.45" "$3,071.45" "$3,071.45" "$3,071.45" "$3,071.45" $640.12 "$3,071.45" "$1,249.47" "$1,514.22" "$3,071.45" "$3,123.68" "$3,071.45" "$3,071.45" "$2,303.63" "$3,071.45" "$3,071.45" "$3,071.45" "$1,535.73" "$1,535.73" "$2,432.59" "$3,071.45" "$2,457.16" "$1,382.15" $609.61 N/A "$1,781.47" "$3,071.45" "$1,842.87" "$3,071.45" $640.09 "$3,071.45" N/A N/A 441.455 SUP HCPCS C1713 441.455 - PLATE BONE 262MM 19 HOLE LCP TITANIUM TIBIA LEFT DISTAL BOTH IP/OP "$3,071.50" "$2,273.00" $609.61 "$3,123.68" "$1,382.15" "$1,382.15" "$1,382.15" "$1,382.15" "$3,071.45" "$3,071.45" "$3,071.45" $640.17 "$3,071.45" "$3,071.45" "$3,071.45" "$3,071.45" "$3,071.45" $640.12 "$3,071.45" "$1,249.47" "$1,514.22" "$3,071.45" "$3,123.68" "$3,071.45" "$3,071.45" "$2,303.63" "$3,071.45" "$3,071.45" "$3,071.45" "$1,535.73" "$1,535.73" "$2,432.59" "$3,071.45" "$2,457.16" "$1,382.15" $609.61 N/A "$1,781.47" "$3,071.45" "$3,071.45" "$3,071.45" $640.09 "$3,071.45" N/A N/A 441.456 SUP HCPCS C1713 441.456 - PLATE BONE 288MM 21 HOLE LCP TITANIUM TIBIA RIGHT DISTAL BOTH IP/OP "$3,101.00" "$2,295.00" $615.46 "$3,153.68" "$1,395.43" "$1,395.43" "$1,395.43" "$1,395.43" "$3,100.95" "$3,100.95" "$3,100.95" $646.32 "$3,100.95" "$3,100.95" "$3,100.95" "$3,100.95" "$3,100.95" $646.27 "$3,100.95" "$1,261.47" "$1,528.77" "$3,100.95" "$3,153.68" "$3,100.95" "$3,100.95" "$2,325.75" "$3,100.95" "$3,100.95" "$3,100.95" "$1,550.48" "$1,550.48" "$2,455.95" "$3,100.95" "$2,480.76" "$1,395.43" $615.46 N/A "$1,798.58" "$3,100.95" "$3,100.95" "$3,100.95" $646.24 "$3,100.95" N/A N/A 441.457 SUP HCPCS C1713 441.457 - PLATE BONE 288MM 21 HOLE LCP TITANIUM TIBIA LEFT DISTAL BOTH IP/OP "$3,101.00" "$2,295.00" $615.46 "$3,153.68" "$1,395.43" "$1,395.43" "$1,395.43" "$1,395.43" "$3,100.95" "$3,100.95" "$3,100.95" $646.32 "$3,100.95" "$3,100.95" "$3,100.95" "$3,100.95" "$3,100.95" $646.27 "$3,100.95" "$3,153.68" "$1,528.77" "$3,100.95" "$3,153.68" "$3,100.95" "$3,100.95" "$2,325.75" "$3,100.95" "$3,100.95" "$3,100.95" "$1,550.48" "$1,550.48" "$2,455.95" "$3,100.95" "$2,480.76" "$1,395.43" $615.46 N/A "$1,798.58" "$3,100.95" "$1,860.57" "$3,100.95" $646.24 "$3,100.95" N/A N/A 441.61 SUP HCPCS C1713 441.61 - PLATE BONE 60MMX1.2MM LC-DCP TITANIUM CALCANEUS NONSTRL BOTH IP/OP $992.50 $734.00 $196.92 $992.18 $446.48 $446.48 $446.48 $446.48 $992.18 $992.18 $992.18 $206.80 $992.18 $992.18 $992.18 $992.18 $992.18 $206.78 $992.18 $992.18 $586.87 $992.18 $992.18 $992.18 $992.18 $744.38 $992.18 $992.18 $992.18 $496.09 $496.09 $785.81 $992.18 $793.74 $446.48 $196.92 N/A $575.65 $992.18 $595.31 $992.18 $206.77 $992.18 N/A N/A 441.62 SUP HCPCS C1713 441.62 - PLATE BONE 70MMX1.2MM LC-DCP TITANIUM CALCANEUS NONSTRL BOTH IP/OP "$1,015.50" $751.00 $201.53 "$1,015.38" $456.92 $456.92 $456.92 $456.92 "$1,015.38" "$1,015.38" "$1,015.38" $211.63 "$1,015.38" "$1,015.38" "$1,015.38" "$1,015.38" "$1,015.38" $211.62 "$1,015.38" $406.15 $600.60 "$1,015.38" "$1,015.38" "$1,015.38" "$1,015.38" $761.63 "$1,015.38" "$1,015.38" "$1,015.38" $507.69 $507.69 $804.18 "$1,015.38" $812.30 $456.92 $201.53 N/A $588.99 "$1,015.38" $609.23 "$1,015.38" $211.61 "$1,015.38" N/A N/A 441.65 SUP HCPCS C1713 441.65 - PLATE BONE Y 87MMX2MM LC-DCP TITANIUM CALCANEUS NONSTRL BOTH IP/OP "$1,015.50" $751.00 $201.53 "$1,015.38" $456.92 $456.92 $456.92 $456.92 "$1,015.38" "$1,015.38" "$1,015.38" $211.63 "$1,015.38" "$1,015.38" "$1,015.38" "$1,015.38" "$1,015.38" $211.62 "$1,015.38" $406.15 $600.60 "$1,015.38" "$1,015.38" "$1,015.38" "$1,015.38" $761.63 "$1,015.38" "$1,015.38" "$1,015.38" $507.69 $507.69 $804.18 "$1,015.38" $812.30 $456.92 $201.53 N/A $588.99 "$1,015.38" $609.23 "$1,015.38" $211.61 "$1,015.38" N/A N/A 441.68 SUP HCPCS C1713 441.680 - PLATE BONE 2.4MM 34MM IMPLANT RIM 2 HOLE LCP TITANIUM RADIAL BOTH IP/OP "$1,112.50" $823.00 $220.76 "$1,165.13" $500.53 $500.53 $500.53 $500.53 "$1,112.28" "$1,112.28" "$1,112.28" $231.83 "$1,112.28" "$1,112.28" "$1,112.28" "$1,112.28" "$1,112.28" $231.81 "$1,112.28" $466.05 $657.91 "$1,112.28" "$1,165.13" "$1,112.28" "$1,112.28" $834.38 "$1,112.28" "$1,112.28" "$1,112.28" $556.14 $556.14 $880.93 "$1,112.28" $889.82 $500.53 $220.76 N/A $645.25 "$1,112.28" "$1,112.28" "$1,112.28" $231.80 "$1,112.28" N/A N/A 441.681 SUP HCPCS C1713 441.681 - PLATE BONE 2.4MM 34MM IMPLANT RIM 2 HOLE LCP TITANIUM RADIAL BOTH IP/OP "$1,146.00" $848.00 $227.38 "$1,165.13" $515.54 $515.54 $515.54 $515.54 "$1,145.65" "$1,145.65" "$1,145.65" $238.78 "$1,145.65" "$1,145.65" "$1,145.65" "$1,145.65" "$1,145.65" $238.77 "$1,145.65" "$1,165.13" $677.65 "$1,145.65" "$1,165.13" "$1,145.65" "$1,145.65" $859.50 "$1,145.65" "$1,145.65" "$1,145.65" $572.83 $572.83 $907.35 "$1,145.65" $916.52 $515.54 $227.38 N/A $664.68 "$1,145.65" $687.39 "$1,145.65" $238.75 "$1,145.65" N/A N/A 441.682 SUP HCPCS C1713 441.682 - PLATE BONE 2.4MM 46MM IMPLANT RIM 3 HOLE LCP TITANIUM RADIAL BOTH IP/OP "$1,178.00" $872.00 $233.80 "$1,198.00" $530.09 $530.09 $530.09 $530.09 "$1,177.98" "$1,177.98" "$1,177.98" $245.52 "$1,177.98" "$1,177.98" "$1,177.98" "$1,177.98" "$1,177.98" $245.50 "$1,177.98" $479.20 $696.78 "$1,177.98" "$1,198.00" "$1,177.98" "$1,177.98" $883.50 "$1,177.98" "$1,177.98" "$1,177.98" $588.99 $588.99 $932.96 "$1,177.98" $942.38 $530.09 $233.80 N/A $683.24 "$1,177.98" $706.79 "$1,177.98" $245.49 "$1,177.98" N/A N/A 441.683 SUP HCPCS C1713 441.683 - PLATE BONE 2.4MM 46MM IMPLANT RIM 3 HOLE LCP TITANIUM RADIAL BOTH IP/OP "$1,178.00" $872.00 $233.80 "$1,198.00" $530.09 $530.09 $530.09 $530.09 "$1,177.98" "$1,177.98" "$1,177.98" $245.52 "$1,177.98" "$1,177.98" "$1,177.98" "$1,177.98" "$1,177.98" $245.50 "$1,177.98" $479.20 $696.78 "$1,177.98" "$1,198.00" "$1,177.98" "$1,177.98" $883.50 "$1,177.98" "$1,177.98" "$1,177.98" $588.99 $588.99 $932.96 "$1,177.98" $942.38 $530.09 $233.80 N/A $683.24 "$1,177.98" $706.79 "$1,177.98" $245.49 "$1,177.98" N/A N/A 441.684 SUP HCPCS C1713 441.684 - PLATE BONE 2.4MM 56MM IMPLANT RIM 4 HOLE LCP TITANIUM RADIAL BOTH IP/OP "$1,199.50" $888.00 $237.98 "$1,219.43" $539.57 $539.57 $539.57 $539.57 "$1,199.05" "$1,199.05" "$1,199.05" $249.91 "$1,199.05" "$1,199.05" "$1,199.05" "$1,199.05" "$1,199.05" $249.90 "$1,199.05" $487.77 $709.24 "$1,199.05" "$1,219.43" "$1,199.05" "$1,199.05" $899.63 "$1,199.05" "$1,199.05" "$1,199.05" $599.53 $599.53 $949.65 "$1,199.05" $959.24 $539.57 $237.98 N/A $695.71 "$1,199.05" "$1,199.05" "$1,199.05" "$1,199.05" "$1,199.05" N/A N/A 441.685 SUP HCPCS C1713 441.685 - PLATE BONE 2.4MM 56MM IMPLANT RIM 4 HOLE LCP TITANIUM RADIAL BOTH IP/OP "$1,199.50" $888.00 $237.98 "$1,219.43" $539.57 $539.57 $539.57 $539.57 "$1,199.05" "$1,199.05" "$1,199.05" $249.91 "$1,199.05" "$1,199.05" "$1,199.05" "$1,199.05" "$1,199.05" $249.90 "$1,199.05" $487.77 $709.24 "$1,199.05" "$1,219.43" "$1,199.05" "$1,199.05" $899.63 "$1,199.05" "$1,199.05" "$1,199.05" $599.53 $599.53 $949.65 "$1,199.05" $959.24 $539.57 $237.98 N/A $695.71 "$1,199.05" $719.43 "$1,199.05" $249.88 "$1,199.05" N/A N/A 441.69 SUP HCPCS C1713 441.690 - PLATE BONE 2.4MM 28MM IMPLANT 2 HOLE LCP TITANIUM RADIAL BOTH IP/OP "$1,112.50" $823.00 $220.76 "$1,165.13" $500.53 $500.53 $500.53 $500.53 "$1,112.28" "$1,112.28" "$1,112.28" $231.83 "$1,112.28" "$1,112.28" "$1,112.28" "$1,112.28" "$1,112.28" $231.81 "$1,112.28" $466.05 $657.91 "$1,112.28" "$1,165.13" "$1,112.28" "$1,112.28" $834.38 "$1,112.28" "$1,112.28" "$1,112.28" $556.14 $556.14 $880.93 "$1,112.28" $889.82 $500.53 $220.76 N/A $645.25 "$1,112.28" $667.37 "$1,112.28" "$1,112.28" "$1,112.28" N/A N/A 441.691 SUP HCPCS C1713 441.691 - PLATE BONE 2.4MM 40MM IMPLANT 3 HOLE LCP TITANIUM RADIAL BOTH IP/OP "$1,178.00" $872.00 $233.80 "$1,198.00" $530.09 $530.09 $530.09 $530.09 "$1,177.98" "$1,177.98" "$1,177.98" $245.52 "$1,177.98" "$1,177.98" "$1,177.98" "$1,177.98" "$1,177.98" $245.50 "$1,177.98" $479.20 $696.78 "$1,177.98" "$1,198.00" "$1,177.98" "$1,177.98" $883.50 "$1,177.98" "$1,177.98" "$1,177.98" $588.99 $588.99 $932.96 "$1,177.98" $942.38 $530.09 $233.80 N/A $683.24 "$1,177.98" $706.79 "$1,177.98" "$1,177.98" "$1,177.98" N/A N/A 441.692 SUP HCPCS C1713 441.692 - PLATE BONE 2.4MM 50MM IMPLANT 4 HOLE LCP TITANIUM RADIAL BOTH IP/OP "$1,200.50" $888.00 $238.26 "$1,220.85" $540.20 $540.20 $540.20 $540.20 "$1,200.45" "$1,200.45" "$1,200.45" $250.20 "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" $250.19 "$1,200.45" "$1,220.85" $710.07 "$1,200.45" "$1,220.85" "$1,200.45" "$1,200.45" $900.38 "$1,200.45" "$1,200.45" "$1,200.45" $600.23 $600.23 $950.76 "$1,200.45" $960.36 $540.20 $238.26 N/A $696.29 "$1,200.45" $720.27 "$1,200.45" $250.17 "$1,200.45" N/A N/A 441.83 SUP HCPCS C1713 441.83 - PLATE BONE CLOVERLEAF 88X15X2MM 3 HOLE THIN BLADE LP HEAD BOTH IP/OP $570.50 $422.00 $113.23 $570.48 $256.72 $256.72 $256.72 $256.72 $570.48 $570.48 $570.48 $118.90 $570.48 $570.48 $570.48 $570.48 $570.48 $118.89 $570.48 $228.19 $337.44 $570.48 $570.48 $570.48 $570.48 $427.88 $570.48 $570.48 $570.48 $285.24 $285.24 $451.82 $570.48 $456.38 $256.72 $113.23 N/A $330.89 $570.48 $342.29 $570.48 $118.89 $570.48 N/A N/A 441.84 SUP HCPCS C1713 441.84 - PLATE BONE CLOVERLEAF 104X15X2MM 4 HOLE THIN BLADE LP HEAD BOTH IP/OP $610.50 $452.00 $121.08 $610.05 $274.52 $274.52 $274.52 $274.52 $610.05 $610.05 $610.05 $127.15 $610.05 $610.05 $610.05 $610.05 $610.05 $127.14 $610.05 $244.02 $360.84 $610.05 $610.05 $610.05 $610.05 $457.88 $610.05 $610.05 $610.05 $305.03 $305.03 $483.16 $610.05 $488.04 $274.52 $121.08 N/A $354.09 $610.05 $366.03 $610.05 $127.13 $610.05 N/A N/A 441.85 SUP HCPCS C1713 441.85 - PLATE BONE CLOVERLEAF 120X15X2MM 5 HOLE THIN BLADE LP HEAD BOTH IP/OP $768.50 $569.00 $152.50 $768.35 $345.76 $345.76 $345.76 $345.76 $768.35 $768.35 $768.35 $160.14 $768.35 $768.35 $768.35 $768.35 $768.35 $160.13 $768.35 $768.35 $454.48 $768.35 $768.35 $768.35 $768.35 $576.38 $768.35 $768.35 $768.35 $384.18 $384.18 $608.53 $768.35 $614.68 $345.76 $152.50 N/A $445.73 $768.35 $768.35 $768.35 $160.12 $768.35 N/A N/A 441.86 SUP HCPCS C1713 441.86 - PLATE BONE CLOVERLEAF 136X15X2MM 6 HOLE THIN BLADE LP HEAD BOTH IP/OP $834.00 $617.00 $165.50 $833.85 $375.23 $375.23 $375.23 $375.23 $833.85 $833.85 $833.85 $173.80 $833.85 $833.85 $833.85 $833.85 $833.85 $173.78 $833.85 $833.85 $493.22 $833.85 $833.85 $833.85 $833.85 $625.50 $833.85 $833.85 $833.85 $416.93 $416.93 $660.41 $833.85 $667.08 $375.23 $165.50 N/A $483.72 $833.85 $833.85 $833.85 $173.77 $833.85 N/A N/A 441.87 SUP HCPCS C1713 441.87 - PLATE BONE CLOVERLEAF 152X15X2MM 7 HOLE THIN BLADE LP HEAD BOTH IP/OP $898.00 $665.00 $178.23 $898.00 $404.10 $404.10 $404.10 $404.10 $898.00 $898.00 $898.00 $187.17 $898.00 $898.00 $898.00 $898.00 $898.00 $187.15 $898.00 $898.00 $531.17 $898.00 $898.00 $898.00 $898.00 $673.50 $898.00 $898.00 $898.00 $449.00 $449.00 $711.22 $898.00 $718.40 $404.10 $178.23 N/A $520.84 $898.00 $538.80 $898.00 $187.14 $898.00 N/A N/A 441.88 SUP HCPCS C1713 441.88 - PLATE BONE CLOVERLEAF 168X15X2MM 8 HOLE THIN BLADE LP HEAD BOTH IP/OP $954.00 $706.00 $189.34 $953.95 $429.28 $429.28 $429.28 $429.28 $953.95 $953.95 $953.95 $198.83 $953.95 $953.95 $953.95 $953.95 $953.95 $198.81 $953.95 $381.58 $564.26 $953.95 $953.95 $953.95 $953.95 $715.50 $953.95 $953.95 $953.95 $476.98 $476.98 $755.53 $953.95 $763.16 $429.28 $189.34 N/A $553.32 $953.95 $572.37 $953.95 $198.80 $953.95 N/A N/A 441.89 SUP HCPCS C1713 441.89 - PLATE BONE CLOVERLEAF 200X15X2MM 10 HOLE THIN BLADE LP HEAD BOTH IP/OP "$1,030.50" $763.00 $204.50 "$1,030.38" $463.67 $463.67 $463.67 $463.67 "$1,030.38" "$1,030.38" "$1,030.38" $214.76 "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" $214.74 "$1,030.38" $412.15 $609.47 "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" $772.88 "$1,030.38" "$1,030.38" "$1,030.38" $515.19 $515.19 $816.06 "$1,030.38" $824.30 $463.67 $204.50 N/A $597.69 "$1,030.38" $618.23 "$1,030.38" $214.73 "$1,030.38" N/A N/A 441.901 SUP HCPCS C1713 441.901 - PLATE BN STD 90X12X2.5MM NS LCP CMBN PHLS 3 HL SHFT LCK CMPR BOTH IP/OP "$2,955.00" "$2,187.00" $586.45 "$3,005.00" "$1,329.65" "$1,329.65" "$1,329.65" "$1,329.65" "$2,954.78" "$2,954.78" "$2,954.78" $615.85 "$2,954.78" "$2,954.78" "$2,954.78" "$2,954.78" "$2,954.78" $615.81 "$2,954.78" "$1,202.00" "$1,456.71" "$2,954.78" "$3,005.00" "$2,954.78" "$2,954.78" "$2,216.25" "$2,954.78" "$2,954.78" "$2,954.78" "$1,477.39" "$1,477.39" "$2,340.19" "$2,954.78" "$2,363.82" "$1,329.65" $586.45 N/A "$1,713.90" "$2,954.78" "$2,954.78" "$2,954.78" $615.78 "$2,954.78" N/A N/A 441.903 SUP HCPCS C1713 441.903 - PLATE BONE STANDARD 114X12X2.5MM 6 HOLE HEAD 5 HOLE SHAFT BOTH IP/OP "$3,048.00" "$2,256.00" $604.86 "$3,099.35" "$1,371.40" "$1,371.40" "$1,371.40" "$1,371.40" "$3,047.55" "$3,047.55" "$3,047.55" $635.19 "$3,047.55" "$3,047.55" "$3,047.55" "$3,047.55" "$3,047.55" $635.14 "$3,047.55" "$1,239.74" "$1,502.44" "$3,047.55" "$3,099.35" "$3,047.55" "$3,047.55" "$2,286.00" "$3,047.55" "$3,047.55" "$3,047.55" "$1,523.78" "$1,523.78" "$2,413.66" "$3,047.55" "$2,438.04" "$1,371.40" $604.86 N/A "$1,767.84" "$3,047.55" "$3,047.55" "$3,047.55" $635.11 "$3,047.55" N/A N/A 441.918 SUP HCPCS C1713 441.918 - PLATE BONE LONG 142MM 5 HOLE LOCKING LCP TITANIUM HUMERUS BOTH IP/OP "$3,077.50" "$2,277.00" $610.72 "$3,129.35" "$1,384.67" "$1,384.67" "$1,384.67" "$1,384.67" "$3,077.05" "$3,077.05" "$3,077.05" $641.33 "$3,077.05" "$3,077.05" "$3,077.05" "$3,077.05" "$3,077.05" $641.29 "$3,077.05" "$1,251.74" "$1,516.99" "$3,077.05" "$3,129.35" "$3,077.05" "$3,077.05" "$2,308.13" "$3,077.05" "$3,077.05" "$3,077.05" "$1,538.53" "$1,538.53" "$2,437.02" "$3,077.05" "$2,461.64" "$1,384.67" $610.72 N/A "$1,784.95" "$3,077.05" "$1,846.23" "$3,077.05" $641.26 "$3,077.05" N/A N/A 441.919 SUP HCPCS C1713 441.919 - PLATE BONE LONG 160MM 6 HOLE LOCKING LCP TITANIUM HUMERUS BOTH IP/OP "$3,198.00" "$2,367.00" $634.71 "$3,252.33" "$1,439.08" "$1,439.08" "$1,439.08" "$1,439.08" "$3,197.95" "$3,197.95" "$3,197.95" $666.53 "$3,197.95" "$3,197.95" "$3,197.95" "$3,197.95" "$3,197.95" $666.49 "$3,197.95" "$1,300.93" "$1,576.59" "$3,197.95" "$3,252.33" "$3,197.95" "$3,197.95" "$2,398.50" "$3,197.95" "$3,197.95" "$3,197.95" "$1,598.98" "$1,598.98" "$2,532.78" "$3,197.95" "$2,558.36" "$1,439.08" $634.71 N/A "$1,854.84" "$3,197.95" "$1,918.77" "$3,197.95" "$3,197.95" "$3,197.95" N/A N/A 441.921 SUP HCPCS C1713 441.921 - PLATE BN 196X12X3.7MM NS LCP CMBN PHLS LNG 8 HL SHFT LCK BOTH IP/OP "$3,322.00" "$2,458.00" $659.26 "$3,378.13" "$1,494.74" "$1,494.74" "$1,494.74" "$1,494.74" "$3,321.65" "$3,321.65" "$3,321.65" $692.31 "$3,321.65" "$3,321.65" "$3,321.65" "$3,321.65" "$3,321.65" $692.27 "$3,321.65" "$1,351.25" "$1,637.57" "$3,321.65" "$3,378.13" "$3,321.65" "$3,321.65" "$2,491.50" "$3,321.65" "$3,321.65" "$3,321.65" "$1,660.83" "$1,660.83" "$2,630.75" "$3,321.65" "$2,657.32" "$1,494.74" $659.26 N/A "$1,926.76" "$3,321.65" "$1,992.99" "$3,321.65" "$3,321.65" "$3,321.65" N/A N/A 441.923 SUP HCPCS C1713 441.923 - PLATE BONE 3.5MM 232MM 10 HOLE LCP TITANIUM HUMERUS PROXIMAL BOTH IP/OP "$3,445.50" "$2,550.00" $683.82 "$3,503.93" "$1,550.41" "$1,550.41" "$1,550.41" "$1,550.41" "$3,445.35" "$3,445.35" "$3,445.35" $718.10 "$3,445.35" "$3,445.35" "$3,445.35" "$3,445.35" "$3,445.35" $718.05 "$3,445.35" "$1,401.57" "$1,698.56" "$3,445.35" "$3,503.93" "$3,445.35" "$3,445.35" "$2,584.13" "$3,445.35" "$3,445.35" "$3,445.35" "$1,722.68" "$1,722.68" "$2,728.72" "$3,445.35" "$2,756.28" "$1,550.41" $683.82 N/A "$1,998.39" "$3,445.35" "$2,067.21" "$3,445.35" $718.01 "$3,445.35" N/A N/A 441.925 SUP HCPCS C1713 441.925 - PLATE BONE LONG 268MM 12 HOLE LOCKING LCP TITANIUM HUMERUS BOTH IP/OP "$3,565.00" "$2,638.00" $707.53 "$3,625.43" "$1,604.17" "$1,604.17" "$1,604.17" "$1,604.17" "$3,564.83" "$3,564.83" "$3,564.83" $743.00 "$3,564.83" "$3,564.83" "$3,564.83" "$3,564.83" "$3,564.83" $742.95 "$3,564.83" "$1,450.17" "$1,757.46" "$3,564.83" "$3,625.43" "$3,564.83" "$3,564.83" "$2,673.75" "$3,564.83" "$3,564.83" "$3,564.83" "$1,782.42" "$1,782.42" "$2,823.35" "$3,564.83" "$2,851.86" "$1,604.17" $707.53 N/A "$2,067.70" "$3,564.83" "$2,138.90" "$3,564.83" $742.91 "$3,564.83" N/A N/A 441.931 SUP HCPCS C1713 441.931 - PLATE BONE T OBLIQUE LEFT 52X10X1.5MM 3 HOLE HEAD 3 HOLE BOTH IP/OP $721.50 $534.00 $143.13 $733.38 $324.51 $324.51 $324.51 $324.51 $721.13 $721.13 $721.13 $150.30 $721.13 $721.13 $721.13 $721.13 $721.13 $150.29 $721.13 $293.35 $426.55 $721.13 $733.38 $721.13 $721.13 $541.13 $721.13 $721.13 $721.13 $360.57 $360.57 $571.13 $721.13 $576.90 $324.51 $143.13 N/A $418.47 $721.13 $432.68 $721.13 $150.28 $721.13 N/A N/A 441.941 SUP HCPCS C1713 441.941 - PLATE BONE T OBLIQUE LEFT 63X10X1.5MM 3 HOLE HEAD 4 HOLE BOTH IP/OP $756.50 $560.00 $150.10 $769.13 $340.33 $340.33 $340.33 $340.33 $756.28 $756.28 $756.28 $157.63 $756.28 $756.28 $756.28 $756.28 $756.28 $157.62 $756.28 $307.65 $447.34 $756.28 $769.13 $756.28 $756.28 $567.38 $756.28 $756.28 $756.28 $378.14 $378.14 $598.97 $756.28 $605.02 $340.33 $150.10 N/A $438.77 $756.28 $453.77 $756.28 $157.61 $756.28 N/A N/A 441.951 SUP HCPCS C1713 441.951 - PLATE BONE T OBLIQUE LEFT 74X10X1.5MM 3 HOLE HEAD 5 HOLE BOTH IP/OP $789.00 $584.00 $156.52 $802.00 $354.87 $354.87 $354.87 $354.87 $788.60 $788.60 $788.60 $164.36 $788.60 $788.60 $788.60 $788.60 $788.60 $164.35 $788.60 $802.00 $466.46 $788.60 $802.00 $788.60 $788.60 $591.75 $788.60 $788.60 $788.60 $394.30 $394.30 $624.57 $788.60 $630.88 $354.87 $156.52 N/A $457.62 $788.60 $788.60 $788.60 $164.34 $788.60 N/A N/A 441.961 SUP HCPCS C1713 441.961 - PLATE BONE 85MM 3 HOLE HEAD 6 HOLE SHAFT T OBLIQUE LEFT LCP BOTH IP/OP $821.00 $608.00 $162.93 $834.88 $369.42 $369.42 $369.42 $369.42 $820.93 $820.93 $820.93 $171.10 $820.93 $820.93 $820.93 $820.93 $820.93 $171.09 $820.93 $834.88 $485.58 $820.93 $834.88 $820.93 $820.93 $615.75 $820.93 $820.93 $820.93 $410.47 $410.47 $650.18 $820.93 $656.74 $369.42 $162.93 N/A $476.18 $820.93 $492.56 $820.93 $820.93 $820.93 N/A N/A 441.971 SUP HCPCS C1713 441.971 - PLATE BONE T OBLIQUE 96X10X1.5MM 3 HOLE HEAD 7 HOLE SHAFT BOTH IP/OP $855.00 $633.00 $169.63 $869.18 $384.59 $384.59 $384.59 $384.59 $854.65 $854.65 $854.65 $178.13 $854.65 $854.65 $854.65 $854.65 $854.65 $178.12 $854.65 $347.67 $505.53 $854.65 $869.18 $854.65 $854.65 $641.25 $854.65 $854.65 $854.65 $427.33 $427.33 $676.88 $854.65 $683.72 $384.59 $169.63 N/A $495.90 $854.65 $512.79 $854.65 $178.11 $854.65 N/A N/A 441.981 SUP HCPCS C1713 441.981 - PLATE BONE 107MM 8 SHAFT HOLE 3 HOLE HEAD T OBLIQUE LEFT LCP BOTH IP/OP $901.50 $667.00 $178.84 $916.38 $405.47 $405.47 $405.47 $405.47 $901.05 $901.05 $901.05 $187.80 $901.05 $901.05 $901.05 $901.05 $901.05 $187.79 $901.05 $366.55 $532.97 $901.05 $916.38 $901.05 $901.05 $676.13 $901.05 $901.05 $901.05 $450.53 $450.53 $713.63 $901.05 $720.84 $405.47 $178.84 N/A $522.87 $901.05 $540.63 $901.05 $901.05 $901.05 N/A N/A 442.03 SUP HCPCS C1713 442.03 - PLATE BONE 23X7X1MM .3MM 3 HOLE .25 TUBULAR COLLAR TITANIUM BOTH IP/OP $146.50 $108.00 $28.98 $146.03 $65.71 $65.71 $65.71 $65.71 $146.03 $146.03 $146.03 $30.44 $146.03 $146.03 $146.03 $146.03 $146.03 $30.43 $146.03 $58.41 $86.38 $146.03 $146.03 $146.03 $146.03 $109.88 $146.03 $146.03 $146.03 $73.02 $73.02 $115.66 $146.03 $116.82 $65.71 $28.98 N/A $84.97 $146.03 $146.03 $146.03 $30.43 $146.03 N/A N/A 442.04 SUP HCPCS C1713 442.04 - PLATE BONE 31X7X1MM .3MM 4 HOLE .25 TUBULAR COLLAR TITANIUM BOTH IP/OP $156.50 $116.00 $30.97 $158.68 $70.21 $70.21 $70.21 $70.21 $156.03 $156.03 $156.03 $32.52 $156.03 $156.03 $156.03 $156.03 $156.03 $32.52 $156.03 $158.68 $92.29 $156.03 $158.68 $156.03 $156.03 $117.38 $156.03 $156.03 $156.03 $78.02 $78.02 $123.58 $156.03 $124.82 $70.21 $30.97 N/A $90.77 $156.03 $156.03 $156.03 $32.52 $156.03 N/A N/A 442.05 SUP HCPCS C1713 442.05 - PLATE BONE 39X7X1MM .3MM 5 HOLE .25 TUBULAR COLLAR TITANIUM BOTH IP/OP $161.50 $120.00 $31.96 $161.05 $72.47 $72.47 $72.47 $72.47 $161.05 $161.05 $161.05 $33.57 $161.05 $161.05 $161.05 $161.05 $161.05 $33.56 $161.05 $161.05 $95.26 $161.05 $161.05 $161.05 $161.05 $121.13 $161.05 $161.05 $161.05 $80.53 $80.53 $127.55 $161.05 $128.84 $72.47 $31.96 N/A $93.67 $161.05 $161.05 $161.05 $161.05 $161.05 N/A N/A 442.06 SUP HCPCS C1713 442.06 - PLATE BONE 47X7X1MM .3MM 6 HOLE .25 TUBULAR COLLAR TITANIUM BOTH IP/OP $180.00 $133.00 $35.71 $182.98 $80.97 $80.97 $80.97 $80.97 $179.93 $179.93 $179.93 $37.50 $179.93 $179.93 $179.93 $179.93 $179.93 $37.50 $179.93 $182.98 $106.43 $179.93 $182.98 $179.93 $179.93 $135.00 $179.93 $179.93 $179.93 $89.97 $89.97 $142.50 $179.93 $143.94 $80.97 $35.71 N/A $104.40 $179.93 $179.93 $179.93 $37.50 $179.93 N/A N/A 442.07 SUP HCPCS C1713 442.07 - PLATE BONE 55X7X1MM .3MM 7 HOLE .25 TUBULAR COLLAR TITANIUM BOTH IP/OP $197.00 $146.00 $39.06 $200.15 $88.56 $88.56 $88.56 $88.56 $196.80 $196.80 $196.80 $41.02 $196.80 $196.80 $196.80 $196.80 $196.80 $41.02 $196.80 $80.06 $116.41 $196.80 $200.15 $196.80 $196.80 $147.75 $196.80 $196.80 $196.80 $98.40 $98.40 $155.87 $196.80 $157.44 $88.56 $39.06 N/A $114.26 $196.80 $196.80 $196.80 $41.01 $196.80 N/A N/A 442.08 SUP HCPCS C1713 442.08 - PLATE BONE 63X7X1MM .3MM 8 HOLE .25 TUBULAR COLLAR TITANIUM BOTH IP/OP $199.50 $148.00 $39.55 $199.25 $89.66 $89.66 $89.66 $89.66 $199.25 $199.25 $199.25 $41.53 $199.25 $199.25 $199.25 $199.25 $199.25 $41.53 $199.25 $79.70 $117.86 $199.25 $199.25 $199.25 $199.25 $149.63 $199.25 $199.25 $199.25 $99.63 $99.63 $157.81 $199.25 $159.40 $89.66 $39.55 N/A $115.71 $199.25 $119.55 $199.25 $41.52 $199.25 N/A N/A 442.33 SUP HCPCS C1713 442.33 - PLATE BONE L LEFT OBLIQUE 34X7X1MM 3 HOLE CNTOUR TITANIUM BOTH IP/OP $113.50 $84.00 $22.48 $113.28 $50.98 $50.98 $50.98 $50.98 $113.28 $113.28 $113.28 $23.61 $113.28 $113.28 $113.28 $113.28 $113.28 $23.61 $113.28 $45.31 $67.01 $113.28 $113.28 $113.28 $113.28 $85.13 $113.28 $113.28 $113.28 $56.64 $56.64 $89.72 $113.28 $90.62 $50.98 $22.48 N/A $65.83 $113.28 $67.97 $113.28 $23.61 $113.28 N/A N/A 442.34 SUP HCPCS C1713 442.34 - PLATE BONE L RIGHT OBLIQUE 34X7X1MM 3 HOLE CNTOUR TITANIUM BOTH IP/OP $113.50 $84.00 $22.48 $113.28 $50.98 $50.98 $50.98 $50.98 $113.28 $113.28 $113.28 $23.61 $113.28 $113.28 $113.28 $113.28 $113.28 $23.61 $113.28 $45.31 $67.01 $113.28 $113.28 $113.28 $113.28 $85.13 $113.28 $113.28 $113.28 $56.64 $56.64 $89.72 $113.28 $90.62 $50.98 $22.48 N/A $65.83 $113.28 $67.97 $113.28 $23.61 $113.28 N/A N/A 442.41 SUP HCPCS C1713 442.41 - PLATE BN T 32X7X1.2MM 3 HL TI 2.7MM SCR BOTH IP/OP $113.50 $84.00 $22.48 $113.28 $50.98 $50.98 $50.98 $50.98 $113.28 $113.28 $113.28 $23.61 $113.28 $113.28 $113.28 $113.28 $113.28 $23.61 $113.28 $45.31 $67.01 $113.28 $113.28 $113.28 $113.28 $85.13 $113.28 $113.28 $113.28 $56.64 $56.64 $89.72 $113.28 $90.62 $50.98 $22.48 N/A $65.83 $113.28 $67.97 $113.28 $23.61 $113.28 N/A N/A 442.472 SUP HCPCS C1713 442.472 - PLATE BN TI RDS RT DIST DRSL BOTH IP/OP "$1,854.50" "$1,372.00" $368.07 "$1,854.48" $834.52 $834.52 $834.52 $834.52 "$1,854.48" "$1,854.48" "$1,854.48" $386.52 "$1,854.48" "$1,854.48" "$1,854.48" "$1,854.48" "$1,854.48" $386.49 "$1,854.48" $741.79 "$1,096.92" "$1,854.48" "$1,854.48" "$1,854.48" "$1,854.48" "$1,390.88" "$1,854.48" "$1,854.48" "$1,854.48" $927.24 $927.24 "$1,468.75" "$1,854.48" "$1,483.58" $834.52 $368.07 N/A "$1,075.61" "$1,854.48" "$1,112.69" "$1,854.48" $386.47 "$1,854.48" N/A N/A 442.473 SUP HCPCS C1713 442.473 - PLATE BN TI RDS RT DIST VOLR BOTH IP/OP "$1,531.00" "$1,133.00" $303.79 "$1,530.63" $688.78 $688.78 $688.78 $688.78 "$1,530.63" "$1,530.63" "$1,530.63" $319.02 "$1,530.63" "$1,530.63" "$1,530.63" "$1,530.63" "$1,530.63" $319.00 "$1,530.63" "$1,530.63" $905.37 "$1,530.63" "$1,530.63" "$1,530.63" "$1,530.63" "$1,148.25" "$1,530.63" "$1,530.63" "$1,530.63" $765.32 $765.32 "$1,212.26" "$1,530.63" "$1,224.50" $688.78 $303.79 N/A $887.98 "$1,530.63" "$1,530.63" "$1,530.63" $318.98 "$1,530.63" N/A N/A 442.477 SUP HCPCS C1713 442.477 - PLATE BONE 40MM 3X3 HOLE LCP TITANIUM DISTAL RAD NONSTRL 2.4 BOTH IP/OP $877.50 $649.00 $174.09 $892.05 $394.72 $394.72 $394.72 $394.72 $877.15 $877.15 $877.15 $182.82 $877.15 $877.15 $877.15 $877.15 $877.15 $182.81 $877.15 $892.05 $518.83 $877.15 $892.05 $877.15 $877.15 $658.13 $877.15 $877.15 $877.15 $438.58 $438.58 $694.70 $877.15 $701.72 $394.72 $174.09 N/A $508.95 $877.15 $877.15 $877.15 $182.80 $877.15 N/A N/A 442.478 SUP HCPCS C1713 442.478 - PLATE BONE 49MM 3X4 HOLE LCP TITANIUM DISTAL RAD NONSTRL 2.4 BOTH IP/OP $914.00 $676.00 $181.35 $929.23 $411.17 $411.17 $411.17 $411.17 $913.70 $913.70 $913.70 $190.44 $913.70 $913.70 $913.70 $913.70 $913.70 $190.43 $913.70 $371.69 $540.45 $913.70 $929.23 $913.70 $913.70 $685.50 $913.70 $913.70 $913.70 $456.85 $456.85 $723.65 $913.70 $730.96 $411.17 $181.35 N/A $530.12 $913.70 $913.70 $913.70 $190.42 $913.70 N/A N/A 442.479 SUP HCPCS C1713 442.479 - PLATE BONE STR 48MM 5 HOLE LCP TITANIUM DISTAL RAD NONSTRL BOTH IP/OP $832.50 $616.00 $165.17 $846.33 $374.48 $374.48 $374.48 $374.48 $832.18 $832.18 $832.18 $173.45 $832.18 $832.18 $832.18 $832.18 $832.18 $173.44 $832.18 $846.33 $492.23 $832.18 $846.33 $832.18 $832.18 $624.38 $832.18 $832.18 $832.18 $416.09 $416.09 $659.09 $832.18 $665.74 $374.48 $165.17 N/A $482.85 $832.18 $832.18 $832.18 $173.43 $832.18 N/A N/A 442.482 SUP HCPCS C1713 442.482 - PLATE BN TI RDS LT DIST DRSL BOTH IP/OP "$1,854.50" "$1,372.00" $368.07 "$1,854.48" $834.52 $834.52 $834.52 $834.52 "$1,854.48" "$1,854.48" "$1,854.48" $386.52 "$1,854.48" "$1,854.48" "$1,854.48" "$1,854.48" "$1,854.48" $386.49 "$1,854.48" $741.79 "$1,096.92" "$1,854.48" "$1,854.48" "$1,854.48" "$1,854.48" "$1,390.88" "$1,854.48" "$1,854.48" "$1,854.48" $927.24 $927.24 "$1,468.75" "$1,854.48" "$1,483.58" $834.52 $368.07 N/A "$1,075.61" "$1,854.48" "$1,854.48" "$1,854.48" "$1,854.48" "$1,854.48" N/A N/A 442.483 SUP HCPCS C1713 442.483 - PLATE BN TI RDS LT DIST VOLR BOTH IP/OP "$1,531.00" "$1,133.00" $303.79 "$1,530.63" $688.78 $688.78 $688.78 $688.78 "$1,530.63" "$1,530.63" "$1,530.63" $319.02 "$1,530.63" "$1,530.63" "$1,530.63" "$1,530.63" "$1,530.63" $319.00 "$1,530.63" $612.25 $905.37 "$1,530.63" "$1,530.63" "$1,530.63" "$1,530.63" "$1,148.25" "$1,530.63" "$1,530.63" "$1,530.63" $765.32 $765.32 "$1,212.26" "$1,530.63" "$1,224.50" $688.78 $303.79 N/A $887.98 "$1,530.63" $918.38 "$1,530.63" "$1,530.63" "$1,530.63" N/A N/A 442.49 SUP HCPCS C1713 442.490 - PLATE BONE STR 57MM 6 HOLE LCP TITANIUM DISTAL RAD NONSTRL BOTH IP/OP $852.00 $630.00 $169.02 $892.05 $383.22 $383.22 $383.22 $383.22 $851.60 $851.60 $851.60 $177.49 $851.60 $851.60 $851.60 $851.60 $851.60 $177.48 $851.60 $356.82 $503.72 $851.60 $892.05 $851.60 $851.60 $639.00 $851.60 $851.60 $851.60 $425.80 $425.80 $674.47 $851.60 $681.28 $383.22 $169.02 N/A $494.16 $851.60 $510.96 $851.60 $177.47 $851.60 N/A N/A 442.491 SUP HCPCS C1713 442.491 - PLATE BN 43MM LCP 5 HLE/HD 3 HL SHFT TI RDS LT DIST VOLR 2.4 BOTH IP/OP "$1,536.50" "$1,137.00" $304.94 "$1,562.55" $691.39 $691.39 $691.39 $691.39 "$1,536.43" "$1,536.43" "$1,536.43" $320.23 "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" $320.21 "$1,536.43" $625.02 $908.80 "$1,536.43" "$1,562.55" "$1,536.43" "$1,536.43" "$1,152.38" "$1,536.43" "$1,536.43" "$1,536.43" $768.22 $768.22 "$1,216.85" "$1,536.43" "$1,229.14" $691.39 $304.94 N/A $891.17 "$1,536.43" $921.86 "$1,536.43" $320.19 "$1,536.43" N/A N/A 442.492 SUP HCPCS C1713 442.492 - PLATE BONE 61MM 5X5 HOLE LCP TITANIUM LEFT DISTAL VOLAR RAD BOTH IP/OP "$1,626.50" "$1,204.00" $322.80 "$1,654.03" $731.87 $731.87 $731.87 $731.87 "$1,626.38" "$1,626.38" "$1,626.38" $338.98 "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" $338.96 "$1,626.38" "$1,654.03" $962.00 "$1,626.38" "$1,654.03" "$1,626.38" "$1,626.38" "$1,219.88" "$1,626.38" "$1,626.38" "$1,626.38" $813.19 $813.19 "$1,288.09" "$1,626.38" "$1,301.10" $731.87 $322.80 N/A $943.37 "$1,626.38" "$1,626.38" "$1,626.38" $338.94 "$1,626.38" N/A N/A 442.493 SUP HCPCS C1713 442.493 - PLATE BONE 43MM 5 HOLE HEAD 3 HOLE SHAFT LCP TITANIUM RAD BOTH IP/OP "$1,536.50" "$1,137.00" $304.94 "$1,562.55" $691.39 $691.39 $691.39 $691.39 "$1,536.43" "$1,536.43" "$1,536.43" $320.23 "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" "$1,536.43" $320.21 "$1,536.43" "$1,562.55" $908.80 "$1,536.43" "$1,562.55" "$1,536.43" "$1,536.43" "$1,152.38" "$1,536.43" "$1,536.43" "$1,536.43" $768.22 $768.22 "$1,216.85" "$1,536.43" "$1,229.14" $691.39 $304.94 N/A $891.17 "$1,536.43" $921.86 "$1,536.43" $320.19 "$1,536.43" N/A N/A 442.494 SUP HCPCS C1713 442.494 - PLATE BONE 61MM 5 HOLE HEAD 5 HOLE SHAFT LCP TITANIUM RAD BOTH IP/OP "$1,626.50" "$1,204.00" $322.80 "$1,654.03" $731.87 $731.87 $731.87 $731.87 "$1,626.38" "$1,626.38" "$1,626.38" $338.98 "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" "$1,626.38" $338.96 "$1,626.38" $661.61 $962.00 "$1,626.38" "$1,654.03" "$1,626.38" "$1,626.38" "$1,219.88" "$1,626.38" "$1,626.38" "$1,626.38" $813.19 $813.19 "$1,288.09" "$1,626.38" "$1,301.10" $731.87 $322.80 N/A $943.37 "$1,626.38" $975.83 "$1,626.38" $338.94 "$1,626.38" N/A N/A 442.5 SUP HCPCS C1713 442.500 - PLATE BONE -90D L 40MM 2X3 HOLE LCP TITANIUM DISTAL RAD BOTH IP/OP $823.00 $609.00 $163.34 $862.03 $370.33 $370.33 $370.33 $370.33 $822.95 $822.95 $822.95 $171.52 $822.95 $822.95 $822.95 $822.95 $822.95 $171.51 $822.95 $862.03 $486.77 $822.95 $862.03 $822.95 $822.95 $617.25 $822.95 $822.95 $822.95 $411.48 $411.48 $651.78 $822.95 $658.36 $370.33 $163.34 N/A $477.34 $822.95 $822.95 $822.95 $171.50 $822.95 N/A N/A 442.501 SUP HCPCS C1713 442.501 - PLATE BONE -90D L 49MM 2X4 HOLE LCP TITANIUM DISTAL RAD BOTH IP/OP $890.00 $659.00 $176.60 $904.93 $400.41 $400.41 $400.41 $400.41 $889.80 $889.80 $889.80 $185.46 $889.80 $889.80 $889.80 $889.80 $889.80 $185.44 $889.80 $361.97 $526.32 $889.80 $904.93 $889.80 $889.80 $667.50 $889.80 $889.80 $889.80 $444.90 $444.90 $704.72 $889.80 $711.84 $400.41 $176.60 N/A $516.20 $889.80 $533.88 $889.80 $185.43 $889.80 N/A N/A 442.502 SUP HCPCS C1713 442.502 - PLATE BONE 90D L 40MM 2X3 HOLE LCP TITANIUM DISTAL RAD BOTH IP/OP $848.00 $628.00 $168.23 $862.03 $381.43 $381.43 $381.43 $381.43 $847.63 $847.63 $847.63 $176.67 $847.63 $847.63 $847.63 $847.63 $847.63 $176.66 $847.63 $862.03 $501.37 $847.63 $862.03 $847.63 $847.63 $636.00 $847.63 $847.63 $847.63 $423.82 $423.82 $671.32 $847.63 $678.10 $381.43 $168.23 N/A $491.84 $847.63 $508.58 $847.63 $176.65 $847.63 N/A N/A 442.503 SUP HCPCS C1713 442.503 - PLATE BONE 90D L 49MM 2X4 HOLE LCP TITANIUM DISTAL RAD BOTH IP/OP $890.00 $659.00 $176.60 $904.93 $400.41 $400.41 $400.41 $400.41 $889.80 $889.80 $889.80 $185.46 $889.80 $889.80 $889.80 $889.80 $889.80 $185.44 $889.80 $361.97 $526.32 $889.80 $904.93 $889.80 $889.80 $667.50 $889.80 $889.80 $889.80 $444.90 $444.90 $704.72 $889.80 $711.84 $400.41 $176.60 N/A $516.20 $889.80 $533.88 $889.80 $185.43 $889.80 N/A N/A 442.504 SUP HCPCS C1713 442.504 - PLATE BONE 90D L 40MM 3X3 HOLE LCP TITANIUM DISTAL RAD BOTH IP/OP $848.00 $628.00 $168.23 $862.03 $381.43 $381.43 $381.43 $381.43 $847.63 $847.63 $847.63 $176.67 $847.63 $847.63 $847.63 $847.63 $847.63 $176.66 $847.63 $344.81 $501.37 $847.63 $862.03 $847.63 $847.63 $636.00 $847.63 $847.63 $847.63 $423.82 $423.82 $671.32 $847.63 $678.10 $381.43 $168.23 N/A $491.84 $847.63 $847.63 $847.63 $176.65 $847.63 N/A N/A 442.505 SUP HCPCS C1713 442.505 - PLATE BONE 90D L 49MM 3X4 HOLE LCP TITANIUM DISTAL RAD BOTH IP/OP $890.00 $659.00 $176.60 $904.93 $400.41 $400.41 $400.41 $400.41 $889.80 $889.80 $889.80 $185.46 $889.80 $889.80 $889.80 $889.80 $889.80 $185.44 $889.80 $361.97 $526.32 $889.80 $904.93 $889.80 $889.80 $667.50 $889.80 $889.80 $889.80 $444.90 $444.90 $704.72 $889.80 $711.84 $400.41 $176.60 N/A $516.20 $889.80 $533.88 $889.80 $185.43 $889.80 N/A N/A 442.506 SUP HCPCS C1713 442.506 - PLATE BONE -90D L 40MM 3X3 HOLE LCP TITANIUM DISTAL RAD BOTH IP/OP $848.00 $628.00 $168.23 $862.03 $381.43 $381.43 $381.43 $381.43 $847.63 $847.63 $847.63 $176.67 $847.63 $847.63 $847.63 $847.63 $847.63 $176.66 $847.63 $344.81 $501.37 $847.63 $862.03 $847.63 $847.63 $636.00 $847.63 $847.63 $847.63 $423.82 $423.82 $671.32 $847.63 $678.10 $381.43 $168.23 N/A $491.84 $847.63 $508.58 $847.63 $176.65 $847.63 N/A N/A 442.507 SUP HCPCS C1713 442.507 - PLATE BONE -90D L 49MM 3X4 HOLE LCP TITANIUM DISTAL RAD BOTH IP/OP $890.00 $659.00 $176.60 $904.93 $400.41 $400.41 $400.41 $400.41 $889.80 $889.80 $889.80 $185.46 $889.80 $889.80 $889.80 $889.80 $889.80 $185.44 $889.80 $361.97 $526.32 $889.80 $904.93 $889.80 $889.80 $667.50 $889.80 $889.80 $889.80 $444.90 $444.90 $704.72 $889.80 $711.84 $400.41 $176.60 N/A $516.20 $889.80 $533.88 $889.80 $185.43 $889.80 N/A N/A 442.508 SUP HCPCS C1713 442.508 - PLATE BONE +20D L 43MM 3X3 HOLE LCP TITANIUM DISTAL RAD BOTH IP/OP $848.00 $628.00 $168.23 $862.03 $381.43 $381.43 $381.43 $381.43 $847.63 $847.63 $847.63 $176.67 $847.63 $847.63 $847.63 $847.63 $847.63 $176.66 $847.63 $344.81 $501.37 $847.63 $862.03 $847.63 $847.63 $636.00 $847.63 $847.63 $847.63 $423.82 $423.82 $671.32 $847.63 $678.10 $381.43 $168.23 N/A $491.84 $847.63 $508.58 $847.63 $176.65 $847.63 N/A N/A 442.509 SUP HCPCS C1713 442.509 - PLATE BONE +20D L 52MM 3X4 HOLE LCP TITANIUM DISTAL RAD BOTH IP/OP $890.00 $659.00 $176.60 $904.93 $400.41 $400.41 $400.41 $400.41 $889.80 $889.80 $889.80 $185.46 $889.80 $889.80 $889.80 $889.80 $889.80 $185.44 $889.80 $904.93 $526.32 $889.80 $904.93 $889.80 $889.80 $667.50 $889.80 $889.80 $889.80 $444.90 $444.90 $704.72 $889.80 $711.84 $400.41 $176.60 N/A $516.20 $889.80 $889.80 $889.80 $185.43 $889.80 N/A N/A 442.51 SUP HCPCS C1713 442.51 - PLATE BN STD BND NS 8 HL FSN TI WRST 2.7/3.5MM CORT SCR BOTH IP/OP "$1,973.50" "$1,460.00" $391.68 "$1,973.43" $888.04 $888.04 $888.04 $888.04 "$1,973.43" "$1,973.43" "$1,973.43" $411.31 "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" $411.28 "$1,973.43" "$1,973.43" "$1,167.28" "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" "$1,480.13" "$1,973.43" "$1,973.43" "$1,973.43" $986.72 $986.72 "$1,562.96" "$1,973.43" "$1,578.74" $888.04 $391.68 N/A "$1,144.63" "$1,973.43" "$1,973.43" "$1,973.43" $411.26 "$1,973.43" N/A N/A 442.511 SUP HCPCS C1713 442.511 - PLATE BONE -20D L 43MM 3X3 HOLE LCP TITANIUM DISTAL RAD BOTH IP/OP $848.00 $628.00 $168.23 $862.03 $381.43 $381.43 $381.43 $381.43 $847.63 $847.63 $847.63 $176.67 $847.63 $847.63 $847.63 $847.63 $847.63 $176.66 $847.63 $344.81 $501.37 $847.63 $862.03 $847.63 $847.63 $636.00 $847.63 $847.63 $847.63 $423.82 $423.82 $671.32 $847.63 $678.10 $381.43 $168.23 N/A $491.84 $847.63 $508.58 $847.63 $176.65 $847.63 N/A N/A 442.512 SUP HCPCS C1713 442.512 - PLATE BONE -20D L 52MM 3X4 HOLE LCP TITANIUM DISTAL RAD BOTH IP/OP $890.00 $659.00 $176.60 $904.93 $400.41 $400.41 $400.41 $400.41 $889.80 $889.80 $889.80 $185.46 $889.80 $889.80 $889.80 $889.80 $889.80 $185.44 $889.80 $361.97 $526.32 $889.80 $904.93 $889.80 $889.80 $667.50 $889.80 $889.80 $889.80 $444.90 $444.90 $704.72 $889.80 $711.84 $400.41 $176.60 N/A $516.20 $889.80 $533.88 $889.80 $185.43 $889.80 N/A N/A 442.52 SUP HCPCS C1713 442.52 - PLATE BN SHRT BND NS 8 HL FSN TI WRST 2.7/3.5MM CORT SCR BOTH IP/OP "$1,973.50" "$1,460.00" $391.68 "$1,973.43" $888.04 $888.04 $888.04 $888.04 "$1,973.43" "$1,973.43" "$1,973.43" $411.31 "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" $411.28 "$1,973.43" $789.37 "$1,167.28" "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" "$1,480.13" "$1,973.43" "$1,973.43" "$1,973.43" $986.72 $986.72 "$1,562.96" "$1,973.43" "$1,578.74" $888.04 $391.68 N/A "$1,144.63" "$1,973.43" "$1,184.06" "$1,973.43" $411.26 "$1,973.43" N/A N/A 442.53 SUP HCPCS C1713 442.53 - PLATE BN STRG NS 9 HL FSN TI WRST 2.7/3.5MM CORT SCR BOTH IP/OP "$1,973.50" "$1,460.00" $391.68 "$1,973.43" $888.04 $888.04 $888.04 $888.04 "$1,973.43" "$1,973.43" "$1,973.43" $411.31 "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" $411.28 "$1,973.43" $789.37 "$1,167.28" "$1,973.43" "$1,973.43" "$1,973.43" "$1,973.43" "$1,480.13" "$1,973.43" "$1,973.43" "$1,973.43" $986.72 $986.72 "$1,562.96" "$1,973.43" "$1,578.74" $888.04 $391.68 N/A "$1,144.63" "$1,973.43" "$1,184.06" "$1,973.43" $411.26 "$1,973.43" N/A N/A 442.61 SUP HCPCS C1713 442.61 - PLATE BN 57X7X1.5MM NS 7 HL TI CNDRL LT 2.7MM SCR BOTH IP/OP $609.00 $451.00 $120.81 $608.68 $273.91 $273.91 $273.91 $273.91 $608.68 $608.68 $608.68 $126.86 $608.68 $608.68 $608.68 $608.68 $608.68 $126.86 $608.68 $608.68 $360.03 $608.68 $608.68 $608.68 $608.68 $456.75 $608.68 $608.68 $608.68 $304.34 $304.34 $482.07 $608.68 $486.94 $273.91 $120.81 N/A $353.22 $608.68 $608.68 $608.68 $126.85 $608.68 N/A N/A 442.62 SUP HCPCS C1713 442.62 - PLATE BN 57X7X1.5MM NS 7 HL TI CNDRL RT 2.7MM SCR BOTH IP/OP $609.00 $451.00 $120.81 $608.68 $273.91 $273.91 $273.91 $273.91 $608.68 $608.68 $608.68 $126.86 $608.68 $608.68 $608.68 $608.68 $608.68 $126.86 $608.68 $243.47 $360.03 $608.68 $608.68 $608.68 $608.68 $456.75 $608.68 $608.68 $608.68 $304.34 $304.34 $482.07 $608.68 $486.94 $273.91 $120.81 N/A $353.22 $608.68 $608.68 $608.68 $126.85 $608.68 N/A N/A 443.054 SUP HCPCS C1713 443.054 - PLATE BONE 22X5X1MM 4 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL 2 BOTH IP/OP $408.50 $302.00 $80.99 $408.05 $183.62 $183.62 $183.62 $183.62 $408.05 $408.05 $408.05 $85.05 $408.05 $408.05 $408.05 $408.05 $408.05 $85.04 $408.05 $163.22 $241.36 $408.05 $408.05 $408.05 $408.05 $306.38 $408.05 $408.05 $408.05 $204.03 $204.03 $323.18 $408.05 $326.44 $183.62 $80.99 N/A $236.93 $408.05 $244.83 $408.05 $85.04 $408.05 N/A N/A 443.055 SUP HCPCS C1713 443.055 - PLATE BONE 27X5X1MM 5 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL 2 BOTH IP/OP $450.50 $333.00 $89.39 $450.38 $202.67 $202.67 $202.67 $202.67 $450.38 $450.38 $450.38 $93.87 $450.38 $450.38 $450.38 $450.38 $450.38 $93.86 $450.38 $450.38 $266.40 $450.38 $450.38 $450.38 $450.38 $337.88 $450.38 $450.38 $450.38 $225.19 $225.19 $356.70 $450.38 $360.30 $202.67 $89.39 N/A $261.29 $450.38 $270.23 $450.38 $450.38 $450.38 N/A N/A 443.056 SUP HCPCS C1713 443.056 - PLATE BONE 32X5X1MM 6 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL 2 BOTH IP/OP $491.50 $364.00 $97.51 $491.30 $221.09 $221.09 $221.09 $221.09 $491.30 $491.30 $491.30 $102.40 $491.30 $491.30 $491.30 $491.30 $491.30 $102.39 $491.30 $491.30 $290.60 $491.30 $491.30 $491.30 $491.30 $368.63 $491.30 $491.30 $491.30 $245.65 $245.65 $389.11 $491.30 $393.04 $221.09 $97.51 N/A $285.07 $491.30 $294.78 $491.30 $491.30 $491.30 N/A N/A 443.057 SUP HCPCS C1713 443.057 - PLATE BONE 37X5X1.5MM 7 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $532.50 $394.00 $105.64 $532.25 $239.51 $239.51 $239.51 $239.51 $532.25 $532.25 $532.25 $110.93 $532.25 $532.25 $532.25 $532.25 $532.25 $110.93 $532.25 $532.25 $314.83 $532.25 $532.25 $532.25 $532.25 $399.38 $532.25 $532.25 $532.25 $266.13 $266.13 $421.54 $532.25 $425.80 $239.51 $105.64 N/A $308.85 $532.25 $532.25 $532.25 $110.92 $532.25 N/A N/A 443.058 SUP HCPCS C1713 443.058 - PLATE BONE 42X5X1.5MM 8 HOLE DCP TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $572.00 $423.00 $113.49 $571.83 $257.32 $257.32 $257.32 $257.32 $571.83 $571.83 $571.83 $119.18 $571.83 $571.83 $571.83 $571.83 $571.83 $119.18 $571.83 $228.73 $338.24 $571.83 $571.83 $571.83 $571.83 $429.00 $571.83 $571.83 $571.83 $285.92 $285.92 $452.89 $571.83 $457.46 $257.32 $113.49 N/A $331.76 $571.83 $571.83 $571.83 $119.17 $571.83 N/A N/A 443.178 SUP HCPCS C1713 443.178 - PLATE BONE 8MM SPACE MINI 31MM 2 BEND LP ARCH TITANIUM SPN BOTH IP/OP "$1,342.50" $993.00 $266.40 "$1,342.25" $604.01 $604.01 $604.01 $604.01 "$1,342.25" "$1,342.25" "$1,342.25" $279.76 "$1,342.25" "$1,342.25" "$1,342.25" "$1,342.25" "$1,342.25" $279.74 "$1,342.25" $536.90 $793.94 "$1,342.25" "$1,342.25" "$1,342.25" "$1,342.25" "$1,006.88" "$1,342.25" "$1,342.25" "$1,342.25" $671.13 $671.13 "$1,063.06" "$1,342.25" "$1,073.80" $604.01 $266.40 N/A $778.65 "$1,342.25" $805.35 "$1,342.25" $279.72 "$1,342.25" N/A N/A 443.18 SUP HCPCS C1713 443.180 - PLATE BONE 10MM SPACE MINI LP 33MM 2 BEND ARCH TITANIUM SPN BOTH IP/OP "$1,342.50" $993.00 $266.40 "$1,342.25" $604.01 $604.01 $604.01 $604.01 "$1,342.25" "$1,342.25" "$1,342.25" $279.76 "$1,342.25" "$1,342.25" "$1,342.25" "$1,342.25" "$1,342.25" $279.74 "$1,342.25" $536.90 $793.94 "$1,342.25" "$1,342.25" "$1,342.25" "$1,342.25" "$1,006.88" "$1,342.25" "$1,342.25" "$1,342.25" $671.13 $671.13 "$1,063.06" "$1,342.25" "$1,073.80" $604.01 $266.40 N/A $778.65 "$1,342.25" $805.35 "$1,342.25" $279.72 "$1,342.25" N/A N/A 443.182 SUP HCPCS C1713 443.182 - PLATE BONE 12MM SPACE MINI LP 35MM 2 BEND ARCH TITANIUM SPN BOTH IP/OP "$1,342.50" $993.00 $266.40 "$1,342.25" $604.01 $604.01 $604.01 $604.01 "$1,342.25" "$1,342.25" "$1,342.25" $279.76 "$1,342.25" "$1,342.25" "$1,342.25" "$1,342.25" "$1,342.25" $279.74 "$1,342.25" $536.90 $793.94 "$1,342.25" "$1,342.25" "$1,342.25" "$1,342.25" "$1,006.88" "$1,342.25" "$1,342.25" "$1,342.25" $671.13 $671.13 "$1,063.06" "$1,342.25" "$1,073.80" $604.01 $266.40 N/A $778.65 "$1,342.25" "$1,342.25" "$1,342.25" $279.72 "$1,342.25" N/A N/A 443.19 SUP HCPCS C1713 443.19 - PLATE BN STRG 100X5X1MM NS 20 HL TI 2MM SCR BOTH IP/OP $459.00 $340.00 $91.01 $458.55 $206.35 $206.35 $206.35 $206.35 $458.55 $458.55 $458.55 $95.57 $458.55 $458.55 $458.55 $458.55 $458.55 $95.57 $458.55 $183.42 $271.23 $458.55 $458.55 $458.55 $458.55 $344.25 $458.55 $458.55 $458.55 $229.28 $229.28 $363.17 $458.55 $366.84 $206.35 $91.01 N/A $266.22 $458.55 $275.13 $458.55 $95.56 $458.55 N/A N/A 443.23 SUP HCPCS C1713 443.23 - PLATE BN T 50X5X1.2MM NS 3 HLE/HD 9 HL SHFT TI 2MM SCR BOTH IP/OP $390.50 $289.00 $77.47 $390.33 $175.65 $175.65 $175.65 $175.65 $390.33 $390.33 $390.33 $81.35 $390.33 $390.33 $390.33 $390.33 $390.33 $81.35 $390.33 $156.13 $230.88 $390.33 $390.33 $390.33 $390.33 $292.88 $390.33 $390.33 $390.33 $195.17 $195.17 $309.14 $390.33 $312.26 $175.65 $77.47 N/A $226.49 $390.33 $234.20 $390.33 $81.34 $390.33 N/A N/A 443.24 SUP HCPCS C1713 443.24 - PLATE BN T 50X5X1.2MM NS 4 HLE/HD 9 HL SHFT TI 2MM SCR BOTH IP/OP $422.00 $312.00 $83.70 $421.70 $189.77 $189.77 $189.77 $189.77 $421.70 $421.70 $421.70 $87.89 $421.70 $421.70 $421.70 $421.70 $421.70 $87.89 $421.70 $168.68 $249.44 $421.70 $421.70 $421.70 $421.70 $316.50 $421.70 $421.70 $421.70 $210.85 $210.85 $333.99 $421.70 $337.36 $189.77 $83.70 N/A $244.76 $421.70 $253.02 $421.70 $87.88 $421.70 N/A N/A 443.44 SUP HCPCS C1713 443.44 - PLATE BN 22X5X.9MM NS DCP 4 HL TI ZYG 2MM CORT SCR BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $555.75 $555.75 $555.75 $555.75 N/A N/A 443.45 SUP HCPCS C1713 443.45 - PLATE BN 27X5X.9MM NS DCP 5 HL TI ZYG 2MM SCR BOTH IP/OP $578.50 $428.00 $114.77 $578.25 $260.21 $260.21 $260.21 $260.21 $578.25 $578.25 $578.25 $120.52 $578.25 $578.25 $578.25 $578.25 $578.25 $120.51 $578.25 $578.25 $342.03 $578.25 $578.25 $578.25 $578.25 $433.88 $578.25 $578.25 $578.25 $289.13 $289.13 $457.97 $578.25 $462.60 $260.21 $114.77 N/A $335.53 $578.25 $346.95 $578.25 $120.51 $578.25 N/A N/A 443.46 SUP HCPCS C1713 443.46 - PLATE BN 32X5X.9MM NS DCP 6 HL TI ZYG 2MM SCR BOTH IP/OP $621.00 $460.00 $123.25 $621.00 $279.45 $279.45 $279.45 $279.45 $621.00 $621.00 $621.00 $129.43 $621.00 $621.00 $621.00 $621.00 $621.00 $129.42 $621.00 $621.00 $367.32 $621.00 $621.00 $621.00 $621.00 $465.75 $621.00 $621.00 $621.00 $310.50 $310.50 $491.83 $621.00 $496.80 $279.45 $123.25 N/A $360.18 $621.00 $372.60 $621.00 $129.42 $621.00 N/A N/A 443.48 SUP HCPCS C1713 443.48 - PLATE BONE H 12X11MM 4 HOLE TITANIUM CONDYLE NONSTRL 2MM BOTH IP/OP $398.50 $295.00 $79.09 $398.50 $179.33 $179.33 $179.33 $179.33 $398.50 $398.50 $398.50 $83.06 $398.50 $398.50 $398.50 $398.50 $398.50 $83.05 $398.50 $159.40 $235.71 $398.50 $398.50 $398.50 $398.50 $298.88 $398.50 $398.50 $398.50 $199.25 $199.25 $315.61 $398.50 $318.80 $179.33 $79.09 N/A $231.13 $398.50 $239.10 $398.50 $398.50 $398.50 N/A N/A 443.54 SUP HCPCS C1713 443.54 - PLATE BONE MINI 22MM 4 HOLE DCP TITANIUM CRANFCL NONSTRL 2MM BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $630.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $131.29 $630.00 N/A N/A 443.55 SUP HCPCS C1713 443.55 - PLATE BONE MINI 27MM 5 HOLE DCP TITANIUM CRANFCL NONSTRL 2MM BOTH IP/OP $695.50 $515.00 $137.99 $695.25 $312.86 $312.86 $312.86 $312.86 $695.25 $695.25 $695.25 $144.91 $695.25 $695.25 $695.25 $695.25 $695.25 $144.90 $695.25 $695.25 $411.24 $695.25 $695.25 $695.25 $695.25 $521.63 $695.25 $695.25 $695.25 $347.63 $347.63 $550.64 $695.25 $556.20 $312.86 $137.99 N/A $403.39 $695.25 $417.15 $695.25 $144.89 $695.25 N/A N/A 443.56 SUP HCPCS C1713 443.56 - PLATE BONE MINI 32MM 6 HOLE DCP TITANIUM CRANFCL NONSTRL 2MM BOTH IP/OP $760.50 $563.00 $150.94 $760.50 $342.23 $342.23 $342.23 $342.23 $760.50 $760.50 $760.50 $158.51 $760.50 $760.50 $760.50 $760.50 $760.50 $158.50 $760.50 $760.50 $449.84 $760.50 $760.50 $760.50 $760.50 $570.38 $760.50 $760.50 $760.50 $380.25 $380.25 $602.32 $760.50 $608.40 $342.23 $150.94 N/A $441.09 $760.50 $456.30 $760.50 $158.49 $760.50 N/A N/A 443.57 SUP HCPCS C1713 443.57 - PLATE BONE MINI 37MM 7 HOLE DCP TITANIUM CRANFCL NONSTRL 2MM BOTH IP/OP $817.00 $605.00 $162.10 $816.75 $367.54 $367.54 $367.54 $367.54 $816.75 $816.75 $816.75 $170.23 $816.75 $816.75 $816.75 $816.75 $816.75 $170.22 $816.75 $816.75 $483.11 $816.75 $816.75 $816.75 $816.75 $612.75 $816.75 $816.75 $816.75 $408.38 $408.38 $646.87 $816.75 $653.40 $367.54 $162.10 N/A $473.86 $816.75 $490.05 $816.75 $170.21 $816.75 N/A N/A 443.58 SUP HCPCS C1713 443.58 - PLATE BONE MINI 42MM 8 HOLE DCP TITANIUM CRANFCL NONSTRL 2MM BOTH IP/OP $884.50 $655.00 $175.50 $884.25 $397.91 $397.91 $397.91 $397.91 $884.25 $884.25 $884.25 $184.30 $884.25 $884.25 $884.25 $884.25 $884.25 $184.29 $884.25 $884.25 $523.03 $884.25 $884.25 $884.25 $884.25 $663.38 $884.25 $884.25 $884.25 $442.13 $442.13 $700.33 $884.25 $707.40 $397.91 $175.50 N/A $513.01 $884.25 $884.25 $884.25 $184.28 $884.25 N/A N/A 443.61 SUP HCPCS C1713 443.61 - PLATE BN 39X5X1.2MM NS 7 HL TI CNDRL LT 2MM SCR BOTH IP/OP $551.50 $408.00 $109.43 $551.35 $248.11 $248.11 $248.11 $248.11 $551.35 $551.35 $551.35 $114.92 $551.35 $551.35 $551.35 $551.35 $551.35 $114.91 $551.35 $220.54 $326.12 $551.35 $551.35 $551.35 $551.35 $413.63 $551.35 $551.35 $551.35 $275.68 $275.68 $436.67 $551.35 $441.08 $248.11 $109.43 N/A $319.87 $551.35 $330.81 $551.35 $551.35 $551.35 N/A N/A 443.62 SUP HCPCS C1713 443.62 - PLATE BN 39X5X1.2MM NS 7 HL TI CNDRL RT 2MM SCR BOTH IP/OP $551.50 $408.00 $109.43 $551.35 $248.11 $248.11 $248.11 $248.11 $551.35 $551.35 $551.35 $114.92 $551.35 $551.35 $551.35 $551.35 $551.35 $114.91 $551.35 $551.35 $326.12 $551.35 $551.35 $551.35 $551.35 $413.63 $551.35 $551.35 $551.35 $275.68 $275.68 $436.67 $551.35 $441.08 $248.11 $109.43 N/A $319.87 $551.35 $330.81 $551.35 $114.90 $551.35 N/A N/A 444.002 SUP HCPCS C1713 444.002 - PLATE BONE 2.7MM 20X8X2MM 2 HOLE DCP TITANIUM FT NONSTRL 2.7 BOTH IP/OP $474.50 $351.00 $94.15 $474.35 $213.46 $213.46 $213.46 $213.46 $474.35 $474.35 $474.35 $98.87 $474.35 $474.35 $474.35 $474.35 $474.35 $98.86 $474.35 $474.35 $280.58 $474.35 $474.35 $474.35 $474.35 $355.88 $474.35 $474.35 $474.35 $237.18 $237.18 $375.69 $474.35 $379.48 $213.46 $94.15 N/A $275.21 $474.35 $284.61 $474.35 $98.85 $474.35 N/A N/A 444.004 SUP HCPCS C1713 444.004 - PLATE BONE 36X8X2MM 4 HOLE DCP TITANIUM FT NONSTRL 2.7MM BOTH IP/OP $594.00 $440.00 $117.81 $593.60 $267.12 $267.12 $267.12 $267.12 $593.60 $593.60 $593.60 $123.72 $593.60 $593.60 $593.60 $593.60 $593.60 $123.71 $593.60 $593.60 $351.11 $593.60 $593.60 $593.60 $593.60 $445.50 $593.60 $593.60 $593.60 $296.80 $296.80 $470.13 $593.60 $474.88 $267.12 $117.81 N/A $344.52 $593.60 $593.60 $593.60 $123.71 $593.60 N/A N/A 444.005 SUP HCPCS C1713 444.005 - PLATE BONE 44X8X2MM 5 HOLE DCP TITANIUM FT NONSTRL 2.7MM BOTH IP/OP $669.50 $495.00 $132.81 $669.13 $301.11 $301.11 $301.11 $301.11 $669.13 $669.13 $669.13 $139.46 $669.13 $669.13 $669.13 $669.13 $669.13 $139.45 $669.13 $669.13 $395.79 $669.13 $669.13 $669.13 $669.13 $502.13 $669.13 $669.13 $669.13 $334.57 $334.57 $529.95 $669.13 $535.30 $301.11 $132.81 N/A $388.31 $669.13 $669.13 $669.13 $669.13 $669.13 N/A N/A 444.006 SUP HCPCS C1713 444.006 - PLATE BONE 2.7MM 52X8X2MM 6 HOLE DCP TITANIUM FT NONSTRL 2.7 BOTH IP/OP $717.00 $531.00 $142.27 $716.83 $322.57 $322.57 $322.57 $322.57 $716.83 $716.83 $716.83 $149.41 $716.83 $716.83 $716.83 $716.83 $716.83 $149.40 $716.83 $716.83 $424.00 $716.83 $716.83 $716.83 $716.83 $537.75 $716.83 $716.83 $716.83 $358.42 $358.42 $567.73 $716.83 $573.46 $322.57 $142.27 N/A $415.86 $716.83 $430.10 $716.83 $149.39 $716.83 N/A N/A 444.007 SUP HCPCS C1713 444.007 - PLATE BONE 60X8X2.5MM 7 HOLE DCP TITANIUM FT NONSTRL 2.7MM BOTH IP/OP $798.00 $591.00 $158.31 $797.65 $358.94 $358.94 $358.94 $358.94 $797.65 $797.65 $797.65 $166.25 $797.65 $797.65 $797.65 $797.65 $797.65 $166.24 $797.65 $797.65 $471.81 $797.65 $797.65 $797.65 $797.65 $598.50 $797.65 $797.65 $797.65 $398.83 $398.83 $631.74 $797.65 $638.12 $358.94 $158.31 N/A $462.84 $797.65 $478.59 $797.65 $797.65 $797.65 N/A N/A 444.008 SUP HCPCS C1713 444.008 - PLATE BONE 68X8X2.5MM 8 HOLE DCP TITANIUM FT NONSTRL 2.7MM BOTH IP/OP $836.50 $619.00 $165.94 $836.08 $376.24 $376.24 $376.24 $376.24 $836.08 $836.08 $836.08 $174.26 $836.08 $836.08 $836.08 $836.08 $836.08 $174.25 $836.08 $836.08 $494.54 $836.08 $836.08 $836.08 $836.08 $627.38 $836.08 $836.08 $836.08 $418.04 $418.04 $662.18 $836.08 $668.86 $376.24 $165.94 N/A $485.17 $836.08 $501.65 $836.08 $836.08 $836.08 N/A N/A 444.009 SUP HCPCS C1713 444.009 - PLATE BONE 2.7MM 76X8X2.5MM 9 HOLE DCP TITANIUM FT NONSTRL BOTH IP/OP $910.50 $674.00 $180.67 $910.28 $409.63 $409.63 $409.63 $409.63 $910.28 $910.28 $910.28 $189.73 $910.28 $910.28 $910.28 $910.28 $910.28 $189.71 $910.28 $910.28 $538.43 $910.28 $910.28 $910.28 $910.28 $682.88 $910.28 $910.28 $910.28 $455.14 $455.14 $720.94 $910.28 $728.22 $409.63 $180.67 N/A $528.09 $910.28 $910.28 $910.28 $189.70 $910.28 N/A N/A 444.01 SUP HCPCS C1713 444.010 - PLATE BONE 2.7MM 84X8X2.5MM 10 HOLE DCP TITANIUM FT NONSTRL BOTH IP/OP $986.00 $730.00 $195.66 $985.80 $443.61 $443.61 $443.61 $443.61 $985.80 $985.80 $985.80 $205.47 $985.80 $985.80 $985.80 $985.80 $985.80 $205.45 $985.80 $985.80 $583.10 $985.80 $985.80 $985.80 $985.80 $739.50 $985.80 $985.80 $985.80 $492.90 $492.90 $780.75 $985.80 $788.64 $443.61 $195.66 N/A $571.88 $985.80 $591.48 $985.80 $205.44 $985.80 N/A N/A 444.012 SUP HCPCS C1713 444.012 - PLATE BONE 2.7MM 100X8X2.5MM 12 HOLE DCP TITANIUM FT NONSTRL BOTH IP/OP "$1,094.50" $810.00 $217.22 "$1,094.45" $492.50 $492.50 $492.50 $492.50 "$1,094.45" "$1,094.45" "$1,094.45" $228.11 "$1,094.45" "$1,094.45" "$1,094.45" "$1,094.45" "$1,094.45" $228.10 "$1,094.45" "$1,094.45" $647.37 "$1,094.45" "$1,094.45" "$1,094.45" "$1,094.45" $820.88 "$1,094.45" "$1,094.45" "$1,094.45" $547.23 $547.23 $866.80 "$1,094.45" $875.56 $492.50 $217.22 N/A $634.81 "$1,094.45" $656.67 "$1,094.45" $228.08 "$1,094.45" N/A N/A 444.022 SUP HCPCS C1713 444.022 - PLATE BONE 1.5MM 26X8X2.5MM 2 HOLE DCP TITANIUM FT NONSTRL BOTH IP/OP $494.50 $366.00 $98.09 $494.23 $222.40 $222.40 $222.40 $222.40 $494.23 $494.23 $494.23 $103.01 $494.23 $494.23 $494.23 $494.23 $494.23 $103.00 $494.23 $494.23 $292.34 $494.23 $494.23 $494.23 $494.23 $370.88 $494.23 $494.23 $494.23 $247.12 $247.12 $391.43 $494.23 $395.38 $222.40 $98.09 N/A $286.81 $494.23 $296.54 $494.23 $103.00 $494.23 N/A N/A 445 SUP HCPCS C1713 445.00 - PLATE BONE 3.5MM 118MM 10 HOLE RECONSTRUCTION LC-DCP BOTH IP/OP $942.00 $697.00 $186.90 $986.43 $423.76 $423.76 $423.76 $423.76 $941.68 $941.68 $941.68 $196.27 $941.68 $941.68 $941.68 $941.68 $941.68 $196.26 $941.68 $986.43 $557.00 $941.68 $986.43 $941.68 $941.68 $706.50 $941.68 $941.68 $941.68 $470.84 $470.84 $745.81 $941.68 $753.34 $423.76 $186.90 N/A $546.36 $941.68 $941.68 $941.68 $196.25 $941.68 N/A N/A 445.01 SUP HCPCS C1713 445.01 - PLATE BN 130MM NS 11 HL RECON TI 3.5MM SCR BOTH IP/OP $962.50 $712.00 $190.96 $962.15 $432.97 $432.97 $432.97 $432.97 $962.15 $962.15 $962.15 $200.54 $962.15 $962.15 $962.15 $962.15 $962.15 $200.52 $962.15 $962.15 $569.11 $962.15 $962.15 $962.15 $962.15 $721.88 $962.15 $962.15 $962.15 $481.08 $481.08 $762.02 $962.15 $769.72 $432.97 $190.96 N/A $558.25 $962.15 $962.15 $962.15 $200.51 $962.15 N/A N/A 445.041 SUP HCPCS C1713 445.041 - PLATE BONE 56MM 4 HOLE RECONSTRUCTION LCP TITANIUM BOTH IP/OP $818.50 $606.00 $162.38 $832.03 $368.16 $368.16 $368.16 $368.16 $818.13 $818.13 $818.13 $170.52 $818.13 $818.13 $818.13 $818.13 $818.13 $170.51 $818.13 $832.03 $483.92 $818.13 $832.03 $818.13 $818.13 $613.88 $818.13 $818.13 $818.13 $409.07 $409.07 $647.96 $818.13 $654.50 $368.16 $162.38 N/A $474.73 $818.13 $818.13 $818.13 $170.50 $818.13 N/A N/A 445.051 SUP HCPCS C1713 445.051 - PLATE BN 70X10.1X3.5MM NS LCP CMBN 5 HL RECON TI 3.5MM SCR BOTH IP/OP $824.00 $610.00 $163.49 $837.73 $370.68 $370.68 $370.68 $370.68 $823.73 $823.73 $823.73 $171.69 $823.73 $823.73 $823.73 $823.73 $823.73 $171.67 $823.73 $837.73 $487.24 $823.73 $837.73 $823.73 $823.73 $618.00 $823.73 $823.73 $823.73 $411.87 $411.87 $652.39 $823.73 $658.98 $370.68 $163.49 N/A $477.92 $823.73 $823.73 $823.73 $171.67 $823.73 N/A N/A 445.061 SUP HCPCS C1713 445.061 - PLATE BN 84X10.1X3.5MM NS LCP CMBN 6 HL RECON TI 3.5MM SCR BOTH IP/OP $953.50 $706.00 $189.16 $969.25 $428.87 $428.87 $428.87 $428.87 $953.05 $953.05 $953.05 $198.64 $953.05 $953.05 $953.05 $953.05 $953.05 $198.63 $953.05 $969.25 $563.73 $953.05 $969.25 $953.05 $953.05 $715.13 $953.05 $953.05 $953.05 $476.53 $476.53 $754.82 $953.05 $762.44 $428.87 $189.16 N/A $553.03 $953.05 $953.05 $953.05 $198.62 $953.05 N/A N/A 445.071 SUP HCPCS C1713 445.071 - PLATE BONE 98X10.1X3.5MM 7 HOLE LCP TITANIUM CLAVICLE BOTH IP/OP "$1,002.50" $742.00 $198.92 "$1,019.30" $451.01 $451.01 $451.01 $451.01 "$1,002.25" "$1,002.25" "$1,002.25" $208.89 "$1,002.25" "$1,002.25" "$1,002.25" "$1,002.25" "$1,002.25" $208.88 "$1,002.25" "$1,019.30" $592.83 "$1,002.25" "$1,019.30" "$1,002.25" "$1,002.25" $751.88 "$1,002.25" "$1,002.25" "$1,002.25" $501.13 $501.13 $793.78 "$1,002.25" $801.80 $451.01 $198.92 N/A $581.45 "$1,002.25" "$1,002.25" "$1,002.25" $208.87 "$1,002.25" N/A N/A 445.081 SUP HCPCS C1713 445.081 - PLATE BN 112X10.1X3.5MM NS LCP CMBN 8 HL RECON TI 3.5MM SCR BOTH IP/OP "$1,046.00" $774.00 $207.57 "$1,063.60" $470.62 $470.62 $470.62 $470.62 "$1,045.83" "$1,045.83" "$1,045.83" $217.98 "$1,045.83" "$1,045.83" "$1,045.83" "$1,045.83" "$1,045.83" $217.96 "$1,045.83" "$1,063.60" $618.61 "$1,045.83" "$1,063.60" "$1,045.83" "$1,045.83" $784.50 "$1,045.83" "$1,045.83" "$1,045.83" $522.92 $522.92 $828.30 "$1,045.83" $836.66 $470.62 $207.57 N/A $606.68 "$1,045.83" "$1,045.83" "$1,045.83" $217.95 "$1,045.83" N/A N/A 445.091 SUP HCPCS C1713 445.091 - PLATE BONE 126MM 9 HOLE RECONSTRUCTION LCP TITANIUM BOTH IP/OP "$1,101.00" $815.00 $218.45 "$1,119.35" $495.29 $495.29 $495.29 $495.29 "$1,100.65" "$1,100.65" "$1,100.65" $229.40 "$1,100.65" "$1,100.65" "$1,100.65" "$1,100.65" "$1,100.65" $229.39 "$1,100.65" $447.74 $651.03 "$1,100.65" "$1,119.35" "$1,100.65" "$1,100.65" $825.75 "$1,100.65" "$1,100.65" "$1,100.65" $550.33 $550.33 $871.71 "$1,100.65" $880.52 $495.29 $218.45 N/A $638.58 "$1,100.65" "$1,100.65" "$1,100.65" $229.38 "$1,100.65" N/A N/A 445.101 SUP HCPCS C1713 445.101 - PLATE BONE 140X10.1X3.5MM 10 HOLE LCP TITANIUM CLAVICLE BOTH IP/OP "$1,082.50" $801.00 $214.83 "$1,100.78" $487.07 $487.07 $487.07 $487.07 "$1,082.38" "$1,082.38" "$1,082.38" $225.60 "$1,082.38" "$1,082.38" "$1,082.38" "$1,082.38" "$1,082.38" $225.58 "$1,082.38" $440.31 $640.23 "$1,082.38" "$1,100.78" "$1,082.38" "$1,082.38" $811.88 "$1,082.38" "$1,082.38" "$1,082.38" $541.19 $541.19 $857.24 "$1,082.38" $865.90 $487.07 $214.83 N/A $627.85 "$1,082.38" "$1,082.38" "$1,082.38" $225.57 "$1,082.38" N/A N/A 445.111 SUP HCPCS C1713 445.111 - PLATE BONE 154MM 11 HOLE RECONSTRUCTION LCP TITANIUM BOTH IP/OP "$1,172.50" $868.00 $232.68 "$1,192.28" $527.56 $527.56 $527.56 $527.56 "$1,172.35" "$1,172.35" "$1,172.35" $244.35 "$1,172.35" "$1,172.35" "$1,172.35" "$1,172.35" "$1,172.35" $244.33 "$1,172.35" $476.91 $693.45 "$1,172.35" "$1,192.28" "$1,172.35" "$1,172.35" $879.38 "$1,172.35" "$1,172.35" "$1,172.35" $586.18 $586.18 $928.50 "$1,172.35" $937.88 $527.56 $232.68 N/A $680.05 "$1,172.35" "$1,172.35" "$1,172.35" $244.32 "$1,172.35" N/A N/A 445.121 SUP HCPCS C1713 445.121 - PLATE BONE 168X10.1X3.5MM 12 HOLE LCP TITANIUM CLAVICLE BOTH IP/OP "$1,177.00" $871.00 $233.52 "$1,196.58" $529.46 $529.46 $529.46 $529.46 "$1,176.58" "$1,176.58" "$1,176.58" $245.23 "$1,176.58" "$1,176.58" "$1,176.58" "$1,176.58" "$1,176.58" $245.21 "$1,176.58" "$1,196.58" $695.95 "$1,176.58" "$1,196.58" "$1,176.58" "$1,176.58" $882.75 "$1,176.58" "$1,176.58" "$1,176.58" $588.29 $588.29 $931.85 "$1,176.58" $941.26 $529.46 $233.52 N/A $682.66 "$1,176.58" "$1,176.58" "$1,176.58" $245.20 "$1,176.58" N/A N/A 445.131 SUP HCPCS C1713 445.131 - PLATE BONE 182MM 13 HOLE RECONSTRUCTION LCP TITANIUM BOTH IP/OP "$1,274.00" $943.00 $252.77 "$1,295.20" $573.10 $573.10 $573.10 $573.10 "$1,273.55" "$1,273.55" "$1,273.55" $265.44 "$1,273.55" "$1,273.55" "$1,273.55" "$1,273.55" "$1,273.55" $265.42 "$1,273.55" "$1,295.20" $753.30 "$1,273.55" "$1,295.20" "$1,273.55" "$1,273.55" $955.50 "$1,273.55" "$1,273.55" "$1,273.55" $636.78 $636.78 "$1,008.65" "$1,273.55" "$1,018.84" $573.10 $252.77 N/A $738.92 "$1,273.55" "$1,273.55" "$1,273.55" $265.41 "$1,273.55" N/A N/A 445.141 SUP HCPCS C1713 445.141 - PLATE BONE 196MM 14 HOLE RECONSTRUCTION LCP TITANIUM BOTH IP/OP "$1,323.00" $979.00 $262.53 "$1,345.23" $595.24 $595.24 $595.24 $595.24 "$1,322.75" "$1,322.75" "$1,322.75" $275.69 "$1,322.75" "$1,322.75" "$1,322.75" "$1,322.75" "$1,322.75" $275.68 "$1,322.75" $538.09 $782.41 "$1,322.75" "$1,345.23" "$1,322.75" "$1,322.75" $992.25 "$1,322.75" "$1,322.75" "$1,322.75" $661.38 $661.38 "$1,047.62" "$1,322.75" "$1,058.20" $595.24 $262.53 N/A $767.34 "$1,322.75" "$1,322.75" "$1,322.75" $275.66 "$1,322.75" N/A N/A 445.15 SUP HCPCS C1713 445.15 - PLATE BONE 58MM 5 HOLE RECONSTRUCTION LC-DCP TITANIUM BOTH IP/OP $716.50 $530.00 $142.21 $716.50 $322.43 $322.43 $322.43 $322.43 $716.50 $716.50 $716.50 $149.34 $716.50 $716.50 $716.50 $716.50 $716.50 $149.33 $716.50 $286.60 $423.81 $716.50 $716.50 $716.50 $716.50 $537.38 $716.50 $716.50 $716.50 $358.25 $358.25 $567.47 $716.50 $573.20 $322.43 $142.21 N/A $415.57 $716.50 $716.50 $716.50 $149.32 $716.50 N/A N/A 445.16 SUP HCPCS C1713 445.16 - PLATE BONE 70MM 6 HOLE RECONSTRUCTION LC-DCP TITANIUM BOTH IP/OP $826.00 $611.00 $163.88 $825.68 $371.56 $371.56 $371.56 $371.56 $825.68 $825.68 $825.68 $172.09 $825.68 $825.68 $825.68 $825.68 $825.68 $172.08 $825.68 $825.68 $488.39 $825.68 $825.68 $825.68 $825.68 $619.50 $825.68 $825.68 $825.68 $412.84 $412.84 $653.94 $825.68 $660.54 $371.56 $163.88 N/A $479.08 $825.68 $825.68 $825.68 $172.07 $825.68 N/A N/A 445.161 SUP HCPCS C1713 445.161 - PLATE BONE 224MM 16 HOLE RECONSTRUCTION LCP TITANIUM BOTH IP/OP "$1,434.00" "$1,061.00" $284.57 "$1,458.18" $645.21 $645.21 $645.21 $645.21 "$1,433.80" "$1,433.80" "$1,433.80" $298.84 "$1,433.80" "$1,433.80" "$1,433.80" "$1,433.80" "$1,433.80" $298.82 "$1,433.80" "$1,458.18" $848.09 "$1,433.80" "$1,458.18" "$1,433.80" "$1,433.80" "$1,075.50" "$1,433.80" "$1,433.80" "$1,433.80" $716.90 $716.90 "$1,135.57" "$1,433.80" "$1,147.04" $645.21 $284.57 N/A $831.72 "$1,433.80" "$1,433.80" "$1,433.80" $298.80 "$1,433.80" N/A N/A 445.17 SUP HCPCS C1713 445.17 - PLATE BONE 82MM 7 HOLE RECONSTRUCTION LC-DCP TITANIUM BOTH IP/OP $849.00 $628.00 $168.48 $848.88 $382.00 $382.00 $382.00 $382.00 $848.88 $848.88 $848.88 $176.93 $848.88 $848.88 $848.88 $848.88 $848.88 $176.92 $848.88 $848.88 $502.11 $848.88 $848.88 $848.88 $848.88 $636.75 $848.88 $848.88 $848.88 $424.44 $424.44 $672.31 $848.88 $679.10 $382.00 $168.48 N/A $492.42 $848.88 $848.88 $848.88 $176.91 $848.88 N/A N/A 445.18 SUP HCPCS C1713 445.18 - PLATE BONE 94MM 8 HOLE RECONSTRUCTION LC-DCP TITANIUM BOTH IP/OP $899.50 $666.00 $178.50 $899.38 $404.72 $404.72 $404.72 $404.72 $899.38 $899.38 $899.38 $187.45 $899.38 $899.38 $899.38 $899.38 $899.38 $187.44 $899.38 $899.38 $531.98 $899.38 $899.38 $899.38 $899.38 $674.63 $899.38 $899.38 $899.38 $449.69 $449.69 $712.31 $899.38 $719.50 $404.72 $178.50 N/A $521.71 $899.38 $899.38 $899.38 $187.43 $899.38 N/A N/A 445.181 SUP HCPCS C1713 445.181 - PLATE BN 252X10.1X3.5MM NS LCP CMBN 18 HL RECON TI 3.5MM SCR BOTH IP/OP "$1,501.50" "$1,111.00" $297.97 "$1,526.80" $675.58 $675.58 $675.58 $675.58 "$1,501.28" "$1,501.28" "$1,501.28" $312.90 "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" $312.88 "$1,501.28" "$1,526.80" $888.01 "$1,501.28" "$1,526.80" "$1,501.28" "$1,501.28" "$1,126.13" "$1,501.28" "$1,501.28" "$1,501.28" $750.64 $750.64 "$1,189.01" "$1,501.28" "$1,201.02" $675.58 $297.97 N/A $870.87 "$1,501.28" "$1,501.28" "$1,501.28" $312.87 "$1,501.28" N/A N/A 445.19 SUP HCPCS C1713 445.19 - PLATE BONE 106MM 9 HOLE RECONSTRUCTION LC-DCP TITANIUM BOTH IP/OP $927.00 $686.00 $183.92 $926.68 $417.01 $417.01 $417.01 $417.01 $926.68 $926.68 $926.68 $193.14 $926.68 $926.68 $926.68 $926.68 $926.68 $193.13 $926.68 $926.68 $548.13 $926.68 $926.68 $926.68 $926.68 $695.25 $926.68 $926.68 $926.68 $463.34 $463.34 $733.93 $926.68 $741.34 $417.01 $183.92 N/A $537.66 $926.68 $926.68 $926.68 $193.12 $926.68 N/A N/A 445.201 SUP HCPCS C1713 445.201 - PLATE BN 280X10.1X3.5MM NS LCP CMBN 20 HL RECON TI 3.5MM SCR BOTH IP/OP "$1,823.50" "$1,349.00" $361.86 "$1,854.18" $820.43 $820.43 $820.43 $820.43 "$1,823.18" "$1,823.18" "$1,823.18" $380.00 "$1,823.18" "$1,823.18" "$1,823.18" "$1,823.18" "$1,823.18" $379.97 "$1,823.18" "$1,854.18" "$1,078.41" "$1,823.18" "$1,854.18" "$1,823.18" "$1,823.18" "$1,367.63" "$1,823.18" "$1,823.18" "$1,823.18" $911.59 $911.59 "$1,443.96" "$1,823.18" "$1,458.54" $820.43 $361.86 N/A "$1,057.63" "$1,823.18" "$1,823.18" "$1,823.18" $379.95 "$1,823.18" N/A N/A 445.221 SUP HCPCS C1713 445.221 - PLATE BONE 308MM 22 HOLE RECONSTRUCTION LCP TITANIUM NONSTRL BOTH IP/OP "$1,858.50" "$1,375.00" $368.83 "$1,889.93" $836.25 $836.25 $836.25 $836.25 "$1,858.33" "$1,858.33" "$1,858.33" $387.32 "$1,858.33" "$1,858.33" "$1,858.33" "$1,858.33" "$1,858.33" $387.30 "$1,858.33" "$1,889.93" "$1,099.20" "$1,858.33" "$1,889.93" "$1,858.33" "$1,858.33" "$1,393.88" "$1,858.33" "$1,858.33" "$1,858.33" $929.17 $929.17 "$1,471.80" "$1,858.33" "$1,486.66" $836.25 $368.83 N/A "$1,077.93" "$1,858.33" "$1,858.33" "$1,858.33" $387.28 "$1,858.33" N/A N/A 446.014 SUP HCPCS C1713 446.014 - PLATE BN RECT 45X38X.4MM NS CNTR MESH MLBL TI CRNFCL 1.5MM BOTH IP/OP "$3,413.50" "$2,526.00" $677.44 "$3,413.25" "$1,535.96" "$1,535.96" "$1,535.96" "$1,535.96" "$3,413.25" "$3,413.25" "$3,413.25" $711.41 "$3,413.25" "$3,413.25" "$3,413.25" "$3,413.25" "$3,413.25" $711.36 "$3,413.25" "$3,413.25" "$1,682.73" "$3,413.25" "$3,413.25" "$3,413.25" "$3,413.25" "$2,560.13" "$3,413.25" "$3,413.25" "$3,413.25" "$1,706.63" "$1,706.63" "$2,703.29" "$3,413.25" "$2,730.60" "$1,535.96" $677.44 N/A "$1,979.83" "$3,413.25" "$3,413.25" "$3,413.25" $711.32 "$3,413.25" N/A N/A 446.015 SUP HCPCS C1713 446.015 - PLATE BN RECT 45X38X.6MM NS CNTR MESH RGD TI CRNFCL 1.5MM BOTH IP/OP "$3,413.50" "$2,526.00" $677.44 "$3,413.25" "$1,535.96" "$1,535.96" "$1,535.96" "$1,535.96" "$3,413.25" "$3,413.25" "$3,413.25" $711.41 "$3,413.25" "$3,413.25" "$3,413.25" "$3,413.25" "$3,413.25" $711.36 "$3,413.25" "$3,413.25" "$1,682.73" "$3,413.25" "$3,413.25" "$3,413.25" "$3,413.25" "$2,560.13" "$3,413.25" "$3,413.25" "$3,413.25" "$1,706.63" "$1,706.63" "$2,703.29" "$3,413.25" "$2,730.60" "$1,535.96" $677.44 N/A "$1,979.83" "$3,413.25" "$2,047.95" "$3,413.25" $711.32 "$3,413.25" N/A N/A 446.017 SUP HCPCS C1713 446.017 - PLATE BN RECT 100X100X.3MM NS CNTR MESH MLBL TI CRNFCL 1.5MM BOTH IP/OP "$5,335.00" "$3,948.00" "$1,058.81" "$5,334.75" "$2,400.64" "$2,400.64" "$2,400.64" "$2,400.64" "$5,334.75" "$5,334.75" "$5,334.75" "$1,111.90" "$5,334.75" "$5,334.75" "$5,334.75" "$5,334.75" "$5,334.75" "$1,111.82" "$5,334.75" "$5,334.75" "$2,630.03" "$5,334.75" "$5,334.75" "$5,334.75" "$5,334.75" "$4,001.25" "$5,334.75" "$5,334.75" "$5,334.75" "$2,667.38" "$2,667.38" "$4,225.12" "$5,334.75" "$4,267.80" "$2,400.64" "$1,058.81" N/A "$3,094.30" "$5,334.75" "$3,200.85" "$5,334.75" "$1,111.76" "$5,334.75" N/A N/A 446.018 SUP HCPCS C1713 446.018 - PLATE BN RECT 100X100X.6MM NS CNTR MESH RGD TI CRNFCL 1.5MM BOTH IP/OP "$5,335.00" "$3,948.00" "$1,058.81" "$5,334.75" "$2,400.64" "$2,400.64" "$2,400.64" "$2,400.64" "$5,334.75" "$5,334.75" "$5,334.75" "$1,111.90" "$5,334.75" "$5,334.75" "$5,334.75" "$5,334.75" "$5,334.75" "$1,111.82" "$5,334.75" "$5,334.75" "$2,630.03" "$5,334.75" "$5,334.75" "$5,334.75" "$5,334.75" "$4,001.25" "$5,334.75" "$5,334.75" "$5,334.75" "$2,667.38" "$2,667.38" "$4,225.12" "$5,334.75" "$4,267.80" "$2,400.64" "$1,058.81" N/A "$3,094.30" "$5,334.75" "$3,200.85" "$5,334.75" "$1,111.76" "$5,334.75" N/A N/A 446.019 SUP HCPCS C1713 446.019 - PLATE BONE RECTANGLE 200X200X.6MM CONTUR MESH RIGID GOLD BOTH IP/OP "$19,163.50" "$14,181.00" "$3,803.43" "$19,163.25" "$8,623.46" "$8,623.46" "$8,623.46" "$8,623.46" "$19,163.25" "$19,163.25" "$19,163.25" "$3,994.10" "$19,163.25" "$19,163.25" "$19,163.25" "$19,163.25" "$19,163.25" "$3,993.83" "$19,163.25" "$19,163.25" "$9,447.48" "$19,163.25" "$19,163.25" "$19,163.25" "$19,163.25" "$14,372.63" "$19,163.25" "$19,163.25" "$19,163.25" "$9,581.63" "$9,581.63" "$15,177.29" "$19,163.25" "$15,330.60" "$8,623.46" "$3,803.43" N/A "$11,114.83" "$19,163.25" "$11,497.95" "$19,163.25" "$3,993.62" "$19,163.25" N/A N/A 446.02 SUP HCPCS C1713 446.020 - PLATE BONE STR 2 HOLE TITANIUM CRANFCL NONSTRL 1.5MM SCREW BOTH IP/OP $106.00 $78.00 $20.99 $105.75 $47.59 $47.59 $47.59 $47.59 $105.75 $105.75 $105.75 $22.04 $105.75 $105.75 $105.75 $105.75 $105.75 $22.04 $105.75 $105.75 $62.55 $105.75 $105.75 $105.75 $105.75 $79.50 $105.75 $105.75 $105.75 $52.88 $52.88 $83.75 $105.75 $84.60 $47.59 $20.99 N/A $61.48 $105.75 $63.45 $105.75 $22.04 $105.75 N/A N/A 446.024 SUP HCPCS C1713 446.024 - PLATE BONE STR 25MM 4 HOLE LP TITANIUM CRANFCL NONSTRL 1.5MM BOTH IP/OP $144.00 $107.00 $28.58 $144.00 $64.80 $64.80 $64.80 $64.80 $144.00 $144.00 $144.00 $30.01 $144.00 $144.00 $144.00 $144.00 $144.00 $30.01 $144.00 $144.00 $85.18 $144.00 $144.00 $144.00 $144.00 $108.00 $144.00 $144.00 $144.00 $72.00 $72.00 $114.05 $144.00 $115.20 $64.80 $28.58 N/A $83.52 $144.00 $144.00 $144.00 $30.01 $144.00 N/A N/A 446.031 SUP HCPCS C1713 446.031 - PLATE BN STRG 29X3.8X.8MM NS PRO-PK 6 HL LOPRFL PRECONTOUR BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 446.032 SUP HCPCS C1713 446.032 - PLATE BN STRG 59X3.8X.8MM NS PRO-PK 12 HL LOPRFL PRECONTOUR BOTH IP/OP $465.50 $344.00 $92.35 $473.18 $209.38 $209.38 $209.38 $209.38 $465.28 $465.28 $465.28 $96.98 $465.28 $465.28 $465.28 $465.28 $465.28 $96.97 $465.28 $473.18 $275.21 $465.28 $473.18 $465.28 $465.28 $349.13 $465.28 $465.28 $465.28 $232.64 $232.64 $368.50 $465.28 $372.22 $209.38 $92.35 N/A $269.99 $465.28 $279.17 $465.28 $96.96 $465.28 N/A N/A 446.033 SUP HCPCS C1713 446.033 - PLATE BONE SMALL ARC .4MM CONTUR MESH MALBLE TEAL TITANIUM BOTH IP/OP "$1,768.50" "$1,309.00" $351.00 "$1,768.50" $795.83 $795.83 $795.83 $795.83 "$1,768.50" "$1,768.50" "$1,768.50" $368.60 "$1,768.50" "$1,768.50" "$1,768.50" "$1,768.50" "$1,768.50" $368.57 "$1,768.50" "$1,768.50" "$1,046.07" "$1,768.50" "$1,768.50" "$1,768.50" "$1,768.50" "$1,326.38" "$1,768.50" "$1,768.50" "$1,768.50" $884.25 $884.25 "$1,400.65" "$1,768.50" "$1,414.80" $795.83 $351.00 N/A "$1,025.73" "$1,768.50" "$1,768.50" "$1,768.50" "$1,768.50" "$1,768.50" N/A N/A 446.034 SUP HCPCS C1713 446.034 - PLATE BONE LARGE ARC .4MM CONTUR MESH MALBLE TEAL TITANIUM BOTH IP/OP "$2,754.00" "$2,038.00" $546.60 "$2,754.00" "$1,239.30" "$1,239.30" "$1,239.30" "$1,239.30" "$2,754.00" "$2,754.00" "$2,754.00" $574.00 "$2,754.00" "$2,754.00" "$2,754.00" "$2,754.00" "$2,754.00" $573.96 "$2,754.00" "$2,754.00" "$1,357.72" "$2,754.00" "$2,754.00" "$2,754.00" "$2,754.00" "$2,065.50" "$2,754.00" "$2,754.00" "$2,754.00" "$1,377.00" "$1,377.00" "$2,181.17" "$2,754.00" "$2,203.20" "$1,239.30" $546.60 N/A "$1,597.32" "$2,754.00" "$2,754.00" "$2,754.00" "$2,754.00" "$2,754.00" N/A N/A 446.035 SUP HCPCS C1713 446.035 - PLATE BONE SMALL ARC .6MM CONTUR MESH RIGID GOLD TITANIUM BOTH IP/OP "$1,768.50" "$1,309.00" $351.00 "$1,768.50" $795.83 $795.83 $795.83 $795.83 "$1,768.50" "$1,768.50" "$1,768.50" $368.60 "$1,768.50" "$1,768.50" "$1,768.50" "$1,768.50" "$1,768.50" $368.57 "$1,768.50" "$1,768.50" "$1,046.07" "$1,768.50" "$1,768.50" "$1,768.50" "$1,768.50" "$1,326.38" "$1,768.50" "$1,768.50" "$1,768.50" $884.25 $884.25 "$1,400.65" "$1,768.50" "$1,414.80" $795.83 $351.00 N/A "$1,025.73" "$1,768.50" "$1,768.50" "$1,768.50" $368.56 "$1,768.50" N/A N/A 446.036 SUP HCPCS C1713 446.036 - PLATE BONE LARGE ARC .6MM CONTUR MESH RIGID GOLD TITANIUM BOTH IP/OP "$2,754.00" "$2,038.00" $546.60 "$2,754.00" "$1,239.30" "$1,239.30" "$1,239.30" "$1,239.30" "$2,754.00" "$2,754.00" "$2,754.00" $574.00 "$2,754.00" "$2,754.00" "$2,754.00" "$2,754.00" "$2,754.00" $573.96 "$2,754.00" "$2,754.00" "$1,357.72" "$2,754.00" "$2,754.00" "$2,754.00" "$2,754.00" "$2,065.50" "$2,754.00" "$2,754.00" "$2,754.00" "$1,377.00" "$1,377.00" "$2,181.17" "$2,754.00" "$2,203.20" "$1,239.30" $546.60 N/A "$1,597.32" "$2,754.00" "$1,652.40" "$2,754.00" $573.93 "$2,754.00" N/A N/A 446.04 SUP HCPCS C1713 446.040 - PLATE BONE 0MM OFFST PREBENT 27.1X.9MM PREBENT OFFST BOTH IP/OP $967.50 $716.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $967.50 $572.28 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $561.15 $967.50 $580.50 $967.50 $201.63 $967.50 N/A N/A 446.041 SUP HCPCS C1713 446.041 - PLATE BONE 0MM OFFST PREBENT 27.1X.9MM 0MM PREBENT TITANIUM BOTH IP/OP $967.50 $716.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $967.50 $572.28 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $561.15 $967.50 $580.50 $967.50 $201.63 $967.50 N/A N/A 446.042 SUP HCPCS C1713 446.042 - PLATE BN 3MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR BOTH IP/OP $967.50 $716.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $967.50 $572.28 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $561.15 $967.50 $580.50 $967.50 $201.63 $967.50 N/A N/A 446.043 SUP HCPCS C1713 446.043 - PLATE BN 3MM PREBNT 27.1X.9MM NS TI MXL LT 1.5MM CORT SCR BOTH IP/OP $967.50 $716.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $967.50 $572.28 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $561.15 $967.50 $580.50 $967.50 $201.63 $967.50 N/A N/A 446.044 SUP HCPCS C1713 446.044 - PLATE BN 5MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR BOTH IP/OP $967.50 $716.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $967.50 $572.28 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $561.15 $967.50 $580.50 $967.50 $967.50 $967.50 N/A N/A 446.045 SUP HCPCS C1713 446.045 - PLATE BN 5MM PREBNT 27.1X.9MM NS TI MXL LT 1.5MM CORT SCR BOTH IP/OP $967.50 $716.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $967.50 $572.28 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $561.15 $967.50 $580.50 $967.50 $201.63 $967.50 N/A N/A 446.046 SUP HCPCS C1713 446.046 - PLATE BN 7MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR BOTH IP/OP $967.50 $716.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $387.00 $572.28 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $561.15 $967.50 $967.50 $967.50 $201.63 $967.50 N/A N/A 446.047 SUP HCPCS C1713 446.047 - PLATE BONE 7MM PREBENT TITANIUM LEFT MAXL NONSTRL 1.5MM BOTH IP/OP $967.50 $716.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $967.50 $572.28 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $561.15 $967.50 $967.50 $967.50 $201.63 $967.50 N/A N/A 446.048 SUP HCPCS C1713 446.048 - PLATE BN 9MM PREBNT 27.1X.9MM NS TI MXL RT 1.5MM CORT SCR BOTH IP/OP $967.50 $716.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $387.00 $572.28 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $561.15 $967.50 $967.50 $967.50 $201.63 $967.50 N/A N/A 446.049 SUP HCPCS C1713 446.049 - PLATE BN 9MM PREBNT 27.1X.9MM NS TI MXL LT 1.5MM CORT SCR BOTH IP/OP $967.50 $716.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $967.50 $572.28 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $561.15 $967.50 $967.50 $967.50 $201.63 $967.50 N/A N/A 446.05 SUP HCPCS C1713 446.050 - PLATE BONE ROUND 30MM .4MM CONTUR MESH MALBLE TEAL TITANIUM BOTH IP/OP "$1,768.50" "$1,309.00" $351.00 "$1,768.50" $795.83 $795.83 $795.83 $795.83 "$1,768.50" "$1,768.50" "$1,768.50" $368.60 "$1,768.50" "$1,768.50" "$1,768.50" "$1,768.50" "$1,768.50" $368.57 "$1,768.50" $707.40 "$1,046.07" "$1,768.50" "$1,768.50" "$1,768.50" "$1,768.50" "$1,326.38" "$1,768.50" "$1,768.50" "$1,768.50" $884.25 $884.25 "$1,400.65" "$1,768.50" "$1,414.80" $795.83 $351.00 N/A "$1,025.73" "$1,768.50" "$1,768.50" "$1,768.50" $368.56 "$1,768.50" N/A N/A 446.051 SUP HCPCS C1713 446.051 - PLATE BONE ROUND 70MM .4MM CONTUR MESH MALBLE TEAL TITANIUM BOTH IP/OP "$3,665.50" "$2,712.00" $727.46 "$3,665.25" "$1,649.36" "$1,649.36" "$1,649.36" "$1,649.36" "$3,665.25" "$3,665.25" "$3,665.25" $763.93 "$3,665.25" "$3,665.25" "$3,665.25" "$3,665.25" "$3,665.25" $763.88 "$3,665.25" "$3,665.25" "$1,806.97" "$3,665.25" "$3,665.25" "$3,665.25" "$3,665.25" "$2,749.13" "$3,665.25" "$3,665.25" "$3,665.25" "$1,832.63" "$1,832.63" "$2,902.88" "$3,665.25" "$2,932.20" "$1,649.36" $727.46 N/A "$2,125.99" "$3,665.25" "$3,665.25" "$3,665.25" $763.84 "$3,665.25" N/A N/A 446.052 SUP HCPCS C1713 446.052 - PLATE BONE ROUND 100MM .4MM CONTUR MESH MALBLE TEAL TITANIUM BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$3,051.00" "$5,085.00" "$5,085.00" "$5,085.00" N/A N/A 446.053 SUP HCPCS C1713 446.053 - PLATE BONE ROUND 30MM .6MM CONTUR MESH RIGID GOLD TITANIUM BOTH IP/OP "$1,966.50" "$1,455.00" $390.30 "$1,966.50" $884.93 $884.93 $884.93 $884.93 "$1,966.50" "$1,966.50" "$1,966.50" $409.87 "$1,966.50" "$1,966.50" "$1,966.50" "$1,966.50" "$1,966.50" $409.84 "$1,966.50" "$1,966.50" "$1,163.18" "$1,966.50" "$1,966.50" "$1,966.50" "$1,966.50" "$1,474.88" "$1,966.50" "$1,966.50" "$1,966.50" $983.25 $983.25 "$1,557.47" "$1,966.50" "$1,573.20" $884.93 $390.30 N/A "$1,140.57" "$1,966.50" "$1,179.90" "$1,966.50" $409.82 "$1,966.50" N/A N/A 446.054 SUP HCPCS C1713 446.054 - PLATE BONE ROUND 70MM .6MM CONTUR MESH RIGID GOLD TITANIUM BOTH IP/OP "$4,070.50" "$3,012.00" $807.84 "$4,070.25" "$1,831.61" "$1,831.61" "$1,831.61" "$1,831.61" "$4,070.25" "$4,070.25" "$4,070.25" $848.34 "$4,070.25" "$4,070.25" "$4,070.25" "$4,070.25" "$4,070.25" $848.28 "$4,070.25" "$4,070.25" "$2,006.63" "$4,070.25" "$4,070.25" "$4,070.25" "$4,070.25" "$3,052.88" "$4,070.25" "$4,070.25" "$4,070.25" "$2,035.13" "$2,035.13" "$3,223.64" "$4,070.25" "$3,256.20" "$1,831.61" $807.84 N/A "$2,360.89" "$4,070.25" "$2,442.15" "$4,070.25" $848.24 "$4,070.25" N/A N/A 446.055 SUP HCPCS C1713 446.055 - PLATE BONE ROUND 100MM .6MM CONTUR MESH RIGID GOLD TITANIUM BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" N/A N/A 446.06 SUP HCPCS C1713 446.060 - PLATE BONE 11MM OFFST PREBENT 27.1X.9MM PREBENT TITANIUM BOTH IP/OP $967.50 $716.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $967.50 $572.28 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $561.15 $967.50 $967.50 $967.50 $967.50 $967.50 N/A N/A 446.061 SUP HCPCS C1713 446.061 - PLATE BONE 11MM OFFST PREBENT 27.1X.9MM 11MM PREBENT BOTH IP/OP $967.50 $716.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $387.00 $572.28 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $561.15 $967.50 $967.50 $967.50 $201.63 $967.50 N/A N/A 446.09 SUP HCPCS C1713 446.090 - PLATE BONE T 31X.9MM 4X7 HOLE GOLD TITANIUM ORTHGNAT NONSTRL BOTH IP/OP $625.50 $463.00 $124.15 $625.50 $281.48 $281.48 $281.48 $281.48 $625.50 $625.50 $625.50 $130.37 $625.50 $625.50 $625.50 $625.50 $625.50 $130.36 $625.50 $250.20 $369.98 $625.50 $625.50 $625.50 $625.50 $469.13 $625.50 $625.50 $625.50 $312.75 $312.75 $495.40 $625.50 $500.40 $281.48 $124.15 N/A $362.79 $625.50 $625.50 $625.50 $625.50 $625.50 N/A N/A 446.091 SUP HCPCS C1713 446.091 - PLATE BONE T 31X.9MM 4X7 HOLE MALBLE TITANIUM ORTHGNAT BOTH IP/OP $553.50 $410.00 $109.86 $553.50 $249.08 $249.08 $249.08 $249.08 $553.50 $553.50 $553.50 $115.36 $553.50 $553.50 $553.50 $553.50 $553.50 $115.36 $553.50 $221.40 $327.40 $553.50 $553.50 $553.50 $553.50 $415.13 $553.50 $553.50 $553.50 $276.75 $276.75 $438.37 $553.50 $442.80 $249.08 $109.86 N/A $321.03 $553.50 $332.10 $553.50 $115.35 $553.50 N/A N/A 446.096 SUP HCPCS C1713 446.096 - PLATE BONE BOX 14X14MM 4 HOLE CNTOUR ANATOMIC REDX TITANIUM BOTH IP/OP $553.50 $410.00 $109.86 $553.50 $249.08 $249.08 $249.08 $249.08 $553.50 $553.50 $553.50 $115.36 $553.50 $553.50 $553.50 $553.50 $553.50 $115.36 $553.50 $553.50 $327.40 $553.50 $553.50 $553.50 $553.50 $415.13 $553.50 $553.50 $553.50 $276.75 $276.75 $438.37 $553.50 $442.80 $249.08 $109.86 N/A $321.03 $553.50 $332.10 $553.50 $115.35 $553.50 N/A N/A 446.097 SUP HCPCS C1713 446.097 - PLATE BONE BOX 16X16MM 4 HOLE TITANIUM CRANFCL NONSTRL 1.5MM BOTH IP/OP $553.50 $410.00 $109.86 $553.50 $249.08 $249.08 $249.08 $249.08 $553.50 $553.50 $553.50 $115.36 $553.50 $553.50 $553.50 $553.50 $553.50 $115.36 $553.50 $221.40 $327.40 $553.50 $553.50 $553.50 $553.50 $415.13 $553.50 $553.50 $553.50 $276.75 $276.75 $438.37 $553.50 $442.80 $249.08 $109.86 N/A $321.03 $553.50 $332.10 $553.50 $115.35 $553.50 N/A N/A 446.1 SUP HCPCS C1713 446.10 - PLATE BONE 90MM 20 HOLE ADAPTION TITANIUM BOTH IP/OP $859.50 $636.00 $170.59 $859.50 $386.78 $386.78 $386.78 $386.78 $859.50 $859.50 $859.50 $179.14 $859.50 $859.50 $859.50 $859.50 $859.50 $179.13 $859.50 $343.80 $508.39 $859.50 $859.50 $859.50 $859.50 $644.63 $859.50 $859.50 $859.50 $429.75 $429.75 $680.72 $859.50 $687.60 $386.78 $170.59 N/A $498.51 $859.50 $515.70 $859.50 $179.12 $859.50 N/A N/A 446.101 SUP HCPCS C1713 446.101 - PLATE BONE LP 90X4X.6MM 20 HOLE ADAPTION TITANIUM CRANFCL BOTH IP/OP $819.00 $606.00 $162.55 $819.00 $368.55 $368.55 $368.55 $368.55 $819.00 $819.00 $819.00 $170.70 $819.00 $819.00 $819.00 $819.00 $819.00 $170.69 $819.00 $327.60 $484.44 $819.00 $819.00 $819.00 $819.00 $614.25 $819.00 $819.00 $819.00 $409.50 $409.50 $648.65 $819.00 $655.20 $368.55 $162.55 N/A $475.02 $819.00 $819.00 $819.00 $170.68 $819.00 N/A N/A 446.154 SUP HCPCS C1713 446.154 - PLATE BONE 90D L 17MM 2X2 HOLE LP TITANIUM LEFT BOTH IP/OP $459.00 $340.00 $91.10 $459.00 $206.55 $206.55 $206.55 $206.55 $459.00 $459.00 $459.00 $95.67 $459.00 $459.00 $459.00 $459.00 $459.00 $95.66 $459.00 $459.00 $271.50 $459.00 $459.00 $459.00 $459.00 $344.25 $459.00 $459.00 $459.00 $229.50 $229.50 $363.53 $459.00 $367.20 $206.55 $91.10 N/A $266.22 $459.00 $459.00 $459.00 $95.66 $459.00 N/A N/A 446.155 SUP HCPCS C1713 446.155 - PLATE BONE 90D L 17MM 2X2 HOLE LP TITANIUM RIGHT BOTH IP/OP $459.00 $340.00 $91.10 $459.00 $206.55 $206.55 $206.55 $206.55 $459.00 $459.00 $459.00 $95.67 $459.00 $459.00 $459.00 $459.00 $459.00 $95.66 $459.00 $183.60 $271.50 $459.00 $459.00 $459.00 $459.00 $344.25 $459.00 $459.00 $459.00 $229.50 $229.50 $363.53 $459.00 $367.20 $206.55 $91.10 N/A $266.22 $459.00 $275.40 $459.00 $95.66 $459.00 N/A N/A 446.156 SUP HCPCS C1713 446.156 - PLATE BONE 90D L 19MM 2X2 HOLE LP TITANIUM LEFT BOTH IP/OP $459.00 $340.00 $91.10 $459.00 $206.55 $206.55 $206.55 $206.55 $459.00 $459.00 $459.00 $95.67 $459.00 $459.00 $459.00 $459.00 $459.00 $95.66 $459.00 $183.60 $271.50 $459.00 $459.00 $459.00 $459.00 $344.25 $459.00 $459.00 $459.00 $229.50 $229.50 $363.53 $459.00 $367.20 $206.55 $91.10 N/A $266.22 $459.00 $275.40 $459.00 $95.66 $459.00 N/A N/A 446.157 SUP HCPCS C1713 446.157 - PLATE BONE 90D L 19MM 2X2 HOLE LP TITANIUM RIGHT BOTH IP/OP $459.00 $340.00 $91.10 $459.00 $206.55 $206.55 $206.55 $206.55 $459.00 $459.00 $459.00 $95.67 $459.00 $459.00 $459.00 $459.00 $459.00 $95.66 $459.00 $459.00 $271.50 $459.00 $459.00 $459.00 $459.00 $344.25 $459.00 $459.00 $459.00 $229.50 $229.50 $363.53 $459.00 $367.20 $206.55 $91.10 N/A $266.22 $459.00 $275.40 $459.00 $459.00 $459.00 N/A N/A 446.158 SUP HCPCS C1713 446.158 - PLATE BONE 90D L 23MM 2X2 HOLE LP TITANIUM LEFT BOTH IP/OP $459.00 $340.00 $91.10 $459.00 $206.55 $206.55 $206.55 $206.55 $459.00 $459.00 $459.00 $95.67 $459.00 $459.00 $459.00 $459.00 $459.00 $95.66 $459.00 $183.60 $271.50 $459.00 $459.00 $459.00 $459.00 $344.25 $459.00 $459.00 $459.00 $229.50 $229.50 $363.53 $459.00 $367.20 $206.55 $91.10 N/A $266.22 $459.00 $275.40 $459.00 $95.66 $459.00 N/A N/A 446.159 SUP HCPCS C1713 446.159 - PLATE BONE 90D L 23MM 2X2 HOLE LP TITANIUM RIGHT BOTH IP/OP $459.00 $340.00 $91.10 $459.00 $206.55 $206.55 $206.55 $206.55 $459.00 $459.00 $459.00 $95.67 $459.00 $459.00 $459.00 $459.00 $459.00 $95.66 $459.00 $183.60 $271.50 $459.00 $459.00 $459.00 $459.00 $344.25 $459.00 $459.00 $459.00 $229.50 $229.50 $363.53 $459.00 $367.20 $206.55 $91.10 N/A $266.22 $459.00 $275.40 $459.00 $95.66 $459.00 N/A N/A 446.18 SUP HCPCS C1713 446.18 - PLATE BONE 34MM 8 HOLE RIGID GOLD TITANIUM ORBTL RIM NONSTRL BOTH IP/OP $684.00 $506.00 $135.76 $684.00 $307.80 $307.80 $307.80 $307.80 $684.00 $684.00 $684.00 $142.56 $684.00 $684.00 $684.00 $684.00 $684.00 $142.55 $684.00 $273.60 $404.59 $684.00 $684.00 $684.00 $684.00 $513.00 $684.00 $684.00 $684.00 $342.00 $342.00 $541.73 $684.00 $547.20 $307.80 $135.76 N/A $396.72 $684.00 $684.00 $684.00 $142.55 $684.00 N/A N/A 446.19 SUP HCPCS C1713 446.19 - PLATE BN STRG 100X3.8X.8MM NS 20 HL TI 1.5MM SCR BOTH IP/OP $451.50 $334.00 $89.56 $458.90 $203.05 $203.05 $203.05 $203.05 $451.23 $451.23 $451.23 $94.05 $451.23 $451.23 $451.23 $451.23 $451.23 $94.04 $451.23 $458.90 $266.90 $451.23 $458.90 $451.23 $451.23 $338.63 $451.23 $451.23 $451.23 $225.62 $225.62 $357.37 $451.23 $360.98 $203.05 $89.56 N/A $261.87 $451.23 $451.23 $451.23 $94.04 $451.23 N/A N/A 446.2 SUP HCPCS C1713 446.20 - PLATE BN 41MM NS 10 HL TI ORBT RIM 1.5MM SCR BOTH IP/OP $722.50 $535.00 $143.35 $722.25 $325.01 $325.01 $325.01 $325.01 $722.25 $722.25 $722.25 $150.53 $722.25 $722.25 $722.25 $722.25 $722.25 $150.52 $722.25 $288.90 $427.21 $722.25 $722.25 $722.25 $722.25 $541.88 $722.25 $722.25 $722.25 $361.13 $361.13 $572.02 $722.25 $577.80 $325.01 $143.35 N/A $419.05 $722.25 $722.25 $722.25 $150.52 $722.25 N/A N/A 446.22 SUP HCPCS C1713 446.22 - PLATE BN 49MM NS 12 HL TI ORBT RIM 1.5MM SCR BOTH IP/OP $776.50 $575.00 $154.07 $776.25 $349.31 $349.31 $349.31 $349.31 $776.25 $776.25 $776.25 $161.79 $776.25 $776.25 $776.25 $776.25 $776.25 $161.78 $776.25 $310.50 $459.15 $776.25 $776.25 $776.25 $776.25 $582.38 $776.25 $776.25 $776.25 $388.13 $388.13 $614.79 $776.25 $621.00 $349.31 $154.07 N/A $450.37 $776.25 $776.25 $776.25 $161.77 $776.25 N/A N/A 446.23 SUP HCPCS C1713 446.23 - PLATE BONE T 1.5MM 50MM 3X9 HOLE LCP TITANIUM CONDYLE BOTH IP/OP $391.00 $289.00 $77.56 $397.43 $175.85 $175.85 $175.85 $175.85 $390.78 $390.78 $390.78 $81.45 $390.78 $390.78 $390.78 $390.78 $390.78 $81.44 $390.78 $397.43 $231.15 $390.78 $397.43 $390.78 $390.78 $293.25 $390.78 $390.78 $390.78 $195.39 $195.39 $309.50 $390.78 $312.62 $175.85 $77.56 N/A $226.78 $390.78 $390.78 $390.78 $81.44 $390.78 N/A N/A 446.233 SUP HCPCS C1713 446.233 - PLATE BN T 44X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $426.00 $315.00 $84.54 $433.18 $191.67 $191.67 $191.67 $191.67 $425.93 $425.93 $425.93 $88.77 $425.93 $425.93 $425.93 $425.93 $425.93 $88.77 $425.93 $433.18 $251.94 $425.93 $433.18 $425.93 $425.93 $319.50 $425.93 $425.93 $425.93 $212.97 $212.97 $337.34 $425.93 $340.74 $191.67 $84.54 N/A $247.08 $425.93 $255.56 $425.93 $88.76 $425.93 N/A N/A 446.234 SUP HCPCS C1713 446.234 - PLATE BN T 44X4X1MM NS PRO-PK 4 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $180.70 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $444.20 $444.20 $92.57 $444.20 N/A N/A 446.24 SUP HCPCS C1713 446.24 - PLATE BN T 50X4X1MM NS 4 HLE/HD 9 HL SHFT TI 1.5MM SCR BOTH IP/OP $426.00 $315.00 $84.54 $433.18 $191.67 $191.67 $191.67 $191.67 $425.93 $425.93 $425.93 $88.77 $425.93 $425.93 $425.93 $425.93 $425.93 $88.77 $425.93 $433.18 $251.94 $425.93 $433.18 $425.93 $425.93 $319.50 $425.93 $425.93 $425.93 $212.97 $212.97 $337.34 $425.93 $340.74 $191.67 $84.54 N/A $247.08 $425.93 $425.93 $425.93 $88.76 $425.93 N/A N/A 446.4 SUP HCPCS C1713 446.40 - PLATE BONE UNIVERSAL .6MM GOLD TITANIUM ORBTL FLOOR CRANFCL BOTH IP/OP "$2,772.00" "$2,051.00" $550.17 "$2,772.00" "$1,247.40" "$1,247.40" "$1,247.40" "$1,247.40" "$2,772.00" "$2,772.00" "$2,772.00" $577.75 "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" $577.72 "$2,772.00" "$1,108.80" "$1,366.60" "$2,772.00" "$2,772.00" "$2,772.00" "$2,772.00" "$2,079.00" "$2,772.00" "$2,772.00" "$2,772.00" "$1,386.00" "$1,386.00" "$2,195.42" "$2,772.00" "$2,217.60" "$1,247.40" $550.17 N/A "$1,607.76" "$2,772.00" "$1,663.20" "$2,772.00" $577.68 "$2,772.00" N/A N/A 446.44 SUP HCPCS C1713 446.44 - PLATE BONE 36X32X.6MM 6 HOLE GOLD TITANIUM MEDIAL WALL BOTH IP/OP "$2,457.00" "$1,818.00" $487.65 "$2,457.00" "$1,105.65" "$1,105.65" "$1,105.65" "$1,105.65" "$2,457.00" "$2,457.00" "$2,457.00" $512.10 "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" $512.07 "$2,457.00" $982.80 "$1,453.32" "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" "$1,842.75" "$2,457.00" "$2,457.00" "$2,457.00" "$1,228.50" "$1,228.50" "$1,945.94" "$2,457.00" "$1,965.60" "$1,105.65" $487.65 N/A "$1,425.06" "$2,457.00" "$2,457.00" "$2,457.00" $512.04 "$2,457.00" N/A N/A 446.45 SUP HCPCS C1713 446.45 - PLATE BONE 36X32X.6MM 6 HOLE GOLD TITANIUM MEDIAL WALL BOTH IP/OP "$2,457.00" "$1,818.00" $487.65 "$2,457.00" "$1,105.65" "$1,105.65" "$1,105.65" "$1,105.65" "$2,457.00" "$2,457.00" "$2,457.00" $512.10 "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" $512.07 "$2,457.00" "$2,457.00" "$1,453.32" "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" "$1,842.75" "$2,457.00" "$2,457.00" "$2,457.00" "$1,228.50" "$1,228.50" "$1,945.94" "$2,457.00" "$1,965.60" "$1,105.65" $487.65 N/A "$1,425.06" "$2,457.00" "$2,457.00" "$2,457.00" $512.04 "$2,457.00" N/A N/A 446.48 SUP HCPCS C1713 446.48 - PLATE BONE H 1.5MM 6MM 4 HOLE TITANIUM HAND NONSTRL 1.5MM BOTH IP/OP $399.50 $296.00 $79.24 $406.00 $179.65 $179.65 $179.65 $179.65 $399.23 $399.23 $399.23 $83.21 $399.23 $399.23 $399.23 $399.23 $399.23 $83.20 $399.23 $406.00 $236.14 $399.23 $406.00 $399.23 $399.23 $299.63 $399.23 $399.23 $399.23 $199.62 $199.62 $316.19 $399.23 $319.38 $179.65 $79.24 N/A $231.71 $399.23 $399.23 $399.23 $83.20 $399.23 N/A N/A 446.482 SUP HCPCS C1713 446.482 - PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR TI RT BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $180.70 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $444.20 $444.20 $444.20 $444.20 N/A N/A 446.483 SUP HCPCS C1713 446.483 - PLATE BN H 22MM NS PRO-PK 8 HL XTD LOPRFL PRECONTOUR TI LT BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $180.70 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $444.20 $444.20 $92.57 $444.20 N/A N/A 446.5 SUP HCPCS C1713 446.50 - PLATE BN OB L L NS 2X3 HL RGD TI CRNFCL 1.5MM SCR BOTH IP/OP $616.50 $456.00 $122.36 $616.50 $277.43 $277.43 $277.43 $277.43 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $616.50 $616.50 $616.50 $128.49 $616.50 $246.60 $364.66 $616.50 $616.50 $616.50 $616.50 $462.38 $616.50 $616.50 $616.50 $308.25 $308.25 $488.27 $616.50 $493.20 $277.43 $122.36 N/A $357.57 $616.50 $616.50 $616.50 $128.48 $616.50 N/A N/A 446.504 SUP HCPCS C1713 446.504 - PLATE BONE 22MM 3X3 HOLE L TITANIUM RIGHT MAXL NONSTRL 1.5MM BOTH IP/OP $596.50 $441.00 $118.34 $596.25 $268.31 $268.31 $268.31 $268.31 $596.25 $596.25 $596.25 $124.27 $596.25 $596.25 $596.25 $596.25 $596.25 $124.27 $596.25 $238.50 $352.68 $596.25 $596.25 $596.25 $596.25 $447.38 $596.25 $596.25 $596.25 $298.13 $298.13 $472.23 $596.25 $477.00 $268.31 $118.34 N/A $345.97 $596.25 $596.25 $596.25 $124.26 $596.25 N/A N/A 446.505 SUP HCPCS C1713 446.505 - PLATE BONE 22MM 3X3 HOLE L TITANIUM LEFT MAXL NONSTRL 1.5MM BOTH IP/OP $596.50 $441.00 $118.34 $596.25 $268.31 $268.31 $268.31 $268.31 $596.25 $596.25 $596.25 $124.27 $596.25 $596.25 $596.25 $596.25 $596.25 $124.27 $596.25 $238.50 $352.68 $596.25 $596.25 $596.25 $596.25 $447.38 $596.25 $596.25 $596.25 $298.13 $298.13 $472.23 $596.25 $477.00 $268.31 $118.34 N/A $345.97 $596.25 $596.25 $596.25 $124.26 $596.25 N/A N/A 446.506 SUP HCPCS C1713 446.506 - PLATE BONE 24MM 3X3 HOLE L TITANIUM RIGHT MAXL NONSTRL 1.5MM BOTH IP/OP $596.50 $441.00 $118.34 $596.25 $268.31 $268.31 $268.31 $268.31 $596.25 $596.25 $596.25 $124.27 $596.25 $596.25 $596.25 $596.25 $596.25 $124.27 $596.25 $238.50 $352.68 $596.25 $596.25 $596.25 $596.25 $447.38 $596.25 $596.25 $596.25 $298.13 $298.13 $472.23 $596.25 $477.00 $268.31 $118.34 N/A $345.97 $596.25 $596.25 $596.25 $124.26 $596.25 N/A N/A 446.507 SUP HCPCS C1713 446.507 - PLATE BONE L 24X4X.9MM 13MM 3X3 HOLE TITANIUM LEFT MAXILLA BOTH IP/OP $596.50 $441.00 $118.34 $596.25 $268.31 $268.31 $268.31 $268.31 $596.25 $596.25 $596.25 $124.27 $596.25 $596.25 $596.25 $596.25 $596.25 $124.27 $596.25 $238.50 $352.68 $596.25 $596.25 $596.25 $596.25 $447.38 $596.25 $596.25 $596.25 $298.13 $298.13 $472.23 $596.25 $477.00 $268.31 $118.34 N/A $345.97 $596.25 $596.25 $596.25 $124.26 $596.25 N/A N/A 446.508 SUP HCPCS C1713 446.508 - PLATE BONE L 26X4X.9MM 13MM 3X3 HOLE TITANIUM RIGHT MAXILLA BOTH IP/OP $596.50 $441.00 $118.34 $596.25 $268.31 $268.31 $268.31 $268.31 $596.25 $596.25 $596.25 $124.27 $596.25 $596.25 $596.25 $596.25 $596.25 $124.27 $596.25 $238.50 $352.68 $596.25 $596.25 $596.25 $596.25 $447.38 $596.25 $596.25 $596.25 $298.13 $298.13 $472.23 $596.25 $477.00 $268.31 $118.34 N/A $345.97 $596.25 $357.75 $596.25 $124.26 $596.25 N/A N/A 446.509 SUP HCPCS C1713 446.509 - PLATE BONE 26MM 3X3 HOLE L TITANIUM LEFT MAXL NONSTRL 1.5MM BOTH IP/OP $596.50 $441.00 $118.34 $596.25 $268.31 $268.31 $268.31 $268.31 $596.25 $596.25 $596.25 $124.27 $596.25 $596.25 $596.25 $596.25 $596.25 $124.27 $596.25 $596.25 $352.68 $596.25 $596.25 $596.25 $596.25 $447.38 $596.25 $596.25 $596.25 $298.13 $298.13 $472.23 $596.25 $477.00 $268.31 $118.34 N/A $345.97 $596.25 $357.75 $596.25 $124.26 $596.25 N/A N/A 446.51 SUP HCPCS C1713 446.51 - PLATE BN OB R L NS 2X3 HL RGD TI CRNFCL 1.5MM SCR BOTH IP/OP $616.50 $456.00 $122.36 $616.50 $277.43 $277.43 $277.43 $277.43 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $364.66 $616.50 $616.50 $616.50 $616.50 $462.38 $616.50 $616.50 $616.50 $308.25 $308.25 $488.27 $616.50 $493.20 $277.43 $122.36 N/A $357.57 $616.50 $369.90 $616.50 $616.50 $616.50 N/A N/A 446.515 SUP HCPCS C1713 446.515 - PLATE BONE 100D L RIGHT OBLIQUE 22X4X.6MM 2X3 HOLE MALBLE BOTH IP/OP $637.00 $471.00 $126.38 $636.75 $286.54 $286.54 $286.54 $286.54 $636.75 $636.75 $636.75 $132.71 $636.75 $636.75 $636.75 $636.75 $636.75 $132.71 $636.75 $636.75 $376.64 $636.75 $636.75 $636.75 $636.75 $477.75 $636.75 $636.75 $636.75 $318.38 $318.38 $504.31 $636.75 $509.40 $286.54 $126.38 N/A $369.46 $636.75 $382.05 $636.75 $636.75 $636.75 N/A N/A 446.516 SUP HCPCS C1713 446.516 - PLATE BONE 100D L OBLIQUE 22X4X.6MM 3X2 HOLE MALBLE TEAL BOTH IP/OP $637.00 $471.00 $126.38 $636.75 $286.54 $286.54 $286.54 $286.54 $636.75 $636.75 $636.75 $132.71 $636.75 $636.75 $636.75 $636.75 $636.75 $132.71 $636.75 $254.70 $376.64 $636.75 $636.75 $636.75 $636.75 $477.75 $636.75 $636.75 $636.75 $318.38 $318.38 $504.31 $636.75 $509.40 $286.54 $126.38 N/A $369.46 $636.75 $636.75 $636.75 $132.70 $636.75 N/A N/A 446.52 SUP HCPCS C1713 446.52 - PLATE BN OB L L 3X4 HL TI CRNFCL 1.5MM SCR BOTH IP/OP $652.50 $483.00 $129.50 $652.50 $293.63 $293.63 $293.63 $293.63 $652.50 $652.50 $652.50 $136.00 $652.50 $652.50 $652.50 $652.50 $652.50 $135.99 $652.50 $652.50 $385.95 $652.50 $652.50 $652.50 $652.50 $489.38 $652.50 $652.50 $652.50 $326.25 $326.25 $516.78 $652.50 $522.00 $293.63 $129.50 N/A $378.45 $652.50 $652.50 $652.50 $135.98 $652.50 N/A N/A 446.527 SUP HCPCS C1713 446.527 - PLATE BONE 100D L LEFT OBLIQUE 27X4X.6MM 3X4 HOLE MALBLE BOTH IP/OP $666.00 $493.00 $132.18 $666.00 $299.70 $299.70 $299.70 $299.70 $666.00 $666.00 $666.00 $138.81 $666.00 $666.00 $666.00 $666.00 $666.00 $138.80 $666.00 $666.00 $393.94 $666.00 $666.00 $666.00 $666.00 $499.50 $666.00 $666.00 $666.00 $333.00 $333.00 $527.47 $666.00 $532.80 $299.70 $132.18 N/A $386.28 $666.00 $666.00 $666.00 $138.79 $666.00 N/A N/A 446.53 SUP HCPCS C1713 446.53 - PLATE BN OB R L NS 3X4 HL RGD TI CRNFCL 1.5MM SCR BOTH IP/OP $652.50 $483.00 $129.50 $652.50 $293.63 $293.63 $293.63 $293.63 $652.50 $652.50 $652.50 $136.00 $652.50 $652.50 $652.50 $652.50 $652.50 $135.99 $652.50 $261.00 $385.95 $652.50 $652.50 $652.50 $652.50 $489.38 $652.50 $652.50 $652.50 $326.25 $326.25 $516.78 $652.50 $522.00 $293.63 $129.50 N/A $378.45 $652.50 $652.50 $652.50 $135.98 $652.50 N/A N/A 446.537 SUP HCPCS C1713 446.537 - PLATE BONE 100D L RIGHT OBLIQUE 27X4X.6MM 3X4 HOLE MALBLE BOTH IP/OP $666.00 $493.00 $132.18 $666.00 $299.70 $299.70 $299.70 $299.70 $666.00 $666.00 $666.00 $138.81 $666.00 $666.00 $666.00 $666.00 $666.00 $138.80 $666.00 $266.40 $393.94 $666.00 $666.00 $666.00 $666.00 $499.50 $666.00 $666.00 $666.00 $333.00 $333.00 $527.47 $666.00 $532.80 $299.70 $132.18 N/A $386.28 $666.00 $666.00 $666.00 $138.79 $666.00 N/A N/A 446.538 SUP HCPCS C1713 446.538 - PLATE BONE 34X4X.6MM 8 HOLE MALBLE TEAL TITANIUM ORBTL RIM BOTH IP/OP $607.50 $450.00 $120.57 $607.50 $273.38 $273.38 $273.38 $273.38 $607.50 $607.50 $607.50 $126.62 $607.50 $607.50 $607.50 $607.50 $607.50 $126.61 $607.50 $243.00 $359.34 $607.50 $607.50 $607.50 $607.50 $455.63 $607.50 $607.50 $607.50 $303.75 $303.75 $481.14 $607.50 $486.00 $273.38 $120.57 N/A $352.35 $607.50 $607.50 $607.50 $126.60 $607.50 N/A N/A 446.54 SUP HCPCS C1713 446.540 - PLATE BONE 41X4X.6MM 10 HOLE MALBLE TEAL TITANIUM ORBTL RIM BOTH IP/OP $641.50 $475.00 $127.27 $641.25 $288.56 $288.56 $288.56 $288.56 $641.25 $641.25 $641.25 $133.65 $641.25 $641.25 $641.25 $641.25 $641.25 $133.64 $641.25 $641.25 $379.30 $641.25 $641.25 $641.25 $641.25 $481.13 $641.25 $641.25 $641.25 $320.63 $320.63 $507.87 $641.25 $513.00 $288.56 $127.27 N/A $372.07 $641.25 $641.25 $641.25 $133.64 $641.25 N/A N/A 446.542 SUP HCPCS C1713 446.542 - PLATE BONE 49X4X.6MM 12 HOLE MALBLE TEAL TITANIUM ORBTL RIM BOTH IP/OP $691.00 $511.00 $137.10 $690.75 $310.84 $310.84 $310.84 $310.84 $690.75 $690.75 $690.75 $143.97 $690.75 $690.75 $690.75 $690.75 $690.75 $143.96 $690.75 $690.75 $408.58 $690.75 $690.75 $690.75 $690.75 $518.25 $690.75 $690.75 $690.75 $345.38 $345.38 $547.07 $690.75 $552.60 $310.84 $137.10 N/A $400.78 $690.75 $690.75 $690.75 $143.95 $690.75 N/A N/A 446.61 SUP HCPCS C1713 446.61 - PLATE BN 36X3.5X.9MM NS 7 HL TI CNDYL LT 1.5MM SCR MDLR HND BOTH IP/OP $616.50 $456.00 $122.36 $616.50 $277.43 $277.43 $277.43 $277.43 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $364.66 $616.50 $616.50 $616.50 $616.50 $462.38 $616.50 $616.50 $616.50 $308.25 $308.25 $488.27 $616.50 $493.20 $277.43 $122.36 N/A $357.57 $616.50 $616.50 $616.50 $128.48 $616.50 N/A N/A 446.611 SUP HCPCS C1713 446.611 - PLATE BONE Y 22X11MM 3X1 HOLE LP TITANIUM CRANFCL NONSTRL BOTH IP/OP $616.50 $456.00 $122.36 $616.50 $277.43 $277.43 $277.43 $277.43 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $364.66 $616.50 $616.50 $616.50 $616.50 $462.38 $616.50 $616.50 $616.50 $308.25 $308.25 $488.27 $616.50 $493.20 $277.43 $122.36 N/A $357.57 $616.50 $616.50 $616.50 $128.48 $616.50 N/A N/A 446.612 SUP HCPCS C1713 446.612 - PLATE BN Y 46X4X1MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $426.00 $315.00 $84.54 $433.18 $191.67 $191.67 $191.67 $191.67 $425.93 $425.93 $425.93 $88.77 $425.93 $425.93 $425.93 $425.93 $425.93 $88.77 $425.93 $173.27 $251.94 $425.93 $433.18 $425.93 $425.93 $319.50 $425.93 $425.93 $425.93 $212.97 $212.97 $337.34 $425.93 $340.74 $191.67 $84.54 N/A $247.08 $425.93 $425.93 $425.93 $88.76 $425.93 N/A N/A 446.614 SUP HCPCS C1713 446.614 - PLATE BN 2Y 18MM 6 HL TI CRNFCL 1.5MM SCR BOTH IP/OP $616.50 $456.00 $122.36 $616.50 $277.43 $277.43 $277.43 $277.43 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $364.66 $616.50 $616.50 $616.50 $616.50 $462.38 $616.50 $616.50 $616.50 $308.25 $308.25 $488.27 $616.50 $493.20 $277.43 $122.36 N/A $357.57 $616.50 $369.90 $616.50 $128.48 $616.50 N/A N/A 446.615 SUP HCPCS C1713 446.615 - PLATE BN 2Y 21MM 6 HL TI CRNFCL 1.5MM SCR BOTH IP/OP $616.50 $456.00 $122.36 $616.50 $277.43 $277.43 $277.43 $277.43 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $364.66 $616.50 $616.50 $616.50 $616.50 $462.38 $616.50 $616.50 $616.50 $308.25 $308.25 $488.27 $616.50 $493.20 $277.43 $122.36 N/A $357.57 $616.50 $369.90 $616.50 $128.48 $616.50 N/A N/A 446.63 SUP HCPCS C1713 446.63 - PLATE BONE 36X3.5X.9MM 7 HOLE SLFTAP LCP TITANIUM LEFT BOTH IP/OP $540.00 $400.00 $107.13 $548.95 $242.90 $242.90 $242.90 $242.90 $539.78 $539.78 $539.78 $112.50 $539.78 $539.78 $539.78 $539.78 $539.78 $112.50 $539.78 $548.95 $319.28 $539.78 $548.95 $539.78 $539.78 $405.00 $539.78 $539.78 $539.78 $269.89 $269.89 $427.51 $539.78 $431.82 $242.90 $107.13 N/A $313.20 $539.78 $539.78 $539.78 $112.49 $539.78 N/A N/A 446.64 SUP HCPCS C1713 446.64 - PLATE BONE 36X3.5X.9MM 7 HOLE SLFTAP LCP TITANIUM RIGHT BOTH IP/OP $540.00 $400.00 $107.13 $548.95 $242.90 $242.90 $242.90 $242.90 $539.78 $539.78 $539.78 $112.50 $539.78 $539.78 $539.78 $539.78 $539.78 $112.50 $539.78 $548.95 $319.28 $539.78 $548.95 $539.78 $539.78 $405.00 $539.78 $539.78 $539.78 $269.89 $269.89 $427.51 $539.78 $431.82 $242.90 $107.13 N/A $313.20 $539.78 $539.78 $539.78 $112.49 $539.78 N/A N/A 446.642 SUP HCPCS C1713 446.642 - PLATE BONE 2MM T OFFST 4.2X.6MM 5X3 HOLE TITANIUM MAXILLA BOTH IP/OP $821.50 $608.00 $163.00 $821.25 $369.56 $369.56 $369.56 $369.56 $821.25 $821.25 $821.25 $171.17 $821.25 $821.25 $821.25 $821.25 $821.25 $171.16 $821.25 $821.25 $485.77 $821.25 $821.25 $821.25 $821.25 $616.13 $821.25 $821.25 $821.25 $410.63 $410.63 $650.43 $821.25 $657.00 $369.56 $163.00 N/A $476.47 $821.25 $492.75 $821.25 $171.15 $821.25 N/A N/A 446.644 SUP HCPCS C1713 446.644 - PLATE BONE 4MM T OFFST 4.2X.6MM 5X3 HOLE TITANIUM MAXILLA BOTH IP/OP $821.50 $608.00 $163.00 $821.25 $369.56 $369.56 $369.56 $369.56 $821.25 $821.25 $821.25 $171.17 $821.25 $821.25 $821.25 $821.25 $821.25 $171.16 $821.25 $821.25 $485.77 $821.25 $821.25 $821.25 $821.25 $616.13 $821.25 $821.25 $821.25 $410.63 $410.63 $650.43 $821.25 $657.00 $369.56 $163.00 N/A $476.47 $821.25 $492.75 $821.25 $171.15 $821.25 N/A N/A 446.646 SUP HCPCS C1713 446.646 - PLATE BONE 6MM T OFFST 4.2X.6MM 5X3 HOLE TITANIUM MAXILLA BOTH IP/OP $821.50 $608.00 $163.00 $821.25 $369.56 $369.56 $369.56 $369.56 $821.25 $821.25 $821.25 $171.17 $821.25 $821.25 $821.25 $821.25 $821.25 $171.16 $821.25 $821.25 $485.77 $821.25 $821.25 $821.25 $821.25 $616.13 $821.25 $821.25 $821.25 $410.63 $410.63 $650.43 $821.25 $657.00 $369.56 $163.00 N/A $476.47 $821.25 $492.75 $821.25 $171.15 $821.25 N/A N/A 446.782 SUP HCPCS C1713 446.782 - PLATE BONE L SHORT OBLIQUE .3MM 2X2 HOLE MALBLE TITANIUM BOTH IP/OP $567.00 $420.00 $112.54 $567.00 $255.15 $255.15 $255.15 $255.15 $567.00 $567.00 $567.00 $118.18 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $567.00 $335.38 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $112.54 N/A $328.86 $567.00 $340.20 $567.00 $118.16 $567.00 N/A N/A 446.783 SUP HCPCS C1713 446.783 - PLATE BONE L SHORT OBLIQUE .3MM 2X2 HOLE MALBLE TITANIUM BOTH IP/OP $567.00 $420.00 $112.54 $567.00 $255.15 $255.15 $255.15 $255.15 $567.00 $567.00 $567.00 $118.18 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $567.00 $335.38 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $112.54 N/A $328.86 $567.00 $340.20 $567.00 $118.16 $567.00 N/A N/A 446.784 SUP HCPCS C1713 446.784 - PLATE BONE L LONG OBLIQUE .3MM 2X2 HOLE MALBLE TITANIUM BOTH IP/OP $567.00 $420.00 $112.54 $567.00 $255.15 $255.15 $255.15 $255.15 $567.00 $567.00 $567.00 $118.18 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $567.00 $335.38 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $112.54 N/A $328.86 $567.00 $340.20 $567.00 $567.00 $567.00 N/A N/A 446.785 SUP HCPCS C1713 446.785 - PLATE BONE LONG 2X2 HOLE L LEFT OBLIQUE MALBLE TITANIUM BOTH IP/OP $567.00 $420.00 $112.54 $567.00 $255.15 $255.15 $255.15 $255.15 $567.00 $567.00 $567.00 $118.18 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $567.00 $335.38 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $112.54 N/A $328.86 $567.00 $340.20 $567.00 $567.00 $567.00 N/A N/A 446.786 SUP HCPCS C1713 446.786 - PLATE BONE Z SHORT .6MM MALBLE TITANIUM RIGHT MAXFACL BOTH IP/OP $580.50 $430.00 $115.21 $580.50 $261.23 $261.23 $261.23 $261.23 $580.50 $580.50 $580.50 $120.99 $580.50 $580.50 $580.50 $580.50 $580.50 $120.98 $580.50 $580.50 $343.37 $580.50 $580.50 $580.50 $580.50 $435.38 $580.50 $580.50 $580.50 $290.25 $290.25 $459.76 $580.50 $464.40 $261.23 $115.21 N/A $336.69 $580.50 $348.30 $580.50 $580.50 $580.50 N/A N/A 446.787 SUP HCPCS C1713 446.787 - PLATE BONE Z SHORT .6MM MALBLE TITANIUM LEFT MAXFACL NONSTRL BOTH IP/OP $580.50 $430.00 $115.21 $580.50 $261.23 $261.23 $261.23 $261.23 $580.50 $580.50 $580.50 $120.99 $580.50 $580.50 $580.50 $580.50 $580.50 $120.98 $580.50 $580.50 $343.37 $580.50 $580.50 $580.50 $580.50 $435.38 $580.50 $580.50 $580.50 $290.25 $290.25 $459.76 $580.50 $464.40 $261.23 $115.21 N/A $336.69 $580.50 $348.30 $580.50 $120.98 $580.50 N/A N/A 446.788 SUP HCPCS C1713 446.788 - PLATE BONE Z LONG .6MM MALBLE TITANIUM RIGHT MAXFACL NONSTRL BOTH IP/OP $580.50 $430.00 $115.21 $580.50 $261.23 $261.23 $261.23 $261.23 $580.50 $580.50 $580.50 $120.99 $580.50 $580.50 $580.50 $580.50 $580.50 $120.98 $580.50 $580.50 $343.37 $580.50 $580.50 $580.50 $580.50 $435.38 $580.50 $580.50 $580.50 $290.25 $290.25 $459.76 $580.50 $464.40 $261.23 $115.21 N/A $336.69 $580.50 $348.30 $580.50 $580.50 $580.50 N/A N/A 446.789 SUP HCPCS C1713 446.789 - PLATE BONE Z LONG .6MM MALBLE TITANIUM LEFT MAXFACL NONSTRL BOTH IP/OP $580.50 $430.00 $115.21 $580.50 $261.23 $261.23 $261.23 $261.23 $580.50 $580.50 $580.50 $120.99 $580.50 $580.50 $580.50 $580.50 $580.50 $120.98 $580.50 $580.50 $343.37 $580.50 $580.50 $580.50 $580.50 $435.38 $580.50 $580.50 $580.50 $290.25 $290.25 $459.76 $580.50 $464.40 $261.23 $115.21 N/A $336.69 $580.50 $348.30 $580.50 $120.98 $580.50 N/A N/A 446.792 SUP HCPCS C1713 446.792 - PLATE BONE L SHORT 15X4X.9MM 10MM 2X2 HOLE OBLIQUE TITANIUM BOTH IP/OP $567.00 $420.00 $112.54 $567.00 $255.15 $255.15 $255.15 $255.15 $567.00 $567.00 $567.00 $118.18 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $226.80 $335.38 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $112.54 N/A $328.86 $567.00 $340.20 $567.00 $118.16 $567.00 N/A N/A 446.793 SUP HCPCS C1713 446.793 - PLATE BONE L SHORT 15X4X.9MM 10MM 2X2 HOLE OBLIQUE TITANIUM BOTH IP/OP $567.00 $420.00 $112.54 $567.00 $255.15 $255.15 $255.15 $255.15 $567.00 $567.00 $567.00 $118.18 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $226.80 $335.38 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $112.54 N/A $328.86 $567.00 $340.20 $567.00 $118.16 $567.00 N/A N/A 446.794 SUP HCPCS C1713 446.794 - PLATE BONE L SHORT 17X4X.9MM 10MM 2X2 HOLE OBLIQUE TITANIUM BOTH IP/OP $567.00 $420.00 $112.54 $567.00 $255.15 $255.15 $255.15 $255.15 $567.00 $567.00 $567.00 $118.18 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $226.80 $335.38 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $112.54 N/A $328.86 $567.00 $340.20 $567.00 $118.16 $567.00 N/A N/A 446.795 SUP HCPCS C1713 446.795 - PLATE BONE L SHORT 17X4X.9MM 10MM 2X2 HOLE OBLIQUE TITANIUM BOTH IP/OP $567.00 $420.00 $112.54 $567.00 $255.15 $255.15 $255.15 $255.15 $567.00 $567.00 $567.00 $118.18 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $226.80 $335.38 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $112.54 N/A $328.86 $567.00 $340.20 $567.00 $118.16 $567.00 N/A N/A 446.796 SUP HCPCS C1713 446.796 - PLATE BONE Z SHORT 19X4X.9MM 15MM 2X2 HOLE OBLIQUE TITANIUM BOTH IP/OP $655.00 $485.00 $129.95 $654.75 $294.64 $294.64 $294.64 $294.64 $654.75 $654.75 $654.75 $136.47 $654.75 $654.75 $654.75 $654.75 $654.75 $136.46 $654.75 $261.90 $387.28 $654.75 $654.75 $654.75 $654.75 $491.25 $654.75 $654.75 $654.75 $327.38 $327.38 $518.56 $654.75 $523.80 $294.64 $129.95 N/A $379.90 $654.75 $392.85 $654.75 $136.45 $654.75 N/A N/A 446.797 SUP HCPCS C1713 446.797 - PLATE BONE Z SHORT 19X4X.9MM 15MM 2X2 HOLE TITANIUM LEFT BOTH IP/OP $655.00 $485.00 $129.95 $654.75 $294.64 $294.64 $294.64 $294.64 $654.75 $654.75 $654.75 $136.47 $654.75 $654.75 $654.75 $654.75 $654.75 $136.46 $654.75 $654.75 $387.28 $654.75 $654.75 $654.75 $654.75 $491.25 $654.75 $654.75 $654.75 $327.38 $327.38 $518.56 $654.75 $523.80 $294.64 $129.95 N/A $379.90 $654.75 $392.85 $654.75 $136.45 $654.75 N/A N/A 446.798 SUP HCPCS C1713 446.798 - PLATE BONE Z LONG 23X4X.9MM 15MM 2X2 HOLE TITANIUM RIGHT BOTH IP/OP $655.00 $485.00 $129.95 $654.75 $294.64 $294.64 $294.64 $294.64 $654.75 $654.75 $654.75 $136.47 $654.75 $654.75 $654.75 $654.75 $654.75 $136.46 $654.75 $261.90 $387.28 $654.75 $654.75 $654.75 $654.75 $491.25 $654.75 $654.75 $654.75 $327.38 $327.38 $518.56 $654.75 $523.80 $294.64 $129.95 N/A $379.90 $654.75 $392.85 $654.75 $136.45 $654.75 N/A N/A 446.799 SUP HCPCS C1713 446.799 - PLATE BONE Z LONG 23X4X.9MM 15MM 2X2 HOLE TITANIUM LEFT BOTH IP/OP $655.00 $485.00 $129.95 $654.75 $294.64 $294.64 $294.64 $294.64 $654.75 $654.75 $654.75 $136.47 $654.75 $654.75 $654.75 $654.75 $654.75 $136.46 $654.75 $261.90 $387.28 $654.75 $654.75 $654.75 $654.75 $491.25 $654.75 $654.75 $654.75 $327.38 $327.38 $518.56 $654.75 $523.80 $294.64 $129.95 N/A $379.90 $654.75 $392.85 $654.75 $136.45 $654.75 N/A N/A 446.81 SUP HCPCS C1713 446.81 - PLATE BONE X 4 HOLE X TITANIUM CRANFCL NONSTRL 1.5MM SCREW BOTH IP/OP $616.50 $456.00 $122.36 $616.50 $277.43 $277.43 $277.43 $277.43 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $364.66 $616.50 $616.50 $616.50 $616.50 $462.38 $616.50 $616.50 $616.50 $308.25 $308.25 $488.27 $616.50 $493.20 $277.43 $122.36 N/A $357.57 $616.50 $616.50 $616.50 $128.48 $616.50 N/A N/A 446.811 SUP HCPCS C1713 446.811 - PLATE BONE 4 HOLE X LP TITANIUM CRANFCL NONSTRL 1.5 MM BOTH IP/OP $616.50 $456.00 $122.36 $616.50 $277.43 $277.43 $277.43 $277.43 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $616.50 $616.50 $616.50 $128.49 $616.50 $616.50 $364.66 $616.50 $616.50 $616.50 $616.50 $462.38 $616.50 $616.50 $616.50 $308.25 $308.25 $488.27 $616.50 $493.20 $277.43 $122.36 N/A $357.57 $616.50 $369.90 $616.50 $128.48 $616.50 N/A N/A 446.9 SUP HCPCS C1713 446.900 - PLATE BONE 12MM 6 HOLE TITANIUM CRANFCL NONSTRL 1.5MM SCREWS BOTH IP/OP $574.00 $425.00 $113.88 $573.75 $258.19 $258.19 $258.19 $258.19 $573.75 $573.75 $573.75 $119.58 $573.75 $573.75 $573.75 $573.75 $573.75 $119.58 $573.75 $229.50 $339.37 $573.75 $573.75 $573.75 $573.75 $430.50 $573.75 $573.75 $573.75 $286.88 $286.88 $454.41 $573.75 $459.00 $258.19 $113.88 N/A $332.92 $573.75 $344.25 $573.75 $119.57 $573.75 N/A N/A 446.901 SUP Custom 27803010 446.901 - COVER BURR HOLE 15MM 6 HOLE TITANIUM CRANFCL NONSTRL 1.5MM BOTH IP/OP $574.00 $425.00 $102.13 $573.75 $573.75 $573.75 $573.75 $573.75 $573.75 $573.75 $102.13 $573.75 $573.75 $573.75 $573.75 $573.75 $573.75 $119.58 $573.75 $229.50 $573.75 $573.75 $573.75 $573.75 $573.75 $430.50 $573.75 $573.75 $573.75 $286.88 $286.88 $454.41 $573.75 $459.00 $258.19 $573.75 N/A $332.92 $573.75 $344.25 $573.75 $573.75 $573.75 N/A N/A 446.902 SUP Custom 27803010 446.902 - COVER BURR HOLE 24MM 6 HOLE TITANIUM CRANFCL NONSTRL 1.5MM BOTH IP/OP $574.00 $425.00 $102.13 $573.75 $573.75 $573.75 $573.75 $573.75 $573.75 $573.75 $102.13 $573.75 $573.75 $573.75 $573.75 $573.75 $573.75 $119.58 $573.75 $229.50 $573.75 $573.75 $573.75 $573.75 $573.75 $430.50 $573.75 $573.75 $573.75 $286.88 $286.88 $454.41 $573.75 $459.00 $258.19 $573.75 N/A $332.92 $573.75 $344.25 $573.75 $573.75 $573.75 N/A N/A 446.91 SUP Custom 27803010 446.91 - COVER BURR HOLE 17MM 6 HOLE TITANIUM CRANFCL NONSTRL 1.5MM BOTH IP/OP $574.00 $425.00 $102.13 $573.75 $573.75 $573.75 $573.75 $573.75 $573.75 $573.75 $102.13 $573.75 $573.75 $573.75 $573.75 $573.75 $573.75 $119.58 $573.75 $229.50 $573.75 $573.75 $573.75 $573.75 $573.75 $430.50 $573.75 $573.75 $573.75 $286.88 $286.88 $454.41 $573.75 $459.00 $258.19 $573.75 N/A $332.92 $573.75 $344.25 $573.75 $573.75 $573.75 N/A N/A 446.911 SUP Custom 27803010 446.911 - CLIP CRNL SPRG TI LT 1.5 MM BUR HL BOTH IP/OP $567.00 $420.00 $100.93 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $100.93 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $226.80 $567.00 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $567.00 N/A $328.86 $567.00 $340.20 $567.00 $567.00 $567.00 N/A N/A 446.912 SUP Custom 27803010 446.912 - CLIP CRNL SPRG TI RT 1.5 MM BUR HL BOTH IP/OP $567.00 $420.00 $100.93 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $100.93 $567.00 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $226.80 $567.00 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $567.00 N/A $328.86 $567.00 $340.20 $567.00 $567.00 $567.00 N/A N/A 446.913 SUP Custom 27803010 446.913 - CLIP CRNL SPRG TI 1.5 MM BUR HL BOTH IP/OP $436.50 $323.00 $77.70 $436.50 $436.50 $436.50 $436.50 $436.50 $436.50 $436.50 $77.70 $436.50 $436.50 $436.50 $436.50 $436.50 $436.50 $90.97 $436.50 $174.60 $436.50 $436.50 $436.50 $436.50 $436.50 $327.38 $436.50 $436.50 $436.50 $218.25 $218.25 $345.71 $436.50 $349.20 $196.43 $436.50 N/A $253.17 $436.50 $261.90 $436.50 $436.50 $436.50 N/A N/A 446.916 SUP HCPCS C1713 446.916 - PLATE BONE BOX 16X10MM 4 HOLE TITANIUM CRANFCL NONSTRL 1.5MM BOTH IP/OP $533.50 $395.00 $105.84 $533.25 $239.96 $239.96 $239.96 $239.96 $533.25 $533.25 $533.25 $111.14 $533.25 $533.25 $533.25 $533.25 $533.25 $111.14 $533.25 $213.30 $315.42 $533.25 $533.25 $533.25 $533.25 $400.13 $533.25 $533.25 $533.25 $266.63 $266.63 $422.33 $533.25 $426.60 $239.96 $105.84 N/A $309.43 $533.25 $319.95 $533.25 $533.25 $533.25 N/A N/A 446.917 SUP HCPCS C1713 446.917 - PLATE BONE 4MM 2 BEND OFFST 4MM 6 HOLE TITANIUM CHIN NONSTRL BOTH IP/OP $794.50 $588.00 $157.64 $794.25 $357.41 $357.41 $357.41 $357.41 $794.25 $794.25 $794.25 $165.54 $794.25 $794.25 $794.25 $794.25 $794.25 $165.53 $794.25 $794.25 $469.80 $794.25 $794.25 $794.25 $794.25 $595.88 $794.25 $794.25 $794.25 $397.13 $397.13 $629.05 $794.25 $635.40 $357.41 $157.64 N/A $460.81 $794.25 $476.55 $794.25 $165.52 $794.25 N/A N/A 446.918 SUP HCPCS C1713 446.918 - PLATE BONE 6MM 2 BEND OFFST 6MM 6 HOLE TITANIUM CHIN NONSTRL BOTH IP/OP $794.50 $588.00 $157.64 $794.25 $357.41 $357.41 $357.41 $357.41 $794.25 $794.25 $794.25 $165.54 $794.25 $794.25 $794.25 $794.25 $794.25 $165.53 $794.25 $794.25 $469.80 $794.25 $794.25 $794.25 $794.25 $595.88 $794.25 $794.25 $794.25 $397.13 $397.13 $629.05 $794.25 $635.40 $357.41 $157.64 N/A $460.81 $794.25 $794.25 $794.25 $165.52 $794.25 N/A N/A 446.919 SUP HCPCS C1713 446.919 - PLATE BONE 8MM 2 BEND OFFST 8MM 6 HOLE TITANIUM CHIN NONSTRL BOTH IP/OP $794.50 $588.00 $157.64 $794.25 $357.41 $357.41 $357.41 $357.41 $794.25 $794.25 $794.25 $165.54 $794.25 $794.25 $794.25 $794.25 $794.25 $165.53 $794.25 $317.70 $469.80 $794.25 $794.25 $794.25 $794.25 $595.88 $794.25 $794.25 $794.25 $397.13 $397.13 $629.05 $794.25 $635.40 $357.41 $157.64 N/A $460.81 $794.25 $794.25 $794.25 $165.52 $794.25 N/A N/A 446.92 SUP HCPCS C1713 446.920 - PLATE BONE 10MM 2 BEND OFFST 10MM 6 HOLE TITANIUM CHIN BOTH IP/OP $794.50 $588.00 $157.64 $794.25 $357.41 $357.41 $357.41 $357.41 $794.25 $794.25 $794.25 $165.54 $794.25 $794.25 $794.25 $794.25 $794.25 $165.53 $794.25 $317.70 $469.80 $794.25 $794.25 $794.25 $794.25 $595.88 $794.25 $794.25 $794.25 $397.13 $397.13 $629.05 $794.25 $635.40 $357.41 $157.64 N/A $460.81 $794.25 $794.25 $794.25 $794.25 $794.25 N/A N/A 446.923 SUP Custom 27803010 446.923 - COVER BURR HOLE 15MM 5 HOLE SHUNT TITANIUM CRANIUM NONSTRL BOTH IP/OP $574.00 $425.00 $102.13 $573.75 $573.75 $573.75 $573.75 $573.75 $573.75 $573.75 $102.13 $573.75 $573.75 $573.75 $573.75 $573.75 $573.75 $119.58 $573.75 $229.50 $573.75 $573.75 $573.75 $573.75 $573.75 $430.50 $573.75 $573.75 $573.75 $286.88 $286.88 $454.41 $573.75 $459.00 $258.19 $573.75 N/A $332.92 $573.75 $344.25 $573.75 $573.75 $573.75 N/A N/A 447.007 SUP Custom 27803010 447.007 - FOOTPLATE BONE 3 HOLE TITANIUM ZYGOMATIC NONSTRL BOTH IP/OP $499.50 $370.00 $88.91 $499.50 $499.50 $499.50 $499.50 $499.50 $499.50 $499.50 $88.91 $499.50 $499.50 $499.50 $499.50 $499.50 $499.50 $104.10 $499.50 $199.80 $499.50 $499.50 $499.50 $499.50 $499.50 $374.63 $499.50 $499.50 $499.50 $249.75 $249.75 $395.60 $499.50 $399.60 $224.78 $499.50 N/A $289.71 $499.50 $299.70 $499.50 $499.50 $499.50 N/A N/A 447.008 SUP HCPCS C1713 447.008 - PLATE BONE CURVE 6MMX1MM 6 HOLE LP SAGITTAL SPLIT TITANIUM BOTH IP/OP $727.00 $538.00 $144.24 $726.75 $327.04 $327.04 $327.04 $327.04 $726.75 $726.75 $726.75 $151.47 $726.75 $726.75 $726.75 $726.75 $726.75 $151.46 $726.75 $290.70 $429.87 $726.75 $726.75 $726.75 $726.75 $545.25 $726.75 $726.75 $726.75 $363.38 $363.38 $575.59 $726.75 $581.40 $327.04 $144.24 N/A $421.66 $726.75 $436.05 $726.75 $726.75 $726.75 N/A N/A 447.009 SUP HCPCS C1713 447.009 - PLATE BONE 10MM 6 HOLE SAGITTAL SPLIT CVD LP TITANIUM BOTH IP/OP $727.00 $538.00 $144.24 $726.75 $327.04 $327.04 $327.04 $327.04 $726.75 $726.75 $726.75 $151.47 $726.75 $726.75 $726.75 $726.75 $726.75 $151.46 $726.75 $290.70 $429.87 $726.75 $726.75 $726.75 $726.75 $545.25 $726.75 $726.75 $726.75 $363.38 $363.38 $575.59 $726.75 $581.40 $327.04 $144.24 N/A $421.66 $726.75 $436.05 $726.75 $151.45 $726.75 N/A N/A 447.01 SUP HCPCS C1713 447.010 - PLATE BONE CURVE 6MMX1.25MM 6MM 6 HOLE SAGITTAL SPLIT LP BOTH IP/OP $727.00 $538.00 $144.24 $726.75 $327.04 $327.04 $327.04 $327.04 $726.75 $726.75 $726.75 $151.47 $726.75 $726.75 $726.75 $726.75 $726.75 $151.46 $726.75 $290.70 $429.87 $726.75 $726.75 $726.75 $726.75 $545.25 $726.75 $726.75 $726.75 $363.38 $363.38 $575.59 $726.75 $581.40 $327.04 $144.24 N/A $421.66 $726.75 $436.05 $726.75 $151.45 $726.75 N/A N/A 447.011 SUP HCPCS C1713 447.011 - PLATE BONE CURVE 10MMX1.25MM 10MM 6 HOLE SAGITTAL SPLIT LP BOTH IP/OP $727.00 $538.00 $144.24 $726.75 $327.04 $327.04 $327.04 $327.04 $726.75 $726.75 $726.75 $151.47 $726.75 $726.75 $726.75 $726.75 $726.75 $151.46 $726.75 $290.70 $429.87 $726.75 $726.75 $726.75 $726.75 $545.25 $726.75 $726.75 $726.75 $363.38 $363.38 $575.59 $726.75 $581.40 $327.04 $144.24 N/A $421.66 $726.75 $436.05 $726.75 $151.45 $726.75 N/A N/A 447.013 SUP HCPCS C1713 447.013 - PLATE BONE 65X5.5X1.25MM 13 HOLE ZYDAPTON TITANIUM CRANFCL BOTH IP/OP $805.50 $596.00 $159.87 $805.50 $362.48 $362.48 $362.48 $362.48 $805.50 $805.50 $805.50 $167.89 $805.50 $805.50 $805.50 $805.50 $805.50 $167.88 $805.50 $805.50 $476.45 $805.50 $805.50 $805.50 $805.50 $604.13 $805.50 $805.50 $805.50 $402.75 $402.75 $637.96 $805.50 $644.40 $362.48 $159.87 N/A $467.19 $805.50 $483.30 $805.50 $167.87 $805.50 N/A N/A 447.03 SUP HCPCS C1713 447.030 - PLATE BONE CURVE 14MMX1.25MM 14MM 6 HOLE SAGITTAL SPLIT BOTH IP/OP $783.00 $579.00 $155.41 $783.00 $352.35 $352.35 $352.35 $352.35 $783.00 $783.00 $783.00 $163.20 $783.00 $783.00 $783.00 $783.00 $783.00 $163.19 $783.00 $313.20 $463.14 $783.00 $783.00 $783.00 $783.00 $587.25 $783.00 $783.00 $783.00 $391.50 $391.50 $620.14 $783.00 $626.40 $352.35 $155.41 N/A $454.14 $783.00 $469.80 $783.00 $163.18 $783.00 N/A N/A 447.031 SUP HCPCS C1713 447.031 - PLATE BN STRG 35X5X1.2MM NS PRO-PK 6 HL LOPRFL PRECONTOUR BOTH IP/OP $405.00 $300.00 $80.35 $411.73 $182.18 $182.18 $182.18 $182.18 $404.85 $404.85 $404.85 $84.38 $404.85 $404.85 $404.85 $404.85 $404.85 $84.38 $404.85 $411.73 $239.47 $404.85 $411.73 $404.85 $404.85 $303.75 $404.85 $404.85 $404.85 $202.43 $202.43 $320.64 $404.85 $323.88 $182.18 $80.35 N/A $234.90 $404.85 $242.91 $404.85 $84.37 $404.85 N/A N/A 447.032 SUP HCPCS C1713 447.032 - PLATE BN STRG 71X5X1.2MM NS PRO-PK 12 HL LOPRFL PRECONTOUR BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $491.78 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 447.033 SUP HCPCS C1713 447.033 - PLATE BONE CURVE 4MMX1MM 6 HOLE LP SAGITTAL SPLIT TITANIUM BOTH IP/OP $783.00 $579.00 $155.41 $783.00 $352.35 $352.35 $352.35 $352.35 $783.00 $783.00 $783.00 $163.20 $783.00 $783.00 $783.00 $783.00 $783.00 $163.19 $783.00 $313.20 $463.14 $783.00 $783.00 $783.00 $783.00 $587.25 $783.00 $783.00 $783.00 $391.50 $391.50 $620.14 $783.00 $626.40 $352.35 $155.41 N/A $454.14 $783.00 $469.80 $783.00 $783.00 $783.00 N/A N/A 447.034 SUP HCPCS C1713 447.034 - PLATE BONE CURVE 8MMX1MM 8MM 6 HOLE LP SAGITTAL SPLIT BOTH IP/OP $783.00 $579.00 $155.41 $783.00 $352.35 $352.35 $352.35 $352.35 $783.00 $783.00 $783.00 $163.20 $783.00 $783.00 $783.00 $783.00 $783.00 $163.19 $783.00 $783.00 $463.14 $783.00 $783.00 $783.00 $783.00 $587.25 $783.00 $783.00 $783.00 $391.50 $391.50 $620.14 $783.00 $626.40 $352.35 $155.41 N/A $454.14 $783.00 $783.00 $783.00 $163.18 $783.00 N/A N/A 447.035 SUP HCPCS C1713 447.035 - PLATE BN CRV 4MMX1.25MM NS 6 HL SGTL SPLT TI CRNFCL 2MM SCR BOTH IP/OP $783.00 $579.00 $155.41 $783.00 $352.35 $352.35 $352.35 $352.35 $783.00 $783.00 $783.00 $163.20 $783.00 $783.00 $783.00 $783.00 $783.00 $163.19 $783.00 $783.00 $463.14 $783.00 $783.00 $783.00 $783.00 $587.25 $783.00 $783.00 $783.00 $391.50 $391.50 $620.14 $783.00 $626.40 $352.35 $155.41 N/A $454.14 $783.00 $783.00 $783.00 $163.18 $783.00 N/A N/A 447.036 SUP HCPCS C1713 447.036 - PLATE BN CRV 12MMX1.25MM NS 6 HL SGTL SPLT TI CRNFCL 2MM SCR BOTH IP/OP $783.00 $579.00 $155.41 $783.00 $352.35 $352.35 $352.35 $352.35 $783.00 $783.00 $783.00 $163.20 $783.00 $783.00 $783.00 $783.00 $783.00 $163.19 $783.00 $313.20 $463.14 $783.00 $783.00 $783.00 $783.00 $587.25 $783.00 $783.00 $783.00 $391.50 $391.50 $620.14 $783.00 $626.40 $352.35 $155.41 N/A $454.14 $783.00 $469.80 $783.00 $783.00 $783.00 N/A N/A 447.037 SUP HCPCS C1713 447.037 - PLATE BONE CURVE 12MMX1MM 12MM 6 HOLE LP SAGITTAL SPLIT BOTH IP/OP $783.00 $579.00 $155.41 $783.00 $352.35 $352.35 $352.35 $352.35 $783.00 $783.00 $783.00 $163.20 $783.00 $783.00 $783.00 $783.00 $783.00 $163.19 $783.00 $313.20 $463.14 $783.00 $783.00 $783.00 $783.00 $587.25 $783.00 $783.00 $783.00 $391.50 $391.50 $620.14 $783.00 $626.40 $352.35 $155.41 N/A $454.14 $783.00 $469.80 $783.00 $783.00 $783.00 N/A N/A 447.038 SUP HCPCS C1713 447.038 - PLATE BN CRV 8MMX1.25MM NS 6 HL SGTL SPLT TI CRNFCL 2MM SCR BOTH IP/OP $783.00 $579.00 $155.41 $783.00 $352.35 $352.35 $352.35 $352.35 $783.00 $783.00 $783.00 $163.20 $783.00 $783.00 $783.00 $783.00 $783.00 $163.19 $783.00 $313.20 $463.14 $783.00 $783.00 $783.00 $783.00 $587.25 $783.00 $783.00 $783.00 $391.50 $391.50 $620.14 $783.00 $626.40 $352.35 $155.41 N/A $454.14 $783.00 $783.00 $783.00 $163.18 $783.00 N/A N/A 447.039 SUP HCPCS C1713 447.039 - PLATE BONE CURVE 16MMX1.25MM 16MM 6 HOLE SAGITTAL SPLIT BOTH IP/OP $783.00 $579.00 $155.41 $783.00 $352.35 $352.35 $352.35 $352.35 $783.00 $783.00 $783.00 $163.20 $783.00 $783.00 $783.00 $783.00 $783.00 $163.19 $783.00 $313.20 $463.14 $783.00 $783.00 $783.00 $783.00 $587.25 $783.00 $783.00 $783.00 $391.50 $391.50 $620.14 $783.00 $626.40 $352.35 $155.41 N/A $454.14 $783.00 $469.80 $783.00 $163.18 $783.00 N/A N/A 447.04 SUP HCPCS C1713 447.040 - PLATE BONE L 25X4.8X.9MM 15MM 3X3 HOLE TITANIUM RIGHT MAXL BOTH IP/OP $515.50 $381.00 $102.26 $515.25 $231.86 $231.86 $231.86 $231.86 $515.25 $515.25 $515.25 $107.39 $515.25 $515.25 $515.25 $515.25 $515.25 $107.38 $515.25 $206.10 $304.77 $515.25 $515.25 $515.25 $515.25 $386.63 $515.25 $515.25 $515.25 $257.63 $257.63 $408.08 $515.25 $412.20 $231.86 $102.26 N/A $298.99 $515.25 $309.15 $515.25 $107.38 $515.25 N/A N/A 447.041 SUP HCPCS C1713 447.041 - PLATE BN L 25X4.8X.9MM NS 15MM 3 HL SHFT 3 HL BS TI MXL LT 2 BOTH IP/OP $515.50 $381.00 $102.26 $515.25 $231.86 $231.86 $231.86 $231.86 $515.25 $515.25 $515.25 $107.39 $515.25 $515.25 $515.25 $515.25 $515.25 $107.38 $515.25 $515.25 $304.77 $515.25 $515.25 $515.25 $515.25 $386.63 $515.25 $515.25 $515.25 $257.63 $257.63 $408.08 $515.25 $412.20 $231.86 $102.26 N/A $298.99 $515.25 $515.25 $515.25 $107.38 $515.25 N/A N/A 447.042 SUP HCPCS C1713 447.042 - PLATE BONE L 27X4.8X.9MM 15MM 3X3 HOLE TITANIUM RIGHT MAXL BOTH IP/OP $515.50 $381.00 $102.26 $515.25 $231.86 $231.86 $231.86 $231.86 $515.25 $515.25 $515.25 $107.39 $515.25 $515.25 $515.25 $515.25 $515.25 $107.38 $515.25 $206.10 $304.77 $515.25 $515.25 $515.25 $515.25 $386.63 $515.25 $515.25 $515.25 $257.63 $257.63 $408.08 $515.25 $412.20 $231.86 $102.26 N/A $298.99 $515.25 $309.15 $515.25 $107.38 $515.25 N/A N/A 447.043 SUP HCPCS C1713 447.043 - PLATE BONE L 27X4.8X.9MM 15MM 3X3 HOLE TITANIUM LEFT MAXL BOTH IP/OP $515.50 $381.00 $102.26 $515.25 $231.86 $231.86 $231.86 $231.86 $515.25 $515.25 $515.25 $107.39 $515.25 $515.25 $515.25 $515.25 $515.25 $107.38 $515.25 $206.10 $304.77 $515.25 $515.25 $515.25 $515.25 $386.63 $515.25 $515.25 $515.25 $257.63 $257.63 $408.08 $515.25 $412.20 $231.86 $102.26 N/A $298.99 $515.25 $309.15 $515.25 $107.38 $515.25 N/A N/A 447.044 SUP HCPCS C1713 447.044 - PLATE BONE L 29X4.8X.9MM 15MM 3X3 HOLE TITANIUM RIGHT MAXL BOTH IP/OP $515.50 $381.00 $102.26 $515.25 $231.86 $231.86 $231.86 $231.86 $515.25 $515.25 $515.25 $107.39 $515.25 $515.25 $515.25 $515.25 $515.25 $107.38 $515.25 $206.10 $304.77 $515.25 $515.25 $515.25 $515.25 $386.63 $515.25 $515.25 $515.25 $257.63 $257.63 $408.08 $515.25 $412.20 $231.86 $102.26 N/A $298.99 $515.25 $515.25 $515.25 $107.38 $515.25 N/A N/A 447.045 SUP HCPCS C1713 447.045 - PLATE BONE L 29X4.8X.9MM 15MM 3X3 HOLE TITANIUM LEFT MAXL BOTH IP/OP $515.50 $381.00 $102.26 $515.25 $231.86 $231.86 $231.86 $231.86 $515.25 $515.25 $515.25 $107.39 $515.25 $515.25 $515.25 $515.25 $515.25 $107.38 $515.25 $515.25 $304.77 $515.25 $515.25 $515.25 $515.25 $386.63 $515.25 $515.25 $515.25 $257.63 $257.63 $408.08 $515.25 $412.20 $231.86 $102.26 N/A $298.99 $515.25 $515.25 $515.25 $107.38 $515.25 N/A N/A 447.046 SUP HCPCS C1713 447.046 - PLATE BN MN NAR 4.8X1MM 4 HL LCK MLBL TI MNDB 2MM SCR BOTH IP/OP $844.00 $625.00 $167.46 $843.75 $379.69 $379.69 $379.69 $379.69 $843.75 $843.75 $843.75 $175.86 $843.75 $843.75 $843.75 $843.75 $843.75 $175.85 $843.75 $337.50 $499.08 $843.75 $843.75 $843.75 $843.75 $633.00 $843.75 $843.75 $843.75 $421.88 $421.88 $668.25 $843.75 $675.00 $379.69 $167.46 N/A $489.52 $843.75 $843.75 $843.75 $175.84 $843.75 N/A N/A 447.047 SUP HCPCS C1713 447.047 - PLATE BN MN NAR 4.8X1MM 6 HL LCK MLBL TI MNDB 2MM SCR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.048 SUP HCPCS C1713 447.048 - PLATE BN MN NAR 4.8X1MM 4 HL LCK MLBL TI MNDB 2MM SCR BOTH IP/OP $844.00 $625.00 $167.46 $843.75 $379.69 $379.69 $379.69 $379.69 $843.75 $843.75 $843.75 $175.86 $843.75 $843.75 $843.75 $843.75 $843.75 $175.85 $843.75 $337.50 $499.08 $843.75 $843.75 $843.75 $843.75 $633.00 $843.75 $843.75 $843.75 $421.88 $421.88 $668.25 $843.75 $675.00 $379.69 $167.46 N/A $489.52 $843.75 $506.25 $843.75 $175.84 $843.75 N/A N/A 447.049 SUP HCPCS C1713 447.049 - PLATE BN MN NAR 4.8X1MM 6 HL LCK TI MNDB 2MM SCR BOTH IP/OP $918.00 $679.00 $182.20 $918.00 $413.10 $413.10 $413.10 $413.10 $918.00 $918.00 $918.00 $191.33 $918.00 $918.00 $918.00 $918.00 $918.00 $191.32 $918.00 $367.20 $543.00 $918.00 $918.00 $918.00 $918.00 $688.50 $918.00 $918.00 $918.00 $459.00 $459.00 $727.06 $918.00 $734.40 $413.10 $182.20 N/A $532.44 $918.00 $550.80 $918.00 $191.31 $918.00 N/A N/A 447.05 SUP HCPCS C1713 447.050 - PLATE BONE MINI 4.8X1MM 12 HOLE LOCKING ADAPTION TITANIUM BOTH IP/OP "$1,501.00" "$1,111.00" $297.86 "$1,500.75" $675.34 $675.34 $675.34 $675.34 "$1,500.75" "$1,500.75" "$1,500.75" $312.79 "$1,500.75" "$1,500.75" "$1,500.75" "$1,500.75" "$1,500.75" $312.77 "$1,500.75" $600.30 $887.69 "$1,500.75" "$1,500.75" "$1,500.75" "$1,500.75" "$1,125.75" "$1,500.75" "$1,500.75" "$1,500.75" $750.38 $750.38 "$1,188.59" "$1,500.75" "$1,200.60" $675.34 $297.86 N/A $870.58 "$1,500.75" "$1,500.75" "$1,500.75" "$1,500.75" "$1,500.75" N/A N/A 447.051 SUP HCPCS C1713 447.051 - PLATE BN MN 4.8X1MM 20 HL LCK ADP TI MNDB 2MM SCR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.053 SUP HCPCS C1713 447.053 - PLATE BN MN 4.8X1MM 4 HL LCK TNSNBND TI MNDB 2MM SCR BOTH IP/OP "$1,055.50" $781.00 $209.44 "$1,055.25" $474.86 $474.86 $474.86 $474.86 "$1,055.25" "$1,055.25" "$1,055.25" $219.94 "$1,055.25" "$1,055.25" "$1,055.25" "$1,055.25" "$1,055.25" $219.93 "$1,055.25" $422.10 $624.18 "$1,055.25" "$1,055.25" "$1,055.25" "$1,055.25" $791.63 "$1,055.25" "$1,055.25" "$1,055.25" $527.63 $527.63 $835.76 "$1,055.25" $844.20 $474.86 $209.44 N/A $612.19 "$1,055.25" $633.15 "$1,055.25" $219.91 "$1,055.25" N/A N/A 447.055 SUP HCPCS C1713 447.055 - PLATE BN MN BRD 4.8X1.3MM 4 HL LCK TI MNDB 2MM SCR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.057 SUP HCPCS C1713 447.057 - PLATE BN MN BRD CRV 4.8X1.3MM 4 HL LCK TI MNDB 2MM SCR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.07 SUP HCPCS C1713 447.070 - PLATE BONE STR 3MM 4 HOLE TITANIUM CHIN NONSTRL 2MM SCREW BOTH IP/OP $571.50 $423.00 $113.43 $571.50 $257.18 $257.18 $257.18 $257.18 $571.50 $571.50 $571.50 $119.11 $571.50 $571.50 $571.50 $571.50 $571.50 $119.11 $571.50 $228.60 $338.04 $571.50 $571.50 $571.50 $571.50 $428.63 $571.50 $571.50 $571.50 $285.75 $285.75 $452.63 $571.50 $457.20 $257.18 $113.43 N/A $331.47 $571.50 $571.50 $571.50 $571.50 $571.50 N/A N/A 447.071 SUP HCPCS C1713 447.071 - PLATE BONE 5MM STR OFFST 17X12X.9MM 5MM 4 HOLE TITANIUM CHIN BOTH IP/OP $601.00 $445.00 $119.23 $600.75 $270.34 $270.34 $270.34 $270.34 $600.75 $600.75 $600.75 $125.21 $600.75 $600.75 $600.75 $600.75 $600.75 $125.20 $600.75 $600.75 $355.34 $600.75 $600.75 $600.75 $600.75 $450.75 $600.75 $600.75 $600.75 $300.38 $300.38 $475.79 $600.75 $480.60 $270.34 $119.23 N/A $348.58 $600.75 $600.75 $600.75 $600.75 $600.75 N/A N/A 447.072 SUP HCPCS C1713 447.072 - PLATE BONE 8MM STR OFFST 12X12X.9MM 8MM 4 HOLE TITANIUM CHIN BOTH IP/OP $632.50 $468.00 $125.49 $632.25 $284.51 $284.51 $284.51 $284.51 $632.25 $632.25 $632.25 $131.78 $632.25 $632.25 $632.25 $632.25 $632.25 $131.77 $632.25 $632.25 $373.98 $632.25 $632.25 $632.25 $632.25 $474.38 $632.25 $632.25 $632.25 $316.13 $316.13 $500.74 $632.25 $505.80 $284.51 $125.49 N/A $366.85 $632.25 $632.25 $632.25 $131.76 $632.25 N/A N/A 447.073 SUP HCPCS C1713 447.073 - PLATE BONE 4MM 2 BEND OFFST 17X15/21X.6MM 5 HOLE TITANIUM BOTH IP/OP $709.00 $525.00 $140.67 $708.75 $318.94 $318.94 $318.94 $318.94 $708.75 $708.75 $708.75 $147.72 $708.75 $708.75 $708.75 $708.75 $708.75 $147.71 $708.75 $283.50 $419.23 $708.75 $708.75 $708.75 $708.75 $531.75 $708.75 $708.75 $708.75 $354.38 $354.38 $561.33 $708.75 $567.00 $318.94 $140.67 N/A $411.22 $708.75 $708.75 $708.75 $708.75 $708.75 N/A N/A 447.074 SUP HCPCS C1713 447.074 - PLATE BONE 6MM 19X15-21X1.6MM 5 HOLE 2 BEND OFFST TITANIUM BOTH IP/OP $709.00 $525.00 $140.67 $708.75 $318.94 $318.94 $318.94 $318.94 $708.75 $708.75 $708.75 $147.72 $708.75 $708.75 $708.75 $708.75 $708.75 $147.71 $708.75 $283.50 $419.23 $708.75 $708.75 $708.75 $708.75 $531.75 $708.75 $708.75 $708.75 $354.38 $354.38 $561.33 $708.75 $567.00 $318.94 $140.67 N/A $411.22 $708.75 $425.25 $708.75 $147.70 $708.75 N/A N/A 447.075 SUP HCPCS C1713 447.075 - PLATE BONE 8MM 5 HOLE 2 BEND TITANIUM CHIN NONSTRL 2MM BOTH IP/OP $747.00 $553.00 $148.26 $747.00 $336.15 $336.15 $336.15 $336.15 $747.00 $747.00 $747.00 $155.69 $747.00 $747.00 $747.00 $747.00 $747.00 $155.68 $747.00 $298.80 $441.85 $747.00 $747.00 $747.00 $747.00 $560.25 $747.00 $747.00 $747.00 $373.50 $373.50 $591.62 $747.00 $597.60 $336.15 $148.26 N/A $433.26 $747.00 $448.20 $747.00 $155.67 $747.00 N/A N/A 447.076 SUP HCPCS C1713 447.076 - PLATE BONE 10MM 5 HOLE 2 BEND TITANIUM CHIN NONSTRL 2MM BOTH IP/OP $747.00 $553.00 $148.26 $747.00 $336.15 $336.15 $336.15 $336.15 $747.00 $747.00 $747.00 $155.69 $747.00 $747.00 $747.00 $747.00 $747.00 $155.68 $747.00 $298.80 $441.85 $747.00 $747.00 $747.00 $747.00 $560.25 $747.00 $747.00 $747.00 $373.50 $373.50 $591.62 $747.00 $597.60 $336.15 $148.26 N/A $433.26 $747.00 $747.00 $747.00 $747.00 $747.00 N/A N/A 447.077 SUP HCPCS C1713 447.077 - PLATE BONE 3-5MM 1 BEND 17X15/21X.6MM 3-5MM 5 HOLE OFFST BOTH IP/OP $709.00 $525.00 $140.67 $708.75 $318.94 $318.94 $318.94 $318.94 $708.75 $708.75 $708.75 $147.72 $708.75 $708.75 $708.75 $708.75 $708.75 $147.71 $708.75 $283.50 $419.23 $708.75 $708.75 $708.75 $708.75 $531.75 $708.75 $708.75 $708.75 $354.38 $354.38 $561.33 $708.75 $567.00 $318.94 $140.67 N/A $411.22 $708.75 $708.75 $708.75 $708.75 $708.75 N/A N/A 447.078 SUP HCPCS C1713 447.078 - PLATE BONE 6-8MM 1 BEND 20X15/21X.6MM 6-8MM 5 HOLE OFFST BOTH IP/OP $709.00 $525.00 $140.67 $708.75 $318.94 $318.94 $318.94 $318.94 $708.75 $708.75 $708.75 $147.72 $708.75 $708.75 $708.75 $708.75 $708.75 $147.71 $708.75 $283.50 $419.23 $708.75 $708.75 $708.75 $708.75 $531.75 $708.75 $708.75 $708.75 $354.38 $354.38 $561.33 $708.75 $567.00 $318.94 $140.67 N/A $411.22 $708.75 $425.25 $708.75 $147.70 $708.75 N/A N/A 447.079 SUP HCPCS C1713 447.079 - PLATE BONE 9-11MM 1 BEND 20X15/21X.6MM 9-11MM 5 HOLE OFFST BOTH IP/OP $709.00 $525.00 $140.67 $708.75 $318.94 $318.94 $318.94 $318.94 $708.75 $708.75 $708.75 $147.72 $708.75 $708.75 $708.75 $708.75 $708.75 $147.71 $708.75 $283.50 $419.23 $708.75 $708.75 $708.75 $708.75 $531.75 $708.75 $708.75 $708.75 $354.38 $354.38 $561.33 $708.75 $567.00 $318.94 $140.67 N/A $411.22 $708.75 $425.25 $708.75 $147.70 $708.75 N/A N/A 447.082 SUP HCPCS C1713 447.082 - PLATE BONE .9MM 8 HOLE SAGITTAL SPLIT TITANIUM BOTH IP/OP $943.00 $698.00 $187.11 $942.75 $424.24 $424.24 $424.24 $424.24 $942.75 $942.75 $942.75 $196.49 $942.75 $942.75 $942.75 $942.75 $942.75 $196.48 $942.75 $377.10 $557.64 $942.75 $942.75 $942.75 $942.75 $707.25 $942.75 $942.75 $942.75 $471.38 $471.38 $746.66 $942.75 $754.20 $424.24 $187.11 N/A $546.94 $942.75 $942.75 $942.75 $196.47 $942.75 N/A N/A 447.083 SUP HCPCS C1713 447.083 - PLATE BONE -90D 2MM 38MM 10 HOLE CVD SAGITTAL SPLIT CURVE BOTH IP/OP $828.00 $613.00 $164.34 $828.00 $372.60 $372.60 $372.60 $372.60 $828.00 $828.00 $828.00 $172.58 $828.00 $828.00 $828.00 $828.00 $828.00 $172.56 $828.00 $331.20 $489.76 $828.00 $828.00 $828.00 $828.00 $621.00 $828.00 $828.00 $828.00 $414.00 $414.00 $655.78 $828.00 $662.40 $372.60 $164.34 N/A $480.24 $828.00 $828.00 $828.00 $828.00 $828.00 N/A N/A 447.084 SUP HCPCS C1713 447.084 - PLATE BONE 30MM 4 HOLE STR TITANIUM MAXFACL NONSTRL 2MM BOTH IP/OP $828.00 $613.00 $164.34 $828.00 $372.60 $372.60 $372.60 $372.60 $828.00 $828.00 $828.00 $172.58 $828.00 $828.00 $828.00 $828.00 $828.00 $172.56 $828.00 $331.20 $489.76 $828.00 $828.00 $828.00 $828.00 $621.00 $828.00 $828.00 $828.00 $414.00 $414.00 $655.78 $828.00 $662.40 $372.60 $164.34 N/A $480.24 $828.00 $496.80 $828.00 $828.00 $828.00 N/A N/A 447.088 SUP HCPCS C1713 447.088 - PLATE BONE 8 HOLE CVD TITANIUM MAXFACL NONSTRL 2 MM SCREWS BOTH IP/OP $828.00 $613.00 $164.34 $828.00 $372.60 $372.60 $372.60 $372.60 $828.00 $828.00 $828.00 $172.58 $828.00 $828.00 $828.00 $828.00 $828.00 $172.56 $828.00 $331.20 $489.76 $828.00 $828.00 $828.00 $828.00 $621.00 $828.00 $828.00 $828.00 $414.00 $414.00 $655.78 $828.00 $662.40 $372.60 $164.34 N/A $480.24 $828.00 $496.80 $828.00 $828.00 $828.00 N/A N/A 447.1 SUP HCPCS C1713 447.10 - PLATE BONE 5MM SPACING 100MM 20 HOLE ADAPTION TITANIUM BOTH IP/OP "$1,060.00" $784.00 $210.33 "$1,059.75" $476.89 $476.89 $476.89 $476.89 "$1,059.75" "$1,059.75" "$1,059.75" $220.88 "$1,059.75" "$1,059.75" "$1,059.75" "$1,059.75" "$1,059.75" $220.86 "$1,059.75" $423.90 $626.84 "$1,059.75" "$1,059.75" "$1,059.75" "$1,059.75" $795.00 "$1,059.75" "$1,059.75" "$1,059.75" $529.88 $529.88 $839.32 "$1,059.75" $847.80 $476.89 $210.33 N/A $614.80 "$1,059.75" $635.85 "$1,059.75" $220.85 "$1,059.75" N/A N/A 447.101 SUP HCPCS C1713 447.101 - PLATE BONE INTERMEDIATE 5X1.3MM 6 HOLE LP LOCKING TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.102 SUP HCPCS C1713 447.102 - PLATE BONE INTERMEDIATE 5X1.3MM 12 HOLE LP LOCKING TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.103 SUP HCPCS C1713 447.103 - PLATE BONE LARGE 6.5X1.5MM 3X3 HOLE LOCKING TITANIUM MANDIB BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.104 SUP HCPCS C1713 447.104 - PLATE BONE LARGE 6.5X1.5MM 6 HOLE LOCKING TITANIUM MANDIB BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.105 SUP HCPCS C1713 447.105 - PLATE BN 8MM SPC LG 95X6.5X1.5MM NS 12 HL LCK LOPRFL TI MNDB BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.106 SUP HCPCS C1713 447.106 - PLATE BONE LARGE 6.5X1.5MM 20 HOLE LP LOCKING TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.108 SUP HCPCS C1713 447.108 - PLATE BONE LARGE RIGHT ANG 6.5X1.5MM 6X21 HOLE LP LOCKING BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.109 SUP HCPCS C1713 447.109 - PLATE BONE LARGE LEFT ANGLE 6.5X1.5MM 6X21 HOLE LP LOCKING BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.114 SUP HCPCS C1713 447.114 - PLATE BONE 33X7X.7MM 4 HOLE SAGITTAL SPLIT ADJUSTABLE SLIDER BOTH IP/OP "$1,064.50" $788.00 $211.23 "$1,064.25" $478.91 $478.91 $478.91 $478.91 "$1,064.25" "$1,064.25" "$1,064.25" $221.82 "$1,064.25" "$1,064.25" "$1,064.25" "$1,064.25" "$1,064.25" $221.80 "$1,064.25" "$1,064.25" $629.50 "$1,064.25" "$1,064.25" "$1,064.25" "$1,064.25" $798.38 "$1,064.25" "$1,064.25" "$1,064.25" $532.13 $532.13 $842.89 "$1,064.25" $851.40 $478.91 $211.23 N/A $617.41 "$1,064.25" $638.55 "$1,064.25" $221.79 "$1,064.25" N/A N/A 447.116 SUP HCPCS C1713 447.116 - PLATE BONE 40X7X.7MM 4 HOLE SAGITTAL SPLIT ADJUSTABLE SLIDER BOTH IP/OP "$1,064.50" $788.00 $211.23 "$1,064.25" $478.91 $478.91 $478.91 $478.91 "$1,064.25" "$1,064.25" "$1,064.25" $221.82 "$1,064.25" "$1,064.25" "$1,064.25" "$1,064.25" "$1,064.25" $221.80 "$1,064.25" $425.70 $629.50 "$1,064.25" "$1,064.25" "$1,064.25" "$1,064.25" $798.38 "$1,064.25" "$1,064.25" "$1,064.25" $532.13 $532.13 $842.89 "$1,064.25" $851.40 $478.91 $211.23 N/A $617.41 "$1,064.25" $638.55 "$1,064.25" $221.79 "$1,064.25" N/A N/A 447.117 SUP HCPCS C1713 447.117 - PLATE BONE LARGE CRESCENT 6.5X1.5MM 3X3 HOLE LOCKING BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.118 SUP HCPCS C1713 447.118 - PLATE BONE LARGE ANGLED 6.5X1.5MM 3X3 HOLE LP LOCKING BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.119 SUP HCPCS C1713 447.119 - PLATE BONE LARGE ANGLED 6.5X1.5MM 4X4 HOLE LP LOCKING BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 447.14 SUP HCPCS C1713 447.140 - PLATE BONE 24MM 3X3 HOLE T TITANIUM CRANFCL NONSTRL 2MM BOTH IP/OP $549.00 $406.00 $108.96 $549.00 $247.05 $247.05 $247.05 $247.05 $549.00 $549.00 $549.00 $114.43 $549.00 $549.00 $549.00 $549.00 $549.00 $114.42 $549.00 $219.60 $324.73 $549.00 $549.00 $549.00 $549.00 $411.75 $549.00 $549.00 $549.00 $274.50 $274.50 $434.81 $549.00 $439.20 $247.05 $108.96 N/A $318.42 $549.00 $329.40 $549.00 $114.41 $549.00 N/A N/A 447.141 SUP HCPCS C1713 447.141 - PLATE BONE 4MM 2 BEND 10/15X.6MM 4MM 4 HOLE OFFST TITANIUM BOTH IP/OP $619.00 $458.00 $122.81 $618.75 $278.44 $278.44 $278.44 $278.44 $618.75 $618.75 $618.75 $128.96 $618.75 $618.75 $618.75 $618.75 $618.75 $128.95 $618.75 $247.50 $365.99 $618.75 $618.75 $618.75 $618.75 $464.25 $618.75 $618.75 $618.75 $309.38 $309.38 $490.05 $618.75 $495.00 $278.44 $122.81 N/A $359.02 $618.75 $371.25 $618.75 $128.95 $618.75 N/A N/A 447.142 SUP HCPCS C1713 447.142 - PLATE BONE 6MM 2 BEND 10/15X.6MM 6MM 4 HOLE OFFST TITANIUM BOTH IP/OP $619.00 $458.00 $122.81 $618.75 $278.44 $278.44 $278.44 $278.44 $618.75 $618.75 $618.75 $128.96 $618.75 $618.75 $618.75 $618.75 $618.75 $128.95 $618.75 $618.75 $365.99 $618.75 $618.75 $618.75 $618.75 $464.25 $618.75 $618.75 $618.75 $309.38 $309.38 $490.05 $618.75 $495.00 $278.44 $122.81 N/A $359.02 $618.75 $371.25 $618.75 $128.95 $618.75 N/A N/A 447.143 SUP HCPCS C1713 447.143 - PLATE BONE 8MM 2 BEND 10/15X.6MM 8MM 4 HOLE OFFST TITANIUM BOTH IP/OP $619.00 $458.00 $122.81 $618.75 $278.44 $278.44 $278.44 $278.44 $618.75 $618.75 $618.75 $128.96 $618.75 $618.75 $618.75 $618.75 $618.75 $128.95 $618.75 $247.50 $365.99 $618.75 $618.75 $618.75 $618.75 $464.25 $618.75 $618.75 $618.75 $309.38 $309.38 $490.05 $618.75 $495.00 $278.44 $122.81 N/A $359.02 $618.75 $371.25 $618.75 $128.95 $618.75 N/A N/A 447.144 SUP HCPCS C1713 447.144 - PLATE BONE 10MM 2 BEND 10/15X.6MM 10MM 4 HOLE OFFST TITANIUM BOTH IP/OP $619.00 $458.00 $122.81 $618.75 $278.44 $278.44 $278.44 $278.44 $618.75 $618.75 $618.75 $128.96 $618.75 $618.75 $618.75 $618.75 $618.75 $128.95 $618.75 $247.50 $365.99 $618.75 $618.75 $618.75 $618.75 $464.25 $618.75 $618.75 $618.75 $309.38 $309.38 $490.05 $618.75 $495.00 $278.44 $122.81 N/A $359.02 $618.75 $618.75 $618.75 $128.95 $618.75 N/A N/A 447.145 SUP HCPCS C1713 447.145 - PLATE BONE 12MM 2 BEND 10/15X.6MM 12MM 4 HOLE OFFST TITANIUM BOTH IP/OP $619.00 $458.00 $122.81 $618.75 $278.44 $278.44 $278.44 $278.44 $618.75 $618.75 $618.75 $128.96 $618.75 $618.75 $618.75 $618.75 $618.75 $128.95 $618.75 $618.75 $365.99 $618.75 $618.75 $618.75 $618.75 $464.25 $618.75 $618.75 $618.75 $309.38 $309.38 $490.05 $618.75 $495.00 $278.44 $122.81 N/A $359.02 $618.75 $618.75 $618.75 $128.95 $618.75 N/A N/A 447.146 SUP HCPCS C1713 447.146 - PLATE BONE 6MM 4 HOLE 2 BEND TITANIUM CHIN NONSTRL 2MM BOTH IP/OP $677.50 $501.00 $134.42 $677.25 $304.76 $304.76 $304.76 $304.76 $677.25 $677.25 $677.25 $141.16 $677.25 $677.25 $677.25 $677.25 $677.25 $141.15 $677.25 $677.25 $400.59 $677.25 $677.25 $677.25 $677.25 $508.13 $677.25 $677.25 $677.25 $338.63 $338.63 $536.38 $677.25 $541.80 $304.76 $134.42 N/A $392.95 $677.25 $406.35 $677.25 $141.14 $677.25 N/A N/A 447.147 SUP HCPCS C1713 447.147 - PLATE BONE 6MM 4 HOLE 2 BEND TITANIUM CHIN NONSTRL 2MM BOTH IP/OP $677.50 $501.00 $134.42 $677.25 $304.76 $304.76 $304.76 $304.76 $677.25 $677.25 $677.25 $141.16 $677.25 $677.25 $677.25 $677.25 $677.25 $141.15 $677.25 $270.90 $400.59 $677.25 $677.25 $677.25 $677.25 $508.13 $677.25 $677.25 $677.25 $338.63 $338.63 $536.38 $677.25 $541.80 $304.76 $134.42 N/A $392.95 $677.25 $406.35 $677.25 $141.14 $677.25 N/A N/A 447.148 SUP HCPCS C1713 447.148 - PLATE BONE 8MM 4 HOLE 2 BEND TITANIUM CHIN NONSTRL 2MM BOTH IP/OP $677.50 $501.00 $134.42 $677.25 $304.76 $304.76 $304.76 $304.76 $677.25 $677.25 $677.25 $141.16 $677.25 $677.25 $677.25 $677.25 $677.25 $141.15 $677.25 $270.90 $400.59 $677.25 $677.25 $677.25 $677.25 $508.13 $677.25 $677.25 $677.25 $338.63 $338.63 $536.38 $677.25 $541.80 $304.76 $134.42 N/A $392.95 $677.25 $406.35 $677.25 $141.14 $677.25 N/A N/A 447.149 SUP HCPCS C1713 447.149 - PLATE BONE 8MM 4 HOLE 2 BEND TITANIUM CHIN NONSTRL 2MM BOTH IP/OP $677.50 $501.00 $134.42 $677.25 $304.76 $304.76 $304.76 $304.76 $677.25 $677.25 $677.25 $141.16 $677.25 $677.25 $677.25 $677.25 $677.25 $141.15 $677.25 $270.90 $400.59 $677.25 $677.25 $677.25 $677.25 $508.13 $677.25 $677.25 $677.25 $338.63 $338.63 $536.38 $677.25 $541.80 $304.76 $134.42 N/A $392.95 $677.25 $406.35 $677.25 $141.14 $677.25 N/A N/A 447.15 SUP HCPCS C1713 447.150 - PLATE BONE 10MM 2 BEND 12.5/15X.6MM 10MM 4 HOLE OFFST BOTH IP/OP $677.50 $501.00 $134.42 $677.25 $304.76 $304.76 $304.76 $304.76 $677.25 $677.25 $677.25 $141.16 $677.25 $677.25 $677.25 $677.25 $677.25 $141.15 $677.25 $270.90 $400.59 $677.25 $677.25 $677.25 $677.25 $508.13 $677.25 $677.25 $677.25 $338.63 $338.63 $536.38 $677.25 $541.80 $304.76 $134.42 N/A $392.95 $677.25 $406.35 $677.25 $141.14 $677.25 N/A N/A 447.151 SUP HCPCS C1713 447.151 - PLATE BONE 10MM 2 BEND 12.5/15X.6MM 10MM 4 HOLE OFFST BOTH IP/OP $677.50 $501.00 $134.42 $677.25 $304.76 $304.76 $304.76 $304.76 $677.25 $677.25 $677.25 $141.16 $677.25 $677.25 $677.25 $677.25 $677.25 $141.15 $677.25 $270.90 $400.59 $677.25 $677.25 $677.25 $677.25 $508.13 $677.25 $677.25 $677.25 $338.63 $338.63 $536.38 $677.25 $541.80 $304.76 $134.42 N/A $392.95 $677.25 $406.35 $677.25 $141.14 $677.25 N/A N/A 447.152 SUP HCPCS C1713 447.152 - PLATE BONE STR 24X4.5X.6MM 4 HOLE LP TITANIUM CRANFCL BOTH IP/OP $612.00 $453.00 $121.47 $612.00 $275.40 $275.40 $275.40 $275.40 $612.00 $612.00 $612.00 $127.56 $612.00 $612.00 $612.00 $612.00 $612.00 $127.55 $612.00 $244.80 $362.00 $612.00 $612.00 $612.00 $612.00 $459.00 $612.00 $612.00 $612.00 $306.00 $306.00 $484.70 $612.00 $489.60 $275.40 $121.47 N/A $354.96 $612.00 $367.20 $612.00 $127.54 $612.00 N/A N/A 447.153 SUP HCPCS C1713 447.153 - PLATE BONE STR 24X4.5X.6MM 4 HOLE LP TITANIUM CRANFCL BOTH IP/OP $612.00 $453.00 $121.47 $612.00 $275.40 $275.40 $275.40 $275.40 $612.00 $612.00 $612.00 $127.56 $612.00 $612.00 $612.00 $612.00 $612.00 $127.55 $612.00 $244.80 $362.00 $612.00 $612.00 $612.00 $612.00 $459.00 $612.00 $612.00 $612.00 $306.00 $306.00 $484.70 $612.00 $489.60 $275.40 $121.47 N/A $354.96 $612.00 $612.00 $612.00 $127.54 $612.00 N/A N/A 447.154 SUP HCPCS C1713 447.154 - PLATE BONE 90D L 17X4.8X.6MM 2X2 HOLE LP TITANIUM RIGHT BOTH IP/OP $517.50 $383.00 $102.71 $517.50 $232.88 $232.88 $232.88 $232.88 $517.50 $517.50 $517.50 $107.86 $517.50 $517.50 $517.50 $517.50 $517.50 $107.85 $517.50 $207.00 $306.10 $517.50 $517.50 $517.50 $517.50 $388.13 $517.50 $517.50 $517.50 $258.75 $258.75 $409.86 $517.50 $414.00 $232.88 $102.71 N/A $300.15 $517.50 $310.50 $517.50 $107.85 $517.50 N/A N/A 447.155 SUP HCPCS C1713 447.155 - PLATE BONE 90D L 17X4.8X.6MM 2X2 HOLE LP TITANIUM LEFT BOTH IP/OP $517.50 $383.00 $102.71 $517.50 $232.88 $232.88 $232.88 $232.88 $517.50 $517.50 $517.50 $107.86 $517.50 $517.50 $517.50 $517.50 $517.50 $107.85 $517.50 $207.00 $306.10 $517.50 $517.50 $517.50 $517.50 $388.13 $517.50 $517.50 $517.50 $258.75 $258.75 $409.86 $517.50 $414.00 $232.88 $102.71 N/A $300.15 $517.50 $310.50 $517.50 $107.85 $517.50 N/A N/A 447.156 SUP HCPCS C1713 447.156 - PLATE BONE 90D L 19X4.8X.6MM 2X2 HOLE LP TITANIUM RIGHT BOTH IP/OP $517.50 $383.00 $102.71 $517.50 $232.88 $232.88 $232.88 $232.88 $517.50 $517.50 $517.50 $107.86 $517.50 $517.50 $517.50 $517.50 $517.50 $107.85 $517.50 $207.00 $306.10 $517.50 $517.50 $517.50 $517.50 $388.13 $517.50 $517.50 $517.50 $258.75 $258.75 $409.86 $517.50 $414.00 $232.88 $102.71 N/A $300.15 $517.50 $310.50 $517.50 $107.85 $517.50 N/A N/A 447.157 SUP HCPCS C1713 447.157 - PLATE BONE 90D L 19X4.8X.6MM 2X2 HOLE LP TITANIUM LEFT BOTH IP/OP $517.50 $383.00 $102.71 $517.50 $232.88 $232.88 $232.88 $232.88 $517.50 $517.50 $517.50 $107.86 $517.50 $517.50 $517.50 $517.50 $517.50 $107.85 $517.50 $207.00 $306.10 $517.50 $517.50 $517.50 $517.50 $388.13 $517.50 $517.50 $517.50 $258.75 $258.75 $409.86 $517.50 $414.00 $232.88 $102.71 N/A $300.15 $517.50 $310.50 $517.50 $107.85 $517.50 N/A N/A 447.158 SUP HCPCS C1713 447.158 - PLATE BONE 90D L 23X4.8X.6MM 2X2 HOLE LP TITANIUM RIGHT BOTH IP/OP $517.50 $383.00 $102.71 $517.50 $232.88 $232.88 $232.88 $232.88 $517.50 $517.50 $517.50 $107.86 $517.50 $517.50 $517.50 $517.50 $517.50 $107.85 $517.50 $207.00 $306.10 $517.50 $517.50 $517.50 $517.50 $388.13 $517.50 $517.50 $517.50 $258.75 $258.75 $409.86 $517.50 $414.00 $232.88 $102.71 N/A $300.15 $517.50 $310.50 $517.50 $107.85 $517.50 N/A N/A 447.159 SUP HCPCS C1713 447.159 - PLATE BONE 90D L 23X4.8X.6MM 2X2 HOLE LP TITANIUM LEFT BOTH IP/OP $517.50 $383.00 $102.71 $517.50 $232.88 $232.88 $232.88 $232.88 $517.50 $517.50 $517.50 $107.86 $517.50 $517.50 $517.50 $517.50 $517.50 $107.85 $517.50 $207.00 $306.10 $517.50 $517.50 $517.50 $517.50 $388.13 $517.50 $517.50 $517.50 $258.75 $258.75 $409.86 $517.50 $414.00 $232.88 $102.71 N/A $300.15 $517.50 $310.50 $517.50 $107.85 $517.50 N/A N/A 447.18 SUP HCPCS C1713 447.18 - PLATE BONE 38X4.8X.9MM 8 HOLE TITANIUM ORBTL RIM NONSTRL 2MM BOTH IP/OP $529.00 $391.00 $104.94 $528.75 $237.94 $237.94 $237.94 $237.94 $528.75 $528.75 $528.75 $110.20 $528.75 $528.75 $528.75 $528.75 $528.75 $110.20 $528.75 $211.50 $312.76 $528.75 $528.75 $528.75 $528.75 $396.75 $528.75 $528.75 $528.75 $264.38 $264.38 $418.77 $528.75 $423.00 $237.94 $104.94 N/A $306.82 $528.75 $528.75 $528.75 $110.19 $528.75 N/A N/A 447.184 SUP HCPCS C1713 447.184 - PLATE BONE STR 22MM 4 HOLE SAGITTAL SPLIT LP TITANIUM MANDIB BOTH IP/OP $686.50 $508.00 $136.20 $686.25 $308.81 $308.81 $308.81 $308.81 $686.25 $686.25 $686.25 $143.03 $686.25 $686.25 $686.25 $686.25 $686.25 $143.02 $686.25 $686.25 $405.92 $686.25 $686.25 $686.25 $686.25 $514.88 $686.25 $686.25 $686.25 $343.13 $343.13 $543.51 $686.25 $549.00 $308.81 $136.20 N/A $398.17 $686.25 $686.25 $686.25 $143.01 $686.25 N/A N/A 447.185 SUP HCPCS C1713 447.185 - PLATE BONE STR 29MM 4 HOLE SAGITTAL SPLIT LP TITANIUM MANDIB BOTH IP/OP $686.50 $508.00 $136.20 $686.25 $308.81 $308.81 $308.81 $308.81 $686.25 $686.25 $686.25 $143.03 $686.25 $686.25 $686.25 $686.25 $686.25 $143.02 $686.25 $686.25 $405.92 $686.25 $686.25 $686.25 $686.25 $514.88 $686.25 $686.25 $686.25 $343.13 $343.13 $543.51 $686.25 $549.00 $308.81 $136.20 N/A $398.17 $686.25 $686.25 $686.25 $143.01 $686.25 N/A N/A 447.186 SUP HCPCS C1713 447.186 - PLATE BONE STR 36MM 4 HOLE SAGITTAL SPLIT LP TITANIUM MANDIB BOTH IP/OP $686.50 $508.00 $136.20 $686.25 $308.81 $308.81 $308.81 $308.81 $686.25 $686.25 $686.25 $143.03 $686.25 $686.25 $686.25 $686.25 $686.25 $143.02 $686.25 $686.25 $405.92 $686.25 $686.25 $686.25 $686.25 $514.88 $686.25 $686.25 $686.25 $343.13 $343.13 $543.51 $686.25 $549.00 $308.81 $136.20 N/A $398.17 $686.25 $686.25 $686.25 $143.01 $686.25 N/A N/A 447.2 SUP HCPCS C1713 447.20 - PLATE BONE 38X4.8X.9MM 10 HOLE TITANIUM ORBTL RIM NONSTRL 2 BOTH IP/OP $558.00 $413.00 $110.75 $558.00 $251.10 $251.10 $251.10 $251.10 $558.00 $558.00 $558.00 $116.30 $558.00 $558.00 $558.00 $558.00 $558.00 $116.29 $558.00 $558.00 $330.06 $558.00 $558.00 $558.00 $558.00 $418.50 $558.00 $558.00 $558.00 $279.00 $279.00 $441.94 $558.00 $446.40 $251.10 $110.75 N/A $323.64 $558.00 $558.00 $558.00 $116.29 $558.00 N/A N/A 447.204 SUP HCPCS C1713 447.204 - PLATE BONE 1.3MM 4 HOLE INTERMEDIATE LOCKING COMPRESSION BOTH IP/OP $817.00 $605.00 $162.10 $816.75 $367.54 $367.54 $367.54 $367.54 $816.75 $816.75 $816.75 $170.23 $816.75 $816.75 $816.75 $816.75 $816.75 $170.22 $816.75 $816.75 $483.11 $816.75 $816.75 $816.75 $816.75 $612.75 $816.75 $816.75 $816.75 $408.38 $408.38 $646.87 $816.75 $653.40 $367.54 $162.10 N/A $473.86 $816.75 $490.05 $816.75 $170.21 $816.75 N/A N/A 447.205 SUP HCPCS C1713 447.205 - PLATE BONE 1.3MM 5 HOLE INTERMEDIATE LOCKING COMPRESSION BOTH IP/OP $889.00 $658.00 $176.39 $888.75 $399.94 $399.94 $399.94 $399.94 $888.75 $888.75 $888.75 $185.24 $888.75 $888.75 $888.75 $888.75 $888.75 $185.23 $888.75 $888.75 $525.70 $888.75 $888.75 $888.75 $888.75 $666.75 $888.75 $888.75 $888.75 $444.38 $444.38 $703.89 $888.75 $711.00 $399.94 $176.39 N/A $515.62 $888.75 $533.25 $888.75 $888.75 $888.75 N/A N/A 447.206 SUP HCPCS C1713 447.206 - PLATE BONE 1.3MM 6 HOLE INTERMEDIATE LOCKING COMPRESSION BOTH IP/OP $958.50 $709.00 $190.24 $958.50 $431.33 $431.33 $431.33 $431.33 $958.50 $958.50 $958.50 $199.78 $958.50 $958.50 $958.50 $958.50 $958.50 $199.76 $958.50 $958.50 $566.95 $958.50 $958.50 $958.50 $958.50 $718.88 $958.50 $958.50 $958.50 $479.25 $479.25 $759.13 $958.50 $766.80 $431.33 $190.24 N/A $555.93 $958.50 $958.50 $958.50 $958.50 $958.50 N/A N/A 447.208 SUP HCPCS C1713 447.208 - PLATE BONE 1.3MM 8 HOLE INTERMEDIATE LOCKING COMPRESSION BOTH IP/OP "$1,084.50" $803.00 $215.25 "$1,084.50" $488.03 $488.03 $488.03 $488.03 "$1,084.50" "$1,084.50" "$1,084.50" $226.04 "$1,084.50" "$1,084.50" "$1,084.50" "$1,084.50" "$1,084.50" $226.02 "$1,084.50" "$1,084.50" $641.48 "$1,084.50" "$1,084.50" "$1,084.50" "$1,084.50" $813.38 "$1,084.50" "$1,084.50" "$1,084.50" $542.25 $542.25 $858.92 "$1,084.50" $867.60 $488.03 $215.25 N/A $629.01 "$1,084.50" $650.70 "$1,084.50" $226.01 "$1,084.50" N/A N/A 447.21 SUP HCPCS C1713 447.210 - PLATE BONE ANGLED 1.3MM 6 HOLE INTERMEDIATE LOCKING BOTH IP/OP "$1,208.50" $894.00 $239.81 "$1,208.25" $543.71 $543.71 $543.71 $543.71 "$1,208.25" "$1,208.25" "$1,208.25" $251.83 "$1,208.25" "$1,208.25" "$1,208.25" "$1,208.25" "$1,208.25" $251.81 "$1,208.25" "$1,208.25" $714.68 "$1,208.25" "$1,208.25" "$1,208.25" "$1,208.25" $906.38 "$1,208.25" "$1,208.25" "$1,208.25" $604.13 $604.13 $956.93 "$1,208.25" $966.60 $543.71 $239.81 N/A $700.93 "$1,208.25" $724.95 "$1,208.25" $251.80 "$1,208.25" N/A N/A 447.212 SUP HCPCS C1713 447.212 - PLATE BONE ANGLED 1.3MM 8 HOLE INTERMEDIATE LOCKING BOTH IP/OP "$1,300.50" $962.00 $258.12 "$1,300.50" $585.23 $585.23 $585.23 $585.23 "$1,300.50" "$1,300.50" "$1,300.50" $271.06 "$1,300.50" "$1,300.50" "$1,300.50" "$1,300.50" "$1,300.50" $271.04 "$1,300.50" "$1,300.50" $769.25 "$1,300.50" "$1,300.50" "$1,300.50" "$1,300.50" $975.38 "$1,300.50" "$1,300.50" "$1,300.50" $650.25 $650.25 "$1,030.00" "$1,300.50" "$1,040.40" $585.23 $258.12 N/A $754.29 "$1,300.50" $780.30 "$1,300.50" $271.02 "$1,300.50" N/A N/A 447.215 SUP HCPCS C1713 447.215 - PLATE BONE CRESCENT 1.3MM 5 HOLE INTERMEDIATE LOCKING BOTH IP/OP "$1,084.50" $803.00 $215.25 "$1,084.50" $488.03 $488.03 $488.03 $488.03 "$1,084.50" "$1,084.50" "$1,084.50" $226.04 "$1,084.50" "$1,084.50" "$1,084.50" "$1,084.50" "$1,084.50" $226.02 "$1,084.50" "$1,084.50" $641.48 "$1,084.50" "$1,084.50" "$1,084.50" "$1,084.50" $813.38 "$1,084.50" "$1,084.50" "$1,084.50" $542.25 $542.25 $858.92 "$1,084.50" $867.60 $488.03 $215.25 N/A $629.01 "$1,084.50" "$1,084.50" "$1,084.50" $226.01 "$1,084.50" N/A N/A 447.217 SUP HCPCS C1713 447.217 - PLATE BONE CRESCENT 1.3MM 7 HOLE INTERMEDIATE LOCKING BOTH IP/OP "$1,154.50" $854.00 $229.09 "$1,154.25" $519.41 $519.41 $519.41 $519.41 "$1,154.25" "$1,154.25" "$1,154.25" $240.57 "$1,154.25" "$1,154.25" "$1,154.25" "$1,154.25" "$1,154.25" $240.56 "$1,154.25" "$1,154.25" $682.74 "$1,154.25" "$1,154.25" "$1,154.25" "$1,154.25" $865.88 "$1,154.25" "$1,154.25" "$1,154.25" $577.13 $577.13 $914.17 "$1,154.25" $923.40 $519.41 $229.09 N/A $669.61 "$1,154.25" "$1,154.25" "$1,154.25" $240.55 "$1,154.25" N/A N/A 447.22 SUP HCPCS C1713 447.22 - PLATE BONE 53X4.8X.9MM 12 HOLE TITANIUM ORBTL RIM BOTH IP/OP $589.50 $436.00 $117.00 $589.50 $265.28 $265.28 $265.28 $265.28 $589.50 $589.50 $589.50 $122.87 $589.50 $589.50 $589.50 $589.50 $589.50 $122.86 $589.50 $589.50 $348.69 $589.50 $589.50 $589.50 $589.50 $442.13 $589.50 $589.50 $589.50 $294.75 $294.75 $466.88 $589.50 $471.60 $265.28 $117.00 N/A $341.91 $589.50 $589.50 $589.50 $589.50 $589.50 N/A N/A 447.232 SUP HCPCS C1713 447.232 - PLATE BN T 53X5X1.2MM NS PRO-PK 2 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $180.70 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $444.20 $444.20 $92.57 $444.20 N/A N/A 447.233 SUP HCPCS C1713 447.233 - PLATE BN T 53X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $290.13 $483.55 $100.77 $483.55 N/A N/A 447.244 SUP HCPCS C1713 447.244 - PLATE BONE T 25X4.5/4.8X.9MM 3X4 HOLE TITANIUM ORTHGNAT BOTH IP/OP $517.50 $383.00 $102.71 $517.50 $232.88 $232.88 $232.88 $232.88 $517.50 $517.50 $517.50 $107.86 $517.50 $517.50 $517.50 $517.50 $517.50 $107.85 $517.50 $517.50 $306.10 $517.50 $517.50 $517.50 $517.50 $388.13 $517.50 $517.50 $517.50 $258.75 $258.75 $409.86 $517.50 $414.00 $232.88 $102.71 N/A $300.15 $517.50 $517.50 $517.50 $517.50 $517.50 N/A N/A 447.304 SUP HCPCS C1713 447.304 - PLATE BONE MINI 1MM 4 HOLE LOCK TENSION BAND PREBENT BOTH IP/OP $988.00 $731.00 $196.04 $987.75 $444.49 $444.49 $444.49 $444.49 $987.75 $987.75 $987.75 $205.87 $987.75 $987.75 $987.75 $987.75 $987.75 $205.86 $987.75 $987.75 $584.25 $987.75 $987.75 $987.75 $987.75 $741.00 $987.75 $987.75 $987.75 $493.88 $493.88 $782.30 $987.75 $790.20 $444.49 $196.04 N/A $573.04 $987.75 $987.75 $987.75 $205.85 $987.75 N/A N/A 447.305 SUP HCPCS C1713 447.305 - PLATE BONE MINI 1MM 4 HOLE LOCK TENSION BAND PREBENT BOTH IP/OP $988.00 $731.00 $196.04 $987.75 $444.49 $444.49 $444.49 $444.49 $987.75 $987.75 $987.75 $205.87 $987.75 $987.75 $987.75 $987.75 $987.75 $205.86 $987.75 $987.75 $584.25 $987.75 $987.75 $987.75 $987.75 $741.00 $987.75 $987.75 $987.75 $493.88 $493.88 $782.30 $987.75 $790.20 $444.49 $196.04 N/A $573.04 $987.75 $592.65 $987.75 $205.85 $987.75 N/A N/A 447.308 SUP HCPCS C1713 447.308 - PLATE BONE 2 WIDE MINI 4.8X1MM 12 HOLE MALBLE LOCKING LP BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" "$1,057.50" $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" $634.50 "$1,057.50" $220.38 "$1,057.50" N/A N/A 447.309 SUP HCPCS C1713 447.309 - PLATE BONE 2 WIDE MINI 4.8X1MM 9 HOLE MALBLE LOCKING LP BOTH IP/OP $949.50 $703.00 $188.45 $949.50 $427.28 $427.28 $427.28 $427.28 $949.50 $949.50 $949.50 $197.90 $949.50 $949.50 $949.50 $949.50 $949.50 $197.89 $949.50 $949.50 $561.63 $949.50 $949.50 $949.50 $949.50 $712.13 $949.50 $949.50 $949.50 $474.75 $474.75 $752.00 $949.50 $759.60 $427.28 $188.45 N/A $550.71 $949.50 $569.70 $949.50 $197.88 $949.50 N/A N/A 447.31 SUP HCPCS C1713 447.310 - PLATE BONE MINI BOX 1MM 4 HOLE LOCKING MALBLE TITANIUM BOTH IP/OP $664.00 $491.00 $131.74 $663.75 $298.69 $298.69 $298.69 $298.69 $663.75 $663.75 $663.75 $138.34 $663.75 $663.75 $663.75 $663.75 $663.75 $138.33 $663.75 $663.75 $392.61 $663.75 $663.75 $663.75 $663.75 $498.00 $663.75 $663.75 $663.75 $331.88 $331.88 $525.69 $663.75 $531.00 $298.69 $131.74 N/A $385.12 $663.75 $398.25 $663.75 $138.33 $663.75 N/A N/A 447.312 SUP HCPCS C1713 447.312 - PLATE BONE MINI 1MM 8 HOLE LOCKING STRUT MALBLE DUCKBILL END BOTH IP/OP "$1,300.50" $962.00 $258.12 "$1,300.50" $585.23 $585.23 $585.23 $585.23 "$1,300.50" "$1,300.50" "$1,300.50" $271.06 "$1,300.50" "$1,300.50" "$1,300.50" "$1,300.50" "$1,300.50" $271.04 "$1,300.50" "$1,300.50" $769.25 "$1,300.50" "$1,300.50" "$1,300.50" "$1,300.50" $975.38 "$1,300.50" "$1,300.50" "$1,300.50" $650.25 $650.25 "$1,030.00" "$1,300.50" "$1,040.40" $585.23 $258.12 N/A $754.29 "$1,300.50" $780.30 "$1,300.50" $271.02 "$1,300.50" N/A N/A 447.315 SUP HCPCS C1713 447.315 - PLATE BONE MINI CVD STRUT 4.8X1MM 8 HOLE MALBLE LOCKING LP BOTH IP/OP "$1,300.50" $962.00 $258.12 "$1,300.50" $585.23 $585.23 $585.23 $585.23 "$1,300.50" "$1,300.50" "$1,300.50" $271.06 "$1,300.50" "$1,300.50" "$1,300.50" "$1,300.50" "$1,300.50" $271.04 "$1,300.50" $520.20 $769.25 "$1,300.50" "$1,300.50" "$1,300.50" "$1,300.50" $975.38 "$1,300.50" "$1,300.50" "$1,300.50" $650.25 $650.25 "$1,030.00" "$1,300.50" "$1,040.40" $585.23 $258.12 N/A $754.29 "$1,300.50" $780.30 "$1,300.50" $271.02 "$1,300.50" N/A N/A 447.317 SUP HCPCS C1713 447.317 - PLATE BONE 2Y MINI 4.8X1MM 6 HOLE MALBLE LOCKING LP TITANIUM BOTH IP/OP $679.50 $503.00 $134.86 $679.50 $305.78 $305.78 $305.78 $305.78 $679.50 $679.50 $679.50 $141.62 $679.50 $679.50 $679.50 $679.50 $679.50 $141.62 $679.50 $679.50 $401.92 $679.50 $679.50 $679.50 $679.50 $509.63 $679.50 $679.50 $679.50 $339.75 $339.75 $538.16 $679.50 $543.60 $305.78 $134.86 N/A $394.11 $679.50 $407.70 $679.50 $141.61 $679.50 N/A N/A 447.318 SUP HCPCS C1713 447.318 - PLATE BONE L MINI 4.8X1MM 5 HOLE MALBLE LOCKING LP TITANIUM BOTH IP/OP $628.00 $465.00 $124.59 $627.75 $282.49 $282.49 $282.49 $282.49 $627.75 $627.75 $627.75 $130.84 $627.75 $627.75 $627.75 $627.75 $627.75 $130.83 $627.75 $251.10 $371.31 $627.75 $627.75 $627.75 $627.75 $471.00 $627.75 $627.75 $627.75 $313.88 $313.88 $497.18 $627.75 $502.20 $282.49 $124.59 N/A $364.24 $627.75 $376.65 $627.75 $130.82 $627.75 N/A N/A 447.319 SUP HCPCS C1713 447.319 - PLATE BONE L MINI 4.8X1MM 5 HOLE MALBLE LOCKING LP TITANIUM BOTH IP/OP $628.00 $465.00 $124.59 $627.75 $282.49 $282.49 $282.49 $282.49 $627.75 $627.75 $627.75 $130.84 $627.75 $627.75 $627.75 $627.75 $627.75 $130.83 $627.75 $627.75 $371.31 $627.75 $627.75 $627.75 $627.75 $471.00 $627.75 $627.75 $627.75 $313.88 $313.88 $497.18 $627.75 $502.20 $282.49 $124.59 N/A $364.24 $627.75 $376.65 $627.75 $130.82 $627.75 N/A N/A 447.344 SUP HCPCS C1713 447.344 - PLATE BONE 31MM 4 HOLE LP LCP TITANIUM SMALL BONE CORTICAL BOTH IP/OP $460.00 $340.00 $91.23 $467.48 $206.84 $206.84 $206.84 $206.84 $459.65 $459.65 $459.65 $95.80 $459.65 $459.65 $459.65 $459.65 $459.65 $95.80 $459.65 $467.48 $271.88 $459.65 $467.48 $459.65 $459.65 $345.00 $459.65 $459.65 $459.65 $229.83 $229.83 $364.04 $459.65 $367.72 $206.84 $91.23 N/A $266.80 $459.65 $459.65 $459.65 $95.79 $459.65 N/A N/A 447.345 SUP HCPCS C1713 447.345 - PLATE BONE 38MM 5 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM BOTH IP/OP $460.00 $340.00 $91.23 $467.48 $206.84 $206.84 $206.84 $206.84 $459.65 $459.65 $459.65 $95.80 $459.65 $459.65 $459.65 $459.65 $459.65 $95.80 $459.65 $467.48 $271.88 $459.65 $467.48 $459.65 $459.65 $345.00 $459.65 $459.65 $459.65 $229.83 $229.83 $364.04 $459.65 $367.72 $206.84 $91.23 N/A $266.80 $459.65 $459.65 $459.65 $95.79 $459.65 N/A N/A 447.346 SUP HCPCS C1713 447.346 - PLATE BONE 45MM 6 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM BOTH IP/OP $460.00 $340.00 $91.23 $467.48 $206.84 $206.84 $206.84 $206.84 $459.65 $459.65 $459.65 $95.80 $459.65 $459.65 $459.65 $459.65 $459.65 $95.80 $459.65 $467.48 $271.88 $459.65 $467.48 $459.65 $459.65 $345.00 $459.65 $459.65 $459.65 $229.83 $229.83 $364.04 $459.65 $367.72 $206.84 $91.23 N/A $266.80 $459.65 $459.65 $459.65 $95.79 $459.65 N/A N/A 447.347 SUP HCPCS C1713 447.347 - PLATE BONE 52MM 7 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM BOTH IP/OP $460.00 $340.00 $91.23 $467.48 $206.84 $206.84 $206.84 $206.84 $459.65 $459.65 $459.65 $95.80 $459.65 $459.65 $459.65 $459.65 $459.65 $95.80 $459.65 $186.99 $271.88 $459.65 $467.48 $459.65 $459.65 $345.00 $459.65 $459.65 $459.65 $229.83 $229.83 $364.04 $459.65 $367.72 $206.84 $91.23 N/A $266.80 $459.65 $459.65 $459.65 $95.79 $459.65 N/A N/A 447.348 SUP HCPCS C1713 447.348 - PLATE BONE 59MM 8 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2MM BOTH IP/OP $460.00 $340.00 $91.23 $467.48 $206.84 $206.84 $206.84 $206.84 $459.65 $459.65 $459.65 $95.80 $459.65 $459.65 $459.65 $459.65 $459.65 $95.80 $459.65 $186.99 $271.88 $459.65 $467.48 $459.65 $459.65 $345.00 $459.65 $459.65 $459.65 $229.83 $229.83 $364.04 $459.65 $367.72 $206.84 $91.23 N/A $266.80 $459.65 $459.65 $459.65 $95.79 $459.65 N/A N/A 447.349 SUP HCPCS C1713 447.349 - PLATE BONE 7 HOLE LCP TITANIUM CONDYLE NONSTRL 2 MM SCREWS BOTH IP/OP "$1,446.50" "$1,070.00" $287.08 "$1,471.05" $650.90 $650.90 $650.90 $650.90 "$1,446.45" "$1,446.45" "$1,446.45" $301.48 "$1,446.45" "$1,446.45" "$1,446.45" "$1,446.45" "$1,446.45" $301.46 "$1,446.45" $588.42 $855.58 "$1,446.45" "$1,471.05" "$1,446.45" "$1,446.45" "$1,084.88" "$1,446.45" "$1,446.45" "$1,446.45" $723.23 $723.23 "$1,145.59" "$1,446.45" "$1,157.16" $650.90 $287.08 N/A $838.97 "$1,446.45" "$1,446.45" "$1,446.45" $301.44 "$1,446.45" N/A N/A 447.35 SUP HCPCS C1713 447.350 - PLATE BONE Y 55MM 3X7 HOLE LCP TITANIUM SMALL BONE NONSTRL 2 BOTH IP/OP $789.00 $584.00 $156.56 $826.33 $354.97 $354.97 $354.97 $354.97 $788.83 $788.83 $788.83 $164.41 $788.83 $788.83 $788.83 $788.83 $788.83 $164.40 $788.83 $826.33 $466.59 $788.83 $826.33 $788.83 $788.83 $591.75 $788.83 $788.83 $788.83 $394.42 $394.42 $624.75 $788.83 $631.06 $354.97 $156.56 N/A $457.62 $788.83 $788.83 $788.83 $164.39 $788.83 N/A N/A 447.351 SUP HCPCS C1713 447.351 - PLATE BONE 2 HOLE HEAD 7 HOLE SHAFT T LCP TITANIUM BOTH IP/OP $812.50 $601.00 $161.26 $826.33 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $826.33 $480.59 $812.50 $826.33 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 447.36 SUP HCPCS C1713 447.360 - PLATE BONE 73MM 10 HOLE LCP TITANIUM SMALL BONE NONSTRL 2MM BOTH IP/OP $446.50 $330.00 $88.58 $467.48 $200.83 $200.83 $200.83 $200.83 $446.28 $446.28 $446.28 $93.02 $446.28 $446.28 $446.28 $446.28 $446.28 $93.01 $446.28 $467.48 $263.97 $446.28 $467.48 $446.28 $446.28 $334.88 $446.28 $446.28 $446.28 $223.14 $223.14 $353.45 $446.28 $357.02 $200.83 $88.58 N/A $258.97 $446.28 $446.28 $446.28 $93.00 $446.28 N/A N/A 447.362 SUP HCPCS C1713 447.362 - PLATE BONE 81MM 12 HOLE ADAPTION LCP TITANIUM ORTHOPEDIC BOTH IP/OP $777.50 $575.00 $154.28 $790.58 $349.81 $349.81 $349.81 $349.81 $777.35 $777.35 $777.35 $162.02 $777.35 $777.35 $777.35 $777.35 $777.35 $162.01 $777.35 $316.23 $459.80 $777.35 $790.58 $777.35 $777.35 $583.13 $777.35 $777.35 $777.35 $388.68 $388.68 $615.66 $777.35 $621.88 $349.81 $154.28 N/A $450.95 $777.35 $777.35 $777.35 $162.00 $777.35 N/A N/A 447.364 SUP HCPCS C1713 447.364 - PLATE BONE 84MM 10 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4 BOTH IP/OP $735.50 $544.00 $145.91 $747.68 $330.83 $330.83 $330.83 $330.83 $735.18 $735.18 $735.18 $153.23 $735.18 $735.18 $735.18 $735.18 $735.18 $153.22 $735.18 $299.07 $434.86 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $330.83 $145.91 N/A $426.59 $735.18 $735.18 $735.18 $153.21 $735.18 N/A N/A 447.366 SUP HCPCS C1713 447.366 - PLATE BONE 88MM 12 HOLE ADAPTION LCP TITANIUM ORTHOPEDIC BOTH IP/OP $856.50 $634.00 $169.91 $870.63 $385.24 $385.24 $385.24 $385.24 $856.08 $856.08 $856.08 $178.43 $856.08 $856.08 $856.08 $856.08 $856.08 $178.42 $856.08 $870.63 $506.37 $856.08 $870.63 $856.08 $856.08 $642.38 $856.08 $856.08 $856.08 $428.04 $428.04 $678.02 $856.08 $684.86 $385.24 $169.91 N/A $496.77 $856.08 $856.08 $856.08 $178.41 $856.08 N/A N/A 447.37 SUP HCPCS C1713 447.370 - PLATE BONE 97MM 12 HOLE ADAPTION LCP TITANIUM SMALL BONE BOTH IP/OP $831.50 $615.00 $164.96 $870.63 $374.01 $374.01 $374.01 $374.01 $831.13 $831.13 $831.13 $173.23 $831.13 $831.13 $831.13 $831.13 $831.13 $173.22 $831.13 $870.63 $491.61 $831.13 $870.63 $831.13 $831.13 $623.63 $831.13 $831.13 $831.13 $415.57 $415.57 $658.25 $831.13 $664.90 $374.01 $164.96 N/A $482.27 $831.13 $831.13 $831.13 $173.21 $831.13 N/A N/A 447.372 SUP HCPCS C1713 447.372 - PLATE BONE 76MM 8 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.7MM BOTH IP/OP $776.00 $574.00 $154.01 $789.15 $349.18 $349.18 $349.18 $349.18 $775.95 $775.95 $775.95 $161.73 $775.95 $775.95 $775.95 $775.95 $775.95 $161.72 $775.95 $315.66 $458.97 $775.95 $789.15 $775.95 $775.95 $582.00 $775.95 $775.95 $775.95 $387.98 $387.98 $614.55 $775.95 $620.76 $349.18 $154.01 N/A $450.08 $775.95 $775.95 $775.95 $161.71 $775.95 N/A N/A 447.374 SUP HCPCS C1713 447.374 - PLATE BN 94MM NS LCP PRO-PK 10 HL LOPRFL CUT TO LGTH TI 2.7 BOTH IP/OP $776.00 $574.00 $154.01 $789.15 $349.18 $349.18 $349.18 $349.18 $775.95 $775.95 $775.95 $161.73 $775.95 $775.95 $775.95 $775.95 $775.95 $161.72 $775.95 $315.66 $458.97 $775.95 $789.15 $775.95 $775.95 $582.00 $775.95 $775.95 $775.95 $387.98 $387.98 $614.55 $775.95 $620.76 $349.18 $154.01 N/A $450.08 $775.95 $775.95 $775.95 $775.95 $775.95 N/A N/A 447.375 SUP HCPCS C1713 447.375 - PLATE BONE 44MM 5 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM BOTH IP/OP $735.50 $544.00 $145.91 $747.68 $330.83 $330.83 $330.83 $330.83 $735.18 $735.18 $735.18 $153.23 $735.18 $735.18 $735.18 $735.18 $735.18 $153.22 $735.18 $299.07 $434.86 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $330.83 $145.91 N/A $426.59 $735.18 $735.18 $735.18 $735.18 $735.18 N/A N/A 447.377 SUP HCPCS C1713 447.377 - PLATE BONE 60MM 7 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM BOTH IP/OP $735.50 $544.00 $145.91 $747.68 $330.83 $330.83 $330.83 $330.83 $735.18 $735.18 $735.18 $153.23 $735.18 $735.18 $735.18 $735.18 $735.18 $153.22 $735.18 $299.07 $434.86 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $330.83 $145.91 N/A $426.59 $735.18 $735.18 $735.18 $153.21 $735.18 N/A N/A 447.38 SUP HCPCS C1713 447.38 - PLATE BONE 6.5MM SPACING 193MMX.9MM 30 HOLE ADAPTION BOTH IP/OP "$1,156.50" $856.00 $229.54 "$1,156.50" $520.43 $520.43 $520.43 $520.43 "$1,156.50" "$1,156.50" "$1,156.50" $241.04 "$1,156.50" "$1,156.50" "$1,156.50" "$1,156.50" "$1,156.50" $241.03 "$1,156.50" $462.60 $684.07 "$1,156.50" "$1,156.50" "$1,156.50" "$1,156.50" $867.38 "$1,156.50" "$1,156.50" "$1,156.50" $578.25 $578.25 $915.95 "$1,156.50" $925.20 $520.43 $229.54 N/A $670.77 "$1,156.50" "$1,156.50" "$1,156.50" "$1,156.50" "$1,156.50" N/A N/A 447.404 SUP HCPCS C1713 447.404 - PLATE BONE 2 ANGLE LARGE 6.5X1.5MM 4X20X4 HOLE LOCKING LP BOTH IP/OP "$4,916.50" "$3,638.00" $975.75 "$4,916.25" "$2,212.31" "$2,212.31" "$2,212.31" "$2,212.31" "$4,916.25" "$4,916.25" "$4,916.25" "$1,024.67" "$4,916.25" "$4,916.25" "$4,916.25" "$4,916.25" "$4,916.25" "$1,024.60" "$4,916.25" "$4,916.25" "$2,423.71" "$4,916.25" "$4,916.25" "$4,916.25" "$4,916.25" "$3,687.38" "$4,916.25" "$4,916.25" "$4,916.25" "$2,458.13" "$2,458.13" "$3,893.67" "$4,916.25" "$3,933.00" "$2,212.31" $975.75 N/A "$2,851.57" "$4,916.25" "$2,949.75" "$4,916.25" "$1,024.55" "$4,916.25" N/A N/A 447.405 SUP HCPCS C1713 447.405 - PLATE BONE 2 ANGLE LARGE 6.5X1.5MM 5X22X5 HOLE LOCKING LP BOTH IP/OP "$5,191.00" "$3,841.00" "$1,030.23" "$5,190.75" "$2,335.84" "$2,335.84" "$2,335.84" "$2,335.84" "$5,190.75" "$5,190.75" "$5,190.75" "$1,081.88" "$5,190.75" "$5,190.75" "$5,190.75" "$5,190.75" "$5,190.75" "$1,081.81" "$5,190.75" "$2,076.30" "$2,559.04" "$5,190.75" "$5,190.75" "$5,190.75" "$5,190.75" "$3,893.25" "$5,190.75" "$5,190.75" "$5,190.75" "$2,595.38" "$2,595.38" "$4,111.07" "$5,190.75" "$4,152.60" "$2,335.84" "$1,030.23" N/A "$3,010.78" "$5,190.75" "$3,114.45" "$5,190.75" "$1,081.75" "$5,190.75" N/A N/A 447.406 SUP HCPCS C1713 447.406 - PLATE BONE 2 ANGLE LARGE 6.5X1.5MM 6X24X6 HOLE LOCKING LP BOTH IP/OP "$5,474.50" "$4,051.00" "$1,086.50" "$5,474.25" "$2,463.41" "$2,463.41" "$2,463.41" "$2,463.41" "$5,474.25" "$5,474.25" "$5,474.25" "$1,140.97" "$5,474.25" "$5,474.25" "$5,474.25" "$5,474.25" "$5,474.25" "$1,140.89" "$5,474.25" "$5,474.25" "$2,698.81" "$5,474.25" "$5,474.25" "$5,474.25" "$5,474.25" "$4,105.88" "$5,474.25" "$5,474.25" "$5,474.25" "$2,737.13" "$2,737.13" "$4,335.61" "$5,474.25" "$4,379.40" "$2,463.41" "$1,086.50" N/A "$3,175.21" "$5,474.25" "$3,284.55" "$5,474.25" "$5,474.25" "$5,474.25" N/A N/A 447.412 SUP HCPCS C1713 447.412 - PLATE BONE XL STR 6.5X2MM 12 HOLE LOCKING LP TITANIUM MANDIB BOTH IP/OP "$1,953.00" "$1,445.00" $387.62 "$1,953.00" $878.85 $878.85 $878.85 $878.85 "$1,953.00" "$1,953.00" "$1,953.00" $407.05 "$1,953.00" "$1,953.00" "$1,953.00" "$1,953.00" "$1,953.00" $407.03 "$1,953.00" $781.20 "$1,155.20" "$1,953.00" "$1,953.00" "$1,953.00" "$1,953.00" "$1,464.75" "$1,953.00" "$1,953.00" "$1,953.00" $976.50 $976.50 "$1,546.78" "$1,953.00" "$1,562.40" $878.85 $387.62 N/A "$1,132.74" "$1,953.00" "$1,171.80" "$1,953.00" $407.01 "$1,953.00" N/A N/A 447.42 SUP HCPCS C1713 447.420 - PLATE BONE XL STR 6.5X2MM 20 HOLE LOCKING LP TITANIUM MANDIB BOTH IP/OP "$2,698.00" "$1,997.00" $535.44 "$2,697.75" "$1,213.99" "$1,213.99" "$1,213.99" "$1,213.99" "$2,697.75" "$2,697.75" "$2,697.75" $562.28 "$2,697.75" "$2,697.75" "$2,697.75" "$2,697.75" "$2,697.75" $562.24 "$2,697.75" "$1,079.10" "$1,329.99" "$2,697.75" "$2,697.75" "$2,697.75" "$2,697.75" "$2,023.50" "$2,697.75" "$2,697.75" "$2,697.75" "$1,348.88" "$1,348.88" "$2,136.62" "$2,697.75" "$2,158.20" "$1,213.99" $535.44 N/A "$1,564.84" "$2,697.75" "$2,697.75" "$2,697.75" $562.21 "$2,697.75" N/A N/A 447.422 SUP HCPCS C1713 447.422 - PLATE BONE MINI 2MM 6X21 HOLE 1 HAND USE EASILY BEND EXTRA BOTH IP/OP "$4,459.50" "$3,300.00" $885.10 "$4,459.50" "$2,006.78" "$2,006.78" "$2,006.78" "$2,006.78" "$4,459.50" "$4,459.50" "$4,459.50" $929.47 "$4,459.50" "$4,459.50" "$4,459.50" "$4,459.50" "$4,459.50" $929.41 "$4,459.50" "$4,459.50" "$2,198.53" "$4,459.50" "$4,459.50" "$4,459.50" "$4,459.50" "$3,344.63" "$4,459.50" "$4,459.50" "$4,459.50" "$2,229.75" "$2,229.75" "$3,531.92" "$4,459.50" "$3,567.60" "$2,006.78" $885.10 N/A "$2,586.51" "$4,459.50" "$2,675.70" "$4,459.50" $929.36 "$4,459.50" N/A N/A 447.423 SUP HCPCS C1713 447.423 - PLATE BONE XL LEFT ANGLE 6.5X2MM 6X21 HOLE LOCKING LP BOTH IP/OP "$4,459.50" "$3,300.00" $885.10 "$4,459.50" "$2,006.78" "$2,006.78" "$2,006.78" "$2,006.78" "$4,459.50" "$4,459.50" "$4,459.50" $929.47 "$4,459.50" "$4,459.50" "$4,459.50" "$4,459.50" "$4,459.50" $929.41 "$4,459.50" "$1,783.80" "$2,198.53" "$4,459.50" "$4,459.50" "$4,459.50" "$4,459.50" "$3,344.63" "$4,459.50" "$4,459.50" "$4,459.50" "$2,229.75" "$2,229.75" "$3,531.92" "$4,459.50" "$3,567.60" "$2,006.78" $885.10 N/A "$2,586.51" "$4,459.50" "$2,675.70" "$4,459.50" $929.36 "$4,459.50" N/A N/A 447.424 SUP HCPCS C1713 447.424 - PLATE BONE 2 ANGLE XL 6.5X2MM 4X20X4 HOLE LOCKING LP BOTH IP/OP "$5,155.00" "$3,815.00" "$1,023.09" "$5,154.75" "$2,319.64" "$2,319.64" "$2,319.64" "$2,319.64" "$5,154.75" "$5,154.75" "$5,154.75" "$1,074.38" "$5,154.75" "$5,154.75" "$5,154.75" "$5,154.75" "$5,154.75" "$1,074.31" "$5,154.75" "$5,154.75" "$2,541.29" "$5,154.75" "$5,154.75" "$5,154.75" "$5,154.75" "$3,866.25" "$5,154.75" "$5,154.75" "$5,154.75" "$2,577.38" "$2,577.38" "$4,082.56" "$5,154.75" "$4,123.80" "$2,319.64" "$1,023.09" N/A "$2,989.90" "$5,154.75" "$5,154.75" "$5,154.75" "$1,074.25" "$5,154.75" N/A N/A 447.425 SUP HCPCS C1713 447.425 - PLATE BONE 2 ANGLE XL 6.5X2MM 5X22X5 HOLE LOCKING LP BOTH IP/OP "$5,447.50" "$4,031.00" "$1,081.14" "$5,447.25" "$2,451.26" "$2,451.26" "$2,451.26" "$2,451.26" "$5,447.25" "$5,447.25" "$5,447.25" "$1,135.34" "$5,447.25" "$5,447.25" "$5,447.25" "$5,447.25" "$5,447.25" "$1,135.27" "$5,447.25" "$5,447.25" "$2,685.49" "$5,447.25" "$5,447.25" "$5,447.25" "$5,447.25" "$4,085.63" "$5,447.25" "$5,447.25" "$5,447.25" "$2,723.63" "$2,723.63" "$4,314.22" "$5,447.25" "$4,357.80" "$2,451.26" "$1,081.14" N/A "$3,159.55" "$5,447.25" "$3,268.35" "$5,447.25" "$1,135.21" "$5,447.25" N/A N/A 447.426 SUP HCPCS C1713 447.426 - PLATE BONE 2 ANGLE XL 6.5X2MM 6X24X6 HOLE LOCKING LP BOTH IP/OP "$5,735.50" "$4,244.00" "$1,138.30" "$5,735.25" "$2,580.86" "$2,580.86" "$2,580.86" "$2,580.86" "$5,735.25" "$5,735.25" "$5,735.25" "$1,195.37" "$5,735.25" "$5,735.25" "$5,735.25" "$5,735.25" "$5,735.25" "$1,195.29" "$5,735.25" "$5,735.25" "$2,827.48" "$5,735.25" "$5,735.25" "$5,735.25" "$5,735.25" "$4,301.63" "$5,735.25" "$5,735.25" "$5,735.25" "$2,867.63" "$2,867.63" "$4,542.32" "$5,735.25" "$4,588.20" "$2,580.86" "$1,138.30" N/A "$3,326.59" "$5,735.25" "$3,441.15" "$5,735.25" "$1,195.23" "$5,735.25" N/A N/A 447.5 SUP HCPCS C1713 447.50 - PLATE BN 5MM SPC OB L L 25X10X.9MM NS 4.8MM 2 HL BS 3 HL BOTH IP/OP $558.00 $413.00 $110.75 $558.00 $251.10 $251.10 $251.10 $251.10 $558.00 $558.00 $558.00 $116.30 $558.00 $558.00 $558.00 $558.00 $558.00 $116.29 $558.00 $558.00 $330.06 $558.00 $558.00 $558.00 $558.00 $418.50 $558.00 $558.00 $558.00 $279.00 $279.00 $441.94 $558.00 $446.40 $251.10 $110.75 N/A $323.64 $558.00 $334.80 $558.00 $116.29 $558.00 N/A N/A 447.51 SUP HCPCS C1713 447.51 - PLATE BONE 100D 3 HOLE RIGHT OBLIQUE TITANIUM ORTHOPEDIC BOTH IP/OP $558.00 $413.00 $110.75 $558.00 $251.10 $251.10 $251.10 $251.10 $558.00 $558.00 $558.00 $116.30 $558.00 $558.00 $558.00 $558.00 $558.00 $116.29 $558.00 $558.00 $330.06 $558.00 $558.00 $558.00 $558.00 $418.50 $558.00 $558.00 $558.00 $279.00 $279.00 $441.94 $558.00 $446.40 $251.10 $110.75 N/A $323.64 $558.00 $558.00 $558.00 $116.29 $558.00 N/A N/A 447.515 SUP HCPCS C1713 447.515 - PLATE BONE 100D L RIGHT OBLIQUE 25X10X.6MM 2X3 HOLE MALBLE BOTH IP/OP $549.00 $406.00 $108.96 $549.00 $247.05 $247.05 $247.05 $247.05 $549.00 $549.00 $549.00 $114.43 $549.00 $549.00 $549.00 $549.00 $549.00 $114.42 $549.00 $549.00 $324.73 $549.00 $549.00 $549.00 $549.00 $411.75 $549.00 $549.00 $549.00 $274.50 $274.50 $434.81 $549.00 $439.20 $247.05 $108.96 N/A $318.42 $549.00 $549.00 $549.00 $114.41 $549.00 N/A N/A 447.516 SUP HCPCS C1713 447.516 - PLATE BONE 100D L LEFT OBLIQUE 25X10X.6MM 2X3 HOLE MALBLE BOTH IP/OP $549.00 $406.00 $108.96 $549.00 $247.05 $247.05 $247.05 $247.05 $549.00 $549.00 $549.00 $114.43 $549.00 $549.00 $549.00 $549.00 $549.00 $114.42 $549.00 $549.00 $324.73 $549.00 $549.00 $549.00 $549.00 $411.75 $549.00 $549.00 $549.00 $274.50 $274.50 $434.81 $549.00 $439.20 $247.05 $108.96 N/A $318.42 $549.00 $549.00 $549.00 $114.41 $549.00 N/A N/A 447.52 SUP HCPCS C1713 447.52 - PLATE BN 5MM SPC OB L L 31X15X.9MM NS 4.8MM 3 HL BS 4 HL BOTH IP/OP $587.50 $435.00 $116.55 $587.25 $264.26 $264.26 $264.26 $264.26 $587.25 $587.25 $587.25 $122.40 $587.25 $587.25 $587.25 $587.25 $587.25 $122.39 $587.25 $587.25 $347.36 $587.25 $587.25 $587.25 $587.25 $440.63 $587.25 $587.25 $587.25 $293.63 $293.63 $465.10 $587.25 $469.80 $264.26 $116.55 N/A $340.75 $587.25 $587.25 $587.25 $587.25 $587.25 N/A N/A 447.521 SUP HCPCS C1713 447.521 - PLATE BONE 100D 4X3 HOLE L RIGHT OBLIQUE NO BAR TITANIUM BOTH IP/OP $481.50 $356.00 $95.57 $481.50 $216.68 $216.68 $216.68 $216.68 $481.50 $481.50 $481.50 $100.36 $481.50 $481.50 $481.50 $481.50 $481.50 $100.35 $481.50 $481.50 $284.81 $481.50 $481.50 $481.50 $481.50 $361.13 $481.50 $481.50 $481.50 $240.75 $240.75 $381.35 $481.50 $385.20 $216.68 $95.57 N/A $279.27 $481.50 $288.90 $481.50 $481.50 $481.50 N/A N/A 447.522 SUP HCPCS C1713 447.522 - PLATE BONE 100D 4X3 HOLE L LEFT OBLIQUE NO BAR TITANIUM BOTH IP/OP $481.50 $356.00 $95.57 $481.50 $216.68 $216.68 $216.68 $216.68 $481.50 $481.50 $481.50 $100.36 $481.50 $481.50 $481.50 $481.50 $481.50 $100.35 $481.50 $481.50 $284.81 $481.50 $481.50 $481.50 $481.50 $361.13 $481.50 $481.50 $481.50 $240.75 $240.75 $381.35 $481.50 $385.20 $216.68 $95.57 N/A $279.27 $481.50 $288.90 $481.50 $100.34 $481.50 N/A N/A 447.524 SUP HCPCS C1713 447.524 - PLATE BONE 90D 20MM 2X2 HOLE L TITANIUM RIGHT BOTH IP/OP $488.50 $361.00 $96.91 $488.25 $219.71 $219.71 $219.71 $219.71 $488.25 $488.25 $488.25 $101.76 $488.25 $488.25 $488.25 $488.25 $488.25 $101.76 $488.25 $488.25 $288.80 $488.25 $488.25 $488.25 $488.25 $366.38 $488.25 $488.25 $488.25 $244.13 $244.13 $386.69 $488.25 $390.60 $219.71 $96.91 N/A $283.33 $488.25 $488.25 $488.25 $101.75 $488.25 N/A N/A 447.525 SUP HCPCS C1713 447.525 - PLATE BONE 90D 20MM 2X2 HOLE L TITANIUM LEFT BOTH IP/OP $488.50 $361.00 $96.91 $488.25 $219.71 $219.71 $219.71 $219.71 $488.25 $488.25 $488.25 $101.76 $488.25 $488.25 $488.25 $488.25 $488.25 $101.76 $488.25 $488.25 $288.80 $488.25 $488.25 $488.25 $488.25 $366.38 $488.25 $488.25 $488.25 $244.13 $244.13 $386.69 $488.25 $390.60 $219.71 $96.91 N/A $283.33 $488.25 $488.25 $488.25 $101.75 $488.25 N/A N/A 447.527 SUP HCPCS C1713 447.527 - PLATE BONE 100D 3X4 HOLE LEFT OBLIQUE MALBLE TITANIUM BOTH IP/OP $576.00 $426.00 $114.32 $576.00 $259.20 $259.20 $259.20 $259.20 $576.00 $576.00 $576.00 $120.05 $576.00 $576.00 $576.00 $576.00 $576.00 $120.04 $576.00 $576.00 $340.70 $576.00 $576.00 $576.00 $576.00 $432.00 $576.00 $576.00 $576.00 $288.00 $288.00 $456.19 $576.00 $460.80 $259.20 $114.32 N/A $334.08 $576.00 $345.60 $576.00 $120.04 $576.00 N/A N/A 447.53 SUP HCPCS C1713 447.53 - PLATE BN 5MM SPC OB R L 31X15X.9MM NS 4.8MM 3 HL BS 4 HL BOTH IP/OP $587.50 $435.00 $116.55 $587.25 $264.26 $264.26 $264.26 $264.26 $587.25 $587.25 $587.25 $122.40 $587.25 $587.25 $587.25 $587.25 $587.25 $122.39 $587.25 $587.25 $347.36 $587.25 $587.25 $587.25 $587.25 $440.63 $587.25 $587.25 $587.25 $293.63 $293.63 $465.10 $587.25 $469.80 $264.26 $116.55 N/A $340.75 $587.25 $352.35 $587.25 $122.38 $587.25 N/A N/A 447.537 SUP HCPCS C1713 447.537 - PLATE BONE 100D 3X4 HOLE L RIGHT OBLIQUE MALBLE TITANIUM BOTH IP/OP $576.00 $426.00 $114.32 $576.00 $259.20 $259.20 $259.20 $259.20 $576.00 $576.00 $576.00 $120.05 $576.00 $576.00 $576.00 $576.00 $576.00 $120.04 $576.00 $576.00 $340.70 $576.00 $576.00 $576.00 $576.00 $432.00 $576.00 $576.00 $576.00 $288.00 $288.00 $456.19 $576.00 $460.80 $259.20 $114.32 N/A $334.08 $576.00 $345.60 $576.00 $120.04 $576.00 N/A N/A 447.54 SUP HCPCS C1713 447.54 - PLATE BN 5MM SPC OB L L 41X20X.9MM NS 4.8MM 4 HL BS 6 HL BOTH IP/OP $641.50 $475.00 $127.27 $641.25 $288.56 $288.56 $288.56 $288.56 $641.25 $641.25 $641.25 $133.65 $641.25 $641.25 $641.25 $641.25 $641.25 $133.64 $641.25 $641.25 $379.30 $641.25 $641.25 $641.25 $641.25 $481.13 $641.25 $641.25 $641.25 $320.63 $320.63 $507.87 $641.25 $513.00 $288.56 $127.27 N/A $372.07 $641.25 $641.25 $641.25 $133.64 $641.25 N/A N/A 447.546 SUP HCPCS C1713 447.546 - PLATE BONE L SHORT RIGHT OBLIQUE 18X4.8X.6MM 11MM 2X2 HOLE BOTH IP/OP $430.00 $318.00 $85.29 $429.75 $193.39 $193.39 $193.39 $193.39 $429.75 $429.75 $429.75 $89.57 $429.75 $429.75 $429.75 $429.75 $429.75 $89.56 $429.75 $429.75 $254.20 $429.75 $429.75 $429.75 $429.75 $322.50 $429.75 $429.75 $429.75 $214.88 $214.88 $340.36 $429.75 $343.80 $193.39 $85.29 N/A $249.40 $429.75 $429.75 $429.75 $89.56 $429.75 N/A N/A 447.547 SUP HCPCS C1713 447.547 - PLATE BONE L SHORT LEFT OBLIQUE 18X4.8X.6MM 11MM 2X2 HOLE BOTH IP/OP $430.00 $318.00 $85.29 $429.75 $193.39 $193.39 $193.39 $193.39 $429.75 $429.75 $429.75 $89.57 $429.75 $429.75 $429.75 $429.75 $429.75 $89.56 $429.75 $429.75 $254.20 $429.75 $429.75 $429.75 $429.75 $322.50 $429.75 $429.75 $429.75 $214.88 $214.88 $340.36 $429.75 $343.80 $193.39 $85.29 N/A $249.40 $429.75 $257.85 $429.75 $89.56 $429.75 N/A N/A 447.548 SUP HCPCS C1713 447.548 - PLATE BONE L LONG RIGHT OBLIQUE 20X4.8X.6MM 11MM 2X2 HOLE BOTH IP/OP $486.00 $360.00 $96.46 $486.00 $218.70 $218.70 $218.70 $218.70 $486.00 $486.00 $486.00 $101.29 $486.00 $486.00 $486.00 $486.00 $486.00 $101.29 $486.00 $486.00 $287.47 $486.00 $486.00 $486.00 $486.00 $364.50 $486.00 $486.00 $486.00 $243.00 $243.00 $384.91 $486.00 $388.80 $218.70 $96.46 N/A $281.88 $486.00 $291.60 $486.00 $101.28 $486.00 N/A N/A 447.549 SUP HCPCS C1713 447.549 - PLATE BONE L LONG LEFT OBLIQUE 20X4.8X.6MM 11MM 2X2 HOLE BOTH IP/OP $486.00 $360.00 $96.46 $486.00 $218.70 $218.70 $218.70 $218.70 $486.00 $486.00 $486.00 $101.29 $486.00 $486.00 $486.00 $486.00 $486.00 $101.29 $486.00 $486.00 $287.47 $486.00 $486.00 $486.00 $486.00 $364.50 $486.00 $486.00 $486.00 $243.00 $243.00 $384.91 $486.00 $388.80 $218.70 $96.46 N/A $281.88 $486.00 $291.60 $486.00 $101.28 $486.00 N/A N/A 447.55 SUP HCPCS C1713 447.55 - PLATE BN 5MM SPC OB R L 41X20X.9MM NS 4.8MM 4 HL BS 6 HL BOTH IP/OP $641.50 $475.00 $127.27 $641.25 $288.56 $288.56 $288.56 $288.56 $641.25 $641.25 $641.25 $133.65 $641.25 $641.25 $641.25 $641.25 $641.25 $133.64 $641.25 $641.25 $379.30 $641.25 $641.25 $641.25 $641.25 $481.13 $641.25 $641.25 $641.25 $320.63 $320.63 $507.87 $641.25 $513.00 $288.56 $127.27 N/A $372.07 $641.25 $641.25 $641.25 $133.64 $641.25 N/A N/A 447.556 SUP HCPCS C1713 447.556 - PLATE BONE L SHORT RIGHT OBLIQUE 18X4.8X.6MM 11MM 2X2 HOLE BOTH IP/OP $486.00 $360.00 $96.46 $486.00 $218.70 $218.70 $218.70 $218.70 $486.00 $486.00 $486.00 $101.29 $486.00 $486.00 $486.00 $486.00 $486.00 $101.29 $486.00 $486.00 $287.47 $486.00 $486.00 $486.00 $486.00 $364.50 $486.00 $486.00 $486.00 $243.00 $243.00 $384.91 $486.00 $388.80 $218.70 $96.46 N/A $281.88 $486.00 $486.00 $486.00 $101.28 $486.00 N/A N/A 447.557 SUP HCPCS C1713 447.557 - PLATE BONE L SHORT LEFT OBLIQUE 18X4.8X.6MM 11MM 2X2 HOLE BOTH IP/OP $486.00 $360.00 $96.46 $486.00 $218.70 $218.70 $218.70 $218.70 $486.00 $486.00 $486.00 $101.29 $486.00 $486.00 $486.00 $486.00 $486.00 $101.29 $486.00 $486.00 $287.47 $486.00 $486.00 $486.00 $486.00 $364.50 $486.00 $486.00 $486.00 $243.00 $243.00 $384.91 $486.00 $388.80 $218.70 $96.46 N/A $281.88 $486.00 $486.00 $486.00 $101.28 $486.00 N/A N/A 447.558 SUP HCPCS C1713 447.558 - PLATE BONE L LONG RIGHT OBLIQUE 20X4.8X.6MM 11MM 2X2 HOLE BOTH IP/OP $486.00 $360.00 $96.46 $486.00 $218.70 $218.70 $218.70 $218.70 $486.00 $486.00 $486.00 $101.29 $486.00 $486.00 $486.00 $486.00 $486.00 $101.29 $486.00 $486.00 $287.47 $486.00 $486.00 $486.00 $486.00 $364.50 $486.00 $486.00 $486.00 $243.00 $243.00 $384.91 $486.00 $388.80 $218.70 $96.46 N/A $281.88 $486.00 $486.00 $486.00 $486.00 $486.00 N/A N/A 447.559 SUP HCPCS C1713 447.559 - PLATE BONE L LONG LEFT OBLIQUE 20X4.8X.6MM 11MM 2X2 HOLE BOTH IP/OP $486.00 $360.00 $96.46 $486.00 $218.70 $218.70 $218.70 $218.70 $486.00 $486.00 $486.00 $101.29 $486.00 $486.00 $486.00 $486.00 $486.00 $101.29 $486.00 $486.00 $287.47 $486.00 $486.00 $486.00 $486.00 $364.50 $486.00 $486.00 $486.00 $243.00 $243.00 $384.91 $486.00 $388.80 $218.70 $96.46 N/A $281.88 $486.00 $486.00 $486.00 $486.00 $486.00 N/A N/A 447.562 SUP HCPCS C1713 447.562 - PLATE BONE Z SHORT 21X4.8X.9MM 17MM 2X2 HOLE TITANIUM RIGHT BOTH IP/OP $551.50 $408.00 $109.41 $551.25 $248.06 $248.06 $248.06 $248.06 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $326.06 $551.25 $551.25 $551.25 $551.25 $413.63 $551.25 $551.25 $551.25 $275.63 $275.63 $436.59 $551.25 $441.00 $248.06 $109.41 N/A $319.87 $551.25 $551.25 $551.25 $114.88 $551.25 N/A N/A 447.563 SUP HCPCS C1713 447.563 - PLATE BONE Z SHORT 21X4.8X.9MM 17MM 2X2 HOLE TITANIUM LEFT BOTH IP/OP $551.50 $408.00 $109.41 $551.25 $248.06 $248.06 $248.06 $248.06 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $326.06 $551.25 $551.25 $551.25 $551.25 $413.63 $551.25 $551.25 $551.25 $275.63 $275.63 $436.59 $551.25 $441.00 $248.06 $109.41 N/A $319.87 $551.25 $330.75 $551.25 $551.25 $551.25 N/A N/A 447.564 SUP HCPCS C1713 447.564 - PLATE BONE Z LONG 25X4.8X.9MM 17MM 2X2 HOLE TITANIUM RIGHT BOTH IP/OP $551.50 $408.00 $109.41 $551.25 $248.06 $248.06 $248.06 $248.06 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $326.06 $551.25 $551.25 $551.25 $551.25 $413.63 $551.25 $551.25 $551.25 $275.63 $275.63 $436.59 $551.25 $441.00 $248.06 $109.41 N/A $319.87 $551.25 $330.75 $551.25 $551.25 $551.25 N/A N/A 447.565 SUP HCPCS C1713 447.565 - PLATE BONE Z LONG 25X4.8X.9MM 17MM 2X2 HOLE TITANIUM LEFT BOTH IP/OP $551.50 $408.00 $109.41 $551.25 $248.06 $248.06 $248.06 $248.06 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $326.06 $551.25 $551.25 $551.25 $551.25 $413.63 $551.25 $551.25 $551.25 $275.63 $275.63 $436.59 $551.25 $441.00 $248.06 $109.41 N/A $319.87 $551.25 $330.75 $551.25 $114.88 $551.25 N/A N/A 447.572 SUP HCPCS C1713 447.572 - PLATE BONE Z SHORT 21X4.8X.6MM 11.9MM 2X2 HOLE MALBLE BOTH IP/OP $551.50 $408.00 $109.41 $551.25 $248.06 $248.06 $248.06 $248.06 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $326.06 $551.25 $551.25 $551.25 $551.25 $413.63 $551.25 $551.25 $551.25 $275.63 $275.63 $436.59 $551.25 $441.00 $248.06 $109.41 N/A $319.87 $551.25 $551.25 $551.25 $114.88 $551.25 N/A N/A 447.573 SUP HCPCS C1713 447.573 - PLATE BONE Z SHORT 21X4.8X.6MM 11.9MM 2X2 HOLE MALBLE BOTH IP/OP $551.50 $408.00 $109.41 $551.25 $248.06 $248.06 $248.06 $248.06 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $326.06 $551.25 $551.25 $551.25 $551.25 $413.63 $551.25 $551.25 $551.25 $275.63 $275.63 $436.59 $551.25 $441.00 $248.06 $109.41 N/A $319.87 $551.25 $551.25 $551.25 $114.88 $551.25 N/A N/A 447.574 SUP HCPCS C1713 447.574 - PLATE BONE Z LONG 25X4.8X.6MM 15.7MM 2X2 HOLE MALBLE BOTH IP/OP $551.50 $408.00 $109.41 $551.25 $248.06 $248.06 $248.06 $248.06 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $326.06 $551.25 $551.25 $551.25 $551.25 $413.63 $551.25 $551.25 $551.25 $275.63 $275.63 $436.59 $551.25 $441.00 $248.06 $109.41 N/A $319.87 $551.25 $330.75 $551.25 $114.88 $551.25 N/A N/A 447.575 SUP HCPCS C1713 447.575 - PLATE BONE Z LONG 25X4.8X.6MM 15.7MM 2X2 HOLE MALBLE BOTH IP/OP $551.50 $408.00 $109.41 $551.25 $248.06 $248.06 $248.06 $248.06 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $551.25 $551.25 $551.25 $114.89 $551.25 $551.25 $326.06 $551.25 $551.25 $551.25 $551.25 $413.63 $551.25 $551.25 $551.25 $275.63 $275.63 $436.59 $551.25 $441.00 $248.06 $109.41 N/A $319.87 $551.25 $330.75 $551.25 $114.88 $551.25 N/A N/A 447.61 SUP HCPCS C1713 447.61 - PLATE BONE Y 24X12X.9MM 1X3 HOLE TITANIUM BOTH IP/OP $567.00 $420.00 $112.54 $567.00 $255.15 $255.15 $255.15 $255.15 $567.00 $567.00 $567.00 $118.18 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $567.00 $335.38 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $112.54 N/A $328.86 $567.00 $340.20 $567.00 $118.16 $567.00 N/A N/A 447.612 SUP HCPCS C1713 447.612 - PLATE BN Y 48X5X1.2MM NS PRO-PK 3 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $484.00 $358.00 $95.97 $491.78 $217.60 $217.60 $217.60 $217.60 $483.55 $483.55 $483.55 $100.78 $483.55 $483.55 $483.55 $483.55 $483.55 $100.78 $483.55 $196.71 $286.02 $483.55 $491.78 $483.55 $483.55 $363.00 $483.55 $483.55 $483.55 $241.78 $241.78 $382.97 $483.55 $386.84 $217.60 $95.97 N/A $280.72 $483.55 $483.55 $483.55 $100.77 $483.55 N/A N/A 447.615 SUP HCPCS C1713 447.615 - PLATE BONE 3 HOLE HEAD 7 HOLE SHAFT T LCP TITANIUM BOTH IP/OP $812.50 $601.00 $161.26 $826.33 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $330.53 $480.59 $812.50 $826.33 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 447.62 SUP HCPCS C1713 447.62 - PLATE BN Y 32X19X.9MM NS 4.8MM 2 HLE/HD 4 HL SHFT 2 ARM TI BOTH IP/OP $580.50 $430.00 $115.21 $580.50 $261.23 $261.23 $261.23 $261.23 $580.50 $580.50 $580.50 $120.99 $580.50 $580.50 $580.50 $580.50 $580.50 $120.98 $580.50 $580.50 $343.37 $580.50 $580.50 $580.50 $580.50 $435.38 $580.50 $580.50 $580.50 $290.25 $290.25 $459.76 $580.50 $464.40 $261.23 $115.21 N/A $336.69 $580.50 $580.50 $580.50 $120.98 $580.50 N/A N/A 447.63 SUP HCPCS C1713 447.630 - PLATE BONE 110D Y 27MMX.6MM 23MM 3X2 HOLE MALBLE TITANIUM BOTH IP/OP $490.50 $363.00 $97.35 $490.50 $220.73 $220.73 $220.73 $220.73 $490.50 $490.50 $490.50 $102.23 $490.50 $490.50 $490.50 $490.50 $490.50 $102.23 $490.50 $490.50 $290.13 $490.50 $490.50 $490.50 $490.50 $367.88 $490.50 $490.50 $490.50 $245.25 $245.25 $388.48 $490.50 $392.40 $220.73 $97.35 N/A $284.49 $490.50 $294.30 $490.50 $102.22 $490.50 N/A N/A 447.68 SUP HCPCS C1713 447.68 - PLATE BONE Y 30MMX.9MM 19MM 2 HOLE 2 ARM TITANIUM CRANFCL BOTH IP/OP $601.00 $445.00 $119.23 $600.75 $270.34 $270.34 $270.34 $270.34 $600.75 $600.75 $600.75 $125.21 $600.75 $600.75 $600.75 $600.75 $600.75 $125.20 $600.75 $600.75 $355.34 $600.75 $600.75 $600.75 $600.75 $450.75 $600.75 $600.75 $600.75 $300.38 $300.38 $475.79 $600.75 $480.60 $270.34 $119.23 N/A $348.58 $600.75 $600.75 $600.75 $125.20 $600.75 N/A N/A 447.681 SUP HCPCS C1713 447.681 - PLATE BONE 8 HOLE Y TITANIUM NONSTRL 2 MM SCREW BOTH IP/OP $601.00 $445.00 $119.23 $600.75 $270.34 $270.34 $270.34 $270.34 $600.75 $600.75 $600.75 $125.21 $600.75 $600.75 $600.75 $600.75 $600.75 $125.20 $600.75 $240.30 $355.34 $600.75 $600.75 $600.75 $600.75 $450.75 $600.75 $600.75 $600.75 $300.38 $300.38 $475.79 $600.75 $480.60 $270.34 $119.23 N/A $348.58 $600.75 $360.45 $600.75 $125.20 $600.75 N/A N/A 447.702 SUP HCPCS C1713 447.702 - PLATE BONE SMALL 24X18MM X LOCKING TITANIUM FT NONSTRL BOTH IP/OP "$1,439.50" "$1,065.00" $285.69 "$1,463.90" $647.74 $647.74 $647.74 $647.74 "$1,439.43" "$1,439.43" "$1,439.43" $300.01 "$1,439.43" "$1,439.43" "$1,439.43" "$1,439.43" "$1,439.43" $299.99 "$1,439.43" $585.56 $851.42 "$1,439.43" "$1,463.90" "$1,439.43" "$1,439.43" "$1,079.63" "$1,439.43" "$1,439.43" "$1,439.43" $719.72 $719.72 "$1,140.03" "$1,439.43" "$1,151.54" $647.74 $285.69 N/A $834.91 "$1,439.43" "$1,439.43" "$1,439.43" $299.98 "$1,439.43" N/A N/A 447.704 SUP HCPCS C1713 447.704 - PLATE BONE MEDIUM 30X20MM X LOCKING TITANIUM FT NONSTRL BOTH IP/OP "$1,458.00" "$1,079.00" $289.32 "$1,482.48" $655.97 $655.97 $655.97 $655.97 "$1,457.70" "$1,457.70" "$1,457.70" $303.82 "$1,457.70" "$1,457.70" "$1,457.70" "$1,457.70" "$1,457.70" $303.80 "$1,457.70" "$1,482.48" $862.23 "$1,457.70" "$1,482.48" "$1,457.70" "$1,457.70" "$1,093.50" "$1,457.70" "$1,457.70" "$1,457.70" $728.85 $728.85 "$1,154.50" "$1,457.70" "$1,166.16" $655.97 $289.32 N/A $845.64 "$1,457.70" "$1,457.70" "$1,457.70" $303.78 "$1,457.70" N/A N/A 447.706 SUP HCPCS C1713 447.706 - PLATE BONE LARGE 36X20MM X LOCKING TITANIUM FT NONSTRL BOTH IP/OP "$1,477.50" "$1,093.00" $293.22 "$1,502.50" $664.82 $664.82 $664.82 $664.82 "$1,477.38" "$1,477.38" "$1,477.38" $307.92 "$1,477.38" "$1,477.38" "$1,477.38" "$1,477.38" "$1,477.38" $307.90 "$1,477.38" $601.00 $873.87 "$1,477.38" "$1,502.50" "$1,477.38" "$1,477.38" "$1,108.13" "$1,477.38" "$1,477.38" "$1,477.38" $738.69 $738.69 "$1,170.08" "$1,477.38" "$1,181.90" $664.82 $293.22 N/A $856.95 "$1,477.38" "$1,477.38" "$1,477.38" "$1,477.38" "$1,477.38" N/A N/A 447.71 SUP HCPCS C1713 447.710 - PLATE BN STRG 17X6X1.6MM NS 2 HL LCK RND THRD HL TI HND/MDFT BOTH IP/OP $681.00 $504.00 $135.16 $713.38 $306.45 $306.45 $306.45 $306.45 $681.00 $681.00 $681.00 $141.94 $681.00 $681.00 $681.00 $681.00 $681.00 $141.93 $681.00 $285.35 $402.81 $681.00 $713.38 $681.00 $681.00 $510.75 $681.00 $681.00 $681.00 $340.50 $340.50 $539.35 $681.00 $544.80 $306.45 $135.16 N/A $394.98 $681.00 $681.00 $681.00 $141.92 $681.00 N/A N/A 447.711 SUP HCPCS C1713 447.711 - PLATE BONE XS 22X14MM X LOCKING TITANIUM NONSTRL 2.4/2.7MM BOTH IP/OP "$1,461.00" "$1,081.00" $289.88 "$1,485.35" $657.24 $657.24 $657.24 $657.24 "$1,460.53" "$1,460.53" "$1,460.53" $304.41 "$1,460.53" "$1,460.53" "$1,460.53" "$1,460.53" "$1,460.53" $304.39 "$1,460.53" $594.14 $863.90 "$1,460.53" "$1,485.35" "$1,460.53" "$1,460.53" "$1,095.75" "$1,460.53" "$1,460.53" "$1,460.53" $730.27 $730.27 "$1,156.74" "$1,460.53" "$1,168.42" $657.24 $289.88 N/A $847.38 "$1,460.53" "$1,460.53" "$1,460.53" "$1,460.53" "$1,460.53" N/A N/A 447.81 SUP HCPCS C1713 447.81 - PLATE BN 13MM SPC X 18X18X.9MM NS 4.8MM 4 HL TI CRNFCL 2MM BOTH IP/OP $529.00 $391.00 $104.94 $528.75 $237.94 $237.94 $237.94 $237.94 $528.75 $528.75 $528.75 $110.20 $528.75 $528.75 $528.75 $528.75 $528.75 $110.20 $528.75 $528.75 $312.76 $528.75 $528.75 $528.75 $528.75 $396.75 $528.75 $528.75 $528.75 $264.38 $264.38 $418.77 $528.75 $423.00 $237.94 $104.94 N/A $306.82 $528.75 $317.25 $528.75 $110.19 $528.75 N/A N/A 447.811 SUP HCPCS C1713 447.811 - PLATE BONE X 18X4.8X.6MM 18MM 4 HOLE MALBLE TITANIUM CRANFCL BOTH IP/OP $432.00 $320.00 $85.74 $432.00 $194.40 $194.40 $194.40 $194.40 $432.00 $432.00 $432.00 $90.04 $432.00 $432.00 $432.00 $432.00 $432.00 $90.03 $432.00 $172.80 $255.53 $432.00 $432.00 $432.00 $432.00 $324.00 $432.00 $432.00 $432.00 $216.00 $216.00 $342.14 $432.00 $345.60 $194.40 $85.74 N/A $250.56 $432.00 $259.20 $432.00 $90.03 $432.00 N/A N/A 447.85 SUP HCPCS C1713 447.85 - PLATE BONE H 22X4.8X.9MM 23MM 9 HOLE TITANIUM CRANFCL BOTH IP/OP $594.00 $440.00 $117.89 $594.00 $267.30 $267.30 $267.30 $267.30 $594.00 $594.00 $594.00 $123.80 $594.00 $594.00 $594.00 $594.00 $594.00 $123.80 $594.00 $594.00 $351.35 $594.00 $594.00 $594.00 $594.00 $445.50 $594.00 $594.00 $594.00 $297.00 $297.00 $470.45 $594.00 $475.20 $267.30 $117.89 N/A $344.52 $594.00 $356.40 $594.00 $123.79 $594.00 N/A N/A 447.86 SUP HCPCS C1713 447.86 - PLATE BONE H 22X4.8X.9MM 17MM 8 HOLE TITANIUM CRANFCL BOTH IP/OP $594.00 $440.00 $117.89 $594.00 $267.30 $267.30 $267.30 $267.30 $594.00 $594.00 $594.00 $123.80 $594.00 $594.00 $594.00 $594.00 $594.00 $123.80 $594.00 $594.00 $351.35 $594.00 $594.00 $594.00 $594.00 $445.50 $594.00 $594.00 $594.00 $297.00 $297.00 $470.45 $594.00 $475.20 $267.30 $117.89 N/A $344.52 $594.00 $594.00 $594.00 $123.79 $594.00 N/A N/A 447.915 SUP HCPCS C1713 447.915 - PLATE BONE BOX 13X12X.9MM 13MM 4 HOLE TITANIUM CRANFCL BOTH IP/OP $475.00 $352.00 $94.23 $474.75 $213.64 $213.64 $213.64 $213.64 $474.75 $474.75 $474.75 $98.95 $474.75 $474.75 $474.75 $474.75 $474.75 $98.94 $474.75 $474.75 $280.81 $474.75 $474.75 $474.75 $474.75 $356.25 $474.75 $474.75 $474.75 $237.38 $237.38 $376.00 $474.75 $379.80 $213.64 $94.23 N/A $275.50 $474.75 $474.75 $474.75 $474.75 $474.75 N/A N/A 449.004 SUP HCPCS C1713 449.004 - PLATE BN NAR STRG 29X4.8X1MM NS 4 HL LOPRFL TI MNDB 2MM SCR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.006 SUP HCPCS C1713 449.006 - PLATE BN NAR STRG 42X4.8X1MM NS 6 HL LOPRFL TI MNDB 2MM SCR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.008 SUP HCPCS C1713 449.008 - PLATE BONE STR NARROW 55X4.8X1MM 8 HOLE LP EASILY CNTOUR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.014 SUP HCPCS C1713 449.014 - PLATE BN CRV NAR 29X4.8X1MM NS 4 HL LOPRFL TI MNDB 2MM SCR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.016 SUP HCPCS C1713 449.016 - PLATE BN CRV NAR 41X4.8X1MM NS 6 HL LOPRFL TI MNDB 2MM SCR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.017 SUP HCPCS C1713 449.017 - PLATE BONE NARROW 6 HOLE STRUT TITANIUM MANDIB NONSTRL 2MM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.018 SUP HCPCS C1713 449.018 - PLATE BONE CURVE 39.2MMX.9MM 13MM 8 HOLE STRUT LP TITANIUM BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" "$1,237.50" $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A 449.02 SUP HCPCS C1713 449.020 - PLATE BONE 119X4.8X1MM 20 HOLE ADAPTION LP EASILY CNTOUR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.021 SUP HCPCS C1713 449.021 - PLATE BONE 2 ADAPTION 100MMX.7MM 2X20 HOLE TITANIUM CRANFCL BOTH IP/OP "$1,496.50" "$1,107.00" $296.97 "$1,496.25" $673.31 $673.31 $673.31 $673.31 "$1,496.25" "$1,496.25" "$1,496.25" $311.86 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" $311.83 "$1,496.25" $598.50 $885.03 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,122.38" "$1,496.25" "$1,496.25" "$1,496.25" $748.13 $748.13 "$1,185.03" "$1,496.25" "$1,197.00" $673.31 $296.97 N/A $867.97 "$1,496.25" $897.75 "$1,496.25" $311.82 "$1,496.25" N/A N/A 449.024 SUP HCPCS C1713 449.024 - PLATE BN BRD STRG 29X4.8X1.25MM NS 4 HL LOPRFL TI MNDB 2MM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.025 SUP HCPCS C1713 449.025 - PLATE BN BRD CRV 29X4.8X1.25MM NS 4 HL LOPRFL TI MNDB 2MM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.026 SUP HCPCS C1713 449.026 - PLATE BN BRD STRG 42X4.8X1.25MM NS 6 HL LOPRFL TI MNDB 2MM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.027 SUP HCPCS C1713 449.027 - PLATE BN BRD CRV 41X4.8X1.25MM NS 6 HL LOPRFL TI MNDB 2MM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.028 SUP HCPCS C1713 449.028 - PLATE BN BRD STRG 55X4.8X1.25MM NS 8 HL LOPRFL TI MNDB 2MM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.032 SUP HCPCS C1713 449.032 - PLATE BONE 21MM 4X4 HOLE ANGLED DCP TITANIUM MANDIB NONSTRL BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.034 SUP HCPCS C1713 449.034 - PLATE BN 30X5X1.25MM NS DCP 4 HL LOPRFL TI MNDB 2MM SCR MDLR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.035 SUP HCPCS C1713 449.035 - PLATE BN 32X5X1.25MM NS DCP 5 HL LOPRFL TI MNDB 2MM SCR MDLR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.036 SUP HCPCS C1713 449.036 - PLATE BN 42X5X1.25MM NS DCP 6 HL LOPRFL TI MNDB 2MM SCR MDLR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.037 SUP HCPCS C1713 449.037 - PLATE BONE 48X5X1.25MM 7 HOLE LP EASILY CNTOUR DCP TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.038 SUP HCPCS C1713 449.038 - PLATE BONE 54X5X1.25MM 8 HOLE LP EASILY CNTOUR DCP TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.04 SUP HCPCS C1713 449.04 - PLATE BONE STR 22MM 4 HOLE TENSION BAND TITANIUM MANDIB BOTH IP/OP $857.50 $635.00 $170.14 $857.25 $385.76 $385.76 $385.76 $385.76 $857.25 $857.25 $857.25 $178.67 $857.25 $857.25 $857.25 $857.25 $857.25 $178.66 $857.25 $857.25 $507.06 $857.25 $857.25 $857.25 $857.25 $643.13 $857.25 $857.25 $857.25 $428.63 $428.63 $678.94 $857.25 $685.80 $385.76 $170.14 N/A $497.35 $857.25 $514.35 $857.25 $178.65 $857.25 N/A N/A 449.05 SUP HCPCS C1713 449.05 - PLATE BONE STR 25MM 4 HOLE TENSION BAND TITANIUM MANDIB BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.06 SUP HCPCS C1713 449.06 - PLATE BONE STR 35MM 6 HOLE TENSION BAND TITANIUM MANDIB BOTH IP/OP $954.00 $706.00 $189.35 $954.00 $429.30 $429.30 $429.30 $429.30 $954.00 $954.00 $954.00 $198.84 $954.00 $954.00 $954.00 $954.00 $954.00 $198.82 $954.00 $954.00 $564.29 $954.00 $954.00 $954.00 $954.00 $715.50 $954.00 $954.00 $954.00 $477.00 $477.00 $755.57 $954.00 $763.20 $429.30 $189.35 N/A $553.32 $954.00 $572.40 $954.00 $198.81 $954.00 N/A N/A 449.1 SUP HCPCS C1713 449.100 - PLATE BONE THK1.25MM 26X5MM 4 HOLE COMPRESSION TENSION BAND BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.11 SUP HCPCS C1713 449.110 - PLATE BONE 36X5X1.25MM 6 HOLE COMPRESSION TENSION BAND BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.14 SUP HCPCS C1713 449.14 - PLATE BN 35X6.5X1.65MM NS LC DCP 4 HL TI MNDB 2.4MM SCR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.15 SUP HCPCS C1713 449.15 - PLATE BN 39X6.5X1.65MM NS LC DCP 5 HL TI MNDB 2.4MM SCR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.16 SUP HCPCS C1713 449.16 - PLATE BN 51X6.5X1.65MM NS LC DCP 6 HL TI MNDB 2.4MM SCR BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.234 SUP HCPCS C1713 449.234 - PLATE BONE 35X6.5X1.65MM 4 HOLE ECCENTRIC LOCK LC-DCP BOTH IP/OP "$1,359.00" "$1,006.00" $269.73 "$1,359.00" $611.55 $611.55 $611.55 $611.55 "$1,359.00" "$1,359.00" "$1,359.00" $283.25 "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" $283.23 "$1,359.00" "$1,359.00" $803.85 "$1,359.00" "$1,359.00" "$1,359.00" "$1,359.00" "$1,019.25" "$1,359.00" "$1,359.00" "$1,359.00" $679.50 $679.50 "$1,076.33" "$1,359.00" "$1,087.20" $611.55 $269.73 N/A $788.22 "$1,359.00" $815.40 "$1,359.00" $283.22 "$1,359.00" N/A N/A 449.236 SUP HCPCS C1713 449.236 - PLATE BONE 51X6.5X1.65MM 6 HOLE ECCENTRIC LOCKING BOTH IP/OP "$1,638.00" "$1,212.00" $325.10 "$1,638.00" $737.10 $737.10 $737.10 $737.10 "$1,638.00" "$1,638.00" "$1,638.00" $341.40 "$1,638.00" "$1,638.00" "$1,638.00" "$1,638.00" "$1,638.00" $341.38 "$1,638.00" "$1,638.00" $968.88 "$1,638.00" "$1,638.00" "$1,638.00" "$1,638.00" "$1,228.50" "$1,638.00" "$1,638.00" "$1,638.00" $819.00 $819.00 "$1,297.30" "$1,638.00" "$1,310.40" $737.10 $325.10 N/A $950.04 "$1,638.00" $982.80 "$1,638.00" $341.36 "$1,638.00" N/A N/A 449.24 SUP HCPCS C1713 449.24 - PLATE BONE CRESCENT 35X6.5X2MM 4 HOLE LC-DCP TITANIUM MANDIB BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.25 SUP HCPCS C1713 449.250 - PLATE BONE 38MM 5 HOLE CRESCENT LOCKING RECONSTRUCTION BOTH IP/OP "$1,458.00" "$1,079.00" $289.38 "$1,458.00" $656.10 $656.10 $656.10 $656.10 "$1,458.00" "$1,458.00" "$1,458.00" $303.88 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" $583.20 $862.41 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 $289.38 N/A $845.64 "$1,458.00" "$1,458.00" "$1,458.00" $303.85 "$1,458.00" N/A N/A 449.26 SUP HCPCS C1713 449.26 - PLATE BONE CRESCENT 50X6.5X2MM 6 HOLE CRESCENT LC-DCP BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.38 SUP HCPCS C1713 449.38 - PLATE BONE STR 64MM 8 HOLE TITANIUM MANDIB NONSTRL 2.4MM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.4 SUP HCPCS C1713 449.40 - PLATE BONE UNIVERSAL STR 80MM 10 HOLE TITANIUM MANDIB BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.412 SUP HCPCS C1713 449.412 - PLATE BONE STR 12 HOLE MICROVASCULAR NOTCHED TITANIUM MANDIB BOTH IP/OP "$1,687.50" "$1,249.00" $334.93 "$1,687.50" $759.38 $759.38 $759.38 $759.38 "$1,687.50" "$1,687.50" "$1,687.50" $351.72 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" $351.69 "$1,687.50" $675.00 $998.16 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" $759.38 $334.93 N/A $978.75 "$1,687.50" "$1,687.50" "$1,687.50" $351.68 "$1,687.50" N/A N/A 449.416 SUP HCPCS C1713 449.416 - PLATE BONE STR 16 HOLE MICROVASCULAR NOTCHED TITANIUM MANDIB BOTH IP/OP "$2,311.00" "$1,710.00" $458.63 "$2,310.75" "$1,039.84" "$1,039.84" "$1,039.84" "$1,039.84" "$2,310.75" "$2,310.75" "$2,310.75" $481.62 "$2,310.75" "$2,310.75" "$2,310.75" "$2,310.75" "$2,310.75" $481.59 "$2,310.75" "$2,310.75" "$1,366.81" "$2,310.75" "$2,310.75" "$2,310.75" "$2,310.75" "$1,733.25" "$2,310.75" "$2,310.75" "$2,310.75" "$1,155.38" "$1,155.38" "$1,830.11" "$2,310.75" "$1,848.60" "$1,039.84" $458.63 N/A "$1,340.38" "$2,310.75" "$1,386.45" "$2,310.75" $481.56 "$2,310.75" N/A N/A 449.418 SUP HCPCS C1713 449.418 - PLATE BONE STR 144MM 18 HOLE MICROVASCULAR NOTCHED TITANIUM BOTH IP/OP "$2,623.50" "$1,941.00" $520.70 "$2,623.50" "$1,180.58" "$1,180.58" "$1,180.58" "$1,180.58" "$2,623.50" "$2,623.50" "$2,623.50" $546.80 "$2,623.50" "$2,623.50" "$2,623.50" "$2,623.50" "$2,623.50" $546.77 "$2,623.50" "$2,623.50" "$1,293.39" "$2,623.50" "$2,623.50" "$2,623.50" "$2,623.50" "$1,967.63" "$2,623.50" "$2,623.50" "$2,623.50" "$1,311.75" "$1,311.75" "$2,077.81" "$2,623.50" "$2,098.80" "$1,180.58" $520.70 N/A "$1,521.63" "$2,623.50" "$1,574.10" "$2,623.50" $546.74 "$2,623.50" N/A N/A 449.42 SUP HCPCS C1713 449.420 - PLATE BONE STR 20 HOLE MICROVASCULAR NOTCHED TITANIUM MANDIB BOTH IP/OP "$2,938.50" "$2,174.00" $583.22 "$2,938.50" "$1,322.33" "$1,322.33" "$1,322.33" "$1,322.33" "$2,938.50" "$2,938.50" "$2,938.50" $612.46 "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" $612.42 "$2,938.50" "$2,938.50" "$1,448.68" "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" "$2,203.88" "$2,938.50" "$2,938.50" "$2,938.50" "$1,469.25" "$1,469.25" "$2,327.29" "$2,938.50" "$2,350.80" "$1,322.33" $583.22 N/A "$1,704.33" "$2,938.50" "$1,763.10" "$2,938.50" $612.38 "$2,938.50" N/A N/A 449.422 SUP HCPCS C1713 449.422 - PLATE BONE STR 176MM 22 HOLE MICROVASCULAR NOTCHED TITANIUM BOTH IP/OP "$2,938.50" "$2,174.00" $583.22 "$2,938.50" "$1,322.33" "$1,322.33" "$1,322.33" "$1,322.33" "$2,938.50" "$2,938.50" "$2,938.50" $612.46 "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" $612.42 "$2,938.50" "$1,175.40" "$1,448.68" "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" "$2,203.88" "$2,938.50" "$2,938.50" "$2,938.50" "$1,469.25" "$1,469.25" "$2,327.29" "$2,938.50" "$2,350.80" "$1,322.33" $583.22 N/A "$1,704.33" "$2,938.50" "$1,763.10" "$2,938.50" $612.38 "$2,938.50" N/A N/A 449.424 SUP HCPCS C1713 449.424 - PLATE BONE STR 192MM 24 HOLE MICROVASCULAR NOTCHED TITANIUM BOTH IP/OP "$2,938.50" "$2,174.00" $583.22 "$2,938.50" "$1,322.33" "$1,322.33" "$1,322.33" "$1,322.33" "$2,938.50" "$2,938.50" "$2,938.50" $612.46 "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" $612.42 "$2,938.50" "$1,175.40" "$1,448.68" "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" "$2,203.88" "$2,938.50" "$2,938.50" "$2,938.50" "$1,469.25" "$1,469.25" "$2,327.29" "$2,938.50" "$2,350.80" "$1,322.33" $583.22 N/A "$1,704.33" "$2,938.50" "$1,763.10" "$2,938.50" $612.38 "$2,938.50" N/A N/A 449.44 SUP HCPCS C1713 449.440 - PLATE BONE RIGHT ANG 4X8 HOLE MICROVASCULAR NOTCHED TITANIUM BOTH IP/OP "$2,938.50" "$2,174.00" $583.22 "$2,938.50" "$1,322.33" "$1,322.33" "$1,322.33" "$1,322.33" "$2,938.50" "$2,938.50" "$2,938.50" $612.46 "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" $612.42 "$2,938.50" "$1,175.40" "$1,448.68" "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" "$2,203.88" "$2,938.50" "$2,938.50" "$2,938.50" "$1,469.25" "$1,469.25" "$2,327.29" "$2,938.50" "$2,350.80" "$1,322.33" $583.22 N/A "$1,704.33" "$2,938.50" "$1,763.10" "$2,938.50" $612.38 "$2,938.50" N/A N/A 449.441 SUP HCPCS C1713 449.441 - PLATE BONE LEFT ANGLE 4X8 HOLE MICROVASCULAR NOTCHED BOTH IP/OP "$2,938.50" "$2,174.00" $583.22 "$2,938.50" "$1,322.33" "$1,322.33" "$1,322.33" "$1,322.33" "$2,938.50" "$2,938.50" "$2,938.50" $612.46 "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" $612.42 "$2,938.50" "$2,938.50" "$1,448.68" "$2,938.50" "$2,938.50" "$2,938.50" "$2,938.50" "$2,203.88" "$2,938.50" "$2,938.50" "$2,938.50" "$1,469.25" "$1,469.25" "$2,327.29" "$2,938.50" "$2,350.80" "$1,322.33" $583.22 N/A "$1,704.33" "$2,938.50" "$2,938.50" "$2,938.50" $612.38 "$2,938.50" N/A N/A 449.442 SUP HCPCS C1713 449.442 - PLATE BONE RIGHT ANG 4X16 HOLE MICROVASCULAR NOTCHED BOTH IP/OP "$3,343.50" "$2,474.00" $663.60 "$3,343.50" "$1,504.58" "$1,504.58" "$1,504.58" "$1,504.58" "$3,343.50" "$3,343.50" "$3,343.50" $696.87 "$3,343.50" "$3,343.50" "$3,343.50" "$3,343.50" "$3,343.50" $696.82 "$3,343.50" "$3,343.50" "$1,648.35" "$3,343.50" "$3,343.50" "$3,343.50" "$3,343.50" "$2,507.63" "$3,343.50" "$3,343.50" "$3,343.50" "$1,671.75" "$1,671.75" "$2,648.05" "$3,343.50" "$2,674.80" "$1,504.58" $663.60 N/A "$1,939.23" "$3,343.50" "$3,343.50" "$3,343.50" $696.79 "$3,343.50" N/A N/A 449.443 SUP HCPCS C1713 449.443 - PLATE BONE LEFT ANGLE 4X16 HOLE MICROVASCULAR NOTCHED BOTH IP/OP "$3,343.50" "$2,474.00" $663.60 "$3,343.50" "$1,504.58" "$1,504.58" "$1,504.58" "$1,504.58" "$3,343.50" "$3,343.50" "$3,343.50" $696.87 "$3,343.50" "$3,343.50" "$3,343.50" "$3,343.50" "$3,343.50" $696.82 "$3,343.50" "$3,343.50" "$1,648.35" "$3,343.50" "$3,343.50" "$3,343.50" "$3,343.50" "$2,507.63" "$3,343.50" "$3,343.50" "$3,343.50" "$1,671.75" "$1,671.75" "$2,648.05" "$3,343.50" "$2,674.80" "$1,504.58" $663.60 N/A "$1,939.23" "$3,343.50" "$3,343.50" "$3,343.50" "$3,343.50" "$3,343.50" N/A N/A 449.444 SUP HCPCS C1713 449.444 - PLATE BONE RIGHT ANG 5X17 HOLE MICROVASCULAR NOTCHED BOTH IP/OP "$3,661.00" "$2,709.00" $726.57 "$3,660.75" "$1,647.34" "$1,647.34" "$1,647.34" "$1,647.34" "$3,660.75" "$3,660.75" "$3,660.75" $762.99 "$3,660.75" "$3,660.75" "$3,660.75" "$3,660.75" "$3,660.75" $762.94 "$3,660.75" "$3,660.75" "$1,804.75" "$3,660.75" "$3,660.75" "$3,660.75" "$3,660.75" "$2,745.75" "$3,660.75" "$3,660.75" "$3,660.75" "$1,830.38" "$1,830.38" "$2,899.31" "$3,660.75" "$2,928.60" "$1,647.34" $726.57 N/A "$2,123.38" "$3,660.75" "$3,660.75" "$3,660.75" "$3,660.75" "$3,660.75" N/A N/A 449.445 SUP HCPCS C1713 449.445 - PLATE BONE LEFT ANGLE 5X17 HOLE MICROVASCULAR NOTCHED BOTH IP/OP "$3,661.00" "$2,709.00" $726.57 "$3,660.75" "$1,647.34" "$1,647.34" "$1,647.34" "$1,647.34" "$3,660.75" "$3,660.75" "$3,660.75" $762.99 "$3,660.75" "$3,660.75" "$3,660.75" "$3,660.75" "$3,660.75" $762.94 "$3,660.75" "$1,464.30" "$1,804.75" "$3,660.75" "$3,660.75" "$3,660.75" "$3,660.75" "$2,745.75" "$3,660.75" "$3,660.75" "$3,660.75" "$1,830.38" "$1,830.38" "$2,899.31" "$3,660.75" "$2,928.60" "$1,647.34" $726.57 N/A "$2,123.38" "$3,660.75" "$2,196.45" "$3,660.75" $762.90 "$3,660.75" N/A N/A 449.446 SUP HCPCS C1713 449.446 - PLATE BONE RIGHT ANG 6X18 HOLE MICROVASCULAR NOTCHED BOTH IP/OP "$4,027.50" "$2,980.00" $799.36 "$4,027.50" "$1,812.38" "$1,812.38" "$1,812.38" "$1,812.38" "$4,027.50" "$4,027.50" "$4,027.50" $839.43 "$4,027.50" "$4,027.50" "$4,027.50" "$4,027.50" "$4,027.50" $839.38 "$4,027.50" "$1,611.00" "$1,985.56" "$4,027.50" "$4,027.50" "$4,027.50" "$4,027.50" "$3,020.63" "$4,027.50" "$4,027.50" "$4,027.50" "$2,013.75" "$2,013.75" "$3,189.78" "$4,027.50" "$3,222.00" "$1,812.38" $799.36 N/A "$2,335.95" "$4,027.50" "$2,416.50" "$4,027.50" $839.33 "$4,027.50" N/A N/A 449.447 SUP HCPCS C1713 449.447 - PLATE BONE LEFT ANGLE 6X18 HOLE MICROVASCULAR NOTCHED BOTH IP/OP "$4,027.50" "$2,980.00" $799.36 "$4,027.50" "$1,812.38" "$1,812.38" "$1,812.38" "$1,812.38" "$4,027.50" "$4,027.50" "$4,027.50" $839.43 "$4,027.50" "$4,027.50" "$4,027.50" "$4,027.50" "$4,027.50" $839.38 "$4,027.50" "$1,611.00" "$1,985.56" "$4,027.50" "$4,027.50" "$4,027.50" "$4,027.50" "$3,020.63" "$4,027.50" "$4,027.50" "$4,027.50" "$2,013.75" "$2,013.75" "$3,189.78" "$4,027.50" "$3,222.00" "$1,812.38" $799.36 N/A "$2,335.95" "$4,027.50" "$2,416.50" "$4,027.50" $839.33 "$4,027.50" N/A N/A 449.448 SUP HCPCS C1713 449.448 - PLATE BONE RIGHT ANG 6X12 HOLE MICROVASCULAR NOTCHED BOTH IP/OP "$4,401.00" "$3,257.00" $873.49 "$4,401.00" "$1,980.45" "$1,980.45" "$1,980.45" "$1,980.45" "$4,401.00" "$4,401.00" "$4,401.00" $917.28 "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" $917.22 "$4,401.00" "$1,760.40" "$2,169.69" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$3,300.75" "$4,401.00" "$4,401.00" "$4,401.00" "$2,200.50" "$2,200.50" "$3,485.59" "$4,401.00" "$3,520.80" "$1,980.45" $873.49 N/A "$2,552.58" "$4,401.00" "$2,640.60" "$4,401.00" $917.17 "$4,401.00" N/A N/A 449.449 SUP HCPCS C1713 449.449 - PLATE BONE LEFT ANGLE 6X12 HOLE MICROVASCULAR NOTCHED BOTH IP/OP "$4,401.00" "$3,257.00" $873.49 "$4,401.00" "$1,980.45" "$1,980.45" "$1,980.45" "$1,980.45" "$4,401.00" "$4,401.00" "$4,401.00" $917.28 "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" $917.22 "$4,401.00" "$4,401.00" "$2,169.69" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$3,300.75" "$4,401.00" "$4,401.00" "$4,401.00" "$2,200.50" "$2,200.50" "$3,485.59" "$4,401.00" "$3,520.80" "$1,980.45" $873.49 N/A "$2,552.58" "$4,401.00" "$2,640.60" "$4,401.00" $917.17 "$4,401.00" N/A N/A 449.45 SUP HCPCS C1713 449.450 - PLATE BONE 2 ANGLE 162MM 33MM 4X20X4 HOLE MICROVASCULAR BOTH IP/OP "$7,537.50" "$5,578.00" "$1,496.01" "$7,537.50" "$3,391.88" "$3,391.88" "$3,391.88" "$3,391.88" "$7,537.50" "$7,537.50" "$7,537.50" "$1,571.00" "$7,537.50" "$7,537.50" "$7,537.50" "$7,537.50" "$7,537.50" "$1,570.90" "$7,537.50" "$7,537.50" "$3,715.99" "$7,537.50" "$7,537.50" "$7,537.50" "$7,537.50" "$5,653.13" "$7,537.50" "$7,537.50" "$7,537.50" "$3,768.75" "$3,768.75" "$5,969.70" "$7,537.50" "$6,030.00" "$3,391.88" "$1,496.01" N/A "$4,371.75" "$7,537.50" "$7,537.50" "$7,537.50" "$7,537.50" "$7,537.50" N/A N/A 449.451 SUP HCPCS C1713 449.451 - PLATE BONE 2 ANGLE 5X22X5 HOLE MICROVASCULAR NOTCHED BOTH IP/OP "$7,850.50" "$5,809.00" "$1,558.08" "$7,850.25" "$3,532.61" "$3,532.61" "$3,532.61" "$3,532.61" "$7,850.25" "$7,850.25" "$7,850.25" "$1,636.19" "$7,850.25" "$7,850.25" "$7,850.25" "$7,850.25" "$7,850.25" "$1,636.08" "$7,850.25" "$3,140.10" "$3,870.17" "$7,850.25" "$7,850.25" "$7,850.25" "$7,850.25" "$5,887.88" "$7,850.25" "$7,850.25" "$7,850.25" "$3,925.13" "$3,925.13" "$6,217.40" "$7,850.25" "$6,280.20" "$3,532.61" "$1,558.08" N/A "$4,553.29" "$7,850.25" "$7,850.25" "$7,850.25" "$1,635.99" "$7,850.25" N/A N/A 449.452 SUP HCPCS C1713 449.452 - PLATE BONE 2 ANGLE 6X24X6 HOLE MICROVASCULAR NOTCHED BOTH IP/OP "$9,412.00" "$6,965.00" "$1,868.00" "$9,411.75" "$4,235.29" "$4,235.29" "$4,235.29" "$4,235.29" "$9,411.75" "$9,411.75" "$9,411.75" "$1,961.64" "$9,411.75" "$9,411.75" "$9,411.75" "$9,411.75" "$9,411.75" "$1,961.51" "$9,411.75" "$3,764.70" "$4,639.99" "$9,411.75" "$9,411.75" "$9,411.75" "$9,411.75" "$7,059.00" "$9,411.75" "$9,411.75" "$9,411.75" "$4,705.88" "$4,705.88" "$7,454.11" "$9,411.75" "$7,529.40" "$4,235.29" "$1,868.00" N/A "$5,458.96" "$9,411.75" "$9,411.75" "$9,411.75" "$1,961.41" "$9,411.75" N/A N/A 449.612 SUP HCPCS C1713 449.612 - PLATE BONE THK2.5MM UNIVERSAL STR 96X8MM 12 HOLE BOTH IP/OP "$2,302.00" "$1,703.00" $456.84 "$2,301.75" "$1,035.79" "$1,035.79" "$1,035.79" "$1,035.79" "$2,301.75" "$2,301.75" "$2,301.75" $479.74 "$2,301.75" "$2,301.75" "$2,301.75" "$2,301.75" "$2,301.75" $479.71 "$2,301.75" $920.70 "$1,361.49" "$2,301.75" "$2,301.75" "$2,301.75" "$2,301.75" "$1,726.50" "$2,301.75" "$2,301.75" "$2,301.75" "$1,150.88" "$1,150.88" "$1,822.99" "$2,301.75" "$1,841.40" "$1,035.79" $456.84 N/A "$1,335.16" "$2,301.75" "$1,381.05" "$2,301.75" $479.68 "$2,301.75" N/A N/A 449.615 SUP HCPCS C1713 449.615 - PLATE BONE 3 HOLE HEAD 7 HOLE SHAFT T LCP TITANIUM BOTH IP/OP "$1,351.00" "$1,000.00" $268.12 "$1,373.85" $607.90 $607.90 $607.90 $607.90 "$1,350.88" "$1,350.88" "$1,350.88" $281.56 "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" $281.54 "$1,350.88" $549.54 $799.05 "$1,350.88" "$1,373.85" "$1,350.88" "$1,350.88" "$1,013.25" "$1,350.88" "$1,350.88" "$1,350.88" $675.44 $675.44 "$1,069.90" "$1,350.88" "$1,080.70" $607.90 $268.12 N/A $783.58 "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" N/A N/A 449.62 SUP HCPCS C1713 449.62 - PLATE BONE STR 95MM 12 HOLE LOCKING RECONSTRUCTION TITANIUM BOTH IP/OP "$2,221.00" "$1,644.00" $440.76 "$2,220.75" $999.34 $999.34 $999.34 $999.34 "$2,220.75" "$2,220.75" "$2,220.75" $462.86 "$2,220.75" "$2,220.75" "$2,220.75" "$2,220.75" "$2,220.75" $462.83 "$2,220.75" "$2,220.75" "$1,313.57" "$2,220.75" "$2,220.75" "$2,220.75" "$2,220.75" "$1,665.75" "$2,220.75" "$2,220.75" "$2,220.75" "$1,110.38" "$1,110.38" "$1,758.83" "$2,220.75" "$1,776.60" $999.34 $440.76 N/A "$1,288.18" "$2,220.75" "$2,220.75" "$2,220.75" $462.80 "$2,220.75" N/A N/A 449.621 SUP HCPCS C1713 449.621 - PLATE BN STRG 160X8X2.5MM NS 20 HL LCK RECON TI MNDB 2.4/3MM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.632 SUP HCPCS C1713 449.632 - PLATE BONE LEFT ANGLE 214MM 6X23 HOLE LOCKING RECONSTRUCTION BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.633 SUP HCPCS C1713 449.633 - PLATE BN ANG 214X44X2.4MM NS 44MM 6 HLE/HD 23 HL SHFT LOPRFL BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.636 SUP HCPCS C1713 449.636 - PLATE BONE 2 ANGLE 4X20X4 HOLE LOCKING RECONSTRUCTION LP BOTH IP/OP "$5,553.00" "$4,109.00" "$1,102.13" "$5,553.00" "$2,498.85" "$2,498.85" "$2,498.85" "$2,498.85" "$5,553.00" "$5,553.00" "$5,553.00" "$1,157.38" "$5,553.00" "$5,553.00" "$5,553.00" "$5,553.00" "$5,553.00" "$1,157.31" "$5,553.00" "$5,553.00" "$2,737.63" "$5,553.00" "$5,553.00" "$5,553.00" "$5,553.00" "$4,164.75" "$5,553.00" "$5,553.00" "$5,553.00" "$2,776.50" "$2,776.50" "$4,397.98" "$5,553.00" "$4,442.40" "$2,498.85" "$1,102.13" N/A "$3,220.74" "$5,553.00" "$3,331.80" "$5,553.00" "$1,157.25" "$5,553.00" N/A N/A 449.637 SUP HCPCS C1713 449.637 - PLATE BONE 2 ANGLE 8X2.5MM 5X22X5 HOLE LOCK TITANIUM MANDIB BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.638 SUP HCPCS C1713 449.638 - PLATE BONE 2 ANGLE 6X24X6 HOLE LOCKING RECONSTRUCTION LP BOTH IP/OP "$6,187.50" "$4,579.00" "$1,228.06" "$6,187.50" "$2,784.38" "$2,784.38" "$2,784.38" "$2,784.38" "$6,187.50" "$6,187.50" "$6,187.50" "$1,289.63" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$1,289.54" "$6,187.50" "$2,475.00" "$3,050.44" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$4,640.63" "$6,187.50" "$6,187.50" "$6,187.50" "$3,093.75" "$3,093.75" "$4,900.50" "$6,187.50" "$4,950.00" "$2,784.38" "$1,228.06" N/A "$3,588.75" "$6,187.50" "$3,712.50" "$6,187.50" "$1,289.48" "$6,187.50" N/A N/A 449.644 SUP HCPCS C1713 449.644 - PLATE BONE ANGLED 48X8X2.5MM 1 PIECE 3X16 HOLE LOCKING BOTH IP/OP "$9,706.50" "$7,183.00" "$1,926.50" "$9,706.50" "$4,367.93" "$4,367.93" "$4,367.93" "$4,367.93" "$9,706.50" "$9,706.50" "$9,706.50" "$2,023.08" "$9,706.50" "$9,706.50" "$9,706.50" "$9,706.50" "$9,706.50" "$2,022.94" "$9,706.50" "$3,882.60" "$4,785.30" "$9,706.50" "$9,706.50" "$9,706.50" "$9,706.50" "$7,279.88" "$9,706.50" "$9,706.50" "$9,706.50" "$4,853.25" "$4,853.25" "$7,687.55" "$9,706.50" "$7,765.20" "$4,367.93" "$1,926.50" N/A "$5,629.77" "$9,706.50" "$5,823.90" "$9,706.50" "$2,022.83" "$9,706.50" N/A N/A 449.645 SUP HCPCS C1713 449.645 - PLATE BONE ANGLED 48X8X2.5MM 1 PIECE 3X16 HOLE LOCKING BOTH IP/OP "$9,706.50" "$7,183.00" "$1,926.50" "$9,706.50" "$4,367.93" "$4,367.93" "$4,367.93" "$4,367.93" "$9,706.50" "$9,706.50" "$9,706.50" "$2,023.08" "$9,706.50" "$9,706.50" "$9,706.50" "$9,706.50" "$9,706.50" "$2,022.94" "$9,706.50" "$3,882.60" "$4,785.30" "$9,706.50" "$9,706.50" "$9,706.50" "$9,706.50" "$7,279.88" "$9,706.50" "$9,706.50" "$9,706.50" "$4,853.25" "$4,853.25" "$7,687.55" "$9,706.50" "$7,765.20" "$4,367.93" "$1,926.50" N/A "$5,629.77" "$9,706.50" "$9,706.50" "$9,706.50" "$2,022.83" "$9,706.50" N/A N/A 449.646 SUP HCPCS C1713 449.646 - PLATE BONE ANGLED 56X8X2.5MM 1 PIECE 4X18 HOLE LOCKING BOTH IP/OP "$10,249.00" "$7,584.00" "$2,034.12" "$10,248.75" "$4,611.94" "$4,611.94" "$4,611.94" "$4,611.94" "$10,248.75" "$10,248.75" "$10,248.75" "$2,136.10" "$10,248.75" "$10,248.75" "$10,248.75" "$10,248.75" "$10,248.75" "$2,135.95" "$10,248.75" "$4,099.50" "$5,052.63" "$10,248.75" "$10,248.75" "$10,248.75" "$10,248.75" "$7,686.75" "$10,248.75" "$10,248.75" "$10,248.75" "$5,124.38" "$5,124.38" "$8,117.01" "$10,248.75" "$8,199.00" "$4,611.94" "$2,034.12" N/A "$5,944.42" "$10,248.75" "$6,149.25" "$10,248.75" "$2,135.84" "$10,248.75" N/A N/A 449.647 SUP HCPCS C1713 449.647 - PLATE BONE ANGLED 56X8X2.5MM 1 PIECE 4X18 HOLE LOCKING BOTH IP/OP "$10,249.00" "$7,584.00" "$2,034.12" "$10,248.75" "$4,611.94" "$4,611.94" "$4,611.94" "$4,611.94" "$10,248.75" "$10,248.75" "$10,248.75" "$2,136.10" "$10,248.75" "$10,248.75" "$10,248.75" "$10,248.75" "$10,248.75" "$2,135.95" "$10,248.75" "$4,099.50" "$5,052.63" "$10,248.75" "$10,248.75" "$10,248.75" "$10,248.75" "$7,686.75" "$10,248.75" "$10,248.75" "$10,248.75" "$5,124.38" "$5,124.38" "$8,117.01" "$10,248.75" "$8,199.00" "$4,611.94" "$2,034.12" N/A "$5,944.42" "$10,248.75" "$6,149.25" "$10,248.75" "$2,135.84" "$10,248.75" N/A N/A 449.648 SUP HCPCS C1713 449.648 - PLATE BONE ANGLED 64X8X2.5MM 1 PIECE 5X20 HOLE LOCKING BOTH IP/OP "$10,782.00" "$7,979.00" "$2,139.96" "$10,782.00" "$4,851.90" "$4,851.90" "$4,851.90" "$4,851.90" "$10,782.00" "$10,782.00" "$10,782.00" "$2,247.24" "$10,782.00" "$10,782.00" "$10,782.00" "$10,782.00" "$10,782.00" "$2,247.09" "$10,782.00" "$4,312.80" "$5,315.53" "$10,782.00" "$10,782.00" "$10,782.00" "$10,782.00" "$8,086.50" "$10,782.00" "$10,782.00" "$10,782.00" "$5,391.00" "$5,391.00" "$8,539.34" "$10,782.00" "$8,625.60" "$4,851.90" "$2,139.96" N/A "$6,253.56" "$10,782.00" "$6,469.20" "$10,782.00" "$2,246.97" "$10,782.00" N/A N/A 449.649 SUP HCPCS C1713 449.649 - PLATE BONE ANGLED 64X8X2.5MM 1 PIECE 5X20 HOLE LOCKING BOTH IP/OP "$10,782.00" "$7,979.00" "$2,139.96" "$10,782.00" "$4,851.90" "$4,851.90" "$4,851.90" "$4,851.90" "$10,782.00" "$10,782.00" "$10,782.00" "$2,247.24" "$10,782.00" "$10,782.00" "$10,782.00" "$10,782.00" "$10,782.00" "$2,247.09" "$10,782.00" "$4,312.80" "$5,315.53" "$10,782.00" "$10,782.00" "$10,782.00" "$10,782.00" "$8,086.50" "$10,782.00" "$10,782.00" "$10,782.00" "$5,391.00" "$5,391.00" "$8,539.34" "$10,782.00" "$8,625.60" "$4,851.90" "$2,139.96" N/A "$6,253.56" "$10,782.00" "$6,469.20" "$10,782.00" "$2,246.97" "$10,782.00" N/A N/A 449.651 SUP HCPCS C1713 449.651 - PLATE BONE 255D CRESCENT 8X2.5MM 3X3 HOLE LOCKING BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.652 SUP HCPCS C1713 449.652 - PLATE BONE 120D 8X2.5MM 3X3 HOLE LOCKING RECONSTRUCTION BOTH IP/OP "$2,756.50" "$2,040.00" $547.05 "$2,756.25" "$1,240.31" "$1,240.31" "$1,240.31" "$1,240.31" "$2,756.25" "$2,756.25" "$2,756.25" $574.47 "$2,756.25" "$2,756.25" "$2,756.25" "$2,756.25" "$2,756.25" $574.43 "$2,756.25" "$1,102.50" "$1,358.83" "$2,756.25" "$2,756.25" "$2,756.25" "$2,756.25" "$2,067.38" "$2,756.25" "$2,756.25" "$2,756.25" "$1,378.13" "$1,378.13" "$2,182.95" "$2,756.25" "$2,205.00" "$1,240.31" $547.05 N/A "$1,598.77" "$2,756.25" "$1,653.75" "$2,756.25" $574.40 "$2,756.25" N/A N/A 449.653 SUP HCPCS C1713 449.653 - PLATE BONE 120D 8X2.5MM 4X4 HOLE LOCKING RECONSTRUCTION BOTH IP/OP "$2,972.50" "$2,200.00" $589.92 "$2,972.25" "$1,337.51" "$1,337.51" "$1,337.51" "$1,337.51" "$2,972.25" "$2,972.25" "$2,972.25" $619.49 "$2,972.25" "$2,972.25" "$2,972.25" "$2,972.25" "$2,972.25" $619.45 "$2,972.25" "$1,188.90" "$1,465.32" "$2,972.25" "$2,972.25" "$2,972.25" "$2,972.25" "$2,229.38" "$2,972.25" "$2,972.25" "$2,972.25" "$1,486.13" "$1,486.13" "$2,354.02" "$2,972.25" "$2,377.80" "$1,337.51" $589.92 N/A "$1,724.05" "$2,972.25" "$1,783.35" "$2,972.25" $619.42 "$2,972.25" N/A N/A 449.654 SUP HCPCS C1713 449.654 - PLATE BONE 120D 8X2.5MM 5X8 HOLE LOCKING RECONSTRUCTION BOTH IP/OP "$3,242.50" "$2,399.00" $643.51 "$3,242.25" "$1,459.01" "$1,459.01" "$1,459.01" "$1,459.01" "$3,242.25" "$3,242.25" "$3,242.25" $675.77 "$3,242.25" "$3,242.25" "$3,242.25" "$3,242.25" "$3,242.25" $675.72 "$3,242.25" "$3,242.25" "$1,598.43" "$3,242.25" "$3,242.25" "$3,242.25" "$3,242.25" "$2,431.88" "$3,242.25" "$3,242.25" "$3,242.25" "$1,621.13" "$1,621.13" "$2,567.86" "$3,242.25" "$2,593.80" "$1,459.01" $643.51 N/A "$1,880.65" "$3,242.25" "$1,945.35" "$3,242.25" $675.68 "$3,242.25" N/A N/A 449.655 SUP HCPCS C1713 449.655 - PLATE BONE 120D 8X2.5MM 5X8 HOLE LOCKING RECONSTRUCTION BOTH IP/OP "$3,242.50" "$2,399.00" $643.51 "$3,242.25" "$1,459.01" "$1,459.01" "$1,459.01" "$1,459.01" "$3,242.25" "$3,242.25" "$3,242.25" $675.77 "$3,242.25" "$3,242.25" "$3,242.25" "$3,242.25" "$3,242.25" $675.72 "$3,242.25" "$1,296.90" "$1,598.43" "$3,242.25" "$3,242.25" "$3,242.25" "$3,242.25" "$2,431.88" "$3,242.25" "$3,242.25" "$3,242.25" "$1,621.13" "$1,621.13" "$2,567.86" "$3,242.25" "$2,593.80" "$1,459.01" $643.51 N/A "$1,880.65" "$3,242.25" "$3,242.25" "$3,242.25" $675.68 "$3,242.25" N/A N/A 449.669 SUP HCPCS C1713 449.669 - PLATE BONE 3 HOLE HEAD 7 HOLE SHAFT Y LCP TITANIUM BOTH IP/OP "$1,351.00" "$1,000.00" $268.12 "$1,373.85" $607.90 $607.90 $607.90 $607.90 "$1,350.88" "$1,350.88" "$1,350.88" $281.56 "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" $281.54 "$1,350.88" $549.54 $799.05 "$1,350.88" "$1,373.85" "$1,350.88" "$1,350.88" "$1,013.25" "$1,350.88" "$1,350.88" "$1,350.88" $675.44 $675.44 "$1,069.90" "$1,350.88" "$1,080.70" $607.90 $268.12 N/A $783.58 "$1,350.88" "$1,350.88" "$1,350.88" $281.52 "$1,350.88" N/A N/A 449.67 SUP HCPCS C1713 449.670 - PLATE BONE T 58MM 2X7 HOLE LCP TITANIUM CONDYLE NONSTRL 2.4 BOTH IP/OP "$1,312.00" $971.00 $260.31 "$1,373.85" $590.19 $590.19 $590.19 $590.19 "$1,311.53" "$1,311.53" "$1,311.53" $273.36 "$1,311.53" "$1,311.53" "$1,311.53" "$1,311.53" "$1,311.53" $273.34 "$1,311.53" $549.54 $775.77 "$1,311.53" "$1,373.85" "$1,311.53" "$1,311.53" $984.00 "$1,311.53" "$1,311.53" "$1,311.53" $655.77 $655.77 "$1,038.73" "$1,311.53" "$1,049.22" $590.19 $260.31 N/A $760.96 "$1,311.53" "$1,311.53" "$1,311.53" $273.32 "$1,311.53" N/A N/A 449.674 SUP HCPCS C1713 449.674 - PLATE BONE 36MM 4 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM BOTH IP/OP $735.50 $544.00 $145.91 $747.68 $330.83 $330.83 $330.83 $330.83 $735.18 $735.18 $735.18 $153.23 $735.18 $735.18 $735.18 $735.18 $735.18 $153.22 $735.18 $299.07 $434.86 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $330.83 $145.91 N/A $426.59 $735.18 $735.18 $735.18 $153.21 $735.18 N/A N/A 449.676 SUP HCPCS C1713 449.676 - PLATE BONE 52MM 6 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM BOTH IP/OP $735.50 $544.00 $145.91 $747.68 $330.83 $330.83 $330.83 $330.83 $735.18 $735.18 $735.18 $153.23 $735.18 $735.18 $735.18 $735.18 $735.18 $153.22 $735.18 $299.07 $434.86 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $330.83 $145.91 N/A $426.59 $735.18 $735.18 $735.18 $153.21 $735.18 N/A N/A 449.678 SUP HCPCS C1713 449.678 - PLATE BONE 68MM 8 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.4MM BOTH IP/OP $735.50 $544.00 $145.91 $747.68 $330.83 $330.83 $330.83 $330.83 $735.18 $735.18 $735.18 $153.23 $735.18 $735.18 $735.18 $735.18 $735.18 $153.22 $735.18 $299.07 $434.86 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $330.83 $145.91 N/A $426.59 $735.18 $735.18 $735.18 $153.21 $735.18 N/A N/A 449.679 SUP HCPCS C1713 449.679 - PLATE BONE 7 HOLE LCP TITANIUM CONDYLE NONSTRL 2.4 MM SCREW BOTH IP/OP "$1,103.50" $817.00 $219.01 "$1,122.23" $496.57 $496.57 $496.57 $496.57 "$1,103.48" "$1,103.48" "$1,103.48" $229.99 "$1,103.48" "$1,103.48" "$1,103.48" "$1,103.48" "$1,103.48" $229.98 "$1,103.48" "$1,122.23" $652.71 "$1,103.48" "$1,122.23" "$1,103.48" "$1,103.48" $827.63 "$1,103.48" "$1,103.48" "$1,103.48" $551.74 $551.74 $873.96 "$1,103.48" $882.78 $496.57 $219.01 N/A $640.03 "$1,103.48" $662.09 "$1,103.48" $229.97 "$1,103.48" N/A N/A 449.68 SUP HCPCS C1713 449.680 - PLATE BONE 40MM 4 HOLE LCP TITANIUM CONDYLE NONSTRL 2.7MM BOTH IP/OP $753.50 $558.00 $149.52 $789.15 $339.01 $339.01 $339.01 $339.01 $753.35 $753.35 $753.35 $157.02 $753.35 $753.35 $753.35 $753.35 $753.35 $157.01 $753.35 $315.66 $445.61 $753.35 $789.15 $753.35 $753.35 $565.13 $753.35 $753.35 $753.35 $376.68 $376.68 $596.65 $753.35 $602.68 $339.01 $149.52 N/A $437.03 $753.35 $452.01 $753.35 $157.00 $753.35 N/A N/A 449.681 SUP HCPCS C1713 449.681 - PLATE BONE 49MM 5 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.7MM BOTH IP/OP $776.00 $574.00 $154.01 $789.15 $349.18 $349.18 $349.18 $349.18 $775.95 $775.95 $775.95 $161.73 $775.95 $775.95 $775.95 $775.95 $775.95 $161.72 $775.95 $315.66 $458.97 $775.95 $789.15 $775.95 $775.95 $582.00 $775.95 $775.95 $775.95 $387.98 $387.98 $614.55 $775.95 $620.76 $349.18 $154.01 N/A $450.08 $775.95 $465.57 $775.95 $161.71 $775.95 N/A N/A 449.682 SUP HCPCS C1713 449.682 - PLATE BONE 6 HOLE LCP TITANIUM CONDYLE NONSTRL 2.4 MM SCREW BOTH IP/OP $776.00 $574.00 $154.01 $789.15 $349.18 $349.18 $349.18 $349.18 $775.95 $775.95 $775.95 $161.73 $775.95 $775.95 $775.95 $775.95 $775.95 $161.72 $775.95 $315.66 $458.97 $775.95 $789.15 $775.95 $775.95 $582.00 $775.95 $775.95 $775.95 $387.98 $387.98 $614.55 $775.95 $620.76 $349.18 $154.01 N/A $450.08 $775.95 $465.57 $775.95 $161.71 $775.95 N/A N/A 449.683 SUP HCPCS C1713 449.683 - PLATE BONE 67MM 7 HOLE LCP TITANIUM ORTHOPEDIC NONSTRL 2.7MM BOTH IP/OP $776.00 $574.00 $154.01 $789.15 $349.18 $349.18 $349.18 $349.18 $775.95 $775.95 $775.95 $161.73 $775.95 $775.95 $775.95 $775.95 $775.95 $161.72 $775.95 $789.15 $458.97 $775.95 $789.15 $775.95 $775.95 $582.00 $775.95 $775.95 $775.95 $387.98 $387.98 $614.55 $775.95 $620.76 $349.18 $154.01 N/A $450.08 $775.95 $465.57 $775.95 $161.71 $775.95 N/A N/A 449.684 SUP HCPCS C1713 449.684 - PLATE BONE 7 HOLE LCP TITANIUM CONDYLE NONSTRL 2.7 MM SCREWS BOTH IP/OP "$1,203.50" $891.00 $238.82 "$1,223.73" $541.48 $541.48 $541.48 $541.48 "$1,203.28" "$1,203.28" "$1,203.28" $250.79 "$1,203.28" "$1,203.28" "$1,203.28" "$1,203.28" "$1,203.28" $250.78 "$1,203.28" "$1,223.73" $711.74 "$1,203.28" "$1,223.73" "$1,203.28" "$1,203.28" $902.63 "$1,203.28" "$1,203.28" "$1,203.28" $601.64 $601.64 $953.00 "$1,203.28" $962.62 $541.48 $238.82 N/A $698.03 "$1,203.28" "$1,203.28" "$1,203.28" $250.76 "$1,203.28" N/A N/A 449.685 SUP HCPCS C1713 449.685 - PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT T LCP TITANIUM BOTH IP/OP "$1,351.00" "$1,000.00" $268.12 "$1,373.85" $607.90 $607.90 $607.90 $607.90 "$1,350.88" "$1,350.88" "$1,350.88" $281.56 "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" $281.54 "$1,350.88" "$1,373.85" $799.05 "$1,350.88" "$1,373.85" "$1,350.88" "$1,350.88" "$1,013.25" "$1,350.88" "$1,350.88" "$1,350.88" $675.44 $675.44 "$1,069.90" "$1,350.88" "$1,080.70" $607.90 $268.12 N/A $783.58 "$1,350.88" $810.53 "$1,350.88" $281.52 "$1,350.88" N/A N/A 449.686 SUP HCPCS C1713 449.686 - PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT L RIGHT OBLIQUE LCP BOTH IP/OP $737.00 $545.00 $146.19 $749.10 $331.46 $331.46 $331.46 $331.46 $736.58 $736.58 $736.58 $153.52 $736.58 $736.58 $736.58 $736.58 $736.58 $153.51 $736.58 $749.10 $435.69 $736.58 $749.10 $736.58 $736.58 $552.75 $736.58 $736.58 $736.58 $368.29 $368.29 $583.37 $736.58 $589.26 $331.46 $146.19 N/A $427.46 $736.58 $441.95 $736.58 $153.50 $736.58 N/A N/A 449.687 SUP HCPCS C1713 449.687 - PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT L LEFT OBLIQUE LCP BOTH IP/OP $737.00 $545.00 $146.19 $749.10 $331.46 $331.46 $331.46 $331.46 $736.58 $736.58 $736.58 $153.52 $736.58 $736.58 $736.58 $736.58 $736.58 $153.51 $736.58 $749.10 $435.69 $736.58 $749.10 $736.58 $736.58 $552.75 $736.58 $736.58 $736.58 $368.29 $368.29 $583.37 $736.58 $589.26 $331.46 $146.19 N/A $427.46 $736.58 $441.95 $736.58 $153.50 $736.58 N/A N/A 449.688 SUP HCPCS C1713 449.688 - PLATE BONE 2 HOLE HEAD 3 HOLE SHAFT L LCP TITANIUM RIGHT BOTH IP/OP $737.00 $545.00 $146.19 $749.10 $331.46 $331.46 $331.46 $331.46 $736.58 $736.58 $736.58 $153.52 $736.58 $736.58 $736.58 $736.58 $736.58 $153.51 $736.58 $749.10 $435.69 $736.58 $749.10 $736.58 $736.58 $552.75 $736.58 $736.58 $736.58 $368.29 $368.29 $583.37 $736.58 $589.26 $331.46 $146.19 N/A $427.46 $736.58 $441.95 $736.58 $153.50 $736.58 N/A N/A 449.689 SUP HCPCS C1713 449.689 - PLATE BONE 2.7MM 2 HOLE HEAD 3 HOLE SHAFT LCP TITANIUM LEFT BOTH IP/OP $737.00 $545.00 $146.19 $749.10 $331.46 $331.46 $331.46 $331.46 $736.58 $736.58 $736.58 $153.52 $736.58 $736.58 $736.58 $736.58 $736.58 $153.51 $736.58 $749.10 $435.69 $736.58 $749.10 $736.58 $736.58 $552.75 $736.58 $736.58 $736.58 $368.29 $368.29 $583.37 $736.58 $589.26 $331.46 $146.19 N/A $427.46 $736.58 $736.58 $736.58 $153.50 $736.58 N/A N/A 449.69 SUP HCPCS C1713 449.690 - PLATE BONE 31MM 5 HOLE LOCKING TITANIUM HIND MIDFT NONSTRL BOTH IP/OP "$1,455.00" "$1,077.00" $288.75 "$1,523.95" $654.67 $654.67 $654.67 $654.67 "$1,454.83" "$1,454.83" "$1,454.83" $303.22 "$1,454.83" "$1,454.83" "$1,454.83" "$1,454.83" "$1,454.83" $303.20 "$1,454.83" "$1,523.95" $860.53 "$1,454.83" "$1,523.95" "$1,454.83" "$1,454.83" "$1,091.25" "$1,454.83" "$1,454.83" "$1,454.83" $727.42 $727.42 "$1,152.23" "$1,454.83" "$1,163.86" $654.67 $288.75 N/A $843.90 "$1,454.83" $872.90 "$1,454.83" $303.19 "$1,454.83" N/A N/A 449.691 SUP HCPCS C1713 449.691 - PLATE BONE 45MM 8 HOLE LOCKING TITANIUM HIND MIDFT NONSTRL BOTH IP/OP "$1,529.50" "$1,132.00" $303.55 "$1,555.40" $688.23 $688.23 $688.23 $688.23 "$1,529.40" "$1,529.40" "$1,529.40" $318.77 "$1,529.40" "$1,529.40" "$1,529.40" "$1,529.40" "$1,529.40" $318.74 "$1,529.40" $622.16 $904.64 "$1,529.40" "$1,555.40" "$1,529.40" "$1,529.40" "$1,147.13" "$1,529.40" "$1,529.40" "$1,529.40" $764.70 $764.70 "$1,211.28" "$1,529.40" "$1,223.52" $688.23 $303.55 N/A $887.11 "$1,529.40" $917.64 "$1,529.40" $318.73 "$1,529.40" N/A N/A 449.697 SUP HCPCS C1713 449.697 - PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT T LCP TITANIUM BOTH IP/OP "$1,351.00" "$1,000.00" $268.12 "$1,373.85" $607.90 $607.90 $607.90 $607.90 "$1,350.88" "$1,350.88" "$1,350.88" $281.56 "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" $281.54 "$1,350.88" $549.54 $799.05 "$1,350.88" "$1,373.85" "$1,350.88" "$1,350.88" "$1,013.25" "$1,350.88" "$1,350.88" "$1,350.88" $675.44 $675.44 "$1,069.90" "$1,350.88" "$1,080.70" $607.90 $268.12 N/A $783.58 "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" N/A N/A 449.698 SUP HCPCS C1713 449.698 - PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L RIGHT OBLIQUE LCP BOTH IP/OP $760.50 $563.00 $150.94 $773.40 $342.22 $342.22 $342.22 $342.22 $760.48 $760.48 $760.48 $158.50 $760.48 $760.48 $760.48 $760.48 $760.48 $158.49 $760.48 $773.40 $449.82 $760.48 $773.40 $760.48 $760.48 $570.38 $760.48 $760.48 $760.48 $380.24 $380.24 $602.30 $760.48 $608.38 $342.22 $150.94 N/A $441.09 $760.48 $456.29 $760.48 $760.48 $760.48 N/A N/A 449.699 SUP HCPCS C1713 449.699 - PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L LEFT OBLIQUE LCP BOTH IP/OP $760.50 $563.00 $150.94 $773.40 $342.22 $342.22 $342.22 $342.22 $760.48 $760.48 $760.48 $158.50 $760.48 $760.48 $760.48 $760.48 $760.48 $158.49 $760.48 $773.40 $449.82 $760.48 $773.40 $760.48 $760.48 $570.38 $760.48 $760.48 $760.48 $380.24 $380.24 $602.30 $760.48 $608.38 $342.22 $150.94 N/A $441.09 $760.48 $456.29 $760.48 $158.48 $760.48 N/A N/A 449.7 SUP HCPCS C1713 449.70 - PLATE BONE 159MM 20 HOLE RECONSTRUCTION TITANIUM MANDIB BOTH IP/OP "$3,154.50" "$2,334.00" $626.09 "$3,154.50" "$1,419.53" "$1,419.53" "$1,419.53" "$1,419.53" "$3,154.50" "$3,154.50" "$3,154.50" $657.48 "$3,154.50" "$3,154.50" "$3,154.50" "$3,154.50" "$3,154.50" $657.43 "$3,154.50" "$1,261.80" "$1,555.17" "$3,154.50" "$3,154.50" "$3,154.50" "$3,154.50" "$2,365.88" "$3,154.50" "$3,154.50" "$3,154.50" "$1,577.25" "$1,577.25" "$2,498.36" "$3,154.50" "$2,523.60" "$1,419.53" $626.09 N/A "$1,829.61" "$3,154.50" "$1,892.70" "$3,154.50" $657.40 "$3,154.50" N/A N/A 449.701 SUP HCPCS C1713 449.701 - PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L LCP TITANIUM RIGHT BOTH IP/OP $760.50 $563.00 $150.94 $773.40 $342.22 $342.22 $342.22 $342.22 $760.48 $760.48 $760.48 $158.50 $760.48 $760.48 $760.48 $760.48 $760.48 $158.49 $760.48 $309.36 $449.82 $760.48 $773.40 $760.48 $760.48 $570.38 $760.48 $760.48 $760.48 $380.24 $380.24 $602.30 $760.48 $608.38 $342.22 $150.94 N/A $441.09 $760.48 $760.48 $760.48 $158.48 $760.48 N/A N/A 449.702 SUP HCPCS C1713 449.702 - PLATE BONE 2 HOLE HEAD 4 HOLE SHAFT L LCP TITANIUM LEFT BOTH IP/OP $760.50 $563.00 $150.94 $773.40 $342.22 $342.22 $342.22 $342.22 $760.48 $760.48 $760.48 $158.50 $760.48 $760.48 $760.48 $760.48 $760.48 $158.49 $760.48 $309.36 $449.82 $760.48 $773.40 $760.48 $760.48 $570.38 $760.48 $760.48 $760.48 $380.24 $380.24 $602.30 $760.48 $608.38 $342.22 $150.94 N/A $441.09 $760.48 $456.29 $760.48 $158.48 $760.48 N/A N/A 449.82 SUP HCPCS C1713 449.82 - PLATE UNV 26MM CRNMXF 3X3 HOLE ANG 2.4MM SCR FRAC BONE TI BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.84 SUP HCPCS C1713 449.84 - PLATE BONE ANGLE UNIVERSAL 32X6.5X2MM 4X4 HOLE FRAC TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 449.87 SUP HCPCS C1713 449.87 - PLATE BONE LEFT ANGLE 97X47MM 5X13 HOLE RECONSTRUCTION BOTH IP/OP "$3,472.00" "$2,569.00" $689.06 "$3,471.75" "$1,562.29" "$1,562.29" "$1,562.29" "$1,562.29" "$3,471.75" "$3,471.75" "$3,471.75" $723.60 "$3,471.75" "$3,471.75" "$3,471.75" "$3,471.75" "$3,471.75" $723.55 "$3,471.75" "$1,388.70" "$1,711.57" "$3,471.75" "$3,471.75" "$3,471.75" "$3,471.75" "$2,604.00" "$3,471.75" "$3,471.75" "$3,471.75" "$1,735.88" "$1,735.88" "$2,749.63" "$3,471.75" "$2,777.40" "$1,562.29" $689.06 N/A "$2,013.76" "$3,471.75" "$2,083.05" "$3,471.75" "$3,471.75" "$3,471.75" N/A N/A 449.88 SUP HCPCS C1713 449.88 - PLATE BONE RIGHT ANG 97X47MM 5X13 HOLE RECONSTRUCTION BOTH IP/OP "$3,472.00" "$2,569.00" $689.06 "$3,471.75" "$1,562.29" "$1,562.29" "$1,562.29" "$1,562.29" "$3,471.75" "$3,471.75" "$3,471.75" $723.60 "$3,471.75" "$3,471.75" "$3,471.75" "$3,471.75" "$3,471.75" $723.55 "$3,471.75" "$3,471.75" "$1,711.57" "$3,471.75" "$3,471.75" "$3,471.75" "$3,471.75" "$2,604.00" "$3,471.75" "$3,471.75" "$3,471.75" "$1,735.88" "$1,735.88" "$2,749.63" "$3,471.75" "$2,777.40" "$1,562.29" $689.06 N/A "$2,013.76" "$3,471.75" "$2,083.05" "$3,471.75" "$3,471.75" "$3,471.75" N/A N/A 449.906 SUP HCPCS C1713 449.906 - PLATE BN STRG 36X6.3X1.25MM NS 6 HL LOPRFL PRECONTOUR CUT TO BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $180.70 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $266.52 $444.20 $92.57 $444.20 N/A N/A 449.912 SUP HCPCS C1713 449.912 - PLATE BN STRG 72X6.3X1.25MM NS 12 HL LOPRFL PRECONTOUR CUT BOTH IP/OP $523.00 $387.00 $103.79 $531.83 $235.32 $235.32 $235.32 $235.32 $522.93 $522.93 $522.93 $108.99 $522.93 $522.93 $522.93 $522.93 $522.93 $108.98 $522.93 $212.73 $309.31 $522.93 $531.83 $522.93 $522.93 $392.25 $522.93 $522.93 $522.93 $261.47 $261.47 $414.16 $522.93 $418.34 $235.32 $103.79 N/A $303.34 $522.93 $522.93 $522.93 $108.98 $522.93 N/A N/A 449.913 SUP HCPCS C1713 449.913 - PLATE BN T 54X6.3X1.25MM NS 2 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $498.00 $369.00 $98.77 $506.08 $223.93 $223.93 $223.93 $223.93 $497.63 $497.63 $497.63 $103.72 $497.63 $497.63 $497.63 $497.63 $497.63 $103.71 $497.63 $202.43 $294.35 $497.63 $506.08 $497.63 $497.63 $373.50 $497.63 $497.63 $497.63 $248.82 $248.82 $394.12 $497.63 $398.10 $223.93 $98.77 N/A $288.84 $497.63 $298.58 $497.63 $103.71 $497.63 N/A N/A 449.914 SUP HCPCS C1713 449.914 - PLATE BN T 54X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $531.50 $393.00 $105.46 $540.38 $239.11 $239.11 $239.11 $239.11 $531.35 $531.35 $531.35 $110.75 $531.35 $531.35 $531.35 $531.35 $531.35 $110.74 $531.35 $540.38 $314.29 $531.35 $540.38 $531.35 $531.35 $398.63 $531.35 $531.35 $531.35 $265.68 $265.68 $420.83 $531.35 $425.08 $239.11 $105.46 N/A $308.27 $531.35 $318.81 $531.35 $110.73 $531.35 N/A N/A 449.915 SUP HCPCS C1713 449.915 - PLATE BN Y 56X6.3X1.25MM NS 3 HLE/HD 8 HL SHFT LOPRFL BOTH IP/OP $514.50 $381.00 $102.11 $523.23 $231.52 $231.52 $231.52 $231.52 $514.48 $514.48 $514.48 $107.23 $514.48 $514.48 $514.48 $514.48 $514.48 $107.22 $514.48 $523.23 $304.31 $514.48 $523.23 $514.48 $514.48 $385.88 $514.48 $514.48 $514.48 $257.24 $257.24 $407.47 $514.48 $411.58 $231.52 $102.11 N/A $298.41 $514.48 $514.48 $514.48 $107.22 $514.48 N/A N/A 449.916 SUP HCPCS C1713 449.916 - PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH BOTH IP/OP $581.00 $430.00 $115.22 $590.43 $261.25 $261.25 $261.25 $261.25 $580.55 $580.55 $580.55 $121.00 $580.55 $580.55 $580.55 $580.55 $580.55 $120.99 $580.55 $236.17 $343.40 $580.55 $590.43 $580.55 $580.55 $435.75 $580.55 $580.55 $580.55 $290.28 $290.28 $459.80 $580.55 $464.44 $261.25 $115.22 N/A $336.98 $580.55 $348.33 $580.55 $120.99 $580.55 N/A N/A 449.917 SUP HCPCS C1713 449.917 - PLATE BN 57X6.3X1.25MM NS 8 HL LOPRFL PRECONTOUR CUT TO LGTH BOTH IP/OP $581.00 $430.00 $115.22 $590.43 $261.25 $261.25 $261.25 $261.25 $580.55 $580.55 $580.55 $121.00 $580.55 $580.55 $580.55 $580.55 $580.55 $120.99 $580.55 $236.17 $343.40 $580.55 $590.43 $580.55 $580.55 $435.75 $580.55 $580.55 $580.55 $290.28 $290.28 $459.80 $580.55 $464.44 $261.25 $115.22 N/A $336.98 $580.55 $348.33 $580.55 $120.99 $580.55 N/A N/A 449.924 SUP HCPCS C1713 449.924 - PLATE BN 31X6.5X1.6MM NS LC DCP 4 HL LOPRFL PRECONTOUR CUT BOTH IP/OP $618.50 $458.00 $122.76 $629.03 $278.33 $278.33 $278.33 $278.33 $618.50 $618.50 $618.50 $128.91 $618.50 $618.50 $618.50 $618.50 $618.50 $128.90 $618.50 $251.61 $365.84 $618.50 $629.03 $618.50 $618.50 $463.88 $618.50 $618.50 $618.50 $309.25 $309.25 $489.85 $618.50 $494.80 $278.33 $122.76 N/A $358.73 $618.50 $371.10 $618.50 $128.90 $618.50 N/A N/A 449.926 SUP HCPCS C1713 449.926 - PLATE BN 47X6.5X1.6MM NS LC DCP 6 HL LOPRFL PRECONTOUR CUT BOTH IP/OP $696.00 $515.00 $138.10 $707.65 $313.12 $313.12 $313.12 $313.12 $695.83 $695.83 $695.83 $145.03 $695.83 $695.83 $695.83 $695.83 $695.83 $145.02 $695.83 $707.65 $411.58 $695.83 $707.65 $695.83 $695.83 $522.00 $695.83 $695.83 $695.83 $347.92 $347.92 $551.10 $695.83 $556.66 $313.12 $138.10 N/A $403.68 $695.83 $695.83 $695.83 $145.01 $695.83 N/A N/A 449.928 SUP HCPCS C1713 449.928 - PLATE BN 63X6.5X1.6MM NS LC DCP 8 HL LOPRFL PRECONTOUR CUT BOTH IP/OP $751.00 $556.00 $148.99 $763.40 $337.79 $337.79 $337.79 $337.79 $750.65 $750.65 $750.65 $156.45 $750.65 $750.65 $750.65 $750.65 $750.65 $156.44 $750.65 $763.40 $444.01 $750.65 $763.40 $750.65 $750.65 $563.25 $750.65 $750.65 $750.65 $375.33 $375.33 $594.51 $750.65 $600.52 $337.79 $148.99 N/A $435.58 $750.65 $750.65 $750.65 $156.44 $750.65 N/A N/A 449.931 SUP HCPCS C1713 449.931 - PLATE BN 24X5.5X1.25MM NS LC DCP 4 HL LOPRFL PRECONTOUR TI BOTH IP/OP $444.50 $329.00 $88.16 $451.75 $199.89 $199.89 $199.89 $199.89 $444.20 $444.20 $444.20 $92.58 $444.20 $444.20 $444.20 $444.20 $444.20 $92.58 $444.20 $180.70 $262.74 $444.20 $451.75 $444.20 $444.20 $333.38 $444.20 $444.20 $444.20 $222.10 $222.10 $351.81 $444.20 $355.36 $199.89 $88.16 N/A $257.81 $444.20 $444.20 $444.20 $92.57 $444.20 N/A N/A 449.936 SUP HCPCS C1713 449.936 - PLATE BN 36X5.5X1.25MM NS LC DCP 6 HL LOPRFL PRECONTOUR TI BOTH IP/OP $523.00 $387.00 $103.79 $531.83 $235.32 $235.32 $235.32 $235.32 $522.93 $522.93 $522.93 $108.99 $522.93 $522.93 $522.93 $522.93 $522.93 $108.98 $522.93 $531.83 $309.31 $522.93 $531.83 $522.93 $522.93 $392.25 $522.93 $522.93 $522.93 $261.47 $261.47 $414.16 $522.93 $418.34 $235.32 $103.79 N/A $303.34 $522.93 $313.76 $522.93 $108.98 $522.93 N/A N/A 449.938 SUP HCPCS C1713 449.938 - PLATE BN 48X5.5X1.25MM NS LC DCP 8 HL LOPRFL PRECONTOUR TI BOTH IP/OP $595.00 $440.00 $118.01 $604.70 $267.57 $267.57 $267.57 $267.57 $594.60 $594.60 $594.60 $123.93 $594.60 $594.60 $594.60 $594.60 $594.60 $123.92 $594.60 $241.88 $351.71 $594.60 $604.70 $594.60 $594.60 $446.25 $594.60 $594.60 $594.60 $297.30 $297.30 $470.92 $594.60 $475.68 $267.57 $118.01 N/A $345.10 $594.60 $356.76 $594.60 $594.60 $594.60 N/A N/A 450.101 SUP HCPCS C1713 450.101 - PLATE BONE 90X4X.6MM 20 HOLE ADAPTION MALBLE ANATOMIC REDX BOTH IP/OP $819.00 $606.00 $162.55 $819.00 $368.55 $368.55 $368.55 $368.55 $819.00 $819.00 $819.00 $170.70 $819.00 $819.00 $819.00 $819.00 $819.00 $170.69 $819.00 $819.00 $484.44 $819.00 $819.00 $819.00 $819.00 $614.25 $819.00 $819.00 $819.00 $409.50 $409.50 $648.65 $819.00 $655.20 $368.55 $162.55 N/A $475.02 $819.00 $491.40 $819.00 $170.68 $819.00 N/A N/A 450.611 SUP HCPCS C1713 450.611 - PLATE BONE Y 1X3 HOLE MALBLE ANATOMIC REDX CNTOUR RED BOTH IP/OP $567.00 $420.00 $112.54 $567.00 $255.15 $255.15 $255.15 $255.15 $567.00 $567.00 $567.00 $118.18 $567.00 $567.00 $567.00 $567.00 $567.00 $118.17 $567.00 $567.00 $335.38 $567.00 $567.00 $567.00 $567.00 $425.25 $567.00 $567.00 $567.00 $283.50 $283.50 $449.06 $567.00 $453.60 $255.15 $112.54 N/A $328.86 $567.00 $340.20 $567.00 $118.16 $567.00 N/A N/A 450.861 SUP HCPCS C1713 450.861 - SCREW BONE FULTHD 6MM 45MM SELF TAP LOCKING HEXAGONAL RECESS BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $361.65 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 450.862 SUP HCPCS C1713 450.862 - SCREW BONE 6MM 50MM LOCKING HEXAGONAL RECESS AQUA TITANIUM BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $144.66 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $361.65 $361.65 $75.37 $361.65 N/A N/A 450.863 SUP HCPCS C1713 450.863 - SCREW BONE 6MM 55MM LOCKING HEXAGONAL RECESS AQUA TITANIUM BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $144.66 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 450.864 SUP HCPCS C1713 450.864 - SCREW BONE 6MM 60MM LOCKING HEXAGONAL RECESS AQUA TITANIUM BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $144.66 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 450.865 SUP HCPCS C1713 450.865 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 65MM 2 LEAD BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $144.66 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 450.866 SUP HCPCS C1713 450.866 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 70MM 2 LEAD BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $144.66 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 450.867 SUP HCPCS C1713 450.867 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 75MM 2 LEAD BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $144.66 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 450.868 SUP HCPCS C1713 450.868 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 80MM 2 LEAD BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $144.66 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $361.65 $361.65 $361.65 $361.65 N/A N/A 450.869 SUP HCPCS C1713 450.869 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 6MM 8MM 85MM 2 LEAD BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $144.66 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 450.87 SUP HCPCS C1713 450.870 - SCREW BONE 6MM 90MM LOCKING HEXAGONAL RECESS AQUA TITANIUM BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $144.66 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 450.871 SUP HCPCS C1713 450.871 - SCREW BONE 6MM 95MM LOCKING HEXAGONAL RECESS AQUA TITANIUM BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $361.65 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 450.872 SUP HCPCS C1713 450.872 - SCREW BONE 6MM 100MM LOCKING HEXAGONAL RECESS AQUA TITANIUM BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $144.66 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 450.873 SUP HCPCS C1713 450.873 - SCREW BONE 3.5MM FULTHD 6MM 8MM 30MM 2 LEAD THREAD LOCKING BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $144.66 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 450.874 SUP HCPCS C1713 450.874 - SCREW BONE FULTHD 6MM 4.8MM 35MM 2 LEAD THREAD LOCKING BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $361.65 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $216.99 $361.65 $75.37 $361.65 N/A N/A 450.875 SUP HCPCS C1713 450.875 - SCREW BONE FULTHD 6MM 4.8MM 40MM 2 LEAD THREAD LOCKING BOTH IP/OP $362.00 $268.00 $71.78 $361.65 $162.74 $162.74 $162.74 $162.74 $361.65 $361.65 $361.65 $75.38 $361.65 $361.65 $361.65 $361.65 $361.65 $75.37 $361.65 $361.65 $213.92 $361.65 $361.65 $361.65 $361.65 $271.50 $361.65 $361.65 $361.65 $180.83 $180.83 $286.43 $361.65 $289.32 $162.74 $71.78 N/A $209.96 $361.65 $361.65 $361.65 $75.37 $361.65 N/A N/A 451 SUP Custom 27203010 451 - EVACUATOR SRG STRL LTX ELLIK CMPLT BLDR DISP BOTH IP/OP $157.50 $117.00 $1.25 $118.13 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $118.13 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $91.35 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 451.101 SUP HCPCS C1713 451.101 - PLATE BONE 100MMX6MM 20 HOLE ADAPTION MALBLE BLUE TITANIUM BOTH IP/OP "$1,017.00" $753.00 $201.85 "$1,017.00" $457.65 $457.65 $457.65 $457.65 "$1,017.00" "$1,017.00" "$1,017.00" $211.97 "$1,017.00" "$1,017.00" "$1,017.00" "$1,017.00" "$1,017.00" $211.95 "$1,017.00" "$1,017.00" $601.56 "$1,017.00" "$1,017.00" "$1,017.00" "$1,017.00" $762.75 "$1,017.00" "$1,017.00" "$1,017.00" $508.50 $508.50 $805.46 "$1,017.00" $813.60 $457.65 $201.85 N/A $589.86 "$1,017.00" $610.20 "$1,017.00" $211.94 "$1,017.00" N/A N/A 451.611 SUP HCPCS C1713 451.611 - PLATE BONE Y 24X12X6MM 1X3 HOLE MALBLE TITANIUM CRANFCL BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A 457.07 SUP HCPCS C1713 457.070 - SCREW BONE 5MM 70MM 16MM SLFTAP SHAFT GOLD TITANIUM FEMUR BOTH IP/OP $518.50 $384.00 $102.88 $518.33 $233.25 $233.25 $233.25 $233.25 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $306.59 $518.33 $518.33 $518.33 $518.33 $388.88 $518.33 $518.33 $518.33 $259.17 $259.17 $410.52 $518.33 $414.66 $233.25 $102.88 N/A $300.73 $518.33 $518.33 $518.33 $108.02 $518.33 N/A N/A 457.075 SUP HCPCS C1713 457.075 - SCREW BONE 5MM 75MM 16MM SLFTAP SHAFT GOLD TITANIUM FEMUR BOTH IP/OP $518.50 $384.00 $102.88 $518.33 $233.25 $233.25 $233.25 $233.25 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $306.59 $518.33 $518.33 $518.33 $518.33 $388.88 $518.33 $518.33 $518.33 $259.17 $259.17 $410.52 $518.33 $414.66 $233.25 $102.88 N/A $300.73 $518.33 $311.00 $518.33 $108.02 $518.33 N/A N/A 457.08 SUP HCPCS C1713 457.080 - SCREW BONE 5MM 80MM 16MM SLFTAP SHAFT GOLD TITANIUM FEMUR BOTH IP/OP $518.50 $384.00 $102.88 $518.33 $233.25 $233.25 $233.25 $233.25 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $306.59 $518.33 $518.33 $518.33 $518.33 $388.88 $518.33 $518.33 $518.33 $259.17 $259.17 $410.52 $518.33 $414.66 $233.25 $102.88 N/A $300.73 $518.33 $311.00 $518.33 $108.02 $518.33 N/A N/A 457.085 SUP HCPCS C1713 457.085 - SCREW BONE 5MM 85MM 16MM SLFTAP SHAFT GOLD TITANIUM FEMUR BOTH IP/OP $518.50 $384.00 $102.88 $518.33 $233.25 $233.25 $233.25 $233.25 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $306.59 $518.33 $518.33 $518.33 $518.33 $388.88 $518.33 $518.33 $518.33 $259.17 $259.17 $410.52 $518.33 $414.66 $233.25 $102.88 N/A $300.73 $518.33 $518.33 $518.33 $108.02 $518.33 N/A N/A 457.09 SUP HCPCS C1713 457.090 - SCREW BONE 5MM 90MM 16MM SLFTAP SHAFT GOLD TITANIUM FEMUR BOTH IP/OP $518.50 $384.00 $102.88 $518.33 $233.25 $233.25 $233.25 $233.25 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $306.59 $518.33 $518.33 $518.33 $518.33 $388.88 $518.33 $518.33 $518.33 $259.17 $259.17 $410.52 $518.33 $414.66 $233.25 $102.88 N/A $300.73 $518.33 $311.00 $518.33 $108.02 $518.33 N/A N/A 457.095 SUP HCPCS C1713 457.095 - SCREW BONE 5MM 95MM 16MM SLFTAP SHAFT GOLD TITANIUM FEMUR BOTH IP/OP $518.50 $384.00 $102.88 $518.33 $233.25 $233.25 $233.25 $233.25 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $306.59 $518.33 $518.33 $518.33 $518.33 $388.88 $518.33 $518.33 $518.33 $259.17 $259.17 $410.52 $518.33 $414.66 $233.25 $102.88 N/A $300.73 $518.33 $311.00 $518.33 $108.02 $518.33 N/A N/A 457.1 SUP HCPCS C1713 457.100 - SCREW BONE 5MM 100MM 16MM SLFTAP SHAFT GOLD TITANIUM FEMUR BOTH IP/OP $518.50 $384.00 $102.88 $518.33 $233.25 $233.25 $233.25 $233.25 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $518.33 $518.33 $518.33 $108.03 $518.33 $207.33 $306.59 $518.33 $518.33 $518.33 $518.33 $388.88 $518.33 $518.33 $518.33 $259.17 $259.17 $410.52 $518.33 $414.66 $233.25 $102.88 N/A $300.73 $518.33 $518.33 $518.33 $108.02 $518.33 N/A N/A 457.105 SUP HCPCS C1713 457.105 - SCREW BONE 5MM 105MM 16MM SLFTAP SHAFT GOLD TITANIUM FEMUR BOTH IP/OP $518.50 $384.00 $102.88 $518.33 $233.25 $233.25 $233.25 $233.25 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $518.33 $518.33 $518.33 $108.03 $518.33 $207.33 $306.59 $518.33 $518.33 $518.33 $518.33 $388.88 $518.33 $518.33 $518.33 $259.17 $259.17 $410.52 $518.33 $414.66 $233.25 $102.88 N/A $300.73 $518.33 $311.00 $518.33 $518.33 $518.33 N/A N/A 457.11 SUP HCPCS C1713 457.110 - SCREW BONE 5MM 110MM 16MM SLFTAP SHAFT GOLD TITANIUM FEMUR BOTH IP/OP $518.50 $384.00 $102.88 $518.33 $233.25 $233.25 $233.25 $233.25 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $518.33 $518.33 $518.33 $108.03 $518.33 $207.33 $306.59 $518.33 $518.33 $518.33 $518.33 $388.88 $518.33 $518.33 $518.33 $259.17 $259.17 $410.52 $518.33 $414.66 $233.25 $102.88 N/A $300.73 $518.33 $311.00 $518.33 $108.02 $518.33 N/A N/A 457.115 SUP HCPCS C1713 457.115 - SCREW BONE 5MM 115MM 16MM SLFTAP SHAFT GOLD TITANIUM FEMUR BOTH IP/OP $518.50 $384.00 $102.88 $518.33 $233.25 $233.25 $233.25 $233.25 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $306.59 $518.33 $518.33 $518.33 $518.33 $388.88 $518.33 $518.33 $518.33 $259.17 $259.17 $410.52 $518.33 $414.66 $233.25 $102.88 N/A $300.73 $518.33 $311.00 $518.33 $518.33 $518.33 N/A N/A 457.12 SUP HCPCS C1713 457.120 - SCREW BONE 5MM 120MM 16MM SLFTAP SHAFT GOLD TITANIUM FEMUR BOTH IP/OP $518.50 $384.00 $102.88 $518.33 $233.25 $233.25 $233.25 $233.25 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $306.59 $518.33 $518.33 $518.33 $518.33 $388.88 $518.33 $518.33 $518.33 $259.17 $259.17 $410.52 $518.33 $414.66 $233.25 $102.88 N/A $300.73 $518.33 $311.00 $518.33 $518.33 $518.33 N/A N/A 457.125 SUP HCPCS C1713 457.125 - SCREW BONE 5MM 125MM 16MM SLFTAP SHAFT GOLD TITANIUM FEMUR BOTH IP/OP $518.50 $384.00 $102.88 $518.33 $233.25 $233.25 $233.25 $233.25 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $518.33 $518.33 $518.33 $108.03 $518.33 $518.33 $306.59 $518.33 $518.33 $518.33 $518.33 $388.88 $518.33 $518.33 $518.33 $259.17 $259.17 $410.52 $518.33 $414.66 $233.25 $102.88 N/A $300.73 $518.33 $311.00 $518.33 $108.02 $518.33 N/A N/A 458.818 SUP HCPCS C1713 458.818 - SCREW BONE 4MM 3.3MM 18MM SELF CUTTING TROCAR TIP LOCKING BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $330.00 $330.00 $68.77 $330.00 N/A N/A 458.82 SUP HCPCS C1713 458.820 - SCREW BONE TROCAR 4MM 8MM 20MM 2 LEAD THREAD LOCKING SLFTAP BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.822 SUP HCPCS C1713 458.822 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 22MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.824 SUP HCPCS C1713 458.824 - SCREW BONE 4MM 3.3MM 24MM SELF CUTTING TROCAR TIP LOCKING BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $330.00 $330.00 N/A N/A 458.826 SUP HCPCS C1713 458.826 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 26MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $330.00 $330.00 N/A N/A 458.828 SUP HCPCS C1713 458.828 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 28MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.83 SUP HCPCS C1713 458.830 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 30MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.832 SUP HCPCS C1713 458.832 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 32MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.834 SUP HCPCS C1713 458.834 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 34MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.836 SUP HCPCS C1713 458.836 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 36MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $330.00 $330.00 N/A N/A 458.838 SUP HCPCS C1713 458.838 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 38MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $330.00 $330.00 N/A N/A 458.84 SUP HCPCS C1713 458.840 - SCREW BONE HEXAGON TROCAR 4MM 3.3MM 40MM SELF CUT LOCK BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.842 SUP HCPCS C1713 458.842 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 42MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $330.00 $330.00 N/A N/A 458.844 SUP HCPCS C1713 458.844 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 44MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.846 SUP HCPCS C1713 458.846 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 46MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.848 SUP HCPCS C1713 458.848 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 48MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.85 SUP HCPCS C1713 458.850 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 50MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $330.00 $330.00 $68.77 $330.00 N/A N/A 458.852 SUP HCPCS C1713 458.852 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 52MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.854 SUP HCPCS C1713 458.854 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 54MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.856 SUP HCPCS C1713 458.856 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 56MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.858 SUP HCPCS C1713 458.858 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 58MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $330.00 $330.00 N/A N/A 458.86 SUP HCPCS C1713 458.860 - SCREW BONE TROCAR 4MM 8MM 60MM 2 LEAD THREAD LOCKING SLFTAP BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.862 SUP HCPCS C1713 458.862 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 62MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.864 SUP HCPCS C1713 458.864 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 64MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.866 SUP HCPCS C1713 458.866 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 66MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.868 SUP HCPCS C1713 458.868 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 68MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A 458.87 SUP HCPCS C1713 458.870 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 70MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $330.00 $330.00 N/A N/A 458.872 SUP HCPCS C1713 458.872 - SCREW BONE TROCAR FULTHD 4MM 8MM 72MM 2 LEAD THREAD LOCKING BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $330.00 $330.00 N/A N/A 458.874 SUP HCPCS C1713 458.874 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 74MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $330.00 $330.00 $68.77 $330.00 N/A N/A 458.876 SUP HCPCS C1713 458.876 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 76MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $330.00 $330.00 N/A N/A 458.878 SUP HCPCS C1713 458.878 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 4MM 8MM 78MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $330.00 $330.00 N/A N/A 458.88 SUP HCPCS C1713 458.880 - SCREW BONE TROCAR 4MM 8MM 80MM 2 LEAD THREAD SLFTAP BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $330.00 $330.00 N/A N/A 458.926 SUP HCPCS C1713 458.926 - SCREW BONE 5MM 26MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 458.928 SUP HCPCS C1713 458.928 - SCREW BONE NONSTRL IM NAIL 5MM 28MM NLEX TI DISTAL FEM/TIB BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $290.00 $290.00 $60.44 $290.00 N/A N/A 458.93 SUP HCPCS C1713 458.930 - SCREW BONE NONSTRL 5MM 30MM NLEX TI DISTAL FEM/TIB LCK HEX BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 458.932 SUP HCPCS C1713 458.932 - SCREW BONE NONSTRL IM NAIL 5MM 32MM NLEX TI DISTAL FEM/TIB BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 458.934 SUP HCPCS C1713 458.934 - SCREW BONE NONSTRL IM NAIL 5MM 34MM NLEX TI DISTAL FEM/TIB BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 458.936 SUP HCPCS C1713 458.936 - SCREW BONE NONSTRL IM NAIL 5MM 36MM NLEX TI DISTAL FEM/TIB BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $123.06 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 458.938 SUP HCPCS C1713 458.938 - SCREW BONE 5MM 38MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $307.65 $307.65 $64.11 $307.65 N/A N/A 458.942 SUP HCPCS C1713 458.942 - SCREW BONE 5MM 42MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 458.944 SUP HCPCS C1713 458.944 - SCREW BONE 5MM 44MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $123.06 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 458.946 SUP HCPCS C1713 458.946 - SCREW BONE 5MM 46MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $123.06 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 458.948 SUP HCPCS C1713 458.948 - SCREW BONE 5MM 48MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $123.06 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $307.65 $307.65 $64.11 $307.65 N/A N/A 458.95 SUP HCPCS C1713 458.950 - SCREW BONE 3.5MM FULTHD BLUNT HEXAGON 5MM 8MM 50MM 2 LEAD BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $330.00 $330.00 $68.77 $330.00 N/A N/A 458.952 SUP HCPCS C1713 458.952 - SCREW BONE 5MM 52MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $123.06 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 458.954 SUP HCPCS C1713 458.954 - SCREW BONE NONSTRL CANN IM NAIL 5MM 54MM NLEX TI DISTAL BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $123.06 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 458.956 SUP HCPCS C1713 458.956 - SCREW BONE NONSTRL IM NAIL 5MM 56MM NLEX TI DISTAL FEM/TIB BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 458.958 SUP HCPCS C1713 458.958 - SCREW BONE NONSTRL IM NAIL 5MM 58MM NLEX TI DISTAL FEM/TIB BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $123.06 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $307.65 $307.65 $64.11 $307.65 N/A N/A 458.96 SUP HCPCS C1713 458.960 - SCREW BONE NONSTRL IM NAIL 5MM 60MM NLEX TI DISTAL FEM/TIB BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $123.06 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 458.964 SUP HCPCS C1713 458.964 - SCREW BONE 5MM 64MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 458.968 SUP HCPCS C1713 458.968 - SCREW BONE NONSTRL CANN IM NAIL 5MM 68MM NLEX TI DISTAL BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 458.972 SUP HCPCS C1713 458.972 - SCREW BONE 5MM 72MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 458.976 SUP HCPCS C1713 458.976 - SCREW BONE 5MM 76MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $290.00 $290.00 $60.44 $290.00 N/A N/A 458.98 SUP HCPCS C1713 458.980 - SCREW BONE NONSTRL CANN IM NAIL 5MM 80MM NLEX TI DISTAL BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 458.985 SUP HCPCS C1713 458.985 - SCREW BONE 5MM 85MM TI ALLOY LCK SLFTAP NONSTRL BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 458.99 SUP HCPCS C1713 458.990 - SCREW BONE 5MM 90MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 458.995 SUP HCPCS C1713 458.995 - SCREW BONE 5MM 95MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 458.999 SUP HCPCS C1713 458.999 - SCREW BONE 5MM 100MM NLEX TI DISTAL FEM/TIB LCK HEX RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 459.68 SUP HCPCS C1713 459.68 - BOLT LOCKING HEXAGON 4.9MM 8MM 68MM SELF TAP SELF CUT TROCAR BOTH IP/OP $329.00 $243.00 $65.28 $328.90 $148.01 $148.01 $148.01 $148.01 $328.90 $328.90 $328.90 $68.55 $328.90 $328.90 $328.90 $328.90 $328.90 $68.55 $328.90 $131.56 $194.54 $328.90 $328.90 $328.90 $328.90 $246.75 $328.90 $328.90 $328.90 $164.45 $164.45 $260.49 $328.90 $263.12 $148.01 $65.28 N/A $190.82 $328.90 $328.90 $328.90 $68.54 $328.90 N/A N/A 460.022 SUP HCPCS C1713 460.022 - PIN FIX EMERGENCY RELEASE TITANIUM STERNUM NONSTRL BOTH IP/OP $226.50 $168.00 $44.90 $226.25 $101.81 $101.81 $101.81 $101.81 $226.25 $226.25 $226.25 $47.16 $226.25 $226.25 $226.25 $226.25 $226.25 $47.15 $226.25 $226.25 $133.83 $226.25 $226.25 $226.25 $226.25 $169.88 $226.25 $226.25 $226.25 $113.13 $113.13 $179.19 $226.25 $181.00 $101.81 $44.90 N/A $131.37 $226.25 $226.25 $226.25 $47.15 $226.25 N/A N/A 460.023 SUP HCPCS C1713 460.023 - PLATE BONE STR 20 HOLE LOCKING TITANIUM STERNUM NONSTRL 2.4 BOTH IP/OP "$5,407.50" "$4,002.00" "$1,073.25" "$5,407.50" "$2,433.38" "$2,433.38" "$2,433.38" "$2,433.38" "$5,407.50" "$5,407.50" "$5,407.50" "$1,127.06" "$5,407.50" "$5,407.50" "$5,407.50" "$5,407.50" "$5,407.50" "$1,126.98" "$5,407.50" "$5,407.50" "$2,665.90" "$5,407.50" "$5,407.50" "$5,407.50" "$5,407.50" "$4,055.63" "$5,407.50" "$5,407.50" "$5,407.50" "$2,703.75" "$2,703.75" "$4,282.74" "$5,407.50" "$4,326.00" "$2,433.38" "$1,073.25" N/A "$3,136.35" "$5,407.50" "$3,244.50" "$5,407.50" "$1,126.92" "$5,407.50" N/A N/A 460.027 SUP HCPCS C1713 460.027 - PLATE BONE H SMALL 8 HOLE LOCKING TITANIUM MANUBRIUM STERNUM BOTH IP/OP "$2,380.00" "$1,761.00" $472.37 "$2,380.00" "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" "$2,380.00" "$2,380.00" "$2,380.00" $496.05 "$2,380.00" "$2,380.00" "$2,380.00" "$2,380.00" "$2,380.00" $496.02 "$2,380.00" "$2,380.00" "$1,407.77" "$2,380.00" "$2,380.00" "$2,380.00" "$2,380.00" "$1,785.00" "$2,380.00" "$2,380.00" "$2,380.00" "$1,190.00" "$1,190.00" "$1,884.96" "$2,380.00" "$1,904.00" "$1,071.00" $472.37 N/A "$1,380.40" "$2,380.00" "$1,428.00" "$2,380.00" $495.99 "$2,380.00" N/A N/A 460.028 SUP HCPCS C1713 460.028 - PLATE BONE H LARGE 8 HOLE LOCKING TITANIUM MANUBRIUM STERNUM BOTH IP/OP "$2,380.00" "$1,761.00" $472.37 "$2,380.00" "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" "$2,380.00" "$2,380.00" "$2,380.00" $496.05 "$2,380.00" "$2,380.00" "$2,380.00" "$2,380.00" "$2,380.00" $496.02 "$2,380.00" $952.00 "$1,407.77" "$2,380.00" "$2,380.00" "$2,380.00" "$2,380.00" "$1,785.00" "$2,380.00" "$2,380.00" "$2,380.00" "$1,190.00" "$1,190.00" "$1,884.96" "$2,380.00" "$1,904.00" "$1,071.00" $472.37 N/A "$1,380.40" "$2,380.00" "$1,428.00" "$2,380.00" $495.99 "$2,380.00" N/A N/A 460.035 SUP HCPCS C1713 460.035 - PLATE BONE STAR 6 HOLE LOCKING TITANIUM STERNUM NONSTRL BOTH IP/OP "$2,260.00" "$1,672.00" $448.55 "$2,260.00" "$1,017.00" "$1,017.00" "$1,017.00" "$1,017.00" "$2,260.00" "$2,260.00" "$2,260.00" $471.04 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $471.01 "$2,260.00" $904.00 "$1,336.79" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,695.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,130.00" "$1,130.00" "$1,789.92" "$2,260.00" "$1,808.00" "$1,017.00" $448.55 N/A "$1,310.80" "$2,260.00" "$1,356.00" "$2,260.00" $470.98 "$2,260.00" N/A N/A 460.036 SUP HCPCS C1713 460.036 - PLATE BONE STAR 12 HOLE LOCKING TITANIUM STERNUM NONSTRL BOTH IP/OP "$2,827.50" "$2,092.00" $561.19 "$2,827.50" "$1,272.38" "$1,272.38" "$1,272.38" "$1,272.38" "$2,827.50" "$2,827.50" "$2,827.50" $589.32 "$2,827.50" "$2,827.50" "$2,827.50" "$2,827.50" "$2,827.50" $589.28 "$2,827.50" "$2,827.50" "$1,393.96" "$2,827.50" "$2,827.50" "$2,827.50" "$2,827.50" "$2,120.63" "$2,827.50" "$2,827.50" "$2,827.50" "$1,413.75" "$1,413.75" "$2,239.38" "$2,827.50" "$2,262.00" "$1,272.38" $561.19 N/A "$1,639.95" "$2,827.50" "$1,696.50" "$2,827.50" $589.25 "$2,827.50" N/A N/A 460.037 SUP HCPCS C1713 460.037 - PLATE BONE X 10 HOLE LOCKING TITANIUM STERNUM NONSTRL BOTH IP/OP "$2,492.50" "$1,844.00" $494.70 "$2,492.50" "$1,121.63" "$1,121.63" "$1,121.63" "$1,121.63" "$2,492.50" "$2,492.50" "$2,492.50" $519.50 "$2,492.50" "$2,492.50" "$2,492.50" "$2,492.50" "$2,492.50" $519.46 "$2,492.50" $997.00 "$1,474.31" "$2,492.50" "$2,492.50" "$2,492.50" "$2,492.50" "$1,869.38" "$2,492.50" "$2,492.50" "$2,492.50" "$1,246.25" "$1,246.25" "$1,974.06" "$2,492.50" "$1,994.00" "$1,121.63" $494.70 N/A "$1,445.65" "$2,492.50" "$1,495.50" "$2,492.50" $519.44 "$2,492.50" N/A N/A 460.038 SUP HCPCS C1713 460.038 - PLATE BONE 2T 14 HOLE LOCKING TITANIUM STERNUM NONSTRL BOTH IP/OP "$2,825.00" "$2,091.00" $560.69 "$2,825.00" "$1,271.25" "$1,271.25" "$1,271.25" "$1,271.25" "$2,825.00" "$2,825.00" "$2,825.00" $588.80 "$2,825.00" "$2,825.00" "$2,825.00" "$2,825.00" "$2,825.00" $588.76 "$2,825.00" "$1,130.00" "$1,392.73" "$2,825.00" "$2,825.00" "$2,825.00" "$2,825.00" "$2,118.75" "$2,825.00" "$2,825.00" "$2,825.00" "$1,412.50" "$1,412.50" "$2,237.40" "$2,825.00" "$2,260.00" "$1,271.25" $560.69 N/A "$1,638.50" "$2,825.00" "$1,695.00" "$2,825.00" $588.73 "$2,825.00" N/A N/A 460.039 SUP HCPCS C1713 460.039 - PLATE BONE ANGLED 12 HOLE LOCKING TITANIUM STERNUM NONSTRL BOTH IP/OP "$3,817.50" "$2,825.00" $757.68 "$3,817.50" "$1,717.88" "$1,717.88" "$1,717.88" "$1,717.88" "$3,817.50" "$3,817.50" "$3,817.50" $795.66 "$3,817.50" "$3,817.50" "$3,817.50" "$3,817.50" "$3,817.50" $795.61 "$3,817.50" "$1,527.00" "$1,882.03" "$3,817.50" "$3,817.50" "$3,817.50" "$3,817.50" "$2,863.13" "$3,817.50" "$3,817.50" "$3,817.50" "$1,908.75" "$1,908.75" "$3,023.46" "$3,817.50" "$3,054.00" "$1,717.88" $757.68 N/A "$2,214.15" "$3,817.50" "$2,290.50" "$3,817.50" $795.57 "$3,817.50" N/A N/A 460.04 SUP HCPCS C1713 460.040 - PLATE BONE X 10 HOLE LOCKING TITANIUM STERNUM NONSTRL BOTH IP/OP "$2,492.50" "$1,844.00" $494.70 "$2,492.50" "$1,121.63" "$1,121.63" "$1,121.63" "$1,121.63" "$2,492.50" "$2,492.50" "$2,492.50" $519.50 "$2,492.50" "$2,492.50" "$2,492.50" "$2,492.50" "$2,492.50" $519.46 "$2,492.50" $997.00 "$1,474.31" "$2,492.50" "$2,492.50" "$2,492.50" "$2,492.50" "$1,869.38" "$2,492.50" "$2,492.50" "$2,492.50" "$1,246.25" "$1,246.25" "$1,974.06" "$2,492.50" "$1,994.00" "$1,121.63" $494.70 N/A "$1,445.65" "$2,492.50" "$2,492.50" "$2,492.50" $519.44 "$2,492.50" N/A N/A 460.045 SUP HCPCS C1713 460.045 - PLATE BONE STR 8 HOLE LOCKING TITANIUM STERNUM NONSTRL BOTH IP/OP "$2,720.00" "$2,013.00" $539.85 "$2,720.00" "$1,224.00" "$1,224.00" "$1,224.00" "$1,224.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.92 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$1,340.96" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" $539.85 N/A "$1,577.60" "$2,720.00" "$2,720.00" "$2,720.00" $566.85 "$2,720.00" N/A N/A 460.046 SUP HCPCS C1713 460.046 - PLATE BONE STR 13 HOLE LOCKING TITANIUM STERNUM NONSTRL BOTH IP/OP "$2,825.00" "$2,091.00" $560.69 "$2,825.00" "$1,271.25" "$1,271.25" "$1,271.25" "$1,271.25" "$2,825.00" "$2,825.00" "$2,825.00" $588.80 "$2,825.00" "$2,825.00" "$2,825.00" "$2,825.00" "$2,825.00" $588.76 "$2,825.00" "$1,130.00" "$1,392.73" "$2,825.00" "$2,825.00" "$2,825.00" "$2,825.00" "$2,118.75" "$2,825.00" "$2,825.00" "$2,825.00" "$1,412.50" "$1,412.50" "$2,237.40" "$2,825.00" "$2,260.00" "$1,271.25" $560.69 N/A "$1,638.50" "$2,825.00" "$2,825.00" "$2,825.00" $588.73 "$2,825.00" N/A N/A 461 SUP Custom 27203010 461 - DRESSING GAUZE 4YDX3IN ROLL HEMOSTATIC QUIKCLOT BOTH IP/OP $100.00 $74.00 $17.75 $99.72 $99.72 $99.72 $99.72 $99.72 $99.72 $99.72 $17.75 $99.72 $99.72 $74.01 $74.01 $76.86 $51.95 $20.78 $99.72 $38.60 $99.72 $99.72 $96.50 $99.72 $99.72 $75.00 $99.72 $99.72 $99.72 $49.86 $49.86 $78.98 $99.72 $79.78 $64.82 $99.72 N/A $58.00 $99.72 $59.83 $99.72 $99.72 $99.72 N/A N/A 462.64 SUP HCPCS C1713 462.640 - BLADE IM NAIL GOLD 40MM HUM TI SPRL SLD NONSTRL BOTH IP/OP "$1,253.50" $928.00 $248.71 "$1,253.08" $563.89 $563.89 $563.89 $563.89 "$1,253.08" "$1,253.08" "$1,253.08" $261.17 "$1,253.08" "$1,253.08" "$1,253.08" "$1,253.08" "$1,253.08" $261.16 "$1,253.08" $501.23 $741.20 "$1,253.08" "$1,253.08" "$1,253.08" "$1,253.08" $940.13 "$1,253.08" "$1,253.08" "$1,253.08" $626.54 $626.54 $992.44 "$1,253.08" "$1,002.46" $563.89 $248.71 N/A $727.03 "$1,253.08" "$1,253.08" "$1,253.08" $261.14 "$1,253.08" N/A N/A 462.644 SUP HCPCS C1713 462.644 - BLADE IM FIX GOLD 44CM HUM TI SPRL NONSTRL BOTH IP/OP "$1,253.50" $928.00 $248.71 "$1,253.08" $563.89 $563.89 $563.89 $563.89 "$1,253.08" "$1,253.08" "$1,253.08" $261.17 "$1,253.08" "$1,253.08" "$1,253.08" "$1,253.08" "$1,253.08" $261.16 "$1,253.08" "$1,253.08" $741.20 "$1,253.08" "$1,253.08" "$1,253.08" "$1,253.08" $940.13 "$1,253.08" "$1,253.08" "$1,253.08" $626.54 $626.54 $992.44 "$1,253.08" "$1,002.46" $563.89 $248.71 N/A $727.03 "$1,253.08" $751.85 "$1,253.08" $261.14 "$1,253.08" N/A N/A 476 SUP Custom 27803010 00476 - TUBE NASOGASTRIC 10FR 45IN SIDEPORT WEIGHTED TIP STYLET BOTH IP/OP $23.00 $17.00 $4.07 $22.88 $22.88 $22.88 $22.88 $22.88 $22.88 $22.88 $4.07 $22.88 $22.88 $22.88 $22.88 $22.88 $22.88 $4.77 $22.88 $9.15 $22.88 $22.88 $22.88 $22.88 $22.88 $17.25 $22.88 $22.88 $22.88 $11.44 $11.44 $18.12 $22.88 $18.30 $10.30 $22.88 N/A $13.34 $22.88 $13.73 $22.88 $22.88 $22.88 N/A N/A 482.823 SUP HCPCS C1713 482.823 - PLATE BONE 17X10X.7MM 7 HOLE BUTTON OVAL TITANIUM ORTHOPEDIC BOTH IP/OP $721.50 $534.00 $143.13 $733.38 $324.51 $324.51 $324.51 $324.51 $721.13 $721.13 $721.13 $150.30 $721.13 $721.13 $721.13 $721.13 $721.13 $150.29 $721.13 $293.35 $426.55 $721.13 $733.38 $721.13 $721.13 $541.13 $721.13 $721.13 $721.13 $360.57 $360.57 $571.13 $721.13 $576.90 $324.51 $143.13 N/A $418.47 $721.13 $432.68 $721.13 $150.28 $721.13 N/A N/A 487.931 SUP Custom 27803010 487.931 - DISTRACTOR SURG MULTI VECTOR BODY TITANIUM MANDIB NONSTRL BOTH IP/OP "$12,302.50" "$9,104.00" "$2,189.85" "$12,302.50" "$12,302.50" "$12,302.50" "$12,302.50" "$12,302.50" "$12,302.50" "$12,302.50" "$2,189.85" "$12,302.50" "$12,302.50" "$12,302.50" "$12,302.50" "$12,302.50" "$12,302.50" "$2,563.98" "$12,302.50" "$4,921.00" "$12,302.50" "$12,302.50" "$12,302.50" "$12,302.50" "$12,302.50" "$9,226.88" "$12,302.50" "$12,302.50" "$12,302.50" "$6,151.25" "$6,151.25" "$9,743.58" "$12,302.50" "$9,842.00" "$5,536.13" "$12,302.50" N/A "$7,135.45" "$12,302.50" "$7,381.50" "$12,302.50" "$12,302.50" "$12,302.50" N/A N/A 487.933 SUP Custom 27803010 487.933 - DISTRACTOR SURG 15MM MULTI VECTOR ARM TITANIUM MANDIB BOTH IP/OP $797.50 $590.00 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $166.21 $797.50 $319.00 $797.50 $797.50 $797.50 $797.50 $797.50 $598.13 $797.50 $797.50 $797.50 $398.75 $398.75 $631.62 $797.50 $638.00 $358.88 $797.50 N/A $462.55 $797.50 $478.50 $797.50 $797.50 $797.50 N/A N/A 487.934 SUP Custom 27803010 487.934 - DISTRACTOR SURG 25MM MULTI VECTOR ARM TITANIUM MANDIB BOTH IP/OP $797.50 $590.00 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $166.21 $797.50 $319.00 $797.50 $797.50 $797.50 $797.50 $797.50 $598.13 $797.50 $797.50 $797.50 $398.75 $398.75 $631.62 $797.50 $638.00 $358.88 $797.50 N/A $462.55 $797.50 $478.50 $797.50 $797.50 $797.50 N/A N/A 487.935 SUP Custom 27803010 487.935 - DISTRACTOR SURG 35MM MULTI VECTOR ARM TITANIUM MANDIB BOTH IP/OP $797.50 $590.00 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $166.21 $797.50 $319.00 $797.50 $797.50 $797.50 $797.50 $797.50 $598.13 $797.50 $797.50 $797.50 $398.75 $398.75 $631.62 $797.50 $638.00 $358.88 $797.50 N/A $462.55 $797.50 $478.50 $797.50 $797.50 $797.50 N/A N/A 487.937 SUP Custom 27803010 487.937 - DISTRACTOR SURG NUT LINEAR ACTIVATION TITANIUM MANDIB BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 487.938 SUP Custom 27803010 487.938 - DISTRACTOR SURG MULTI VECTOR PIN HOLDING CLMP TITANIUM BOTH IP/OP "$2,622.50" "$1,941.00" $466.81 "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" $466.81 "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" $546.56 "$2,622.50" "$1,049.00" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$1,966.88" "$2,622.50" "$2,622.50" "$2,622.50" "$1,311.25" "$1,311.25" "$2,077.02" "$2,622.50" "$2,098.00" "$1,180.13" "$2,622.50" N/A "$1,521.05" "$2,622.50" "$1,573.50" "$2,622.50" "$2,622.50" "$2,622.50" N/A N/A 487.939 SUP Custom 27803010 487.939 - DISTRACTOR SURG MULTI VECTOR PIN HOLDING BODY TITANIUM BOTH IP/OP "$2,622.50" "$1,941.00" $466.81 "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" $466.81 "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" $546.56 "$2,622.50" "$1,049.00" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$1,966.88" "$2,622.50" "$2,622.50" "$2,622.50" "$1,311.25" "$1,311.25" "$2,077.02" "$2,622.50" "$2,098.00" "$1,180.13" "$2,622.50" N/A "$1,521.05" "$2,622.50" "$1,573.50" "$2,622.50" "$2,622.50" "$2,622.50" N/A N/A 487.94 SUP Custom 27203010 487.940 - CLAMP EXFIX UNIVERSAL PIN HOLDING TITANIUM MULTI VECTOR BOTH IP/OP "$2,622.50" "$1,941.00" $466.81 "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" $466.81 "$2,622.50" "$2,622.50" "$1,946.42" "$1,946.42" "$2,021.42" "$1,366.32" $546.56 "$2,622.50" "$1,049.00" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$1,966.88" "$2,622.50" "$2,622.50" "$2,622.50" "$1,311.25" "$1,311.25" "$2,077.02" "$2,622.50" "$2,098.00" "$1,704.63" "$2,622.50" N/A "$1,521.05" "$2,622.50" "$1,573.50" "$2,622.50" "$2,622.50" "$2,622.50" N/A N/A 487.941 SUP Custom 27203010 487.941 - CLAMP EXFIX BODY PIN HOLDING MULTIVECTOR DISTRCT BLUE BOTH IP/OP "$2,622.50" "$1,941.00" $466.81 "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" $466.81 "$2,622.50" "$2,622.50" "$1,946.42" "$1,946.42" "$2,021.42" "$1,366.32" $546.56 "$2,622.50" "$1,049.00" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$1,966.88" "$2,622.50" "$2,622.50" "$2,622.50" "$1,311.25" "$1,311.25" "$2,077.02" "$2,622.50" "$2,098.00" "$1,704.63" "$2,622.50" N/A "$1,521.05" "$2,622.50" "$1,573.50" "$2,622.50" "$2,622.50" "$2,622.50" N/A N/A 487.942 SUP Custom 27203010 487.942 - CLAMP EXFIX RAMUS PIN HOLDING MULTIVECTOR DISTRCT GOLD BOTH IP/OP "$2,622.50" "$1,941.00" $466.81 "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" $466.81 "$2,622.50" "$2,622.50" "$1,946.42" "$1,946.42" "$2,021.42" "$1,366.32" $546.56 "$2,622.50" "$1,049.00" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$2,622.50" "$1,966.88" "$2,622.50" "$2,622.50" "$2,622.50" "$1,311.25" "$1,311.25" "$2,077.02" "$2,622.50" "$2,098.00" "$1,704.63" "$2,622.50" N/A "$1,521.05" "$2,622.50" "$1,573.50" "$2,622.50" "$2,622.50" "$2,622.50" N/A N/A 487.96 SUP HCPCS C1713 487.960 - PLATE BONE 1.6MM ASMBLY TITANIUM MAXL BOTH IP/OP "$1,838.50" "$1,360.00" $364.85 "$1,838.25" $827.21 $827.21 $827.21 $827.21 "$1,838.25" "$1,838.25" "$1,838.25" $383.14 "$1,838.25" "$1,838.25" "$1,838.25" "$1,838.25" "$1,838.25" $383.11 "$1,838.25" $735.30 "$1,087.32" "$1,838.25" "$1,838.25" "$1,838.25" "$1,838.25" "$1,378.88" "$1,838.25" "$1,838.25" "$1,838.25" $919.13 $919.13 "$1,455.89" "$1,838.25" "$1,470.60" $827.21 $364.85 N/A "$1,066.33" "$1,838.25" "$1,102.95" "$1,838.25" "$1,838.25" "$1,838.25" N/A N/A 487.962 SUP Custom 27803010 487.962 - FOOTPLATE BONE 20MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB BOTH IP/OP "$16,635.00" "$12,310.00" "$2,961.03" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$2,961.03" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$3,466.92" "$16,635.00" "$6,654.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$12,476.25" "$16,635.00" "$16,635.00" "$16,635.00" "$8,317.50" "$8,317.50" "$13,174.92" "$16,635.00" "$13,308.00" "$7,485.75" "$16,635.00" N/A "$9,648.30" "$16,635.00" "$9,981.00" "$16,635.00" "$16,635.00" "$16,635.00" N/A N/A 487.963 SUP Custom 27803010 487.963 - FOOTPLATE BONE 20MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB BOTH IP/OP "$16,635.00" "$12,310.00" "$2,961.03" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$2,961.03" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$3,466.92" "$16,635.00" "$6,654.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$12,476.25" "$16,635.00" "$16,635.00" "$16,635.00" "$8,317.50" "$8,317.50" "$13,174.92" "$16,635.00" "$13,308.00" "$7,485.75" "$16,635.00" N/A "$9,648.30" "$16,635.00" "$9,981.00" "$16,635.00" "$16,635.00" "$16,635.00" N/A N/A 487.964 SUP Custom 27803010 487.964 - FOOTPLATE BONE 30MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB BOTH IP/OP "$16,635.00" "$12,310.00" "$2,961.03" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$2,961.03" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$3,466.92" "$16,635.00" "$6,654.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$12,476.25" "$16,635.00" "$16,635.00" "$16,635.00" "$8,317.50" "$8,317.50" "$13,174.92" "$16,635.00" "$13,308.00" "$7,485.75" "$16,635.00" N/A "$9,648.30" "$16,635.00" "$9,981.00" "$16,635.00" "$16,635.00" "$16,635.00" N/A N/A 487.965 SUP Custom 27803010 487.965 - FOOTPLATE BONE 30MM 1 VECTOR DISTRCT BODY TITANIUM MANDIB BOTH IP/OP "$16,635.00" "$12,310.00" "$2,961.03" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$2,961.03" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$3,466.92" "$16,635.00" "$6,654.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$16,635.00" "$12,476.25" "$16,635.00" "$16,635.00" "$16,635.00" "$8,317.50" "$8,317.50" "$13,174.92" "$16,635.00" "$13,308.00" "$7,485.75" "$16,635.00" N/A "$9,648.30" "$16,635.00" "$9,981.00" "$16,635.00" "$16,635.00" "$16,635.00" N/A N/A 487.966 SUP Custom 27803010 487.966 - DISTRACTOR SURG MULTI VECTOR ASMBLY TITANIUM RIGHT MANDIB BOTH IP/OP "$19,727.50" "$14,598.00" "$3,511.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$3,511.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$4,111.43" "$19,727.50" "$7,891.00" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$14,795.63" "$19,727.50" "$19,727.50" "$19,727.50" "$9,863.75" "$9,863.75" "$15,624.18" "$19,727.50" "$15,782.00" "$8,877.38" "$19,727.50" N/A "$11,441.95" "$19,727.50" "$11,836.50" "$19,727.50" "$19,727.50" "$19,727.50" N/A N/A 487.967 SUP Custom 27803010 487.967 - DISTRACTOR SURG MULTI VECTOR ASMBLY TITANIUM MANDIB LEFT BOTH IP/OP "$19,727.50" "$14,598.00" "$3,511.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$3,511.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$4,111.43" "$19,727.50" "$7,891.00" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$19,727.50" "$14,795.63" "$19,727.50" "$19,727.50" "$19,727.50" "$9,863.75" "$9,863.75" "$15,624.18" "$19,727.50" "$15,782.00" "$8,877.38" "$19,727.50" N/A "$11,441.95" "$19,727.50" "$11,836.50" "$19,727.50" "$19,727.50" "$19,727.50" N/A N/A 487.971 SUP Custom 27803010 487.971 - DISTRACTOR SURG 45MM MULTI VECTOR ARM TITANIUM MANDIB BOTH IP/OP $797.50 $590.00 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $166.21 $797.50 $319.00 $797.50 $797.50 $797.50 $797.50 $797.50 $598.13 $797.50 $797.50 $797.50 $398.75 $398.75 $631.62 $797.50 $638.00 $358.88 $797.50 N/A $462.55 $797.50 $478.50 $797.50 $797.50 $797.50 N/A N/A 487.973 SUP Custom 27803010 487.973 - DISTRACTOR SURG 55MM MULTI VECTOR ARM TITANIUM MANDIB BOTH IP/OP $797.50 $590.00 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $166.21 $797.50 $319.00 $797.50 $797.50 $797.50 $797.50 $797.50 $598.13 $797.50 $797.50 $797.50 $398.75 $398.75 $631.62 $797.50 $638.00 $358.88 $797.50 N/A $462.55 $797.50 $478.50 $797.50 $797.50 $797.50 N/A N/A 487.974 SUP Custom 27803010 487.974 - DISTRACTOR SURG 1 VECTOR TITANIUM MANDIB RIGHT NONSTRL BOTH IP/OP $690.00 $511.00 $122.82 $690.00 $690.00 $690.00 $690.00 $690.00 $690.00 $690.00 $122.82 $690.00 $690.00 $690.00 $690.00 $690.00 $690.00 $143.80 $690.00 $276.00 $690.00 $690.00 $690.00 $690.00 $690.00 $517.50 $690.00 $690.00 $690.00 $345.00 $345.00 $546.48 $690.00 $552.00 $310.50 $690.00 N/A $400.20 $690.00 $414.00 $690.00 $690.00 $690.00 N/A N/A 487.975 SUP Custom 27803010 487.975 - DISTRACTOR SURG 1 VECTOR TITANIUM MANDIB LEFT NONSTRL BOTH IP/OP $690.00 $511.00 $122.82 $690.00 $690.00 $690.00 $690.00 $690.00 $690.00 $690.00 $122.82 $690.00 $690.00 $690.00 $690.00 $690.00 $690.00 $143.80 $690.00 $276.00 $690.00 $690.00 $690.00 $690.00 $690.00 $517.50 $690.00 $690.00 $690.00 $345.00 $345.00 $546.48 $690.00 $552.00 $310.50 $690.00 N/A $400.20 $690.00 $414.00 $690.00 $690.00 $690.00 N/A N/A 487.976 SUP Custom 27803010 487.976 - DISTRACTOR SURG 65MM MULTI VECTOR ARM TITANIUM MANDIB BOTH IP/OP $797.50 $590.00 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $166.21 $797.50 $319.00 $797.50 $797.50 $797.50 $797.50 $797.50 $598.13 $797.50 $797.50 $797.50 $398.75 $398.75 $631.62 $797.50 $638.00 $358.88 $797.50 N/A $462.55 $797.50 $478.50 $797.50 $797.50 $797.50 N/A N/A 487.977 SUP Custom 27803010 487.977 - DISTRACTOR SURG 75MM MULTI VECTOR ARM TITANIUM MANDIB BOTH IP/OP $797.50 $590.00 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $166.21 $797.50 $319.00 $797.50 $797.50 $797.50 $797.50 $797.50 $598.13 $797.50 $797.50 $797.50 $398.75 $398.75 $631.62 $797.50 $638.00 $358.88 $797.50 N/A $462.55 $797.50 $478.50 $797.50 $797.50 $797.50 N/A N/A 487.978 SUP Custom 27803010 487.978 - DISTRACTOR SURG 85MM MULTI VECTOR ARM TITANIUM MANDIB BOTH IP/OP $797.50 $590.00 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $166.21 $797.50 $319.00 $797.50 $797.50 $797.50 $797.50 $797.50 $598.13 $797.50 $797.50 $797.50 $398.75 $398.75 $631.62 $797.50 $638.00 $358.88 $797.50 N/A $462.55 $797.50 $478.50 $797.50 $797.50 $797.50 N/A N/A 487.98 SUP Custom 27803010 487.980 - DISTRACTOR SURG 7MM NUT HEXAGONAL TITANIUM MIDFAC NONSTRL BOTH IP/OP $347.50 $257.00 $61.86 $347.50 $347.50 $347.50 $347.50 $347.50 $347.50 $347.50 $61.86 $347.50 $347.50 $347.50 $347.50 $347.50 $347.50 $72.42 $347.50 $139.00 $347.50 $347.50 $347.50 $347.50 $347.50 $260.63 $347.50 $347.50 $347.50 $173.75 $173.75 $275.22 $347.50 $278.00 $156.38 $347.50 N/A $201.55 $347.50 $208.50 $347.50 $347.50 $347.50 N/A N/A 487.982 SUP Custom 27803010 487.982 - DISTRACTOR SURG 40MM ASMBLY TITANIUM MIDFAC NONSTRL BOTH IP/OP "$13,747.50" "$10,173.00" "$2,447.06" "$13,747.50" "$13,747.50" "$13,747.50" "$13,747.50" "$13,747.50" "$13,747.50" "$13,747.50" "$2,447.06" "$13,747.50" "$13,747.50" "$13,747.50" "$13,747.50" "$13,747.50" "$13,747.50" "$2,865.13" "$13,747.50" "$5,499.00" "$13,747.50" "$13,747.50" "$13,747.50" "$13,747.50" "$13,747.50" "$10,310.63" "$13,747.50" "$13,747.50" "$13,747.50" "$6,873.75" "$6,873.75" "$10,888.02" "$13,747.50" "$10,998.00" "$6,186.38" "$13,747.50" N/A "$7,973.55" "$13,747.50" "$8,248.50" "$13,747.50" "$13,747.50" "$13,747.50" N/A N/A 487.984 SUP Custom 27803010 487.984 - FOOTPLATE BONE ELEVATE TITANIUM RIGHT ANTERIOR MIDFAC BOTH IP/OP "$2,452.50" "$1,815.00" $436.55 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $436.55 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" "$2,452.50" N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" "$2,452.50" "$2,452.50" N/A N/A 487.985 SUP Custom 27803010 487.985 - FOOTPLATE BONE ELEVATE TITANIUM LEFT ANTERIOR MIDFAC NONSTRL BOTH IP/OP "$2,452.50" "$1,815.00" $436.55 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $436.55 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" "$2,452.50" N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" "$2,452.50" "$2,452.50" N/A N/A 487.986 SUP Custom 27803010 487.986 - FOOTPLATE BONE LP SYMMETRICAL TITANIUM ANTERIOR MIDFAC BOTH IP/OP "$2,452.50" "$1,815.00" $436.55 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $436.55 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" "$2,452.50" N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" "$2,452.50" "$2,452.50" N/A N/A 487.987 SUP Custom 27803010 487.987 - FOOTPLATE BONE ELEVATED SYMMETRICAL TITANIUM ANTERIOR MIDFAC BOTH IP/OP "$2,452.50" "$1,815.00" $436.55 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $436.55 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" "$2,452.50" N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" "$2,452.50" "$2,452.50" N/A N/A 487.988 SUP Custom 27803010 487.988 - FOOTPLATE BONE MESH TITANIUM ANTERIOR MIDFAC NONSTRL MIDFAC BOTH IP/OP "$1,542.50" "$1,141.00" $274.57 "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" $274.57 "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" $321.47 "$1,542.50" $617.00 "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" "$1,156.88" "$1,542.50" "$1,542.50" "$1,542.50" $771.25 $771.25 "$1,221.66" "$1,542.50" "$1,234.00" $694.13 "$1,542.50" N/A $894.65 "$1,542.50" $925.50 "$1,542.50" "$1,542.50" "$1,542.50" N/A N/A 487.989 SUP Custom 27803010 487.989 - FOOTPLATE BONE BUTTRESS TITANIUM ANTERIOR MIDFAC NONSTRL BOTH IP/OP "$1,542.50" "$1,141.00" $274.57 "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" $274.57 "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" $321.47 "$1,542.50" $617.00 "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" "$1,542.50" "$1,156.88" "$1,542.50" "$1,542.50" "$1,542.50" $771.25 $771.25 "$1,221.66" "$1,542.50" "$1,234.00" $694.13 "$1,542.50" N/A $894.65 "$1,542.50" $925.50 "$1,542.50" "$1,542.50" "$1,542.50" N/A N/A 487.99 SUP Custom 27803010 487.990 - FOOTPLATE BONE 1 VECTOR TITANIUM MIDFAC POSTERIOR NONSTRL BOTH IP/OP "$2,452.50" "$1,815.00" $436.55 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $436.55 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" "$2,452.50" N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" "$2,452.50" "$2,452.50" N/A N/A 487.992 SUP Custom 27803010 487.992 - DISTRACTOR SURG 20MM RIGID EXTN TITANIUM MIDFAC NONSTRL BOTH IP/OP "$1,252.50" $927.00 $222.95 "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" $222.95 "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" $261.03 "$1,252.50" $501.00 "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" $939.38 "$1,252.50" "$1,252.50" "$1,252.50" $626.25 $626.25 $991.98 "$1,252.50" "$1,002.00" $563.63 "$1,252.50" N/A $726.45 "$1,252.50" $751.50 "$1,252.50" "$1,252.50" "$1,252.50" N/A N/A 487.993 SUP Custom 27803010 487.993 - DISTRACTOR SURG 20MM UNIVERSAL JOINT EXTN TITANIUM BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 487.994 SUP Custom 27803010 487.994 - DISTRACTOR SURG 40MM FLEXIBLE CABLE EXTN TITANIUM MIDFAC BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 487.995 SUP HCPCS C1713 487.995 - SCREW EXTERNAL DISTRCT EXTERNAL MIDFAC DISTRCT SYSTEM BOTH IP/OP $365.00 $270.00 $72.44 $365.00 $164.25 $164.25 $164.25 $164.25 $365.00 $365.00 $365.00 $76.08 $365.00 $365.00 $365.00 $365.00 $365.00 $76.07 $365.00 $146.00 $215.90 $365.00 $365.00 $365.00 $365.00 $273.75 $365.00 $365.00 $365.00 $182.50 $182.50 $289.08 $365.00 $292.00 $164.25 $72.44 N/A $211.70 $365.00 $219.00 $365.00 $76.07 $365.00 N/A N/A 488.066 SUP HCPCS C1713 488.066 - SCREW BONE 1.6MM MACHINE TITANIUM CRANIAL NONSTRL BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A 488.074 SUP Custom 27803010 488.074 - DISTRACTOR SURG 8MM STR PLATE TITANIUM ALVEOLAR NONSTRL BOTH IP/OP "$2,595.00" "$1,920.00" $461.91 "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" $461.91 "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" $540.83 "$2,595.00" "$1,038.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$1,946.25" "$2,595.00" "$2,595.00" "$2,595.00" "$1,297.50" "$1,297.50" "$2,055.24" "$2,595.00" "$2,076.00" "$1,167.75" "$2,595.00" N/A "$1,505.10" "$2,595.00" "$1,557.00" "$2,595.00" "$2,595.00" "$2,595.00" N/A N/A 488.075 SUP Custom 27803010 488.075 - BODY DISTRCT 12MM STR PLATE TITANIUM ALVEOLAR NONSTRL BOTH IP/OP "$2,595.00" "$1,920.00" $461.91 "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" $461.91 "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" $540.83 "$2,595.00" "$1,038.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$1,946.25" "$2,595.00" "$2,595.00" "$2,595.00" "$1,297.50" "$1,297.50" "$2,055.24" "$2,595.00" "$2,076.00" "$1,167.75" "$2,595.00" N/A "$1,505.10" "$2,595.00" "$1,557.00" "$2,595.00" "$2,595.00" "$2,595.00" N/A N/A 488.076 SUP Custom 27803010 488.076 - BODY DISTRCT 16MM STR PLATE TITANIUM ALVEOLAR NONSTRL BOTH IP/OP "$2,595.00" "$1,920.00" $461.91 "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" $461.91 "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" $540.83 "$2,595.00" "$1,038.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$2,595.00" "$1,946.25" "$2,595.00" "$2,595.00" "$2,595.00" "$1,297.50" "$1,297.50" "$2,055.24" "$2,595.00" "$2,076.00" "$1,167.75" "$2,595.00" N/A "$1,505.10" "$2,595.00" "$1,557.00" "$2,595.00" "$2,595.00" "$2,595.00" N/A N/A 488.75 SUP HCPCS C1713 488.750 - SCREW BONE 4.35MM 25MM 2 HOLE BUTTRESS LOCKING PLATE BOTH IP/OP $548.00 $406.00 $108.71 $547.75 $246.49 $246.49 $246.49 $246.49 $547.75 $547.75 $547.75 $114.16 $547.75 $547.75 $547.75 $547.75 $547.75 $114.16 $547.75 $219.10 $323.99 $547.75 $547.75 $547.75 $547.75 $411.00 $547.75 $547.75 $547.75 $273.88 $273.88 $433.82 $547.75 $438.20 $246.49 $108.71 N/A $317.84 $547.75 $328.65 $547.75 $114.15 $547.75 N/A N/A 488.915 SUP HCPCS C1713 488.915 - PLATE BONE BUTTRESS 30MM 2 HOLE LOCK TITANIUM SPN NONSTRL BOTH IP/OP "$1,232.00" $912.00 $244.52 "$1,232.00" $554.40 $554.40 $554.40 $554.40 "$1,232.00" "$1,232.00" "$1,232.00" $256.78 "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" $256.76 "$1,232.00" $492.80 $728.73 "$1,232.00" "$1,232.00" "$1,232.00" "$1,232.00" $924.00 "$1,232.00" "$1,232.00" "$1,232.00" $616.00 $616.00 $975.74 "$1,232.00" $985.60 $554.40 $244.52 N/A $714.56 "$1,232.00" $739.20 "$1,232.00" $256.75 "$1,232.00" N/A N/A 492.08 SUP Custom 27203010 492.08 - WIRE FX .8MM 70MM NS KRSH TROC PNT TI BOTH IP/OP $19.50 $14.00 $3.40 $19.44 $19.12 $19.12 $19.12 $19.12 $19.12 $19.12 $3.40 $19.12 $19.12 $14.19 $14.19 $14.74 $9.96 $3.98 $19.12 $7.78 $19.12 $19.12 $19.44 $19.12 $19.12 $14.63 $19.12 $19.12 $19.12 $9.56 $9.56 $15.14 $19.12 $15.30 $12.43 $19.12 N/A $11.31 $19.12 $11.47 $19.12 $19.12 $19.12 N/A N/A 492.1 SUP Custom 27203010 492.10 - WIRE FX 1MM 150MM NS KRSH TROC PNT TI BOTH IP/OP $19.00 $14.00 $3.30 $19.44 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $3.30 $18.56 $18.56 $13.78 $13.78 $14.31 $9.67 $3.87 $18.56 $7.78 $18.56 $18.56 $19.44 $18.56 $18.56 $14.25 $18.56 $18.56 $18.56 $9.28 $9.28 $14.70 $18.56 $14.85 $12.06 $18.56 N/A $11.02 $18.56 $11.14 $18.56 $18.56 $18.56 N/A N/A 492.12 SUP Custom 27203010 492.12 - WIRE FX 1.25MM 150MM NS KRSH TROC PNT TI BOTH IP/OP $19.50 $14.00 $3.40 $19.44 $19.12 $19.12 $19.12 $19.12 $19.12 $19.12 $3.40 $19.12 $19.12 $14.19 $14.19 $14.74 $9.96 $3.98 $19.12 $7.78 $19.12 $19.12 $19.44 $19.12 $19.12 $14.63 $19.12 $19.12 $19.12 $9.56 $9.56 $15.14 $19.12 $15.30 $12.43 $19.12 N/A $11.31 $19.12 $11.47 $19.12 $19.12 $19.12 N/A N/A 492.16 SUP Custom 27203010 492.16 - WIRE FX 1.6MM 150MM NS KRSH TROC PNT TI BOTH IP/OP $19.50 $14.00 $3.40 $19.44 $19.12 $19.12 $19.12 $19.12 $19.12 $19.12 $3.40 $19.12 $19.12 $14.19 $14.19 $14.74 $9.96 $3.98 $19.12 $7.78 $19.12 $19.12 $19.44 $19.12 $19.12 $14.63 $19.12 $19.12 $19.12 $9.56 $9.56 $15.14 $19.12 $15.30 $12.43 $19.12 N/A $11.31 $19.12 $11.47 $19.12 $19.12 $19.12 N/A N/A 492.18 SUP Custom 27203010 492.18 - WIRE FX 1.6MM 285MM NS KRSH TROC PNT TI BOTH IP/OP $23.50 $17.00 $4.10 $23.45 $23.05 $23.05 $23.05 $23.05 $23.05 $23.05 $4.10 $23.05 $23.05 $17.11 $17.11 $17.77 $12.01 $4.80 $23.05 $9.38 $23.05 $23.05 $23.45 $23.05 $23.05 $17.63 $23.05 $23.05 $23.05 $11.53 $11.53 $18.26 $23.05 $18.44 $14.98 $23.05 N/A $13.63 $23.05 $13.83 $23.05 $23.05 $23.05 N/A N/A 492.2 SUP Custom 27203010 492.20 - WIRE FX 2MM 150MM NS KRSH TROC PNT TI BOTH IP/OP $19.00 $14.00 $3.30 $19.44 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $3.30 $18.56 $18.56 $13.78 $13.78 $14.31 $9.67 $3.87 $18.56 $7.78 $18.56 $18.56 $19.44 $18.56 $18.56 $14.25 $18.56 $18.56 $18.56 $9.28 $9.28 $14.70 $18.56 $14.85 $12.06 $18.56 N/A $11.02 $18.56 $11.14 $18.56 $18.56 $18.56 N/A N/A 492.21 SUP Custom 27203010 492.21 - WIRE FX 2MM 285MM NS KRSH TROC PNT TI BOTH IP/OP $23.50 $17.00 $4.10 $23.45 $23.05 $23.05 $23.05 $23.05 $23.05 $23.05 $4.10 $23.05 $23.05 $17.11 $17.11 $17.77 $12.01 $4.80 $23.05 $9.38 $23.05 $23.05 $23.45 $23.05 $23.05 $17.63 $23.05 $23.05 $23.05 $11.53 $11.53 $18.26 $23.05 $18.44 $14.98 $23.05 N/A $13.63 $23.05 $13.83 $23.05 $23.05 $23.05 N/A N/A 492.25 SUP Custom 27203010 492.25 - WIRE FX 2.5MM 150MM NS KRSH TROC PNT TI BOTH IP/OP $19.50 $14.00 $3.40 $19.44 $19.12 $19.12 $19.12 $19.12 $19.12 $19.12 $3.40 $19.12 $19.12 $14.19 $14.19 $14.74 $9.96 $3.98 $19.12 $7.78 $19.12 $19.12 $19.44 $19.12 $19.12 $14.63 $19.12 $19.12 $19.12 $9.56 $9.56 $15.14 $19.12 $15.30 $12.43 $19.12 N/A $11.31 $19.12 $11.47 $19.12 $19.12 $19.12 N/A N/A 492.26 SUP Custom 27203010 492.26 - WIRE FX 2.5MM 285MM NS KRSH TROC PNT TI BOTH IP/OP $23.50 $17.00 $4.10 $23.45 $23.05 $23.05 $23.05 $23.05 $23.05 $23.05 $4.10 $23.05 $23.05 $17.11 $17.11 $17.77 $12.01 $4.80 $23.05 $9.38 $23.05 $23.05 $23.45 $23.05 $23.05 $17.63 $23.05 $23.05 $23.05 $11.53 $11.53 $18.26 $23.05 $18.44 $14.98 $23.05 N/A $13.63 $23.05 $13.83 $23.05 $23.05 $23.05 N/A N/A 492.3 SUP Custom 27203010 492.30 - WIRE FX 3MM 150MM NS KRSH TROC PNT TI BOTH IP/OP $19.00 $14.00 $3.30 $19.44 $18.56 $18.56 $18.56 $18.56 $18.56 $18.56 $3.30 $18.56 $18.56 $13.78 $13.78 $14.31 $9.67 $3.87 $18.56 $7.78 $18.56 $18.56 $19.44 $18.56 $18.56 $14.25 $18.56 $18.56 $18.56 $9.28 $9.28 $14.70 $18.56 $14.85 $12.06 $18.56 N/A $11.02 $18.56 $11.14 $18.56 $18.56 $18.56 N/A N/A 492.31 SUP Custom 27203010 492.31 - WIRE FX 3MM 285MM NS KRSH TROC PNT TI BOTH IP/OP $23.50 $17.00 $4.10 $23.45 $23.05 $23.05 $23.05 $23.05 $23.05 $23.05 $4.10 $23.05 $23.05 $17.11 $17.11 $17.77 $12.01 $4.80 $23.05 $9.38 $23.05 $23.05 $23.45 $23.05 $23.05 $17.63 $23.05 $23.05 $23.05 $11.53 $11.53 $18.26 $23.05 $18.44 $14.98 $23.05 N/A $13.63 $23.05 $13.83 $23.05 $23.05 $23.05 N/A N/A 494.769 SUP HCPCS C1713 494.769 - SCREW BONE 4/2.5MM 80MM 20MM SLFDRILL REINFORCED BONE ANCHOR BOTH IP/OP $250.00 $185.00 $49.53 $253.78 $112.29 $112.29 $112.29 $112.29 $249.53 $249.53 $249.53 $52.01 $249.53 $249.53 $249.53 $249.53 $249.53 $52.00 $249.53 $253.78 $147.60 $249.53 $253.78 $249.53 $249.53 $187.50 $249.53 $249.53 $249.53 $124.77 $124.77 $197.63 $249.53 $199.62 $112.29 $49.53 N/A $145.00 $249.53 $149.72 $249.53 $52.00 $249.53 N/A N/A 494.771 SUP HCPCS C1713 494.771 - SCREW XTRNFX 4MM 3MM 80MM NS 20MM SCHNZ SLF DRL MR BOTH IP/OP $278.50 $206.00 $55.27 $283.20 $125.32 $125.32 $125.32 $125.32 $278.48 $278.48 $278.48 $58.04 $278.48 $278.48 $278.48 $278.48 $278.48 $58.04 $278.48 $283.20 $164.72 $278.48 $283.20 $278.48 $278.48 $208.88 $278.48 $278.48 $278.48 $139.24 $139.24 $220.56 $278.48 $222.78 $125.32 $55.27 N/A $161.53 $278.48 $167.09 $278.48 $58.04 $278.48 N/A N/A 494.772 SUP HCPCS C1713 494.772 - SCREW BONE 4/3MM 100MM 20MM SLFDRILL SCHANZ TITANIUM BOTH IP/OP $278.50 $206.00 $55.27 $283.20 $125.32 $125.32 $125.32 $125.32 $278.48 $278.48 $278.48 $58.04 $278.48 $278.48 $278.48 $278.48 $278.48 $58.04 $278.48 $283.20 $164.72 $278.48 $283.20 $278.48 $278.48 $208.88 $278.48 $278.48 $278.48 $139.24 $139.24 $220.56 $278.48 $222.78 $125.32 $55.27 N/A $161.53 $278.48 $167.09 $278.48 $58.04 $278.48 N/A N/A 494.774 SUP HCPCS C1713 494.774 - SCREW BONE 4MM 60MM 20MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC BOTH IP/OP $278.50 $206.00 $55.27 $283.20 $125.32 $125.32 $125.32 $125.32 $278.48 $278.48 $278.48 $58.04 $278.48 $278.48 $278.48 $278.48 $278.48 $58.04 $278.48 $283.20 $164.72 $278.48 $283.20 $278.48 $278.48 $208.88 $278.48 $278.48 $278.48 $139.24 $139.24 $220.56 $278.48 $222.78 $125.32 $55.27 N/A $161.53 $278.48 $167.09 $278.48 $58.04 $278.48 N/A N/A 494.775 SUP HCPCS C1713 494.775 - PIN HALF 4MM 80MM 20MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC BOTH IP/OP $278.50 $206.00 $55.27 $283.20 $125.32 $125.32 $125.32 $125.32 $278.48 $278.48 $278.48 $58.04 $278.48 $278.48 $278.48 $278.48 $278.48 $58.04 $278.48 $113.28 $164.72 $278.48 $283.20 $278.48 $278.48 $208.88 $278.48 $278.48 $278.48 $139.24 $139.24 $220.56 $278.48 $222.78 $125.32 $55.27 N/A $161.53 $278.48 $278.48 $278.48 $58.04 $278.48 N/A N/A 494.776 SUP HCPCS C1713 494.776 - SCREW FIX 4MM 100MM 30MM SELF DRILL REINFORCE SYMMETRICAL BOTH IP/OP $278.50 $206.00 $55.27 $283.20 $125.32 $125.32 $125.32 $125.32 $278.48 $278.48 $278.48 $58.04 $278.48 $278.48 $278.48 $278.48 $278.48 $58.04 $278.48 $113.28 $164.72 $278.48 $283.20 $278.48 $278.48 $208.88 $278.48 $278.48 $278.48 $139.24 $139.24 $220.56 $278.48 $222.78 $125.32 $55.27 N/A $161.53 $278.48 $167.09 $278.48 $58.04 $278.48 N/A N/A 494.777 SUP HCPCS C1713 494.777 - SCREW BONE 4MM 125MM 40MM SLFDRILL SCHANZ TITANIUM BOTH IP/OP $278.50 $206.00 $55.27 $283.20 $125.32 $125.32 $125.32 $125.32 $278.48 $278.48 $278.48 $58.04 $278.48 $278.48 $278.48 $278.48 $278.48 $58.04 $278.48 $283.20 $164.72 $278.48 $283.20 $278.48 $278.48 $208.88 $278.48 $278.48 $278.48 $139.24 $139.24 $220.56 $278.48 $222.78 $125.32 $55.27 N/A $161.53 $278.48 $167.09 $278.48 $58.04 $278.48 N/A N/A 494.778 SUP HCPCS C1713 494.778 - SCREW BONE 4MM 150MM 40MM SLFDRILL SCHANZ TITANIUM BOTH IP/OP $278.50 $206.00 $55.27 $283.20 $125.32 $125.32 $125.32 $125.32 $278.48 $278.48 $278.48 $58.04 $278.48 $278.48 $278.48 $278.48 $278.48 $58.04 $278.48 $283.20 $164.72 $278.48 $283.20 $278.48 $278.48 $208.88 $278.48 $278.48 $278.48 $139.24 $139.24 $220.56 $278.48 $222.78 $125.32 $55.27 N/A $161.53 $278.48 $167.09 $278.48 $58.04 $278.48 N/A N/A 494.779 SUP HCPCS C1713 494.779 - PIN HALF 4MM 175MM 40MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC BOTH IP/OP $278.50 $206.00 $55.27 $283.20 $125.32 $125.32 $125.32 $125.32 $278.48 $278.48 $278.48 $58.04 $278.48 $278.48 $278.48 $278.48 $278.48 $58.04 $278.48 $283.20 $164.72 $278.48 $283.20 $278.48 $278.48 $208.88 $278.48 $278.48 $278.48 $139.24 $139.24 $220.56 $278.48 $222.78 $125.32 $55.27 N/A $161.53 $278.48 $167.09 $278.48 $58.04 $278.48 N/A N/A 494.782 SUP HCPCS C1713 494.782 - PIN HALF 5MM 100MM 30MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC BOTH IP/OP $321.00 $238.00 $63.68 $326.28 $144.37 $144.37 $144.37 $144.37 $320.83 $320.83 $320.83 $66.87 $320.83 $320.83 $320.83 $320.83 $320.83 $66.86 $320.83 $326.28 $189.77 $320.83 $326.28 $320.83 $320.83 $240.75 $320.83 $320.83 $320.83 $160.42 $160.42 $254.10 $320.83 $256.66 $144.37 $63.68 N/A $186.18 $320.83 $192.50 $320.83 $66.86 $320.83 N/A N/A 494.783 SUP HCPCS C1713 494.783 - PIN HALF 5MM 125MM 40MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC BOTH IP/OP $321.00 $238.00 $63.68 $326.28 $144.37 $144.37 $144.37 $144.37 $320.83 $320.83 $320.83 $66.87 $320.83 $320.83 $320.83 $320.83 $320.83 $66.86 $320.83 $326.28 $189.77 $320.83 $326.28 $320.83 $320.83 $240.75 $320.83 $320.83 $320.83 $160.42 $160.42 $254.10 $320.83 $256.66 $144.37 $63.68 N/A $186.18 $320.83 $192.50 $320.83 $66.86 $320.83 N/A N/A 494.784 SUP HCPCS C1713 494.784 - SCREW XTRNFX 5MM 150MM NS 60MM SCHNZ SLF DRL TI HIP CNDYL LG BOTH IP/OP $321.00 $238.00 $63.68 $326.28 $144.37 $144.37 $144.37 $144.37 $320.83 $320.83 $320.83 $66.87 $320.83 $320.83 $320.83 $320.83 $320.83 $66.86 $320.83 $326.28 $189.77 $320.83 $326.28 $320.83 $320.83 $240.75 $320.83 $320.83 $320.83 $160.42 $160.42 $254.10 $320.83 $256.66 $144.37 $63.68 N/A $186.18 $320.83 $192.50 $320.83 $66.86 $320.83 N/A N/A 494.785 SUP HCPCS C1713 494.785 - SCREW XTRNFX 5MM 175MM NS 60MM SCHNZ SLF DRL MR CONDITIONAL BOTH IP/OP $321.00 $238.00 $63.68 $326.28 $144.37 $144.37 $144.37 $144.37 $320.83 $320.83 $320.83 $66.87 $320.83 $320.83 $320.83 $320.83 $320.83 $66.86 $320.83 $130.51 $189.77 $320.83 $326.28 $320.83 $320.83 $240.75 $320.83 $320.83 $320.83 $160.42 $160.42 $254.10 $320.83 $256.66 $144.37 $63.68 N/A $186.18 $320.83 $192.50 $320.83 $66.86 $320.83 N/A N/A 494.786 SUP HCPCS C1713 494.786 - SCREW XTRNFX 5MM 200MM NS 80MM SCHNZ SLF DRL TI HIP CNDYL LG BOTH IP/OP $321.00 $238.00 $63.68 $326.28 $144.37 $144.37 $144.37 $144.37 $320.83 $320.83 $320.83 $66.87 $320.83 $320.83 $320.83 $320.83 $320.83 $66.86 $320.83 $130.51 $189.77 $320.83 $326.28 $320.83 $320.83 $240.75 $320.83 $320.83 $320.83 $160.42 $160.42 $254.10 $320.83 $256.66 $144.37 $63.68 N/A $186.18 $320.83 $320.83 $320.83 $320.83 $320.83 N/A N/A 494.788 SUP HCPCS C1713 494.788 - PIN HALF 5MM 250MM 80MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC BOTH IP/OP $321.00 $238.00 $63.68 $326.28 $144.37 $144.37 $144.37 $144.37 $320.83 $320.83 $320.83 $66.87 $320.83 $320.83 $320.83 $320.83 $320.83 $66.86 $320.83 $130.51 $189.77 $320.83 $326.28 $320.83 $320.83 $240.75 $320.83 $320.83 $320.83 $160.42 $160.42 $254.10 $320.83 $256.66 $144.37 $63.68 N/A $186.18 $320.83 $192.50 $320.83 $66.86 $320.83 N/A N/A 494.792 SUP HCPCS C1713 494.792 - SCREW BONE 6MM 100MM 30MM SLFDRILL SCHANZ TITANIUM BOTH IP/OP $342.00 $253.00 $67.87 $347.80 $153.89 $153.89 $153.89 $153.89 $341.98 $341.98 $341.98 $71.28 $341.98 $341.98 $341.98 $341.98 $341.98 $71.27 $341.98 $139.12 $202.28 $341.98 $347.80 $341.98 $341.98 $256.50 $341.98 $341.98 $341.98 $170.99 $170.99 $270.85 $341.98 $273.58 $153.89 $67.87 N/A $198.36 $341.98 $205.19 $341.98 $71.27 $341.98 N/A N/A 494.793 SUP HCPCS C1713 494.793 - PIN HALF 6MM 125MM 40MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC BOTH IP/OP $342.00 $253.00 $67.87 $347.80 $153.89 $153.89 $153.89 $153.89 $341.98 $341.98 $341.98 $71.28 $341.98 $341.98 $341.98 $341.98 $341.98 $71.27 $341.98 $139.12 $202.28 $341.98 $347.80 $341.98 $341.98 $256.50 $341.98 $341.98 $341.98 $170.99 $170.99 $270.85 $341.98 $273.58 $153.89 $67.87 N/A $198.36 $341.98 $205.19 $341.98 $341.98 $341.98 N/A N/A 494.794 SUP HCPCS C1713 494.794 - SCREW BONE 6MM 150MM 60MM SLFDRILL SCHANZ TITANIUM BOTH IP/OP $342.00 $253.00 $67.87 $347.80 $153.89 $153.89 $153.89 $153.89 $341.98 $341.98 $341.98 $71.28 $341.98 $341.98 $341.98 $341.98 $341.98 $71.27 $341.98 $139.12 $202.28 $341.98 $347.80 $341.98 $341.98 $256.50 $341.98 $341.98 $341.98 $170.99 $170.99 $270.85 $341.98 $273.58 $153.89 $67.87 N/A $198.36 $341.98 $205.19 $341.98 $71.27 $341.98 N/A N/A 494.795 SUP HCPCS C1713 494.795 - PIN HALF 6MM 175MM 60MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC BOTH IP/OP $342.00 $253.00 $67.87 $347.80 $153.89 $153.89 $153.89 $153.89 $341.98 $341.98 $341.98 $71.28 $341.98 $341.98 $341.98 $341.98 $341.98 $71.27 $341.98 $139.12 $202.28 $341.98 $347.80 $341.98 $341.98 $256.50 $341.98 $341.98 $341.98 $170.99 $170.99 $270.85 $341.98 $273.58 $153.89 $67.87 N/A $198.36 $341.98 $341.98 $341.98 $71.27 $341.98 N/A N/A 494.796 SUP HCPCS C1713 494.796 - SCREW BONE 6MM 200MM 80MM SLFDRILL SCHANZ TITANIUM BOTH IP/OP $342.00 $253.00 $67.87 $347.80 $153.89 $153.89 $153.89 $153.89 $341.98 $341.98 $341.98 $71.28 $341.98 $341.98 $341.98 $341.98 $341.98 $71.27 $341.98 $347.80 $202.28 $341.98 $347.80 $341.98 $341.98 $256.50 $341.98 $341.98 $341.98 $170.99 $170.99 $270.85 $341.98 $273.58 $153.89 $67.87 N/A $198.36 $341.98 $341.98 $341.98 $71.27 $341.98 N/A N/A 494.798 SUP HCPCS C1713 494.798 - PIN HALF 6MM 250MM 80MM SLFDRILL SCHANZ TITANIUM ORTHOPEDIC BOTH IP/OP $342.00 $253.00 $67.87 $347.80 $153.89 $153.89 $153.89 $153.89 $341.98 $341.98 $341.98 $71.28 $341.98 $341.98 $341.98 $341.98 $341.98 $71.27 $341.98 $347.80 $202.28 $341.98 $347.80 $341.98 $341.98 $256.50 $341.98 $341.98 $341.98 $170.99 $170.99 $270.85 $341.98 $273.58 $153.89 $67.87 N/A $198.36 $341.98 $205.19 $341.98 $71.27 $341.98 N/A N/A 495.372 SUP HCPCS C1713 495.372 - CAGE SPNL OBLNG 22X17X12MM NS SNMSH TI VERT BD REPL BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$2,625.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A 495.394 SUP HCPCS C1713 495.394 - RING SPNL 5D OBLNG 22MM 17MM 22X17MM NS SNMSH PRFT ALAT BOTH IP/OP $830.00 $614.00 $164.73 $830.00 $373.50 $373.50 $373.50 $373.50 $830.00 $830.00 $830.00 $172.99 $830.00 $830.00 $830.00 $830.00 $830.00 $172.98 $830.00 $332.00 $490.95 $830.00 $830.00 $830.00 $830.00 $622.50 $830.00 $830.00 $830.00 $415.00 $415.00 $657.36 $830.00 $664.00 $373.50 $164.73 N/A $481.40 $830.00 $830.00 $830.00 $830.00 $830.00 N/A N/A 497.674 SUP HCPCS C1713 497.674 - SCREW TI 14MM 2.4MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT BOTH IP/OP $272.50 $202.00 $54.03 $272.25 $122.51 $122.51 $122.51 $122.51 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $161.04 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $122.51 $54.03 N/A $158.05 $272.25 $163.35 $272.25 $56.74 $272.25 N/A N/A 497.676 SUP HCPCS C1713 497.676 - SCREW TI 16MM 2.4MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT BOTH IP/OP $272.50 $202.00 $54.03 $272.25 $122.51 $122.51 $122.51 $122.51 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $272.25 $272.25 $272.25 $56.74 $272.25 $108.90 $161.04 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $122.51 $54.03 N/A $158.05 $272.25 $163.35 $272.25 $56.74 $272.25 N/A N/A 497.678 SUP HCPCS C1713 497.678 - SCREW TI 18MM 2.4MM MANDIB SLFTAP LCK BONE NONSTRL RECON PLT BOTH IP/OP $272.50 $202.00 $54.03 $272.25 $122.51 $122.51 $122.51 $122.51 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $272.25 $272.25 $272.25 $56.74 $272.25 $108.90 $161.04 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $122.51 $54.03 N/A $158.05 $272.25 $272.25 $272.25 $56.74 $272.25 N/A N/A 497.78 SUP HCPCS C1713 497.78 - SCREW BN 1.8MM 5MM LCK TI SPNE BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $24.15 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $60.38 $60.38 $12.58 $60.38 N/A N/A 497.797 SUP Custom 27803010 497.797 - TRANSCONNECTOR ROD 6MM 35-41MM LP STABILIZER PREASSEMBLED BOTH IP/OP "$2,432.50" "$1,800.00" $432.99 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" $432.99 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" $506.96 "$2,432.50" $973.00 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$1,824.38" "$2,432.50" "$2,432.50" "$2,432.50" "$1,216.25" "$1,216.25" "$1,926.54" "$2,432.50" "$1,946.00" "$1,094.63" "$2,432.50" N/A "$1,410.85" "$2,432.50" "$1,459.50" "$2,432.50" "$2,432.50" "$2,432.50" N/A N/A 498.104 SUP HCPCS C1713 498.104 - ROD SPINAL 6MM 100MM HARD USS TITANIUM NONSTRL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 498.105 SUP HCPCS C1713 498.105 - ROD SPINAL 6MM 125MM HARD USS TITANIUM NONSTRL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 498.106 SUP HCPCS C1713 498.106 - ROD SPINAL 6MM 150MM HARD USS TITANIUM NONSTRL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 498.108 SUP HCPCS C1713 498.108 - ROD SPINAL 6MM 200MM HARD USS TITANIUM NONSTRL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 498.116 SUP HCPCS C1713 498.116 - ROD SPINAL 6MM 400MM HARD USS TITANIUM NONSTRL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 498.12 SUP HCPCS C1713 498.120 - ROD SPINAL 3.5MM 80MM CLICKX USS TITANIUM NONSTRL TRNCON BOTH IP/OP $289.00 $214.00 $57.31 $288.75 $129.94 $129.94 $129.94 $129.94 $288.75 $288.75 $288.75 $60.18 $288.75 $288.75 $288.75 $288.75 $288.75 $60.18 $288.75 $115.50 $170.80 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $129.94 $57.31 N/A $167.62 $288.75 $288.75 $288.75 $60.18 $288.75 N/A N/A 498.125 SUP HCPCS C1713 498.125 - CONNECTOR ROD STR 3.5MM 120MM SET UPPER BAR USS TITANIUM SPN BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 498.136 SUP HCPCS C1713 498.136 - ROD SPINAL 3.5MM 40MM CVD AXON TITANIUM NONSTRL BOTH IP/OP $353.50 $262.00 $70.16 $353.50 $159.08 $159.08 $159.08 $159.08 $353.50 $353.50 $353.50 $73.68 $353.50 $353.50 $353.50 $353.50 $353.50 $73.67 $353.50 $141.40 $209.10 $353.50 $353.50 $353.50 $353.50 $265.13 $353.50 $353.50 $353.50 $176.75 $176.75 $279.97 $353.50 $282.80 $159.08 $70.16 N/A $205.03 $353.50 $353.50 $353.50 $73.67 $353.50 N/A N/A 498.137 SUP HCPCS C1713 498.137 - ROD SPINAL CURVE 3.5MM 80MM PREBENT AXON TITANIUM NONSTRL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 498.141 SUP HCPCS C1713 498.141 - ROD SPINAL CURVE 6MM 65MM SOFT NORMALISED CLICKX TITANIUM BOTH IP/OP $483.00 $357.00 $95.86 $483.00 $217.35 $217.35 $217.35 $217.35 $483.00 $483.00 $483.00 $100.67 $483.00 $483.00 $483.00 $483.00 $483.00 $100.66 $483.00 $193.20 $285.69 $483.00 $483.00 $483.00 $483.00 $362.25 $483.00 $483.00 $483.00 $241.50 $241.50 $382.54 $483.00 $386.40 $217.35 $95.86 N/A $280.14 $483.00 $483.00 $483.00 $100.66 $483.00 N/A N/A 510.01 SUP HCPCS C1713 510.010 - SCREW BONE 4MM 10MM SLFDRILL FIXANG TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.012 SUP HCPCS C1713 510.012 - SCREW BONE 4MM 12MM SLFDRILL FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.014 SUP HCPCS C1713 510.014 - SCREW BONE 4MM 14MM SLFDRILL FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.016 SUP HCPCS C1713 510.016 - SCREW BONE 4MM 16MM SLFDRILL FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.03 SUP HCPCS C1713 510.030 - SCREW BONE 4MM 10MM SLFTAP FIXANG TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.032 SUP HCPCS C1713 510.032 - SCREW BONE 4MM 12MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.034 SUP HCPCS C1713 510.034 - SCREW BONE 4MM 14MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 510.036 SUP HCPCS C1713 510.036 - SCREW BONE 4MM 16MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.038 SUP HCPCS C1713 510.038 - SCREW BONE 4MM 18MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.04 SUP HCPCS C1713 510.040 - SCREW BONE 4MM 20MM SLFTAP FIXANG TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.512 SUP HCPCS C1713 510.512 - SCREW BONE 4.5MM 12MM SLFDRILL FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.514 SUP HCPCS C1713 510.514 - SCREW BONE 4.5MM 14MM SLFDRILL FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.516 SUP HCPCS C1713 510.516 - SCREW BONE 4.5MM 16MM SLFDRILL FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.53 SUP HCPCS C1713 510.530 - SCREW BONE 4.5MM 10MM SLFTAP FIXANG TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.532 SUP HCPCS C1713 510.532 - SCREW BONE 4.5MM 12MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.534 SUP HCPCS C1713 510.534 - SCREW BONE 4.5MM 14MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.536 SUP HCPCS C1713 510.536 - SCREW BONE 4.5MM 16MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.538 SUP HCPCS C1713 510.538 - SCREW BONE 4.5MM 18MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 510.54 SUP HCPCS C1713 510.540 - SCREW BONE 4.5MM 20MM SLFTAP FIXANG TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.61 SUP HCPCS C1713 510.610 - SCREW BONE STANDARD 4MM 10MM SLFDRILL FIXANG TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.612 SUP HCPCS C1713 510.612 - SCREW BONE STANDARD 4MM 12MM SLFDRILL FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 510.614 SUP HCPCS C1713 510.614 - SCREW BONE STANDARD 4MM 14MM SLFDRILL FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.616 SUP HCPCS C1713 510.616 - SCREW BONE STANDARD 4MM 16MM SLFDRILL FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.71 SUP HCPCS C1713 510.710 - SCREW BONE STANDARD 4.5MM 10MM SLFDRILL FIXANG TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.712 SUP HCPCS C1713 510.712 - SCREW BONE STANDARD 4.5MM 12MM SLFDRILL FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.714 SUP HCPCS C1713 510.714 - SCREW BONE STANDARD 4.5MM 14MM SLFDRILL FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.716 SUP HCPCS C1713 510.716 - SCREW BONE STANDARD 4.5MM 16MM SLFDRILL FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.81 SUP HCPCS C1713 510.810 - SCREW BONE STANDARD 4MM 10MM SLFTAP FIXANG TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.812 SUP HCPCS C1713 510.812 - SCREW BONE STANDARD 4MM 12MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.814 SUP HCPCS C1713 510.814 - SCREW BONE STANDARD 4MM 14MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.816 SUP HCPCS C1713 510.816 - SCREW BONE STANDARD 4MM 16MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.818 SUP HCPCS C1713 510.818 - SCREW BONE STANDARD 4MM 18MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.82 SUP HCPCS C1713 510.820 - SCREW BONE STANDARD 4MM 20MM SLFTAP FIXANG TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 510.91 SUP HCPCS C1713 510.910 - SCREW BONE STANDARD 4.5MM 10MM SLFTAP FIXANG TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.912 SUP HCPCS C1713 510.912 - SCREW BONE STANDARD 4.5MM 12MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.914 SUP HCPCS C1713 510.914 - SCREW BONE STANDARD 4.5MM 14MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 510.916 SUP HCPCS C1713 510.916 - SCREW BONE STANDARD 4.5MM 16MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.918 SUP HCPCS C1713 510.918 - SCREW BONE STANDARD 4.5MM 18MM SLFTAP FIX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 510.92 SUP HCPCS C1713 510.920 - SCREW BONE STANDARD 4.5MM 20MM SLFTAP FIXANG TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 511.411 SUP Custom 27203010 511.411 - BIT DRILL 2MM 150MM BRAD POINT 3 FLUTED NONSTRL BOTH IP/OP $502.00 $371.00 $89.32 $510.33 $501.80 $501.80 $501.80 $501.80 $501.80 $501.80 $89.32 $501.80 $501.80 $372.44 $372.44 $386.79 $261.44 $104.58 $501.80 $204.13 $501.80 $501.80 $510.33 $501.80 $501.80 $376.50 $501.80 $501.80 $501.80 $250.90 $250.90 $397.43 $501.80 $401.44 $326.17 $501.80 N/A $291.16 $501.80 $301.08 $501.80 $501.80 $501.80 N/A N/A 511.412 SUP Custom 27203010 511.412 - BIT DRILL 2.5MM 150MM BRAD POINT 3 FLUTED NONSTRL BOTH IP/OP $502.00 $371.00 $89.32 $510.33 $501.80 $501.80 $501.80 $501.80 $501.80 $501.80 $89.32 $501.80 $501.80 $372.44 $372.44 $386.79 $261.44 $104.58 $501.80 $204.13 $501.80 $501.80 $510.33 $501.80 $501.80 $376.50 $501.80 $501.80 $501.80 $250.90 $250.90 $397.43 $501.80 $401.44 $326.17 $501.80 N/A $291.16 $501.80 $301.08 $501.80 $501.80 $501.80 N/A N/A 511.413 SUP Custom 27203010 511.413 - BIT DRILL 2.7MM 150MM QUICK COUPLING BRAD POINT 3 FLUTED BOTH IP/OP $502.00 $371.00 $89.32 $510.33 $501.80 $501.80 $501.80 $501.80 $501.80 $501.80 $89.32 $501.80 $501.80 $372.44 $372.44 $386.79 $261.44 $104.58 $501.80 $204.13 $501.80 $501.80 $510.33 $501.80 $501.80 $376.50 $501.80 $501.80 $501.80 $250.90 $250.90 $397.43 $501.80 $401.44 $326.17 $501.80 N/A $291.16 $501.80 $301.08 $501.80 $501.80 $501.80 N/A N/A 511.414 SUP Custom 27203010 511.414 - BIT DRILL 3 FLUTE 3.2MM 122MM QUICK COUPLING BRAD POINT BOTH IP/OP $502.00 $371.00 $89.32 $510.33 $501.80 $501.80 $501.80 $501.80 $501.80 $501.80 $89.32 $501.80 $501.80 $372.44 $372.44 $386.79 $261.44 $104.58 $501.80 $204.13 $501.80 $501.80 $510.33 $501.80 $501.80 $376.50 $501.80 $501.80 $501.80 $250.90 $250.90 $397.43 $501.80 $401.44 $326.17 $501.80 N/A $291.16 $501.80 $301.08 $501.80 $501.80 $501.80 N/A N/A 511.415 SUP Custom 27203010 511.415 - BIT DRILL 3.5MM 150MM QUICK COUPLING BRAD POINT 3 FLUTED BOTH IP/OP $502.00 $371.00 $89.32 $510.33 $501.80 $501.80 $501.80 $501.80 $501.80 $501.80 $89.32 $501.80 $501.80 $372.44 $372.44 $386.79 $261.44 $104.58 $501.80 $204.13 $501.80 $501.80 $510.33 $501.80 $501.80 $376.50 $501.80 $501.80 $501.80 $250.90 $250.90 $397.43 $501.80 $401.44 $326.17 $501.80 N/A $291.16 $501.80 $301.08 $501.80 $501.80 $501.80 N/A N/A 511.416 SUP Custom 27203010 511.416 - BIT DRILL 3.6MM 150MM 3 FLUTED QUICK COUPLING BRAD POINT BOTH IP/OP $502.00 $371.00 $89.32 $510.33 $501.80 $501.80 $501.80 $501.80 $501.80 $501.80 $89.32 $501.80 $501.80 $372.44 $372.44 $386.79 $261.44 $104.58 $501.80 $204.13 $501.80 $501.80 $510.33 $501.80 $501.80 $376.50 $501.80 $501.80 $501.80 $250.90 $250.90 $397.43 $501.80 $401.44 $326.17 $501.80 N/A $291.16 $501.80 $301.08 $501.80 $501.80 $501.80 N/A N/A 511.417 SUP Custom 27203010 511.417 - BIT DRILL 4MM 150MM 3 FLUTED QUICK COUPLING BRAD POINT BOTH IP/OP $502.00 $371.00 $89.32 $510.33 $501.80 $501.80 $501.80 $501.80 $501.80 $501.80 $89.32 $501.80 $501.80 $372.44 $372.44 $386.79 $261.44 $104.58 $501.80 $204.13 $501.80 $501.80 $510.33 $501.80 $501.80 $376.50 $501.80 $501.80 $501.80 $250.90 $250.90 $397.43 $501.80 $401.44 $326.17 $501.80 N/A $291.16 $501.80 $301.08 $501.80 $501.80 $501.80 N/A N/A 511.418 SUP Custom 27203010 511.418 - BIT DRILL 4.5MM 150MM QUICK COUPLING BRAD POINT 3 FLUTED BOTH IP/OP $502.00 $371.00 $89.32 $510.33 $501.80 $501.80 $501.80 $501.80 $501.80 $501.80 $89.32 $501.80 $501.80 $372.44 $372.44 $386.79 $261.44 $104.58 $501.80 $204.13 $501.80 $501.80 $510.33 $501.80 $501.80 $376.50 $501.80 $501.80 $501.80 $250.90 $250.90 $397.43 $501.80 $401.44 $326.17 $501.80 N/A $291.16 $501.80 $301.08 $501.80 $501.80 $501.80 N/A N/A 511.431 SUP Custom 27203010 511.431 - BIT DRILL 3.2MM 105MM BRAD POINT 3 FLUTE NONSTRL BOTH IP/OP $502.00 $371.00 $89.32 $510.33 $501.80 $501.80 $501.80 $501.80 $501.80 $501.80 $89.32 $501.80 $501.80 $372.44 $372.44 $386.79 $261.44 $104.58 $501.80 $204.13 $501.80 $501.80 $510.33 $501.80 $501.80 $376.50 $501.80 $501.80 $501.80 $250.90 $250.90 $397.43 $501.80 $401.44 $326.17 $501.80 N/A $291.16 $501.80 $301.08 $501.80 $501.80 $501.80 N/A N/A 511.432 SUP Custom 27203010 511.432 - BIT DRILL 4MM 105MM BRAD POINT 3 FLUTED NONSTRL BOTH IP/OP $502.00 $371.00 $89.32 $510.33 $501.80 $501.80 $501.80 $501.80 $501.80 $501.80 $89.32 $501.80 $501.80 $372.44 $372.44 $386.79 $261.44 $104.58 $501.80 $204.13 $501.80 $501.80 $510.33 $501.80 $501.80 $376.50 $501.80 $501.80 $501.80 $250.90 $250.90 $397.43 $501.80 $401.44 $326.17 $501.80 N/A $291.16 $501.80 $301.08 $501.80 $501.80 $501.80 N/A N/A 513.01 SUP Custom 27203010 513.01 - BIT DRILL MINI 1.1MM 28MM QUICK COUPLING NONSTRL BOTH IP/OP $125.00 $93.00 $22.17 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $22.17 $124.55 $124.55 $92.44 $92.44 $96.00 $64.89 $25.96 $124.55 $49.82 $124.55 $124.55 $124.55 $124.55 $124.55 $93.75 $124.55 $124.55 $124.55 $62.28 $62.28 $98.64 $124.55 $99.64 $80.96 $124.55 N/A $72.50 $124.55 $74.73 $124.55 $124.55 $124.55 N/A N/A 513.03 SUP Custom 27203010 513.03 - BIT DRILL MINI 1.1MM 45MM QUICK COUPLING NONSTRL BOTH IP/OP $125.00 $93.00 $22.17 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $22.17 $124.55 $124.55 $92.44 $92.44 $96.00 $64.89 $25.96 $124.55 $49.82 $124.55 $124.55 $124.55 $124.55 $124.55 $93.75 $124.55 $124.55 $124.55 $62.28 $62.28 $98.64 $124.55 $99.64 $80.96 $124.55 N/A $72.50 $124.55 $74.73 $124.55 $124.55 $124.55 N/A N/A 513.05 SUP Custom 27203010 513.05 - BIT DRILL MINI 3MM 28MM QUICK COUPLING NONSTRL BOTH IP/OP $125.00 $93.00 $22.17 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $22.17 $124.55 $124.55 $92.44 $92.44 $96.00 $64.89 $25.96 $124.55 $49.82 $124.55 $124.55 $124.55 $124.55 $124.55 $93.75 $124.55 $124.55 $124.55 $62.28 $62.28 $98.64 $124.55 $99.64 $80.96 $124.55 N/A $72.50 $124.55 $74.73 $124.55 $124.55 $124.55 N/A N/A 513.08 SUP Custom 27203010 513.08 - BIT DRILL MINI 1.5MM 52MM QUICK COUPLING NONSTRL BOTH IP/OP $125.00 $93.00 $22.17 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $22.17 $124.55 $124.55 $92.44 $92.44 $96.00 $64.89 $25.96 $124.55 $49.82 $124.55 $124.55 $124.55 $124.55 $124.55 $93.75 $124.55 $124.55 $124.55 $62.28 $62.28 $98.64 $124.55 $99.64 $80.96 $124.55 N/A $72.50 $124.55 $74.73 $124.55 $124.55 $124.55 N/A N/A 513.1 SUP Custom 27203010 513.10 - BIT DRILL MINI 2MM 28MM QUICK COUPLING NONSTRL BOTH IP/OP $125.00 $93.00 $22.17 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $22.17 $124.55 $124.55 $92.44 $92.44 $96.00 $64.89 $25.96 $124.55 $49.82 $124.55 $124.55 $124.55 $124.55 $124.55 $93.75 $124.55 $124.55 $124.55 $62.28 $62.28 $98.64 $124.55 $99.64 $80.96 $124.55 N/A $72.50 $124.55 $74.73 $124.55 $124.55 $124.55 N/A N/A 513.13 SUP Custom 27203010 513.13 - BIT DRILL MINI 2MM 52MM QUICK COUPLING NONSTRL BOTH IP/OP $125.00 $93.00 $22.17 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $22.17 $124.55 $124.55 $92.44 $92.44 $96.00 $64.89 $25.96 $124.55 $49.82 $124.55 $124.55 $124.55 $124.55 $124.55 $93.75 $124.55 $124.55 $124.55 $62.28 $62.28 $98.64 $124.55 $99.64 $80.96 $124.55 N/A $72.50 $124.55 $74.73 $124.55 $124.55 $124.55 N/A N/A 513.14 SUP Custom 27203010 513.14 - BIT DRILL MINI 2MM 67MM QUICK COUPLING NONSTRL BOTH IP/OP $125.00 $93.00 $22.17 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $22.17 $124.55 $124.55 $92.44 $92.44 $96.00 $64.89 $25.96 $124.55 $49.82 $124.55 $124.55 $124.55 $124.55 $124.55 $93.75 $124.55 $124.55 $124.55 $62.28 $62.28 $98.64 $124.55 $99.64 $80.96 $124.55 N/A $72.50 $124.55 $74.73 $124.55 $124.55 $124.55 N/A N/A 513.17 SUP Custom 27203010 513.17 - BIT DRILL MINI 2.7MM 28MM QUICK COUPLING NONSTRL BOTH IP/OP $125.00 $93.00 $22.17 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $22.17 $124.55 $124.55 $92.44 $92.44 $96.00 $64.89 $25.96 $124.55 $49.82 $124.55 $124.55 $124.55 $124.55 $124.55 $93.75 $124.55 $124.55 $124.55 $62.28 $62.28 $98.64 $124.55 $99.64 $80.96 $124.55 N/A $72.50 $124.55 $74.73 $124.55 $124.55 $124.55 N/A N/A 513.19 SUP Custom 27203010 513.19 - BIT DRILL MINI 2.7MM 67MM QUICK COUPLING NONSTRL BOTH IP/OP $125.00 $93.00 $22.17 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $124.55 $22.17 $124.55 $124.55 $92.44 $92.44 $96.00 $64.89 $25.96 $124.55 $49.82 $124.55 $124.55 $124.55 $124.55 $124.55 $93.75 $124.55 $124.55 $124.55 $62.28 $62.28 $98.64 $124.55 $99.64 $80.96 $124.55 N/A $72.50 $124.55 $74.73 $124.55 $124.55 $124.55 N/A N/A 524.001 SUP Custom 27803010 524.001 - ROD SPINAL 5.5MM STR HEXAGONAL END CENTRL POST BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.002 SUP Custom 27803010 524.002 - ROD SPINAL 5.5MM STR HEXAGONAL END CENTRL POST BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.003 SUP Custom 27803010 524.003 - ROD SPINAL 5.5MM STR HEXAGONAL END CENTRL POST BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.004 SUP Custom 27803010 524.004 - ROD SPINAL 5.5MM STR HEXAGONAL END CENTRL POST BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.005 SUP Custom 27803010 524.005 - ROD SPINAL 5.5MM STR HEXAGONAL END CENTRL POST BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.006 SUP Custom 27803010 524.006 - ROD SPINAL 5.5MM STR HEXAGONAL END CENTRL POST BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.007 SUP Custom 27803010 524.007 - ROD SPINAL 5.5MM 500MM STR HEXAGONAL END CENTRL POST REVERE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.008 SUP Custom 27803010 524.008 - ROD SPINAL 5.5MM 500MM STR HEXAGONAL END CENTRL POST REVERE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.009 SUP Custom 27803010 524.009 - ROD SPINAL 5.5MM 500MM STR HEXAGONAL END CENTRL POST REVERE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.051 SUP HCPCS C1713 524.051 - SCREW BONE 5MM 25MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.052 SUP HCPCS C1713 524.052 - SCREW BONE 5MM 30MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.053 SUP HCPCS C1713 524.053 - SCREW BONE 5MM 35MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.054 SUP HCPCS C1713 524.054 - SCREW BONE 5MM 40MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.055 SUP HCPCS C1713 524.055 - SCREW BONE 5MM 45MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.056 SUP HCPCS C1713 524.056 - SCREW BONE 5MM 50MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.057 SUP HCPCS C1713 524.057 - SCREW BONE 5MM 55MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.071 SUP HCPCS C1713 524.071 - SCREW BONE 7.5MM 70MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.072 SUP HCPCS C1713 524.072 - SCREW BONE 7.5MM 75MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.073 SUP HCPCS C1713 524.073 - SCREW BONE 7.5MM 80MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.074 SUP HCPCS C1713 524.074 - SCREW BONE 7.5MM 85MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.075 SUP HCPCS C1713 524.075 - SCREW BONE 7.5MM 90MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.081 SUP HCPCS C1713 524.081 - SCREW BONE 8.5MM 70MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.082 SUP HCPCS C1713 524.082 - SCREW BONE 8.5MM 75MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.083 SUP HCPCS C1713 524.083 - SCREW BONE 8.5MM 80MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.084 SUP HCPCS C1713 524.084 - SCREW BONE 8.5MM 85MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.085 SUP HCPCS C1713 524.085 - SCREW BONE 8.5MM 90MM POLYAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.2 SUP HCPCS C1713 524.200 - SCREW BONE 4MM 20MM REDX MNOAX REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.201 SUP HCPCS C1713 524.201 - SCREW BONE 4MM 25MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.202 SUP HCPCS C1713 524.202 - SCREW BONE 4MM 30MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.203 SUP HCPCS C1713 524.203 - SCREW BONE 4MM 35MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.204 SUP HCPCS C1713 524.204 - SCREW BONE 4MM 40MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.241 SUP HCPCS C1713 524.241 - SCREW BONE 4.5MM 25MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.242 SUP HCPCS C1713 524.242 - SCREW BONE 4.5MM 30MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.243 SUP HCPCS C1713 524.243 - SCREW BONE 4.5MM 35MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.244 SUP HCPCS C1713 524.244 - SCREW BONE 4.5MM 40MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.245 SUP HCPCS C1713 524.245 - SCREW BONE 4.5MM 45MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.252 SUP HCPCS C1713 524.252 - SCREW BONE 5.5MM 30MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.253 SUP HCPCS C1713 524.253 - SCREW BONE 5.5MM 35MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.254 SUP HCPCS C1713 524.254 - SCREW BONE 5.5MM 40MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.255 SUP HCPCS C1713 524.255 - SCREW BONE 5.5MM 45MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.256 SUP HCPCS C1713 524.256 - SCREW BONE 5.5MM 50MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.257 SUP HCPCS C1713 524.257 - SCREW BONE 5.5MM 55MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.258 SUP HCPCS C1713 524.258 - SCREW BONE 5.5MM 60MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.259 SUP HCPCS C1713 524.259 - SCREW BONE 5.5MM 65MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.262 SUP HCPCS C1713 524.262 - SCREW BONE 6.5MM 30MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.263 SUP HCPCS C1713 524.263 - SCREW BONE 6.5MM 35MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.264 SUP HCPCS C1713 524.264 - SCREW BONE 6.5MM 40MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.265 SUP HCPCS C1713 524.265 - SCREW BONE 6.5MM 45MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.266 SUP HCPCS C1713 524.266 - SCREW BONE 6.5MM 50MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.267 SUP HCPCS C1713 524.267 - SCREW BONE 6.5MM 55MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.268 SUP HCPCS C1713 524.268 - SCREW BONE 6.5MM 60MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.269 SUP HCPCS C1713 524.269 - SCREW BONE 6.5MM 65MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.272 SUP HCPCS C1713 524.272 - SCREW BONE 7.5MM 30MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.273 SUP HCPCS C1713 524.273 - SCREW BONE 7.5MM 35MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.274 SUP HCPCS C1713 524.274 - SCREW BONE 7.5MM 40MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.275 SUP HCPCS C1713 524.275 - SCREW BONE 7.5MM 45MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.276 SUP HCPCS C1713 524.276 - SCREW BONE 7.5MM 50MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.277 SUP HCPCS C1713 524.277 - SCREW BONE 7.5MM 55MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.278 SUP HCPCS C1713 524.278 - SCREW BONE 7.5MM 60MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.279 SUP HCPCS C1713 524.279 - SCREW BONE 7.5MM 65MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.282 SUP HCPCS C1713 524.282 - SCREW BONE 8.5MM 30MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.283 SUP HCPCS C1713 524.283 - SCREW BONE 8.5MM 35MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.284 SUP HCPCS C1713 524.284 - SCREW BONE 8.5MM 40MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.285 SUP HCPCS C1713 524.285 - SCREW BONE 8.5MM 45MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.286 SUP HCPCS C1713 524.286 - SCREW BONE 8.5MM 50MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.287 SUP HCPCS C1713 524.287 - SCREW BONE 8.5MM 55MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.288 SUP HCPCS C1713 524.288 - SCREW BONE 8.5MM 60MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.289 SUP HCPCS C1713 524.289 - SCREW BONE 8.5MM 65MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.341 SUP HCPCS C1713 524.341 - SCREW BONE 4.5MM 25MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.342 SUP HCPCS C1713 524.342 - SCREW BONE 4.5MM 30MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.343 SUP HCPCS C1713 524.343 - SCREW BONE 4.5MM 35MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.344 SUP HCPCS C1713 524.344 - SCREW BONE 4.5MM 40MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.345 SUP HCPCS C1713 524.345 - SCREW BONE 4.5MM 45MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.346 SUP HCPCS C1713 524.346 - SCREW BONE 4.5MM 50MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.347 SUP HCPCS C1713 524.347 - SCREW BONE 4.5MM 55MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.351 SUP HCPCS C1713 524.351 - SCREW BONE 5MM 25MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.352 SUP HCPCS C1713 524.352 - SCREW BONE 5MM 30MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.353 SUP HCPCS C1713 524.353 - SCREW BONE 5MM 35MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.354 SUP HCPCS C1713 524.354 - SCREW BONE 5MM 40MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.355 SUP HCPCS C1713 524.355 - SCREW BONE 5MM 45MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.356 SUP HCPCS C1713 524.356 - SCREW BONE 5MM 50MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.357 SUP HCPCS C1713 524.357 - SCREW BONE 5MM 55MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.361 SUP HCPCS C1713 524.361 - SCREW BONE 5.5MM 25MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.362 SUP HCPCS C1713 524.362 - SCREW BONE 5.5MM 30MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.363 SUP HCPCS C1713 524.363 - SCREW BONE 5.5MM 35MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.364 SUP HCPCS C1713 524.364 - SCREW BONE 5.5MM 40MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.365 SUP HCPCS C1713 524.365 - SCREW BONE 5.5MM 45MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.366 SUP HCPCS C1713 524.366 - SCREW BONE 5.5MM 50MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.367 SUP HCPCS C1713 524.367 - SCREW BONE 5.5MM 55MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.371 SUP HCPCS C1713 524.371 - SCREW BONE 6.5MM 25MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.372 SUP HCPCS C1713 524.372 - SCREW BONE 6.5MM 30MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.373 SUP HCPCS C1713 524.373 - SCREW BONE 6.5MM 35MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.374 SUP HCPCS C1713 524.374 - SCREW BONE 6.5MM 40MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.375 SUP HCPCS C1713 524.375 - SCREW BONE 6.5MM 45MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.376 SUP HCPCS C1713 524.376 - SCREW BONE 6.5MM 50MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.377 SUP HCPCS C1713 524.377 - SCREW BONE 6.5MM 55MM REDX UNIPLNR REVERE SPN PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.441 SUP HCPCS C1713 524.441 - SCREW BONE 4.5MM 25MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.442 SUP HCPCS C1713 524.442 - SCREW BONE 4.5MM 30MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.443 SUP HCPCS C1713 524.443 - SCREW BONE 4.5MM 35MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.444 SUP HCPCS C1713 524.444 - SCREW BONE 4.5MM 40MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.445 SUP HCPCS C1713 524.445 - SCREW BONE 4.5MM 45MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.451 SUP HCPCS C1713 524.451 - SCREW BONE 5.5MM 25MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.452 SUP HCPCS C1713 524.452 - SCREW BONE 5.5MM 30MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.453 SUP HCPCS C1713 524.453 - SCREW BONE 5.5MM 35MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.454 SUP HCPCS C1713 524.454 - SCREW BONE 5.5MM 40MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.455 SUP HCPCS C1713 524.455 - SCREW BONE 5.5MM 45MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.456 SUP HCPCS C1713 524.456 - SCREW BONE 5.5MM 50MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.457 SUP HCPCS C1713 524.457 - SCREW BONE 5.5MM 55MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.461 SUP HCPCS C1713 524.461 - SCREW BONE 6.5MM 25MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.462 SUP HCPCS C1713 524.462 - SCREW BONE 6.5MM 30MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.463 SUP HCPCS C1713 524.463 - SCREW BONE 6.5MM 35MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.464 SUP HCPCS C1713 524.464 - SCREW BONE 6.5MM 40MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.465 SUP HCPCS C1713 524.465 - SCREW BONE 6.5MM 45MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.466 SUP HCPCS C1713 524.466 - SCREW BONE 6.5MM 50MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.467 SUP HCPCS C1713 524.467 - SCREW BONE 6.5MM 55MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.468 SUP HCPCS C1713 524.468 - SCREW BONE 6.5MM 60MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.469 SUP HCPCS C1713 524.469 - SCREW BONE 6.5MM 65MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.471 SUP HCPCS C1713 524.471 - SCREW BONE 7.5MM 25MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.472 SUP HCPCS C1713 524.472 - SCREW BONE 7.5MM 30MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.473 SUP HCPCS C1713 524.473 - SCREW BONE 7.5MM 35MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.474 SUP HCPCS C1713 524.474 - SCREW BONE 7.5MM 40MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.475 SUP HCPCS C1713 524.475 - SCREW BONE 7.5MM 45MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.476 SUP HCPCS C1713 524.476 - SCREW BONE 7.5MM 50MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.477 SUP HCPCS C1713 524.477 - SCREW BONE 7.5MM 55MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.478 SUP HCPCS C1713 524.478 - SCREW BONE 7.5MM 60MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.479 SUP HCPCS C1713 524.479 - SCREW BONE 7.5MM 65MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.481 SUP HCPCS C1713 524.481 - SCREW BONE 8.5MM 25MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.482 SUP HCPCS C1713 524.482 - SCREW BONE 8.5MM 30MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.483 SUP HCPCS C1713 524.483 - SCREW BONE 8.5MM 35MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.484 SUP HCPCS C1713 524.484 - SCREW BONE 8.5MM 40MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.485 SUP HCPCS C1713 524.485 - SCREW BONE 8.5MM 45MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.486 SUP HCPCS C1713 524.486 - SCREW BONE 8.5MM 50MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.487 SUP HCPCS C1713 524.487 - SCREW BONE 8.5MM 55MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.488 SUP HCPCS C1713 524.488 - SCREW BONE 8.5MM 60MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.489 SUP HCPCS C1713 524.489 - SCREW BONE 8.5MM 65MM REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.51 SUP Custom 27803010 524.510 - ROD SPINAL 5.5MM 100MM STR HEXAGONAL END BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.512 SUP Custom 27803010 524.512 - ROD SPINAL 5.5MM 125MM STR HEXAGONAL END CENTRL POST BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.515 SUP Custom 27803010 524.515 - ROD SPINAL 5.5MM 150MM STR HEXAGONAL END CENTRL POST BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.517 SUP Custom 27803010 524.517 - ROD SPINAL 5.5MM 200MM STR HEXAGONAL END CENTRL POST BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.519 SUP Custom 27803010 524.519 - ROD SPINAL 5.5MM 300MM STR HEXAGONAL END BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.52 SUP Custom 27803010 524.520 - ROD SPINAL 5.5MM 400MM STR HEXAGONAL END BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.521 SUP Custom 27803010 524.521 - ROD SPINAL 5.5MM 500MM STR HEXAGONAL END BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 524.641 SUP HCPCS C1713 524.641 - SCREW BONE 4.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.642 SUP HCPCS C1713 524.642 - SCREW BONE 4.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.643 SUP HCPCS C1713 524.643 - SCREW BONE 4.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.644 SUP HCPCS C1713 524.644 - SCREW BONE 4.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.645 SUP HCPCS C1713 524.645 - SCREW BONE 4.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.646 SUP HCPCS C1713 524.646 - SCREW BONE 4.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.647 SUP HCPCS C1713 524.647 - SCREW BONE 4.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.651 SUP HCPCS C1713 524.651 - SCREW BONE 5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.652 SUP HCPCS C1713 524.652 - SCREW BONE 5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.653 SUP HCPCS C1713 524.653 - SCREW BONE 5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.654 SUP HCPCS C1713 524.654 - SCREW BONE 5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.655 SUP HCPCS C1713 524.655 - SCREW BONE 5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.656 SUP HCPCS C1713 524.656 - SCREW BONE 5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.657 SUP HCPCS C1713 524.657 - SCREW BONE 5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.661 SUP HCPCS C1713 524.661 - SCREW BONE 5.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.662 SUP HCPCS C1713 524.662 - SCREW BONE 5.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.663 SUP HCPCS C1713 524.663 - SCREW BONE 5.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.664 SUP HCPCS C1713 524.664 - SCREW BONE 5.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.665 SUP HCPCS C1713 524.665 - SCREW BONE 5.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.666 SUP HCPCS C1713 524.666 - SCREW BONE 5.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.667 SUP HCPCS C1713 524.667 - SCREW BONE 5.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.671 SUP HCPCS C1713 524.671 - SCREW BONE 6.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.672 SUP HCPCS C1713 524.672 - SCREW BONE 6.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.673 SUP HCPCS C1713 524.673 - SCREW BONE 6.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.674 SUP HCPCS C1713 524.674 - SCREW BONE 6.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.675 SUP HCPCS C1713 524.675 - SCREW BONE 6.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.676 SUP HCPCS C1713 524.676 - SCREW BONE 6.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.677 SUP HCPCS C1713 524.677 - SCREW BONE 6.5MM UNIPLNR REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.851 SUP HCPCS C1713 524.851 - SCREW BONE 5MM 25MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.852 SUP HCPCS C1713 524.852 - SCREW BONE 5MM 30MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.853 SUP HCPCS C1713 524.853 - SCREW BONE 5MM 35MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.854 SUP HCPCS C1713 524.854 - SCREW BONE 5MM 40MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.855 SUP HCPCS C1713 524.855 - SCREW BONE 5MM 45MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.856 SUP HCPCS C1713 524.856 - SCREW BONE 5MM 50MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.857 SUP HCPCS C1713 524.857 - SCREW BONE 5MM 55MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.871 SUP HCPCS C1713 524.871 - SCREW BONE 7.5MM 70MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.872 SUP HCPCS C1713 524.872 - SCREW BONE 7.5MM 75MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.873 SUP HCPCS C1713 524.873 - SCREW BONE 7.5MM 80MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.874 SUP HCPCS C1713 524.874 - SCREW BONE 7.5MM 85MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.875 SUP HCPCS C1713 524.875 - SCREW BONE 7.5MM 90MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.881 SUP HCPCS C1713 524.881 - SCREW BONE 8.5MM 70MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.882 SUP HCPCS C1713 524.882 - SCREW BONE 8.5MM 75MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.883 SUP HCPCS C1713 524.883 - SCREW BONE 8.5MM 80MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.884 SUP HCPCS C1713 524.884 - SCREW BONE 8.5MM 85MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 524.885 SUP HCPCS C1713 524.885 - SCREW BONE 8.5MM 90MM MNOAX REDX REVERE SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 610.514 SUP Custom 27803010 610.514 - BIT DRILL SMALL 4MM STOP BOTH IP/OP $672.50 $498.00 $119.71 $672.50 $672.50 $672.50 $672.50 $672.50 $672.50 $672.50 $119.71 $672.50 $672.50 $672.50 $672.50 $672.50 $672.50 $140.16 $672.50 $269.00 $672.50 $672.50 $672.50 $672.50 $672.50 $504.38 $672.50 $672.50 $672.50 $336.25 $336.25 $532.62 $672.50 $538.00 $302.63 $672.50 N/A $390.05 $672.50 $403.50 $672.50 $672.50 $672.50 N/A N/A 610.712 SUP Custom 27100030 610.712 - BIT DRILL 12MM SPN BOTH IP/OP $672.50 $498.00 $119.71 $672.50 $672.50 $672.50 $672.50 $672.50 $672.50 $672.50 $119.71 $672.50 $672.50 $499.13 $499.13 $518.36 $350.37 $140.16 $672.50 $269.00 $672.50 $672.50 $672.50 $672.50 $672.50 $504.38 $672.50 $672.50 $672.50 $336.25 $336.25 $532.62 $672.50 $538.00 $437.13 $672.50 N/A $390.05 $672.50 $403.50 $672.50 $672.50 $672.50 N/A N/A 610.714 SUP Custom 27100030 610.714 - BIT DRILL 14MM SPN BOTH IP/OP $672.50 $498.00 $119.71 $672.50 $672.50 $672.50 $672.50 $672.50 $672.50 $672.50 $119.71 $672.50 $672.50 $499.13 $499.13 $518.36 $350.37 $140.16 $672.50 $269.00 $672.50 $672.50 $672.50 $672.50 $672.50 $504.38 $672.50 $672.50 $672.50 $336.25 $336.25 $532.62 $672.50 $538.00 $437.13 $672.50 N/A $390.05 $672.50 $403.50 $672.50 $672.50 $672.50 N/A N/A 615.104 SUP Custom 27100030 615.104 - BIT DRILL 2.4MM PROTEX CT NONSTRL 3.5MM SCREW BOTH IP/OP "$1,060.00" $784.00 $188.68 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $188.68 "$1,060.00" "$1,060.00" $786.73 $786.73 $817.05 $552.26 $220.92 "$1,060.00" $424.00 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $795.00 "$1,060.00" "$1,060.00" "$1,060.00" $530.00 $530.00 $839.52 "$1,060.00" $848.00 $689.00 "$1,060.00" N/A $614.80 "$1,060.00" $636.00 "$1,060.00" "$1,060.00" "$1,060.00" N/A N/A 615.107 SUP Custom 27100030 615.107 - TAP SPINAL PROTEX CT 3.5-4 MM SCREWS BOTH IP/OP $967.50 $716.00 $172.22 $967.50 $967.50 $967.50 $967.50 $967.50 $967.50 $967.50 $172.22 $967.50 $967.50 $718.08 $718.08 $745.75 $504.07 $201.64 $967.50 $387.00 $967.50 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $628.88 $967.50 N/A $561.15 $967.50 $580.50 $967.50 $967.50 $967.50 N/A N/A 615.301 SUP HCPCS C1713 615.301 - TEMPLATE ROD 240MM SPN BOTH IP/OP $360.00 $266.00 $71.45 $360.00 $162.00 $162.00 $162.00 $162.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $212.94 $360.00 $360.00 $360.00 $360.00 $270.00 $360.00 $360.00 $360.00 $180.00 $180.00 $285.12 $360.00 $288.00 $162.00 $71.45 N/A $208.80 $360.00 $216.00 $360.00 $75.02 $360.00 N/A N/A 618.6 SUP Custom 27203010 618.60 - LENS OPHTHALMIC GRIESHABER MACULA ASPHERIC VITREORETINAL SUR BOTH IP/OP $618.00 $457.00 $110.00 $618.00 $618.00 $618.00 $618.00 $618.00 $618.00 $618.00 $110.00 $618.00 $618.00 $458.68 $458.68 $476.35 $321.98 $128.80 $618.00 $247.20 $618.00 $618.00 $618.00 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $401.70 $618.00 N/A $358.44 $618.00 $370.80 $618.00 $618.00 $618.00 N/A N/A 624.214 SUP Custom 27100030 624.214 - TAP SURG 4.5MM REVERE SPN BOTH IP/OP $880.00 $651.00 $156.64 $880.00 $880.00 $880.00 $880.00 $880.00 $880.00 $880.00 $156.64 $880.00 $880.00 $653.14 $653.14 $678.30 $458.48 $183.40 $880.00 $352.00 $880.00 $880.00 $880.00 $880.00 $880.00 $660.00 $880.00 $880.00 $880.00 $440.00 $440.00 $696.96 $880.00 $704.00 $572.00 $880.00 N/A $510.40 $880.00 $528.00 $880.00 $880.00 $880.00 N/A N/A 624.215 SUP Custom 27100030 624.215 - TAP SURG 5.5MM REVERE SPN BOTH IP/OP $880.00 $651.00 $156.64 $880.00 $880.00 $880.00 $880.00 $880.00 $880.00 $880.00 $156.64 $880.00 $880.00 $653.14 $653.14 $678.30 $458.48 $183.40 $880.00 $352.00 $880.00 $880.00 $880.00 $880.00 $880.00 $660.00 $880.00 $880.00 $880.00 $440.00 $440.00 $696.96 $880.00 $704.00 $572.00 $880.00 N/A $510.40 $880.00 $528.00 $880.00 $880.00 $880.00 N/A N/A 624.216 SUP Custom 27100030 624.216 - TAP SURG 6.5MM REVERE SPN BOTH IP/OP $880.00 $651.00 $156.64 $880.00 $880.00 $880.00 $880.00 $880.00 $880.00 $880.00 $156.64 $880.00 $880.00 $653.14 $653.14 $678.30 $458.48 $183.40 $880.00 $352.00 $880.00 $880.00 $880.00 $880.00 $880.00 $660.00 $880.00 $880.00 $880.00 $440.00 $440.00 $696.96 $880.00 $704.00 $572.00 $880.00 N/A $510.40 $880.00 $528.00 $880.00 $880.00 $880.00 N/A N/A 632.414 SUP Custom 27803010 632.414 - SET SPINAL 22MM 40MM BEVELED PORT BOTH IP/OP $902.50 $668.00 $160.65 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $160.65 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $188.09 $902.50 $361.00 $902.50 $902.50 $902.50 $902.50 $902.50 $676.88 $902.50 $902.50 $902.50 $451.25 $451.25 $714.78 $902.50 $722.00 $406.13 $902.50 N/A $523.45 $902.50 $541.50 $902.50 $902.50 $902.50 N/A N/A 632.415 SUP Custom 27803010 632.415 - SET SPINAL 22MM 50MM BEVELED PORT BOTH IP/OP $902.50 $668.00 $160.65 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $160.65 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $188.09 $902.50 $361.00 $902.50 $902.50 $902.50 $902.50 $902.50 $676.88 $902.50 $902.50 $902.50 $451.25 $451.25 $714.78 $902.50 $722.00 $406.13 $902.50 N/A $523.45 $902.50 $541.50 $902.50 $902.50 $902.50 N/A N/A 632.416 SUP Custom 27803010 632.416 - SET SPINAL 22MM 60MM BEVELED PORT BOTH IP/OP $902.50 $668.00 $160.65 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $160.65 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $188.09 $902.50 $361.00 $902.50 $902.50 $902.50 $902.50 $902.50 $676.88 $902.50 $902.50 $902.50 $451.25 $451.25 $714.78 $902.50 $722.00 $406.13 $902.50 N/A $523.45 $902.50 $541.50 $902.50 $902.50 $902.50 N/A N/A 632.417 SUP Custom 27803010 632.417 - SET SPINAL 22MM 70MM BEVELED PORT BOTH IP/OP "$1,035.00" $766.00 $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 "$1,035.00" $414.00 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $776.25 "$1,035.00" "$1,035.00" "$1,035.00" $517.50 $517.50 $819.72 "$1,035.00" $828.00 $465.75 "$1,035.00" N/A $600.30 "$1,035.00" $621.00 "$1,035.00" "$1,035.00" "$1,035.00" N/A N/A 632.418 SUP Custom 27803010 632.418 - SET SPINAL 22MM 80MM BEVELED PORT BOTH IP/OP "$1,035.00" $766.00 $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 "$1,035.00" $414.00 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $776.25 "$1,035.00" "$1,035.00" "$1,035.00" $517.50 $517.50 $819.72 "$1,035.00" $828.00 $465.75 "$1,035.00" N/A $600.30 "$1,035.00" $621.00 "$1,035.00" "$1,035.00" "$1,035.00" N/A N/A 632.419 SUP Custom 27803010 632.419 - SET SPINAL 22MM 90MM BEVELED PORT BOTH IP/OP "$1,035.00" $766.00 $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 "$1,035.00" $414.00 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $776.25 "$1,035.00" "$1,035.00" "$1,035.00" $517.50 $517.50 $819.72 "$1,035.00" $828.00 $465.75 "$1,035.00" N/A $600.30 "$1,035.00" $621.00 "$1,035.00" "$1,035.00" "$1,035.00" N/A N/A 632.42 SUP Custom 27803010 632.420 - SET SPINAL 22MM 100MM BEVEL PORT BOTH IP/OP "$1,220.00" $903.00 $217.16 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $217.16 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $254.26 "$1,220.00" $488.00 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $915.00 "$1,220.00" "$1,220.00" "$1,220.00" $610.00 $610.00 $966.24 "$1,220.00" $976.00 $549.00 "$1,220.00" N/A $707.60 "$1,220.00" $732.00 "$1,220.00" "$1,220.00" "$1,220.00" N/A N/A 632.421 SUP Custom 27803010 632.421 - SET SPINAL 22MM 110MM BEVELED PORT BOTH IP/OP "$1,220.00" $903.00 $217.16 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $217.16 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $254.26 "$1,220.00" $488.00 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $915.00 "$1,220.00" "$1,220.00" "$1,220.00" $610.00 $610.00 $966.24 "$1,220.00" $976.00 $549.00 "$1,220.00" N/A $707.60 "$1,220.00" $732.00 "$1,220.00" "$1,220.00" "$1,220.00" N/A N/A 632.422 SUP Custom 27803010 632.422 - SET SPINAL 22MM 120MM BEVELED PORT BOTH IP/OP "$1,220.00" $903.00 $217.16 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $217.16 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $254.26 "$1,220.00" $488.00 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $915.00 "$1,220.00" "$1,220.00" "$1,220.00" $610.00 $610.00 $966.24 "$1,220.00" $976.00 $549.00 "$1,220.00" N/A $707.60 "$1,220.00" $732.00 "$1,220.00" "$1,220.00" "$1,220.00" N/A N/A 632.424 SUP Custom 27803010 632.424 - SET SPINAL 22MM 40MM STR PORT BOTH IP/OP $835.00 $618.00 $148.63 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $148.63 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $174.02 $835.00 $334.00 $835.00 $835.00 $835.00 $835.00 $835.00 $626.25 $835.00 $835.00 $835.00 $417.50 $417.50 $661.32 $835.00 $668.00 $375.75 $835.00 N/A $484.30 $835.00 $501.00 $835.00 $835.00 $835.00 N/A N/A 632.425 SUP Custom 27803010 632.425 - SET SPINAL 22MM 50MM STR PORT MARS BOTH IP/OP $835.00 $618.00 $148.63 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $148.63 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $174.02 $835.00 $334.00 $835.00 $835.00 $835.00 $835.00 $835.00 $626.25 $835.00 $835.00 $835.00 $417.50 $417.50 $661.32 $835.00 $668.00 $375.75 $835.00 N/A $484.30 $835.00 $501.00 $835.00 $835.00 $835.00 N/A N/A 632.426 SUP Custom 27803010 632.426 - SET SPINAL 22MM 60MM STR PORT BOTH IP/OP $835.00 $618.00 $148.63 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $148.63 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $174.02 $835.00 $334.00 $835.00 $835.00 $835.00 $835.00 $835.00 $626.25 $835.00 $835.00 $835.00 $417.50 $417.50 $661.32 $835.00 $668.00 $375.75 $835.00 N/A $484.30 $835.00 $501.00 $835.00 $835.00 $835.00 N/A N/A 632.427 SUP Custom 27803010 632.427 - SET SPINAL 22MM 70MM STR PORT BOTH IP/OP $942.50 $697.00 $167.77 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $167.77 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $196.43 $942.50 $377.00 $942.50 $942.50 $942.50 $942.50 $942.50 $706.88 $942.50 $942.50 $942.50 $471.25 $471.25 $746.46 $942.50 $754.00 $424.13 $942.50 N/A $546.65 $942.50 $565.50 $942.50 $942.50 $942.50 N/A N/A 632.428 SUP Custom 27803010 632.428 - SET SPINAL 22MM 80MM STR PORT BOTH IP/OP $942.50 $697.00 $167.77 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $167.77 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $196.43 $942.50 $377.00 $942.50 $942.50 $942.50 $942.50 $942.50 $706.88 $942.50 $942.50 $942.50 $471.25 $471.25 $746.46 $942.50 $754.00 $424.13 $942.50 N/A $546.65 $942.50 $565.50 $942.50 $942.50 $942.50 N/A N/A 632.429 SUP Custom 27803010 632.429 - SET SPINAL 22MM 90MM STR PORT BOTH IP/OP $942.50 $697.00 $167.77 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $167.77 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $196.43 $942.50 $377.00 $942.50 $942.50 $942.50 $942.50 $942.50 $706.88 $942.50 $942.50 $942.50 $471.25 $471.25 $746.46 $942.50 $754.00 $424.13 $942.50 N/A $546.65 $942.50 $565.50 $942.50 $942.50 $942.50 N/A N/A 632.43 SUP Custom 27803010 632.430 - SET SPNL 22MM 100MM STRG PORT BOTH IP/OP "$1,140.00" $844.00 $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $237.59 "$1,140.00" $456.00 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $855.00 "$1,140.00" "$1,140.00" "$1,140.00" $570.00 $570.00 $902.88 "$1,140.00" $912.00 $513.00 "$1,140.00" N/A $661.20 "$1,140.00" $684.00 "$1,140.00" "$1,140.00" "$1,140.00" N/A N/A 632.431 SUP Custom 27803010 632.431 - SET SPINAL 22MM 110MM STR PORT BOTH IP/OP "$1,140.00" $844.00 $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $237.59 "$1,140.00" $456.00 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $855.00 "$1,140.00" "$1,140.00" "$1,140.00" $570.00 $570.00 $902.88 "$1,140.00" $912.00 $513.00 "$1,140.00" N/A $661.20 "$1,140.00" $684.00 "$1,140.00" "$1,140.00" "$1,140.00" N/A N/A 632.432 SUP Custom 27803010 632.432 - SET SPINAL 22MM 120MM STR PORT BOTH IP/OP "$1,140.00" $844.00 $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $237.59 "$1,140.00" $456.00 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $855.00 "$1,140.00" "$1,140.00" "$1,140.00" $570.00 $570.00 $902.88 "$1,140.00" $912.00 $513.00 "$1,140.00" N/A $661.20 "$1,140.00" $684.00 "$1,140.00" "$1,140.00" "$1,140.00" N/A N/A 632.434 SUP Custom 27803010 632.434 - SET SPINAL 19MM 40MM BEVELED PORT BOTH IP/OP $902.50 $668.00 $160.65 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $160.65 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $188.09 $902.50 $361.00 $902.50 $902.50 $902.50 $902.50 $902.50 $676.88 $902.50 $902.50 $902.50 $451.25 $451.25 $714.78 $902.50 $722.00 $406.13 $902.50 N/A $523.45 $902.50 $541.50 $902.50 $902.50 $902.50 N/A N/A 632.435 SUP Custom 27803010 632.435 - PORT RETRACTION 19MM 40MM BEVELLED BOTH IP/OP $902.50 $668.00 $160.65 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $160.65 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $188.09 $902.50 $361.00 $902.50 $902.50 $902.50 $902.50 $902.50 $676.88 $902.50 $902.50 $902.50 $451.25 $451.25 $714.78 $902.50 $722.00 $406.13 $902.50 N/A $523.45 $902.50 $541.50 $902.50 $902.50 $902.50 N/A N/A 632.436 SUP Custom 27803010 632.436 - SPACER SPNL 60MMX19MM BVL PORT PEEK INTRBD FS BOTH IP/OP $902.50 $668.00 $160.65 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $160.65 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $188.09 $902.50 $361.00 $902.50 $902.50 $902.50 $902.50 $902.50 $676.88 $902.50 $902.50 $902.50 $451.25 $451.25 $714.78 $902.50 $722.00 $406.13 $902.50 N/A $523.45 $902.50 $541.50 $902.50 $902.50 $902.50 N/A N/A 632.437 SUP Custom 27803010 632.437 - SPACER SPNL 70MMX19MM BVL PORT PEEK INTRBD FS BOTH IP/OP "$1,035.00" $766.00 $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 "$1,035.00" $414.00 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $776.25 "$1,035.00" "$1,035.00" "$1,035.00" $517.50 $517.50 $819.72 "$1,035.00" $828.00 $465.75 "$1,035.00" N/A $600.30 "$1,035.00" $621.00 "$1,035.00" "$1,035.00" "$1,035.00" N/A N/A 632.438 SUP Custom 27803010 632.438 - SET SPINAL 19MM 80MM BEVELED PORT BOTH IP/OP "$1,035.00" $766.00 $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 "$1,035.00" $414.00 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $776.25 "$1,035.00" "$1,035.00" "$1,035.00" $517.50 $517.50 $819.72 "$1,035.00" $828.00 $465.75 "$1,035.00" N/A $600.30 "$1,035.00" $621.00 "$1,035.00" "$1,035.00" "$1,035.00" N/A N/A 632.439 SUP Custom 27803010 632.439 - SET SPINAL 19MM 90MM BEVELED PORT BOTH IP/OP "$1,035.00" $766.00 $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $215.71 "$1,035.00" $414.00 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $776.25 "$1,035.00" "$1,035.00" "$1,035.00" $517.50 $517.50 $819.72 "$1,035.00" $828.00 $465.75 "$1,035.00" N/A $600.30 "$1,035.00" $621.00 "$1,035.00" "$1,035.00" "$1,035.00" N/A N/A 632.44 SUP Custom 27803010 632.440 - SET SPINAL 19MM 100MM BEVEL PORT BOTH IP/OP "$1,220.00" $903.00 $217.16 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $217.16 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $254.26 "$1,220.00" $488.00 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $915.00 "$1,220.00" "$1,220.00" "$1,220.00" $610.00 $610.00 $966.24 "$1,220.00" $976.00 $549.00 "$1,220.00" N/A $707.60 "$1,220.00" $732.00 "$1,220.00" "$1,220.00" "$1,220.00" N/A N/A 632.441 SUP Custom 27803010 632.441 - SET SPINAL 19MM 110MM BEVELED PORT BOTH IP/OP "$1,220.00" $903.00 $217.16 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $217.16 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $254.26 "$1,220.00" $488.00 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $915.00 "$1,220.00" "$1,220.00" "$1,220.00" $610.00 $610.00 $966.24 "$1,220.00" $976.00 $549.00 "$1,220.00" N/A $707.60 "$1,220.00" $732.00 "$1,220.00" "$1,220.00" "$1,220.00" N/A N/A 632.442 SUP Custom 27803010 632.442 - SET SPINAL 19MM 120MM BEVELED PORT BOTH IP/OP "$1,220.00" $903.00 $217.16 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $217.16 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $254.26 "$1,220.00" $488.00 "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" "$1,220.00" $915.00 "$1,220.00" "$1,220.00" "$1,220.00" $610.00 $610.00 $966.24 "$1,220.00" $976.00 $549.00 "$1,220.00" N/A $707.60 "$1,220.00" $732.00 "$1,220.00" "$1,220.00" "$1,220.00" N/A N/A 632.444 SUP Custom 27803010 632.444 - SPACER SPNL 19MMX40MM PEEK INTRBD FS BOTH IP/OP $835.00 $618.00 $148.63 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $148.63 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $174.02 $835.00 $334.00 $835.00 $835.00 $835.00 $835.00 $835.00 $626.25 $835.00 $835.00 $835.00 $417.50 $417.50 $661.32 $835.00 $668.00 $375.75 $835.00 N/A $484.30 $835.00 $501.00 $835.00 $835.00 $835.00 N/A N/A 632.445 SUP Custom 27803010 632.445 - SPACER SPNL 50MMX19MM STRG PORT PEEK INTRBD FS BOTH IP/OP $835.00 $618.00 $148.63 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $148.63 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $174.02 $835.00 $334.00 $835.00 $835.00 $835.00 $835.00 $835.00 $626.25 $835.00 $835.00 $835.00 $417.50 $417.50 $661.32 $835.00 $668.00 $375.75 $835.00 N/A $484.30 $835.00 $501.00 $835.00 $835.00 $835.00 N/A N/A 632.446 SUP Custom 27803010 "632.446 - 19mm Port, Straight, 60mm" BOTH IP/OP $835.00 $618.00 $148.63 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $148.63 $835.00 $835.00 $835.00 $835.00 $835.00 $835.00 $174.02 $835.00 $334.00 $835.00 $835.00 $835.00 $835.00 $835.00 $626.25 $835.00 $835.00 $835.00 $417.50 $417.50 $661.32 $835.00 $668.00 $375.75 $835.00 N/A $484.30 $835.00 $501.00 $835.00 $835.00 $835.00 N/A N/A 632.447 SUP Custom 27803010 632.447 - SET SPINAL 19MM 70MM STR PORT BOTH IP/OP $942.50 $697.00 $167.77 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $167.77 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $196.43 $942.50 $377.00 $942.50 $942.50 $942.50 $942.50 $942.50 $706.88 $942.50 $942.50 $942.50 $471.25 $471.25 $746.46 $942.50 $754.00 $424.13 $942.50 N/A $546.65 $942.50 $565.50 $942.50 $942.50 $942.50 N/A N/A 632.448 SUP Custom 27803010 632.448 - SET SPINAL 19MM 80MM PORT STR BOTH IP/OP $942.50 $697.00 $167.77 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $167.77 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $196.43 $942.50 $377.00 $942.50 $942.50 $942.50 $942.50 $942.50 $706.88 $942.50 $942.50 $942.50 $471.25 $471.25 $746.46 $942.50 $754.00 $424.13 $942.50 N/A $546.65 $942.50 $565.50 $942.50 $942.50 $942.50 N/A N/A 632.449 SUP Custom 27803010 "632.449 - 19mm Port, Straight, 90mm" BOTH IP/OP $942.50 $697.00 $167.77 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $167.77 $942.50 $942.50 $942.50 $942.50 $942.50 $942.50 $196.43 $942.50 $377.00 $942.50 $942.50 $942.50 $942.50 $942.50 $706.88 $942.50 $942.50 $942.50 $471.25 $471.25 $746.46 $942.50 $754.00 $424.13 $942.50 N/A $546.65 $942.50 $565.50 $942.50 $942.50 $942.50 N/A N/A 632.45 SUP Custom 27803010 632.450 - SET SPINAL 19MM 100MM STR PORT BOTH IP/OP "$1,140.00" $844.00 $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $237.59 "$1,140.00" $456.00 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $855.00 "$1,140.00" "$1,140.00" "$1,140.00" $570.00 $570.00 $902.88 "$1,140.00" $912.00 $513.00 "$1,140.00" N/A $661.20 "$1,140.00" $684.00 "$1,140.00" "$1,140.00" "$1,140.00" N/A N/A 632.451 SUP Custom 27803010 632.451 - SET SPINAL 19MM 110MM STR PORT BOTH IP/OP "$1,140.00" $844.00 $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $237.59 "$1,140.00" $456.00 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $855.00 "$1,140.00" "$1,140.00" "$1,140.00" $570.00 $570.00 $902.88 "$1,140.00" $912.00 $513.00 "$1,140.00" N/A $661.20 "$1,140.00" $684.00 "$1,140.00" "$1,140.00" "$1,140.00" N/A N/A 632.452 SUP Custom 27803010 632.452 - SET SPINAL 19MM 120MM STR PORT BOTH IP/OP "$1,140.00" $844.00 $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $237.59 "$1,140.00" $456.00 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $855.00 "$1,140.00" "$1,140.00" "$1,140.00" $570.00 $570.00 $902.88 "$1,140.00" $912.00 $513.00 "$1,140.00" N/A $661.20 "$1,140.00" $684.00 "$1,140.00" "$1,140.00" "$1,140.00" N/A N/A 632.454 SUP Custom 27803010 632.454 - SET SPINAL 26MM 40MM BEVELED PORT BOTH IP/OP "$1,167.50" $864.00 $207.82 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $207.82 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $243.32 "$1,167.50" $467.00 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $875.63 "$1,167.50" "$1,167.50" "$1,167.50" $583.75 $583.75 $924.66 "$1,167.50" $934.00 $525.38 "$1,167.50" N/A $677.15 "$1,167.50" $700.50 "$1,167.50" "$1,167.50" "$1,167.50" N/A N/A 632.455 SUP Custom 27803010 632.455 - SET SPINAL 26MM 50MM BEVELED PORT BOTH IP/OP "$1,167.50" $864.00 $207.82 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $207.82 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $243.32 "$1,167.50" $467.00 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $875.63 "$1,167.50" "$1,167.50" "$1,167.50" $583.75 $583.75 $924.66 "$1,167.50" $934.00 $525.38 "$1,167.50" N/A $677.15 "$1,167.50" $700.50 "$1,167.50" "$1,167.50" "$1,167.50" N/A N/A 632.456 SUP Custom 27803010 632.456 - SET SPINAL 26MM 60MM BEVELED PORT BOTH IP/OP "$1,167.50" $864.00 $207.82 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $207.82 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $243.32 "$1,167.50" $467.00 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $875.63 "$1,167.50" "$1,167.50" "$1,167.50" $583.75 $583.75 $924.66 "$1,167.50" $934.00 $525.38 "$1,167.50" N/A $677.15 "$1,167.50" $700.50 "$1,167.50" "$1,167.50" "$1,167.50" N/A N/A 632.457 SUP Custom 27803010 632.457 - SET SPINAL 26MM 70MM BEVELED PORT BOTH IP/OP "$1,272.50" $942.00 $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $265.20 "$1,272.50" $509.00 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $954.38 "$1,272.50" "$1,272.50" "$1,272.50" $636.25 $636.25 "$1,007.82" "$1,272.50" "$1,018.00" $572.63 "$1,272.50" N/A $738.05 "$1,272.50" $763.50 "$1,272.50" "$1,272.50" "$1,272.50" N/A N/A 632.458 SUP Custom 27803010 632.458 - SET SPINAL 26MM 80MM BEVELED PORT BOTH IP/OP "$1,272.50" $942.00 $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $265.20 "$1,272.50" $509.00 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $954.38 "$1,272.50" "$1,272.50" "$1,272.50" $636.25 $636.25 "$1,007.82" "$1,272.50" "$1,018.00" $572.63 "$1,272.50" N/A $738.05 "$1,272.50" $763.50 "$1,272.50" "$1,272.50" "$1,272.50" N/A N/A 632.459 SUP Custom 27803010 632.459 - SET SPINAL 26MM 90MM BEVELED PORT BOTH IP/OP "$1,272.50" $942.00 $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $265.20 "$1,272.50" $509.00 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $954.38 "$1,272.50" "$1,272.50" "$1,272.50" $636.25 $636.25 "$1,007.82" "$1,272.50" "$1,018.00" $572.63 "$1,272.50" N/A $738.05 "$1,272.50" $763.50 "$1,272.50" "$1,272.50" "$1,272.50" N/A N/A 632.46 SUP Custom 27803010 632.460 - SET SPINAL 26MM 100MM BEVEL PORT BOTH IP/OP "$1,380.00" "$1,021.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $287.61 "$1,380.00" $552.00 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,035.00" "$1,380.00" "$1,380.00" "$1,380.00" $690.00 $690.00 "$1,092.96" "$1,380.00" "$1,104.00" $621.00 "$1,380.00" N/A $800.40 "$1,380.00" $828.00 "$1,380.00" "$1,380.00" "$1,380.00" N/A N/A 632.461 SUP Custom 27803010 632.461 - SET SPINAL 26MM 110MM BEVELED PORT BOTH IP/OP "$1,380.00" "$1,021.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $287.61 "$1,380.00" $552.00 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,035.00" "$1,380.00" "$1,380.00" "$1,380.00" $690.00 $690.00 "$1,092.96" "$1,380.00" "$1,104.00" $621.00 "$1,380.00" N/A $800.40 "$1,380.00" $828.00 "$1,380.00" "$1,380.00" "$1,380.00" N/A N/A 632.462 SUP Custom 27803010 632.462 - SET SPINAL 26MM 120MM BEVELED PORT BOTH IP/OP "$1,380.00" "$1,021.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $287.61 "$1,380.00" $552.00 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,035.00" "$1,380.00" "$1,380.00" "$1,380.00" $690.00 $690.00 "$1,092.96" "$1,380.00" "$1,104.00" $621.00 "$1,380.00" N/A $800.40 "$1,380.00" $828.00 "$1,380.00" "$1,380.00" "$1,380.00" N/A N/A 632.464 SUP Custom 27803010 632.464 - SET SPINAL 26MM 40MM STR PORT BOTH IP/OP "$1,140.00" $844.00 $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $237.59 "$1,140.00" $456.00 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $855.00 "$1,140.00" "$1,140.00" "$1,140.00" $570.00 $570.00 $902.88 "$1,140.00" $912.00 $513.00 "$1,140.00" N/A $661.20 "$1,140.00" $684.00 "$1,140.00" "$1,140.00" "$1,140.00" N/A N/A 632.465 SUP Custom 27803010 632.465 - SET SPINAL 26MM 50MM STR PORT BOTH IP/OP "$1,140.00" $844.00 $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $237.59 "$1,140.00" $456.00 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $855.00 "$1,140.00" "$1,140.00" "$1,140.00" $570.00 $570.00 $902.88 "$1,140.00" $912.00 $513.00 "$1,140.00" N/A $661.20 "$1,140.00" $684.00 "$1,140.00" "$1,140.00" "$1,140.00" N/A N/A 632.466 SUP Custom 27803010 632.466 - SPACER SPNL TBLR 60MMX26MM PEEK INTRBD FS BOTH IP/OP "$1,140.00" $844.00 $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $237.59 "$1,140.00" $456.00 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $855.00 "$1,140.00" "$1,140.00" "$1,140.00" $570.00 $570.00 $902.88 "$1,140.00" $912.00 $513.00 "$1,140.00" N/A $661.20 "$1,140.00" $684.00 "$1,140.00" "$1,140.00" "$1,140.00" N/A N/A 632.467 SUP Custom 27803010 632.467 - SPACER SPNL TBLR 70MMX26MM PEEK INTRBD FS BOTH IP/OP "$1,272.50" $942.00 $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $265.20 "$1,272.50" $509.00 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $954.38 "$1,272.50" "$1,272.50" "$1,272.50" $636.25 $636.25 "$1,007.82" "$1,272.50" "$1,018.00" $572.63 "$1,272.50" N/A $738.05 "$1,272.50" $763.50 "$1,272.50" "$1,272.50" "$1,272.50" N/A N/A 632.468 SUP Custom 27803010 632.468 - SPACER SPNL TBLR 80MMX26MM PEEK INTRBD FS BOTH IP/OP "$1,272.50" $942.00 $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $265.20 "$1,272.50" $509.00 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $954.38 "$1,272.50" "$1,272.50" "$1,272.50" $636.25 $636.25 "$1,007.82" "$1,272.50" "$1,018.00" $572.63 "$1,272.50" N/A $738.05 "$1,272.50" $763.50 "$1,272.50" "$1,272.50" "$1,272.50" N/A N/A 632.469 SUP Custom 27803010 632.469 - SET SPINAL 26MM 90MM STR PORT BOTH IP/OP "$1,272.50" $942.00 $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $265.20 "$1,272.50" $509.00 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $954.38 "$1,272.50" "$1,272.50" "$1,272.50" $636.25 $636.25 "$1,007.82" "$1,272.50" "$1,018.00" $572.63 "$1,272.50" N/A $738.05 "$1,272.50" $763.50 "$1,272.50" "$1,272.50" "$1,272.50" N/A N/A 632.47 SUP Custom 27803010 632.470 - SET SPINAL 26MM 100MM STR PORT BOTH IP/OP "$1,380.00" "$1,021.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $287.61 "$1,380.00" $552.00 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,035.00" "$1,380.00" "$1,380.00" "$1,380.00" $690.00 $690.00 "$1,092.96" "$1,380.00" "$1,104.00" $621.00 "$1,380.00" N/A $800.40 "$1,380.00" $828.00 "$1,380.00" "$1,380.00" "$1,380.00" N/A N/A 632.471 SUP Custom 27803010 632.471 - SET SPINAL 26MM 110MM STR PORT BOTH IP/OP "$1,380.00" "$1,021.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $287.61 "$1,380.00" $552.00 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,035.00" "$1,380.00" "$1,380.00" "$1,380.00" $690.00 $690.00 "$1,092.96" "$1,380.00" "$1,104.00" $621.00 "$1,380.00" N/A $800.40 "$1,380.00" $828.00 "$1,380.00" "$1,380.00" "$1,380.00" N/A N/A 632.472 SUP Custom 27803010 632.472 - SET SPINAL 26MM 120MM STR PORT BOTH IP/OP "$1,380.00" "$1,021.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $287.61 "$1,380.00" $552.00 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,035.00" "$1,380.00" "$1,380.00" "$1,380.00" $690.00 $690.00 "$1,092.96" "$1,380.00" "$1,104.00" $621.00 "$1,380.00" N/A $800.40 "$1,380.00" $828.00 "$1,380.00" "$1,380.00" "$1,380.00" N/A N/A 648 SUP Custom 27203010 648 - TRAY SPNL 20GA 3.5IN STRL LF 3 SPNG STK PRP WELL BNDG ADLT BOTH IP/OP $27.50 $20.00 $4.82 $34.25 $27.08 $27.08 $27.08 $27.08 $27.08 $27.08 $4.82 $27.08 $27.08 $20.10 $20.10 $20.87 $14.11 $5.64 $27.08 $13.70 $27.08 $27.08 $34.25 $27.08 $27.08 $20.63 $27.08 $27.08 $27.08 $13.54 $13.54 $21.45 $27.08 $21.66 $17.60 $27.08 N/A $15.95 $27.08 $16.25 $27.08 $27.08 $27.08 N/A N/A 648.216 SUP Custom 27203010 648.216 - BIT DRILL 2.4MM FIX BONE CORRIDOR BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,041.05" "$2,041.05" "$2,119.70" "$1,432.75" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,787.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 650.012 SUP HCPCS C1713 650.012 - HOLDER IMPLANT TEMPORARY FIX SCREW SPN BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A 650.112 SUP Custom 27203010 650.112 - BIT DRL 12MM STRL REUSE BOTH IP/OP $672.50 $498.00 $119.71 $672.50 $672.50 $672.50 $672.50 $672.50 $672.50 $672.50 $119.71 $672.50 $672.50 $499.13 $499.13 $518.36 $350.37 $140.16 $672.50 $269.00 $672.50 $672.50 $672.50 $672.50 $672.50 $504.38 $672.50 $672.50 $672.50 $336.25 $336.25 $532.62 $672.50 $538.00 $437.13 $672.50 N/A $390.05 $672.50 $403.50 $672.50 $672.50 $672.50 N/A N/A 650.114 SUP Custom 27100030 650.114 - BIT DRL 14MM STRL REUSE BOTH IP/OP $672.50 $498.00 $119.71 $672.50 $672.50 $672.50 $672.50 $672.50 $672.50 $672.50 $119.71 $672.50 $672.50 $499.13 $499.13 $518.36 $350.37 $140.16 $672.50 $269.00 $672.50 $672.50 $672.50 $672.50 $672.50 $504.38 $672.50 $672.50 $672.50 $336.25 $336.25 $532.62 $672.50 $538.00 $437.13 $672.50 N/A $390.05 $672.50 $403.50 $672.50 $672.50 $672.50 N/A N/A 650.116 SUP Custom 27203010 650.116 - BIT DRL 16MM STRL REUSE BOTH IP/OP $672.50 $498.00 $119.71 $672.50 $672.50 $672.50 $672.50 $672.50 $672.50 $672.50 $119.71 $672.50 $672.50 $499.13 $499.13 $518.36 $350.37 $140.16 $672.50 $269.00 $672.50 $672.50 $672.50 $672.50 $672.50 $504.38 $672.50 $672.50 $672.50 $336.25 $336.25 $532.62 $672.50 $538.00 $437.13 $672.50 N/A $390.05 $672.50 $403.50 $672.50 $672.50 $672.50 N/A N/A 682.104 SUP Custom 27203010 682.104 - BIT DRILL 2.4MM 3.5MM SCREW ELLI BOTH IP/OP $950.00 $703.00 $169.10 $950.00 $950.00 $950.00 $950.00 $950.00 $950.00 $950.00 $169.10 $950.00 $950.00 $705.09 $705.09 $732.26 $494.95 $197.99 $950.00 $380.00 $950.00 $950.00 $950.00 $950.00 $950.00 $712.50 $950.00 $950.00 $950.00 $475.00 $475.00 $752.40 $950.00 $760.00 $617.50 $950.00 N/A $551.00 $950.00 $570.00 $950.00 $950.00 $950.00 N/A N/A 682.105 SUP Custom 27203010 682.105 - BIT DRILL 4 MM TITANIUM SCREW BOTH IP/OP $950.00 $703.00 $169.10 $950.00 $950.00 $950.00 $950.00 $950.00 $950.00 $950.00 $169.10 $950.00 $950.00 $705.09 $705.09 $732.26 $494.95 $197.99 $950.00 $380.00 $950.00 $950.00 $950.00 $950.00 $950.00 $712.50 $950.00 $950.00 $950.00 $475.00 $475.00 $752.40 $950.00 $760.00 $617.50 $950.00 N/A $551.00 $950.00 $570.00 $950.00 $950.00 $950.00 N/A N/A 682.107 SUP Custom 27203010 682.107 - TAP SURG TITANIUM SPN 4 MM SCREW BOTH IP/OP $950.00 $703.00 $169.10 $950.00 $950.00 $950.00 $950.00 $950.00 $950.00 $950.00 $169.10 $950.00 $950.00 $705.09 $705.09 $732.26 $494.95 $197.99 $950.00 $380.00 $950.00 $950.00 $950.00 $950.00 $950.00 $712.50 $950.00 $950.00 $950.00 $475.00 $475.00 $752.40 $950.00 $760.00 $617.50 $950.00 N/A $551.00 $950.00 $570.00 $950.00 $950.00 $950.00 N/A N/A 685.005 SUP HCPCS C1769 685.005 - GUIDEWIRE ORTHOPEDIC 500MM BLUNT SPN BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A 706.47 SUP Custom 27203010 706.47 - FORCEPS SRG 23GA GRSH RV DSP SRR DISP BOTH IP/OP $330.00 $244.00 $58.74 $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $58.74 $330.00 $330.00 $244.93 $244.93 $254.36 $171.93 $68.78 $330.00 $132.00 $330.00 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $214.50 $330.00 N/A $191.40 $330.00 $198.00 $330.00 $330.00 $330.00 N/A N/A 804 SUP HCPCS C1713 804 - SCREW BONE 2.2MM 4MM CROSS DRIVE TITANIUM SPN BOTH IP/OP $98.00 $73.00 $19.40 $97.75 $43.99 $43.99 $43.99 $43.99 $97.75 $97.75 $97.75 $20.37 $97.75 $97.75 $97.75 $97.75 $97.75 $20.37 $97.75 $39.10 $57.82 $97.75 $97.75 $97.75 $97.75 $73.50 $97.75 $97.75 $97.75 $48.88 $48.88 $77.42 $97.75 $78.20 $43.99 $19.40 N/A $56.84 $97.75 $58.65 $97.75 $20.37 $97.75 N/A N/A 805 SUP HCPCS C1713 805 - APPLICATOR FIBER TIPPED 1 1/12IN 12IN STICK WOOD BOTH IP/OP $98.50 $73.00 $19.47 $98.10 $44.15 $44.15 $44.15 $44.15 $98.10 $98.10 $98.10 $20.45 $98.10 $98.10 $98.10 $98.10 $98.10 $20.45 $98.10 $39.24 $58.03 $98.10 $98.10 $98.10 $98.10 $73.88 $98.10 $98.10 $98.10 $49.05 $49.05 $77.70 $98.10 $78.48 $44.15 $19.47 N/A $57.13 $98.10 $58.86 $98.10 $20.44 $98.10 N/A N/A 807 SUP HCPCS C1713 807 - SCREW BONE 2.2MM 7MM CROSS DRIVE RESCUE CRUCIATE SLFTAP BOTH IP/OP $98.00 $73.00 $19.40 $97.75 $43.99 $43.99 $43.99 $43.99 $97.75 $97.75 $97.75 $20.37 $97.75 $97.75 $97.75 $97.75 $97.75 $20.37 $97.75 $39.10 $57.82 $97.75 $97.75 $97.75 $97.75 $73.50 $97.75 $97.75 $97.75 $48.88 $48.88 $77.42 $97.75 $78.20 $43.99 $19.40 N/A $56.84 $97.75 $58.65 $97.75 $20.37 $97.75 N/A N/A 835.105 SUP Custom 27804086 835.105 - GRAFT BONE 5MM PARALLEL CERV SPN BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.106 SUP Custom 27804086 835.106 - GRAFT BONE 6MM PARALLEL CERV SPN BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.107 SUP Custom 27804086 835.107 - GRAFT BONE 7MM PARALLEL CERV SPN BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.108 SUP Custom 27804086 835.108 - GRAFT BONE 8MM PARALLEL CERV SPN BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.109 SUP Custom 27804086 835.109 - GRAFT BONE 9MM PARALLEL CERV SPN BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.11 SUP Custom 27804086 835.110 - GRAFT BONE 10MM PARALLEL NUBONE DEMINERALIZED BONE MATRIX BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.111 SUP Custom 27804086 835.111 - GRAFT BONE 11MM PARALLEL CERV SPN BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.112 SUP Custom 27804086 835.112 - GRAFT BONE 12MM PARALLEL CERV SPN BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.205 SUP Custom 27804086 835.205 - GRAFT BONE 5MM LORDOTIC ALLOGRAFT CERV BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.206 SUP Custom 27804086 835.206 - GRAFT BONE 6MM SPACER CERV INTERBODY FUSION LORDOTIC BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.207 SUP Custom 27804086 835.207 - GRAFT BONE 7MM LORDOTIC CERV SPN BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.208 SUP Custom 27804086 835.208 - GRAFT BONE 8MM LORDOTIC CERV SPN BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.209 SUP Custom 27804086 835.209 - GRAFT BONE 9MM SPACER CERV INTERBODY FUSION LORDOTIC BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.21 SUP Custom 27804086 835.210 - GRAFT BONE 10MM LORDOTIC NUBONE DEMINERALIZED BONE MATRIX BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.211 SUP Custom 27804086 835.211 - GRAFT BONE 11MM LORDOTIC CERV SPN BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 835.212 SUP Custom 27804086 835.212 - GRAFT BONE 12MM LORDOTIC CERV SPN BOTH IP/OP "$3,460.00" "$2,560.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $615.88 "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" $721.10 "$3,460.00" "$1,384.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$3,460.00" "$2,595.00" "$3,460.00" "$3,460.00" "$3,460.00" "$1,730.00" "$1,730.00" "$2,740.32" "$3,460.00" "$2,768.00" "$1,557.00" "$3,460.00" N/A "$2,006.80" "$3,460.00" "$2,076.00" "$3,460.00" "$3,460.00" "$3,460.00" N/A N/A 846 SUP Custom 27011340 846 - ELECTRODE PATIENT RETURN THK1/8IN 36X20IN 2 CORD MEGA SOFT BOTH IP/OP "$8,500.00" "$6,290.00" "$1,513.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$1,513.00" "$8,500.00" "$8,500.00" "$4,181.12" "$4,181.12" "$6,551.80" "$2,060.15" "$1,771.49" "$8,500.00" "$3,400.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$6,375.00" "$8,500.00" "$8,500.00" "$8,500.00" "$4,250.00" "$4,250.00" "$6,732.00" "$8,500.00" "$6,800.00" "$5,525.00" "$8,500.00" N/A "$4,930.00" "$8,500.00" "$5,100.00" "$8,500.00" "$8,500.00" "$8,500.00" N/A N/A 876 SUP Custom 27203010 BLANKET 64X25IN MXTHR L HPR/HPO NWVN DISP WRM BOTH IP/OP $31.00 $23.00 $5.51 $30.93 $30.93 $30.93 $30.93 $30.93 $30.93 $30.93 $5.51 $30.93 $30.93 $22.96 $22.96 $23.84 $16.11 $6.45 $30.93 $12.37 $30.93 $30.93 $30.93 $30.93 $30.93 $23.25 $30.93 $30.93 $30.93 $15.47 $15.47 $24.50 $30.93 $24.74 $20.10 $30.93 N/A $17.98 $30.93 $18.56 $30.93 $30.93 $30.93 N/A N/A 900.601 SUP Custom 27203010 900.601 - GUIDEWIRE ORTHOPEDIC 1.6MM 150MM DRILL TIP NONSTRL 3.5MM BOTH IP/OP $81.00 $60.00 $14.39 $82.20 $80.83 $80.83 $80.83 $80.83 $80.83 $80.83 $14.39 $80.83 $80.83 $59.99 $59.99 $62.30 $42.11 $16.85 $80.83 $32.88 $80.83 $80.83 $82.20 $80.83 $80.83 $60.75 $80.83 $80.83 $80.83 $40.42 $40.42 $64.02 $80.83 $64.66 $52.54 $80.83 N/A $46.98 $80.83 $48.50 $80.83 $80.83 $80.83 N/A N/A 900.721 SUP HCPCS C1769 900.721 - GUIDEWIRE ORTHOPEDIC 1.25MM 150MM NONTHREADED COBALT NONSTRL BOTH IP/OP $52.50 $39.00 $10.39 $53.25 $28.43 $28.43 $28.43 $28.43 $52.35 $52.35 $52.35 $10.91 $52.35 $38.85 $38.85 $40.35 $27.27 $10.91 $52.35 $53.25 $30.97 $52.35 $53.25 $52.35 $52.35 $39.38 $52.35 $52.35 $52.35 $26.18 $26.18 $41.46 $52.35 $41.88 $34.03 $10.39 N/A $30.45 $52.35 $52.35 $52.35 $10.91 $52.35 N/A N/A 900.722 SUP HCPCS C1769 900.722 - GUIDEWIRE ORTHOPEDIC 1.25MM 150MM THREAD NONSTRL 3.5MM CANN BOTH IP/OP $55.50 $41.00 $11.02 $56.45 $30.14 $30.14 $30.14 $30.14 $55.50 $55.50 $55.50 $11.57 $55.50 $41.19 $41.19 $42.78 $28.92 $11.57 $55.50 $56.45 $32.83 $55.50 $56.45 $55.50 $55.50 $41.63 $55.50 $55.50 $55.50 $27.75 $27.75 $43.96 $55.50 $44.40 $36.08 $11.02 N/A $32.19 $55.50 $55.50 $55.50 $11.57 $55.50 N/A N/A 900.723 SUP HCPCS C1769 900.723 - GUIDEWIRE ORTHOPEDIC SPADE 2.5MM 230MM THREAD LCP DHHS BOTH IP/OP $91.00 $67.00 $17.99 $92.20 $49.22 $49.22 $49.22 $49.22 $90.65 $90.65 $90.65 $18.89 $90.65 $67.28 $67.28 $69.87 $47.23 $18.89 $90.65 $92.20 $53.62 $90.65 $92.20 $90.65 $90.65 $68.25 $90.65 $90.65 $90.65 $45.33 $45.33 $71.79 $90.65 $72.52 $58.92 $17.99 N/A $52.78 $90.65 $90.65 $90.65 $18.89 $90.65 N/A N/A 900.726 SUP HCPCS C1769 900.726 - GUIDEWIRE ORTHOPEDIC 2.8MM 450MM 300MM TROCAR POINT THREADED BOTH IP/OP $148.00 $110.00 $29.29 $150.10 $80.15 $80.15 $80.15 $80.15 $147.60 $147.60 $147.60 $30.76 $147.60 $109.55 $109.55 $113.77 $76.90 $30.76 $147.60 $150.10 $87.31 $147.60 $150.10 $147.60 $147.60 $111.00 $147.60 $147.60 $147.60 $73.80 $73.80 $116.90 $147.60 $118.08 $95.94 $29.29 N/A $85.84 $147.60 $147.60 $147.60 $30.76 $147.60 N/A N/A 910.011 SUP HCPCS C1713 910.011 - ASSURE Screw Rack Insert for 4.0mm Standard Self-Drilling Sc BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $765.00 $765.00 N/A N/A 910.012 SUP HCPCS C1713 910.012 - ASSURE Screw Rack Insert for 4.5mm Standard Self-Drilling Sc BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 910.013 SUP HCPCS C1713 910.013 - ASSURE Screw Rack Insert for 4.0mm Standard Self-Tapping Scr BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $765.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 910.014 SUP HCPCS C1713 910.014 - ASSURE Screw Rack Insert for 4.5mm Standard Self-Tapping Scr BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $765.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $765.00 $765.00 N/A N/A 910.021 SUP HCPCS C1713 910.021 - ASSURE Screw Rack Insert for 4.0mm Rigid Self-Drilling Screw BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 910.022 SUP HCPCS C1713 910.022 - ASSURE Screw Rack Insert for 4.5mm Rigid Self-Drilling Screw BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 910.023 SUP HCPCS C1713 910.023 - ASSURE Screw Rack Insert for 4.0mm Rigid Self-Tapping Screws BOTH IP/OP $530.00 $392.00 $105.19 $530.00 $238.50 $238.50 $238.50 $238.50 $530.00 $530.00 $530.00 $110.47 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $313.50 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $105.19 N/A $307.40 $530.00 $530.00 $530.00 $530.00 $530.00 N/A N/A 910.024 SUP HCPCS C1713 910.024 - ASSURE Screw Rack Insert for 4.5mm Rigid Self-Tapping Screws BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $765.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 910.03 SUP HCPCS C1713 910.030 - ASSURE Screw Rack Insert for Auxillary Screws BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $765.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 910.511 SUP HCPCS C1713 910.511 - ASSURE Screw Rack Insert for 4.0mm Standard Fixed Self-Drill BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $765.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 910.512 SUP HCPCS C1713 910.512 - ASSURE Screw Rack Insert for 4.5mm Standard Fixed Self-Drill BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $765.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 910.513 SUP HCPCS C1713 910.513 - ASSURE Screw Rack Insert for 4.0mm Standard Fixed Self-Tappi BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $765.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 910.514 SUP HCPCS C1713 910.514 - ASSURE Screw Rack Insert for 4.5mm Standard Fixed Self-Tappi BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 910.521 SUP HCPCS C1713 910.521 - ASSURE Screw Rack Insert for 4.0mm Fixed Self-Drilling Screw BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 910.522 SUP HCPCS C1713 910.522 - ASSURE Screw Rack Insert for 4.5mm Fixed Self-Drilling Screw BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 910.523 SUP HCPCS C1713 910.523 - ASSURE Screw Rack Insert for 4.0mm Fixed Self-Tapping Screws BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 910.524 SUP HCPCS C1713 910.524 - ASSURE Screw Rack Insert for 4.5mm Fixed Self-Tapping Screws BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 910.525 SUP HCPCS C1713 910.525 - ASSURE Screw Rack Insert for Auxiliary Fixed Screws BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $765.00 $765.00 $159.43 $765.00 N/A N/A 917.002 SUP HCPCS C1713 "917.002 - ASSURE Translational Cervical Plate Implant Module for 1,2 a" BOTH IP/OP "$2,120.00" "$1,569.00" $420.77 "$2,120.00" $954.00 $954.00 $954.00 $954.00 "$2,120.00" "$2,120.00" "$2,120.00" $441.86 "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" $441.83 "$2,120.00" $848.00 "$1,253.98" "$2,120.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,590.00" "$2,120.00" "$2,120.00" "$2,120.00" "$1,060.00" "$1,060.00" "$1,679.04" "$2,120.00" "$1,696.00" $954.00 $420.77 N/A "$1,229.60" "$2,120.00" "$2,120.00" "$2,120.00" $441.81 "$2,120.00" N/A N/A 917.004 SUP HCPCS C1713 917.004 - ASSURE Translational Cervical Plate Implant Module for 4-Lev BOTH IP/OP "$1,962.50" "$1,452.00" $389.51 "$1,962.50" $883.13 $883.13 $883.13 $883.13 "$1,962.50" "$1,962.50" "$1,962.50" $409.03 "$1,962.50" "$1,962.50" "$1,962.50" "$1,962.50" "$1,962.50" $409.01 "$1,962.50" "$1,962.50" "$1,160.82" "$1,962.50" "$1,962.50" "$1,962.50" "$1,962.50" "$1,471.88" "$1,962.50" "$1,962.50" "$1,962.50" $981.25 $981.25 "$1,554.30" "$1,962.50" "$1,570.00" $883.13 $389.51 N/A "$1,138.25" "$1,962.50" "$1,962.50" "$1,962.50" $408.99 "$1,962.50" N/A N/A 929.007 SUP HCPCS C1713 929.007 - SET SPINAL SCREW MODULE GATEWAY BOTH IP/OP "$3,180.00" "$2,353.00" $631.15 "$3,180.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$3,180.00" "$3,180.00" "$3,180.00" $662.79 "$3,180.00" "$3,180.00" "$3,180.00" "$3,180.00" "$3,180.00" $662.75 "$3,180.00" "$3,180.00" "$1,567.74" "$3,180.00" "$3,180.00" "$3,180.00" "$3,180.00" "$2,385.00" "$3,180.00" "$3,180.00" "$3,180.00" "$1,590.00" "$1,590.00" "$2,518.56" "$3,180.00" "$2,544.00" "$1,431.00" $631.15 N/A "$1,844.40" "$3,180.00" "$3,180.00" "$3,180.00" $662.71 "$3,180.00" N/A N/A 992 SUP HCPCS C1713 992 - KIT ARTHRO FIX TRNFX2 SCR CANN DILAT ROTR CUF STRL DISP BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A 1006 SUP Custom 27203010 1006 - PROBE VITRECTOMY LEGACY EVEREST ATIOP ANTERIOR BOTH IP/OP $413.50 $306.00 $73.57 $413.33 $413.33 $413.33 $413.33 $413.33 $413.33 $413.33 $73.57 $413.33 $413.33 $306.77 $306.77 $318.59 $215.34 $86.14 $413.33 $165.33 $413.33 $413.33 $413.33 $413.33 $413.33 $310.13 $413.33 $413.33 $413.33 $206.67 $206.67 $327.36 $413.33 $330.66 $268.66 $413.33 N/A $239.83 $413.33 $248.00 $413.33 $413.33 $413.33 N/A N/A 1006 SUP Custom 27203010 1006 - PROBE VITRTM LGC VRST ATIOP ANT OCCUTOME STRL DISP BOTH IP/OP $413.50 $306.00 $73.57 $413.33 $413.33 $413.33 $413.33 $413.33 $413.33 $413.33 $73.57 $413.33 $413.33 $306.77 $306.77 $318.59 $215.34 $86.14 $413.33 $165.33 $413.33 $413.33 $413.33 $413.33 $413.33 $310.13 $413.33 $413.33 $413.33 $206.67 $206.67 $327.36 $413.33 $330.66 $268.66 $413.33 N/A $239.83 $413.33 $248.00 $413.33 $413.33 $413.33 N/A N/A 1010 SUP HCPCS C1722 1010 - DEFIBRILLATOR CARDIAC 15.7MM 65.5X78.2IN INTERNAL WARNING BOTH IP/OP "$53,750.00" "$39,775.00" "$31,175.00" "$40,312.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$40,312.50" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$31,175.00" N/A N/A N/A N/A N/A N/A N/A 1028 SUP HCPCS C2628 1028 - CATHETER BLNOCC FLOCONTROL BOTH IP/OP "$6,987.50" "$5,171.00" "$1,386.84" "$6,987.50" "$3,794.21" "$3,794.21" "$3,794.21" "$3,794.21" "$6,987.50" "$6,987.50" "$6,987.50" "$1,456.37" "$6,987.50" "$4,181.12" "$4,181.12" "$5,385.97" "$2,060.15" "$1,456.27" "$6,987.50" "$6,987.50" "$3,094.73" "$6,987.50" "$6,987.50" "$6,987.50" "$6,987.50" "$5,240.63" "$6,987.50" "$6,987.50" "$6,987.50" "$3,493.75" "$3,493.75" "$5,534.10" "$6,987.50" "$5,590.00" "$4,541.88" "$1,386.84" N/A "$4,052.75" "$6,987.50" "$6,987.50" "$6,987.50" "$1,456.20" "$6,987.50" N/A N/A 1104 SUP Custom 27203010 1104 - RETRACTOR SRG 32.2X18.4CM BOTH IP/OP "$2,411.00" "$1,784.00" $429.15 "$2,410.93" "$2,410.93" "$2,410.93" "$2,410.93" "$2,410.93" "$2,410.93" "$2,410.93" $429.15 "$2,410.93" "$2,410.93" "$1,789.39" "$1,789.39" "$1,858.34" "$1,256.09" $502.46 "$2,410.93" $964.37 "$2,410.93" "$2,410.93" "$2,410.93" "$2,410.93" "$2,410.93" "$1,808.25" "$2,410.93" "$2,410.93" "$2,410.93" "$1,205.47" "$1,205.47" "$1,909.46" "$2,410.93" "$1,928.74" "$1,567.10" "$2,410.93" N/A "$1,398.38" "$2,410.93" "$1,446.56" "$2,410.93" "$2,410.93" "$2,410.93" N/A N/A 1151 SUP Custom 27203010 1151 - MANIPULATOR SURG UT INJECTOR 4.5MM DISP BOTH IP/OP $56.00 $41.00 $9.91 $55.70 $55.70 $55.70 $55.70 $55.70 $55.70 $55.70 $9.91 $55.70 $55.70 $41.34 $41.34 $42.93 $29.02 $11.61 $55.70 $22.28 $55.70 $55.70 $55.70 $55.70 $55.70 $42.00 $55.70 $55.70 $55.70 $27.85 $27.85 $44.11 $55.70 $44.56 $36.21 $55.70 N/A $32.48 $55.70 $33.42 $55.70 $55.70 $55.70 N/A N/A 1200 SUP Custom 27100030 1200 - BRACE ORTH FSN XT CSTM AIRTECH FRM PD PVT PNT STRAP TAB KN BOTH IP/OP $836.50 $619.00 $148.85 $836.25 $836.25 $836.25 $836.25 $836.25 $836.25 $836.25 $148.85 $836.25 $836.25 $620.66 $620.66 $644.58 $435.69 $174.28 $836.25 $334.50 $836.25 $836.25 $836.25 $836.25 $836.25 $627.38 $836.25 $836.25 $836.25 $418.13 $418.13 $662.31 $836.25 $669.00 $543.56 $836.25 N/A $485.17 $836.25 $501.75 $836.25 $836.25 $836.25 N/A N/A 1201 SUP Custom 27803010 1201 - CLIP INTERNAL SMALL CHEVRON TRIANGLE WIDE LIGATE CROSS BOTH IP/OP $1.50 $1.00 $0.87 $4.58 $2.06 $2.06 $2.06 $2.06 $4.58 $4.58 $4.58 $0.95 $4.58 $4.58 $4.58 $4.58 $4.58 $0.95 $4.58 $4.58 $2.71 $4.58 $4.58 $4.58 $4.58 $1.13 $4.58 $4.58 $4.58 $2.29 $2.29 $3.63 $4.58 $3.66 $2.06 $0.91 N/A $0.87 $4.58 $4.58 $4.58 $0.95 $4.58 N/A N/A 1201 SUP HCPCS C1760 001201 - CLIP SM INTNL HRZN TI ENDSCP LIGAT STRL DISP LATEX FREE BOTH IP/OP $5.00 $4.00 $0.91 $4.58 $2.06 $2.06 $2.06 $2.06 $4.58 $4.58 $4.58 $0.95 $4.58 $4.58 $4.58 $4.58 $4.58 $0.95 $4.58 $4.58 $2.71 $4.58 $4.58 $4.58 $4.58 $3.75 $4.58 $4.58 $4.58 $2.29 $2.29 $3.63 $4.58 $3.66 $2.06 $0.91 N/A $2.90 $4.58 $4.58 $4.58 $0.95 $4.58 N/A N/A 1435 SUP Custom 27203010 1435 - BANDAGE COMPRESSION A TUBULAR 10MR MULTPUR ELAST COMFORTABLE BOTH IP/OP $40.00 $30.00 $7.08 $39.80 $39.80 $39.80 $39.80 $39.80 $39.80 $39.80 $7.08 $39.80 $39.80 $29.54 $29.54 $30.68 $20.74 $8.29 $39.80 $15.92 $39.80 $39.80 $39.80 $39.80 $39.80 $30.00 $39.80 $39.80 $39.80 $19.90 $19.90 $31.52 $39.80 $31.84 $25.87 $39.80 N/A $23.20 $39.80 $23.88 $39.80 $39.80 $39.80 N/A N/A 1438 SUP Custom 27203010 1438 - BANDAGE COMPRESSION F LARGE KNEE MEDIUM THIGH TUBULAR 10MR BOTH IP/OP $81.00 $60.00 $14.37 $80.75 $80.75 $80.75 $80.75 $80.75 $80.75 $80.75 $14.37 $80.75 $80.75 $59.93 $59.93 $62.24 $42.07 $16.83 $80.75 $32.30 $80.75 $80.75 $80.75 $80.75 $80.75 $60.75 $80.75 $80.75 $80.75 $40.38 $40.38 $63.95 $80.75 $64.60 $52.49 $80.75 N/A $46.98 $80.75 $48.45 $80.75 $80.75 $80.75 N/A N/A 1441 SUP Custom 27203010 1441 - BANDAGE COMPRESSION K 10MR TUBULAR MULTPUR COMFORTABLE BOTH IP/OP $136.50 $101.00 $24.23 $816.90 $136.15 $136.15 $136.15 $136.15 $136.15 $136.15 $24.23 $136.15 $136.15 $101.05 $101.05 $104.94 $70.93 $28.38 $136.15 $326.76 $136.15 $136.15 $816.90 $136.15 $136.15 $102.38 $136.15 $136.15 $136.15 $68.08 $68.08 $107.83 $136.15 $108.92 $88.50 $136.15 N/A $79.17 $136.15 $81.69 $136.15 $136.15 $136.15 N/A N/A 1443 SUP Custom 27203010 1443 - BANDAGE COMPRESSION C MEDIUM ARM SMALL ANKLE TUBULAR 10MR BOTH IP/OP $57.50 $43.00 $10.22 $57.43 $57.43 $57.43 $57.43 $57.43 $57.43 $57.43 $10.22 $57.43 $57.43 $42.62 $42.62 $44.27 $29.92 $11.97 $57.43 $22.97 $57.43 $57.43 $57.43 $57.43 $57.43 $43.13 $57.43 $57.43 $57.43 $28.72 $28.72 $45.48 $57.43 $45.94 $37.33 $57.43 N/A $33.35 $57.43 $34.46 $57.43 $57.43 $57.43 N/A N/A 1534 SUP Custom 27203010 1534 - SYSTEM GSTRC LAV 34FR NS ESLV TUBE RADOPQ STRP EASI-LOK ADPR BOTH IP/OP $365.50 $270.00 $64.99 $365.14 $365.14 $365.14 $365.14 $365.14 $365.14 $365.14 $64.99 $365.14 $365.14 $271.01 $271.01 $281.45 $190.24 $76.10 $365.14 $146.06 $365.14 $365.14 $365.14 $365.14 $365.14 $274.13 $365.14 $365.14 $365.14 $182.57 $182.57 $289.19 $365.14 $292.11 $237.34 $365.14 N/A $211.99 $365.14 $219.08 $365.14 $365.14 $365.14 N/A N/A 1537 SUP Custom 27203010 1537 - FORCEPS BIOPSY COLD BOTH IP/OP $35.00 $26.00 $6.19 $34.78 $34.78 $34.78 $34.78 $34.78 $34.78 $34.78 $6.19 $34.78 $34.78 $25.81 $25.81 $26.81 $18.12 $7.25 $34.78 $13.91 $34.78 $34.78 $34.78 $34.78 $34.78 $26.25 $34.78 $34.78 $34.78 $17.39 $17.39 $27.55 $34.78 $27.82 $22.61 $34.78 N/A $20.30 $34.78 $20.87 $34.78 $34.78 $34.78 N/A N/A 1892 SUP Custom 27011340 1892 - SET PRESSURE MONITR COMBITRANS BOTH IP/OP $114.00 $84.00 $20.25 $113.75 $113.75 $113.75 $113.75 $113.75 $113.75 $113.75 $20.25 $113.75 $113.75 $84.43 $84.43 $87.68 $59.26 $23.71 $113.75 $45.50 $113.75 $113.75 $113.75 $113.75 $113.75 $85.50 $113.75 $113.75 $113.75 $56.88 $56.88 $90.09 $113.75 $91.00 $73.94 $113.75 N/A $66.12 $113.75 $68.25 $113.75 $113.75 $113.75 N/A N/A 1951 SUP Custom 27203010 1951 - HEMOSTAT ABSORBABLE 14X2IN ORIGINAL FLEXIBLE SHEER WEAVE BOTH IP/OP $136.50 $101.00 $24.22 $239.86 $136.04 $136.04 $136.04 $136.04 $136.04 $136.04 $24.22 $136.04 $136.04 $100.97 $100.97 $104.86 $70.88 $28.35 $136.04 $95.94 $136.04 $136.04 $239.86 $136.04 $136.04 $102.38 $136.04 $136.04 $136.04 $68.02 $68.02 $107.74 $136.04 $108.83 $88.43 $136.04 N/A $79.17 $136.04 $81.62 $136.04 $136.04 $136.04 N/A N/A 1974 SUP Custom 27203010 1974 - SPONGE ABSORBABLE THK10MM 100 12.5X8CM HEMOSTAT SURGIFOAM BOTH IP/OP $49.00 $36.00 $8.71 $69.11 $48.96 $48.96 $48.96 $48.96 $48.96 $48.96 $8.71 $48.96 $48.96 $36.34 $36.34 $37.74 $25.51 $10.20 $48.96 $27.64 $48.96 $48.96 $69.11 $48.96 $48.96 $36.75 $48.96 $48.96 $48.96 $24.48 $24.48 $38.78 $48.96 $39.17 $31.82 $48.96 N/A $28.42 $48.96 $29.38 $48.96 $48.96 $48.96 N/A N/A 1985 SUP Custom 27203010 1985 - AGENT HMST STRL LF INSTAT ABS MCFIB CLGN 1GM DISP BOTH IP/OP $109.00 $81.00 $20.25 $113.79 $113.79 $113.79 $113.79 $113.79 $113.79 $113.79 $20.25 $113.79 $113.79 $84.45 $84.45 $87.71 $59.28 $23.72 $113.79 $45.52 $113.79 $113.79 $113.79 $113.79 $113.79 $81.75 $113.79 $113.79 $113.79 $56.90 $56.90 $90.12 $113.79 $91.03 $73.96 $113.79 $113.79 $63.22 $113.79 $68.27 $113.79 $113.79 $113.79 N/A N/A 2056 SUP Custom 27203010 2056 - APPLICATOR BRACHYTHERAPY SPHERE 5-6CM TRAY CATHETER BOTH IP/OP "$6,875.00" "$5,088.00" "$1,223.75" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$1,223.75" "$6,875.00" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$2,750.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$6,875.00" N/A "$3,987.50" "$6,875.00" "$4,125.00" "$6,875.00" "$6,875.00" "$6,875.00" N/A N/A 2083 SUP Custom 27203010 2083 - HEMOSTAT ABS 4X4IN NWVN BCTRCD SRGCL SNOW CLU FBRC BOTH IP/OP $286.50 $212.00 $50.91 $290.29 $286.01 $286.01 $286.01 $286.01 $286.01 $286.01 $50.91 $286.01 $286.01 $212.28 $212.28 $220.46 $149.01 $59.61 $286.01 $116.12 $286.01 $286.01 $290.29 $286.01 $286.01 $214.88 $286.01 $286.01 $286.01 $143.01 $143.01 $226.52 $286.01 $228.81 $185.91 $286.01 N/A $166.17 $286.01 $171.61 $286.01 $286.01 $286.01 N/A N/A 2200 SUP Custom 27803010 2200 - CLIP INTERNAL MEDIUM CHEVRON HEART TRNSVRS GROOVE LIGATE BOTH IP/OP $7.00 $5.00 $1.23 $6.90 $6.90 $6.90 $6.90 $6.90 $6.90 $6.90 $1.23 $6.90 $6.90 $6.90 $6.90 $6.90 $6.90 $1.44 $6.90 $2.76 $6.90 $6.90 $6.90 $6.90 $6.90 $5.25 $6.90 $6.90 $6.90 $3.45 $3.45 $5.46 $6.90 $5.52 $3.11 $6.90 N/A $4.06 $6.90 $4.14 $6.90 $6.90 $6.90 N/A N/A 2200 SUP Custom 27203010 2200 - RING RTRCTR 27.5X18.4CM LNSTR WRNCH CANTILEVER SS 795GM BOTH IP/OP "$3,602.50" "$2,666.00" $1.23 "$2,701.88" $6.90 $6.90 $6.90 $6.90 $6.90 $6.90 $1.23 $6.90 $6.90 $6.90 $6.90 $6.90 $6.90 $1.44 $6.90 $2.76 $6.90 $6.90 $6.90 $6.90 $6.90 "$2,701.88" $6.90 $6.90 $6.90 $3.45 $3.45 $5.46 $6.90 $5.52 $3.11 $6.90 N/A "$2,089.45" $6.90 $4.14 $6.90 $6.90 $6.90 N/A N/A 2456 SUP HCPCS C2618 2456 - PROBE CRYOSURGICAL STRG 4MM LF NSL BOTH IP/OP "$1,219.50" $902.00 $707.31 "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$1,223.75" "$6,875.00" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$2,750.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" $914.63 "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$6,875.00" N/A $707.31 "$6,875.00" "$4,125.00" "$6,875.00" "$6,875.00" "$6,875.00" N/A N/A 2456 SUP Custom 27203010 2456 - APPLICATOR BRACHYTHERAPY 8MM 4-5CM CATHETER RADIATION BOTH IP/OP "$6,875.00" "$5,088.00" "$1,223.75" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$1,223.75" "$6,875.00" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$2,750.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$6,875.00" N/A "$3,987.50" "$6,875.00" "$4,125.00" "$6,875.00" "$6,875.00" "$6,875.00" N/A N/A 2550 SUP Custom 27203010 2550 - BAG DRAIN INLINE SELF FILL OASIS 600ML STERILE ATRIUM ATS BOTH IP/OP $57.50 $43.00 $10.16 $57.10 $57.10 $57.10 $57.10 $57.10 $57.10 $57.10 $10.16 $57.10 $57.10 $42.38 $42.38 $44.01 $29.75 $11.90 $57.10 $22.84 $57.10 $57.10 $57.10 $57.10 $57.10 $43.13 $57.10 $57.10 $57.10 $28.55 $28.55 $45.22 $57.10 $45.68 $37.12 $57.10 N/A $33.35 $57.10 $34.26 $57.10 $57.10 $57.10 N/A N/A 2994 SUP Custom 27203010 2994 - AGENT HMST STRL SURGIFLO KT MTRX THRMB BOTH IP/OP $651.00 $482.00 $115.85 $650.86 $650.86 $650.86 $650.86 $650.86 $650.86 $650.86 $115.85 $650.86 $650.86 $483.07 $483.07 $501.68 $339.10 $135.65 $650.86 $260.34 $650.86 $650.86 $650.86 $650.86 $650.86 $488.25 $650.86 $650.86 $650.86 $325.43 $325.43 $515.48 $650.86 $520.69 $423.06 $650.86 N/A $377.58 $650.86 $390.52 $650.86 $650.86 $650.86 N/A N/A 3055 SUP HCPCS C1729 CATHETER IV 18GA 1.25IN RADIOPQ SFSHLD GRN PCTV TFLN STRL LF BOTH IP/OP $4.00 $3.00 $0.77 $3.88 $2.11 $2.11 $2.11 $2.11 $3.88 $3.88 $3.88 $0.81 $3.88 $2.88 $2.88 $2.99 $2.02 $0.81 $3.88 $3.88 $2.30 $3.88 $3.88 $3.88 $3.88 $3.00 $3.88 $3.88 $3.88 $1.94 $1.94 $3.07 $3.88 $3.10 $2.52 $0.77 N/A $2.32 $3.88 $3.88 $3.88 $0.81 $3.88 N/A N/A 3110 SUP Custom 27803010 03110 - WRENCH SRG 5MM HEX ALN SET XTRNFXTR GW BOTH IP/OP $27.00 $20.00 $4.79 $26.90 $26.90 $26.90 $26.90 $26.90 $26.90 $26.90 $4.79 $26.90 $26.90 $26.90 $26.90 $26.90 $26.90 $5.61 $26.90 $10.76 $26.90 $26.90 $26.90 $26.90 $26.90 $20.25 $26.90 $26.90 $26.90 $13.45 $13.45 $21.30 $26.90 $21.52 $12.11 $26.90 N/A $15.66 $26.90 $16.14 $26.90 $26.90 $26.90 N/A N/A 3125 SUP Custom 27203010 03125 - WRENCH SRG THDL VSN BN SCR BOTH IP/OP "$1,109.00" $821.00 $197.35 "$1,108.70" "$1,108.70" "$1,108.70" "$1,108.70" "$1,108.70" "$1,108.70" "$1,108.70" $197.35 "$1,108.70" "$1,108.70" $822.88 $822.88 $854.59 $577.63 $231.07 "$1,108.70" $443.48 "$1,108.70" "$1,108.70" "$1,108.70" "$1,108.70" "$1,108.70" $831.75 "$1,108.70" "$1,108.70" "$1,108.70" $554.35 $554.35 $878.09 "$1,108.70" $886.96 $720.66 "$1,108.70" N/A $643.22 "$1,108.70" $665.22 "$1,108.70" "$1,108.70" "$1,108.70" N/A N/A 3400 SUP HCPCS C1777 3400 - LEAD PACING 9FR 45CM TRIPOLAR ELECTRODE Q-TRAK POLYURETHANE BOTH IP/OP "$12,500.00" "$9,250.00" "$2,480.94" "$12,500.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,605.31" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,605.14" "$12,500.00" "$12,500.00" "$6,162.50" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$9,375.00" "$12,500.00" "$12,500.00" "$12,500.00" "$6,250.00" "$6,250.00" "$9,900.00" "$12,500.00" "$10,000.00" "$5,625.00" "$2,480.94" N/A "$7,250.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,605.00" "$12,500.00" N/A N/A 3423 SUP HCPCS A6209 3423 - DRESSING FM 7X7IN BIATAIN ADH LNG WR TM FLXB PU BOTH IP/OP $14.50 $11.00 $8.41 $353.57 $353.57 $353.57 $353.57 $353.57 $353.57 $353.57 $62.94 $353.57 $353.57 $262.42 $262.42 $272.53 $184.21 $73.69 $353.57 $141.43 $353.57 $353.57 $353.57 $353.57 $353.57 $10.88 $353.57 $353.57 $353.57 $176.79 $176.79 $280.03 $353.57 $282.86 $229.82 $353.57 $353.57 $8.41 $353.57 $212.14 $353.57 $353.57 $353.57 N/A N/A 3423 SUP Custom 27203010 3423 - DRILL SRG SM SHRT 3.5MM STRL LF EVOS AO QCK CNCT OVR DISP BOTH IP/OP $258.50 $191.00 $62.94 $353.57 $353.57 $353.57 $353.57 $353.57 $353.57 $353.57 $62.94 $353.57 $353.57 $262.42 $262.42 $272.53 $184.21 $73.69 $353.57 $141.43 $353.57 $353.57 $353.57 $353.57 $353.57 $193.88 $353.57 $353.57 $353.57 $176.79 $176.79 $280.03 $353.57 $282.86 $229.82 $353.57 $353.57 $149.93 $353.57 $212.14 $353.57 $353.57 $353.57 N/A N/A 3902 SUP Custom 27203010 3902 - KIT TISS CLSR 2ML EVICEL SLNT FBRN BOTH IP/OP $526.00 $389.00 $93.62 $525.98 $525.98 $525.98 $525.98 $525.98 $525.98 $525.98 $93.62 $525.98 $525.98 $390.38 $390.38 $405.43 $274.04 $109.62 $525.98 $210.39 $525.98 $525.98 $525.98 $525.98 $525.98 $394.50 $525.98 $525.98 $525.98 $262.99 $262.99 $416.58 $525.98 $420.78 $341.89 $525.98 N/A $305.08 $525.98 $315.59 $525.98 $525.98 $525.98 N/A N/A 3935 SUP Custom 27203010 3935 - DRESSING WND 4X4CM V+PD HMST NINVS BOTH IP/OP $139.00 $103.00 $24.74 $139.00 $139.00 $139.00 $139.00 $139.00 $139.00 $139.00 $24.74 $139.00 $139.00 $103.17 $103.17 $107.14 $72.42 $28.97 $139.00 $55.60 $139.00 $139.00 $139.00 $139.00 $139.00 $104.25 $139.00 $139.00 $139.00 $69.50 $69.50 $110.09 $139.00 $111.20 $90.35 $139.00 N/A $80.62 $139.00 $83.40 $139.00 $139.00 $139.00 N/A N/A 4001 SUP Custom 27203010 4001 - RETAINER INTNL ORG SURGIFISH RADOPQ BOTH IP/OP $54.00 $40.00 $9.57 $53.75 $53.75 $53.75 $53.75 $53.75 $53.75 $53.75 $9.57 $53.75 $53.75 $39.89 $39.89 $41.43 $28.00 $11.20 $53.75 $25.00 $53.75 $53.75 $53.75 $53.75 $53.75 $40.50 $53.75 $53.75 $53.75 $26.88 $26.88 $42.57 $53.75 $43.00 $34.94 $53.75 N/A $31.32 $53.75 $32.25 $53.75 $53.75 $53.75 N/A N/A 4030 SUP Custom 27203010 4030 - DRESSING HMST 12X12IN STRL LF QUIKCLOT TRAUMAPAD CNTRL+ 3 BOTH IP/OP $146.00 $108.00 $1.96 $109.50 $11.00 $11.00 $11.00 $11.00 $11.00 $11.00 $1.96 $11.00 $11.00 $8.16 $8.16 $8.48 $5.73 $2.29 $11.00 $4.40 $11.00 $11.00 $11.00 $11.00 $11.00 $109.50 $11.00 $11.00 $11.00 $5.50 $5.50 $8.71 $11.00 $8.80 $7.15 $11.00 $11.00 $84.68 $11.00 $6.60 $11.00 $11.00 $11.00 N/A N/A 4071 SUP HCPCS C1769 4071 - DEVICE TRQ TIP INTRO BOTH IP/OP $45.00 $33.00 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $45.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 N/A $26.10 $45.00 $45.00 $45.00 $9.38 $45.00 N/A N/A 4200 SUP Custom 27803010 004200 - CLIP INTERNAL LARGE ANGLE RIGHT RING HANDLE LIGATE BOTH IP/OP $2.50 $2.00 $0.42 $2.36 $2.36 $2.36 $2.36 $2.36 $2.36 $2.36 $0.42 $2.36 $2.36 $2.36 $2.36 $2.36 $2.36 $0.49 $2.36 $0.94 $2.36 $2.36 $2.36 $2.36 $2.36 $1.88 $2.36 $2.36 $2.36 $1.18 $1.18 $1.87 $2.36 $1.89 $1.06 $2.36 N/A $1.45 $2.36 $1.42 $2.36 $2.36 $2.36 N/A N/A 4259 SUP Custom 27203010 04259 - RESERVOIR ATF XRES B BLD COL DISP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 4273 SUP Custom 27203010 04273 - KIT ATSBWL .25IN X ANCOAG ASP LN SCT ASMB TBG PVC DISP BOTH IP/OP $50.00 $37.00 $8.90 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $8.90 $50.00 $50.00 $37.11 $37.11 $38.54 $26.05 $10.42 $50.00 $20.00 $50.00 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $32.50 $50.00 N/A $29.00 $50.00 $30.00 $50.00 $50.00 $50.00 N/A N/A 4275 SUP Custom 27203010 04275 - RESERVOIR ATF 120UM BTM OULET GRS FLTR BLUTSAMMEL BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 4302 SUP Custom 27203010 4302 - STOCKING CMPR 18 MMHG LG REG THG LGTH WHT NS LF TED CLS TOE BOTH IP/OP $155.00 $115.00 $27.59 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $155.00 $27.59 $155.00 $155.00 $115.04 $115.04 $119.47 $80.76 $32.30 $155.00 $62.00 $155.00 $155.00 $155.00 $155.00 $155.00 $116.25 $155.00 $155.00 $155.00 $77.50 $77.50 $122.76 $155.00 $124.00 $100.75 $155.00 N/A $89.90 $155.00 $93.00 $155.00 $155.00 $155.00 N/A N/A 4350 SUP HCPCS C1765 4350 - BARRIER ADHESION 4X3IN ABSORBABLE INTERCEED PELVIS STERILE BOTH IP/OP $753.50 $558.00 $149.52 $753.34 $339.00 $339.00 $339.00 $339.00 $753.34 $753.34 $753.34 $157.01 $753.34 $753.34 $753.34 $753.34 $753.34 $157.00 $753.34 $753.34 $445.60 $753.34 $753.34 $753.34 $753.34 $565.13 $753.34 $753.34 $753.34 $376.67 $376.67 $596.65 $753.34 $602.67 $339.00 $149.52 N/A $437.03 $753.34 $753.34 $753.34 $157.00 $753.34 N/A N/A 4353 SUP Custom 27803010 4353 - IMPLANT FACIAL PATIENT SPECIFIC BOTH IP/OP "$7,000.00" "$5,180.00" "$1,246.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$1,246.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$1,458.88" "$7,000.00" "$2,800.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$5,250.00" "$7,000.00" "$7,000.00" "$7,000.00" "$3,500.00" "$3,500.00" "$5,544.00" "$7,000.00" "$5,600.00" "$3,150.00" "$7,000.00" N/A "$4,060.00" "$7,000.00" "$4,200.00" "$7,000.00" "$7,000.00" "$7,000.00" N/A N/A 4400 SUP Custom 27803010 4400 - RING ANLPLS 28MM MTRL C-E CL TI BOTH IP/OP "$6,552.50" "$4,849.00" "$1,166.35" "$6,552.50" "$6,552.50" "$6,552.50" "$6,552.50" "$6,552.50" "$6,552.50" "$6,552.50" "$1,166.35" "$6,552.50" "$6,552.50" "$6,552.50" "$6,552.50" "$6,552.50" "$6,552.50" "$1,365.61" "$6,552.50" "$2,621.00" "$6,552.50" "$6,552.50" "$6,552.50" "$6,552.50" "$6,552.50" "$4,914.38" "$6,552.50" "$6,552.50" "$6,552.50" "$3,276.25" "$3,276.25" "$5,189.58" "$6,552.50" "$5,242.00" "$2,948.63" "$6,552.50" N/A "$3,800.45" "$6,552.50" "$3,931.50" "$6,552.50" "$6,552.50" "$6,552.50" N/A N/A 4450 SUP Custom 27803010 4450 - RING ANLPLS 24-40MM MTRL C-E PH BOTH IP/OP "$3,295.00" "$2,438.00" $34.01 "$2,471.25" $191.04 $191.04 $191.04 $191.04 $191.04 $191.04 $34.01 $191.04 $191.04 $141.79 $141.79 $147.25 $99.53 $39.81 $191.04 $76.42 $191.04 $191.04 $191.04 $191.04 $191.04 "$2,471.25" $191.04 $191.04 $191.04 $95.52 $95.52 $151.30 $191.04 $152.83 $124.18 $191.04 $191.04 "$1,911.10" $191.04 $114.62 $191.04 $191.04 $191.04 N/A N/A 4672 SUP Custom 27803010 004672 - DEVICE VENTRICULAR ASSIST 12FR MICROAXIAL PUMP IMPELLA 2.5L BOTH IP/OP "$62,500.00" "$46,250.00" "$11,125.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$11,125.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$13,025.69" "$62,500.00" "$25,000.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$62,500.00" "$46,875.00" "$62,500.00" "$62,500.00" "$62,500.00" "$31,250.00" "$31,250.00" "$49,500.00" "$62,500.00" "$50,000.00" "$28,125.00" "$62,500.00" N/A "$36,250.00" "$62,500.00" "$37,500.00" "$62,500.00" "$62,500.00" "$62,500.00" N/A N/A 4823 SUP HCPCS C1713 4823.000 - BLOCKER SPNL XIA 3 TI BOTH IP/OP $459.50 $340.00 $91.18 $459.38 $206.72 $206.72 $206.72 $206.72 $459.38 $459.38 $459.38 $95.75 $459.38 $459.38 $459.38 $459.38 $459.38 $95.74 $459.38 $459.38 $271.72 $459.38 $459.38 $459.38 $459.38 $344.63 $459.38 $459.38 $459.38 $229.69 $229.69 $363.83 $459.38 $367.50 $206.72 $91.18 N/A $266.51 $459.38 $275.63 $459.38 $459.38 $459.38 N/A N/A 5065 SUP Custom 27203010 5065 - COVER COMPRESSION MEDIUM 12- IN RIGID SOLE VENT HOLE DORSUM BOTH IP/OP $172.50 $128.00 $30.67 $172.30 $172.30 $172.30 $172.30 $172.30 $172.30 $172.30 $30.67 $172.30 $172.30 $127.88 $127.88 $132.81 $89.77 $35.91 $172.30 $68.92 $172.30 $172.30 $172.30 $172.30 $172.30 $129.38 $172.30 $172.30 $172.30 $86.15 $86.15 $136.46 $172.30 $137.84 $112.00 $172.30 N/A $100.05 $172.30 $103.38 $172.30 $172.30 $172.30 N/A N/A 5090 SUP HCPCS C1757 5090 - CATHETER EXTRACTION .035IN 14FR 120CM 122.5CM STR TIP GWIRE BOTH IP/OP "$1,862.50" "$1,378.00" $369.66 "$1,862.50" "$1,011.34" "$1,011.34" "$1,011.34" "$1,011.34" "$1,862.50" "$1,862.50" "$1,862.50" $388.19 "$1,862.50" "$1,382.35" "$1,382.35" "$1,435.62" $970.36 $388.17 "$1,862.50" "$1,862.50" "$1,101.67" "$1,862.50" "$1,862.50" "$1,862.50" "$1,862.50" "$1,396.88" "$1,862.50" "$1,862.50" "$1,862.50" $931.25 $931.25 "$1,475.10" "$1,862.50" "$1,490.00" "$1,210.63" $369.66 N/A "$1,080.25" "$1,862.50" "$1,862.50" "$1,862.50" $388.15 "$1,862.50" N/A N/A 5201 SUP HCPCS C1887 5201 - CATHETER INFS 10D 3.5FR 135CM TWNPS OTW 2 LUM BRD TRQ CNTRL BOTH IP/OP "$1,100.00" $814.00 $218.32 "$1,100.00" $597.30 $597.30 $597.30 $597.30 "$1,100.00" "$1,100.00" "$1,100.00" $229.27 "$1,100.00" $816.42 $816.42 $847.88 $573.10 $229.25 "$1,100.00" "$1,100.00" $650.65 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $715.00 $218.32 N/A $638.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.24 "$1,100.00" N/A N/A 5571 SUP HCPCS C1887 5571 - HANDLE LRNSCP MED STD RUSCH DLPHN REUSE BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $576.94 $576.94 $576.94 $576.94 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" $788.59 $788.59 $818.98 $553.56 $221.44 "$1,062.50" "$1,062.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $690.63 $210.88 N/A $616.25 "$1,062.50" "$1,062.50" "$1,062.50" $221.43 "$1,062.50" N/A N/A 5897 SUP Custom 27203010 5897 - CUFF CMPR REG KDL SCD EXP BLDR FT BOTH IP/OP $72.50 $54.00 $12.88 $82.28 $72.38 $72.38 $72.38 $72.38 $72.38 $72.38 $12.88 $72.38 $72.38 $53.72 $53.72 $55.79 $37.71 $15.08 $72.38 $16.81 $72.38 $72.38 $82.28 $72.38 $72.38 $54.38 $72.38 $72.38 $72.38 $36.19 $36.19 $57.32 $72.38 $57.90 $47.05 $72.38 N/A $42.05 $72.38 $43.43 $72.38 $72.38 $72.38 N/A N/A 5898 SUP Custom 27203010 5898 - SLEEVE CMPR LG SCD EXP ANEMB CUF FT BOTH IP/OP $72.50 $54.00 $12.88 $76.05 $72.38 $72.38 $72.38 $72.38 $72.38 $72.38 $12.88 $72.38 $72.38 $53.72 $53.72 $55.79 $37.71 $15.08 $72.38 $30.42 $72.38 $72.38 $76.05 $72.38 $72.38 $54.38 $72.38 $72.38 $72.38 $36.19 $36.19 $57.32 $72.38 $57.90 $47.05 $72.38 N/A $42.05 $72.38 $43.43 $72.38 $72.38 $72.38 N/A N/A 6056 SUP Custom 27203010 6056 - STYLET LD J 60CM GRN KT KNOB ATR BOTH IP/OP $112.50 $83.00 $65.25 $84.38 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $84.38 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $65.25 N/A N/A N/A N/A N/A N/A N/A 6092 SUP Custom 27203010 6092 - PAPER RECORDING 110MM EKG THERMAL CARELINK BOTH IP/OP $250.00 $185.00 $1.25 $187.50 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $187.50 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $145.00 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 6122 SUP Custom 27203010 6122 - MOUTHWASH ORAL 1.5OZ LF RNS ANSEP 0.05% CPC CL BOTH IP/OP $86.50 $64.00 $15.38 $86.43 $86.43 $86.43 $86.43 $86.43 $86.43 $86.43 $15.38 $86.43 $86.43 $64.15 $64.15 $66.62 $45.03 $18.01 $86.43 $34.57 $86.43 $86.43 $86.43 $86.43 $86.43 $64.88 $86.43 $86.43 $86.43 $43.22 $43.22 $68.45 $86.43 $69.14 $56.18 $86.43 N/A $50.17 $86.43 $51.86 $86.43 $86.43 $86.43 N/A N/A 6177 SUP Custom 27203010 6177 - SLEEVE PACEMAKER RADIO FREQUENCY HEAD WAND COVER STERILE BOTH IP/OP $24.00 $18.00 $4.23 $23.75 $23.75 $23.75 $23.75 $23.75 $23.75 $23.75 $4.23 $23.75 $23.75 $17.63 $17.63 $18.31 $12.37 $4.95 $23.75 $9.50 $23.75 $23.75 $23.75 $23.75 $23.75 $18.00 $23.75 $23.75 $23.75 $11.88 $11.88 $18.81 $23.75 $19.00 $15.44 $23.75 N/A $13.92 $23.75 $14.25 $23.75 $23.75 $23.75 N/A N/A 6215 SUP Custom 27203010 6215 - CATHETER GD 6FR ATN GW PU CS VNGR BOTH IP/OP $230.00 $170.00 $40.94 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $40.94 $230.00 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $92.00 $230.00 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $230.00 N/A $133.40 $230.00 $138.00 $230.00 $230.00 $230.00 N/A N/A 6314 SUP Custom 27803010 6314 - GRAFT SYNTH TISSUE 91X56X4MM SMOOTH EXTERIOR SURFACE BOTH IP/OP "$2,989.00" "$2,212.00" $531.97 "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" $531.97 "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" $622.86 "$2,988.60" "$1,195.44" "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" "$2,241.75" "$2,988.60" "$2,988.60" "$2,988.60" "$1,494.30" "$1,494.30" "$2,366.97" "$2,988.60" "$2,390.88" "$1,344.87" "$2,988.60" N/A "$1,733.62" "$2,988.60" "$1,793.16" "$2,988.60" "$2,988.60" "$2,988.60" N/A N/A 6316 SUP Custom 27803010 6316 - IMPLANT ORBTL 14MM SPHERE BIOCOMPATIBLE POROUS MEDPOR BOTH IP/OP "$1,265.50" $936.00 $225.20 "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" $225.20 "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" $263.68 "$1,265.18" $506.07 "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" $949.13 "$1,265.18" "$1,265.18" "$1,265.18" $632.59 $632.59 "$1,002.02" "$1,265.18" "$1,012.14" $569.33 "$1,265.18" N/A $733.99 "$1,265.18" $759.11 "$1,265.18" "$1,265.18" "$1,265.18" N/A N/A 6317 SUP Custom 27803010 6317 - IMPLANT ORBTL 20MM SPHERE BIOCOMPATIBLE POROUS MEDPOR BOTH IP/OP "$1,265.50" $936.00 $225.20 "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" $225.20 "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" $263.68 "$1,265.18" $506.07 "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" $949.13 "$1,265.18" "$1,265.18" "$1,265.18" $632.59 $632.59 "$1,002.02" "$1,265.18" "$1,012.14" $569.33 "$1,265.18" N/A $733.99 "$1,265.18" $759.11 "$1,265.18" "$1,265.18" "$1,265.18" N/A N/A 6322 SUP Custom 27803010 6322 - SPHERE EYE 22MM THK.45MM 42MMX41MMX1MM STRL PE POR MEDPOR BOTH IP/OP "$1,505.00" "$1,114.00" $267.89 "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" $267.89 "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" $313.66 "$1,505.00" $602.00 "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,505.00" "$1,128.75" "$1,505.00" "$1,505.00" "$1,505.00" $752.50 $752.50 "$1,191.96" "$1,505.00" "$1,204.00" $677.25 "$1,505.00" N/A $872.90 "$1,505.00" $903.00 "$1,505.00" "$1,505.00" "$1,505.00" N/A N/A 6326 SUP Custom 27803010 6326 - IMPLANT ORBTL 16MM SPHERE BIOCOMPATIBLE POROUS MEDPOR BOTH IP/OP "$1,265.50" $936.00 $225.20 "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" $225.20 "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" $263.68 "$1,265.18" $506.07 "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" $949.13 "$1,265.18" "$1,265.18" "$1,265.18" $632.59 $632.59 "$1,002.02" "$1,265.18" "$1,012.14" $569.33 "$1,265.18" N/A $733.99 "$1,265.18" $759.11 "$1,265.18" "$1,265.18" "$1,265.18" N/A N/A 6327 SUP Custom 27803010 6327 - IMPLANT ORBTL ROUND 18MM SPHERE BIOCOMPATIBLE POROUS MEDPOR BOTH IP/OP "$1,265.50" $936.00 $225.20 "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" $225.20 "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" $263.68 "$1,265.18" $506.07 "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" "$1,265.18" $949.13 "$1,265.18" "$1,265.18" "$1,265.18" $632.59 $632.59 "$1,002.02" "$1,265.18" "$1,012.14" $569.33 "$1,265.18" N/A $733.99 "$1,265.18" $759.11 "$1,265.18" "$1,265.18" "$1,265.18" N/A N/A 6330 SUP Custom 27803010 6330 - GRAFT SYNTH TISSUE 50X38X1.5MM SHEET POROUS MEDPOR BOTH IP/OP $911.50 $675.00 $162.17 $911.05 $911.05 $911.05 $911.05 $911.05 $911.05 $911.05 $162.17 $911.05 $911.05 $911.05 $911.05 $911.05 $911.05 $189.87 $911.05 $364.42 $911.05 $911.05 $911.05 $911.05 $911.05 $683.63 $911.05 $911.05 $911.05 $455.53 $455.53 $721.55 $911.05 $728.84 $409.97 $911.05 N/A $528.67 $911.05 $546.63 $911.05 $911.05 $911.05 N/A N/A 6331 SUP Custom 27803010 6331 - GRAFT SYNTH TISSUE 76X50X1.5MM SHEET POROUS MEDPOR BOTH IP/OP "$1,225.00" $907.00 $13.84 $918.75 $77.76 $77.76 $77.76 $77.76 $77.76 $77.76 $13.84 $77.76 $77.76 $57.71 $57.71 $59.94 $40.51 $16.21 $77.76 $31.10 $77.76 $77.76 $77.76 $77.76 $77.76 $918.75 $77.76 $77.76 $77.76 $38.88 $38.88 $61.59 $77.76 $62.21 $50.54 $77.76 $77.76 $710.50 $77.76 $46.66 $77.76 $77.76 $77.76 N/A N/A 6332 SUP Custom 27803010 6332 - GRAFT SYNTH TISSUE 38X13X3MM BLOCK POROUS MEDPOR BOTH IP/OP "$1,150.00" $851.00 $204.66 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $204.66 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" $459.90 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 "$1,149.75" N/A $667.00 "$1,149.75" $689.85 "$1,149.75" "$1,149.75" "$1,149.75" N/A N/A 6333 SUP Custom 27803010 6333 - GRAFT SYNTH TISSUE 38X13X6MM BLOCK POROUS MEDPOR BOTH IP/OP "$1,460.50" "$1,081.00" $259.92 "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" $259.92 "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" $304.33 "$1,460.25" $584.10 "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" "$1,460.25" "$1,095.38" "$1,460.25" "$1,460.25" "$1,460.25" $730.13 $730.13 "$1,156.52" "$1,460.25" "$1,168.20" $657.11 "$1,460.25" N/A $847.09 "$1,460.25" $876.15 "$1,460.25" "$1,460.25" "$1,460.25" N/A N/A 6334 SUP Custom 27803010 6334 - GRAFT SYNTH TISSUE 38X13X9.5MM BLOCK POROUS MEDPOR BOTH IP/OP "$1,940.00" "$1,436.00" $345.32 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $345.32 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" $404.32 "$1,940.00" $776.00 "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,940.00" "$1,455.00" "$1,940.00" "$1,940.00" "$1,940.00" $970.00 $970.00 "$1,536.48" "$1,940.00" "$1,552.00" $873.00 "$1,940.00" N/A "$1,125.20" "$1,940.00" "$1,164.00" "$1,940.00" "$1,940.00" "$1,940.00" N/A N/A 6335 SUP Custom 27803010 6335 - GRAFT SYNTH TISSUE 50X25X3MM BLOCK POROUS MEDPOR BOTH IP/OP "$1,731.00" "$1,281.00" $308.05 "$1,730.63" "$1,730.63" "$1,730.63" "$1,730.63" "$1,730.63" "$1,730.63" "$1,730.63" $308.05 "$1,730.63" "$1,730.63" "$1,730.63" "$1,730.63" "$1,730.63" "$1,730.63" $360.68 "$1,730.63" $692.25 "$1,730.63" "$1,730.63" "$1,730.63" "$1,730.63" "$1,730.63" "$1,298.25" "$1,730.63" "$1,730.63" "$1,730.63" $865.32 $865.32 "$1,370.66" "$1,730.63" "$1,384.50" $778.78 "$1,730.63" N/A "$1,003.98" "$1,730.63" "$1,038.38" "$1,730.63" "$1,730.63" "$1,730.63" N/A N/A 6336 SUP Custom 27803010 6336 - GRAFT SYNTH TISSUE CNTOUR 25X50X6MM BLOCK MEDPOR BOTH IP/OP "$1,905.00" "$1,410.00" $339.09 "$1,905.00" "$1,905.00" "$1,905.00" "$1,905.00" "$1,905.00" "$1,905.00" "$1,905.00" $339.09 "$1,905.00" "$1,905.00" "$1,905.00" "$1,905.00" "$1,905.00" "$1,905.00" $397.02 "$1,905.00" $762.00 "$1,905.00" "$1,905.00" "$1,905.00" "$1,905.00" "$1,905.00" "$1,428.75" "$1,905.00" "$1,905.00" "$1,905.00" $952.50 $952.50 "$1,508.76" "$1,905.00" "$1,524.00" $857.25 "$1,905.00" N/A "$1,104.90" "$1,905.00" "$1,143.00" "$1,905.00" "$1,905.00" "$1,905.00" N/A N/A 6337 SUP Custom 27803010 6337 - GRAFT SYNTH TISSUE 50X25X9.5MM BLOCK POROUS MEDPOR BOTH IP/OP "$3,155.00" "$2,335.00" $561.59 "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" $561.59 "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" $657.54 "$3,155.00" "$1,262.00" "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" "$2,366.25" "$3,155.00" "$3,155.00" "$3,155.00" "$1,577.50" "$1,577.50" "$2,498.76" "$3,155.00" "$2,524.00" "$1,419.75" "$3,155.00" N/A "$1,829.90" "$3,155.00" "$1,893.00" "$3,155.00" "$3,155.00" "$3,155.00" N/A N/A 6338 SUP Custom 27803010 6338 - GRAFT SYNTH TISSUE 63X38X3MM BLOCK POROUS MEDPOR POLYETHLENE BOTH IP/OP "$3,155.00" "$2,335.00" $561.59 "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" $561.59 "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" $657.54 "$3,155.00" "$1,262.00" "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" "$3,155.00" "$2,366.25" "$3,155.00" "$3,155.00" "$3,155.00" "$1,577.50" "$1,577.50" "$2,498.76" "$3,155.00" "$2,524.00" "$1,419.75" "$3,155.00" N/A "$1,829.90" "$3,155.00" "$1,893.00" "$3,155.00" "$3,155.00" "$3,155.00" N/A N/A 6339 SUP Custom 27803010 6339 - GRAFT SYNTH TISSUE CNTOUR 38X63X6MM BLOCK MEDPOR BOTH IP/OP "$3,395.00" "$2,512.00" $604.31 "$3,395.00" "$3,395.00" "$3,395.00" "$3,395.00" "$3,395.00" "$3,395.00" "$3,395.00" $604.31 "$3,395.00" "$3,395.00" "$3,395.00" "$3,395.00" "$3,395.00" "$3,395.00" $707.56 "$3,395.00" "$1,358.00" "$3,395.00" "$3,395.00" "$3,395.00" "$3,395.00" "$3,395.00" "$2,546.25" "$3,395.00" "$3,395.00" "$3,395.00" "$1,697.50" "$1,697.50" "$2,688.84" "$3,395.00" "$2,716.00" "$1,527.75" "$3,395.00" N/A "$1,969.10" "$3,395.00" "$2,037.00" "$3,395.00" "$3,395.00" "$3,395.00" N/A N/A 6340 SUP Custom 27803010 6340 - GRAFT SNTH TISS CNTR 38X63X9.5MM STRL MDPR BLCK PE POR BOTH IP/OP "$3,642.50" "$2,695.00" $648.37 "$3,642.50" "$3,642.50" "$3,642.50" "$3,642.50" "$3,642.50" "$3,642.50" "$3,642.50" $648.37 "$3,642.50" "$3,642.50" "$3,642.50" "$3,642.50" "$3,642.50" "$3,642.50" $759.14 "$3,642.50" "$1,457.00" "$3,642.50" "$3,642.50" "$3,642.50" "$3,642.50" "$3,642.50" "$2,731.88" "$3,642.50" "$3,642.50" "$3,642.50" "$1,821.25" "$1,821.25" "$2,884.86" "$3,642.50" "$2,914.00" "$1,639.13" "$3,642.50" N/A "$2,112.65" "$3,642.50" "$2,185.50" "$3,642.50" "$3,642.50" "$3,642.50" N/A N/A 6351 SUP Custom 27803010 6351 - GRAFT SYNTH TISSUE MEDPOR 178X127MM SHEET POROUS BOTH IP/OP "$5,350.00" "$3,959.00" $952.30 "$5,350.00" "$5,350.00" "$5,350.00" "$5,350.00" "$5,350.00" "$5,350.00" "$5,350.00" $952.30 "$5,350.00" "$5,350.00" "$5,350.00" "$5,350.00" "$5,350.00" "$5,350.00" "$1,115.00" "$5,350.00" "$2,140.00" "$5,350.00" "$5,350.00" "$5,350.00" "$5,350.00" "$5,350.00" "$4,012.50" "$5,350.00" "$5,350.00" "$5,350.00" "$2,675.00" "$2,675.00" "$4,237.20" "$5,350.00" "$4,280.00" "$2,407.50" "$5,350.00" N/A "$3,103.00" "$5,350.00" "$3,210.00" "$5,350.00" "$5,350.00" "$5,350.00" N/A N/A 6640 SUP HCPCS C1729 6640 - SYSTEM DRN 7FR 15ML STRL LF TLS EVACUATE TUBE RADOPQ CATH BOTH IP/OP $105.00 $78.00 $20.84 $105.00 $57.02 $57.02 $57.02 $57.02 $105.00 $105.00 $105.00 $21.88 $105.00 $77.93 $77.93 $80.93 $54.71 $21.88 $105.00 $105.00 $62.11 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $68.25 $20.84 N/A $60.90 $105.00 $105.00 $105.00 $21.88 $105.00 N/A N/A 6650 SUP HCPCS C1729 6650 - SYSTEM DRAIN 10FR EVACUATE TUBE RADIOPQ RESERVOIR LATEX FREE BOTH IP/OP $105.00 $78.00 $20.84 $105.00 $57.02 $57.02 $57.02 $57.02 $105.00 $105.00 $105.00 $21.88 $105.00 $77.93 $77.93 $80.93 $54.71 $21.88 $105.00 $105.00 $62.11 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $68.25 $20.84 N/A $60.90 $105.00 $105.00 $105.00 $21.88 $105.00 N/A N/A 7080 SUP HCPCS C1887 7080 - CATHETER GD CS-ST CRV 8FR 49CM STRL LF ACTY BRKWY INTGR BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $157.47 $157.47 $157.47 $157.47 $290.00 $290.00 $290.00 $60.44 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $57.56 N/A $168.20 $290.00 $290.00 $290.00 $60.44 $290.00 N/A N/A 7115 SUP HCPCS A6549 7115 - PROCESSOR TISSUE 28IN 34X64IN PREPROCESSING SOLUTION RAPID BOTH IP/OP $35.00 $26.00 $20.30 $26.25 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $26.25 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $20.30 N/A N/A N/A N/A N/A N/A N/A 7120 SUP HCPCS C1895 7120 - LEAD DEFIBRILLATOR 7FR 65CM 2 COIL DF-4 CONCTR TRUE BIPOL BOTH IP/OP "$10,500.00" "$7,770.00" "$2,083.99" "$10,500.00" "$4,725.00" "$4,725.00" "$4,725.00" "$4,725.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.46" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.32" "$10,500.00" "$10,500.00" "$5,176.50" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$7,875.00" "$10,500.00" "$10,500.00" "$10,500.00" "$5,250.00" "$5,250.00" "$8,316.00" "$10,500.00" "$8,400.00" "$4,725.00" "$2,083.99" N/A "$6,090.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.20" "$10,500.00" N/A N/A 7122 SUP HCPCS C1898 7122 - LEAD PACING BIPOL ACTIVE FIX EXTENDABLE RETRACTABLE HELIX BOTH IP/OP "$10,500.00" "$7,770.00" "$2,188.32" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.32" "$10,500.00" "$4,200.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$7,875.00" "$10,500.00" "$10,500.00" "$10,500.00" "$5,250.00" "$5,250.00" "$8,316.00" "$10,500.00" "$8,400.00" "$4,725.00" "$10,500.00" N/A "$6,090.00" "$10,500.00" "$6,300.00" "$10,500.00" "$10,500.00" "$10,500.00" N/A N/A 7207 SUP Custom 27803010 7207 - IMPLANT ORBTL CONE FLAT 16MM MULTPUR ANTERIOR SURFACE MEDPOR BOTH IP/OP "$1,154.00" $854.00 $205.35 "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" $205.35 "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" $240.44 "$1,153.66" $461.46 "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" $865.50 "$1,153.66" "$1,153.66" "$1,153.66" $576.83 $576.83 $913.70 "$1,153.66" $922.93 $519.15 "$1,153.66" N/A $669.32 "$1,153.66" $692.20 "$1,153.66" "$1,153.66" "$1,153.66" N/A N/A 7208 SUP Custom 27803010 7208 - SAW SURG SAGITTAL SYSTEM 7 BOTH IP/OP "$1,154.00" $854.00 $205.35 "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" $205.35 "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" $240.44 "$1,153.66" $461.46 "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" $865.50 "$1,153.66" "$1,153.66" "$1,153.66" $576.83 $576.83 $913.70 "$1,153.66" $922.93 $519.15 "$1,153.66" N/A $669.32 "$1,153.66" $692.20 "$1,153.66" "$1,153.66" "$1,153.66" N/A N/A 7209 SUP Custom 27803010 7209 - IMPLANT ORBTL CONE FLAT 20MM MULTPUR ANTERIOR SURFACE MEDPOR BOTH IP/OP "$1,154.00" $854.00 $205.35 "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" $205.35 "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" $240.44 "$1,153.66" $461.46 "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" "$1,153.66" $865.50 "$1,153.66" "$1,153.66" "$1,153.66" $576.83 $576.83 $913.70 "$1,153.66" $922.93 $519.15 "$1,153.66" N/A $669.32 "$1,153.66" $692.20 "$1,153.66" "$1,153.66" "$1,153.66" N/A N/A 7210 SUP Custom 27803010 7210 - GRAFT SYNTH TISSUE ULTRATHIN 50X38X.85MM SHEET POROUS MEDPOR BOTH IP/OP $943.50 $698.00 $167.93 $943.40 $943.40 $943.40 $943.40 $943.40 $943.40 $943.40 $167.93 $943.40 $943.40 $943.40 $943.40 $943.40 $943.40 $196.61 $943.40 $377.36 $943.40 $943.40 $943.40 $943.40 $943.40 $707.63 $943.40 $943.40 $943.40 $471.70 $471.70 $747.17 $943.40 $754.72 $424.53 $943.40 N/A $547.23 $943.40 $566.04 $943.40 $943.40 $943.40 N/A N/A 7212 SUP Custom 27100030 7212 - SUPPORT ORTH SM 15-18IN BTRS OPN BCK NPRN FM KN BOTH IP/OP $53.50 $40.00 $9.47 $53.20 $53.20 $53.20 $53.20 $53.20 $53.20 $53.20 $9.47 $53.20 $53.20 $39.49 $39.49 $41.01 $27.72 $11.09 $53.20 $21.28 $53.20 $53.20 $53.20 $53.20 $53.20 $40.13 $53.20 $53.20 $53.20 $26.60 $26.60 $42.13 $53.20 $42.56 $34.58 $53.20 N/A $31.03 $53.20 $31.92 $53.20 $53.20 $53.20 N/A N/A 7212 SUP Custom 27803010 7212 - GRAFT SYNTH TISSUE ULTRATHIN 76X50X.85MM SHEET SMOOTH BOTH IP/OP "$1,204.00" $891.00 $9.47 $903.00 $53.20 $53.20 $53.20 $53.20 $53.20 $53.20 $9.47 $53.20 $53.20 $39.49 $39.49 $41.01 $27.72 $11.09 $53.20 $21.28 $53.20 $53.20 $53.20 $53.20 $53.20 $903.00 $53.20 $53.20 $53.20 $26.60 $26.60 $42.13 $53.20 $42.56 $34.58 $53.20 N/A $698.32 $53.20 $31.92 $53.20 $53.20 $53.20 N/A N/A 7214 SUP Custom 27100030 7214 - SUPPORT ORTH LG 21-24IN BTRS OPN BCK NPRN FM KN BOTH IP/OP $53.50 $40.00 $9.47 $53.20 $53.20 $53.20 $53.20 $53.20 $53.20 $53.20 $9.47 $53.20 $53.20 $39.49 $39.49 $41.01 $27.72 $11.09 $53.20 $21.28 $53.20 $53.20 $53.20 $53.20 $53.20 $40.13 $53.20 $53.20 $53.20 $26.60 $26.60 $42.13 $53.20 $42.56 $34.58 $53.20 N/A $31.03 $53.20 $31.92 $53.20 $53.20 $53.20 N/A N/A 7214 SUP Custom 27803010 7214 - GRAFT SYNTH TISSUE ULTRATHIN 127X76X.85MM SHEET SMOOTH BOTH IP/OP "$2,291.50" "$1,696.00" $9.47 "$1,718.63" $53.20 $53.20 $53.20 $53.20 $53.20 $53.20 $9.47 $53.20 $53.20 $39.49 $39.49 $41.01 $27.72 $11.09 $53.20 $21.28 $53.20 $53.20 $53.20 $53.20 $53.20 "$1,718.63" $53.20 $53.20 $53.20 $26.60 $26.60 $42.13 $53.20 $42.56 $34.58 $53.20 N/A "$1,329.07" $53.20 $31.92 $53.20 $53.20 $53.20 N/A N/A 7216 SUP Custom 27803010 7216 - GRAFT SYNTH TISSUE ULTRATHIN 127X178X.85MM SHEET POROUS BOTH IP/OP "$3,710.00" "$2,745.00" $660.38 "$3,710.00" "$3,710.00" "$3,710.00" "$3,710.00" "$3,710.00" "$3,710.00" "$3,710.00" $660.38 "$3,710.00" "$3,710.00" "$3,710.00" "$3,710.00" "$3,710.00" "$3,710.00" $773.20 "$3,710.00" "$1,484.00" "$3,710.00" "$3,710.00" "$3,710.00" "$3,710.00" "$3,710.00" "$2,782.50" "$3,710.00" "$3,710.00" "$3,710.00" "$1,855.00" "$1,855.00" "$2,938.32" "$3,710.00" "$2,968.00" "$1,669.50" "$3,710.00" N/A "$2,151.80" "$3,710.00" "$2,226.00" "$3,710.00" "$3,710.00" "$3,710.00" N/A N/A 7222 SUP Custom 27803010 7222 - IMPLANT ORBTL CONICAL FLAT ANTERIOR SURFACE CHANNELS POROUS BOTH IP/OP "$1,417.50" "$1,049.00" $213.68 "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" $213.68 "$1,200.45" "$1,200.45" $890.97 $890.97 $925.31 $625.43 $250.19 "$1,200.45" $480.18 "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,063.13" "$1,200.45" "$1,200.45" "$1,200.45" $600.23 $600.23 $950.76 "$1,200.45" $960.36 $780.29 "$1,200.45" "$1,200.45" $822.15 "$1,200.45" $720.27 "$1,200.45" "$1,200.45" "$1,200.45" N/A N/A 7223 SUP Custom 27803010 7223 - IMPLANT ORBTL CONICAL FLAT ANTERIOR SURFACE CHANNELS POROUS BOTH IP/OP "$1,459.50" "$1,080.00" $259.76 "$1,459.35" "$1,459.35" "$1,459.35" "$1,459.35" "$1,459.35" "$1,459.35" "$1,459.35" $259.76 "$1,459.35" "$1,459.35" "$1,459.35" "$1,459.35" "$1,459.35" "$1,459.35" $304.14 "$1,459.35" $583.74 "$1,459.35" "$1,459.35" "$1,459.35" "$1,459.35" "$1,459.35" "$1,094.63" "$1,459.35" "$1,459.35" "$1,459.35" $729.68 $729.68 "$1,155.81" "$1,459.35" "$1,167.48" $656.71 "$1,459.35" N/A $846.51 "$1,459.35" $875.61 "$1,459.35" "$1,459.35" "$1,459.35" N/A N/A 7511 SUP Custom 27803010 7511 - COVER BURR HOLE 5MM 15X3MM SUPERIOR FLANGE POROUS MEDPOR BOTH IP/OP $672.00 $497.00 $119.62 $672.00 $672.00 $672.00 $672.00 $672.00 $672.00 $672.00 $119.62 $672.00 $672.00 $672.00 $672.00 $672.00 $672.00 $140.05 $672.00 $268.80 $672.00 $672.00 $672.00 $672.00 $672.00 $504.00 $672.00 $672.00 $672.00 $336.00 $336.00 $532.22 $672.00 $537.60 $302.40 $672.00 N/A $389.76 $672.00 $403.20 $672.00 $672.00 $672.00 N/A N/A 7512 SUP Custom 27803010 7512 - COVER BURR HOLE 29X17X7MM 3PK CRANIOMAXILLOFACIAL BOTH IP/OP $672.00 $497.00 $119.62 $672.00 $672.00 $672.00 $672.00 $672.00 $672.00 $672.00 $119.62 $672.00 $672.00 $672.00 $672.00 $672.00 $672.00 $140.05 $672.00 $268.80 $672.00 $672.00 $672.00 $672.00 $672.00 $504.00 $672.00 $672.00 $672.00 $336.00 $336.00 $532.22 $672.00 $537.60 $302.40 $672.00 N/A $389.76 $672.00 $403.20 $672.00 $672.00 $672.00 N/A N/A 7514 SUP Custom 27803010 7514 - COVER BURR HOLE 14MM 16MM DISK BOTH IP/OP $340.00 $252.00 $60.52 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $60.52 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $70.86 $340.00 $136.00 $340.00 $340.00 $340.00 $340.00 $340.00 $255.00 $340.00 $340.00 $340.00 $170.00 $170.00 $269.28 $340.00 $272.00 $153.00 $340.00 N/A $197.20 $340.00 $204.00 $340.00 $340.00 $340.00 N/A N/A 7516 SUP Custom 27803010 7516 - GRAFT SYNTH TISSUE SMALL 53X5MM DESIGN A LATEX FREE MEDPOR BOTH IP/OP $777.50 $575.00 $138.38 $777.43 $777.43 $777.43 $777.43 $777.43 $777.43 $777.43 $138.38 $777.43 $777.43 $777.43 $777.43 $777.43 $777.43 $162.02 $777.43 $310.97 $777.43 $777.43 $777.43 $777.43 $777.43 $583.13 $777.43 $777.43 $777.43 $388.72 $388.72 $615.72 $777.43 $621.94 $349.84 $777.43 N/A $450.95 $777.43 $466.46 $777.43 $777.43 $777.43 N/A N/A 7517 SUP Custom 27803010 7517 - GRAFT SYNTH TISSUE LARGE 66X8MM IMPLANT DESIGN A POROUS BOTH IP/OP $777.50 $575.00 $138.38 $777.43 $777.43 $777.43 $777.43 $777.43 $777.43 $777.43 $138.38 $777.43 $777.43 $777.43 $777.43 $777.43 $777.43 $162.02 $777.43 $310.97 $777.43 $777.43 $777.43 $777.43 $777.43 $583.13 $777.43 $777.43 $777.43 $388.72 $388.72 $615.72 $777.43 $621.94 $349.84 $777.43 N/A $450.95 $777.43 $466.46 $777.43 $777.43 $777.43 N/A N/A 7518 SUP Custom 27803010 7518 - GRAFT SYNTH TISSUE LARGE 67X6.5MM IMPLANT DESIGN B POROUS BOTH IP/OP $777.50 $575.00 $138.38 $777.43 $777.43 $777.43 $777.43 $777.43 $777.43 $777.43 $138.38 $777.43 $777.43 $777.43 $777.43 $777.43 $777.43 $162.02 $777.43 $310.97 $777.43 $777.43 $777.43 $777.43 $777.43 $583.13 $777.43 $777.43 $777.43 $388.72 $388.72 $615.72 $777.43 $621.94 $349.84 $777.43 N/A $450.95 $777.43 $466.46 $777.43 $777.43 $777.43 N/A N/A 7520 SUP Custom 27803010 7520 - GRAFT SYNTH TISSUE SMALL 65X37X5MM IMPLANT 1 PIECE DESIGN BOTH IP/OP $961.00 $711.00 $170.98 $960.58 $960.58 $960.58 $960.58 $960.58 $960.58 $960.58 $170.98 $960.58 $960.58 $960.58 $960.58 $960.58 $960.58 $200.20 $960.58 $384.23 $960.58 $960.58 $960.58 $960.58 $960.58 $720.75 $960.58 $960.58 $960.58 $480.29 $480.29 $760.78 $960.58 $768.46 $432.26 $960.58 N/A $557.38 $960.58 $576.35 $960.58 $960.58 $960.58 N/A N/A 7521 SUP Custom 27803010 7521 - GRAFT SYNTH TISSUE MEDIUM 65X37X7MM IMPLANT 1 PIECE DESIGN BOTH IP/OP $961.00 $711.00 $170.98 $960.58 $960.58 $960.58 $960.58 $960.58 $960.58 $960.58 $170.98 $960.58 $960.58 $960.58 $960.58 $960.58 $960.58 $200.20 $960.58 $384.23 $960.58 $960.58 $960.58 $960.58 $960.58 $720.75 $960.58 $960.58 $960.58 $480.29 $480.29 $760.78 $960.58 $768.46 $432.26 $960.58 N/A $557.38 $960.58 $576.35 $960.58 $960.58 $960.58 N/A N/A 7522 SUP Custom 27803010 7522 - GRAFT SYNTH TISSUE LARGE 65X37X10MM IMPLANT 1 PIECE DESIGN BOTH IP/OP $961.00 $711.00 $170.98 $960.58 $960.58 $960.58 $960.58 $960.58 $960.58 $960.58 $170.98 $960.58 $960.58 $960.58 $960.58 $960.58 $960.58 $200.20 $960.58 $384.23 $960.58 $960.58 $960.58 $960.58 $960.58 $720.75 $960.58 $960.58 $960.58 $480.29 $480.29 $760.78 $960.58 $768.46 $432.26 $960.58 N/A $557.38 $960.58 $576.35 $960.58 $960.58 $960.58 N/A N/A 7525 SUP Custom 27803010 7525 - GRAFT SYNTH TISSUE SMALL 55X28X13MM BASE LATEX FREE EAR LEFT BOTH IP/OP "$2,404.00" "$1,779.00" $427.91 "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" $427.91 "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" $501.02 "$2,404.00" $961.60 "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$2,404.00" "$1,803.00" "$2,404.00" "$2,404.00" "$2,404.00" "$1,202.00" "$1,202.00" "$1,903.97" "$2,404.00" "$1,923.20" "$1,081.80" "$2,404.00" N/A "$1,394.32" "$2,404.00" "$1,442.40" "$2,404.00" "$2,404.00" "$2,404.00" N/A N/A 7526 SUP Custom 27803010 7526 - GRAFT SYNTH TISSUE LARGE 65X32X16MM BASE RECONSTRUCTION BOTH IP/OP "$2,454.50" "$1,816.00" $436.88 "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" $436.88 "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" $511.52 "$2,454.38" $981.75 "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" "$1,840.88" "$2,454.38" "$2,454.38" "$2,454.38" "$1,227.19" "$1,227.19" "$1,943.87" "$2,454.38" "$1,963.50" "$1,104.47" "$2,454.38" N/A "$1,423.61" "$2,454.38" "$1,472.63" "$2,454.38" "$2,454.38" "$2,454.38" N/A N/A 7527 SUP Custom 27803010 7527 - GRAFT SYNTH TISSUE LARGE 65X32X16MM LATEX FREE EAR LEFT BOTH IP/OP "$2,454.50" "$1,816.00" $436.88 "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" $436.88 "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" $511.52 "$2,454.38" $981.75 "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" "$2,454.38" "$1,840.88" "$2,454.38" "$2,454.38" "$2,454.38" "$1,227.19" "$1,227.19" "$1,943.87" "$2,454.38" "$1,963.50" "$1,104.47" "$2,454.38" N/A "$1,423.61" "$2,454.38" "$1,472.63" "$2,454.38" "$2,454.38" "$2,454.38" N/A N/A 7535 SUP Custom 27803010 7535 - GRAFT SYNTH TISSUE 47X37X3MM 6.5X3X3MM LATERAL AUGMENTATION BOTH IP/OP "$1,333.50" $987.00 $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $277.84 "$1,333.13" $533.25 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,000.13" "$1,333.13" "$1,333.13" "$1,333.13" $666.57 $666.57 "$1,055.84" "$1,333.13" "$1,066.50" $599.91 "$1,333.13" N/A $773.43 "$1,333.13" $799.88 "$1,333.13" "$1,333.13" "$1,333.13" N/A N/A 7536 SUP Custom 27803010 7536 - GRAFT SYNTH TISSUE ANGLE 47X37X3MM AUGMENTATION ONLAY MEDPOR BOTH IP/OP "$1,333.50" $987.00 $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $277.84 "$1,333.13" $533.25 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,000.13" "$1,333.13" "$1,333.13" "$1,333.13" $666.57 $666.57 "$1,055.84" "$1,333.13" "$1,066.50" $599.91 "$1,333.13" N/A $773.43 "$1,333.13" $799.88 "$1,333.13" "$1,333.13" "$1,333.13" N/A N/A 7538 SUP Custom 27803010 7538 - GRAFT SYNTH TISSUE ANGLE 79X32X5MM E-5 INFERIOR RIDGE MEDPOR BOTH IP/OP "$1,333.50" $987.00 $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $277.84 "$1,333.13" $533.25 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,000.13" "$1,333.13" "$1,333.13" "$1,333.13" $666.57 $666.57 "$1,055.84" "$1,333.13" "$1,066.50" $599.91 "$1,333.13" N/A $773.43 "$1,333.13" $799.88 "$1,333.13" "$1,333.13" "$1,333.13" N/A N/A 7539 SUP Custom 27803010 7539 - GRAFT SYNTH TISSUE 79X32X10MM IMPLANT RAMUS INFERIOR RIDGE BOTH IP/OP "$1,333.50" $987.00 $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $277.84 "$1,333.13" $533.25 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,000.13" "$1,333.13" "$1,333.13" "$1,333.13" $666.57 $666.57 "$1,055.84" "$1,333.13" "$1,066.50" $599.91 "$1,333.13" N/A $773.43 "$1,333.13" $799.88 "$1,333.13" "$1,333.13" "$1,333.13" N/A N/A 7540 SUP HCPCS C1763 7540 - GRAFT SNTH TISS ANG 79X32X10MM STRL MDPR INFR RIDGE PE POR BOTH IP/OP "$1,333.50" $987.00 $264.59 "$1,333.13" $599.91 $599.91 $599.91 $599.91 "$1,333.13" "$1,333.13" "$1,333.13" $277.86 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $277.84 "$1,333.13" "$1,333.13" $788.55 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,000.13" "$1,333.13" "$1,333.13" "$1,333.13" $666.57 $666.57 "$1,055.84" "$1,333.13" "$1,066.50" $599.91 $264.59 N/A $773.43 "$1,333.13" "$1,333.13" "$1,333.13" $277.82 "$1,333.13" N/A N/A 7541 SUP Custom 27803010 7541 - GRAFT SYNTH TISSUE ANGLE 79X32X4MM ES-5 INFERIOR RIDGE BOTH IP/OP "$1,333.50" $987.00 $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $277.84 "$1,333.13" $533.25 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,000.13" "$1,333.13" "$1,333.13" "$1,333.13" $666.57 $666.57 "$1,055.84" "$1,333.13" "$1,066.50" $599.91 "$1,333.13" N/A $773.43 "$1,333.13" $799.88 "$1,333.13" "$1,333.13" "$1,333.13" N/A N/A 7542 SUP Custom 27803010 7542 - GRAFT SYNTH TISSUE ANGLE 5MM 5MM 79MMX32MM 4MMX5MM RAMUS BOTH IP/OP "$1,333.50" $987.00 $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $277.84 "$1,333.13" $533.25 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,000.13" "$1,333.13" "$1,333.13" "$1,333.13" $666.57 $666.57 "$1,055.84" "$1,333.13" "$1,066.50" $599.91 "$1,333.13" N/A $773.43 "$1,333.13" $799.88 "$1,333.13" "$1,333.13" "$1,333.13" N/A N/A 7543 SUP Custom 27803010 7543 - GRAFT SYNTH TISSUE 79X32X10MM IMPLANT RAMUS INFERIOR RIDGE BOTH IP/OP "$1,333.50" $987.00 $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $277.84 "$1,333.13" $533.25 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,000.13" "$1,333.13" "$1,333.13" "$1,333.13" $666.57 $666.57 "$1,055.84" "$1,333.13" "$1,066.50" $599.91 "$1,333.13" N/A $773.43 "$1,333.13" $799.88 "$1,333.13" "$1,333.13" "$1,333.13" N/A N/A 7544 SUP Custom 27803010 7544 - GRAFT SYNTH TISSUE 79X32X10MM IMPLANT RAMUS INFERIOR RIDGE BOTH IP/OP "$1,333.50" $987.00 $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $277.84 "$1,333.13" $533.25 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,000.13" "$1,333.13" "$1,333.13" "$1,333.13" $666.57 $666.57 "$1,055.84" "$1,333.13" "$1,066.50" $599.91 "$1,333.13" N/A $773.43 "$1,333.13" $799.88 "$1,333.13" "$1,333.13" "$1,333.13" N/A N/A 7594 SUP Custom 27203010 REAGENT ANTI-FYB GMA CLN 5ML MNCLN BLOOD BANK BOTH IP/OP "$1,347.50" $997.00 $239.86 "$1,347.50" "$1,347.50" "$1,347.50" "$1,347.50" "$1,347.50" "$1,347.50" "$1,347.50" $239.86 "$1,347.50" "$1,347.50" "$1,000.11" "$1,000.11" "$1,038.65" $702.05 $280.83 "$1,347.50" $539.00 "$1,347.50" "$1,347.50" "$1,347.50" "$1,347.50" "$1,347.50" "$1,010.63" "$1,347.50" "$1,347.50" "$1,347.50" $673.75 $673.75 "$1,067.22" "$1,347.50" "$1,078.00" $875.88 "$1,347.50" N/A $781.55 "$1,347.50" $808.50 "$1,347.50" "$1,347.50" "$1,347.50" N/A N/A 7730 SUP Custom 27100030 7730 - BRACE ORTH MED 18-19.5IN 14-15IN FSN + AIRTECH FRM PD THBWHL BOTH IP/OP $608.00 $450.00 $108.22 $607.98 $607.98 $607.98 $607.98 $607.98 $607.98 $607.98 $108.22 $607.98 $607.98 $451.24 $451.24 $468.63 $316.76 $126.71 $607.98 $243.19 $607.98 $607.98 $607.98 $607.98 $607.98 $456.00 $607.98 $607.98 $607.98 $303.99 $303.99 $481.52 $607.98 $486.38 $395.19 $607.98 N/A $352.64 $607.98 $364.79 $607.98 $607.98 $607.98 N/A N/A 7828 SUP HCPCS C1768 007828 - FABRIC CARDIO THK.61MM 4X4IN KNITTED FILAMENTOUS BARD BOTH IP/OP $254.50 $188.00 $50.49 $254.37 $114.47 $114.47 $114.47 $114.47 $254.37 $254.37 $254.37 $53.02 $254.37 $254.37 $254.37 $254.37 $254.37 $53.01 $254.37 $254.37 $150.46 $254.37 $254.37 $254.37 $254.37 $190.88 $254.37 $254.37 $254.37 $127.19 $127.19 $201.46 $254.37 $203.50 $114.47 $50.49 N/A $147.61 $254.37 $254.37 $254.37 $53.01 $254.37 N/A N/A 7836 SUP HCPCS C1768 7836 - FELT CARDIO 10X10CM THK1.65MM PTFE BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A 7836 SUP HCPCS C1768 007836 - FELT CARDIO THK1.65MM 4X4IN PTFE STERILE BOTH IP/OP $220.50 $163.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $165.38 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $127.89 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A 7837 SUP HCPCS C1768 007837 - FELT CARDIO THK1.65MM 15X15CM PATCH PTFE STERILE BOTH IP/OP $296.00 $219.00 $58.66 $295.55 $133.00 $133.00 $133.00 $133.00 $295.55 $295.55 $295.55 $61.60 $295.55 $295.55 $295.55 $295.55 $295.55 $61.60 $295.55 $295.55 $174.82 $295.55 $295.55 $295.55 $295.55 $222.00 $295.55 $295.55 $295.55 $147.78 $147.78 $234.08 $295.55 $236.44 $133.00 $58.66 N/A $171.68 $295.55 $295.55 $295.55 $61.59 $295.55 N/A N/A 8185 SUP HCPCS C1769 8185 - GUIDEWIRE VASC STRG 185CM PRIMEWIRE PSTG+ PRSS BOTH IP/OP "$1,687.50" "$1,249.00" $334.93 "$1,687.50" $916.31 $916.31 $916.31 $916.31 "$1,687.50" "$1,687.50" "$1,687.50" $351.72 "$1,687.50" "$1,252.46" "$1,252.46" "$1,300.73" $879.19 $351.69 "$1,687.50" "$1,687.50" $998.16 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" "$1,096.88" $334.93 N/A $978.75 "$1,687.50" "$1,687.50" "$1,687.50" $351.68 "$1,687.50" N/A N/A 8305 SUP Custom 27803010 8305 - GRAFT SNTH TISS TRMPT 50X38X1MM STRL MDPR BRR SHT HDPE NPOR BOTH IP/OP "$1,319.50" $976.00 $234.87 "$1,319.50" "$1,319.50" "$1,319.50" "$1,319.50" "$1,319.50" "$1,319.50" "$1,319.50" $234.87 "$1,319.50" "$1,319.50" "$1,319.50" "$1,319.50" "$1,319.50" "$1,319.50" $275.00 "$1,319.50" $527.80 "$1,319.50" "$1,319.50" "$1,319.50" "$1,319.50" "$1,319.50" $989.63 "$1,319.50" "$1,319.50" "$1,319.50" $659.75 $659.75 "$1,045.04" "$1,319.50" "$1,055.60" $593.78 "$1,319.50" N/A $765.31 "$1,319.50" $791.70 "$1,319.50" "$1,319.50" "$1,319.50" N/A N/A 8312 SUP Custom 27803010 8312 - GRAFT SYNTH TISSUE REGULAR 76X50X1MM IMPLANT RECTANGULAR BOTH IP/OP "$1,288.00" $953.00 $229.26 "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" $229.26 "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" $268.43 "$1,288.00" $515.20 "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" $966.00 "$1,288.00" "$1,288.00" "$1,288.00" $644.00 $644.00 "$1,020.10" "$1,288.00" "$1,030.40" $579.60 "$1,288.00" N/A $747.04 "$1,288.00" $772.80 "$1,288.00" "$1,288.00" "$1,288.00" N/A N/A 8313 SUP Custom 27803010 8313 - GRAFT SYNTH TISSUE SMALL ROUND 47X45X3MM 2 PIECE DESIGN BOTH IP/OP "$1,016.50" $752.00 $180.92 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $180.92 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $211.83 "$1,016.40" $406.56 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $762.38 "$1,016.40" "$1,016.40" "$1,016.40" $508.20 $508.20 $804.99 "$1,016.40" $813.12 $457.38 "$1,016.40" N/A $589.57 "$1,016.40" $609.84 "$1,016.40" "$1,016.40" "$1,016.40" N/A N/A 8314 SUP Custom 27803010 8314 - GRAFT SYNTH TISSUE MEDIUM ROUND 47X45X5MM 2 PIECE DESIGN BOTH IP/OP "$1,016.50" $752.00 $180.92 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $180.92 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $211.83 "$1,016.40" $406.56 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $762.38 "$1,016.40" "$1,016.40" "$1,016.40" $508.20 $508.20 $804.99 "$1,016.40" $813.12 $457.38 "$1,016.40" N/A $589.57 "$1,016.40" $609.84 "$1,016.40" "$1,016.40" "$1,016.40" N/A N/A 8315 SUP Custom 27803010 8315 - IMPLANT CHIN LG RND 47X45X7MM STRL MDPR RZ 2 PC DSGN NTCH BOTH IP/OP "$1,016.50" $752.00 $180.92 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $180.92 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $211.83 "$1,016.40" $406.56 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $762.38 "$1,016.40" "$1,016.40" "$1,016.40" $508.20 $508.20 $804.99 "$1,016.40" $813.12 $457.38 "$1,016.40" N/A $589.57 "$1,016.40" $609.84 "$1,016.40" "$1,016.40" "$1,016.40" N/A N/A 8316 SUP Custom 27803010 8316 - GRAFT SYNTH TISSUE 3MM ROUND EXTEND RZ CHIN BOTH IP/OP "$1,016.50" $752.00 $180.92 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $180.92 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $211.83 "$1,016.40" $406.56 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $762.38 "$1,016.40" "$1,016.40" "$1,016.40" $508.20 $508.20 $804.99 "$1,016.40" $813.12 $457.38 "$1,016.40" N/A $589.57 "$1,016.40" $609.84 "$1,016.40" "$1,016.40" "$1,016.40" N/A N/A 8317 SUP Custom 27803010 8317 - IMPLANT CHIN MED SQ 47X45X5MM STRL MDPR RZ 2 PC DSGN NTCH BOTH IP/OP "$1,016.50" $752.00 $180.92 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $180.92 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $211.83 "$1,016.40" $406.56 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $762.38 "$1,016.40" "$1,016.40" "$1,016.40" $508.20 $508.20 $804.99 "$1,016.40" $813.12 $457.38 "$1,016.40" N/A $589.57 "$1,016.40" $609.84 "$1,016.40" "$1,016.40" "$1,016.40" N/A N/A 8318 SUP Custom 27803010 8318 - IMPLANT CHIN LG SQ 47X45X7MM STRL MDPR RZ 2 PC DSGN NTCH TAB BOTH IP/OP "$1,016.50" $752.00 $180.92 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $180.92 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $211.83 "$1,016.40" $406.56 "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" "$1,016.40" $762.38 "$1,016.40" "$1,016.40" "$1,016.40" $508.20 $508.20 $804.99 "$1,016.40" $813.12 $457.38 "$1,016.40" N/A $589.57 "$1,016.40" $609.84 "$1,016.40" "$1,016.40" "$1,016.40" N/A N/A 8319 SUP Custom 27803010 8319 - IMPLANT CHIN 45X41X4MM MGG 2 PC BOTH IP/OP "$1,075.50" $796.00 $191.39 "$1,075.25" "$1,075.25" "$1,075.25" "$1,075.25" "$1,075.25" "$1,075.25" "$1,075.25" $191.39 "$1,075.25" "$1,075.25" "$1,075.25" "$1,075.25" "$1,075.25" "$1,075.25" $224.09 "$1,075.25" $430.10 "$1,075.25" "$1,075.25" "$1,075.25" "$1,075.25" "$1,075.25" $806.63 "$1,075.25" "$1,075.25" "$1,075.25" $537.63 $537.63 $851.60 "$1,075.25" $860.20 $483.86 "$1,075.25" N/A $623.79 "$1,075.25" $645.15 "$1,075.25" "$1,075.25" "$1,075.25" N/A N/A 8320 SUP Custom 27803010 8320 - GRAFT SNTH TISS SM 56X33X5MM STRL MDPR IMPL 2 PC PRJ TPR WNG BOTH IP/OP $894.00 $662.00 $159.09 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $159.09 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $186.27 $893.75 $357.50 $893.75 $893.75 $893.75 $893.75 $893.75 $670.50 $893.75 $893.75 $893.75 $446.88 $446.88 $707.85 $893.75 $715.00 $402.19 $893.75 N/A $518.52 $893.75 $536.25 $893.75 $893.75 $893.75 N/A N/A 8321 SUP Custom 27803010 8321 - GRAFT SYNTH TISSUE 56X36X7MM IMPLANT 2 PIECE MEDIUM BOTH IP/OP $894.00 $662.00 $159.09 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $159.09 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $186.27 $893.75 $357.50 $893.75 $893.75 $893.75 $893.75 $893.75 $670.50 $893.75 $893.75 $893.75 $446.88 $446.88 $707.85 $893.75 $715.00 $402.19 $893.75 N/A $518.52 $893.75 $536.25 $893.75 $893.75 $893.75 N/A N/A 8322 SUP Custom 27803010 8322 - GRAFT SYNTH TISSUE 56X36X7MM IMPLANT 2 PIECE LARGE BOTH IP/OP $894.00 $662.00 $159.09 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $159.09 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $186.27 $893.75 $357.50 $893.75 $893.75 $893.75 $893.75 $893.75 $670.50 $893.75 $893.75 $893.75 $446.88 $446.88 $707.85 $893.75 $715.00 $402.19 $893.75 N/A $518.52 $893.75 $536.25 $893.75 $893.75 $893.75 N/A N/A 8328 SUP Custom 27803010 8328 - GRAFT SYNTH TISSUE 62X37MM IMPLANT HELICAL RIM POROUS MEDPOR BOTH IP/OP "$1,226.00" $907.00 $218.16 "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" $218.16 "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" $255.43 "$1,225.63" $490.25 "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" $919.50 "$1,225.63" "$1,225.63" "$1,225.63" $612.82 $612.82 $970.70 "$1,225.63" $980.50 $551.53 "$1,225.63" N/A $711.08 "$1,225.63" $735.38 "$1,225.63" "$1,225.63" "$1,225.63" N/A N/A 8329 SUP Custom 27803010 8329 - GRAFT SYNTH TISSUE 62X37MM HELICAL RIM POROUS MEDPOR BOTH IP/OP "$1,226.00" $907.00 $218.16 "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" $218.16 "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" $255.43 "$1,225.63" $490.25 "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" "$1,225.63" $919.50 "$1,225.63" "$1,225.63" "$1,225.63" $612.82 $612.82 $970.70 "$1,225.63" $980.50 $551.53 "$1,225.63" N/A $711.08 "$1,225.63" $735.38 "$1,225.63" "$1,225.63" "$1,225.63" N/A N/A 8330 SUP Custom 27803010 8330 - GRAFT SYNTH TISSUE 60X30MM IMPLANT EXTENDED BASE POROUS BOTH IP/OP "$2,263.00" "$1,675.00" $402.74 "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" $402.74 "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" $471.55 "$2,262.60" $905.04 "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" "$1,697.25" "$2,262.60" "$2,262.60" "$2,262.60" "$1,131.30" "$1,131.30" "$1,791.98" "$2,262.60" "$1,810.08" "$1,018.17" "$2,262.60" N/A "$1,312.54" "$2,262.60" "$1,357.56" "$2,262.60" "$2,262.60" "$2,262.60" N/A N/A 8331 SUP Custom 27803010 8331 - GRAFT SYNTH TISSUE 60X30MM BASE EXTENDED POROUS MEDPOR BOTH IP/OP "$2,263.00" "$1,675.00" $402.74 "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" $402.74 "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" $471.55 "$2,262.60" $905.04 "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" "$2,262.60" "$1,697.25" "$2,262.60" "$2,262.60" "$2,262.60" "$1,131.30" "$1,131.30" "$1,791.98" "$2,262.60" "$1,810.08" "$1,018.17" "$2,262.60" N/A "$1,312.54" "$2,262.60" "$1,357.56" "$2,262.60" "$2,262.60" "$2,262.60" N/A N/A 8340 SUP Custom 27803010 8340 - GRAFT SYNTH TISSUE SMALL 60X25X5MM IMPLANT GENIOPLASTY WEDGE BOTH IP/OP $985.00 $729.00 $175.28 $984.70 $984.70 $984.70 $984.70 $984.70 $984.70 $984.70 $175.28 $984.70 $984.70 $984.70 $984.70 $984.70 $984.70 $205.22 $984.70 $393.88 $984.70 $984.70 $984.70 $984.70 $984.70 $738.75 $984.70 $984.70 $984.70 $492.35 $492.35 $779.88 $984.70 $787.76 $443.12 $984.70 N/A $571.30 $984.70 $590.82 $984.70 $984.70 $984.70 N/A N/A 8341 SUP Custom 27803010 8341 - GRAFT SYNTH TISSUE MEDIUM 60X25X7.5MM IMPLANT GENIOPLASTY BOTH IP/OP $985.00 $729.00 $175.28 $984.70 $984.70 $984.70 $984.70 $984.70 $984.70 $984.70 $175.28 $984.70 $984.70 $984.70 $984.70 $984.70 $984.70 $205.22 $984.70 $393.88 $984.70 $984.70 $984.70 $984.70 $984.70 $738.75 $984.70 $984.70 $984.70 $492.35 $492.35 $779.88 $984.70 $787.76 $443.12 $984.70 N/A $571.30 $984.70 $590.82 $984.70 $984.70 $984.70 N/A N/A 8342 SUP Custom 27803010 8342 - GRAFT SYNTH TISSUE LARGE 60X25X10MM IMPLANT GENIOPLASTY BOTH IP/OP "$1,096.00" $811.00 $195.09 "$1,096.00" "$1,096.00" "$1,096.00" "$1,096.00" "$1,096.00" "$1,096.00" "$1,096.00" $195.09 "$1,096.00" "$1,096.00" "$1,096.00" "$1,096.00" "$1,096.00" "$1,096.00" $228.42 "$1,096.00" $438.40 "$1,096.00" "$1,096.00" "$1,096.00" "$1,096.00" "$1,096.00" $822.00 "$1,096.00" "$1,096.00" "$1,096.00" $548.00 $548.00 $868.03 "$1,096.00" $876.80 $493.20 "$1,096.00" N/A $635.68 "$1,096.00" $657.60 "$1,096.00" "$1,096.00" "$1,096.00" N/A N/A 8438 SUP Custom 27803010 8438 - GRAFT SYNTH TISSUE MICROTHIN 50X30X.4MM SHEET MEDPOR BOTH IP/OP $961.50 $712.00 $171.12 $961.35 $961.35 $961.35 $961.35 $961.35 $961.35 $961.35 $171.12 $961.35 $961.35 $961.35 $961.35 $961.35 $961.35 $200.36 $961.35 $384.54 $961.35 $961.35 $961.35 $961.35 $961.35 $721.13 $961.35 $961.35 $961.35 $480.68 $480.68 $761.39 $961.35 $769.08 $432.61 $961.35 N/A $557.67 $961.35 $576.81 $961.35 $961.35 $961.35 N/A N/A 8536 SUP Custom 27203010 8536 - NEEDLE SUT ULTHN STRL HI-FI 2 ARM SS MNSCL BOTH IP/OP $117.00 $87.00 $20.79 $116.80 $116.80 $116.80 $116.80 $116.80 $116.80 $116.80 $20.79 $116.80 $116.80 $86.69 $86.69 $90.03 $60.85 $24.34 $116.80 $46.72 $116.80 $116.80 $116.80 $116.80 $116.80 $87.75 $116.80 $116.80 $116.80 $58.40 $58.40 $92.51 $116.80 $93.44 $75.92 $116.80 N/A $67.86 $116.80 $70.08 $116.80 $116.80 $116.80 N/A N/A 8570 SUP Custom 27203010 8570 - NEEDLE SUT BLU STRL ZN SPC II REPR EYLT NTNL MNSCS BOTH IP/OP $64.50 $48.00 $11.46 $64.38 $64.38 $64.38 $64.38 $64.38 $64.38 $64.38 $11.46 $64.38 $64.38 $47.78 $47.78 $49.62 $33.54 $13.42 $64.38 $25.75 $64.38 $64.38 $64.38 $64.38 $64.38 $48.38 $64.38 $64.38 $64.38 $32.19 $32.19 $50.99 $64.38 $51.50 $41.85 $64.38 N/A $37.41 $64.38 $38.63 $64.38 $64.38 $64.38 N/A N/A 8630 SUP HCPCS C1769 8630 - GUIDEWIRE VASC STRG .038IN 175CM FXCR PTFE BOTH IP/OP $26.50 $20.00 $15.37 $19.88 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $19.88 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $15.37 N/A N/A N/A N/A N/A N/A N/A 8662 SUP Custom 27803010 8662 - GRAFT SYNTH TISSUE MICROTHIN 76X127MM SHEET POROUS MEDPOR BOTH IP/OP "$2,242.50" "$1,659.00" $399.15 "$2,242.40" "$2,242.40" "$2,242.40" "$2,242.40" "$2,242.40" "$2,242.40" "$2,242.40" $399.15 "$2,242.40" "$2,242.40" "$2,242.40" "$2,242.40" "$2,242.40" "$2,242.40" $467.34 "$2,242.40" $896.96 "$2,242.40" "$2,242.40" "$2,242.40" "$2,242.40" "$2,242.40" "$1,681.88" "$2,242.40" "$2,242.40" "$2,242.40" "$1,121.20" "$1,121.20" "$1,775.98" "$2,242.40" "$1,793.92" "$1,009.08" "$2,242.40" N/A "$1,300.65" "$2,242.40" "$1,345.44" "$2,242.40" "$2,242.40" "$2,242.40" N/A N/A 8703 SUP Custom 27803010 8703 - GRAFT SYNTH TISSUE SPHERE 21MM MEDPOR POLYETHYLENE POROUS BOTH IP/OP "$1,071.50" $793.00 $190.67 "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" $190.67 "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" $223.25 "$1,071.20" $428.48 "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" $803.63 "$1,071.20" "$1,071.20" "$1,071.20" $535.60 $535.60 $848.39 "$1,071.20" $856.96 $482.04 "$1,071.20" N/A $621.47 "$1,071.20" $642.72 "$1,071.20" "$1,071.20" "$1,071.20" N/A N/A 8704 SUP Custom 27803010 8704 - GRAFT SYNTH TISSUE SPHERE 23MM MEDPOR POLYETHYLENE POROUS BOTH IP/OP "$1,071.50" $793.00 $190.67 "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" $190.67 "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" $223.25 "$1,071.20" $428.48 "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" "$1,071.20" $803.63 "$1,071.20" "$1,071.20" "$1,071.20" $535.60 $535.60 $848.39 "$1,071.20" $856.96 $482.04 "$1,071.20" N/A $621.47 "$1,071.20" $642.72 "$1,071.20" "$1,071.20" "$1,071.20" N/A N/A 8800 SUP Custom 27203010 8800 - KIT ARTHRO PINN-ACL ACL DISPOSABLE BOTH IP/OP $319.50 $236.00 $56.84 $319.30 $319.30 $319.30 $319.30 $319.30 $319.30 $319.30 $56.84 $319.30 $319.30 $236.98 $236.98 $246.12 $166.36 $66.55 $319.30 $127.72 $319.30 $319.30 $319.30 $319.30 $319.30 $239.63 $319.30 $319.30 $319.30 $159.65 $159.65 $252.89 $319.30 $255.44 $207.55 $319.30 N/A $185.31 $319.30 $191.58 $319.30 $319.30 $319.30 N/A N/A 8814 SUP Custom 27011340 08814 - BRACE ORTH 30.5- IN 17-27IN TSCP BRIDGETECH ROM HNG PRMR TRM BOTH IP/OP $185.50 $137.00 $32.95 $185.10 $185.10 $185.10 $185.10 $185.10 $185.10 $185.10 $32.95 $185.10 $185.10 $137.38 $137.38 $142.68 $96.44 $38.58 $185.10 $76.26 $185.10 $185.10 $185.10 $185.10 $185.10 $139.13 $185.10 $185.10 $185.10 $92.55 $92.55 $146.60 $185.10 $148.08 $120.32 $185.10 N/A $107.59 $185.10 $111.06 $185.10 $185.10 $185.10 N/A N/A 9019 SUP Custom 27803010 9019 - RESERVOIR SHUNT 18MM CSF VENTRICULAR CATHETER CONVERTIBLE BOTH IP/OP $888.50 $657.00 $158.11 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $158.11 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $185.12 $888.25 $355.30 $888.25 $888.25 $888.25 $888.25 $888.25 $666.38 $888.25 $888.25 $888.25 $444.13 $444.13 $703.49 $888.25 $710.60 $399.71 $888.25 N/A $515.33 $888.25 $532.95 $888.25 $888.25 $888.25 N/A N/A 9025 SUP Custom 27803010 9025 - SHUNT NEUROSURGICAL STANDARD 23CM VENTRICULAR CATHETER EXTRA BOTH IP/OP $356.50 $264.00 $63.41 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $63.41 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $74.25 $356.25 $142.50 $356.25 $356.25 $356.25 $356.25 $356.25 $267.38 $356.25 $356.25 $356.25 $178.13 $178.13 $282.15 $356.25 $285.00 $160.31 $356.25 N/A $206.77 $356.25 $213.75 $356.25 $356.25 $356.25 N/A N/A 9031 SUP Custom 27203010 9031 - DEVICE BRACHYTHERAPY CAVITY EVALUATION TARGET MAMMOSITE BOTH IP/OP $372.50 $276.00 $66.31 $372.50 $372.50 $372.50 $372.50 $372.50 $372.50 $372.50 $66.31 $372.50 $372.50 $276.47 $276.47 $287.12 $194.07 $77.63 $372.50 $149.00 $372.50 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $242.13 $372.50 N/A $216.05 $372.50 $223.50 $372.50 $372.50 $372.50 N/A N/A 9032 SUP Custom 27803010 9032 - CATHETER DRAIN INTROD QUICK RELEASE VENTRICULAR DISPOSABLE BOTH IP/OP $271.00 $201.00 $48.19 $270.75 $270.75 $270.75 $270.75 $270.75 $270.75 $270.75 $48.19 $270.75 $270.75 $270.75 $270.75 $270.75 $270.75 $56.43 $270.75 $108.30 $270.75 $270.75 $270.75 $270.75 $270.75 $203.25 $270.75 $270.75 $270.75 $135.38 $135.38 $214.43 $270.75 $216.60 $121.84 $270.75 N/A $157.18 $270.75 $162.45 $270.75 $270.75 $270.75 N/A N/A 9053 SUP Custom 27203010 9053 - RESERVOIR SHUNT 12MM CSF VENTRICULAR CATHETER CONVERTIBLE BOTH IP/OP $888.50 $657.00 $158.11 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $158.11 $888.25 $888.25 $659.26 $659.26 $684.66 $462.78 $185.12 $888.25 $355.30 $888.25 $888.25 $888.25 $888.25 $888.25 $666.38 $888.25 $888.25 $888.25 $444.13 $444.13 $703.49 $888.25 $710.60 $577.36 $888.25 N/A $515.33 $888.25 $532.95 $888.25 $888.25 $888.25 N/A N/A 9073 SUP Custom 27203010 9073 - STOCKINETTE ORTHOPEDIC 25YDX3IN HIGH ABSORBENT KNIT LATEX BOTH IP/OP $29.00 $21.00 $5.13 $28.80 $28.80 $28.80 $28.80 $28.80 $28.80 $28.80 $5.13 $28.80 $28.80 $21.38 $21.38 $22.20 $15.00 $6.00 $28.80 $11.52 $28.80 $28.80 $28.80 $28.80 $28.80 $21.75 $28.80 $28.80 $28.80 $14.40 $14.40 $22.81 $28.80 $23.04 $18.72 $28.80 N/A $16.82 $28.80 $17.28 $28.80 $28.80 $28.80 N/A N/A 9094 SUP Custom 27203010 9094 - STIMULATOR NRV STRL LF CKPNT LCTR DISP BOTH IP/OP "$1,565.00" "$1,158.00" $278.57 "$1,565.00" "$1,565.00" "$1,565.00" "$1,565.00" "$1,565.00" "$1,565.00" "$1,565.00" $278.57 "$1,565.00" "$1,565.00" "$1,161.54" "$1,161.54" "$1,206.30" $815.37 $326.16 "$1,565.00" $626.00 "$1,565.00" "$1,565.00" "$1,565.00" "$1,565.00" "$1,565.00" "$1,173.75" "$1,565.00" "$1,565.00" "$1,565.00" $782.50 $782.50 "$1,239.48" "$1,565.00" "$1,252.00" "$1,017.25" "$1,565.00" N/A $907.70 "$1,565.00" $939.00 "$1,565.00" "$1,565.00" "$1,565.00" N/A N/A 9305 SUP Custom 27803010 9305 - GRAFT SYNTH TISSUE TRUMPET 50X30X1.6MM SHEET BARRIER MEDPOR BOTH IP/OP "$1,380.00" "$1,021.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $287.61 "$1,380.00" $552.00 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,035.00" "$1,380.00" "$1,380.00" "$1,380.00" $690.00 $690.00 "$1,092.96" "$1,380.00" "$1,104.00" $621.00 "$1,380.00" N/A $800.40 "$1,380.00" $828.00 "$1,380.00" "$1,380.00" "$1,380.00" N/A N/A 9312 SUP Custom 27803010 9312 - GRAFT SYNTH TISSUE RECTANGLE 76X50X1.6MM IMPLANT NONPOROUS BOTH IP/OP "$1,278.00" $946.00 $227.43 "$1,277.70" "$1,277.70" "$1,277.70" "$1,277.70" "$1,277.70" "$1,277.70" "$1,277.70" $227.43 "$1,277.70" "$1,277.70" "$1,277.70" "$1,277.70" "$1,277.70" "$1,277.70" $266.29 "$1,277.70" $511.08 "$1,277.70" "$1,277.70" "$1,277.70" "$1,277.70" "$1,277.70" $958.50 "$1,277.70" "$1,277.70" "$1,277.70" $638.85 $638.85 "$1,011.94" "$1,277.70" "$1,022.16" $574.97 "$1,277.70" N/A $741.24 "$1,277.70" $766.62 "$1,277.70" "$1,277.70" "$1,277.70" N/A N/A 9429 SUP Custom 27803010 9429 - GRAFT SYNTH TISSUE 43X18MM FLANGE MEDPOR POLYETHYLENE POROUS BOTH IP/OP "$1,310.00" $969.00 $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $233.18 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $273.02 "$1,310.00" $524.00 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $589.50 "$1,310.00" N/A $759.80 "$1,310.00" $786.00 "$1,310.00" "$1,310.00" "$1,310.00" N/A N/A 9430 SUP Custom 27803010 9430 - GRAFT SYNTH TISSUE INFERIOR ORBTL RIM RIGHT BOTH IP/OP "$1,310.00" $969.00 $2.33 $982.50 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $11.18 $2.33 $11.18 $4.47 $11.18 $11.18 $11.18 $11.18 $11.18 $982.50 $11.18 $11.18 $11.18 $5.59 $5.59 $8.85 $11.18 $8.94 $7.27 $11.18 $11.18 $759.80 $11.18 $6.71 $11.18 $11.18 $11.18 N/A N/A 9500 SUP HCPCS A4363 9500 - CLAMP OST LF CLPLST SMPL CLSR DRN PCH BOTH IP/OP $1.50 $1.00 $0.87 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $1.13 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $0.87 $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9500 SUP HCPCS C1769 9500 - GUIDEWIRE VASC 3CM COMBOWIRE XT FLXB SHFT DPLR PTFE HDRPHB BOTH IP/OP "$2,750.00" "$2,035.00" $1.25 "$2,062.50" $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 "$2,062.50" $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 "$1,595.00" $6.00 $3.60 $6.00 $6.00 $6.00 N/A N/A 9501 SUP Custom 27803010 9501 - GRAFT SYNTH TISSUE SUPER PETITE 50X19X3MM IMPLANT TAPERED BOTH IP/OP $894.00 $662.00 $19.74 $670.50 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $94.73 $19.74 $94.73 $37.89 $94.73 $94.73 $94.73 $94.73 $94.73 $670.50 $94.73 $94.73 $94.73 $47.37 $47.37 $75.03 $94.73 $75.78 $61.57 $94.73 $94.73 $518.52 $94.73 $56.84 $94.73 $94.73 $94.73 N/A N/A 9502 SUP Custom 27803010 9502 - GRAFT SYNTH TISSUE SUPER PETITE 50X19X3MM IMPLANT TAPERED BOTH IP/OP $894.00 $662.00 $38.20 $670.50 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $183.30 $38.20 $183.30 $73.32 $183.30 $183.30 $183.30 $183.30 $183.30 $670.50 $183.30 $183.30 $183.30 $91.65 $91.65 $145.17 $183.30 $146.64 $119.15 $183.30 $183.30 $518.52 $183.30 $109.98 $183.30 $183.30 $183.30 N/A N/A 9503 SUP Custom 27803010 9503 - GRAFT SYNTH TISSUE PETITE 50X19X5MM IMPLANT POROUS MEDPOR BOTH IP/OP $894.00 $662.00 $159.09 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $159.09 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $186.27 $893.75 $357.50 $893.75 $893.75 $893.75 $893.75 $893.75 $670.50 $893.75 $893.75 $893.75 $446.88 $446.88 $707.85 $893.75 $715.00 $402.19 $893.75 N/A $518.52 $893.75 $536.25 $893.75 $893.75 $893.75 N/A N/A 9504 SUP Custom 27803010 9504 - GRAFT SYNTH TISSUE PETITE 50X19X5MM IMPLANT TAPERED POROUS BOTH IP/OP $894.00 $662.00 $159.09 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $159.09 $893.75 $893.75 $893.75 $893.75 $893.75 $893.75 $186.27 $893.75 $357.50 $893.75 $893.75 $893.75 $893.75 $893.75 $670.50 $893.75 $893.75 $893.75 $446.88 $446.88 $707.85 $893.75 $715.00 $402.19 $893.75 N/A $518.52 $893.75 $536.25 $893.75 $893.75 $893.75 N/A N/A 9513 SUP Custom 27803010 9513 - GRAFT SYNTH TISSUE SMALL CNTOUR 45X24X3MM TRIM AUGMENTATION BOTH IP/OP $936.00 $693.00 $166.54 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $166.54 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $195.00 $935.63 $374.25 $935.63 $935.63 $935.63 $935.63 $935.63 $702.00 $935.63 $935.63 $935.63 $467.82 $467.82 $741.02 $935.63 $748.50 $421.03 $935.63 N/A $542.88 $935.63 $561.38 $935.63 $935.63 $935.63 N/A N/A 9514 SUP Custom 27803010 9514 - GRAFT SYNTH TISSUE SMALL 45X24X3MM EXTEND DESIGN MEDPOR BOTH IP/OP $936.00 $693.00 $166.54 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $166.54 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $195.00 $935.63 $374.25 $935.63 $935.63 $935.63 $935.63 $935.63 $702.00 $935.63 $935.63 $935.63 $467.82 $467.82 $741.02 $935.63 $748.50 $421.03 $935.63 N/A $542.88 $935.63 $561.38 $935.63 $935.63 $935.63 N/A N/A 9515 SUP Custom 27803010 9515 - GRAFT SYNTH TISSUE MEDIUM CNTOUR 50X26X4MM EXTEND MEDPOR BOTH IP/OP $936.00 $693.00 $166.54 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $166.54 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $195.00 $935.63 $374.25 $935.63 $935.63 $935.63 $935.63 $935.63 $702.00 $935.63 $935.63 $935.63 $467.82 $467.82 $741.02 $935.63 $748.50 $421.03 $935.63 N/A $542.88 $935.63 $561.38 $935.63 $935.63 $935.63 N/A N/A 9516 SUP Custom 27803010 9516 - GRAFT SNTH TISS MED 50X26X4MM STRL LF MDPR XTD CNTR PE POR BOTH IP/OP $936.00 $693.00 $1.64 $702.00 $9.21 $9.21 $9.21 $9.21 $9.21 $9.21 $1.64 $9.21 $9.21 $6.84 $6.84 $7.10 $4.80 $1.92 $9.21 $3.68 $9.21 $9.21 $9.21 $9.21 $9.21 $702.00 $9.21 $9.21 $9.21 $4.61 $4.61 $7.29 $9.21 $7.37 $5.99 $9.21 $9.21 $542.88 $9.21 $5.53 $9.21 $9.21 $9.21 N/A N/A 9517 SUP Custom 27803010 9517 - GRAFT SNTH TISS LG 55X27X5MM STRL MDPR XTD CNTR POR PE BOTH IP/OP $936.00 $693.00 $166.54 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $166.54 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $195.00 $935.63 $374.25 $935.63 $935.63 $935.63 $935.63 $935.63 $702.00 $935.63 $935.63 $935.63 $467.82 $467.82 $741.02 $935.63 $748.50 $421.03 $935.63 N/A $542.88 $935.63 $561.38 $935.63 $935.63 $935.63 N/A N/A 9518 SUP Custom 27803010 9518 - GRAFT SYNTH TISSUE LARGE 55X27X5MM EXTEND SHAPE MEDPOR BOTH IP/OP $936.00 $693.00 $166.54 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $166.54 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $195.00 $935.63 $374.25 $935.63 $935.63 $935.63 $935.63 $935.63 $702.00 $935.63 $935.63 $935.63 $467.82 $467.82 $741.02 $935.63 $748.50 $421.03 $935.63 N/A $542.88 $935.63 $561.38 $935.63 $935.63 $935.63 N/A N/A 9519 SUP Custom 27803010 9519 - GRAFT SYNTH TISSUE PARANASAL CRESCENT PETITE 28X26X4.5MM BOTH IP/OP $926.00 $685.00 $164.75 $925.58 $925.58 $925.58 $925.58 $925.58 $925.58 $925.58 $164.75 $925.58 $925.58 $925.58 $925.58 $925.58 $925.58 $192.90 $925.58 $370.23 $925.58 $925.58 $925.58 $925.58 $925.58 $694.50 $925.58 $925.58 $925.58 $462.79 $462.79 $733.06 $925.58 $740.46 $416.51 $925.58 N/A $537.08 $925.58 $555.35 $925.58 $925.58 $925.58 N/A N/A 9520 SUP Custom 27803010 9520 - GRAFT SYNTH TISSUE PARANASAL CRESCENT PETITE 28X26X4.5MM BOTH IP/OP $926.00 $685.00 $164.75 $925.58 $925.58 $925.58 $925.58 $925.58 $925.58 $925.58 $164.75 $925.58 $925.58 $925.58 $925.58 $925.58 $925.58 $192.90 $925.58 $370.23 $925.58 $925.58 $925.58 $925.58 $925.58 $694.50 $925.58 $925.58 $925.58 $462.79 $462.79 $733.06 $925.58 $740.46 $416.51 $925.58 N/A $537.08 $925.58 $555.35 $925.58 $925.58 $925.58 N/A N/A 9521 SUP Custom 27803010 9521 - GRAFT SYNTH TISSUE SMALL 70X70X10MM SMOOTH FLEXIBLE AUGMENT BOTH IP/OP "$2,870.00" "$2,124.00" $510.79 "$2,869.60" "$2,869.60" "$2,869.60" "$2,869.60" "$2,869.60" "$2,869.60" "$2,869.60" $510.79 "$2,869.60" "$2,869.60" "$2,869.60" "$2,869.60" "$2,869.60" "$2,869.60" $598.06 "$2,869.60" "$1,147.84" "$2,869.60" "$2,869.60" "$2,869.60" "$2,869.60" "$2,869.60" "$2,152.50" "$2,869.60" "$2,869.60" "$2,869.60" "$1,434.80" "$1,434.80" "$2,272.72" "$2,869.60" "$2,295.68" "$1,291.32" "$2,869.60" N/A "$1,664.60" "$2,869.60" "$1,721.76" "$2,869.60" "$2,869.60" "$2,869.60" N/A N/A 9522 SUP Custom 27803010 9522 - GRAFT SYNTH TISSUE MEDIUM 88X86X15MM SMOOTH FLEXIBLE AUGMENT BOTH IP/OP "$2,989.00" "$2,212.00" $531.97 "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" $531.97 "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" $622.86 "$2,988.60" "$1,195.44" "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" "$2,988.60" "$2,241.75" "$2,988.60" "$2,988.60" "$2,988.60" "$1,494.30" "$1,494.30" "$2,366.97" "$2,988.60" "$2,390.88" "$1,344.87" "$2,988.60" N/A "$1,733.62" "$2,988.60" "$1,793.16" "$2,988.60" "$2,988.60" "$2,988.60" N/A N/A 9523 SUP Custom 27803010 9523 - GRAFT SYNTH TISSUE LARGE 98X95X18MM SMOOTH FLEXIBLE AUGMENT BOTH IP/OP "$3,102.50" "$2,296.00" $17.97 "$2,326.88" $86.21 $86.21 $86.21 $86.21 $86.21 $86.21 $29.03 $86.21 $86.21 $31.30 $31.30 $32.51 $30.10 $17.97 $86.21 $34.48 $86.21 $86.21 $86.21 $86.21 $86.21 "$2,326.88" $86.21 $86.21 $86.21 $43.11 $43.11 $68.28 $86.21 $68.97 $38.79 $86.21 $86.21 "$1,799.45" $86.21 $51.73 $86.21 $86.21 $86.21 N/A N/A 9524 SUP Custom 27803010 9524 - GRAFT SYNTH TISSUE THK6MM 107MMX97 GRID CNTOUR MEDPOR BOTH IP/OP "$7,351.00" "$5,440.00" "$1,308.44" "$7,350.80" "$7,350.80" "$7,350.80" "$7,350.80" "$7,350.80" "$7,350.80" "$7,350.80" "$1,308.44" "$7,350.80" "$7,350.80" "$7,350.80" "$7,350.80" "$7,350.80" "$7,350.80" "$1,531.99" "$7,350.80" "$2,940.32" "$7,350.80" "$7,350.80" "$7,350.80" "$7,350.80" "$7,350.80" "$5,513.25" "$7,350.80" "$7,350.80" "$7,350.80" "$3,675.40" "$3,675.40" "$5,821.83" "$7,350.80" "$5,880.64" "$3,307.86" "$7,350.80" N/A "$4,263.58" "$7,350.80" "$4,410.48" "$7,350.80" "$7,350.80" "$7,350.80" N/A N/A 9525 SUP Custom 27803010 9525 - GRAFT SYNTH TISSUE PARANASAL CRESCENT LARGE 30X28X7MM BOTH IP/OP $926.00 $685.00 $1.34 $694.50 $7.54 $7.54 $7.54 $7.54 $7.54 $7.54 $1.34 $7.54 $7.54 $5.60 $5.60 $5.81 $3.93 $1.57 $7.54 $3.02 $7.54 $7.54 $7.54 $7.54 $7.54 $694.50 $7.54 $7.54 $7.54 $3.77 $3.77 $5.97 $7.54 $6.03 $4.90 $7.54 $7.54 $537.08 $7.54 $4.52 $7.54 $7.54 $7.54 N/A N/A 9526 SUP Custom 27803010 9526 - GRAFT SYNTH TISSUE PARANASAL CRESCENT LARGE 30X28X7MM BOTH IP/OP $926.00 $685.00 $29.86 $694.50 $143.28 $143.28 $143.28 $143.28 $143.28 $143.28 $56.14 $143.28 $143.28 $45.67 $45.67 $47.42 $43.91 $29.86 $143.28 $57.31 $143.28 $143.28 $143.28 $143.28 $143.28 $694.50 $143.28 $143.28 $143.28 $71.64 $71.64 $113.48 $143.28 $114.62 $64.48 $143.28 $143.28 $537.08 $143.28 $85.97 $143.28 $143.28 $143.28 N/A N/A 9527 SUP Custom 27803010 9527 - GRAFT SYNTH TISSUE 38X50X.85MM 1 CHANNEL SHEET MICROPLATE BOTH IP/OP $1.00 $1.00 $0.18 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.18 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $1.00 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $1.00 N/A $0.58 $1.00 $0.60 $1.00 $1.00 $1.00 N/A N/A 9529 SUP Custom 27203010 9529 - SLEEVE CMPR MED KN LGTH 21- IN NS LF KDL SCD EXP ADJ CRCMF BOTH IP/OP $32.50 $24.00 $5.79 $83.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $5.79 $32.50 $32.50 $24.12 $24.12 $25.05 $16.93 $6.77 $32.50 $9.73 $32.50 $32.50 $83.50 $32.50 $32.50 $24.38 $32.50 $32.50 $32.50 $16.25 $16.25 $25.74 $32.50 $26.00 $21.13 $32.50 N/A $18.85 $32.50 $19.50 $32.50 $32.50 $32.50 N/A N/A 9530 SUP HCPCS C1763 9530 - GRAFT SNTH TISS 52X40X2.3MM STRL MDPR MCPLT CHNL SHT POR PE BOTH IP/OP "$2,172.00" "$1,607.00" $27.40 "$1,629.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $27.40 N/A N/A N/A N/A N/A "$1,629.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,259.76" N/A N/A N/A N/A N/A N/A N/A 9531 SUP Custom 27803010 9531 - GRAFT SYNTH TISSUE 52X40X2.3MM IMPLANT MINIPLATE CHANNEL BOTH IP/OP "$1,766.50" "$1,307.00" $314.39 "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" $314.39 "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" $368.10 "$1,766.23" $706.49 "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" "$1,324.88" "$1,766.23" "$1,766.23" "$1,766.23" $883.12 $883.12 "$1,398.85" "$1,766.23" "$1,412.98" $794.80 "$1,766.23" N/A "$1,024.57" "$1,766.23" "$1,059.74" "$1,766.23" "$1,766.23" "$1,766.23" N/A N/A 9532 SUP Custom 27803010 9532 - GRAFT SNTH TISS 52X40X2.3MM BRR MDPR MCPLT CHNL SHT PE BOTH IP/OP "$1,766.50" "$1,307.00" $314.39 "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" $314.39 "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" $368.10 "$1,766.23" $706.49 "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" "$1,766.23" "$1,324.88" "$1,766.23" "$1,766.23" "$1,766.23" $883.12 $883.12 "$1,398.85" "$1,766.23" "$1,412.98" $794.80 "$1,766.23" N/A "$1,024.57" "$1,766.23" "$1,059.74" "$1,766.23" "$1,766.23" "$1,766.23" N/A N/A 9533 SUP Custom 27803010 9533 - GRAFT SYNTH TISSUE 1.1MM SMALL 70X13X2MM ONLAY ARCH SHAPE BOTH IP/OP $844.00 $625.00 $150.16 $843.60 $843.60 $843.60 $843.60 $843.60 $843.60 $843.60 $150.16 $843.60 $843.60 $843.60 $843.60 $843.60 $843.60 $175.82 $843.60 $337.44 $843.60 $843.60 $843.60 $843.60 $843.60 $633.00 $843.60 $843.60 $843.60 $421.80 $421.80 $668.13 $843.60 $674.88 $379.62 $843.60 N/A $489.52 $843.60 $506.16 $843.60 $843.60 $843.60 N/A N/A 9534 SUP Custom 27803010 9534 - GRAFT SYNTH TISSUE MEDIUM 70X15X2MM NASAL ARCH POROUS MEDPOR BOTH IP/OP $844.00 $625.00 $150.16 $843.60 $843.60 $843.60 $843.60 $843.60 $843.60 $843.60 $150.16 $843.60 $843.60 $843.60 $843.60 $843.60 $843.60 $175.82 $843.60 $337.44 $843.60 $843.60 $843.60 $843.60 $843.60 $633.00 $843.60 $843.60 $843.60 $421.80 $421.80 $668.13 $843.60 $674.88 $379.62 $843.60 N/A $489.52 $843.60 $506.16 $843.60 $843.60 $843.60 N/A N/A 9535 SUP Custom 27803010 9535 - GRAFT SYNTH TISSUE LARGE 70X17X2MM NASAL ARCH ONLAY POROUS BOTH IP/OP $844.00 $625.00 $150.16 $843.60 $843.60 $843.60 $843.60 $843.60 $843.60 $843.60 $150.16 $843.60 $843.60 $843.60 $843.60 $843.60 $843.60 $175.82 $843.60 $337.44 $843.60 $843.60 $843.60 $843.60 $843.60 $633.00 $843.60 $843.60 $843.60 $421.80 $421.80 $668.13 $843.60 $674.88 $379.62 $843.60 N/A $489.52 $843.60 $506.16 $843.60 $843.60 $843.60 N/A N/A 9536 SUP Custom 27803010 9536 - GRAFT SYNTH TISSUE 40X9X1.1MM NASAL SHEET POROUS MEDPOR BOTH IP/OP $406.00 $300.00 $72.27 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $72.27 $406.00 $406.00 $406.00 $406.00 $406.00 $406.00 $84.61 $406.00 $162.40 $406.00 $406.00 $406.00 $406.00 $406.00 $304.50 $406.00 $406.00 $406.00 $203.00 $203.00 $321.55 $406.00 $324.80 $182.70 $406.00 N/A $235.48 $406.00 $243.60 $406.00 $406.00 $406.00 N/A N/A 9537 SUP HCPCS C1763 9537 - TISSUE SYNTH PE POR MEDPOR ORBTL RIM BOTH IP/OP $950.00 $703.00 $188.55 $950.00 $427.50 $427.50 $427.50 $427.50 $950.00 $950.00 $950.00 $198.00 $950.00 $950.00 $950.00 $950.00 $950.00 $197.99 $950.00 $950.00 $561.93 $950.00 $950.00 $950.00 $950.00 $712.50 $950.00 $950.00 $950.00 $475.00 $475.00 $752.40 $950.00 $760.00 $427.50 $188.55 N/A $551.00 $950.00 $950.00 $950.00 $197.98 $950.00 N/A N/A 9539 SUP Custom 27803010 9539 - GRAFT SYNTH TISSUE 47X40X6.3MM EXTEND MEDPOR POLYETHYLENE BOTH IP/OP "$1,372.00" "$1,015.00" $244.14 "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" $244.14 "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" $285.85 "$1,371.58" $548.63 "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,029.00" "$1,371.58" "$1,371.58" "$1,371.58" $685.79 $685.79 "$1,086.29" "$1,371.58" "$1,097.26" $617.21 "$1,371.58" N/A $795.76 "$1,371.58" $822.95 "$1,371.58" "$1,371.58" "$1,371.58" N/A N/A 9540 SUP Custom 27803010 9540 - GRAFT SNTH TISS 47X40X6.3MM STRL MDPR XTD PE POR CRNMXF RT BOTH IP/OP "$1,372.00" "$1,015.00" $244.14 "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" $244.14 "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" $285.85 "$1,371.58" $548.63 "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,029.00" "$1,371.58" "$1,371.58" "$1,371.58" $685.79 $685.79 "$1,086.29" "$1,371.58" "$1,097.26" $617.21 "$1,371.58" N/A $795.76 "$1,371.58" $822.95 "$1,371.58" "$1,371.58" "$1,371.58" N/A N/A 9541 SUP Custom 27803010 9541 - GRAFT SYNTH TISSUE REGULAR 31X22X7MM ENOPHTHALMOS WEDGE BOTH IP/OP "$1,215.00" $899.00 $216.27 "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" $216.27 "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" $253.22 "$1,215.00" $486.00 "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" $911.25 "$1,215.00" "$1,215.00" "$1,215.00" $607.50 $607.50 $962.28 "$1,215.00" $972.00 $546.75 "$1,215.00" N/A $704.70 "$1,215.00" $729.00 "$1,215.00" "$1,215.00" "$1,215.00" N/A N/A 9542 SUP Custom 27803010 9542 - GRAFT SYNTH TISSUE REGULAR 31X22X7MM WEDGE ENOPHTHALMOS BOTH IP/OP "$1,215.00" $899.00 $216.27 "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" $216.27 "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" $253.22 "$1,215.00" $486.00 "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" $911.25 "$1,215.00" "$1,215.00" "$1,215.00" $607.50 $607.50 $962.28 "$1,215.00" $972.00 $546.75 "$1,215.00" N/A $704.70 "$1,215.00" $729.00 "$1,215.00" "$1,215.00" "$1,215.00" N/A N/A 9543 SUP Custom 27803010 9543 - GRAFT SYNTH TISSUE LARGE 40X28X7.5MM ENOPHTHALMOS WEDGE BOTH IP/OP "$1,215.00" $899.00 $216.27 "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" $216.27 "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" $253.22 "$1,215.00" $486.00 "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" $911.25 "$1,215.00" "$1,215.00" "$1,215.00" $607.50 $607.50 $962.28 "$1,215.00" $972.00 $546.75 "$1,215.00" N/A $704.70 "$1,215.00" $729.00 "$1,215.00" "$1,215.00" "$1,215.00" N/A N/A 9544 SUP Custom 27803010 9544 - GRAFT SYNTH TISSUE LARGE 40X28X7.5MM ENOPHTHALMOS WEDGE BOTH IP/OP "$1,215.00" $899.00 $216.27 "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" $216.27 "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" $253.22 "$1,215.00" $486.00 "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" $911.25 "$1,215.00" "$1,215.00" "$1,215.00" $607.50 $607.50 $962.28 "$1,215.00" $972.00 $546.75 "$1,215.00" N/A $704.70 "$1,215.00" $729.00 "$1,215.00" "$1,215.00" "$1,215.00" N/A N/A 9548 SUP Custom 27803010 9548 - CONFORMER OCULAR MEDIUM 24X21X5.3MM NONVENT LATEX FREE ACRYL BOTH IP/OP $120.50 $89.00 $21.40 $120.25 $120.25 $120.25 $120.25 $120.25 $120.25 $120.25 $21.40 $120.25 $120.25 $120.25 $120.25 $120.25 $120.25 $25.06 $120.25 $48.10 $120.25 $120.25 $120.25 $120.25 $120.25 $90.38 $120.25 $120.25 $120.25 $60.13 $60.13 $95.24 $120.25 $96.20 $54.11 $120.25 N/A $69.89 $120.25 $72.15 $120.25 $120.25 $120.25 N/A N/A 9553 SUP Custom 27803010 9553 - GRAFT SYNTH TISSUE REGULAR SHELL 38X21X17MM 2 INSERT BOTH IP/OP "$1,130.00" $836.00 $201.14 "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" $201.14 "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" $235.50 "$1,130.00" $452.00 "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" $847.50 "$1,130.00" "$1,130.00" "$1,130.00" $565.00 $565.00 $894.96 "$1,130.00" $904.00 $508.50 "$1,130.00" N/A $655.40 "$1,130.00" $678.00 "$1,130.00" "$1,130.00" "$1,130.00" N/A N/A 9554 SUP HCPCS L4386 9554 - BRACE WLK LG PIN CAM ROM RCKR BTM ADJ BOTH IP/OP $190.50 $141.00 $39.63 $190.13 $190.13 $190.13 $190.13 $190.13 $190.13 $190.13 $102.64 $190.13 $190.13 $190.13 $190.13 $190.13 $190.13 $39.63 $190.13 $76.05 $190.13 $190.13 $190.13 $190.13 $190.13 $142.88 $190.13 $190.13 $190.13 $95.07 $95.07 $150.58 $190.13 $152.10 $85.56 $190.13 N/A $110.49 $190.13 $114.08 $190.13 $190.13 $190.13 N/A N/A 9554 SUP Custom 27803010 9554 - GRAFT SYNTH TISSUE LARGE 40X20X18MM NASAL SHELL 2 INSERTS BOTH IP/OP "$1,130.00" $836.00 $39.63 $847.50 $190.13 $190.13 $190.13 $190.13 $190.13 $190.13 $102.64 $190.13 $190.13 $190.13 $190.13 $190.13 $190.13 $39.63 $190.13 $76.05 $190.13 $190.13 $190.13 $190.13 $190.13 $847.50 $190.13 $190.13 $190.13 $95.07 $95.07 $150.58 $190.13 $152.10 $85.56 $190.13 N/A $655.40 $190.13 $114.08 $190.13 $190.13 $190.13 N/A N/A 9562 SUP Custom 27803010 9562 - SHEET SNTH 50X38X3MM MDPR NEURO BOTH IP/OP "$2,214.50" "$1,639.00" $394.10 "$2,214.05" "$2,214.05" "$2,214.05" "$2,214.05" "$2,214.05" "$2,214.05" "$2,214.05" $394.10 "$2,214.05" "$2,214.05" "$2,214.05" "$2,214.05" "$2,214.05" "$2,214.05" $461.43 "$2,214.05" $885.62 "$2,214.05" "$2,214.05" "$2,214.05" "$2,214.05" "$2,214.05" "$1,660.88" "$2,214.05" "$2,214.05" "$2,214.05" "$1,107.03" "$1,107.03" "$1,753.53" "$2,214.05" "$1,771.24" $996.32 "$2,214.05" N/A "$1,284.41" "$2,214.05" "$1,328.43" "$2,214.05" "$2,214.05" "$2,214.05" N/A N/A 9568 SUP Custom 27803010 9568 - GRAFT SNTH TISS 108X75MM STRL MDPR IMPL INFR 2/3 ORBT POR PE BOTH IP/OP "$7,026.50" "$5,200.00" "$1,250.72" "$7,026.50" "$7,026.50" "$7,026.50" "$7,026.50" "$7,026.50" "$7,026.50" "$7,026.50" "$1,250.72" "$7,026.50" "$7,026.50" "$7,026.50" "$7,026.50" "$7,026.50" "$7,026.50" "$1,464.40" "$7,026.50" "$2,810.60" "$7,026.50" "$7,026.50" "$7,026.50" "$7,026.50" "$7,026.50" "$5,269.88" "$7,026.50" "$7,026.50" "$7,026.50" "$3,513.25" "$3,513.25" "$5,564.99" "$7,026.50" "$5,621.20" "$3,161.93" "$7,026.50" N/A "$4,075.37" "$7,026.50" "$4,215.90" "$7,026.50" "$7,026.50" "$7,026.50" N/A N/A 9570 SUP Custom 27803010 9570 - GRAFT SNTH TISS 93X75MM STRL MDPR IMPL CMPLT POR PE CRNMXF BOTH IP/OP "$8,343.00" "$6,174.00" "$1,485.01" "$8,342.75" "$8,342.75" "$8,342.75" "$8,342.75" "$8,342.75" "$8,342.75" "$8,342.75" "$1,485.01" "$8,342.75" "$8,342.75" "$8,342.75" "$8,342.75" "$8,342.75" "$8,342.75" "$1,738.72" "$8,342.75" "$3,337.10" "$8,342.75" "$8,342.75" "$8,342.75" "$8,342.75" "$8,342.75" "$6,257.25" "$8,342.75" "$8,342.75" "$8,342.75" "$4,171.38" "$4,171.38" "$6,607.46" "$8,342.75" "$6,674.20" "$3,754.24" "$8,342.75" N/A "$4,838.94" "$8,342.75" "$5,005.65" "$8,342.75" "$8,342.75" "$8,342.75" N/A N/A 9580 SUP Custom 27203010 09580 - DEVICE EXFIX OPTRM ELB TRGT DISC BOTH IP/OP $572.50 $424.00 $101.91 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $101.91 $572.50 $572.50 $424.91 $424.91 $441.28 $298.27 $119.32 $572.50 $229.00 $572.50 $572.50 $572.50 $572.50 $572.50 $429.38 $572.50 $572.50 $572.50 $286.25 $286.25 $453.42 $572.50 $458.00 $372.13 $572.50 N/A $332.05 $572.50 $343.50 $572.50 $572.50 $572.50 N/A N/A 9595 SUP HCPCS C1752 09595 - WIRE FX 3.2MM TRGT BOTH IP/OP $257.50 $191.00 $53.67 $257.50 $257.50 $257.50 $257.50 $257.50 $257.50 $257.50 $257.50 $257.50 $257.50 $257.50 $257.50 $257.50 $257.50 $53.67 $257.50 $103.00 $257.50 $257.50 $257.50 $257.50 $257.50 $193.13 $257.50 $257.50 $257.50 $128.75 $128.75 $203.94 $257.50 $206.00 $115.88 $257.50 N/A $149.35 $257.50 $154.50 $257.50 $257.50 $257.50 N/A N/A 9600 SUP Custom 27203010 09600 - FXTR EXFIX OPTRM PROX ELB CMPNT BOTH IP/OP "$11,645.00" "$8,617.00" "$2,060.15" "$11,645.00" "$11,645.00" "$11,645.00" "$11,645.00" "$11,645.00" "$11,645.00" "$11,645.00" "$2,072.81" "$11,645.00" "$11,645.00" "$4,181.12" "$4,181.12" "$8,975.97" "$2,060.15" "$2,426.95" "$11,645.00" "$4,658.00" "$11,645.00" "$11,645.00" "$11,645.00" "$11,645.00" "$11,645.00" "$8,733.75" "$11,645.00" "$11,645.00" "$11,645.00" "$5,822.50" "$5,822.50" "$9,222.84" "$11,645.00" "$9,316.00" "$7,569.25" "$11,645.00" N/A "$6,754.10" "$11,645.00" "$6,987.00" "$11,645.00" "$11,645.00" "$11,645.00" N/A N/A 9610 SUP Custom 27803010 9610 - LINER ACTB 23 32MM RNGLC E-POLY HIP BOTH IP/OP "$5,727.50" "$4,238.00" $12.92 "$4,295.63" $72.58 $72.58 $72.58 $72.58 $72.58 $72.58 $12.92 $72.58 $72.58 $53.87 $53.87 $55.94 $37.81 $15.13 $72.58 $29.03 $72.58 $72.58 $72.58 $72.58 $72.58 "$4,295.63" $72.58 $72.58 $72.58 $36.29 $36.29 $57.48 $72.58 $58.06 $47.18 $72.58 $72.58 "$3,321.95" $72.58 $43.55 $72.58 $72.58 $72.58 N/A N/A 9780 SUP Custom 27203010 9780 - CONFORMER OCUL LG CUP 25X22X5.6MM STRL LF MDPR VNT ACRL BOTH IP/OP $120.50 $89.00 $21.40 $120.25 $120.25 $120.25 $120.25 $120.25 $120.25 $120.25 $21.40 $120.25 $120.25 $89.25 $89.25 $92.69 $62.65 $25.06 $120.25 $48.10 $120.25 $120.25 $120.25 $120.25 $120.25 $90.38 $120.25 $120.25 $120.25 $60.13 $60.13 $95.24 $120.25 $96.20 $78.16 $120.25 N/A $69.89 $120.25 $72.15 $120.25 $120.25 $120.25 N/A N/A 9789 SUP Custom 27203010 9789 - SLEEVE CMPR LG KN LGTH 26- IN NS LF KDL SCD EXP ADJ CRCMF BOTH IP/OP $42.50 $31.00 $7.57 $115.38 $42.50 $42.50 $42.50 $42.50 $42.50 $42.50 $7.57 $42.50 $42.50 $31.54 $31.54 $32.76 $22.14 $8.86 $42.50 $18.46 $42.50 $42.50 $115.38 $42.50 $42.50 $31.88 $42.50 $42.50 $42.50 $21.25 $21.25 $33.66 $42.50 $34.00 $27.63 $42.50 N/A $24.65 $42.50 $25.50 $42.50 $42.50 $42.50 N/A N/A 9821 SUP Custom 27100030 9821 - RACK SPLNT OVEN WFL BOTH IP/OP $112.50 $83.00 $65.25 $84.38 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $84.38 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $65.25 N/A N/A N/A N/A N/A N/A N/A 9857 SUP Custom 27803010 9857 - SHEET SNTH SM CNTR 78X61X18MM STRL FLXBLK TF2 MDPR CRNMXF LT BOTH IP/OP "$3,042.50" "$2,251.00" $541.52 "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" $541.52 "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" $634.04 "$3,042.25" "$1,216.90" "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" "$2,281.88" "$3,042.25" "$3,042.25" "$3,042.25" "$1,521.13" "$1,521.13" "$2,409.46" "$3,042.25" "$2,433.80" "$1,369.01" "$3,042.25" N/A "$1,764.65" "$3,042.25" "$1,825.35" "$3,042.25" "$3,042.25" "$3,042.25" N/A N/A 9858 SUP Custom 27803010 9858 - GRAFT SYNTH TISSUE SMALL CNTOUR 78X61X18MM FLEXBLOCK TF2 BOTH IP/OP "$3,042.50" "$2,251.00" $541.52 "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" $541.52 "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" $634.04 "$3,042.25" "$1,216.90" "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" "$3,042.25" "$2,281.88" "$3,042.25" "$3,042.25" "$3,042.25" "$1,521.13" "$1,521.13" "$2,409.46" "$3,042.25" "$2,433.80" "$1,369.01" "$3,042.25" N/A "$1,764.65" "$3,042.25" "$1,825.35" "$3,042.25" "$3,042.25" "$3,042.25" N/A N/A 9859 SUP Custom 27803010 9859 - GRAFT SYNTH TISSUE MEDIUM CNTOUR 93X74X20MM FLEXBLOCK MEDPOR BOTH IP/OP "$3,041.50" "$2,251.00" $47.42 "$2,281.13" $282.14 $282.14 $282.14 $282.14 $282.14 $282.14 $47.42 $282.14 $282.14 $57.13 $57.13 $59.32 $54.93 $64.53 $282.14 $112.86 $282.14 $282.14 $282.14 $282.14 $282.14 "$2,281.13" $282.14 $282.14 $282.14 $141.07 $141.07 $223.45 $282.14 $225.71 $126.96 $282.14 $282.14 "$1,764.07" $282.14 $169.28 $282.14 $282.14 $282.14 N/A N/A 9860 SUP Custom 27803010 9860 - GRAFT SYNTH TISSUE MEDIUM CNTOUR 93X74X20MM FLEXBLOCK MEDPOR BOTH IP/OP "$3,041.50" "$2,251.00" $541.36 "$3,041.35" "$3,041.35" "$3,041.35" "$3,041.35" "$3,041.35" "$3,041.35" "$3,041.35" $541.36 "$3,041.35" "$3,041.35" "$3,041.35" "$3,041.35" "$3,041.35" "$3,041.35" $633.85 "$3,041.35" "$1,216.54" "$3,041.35" "$3,041.35" "$3,041.35" "$3,041.35" "$3,041.35" "$2,281.13" "$3,041.35" "$3,041.35" "$3,041.35" "$1,520.68" "$1,520.68" "$2,408.75" "$3,041.35" "$2,433.08" "$1,368.61" "$3,041.35" N/A "$1,764.07" "$3,041.35" "$1,824.81" "$3,041.35" "$3,041.35" "$3,041.35" N/A N/A 9861 SUP Custom 27803010 9861 - GRAFT SYNTH TISSUE LARGE IMPLANT CNTOUR POROUS MEDPOR BOTH IP/OP "$3,170.50" "$2,346.00" $564.35 "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" $564.35 "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" $660.77 "$3,170.50" "$1,268.20" "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" "$2,377.88" "$3,170.50" "$3,170.50" "$3,170.50" "$1,585.25" "$1,585.25" "$2,511.04" "$3,170.50" "$2,536.40" "$1,426.73" "$3,170.50" N/A "$1,838.89" "$3,170.50" "$1,902.30" "$3,170.50" "$3,170.50" "$3,170.50" N/A N/A 9862 SUP Custom 27803010 9862 - GRAFT SYNTH TISSUE LARGE IMPLANT POROUS MEDPOR FLEXBLOCK TF2 BOTH IP/OP "$3,170.50" "$2,346.00" $564.35 "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" $564.35 "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" $660.77 "$3,170.50" "$1,268.20" "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" "$3,170.50" "$2,377.88" "$3,170.50" "$3,170.50" "$3,170.50" "$1,585.25" "$1,585.25" "$2,511.04" "$3,170.50" "$2,536.40" "$1,426.73" "$3,170.50" N/A "$1,838.89" "$3,170.50" "$1,902.30" "$3,170.50" "$3,170.50" "$3,170.50" N/A N/A 9864 SUP Custom 27803010 9864 - GRAFT SYNTH TISSUE 44X43X6MM MEDPOR POLYETHYLENE POROUS BOTH IP/OP "$2,026.50" "$1,500.00" $360.70 "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" $360.70 "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" $422.32 "$2,026.38" $810.55 "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" "$1,519.88" "$2,026.38" "$2,026.38" "$2,026.38" "$1,013.19" "$1,013.19" "$1,604.89" "$2,026.38" "$1,621.10" $911.87 "$2,026.38" N/A "$1,175.37" "$2,026.38" "$1,215.83" "$2,026.38" "$2,026.38" "$2,026.38" N/A N/A 9865 SUP Custom 27803010 9865 - GRAFT SYNTH TISSUE 44X43X6MM MEDPOR POLYETHYLENE POROUS LEFT BOTH IP/OP "$2,026.50" "$1,500.00" $360.70 "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" $360.70 "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" $422.32 "$2,026.38" $810.55 "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" "$2,026.38" "$1,519.88" "$2,026.38" "$2,026.38" "$2,026.38" "$1,013.19" "$1,013.19" "$1,604.89" "$2,026.38" "$1,621.10" $911.87 "$2,026.38" N/A "$1,175.37" "$2,026.38" "$1,215.83" "$2,026.38" "$2,026.38" "$2,026.38" N/A N/A 9866 SUP Custom 27803010 9866 - IMPLANT ORBTL 16MM SMALL ROUND MOTILITY 2 CHANNEL 4 ANTERIOR BOTH IP/OP "$1,273.50" $942.00 $226.60 "$1,273.05" "$1,273.05" "$1,273.05" "$1,273.05" "$1,273.05" "$1,273.05" "$1,273.05" $226.60 "$1,273.05" "$1,273.05" "$1,273.05" "$1,273.05" "$1,273.05" "$1,273.05" $265.32 "$1,273.05" $509.22 "$1,273.05" "$1,273.05" "$1,273.05" "$1,273.05" "$1,273.05" $955.13 "$1,273.05" "$1,273.05" "$1,273.05" $636.53 $636.53 "$1,008.26" "$1,273.05" "$1,018.44" $572.87 "$1,273.05" N/A $738.63 "$1,273.05" $763.83 "$1,273.05" "$1,273.05" "$1,273.05" N/A N/A 9867 SUP Custom 27803010 9867 - IMPLANT ORBTL 18MM MEDIUM ROUND MOTILITY 2 CHANNEL 4 BOTH IP/OP "$1,592.50" "$1,178.00" $283.47 "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" $283.47 "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" $331.89 "$1,592.50" $637.00 "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,194.38" "$1,592.50" "$1,592.50" "$1,592.50" $796.25 $796.25 "$1,261.26" "$1,592.50" "$1,274.00" $716.63 "$1,592.50" N/A $923.65 "$1,592.50" $955.50 "$1,592.50" "$1,592.50" "$1,592.50" N/A N/A 9868 SUP Custom 27803010 9868 - IMPLANT ORBTL 20MM LARGE ROUND MOTILITY 2 CHANNEL 4 ANTERIOR BOTH IP/OP "$1,592.50" "$1,178.00" $283.47 "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" $283.47 "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" $331.89 "$1,592.50" $637.00 "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,194.38" "$1,592.50" "$1,592.50" "$1,592.50" $796.25 $796.25 "$1,261.26" "$1,592.50" "$1,274.00" $716.63 "$1,592.50" N/A $923.65 "$1,592.50" $955.50 "$1,592.50" "$1,592.50" "$1,592.50" N/A N/A 9952 SUP Custom 27803010 9952 - SET SZR MALAR BOTH IP/OP $521.50 $386.00 $92.78 $521.25 $521.25 $521.25 $521.25 $521.25 $521.25 $521.25 $92.78 $521.25 $521.25 $521.25 $521.25 $521.25 $521.25 $108.63 $521.25 $208.50 $521.25 $521.25 $521.25 $521.25 $521.25 $391.13 $521.25 $521.25 $521.25 $260.63 $260.63 $412.83 $521.25 $417.00 $234.56 $521.25 N/A $302.47 $521.25 $312.75 $521.25 $521.25 $521.25 N/A N/A 9955 SUP Custom 27803010 9955 - GRAFT SYNTH TISSUE SMALL 65X35X3MM IMPLANT ANGLED WRAPAROUND BOTH IP/OP "$1,511.00" "$1,118.00" $268.94 "$1,510.88" "$1,510.88" "$1,510.88" "$1,510.88" "$1,510.88" "$1,510.88" "$1,510.88" $268.94 "$1,510.88" "$1,510.88" "$1,510.88" "$1,510.88" "$1,510.88" "$1,510.88" $314.88 "$1,510.88" $604.35 "$1,510.88" "$1,510.88" "$1,510.88" "$1,510.88" "$1,510.88" "$1,133.25" "$1,510.88" "$1,510.88" "$1,510.88" $755.44 $755.44 "$1,196.62" "$1,510.88" "$1,208.70" $679.90 "$1,510.88" N/A $876.38 "$1,510.88" $906.53 "$1,510.88" "$1,510.88" "$1,510.88" N/A N/A 9956 SUP Custom 27803010 9956 - GRAFT SYNTH TISSUE SMALL ANGLE RIGHT 65X35X3MM WRAPAROUND BOTH IP/OP "$1,420.50" "$1,051.00" $252.77 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" $252.77 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" $295.96 "$1,420.08" $568.03 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,065.38" "$1,420.08" "$1,420.08" "$1,420.08" $710.04 $710.04 "$1,124.70" "$1,420.08" "$1,136.06" $639.04 "$1,420.08" N/A $823.89 "$1,420.08" $852.05 "$1,420.08" "$1,420.08" "$1,420.08" N/A N/A 9957 SUP Custom 27803010 9957 - GRAFT SYNTH TISSUE MEDIUM 65X35X7MM IMPLANT ANGLED BOTH IP/OP "$1,420.50" "$1,051.00" $252.77 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" $252.77 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" $295.96 "$1,420.08" $568.03 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,065.38" "$1,420.08" "$1,420.08" "$1,420.08" $710.04 $710.04 "$1,124.70" "$1,420.08" "$1,136.06" $639.04 "$1,420.08" N/A $823.89 "$1,420.08" $852.05 "$1,420.08" "$1,420.08" "$1,420.08" N/A N/A 9958 SUP Custom 27803010 9958 - GRAFT SYNTH TISSUE MEDIUM 65X35X7MM IMPLANT ANGLED BOTH IP/OP "$1,420.50" "$1,051.00" $252.77 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" $252.77 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" $295.96 "$1,420.08" $568.03 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,065.38" "$1,420.08" "$1,420.08" "$1,420.08" $710.04 $710.04 "$1,124.70" "$1,420.08" "$1,136.06" $639.04 "$1,420.08" N/A $823.89 "$1,420.08" $852.05 "$1,420.08" "$1,420.08" "$1,420.08" N/A N/A 9959 SUP Custom 27803010 9959 - GRAFT SYNTH TISSUE LARGE 65X35X11MM IMPLANT ANGLED BOTH IP/OP "$1,420.50" "$1,051.00" $252.77 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" $252.77 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" $295.96 "$1,420.08" $568.03 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,065.38" "$1,420.08" "$1,420.08" "$1,420.08" $710.04 $710.04 "$1,124.70" "$1,420.08" "$1,136.06" $639.04 "$1,420.08" N/A $823.89 "$1,420.08" $852.05 "$1,420.08" "$1,420.08" "$1,420.08" N/A N/A 9960 SUP Custom 27803010 9960 - GRAFT SYNTH TISSUE LARGE 65X35X11MM IMPLANT ANGLED BOTH IP/OP "$1,420.50" "$1,051.00" $252.77 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" $252.77 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" $295.96 "$1,420.08" $568.03 "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,420.08" "$1,065.38" "$1,420.08" "$1,420.08" "$1,420.08" $710.04 $710.04 "$1,124.70" "$1,420.08" "$1,136.06" $639.04 "$1,420.08" N/A $823.89 "$1,420.08" $852.05 "$1,420.08" "$1,420.08" "$1,420.08" N/A N/A 10004 SUP HCPCS C1713 010004 - PLATE BONE 4 HOLE UTILITY SPN BOTH IP/OP $26.50 $20.00 $5.21 $26.25 $11.81 $11.81 $11.81 $11.81 $26.25 $26.25 $26.25 $5.47 $26.25 $26.25 $26.25 $26.25 $26.25 $5.47 $26.25 $10.50 $15.53 $26.25 $26.25 $26.25 $26.25 $19.88 $26.25 $26.25 $26.25 $13.13 $13.13 $20.79 $26.25 $21.00 $11.81 $5.21 N/A $15.37 $26.25 $15.75 $26.25 $26.25 $26.25 100.34 45.37 10014 SUP HCPCS C1713 010014 - PLATE BONE 4MM STANDARD STR 14 HOLE TIMESH TITANIUM CRANIAL BOTH IP/OP $491.00 $363.00 $97.43 $490.88 $220.90 $220.90 $220.90 $220.90 $490.88 $490.88 $490.88 $102.31 $490.88 $490.88 $490.88 $490.88 $490.88 $102.30 $490.88 $196.35 $290.36 $490.88 $490.88 $490.88 $490.88 $368.25 $490.88 $490.88 $490.88 $245.44 $245.44 $388.78 $490.88 $392.70 $220.90 $97.43 N/A $284.78 $490.88 $294.53 $490.88 $102.30 $490.88 N/A N/A 10015 SUP HCPCS C1713 10015 - SPACER ALLOGRAFT 8D NARROW LORDOTIC WEDGE PYRAMIDAL TEETH BOTH IP/OP "$10,725.00" "$7,937.00" "$2,128.64" "$10,725.00" "$4,826.25" "$4,826.25" "$4,826.25" "$4,826.25" "$10,725.00" "$10,725.00" "$10,725.00" "$2,235.36" "$10,725.00" "$10,725.00" "$10,725.00" "$10,725.00" "$10,725.00" "$2,235.21" "$10,725.00" "$10,725.00" "$5,287.43" "$10,725.00" "$10,725.00" "$10,725.00" "$10,725.00" "$8,043.75" "$10,725.00" "$10,725.00" "$10,725.00" "$5,362.50" "$5,362.50" "$8,494.20" "$10,725.00" "$8,580.00" "$4,826.25" "$2,128.64" N/A "$6,220.50" "$10,725.00" "$6,435.00" "$10,725.00" "$2,235.09" "$10,725.00" N/A N/A 10016 SUP HCPCS C1713 010016 - PLATE BONE 3MM STANDARD STR 14 HOLE TIMESH TITANIUM CRANIAL BOTH IP/OP $491.00 $363.00 $97.43 $490.88 $220.90 $220.90 $220.90 $220.90 $490.88 $490.88 $490.88 $102.31 $490.88 $490.88 $490.88 $490.88 $490.88 $102.30 $490.88 $490.88 $290.36 $490.88 $490.88 $490.88 $490.88 $368.25 $490.88 $490.88 $490.88 $245.44 $245.44 $388.78 $490.88 $392.70 $220.90 $97.43 N/A $284.78 $490.88 $490.88 $490.88 $102.30 $490.88 N/A N/A 10019 SUP HCPCS C1713 10019 - SPACER ALLOGRAFT 8D NARROW PYRAMID LORDOTIC WEDGE 23-27MMX19 BOTH IP/OP "$10,725.00" "$7,937.00" "$2,128.64" "$10,725.00" "$4,826.25" "$4,826.25" "$4,826.25" "$4,826.25" "$10,725.00" "$10,725.00" "$10,725.00" "$2,235.36" "$10,725.00" "$10,725.00" "$10,725.00" "$10,725.00" "$10,725.00" "$2,235.21" "$10,725.00" "$10,725.00" "$5,287.43" "$10,725.00" "$10,725.00" "$10,725.00" "$10,725.00" "$8,043.75" "$10,725.00" "$10,725.00" "$10,725.00" "$5,362.50" "$5,362.50" "$8,494.20" "$10,725.00" "$8,580.00" "$4,826.25" "$2,128.64" N/A "$6,220.50" "$10,725.00" "$6,435.00" "$10,725.00" "$2,235.09" "$10,725.00" N/A N/A 10040 SUP HCPCS C1713 010040 - SCREW BONE 1MM 4MM CROSS DRIVE TIMESH TITANIUM CRANIAL BOTH IP/OP $105.50 $78.00 $20.88 $105.19 $47.34 $47.34 $47.34 $47.34 $105.19 $105.19 $105.19 $21.92 $105.19 $105.19 $105.19 $105.19 $105.19 $21.92 $105.19 $42.08 $62.22 $105.19 $105.19 $105.19 $105.19 $79.13 $105.19 $105.19 $105.19 $52.60 $52.60 $83.31 $105.19 $84.15 $47.34 $20.88 N/A $61.19 $105.19 $105.19 $105.19 $21.92 $105.19 166 54.88 10060 SUP HCPCS C1713 010060 - SCREW BONE 1MM 6MM CROSS DRIVE SELF TAP CRUCIATE HEAD TIMESH BOTH IP/OP $107.00 $79.00 $62.06 $352.00 $352.00 $352.00 $352.00 $352.00 $176.64 $176.64 $175.86 $73.37 $176.64 $352.00 $352.00 $352.00 $352.00 $73.36 $282.63 $260.52 $113.00 $176.64 $106.35 $176.64 $185.48 $80.25 $176.64 $176.64 $176.64 $352.00 $176.00 $278.78 $176.64 $281.60 $352.00 $69.86 $176.64 $62.06 $185.48 $255.56 $176.64 $73.36 $176.64 222.32 111.37 10237 SUP Custom 27203010 10237 - KIT GASTROSTOMY 11 .035IN J LP 18FR 22FR INTROD NEEDLE FEED BOTH IP/OP $585.00 $433.00 $104.11 $584.88 $584.88 $584.88 $584.88 $584.88 $584.88 $584.88 $104.11 $584.88 $584.88 $434.10 $434.10 $450.83 $304.72 $121.90 $584.88 $233.95 $584.88 $584.88 $584.88 $584.88 $584.88 $438.75 $584.88 $584.88 $584.88 $292.44 $292.44 $463.22 $584.88 $467.90 $380.17 $584.88 N/A $339.30 $584.88 $350.93 $584.88 $584.88 $584.88 N/A N/A 10241 SUP HCPCS C1713 010241 - CATHETER ANGIOGRAPHIC STR PIGTAIL CURVE 6FR 110CM 6 SIDEHOLE BOTH IP/OP $408.00 $302.00 $80.98 $408.00 $183.60 $183.60 $183.60 $183.60 $408.00 $408.00 $408.00 $85.04 $408.00 $408.00 $408.00 $408.00 $408.00 $85.03 $408.00 $408.00 $241.33 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $183.60 $80.98 N/A $236.64 $408.00 $244.80 $408.00 $85.03 $408.00 N/A N/A 10242 SUP HCPCS C1713 010242 - CATHETER ANGIOGRAPHIC 145D VAN TASSEL ANGLED PIGTAIL CURVE 6 BOTH IP/OP $389.00 $288.00 $77.18 $388.88 $175.00 $175.00 $175.00 $175.00 $388.88 $388.88 $388.88 $81.05 $388.88 $388.88 $388.88 $388.88 $388.88 $81.05 $388.88 $388.88 $230.02 $388.88 $388.88 $388.88 $388.88 $291.75 $388.88 $388.88 $388.88 $194.44 $194.44 $307.99 $388.88 $311.10 $175.00 $77.18 N/A $225.62 $388.88 $233.33 $388.88 $81.04 $388.88 N/A N/A 10250 SUP Custom 27203010 10250 - KIT GASTROSTOMY 12FR INTROD LAPSCOP MIC-KEY BOTH IP/OP $585.00 $433.00 $104.11 $584.88 $584.88 $584.88 $584.88 $584.88 $584.88 $584.88 $104.11 $584.88 $584.88 $434.10 $434.10 $450.83 $304.72 $121.90 $584.88 $233.95 $584.88 $584.88 $584.88 $584.88 $584.88 $438.75 $584.88 $584.88 $584.88 $292.44 $292.44 $463.22 $584.88 $467.90 $380.17 $584.88 N/A $339.30 $584.88 $350.93 $584.88 $584.88 $584.88 N/A N/A 10403 SUP Custom 27203010 10403 - LINER BT 24X9X5.5IN ORANGEAID STRUP BOTH IP/OP $34.50 $26.00 $6.11 $34.30 $34.30 $34.30 $34.30 $34.30 $34.30 $34.30 $6.11 $34.30 $34.30 $25.46 $25.46 $26.44 $17.87 $7.15 $34.30 $13.72 $34.30 $34.30 $34.30 $34.30 $34.30 $25.88 $34.30 $34.30 $34.30 $17.15 $17.15 $27.17 $34.30 $27.44 $22.30 $34.30 N/A $20.01 $34.30 $20.58 $34.30 $34.30 $34.30 N/A N/A 12110 SUP HCPCS A4416 12110 - POUCH OST MN FLT 13/16-2.5IN 5IN 170ML ASR 1 PC CLS SPRL ADH BOTH IP/OP $1.50 $1.00 $0.26 $1.78 $1.25 $1.25 $1.25 $1.25 $1.25 $1.25 $1.78 $1.25 $1.25 $0.93 $0.93 $0.96 $0.65 $0.26 $1.25 $0.51 $1.25 $1.25 $1.28 $1.25 $1.25 $1.13 $1.25 $1.25 $1.25 $0.63 $0.63 $0.99 $1.25 $1.00 $0.81 $1.25 N/A $0.87 $1.25 $0.75 $1.25 $1.25 $1.25 N/A N/A 12110 SUP HCPCS C1887 12110 - CATHETER PERFUSION 10FR 10IN VENT DLP PVC PEDIATRIC BOTH IP/OP "$1,149.50" $851.00 $0.26 $862.13 $1.25 $1.25 $1.25 $1.25 $1.25 $1.25 $1.78 $1.25 $1.25 $0.93 $0.93 $0.96 $0.65 $0.26 $1.25 $0.51 $1.25 $1.25 $1.28 $1.25 $1.25 $862.13 $1.25 $1.25 $1.25 $0.63 $0.63 $0.99 $1.25 $1.00 $0.81 $1.25 N/A $666.71 $1.25 $0.75 $1.25 $1.25 $1.25 N/A N/A 13030 SUP HCPCS C1713 013030 - SCREW BONE 1.3MM 3MM CROSS DRIVE RESCUE TIMESH TITANIUM BOTH IP/OP $100.00 $74.00 $19.75 $99.52 $44.78 $44.78 $44.78 $44.78 $99.52 $99.52 $99.52 $20.74 $99.52 $99.52 $99.52 $99.52 $99.52 $20.74 $99.52 $39.81 $58.87 $99.52 $99.52 $99.52 $99.52 $75.00 $99.52 $99.52 $99.52 $49.76 $49.76 $78.82 $99.52 $79.62 $44.78 $19.75 N/A $58.00 $99.52 $59.71 $99.52 $20.74 $99.52 N/A N/A 13050 SUP HCPCS C1713 013050 - SCREW BONE 1.3MM 5MM SELF TAP CRUCIATE HEAD TIMESH TITANIUM BOTH IP/OP $105.50 $78.00 $20.88 $105.19 $47.34 $47.34 $47.34 $47.34 $105.19 $105.19 $105.19 $21.92 $105.19 $105.19 $105.19 $105.19 $105.19 $21.92 $105.19 $42.08 $62.22 $105.19 $105.19 $105.19 $105.19 $79.13 $105.19 $105.19 $105.19 $52.60 $52.60 $83.31 $105.19 $84.15 $47.34 $20.88 N/A $61.19 $105.19 $63.11 $105.19 $21.92 $105.19 N/A N/A 13186 SUP HCPCS C1713 "13186 - ENDOBUTTON FIXATION BUTTON, 4X 12MM" BOTH IP/OP $452.50 $335.00 $89.79 $452.40 $203.58 $203.58 $203.58 $203.58 $452.40 $452.40 $452.40 $94.29 $452.40 $452.40 $452.40 $452.40 $452.40 $94.29 $452.40 $180.96 $267.59 $452.40 $452.40 $452.40 $452.40 $339.38 $452.40 $452.40 $452.40 $226.20 $226.20 $358.30 $452.40 $361.92 $203.58 $89.79 N/A $262.45 $452.40 $271.44 $452.40 $94.28 $452.40 N/A N/A 14000 SUP Custom 27203010 14000 - SET CRDPLG .25IN 15IN DLP MLT 4 LG ADPR SLIP CNCT BOTH IP/OP $49.50 $37.00 $8.81 $49.48 $49.48 $49.48 $49.48 $49.48 $49.48 $49.48 $8.81 $49.48 $49.48 $36.72 $36.72 $38.14 $25.78 $10.31 $49.48 $19.79 $49.48 $49.48 $49.48 $49.48 $49.48 $37.13 $49.48 $49.48 $49.48 $24.74 $24.74 $39.19 $49.48 $39.58 $32.16 $49.48 N/A $28.71 $49.48 $29.69 $49.48 $49.48 $49.48 1160.18 531.99 14070 SUP Custom 27203010 14070 - SYSTEM 8 1/8-11.75IN OST C2000- ML MAXI DRAIN PORT BOTH IP/OP $44.00 $33.00 $7.76 $43.58 $43.58 $43.58 $43.58 $43.58 $43.58 $43.58 $7.76 $43.58 $43.58 $32.35 $32.35 $33.59 $22.71 $9.08 $43.58 $17.43 $43.58 $43.58 $43.58 $43.58 $43.58 $33.00 $43.58 $43.58 $43.58 $21.79 $21.79 $34.52 $43.58 $34.86 $28.33 $43.58 N/A $25.52 $43.58 $26.15 $43.58 $43.58 $43.58 N/A N/A 14204 SUP Custom 27100030 14204 - BRACE ORTH LG 21-24IN PTO OPN BCK NPRN KN RT BOTH IP/OP $148.50 $110.00 $26.43 $148.50 $148.50 $148.50 $148.50 $148.50 $148.50 $148.50 $26.43 $148.50 $148.50 $110.22 $110.22 $114.46 $77.37 $30.95 $148.50 $59.40 $148.50 $148.50 $148.50 $148.50 $148.50 $111.38 $148.50 $148.50 $148.50 $74.25 $74.25 $117.61 $148.50 $118.80 $96.53 $148.50 N/A $86.13 $148.50 $89.10 $148.50 $148.50 $148.50 N/A N/A 14204 SUP Custom 27100030 14204 - BRACE ORTH LG 21-24IN PTO OPN BCK NPRN KN RT BOTH IP/OP $148.50 $110.00 $26.43 $148.50 $148.50 $148.50 $148.50 $148.50 $148.50 $148.50 $26.43 $148.50 $148.50 $110.22 $110.22 $114.46 $77.37 $30.95 $148.50 $59.40 $148.50 $148.50 $148.50 $148.50 $148.50 $111.38 $148.50 $148.50 $148.50 $74.25 $74.25 $117.61 $148.50 $118.80 $96.53 $148.50 N/A $86.13 $148.50 $89.10 $148.50 $148.50 $148.50 N/A N/A 14271 SUP Custom 27100030 14271 - BRACE ORTH XS 12-15IN PTO CLS BCK HPRFR ARMSH KN LT BOTH IP/OP $195.00 $144.00 $34.71 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $195.00 $34.71 $195.00 $195.00 $144.73 $144.73 $150.31 $101.60 $40.64 $195.00 $78.00 $195.00 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $126.75 $195.00 N/A $113.10 $195.00 $117.00 $195.00 $195.00 $195.00 N/A N/A 15030 SUP HCPCS C1713 015030 - SCREW BN 1.5MM 3MM TIMESH XDR TI CRNM BOTH IP/OP $92.50 $68.00 $18.35 $92.44 $41.60 $41.60 $41.60 $41.60 $92.44 $92.44 $92.44 $19.27 $92.44 $92.44 $92.44 $92.44 $92.44 $19.27 $92.44 $36.98 $54.68 $92.44 $92.44 $92.44 $92.44 $69.38 $92.44 $92.44 $92.44 $46.22 $46.22 $73.21 $92.44 $73.95 $41.60 $18.35 N/A $53.65 $92.44 $92.44 $92.44 $19.26 $92.44 N/A N/A 15031 SUP HCPCS C1713 015031 - SCREW BONE 1.5MM 3MM SELF TAP TIMESH TITANIUM CRANIUM BOTH IP/OP $104.50 $77.00 $20.67 $104.13 $46.86 $46.86 $46.86 $46.86 $104.13 $104.13 $104.13 $21.70 $104.13 $104.13 $104.13 $104.13 $104.13 $21.70 $104.13 $41.65 $61.59 $104.13 $104.13 $104.13 $104.13 $78.38 $104.13 $104.13 $104.13 $52.07 $52.07 $82.47 $104.13 $83.30 $46.86 $20.67 N/A $60.61 $104.13 $104.13 $104.13 $21.70 $104.13 N/A N/A 15040 SUP HCPCS C1713 015040 - PLATE BN STRG 4MM TIMESH 1 HLE/HD 1 HL SHFT TI CRNM 1.5MM BOTH IP/OP $99.50 $74.00 $19.68 $99.17 $44.63 $44.63 $44.63 $44.63 $99.17 $99.17 $99.17 $20.67 $99.17 $99.17 $99.17 $99.17 $99.17 $20.67 $99.17 $39.67 $58.66 $99.17 $99.17 $99.17 $99.17 $74.63 $99.17 $99.17 $99.17 $49.59 $49.59 $78.54 $99.17 $79.34 $44.63 $19.68 N/A $57.71 $99.17 $99.17 $99.17 $20.67 $99.17 296 130.81 15041 SUP HCPCS C1713 015041 - SCREW BONE 1.5MM SLFTAP TIMESH TITANIUM CRANIUM BOTH IP/OP $106.50 $79.00 $21.09 $106.25 $47.81 $47.81 $47.81 $47.81 $106.25 $106.25 $106.25 $22.15 $106.25 $106.25 $106.25 $106.25 $106.25 $22.14 $106.25 $42.50 $62.85 $106.25 $106.25 $106.25 $106.25 $79.88 $106.25 $106.25 $106.25 $53.13 $53.13 $84.15 $106.25 $85.00 $47.81 $21.09 N/A $61.77 $106.25 $63.75 $106.25 $22.14 $106.25 N/A N/A 15050 SUP HCPCS C1713 015050 - SCREW BONE 1.5MM 5MM SELF TAP CRUCIATE TIMESH TITANIUM BOTH IP/OP $98.00 $73.00 $19.40 $97.75 $43.99 $43.99 $43.99 $43.99 $97.75 $97.75 $97.75 $20.37 $97.75 $97.75 $97.75 $97.75 $97.75 $20.37 $97.75 $39.10 $57.82 $97.75 $97.75 $97.75 $97.75 $73.50 $97.75 $97.75 $97.75 $48.88 $48.88 $77.42 $97.75 $78.20 $43.99 $19.40 N/A $56.84 $97.75 $58.65 $97.75 $20.37 $97.75 1026.44 492.58 15051 SUP HCPCS C1713 015051 - SCREW BONE 1.5MM 5MM SELF TAP TIMESH TITANIUM BOTH IP/OP $104.50 $77.00 $20.67 $104.13 $46.86 $46.86 $46.86 $46.86 $104.13 $104.13 $104.13 $21.70 $104.13 $104.13 $104.13 $104.13 $104.13 $21.70 $104.13 $41.65 $61.59 $104.13 $104.13 $104.13 $104.13 $78.38 $104.13 $104.13 $104.13 $52.07 $52.07 $82.47 $104.13 $83.30 $46.86 $20.67 N/A $60.61 $104.13 $104.13 $104.13 $21.70 $104.13 N/A N/A 15060 SUP HCPCS C1713 015060 - SCREW BONE 1.5MM 6MM CROSS DRIVE SELF TAP CRUCIATE HEAD BOTH IP/OP $98.00 $73.00 $19.40 $97.75 $43.99 $43.99 $43.99 $43.99 $97.75 $97.75 $97.75 $20.37 $97.75 $97.75 $97.75 $97.75 $97.75 $20.37 $97.75 $39.10 $57.82 $97.75 $97.75 $97.75 $97.75 $73.50 $97.75 $97.75 $97.75 $48.88 $48.88 $77.42 $97.75 $78.20 $43.99 $19.40 N/A $56.84 $97.75 $58.65 $97.75 $20.37 $97.75 N/A N/A 15070 SUP HCPCS C1713 015070 - SCREW BONE 1.5MM 7MM CROSS DRIVE TIMESH TITANIUM CRANIUM BOTH IP/OP $100.00 $74.00 $19.75 $99.52 $44.78 $44.78 $44.78 $44.78 $99.52 $99.52 $99.52 $20.74 $99.52 $99.52 $99.52 $99.52 $99.52 $20.74 $99.52 $99.52 $58.87 $99.52 $99.52 $99.52 $99.52 $75.00 $99.52 $99.52 $99.52 $49.76 $49.76 $78.82 $99.52 $79.62 $44.78 $19.75 N/A $58.00 $99.52 $59.71 $99.52 $20.74 $99.52 N/A N/A 15080 SUP HCPCS C1713 015080 - SCREW BONE 1.5MM 8MM CROSS DRIVE TIMESH TITANIUM CRANIUM BOTH IP/OP $98.00 $73.00 $19.40 $97.75 $43.99 $43.99 $43.99 $43.99 $97.75 $97.75 $97.75 $20.37 $97.75 $97.75 $97.75 $97.75 $97.75 $20.37 $97.75 $97.75 $57.82 $97.75 $97.75 $97.75 $97.75 $73.50 $97.75 $97.75 $97.75 $48.88 $48.88 $77.42 $97.75 $78.20 $43.99 $19.40 N/A $56.84 $97.75 $58.65 $97.75 $20.37 $97.75 N/A N/A 15090 SUP HCPCS C1713 015090 - SCREW BN 1.5MM 9MM XDR BOTH IP/OP $100.00 $74.00 $19.75 $99.52 $44.78 $44.78 $44.78 $44.78 $99.52 $99.52 $99.52 $20.74 $99.52 $99.52 $99.52 $99.52 $99.52 $20.74 $99.52 $99.52 $58.87 $99.52 $99.52 $99.52 $99.52 $75.00 $99.52 $99.52 $99.52 $49.76 $49.76 $78.82 $99.52 $79.62 $44.78 $19.75 N/A $58.00 $99.52 $99.52 $99.52 $20.74 $99.52 N/A N/A 15110 SUP HCPCS C1713 015110 - PLATE BONE 80X60X.5MM SHEET PROTECTIVE MACROPORE PDLLA BOTH IP/OP $98.00 $73.00 $19.40 $97.75 $43.99 $43.99 $43.99 $43.99 $97.75 $97.75 $97.75 $20.37 $97.75 $97.75 $97.75 $97.75 $97.75 $20.37 $97.75 $97.75 $57.82 $97.75 $97.75 $97.75 $97.75 $73.50 $97.75 $97.75 $97.75 $48.88 $48.88 $77.42 $97.75 $78.20 $43.99 $19.40 N/A $56.84 $97.75 $58.65 $97.75 $20.37 $97.75 1606.1 754.56 15170 SUP Custom 27203010 015170 - STAPLER INTNL 57MMX.17MM LACTOMER ABS STPL SQZ BOTH IP/OP "$1,226.50" $908.00 $218.28 "$1,226.30" "$1,226.30" "$1,226.30" "$1,226.30" "$1,226.30" "$1,226.30" "$1,226.30" $218.28 "$1,226.30" "$1,226.30" $910.16 $910.16 $945.23 $638.90 $255.57 "$1,226.30" $490.52 "$1,226.30" "$1,226.30" "$1,226.30" "$1,226.30" "$1,226.30" $919.88 "$1,226.30" "$1,226.30" "$1,226.30" $613.15 $613.15 $971.23 "$1,226.30" $981.04 $797.10 "$1,226.30" N/A $711.37 "$1,226.30" $735.78 "$1,226.30" "$1,226.30" "$1,226.30" N/A N/A 15850 SUP HCPCS C1758 0015850 - BAG DRN 9.5IN 19OZ STRL LTX 2 ADJ BELT ADPR NTR RBR BILE BOTH IP/OP $254.00 $188.00 $50.37 $253.80 $137.81 $137.81 $137.81 $137.81 $253.80 $253.80 $253.80 $52.90 $253.80 $188.37 $188.37 $195.63 $132.23 $52.89 $253.80 $160.20 $150.12 $253.80 $160.20 $253.80 $253.80 $190.50 $253.80 $253.80 $253.80 $126.90 $126.90 $201.01 $253.80 $203.04 $164.97 $50.37 N/A $147.32 $253.80 $253.80 $253.80 $52.89 $253.80 95.48 N/A 17130 SUP HCPCS C1713 017130 - PLATE BN CRV .6MM SLVR TRAUMAONE 10 HL TI ORBT FLR 1.5MM SCR BOTH IP/OP $540.00 $400.00 $107.18 $540.00 $243.00 $243.00 $243.00 $243.00 $540.00 $540.00 $540.00 $112.55 $540.00 $540.00 $540.00 $540.00 $540.00 $112.54 $540.00 $216.00 $319.41 $540.00 $540.00 $540.00 $540.00 $405.00 $540.00 $540.00 $540.00 $270.00 $270.00 $427.68 $540.00 $432.00 $243.00 $107.18 N/A $313.20 $540.00 $324.00 $540.00 $112.54 $540.00 N/A N/A 17207 SUP HCPCS C1762 017207 - SPACER ALLOGRAFT 5D LARGE LORDOTIC PYRAMID 12X14X7MM FREEZE BOTH IP/OP "$2,967.50" "$2,196.00" $588.97 "$2,967.50" "$1,335.38" "$1,335.38" "$1,335.38" "$1,335.38" "$2,967.50" "$2,967.50" "$2,967.50" $618.50 "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" $618.46 "$2,967.50" "$2,967.50" "$1,462.98" "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" "$2,225.63" "$2,967.50" "$2,967.50" "$2,967.50" "$1,483.75" "$1,483.75" "$2,350.26" "$2,967.50" "$2,374.00" "$1,335.38" $588.97 N/A "$1,721.15" "$2,967.50" "$2,967.50" "$2,967.50" $618.43 "$2,967.50" N/A N/A 17208 SUP HCPCS C1789 017208 - SPACER ALGRF 5D LRDTC OVL 12X14X8MM FRZDR MNLTH LG CNTR LUM BOTH IP/OP "$2,637.50" "$1,952.00" $523.48 "$2,900.00" "$1,186.88" "$1,186.88" "$1,186.88" "$1,186.88" "$2,637.50" "$2,637.50" "$2,637.50" $549.72 "$2,637.50" "$2,637.50" "$2,637.50" "$2,637.50" "$2,637.50" $549.68 "$2,637.50" "$2,900.00" "$1,300.29" "$2,637.50" "$2,900.00" "$2,637.50" "$2,637.50" "$1,978.13" "$2,637.50" "$2,637.50" "$2,637.50" "$1,318.75" "$1,318.75" "$2,088.90" "$2,637.50" "$2,110.00" "$1,186.88" $523.48 N/A "$1,529.75" "$2,637.50" "$2,637.50" "$2,637.50" $549.66 "$2,637.50" N/A N/A 17251 SUP HCPCS C1769 17251 - PLATINUM PLUS GUIDEWIRE .014X300CM WIRE BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $190.05 $190.05 $190.05 $190.05 $350.00 $350.00 $350.00 $72.95 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A 17614 SUP Custom 27203010 17614 - STAPLER INTNL 55X4.8MM TI ENDSCP LNR CTR SQZ HNDL STRL LF BOTH IP/OP $493.50 $365.00 $87.76 $493.05 $493.05 $493.05 $493.05 $493.05 $493.05 $493.05 $87.76 $493.05 $493.05 $365.94 $365.94 $380.04 $256.88 $102.76 $493.05 $197.22 $493.05 $493.05 $493.05 $493.05 $493.05 $370.13 $493.05 $493.05 $493.05 $246.53 $246.53 $390.50 $493.05 $394.44 $320.48 $493.05 N/A $286.23 $493.05 $295.83 $493.05 $493.05 $493.05 N/A N/A 18030 SUP HCPCS C1713 018030 - SCREW BONE 1.8MM 3MM CROSS DRIVE TIMESH RESCUE TITANIUM BOTH IP/OP $92.00 $68.00 $18.21 $91.73 $41.28 $41.28 $41.28 $41.28 $91.73 $91.73 $91.73 $19.12 $91.73 $91.73 $91.73 $91.73 $91.73 $19.12 $91.73 $91.73 $54.26 $91.73 $91.73 $91.73 $91.73 $69.00 $91.73 $91.73 $91.73 $45.87 $45.87 $72.65 $91.73 $73.38 $41.28 $18.21 N/A $53.36 $91.73 $91.73 $91.73 $19.12 $91.73 N/A N/A 18031 SUP HCPCS C1713 018031 - SCREW BONE 1.8MM 3MM CRUCIATE RESCUE TIMESH TITANIUM BOTH IP/OP $98.00 $73.00 $56.84 "$1,531.09" "$1,531.09" "$1,531.09" "$1,531.09" "$1,531.09" "$1,531.09" "$1,531.09" $272.53 "$1,531.09" "$1,531.09" "$1,136.37" "$1,136.37" "$1,180.16" $797.70 $319.10 "$1,531.09" $612.44 "$1,531.09" "$1,531.09" "$1,531.09" "$1,531.09" "$1,531.09" $73.50 "$1,531.09" "$1,531.09" "$1,531.09" $765.55 $765.55 "$1,212.62" "$1,531.09" "$1,224.87" $995.21 "$1,531.09" "$1,531.09" $56.84 "$1,531.09" $918.65 "$1,531.09" "$1,531.09" "$1,531.09" N/A N/A 18050 SUP HCPCS C1713 018050 - SCREW BONE 1.8MM 5MM CROSS DRIVE TIMESH RESCUE TITANIUM BOTH IP/OP $92.00 $68.00 $18.21 $91.73 $41.28 $41.28 $41.28 $41.28 $91.73 $91.73 $91.73 $19.12 $91.73 $91.73 $91.73 $91.73 $91.73 $19.12 $91.73 $91.73 $54.26 $91.73 $91.73 $91.73 $91.73 $69.00 $91.73 $91.73 $91.73 $45.87 $45.87 $72.65 $91.73 $73.38 $41.28 $18.21 N/A $53.36 $91.73 $55.04 $91.73 $19.12 $91.73 N/A N/A 18051 SUP HCPCS C1713 018051 - SCREW BONE 1.8MM 5MM CRUCIATE RESCUE TIMESH TITANIUM BOTH IP/OP $98.00 $73.00 $19.40 $97.75 $43.99 $43.99 $43.99 $43.99 $97.75 $97.75 $97.75 $20.37 $97.75 $97.75 $97.75 $97.75 $97.75 $20.37 $97.75 $97.75 $57.82 $97.75 $97.75 $97.75 $97.75 $73.50 $97.75 $97.75 $97.75 $48.88 $48.88 $77.42 $97.75 $78.20 $43.99 $19.40 N/A $56.84 $97.75 $58.65 $97.75 $20.37 $97.75 N/A N/A 18400 SUP HCPCS C1729 18400 - CATHETER CHOLANGIOGRAM 4.5FR 30CM TAUT BOTH IP/OP $137.50 $102.00 $79.75 $510.43 $510.43 $510.43 $510.43 $510.43 $510.43 $510.43 $90.86 $510.43 $510.43 $378.84 $378.84 $393.44 $265.93 $106.38 $510.43 $204.17 $510.43 $510.43 $510.43 $510.43 $510.43 $103.13 $510.43 $510.43 $510.43 $255.22 $255.22 $404.26 $510.43 $408.34 $331.78 $510.43 $510.43 $79.75 $510.43 $306.26 $510.43 $510.43 $510.43 N/A N/A 19006 SUP Custom 27203010 19006 - KIT OSTOMY 0-3.5IN 4IN 12IN 2 PIECE DRAIN LOCK N ROLL BOTH IP/OP $47.00 $35.00 $8.32 $46.72 $46.72 $46.72 $46.72 $46.72 $46.72 $46.72 $8.32 $46.72 $46.72 $34.68 $34.68 $36.01 $24.34 $9.74 $46.72 $18.69 $46.72 $46.72 $46.72 $46.72 $46.72 $35.25 $46.72 $46.72 $46.72 $23.36 $23.36 $37.00 $46.72 $37.38 $30.37 $46.72 N/A $27.26 $46.72 $28.03 $46.72 $46.72 $46.72 N/A N/A 19203 SUP Custom 27203010 19203 - KIT UROSTOMY CUT TO FIT 1.75- IN 2.25IN 9IN 2 PIECE BELT TAB BOTH IP/OP $7.50 $6.00 $1.29 $7.48 $7.48 $7.48 $7.48 $7.48 $7.48 $7.48 $1.33 $7.48 $7.48 $5.55 $5.55 $5.77 $3.90 $1.56 $7.48 $1.29 $7.48 $7.48 $3.23 $7.48 $7.48 $5.63 $7.48 $7.48 $7.48 $3.74 $3.74 $5.92 $7.48 $5.98 $4.86 $7.48 N/A $4.35 $7.48 $4.49 $7.48 $7.48 $7.48 N/A N/A 20012 SUP Custom 27203010 20012 - CANNULA PRFSN 12GA 5.5IN DLP ANTGRD STD TIP INTRO VNT LN BOTH IP/OP $2.50 $2.00 $0.41 $2.28 $2.28 $2.28 $2.28 $2.28 $2.28 $2.28 $0.41 $2.28 $2.28 $1.69 $1.69 $1.76 $1.19 $0.48 $2.28 $0.91 $2.28 $2.28 $2.28 $2.28 $2.28 $1.88 $2.28 $2.28 $2.28 $1.14 $1.14 $1.81 $2.28 $1.82 $1.48 $2.28 N/A $1.45 $2.28 $1.37 $2.28 $2.28 $2.28 N/A N/A 20028 SUP Custom 27803010 20028 - DEVICE VENTRICULAR ASSIST 12MM 5.5CM INTERMITTENT BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 20033 SUP HCPCS C1788 20033 - CONNECTOR SHUNT 3 WAY CATHETER PORT CSF STERILE BOTH IP/OP $565.50 $418.00 $112.19 $565.25 $254.36 $254.36 $254.36 $254.36 $565.25 $565.25 $565.25 $117.81 $565.25 $565.25 $565.25 $565.25 $565.25 $117.80 $565.25 $565.25 $334.35 $565.25 $565.25 $565.25 $565.25 $424.13 $565.25 $565.25 $565.25 $282.63 $282.63 $447.68 $565.25 $452.20 $254.36 $112.19 N/A $327.99 $565.25 $565.25 $565.25 $117.80 $565.25 N/A N/A 20034 SUP Custom 27203010 20034 - KIT SHUNT 35CM EDM VENTRICULAR STERILE DISPOSABLE BOTH IP/OP $713.00 $528.00 $126.88 $712.80 $712.80 $712.80 $712.80 $712.80 $712.80 $712.80 $126.88 $712.80 $712.80 $529.04 $529.04 $549.43 $371.37 $148.56 $712.80 $285.12 $712.80 $712.80 $712.80 $712.80 $712.80 $534.75 $712.80 $712.80 $712.80 $356.40 $356.40 $564.54 $712.80 $570.24 $463.32 $712.80 N/A $413.54 $712.80 $427.68 $712.80 $712.80 $712.80 N/A N/A 20046 SUP Custom 27803010 20046 - CATHETER DRAIN LARGE 23CM VENTRICULAR BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 20141 SUP Custom 27203010 20141 - DRESSING BURN 5X4IN ANTIMICROBIAL FAST ACT BARRIER CONTROL BOTH IP/OP $40.00 $30.00 $7.11 $39.92 $39.92 $39.92 $39.92 $39.92 $39.92 $39.92 $7.11 $39.92 $39.92 $29.63 $29.63 $30.77 $20.80 $8.32 $39.92 $15.97 $39.92 $39.92 $39.92 $39.92 $39.92 $30.00 $39.92 $39.92 $39.92 $19.96 $19.96 $31.62 $39.92 $31.94 $25.95 $39.92 N/A $23.20 $39.92 $23.95 $39.92 $39.92 $39.92 N/A N/A 20201 SUP Custom 27203010 20201 - DRESSING BURN ANBCTRL FAST ACT VRSTL NCRSTLN SLVR 8X4IN STRL BOTH IP/OP $122.00 $90.00 $21.66 $121.69 $121.69 $121.69 $121.69 $121.69 $121.69 $121.69 $21.66 $121.69 $121.69 $90.32 $90.32 $93.80 $63.40 $25.36 $121.69 $48.68 $121.69 $121.69 $121.69 $121.69 $121.69 $91.50 $121.69 $121.69 $121.69 $60.85 $60.85 $96.38 $121.69 $97.35 $79.10 $121.69 N/A $70.76 $121.69 $73.01 $121.69 $121.69 $121.69 N/A N/A 20401 SUP Custom 27203010 20401 - DRESSING BRN 16X16IN STRL LF ACTCT ANBCTRL FST ACT BRR CNTRL BOTH IP/OP $156.50 $116.00 $27.81 $156.26 $156.26 $156.26 $156.26 $156.26 $156.26 $156.26 $27.81 $156.26 $156.26 $115.98 $115.98 $120.45 $81.41 $32.57 $156.26 $62.50 $156.26 $156.26 $156.26 $156.26 $156.26 $117.38 $156.26 $156.26 $156.26 $78.13 $78.13 $123.76 $156.26 $125.01 $101.57 $156.26 N/A $90.77 $156.26 $93.76 $156.26 $156.26 $156.26 N/A N/A 20421 SUP Custom 27203010 MATTRESS PT 16X10IN TRNWRMR PVC PORT NELCTR HEAT SRC INF BOTH IP/OP $58.00 $43.00 $10.28 $57.78 $57.78 $57.78 $57.78 $57.78 $57.78 $57.78 $10.28 $57.78 $57.78 $42.88 $42.88 $44.54 $30.10 $12.04 $57.78 $23.11 $57.78 $57.78 $57.78 $57.78 $57.78 $43.50 $57.78 $57.78 $57.78 $28.89 $28.89 $45.76 $57.78 $46.22 $37.56 $57.78 N/A $33.64 $57.78 $34.67 $57.78 $57.78 $57.78 N/A N/A 20934 SUP Custom 27203010 020934 - KIT OSTOMY 4IN 12-12.5IN 2 PIECE SKIN BARRIER TAIL CLOSURE BOTH IP/OP $81.50 $60.00 $14.43 $81.06 $81.06 $81.06 $81.06 $81.06 $81.06 $81.06 $14.43 $81.06 $81.06 $60.16 $60.16 $62.48 $42.23 $16.89 $81.06 $32.42 $81.06 $81.06 $81.06 $81.06 $81.06 $61.13 $81.06 $81.06 $81.06 $40.53 $40.53 $64.20 $81.06 $64.85 $52.69 $81.06 N/A $47.27 $81.06 $48.64 $81.06 $81.06 $81.06 1646.69 799.39 21004 SUP Custom 27803010 21004 - CATHETER DIALYSIS SMALL OPEN END SLIT PERITONEAL BOTH IP/OP $418.00 $309.00 $74.40 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $74.40 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $87.12 $418.00 $167.20 $418.00 $418.00 $418.00 $418.00 $418.00 $313.50 $418.00 $418.00 $418.00 $209.00 $209.00 $331.06 $418.00 $334.40 $188.10 $418.00 N/A $242.44 $418.00 $250.80 $418.00 $418.00 $418.00 N/A N/A 21029 SUP Custom 27803010 21029 - RESERVOIR SHUNT 12MM BOTTOM INLET VENTRICULAR STERILE BOTH IP/OP $931.00 $689.00 $214.87 "$1,082.60" $487.17 $487.17 $487.17 $487.17 "$1,082.60" "$1,082.60" "$1,082.60" $225.64 "$1,082.60" "$1,082.60" "$1,082.60" "$1,082.60" "$1,082.60" $225.63 "$1,082.60" "$1,082.60" $640.36 "$1,082.60" "$1,082.60" "$1,082.60" "$1,082.60" $698.25 "$1,082.60" "$1,082.60" "$1,082.60" $541.30 $541.30 $857.42 "$1,082.60" $866.08 $487.17 $214.87 N/A $539.98 "$1,082.60" "$1,082.60" "$1,082.60" $225.61 "$1,082.60" 1479.74 657.51 21029 SUP HCPCS C1768 21029 - GRAFT VASC 10MM 70CM ADVT VXT STD WL REINF PTFE BOTH IP/OP "$1,083.00" $801.00 $214.87 "$1,082.60" $487.17 $487.17 $487.17 $487.17 "$1,082.60" "$1,082.60" "$1,082.60" $225.64 "$1,082.60" "$1,082.60" "$1,082.60" "$1,082.60" "$1,082.60" $225.63 "$1,082.60" "$1,082.60" $640.36 "$1,082.60" "$1,082.60" "$1,082.60" "$1,082.60" $812.25 "$1,082.60" "$1,082.60" "$1,082.60" $541.30 $541.30 $857.42 "$1,082.60" $866.08 $487.17 $214.87 N/A $628.14 "$1,082.60" "$1,082.60" "$1,082.60" $225.61 "$1,082.60" 1479.74 657.51 21038 SUP HCPCS C1769 21038 - GUIDEWIRE NEUROSURGICAL 100CM DRAIN TEFLON LUMBAR BOTH IP/OP $214.00 $158.00 $42.42 $213.75 $116.07 $116.07 $116.07 $116.07 $213.75 $213.75 $213.75 $44.55 $213.75 $158.65 $158.65 $164.76 $111.36 $44.55 $213.75 $213.75 $126.43 $213.75 $213.75 $213.75 $213.75 $160.50 $213.75 $213.75 $213.75 $106.88 $106.88 $169.29 $213.75 $171.00 $138.94 $42.42 N/A $124.12 $213.75 $213.75 $213.75 $44.55 $213.75 N/A N/A 21066 SUP Custom 27803010 21066 - CONNECTOR SHUNT CATHETER STEPDOWN STRATA LUMBOPERITONEAL CSF BOTH IP/OP $178.50 $132.00 $31.71 $178.13 $178.13 $178.13 $178.13 $178.13 $178.13 $178.13 $31.71 $178.13 $178.13 $178.13 $178.13 $178.13 $178.13 $37.12 $178.13 $71.25 $178.13 $178.13 $178.13 $178.13 $178.13 $133.88 $178.13 $178.13 $178.13 $89.07 $89.07 $141.08 $178.13 $142.50 $80.16 $178.13 N/A $103.53 $178.13 $106.88 $178.13 $178.13 $178.13 N/A N/A 22013 SUP Custom 27803010 22013 - CATHETER NEUROSURGICAL SMALL 90CM OPEN END PERITONEAL BOTH IP/OP $418.00 $309.00 $74.40 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $74.40 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $87.12 $418.00 $167.20 $418.00 $418.00 $418.00 $418.00 $418.00 $313.50 $418.00 $418.00 $418.00 $209.00 $209.00 $331.06 $418.00 $334.40 $188.10 $418.00 N/A $242.44 $418.00 $250.80 $418.00 $418.00 $418.00 N/A N/A 22014 SUP Custom 27803010 22014 - CATHETER DIALYSIS STANDARD 96CM OPEN END BARIUM PERITONEUM BOTH IP/OP $418.00 $309.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $967.50 $572.28 $967.50 $967.50 $967.50 $967.50 $313.50 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $242.44 $967.50 $967.50 $967.50 $201.63 $967.50 N/A N/A 22014 SUP HCPCS C1768 22014 - GRAFT VASC STD WL STRG 8MM 40CM STRL LF ADVT VXT COMP REINF BOTH IP/OP $967.50 $716.00 $192.02 $967.50 $435.38 $435.38 $435.38 $435.38 $967.50 $967.50 $967.50 $201.65 $967.50 $967.50 $967.50 $967.50 $967.50 $201.64 $967.50 $967.50 $572.28 $967.50 $967.50 $967.50 $967.50 $725.63 $967.50 $967.50 $967.50 $483.75 $483.75 $766.26 $967.50 $774.00 $435.38 $192.02 N/A $561.15 $967.50 $967.50 $967.50 $201.63 $967.50 N/A N/A 22039 SUP Custom 27803010 22039 - RESERVOIR SHUNT 12MM SIDE INLET VENTRICULAR STERILE BOTH IP/OP $888.50 $657.00 $158.11 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $158.11 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $185.12 $888.25 $355.30 $888.25 $888.25 $888.25 $888.25 $888.25 $666.38 $888.25 $888.25 $888.25 $444.13 $444.13 $703.49 $888.25 $710.60 $399.71 $888.25 N/A $515.33 $888.25 $532.95 $888.25 $888.25 $888.25 N/A N/A 22063 SUP Custom 27803010 22063 - CONNECTOR SHUNT STANDARD STEPDOWN TUBING BOTH IP/OP $204.50 $151.00 $118.61 "$1,596.58" $718.46 $718.46 $718.46 $718.46 "$1,596.58" "$1,596.58" "$1,596.58" $332.77 "$1,596.58" "$1,596.58" "$1,596.58" "$1,596.58" "$1,596.58" $332.74 "$1,596.58" "$1,596.58" $944.38 "$1,596.58" "$1,596.58" "$1,596.58" "$1,596.58" $153.38 "$1,596.58" "$1,596.58" "$1,596.58" $798.29 $798.29 "$1,264.49" "$1,596.58" "$1,277.26" $718.46 $316.88 N/A $118.61 "$1,596.58" "$1,596.58" "$1,596.58" $332.73 "$1,596.58" N/A N/A 22063 SUP HCPCS C1768 22063 - GRAFT VASC STD WL 7MM 50CM STRL ADVT VXT SLDR GDS REINF BOTH IP/OP "$1,597.00" "$1,182.00" $316.88 "$1,596.58" $718.46 $718.46 $718.46 $718.46 "$1,596.58" "$1,596.58" "$1,596.58" $332.77 "$1,596.58" "$1,596.58" "$1,596.58" "$1,596.58" "$1,596.58" $332.74 "$1,596.58" "$1,596.58" $944.38 "$1,596.58" "$1,596.58" "$1,596.58" "$1,596.58" "$1,197.75" "$1,596.58" "$1,596.58" "$1,596.58" $798.29 $798.29 "$1,264.49" "$1,596.58" "$1,277.26" $718.46 $316.88 N/A $926.26 "$1,596.58" "$1,596.58" "$1,596.58" $332.73 "$1,596.58" N/A N/A 22104 SUP Custom 27803010 22104 - RESERVOIR SHUNT SMALL BARIUM INTEGRATED VENTRICULAR CATHETER BOTH IP/OP $888.50 $657.00 $158.11 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $158.11 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $185.12 $888.25 $355.30 $888.25 $888.25 $888.25 $888.25 $888.25 $666.38 $888.25 $888.25 $888.25 $444.13 $444.13 $703.49 $888.25 $710.60 $399.71 $888.25 N/A $515.33 $888.25 $532.95 $888.25 $888.25 $888.25 N/A N/A 22150 SUP Custom 27203010 22150 - DEVICE BLWR/MSTR STRL LF CLRVW TUBE SET N180 N185 BOTH IP/OP $132.00 $98.00 $76.56 $99.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $99.00 N/A N/A N/A N/A N/A $99.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $76.56 N/A N/A N/A N/A N/A N/A N/A 22355 SUP HCPCS C1713 022355 - ROD OST 64MM STRL LF LOOP DISP SFN 70MM FLNG BOTH IP/OP $4.00 $3.00 $0.72 $3.65 $1.64 $1.64 $1.64 $1.64 $3.65 $3.65 $3.65 $0.76 $3.65 $3.65 $3.65 $3.65 $3.65 $0.76 $3.65 $1.46 $2.16 $3.65 $3.65 $3.65 $3.65 $3.00 $3.65 $3.65 $3.65 $1.83 $1.83 $2.89 $3.65 $2.92 $1.64 $0.72 N/A $2.32 $3.65 $3.65 $3.65 $0.76 $3.65 N/A N/A 22356 SUP HCPCS C1713 22356 - ROD OST 90MM STRL LF SFN CNVTC LOOP DISP 4IN FLNG SKN BRR BOTH IP/OP $37.00 $27.00 $7.34 $37.00 $16.65 $16.65 $16.65 $16.65 $37.00 $37.00 $37.00 $7.71 $37.00 $37.00 $37.00 $37.00 $37.00 $7.71 $37.00 $14.80 $21.89 $37.00 $37.00 $37.00 $37.00 $27.75 $37.00 $37.00 $37.00 $18.50 $18.50 $29.30 $37.00 $29.60 $16.65 $7.34 N/A $21.46 $37.00 $37.00 $37.00 $7.71 $37.00 N/A N/A 23014 SUP Custom 27203010 23014 - KIT DRAIN CSF EXTERNAL MONITR BOTH IP/OP $326.50 $242.00 $58.10 $326.40 $326.40 $326.40 $326.40 $326.40 $326.40 $326.40 $58.10 $326.40 $326.40 $242.25 $242.25 $251.59 $170.05 $68.03 $326.40 $130.56 $326.40 $326.40 $326.40 $326.40 $326.40 $244.88 $326.40 $326.40 $326.40 $163.20 $163.20 $258.51 $326.40 $261.12 $212.16 $326.40 N/A $189.37 $326.40 $195.84 $326.40 $326.40 $326.40 N/A N/A 23021 SUP Custom 27803010 23021 - CATHETER DRAIN 1.5MM LUER LOCK LOCK CONCTR NONVENTED BOTH IP/OP $154.00 $114.00 $27.34 $153.60 $153.60 $153.60 $153.60 $153.60 $153.60 $153.60 $27.34 $153.60 $153.60 $153.60 $153.60 $153.60 $153.60 $32.01 $153.60 $61.44 $153.60 $153.60 $153.60 $153.60 $153.60 $115.50 $153.60 $153.60 $153.60 $76.80 $76.80 $121.65 $153.60 $122.88 $69.12 $153.60 N/A $89.32 $153.60 $92.16 $153.60 $153.60 $153.60 N/A N/A 23045 SUP Custom 27203010 23045 - CATHETER DRAIN 10MM 45MM LINE LEVEL EDM NEONATE .1ML STERILE BOTH IP/OP $178.00 $132.00 $31.61 $177.60 $177.60 $177.60 $177.60 $177.60 $177.60 $177.60 $31.61 $177.60 $177.60 $131.81 $131.81 $136.89 $92.53 $37.01 $177.60 $71.04 $177.60 $177.60 $177.60 $177.60 $177.60 $133.50 $177.60 $177.60 $177.60 $88.80 $88.80 $140.66 $177.60 $142.08 $115.44 $177.60 N/A $103.24 $177.60 $106.56 $177.60 $177.60 $177.60 N/A N/A 23047 SUP Custom 27803010 23047 - CATHETER DIALYSIS STANDARD 120CM OPEN END SLIT PERITONEAL BOTH IP/OP $418.00 $309.00 $74.40 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $74.40 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $87.12 $418.00 $167.20 $418.00 $418.00 $418.00 $418.00 $418.00 $313.50 $418.00 $418.00 $418.00 $209.00 $209.00 $331.06 $418.00 $334.40 $188.10 $418.00 N/A $242.44 $418.00 $250.80 $418.00 $418.00 $418.00 N/A N/A 23067 SUP HCPCS C2619 23067 - SET NEUROLOGICAL ADAPTER PREIMPLANT TEST SNAP ASMBLY BOTH IP/OP $226.00 $167.00 $47.02 $225.63 $225.63 $225.63 $225.63 $225.63 $225.63 $225.63 $225.63 $225.63 $225.63 $225.63 $225.63 $225.63 $225.63 $47.02 $225.63 $90.25 $225.63 $225.63 $225.63 $225.63 $225.63 $169.50 $225.63 $225.63 $225.63 $112.82 $112.82 $178.70 $225.63 $180.50 $101.53 $225.63 N/A $131.08 $225.63 $135.38 $225.63 $225.63 $225.63 N/A N/A 23069 SUP Custom 27803010 23069 - SHUNT NEUROSURGICAL 1.5MM .7MM 87CM CSF LUMBOPERITONEAL BOTH IP/OP "$2,273.00" "$1,682.00" $404.57 "$2,272.88" "$2,272.88" "$2,272.88" "$2,272.88" "$2,272.88" "$2,272.88" "$2,272.88" $404.57 "$2,272.88" "$2,272.88" "$2,272.88" "$2,272.88" "$2,272.88" "$2,272.88" $473.69 "$2,272.88" $909.15 "$2,272.88" "$2,272.88" "$2,272.88" "$2,272.88" "$2,272.88" "$1,704.75" "$2,272.88" "$2,272.88" "$2,272.88" "$1,136.44" "$1,136.44" "$1,800.12" "$2,272.88" "$1,818.30" "$1,022.80" "$2,272.88" N/A "$1,318.34" "$2,272.88" "$1,363.73" "$2,272.88" "$2,272.88" "$2,272.88" N/A N/A 23075 SUP Custom 27803010 23075 - CATHETER DRAIN TRANSLUCENT POLYURETHANE VENTRICULAR BOTH IP/OP "$3,479.50" "$2,575.00" $619.33 "$3,479.38" "$3,479.38" "$3,479.38" "$3,479.38" "$3,479.38" "$3,479.38" "$3,479.38" $619.33 "$3,479.38" "$3,479.38" "$3,479.38" "$3,479.38" "$3,479.38" "$3,479.38" $725.14 "$3,479.38" "$1,391.75" "$3,479.38" "$3,479.38" "$3,479.38" "$3,479.38" "$3,479.38" "$2,609.63" "$3,479.38" "$3,479.38" "$3,479.38" "$1,739.69" "$1,739.69" "$2,755.67" "$3,479.38" "$2,783.50" "$1,565.72" "$3,479.38" N/A "$2,018.11" "$3,479.38" "$2,087.63" "$3,479.38" "$3,479.38" "$3,479.38" 753.95 352.98 23076 SUP Custom 27803010 23076 - CATHETER DIALYSIS POLYURETHANE PERITONEAL BOTH IP/OP "$2,470.00" "$1,828.00" $439.66 "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" $439.66 "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" $514.78 "$2,470.00" $988.00 "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" "$1,852.50" "$2,470.00" "$2,470.00" "$2,470.00" "$1,235.00" "$1,235.00" "$1,956.24" "$2,470.00" "$1,976.00" "$1,111.50" "$2,470.00" N/A "$1,432.60" "$2,470.00" "$1,482.00" "$2,470.00" "$2,470.00" "$2,470.00" 1247.9 582.41 23092 SUP HCPCS C1750 23092 - CATHETER DLYS STD 120CM STRL BA IMPRG OP-EN WL SLT BOTH IP/OP $418.00 $309.00 $82.96 $418.00 $188.10 $188.10 $188.10 $188.10 $418.00 $418.00 $418.00 $87.12 $418.00 $418.00 $418.00 $418.00 $418.00 $87.12 $418.00 $418.00 $247.25 $418.00 $418.00 $418.00 $418.00 $313.50 $418.00 $418.00 $418.00 $209.00 $209.00 $331.06 $418.00 $334.40 $188.10 $82.96 N/A $242.44 $418.00 $418.00 $418.00 $87.11 $418.00 N/A N/A 23093 SUP Custom 27803010 23093 - VALVE SHUNT REGULAR CSF LOW TO LOW PRESSURE CNTOUR FLOW BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 24010 SUP Custom 27803010 24010 - CATHETER DRAIN STANDARD 120CM BARIUM IMPREGNATED CARDIAC BOTH IP/OP $411.00 $304.00 $73.14 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $73.14 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $85.63 $410.88 $164.35 $410.88 $410.88 $410.88 $410.88 $410.88 $308.25 $410.88 $410.88 $410.88 $205.44 $205.44 $325.42 $410.88 $328.70 $184.90 $410.88 N/A $238.38 $410.88 $246.53 $410.88 $410.88 $410.88 N/A N/A 24048 SUP Custom 27803010 24048 - VALVE SHUNT REGULAR CSF PERFORMANCE LEVEL .5 DELTA STERILE BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 24052 SUP Custom 27203010 24052 - KIT VENTRICULOSTOMY 18MM RESERVOIR SILICONE STERILE BOTH IP/OP $693.50 $513.00 $123.44 $693.50 $693.50 $693.50 $693.50 $693.50 $693.50 $693.50 $123.44 $693.50 $693.50 $514.72 $514.72 $534.55 $361.31 $144.53 $693.50 $277.40 $693.50 $693.50 $693.50 $693.50 $693.50 $520.13 $693.50 $693.50 $693.50 $346.75 $346.75 $549.25 $693.50 $554.80 $450.78 $693.50 N/A $402.23 $693.50 $416.10 $693.50 $693.50 $693.50 N/A N/A 24053 SUP Custom 27803010 24053 - VALVE SHUNT REGULAR CHAMBER DELTA CSF STERILE BOTH IP/OP "$2,691.00" "$1,991.00" $478.98 "$2,690.88" "$2,690.88" "$2,690.88" "$2,690.88" "$2,690.88" "$2,690.88" "$2,690.88" $478.98 "$2,690.88" "$2,690.88" "$2,690.88" "$2,690.88" "$2,690.88" "$2,690.88" $560.81 "$2,690.88" "$1,076.35" "$2,690.88" "$2,690.88" "$2,690.88" "$2,690.88" "$2,690.88" "$2,018.25" "$2,690.88" "$2,690.88" "$2,690.88" "$1,345.44" "$1,345.44" "$2,131.18" "$2,690.88" "$2,152.70" "$1,210.90" "$2,690.88" N/A "$1,560.78" "$2,690.88" "$1,614.53" "$2,690.88" "$2,690.88" "$2,690.88" N/A N/A 24084 SUP Custom 27803010 24084 - RESERVOIR SHUNT 12MM 12MM INLET OUTLET CONNECT .1ML BOTH IP/OP $888.50 $657.00 $158.11 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $158.11 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $185.12 $888.25 $355.30 $888.25 $888.25 $888.25 $888.25 $888.25 $666.38 $888.25 $888.25 $888.25 $444.13 $444.13 $703.49 $888.25 $710.60 $399.71 $888.25 N/A $515.33 $888.25 $532.95 $888.25 $888.25 $888.25 N/A N/A 24085 SUP Custom 27803010 24085 - SHUNT NEUROSURGICAL 15CM CSF DOME SNAP ASMBLY TUBE BOTH IP/OP $606.00 $448.00 $107.80 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $107.80 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $126.22 $605.63 $242.25 $605.63 $605.63 $605.63 $605.63 $605.63 $454.50 $605.63 $605.63 $605.63 $302.82 $302.82 $479.66 $605.63 $484.50 $272.53 $605.63 N/A $351.48 $605.63 $363.38 $605.63 $605.63 $605.63 N/A N/A 24094 SUP Custom 27803010 24094 - SHUNT NEUROSURGICAL 15CM CSF VENTRICULAR CATHETER SNAP BASE BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 24114 SUP Custom 27803010 24114 - CONNECTOR SHNT .7MM CSF LL INTGR PLG BOTH IP/OP $187.50 $139.00 $33.32 $187.20 $187.20 $187.20 $187.20 $187.20 $187.20 $187.20 $33.32 $187.20 $187.20 $187.20 $187.20 $187.20 $187.20 $39.01 $187.20 $74.88 $187.20 $187.20 $187.20 $187.20 $187.20 $140.63 $187.20 $187.20 $187.20 $93.60 $93.60 $148.26 $187.20 $149.76 $84.24 $187.20 N/A $108.75 $187.20 $112.32 $187.20 $187.20 $187.20 N/A N/A 24146 SUP Custom 27203010 24146 - SYSTEM EXTERNAL DRAIN MONITR BECKER STERILE BOTH IP/OP $547.50 $405.00 $97.40 $547.20 $547.20 $547.20 $547.20 $547.20 $547.20 $547.20 $97.40 $547.20 $547.20 $406.13 $406.13 $421.78 $285.09 $114.04 $547.20 $218.88 $547.20 $547.20 $547.20 $547.20 $547.20 $410.63 $547.20 $547.20 $547.20 $273.60 $273.60 $433.38 $547.20 $437.76 $355.68 $547.20 N/A $317.55 $547.20 $328.32 $547.20 $547.20 $547.20 N/A N/A 24147 SUP Custom 27803010 24147 - VALVE SHUNT SMALL PERFORMANCE LEVEL .5 CSF BIOGLIDE BURR BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" 1431.75 675.62 24148 SUP Custom 27803010 24148 - CATHETER NEUROSURGICAL STANDARD 110CM CARDIAC PERITONEAL BOTH IP/OP $411.00 $304.00 $73.14 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $73.14 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $85.63 $410.88 $164.35 $410.88 $410.88 $410.88 $410.88 $410.88 $308.25 $410.88 $410.88 $410.88 $205.44 $205.44 $325.42 $410.88 $328.70 $184.90 $410.88 N/A $238.38 $410.88 $246.53 $410.88 $410.88 $410.88 N/A N/A 24154 SUP Custom 27803010 24154 - CATHETER DRAIN STANDARD 23CM BARIUM IMPREGNATED STRIPE LATEX BOTH IP/OP $356.50 $264.00 $63.41 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $63.41 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $74.25 $356.25 $142.50 $356.25 $356.25 $356.25 $356.25 $356.25 $267.38 $356.25 $356.25 $356.25 $178.13 $178.13 $282.15 $356.25 $285.00 $160.31 $356.25 N/A $206.77 $356.25 $213.75 $356.25 $356.25 $356.25 N/A N/A 24605 SUP HCPCS C1758 24605 - CATH URET 4.8FR 8FR 70CM CONE TIP MCK BOTH IP/OP $30.00 $22.00 $5.87 $29.59 $16.07 $16.07 $16.07 $16.07 $29.59 $29.59 $29.59 $6.17 $29.59 $21.96 $21.96 $22.81 $15.42 $6.17 $29.59 $29.59 $17.50 $29.59 $29.59 $29.59 $29.59 $22.50 $29.59 $29.59 $29.59 $14.80 $14.80 $23.44 $29.59 $23.67 $19.23 $5.87 N/A $17.40 $29.59 $29.59 $29.59 $6.17 $29.59 1081.08 516.24 24712 SUP Custom 27803010 24712 - TUBE VNT T FIRM FLNG 1.14MM 9.5MM 12MM GOODE SFT SIL EAR BOTH IP/OP $57.00 $42.00 $10.10 $56.75 $56.75 $56.75 $56.75 $56.75 $56.75 $56.75 $10.10 $56.75 $56.75 $56.75 $56.75 $56.75 $56.75 $11.83 $56.75 $22.70 $56.75 $56.75 $56.75 $56.75 $56.75 $42.75 $56.75 $56.75 $56.75 $28.38 $28.38 $44.95 $56.75 $45.40 $25.54 $56.75 N/A $33.06 $56.75 $34.05 $56.75 $56.75 $56.75 N/A N/A 25024 SUP Custom 27803010 25024 - SHUNT NEUROSURGICAL STANDARD 90CM CSF PERITONEAL BARIUM BOTH IP/OP $418.00 $309.00 $94.16 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $94.16 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $313.50 "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A $242.44 "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" 1781.37 837.6 25024 SUP HCPCS Q4137 25024 - GRAFT SFT TIS 5CM DISC AMNIOEXCEL ALGRF AMNIO XCLR MTRX BOTH IP/OP "$1,750.00" "$1,295.00" $94.16 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $94.16 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" 1781.37 837.6 25027 SUP Custom 27803010 25027 - CONNECTOR SHUNT STR STRATA STAINLESS STEEL BOTH IP/OP $204.50 $151.00 $36.36 $204.25 $204.25 $204.25 $204.25 $204.25 $204.25 $204.25 $36.36 $204.25 $204.25 $204.25 $204.25 $204.25 $204.25 $42.57 $204.25 $81.70 $204.25 $204.25 $204.25 $204.25 $204.25 $153.38 $204.25 $204.25 $204.25 $102.13 $102.13 $161.77 $204.25 $163.40 $91.91 $204.25 N/A $118.61 $204.25 $122.55 $204.25 $204.25 $204.25 N/A N/A 25030 SUP Custom 27203010 25030 - KIT DRAIN 20CM CSF MONITR SYSTEM BARIUM CATHETER DRAIN BAG BOTH IP/OP $514.00 $380.00 $91.42 $513.60 $513.60 $513.60 $513.60 $513.60 $513.60 $513.60 $91.42 $513.60 $513.60 $381.19 $381.19 $395.88 $267.59 $107.04 $513.60 $205.44 $513.60 $513.60 $513.60 $513.60 $513.60 $385.50 $513.60 $513.60 $513.60 $256.80 $256.80 $406.77 $513.60 $410.88 $333.84 $513.60 N/A $298.12 $513.60 $308.16 $513.60 $513.60 $513.60 N/A N/A 25068 SUP Custom 27203010 25068 - KIT DRAIN CSF MONITR SYSTEM DRAIN BAG PATIENT LINE ASMBLY BOTH IP/OP $290.50 $215.00 $51.69 $290.40 $290.40 $290.40 $290.40 $290.40 $290.40 $290.40 $51.69 $290.40 $290.40 $215.53 $215.53 $223.84 $151.30 $60.52 $290.40 $116.16 $290.40 $290.40 $290.40 $290.40 $290.40 $217.88 $290.40 $290.40 $290.40 $145.20 $145.20 $230.00 $290.40 $232.32 $188.76 $290.40 N/A $168.49 $290.40 $174.24 $290.40 $290.40 $290.40 N/A N/A 25077 SUP Custom 27803010 25077 - TAB FX 1.5MM SIL BOTH IP/OP $214.00 $158.00 $124.12 "$3,601.78" "$1,620.80" "$1,620.80" "$1,620.80" "$1,620.80" "$3,601.78" "$3,601.78" "$3,601.78" $750.70 "$3,601.78" "$3,601.78" "$3,601.78" "$3,601.78" "$3,601.78" $750.65 "$3,601.78" "$3,601.78" "$1,775.68" "$3,601.78" "$3,601.78" "$3,601.78" "$3,601.78" $160.50 "$3,601.78" "$3,601.78" "$3,601.78" "$1,800.89" "$1,800.89" "$2,852.61" "$3,601.78" "$2,881.42" "$1,620.80" $714.86 N/A $124.12 "$3,601.78" "$3,601.78" "$3,601.78" $750.61 "$3,601.78" 2043.27 952.08 25077 SUP HCPCS C1768 25077 - GRAFT VASC GRAD WL TRMPT 4-7MM 35CM FLIXENE SLDR GDS PTFE BOTH IP/OP "$3,602.00" "$2,665.00" $714.86 "$3,601.78" "$1,620.80" "$1,620.80" "$1,620.80" "$1,620.80" "$3,601.78" "$3,601.78" "$3,601.78" $750.70 "$3,601.78" "$3,601.78" "$3,601.78" "$3,601.78" "$3,601.78" $750.65 "$3,601.78" "$3,601.78" "$1,775.68" "$3,601.78" "$3,601.78" "$3,601.78" "$3,601.78" "$2,701.50" "$3,601.78" "$3,601.78" "$3,601.78" "$1,800.89" "$1,800.89" "$2,852.61" "$3,601.78" "$2,881.42" "$1,620.80" $714.86 N/A "$2,089.16" "$3,601.78" "$3,601.78" "$3,601.78" $750.61 "$3,601.78" 2043.27 952.08 25104 SUP Custom 27803010 25104 - CATHETER NEUROSURGICAL 90CM CSF BARIUM IMPREGNATED DELTA BOTH IP/OP $411.00 $304.00 $73.14 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $73.14 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $85.63 $410.88 $164.35 $410.88 $410.88 $410.88 $410.88 $410.88 $308.25 $410.88 $410.88 $410.88 $205.44 $205.44 $325.42 $410.88 $328.70 $184.90 $410.88 N/A $238.38 $410.88 $246.53 $410.88 $410.88 $410.88 N/A N/A 25120 SUP Custom 27203010 25120 - SYSTEM EXTERNAL DRAIN 1 WAY VALVE BECKER BOTH IP/OP $595.50 $441.00 $130.91 $628.13 $628.13 $628.13 $628.13 $628.13 $628.13 $628.13 $554.21 $628.13 $628.13 $628.13 $628.13 $628.13 $628.13 $130.91 $628.13 $258.79 $628.13 $628.13 $628.13 $628.13 $628.13 $446.63 $628.13 $628.13 $628.13 $314.07 $314.07 $497.48 $628.13 $502.50 $282.66 $628.13 N/A $345.39 $628.13 $376.88 $628.13 $628.13 $628.13 1142.97 539.29 25120 SUP Custom 27203010 25120 - EDMS II 25120 BECKER W/1-WAY VALVE BOTH IP/OP $595.50 $441.00 $130.91 $628.13 $628.13 $628.13 $628.13 $628.13 $628.13 $628.13 $554.21 $628.13 $628.13 $628.13 $628.13 $628.13 $628.13 $130.91 $628.13 $258.79 $628.13 $628.13 $628.13 $628.13 $628.13 $446.63 $628.13 $628.13 $628.13 $314.07 $314.07 $497.48 $628.13 $502.50 $282.66 $628.13 N/A $345.39 $628.13 $376.88 $628.13 $628.13 $628.13 1142.97 539.29 25120 SUP HCPCS L1845 25120 - BRACE ORTH SM 15.5-18IN 12.75-14.5IN X2K PREFABRICATE ADJ BOTH IP/OP $628.50 $465.00 $130.91 $628.13 $628.13 $628.13 $628.13 $628.13 $628.13 $628.13 $554.21 $628.13 $628.13 $628.13 $628.13 $628.13 $628.13 $130.91 $628.13 $258.79 $628.13 $628.13 $628.13 $628.13 $628.13 $471.38 $628.13 $628.13 $628.13 $314.07 $314.07 $497.48 $628.13 $502.50 $282.66 $628.13 N/A $364.53 $628.13 $376.88 $628.13 $628.13 $628.13 1142.97 539.29 25120 SUP HCPCS C1763 25120 - GRAFT VASC 7MM 80CM FLIXENE SLDR GDS GRAD WL PTFE BOTH IP/OP "$4,184.50" "$3,097.00" $130.91 "$3,138.38" $628.13 $628.13 $628.13 $628.13 $628.13 $628.13 $554.21 $628.13 $628.13 $628.13 $628.13 $628.13 $628.13 $130.91 $628.13 $258.79 $628.13 $628.13 $628.13 $628.13 $628.13 "$3,138.38" $628.13 $628.13 $628.13 $314.07 $314.07 $497.48 $628.13 $502.50 $282.66 $628.13 N/A "$2,427.01" $628.13 $376.88 $628.13 $628.13 $628.13 1142.97 539.29 25123 SUP HCPCS C1894 25123 - TROCAR SURG PROTECTOR SHEATH STAINLESS STEEL BOTH IP/OP $238.00 $176.00 $47.16 $237.60 $129.02 $129.02 $129.02 $129.02 $237.60 $237.60 $237.60 $49.52 $237.60 $176.35 $176.35 $183.14 $123.79 $49.52 $237.60 $237.60 $140.54 $237.60 $237.60 $237.60 $237.60 $178.50 $237.60 $237.60 $237.60 $118.80 $118.80 $188.18 $237.60 $190.08 $154.44 $47.16 N/A $138.04 $237.60 $237.60 $237.60 $49.52 $237.60 N/A N/A 26040 SUP HCPCS C1768 26040 - SIZER GFT 12-24MM VASC BOTH IP/OP $31.50 $23.00 $6.24 $31.43 $14.14 $14.14 $14.14 $14.14 $31.43 $31.43 $31.43 $6.55 $31.43 $31.43 $31.43 $31.43 $31.43 $6.55 $31.43 $31.43 $18.59 $31.43 $31.43 $31.43 $31.43 $23.63 $31.43 $31.43 $31.43 $15.72 $15.72 $24.89 $31.43 $25.14 $14.14 $6.24 N/A $18.27 $31.43 $31.43 $31.43 $6.55 $31.43 715.26 340.11 26040 SUP Custom 27203010 26040 - KIT DRAIN MONITR SYSTEM RADIOPQ LATEX FREE BECKER EDMS II BOTH IP/OP $826.00 $611.00 $6.24 $619.50 $14.14 $14.14 $14.14 $14.14 $31.43 $31.43 $31.43 $6.55 $31.43 $31.43 $31.43 $31.43 $31.43 $6.55 $31.43 $31.43 $18.59 $31.43 $31.43 $31.43 $31.43 $619.50 $31.43 $31.43 $31.43 $15.72 $15.72 $24.89 $31.43 $25.14 $14.14 $6.24 N/A $479.08 $31.43 $31.43 $31.43 $6.55 $31.43 715.26 340.11 26057 SUP Custom 27203010 26057 - CATHETER DRAIN STANDARD 25CM EXTERNAL EDM TRANSLUCENT BOTH IP/OP $365.00 $270.00 $64.93 $364.80 $364.80 $364.80 $364.80 $364.80 $364.80 $364.80 $64.93 $364.80 $364.80 $270.75 $270.75 $281.19 $190.06 $76.03 $364.80 $145.92 $364.80 $364.80 $364.80 $364.80 $364.80 $273.75 $364.80 $364.80 $364.80 $182.40 $182.40 $288.92 $364.80 $291.84 $237.12 $364.80 N/A $211.70 $364.80 $218.88 $364.80 $364.80 $364.80 N/A N/A 26075 SUP Custom 27803010 26075 - RESERVOIR DRAIN 7.5MM HOLE V-CATH VENTRICULAR BOTH IP/OP "$1,444.00" "$1,069.00" $257.03 "$1,444.00" "$1,444.00" "$1,444.00" "$1,444.00" "$1,444.00" "$1,444.00" "$1,444.00" $257.03 "$1,444.00" "$1,444.00" "$1,444.00" "$1,444.00" "$1,444.00" "$1,444.00" $300.95 "$1,444.00" $577.60 "$1,444.00" "$1,444.00" "$1,444.00" "$1,444.00" "$1,444.00" "$1,083.00" "$1,444.00" "$1,444.00" "$1,444.00" $722.00 $722.00 "$1,143.65" "$1,444.00" "$1,155.20" $649.80 "$1,444.00" N/A $837.52 "$1,444.00" $866.40 "$1,444.00" "$1,444.00" "$1,444.00" 764.03 363.69 27010 SUP Custom 27803010 27010 - CATHETER DRAIN VENTRICULAR BOTH IP/OP $601.00 $445.00 $106.96 $600.88 $600.88 $600.88 $600.88 $600.88 $600.88 $600.88 $106.96 $600.88 $600.88 $600.88 $600.88 $600.88 $600.88 $125.23 $600.88 $240.35 $600.88 $600.88 $600.88 $600.88 $600.88 $450.75 $600.88 $600.88 $600.88 $300.44 $300.44 $475.90 $600.88 $480.70 $270.40 $600.88 N/A $348.58 $600.88 $360.53 $600.88 $600.88 $600.88 N/A N/A 27051 SUP Custom 27803010 27051 - VALVE SHUNT 6MM HP UNITIZED CSF STERILE BOTH IP/OP $606.00 $448.00 $107.80 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $107.80 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $126.22 $605.63 $242.25 $605.63 $605.63 $605.63 $605.63 $605.63 $454.50 $605.63 $605.63 $605.63 $302.82 $302.82 $479.66 $605.63 $484.50 $272.53 $605.63 N/A $351.48 $605.63 $363.38 $605.63 $605.63 $605.63 N/A N/A 27081 SUP Custom 27803010 27081 - SHUNT NEUROSURGICAL .5 REGULAR ASMBLY DELTA CSF STERILE BOTH IP/OP "$3,463.00" "$2,563.00" $616.37 "$3,462.75" "$3,462.75" "$3,462.75" "$3,462.75" "$3,462.75" "$3,462.75" "$3,462.75" $616.37 "$3,462.75" "$3,462.75" "$3,462.75" "$3,462.75" "$3,462.75" "$3,462.75" $721.68 "$3,462.75" "$1,385.10" "$3,462.75" "$3,462.75" "$3,462.75" "$3,462.75" "$3,462.75" "$2,597.25" "$3,462.75" "$3,462.75" "$3,462.75" "$1,731.38" "$1,731.38" "$2,742.50" "$3,462.75" "$2,770.20" "$1,558.24" "$3,462.75" N/A "$2,008.54" "$3,462.75" "$2,077.65" "$3,462.75" "$3,462.75" "$3,462.75" N/A N/A 27102 SUP Custom 27803010 27102 - VALVE SHUNT SMALL VERY LOW PRESSURE CSF STERILE BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 27106 SUP Custom 27803010 27106 - VALVE SHUNT SNAP ASMBLY LARGER IDENTIFICATION STRATA CSF BOTH IP/OP $275.50 $204.00 $49.04 $275.50 $275.50 $275.50 $275.50 $275.50 $275.50 $275.50 $49.04 $275.50 $275.50 $275.50 $275.50 $275.50 $275.50 $57.42 $275.50 $110.20 $275.50 $275.50 $275.50 $275.50 $275.50 $206.63 $275.50 $275.50 $275.50 $137.75 $137.75 $218.20 $275.50 $220.40 $123.98 $275.50 N/A $159.79 $275.50 $165.30 $275.50 $275.50 $275.50 N/A N/A 27156 SUP Custom 27803010 27156 - SHUNT NEUROSURGICAL 1.3MM 2.5IN CSF VENTRICULAR CATHETER FIX BOTH IP/OP $336.00 $249.00 $59.81 $336.00 $336.00 $336.00 $336.00 $336.00 $336.00 $336.00 $59.81 $336.00 $336.00 $336.00 $336.00 $336.00 $336.00 $70.03 $336.00 $134.40 $336.00 $336.00 $336.00 $336.00 $336.00 $252.00 $336.00 $336.00 $336.00 $168.00 $168.00 $266.11 $336.00 $268.80 $151.20 $336.00 N/A $194.88 $336.00 $201.60 $336.00 $336.00 $336.00 3975.72 1811.85 27165 SUP Custom 27803010 27165 - SHUNT NEUROSURGICAL 1.5MM 2.8IN CSF VENTRICULAR CATHETER BOTH IP/OP $506.00 $374.00 $90.05 $505.88 $505.88 $505.88 $505.88 $505.88 $505.88 $505.88 $90.05 $505.88 $505.88 $505.88 $505.88 $505.88 $505.88 $105.43 $505.88 $202.35 $505.88 $505.88 $505.88 $505.88 $505.88 $379.50 $505.88 $505.88 $505.88 $252.94 $252.94 $400.66 $505.88 $404.70 $227.65 $505.88 N/A $293.48 $505.88 $303.53 $505.88 $505.88 $505.88 3178.88 1468.91 27211 SUP Custom 27803010 27211 - CATHETER DRAIN 16CM CSF SLOTTED VENTRICULAR BOTH IP/OP $473.00 $350.00 $84.13 $472.63 $472.63 $472.63 $472.63 $472.63 $472.63 $472.63 $84.13 $472.63 $472.63 $472.63 $472.63 $472.63 $472.63 $98.50 $472.63 $189.05 $472.63 $472.63 $472.63 $472.63 $472.63 $354.75 $472.63 $472.63 $472.63 $236.32 $236.32 $374.32 $472.63 $378.10 $212.68 $472.63 N/A $274.34 $472.63 $283.58 $472.63 $472.63 $472.63 N/A N/A 27240 SUP Custom 27803010 27240 - CATHETER DRN 15CM STRL LF INNERVISION DISP BOTH IP/OP $506.00 $374.00 $90.05 $505.88 $505.88 $505.88 $505.88 $505.88 $505.88 $505.88 $90.05 $505.88 $505.88 $505.88 $505.88 $505.88 $505.88 $105.43 $505.88 $202.35 $505.88 $505.88 $505.88 $505.88 $505.88 $379.50 $505.88 $505.88 $505.88 $252.94 $252.94 $400.66 $505.88 $404.70 $227.65 $505.88 N/A $293.48 $505.88 $303.53 $505.88 $505.88 $505.88 2210.36 1024.85 27251 SUP Custom 27803010 27251 - CATHETER DRAIN SMALL 8MM 23CM BARIUM IMPREGNATED FLOW HOLE BOTH IP/OP $356.50 $264.00 $63.41 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $63.41 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $74.25 $356.25 $142.50 $356.25 $356.25 $356.25 $356.25 $356.25 $267.38 $356.25 $356.25 $356.25 $178.13 $178.13 $282.15 $356.25 $285.00 $160.31 $356.25 N/A $206.77 $356.25 $213.75 $356.25 $356.25 $356.25 N/A N/A 27274 SUP Custom 27203010 27274 - KIT VENTRICULOSTOMY RESERVOIR LATEX FREE BOTH IP/OP $822.00 $608.00 $146.27 $821.75 $821.75 $821.75 $821.75 $821.75 $821.75 $821.75 $146.27 $821.75 $821.75 $609.90 $609.90 $633.40 $428.13 $171.26 $821.75 $328.70 $821.75 $821.75 $821.75 $821.75 $821.75 $616.50 $821.75 $821.75 $821.75 $410.88 $410.88 $650.83 $821.75 $657.40 $534.14 $821.75 N/A $476.76 $821.75 $493.05 $821.75 $821.75 $821.75 N/A N/A 27297 SUP Custom 27203010 27297 - CATHETER DRAIN MONITR KIT EDM VENTRICULAR BOTH IP/OP $806.50 $597.00 $143.54 $806.40 $806.40 $806.40 $806.40 $806.40 $806.40 $806.40 $143.54 $806.40 $806.40 $598.51 $598.51 $621.57 $420.13 $168.06 $806.40 $322.56 $806.40 $806.40 $806.40 $806.40 $806.40 $604.88 $806.40 $806.40 $806.40 $403.20 $403.20 $638.67 $806.40 $645.12 $524.16 $806.40 N/A $467.77 $806.40 $483.84 $806.40 $806.40 $806.40 N/A N/A 27298 SUP HCPCS C1753 27298 - CATHETER DRAIN 15CM CSF SNAP BASE INNERVISION STERILE BOTH IP/OP $665.00 $492.00 $131.99 $665.00 $361.10 $361.10 $361.10 $361.10 $665.00 $665.00 $665.00 $138.60 $665.00 $493.56 $493.56 $512.58 $346.47 $138.59 $665.00 $665.00 $393.35 $665.00 $665.00 $665.00 $665.00 $498.75 $665.00 $665.00 $665.00 $332.50 $332.50 $526.68 $665.00 $532.00 $432.25 $131.99 N/A $385.70 $665.00 $665.00 $665.00 $138.59 $665.00 N/A N/A 27302 SUP Custom 27203010 27302 - KIT DRAIN CYLINDER CSF LATEX FREE EDM 120ML LUMBAR BOTH IP/OP $809.00 $599.00 $143.97 $808.80 $808.80 $808.80 $808.80 $808.80 $808.80 $808.80 $143.97 $808.80 $808.80 $600.29 $600.29 $623.42 $421.38 $168.56 $808.80 $323.52 $808.80 $808.80 $808.80 $808.80 $808.80 $606.75 $808.80 $808.80 $808.80 $404.40 $404.40 $640.57 $808.80 $647.04 $525.72 $808.80 N/A $469.22 $808.80 $485.28 $808.80 $808.80 $808.80 N/A N/A 27303 SUP Custom 27203010 27303 - KIT DRAIN 80CM CATHETER OPEN TIP MONITR EDM LUMBAR BOTH IP/OP $706.00 $522.00 $125.60 $705.60 $705.60 $705.60 $705.60 $705.60 $705.60 $705.60 $125.60 $705.60 $705.60 $523.70 $523.70 $543.88 $367.62 $147.05 $705.60 $282.24 $705.60 $705.60 $705.60 $705.60 $705.60 $529.50 $705.60 $705.60 $705.60 $352.80 $352.80 $558.84 $705.60 $564.48 $458.64 $705.60 N/A $409.48 $705.60 $423.36 $705.60 $705.60 $705.60 1469.55 684.44 27304 SUP Custom 27203010 27304 - KIT DRAIN 80CM CLOSE EDM LUMBAR BOTH IP/OP $684.00 $506.00 $121.75 $684.00 $684.00 $684.00 $684.00 $684.00 $684.00 $684.00 $121.75 $684.00 $684.00 $507.66 $507.66 $527.23 $356.36 $142.55 $684.00 $273.60 $684.00 $684.00 $684.00 $684.00 $684.00 $513.00 $684.00 $684.00 $684.00 $342.00 $342.00 $541.73 $684.00 $547.20 $444.60 $684.00 N/A $396.72 $684.00 $410.40 $684.00 $684.00 $684.00 N/A N/A 27327 SUP Custom 27803010 27327 - CATHETER DRAIN STANDARD 23CM CSF EXTRACTED PRESSURE MONITR BOTH IP/OP $876.50 $649.00 $156.00 $876.38 $876.38 $876.38 $876.38 $876.38 $876.38 $876.38 $156.00 $876.38 $876.38 $876.38 $876.38 $876.38 $876.38 $182.65 $876.38 $350.55 $876.38 $876.38 $876.38 $876.38 $876.38 $657.38 $876.38 $876.38 $876.38 $438.19 $438.19 $694.09 $876.38 $701.10 $394.37 $876.38 N/A $508.37 $876.38 $525.83 $876.38 $876.38 $876.38 725.21 337.47 27328 SUP HCPCS C1750 27328 - CATHETER NEUROSURGICAL 90CM PERITONEAL HYDROCEPHALUS SHUNT BOTH IP/OP "$1,330.00" $984.00 $263.97 "$1,330.00" $598.50 $598.50 $598.50 $598.50 "$1,330.00" "$1,330.00" "$1,330.00" $277.21 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" "$1,330.00" $786.70 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 $263.97 N/A $771.40 "$1,330.00" "$1,330.00" "$1,330.00" $277.17 "$1,330.00" 1433.7 666.35 27384 SUP Custom 27803010 27384 - CATHETER DRAIN 20CM TROCAR LATEX FREE BECKER EDMS II BOTH IP/OP $396.00 $293.00 $70.49 $396.00 $396.00 $396.00 $396.00 $396.00 $396.00 $396.00 $70.49 $396.00 $396.00 $396.00 $396.00 $396.00 $396.00 $82.53 $396.00 $158.40 $396.00 $396.00 $396.00 $396.00 $396.00 $297.00 $396.00 $396.00 $396.00 $198.00 $198.00 $313.63 $396.00 $316.80 $178.20 $396.00 N/A $229.68 $396.00 $237.60 $396.00 $396.00 $396.00 N/A N/A 27497 SUP Custom 27803010 27497 - SHUNT NEUROSURGICAL .5 SMALL DELTA BIOGLIDE STERILE BOTH IP/OP "$4,949.50" "$3,663.00" $881.01 "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" $881.01 "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$1,031.53" "$4,949.50" "$1,979.80" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$3,712.13" "$4,949.50" "$4,949.50" "$4,949.50" "$2,474.75" "$2,474.75" "$3,920.00" "$4,949.50" "$3,959.60" "$2,227.28" "$4,949.50" N/A "$2,870.71" "$4,949.50" "$2,969.70" "$4,949.50" "$4,949.50" "$4,949.50" 1335.06 623.15 27498 SUP Custom 27803010 27498 - SHUNT NEUROSURGICAL .5 REGULAR DELTA BIOGLIDE STERILE BOTH IP/OP "$4,949.50" "$3,663.00" $881.01 "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" $881.01 "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$1,031.53" "$4,949.50" "$1,979.80" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$3,712.13" "$4,949.50" "$4,949.50" "$4,949.50" "$2,474.75" "$2,474.75" "$3,920.00" "$4,949.50" "$3,959.60" "$2,227.28" "$4,949.50" N/A "$2,870.71" "$4,949.50" "$2,969.70" "$4,949.50" "$4,949.50" "$4,949.50" 1489.47 704.96 27510 SUP Custom 27203010 27510 - SYSTEM EXTERNAL DRAIN Y SITE BECKER BOTH IP/OP $521.00 $386.00 $92.70 $520.80 $520.80 $520.80 $520.80 $520.80 $520.80 $520.80 $92.70 $520.80 $520.80 $386.54 $386.54 $401.43 $271.34 $108.54 $520.80 $208.32 $520.80 $520.80 $520.80 $520.80 $520.80 $390.75 $520.80 $520.80 $520.80 $260.40 $260.40 $412.47 $520.80 $416.64 $338.52 $520.80 N/A $302.18 $520.80 $312.48 $520.80 $520.80 $520.80 1574.43 727.17 27536 SUP Custom 27803010 27536 - CATHETER DIALYSIS 8 SLIT BIOGLIDE PERITONEAL BOTH IP/OP $544.00 $403.00 $96.81 $543.88 $543.88 $543.88 $543.88 $543.88 $543.88 $543.88 $96.81 $543.88 $543.88 $543.88 $543.88 $543.88 $543.88 $113.35 $543.88 $217.55 $543.88 $543.88 $543.88 $543.88 $543.88 $408.00 $543.88 $543.88 $543.88 $271.94 $271.94 $430.75 $543.88 $435.10 $244.75 $543.88 N/A $315.52 $543.88 $326.33 $543.88 $543.88 $543.88 5505.24 2529.72 27548 SUP Custom 27803010 27548 - CATHETER NEUROSURGICAL STANDARD 120CM TRANSPARENT PERITONEAL BOTH IP/OP $418.00 $309.00 $74.40 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $74.40 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $87.12 $418.00 $167.20 $418.00 $418.00 $418.00 $418.00 $418.00 $313.50 $418.00 $418.00 $418.00 $209.00 $209.00 $331.06 $418.00 $334.40 $188.10 $418.00 N/A $242.44 $418.00 $250.80 $418.00 $418.00 $418.00 N/A N/A 27579 SUP Custom 27203010 27579 - CATHETER DRAIN Y PORT EXACTA VENTRICULAR BOTH IP/OP $413.00 $306.00 $73.48 $412.80 $412.80 $412.80 $412.80 $412.80 $412.80 $412.80 $73.48 $412.80 $412.80 $306.38 $306.38 $318.19 $215.07 $86.03 $412.80 $165.12 $412.80 $412.80 $412.80 $412.80 $412.80 $309.75 $412.80 $412.80 $412.80 $206.40 $206.40 $326.94 $412.80 $330.24 $268.32 $412.80 N/A $239.54 $412.80 $247.68 $412.80 $412.80 $412.80 N/A N/A 27581 SUP Custom 27203010 27581 - CATHETER EXTERNAL DRAIN 35CM KIT EXACTA BOTH IP/OP $778.00 $576.00 $138.41 $777.60 $777.60 $777.60 $777.60 $777.60 $777.60 $777.60 $138.41 $777.60 $777.60 $577.13 $577.13 $599.37 $405.13 $162.06 $777.60 $311.04 $777.60 $777.60 $777.60 $777.60 $777.60 $583.50 $777.60 $777.60 $777.60 $388.80 $388.80 $615.86 $777.60 $622.08 $505.44 $777.60 N/A $451.24 $777.60 $466.56 $777.60 $777.60 $777.60 N/A N/A 27600 SUP Custom 27803010 27600 - CATHETER DRAIN 15CM CSF SLOTTED BARIUM IMPREGNATED BOTH IP/OP $665.00 $492.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $138.59 $665.00 $266.00 $665.00 $665.00 $665.00 $665.00 $665.00 $498.75 $665.00 $665.00 $665.00 $332.50 $332.50 $526.68 $665.00 $532.00 $299.25 $665.00 N/A $385.70 $665.00 $399.00 $665.00 $665.00 $665.00 953.97 432.06 27613 SUP Custom 27203010 27613 - LASER SURG SCREW ASMBLY EXACTA BOTH IP/OP "$1,025.00" $759.00 $182.41 "$1,024.80" "$1,024.80" "$1,024.80" "$1,024.80" "$1,024.80" "$1,024.80" "$1,024.80" $182.41 "$1,024.80" "$1,024.80" $760.61 $760.61 $789.92 $533.92 $213.58 "$1,024.80" $409.92 "$1,024.80" "$1,024.80" "$1,024.80" "$1,024.80" "$1,024.80" $768.75 "$1,024.80" "$1,024.80" "$1,024.80" $512.40 $512.40 $811.64 "$1,024.80" $819.84 $666.12 "$1,024.80" N/A $594.50 "$1,024.80" $614.88 "$1,024.80" "$1,024.80" "$1,024.80" 375.71 170.7 27617 SUP Custom 27203010 27617 - VALVE DRAIN CSF STR CONCTR TUBE BOTH IP/OP $539.50 $399.00 $95.97 $539.13 $539.13 $539.13 $539.13 $539.13 $539.13 $539.13 $95.97 $539.13 $539.13 $400.14 $400.14 $415.56 $280.89 $112.36 $539.13 $215.65 $539.13 $539.13 $539.13 $539.13 $539.13 $404.63 $539.13 $539.13 $539.13 $269.57 $269.57 $426.99 $539.13 $431.30 $350.43 $539.13 N/A $312.91 $539.13 $323.48 $539.13 $539.13 $539.13 N/A N/A 27623 SUP Custom 27803010 27623 - CATHETER DRAIN 15CM SLOTTED BARIUM IMPREGNATED EXTRA HOLE BOTH IP/OP $663.00 $491.00 $117.95 $662.63 $662.63 $662.63 $662.63 $662.63 $662.63 $662.63 $117.95 $662.63 $662.63 $662.63 $662.63 $662.63 $662.63 $138.10 $662.63 $265.05 $662.63 $662.63 $662.63 $662.63 $662.63 $497.25 $662.63 $662.63 $662.63 $331.32 $331.32 $524.80 $662.63 $530.10 $298.18 $662.63 N/A $384.54 $662.63 $397.58 $662.63 $662.63 $662.63 N/A N/A 27628 SUP Custom 27203010 27628 - KIT DRAIN 15CM CSF CATHETER RESERVOIR BURR HOLE VENTRICULAR BOTH IP/OP $836.00 $619.00 $148.81 $836.00 $836.00 $836.00 $836.00 $836.00 $836.00 $836.00 $148.81 $836.00 $836.00 $620.48 $620.48 $644.39 $435.56 $174.23 $836.00 $334.40 $836.00 $836.00 $836.00 $836.00 $836.00 $627.00 $836.00 $836.00 $836.00 $418.00 $418.00 $662.11 $836.00 $668.80 $543.40 $836.00 N/A $484.88 $836.00 $501.60 $836.00 $836.00 $836.00 N/A N/A 27629 SUP HCPCS C1729 27629 - CATHETER DRAIN 90CM TRNSVRS STRIPE PERITONEAL STERILE BOTH IP/OP $418.00 $309.00 $82.96 $418.00 $226.97 $226.97 $226.97 $226.97 $418.00 $418.00 $418.00 $87.12 $418.00 $310.24 $310.24 $322.19 $217.78 $87.12 $418.00 $418.00 $247.25 $418.00 $418.00 $418.00 $418.00 $313.50 $418.00 $418.00 $418.00 $209.00 $209.00 $331.06 $418.00 $334.40 $271.70 $82.96 N/A $242.44 $418.00 $418.00 $418.00 $87.11 $418.00 N/A N/A 27636 SUP Custom 27203010 27636 - SYSTEM DRAIN MONITR CORD LOCK BRAIDED EXACTA BOTH IP/OP $446.50 $330.00 $6.75 $334.88 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $32.37 $6.75 $32.37 $12.95 $32.37 $32.37 $32.37 $32.37 $32.37 $334.88 $32.37 $32.37 $32.37 $16.19 $16.19 $25.64 $32.37 $25.90 $21.04 $32.37 $32.37 $258.97 $32.37 $19.42 $32.37 $32.37 $32.37 N/A N/A 27637 SUP Custom 27203010 27637 - CATHETER DRAIN 4.9MM TRNSVRS STRIPE TROCAR EDM VENTRICULAR BOTH IP/OP $554.50 $410.00 $98.68 $554.40 $554.40 $554.40 $554.40 $554.40 $554.40 $554.40 $98.68 $554.40 $554.40 $411.48 $411.48 $427.33 $288.84 $115.54 $554.40 $221.76 $554.40 $554.40 $554.40 $554.40 $554.40 $415.88 $554.40 $554.40 $554.40 $277.20 $277.20 $439.08 $554.40 $443.52 $360.36 $554.40 N/A $321.61 $554.40 $332.64 $554.40 $554.40 $554.40 1730.3 786.26 27654 SUP Custom 27203010 27654 - SYSTEM DRAIN DRAIN PORT BAG EXACTA BOTH IP/OP $336.00 $249.00 $59.81 $336.00 $336.00 $336.00 $336.00 $336.00 $336.00 $336.00 $59.81 $336.00 $336.00 $249.38 $249.38 $258.99 $175.06 $70.03 $336.00 $134.40 $336.00 $336.00 $336.00 $336.00 $336.00 $252.00 $336.00 $336.00 $336.00 $168.00 $168.00 $266.11 $336.00 $268.80 $218.40 $336.00 N/A $194.88 $336.00 $201.60 $336.00 $336.00 $336.00 1636.01 761.66 27659 SUP Custom 27203010 27659 - CATHETER DRAIN 20CM MARKER EDM BOTH IP/OP $437.00 $323.00 $1.25 $327.75 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $1.25 $6.00 $2.40 $6.00 $6.00 $6.00 $6.00 $6.00 $327.75 $6.00 $6.00 $6.00 $3.00 $3.00 $4.75 $6.00 $4.80 $3.90 $6.00 $6.00 $253.46 $6.00 $3.60 $6.00 $6.00 $6.00 1113.63 502.39 27664 SUP Custom 27803010 27664 - RESERVOIR SHUNT 12MM CSF VENTRICULAR BOTH IP/OP $888.50 $657.00 $158.11 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $158.11 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $185.12 $888.25 $355.30 $888.25 $888.25 $888.25 $888.25 $888.25 $666.38 $888.25 $888.25 $888.25 $444.13 $444.13 $703.49 $888.25 $710.60 $399.71 $888.25 N/A $515.33 $888.25 $532.95 $888.25 $888.25 $888.25 834.08 390.81 27666 SUP Custom 27203010 27666 - SYSTEM EXTERNAL DRAIN STOPCOCK GLUED PATIENT LINE EXACTA BOTH IP/OP $401.00 $297.00 $71.34 $400.80 $400.80 $400.80 $400.80 $400.80 $400.80 $400.80 $71.34 $400.80 $400.80 $297.47 $297.47 $308.94 $208.82 $83.53 $400.80 $160.32 $400.80 $400.80 $400.80 $400.80 $400.80 $300.75 $400.80 $400.80 $400.80 $200.40 $200.40 $317.43 $400.80 $320.64 $260.52 $400.80 N/A $232.58 $400.80 $240.48 $400.80 $400.80 $400.80 N/A N/A 27673 SUP Custom 27203010 27673 - SYSTEM EXTERNAL DRAIN 35CM LATEX FREE EXACTA BOTH IP/OP $859.50 $636.00 $152.94 $859.20 $859.20 $859.20 $859.20 $859.20 $859.20 $859.20 $152.94 $859.20 $859.20 $637.70 $637.70 $662.27 $447.64 $179.07 $859.20 $343.68 $859.20 $859.20 $859.20 $859.20 $859.20 $644.63 $859.20 $859.20 $859.20 $429.60 $429.60 $680.49 $859.20 $687.36 $558.48 $859.20 N/A $498.51 $859.20 $515.52 $859.20 $859.20 $859.20 N/A N/A 27695 SUP Custom 27803010 27695 - CATHETER EXTERNAL DRAIN 35CM SET HERMETIC TRANSLUCENT CSF BOTH IP/OP $451.50 $334.00 $80.31 $451.20 $451.20 $451.20 $451.20 $451.20 $451.20 $451.20 $80.31 $451.20 $451.20 $451.20 $451.20 $451.20 $451.20 $94.04 $451.20 $180.48 $451.20 $451.20 $451.20 $451.20 $451.20 $338.63 $451.20 $451.20 $451.20 $225.60 $225.60 $357.35 $451.20 $360.96 $203.04 $451.20 N/A $261.87 $451.20 $270.72 $451.20 $451.20 $451.20 1098.41 513.1 27702 SUP Custom 27203010 27702 - SYSTEM EXTERNAL DRAIN NEUROLOGICAL BECKER GREEN STRIPED BOTH IP/OP $557.00 $412.00 $99.11 $556.80 $556.80 $556.80 $556.80 $556.80 $556.80 $556.80 $99.11 $556.80 $556.80 $413.26 $413.26 $429.18 $290.09 $116.04 $556.80 $222.72 $556.80 $556.80 $556.80 $556.80 $556.80 $417.75 $556.80 $556.80 $556.80 $278.40 $278.40 $440.99 $556.80 $445.44 $361.92 $556.80 N/A $323.06 $556.80 $334.08 $556.80 $556.80 $556.80 2234.39 1027.39 27703 SUP HCPCS C1729 27703 - CATHETER DRN LG 35CM STRL LL CNCT LGTH MRKNG VNTRC BOTH IP/OP $425.00 $315.00 $84.31 $424.80 $230.67 $230.67 $230.67 $230.67 $424.80 $424.80 $424.80 $88.54 $424.80 $315.29 $315.29 $327.44 $221.32 $88.53 $424.80 $424.80 $251.27 $424.80 $424.80 $424.80 $424.80 $318.75 $424.80 $424.80 $424.80 $212.40 $212.40 $336.44 $424.80 $339.84 $276.12 $84.31 N/A $246.50 $424.80 $424.80 $424.80 $88.53 $424.80 2565.9 1181.59 27705 SUP Custom 27803010 27705 - CATHETER DRAIN 35CM LUER LOCK LOCK CONCTR LENGTH MARKING BOTH IP/OP $461.00 $341.00 $82.02 $460.80 $460.80 $460.80 $460.80 $460.80 $460.80 $460.80 $82.02 $460.80 $460.80 $460.80 $460.80 $460.80 $460.80 $96.04 $460.80 $184.32 $460.80 $460.80 $460.80 $460.80 $460.80 $345.75 $460.80 $460.80 $460.80 $230.40 $230.40 $364.95 $460.80 $368.64 $207.36 $460.80 N/A $267.38 $460.80 $276.48 $460.80 $460.80 $460.80 1754.61 811.5 27710 SUP Custom 27803010 27710 - CATHETER DRAIN 35CM NUMBER LENGTH MARKING BIOGLIDE BOTH IP/OP $492.00 $364.00 $87.58 $492.00 $492.00 $492.00 $492.00 $492.00 $492.00 $492.00 $87.58 $492.00 $492.00 $492.00 $492.00 $492.00 $492.00 $102.54 $492.00 $196.80 $492.00 $492.00 $492.00 $492.00 $492.00 $369.00 $492.00 $492.00 $492.00 $246.00 $246.00 $389.66 $492.00 $393.60 $221.40 $492.00 N/A $285.36 $492.00 $295.20 $492.00 $492.00 $492.00 N/A N/A 27725 SUP Custom 27803010 27725 - CATHETER DRAIN 8MM 23CM HOLE LUMEN VENTRICULAR BOTH IP/OP $356.50 $264.00 $63.41 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $63.41 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $74.25 $356.25 $142.50 $356.25 $356.25 $356.25 $356.25 $356.25 $267.38 $356.25 $356.25 $356.25 $178.13 $178.13 $282.15 $356.25 $285.00 $160.31 $356.25 N/A $206.77 $356.25 $213.75 $356.25 $356.25 $356.25 2790.26 1295.2 27726 SUP Custom 27803010 27726 - CATHETER DRAIN 8MM 23CM HOLE LENGTH MARKING BIOGLIDE BOTH IP/OP $513.00 $380.00 $91.31 $513.00 $513.00 $513.00 $513.00 $513.00 $513.00 $513.00 $91.31 $513.00 $513.00 $513.00 $513.00 $513.00 $513.00 $106.91 $513.00 $205.20 $513.00 $513.00 $513.00 $513.00 $513.00 $384.75 $513.00 $513.00 $513.00 $256.50 $256.50 $406.30 $513.00 $410.40 $230.85 $513.00 N/A $297.54 $513.00 $307.80 $513.00 $513.00 $513.00 2236.56 1023.58 27732 SUP Custom 27203010 27732 - SYSTEM DRAIN NEEDLELESS INJEC CAP EXACTA EDM BOTH IP/OP $473.00 $350.00 $84.16 $472.80 $472.80 $472.80 $472.80 $472.80 $472.80 $472.80 $84.16 $472.80 $472.80 $350.91 $350.91 $364.43 $246.33 $98.54 $472.80 $189.12 $472.80 $472.80 $472.80 $472.80 $472.80 $354.75 $472.80 $472.80 $472.80 $236.40 $236.40 $374.46 $472.80 $378.24 $307.32 $472.80 N/A $274.34 $472.80 $283.68 $472.80 $472.80 $472.80 936.32 487.62 27739 SUP Custom 27803010 27739 - VALVE SHUNT SMALL CSF NONSIPHON CONTROL STRATA NSC STERILE BOTH IP/OP "$10,361.50" "$7,668.00" "$1,844.28" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$1,844.28" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$2,159.38" "$10,361.15" "$4,144.46" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$7,771.13" "$10,361.15" "$10,361.15" "$10,361.15" "$5,180.58" "$5,180.58" "$8,206.03" "$10,361.15" "$8,288.92" "$4,662.52" "$10,361.15" N/A "$6,009.67" "$10,361.15" "$6,216.69" "$10,361.15" "$10,361.15" "$10,361.15" N/A N/A 27740 SUP Custom 27803010 27740 - SHUNT NEUROSURGICAL REGULAR 12CM STRATA NSC BOTH IP/OP "$10,361.50" "$7,668.00" "$1,844.28" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$1,844.28" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$2,159.38" "$10,361.15" "$4,144.46" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$7,771.13" "$10,361.15" "$10,361.15" "$10,361.15" "$5,180.58" "$5,180.58" "$8,206.03" "$10,361.15" "$8,288.92" "$4,662.52" "$10,361.15" N/A "$6,009.67" "$10,361.15" "$6,216.69" "$10,361.15" "$10,361.15" "$10,361.15" 1634.64 759.07 27771 SUP Custom 27803010 27771 - CATHETER DRAIN STANDARD CSF LENGTH MARKING VENTRICULAR BOTH IP/OP $374.50 $277.00 $66.64 $374.40 $374.40 $374.40 $374.40 $374.40 $374.40 $374.40 $66.64 $374.40 $374.40 $374.40 $374.40 $374.40 $374.40 $78.03 $374.40 $149.76 $374.40 $374.40 $374.40 $374.40 $374.40 $280.88 $374.40 $374.40 $374.40 $187.20 $187.20 $296.52 $374.40 $299.52 $168.48 $374.40 N/A $217.21 $374.40 $224.64 $374.40 $374.40 $374.40 N/A N/A 27779 SUP Custom 27203010 27779 - SYSTEM EXTERNAL DRAIN VENTRICULAR BOTH IP/OP $550.00 $407.00 $97.83 $549.60 $549.60 $549.60 $549.60 $549.60 $549.60 $549.60 $97.83 $549.60 $549.60 $407.91 $407.91 $423.63 $286.34 $114.54 $549.60 $219.84 $549.60 $549.60 $549.60 $549.60 $549.60 $412.50 $549.60 $549.60 $549.60 $274.80 $274.80 $435.28 $549.60 $439.68 $357.24 $549.60 N/A $319.00 $549.60 $329.76 $549.60 $549.60 $549.60 N/A N/A 27781 SUP Custom 27803010 27781 - CATHETER DRAIN 23CM FLOW HOLE INNERVISION VENTRICULAR BOTH IP/OP $841.00 $622.00 $149.65 $840.75 $840.75 $840.75 $840.75 $840.75 $840.75 $840.75 $149.65 $840.75 $840.75 $840.75 $840.75 $840.75 $840.75 $175.22 $840.75 $336.30 $840.75 $840.75 $840.75 $840.75 $840.75 $630.75 $840.75 $840.75 $840.75 $420.38 $420.38 $665.87 $840.75 $672.60 $378.34 $840.75 N/A $487.78 $840.75 $504.45 $840.75 $840.75 $840.75 899.07 434.5 27785 SUP Custom 27203010 27785 - CATHETER DRAIN CSF STYLET SYSTEM EXACTA 50ML VENTRICULAR BOTH IP/OP $475.50 $352.00 $84.59 $475.20 $475.20 $475.20 $475.20 $475.20 $475.20 $475.20 $84.59 $475.20 $475.20 $352.69 $352.69 $366.28 $247.58 $99.04 $475.20 $190.08 $475.20 $475.20 $475.20 $475.20 $475.20 $356.63 $475.20 $475.20 $475.20 $237.60 $237.60 $376.36 $475.20 $380.16 $308.88 $475.20 N/A $275.79 $475.20 $285.12 $475.20 $475.20 $475.20 N/A N/A 27786 SUP Custom 27803010 27786 - KIT SHUNT SMALL 2.5M 1.3MM 90CM 11.5CM UNITIZED BIOGLIDE BOTH IP/OP "$10,114.50" "$7,485.00" "$1,800.36" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$1,800.36" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$2,107.95" "$10,114.40" "$4,045.76" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$7,585.88" "$10,114.40" "$10,114.40" "$10,114.40" "$5,057.20" "$5,057.20" "$8,010.60" "$10,114.40" "$8,091.52" "$4,551.48" "$10,114.40" N/A "$5,866.41" "$10,114.40" "$6,068.64" "$10,114.40" "$10,114.40" "$10,114.40" 656.84 313.08 27787 SUP Custom 27803010 27787 - KIT SHUNT REGULAR 2.5M 1.3MM 90CM 13.5CM UNITIZED BIOGLIDE BOTH IP/OP "$10,114.50" "$7,485.00" "$1,800.36" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$1,800.36" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$2,107.95" "$10,114.40" "$4,045.76" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$10,114.40" "$7,585.88" "$10,114.40" "$10,114.40" "$10,114.40" "$5,057.20" "$5,057.20" "$8,010.60" "$10,114.40" "$8,091.52" "$4,551.48" "$10,114.40" N/A "$5,866.41" "$10,114.40" "$6,068.64" "$10,114.40" "$10,114.40" "$10,114.40" N/A N/A 27788 SUP Custom 27803010 27788 - SHUNT NEUROSURGICAL SMALL SNAP ASMBLY STRATA NSC BIOGLIDE BOTH IP/OP "$11,202.50" "$8,290.00" "$1,994.04" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$1,994.04" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$2,334.71" "$11,202.45" "$4,480.98" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$8,401.88" "$11,202.45" "$11,202.45" "$11,202.45" "$5,601.23" "$5,601.23" "$8,872.34" "$11,202.45" "$8,961.96" "$5,041.10" "$11,202.45" N/A "$6,497.45" "$11,202.45" "$6,721.47" "$11,202.45" "$11,202.45" "$11,202.45" 883.82 416.47 27789 SUP Custom 27803010 27789 - SHUNT NEUROSURGICAL SNAP PS MEDICAL STRATA NSC BIOGLIDE BOTH IP/OP "$11,202.50" "$8,290.00" "$1,994.04" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$1,994.04" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$2,334.71" "$11,202.45" "$4,480.98" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$11,202.45" "$8,401.88" "$11,202.45" "$11,202.45" "$11,202.45" "$5,601.23" "$5,601.23" "$8,872.34" "$11,202.45" "$8,961.96" "$5,041.10" "$11,202.45" N/A "$6,497.45" "$11,202.45" "$6,721.47" "$11,202.45" "$11,202.45" "$11,202.45" N/A N/A 27794 SUP Custom 27803010 27794 - SHUNT NEUROSURGICAL NEEDLE SNAP ASMBLY NSC BOTH IP/OP "$10,361.50" "$7,668.00" "$1,844.28" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$1,844.28" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$2,159.38" "$10,361.15" "$4,144.46" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$10,361.15" "$7,771.13" "$10,361.15" "$10,361.15" "$10,361.15" "$5,180.58" "$5,180.58" "$8,206.03" "$10,361.15" "$8,288.92" "$4,662.52" "$10,361.15" N/A "$6,009.67" "$10,361.15" "$6,216.69" "$10,361.15" "$10,361.15" "$10,361.15" N/A N/A 27795 SUP Custom 27203010 27795 - CATHETER DRAIN INTERLINK NEEDLESS INJEC SITE DRIP CHAMBER BOTH IP/OP $775.50 $574.00 $137.99 $775.20 $775.20 $775.20 $775.20 $775.20 $775.20 $775.20 $137.99 $775.20 $775.20 $575.35 $575.35 $597.52 $403.88 $161.56 $775.20 $310.08 $775.20 $775.20 $775.20 $775.20 $775.20 $581.63 $775.20 $775.20 $775.20 $387.60 $387.60 $613.96 $775.20 $620.16 $503.88 $775.20 N/A $449.79 $775.20 $465.12 $775.20 $775.20 $775.20 N/A N/A 27811 SUP Custom 27203010 27811 - CATHETER DRAIN 20CM BARIUM IMPREGNATE LUERLOCK CONCTR STYLET BOTH IP/OP $792.00 $586.00 $140.98 $792.00 $792.00 $792.00 $792.00 $792.00 $792.00 $792.00 $140.98 $792.00 $792.00 $587.82 $587.82 $610.47 $412.63 $165.06 $792.00 $316.80 $792.00 $792.00 $792.00 $792.00 $792.00 $594.00 $792.00 $792.00 $792.00 $396.00 $396.00 $627.26 $792.00 $633.60 $514.80 $792.00 N/A $459.36 $792.00 $475.20 $792.00 $792.00 $792.00 N/A N/A 27812 SUP Custom 27803010 27812 - VALVE SHUNT SMALL CSF EXTRACTED STRATA II BOTH IP/OP "$10,145.00" "$7,507.00" "$1,805.80" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$1,805.80" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$2,114.32" "$10,144.95" "$4,057.98" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$7,608.75" "$10,144.95" "$10,144.95" "$10,144.95" "$5,072.48" "$5,072.48" "$8,034.80" "$10,144.95" "$8,115.96" "$4,565.23" "$10,144.95" N/A "$5,884.10" "$10,144.95" "$6,086.97" "$10,144.95" "$10,144.95" "$10,144.95" N/A N/A 27814 SUP Custom 27803010 27814 - SHUNT NEUROSURGICAL SMALL 90CM CSF PERITONEAL CATHETER BOTH IP/OP "$10,770.50" "$7,970.00" "$1,917.07" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$1,917.07" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$2,244.60" "$10,770.05" "$4,308.02" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$8,077.88" "$10,770.05" "$10,770.05" "$10,770.05" "$5,385.03" "$5,385.03" "$8,529.88" "$10,770.05" "$8,616.04" "$4,846.52" "$10,770.05" N/A "$6,246.89" "$10,770.05" "$6,462.03" "$10,770.05" "$10,770.05" "$10,770.05" 1783.56 818.41 27815 SUP Custom 27803010 27815 - SHUNT NEUROSURGICAL REGULAR 90CM CSF PERITONEAL CATHETER BOTH IP/OP "$10,770.50" "$7,970.00" "$1,917.07" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$1,917.07" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$2,244.60" "$10,770.05" "$4,308.02" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$8,077.88" "$10,770.05" "$10,770.05" "$10,770.05" "$5,385.03" "$5,385.03" "$8,529.88" "$10,770.05" "$8,616.04" "$4,846.52" "$10,770.05" N/A "$6,246.89" "$10,770.05" "$6,462.03" "$10,770.05" "$10,770.05" "$10,770.05" N/A N/A 27816 SUP Custom 27803010 27816 - VALVE SHUNT SMALL STANDARD BARIUM IMPREGNATED SNAP ASMBLY BOTH IP/OP "$11,167.50" "$8,264.00" "$1,987.76" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$1,987.76" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$2,327.37" "$11,167.20" "$4,466.88" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$8,375.63" "$11,167.20" "$11,167.20" "$11,167.20" "$5,583.60" "$5,583.60" "$8,844.42" "$11,167.20" "$8,933.76" "$5,025.24" "$11,167.20" N/A "$6,477.15" "$11,167.20" "$6,700.32" "$11,167.20" "$11,167.20" "$11,167.20" 659.21 319.11 27817 SUP Custom 27803010 27817 - VALVE SHUNT REGULAR 120CM CSF PERITONEAL CATHETER BARIUM BOTH IP/OP "$11,167.50" "$8,264.00" "$1,987.76" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$1,987.76" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$2,327.37" "$11,167.20" "$4,466.88" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$8,375.63" "$11,167.20" "$11,167.20" "$11,167.20" "$5,583.60" "$5,583.60" "$8,844.42" "$11,167.20" "$8,933.76" "$5,025.24" "$11,167.20" N/A "$6,477.15" "$11,167.20" "$6,700.32" "$11,167.20" "$11,167.20" "$11,167.20" N/A N/A 27818 SUP Custom 27803010 27818 - VALVE SHUNT SMALL CSF ASMBLY BIOGLIDE STRATA II STERILE BOTH IP/OP "$11,419.00" "$8,450.00" "$2,032.52" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$2,032.52" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$2,379.77" "$11,418.65" "$4,567.46" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$8,564.25" "$11,418.65" "$11,418.65" "$11,418.65" "$5,709.33" "$5,709.33" "$9,043.57" "$11,418.65" "$9,134.92" "$5,138.39" "$11,418.65" N/A "$6,623.02" "$11,418.65" "$6,851.19" "$11,418.65" "$11,418.65" "$11,418.65" 996.8 472.01 27819 SUP Custom 27803010 27819 - VALVE SHUNT REGULAR CSF BIOGLIDE CATHETER SNAP ASMBLY STRATA BOTH IP/OP "$11,419.00" "$8,450.00" "$2,032.52" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$2,032.52" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$2,379.77" "$11,418.65" "$4,567.46" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$11,418.65" "$8,564.25" "$11,418.65" "$11,418.65" "$11,418.65" "$5,709.33" "$5,709.33" "$9,043.57" "$11,418.65" "$9,134.92" "$5,138.39" "$11,418.65" N/A "$6,623.02" "$11,418.65" "$6,851.19" "$11,418.65" "$11,418.65" "$11,418.65" N/A N/A 27820 SUP Custom 27203010 27820 - SHUNT NEUROSURGICAL SMALL CSF UNITIZED STRATA II STERILE BOTH IP/OP "$10,916.00" "$8,078.00" "$1,943.00" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$1,943.00" "$10,915.75" "$10,915.75" "$4,181.12" "$4,181.12" "$8,413.86" "$2,060.15" "$2,274.96" "$10,915.75" "$4,366.30" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$8,187.00" "$10,915.75" "$10,915.75" "$10,915.75" "$5,457.88" "$5,457.88" "$8,645.27" "$10,915.75" "$8,732.60" "$7,095.24" "$10,915.75" N/A "$6,331.28" "$10,915.75" "$6,549.45" "$10,915.75" "$10,915.75" "$10,915.75" N/A N/A 27821 SUP Custom 27203010 27821 - SHUNT NEUROSURGICAL REGULAR CSF UNITIZED STRATA II STERILE BOTH IP/OP "$10,916.00" "$8,078.00" "$1,943.00" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$1,943.00" "$10,915.75" "$10,915.75" "$4,181.12" "$4,181.12" "$8,413.86" "$2,060.15" "$2,274.96" "$10,915.75" "$4,366.30" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$8,187.00" "$10,915.75" "$10,915.75" "$10,915.75" "$5,457.88" "$5,457.88" "$8,645.27" "$10,915.75" "$8,732.60" "$7,095.24" "$10,915.75" N/A "$6,331.28" "$10,915.75" "$6,549.45" "$10,915.75" "$10,915.75" "$10,915.75" N/A N/A 27822 SUP Custom 27803010 27822 - SHUNT NEUROSURGICAL SMALL CSF SNAP ASMBLY BIOGLIDE CATHETER BOTH IP/OP "$12,004.00" "$8,883.00" "$2,136.68" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$2,136.68" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$2,501.72" "$12,003.80" "$4,801.52" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$9,003.00" "$12,003.80" "$12,003.80" "$12,003.80" "$6,001.90" "$6,001.90" "$9,507.01" "$12,003.80" "$9,603.04" "$5,401.71" "$12,003.80" N/A "$6,962.32" "$12,003.80" "$7,202.28" "$12,003.80" "$12,003.80" "$12,003.80" 1942.32 942.43 27823 SUP Custom 27803010 27823 - SHUNT NEUROSURGICAL REGULAR CSF SNAP ASMBLY BIOGLIDE BOTH IP/OP "$12,004.00" "$8,883.00" "$2,136.68" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$2,136.68" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$2,501.72" "$12,003.80" "$4,801.52" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$12,003.80" "$9,003.00" "$12,003.80" "$12,003.80" "$12,003.80" "$6,001.90" "$6,001.90" "$9,507.01" "$12,003.80" "$9,603.04" "$5,401.71" "$12,003.80" N/A "$6,962.32" "$12,003.80" "$7,202.28" "$12,003.80" "$12,003.80" "$12,003.80" 2206.01 1058.07 27824 SUP Custom 27803010 27824 - SHUNT NEUROSURGICAL SMALL UNITIZED BIOGLIDE CATHETER STRATA BOTH IP/OP "$11,386.00" "$8,426.00" "$2,026.66" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$2,026.66" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$2,372.92" "$11,385.75" "$4,554.30" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$8,539.50" "$11,385.75" "$11,385.75" "$11,385.75" "$5,692.88" "$5,692.88" "$9,017.51" "$11,385.75" "$9,108.60" "$5,123.59" "$11,385.75" N/A "$6,603.88" "$11,385.75" "$6,831.45" "$11,385.75" "$11,385.75" "$11,385.75" 700.05 329.97 27825 SUP Custom 27803010 27825 - SHUNT NEUROSURGICAL REGULAR UNITIZED BIOGLIDE CATHETER BOTH IP/OP "$11,386.00" "$8,426.00" "$2,026.66" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$2,026.66" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$2,372.92" "$11,385.75" "$4,554.30" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$11,385.75" "$8,539.50" "$11,385.75" "$11,385.75" "$11,385.75" "$5,692.88" "$5,692.88" "$9,017.51" "$11,385.75" "$9,108.60" "$5,123.59" "$11,385.75" N/A "$6,603.88" "$11,385.75" "$6,831.45" "$11,385.75" "$11,385.75" "$11,385.75" 1136.69 528.3 27827 SUP Custom 27803010 27827 - VALVE SHUNT REGULAR EXTRACTED STRATA II BOTH IP/OP "$10,145.00" "$7,507.00" "$1,805.80" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$1,805.80" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$2,114.32" "$10,144.95" "$4,057.98" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$10,144.95" "$7,608.75" "$10,144.95" "$10,144.95" "$10,144.95" "$5,072.48" "$5,072.48" "$8,034.80" "$10,144.95" "$8,115.96" "$4,565.23" "$10,144.95" N/A "$5,884.10" "$10,144.95" "$6,086.97" "$10,144.95" "$10,144.95" "$10,144.95" 2496.68 1202.64 27828 SUP Custom 27803010 27828 - VALVE SHUNT SMALL INLET BUTTON STRATA II BOTH IP/OP "$10,953.50" "$8,106.00" "$1,949.70" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$1,949.70" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$2,282.80" "$10,953.35" "$4,381.34" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$8,215.13" "$10,953.35" "$10,953.35" "$10,953.35" "$5,476.68" "$5,476.68" "$8,675.05" "$10,953.35" "$8,762.68" "$4,929.01" "$10,953.35" N/A "$6,353.03" "$10,953.35" "$6,572.01" "$10,953.35" "$10,953.35" "$10,953.35" 2993.58 1425.22 27829 SUP Custom 27803010 27829 - VALVE SHUNT REGULAR INLET BUTTON STRATA II BOTH IP/OP "$10,953.50" "$8,106.00" "$1,949.70" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$1,949.70" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$2,282.80" "$10,953.35" "$4,381.34" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$10,953.35" "$8,215.13" "$10,953.35" "$10,953.35" "$10,953.35" "$5,476.68" "$5,476.68" "$8,675.05" "$10,953.35" "$8,762.68" "$4,929.01" "$10,953.35" N/A "$6,353.03" "$10,953.35" "$6,572.01" "$10,953.35" "$10,953.35" "$10,953.35" 1578.98 762.34 27830 SUP Custom 27803010 27830 - SHUNT NEUROSURGICAL SMALL CSF SNAP ASMBLY BLUNT TIP STRATA BOTH IP/OP "$11,167.50" "$8,264.00" "$1,987.76" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$1,987.76" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$2,327.37" "$11,167.20" "$4,466.88" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$8,375.63" "$11,167.20" "$11,167.20" "$11,167.20" "$5,583.60" "$5,583.60" "$8,844.42" "$11,167.20" "$8,933.76" "$5,025.24" "$11,167.20" N/A "$6,477.15" "$11,167.20" "$6,700.32" "$11,167.20" "$11,167.20" "$11,167.20" 815.33 390.56 27831 SUP Custom 27803010 27831 - SHUNT NEUROSURGICAL REGULAR CSF SNAP ASMBLY BLUNT TIP STRATA BOTH IP/OP "$11,167.50" "$8,264.00" "$1,987.76" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$1,987.76" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$2,327.37" "$11,167.20" "$4,466.88" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$11,167.20" "$8,375.63" "$11,167.20" "$11,167.20" "$11,167.20" "$5,583.60" "$5,583.60" "$8,844.42" "$11,167.20" "$8,933.76" "$5,025.24" "$11,167.20" N/A "$6,477.15" "$11,167.20" "$6,700.32" "$11,167.20" "$11,167.20" "$11,167.20" 902.46 441.96 27832 SUP Custom 27803010 27832 - VALVE SHUNT REGULAR BLUNT SNAP STRATA II BOTH IP/OP "$10,157.00" "$7,516.00" "$1,807.89" "$10,156.70" "$10,156.70" "$10,156.70" "$10,156.70" "$10,156.70" "$10,156.70" "$10,156.70" "$1,807.89" "$10,156.70" "$10,156.70" "$10,156.70" "$10,156.70" "$10,156.70" "$10,156.70" "$2,116.77" "$10,156.70" "$4,062.68" "$10,156.70" "$10,156.70" "$10,156.70" "$10,156.70" "$10,156.70" "$7,617.75" "$10,156.70" "$10,156.70" "$10,156.70" "$5,078.35" "$5,078.35" "$8,044.11" "$10,156.70" "$8,125.36" "$4,570.52" "$10,156.70" N/A "$5,891.06" "$10,156.70" "$6,094.02" "$10,156.70" "$10,156.70" "$10,156.70" 1747.16 810.99 27842 SUP Custom 27803010 27842 - CATHETER DRAIN STANDARD 28CM LATEX FREE EDMS VENTRICULAR BOTH IP/OP $298.00 $221.00 $52.97 $297.60 $297.60 $297.60 $297.60 $297.60 $297.60 $297.60 $52.97 $297.60 $297.60 $297.60 $297.60 $297.60 $297.60 $62.02 $297.60 $119.04 $297.60 $297.60 $297.60 $297.60 $297.60 $223.50 $297.60 $297.60 $297.60 $148.80 $148.80 $235.70 $297.60 $238.08 $133.92 $297.60 N/A $172.84 $297.60 $178.56 $297.60 $297.60 $297.60 1142.54 534.36 27843 SUP Custom 27803010 27843 - CATHETER DRAIN STANDARD 15CM VENTRICULAR BOTH IP/OP $411.00 $304.00 $73.14 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $73.14 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $85.63 $410.88 $164.35 $410.88 $410.88 $410.88 $410.88 $410.88 $308.25 $410.88 $410.88 $410.88 $205.44 $205.44 $325.42 $410.88 $328.70 $184.90 $410.88 N/A $238.38 $410.88 $246.53 $410.88 $410.88 $410.88 N/A N/A 27848 SUP Custom 27203010 27848 - KIT SHUNT SMALL 90CM PERITONEAL CATHETER STRATA II BOTH IP/OP "$10,770.50" "$7,970.00" "$1,917.07" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$1,917.07" "$10,770.05" "$10,770.05" "$4,181.12" "$4,181.12" "$8,301.55" "$2,060.15" "$2,244.60" "$10,770.05" "$4,308.02" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$8,077.88" "$10,770.05" "$10,770.05" "$10,770.05" "$5,385.03" "$5,385.03" "$8,529.88" "$10,770.05" "$8,616.04" "$7,000.53" "$10,770.05" N/A "$6,246.89" "$10,770.05" "$6,462.03" "$10,770.05" "$10,770.05" "$10,770.05" 1874.84 845.67 27852 SUP Custom 27803010 27852 - CATHETER DRAIN 15CM CSF PLIANT FIX COLONIC BOTH IP/OP $522.50 $387.00 $93.01 $522.50 $522.50 $522.50 $522.50 $522.50 $522.50 $522.50 $93.01 $522.50 $522.50 $522.50 $522.50 $522.50 $522.50 $108.89 $522.50 $209.00 $522.50 $522.50 $522.50 $522.50 $522.50 $391.88 $522.50 $522.50 $522.50 $261.25 $261.25 $413.82 $522.50 $418.00 $235.13 $522.50 N/A $303.05 $522.50 $313.50 $522.50 $522.50 $522.50 N/A N/A 27853 SUP Custom 27803010 27853 - CATHETER DRAIN 23CM BIOGLIDE OPUS VENTRICULAR BOTH IP/OP $606.00 $448.00 $107.80 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $107.80 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $126.22 $605.63 $242.25 $605.63 $605.63 $605.63 $605.63 $605.63 $454.50 $605.63 $605.63 $605.63 $302.82 $302.82 $479.66 $605.63 $484.50 $272.53 $605.63 N/A $351.48 $605.63 $363.38 $605.63 $605.63 $605.63 N/A N/A 27855 SUP Custom 27203010 27855 - CATHETER DRAIN NEEDLELESS INJEC SITE LATEX FREE EDMS EXACTA BOTH IP/OP $689.00 $510.00 $302.12 "$1,697.32" "$1,697.32" "$1,697.32" "$1,697.32" "$1,697.32" "$1,697.32" "$1,697.32" $302.12 "$1,697.32" "$1,697.32" "$1,259.75" "$1,259.75" "$1,308.29" $884.30 $353.74 "$1,697.32" $678.93 "$1,697.32" "$1,697.32" "$1,697.32" "$1,697.32" "$1,697.32" $516.75 "$1,697.32" "$1,697.32" "$1,697.32" $848.66 $848.66 "$1,344.28" "$1,697.32" "$1,357.86" "$1,103.26" "$1,697.32" "$1,697.32" $399.62 "$1,697.32" "$1,018.39" "$1,697.32" "$1,697.32" "$1,697.32" N/A N/A 27857 SUP Custom 27803010 27857 - CATHETER SHUNT STANDARD 130CM CSF PERITONEAL STERILE BOTH IP/OP $418.00 $309.00 $3.75 $313.50 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $17.99 $3.75 $17.99 $7.20 $17.99 $17.99 $17.99 $17.99 $17.99 $313.50 $17.99 $17.99 $17.99 $9.00 $9.00 $14.25 $17.99 $14.39 $11.69 $17.99 $17.99 $242.44 $17.99 $10.79 $17.99 $17.99 $17.99 N/A N/A 27861 SUP Custom 27203010 27861 - VALVE DRAIN ANTIREFLUX LATEX FREE EXACTA EDM 50ML BOTH IP/OP $470.50 $348.00 $83.73 $470.40 $470.40 $470.40 $470.40 $470.40 $470.40 $470.40 $83.73 $470.40 $470.40 $349.13 $349.13 $362.58 $245.08 $98.04 $470.40 $188.16 $470.40 $470.40 $470.40 $470.40 $470.40 $352.88 $470.40 $470.40 $470.40 $235.20 $235.20 $372.56 $470.40 $376.32 $305.76 $470.40 N/A $272.89 $470.40 $282.24 $470.40 $470.40 $470.40 N/A N/A 27864 SUP Custom 27803010 27864 - SHUNT NEUROSURGICAL REGULAR 120CM STRATA II BOTH IP/OP "$10,838.50" "$8,020.00" "$1,929.20" "$10,838.20" "$10,838.20" "$10,838.20" "$10,838.20" "$10,838.20" "$10,838.20" "$10,838.20" "$1,929.20" "$10,838.20" "$10,838.20" "$10,838.20" "$10,838.20" "$10,838.20" "$10,838.20" "$2,258.80" "$10,838.20" "$4,335.28" "$10,838.20" "$10,838.20" "$10,838.20" "$10,838.20" "$10,838.20" "$8,128.88" "$10,838.20" "$10,838.20" "$10,838.20" "$5,419.10" "$5,419.10" "$8,583.85" "$10,838.20" "$8,670.56" "$4,877.19" "$10,838.20" N/A "$6,286.33" "$10,838.20" "$6,502.92" "$10,838.20" "$10,838.20" "$10,838.20" N/A N/A 27867 SUP Custom 27803010 27867 - SHUNT NEUROSURGICAL SMALL 130CM PERITONEAL CATHETER LATEX BOTH IP/OP "$10,770.50" "$7,970.00" "$1,917.07" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$1,917.07" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$2,244.60" "$10,770.05" "$4,308.02" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$10,770.05" "$8,077.88" "$10,770.05" "$10,770.05" "$10,770.05" "$5,385.03" "$5,385.03" "$8,529.88" "$10,770.05" "$8,616.04" "$4,846.52" "$10,770.05" N/A "$6,246.89" "$10,770.05" "$6,462.03" "$10,770.05" "$10,770.05" "$10,770.05" N/A N/A 27868 SUP Custom 27803010 27868 - SHUNT NEUROSURGICAL SMALL 130CM PERITONEAL CATHETER LATEX BOTH IP/OP "$9,459.00" "$7,000.00" "$1,683.66" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$1,683.66" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$1,971.31" "$9,458.75" "$3,783.50" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$7,094.25" "$9,458.75" "$9,458.75" "$9,458.75" "$4,729.38" "$4,729.38" "$7,491.33" "$9,458.75" "$7,567.00" "$4,256.44" "$9,458.75" N/A "$5,486.22" "$9,458.75" "$5,675.25" "$9,458.75" "$9,458.75" "$9,458.75" N/A N/A 27873 SUP Custom 27203010 27873 - CATHETER DRAIN STOPCOCK DRIP CHAMBER NEEDLELESS INJEC EDMS BOTH IP/OP $497.00 $368.00 $88.43 $496.80 $496.80 $496.80 $496.80 $496.80 $496.80 $496.80 $88.43 $496.80 $496.80 $368.72 $368.72 $382.93 $258.83 $103.54 $496.80 $198.72 $496.80 $496.80 $496.80 $496.80 $496.80 $372.75 $496.80 $496.80 $496.80 $248.40 $248.40 $393.47 $496.80 $397.44 $322.92 $496.80 N/A $288.26 $496.80 $298.08 $496.80 $496.80 $496.80 N/A N/A 27875 SUP Custom 27803010 27875 - SHUNT NEUROSURGICAL 15CM VENTRICLE BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 27888 SUP Custom 27803010 27888 - SHUNT NEUROSURGICAL PROGRAM STRATA BOTH IP/OP "$10,916.00" "$8,078.00" "$1,943.00" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$1,943.00" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$2,274.96" "$10,915.75" "$4,366.30" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$8,187.00" "$10,915.75" "$10,915.75" "$10,915.75" "$5,457.88" "$5,457.88" "$8,645.27" "$10,915.75" "$8,732.60" "$4,912.09" "$10,915.75" N/A "$6,331.28" "$10,915.75" "$6,549.45" "$10,915.75" "$10,915.75" "$10,915.75" 1588.7 692.57 27889 SUP Custom 27803010 27889 - RESERVOIR SHUNT SNAP EXTEND FLANGE LATEX FREE VENTRICULAR BOTH IP/OP $731.50 $541.00 $130.21 $731.50 $731.50 $731.50 $731.50 $731.50 $731.50 $731.50 $130.21 $731.50 $731.50 $731.50 $731.50 $731.50 $731.50 $152.45 $731.50 $292.60 $731.50 $731.50 $731.50 $731.50 $731.50 $548.63 $731.50 $731.50 $731.50 $365.75 $365.75 $579.35 $731.50 $585.20 $329.18 $731.50 N/A $424.27 $731.50 $438.90 $731.50 $731.50 $731.50 1521.02 677.62 27903 SUP Custom 27803010 27903 - CATHETER NEUROSURGICAL SMALL CHAMP CURVE PS MEDICAL STRATA BOTH IP/OP "$9,950.00" "$7,363.00" "$1,771.08" "$9,949.90" "$9,949.90" "$9,949.90" "$9,949.90" "$9,949.90" "$9,949.90" "$9,949.90" "$1,771.08" "$9,949.90" "$9,949.90" "$9,949.90" "$9,949.90" "$9,949.90" "$9,949.90" "$2,073.67" "$9,949.90" "$3,979.96" "$9,949.90" "$9,949.90" "$9,949.90" "$9,949.90" "$9,949.90" "$7,462.50" "$9,949.90" "$9,949.90" "$9,949.90" "$4,974.95" "$4,974.95" "$7,880.32" "$9,949.90" "$7,959.92" "$4,477.46" "$9,949.90" N/A "$5,771.00" "$9,949.90" "$5,969.94" "$9,949.90" "$9,949.90" "$9,949.90" N/A N/A 27922 SUP Custom 27803010 27922 - SHUNT NEUROSURGICAL REGULAR INTEGRITY RESERVOIR PS MEDICAL BOTH IP/OP "$11,433.00" "$8,460.00" "$2,035.03" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$2,035.03" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$2,382.71" "$11,432.75" "$4,573.10" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$8,574.75" "$11,432.75" "$11,432.75" "$11,432.75" "$5,716.38" "$5,716.38" "$9,054.74" "$11,432.75" "$9,146.20" "$5,144.74" "$11,432.75" N/A "$6,631.14" "$11,432.75" "$6,859.65" "$11,432.75" "$11,432.75" "$11,432.75" N/A N/A 27923 SUP Custom 27803010 27923 - SHUNT NEUROSURGICAL SMALL INTEGRAL CONCTR VENTRICULAR BOTH IP/OP "$11,433.00" "$8,460.00" "$2,035.03" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$2,035.03" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$2,382.71" "$11,432.75" "$4,573.10" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$11,432.75" "$8,574.75" "$11,432.75" "$11,432.75" "$11,432.75" "$5,716.38" "$5,716.38" "$9,054.74" "$11,432.75" "$9,146.20" "$5,144.74" "$11,432.75" N/A "$6,631.14" "$11,432.75" "$6,859.65" "$11,432.75" "$11,432.75" "$11,432.75" N/A N/A 27924 SUP Custom 27803010 27924 - SHUNT NEUROSURGICAL REGULAR INTEGRITY RESERVOIR PS MEDICAL BOTH IP/OP "$10,624.50" "$7,862.00" "$1,891.13" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$1,891.13" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$2,214.23" "$10,624.35" "$4,249.74" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$7,968.38" "$10,624.35" "$10,624.35" "$10,624.35" "$5,312.18" "$5,312.18" "$8,414.49" "$10,624.35" "$8,499.48" "$4,780.96" "$10,624.35" N/A "$6,162.21" "$10,624.35" "$6,374.61" "$10,624.35" "$10,624.35" "$10,624.35" N/A N/A 27925 SUP Custom 27803010 27925 - SHUNT NEUROSURGICAL SMALL INTEGRITY RESERVOIR PS MEDICAL BOTH IP/OP "$10,624.50" "$7,862.00" "$1,891.13" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$1,891.13" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$2,214.23" "$10,624.35" "$4,249.74" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$10,624.35" "$7,968.38" "$10,624.35" "$10,624.35" "$10,624.35" "$5,312.18" "$5,312.18" "$8,414.49" "$10,624.35" "$8,499.48" "$4,780.96" "$10,624.35" N/A "$6,162.21" "$10,624.35" "$6,374.61" "$10,624.35" "$10,624.35" "$10,624.35" N/A N/A 27926 SUP Custom 27803010 27926 - SHUNT NEUROSURGICAL REGULAR INNERVISION RESERVOIR PS MEDICAL BOTH IP/OP "$11,900.50" "$8,806.00" "$2,118.27" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$2,118.27" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$2,480.17" "$11,900.40" "$4,760.16" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$8,925.38" "$11,900.40" "$11,900.40" "$11,900.40" "$5,950.20" "$5,950.20" "$9,425.12" "$11,900.40" "$9,520.32" "$5,355.18" "$11,900.40" N/A "$6,902.29" "$11,900.40" "$7,140.24" "$11,900.40" "$11,900.40" "$11,900.40" N/A N/A 27927 SUP Custom 27803010 27927 - SHUNT NEUROSURGICAL SMALL INNERVISION RESERVOIR PS MEDICAL BOTH IP/OP "$11,900.50" "$8,806.00" "$2,118.27" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$2,118.27" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$2,480.17" "$11,900.40" "$4,760.16" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$11,900.40" "$8,925.38" "$11,900.40" "$11,900.40" "$11,900.40" "$5,950.20" "$5,950.20" "$9,425.12" "$11,900.40" "$9,520.32" "$5,355.18" "$11,900.40" N/A "$6,902.29" "$11,900.40" "$7,140.24" "$11,900.40" "$11,900.40" "$11,900.40" N/A N/A 27929 SUP Custom 27803010 27929 - CATHETER PERITONEAL SMALL EXTRACT LATEX FREE BOTH IP/OP "$1,330.00" $984.00 $236.74 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $236.74 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $277.19 "$1,330.00" $532.00 "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" "$1,330.00" $997.50 "$1,330.00" "$1,330.00" "$1,330.00" $665.00 $665.00 "$1,053.36" "$1,330.00" "$1,064.00" $598.50 "$1,330.00" N/A $771.40 "$1,330.00" $798.00 "$1,330.00" "$1,330.00" "$1,330.00" N/A N/A 27930 SUP Custom 27803010 27930 - CATHETER VENTRICULAR SMALL EXTRACT LATEX FREE BOTH IP/OP $876.50 $649.00 $156.00 $876.38 $876.38 $876.38 $876.38 $876.38 $876.38 $876.38 $156.00 $876.38 $876.38 $876.38 $876.38 $876.38 $876.38 $182.65 $876.38 $350.55 $876.38 $876.38 $876.38 $876.38 $876.38 $657.38 $876.38 $876.38 $876.38 $438.19 $438.19 $694.09 $876.38 $701.10 $394.37 $876.38 N/A $508.37 $876.38 $525.83 $876.38 $876.38 $876.38 N/A N/A 27931 SUP Custom 27203010 27931 - SYSTEM EXTERNAL DRAIN MONITR GAS TUBE BECKER SMARTSITE BOTH IP/OP $557.00 $412.00 $99.11 $556.80 $556.80 $556.80 $556.80 $556.80 $556.80 $556.80 $99.11 $556.80 $556.80 $413.26 $413.26 $429.18 $290.09 $116.04 $556.80 $222.72 $556.80 $556.80 $556.80 $556.80 $556.80 $417.75 $556.80 $556.80 $556.80 $278.40 $278.40 $440.99 $556.80 $445.44 $361.92 $556.80 N/A $323.06 $556.80 $334.08 $556.80 $556.80 $556.80 N/A N/A 27932 SUP Custom 27803010 27932 - VALVE SHUNT SMALL EXTRACT PS MEDICAL STRATA NSC BOTH IP/OP "$8,782.00" "$6,499.00" "$1,563.19" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$1,563.19" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$1,830.25" "$8,781.95" "$3,512.78" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$6,586.50" "$8,781.95" "$8,781.95" "$8,781.95" "$4,390.98" "$4,390.98" "$6,955.30" "$8,781.95" "$7,025.56" "$3,951.88" "$8,781.95" N/A "$5,093.56" "$8,781.95" "$5,269.17" "$8,781.95" "$8,781.95" "$8,781.95" N/A N/A 27933 SUP Custom 27803010 27933 - VALVE SHUNT REGULAR EXTRACT LATEX FREE NSC STRATA BOTH IP/OP "$8,782.00" "$6,499.00" "$1,563.19" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$1,563.19" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$1,830.25" "$8,781.95" "$3,512.78" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$8,781.95" "$6,586.50" "$8,781.95" "$8,781.95" "$8,781.95" "$4,390.98" "$4,390.98" "$6,955.30" "$8,781.95" "$7,025.56" "$3,951.88" "$8,781.95" N/A "$5,093.56" "$8,781.95" "$5,269.17" "$8,781.95" "$8,781.95" "$8,781.95" N/A N/A 28707 SUP Custom 27203010 SET RTRCTR OCTOBASE HLD INS SUTURE DISP BOTH IP/OP $137.50 $102.00 $24.48 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $24.48 $137.50 $137.50 $102.05 $102.05 $105.99 $71.64 $28.66 $137.50 $55.00 $137.50 $137.50 $137.50 $137.50 $137.50 $103.13 $137.50 $137.50 $137.50 $68.75 $68.75 $108.90 $137.50 $110.00 $89.38 $137.50 N/A $79.75 $137.50 $82.50 $137.50 $137.50 $137.50 N/A N/A 30011 SUP HCPCS C1776 30011 - STEM ULNAR SMALL BOW SHORT 41X6.2MM PLASMA SPRAY EASE OF BOTH IP/OP "$7,947.50" "$5,881.00" "$1,577.38" "$7,947.50" "$3,576.38" "$3,576.38" "$3,576.38" "$3,576.38" "$7,947.50" "$7,947.50" "$7,947.50" "$1,656.46" "$7,947.50" "$7,947.50" "$7,947.50" "$7,947.50" "$7,947.50" "$1,656.35" "$7,947.50" "$3,179.00" "$3,918.12" "$7,947.50" "$7,947.50" "$7,947.50" "$7,947.50" "$5,960.63" "$7,947.50" "$7,947.50" "$7,947.50" "$3,973.75" "$3,973.75" "$6,294.42" "$7,947.50" "$6,358.00" "$3,576.38" "$1,577.38" N/A "$4,609.55" "$7,947.50" "$7,947.50" "$7,947.50" "$1,656.26" "$7,947.50" N/A N/A 30121 SUP HCPCS C1776 30121 - STEM ULNAR MEDIUM STANDARD LATITUDE LEFT ELBOW BOTH IP/OP "$7,947.00" "$5,881.00" "$1,577.23" "$7,946.75" "$3,576.04" "$3,576.04" "$3,576.04" "$3,576.04" "$7,946.75" "$7,946.75" "$7,946.75" "$1,656.30" "$7,946.75" "$7,946.75" "$7,946.75" "$7,946.75" "$7,946.75" "$1,656.19" "$7,946.75" "$3,178.70" "$3,917.75" "$7,946.75" "$7,946.75" "$7,946.75" "$7,946.75" "$5,960.25" "$7,946.75" "$7,946.75" "$7,946.75" "$3,973.38" "$3,973.38" "$6,293.83" "$7,946.75" "$6,357.40" "$3,576.04" "$1,577.23" N/A "$4,609.26" "$7,946.75" "$7,946.75" "$7,946.75" "$1,656.10" "$7,946.75" N/A N/A 30303 SUP HCPCS C1776 30303 - STEM HUMERAL 6.5MM 4MM SMALL BOW STANDARD 90X7.7MM 72X4.4MM BOTH IP/OP "$8,915.00" "$6,597.00" "$1,769.40" "$8,915.00" "$4,011.75" "$4,011.75" "$4,011.75" "$4,011.75" "$8,915.00" "$8,915.00" "$8,915.00" "$1,858.11" "$8,915.00" "$8,915.00" "$8,915.00" "$8,915.00" "$8,915.00" "$1,857.98" "$8,915.00" "$8,915.00" "$4,395.10" "$8,915.00" "$8,915.00" "$8,915.00" "$8,915.00" "$6,686.25" "$8,915.00" "$8,915.00" "$8,915.00" "$4,457.50" "$4,457.50" "$7,060.68" "$8,915.00" "$7,132.00" "$4,011.75" "$1,769.40" N/A "$5,170.70" "$8,915.00" "$8,915.00" "$8,915.00" "$1,857.89" "$8,915.00" N/A N/A 30418 SUP Custom 27203010 030418 - RELOAD STPLR UNV STRG 12MM 30MMX2.5MM WHT STRL LF EGIA 6 ROW BOTH IP/OP $223.50 $165.00 $39.73 $223.20 $223.20 $223.20 $223.20 $223.20 $223.20 $223.20 $39.73 $223.20 $223.20 $165.66 $165.66 $172.04 $116.29 $46.52 $223.20 $89.28 $223.20 $223.20 $223.20 $223.20 $223.20 $167.63 $223.20 $223.20 $223.20 $111.60 $111.60 $176.77 $223.20 $178.56 $145.08 $223.20 N/A $129.63 $223.20 $133.92 $223.20 $223.20 $223.20 N/A N/A 30419 SUP Custom 27203010 030419 - RELOAD STPLR UNV STRG 12MM 30MMX3.5MM BLU STRL LF EGIA 6 ROW BOTH IP/OP $223.50 $165.00 $39.73 $223.20 $223.20 $223.20 $223.20 $223.20 $223.20 $223.20 $39.73 $223.20 $223.20 $165.66 $165.66 $172.04 $116.29 $46.52 $223.20 $89.28 $223.20 $223.20 $223.20 $223.20 $223.20 $167.63 $223.20 $223.20 $223.20 $111.60 $111.60 $176.77 $223.20 $178.56 $145.08 $223.20 N/A $129.63 $223.20 $133.92 $223.20 $223.20 $223.20 N/A N/A 30422 SUP Custom 27203010 030422 - RELOAD STPLR UNV STRG 12MM 45MMX3.5MM BLU STRL LF EGIA 6 ROW BOTH IP/OP $230.50 $171.00 $41.00 $230.33 $230.33 $230.33 $230.33 $230.33 $230.33 $230.33 $41.00 $230.33 $230.33 $170.95 $170.95 $177.54 $120.00 $48.00 $230.33 $92.13 $230.33 $230.33 $230.33 $230.33 $230.33 $172.88 $230.33 $230.33 $230.33 $115.17 $115.17 $182.42 $230.33 $184.26 $149.71 $230.33 N/A $133.69 $230.33 $138.20 $230.33 $230.33 $230.33 N/A N/A 30423 SUP Custom 27203010 030423 - RELOAD STPLR UNV 45X4.8MM EGIA 2 TI THKTIS ENDSCP LNR CTR BOTH IP/OP $228.50 $169.00 $40.59 $228.04 $228.04 $228.04 $228.04 $228.04 $228.04 $228.04 $40.59 $228.04 $228.04 $169.25 $169.25 $175.77 $118.81 $47.53 $228.04 $91.22 $228.04 $228.04 $228.04 $228.04 $228.04 $171.38 $228.04 $228.04 $228.04 $114.02 $114.02 $180.61 $228.04 $182.43 $148.23 $228.04 N/A $132.53 $228.04 $136.82 $228.04 $228.04 $228.04 N/A N/A 30425 SUP Custom 27203010 030425 - RELOAD STPLR UNV 45X2.5MM EGIA 2 TI VASC ENDSCP LNR CTR STRG BOTH IP/OP $228.50 $169.00 $40.59 $228.04 $228.04 $228.04 $228.04 $228.04 $228.04 $228.04 $40.59 $228.04 $228.04 $169.25 $169.25 $175.77 $118.81 $47.53 $228.04 $91.22 $228.04 $228.04 $228.04 $228.04 $228.04 $171.38 $228.04 $228.04 $228.04 $114.02 $114.02 $180.61 $228.04 $182.43 $148.23 $228.04 N/A $132.53 $228.04 $136.82 $228.04 $228.04 $228.04 N/A N/A 30449 SUP Custom 27203010 030449 - RELOAD STPLR 12X4MM TI UNV LD UN STRL LATEX FREE DISP EGIA BOTH IP/OP $253.50 $188.00 $45.09 $253.34 $253.34 $253.34 $253.34 $253.34 $253.34 $253.34 $45.09 $253.34 $253.34 $188.03 $188.03 $195.27 $131.99 $52.80 $253.34 $101.34 $253.34 $253.34 $253.34 $253.34 $253.34 $190.13 $253.34 $253.34 $253.34 $126.67 $126.67 $200.65 $253.34 $202.67 $164.67 $253.34 N/A $147.03 $253.34 $152.00 $253.34 $253.34 $253.34 N/A N/A 30454 SUP Custom 27203010 030454 - RELOAD STPLR UNV 12MM 45MMX2.5MM WHT STRL LF EGIA ROTC 6 ROW BOTH IP/OP $387.00 $286.00 $68.85 $386.78 $386.78 $386.78 $386.78 $386.78 $386.78 $386.78 $68.85 $386.78 $386.78 $287.07 $287.07 $298.13 $201.51 $80.61 $386.78 $138.34 $386.78 $386.78 $345.85 $386.78 $386.78 $290.25 $386.78 $386.78 $386.78 $193.39 $193.39 $306.33 $386.78 $309.42 $251.41 $386.78 N/A $224.46 $386.78 $232.07 $386.78 $386.78 $386.78 N/A N/A 30455 SUP Custom 27203010 030455 - RELOAD STPLR UNV 12MM 45MMX3.5MM BLU STRL LF EGIA ROTC 6 ROW BOTH IP/OP $397.00 $294.00 $70.63 $396.79 $396.79 $396.79 $396.79 $396.79 $396.79 $396.79 $70.63 $396.79 $396.79 $294.50 $294.50 $305.85 $206.73 $82.70 $396.79 $158.72 $396.79 $396.79 $396.79 $396.79 $396.79 $297.75 $396.79 $396.79 $396.79 $198.40 $198.40 $314.26 $396.79 $317.43 $257.91 $396.79 N/A $230.26 $396.79 $238.07 $396.79 $396.79 $396.79 N/A N/A 30456 SUP Custom 27203010 030456 - RELOAD STPLR UNV 12MM 45MMX4.8MM GRN STRL LF EGIA ROTC 6 ROW BOTH IP/OP $417.00 $309.00 $74.17 $416.66 $416.66 $416.66 $416.66 $416.66 $416.66 $416.66 $74.17 $416.66 $416.66 $309.25 $309.25 $321.16 $217.08 $86.84 $416.66 $166.66 $416.66 $416.66 $416.66 $416.66 $416.66 $312.75 $416.66 $416.66 $416.66 $208.33 $208.33 $329.99 $416.66 $333.33 $270.83 $416.66 N/A $241.86 $416.66 $250.00 $416.66 $416.66 $416.66 N/A N/A 31031 SUP Custom 27203010 31031 - BIT DRILL 145MM 3.2MM QC NONSTRL BOTH IP/OP $153.00 $113.00 $27.18 $152.70 $152.70 $152.70 $152.70 $152.70 $152.70 $152.70 $27.18 $152.70 $152.70 $113.33 $113.33 $117.70 $79.56 $31.82 $152.70 $61.08 $152.70 $152.70 $152.70 $152.70 $152.70 $114.75 $152.70 $152.70 $152.70 $76.35 $76.35 $120.94 $152.70 $122.16 $99.26 $152.70 N/A $88.74 $152.70 $91.62 $152.70 $152.70 $152.70 N/A N/A 31035 SUP Custom 27203010 31035 - BIT DRILL 110MM 3.5MM QC CANN NONSTRL BOTH IP/OP $149.50 $111.00 $26.58 $149.30 $149.30 $149.30 $149.30 $149.30 $149.30 $149.30 $26.58 $149.30 $149.30 $110.81 $110.81 $115.08 $77.79 $31.12 $149.30 $59.72 $149.30 $149.30 $149.30 $149.30 $149.30 $112.13 $149.30 $149.30 $149.30 $74.65 $74.65 $118.25 $149.30 $119.44 $97.05 $149.30 N/A $86.71 $149.30 $89.58 $149.30 $149.30 $149.30 N/A N/A 31100 SUP Custom 27203010 31100 - SHUNT CV 1MM 14MM STRL CLRVW BLB TPR TIP RADOPQ SIL INTRCOR BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A 31150 SUP Custom 27203010 31150 - SHUNT CV 1.5MM 14MM STRL CLRVW RADOPQ BLB TPR TIP SFT SIL BOTH IP/OP $207.50 $154.00 $36.94 $207.50 $207.50 $207.50 $207.50 $207.50 $207.50 $207.50 $36.94 $207.50 $207.50 $154.01 $154.01 $159.94 $108.11 $43.25 $207.50 $76.46 $207.50 $207.50 $207.50 $207.50 $207.50 $155.63 $207.50 $207.50 $207.50 $103.75 $103.75 $164.34 $207.50 $166.00 $134.88 $207.50 N/A $120.35 $207.50 $124.50 $207.50 $207.50 $207.50 N/A N/A 31175 SUP Custom 27203010 31175 - SHUNT CV 1.75MM 14MM STRL CLRVW BLB INTRCOR ARTMY BOTH IP/OP $207.50 $154.00 $36.94 $207.50 $207.50 $207.50 $207.50 $207.50 $207.50 $207.50 $36.94 $207.50 $207.50 $154.01 $154.01 $159.94 $108.11 $43.25 $207.50 $83.00 $207.50 $207.50 $207.50 $207.50 $207.50 $155.63 $207.50 $207.50 $207.50 $103.75 $103.75 $164.34 $207.50 $166.00 $134.88 $207.50 N/A $120.35 $207.50 $124.50 $207.50 $207.50 $207.50 N/A N/A 31200 SUP Custom 27203010 31200 - SHUNT CV 2MM 14MM STRL CLRVW RADOPQ BLB TPR TIP SFT SIL BOTH IP/OP $207.50 $154.00 $36.94 $207.50 $207.50 $207.50 $207.50 $207.50 $207.50 $207.50 $36.94 $207.50 $207.50 $154.01 $154.01 $159.94 $108.11 $43.25 $207.50 $83.00 $207.50 $207.50 $207.50 $207.50 $207.50 $155.63 $207.50 $207.50 $207.50 $103.75 $103.75 $164.34 $207.50 $166.00 $134.88 $207.50 N/A $120.35 $207.50 $124.50 $207.50 $207.50 $207.50 1308.95 678.09 31250 SUP Custom 27203010 31250 - SHUNT CV 2.5MM 14MM STRL 14MM CLRVW BLB TPR TIP RADOPQ SIL BOTH IP/OP $207.50 $154.00 $36.94 $207.50 $207.50 $207.50 $207.50 $207.50 $207.50 $207.50 $36.94 $207.50 $207.50 $154.01 $154.01 $159.94 $108.11 $43.25 $207.50 $83.00 $207.50 $207.50 $207.50 $207.50 $207.50 $155.63 $207.50 $207.50 $207.50 $103.75 $103.75 $164.34 $207.50 $166.00 $134.88 $207.50 N/A $120.35 $207.50 $124.50 $207.50 $207.50 $207.50 N/A N/A 31592 SUP Custom 27203010 31592 - BIT DRILL 230MM 2.5MM 3 FLT QC NONSTRL BOTH IP/OP $451.00 $334.00 $80.28 $451.00 $451.00 $451.00 $451.00 $451.00 $451.00 $451.00 $80.28 $451.00 $451.00 $334.73 $334.73 $347.63 $234.97 $93.99 $451.00 $180.40 $451.00 $451.00 $451.00 $451.00 $451.00 $338.25 $451.00 $451.00 $451.00 $225.50 $225.50 $357.19 $451.00 $360.80 $293.15 $451.00 N/A $261.58 $451.00 $270.60 $451.00 $451.00 $451.00 3883.64 1858.73 37970 SUP Custom 27203010 0037970 - DEVICE IRR EFL DISP BOTH IP/OP $97.00 $72.00 $17.22 $96.75 $96.75 $96.75 $96.75 $96.75 $96.75 $96.75 $17.22 $96.75 $96.75 $71.81 $71.81 $74.57 $50.41 $20.16 $96.75 $38.70 $96.75 $96.75 $96.75 $96.75 $96.75 $72.75 $96.75 $96.75 $96.75 $48.38 $48.38 $76.63 $96.75 $77.40 $62.89 $96.75 N/A $56.26 $96.75 $58.05 $96.75 $96.75 $96.75 N/A N/A 38005 SUP Custom 27803010 038005 - FILLER BONE VOID MOLDABLE DBX PUTTY .5ML BOTH IP/OP $243.50 $180.00 $43.30 $276.50 $243.25 $243.25 $243.25 $243.25 $243.25 $243.25 $43.30 $243.25 $243.25 $243.25 $243.25 $243.25 $243.25 $50.70 $243.25 $110.60 $243.25 $243.25 $276.50 $243.25 $243.25 $182.63 $243.25 $243.25 $243.25 $121.63 $121.63 $192.65 $243.25 $194.60 $109.46 $243.25 N/A $141.23 $243.25 $145.95 $243.25 $243.25 $243.25 N/A N/A 38010 SUP Custom 27803010 038010 - FILLER BN VOID 1CC ALGRF PTTY FRZDR DBX BOTH IP/OP $485.00 $359.00 $86.29 $484.75 $484.75 $484.75 $484.75 $484.75 $484.75 $484.75 $86.29 $484.75 $484.75 $484.75 $484.75 $484.75 $484.75 $101.03 $484.75 $193.90 $484.75 $484.75 $484.75 $484.75 $484.75 $363.75 $484.75 $484.75 $484.75 $242.38 $242.38 $383.92 $484.75 $387.80 $218.14 $484.75 N/A $281.30 $484.75 $290.85 $484.75 $484.75 $484.75 N/A N/A 38025 SUP HCPCS C1713 038025 - FILLER BONE VOID ALLOGRAFT FREEZE DRY PUTTY DBX 2.5CC BOTH IP/OP $935.00 $692.00 $185.57 "$1,083.25" $420.75 $420.75 $420.75 $420.75 $935.00 $935.00 $935.00 $194.88 $935.00 $935.00 $935.00 $935.00 $935.00 $194.86 $935.00 $433.30 $553.05 $935.00 "$1,083.25" $935.00 $935.00 $701.25 $935.00 $935.00 $935.00 $467.50 $467.50 $740.52 $935.00 $748.00 $420.75 $185.57 N/A $542.30 $935.00 $561.00 $935.00 $194.85 $935.00 N/A N/A 38050 SUP HCPCS C1713 038050 - FILLER BONE VOID ALLOGRAFT FREEZE DRY PUTTY DBX 5ML BOTH IP/OP "$1,725.50" "$1,277.00" $342.47 "$1,996.75" $776.48 $776.48 $776.48 $776.48 "$1,725.50" "$1,725.50" "$1,725.50" $359.64 "$1,725.50" "$1,725.50" "$1,725.50" "$1,725.50" "$1,725.50" $359.61 "$1,725.50" "$1,996.75" "$1,020.63" "$1,725.50" "$1,996.75" "$1,725.50" "$1,725.50" "$1,294.13" "$1,725.50" "$1,725.50" "$1,725.50" $862.75 $862.75 "$1,366.60" "$1,725.50" "$1,380.40" $776.48 $342.47 N/A "$1,000.79" "$1,725.50" "$1,035.30" "$1,725.50" $359.59 "$1,725.50" N/A N/A 38100 SUP Custom 27803010 038100 - FILLER BONE VOID ALLOGRAFT FREEZE DRY PUTTY DBX 10ML BOTH IP/OP "$2,652.00" "$1,962.00" $25.42 "$1,989.00" $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $121.99 $25.42 $121.99 $48.80 $121.99 $121.99 $121.99 $121.99 $121.99 "$1,989.00" $121.99 $121.99 $121.99 $61.00 $61.00 $96.62 $121.99 $97.59 $79.29 $121.99 $121.99 "$1,538.16" $121.99 $73.19 $121.99 $121.99 $121.99 2680.74 1227.58 41101 SUP HCPCS C1729 41101 - CATHETER DRN STD 4FR 23CM STRL LF INPT TS CSF IMPREGNATE BOTH IP/OP $356.50 $264.00 $70.71 $356.25 $193.44 $193.44 $193.44 $193.44 $356.25 $356.25 $356.25 $74.25 $356.25 $264.41 $264.41 $274.60 $185.61 $74.25 $356.25 $356.25 $210.72 $356.25 $356.25 $356.25 $356.25 $267.38 $356.25 $356.25 $356.25 $178.13 $178.13 $282.15 $356.25 $285.00 $231.56 $70.71 N/A $206.77 $356.25 $356.25 $356.25 $74.24 $356.25 N/A N/A 41103 SUP Custom 27803010 41103 - CATHETER DRAIN STANDARD 2.5MM 15CM BARIUM IMPREGNATED PLAINT BOTH IP/OP $356.50 $264.00 $63.41 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $63.41 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $74.25 $356.25 $142.50 $356.25 $356.25 $356.25 $356.25 $356.25 $267.38 $356.25 $356.25 $356.25 $178.13 $178.13 $282.15 $356.25 $285.00 $160.31 $356.25 N/A $206.77 $356.25 $213.75 $356.25 $356.25 $356.25 N/A N/A 41115 SUP Custom 27803010 41115 - CATHETER DRAIN STANDARD 23CM NONMETALLIC BARIUM IMPREGNATED BOTH IP/OP $356.50 $264.00 $63.41 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $63.41 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $74.25 $356.25 $142.50 $356.25 $356.25 $356.25 $356.25 $356.25 $267.38 $356.25 $356.25 $356.25 $178.13 $178.13 $282.15 $356.25 $285.00 $160.31 $356.25 N/A $206.77 $356.25 $213.75 $356.25 $356.25 $356.25 361.31 156.3 41207 SUP Custom 27803010 41207 - CATHETER DRAIN SMALL 23CM BARIUM IMPREGNATED VENTRICULAR BOTH IP/OP $356.50 $264.00 $63.41 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $63.41 $356.25 $356.25 $356.25 $356.25 $356.25 $356.25 $74.25 $356.25 $142.50 $356.25 $356.25 $356.25 $356.25 $356.25 $267.38 $356.25 $356.25 $356.25 $178.13 $178.13 $282.15 $356.25 $285.00 $160.31 $356.25 N/A $206.77 $356.25 $213.75 $356.25 $356.25 $356.25 N/A N/A 41308 SUP Custom 27803010 41308 - CATHETER DRAIN SMALL 23CM FLANGED VENTRICULAR BOTH IP/OP "$1,368.00" "$1,012.00" $243.50 "$1,368.00" "$1,368.00" "$1,368.00" "$1,368.00" "$1,368.00" "$1,368.00" "$1,368.00" $243.50 "$1,368.00" "$1,368.00" "$1,368.00" "$1,368.00" "$1,368.00" "$1,368.00" $285.11 "$1,368.00" $547.20 "$1,368.00" "$1,368.00" "$1,368.00" "$1,368.00" "$1,368.00" "$1,026.00" "$1,368.00" "$1,368.00" "$1,368.00" $684.00 $684.00 "$1,083.46" "$1,368.00" "$1,094.40" $615.60 "$1,368.00" N/A $793.44 "$1,368.00" $820.80 "$1,368.00" "$1,368.00" "$1,368.00" N/A N/A 41404 SUP Custom 27803010 41404 - SHUNT NEUROSURGICAL STANDARD 4CM CSF VENTRICULAR CATHETER BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 41405 SUP Custom 27803010 41405 - SHUNT NEUROSURGICAL STANDARD 5CM CSF VENTRICULAR CATHETER BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 41406 SUP Custom 27803010 41406 - SHUNT NEUROSURGICAL STANDARD 6CM CSF VENTRICULAR CATHETER BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 41407 SUP Custom 27803010 41407 - SHUNT NEUROSURGICAL STANDARD 7CM CSF VENTRICULAR CATHETER BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 41408 SUP Custom 27803010 41408 - CATHETER DRN STD 8CM STRL LF CSF SNP SHNT VNTRC DISP BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 41409 SUP Custom 27803010 41409 - CATHETER DRN STD 9CM STRL LF CSF SNP SHNT VNTRC DISP BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 41501 SUP Custom 27803010 41501 - CATHETER DRAIN SMALL RIGHT ANG 23CM BARIUM IMPREGNATED BOTH IP/OP $465.50 $344.00 $82.86 $465.50 $465.50 $465.50 $465.50 $465.50 $465.50 $465.50 $82.86 $465.50 $465.50 $465.50 $465.50 $465.50 $465.50 $97.02 $465.50 $186.20 $465.50 $465.50 $465.50 $465.50 $465.50 $349.13 $465.50 $465.50 $465.50 $232.75 $232.75 $368.68 $465.50 $372.40 $209.48 $465.50 N/A $269.99 $465.50 $279.30 $465.50 $465.50 $465.50 N/A N/A 41503 SUP Custom 27803010 41503 - CATHETER DRAIN STANDARD 23CM BARIUM IMPREGNATED RIGHT ANGLED BOTH IP/OP $465.50 $344.00 $82.86 $465.50 $465.50 $465.50 $465.50 $465.50 $465.50 $465.50 $82.86 $465.50 $465.50 $465.50 $465.50 $465.50 $465.50 $97.02 $465.50 $186.20 $465.50 $465.50 $465.50 $465.50 $465.50 $349.13 $465.50 $465.50 $465.50 $232.75 $232.75 $368.68 $465.50 $372.40 $209.48 $465.50 N/A $269.99 $465.50 $279.30 $465.50 $465.50 $465.50 N/A N/A 41701 SUP Custom 27803010 41701 - CATHETER DRAIN RIGHT ANG 15CM CLIP RIVULET VENTRICULAR BOTH IP/OP $620.00 $459.00 $110.34 $619.88 $619.88 $619.88 $619.88 $619.88 $619.88 $619.88 $110.34 $619.88 $619.88 $619.88 $619.88 $619.88 $619.88 $129.19 $619.88 $247.95 $619.88 $619.88 $619.88 $619.88 $619.88 $465.00 $619.88 $619.88 $619.88 $309.94 $309.94 $490.94 $619.88 $495.90 $278.95 $619.88 N/A $359.60 $619.88 $371.93 $619.88 $619.88 $619.88 N/A N/A 41704 SUP Custom 27803010 41704 - CATHETER DRAIN 4CM SNAP ASMBLY RIVULET VENTRICULAR BOTH IP/OP $791.00 $585.00 $140.78 $790.88 $790.88 $790.88 $790.88 $790.88 $790.88 $790.88 $140.78 $790.88 $790.88 $790.88 $790.88 $790.88 $790.88 $164.83 $790.88 $316.35 $790.88 $790.88 $790.88 $790.88 $790.88 $593.25 $790.88 $790.88 $790.88 $395.44 $395.44 $626.38 $790.88 $632.70 $355.90 $790.88 N/A $458.78 $790.88 $474.53 $790.88 $790.88 $790.88 N/A N/A 41705 SUP Custom 27803010 41705 - CATHETER DRAIN 5CM SNAP ASMBLY RIVULET VENTRICULAR BOTH IP/OP $791.00 $585.00 $140.78 $790.88 $790.88 $790.88 $790.88 $790.88 $790.88 $790.88 $140.78 $790.88 $790.88 $790.88 $790.88 $790.88 $790.88 $164.83 $790.88 $316.35 $790.88 $790.88 $790.88 $790.88 $790.88 $593.25 $790.88 $790.88 $790.88 $395.44 $395.44 $626.38 $790.88 $632.70 $355.90 $790.88 N/A $458.78 $790.88 $474.53 $790.88 $790.88 $790.88 N/A N/A 41707 SUP Custom 27803010 41707 - CATHETER DRAIN 7CM SNAP ASMBLY RIVULET VENTRICULAR BOTH IP/OP $791.00 $585.00 $140.78 $790.88 $790.88 $790.88 $790.88 $790.88 $790.88 $790.88 $140.78 $790.88 $790.88 $790.88 $790.88 $790.88 $790.88 $164.83 $790.88 $316.35 $790.88 $790.88 $790.88 $790.88 $790.88 $593.25 $790.88 $790.88 $790.88 $395.44 $395.44 $626.38 $790.88 $632.70 $355.90 $790.88 N/A $458.78 $790.88 $474.53 $790.88 $790.88 $790.88 N/A N/A 41709 SUP Custom 27803010 41709 - CATHETER DRAIN 9CM SNAP ASMBLY RIVULET VENTRICULAR BOTH IP/OP $791.00 $585.00 $140.78 $790.88 $790.88 $790.88 $790.88 $790.88 $790.88 $790.88 $140.78 $790.88 $790.88 $790.88 $790.88 $790.88 $790.88 $164.83 $790.88 $316.35 $790.88 $790.88 $790.88 $790.88 $790.88 $593.25 $790.88 $790.88 $790.88 $395.44 $395.44 $626.38 $790.88 $632.70 $355.90 $790.88 N/A $458.78 $790.88 $474.53 $790.88 $790.88 $790.88 N/A N/A 42102 SUP Custom 27803010 42102 - VALVE SHUNT STANDARD CSF FLOW CONTROL LOW PRESSURE DELTA BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42104 SUP Custom 27803010 42104 - VALVE SHUNT STANDARD CSF CNTOUR BURR HOLE MEDIUM PRESSURE BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" 329.16 143.34 42106 SUP Custom 27803010 42106 - VALVE SHUNT STANDARD CSF FLOW CONTROL HIGH PRESSURE DELTA BOTH IP/OP "$1,655.50" "$1,225.00" $294.66 "$1,655.38" "$1,655.38" "$1,655.38" "$1,655.38" "$1,655.38" "$1,655.38" "$1,655.38" $294.66 "$1,655.38" "$1,655.38" "$1,655.38" "$1,655.38" "$1,655.38" "$1,655.38" $345.00 "$1,655.38" $662.15 "$1,655.38" "$1,655.38" "$1,655.38" "$1,655.38" "$1,655.38" "$1,241.63" "$1,655.38" "$1,655.38" "$1,655.38" $827.69 $827.69 "$1,311.06" "$1,655.38" "$1,324.30" $744.92 "$1,655.38" N/A $960.19 "$1,655.38" $993.23 "$1,655.38" "$1,655.38" "$1,655.38" 423.26 174.49 42312 SUP Custom 27803010 42312 - VALVE SHUNT SMALL CSF BURR HOLE FLOW CONTROL LOW PRESSURE BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42314 SUP Custom 27803010 42314 - VALVE SHUNT MEDIUM CNTOUR 25X12X5.5MM 10MM CSF HIGH PRESSURE BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42316 SUP Custom 27803010 42316 - VALVE SHUNT SMALL CNTOUR 25X12X5.5MM 10MM CSF HIGH PRESSURE BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42322 SUP Custom 27803010 42322 - VALVE SHNT REG STRL DLT CNTR LP CSF BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42324 SUP Custom 27803010 42324 - VALVE SHNT REG CNTR 32X18X7.5MM STRL LF 14MM DLT PS MDCL CSF BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42326 SUP Custom 27803010 42326 - VALVE SHNT REG STRL DLT CNTR HI-PRS IMPRG CSF BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42335 SUP Custom 27803010 42335 - VALVE SHUNT BURR HOLE LATEX FREE STRATA NSC BOTH IP/OP "$9,038.50" "$6,688.00" "$1,608.78" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$1,608.78" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$1,883.64" "$9,038.10" "$3,615.24" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$6,778.88" "$9,038.10" "$9,038.10" "$9,038.10" "$4,519.05" "$4,519.05" "$7,158.18" "$9,038.10" "$7,230.48" "$4,067.15" "$9,038.10" N/A "$5,242.33" "$9,038.10" "$5,422.86" "$9,038.10" "$9,038.10" "$9,038.10" 606.54 278.3 42355 SUP Custom 27803010 42355 - VALVE SHUNT SMALL FULL PORT STRATA NSC CSF STERILE FP BOTH IP/OP "$9,038.50" "$6,688.00" "$1,608.78" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$1,608.78" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$1,883.64" "$9,038.10" "$3,615.24" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$6,778.88" "$9,038.10" "$9,038.10" "$9,038.10" "$4,519.05" "$4,519.05" "$7,158.18" "$9,038.10" "$7,230.48" "$4,067.15" "$9,038.10" N/A "$5,242.33" "$9,038.10" "$5,422.86" "$9,038.10" "$9,038.10" "$9,038.10" N/A N/A 42365 SUP Custom 27803010 42365 - VALVE SHUNT REGULAR 32X16X8MM CSF ADJUSTABLE W/O BIOGLIDE PS BOTH IP/OP "$9,038.50" "$6,688.00" "$1,608.78" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$1,608.78" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$1,883.64" "$9,038.10" "$3,615.24" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$9,038.10" "$6,778.88" "$9,038.10" "$9,038.10" "$9,038.10" "$4,519.05" "$4,519.05" "$7,158.18" "$9,038.10" "$7,230.48" "$4,067.15" "$9,038.10" N/A "$5,242.33" "$9,038.10" "$5,422.86" "$9,038.10" "$9,038.10" "$9,038.10" N/A N/A 42410 SUP Custom 27803010 42410 - VALVE SHUNT ULTRA SMALL CNTOUR FLOW CONTROL VERY LOW BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" 1453.02 672.29 42412 SUP Custom 27803010 42412 - VALVE SHUNT ULTRA SMALL CSF LOW PRESSURE CNTOUR FLOW CONTROL BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42414 SUP Custom 27803010 42414 - VALVE SHUNT ULTRA SMALL CSF MEDIUM PRESSURE CNTOUR FLOW BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42532 SUP Custom 27803010 42532 - VALVE SHUNT 12MM CSF BURR HOLE LOW PRESSURE STERILE BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42534 SUP Custom 27803010 42534 - VALVE SHUNT 12MM CSF BURR HOLE MEDIUM PRESSURE STERILE BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42536 SUP Custom 27803010 42536 - VALVE SHUNT 12MM CSF BURR HOLE HIGH PRESSURE STERILE BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42542 SUP Custom 27803010 42542 - VALVE SHUNT 16MM BURR HOLE LOW PRESSURE DELTA CSF STERILE BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42544 SUP Custom 27803010 42544 - VALVE SHUNT 16MM CSF MEDIUM PRESSURE BURR HOLE FLOW CONTROL BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42546 SUP Custom 27803010 42546 - VALVE SHUNT 16MM CSF BURR HOLE FLOW CONTROL HIGH PRESSURE BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 42812 SUP Custom 27803010 42812 - VALVE SHUNT SMALL PERFORMANCE LEVEL 1 DELTA CSF STERILE BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 42813 SUP Custom 27803010 42813 - VALVE SHUNT SMALL LEVEL 1.5 DELTA CSF STERILE BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 42814 SUP Custom 27803010 42814 - VALVE SHUNT SMALL LEVEL 2 DELTA CSF STERILE BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 42830 SUP Custom 27803010 42830 - VALVE SHUNT 12MM CSF PERFORMANCE LEVEL .5 BURR HOLE DELTA BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" 485.24 226.6 42832 SUP Custom 27803010 42832 - VALVE SHUNT 12MM CSF PERFORMANCE LEVEL 1 BURR HOLE DELTA BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 42833 SUP Custom 27803010 42833 - VALVE SHUNT 12MM CSF PERFORMANCE LEVEL 1.5 BURR HOLE DELTA BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 42834 SUP Custom 27803010 42834 - VALVE SHUNT 12MM CSF PERFORMANCE LEVEL 2 BURR HOLE DELTA BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 42836 SUP Custom 27803010 42836 - VALVE SHUNT BURR HOLE LATEX FREE STRATA II BOTH IP/OP "$9,839.50" "$7,281.00" "$1,751.42" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$1,751.42" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$2,050.65" "$9,839.45" "$3,935.78" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$7,379.63" "$9,839.45" "$9,839.45" "$9,839.45" "$4,919.73" "$4,919.73" "$7,792.84" "$9,839.45" "$7,871.56" "$4,427.75" "$9,839.45" N/A "$5,706.91" "$9,839.45" "$5,903.67" "$9,839.45" "$9,839.45" "$9,839.45" 563.88 260.56 42840 SUP Custom 27803010 42840 - VALVE SHUNT 16MM CSF PERFORMANCE LEVEL .5 BURR HOLE DELTA BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 42842 SUP Custom 27803010 42842 - VALVE SHUNT 16MM PERFORMANCE LEVEL 1 BURR HOLE LATEX FREE BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" 2403.72 1088.46 42843 SUP Custom 27803010 42843 - VALVE SHUNT 16MM PERFORMANCE LEVEL 1.5 BURR HOLE LATEX FREE BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 42844 SUP Custom 27803010 42844 - VALVE SHUNT 16MM LEVEL 2 BURR HOLE DELTA CSF STERILE BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" 3293.09 1476.48 42856 SUP Custom 27803010 42856 - VALVE SHUNT SMALL 2IN 30MM FULL PORT STRATA II CSF BOTH IP/OP "$9,839.50" "$7,281.00" "$1,751.42" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$1,751.42" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$2,050.65" "$9,839.45" "$3,935.78" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$7,379.63" "$9,839.45" "$9,839.45" "$9,839.45" "$4,919.73" "$4,919.73" "$7,792.84" "$9,839.45" "$7,871.56" "$4,427.75" "$9,839.45" N/A "$5,706.91" "$9,839.45" "$5,903.67" "$9,839.45" "$9,839.45" "$9,839.45" N/A N/A 43103 SUP HCPCS C1750 43103 - CATHETER PERITONEAL STANDARD 90CM IMPREGNATE BARIUM CARDIAC BOTH IP/OP $411.00 $304.00 $81.55 $410.88 $184.90 $184.90 $184.90 $184.90 $410.88 $410.88 $410.88 $85.64 $410.88 $410.88 $410.88 $410.88 $410.88 $85.63 $410.88 $410.88 $243.04 $410.88 $410.88 $410.88 $410.88 $308.25 $410.88 $410.88 $410.88 $205.44 $205.44 $325.42 $410.88 $328.70 $184.90 $81.55 N/A $238.38 $410.88 $410.88 $410.88 $85.63 $410.88 N/A N/A 43105 SUP HCPCS C1713 43105 - FILLER BN VOID 5ML GRFTN ALGRF PTTY JR DBM BOTH IP/OP "$2,162.50" "$1,600.00" $429.20 "$2,162.50" $973.13 $973.13 $973.13 $973.13 "$2,162.50" "$2,162.50" "$2,162.50" $450.72 "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" $450.69 "$2,162.50" "$2,162.50" "$1,279.12" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$1,621.88" "$2,162.50" "$2,162.50" "$2,162.50" "$1,081.25" "$1,081.25" "$1,712.70" "$2,162.50" "$1,730.00" $973.13 $429.20 N/A "$1,254.25" "$2,162.50" "$2,162.50" "$2,162.50" $450.67 "$2,162.50" N/A N/A 43110 SUP Custom 27804086 43110 - FILLER BN VOID 10ML GRFTN ALGRF PTTY JR DBM BOTH IP/OP "$2,418.00" "$1,789.00" $430.40 "$2,418.00" "$2,418.00" "$2,418.00" "$2,418.00" "$2,418.00" "$2,418.00" "$2,418.00" $430.40 "$2,418.00" "$2,418.00" "$2,418.00" "$2,418.00" "$2,418.00" "$2,418.00" $503.94 "$2,418.00" $967.20 "$2,418.00" "$2,418.00" "$2,418.00" "$2,418.00" "$2,418.00" "$1,813.50" "$2,418.00" "$2,418.00" "$2,418.00" "$1,209.00" "$1,209.00" "$1,915.06" "$2,418.00" "$1,934.40" "$1,088.10" "$2,418.00" N/A "$1,402.44" "$2,418.00" "$1,450.80" "$2,418.00" "$2,418.00" "$2,418.00" N/A N/A 43111 SUP Custom 27803010 43111 - CATHETER DRAIN STANDARD TRANSLUCENT CARDIAC PERITONEAL BOTH IP/OP $411.00 $304.00 $73.14 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $73.14 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $85.63 $410.88 $164.35 $410.88 $410.88 $410.88 $410.88 $410.88 $308.25 $410.88 $410.88 $410.88 $205.44 $205.44 $325.42 $410.88 $328.70 $184.90 $410.88 N/A $238.38 $410.88 $246.53 $410.88 $410.88 $410.88 N/A N/A 43209 SUP Custom 27803010 43209 - CATHETER NEUROSURGICAL SMALL 90CM BARIUM PEDIATRIC CARDIAC BOTH IP/OP $411.00 $304.00 $73.14 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $73.14 $410.88 $410.88 $410.88 $410.88 $410.88 $410.88 $85.63 $410.88 $164.35 $410.88 $410.88 $410.88 $410.88 $410.88 $308.25 $410.88 $410.88 $410.88 $205.44 $205.44 $325.42 $410.88 $328.70 $184.90 $410.88 N/A $238.38 $410.88 $246.53 $410.88 $410.88 $410.88 N/A N/A 43418 SUP Custom 27803010 43418 - CATHETER NEUROSURGICAL STANDARD 58CM CSF TIP REDUCER BOTH IP/OP $534.50 $396.00 $95.12 $534.38 $534.38 $534.38 $534.38 $534.38 $534.38 $534.38 $95.12 $534.38 $534.38 $534.38 $534.38 $534.38 $534.38 $111.37 $534.38 $213.75 $534.38 $534.38 $534.38 $534.38 $534.38 $400.88 $534.38 $534.38 $534.38 $267.19 $267.19 $423.23 $534.38 $427.50 $240.47 $534.38 N/A $310.01 $534.38 $320.63 $534.38 $534.38 $534.38 N/A N/A 43522 SUP Custom 27803010 43522 - CATHETER NEUROSURGICAL STANDARD CSF PERITONEUM STERILE CP BOTH IP/OP $418.00 $309.00 $74.40 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $74.40 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $87.12 $418.00 $167.20 $418.00 $418.00 $418.00 $418.00 $418.00 $313.50 $418.00 $418.00 $418.00 $209.00 $209.00 $331.06 $418.00 $334.40 $188.10 $418.00 N/A $242.44 $418.00 $250.80 $418.00 $418.00 $418.00 N/A N/A 43551 SUP Custom 27803010 43551 - SHUNT NEUROSURGICAL STANDARD 2.5MM 1.3MM 90CM CSF PERITONEUM BOTH IP/OP $418.00 $309.00 $74.40 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $74.40 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $87.12 $418.00 $167.20 $418.00 $418.00 $418.00 $418.00 $418.00 $313.50 $418.00 $418.00 $418.00 $209.00 $209.00 $331.06 $418.00 $334.40 $188.10 $418.00 N/A $242.44 $418.00 $250.80 $418.00 $418.00 $418.00 N/A N/A 43555 SUP Custom 27803010 43555 - CATHETER NEUROSURGICAL 2.5MM 120CM SMALL LUMEN RADIOPQ BOTH IP/OP $594.00 $440.00 $105.69 $593.75 $593.75 $593.75 $593.75 $593.75 $593.75 $593.75 $105.69 $593.75 $593.75 $593.75 $593.75 $593.75 $593.75 $123.74 $593.75 $237.50 $593.75 $593.75 $593.75 $593.75 $593.75 $445.50 $593.75 $593.75 $593.75 $296.88 $296.88 $470.25 $593.75 $475.00 $267.19 $593.75 N/A $344.52 $593.75 $356.25 $593.75 $593.75 $593.75 N/A N/A 44000 SUP Custom 27803010 44000 - SHUNT NEUROSURGICAL STANDARD CSF BARIUM IMPREGNATED BOTTOM BOTH IP/OP $959.50 $710.00 $170.79 $959.50 $959.50 $959.50 $959.50 $959.50 $959.50 $959.50 $170.79 $959.50 $959.50 $959.50 $959.50 $959.50 $959.50 $199.97 $959.50 $383.80 $959.50 $959.50 $959.50 $959.50 $959.50 $719.63 $959.50 $959.50 $959.50 $479.75 $479.75 $759.92 $959.50 $767.60 $431.78 $959.50 N/A $556.51 $959.50 $575.70 $959.50 $959.50 $959.50 N/A N/A 44010 SUP Custom 27803010 44010 - SHUNT NEUROSURGICAL STANDARD 16MM CSF BARIUM IMPREGNATED BOTH IP/OP $959.50 $710.00 $170.79 $959.50 $959.50 $959.50 $959.50 $959.50 $959.50 $959.50 $170.79 $959.50 $959.50 $959.50 $959.50 $959.50 $959.50 $199.97 $959.50 $383.80 $959.50 $959.50 $959.50 $959.50 $959.50 $719.63 $959.50 $959.50 $959.50 $479.75 $479.75 $759.92 $959.50 $767.60 $431.78 $959.50 N/A $556.51 $959.50 $575.70 $959.50 $959.50 $959.50 2004.96 915 44100 SUP Custom 27803010 44100 - RESERVOIR SHUNT 12MM 20MM CSF VENTRICULAR CATHETER OMMAYA BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" 253.68 112.9 44101 SUP Custom 27803010 44101 - RESERVOIR DRN SM RT ANG 2.1MM 1.2MM 3CM .1ML STRL LF 12MM BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 44103 SUP Custom 27803010 44103 - RESERVOIR DRN SM 28MM 2.1MM 1.2MM 23CM 1.1ML CSF SD INLT BOTH IP/OP $931.00 $689.00 $165.72 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $165.72 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $194.03 $931.00 $372.40 $931.00 $931.00 $931.00 $931.00 $931.00 $698.25 $931.00 $931.00 $931.00 $465.50 $465.50 $737.35 $931.00 $744.80 $418.95 $931.00 N/A $539.98 $931.00 $558.60 $931.00 $931.00 $931.00 N/A N/A 44104 SUP Custom 27803010 44104 - RESERVOIR SHUNT 23MM 23CM BOTTOM INLET VENTRICULAR CATHETER BOTH IP/OP $931.00 $689.00 $165.72 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $165.72 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $194.03 $931.00 $372.40 $931.00 $931.00 $931.00 $931.00 $931.00 $698.25 $931.00 $931.00 $931.00 $465.50 $465.50 $737.35 $931.00 $744.80 $418.95 $931.00 N/A $539.98 $931.00 $558.60 $931.00 $931.00 $931.00 N/A N/A 44105 SUP HCPCS C1734 44105 - GRAFT BN 5CC STRL LF GRFTN CRNCH DBM BOTH IP/OP $931.00 $689.00 $194.03 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $194.03 $931.00 $372.40 $931.00 $931.00 $931.00 $931.00 $931.00 $698.25 $931.00 $931.00 $931.00 $465.50 $465.50 $737.35 $931.00 $744.80 $418.95 $931.00 N/A $539.98 $931.00 $558.60 $931.00 $931.00 $931.00 N/A N/A 44108 SUP Custom 27803010 44108 - RESERVOIR DRN SM 2.1MM 1.2MM 90CM 2.4ML STRL LF 30MM CSF BOTH IP/OP "$1,503.50" "$1,113.00" $267.60 "$1,503.38" "$1,503.38" "$1,503.38" "$1,503.38" "$1,503.38" "$1,503.38" "$1,503.38" $267.60 "$1,503.38" "$1,503.38" "$1,503.38" "$1,503.38" "$1,503.38" "$1,503.38" $313.32 "$1,503.38" $601.35 "$1,503.38" "$1,503.38" "$1,503.38" "$1,503.38" "$1,503.38" "$1,127.63" "$1,503.38" "$1,503.38" "$1,503.38" $751.69 $751.69 "$1,190.68" "$1,503.38" "$1,202.70" $676.52 "$1,503.38" N/A $872.03 "$1,503.38" $902.03 "$1,503.38" "$1,503.38" "$1,503.38" N/A N/A 44111 SUP Custom 27803010 44111 - RESERVOIR SHUNT 12MM 23CM CSF CATHETER STYLET BURR HOLE BOTH IP/OP $931.00 $689.00 $165.72 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $165.72 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $194.03 $931.00 $372.40 $931.00 $931.00 $931.00 $931.00 $931.00 $698.25 $931.00 $931.00 $931.00 $465.50 $465.50 $737.35 $931.00 $744.80 $418.95 $931.00 N/A $539.98 $931.00 $558.60 $931.00 $931.00 $931.00 2287.5 1044.97 44113 SUP Custom 27803010 44113 - RESERVOIR SHNT 12MM STRL DLT CSF BUR HL BOTH IP/OP $931.00 $689.00 $165.72 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $165.72 $931.00 $931.00 $931.00 $931.00 $931.00 $931.00 $194.03 $931.00 $372.40 $931.00 $931.00 $931.00 $931.00 $931.00 $698.25 $931.00 $931.00 $931.00 $465.50 $465.50 $737.35 $931.00 $744.80 $418.95 $931.00 N/A $539.98 $931.00 $558.60 $931.00 $931.00 $931.00 N/A N/A 44150 SUP HCPCS C9359 44150 - GRAFT BN SM DFCT 10ML GRFTN OTHBLND JR DBM BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" 4347.51 1975.65 44200 SUP Custom 27803010 44200 - RESERVOIR SHUNT REGULAR 6MM CSF BURR HOLE DELTA STERILE BOTH IP/OP $404.00 $299.00 $71.87 $403.75 $403.75 $403.75 $403.75 $403.75 $403.75 $403.75 $71.87 $403.75 $403.75 $403.75 $403.75 $403.75 $403.75 $84.15 $403.75 $161.50 $403.75 $403.75 $403.75 $403.75 $403.75 $303.00 $403.75 $403.75 $403.75 $201.88 $201.88 $319.77 $403.75 $323.00 $181.69 $403.75 N/A $234.32 $403.75 $242.25 $403.75 $403.75 $403.75 N/A N/A 44201 SUP Custom 27803010 44201 - KIT VNCLSTM REG 6MM STRL BUR HL CSF BOTH IP/OP $715.00 $529.00 $127.25 $714.88 $714.88 $714.88 $714.88 $714.88 $714.88 $714.88 $127.25 $714.88 $714.88 $714.88 $714.88 $714.88 $714.88 $148.99 $714.88 $285.95 $714.88 $714.88 $714.88 $714.88 $714.88 $536.25 $714.88 $714.88 $714.88 $357.44 $357.44 $566.18 $714.88 $571.90 $321.70 $714.88 N/A $414.70 $714.88 $428.93 $714.88 $714.88 $714.88 N/A N/A 44210 SUP Custom 27803010 44210 - RESERVOIR VNCLSTM SHLW 6MM CSF BUR HL BOTH IP/OP $404.00 $299.00 $71.87 $403.75 $403.75 $403.75 $403.75 $403.75 $403.75 $403.75 $71.87 $403.75 $403.75 $403.75 $403.75 $403.75 $403.75 $84.15 $403.75 $161.50 $403.75 $403.75 $403.75 $403.75 $403.75 $303.00 $403.75 $403.75 $403.75 $201.88 $201.88 $319.77 $403.75 $323.00 $181.69 $403.75 N/A $234.32 $403.75 $242.25 $403.75 $403.75 $403.75 4142 1877.49 44211 SUP Custom 27803010 44211 - KIT VNCLSTM REG 6MM STRL CSF BUR HL SHLW D BOTH IP/OP $715.00 $529.00 $127.25 $714.88 $714.88 $714.88 $714.88 $714.88 $714.88 $714.88 $127.25 $714.88 $714.88 $714.88 $714.88 $714.88 $714.88 $148.99 $714.88 $285.95 $714.88 $714.88 $714.88 $714.88 $714.88 $536.25 $714.88 $714.88 $714.88 $357.44 $357.44 $566.18 $714.88 $571.90 $321.70 $714.88 N/A $414.70 $714.88 $428.93 $714.88 $714.88 $714.88 5074.77 2235.41 Jun-21 SUP Custom 27803010 6-2021 - CAGE SPNL 20MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF BOTH IP/OP "$7,813.50" "$5,782.00" "$1,390.78" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$1,390.78" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$1,628.39" "$7,813.35" "$3,125.34" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$5,860.13" "$7,813.35" "$7,813.35" "$7,813.35" "$3,906.68" "$3,906.68" "$6,188.17" "$7,813.35" "$6,250.68" "$3,516.01" "$7,813.35" N/A "$4,531.83" "$7,813.35" "$4,688.01" "$7,813.35" "$7,813.35" "$7,813.35" N/A N/A Jul-21 SUP Custom 27803010 7-2021 - DEVICE FSN 20MM 21MM RYTFC BOTH IP/OP "$6,616.00" "$4,896.00" "$1,177.64" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$1,177.64" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$1,378.84" "$6,615.95" "$2,646.38" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$4,962.00" "$6,615.95" "$6,615.95" "$6,615.95" "$3,307.98" "$3,307.98" "$5,239.83" "$6,615.95" "$5,292.76" "$2,977.18" "$6,615.95" N/A "$3,837.28" "$6,615.95" "$3,969.57" "$6,615.95" "$6,615.95" "$6,615.95" 921.27 405.85 44405 SUP Custom 27803010 44405 - CATHETER DRAIN 14GA CLOSE TIP MULTIPLE INLET HOLE GWIRE BOTH IP/OP "$1,472.50" "$1,090.00" $262.11 "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" $262.11 "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" $306.89 "$1,472.50" $589.00 "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" "$1,104.38" "$1,472.50" "$1,472.50" "$1,472.50" $736.25 $736.25 "$1,166.22" "$1,472.50" "$1,178.00" $662.63 "$1,472.50" N/A $854.05 "$1,472.50" $883.50 "$1,472.50" "$1,472.50" "$1,472.50" 444.65 193.05 44406 SUP Custom 27803010 44406 - CATHETER DRAIN 14GA OPEN TIP MULTIPLE INLET HOLE GWIRE BOTH IP/OP "$1,472.50" "$1,090.00" $262.11 "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" $262.11 "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" $306.89 "$1,472.50" $589.00 "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" "$1,472.50" "$1,104.38" "$1,472.50" "$1,472.50" "$1,472.50" $736.25 $736.25 "$1,166.22" "$1,472.50" "$1,178.00" $662.63 "$1,472.50" N/A $854.05 "$1,472.50" $883.50 "$1,472.50" "$1,472.50" "$1,472.50" 553.76 241.44 44410 SUP Custom 27803010 44410 - SYSTEM CATH C14-24CM 2O 20GA 14GA 84CM PS MDCL CNCT 3 FX TAB BOTH IP/OP "$1,686.50" "$1,248.00" $300.15 "$1,686.25" "$1,686.25" "$1,686.25" "$1,686.25" "$1,686.25" "$1,686.25" "$1,686.25" $300.15 "$1,686.25" "$1,686.25" "$1,686.25" "$1,686.25" "$1,686.25" "$1,686.25" $351.43 "$1,686.25" $674.50 "$1,686.25" "$1,686.25" "$1,686.25" "$1,686.25" "$1,686.25" "$1,264.88" "$1,686.25" "$1,686.25" "$1,686.25" $843.13 $843.13 "$1,335.51" "$1,686.25" "$1,349.00" $758.81 "$1,686.25" N/A $978.17 "$1,686.25" "$1,011.75" "$1,686.25" "$1,686.25" "$1,686.25" N/A N/A 44420 SUP Custom 27803010 44420 - VALVE SHUNT KIT NSC STRATA SILICONE LUMBOPERITONEAL BOTH IP/OP "$11,247.50" "$8,323.00" "$2,001.98" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$2,001.98" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$2,344.02" "$11,247.10" "$4,498.84" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$8,435.63" "$11,247.10" "$11,247.10" "$11,247.10" "$5,623.55" "$5,623.55" "$8,907.70" "$11,247.10" "$8,997.68" "$5,061.20" "$11,247.10" N/A "$6,523.55" "$11,247.10" "$6,748.26" "$11,247.10" "$11,247.10" "$11,247.10" N/A N/A 44421 SUP Custom 27203010 44421 - KIT SHUNT OPEN NONPYROGENIC PS MEDICAL STRATA NSC BOTH IP/OP "$11,247.50" "$8,323.00" "$2,001.98" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$2,001.98" "$11,247.10" "$11,247.10" "$4,181.12" "$4,181.12" "$8,669.26" "$2,060.15" "$2,344.02" "$11,247.10" "$4,498.84" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$11,247.10" "$8,435.63" "$11,247.10" "$11,247.10" "$11,247.10" "$5,623.55" "$5,623.55" "$8,907.70" "$11,247.10" "$8,997.68" "$7,310.62" "$11,247.10" N/A "$6,523.55" "$11,247.10" "$6,748.26" "$11,247.10" "$11,247.10" "$11,247.10" N/A N/A 44430 SUP Custom 27803010 44430 - VALVE SHUNT KIT LATEX FREE NSC STRATA LUMBOPERITONEAL BOTH IP/OP "$11,647.00" "$8,619.00" "$2,073.09" "$11,646.60" "$11,646.60" "$11,646.60" "$11,646.60" "$11,646.60" "$11,646.60" "$11,646.60" "$2,073.09" "$11,646.60" "$11,646.60" "$11,646.60" "$11,646.60" "$11,646.60" "$11,646.60" "$2,427.28" "$11,646.60" "$4,658.64" "$11,646.60" "$11,646.60" "$11,646.60" "$11,646.60" "$11,646.60" "$8,735.25" "$11,646.60" "$11,646.60" "$11,646.60" "$5,823.30" "$5,823.30" "$9,224.11" "$11,646.60" "$9,317.28" "$5,240.97" "$11,646.60" N/A "$6,755.26" "$11,646.60" "$6,987.96" "$11,646.60" "$11,646.60" "$11,646.60" N/A N/A 44465 SUP Custom 27803010 44465 - VALVE SHUNT NONPYROGENIC STRATA NSC POLYPRO ACETAL SILICONE BOTH IP/OP "$9,677.50" "$7,161.00" "$1,722.56" "$9,677.30" "$9,677.30" "$9,677.30" "$9,677.30" "$9,677.30" "$9,677.30" "$9,677.30" "$1,722.56" "$9,677.30" "$9,677.30" "$9,677.30" "$9,677.30" "$9,677.30" "$9,677.30" "$2,016.86" "$9,677.30" "$3,870.92" "$9,677.30" "$9,677.30" "$9,677.30" "$9,677.30" "$9,677.30" "$7,258.13" "$9,677.30" "$9,677.30" "$9,677.30" "$4,838.65" "$4,838.65" "$7,664.42" "$9,677.30" "$7,741.84" "$4,354.79" "$9,677.30" N/A "$5,612.95" "$9,677.30" "$5,806.38" "$9,677.30" "$9,677.30" "$9,677.30" N/A N/A 44513 SUP Custom 27803010 44513 - RESERVOIR SHUNT 20MM CSF LUMBOPERITONEAL CSF STERILE BOTH IP/OP $824.50 $610.00 $146.70 $824.13 $824.13 $824.13 $824.13 $824.13 $824.13 $824.13 $146.70 $824.13 $824.13 $824.13 $824.13 $824.13 $824.13 $171.76 $824.13 $329.65 $824.13 $824.13 $824.13 $824.13 $824.13 $618.38 $824.13 $824.13 $824.13 $412.07 $412.07 $652.71 $824.13 $659.30 $370.86 $824.13 N/A $478.21 $824.13 $494.48 $824.13 $824.13 $824.13 N/A N/A 44515 SUP Custom 27803010 44515 - RESERVOIR SHUNT 30MM CSF LUMBOPERITONEAL STERILE BOTH IP/OP $824.50 $610.00 $146.70 $824.13 $824.13 $824.13 $824.13 $824.13 $824.13 $824.13 $146.70 $824.13 $824.13 $824.13 $824.13 $824.13 $824.13 $171.76 $824.13 $329.65 $824.13 $824.13 $824.13 $824.13 $824.13 $618.38 $824.13 $824.13 $824.13 $412.07 $412.07 $652.71 $824.13 $659.30 $370.86 $824.13 N/A $478.21 $824.13 $494.48 $824.13 $824.13 $824.13 N/A N/A 44520 SUP Custom 27803010 44520 - SHUNT NS 87CM STRL LMBPRTNL CATH T CSF BOTH IP/OP "$1,836.00" "$1,359.00" $326.79 "$1,835.88" "$1,835.88" "$1,835.88" "$1,835.88" "$1,835.88" "$1,835.88" "$1,835.88" $326.79 "$1,835.88" "$1,835.88" "$1,835.88" "$1,835.88" "$1,835.88" "$1,835.88" $382.62 "$1,835.88" $734.35 "$1,835.88" "$1,835.88" "$1,835.88" "$1,835.88" "$1,835.88" "$1,377.00" "$1,835.88" "$1,835.88" "$1,835.88" $917.94 $917.94 "$1,454.02" "$1,835.88" "$1,468.70" $826.15 "$1,835.88" N/A "$1,064.88" "$1,835.88" "$1,101.53" "$1,835.88" "$1,835.88" "$1,835.88" N/A N/A 45001 SUP Custom 27804086 45001 - GRAFT BN 1ML GRFTN + PST SYR DBM BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A 45005 SUP Custom 27804086 45005 - CANNULA LAPSCP 10MM DL PK DP50-0116-006 BOTH IP/OP "$1,400.00" "$1,036.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $291.78 "$1,400.00" $560.00 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,050.00" "$1,400.00" "$1,400.00" "$1,400.00" $700.00 $700.00 "$1,108.80" "$1,400.00" "$1,120.00" $630.00 "$1,400.00" N/A $812.00 "$1,400.00" $840.00 "$1,400.00" "$1,400.00" "$1,400.00" 374.28 180.81 45010 SUP Custom 27804086 45010 - GRAFT BN 10ML GRFTN + PST SYR DBM BOTH IP/OP "$2,170.00" "$1,606.00" $386.26 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" $386.26 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" $452.25 "$2,170.00" $868.00 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$1,627.50" "$2,170.00" "$2,170.00" "$2,170.00" "$1,085.00" "$1,085.00" "$1,718.64" "$2,170.00" "$1,736.00" $976.50 "$2,170.00" N/A "$1,258.60" "$2,170.00" "$1,302.00" "$2,170.00" "$2,170.00" "$2,170.00" N/A N/A 45103 SUP Custom 27803010 45103 - CONNECTOR SHNT STRG STRL ACFL CSF RADOPQ CATH PLS BOTH IP/OP $178.50 $132.00 $31.71 $178.13 $178.13 $178.13 $178.13 $178.13 $178.13 $178.13 $31.71 $178.13 $178.13 $178.13 $178.13 $178.13 $178.13 $37.12 $178.13 $71.25 $178.13 $178.13 $178.13 $178.13 $178.13 $133.88 $178.13 $178.13 $178.13 $89.07 $89.07 $141.08 $178.13 $142.50 $80.16 $178.13 N/A $103.53 $178.13 $106.88 $178.13 $178.13 $178.13 N/A N/A 45104 SUP Custom 27803010 45104 - CONNECTOR SHNT RT ANG STRL ACFL CSF CATH PLS BOTH IP/OP $178.50 $132.00 $31.71 $178.13 $178.13 $178.13 $178.13 $178.13 $178.13 $178.13 $31.71 $178.13 $178.13 $178.13 $178.13 $178.13 $178.13 $37.12 $178.13 $71.25 $178.13 $178.13 $178.13 $178.13 $178.13 $133.88 $178.13 $178.13 $178.13 $89.07 $89.07 $141.08 $178.13 $142.50 $80.16 $178.13 N/A $103.53 $178.13 $106.88 $178.13 $178.13 $178.13 N/A N/A 45105 SUP Custom 27803010 45105 - CONNECTOR SHNT STRL ACFL CSF CATH 3W PLS BOTH IP/OP $565.50 $418.00 $100.61 $565.25 $565.25 $565.25 $565.25 $565.25 $565.25 $565.25 $100.61 $565.25 $565.25 $565.25 $565.25 $565.25 $565.25 $117.80 $565.25 $226.10 $565.25 $565.25 $565.25 $565.25 $565.25 $424.13 $565.25 $565.25 $565.25 $282.63 $282.63 $447.68 $565.25 $452.20 $254.36 $565.25 N/A $327.99 $565.25 $339.15 $565.25 $565.25 $565.25 N/A N/A 45402 SUP Custom 27203010 45402 - SHUNT NEUROSURGICAL SNAP ASMBLY TOOL BOTH IP/OP $729.50 $540.00 $129.79 $729.13 $729.13 $729.13 $729.13 $729.13 $729.13 $729.13 $129.79 $729.13 $729.13 $541.16 $541.16 $562.01 $379.88 $151.96 $729.13 $291.65 $729.13 $729.13 $729.13 $729.13 $729.13 $547.13 $729.13 $729.13 $729.13 $364.57 $364.57 $577.47 $729.13 $583.30 $473.93 $729.13 N/A $423.11 $729.13 $437.48 $729.13 $729.13 $729.13 3529.26 1605.9 45806 SUP Custom 27203010 45806 - KIT SHUNT PROGRAMMABLE ADJUSTABLE VALVE STRATA II CSF BOTH IP/OP "$8,923.00" "$6,603.00" "$1,588.29" "$8,922.95" "$8,922.95" "$8,922.95" "$8,922.95" "$8,922.95" "$8,922.95" "$8,922.95" "$1,588.29" "$8,922.95" "$8,922.95" "$4,181.12" "$4,181.12" "$6,877.81" "$2,060.15" "$1,859.64" "$8,922.95" "$3,569.18" "$8,922.95" "$8,922.95" "$8,922.95" "$8,922.95" "$8,922.95" "$6,692.25" "$8,922.95" "$8,922.95" "$8,922.95" "$4,461.48" "$4,461.48" "$7,066.98" "$8,922.95" "$7,138.36" "$5,799.92" "$8,922.95" N/A "$5,175.34" "$8,922.95" "$5,353.77" "$8,922.95" "$8,922.95" "$8,922.95" N/A N/A 45807 SUP Custom 27203010 45807 - VALVE SHUNT SMARTCARD REPLACEMENT STRATA II BOTH IP/OP $169.50 $125.00 $30.12 $169.20 $169.20 $169.20 $169.20 $169.20 $169.20 $169.20 $30.12 $169.20 $169.20 $125.58 $125.58 $130.42 $88.15 $35.26 $169.20 $67.68 $169.20 $169.20 $169.20 $169.20 $169.20 $127.13 $169.20 $169.20 $169.20 $84.60 $84.60 $134.01 $169.20 $135.36 $109.98 $169.20 N/A $98.31 $169.20 $101.52 $169.20 $169.20 $169.20 N/A N/A 45808 SUP Custom 27203010 45808 - VALVE SHUNT SMARTCARD REPLACEMENT NSC STRATA BOTH IP/OP $233.00 $172.00 $41.41 $232.65 $232.65 $232.65 $232.65 $232.65 $232.65 $232.65 $41.41 $232.65 $232.65 $172.67 $172.67 $179.33 $121.21 $48.49 $232.65 $93.06 $232.65 $232.65 $232.65 $232.65 $232.65 $174.75 $232.65 $232.65 $232.65 $116.33 $116.33 $184.26 $232.65 $186.12 $151.22 $232.65 N/A $135.14 $232.65 $139.59 $232.65 $232.65 $232.65 N/A N/A 45809 SUP Custom 27203010 45809 - KIT STIMULATOR NEUROMUSCULAR MAGNET CONTROL INTERSTIM II BOTH IP/OP $492.00 $364.00 $87.51 $491.63 $491.63 $491.63 $491.63 $491.63 $491.63 $491.63 $87.51 $491.63 $491.63 $364.89 $364.89 $378.95 $256.14 $102.46 $491.63 $196.65 $491.63 $491.63 $491.63 $491.63 $491.63 $369.00 $491.63 $491.63 $491.63 $245.82 $245.82 $389.37 $491.63 $393.30 $319.56 $491.63 N/A $285.36 $491.63 $294.98 $491.63 $491.63 $491.63 N/A N/A 46012 SUP Custom 27803010 46012 - SHUNT NEUROSURGICAL SMALL LOW PRESSURE UNITIZED KIT CSF BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 46014 SUP Custom 27803010 46014 - SHUNT NEUROSURGICAL SMALL MEDIUM PRESSURE UNITIZED KIT CSF BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 46016 SUP Custom 27803010 46016 - SHUNT NEUROSURGICAL SMALL HIGH PRESSURE UNITIZED KIT CSF BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 46022 SUP Custom 27803010 46022 - SHUNT NEUROSURGICAL REGULAR LOW PRESSURE UNITIZED KIT CSF BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 46024 SUP Custom 27803010 46024 - SHUNT NEUROSURGICAL REGULAR MEDIUM PRESSURE UNITIZED KIT CSF BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 46026 SUP Custom 27803010 46026 - SHUNT NEUROSURGICAL REGULAR HIGH PRESSURE UNITIZED KIT CSF BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 46070 SUP Custom 27803010 46070 - SHUNT NEUROSURGICAL SMALL 8CM UNITIZED NSC STRATA FP BOTH IP/OP "$10,112.50" "$7,483.00" "$1,799.94" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$1,799.94" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$2,107.46" "$10,112.05" "$4,044.82" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$7,584.38" "$10,112.05" "$10,112.05" "$10,112.05" "$5,056.03" "$5,056.03" "$8,008.74" "$10,112.05" "$8,089.64" "$4,550.42" "$10,112.05" N/A "$5,865.25" "$10,112.05" "$6,067.23" "$10,112.05" "$10,112.05" "$10,112.05" 525.66 295.1 46075 SUP Custom 27803010 46075 - SHUNT NEUROSURGICAL SMALL 11.5CM UNITIZED NSC STRATA FP BOTH IP/OP "$10,112.50" "$7,483.00" "$1,799.94" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$1,799.94" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$2,107.46" "$10,112.05" "$4,044.82" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$7,584.38" "$10,112.05" "$10,112.05" "$10,112.05" "$5,056.03" "$5,056.03" "$8,008.74" "$10,112.05" "$8,089.64" "$4,550.42" "$10,112.05" N/A "$5,865.25" "$10,112.05" "$6,067.23" "$10,112.05" "$10,112.05" "$10,112.05" N/A N/A 46080 SUP Custom 27803010 46080 - SHUNT NEUROSURGICAL SMALL 11CM UNITIZED NSC STRATA FP BOTH IP/OP "$10,112.50" "$7,483.00" "$1,799.94" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$1,799.94" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$2,107.46" "$10,112.05" "$4,044.82" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$7,584.38" "$10,112.05" "$10,112.05" "$10,112.05" "$5,056.03" "$5,056.03" "$8,008.74" "$10,112.05" "$8,089.64" "$4,550.42" "$10,112.05" N/A "$5,865.25" "$10,112.05" "$6,067.23" "$10,112.05" "$10,112.05" "$10,112.05" 368.82 168.56 46085 SUP Custom 27803010 46085 - SHUNT NEUROSURGICAL SMALL 13.5CM UNITIZED NSC STRATA FP BOTH IP/OP "$10,112.50" "$7,483.00" "$1,799.94" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$1,799.94" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$2,107.46" "$10,112.05" "$4,044.82" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$10,112.05" "$7,584.38" "$10,112.05" "$10,112.05" "$10,112.05" "$5,056.03" "$5,056.03" "$8,008.74" "$10,112.05" "$8,089.64" "$4,550.42" "$10,112.05" N/A "$5,865.25" "$10,112.05" "$6,067.23" "$10,112.05" "$10,112.05" "$10,112.05" N/A N/A 46115 SUP HCPCS C1729 46115 - CATHETER DRN 20CM CLR STRL LF BCKR EDMS BA IMPRG SIL VNTRC BOTH IP/OP $269.00 $199.00 $53.35 $268.80 $145.96 $145.96 $145.96 $145.96 $268.80 $268.80 $268.80 $56.02 $268.80 $199.50 $199.50 $207.19 $140.04 $56.02 $268.80 $268.80 $159.00 $268.80 $268.80 $268.80 $268.80 $201.75 $268.80 $268.80 $268.80 $134.40 $134.40 $212.89 $268.80 $215.04 $174.72 $53.35 N/A $156.02 $268.80 $268.80 $268.80 $56.02 $268.80 N/A N/A 46118 SUP HCPCS C1729 46118 - CATHETER XTRN DRN 2.8MM 1.5MM 35CM 700ML STRL LF 15CM EDM BOTH IP/OP $403.50 $299.00 $80.03 $403.20 $218.94 $218.94 $218.94 $218.94 $403.20 $403.20 $403.20 $84.04 $403.20 $299.26 $299.26 $310.79 $210.07 $84.03 $403.20 $403.20 $238.49 $403.20 $403.20 $403.20 $403.20 $302.63 $403.20 $403.20 $403.20 $201.60 $201.60 $319.33 $403.20 $322.56 $262.08 $80.03 N/A $234.03 $403.20 $403.20 $403.20 $84.03 $403.20 N/A N/A 46126 SUP Custom 27203010 46126 - KIT EXTERNAL DRAIN CSF ASMBLY PATIENT CONNECT LINE MONITR BOTH IP/OP $168.00 $124.00 $29.90 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $29.90 $168.00 $168.00 $124.69 $124.69 $129.49 $87.53 $35.01 $168.00 $67.20 $168.00 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $109.20 $168.00 N/A $97.44 $168.00 $100.80 $168.00 $168.00 $168.00 N/A N/A 46129 SUP Custom 27203010 46129 - CATHETER DRAIN BECKER EDMS III BOTH IP/OP $509.00 $377.00 $90.57 $508.80 $508.80 $508.80 $508.80 $508.80 $508.80 $508.80 $90.57 $508.80 $508.80 $377.63 $377.63 $392.18 $265.08 $106.04 $508.80 $203.52 $508.80 $508.80 $508.80 $508.80 $508.80 $381.75 $508.80 $508.80 $508.80 $254.40 $254.40 $402.97 $508.80 $407.04 $330.72 $508.80 N/A $295.22 $508.80 $305.28 $508.80 $508.80 $508.80 N/A N/A 46135 SUP HCPCS C1713 46135 - CLAMP POLE QUICK-ATTACH BOTH IP/OP "$1,121.00" $830.00 $222.45 "$1,120.80" $504.36 $504.36 $504.36 $504.36 "$1,120.80" "$1,120.80" "$1,120.80" $233.60 "$1,120.80" "$1,120.80" "$1,120.80" "$1,120.80" "$1,120.80" $233.59 "$1,120.80" $448.32 $662.95 "$1,120.80" "$1,120.80" "$1,120.80" "$1,120.80" $840.75 "$1,120.80" "$1,120.80" "$1,120.80" $560.40 $560.40 $887.67 "$1,120.80" $896.64 $504.36 $222.45 N/A $650.18 "$1,120.80" $672.48 "$1,120.80" $233.57 "$1,120.80" N/A N/A 46137 SUP HCPCS C1713 46137 - CLAMP POLE QUICK-ATTACH BOTH IP/OP "$1,294.00" $958.00 $256.75 "$1,293.60" $582.12 $582.12 $582.12 $582.12 "$1,293.60" "$1,293.60" "$1,293.60" $269.62 "$1,293.60" "$1,293.60" "$1,293.60" "$1,293.60" "$1,293.60" $269.60 "$1,293.60" $517.44 $765.16 "$1,293.60" "$1,293.60" "$1,293.60" "$1,293.60" $970.50 "$1,293.60" "$1,293.60" "$1,293.60" $646.80 $646.80 "$1,024.53" "$1,293.60" "$1,034.88" $582.12 $256.75 N/A $750.52 "$1,293.60" $776.16 "$1,293.60" $269.59 "$1,293.60" N/A N/A 46141 SUP Custom 27203010 46141 - KIT DRAIN EDM VENTRICULAR BOTH IP/OP $751.50 $556.00 $133.71 $751.20 $751.20 $751.20 $751.20 $751.20 $751.20 $751.20 $133.71 $751.20 $751.20 $557.54 $557.54 $579.02 $391.38 $156.56 $751.20 $300.48 $751.20 $751.20 $751.20 $751.20 $751.20 $563.63 $751.20 $751.20 $751.20 $375.60 $375.60 $594.95 $751.20 $600.96 $488.28 $751.20 N/A $435.87 $751.20 $450.72 $751.20 $751.20 $751.20 N/A N/A 46154 SUP Custom 27203010 46154 - KIT SURG VENTRICULOSTOMY BOTH IP/OP $785.00 $581.00 $139.69 $784.80 $784.80 $784.80 $784.80 $784.80 $784.80 $784.80 $139.69 $784.80 $784.80 $582.48 $582.48 $604.92 $408.88 $163.56 $784.80 $313.92 $784.80 $784.80 $784.80 $784.80 $784.80 $588.75 $784.80 $784.80 $784.80 $392.40 $392.40 $621.56 $784.80 $627.84 $510.12 $784.80 N/A $455.30 $784.80 $470.88 $784.80 $784.80 $784.80 N/A N/A Jun-26 SUP Custom 27803010 6-2026 - CAGE SPNL 20MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF BOTH IP/OP "$7,813.50" "$5,782.00" "$1,390.78" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$1,390.78" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$1,628.39" "$7,813.35" "$3,125.34" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$7,813.35" "$5,860.13" "$7,813.35" "$7,813.35" "$7,813.35" "$3,906.68" "$3,906.68" "$6,188.17" "$7,813.35" "$6,250.68" "$3,516.01" "$7,813.35" N/A "$4,531.83" "$7,813.35" "$4,688.01" "$7,813.35" "$7,813.35" "$7,813.35" N/A N/A 46220 SUP Custom 27803010 46220 - VALVE SHUNT ULTRA SMALL 4CM LOW PRESSURE CSF STERILE BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" 274.7 129.32 46222 SUP Custom 27803010 46222 - SHUNT NEUROSURGICAL ULTRA SMALL 4CM LOW PRESSURE CSF STERILE BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 46224 SUP Custom 27803010 46224 - SHUNT NEUROSURGICAL ULTRA SMALL 4CM KIT CSF MEDIUM PRESSURE BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 46240 SUP Custom 27803010 46240 - KIT SHUNT ULTRA SMALL 90CM 6CM INTEGRAL ANGULAR VENTRICULAR BOTH IP/OP "$3,080.50" "$2,280.00" $548.31 "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" $548.31 "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" $641.99 "$3,080.38" "$1,232.15" "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" "$2,310.38" "$3,080.38" "$3,080.38" "$3,080.38" "$1,540.19" "$1,540.19" "$2,439.66" "$3,080.38" "$2,464.30" "$1,386.17" "$3,080.38" N/A "$1,786.69" "$3,080.38" "$1,848.23" "$3,080.38" "$3,080.38" "$3,080.38" N/A N/A 46242 SUP Custom 27803010 46242 - SHUNT NEUROSURGICAL ULTRA SMALL 6CM LOW PRESSURE CSF STERILE BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 46244 SUP Custom 27803010 46244 - KIT SHUNT ULTRA SMALL 90CM 6CM INTEGRAL ANGULAR VENTRICULAR BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 46418 SUP Custom 27803010 46418 - CATHETER DRAIN 24CM OPEN TIP EDM SILICONE LUMBAR STERILE BOTH IP/OP $391.50 $290.00 $69.63 $391.20 $391.20 $391.20 $391.20 $391.20 $391.20 $391.20 $69.63 $391.20 $391.20 $391.20 $391.20 $391.20 $391.20 $81.53 $391.20 $156.48 $391.20 $391.20 $391.20 $391.20 $391.20 $293.63 $391.20 $391.20 $391.20 $195.60 $195.60 $309.83 $391.20 $312.96 $176.04 $391.20 N/A $227.07 $391.20 $234.72 $391.20 $391.20 $391.20 N/A N/A 46419 SUP HCPCS C1729 46419 - CATHETER XTRN DRN 80CM STRL EDM CLS TIP BA IMPRG SIL LMBR BOTH IP/OP $566.50 $419.00 $112.42 $566.40 $307.56 $307.56 $307.56 $307.56 $566.40 $566.40 $566.40 $118.05 $566.40 $420.38 $420.38 $436.58 $295.09 $118.04 $566.40 $566.40 $335.03 $566.40 $566.40 $566.40 $566.40 $424.88 $566.40 $566.40 $566.40 $283.20 $283.20 $448.59 $566.40 $453.12 $368.16 $112.42 N/A $328.57 $566.40 $566.40 $566.40 $118.04 $566.40 N/A N/A 46420 SUP Custom 27803010 46420 - CATHETER DRAIN 80CM OPEN TIP IMPREGNATE LATEX FREE EDM BOTH IP/OP $545.00 $403.00 $96.97 $544.80 $544.80 $544.80 $544.80 $544.80 $544.80 $544.80 $96.97 $544.80 $544.80 $544.80 $544.80 $544.80 $544.80 $113.54 $544.80 $217.92 $544.80 $544.80 $544.80 $544.80 $544.80 $408.75 $544.80 $544.80 $544.80 $272.40 $272.40 $431.48 $544.80 $435.84 $245.16 $544.80 N/A $316.10 $544.80 $326.88 $544.80 $544.80 $544.80 N/A N/A 46430 SUP Custom 27203010 46430 - BAG DRAIN VENT BECKER EDMS 700ML BOTH IP/OP $88.50 $65.00 $15.68 $88.08 $88.08 $88.08 $88.08 $88.08 $88.08 $88.08 $15.68 $88.08 $88.08 $65.37 $65.37 $67.89 $45.89 $18.36 $88.08 $35.23 $88.08 $88.08 $88.08 $88.08 $88.08 $66.38 $88.08 $88.08 $88.08 $44.04 $44.04 $69.76 $88.08 $70.46 $57.25 $88.08 N/A $51.33 $88.08 $52.85 $88.08 $88.08 $88.08 N/A N/A 46440 SUP Custom 27203010 46440 - KIT XTRN DRN 35CM 700ML BE2 MNTR LMBR BOTH IP/OP $768.00 $568.00 $136.62 $767.52 $767.52 $767.52 $767.52 $767.52 $767.52 $767.52 $136.62 $767.52 $767.52 $569.65 $569.65 $591.60 $399.88 $159.96 $767.52 $307.01 $767.52 $767.52 $767.52 $767.52 $767.52 $576.00 $767.52 $767.52 $767.52 $383.76 $383.76 $607.88 $767.52 $614.02 $498.89 $767.52 N/A $445.44 $767.52 $460.51 $767.52 $767.52 $767.52 N/A N/A 46441 SUP Custom 27203010 46441 - KIT DRAIN STR 80CM OPEN TIP RADIOPQ LATEX FREE EDM LUMBAR BOTH IP/OP $630.00 $466.00 $112.10 $629.76 $629.76 $629.76 $629.76 $629.76 $629.76 $629.76 $112.10 $629.76 $629.76 $467.41 $467.41 $485.42 $328.10 $131.25 $629.76 $251.90 $629.76 $629.76 $629.76 $629.76 $629.76 $472.50 $629.76 $629.76 $629.76 $314.88 $314.88 $498.77 $629.76 $503.81 $409.34 $629.76 N/A $365.40 $629.76 $377.86 $629.76 $629.76 $629.76 N/A N/A 46442 SUP Custom 27203010 46442 - KIT DRAIN 80CM EXTERNAL MONITR EDM LUMBAR BOTH IP/OP $630.00 $466.00 $112.10 $629.76 $629.76 $629.76 $629.76 $629.76 $629.76 $629.76 $112.10 $629.76 $629.76 $467.41 $467.41 $485.42 $328.10 $131.25 $629.76 $251.90 $629.76 $629.76 $629.76 $629.76 $629.76 $472.50 $629.76 $629.76 $629.76 $314.88 $314.88 $498.77 $629.76 $503.81 $409.34 $629.76 N/A $365.40 $629.76 $377.86 $629.76 $629.76 $629.76 N/A N/A 46540 SUP Custom 27803010 46540 - SHUNT NEUROSURGICAL CSF ASMBLY SNAP BUTTON VERY LOW PRESSURE BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 46542 SUP Custom 27803010 46542 - SHUNT NS CSF ASMB SNP BTN LP BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 46544 SUP Custom 27803010 46544 - SHUNT NS CSF ASMB SNP BTN MED PRSS BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 46560 SUP Custom 27803010 46560 - SHUNT NEUROSURGICAL ULTRA SMALL 90CM CSF SNAP ASMBLY DOME BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 46562 SUP Custom 27803010 46562 - SHUNT NEUROSURGICAL ULTRA SMALL 90CM CSF SNAP ASMBLY DOME BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 46564 SUP Custom 27803010 46564 - SHUNT NEUROSURGICAL ULTRA SMALL 90CM CSF SNAP ASMBLY DOME BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 46622 SUP Custom 27803010 46622 - SHUNT NEUROSURGICAL SMALL CNTOUR 2.5MM 1.3MM 90CM 25MM CSF BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 46624 SUP Custom 27803010 46624 - SHUNT NEUROSURGICAL SMALL 90CM CSF CNTOUR MEDIUM PRESSURE BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 46626 SUP Custom 27803010 46626 - SHUNT NEUROSURGICAL SMALL 90CM CSF CNTOUR HIGH PRESSURE BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 46635 SUP Custom 27803010 46635 - SHUNT NEUROSURGICAL BURR HOLE STRATA NSC STERILE DISPOSABLE BOTH IP/OP "$9,459.00" "$7,000.00" "$1,683.66" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$1,683.66" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$1,971.31" "$9,458.75" "$3,783.50" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$7,094.25" "$9,458.75" "$9,458.75" "$9,458.75" "$4,729.38" "$4,729.38" "$7,491.33" "$9,458.75" "$7,567.00" "$4,256.44" "$9,458.75" N/A "$5,486.22" "$9,458.75" "$5,675.25" "$9,458.75" "$9,458.75" "$9,458.75" N/A N/A 46642 SUP Custom 27803010 46642 - SHUNT NEUROSURGICAL REGULAR CNTOUR 2.5MM 1.3MM 90CM 32MM CSF BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 46644 SUP Custom 27803010 46644 - SHUNT NEUROSURGICAL REGULAR CNTOUR 2.5MM 1.3MM 90CM 32MM CSF BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 46646 SUP Custom 27803010 46646 - SHUNT NEUROSURGICAL REGULAR 90CM CSF CNTOUR HIGH PRESSURE BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 46655 SUP Custom 27803010 46655 - SHUNT NEUROSURGICAL SMALL CSF ASMBLY STRATA STERILE BOTH IP/OP "$9,459.00" "$7,000.00" "$1,683.66" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$1,683.66" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$1,971.31" "$9,458.75" "$3,783.50" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$7,094.25" "$9,458.75" "$9,458.75" "$9,458.75" "$4,729.38" "$4,729.38" "$7,491.33" "$9,458.75" "$7,567.00" "$4,256.44" "$9,458.75" N/A "$5,486.22" "$9,458.75" "$5,675.25" "$9,458.75" "$9,458.75" "$9,458.75" N/A N/A 46665 SUP Custom 27803010 46665 - SHUNT NEUROSURGICAL REGULAR CSF ASMBLY STRATA STERILE BOTH IP/OP "$9,459.00" "$7,000.00" "$1,683.66" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$1,683.66" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$1,971.31" "$9,458.75" "$3,783.50" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$9,458.75" "$7,094.25" "$9,458.75" "$9,458.75" "$9,458.75" "$4,729.38" "$4,729.38" "$7,491.33" "$9,458.75" "$7,567.00" "$4,256.44" "$9,458.75" N/A "$5,486.22" "$9,458.75" "$5,675.25" "$9,458.75" "$9,458.75" "$9,458.75" N/A N/A 46700 SUP Custom 27203010 46700 - SYSTEM DRAIN NONVENTED CATHETER COLLECT BAG EXACTA VENTRICLE BOTH IP/OP $398.50 $295.00 $70.92 $398.40 $398.40 $398.40 $398.40 $398.40 $398.40 $398.40 $70.92 $398.40 $398.40 $295.69 $295.69 $307.09 $207.57 $83.03 $398.40 $159.36 $398.40 $398.40 $398.40 $398.40 $398.40 $298.88 $398.40 $398.40 $398.40 $199.20 $199.20 $315.53 $398.40 $318.72 $258.96 $398.40 N/A $231.13 $398.40 $239.04 $398.40 $398.40 $398.40 1514.46 703.29 46705 SUP Custom 27203010 46705 - SYSTEM DRAIN MONITR DRIP CHAMBER EXACTA 100ML VENTRICULAR BOTH IP/OP $432.00 $320.00 $76.90 $432.00 $432.00 $432.00 $432.00 $432.00 $432.00 $432.00 $76.90 $432.00 $432.00 $320.63 $320.63 $332.99 $225.07 $90.03 $432.00 $172.80 $432.00 $432.00 $432.00 $432.00 $432.00 $324.00 $432.00 $432.00 $432.00 $216.00 $216.00 $342.14 $432.00 $345.60 $280.80 $432.00 N/A $250.56 $432.00 $259.20 $432.00 $432.00 $432.00 1161.02 617.56 46710 SUP Custom 27203010 46710 - BAG EXTERNAL DRAIN REPLACEMENT EXACTA 600ML BOTH IP/OP $110.50 $82.00 $19.65 $110.40 $110.40 $110.40 $110.40 $110.40 $110.40 $110.40 $19.65 $110.40 $110.40 $81.94 $81.94 $85.10 $57.52 $23.01 $110.40 $44.16 $110.40 $110.40 $110.40 $110.40 $110.40 $82.88 $110.40 $110.40 $110.40 $55.20 $55.20 $87.44 $110.40 $88.32 $71.76 $110.40 N/A $64.09 $110.40 $66.24 $110.40 $110.40 $110.40 2440.22 1193.71 46711 SUP Custom 27203010 46711 - CLAMP POLE ASMBLY LASER EXACTA CSF BOTH IP/OP "$1,282.00" $949.00 $228.12 "$1,281.60" "$1,281.60" "$1,281.60" "$1,281.60" "$1,281.60" "$1,281.60" "$1,281.60" $228.12 "$1,281.60" "$1,281.60" $951.20 $951.20 $987.86 $667.71 $267.10 "$1,281.60" $512.64 "$1,281.60" "$1,281.60" "$1,281.60" "$1,281.60" "$1,281.60" $961.50 "$1,281.60" "$1,281.60" "$1,281.60" $640.80 $640.80 "$1,015.03" "$1,281.60" "$1,025.28" $833.04 "$1,281.60" N/A $743.56 "$1,281.60" $768.96 "$1,281.60" "$1,281.60" "$1,281.60" N/A N/A 46712 SUP Custom 27203010 46712 - BAG EXTERNAL DRAIN LATEX FREE EXACTA SILICONE VENTRICLE BOTH IP/OP $88.50 $65.00 $15.68 $88.08 $88.08 $88.08 $88.08 $88.08 $88.08 $88.08 $15.68 $88.08 $88.08 $65.37 $65.37 $67.89 $45.89 $18.36 $88.08 $35.23 $88.08 $88.08 $88.08 $88.08 $88.08 $66.38 $88.08 $88.08 $88.08 $44.04 $44.04 $69.76 $88.08 $70.46 $57.25 $88.08 N/A $51.33 $88.08 $52.85 $88.08 $88.08 $88.08 4960.05 2377.29 46713 SUP Custom 27203010 46713 - CLAMP POLE CSF ASMBLY LASER EXACTA BOTH IP/OP "$1,142.50" $845.00 $203.35 "$1,142.40" "$1,142.40" "$1,142.40" "$1,142.40" "$1,142.40" "$1,142.40" "$1,142.40" $203.35 "$1,142.40" "$1,142.40" $847.89 $847.89 $880.56 $595.19 $238.09 "$1,142.40" $456.96 "$1,142.40" "$1,142.40" "$1,142.40" "$1,142.40" "$1,142.40" $856.88 "$1,142.40" "$1,142.40" "$1,142.40" $571.20 $571.20 $904.78 "$1,142.40" $913.92 $742.56 "$1,142.40" N/A $662.65 "$1,142.40" $685.44 "$1,142.40" "$1,142.40" "$1,142.40" N/A N/A 46715 SUP HCPCS C1713 46715 - CLAMP POLE CSF ASMBLY LASER EXACTA BOTH IP/OP "$1,399.50" "$1,036.00" $277.71 "$1,399.20" $629.64 $629.64 $629.64 $629.64 "$1,399.20" "$1,399.20" "$1,399.20" $291.63 "$1,399.20" "$1,399.20" "$1,399.20" "$1,399.20" "$1,399.20" $291.61 "$1,399.20" $559.68 $827.63 "$1,399.20" "$1,399.20" "$1,399.20" "$1,399.20" "$1,049.63" "$1,399.20" "$1,399.20" "$1,399.20" $699.60 $699.60 "$1,108.17" "$1,399.20" "$1,119.36" $629.64 $277.71 N/A $811.71 "$1,399.20" $839.52 "$1,399.20" $291.59 "$1,399.20" 1255.52 600.99 46717 SUP HCPCS C1713 46717 - CLAMP POLE 25CM W/O LASER EXACTA CSF NONSTRL BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" $720.00 "$1,200.00" $250.08 "$1,200.00" N/A N/A 46812 SUP Custom 27803010 46812 - SHUNT NEUROSURGICAL SMALL PERFORMANCE LEVEL 1 CSF ASMBLY BOTH IP/OP "$4,135.00" "$3,060.00" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $861.75 "$4,134.88" "$1,653.95" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$3,101.25" "$4,134.88" "$4,134.88" "$4,134.88" "$2,067.44" "$2,067.44" "$3,274.82" "$4,134.88" "$3,307.90" "$1,860.70" "$4,134.88" N/A "$2,398.30" "$4,134.88" "$2,480.93" "$4,134.88" "$4,134.88" "$4,134.88" N/A N/A 46813 SUP Custom 27803010 46813 - SHUNT NEUROSURGICAL SMALL PERFORMANCE LEVEL 1.5 CSF ASMBLY BOTH IP/OP "$4,135.00" "$3,060.00" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $861.75 "$4,134.88" "$1,653.95" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$3,101.25" "$4,134.88" "$4,134.88" "$4,134.88" "$2,067.44" "$2,067.44" "$3,274.82" "$4,134.88" "$3,307.90" "$1,860.70" "$4,134.88" N/A "$2,398.30" "$4,134.88" "$2,480.93" "$4,134.88" "$4,134.88" "$4,134.88" N/A N/A 46814 SUP Custom 27803010 46814 - SHUNT NEUROSURGICAL SMALL PERFORMANCE LEVEL 2 CSF ASMBLY BOTH IP/OP "$4,135.00" "$3,060.00" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $861.75 "$4,134.88" "$1,653.95" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$3,101.25" "$4,134.88" "$4,134.88" "$4,134.88" "$2,067.44" "$2,067.44" "$3,274.82" "$4,134.88" "$3,307.90" "$1,860.70" "$4,134.88" N/A "$2,398.30" "$4,134.88" "$2,480.93" "$4,134.88" "$4,134.88" "$4,134.88" N/A N/A 46822 SUP Custom 27803010 46822 - SHUNT NEUROSURGICAL REGULAR PERFORMANCE LEVEL 1 CSF ASMBLY BOTH IP/OP "$4,135.00" "$3,060.00" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $861.75 "$4,134.88" "$1,653.95" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$3,101.25" "$4,134.88" "$4,134.88" "$4,134.88" "$2,067.44" "$2,067.44" "$3,274.82" "$4,134.88" "$3,307.90" "$1,860.70" "$4,134.88" N/A "$2,398.30" "$4,134.88" "$2,480.93" "$4,134.88" "$4,134.88" "$4,134.88" N/A N/A 46823 SUP Custom 27803010 46823 - VALVE SHUNT REGULAR PERFORMANCE LEVEL 1.5 BARIUM IMPREGNATED BOTH IP/OP "$4,135.00" "$3,060.00" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $861.75 "$4,134.88" "$1,653.95" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$3,101.25" "$4,134.88" "$4,134.88" "$4,134.88" "$2,067.44" "$2,067.44" "$3,274.82" "$4,134.88" "$3,307.90" "$1,860.70" "$4,134.88" N/A "$2,398.30" "$4,134.88" "$2,480.93" "$4,134.88" "$4,134.88" "$4,134.88" N/A N/A 46824 SUP Custom 27803010 46824 - SHUNT PERITONEAL REGULAR CSF PERFORMANCE LEVEL 2 OPEN END BOTH IP/OP "$4,135.00" "$3,060.00" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $861.75 "$4,134.88" "$1,653.95" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$3,101.25" "$4,134.88" "$4,134.88" "$4,134.88" "$2,067.44" "$2,067.44" "$3,274.82" "$4,134.88" "$3,307.90" "$1,860.70" "$4,134.88" N/A "$2,398.30" "$4,134.88" "$2,480.93" "$4,134.88" "$4,134.88" "$4,134.88" N/A N/A 46832 SUP Custom 27803010 46832 - SHUNT NEUROSURGICAL CSF PERFORMANCE LEVEL 1 SNAP DELTA BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$2,139.64" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 46833 SUP Custom 27803010 46833 - SHUNT NEUROSURGICAL CSF PERFORMANCE LEVEL 1.5 SNAP DELTA BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$2,139.64" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 46834 SUP Custom 27803010 46834 - SHUNT NEUROSURGICAL CSF PERFORMANCE LEVEL 2 SNAP DELTA BOTH IP/OP "$5,192.00" "$3,842.00" $924.13 "$5,191.75" "$5,191.75" "$5,191.75" "$5,191.75" "$5,191.75" "$5,191.75" "$5,191.75" $924.13 "$5,191.75" "$5,191.75" "$5,191.75" "$5,191.75" "$5,191.75" "$5,191.75" "$1,082.02" "$5,191.75" "$2,076.70" "$5,191.75" "$5,191.75" "$5,191.75" "$5,191.75" "$5,191.75" "$3,894.00" "$5,191.75" "$5,191.75" "$5,191.75" "$2,595.88" "$2,595.88" "$4,111.87" "$5,191.75" "$4,153.40" "$2,336.29" "$5,191.75" N/A "$3,011.36" "$5,191.75" "$3,115.05" "$5,191.75" "$5,191.75" "$5,191.75" N/A N/A 46836 SUP Custom 27803010 46836 - VALVE SHUNT BURR HOLE STRATA II BOTH IP/OP "$10,302.50" "$7,624.00" "$1,833.83" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$1,833.83" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$2,147.13" "$10,302.40" "$4,120.96" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$7,726.88" "$10,302.40" "$10,302.40" "$10,302.40" "$5,151.20" "$5,151.20" "$8,159.50" "$10,302.40" "$8,241.92" "$4,636.08" "$10,302.40" N/A "$5,975.45" "$10,302.40" "$6,181.44" "$10,302.40" "$10,302.40" "$10,302.40" N/A N/A 46856 SUP Custom 27803010 46856 - SHUNT NEUROSURGICAL SMALL 120CM CSF CATHETER BARIUM BOTH IP/OP "$10,302.50" "$7,624.00" "$1,833.83" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$1,833.83" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$2,147.13" "$10,302.40" "$4,120.96" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$7,726.88" "$10,302.40" "$10,302.40" "$10,302.40" "$5,151.20" "$5,151.20" "$8,159.50" "$10,302.40" "$8,241.92" "$4,636.08" "$10,302.40" N/A "$5,975.45" "$10,302.40" "$6,181.44" "$10,302.40" "$10,302.40" "$10,302.40" N/A N/A 46866 SUP Custom 27803010 46866 - SHUNT NEUROSURGICAL REGULAR 120CM CSF CATHETER BARIUM BOTH IP/OP "$10,302.50" "$7,624.00" "$1,833.83" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$1,833.83" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$2,147.13" "$10,302.40" "$4,120.96" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$10,302.40" "$7,726.88" "$10,302.40" "$10,302.40" "$10,302.40" "$5,151.20" "$5,151.20" "$8,159.50" "$10,302.40" "$8,241.92" "$4,636.08" "$10,302.40" N/A "$5,975.45" "$10,302.40" "$6,181.44" "$10,302.40" "$10,302.40" "$10,302.40" N/A N/A 46871 SUP Custom 27803010 46871 - SHUNT NEUROSURGICAL SMALL 8CM CSF UNITIZED CATHETER STRATA BOTH IP/OP "$10,916.00" "$8,078.00" "$1,943.00" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$1,943.00" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$2,274.96" "$10,915.75" "$4,366.30" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$8,187.00" "$10,915.75" "$10,915.75" "$10,915.75" "$5,457.88" "$5,457.88" "$8,645.27" "$10,915.75" "$8,732.60" "$4,912.09" "$10,915.75" N/A "$6,331.28" "$10,915.75" "$6,549.45" "$10,915.75" "$10,915.75" "$10,915.75" N/A N/A 46876 SUP Custom 27803010 46876 - SHUNT NEUROSURGICAL SMALL 11.5CM UNITIZED FIX PRESSURE BOTH IP/OP "$10,916.00" "$8,078.00" "$1,943.00" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$1,943.00" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$2,274.96" "$10,915.75" "$4,366.30" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$8,187.00" "$10,915.75" "$10,915.75" "$10,915.75" "$5,457.88" "$5,457.88" "$8,645.27" "$10,915.75" "$8,732.60" "$4,912.09" "$10,915.75" N/A "$6,331.28" "$10,915.75" "$6,549.45" "$10,915.75" "$10,915.75" "$10,915.75" N/A N/A 46881 SUP Custom 27803010 46881 - SHUNT NEUROSURGICAL REGULAR 11CM CSF UNITIZED CATHETER BOTH IP/OP "$10,916.00" "$8,078.00" "$1,943.00" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$1,943.00" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$2,274.96" "$10,915.75" "$4,366.30" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$8,187.00" "$10,915.75" "$10,915.75" "$10,915.75" "$5,457.88" "$5,457.88" "$8,645.27" "$10,915.75" "$8,732.60" "$4,912.09" "$10,915.75" N/A "$6,331.28" "$10,915.75" "$6,549.45" "$10,915.75" "$10,915.75" "$10,915.75" N/A N/A 46886 SUP Custom 27803010 46886 - SHUNT NEUROSURGICAL REGULAR 13.5CM CSF UNITIZED CATHETER BOTH IP/OP "$10,916.00" "$8,078.00" "$1,943.00" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$1,943.00" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$2,274.96" "$10,915.75" "$4,366.30" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$10,915.75" "$8,187.00" "$10,915.75" "$10,915.75" "$10,915.75" "$5,457.88" "$5,457.88" "$8,645.27" "$10,915.75" "$8,732.60" "$4,912.09" "$10,915.75" N/A "$6,331.28" "$10,915.75" "$6,549.45" "$10,915.75" "$10,915.75" "$10,915.75" N/A N/A 46911 SUP Custom 27203010 46911 - BAG EXTERNAL DRAIN REPLACEMENT LATEX FREE DUET DISPOSABLE BOTH IP/OP $110.50 $82.00 $19.65 $110.40 $110.40 $110.40 $110.40 $110.40 $110.40 $110.40 $19.65 $110.40 $110.40 $81.94 $81.94 $85.10 $57.52 $23.01 $110.40 $44.16 $110.40 $110.40 $110.40 $110.40 $110.40 $82.88 $110.40 $110.40 $110.40 $55.20 $55.20 $87.44 $110.40 $88.32 $71.76 $110.40 N/A $64.09 $110.40 $66.24 $110.40 $110.40 $110.40 N/A N/A 46912 SUP Custom 27203010 46912 - BAG EXTERNAL DRAIN DEHP FREE DUET BOTH IP/OP $88.50 $65.00 $15.68 $88.08 $88.08 $88.08 $88.08 $88.08 $88.08 $88.08 $15.68 $88.08 $88.08 $65.37 $65.37 $67.89 $45.89 $18.36 $88.08 $35.23 $88.08 $88.08 $88.08 $88.08 $88.08 $66.38 $88.08 $88.08 $88.08 $44.04 $44.04 $69.76 $88.08 $70.46 $57.25 $88.08 N/A $51.33 $88.08 $52.85 $88.08 $88.08 $88.08 N/A N/A 46913 SUP Custom 27203010 46913 - SYSTEM EXTERNAL DRAIN CSF DRAIN VENTRICULAR AND LUMBAR DRAIN BOTH IP/OP $566.50 $419.00 $100.82 $566.40 $566.40 $566.40 $566.40 $566.40 $566.40 $566.40 $100.82 $566.40 $566.40 $420.38 $420.38 $436.58 $295.09 $118.04 $566.40 $226.56 $566.40 $566.40 $566.40 $566.40 $566.40 $424.88 $566.40 $566.40 $566.40 $283.20 $283.20 $448.59 $566.40 $453.12 $368.16 $566.40 N/A $328.57 $566.40 $339.84 $566.40 $566.40 $566.40 N/A N/A 46914 SUP Custom 27203010 46914 - SYSTEM EXTERNAL DRAIN CSF VENTRICULAR LUMBAR DUET DISPOSABLE BOTH IP/OP $566.50 $419.00 $100.82 $566.40 $566.40 $566.40 $566.40 $566.40 $566.40 $566.40 $100.82 $566.40 $566.40 $420.38 $420.38 $436.58 $295.09 $118.04 $566.40 $226.56 $566.40 $566.40 $566.40 $566.40 $566.40 $424.88 $566.40 $566.40 $566.40 $283.20 $283.20 $448.59 $566.40 $453.12 $368.16 $566.40 N/A $328.57 $566.40 $339.84 $566.40 $566.40 $566.40 N/A N/A 46915 SUP Custom 27203010 46915 - SYSTEM EXTERNAL DRAIN 35CM NEEDLELESS INJEC SITE EDM BOTH IP/OP $960.00 $710.00 $170.88 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $170.88 $960.00 $960.00 $712.51 $712.51 $739.97 $500.16 $200.07 $960.00 $384.00 $960.00 $960.00 $960.00 $960.00 $960.00 $720.00 $960.00 $960.00 $960.00 $480.00 $480.00 $760.32 $960.00 $768.00 $624.00 $960.00 N/A $556.80 $960.00 $576.00 $960.00 $960.00 $960.00 N/A N/A 46916 SUP Custom 27203010 46916 - SYSTEM EXTERNAL DRAIN 35CM MONITR SMARTSITE NEEDLELESS INJEC BOTH IP/OP $960.00 $710.00 $170.88 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $170.88 $960.00 $960.00 $712.51 $712.51 $739.97 $500.16 $200.07 $960.00 $384.00 $960.00 $960.00 $960.00 $960.00 $960.00 $720.00 $960.00 $960.00 $960.00 $480.00 $480.00 $760.32 $960.00 $768.00 $624.00 $960.00 N/A $556.80 $960.00 $576.00 $960.00 $960.00 $960.00 331.5 149.95 46917 SUP Custom 27203010 46917 - SYSTEM XTRN DRN 60IN DUET LCATH INTLNK CLS SYS XTRN VNTRC BOTH IP/OP "$1,104.00" $817.00 $196.51 "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" $196.51 "$1,104.00" "$1,104.00" $819.39 $819.39 $850.96 $575.18 $230.09 "$1,104.00" $441.60 "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" "$1,104.00" $828.00 "$1,104.00" "$1,104.00" "$1,104.00" $552.00 $552.00 $874.37 "$1,104.00" $883.20 $717.60 "$1,104.00" N/A $640.32 "$1,104.00" $662.40 "$1,104.00" "$1,104.00" "$1,104.00" 304.79 135.5 46918 SUP Custom 27203010 46918 - LEVEL LSR NS LF CLRST REUSE XTRN DRN MNTR SYS BOTH IP/OP $211.50 $157.00 $37.59 $211.20 $211.20 $211.20 $211.20 $211.20 $211.20 $211.20 $37.59 $211.20 $211.20 $156.75 $156.75 $162.79 $110.04 $44.02 $211.20 $84.48 $211.20 $211.20 $211.20 $211.20 $211.20 $158.63 $211.20 $211.20 $211.20 $105.60 $105.60 $167.27 $211.20 $168.96 $137.28 $211.20 N/A $122.67 $211.20 $126.72 $211.20 $211.20 $211.20 N/A N/A 48270 SUP Custom 27203010 48270 - CATHETER URTH 20FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN BOTH IP/OP $14.00 $10.00 $2.41 $13.52 $13.52 $13.52 $13.52 $13.52 $13.52 $13.52 $2.41 $13.52 $13.52 $10.03 $10.03 $10.42 $7.04 $2.82 $13.52 $5.41 $13.52 $13.52 $13.52 $13.52 $13.52 $10.50 $13.52 $13.52 $13.52 $6.76 $6.76 $10.71 $13.52 $10.82 $8.79 $13.52 N/A $8.12 $13.52 $8.11 $13.52 $13.52 $13.52 N/A N/A 48403 SUP Custom 27203010 48403 - PASSER SURG LONG 38CM CATHETER LOW PRESSURE SHUNT LUMBAR BOTH IP/OP "$2,767.00" "$2,048.00" $492.50 "$2,766.88" "$2,766.88" "$2,766.88" "$2,766.88" "$2,766.88" "$2,766.88" "$2,766.88" $492.50 "$2,766.88" "$2,766.88" "$2,053.58" "$2,053.58" "$2,132.71" "$1,441.54" $576.65 "$2,766.88" "$1,106.75" "$2,766.88" "$2,766.88" "$2,766.88" "$2,766.88" "$2,766.88" "$2,075.25" "$2,766.88" "$2,766.88" "$2,766.88" "$1,383.44" "$1,383.44" "$2,191.37" "$2,766.88" "$2,213.50" "$1,798.47" "$2,766.88" N/A "$1,604.86" "$2,766.88" "$1,660.13" "$2,766.88" "$2,766.88" "$2,766.88" N/A N/A 48405 SUP Custom 27203010 48405 - PASSER SURG 60CM CATHETER VERY LOW PRESSURE VENTRICULAR BOTH IP/OP "$2,914.50" "$2,157.00" $518.72 "$2,914.13" "$2,914.13" "$2,914.13" "$2,914.13" "$2,914.13" "$2,914.13" "$2,914.13" $518.72 "$2,914.13" "$2,914.13" "$2,162.87" "$2,162.87" "$2,246.21" "$1,518.26" $607.34 "$2,914.13" "$1,165.65" "$2,914.13" "$2,914.13" "$2,914.13" "$2,914.13" "$2,914.13" "$2,185.88" "$2,914.13" "$2,914.13" "$2,914.13" "$1,457.07" "$1,457.07" "$2,307.99" "$2,914.13" "$2,331.30" "$1,894.18" "$2,914.13" N/A "$1,690.41" "$2,914.13" "$1,748.48" "$2,914.13" "$2,914.13" "$2,914.13" N/A N/A 48407 SUP Custom 27203010 48407 - PASSER SURG 38CM CATHETER SUBCUTANEOUS DISPOSABLE BOTH IP/OP $344.50 $255.00 $61.30 $344.38 $344.38 $344.38 $344.38 $344.38 $344.38 $344.38 $61.30 $344.38 $344.38 $255.60 $255.60 $265.45 $179.42 $71.77 $344.38 $137.75 $344.38 $344.38 $344.38 $344.38 $344.38 $258.38 $344.38 $344.38 $344.38 $172.19 $172.19 $272.75 $344.38 $275.50 $223.85 $344.38 N/A $199.81 $344.38 $206.63 $344.38 $344.38 $344.38 N/A N/A 48409 SUP Custom 27203010 48409 - PASSER SURG 60CM CATHETER SUBCUTANEOUS DISPOSABLE BOTH IP/OP $368.50 $273.00 $65.53 $368.13 $368.13 $368.13 $368.13 $368.13 $368.13 $368.13 $65.53 $368.13 $368.13 $273.23 $273.23 $283.75 $191.80 $76.72 $368.13 $147.25 $368.13 $368.13 $368.13 $368.13 $368.13 $276.38 $368.13 $368.13 $368.13 $184.07 $184.07 $291.56 $368.13 $294.50 $239.28 $368.13 N/A $213.73 $368.13 $220.88 $368.13 $368.13 $368.13 N/A N/A 50011 SUP Custom 27203010 050011 - SET PRSS MNTR 5FR 14GA 24IN STRL LF DLP PLWY PED LT ATR BOTH IP/OP $22.00 $16.00 $12.76 "$2,312.50" "$1,040.63" "$1,040.63" "$1,040.63" "$1,040.63" "$2,312.50" "$2,312.50" "$2,312.50" $481.98 "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" $481.95 "$2,312.50" "$2,312.50" "$1,367.84" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" $16.50 "$2,312.50" "$2,312.50" "$2,312.50" "$1,156.25" "$1,156.25" "$1,831.50" "$2,312.50" "$1,850.00" "$1,040.63" $458.97 N/A $12.76 "$2,312.50" "$2,312.50" "$2,312.50" $481.93 "$2,312.50" N/A N/A 50011 SUP HCPCS C2625 50011 - IMPLANT NSL STRL LF PROPEL CNTR BOTH IP/OP "$2,312.50" "$1,711.00" $458.97 "$2,312.50" "$1,040.63" "$1,040.63" "$1,040.63" "$1,040.63" "$2,312.50" "$2,312.50" "$2,312.50" $481.98 "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" $481.95 "$2,312.50" "$2,312.50" "$1,367.84" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$1,734.38" "$2,312.50" "$2,312.50" "$2,312.50" "$1,156.25" "$1,156.25" "$1,831.50" "$2,312.50" "$1,850.00" "$1,040.63" $458.97 N/A "$1,341.25" "$2,312.50" "$2,312.50" "$2,312.50" $481.93 "$2,312.50" N/A N/A 50120 SUP Custom 27803010 50120 - CLIP LGT MED LG VESOCCLUDE SMTR 6 CRTDG TI BOTH IP/OP $9.50 $7.00 $1.67 $9.38 $9.38 $9.38 $9.38 $9.38 $9.38 $9.38 $1.67 $9.38 $9.38 $9.38 $9.38 $9.38 $9.38 $1.95 $9.38 $3.75 $9.38 $9.38 $9.38 $9.38 $9.38 $7.13 $9.38 $9.38 $9.38 $4.69 $4.69 $7.43 $9.38 $7.50 $4.22 $9.38 N/A $5.51 $9.38 $5.63 $9.38 $9.38 $9.38 2192.94 999.88 50318 SUP Custom 27803010 50318 - CATHETER EXTERNAL DRAIN 1.5FR 33CM HERMETIC SET EVD CSF BOTH IP/OP "$3,600.00" "$2,664.00" $640.80 "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" $640.80 "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" $750.28 "$3,600.00" "$1,440.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$2,700.00" "$3,600.00" "$3,600.00" "$3,600.00" "$1,800.00" "$1,800.00" "$2,851.20" "$3,600.00" "$2,880.00" "$1,620.00" "$3,600.00" N/A "$2,088.00" "$3,600.00" "$2,160.00" "$3,600.00" "$3,600.00" "$3,600.00" N/A N/A 50823 SUP Custom 27203010 50823 - INFLATION SYSTEM BOTH IP/OP $55.50 $41.00 $9.82 $55.15 $55.15 $55.15 $55.15 $55.15 $55.15 $55.15 $9.82 $55.15 $55.15 $40.93 $40.93 $42.51 $28.73 $11.49 $55.15 $22.06 $55.15 $55.15 $55.15 $55.15 $55.15 $41.63 $55.15 $55.15 $55.15 $27.58 $27.58 $43.68 $55.15 $44.12 $35.85 $55.15 N/A $32.19 $55.15 $33.09 $55.15 $55.15 $55.15 N/A N/A 52021 SUP HCPCS Q4108 52021 - DRESSING WND 2X2IN MTRX BVN CLGN BOTH IP/OP "$1,206.00" $892.00 $239.34 "$1,205.92" $542.66 $542.66 $542.66 $542.66 "$1,205.92" "$1,205.92" "$1,205.92" $251.34 "$1,205.92" "$1,205.92" "$1,205.92" "$1,205.92" "$1,205.92" $251.33 "$1,205.92" "$1,205.92" $713.30 "$1,205.92" "$1,205.92" "$1,205.92" "$1,205.92" $904.50 "$1,205.92" "$1,205.92" "$1,205.92" $602.96 $602.96 $955.09 "$1,205.92" $964.74 $542.66 $239.34 N/A $699.48 "$1,205.92" "$1,205.92" "$1,205.92" $251.31 "$1,205.92" N/A N/A 54051 SUP HCPCS Q4108 54051 - DRESSING WND 5X4IN STRL BVN CLGN GAG DISP BOTH IP/OP "$8,047.00" "$5,955.00" "$1,597.04" "$8,046.58" "$3,620.96" "$3,620.96" "$3,620.96" "$3,620.96" "$8,046.58" "$8,046.58" "$8,046.58" "$1,677.11" "$8,046.58" "$8,046.58" "$8,046.58" "$8,046.58" "$8,046.58" "$1,677.00" "$8,046.58" "$8,046.58" "$3,966.96" "$8,046.58" "$8,046.58" "$8,046.58" "$8,046.58" "$6,035.25" "$8,046.58" "$8,046.58" "$8,046.58" "$4,023.29" "$4,023.29" "$6,372.89" "$8,046.58" "$6,437.26" "$3,620.96" "$1,597.04" N/A "$4,667.26" "$8,046.58" "$8,046.58" "$8,046.58" "$1,676.91" "$8,046.58" N/A N/A 56030 SUP HCPCS C1729 "056030 - Urethral Catheters, BARDEX, Robinson Model, Latex 30FR" BOTH IP/OP $7.50 $6.00 $1.40 $7.20 $3.82 $3.82 $3.82 $3.82 $7.03 $7.03 $7.03 $1.47 $7.03 $5.22 $5.22 $5.42 $3.66 $1.47 $7.03 $7.20 $4.16 $7.03 $7.20 $7.03 $7.03 $5.63 $7.03 $7.03 $7.03 $3.52 $3.52 $5.57 $7.03 $5.62 $4.57 $1.40 N/A $4.35 $7.03 $7.03 $7.03 $1.47 $7.03 N/A N/A 58025 SUP Custom 27803010 58025 - FILLER BONE VOID ALLOGRAFT FREEZE DRY MIX DBX 2.5CC BOTH IP/OP "$1,156.00" $855.00 $205.77 "$1,298.50" "$1,156.00" "$1,156.00" "$1,156.00" "$1,156.00" "$1,156.00" "$1,156.00" $205.77 "$1,156.00" "$1,156.00" "$1,156.00" "$1,156.00" "$1,156.00" "$1,156.00" $240.92 "$1,156.00" $519.40 "$1,156.00" "$1,156.00" "$1,298.50" "$1,156.00" "$1,156.00" $867.00 "$1,156.00" "$1,156.00" "$1,156.00" $578.00 $578.00 $915.55 "$1,156.00" $924.80 $520.20 "$1,156.00" N/A $670.48 "$1,156.00" $693.60 "$1,156.00" "$1,156.00" "$1,156.00" N/A N/A 58050 SUP HCPCS C1713 58050 - FILLER BONE VOID ALLOGRAFT FREEZE DRIED MIX DBX 5ML BOTH IP/OP "$2,091.00" "$1,547.00" $415.01 "$2,091.00" $940.95 $940.95 $940.95 $940.95 "$2,091.00" "$2,091.00" "$2,091.00" $435.82 "$2,091.00" "$2,091.00" "$2,091.00" "$2,091.00" "$2,091.00" $435.79 "$2,091.00" $836.40 "$1,236.83" "$2,091.00" "$2,091.00" "$2,091.00" "$2,091.00" "$1,568.25" "$2,091.00" "$2,091.00" "$2,091.00" "$1,045.50" "$1,045.50" "$1,656.07" "$2,091.00" "$1,672.80" $940.95 $415.01 N/A "$1,212.78" "$2,091.00" "$1,254.60" "$2,091.00" $435.76 "$2,091.00" N/A N/A 58200 SUP HCPCS C1713 58200 - FILLER BONE VOID ALLOGRAFT MIX FREEZE DRIED DBX BOTH IP/OP "$9,475.00" "$7,012.00" "$1,880.55" "$9,475.00" "$4,263.75" "$4,263.75" "$4,263.75" "$4,263.75" "$9,475.00" "$9,475.00" "$9,475.00" "$1,974.83" "$9,475.00" "$9,475.00" "$9,475.00" "$9,475.00" "$9,475.00" "$1,974.69" "$9,475.00" "$3,790.00" "$4,671.18" "$9,475.00" "$9,475.00" "$9,475.00" "$9,475.00" "$7,106.25" "$9,475.00" "$9,475.00" "$9,475.00" "$4,737.50" "$4,737.50" "$7,504.20" "$9,475.00" "$7,580.00" "$4,263.75" "$1,880.55" N/A "$5,495.50" "$9,475.00" "$5,685.00" "$9,475.00" "$1,974.59" "$9,475.00" 3143.1 1436.42 60011 SUP HCPCS C2625 60011 - IMPLANT NASAL 370 MCG MINI 4MM 16MM STEROID RELEASE ZIP TIE BOTH IP/OP "$2,375.00" "$1,758.00" $471.38 "$2,375.00" "$1,068.75" "$1,068.75" "$1,068.75" "$1,068.75" "$2,375.00" "$2,375.00" "$2,375.00" $495.01 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" "$2,375.00" "$1,404.81" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" $471.38 N/A "$1,377.50" "$2,375.00" "$2,375.00" "$2,375.00" $494.95 "$2,375.00" N/A N/A 60120 SUP Custom 27803010 60120 - CLIP LGT LG VESOCCLUDE SMTR 6 CRTDG TI BOTH IP/OP $2.00 $1.00 $0.32 $1.79 $1.79 $1.79 $1.79 $1.79 $1.79 $1.79 $0.32 $1.79 $1.79 $1.79 $1.79 $1.79 $1.79 $0.37 $1.79 $0.72 $1.79 $1.79 $1.79 $1.79 $1.79 $1.50 $1.79 $1.79 $1.79 $0.90 $0.90 $1.42 $1.79 $1.43 $0.81 $1.79 N/A $1.16 $1.79 $1.07 $1.79 $1.79 $1.79 N/A N/A 61621 SUP Custom 27803010 61621 - CAGE SPNL 16MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF BOTH IP/OP "$8,031.50" "$5,943.00" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,673.80" "$8,031.25" "$3,212.50" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$6,023.63" "$8,031.25" "$8,031.25" "$8,031.25" "$4,015.63" "$4,015.63" "$6,360.75" "$8,031.25" "$6,425.00" "$3,614.06" "$8,031.25" N/A "$4,658.27" "$8,031.25" "$4,818.75" "$8,031.25" "$8,031.25" "$8,031.25" N/A N/A 62100 SUP Custom 27803010 62100 - PATCH DURA 2X2IN STRL DUREPAIR RSRB BVN CLGN MTRX CRNL DRPLS BOTH IP/OP $996.50 $737.00 $177.36 $996.40 $996.40 $996.40 $996.40 $996.40 $996.40 $996.40 $177.36 $996.40 $996.40 $996.40 $996.40 $996.40 $996.40 $207.66 $996.40 $398.56 $996.40 $996.40 $996.40 $996.40 $996.40 $747.38 $996.40 $996.40 $996.40 $498.20 $498.20 $789.15 $996.40 $797.12 $448.38 $996.40 N/A $577.97 $996.40 $597.84 $996.40 $996.40 $996.40 3737.6 1675.52 62105 SUP Custom 27803010 62105 - PATCH DURAL 3X3IN RESORB DUREPAIR BOVINE COLLAGEN MATRIX BOTH IP/OP "$1,817.00" "$1,345.00" $323.35 "$1,816.55" "$1,816.55" "$1,816.55" "$1,816.55" "$1,816.55" "$1,816.55" "$1,816.55" $323.35 "$1,816.55" "$1,816.55" "$1,816.55" "$1,816.55" "$1,816.55" "$1,816.55" $378.59 "$1,816.55" $726.62 "$1,816.55" "$1,816.55" "$1,816.55" "$1,816.55" "$1,816.55" "$1,362.75" "$1,816.55" "$1,816.55" "$1,816.55" $908.28 $908.28 "$1,438.71" "$1,816.55" "$1,453.24" $817.45 "$1,816.55" N/A "$1,053.86" "$1,816.55" "$1,089.93" "$1,816.55" "$1,816.55" "$1,816.55" N/A N/A 62106 SUP Custom 27803010 62106 - PATCH DURAL 3X1IN RESORB DUREPAIR BOVINE COLLAGEN MATRIX BOTH IP/OP $822.50 $609.00 $146.41 $822.50 $822.50 $822.50 $822.50 $822.50 $822.50 $822.50 $146.41 $822.50 $822.50 $822.50 $822.50 $822.50 $822.50 $171.42 $822.50 $329.00 $822.50 $822.50 $822.50 $822.50 $822.50 $616.88 $822.50 $822.50 $822.50 $411.25 $411.25 $651.42 $822.50 $658.00 $370.13 $822.50 N/A $477.05 $822.50 $493.50 $822.50 $822.50 $822.50 N/A N/A 62110 SUP Custom 27803010 62110 - PATCH DURAL 5X4IN RESORB DUREPAIR BOVINE COLLAGEN MATRIX BOTH IP/OP "$3,520.50" "$2,605.00" $626.61 "$3,520.30" "$3,520.30" "$3,520.30" "$3,520.30" "$3,520.30" "$3,520.30" "$3,520.30" $626.61 "$3,520.30" "$3,520.30" "$3,520.30" "$3,520.30" "$3,520.30" "$3,520.30" $733.67 "$3,520.30" "$1,408.12" "$3,520.30" "$3,520.30" "$3,520.30" "$3,520.30" "$3,520.30" "$2,640.38" "$3,520.30" "$3,520.30" "$3,520.30" "$1,760.15" "$1,760.15" "$2,788.08" "$3,520.30" "$2,816.24" "$1,584.14" "$3,520.30" N/A "$2,041.89" "$3,520.30" "$2,112.18" "$3,520.30" "$3,520.30" "$3,520.30" N/A N/A 62111 SUP Custom 27803010 62111 - PATCH DURAL 1X1IN RESORB DUREPAIR BOVINE COLLAGEN MATRIX BOTH IP/OP $392.50 $290.00 $69.86 $392.45 $392.45 $392.45 $392.45 $392.45 $392.45 $392.45 $69.86 $392.45 $392.45 $392.45 $392.45 $392.45 $392.45 $81.79 $392.45 $156.98 $392.45 $392.45 $392.45 $392.45 $392.45 $294.38 $392.45 $392.45 $392.45 $196.23 $196.23 $310.82 $392.45 $313.96 $176.60 $392.45 N/A $227.65 $392.45 $235.47 $392.45 $392.45 $392.45 N/A N/A 62158 SUP Custom 27803010 62158 - PATCH DURAL 8X5IN RESORB DUREPAIR BOVINE COLLAGEN MATRIX BOTH IP/OP "$8,742.00" "$6,469.00" "$1,556.08" "$8,742.00" "$8,742.00" "$8,742.00" "$8,742.00" "$8,742.00" "$8,742.00" "$8,742.00" "$1,556.08" "$8,742.00" "$8,742.00" "$8,742.00" "$8,742.00" "$8,742.00" "$8,742.00" "$1,821.93" "$8,742.00" "$3,496.80" "$8,742.00" "$8,742.00" "$8,742.00" "$8,742.00" "$8,742.00" "$6,556.50" "$8,742.00" "$8,742.00" "$8,742.00" "$4,371.00" "$4,371.00" "$6,923.66" "$8,742.00" "$6,993.60" "$3,933.90" "$8,742.00" N/A "$5,070.36" "$8,742.00" "$5,245.20" "$8,742.00" "$8,742.00" "$8,742.00" N/A N/A 64018 SUP HCPCS C1729 064018 - CATHETER NEPHROSTOMY 18FR 2 EYE DRAIN LATEX PEZZER STERILE BOTH IP/OP $43.50 $32.00 $8.58 $43.23 $23.47 $23.47 $23.47 $23.47 $43.23 $43.23 $43.23 $9.01 $43.23 $32.09 $32.09 $33.32 $22.52 $9.01 $43.23 $43.23 $25.57 $43.23 $43.23 $43.23 $43.23 $32.63 $43.23 $43.23 $43.23 $21.62 $21.62 $34.24 $43.23 $34.58 $28.10 $8.58 N/A $25.23 $43.23 $43.23 $43.23 $9.01 $43.23 N/A N/A 64024 SUP HCPCS C1729 064024 - CATHETER NEPHROSTOMY 24FR 2 EYE DRAIN LATEX PEZZER STERILE BOTH IP/OP $43.50 $32.00 $8.58 $43.23 $23.47 $23.47 $23.47 $23.47 $43.23 $43.23 $43.23 $9.01 $43.23 $32.09 $32.09 $33.32 $22.52 $9.01 $43.23 $43.23 $25.57 $43.23 $43.23 $43.23 $43.23 $32.63 $43.23 $43.23 $43.23 $21.62 $21.62 $34.24 $43.23 $34.58 $28.10 $8.58 N/A $25.23 $43.23 $43.23 $43.23 $9.01 $43.23 N/A N/A 64026 SUP HCPCS C1729 064026 - CATHETER NEPHROSTOMY 26FR 2 EYE DRAIN PROPORTIONATE HEAD BOTH IP/OP $43.50 $32.00 $8.58 $43.23 $23.47 $23.47 $23.47 $23.47 $43.23 $43.23 $43.23 $9.01 $43.23 $32.09 $32.09 $33.32 $22.52 $9.01 $43.23 $43.23 $25.57 $43.23 $43.23 $43.23 $43.23 $32.63 $43.23 $43.23 $43.23 $21.62 $21.62 $34.24 $43.23 $34.58 $28.10 $8.58 N/A $25.23 $43.23 $43.23 $43.23 $9.01 $43.23 N/A N/A 64030 SUP HCPCS C1729 064030 - CATHETER NEPHROSTOMY 30FR 2 EYE DRAIN LATEX PEZZER STERILE BOTH IP/OP $43.50 $32.00 $8.58 $43.23 $23.47 $23.47 $23.47 $23.47 $43.23 $43.23 $43.23 $9.01 $43.23 $32.09 $32.09 $33.32 $22.52 $9.01 $43.23 $43.23 $25.57 $43.23 $43.23 $43.23 $43.23 $32.63 $43.23 $43.23 $43.23 $21.62 $21.62 $34.24 $43.23 $34.58 $28.10 $8.58 N/A $25.23 $43.23 $43.23 $43.23 $9.01 $43.23 N/A N/A 64036 SUP HCPCS C1729 064036 - CATHETER URTH 36FR STRL LTX PEZ 2 EYE DRN PROPORTIONATE HD BOTH IP/OP $3.00 $2.00 $0.56 $2.84 $1.54 $1.54 $1.54 $1.54 $2.84 $2.84 $2.84 $0.59 $2.84 $2.11 $2.11 $2.19 $1.48 $0.59 $2.84 $2.84 $1.68 $2.84 $2.84 $2.84 $2.84 $2.25 $2.84 $2.84 $2.84 $1.42 $1.42 $2.25 $2.84 $2.27 $1.85 $0.56 N/A $1.74 $2.84 $2.84 $2.84 $0.59 $2.84 N/A N/A 67910 SUP Custom 27203010 0067910 - BRUSH FEMORAL CANAL SUCTION IRRIGATION LATEX SIMPULSE PLUS BOTH IP/OP $162.50 $120.00 $28.88 $172.10 $162.24 $162.24 $162.24 $162.24 $162.24 $162.24 $28.88 $162.24 $162.24 $120.41 $120.41 $125.05 $84.53 $33.81 $162.24 $68.84 $162.24 $162.24 $172.10 $162.24 $162.24 $121.88 $162.24 $162.24 $162.24 $81.12 $81.12 $128.49 $162.24 $129.79 $105.46 $162.24 N/A $94.25 $162.24 $97.34 $162.24 $162.24 $162.24 N/A N/A 68124 SUP Custom 27203010 68124 - CATHETER PRFSN .5IN FLR 36FR 16IN SRN MLBL VNS RTN BOTH IP/OP $134.00 $99.00 $23.78 $133.62 $133.62 $133.62 $133.62 $133.62 $133.62 $133.62 $23.78 $133.62 $133.62 $99.17 $99.17 $102.99 $69.62 $27.85 $133.62 $31.47 $133.62 $133.62 $78.68 $133.62 $133.62 $100.50 $133.62 $133.62 $133.62 $66.81 $66.81 $105.83 $133.62 $106.90 $86.85 $133.62 N/A $77.72 $133.62 $80.17 $133.62 $133.62 $133.62 N/A N/A 68128 SUP Custom 27203010 68128 - CANNULA PERFUSION 3/8IN CONCTR 28FR 12-15IN 1 STAGE MALBLE BOTH IP/OP $783.00 $579.00 $139.33 $786.79 $782.75 $782.75 $782.75 $782.75 $782.75 $782.75 $139.33 $782.75 $782.75 $580.96 $580.96 $603.34 $407.81 $163.13 $782.75 $314.72 $782.75 $782.75 $786.79 $782.75 $782.75 $587.25 $782.75 $782.75 $782.75 $391.38 $391.38 $619.94 $782.75 $626.20 $508.79 $782.75 N/A $454.14 $782.75 $469.65 $782.75 $782.75 $782.75 N/A N/A 68130 SUP Custom 27203010 68130 - CATHETER PRFSN 3/8IN 30FR 16IN SRN MLBL FLR VNS RTN BOTH IP/OP $134.00 $99.00 $23.78 $133.62 $133.62 $133.62 $133.62 $133.62 $133.62 $133.62 $23.78 $133.62 $133.62 $99.17 $99.17 $102.99 $69.62 $27.85 $133.62 $31.47 $133.62 $133.62 $78.68 $133.62 $133.62 $100.50 $133.62 $133.62 $133.62 $66.81 $66.81 $105.83 $133.62 $106.90 $86.85 $133.62 N/A $77.72 $133.62 $80.17 $133.62 $133.62 $133.62 941.75 431.67 68132 SUP Custom 27203010 68132 - CANNULA PRFSN 3/8IN FLR 32FR 16IN SRN 1 PC LOPRFL WRE REINF BOTH IP/OP $79.00 $58.00 $14.04 $81.65 $78.88 $78.88 $78.88 $78.88 $78.88 $78.88 $14.04 $78.88 $78.88 $58.54 $58.54 $60.80 $41.10 $16.44 $78.88 $32.66 $78.88 $78.88 $81.65 $78.88 $78.88 $59.25 $78.88 $78.88 $78.88 $39.44 $39.44 $62.47 $78.88 $63.10 $51.27 $78.88 N/A $45.82 $78.88 $47.33 $78.88 $78.88 $78.88 N/A N/A 68182 SUP Custom 27203010 68182 - CANNULA PRFSN 3/8IN FLR 28FR 16IN SRN 1 PC LOPRFL WRE REINF BOTH IP/OP $85.00 $63.00 $15.11 $84.88 $84.88 $84.88 $84.88 $84.88 $84.88 $84.88 $15.11 $84.88 $84.88 $63.00 $63.00 $65.43 $44.22 $17.69 $84.88 $33.95 $84.88 $84.88 $84.88 $84.88 $84.88 $63.75 $84.88 $84.88 $84.88 $42.44 $42.44 $67.22 $84.88 $67.90 $55.17 $84.88 N/A $49.30 $84.88 $50.93 $84.88 $84.88 $84.88 N/A N/A 68250 SUP Custom 27803010 68250 - GRAFT SFT TIS 1.5X1.5CM TTPLST PRICRD ALGRF PRC STRL BOTH IP/OP $637.50 $472.00 $113.48 $637.50 $637.50 $637.50 $637.50 $637.50 $637.50 $637.50 $113.48 $637.50 $637.50 $637.50 $637.50 $637.50 $637.50 $132.86 $637.50 $255.00 $637.50 $637.50 $637.50 $637.50 $637.50 $478.13 $637.50 $637.50 $637.50 $318.75 $318.75 $504.90 $637.50 $510.00 $286.88 $637.50 N/A $369.75 $637.50 $382.50 $637.50 $637.50 $637.50 N/A N/A 68333 SUP Custom 27803010 68333 - GRAFT SFT TIS .8X.5CM STRL TTPLST LOPRFL SCLR BOTH IP/OP $725.00 $537.00 $129.05 $725.00 $725.00 $725.00 $725.00 $725.00 $725.00 $725.00 $129.05 $725.00 $725.00 $725.00 $725.00 $725.00 $725.00 $151.10 $725.00 $290.00 $725.00 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $326.25 $725.00 N/A $420.50 $725.00 $435.00 $725.00 $725.00 $725.00 N/A N/A 70011 SUP HCPCS C2625 70011 - STENT NSL 370 MCG PROPEL MOMETASONE FUROATE BOTH IP/OP "$2,375.00" "$1,758.00" $471.38 "$2,375.00" "$1,068.75" "$1,068.75" "$1,068.75" "$1,068.75" "$2,375.00" "$2,375.00" "$2,375.00" $495.01 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" "$2,375.00" "$1,404.81" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" $471.38 N/A "$1,377.50" "$2,375.00" "$2,375.00" "$2,375.00" $494.95 "$2,375.00" N/A N/A 71221 SUP Custom 27803010 71221 - CAGE SPNL STD 12MM 21MM RYTFC THRD CNCT TI PLIF BOTH IP/OP "$7,088.00" "$5,245.00" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,477.17" "$7,087.75" "$2,835.10" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$5,316.00" "$7,087.75" "$7,087.75" "$7,087.75" "$3,543.88" "$3,543.88" "$5,613.50" "$7,087.75" "$5,670.20" "$3,189.49" "$7,087.75" N/A "$4,111.04" "$7,087.75" "$4,252.65" "$7,087.75" "$7,087.75" "$7,087.75" N/A N/A 71226 SUP Custom 27803010 71226 - CAGE SPNL STD 12MM 26MM RYTFC THRD CNCT TI PLIF BOTH IP/OP "$7,088.00" "$5,245.00" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,477.17" "$7,087.75" "$2,835.10" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$5,316.00" "$7,087.75" "$7,087.75" "$7,087.75" "$3,543.88" "$3,543.88" "$5,613.50" "$7,087.75" "$5,670.20" "$3,189.49" "$7,087.75" N/A "$4,111.04" "$7,087.75" "$4,252.65" "$7,087.75" "$7,087.75" "$7,087.75" N/A N/A 71421 SUP Custom 27803010 71421 - CAGE SPNL STD 14MM 21MM RYTFC THRD CNCT TI PLIF BOTH IP/OP "$7,088.00" "$5,245.00" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,477.17" "$7,087.75" "$2,835.10" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$5,316.00" "$7,087.75" "$7,087.75" "$7,087.75" "$3,543.88" "$3,543.88" "$5,613.50" "$7,087.75" "$5,670.20" "$3,189.49" "$7,087.75" N/A "$4,111.04" "$7,087.75" "$4,252.65" "$7,087.75" "$7,087.75" "$7,087.75" N/A N/A 71426 SUP Custom 27803010 71426 - CAGE SPNL STD 14MM 26MM RYTFC THRD CNCT TI PLIF BOTH IP/OP "$7,088.00" "$5,245.00" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,477.17" "$7,087.75" "$2,835.10" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$5,316.00" "$7,087.75" "$7,087.75" "$7,087.75" "$3,543.88" "$3,543.88" "$5,613.50" "$7,087.75" "$5,670.20" "$3,189.49" "$7,087.75" N/A "$4,111.04" "$7,087.75" "$4,252.65" "$7,087.75" "$7,087.75" "$7,087.75" N/A N/A 71621 SUP Custom 27803010 71621 - CAGE SPNL STD 16MM 21MM RYTFC THRD CNCT TI PLIF BOTH IP/OP "$7,088.00" "$5,245.00" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,477.17" "$7,087.75" "$2,835.10" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$5,316.00" "$7,087.75" "$7,087.75" "$7,087.75" "$3,543.88" "$3,543.88" "$5,613.50" "$7,087.75" "$5,670.20" "$3,189.49" "$7,087.75" N/A "$4,111.04" "$7,087.75" "$4,252.65" "$7,087.75" "$7,087.75" "$7,087.75" N/A N/A 71626 SUP Custom 27803010 71626 - CAGE SPNL STD 16MM 26MM RYTFC THRD CNCT TI PLIF BOTH IP/OP "$7,088.00" "$5,245.00" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,477.17" "$7,087.75" "$2,835.10" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$5,316.00" "$7,087.75" "$7,087.75" "$7,087.75" "$3,543.88" "$3,543.88" "$5,613.50" "$7,087.75" "$5,670.20" "$3,189.49" "$7,087.75" N/A "$4,111.04" "$7,087.75" "$4,252.65" "$7,087.75" "$7,087.75" "$7,087.75" N/A N/A 71821 SUP Custom 27803010 71821 - CAGE SPNL STD 18MM 21MM RYTFC THRD CNCT TI PLIF BOTH IP/OP "$7,088.00" "$5,245.00" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,477.17" "$7,087.75" "$2,835.10" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$5,316.00" "$7,087.75" "$7,087.75" "$7,087.75" "$3,543.88" "$3,543.88" "$5,613.50" "$7,087.75" "$5,670.20" "$3,189.49" "$7,087.75" N/A "$4,111.04" "$7,087.75" "$4,252.65" "$7,087.75" "$7,087.75" "$7,087.75" N/A N/A 71826 SUP Custom 27803010 71826 - CAGE SPNL STD 18MM 26MM RYTFC THRD CNCT TI PLIF BOTH IP/OP "$7,088.00" "$5,245.00" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,261.62" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$1,477.17" "$7,087.75" "$2,835.10" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$7,087.75" "$5,316.00" "$7,087.75" "$7,087.75" "$7,087.75" "$3,543.88" "$3,543.88" "$5,613.50" "$7,087.75" "$5,670.20" "$3,189.49" "$7,087.75" N/A "$4,111.04" "$7,087.75" "$4,252.65" "$7,087.75" "$7,087.75" "$7,087.75" N/A N/A 72026 SUP Custom 27803010 72026 - CAGE SPNL STD 20MM 26MM RYTFC THRD CNCT TI PLIF BOTH IP/OP "$6,616.00" "$4,896.00" "$1,177.64" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$1,177.64" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$1,378.84" "$6,615.95" "$2,646.38" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$6,615.95" "$4,962.00" "$6,615.95" "$6,615.95" "$6,615.95" "$3,307.98" "$3,307.98" "$5,239.83" "$6,615.95" "$5,292.76" "$2,977.18" "$6,615.95" N/A "$3,837.28" "$6,615.95" "$3,969.57" "$6,615.95" "$6,615.95" "$6,615.95" N/A N/A 72228 SUP Custom 27203010 72228 - DRAIN INCISION FULL FLUTE ROUND 15FR 3/16IN CHANNEL RADIOPQ BOTH IP/OP $34.50 $26.00 $6.13 $34.44 $34.44 $34.44 $34.44 $34.44 $34.44 $34.44 $6.13 $34.44 $34.44 $25.56 $25.56 $26.55 $17.94 $7.18 $34.44 $13.78 $34.44 $34.44 $34.44 $34.44 $34.44 $25.88 $34.44 $34.44 $34.44 $17.22 $17.22 $27.28 $34.44 $27.55 $22.39 $34.44 N/A $20.01 $34.44 $20.66 $34.44 $34.44 $34.44 N/A N/A 72230 SUP Custom 27203010 072230 - DRAIN 19FR HUBLESS FULL FLUTED BOTH IP/OP $44.00 $33.00 $7.78 $43.68 $43.68 $43.68 $43.68 $43.68 $43.68 $43.68 $7.78 $43.68 $43.68 $32.42 $32.42 $33.67 $22.76 $9.10 $43.68 $17.47 $43.68 $43.68 $43.68 $43.68 $43.68 $33.00 $43.68 $43.68 $43.68 $21.84 $21.84 $34.59 $43.68 $34.94 $28.39 $43.68 N/A $25.52 $43.68 $26.21 $43.68 $43.68 $43.68 N/A N/A 72530 SUP Custom 27203010 72530 - SPLINT ORTHOPEDIC 30X5IN CONFORMABLE PAD HYPOALLERGENIC BOTH IP/OP $31.50 $23.00 $5.58 $31.37 $31.37 $31.37 $31.37 $31.37 $31.37 $31.37 $5.58 $31.37 $31.37 $23.28 $23.28 $24.18 $16.34 $6.54 $31.37 $12.55 $31.37 $31.37 $31.37 $31.37 $31.37 $23.63 $31.37 $31.37 $31.37 $15.69 $15.69 $24.85 $31.37 $25.10 $20.39 $31.37 N/A $18.27 $31.37 $18.82 $31.37 $31.37 $31.37 N/A N/A 73210 SUP Custom 27203010 73210 - HANDLE LIGHT 6V .9MR CORD DISPOSABLE ANOSCOPE SIGMOIDOSCOPE BOTH IP/OP $191.00 $141.00 $110.78 $143.25 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $143.25 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $110.78 N/A N/A N/A N/A N/A N/A N/A 75335 SUP Custom 27203010 75335 - SPLINT ORTHOPEDIC LP 35X3IN PRECUT PAD WATER REPELLENT LATEX BOTH IP/OP $24.00 $18.00 $4.22 $23.68 $23.68 $23.68 $23.68 $23.68 $23.68 $23.68 $4.22 $23.68 $23.68 $17.58 $17.58 $18.25 $12.34 $4.94 $23.68 $9.35 $23.68 $23.68 $23.38 $23.68 $23.68 $18.00 $23.68 $23.68 $23.68 $11.84 $11.84 $18.75 $23.68 $18.94 $15.39 $23.68 N/A $13.92 $23.68 $14.21 $23.68 $23.68 $23.68 N/A N/A 76430 SUP Custom 27203010 76430 - SPLINT ORTHOPEDIC 30X4IN CONFORMABLE MOLDABLE LIGHTWEIGHT 3M BOTH IP/OP $72.50 $54.00 $10.44 $72.14 $72.14 $72.14 $72.14 $72.14 $72.14 $72.14 $12.84 $72.14 $72.14 $53.54 $53.54 $55.61 $37.58 $15.03 $72.14 $10.44 $72.14 $72.14 $26.09 $72.14 $72.14 $54.38 $72.14 $72.14 $72.14 $36.07 $36.07 $57.13 $72.14 $57.71 $46.89 $72.14 N/A $42.05 $72.14 $43.28 $72.14 $72.14 $72.14 N/A N/A 77622 SUP Custom 27203010 77622 - CANNULA PRFSN 3/8IN CNCT 22FR 12IN EOPA VNT DIL TIP INTRO GW BOTH IP/OP "$1,345.00" $995.00 $239.41 "$1,352.03" "$1,345.00" "$1,345.00" "$1,345.00" "$1,345.00" "$1,345.00" "$1,345.00" $239.41 "$1,345.00" "$1,345.00" $998.26 $998.26 "$1,036.73" $700.75 $280.31 "$1,345.00" $540.81 "$1,345.00" "$1,345.00" "$1,352.03" "$1,345.00" "$1,345.00" "$1,008.75" "$1,345.00" "$1,345.00" "$1,345.00" $672.50 $672.50 "$1,065.24" "$1,345.00" "$1,076.00" $874.25 "$1,345.00" N/A $780.10 "$1,345.00" $807.00 "$1,345.00" "$1,345.00" "$1,345.00" N/A N/A 80010 SUP Custom 27803010 80010 - IMPLANT ORBTL 18MM SPHERE SMOOTH SUTURE TUNNELS POROUS BOTH IP/OP "$1,630.50" "$1,207.00" $290.16 "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" $290.16 "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" $339.74 "$1,630.13" $652.05 "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$1,222.88" "$1,630.13" "$1,630.13" "$1,630.13" $815.07 $815.07 "$1,291.06" "$1,630.13" "$1,304.10" $733.56 "$1,630.13" N/A $945.69 "$1,630.13" $978.08 "$1,630.13" "$1,630.13" "$1,630.13" N/A N/A 80018 SUP Custom 27203010 80018 - IMPLANT ORBTL 18MM CONICAL MULTPUR SMOOTH SUTURE TUNNELS BOTH IP/OP "$1,912.50" "$1,415.00" $340.43 "$1,912.50" "$1,912.50" "$1,912.50" "$1,912.50" "$1,912.50" "$1,912.50" "$1,912.50" $340.43 "$1,912.50" "$1,912.50" "$1,419.46" "$1,419.46" "$1,474.16" $996.41 $398.59 "$1,912.50" $765.00 "$1,912.50" "$1,912.50" "$1,912.50" "$1,912.50" "$1,912.50" "$1,434.38" "$1,912.50" "$1,912.50" "$1,912.50" $956.25 $956.25 "$1,514.70" "$1,912.50" "$1,530.00" "$1,243.13" "$1,912.50" N/A "$1,109.25" "$1,912.50" "$1,147.50" "$1,912.50" "$1,912.50" "$1,912.50" N/A N/A 80022 SUP Custom 27803010 80022 - QUAD Motility Implant - Extra Large (Approx. 22mm volume) BOTH IP/OP "$1,188.50" $879.00 $211.47 "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" $211.47 "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" $247.60 "$1,188.06" $475.22 "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" $891.38 "$1,188.06" "$1,188.06" "$1,188.06" $594.03 $594.03 $940.94 "$1,188.06" $950.45 $534.63 "$1,188.06" N/A $689.33 "$1,188.06" $712.84 "$1,188.06" "$1,188.06" "$1,188.06" N/A N/A 80026 SUP Custom 27803010 80026 - IMPLANT ORBTL CONICAL CONICAL FLAT ANTERIOR SURFACE CHANNELS BOTH IP/OP "$1,188.50" $879.00 $211.47 "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" $211.47 "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" $247.60 "$1,188.06" $475.22 "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" "$1,188.06" $891.38 "$1,188.06" "$1,188.06" "$1,188.06" $594.03 $594.03 $940.94 "$1,188.06" $950.45 $534.63 "$1,188.06" N/A $689.33 "$1,188.06" $712.84 "$1,188.06" "$1,188.06" "$1,188.06" N/A N/A 80036 SUP Custom 27803010 80036 - IMPLANT ORBTL 16MM SPHERE BIOCOMPATIBLE POROUS MEDPOR PLUS BOTH IP/OP "$1,277.50" $945.00 $227.34 "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" $227.34 "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" $266.18 "$1,277.20" $510.88 "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" $958.13 "$1,277.20" "$1,277.20" "$1,277.20" $638.60 $638.60 "$1,011.54" "$1,277.20" "$1,021.76" $574.74 "$1,277.20" N/A $740.95 "$1,277.20" $766.32 "$1,277.20" "$1,277.20" "$1,277.20" N/A N/A 80038 SUP Custom 27803010 80038 - IMPLANT ORBTL STANDARD SPHERE 18MM MEDPOR PLUS BIOACTIVE BOTH IP/OP "$1,742.50" "$1,289.00" $310.17 "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" $310.17 "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" $363.16 "$1,742.50" $697.00 "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" "$1,306.88" "$1,742.50" "$1,742.50" "$1,742.50" $871.25 $871.25 "$1,380.06" "$1,742.50" "$1,394.00" $784.13 "$1,742.50" N/A "$1,010.65" "$1,742.50" "$1,045.50" "$1,742.50" "$1,742.50" "$1,742.50" N/A N/A 80040 SUP Custom 27803010 80040 - IMPLANT ORBTL 20MM SPHERE BIOCOMPATIBLE POROUS MEDPOR PLUS BOTH IP/OP "$1,277.50" $945.00 $227.34 "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" $227.34 "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" $266.18 "$1,277.20" $510.88 "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" $958.13 "$1,277.20" "$1,277.20" "$1,277.20" $638.60 $638.60 "$1,011.54" "$1,277.20" "$1,021.76" $574.74 "$1,277.20" N/A $740.95 "$1,277.20" $766.32 "$1,277.20" "$1,277.20" "$1,277.20" N/A N/A 80042 SUP Custom 27803010 80042 - IMPLANT ORBTL 22MM SPHERE POROUS MEDPOR PLUS POLYETHYLENE BOTH IP/OP "$1,277.50" $945.00 $227.34 "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" $227.34 "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" $266.18 "$1,277.20" $510.88 "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" "$1,277.20" $958.13 "$1,277.20" "$1,277.20" "$1,277.20" $638.60 $638.60 "$1,011.54" "$1,277.20" "$1,021.76" $574.74 "$1,277.20" N/A $740.95 "$1,277.20" $766.32 "$1,277.20" "$1,277.20" "$1,277.20" N/A N/A 80046 SUP Custom 27803010 80046 - IMPLANT ORBTL 16MM SPHERE SMOOTH SUTURE TUNNELS POROUS BOTH IP/OP "$1,483.50" "$1,098.00" $264.01 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" $264.01 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" $309.12 "$1,483.20" $593.28 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,112.63" "$1,483.20" "$1,483.20" "$1,483.20" $741.60 $741.60 "$1,174.69" "$1,483.20" "$1,186.56" $667.44 "$1,483.20" N/A $860.43 "$1,483.20" $889.92 "$1,483.20" "$1,483.20" "$1,483.20" N/A N/A 80048 SUP Custom 27803010 80048 - MEDPOR PLUS SST - 18mm BOTH IP/OP "$1,483.50" "$1,098.00" $4.23 "$1,112.63" $16.59 $16.59 $16.59 $16.59 $8.46 $8.46 $4.23 $4.23 $8.46 $12.85 $12.85 $13.35 $9.38 $12.52 $13.54 $13.54 $15.38 $8.46 $8.46 $8.46 $26.00 "$1,112.63" $8.46 $8.46 $8.46 $26.00 $26.00 $20.59 $8.46 $20.80 $13.96 $11.92 $8.46 $860.43 $26.00 $12.27 $8.46 $9.36 $8.46 24 N/A 80050 SUP Custom 27803010 80050 - MEDPOR PLUS SST - 20mm BOTH IP/OP "$1,483.50" "$1,098.00" $264.01 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" $264.01 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" $309.12 "$1,483.20" $593.28 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,112.63" "$1,483.20" "$1,483.20" "$1,483.20" $741.60 $741.60 "$1,174.69" "$1,483.20" "$1,186.56" $667.44 "$1,483.20" N/A $860.43 "$1,483.20" $889.92 "$1,483.20" "$1,483.20" "$1,483.20" 54.5 N/A 80052 SUP Custom 27803010 80052 - KIT RTRV 4MM .018IN 32MM STRL LF 20MM TREVO XP PROVUE TREVO BOTH IP/OP "$1,483.50" "$1,098.00" $264.01 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" $264.01 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" $309.12 "$1,483.20" $593.28 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,112.63" "$1,483.20" "$1,483.20" "$1,483.20" $741.60 $741.60 "$1,174.69" "$1,483.20" "$1,186.56" $667.44 "$1,483.20" N/A $860.43 "$1,483.20" $889.92 "$1,483.20" "$1,483.20" "$1,483.20" N/A N/A 80052 SUP Custom 27803010 80052 - KIT RETRIEVER 18MM 20X4MM 32MM MICROCATHETER FLEXCELL TREVO BOTH IP/OP "$13,641.50" "$10,095.00" $264.01 "$10,231.13" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" $264.01 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" $309.12 "$1,483.20" $593.28 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$10,231.13" "$1,483.20" "$1,483.20" "$1,483.20" $741.60 $741.60 "$1,174.69" "$1,483.20" "$1,186.56" $667.44 "$1,483.20" N/A "$7,912.07" "$1,483.20" $889.92 "$1,483.20" "$1,483.20" "$1,483.20" N/A N/A 80056 SUP Custom 27803010 80056 - IMPLANT ORBTL 16MM SPHERE SMOOTH SUTURE TUNNELS POROUS BOTH IP/OP "$1,483.50" "$1,098.00" $264.01 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" $264.01 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" $309.12 "$1,483.20" $593.28 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,112.63" "$1,483.20" "$1,483.20" "$1,483.20" $741.60 $741.60 "$1,174.69" "$1,483.20" "$1,186.56" $667.44 "$1,483.20" N/A $860.43 "$1,483.20" $889.92 "$1,483.20" "$1,483.20" "$1,483.20" N/A N/A 80058 SUP Custom 27803010 80058 - SPHERE EYE 18MM SST EZ BOTH IP/OP "$1,483.50" "$1,098.00" $264.01 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" $264.01 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" $309.12 "$1,483.20" $593.28 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,112.63" "$1,483.20" "$1,483.20" "$1,483.20" $741.60 $741.60 "$1,174.69" "$1,483.20" "$1,186.56" $667.44 "$1,483.20" N/A $860.43 "$1,483.20" $889.92 "$1,483.20" "$1,483.20" "$1,483.20" N/A N/A 80060 SUP Custom 27803010 80060 - IMPLANT ORBTL ROUND 22MM SPHERE SMOOTH SURFACE SUTURE BOTH IP/OP "$1,483.50" "$1,098.00" $264.01 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" $264.01 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" $309.12 "$1,483.20" $593.28 "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,483.20" "$1,112.63" "$1,483.20" "$1,483.20" "$1,483.20" $741.60 $741.60 "$1,174.69" "$1,483.20" "$1,186.56" $667.44 "$1,483.20" N/A $860.43 "$1,483.20" $889.92 "$1,483.20" "$1,483.20" "$1,483.20" N/A N/A 80062 SUP Custom 27803010 80062 - IMPLANT ORBTL ROUND 22MM SPHERE SMOOTH SURFACE SUTURE BOTH IP/OP "$2,052.50" "$1,519.00" $365.35 "$2,052.50" "$2,052.50" "$2,052.50" "$2,052.50" "$2,052.50" "$2,052.50" "$2,052.50" $365.35 "$2,052.50" "$2,052.50" "$2,052.50" "$2,052.50" "$2,052.50" "$2,052.50" $427.76 "$2,052.50" $821.00 "$2,052.50" "$2,052.50" "$2,052.50" "$2,052.50" "$2,052.50" "$1,539.38" "$2,052.50" "$2,052.50" "$2,052.50" "$1,026.25" "$1,026.25" "$1,625.58" "$2,052.50" "$1,642.00" $923.63 "$2,052.50" N/A "$1,190.45" "$2,052.50" "$1,231.50" "$2,052.50" "$2,052.50" "$2,052.50" N/A N/A 80400 SUP HCPCS C1751 0080400 - DRAIN INCISION 15X5/8IN 3 LUMEN ANTIBACTERIAL FILTER SUMP BOTH IP/OP $56.00 $41.00 $11.09 $55.90 $30.35 $30.35 $30.35 $30.35 $55.90 $55.90 $55.90 $11.65 $55.90 $41.49 $41.49 $43.09 $29.12 $11.65 $55.90 $53.25 $33.06 $55.90 $53.25 $55.90 $55.90 $42.00 $55.90 $55.90 $55.90 $27.95 $27.95 $44.27 $55.90 $44.72 $36.34 $11.09 N/A $32.48 $55.90 $55.90 $55.90 $11.65 $55.90 83 N/A 81001 SUP Custom 27803010 81001 - IMPLANT ORBT 40X40X8.45MM STRL MDPR ONLAY PE POR LT CRNMXF BOTH IP/OP "$1,372.00" "$1,015.00" $244.14 "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" $244.14 "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" $285.85 "$1,371.58" $548.63 "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,029.00" "$1,371.58" "$1,371.58" "$1,371.58" $685.79 $685.79 "$1,086.29" "$1,371.58" "$1,097.26" $617.21 "$1,371.58" N/A $795.76 "$1,371.58" $822.95 "$1,371.58" "$1,371.58" "$1,371.58" 9.5 N/A 81002 SUP Custom 27803010 81002 - GRAFT SYNTH TISSUE 40X40MM ONLAY MEDPOR POLYETHYLENE POROUS BOTH IP/OP "$1,372.00" "$1,015.00" $244.14 "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" $244.14 "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" $285.85 "$1,371.58" $548.63 "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,371.58" "$1,029.00" "$1,371.58" "$1,371.58" "$1,371.58" $685.79 $685.79 "$1,086.29" "$1,371.58" "$1,097.26" $617.21 "$1,371.58" N/A $795.76 "$1,371.58" $822.95 "$1,371.58" "$1,371.58" "$1,371.58" 7.5 N/A 81007 SUP Custom 27803010 81007 - GRAFT SYNTH TISSUE 33X45MM IMPLANT POROUS MEDPOR BOTH IP/OP "$1,387.50" "$1,027.00" $246.98 "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" $246.98 "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" $289.17 "$1,387.50" $555.00 "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" "$1,040.63" "$1,387.50" "$1,387.50" "$1,387.50" $693.75 $693.75 "$1,098.90" "$1,387.50" "$1,110.00" $624.38 "$1,387.50" N/A $804.75 "$1,387.50" $832.50 "$1,387.50" "$1,387.50" "$1,387.50" 9.5 N/A 81008 SUP Custom 27803010 81008 - GRAFT SYNTH TISSUE 45X33MM IMPLANT POROUS MEDPOR BOTH IP/OP "$1,387.50" "$1,027.00" $246.98 "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" $246.98 "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" $289.17 "$1,387.50" $555.00 "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" "$1,387.50" "$1,040.63" "$1,387.50" "$1,387.50" "$1,387.50" $693.75 $693.75 "$1,098.90" "$1,387.50" "$1,110.00" $624.38 "$1,387.50" N/A $804.75 "$1,387.50" $832.50 "$1,387.50" "$1,387.50" "$1,387.50" N/A N/A 81013 SUP Custom 27803010 81013 - GRAFT SYNTH TISSUE 30MM 38X33X.8MM IMPLANT ORBITO-ZYGOMATIC BOTH IP/OP "$1,984.50" "$1,469.00" $353.18 "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" $353.18 "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" $413.52 "$1,984.15" $793.66 "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" "$1,488.38" "$1,984.15" "$1,984.15" "$1,984.15" $992.08 $992.08 "$1,571.45" "$1,984.15" "$1,587.32" $892.87 "$1,984.15" N/A "$1,151.01" "$1,984.15" "$1,190.49" "$1,984.15" "$1,984.15" "$1,984.15" N/A N/A 81014 SUP Custom 27803010 81014 - IMPLANT ORBT 38X33X.8MM TRM OFF THE SHLF MDPR RT BOTH IP/OP "$1,984.50" "$1,469.00" $353.18 "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" $353.18 "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" $413.52 "$1,984.15" $793.66 "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" "$1,984.15" "$1,488.38" "$1,984.15" "$1,984.15" "$1,984.15" $992.08 $992.08 "$1,571.45" "$1,984.15" "$1,587.32" $892.87 "$1,984.15" N/A "$1,151.01" "$1,984.15" "$1,190.49" "$1,984.15" "$1,984.15" "$1,984.15" N/A N/A 81020 SUP Custom 27803010 81020 - MESH CRANIAL 76X50X.85MM EMBED SHEET MEDPOR TITAN MEDPOR BOTH IP/OP "$2,677.50" "$1,981.00" $476.60 "$2,677.50" "$2,677.50" "$2,677.50" "$2,677.50" "$2,677.50" "$2,677.50" "$2,677.50" $476.60 "$2,677.50" "$2,677.50" "$2,677.50" "$2,677.50" "$2,677.50" "$2,677.50" $558.02 "$2,677.50" "$1,071.00" "$2,677.50" "$2,677.50" "$2,677.50" "$2,677.50" "$2,677.50" "$2,008.13" "$2,677.50" "$2,677.50" "$2,677.50" "$1,338.75" "$1,338.75" "$2,120.58" "$2,677.50" "$2,142.00" "$1,204.88" "$2,677.50" N/A "$1,552.95" "$2,677.50" "$1,606.50" "$2,677.50" "$2,677.50" "$2,677.50" 8 N/A 81021 SUP Custom 27803010 81021 - PLATE BONE 38X50X.85MM MESH EMBEDDED POROUS MEDPOR TITAN MTM BOTH IP/OP "$1,958.50" "$1,449.00" $348.54 "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" $348.54 "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" $408.09 "$1,958.10" $783.24 "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" "$1,468.88" "$1,958.10" "$1,958.10" "$1,958.10" $979.05 $979.05 "$1,550.82" "$1,958.10" "$1,566.48" $881.15 "$1,958.10" N/A "$1,135.93" "$1,958.10" "$1,174.86" "$1,958.10" "$1,958.10" "$1,958.10" N/A N/A 81022 SUP Custom 27803010 81022 - PLATE BONE 38X50X1.5MM MESH EMBEDDED POROUS MEDPOR TITAN MTM BOTH IP/OP "$1,958.50" "$1,449.00" $348.54 "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" $348.54 "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" $408.09 "$1,958.10" $783.24 "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" "$1,958.10" "$1,468.88" "$1,958.10" "$1,958.10" "$1,958.10" $979.05 $979.05 "$1,550.82" "$1,958.10" "$1,566.48" $881.15 "$1,958.10" N/A "$1,135.93" "$1,958.10" "$1,174.86" "$1,958.10" "$1,958.10" "$1,958.10" N/A N/A 81023 SUP Custom 27803010 81023 - PLATE BONE 76X50X1.5MM MESH EMBEDDED POROUS MEDPOR TITAN MTM BOTH IP/OP "$2,447.50" "$1,811.00" $435.61 "$2,447.23" "$2,447.23" "$2,447.23" "$2,447.23" "$2,447.23" "$2,447.23" "$2,447.23" $435.61 "$2,447.23" "$2,447.23" "$2,447.23" "$2,447.23" "$2,447.23" "$2,447.23" $510.03 "$2,447.23" $978.89 "$2,447.23" "$2,447.23" "$2,447.23" "$2,447.23" "$2,447.23" "$1,835.63" "$2,447.23" "$2,447.23" "$2,447.23" "$1,223.62" "$1,223.62" "$1,938.21" "$2,447.23" "$1,957.78" "$1,101.25" "$2,447.23" N/A "$1,419.55" "$2,447.23" "$1,468.34" "$2,447.23" "$2,447.23" "$2,447.23" N/A N/A 81024 SUP Custom 27803010 81024 - PLATE BONE 38X50X.6MM MESH EMBEDDED NONPOROUS BARRIER BOTH IP/OP "$2,301.50" "$1,703.00" $409.67 "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" $409.67 "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" $479.66 "$2,301.50" $920.60 "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$1,726.13" "$2,301.50" "$2,301.50" "$2,301.50" "$1,150.75" "$1,150.75" "$1,822.79" "$2,301.50" "$1,841.20" "$1,035.68" "$2,301.50" N/A "$1,334.87" "$2,301.50" "$1,380.90" "$2,301.50" "$2,301.50" "$2,301.50" N/A N/A 81025 SUP Custom 27803010 81025 - MESH CRANIAL 76X50X.6MM EMBED SHEET MEDPOR TITAN BARRIER BOTH IP/OP "$2,791.00" "$2,065.00" $3.87 "$2,093.25" $12.40 $12.40 $12.40 $12.40 $8.61 $8.61 $4.31 $3.87 $8.61 $9.61 $9.61 $9.98 $7.01 $9.36 $13.78 $13.78 $15.38 $8.61 $8.61 $8.61 $26.00 "$2,093.25" $8.61 $8.61 $8.61 $26.00 $26.00 $20.59 $8.61 $20.80 $14.21 $8.91 $8.61 "$1,618.78" $26.00 $12.48 $8.61 $7.00 $8.61 14.5 N/A 81026 SUP Custom 27803010 81026 - MESH CRANIAL 38X50X1MM EMBED SHEET SOLID MEDPOR TITAN DOUBLE BOTH IP/OP "$2,301.50" "$1,703.00" $409.67 "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" $409.67 "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" $479.66 "$2,301.50" $920.60 "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$1,726.13" "$2,301.50" "$2,301.50" "$2,301.50" "$1,150.75" "$1,150.75" "$1,822.79" "$2,301.50" "$1,841.20" "$1,035.68" "$2,301.50" N/A "$1,334.87" "$2,301.50" "$1,380.90" "$2,301.50" "$2,301.50" "$2,301.50" N/A N/A 81027 SUP Custom 27803010 81027 - MESH CRANIAL 76X50X1MM EMBED SHEET SOLID MEDPOR TITAN DOUBLE BOTH IP/OP "$2,791.00" "$2,065.00" $496.73 "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" $496.73 "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" $581.60 "$2,790.63" "$1,116.25" "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" "$2,093.25" "$2,790.63" "$2,790.63" "$2,790.63" "$1,395.32" "$1,395.32" "$2,210.18" "$2,790.63" "$2,232.50" "$1,255.78" "$2,790.63" N/A "$1,618.78" "$2,790.63" "$1,674.38" "$2,790.63" "$2,790.63" "$2,790.63" N/A N/A 81028 SUP Custom 27803010 81028 - PLATE BONE 50X38X1.6MM SHEET SOLID SURFACE MTB POLYETHYLENE BOTH IP/OP "$2,301.50" "$1,703.00" $409.67 "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" $409.67 "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" $479.66 "$2,301.50" $920.60 "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$2,301.50" "$1,726.13" "$2,301.50" "$2,301.50" "$2,301.50" "$1,150.75" "$1,150.75" "$1,822.79" "$2,301.50" "$1,841.20" "$1,035.68" "$2,301.50" N/A "$1,334.87" "$2,301.50" "$1,380.90" "$2,301.50" "$2,301.50" "$2,301.50" N/A N/A 81029 SUP Custom 27803010 81029 - PLATE BONE 76X50X1.6MM MESH EMBEDDED NONPOROUS BARRIER BOTH IP/OP "$2,791.00" "$2,065.00" $496.73 "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" $496.73 "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" $581.60 "$2,790.63" "$1,116.25" "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" "$2,790.63" "$2,093.25" "$2,790.63" "$2,790.63" "$2,790.63" "$1,395.32" "$1,395.32" "$2,210.18" "$2,790.63" "$2,232.50" "$1,255.78" "$2,790.63" N/A "$1,618.78" "$2,790.63" "$1,674.38" "$2,790.63" "$2,790.63" "$2,790.63" N/A N/A 81030 SUP Custom 27803010 81030 - GRAFT SYNTH TISSUE 41X42X.85MM MESH EMBED MEDPOR TITAN BOTH IP/OP "$2,100.00" "$1,554.00" $373.79 "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" $373.79 "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" $437.65 "$2,099.93" $839.97 "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" "$1,575.00" "$2,099.93" "$2,099.93" "$2,099.93" "$1,049.97" "$1,049.97" "$1,663.14" "$2,099.93" "$1,679.94" $944.97 "$2,099.93" N/A "$1,218.00" "$2,099.93" "$1,259.96" "$2,099.93" "$2,099.93" "$2,099.93" N/A N/A 81031 SUP Custom 27803010 81031 - PLATE BN 42X41X1MM STRL MDPR TN MTB MESH EMBED XTN TI PE BOTH IP/OP "$2,352.00" "$1,740.00" $418.66 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $418.66 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" "$2,352.00" N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" "$2,352.00" "$2,352.00" N/A N/A 81032 SUP Custom 27803010 81032 - PLATE BONE 42X41X1MM MESH EMBED EXTN MEDPOR TITAN MTB BOTH IP/OP "$2,352.00" "$1,740.00" $418.66 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $418.66 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" "$2,352.00" N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" "$2,352.00" "$2,352.00" N/A N/A 81033 SUP Custom 27803010 81033 - PLATE BONE 42X41X.6MM MESH EMBED EXTN MEDPOR TITAN DOUBLE BOTH IP/OP "$2,352.00" "$1,740.00" $418.66 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $418.66 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" "$2,352.00" N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" "$2,352.00" "$2,352.00" N/A N/A 81034 SUP Custom 27803010 81034 - GRAFT SYNTH TISSUE 41X42X.85MM MESH EMBED MEDPOR TITAN MAX BOTH IP/OP "$2,100.00" "$1,554.00" $373.79 "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" $373.79 "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" $437.65 "$2,099.93" $839.97 "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" "$2,099.93" "$1,575.00" "$2,099.93" "$2,099.93" "$2,099.93" "$1,049.97" "$1,049.97" "$1,663.14" "$2,099.93" "$1,679.94" $944.97 "$2,099.93" N/A "$1,218.00" "$2,099.93" "$1,259.96" "$2,099.93" "$2,099.93" "$2,099.93" N/A N/A 81035 SUP Custom 27803010 81035 - PLATE BONE 42X41X1MM MESH EMBED EXTN MEDPOR TITAN BARRIER BOTH IP/OP "$2,352.00" "$1,740.00" $418.66 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $418.66 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" "$2,352.00" N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" "$2,352.00" "$2,352.00" N/A N/A 81036 SUP Custom 27803010 81036 - PLATE BONE THK1MM 42X41X1MM MESH EMBEDDED EXTENSIONS POROUS BOTH IP/OP "$2,352.00" "$1,740.00" $418.66 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $418.66 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" "$2,352.00" N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" "$2,352.00" "$2,352.00" N/A N/A 81037 SUP Custom 27803010 81037 - PLATE BONE THIN PROFILE 130X130X3MM RADIOPQ MEDPOR TITANIUM BOTH IP/OP "$15,775.50" "$11,674.00" "$2,808.04" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$2,808.04" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$3,287.79" "$15,775.50" "$6,310.20" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$11,831.63" "$15,775.50" "$15,775.50" "$15,775.50" "$7,887.75" "$7,887.75" "$12,494.20" "$15,775.50" "$12,620.40" "$7,098.98" "$15,775.50" N/A "$9,149.79" "$15,775.50" "$9,465.30" "$15,775.50" "$15,775.50" "$15,775.50" N/A N/A 81038 SUP Custom 27803010 81038 - PLATE BONE 130X130X3MM MESH EMBEDDED POROUS MEDPOR TITAN BOTH IP/OP "$15,775.50" "$11,674.00" "$2,808.04" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$2,808.04" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$3,287.79" "$15,775.50" "$6,310.20" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$15,775.50" "$11,831.63" "$15,775.50" "$15,775.50" "$15,775.50" "$7,887.75" "$7,887.75" "$12,494.20" "$15,775.50" "$12,620.40" "$7,098.98" "$15,775.50" N/A "$9,149.79" "$15,775.50" "$9,465.30" "$15,775.50" "$15,775.50" "$15,775.50" N/A N/A 81040 SUP Custom 27803010 81040 - PLATE BONE 76X100X1.5MM MESH EMBEDDED SHEET POROUS MEDPOR BOTH IP/OP "$5,757.00" "$4,260.00" "$1,024.73" "$5,756.90" "$5,756.90" "$5,756.90" "$5,756.90" "$5,756.90" "$5,756.90" "$5,756.90" "$1,024.73" "$5,756.90" "$5,756.90" "$5,756.90" "$5,756.90" "$5,756.90" "$5,756.90" "$1,199.80" "$5,756.90" "$2,302.76" "$5,756.90" "$5,756.90" "$5,756.90" "$5,756.90" "$5,756.90" "$4,317.75" "$5,756.90" "$5,756.90" "$5,756.90" "$2,878.45" "$2,878.45" "$4,559.46" "$5,756.90" "$4,605.52" "$2,590.61" "$5,756.90" N/A "$3,339.06" "$5,756.90" "$3,454.14" "$5,756.90" "$5,756.90" "$5,756.90" N/A N/A 81044 SUP Custom 27203010 81044 - POUCH SPEC RTRVL 10MM STRL ENDO-SOCK SLF OPN FLD TIGHT DISP BOTH IP/OP $210.00 $155.00 $121.80 $157.50 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $157.50 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $121.80 N/A N/A N/A N/A N/A N/A N/A 81050 SUP HCPCS C1713 81050 - PLATE BONE FAN MTB CRANFCL BOTH IP/OP "$2,546.50" "$1,884.00" $505.37 "$2,546.25" "$1,145.81" "$1,145.81" "$1,145.81" "$1,145.81" "$2,546.25" "$2,546.25" "$2,546.25" $530.70 "$2,546.25" "$2,546.25" "$2,546.25" "$2,546.25" "$2,546.25" $530.67 "$2,546.25" "$2,546.25" "$1,255.30" "$2,546.25" "$2,546.25" "$2,546.25" "$2,546.25" "$1,909.88" "$2,546.25" "$2,546.25" "$2,546.25" "$1,273.13" "$1,273.13" "$2,016.63" "$2,546.25" "$2,037.00" "$1,145.81" $505.37 N/A "$1,476.97" "$2,546.25" "$1,527.75" "$2,546.25" $530.64 "$2,546.25" 7.5 N/A 81060 SUP Custom 27803010 81060 - IMPLANT MANDIB 30X15X.25MM BIOCOMPATIBLE SPACE MAINTENANCE BOTH IP/OP $477.50 $353.00 $85.00 $477.50 $477.50 $477.50 $477.50 $477.50 $477.50 $477.50 $85.00 $477.50 $477.50 $477.50 $477.50 $477.50 $477.50 $99.52 $477.50 $191.00 $477.50 $477.50 $477.50 $477.50 $477.50 $358.13 $477.50 $477.50 $477.50 $238.75 $238.75 $378.18 $477.50 $382.00 $214.88 $477.50 N/A $276.95 $477.50 $286.50 $477.50 $477.50 $477.50 N/A N/A 81061 SUP Custom 27803010 81061 - IMPLANT MANDIB 30X25X.25MM BIOCOMPATIBLE SPACE MAINTENANCE BOTH IP/OP $720.00 $533.00 $128.16 $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $128.16 $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $150.06 $720.00 $288.00 $720.00 $720.00 $720.00 $720.00 $720.00 $540.00 $720.00 $720.00 $720.00 $360.00 $360.00 $570.24 $720.00 $576.00 $324.00 $720.00 N/A $417.60 $720.00 $432.00 $720.00 $720.00 $720.00 N/A N/A 81062 SUP Custom 27803010 81062 - GRAFT SYNTH TISSUE ULTRATHIN 35X45X.25IN SHEET CONTAINMENT BOTH IP/OP $957.50 $709.00 $170.44 $957.50 $957.50 $957.50 $957.50 $957.50 $957.50 $957.50 $170.44 $957.50 $957.50 $957.50 $957.50 $957.50 $957.50 $199.55 $957.50 $383.00 $957.50 $957.50 $957.50 $957.50 $957.50 $718.13 $957.50 $957.50 $957.50 $478.75 $478.75 $758.34 $957.50 $766.00 $430.88 $957.50 N/A $555.35 $957.50 $574.50 $957.50 $957.50 $957.50 N/A N/A 81063 SUP Custom 27803010 81063 - IMPLANT MANDIB 30X15X.35MM BIOCOMPATIBLE SPACE MAINTENANCE BOTH IP/OP $348.50 $258.00 $62.02 $348.43 $348.43 $348.43 $348.43 $348.43 $348.43 $348.43 $62.02 $348.43 $348.43 $348.43 $348.43 $348.43 $348.43 $72.62 $348.43 $139.37 $348.43 $348.43 $348.43 $348.43 $348.43 $261.38 $348.43 $348.43 $348.43 $174.22 $174.22 $275.96 $348.43 $278.74 $156.79 $348.43 N/A $202.13 $348.43 $209.06 $348.43 $348.43 $348.43 N/A N/A 81064 SUP Custom 27803010 81064 - IMPLANT MANDIB 30X25X.35MM BIOCOMPATIBLE SPACE MAINTENANCE BOTH IP/OP $527.50 $390.00 $93.89 $527.45 $527.45 $527.45 $527.45 $527.45 $527.45 $527.45 $93.89 $527.45 $527.45 $527.45 $527.45 $527.45 $527.45 $109.93 $527.45 $210.98 $527.45 $527.45 $527.45 $527.45 $527.45 $395.63 $527.45 $527.45 $527.45 $263.73 $263.73 $417.74 $527.45 $421.96 $237.35 $527.45 N/A $305.95 $527.45 $316.47 $527.45 $527.45 $527.45 N/A N/A 81065 SUP Custom 27803010 81065 - IMPLANT MANDIB 45X35X.35MM BIOCOMPATIBLE SPACE MAINTENANCE BOTH IP/OP $703.00 $520.00 $125.07 $702.63 $702.63 $702.63 $702.63 $702.63 $702.63 $702.63 $125.07 $702.63 $702.63 $702.63 $702.63 $702.63 $702.63 $146.44 $702.63 $281.05 $702.63 $702.63 $702.63 $702.63 $702.63 $527.25 $702.63 $702.63 $702.63 $351.32 $351.32 $556.48 $702.63 $562.10 $316.18 $702.63 N/A $407.74 $702.63 $421.58 $702.63 $702.63 $702.63 N/A N/A 81066 SUP Custom 27803010 81066 - IMPLANT MANDIB 30X15X.45MM BIOCOMPATIBLE SPACE MAINTENANCE BOTH IP/OP $477.50 $353.00 $85.00 $477.50 $477.50 $477.50 $477.50 $477.50 $477.50 $477.50 $85.00 $477.50 $477.50 $477.50 $477.50 $477.50 $477.50 $99.52 $477.50 $191.00 $477.50 $477.50 $477.50 $477.50 $477.50 $358.13 $477.50 $477.50 $477.50 $238.75 $238.75 $378.18 $477.50 $382.00 $214.88 $477.50 N/A $276.95 $477.50 $286.50 $477.50 $477.50 $477.50 N/A N/A 81067 SUP Custom 27803010 81067 - IMPLANT MANDIB 30X25X.45MM BIOCOMPATIBLE SPACE MAINTENANCE BOTH IP/OP $527.00 $390.00 $93.78 $526.88 $526.88 $526.88 $526.88 $526.88 $526.88 $526.88 $93.78 $526.88 $526.88 $526.88 $526.88 $526.88 $526.88 $109.81 $526.88 $210.75 $526.88 $526.88 $526.88 $526.88 $526.88 $395.25 $526.88 $526.88 $526.88 $263.44 $263.44 $417.29 $526.88 $421.50 $237.10 $526.88 N/A $305.66 $526.88 $316.13 $526.88 $526.88 $526.88 N/A N/A 81068 SUP Custom 27803010 81068 - IMPLANT MANDIB 35X45X.45MM BIOCOMPATIBLE SPACE MAINTENANCE BOTH IP/OP $701.50 $519.00 $124.82 $701.25 $701.25 $701.25 $701.25 $701.25 $701.25 $701.25 $124.82 $701.25 $701.25 $701.25 $701.25 $701.25 $701.25 $146.15 $701.25 $280.50 $701.25 $701.25 $701.25 $701.25 $701.25 $526.13 $701.25 $701.25 $701.25 $350.63 $350.63 $555.39 $701.25 $561.00 $315.56 $701.25 N/A $406.87 $701.25 $420.75 $701.25 $701.25 $701.25 N/A N/A 81200 SUP Custom 27803010 81200 - ROD SPNL 5.5MM 50MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81201 SUP Custom 27803010 81201 - ROD SPNL 5.5MM 60MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81202 SUP Custom 27803010 81202 - ROD SPNL 5.5MM 70MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81203 SUP Custom 27803010 81203 - ROD SPNL 5.5MM 80MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81204 SUP Custom 27803010 81204 - ROD SPNL 5.5MM 90MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81205 SUP Custom 27803010 81205 - ROD SPNL 5.5MM 100MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81206 SUP Custom 27803010 81206 - ROD SPNL 5.5MM 110MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81207 SUP Custom 27803010 81207 - ROD SPNL 5.5MM 120MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81208 SUP Custom 27803010 81208 - ROD SPNL 5.5MM 140MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81210 SUP Custom 27803010 81210 - ROD SPNL 5.5MM 160MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81211 SUP Custom 27803010 81211 - ROD SPNL 5.5MM 180MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81212 SUP Custom 27803010 81212 - ROD SPNL 5.5MM 220MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81213 SUP Custom 27803010 81213 - ROD SPNL 5.5MM 240MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81214 SUP Custom 27803010 81214 - ROD SPNL 5.5MM 260MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81215 SUP Custom 27803010 81215 - ROD SPNL 5.5MM 280MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81216 SUP Custom 27803010 81216 - ROD SPNL 5.5MM 300MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81217 SUP Custom 27803010 81217 - ROD SPNL 5.5MM 320MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81218 SUP Custom 27803010 81218 - ROD SPNL 5.5MM 340MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81219 SUP Custom 27803010 81219 - ROD SPNL 5.5MM 360MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 81220 SUP Custom 27803010 81220 - ROD SPNL 5.5MM 380MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 82000 SUP Custom 27203010 82000 - DRESSING PRSS 24CM SFGRD HMSTS MGMT PT CMFT EZ TO USE SMPL BOTH IP/OP $162.50 $120.00 $94.25 "$8,921.60" "$4,014.72" "$4,014.72" "$4,014.72" "$4,014.72" "$8,921.60" "$8,921.60" "$8,921.60" "$1,859.48" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$1,859.36" "$8,921.60" "$8,921.60" "$4,398.35" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" $121.88 "$8,921.60" "$8,921.60" "$8,921.60" "$4,460.80" "$4,460.80" "$7,065.91" "$8,921.60" "$7,137.28" "$4,014.72" "$1,770.71" N/A $94.25 "$8,921.60" "$8,921.60" "$8,921.60" "$1,859.26" "$8,921.60" N/A N/A 82000 SUP HCPCS C1763 82000 - GRAFT SYNTH TISSUE THK4MM HEMISPHERE CNTOUR POROUS MEDPOR BOTH IP/OP "$8,922.00" "$6,602.00" "$1,770.71" "$8,921.60" "$4,014.72" "$4,014.72" "$4,014.72" "$4,014.72" "$8,921.60" "$8,921.60" "$8,921.60" "$1,859.48" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$1,859.36" "$8,921.60" "$8,921.60" "$4,398.35" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$6,691.50" "$8,921.60" "$8,921.60" "$8,921.60" "$4,460.80" "$4,460.80" "$7,065.91" "$8,921.60" "$7,137.28" "$4,014.72" "$1,770.71" N/A "$5,174.76" "$8,921.60" "$8,921.60" "$8,921.60" "$1,859.26" "$8,921.60" N/A N/A 82001 SUP Custom 27803010 82001 - GRAFT SYNTH TISSUE HEMISPHERE 170X124X4.5MM OFF THE SHELF BOTH IP/OP "$8,922.00" "$6,602.00" "$1,588.04" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$1,588.04" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$1,859.36" "$8,921.60" "$3,568.64" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$6,691.50" "$8,921.60" "$8,921.60" "$8,921.60" "$4,460.80" "$4,460.80" "$7,065.91" "$8,921.60" "$7,137.28" "$4,014.72" "$8,921.60" N/A "$5,174.76" "$8,921.60" "$5,352.96" "$8,921.60" "$8,921.60" "$8,921.60" N/A N/A 82002 SUP HCPCS C1763 82002 - GRAFT SNTH TISS HMSPHR 170X124X6MM STRL MDPR PE POR RT CRNM BOTH IP/OP "$8,922.00" "$6,602.00" "$1,770.71" "$8,921.60" "$4,014.72" "$4,014.72" "$4,014.72" "$4,014.72" "$8,921.60" "$8,921.60" "$8,921.60" "$1,859.48" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$1,859.36" "$8,921.60" "$8,921.60" "$4,398.35" "$8,921.60" "$8,921.60" "$8,921.60" "$8,921.60" "$6,691.50" "$8,921.60" "$8,921.60" "$8,921.60" "$4,460.80" "$4,460.80" "$7,065.91" "$8,921.60" "$7,137.28" "$4,014.72" "$1,770.71" N/A "$5,174.76" "$8,921.60" "$8,921.60" "$8,921.60" "$1,859.26" "$8,921.60" N/A N/A 82006 SUP Custom 27803010 82006 - GRAFT SYNTH TISSUE DOME 180X150X6MM PRESHAPED POROUS MEDPOR BOTH IP/OP "$15,460.00" "$11,440.00" "$2,751.88" "$15,460.00" "$15,460.00" "$15,460.00" "$15,460.00" "$15,460.00" "$15,460.00" "$15,460.00" "$2,751.88" "$15,460.00" "$15,460.00" "$15,460.00" "$15,460.00" "$15,460.00" "$15,460.00" "$3,222.03" "$15,460.00" "$6,184.00" "$15,460.00" "$15,460.00" "$15,460.00" "$15,460.00" "$15,460.00" "$11,595.00" "$15,460.00" "$15,460.00" "$15,460.00" "$7,730.00" "$7,730.00" "$12,244.32" "$15,460.00" "$12,368.00" "$6,957.00" "$15,460.00" N/A "$8,966.80" "$15,460.00" "$9,276.00" "$15,460.00" "$15,460.00" "$15,460.00" N/A N/A 82007 SUP Custom 27803010 82007 - GRAFT SNTH TISS LG 20X2.5X2.5MM STRL MDPR TSI TAB NPOR POST BOTH IP/OP "$1,108.50" $820.00 $197.27 "$1,108.25" "$1,108.25" "$1,108.25" "$1,108.25" "$1,108.25" "$1,108.25" "$1,108.25" $197.27 "$1,108.25" "$1,108.25" "$1,108.25" "$1,108.25" "$1,108.25" "$1,108.25" $230.97 "$1,108.25" $443.30 "$1,108.25" "$1,108.25" "$1,108.25" "$1,108.25" "$1,108.25" $831.38 "$1,108.25" "$1,108.25" "$1,108.25" $554.13 $554.13 $877.73 "$1,108.25" $886.60 $498.71 "$1,108.25" N/A $642.93 "$1,108.25" $664.95 "$1,108.25" "$1,108.25" "$1,108.25" N/A N/A 82008 SUP Custom 27803010 82008 - GRAFT SYNTH TISSUE LARGE 40X40X2.5MM .73MM 3 TABS NONPOROUS BOTH IP/OP "$1,269.00" $939.00 $225.84 "$1,268.75" "$1,268.75" "$1,268.75" "$1,268.75" "$1,268.75" "$1,268.75" "$1,268.75" $225.84 "$1,268.75" "$1,268.75" "$1,268.75" "$1,268.75" "$1,268.75" "$1,268.75" $264.42 "$1,268.75" $507.50 "$1,268.75" "$1,268.75" "$1,268.75" "$1,268.75" "$1,268.75" $951.75 "$1,268.75" "$1,268.75" "$1,268.75" $634.38 $634.38 "$1,004.85" "$1,268.75" "$1,015.00" $570.94 "$1,268.75" N/A $736.02 "$1,268.75" $761.25 "$1,268.75" "$1,268.75" "$1,268.75" N/A N/A 82011 SUP Custom 27803010 82011 - GRAFT SYNTH TISSUE TRIANGLE 102X3.6X4MM 102X10X6MM IMPLANT BOTH IP/OP $672.00 $497.00 $119.62 $672.00 $672.00 $672.00 $672.00 $672.00 $672.00 $672.00 $119.62 $672.00 $672.00 $672.00 $672.00 $672.00 $672.00 $140.05 $672.00 $268.80 $672.00 $672.00 $672.00 $672.00 $672.00 $504.00 $672.00 $672.00 $672.00 $336.00 $336.00 $532.22 $672.00 $537.60 $302.40 $672.00 N/A $389.76 $672.00 $403.20 $672.00 $672.00 $672.00 N/A N/A 82013 SUP Custom 27803010 82013 - GRAFT SYNTH TISSUE .6MM V SHAPE 30X10X6MM IMPLANT CRANIOTOMY BOTH IP/OP $880.00 $651.00 $156.64 $880.00 $880.00 $880.00 $880.00 $880.00 $880.00 $880.00 $156.64 $880.00 $880.00 $880.00 $880.00 $880.00 $880.00 $183.40 $880.00 $352.00 $880.00 $880.00 $880.00 $880.00 $880.00 $660.00 $880.00 $880.00 $880.00 $440.00 $440.00 $696.96 $880.00 $704.00 $396.00 $880.00 N/A $510.40 $880.00 $528.00 $880.00 $880.00 $880.00 40.5 N/A 82014 SUP Custom 27803010 82014 - GRAFT SYNTH TISSUE SMALL 36X45X1MM IMPLANT POROUS MEDPOR BOTH IP/OP "$1,521.50" "$1,126.00" $270.83 "$1,521.50" "$1,521.50" "$1,521.50" "$1,521.50" "$1,521.50" "$1,521.50" "$1,521.50" $270.83 "$1,521.50" "$1,521.50" "$1,521.50" "$1,521.50" "$1,521.50" "$1,521.50" $317.10 "$1,521.50" $608.60 "$1,521.50" "$1,521.50" "$1,521.50" "$1,521.50" "$1,521.50" "$1,141.13" "$1,521.50" "$1,521.50" "$1,521.50" $760.75 $760.75 "$1,205.03" "$1,521.50" "$1,217.20" $684.68 "$1,521.50" N/A $882.47 "$1,521.50" $912.90 "$1,521.50" "$1,521.50" "$1,521.50" N/A N/A 82015 SUP Custom 27803010 82015 - GRAFT SYNTH TISSUE 58X56X1.5MM IMPLANT POROUS MEDPOR BOTH IP/OP "$1,974.50" "$1,461.00" $351.44 "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" $351.44 "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" $411.48 "$1,974.38" $789.75 "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" "$1,480.88" "$1,974.38" "$1,974.38" "$1,974.38" $987.19 $987.19 "$1,563.71" "$1,974.38" "$1,579.50" $888.47 "$1,974.38" N/A "$1,145.21" "$1,974.38" "$1,184.63" "$1,974.38" "$1,974.38" "$1,974.38" N/A N/A 82016 SUP Custom 27803010 82016 - GRAFT SYNTH TISSUE 58X56X1.5MM IMPLANT POROUS MEDPOR BOTH IP/OP "$1,974.50" "$1,461.00" $351.44 "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" $351.44 "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" $411.48 "$1,974.38" $789.75 "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" "$1,974.38" "$1,480.88" "$1,974.38" "$1,974.38" "$1,974.38" $987.19 $987.19 "$1,563.71" "$1,974.38" "$1,579.50" $888.47 "$1,974.38" N/A "$1,145.21" "$1,974.38" "$1,184.63" "$1,974.38" "$1,974.38" "$1,974.38" 52 N/A 82019 SUP Custom 27803010 82019 - PLATE BONE CURVE 48X38X.85MM MESH EMBED PRESHAPE MEDPOR BOTH IP/OP "$2,728.50" "$2,019.00" $485.65 "$2,728.38" "$2,728.38" "$2,728.38" "$2,728.38" "$2,728.38" "$2,728.38" "$2,728.38" $485.65 "$2,728.38" "$2,728.38" "$2,728.38" "$2,728.38" "$2,728.38" "$2,728.38" $568.62 "$2,728.38" "$1,091.35" "$2,728.38" "$2,728.38" "$2,728.38" "$2,728.38" "$2,728.38" "$2,046.38" "$2,728.38" "$2,728.38" "$2,728.38" "$1,364.19" "$1,364.19" "$2,160.88" "$2,728.38" "$2,182.70" "$1,227.77" "$2,728.38" N/A "$1,582.53" "$2,728.38" "$1,637.03" "$2,728.38" "$2,728.38" "$2,728.38" N/A N/A 82020 SUP Custom 27803010 82020 - PLATE BONE CURVE 48X38X1MM MESH EMBEDDED PCVD NONPOROUS BOTH IP/OP "$2,860.00" "$2,116.00" $509.04 "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" $509.04 "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" $596.00 "$2,859.75" "$1,143.90" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$2,145.00" "$2,859.75" "$2,859.75" "$2,859.75" "$1,429.88" "$1,429.88" "$2,264.92" "$2,859.75" "$2,287.80" "$1,286.89" "$2,859.75" N/A "$1,658.80" "$2,859.75" "$1,715.85" "$2,859.75" "$2,859.75" "$2,859.75" N/A N/A 82022 SUP Custom 27803010 82022 - GRAFT SYNTH TISSUE 91X56X4MM IMPLANT SMOOTH EXTERIOR SURFACE BOTH IP/OP "$3,712.00" "$2,747.00" $660.74 "$3,712.00" "$3,712.00" "$3,712.00" "$3,712.00" "$3,712.00" "$3,712.00" "$3,712.00" $660.74 "$3,712.00" "$3,712.00" "$3,712.00" "$3,712.00" "$3,712.00" "$3,712.00" $773.62 "$3,712.00" "$1,484.80" "$3,712.00" "$3,712.00" "$3,712.00" "$3,712.00" "$3,712.00" "$2,784.00" "$3,712.00" "$3,712.00" "$3,712.00" "$1,856.00" "$1,856.00" "$2,939.90" "$3,712.00" "$2,969.60" "$1,670.40" "$3,712.00" N/A "$2,152.96" "$3,712.00" "$2,227.20" "$3,712.00" "$3,712.00" "$3,712.00" N/A N/A 82030 SUP Custom 27803010 82030 - PLATE BONE 96X61X1.5MM IMPLANT POROUS MEDPOR TITAN TITANIUM BOTH IP/OP "$5,757.00" "$4,260.00" "$1,024.72" "$5,756.83" "$5,756.83" "$5,756.83" "$5,756.83" "$5,756.83" "$5,756.83" "$5,756.83" "$1,024.72" "$5,756.83" "$5,756.83" "$5,756.83" "$5,756.83" "$5,756.83" "$5,756.83" "$1,199.79" "$5,756.83" "$2,302.73" "$5,756.83" "$5,756.83" "$5,756.83" "$5,756.83" "$5,756.83" "$4,317.75" "$5,756.83" "$5,756.83" "$5,756.83" "$2,878.42" "$2,878.42" "$4,559.41" "$5,756.83" "$4,605.46" "$2,590.57" "$5,756.83" N/A "$3,339.06" "$5,756.83" "$3,454.10" "$5,756.83" "$5,756.83" "$5,756.83" 74.5 N/A 82301 SUP HCPCS B4088 082301 - TUBE JEJUNOSTOMY 9-18FR 60IN FEED COMPAT STAY-PUT BOTH IP/OP $466.50 $345.00 $2.70 $349.88 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $2.70 $7.07 $22.00 $4.39 $4.39 $4.56 $4.22 $3.31 $22.00 $8.80 $13.01 $22.00 $22.00 $22.00 $22.00 $349.88 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $3.16 $22.00 $270.57 $22.00 $13.20 $22.00 $3.16 $22.00 N/A N/A 83003 SUP Custom 27803010 83003 - GRAFT SYNTH TISSUE 47X28X3MM MEDPOR POLYETHYLENE POROUS BOTH IP/OP "$1,025.50" $759.00 $182.53 "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" $182.53 "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" $213.71 "$1,025.43" $410.17 "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" $769.13 "$1,025.43" "$1,025.43" "$1,025.43" $512.72 $512.72 $812.14 "$1,025.43" $820.34 $461.44 "$1,025.43" N/A $594.79 "$1,025.43" $615.26 "$1,025.43" "$1,025.43" "$1,025.43" 47 N/A 83004 SUP Custom 27803010 83004 - GRAFT SYNTH TISSUE 47X28X3MM MEDPOR POLYETHYLENE POROUS BOTH IP/OP "$1,025.50" $759.00 $182.53 "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" $182.53 "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" $213.71 "$1,025.43" $410.17 "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" $769.13 "$1,025.43" "$1,025.43" "$1,025.43" $512.72 $512.72 $812.14 "$1,025.43" $820.34 $461.44 "$1,025.43" N/A $594.79 "$1,025.43" $615.26 "$1,025.43" "$1,025.43" "$1,025.43" N/A N/A 83007 SUP Custom 27803010 83007 - GRAFT SNTH TISS 60X40X4MM STRL MDPR IMPL CNTR SHL-TY DSGN BOTH IP/OP "$1,025.50" $759.00 $182.53 "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" $182.53 "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" $213.71 "$1,025.43" $410.17 "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" $769.13 "$1,025.43" "$1,025.43" "$1,025.43" $512.72 $512.72 $812.14 "$1,025.43" $820.34 $461.44 "$1,025.43" N/A $594.79 "$1,025.43" $615.26 "$1,025.43" "$1,025.43" "$1,025.43" N/A N/A 83008 SUP Custom 27803010 83008 - GRAFT SNTH TISS 60X40MM STRL MDPR IMPL CNTR SHL-TY DSGN POR BOTH IP/OP "$1,025.50" $759.00 $182.53 "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" $182.53 "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" $213.71 "$1,025.43" $410.17 "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" "$1,025.43" $769.13 "$1,025.43" "$1,025.43" "$1,025.43" $512.72 $512.72 $812.14 "$1,025.43" $820.34 $461.44 "$1,025.43" N/A $594.79 "$1,025.43" $615.26 "$1,025.43" "$1,025.43" "$1,025.43" N/A N/A 83020 SUP Custom 27803010 83020 - GRAFT SYNTH TISSUE MICROTHIN 38X50X.25MM SHEET POROUS MEDPOR BOTH IP/OP $961.50 $712.00 $171.12 $961.35 $961.35 $961.35 $961.35 $961.35 $961.35 $961.35 $171.12 $961.35 $961.35 $961.35 $961.35 $961.35 $961.35 $200.36 $961.35 $384.54 $961.35 $961.35 $961.35 $961.35 $961.35 $721.13 $961.35 $961.35 $961.35 $480.68 $480.68 $761.39 $961.35 $769.08 $432.61 $961.35 N/A $557.67 $961.35 $576.81 $961.35 $961.35 $961.35 46 N/A 83021 SUP Custom 27803010 83021 - GRAFT SYNTH TISSUE MICROTHIN 76X50X.25MM SHEET POROUS MEDPOR BOTH IP/OP "$1,777.50" "$1,315.00" $316.40 "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" $316.40 "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" $370.45 "$1,777.50" $711.00 "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" "$1,333.13" "$1,777.50" "$1,777.50" "$1,777.50" $888.75 $888.75 "$1,407.78" "$1,777.50" "$1,422.00" $799.88 "$1,777.50" N/A "$1,030.95" "$1,777.50" "$1,066.50" "$1,777.50" "$1,777.50" "$1,777.50" 59 N/A 83022 SUP Custom 27803010 83022 - GRAFT SNTH 38X50X.35MM STRL OFF THE SHLF FTHR EDG SMTH TRNS BOTH IP/OP $949.50 $703.00 $168.93 $949.03 $949.03 $949.03 $949.03 $949.03 $949.03 $949.03 $168.93 $949.03 $949.03 $949.03 $949.03 $949.03 $949.03 $197.79 $949.03 $379.61 $949.03 $949.03 $949.03 $949.03 $949.03 $712.13 $949.03 $949.03 $949.03 $474.52 $474.52 $751.63 $949.03 $759.22 $427.06 $949.03 N/A $550.71 $949.03 $569.42 $949.03 $949.03 $949.03 N/A N/A 83023 SUP Custom 27803010 83023 - GRAFT SYNTH TISSUE MICROTHIN 76X50X.35MM SHEET POROUS MEDPOR BOTH IP/OP "$1,777.50" "$1,315.00" $316.40 "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" $316.40 "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" $370.45 "$1,777.50" $711.00 "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" "$1,777.50" "$1,333.13" "$1,777.50" "$1,777.50" "$1,777.50" $888.75 $888.75 "$1,407.78" "$1,777.50" "$1,422.00" $799.88 "$1,777.50" N/A "$1,030.95" "$1,777.50" "$1,066.50" "$1,777.50" "$1,777.50" "$1,777.50" N/A N/A 83029 SUP Custom 27803010 83029 - GRAFT SYNTH TISSUE MICROTHIN 50X38X.45MM SHEET POROUS MEDPOR BOTH IP/OP $949.50 $703.00 $168.93 $949.03 $949.03 $949.03 $949.03 $949.03 $949.03 $949.03 $168.93 $949.03 $949.03 $949.03 $949.03 $949.03 $949.03 $197.79 $949.03 $379.61 $949.03 $949.03 $949.03 $949.03 $949.03 $712.13 $949.03 $949.03 $949.03 $474.52 $474.52 $751.63 $949.03 $759.22 $427.06 $949.03 N/A $550.71 $949.03 $569.42 $949.03 $949.03 $949.03 N/A N/A 83030 SUP Custom 27803010 83030 - GRAFT SYNTH TISSUE MICROTHIN 76X50X.45MM SHEET MEDPOR POROUS BOTH IP/OP "$1,276.50" $945.00 $227.18 "$1,276.28" "$1,276.28" "$1,276.28" "$1,276.28" "$1,276.28" "$1,276.28" "$1,276.28" $227.18 "$1,276.28" "$1,276.28" "$1,276.28" "$1,276.28" "$1,276.28" "$1,276.28" $265.99 "$1,276.28" $510.51 "$1,276.28" "$1,276.28" "$1,276.28" "$1,276.28" "$1,276.28" $957.38 "$1,276.28" "$1,276.28" "$1,276.28" $638.14 $638.14 "$1,010.81" "$1,276.28" "$1,021.02" $574.33 "$1,276.28" N/A $740.37 "$1,276.28" $765.77 "$1,276.28" "$1,276.28" "$1,276.28" 29 N/A 84000 SUP Custom 27803010 84000 - GRAFT SYNTH TISSUE PETITE 45X4X4MM IMPLANT TAPERED PROFILE BOTH IP/OP $651.00 $482.00 $115.81 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $115.81 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $135.60 $650.63 $260.25 $650.63 $650.63 $650.63 $650.63 $650.63 $488.25 $650.63 $650.63 $650.63 $325.32 $325.32 $515.30 $650.63 $520.50 $292.78 $650.63 N/A $377.58 $650.63 $390.38 $650.63 $650.63 $650.63 N/A N/A 84001 SUP Custom 27803010 84001 - GRAFT SYNTH TISSUE PETITE 55X4X4MM IMPLANT TAPERED PROFILE BOTH IP/OP $651.00 $482.00 $115.81 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $115.81 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $135.60 $650.63 $260.25 $650.63 $650.63 $650.63 $650.63 $650.63 $488.25 $650.63 $650.63 $650.63 $325.32 $325.32 $515.30 $650.63 $520.50 $292.78 $650.63 N/A $377.58 $650.63 $390.38 $650.63 $650.63 $650.63 N/A N/A 84002 SUP Custom 27803010 84002 - GRAFT SYNTH TISSUE PETITE 45X5X5MM IMPLANT TAPERED PROFILE BOTH IP/OP $651.00 $482.00 $115.81 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $115.81 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $135.60 $650.63 $260.25 $650.63 $650.63 $650.63 $650.63 $650.63 $488.25 $650.63 $650.63 $650.63 $325.32 $325.32 $515.30 $650.63 $520.50 $292.78 $650.63 N/A $377.58 $650.63 $390.38 $650.63 $650.63 $650.63 N/A N/A 84003 SUP Custom 27803010 84003 - GRAFT SYNTH TISSUE PETITE 55X5X5MM IMPLANT TAPERED PROFILE BOTH IP/OP $651.00 $482.00 $115.81 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $115.81 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $135.60 $650.63 $260.25 $650.63 $650.63 $650.63 $650.63 $650.63 $488.25 $650.63 $650.63 $650.63 $325.32 $325.32 $515.30 $650.63 $520.50 $292.78 $650.63 N/A $377.58 $650.63 $390.38 $650.63 $650.63 $650.63 N/A N/A 84004 SUP Custom 27803010 84004 - GRAFT SYNTH TISSUE PETITE 55X9X6MM IMPLANT TAPERED PROFILE BOTH IP/OP $651.00 $482.00 $115.81 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $115.81 $650.63 $650.63 $650.63 $650.63 $650.63 $650.63 $135.60 $650.63 $260.25 $650.63 $650.63 $650.63 $650.63 $650.63 $488.25 $650.63 $650.63 $650.63 $325.32 $325.32 $515.30 $650.63 $520.50 $292.78 $650.63 N/A $377.58 $650.63 $390.38 $650.63 $650.63 $650.63 N/A N/A 84006 SUP Custom 27803010 84006 - IMPLANT FACIAL THIN SHELL NASAL DORSAL BOTH IP/OP "$1,130.00" $836.00 $201.14 "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" $201.14 "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" $235.50 "$1,130.00" $452.00 "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" "$1,130.00" $847.50 "$1,130.00" "$1,130.00" "$1,130.00" $565.00 $565.00 $894.96 "$1,130.00" $904.00 $508.50 "$1,130.00" N/A $655.40 "$1,130.00" $678.00 "$1,130.00" "$1,130.00" "$1,130.00" N/A N/A 84008 SUP Custom 27803010 84008 - GRAFT SYNTH TISSUE 40X4X1.4MM IMPLANT STRUTS PIN POROUS BOTH IP/OP $884.00 $654.00 $157.35 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $157.35 $884.00 $884.00 $884.00 $884.00 $884.00 $884.00 $184.24 $884.00 $353.60 $884.00 $884.00 $884.00 $884.00 $884.00 $663.00 $884.00 $884.00 $884.00 $442.00 $442.00 $700.13 $884.00 $707.20 $397.80 $884.00 N/A $512.72 $884.00 $530.40 $884.00 $884.00 $884.00 N/A N/A 84010 SUP Custom 27803010 84010 - IMPLANT FACIAL 37X22X.5MM TIP TOP MEDPOR NASAL BOTH IP/OP $901.00 $667.00 $160.36 $900.90 $900.90 $900.90 $900.90 $900.90 $900.90 $900.90 $160.36 $900.90 $900.90 $900.90 $900.90 $900.90 $900.90 $187.76 $900.90 $360.36 $900.90 $900.90 $900.90 $900.90 $900.90 $675.75 $900.90 $900.90 $900.90 $450.45 $450.45 $713.51 $900.90 $720.72 $405.41 $900.90 N/A $522.58 $900.90 $540.54 $900.90 $900.90 $900.90 N/A N/A 84012 SUP Custom 27803010 84012 - GRAFT SYNTH TISSUE 41X9X3MM ONLAY POROUS MEDPOR POLYETHYLENE BOTH IP/OP $777.50 $575.00 $138.38 $777.43 $777.43 $777.43 $777.43 $777.43 $777.43 $777.43 $138.38 $777.43 $777.43 $777.43 $777.43 $777.43 $777.43 $162.02 $777.43 $310.97 $777.43 $777.43 $777.43 $777.43 $777.43 $583.13 $777.43 $777.43 $777.43 $388.72 $388.72 $615.72 $777.43 $621.94 $349.84 $777.43 N/A $450.95 $777.43 $466.46 $777.43 $777.43 $777.43 N/A N/A 84129 SUP Custom 27803010 84129 - GRAFT SYNTH TISSUE SMALL 59X34X19.5MM IMPLANT S-SHAPE 1 BOTH IP/OP "$4,354.50" "$3,222.00" $775.04 "$4,354.13" "$4,354.13" "$4,354.13" "$4,354.13" "$4,354.13" "$4,354.13" "$4,354.13" $775.04 "$4,354.13" "$4,354.13" "$4,354.13" "$4,354.13" "$4,354.13" "$4,354.13" $907.45 "$4,354.13" "$1,741.65" "$4,354.13" "$4,354.13" "$4,354.13" "$4,354.13" "$4,354.13" "$3,265.88" "$4,354.13" "$4,354.13" "$4,354.13" "$2,177.07" "$2,177.07" "$3,448.47" "$4,354.13" "$3,483.30" "$1,959.36" "$4,354.13" N/A "$2,525.61" "$4,354.13" "$2,612.48" "$4,354.13" "$4,354.13" "$4,354.13" N/A N/A 84130 SUP Custom 27803010 84130 - GRAFT SYNTH TISSUE SMALL 59X34X19.5MM 1 PIECE MEDPOR EAR BOTH IP/OP "$3,886.00" "$2,876.00" $691.71 "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" $691.71 "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" $809.89 "$3,886.00" "$1,554.40" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$2,914.50" "$3,886.00" "$3,886.00" "$3,886.00" "$1,943.00" "$1,943.00" "$3,077.71" "$3,886.00" "$3,108.80" "$1,748.70" "$3,886.00" N/A "$2,253.88" "$3,886.00" "$2,331.60" "$3,886.00" "$3,886.00" "$3,886.00" N/A N/A 84131 SUP Custom 27803010 84131 - GRAFT SYNTH TISSUE MEDIUM 62X36X20.5MM IMPLANT S-SHAPE ONE BOTH IP/OP "$3,886.00" "$2,876.00" $691.71 "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" $691.71 "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" $809.89 "$3,886.00" "$1,554.40" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$2,914.50" "$3,886.00" "$3,886.00" "$3,886.00" "$1,943.00" "$1,943.00" "$3,077.71" "$3,886.00" "$3,108.80" "$1,748.70" "$3,886.00" N/A "$2,253.88" "$3,886.00" "$2,331.60" "$3,886.00" "$3,886.00" "$3,886.00" N/A N/A 84132 SUP Custom 27803010 84132 - GRAFT SYNTH TISSUE MEDIUM 62X36X20.5MM IMPLANT S-SHAPE 1 BOTH IP/OP "$3,886.00" "$2,876.00" $2.30 "$2,914.50" $9.04 $9.04 $9.04 $9.04 $4.76 $4.76 $2.38 $2.30 $4.76 $6.97 $6.97 $7.24 $5.09 $6.79 $7.62 $7.62 $8.87 $4.76 $4.76 $4.76 $15.00 "$2,914.50" $4.76 $4.76 $4.76 $15.00 $15.00 $11.88 $4.76 $12.00 $7.85 $6.47 $4.76 "$2,253.88" $15.00 $6.90 $4.76 $5.08 $4.76 15 N/A 84133 SUP Custom 27803010 84133 - GRAFT SYNTH TISSUE LARGE 65X37X21.5MM 1 PIECE EAR LEFT BOTH IP/OP "$3,886.00" "$2,876.00" $691.71 "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" $691.71 "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" $809.89 "$3,886.00" "$1,554.40" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$3,886.00" "$2,914.50" "$3,886.00" "$3,886.00" "$3,886.00" "$1,943.00" "$1,943.00" "$3,077.71" "$3,886.00" "$3,108.80" "$1,748.70" "$3,886.00" N/A "$2,253.88" "$3,886.00" "$2,331.60" "$3,886.00" "$3,886.00" "$3,886.00" 17.5 N/A 84134 SUP Custom 27803010 84134 - GRAFT SYNTH TISSUE LARGE 65X37X21.5MM 1 PIECE EAR RIGHT BOTH IP/OP "$4,004.00" "$2,963.00" $712.71 "$4,004.00" "$4,004.00" "$4,004.00" "$4,004.00" "$4,004.00" "$4,004.00" "$4,004.00" $712.71 "$4,004.00" "$4,004.00" "$4,004.00" "$4,004.00" "$4,004.00" "$4,004.00" $834.48 "$4,004.00" "$1,601.60" "$4,004.00" "$4,004.00" "$4,004.00" "$4,004.00" "$4,004.00" "$3,003.00" "$4,004.00" "$4,004.00" "$4,004.00" "$2,002.00" "$2,002.00" "$3,171.17" "$4,004.00" "$3,203.20" "$1,801.80" "$4,004.00" N/A "$2,322.32" "$4,004.00" "$2,402.40" "$4,004.00" "$4,004.00" "$4,004.00" 42.5 N/A 84505 SUP Custom 27803010 84505 - CONNECTOR ROD 7/7MM CLOSE BODY CD HORIZON DOMINO SPN BOTH IP/OP "$1,991.50" "$1,474.00" $354.44 "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" $354.44 "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" $415.00 "$1,991.25" $796.50 "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" "$1,493.63" "$1,991.25" "$1,991.25" "$1,991.25" $995.63 $995.63 "$1,577.07" "$1,991.25" "$1,593.00" $896.06 "$1,991.25" N/A "$1,155.07" "$1,991.25" "$1,194.75" "$1,991.25" "$1,991.25" "$1,991.25" N/A N/A 85040 SUP Custom 27203010 85040 - APPLICATOR FBRTP 6IN FOAM CTTN POLYPRO CSTM OVR 1IN 3/8IN BOTH IP/OP $152.00 $112.00 $26.99 $151.63 $151.63 $151.63 $151.63 $151.63 $151.63 $151.63 $26.99 $151.63 $151.63 $112.54 $112.54 $116.88 $79.00 $31.60 $151.63 $60.65 $151.63 $151.63 $151.63 $151.63 $151.63 $114.00 $151.63 $151.63 $151.63 $75.82 $75.82 $120.09 $151.63 $121.30 $98.56 $151.63 N/A $88.16 $151.63 $90.98 $151.63 $151.63 $151.63 N/A N/A 85201 SUP HCPCS C1768 85201 - GRAFT HEMASHIELD GRAFT? 20X10MM X 40L962.45 BOTH IP/OP "$1,688.50" "$1,249.00" $335.04 "$1,688.05" $759.62 $759.62 $759.62 $759.62 "$1,688.05" "$1,688.05" "$1,688.05" $351.83 "$1,688.05" "$1,688.05" "$1,688.05" "$1,688.05" "$1,688.05" $351.81 "$1,688.05" "$1,688.05" $998.48 "$1,688.05" "$1,688.05" "$1,688.05" "$1,688.05" "$1,266.38" "$1,688.05" "$1,688.05" "$1,688.05" $844.03 $844.03 "$1,336.94" "$1,688.05" "$1,350.44" $759.62 $335.04 N/A $979.33 "$1,688.05" "$1,688.05" "$1,688.05" $351.79 "$1,688.05" N/A N/A 85412 SUP HCPCS C1876 85412 - STENT TRCHBR 6MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO BOTH IP/OP "$6,125.00" "$4,533.00" "$1,215.66" "$6,125.00" "$2,756.25" "$2,756.25" "$2,756.25" "$2,756.25" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.60" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.52" "$6,125.00" "$6,125.00" "$3,019.63" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$4,593.75" "$6,125.00" "$6,125.00" "$6,125.00" "$3,062.50" "$3,062.50" "$4,851.00" "$6,125.00" "$4,900.00" "$2,756.25" "$1,215.66" N/A "$3,552.50" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.45" "$6,125.00" N/A N/A 85414 SUP HCPCS C1876 85414 - STENT TRCHBR 7MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO BOTH IP/OP "$6,116.00" "$4,526.00" "$1,213.80" "$6,115.63" "$2,752.03" "$2,752.03" "$2,752.03" "$2,752.03" "$6,115.63" "$6,115.63" "$6,115.63" "$1,274.65" "$6,115.63" "$6,115.63" "$6,115.63" "$6,115.63" "$6,115.63" "$1,274.56" "$6,115.63" "$6,115.63" "$3,015.01" "$6,115.63" "$6,115.63" "$6,115.63" "$6,115.63" "$4,587.00" "$6,115.63" "$6,115.63" "$6,115.63" "$3,057.82" "$3,057.82" "$4,843.58" "$6,115.63" "$4,892.50" "$2,752.03" "$1,213.80" N/A "$3,547.28" "$6,115.63" "$6,115.63" "$6,115.63" "$1,274.50" "$6,115.63" N/A N/A 85415 SUP HCPCS C1876 85415 - STENT TRCHBR 7MM 7FR 59MM STRL 120CM ICAST CVR CATH INTRO BOTH IP/OP "$6,591.00" "$4,877.00" "$1,308.08" "$6,590.63" "$2,965.78" "$2,965.78" "$2,965.78" "$2,965.78" "$6,590.63" "$6,590.63" "$6,590.63" "$1,373.65" "$6,590.63" "$6,590.63" "$6,590.63" "$6,590.63" "$6,590.63" "$1,373.56" "$6,590.63" "$6,590.63" "$3,249.18" "$6,590.63" "$6,590.63" "$6,590.63" "$6,590.63" "$4,943.25" "$6,590.63" "$6,590.63" "$6,590.63" "$3,295.32" "$3,295.32" "$5,219.78" "$6,590.63" "$5,272.50" "$2,965.78" "$1,308.08" N/A "$3,822.78" "$6,590.63" "$6,590.63" "$6,590.63" "$1,373.49" "$6,590.63" 40 N/A 85416 SUP HCPCS C1876 85416 - STENT TRCHBR 8MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO SS BOTH IP/OP "$6,116.00" "$4,526.00" "$1,213.80" "$6,115.63" "$2,752.03" "$2,752.03" "$2,752.03" "$2,752.03" "$6,115.63" "$6,115.63" "$6,115.63" "$1,274.65" "$6,115.63" "$6,115.63" "$6,115.63" "$6,115.63" "$6,115.63" "$1,274.56" "$6,115.63" "$6,115.63" "$3,015.01" "$6,115.63" "$6,115.63" "$6,115.63" "$6,115.63" "$4,587.00" "$6,115.63" "$6,115.63" "$6,115.63" "$3,057.82" "$3,057.82" "$4,843.58" "$6,115.63" "$4,892.50" "$2,752.03" "$1,213.80" N/A "$3,547.28" "$6,115.63" "$6,115.63" "$6,115.63" "$1,274.50" "$6,115.63" N/A N/A 85417 SUP HCPCS C1876 85417 - STENT TRCHBR 8MM 7FR 59MM STRL 120CM ICAST CVR CATH INTRO SS BOTH IP/OP "$6,591.00" "$4,877.00" "$1,308.08" "$6,590.63" "$2,965.78" "$2,965.78" "$2,965.78" "$2,965.78" "$6,590.63" "$6,590.63" "$6,590.63" "$1,373.65" "$6,590.63" "$6,590.63" "$6,590.63" "$6,590.63" "$6,590.63" "$1,373.56" "$6,590.63" "$6,590.63" "$3,249.18" "$6,590.63" "$6,590.63" "$6,590.63" "$6,590.63" "$4,943.25" "$6,590.63" "$6,590.63" "$6,590.63" "$3,295.32" "$3,295.32" "$5,219.78" "$6,590.63" "$5,272.50" "$2,965.78" "$1,308.08" N/A "$3,822.78" "$6,590.63" "$6,590.63" "$6,590.63" "$1,373.49" "$6,590.63" N/A N/A 85418 SUP HCPCS C1876 85418 - STENT TRCHBR 9MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO BOTH IP/OP "$6,116.00" "$4,526.00" "$1,213.80" "$6,115.63" "$2,752.03" "$2,752.03" "$2,752.03" "$2,752.03" "$6,115.63" "$6,115.63" "$6,115.63" "$1,274.65" "$6,115.63" "$6,115.63" "$6,115.63" "$6,115.63" "$6,115.63" "$1,274.56" "$6,115.63" "$6,115.63" "$3,015.01" "$6,115.63" "$6,115.63" "$6,115.63" "$6,115.63" "$4,587.00" "$6,115.63" "$6,115.63" "$6,115.63" "$3,057.82" "$3,057.82" "$4,843.58" "$6,115.63" "$4,892.50" "$2,752.03" "$1,213.80" N/A "$3,547.28" "$6,115.63" "$6,115.63" "$6,115.63" "$1,274.50" "$6,115.63" N/A N/A 85419 SUP HCPCS C1876 85419 - STENT TRCHBR 9MM 7FR 59MM STRL 120CM ICAST CVR CATH INTRO SS BOTH IP/OP "$6,591.00" "$4,877.00" "$1,308.08" "$6,590.63" "$2,965.78" "$2,965.78" "$2,965.78" "$2,965.78" "$6,590.63" "$6,590.63" "$6,590.63" "$1,373.65" "$6,590.63" "$6,590.63" "$6,590.63" "$6,590.63" "$6,590.63" "$1,373.56" "$6,590.63" "$6,590.63" "$3,249.18" "$6,590.63" "$6,590.63" "$6,590.63" "$6,590.63" "$4,943.25" "$6,590.63" "$6,590.63" "$6,590.63" "$3,295.32" "$3,295.32" "$5,219.78" "$6,590.63" "$5,272.50" "$2,965.78" "$1,308.08" N/A "$3,822.78" "$6,590.63" "$6,590.63" "$6,590.63" "$1,373.49" "$6,590.63" N/A N/A 85424 SUP HCPCS C1876 85424 - STENT TRCHBR 10MM 7FR 38MM STRL 120CM ICAST CVR CATH INTRO BOTH IP/OP "$6,116.00" "$4,526.00" "$1,213.80" "$6,115.63" "$2,752.03" "$2,752.03" "$2,752.03" "$2,752.03" "$6,115.63" "$6,115.63" "$6,115.63" "$1,274.65" "$6,115.63" "$6,115.63" "$6,115.63" "$6,115.63" "$6,115.63" "$1,274.56" "$6,115.63" "$6,115.63" "$3,015.01" "$6,115.63" "$6,115.63" "$6,115.63" "$6,115.63" "$4,587.00" "$6,115.63" "$6,115.63" "$6,115.63" "$3,057.82" "$3,057.82" "$4,843.58" "$6,115.63" "$4,892.50" "$2,752.03" "$1,213.80" N/A "$3,547.28" "$6,115.63" "$6,115.63" "$6,115.63" "$1,274.50" "$6,115.63" N/A N/A 85426 SUP HCPCS C1768 85426 - STENT COVERED 12MMX38MMX120CM BOTH IP/OP "$6,125.00" "$4,533.00" "$1,215.66" "$6,125.00" "$2,756.25" "$2,756.25" "$2,756.25" "$2,756.25" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.60" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.52" "$6,125.00" "$6,125.00" "$3,019.63" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$4,593.75" "$6,125.00" "$6,125.00" "$6,125.00" "$3,062.50" "$3,062.50" "$4,851.00" "$6,125.00" "$4,900.00" "$2,756.25" "$1,215.66" N/A "$3,552.50" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.45" "$6,125.00" N/A N/A 85450 SUP HCPCS C1876 85450 - STENT TRCHBR 5MM 6FR 16MM 120CM ICAST CVR ULT LO CX PRFL PWR BOTH IP/OP "$5,724.00" "$4,236.00" "$1,136.02" "$5,723.75" "$2,575.69" "$2,575.69" "$2,575.69" "$2,575.69" "$5,723.75" "$5,723.75" "$5,723.75" "$1,192.97" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$1,192.89" "$5,723.75" "$5,723.75" "$2,821.81" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$4,293.00" "$5,723.75" "$5,723.75" "$5,723.75" "$2,861.88" "$2,861.88" "$4,533.21" "$5,723.75" "$4,579.00" "$2,575.69" "$1,136.02" N/A "$3,319.92" "$5,723.75" "$5,723.75" "$5,723.75" "$1,192.83" "$5,723.75" N/A N/A 85451 SUP HCPCS C1876 85451 - STENT TRCHBR 5MM 6FR 22MM STRL 120CM ICAST CVR CATH INTRO SS BOTH IP/OP "$6,287.50" "$4,653.00" "$1,247.91" "$6,287.50" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$6,287.50" "$6,287.50" "$6,287.50" "$1,310.47" "$6,287.50" "$6,287.50" "$6,287.50" "$6,287.50" "$6,287.50" "$1,310.38" "$6,287.50" "$6,287.50" "$3,099.74" "$6,287.50" "$6,287.50" "$6,287.50" "$6,287.50" "$4,715.63" "$6,287.50" "$6,287.50" "$6,287.50" "$3,143.75" "$3,143.75" "$4,979.70" "$6,287.50" "$5,030.00" "$2,829.38" "$1,247.91" N/A "$3,646.75" "$6,287.50" "$6,287.50" "$6,287.50" "$1,310.32" "$6,287.50" N/A N/A 85454 SUP HCPCS C1875 85454 - STENT TRCHBR 7MM 7FR 16MM STRL 120CM ICAST CVR CATH INTRO BOTH IP/OP "$5,724.00" "$4,236.00" "$1,192.89" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$1,192.89" "$5,723.75" "$2,289.50" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$5,723.75" "$4,293.00" "$5,723.75" "$5,723.75" "$5,723.75" "$2,861.88" "$2,861.88" "$4,533.21" "$5,723.75" "$4,579.00" "$2,575.69" "$5,723.75" N/A "$3,319.92" "$5,723.75" "$3,434.25" "$5,723.75" "$5,723.75" "$5,723.75" N/A N/A 85785 SUP HCPCS C1733 85785 - SET TBG 260CM CL PNT 2W CMUNC IRR PMP CATH BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $67.88 $67.88 $67.88 $67.88 $125.00 $125.00 $125.00 $26.05 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 86000 SUP Custom 27803010 86000 - IMPLANT CHIN CNTR LF 2 PC BOTH IP/OP "$1,005.00" $744.00 $178.89 "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" $178.89 "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" $209.45 "$1,005.00" $402.00 "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" $753.75 "$1,005.00" "$1,005.00" "$1,005.00" $502.50 $502.50 $795.96 "$1,005.00" $804.00 $452.25 "$1,005.00" N/A $582.90 "$1,005.00" $603.00 "$1,005.00" "$1,005.00" "$1,005.00" 20.5 N/A 86001 SUP Custom 27803010 86001 - GRAFT SYNTH TISSUE CNTOUR CONCAVE TAPER 74X42X5MM 2 PIECE BOTH IP/OP "$1,005.00" $744.00 $178.89 "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" $178.89 "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" $209.45 "$1,005.00" $402.00 "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" $753.75 "$1,005.00" "$1,005.00" "$1,005.00" $502.50 $502.50 $795.96 "$1,005.00" $804.00 $452.25 "$1,005.00" N/A $582.90 "$1,005.00" $603.00 "$1,005.00" "$1,005.00" "$1,005.00" 11 N/A 86002 SUP Custom 27803010 86002 - IMPLANT CHIN CNTR TPR 78X50X7MM STRL MDPR 2 PC PE POR BOTH IP/OP "$1,005.00" $744.00 $178.89 "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" $178.89 "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" $209.45 "$1,005.00" $402.00 "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" $753.75 "$1,005.00" "$1,005.00" "$1,005.00" $502.50 $502.50 $795.96 "$1,005.00" $804.00 $452.25 "$1,005.00" N/A $582.90 "$1,005.00" $603.00 "$1,005.00" "$1,005.00" "$1,005.00" N/A N/A 86003 SUP Custom 27803010 86003 - GRAFT SYNTH TISSUE CNTOUR TAPER 80X55X9MM 2 PIECE GRADUAL BOTH IP/OP "$1,005.00" $744.00 $178.89 "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" $178.89 "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" $209.45 "$1,005.00" $402.00 "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" $753.75 "$1,005.00" "$1,005.00" "$1,005.00" $502.50 $502.50 $795.96 "$1,005.00" $804.00 $452.25 "$1,005.00" N/A $582.90 "$1,005.00" $603.00 "$1,005.00" "$1,005.00" "$1,005.00" 11.5 N/A 86010 SUP Custom 27803010 86010 - GRAFT SNTH TISS SM 3D 40X25X4MM STRL MDPR BTN MXLFCL CHIN BOTH IP/OP $848.00 $628.00 $150.94 $848.00 $848.00 $848.00 $848.00 $848.00 $848.00 $848.00 $150.94 $848.00 $848.00 $848.00 $848.00 $848.00 $848.00 $176.73 $848.00 $339.20 $848.00 $848.00 $848.00 $848.00 $848.00 $636.00 $848.00 $848.00 $848.00 $424.00 $424.00 $671.62 $848.00 $678.40 $381.60 $848.00 N/A $491.84 $848.00 $508.80 $848.00 $848.00 $848.00 N/A N/A 86011 SUP Custom 27803010 86011 - GRAFT SNTH TISS MED 3D 47.5X37.5X5.5MM STRL MDPR BTN MXLFCL BOTH IP/OP $848.00 $628.00 $150.94 $848.00 $848.00 $848.00 $848.00 $848.00 $848.00 $848.00 $150.94 $848.00 $848.00 $848.00 $848.00 $848.00 $848.00 $176.73 $848.00 $339.20 $848.00 $848.00 $848.00 $848.00 $848.00 $636.00 $848.00 $848.00 $848.00 $424.00 $424.00 $671.62 $848.00 $678.40 $381.60 $848.00 N/A $491.84 $848.00 $508.80 $848.00 $848.00 $848.00 N/A N/A 86012 SUP HCPCS C1729 086012 - CATH NPHSTM 12FR MLCT DRAIN 4 WNG STRL LATEX DISP BOTH IP/OP $165.50 $122.00 $32.78 $165.15 $89.68 $89.68 $89.68 $89.68 $165.15 $165.15 $165.15 $34.42 $165.15 $122.57 $122.57 $127.30 $86.04 $34.42 $165.15 $165.15 $97.69 $165.15 $165.15 $165.15 $165.15 $124.13 $165.15 $165.15 $165.15 $82.58 $82.58 $130.80 $165.15 $132.12 $107.35 $32.78 N/A $95.99 $165.15 $165.15 $165.15 $34.42 $165.15 N/A N/A 86014 SUP HCPCS C1729 086014 - CATHETER SUPRAPUBIC 14FR 4 WING DRAIN LATEX MALECOT STERILE BOTH IP/OP $25.00 $19.00 $4.94 $24.90 $13.52 $13.52 $13.52 $13.52 $24.90 $24.90 $24.90 $5.19 $24.90 $18.48 $18.48 $19.19 $12.97 $5.19 $24.90 $24.90 $14.73 $24.90 $24.90 $24.90 $24.90 $18.75 $24.90 $24.90 $24.90 $12.45 $12.45 $19.72 $24.90 $19.92 $16.19 $4.94 N/A $14.50 $24.90 $24.90 $24.90 $5.19 $24.90 N/A N/A 86016 SUP HCPCS C1729 086016 - CATHETER NPHSTM 16FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP BOTH IP/OP $25.00 $19.00 $4.94 $24.90 $13.52 $13.52 $13.52 $13.52 $24.90 $24.90 $24.90 $5.19 $24.90 $18.48 $18.48 $19.19 $12.97 $5.19 $24.90 $24.90 $14.73 $24.90 $24.90 $24.90 $24.90 $18.75 $24.90 $24.90 $24.90 $12.45 $12.45 $19.72 $24.90 $19.92 $16.19 $4.94 N/A $14.50 $24.90 $24.90 $24.90 $5.19 $24.90 N/A N/A 86018 SUP HCPCS C1751 086018 - CATHETER NPHSTM 18FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP BOTH IP/OP $25.00 $19.00 $4.94 $24.90 $13.52 $13.52 $13.52 $13.52 $24.90 $24.90 $24.90 $5.19 $24.90 $18.48 $18.48 $19.19 $12.97 $5.19 $24.90 $24.90 $14.73 $24.90 $24.90 $24.90 $24.90 $18.75 $24.90 $24.90 $24.90 $12.45 $12.45 $19.72 $24.90 $19.92 $16.19 $4.94 N/A $14.50 $24.90 $24.90 $24.90 $5.19 $24.90 N/A N/A 86020 SUP HCPCS C1729 086020 - CATHETER NPHSTM 20FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP BOTH IP/OP $285.00 $211.00 $56.51 $284.70 $154.59 $154.59 $154.59 $154.59 $284.70 $284.70 $284.70 $59.34 $284.70 $211.30 $211.30 $219.45 $148.33 $59.33 $284.70 $149.40 $168.40 $284.70 $284.70 $284.70 $284.70 $213.75 $284.70 $284.70 $284.70 $142.35 $142.35 $225.48 $284.70 $227.76 $185.06 $56.51 N/A $165.30 $284.70 $284.70 $284.70 $59.33 $284.70 N/A N/A 86022 SUP HCPCS C1729 086022 - CATHETER NPHSTM 22FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP BOTH IP/OP $25.00 $19.00 $4.94 $24.90 $13.52 $13.52 $13.52 $13.52 $24.90 $24.90 $24.90 $5.19 $24.90 $18.48 $18.48 $19.19 $12.97 $5.19 $24.90 $24.90 $14.73 $24.90 $24.90 $24.90 $24.90 $18.75 $24.90 $24.90 $24.90 $12.45 $12.45 $19.72 $24.90 $19.92 $16.19 $4.94 N/A $14.50 $24.90 $24.90 $24.90 $5.19 $24.90 84 N/A 86024 SUP HCPCS C1729 086024 - CATHETER NPHSTM 24FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP BOTH IP/OP $25.00 $19.00 $4.94 $24.90 $13.52 $13.52 $13.52 $13.52 $24.90 $24.90 $24.90 $5.19 $24.90 $18.48 $18.48 $19.19 $12.97 $5.19 $24.90 $24.90 $14.73 $24.90 $24.90 $24.90 $24.90 $18.75 $24.90 $24.90 $24.90 $12.45 $12.45 $19.72 $24.90 $19.92 $16.19 $4.94 N/A $14.50 $24.90 $24.90 $24.90 $5.19 $24.90 N/A N/A 86026 SUP HCPCS C1729 086026 - CATHETER NPHSTM 26FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP BOTH IP/OP $25.00 $19.00 $4.94 $24.90 $13.52 $13.52 $13.52 $13.52 $24.90 $24.90 $24.90 $5.19 $24.90 $18.48 $18.48 $19.19 $12.97 $5.19 $24.90 $24.90 $14.73 $24.90 $24.90 $24.90 $24.90 $18.75 $24.90 $24.90 $24.90 $12.45 $12.45 $19.72 $24.90 $19.92 $16.19 $4.94 N/A $14.50 $24.90 $24.90 $24.90 $5.19 $24.90 N/A N/A 86028 SUP HCPCS C1729 086028 - CATHETER NPHSTM 28FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP BOTH IP/OP $25.00 $19.00 $4.94 $24.90 $13.52 $13.52 $13.52 $13.52 $24.90 $24.90 $24.90 $5.19 $24.90 $18.48 $18.48 $19.19 $12.97 $5.19 $24.90 $24.90 $14.73 $24.90 $24.90 $24.90 $24.90 $18.75 $24.90 $24.90 $24.90 $12.45 $12.45 $19.72 $24.90 $19.92 $16.19 $4.94 N/A $14.50 $24.90 $24.90 $24.90 $5.19 $24.90 N/A N/A 86030 SUP HCPCS C1729 086030 - CATHETER NPHSTM 30FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP BOTH IP/OP $25.00 $19.00 $4.94 $24.90 $13.52 $13.52 $13.52 $13.52 $24.90 $24.90 $24.90 $5.19 $24.90 $18.48 $18.48 $19.19 $12.97 $5.19 $24.90 $24.90 $14.73 $24.90 $24.90 $24.90 $24.90 $18.75 $24.90 $24.90 $24.90 $12.45 $12.45 $19.72 $24.90 $19.92 $16.19 $4.94 N/A $14.50 $24.90 $24.90 $24.90 $5.19 $24.90 N/A N/A 86032 SUP HCPCS C1729 086032 - CATHETER NPHSTM 32FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP BOTH IP/OP $25.00 $19.00 $4.94 $24.90 $13.52 $13.52 $13.52 $13.52 $24.90 $24.90 $24.90 $5.19 $24.90 $18.48 $18.48 $19.19 $12.97 $5.19 $24.90 $24.90 $14.73 $24.90 $24.90 $24.90 $24.90 $18.75 $24.90 $24.90 $24.90 $12.45 $12.45 $19.72 $24.90 $19.92 $16.19 $4.94 N/A $14.50 $24.90 $24.90 $24.90 $5.19 $24.90 N/A N/A 86034 SUP HCPCS C1729 086034 - CATHETER NPHSTM 34FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP BOTH IP/OP $25.00 $19.00 $4.94 $24.90 $13.52 $13.52 $13.52 $13.52 $24.90 $24.90 $24.90 $5.19 $24.90 $18.48 $18.48 $19.19 $12.97 $5.19 $24.90 $24.90 $14.73 $24.90 $24.90 $24.90 $24.90 $18.75 $24.90 $24.90 $24.90 $12.45 $12.45 $19.72 $24.90 $19.92 $16.19 $4.94 N/A $14.50 $24.90 $24.90 $24.90 $5.19 $24.90 N/A N/A 86036 SUP HCPCS C1729 086036 - CATHETER NPHSTM 36FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP BOTH IP/OP $4.50 $3.00 $0.82 $4.15 $2.25 $2.25 $2.25 $2.25 $4.15 $4.15 $4.15 $0.86 $4.15 $3.08 $3.08 $3.20 $2.16 $0.86 $4.15 $4.15 $2.45 $4.15 $4.15 $4.15 $4.15 $3.38 $4.15 $4.15 $4.15 $2.08 $2.08 $3.29 $4.15 $3.32 $2.70 $0.82 N/A $2.61 $4.15 $4.15 $4.15 $0.86 $4.15 N/A N/A 86038 SUP HCPCS C1751 086038 - CATHETER NPHSTM 38FR STRL LTX MLCT 4 WNG DRN NTR RBR DISP BOTH IP/OP $25.00 $19.00 $4.94 $24.90 $13.52 $13.52 $13.52 $13.52 $24.90 $24.90 $24.90 $5.19 $24.90 $18.48 $18.48 $19.19 $12.97 $5.19 $24.90 $24.90 $14.73 $24.90 $24.90 $24.90 $24.90 $18.75 $24.90 $24.90 $24.90 $12.45 $12.45 $19.72 $24.90 $19.92 $16.19 $4.94 N/A $14.50 $24.90 $24.90 $24.90 $5.19 $24.90 34.5 N/A 86202 SUP Custom 27203010 86202 - TUBE ET 6MM CLR STRL LF MALLINCKRODT RAE CUF MRPH TIP RADOPQ BOTH IP/OP $41.50 $31.00 $7.36 $41.37 $41.37 $41.37 $41.37 $41.37 $41.37 $41.37 $7.36 $41.37 $41.37 $30.70 $30.70 $31.89 $21.55 $8.62 $41.37 $16.55 $41.37 $41.37 $41.37 $41.37 $41.37 $31.13 $41.37 $41.37 $41.37 $20.69 $20.69 $32.77 $41.37 $33.10 $26.89 $41.37 N/A $24.07 $41.37 $24.82 $41.37 $41.37 $41.37 N/A N/A 86203 SUP Custom 27203010 86203 - TUBE ENDOTRAC 6.5MM CUF MRPH EYE PREFRM CURVE OR R STRL BOTH IP/OP $12.50 $9.00 $2.18 $12.26 $12.26 $12.26 $12.26 $12.26 $12.26 $12.26 $2.18 $12.26 $12.26 $9.10 $9.10 $9.45 $6.39 $2.56 $12.26 $4.90 $12.26 $12.26 $12.26 $12.26 $12.26 $9.38 $12.26 $12.26 $12.26 $6.13 $6.13 $9.71 $12.26 $9.81 $7.97 $12.26 N/A $7.25 $12.26 $7.36 $12.26 $12.26 $12.26 N/A N/A 86204 SUP Custom 27203010 86204 - TUBE ET PREFORM CRV 7MM STRL LF RAE CUF MRPH EYE RADOPQ BOTH IP/OP $44.00 $33.00 $7.81 $43.88 $43.88 $43.88 $43.88 $43.88 $43.88 $43.88 $7.81 $43.88 $43.88 $32.57 $32.57 $33.82 $22.86 $9.15 $43.88 $17.55 $43.88 $43.88 $43.88 $43.88 $43.88 $33.00 $43.88 $43.88 $43.88 $21.94 $21.94 $34.75 $43.88 $35.10 $28.52 $43.88 N/A $25.52 $43.88 $26.33 $43.88 $43.88 $43.88 N/A N/A 86207 SUP Custom 27203010 086207 - TUBE ORAL/TRACHEAL RAE 8.5MM CUFFED MURPHY TIP PREFORMED PVC BOTH IP/OP $14.50 $11.00 $2.56 $14.41 $14.41 $14.41 $14.41 $14.41 $14.41 $14.41 $2.56 $14.41 $14.41 $10.70 $10.70 $11.11 $7.51 $3.00 $14.41 $5.76 $14.41 $14.41 $14.41 $14.41 $14.41 $10.88 $14.41 $14.41 $14.41 $7.21 $7.21 $11.41 $14.41 $11.53 $9.37 $14.41 N/A $8.41 $14.41 $8.65 $14.41 $14.41 $14.41 N/A N/A 86228 SUP Custom 27203010 86228 - TUBE ENDOTRAC THIN WALL 5.5MM CUFFLESS HOOD MURPHY EYE BOTH IP/OP $25.50 $19.00 $4.47 $25.12 $25.12 $25.12 $25.12 $25.12 $25.12 $25.12 $4.47 $25.12 $25.12 $18.64 $18.64 $19.36 $13.09 $5.24 $25.12 $10.05 $25.12 $25.12 $25.12 $25.12 $25.12 $19.13 $25.12 $25.12 $25.12 $12.56 $12.56 $19.90 $25.12 $20.10 $16.33 $25.12 N/A $14.79 $25.12 $15.07 $25.12 $25.12 $25.12 N/A N/A 86266 SUP Custom 27203010 86266 - TUBE ENDOTRAC 4.5MM UNCUF MRPH EYE OR R BOTH IP/OP $88.00 $65.00 $15.64 $87.85 $87.85 $87.85 $87.85 $87.85 $87.85 $87.85 $15.64 $87.85 $87.85 $65.20 $65.20 $67.71 $45.77 $18.31 $87.85 $35.14 $87.85 $87.85 $87.85 $87.85 $87.85 $66.00 $87.85 $87.85 $87.85 $43.93 $43.93 $69.58 $87.85 $70.28 $57.10 $87.85 N/A $51.04 $87.85 $52.71 $87.85 $87.85 $87.85 N/A N/A 86287 SUP Custom 27203010 86287 - TUBE ET 5MM SHLY RAE CUFLS MRPH EYE NSL BOTH IP/OP $7.00 $5.00 $1.17 $6.57 $6.57 $6.57 $6.57 $6.57 $6.57 $6.57 $1.17 $6.57 $6.57 $4.88 $4.88 $5.06 $3.42 $1.37 $6.57 $2.63 $6.57 $6.57 $6.57 $6.57 $6.57 $5.25 $6.57 $6.57 $6.57 $3.29 $3.29 $5.20 $6.57 $5.26 $4.27 $6.57 N/A $4.06 $6.57 $3.94 $6.57 $6.57 $6.57 N/A N/A 86311 SUP HCPCS C1757 86311 - CATHETER THROMBECTOMY PROGREAT PRELUMEN BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $807.71 $807.71 $807.71 $807.71 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,104.02" "$1,104.02" "$1,146.57" $774.99 $310.01 "$1,487.50" "$1,487.50" $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $966.88 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A 86395 SUP Custom 27203010 86395 - TUBE ET 7.9MM 5.5MM STRL SHLY LSRFLX 2 CUF MRPH EYE SS BOTH IP/OP $115.00 $85.00 $20.43 $114.75 $114.75 $114.75 $114.75 $114.75 $114.75 $114.75 $20.43 $114.75 $114.75 $85.17 $85.17 $88.45 $59.78 $23.92 $114.75 $45.90 $114.75 $114.75 $114.75 $114.75 $114.75 $86.25 $114.75 $114.75 $114.75 $57.38 $57.38 $90.88 $114.75 $91.80 $74.59 $114.75 N/A $66.70 $114.75 $68.85 $114.75 $114.75 $114.75 N/A N/A 86397 SUP Custom 27203010 86397 - TUBE ET MGL CRV 7MM 4.5MM STRL LF LSRFLX MALLINCKRODT 2 CUF BOTH IP/OP $115.00 $85.00 $20.43 $114.75 $114.75 $114.75 $114.75 $114.75 $114.75 $114.75 $20.43 $114.75 $114.75 $85.17 $85.17 $88.45 $59.78 $23.92 $114.75 $45.90 $114.75 $114.75 $114.75 $114.75 $114.75 $86.25 $114.75 $114.75 $114.75 $57.38 $57.38 $90.88 $114.75 $91.80 $74.59 $114.75 N/A $66.70 $114.75 $68.85 $114.75 $114.75 $114.75 N/A N/A 86551 SUP Custom 27203010 86551 - TUBE ET 7.5MM STRL CUF REINF MRPH EYE PVC SIL NSL/ORL DISP BOTH IP/OP $45.00 $33.00 $7.94 $44.63 $44.63 $44.63 $44.63 $44.63 $44.63 $44.63 $7.94 $44.63 $44.63 $33.12 $33.12 $34.40 $23.25 $9.30 $44.63 $17.85 $44.63 $44.63 $44.63 $44.63 $44.63 $33.75 $44.63 $44.63 $44.63 $22.32 $22.32 $35.35 $44.63 $35.70 $29.01 $44.63 N/A $26.10 $44.63 $26.78 $44.63 $44.63 $44.63 N/A N/A 86552 SUP Custom 27203010 86552 - TUBE ET 9.5MM STRL LF SHLY CUF FULL MGL CRV MRPH EYE REINF BOTH IP/OP $45.00 $33.00 $7.94 $44.63 $44.63 $44.63 $44.63 $44.63 $44.63 $44.63 $7.94 $44.63 $44.63 $33.12 $33.12 $34.40 $23.25 $9.30 $44.63 $17.85 $44.63 $44.63 $44.63 $44.63 $44.63 $33.75 $44.63 $44.63 $44.63 $22.32 $22.32 $35.35 $44.63 $35.70 $29.01 $44.63 N/A $26.10 $44.63 $26.78 $44.63 $44.63 $44.63 N/A N/A 86700 SUP HCPCS C1753 86700 - CATHETER ULTRASOUND 20MHZ 3.4FR 135CM SCANNER TRANSDUCER BOTH IP/OP "$1,687.50" "$1,249.00" $334.93 "$1,687.50" $916.31 $916.31 $916.31 $916.31 "$1,687.50" "$1,687.50" "$1,687.50" $351.72 "$1,687.50" "$1,252.46" "$1,252.46" "$1,300.73" $879.19 $351.69 "$1,687.50" "$1,687.50" $998.16 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" "$1,096.88" $334.93 N/A $978.75 "$1,687.50" "$1,687.50" "$1,687.50" $351.68 "$1,687.50" N/A N/A 87003 SUP Custom 27803010 87003 - GRAFT SYNTH TISSUE 26X25X2.5MM IMPLANT POROUS MEDPOR IMORI BOTH IP/OP $936.00 $693.00 $166.54 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $166.54 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $195.00 $935.63 $374.25 $935.63 $935.63 $935.63 $935.63 $935.63 $702.00 $935.63 $935.63 $935.63 $467.82 $467.82 $741.02 $935.63 $748.50 $421.03 $935.63 N/A $542.88 $935.63 $561.38 $935.63 $935.63 $935.63 37 N/A 87004 SUP Custom 27803010 87004 - GRAFT SYNTH TISSUE 26X25X2.5MM IMPLANT POROUS MEDPOR IMORI BOTH IP/OP $936.00 $693.00 $166.54 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $166.54 $935.63 $935.63 $935.63 $935.63 $935.63 $935.63 $195.00 $935.63 $374.25 $935.63 $935.63 $935.63 $935.63 $935.63 $702.00 $935.63 $935.63 $935.63 $467.82 $467.82 $741.02 $935.63 $748.50 $421.03 $935.63 N/A $542.88 $935.63 $561.38 $935.63 $935.63 $935.63 N/A N/A 88000 SUP HCPCS B4088 88000 - TUBE JEJUNOSTOMY 28FR 12FR 55IN BALLOON RADIOPQ STRIPE BOTH IP/OP $264.00 $195.00 $23.24 $263.90 $263.90 $263.90 $263.90 $263.90 $263.90 $263.90 $23.24 $263.90 $263.90 $263.90 $263.90 $263.90 $263.90 $55.00 $263.90 $105.56 $263.90 $263.90 $263.90 $263.90 $263.90 $198.00 $263.90 $263.90 $263.90 $131.95 $131.95 $209.01 $263.90 $211.12 $118.76 $263.90 N/A $153.12 $263.90 $158.34 $263.90 $263.90 $263.90 266 N/A 88037 SUP Custom 27803010 88037 - GRAFT SYNTH TISSUE 59X29X7MM IMPLANT CNTOUR ANGLED POROUS BOTH IP/OP "$1,354.00" "$1,002.00" $240.97 "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" $240.97 "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" $282.14 "$1,353.75" $541.50 "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" "$1,015.50" "$1,353.75" "$1,353.75" "$1,353.75" $676.88 $676.88 "$1,072.17" "$1,353.75" "$1,083.00" $609.19 "$1,353.75" N/A $785.32 "$1,353.75" $812.25 "$1,353.75" "$1,353.75" "$1,353.75" 106.5 N/A 88038 SUP Custom 27803010 88038 - GRAFT SYNTH TISSUE 59X29X7MM IMPLANT CNTOUR ANGLED POROUS BOTH IP/OP "$1,354.00" "$1,002.00" $240.97 "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" $240.97 "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" $282.14 "$1,353.75" $541.50 "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" "$1,353.75" "$1,015.50" "$1,353.75" "$1,353.75" "$1,353.75" $676.88 $676.88 "$1,072.17" "$1,353.75" "$1,083.00" $609.19 "$1,353.75" N/A $785.32 "$1,353.75" $812.25 "$1,353.75" "$1,353.75" "$1,353.75" N/A N/A 88051 SUP Custom 27803010 88051 - GRAFT SYNTH TISSUE 79X37X5MM IMPLANT RAMUS INFERIOR RIDGE BOTH IP/OP "$1,867.50" "$1,382.00" $332.42 "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" $332.42 "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" $389.21 "$1,867.50" $747.00 "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,400.63" "$1,867.50" "$1,867.50" "$1,867.50" $933.75 $933.75 "$1,479.06" "$1,867.50" "$1,494.00" $840.38 "$1,867.50" N/A "$1,083.15" "$1,867.50" "$1,120.50" "$1,867.50" "$1,867.50" "$1,867.50" N/A N/A 88052 SUP Custom 27803010 88052 - GRAFT SYNTH TISSUE 79X37X5MM IMPLANT RAMUS INFERIOR RIDGE BOTH IP/OP "$1,867.50" "$1,382.00" $332.42 "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" $332.42 "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" $389.21 "$1,867.50" $747.00 "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,400.63" "$1,867.50" "$1,867.50" "$1,867.50" $933.75 $933.75 "$1,479.06" "$1,867.50" "$1,494.00" $840.38 "$1,867.50" N/A "$1,083.15" "$1,867.50" "$1,120.50" "$1,867.50" "$1,867.50" "$1,867.50" N/A N/A 88053 SUP Custom 27803010 88053 - GRAFT SYNTH TISSUE ANGLE LARGE 57X40X4MM AUGMENTATION BOTH IP/OP "$1,333.50" $987.00 $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $237.30 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" $277.84 "$1,333.13" $533.25 "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$1,000.13" "$1,333.13" "$1,333.13" "$1,333.13" $666.57 $666.57 "$1,055.84" "$1,333.13" "$1,066.50" $599.91 "$1,333.13" N/A $773.43 "$1,333.13" $799.88 "$1,333.13" "$1,333.13" "$1,333.13" N/A N/A 88054 SUP Custom 27803010 88054 - GRAFT SYNTH TISSUE 57X40X10MM AUGMENTATION ONLAY MANDIB BOTH IP/OP "$1,380.00" "$1,021.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $245.64 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" $287.61 "$1,380.00" $552.00 "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,380.00" "$1,035.00" "$1,380.00" "$1,380.00" "$1,380.00" $690.00 $690.00 "$1,092.96" "$1,380.00" "$1,104.00" $621.00 "$1,380.00" N/A $800.40 "$1,380.00" $828.00 "$1,380.00" "$1,380.00" "$1,380.00" N/A N/A 88900 SUP HCPCS C1725 88900 - CATHETER ULTRASOUND .038IN 8.2FR 90CM PULLBACK SLED BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" "$1,153.88" "$1,153.88" "$1,153.88" "$1,153.88" "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$1,577.18" "$1,577.18" "$1,637.95" "$1,107.13" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" "$1,381.25" $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 88901 SUP HCPCS C1753 88901 - CATHETER ULTRASOUND .035IN 8.5FR 90CM 100CM OTW RADIOPQ BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,357.50" "$1,357.50" "$1,357.50" "$1,357.50" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$1,855.50" "$1,855.50" "$1,927.00" "$1,302.50" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,625.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 89007 SUP HCPCS C2617 089007 - STENT URETERAL 7FR 90CM LUBRICIOUS GWIRE LATEX FREE STERILE BOTH IP/OP $213.50 $158.00 $42.29 $213.05 $95.87 $95.87 $95.87 $95.87 $213.05 $213.05 $213.05 $44.40 $213.05 $213.05 $213.05 $213.05 $213.05 $44.40 $213.05 $213.05 $126.02 $213.05 $213.05 $213.05 $213.05 $160.13 $213.05 $213.05 $213.05 $106.53 $106.53 $168.74 $213.05 $170.44 $95.87 $42.29 N/A $123.83 $213.05 $213.05 $213.05 $44.40 $213.05 N/A N/A 89008 SUP HCPCS C2617 089008 - STENT URETERAL 8FR 90CM LUBRICIOUS GWIRE LATEX FREE STERILE BOTH IP/OP $213.50 $158.00 $42.29 $213.05 $95.87 $95.87 $95.87 $95.87 $213.05 $213.05 $213.05 $44.40 $213.05 $213.05 $213.05 $213.05 $213.05 $44.40 $213.05 $213.05 $126.02 $213.05 $213.05 $213.05 $213.05 $160.13 $213.05 $213.05 $213.05 $106.53 $106.53 $168.74 $213.05 $170.44 $95.87 $42.29 N/A $123.83 $213.05 $213.05 $213.05 $44.40 $213.05 N/A N/A 89020 SUP HCPCS C1763 89020 - TISSUE SYNTH PE POR MEDPOR IMPL CSTM CRANIAL BOTH IP/OP "$4,500.00" "$3,330.00" $893.14 "$4,500.00" "$2,025.00" "$2,025.00" "$2,025.00" "$2,025.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.91 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 "$4,500.00" "$4,500.00" "$2,218.50" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,025.00" $893.14 N/A "$2,610.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.80 "$4,500.00" N/A N/A 89104 SUP HCPCS C1713 89104 - SCREW BONE THREAD PLUG CD HORIZON SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 89131 SUP HCPCS L8610 89131 - CONFORMER OCUL 6 MED 26X22X10MM DRK BRN STRL NTR-IRIS SCKT BOTH IP/OP $504.50 $373.00 $100.11 $504.38 $226.97 $226.97 $226.97 $226.97 $504.38 $504.38 $504.38 $105.13 $504.38 $504.38 $504.38 $504.38 $504.38 $105.12 $504.38 $504.38 $298.34 $504.38 $504.38 $504.38 $504.38 $378.38 $504.38 $504.38 $504.38 $252.19 $252.19 $399.47 $504.38 $403.50 $226.97 $100.11 N/A $292.61 $504.38 $504.38 $504.38 $105.11 $504.38 N/A N/A 89185 SUP HCPCS C1769 89185 - GUIDEWIRE SRG STRG TIP 185CM OMNIWIRE PRSS GW BOTH IP/OP "$1,687.50" "$1,249.00" $334.93 "$1,687.50" $916.31 $916.31 $916.31 $916.31 "$1,687.50" "$1,687.50" "$1,687.50" $351.72 "$1,687.50" "$1,252.46" "$1,252.46" "$1,300.73" $879.19 $351.69 "$1,687.50" "$1,687.50" $998.16 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" "$1,096.88" $334.93 N/A $978.75 "$1,687.50" "$1,687.50" "$1,687.50" $351.68 "$1,687.50" N/A N/A 89221 SUP HCPCS C1763 89221 - IMPLANT SFT TIS THK.5MM FLT 5X2CM OFF WHT STRL ENDURAGEN BOTH IP/OP "$1,742.50" "$1,289.00" "$1,010.65" "$1,306.88" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,306.88" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,010.65" N/A N/A N/A N/A N/A N/A N/A 89223 SUP Custom 27803010 89223 - IMPLANT SOFT TISSUE FLAT 4X1X1CM MOIST TOUGH FLEXIBLE SHEET BOTH IP/OP $861.00 $637.00 $153.26 $861.00 $861.00 $861.00 $861.00 $861.00 $861.00 $861.00 $153.26 $861.00 $861.00 $861.00 $861.00 $861.00 $861.00 $179.44 $861.00 $344.40 $861.00 $861.00 $861.00 $861.00 $861.00 $645.75 $861.00 $861.00 $861.00 $430.50 $430.50 $681.91 $861.00 $688.80 $387.45 $861.00 N/A $499.38 $861.00 $516.60 $861.00 $861.00 $861.00 N/A N/A 89224 SUP Custom 27803010 89224 - IMPLANT SOFT TISSUE THK1MM FLAT 5X2CM MOIST TOUGH FLEXIBLE BOTH IP/OP "$1,742.50" "$1,289.00" $310.17 "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" $310.17 "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" $363.16 "$1,742.50" $697.00 "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" "$1,742.50" "$1,306.88" "$1,742.50" "$1,742.50" "$1,742.50" $871.25 $871.25 "$1,380.06" "$1,742.50" "$1,394.00" $784.13 "$1,742.50" N/A "$1,010.65" "$1,742.50" "$1,045.50" "$1,742.50" "$1,742.50" "$1,742.50" N/A N/A 89225 SUP Custom 27803010 89225 - IMPLANT SOFT TISSUE 8X3X1CM MOIST TOUGH FLEXIBLE FLAT SHEET BOTH IP/OP "$2,109.50" "$1,561.00" $375.48 "$2,109.45" "$2,109.45" "$2,109.45" "$2,109.45" "$2,109.45" "$2,109.45" "$2,109.45" $375.48 "$2,109.45" "$2,109.45" "$2,109.45" "$2,109.45" "$2,109.45" "$2,109.45" $439.63 "$2,109.45" $843.78 "$2,109.45" "$2,109.45" "$2,109.45" "$2,109.45" "$2,109.45" "$1,582.13" "$2,109.45" "$2,109.45" "$2,109.45" "$1,054.73" "$1,054.73" "$1,670.68" "$2,109.45" "$1,687.56" $949.25 "$2,109.45" N/A "$1,223.51" "$2,109.45" "$1,265.67" "$2,109.45" "$2,109.45" "$2,109.45" N/A N/A 90044 SUP HCPCS C1887 90044 - CATHETER ANGIO 3-2.4FR 150CM MRC 1 LUM RADOPQ BOTH IP/OP "$1,187.50" $879.00 $235.69 "$1,187.50" $644.81 $644.81 $644.81 $644.81 "$1,187.50" "$1,187.50" "$1,187.50" $247.50 "$1,187.50" $881.36 $881.36 $915.33 $618.69 $247.49 "$1,187.50" "$1,187.50" $702.41 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $771.88 $235.69 N/A $688.75 "$1,187.50" "$1,187.50" "$1,187.50" $247.48 "$1,187.50" N/A N/A 90051 SUP Custom 27203010 90051 - CATHETER URETHRAL 16FR FOLEY TEMPERATURE SENSOR LATEX FREE BOTH IP/OP $4.00 $3.00 $0.70 $3.93 $3.93 $3.93 $3.93 $3.93 $3.93 $3.93 $0.70 $3.93 $3.93 $2.92 $2.92 $3.03 $2.05 $0.82 $3.93 $1.57 $3.93 $3.93 $3.93 $3.93 $3.93 $3.00 $3.93 $3.93 $3.93 $1.97 $1.97 $3.11 $3.93 $3.14 $2.55 $3.93 N/A $2.32 $3.93 $2.36 $3.93 $3.93 $3.93 N/A N/A 90071 SUP Custom 27203010 090071 - NEEDLE FASCIAL INCISING 10MM BOTH IP/OP $77.00 $57.00 $13.70 $76.95 $76.95 $76.95 $76.95 $76.95 $76.95 $76.95 $13.70 $76.95 $76.95 $57.11 $57.11 $59.31 $40.09 $16.04 $76.95 $30.78 $76.95 $76.95 $76.95 $76.95 $76.95 $57.75 $76.95 $76.95 $76.95 $38.48 $38.48 $60.94 $76.95 $61.56 $50.02 $76.95 N/A $44.66 $76.95 $46.17 $76.95 $76.95 $76.95 N/A N/A 90071 SUP Custom 27203010 90071 - NEEDLE 5CM 18GA GWIRE PRC RNL FSCA 10MM BOTH IP/OP $82.50 $61.00 $13.70 $76.95 $76.95 $76.95 $76.95 $76.95 $76.95 $76.95 $13.70 $76.95 $76.95 $57.11 $57.11 $59.31 $40.09 $16.04 $76.95 $30.78 $76.95 $76.95 $76.95 $76.95 $76.95 $61.88 $76.95 $76.95 $76.95 $38.48 $38.48 $60.94 $76.95 $61.56 $50.02 $76.95 N/A $47.85 $76.95 $46.17 $76.95 $76.95 $76.95 N/A N/A 90110 SUP HCPCS C1757 90110 - CATHETER THRMB CRKSCR 2MM 180CM 5MM MRC V RTRV V2 FIRM NTNL BOTH IP/OP "$7,987.50" "$5,911.00" "$1,585.32" "$7,987.50" "$4,337.21" "$4,337.21" "$4,337.21" "$4,337.21" "$7,987.50" "$7,987.50" "$7,987.50" "$1,664.79" "$7,987.50" "$4,181.12" "$4,181.12" "$6,156.77" "$2,060.15" "$1,664.68" "$7,987.50" "$7,987.50" "$3,094.73" "$7,987.50" "$7,987.50" "$7,987.50" "$7,987.50" "$5,990.63" "$7,987.50" "$7,987.50" "$7,987.50" "$3,993.75" "$3,993.75" "$6,326.10" "$7,987.50" "$6,390.00" "$5,191.88" "$1,585.32" N/A "$4,632.75" "$7,987.50" "$7,987.50" "$7,987.50" "$1,664.60" "$7,987.50" N/A N/A 90111 SUP HCPCS C1757 90111 - CATHETER THRMB CRKSCR 2.5MM 180CM 6MM MRC V RETREIEVER V2.5 BOTH IP/OP "$7,987.50" "$5,911.00" "$1,585.32" "$7,987.50" "$4,337.21" "$4,337.21" "$4,337.21" "$4,337.21" "$7,987.50" "$7,987.50" "$7,987.50" "$1,664.79" "$7,987.50" "$4,181.12" "$4,181.12" "$6,156.77" "$2,060.15" "$1,664.68" "$7,987.50" "$7,978.25" "$3,094.73" "$7,987.50" "$7,987.50" "$7,987.50" "$7,987.50" "$5,990.63" "$7,987.50" "$7,987.50" "$7,987.50" "$3,993.75" "$3,993.75" "$6,326.10" "$7,987.50" "$6,390.00" "$5,191.88" "$1,585.32" N/A "$4,632.75" "$7,987.50" "$7,987.50" "$7,987.50" "$1,664.60" "$7,987.50" N/A N/A 90112 SUP HCPCS C1757 90112 - CATHETER THRMB CRKSCR 2.5MM 180CM 6MM MRC V RETREIVER V2.5 BOTH IP/OP "$7,987.50" "$5,911.00" "$1,585.32" "$7,987.50" "$4,337.21" "$4,337.21" "$4,337.21" "$4,337.21" "$7,987.50" "$7,987.50" "$7,987.50" "$1,664.79" "$7,987.50" "$4,181.12" "$4,181.12" "$6,156.77" "$2,060.15" "$1,664.68" "$7,987.50" "$7,978.25" "$3,094.73" "$7,987.50" "$7,987.50" "$7,987.50" "$7,987.50" "$5,990.63" "$7,987.50" "$7,987.50" "$7,987.50" "$3,993.75" "$3,993.75" "$6,326.10" "$7,987.50" "$6,390.00" "$5,191.88" "$1,585.32" N/A "$4,632.75" "$7,987.50" "$7,987.50" "$7,987.50" "$1,664.60" "$7,987.50" N/A N/A 90113 SUP HCPCS C1757 90113 - CATHETER THRMB CRKSCR 3MM 180CM 7MM MRC V RTRV V3 SFT NTNL BOTH IP/OP "$7,987.50" "$5,911.00" "$1,585.32" "$7,987.50" "$4,337.21" "$4,337.21" "$4,337.21" "$4,337.21" "$7,987.50" "$7,987.50" "$7,987.50" "$1,664.79" "$7,987.50" "$4,181.12" "$4,181.12" "$6,156.77" "$2,060.15" "$1,664.68" "$7,987.50" "$7,978.25" "$3,094.73" "$7,987.50" "$7,987.50" "$7,987.50" "$7,987.50" "$5,990.63" "$7,987.50" "$7,987.50" "$7,987.50" "$3,993.75" "$3,993.75" "$6,326.10" "$7,987.50" "$6,390.00" "$5,191.88" "$1,585.32" N/A "$4,632.75" "$7,987.50" "$7,987.50" "$7,987.50" "$1,664.60" "$7,987.50" N/A N/A 90120 SUP HCPCS C1757 90120 - CATHETER THRMB 3.9FR .038IN 125CM DAC 1 LUM BRAID RADOPQ LL BOTH IP/OP "$2,700.50" "$1,998.00" $535.91 "$2,700.15" "$1,466.18" "$1,466.18" "$1,466.18" "$1,466.18" "$2,700.15" "$2,700.15" "$2,700.15" $562.78 "$2,700.15" "$2,004.05" "$2,004.05" "$2,081.28" "$1,406.78" $562.74 "$2,700.15" "$2,700.15" "$1,597.14" "$2,700.15" "$2,700.15" "$2,700.15" "$2,700.15" "$2,025.38" "$2,700.15" "$2,700.15" "$2,700.15" "$1,350.08" "$1,350.08" "$2,138.52" "$2,700.15" "$2,160.12" "$1,755.10" $535.91 N/A "$1,566.29" "$2,700.15" "$2,700.15" "$2,700.15" $562.71 "$2,700.15" N/A N/A 90160 SUP HCPCS L1902 90160 - BRACE ORTH 2XS LOPRFL LF ULT CTS KNIT TNG ELC PNL LACE UP BOTH IP/OP $29.50 $22.00 $17.11 "$2,700.15" "$1,466.18" "$1,466.18" "$1,466.18" "$1,466.18" "$2,700.15" "$2,700.15" "$2,700.15" $562.78 "$2,700.15" "$2,004.05" "$2,004.05" "$2,081.28" "$1,406.78" $562.74 "$2,700.15" "$2,700.15" "$1,597.14" "$2,700.15" "$2,700.15" "$2,700.15" "$2,700.15" $22.13 "$2,700.15" "$2,700.15" "$2,700.15" "$1,350.08" "$1,350.08" "$2,138.52" "$2,700.15" "$2,160.12" "$1,755.10" $535.91 N/A $17.11 "$2,700.15" "$2,700.15" "$2,700.15" $562.71 "$2,700.15" N/A N/A 90160 SUP HCPCS C1757 90160 - CATHETER THRMB 4.3FR .044IN 115CM DAC 1 LUM BRAID RADOPQ LL BOTH IP/OP "$2,700.50" "$1,998.00" $535.91 "$2,700.15" "$1,466.18" "$1,466.18" "$1,466.18" "$1,466.18" "$2,700.15" "$2,700.15" "$2,700.15" $562.78 "$2,700.15" "$2,004.05" "$2,004.05" "$2,081.28" "$1,406.78" $562.74 "$2,700.15" "$2,700.15" "$1,597.14" "$2,700.15" "$2,700.15" "$2,700.15" "$2,700.15" "$2,025.38" "$2,700.15" "$2,700.15" "$2,700.15" "$1,350.08" "$1,350.08" "$2,138.52" "$2,700.15" "$2,160.12" "$1,755.10" $535.91 N/A "$1,566.29" "$2,700.15" "$2,700.15" "$2,700.15" $562.71 "$2,700.15" N/A N/A 90161 SUP HCPCS L1902 90161 - BRACE ORTH XS LOPRFL LF ULT CTS KNIT TNG ELC PNL LACE UP NYL BOTH IP/OP $29.50 $22.00 $6.11 $54.06 $29.30 $29.30 $29.30 $29.30 $29.30 $29.30 $54.06 $29.30 $29.30 $29.30 $29.30 $29.30 $29.30 $6.11 $29.30 $12.07 $29.30 $29.30 $29.30 $29.30 $29.30 $22.13 $29.30 $29.30 $29.30 $14.65 $14.65 $23.21 $29.30 $23.44 $13.19 $29.30 N/A $17.11 $29.30 $17.58 $29.30 $29.30 $29.30 N/A N/A 90162 SUP HCPCS L1902 90162 - BRACE ORTH SM LOPRFL LF ULT CTS KNIT TNG ELC PNL LACE UP NYL BOTH IP/OP $29.50 $22.00 $17.11 "$2,700.15" "$1,466.18" "$1,466.18" "$1,466.18" "$1,466.18" "$2,700.15" "$2,700.15" "$2,700.15" $562.78 "$2,700.15" "$2,004.05" "$2,004.05" "$2,081.28" "$1,406.78" $562.74 "$2,700.15" "$2,700.15" "$1,597.14" "$2,700.15" "$2,700.15" "$2,700.15" "$2,700.15" $22.13 "$2,700.15" "$2,700.15" "$2,700.15" "$1,350.08" "$1,350.08" "$2,138.52" "$2,700.15" "$2,160.12" "$1,755.10" $535.91 N/A $17.11 "$2,700.15" "$2,700.15" "$2,700.15" $562.71 "$2,700.15" N/A N/A 90162 SUP HCPCS C1757 90162 - CATHETER THRMB 4.3FR .044IN 136CM DAC 1 LUM BRAID RADOPQ LL BOTH IP/OP "$2,700.50" "$1,998.00" $535.91 "$2,700.15" "$1,466.18" "$1,466.18" "$1,466.18" "$1,466.18" "$2,700.15" "$2,700.15" "$2,700.15" $562.78 "$2,700.15" "$2,004.05" "$2,004.05" "$2,081.28" "$1,406.78" $562.74 "$2,700.15" "$2,700.15" "$1,597.14" "$2,700.15" "$2,700.15" "$2,700.15" "$2,700.15" "$2,025.38" "$2,700.15" "$2,700.15" "$2,700.15" "$1,350.08" "$1,350.08" "$2,138.52" "$2,700.15" "$2,160.12" "$1,755.10" $535.91 N/A "$1,566.29" "$2,700.15" "$2,700.15" "$2,700.15" $562.71 "$2,700.15" N/A N/A 90170 SUP HCPCS L1902 90170 - BRACE ORTH 2XS LOPRFL ULT CTS LACE UP STAY ELC CUF CLSR BOTH IP/OP $39.50 $29.00 $22.91 "$2,700.15" "$1,466.18" "$1,466.18" "$1,466.18" "$1,466.18" "$2,700.15" "$2,700.15" "$2,700.15" $562.78 "$2,700.15" "$2,004.05" "$2,004.05" "$2,081.28" "$1,406.78" $562.74 "$2,700.15" "$2,700.15" "$1,597.14" "$2,700.15" "$2,700.15" "$2,700.15" "$2,700.15" $29.63 "$2,700.15" "$2,700.15" "$2,700.15" "$1,350.08" "$1,350.08" "$2,138.52" "$2,700.15" "$2,160.12" "$1,755.10" $535.91 N/A $22.91 "$2,700.15" "$2,700.15" "$2,700.15" $562.71 "$2,700.15" N/A N/A 90170 SUP HCPCS C1757 90170 - CATHETER THRMB 6.3FR .07IN 105CM DAC 1 LUM BRD RADOPQ LL HUB BOTH IP/OP "$2,700.50" "$1,998.00" $535.91 "$2,700.15" "$1,466.18" "$1,466.18" "$1,466.18" "$1,466.18" "$2,700.15" "$2,700.15" "$2,700.15" $562.78 "$2,700.15" "$2,004.05" "$2,004.05" "$2,081.28" "$1,406.78" $562.74 "$2,700.15" "$2,700.15" "$1,597.14" "$2,700.15" "$2,700.15" "$2,700.15" "$2,700.15" "$2,025.38" "$2,700.15" "$2,700.15" "$2,700.15" "$1,350.08" "$1,350.08" "$2,138.52" "$2,700.15" "$2,160.12" "$1,755.10" $535.91 N/A "$1,566.29" "$2,700.15" "$2,700.15" "$2,700.15" $562.71 "$2,700.15" N/A N/A 90182 SUP Custom 27203010 90182 - RETRIEVER ESCP 4MM 20MM TREVO XP PROVUE BOTH IP/OP "$13,116.50" "$9,706.00" "$2,060.15" "$13,116.25" "$13,116.25" "$13,116.25" "$13,116.25" "$13,116.25" "$13,116.25" "$13,116.25" "$2,334.69" "$13,116.25" "$13,116.25" "$4,181.12" "$4,181.12" "$10,110.01" "$2,060.15" "$2,733.57" "$13,116.25" "$5,246.50" "$13,116.25" "$13,116.25" "$13,116.25" "$13,116.25" "$13,116.25" "$9,837.38" "$13,116.25" "$13,116.25" "$13,116.25" "$6,558.13" "$6,558.13" "$10,388.07" "$13,116.25" "$10,493.00" "$8,525.56" "$13,116.25" N/A "$7,607.57" "$13,116.25" "$7,869.75" "$13,116.25" "$13,116.25" "$13,116.25" N/A N/A 90183 SUP Custom 27203010 90183 - RETRIEVER ESCP 3MM 20MM TREVO XP PROVUE BOTH IP/OP "$13,116.50" "$9,706.00" "$2,060.15" "$13,116.25" "$13,116.25" "$13,116.25" "$13,116.25" "$13,116.25" "$13,116.25" "$13,116.25" "$2,334.69" "$13,116.25" "$13,116.25" "$4,181.12" "$4,181.12" "$10,110.01" "$2,060.15" "$2,733.57" "$13,116.25" "$5,246.50" "$13,116.25" "$13,116.25" "$13,116.25" "$13,116.25" "$13,116.25" "$9,837.38" "$13,116.25" "$13,116.25" "$13,116.25" "$6,558.13" "$6,558.13" "$10,388.07" "$13,116.25" "$10,493.00" "$8,525.56" "$13,116.25" N/A "$7,607.57" "$13,116.25" "$7,869.75" "$13,116.25" "$13,116.25" "$13,116.25" N/A N/A 90231 SUP HCPCS C1757 90231 - CATHETER INFS MIC 18FR TREVO PRO NRVSC BOTH IP/OP "$1,704.00" "$1,261.00" $338.15 "$1,703.75" $925.14 $925.14 $925.14 $925.14 "$1,703.75" "$1,703.75" "$1,703.75" $355.10 "$1,703.75" "$1,264.52" "$1,264.52" "$1,313.25" $887.65 $355.08 "$1,703.75" "$1,703.75" "$1,007.77" "$1,703.75" "$1,703.75" "$1,703.75" "$1,703.75" "$1,278.00" "$1,703.75" "$1,703.75" "$1,703.75" $851.88 $851.88 "$1,349.37" "$1,703.75" "$1,363.00" "$1,107.44" $338.15 N/A $988.32 "$1,703.75" "$1,703.75" "$1,703.75" $355.06 "$1,703.75" N/A N/A 90603 SUP Custom 27203010 90603 - DRESSING TRANSPARENT 8X8IN ABSORBENT NONADHESIVE BOTH IP/OP $29.00 $21.00 $5.14 $28.88 $28.88 $28.88 $28.88 $28.88 $28.88 $28.88 $5.14 $28.88 $28.88 $21.43 $21.43 $22.26 $15.05 $6.02 $28.88 $11.55 $28.88 $28.88 $28.88 $28.88 $28.88 $21.75 $28.88 $28.88 $28.88 $14.44 $14.44 $22.87 $28.88 $23.10 $18.77 $28.88 N/A $16.82 $28.88 $17.33 $28.88 $28.88 $28.88 N/A N/A 90605 SUP Custom 27203010 90605 - DRESSING FOAM 24X4IN NONADHESIVE HIGH FLUID HANDLE BOTH IP/OP $50.00 $37.00 $8.83 $49.61 $49.61 $49.61 $49.61 $49.61 $49.61 $49.61 $8.83 $49.61 $49.61 $36.82 $36.82 $38.24 $25.85 $10.34 $49.61 $19.84 $49.61 $49.61 $49.61 $49.61 $49.61 $37.50 $49.61 $49.61 $49.61 $24.81 $24.81 $39.29 $49.61 $39.69 $32.25 $49.61 N/A $29.00 $49.61 $29.77 $49.61 $49.61 $49.61 N/A N/A 90721 SUP HCPCS C1887 90721 - CATHETER THRMB 3.9FR .038IN 136CM DAC 1 LUM BRAID RADOPQ LL BOTH IP/OP "$2,700.50" "$1,998.00" $535.91 "$2,700.15" "$1,466.18" "$1,466.18" "$1,466.18" "$1,466.18" "$2,700.15" "$2,700.15" "$2,700.15" $562.78 "$2,700.15" "$2,004.05" "$2,004.05" "$2,081.28" "$1,406.78" $562.74 "$2,700.15" "$2,700.15" "$1,597.14" "$2,700.15" "$2,700.15" "$2,700.15" "$2,700.15" "$2,025.38" "$2,700.15" "$2,700.15" "$2,700.15" "$1,350.08" "$1,350.08" "$2,138.52" "$2,700.15" "$2,160.12" "$1,755.10" $535.91 N/A "$1,566.29" "$2,700.15" "$2,700.15" "$2,700.15" $562.71 "$2,700.15" N/A N/A 90730 SUP HCPCS C1757 90730 - CATHETER THRMB 5.2FR .057IN 115CM DAC 1 LUM BRAID RADOPQ LL BOTH IP/OP "$2,700.50" "$1,998.00" $535.91 "$2,700.15" "$1,466.18" "$1,466.18" "$1,466.18" "$1,466.18" "$2,700.15" "$2,700.15" "$2,700.15" $562.78 "$2,700.15" "$2,004.05" "$2,004.05" "$2,081.28" "$1,406.78" $562.74 "$2,700.15" "$2,700.15" "$1,597.14" "$2,700.15" "$2,700.15" "$2,700.15" "$2,700.15" "$2,025.38" "$2,700.15" "$2,700.15" "$2,700.15" "$1,350.08" "$1,350.08" "$2,138.52" "$2,700.15" "$2,160.12" "$1,755.10" $535.91 N/A "$1,566.29" "$2,700.15" "$2,700.15" "$2,700.15" $562.71 "$2,700.15" N/A N/A 90760 SUP HCPCS C1757 90760 - CATHETER THRMB 4.3FR .044IN 130CM DAC 1 LUM BRAID RADOPQ LL BOTH IP/OP "$2,573.50" "$1,904.00" $510.73 "$2,700.15" "$1,397.27" "$1,397.27" "$1,397.27" "$1,397.27" "$2,573.25" "$2,573.25" "$2,573.25" $536.33 "$2,573.25" "$1,909.87" "$1,909.87" "$1,983.46" "$1,340.66" $536.29 "$2,573.25" "$2,700.15" "$1,522.08" "$2,573.25" "$2,573.25" "$2,573.25" "$2,573.25" "$1,930.13" "$2,573.25" "$2,573.25" "$2,573.25" "$1,286.63" "$1,286.63" "$2,038.01" "$2,573.25" "$2,058.60" "$1,672.61" $510.73 N/A "$1,492.63" "$2,573.25" "$2,573.25" "$2,573.25" $536.27 "$2,573.25" N/A N/A 90805 SUP Custom 27203010 90805 - DRESSING TRANSPARENT LARGE SQUARE 8INX7 7/8IN 6INX5 7/8IN BOTH IP/OP $24.50 $18.00 $4.35 $24.44 $24.44 $24.44 $24.44 $24.44 $24.44 $24.44 $4.35 $24.44 $24.44 $18.14 $18.14 $18.84 $12.73 $5.09 $24.44 $9.78 $24.44 $24.44 $24.44 $24.44 $24.44 $18.38 $24.44 $24.44 $24.44 $12.22 $12.22 $19.36 $24.44 $19.55 $15.89 $24.44 N/A $14.21 $24.44 $14.66 $24.44 $24.44 $24.44 N/A N/A 91101 SUP Custom 27203010 91101 - CATHETER NEUROSURGICAL ANTIBIOTIC IMPREGNATED ARES VENTRICLE BOTH IP/OP $770.00 $570.00 $137.06 $770.00 $770.00 $770.00 $770.00 $770.00 $770.00 $770.00 $137.06 $770.00 $770.00 $571.49 $571.49 $593.52 $401.17 $160.48 $770.00 $308.00 $770.00 $770.00 $770.00 $770.00 $770.00 $577.50 $770.00 $770.00 $770.00 $385.00 $385.00 $609.84 $770.00 $616.00 $500.50 $770.00 N/A $446.60 $770.00 $462.00 $770.00 $770.00 $770.00 N/A N/A 91265 SUP Custom 27203010 91265 - CANNULA PERFUSION .5IN 36-46FR 15IN 2 STAGE OVAL BODY MC2 BOTH IP/OP $86.50 $64.00 $15.32 $86.09 $86.09 $86.09 $86.09 $86.09 $86.09 $86.09 $15.32 $86.09 $86.09 $63.90 $63.90 $66.36 $44.85 $17.94 $86.09 $31.47 $86.09 $86.09 $78.68 $86.09 $86.09 $64.88 $86.09 $86.09 $86.09 $43.05 $43.05 $68.18 $86.09 $68.87 $55.96 $86.09 N/A $50.17 $86.09 $51.65 $86.09 $86.09 $86.09 N/A N/A 91503 SUP Custom 27803010 91503 - CATHETER NEUROSURGICAL STANDARD 23CM CATHETER BIOGLIDE BOTH IP/OP $513.00 $380.00 $91.31 $513.00 $513.00 $513.00 $513.00 $513.00 $513.00 $513.00 $91.31 $513.00 $513.00 $513.00 $513.00 $513.00 $513.00 $106.91 $513.00 $205.20 $513.00 $513.00 $513.00 $513.00 $513.00 $384.75 $513.00 $513.00 $513.00 $256.50 $256.50 $406.30 $513.00 $410.40 $230.85 $513.00 N/A $297.54 $513.00 $307.80 $513.00 $513.00 $513.00 N/A N/A 92001 SUP Custom 27203010 092001 - CLIP INTNL ANG RT 15MM STRL LF LDS LNR CTR PWR SF LKOUT BOTH IP/OP $387.50 $287.00 $68.91 $387.15 $387.15 $387.15 $387.15 $387.15 $387.15 $387.15 $68.91 $387.15 $387.15 $287.34 $287.34 $298.42 $201.71 $80.69 $387.15 $154.86 $387.15 $387.15 $387.15 $387.15 $387.15 $290.63 $387.15 $387.15 $387.15 $193.58 $193.58 $306.62 $387.15 $309.72 $251.65 $387.15 N/A $224.75 $387.15 $232.29 $387.15 $387.15 $387.15 N/A N/A 92100 SUP Custom 27203010 0092100 - TUBE ESPH 20FR 8IN NS LTX 1.5IN BLKMR BLN SPCL NTR RBR ADLT BOTH IP/OP $758.50 $561.00 $134.97 $758.28 $758.28 $758.28 $758.28 $758.28 $758.28 $758.28 $134.97 $758.28 $758.28 $562.80 $562.80 $584.48 $395.06 $158.03 $758.28 $144.19 $758.28 $758.28 $360.48 $758.28 $758.28 $568.88 $758.28 $758.28 $758.28 $379.14 $379.14 $600.56 $758.28 $606.62 $492.88 $758.28 N/A $439.93 $758.28 $454.97 $758.28 $758.28 $758.28 53.74 34.06 92312 SUP Custom 27803010 92312 - VALVE SHUNT SMALL CSF LOW PRESSURE CNTOUR BIOGLIDE BOTH IP/OP "$2,681.50" "$1,984.00" $477.29 "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" $477.29 "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" $558.83 "$2,681.38" "$1,072.55" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,011.13" "$2,681.38" "$2,681.38" "$2,681.38" "$1,340.69" "$1,340.69" "$2,123.65" "$2,681.38" "$2,145.10" "$1,206.62" "$2,681.38" N/A "$1,555.27" "$2,681.38" "$1,608.83" "$2,681.38" "$2,681.38" "$2,681.38" 100.71 64.21 92314 SUP Custom 27803010 92314 - VALVE SHUNT SMALL CSF MEDIUM PRESSURE CNTOUR BIOGLIDE BOTH IP/OP "$2,681.50" "$1,984.00" $477.29 "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" $477.29 "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" $558.83 "$2,681.38" "$1,072.55" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,011.13" "$2,681.38" "$2,681.38" "$2,681.38" "$1,340.69" "$1,340.69" "$2,123.65" "$2,681.38" "$2,145.10" "$1,206.62" "$2,681.38" N/A "$1,555.27" "$2,681.38" "$1,608.83" "$2,681.38" "$2,681.38" "$2,681.38" 55.33 N/A 92316 SUP Custom 27803010 92316 - VALVE SHUNT SMALL CSF HIGH PRESSURE CNTOUR BIOGLIDE BOTH IP/OP "$3,019.00" "$2,234.00" $537.32 "$3,018.63" "$3,018.63" "$3,018.63" "$3,018.63" "$3,018.63" "$3,018.63" "$3,018.63" $537.32 "$3,018.63" "$3,018.63" "$3,018.63" "$3,018.63" "$3,018.63" "$3,018.63" $629.12 "$3,018.63" "$1,207.45" "$3,018.63" "$3,018.63" "$3,018.63" "$3,018.63" "$3,018.63" "$2,264.25" "$3,018.63" "$3,018.63" "$3,018.63" "$1,509.32" "$1,509.32" "$2,390.75" "$3,018.63" "$2,414.90" "$1,358.38" "$3,018.63" N/A "$1,751.02" "$3,018.63" "$1,811.18" "$3,018.63" "$3,018.63" "$3,018.63" 52.03 33.38 92322 SUP Custom 27803010 92322 - VALVE SHUNT REGULAR CSF LOW PRESSURE CNTOUR BIOGLIDE BOTH IP/OP "$2,681.50" "$1,984.00" $477.29 "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" $477.29 "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" $558.83 "$2,681.38" "$1,072.55" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,011.13" "$2,681.38" "$2,681.38" "$2,681.38" "$1,340.69" "$1,340.69" "$2,123.65" "$2,681.38" "$2,145.10" "$1,206.62" "$2,681.38" N/A "$1,555.27" "$2,681.38" "$1,608.83" "$2,681.38" "$2,681.38" "$2,681.38" N/A N/A 92324 SUP Custom 27803010 92324 - VALVE SHUNT REGULAR CNTOUR MEDIUM PRESSURE BIOGLIDE BOTH IP/OP "$2,681.50" "$1,984.00" $477.29 "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" $477.29 "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" $558.83 "$2,681.38" "$1,072.55" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,011.13" "$2,681.38" "$2,681.38" "$2,681.38" "$1,340.69" "$1,340.69" "$2,123.65" "$2,681.38" "$2,145.10" "$1,206.62" "$2,681.38" N/A "$1,555.27" "$2,681.38" "$1,608.83" "$2,681.38" "$2,681.38" "$2,681.38" N/A N/A 92326 SUP Custom 27803010 92326 - VALVE SHUNT REGULAR CSF HIGH PRESSURE CNTOUR BIOGLIDE BOTH IP/OP "$2,681.50" "$1,984.00" $477.29 "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" $477.29 "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" $558.83 "$2,681.38" "$1,072.55" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,681.38" "$2,011.13" "$2,681.38" "$2,681.38" "$2,681.38" "$1,340.69" "$1,340.69" "$2,123.65" "$2,681.38" "$2,145.10" "$1,206.62" "$2,681.38" N/A "$1,555.27" "$2,681.38" "$1,608.83" "$2,681.38" "$2,681.38" "$2,681.38" 55.63 42.03 92355 SUP Custom 27803010 92355 - VALVE SHUNT SMALL NSC STRATA BIOGLIDE BOTH IP/OP "$9,501.50" "$7,031.00" "$1,691.19" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$1,691.19" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$1,980.12" "$9,501.05" "$3,800.42" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$7,126.13" "$9,501.05" "$9,501.05" "$9,501.05" "$4,750.53" "$4,750.53" "$7,524.83" "$9,501.05" "$7,600.84" "$4,275.47" "$9,501.05" N/A "$5,510.87" "$9,501.05" "$5,700.63" "$9,501.05" "$9,501.05" "$9,501.05" 33.14 N/A 92365 SUP Custom 27803010 92365 - VALVE SHUNT REGULAR NSC STRATA BIOGLIDE BOTH IP/OP "$9,501.50" "$7,031.00" "$1,691.19" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$1,691.19" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$1,980.12" "$9,501.05" "$3,800.42" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$9,501.05" "$7,126.13" "$9,501.05" "$9,501.05" "$9,501.05" "$4,750.53" "$4,750.53" "$7,524.83" "$9,501.05" "$7,600.84" "$4,275.47" "$9,501.05" N/A "$5,510.87" "$9,501.05" "$5,700.63" "$9,501.05" "$9,501.05" "$9,501.05" N/A N/A 92812 SUP Custom 27803010 92812 - VALVE SHUNT SMALL PERFORMANCE LEVEL 1 CSF DELTA BIOGLIDE BOTH IP/OP "$4,358.50" "$3,225.00" $775.75 "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" $775.75 "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" $908.28 "$4,358.13" "$1,743.25" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$3,268.88" "$4,358.13" "$4,358.13" "$4,358.13" "$2,179.07" "$2,179.07" "$3,451.64" "$4,358.13" "$3,486.50" "$1,961.16" "$4,358.13" N/A "$2,527.93" "$4,358.13" "$2,614.88" "$4,358.13" "$4,358.13" "$4,358.13" N/A N/A 92813 SUP Custom 27803010 92813 - VALVE SHUNT SMALL PERFORMANCE LEVEL 1.5 CSF DELTA BIOGLIDE BOTH IP/OP "$4,358.50" "$3,225.00" $775.75 "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" $775.75 "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" $908.28 "$4,358.13" "$1,743.25" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$3,268.88" "$4,358.13" "$4,358.13" "$4,358.13" "$2,179.07" "$2,179.07" "$3,451.64" "$4,358.13" "$3,486.50" "$1,961.16" "$4,358.13" N/A "$2,527.93" "$4,358.13" "$2,614.88" "$4,358.13" "$4,358.13" "$4,358.13" N/A N/A 92814 SUP Custom 27803010 92814 - VALVE SHUNT SMALL PERFORMANCE LEVEL 2 CSF DELTA BIOGLIDE BOTH IP/OP "$4,358.50" "$3,225.00" $775.75 "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" $775.75 "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" $908.28 "$4,358.13" "$1,743.25" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$3,268.88" "$4,358.13" "$4,358.13" "$4,358.13" "$2,179.07" "$2,179.07" "$3,451.64" "$4,358.13" "$3,486.50" "$1,961.16" "$4,358.13" N/A "$2,527.93" "$4,358.13" "$2,614.88" "$4,358.13" "$4,358.13" "$4,358.13" N/A N/A 92822 SUP Custom 27803010 92822 - VALVE SHUNT REGULAR PERFORMANCE LEVEL 1 CSF DELTA BIOGLIDE BOTH IP/OP "$4,358.50" "$3,225.00" $775.75 "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" $775.75 "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" $908.28 "$4,358.13" "$1,743.25" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$3,268.88" "$4,358.13" "$4,358.13" "$4,358.13" "$2,179.07" "$2,179.07" "$3,451.64" "$4,358.13" "$3,486.50" "$1,961.16" "$4,358.13" N/A "$2,527.93" "$4,358.13" "$2,614.88" "$4,358.13" "$4,358.13" "$4,358.13" N/A N/A 92823 SUP Custom 27803010 92823 - VALVE SHUNT REGULAR PERFORMANCE LEVEL 1.5 CSF DELTA BIOGLIDE BOTH IP/OP "$4,358.50" "$3,225.00" $775.75 "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" $775.75 "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" $908.28 "$4,358.13" "$1,743.25" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$3,268.88" "$4,358.13" "$4,358.13" "$4,358.13" "$2,179.07" "$2,179.07" "$3,451.64" "$4,358.13" "$3,486.50" "$1,961.16" "$4,358.13" N/A "$2,527.93" "$4,358.13" "$2,614.88" "$4,358.13" "$4,358.13" "$4,358.13" N/A N/A 92824 SUP Custom 27803010 92824 - VALVE SHUNT REGULAR PERFORMANCE LEVEL 2 CSF DELTA BIOGLIDE BOTH IP/OP "$4,358.50" "$3,225.00" $775.75 "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" $775.75 "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" $908.28 "$4,358.13" "$1,743.25" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$4,358.13" "$3,268.88" "$4,358.13" "$4,358.13" "$4,358.13" "$2,179.07" "$2,179.07" "$3,451.64" "$4,358.13" "$3,486.50" "$1,961.16" "$4,358.13" N/A "$2,527.93" "$4,358.13" "$2,614.88" "$4,358.13" "$4,358.13" "$4,358.13" N/A N/A 92830 SUP Custom 27803010 92830 - VALVE SHUNT 12MM PERFORMANCE LEVEL .5 BURR HOLE DELTA BOTH IP/OP "$4,612.50" "$3,413.00" $820.98 "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" $820.98 "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" $961.24 "$4,612.25" "$1,844.90" "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" "$3,459.38" "$4,612.25" "$4,612.25" "$4,612.25" "$2,306.13" "$2,306.13" "$3,652.90" "$4,612.25" "$3,689.80" "$2,075.51" "$4,612.25" N/A "$2,675.25" "$4,612.25" "$2,767.35" "$4,612.25" "$4,612.25" "$4,612.25" N/A N/A 92833 SUP Custom 27803010 92833 - VALVE SHUNT 12MM CSF PERFORMANCE LEVEL 1.5 BURR HOLE DELTA BOTH IP/OP "$3,904.50" "$2,889.00" $695.00 "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" $695.00 "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" $813.74 "$3,904.50" "$1,561.80" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$2,928.38" "$3,904.50" "$3,904.50" "$3,904.50" "$1,952.25" "$1,952.25" "$3,092.36" "$3,904.50" "$3,123.60" "$1,757.03" "$3,904.50" N/A "$2,264.61" "$3,904.50" "$2,342.70" "$3,904.50" "$3,904.50" "$3,904.50" N/A N/A 92834 SUP Custom 27803010 92834 - VALVE SHUNT 12MM CSF PERFORMANCE LEVEL 2 BURR HOLE DELTA BOTH IP/OP "$4,612.50" "$3,413.00" $820.98 "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" $820.98 "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" $961.24 "$4,612.25" "$1,844.90" "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" "$4,612.25" "$3,459.38" "$4,612.25" "$4,612.25" "$4,612.25" "$2,306.13" "$2,306.13" "$3,652.90" "$4,612.25" "$3,689.80" "$2,075.51" "$4,612.25" N/A "$2,675.25" "$4,612.25" "$2,767.35" "$4,612.25" "$4,612.25" "$4,612.25" N/A N/A 92840 SUP Custom 27803010 92840 - VALVE SHUNT 16MM PERFORMANCE LEVEL .5 BURR HOLE DELTA BOTH IP/OP "$3,904.50" "$2,889.00" $695.00 "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" $695.00 "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" $813.74 "$3,904.50" "$1,561.80" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$2,928.38" "$3,904.50" "$3,904.50" "$3,904.50" "$1,952.25" "$1,952.25" "$3,092.36" "$3,904.50" "$3,123.60" "$1,757.03" "$3,904.50" N/A "$2,264.61" "$3,904.50" "$2,342.70" "$3,904.50" "$3,904.50" "$3,904.50" N/A N/A 92842 SUP Custom 27803010 92842 - VALVE SHUNT 16MM RESERVOIR DOME NONMETALLIC RADIOPQ DELTA BOTH IP/OP "$3,904.50" "$2,889.00" $695.00 "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" $695.00 "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" $813.74 "$3,904.50" "$1,561.80" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$2,928.38" "$3,904.50" "$3,904.50" "$3,904.50" "$1,952.25" "$1,952.25" "$3,092.36" "$3,904.50" "$3,123.60" "$1,757.03" "$3,904.50" N/A "$2,264.61" "$3,904.50" "$2,342.70" "$3,904.50" "$3,904.50" "$3,904.50" N/A N/A 92843 SUP Custom 27803010 92843 - VALVE SHUNT 16MM BURR HOLE DELTA CSF STERILE BOTH IP/OP "$3,904.50" "$2,889.00" $695.00 "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" $695.00 "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" $813.74 "$3,904.50" "$1,561.80" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$2,928.38" "$3,904.50" "$3,904.50" "$3,904.50" "$1,952.25" "$1,952.25" "$3,092.36" "$3,904.50" "$3,123.60" "$1,757.03" "$3,904.50" N/A "$2,264.61" "$3,904.50" "$2,342.70" "$3,904.50" "$3,904.50" "$3,904.50" N/A N/A 92844 SUP Custom 27803010 92844 - VALVE SHUNT 16MM RESERVOIR DOME NONMETALLIC RADIOPQ DELTA BOTH IP/OP "$3,904.50" "$2,889.00" $695.00 "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" $695.00 "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" $813.74 "$3,904.50" "$1,561.80" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$3,904.50" "$2,928.38" "$3,904.50" "$3,904.50" "$3,904.50" "$1,952.25" "$1,952.25" "$3,092.36" "$3,904.50" "$3,123.60" "$1,757.03" "$3,904.50" N/A "$2,264.61" "$3,904.50" "$2,342.70" "$3,904.50" "$3,904.50" "$3,904.50" N/A N/A 92856 SUP Custom 27803010 92856 - VALVE SHUNT SMALL CSF ADJUSTABLE FLOW CONTROL STRATA II BOTH IP/OP "$10,338.00" "$7,650.00" "$1,840.10" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$1,840.10" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$2,154.48" "$10,337.65" "$4,135.06" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$7,753.50" "$10,337.65" "$10,337.65" "$10,337.65" "$5,168.83" "$5,168.83" "$8,187.42" "$10,337.65" "$8,270.12" "$4,651.94" "$10,337.65" N/A "$5,996.04" "$10,337.65" "$6,202.59" "$10,337.65" "$10,337.65" "$10,337.65" N/A N/A 92866 SUP Custom 27803010 92866 - VALVE SHUNT REGULAR CSF ADJUSTABLE FLOW CONTROL STRATA II BOTH IP/OP "$10,338.00" "$7,650.00" "$1,840.10" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$1,840.10" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$2,154.48" "$10,337.65" "$4,135.06" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$10,337.65" "$7,753.50" "$10,337.65" "$10,337.65" "$10,337.65" "$5,168.83" "$5,168.83" "$8,187.42" "$10,337.65" "$8,270.12" "$4,651.94" "$10,337.65" N/A "$5,996.04" "$10,337.65" "$6,202.59" "$10,337.65" "$10,337.65" "$10,337.65" N/A N/A 93092 SUP Custom 27203010 93092 - CATHETER NEUROSURGICAL .25CM .13CM 120CM ANTIBIOTIC BOTH IP/OP $770.00 $570.00 $137.06 $770.00 $770.00 $770.00 $770.00 $770.00 $770.00 $770.00 $137.06 $770.00 $770.00 $571.49 $571.49 $593.52 $401.17 $160.48 $770.00 $308.00 $770.00 $770.00 $770.00 $770.00 $770.00 $577.50 $770.00 $770.00 $770.00 $385.00 $385.00 $609.84 $770.00 $616.00 $500.50 $770.00 N/A $446.60 $770.00 $462.00 $770.00 $770.00 $770.00 N/A N/A 93522 SUP Custom 27803010 93522 - CATHETER DRAIN 90CM CSF BIOGLIDE PERITONEAL BOTH IP/OP $544.00 $403.00 $96.81 $543.88 $543.88 $543.88 $543.88 $543.88 $543.88 $543.88 $96.81 $543.88 $543.88 $543.88 $543.88 $543.88 $543.88 $113.35 $543.88 $217.55 $543.88 $543.88 $543.88 $543.88 $543.88 $408.00 $543.88 $543.88 $543.88 $271.94 $271.94 $430.75 $543.88 $435.10 $244.75 $543.88 N/A $315.52 $543.88 $326.33 $543.88 $543.88 $543.88 N/A N/A 94965 SUP Custom 27203010 94965 - CANNULA PERFUSION 15FR 12.5IN RTRGRD MANUAL INFLATE RIDGED BOTH IP/OP $218.50 $162.00 $38.85 $218.25 $218.25 $218.25 $218.25 $218.25 $218.25 $218.25 $38.85 $218.25 $218.25 $161.99 $161.99 $168.23 $113.71 $45.49 $218.25 $79.80 $218.25 $218.25 $199.49 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $141.86 $218.25 N/A $126.73 $218.25 $130.95 $218.25 $218.25 $218.25 N/A N/A 95001 SUP Custom 27100030 95001 - SPLINT TRC CURAPLEX 4 LG ADJ ANKL STRAP CRRY CA TLSCP NYL BOTH IP/OP $337.00 $249.00 $59.96 $336.88 $336.88 $336.88 $336.88 $336.88 $336.88 $336.88 $59.96 $336.88 $336.88 $250.03 $250.03 $259.67 $175.51 $70.21 $336.88 $134.75 $336.88 $336.88 $336.88 $336.88 $336.88 $252.75 $336.88 $336.88 $336.88 $168.44 $168.44 $266.81 $336.88 $269.50 $218.97 $336.88 N/A $195.46 $336.88 $202.13 $336.88 $336.88 $336.88 N/A N/A 95001 SUP Custom 27203010 95001 - KIT CATH STRL LF ARES ANBTC BOTH IP/OP "$1,350.00" $999.00 $59.96 "$1,012.50" $336.88 $336.88 $336.88 $336.88 $336.88 $336.88 $59.96 $336.88 $336.88 $250.03 $250.03 $259.67 $175.51 $70.21 $336.88 $134.75 $336.88 $336.88 $336.88 $336.88 $336.88 "$1,012.50" $336.88 $336.88 $336.88 $168.44 $168.44 $266.81 $336.88 $269.50 $218.97 $336.88 N/A $783.00 $336.88 $202.13 $336.88 $336.88 $336.88 N/A N/A 96115 SUP Custom 27803010 96115 - CATHETER DRAIN LONG 20CM BIOGLIDE VENTRICULAR BOTH IP/OP $458.50 $339.00 $81.60 $458.40 $458.40 $458.40 $458.40 $458.40 $458.40 $458.40 $81.60 $458.40 $458.40 $458.40 $458.40 $458.40 $458.40 $95.54 $458.40 $183.36 $458.40 $458.40 $458.40 $458.40 $458.40 $343.88 $458.40 $458.40 $458.40 $229.20 $229.20 $363.05 $458.40 $366.72 $206.28 $458.40 N/A $265.93 $458.40 $275.04 $458.40 $458.40 $458.40 N/A N/A 96118 SUP Custom 27803010 96118 - CATHETER DRAIN 35CM EXTERNAL SYSTEM BIOGLIDE VENTRICULAR BOTH IP/OP $550.00 $407.00 $97.83 $549.60 $549.60 $549.60 $549.60 $549.60 $549.60 $549.60 $97.83 $549.60 $549.60 $549.60 $549.60 $549.60 $549.60 $114.54 $549.60 $219.84 $549.60 $549.60 $549.60 $549.60 $549.60 $412.50 $549.60 $549.60 $549.60 $274.80 $274.80 $435.28 $549.60 $439.68 $247.32 $549.60 N/A $319.00 $549.60 $329.76 $549.60 $549.60 $549.60 N/A N/A 96655 SUP Custom 27803010 96655 - VALVE SHUNT SMALL ASMBLY NSC STRATA BIOGLIDE BOTH IP/OP "$9,922.00" "$7,342.00" "$1,766.06" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$1,766.06" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$2,067.79" "$9,921.70" "$3,968.68" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$7,441.50" "$9,921.70" "$9,921.70" "$9,921.70" "$4,960.85" "$4,960.85" "$7,857.99" "$9,921.70" "$7,937.36" "$4,464.77" "$9,921.70" N/A "$5,754.76" "$9,921.70" "$5,953.02" "$9,921.70" "$9,921.70" "$9,921.70" N/A N/A 96665 SUP Custom 27803010 96665 - VALVE SHUNT REGULAR ASMBLY NSC STRATA BIOGLIDE BOTH IP/OP "$9,922.00" "$7,342.00" "$1,766.06" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$1,766.06" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$2,067.79" "$9,921.70" "$3,968.68" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$9,921.70" "$7,441.50" "$9,921.70" "$9,921.70" "$9,921.70" "$4,960.85" "$4,960.85" "$7,857.99" "$9,921.70" "$7,937.36" "$4,464.77" "$9,921.70" N/A "$5,754.76" "$9,921.70" "$5,953.02" "$9,921.70" "$9,921.70" "$9,921.70" N/A N/A 96812 SUP Custom 27803010 96812 - VALVE SHUNT SMALL PERFORMANCE LEVEL 1 ASMBLY DELTA CSF BOTH IP/OP "$4,949.50" "$3,663.00" $881.01 "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" $881.01 "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$1,031.53" "$4,949.50" "$1,979.80" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$3,712.13" "$4,949.50" "$4,949.50" "$4,949.50" "$2,474.75" "$2,474.75" "$3,920.00" "$4,949.50" "$3,959.60" "$2,227.28" "$4,949.50" N/A "$2,870.71" "$4,949.50" "$2,969.70" "$4,949.50" "$4,949.50" "$4,949.50" N/A N/A 96813 SUP Custom 27803010 96813 - VALVE SHUNT SMALL PERFORMANCE LEVEL 1.5 ASMBLY DELTA CSF BOTH IP/OP "$4,949.50" "$3,663.00" $881.01 "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" $881.01 "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$1,031.53" "$4,949.50" "$1,979.80" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$3,712.13" "$4,949.50" "$4,949.50" "$4,949.50" "$2,474.75" "$2,474.75" "$3,920.00" "$4,949.50" "$3,959.60" "$2,227.28" "$4,949.50" N/A "$2,870.71" "$4,949.50" "$2,969.70" "$4,949.50" "$4,949.50" "$4,949.50" N/A N/A 96814 SUP Custom 27803010 96814 - VALVE SHUNT SMALL PERFORMANCE LEVEL 2 ASMBLY DELTA CSF BOTH IP/OP "$4,949.50" "$3,663.00" $881.01 "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" $881.01 "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$1,031.53" "$4,949.50" "$1,979.80" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$3,712.13" "$4,949.50" "$4,949.50" "$4,949.50" "$2,474.75" "$2,474.75" "$3,920.00" "$4,949.50" "$3,959.60" "$2,227.28" "$4,949.50" N/A "$2,870.71" "$4,949.50" "$2,969.70" "$4,949.50" "$4,949.50" "$4,949.50" N/A N/A 96822 SUP Custom 27803010 96822 - VALVE SHUNT REGULAR PERFORMANCE LEVEL 1 ASMBLY DELTA CSF BOTH IP/OP "$4,949.50" "$3,663.00" $881.01 "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" $881.01 "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$1,031.53" "$4,949.50" "$1,979.80" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$3,712.13" "$4,949.50" "$4,949.50" "$4,949.50" "$2,474.75" "$2,474.75" "$3,920.00" "$4,949.50" "$3,959.60" "$2,227.28" "$4,949.50" N/A "$2,870.71" "$4,949.50" "$2,969.70" "$4,949.50" "$4,949.50" "$4,949.50" N/A N/A 96823 SUP Custom 27803010 96823 - VALVE SHUNT REGULAR PERFORMANCE LEVEL 1.5 ASMBLY DELTA CSF BOTH IP/OP "$4,949.50" "$3,663.00" $881.01 "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" $881.01 "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$1,031.53" "$4,949.50" "$1,979.80" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$4,949.50" "$3,712.13" "$4,949.50" "$4,949.50" "$4,949.50" "$2,474.75" "$2,474.75" "$3,920.00" "$4,949.50" "$3,959.60" "$2,227.28" "$4,949.50" N/A "$2,870.71" "$4,949.50" "$2,969.70" "$4,949.50" "$4,949.50" "$4,949.50" N/A N/A 96824 SUP Custom 27803010 96824 - VALVE SHUNT REGULAR PERFORMANCE LEVEL 2 ASMBLY DELTA CSF BOTH IP/OP "$5,569.50" "$4,121.00" $991.35 "$5,569.38" "$5,569.38" "$5,569.38" "$5,569.38" "$5,569.38" "$5,569.38" "$5,569.38" $991.35 "$5,569.38" "$5,569.38" "$5,569.38" "$5,569.38" "$5,569.38" "$5,569.38" "$1,160.72" "$5,569.38" "$2,227.75" "$5,569.38" "$5,569.38" "$5,569.38" "$5,569.38" "$5,569.38" "$4,177.13" "$5,569.38" "$5,569.38" "$5,569.38" "$2,784.69" "$2,784.69" "$4,410.95" "$5,569.38" "$4,455.50" "$2,506.22" "$5,569.38" N/A "$3,230.31" "$5,569.38" "$3,341.63" "$5,569.38" "$5,569.38" "$5,569.38" N/A N/A 98433 SUP HCPCS C1894 98433 - KIT GASTROSTOMY 22FR 18GA DILAT INTROD NEEDLE HEMOSTAT LATEX BOTH IP/OP $532.00 $394.00 $105.53 $531.70 $288.71 $288.71 $288.71 $288.71 $531.70 $531.70 $531.70 $110.82 $531.70 $394.63 $394.63 $409.83 $277.02 $110.81 $531.70 $531.70 $314.50 $531.70 $531.70 $531.70 $531.70 $399.00 $531.70 $531.70 $531.70 $265.85 $265.85 $421.11 $531.70 $425.36 $345.61 $105.53 N/A $308.56 $531.70 $531.70 $531.70 $110.81 $531.70 N/A N/A 98701 SUP Custom 27203010 98701 - SET GASTROSTOMY ANCHOR T FASTENER ABSORBABLE SUTURE TUBE BOTH IP/OP $283.50 $210.00 $50.40 $283.12 $283.12 $283.12 $283.12 $283.12 $283.12 $283.12 $50.40 $283.12 $283.12 $210.13 $210.13 $218.23 $147.51 $59.01 $283.12 $113.25 $283.12 $283.12 $283.12 $283.12 $283.12 $212.63 $283.12 $283.12 $283.12 $141.56 $141.56 $224.23 $283.12 $226.50 $184.03 $283.12 N/A $164.43 $283.12 $169.87 $283.12 $283.12 $283.12 N/A N/A 98770 SUP Custom 27203010 98770 - DRAIN INCS 5FR 12IN STRL LTX 5IN DVR GRVTY T-TB STM XBAR NTR BOTH IP/OP $60.00 $44.00 $10.67 $59.93 $59.93 $59.93 $59.93 $59.93 $59.93 $59.93 $10.67 $59.93 $59.93 $44.48 $44.48 $46.19 $31.22 $12.49 $59.93 $23.97 $59.93 $59.93 $59.93 $59.93 $59.93 $45.00 $59.93 $59.93 $59.93 $29.97 $29.97 $47.46 $59.93 $47.94 $38.95 $59.93 N/A $34.80 $59.93 $35.96 $59.93 $59.93 $59.93 N/A N/A 99102 SUP Custom 27803010 99102 - CATHETER DRAIN INNERVISION BIOGLIDE VENTRICULAR STERILE BOTH IP/OP $729.50 $540.00 $129.79 $729.13 $729.13 $729.13 $729.13 $729.13 $729.13 $729.13 $129.79 $729.13 $729.13 $729.13 $729.13 $729.13 $729.13 $151.96 $729.13 $291.65 $729.13 $729.13 $729.13 $729.13 $729.13 $547.13 $729.13 $729.13 $729.13 $364.57 $364.57 $577.47 $729.13 $583.30 $328.11 $729.13 N/A $423.11 $729.13 $437.48 $729.13 $729.13 $729.13 N/A N/A 99800 SUP Custom 27203010 0099800 - DRAIN INCS 10FR 12IN DEAVER RBR BIL 5IN T-TB STM XBAR GRVTY BOTH IP/OP $35.00 $26.00 $6.21 $34.88 $34.88 $34.88 $34.88 $34.88 $34.88 $34.88 $6.21 $34.88 $34.88 $25.89 $25.89 $26.89 $18.17 $7.27 $34.88 $13.95 $34.88 $34.88 $34.88 $34.88 $34.88 $26.25 $34.88 $34.88 $34.88 $17.44 $17.44 $27.62 $34.88 $27.90 $22.67 $34.88 N/A $20.30 $34.88 $20.93 $34.88 $34.88 $34.88 N/A N/A 99810 SUP HCPCS C1729 0099810 - DRAIN INCISION 12FR 12IN 5IN T TUBE STEM CROSSBAR GRAVITY BOTH IP/OP $29.00 $21.00 $5.71 $28.78 $15.63 $15.63 $15.63 $15.63 $28.78 $28.78 $28.78 $6.00 $28.78 $21.36 $21.36 $22.18 $14.99 $6.00 $28.78 $28.78 $17.02 $28.78 $28.78 $28.78 $28.78 $21.75 $28.78 $28.78 $28.78 $14.39 $14.39 $22.79 $28.78 $23.02 $18.71 $5.71 N/A $16.82 $28.78 $28.78 $28.78 $6.00 $28.78 N/A N/A 99820 SUP Custom 27203010 99820 - TUBES T 14FR BOTH IP/OP $32.00 $24.00 $5.64 $31.68 $31.68 $31.68 $31.68 $31.68 $31.68 $31.68 $5.64 $31.68 $31.68 $23.51 $23.51 $24.42 $16.51 $6.60 $31.68 $12.67 $31.68 $31.68 $31.68 $31.68 $31.68 $24.00 $31.68 $31.68 $31.68 $15.84 $15.84 $25.09 $31.68 $25.34 $20.59 $31.68 N/A $18.56 $31.68 $19.01 $31.68 $31.68 $31.68 N/A N/A 99830 SUP Custom 27203010 99830 - DRAIN INCS 16FR 12IN STRL LTX 5IN DVR T-TB STM XBAR GRVTY BOTH IP/OP $30.50 $23.00 $5.38 $30.20 $30.20 $30.20 $30.20 $30.20 $30.20 $30.20 $5.38 $30.20 $30.20 $22.41 $22.41 $23.28 $15.73 $6.29 $30.20 $12.08 $30.20 $30.20 $30.20 $30.20 $30.20 $22.88 $30.20 $30.20 $30.20 $15.10 $15.10 $23.92 $30.20 $24.16 $19.63 $30.20 N/A $17.69 $30.20 $18.12 $30.20 $30.20 $30.20 N/A N/A 99830 SUP Custom 27203010 99830 - DRAIN INCS 16FR 12IN DEAVER RBR BIL 5IN T-TB STM XBAR GRVTY BOTH IP/OP $173.50 $128.00 $5.38 $130.13 $30.20 $30.20 $30.20 $30.20 $30.20 $30.20 $5.38 $30.20 $30.20 $22.41 $22.41 $23.28 $15.73 $6.29 $30.20 $12.08 $30.20 $30.20 $30.20 $30.20 $30.20 $130.13 $30.20 $30.20 $30.20 $15.10 $15.10 $23.92 $30.20 $24.16 $19.63 $30.20 N/A $100.63 $30.20 $18.12 $30.20 $30.20 $30.20 N/A N/A 99840 SUP HCPCS C1729 0099840 - DRAIN INCISION 18FR 12IN 5IN T TUBE STEM CROSSBAR GRAVITY BOTH IP/OP $29.00 $21.00 $5.71 $28.78 $15.63 $15.63 $15.63 $15.63 $28.78 $28.78 $28.78 $6.00 $28.78 $21.36 $21.36 $22.18 $14.99 $6.00 $28.78 $28.78 $17.02 $28.78 $28.78 $28.78 $28.78 $21.75 $28.78 $28.78 $28.78 $14.39 $14.39 $22.79 $28.78 $23.02 $18.71 $5.71 N/A $16.82 $28.78 $28.78 $28.78 $6.00 $28.78 N/A N/A 100100 SUP Custom 27011340 100100 - ROD XTRNFX LG 100MM ILZ TLSCP BSC SET SS AL PED FEM BOTH IP/OP "$1,686.50" "$1,248.00" $300.18 "$1,686.40" "$1,686.40" "$1,686.40" "$1,686.40" "$1,686.40" "$1,686.40" "$1,686.40" $300.18 "$1,686.40" "$1,686.40" "$1,251.65" "$1,251.65" "$1,299.88" $878.61 $351.46 "$1,686.40" $674.56 "$1,686.40" "$1,686.40" "$1,686.40" "$1,686.40" "$1,686.40" "$1,264.88" "$1,686.40" "$1,686.40" "$1,686.40" $843.20 $843.20 "$1,335.63" "$1,686.40" "$1,349.12" "$1,096.16" "$1,686.40" N/A $978.17 "$1,686.40" "$1,011.84" "$1,686.40" "$1,686.40" "$1,686.40" N/A N/A 100101 SUP Custom 27011340 100101 - ROD XTRNFX LG 150MM ILZ TLSCP SYS BOTH IP/OP "$1,686.50" "$1,248.00" $300.18 "$1,686.40" "$1,686.40" "$1,686.40" "$1,686.40" "$1,686.40" "$1,686.40" "$1,686.40" $300.18 "$1,686.40" "$1,686.40" "$1,251.65" "$1,251.65" "$1,299.88" $878.61 $351.46 "$1,686.40" $674.56 "$1,686.40" "$1,686.40" "$1,686.40" "$1,686.40" "$1,686.40" "$1,264.88" "$1,686.40" "$1,686.40" "$1,686.40" $843.20 $843.20 "$1,335.63" "$1,686.40" "$1,349.12" "$1,096.16" "$1,686.40" N/A $978.17 "$1,686.40" "$1,011.84" "$1,686.40" "$1,686.40" "$1,686.40" N/A N/A 100102 SUP Custom 27011340 100102 - ROD XTRNFX LG 200MM ILZ TLSCP BOTH IP/OP "$2,048.50" "$1,516.00" $364.63 "$2,048.50" "$2,048.50" "$2,048.50" "$2,048.50" "$2,048.50" "$2,048.50" "$2,048.50" $364.63 "$2,048.50" "$2,048.50" "$1,520.40" "$1,520.40" "$1,578.98" "$1,067.27" $426.93 "$2,048.50" $819.40 "$2,048.50" "$2,048.50" "$2,048.50" "$2,048.50" "$2,048.50" "$1,536.38" "$2,048.50" "$2,048.50" "$2,048.50" "$1,024.25" "$1,024.25" "$1,622.41" "$2,048.50" "$1,638.80" "$1,331.53" "$2,048.50" N/A "$1,188.13" "$2,048.50" "$1,229.10" "$2,048.50" "$2,048.50" "$2,048.50" N/A N/A 100103 SUP Custom 27011340 100103 - ROD XTRNFX LG 250MM ILZ CIRC TLSCP SS AL BOTH IP/OP "$2,048.50" "$1,516.00" $364.63 "$2,048.50" "$2,048.50" "$2,048.50" "$2,048.50" "$2,048.50" "$2,048.50" "$2,048.50" $364.63 "$2,048.50" "$2,048.50" "$1,520.40" "$1,520.40" "$1,578.98" "$1,067.27" $426.93 "$2,048.50" $819.40 "$2,048.50" "$2,048.50" "$2,048.50" "$2,048.50" "$2,048.50" "$1,536.38" "$2,048.50" "$2,048.50" "$2,048.50" "$1,024.25" "$1,024.25" "$1,622.41" "$2,048.50" "$1,638.80" "$1,331.53" "$2,048.50" N/A "$1,188.13" "$2,048.50" "$1,229.10" "$2,048.50" "$2,048.50" "$2,048.50" N/A N/A 100104 SUP Custom 27011340 100104 - ROD XTRNFX 60MM ILZ GRAD TLSCP SYS SS AL BOTH IP/OP "$3,145.00" "$2,327.00" $559.81 "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" $559.81 "$3,145.00" "$3,145.00" "$2,334.22" "$2,334.22" "$2,424.17" "$1,638.55" $655.45 "$3,145.00" "$1,258.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$2,358.75" "$3,145.00" "$3,145.00" "$3,145.00" "$1,572.50" "$1,572.50" "$2,490.84" "$3,145.00" "$2,516.00" "$2,044.25" "$3,145.00" N/A "$1,824.10" "$3,145.00" "$1,887.00" "$3,145.00" "$3,145.00" "$3,145.00" N/A N/A 100105 SUP Custom 27011340 100105 - ROD XTRNFX LG 100MM ILZ TLSCP GRAD DLX SET ADLT TIB BOTH IP/OP "$3,145.00" "$2,327.00" $559.81 "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" $559.81 "$3,145.00" "$3,145.00" "$2,334.22" "$2,334.22" "$2,424.17" "$1,638.55" $655.45 "$3,145.00" "$1,258.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$2,358.75" "$3,145.00" "$3,145.00" "$3,145.00" "$1,572.50" "$1,572.50" "$2,490.84" "$3,145.00" "$2,516.00" "$2,044.25" "$3,145.00" N/A "$1,824.10" "$3,145.00" "$1,887.00" "$3,145.00" "$3,145.00" "$3,145.00" N/A N/A 100106 SUP Custom 27011340 100106 - ROD XTRNFX 150MM ILZ GRAD TLSCP SYS SS AL BOTH IP/OP "$4,615.50" "$3,415.00" $821.56 "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" $821.56 "$4,615.50" "$4,615.50" "$3,425.62" "$3,425.62" "$3,557.63" "$2,060.15" $961.92 "$4,615.50" "$1,846.20" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$3,461.63" "$4,615.50" "$4,615.50" "$4,615.50" "$2,307.75" "$2,307.75" "$3,655.48" "$4,615.50" "$3,692.40" "$3,000.08" "$4,615.50" N/A "$2,676.99" "$4,615.50" "$2,769.30" "$4,615.50" "$4,615.50" "$4,615.50" N/A N/A 100107 SUP Custom 27011340 100107 - ROD XTRNFX 200MM ILZ GRAD TLSCP SYS SS AL BOTH IP/OP "$4,615.50" "$3,415.00" $821.56 "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" $821.56 "$4,615.50" "$4,615.50" "$3,425.62" "$3,425.62" "$3,557.63" "$2,060.15" $961.92 "$4,615.50" "$1,846.20" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$3,461.63" "$4,615.50" "$4,615.50" "$4,615.50" "$2,307.75" "$2,307.75" "$3,655.48" "$4,615.50" "$3,692.40" "$3,000.08" "$4,615.50" N/A "$2,676.99" "$4,615.50" "$2,769.30" "$4,615.50" "$4,615.50" "$4,615.50" N/A N/A 100108 SUP Custom 27011340 100108 - ROD XTRNFX 250MM ILZ GRAD TLSCP AL SS BOTH IP/OP "$4,615.50" "$3,415.00" $821.56 "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" $821.56 "$4,615.50" "$4,615.50" "$3,425.62" "$3,425.62" "$3,557.63" "$2,060.15" $961.92 "$4,615.50" "$1,846.20" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$4,615.50" "$3,461.63" "$4,615.50" "$4,615.50" "$4,615.50" "$2,307.75" "$2,307.75" "$3,655.48" "$4,615.50" "$3,692.40" "$3,000.08" "$4,615.50" N/A "$2,676.99" "$4,615.50" "$2,769.30" "$4,615.50" "$4,615.50" "$4,615.50" N/A N/A 100200 SUP Custom 27011340 100200 - WIRE XTRNFX ILZ BSC SET BCKL DTCH ADLT FEM SS RING BOTH IP/OP $826.50 $612.00 $147.06 $826.20 $826.20 $826.20 $826.20 $826.20 $826.20 $826.20 $147.06 $826.20 $826.20 $613.21 $613.21 $636.83 $430.45 $172.19 $826.20 $330.48 $826.20 $826.20 $826.20 $826.20 $826.20 $619.88 $826.20 $826.20 $826.20 $413.10 $413.10 $654.35 $826.20 $660.96 $537.03 $826.20 N/A $479.37 $826.20 $495.72 $826.20 $826.20 $826.20 N/A N/A 100241 SUP Custom 27011340 100241 - DEVICE XTRNFX ILZ WRE FX BCKL CIRC SM BN FXTR BOTH IP/OP "$1,768.00" "$1,308.00" $314.70 "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" $314.70 "$1,768.00" "$1,768.00" "$1,312.21" "$1,312.21" "$1,362.77" $921.13 $368.47 "$1,768.00" $707.20 "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" "$1,326.00" "$1,768.00" "$1,768.00" "$1,768.00" $884.00 $884.00 "$1,400.26" "$1,768.00" "$1,414.40" "$1,149.20" "$1,768.00" N/A "$1,025.44" "$1,768.00" "$1,060.80" "$1,768.00" "$1,768.00" "$1,768.00" N/A N/A 100250 SUP Custom 27203010 100250 - DEVICE XTRNFX ILZ WRE FX BCKL CIRC COMP RING BOTH IP/OP $911.50 $675.00 $162.19 $911.20 $911.20 $911.20 $911.20 $911.20 $911.20 $911.20 $162.19 $911.20 $911.20 $676.29 $676.29 $702.35 $474.74 $189.90 $911.20 $364.48 $911.20 $911.20 $911.20 $911.20 $911.20 $683.63 $911.20 $911.20 $911.20 $455.60 $455.60 $721.67 $911.20 $728.96 $592.28 $911.20 N/A $528.67 $911.20 $546.72 $911.20 $911.20 $911.20 N/A N/A 100301 SUP Custom 27011340 100301 - CLAMP XTRNFX ILZ 1 HL PIN BOTH IP/OP $892.50 $660.00 $158.87 $892.50 $892.50 $892.50 $892.50 $892.50 $892.50 $892.50 $158.87 $892.50 $892.50 $662.41 $662.41 $687.94 $464.99 $186.01 $892.50 $357.00 $892.50 $892.50 $892.50 $892.50 $892.50 $669.38 $892.50 $892.50 $892.50 $446.25 $446.25 $706.86 $892.50 $714.00 $580.13 $892.50 N/A $517.65 $892.50 $535.50 $892.50 $892.50 $892.50 N/A N/A 100302 SUP Custom 27011340 100302 - CLAMP XTRNFX ILZ 2 HL PIN BOTH IP/OP $892.50 $660.00 $158.87 $892.50 $892.50 $892.50 $892.50 $892.50 $892.50 $892.50 $158.87 $892.50 $892.50 $662.41 $662.41 $687.94 $464.99 $186.01 $892.50 $357.00 $892.50 $892.50 $892.50 $892.50 $892.50 $669.38 $892.50 $892.50 $892.50 $446.25 $446.25 $706.86 $892.50 $714.00 $580.13 $892.50 N/A $517.65 $892.50 $535.50 $892.50 $892.50 $892.50 N/A N/A 100303 SUP Custom 27011340 100303 - CLAMP XTRNFX ILZ 3 HL PIN BOTH IP/OP $892.50 $660.00 $158.87 $892.50 $892.50 $892.50 $892.50 $892.50 $892.50 $892.50 $158.87 $892.50 $892.50 $662.41 $662.41 $687.94 $464.99 $186.01 $892.50 $357.00 $892.50 $892.50 $892.50 $892.50 $892.50 $669.38 $892.50 $892.50 $892.50 $446.25 $446.25 $706.86 $892.50 $714.00 $580.13 $892.50 N/A $517.65 $892.50 $535.50 $892.50 $892.50 $892.50 N/A N/A 100304 SUP Custom 27011340 100304 - CLAMP XTRNFX ILZ 4 HL PIN BOTH IP/OP "$1,251.50" $926.00 $222.71 "$1,251.20" "$1,251.20" "$1,251.20" "$1,251.20" "$1,251.20" "$1,251.20" "$1,251.20" $222.71 "$1,251.20" "$1,251.20" $928.64 $928.64 $964.42 $651.88 $260.76 "$1,251.20" $500.48 "$1,251.20" "$1,251.20" "$1,251.20" "$1,251.20" "$1,251.20" $938.63 "$1,251.20" "$1,251.20" "$1,251.20" $625.60 $625.60 $990.95 "$1,251.20" "$1,000.96" $813.28 "$1,251.20" N/A $725.87 "$1,251.20" $750.72 "$1,251.20" "$1,251.20" "$1,251.20" N/A N/A 100305 SUP Custom 27203010 100305 - VALVE AIR/H20 DEFENDO BTN KIT SCT CLEAN BIOP STRL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 100305 SUP Custom 27011340 100305 - CLAMP XTRNFX ILZ 5 HL PIN BOTH IP/OP "$1,251.50" $926.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $938.63 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 "$1,250.00" N/A $725.87 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 100400 SUP Custom 27011340 100400 - PLATE XTRNFX LNG 155MM 8 HL CNCT BOTH IP/OP $974.50 $721.00 $173.39 $974.10 $974.10 $974.10 $974.10 $974.10 $974.10 $974.10 $173.39 $974.10 $974.10 $722.98 $722.98 $750.84 $507.51 $203.01 $974.10 $389.64 $974.10 $974.10 $974.10 $974.10 $974.10 $730.88 $974.10 $974.10 $974.10 $487.05 $487.05 $771.49 $974.10 $779.28 $633.17 $974.10 N/A $565.21 $974.10 $584.46 $974.10 $974.10 $974.10 N/A N/A 100401 SUP Custom 27011340 100401 - PLATE XTRNFX LNG 235MM ILZ 12 HL CNCT BOTH IP/OP $974.50 $721.00 $173.39 $974.10 $974.10 $974.10 $974.10 $974.10 $974.10 $974.10 $173.39 $974.10 $974.10 $722.98 $722.98 $750.84 $507.51 $203.01 $974.10 $389.64 $974.10 $974.10 $974.10 $974.10 $974.10 $730.88 $974.10 $974.10 $974.10 $487.05 $487.05 $771.49 $974.10 $779.28 $633.17 $974.10 N/A $565.21 $974.10 $584.46 $974.10 $974.10 $974.10 N/A N/A 100402 SUP Custom 27011340 100402 - PLATE XTRNFX LNG 355MM ILZ 17 HL CNCT SYS BOTH IP/OP "$1,185.00" $877.00 $210.91 "$1,184.90" "$1,184.90" "$1,184.90" "$1,184.90" "$1,184.90" "$1,184.90" "$1,184.90" $210.91 "$1,184.90" "$1,184.90" $879.43 $879.43 $913.32 $617.33 $246.95 "$1,184.90" $473.96 "$1,184.90" "$1,184.90" "$1,184.90" "$1,184.90" "$1,184.90" $888.75 "$1,184.90" "$1,184.90" "$1,184.90" $592.45 $592.45 $938.44 "$1,184.90" $947.92 $770.19 "$1,184.90" N/A $687.30 "$1,184.90" $710.94 "$1,184.90" "$1,184.90" "$1,184.90" N/A N/A 100409 SUP Custom 27011340 100409 - PLATE XTRNFX LNG 72MM ILZ 5 HL SM BN FXTR SET BOTH IP/OP $874.00 $647.00 $155.54 $873.80 $873.80 $873.80 $873.80 $873.80 $873.80 $873.80 $155.54 $873.80 $873.80 $648.53 $648.53 $673.53 $455.25 $182.11 $873.80 $349.52 $873.80 $873.80 $873.80 $873.80 $873.80 $655.50 $873.80 $873.80 $873.80 $436.90 $436.90 $692.05 $873.80 $699.04 $567.97 $873.80 N/A $506.92 $873.80 $524.28 $873.80 $873.80 $873.80 N/A N/A 100412 SUP Custom 27011340 100412 - PLATE XTRNFX LNG 102MM ILZ 7 HL SM BN FXTR SET BOTH IP/OP $959.00 $710.00 $170.67 $958.80 $958.80 $958.80 $958.80 $958.80 $958.80 $958.80 $170.67 $958.80 $958.80 $711.62 $711.62 $739.04 $499.53 $199.82 $958.80 $383.52 $958.80 $958.80 $958.80 $958.80 $958.80 $719.25 $958.80 $958.80 $958.80 $479.40 $479.40 $759.37 $958.80 $767.04 $623.22 $958.80 N/A $556.22 $958.80 $575.28 $958.80 $958.80 $958.80 N/A N/A 100415 SUP Custom 27011340 100415 - PLATE XTRNFX LNG 72MM ILZ 9 HL SM BN FXTR SET BOTH IP/OP "$1,015.00" $751.00 $180.65 "$1,014.90" "$1,014.90" "$1,014.90" "$1,014.90" "$1,014.90" "$1,014.90" "$1,014.90" $180.65 "$1,014.90" "$1,014.90" $753.26 $753.26 $782.28 $528.76 $211.52 "$1,014.90" $405.96 "$1,014.90" "$1,014.90" "$1,014.90" "$1,014.90" "$1,014.90" $761.25 "$1,014.90" "$1,014.90" "$1,014.90" $507.45 $507.45 $803.80 "$1,014.90" $811.92 $659.69 "$1,014.90" N/A $588.70 "$1,014.90" $608.94 "$1,014.90" "$1,014.90" "$1,014.90" N/A N/A 100418 SUP Custom 27011340 100418 - PLATE XTRNFX LNG 162MM ILZ 11 HL SM BN FXTR SET BOTH IP/OP "$1,100.00" $814.00 $195.80 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $195.80 "$1,100.00" "$1,100.00" $816.42 $816.42 $847.88 $573.10 $229.25 "$1,100.00" $440.00 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $715.00 "$1,100.00" N/A $638.00 "$1,100.00" $660.00 "$1,100.00" "$1,100.00" "$1,100.00" N/A N/A 100420 SUP Custom 27011340 100420 - PLATE XTRNFX LNG 155MM ILZ 8 HL CNCT CIRC COMP CFBR EPOXY BOTH IP/OP "$1,214.00" $898.00 $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $216.09 "$1,214.00" "$1,214.00" $901.03 $901.03 $935.75 $632.49 $253.01 "$1,214.00" $485.60 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $910.50 "$1,214.00" "$1,214.00" "$1,214.00" $607.00 $607.00 $961.49 "$1,214.00" $971.20 $789.10 "$1,214.00" N/A $704.12 "$1,214.00" $728.40 "$1,214.00" "$1,214.00" "$1,214.00" N/A N/A 100421 SUP Custom 27011340 100421 - PLATE XTRNFX LNG 235MM ILZ 12 HL CNCT CIRC COMP CFBR EPOXY BOTH IP/OP "$1,214.00" $898.00 $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $216.09 "$1,214.00" "$1,214.00" $901.03 $901.03 $935.75 $632.49 $253.01 "$1,214.00" $485.60 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $910.50 "$1,214.00" "$1,214.00" "$1,214.00" $607.00 $607.00 $961.49 "$1,214.00" $971.20 $789.10 "$1,214.00" N/A $704.12 "$1,214.00" $728.40 "$1,214.00" "$1,214.00" "$1,214.00" N/A N/A 100422 SUP Custom 27011340 100422 - PLATE XTRNFX LNG 335MM ILZ 17 HL CNCT CIRC COMP CFBR EPOXY BOTH IP/OP "$1,354.00" "$1,002.00" $241.01 "$1,354.00" "$1,354.00" "$1,354.00" "$1,354.00" "$1,354.00" "$1,354.00" "$1,354.00" $241.01 "$1,354.00" "$1,354.00" "$1,004.94" "$1,004.94" "$1,043.66" $705.43 $282.19 "$1,354.00" $541.60 "$1,354.00" "$1,354.00" "$1,354.00" "$1,354.00" "$1,354.00" "$1,015.50" "$1,354.00" "$1,354.00" "$1,354.00" $677.00 $677.00 "$1,072.37" "$1,354.00" "$1,083.20" $880.10 "$1,354.00" N/A $785.32 "$1,354.00" $812.40 "$1,354.00" "$1,354.00" "$1,354.00" N/A N/A 100500 SUP Custom 27011340 100500 - PLATE XTRNFX 135MM ILZ 5 HL CNCT THRD END BOTH IP/OP "$1,079.50" $799.00 $192.15 "$1,079.50" "$1,079.50" "$1,079.50" "$1,079.50" "$1,079.50" "$1,079.50" "$1,079.50" $192.15 "$1,079.50" "$1,079.50" $801.20 $801.20 $832.08 $562.42 $224.98 "$1,079.50" $431.80 "$1,079.50" "$1,079.50" "$1,079.50" "$1,079.50" "$1,079.50" $809.63 "$1,079.50" "$1,079.50" "$1,079.50" $539.75 $539.75 $854.96 "$1,079.50" $863.60 $701.68 "$1,079.50" N/A $626.11 "$1,079.50" $647.70 "$1,079.50" "$1,079.50" "$1,079.50" N/A N/A 100501 SUP Custom 27011340 100501 - PLATE XTRNFX 175MM ILZ 7 HL CNCT SYS THRD END BOTH IP/OP "$1,079.50" $799.00 $192.15 "$1,079.50" "$1,079.50" "$1,079.50" "$1,079.50" "$1,079.50" "$1,079.50" "$1,079.50" $192.15 "$1,079.50" "$1,079.50" $801.20 $801.20 $832.08 $562.42 $224.98 "$1,079.50" $431.80 "$1,079.50" "$1,079.50" "$1,079.50" "$1,079.50" "$1,079.50" $809.63 "$1,079.50" "$1,079.50" "$1,079.50" $539.75 $539.75 $854.96 "$1,079.50" $863.60 $701.68 "$1,079.50" N/A $626.11 "$1,079.50" $647.70 "$1,079.50" "$1,079.50" "$1,079.50" N/A N/A 100502 SUP Custom 27011340 100502 - PLATE XTRNFX 215MM ILZ 9 HL CNCT CIRC THRD END BOTH IP/OP "$1,380.50" "$1,022.00" $245.71 "$1,380.40" "$1,380.40" "$1,380.40" "$1,380.40" "$1,380.40" "$1,380.40" "$1,380.40" $245.71 "$1,380.40" "$1,380.40" "$1,024.53" "$1,024.53" "$1,064.01" $719.19 $287.69 "$1,380.40" $552.16 "$1,380.40" "$1,380.40" "$1,380.40" "$1,380.40" "$1,380.40" "$1,035.38" "$1,380.40" "$1,380.40" "$1,380.40" $690.20 $690.20 "$1,093.28" "$1,380.40" "$1,104.32" $897.26 "$1,380.40" N/A $800.69 "$1,380.40" $828.24 "$1,380.40" "$1,380.40" "$1,380.40" N/A N/A 100503 SUP Custom 27203010 100503 - FORCEP ENDSCP BIOP 1.8MM 1.8MM PULM BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,020.53" "$1,020.53" "$1,059.85" $716.38 $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $893.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 100503 SUP Custom 27011340 100503 - PLATE XTRNFX 255MM ILZ 11 HL CNCT THRD END SS ADLT TIB BOTH IP/OP "$1,416.00" "$1,048.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,020.53" "$1,020.53" "$1,059.85" $716.38 $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,062.00" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $893.75 "$1,375.00" N/A $821.28 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 100550 SUP HCPCS C1713 100550 - BOLT XTRNFX 8MM ILZ CNCT SS ADLT BOTH IP/OP $16.50 $12.00 $3.21 $16.15 $7.27 $7.27 $7.27 $7.27 $16.15 $16.15 $16.15 $3.37 $16.15 $16.15 $16.15 $16.15 $16.15 $3.37 $16.15 $6.46 $9.55 $16.15 $16.15 $16.15 $16.15 $12.38 $16.15 $16.15 $16.15 $8.08 $8.08 $12.79 $16.15 $12.92 $7.27 $3.21 N/A $9.57 $16.15 $9.69 $16.15 $16.15 $16.15 N/A N/A 100600 SUP Custom 27203010 100600 - BOLT XTRNFX ILZ CNN WRE FEM BOTH IP/OP $144.00 $107.00 $25.60 $143.83 $143.83 $143.83 $143.83 $143.83 $143.83 $143.83 $25.60 $143.83 $143.83 $106.75 $106.75 $110.86 $74.94 $29.98 $143.83 $57.53 $143.83 $143.83 $143.83 $143.83 $143.83 $108.00 $143.83 $143.83 $143.83 $71.92 $71.92 $113.91 $143.83 $115.06 $93.49 $143.83 N/A $83.52 $143.83 $86.30 $143.83 $143.83 $143.83 N/A N/A 100601 SUP Custom 27011340 100601 - BOLT XTRNFX ILZ CNN WRE CIRC THRD HD BOTH IP/OP $223.50 $165.00 $39.73 $223.20 $223.20 $223.20 $223.20 $223.20 $223.20 $223.20 $39.73 $223.20 $223.20 $165.66 $165.66 $172.04 $116.29 $46.52 $223.20 $87.18 $223.20 $223.20 $217.95 $223.20 $223.20 $167.63 $223.20 $223.20 $223.20 $111.60 $111.60 $176.77 $223.20 $178.56 $145.08 $223.20 N/A $129.63 $223.20 $133.92 $223.20 $223.20 $223.20 N/A N/A 100613 SUP Custom 27011340 100613 - BOLT XTRNFX 3MM ILZ .5 PIN CIRC BOTH IP/OP $740.00 $548.00 $131.72 $740.00 $740.00 $740.00 $740.00 $740.00 $740.00 $740.00 $131.72 $740.00 $740.00 $549.23 $549.23 $570.39 $385.54 $154.22 $740.00 $288.32 $740.00 $740.00 $720.80 $740.00 $740.00 $555.00 $740.00 $740.00 $740.00 $370.00 $370.00 $586.08 $740.00 $592.00 $481.00 $740.00 N/A $429.20 $740.00 $444.00 $740.00 $740.00 $740.00 N/A N/A 100614 SUP Custom 27011340 100614 - BOLT XTRNFX 4MM ILZ .5 PIN CIRC BOTH IP/OP $740.00 $548.00 $131.72 $740.00 $740.00 $740.00 $740.00 $740.00 $740.00 $740.00 $131.72 $740.00 $740.00 $549.23 $549.23 $570.39 $385.54 $154.22 $740.00 $288.32 $740.00 $740.00 $720.80 $740.00 $740.00 $555.00 $740.00 $740.00 $740.00 $370.00 $370.00 $586.08 $740.00 $592.00 $481.00 $740.00 N/A $429.20 $740.00 $444.00 $740.00 $740.00 $740.00 N/A N/A 100615 SUP Custom 27011340 100615 - BOLT XTRNFX CRC 5MM ILZ HLF PIN BOTH IP/OP $672.00 $497.00 $119.62 $672.00 $672.00 $672.00 $672.00 $672.00 $672.00 $672.00 $119.62 $672.00 $672.00 $498.76 $498.76 $517.98 $350.11 $140.05 $672.00 $262.48 $672.00 $672.00 $656.20 $672.00 $672.00 $504.00 $672.00 $672.00 $672.00 $336.00 $336.00 $532.22 $672.00 $537.60 $436.80 $672.00 N/A $389.76 $672.00 $403.20 $672.00 $672.00 $672.00 N/A N/A 100616 SUP Custom 27203010 100616 - BOLT XTRNFX CRC 6MM ILZ HLF PIN BOTH IP/OP $721.00 $534.00 $128.30 $720.80 $720.80 $720.80 $720.80 $720.80 $720.80 $720.80 $128.30 $720.80 $720.80 $534.98 $534.98 $555.59 $375.54 $150.22 $720.80 $288.32 $720.80 $720.80 $720.80 $720.80 $720.80 $540.75 $720.80 $720.80 $720.80 $360.40 $360.40 $570.87 $720.80 $576.64 $468.52 $720.80 N/A $418.18 $720.80 $432.48 $720.80 $720.80 $720.80 N/A N/A 100616 SUP Custom 27011340 100616 - BOLT XTRNFX CRC 6MM ILZ HLF PIN BOTH IP/OP $740.00 $548.00 $128.30 $720.80 $720.80 $720.80 $720.80 $720.80 $720.80 $720.80 $128.30 $720.80 $720.80 $534.98 $534.98 $555.59 $375.54 $150.22 $720.80 $288.32 $720.80 $720.80 $720.80 $720.80 $720.80 $555.00 $720.80 $720.80 $720.80 $360.40 $360.40 $570.87 $720.80 $576.64 $468.52 $720.80 N/A $429.20 $720.80 $432.48 $720.80 $720.80 $720.80 N/A N/A 100700 SUP HCPCS C1713 100700 - BOLT XTRNFX ILZ SLOT WRE BSC SET FEM BOTH IP/OP $162.00 $120.00 $32.12 $161.85 $72.83 $72.83 $72.83 $72.83 $161.85 $161.85 $161.85 $33.73 $161.85 $161.85 $161.85 $161.85 $161.85 $33.73 $161.85 $64.74 $95.73 $161.85 $161.85 $161.85 $161.85 $121.50 $161.85 $161.85 $161.85 $80.93 $80.93 $128.19 $161.85 $129.48 $72.83 $32.12 N/A $93.96 $161.85 $97.11 $161.85 $33.73 $161.85 N/A N/A 100819 SUP HCPCS C1713 100819 - PLATE XTRNFX SHRT 27MM 2 HL CNCT CIRC SM BN BOTH IP/OP $484.50 $359.00 $96.16 $484.50 $218.03 $218.03 $218.03 $218.03 $484.50 $484.50 $484.50 $100.98 $484.50 $484.50 $484.50 $484.50 $484.50 $100.98 $484.50 $193.80 $286.58 $484.50 $484.50 $484.50 $484.50 $363.38 $484.50 $484.50 $484.50 $242.25 $242.25 $383.72 $484.50 $387.60 $218.03 $96.16 N/A $281.01 $484.50 $484.50 $484.50 $100.97 $484.50 N/A N/A 100822 SUP HCPCS C1713 100822 - PLATE XTRNFX SHRT 37MM 3 HL CNCT CIRC SM BN BOTH IP/OP $564.50 $418.00 $112.02 $564.40 $253.98 $253.98 $253.98 $253.98 $564.40 $564.40 $564.40 $117.64 $564.40 $564.40 $564.40 $564.40 $564.40 $117.63 $564.40 $564.40 $333.84 $564.40 $564.40 $564.40 $564.40 $423.38 $564.40 $564.40 $564.40 $282.20 $282.20 $447.00 $564.40 $451.52 $253.98 $112.02 N/A $327.41 $564.40 $564.40 $564.40 $564.40 $564.40 N/A N/A 100825 SUP HCPCS C1713 100825 - PLATE XTRNFX SHRT 47MM 4 HL CNCT CIRC SM BN BOTH IP/OP $600.50 $444.00 $119.10 $600.10 $270.05 $270.05 $270.05 $270.05 $600.10 $600.10 $600.10 $125.08 $600.10 $600.10 $600.10 $600.10 $600.10 $125.07 $600.10 $240.04 $354.96 $600.10 $600.10 $600.10 $600.10 $450.38 $600.10 $600.10 $600.10 $300.05 $300.05 $475.28 $600.10 $480.08 $270.05 $119.10 N/A $348.29 $600.10 $600.10 $600.10 $600.10 $600.10 N/A N/A 100882 SUP HCPCS C1713 100882 - SPACER XTRNFX 20MM SM BN FXTR BOTH IP/OP $512.00 $379.00 $101.56 $511.70 $230.27 $230.27 $230.27 $230.27 $511.70 $511.70 $511.70 $106.65 $511.70 $511.70 $511.70 $511.70 $511.70 $106.64 $511.70 $511.70 $302.67 $511.70 $511.70 $511.70 $511.70 $384.00 $511.70 $511.70 $511.70 $255.85 $255.85 $405.27 $511.70 $409.36 $230.27 $101.56 N/A $296.96 $511.70 $511.70 $511.70 $511.70 $511.70 N/A N/A 100883 SUP HCPCS C1713 100883 - SPACER XTRNFX 30MM SM BN FXTR BOTH IP/OP $512.00 $379.00 $101.56 $511.70 $230.27 $230.27 $230.27 $230.27 $511.70 $511.70 $511.70 $106.65 $511.70 $511.70 $511.70 $511.70 $511.70 $106.64 $511.70 $204.68 $302.67 $511.70 $511.70 $511.70 $511.70 $384.00 $511.70 $511.70 $511.70 $255.85 $255.85 $405.27 $511.70 $409.36 $230.27 $101.56 N/A $296.96 $511.70 $511.70 $511.70 $511.70 $511.70 N/A N/A 101010 SUP HCPCS Q4116 101010 - GRAFT SKIN 14X5CM ALLOGRAFT NON MESHED ALLODERM ACELLULAR BOTH IP/OP $1.50 $1.00 $0.28 $1.39 $0.63 $0.63 $0.63 $0.63 $1.39 $1.39 $1.39 $0.29 $1.39 $1.39 $1.39 $1.39 $1.39 $0.29 $1.39 $1.39 $0.82 $1.39 $1.39 $1.39 $1.39 $1.13 $1.39 $1.39 $1.39 $0.70 $0.70 $1.10 $1.39 $1.11 $0.63 $0.28 N/A $0.87 $1.39 $1.39 $1.39 $0.29 $1.39 N/A N/A 101020 SUP HCPCS Q4116 101020 - GRAFT SKIN 12X5CM ALLOGRAFT NON MESHED ALLODERM ACELLULAR BOTH IP/OP $2.00 $1.00 $0.32 $1.63 $0.73 $0.73 $0.73 $0.73 $1.63 $1.63 $1.63 $0.34 $1.63 $1.63 $1.63 $1.63 $1.63 $0.34 $1.63 $1.63 $0.96 $1.63 $1.63 $1.63 $1.63 $1.50 $1.63 $1.63 $1.63 $0.82 $0.82 $1.29 $1.63 $1.30 $0.73 $0.32 N/A $1.16 $1.63 $1.63 $1.63 $0.34 $1.63 N/A N/A 101400 SUP Custom 27011340 101400 - POST EXFIX ILZ SS 2 HOLE MALE BOTH IP/OP $410.00 $303.00 $72.93 $409.70 $409.70 $409.70 $409.70 $409.70 $409.70 $409.70 $72.93 $409.70 $409.70 $304.08 $304.08 $315.80 $213.45 $85.39 $409.70 $163.88 $409.70 $409.70 $409.70 $409.70 $409.70 $307.50 $409.70 $409.70 $409.70 $204.85 $204.85 $324.48 $409.70 $327.76 $266.31 $409.70 N/A $237.80 $409.70 $245.82 $409.70 $409.70 $409.70 N/A N/A 101401 SUP Custom 27011340 101401 - POST EXFIX ILZ TIB 3 HOLE MALE PED BOTH IP/OP $428.50 $317.00 $76.26 $428.40 $428.40 $428.40 $428.40 $428.40 $428.40 $428.40 $76.26 $428.40 $428.40 $317.96 $317.96 $330.21 $223.20 $89.28 $428.40 $171.36 $428.40 $428.40 $428.40 $428.40 $428.40 $321.38 $428.40 $428.40 $428.40 $214.20 $214.20 $339.29 $428.40 $342.72 $278.46 $428.40 N/A $248.53 $428.40 $257.04 $428.40 $428.40 $428.40 N/A N/A 101510 SUP HCPCS Q4116 101510 - GRAFT SKIN 36X5MM ALLOGRAFT MESHED ALLODERM ACELLULAR DERMIS BOTH IP/OP $1.00 $1.00 $0.11 $0.75 $0.24 $0.24 $0.24 $0.24 $0.54 $0.54 $0.54 $0.11 $0.54 $0.54 $0.54 $0.54 $0.54 $0.11 $0.54 $0.54 $0.32 $0.54 $0.54 $0.54 $0.54 $0.75 $0.54 $0.54 $0.54 $0.27 $0.27 $0.43 $0.54 $0.43 $0.24 $0.11 N/A $0.58 $0.54 $0.54 $0.54 $0.11 $0.54 N/A N/A 101520 SUP HCPCS Q4116 101520 - GRAFT SKIN 14.5X4CM ALLOGRAFT MESHED ALLODERM ACELLULAR BOTH IP/OP $2.00 $1.00 $0.33 $1.68 $0.76 $0.76 $0.76 $0.76 $1.68 $1.68 $1.68 $0.35 $1.68 $1.68 $1.68 $1.68 $1.68 $0.35 $1.68 $1.68 $0.99 $1.68 $1.68 $1.68 $1.68 $1.50 $1.68 $1.68 $1.68 $0.84 $0.84 $1.33 $1.68 $1.34 $0.76 $0.33 N/A $1.16 $1.68 $1.68 $1.68 $0.35 $1.68 N/A N/A 101602 SUP Custom 27011340 101602 - HINGE XTRNFX ILZ M CNCT LOPRFL SS TIB BOTH IP/OP $367.50 $272.00 $65.36 $367.20 $367.20 $367.20 $367.20 $367.20 $367.20 $367.20 $65.36 $367.20 $367.20 $272.54 $272.54 $283.04 $191.31 $76.53 $367.20 $146.88 $367.20 $367.20 $367.20 $367.20 $367.20 $275.63 $367.20 $367.20 $367.20 $183.60 $183.60 $290.82 $367.20 $293.76 $238.68 $367.20 N/A $213.15 $367.20 $220.32 $367.20 $367.20 $367.20 N/A N/A 101804 SUP HCPCS C1713 101804 - PLATE XTRNFX SHRT 85MM ILZ 7 HL CNCT TIB BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $535.50 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $535.50 $535.50 N/A N/A 101805 SUP HCPCS C1713 101805 - PLATE XTRNFX SHRT 95MM ILZ 8 HL CNCT TIB BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $214.20 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $111.60 $535.50 N/A N/A 101806 SUP HCPCS C1713 101806 - PLATE XTRNFX SHRT 105MM ILZ 9 HL CNCT TIB BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $535.50 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $535.50 $535.50 N/A N/A 101807 SUP HCPCS C1713 101807 - PLATE XTRNFX SHRT 115MM ILZ 10 HL CNCT CIRC BOTH IP/OP $643.00 $476.00 $127.54 $642.60 $289.17 $289.17 $289.17 $289.17 $642.60 $642.60 $642.60 $133.93 $642.60 $642.60 $642.60 $642.60 $642.60 $133.92 $642.60 $257.04 $380.10 $642.60 $642.60 $642.60 $642.60 $482.25 $642.60 $642.60 $642.60 $321.30 $321.30 $508.94 $642.60 $514.08 $289.17 $127.54 N/A $372.94 $642.60 $642.60 $642.60 $133.92 $642.60 N/A N/A 101900 SUP HCPCS C1713 101900 - PLATE BN 45MM 2 HL TWST ORTH BOTH IP/OP $364.00 $269.00 $72.24 $364.00 $163.80 $163.80 $163.80 $163.80 $364.00 $364.00 $364.00 $75.87 $364.00 $364.00 $364.00 $364.00 $364.00 $75.86 $364.00 $142.80 $215.31 $364.00 $357.00 $364.00 $364.00 $273.00 $364.00 $364.00 $364.00 $182.00 $182.00 $288.29 $364.00 $291.20 $163.80 $72.24 N/A $211.12 $364.00 $218.40 $364.00 $75.86 $364.00 N/A N/A 101901 SUP HCPCS C1713 101901 - PLATE XTRNFX 65MM ILZ 3 HL TWST DLX SET ADLT TIB BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $535.50 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $321.30 $535.50 $111.60 $535.50 N/A N/A 101902 SUP HCPCS C1713 101902 - PLATE XTRNFX 85MM ILZ 3 HL TWST DLX SET ADLT BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $535.50 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $321.30 $535.50 $535.50 $535.50 N/A N/A 102000 SUP Custom 27100030 102000 - SPLINT ORTH UNV CNTR PD STAY HND BOTH IP/OP $28.50 $21.00 $16.53 $623.90 $280.76 $280.76 $280.76 $280.76 $623.90 $623.90 $623.90 $130.04 $623.90 $623.90 $623.90 $623.90 $623.90 $130.03 $623.90 $249.56 $369.04 $623.90 $623.90 $623.90 $623.90 $21.38 $623.90 $623.90 $623.90 $311.95 $311.95 $494.13 $623.90 $499.12 $280.76 $123.83 N/A $16.53 $623.90 $374.34 $623.90 $623.90 $623.90 N/A N/A 102000 SUP HCPCS C1713 102000 - PLATE XTRNFX ILZ 3 HL CRV CIRC BOTH IP/OP $624.00 $462.00 $123.83 $623.90 $280.76 $280.76 $280.76 $280.76 $623.90 $623.90 $623.90 $130.04 $623.90 $623.90 $623.90 $623.90 $623.90 $130.03 $623.90 $249.56 $369.04 $623.90 $623.90 $623.90 $623.90 $468.00 $623.90 $623.90 $623.90 $311.95 $311.95 $494.13 $623.90 $499.12 $280.76 $123.83 N/A $361.92 $623.90 $374.34 $623.90 $623.90 $623.90 N/A N/A 102003 SUP HCPCS Q4116 102003 - MATRIX TISSUE THICK 2X1CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $274.00 $203.00 $54.33 $273.75 $123.19 $123.19 $123.19 $123.19 $273.75 $273.75 $273.75 $57.06 $273.75 $273.75 $273.75 $273.75 $273.75 $57.05 $273.75 $177.50 $161.92 $273.75 $177.50 $273.75 $273.75 $205.50 $273.75 $273.75 $273.75 $136.88 $136.88 $216.81 $273.75 $219.00 $123.19 $54.33 N/A $158.92 $273.75 $273.75 $273.75 $57.05 $273.75 N/A N/A 102007 SUP HCPCS Q4116 102007 - MATRIX TISSUE THIN 4X1CM ALLOGRAFT REGENERATIVE FREEZE DRIED BOTH IP/OP $230.00 $170.00 $45.65 $230.00 $103.50 $103.50 $103.50 $103.50 $230.00 $230.00 $230.00 $47.94 $230.00 $230.00 $230.00 $230.00 $230.00 $47.93 $230.00 $148.13 $136.05 $230.00 $148.13 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $103.50 $45.65 N/A $133.40 $230.00 $230.00 $230.00 $47.93 $230.00 N/A N/A 102009 SUP HCPCS Q4116 102009 - GRAFT SKIN 4X2CM ALLOGRAFT ALLODERM ACELLULAR DERMIS BOTH IP/OP $101.00 $75.00 $20.03 $100.94 $45.42 $45.42 $45.42 $45.42 $100.94 $100.94 $100.94 $21.04 $100.94 $100.94 $100.94 $100.94 $100.94 $21.04 $100.94 $65.00 $59.71 $100.94 $65.00 $100.94 $100.94 $75.75 $100.94 $100.94 $100.94 $50.47 $50.47 $79.94 $100.94 $80.75 $45.42 $20.03 N/A $58.58 $100.94 $100.94 $100.94 $21.04 $100.94 N/A N/A 102010 SUP HCPCS Q4116 102010 - MATRIX TISSUE THIN 4X2CM ALLOGRAFT REGENERATIVE FREEZE DRIED BOTH IP/OP "$1,600.00" "$1,184.00" $317.56 "$1,600.00" $720.00 $720.00 $720.00 $720.00 "$1,600.00" "$1,600.00" "$1,600.00" $333.48 "$1,600.00" "$1,600.00" "$1,600.00" "$1,600.00" "$1,600.00" $333.46 "$1,600.00" "$1,030.00" $946.40 "$1,600.00" "$1,030.00" "$1,600.00" "$1,600.00" "$1,200.00" "$1,600.00" "$1,600.00" "$1,600.00" $800.00 $800.00 "$1,267.20" "$1,600.00" "$1,280.00" $720.00 $317.56 N/A $928.00 "$1,600.00" "$1,600.00" "$1,600.00" $333.44 "$1,600.00" N/A N/A 102012 SUP HCPCS Q4116 102012 - MATRIX TISSUE THICK 4X2CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $90.00 $90.00 $90.00 $90.00 $200.00 $200.00 $200.00 $41.69 $200.00 $200.00 $200.00 $200.00 $200.00 $41.68 $200.00 $128.75 $118.30 $200.00 $128.75 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $90.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 102016 SUP HCPCS Q4116 102016 - Alloderm Implantable BOTH IP/OP "$12,497.50" "$9,248.00" "$2,480.44" "$12,497.50" "$5,623.88" "$5,623.88" "$5,623.88" "$5,623.88" "$12,497.50" "$12,497.50" "$12,497.50" "$2,604.79" "$12,497.50" "$12,497.50" "$12,497.50" "$12,497.50" "$12,497.50" "$2,604.62" "$12,497.50" "$11,977.50" "$6,161.27" "$12,497.50" "$12,497.50" "$12,497.50" "$12,497.50" "$9,373.13" "$12,497.50" "$12,497.50" "$12,497.50" "$6,248.75" "$6,248.75" "$9,898.02" "$12,497.50" "$9,998.00" "$5,623.88" "$2,480.44" N/A "$7,248.55" "$12,497.50" "$12,497.50" "$12,497.50" "$2,604.48" "$12,497.50" N/A N/A 102020 SUP HCPCS Q4116 102020 - MATRIX TISSUE MEDIUM 7X3CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $129.50 $96.00 $25.68 $129.40 $58.23 $58.23 $58.23 $58.23 $129.40 $129.40 $129.40 $26.97 $129.40 $129.40 $129.40 $129.40 $129.40 $26.97 $129.40 $83.45 $76.54 $129.40 $83.45 $129.40 $129.40 $97.13 $129.40 $129.40 $129.40 $64.70 $64.70 $102.48 $129.40 $103.52 $58.23 $25.68 N/A $75.11 $129.40 $129.40 $129.40 $26.97 $129.40 N/A N/A 102021 SUP HCPCS Q4116 102021 - MATRIX TISSUE THICK 7X3CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $129.50 $96.00 $25.68 $129.40 $58.23 $58.23 $58.23 $58.23 $129.40 $129.40 $129.40 $26.97 $129.40 $129.40 $129.40 $129.40 $129.40 $26.97 $129.40 $83.45 $76.54 $129.40 $83.45 $129.40 $129.40 $97.13 $129.40 $129.40 $129.40 $64.70 $64.70 $102.48 $129.40 $103.52 $58.23 $25.68 N/A $75.11 $129.40 $129.40 $129.40 $26.97 $129.40 N/A N/A 102031 SUP HCPCS Q4116 102031 - MATRIX TISSUE THIN 7X4CM ALLOGRAFT REGENERATIVE FREEZE DRIED BOTH IP/OP $51.00 $38.00 $10.05 $50.63 $22.78 $22.78 $22.78 $22.78 $50.63 $50.63 $50.63 $10.55 $50.63 $50.63 $50.63 $50.63 $50.63 $10.55 $50.63 $32.59 $29.95 $50.63 $32.59 $50.63 $50.63 $38.25 $50.63 $50.63 $50.63 $25.32 $25.32 $40.10 $50.63 $40.50 $22.78 $10.05 N/A $29.58 $50.63 $50.63 $50.63 $10.55 $50.63 N/A N/A 102033 SUP HCPCS Q4116 102033 - MATRIX TISSUE MEDIUM 7X4CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $101.00 $75.00 $19.95 $100.54 $45.24 $45.24 $45.24 $45.24 $100.54 $100.54 $100.54 $20.96 $100.54 $100.54 $100.54 $100.54 $100.54 $20.95 $100.54 $64.73 $59.47 $100.54 $64.73 $100.54 $100.54 $75.75 $100.54 $100.54 $100.54 $50.27 $50.27 $79.63 $100.54 $80.43 $45.24 $19.95 N/A $58.58 $100.54 $100.54 $100.54 $20.95 $100.54 N/A N/A 102034 SUP HCPCS Q4116 102034 - MATRIX TISSUE THICK 7X4CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $101.00 $75.00 $19.95 $100.54 $45.24 $45.24 $45.24 $45.24 $100.54 $100.54 $100.54 $20.96 $100.54 $100.54 $100.54 $100.54 $100.54 $20.95 $100.54 $64.73 $59.47 $100.54 $64.73 $100.54 $100.54 $75.75 $100.54 $100.54 $100.54 $50.27 $50.27 $79.63 $100.54 $80.43 $45.24 $19.95 N/A $58.58 $100.54 $100.54 $100.54 $20.95 $100.54 N/A N/A 102049 SUP HCPCS Q4116 102049 - MATRIX TISSUE MEDIUM 12X4CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $104.50 $77.00 $20.66 $104.11 $46.85 $46.85 $46.85 $46.85 $104.11 $104.11 $104.11 $21.70 $104.11 $104.11 $104.11 $104.11 $104.11 $21.70 $104.11 $70.83 $61.58 $104.11 $104.11 $104.11 $104.11 $78.38 $104.11 $104.11 $104.11 $52.06 $52.06 $82.46 $104.11 $83.29 $46.85 $20.66 N/A $60.61 $104.11 $104.11 $104.11 $21.70 $104.11 N/A N/A 102050 SUP HCPCS Q4116 102050 - MATRIX TISSUE THICK 12X4CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 102061 SUP HCPCS Q4116 102061 - MATRIX TISSUE MEDIUM 10X5CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $100.50 $74.00 $19.89 $100.20 $45.09 $45.09 $45.09 $45.09 $100.20 $100.20 $100.20 $20.88 $100.20 $100.20 $100.20 $100.20 $100.20 $20.88 $100.20 $64.55 $59.27 $100.20 $64.55 $100.20 $100.20 $75.38 $100.20 $100.20 $100.20 $50.10 $50.10 $79.36 $100.20 $80.16 $45.09 $19.89 N/A $58.29 $100.20 $100.20 $100.20 $20.88 $100.20 N/A N/A 102062 SUP HCPCS Q4116 102062 - MATRIX TISSUE THICK 10X5CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP "$5,010.00" "$3,707.00" $994.36 "$5,010.00" "$2,254.50" "$2,254.50" "$2,254.50" "$2,254.50" "$5,010.00" "$5,010.00" "$5,010.00" "$1,044.21" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$5,010.00" "$1,044.14" "$5,010.00" "$3,227.50" "$2,469.93" "$5,010.00" "$3,227.50" "$5,010.00" "$5,010.00" "$3,757.50" "$5,010.00" "$5,010.00" "$5,010.00" "$2,505.00" "$2,505.00" "$3,967.92" "$5,010.00" "$4,008.00" "$2,254.50" $994.36 N/A "$2,905.80" "$5,010.00" "$5,010.00" "$5,010.00" "$1,044.08" "$5,010.00" N/A N/A 102071 SUP HCPCS Q4116 102071 - MATRIX TISSUE MEDIUM 12X6CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $71.00 $53.00 $14.05 $70.80 $31.86 $31.86 $31.86 $31.86 $70.80 $70.80 $70.80 $14.76 $70.80 $70.80 $70.80 $70.80 $70.80 $14.76 $70.80 $70.80 $41.88 $70.80 $70.80 $70.80 $70.80 $53.25 $70.80 $70.80 $70.80 $35.40 $35.40 $56.07 $70.80 $56.64 $31.86 $14.05 N/A $41.18 $70.80 $70.80 $70.80 $14.75 $70.80 N/A N/A 102072 SUP HCPCS Q4116 102072 - MATRIX TISSUE THICK 12X6CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $71.00 $53.00 $33.61 $188.80 $188.80 $188.80 $188.80 $188.80 $188.80 $188.80 $33.61 $188.80 $188.80 $140.13 $140.13 $145.53 $98.36 $39.35 $188.80 $73.27 $188.80 $188.80 $183.18 $188.80 $188.80 $53.25 $188.80 $188.80 $188.80 $94.40 $94.40 $149.53 $188.80 $151.04 $122.72 $188.80 N/A $41.18 $188.80 $113.28 $188.80 $188.80 $188.80 N/A N/A 102072 SUP Custom 27203010 102072 - WIRE FX 1.2MM 300MM ILZ BYNT PNT SS TIB BOTH IP/OP $189.00 $140.00 $33.61 $188.80 $188.80 $188.80 $188.80 $188.80 $188.80 $188.80 $33.61 $188.80 $188.80 $140.13 $140.13 $145.53 $98.36 $39.35 $188.80 $73.27 $188.80 $188.80 $183.18 $188.80 $188.80 $141.75 $188.80 $188.80 $188.80 $94.40 $94.40 $149.53 $188.80 $151.04 $122.72 $188.80 N/A $109.62 $188.80 $113.28 $188.80 $188.80 $188.80 N/A N/A 102081 SUP HCPCS Q4116 102081 - MATRIX TISSUE MEDIUM 16X4CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $78.50 $58.00 $15.50 $78.09 $35.14 $35.14 $35.14 $35.14 $78.09 $78.09 $78.09 $16.28 $78.09 $78.09 $78.09 $78.09 $78.09 $16.27 $78.09 $70.82 $46.19 $78.09 $78.09 $78.09 $78.09 $58.88 $78.09 $78.09 $78.09 $39.05 $39.05 $61.85 $78.09 $62.47 $35.14 $15.50 N/A $45.53 $78.09 $78.09 $78.09 $16.27 $78.09 N/A N/A 102082 SUP HCPCS Q4116 102082 - MATRIX TISSUE THICK 16X4CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $78.50 $58.00 $45.53 $867.50 $867.50 $867.50 $867.50 $867.50 $867.50 $867.50 $154.42 $867.50 $867.50 $643.86 $643.86 $668.67 $451.97 $180.80 $867.50 $335.41 $867.50 $867.50 $838.53 $867.50 $867.50 $58.88 $867.50 $867.50 $867.50 $433.75 $433.75 $687.06 $867.50 $694.00 $563.88 $867.50 N/A $45.53 $867.50 $520.50 $867.50 $867.50 $867.50 N/A N/A 102082 SUP Custom 27203010 102082 - WIRE FX 1.2MM 250MM ILZ STPR BYNT SS BOTH IP/OP $867.50 $642.00 $154.42 $867.50 $867.50 $867.50 $867.50 $867.50 $867.50 $867.50 $154.42 $867.50 $867.50 $643.86 $643.86 $668.67 $451.97 $180.80 $867.50 $335.41 $867.50 $867.50 $838.53 $867.50 $867.50 $650.63 $867.50 $867.50 $867.50 $433.75 $433.75 $687.06 $867.50 $694.00 $563.88 $867.50 N/A $503.15 $867.50 $520.50 $867.50 $867.50 $867.50 N/A N/A 102096 SUP HCPCS Q4116 102096 - MATRIX TISSUE THICK 12X8CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $78.50 $58.00 $15.50 $78.10 $35.15 $35.15 $35.15 $35.15 $78.10 $78.10 $78.10 $16.28 $78.10 $78.10 $78.10 $78.10 $78.10 $16.28 $78.10 $74.84 $46.20 $78.10 $78.10 $78.10 $78.10 $58.88 $78.10 $78.10 $78.10 $39.05 $39.05 $61.86 $78.10 $62.48 $35.15 $15.50 N/A $45.53 $78.10 $78.10 $78.10 $16.28 $78.10 N/A N/A 102102 SUP Custom 27203010 102102 - WIRE XTRNFX 1.8MM 370MM NS ILZ BYNT PNT DLX SET SS TIB BOTH IP/OP $208.50 $154.00 $37.11 $208.50 $208.50 $208.50 $208.50 $208.50 $208.50 $208.50 $37.11 $208.50 $208.50 $154.75 $154.75 $160.71 $108.63 $43.45 $208.50 $81.43 $208.50 $208.50 $208.50 $208.50 $208.50 $156.38 $208.50 $208.50 $208.50 $104.25 $104.25 $165.13 $208.50 $166.80 $135.53 $208.50 N/A $120.93 $208.50 $125.10 $208.50 $208.50 $208.50 N/A N/A 102128 SUP HCPCS Q4116 102128 - MATRIX TISSUE THICK 16X8CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $78.50 $58.00 $15.50 $78.11 $35.15 $35.15 $35.15 $35.15 $78.11 $78.11 $78.11 $16.28 $78.11 $78.11 $78.11 $78.11 $78.11 $16.28 $78.11 $74.82 $46.20 $78.11 $78.11 $78.11 $78.11 $58.88 $78.11 $78.11 $78.11 $39.06 $39.06 $61.86 $78.11 $62.49 $35.15 $15.50 N/A $45.53 $78.11 $78.11 $78.11 $16.28 $78.11 N/A N/A 102144 SUP HCPCS Q4116 102144 - MATRIX TISSUE THICK 12X12CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $106.00 $78.00 $21.01 $105.87 $47.64 $47.64 $47.64 $47.64 $105.87 $105.87 $105.87 $22.07 $105.87 $105.87 $105.87 $105.87 $105.87 $22.06 $105.87 $68.23 $62.62 $105.87 $68.23 $105.87 $105.87 $79.50 $105.87 $105.87 $105.87 $52.94 $52.94 $83.85 $105.87 $84.70 $47.64 $21.01 N/A $61.48 $105.87 $105.87 $105.87 $22.06 $105.87 N/A N/A 102196 SUP HCPCS Q4116 102196 - MATRIX TISSUE THICK 16X6CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $78.50 $58.00 $15.50 $78.10 $35.15 $35.15 $35.15 $35.15 $78.10 $78.10 $78.10 $16.28 $78.10 $78.10 $78.10 $78.10 $78.10 $16.28 $78.10 $74.84 $46.20 $78.10 $78.10 $78.10 $78.10 $58.88 $78.10 $78.10 $78.10 $39.05 $39.05 $61.86 $78.10 $62.48 $35.15 $15.50 N/A $45.53 $78.10 $78.10 $78.10 $16.28 $78.10 N/A N/A 102302 SUP HCPCS C1713 102302 - SET XTRNFX 100MM ILZ THRD ROD ADLT TIB BOTH IP/OP $110.00 $81.00 $21.75 $109.60 $49.32 $49.32 $49.32 $49.32 $109.60 $109.60 $109.60 $22.84 $109.60 $109.60 $109.60 $109.60 $109.60 $22.84 $109.60 $43.84 $64.83 $109.60 $109.60 $109.60 $109.60 $82.50 $109.60 $109.60 $109.60 $54.80 $54.80 $86.80 $109.60 $87.68 $49.32 $21.75 N/A $63.80 $109.60 $65.76 $109.60 $22.84 $109.60 N/A N/A 102303 SUP HCPCS C1713 102303 - ROD EXFIX 120MM ILZ TIB THRD DLX SET ADLT BOTH IP/OP $110.00 $81.00 $21.75 $109.60 $49.32 $49.32 $49.32 $49.32 $109.60 $109.60 $109.60 $22.84 $109.60 $109.60 $109.60 $109.60 $109.60 $22.84 $109.60 $106.75 $64.83 $109.60 $106.75 $109.60 $109.60 $82.50 $109.60 $109.60 $109.60 $54.80 $54.80 $86.80 $109.60 $87.68 $49.32 $21.75 N/A $63.80 $109.60 $109.60 $109.60 $22.84 $109.60 N/A N/A 102304 SUP HCPCS C1713 102304 - ROD XTRNFX 150MM ILZ THRD DLX SET SS ADLT TIB BOTH IP/OP $110.00 $81.00 $21.75 $109.60 $49.32 $49.32 $49.32 $49.32 $109.60 $109.60 $109.60 $22.84 $109.60 $109.60 $109.60 $109.60 $109.60 $22.84 $109.60 $42.70 $64.83 $109.60 $106.75 $109.60 $109.60 $82.50 $109.60 $109.60 $109.60 $54.80 $54.80 $86.80 $109.60 $87.68 $49.32 $21.75 N/A $63.80 $109.60 $65.76 $109.60 $109.60 $109.60 N/A N/A 102320 SUP HCPCS Q4116 102320 - MATRIX TISSUE THICK 20X16CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $78.50 $58.00 $15.50 $78.12 $35.15 $35.15 $35.15 $35.15 $78.12 $78.12 $78.12 $16.28 $78.12 $78.12 $78.12 $78.12 $78.12 $16.28 $78.12 $74.84 $46.21 $78.12 $78.12 $78.12 $78.12 $58.88 $78.12 $78.12 $78.12 $39.06 $39.06 $61.87 $78.12 $62.50 $35.15 $15.50 N/A $45.53 $78.12 $78.12 $78.12 $16.28 $78.12 N/A N/A 102600 SUP HCPCS C1713 102600 - WASHER XTRNFX THK3MM 14MM ILZ SLT BSC SET ADLT FEM BOTH IP/OP $65.50 $48.00 $12.98 $65.40 $29.43 $29.43 $29.43 $29.43 $65.40 $65.40 $65.40 $13.63 $65.40 $65.40 $65.40 $65.40 $65.40 $13.63 $65.40 $63.83 $38.68 $65.40 $63.83 $65.40 $65.40 $49.13 $65.40 $65.40 $65.40 $32.70 $32.70 $51.80 $65.40 $52.32 $29.43 $12.98 N/A $37.99 $65.40 $65.40 $65.40 $13.63 $65.40 N/A N/A 102701 SUP HCPCS C1713 102701 - WASHER XTRNFX 2MM 14MM ILZ BSC SET ADLT TIB BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $13.50 $13.50 $13.50 $13.50 $30.00 $30.00 $30.00 $6.25 $30.00 $30.00 $30.00 $30.00 $30.00 $6.25 $30.00 $29.25 $17.75 $30.00 $29.25 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $5.95 N/A $17.40 $30.00 $18.00 $30.00 $6.25 $30.00 N/A N/A 102706 SUP HCPCS C1713 102706 - WASHER XTRNFX THK2MM ILZ BOLT BOTH IP/OP $65.50 $48.00 $12.98 $65.40 $29.43 $29.43 $29.43 $29.43 $65.40 $65.40 $65.40 $13.63 $65.40 $65.40 $65.40 $65.40 $65.40 $13.63 $65.40 $63.83 $38.68 $65.40 $63.83 $65.40 $65.40 $49.13 $65.40 $65.40 $65.40 $32.70 $32.70 $51.80 $65.40 $52.32 $29.43 $12.98 N/A $37.99 $65.40 $65.40 $65.40 $13.63 $65.40 N/A N/A 102707 SUP HCPCS C1713 102707 - WASHER XTRNFX THK4MM ILZ BOLT BOTH IP/OP $65.50 $48.00 $12.98 $65.40 $29.43 $29.43 $29.43 $29.43 $65.40 $65.40 $65.40 $13.63 $65.40 $65.40 $65.40 $65.40 $65.40 $13.63 $65.40 $63.83 $38.68 $65.40 $63.83 $65.40 $65.40 $49.13 $65.40 $65.40 $65.40 $32.70 $32.70 $51.80 $65.40 $52.32 $29.43 $12.98 N/A $37.99 $65.40 $39.24 $65.40 $13.63 $65.40 N/A N/A 102715 SUP HCPCS C1713 102715 - WASHER XTRNFX THK1MM 1MM CIRC SM BN FXTR BOTH IP/OP $46.00 $34.00 $9.11 $45.90 $20.66 $20.66 $20.66 $20.66 $45.90 $45.90 $45.90 $9.57 $45.90 $45.90 $45.90 $45.90 $45.90 $9.57 $45.90 $44.45 $27.15 $45.90 $44.45 $45.90 $45.90 $34.50 $45.90 $45.90 $45.90 $22.95 $22.95 $36.35 $45.90 $36.72 $20.66 $9.11 N/A $26.68 $45.90 $27.54 $45.90 $9.57 $45.90 N/A N/A 102718 SUP HCPCS C1713 102718 - WASHER XTRNFX THK1.5MM 1.5MM CIRC SM BN FXTR BOTH IP/OP $46.00 $34.00 $9.11 $45.90 $20.66 $20.66 $20.66 $20.66 $45.90 $45.90 $45.90 $9.57 $45.90 $45.90 $45.90 $45.90 $45.90 $9.57 $45.90 $44.45 $27.15 $45.90 $44.45 $45.90 $45.90 $34.50 $45.90 $45.90 $45.90 $22.95 $22.95 $36.35 $45.90 $36.72 $20.66 $9.11 N/A $26.68 $45.90 $27.54 $45.90 $45.90 $45.90 N/A N/A 102721 SUP HCPCS C1713 102721 - WASHER XTRNFX THK3MM SLT SM BN FXTR BOTH IP/OP $86.50 $64.00 $17.13 $86.30 $38.84 $38.84 $38.84 $38.84 $86.30 $86.30 $86.30 $17.99 $86.30 $86.30 $86.30 $86.30 $86.30 $17.99 $86.30 $83.65 $51.05 $86.30 $83.65 $86.30 $86.30 $64.88 $86.30 $86.30 $86.30 $43.15 $43.15 $68.35 $86.30 $69.04 $38.84 $17.13 N/A $50.17 $86.30 $86.30 $86.30 $86.30 $86.30 N/A N/A 103044 SUP Custom 27203010 103044 - BIT DRL 2.7MM STRL ILZ SHNK CMPNT SET DISP RNCH SYS BOTH IP/OP "$1,023.50" $757.00 $182.17 "$1,023.40" "$1,023.40" "$1,023.40" "$1,023.40" "$1,023.40" "$1,023.40" "$1,023.40" $182.17 "$1,023.40" "$1,023.40" $759.57 $759.57 $788.84 $533.19 $213.29 "$1,023.40" $409.36 "$1,023.40" "$1,023.40" "$1,023.40" "$1,023.40" "$1,023.40" $767.63 "$1,023.40" "$1,023.40" "$1,023.40" $511.70 $511.70 $810.53 "$1,023.40" $818.72 $665.21 "$1,023.40" N/A $593.63 "$1,023.40" $614.04 "$1,023.40" "$1,023.40" "$1,023.40" N/A N/A 103045 SUP Custom 27203010 103045 - BIT DRL 3.8MM STRL ILZ SHNK CMPNT SET DISP RNCH SYS BOTH IP/OP "$1,023.50" $757.00 $182.17 "$1,023.40" "$1,023.40" "$1,023.40" "$1,023.40" "$1,023.40" "$1,023.40" "$1,023.40" $182.17 "$1,023.40" "$1,023.40" $759.57 $759.57 $788.84 $533.19 $213.29 "$1,023.40" $409.36 "$1,023.40" "$1,023.40" "$1,023.40" "$1,023.40" "$1,023.40" $767.63 "$1,023.40" "$1,023.40" "$1,023.40" $511.70 $511.70 $810.53 "$1,023.40" $818.72 $665.21 "$1,023.40" N/A $593.63 "$1,023.40" $614.04 "$1,023.40" "$1,023.40" "$1,023.40" N/A N/A 103201 SUP HCPCS C1713 103201 - BOLT XTRNFX UNV 16MM ILZ CMPS BSC SET CIRC CNCT HNG SS ADLT BOTH IP/OP $1.00 $1.00 $0.16 $16.15 $0.36 $0.36 $0.36 $0.36 $0.81 $0.81 $0.81 $0.17 $0.81 $0.81 $0.81 $0.81 $0.81 $0.17 $0.81 $16.15 $0.48 $0.81 $16.15 $0.81 $0.81 $0.75 $0.81 $0.81 $0.81 $0.41 $0.41 $0.64 $0.81 $0.65 $0.36 $0.16 N/A $0.58 $0.81 $0.81 $0.81 $0.17 $0.81 N/A N/A 103301 SUP HCPCS C1713 103301 - NUT XTRNFX THK5MM 10MM 6MM ILZ THRD INS HEX SS NYL BOTH IP/OP $77.50 $57.00 $15.32 $77.20 $34.74 $34.74 $34.74 $34.74 $77.20 $77.20 $77.20 $16.09 $77.20 $77.20 $77.20 $77.20 $77.20 $16.09 $77.20 $30.88 $45.66 $77.20 $77.20 $77.20 $77.20 $58.13 $77.20 $77.20 $77.20 $38.60 $38.60 $61.14 $77.20 $61.76 $34.74 $15.32 N/A $44.95 $77.20 $77.20 $77.20 $16.09 $77.20 N/A N/A 103313 SUP HCPCS C1713 103313 - NUT XTRNFX 3ANG SM BN FXTR BOTH IP/OP $410.00 $303.00 $81.32 $409.70 $184.37 $184.37 $184.37 $184.37 $409.70 $409.70 $409.70 $85.39 $409.70 $409.70 $409.70 $409.70 $409.70 $85.39 $409.70 $409.70 $242.34 $409.70 $409.70 $409.70 $409.70 $307.50 $409.70 $409.70 $409.70 $204.85 $204.85 $324.48 $409.70 $327.76 $184.37 $81.32 N/A $237.80 $409.70 $409.70 $409.70 $85.38 $409.70 N/A N/A 103406 SUP HCPCS C1776 103406 - SLEEVE XTRNFX 6MM ILZ CENTERING BOTH IP/OP $406.50 $301.00 $80.64 $406.30 $182.84 $182.84 $182.84 $182.84 $406.30 $406.30 $406.30 $84.68 $406.30 $406.30 $406.30 $406.30 $406.30 $84.68 $406.30 $406.30 $240.33 $406.30 $406.30 $406.30 $406.30 $304.88 $406.30 $406.30 $406.30 $203.15 $203.15 $321.79 $406.30 $325.04 $182.84 $80.64 N/A $235.77 $406.30 $406.30 $406.30 $84.67 $406.30 N/A N/A 103452 SUP HCPCS C1713 103452 - CUBE XTRNFX ILZ 2 HL SS RNCH SYS BOTH IP/OP $578.00 $428.00 $114.72 $578.00 $260.10 $260.10 $260.10 $260.10 $578.00 $578.00 $578.00 $120.47 $578.00 $578.00 $578.00 $578.00 $578.00 $120.46 $578.00 $231.20 $341.89 $578.00 $578.00 $578.00 $578.00 $433.50 $578.00 $578.00 $578.00 $289.00 $289.00 $457.78 $578.00 $462.40 $260.10 $114.72 N/A $335.24 $578.00 $346.80 $578.00 $120.46 $578.00 N/A N/A 103453 SUP HCPCS C1713 103453 - CUBE EXFIX UNIVERSAL 3 HOLE COMPONENT SET HINGE COMPASS BOTH IP/OP $668.00 $494.00 $132.58 $668.00 $300.60 $300.60 $300.60 $300.60 $668.00 $668.00 $668.00 $139.23 $668.00 $668.00 $668.00 $668.00 $668.00 $139.22 $668.00 $649.40 $395.12 $668.00 $668.00 $668.00 $668.00 $501.00 $668.00 $668.00 $668.00 $334.00 $334.00 $529.06 $668.00 $534.40 $300.60 $132.58 N/A $387.44 $668.00 $400.80 $668.00 $139.21 $668.00 N/A N/A 103454 SUP Custom 27203010 103454 - CUBE XTRNFX ILZ 4 HL SS RNCH SYS BOTH IP/OP $687.00 $508.00 $122.25 $686.80 $686.80 $686.80 $686.80 $686.80 $686.80 $686.80 $122.25 $686.80 $686.80 $509.74 $509.74 $529.39 $357.82 $143.14 $686.80 $274.72 $686.80 $686.80 $686.80 $686.80 $686.80 $515.25 $686.80 $686.80 $686.80 $343.40 $343.40 $543.95 $686.80 $549.44 $446.42 $686.80 N/A $398.46 $686.80 $412.08 $686.80 $686.80 $686.80 N/A N/A 103455 SUP Custom 27203010 103455 - CUBE XTRNFX ILZ 5 HL SS RNCH SYS BOTH IP/OP $758.50 $561.00 $134.96 $758.20 $758.20 $758.20 $758.20 $758.20 $758.20 $758.20 $134.96 $758.20 $758.20 $562.74 $562.74 $584.42 $395.02 $158.02 $758.20 $303.28 $758.20 $758.20 $758.20 $758.20 $758.20 $568.88 $758.20 $758.20 $758.20 $379.10 $379.10 $600.49 $758.20 $606.56 $492.83 $758.20 N/A $439.93 $758.20 $454.92 $758.20 $758.20 $758.20 N/A N/A 106132 SUP HCPCS C1713 106132 - BLADE SW DMD 800X.64X.54MM BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $165.00 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A 106133 SUP HCPCS C1713 106133 - SAW 0106133 DIAMOND 0.81 0.91MM X 800MM BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A 108280 SUP Custom 27203010 108280 - DOPPLER VASC 8MHZ STRL PRB DISP BOTH IP/OP $374.50 $277.00 $66.64 $374.38 $374.38 $374.38 $374.38 $374.38 $374.38 $374.38 $66.64 $374.38 $374.38 $277.86 $277.86 $288.57 $195.05 $78.02 $374.38 $149.75 $374.38 $374.38 $374.38 $374.38 $374.38 $280.88 $374.38 $374.38 $374.38 $187.19 $187.19 $296.51 $374.38 $299.50 $243.35 $374.38 N/A $217.21 $374.38 $224.63 $374.38 $374.38 $374.38 N/A N/A Jan-00 SUP Custom 27803010 01-2200 - HEAD FEMORAL MORSE TAPER LFIT HIP BOTH IP/OP "$1,795.00" "$1,328.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $374.10 "$1,795.00" $718.00 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,346.25" "$1,795.00" "$1,795.00" "$1,795.00" $897.50 $897.50 "$1,421.64" "$1,795.00" "$1,436.00" $807.75 "$1,795.00" N/A "$1,041.10" "$1,795.00" "$1,077.00" "$1,795.00" "$1,795.00" "$1,795.00" N/A N/A Jun-00 SUP Custom 27803010 06-2200 - HEAD FEM +0MM OFST CTPR 22MM STRL LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 110021 SUP Custom 27203010 110021 - BIT DRL 6.3MM AMBI PRFR BOTH IP/OP $201.00 $149.00 $35.70 $200.55 $200.55 $200.55 $200.55 $200.55 $200.55 $200.55 $35.70 $200.55 $200.55 $148.85 $148.85 $154.58 $104.49 $41.80 $200.55 $80.22 $200.55 $200.55 $200.55 $200.55 $200.55 $150.75 $200.55 $200.55 $200.55 $100.28 $100.28 $158.84 $200.55 $160.44 $130.36 $200.55 N/A $116.58 $200.55 $120.33 $200.55 $200.55 $200.55 N/A N/A 110107 SUP HCPCS C1713 110107 - SCREW SET CLLS FRM BOTH IP/OP $111.00 $82.00 $22.03 $111.00 $49.95 $49.95 $49.95 $49.95 $111.00 $111.00 $111.00 $23.14 $111.00 $111.00 $111.00 $111.00 $111.00 $23.13 $111.00 $108.80 $65.66 $111.00 $108.80 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $49.95 $22.03 N/A $64.38 $111.00 $66.60 $111.00 $23.13 $111.00 N/A N/A 110242 SUP Custom 27203010 110242 - BIT DRL 2.7MM STRL COLE TWST RDLCNT BOTH IP/OP $636.00 $471.00 $113.14 $635.63 $635.63 $635.63 $635.63 $635.63 $635.63 $635.63 $113.14 $635.63 $635.63 $471.76 $471.76 $489.94 $331.16 $132.47 $635.63 $254.25 $635.63 $635.63 $635.63 $635.63 $635.63 $477.00 $635.63 $635.63 $635.63 $317.82 $317.82 $503.42 $635.63 $508.50 $413.16 $635.63 N/A $368.88 $635.63 $381.38 $635.63 $635.63 $635.63 N/A N/A 110244 SUP Custom 27203010 110244 - BIT DRL 3.5MM STRL COLE TWST RDLCNT BOTH IP/OP $636.00 $471.00 $113.14 $635.63 $635.63 $635.63 $635.63 $635.63 $635.63 $635.63 $113.14 $635.63 $635.63 $471.76 $471.76 $489.94 $331.16 $132.47 $635.63 $254.25 $635.63 $635.63 $635.63 $635.63 $635.63 $477.00 $635.63 $635.63 $635.63 $317.82 $317.82 $503.42 $635.63 $508.50 $413.16 $635.63 N/A $368.88 $635.63 $381.38 $635.63 $635.63 $635.63 N/A N/A 110245 SUP Custom 27203010 110245 - BIT DRL 4MM COLE RDLCNT BOTH IP/OP $636.00 $471.00 $113.14 $635.63 $635.63 $635.63 $635.63 $635.63 $635.63 $635.63 $113.14 $635.63 $635.63 $471.76 $471.76 $489.94 $331.16 $132.47 $635.63 $254.25 $635.63 $635.63 $635.63 $635.63 $635.63 $477.00 $635.63 $635.63 $635.63 $317.82 $317.82 $503.42 $635.63 $508.50 $413.16 $635.63 N/A $368.88 $635.63 $381.38 $635.63 $635.63 $635.63 N/A N/A 110246 SUP Custom 27203010 110246 - BIT DRL 4.8MM COLE RDLCNT BOTH IP/OP $636.00 $471.00 $113.14 $635.63 $635.63 $635.63 $635.63 $635.63 $635.63 $635.63 $113.14 $635.63 $635.63 $471.76 $471.76 $489.94 $331.16 $132.47 $635.63 $254.25 $635.63 $635.63 $635.63 $635.63 $635.63 $477.00 $635.63 $635.63 $635.63 $317.82 $317.82 $503.42 $635.63 $508.50 $413.16 $635.63 N/A $368.88 $635.63 $381.38 $635.63 $635.63 $635.63 N/A N/A 110300 SUP HCPCS C1713 110300 - SCREW SET SELF BREAKING CD HORIZON PEDIATRIC SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 110675 SUP Custom 27203010 110675 - PASSER SUT 6.1IN BLK STRL LF 3.6CM SWNSN WIRELOOP ATCL SS BOTH IP/OP $200.00 $148.00 $35.55 $199.70 $199.70 $199.70 $199.70 $199.70 $199.70 $199.70 $35.55 $199.70 $199.70 $148.22 $148.22 $153.93 $104.04 $41.62 $199.70 $56.49 $199.70 $199.70 $141.23 $199.70 $199.70 $150.00 $199.70 $199.70 $199.70 $99.85 $99.85 $158.16 $199.70 $159.76 $129.81 $199.70 N/A $116.00 $199.70 $119.82 $199.70 $199.70 $199.70 N/A N/A 111250 SUP HCPCS C1762 111250 - GRAFT SOFT TISSUE 1-2MM 50MM ALLOGRAFT AXONAL REGENERATION BOTH IP/OP "$11,165.00" "$8,262.00" "$2,215.97" "$12,190.00" "$5,024.25" "$5,024.25" "$5,024.25" "$5,024.25" "$11,165.00" "$11,165.00" "$11,165.00" "$2,327.07" "$11,165.00" "$11,165.00" "$11,165.00" "$11,165.00" "$11,165.00" "$2,326.91" "$11,165.00" "$12,190.00" "$5,504.35" "$11,165.00" "$11,610.00" "$11,165.00" "$11,165.00" "$8,373.75" "$11,165.00" "$11,165.00" "$11,165.00" "$5,582.50" "$5,582.50" "$8,842.68" "$11,165.00" "$8,932.00" "$5,024.25" "$2,215.97" N/A "$6,475.70" "$11,165.00" "$11,165.00" "$11,165.00" "$2,326.79" "$11,165.00" N/A N/A Jan-05 SUP Custom 27803010 01-2205 - HEAD FEMORAL +5MM 22MM MORSE TAPERED LFIT COCR HIP BOTH IP/OP "$1,795.00" "$1,328.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $374.10 "$1,795.00" $718.00 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,346.25" "$1,795.00" "$1,795.00" "$1,795.00" $897.50 $897.50 "$1,421.64" "$1,795.00" "$1,436.00" $807.75 "$1,795.00" N/A "$1,041.10" "$1,795.00" "$1,077.00" "$1,795.00" "$1,795.00" "$1,795.00" N/A N/A Jun-05 SUP Custom 27803010 06-2205 - HEAD FEM +5MM OFST CTPR 22MM STRL LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 111630 SUP HCPCS C1713 111630 - PIN FX SM DUNN-DAUTREY STRPR UNCMP BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $302.50 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $63.04 $302.50 N/A N/A 111640 SUP HCPCS C1713 111640 - PIN FX 4MM 170MM STRL KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $302.50 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $63.04 $302.50 N/A N/A 111650 SUP HCPCS C1776 111650 - KIT THR STRL FEM/TIB CKPNT KT KN BOTH IP/OP $387.50 $287.00 $76.91 $387.50 $174.38 $174.38 $174.38 $174.38 $387.50 $387.50 $387.50 $80.76 $387.50 $387.50 $387.50 $387.50 $387.50 $80.76 $387.50 $387.50 $229.21 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $174.38 $76.91 N/A $224.75 $387.50 $232.50 $387.50 $80.76 $387.50 N/A N/A 111651 SUP HCPCS C1776 111651 - COMPONENT FEM STRL TIB CKPNT KN BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $54.00 $54.00 $54.00 $54.00 $120.00 $120.00 $120.00 $25.01 $120.00 $120.00 $120.00 $120.00 $120.00 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $54.00 $23.82 N/A $69.60 $120.00 $72.00 $120.00 $25.01 $120.00 N/A N/A 111652 SUP HCPCS C1776 111652 - COMPONENT FEM STRL FEM CKPNT KN BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $92.25 $92.25 $92.25 $92.25 $205.00 $205.00 $205.00 $42.73 $205.00 $205.00 $205.00 $205.00 $205.00 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $92.25 $40.69 N/A $118.90 $205.00 $123.00 $205.00 $42.72 $205.00 N/A N/A 111655 SUP HCPCS C1713 111655 - SCREW BN STRL VA CORT BOTH IP/OP $662.50 $490.00 $131.49 $662.50 $298.13 $298.13 $298.13 $298.13 $662.50 $662.50 $662.50 $138.08 $662.50 $662.50 $662.50 $662.50 $662.50 $138.07 $662.50 $662.50 $391.87 $662.50 $662.50 $662.50 $662.50 $496.88 $662.50 $662.50 $662.50 $331.25 $331.25 $524.70 $662.50 $530.00 $298.13 $131.49 N/A $384.25 $662.50 $662.50 $662.50 $138.07 $662.50 N/A N/A 111670 SUP HCPCS C1713 111670 - PIN ORTH 3.2MM 80MM STRL KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $302.50 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $63.04 $302.50 N/A N/A 111680 SUP HCPCS C1713 111680 - PIN FX 4MM 80MM STRL KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $302.50 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $63.04 $302.50 N/A N/A Jan-06 SUP HCPCS C1713 1-2206 - SPACER SPNL 6MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS BOTH IP/OP "$7,632.00" "$5,648.00" "$1,514.76" "$7,632.00" "$3,434.40" "$3,434.40" "$3,434.40" "$3,434.40" "$7,632.00" "$7,632.00" "$7,632.00" "$1,590.70" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$1,590.59" "$7,632.00" "$3,052.80" "$3,762.58" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$5,724.00" "$7,632.00" "$7,632.00" "$7,632.00" "$3,816.00" "$3,816.00" "$6,044.54" "$7,632.00" "$6,105.60" "$3,434.40" "$1,514.76" N/A "$4,426.56" "$7,632.00" "$7,632.00" "$7,632.00" "$1,590.51" "$7,632.00" N/A N/A Jan-08 SUP HCPCS C1713 1-2208 - SPACER SPNL 8MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS BOTH IP/OP "$7,632.00" "$5,648.00" "$1,514.76" "$7,632.00" "$3,434.40" "$3,434.40" "$3,434.40" "$3,434.40" "$7,632.00" "$7,632.00" "$7,632.00" "$1,590.70" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$1,590.59" "$7,632.00" "$3,052.80" "$3,762.58" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$5,724.00" "$7,632.00" "$7,632.00" "$7,632.00" "$3,816.00" "$3,816.00" "$6,044.54" "$7,632.00" "$6,105.60" "$3,434.40" "$1,514.76" N/A "$4,426.56" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" N/A N/A 112640 SUP HCPCS C1781 0112640 - MESH SURG 4X1IN PATCH FLAT SHEET KNIT MARLEX GROIN HERN BOTH IP/OP $118.50 $88.00 $23.47 $118.25 $53.21 $53.21 $53.21 $53.21 $118.25 $118.25 $118.25 $24.65 $118.25 $118.25 $118.25 $118.25 $118.25 $24.64 $118.25 $118.25 $69.94 $118.25 $118.25 $118.25 $118.25 $88.88 $118.25 $118.25 $118.25 $59.13 $59.13 $93.65 $118.25 $94.60 $53.21 $23.47 N/A $68.73 $118.25 $118.25 $118.25 $24.64 $118.25 N/A N/A 112660 SUP HCPCS C1781 0112660 - MESH SRG RECT 14X10IN STRL BARD MRLX MFL AU STD FLT SHT PP BOTH IP/OP $349.00 $258.00 $69.22 $348.75 $156.94 $156.94 $156.94 $156.94 $348.75 $348.75 $348.75 $72.69 $348.75 $348.75 $348.75 $348.75 $348.75 $72.68 $348.75 $348.75 $206.29 $348.75 $348.75 $348.75 $348.75 $261.75 $348.75 $348.75 $348.75 $174.38 $174.38 $276.21 $348.75 $279.00 $156.94 $69.22 N/A $202.42 $348.75 $348.75 $348.75 $72.68 $348.75 N/A N/A 112727 SUP Custom 27203010 112727 - SCREW XTRNFX SPTL FRM HXFX SET SS BOTH IP/OP $34.00 $25.00 $6.02 $33.83 $33.83 $33.83 $33.83 $33.83 $33.83 $33.83 $6.02 $33.83 $33.83 $25.11 $25.11 $26.08 $17.63 $7.05 $33.83 $13.53 $33.83 $33.83 $33.83 $33.83 $33.83 $25.50 $33.83 $33.83 $33.83 $16.92 $16.92 $26.79 $33.83 $27.06 $21.99 $33.83 N/A $19.72 $33.83 $20.30 $33.83 $33.83 $33.83 N/A N/A 112960 SUP HCPCS C1781 0112960 - PLUG SURG MEDIUM TAPER 1.55X1.3IN MONOFILAMENT NONABSORBABLE BOTH IP/OP $726.00 $537.00 $144.04 $725.75 $326.59 $326.59 $326.59 $326.59 $725.75 $725.75 $725.75 $151.26 $725.75 $725.75 $725.75 $725.75 $725.75 $151.25 $725.75 $725.75 $429.28 $725.75 $725.75 $725.75 $725.75 $544.50 $725.75 $725.75 $725.75 $362.88 $362.88 $574.79 $725.75 $580.60 $326.59 $144.04 N/A $421.08 $725.75 $725.75 $725.75 $151.25 $725.75 N/A N/A 112970 SUP HCPCS C1781 0112970 - MESH SRG LG 1.9IN 1.6IN STRL BARD PRFX PLG MFL PLT EDG PP BOTH IP/OP $732.50 $542.00 $145.33 $732.25 $329.51 $329.51 $329.51 $329.51 $732.25 $732.25 $732.25 $152.62 $732.25 $732.25 $732.25 $732.25 $732.25 $152.61 $732.25 $732.25 $433.13 $732.25 $732.25 $732.25 $732.25 $549.38 $732.25 $732.25 $732.25 $366.13 $366.13 $579.94 $732.25 $585.80 $329.51 $145.33 N/A $424.85 $732.25 $732.25 $732.25 $152.60 $732.25 N/A N/A 112970 SUP HCPCS C1781 112970 - MESH SURG LARGE 1.9IN 1.6IN PLUG MONOFILAMENT PERFIX POLYPRO BOTH IP/OP "$3,418.00" "$2,529.00" $145.33 "$2,563.50" $329.51 $329.51 $329.51 $329.51 $732.25 $732.25 $732.25 $152.62 $732.25 $732.25 $732.25 $732.25 $732.25 $152.61 $732.25 $732.25 $433.13 $732.25 $732.25 $732.25 $732.25 "$2,563.50" $732.25 $732.25 $732.25 $366.13 $366.13 $579.94 $732.25 $585.80 $329.51 $145.33 N/A "$1,982.44" $732.25 $732.25 $732.25 $152.60 $732.25 N/A N/A 112980 SUP HCPCS C1781 0112980 - MESH SURG XL 2X1.6IN NONABSORBABLE PLUG TAPERED MARLEX BOTH IP/OP $849.50 $629.00 $168.55 $849.25 $382.16 $382.16 $382.16 $382.16 $849.25 $849.25 $849.25 $177.00 $849.25 $849.25 $849.25 $849.25 $849.25 $176.99 $849.25 $849.25 $502.33 $849.25 $849.25 $849.25 $849.25 $637.13 $849.25 $849.25 $849.25 $424.63 $424.63 $672.61 $849.25 $679.40 $382.16 $168.55 N/A $492.71 $849.25 $849.25 $849.25 $176.98 $849.25 N/A N/A Jan-10 SUP HCPCS C1713 1-2210 - SPACER SPNL 10MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS BOTH IP/OP "$7,632.00" "$5,648.00" "$1,514.76" "$7,632.00" "$3,434.40" "$3,434.40" "$3,434.40" "$3,434.40" "$7,632.00" "$7,632.00" "$7,632.00" "$1,590.70" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$1,590.59" "$7,632.00" "$7,632.00" "$3,762.58" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$5,724.00" "$7,632.00" "$7,632.00" "$7,632.00" "$3,816.00" "$3,816.00" "$6,044.54" "$7,632.00" "$6,105.60" "$3,434.40" "$1,514.76" N/A "$4,426.56" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" N/A N/A Jun-10 SUP Custom 27803010 06-2210 - HEAD FEM +10MM OFST CTPR 22MM STRL LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A Jan-12 SUP HCPCS C1713 1-2212 - SPACER SPNL 12MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS BOTH IP/OP "$7,632.00" "$5,648.00" "$1,514.76" "$7,632.00" "$3,434.40" "$3,434.40" "$3,434.40" "$3,434.40" "$7,632.00" "$7,632.00" "$7,632.00" "$1,590.70" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$1,590.59" "$7,632.00" "$7,632.00" "$3,762.58" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$5,724.00" "$7,632.00" "$7,632.00" "$7,632.00" "$3,816.00" "$3,816.00" "$6,044.54" "$7,632.00" "$6,105.60" "$3,434.40" "$1,514.76" N/A "$4,426.56" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" N/A N/A 114153 SUP HCPCS C1880 114153 - CATHETER SCT KT 2 LUM COIL XTD LGTH BOTH IP/OP $200.00 $148.00 $41.68 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $90.00 $200.00 N/A $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A 114156 SUP HCPCS C1788 114156 - SET HMDIAL 33ML LF AQDX BLD CRCT UF-500 BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,450.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,450.00" "$1,330.88" "$2,250.00" "$2,450.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A Jan-14 SUP HCPCS C1713 1-2214 - SPACER SPNL 14MM X-STP TI LMBR INTERSPINOUS PRC DCMPRS BOTH IP/OP "$7,632.00" "$5,648.00" "$1,514.76" "$7,632.00" "$3,434.40" "$3,434.40" "$3,434.40" "$3,434.40" "$7,632.00" "$7,632.00" "$7,632.00" "$1,590.70" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$1,590.59" "$7,632.00" "$3,052.80" "$3,762.58" "$7,632.00" "$7,632.00" "$7,632.00" "$7,632.00" "$5,724.00" "$7,632.00" "$7,632.00" "$7,632.00" "$3,816.00" "$3,816.00" "$6,044.54" "$7,632.00" "$6,105.60" "$3,434.40" "$1,514.76" N/A "$4,426.56" "$7,632.00" "$7,632.00" "$7,632.00" "$1,590.51" "$7,632.00" N/A N/A 116240 SUP HCPCS C1713 116240 - SCREW BN STRL CORT BOTH IP/OP $662.50 $490.00 $131.49 $662.50 $298.13 $298.13 $298.13 $298.13 $662.50 $662.50 $662.50 $138.08 $662.50 $662.50 $662.50 $662.50 $662.50 $138.07 $662.50 $265.00 $391.87 $662.50 $662.50 $662.50 $662.50 $496.88 $662.50 $662.50 $662.50 $331.25 $331.25 $524.70 $662.50 $530.00 $298.13 $131.49 N/A $384.25 $662.50 $662.50 $662.50 $138.07 $662.50 N/A N/A 120019 SUP HCPCS C1713 120019 - BUTTON SUT 19MM STRL LF HWSN 4 HL HD PE LGMNT DISP BOTH IP/OP $310.50 $230.00 $61.61 $310.40 $139.68 $139.68 $139.68 $139.68 $310.40 $310.40 $310.40 $64.70 $310.40 $310.40 $310.40 $310.40 $310.40 $64.69 $310.40 $87.57 $183.60 $310.40 $218.93 $310.40 $310.40 $232.88 $310.40 $310.40 $310.40 $155.20 $155.20 $245.84 $310.40 $248.32 $139.68 $61.61 N/A $180.09 $310.40 $186.24 $310.40 $64.69 $310.40 N/A N/A 121100 SUP HCPCS C1713 121100 - SCREW BN STD 12.7MM 9MM 55MM STRL 21MM AMBI CLS LG CMPR SS BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $726.60 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 121101 SUP HCPCS C1713 121101 - SCREW BN STD 9MM .5MM 60MM CLS AMBI IMHS LG THRD HIP BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $726.60 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 121102 SUP HCPCS C1713 121102 - SCREW BN STD 12.7MM 9MM 65MM STRL 21MM AMBI CLS LG CMPR SS BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 121103 SUP HCPCS C1713 121103 - SCREW BN STD 9MM .5MM 70MM CLS AMBI IMHS LG THRD HIP BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $726.60 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 121104 SUP HCPCS C1713 121104 - SCREW BN STD 12.7MM 9MM 75MM STRL 21MM AMBI IMHS CLS LG CMPR BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $726.60 $726.60 N/A N/A 121105 SUP HCPCS C1713 121105 - SCREW BN STD 12.7MM 9MM 80MM STRL 21MM AMBI IMHS CLS LG CMPR BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $726.60 $726.60 N/A N/A 121106 SUP HCPCS C1713 121106 - SCREW BN P/T 12.7MM 9MM 85MM 21MM AMBI CHS IMHS STD LG HIP BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $726.60 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 121107 SUP HCPCS C1713 121107 - SCREW BN P/T 12.7MM 9MM 90MM 21MM AMBI CHS IMHS STD LG HIP BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 121108 SUP HCPCS C1713 121108 - SCREW BN 12.7MM 9MM 95MM 21MM AMBI CHS STD LG SS HIP BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $726.60 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 121109 SUP HCPCS C1713 121109 - SCREW BN STD 12.7MM 9MM 100MM STRL 21MM AMBI IMHS CLS LG BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 121110 SUP HCPCS C1713 121110 - SCREW BN 12.7MM 9MM 105MM 21MM AMBI CHS STD LG SS HIP BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $726.60 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $726.60 $726.60 $151.42 $726.60 N/A N/A 121111 SUP HCPCS C1713 121111 - SCREW BN STD .5IN 9MM 110MM 21MM IMHS LG HIP SP CNDL PLT BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 121112 SUP HCPCS C1713 121112 - SCREW BN STD .5IN 9MM 115MM 21MM AMBI CLS IMHS LG BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $726.60 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 121116 SUP HCPCS C1713 121116 - SCREW BN HEX 3.5MM 19MM AMBI IMHS CLS CMPR SS HIP SP CNDL IM BOTH IP/OP $199.50 $148.00 $39.58 $199.40 $89.73 $89.73 $89.73 $89.73 $199.40 $199.40 $199.40 $41.56 $199.40 $199.40 $199.40 $199.40 $199.40 $41.56 $199.40 $51.03 $117.95 $199.40 $127.58 $199.40 $199.40 $149.63 $199.40 $199.40 $199.40 $99.70 $99.70 $157.92 $199.40 $159.52 $89.73 $39.58 N/A $115.71 $199.40 $199.40 $199.40 $41.55 $199.40 N/A N/A 121117 SUP HCPCS C1713 121117 - SCREW BN HEX 3.5MM 28.5MM AMBI IMHS CLS CMPR SS HIP SP CNDL BOTH IP/OP $199.50 $148.00 $39.58 $199.40 $89.73 $89.73 $89.73 $89.73 $199.40 $199.40 $199.40 $41.56 $199.40 $199.40 $199.40 $199.40 $199.40 $41.56 $199.40 $127.58 $117.95 $199.40 $127.58 $199.40 $199.40 $149.63 $199.40 $199.40 $199.40 $99.70 $99.70 $157.92 $199.40 $159.52 $89.73 $39.58 N/A $115.71 $199.40 $119.64 $199.40 $41.55 $199.40 N/A N/A 121120 SUP HCPCS C1713 121120 - PLATE BN 130D STD BRL 60MM 38.1MM AMBI 2 HL SS HIP BOTH IP/OP "$1,081.50" $800.00 $214.65 "$1,081.50" $486.68 $486.68 $486.68 $486.68 "$1,081.50" "$1,081.50" "$1,081.50" $225.41 "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" $225.40 "$1,081.50" "$1,081.50" $639.71 "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" $811.13 "$1,081.50" "$1,081.50" "$1,081.50" $540.75 $540.75 $856.55 "$1,081.50" $865.20 $486.68 $214.65 N/A $627.27 "$1,081.50" $648.90 "$1,081.50" $225.38 "$1,081.50" N/A N/A 121121 SUP HCPCS C1713 121121 - PLATE BN 135D STD BRL 60MM 38.1MM AMBI 2 HL CMPR SS HIP BOTH IP/OP "$1,081.50" $800.00 $214.65 "$1,081.50" $486.68 $486.68 $486.68 $486.68 "$1,081.50" "$1,081.50" "$1,081.50" $225.41 "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" $225.40 "$1,081.50" "$1,081.50" $639.71 "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" $811.13 "$1,081.50" "$1,081.50" "$1,081.50" $540.75 $540.75 $856.55 "$1,081.50" $865.20 $486.68 $214.65 N/A $627.27 "$1,081.50" "$1,081.50" "$1,081.50" $225.38 "$1,081.50" N/A N/A 121122 SUP HCPCS C1713 121122 - PLATE BN 140D STD BRL 60MM 38.1MM AMBI 2 HL CMPR SS HIP BOTH IP/OP "$1,081.50" $800.00 $214.65 "$1,081.50" $486.68 $486.68 $486.68 $486.68 "$1,081.50" "$1,081.50" "$1,081.50" $225.41 "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" $225.40 "$1,081.50" "$1,081.50" $639.71 "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" $811.13 "$1,081.50" "$1,081.50" "$1,081.50" $540.75 $540.75 $856.55 "$1,081.50" $865.20 $486.68 $214.65 N/A $627.27 "$1,081.50" $648.90 "$1,081.50" $225.38 "$1,081.50" N/A N/A 121123 SUP HCPCS C1713 121123 - PLATE BN 145D STD BRL 60MM 38.1MM AMBI 2 HL SS HIP BOTH IP/OP "$1,081.50" $800.00 $214.65 "$1,081.50" $486.68 $486.68 $486.68 $486.68 "$1,081.50" "$1,081.50" "$1,081.50" $225.41 "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" $225.40 "$1,081.50" "$1,081.50" $639.71 "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" $811.13 "$1,081.50" "$1,081.50" "$1,081.50" $540.75 $540.75 $856.55 "$1,081.50" $865.20 $486.68 $214.65 N/A $627.27 "$1,081.50" $648.90 "$1,081.50" $225.38 "$1,081.50" N/A N/A 121124 SUP HCPCS C1713 121124 - PLATE BN 150D STD BRL 60MM 38.1MM AMBI 2 HL CMPR SS HIP BOTH IP/OP "$1,081.50" $800.00 $214.65 "$1,081.50" $486.68 $486.68 $486.68 $486.68 "$1,081.50" "$1,081.50" "$1,081.50" $225.41 "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" $225.40 "$1,081.50" "$1,081.50" $639.71 "$1,081.50" "$1,081.50" "$1,081.50" "$1,081.50" $811.13 "$1,081.50" "$1,081.50" "$1,081.50" $540.75 $540.75 $856.55 "$1,081.50" $865.20 $486.68 $214.65 N/A $627.27 "$1,081.50" "$1,081.50" "$1,081.50" $225.38 "$1,081.50" N/A N/A 121125 SUP HCPCS C1713 121125 - PLATE BN 130D STD BRL 80MM 38.1MM AMBI 3 HL CMPR SS HIP BOTH IP/OP "$1,113.00" $824.00 $220.90 "$1,113.00" $500.85 $500.85 $500.85 $500.85 "$1,113.00" "$1,113.00" "$1,113.00" $231.98 "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" $231.96 "$1,113.00" "$1,113.00" $658.34 "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" $834.75 "$1,113.00" "$1,113.00" "$1,113.00" $556.50 $556.50 $881.50 "$1,113.00" $890.40 $500.85 $220.90 N/A $645.54 "$1,113.00" $667.80 "$1,113.00" $231.95 "$1,113.00" N/A N/A 121126 SUP HCPCS C1713 121126 - PLATE BN 135D STD BRL 80MM 38.1MM AMBI 3 HL CMPR SS HIP BOTH IP/OP "$1,113.00" $824.00 $220.90 "$1,113.00" $500.85 $500.85 $500.85 $500.85 "$1,113.00" "$1,113.00" "$1,113.00" $231.98 "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" $231.96 "$1,113.00" "$1,113.00" $658.34 "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" $834.75 "$1,113.00" "$1,113.00" "$1,113.00" $556.50 $556.50 $881.50 "$1,113.00" $890.40 $500.85 $220.90 N/A $645.54 "$1,113.00" $667.80 "$1,113.00" $231.95 "$1,113.00" N/A N/A 121127 SUP HCPCS C1713 121127 - PLATE BN 140D STD BRL 80MM 38.1MM AMBI 3 HL CMPR HIP BOTH IP/OP "$1,113.00" $824.00 $220.90 "$1,113.00" $500.85 $500.85 $500.85 $500.85 "$1,113.00" "$1,113.00" "$1,113.00" $231.98 "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" $231.96 "$1,113.00" "$1,113.00" $658.34 "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" $834.75 "$1,113.00" "$1,113.00" "$1,113.00" $556.50 $556.50 $881.50 "$1,113.00" $890.40 $500.85 $220.90 N/A $645.54 "$1,113.00" $667.80 "$1,113.00" $231.95 "$1,113.00" N/A N/A 121128 SUP HCPCS C1713 121128 - PLATE BN 145D STD BRL 80MM 38.1MM AMBI 3 HL CMPR HIP BOTH IP/OP "$1,113.00" $824.00 $220.90 "$1,113.00" $500.85 $500.85 $500.85 $500.85 "$1,113.00" "$1,113.00" "$1,113.00" $231.98 "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" $231.96 "$1,113.00" "$1,113.00" $658.34 "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" $834.75 "$1,113.00" "$1,113.00" "$1,113.00" $556.50 $556.50 $881.50 "$1,113.00" $890.40 $500.85 $220.90 N/A $645.54 "$1,113.00" $667.80 "$1,113.00" $231.95 "$1,113.00" N/A N/A 121130 SUP HCPCS C1713 121130 - PLATE BN 130D STD BRL 100MM 38.1MM AMBI 4 HL CMPR SS HIP BOTH IP/OP "$1,113.00" $824.00 $220.90 "$1,113.00" $500.85 $500.85 $500.85 $500.85 "$1,113.00" "$1,113.00" "$1,113.00" $231.98 "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" $231.96 "$1,113.00" "$1,113.00" $658.34 "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" $834.75 "$1,113.00" "$1,113.00" "$1,113.00" $556.50 $556.50 $881.50 "$1,113.00" $890.40 $500.85 $220.90 N/A $645.54 "$1,113.00" $667.80 "$1,113.00" $231.95 "$1,113.00" N/A N/A 121131 SUP HCPCS C1713 121131 - PLATE BN 135D STD BRL 135MM 38.1MM AMBI 4 HL CMPR SS HIP BOTH IP/OP "$1,113.00" $824.00 $220.90 "$1,113.00" $500.85 $500.85 $500.85 $500.85 "$1,113.00" "$1,113.00" "$1,113.00" $231.98 "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" $231.96 "$1,113.00" $445.20 $658.34 "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" $834.75 "$1,113.00" "$1,113.00" "$1,113.00" $556.50 $556.50 $881.50 "$1,113.00" $890.40 $500.85 $220.90 N/A $645.54 "$1,113.00" $667.80 "$1,113.00" $231.95 "$1,113.00" N/A N/A 121135 SUP HCPCS C1713 121135 - PLATE BN 130D STD BRL 120MM 38.1MM AMBI CHS 5 HL SS HIP BOTH IP/OP "$1,192.00" $882.00 $236.53 "$1,191.75" $536.29 $536.29 $536.29 $536.29 "$1,191.75" "$1,191.75" "$1,191.75" $248.39 "$1,191.75" "$1,191.75" "$1,191.75" "$1,191.75" "$1,191.75" $248.37 "$1,191.75" $476.70 $704.92 "$1,191.75" "$1,191.75" "$1,191.75" "$1,191.75" $894.00 "$1,191.75" "$1,191.75" "$1,191.75" $595.88 $595.88 $943.87 "$1,191.75" $953.40 $536.29 $236.53 N/A $691.36 "$1,191.75" $715.05 "$1,191.75" $248.36 "$1,191.75" N/A N/A 121137 SUP HCPCS C1713 121137 - PLATE BN 140D STD BRL 120MM 38.1MM AMBI 5 HL HIP BOTH IP/OP "$1,192.00" $882.00 $236.53 "$1,191.75" $536.29 $536.29 $536.29 $536.29 "$1,191.75" "$1,191.75" "$1,191.75" $248.39 "$1,191.75" "$1,191.75" "$1,191.75" "$1,191.75" "$1,191.75" $248.37 "$1,191.75" $476.70 $704.92 "$1,191.75" "$1,191.75" "$1,191.75" "$1,191.75" $894.00 "$1,191.75" "$1,191.75" "$1,191.75" $595.88 $595.88 $943.87 "$1,191.75" $953.40 $536.29 $236.53 N/A $691.36 "$1,191.75" $715.05 "$1,191.75" $248.36 "$1,191.75" N/A N/A 121138 SUP HCPCS C1713 121138 - PLATE BN 145D STD BRL 120MM 38.1MM AMBI 5 HL CMPR SS HIP BOTH IP/OP "$1,192.00" $882.00 $236.53 "$1,191.75" $536.29 $536.29 $536.29 $536.29 "$1,191.75" "$1,191.75" "$1,191.75" $248.39 "$1,191.75" "$1,191.75" "$1,191.75" "$1,191.75" "$1,191.75" $248.37 "$1,191.75" "$1,191.75" $704.92 "$1,191.75" "$1,191.75" "$1,191.75" "$1,191.75" $894.00 "$1,191.75" "$1,191.75" "$1,191.75" $595.88 $595.88 $943.87 "$1,191.75" $953.40 $536.29 $236.53 N/A $691.36 "$1,191.75" $715.05 "$1,191.75" $248.36 "$1,191.75" N/A N/A 121139 SUP HCPCS C1713 121139 - PLATE BN 150D STD BRL 120MM 38.1MM AMBI 5 HL CMPR SS HIP BOTH IP/OP "$1,192.00" $882.00 $236.53 "$1,191.75" $536.29 $536.29 $536.29 $536.29 "$1,191.75" "$1,191.75" "$1,191.75" $248.39 "$1,191.75" "$1,191.75" "$1,191.75" "$1,191.75" "$1,191.75" $248.37 "$1,191.75" "$1,191.75" $704.92 "$1,191.75" "$1,191.75" "$1,191.75" "$1,191.75" $894.00 "$1,191.75" "$1,191.75" "$1,191.75" $595.88 $595.88 $943.87 "$1,191.75" $953.40 $536.29 $236.53 N/A $691.36 "$1,191.75" $715.05 "$1,191.75" $248.36 "$1,191.75" N/A N/A 121141 SUP HCPCS C1713 121141 - PLATE BN 135D STD BRL 140MM 38.1MM AMBI 6 HL CMPR SS HIP BOTH IP/OP "$1,239.00" $917.00 $245.91 "$1,239.00" $557.55 $557.55 $557.55 $557.55 "$1,239.00" "$1,239.00" "$1,239.00" $258.24 "$1,239.00" "$1,239.00" "$1,239.00" "$1,239.00" "$1,239.00" $258.22 "$1,239.00" "$1,239.00" $732.87 "$1,239.00" "$1,239.00" "$1,239.00" "$1,239.00" $929.25 "$1,239.00" "$1,239.00" "$1,239.00" $619.50 $619.50 $981.29 "$1,239.00" $991.20 $557.55 $245.91 N/A $718.62 "$1,239.00" $743.40 "$1,239.00" $258.21 "$1,239.00" N/A N/A 121143 SUP HCPCS C1713 121143 - PLATE BN 145D STD BRL 140MM 38.1MM AMBI 6 HL CMPR SS HIP BOTH IP/OP "$1,239.00" $917.00 $245.91 "$1,239.00" $557.55 $557.55 $557.55 $557.55 "$1,239.00" "$1,239.00" "$1,239.00" $258.24 "$1,239.00" "$1,239.00" "$1,239.00" "$1,239.00" "$1,239.00" $258.22 "$1,239.00" $495.60 $732.87 "$1,239.00" "$1,239.00" "$1,239.00" "$1,239.00" $929.25 "$1,239.00" "$1,239.00" "$1,239.00" $619.50 $619.50 $981.29 "$1,239.00" $991.20 $557.55 $245.91 N/A $718.62 "$1,239.00" $743.40 "$1,239.00" $258.21 "$1,239.00" N/A N/A 121144 SUP HCPCS C1713 121144 - PLATE BN 150D STD BRL 140MM 38.1MM AMBI 6 HL CMPR SS HIP BOTH IP/OP "$1,239.00" $917.00 $245.91 "$1,239.00" $557.55 $557.55 $557.55 $557.55 "$1,239.00" "$1,239.00" "$1,239.00" $258.24 "$1,239.00" "$1,239.00" "$1,239.00" "$1,239.00" "$1,239.00" $258.22 "$1,239.00" $495.60 $732.87 "$1,239.00" "$1,239.00" "$1,239.00" "$1,239.00" $929.25 "$1,239.00" "$1,239.00" "$1,239.00" $619.50 $619.50 $981.29 "$1,239.00" $991.20 $557.55 $245.91 N/A $718.62 "$1,239.00" $743.40 "$1,239.00" $258.21 "$1,239.00" N/A N/A 121145 SUP HCPCS C1713 121145 - PLATE BN 130D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP BOTH IP/OP "$1,501.50" "$1,111.00" $298.01 "$1,501.50" $675.68 $675.68 $675.68 $675.68 "$1,501.50" "$1,501.50" "$1,501.50" $312.95 "$1,501.50" "$1,501.50" "$1,501.50" "$1,501.50" "$1,501.50" $312.93 "$1,501.50" $600.60 $888.14 "$1,501.50" "$1,501.50" "$1,501.50" "$1,501.50" "$1,126.13" "$1,501.50" "$1,501.50" "$1,501.50" $750.75 $750.75 "$1,189.19" "$1,501.50" "$1,201.20" $675.68 $298.01 N/A $870.87 "$1,501.50" $900.90 "$1,501.50" $312.91 "$1,501.50" N/A N/A 121147 SUP HCPCS C1713 121147 - PLATE BN 140D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP BOTH IP/OP "$1,501.50" "$1,111.00" $298.01 "$1,501.50" $675.68 $675.68 $675.68 $675.68 "$1,501.50" "$1,501.50" "$1,501.50" $312.95 "$1,501.50" "$1,501.50" "$1,501.50" "$1,501.50" "$1,501.50" $312.93 "$1,501.50" "$1,501.50" $888.14 "$1,501.50" "$1,501.50" "$1,501.50" "$1,501.50" "$1,126.13" "$1,501.50" "$1,501.50" "$1,501.50" $750.75 $750.75 "$1,189.19" "$1,501.50" "$1,201.20" $675.68 $298.01 N/A $870.87 "$1,501.50" $900.90 "$1,501.50" $312.91 "$1,501.50" N/A N/A 121148 SUP HCPCS C1713 121148 - PLATE BN 145D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP BOTH IP/OP "$1,501.50" "$1,111.00" $298.01 "$1,501.50" $675.68 $675.68 $675.68 $675.68 "$1,501.50" "$1,501.50" "$1,501.50" $312.95 "$1,501.50" "$1,501.50" "$1,501.50" "$1,501.50" "$1,501.50" $312.93 "$1,501.50" $600.60 $888.14 "$1,501.50" "$1,501.50" "$1,501.50" "$1,501.50" "$1,126.13" "$1,501.50" "$1,501.50" "$1,501.50" $750.75 $750.75 "$1,189.19" "$1,501.50" "$1,201.20" $675.68 $298.01 N/A $870.87 "$1,501.50" $900.90 "$1,501.50" $312.91 "$1,501.50" N/A N/A 121149 SUP HCPCS C1713 121149 - PLATE BN 150D STD BRL 180MM 38.1MM AMBI 8 HL CMPR SS HIP BOTH IP/OP "$1,501.50" "$1,111.00" $298.01 "$1,501.50" $675.68 $675.68 $675.68 $675.68 "$1,501.50" "$1,501.50" "$1,501.50" $312.95 "$1,501.50" "$1,501.50" "$1,501.50" "$1,501.50" "$1,501.50" $312.93 "$1,501.50" $600.60 $888.14 "$1,501.50" "$1,501.50" "$1,501.50" "$1,501.50" "$1,126.13" "$1,501.50" "$1,501.50" "$1,501.50" $750.75 $750.75 "$1,189.19" "$1,501.50" "$1,201.20" $675.68 $298.01 N/A $870.87 "$1,501.50" $900.90 "$1,501.50" $312.91 "$1,501.50" N/A N/A 121150 SUP HCPCS C1713 121150 - PLATE BN 130D STD BRL 220MM 38.1MM AMBI 10 HL SS HIP BOTH IP/OP "$1,759.00" "$1,302.00" $349.07 "$1,758.75" $791.44 $791.44 $791.44 $791.44 "$1,758.75" "$1,758.75" "$1,758.75" $366.57 "$1,758.75" "$1,758.75" "$1,758.75" "$1,758.75" "$1,758.75" $366.54 "$1,758.75" $703.50 "$1,040.30" "$1,758.75" "$1,758.75" "$1,758.75" "$1,758.75" "$1,319.25" "$1,758.75" "$1,758.75" "$1,758.75" $879.38 $879.38 "$1,392.93" "$1,758.75" "$1,407.00" $791.44 $349.07 N/A "$1,020.22" "$1,758.75" "$1,055.25" "$1,758.75" $366.52 "$1,758.75" N/A N/A 121152 SUP HCPCS C1713 121152 - PLATE BN 140D STD BRL 220MM 1.5IN AMBI 10 HL SS HIP BOTH IP/OP "$1,759.00" "$1,302.00" $349.07 "$1,758.75" $791.44 $791.44 $791.44 $791.44 "$1,758.75" "$1,758.75" "$1,758.75" $366.57 "$1,758.75" "$1,758.75" "$1,758.75" "$1,758.75" "$1,758.75" $366.54 "$1,758.75" $703.50 "$1,040.30" "$1,758.75" "$1,758.75" "$1,758.75" "$1,758.75" "$1,319.25" "$1,758.75" "$1,758.75" "$1,758.75" $879.38 $879.38 "$1,392.93" "$1,758.75" "$1,407.00" $791.44 $349.07 N/A "$1,020.22" "$1,758.75" "$1,055.25" "$1,758.75" $366.52 "$1,758.75" N/A N/A 121153 SUP HCPCS C1713 121153 - PLATE BN 145D STD BRL 180MM 38.1MM AMBI 10 HL CMPR SS HIP BOTH IP/OP "$1,759.00" "$1,302.00" $349.07 "$1,758.75" $791.44 $791.44 $791.44 $791.44 "$1,758.75" "$1,758.75" "$1,758.75" $366.57 "$1,758.75" "$1,758.75" "$1,758.75" "$1,758.75" "$1,758.75" $366.54 "$1,758.75" $703.50 "$1,040.30" "$1,758.75" "$1,758.75" "$1,758.75" "$1,758.75" "$1,319.25" "$1,758.75" "$1,758.75" "$1,758.75" $879.38 $879.38 "$1,392.93" "$1,758.75" "$1,407.00" $791.44 $349.07 N/A "$1,020.22" "$1,758.75" "$1,758.75" "$1,758.75" $366.52 "$1,758.75" N/A N/A 121154 SUP HCPCS C1713 121154 - PLATE BN 150D STD BRL 220MM 38.1MM AMBI 10 HL CMPR SS HIP BOTH IP/OP "$1,759.00" "$1,302.00" $349.07 "$1,758.75" $791.44 $791.44 $791.44 $791.44 "$1,758.75" "$1,758.75" "$1,758.75" $366.57 "$1,758.75" "$1,758.75" "$1,758.75" "$1,758.75" "$1,758.75" $366.54 "$1,758.75" $703.50 "$1,040.30" "$1,758.75" "$1,758.75" "$1,758.75" "$1,758.75" "$1,319.25" "$1,758.75" "$1,758.75" "$1,758.75" $879.38 $879.38 "$1,392.93" "$1,758.75" "$1,407.00" $791.44 $349.07 N/A "$1,020.22" "$1,758.75" "$1,055.25" "$1,758.75" $366.52 "$1,758.75" N/A N/A 121156 SUP HCPCS C1713 121156 - PLATE BN 135D STD BRL 260MM 38.1MM AMBI 12 HL CMPR SS HIP BOTH IP/OP "$1,879.50" "$1,391.00" $373.03 "$1,879.50" $845.78 $845.78 $845.78 $845.78 "$1,879.50" "$1,879.50" "$1,879.50" $391.73 "$1,879.50" "$1,879.50" "$1,879.50" "$1,879.50" "$1,879.50" $391.71 "$1,879.50" $751.80 "$1,111.72" "$1,879.50" "$1,879.50" "$1,879.50" "$1,879.50" "$1,409.63" "$1,879.50" "$1,879.50" "$1,879.50" $939.75 $939.75 "$1,488.56" "$1,879.50" "$1,503.60" $845.78 $373.03 N/A "$1,090.11" "$1,879.50" "$1,127.70" "$1,879.50" $391.69 "$1,879.50" N/A N/A 121158 SUP HCPCS C1713 121158 - PLATE BN 145D STD BRL 260MM 38.1MM AMBI 12 HL CMPR SS HIP BOTH IP/OP "$1,879.50" "$1,391.00" $373.03 "$1,879.50" $845.78 $845.78 $845.78 $845.78 "$1,879.50" "$1,879.50" "$1,879.50" $391.73 "$1,879.50" "$1,879.50" "$1,879.50" "$1,879.50" "$1,879.50" $391.71 "$1,879.50" "$1,879.50" "$1,111.72" "$1,879.50" "$1,879.50" "$1,879.50" "$1,879.50" "$1,409.63" "$1,879.50" "$1,879.50" "$1,879.50" $939.75 $939.75 "$1,488.56" "$1,879.50" "$1,503.60" $845.78 $373.03 N/A "$1,090.11" "$1,879.50" "$1,879.50" "$1,879.50" "$1,879.50" "$1,879.50" N/A N/A 121159 SUP HCPCS C1713 121159 - PLATE BN 150D STD BRL 260MM 38.1MM AMBI 12 HL CMPR HIP BOTH IP/OP $889.50 $658.00 $176.51 $889.35 $400.21 $400.21 $400.21 $400.21 $889.35 $889.35 $889.35 $185.36 $889.35 $889.35 $889.35 $889.35 $889.35 $185.35 $889.35 $889.35 $526.05 $889.35 $889.35 $889.35 $889.35 $667.13 $889.35 $889.35 $889.35 $444.68 $444.68 $704.37 $889.35 $711.48 $400.21 $176.51 N/A $515.91 $889.35 $533.61 $889.35 $889.35 $889.35 N/A N/A 121161 SUP HCPCS C1713 121161 - PLATE BN 135D STD BRL 300MM 38.1MM AMBI 14 SLOT SS HIP BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 121165 SUP HCPCS C1713 121165 - PLATE BN 130D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP BOTH IP/OP "$1,213.00" $898.00 $240.70 "$1,212.75" $545.74 $545.74 $545.74 $545.74 "$1,212.75" "$1,212.75" "$1,212.75" $252.77 "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" $252.75 "$1,212.75" $485.10 $717.34 "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" $909.75 "$1,212.75" "$1,212.75" "$1,212.75" $606.38 $606.38 $960.50 "$1,212.75" $970.20 $545.74 $240.70 N/A $703.54 "$1,212.75" $727.65 "$1,212.75" $252.74 "$1,212.75" N/A N/A 121166 SUP HCPCS C1713 121166 - PLATE BN 135D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP BOTH IP/OP "$1,213.00" $898.00 $240.70 "$1,212.75" $545.74 $545.74 $545.74 $545.74 "$1,212.75" "$1,212.75" "$1,212.75" $252.77 "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" $252.75 "$1,212.75" "$1,212.75" $717.34 "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" $909.75 "$1,212.75" "$1,212.75" "$1,212.75" $606.38 $606.38 $960.50 "$1,212.75" $970.20 $545.74 $240.70 N/A $703.54 "$1,212.75" $727.65 "$1,212.75" $252.74 "$1,212.75" N/A N/A 121167 SUP HCPCS C1713 121167 - PLATE BN 140D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP BOTH IP/OP "$1,213.00" $898.00 $240.70 "$1,212.75" $545.74 $545.74 $545.74 $545.74 "$1,212.75" "$1,212.75" "$1,212.75" $252.77 "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" $252.75 "$1,212.75" $485.10 $717.34 "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" $909.75 "$1,212.75" "$1,212.75" "$1,212.75" $606.38 $606.38 $960.50 "$1,212.75" $970.20 $545.74 $240.70 N/A $703.54 "$1,212.75" $727.65 "$1,212.75" $252.74 "$1,212.75" N/A N/A 121168 SUP HCPCS C1713 121168 - PLATE BN 145D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP BOTH IP/OP "$1,213.00" $898.00 $240.70 "$1,212.75" $545.74 $545.74 $545.74 $545.74 "$1,212.75" "$1,212.75" "$1,212.75" $252.77 "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" $252.75 "$1,212.75" $485.10 $717.34 "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" $909.75 "$1,212.75" "$1,212.75" "$1,212.75" $606.38 $606.38 $960.50 "$1,212.75" $970.20 $545.74 $240.70 N/A $703.54 "$1,212.75" $727.65 "$1,212.75" $252.74 "$1,212.75" N/A N/A 121169 SUP HCPCS C1713 121169 - PLATE BN 150D SHRT BRL 120MM 25.4MM AMBI CHS 5 HL SS HIP BOTH IP/OP "$1,213.00" $898.00 $240.70 "$1,212.75" $545.74 $545.74 $545.74 $545.74 "$1,212.75" "$1,212.75" "$1,212.75" $252.77 "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" $252.75 "$1,212.75" $485.10 $717.34 "$1,212.75" "$1,212.75" "$1,212.75" "$1,212.75" $909.75 "$1,212.75" "$1,212.75" "$1,212.75" $606.38 $606.38 $960.50 "$1,212.75" $970.20 $545.74 $240.70 N/A $703.54 "$1,212.75" $727.65 "$1,212.75" $252.74 "$1,212.75" N/A N/A 121176 SUP HCPCS C1713 121176 - SCREW BN STD .5IN 9MM 130MM 21MM AMBI CLS IMHS LG BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $726.60 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 121177 SUP HCPCS C1713 121177 - SCREW BN 12.7MM 9MM 135MM 21MM IMHS CP STD LG SS HIP IM NL BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $726.60 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 121178 SUP HCPCS C1713 121178 - SCREW BN 12.7MM 9MM 140MM 21MM IMHS CP STD LG SS HIP IM NL BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $726.60 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $726.60 $726.60 N/A N/A 121181 SUP HCPCS C1713 121181 - SCREW BN 14.3MM 9MM 60MM 21MM SPLG HIP BOTH IP/OP $775.00 $574.00 $153.80 $774.90 $348.71 $348.71 $348.71 $348.71 $774.90 $774.90 $774.90 $161.51 $774.90 $774.90 $774.90 $774.90 $774.90 $161.50 $774.90 $774.90 $458.35 $774.90 $774.90 $774.90 $774.90 $581.25 $774.90 $774.90 $774.90 $387.45 $387.45 $613.72 $774.90 $619.92 $348.71 $153.80 N/A $449.50 $774.90 $774.90 $774.90 $161.49 $774.90 N/A N/A 121191 SUP HCPCS C1713 121191 - SCREW BN 9/16IN 9MM 110MM 21MM AMBI CLS SPLG BOTH IP/OP $775.00 $574.00 $153.80 $774.90 $348.71 $348.71 $348.71 $348.71 $774.90 $774.90 $774.90 $161.51 $774.90 $774.90 $774.90 $774.90 $774.90 $161.50 $774.90 $774.90 $458.35 $774.90 $774.90 $774.90 $774.90 $581.25 $774.90 $774.90 $774.90 $387.45 $387.45 $613.72 $774.90 $619.92 $348.71 $153.80 N/A $449.50 $774.90 $464.94 $774.90 $774.90 $774.90 N/A N/A 121192 SUP HCPCS C1713 121192 - SCREW BN 14.3MM 9MM 115MM STRL 21MM AMBI CLS SPLG CMPR SS BOTH IP/OP $775.00 $574.00 $153.80 $774.90 $348.71 $348.71 $348.71 $348.71 $774.90 $774.90 $774.90 $161.51 $774.90 $774.90 $774.90 $774.90 $774.90 $161.50 $774.90 $774.90 $458.35 $774.90 $774.90 $774.90 $774.90 $581.25 $774.90 $774.90 $774.90 $387.45 $387.45 $613.72 $774.90 $619.92 $348.71 $153.80 N/A $449.50 $774.90 $464.94 $774.90 $774.90 $774.90 N/A N/A 121193 SUP HCPCS C1713 121193 - SCREW BN 14.3MM 9MM 120MM STRL 21MM AMBI CLS SPLG CMPR SS BOTH IP/OP $775.00 $574.00 $153.80 $774.90 $348.71 $348.71 $348.71 $348.71 $774.90 $774.90 $774.90 $161.51 $774.90 $774.90 $774.90 $774.90 $774.90 $161.50 $774.90 $774.90 $458.35 $774.90 $774.90 $774.90 $774.90 $581.25 $774.90 $774.90 $774.90 $387.45 $387.45 $613.72 $774.90 $619.92 $348.71 $153.80 N/A $449.50 $774.90 $464.94 $774.90 $774.90 $774.90 N/A N/A 121194 SUP HCPCS C1713 121194 - SCREW BN 14.3MM 9MM 125MM STRL 21MM AMBI CLS SPLG CMPR SS BOTH IP/OP $775.00 $574.00 $153.80 $774.90 $348.71 $348.71 $348.71 $348.71 $774.90 $774.90 $774.90 $161.51 $774.90 $774.90 $774.90 $774.90 $774.90 $161.50 $774.90 $774.90 $458.35 $774.90 $774.90 $774.90 $774.90 $581.25 $774.90 $774.90 $774.90 $387.45 $387.45 $613.72 $774.90 $619.92 $348.71 $153.80 N/A $449.50 $774.90 $464.94 $774.90 $161.49 $774.90 N/A N/A 121195 SUP HCPCS C1713 121195 - SCREW BN 14.3MM 9MM 130MM 21MM CHS SPLG SS HIP BOTH IP/OP $775.00 $574.00 $153.80 $774.90 $348.71 $348.71 $348.71 $348.71 $774.90 $774.90 $774.90 $161.51 $774.90 $774.90 $774.90 $774.90 $774.90 $161.50 $774.90 $774.90 $458.35 $774.90 $774.90 $774.90 $774.90 $581.25 $774.90 $774.90 $774.90 $387.45 $387.45 $613.72 $774.90 $619.92 $348.71 $153.80 N/A $449.50 $774.90 $464.94 $774.90 $774.90 $774.90 N/A N/A 121196 SUP HCPCS C1713 121196 - SCREW BN 14.3MM 9MM 135MM 21MM CHS SPLG SS HIP BOTH IP/OP $775.00 $574.00 $153.80 $774.90 $348.71 $348.71 $348.71 $348.71 $774.90 $774.90 $774.90 $161.51 $774.90 $774.90 $774.90 $774.90 $774.90 $161.50 $774.90 $309.96 $458.35 $774.90 $774.90 $774.90 $774.90 $581.25 $774.90 $774.90 $774.90 $387.45 $387.45 $613.72 $774.90 $619.92 $348.71 $153.80 N/A $449.50 $774.90 $774.90 $774.90 $774.90 $774.90 N/A N/A 121197 SUP HCPCS C1713 121197 - SCREW BN 14.3MM 9MM 140MM 21MM CHS SPLG SS HIP BOTH IP/OP $775.00 $574.00 $153.80 $774.90 $348.71 $348.71 $348.71 $348.71 $774.90 $774.90 $774.90 $161.51 $774.90 $774.90 $774.90 $774.90 $774.90 $161.50 $774.90 $774.90 $458.35 $774.90 $774.90 $774.90 $774.90 $581.25 $774.90 $774.90 $774.90 $387.45 $387.45 $613.72 $774.90 $619.92 $348.71 $153.80 N/A $449.50 $774.90 $464.94 $774.90 $774.90 $774.90 N/A N/A 121198 SUP HCPCS C1713 121198 - PLATE BN 130D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP BOTH IP/OP "$1,165.50" $862.00 $231.32 "$1,165.50" $524.48 $524.48 $524.48 $524.48 "$1,165.50" "$1,165.50" "$1,165.50" $242.92 "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" $242.90 "$1,165.50" "$1,165.50" $689.39 "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" $874.13 "$1,165.50" "$1,165.50" "$1,165.50" $582.75 $582.75 $923.08 "$1,165.50" $932.40 $524.48 $231.32 N/A $675.99 "$1,165.50" $699.30 "$1,165.50" $242.89 "$1,165.50" N/A N/A 121199 SUP HCPCS C1713 121199 - PLATE BN 135D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP BOTH IP/OP "$1,165.50" $862.00 $231.32 "$1,165.50" $524.48 $524.48 $524.48 $524.48 "$1,165.50" "$1,165.50" "$1,165.50" $242.92 "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" $242.90 "$1,165.50" "$1,165.50" $689.39 "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" $874.13 "$1,165.50" "$1,165.50" "$1,165.50" $582.75 $582.75 $923.08 "$1,165.50" $932.40 $524.48 $231.32 N/A $675.99 "$1,165.50" $699.30 "$1,165.50" $242.89 "$1,165.50" N/A N/A 121200 SUP HCPCS C1713 121200 - PLATE BN 140D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP BOTH IP/OP "$1,165.50" $862.00 $231.32 "$1,165.50" $524.48 $524.48 $524.48 $524.48 "$1,165.50" "$1,165.50" "$1,165.50" $242.92 "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" $242.90 "$1,165.50" $466.20 $689.39 "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" $874.13 "$1,165.50" "$1,165.50" "$1,165.50" $582.75 $582.75 $923.08 "$1,165.50" $932.40 $524.48 $231.32 N/A $675.99 "$1,165.50" $699.30 "$1,165.50" $242.89 "$1,165.50" N/A N/A 121201 SUP HCPCS C1713 121201 - PLATE BN 145D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP BOTH IP/OP "$1,165.50" $862.00 $231.32 "$1,165.50" $524.48 $524.48 $524.48 $524.48 "$1,165.50" "$1,165.50" "$1,165.50" $242.92 "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" $242.90 "$1,165.50" $466.20 $689.39 "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" $874.13 "$1,165.50" "$1,165.50" "$1,165.50" $582.75 $582.75 $923.08 "$1,165.50" $932.40 $524.48 $231.32 N/A $675.99 "$1,165.50" $699.30 "$1,165.50" $242.89 "$1,165.50" N/A N/A 121202 SUP HCPCS C1713 121202 - PLATE BN 150D SHRT BRL 100MM 25.4MM AMBI CHS 4 HL SS HIP BOTH IP/OP "$1,165.50" $862.00 $231.32 "$1,165.50" $524.48 $524.48 $524.48 $524.48 "$1,165.50" "$1,165.50" "$1,165.50" $242.92 "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" $242.90 "$1,165.50" $466.20 $689.39 "$1,165.50" "$1,165.50" "$1,165.50" "$1,165.50" $874.13 "$1,165.50" "$1,165.50" "$1,165.50" $582.75 $582.75 $923.08 "$1,165.50" $932.40 $524.48 $231.32 N/A $675.99 "$1,165.50" $699.30 "$1,165.50" "$1,165.50" "$1,165.50" N/A N/A 121410 SUP Custom 27203010 121410 - INSTRUMENT BIOP ANGLE 22MM TWIST BEVEL 14GA 100MM 7.8CM BOTH IP/OP $176.50 $131.00 $31.38 $176.32 $176.32 $176.32 $176.32 $176.32 $176.32 $176.32 $31.38 $176.32 $176.32 $130.86 $130.86 $135.91 $91.86 $36.75 $176.32 $70.53 $176.32 $176.32 $176.32 $176.32 $176.32 $132.38 $176.32 $176.32 $176.32 $88.16 $88.16 $139.65 $176.32 $141.06 $114.61 $176.32 N/A $102.37 $176.32 $105.79 $176.32 $176.32 $176.32 N/A N/A 121625 SUP HCPCS C1713 121625 - SCREW BN 6.5MM 25MM STRL 16MM IMSC CNN SS SP CNDL BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $531.30 $531.30 N/A N/A 121626 SUP HCPCS C1713 121626 - SCREW BN UNV 6.5MM 30MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $531.30 $531.30 $531.30 $531.30 N/A N/A 121627 SUP HCPCS C1713 121627 - SCREW BN UNV 6.5MM 35MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $531.30 $531.30 $531.30 $531.30 N/A N/A 121628 SUP HCPCS C1713 121628 - SCREW BN UNV 6.5MM 40MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $531.30 $531.30 $531.30 $531.30 N/A N/A 121629 SUP HCPCS C1713 121629 - SCREW BN UNV 6.5MM 45MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $531.30 $531.30 N/A N/A 121630 SUP HCPCS C1713 121630 - SCREW BN UNV 6.5MM 50MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $531.30 $531.30 N/A N/A 121631 SUP HCPCS C1713 121631 - SCREW BN UNV 6.5MM 55MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 121632 SUP HCPCS C1713 121632 - SCREW BN UNV 6.5MM 60MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 121633 SUP HCPCS C1713 121633 - SCREW BN UNV 6.5MM 65MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $531.30 $531.30 $531.30 $531.30 N/A N/A 121634 SUP HCPCS C1713 121634 - SCREW BN UNV 6.5MM 70MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $531.30 $531.30 $110.72 $531.30 N/A N/A 121635 SUP HCPCS C1713 121635 - SCREW BN UNV 6.5MM 75MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $531.30 $531.30 $110.72 $531.30 N/A N/A 121636 SUP HCPCS C1713 121636 - SCREW BN P/T 6.5MM 4.5MM 80MM STRL 20MM CNN SS HIP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 121637 SUP HCPCS C1713 121637 - SCREW BN UNV 6.5MM 85MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 121638 SUP HCPCS C1713 121638 - SCREW BN 6.5MM 90MM CNN MTPHSL BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 121639 SUP HCPCS C1713 121639 - SCREW BN UNV 6.5MM 95MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 121640 SUP HCPCS C1713 121640 - SCREW BN 6.5MM 100MM CNN SP CNDL BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $531.30 $531.30 N/A N/A 121641 SUP HCPCS C1713 121641 - SCREW BN UNV 6.5MM 105MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 121642 SUP HCPCS C1713 121642 - SCREW BN UNV 6.5MM 110MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 121643 SUP HCPCS C1713 121643 - SCREW BN UNV 6.5MM 115MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $531.30 $531.30 N/A N/A 121644 SUP HCPCS C1713 121644 - SCREW BN UNV 6.5MM 120MM STRL 20MM IMSC CNN CMPR SS HIP SP BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 121654 SUP HCPCS C1713 121654 - PIN FX 30MM CNN HIP BOTH IP/OP $761.50 $564.00 $151.09 $761.25 $342.56 $342.56 $342.56 $342.56 $761.25 $761.25 $761.25 $158.66 $761.25 $761.25 $761.25 $761.25 $761.25 $158.65 $761.25 $761.25 $450.28 $761.25 $761.25 $761.25 $761.25 $571.13 $761.25 $761.25 $761.25 $380.63 $380.63 $602.91 $761.25 $609.00 $342.56 $151.09 N/A $441.67 $761.25 $456.75 $761.25 $158.64 $761.25 N/A N/A 121655 SUP HCPCS C1713 121655 - PIN FX 35MM CNN HIP BOTH IP/OP $761.50 $564.00 $151.09 $761.25 $342.56 $342.56 $342.56 $342.56 $761.25 $761.25 $761.25 $158.66 $761.25 $761.25 $761.25 $761.25 $761.25 $158.65 $761.25 $304.50 $450.28 $761.25 $761.25 $761.25 $761.25 $571.13 $761.25 $761.25 $761.25 $380.63 $380.63 $602.91 $761.25 $609.00 $342.56 $151.09 N/A $441.67 $761.25 $761.25 $761.25 $158.64 $761.25 N/A N/A 121656 SUP HCPCS C1713 121656 - PIN FX 40MM CNN HIP BOTH IP/OP $761.50 $564.00 $151.09 $761.25 $342.56 $342.56 $342.56 $342.56 $761.25 $761.25 $761.25 $158.66 $761.25 $761.25 $761.25 $761.25 $761.25 $158.65 $761.25 $761.25 $450.28 $761.25 $761.25 $761.25 $761.25 $571.13 $761.25 $761.25 $761.25 $380.63 $380.63 $602.91 $761.25 $609.00 $342.56 $151.09 N/A $441.67 $761.25 $456.75 $761.25 $158.64 $761.25 N/A N/A 121657 SUP HCPCS C1713 121657 - PIN FX 45MM CNN HIP BOTH IP/OP $761.50 $564.00 $151.09 $761.25 $342.56 $342.56 $342.56 $342.56 $761.25 $761.25 $761.25 $158.66 $761.25 $761.25 $761.25 $761.25 $761.25 $158.65 $761.25 $304.50 $450.28 $761.25 $761.25 $761.25 $761.25 $571.13 $761.25 $761.25 $761.25 $380.63 $380.63 $602.91 $761.25 $609.00 $342.56 $151.09 N/A $441.67 $761.25 $456.75 $761.25 $158.64 $761.25 N/A N/A 121658 SUP HCPCS C1713 121658 - PIN FX 50MM CNN HIP BOTH IP/OP $761.50 $564.00 $151.09 $761.25 $342.56 $342.56 $342.56 $342.56 $761.25 $761.25 $761.25 $158.66 $761.25 $761.25 $761.25 $761.25 $761.25 $158.65 $761.25 $761.25 $450.28 $761.25 $761.25 $761.25 $761.25 $571.13 $761.25 $761.25 $761.25 $380.63 $380.63 $602.91 $761.25 $609.00 $342.56 $151.09 N/A $441.67 $761.25 $456.75 $761.25 $761.25 $761.25 N/A N/A 121659 SUP HCPCS C1713 121659 - PIN FX 55MM CNN HIP BOTH IP/OP $761.50 $564.00 $151.09 $761.25 $342.56 $342.56 $342.56 $342.56 $761.25 $761.25 $761.25 $158.66 $761.25 $761.25 $761.25 $761.25 $761.25 $158.65 $761.25 $304.50 $450.28 $761.25 $761.25 $761.25 $761.25 $571.13 $761.25 $761.25 $761.25 $380.63 $380.63 $602.91 $761.25 $609.00 $342.56 $151.09 N/A $441.67 $761.25 $456.75 $761.25 $761.25 $761.25 N/A N/A 121660 SUP HCPCS C1713 121660 - PIN FX 60MM CNN HIP BOTH IP/OP $700.50 $518.00 $139.00 $700.35 $315.16 $315.16 $315.16 $315.16 $700.35 $700.35 $700.35 $145.97 $700.35 $700.35 $700.35 $700.35 $700.35 $145.96 $700.35 $700.35 $414.26 $700.35 $700.35 $700.35 $700.35 $525.38 $700.35 $700.35 $700.35 $350.18 $350.18 $554.68 $700.35 $560.28 $315.16 $139.00 N/A $406.29 $700.35 $420.21 $700.35 $145.95 $700.35 N/A N/A 121661 SUP HCPCS C1713 121661 - PIN FX 65MM CNN HIP BOTH IP/OP $700.50 $518.00 $139.00 $700.35 $315.16 $315.16 $315.16 $315.16 $700.35 $700.35 $700.35 $145.97 $700.35 $700.35 $700.35 $700.35 $700.35 $145.96 $700.35 $700.35 $414.26 $700.35 $700.35 $700.35 $700.35 $525.38 $700.35 $700.35 $700.35 $350.18 $350.18 $554.68 $700.35 $560.28 $315.16 $139.00 N/A $406.29 $700.35 $700.35 $700.35 $145.95 $700.35 N/A N/A 121662 SUP HCPCS C1713 121662 - PIN FX 6.35MM 70MM 16MM CNN HIP BOTH IP/OP $700.50 $518.00 $139.00 $700.35 $315.16 $315.16 $315.16 $315.16 $700.35 $700.35 $700.35 $145.97 $700.35 $700.35 $700.35 $700.35 $700.35 $145.96 $700.35 $700.35 $414.26 $700.35 $700.35 $700.35 $700.35 $525.38 $700.35 $700.35 $700.35 $350.18 $350.18 $554.68 $700.35 $560.28 $315.16 $139.00 N/A $406.29 $700.35 $420.21 $700.35 $700.35 $700.35 N/A N/A 121663 SUP HCPCS C1713 121663 - PIN FX 75MM CNN HIP BOTH IP/OP $700.50 $518.00 $139.00 $700.35 $315.16 $315.16 $315.16 $315.16 $700.35 $700.35 $700.35 $145.97 $700.35 $700.35 $700.35 $700.35 $700.35 $145.96 $700.35 $700.35 $414.26 $700.35 $700.35 $700.35 $700.35 $525.38 $700.35 $700.35 $700.35 $350.18 $350.18 $554.68 $700.35 $560.28 $315.16 $139.00 N/A $406.29 $700.35 $420.21 $700.35 $700.35 $700.35 N/A N/A 121664 SUP HCPCS C1713 121664 - PIN FX 6.35MM 80MM 16MM CNN HIP BOTH IP/OP $700.50 $518.00 $139.00 $700.35 $315.16 $315.16 $315.16 $315.16 $700.35 $700.35 $700.35 $145.97 $700.35 $700.35 $700.35 $700.35 $700.35 $145.96 $700.35 $700.35 $414.26 $700.35 $700.35 $700.35 $700.35 $525.38 $700.35 $700.35 $700.35 $350.18 $350.18 $554.68 $700.35 $560.28 $315.16 $139.00 N/A $406.29 $700.35 $700.35 $700.35 $145.95 $700.35 N/A N/A 121665 SUP HCPCS C1713 121665 - PIN FX 6.35MM 85MM 16MM CNN HIP BOTH IP/OP $700.50 $518.00 $139.00 $700.35 $315.16 $315.16 $315.16 $315.16 $700.35 $700.35 $700.35 $145.97 $700.35 $700.35 $700.35 $700.35 $700.35 $145.96 $700.35 $700.35 $414.26 $700.35 $700.35 $700.35 $700.35 $525.38 $700.35 $700.35 $700.35 $350.18 $350.18 $554.68 $700.35 $560.28 $315.16 $139.00 N/A $406.29 $700.35 $420.21 $700.35 $700.35 $700.35 N/A N/A 121666 SUP HCPCS C1713 121666 - PIN FX 6.35MM 90MM 16MM CNN HIP BOTH IP/OP $700.50 $518.00 $139.00 $700.35 $315.16 $315.16 $315.16 $315.16 $700.35 $700.35 $700.35 $145.97 $700.35 $700.35 $700.35 $700.35 $700.35 $145.96 $700.35 $700.35 $414.26 $700.35 $700.35 $700.35 $700.35 $525.38 $700.35 $700.35 $700.35 $350.18 $350.18 $554.68 $700.35 $560.28 $315.16 $139.00 N/A $406.29 $700.35 $420.21 $700.35 $700.35 $700.35 N/A N/A 121667 SUP HCPCS C1713 121667 - PIN FX 6.35MM 95MM 16MM CNN HIP BOTH IP/OP $700.50 $518.00 $139.00 $700.35 $315.16 $315.16 $315.16 $315.16 $700.35 $700.35 $700.35 $145.97 $700.35 $700.35 $700.35 $700.35 $700.35 $145.96 $700.35 $700.35 $414.26 $700.35 $700.35 $700.35 $700.35 $525.38 $700.35 $700.35 $700.35 $350.18 $350.18 $554.68 $700.35 $560.28 $315.16 $139.00 N/A $406.29 $700.35 $420.21 $700.35 $700.35 $700.35 N/A N/A 121668 SUP HCPCS C1713 121668 - PIN FX 6.35MM 100MM 16MM CNN HIP BOTH IP/OP $700.50 $518.00 $139.00 $700.35 $315.16 $315.16 $315.16 $315.16 $700.35 $700.35 $700.35 $145.97 $700.35 $700.35 $700.35 $700.35 $700.35 $145.96 $700.35 $700.35 $414.26 $700.35 $700.35 $700.35 $700.35 $525.38 $700.35 $700.35 $700.35 $350.18 $350.18 $554.68 $700.35 $560.28 $315.16 $139.00 N/A $406.29 $700.35 $420.21 $700.35 $145.95 $700.35 N/A N/A 121669 SUP HCPCS C1713 121669 - PIN FX 105MM CNN HIP BOTH IP/OP $700.50 $518.00 $139.00 $700.35 $315.16 $315.16 $315.16 $315.16 $700.35 $700.35 $700.35 $145.97 $700.35 $700.35 $700.35 $700.35 $700.35 $145.96 $700.35 $280.14 $414.26 $700.35 $700.35 $700.35 $700.35 $525.38 $700.35 $700.35 $700.35 $350.18 $350.18 $554.68 $700.35 $560.28 $315.16 $139.00 N/A $406.29 $700.35 $420.21 $700.35 $700.35 $700.35 N/A N/A 121670 SUP HCPCS C1713 121670 - PIN FX 6.35MM 110MM 16MM CNN HIP BOTH IP/OP $700.50 $518.00 $139.00 $700.35 $315.16 $315.16 $315.16 $315.16 $700.35 $700.35 $700.35 $145.97 $700.35 $700.35 $700.35 $700.35 $700.35 $145.96 $700.35 $700.35 $414.26 $700.35 $700.35 $700.35 $700.35 $525.38 $700.35 $700.35 $700.35 $350.18 $350.18 $554.68 $700.35 $560.28 $315.16 $139.00 N/A $406.29 $700.35 $420.21 $700.35 $700.35 $700.35 N/A N/A 121671 SUP HCPCS C1713 121671 - PIN FX 6.35MM 115MM 16MM CNN HIP BOTH IP/OP $700.50 $518.00 $139.00 $700.35 $315.16 $315.16 $315.16 $315.16 $700.35 $700.35 $700.35 $145.97 $700.35 $700.35 $700.35 $700.35 $700.35 $145.96 $700.35 $700.35 $414.26 $700.35 $700.35 $700.35 $700.35 $525.38 $700.35 $700.35 $700.35 $350.18 $350.18 $554.68 $700.35 $560.28 $315.16 $139.00 N/A $406.29 $700.35 $420.21 $700.35 $145.95 $700.35 N/A N/A 121672 SUP HCPCS C1713 121672 - PIN FX 6.86MM 115MM STRL 16MM CNN HEX HD SS HIP BOTH IP/OP $761.50 $564.00 $151.09 $761.25 $342.56 $342.56 $342.56 $342.56 $761.25 $761.25 $761.25 $158.66 $761.25 $761.25 $761.25 $761.25 $761.25 $158.65 $761.25 $761.25 $450.28 $761.25 $761.25 $761.25 $761.25 $571.13 $761.25 $761.25 $761.25 $380.63 $380.63 $602.91 $761.25 $609.00 $342.56 $151.09 N/A $441.67 $761.25 $456.75 $761.25 $158.64 $761.25 N/A N/A 121673 SUP HCPCS C1713 121673 - PIN FX 125MM CNN HIP BOTH IP/OP $761.50 $564.00 $151.09 $761.25 $342.56 $342.56 $342.56 $342.56 $761.25 $761.25 $761.25 $158.66 $761.25 $761.25 $761.25 $761.25 $761.25 $158.65 $761.25 $761.25 $450.28 $761.25 $761.25 $761.25 $761.25 $571.13 $761.25 $761.25 $761.25 $380.63 $380.63 $602.91 $761.25 $609.00 $342.56 $151.09 N/A $441.67 $761.25 $456.75 $761.25 $158.64 $761.25 N/A N/A 121674 SUP HCPCS C1713 121674 - PIN FX 130MM CNN HIP BOTH IP/OP $761.50 $564.00 $151.09 $761.25 $342.56 $342.56 $342.56 $342.56 $761.25 $761.25 $761.25 $158.66 $761.25 $761.25 $761.25 $761.25 $761.25 $158.65 $761.25 $304.50 $450.28 $761.25 $761.25 $761.25 $761.25 $571.13 $761.25 $761.25 $761.25 $380.63 $380.63 $602.91 $761.25 $609.00 $342.56 $151.09 N/A $441.67 $761.25 $456.75 $761.25 $158.64 $761.25 N/A N/A 121675 SUP HCPCS C1713 121675 - PIN FX 135MM CNN HIP BOTH IP/OP $761.50 $564.00 $151.09 $761.25 $342.56 $342.56 $342.56 $342.56 $761.25 $761.25 $761.25 $158.66 $761.25 $761.25 $761.25 $761.25 $761.25 $158.65 $761.25 $761.25 $450.28 $761.25 $761.25 $761.25 $761.25 $571.13 $761.25 $761.25 $761.25 $380.63 $380.63 $602.91 $761.25 $609.00 $342.56 $151.09 N/A $441.67 $761.25 $456.75 $761.25 $158.64 $761.25 N/A N/A 121680 SUP HCPCS C1713 121680 - WASHER ORTH UNV 12.7MM 6.5MM 1MM STRL SET SS 6.5MM CNN SCR BOTH IP/OP $158.00 $117.00 $31.36 $158.00 $71.10 $71.10 $71.10 $71.10 $158.00 $158.00 $158.00 $32.93 $158.00 $158.00 $158.00 $158.00 $158.00 $32.93 $158.00 $99.75 $93.46 $158.00 $99.75 $158.00 $158.00 $118.50 $158.00 $158.00 $158.00 $79.00 $79.00 $125.14 $158.00 $126.40 $71.10 $31.36 N/A $91.64 $158.00 $94.80 $158.00 $32.93 $158.00 N/A N/A 121810 SUP HCPCS C1713 121810 - SCREW BN 2.5MM FLUT 4MM 6MM 10MM STRL 5MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121812 SUP HCPCS C1713 121812 - SCREW BN 2.5MM FLUT 4MM 6MM 12MM STRL 5MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121814 SUP HCPCS C1713 121814 - SCREW BN 2.5MM FLUT 4MM 6MM 14MM STRL 5MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121816 SUP Custom 27203010 121816 - NEEDLE BIOP 22MM 18GA 16CM ULTRA SHARP TIP POLISHED SURFACE BOTH IP/OP $217.50 $161.00 $38.66 $217.20 $217.20 $217.20 $217.20 $217.20 $217.20 $217.20 $38.66 $217.20 $217.20 $161.21 $161.21 $167.42 $113.16 $45.27 $217.20 $86.88 $217.20 $217.20 $217.20 $217.20 $217.20 $163.13 $217.20 $217.20 $217.20 $108.60 $108.60 $172.02 $217.20 $173.76 $141.18 $217.20 N/A $126.15 $217.20 $130.32 $217.20 $217.20 $217.20 N/A N/A 121816 SUP HCPCS C1713 121816 - SCREW BN 2.5MM FLUT 4MM 6MM 16MM STRL 6MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $38.66 $299.25 $217.20 $217.20 $217.20 $217.20 $217.20 $217.20 $38.66 $217.20 $217.20 $161.21 $161.21 $167.42 $113.16 $45.27 $217.20 $86.88 $217.20 $217.20 $217.20 $217.20 $217.20 $299.25 $217.20 $217.20 $217.20 $108.60 $108.60 $172.02 $217.20 $173.76 $141.18 $217.20 N/A $231.42 $217.20 $130.32 $217.20 $217.20 $217.20 N/A N/A 121818 SUP HCPCS C1713 121818 - SCREW BN 2.5MM FLUT 4MM 6MM 18MM STRL 7MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121820 SUP HCPCS C1713 121820 - SCREW BN 2.5MM FLUT 4MM 6MM 20MM STRL 8MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121822 SUP HCPCS C1713 121822 - SCREW BN 2.5MM FLUT 4MM 6MM 22MM STRL 9MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 121824 SUP HCPCS C1713 121824 - SCREW BN 2.5MM FLUT 4MM 6MM 24MM STRL 10MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $399.00 $399.00 $83.15 $399.00 N/A N/A 121826 SUP HCPCS C1713 121826 - SCREW BN 2.5MM FLUT 4MM 6MM 26MM STRL 12MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121828 SUP HCPCS C1713 121828 - SCREW BN 2.5MM FLUT 4MM 6MM 28MM STRL 14MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 121830 SUP HCPCS C1713 121830 - SCREW BN 2.5MM FLUT 4MM 6MM 30MM STRL 14MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 121832 SUP HCPCS C1713 121832 - SCREW BN 2.5MM FLUT 4MM 6MM 32MM STRL 14MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121834 SUP HCPCS C1713 121834 - SCREW BN 2.5MM FLUT 4MM 6MM 34MM STRL 14MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121836 SUP HCPCS C1713 121836 - SCREW BN 2.5MM FLUT 4MM 6MM 36MM STRL 14MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121838 SUP HCPCS C1713 121838 - SCREW BN 2.5MM FLUT 4MM 6MM 38MM STRL 14MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121840 SUP HCPCS C1713 121840 - SCREW BN 2.5MM FLUT 4MM 6MM 40MM STRL 14MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $399.00 $399.00 $83.15 $399.00 N/A N/A 121842 SUP HCPCS C1713 121842 - SCREW BN 2.5MM FLUT 4MM 6MM 42MM STRL 14MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121844 SUP HCPCS C1713 121844 - SCREW BN P/T 4MM 6MM 1.3MM 44MM STRL 2.9MM CNN ST SLF DRL BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 121846 SUP HCPCS C1713 121846 - SCREW BN 2.5MM FLUT 4MM 6MM 46MM STRL 15MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 121848 SUP HCPCS C1713 121848 - SCREW BN 2.5MM FLUT P/T 4MM 6MM 48MM STRL 15MM PRLC ST CNN BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121850 SUP HCPCS C1713 121850 - SCREW BN 2.5MM FLUT 4MM 6MM 50MM STRL 15MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121852 SUP HCPCS C1713 121852 - SCREW BN 2.5MM FLUT 4MM 6MM 52MM STRL 15MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121854 SUP HCPCS C1713 121854 - SCREW BN 2.5MM FLUT 4MM 6MM 54MM STRL 15MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $36.16 $299.25 $203.16 $203.16 $203.16 $203.16 $203.16 $203.16 $36.16 $203.16 $203.16 $150.79 $150.79 $156.60 $105.85 $42.34 $203.16 $81.26 $203.16 $203.16 $203.16 $203.16 $203.16 $299.25 $203.16 $203.16 $203.16 $101.58 $101.58 $160.90 $203.16 $162.53 $132.05 $203.16 $203.16 $231.42 $203.16 $121.90 $203.16 $203.16 $203.16 N/A N/A 121856 SUP HCPCS C1713 121856 - SCREW BN 2.5MM FLUT 4MM 6MM 56MM STRL 15MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 121858 SUP HCPCS C1713 121858 - SCREW BN 2.5MM FLUT 4MM 6MM 58MM STRL 15MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121860 SUP HCPCS C1713 121860 - SCREW BN 2.5MM FLUT 4MM 6MM 60MM STRL 15MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121865 SUP HCPCS C1713 121865 - SCREW BN 2.5MM FLUT 4MM 6MM 65MM STRL 15MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121870 SUP HCPCS C1713 121870 - SCREW BN 2.5MM FLUT 4MM 6MM 70MM STRL 15MM PRLC ST CNN TROC BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 121905 SUP HCPCS C1713 121905 - NAIL IM 8MM 32CM RUS-TYLR DLT SS FEM BOTH IP/OP "$1,704.50" "$1,261.00" $338.28 "$1,704.38" $766.97 $766.97 $766.97 $766.97 "$1,704.38" "$1,704.38" "$1,704.38" $355.24 "$1,704.38" "$1,704.38" "$1,704.38" "$1,704.38" "$1,704.38" $355.21 "$1,704.38" "$1,704.38" "$1,008.14" "$1,704.38" "$1,704.38" "$1,704.38" "$1,704.38" "$1,278.38" "$1,704.38" "$1,704.38" "$1,704.38" $852.19 $852.19 "$1,349.87" "$1,704.38" "$1,363.50" $766.97 $338.28 N/A $988.61 "$1,704.38" "$1,704.38" "$1,704.38" $355.19 "$1,704.38" N/A N/A 121906 SUP HCPCS C1713 121906 - NAIL IM 8MM 34CM RUS-TYLR DLT II FEM BOTH IP/OP "$1,704.50" "$1,261.00" $338.28 "$1,704.38" $766.97 $766.97 $766.97 $766.97 "$1,704.38" "$1,704.38" "$1,704.38" $355.24 "$1,704.38" "$1,704.38" "$1,704.38" "$1,704.38" "$1,704.38" $355.21 "$1,704.38" "$1,704.38" "$1,008.14" "$1,704.38" "$1,704.38" "$1,704.38" "$1,704.38" "$1,278.38" "$1,704.38" "$1,704.38" "$1,704.38" $852.19 $852.19 "$1,349.87" "$1,704.38" "$1,363.50" $766.97 $338.28 N/A $988.61 "$1,704.38" "$1,022.63" "$1,704.38" $355.19 "$1,704.38" N/A N/A 121907 SUP HCPCS C1713 121907 - NAIL IM 8MM 36CM RUS-TYLR DLT II FEM BOTH IP/OP "$1,704.50" "$1,261.00" $338.28 "$1,704.38" $766.97 $766.97 $766.97 $766.97 "$1,704.38" "$1,704.38" "$1,704.38" $355.24 "$1,704.38" "$1,704.38" "$1,704.38" "$1,704.38" "$1,704.38" $355.21 "$1,704.38" "$1,704.38" "$1,008.14" "$1,704.38" "$1,704.38" "$1,704.38" "$1,704.38" "$1,278.38" "$1,704.38" "$1,704.38" "$1,704.38" $852.19 $852.19 "$1,349.87" "$1,704.38" "$1,363.50" $766.97 $338.28 N/A $988.61 "$1,704.38" "$1,022.63" "$1,704.38" $355.19 "$1,704.38" N/A N/A 122034 SUP HCPCS C1713 122034 - NAIL IM 11MM 44CM RUS-TYLR DLT SS FEM BOTH IP/OP "$1,564.00" "$1,157.00" $310.37 "$1,563.75" $703.69 $703.69 $703.69 $703.69 "$1,563.75" "$1,563.75" "$1,563.75" $325.92 "$1,563.75" "$1,563.75" "$1,563.75" "$1,563.75" "$1,563.75" $325.90 "$1,563.75" "$1,563.75" $924.96 "$1,563.75" "$1,563.75" "$1,563.75" "$1,563.75" "$1,173.00" "$1,563.75" "$1,563.75" "$1,563.75" $781.88 $781.88 "$1,238.49" "$1,563.75" "$1,251.00" $703.69 $310.37 N/A $907.12 "$1,563.75" $938.25 "$1,563.75" $325.89 "$1,563.75" N/A N/A 122153 SUP HCPCS C1713 122153 - NAIL IM 15MM 42CM RUS-TYLR INTLK SS FEM BOTH IP/OP "$2,711.50" "$2,007.00" $538.12 "$2,711.25" "$1,220.06" "$1,220.06" "$1,220.06" "$1,220.06" "$2,711.25" "$2,711.25" "$2,711.25" $565.09 "$2,711.25" "$2,711.25" "$2,711.25" "$2,711.25" "$2,711.25" $565.05 "$2,711.25" "$2,711.25" "$1,336.65" "$2,711.25" "$2,711.25" "$2,711.25" "$2,711.25" "$2,033.63" "$2,711.25" "$2,711.25" "$2,711.25" "$1,355.63" "$1,355.63" "$2,147.31" "$2,711.25" "$2,169.00" "$1,220.06" $538.12 N/A "$1,572.67" "$2,711.25" "$1,626.75" "$2,711.25" $565.02 "$2,711.25" N/A N/A 122159 SUP HCPCS C1713 122159 - NAIL IM 16MM 40CM RUS-TYLR INTLK SS FEM BOTH IP/OP "$2,711.50" "$2,007.00" $538.12 "$2,711.25" "$1,220.06" "$1,220.06" "$1,220.06" "$1,220.06" "$2,711.25" "$2,711.25" "$2,711.25" $565.09 "$2,711.25" "$2,711.25" "$2,711.25" "$2,711.25" "$2,711.25" $565.05 "$2,711.25" "$2,711.25" "$1,336.65" "$2,711.25" "$2,711.25" "$2,711.25" "$2,711.25" "$2,033.63" "$2,711.25" "$2,711.25" "$2,711.25" "$1,355.63" "$1,355.63" "$2,147.31" "$2,711.25" "$2,169.00" "$1,220.06" $538.12 N/A "$1,572.67" "$2,711.25" "$1,626.75" "$2,711.25" $565.02 "$2,711.25" N/A N/A 122202 SUP HCPCS C1713 122202 - NAIL IM 13MM 36CM RUS-TYLR INTLK SS TIB BOTH IP/OP "$3,150.00" "$2,331.00" $625.20 "$3,150.00" "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$3,150.00" "$3,150.00" "$3,150.00" $656.54 "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" $656.49 "$3,150.00" "$1,260.00" "$1,552.95" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$2,362.50" "$3,150.00" "$3,150.00" "$3,150.00" "$1,575.00" "$1,575.00" "$2,494.80" "$3,150.00" "$2,520.00" "$1,417.50" $625.20 N/A "$1,827.00" "$3,150.00" "$1,890.00" "$3,150.00" $656.46 "$3,150.00" N/A N/A 122341 SUP HCPCS C1713 122341 - NAIL IM 10MM 38CM RUS-TYLR DLT INTLK RECON SS FEM RT BOTH IP/OP "$8,376.00" "$6,198.00" "$1,662.35" "$8,375.63" "$3,769.03" "$3,769.03" "$3,769.03" "$3,769.03" "$8,375.63" "$8,375.63" "$8,375.63" "$1,745.69" "$8,375.63" "$8,375.63" "$8,375.63" "$8,375.63" "$8,375.63" "$1,745.57" "$8,375.63" "$3,350.25" "$4,129.19" "$8,375.63" "$8,375.63" "$8,375.63" "$8,375.63" "$6,282.00" "$8,375.63" "$8,375.63" "$8,375.63" "$4,187.82" "$4,187.82" "$6,633.50" "$8,375.63" "$6,700.50" "$3,769.03" "$1,662.35" N/A "$4,858.08" "$8,375.63" "$5,025.38" "$8,375.63" "$8,375.63" "$8,375.63" N/A N/A 122466 SUP HCPCS C1713 122466 - NAIL IM 8MM 30CM RUS-TYLR INTLK SS HUM BOTH IP/OP "$6,519.50" "$4,824.00" "$1,293.93" "$6,519.38" "$2,933.72" "$2,933.72" "$2,933.72" "$2,933.72" "$6,519.38" "$6,519.38" "$6,519.38" "$1,358.80" "$6,519.38" "$6,519.38" "$6,519.38" "$6,519.38" "$6,519.38" "$1,358.71" "$6,519.38" "$2,607.75" "$3,214.05" "$6,519.38" "$6,519.38" "$6,519.38" "$6,519.38" "$4,889.63" "$6,519.38" "$6,519.38" "$6,519.38" "$3,259.69" "$3,259.69" "$5,163.35" "$6,519.38" "$5,215.50" "$2,933.72" "$1,293.93" N/A "$3,781.31" "$6,519.38" "$6,519.38" "$6,519.38" "$6,519.38" "$6,519.38" N/A N/A 122670 SUP HCPCS C1713 122670 - CAP END RECON FEM BOTH IP/OP $70.50 $52.00 $13.91 $70.10 $31.55 $31.55 $31.55 $31.55 $70.10 $70.10 $70.10 $14.61 $70.10 $70.10 $70.10 $70.10 $70.10 $14.61 $70.10 $70.10 $41.46 $70.10 $70.10 $70.10 $70.10 $52.88 $70.10 $70.10 $70.10 $35.05 $35.05 $55.52 $70.10 $56.08 $31.55 $13.91 N/A $40.89 $70.10 $42.06 $70.10 $70.10 $70.10 N/A N/A 122671 SUP HCPCS C1713 122671 - CAP END RUS-TYLR RUS-TYLR RECON NL BOTH IP/OP $67.00 $50.00 $13.26 $66.83 $30.07 $30.07 $30.07 $30.07 $66.83 $66.83 $66.83 $13.93 $66.83 $66.83 $66.83 $66.83 $66.83 $13.93 $66.83 $66.83 $39.53 $66.83 $66.83 $66.83 $66.83 $50.25 $66.83 $66.83 $66.83 $33.42 $33.42 $52.93 $66.83 $53.46 $30.07 $13.26 N/A $38.86 $66.83 $40.10 $66.83 $66.83 $66.83 N/A N/A 122700 SUP HCPCS C1713 122700 - PIN HLF UNV 4MM 20MM 20MM HXFX RN HNG KT CMPS TI ORTH XTRNFX BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $312.12 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $468.18 $780.30 $780.30 $780.30 N/A N/A 122701 SUP HCPCS C1713 122701 - PIN HLF 4MM 25MM HXFX RN UNLAT TI ORTH XTRNFX SYS BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $780.30 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $468.18 $780.30 $162.61 $780.30 N/A N/A 122703 SUP HCPCS C1713 122703 - PIN HLF 4MM 35MM HXFX TI ORTH BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $312.12 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $468.18 $780.30 $162.61 $780.30 N/A N/A 122704 SUP HCPCS C1713 122704 - PIN HLF 4MM 40MM HXFX RN UNLAT TI ORTH XTRNFX SYS BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $312.12 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $468.18 $780.30 $162.61 $780.30 N/A N/A 122705 SUP HCPCS C1713 122705 - PIN HLF 4MM 45MM HXFX TI ORTH BOTH IP/OP $469.50 $347.00 $93.12 $469.20 $211.14 $211.14 $211.14 $211.14 $469.20 $469.20 $469.20 $97.79 $469.20 $469.20 $469.20 $469.20 $469.20 $97.79 $469.20 $187.68 $277.53 $469.20 $469.20 $469.20 $469.20 $352.13 $469.20 $469.20 $469.20 $234.60 $234.60 $371.61 $469.20 $375.36 $211.14 $93.12 N/A $272.31 $469.20 $469.20 $469.20 $97.78 $469.20 N/A N/A 122706 SUP HCPCS C1713 122706 - PIN HLF 4MM 50MM HXFX TI BOTH IP/OP $561.00 $415.00 $111.34 $561.00 $252.45 $252.45 $252.45 $252.45 $561.00 $561.00 $561.00 $116.93 $561.00 $561.00 $561.00 $561.00 $561.00 $116.92 $561.00 $224.40 $331.83 $561.00 $561.00 $561.00 $561.00 $420.75 $561.00 $561.00 $561.00 $280.50 $280.50 $444.31 $561.00 $448.80 $252.45 $111.34 N/A $325.38 $561.00 $561.00 $561.00 $116.91 $561.00 N/A N/A 122707 SUP HCPCS C1713 122707 - PIN HLF P/T 5MM 20MM HXFX SET TI ORTH XTRNFX SYS BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $312.12 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $468.18 $780.30 $162.61 $780.30 N/A N/A 122708 SUP HCPCS C1713 122708 - PIN HLF P/T 5MM 25MM 25MM HXFX TI ORTH XTRNFX SYS BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $312.12 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $468.18 $780.30 $162.61 $780.30 N/A N/A 122709 SUP HCPCS C1713 122709 - PIN HLF P/T 5MM 30MM HXFX TI BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $312.12 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $780.30 $780.30 $162.61 $780.30 N/A N/A 122710 SUP HCPCS C1713 122710 - PIN HLF P/T 5MM 35MM HXFX TI XTRNFX SYS BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $312.12 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $468.18 $780.30 $162.61 $780.30 N/A N/A 122711 SUP HCPCS C1713 122711 - PIN HLF P/T 5MM 40MM HXFX TI XTRNFX SYS BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $312.12 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $468.18 $780.30 $162.61 $780.30 N/A N/A 122712 SUP HCPCS C1713 122712 - PIN HLF 5MM 45MM HXFX RN TI ORTH XTRNFX SYS BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $312.12 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $780.30 $780.30 $162.61 $780.30 N/A N/A 122714 SUP HCPCS C1713 122714 - PIN HLF 5MM 55MM HXFX RN UNLAT TI ORTH XTRNFX SYS BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $312.12 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $468.18 $780.30 $162.61 $780.30 N/A N/A 122715 SUP HCPCS C1713 122715 - PIN HLF 5MM 60MM HXFX RN UNLAT TI ORTH XTRNFX SYS BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $312.12 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $468.18 $780.30 $162.61 $780.30 N/A N/A 122716 SUP HCPCS C1713 122716 - PIN HLF 5MM 65MM HXFX RN UNLAT TI ORTH XTRNFX SYS BOTH IP/OP $534.00 $395.00 $105.95 $533.80 $240.21 $240.21 $240.21 $240.21 $533.80 $533.80 $533.80 $111.26 $533.80 $533.80 $533.80 $533.80 $533.80 $111.25 $533.80 $213.52 $315.74 $533.80 $533.80 $533.80 $533.80 $400.50 $533.80 $533.80 $533.80 $266.90 $266.90 $422.77 $533.80 $427.04 $240.21 $105.95 N/A $309.72 $533.80 $320.28 $533.80 $111.24 $533.80 N/A N/A 122717 SUP HCPCS C1713 122717 - PIN HLF 5MM 70MM HXFX TI ORTH BOTH IP/OP $394.50 $292.00 $78.28 $394.40 $177.48 $177.48 $177.48 $177.48 $394.40 $394.40 $394.40 $82.20 $394.40 $394.40 $394.40 $394.40 $394.40 $82.20 $394.40 $157.76 $233.29 $394.40 $394.40 $394.40 $394.40 $295.88 $394.40 $394.40 $394.40 $197.20 $197.20 $312.36 $394.40 $315.52 $177.48 $78.28 N/A $228.81 $394.40 $394.40 $394.40 $394.40 $394.40 N/A N/A 122718 SUP HCPCS C1713 122718 - PIN HLF 5MM 75MM HXFX TI ORTH BOTH IP/OP $561.00 $415.00 $111.34 $561.00 $252.45 $252.45 $252.45 $252.45 $561.00 $561.00 $561.00 $116.93 $561.00 $561.00 $561.00 $561.00 $561.00 $116.92 $561.00 $224.40 $331.83 $561.00 $561.00 $561.00 $561.00 $420.75 $561.00 $561.00 $561.00 $280.50 $280.50 $444.31 $561.00 $448.80 $252.45 $111.34 N/A $325.38 $561.00 $561.00 $561.00 $116.91 $561.00 N/A N/A 122719 SUP HCPCS C1713 122719 - PIN HLF 5MM 80MM HXFX TI BOTH IP/OP $561.00 $415.00 $111.34 $561.00 $252.45 $252.45 $252.45 $252.45 $561.00 $561.00 $561.00 $116.93 $561.00 $561.00 $561.00 $561.00 $561.00 $116.92 $561.00 $224.40 $331.83 $561.00 $561.00 $561.00 $561.00 $420.75 $561.00 $561.00 $561.00 $280.50 $280.50 $444.31 $561.00 $448.80 $252.45 $111.34 N/A $325.38 $561.00 $336.60 $561.00 $116.91 $561.00 N/A N/A 122720 SUP HCPCS C1713 122720 - PIN HLF 5MM 85MM HXFX TI ORTH BOTH IP/OP $473.00 $350.00 $93.80 $472.60 $212.67 $212.67 $212.67 $212.67 $472.60 $472.60 $472.60 $98.50 $472.60 $472.60 $472.60 $472.60 $472.60 $98.50 $472.60 $472.60 $279.54 $472.60 $472.60 $472.60 $472.60 $354.75 $472.60 $472.60 $472.60 $236.30 $236.30 $374.30 $472.60 $378.08 $212.67 $93.80 N/A $274.34 $472.60 $472.60 $472.60 $98.49 $472.60 N/A N/A 122721 SUP HCPCS C1713 122721 - PIN HLF 5MM 90MM HXFX TI ORTH BOTH IP/OP $561.00 $415.00 $111.34 $561.00 $252.45 $252.45 $252.45 $252.45 $561.00 $561.00 $561.00 $116.93 $561.00 $561.00 $561.00 $561.00 $561.00 $116.92 $561.00 $224.40 $331.83 $561.00 $561.00 $561.00 $561.00 $420.75 $561.00 $561.00 $561.00 $280.50 $280.50 $444.31 $561.00 $448.80 $252.45 $111.34 N/A $325.38 $561.00 $561.00 $561.00 $561.00 $561.00 N/A N/A 122725 SUP HCPCS C1713 122725 - PIN HLF 6MM 40MM 40MM HXFX RN UNLAT THRD TI ORTH XTRNFX SYS BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $312.12 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $468.18 $780.30 $162.61 $780.30 N/A N/A 122727 SUP HCPCS C1713 122727 - PIN HLF 6MM 50MM HXFX RN UNLAT TI ORTH XTRNFX SYS BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $312.12 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $468.18 $780.30 $780.30 $780.30 N/A N/A 122729 SUP HCPCS C1713 122729 - PIN HLF 6MM 60MM HXFX RN UNLAT TI ORTH XTRNFX SYS BOTH IP/OP $780.50 $578.00 $154.87 $780.30 $351.14 $351.14 $351.14 $351.14 $780.30 $780.30 $780.30 $162.63 $780.30 $780.30 $780.30 $780.30 $780.30 $162.62 $780.30 $312.12 $461.55 $780.30 $780.30 $780.30 $780.30 $585.38 $780.30 $780.30 $780.30 $390.15 $390.15 $618.00 $780.30 $624.24 $351.14 $154.87 N/A $452.69 $780.30 $468.18 $780.30 $780.30 $780.30 N/A N/A 122733 SUP HCPCS C1713 122733 - PIN HLF 6MM 80MM HXFX TI BOTH IP/OP $473.00 $350.00 $93.80 $472.60 $212.67 $212.67 $212.67 $212.67 $472.60 $472.60 $472.60 $98.50 $472.60 $472.60 $472.60 $472.60 $472.60 $98.50 $472.60 $189.04 $279.54 $472.60 $472.60 $472.60 $472.60 $354.75 $472.60 $472.60 $472.60 $236.30 $236.30 $374.30 $472.60 $378.08 $212.67 $93.80 N/A $274.34 $472.60 $283.56 $472.60 $98.49 $472.60 N/A N/A 122735 SUP HCPCS C1713 122735 - PIN FX HLF 6MM 90MM BOTH IP/OP $561.00 $415.00 $111.34 $561.00 $252.45 $252.45 $252.45 $252.45 $561.00 $561.00 $561.00 $116.93 $561.00 $561.00 $561.00 $561.00 $561.00 $116.92 $561.00 $224.40 $331.83 $561.00 $561.00 $561.00 $561.00 $420.75 $561.00 $561.00 $561.00 $280.50 $280.50 $444.31 $561.00 $448.80 $252.45 $111.34 N/A $325.38 $561.00 $336.60 $561.00 $116.91 $561.00 N/A N/A 122741 SUP HCPCS C1713 122741 - PIN HLF 4MM 25MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $500.00 $370.00 $99.20 $499.80 $224.91 $224.91 $224.91 $224.91 $499.80 $499.80 $499.80 $104.17 $499.80 $499.80 $499.80 $499.80 $499.80 $104.16 $499.80 $199.92 $295.63 $499.80 $499.80 $499.80 $499.80 $375.00 $499.80 $499.80 $499.80 $249.90 $249.90 $395.84 $499.80 $399.84 $224.91 $99.20 N/A $290.00 $499.80 $299.88 $499.80 $499.80 $499.80 N/A N/A 122742 SUP HCPCS C1713 122742 - PIN HLF 4MM 30MM HXFX SS ORTH BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $112.88 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $169.32 $282.20 $282.20 $282.20 N/A N/A 122743 SUP HCPCS C1713 122743 - PIN HLF 4MM 35MM HXFX SS ORTH BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $282.20 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $169.32 $282.20 $282.20 $282.20 N/A N/A 122744 SUP HCPCS C1713 122744 - PIN HLF 4MM 40MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $500.00 $370.00 $99.20 $499.80 $224.91 $224.91 $224.91 $224.91 $499.80 $499.80 $499.80 $104.17 $499.80 $499.80 $499.80 $499.80 $499.80 $104.16 $499.80 $199.92 $295.63 $499.80 $499.80 $499.80 $499.80 $375.00 $499.80 $499.80 $499.80 $249.90 $249.90 $395.84 $499.80 $399.84 $224.91 $99.20 N/A $290.00 $499.80 $299.88 $499.80 $104.16 $499.80 N/A N/A 122745 SUP HCPCS C1713 122745 - PIN HLF 4MM 45MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $500.00 $370.00 $99.20 $499.80 $224.91 $224.91 $224.91 $224.91 $499.80 $499.80 $499.80 $104.17 $499.80 $499.80 $499.80 $499.80 $499.80 $104.16 $499.80 $499.80 $295.63 $499.80 $499.80 $499.80 $499.80 $375.00 $499.80 $499.80 $499.80 $249.90 $249.90 $395.84 $499.80 $399.84 $224.91 $99.20 N/A $290.00 $499.80 $499.80 $499.80 $499.80 $499.80 N/A N/A 122746 SUP HCPCS C1713 122746 - PIN HLF 4MM 50MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $500.00 $370.00 $99.20 $499.80 $224.91 $224.91 $224.91 $224.91 $499.80 $499.80 $499.80 $104.17 $499.80 $499.80 $499.80 $499.80 $499.80 $104.16 $499.80 $199.92 $295.63 $499.80 $499.80 $499.80 $499.80 $375.00 $499.80 $499.80 $499.80 $249.90 $249.90 $395.84 $499.80 $399.84 $224.91 $99.20 N/A $290.00 $499.80 $299.88 $499.80 $499.80 $499.80 N/A N/A 122747 SUP HCPCS C1713 122747 - PIN HLF 5MM 20MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $568.00 $420.00 $112.69 $567.80 $255.51 $255.51 $255.51 $255.51 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $567.80 $567.80 $567.80 $118.34 $567.80 $227.12 $335.85 $567.80 $567.80 $567.80 $567.80 $426.00 $567.80 $567.80 $567.80 $283.90 $283.90 $449.70 $567.80 $454.24 $255.51 $112.69 N/A $329.44 $567.80 $340.68 $567.80 $118.33 $567.80 N/A N/A 122748 SUP HCPCS C1713 122748 - PIN HLF 5MM 25MM 25MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $568.00 $420.00 $112.69 $567.80 $255.51 $255.51 $255.51 $255.51 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $335.85 $567.80 $567.80 $567.80 $567.80 $426.00 $567.80 $567.80 $567.80 $283.90 $283.90 $449.70 $567.80 $454.24 $255.51 $112.69 N/A $329.44 $567.80 $340.68 $567.80 $118.33 $567.80 N/A N/A 122749 SUP HCPCS C1713 122749 - PIN HLF 5MM 30MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $568.00 $420.00 $112.69 $567.80 $255.51 $255.51 $255.51 $255.51 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $567.80 $567.80 $567.80 $118.34 $567.80 $227.12 $335.85 $567.80 $567.80 $567.80 $567.80 $426.00 $567.80 $567.80 $567.80 $283.90 $283.90 $449.70 $567.80 $454.24 $255.51 $112.69 N/A $329.44 $567.80 $567.80 $567.80 $118.33 $567.80 N/A N/A 122750 SUP HCPCS C1713 122750 - PIN HLF 5MM 35MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $568.00 $420.00 $112.69 $567.80 $255.51 $255.51 $255.51 $255.51 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $335.85 $567.80 $567.80 $567.80 $567.80 $426.00 $567.80 $567.80 $567.80 $283.90 $283.90 $449.70 $567.80 $454.24 $255.51 $112.69 N/A $329.44 $567.80 $340.68 $567.80 $118.33 $567.80 N/A N/A 122751 SUP HCPCS C1713 122751 - PIN HLF 5MM 40MM 40MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $568.00 $420.00 $112.69 $567.80 $255.51 $255.51 $255.51 $255.51 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $567.80 $567.80 $567.80 $118.34 $567.80 $227.12 $335.85 $567.80 $567.80 $567.80 $567.80 $426.00 $567.80 $567.80 $567.80 $283.90 $283.90 $449.70 $567.80 $454.24 $255.51 $112.69 N/A $329.44 $567.80 $340.68 $567.80 $118.33 $567.80 N/A N/A 122752 SUP HCPCS C1713 122752 - PIN HLF 5MM 45MM 45MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $568.00 $420.00 $112.69 $567.80 $255.51 $255.51 $255.51 $255.51 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $567.80 $567.80 $567.80 $118.34 $567.80 $227.12 $335.85 $567.80 $567.80 $567.80 $567.80 $426.00 $567.80 $567.80 $567.80 $283.90 $283.90 $449.70 $567.80 $454.24 $255.51 $112.69 N/A $329.44 $567.80 $340.68 $567.80 $118.33 $567.80 N/A N/A 122753 SUP HCPCS C1713 122753 - PIN HLF 5MM 50MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $568.00 $420.00 $112.69 $567.80 $255.51 $255.51 $255.51 $255.51 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $335.85 $567.80 $567.80 $567.80 $567.80 $426.00 $567.80 $567.80 $567.80 $283.90 $283.90 $449.70 $567.80 $454.24 $255.51 $112.69 N/A $329.44 $567.80 $340.68 $567.80 $118.33 $567.80 N/A N/A 122754 SUP HCPCS C1713 122754 - PIN HLF 5MM 55MM HXFX SS ORTH BOTH IP/OP $340.00 $252.00 $67.48 $340.00 $153.00 $153.00 $153.00 $153.00 $340.00 $340.00 $340.00 $70.86 $340.00 $340.00 $340.00 $340.00 $340.00 $70.86 $340.00 $136.00 $201.11 $340.00 $340.00 $340.00 $340.00 $255.00 $340.00 $340.00 $340.00 $170.00 $170.00 $269.28 $340.00 $272.00 $153.00 $67.48 N/A $197.20 $340.00 $204.00 $340.00 $340.00 $340.00 N/A N/A 122755 SUP HCPCS C1713 122755 - PIN HLF 5MM 60MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $209.50 $155.00 $41.50 $209.10 $94.10 $94.10 $94.10 $94.10 $209.10 $209.10 $209.10 $43.58 $209.10 $209.10 $209.10 $209.10 $209.10 $43.58 $209.10 $209.10 $123.68 $209.10 $209.10 $209.10 $209.10 $157.13 $209.10 $209.10 $209.10 $104.55 $104.55 $165.61 $209.10 $167.28 $94.10 $41.50 N/A $121.51 $209.10 $125.46 $209.10 $209.10 $209.10 N/A N/A 122756 SUP HCPCS C1713 122756 - PIN HLF 5MM 65MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $500.00 $370.00 $99.20 $499.80 $224.91 $224.91 $224.91 $224.91 $499.80 $499.80 $499.80 $104.17 $499.80 $499.80 $499.80 $499.80 $499.80 $104.16 $499.80 $499.80 $295.63 $499.80 $499.80 $499.80 $499.80 $375.00 $499.80 $499.80 $499.80 $249.90 $249.90 $395.84 $499.80 $399.84 $224.91 $99.20 N/A $290.00 $499.80 $299.88 $499.80 $104.16 $499.80 N/A N/A 122757 SUP HCPCS C1713 122757 - PIN HLF 5MM 70MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $209.50 $155.00 $41.50 $209.10 $94.10 $94.10 $94.10 $94.10 $209.10 $209.10 $209.10 $43.58 $209.10 $209.10 $209.10 $209.10 $209.10 $43.58 $209.10 $83.64 $123.68 $209.10 $209.10 $209.10 $209.10 $157.13 $209.10 $209.10 $209.10 $104.55 $104.55 $165.61 $209.10 $167.28 $94.10 $41.50 N/A $121.51 $209.10 $125.46 $209.10 $209.10 $209.10 N/A N/A 122758 SUP HCPCS C1713 122758 - PIN HLF 5MM 75MM HXFX SS ORTH BOTH IP/OP $340.00 $252.00 $67.48 $340.00 $153.00 $153.00 $153.00 $153.00 $340.00 $340.00 $340.00 $70.86 $340.00 $340.00 $340.00 $340.00 $340.00 $70.86 $340.00 $340.00 $201.11 $340.00 $340.00 $340.00 $340.00 $255.00 $340.00 $340.00 $340.00 $170.00 $170.00 $269.28 $340.00 $272.00 $153.00 $67.48 N/A $197.20 $340.00 $204.00 $340.00 $70.86 $340.00 N/A N/A 122759 SUP HCPCS C1713 122759 - PIN HLF 5MM 80MM HXFX SS ORTH BOTH IP/OP $340.00 $252.00 $67.48 $340.00 $153.00 $153.00 $153.00 $153.00 $340.00 $340.00 $340.00 $70.86 $340.00 $340.00 $340.00 $340.00 $340.00 $70.86 $340.00 $136.00 $201.11 $340.00 $340.00 $340.00 $340.00 $255.00 $340.00 $340.00 $340.00 $170.00 $170.00 $269.28 $340.00 $272.00 $153.00 $67.48 N/A $197.20 $340.00 $204.00 $340.00 $70.86 $340.00 N/A N/A 122760 SUP HCPCS C1713 122760 - PIN HLF 5MM 85MM HXFX SS ORTH BOTH IP/OP $340.00 $252.00 $67.48 $340.00 $153.00 $153.00 $153.00 $153.00 $340.00 $340.00 $340.00 $70.86 $340.00 $340.00 $340.00 $340.00 $340.00 $70.86 $340.00 $340.00 $201.11 $340.00 $340.00 $340.00 $340.00 $255.00 $340.00 $340.00 $340.00 $170.00 $170.00 $269.28 $340.00 $272.00 $153.00 $67.48 N/A $197.20 $340.00 $204.00 $340.00 $70.86 $340.00 N/A N/A 122761 SUP HCPCS C1713 122761 - PIN HLF 5MM 90MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $209.50 $155.00 $41.50 $209.10 $94.10 $94.10 $94.10 $94.10 $209.10 $209.10 $209.10 $43.58 $209.10 $209.10 $209.10 $209.10 $209.10 $43.58 $209.10 $83.64 $123.68 $209.10 $209.10 $209.10 $209.10 $157.13 $209.10 $209.10 $209.10 $104.55 $104.55 $165.61 $209.10 $167.28 $94.10 $41.50 N/A $121.51 $209.10 $125.46 $209.10 $43.58 $209.10 N/A N/A 122765 SUP HCPCS C1713 122765 - PIN HLF 6MM 40MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $568.00 $420.00 $112.69 $567.80 $255.51 $255.51 $255.51 $255.51 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $335.85 $567.80 $567.80 $567.80 $567.80 $426.00 $567.80 $567.80 $567.80 $283.90 $283.90 $449.70 $567.80 $454.24 $255.51 $112.69 N/A $329.44 $567.80 $340.68 $567.80 $567.80 $567.80 N/A N/A 122767 SUP HCPCS C1713 122767 - PIN HLF 6MM 50MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $568.00 $420.00 $112.69 $567.80 $255.51 $255.51 $255.51 $255.51 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $567.80 $567.80 $567.80 $118.34 $567.80 $227.12 $335.85 $567.80 $567.80 $567.80 $567.80 $426.00 $567.80 $567.80 $567.80 $283.90 $283.90 $449.70 $567.80 $454.24 $255.51 $112.69 N/A $329.44 $567.80 $340.68 $567.80 $118.33 $567.80 N/A N/A 122769 SUP HCPCS C1713 122769 - PIN HLF 6MM 60MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $568.00 $420.00 $112.69 $567.80 $255.51 $255.51 $255.51 $255.51 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $567.80 $567.80 $567.80 $118.34 $567.80 $567.80 $335.85 $567.80 $567.80 $567.80 $567.80 $426.00 $567.80 $567.80 $567.80 $283.90 $283.90 $449.70 $567.80 $454.24 $255.51 $112.69 N/A $329.44 $567.80 $340.68 $567.80 $118.33 $567.80 N/A N/A 122771 SUP HCPCS C1713 122771 - PIN HLF 6MM 70MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $500.00 $370.00 $99.20 $499.80 $224.91 $224.91 $224.91 $224.91 $499.80 $499.80 $499.80 $104.17 $499.80 $499.80 $499.80 $499.80 $499.80 $104.16 $499.80 $199.92 $295.63 $499.80 $499.80 $499.80 $499.80 $375.00 $499.80 $499.80 $499.80 $249.90 $249.90 $395.84 $499.80 $399.84 $224.91 $99.20 N/A $290.00 $499.80 $299.88 $499.80 $499.80 $499.80 N/A N/A 122773 SUP HCPCS C1713 122773 - PIN HLF 6MM 80MM HXFX SS ORTH BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $282.20 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $169.32 $282.20 $58.81 $282.20 N/A N/A 122775 SUP HCPCS C1713 122775 - PIN HLF 6MM 90MM HXFX UNLAT SS ORTH XTRNFX SYS BOTH IP/OP $500.00 $370.00 $99.20 $499.80 $224.91 $224.91 $224.91 $224.91 $499.80 $499.80 $499.80 $104.17 $499.80 $499.80 $499.80 $499.80 $499.80 $104.16 $499.80 $499.80 $295.63 $499.80 $499.80 $499.80 $499.80 $375.00 $499.80 $499.80 $499.80 $249.90 $249.90 $395.84 $499.80 $399.84 $224.91 $99.20 N/A $290.00 $499.80 $299.88 $499.80 $104.16 $499.80 N/A N/A 124120 SUP HCPCS C1713 124120 - PLATE BN 130D STD BRL 60MM 38.1MM CLS CHS 2 HL SS HIP BOTH IP/OP "$1,108.00" $820.00 $219.86 "$1,107.75" $498.49 $498.49 $498.49 $498.49 "$1,107.75" "$1,107.75" "$1,107.75" $230.88 "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" $230.87 "$1,107.75" $443.10 $655.23 "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" $831.00 "$1,107.75" "$1,107.75" "$1,107.75" $553.88 $553.88 $877.34 "$1,107.75" $886.20 $498.49 $219.86 N/A $642.64 "$1,107.75" $664.65 "$1,107.75" $230.86 "$1,107.75" N/A N/A 124121 SUP HCPCS C1713 124121 - PLATE BN 135D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP BOTH IP/OP "$1,108.00" $820.00 $219.86 "$1,107.75" $498.49 $498.49 $498.49 $498.49 "$1,107.75" "$1,107.75" "$1,107.75" $230.88 "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" $230.87 "$1,107.75" $443.10 $655.23 "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" $831.00 "$1,107.75" "$1,107.75" "$1,107.75" $553.88 $553.88 $877.34 "$1,107.75" $886.20 $498.49 $219.86 N/A $642.64 "$1,107.75" $664.65 "$1,107.75" "$1,107.75" "$1,107.75" N/A N/A 124122 SUP HCPCS C1713 124122 - PLATE BN 140D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP BOTH IP/OP "$1,108.00" $820.00 $219.86 "$1,107.75" $498.49 $498.49 $498.49 $498.49 "$1,107.75" "$1,107.75" "$1,107.75" $230.88 "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" $230.87 "$1,107.75" "$1,107.75" $655.23 "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" $831.00 "$1,107.75" "$1,107.75" "$1,107.75" $553.88 $553.88 $877.34 "$1,107.75" $886.20 $498.49 $219.86 N/A $642.64 "$1,107.75" $664.65 "$1,107.75" "$1,107.75" "$1,107.75" N/A N/A 124123 SUP HCPCS C1713 124123 - PLATE BN 145D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP BOTH IP/OP "$1,108.00" $820.00 $219.86 "$1,107.75" $498.49 $498.49 $498.49 $498.49 "$1,107.75" "$1,107.75" "$1,107.75" $230.88 "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" $230.87 "$1,107.75" "$1,107.75" $655.23 "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" $831.00 "$1,107.75" "$1,107.75" "$1,107.75" $553.88 $553.88 $877.34 "$1,107.75" $886.20 $498.49 $219.86 N/A $642.64 "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" N/A N/A 124124 SUP HCPCS C1713 124124 - PLATE BN 150D STD BRL 60MM 38.1MM CLS CHS 2 HL CMPR HIP BOTH IP/OP "$1,108.00" $820.00 $219.86 "$1,107.75" $498.49 $498.49 $498.49 $498.49 "$1,107.75" "$1,107.75" "$1,107.75" $230.88 "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" $230.87 "$1,107.75" "$1,107.75" $655.23 "$1,107.75" "$1,107.75" "$1,107.75" "$1,107.75" $831.00 "$1,107.75" "$1,107.75" "$1,107.75" $553.88 $553.88 $877.34 "$1,107.75" $886.20 $498.49 $219.86 N/A $642.64 "$1,107.75" $664.65 "$1,107.75" $230.86 "$1,107.75" N/A N/A 124125 SUP HCPCS C1713 124125 - PLATE BN 130D STD BRL 80MM 38.1MM CLS CHS 3 HL CMPR HIP BOTH IP/OP "$1,144.50" $847.00 $227.15 "$1,144.50" $515.03 $515.03 $515.03 $515.03 "$1,144.50" "$1,144.50" "$1,144.50" $238.54 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $238.53 "$1,144.50" $457.80 $676.97 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $858.38 "$1,144.50" "$1,144.50" "$1,144.50" $572.25 $572.25 $906.44 "$1,144.50" $915.60 $515.03 $227.15 N/A $663.81 "$1,144.50" $686.70 "$1,144.50" $238.51 "$1,144.50" N/A N/A 124126 SUP HCPCS C1713 124126 - PLATE BN 135D STD BRL 80MM 38.1MM CLS CHS 3 HL CMPR SS HIP BOTH IP/OP "$1,144.50" $847.00 $227.15 "$1,144.50" $515.03 $515.03 $515.03 $515.03 "$1,144.50" "$1,144.50" "$1,144.50" $238.54 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $238.53 "$1,144.50" $457.80 $676.97 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $858.38 "$1,144.50" "$1,144.50" "$1,144.50" $572.25 $572.25 $906.44 "$1,144.50" $915.60 $515.03 $227.15 N/A $663.81 "$1,144.50" $686.70 "$1,144.50" $238.51 "$1,144.50" N/A N/A 124127 SUP HCPCS C1713 124127 - PLATE BN 140D STD BRL 80MM 38.1MM CLS CHS 3 HL CMPR SS HIP BOTH IP/OP "$1,144.50" $847.00 $227.15 "$1,144.50" $515.03 $515.03 $515.03 $515.03 "$1,144.50" "$1,144.50" "$1,144.50" $238.54 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $238.53 "$1,144.50" "$1,144.50" $676.97 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $858.38 "$1,144.50" "$1,144.50" "$1,144.50" $572.25 $572.25 $906.44 "$1,144.50" $915.60 $515.03 $227.15 N/A $663.81 "$1,144.50" $686.70 "$1,144.50" $238.51 "$1,144.50" N/A N/A 124128 SUP HCPCS C1713 124128 - PLATE BN 145D STD BRL 80MM 38.1MM CLS CHS 3 HL SS HIP BOTH IP/OP "$1,144.50" $847.00 $227.15 "$1,144.50" $515.03 $515.03 $515.03 $515.03 "$1,144.50" "$1,144.50" "$1,144.50" $238.54 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $238.53 "$1,144.50" "$1,144.50" $676.97 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $858.38 "$1,144.50" "$1,144.50" "$1,144.50" $572.25 $572.25 $906.44 "$1,144.50" $915.60 $515.03 $227.15 N/A $663.81 "$1,144.50" $686.70 "$1,144.50" "$1,144.50" "$1,144.50" N/A N/A 124129 SUP HCPCS C1713 124129 - PLATE BN 150D STD BRL 80MM 38.1MM CLS CHS 3 HL SS HIP BOTH IP/OP "$1,144.50" $847.00 $227.15 "$1,144.50" $515.03 $515.03 $515.03 $515.03 "$1,144.50" "$1,144.50" "$1,144.50" $238.54 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $238.53 "$1,144.50" $457.80 $676.97 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $858.38 "$1,144.50" "$1,144.50" "$1,144.50" $572.25 $572.25 $906.44 "$1,144.50" $915.60 $515.03 $227.15 N/A $663.81 "$1,144.50" $686.70 "$1,144.50" "$1,144.50" "$1,144.50" N/A N/A 124130 SUP HCPCS C1713 124130 - PLATE BN 130D STD BRL 100MM 38.1MM CLS CHS 4 HL CMPR HIP BOTH IP/OP "$1,144.50" $847.00 $227.15 "$1,144.50" $515.03 $515.03 $515.03 $515.03 "$1,144.50" "$1,144.50" "$1,144.50" $238.54 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $238.53 "$1,144.50" $457.80 $676.97 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $858.38 "$1,144.50" "$1,144.50" "$1,144.50" $572.25 $572.25 $906.44 "$1,144.50" $915.60 $515.03 $227.15 N/A $663.81 "$1,144.50" $686.70 "$1,144.50" $238.51 "$1,144.50" N/A N/A 124131 SUP HCPCS C1713 124131 - PLATE BN 135D STD BRL 100MM 1.5MM CLS 4 HL HIP BOTH IP/OP "$1,144.50" $847.00 $227.15 "$1,144.50" $515.03 $515.03 $515.03 $515.03 "$1,144.50" "$1,144.50" "$1,144.50" $238.54 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $238.53 "$1,144.50" $457.80 $676.97 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $858.38 "$1,144.50" "$1,144.50" "$1,144.50" $572.25 $572.25 $906.44 "$1,144.50" $915.60 $515.03 $227.15 N/A $663.81 "$1,144.50" "$1,144.50" "$1,144.50" $238.51 "$1,144.50" N/A N/A 124132 SUP HCPCS C1713 124132 - PLATE BN 140D STD BRL 100MM 38.1MM CLS CHS 4 HL CMPR HIP BOTH IP/OP "$1,144.50" $847.00 $227.15 "$1,144.50" $515.03 $515.03 $515.03 $515.03 "$1,144.50" "$1,144.50" "$1,144.50" $238.54 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $238.53 "$1,144.50" $457.80 $676.97 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $858.38 "$1,144.50" "$1,144.50" "$1,144.50" $572.25 $572.25 $906.44 "$1,144.50" $915.60 $515.03 $227.15 N/A $663.81 "$1,144.50" $686.70 "$1,144.50" $238.51 "$1,144.50" N/A N/A 124133 SUP HCPCS C1713 124133 - PLATE BN 145D STD BRL 100MM 38.1MM CLS CHS 4 HL CMPR HIP BOTH IP/OP "$1,144.50" $847.00 $227.15 "$1,144.50" $515.03 $515.03 $515.03 $515.03 "$1,144.50" "$1,144.50" "$1,144.50" $238.54 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $238.53 "$1,144.50" $457.80 $676.97 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $858.38 "$1,144.50" "$1,144.50" "$1,144.50" $572.25 $572.25 $906.44 "$1,144.50" $915.60 $515.03 $227.15 N/A $663.81 "$1,144.50" $686.70 "$1,144.50" "$1,144.50" "$1,144.50" N/A N/A 124134 SUP HCPCS C1713 124134 - PLATE BN 150D STD BRL 100MM 38.1MM CLS CHS 4 HL SS HIP BOTH IP/OP "$1,144.50" $847.00 $227.15 "$1,144.50" $515.03 $515.03 $515.03 $515.03 "$1,144.50" "$1,144.50" "$1,144.50" $238.54 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $238.53 "$1,144.50" $457.80 $676.97 "$1,144.50" "$1,144.50" "$1,144.50" "$1,144.50" $858.38 "$1,144.50" "$1,144.50" "$1,144.50" $572.25 $572.25 $906.44 "$1,144.50" $915.60 $515.03 $227.15 N/A $663.81 "$1,144.50" $686.70 "$1,144.50" "$1,144.50" "$1,144.50" N/A N/A 124135 SUP HCPCS C1713 124135 - PLATE BN 130D STD BRL 120MM 38.1MM CLS CHS 5 HL CMPR SS HIP BOTH IP/OP "$1,223.50" $905.00 $242.78 "$1,223.25" $550.46 $550.46 $550.46 $550.46 "$1,223.25" "$1,223.25" "$1,223.25" $254.96 "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" $254.94 "$1,223.25" $489.30 $723.55 "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" $917.63 "$1,223.25" "$1,223.25" "$1,223.25" $611.63 $611.63 $968.81 "$1,223.25" $978.60 $550.46 $242.78 N/A $709.63 "$1,223.25" $733.95 "$1,223.25" "$1,223.25" "$1,223.25" N/A N/A 124136 SUP HCPCS C1713 124136 - PLATE BN 135D STD BRL 120MM 1.5MM CLS 5 HL HIP BOTH IP/OP "$1,223.50" $905.00 $242.78 "$1,223.25" $550.46 $550.46 $550.46 $550.46 "$1,223.25" "$1,223.25" "$1,223.25" $254.96 "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" $254.94 "$1,223.25" $489.30 $723.55 "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" $917.63 "$1,223.25" "$1,223.25" "$1,223.25" $611.63 $611.63 $968.81 "$1,223.25" $978.60 $550.46 $242.78 N/A $709.63 "$1,223.25" $733.95 "$1,223.25" $254.93 "$1,223.25" N/A N/A 124137 SUP HCPCS C1713 124137 - PLATE BN 140D STD BRL 120MM 38.1MM CHS 5 HL CMPR SS HIP BOTH IP/OP "$1,223.50" $905.00 $242.78 "$1,223.25" $550.46 $550.46 $550.46 $550.46 "$1,223.25" "$1,223.25" "$1,223.25" $254.96 "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" $254.94 "$1,223.25" "$1,223.25" $723.55 "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" $917.63 "$1,223.25" "$1,223.25" "$1,223.25" $611.63 $611.63 $968.81 "$1,223.25" $978.60 $550.46 $242.78 N/A $709.63 "$1,223.25" $733.95 "$1,223.25" $254.93 "$1,223.25" N/A N/A 124138 SUP HCPCS C1713 124138 - PLATE BN 145D STD BRL 120MM 38.1MM CLS CHS 5 HL SS HIP BOTH IP/OP "$1,223.50" $905.00 $242.78 "$1,223.25" $550.46 $550.46 $550.46 $550.46 "$1,223.25" "$1,223.25" "$1,223.25" $254.96 "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" $254.94 "$1,223.25" "$1,223.25" $723.55 "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" $917.63 "$1,223.25" "$1,223.25" "$1,223.25" $611.63 $611.63 $968.81 "$1,223.25" $978.60 $550.46 $242.78 N/A $709.63 "$1,223.25" $733.95 "$1,223.25" $254.93 "$1,223.25" N/A N/A 124139 SUP HCPCS C1713 124139 - PLATE BN 150D STD BRL 120MM 38.1MM CLS CHS 5 HL SS HIP BOTH IP/OP "$1,223.50" $905.00 $242.78 "$1,223.25" $550.46 $550.46 $550.46 $550.46 "$1,223.25" "$1,223.25" "$1,223.25" $254.96 "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" $254.94 "$1,223.25" $489.30 $723.55 "$1,223.25" "$1,223.25" "$1,223.25" "$1,223.25" $917.63 "$1,223.25" "$1,223.25" "$1,223.25" $611.63 $611.63 $968.81 "$1,223.25" $978.60 $550.46 $242.78 N/A $709.63 "$1,223.25" $733.95 "$1,223.25" $254.93 "$1,223.25" N/A N/A 124140 SUP HCPCS C1713 124140 - PLATE BN 130D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 124141 SUP HCPCS C1713 124141 - PLATE BN 135D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 124142 SUP HCPCS C1713 124142 - PLATE BN 140D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" "$1,260.00" $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 124143 SUP HCPCS C1713 124143 - PLATE BN 145D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" "$1,260.00" $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 124144 SUP HCPCS C1713 124144 - PLATE BN 150D STD BRL 140MM 38.1MM CLS CHS 6 HL SS HIP BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" "$1,260.00" $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 124145 SUP HCPCS C1713 124145 - PLATE BN 130D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP BOTH IP/OP "$1,554.00" "$1,150.00" $308.43 "$1,554.00" $699.30 $699.30 $699.30 $699.30 "$1,554.00" "$1,554.00" "$1,554.00" $323.89 "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" $323.87 "$1,554.00" "$1,554.00" $919.19 "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" "$1,165.50" "$1,554.00" "$1,554.00" "$1,554.00" $777.00 $777.00 "$1,230.77" "$1,554.00" "$1,243.20" $699.30 $308.43 N/A $901.32 "$1,554.00" $932.40 "$1,554.00" $323.85 "$1,554.00" N/A N/A 124146 SUP HCPCS C1713 124146 - PLATE BN 135D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP BOTH IP/OP "$1,554.00" "$1,150.00" $308.43 "$1,554.00" $699.30 $699.30 $699.30 $699.30 "$1,554.00" "$1,554.00" "$1,554.00" $323.89 "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" $323.87 "$1,554.00" $621.60 $919.19 "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" "$1,165.50" "$1,554.00" "$1,554.00" "$1,554.00" $777.00 $777.00 "$1,230.77" "$1,554.00" "$1,243.20" $699.30 $308.43 N/A $901.32 "$1,554.00" $932.40 "$1,554.00" "$1,554.00" "$1,554.00" N/A N/A 124147 SUP HCPCS C1713 124147 - PLATE BN 140D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP BOTH IP/OP "$1,554.00" "$1,150.00" $308.43 "$1,554.00" $699.30 $699.30 $699.30 $699.30 "$1,554.00" "$1,554.00" "$1,554.00" $323.89 "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" $323.87 "$1,554.00" $621.60 $919.19 "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" "$1,165.50" "$1,554.00" "$1,554.00" "$1,554.00" $777.00 $777.00 "$1,230.77" "$1,554.00" "$1,243.20" $699.30 $308.43 N/A $901.32 "$1,554.00" $932.40 "$1,554.00" "$1,554.00" "$1,554.00" N/A N/A 124148 SUP HCPCS C1713 124148 - PLATE BN 145D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP BOTH IP/OP "$1,554.00" "$1,150.00" $308.43 "$1,554.00" $699.30 $699.30 $699.30 $699.30 "$1,554.00" "$1,554.00" "$1,554.00" $323.89 "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" $323.87 "$1,554.00" $621.60 $919.19 "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" "$1,165.50" "$1,554.00" "$1,554.00" "$1,554.00" $777.00 $777.00 "$1,230.77" "$1,554.00" "$1,243.20" $699.30 $308.43 N/A $901.32 "$1,554.00" $932.40 "$1,554.00" $323.85 "$1,554.00" N/A N/A 124149 SUP HCPCS C1713 124149 - PLATE BN 150D STD BRL 180MM 38.1MM CLS CHS 8 HL CMPR HIP BOTH IP/OP "$1,554.00" "$1,150.00" $308.43 "$1,554.00" $699.30 $699.30 $699.30 $699.30 "$1,554.00" "$1,554.00" "$1,554.00" $323.89 "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" $323.87 "$1,554.00" "$1,554.00" $919.19 "$1,554.00" "$1,554.00" "$1,554.00" "$1,554.00" "$1,165.50" "$1,554.00" "$1,554.00" "$1,554.00" $777.00 $777.00 "$1,230.77" "$1,554.00" "$1,243.20" $699.30 $308.43 N/A $901.32 "$1,554.00" $932.40 "$1,554.00" $323.85 "$1,554.00" N/A N/A 124150 SUP HCPCS C1713 124150 - PLATE BN 130D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP BOTH IP/OP "$1,811.50" "$1,341.00" $359.49 "$1,811.25" $815.06 $815.06 $815.06 $815.06 "$1,811.25" "$1,811.25" "$1,811.25" $377.51 "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" $377.48 "$1,811.25" "$1,811.25" "$1,071.35" "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" "$1,358.63" "$1,811.25" "$1,811.25" "$1,811.25" $905.63 $905.63 "$1,434.51" "$1,811.25" "$1,449.00" $815.06 $359.49 N/A "$1,050.67" "$1,811.25" "$1,086.75" "$1,811.25" $377.46 "$1,811.25" N/A N/A 124151 SUP HCPCS C1713 124151 - PLATE BN 135D STD BRL 220MM 38.1MM CHS 10 HL SS HIP BOTH IP/OP "$1,811.50" "$1,341.00" $359.49 "$1,811.25" $815.06 $815.06 $815.06 $815.06 "$1,811.25" "$1,811.25" "$1,811.25" $377.51 "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" $377.48 "$1,811.25" "$1,811.25" "$1,071.35" "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" "$1,358.63" "$1,811.25" "$1,811.25" "$1,811.25" $905.63 $905.63 "$1,434.51" "$1,811.25" "$1,449.00" $815.06 $359.49 N/A "$1,050.67" "$1,811.25" "$1,086.75" "$1,811.25" $377.46 "$1,811.25" N/A N/A 124152 SUP HCPCS C1713 124152 - PLATE BN 140D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP BOTH IP/OP "$1,811.50" "$1,341.00" $359.49 "$1,811.25" $815.06 $815.06 $815.06 $815.06 "$1,811.25" "$1,811.25" "$1,811.25" $377.51 "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" $377.48 "$1,811.25" "$1,811.25" "$1,071.35" "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" "$1,358.63" "$1,811.25" "$1,811.25" "$1,811.25" $905.63 $905.63 "$1,434.51" "$1,811.25" "$1,449.00" $815.06 $359.49 N/A "$1,050.67" "$1,811.25" "$1,086.75" "$1,811.25" $377.46 "$1,811.25" N/A N/A 124153 SUP HCPCS C1713 124153 - PLATE BN 145D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP BOTH IP/OP "$1,811.50" "$1,341.00" $359.49 "$1,811.25" $815.06 $815.06 $815.06 $815.06 "$1,811.25" "$1,811.25" "$1,811.25" $377.51 "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" $377.48 "$1,811.25" "$1,811.25" "$1,071.35" "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" "$1,358.63" "$1,811.25" "$1,811.25" "$1,811.25" $905.63 $905.63 "$1,434.51" "$1,811.25" "$1,449.00" $815.06 $359.49 N/A "$1,050.67" "$1,811.25" "$1,086.75" "$1,811.25" $377.46 "$1,811.25" N/A N/A 124154 SUP HCPCS C1713 124154 - PLATE BN 150D STD BRL 220MM 38.1MM CLS CHS 10 HL CMPR HIP BOTH IP/OP "$1,811.50" "$1,341.00" $359.49 "$1,811.25" $815.06 $815.06 $815.06 $815.06 "$1,811.25" "$1,811.25" "$1,811.25" $377.51 "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" $377.48 "$1,811.25" "$1,811.25" "$1,071.35" "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" "$1,358.63" "$1,811.25" "$1,811.25" "$1,811.25" $905.63 $905.63 "$1,434.51" "$1,811.25" "$1,449.00" $815.06 $359.49 N/A "$1,050.67" "$1,811.25" "$1,086.75" "$1,811.25" "$1,811.25" "$1,811.25" N/A N/A 124156 SUP HCPCS C1713 124156 - PLATE BN 135D STD BRL 260MM 38.1MM CLS CHS 12 HL CMPR HIP BOTH IP/OP "$1,937.50" "$1,434.00" $384.50 "$1,937.25" $871.76 $871.76 $871.76 $871.76 "$1,937.25" "$1,937.25" "$1,937.25" $403.77 "$1,937.25" "$1,937.25" "$1,937.25" "$1,937.25" "$1,937.25" $403.74 "$1,937.25" $774.90 "$1,145.88" "$1,937.25" "$1,937.25" "$1,937.25" "$1,937.25" "$1,453.13" "$1,937.25" "$1,937.25" "$1,937.25" $968.63 $968.63 "$1,534.30" "$1,937.25" "$1,549.80" $871.76 $384.50 N/A "$1,123.75" "$1,937.25" "$1,162.35" "$1,937.25" $403.72 "$1,937.25" N/A N/A 124158 SUP HCPCS C1713 124158 - PLATE BN 145D STD BRL 260MM 38.1MM CLS CHS 12 HL SS HIP BOTH IP/OP "$1,937.50" "$1,434.00" $384.50 "$1,937.25" $871.76 $871.76 $871.76 $871.76 "$1,937.25" "$1,937.25" "$1,937.25" $403.77 "$1,937.25" "$1,937.25" "$1,937.25" "$1,937.25" "$1,937.25" $403.74 "$1,937.25" $774.90 "$1,145.88" "$1,937.25" "$1,937.25" "$1,937.25" "$1,937.25" "$1,453.13" "$1,937.25" "$1,937.25" "$1,937.25" $968.63 $968.63 "$1,534.30" "$1,937.25" "$1,549.80" $871.76 $384.50 N/A "$1,123.75" "$1,937.25" "$1,162.35" "$1,937.25" $403.72 "$1,937.25" N/A N/A 124161 SUP HCPCS C1713 124161 - PLATE BN 135D STD BRL 300MM 38.1MM CLS CHS 14 HL CMPR HIP BOTH IP/OP "$2,294.50" "$1,698.00" $455.35 "$2,294.25" "$1,032.41" "$1,032.41" "$1,032.41" "$1,032.41" "$2,294.25" "$2,294.25" "$2,294.25" $478.18 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $478.15 "$2,294.25" $917.70 "$1,357.05" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$1,720.88" "$2,294.25" "$2,294.25" "$2,294.25" "$1,147.13" "$1,147.13" "$1,817.05" "$2,294.25" "$1,835.40" "$1,032.41" $455.35 N/A "$1,330.81" "$2,294.25" "$1,376.55" "$2,294.25" $478.12 "$2,294.25" N/A N/A 124162 SUP HCPCS C1713 124162 - PLATE BN 140D STD BRL 300MM 38.1MM CLS CHS 14 HL SS HIP BOTH IP/OP "$2,160.00" "$1,598.00" $428.71 "$2,160.00" $972.00 $972.00 $972.00 $972.00 "$2,160.00" "$2,160.00" "$2,160.00" $450.20 "$2,160.00" "$2,160.00" "$2,160.00" "$2,160.00" "$2,160.00" $450.17 "$2,160.00" $864.00 "$1,277.64" "$2,160.00" "$2,160.00" "$2,160.00" "$2,160.00" "$1,620.00" "$2,160.00" "$2,160.00" "$2,160.00" "$1,080.00" "$1,080.00" "$1,710.72" "$2,160.00" "$1,728.00" $972.00 $428.71 N/A "$1,252.80" "$2,160.00" "$1,296.00" "$2,160.00" $450.14 "$2,160.00" N/A N/A 124163 SUP HCPCS C1713 124163 - PLATE BN 145D STD BRL 300MM 38.1MM CLS CHS 14 HL SS HIP BOTH IP/OP "$2,294.50" "$1,698.00" $455.35 "$2,294.25" "$1,032.41" "$1,032.41" "$1,032.41" "$1,032.41" "$2,294.25" "$2,294.25" "$2,294.25" $478.18 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $478.15 "$2,294.25" $917.70 "$1,357.05" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$1,720.88" "$2,294.25" "$2,294.25" "$2,294.25" "$1,147.13" "$1,147.13" "$1,817.05" "$2,294.25" "$1,835.40" "$1,032.41" $455.35 N/A "$1,330.81" "$2,294.25" "$1,376.55" "$2,294.25" $478.12 "$2,294.25" N/A N/A 124164 SUP HCPCS C1713 124164 - PLATE BN 150D STD BRL 300MM 38.1MM CLS CHS 14 HL SS HIP BOTH IP/OP "$1,386.00" "$1,026.00" $275.09 "$1,386.00" $623.70 $623.70 $623.70 $623.70 "$1,386.00" "$1,386.00" "$1,386.00" $288.88 "$1,386.00" "$1,386.00" "$1,386.00" "$1,386.00" "$1,386.00" $288.86 "$1,386.00" $554.40 $819.82 "$1,386.00" "$1,386.00" "$1,386.00" "$1,386.00" "$1,039.50" "$1,386.00" "$1,386.00" "$1,386.00" $693.00 $693.00 "$1,097.71" "$1,386.00" "$1,108.80" $623.70 $275.09 N/A $803.88 "$1,386.00" $831.60 "$1,386.00" $288.84 "$1,386.00" N/A N/A 124165 SUP HCPCS C1713 124165 - PLATE BN 130D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP BOTH IP/OP "$1,249.50" $925.00 $247.99 "$1,249.50" $562.28 $562.28 $562.28 $562.28 "$1,249.50" "$1,249.50" "$1,249.50" $260.43 "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" $260.41 "$1,249.50" $499.80 $739.08 "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" $937.13 "$1,249.50" "$1,249.50" "$1,249.50" $624.75 $624.75 $989.60 "$1,249.50" $999.60 $562.28 $247.99 N/A $724.71 "$1,249.50" $749.70 "$1,249.50" $260.40 "$1,249.50" N/A N/A 124166 SUP HCPCS C1713 124166 - PLATE BN 135D SHRT BRL 120MM 25.9MM CLS CHS 5 HL CMPR SS HIP BOTH IP/OP "$1,249.50" $925.00 $247.99 "$1,249.50" $562.28 $562.28 $562.28 $562.28 "$1,249.50" "$1,249.50" "$1,249.50" $260.43 "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" $260.41 "$1,249.50" $499.80 $739.08 "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" $937.13 "$1,249.50" "$1,249.50" "$1,249.50" $624.75 $624.75 $989.60 "$1,249.50" $999.60 $562.28 $247.99 N/A $724.71 "$1,249.50" $749.70 "$1,249.50" $260.40 "$1,249.50" N/A N/A 124167 SUP HCPCS C1713 124167 - PLATE BN 140D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP BOTH IP/OP "$1,249.50" $925.00 $247.99 "$1,249.50" $562.28 $562.28 $562.28 $562.28 "$1,249.50" "$1,249.50" "$1,249.50" $260.43 "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" $260.41 "$1,249.50" $499.80 $739.08 "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" $937.13 "$1,249.50" "$1,249.50" "$1,249.50" $624.75 $624.75 $989.60 "$1,249.50" $999.60 $562.28 $247.99 N/A $724.71 "$1,249.50" $749.70 "$1,249.50" $260.40 "$1,249.50" N/A N/A 124168 SUP HCPCS C1713 124168 - PLATE BN 145D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP BOTH IP/OP "$1,249.50" $925.00 $247.99 "$1,249.50" $562.28 $562.28 $562.28 $562.28 "$1,249.50" "$1,249.50" "$1,249.50" $260.43 "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" $260.41 "$1,249.50" $499.80 $739.08 "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" $937.13 "$1,249.50" "$1,249.50" "$1,249.50" $624.75 $624.75 $989.60 "$1,249.50" $999.60 $562.28 $247.99 N/A $724.71 "$1,249.50" $749.70 "$1,249.50" $260.40 "$1,249.50" N/A N/A 124169 SUP HCPCS C1713 124169 - PLATE BN 150D SHRT BRL 120MM 25.4MM CLS CHS 5 HL CMPR SS HIP BOTH IP/OP "$1,249.50" $925.00 $247.99 "$1,249.50" $562.28 $562.28 $562.28 $562.28 "$1,249.50" "$1,249.50" "$1,249.50" $260.43 "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" $260.41 "$1,249.50" $499.80 $739.08 "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" $937.13 "$1,249.50" "$1,249.50" "$1,249.50" $624.75 $624.75 $989.60 "$1,249.50" $999.60 $562.28 $247.99 N/A $724.71 "$1,249.50" $749.70 "$1,249.50" $260.40 "$1,249.50" N/A N/A 124176 SUP HCPCS C1713 124176 - PLATE BN 130D SHRT BRL 100MM 25.4MM CLS CHS 4 HL CMPR HIP SP BOTH IP/OP "$1,197.00" $886.00 $237.57 "$1,197.00" $538.65 $538.65 $538.65 $538.65 "$1,197.00" "$1,197.00" "$1,197.00" $249.48 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $249.47 "$1,197.00" "$1,197.00" $708.03 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $897.75 "$1,197.00" "$1,197.00" "$1,197.00" $598.50 $598.50 $948.02 "$1,197.00" $957.60 $538.65 $237.57 N/A $694.26 "$1,197.00" $718.20 "$1,197.00" "$1,197.00" "$1,197.00" N/A N/A 124177 SUP HCPCS C1713 124177 - PLATE BN 135D SHRT BRL 100MM 1MM CLS 4 HL HIP BOTH IP/OP "$1,197.00" $886.00 $237.57 "$1,197.00" $538.65 $538.65 $538.65 $538.65 "$1,197.00" "$1,197.00" "$1,197.00" $249.48 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $249.47 "$1,197.00" "$1,197.00" $708.03 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $897.75 "$1,197.00" "$1,197.00" "$1,197.00" $598.50 $598.50 $948.02 "$1,197.00" $957.60 $538.65 $237.57 N/A $694.26 "$1,197.00" $718.20 "$1,197.00" "$1,197.00" "$1,197.00" N/A N/A 124178 SUP HCPCS C1713 124178 - PLATE BN 140D SHRT BRL 100MM CLS 4 SLOT CMPR BOTH IP/OP "$1,197.00" $886.00 $237.57 "$1,197.00" $538.65 $538.65 $538.65 $538.65 "$1,197.00" "$1,197.00" "$1,197.00" $249.48 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $249.47 "$1,197.00" $478.80 $708.03 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $897.75 "$1,197.00" "$1,197.00" "$1,197.00" $598.50 $598.50 $948.02 "$1,197.00" $957.60 $538.65 $237.57 N/A $694.26 "$1,197.00" "$1,197.00" "$1,197.00" $249.45 "$1,197.00" N/A N/A 124179 SUP HCPCS C1713 124179 - PLATE BN 145D SHRT BRL 100MM 25.4MM CLS CHS 4 HL CMPR HIP SP BOTH IP/OP "$1,197.00" $886.00 $237.57 "$1,197.00" $538.65 $538.65 $538.65 $538.65 "$1,197.00" "$1,197.00" "$1,197.00" $249.48 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $249.47 "$1,197.00" "$1,197.00" $708.03 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $897.75 "$1,197.00" "$1,197.00" "$1,197.00" $598.50 $598.50 $948.02 "$1,197.00" $957.60 $538.65 $237.57 N/A $694.26 "$1,197.00" $718.20 "$1,197.00" $249.45 "$1,197.00" N/A N/A 124180 SUP HCPCS C1713 124180 - PLATE BN 150D SHRT BRL 100MM 25.4MM CLS CHS 4 HL CMPR HIP SP BOTH IP/OP "$1,197.00" $886.00 $237.57 "$1,197.00" $538.65 $538.65 $538.65 $538.65 "$1,197.00" "$1,197.00" "$1,197.00" $249.48 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $249.47 "$1,197.00" $478.80 $708.03 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $897.75 "$1,197.00" "$1,197.00" "$1,197.00" $598.50 $598.50 $948.02 "$1,197.00" $957.60 $538.65 $237.57 N/A $694.26 "$1,197.00" $718.20 "$1,197.00" $249.45 "$1,197.00" N/A N/A 124810 SUP HCPCS C1713 124810 - PIN TRC 4MM 250MM 50MM FULL COVE PNT ORTH BOTH IP/OP $894.50 $662.00 $177.54 $894.50 $402.53 $402.53 $402.53 $402.53 $894.50 $894.50 $894.50 $186.44 $894.50 $894.50 $894.50 $894.50 $894.50 $186.42 $894.50 $346.80 $529.10 $894.50 $867.00 $894.50 $894.50 $670.88 $894.50 $894.50 $894.50 $447.25 $447.25 $708.44 $894.50 $715.60 $402.53 $177.54 N/A $518.81 $894.50 $536.70 $894.50 $186.41 $894.50 N/A N/A 124811 SUP HCPCS C1713 124811 - PIN TRC 4MM 150MM 60MM FULL COVE PNT ORTH BOTH IP/OP $894.50 $662.00 $177.54 $894.50 $402.53 $402.53 $402.53 $402.53 $894.50 $894.50 $894.50 $186.44 $894.50 $894.50 $894.50 $894.50 $894.50 $186.42 $894.50 $867.00 $529.10 $894.50 $867.00 $894.50 $894.50 $670.88 $894.50 $894.50 $894.50 $447.25 $447.25 $708.44 $894.50 $715.60 $402.53 $177.54 N/A $518.81 $894.50 $894.50 $894.50 $186.41 $894.50 N/A N/A 124820 SUP HCPCS C1713 124820 - PIN TRC 4MM 250MM 40MM FULL COVE PNT ORTH BOTH IP/OP $894.50 $662.00 $177.54 $894.50 $402.53 $402.53 $402.53 $402.53 $894.50 $894.50 $894.50 $186.44 $894.50 $894.50 $894.50 $894.50 $894.50 $186.42 $894.50 $867.00 $529.10 $894.50 $867.00 $894.50 $894.50 $670.88 $894.50 $894.50 $894.50 $447.25 $447.25 $708.44 $894.50 $715.60 $402.53 $177.54 N/A $518.81 $894.50 $536.70 $894.50 $186.41 $894.50 N/A N/A 124823 SUP HCPCS C1713 124823 - PIN TRC 4MM 300MM 40MM FULL COVE PNT ORTH BOTH IP/OP $894.50 $662.00 $177.54 $894.50 $402.53 $402.53 $402.53 $402.53 $894.50 $894.50 $894.50 $186.44 $894.50 $894.50 $894.50 $894.50 $894.50 $186.42 $894.50 $346.80 $529.10 $894.50 $867.00 $894.50 $894.50 $670.88 $894.50 $894.50 $894.50 $447.25 $447.25 $708.44 $894.50 $715.60 $402.53 $177.54 N/A $518.81 $894.50 $536.70 $894.50 $186.41 $894.50 N/A N/A 124824 SUP HCPCS C1713 124824 - PIN TRC 4MM 300MM 50MM FULL COVE PNT ORTH BOTH IP/OP $894.50 $662.00 $177.54 $894.50 $402.53 $402.53 $402.53 $402.53 $894.50 $894.50 $894.50 $186.44 $894.50 $894.50 $894.50 $894.50 $894.50 $186.42 $894.50 $867.00 $529.10 $894.50 $867.00 $894.50 $894.50 $670.88 $894.50 $894.50 $894.50 $447.25 $447.25 $708.44 $894.50 $715.60 $402.53 $177.54 N/A $518.81 $894.50 $536.70 $894.50 $186.41 $894.50 N/A N/A 124825 SUP HCPCS C1713 124825 - PIN TRC 4MM 250MM 40MM FULL COVE PNT ORTH BOTH IP/OP $894.50 $662.00 $177.54 $894.50 $402.53 $402.53 $402.53 $402.53 $894.50 $894.50 $894.50 $186.44 $894.50 $894.50 $894.50 $894.50 $894.50 $186.42 $894.50 $346.80 $529.10 $894.50 $867.00 $894.50 $894.50 $670.88 $894.50 $894.50 $894.50 $447.25 $447.25 $708.44 $894.50 $715.60 $402.53 $177.54 N/A $518.81 $894.50 $536.70 $894.50 $186.41 $894.50 N/A N/A 124826 SUP HCPCS C1713 124826 - PIN TRC 5MM 250MM 50MM FULL COVE PNT ORTH BOTH IP/OP $894.50 $662.00 $177.54 $894.50 $402.53 $402.53 $402.53 $402.53 $894.50 $894.50 $894.50 $186.44 $894.50 $894.50 $894.50 $894.50 $894.50 $186.42 $894.50 $867.00 $529.10 $894.50 $867.00 $894.50 $894.50 $670.88 $894.50 $894.50 $894.50 $447.25 $447.25 $708.44 $894.50 $715.60 $402.53 $177.54 N/A $518.81 $894.50 $536.70 $894.50 $186.41 $894.50 N/A N/A 124827 SUP HCPCS C1713 124827 - PIN TRC 5MM 250MM 60MM FULL COVE PNT ORTH BOTH IP/OP $894.50 $662.00 $177.54 $894.50 $402.53 $402.53 $402.53 $402.53 $894.50 $894.50 $894.50 $186.44 $894.50 $894.50 $894.50 $894.50 $894.50 $186.42 $894.50 $346.80 $529.10 $894.50 $867.00 $894.50 $894.50 $670.88 $894.50 $894.50 $894.50 $447.25 $447.25 $708.44 $894.50 $715.60 $402.53 $177.54 N/A $518.81 $894.50 $536.70 $894.50 $186.41 $894.50 N/A N/A 124828 SUP HCPCS C1713 124828 - PIN TRC 3MM 60MM 16MM HLF COVE PNT ORTH BOTH IP/OP $558.00 $413.00 $110.75 $558.00 $251.10 $251.10 $251.10 $251.10 $558.00 $558.00 $558.00 $116.30 $558.00 $558.00 $558.00 $558.00 $558.00 $116.29 $558.00 $540.60 $330.06 $558.00 $540.60 $558.00 $558.00 $418.50 $558.00 $558.00 $558.00 $279.00 $279.00 $441.94 $558.00 $446.40 $251.10 $110.75 N/A $323.64 $558.00 $334.80 $558.00 $558.00 $558.00 N/A N/A 124829 SUP HCPCS C1713 124829 - PIN TRC 3MM 60MM 22MM HLF COVE PNT BOTH IP/OP $558.00 $413.00 $110.75 $558.00 $251.10 $251.10 $251.10 $251.10 $558.00 $558.00 $558.00 $116.30 $558.00 $558.00 $558.00 $558.00 $558.00 $116.29 $558.00 $540.60 $330.06 $558.00 $540.60 $558.00 $558.00 $418.50 $558.00 $558.00 $558.00 $279.00 $279.00 $441.94 $558.00 $446.40 $251.10 $110.75 N/A $323.64 $558.00 $334.80 $558.00 $116.29 $558.00 N/A N/A 124830 SUP HCPCS C1713 124830 - PIN TRC 3MM 75MM 28MM HLF COVE PNT ORTH BOTH IP/OP $558.00 $413.00 $110.75 $558.00 $251.10 $251.10 $251.10 $251.10 $558.00 $558.00 $558.00 $116.30 $558.00 $558.00 $558.00 $558.00 $558.00 $116.29 $558.00 $540.60 $330.06 $558.00 $540.60 $558.00 $558.00 $418.50 $558.00 $558.00 $558.00 $279.00 $279.00 $441.94 $558.00 $446.40 $251.10 $110.75 N/A $323.64 $558.00 $334.80 $558.00 $116.29 $558.00 N/A N/A 124831 SUP HCPCS C1713 124831 - PIN TRC 4MM 150MM 50MM HLF COVE PNT ORTH BOTH IP/OP $770.00 $570.00 $152.83 $770.00 $346.50 $346.50 $346.50 $346.50 $770.00 $770.00 $770.00 $160.49 $770.00 $770.00 $770.00 $770.00 $770.00 $160.48 $770.00 $298.52 $455.46 $770.00 $746.30 $770.00 $770.00 $577.50 $770.00 $770.00 $770.00 $385.00 $385.00 $609.84 $770.00 $616.00 $346.50 $152.83 N/A $446.60 $770.00 $462.00 $770.00 $770.00 $770.00 N/A N/A 124833 SUP HCPCS C1713 124833 - PIN TRC 5MM 150MM 50MM HLF COVE PNT ORTH BOTH IP/OP $770.00 $570.00 $152.83 $770.00 $346.50 $346.50 $346.50 $346.50 $770.00 $770.00 $770.00 $160.49 $770.00 $770.00 $770.00 $770.00 $770.00 $160.48 $770.00 $746.30 $455.46 $770.00 $746.30 $770.00 $770.00 $577.50 $770.00 $770.00 $770.00 $385.00 $385.00 $609.84 $770.00 $616.00 $346.50 $152.83 N/A $446.60 $770.00 $770.00 $770.00 $770.00 $770.00 N/A N/A 124834 SUP HCPCS C1713 124834 - PIN TRC 5MM 200MM 35MM HLF COVE PNT ORTH BOTH IP/OP $614.00 $454.00 $121.86 $614.00 $276.30 $276.30 $276.30 $276.30 $614.00 $614.00 $614.00 $127.97 $614.00 $614.00 $614.00 $614.00 $614.00 $127.96 $614.00 $238.00 $363.18 $614.00 $595.00 $614.00 $614.00 $460.50 $614.00 $614.00 $614.00 $307.00 $307.00 $486.29 $614.00 $491.20 $276.30 $121.86 N/A $356.12 $614.00 $368.40 $614.00 $127.96 $614.00 N/A N/A 124835 SUP HCPCS C1713 124835 - PIN TRC 3MM 250MM 50MM HLF COVE PNT ORTH BOTH IP/OP $894.50 $662.00 $177.54 $894.50 $402.53 $402.53 $402.53 $402.53 $894.50 $894.50 $894.50 $186.44 $894.50 $894.50 $894.50 $894.50 $894.50 $186.42 $894.50 $867.00 $529.10 $894.50 $867.00 $894.50 $894.50 $670.88 $894.50 $894.50 $894.50 $447.25 $447.25 $708.44 $894.50 $715.60 $402.53 $177.54 N/A $518.81 $894.50 $536.70 $894.50 $186.41 $894.50 N/A N/A 124839 SUP HCPCS C1713 124839 - PIN HLF 5MM 150MM 40MM PDRLL ORTH BOTH IP/OP $614.00 $454.00 $121.86 $614.00 $276.30 $276.30 $276.30 $276.30 $614.00 $614.00 $614.00 $127.97 $614.00 $614.00 $614.00 $614.00 $614.00 $127.96 $614.00 $595.00 $363.18 $614.00 $595.00 $614.00 $614.00 $460.50 $614.00 $614.00 $614.00 $307.00 $307.00 $486.29 $614.00 $491.20 $276.30 $121.86 N/A $356.12 $614.00 $368.40 $614.00 $127.96 $614.00 N/A N/A 124840 SUP HCPCS C1713 124840 - PIN HLF 5MM 150MM 45MM PDRLL ORTH BOTH IP/OP $493.00 $365.00 $97.85 $493.00 $221.85 $221.85 $221.85 $221.85 $493.00 $493.00 $493.00 $102.75 $493.00 $493.00 $493.00 $493.00 $493.00 $102.75 $493.00 $493.00 $291.61 $493.00 $493.00 $493.00 $493.00 $369.75 $493.00 $493.00 $493.00 $246.50 $246.50 $390.46 $493.00 $394.40 $221.85 $97.85 N/A $285.94 $493.00 $295.80 $493.00 $102.74 $493.00 N/A N/A 124841 SUP HCPCS C1713 124841 - PIN HLF 5MM 150MM 50MM PDRLL ORTH BOTH IP/OP $493.00 $365.00 $97.85 $493.00 $221.85 $221.85 $221.85 $221.85 $493.00 $493.00 $493.00 $102.75 $493.00 $493.00 $493.00 $493.00 $493.00 $102.75 $493.00 $493.00 $291.61 $493.00 $493.00 $493.00 $493.00 $369.75 $493.00 $493.00 $493.00 $246.50 $246.50 $390.46 $493.00 $394.40 $221.85 $97.85 N/A $285.94 $493.00 $295.80 $493.00 $102.74 $493.00 N/A N/A 125037 SUP Custom 27203010 125037 - TUBE ENDBR 37FR 5.1MM BLU CLR SHLY B-CTH LT CUF RADOPQ SLT BOTH IP/OP $125.00 $93.00 $22.24 $124.95 $124.95 $124.95 $124.95 $124.95 $124.95 $124.95 $22.24 $124.95 $124.95 $92.74 $92.74 $96.31 $65.10 $26.04 $124.95 $49.98 $124.95 $124.95 $124.95 $124.95 $124.95 $93.75 $124.95 $124.95 $124.95 $62.48 $62.48 $98.96 $124.95 $99.96 $81.22 $124.95 N/A $72.50 $124.95 $74.97 $124.95 $124.95 $124.95 N/A N/A 125039 SUP Custom 27203010 125039 - TUBE ENDBR 39FR 5.3MM BLU CLR SHLY B-CTH LT CUF RADOPQ SLT BOTH IP/OP $125.00 $93.00 $22.24 $124.95 $124.95 $124.95 $124.95 $124.95 $124.95 $124.95 $22.24 $124.95 $124.95 $92.74 $92.74 $96.31 $65.10 $26.04 $124.95 $49.98 $124.95 $124.95 $124.95 $124.95 $124.95 $93.75 $124.95 $124.95 $124.95 $62.48 $62.48 $98.96 $124.95 $99.96 $81.22 $124.95 N/A $72.50 $124.95 $74.97 $124.95 $124.95 $124.95 N/A N/A 125195 SUP HCPCS C1713 125195 - SCREW BN SLT HD CMPR PED BOTH IP/OP $184.00 $136.00 $36.47 $183.75 $82.69 $82.69 $82.69 $82.69 $183.75 $183.75 $183.75 $38.30 $183.75 $183.75 $183.75 $183.75 $183.75 $38.30 $183.75 $73.50 $108.69 $183.75 $183.75 $183.75 $183.75 $138.00 $183.75 $183.75 $183.75 $91.88 $91.88 $145.53 $183.75 $147.00 $82.69 $36.47 N/A $106.72 $183.75 $110.25 $183.75 $38.29 $183.75 N/A N/A 125292 SUP HCPCS C1713 125292 - PLATE BN 100D 3 HL BRL INTMD SS HIP BOTH IP/OP $602.00 $445.00 $119.41 $601.65 $270.74 $270.74 $270.74 $270.74 $601.65 $601.65 $601.65 $125.40 $601.65 $601.65 $601.65 $601.65 $601.65 $125.39 $601.65 $240.66 $355.88 $601.65 $601.65 $601.65 $601.65 $451.50 $601.65 $601.65 $601.65 $300.83 $300.83 $476.51 $601.65 $481.32 $270.74 $119.41 N/A $349.16 $601.65 $360.99 $601.65 $125.38 $601.65 N/A N/A 125294 SUP HCPCS C1713 125294 - PLATE BN 130D 76.2MM 3 HL BRL INTMD SS HIP KY-LOK BOTH IP/OP $559.00 $414.00 $110.87 $558.60 $251.37 $251.37 $251.37 $251.37 $558.60 $558.60 $558.60 $116.43 $558.60 $558.60 $558.60 $558.60 $558.60 $116.42 $558.60 $223.44 $330.41 $558.60 $558.60 $558.60 $558.60 $419.25 $558.60 $558.60 $558.60 $279.30 $279.30 $442.41 $558.60 $446.88 $251.37 $110.87 N/A $324.22 $558.60 $335.16 $558.60 $558.60 $558.60 N/A N/A 125800 SUP HCPCS C1713 125800 - PIN HLF 4MM 150MM 35MM SKL TRX COVE PNT BOTH IP/OP $383.50 $284.00 $76.12 $383.50 $172.58 $172.58 $172.58 $172.58 $383.50 $383.50 $383.50 $79.93 $383.50 $383.50 $383.50 $383.50 $383.50 $79.93 $383.50 $370.60 $226.84 $383.50 $370.60 $383.50 $383.50 $287.63 $383.50 $383.50 $383.50 $191.75 $191.75 $303.73 $383.50 $306.80 $172.58 $76.12 N/A $222.43 $383.50 $230.10 $383.50 $79.92 $383.50 N/A N/A 125900 SUP HCPCS C1713 125900 - PIN TRC 4MM 300MM 60MM FULL COVE PNT ORTH BOTH IP/OP $894.50 $662.00 $177.54 $894.50 $402.53 $402.53 $402.53 $402.53 $894.50 $894.50 $894.50 $186.44 $894.50 $894.50 $894.50 $894.50 $894.50 $186.42 $894.50 $346.80 $529.10 $894.50 $867.00 $894.50 $894.50 $670.88 $894.50 $894.50 $894.50 $447.25 $447.25 $708.44 $894.50 $715.60 $402.53 $177.54 N/A $518.81 $894.50 $536.70 $894.50 $186.41 $894.50 N/A N/A 127016 SUP HCPCS C1713 127016 - SCREW BN 4.5MM 16MM IMHS ST HIP BOTH IP/OP $36.50 $27.00 $7.24 $36.50 $16.43 $16.43 $16.43 $16.43 $36.50 $36.50 $36.50 $7.61 $36.50 $36.50 $36.50 $36.50 $36.50 $7.61 $36.50 $14.60 $21.59 $36.50 $36.50 $36.50 $36.50 $27.38 $36.50 $36.50 $36.50 $18.25 $18.25 $28.91 $36.50 $29.20 $16.43 $7.24 N/A $21.17 $36.50 $21.90 $36.50 $7.61 $36.50 N/A N/A 127018 SUP HCPCS C1713 127018 - SCREW BN 4.5MM 18MM IMHS ST HIP BOTH IP/OP $36.50 $27.00 $7.24 $36.50 $16.43 $16.43 $16.43 $16.43 $36.50 $36.50 $36.50 $7.61 $36.50 $36.50 $36.50 $36.50 $36.50 $7.61 $36.50 $36.50 $21.59 $36.50 $36.50 $36.50 $36.50 $27.38 $36.50 $36.50 $36.50 $18.25 $18.25 $28.91 $36.50 $29.20 $16.43 $7.24 N/A $21.17 $36.50 $21.90 $36.50 $7.61 $36.50 N/A N/A 127020 SUP HCPCS C1713 127020 - SCREW BN 4.5MM 20MM IMHS ST HIP BOTH IP/OP $36.50 $27.00 $7.24 $36.50 $16.43 $16.43 $16.43 $16.43 $36.50 $36.50 $36.50 $7.61 $36.50 $36.50 $36.50 $36.50 $36.50 $7.61 $36.50 $14.60 $21.59 $36.50 $36.50 $36.50 $36.50 $27.38 $36.50 $36.50 $36.50 $18.25 $18.25 $28.91 $36.50 $29.20 $16.43 $7.24 N/A $21.17 $36.50 $21.90 $36.50 $7.61 $36.50 N/A N/A 127026 SUP HCPCS C1713 127026 - SCREW BN 4.5MM 26MM IMHS ST HIP BOTH IP/OP $36.50 $27.00 $7.24 $36.50 $16.43 $16.43 $16.43 $16.43 $36.50 $36.50 $36.50 $7.61 $36.50 $36.50 $36.50 $36.50 $36.50 $7.61 $36.50 $14.60 $21.59 $36.50 $36.50 $36.50 $36.50 $27.38 $36.50 $36.50 $36.50 $18.25 $18.25 $28.91 $36.50 $29.20 $16.43 $7.24 N/A $21.17 $36.50 $36.50 $36.50 $7.61 $36.50 N/A N/A 127032 SUP HCPCS C1713 127032 - SCREW BN 4.5MM 32MM IMHS ST HIP BOTH IP/OP $39.00 $29.00 $7.74 $39.00 $17.55 $17.55 $17.55 $17.55 $39.00 $39.00 $39.00 $8.13 $39.00 $39.00 $39.00 $39.00 $39.00 $8.13 $39.00 $15.60 $23.07 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $17.55 $7.74 N/A $22.62 $39.00 $23.40 $39.00 $8.13 $39.00 N/A N/A 127042 SUP HCPCS C1713 127042 - SCREW BN 4.5MM 8MM 42MM IMHS ST THRD HD CORT BOTH IP/OP $32.50 $24.00 $6.37 $32.10 $14.45 $14.45 $14.45 $14.45 $32.10 $32.10 $32.10 $6.69 $32.10 $32.10 $32.10 $32.10 $32.10 $6.69 $32.10 $32.10 $18.99 $32.10 $32.10 $32.10 $32.10 $24.38 $32.10 $32.10 $32.10 $16.05 $16.05 $25.42 $32.10 $25.68 $14.45 $6.37 N/A $18.85 $32.10 $19.26 $32.10 $6.69 $32.10 N/A N/A 127056 SUP HCPCS C1713 127056 - SCREW BN 4.5MM 56MM IMHS ST HIP BOTH IP/OP $39.00 $29.00 $7.74 $39.00 $17.55 $17.55 $17.55 $17.55 $39.00 $39.00 $39.00 $8.13 $39.00 $39.00 $39.00 $39.00 $39.00 $8.13 $39.00 $39.00 $23.07 $39.00 $39.00 $39.00 $39.00 $29.25 $39.00 $39.00 $39.00 $19.50 $19.50 $30.89 $39.00 $31.20 $17.55 $7.74 N/A $22.62 $39.00 $39.00 $39.00 $8.13 $39.00 N/A N/A 127060 SUP HCPCS C1713 127060 - SCREW BN 4.5MM 60MM IMHS ST SS HIP BOTH IP/OP $36.50 $27.00 $7.24 $36.50 $16.43 $16.43 $16.43 $16.43 $36.50 $36.50 $36.50 $7.61 $36.50 $36.50 $36.50 $36.50 $36.50 $7.61 $36.50 $36.50 $21.59 $36.50 $36.50 $36.50 $36.50 $27.38 $36.50 $36.50 $36.50 $18.25 $18.25 $28.91 $36.50 $29.20 $16.43 $7.24 N/A $21.17 $36.50 $21.90 $36.50 $7.61 $36.50 N/A N/A 127062 SUP HCPCS C1713 127062 - SCREW BN 4.5MM 62MM ST CORT BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $18.81 $18.81 $18.81 $18.81 $41.80 $41.80 $41.80 $8.71 $41.80 $41.80 $41.80 $41.80 $41.80 $8.71 $41.80 $16.72 $24.72 $41.80 $41.80 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $18.81 $8.30 N/A $24.36 $41.80 $25.08 $41.80 $8.71 $41.80 N/A N/A 127820 SUP HCPCS C1769 127820 - WIRE FX .85MM 9IN NS KRSH THRD DMD PT 1 END RND TY E SS ORTH BOTH IP/OP $165.00 $122.00 $32.69 $164.70 $89.43 $89.43 $89.43 $89.43 $164.70 $164.70 $164.70 $34.33 $164.70 $122.24 $122.24 $126.95 $85.81 $34.33 $164.70 $158.95 $97.42 $164.70 $158.95 $164.70 $164.70 $123.75 $164.70 $164.70 $164.70 $82.35 $82.35 $130.44 $164.70 $131.76 $107.06 $32.69 N/A $95.70 $164.70 $164.70 $164.70 $34.32 $164.70 N/A N/A 127821 SUP HCPCS C1769 127821 - WIRE FX .035MM 9IN NS KRSH THRD DMD PT BOTH ENDS TY F SS BOTH IP/OP $165.00 $122.00 $32.69 $164.70 $89.43 $89.43 $89.43 $89.43 $164.70 $164.70 $164.70 $34.33 $164.70 $122.24 $122.24 $126.95 $85.81 $34.33 $164.70 $158.95 $97.42 $164.70 $158.95 $164.70 $164.70 $123.75 $164.70 $164.70 $164.70 $82.35 $82.35 $130.44 $164.70 $131.76 $107.06 $32.69 N/A $95.70 $164.70 $164.70 $164.70 $34.32 $164.70 N/A N/A 127840 SUP HCPCS C1769 127840 - WIRE FX 1.1MM 9IN NS KRSH THRD DMD PT 1 END RND TY E SS ORTH BOTH IP/OP $165.00 $122.00 $32.69 $164.70 $89.43 $89.43 $89.43 $89.43 $164.70 $164.70 $164.70 $34.33 $164.70 $122.24 $122.24 $126.95 $85.81 $34.33 $164.70 $158.95 $97.42 $164.70 $158.95 $164.70 $164.70 $123.75 $164.70 $164.70 $164.70 $82.35 $82.35 $130.44 $164.70 $131.76 $107.06 $32.69 N/A $95.70 $164.70 $164.70 $164.70 $34.32 $164.70 N/A N/A 127841 SUP HCPCS C1769 127841 - WIRE FX 1.1MM 9IN NS KRSH THRD DMD PT BOTH ENDS TY F SS BOTH IP/OP $165.00 $122.00 $32.69 $164.70 $89.43 $89.43 $89.43 $89.43 $164.70 $164.70 $164.70 $34.33 $164.70 $122.24 $122.24 $126.95 $85.81 $34.33 $164.70 $158.95 $97.42 $164.70 $158.95 $164.70 $164.70 $123.75 $164.70 $164.70 $164.70 $82.35 $82.35 $130.44 $164.70 $131.76 $107.06 $32.69 N/A $95.70 $164.70 $164.70 $164.70 $34.32 $164.70 N/A N/A 127860 SUP HCPCS C1769 127860 - WIRE FX 1.5MM 9IN NS KRSH THRD DMD PT 1 END RND TY E SS ORTH BOTH IP/OP $165.00 $122.00 $32.69 $164.70 $89.43 $89.43 $89.43 $89.43 $164.70 $164.70 $164.70 $34.33 $164.70 $122.24 $122.24 $126.95 $85.81 $34.33 $164.70 $158.95 $97.42 $164.70 $158.95 $164.70 $164.70 $123.75 $164.70 $164.70 $164.70 $82.35 $82.35 $130.44 $164.70 $131.76 $107.06 $32.69 N/A $95.70 $164.70 $164.70 $164.70 $34.32 $164.70 N/A N/A 127861 SUP HCPCS C1769 127861 - WIRE FX 1.5IN 9IN NS KRSH THRD F TY PNT SS ORTH BOTH IP/OP $165.00 $122.00 $32.69 $164.70 $89.43 $89.43 $89.43 $89.43 $164.70 $164.70 $164.70 $34.33 $164.70 $122.24 $122.24 $126.95 $85.81 $34.33 $164.70 $158.95 $97.42 $164.70 $158.95 $164.70 $164.70 $123.75 $164.70 $164.70 $164.70 $82.35 $82.35 $130.44 $164.70 $131.76 $107.06 $32.69 N/A $95.70 $164.70 $164.70 $164.70 $34.32 $164.70 N/A N/A 127874 SUP HCPCS C1713 127874 - PIN FX 1.9MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127877 SUP HCPCS C1713 127877 - PIN FX 1.9IN 9IN NS STNM SMTH TY D THRD SS ORTH BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127880 SUP HCPCS C1713 127880 - PIN FX 5/64IN 9IN NS STNM THRD SS ORTH BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127881 SUP HCPCS C1713 127881 - PIN FX 1.9IN 9IN NS STNM F PLN THRD SS ORTH BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127894 SUP HCPCS C1713 127894 - PIN FX 2.3MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127900 SUP HCPCS C1713 127900 - PIN FX 2.3IN 9IN NS STNM THRD TY E SS ORTH BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127901 SUP HCPCS C1713 127901 - PIN FX 2.3MM 9IN NS STNM 2 END DMD PT TY F SS BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $66.30 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127914 SUP HCPCS C1713 127914 - PIN FX 2.7MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $66.30 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127917 SUP HCPCS C1713 127917 - PIN FX 2.7MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127920 SUP HCPCS C1713 127920 - PIN FX 7/64IN 9IN NS STNM THRD SS ORTH BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127921 SUP HCPCS C1713 127921 - PIN FX 2.7IN 9IN NS STNM F PLN THRD SS ORTH BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $66.30 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $170.40 $170.40 $35.51 $170.40 N/A N/A 127934 SUP HCPCS C1713 127934 - PIN FX 3.1MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127937 SUP HCPCS C1713 127937 - PIN FX 3.1MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127940 SUP HCPCS C1713 127940 - PIN FX 1/8IN 9IN NS STNM THRD SS ORTH BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $170.40 $170.40 N/A N/A 127941 SUP HCPCS C1713 127941 - PIN FX 3.1IN 9IN NS STNM F PLN THRD SS ORTH BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127954 SUP HCPCS C1713 127954 - PIN FX 3.5MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $170.40 $170.40 $170.40 $170.40 N/A N/A 127957 SUP HCPCS C1713 127957 - PIN FX 3.5MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127960 SUP HCPCS C1713 127960 - PIN FX 9/64IN 9IN NS STNM THRD SS ORTH BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $66.30 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127961 SUP HCPCS C1713 127961 - PIN FX 3.5MM 9IN NS STNM THRD DMD PT BOTH ENDS TY F SS ORTH BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127974 SUP HCPCS C1713 127974 - PIN FX 3.9MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $66.30 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $170.40 $170.40 $35.51 $170.40 N/A N/A 127977 SUP HCPCS C1713 127977 - PIN FX 3.9MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $66.30 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127980 SUP HCPCS C1713 127980 - PIN FX 5/32IN 9IN NS STNM THRD SS ORTH BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127981 SUP HCPCS C1713 127981 - PIN FX 3.9IN 9IN NS STNM THRD TY F SS ORTH BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $66.30 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 127994 SUP HCPCS C1713 127994 - PIN FX 4.7MM 9IN NS STNM THRD TROC PNT BOTH ENDS TY A SS BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $170.40 $170.40 $170.40 $170.40 N/A N/A 127997 SUP HCPCS C1713 127997 - PIN FX 4.7MM 9IN NS STNM THRD TROC PNT 1 END RND TY D SS BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $170.40 $170.40 N/A N/A 128000 SUP HCPCS C1713 128000 - PIN FX 3/16IN 9IN NS STNM THRD SS ORTH BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $165.75 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $102.24 $170.40 $35.51 $170.40 N/A N/A 128001 SUP HCPCS C1713 128001 - PIN FX 4.7MM 9IN NS STNM THRD DMD PT BOTH ENDS TY F SS ORTH BOTH IP/OP $170.50 $126.00 $33.82 $170.40 $76.68 $76.68 $76.68 $76.68 $170.40 $170.40 $170.40 $35.52 $170.40 $170.40 $170.40 $170.40 $170.40 $35.51 $170.40 $66.30 $100.79 $170.40 $165.75 $170.40 $170.40 $127.88 $170.40 $170.40 $170.40 $85.20 $85.20 $134.96 $170.40 $136.32 $76.68 $33.82 N/A $98.89 $170.40 $170.40 $170.40 $35.51 $170.40 N/A N/A 128005 SUP HCPCS C1769 128005 - WIRE FX .028MM 4MM NS KRSH SMTH TROC PNT BOTH END TY A SS BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128007 SUP HCPCS C1769 128007 - WIRE FX .76IN 4IN NS KRSH PLN PNT TY A SS ORTH BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128010 SUP HCPCS C1769 128010 - WIRE FX .035IN 4IN STRL KRSH PLN 2 PNT TY A TROC SS BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128011 SUP HCPCS C1769 128011 - WIRE FX .85MM 4IN NS KRSH SMTH TROC PNT 1 END RND TY D SS BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128012 SUP HCPCS C1769 128012 - WIRE FX .035IN 9IN NS KRSH 1 DMD PT SS BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128017 SUP HCPCS C1769 128017 - WIRE FX .85IN 4IN NS KRSH PLN PNT TY A SS ORTH BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128020 SUP HCPCS C1769 128020 - WIRE FX .85MM 5IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS ORTH BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128021 SUP HCPCS C1769 128021 - WIRE FX .035IN 7IN NS KRSH PLN PNT TY F SS ORTH BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128022 SUP HCPCS C1769 128022 - WIRE FX .85IN 9IN NS KRSH PLN PNT TY F SS BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128030 SUP HCPCS C1769 128030 - WIRE FX .045MM 4MM STRL KRSH TROC PNT BOTH END TY A SS BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128031 SUP HCPCS C1769 128031 - WIRE FX 1.1MM 4IN NS KRSH SMTH TROC PNT 1 END RND TY D SS BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128032 SUP HCPCS C1769 128032 - WIRE FX .045IN 9IN NS KRSH PLN PNT TY E SS ORTH BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128034 SUP HCPCS C1769 128034 - WIRE FX 1.1MM 12IN NS KRSH SMTH DMD PT 1 END RND TY E SS BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128037 SUP HCPCS C1769 128037 - WIRE FX .045IN 4IN NS KRSH SMTH TY A SS ORTH BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128040 SUP HCPCS C1769 128040 - WIRE FX 1.1MM 5IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS ORTH BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128041 SUP HCPCS C1769 128041 - WIRE FX .045IN 7IN NS KRSH PLN PNT TY F SS ORTH BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128042 SUP HCPCS C1769 128042 - WIRE FX .045IN 9IN NS KRSH DMD PT 2 END SS BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128044 SUP HCPCS C1769 128044 - WIRE FX 1.1MM 12IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS BOTH IP/OP $49.50 $37.00 $9.80 $49.40 $26.82 $26.82 $26.82 $26.82 $49.40 $49.40 $49.40 $10.30 $49.40 $36.66 $36.66 $38.08 $25.74 $10.30 $49.40 $19.38 $29.22 $49.40 $48.45 $49.40 $49.40 $37.13 $49.40 $49.40 $49.40 $24.70 $24.70 $39.12 $49.40 $39.52 $32.11 $9.80 N/A $28.71 $49.40 $49.40 $49.40 $10.29 $49.40 N/A N/A 128050 SUP HCPCS C1769 128050 - WIRE FX .062IN 4IN NS KRSH PLN 2 PNT TY A TROC SS ORTH BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128051 SUP HCPCS C1769 128051 - WIRE FX 1.5MM 4IN NS KRSH SMTH TROC PNT 1 END RND TY D SS BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128052 SUP HCPCS C1769 128052 - WIRE FX .062IN 9IN NS KRSH PLN PNT TY E SS ORTH BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128054 SUP HCPCS C1769 128054 - WIRE FX 1.5MM 12IN NS KRSH SMTH DMD PT 1 END RND TY E SS BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128057 SUP HCPCS C1769 128057 - WIRE FX 1.5IN 4IN NS KRSH PLN PNT TY A SS ORTH BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128060 SUP HCPCS C1769 128060 - WIRE FX 1.5MM 5IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS ORTH BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128061 SUP HCPCS C1769 128061 - WIRE FX .062IN 7IN NS KRSH PLN PNT TY F SS ORTH BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128062 SUP HCPCS C1769 128062 - WIRE FX 1.5IN 9IN NS KRSH PLN TY F SS BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128064 SUP HCPCS C1769 128064 - WIRE FX 1.5MM 12IN NS KRSH SMTH DMD PT BOTH ENDS TY F SS BOTH IP/OP $79.00 $58.00 $15.62 $78.70 $42.73 $42.73 $42.73 $42.73 $78.70 $78.70 $78.70 $16.40 $78.70 $58.41 $58.41 $60.66 $41.00 $16.40 $78.70 $75.65 $46.55 $78.70 $75.65 $78.70 $78.70 $59.25 $78.70 $78.70 $78.70 $39.35 $39.35 $62.33 $78.70 $62.96 $51.16 $15.62 N/A $45.82 $78.70 $78.70 $78.70 $16.40 $78.70 N/A N/A 128076 SUP HCPCS C1713 128076 - PIN FX 1.9IN 9IN NS STNM 2 END DMD PT PLN TY A SS ORTH BOTH IP/OP $87.50 $65.00 $17.35 $87.40 $39.33 $39.33 $39.33 $39.33 $87.40 $87.40 $87.40 $18.22 $87.40 $87.40 $87.40 $87.40 $87.40 $18.22 $87.40 $34.00 $51.70 $87.40 $85.00 $87.40 $87.40 $65.63 $87.40 $87.40 $87.40 $43.70 $43.70 $69.22 $87.40 $69.92 $39.33 $17.35 N/A $50.75 $87.40 $87.40 $87.40 $18.21 $87.40 N/A N/A 128077 SUP HCPCS C1713 128077 - PIN FX 1.9MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS BOTH IP/OP $87.50 $65.00 $17.35 $87.40 $39.33 $39.33 $39.33 $39.33 $87.40 $87.40 $87.40 $18.22 $87.40 $87.40 $87.40 $87.40 $87.40 $18.22 $87.40 $34.00 $51.70 $87.40 $85.00 $87.40 $87.40 $65.63 $87.40 $87.40 $87.40 $43.70 $43.70 $69.22 $87.40 $69.92 $39.33 $17.35 N/A $50.75 $87.40 $52.44 $87.40 $18.21 $87.40 N/A N/A 128078 SUP HCPCS C1713 128078 - PIN FX 1.9MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH BOTH IP/OP $87.50 $65.00 $17.35 $87.40 $39.33 $39.33 $39.33 $39.33 $87.40 $87.40 $87.40 $18.22 $87.40 $87.40 $87.40 $87.40 $87.40 $18.22 $87.40 $85.00 $51.70 $87.40 $85.00 $87.40 $87.40 $65.63 $87.40 $87.40 $87.40 $43.70 $43.70 $69.22 $87.40 $69.92 $39.33 $17.35 N/A $50.75 $87.40 $52.44 $87.40 $18.21 $87.40 N/A N/A 128079 SUP HCPCS C1713 128079 - PIN FX 1.9MM 9IN NS STNM SMTH TROC PNT 1 END RND TY D SS BOTH IP/OP $87.50 $65.00 $17.35 $87.40 $39.33 $39.33 $39.33 $39.33 $87.40 $87.40 $87.40 $18.22 $87.40 $87.40 $87.40 $87.40 $87.40 $18.22 $87.40 $34.00 $51.70 $87.40 $85.00 $87.40 $87.40 $65.63 $87.40 $87.40 $87.40 $43.70 $43.70 $69.22 $87.40 $69.92 $39.33 $17.35 N/A $50.75 $87.40 $52.44 $87.40 $18.21 $87.40 N/A N/A 128080 SUP HCPCS C1713 128080 - PIN FX 1.9IN 9IN NS STNM SMTH TY E SS ORTH BOTH IP/OP $87.50 $65.00 $17.35 $87.40 $39.33 $39.33 $39.33 $39.33 $87.40 $87.40 $87.40 $18.22 $87.40 $87.40 $87.40 $87.40 $87.40 $18.22 $87.40 $34.00 $51.70 $87.40 $85.00 $87.40 $87.40 $65.63 $87.40 $87.40 $87.40 $43.70 $43.70 $69.22 $87.40 $69.92 $39.33 $17.35 N/A $50.75 $87.40 $52.44 $87.40 $18.21 $87.40 N/A N/A 128081 SUP HCPCS C1713 128081 - PIN FX 1.9IN 9IN NS STNM 2 END DMD PT TY F SS BOTH IP/OP $87.50 $65.00 $17.35 $87.40 $39.33 $39.33 $39.33 $39.33 $87.40 $87.40 $87.40 $18.22 $87.40 $87.40 $87.40 $87.40 $87.40 $18.22 $87.40 $34.00 $51.70 $87.40 $85.00 $87.40 $87.40 $65.63 $87.40 $87.40 $87.40 $43.70 $43.70 $69.22 $87.40 $69.92 $39.33 $17.35 N/A $50.75 $87.40 $87.40 $87.40 $18.21 $87.40 N/A N/A 128086 SUP HCPCS C1713 128086 - PIN FX 2.3IN 9IN NS STNM A PLN SS ORTH BOTH IP/OP $95.00 $70.00 $18.86 $95.00 $42.75 $42.75 $42.75 $42.75 $95.00 $95.00 $95.00 $19.80 $95.00 $95.00 $95.00 $95.00 $95.00 $19.80 $95.00 $37.06 $56.19 $95.00 $92.65 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $42.75 $18.86 N/A $55.10 $95.00 $57.00 $95.00 $19.80 $95.00 N/A N/A 128087 SUP HCPCS C1713 128087 - PIN FX 2.3MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS BOTH IP/OP $95.00 $70.00 $18.86 $95.00 $42.75 $42.75 $42.75 $42.75 $95.00 $95.00 $95.00 $19.80 $95.00 $95.00 $95.00 $95.00 $95.00 $19.80 $95.00 $37.06 $56.19 $95.00 $92.65 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $42.75 $18.86 N/A $55.10 $95.00 $57.00 $95.00 $19.80 $95.00 N/A N/A 128088 SUP HCPCS C1713 128088 - PIN FX 2.3MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH BOTH IP/OP $95.00 $70.00 $18.86 $95.00 $42.75 $42.75 $42.75 $42.75 $95.00 $95.00 $95.00 $19.80 $95.00 $95.00 $95.00 $95.00 $95.00 $19.80 $95.00 $92.65 $56.19 $95.00 $92.65 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $42.75 $18.86 N/A $55.10 $95.00 $95.00 $95.00 $95.00 $95.00 N/A N/A 128089 SUP HCPCS C1713 128089 - PIN FX 3/32IN 9IN NS STNM TY D SS ORTH BOTH IP/OP $95.00 $70.00 $18.86 $95.00 $42.75 $42.75 $42.75 $42.75 $95.00 $95.00 $95.00 $19.80 $95.00 $95.00 $95.00 $95.00 $95.00 $19.80 $95.00 $92.65 $56.19 $95.00 $92.65 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $42.75 $18.86 N/A $55.10 $95.00 $57.00 $95.00 $95.00 $95.00 N/A N/A 128090 SUP HCPCS C1713 128090 - PIN FX 2.3IN 9IN NS STNM SMTH TY E SS ORTH BOTH IP/OP $95.00 $70.00 $18.86 $95.00 $42.75 $42.75 $42.75 $42.75 $95.00 $95.00 $95.00 $19.80 $95.00 $95.00 $95.00 $95.00 $95.00 $19.80 $95.00 $37.06 $56.19 $95.00 $92.65 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $42.75 $18.86 N/A $55.10 $95.00 $57.00 $95.00 $19.80 $95.00 N/A N/A 128091 SUP HCPCS C1713 128091 - PIN FX 2.3MM 9IN NS STNM 2 END DMD PT SMTH TY F SS BOTH IP/OP $95.00 $70.00 $18.86 $95.00 $42.75 $42.75 $42.75 $42.75 $95.00 $95.00 $95.00 $19.80 $95.00 $95.00 $95.00 $95.00 $95.00 $19.80 $95.00 $37.06 $56.19 $95.00 $92.65 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $42.75 $18.86 N/A $55.10 $95.00 $57.00 $95.00 $19.80 $95.00 N/A N/A 128097 SUP HCPCS C1713 128097 - PIN FX 2.7MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS BOTH IP/OP $95.00 $70.00 $18.86 $95.00 $42.75 $42.75 $42.75 $42.75 $95.00 $95.00 $95.00 $19.80 $95.00 $95.00 $95.00 $95.00 $95.00 $19.80 $95.00 $92.65 $56.19 $95.00 $92.65 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $42.75 $18.86 N/A $55.10 $95.00 $57.00 $95.00 $19.80 $95.00 N/A N/A 128098 SUP HCPCS C1713 128098 - PIN FX 2.7MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH BOTH IP/OP $95.00 $70.00 $18.86 $95.00 $42.75 $42.75 $42.75 $42.75 $95.00 $95.00 $95.00 $19.80 $95.00 $95.00 $95.00 $95.00 $95.00 $19.80 $95.00 $92.65 $56.19 $95.00 $92.65 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $42.75 $18.86 N/A $55.10 $95.00 $57.00 $95.00 $19.80 $95.00 N/A N/A 128099 SUP HCPCS C1713 128099 - PIN FX 2.7MM 9IN NS STNM SMTH TROC PNT 1 END RND TY D SS BOTH IP/OP $95.00 $70.00 $18.86 $95.00 $42.75 $42.75 $42.75 $42.75 $95.00 $95.00 $95.00 $19.80 $95.00 $95.00 $95.00 $95.00 $95.00 $19.80 $95.00 $92.65 $56.19 $95.00 $92.65 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $42.75 $18.86 N/A $55.10 $95.00 $95.00 $95.00 $19.80 $95.00 N/A N/A 128100 SUP HCPCS C1713 128100 - PIN FX 2.7IN 9IN NS STNM SMTH DMD PT RND END TY E SS ORTH BOTH IP/OP $95.00 $70.00 $18.86 $95.00 $42.75 $42.75 $42.75 $42.75 $95.00 $95.00 $95.00 $19.80 $95.00 $95.00 $95.00 $95.00 $95.00 $19.80 $95.00 $92.65 $56.19 $95.00 $92.65 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $42.75 $18.86 N/A $55.10 $95.00 $57.00 $95.00 $19.80 $95.00 N/A N/A 128101 SUP HCPCS C1713 128101 - PIN FX 7/64IN 9IN NS STNM SMTH DMD PT BOTH ENDS TY F SS BOTH IP/OP $95.00 $70.00 $18.86 $95.00 $42.75 $42.75 $42.75 $42.75 $95.00 $95.00 $95.00 $19.80 $95.00 $95.00 $95.00 $95.00 $95.00 $19.80 $95.00 $37.06 $56.19 $95.00 $92.65 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $42.75 $18.86 N/A $55.10 $95.00 $57.00 $95.00 $19.80 $95.00 N/A N/A 128106 SUP HCPCS C1713 128106 - PIN FX 3.1IN 9IN NS STNM A PLN SS ORTH BOTH IP/OP $95.00 $70.00 $18.86 $95.00 $42.75 $42.75 $42.75 $42.75 $95.00 $95.00 $95.00 $19.80 $95.00 $95.00 $95.00 $95.00 $95.00 $19.80 $95.00 $37.06 $56.19 $95.00 $92.65 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $42.75 $18.86 N/A $55.10 $95.00 $57.00 $95.00 $19.80 $95.00 N/A N/A 128107 SUP HCPCS C1713 128107 - PIN FX 3.1MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS BOTH IP/OP $103.00 $76.00 $20.38 $102.70 $46.22 $46.22 $46.22 $46.22 $102.70 $102.70 $102.70 $21.41 $102.70 $102.70 $102.70 $102.70 $102.70 $21.40 $102.70 $39.78 $60.75 $102.70 $99.45 $102.70 $102.70 $77.25 $102.70 $102.70 $102.70 $51.35 $51.35 $81.34 $102.70 $82.16 $46.22 $20.38 N/A $59.74 $102.70 $102.70 $102.70 $21.40 $102.70 N/A N/A 128108 SUP HCPCS C1713 128108 - PIN FX 3.1MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH BOTH IP/OP $103.00 $76.00 $20.38 $102.70 $46.22 $46.22 $46.22 $46.22 $102.70 $102.70 $102.70 $21.41 $102.70 $102.70 $102.70 $102.70 $102.70 $21.40 $102.70 $99.45 $60.75 $102.70 $99.45 $102.70 $102.70 $77.25 $102.70 $102.70 $102.70 $51.35 $51.35 $81.34 $102.70 $82.16 $46.22 $20.38 N/A $59.74 $102.70 $61.62 $102.70 $21.40 $102.70 N/A N/A 128109 SUP HCPCS C1713 128109 - PIN FX 3.1IN 9IN NS STNM PLN PNT TY D TROC RND END SS BOTH IP/OP $103.00 $76.00 $20.38 $102.70 $46.22 $46.22 $46.22 $46.22 $102.70 $102.70 $102.70 $21.41 $102.70 $102.70 $102.70 $102.70 $102.70 $21.40 $102.70 $99.45 $60.75 $102.70 $99.45 $102.70 $102.70 $77.25 $102.70 $102.70 $102.70 $51.35 $51.35 $81.34 $102.70 $82.16 $46.22 $20.38 N/A $59.74 $102.70 $61.62 $102.70 $21.40 $102.70 N/A N/A 128110 SUP HCPCS C1713 128110 - PIN FX 3.1IN 9IN NS STNM SMTH TY E SS ORTH BOTH IP/OP $103.00 $76.00 $20.38 $102.70 $46.22 $46.22 $46.22 $46.22 $102.70 $102.70 $102.70 $21.41 $102.70 $102.70 $102.70 $102.70 $102.70 $21.40 $102.70 $99.45 $60.75 $102.70 $99.45 $102.70 $102.70 $77.25 $102.70 $102.70 $102.70 $51.35 $51.35 $81.34 $102.70 $82.16 $46.22 $20.38 N/A $59.74 $102.70 $61.62 $102.70 $21.40 $102.70 N/A N/A 128111 SUP HCPCS C1713 128111 - PIN FX 3.1IN 9IN NS STNM F PLN SS BOTH IP/OP $103.00 $76.00 $20.38 $102.70 $46.22 $46.22 $46.22 $46.22 $102.70 $102.70 $102.70 $21.41 $102.70 $102.70 $102.70 $102.70 $102.70 $21.40 $102.70 $39.78 $60.75 $102.70 $99.45 $102.70 $102.70 $77.25 $102.70 $102.70 $102.70 $51.35 $51.35 $81.34 $102.70 $82.16 $46.22 $20.38 N/A $59.74 $102.70 $61.62 $102.70 $21.40 $102.70 N/A N/A 128116 SUP HCPCS C1713 128116 - PIN FX 3.5IN 9IN NS STNM A PLN SS ORTH BOTH IP/OP $111.00 $82.00 $22.03 $111.00 $49.95 $49.95 $49.95 $49.95 $111.00 $111.00 $111.00 $23.14 $111.00 $111.00 $111.00 $111.00 $111.00 $23.13 $111.00 $43.18 $65.66 $111.00 $107.95 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $49.95 $22.03 N/A $64.38 $111.00 $66.60 $111.00 $23.13 $111.00 N/A N/A 128117 SUP HCPCS C1713 128117 - PIN FX 3.5IN 9IN NS STNM PLN PNT TY A SS BOTH IP/OP $111.00 $82.00 $22.03 $111.00 $49.95 $49.95 $49.95 $49.95 $111.00 $111.00 $111.00 $23.14 $111.00 $111.00 $111.00 $111.00 $111.00 $23.13 $111.00 $107.95 $65.66 $111.00 $107.95 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $49.95 $22.03 N/A $64.38 $111.00 $66.60 $111.00 $23.13 $111.00 N/A N/A 128118 SUP HCPCS C1713 128118 - PIN FX 3.5MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH BOTH IP/OP $111.00 $82.00 $22.03 $111.00 $49.95 $49.95 $49.95 $49.95 $111.00 $111.00 $111.00 $23.14 $111.00 $111.00 $111.00 $111.00 $111.00 $23.13 $111.00 $107.95 $65.66 $111.00 $107.95 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $49.95 $22.03 N/A $64.38 $111.00 $66.60 $111.00 $23.13 $111.00 N/A N/A 128119 SUP HCPCS C1713 128119 - PIN FX 3.5IN 9IN NS STNM PLN PNT TY D TROC RND END SS BOTH IP/OP $111.00 $82.00 $22.03 $111.00 $49.95 $49.95 $49.95 $49.95 $111.00 $111.00 $111.00 $23.14 $111.00 $111.00 $111.00 $111.00 $111.00 $23.13 $111.00 $43.18 $65.66 $111.00 $107.95 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $49.95 $22.03 N/A $64.38 $111.00 $66.60 $111.00 $111.00 $111.00 N/A N/A 128120 SUP HCPCS C1713 128120 - PIN FX 3.5MM 9IN NS STNM SMTH DMD PT 1 END RND TY E SS ORTH BOTH IP/OP $111.00 $82.00 $22.03 $111.00 $49.95 $49.95 $49.95 $49.95 $111.00 $111.00 $111.00 $23.14 $111.00 $111.00 $111.00 $111.00 $111.00 $23.13 $111.00 $107.95 $65.66 $111.00 $107.95 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $49.95 $22.03 N/A $64.38 $111.00 $111.00 $111.00 $23.13 $111.00 N/A N/A 128121 SUP HCPCS C1713 128121 - PIN FX 3.5IN 9IN NS STNM F PLN SS BOTH IP/OP $111.00 $82.00 $22.03 $111.00 $49.95 $49.95 $49.95 $49.95 $111.00 $111.00 $111.00 $23.14 $111.00 $111.00 $111.00 $111.00 $111.00 $23.13 $111.00 $43.18 $65.66 $111.00 $107.95 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $49.95 $22.03 N/A $64.38 $111.00 $66.60 $111.00 $23.13 $111.00 N/A N/A 128126 SUP HCPCS C1713 128126 - PIN FX 3.9IN 9IN NS STNM A PLN SS ORTH BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $48.28 $73.35 $124.00 $120.70 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $24.61 N/A $71.92 $124.00 $74.40 $124.00 $25.84 $124.00 N/A N/A 128127 SUP HCPCS C1713 128127 - PIN FX 3.9MM 9IN NS STNM SMTH TROC PNT 1 END CHK TY B SS BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $48.28 $73.35 $124.00 $120.70 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $24.61 N/A $71.92 $124.00 $74.40 $124.00 $124.00 $124.00 N/A N/A 128128 SUP HCPCS C1713 128128 - PIN FX 3.9MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $120.70 $73.35 $124.00 $120.70 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $24.61 N/A $71.92 $124.00 $74.40 $124.00 $25.84 $124.00 N/A N/A 128129 SUP HCPCS C1713 128129 - PIN FX 5/32IN 9IN NS STNM TY D SS ORTH BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $120.70 $73.35 $124.00 $120.70 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $24.61 N/A $71.92 $124.00 $74.40 $124.00 $25.84 $124.00 N/A N/A 128130 SUP HCPCS C1713 128130 - PIN FX 3.9MM 9IN NS STNM SMTH DMD PT 1 END RND TY E SS ORTH BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $120.70 $73.35 $124.00 $120.70 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $24.61 N/A $71.92 $124.00 $74.40 $124.00 $25.84 $124.00 N/A N/A 128131 SUP HCPCS C1713 128131 - PIN FX 3.9IN 9IN NS STNM F PLN SS BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $48.28 $73.35 $124.00 $120.70 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $24.61 N/A $71.92 $124.00 $74.40 $124.00 $25.84 $124.00 N/A N/A 128136 SUP HCPCS C1713 128136 - PIN FX 4.7IN 9IN NS STNM PLN TY A SS ORTH BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $120.70 $73.35 $124.00 $120.70 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $24.61 N/A $71.92 $124.00 $74.40 $124.00 $25.84 $124.00 N/A N/A 128137 SUP HCPCS C1713 128137 - PIN FX 4.7IN 9IN NS STNM SMTH TROC PNT 1 END TY B SS ORTH BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $120.70 $73.35 $124.00 $120.70 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $24.61 N/A $71.92 $124.00 $74.40 $124.00 $25.84 $124.00 N/A N/A 128138 SUP HCPCS C1713 128138 - PIN FX 4.7MM 9IN NS STNM SMTH DMD PT 1 END CHK TY C SS ORTH BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $120.70 $73.35 $124.00 $120.70 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $24.61 N/A $71.92 $124.00 $124.00 $124.00 $25.84 $124.00 N/A N/A 128139 SUP HCPCS C1713 128139 - PIN FX 4.7MM 9IN NS STNM SMTH TROC PNT 1 END RND TY D SS BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $120.70 $73.35 $124.00 $120.70 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $24.61 N/A $71.92 $124.00 $74.40 $124.00 $25.84 $124.00 N/A N/A 128140 SUP HCPCS C1713 128140 - PIN FX 4.7IN 9IN NS STNM SMTH DMD PT BOTH ENDS TY E SS ORTH BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $120.70 $73.35 $124.00 $120.70 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $24.61 N/A $71.92 $124.00 $74.40 $124.00 $124.00 $124.00 N/A N/A 128141 SUP HCPCS C1713 128141 - PIN FX 4.7IN 9IN NS STNM F PLN SS BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $48.28 $73.35 $124.00 $120.70 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $24.61 N/A $71.92 $124.00 $74.40 $124.00 $25.84 $124.00 N/A N/A 128146 SUP HCPCS C1713 128146 - PIN FX 1.14MM 5IN SWNSN SS FNGR XTRNFX SYS BOTH IP/OP $76.00 $56.00 $15.08 $76.00 $34.20 $34.20 $34.20 $34.20 $76.00 $76.00 $76.00 $15.84 $76.00 $76.00 $76.00 $76.00 $76.00 $15.84 $76.00 $29.58 $44.95 $76.00 $73.95 $76.00 $76.00 $57.00 $76.00 $76.00 $76.00 $38.00 $38.00 $60.19 $76.00 $60.80 $34.20 $15.08 N/A $44.08 $76.00 $76.00 $76.00 $76.00 $76.00 N/A N/A 128162 SUP HCPCS C1713 128162 - PIN FX 5/32IN 11.5IN THRD ORTH K-DONK BOTH IP/OP $452.50 $335.00 $89.75 $452.20 $203.49 $203.49 $203.49 $203.49 $452.20 $452.20 $452.20 $94.25 $452.20 $452.20 $452.20 $452.20 $452.20 $94.24 $452.20 $180.88 $267.48 $452.20 $452.20 $452.20 $452.20 $339.38 $452.20 $452.20 $452.20 $226.10 $226.10 $358.14 $452.20 $361.76 $203.49 $89.75 N/A $262.45 $452.20 $271.32 $452.20 $94.24 $452.20 N/A N/A 128175 SUP HCPCS C1713 128175 - PIN FX TROC PNT 1 END ORTH K-DONK BOTH IP/OP $452.50 $335.00 $89.75 $452.20 $203.49 $203.49 $203.49 $203.49 $452.20 $452.20 $452.20 $94.25 $452.20 $452.20 $452.20 $452.20 $452.20 $94.24 $452.20 $452.20 $267.48 $452.20 $452.20 $452.20 $452.20 $339.38 $452.20 $452.20 $452.20 $226.10 $226.10 $358.14 $452.20 $361.76 $203.49 $89.75 N/A $262.45 $452.20 $271.32 $452.20 $94.24 $452.20 N/A N/A 128177 SUP HCPCS C1713 128177 - PIN FX 7/64IN 9IN TROC PNT 1 END ORTH K-DONK BOTH IP/OP $598.50 $443.00 $118.77 $598.40 $269.28 $269.28 $269.28 $269.28 $598.40 $598.40 $598.40 $124.72 $598.40 $598.40 $598.40 $598.40 $598.40 $124.71 $598.40 $239.36 $353.95 $598.40 $598.40 $598.40 $598.40 $448.88 $598.40 $598.40 $598.40 $299.20 $299.20 $473.93 $598.40 $478.72 $269.28 $118.77 N/A $347.13 $598.40 $359.04 $598.40 $598.40 $598.40 N/A N/A 128307 SUP HCPCS C1713 128307 - PIN FX .15IN 2.25IN KNWL SS ORTH BOTH IP/OP $419.00 $310.00 $83.15 $418.95 $188.53 $188.53 $188.53 $188.53 $418.95 $418.95 $418.95 $87.32 $418.95 $418.95 $418.95 $418.95 $418.95 $87.31 $418.95 $418.95 $247.81 $418.95 $418.95 $418.95 $418.95 $314.25 $418.95 $418.95 $418.95 $209.48 $209.48 $331.81 $418.95 $335.16 $188.53 $83.15 N/A $243.02 $418.95 $251.37 $418.95 $418.95 $418.95 N/A N/A 128310 SUP HCPCS C1713 128310 - PIN FX 5/32IN 3IN KNWL SS BOTH IP/OP $419.00 $310.00 $83.15 $418.95 $188.53 $188.53 $188.53 $188.53 $418.95 $418.95 $418.95 $87.32 $418.95 $418.95 $418.95 $418.95 $418.95 $87.31 $418.95 $167.58 $247.81 $418.95 $418.95 $418.95 $418.95 $314.25 $418.95 $418.95 $418.95 $209.48 $209.48 $331.81 $418.95 $335.16 $188.53 $83.15 N/A $243.02 $418.95 $251.37 $418.95 $418.95 $418.95 N/A N/A 128314 SUP HCPCS C1713 128314 - PIN FX 5/32IN 4IN KNWL SS BOTH IP/OP $419.00 $310.00 $83.15 $418.95 $188.53 $188.53 $188.53 $188.53 $418.95 $418.95 $418.95 $87.32 $418.95 $418.95 $418.95 $418.95 $418.95 $87.31 $418.95 $418.95 $247.81 $418.95 $418.95 $418.95 $418.95 $314.25 $418.95 $418.95 $418.95 $209.48 $209.48 $331.81 $418.95 $335.16 $188.53 $83.15 N/A $243.02 $418.95 $251.37 $418.95 $418.95 $418.95 N/A N/A 128408 SUP HCPCS C1713 128408 - PIN FX 5/32IN 6IN 1.5IN HAGIE ORTH BOTH IP/OP $319.50 $236.00 $63.35 $319.20 $143.64 $143.64 $143.64 $143.64 $319.20 $319.20 $319.20 $66.53 $319.20 $319.20 $319.20 $319.20 $319.20 $66.52 $319.20 $319.20 $188.81 $319.20 $319.20 $319.20 $319.20 $239.63 $319.20 $319.20 $319.20 $159.60 $159.60 $252.81 $319.20 $255.36 $143.64 $63.35 N/A $185.31 $319.20 $319.20 $319.20 $319.20 $319.20 N/A N/A 128416 SUP HCPCS C1713 128416 - PIN FX 3/16IN 6IN 1.25IN HAGIE ORTH BOTH IP/OP $319.50 $236.00 $63.35 $319.20 $143.64 $143.64 $143.64 $143.64 $319.20 $319.20 $319.20 $66.53 $319.20 $319.20 $319.20 $319.20 $319.20 $66.52 $319.20 $127.68 $188.81 $319.20 $319.20 $319.20 $319.20 $239.63 $319.20 $319.20 $319.20 $159.60 $159.60 $252.81 $319.20 $255.36 $143.64 $63.35 N/A $185.31 $319.20 $191.52 $319.20 $66.52 $319.20 N/A N/A 128418 SUP HCPCS C1713 128418 - PIN FX 3/16IN 6IN 1.5IN HAGIE ORTH BOTH IP/OP $319.50 $236.00 $63.35 $319.20 $143.64 $143.64 $143.64 $143.64 $319.20 $319.20 $319.20 $66.53 $319.20 $319.20 $319.20 $319.20 $319.20 $66.52 $319.20 $127.68 $188.81 $319.20 $319.20 $319.20 $319.20 $239.63 $319.20 $319.20 $319.20 $159.60 $159.60 $252.81 $319.20 $255.36 $143.64 $63.35 N/A $185.31 $319.20 $191.52 $319.20 $319.20 $319.20 N/A N/A 128436 SUP HCPCS C1713 128436 - PIN FX .25IN 6IN 1.25IN HAGIE ORTH BOTH IP/OP $319.50 $236.00 $63.35 $319.20 $143.64 $143.64 $143.64 $143.64 $319.20 $319.20 $319.20 $66.53 $319.20 $319.20 $319.20 $319.20 $319.20 $66.52 $319.20 $127.68 $188.81 $319.20 $319.20 $319.20 $319.20 $239.63 $319.20 $319.20 $319.20 $159.60 $159.60 $252.81 $319.20 $255.36 $143.64 $63.35 N/A $185.31 $319.20 $191.52 $319.20 $66.52 $319.20 N/A N/A 128518 SUP HCPCS C1713 128518 - PIN FX .89MM 2IN STRL INSTR ORTH XTRNFX SYS BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $48.28 $73.35 $124.00 $120.70 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $24.61 N/A $71.92 $124.00 $124.00 $124.00 $124.00 $124.00 N/A N/A 128520 SUP HCPCS C1713 128520 - PIN FX 1.1MM 2IN STRL INSTR ORTH XTRNFX SYS BOTH IP/OP $103.00 $76.00 $20.38 $102.70 $46.22 $46.22 $46.22 $46.22 $102.70 $102.70 $102.70 $21.41 $102.70 $102.70 $102.70 $102.70 $102.70 $21.40 $102.70 $39.78 $60.75 $102.70 $99.45 $102.70 $102.70 $77.25 $102.70 $102.70 $102.70 $51.35 $51.35 $81.34 $102.70 $82.16 $46.22 $20.38 N/A $59.74 $102.70 $61.62 $102.70 $21.40 $102.70 N/A N/A 128522 SUP HCPCS C1713 128522 - PIN FX 1.5MM 2IN STRL INSTR ORTH XTRNFX SYS BOTH IP/OP $124.00 $92.00 $24.61 $124.00 $55.80 $55.80 $55.80 $55.80 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $124.00 $124.00 $124.00 $25.84 $124.00 $124.00 $73.35 $124.00 $124.00 $124.00 $124.00 $93.00 $124.00 $124.00 $124.00 $62.00 $62.00 $98.21 $124.00 $99.20 $55.80 $24.61 N/A $71.92 $124.00 $74.40 $124.00 $25.84 $124.00 N/A N/A 128551 SUP HCPCS C1713 128551 - PIN FX .062IN 5.8IN SML SS ORTH BOTH IP/OP $149.00 $110.00 $29.57 $149.00 $67.05 $67.05 $67.05 $67.05 $149.00 $149.00 $149.00 $31.06 $149.00 $149.00 $149.00 $149.00 $149.00 $31.05 $149.00 $149.00 $88.13 $149.00 $149.00 $149.00 $149.00 $111.75 $149.00 $149.00 $149.00 $74.50 $74.50 $118.01 $149.00 $119.20 $67.05 $29.57 N/A $86.42 $149.00 $89.40 $149.00 $31.05 $149.00 N/A N/A 128552 SUP HCPCS C1713 128552 - PIN FX .062IN 7.8IN SML SS ORTH BOTH IP/OP $119.00 $88.00 $23.62 $119.00 $53.55 $53.55 $53.55 $53.55 $119.00 $119.00 $119.00 $24.80 $119.00 $119.00 $119.00 $119.00 $119.00 $24.80 $119.00 $115.60 $70.39 $119.00 $115.60 $119.00 $119.00 $89.25 $119.00 $119.00 $119.00 $59.50 $59.50 $94.25 $119.00 $95.20 $53.55 $23.62 N/A $69.02 $119.00 $119.00 $119.00 $24.80 $119.00 N/A N/A 128553 SUP HCPCS C1713 128553 - PIN FX .062IN 1IN SML SS ORTH BOTH IP/OP $119.00 $88.00 $23.62 $119.00 $53.55 $53.55 $53.55 $53.55 $119.00 $119.00 $119.00 $24.80 $119.00 $119.00 $119.00 $119.00 $119.00 $24.80 $119.00 $115.60 $70.39 $119.00 $115.60 $119.00 $119.00 $89.25 $119.00 $119.00 $119.00 $59.50 $59.50 $94.25 $119.00 $95.20 $53.55 $23.62 N/A $69.02 $119.00 $71.40 $119.00 $24.80 $119.00 N/A N/A 128555 SUP HCPCS C1713 128555 - PIN FX .062IN 1.25IN SML SS ORTH BOTH IP/OP $119.00 $88.00 $23.62 $119.00 $53.55 $53.55 $53.55 $53.55 $119.00 $119.00 $119.00 $24.80 $119.00 $119.00 $119.00 $119.00 $119.00 $24.80 $119.00 $119.00 $70.39 $119.00 $119.00 $119.00 $119.00 $89.25 $119.00 $119.00 $119.00 $59.50 $59.50 $94.25 $119.00 $95.20 $53.55 $23.62 N/A $69.02 $119.00 $71.40 $119.00 $24.80 $119.00 N/A N/A 128607 SUP HCPCS C1713 128607 - STAPLE BN 12MM 12MM KRCKW HTO OFST COCR TIB LAT BLDE BOTH IP/OP $853.00 $631.00 $169.22 $852.60 $383.67 $383.67 $383.67 $383.67 $852.60 $852.60 $852.60 $177.70 $852.60 $852.60 $852.60 $852.60 $852.60 $177.69 $852.60 $852.60 $504.31 $852.60 $852.60 $852.60 $852.60 $639.75 $852.60 $852.60 $852.60 $426.30 $426.30 $675.26 $852.60 $682.08 $383.67 $169.22 N/A $494.74 $852.60 $852.60 $852.60 $177.68 $852.60 N/A N/A 128608 SUP HCPCS C1713 128608 - STAPLE BN 14MM 14MM KRCKW HTO OFST COCR TIB LAT BLDE BOTH IP/OP $853.00 $631.00 $169.22 $852.60 $383.67 $383.67 $383.67 $383.67 $852.60 $852.60 $852.60 $177.70 $852.60 $852.60 $852.60 $852.60 $852.60 $177.69 $852.60 $852.60 $504.31 $852.60 $852.60 $852.60 $852.60 $639.75 $852.60 $852.60 $852.60 $426.30 $426.30 $675.26 $852.60 $682.08 $383.67 $169.22 N/A $494.74 $852.60 $852.60 $852.60 $177.68 $852.60 N/A N/A 128609 SUP HCPCS C1713 128609 - STAPLE BN 16MM 16MM KRCKW HTO OFST COCR TIB LAT BLDE BOTH IP/OP $853.00 $631.00 $169.22 $852.60 $383.67 $383.67 $383.67 $383.67 $852.60 $852.60 $852.60 $177.70 $852.60 $852.60 $852.60 $852.60 $852.60 $177.69 $852.60 $852.60 $504.31 $852.60 $852.60 $852.60 $852.60 $639.75 $852.60 $852.60 $852.60 $426.30 $426.30 $675.26 $852.60 $682.08 $383.67 $169.22 N/A $494.74 $852.60 $511.56 $852.60 $177.68 $852.60 N/A N/A 128610 SUP HCPCS C1713 128610 - STAPLE BN 25X25MM BLK KRCKW HTO COCR TIB MDL MEDAL BOTH IP/OP $853.00 $631.00 $169.22 $852.60 $383.67 $383.67 $383.67 $383.67 $852.60 $852.60 $852.60 $177.70 $852.60 $852.60 $852.60 $852.60 $852.60 $177.69 $852.60 $341.04 $504.31 $852.60 $852.60 $852.60 $852.60 $639.75 $852.60 $852.60 $852.60 $426.30 $426.30 $675.26 $852.60 $682.08 $383.67 $169.22 N/A $494.74 $852.60 $511.56 $852.60 $177.68 $852.60 N/A N/A 128673 SUP HCPCS C1713 128673 - STAPLE BN 5MM OFST 26.5X23MM FX COCR OSTM BOTH IP/OP $680.50 $504.00 $135.04 $680.40 $306.18 $306.18 $306.18 $306.18 $680.40 $680.40 $680.40 $141.81 $680.40 $680.40 $680.40 $680.40 $680.40 $141.80 $680.40 $272.16 $402.46 $680.40 $680.40 $680.40 $680.40 $510.38 $680.40 $680.40 $680.40 $340.20 $340.20 $538.88 $680.40 $544.32 $306.18 $135.04 N/A $394.69 $680.40 $408.24 $680.40 $680.40 $680.40 N/A N/A 128674 SUP HCPCS C1713 128674 - STAPLE BN 10MM 21.5X23MM FX OFST COCR ORTH OSTM BOTH IP/OP $680.50 $504.00 $135.04 $680.40 $306.18 $306.18 $306.18 $306.18 $680.40 $680.40 $680.40 $141.81 $680.40 $680.40 $680.40 $680.40 $680.40 $141.80 $680.40 $680.40 $402.46 $680.40 $680.40 $680.40 $680.40 $510.38 $680.40 $680.40 $680.40 $340.20 $340.20 $538.88 $680.40 $544.32 $306.18 $135.04 N/A $394.69 $680.40 $408.24 $680.40 $141.80 $680.40 N/A N/A 128675 SUP HCPCS C1713 128675 - STAPLE BN 14MM 17.5X23MM FX COCR ORTH OSTM BOTH IP/OP $680.50 $504.00 $135.04 $680.40 $306.18 $306.18 $306.18 $306.18 $680.40 $680.40 $680.40 $141.81 $680.40 $680.40 $680.40 $680.40 $680.40 $141.80 $680.40 $680.40 $402.46 $680.40 $680.40 $680.40 $680.40 $510.38 $680.40 $680.40 $680.40 $340.20 $340.20 $538.88 $680.40 $544.32 $306.18 $135.04 N/A $394.69 $680.40 $408.24 $680.40 $141.80 $680.40 N/A N/A 128690 SUP HCPCS C1713 128690 - STAPLE BN XS 23.22X6.35MM SPK FX COCR BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 128691 SUP HCPCS C1713 128691 - STAPLE BN XS 23.22X6.35MM WO SPK COCR ORTH BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 128692 SUP HCPCS C1713 128692 - STAPLE BN SM SPK 23X12MM FX COCR BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 128693 SUP HCPCS C1713 128693 - STAPLE BN SM REG 23.22X7.94MM FX COCR OSTM BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $507.15 $507.15 $105.69 $507.15 N/A N/A 128695 SUP HCPCS C1713 128695 - STAPLE BN MED 23.22X11.11MM SPK COCR ORTH BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 128696 SUP HCPCS C1713 128696 - STAPLE BN LG REG 23.22X14.29MM SPK COCR ORTH OSTM BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $507.15 $507.15 $105.69 $507.15 N/A N/A 128697 SUP HCPCS C1713 128697 - STAPLE BN LG 23.22X14.29MM FX COCR OSTM BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $507.15 $507.15 N/A N/A 128698 SUP HCPCS C1713 128698 - STAPLE BN SM 16X13MM TBL FX COCR BOTH IP/OP $655.50 $485.00 $130.04 $655.20 $294.84 $294.84 $294.84 $294.84 $655.20 $655.20 $655.20 $136.56 $655.20 $655.20 $655.20 $655.20 $655.20 $136.55 $655.20 $655.20 $387.55 $655.20 $655.20 $655.20 $655.20 $491.63 $655.20 $655.20 $655.20 $327.60 $327.60 $518.92 $655.20 $524.16 $294.84 $130.04 N/A $380.19 $655.20 $393.12 $655.20 $655.20 $655.20 N/A N/A 128699 SUP HCPCS C1713 128699 - STAPLE BN 16 MED 22X16MM TBL FX RTRCT COCR ORTH BOTH IP/OP $655.50 $485.00 $130.04 $655.20 $294.84 $294.84 $294.84 $294.84 $655.20 $655.20 $655.20 $136.56 $655.20 $655.20 $655.20 $655.20 $655.20 $136.55 $655.20 $655.20 $387.55 $655.20 $655.20 $655.20 $655.20 $491.63 $655.20 $655.20 $655.20 $327.60 $327.60 $518.92 $655.20 $524.16 $294.84 $130.04 N/A $380.19 $655.20 $393.12 $655.20 $136.54 $655.20 N/A N/A 128720 SUP HCPCS C1713 128720 - STAPLE BN XS 15X6.35MM FX SPK SHRT LG COCR BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 128721 SUP HCPCS C1713 128721 - STAPLE BN XS 15X6.35MM WO SPK SHRT LG COCR ORTH BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 128722 SUP HCPCS C1713 128722 - STAPLE BN SM 15X7.94MM SPK SHRT LG FX COCR BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $507.15 $507.15 $105.69 $507.15 N/A N/A 128723 SUP HCPCS C1713 128723 - STAPLE BN SM 15X7.94MM WO SPK SHRT LG COCR ORTH BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 128724 SUP HCPCS C1713 128724 - STAPLE BN MED 15X11.11MM SPK SHRT LG FX COCR BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 128725 SUP HCPCS C1713 128725 - STAPLE BN MED 15X11.11MM WO SPK SHRT LG COCR ORTH BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 128726 SUP HCPCS C1713 128726 - STAPLE BN LG 15X14.29MM SPK SHRT LG FX COCR BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 128727 SUP HCPCS C1713 128727 - STAPLE BN LG 15X14.29MM WO SPK SHRT LG COCR ORTH BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $507.15 $507.15 N/A N/A 131710 SUP HCPCS Q4130 131710 - DRESSING BIO 48X3IN EZ DERM MSH PRFR PRCN XENOGRAFT BOTH IP/OP $890.50 $659.00 $185.55 $890.29 $890.29 $890.29 $890.29 $890.29 $890.29 $890.29 $890.29 $890.29 $890.29 $890.29 $890.29 $890.29 $890.29 $185.55 $890.29 $356.12 $890.29 $890.29 $890.29 $890.29 $890.29 $667.88 $890.29 $890.29 $890.29 $445.15 $445.15 $705.11 $890.29 $712.23 $400.63 $890.29 N/A $516.49 $890.29 $534.17 $890.29 $890.29 $890.29 N/A N/A 143080 SUP HCPCS C1713 143080 - PIN FX 3.2MM 80MM STRL BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $63.04 $302.50 N/A N/A 143090 SUP HCPCS C1713 143090 - PIN FX 3.2MM 90MM STRL PRM KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $63.04 $302.50 N/A N/A 143100 SUP HCPCS C1713 143100 - PIN FX 3.2MM 100MM STRL PRM KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $63.04 $302.50 N/A N/A 143110 SUP HCPCS C1713 143110 - PIN FX 3.2MM 110MM STRL BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $302.50 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $63.04 $302.50 N/A N/A 143120 SUP HCPCS C1713 143120 - PIN FX 3.2MM 120MM STRL PRM KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $63.04 $302.50 N/A N/A 143130 SUP HCPCS C1713 143130 - PIN FX 3.2MM 130MM STRL PRM KN BOTH IP/OP $302.50 $224.00 $175.45 "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" $201.21 "$1,130.37" "$1,130.37" $838.96 $838.96 $871.29 $588.92 $235.58 "$1,130.37" $452.15 "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" "$1,130.37" $226.88 "$1,130.37" "$1,130.37" "$1,130.37" $565.19 $565.19 $895.25 "$1,130.37" $904.30 $734.74 "$1,130.37" "$1,130.37" $175.45 "$1,130.37" $678.22 "$1,130.37" "$1,130.37" "$1,130.37" N/A N/A 143140 SUP HCPCS C1713 143140 - PIN FX 3.2MM 140MM STRL BOTH IP/OP $302.50 $224.00 $3.92 $226.88 $22.00 $22.00 $22.00 $22.00 $22.00 $22.00 $3.92 $22.00 $22.00 $16.33 $16.33 $16.96 $11.46 $4.59 $22.00 $8.80 $22.00 $22.00 $22.00 $22.00 $22.00 $226.88 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $14.30 $22.00 $22.00 $175.45 $22.00 $13.20 $22.00 $22.00 $22.00 N/A N/A 144080 SUP HCPCS C1713 144080 - PIN FX 4MM 80MM NS KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $302.50 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $181.50 $302.50 $63.04 $302.50 N/A N/A 144090 SUP HCPCS C1713 144090 - PIN FX 4MM 90MM STRL PRM KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $302.50 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $181.50 $302.50 $63.04 $302.50 N/A N/A 144100 SUP HCPCS C1713 144100 - PIN FX 4MM 100MM STRL PRM KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $302.50 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $181.50 $302.50 $63.04 $302.50 N/A N/A 144110 SUP HCPCS C1713 144110 - PIN FX 4MM 110MM STRL BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $63.04 $302.50 N/A N/A 144120 SUP HCPCS C1713 144120 - PIN FX 4MM 1200MM STRL PRM KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $302.50 $302.50 N/A N/A 144130 SUP HCPCS C1713 144130 - PIN FX 4MM 130MM STRL PRM KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $181.50 $302.50 $302.50 $302.50 N/A N/A 144140 SUP HCPCS C1713 144140 - PIN FX 4MM 140MM STRL KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $181.50 $302.50 $63.04 $302.50 N/A N/A 144150 SUP HCPCS C1713 144150 - PIN FX 4MM 150MM STRL PRM KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $181.50 $302.50 $302.50 $302.50 N/A N/A 144160 SUP HCPCS C1713 144160 - PIN FX 4MM 160MM STRL PRM KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $181.50 $302.50 $302.50 $302.50 N/A N/A 144170 SUP HCPCS C1713 144170 - PIN FX 4MM 170MM STRL KN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $181.50 $302.50 $63.04 $302.50 N/A N/A 151436 SUP Custom 27203010 151436 - RETAINER TBGRP B 33FTX2.5IN NTR ELAST TBLR DRSG LF BOTH IP/OP $53.00 $39.00 $9.42 $52.92 $52.92 $52.92 $52.92 $52.92 $52.92 $52.92 $9.42 $52.92 $52.92 $39.28 $39.28 $40.79 $27.57 $11.03 $52.92 $21.17 $52.92 $52.92 $52.92 $52.92 $52.92 $39.75 $52.92 $52.92 $52.92 $26.46 $26.46 $41.91 $52.92 $42.34 $34.40 $52.92 N/A $30.74 $52.92 $31.75 $52.92 $52.92 $52.92 N/A N/A 151437 SUP Custom 27203010 151437 - RETAINER DRSG D 33FTX3IN NTR LF TBGRP ELC TBLR BOTH IP/OP $73.50 $54.00 $13.02 $73.13 $73.13 $73.13 $73.13 $73.13 $73.13 $73.13 $13.02 $73.13 $73.13 $54.28 $54.28 $56.37 $38.10 $15.24 $73.13 $29.25 $73.13 $73.13 $73.13 $73.13 $73.13 $55.13 $73.13 $73.13 $73.13 $36.57 $36.57 $57.92 $73.13 $58.50 $47.53 $73.13 N/A $42.63 $73.13 $43.88 $73.13 $73.13 $73.13 N/A N/A 151440 SUP Custom 27203010 151440 - RETAINER TBGRP J 33FTX6.75IN NTR ELAST TBLR DRSG LTX BOTH IP/OP $56.00 $41.00 $9.90 $55.61 $55.61 $55.61 $55.61 $55.61 $55.61 $55.61 $9.90 $55.61 $55.61 $41.27 $41.27 $42.86 $28.97 $11.59 $55.61 $22.24 $55.61 $55.61 $55.61 $55.61 $55.61 $42.00 $55.61 $55.61 $55.61 $27.81 $27.81 $44.04 $55.61 $44.49 $36.15 $55.61 N/A $32.48 $55.61 $33.37 $55.61 $55.61 $55.61 N/A N/A 151442 SUP Custom 27203010 151442 - RTNR TBGRP LG 10MR NTR ELAST TBLR DRSG LATEX BOTH IP/OP $605.00 $448.00 $107.69 $605.00 $605.00 $605.00 $605.00 $605.00 $605.00 $605.00 $107.69 $605.00 $605.00 $449.03 $449.03 $466.33 $315.21 $126.09 $605.00 $242.00 $605.00 $605.00 $605.00 $605.00 $605.00 $453.75 $605.00 $605.00 $605.00 $302.50 $302.50 $479.16 $605.00 $484.00 $393.25 $605.00 N/A $350.90 $605.00 $363.00 $605.00 $605.00 $605.00 N/A N/A 160821 SUP Custom 27203010 160821 - BURR SURG MICRO 14 FLUTE BARREL .24IN 2.13IN .41IN STAINLESS BOTH IP/OP $137.50 $102.00 $24.48 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $24.48 $137.50 $137.50 $102.05 $102.05 $105.99 $71.64 $28.66 $137.50 $55.00 $137.50 $137.50 $137.50 $137.50 $137.50 $103.13 $137.50 $137.50 $137.50 $68.75 $68.75 $108.90 $137.50 $110.00 $89.38 $137.50 N/A $79.75 $137.50 $82.50 $137.50 $137.50 $137.50 N/A N/A 165808 SUP Custom 27203010 165808 - CATHETER URETHRAL 8FR 2 WAY FOLEY LATEX FREE BARD SILICONE 3 BOTH IP/OP $8.50 $6.00 $1.45 $8.33 $8.13 $8.13 $8.13 $8.13 $8.13 $8.13 $1.45 $8.13 $8.13 $6.03 $6.03 $6.27 $4.24 $1.69 $8.13 $3.33 $8.13 $8.13 $8.33 $8.13 $8.13 $6.38 $8.13 $8.13 $8.13 $4.07 $4.07 $6.44 $8.13 $6.50 $5.28 $8.13 N/A $4.93 $8.13 $4.88 $8.13 $8.13 $8.13 N/A N/A 165810 SUP Custom 27203010 165810 - CATHETER URETHRAL 10FR 2 WAY FOLEY LATEX FREE BARD SILICONE BOTH IP/OP $8.50 $6.00 $1.45 $8.13 $8.13 $8.13 $8.13 $8.13 $8.13 $8.13 $1.45 $8.13 $8.13 $6.03 $6.03 $6.27 $4.24 $1.69 $8.13 $3.25 $8.13 $8.13 $8.13 $8.13 $8.13 $6.38 $8.13 $8.13 $8.13 $4.07 $4.07 $6.44 $8.13 $6.50 $5.28 $8.13 N/A $4.93 $8.13 $4.88 $8.13 $8.13 $8.13 N/A N/A 165814 SUP Custom 27203010 165814 - CATHETER URTH 14FR 5CC STRL LF BARD 2W FL BLN UNCOAT SIL BOTH IP/OP $8.00 $6.00 $1.39 $8.03 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $1.39 $7.83 $7.83 $5.81 $5.81 $6.04 $4.08 $1.63 $7.83 $3.21 $7.83 $7.83 $8.03 $7.83 $7.83 $6.00 $7.83 $7.83 $7.83 $3.92 $3.92 $6.20 $7.83 $6.26 $5.09 $7.83 N/A $4.64 $7.83 $4.70 $7.83 $7.83 $7.83 N/A N/A 165816 SUP Custom 27203010 165816 - CATHETER URTH 16FR 5CC STRL LF BARD 2W FL BLN UNCOAT SIL BOTH IP/OP $8.00 $6.00 $1.39 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $1.39 $7.83 $7.83 $5.81 $5.81 $6.04 $4.08 $1.63 $7.83 $3.13 $7.83 $7.83 $7.83 $7.83 $7.83 $6.00 $7.83 $7.83 $7.83 $3.92 $3.92 $6.20 $7.83 $6.26 $5.09 $7.83 N/A $4.64 $7.83 $4.70 $7.83 $7.83 $7.83 N/A N/A 165818 SUP Custom 27203010 165818 - CATHETER URTH 18FR 5CC STRL LF BARD 2W FL BLN UNCOAT SIL BOTH IP/OP $8.00 $6.00 $1.39 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $1.39 $7.83 $7.83 $5.81 $5.81 $6.04 $4.08 $1.63 $7.83 $3.13 $7.83 $7.83 $7.83 $7.83 $7.83 $6.00 $7.83 $7.83 $7.83 $3.92 $3.92 $6.20 $7.83 $6.26 $5.09 $7.83 N/A $4.64 $7.83 $4.70 $7.83 $7.83 $7.83 N/A N/A 165820 SUP HCPCS A4344 165820 - CATHETER URTH 20FR 5CC STRL LF BARD 2W FL BLN UNCT SIL DISP BOTH IP/OP $8.00 $6.00 $1.55 $8.03 $4.25 $4.25 $4.25 $4.25 $7.83 $7.83 $7.83 $1.63 $7.83 $5.81 $5.81 $6.04 $4.08 $1.63 $7.83 $8.03 $4.63 $7.83 $8.03 $7.83 $7.83 $6.00 $7.83 $7.83 $7.83 $3.92 $3.92 $6.20 $7.83 $6.26 $5.09 $1.55 N/A $4.64 $7.83 $7.83 $7.83 $1.63 $7.83 N/A N/A 165822 SUP Custom 27203010 165822 - CATHETER URETHRAL 22FR 2 WAY FOLEY LATEX FREE BARD SILICONE BOTH IP/OP $8.00 $6.00 $1.39 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $7.83 $1.39 $7.83 $7.83 $5.81 $5.81 $6.04 $4.08 $1.63 $7.83 $3.13 $7.83 $7.83 $7.83 $7.83 $7.83 $6.00 $7.83 $7.83 $7.83 $3.92 $3.92 $6.20 $7.83 $6.26 $5.09 $7.83 N/A $4.64 $7.83 $4.70 $7.83 $7.83 $7.83 N/A N/A 170057 SUP Custom 27803010 170057 - RELOAD SUT AS 2-0 ES-9 48IN UD E STCH PLSRB 1 STCH LACTOMER BOTH IP/OP $620.50 $459.00 $110.38 $620.10 $620.10 $620.10 $620.10 $620.10 $620.10 $620.10 $110.38 $620.10 $620.10 $620.10 $620.10 $620.10 $620.10 $129.24 $620.10 $248.04 $620.10 $620.10 $620.10 $620.10 $620.10 $465.38 $620.10 $620.10 $620.10 $310.05 $310.05 $491.12 $620.10 $496.08 $279.05 $620.10 N/A $359.89 $620.10 $372.06 $620.10 $620.10 $620.10 N/A N/A 173016 SUP Custom 27203010 173016 - DEVICE SUTURING 10MM 15IN PUSH BUTTON GRIP HANDLE LATEX FREE BOTH IP/OP $284.50 $211.00 $50.62 $284.40 $284.40 $284.40 $284.40 $284.40 $284.40 $284.40 $50.62 $284.40 $284.40 $211.08 $211.08 $219.22 $148.17 $59.27 $284.40 $97.82 $284.40 $284.40 $244.55 $284.40 $284.40 $213.38 $284.40 $284.40 $284.40 $142.20 $142.20 $225.24 $284.40 $227.52 $184.86 $284.40 N/A $165.01 $284.40 $170.64 $284.40 $284.40 $284.40 N/A N/A 173019 SUP Custom 27203010 173019 - RETRACTOR LAPSCOP STANDARD LENGTH 5MM 45CM TROCAR ADAPTER BOTH IP/OP $50.50 $37.00 $8.98 $55.58 $50.43 $50.43 $50.43 $50.43 $50.43 $50.43 $8.98 $50.43 $50.43 $37.43 $37.43 $38.87 $26.27 $10.51 $50.43 $22.23 $50.43 $50.43 $55.58 $50.43 $50.43 $37.88 $50.43 $50.43 $50.43 $25.22 $25.22 $39.94 $50.43 $40.34 $32.78 $50.43 N/A $29.29 $50.43 $30.26 $50.43 $50.43 $50.43 N/A N/A 174006 SUP Custom 27203010 174006 - STAPLER INTERNAL 35.5X5MM 30 HELICAL FASTENER LATEX FREE BOTH IP/OP $585.00 $433.00 $104.12 $584.95 $584.95 $584.95 $584.95 $584.95 $584.95 $584.95 $104.12 $584.95 $584.95 $434.15 $434.15 $450.88 $304.76 $121.91 $584.95 $200.00 $584.95 $584.95 $500.00 $584.95 $584.95 $438.75 $584.95 $584.95 $584.95 $292.48 $292.48 $463.28 $584.95 $467.96 $380.22 $584.95 N/A $339.30 $584.95 $350.97 $584.95 $584.95 $584.95 N/A N/A 175424 SUP HCPCS C1768 175424 - GRAFT CV 24MM 30CM HMSH PL WVN STRG BOTH IP/OP "$1,237.00" $915.00 $245.43 "$1,236.58" $556.46 $556.46 $556.46 $556.46 "$1,236.58" "$1,236.58" "$1,236.58" $257.73 "$1,236.58" "$1,236.58" "$1,236.58" "$1,236.58" "$1,236.58" $257.72 "$1,236.58" "$1,236.58" $731.44 "$1,236.58" "$1,236.58" "$1,236.58" "$1,236.58" $927.75 "$1,236.58" "$1,236.58" "$1,236.58" $618.29 $618.29 $979.37 "$1,236.58" $989.26 $556.46 $245.43 N/A $717.46 "$1,236.58" "$1,236.58" "$1,236.58" $257.70 "$1,236.58" N/A N/A 175428 SUP HCPCS C1768 175428 - GRAFT VASCULAR 28MM 30CM WOVEN STR HEMASHIELD GOLD MICROVEL BOTH IP/OP "$1,317.50" $975.00 $261.47 "$1,317.40" $592.83 $592.83 $592.83 $592.83 "$1,317.40" "$1,317.40" "$1,317.40" $274.58 "$1,317.40" "$1,317.40" "$1,317.40" "$1,317.40" "$1,317.40" $274.56 "$1,317.40" "$1,317.40" $779.24 "$1,317.40" "$1,317.40" "$1,317.40" "$1,317.40" $988.13 "$1,317.40" "$1,317.40" "$1,317.40" $658.70 $658.70 "$1,043.38" "$1,317.40" "$1,053.92" $592.83 $261.47 N/A $764.15 "$1,317.40" "$1,317.40" "$1,317.40" $274.55 "$1,317.40" N/A N/A 175432 SUP HCPCS C1768 175432 - GRAFT CV 32MM 30CM HMSH GMCVL WVN STRG BOTH IP/OP "$1,317.50" $975.00 $261.47 "$1,317.40" $592.83 $592.83 $592.83 $592.83 "$1,317.40" "$1,317.40" "$1,317.40" $274.58 "$1,317.40" "$1,317.40" "$1,317.40" "$1,317.40" "$1,317.40" $274.56 "$1,317.40" "$1,317.40" $779.24 "$1,317.40" "$1,317.40" "$1,317.40" "$1,317.40" $988.13 "$1,317.40" "$1,317.40" "$1,317.40" $658.70 $658.70 "$1,043.38" "$1,317.40" "$1,053.92" $592.83 $261.47 N/A $764.15 "$1,317.40" "$1,317.40" "$1,317.40" $274.55 "$1,317.40" N/A N/A 176605 SUP Custom 27203010 176605 - SCISSORS LAPSCP 5MM 31CM E SCZ MNPLR CAUT ADPR HK CRV JAW BOTH IP/OP $187.50 $139.00 $33.29 $187.02 $187.02 $187.02 $187.02 $187.02 $187.02 $187.02 $33.29 $187.02 $187.02 $138.81 $138.81 $144.16 $97.44 $38.98 $187.02 $74.81 $187.02 $187.02 $187.02 $187.02 $187.02 $140.63 $187.02 $187.02 $187.02 $93.51 $93.51 $148.12 $187.02 $149.62 $121.56 $187.02 N/A $108.75 $187.02 $112.21 $187.02 $187.02 $187.02 N/A N/A 176620 SUP Custom 27203010 176620 - APPLIER INTERNAL CLIP LARGE 5MM 11IN TROCAR SLEEVE ENDO CLIP BOTH IP/OP $374.00 $277.00 $66.55 $373.88 $373.88 $373.88 $373.88 $373.88 $373.88 $373.88 $66.55 $373.88 $373.88 $277.49 $277.49 $288.19 $194.79 $77.92 $373.88 $149.55 $373.88 $373.88 $373.88 $373.88 $373.88 $280.50 $373.88 $373.88 $373.88 $186.94 $186.94 $296.11 $373.88 $299.10 $243.02 $373.88 N/A $216.92 $373.88 $224.33 $373.88 $373.88 $373.88 N/A N/A 176643 SUP Custom 27203010 176643 - SHEARS MONOPOLAR STANDARD CURVE 5MM 31CM MONOPOLAR CAUTERY BOTH IP/OP $151.50 $112.00 $26.90 $151.10 $151.10 $151.10 $151.10 $151.10 $151.10 $151.10 $26.90 $151.10 $151.10 $112.15 $112.15 $116.47 $78.72 $31.49 $151.10 $44.47 $151.10 $151.10 $151.10 $151.10 $151.10 $113.63 $151.10 $151.10 $151.10 $75.55 $75.55 $119.67 $151.10 $120.88 $98.22 $151.10 N/A $87.87 $151.10 $90.66 $151.10 $151.10 $151.10 N/A N/A 176657 SUP Custom 27203010 176657 - APPLIER INTERNAL CLIP MEDIUM LARGE 10MM 10MM PISTOL GRIP BOTH IP/OP $206.50 $153.00 $36.68 $206.08 $206.08 $206.08 $206.08 $206.08 $206.08 $206.08 $36.68 $206.08 $206.08 $152.95 $152.95 $158.85 $107.37 $42.95 $206.08 $68.48 $206.08 $206.08 $171.20 $206.08 $206.08 $154.88 $206.08 $206.08 $206.08 $103.04 $103.04 $163.22 $206.08 $164.86 $133.95 $206.08 N/A $119.77 $206.08 $123.65 $206.08 $206.08 $206.08 N/A N/A 176816 SUP Custom 27203010 176816 - CATHETER URTH 16FR 30ML STRL LF BARD LBRSL 2W FL BLN SIL BOTH IP/OP $19.00 $14.00 $3.33 $18.70 $18.70 $18.70 $18.70 $18.70 $18.70 $18.70 $3.33 $18.70 $18.70 $13.88 $13.88 $14.41 $9.74 $3.90 $18.70 $7.48 $18.70 $18.70 $18.70 $18.70 $18.70 $14.25 $18.70 $18.70 $18.70 $9.35 $9.35 $14.81 $18.70 $14.96 $12.16 $18.70 N/A $11.02 $18.70 $11.22 $18.70 $18.70 $18.70 N/A N/A 179301 SUP Custom 27203010 179301 - TROCAR ENDSCP 10.5MM NONCONDUCTIVE SLEEVE THORACOPORT TEAL BOTH IP/OP $38.50 $28.00 $6.81 $38.25 $38.25 $38.25 $38.25 $38.25 $38.25 $38.25 $6.81 $38.25 $38.25 $28.39 $28.39 $29.48 $19.93 $7.97 $38.25 $14.40 $38.25 $38.25 $36.00 $38.25 $38.25 $28.88 $38.25 $38.25 $38.25 $19.13 $19.13 $30.29 $38.25 $30.60 $24.86 $38.25 N/A $22.33 $38.25 $22.95 $38.25 $38.25 $38.25 N/A N/A 179309 SUP Custom 27203010 179309 - TROCAR ENDSCP 12MM SOFT CONDUCTIVE SLEEVE OBTURATOR BOTH IP/OP $38.50 $28.00 $6.81 $38.25 $38.25 $38.25 $38.25 $38.25 $38.25 $38.25 $6.81 $38.25 $38.25 $28.39 $28.39 $29.48 $19.93 $7.97 $38.25 $14.40 $38.25 $38.25 $36.00 $38.25 $38.25 $28.88 $38.25 $38.25 $38.25 $19.13 $19.13 $30.29 $38.25 $30.60 $24.86 $38.25 N/A $22.33 $38.25 $22.95 $38.25 $38.25 $38.25 N/A N/A 180402 SUP HCPCS C1776 180402 - COMPONENT FEM 2 KN LT PTLFEM MULTICOMPARTMENTAL KN SYS BOTH IP/OP "$9,780.00" "$7,237.00" "$1,941.09" "$9,780.00" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.40" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.26" "$9,780.00" "$3,912.00" "$4,821.54" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$7,335.00" "$9,780.00" "$9,780.00" "$9,780.00" "$4,890.00" "$4,890.00" "$7,745.76" "$9,780.00" "$7,824.00" "$4,401.00" "$1,941.09" N/A "$5,672.40" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.15" "$9,780.00" N/A N/A 180403 SUP HCPCS C1776 180403 - COMPONENT FEM 3 KN PTLFEM LT MCK SYS BOTH IP/OP "$9,780.00" "$7,237.00" "$1,941.09" "$9,780.00" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.40" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.26" "$9,780.00" "$9,780.00" "$4,821.54" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$7,335.00" "$9,780.00" "$9,780.00" "$9,780.00" "$4,890.00" "$4,890.00" "$7,745.76" "$9,780.00" "$7,824.00" "$4,401.00" "$1,941.09" N/A "$5,672.40" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.15" "$9,780.00" N/A N/A 180404 SUP HCPCS C1776 180404 - COMPONENT FEM 4 KN PTLFEM LT MCK SYS BOTH IP/OP "$9,780.00" "$7,237.00" "$1,941.09" "$9,780.00" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.40" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.26" "$9,780.00" "$9,780.00" "$4,821.54" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$7,335.00" "$9,780.00" "$9,780.00" "$9,780.00" "$4,890.00" "$4,890.00" "$7,745.76" "$9,780.00" "$7,824.00" "$4,401.00" "$1,941.09" N/A "$5,672.40" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.15" "$9,780.00" N/A N/A 180405 SUP HCPCS C1776 180405 - COMPONENT FEM 5 KN PTLFEM LT MCK SYS BOTH IP/OP "$9,780.00" "$7,237.00" "$1,941.09" "$9,780.00" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.40" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.26" "$9,780.00" "$9,780.00" "$4,821.54" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$7,335.00" "$9,780.00" "$9,780.00" "$9,780.00" "$4,890.00" "$4,890.00" "$7,745.76" "$9,780.00" "$7,824.00" "$4,401.00" "$1,941.09" N/A "$5,672.40" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.15" "$9,780.00" N/A N/A 180406 SUP HCPCS C1776 180406 - COMPONENT FEM 6 KN LT PTLFEM MULTICOMPARTMENTAL KN SYS BOTH IP/OP "$9,780.00" "$7,237.00" "$1,941.09" "$9,780.00" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.40" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.26" "$9,780.00" "$9,780.00" "$4,821.54" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$7,335.00" "$9,780.00" "$9,780.00" "$9,780.00" "$4,890.00" "$4,890.00" "$7,745.76" "$9,780.00" "$7,824.00" "$4,401.00" "$1,941.09" N/A "$5,672.40" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.15" "$9,780.00" N/A N/A 180407 SUP HCPCS C1776 180407 - COMPONENT FEM 7 KN PTLFEM LT MCK SYS BOTH IP/OP "$9,780.00" "$7,237.00" "$1,941.09" "$9,780.00" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.40" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.26" "$9,780.00" "$9,780.00" "$4,821.54" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$7,335.00" "$9,780.00" "$9,780.00" "$9,780.00" "$4,890.00" "$4,890.00" "$7,745.76" "$9,780.00" "$7,824.00" "$4,401.00" "$1,941.09" N/A "$5,672.40" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.15" "$9,780.00" N/A N/A 180412 SUP HCPCS C1776 180412 - COMPONENT FEM 2 KN PTLFEM RT MCK SYS BOTH IP/OP "$9,780.00" "$7,237.00" "$1,941.09" "$9,780.00" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.40" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.26" "$9,780.00" "$9,780.00" "$4,821.54" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$7,335.00" "$9,780.00" "$9,780.00" "$9,780.00" "$4,890.00" "$4,890.00" "$7,745.76" "$9,780.00" "$7,824.00" "$4,401.00" "$1,941.09" N/A "$5,672.40" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.15" "$9,780.00" N/A N/A 180413 SUP HCPCS C1776 180413 - COMPONENT FEM 3 KN RT PTLFEM MULTICOMPARTMENTAL KN SYS BOTH IP/OP "$9,780.00" "$7,237.00" "$1,941.09" "$9,780.00" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.40" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.26" "$9,780.00" "$3,912.00" "$4,821.54" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$7,335.00" "$9,780.00" "$9,780.00" "$9,780.00" "$4,890.00" "$4,890.00" "$7,745.76" "$9,780.00" "$7,824.00" "$4,401.00" "$1,941.09" N/A "$5,672.40" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.15" "$9,780.00" N/A N/A 180414 SUP HCPCS C1776 180414 - COMPONENT FEM 4 KN PTLFEM RT MCK SYS BOTH IP/OP "$9,780.00" "$7,237.00" "$1,941.09" "$9,780.00" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.40" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.26" "$9,780.00" "$3,912.00" "$4,821.54" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$7,335.00" "$9,780.00" "$9,780.00" "$9,780.00" "$4,890.00" "$4,890.00" "$7,745.76" "$9,780.00" "$7,824.00" "$4,401.00" "$1,941.09" N/A "$5,672.40" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.15" "$9,780.00" N/A N/A 180415 SUP HCPCS C1776 180415 - COMPONENT FEM 5 KN PTLFEM RT MCK SYS BOTH IP/OP "$9,780.00" "$7,237.00" "$1,941.09" "$9,780.00" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.40" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.26" "$9,780.00" "$9,780.00" "$4,821.54" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$7,335.00" "$9,780.00" "$9,780.00" "$9,780.00" "$4,890.00" "$4,890.00" "$7,745.76" "$9,780.00" "$7,824.00" "$4,401.00" "$1,941.09" N/A "$5,672.40" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.15" "$9,780.00" N/A N/A 180416 SUP HCPCS C1776 180416 - COMPONENT FEM 6 KN PTLFEM RT MCK SYS BOTH IP/OP "$9,780.00" "$7,237.00" "$1,941.09" "$9,780.00" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.40" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.26" "$9,780.00" "$9,780.00" "$4,821.54" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$7,335.00" "$9,780.00" "$9,780.00" "$9,780.00" "$4,890.00" "$4,890.00" "$7,745.76" "$9,780.00" "$7,824.00" "$4,401.00" "$1,941.09" N/A "$5,672.40" "$9,780.00" "$5,868.00" "$9,780.00" "$2,038.15" "$9,780.00" N/A N/A 180417 SUP HCPCS C1776 180417 - COMPONENT FEM 7 STD KN PTLFEM RT BOTH IP/OP "$9,780.00" "$7,237.00" "$1,941.09" "$9,780.00" "$4,401.00" "$4,401.00" "$4,401.00" "$4,401.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.40" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$2,038.26" "$9,780.00" "$3,912.00" "$4,821.54" "$9,780.00" "$9,780.00" "$9,780.00" "$9,780.00" "$7,335.00" "$9,780.00" "$9,780.00" "$9,780.00" "$4,890.00" "$4,890.00" "$7,745.76" "$9,780.00" "$7,824.00" "$4,401.00" "$1,941.09" N/A "$5,672.40" "$9,780.00" "$5,868.00" "$9,780.00" "$2,038.15" "$9,780.00" N/A N/A 180502 SUP HCPCS C1776 180502 - COMPONENT FEM 2 KN LT MDL RL MCK SYS BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$3,302.50" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$1,981.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 180503 SUP HCPCS C1776 180503 - COMPONENT FEM 3 KN LT MDL RL MCK SYS BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$1,321.00" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$1,981.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 180504 SUP HCPCS C1776 180504 - COMPONENT FEM 4 KN LT MDL RL MCK SYS BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$3,302.50" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 180505 SUP HCPCS C1776 180505 - COMPONENT FEM 5 KN LT MDL RL MCK SYS BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$1,321.00" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 180506 SUP HCPCS C1776 180506 - COMPONENT FEM 6 KN LT MDL RL MCK SYS BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$1,321.00" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$1,981.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 180507 SUP HCPCS C1776 180507 - COMPONENT FEM 7 KN LT MDL RL MCK SYS BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$3,302.50" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$1,981.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 180512 SUP HCPCS C1776 180512 - COMPONENT FEM 2 KN RMLL MCK SYS BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$1,321.00" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$1,981.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 180513 SUP HCPCS C1776 180513 - COMPONENT FEM 3 KN RMLL MCK SYS BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$1,321.00" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$1,981.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 180514 SUP HCPCS C1776 180514 - COMPONENT FEM 4 KN RMLL MCK SYS BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$3,302.50" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 180515 SUP HCPCS C1776 180515 - COMPONENT FEM 5 KN RMLL MCK SYS BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$3,302.50" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$1,981.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 180516 SUP HCPCS C1776 180516 - COMPONENT FEM 6 KN RMLL MCK SYS BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$3,302.50" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$1,981.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 180517 SUP HCPCS C1776 180517 - COMPONENT FEM 7 STRL RESTORIS MULTICOMPARTMENTAL KN RMLL BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$1,321.00" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$1,981.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 180518 SUP HCPCS C1776 180518 - COMPONENT FEM 8 STRL RESTORIS MULTICOMPARTMENTAL KN RMLL BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$1,321.00" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 180601 SUP HCPCS C1776 180601 - BASEPLATE TIB 1 STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN LT BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" "$2,402.50" "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 180602 SUP HCPCS C1776 180602 - BASEPLATE TIB 2 KN LT MDL RL MCK SYS BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$1,441.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 180603 SUP HCPCS C1776 180603 - BASEPLATE TIB 3 KN LT MDL RL MCK SYS BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$1,441.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 180604 SUP HCPCS C1776 180604 - BASEPLATE TIB 4 KN LT MDL RL MCK SYS BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" "$2,402.50" "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$1,441.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 180605 SUP HCPCS C1776 180605 - BASEPLATE TIB 5 KN LT MDL RL MCK SYS BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$1,441.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 180606 SUP HCPCS C1776 180606 - BASEPLATE TIB 6 KN LT MDL RL MCK SYS BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$1,441.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 180607 SUP HCPCS C1776 180607 - BASEPLATE TIB 7 KN LT MDL RL MCK SYS BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 180608 SUP HCPCS C1776 180608 - BASEPLATE TIB 8 STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN LT BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 180612 SUP HCPCS C1776 180612 - BASEPLATE TIB 2 KN RMLL MCK SYS BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 180613 SUP HCPCS C1776 180613 - BASEPLATE TIB 3 KN RMLL MCK SYS BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 180614 SUP HCPCS C1776 180614 - BASEPLATE TIB 4 STRL RESTORIS KN RMLL MCK SYS BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 180615 SUP HCPCS C1776 180615 - BASEPLATE TIB 5 STRL RESTORIS KN RMLL MCK SYS BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 180616 SUP HCPCS C1776 180616 - BASEPLATE TIB 6 KN RMLL MCK SYS BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 180617 SUP HCPCS C1776 180617 - BASEPLATE TIB 7 KN RMLL MCK SYS BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 180618 SUP HCPCS C1776 180618 - BASEPLATE TIB 8 STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 186140 SUP HCPCS C1776 186140 - LINER ACTB NTRL RESTORIS XLVE HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186240 SUP HCPCS C1776 186240 - LINER ACTB RESTORIS HW XLVE HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 200641 SUP Custom 27805411 200641 - GRAFT BONE 14X11X6MM BLOCK FREEZE DRY CORNERSTONE CORTICAL BOTH IP/OP "$2,875.00" "$2,128.00" $511.75 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $511.75 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$1,150.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" "$2,875.00" N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" "$2,875.00" "$2,875.00" N/A N/A 200741 SUP HCPCS C1713 200741 - GRAFT BONE CRSTN SR CORT BLCK 14X11X7MM CERV SPNE BOTH IP/OP "$2,875.00" "$2,128.00" $570.62 "$2,875.00" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$2,875.00" "$2,875.00" "$2,875.00" $599.22 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$2,875.00" "$1,417.38" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" $570.62 N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" $599.15 "$2,875.00" N/A N/A 200744 SUP Custom 27804086 200744 - GRAFT BONE 14X14X7MM BLOCK CORNERSTONE SR CORTICAL CERV SPN BOTH IP/OP "$2,875.00" "$2,128.00" $511.75 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $511.75 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$1,150.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" "$2,875.00" N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" "$2,875.00" "$2,875.00" N/A N/A 200841 SUP HCPCS C1713 200841 - GRAFT BONE 14X11X8MM BLOCK CORNERSTONE PSR CORTICAL CERV SPN BOTH IP/OP "$2,875.00" "$2,128.00" $570.62 "$2,875.00" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$2,875.00" "$2,875.00" "$2,875.00" $599.22 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$2,875.00" "$1,417.38" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" $570.62 N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" $599.15 "$2,875.00" N/A N/A 200941 SUP Custom 27804086 200941 - GRAFT BONE 14X11X9MM BLOCK FREEZE DRIED CORNERSTONE CORTICAL BOTH IP/OP "$2,875.00" "$2,128.00" $511.75 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $511.75 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$1,150.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" "$2,875.00" N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" "$2,875.00" "$2,875.00" N/A N/A 201037 SUP HCPCS C1760 201037 - CLIP SRG STRL RANEY TEMP PLS PED SCLP DISP HMST BOTH IP/OP $3.00 $2.00 $0.53 $2.73 $1.19 $1.19 $1.19 $1.19 $2.65 $2.65 $2.65 $0.55 $2.65 $2.65 $2.65 $2.65 $2.65 $0.55 $2.65 $2.73 $1.57 $2.65 $2.73 $2.65 $2.65 $2.25 $2.65 $2.65 $2.65 $1.33 $1.33 $2.10 $2.65 $2.12 $1.19 $0.53 N/A $1.74 $2.65 $2.65 $2.65 $0.55 $2.65 N/A N/A 201400 SUP HCPCS C1713 201400 - PIN HLF 4MM 120MM 30MM ILZ THRD ORTH BOTH IP/OP $422.00 $312.00 $83.76 $422.00 $189.90 $189.90 $189.90 $189.90 $422.00 $422.00 $422.00 $87.96 $422.00 $422.00 $422.00 $422.00 $422.00 $87.95 $422.00 $413.10 $249.61 $422.00 $413.10 $422.00 $422.00 $316.50 $422.00 $422.00 $422.00 $211.00 $211.00 $334.22 $422.00 $337.60 $189.90 $83.76 N/A $244.76 $422.00 $253.20 $422.00 $87.94 $422.00 N/A N/A 201401 SUP HCPCS C1713 201401 - PIN HLF 4MM 150MM 35MM ILZ THRD ORTH BOTH IP/OP $428.00 $317.00 $84.95 $428.00 $192.60 $192.60 $192.60 $192.60 $428.00 $428.00 $428.00 $89.21 $428.00 $428.00 $428.00 $428.00 $428.00 $89.20 $428.00 $418.20 $253.16 $428.00 $418.20 $428.00 $428.00 $321.00 $428.00 $428.00 $428.00 $214.00 $214.00 $338.98 $428.00 $342.40 $192.60 $84.95 N/A $248.24 $428.00 $256.80 $428.00 $89.20 $428.00 N/A N/A 201402 SUP HCPCS C1713 201402 - PIN HLF 4MM 180MM 40MM ILZ THRD ORTH BOTH IP/OP $448.00 $332.00 $88.92 $448.00 $201.60 $201.60 $201.60 $201.60 $448.00 $448.00 $448.00 $93.37 $448.00 $448.00 $448.00 $448.00 $448.00 $93.37 $448.00 $436.90 $264.99 $448.00 $436.90 $448.00 $448.00 $336.00 $448.00 $448.00 $448.00 $224.00 $224.00 $354.82 $448.00 $358.40 $201.60 $88.92 N/A $259.84 $448.00 $268.80 $448.00 $93.36 $448.00 N/A N/A 201502 SUP HCPCS C1713 201502 - PIN HLF 5MM 180MM 50MM ILZ THRD CNCL ORTH BOTH IP/OP $480.00 $355.00 $95.27 $480.00 $216.00 $216.00 $216.00 $216.00 $480.00 $480.00 $480.00 $100.04 $480.00 $480.00 $480.00 $480.00 $480.00 $100.04 $480.00 $469.20 $283.92 $480.00 $469.20 $480.00 $480.00 $360.00 $480.00 $480.00 $480.00 $240.00 $240.00 $380.16 $480.00 $384.00 $216.00 $95.27 N/A $278.40 $480.00 $288.00 $480.00 $100.03 $480.00 N/A N/A 201700 SUP HCPCS C1713 201700 - WASHER ORTH ILZ CNCL CPL BOTH IP/OP $129.00 $95.00 $25.56 $128.80 $57.96 $57.96 $57.96 $57.96 $128.80 $128.80 $128.80 $26.85 $128.80 $128.80 $128.80 $128.80 $128.80 $26.84 $128.80 $50.18 $76.19 $128.80 $125.45 $128.80 $128.80 $96.75 $128.80 $128.80 $128.80 $64.40 $64.40 $102.01 $128.80 $103.04 $57.96 $25.56 N/A $74.82 $128.80 $77.28 $128.80 $26.84 $128.80 N/A N/A 202050 SUP Custom 27203010 202050 - SEALANT DURA 5ML DURASEAL PG TRILYSINE AMINE BOTH IP/OP "$2,733.00" "$2,022.00" $486.41 "$2,732.63" "$2,732.63" "$2,732.63" "$2,732.63" "$2,732.63" "$2,732.63" "$2,732.63" $486.41 "$2,732.63" "$2,732.63" "$2,028.16" "$2,028.16" "$2,106.31" "$1,423.70" $569.51 "$2,732.63" "$1,093.05" "$2,732.63" "$2,732.63" "$2,732.63" "$2,732.63" "$2,732.63" "$2,049.75" "$2,732.63" "$2,732.63" "$2,732.63" "$1,366.32" "$1,366.32" "$2,164.24" "$2,732.63" "$2,186.10" "$1,776.21" "$2,732.63" N/A "$1,585.14" "$2,732.63" "$1,639.58" "$2,732.63" "$2,732.63" "$2,732.63" N/A N/A 204002 SUP HCPCS Q4116 204002 - GRAFT SKN STRATTICE 20 X 40 BOTH IP/OP "$50,720.00" "$37,533.00" "$7,712.84" "$50,720.00" "$22,824.00" "$22,824.00" "$22,824.00" "$22,824.00" "$50,720.00" "$50,720.00" "$50,720.00" "$9,417.94" "$50,720.00" "$50,720.00" "$50,720.00" "$50,720.00" "$50,720.00" "$10,570.61" "$50,720.00" "$50,720.00" "$25,004.96" "$50,720.00" "$50,720.00" "$50,720.00" "$50,720.00" "$38,040.00" "$50,720.00" "$50,720.00" "$50,720.00" "$25,360.00" "$25,360.00" "$40,170.24" "$50,720.00" "$40,576.00" "$22,824.00" "$7,712.84" N/A "$29,417.60" "$50,720.00" "$50,720.00" "$50,720.00" "$8,098.48" "$50,720.00" N/A N/A 205108 SUP Custom 27203010 205108 - DEVICE TISSUE CLOSURE 8CM EXTEND TIP APPLICATOR BOTH IP/OP "$2,830.50" "$2,095.00" $503.76 "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" $503.76 "$2,830.10" "$2,830.10" "$2,100.50" "$2,100.50" "$2,181.44" "$1,474.48" $589.82 "$2,830.10" "$1,132.04" "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" "$2,122.88" "$2,830.10" "$2,830.10" "$2,830.10" "$1,415.05" "$1,415.05" "$2,241.44" "$2,830.10" "$2,264.08" "$1,839.57" "$2,830.10" N/A "$1,641.69" "$2,830.10" "$1,698.06" "$2,830.10" "$2,830.10" "$2,830.10" N/A N/A 206010 SUP Custom 27203010 206010 - STONE BREAKER BOTH IP/OP "$1,687.50" "$1,249.00" $300.38 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" $300.38 "$1,687.50" "$1,687.50" "$1,252.46" "$1,252.46" "$1,300.73" $879.19 $351.69 "$1,687.50" $675.00 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" "$1,096.88" "$1,687.50" N/A $978.75 "$1,687.50" "$1,012.50" "$1,687.50" "$1,687.50" "$1,687.50" N/A N/A 206020 SUP Custom 27203010 206020 - STONE BRAKER PROBE 20 MM BOTH IP/OP "$1,687.50" "$1,249.00" $300.38 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" $300.38 "$1,687.50" "$1,687.50" "$1,252.46" "$1,252.46" "$1,300.73" $879.19 $351.69 "$1,687.50" $675.00 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" "$1,096.88" "$1,687.50" N/A $978.75 "$1,687.50" "$1,012.50" "$1,687.50" "$1,687.50" "$1,687.50" N/A N/A 206520 SUP Custom 27203010 206520 - SEALANT TISS CLSR 5ML STRL LF DURASEAL EXACT SPNE DISP BOTH IP/OP "$14,296.50" "$10,579.00" "$2,060.15" "$14,296.10" "$14,296.10" "$14,296.10" "$14,296.10" "$14,296.10" "$14,296.10" "$14,296.10" "$2,544.71" "$14,296.10" "$14,296.10" "$4,181.12" "$4,181.12" "$11,019.43" "$2,060.15" "$2,979.46" "$14,296.10" "$5,718.44" "$14,296.10" "$14,296.10" "$14,296.10" "$14,296.10" "$14,296.10" "$10,722.38" "$14,296.10" "$14,296.10" "$14,296.10" "$7,148.05" "$7,148.05" "$11,322.51" "$14,296.10" "$11,436.88" "$9,292.47" "$14,296.10" N/A "$8,291.97" "$14,296.10" "$8,577.66" "$14,296.10" "$14,296.10" "$14,296.10" N/A N/A 210439 SUP Custom 27203010 210439 - BIT DRL LNG 2MM 127MM STRL TWST SS BOTH IP/OP $175.50 $130.00 $31.22 $175.40 $175.40 $175.40 $175.40 $175.40 $175.40 $175.40 $31.22 $175.40 $175.40 $130.18 $130.18 $135.20 $91.38 $36.56 $175.40 $49.56 $175.40 $175.40 $123.90 $175.40 $175.40 $131.63 $175.40 $175.40 $175.40 $87.70 $87.70 $138.92 $175.40 $140.32 $114.01 $175.40 N/A $101.79 $175.40 $105.24 $175.40 $175.40 $175.40 N/A N/A 210440 SUP Custom 27203010 210440 - BIT DRL LNG 2.4MM 127MM STRL CUT SS BOTH IP/OP $175.50 $130.00 $31.22 $175.40 $175.40 $175.40 $175.40 $175.40 $175.40 $175.40 $31.22 $175.40 $175.40 $130.18 $130.18 $135.20 $91.38 $36.56 $175.40 $49.56 $175.40 $175.40 $123.90 $175.40 $175.40 $131.63 $175.40 $175.40 $175.40 $87.70 $87.70 $138.92 $175.40 $140.32 $114.01 $175.40 N/A $101.79 $175.40 $105.24 $175.40 $175.40 $175.40 N/A N/A 210441 SUP Custom 27203010 210441 - BIT DRL LNG 2.7MM 127MM STRL TWST SS BOTH IP/OP $175.50 $130.00 $31.22 $175.40 $175.40 $175.40 $175.40 $175.40 $175.40 $175.40 $31.22 $175.40 $175.40 $130.18 $130.18 $135.20 $91.38 $36.56 $175.40 $49.56 $175.40 $175.40 $123.90 $175.40 $175.40 $131.63 $175.40 $175.40 $175.40 $87.70 $87.70 $138.92 $175.40 $140.32 $114.01 $175.40 N/A $101.79 $175.40 $105.24 $175.40 $175.40 $175.40 N/A N/A 210442 SUP Custom 27203010 210442 - BIT DRL 3.2MM 127MM STRL TWST SS BOTH IP/OP $175.50 $130.00 $31.22 $175.40 $175.40 $175.40 $175.40 $175.40 $175.40 $175.40 $31.22 $175.40 $175.40 $130.18 $130.18 $135.20 $91.38 $36.56 $175.40 $49.56 $175.40 $175.40 $123.90 $175.40 $175.40 $131.63 $175.40 $175.40 $175.40 $87.70 $87.70 $138.92 $175.40 $140.32 $114.01 $175.40 N/A $101.79 $175.40 $105.24 $175.40 $175.40 $175.40 N/A N/A 210444 SUP Custom 27203010 210444 - BIT DRL LNG 4MM 127MM STRL TWST SS BOTH IP/OP $132.50 $98.00 $23.55 $132.30 $132.30 $132.30 $132.30 $132.30 $132.30 $132.30 $23.55 $132.30 $132.30 $98.19 $98.19 $101.98 $68.93 $27.57 $132.30 $52.92 $132.30 $132.30 $132.30 $132.30 $132.30 $99.38 $132.30 $132.30 $132.30 $66.15 $66.15 $104.78 $132.30 $105.84 $86.00 $132.30 N/A $76.85 $132.30 $79.38 $132.30 $132.30 $132.30 N/A N/A 210445 SUP Custom 27203010 210445 - BIT DRL LNG 4.3MM 127MM STRL CUT SS BOTH IP/OP $132.50 $98.00 $23.55 $132.30 $132.30 $132.30 $132.30 $132.30 $132.30 $132.30 $23.55 $132.30 $132.30 $98.19 $98.19 $101.98 $68.93 $27.57 $132.30 $52.92 $132.30 $132.30 $132.30 $132.30 $132.30 $99.38 $132.30 $132.30 $132.30 $66.15 $66.15 $104.78 $132.30 $105.84 $86.00 $132.30 N/A $76.85 $132.30 $79.38 $132.30 $132.30 $132.30 N/A N/A 210446 SUP Custom 27203010 210446 - BIT DRL LNG 4.7MM 127MM TWST SS BOTH IP/OP $132.50 $98.00 $23.55 $132.30 $132.30 $132.30 $132.30 $132.30 $132.30 $132.30 $23.55 $132.30 $132.30 $98.19 $98.19 $101.98 $68.93 $27.57 $132.30 $52.92 $132.30 $132.30 $132.30 $132.30 $132.30 $99.38 $132.30 $132.30 $132.30 $66.15 $66.15 $104.78 $132.30 $105.84 $86.00 $132.30 N/A $76.85 $132.30 $79.38 $132.30 $132.30 $132.30 N/A N/A 210447 SUP Custom 27203010 210447 - BIT DRL 5.5MM 127MM STRL TWST SS BOTH IP/OP $141.00 $104.00 $25.04 $140.70 $140.70 $140.70 $140.70 $140.70 $140.70 $140.70 $25.04 $140.70 $140.70 $104.43 $104.43 $108.45 $73.30 $29.32 $140.70 $56.28 $140.70 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $91.46 $140.70 N/A $81.78 $140.70 $84.42 $140.70 $140.70 $140.70 N/A N/A 210448 SUP Custom 27203010 210448 - BIT DRL LNG 6.4MM 127MM STRL CUT SS BOTH IP/OP $132.50 $98.00 $23.55 $132.30 $132.30 $132.30 $132.30 $132.30 $132.30 $132.30 $23.55 $132.30 $132.30 $98.19 $98.19 $101.98 $68.93 $27.57 $132.30 $52.92 $132.30 $132.30 $132.30 $132.30 $132.30 $99.38 $132.30 $132.30 $132.30 $66.15 $66.15 $104.78 $132.30 $105.84 $86.00 $132.30 N/A $76.85 $132.30 $79.38 $132.30 $132.30 $132.30 N/A N/A 210450 SUP Custom 27203010 210450 - BIT DRL 2.7MM 152.4MM STRL TWST SS BOTH IP/OP $157.50 $117.00 $28.04 $157.50 $157.50 $157.50 $157.50 $157.50 $157.50 $157.50 $28.04 $157.50 $157.50 $116.90 $116.90 $121.40 $82.06 $32.82 $157.50 $63.00 $157.50 $157.50 $157.50 $157.50 $157.50 $118.13 $157.50 $157.50 $157.50 $78.75 $78.75 $124.74 $157.50 $126.00 $102.38 $157.50 N/A $91.35 $157.50 $94.50 $157.50 $157.50 $157.50 N/A N/A 210451 SUP Custom 27203010 210451 - BIT DRL LNG 3.5MM 152.4MM STRL TWST SS BOTH IP/OP $230.00 $170.00 $40.94 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $230.00 $40.94 $230.00 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $64.89 $230.00 $230.00 $162.23 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $230.00 N/A $133.40 $230.00 $138.00 $230.00 $230.00 $230.00 N/A N/A 210454 SUP Custom 27203010 210454 - BIT DRL 5/16MM STRL TWST SS BOTH IP/OP $507.50 $376.00 $90.27 $507.15 $507.15 $507.15 $507.15 $507.15 $507.15 $507.15 $90.27 $507.15 $507.15 $376.41 $376.41 $390.91 $264.23 $105.70 $507.15 $202.86 $507.15 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $329.65 $507.15 N/A $294.35 $507.15 $304.29 $507.15 $507.15 $507.15 N/A N/A 210455 SUP Custom 27203010 210455 - BIT DRL LG 9.5MM 127MM STRL TWST SS BOTH IP/OP $632.50 $468.00 $112.51 $632.10 $632.10 $632.10 $632.10 $632.10 $632.10 $632.10 $112.51 $632.10 $632.10 $469.14 $469.14 $487.22 $329.32 $131.74 $632.10 $252.84 $632.10 $632.10 $632.10 $632.10 $632.10 $474.38 $632.10 $632.10 $632.10 $316.05 $316.05 $500.62 $632.10 $505.68 $410.87 $632.10 N/A $366.85 $632.10 $379.26 $632.10 $632.10 $632.10 N/A N/A 210458 SUP Custom 27203010 210458 - BIT DRL LG 11.1MM 127MM STRL TWST SS BOTH IP/OP $679.50 $503.00 $120.92 $679.35 $679.35 $679.35 $679.35 $679.35 $679.35 $679.35 $120.92 $679.35 $679.35 $504.21 $504.21 $523.64 $353.94 $141.58 $679.35 $271.74 $679.35 $679.35 $679.35 $679.35 $679.35 $509.63 $679.35 $679.35 $679.35 $339.68 $339.68 $538.05 $679.35 $543.48 $441.58 $679.35 N/A $394.11 $679.35 $407.61 $679.35 $679.35 $679.35 N/A N/A 210461 SUP Custom 27203010 210461 - BIT DRL LG 12.7MM 127MM TWST BOTH IP/OP $679.50 $503.00 $120.92 $679.35 $679.35 $679.35 $679.35 $679.35 $679.35 $679.35 $120.92 $679.35 $679.35 $504.21 $504.21 $523.64 $353.94 $141.58 $679.35 $271.74 $679.35 $679.35 $679.35 $679.35 $679.35 $509.63 $679.35 $679.35 $679.35 $339.68 $339.68 $538.05 $679.35 $543.48 $441.58 $679.35 N/A $394.11 $679.35 $407.61 $679.35 $679.35 $679.35 N/A N/A 210465 SUP Custom 27203010 210465 - BIT DRL 3.6MM 152.4MM STRL TWST SS BOTH IP/OP $217.50 $161.00 $38.69 $217.35 $217.35 $217.35 $217.35 $217.35 $217.35 $217.35 $38.69 $217.35 $217.35 $161.32 $161.32 $167.53 $113.24 $45.30 $217.35 $86.94 $217.35 $217.35 $217.35 $217.35 $217.35 $163.13 $217.35 $217.35 $217.35 $108.68 $108.68 $172.14 $217.35 $173.88 $141.28 $217.35 N/A $126.15 $217.35 $130.41 $217.35 $217.35 $217.35 N/A N/A 210550 SUP Custom 27203010 210550 - BIT DRL 2.4MM 127MM STRL TWST SUT HL SS BOTH IP/OP $167.00 $124.00 $29.72 $166.95 $166.95 $166.95 $166.95 $166.95 $166.95 $166.95 $29.72 $166.95 $166.95 $123.91 $123.91 $128.69 $86.98 $34.79 $166.95 $66.78 $166.95 $166.95 $166.95 $166.95 $166.95 $125.25 $166.95 $166.95 $166.95 $83.48 $83.48 $132.22 $166.95 $133.56 $108.52 $166.95 N/A $96.86 $166.95 $100.17 $166.95 $166.95 $166.95 N/A N/A 210551 SUP Custom 27203010 210551 - BIT DRL 2.7MM 127MM STRL TWST SUT HL SS BOTH IP/OP $167.00 $124.00 $29.72 $166.95 $166.95 $166.95 $166.95 $166.95 $166.95 $166.95 $29.72 $166.95 $166.95 $123.91 $123.91 $128.69 $86.98 $34.79 $166.95 $66.78 $166.95 $166.95 $166.95 $166.95 $166.95 $125.25 $166.95 $166.95 $166.95 $83.48 $83.48 $132.22 $166.95 $133.56 $108.52 $166.95 N/A $96.86 $166.95 $100.17 $166.95 $166.95 $166.95 N/A N/A 210552 SUP Custom 27203010 210552 - BIT DRL 3.1MM 127MM STRL TWST SUT HL SS BOTH IP/OP $165.00 $122.00 $29.34 $164.85 $164.85 $164.85 $164.85 $164.85 $164.85 $164.85 $29.34 $164.85 $164.85 $122.35 $122.35 $127.07 $85.89 $34.36 $164.85 $65.94 $164.85 $164.85 $164.85 $164.85 $164.85 $123.75 $164.85 $164.85 $164.85 $82.43 $82.43 $130.56 $164.85 $131.88 $107.15 $164.85 N/A $95.70 $164.85 $98.91 $164.85 $164.85 $164.85 N/A N/A 210554 SUP Custom 27203010 210554 - BIT DRL 3.9MM 127MM STRL TWST SUT HL BOTH IP/OP $165.00 $122.00 $29.34 $164.85 $164.85 $164.85 $164.85 $164.85 $164.85 $164.85 $29.34 $164.85 $164.85 $122.35 $122.35 $127.07 $85.89 $34.36 $164.85 $65.94 $164.85 $164.85 $164.85 $164.85 $164.85 $123.75 $164.85 $164.85 $164.85 $82.43 $82.43 $130.56 $164.85 $131.88 $107.15 $164.85 N/A $95.70 $164.85 $98.91 $164.85 $164.85 $164.85 N/A N/A 211250 SUP HCPCS C1763 211250 - GRAFT SOFT TISSUE 2-3MM 50MM ALLOGRAFT MULTIPLE CLEAN AVANCE BOTH IP/OP "$11,165.00" "$8,262.00" "$2,215.97" "$12,190.00" "$5,024.25" "$5,024.25" "$5,024.25" "$5,024.25" "$11,165.00" "$11,165.00" "$11,165.00" "$2,327.07" "$11,165.00" "$11,165.00" "$11,165.00" "$11,165.00" "$11,165.00" "$2,326.91" "$11,165.00" "$12,190.00" "$5,504.35" "$11,165.00" "$11,610.00" "$11,165.00" "$11,165.00" "$8,373.75" "$11,165.00" "$11,165.00" "$11,165.00" "$5,582.50" "$5,582.50" "$8,842.68" "$11,165.00" "$8,932.00" "$5,024.25" "$2,215.97" N/A "$6,475.70" "$11,165.00" "$11,165.00" "$11,165.00" "$2,326.79" "$11,165.00" N/A N/A 211610 SUP Custom 27100030 211610 - SPLINT ORTH 10.5IN UNI-VERSITAL HKLP CLSR MLBL PLMR DRSL BOTH IP/OP $26.00 $19.00 $4.63 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $26.00 $4.63 $26.00 $26.00 $19.30 $19.30 $20.04 $13.55 $5.42 $26.00 $10.71 $26.00 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $16.90 $26.00 N/A $15.08 $26.00 $15.60 $26.00 $26.00 $26.00 N/A N/A 212038 SUP HCPCS C1713 212038 - ANCHOR SUT 0 OS-2 MN 1.8MM 5.4MM QANCHR+ OTHCRD ABS TI NTNL BOTH IP/OP "$1,027.50" $760.00 $203.93 "$1,027.50" $462.38 $462.38 $462.38 $462.38 "$1,027.50" "$1,027.50" "$1,027.50" $214.16 "$1,027.50" "$1,027.50" "$1,027.50" "$1,027.50" "$1,027.50" $214.14 "$1,027.50" "$1,027.50" $607.77 "$1,027.50" "$1,027.50" "$1,027.50" "$1,027.50" $770.63 "$1,027.50" "$1,027.50" "$1,027.50" $513.75 $513.75 $813.78 "$1,027.50" $822.00 $462.38 $203.93 N/A $595.95 "$1,027.50" "$1,027.50" "$1,027.50" $214.13 "$1,027.50" N/A N/A 212133 SUP HCPCS C1713 212133 - ANCHOR SUTURE 0 OS-2 MINI ARTHRO QUICKANCHOR PLUS TITANIUM BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" "$1,000.00" $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.40 "$1,000.00" N/A N/A 212843 SUP HCPCS C1713 212843 - ANCHOR SUT 3-0 V-4 MIC 1.3MM STRL LF QANCHR+ OTHCRD BABSR BOTH IP/OP "$1,480.00" "$1,095.00" $293.74 "$1,480.00" $666.00 $666.00 $666.00 $666.00 "$1,480.00" "$1,480.00" "$1,480.00" $308.47 "$1,480.00" "$1,480.00" "$1,480.00" "$1,480.00" "$1,480.00" $308.45 "$1,480.00" $592.00 $875.42 "$1,480.00" "$1,480.00" "$1,480.00" "$1,480.00" "$1,110.00" "$1,480.00" "$1,480.00" "$1,480.00" $740.00 $740.00 "$1,172.16" "$1,480.00" "$1,184.00" $666.00 $293.74 N/A $858.40 "$1,480.00" $888.00 "$1,480.00" $308.43 "$1,480.00" N/A N/A 212865 SUP HCPCS C1713 212865 - ANCHOR SUT 3-0 V-4 MIC QAN+ ETH BIT BOTH IP/OP $740.00 $548.00 $146.87 $740.00 $333.00 $333.00 $333.00 $333.00 $740.00 $740.00 $740.00 $154.23 $740.00 $740.00 $740.00 $740.00 $740.00 $154.22 $740.00 $740.00 $437.71 $740.00 $740.00 $740.00 $740.00 $555.00 $740.00 $740.00 $740.00 $370.00 $370.00 $586.08 $740.00 $592.00 $333.00 $146.87 N/A $429.20 $740.00 $444.00 $740.00 $154.22 $740.00 N/A N/A 213524 SUP HCPCS C1713 213524 - PIN FX 3.2MM 110MM STRL LF BN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $63.04 $302.50 N/A N/A 213527 SUP HCPCS C1713 213527 - PIN FX 3.2MM 140MM STRL LF BN BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $63.04 $302.50 N/A N/A 219791 SUP Custom 27203010 219791 - MONTEFIORE 7FR X 100CM BOTH IP/OP $39.50 $29.00 $7.01 $39.38 $39.38 $39.38 $39.38 $39.38 $39.38 $39.38 $7.01 $39.38 $39.38 $29.23 $29.23 $30.35 $20.52 $8.21 $39.38 $15.75 $39.38 $39.38 $39.38 $39.38 $39.38 $29.63 $39.38 $39.38 $39.38 $19.69 $19.69 $31.19 $39.38 $31.50 $25.60 $39.38 N/A $22.91 $39.38 $23.63 $39.38 $39.38 $39.38 N/A N/A 222000 SUP HCPCS L1830 222000 - IMMOBILIZER ORTHOPEDIC UNIVERSAL 28- IN 18-24IN 2 CUFF BOTH IP/OP $47.50 $35.00 $9.82 $48.84 $47.13 $47.13 $47.13 $47.13 $47.13 $47.13 $48.84 $47.13 $47.13 $47.13 $47.13 $47.13 $47.13 $9.82 $47.13 $18.85 $47.13 $47.13 $47.13 $47.13 $47.13 $35.63 $47.13 $47.13 $47.13 $23.57 $23.57 $37.33 $47.13 $37.70 $21.21 $47.13 N/A $27.55 $47.13 $28.28 $47.13 $47.13 $47.13 N/A N/A 222820 SUP HCPCS C1713 222820 - SCREW BN 6MM FT 4MM 2.7MM 1.3MM 20MM STRL EXCEL ST FLUT CNN BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 222822 SUP HCPCS C1713 222822 - SCREW BN FT FLUT 4MM 22MM STRL EXCEL ST CNN TROC SS HIP BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 222824 SUP HCPCS C1713 222824 - SCREW BN 6MM FT 4MM 2.7MM 1.3MM 24MM STRL EXCEL ST FLUT CNN BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 222826 SUP HCPCS C1713 222826 - SCREW BN FT FLUT 4MM 26MM STRL EXCEL ST CNN TROC SS HIP BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 222828 SUP HCPCS C1713 222828 - SCREW BN FT FLUT 4MM 28MM STRL EXCEL ST CNN TROC SS HIP BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 222830 SUP HCPCS C1713 222830 - SCREW BN FT FLUT 4MM 30MM STRL EXCEL ST CNN TROC SS HIP BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 222835 SUP HCPCS C1713 222835 - SCREW BN FT FLUT 4MM 35MM STRL EXCEL ST CNN TROC SS HIP BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 222840 SUP HCPCS C1713 222840 - SCREW BN 6MM FT 4MM 2.7MM 1.3MM 40MM STRL EXCEL ST FLUT CNN BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 222845 SUP HCPCS C1713 222845 - SCREW BN FT FLUT 4MM 45MM STRL EXCEL ST CNN TROC SS HIP BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 222850 SUP HCPCS C1713 222850 - SCREW BN FT FLUT 4MM 50MM STRL EXCEL ST CNN TROC SS HIP BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 222855 SUP HCPCS C1713 222855 - SCREW BN FT FLUT 4MM 55MM STRL EXCEL ST CNN TROC SS HIP BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 222860 SUP HCPCS C1713 222860 - SCREW BN FT FLUT 4MM 60MM STRL EXCEL ST CNN TROC SS HIP BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $399.00 $399.00 $83.15 $399.00 N/A N/A 222865 SUP HCPCS C1713 222865 - SCREW BN FT FLUT 4MM 65MM STRL EXCEL ST CNN TROC SS HIP BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 222870 SUP HCPCS C1713 222870 - SCREW BN FT FLUT 4MM 70MM STRL EXCEL ST CNN TROC SS HIP BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 222983 SUP HCPCS C1713 222983 - ANCHOR SUT 2 CP-2 2.4MM 8.8MM STRL G2QKAN + OTHCRD NDL NTNL BOTH IP/OP "$1,030.00" $762.00 $204.43 "$1,030.00" $463.50 $463.50 $463.50 $463.50 "$1,030.00" "$1,030.00" "$1,030.00" $214.68 "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" $214.66 "$1,030.00" "$1,030.00" $609.25 "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" $772.50 "$1,030.00" "$1,030.00" "$1,030.00" $515.00 $515.00 $815.76 "$1,030.00" $824.00 $463.50 $204.43 N/A $597.40 "$1,030.00" "$1,030.00" "$1,030.00" $214.65 "$1,030.00" N/A N/A 222984 SUP HCPCS C1713 222984 - ANCHOR SUT 2 CP-2 2.8MM 11.4MM STRL QANCHR+ OTHCRD NDL NTNL BOTH IP/OP "$1,712.50" "$1,267.00" $339.89 "$1,712.50" $770.63 $770.63 $770.63 $770.63 "$1,712.50" "$1,712.50" "$1,712.50" $356.93 "$1,712.50" "$1,712.50" "$1,712.50" "$1,712.50" "$1,712.50" $356.90 "$1,712.50" "$1,712.50" "$1,012.94" "$1,712.50" "$1,712.50" "$1,712.50" "$1,712.50" "$1,284.38" "$1,712.50" "$1,712.50" "$1,712.50" $856.25 $856.25 "$1,356.30" "$1,712.50" "$1,370.00" $770.63 $339.89 N/A $993.25 "$1,712.50" "$1,712.50" "$1,712.50" $356.89 "$1,712.50" N/A N/A 223522 SUP HCPCS C1713 223522 - NAIL IM 3.5MM 22CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 223524 SUP HCPCS C1713 223524 - NAIL IM 3.5MM 24CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 223525 SUP HCPCS C1713 223525 - NAIL IM 3.5MM 25CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" "$1,092.38" "$1,092.38" $227.65 "$1,092.38" N/A N/A 223526 SUP HCPCS C1713 223526 - NAIL IM 3.5MM 26CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 223527 SUP HCPCS C1713 223527 - NAIL IM 3.5MM 27CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 223528 SUP HCPCS C1713 223528 - NAIL IM 3.5MM 28CM ENDR ORTH BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 223529 SUP HCPCS C1713 223529 - NAIL IM 3.5MM 29CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 223530 SUP HCPCS C1713 223530 - NAIL IM 3.5MM 30CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 223531 SUP HCPCS C1713 223531 - NAIL IM 3.5MM 31CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 223532 SUP HCPCS C1713 223532 - NAIL IM 3.5MM 32CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 223533 SUP HCPCS C1713 223533 - NAIL IM 3.5MM 33CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 223534 SUP HCPCS C1713 223534 - NAIL IM 3.5MM 34CM ENDR ADLT ORTH BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 223535 SUP HCPCS C1713 223535 - NAIL IM 3.5MM 35CM ENDR ORTH BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 223536 SUP HCPCS C1713 223536 - NAIL IM 3.5MM 36CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 223537 SUP HCPCS C1713 223537 - NAIL IM 3.5MM 37CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 223538 SUP HCPCS C1713 223538 - NAIL IM 3.5MM 38CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 224022 SUP HCPCS C1713 224022 - NAIL IM 4MM 22CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224023 SUP HCPCS C1713 224023 - NAIL IM 4MM 23CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224024 SUP HCPCS C1713 224024 - NAIL IM 4MM 24CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224025 SUP HCPCS C1713 224025 - NAIL IM 4MM 25CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224026 SUP HCPCS C1713 224026 - NAIL IM 4MM 26CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 224027 SUP HCPCS C1713 224027 - NAIL IM 4MM 27CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 224028 SUP HCPCS C1713 224028 - NAIL IM 4MM 28CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" "$1,092.38" "$1,092.38" $227.65 "$1,092.38" N/A N/A 224029 SUP HCPCS C1713 224029 - NAIL IM 4MM 29CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224030 SUP HCPCS C1713 224030 - NAIL IM 4MM 30CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224031 SUP HCPCS C1713 224031 - NAIL IM 4MM 31CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 224032 SUP HCPCS C1713 224032 - NAIL IM 4MM 32CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 224033 SUP HCPCS C1713 224033 - NAIL IM 4MM 33CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 224034 SUP HCPCS C1713 224034 - NAIL IM 4MM 34CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224035 SUP HCPCS C1713 224035 - NAIL IM 4MM 35CM ENDR SS HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224037 SUP HCPCS C1713 224037 - NAIL IM 4MM 37CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 224527 SUP HCPCS C1713 224527 - NAIL IM 4.5MM 27CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 224532 SUP HCPCS C1713 224532 - NAIL IM 4.5MM 32CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224533 SUP HCPCS C1713 224533 - NAIL IM 4.5MM 33CM ENDR BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 224534 SUP HCPCS C1713 224534 - NAIL IM 4.5MM 34CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224535 SUP HCPCS C1713 224535 - NAIL IM 4.5MM 35CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224536 SUP HCPCS C1713 224536 - NAIL IM 4.5MM 36CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224537 SUP HCPCS C1713 224537 - NAIL IM 4.5MM 37CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224538 SUP HCPCS C1713 224538 - NAIL IM 4.5MM 38CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224539 SUP HCPCS C1713 224539 - NAIL IM 4.5MM 39CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 224540 SUP HCPCS C1713 224540 - NAIL IM 4.5MM 40CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" "$1,092.38" "$1,092.38" N/A N/A 224541 SUP HCPCS C1713 224541 - NAIL IM 4.5MM 41CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224542 SUP HCPCS C1713 224542 - NAIL IM 4.5MM 42CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224543 SUP HCPCS C1713 224543 - NAIL IM 4.5MM 43CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224544 SUP HCPCS C1713 224544 - NAIL IM 4.5MM 44CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224545 SUP HCPCS C1713 224545 - NAIL IM 4.5MM 45CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" $436.95 $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224546 SUP HCPCS C1713 224546 - NAIL IM 4.5MM 46CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224547 SUP HCPCS C1713 224547 - NAIL IM 4.5MM 47CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224548 SUP HCPCS C1713 224548 - NAIL IM 4.5MM 48CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 224549 SUP HCPCS C1713 224549 - NAIL IM 4.5MM 49CM ENDR HUM TIB BOTH IP/OP "$1,092.50" $808.00 $216.81 "$1,092.38" $491.57 $491.57 $491.57 $491.57 "$1,092.38" "$1,092.38" "$1,092.38" $227.68 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $227.66 "$1,092.38" "$1,092.38" $646.14 "$1,092.38" "$1,092.38" "$1,092.38" "$1,092.38" $819.38 "$1,092.38" "$1,092.38" "$1,092.38" $546.19 $546.19 $865.16 "$1,092.38" $873.90 $491.57 $216.81 N/A $633.65 "$1,092.38" $655.43 "$1,092.38" $227.65 "$1,092.38" N/A N/A 232447 SUP HCPCS C1713 232447 - SYSTEM FX STD RIGIDLOOP ADJ CORT BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A Jan-00 SUP Custom 27803010 01-2600 - HEAD FEMORAL MORSE TAPERED LFIT HIP BOTH IP/OP "$1,795.00" "$1,328.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $374.10 "$1,795.00" $718.00 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,346.25" "$1,795.00" "$1,795.00" "$1,795.00" $897.50 $897.50 "$1,421.64" "$1,795.00" "$1,436.00" $807.75 "$1,795.00" N/A "$1,041.10" "$1,795.00" "$1,077.00" "$1,795.00" "$1,795.00" "$1,795.00" N/A N/A Jun-00 SUP Custom 27803010 06-2600 - HEAD FEMORAL 0 26MM C TAPER LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A Jan-05 SUP Custom 27803010 01-2605 - HEAD FEMORAL +5MM 26MM MORSE TAPERED LFIT COCR HIP BOTH IP/OP "$1,795.00" "$1,328.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $374.10 "$1,795.00" $718.00 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,346.25" "$1,795.00" "$1,795.00" "$1,795.00" $897.50 $897.50 "$1,421.64" "$1,795.00" "$1,436.00" $807.75 "$1,795.00" N/A "$1,041.10" "$1,795.00" "$1,077.00" "$1,795.00" "$1,795.00" "$1,795.00" N/A N/A Jun-05 SUP Custom 27803010 06-2605 - HEAD FEMORAL +5MM 26MM C TAPER OFFST LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 258962 SUP HCPCS C1769 258962 - INTROD TUBE 24-28FR CGL BRHN 8 PERC HYDPHI INTROD SHLY DILAT BOTH IP/OP $844.00 $625.00 $167.46 $843.75 $458.16 $458.16 $458.16 $458.16 $843.75 $843.75 $843.75 $175.86 $843.75 $626.23 $626.23 $650.36 $439.59 $175.85 $843.75 $843.75 $499.08 $843.75 $843.75 $843.75 $843.75 $633.00 $843.75 $843.75 $843.75 $421.88 $421.88 $668.25 $843.75 $675.00 $548.44 $167.46 N/A $489.52 $843.75 $506.25 $843.75 $175.84 $843.75 N/A N/A Jan-10 SUP Custom 27803010 01-2610 - HEAD FEMORAL +10MM 26MM MORSE TAPERED LFIT COCR BOTH IP/OP "$1,795.00" "$1,328.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $374.10 "$1,795.00" $718.00 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,346.25" "$1,795.00" "$1,795.00" "$1,795.00" $897.50 $897.50 "$1,421.64" "$1,795.00" "$1,436.00" $807.75 "$1,795.00" N/A "$1,041.10" "$1,795.00" "$1,077.00" "$1,795.00" "$1,795.00" "$1,795.00" N/A N/A Jun-10 SUP Custom 27803010 06-2610 - HEAD FEMORAL +10MM 26MM C TAPER LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 261221 SUP Custom 27203010 261221 - PERFORATOR SURG 14MM 11MM 14X11MM CRANIUM ADULT STERILE BOTH IP/OP $735.50 $544.00 $130.84 $735.05 $735.05 $735.05 $735.05 $735.05 $735.05 $735.05 $130.84 $735.05 $735.05 $545.55 $545.55 $566.58 $382.96 $153.19 $735.05 $294.02 $735.05 $735.05 $735.05 $735.05 $735.05 $551.63 $735.05 $735.05 $735.05 $367.53 $367.53 $582.16 $735.05 $588.04 $477.78 $735.05 N/A $426.59 $735.05 $441.03 $735.05 $735.05 $735.05 N/A N/A 263567 SUP HCPCS C1769 263567 - SET INTROD 24-26-28FR CGL BRHN 6 PERC EZ-PASS HYDPHI COAT BOTH IP/OP $905.50 $670.00 $179.63 $905.05 $491.44 $491.44 $491.44 $491.44 $905.05 $905.05 $905.05 $188.64 $905.05 $671.73 $671.73 $697.61 $471.53 $188.62 $905.05 $905.05 $535.34 $905.05 $905.05 $905.05 $905.05 $679.13 $905.05 $905.05 $905.05 $452.53 $452.53 $716.80 $905.05 $724.04 $588.28 $179.63 N/A $525.19 $905.05 $905.05 $905.05 $188.61 $905.05 N/A N/A 265724 SUP HCPCS A4338 265724 - CATHETER URTH 24FR 5CC STRL LTX BARD 2W FL 2 OPPS EYE NTR BOTH IP/OP $5.00 $4.00 $0.96 $19.94 $4.60 $4.60 $4.60 $4.60 $4.60 $4.60 $8.88 $4.60 $4.60 $3.41 $3.41 $3.55 $2.40 $0.96 $4.60 $4.80 $4.60 $4.60 $19.94 $4.60 $4.60 $3.75 $4.60 $4.60 $4.60 $2.30 $2.30 $3.64 $4.60 $3.68 $2.99 $4.60 N/A $2.90 $4.60 $2.76 $4.60 $4.60 $4.60 N/A N/A 265726 SUP HCPCS A4338 265726 - CATHETER URETHRAL 26FR 2 WAY FOLEY BALLOON LATEX BARD BOTH IP/OP $5.00 $4.00 $0.96 $8.88 $4.60 $4.60 $4.60 $4.60 $4.60 $4.60 $8.88 $4.60 $4.60 $3.41 $3.41 $3.55 $2.40 $0.96 $4.60 $1.84 $4.60 $4.60 $4.60 $4.60 $4.60 $3.75 $4.60 $4.60 $4.60 $2.30 $2.30 $3.64 $4.60 $3.68 $2.99 $4.60 N/A $2.90 $4.60 $2.76 $4.60 $4.60 $4.60 N/A N/A 266712 SUP HCPCS A4344 266712 - CATHETER URETHRAL 12FR 2 WAY 2 OPPOSING EYE FOLEY ROUND TIP BOTH IP/OP $6.00 $4.00 $1.14 $5.73 $3.11 $3.11 $3.11 $3.11 $5.73 $5.73 $5.73 $1.19 $5.73 $4.25 $4.25 $4.42 $2.99 $1.19 $5.73 $5.73 $3.39 $5.73 $5.73 $5.73 $5.73 $4.50 $5.73 $5.73 $5.73 $2.87 $2.87 $4.54 $5.73 $4.58 $3.72 $1.14 N/A $3.48 $5.73 $5.73 $5.73 $1.19 $5.73 N/A N/A 266714 SUP HCPCS A4344 266714 - CATHETER URETHRAL 14FR 2 WAY 2 OPPOSING EYE FOLEY ROUND TIP BOTH IP/OP $6.00 $4.00 $1.14 $5.73 $3.11 $3.11 $3.11 $3.11 $5.73 $5.73 $5.73 $1.19 $5.73 $4.25 $4.25 $4.42 $2.99 $1.19 $5.73 $5.73 $3.39 $5.73 $5.73 $5.73 $5.73 $4.50 $5.73 $5.73 $5.73 $2.87 $2.87 $4.54 $5.73 $4.58 $3.72 $1.14 N/A $3.48 $5.73 $5.73 $5.73 $1.19 $5.73 N/A N/A 266720 SUP Custom 27203010 266720 - CATHETER URTH 20FR 30CC STRL LTX BARD 2W FL 2 OPPS EYE BOTH IP/OP $6.00 $4.00 $1.02 $5.73 $5.73 $5.73 $5.73 $5.73 $5.73 $5.73 $1.02 $5.73 $5.73 $4.25 $4.25 $4.42 $2.99 $1.19 $5.73 $2.29 $5.73 $5.73 $5.73 $5.73 $5.73 $4.50 $5.73 $5.73 $5.73 $2.87 $2.87 $4.54 $5.73 $4.58 $3.72 $5.73 N/A $3.48 $5.73 $3.44 $5.73 $5.73 $5.73 N/A N/A 266722 SUP Custom 27203010 266722 - CATHETER URTH 22FR 30CC STRL LTX BARD 2W FL 2 OPPS EYE BOTH IP/OP $6.00 $4.00 $1.02 $5.73 $5.73 $5.73 $5.73 $5.73 $5.73 $5.73 $1.02 $5.73 $5.73 $4.25 $4.25 $4.42 $2.99 $1.19 $5.73 $2.29 $5.73 $5.73 $5.73 $5.73 $5.73 $4.50 $5.73 $5.73 $5.73 $2.87 $2.87 $4.54 $5.73 $4.58 $3.72 $5.73 N/A $3.48 $5.73 $3.44 $5.73 $5.73 $5.73 N/A N/A 266724 SUP HCPCS A4338 266724 - CATHETER URTH 24FR 30CC STRL LTX BARD 2W FL 2 OPPS EYE BOTH IP/OP $6.00 $4.00 $1.19 $8.88 $5.73 $5.73 $5.73 $5.73 $5.73 $5.73 $8.88 $5.73 $5.73 $4.25 $4.25 $4.42 $2.99 $1.19 $5.73 $2.29 $5.73 $5.73 $5.73 $5.73 $5.73 $4.50 $5.73 $5.73 $5.73 $2.87 $2.87 $4.54 $5.73 $4.58 $3.72 $5.73 N/A $3.48 $5.73 $3.44 $5.73 $5.73 $5.73 N/A N/A 266726 SUP HCPCS A4338 266726 - CATHETER URTH 26FR 30CC STRL LTX BARD 2W FL 2 OPPOSE EYE NTR BOTH IP/OP $6.00 $4.00 $1.19 $8.88 $5.73 $5.73 $5.73 $5.73 $5.73 $5.73 $8.88 $5.73 $5.73 $4.25 $4.25 $4.42 $2.99 $1.19 $5.73 $2.29 $5.73 $5.73 $5.73 $5.73 $5.73 $4.50 $5.73 $5.73 $5.73 $2.87 $2.87 $4.54 $5.73 $4.58 $3.72 $5.73 N/A $3.48 $5.73 $3.44 $5.73 $5.73 $5.73 N/A N/A 266728 SUP HCPCS A4338 266728 - CATHETER URTH 28FR 30CC STRL LTX BARD 2W FL 2 OPPOSE EYE NTR BOTH IP/OP $0.50 $0.00 $0.10 $8.88 $0.48 $0.48 $0.48 $0.48 $0.48 $0.48 $8.88 $0.48 $0.48 $0.36 $0.36 $0.37 $0.25 $0.10 $0.48 $0.19 $0.48 $0.48 $0.48 $0.48 $0.48 $0.38 $0.48 $0.48 $0.48 $0.24 $0.24 $0.38 $0.48 $0.38 $0.31 $0.48 N/A $0.29 $0.48 $0.29 $0.48 $0.48 $0.48 N/A N/A 276081 SUP Custom 27803010 276081 - SHUNT NEUROSURGICAL SMALL 23CM 120CM CSF PERITONEAL BOTH IP/OP "$4,724.00" "$3,496.00" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $984.51 "$4,723.88" "$1,889.55" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$3,543.00" "$4,723.88" "$4,723.88" "$4,723.88" "$2,361.94" "$2,361.94" "$3,741.31" "$4,723.88" "$3,779.10" "$2,125.75" "$4,723.88" N/A "$2,739.92" "$4,723.88" "$2,834.33" "$4,723.88" "$4,723.88" "$4,723.88" N/A N/A 276082 SUP Custom 27803010 276082 - SHUNT NEUROSURGICAL SMALL 23CM 120CM CSF PERITONEAL BOTH IP/OP "$4,724.00" "$3,496.00" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $984.51 "$4,723.88" "$1,889.55" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$3,543.00" "$4,723.88" "$4,723.88" "$4,723.88" "$2,361.94" "$2,361.94" "$3,741.31" "$4,723.88" "$3,779.10" "$2,125.75" "$4,723.88" N/A "$2,739.92" "$4,723.88" "$2,834.33" "$4,723.88" "$4,723.88" "$4,723.88" N/A N/A 276084 SUP Custom 27803010 276084 - SHUNT NEUROSURGICAL SMALL 23CM 120CM CSF PERITONEAL BOTH IP/OP "$4,724.00" "$3,496.00" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $984.51 "$4,723.88" "$1,889.55" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$3,543.00" "$4,723.88" "$4,723.88" "$4,723.88" "$2,361.94" "$2,361.94" "$3,741.31" "$4,723.88" "$3,779.10" "$2,125.75" "$4,723.88" N/A "$2,739.92" "$4,723.88" "$2,834.33" "$4,723.88" "$4,723.88" "$4,723.88" N/A N/A 276085 SUP Custom 27803010 276085 - SHUNT NEUROSURGICAL MEDIUM 23CM 120CM CSF PERITONEAL BOTH IP/OP "$4,724.00" "$3,496.00" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $984.51 "$4,723.88" "$1,889.55" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$3,543.00" "$4,723.88" "$4,723.88" "$4,723.88" "$2,361.94" "$2,361.94" "$3,741.31" "$4,723.88" "$3,779.10" "$2,125.75" "$4,723.88" N/A "$2,739.92" "$4,723.88" "$2,834.33" "$4,723.88" "$4,723.88" "$4,723.88" N/A N/A 276124 SUP Custom 27803010 276124 - SHUNT NEUROSURGICAL 11CM 90CM UNITIZED PERITONEAL BOTH IP/OP "$4,251.50" "$3,146.00" $756.72 "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" $756.72 "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" $886.01 "$4,251.25" "$1,700.50" "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" "$3,188.63" "$4,251.25" "$4,251.25" "$4,251.25" "$2,125.63" "$2,125.63" "$3,366.99" "$4,251.25" "$3,401.00" "$1,913.06" "$4,251.25" N/A "$2,465.87" "$4,251.25" "$2,550.75" "$4,251.25" "$4,251.25" "$4,251.25" N/A N/A 276125 SUP Custom 27803010 276125 - SHUNT NEUROSURGICAL 11CM 90CM UNITIZED PERITONEAL BOTH IP/OP "$4,251.50" "$3,146.00" $756.72 "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" $756.72 "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" $886.01 "$4,251.25" "$1,700.50" "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" "$4,251.25" "$3,188.63" "$4,251.25" "$4,251.25" "$4,251.25" "$2,125.63" "$2,125.63" "$3,366.99" "$4,251.25" "$3,401.00" "$1,913.06" "$4,251.25" N/A "$2,465.87" "$4,251.25" "$2,550.75" "$4,251.25" "$4,251.25" "$4,251.25" N/A N/A 276201 SUP Custom 27203010 276201 - KIT SHUNT SMALL 90CM 15CM CATHETER ASMBLY BIOGLIDE NEONATE BOTH IP/OP "$5,804.50" "$4,295.00" "$1,033.20" "$5,804.50" "$5,804.50" "$5,804.50" "$5,804.50" "$5,804.50" "$5,804.50" "$5,804.50" "$1,033.20" "$5,804.50" "$5,804.50" "$4,181.12" "$4,181.12" "$4,474.11" "$2,060.15" "$1,209.72" "$5,804.50" "$2,321.80" "$5,804.50" "$5,804.50" "$5,804.50" "$5,804.50" "$5,804.50" "$4,353.38" "$5,804.50" "$5,804.50" "$5,804.50" "$2,902.25" "$2,902.25" "$4,597.16" "$5,804.50" "$4,643.60" "$3,772.93" "$5,804.50" N/A "$3,366.61" "$5,804.50" "$3,482.70" "$5,804.50" "$5,804.50" "$5,804.50" N/A N/A 276391 SUP Custom 27203010 276391 - KIT SHUNT REGULAR 15CM 120CM CSF CATHETER RESERVOIR DELTA BOTH IP/OP "$4,971.00" "$3,679.00" $884.82 "$4,970.88" "$4,970.88" "$4,970.88" "$4,970.88" "$4,970.88" "$4,970.88" "$4,970.88" $884.82 "$4,970.88" "$4,970.88" "$3,689.39" "$3,689.39" "$3,831.55" "$2,060.15" "$1,035.99" "$4,970.88" "$1,988.35" "$4,970.88" "$4,970.88" "$4,970.88" "$4,970.88" "$4,970.88" "$3,728.25" "$4,970.88" "$4,970.88" "$4,970.88" "$2,485.44" "$2,485.44" "$3,936.94" "$4,970.88" "$3,976.70" "$3,231.07" "$4,970.88" N/A "$2,883.18" "$4,970.88" "$2,982.53" "$4,970.88" "$4,970.88" "$4,970.88" N/A N/A 276412 SUP Custom 27803010 276412 - SHUNT NEUROSURGICAL SMALL 130CM THORACIC CATHETER STRIPE BOTH IP/OP "$4,135.00" "$3,060.00" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $861.75 "$4,134.88" "$1,653.95" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$3,101.25" "$4,134.88" "$4,134.88" "$4,134.88" "$2,067.44" "$2,067.44" "$3,274.82" "$4,134.88" "$3,307.90" "$1,860.70" "$4,134.88" N/A "$2,398.30" "$4,134.88" "$2,480.93" "$4,134.88" "$4,134.88" "$4,134.88" N/A N/A 276421 SUP Custom 27803010 276421 - SHUNT NEUROSURGICAL REGULAR 130CM PERFORMANCE LEVEL 1 BOTH IP/OP "$4,135.00" "$3,060.00" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $861.75 "$4,134.88" "$1,653.95" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$3,101.25" "$4,134.88" "$4,134.88" "$4,134.88" "$2,067.44" "$2,067.44" "$3,274.82" "$4,134.88" "$3,307.90" "$1,860.70" "$4,134.88" N/A "$2,398.30" "$4,134.88" "$2,480.93" "$4,134.88" "$4,134.88" "$4,134.88" N/A N/A 278801 SUP Custom 27803010 278801 - SHUNT NEUROSURGICAL SMALL PERFORMANCE LEVEL 1 SNAP LATEX BOTH IP/OP "$2,983.00" "$2,207.00" $530.97 "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" $530.97 "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" $621.69 "$2,983.00" "$1,193.20" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,237.25" "$2,983.00" "$2,983.00" "$2,983.00" "$1,491.50" "$1,491.50" "$2,362.54" "$2,983.00" "$2,386.40" "$1,342.35" "$2,983.00" N/A "$1,730.14" "$2,983.00" "$1,789.80" "$2,983.00" "$2,983.00" "$2,983.00" N/A N/A 278802 SUP Custom 27803010 278802 - SHUNT NEUROSURGICAL SMALL PERFORMANCE LEVEL 2 SNAP LATEX BOTH IP/OP "$2,983.00" "$2,207.00" $530.97 "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" $530.97 "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" $621.69 "$2,983.00" "$1,193.20" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,237.25" "$2,983.00" "$2,983.00" "$2,983.00" "$1,491.50" "$1,491.50" "$2,362.54" "$2,983.00" "$2,386.40" "$1,342.35" "$2,983.00" N/A "$1,730.14" "$2,983.00" "$1,789.80" "$2,983.00" "$2,983.00" "$2,983.00" N/A N/A 278805 SUP Custom 27803010 278805 - SHUNT NEUROSURGICAL SMALL PERFORMANCE LEVEL 1.5 SNAP LATEX BOTH IP/OP "$2,983.00" "$2,207.00" $530.97 "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" $530.97 "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" $621.69 "$2,983.00" "$1,193.20" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,983.00" "$2,237.25" "$2,983.00" "$2,983.00" "$2,983.00" "$1,491.50" "$1,491.50" "$2,362.54" "$2,983.00" "$2,386.40" "$1,342.35" "$2,983.00" N/A "$1,730.14" "$2,983.00" "$1,789.80" "$2,983.00" "$2,983.00" "$2,983.00" N/A N/A 281000 SUP Custom 27203010 281000 - DRESSING FOAM THIN 2X1.6IN SELF ADHERENT MOISTURE PROOF BOTH IP/OP $222.00 $164.00 $39.49 $221.83 $221.83 $221.83 $221.83 $221.83 $221.83 $221.83 $39.49 $221.83 $221.83 $164.64 $164.64 $170.99 $115.57 $46.23 $221.83 $88.73 $221.83 $221.83 $221.83 $221.83 $221.83 $166.50 $221.83 $221.83 $221.83 $110.92 $110.92 $175.69 $221.83 $177.46 $144.19 $221.83 N/A $128.76 $221.83 $133.10 $221.83 $221.83 $221.83 N/A N/A 282400 SUP Custom 27203010 282400 - DRESSING FM 9.2X9.2IN MPLX BR ADH SAFETAC SIL SCRM BOTH IP/OP $27.00 $20.00 $4.75 $26.69 $26.69 $26.69 $26.69 $26.69 $26.69 $26.69 $4.75 $26.69 $26.69 $19.81 $19.81 $20.57 $13.91 $5.56 $26.69 $10.68 $26.69 $26.69 $26.69 $26.69 $26.69 $20.25 $26.69 $26.69 $26.69 $13.35 $13.35 $21.14 $26.69 $21.35 $17.35 $26.69 N/A $15.66 $26.69 $16.01 $26.69 $26.69 $26.69 N/A N/A 287300 SUP Custom 27203010 287300 - DRESSING FOAM 6X6IN ABSORBENT SELF ADHERENT WATERPROOF BOTH IP/OP $39.50 $29.00 $6.98 $39.20 $39.20 $39.20 $39.20 $39.20 $39.20 $39.20 $6.98 $39.20 $39.20 $29.09 $29.09 $30.22 $20.42 $8.17 $39.20 $15.68 $39.20 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $25.48 $39.20 N/A $22.91 $39.20 $23.52 $39.20 $39.20 $39.20 N/A N/A 287500 SUP Custom 27203010 287500 - DRESSING FOAM 20X8IN GENTLE ADHERENCE POLYURETHANE FOAM PAD BOTH IP/OP $154.50 $114.00 $27.44 $154.16 $154.15 $154.15 $154.15 $154.15 $154.15 $154.15 $27.44 $154.15 $154.15 $114.41 $114.41 $118.82 $80.31 $32.13 $154.15 $61.66 $154.15 $154.15 $154.16 $154.15 $154.15 $115.88 $154.15 $154.15 $154.15 $77.08 $77.08 $122.09 $154.15 $123.32 $100.20 $154.15 N/A $89.61 $154.15 $92.49 $154.15 $154.15 $154.15 N/A N/A Jan-91 SUP HCPCS C1713 01-2691 - PLATE BONE RECONSTRUCTION ADD ON LEFT CNDYLR HEAD MANDIB 2.4 BOTH IP/OP "$7,577.50" "$5,607.00" "$1,503.94" "$7,577.50" "$3,409.88" "$3,409.88" "$3,409.88" "$3,409.88" "$7,577.50" "$7,577.50" "$7,577.50" "$1,579.34" "$7,577.50" "$7,577.50" "$7,577.50" "$7,577.50" "$7,577.50" "$1,579.23" "$7,577.50" "$3,031.00" "$3,735.71" "$7,577.50" "$7,577.50" "$7,577.50" "$7,577.50" "$5,683.13" "$7,577.50" "$7,577.50" "$7,577.50" "$3,788.75" "$3,788.75" "$6,001.38" "$7,577.50" "$6,062.00" "$3,409.88" "$1,503.94" N/A "$4,394.95" "$7,577.50" "$7,577.50" "$7,577.50" "$7,577.50" "$7,577.50" N/A N/A Jan-92 SUP HCPCS C1713 01-2692 - PLATE BONE RECONSTRUCTION ADD ON RIGHT CNDYLR HEAD MANDIB BOTH IP/OP "$7,577.50" "$5,607.00" "$1,503.94" "$7,577.50" "$3,409.88" "$3,409.88" "$3,409.88" "$3,409.88" "$7,577.50" "$7,577.50" "$7,577.50" "$1,579.34" "$7,577.50" "$7,577.50" "$7,577.50" "$7,577.50" "$7,577.50" "$1,579.23" "$7,577.50" "$3,031.00" "$3,735.71" "$7,577.50" "$7,577.50" "$7,577.50" "$7,577.50" "$5,683.13" "$7,577.50" "$7,577.50" "$7,577.50" "$3,788.75" "$3,788.75" "$6,001.38" "$7,577.50" "$6,062.00" "$3,409.88" "$1,503.94" N/A "$4,394.95" "$7,577.50" "$7,577.50" "$7,577.50" "$1,579.15" "$7,577.50" N/A N/A 290058 SUP HCPCS C1713 290058 - CAP PCTV 4MM RD STRL BOTH IP/OP $84.50 $63.00 $16.73 $84.30 $37.94 $37.94 $37.94 $37.94 $84.30 $84.30 $84.30 $17.57 $84.30 $84.30 $84.30 $84.30 $84.30 $17.57 $84.30 $32.81 $49.86 $84.30 $82.03 $84.30 $84.30 $63.38 $84.30 $84.30 $84.30 $42.15 $42.15 $66.77 $84.30 $67.44 $37.94 $16.73 N/A $49.01 $84.30 $50.58 $84.30 $17.57 $84.30 N/A N/A 290060 SUP HCPCS C1713 290060 - CAP PCTV 3MM GRN STRL BOTH IP/OP $84.00 $62.00 $16.61 $83.70 $37.67 $37.67 $37.67 $37.67 $83.70 $83.70 $83.70 $17.45 $83.70 $83.70 $83.70 $83.70 $83.70 $17.44 $83.70 $32.64 $49.51 $83.70 $81.60 $83.70 $83.70 $63.00 $83.70 $83.70 $83.70 $41.85 $41.85 $66.29 $83.70 $66.96 $37.67 $16.61 N/A $48.72 $83.70 $83.70 $83.70 $17.44 $83.70 N/A N/A 290061 SUP HCPCS C1713 290061 - CAP PROTECTIVE 5MM BLACK STERILE BOTH IP/OP $78.50 $58.00 $15.52 $78.20 $35.19 $35.19 $35.19 $35.19 $78.20 $78.20 $78.20 $16.30 $78.20 $78.20 $78.20 $78.20 $78.20 $16.30 $78.20 $78.20 $46.26 $78.20 $78.20 $78.20 $78.20 $58.88 $78.20 $78.20 $78.20 $39.10 $39.10 $61.93 $78.20 $62.56 $35.19 $15.52 N/A $45.53 $78.20 $46.92 $78.20 $16.30 $78.20 N/A N/A 295900 SUP Custom 27203010 295900 - DRESSING FOAM 12X4IN ABSORBENT NONADHERENT WATERPROOF BOTH IP/OP $376.50 $279.00 $66.95 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $66.95 $376.13 $376.13 $279.16 $279.16 $289.92 $195.96 $78.39 $376.13 $150.45 $376.13 $376.13 $376.13 $376.13 $376.13 $282.38 $376.13 $376.13 $376.13 $188.07 $188.07 $297.89 $376.13 $300.90 $244.48 $376.13 N/A $218.37 $376.13 $225.68 $376.13 $376.13 $376.13 N/A N/A 310431 SUP Custom 27203010 310431 - BIT DRILL 180MM 4.3MM QC 5MM LCK SCR NONSTRL BOTH IP/OP $260.50 $193.00 $46.30 $260.10 $260.10 $260.10 $260.10 $260.10 $260.10 $260.10 $46.30 $260.10 $260.10 $193.05 $193.05 $200.49 $135.51 $54.21 $260.10 $104.04 $260.10 $260.10 $260.10 $260.10 $260.10 $195.38 $260.10 $260.10 $260.10 $130.05 $130.05 $206.00 $260.10 $208.08 $169.07 $260.10 N/A $151.09 $260.10 $156.06 $260.10 $260.10 $260.10 N/A N/A 311270 SUP HCPCS C1768 "311270 - Graft, Avance Nerve, 3-4mm x 70mm" BOTH IP/OP "$15,635.00" "$11,570.00" "$3,103.16" "$17,050.00" "$7,035.75" "$7,035.75" "$7,035.75" "$7,035.75" "$15,635.00" "$15,635.00" "$15,635.00" "$3,258.72" "$15,635.00" "$15,635.00" "$15,635.00" "$15,635.00" "$15,635.00" "$3,258.51" "$15,635.00" "$17,050.00" "$7,708.06" "$15,635.00" "$16,425.00" "$15,635.00" "$15,635.00" "$11,726.25" "$15,635.00" "$15,635.00" "$15,635.00" "$7,817.50" "$7,817.50" "$12,382.92" "$15,635.00" "$12,508.00" "$7,035.75" "$3,103.16" N/A "$9,068.30" "$15,635.00" "$15,635.00" "$15,635.00" "$3,258.33" "$15,635.00" N/A N/A 315804 SUP Custom 27203010 315804 - CANNULA PERFUSION STR 4MM 11.4IN SELF INFLATING BALLOON BOTH IP/OP $164.00 $121.00 $29.15 $163.75 $163.75 $163.75 $163.75 $163.75 $163.75 $163.75 $29.15 $163.75 $163.75 $121.54 $121.54 $126.22 $85.31 $34.13 $163.75 $65.50 $163.75 $163.75 $163.75 $163.75 $163.75 $123.00 $163.75 $163.75 $163.75 $81.88 $81.88 $129.69 $163.75 $131.00 $106.44 $163.75 N/A $95.12 $163.75 $98.25 $163.75 $163.75 $163.75 N/A N/A 315805 SUP Custom 27203010 315805 - CANNULA PERFUSION 2.1MM STR 5MM 11.4IN SELF INFLATING BOTH IP/OP $205.00 $152.00 $36.49 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $36.49 $205.00 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $82.00 $205.00 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $205.00 N/A $118.90 $205.00 $123.00 $205.00 $205.00 $205.00 N/A N/A 315806 SUP Custom 27203010 315806 - CANNULA PERFUSION 3MM STR 6MM 11.4IN SELF INFLATING BALLOON BOTH IP/OP $196.50 $145.00 $34.98 $196.50 $196.50 $196.50 $196.50 $196.50 $196.50 $196.50 $34.98 $196.50 $196.50 $145.84 $145.84 $151.46 $102.38 $40.95 $196.50 $78.60 $196.50 $196.50 $196.50 $196.50 $196.50 $147.38 $196.50 $196.50 $196.50 $98.25 $98.25 $155.63 $196.50 $157.20 $127.73 $196.50 N/A $113.97 $196.50 $117.90 $196.50 $196.50 $196.50 N/A N/A 315807 SUP Custom 27203010 315807 - CANNULA PERFUSION 3MM STR 7MM 11.4IN SELF INFLATING BALLOON BOTH IP/OP $164.00 $121.00 $29.15 $163.75 $163.75 $163.75 $163.75 $163.75 $163.75 $163.75 $29.15 $163.75 $163.75 $121.54 $121.54 $126.22 $85.31 $34.13 $163.75 $65.50 $163.75 $163.75 $163.75 $163.75 $163.75 $123.00 $163.75 $163.75 $163.75 $81.88 $81.88 $129.69 $163.75 $131.00 $106.44 $163.75 N/A $95.12 $163.75 $98.25 $163.75 $163.75 $163.75 N/A N/A 323020 SUP Custom 27803010 323020 - STENT LARYNGEAL SMALL 2 SUTURE BUTTON FLEXIBLE NONADHERENT BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 323025 SUP Custom 27803010 323025 - STENT LARYNGEAL MEDIUM FLEXIBLE NONADHERENT INTEGRAL BOTH IP/OP $287.50 $213.00 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $115.00 $287.50 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $287.50 N/A $166.75 $287.50 $172.50 $287.50 $287.50 $287.50 N/A N/A 323030 SUP Custom 27803010 323030 - STENT LARYNGEAL LARGE FLEXIBLE NONADHERENT INTEGRAL BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 325014 SUP HCPCS C1713 325014 - SCREW BN 4MM 14MM NS ASNS III P/T CNN SS BOTH IP/OP $242.50 $179.00 $48.08 $242.25 $109.01 $109.01 $109.01 $109.01 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $242.25 $242.25 $242.25 $50.49 $242.25 $96.90 $143.29 $242.25 $242.25 $242.25 $242.25 $181.88 $242.25 $242.25 $242.25 $121.13 $121.13 $191.86 $242.25 $193.80 $109.01 $48.08 N/A $140.65 $242.25 $242.25 $242.25 $50.48 $242.25 N/A N/A 325016 SUP HCPCS C1713 325016 - SCREW BONE PTHRD 4MM 16MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $242.50 $179.00 $48.08 $242.25 $109.01 $109.01 $109.01 $109.01 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $143.29 $242.25 $242.25 $242.25 $242.25 $181.88 $242.25 $242.25 $242.25 $121.13 $121.13 $191.86 $242.25 $193.80 $109.01 $48.08 N/A $140.65 $242.25 $242.25 $242.25 $50.48 $242.25 N/A N/A 325018 SUP HCPCS C1713 325018 - SCREW BN 4MM 18MM STRL ASNS III P/T IMPL SS BOTH IP/OP $242.50 $179.00 $48.08 $242.25 $109.01 $109.01 $109.01 $109.01 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $143.29 $242.25 $242.25 $242.25 $242.25 $181.88 $242.25 $242.25 $242.25 $121.13 $121.13 $191.86 $242.25 $193.80 $109.01 $48.08 N/A $140.65 $242.25 $242.25 $242.25 $50.48 $242.25 N/A N/A 325020 SUP HCPCS C1713 325020 - SCREW BONE 4MM 20MM CANN ASNIS III STAINLESS STEEL NONSTRL BOTH IP/OP $242.50 $179.00 $48.08 $242.25 $109.01 $109.01 $109.01 $109.01 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $143.29 $242.25 $242.25 $242.25 $242.25 $181.88 $242.25 $242.25 $242.25 $121.13 $121.13 $191.86 $242.25 $193.80 $109.01 $48.08 N/A $140.65 $242.25 $242.25 $242.25 $50.48 $242.25 N/A N/A 325022 SUP HCPCS C1713 325022 - SCREW BONE 4MM 22MM CANN ASNIS III STAINLESS STEEL NONSTRL BOTH IP/OP $242.50 $179.00 $48.08 $242.25 $109.01 $109.01 $109.01 $109.01 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $143.29 $242.25 $242.25 $242.25 $242.25 $181.88 $242.25 $242.25 $242.25 $121.13 $121.13 $191.86 $242.25 $193.80 $109.01 $48.08 N/A $140.65 $242.25 $242.25 $242.25 $50.48 $242.25 N/A N/A 325024 SUP HCPCS C1713 325024 - SCREW BONE PTHRD 4MM 24MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $242.50 $179.00 $48.08 $242.25 $109.01 $109.01 $109.01 $109.01 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $143.29 $242.25 $242.25 $242.25 $242.25 $181.88 $242.25 $242.25 $242.25 $121.13 $121.13 $191.86 $242.25 $193.80 $109.01 $48.08 N/A $140.65 $242.25 $242.25 $242.25 $50.48 $242.25 N/A N/A 325026 SUP HCPCS C1713 325026 - SCREW BN P/T 4MM 26MM STRL 9MM ASNS III ST SLF DRL CNN SS BOTH IP/OP $242.50 $179.00 $48.08 $242.25 $109.01 $109.01 $109.01 $109.01 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $143.29 $242.25 $242.25 $242.25 $242.25 $181.88 $242.25 $242.25 $242.25 $121.13 $121.13 $191.86 $242.25 $193.80 $109.01 $48.08 N/A $140.65 $242.25 $242.25 $242.25 $50.48 $242.25 N/A N/A 325028 SUP HCPCS C1713 325028 - SCREW BN 4MM 28MM STRL 9.5MM ASNS III CNN SS BOTH IP/OP $242.50 $179.00 $48.08 $242.25 $109.01 $109.01 $109.01 $109.01 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $143.29 $242.25 $242.25 $242.25 $242.25 $181.88 $242.25 $242.25 $242.25 $121.13 $121.13 $191.86 $242.25 $193.80 $109.01 $48.08 N/A $140.65 $242.25 $242.25 $242.25 $50.48 $242.25 N/A N/A 325030 SUP HCPCS C1713 325030 - SCREW BN P/T 4MM 30MM STRL ASNS III ST SLF DRL CNN SS HIP BOTH IP/OP $242.50 $179.00 $48.08 $242.25 $109.01 $109.01 $109.01 $109.01 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $143.29 $242.25 $242.25 $242.25 $242.25 $181.88 $242.25 $242.25 $242.25 $121.13 $121.13 $191.86 $242.25 $193.80 $109.01 $48.08 N/A $140.65 $242.25 $242.25 $242.25 $50.48 $242.25 N/A N/A 325032 SUP HCPCS C1713 325032 - SCREW BONE PTHRD 4MM 32MM SELF TAP SELF DRILL CANNU ASNIS BOTH IP/OP $242.50 $179.00 $48.08 $242.25 $109.01 $109.01 $109.01 $109.01 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $143.29 $242.25 $242.25 $242.25 $242.25 $181.88 $242.25 $242.25 $242.25 $121.13 $121.13 $191.86 $242.25 $193.80 $109.01 $48.08 N/A $140.65 $242.25 $242.25 $242.25 $50.48 $242.25 N/A N/A 325034 SUP HCPCS C1713 325034 - SCREW BONE PTHRD 4MM 34MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $242.50 $179.00 $48.08 $242.25 $109.01 $109.01 $109.01 $109.01 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $143.29 $242.25 $242.25 $242.25 $242.25 $181.88 $242.25 $242.25 $242.25 $121.13 $121.13 $191.86 $242.25 $193.80 $109.01 $48.08 N/A $140.65 $242.25 $242.25 $242.25 $50.48 $242.25 N/A N/A 325036 SUP HCPCS C1713 325036 - SCREW BONE PTHRD 4MM 36MM ASNIS III STAINLESS STEEL FEMUR BOTH IP/OP $272.50 $202.00 $54.03 $272.25 $122.51 $122.51 $122.51 $122.51 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $161.04 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $122.51 $54.03 N/A $158.05 $272.25 $272.25 $272.25 $56.74 $272.25 N/A N/A 325038 SUP HCPCS C1713 325038 - SCREW BN P/T 4MM 38MM NS ASNS III ST SLF DRL LOPRFL HD CNN BOTH IP/OP $272.50 $202.00 $54.03 $272.25 $122.51 $122.51 $122.51 $122.51 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $161.04 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $122.51 $54.03 N/A $158.05 $272.25 $272.25 $272.25 $56.74 $272.25 N/A N/A 325040 SUP HCPCS C1713 325040 - SCREW BONE PTHRD 4MM 40MM CANN ASNIS III STAINLESS STEEL HIP BOTH IP/OP $272.50 $202.00 $54.03 $272.25 $122.51 $122.51 $122.51 $122.51 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $161.04 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $122.51 $54.03 N/A $158.05 $272.25 $272.25 $272.25 $56.74 $272.25 N/A N/A 325042 SUP HCPCS C1713 325042 - SCREW BONE 4MM 42MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $272.50 $202.00 $54.03 $272.25 $122.51 $122.51 $122.51 $122.51 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $161.04 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $122.51 $54.03 N/A $158.05 $272.25 $163.35 $272.25 $56.74 $272.25 N/A N/A 325044 SUP HCPCS C1713 325044 - SCREW BONE 4MM 44MM 15MM SELF DRILL SELF TAP CANN ASNIS III BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $53.01 $254.38 N/A N/A 325046 SUP HCPCS C1713 325046 - SCREW BONE 4MM 46MM 15.5MM SELF DRILL SELF TAP CANN ASNIS BOTH IP/OP $272.50 $202.00 $54.03 $272.25 $122.51 $122.51 $122.51 $122.51 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $161.04 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $122.51 $54.03 N/A $158.05 $272.25 $163.35 $272.25 $56.74 $272.25 N/A N/A 325048 SUP HCPCS C1713 325048 - SCREW BN P/T 4MM 48MM NS ASNS III ST SLF DRL LOPRFL HD CNN BOTH IP/OP $272.50 $202.00 $54.03 $272.25 $122.51 $122.51 $122.51 $122.51 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $161.04 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $122.51 $54.03 N/A $158.05 $272.25 $163.35 $272.25 $56.74 $272.25 N/A N/A 325050 SUP HCPCS C1713 325050 - SCREW BONE 4MM 50MM CANN ASNIS III STAINLESS STEEL NONSTRL BOTH IP/OP $272.50 $202.00 $54.03 $272.25 $122.51 $122.51 $122.51 $122.51 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $161.04 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $122.51 $54.03 N/A $158.05 $272.25 $163.35 $272.25 $56.74 $272.25 N/A N/A 325055 SUP HCPCS C1713 325055 - SCREW BONE PTHRD 4MM 55MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $272.50 $202.00 $54.03 $272.25 $122.51 $122.51 $122.51 $122.51 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $161.04 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $122.51 $54.03 N/A $158.05 $272.25 $163.35 $272.25 $56.74 $272.25 N/A N/A 325060 SUP HCPCS C1713 325060 - SCREW BONE 4MM 60MM CANN ASNIS III STAINLESS STEEL NONSTRL BOTH IP/OP $272.50 $202.00 $54.03 $272.25 $122.51 $122.51 $122.51 $122.51 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $161.04 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $122.51 $54.03 N/A $158.05 $272.25 $163.35 $272.25 $56.74 $272.25 N/A N/A 325065 SUP HCPCS C1713 325065 - SCREW BONE 4MM 65MM CANN ASNIS III STAINLESS STEEL HIP BOTH IP/OP $275.00 $204.00 $54.49 $274.55 $123.55 $123.55 $123.55 $123.55 $274.55 $274.55 $274.55 $57.22 $274.55 $274.55 $274.55 $274.55 $274.55 $57.22 $274.55 $274.55 $162.40 $274.55 $274.55 $274.55 $274.55 $206.25 $274.55 $274.55 $274.55 $137.28 $137.28 $217.44 $274.55 $219.64 $123.55 $54.49 N/A $159.50 $274.55 $274.55 $274.55 $57.22 $274.55 N/A N/A 325070 SUP HCPCS C1713 325070 - SCREW BONE PTHRD 4MM 70MM CANN ASNIS III STAINLESS STEEL HIP BOTH IP/OP $275.00 $204.00 $54.49 $274.55 $123.55 $123.55 $123.55 $123.55 $274.55 $274.55 $274.55 $57.22 $274.55 $274.55 $274.55 $274.55 $274.55 $57.22 $274.55 $274.55 $162.40 $274.55 $274.55 $274.55 $274.55 $206.25 $274.55 $274.55 $274.55 $137.28 $137.28 $217.44 $274.55 $219.64 $123.55 $54.49 N/A $159.50 $274.55 $274.55 $274.55 $57.22 $274.55 N/A N/A 325420 SUP HCPCS C1713 325420 - SCREW BONE 5MM 20MM CANN PTHRD ASNIS III STAINLESS STEEL BOTH IP/OP $266.50 $197.00 $52.84 $266.25 $119.81 $119.81 $119.81 $119.81 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $266.25 $266.25 $266.25 $55.49 $266.25 $106.50 $157.49 $266.25 $266.25 $266.25 $266.25 $199.88 $266.25 $266.25 $266.25 $133.13 $133.13 $210.87 $266.25 $213.00 $119.81 $52.84 N/A $154.57 $266.25 $159.75 $266.25 $55.49 $266.25 N/A N/A 326260 SUP HCPCS C1713 326260 - SCREW BONE 6.5MM 60MM 40MM ASNS 3 SS ORTH CANN STRL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A Jan-00 SUP Custom 27803010 01-2800 - HEAD FEM +0MM OFST MRS TPR 28MM STRL HIP BOTH IP/OP "$1,795.00" "$1,328.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $374.10 "$1,795.00" $718.00 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,346.25" "$1,795.00" "$1,795.00" "$1,795.00" $897.50 $897.50 "$1,421.64" "$1,795.00" "$1,436.00" $807.75 "$1,795.00" N/A "$1,041.10" "$1,795.00" "$1,077.00" "$1,795.00" "$1,795.00" "$1,795.00" N/A N/A Jun-00 SUP Custom 27803010 06-2800 - HEAD FEM +0MM OFST CTPR 28MM LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A Jan-05 SUP HCPCS C1776 01-2805 - HEAD FEM +5MM 28MM LFIT MRS TPR COCR HIP BOTH IP/OP "$1,795.00" "$1,328.00" $356.26 "$1,795.00" $807.75 $807.75 $807.75 $807.75 "$1,795.00" "$1,795.00" "$1,795.00" $374.12 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $374.10 "$1,795.00" $718.00 "$1,061.74" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,346.25" "$1,795.00" "$1,795.00" "$1,795.00" $897.50 $897.50 "$1,421.64" "$1,795.00" "$1,436.00" $807.75 $356.26 N/A "$1,041.10" "$1,795.00" "$1,077.00" "$1,795.00" $374.08 "$1,795.00" N/A N/A Jun-05 SUP Custom 27803010 06-2805 - HEAD FEM +5MM OFST CTPR 28MM LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 331443 SUP HCPCS C1900 331443 - PACEMAKER CARDIAC THK6MM 53MMX43MM IMPLTABLE 2 CHAMBER RATE BOTH IP/OP "$7,250.00" "$5,365.00" "$1,438.94" "$7,250.00" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$7,250.00" "$7,250.00" "$7,250.00" "$1,511.08" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$1,510.98" "$7,250.00" "$7,250.00" "$3,574.25" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$5,437.50" "$7,250.00" "$7,250.00" "$7,250.00" "$3,625.00" "$3,625.00" "$5,742.00" "$7,250.00" "$5,800.00" "$3,262.50" "$1,438.94" N/A "$4,205.00" "$7,250.00" "$7,250.00" "$7,250.00" "$1,510.90" "$7,250.00" N/A N/A 331446 SUP HCPCS C1900 331446 - PACEMAKER CARDIAC THK6MM 53MMX39MM IMPLTABLE 1 CHAMBER RATE BOTH IP/OP "$7,000.00" "$5,180.00" "$1,389.33" "$7,000.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$7,000.00" "$7,000.00" "$7,000.00" "$1,458.98" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$1,458.88" "$7,000.00" "$7,000.00" "$3,451.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$5,250.00" "$7,000.00" "$7,000.00" "$7,000.00" "$3,500.00" "$3,500.00" "$5,544.00" "$7,000.00" "$5,600.00" "$3,150.00" "$1,389.33" N/A "$4,060.00" "$7,000.00" "$7,000.00" "$7,000.00" "$1,458.80" "$7,000.00" N/A N/A 332079 SUP Custom 27203010 TRAY EPDRL 17GA 3.5IN NDL MTL TIP SYR FLTR PRFX TH SCHF BOTH IP/OP $720.00 $533.00 $417.60 $540.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $540.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $417.60 N/A N/A N/A N/A N/A N/A N/A Jan-10 SUP Custom 27803010 01-2810 - HEAD FEM LFIT MRS TPR BOTH IP/OP "$1,795.00" "$1,328.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $374.10 "$1,795.00" $718.00 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,346.25" "$1,795.00" "$1,795.00" "$1,795.00" $897.50 $897.50 "$1,421.64" "$1,795.00" "$1,436.00" $807.75 "$1,795.00" N/A "$1,041.10" "$1,795.00" "$1,077.00" "$1,795.00" "$1,795.00" "$1,795.00" N/A N/A Jun-10 SUP Custom 27803010 06-2810 - HEAD FEM +10MM OFST CTPR 28MM LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 334050 SUP HCPCS C1900 334050 - PACEMAKER CARDIAC IMPLTABLE 2 CHAMBER RATE ADAPTIVE PHILOS BOTH IP/OP "$8,500.00" "$6,290.00" "$1,687.04" "$8,500.00" "$3,825.00" "$3,825.00" "$3,825.00" "$3,825.00" "$8,500.00" "$8,500.00" "$8,500.00" "$1,771.61" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$1,771.49" "$8,500.00" "$8,500.00" "$4,190.50" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$6,375.00" "$8,500.00" "$8,500.00" "$8,500.00" "$4,250.00" "$4,250.00" "$6,732.00" "$8,500.00" "$6,800.00" "$3,825.00" "$1,687.04" N/A "$4,930.00" "$8,500.00" "$8,500.00" "$8,500.00" "$1,771.40" "$8,500.00" N/A N/A 334051 SUP HCPCS C1900 334051 - PACEMAKER CARDIAC IMPLTABLE PHILOS SR ATRIAL VENTRICULAR BOTH IP/OP "$8,000.00" "$5,920.00" "$1,587.80" "$8,000.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$8,000.00" "$8,000.00" "$8,000.00" "$1,667.40" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$1,667.29" "$8,000.00" "$8,000.00" "$3,944.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$6,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$4,000.00" "$4,000.00" "$6,336.00" "$8,000.00" "$6,400.00" "$3,600.00" "$1,587.80" N/A "$4,640.00" "$8,000.00" "$8,000.00" "$8,000.00" "$1,667.20" "$8,000.00" N/A N/A 338021 SUP HCPCS C1900 338021 - LEAD PACING 15CM TIP TO RING STR 7.2FR 60CM BIPOL ACTIVE FIX BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 338022 SUP HCPCS C1900 338022 - LEAD PACING 15CM J 7.2FR 45CM BIPOL ACTIVE FIX AROX SILICONE BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 338023 SUP HCPCS C1900 338023 - LEAD PACING 15CM TIP TO RING STR 7.2FR 53CM BIPOL ACTIVE FIX BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 338610 SUP HCPCS C1713 338610 - SCREW BONE 2.5MM FULTHD HEXAGON 3.5MM 10MM SELF TAP AXSOS BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $17.70 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338612 SUP HCPCS C1713 338612 - SCREW BONE 2.5MM FULTHD HEXAGON 3.5MM 12MM SELF TAP AXSOS BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338614 SUP HCPCS C1713 338614 - SCREW BONE 2.5MM FULTHD HEXAGON 3.5MM 14MM SELF TAP AXSOS BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338616 SUP HCPCS C1713 338616 - SCREW BONE 2.5MM FULTHD HEXAGON 3.5MM 16MM SELF TAP AXSOS BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $17.70 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338618 SUP HCPCS C1713 338618 - SCREW BONE 2.5MM FULTHD HEXAGON 3.5MM 18MM SELF TAP AXSOS BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338620 SUP HCPCS C1713 338620 - SCREW BN 2.5MM 3.5MM 20MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338622 SUP HCPCS C1713 338622 - SCREW BN 2.5MM 3.5MM 22MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $26.55 $44.25 $9.22 $44.25 N/A N/A 338624 SUP HCPCS C1713 338624 - SCREW BN 2.5MM 3.5MM 24MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $17.70 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338626 SUP HCPCS C1713 338626 - SCREW BN 2.5MM 3.5MM 26MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $17.70 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338628 SUP HCPCS C1713 338628 - SCREW BN 2.5MM 3.5MM 28MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338630 SUP HCPCS C1713 338630 - SCREW BN 2.5MM 3.5MM 30MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338632 SUP HCPCS C1713 338632 - SCREW BONE 2.5MM FULTHD HEXAGON 3.5MM 32MM SELF TAP AXSOS BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $17.70 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $26.55 $44.25 $9.22 $44.25 N/A N/A 338634 SUP HCPCS C1713 338634 - SCREW BN 2.5MM 3.5MM 34MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338636 SUP HCPCS C1713 338636 - SCREW BONE 2.5MM FULTHD HEXAGON 3.5MM 36MM SELF TAP AXSOS BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $17.70 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $26.55 $44.25 $9.22 $44.25 N/A N/A 338638 SUP HCPCS C1713 338638 - SCREW BN 2.5MM 3.5MM 38MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $17.70 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338640 SUP HCPCS C1713 338640 - SCREW BN 2.5MM 3.5MM 40MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $17.70 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $26.55 $44.25 $9.22 $44.25 N/A N/A 338642 SUP HCPCS C1713 338642 - SCREW BONE 2.5MM FULTHD HEXAGON 3.5MM 42MM SELF TAP AXSOS BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $17.70 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $26.55 $44.25 $9.22 $44.25 N/A N/A 338644 SUP HCPCS C1713 338644 - SCREW BONE 2.5MM FULTHD HEXAGON 3.5MM 44MM SELF TAP AXSOS BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $26.55 $44.25 $9.22 $44.25 N/A N/A 338645 SUP HCPCS C1713 338645 - SCREW BN 2.5MM 3.5MM 45MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338646 SUP HCPCS C1713 338646 - SCREW BONE 2.5MM FULTHD HEXAGON 3.5MM 46MM SELF TAP AXSOS BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $26.55 $44.25 $9.22 $44.25 N/A N/A 338648 SUP HCPCS C1713 338648 - SCREW BONE 2.5MM FULTHD HEXAGON 3.5MM 48MM SELF TAP AXSOS BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $26.55 $44.25 $9.22 $44.25 N/A N/A 338650 SUP HCPCS C1713 338650 - SCREW BN 2.5MM 3.5MM 50MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338655 SUP HCPCS C1713 338655 - SCREW BN 2.5MM 3.5MM 55MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $17.70 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $26.55 $44.25 $9.22 $44.25 N/A N/A 338660 SUP HCPCS C1713 338660 - SCREW BN 2.5MM 3.5MM 60MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $17.70 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $26.55 $44.25 $9.22 $44.25 N/A N/A 338665 SUP HCPCS C1713 338665 - SCREW BN 2.5MM 3.5MM 65MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $17.70 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 338670 SUP HCPCS C1713 338670 - SCREW BN 2.5MM 3.5MM 70MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $17.70 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $26.55 $44.25 $9.22 $44.25 N/A N/A 338675 SUP HCPCS C1713 338675 - SCREW BN 2.5MM 3.5MM 75MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $40.50 $30.00 $8.04 $44.25 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $17.70 $23.96 $40.50 $44.25 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 338680 SUP HCPCS C1713 338680 - SCREW BN 2.5MM 3.5MM 80MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $40.50 $30.00 $8.04 $44.25 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $17.70 $23.96 $40.50 $44.25 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 338685 SUP HCPCS C1713 338685 - SCREW BN 2.5MM 3.5MM 85MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $40.50 $30.00 $8.04 $44.25 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $17.70 $23.96 $40.50 $44.25 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 338690 SUP HCPCS C1713 338690 - SCREW BN 2.5MM 3.5MM 90MM NS ST HEX SS CORT AXSOS SM FRAG BOTH IP/OP $40.50 $30.00 $8.04 $44.25 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $17.70 $23.96 $40.50 $44.25 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 338695 SUP HCPCS C1713 338695 - SCREW BONE 2.5MM HEXAGON 3.5MM 95MM SELF TAP AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $44.25 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $17.70 $23.96 $40.50 $44.25 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 338700 SUP HCPCS C1713 338700 - SCREW BN FT 3.5MM 100MM ST HEX SS CORT AXSOS SM FRAG SET BOTH IP/OP $43.50 $32.00 $8.57 $43.20 $19.44 $19.44 $19.44 $19.44 $43.20 $43.20 $43.20 $9.00 $43.20 $43.20 $43.20 $43.20 $43.20 $9.00 $43.20 $17.28 $25.55 $43.20 $43.20 $43.20 $43.20 $32.63 $43.20 $43.20 $43.20 $21.60 $21.60 $34.21 $43.20 $34.56 $19.44 $8.57 N/A $25.23 $43.20 $43.20 $43.20 $9.00 $43.20 N/A N/A 338705 SUP HCPCS C1713 338705 - SCREW BONE 3.5MM 105MM SLFTAP CORTICAL BOTH IP/OP $43.50 $32.00 $8.57 $43.20 $19.44 $19.44 $19.44 $19.44 $43.20 $43.20 $43.20 $9.00 $43.20 $43.20 $43.20 $43.20 $43.20 $9.00 $43.20 $17.28 $25.55 $43.20 $43.20 $43.20 $43.20 $32.63 $43.20 $43.20 $43.20 $21.60 $21.60 $34.21 $43.20 $34.56 $19.44 $8.57 N/A $25.23 $43.20 $43.20 $43.20 $9.00 $43.20 N/A N/A 338710 SUP HCPCS C1713 338710 - SCREW BONE 3.5MM 110MM SLFTAP CORTICAL BOTH IP/OP $43.50 $32.00 $8.57 $43.20 $19.44 $19.44 $19.44 $19.44 $43.20 $43.20 $43.20 $9.00 $43.20 $43.20 $43.20 $43.20 $43.20 $9.00 $43.20 $17.28 $25.55 $43.20 $43.20 $43.20 $43.20 $32.63 $43.20 $43.20 $43.20 $21.60 $21.60 $34.21 $43.20 $34.56 $19.44 $8.57 N/A $25.23 $43.20 $43.20 $43.20 $9.00 $43.20 N/A N/A 338715 SUP HCPCS C1713 338715 - SCREW BONE 3.5MM 115MM SLFTAP STAINLESS STEEL CORTICAL BOTH IP/OP $43.50 $32.00 $8.57 $43.20 $19.44 $19.44 $19.44 $19.44 $43.20 $43.20 $43.20 $9.00 $43.20 $43.20 $43.20 $43.20 $43.20 $9.00 $43.20 $17.28 $25.55 $43.20 $43.20 $43.20 $43.20 $32.63 $43.20 $43.20 $43.20 $21.60 $21.60 $34.21 $43.20 $34.56 $19.44 $8.57 N/A $25.23 $43.20 $25.92 $43.20 $9.00 $43.20 N/A N/A 338720 SUP HCPCS C1713 338720 - SCREW BONE 3.5MM 120MM SLFTAP STAINLESS STEEL CORTICAL BOTH IP/OP $43.50 $32.00 $8.57 $43.20 $19.44 $19.44 $19.44 $19.44 $43.20 $43.20 $43.20 $9.00 $43.20 $43.20 $43.20 $43.20 $43.20 $9.00 $43.20 $17.28 $25.55 $43.20 $43.20 $43.20 $43.20 $32.63 $43.20 $43.20 $43.20 $21.60 $21.60 $34.21 $43.20 $34.56 $19.44 $8.57 N/A $25.23 $43.20 $25.92 $43.20 $9.00 $43.20 N/A N/A 340612 SUP HCPCS C1713 340612 - SCREW BONE 4.5MM 12MM SLFTAP CORTICAL BOTH IP/OP $29.00 $21.00 $5.73 $28.88 $13.00 $13.00 $13.00 $13.00 $28.88 $28.88 $28.88 $6.02 $28.88 $28.88 $28.88 $28.88 $28.88 $6.02 $28.88 $11.55 $17.08 $28.88 $28.88 $28.88 $28.88 $21.75 $28.88 $28.88 $28.88 $14.44 $14.44 $22.87 $28.88 $23.10 $13.00 $5.73 N/A $16.82 $28.88 $17.33 $28.88 $6.02 $28.88 N/A N/A 340614 SUP HCPCS C1713 340614 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 14MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A 340616 SUP HCPCS C1713 340616 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 16MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A 340618 SUP HCPCS C1713 340618 - SCREW BONE 4.5MM 18MM SLFTAP LOCKING HEXAGONAL DRIVE AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340620 SUP HCPCS C1713 340620 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 20MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A 340622 SUP HCPCS C1713 340622 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 22MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A 340624 SUP HCPCS C1713 340624 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 24MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A 340626 SUP HCPCS C1713 340626 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 26MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340628 SUP HCPCS C1713 340628 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 28MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A 340630 SUP HCPCS C1713 340630 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 30MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340632 SUP HCPCS C1713 340632 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 32MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340634 SUP HCPCS C1713 340634 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 34MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A 340636 SUP HCPCS C1713 340636 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 36MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340638 SUP HCPCS C1713 340638 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 38MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340640 SUP HCPCS C1713 340640 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 40MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340642 SUP HCPCS C1713 340642 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 42MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340644 SUP HCPCS C1713 340644 - SCREW BONE 4.5MM 3.5MM 44MM HEXAGONAL DRIVE SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340646 SUP HCPCS C1713 340646 - SCREW BONE 4.5MM 3.5MM 46MM HEXAGONAL DRIVE SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340648 SUP HCPCS C1713 340648 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 48MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A 340650 SUP HCPCS C1713 340650 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 50MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340652 SUP HCPCS C1713 340652 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 52MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340654 SUP HCPCS C1713 340654 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 54MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340656 SUP HCPCS C1713 340656 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 56MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340658 SUP HCPCS C1713 340658 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 58MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340660 SUP HCPCS C1713 340660 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 60MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340665 SUP HCPCS C1713 340665 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 65MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A 340670 SUP HCPCS C1713 340670 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 70MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340675 SUP HCPCS C1713 340675 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 75MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340680 SUP HCPCS C1713 340680 - SCREW BONE 3.5MM FULTHD HEXAGON 4.5MM 80MM SELF TAP AXSOS BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340685 SUP HCPCS C1713 340685 - SCREW BONE 4.5MM 85MM SLFTAP AXSOS STAINLESS STEEL CORTICAL BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340690 SUP HCPCS C1713 340690 - SCREW BONE 4.5MM 90MM SLFTAP AXSOS STAINLESS STEEL CORTICAL BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A 340695 SUP HCPCS C1713 340695 - SCREW BONE 4.5MM 95MM SLFTAP AXSOS STAINLESS STEEL CORTICAL BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A 340700 SUP HCPCS C1713 340700 - SCREW BONE 4.5MM 100MM SLFTAP AXSOS STAINLESS STEEL CORTICAL BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340705 SUP HCPCS C1713 340705 - SCREW BONE 4.5MM 105MM SLFTAP AXSOS STAINLESS STEEL CORTICAL BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340710 SUP HCPCS C1713 340710 - SCREW BONE 4.5MM 100MM SLFTAP AXSOS STAINLESS STEEL CORTICAL BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340715 SUP HCPCS C1713 340715 - SCREW BONE 4.5MM 115MM SLFTAP STAINLESS STEEL CORTICAL BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A 340720 SUP HCPCS C1713 340720 - SCREW BONE 4.5MM 120MM CORTICAL BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A 340725 SUP HCPCS C1713 340725 - SCREW BONE FULTHD 4.5MM 125MM SLFTAP ISO STAINLESS STEEL BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340730 SUP HCPCS C1713 340730 - SCREW BONE FULTHD 4.5MM 130MM SLFTAP ISO STAINLESS STEEL BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340735 SUP HCPCS C1713 340735 - SCREW BONE FULTHD 4.5MM 135MM SLFTAP ISO STAINLESS STEEL BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A 340740 SUP HCPCS C1713 340740 - SCREW BONE FULTHD 4.5MM 140MM SLFTAP ISO STAINLESS STEEL BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340745 SUP HCPCS C1713 340745 - SCREW BONE FULTHD 4.5MM 145MM SLFTAP ISO STAINLESS STEEL BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 340750 SUP HCPCS C1713 340750 - SCREW BONE 4.5MM 150MM SLFTAP FULTHD ISO STAINLESS STEEL BOTH IP/OP $49.00 $36.00 $9.68 $48.75 $21.94 $21.94 $21.94 $21.94 $48.75 $48.75 $48.75 $10.16 $48.75 $48.75 $48.75 $48.75 $48.75 $10.16 $48.75 $19.50 $28.84 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $21.94 $9.68 N/A $28.42 $48.75 $29.25 $48.75 $10.16 $48.75 N/A N/A 341025 SUP HCPCS C1713 341025 - SCREW BN 6.5MM 25MM 16MM P/T CANC BOTH IP/OP $52.50 $39.00 $10.37 $52.25 $23.51 $23.51 $23.51 $23.51 $52.25 $52.25 $52.25 $10.89 $52.25 $52.25 $52.25 $52.25 $52.25 $10.89 $52.25 $20.90 $30.91 $52.25 $52.25 $52.25 $52.25 $39.38 $52.25 $52.25 $52.25 $26.13 $26.13 $41.38 $52.25 $41.80 $23.51 $10.37 N/A $30.45 $52.25 $31.35 $52.25 $10.89 $52.25 N/A N/A 341030 SUP HCPCS C1713 341030 - SCREW BONE 6.5MM 30MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 341035 SUP HCPCS C1713 341035 - SCREW BONE 6.5MM 35MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 341040 SUP HCPCS C1713 341040 - SCREW BONE 6.5MM 40MM 16MM PTHRD CANCELLOUS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 341045 SUP HCPCS C1713 341045 - SCREW BONE 6.5MM 45MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 341050 SUP HCPCS C1713 341050 - SCREW BONE 6.5MM 50MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 341055 SUP HCPCS C1713 341055 - SCREW BONE 6.5MM 55MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 341060 SUP HCPCS C1713 341060 - SCREW BONE 3.5MM 6.5MM 60MM 16MM THREADED HEXAGONAL DRIVE BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 341065 SUP HCPCS C1713 341065 - SCREW BONE 3.5MM 6.5MM 65MM 16MM THREADED HEXAGONAL DRIVE BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 341070 SUP HCPCS C1713 341070 - SCREW BONE 3.5MM HEXAGON 6.5MM 70MM 16MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 341075 SUP HCPCS C1713 341075 - SCREW BONE 3.5MM HEXAGON 6.5MM 75MM 16MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 341080 SUP HCPCS C1713 341080 - SCREW BONE 3.5MM HEXAGON 6.5MM 80MM 16MM THREAD AXSOS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 341085 SUP HCPCS C1713 341085 - SCREW BONE 6.5MM 85MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 341090 SUP HCPCS C1713 341090 - SCREW BONE 6.5MM 90MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 341095 SUP HCPCS C1713 341095 - SCREW BONE 6.5MM 95MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 341100 SUP HCPCS C1713 341100 - SCREW BONE 6.5MM 100MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.32 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 341105 SUP HCPCS C1713 341105 - SCREW BONE 6.5MM 105MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.32 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 341110 SUP HCPCS C1713 341110 - SCREW BONE 6.5MM 110MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.32 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 341115 SUP HCPCS C1713 341115 - SCREW BONE 6.5MM 115MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 341120 SUP HCPCS C1713 341120 - SCREW BONE 6.5MM 120MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 341125 SUP HCPCS C1713 341125 - SCREW BONE 6.5MM 125MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 341130 SUP HCPCS C1713 341130 - SCREW BONE 6.5MM 130MM 16MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 341140 SUP HCPCS C1713 341140 - SCREW BONE 6.5MM 140MM 16MM SLFTAP FULTHD ISO STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.32 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 341824 SUP HCPCS C1786 341824 - PACEMAKER CRD THK6MM 53X39MM 11ML PH2 SR IMPL 1 CHMBR RR BOTH IP/OP "$8,000.00" "$5,920.00" "$1,587.80" "$8,000.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$8,000.00" "$8,000.00" "$8,000.00" "$1,667.40" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$1,667.29" "$8,000.00" "$8,000.00" "$3,944.00" "$8,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$6,000.00" "$8,000.00" "$8,000.00" "$8,000.00" "$4,000.00" "$4,000.00" "$6,336.00" "$8,000.00" "$6,400.00" "$3,600.00" "$1,587.80" N/A "$4,640.00" "$8,000.00" "$8,000.00" "$8,000.00" "$1,667.20" "$8,000.00" N/A N/A 342040 SUP HCPCS C1713 342040 - SCREW BONE 6.5MM 40MM 32MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 342045 SUP HCPCS C1713 342045 - SCREW BONE 3.5MM HEXAGON 6.5MM 45MM 32MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 342050 SUP HCPCS C1713 342050 - SCREW BONE 3.5MM HEXAGON 6.5MM 50MM 32MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 342055 SUP HCPCS C1713 342055 - SCREW BONE 3.5MM HEXAGON 6.5MM 55MM 32MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 342060 SUP HCPCS C1713 342060 - SCREW BONE 3.5MM HEXAGON 6.5MM 60MM 32MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 342065 SUP HCPCS C1713 342065 - SCREW BONE 3.5MM HEXAGON 6.5MM 65MM 32MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 342070 SUP HCPCS C1713 342070 - SCREW BONE 3.5MM HEXAGON 6.5MM 70MM 32MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 342075 SUP HCPCS C1713 342075 - SCREW BONE 3.5MM HEXAGON 6.5MM 75MM 32MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 342080 SUP HCPCS C1713 342080 - SCREW BONE 3.5MM HEXAGON 6.5MM 80MM 32MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 342085 SUP HCPCS C1713 342085 - SCREW BONE 3.5MM HEXAGON 6.5MM 85MM 32MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 342090 SUP HCPCS C1713 342090 - SCREW BONE 3.5MM HEXAGON 6.5MM 90MM 32MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 342095 SUP HCPCS C1713 342095 - SCREW BONE 6.5MM 95MM 32MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 342100 SUP HCPCS C1713 342100 - SCREW BONE 6.5MM 100MM 32MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.32 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 342105 SUP HCPCS C1713 342105 - SCREW BONE 6.5MM 105MM 32MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 342110 SUP HCPCS C1713 342110 - SCREW BONE 6.5MM 110MM 32MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.32 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 342115 SUP HCPCS C1713 342115 - SCREW BONE 6.5MM 115MM 32MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 342120 SUP HCPCS C1713 342120 - SCREW BONE 6.5MM 120MM 32MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.32 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 342125 SUP HCPCS C1713 342125 - SCREW BONE 6.5MM 125MM 32MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 342130 SUP HCPCS C1713 342130 - SCREW BONE 6.5MM 130MM 32MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.32 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 342140 SUP HCPCS C1713 342140 - SCREW BONE 6.5MM 140MM 32MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $62.00 $46.00 $12.28 $61.88 $27.85 $27.85 $27.85 $27.85 $61.88 $61.88 $61.88 $12.90 $61.88 $61.88 $61.88 $61.88 $61.88 $12.90 $61.88 $61.88 $36.60 $61.88 $61.88 $61.88 $61.88 $46.50 $61.88 $61.88 $61.88 $30.94 $30.94 $49.01 $61.88 $49.50 $27.85 $12.28 N/A $35.96 $61.88 $37.13 $61.88 $12.90 $61.88 N/A N/A 343020 SUP HCPCS C1713 343020 - SCREW BONE 3.5MM FULTHD HEXAGON 6.5MM 20MM AXSOS STAINLESS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.32 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 343025 SUP HCPCS C1713 343025 - SCREW BONE FULTHD 6.5MM 25MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 343030 SUP HCPCS C1713 343030 - SCREW BONE FULTHD 6.5MM 30MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 343035 SUP HCPCS C1713 343035 - SCREW BONE FULTHD 6.5MM 35MM LOCKING HEXAGONAL DRIVE BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 343040 SUP HCPCS C1713 343040 - SCREW BONE 3.5MM FULTHD HEXAGON 6.5MM 40MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 343045 SUP HCPCS C1713 343045 - SCREW BONE 3.5MM FULTHD HEXAGON 6.5MM 45MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 343050 SUP HCPCS C1713 343050 - SCREW BONE 3.5MM FULTHD HEXAGON 6.5MM 50MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 343055 SUP HCPCS C1713 343055 - SCREW BONE 3.5MM FULTHD HEXAGON 6.5MM 55MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 343060 SUP HCPCS C1713 343060 - SCREW BONE 3.5MM FULTHD HEXAGON 6.5MM 60MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 343065 SUP HCPCS C1713 343065 - SCREW BONE 3.5MM FULTHD HEXAGON 6.5MM 65MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 343070 SUP HCPCS C1713 343070 - SCREW BONE 3.5MM FULTHD HEXAGON 6.5MM 70MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 343075 SUP HCPCS C1713 343075 - SCREW BONE 3.5MM FULTHD HEXAGON 6.5MM 75MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 343080 SUP HCPCS C1713 343080 - SCREW BONE 3.5MM FULTHD HEXAGON 6.5MM 80MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 343085 SUP HCPCS C1713 343085 - SCREW BONE 3.5MM FULTHD HEXAGON 6.5MM 85MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $57.00 $57.00 $11.88 $57.00 N/A N/A 343090 SUP HCPCS C1713 343090 - SCREW BONE 3.5MM FULTHD HEXAGON 6.5MM 90MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 343095 SUP HCPCS C1713 343095 - SCREW BONE 3.5MM FULTHD HEXAGON 6.5MM 95MM AXSOS STAINLESS BOTH IP/OP $57.00 $42.00 $11.31 $57.00 $25.65 $25.65 $25.65 $25.65 $57.00 $57.00 $57.00 $11.88 $57.00 $57.00 $57.00 $57.00 $57.00 $11.88 $57.00 $22.80 $33.72 $57.00 $57.00 $57.00 $57.00 $42.75 $57.00 $57.00 $57.00 $28.50 $28.50 $45.14 $57.00 $45.60 $25.65 $11.31 N/A $33.06 $57.00 $34.20 $57.00 $11.88 $57.00 N/A N/A 343100 SUP HCPCS C1713 343100 - SCREW BONE FULTHD 6.5MM 100MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.32 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 343105 SUP HCPCS C1713 343105 - SCREW BONE 6.5MM 105MM FULTHRD STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.32 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 343110 SUP HCPCS C1713 343110 - SCREW BONE 6.5MM 110MM FULTHRD STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 343115 SUP HCPCS C1713 343115 - SCREW BONE 6.5MM 115MM FULTHRD STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 343120 SUP HCPCS C1713 343120 - SCREW BONE 6.5MM 120MM FULTHRD ISO STAINLESS STEEL BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $60.80 $60.80 $12.67 $60.80 N/A N/A 343125 SUP HCPCS C1713 343125 - SCREW BONE FULTHD 6.5MM 125MM ISO STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 343130 SUP HCPCS C1713 343130 - SCREW BONE FULTHD 6.5MM 130MM ISO STAINLESS STEEL CANCELLOUS BOTH IP/OP $61.00 $45.00 $12.07 $60.80 $27.36 $27.36 $27.36 $27.36 $60.80 $60.80 $60.80 $12.67 $60.80 $60.80 $60.80 $60.80 $60.80 $12.67 $60.80 $24.32 $35.96 $60.80 $60.80 $60.80 $60.80 $45.75 $60.80 $60.80 $60.80 $30.40 $30.40 $48.15 $60.80 $48.64 $27.36 $12.07 N/A $35.38 $60.80 $36.48 $60.80 $12.67 $60.80 N/A N/A 345410 SUP HCPCS C1713 345410 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 10MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345412 SUP HCPCS C1713 345412 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 12MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345414 SUP HCPCS C1713 345414 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 14MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345416 SUP HCPCS C1713 345416 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 16MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345418 SUP HCPCS C1713 345418 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 18MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345420 SUP HCPCS C1713 345420 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 20MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345422 SUP HCPCS C1713 345422 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 22MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345424 SUP HCPCS C1713 345424 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 24MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345426 SUP HCPCS C1713 345426 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 26MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345428 SUP HCPCS C1713 345428 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 28MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345430 SUP HCPCS C1713 345430 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 30MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345432 SUP HCPCS C1713 345432 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 32MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345434 SUP HCPCS C1713 345434 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 34MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345436 SUP HCPCS C1713 345436 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 36MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345438 SUP HCPCS C1713 345438 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 38MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345440 SUP HCPCS C1713 345440 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 40MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345445 SUP HCPCS C1713 345445 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 45MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345450 SUP HCPCS C1713 345450 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 50MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345455 SUP HCPCS C1713 345455 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 55MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345460 SUP HCPCS C1713 345460 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 60MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345465 SUP HCPCS C1713 345465 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 65MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345470 SUP HCPCS C1713 345470 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 70MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345475 SUP HCPCS C1713 345475 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 75MM AXSOS STAINLESS BOTH IP/OP $46.50 $34.00 $9.23 $46.50 $20.93 $20.93 $20.93 $20.93 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $46.50 $46.50 $46.50 $9.69 $46.50 $18.60 $27.50 $46.50 $46.50 $46.50 $46.50 $34.88 $46.50 $46.50 $46.50 $23.25 $23.25 $36.83 $46.50 $37.20 $20.93 $9.23 N/A $26.97 $46.50 $27.90 $46.50 $9.69 $46.50 N/A N/A 345480 SUP HCPCS C1713 345480 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 80MM AXSOS STAINLESS BOTH IP/OP $46.50 $34.00 $9.23 $46.50 $20.93 $20.93 $20.93 $20.93 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $46.50 $46.50 $46.50 $9.69 $46.50 $18.60 $27.50 $46.50 $46.50 $46.50 $46.50 $34.88 $46.50 $46.50 $46.50 $23.25 $23.25 $36.83 $46.50 $37.20 $20.93 $9.23 N/A $26.97 $46.50 $27.90 $46.50 $9.69 $46.50 N/A N/A 345485 SUP HCPCS C1713 345485 - SCREW BONE 2.5MM FULTHD HEXAGON 4MM 85MM AXSOS STAINLESS BOTH IP/OP $46.50 $34.00 $9.23 $46.50 $20.93 $20.93 $20.93 $20.93 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $27.50 $46.50 $46.50 $46.50 $46.50 $34.88 $46.50 $46.50 $46.50 $23.25 $23.25 $36.83 $46.50 $37.20 $20.93 $9.23 N/A $26.97 $46.50 $27.90 $46.50 $9.69 $46.50 N/A N/A 345490 SUP HCPCS C1713 345490 - SCREW BONE FULTHD 4MM 90MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $46.50 $34.00 $9.23 $46.50 $20.93 $20.93 $20.93 $20.93 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $27.50 $46.50 $46.50 $46.50 $46.50 $34.88 $46.50 $46.50 $46.50 $23.25 $23.25 $36.83 $46.50 $37.20 $20.93 $9.23 N/A $26.97 $46.50 $27.90 $46.50 $9.69 $46.50 N/A N/A 345495 SUP HCPCS C1713 345495 - SCREW BONE FULTHD 4MM 95MM ISO STAINLESS STEEL CANCELLOUS BOTH IP/OP $46.50 $34.00 $9.23 $46.50 $20.93 $20.93 $20.93 $20.93 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $27.50 $46.50 $46.50 $46.50 $46.50 $34.88 $46.50 $46.50 $46.50 $23.25 $23.25 $36.83 $46.50 $37.20 $20.93 $9.23 N/A $26.97 $46.50 $27.90 $46.50 $9.69 $46.50 N/A N/A 345500 SUP HCPCS C1713 345500 - SCREW BONE FULTHD 4MM 100MM ISO STAINLESS STEEL CANCELLOUS BOTH IP/OP $46.50 $34.00 $9.23 $46.50 $20.93 $20.93 $20.93 $20.93 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $27.50 $46.50 $46.50 $46.50 $46.50 $34.88 $46.50 $46.50 $46.50 $23.25 $23.25 $36.83 $46.50 $37.20 $20.93 $9.23 N/A $26.97 $46.50 $27.90 $46.50 $9.69 $46.50 N/A N/A 345510 SUP HCPCS C1713 345510 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 10MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345512 SUP HCPCS C1713 345512 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 12MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345514 SUP HCPCS C1713 345514 - SCREW BONE PTHRD 4MM 14MM HEXAGONAL DRIVE AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345516 SUP HCPCS C1713 345516 - SCREW BONE PTHRD 4MM 16MM HEXAGONAL DRIVE AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345518 SUP HCPCS C1758 345518 - SCREW BONE PTHRD 4MM 18MM HEXAGONAL DRIVE AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $21.99 $21.99 $21.99 $21.99 $40.50 $40.50 $40.50 $8.44 $40.50 $30.06 $30.06 $31.22 $21.10 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $26.33 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345520 SUP HCPCS C1713 345520 - SCREW BONE PTHRD 4MM 20MM HEXAGONAL DRIVE AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345522 SUP HCPCS C1713 345522 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 22MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345524 SUP HCPCS C1713 345524 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 24MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345526 SUP HCPCS C1713 345526 - SCREW BONE 4MM 26MM STAINLESS STEEL CANCELLOUS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345528 SUP HCPCS C1713 345528 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 28MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345530 SUP HCPCS C1713 345530 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 30MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345532 SUP HCPCS C1713 345532 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 32MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345534 SUP HCPCS C1713 345534 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 34MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345536 SUP HCPCS C1713 345536 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 36MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345538 SUP HCPCS C1713 345538 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 38MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345540 SUP HCPCS C1713 345540 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 40MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345545 SUP HCPCS C1713 345545 - SCREW BN 2.5MM P/T 4MM 45MM NS HEX SS CANC AXSOS SM FRAG SET BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345550 SUP HCPCS C1713 345550 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 50MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345555 SUP HCPCS C1713 345555 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 55MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345560 SUP HCPCS C1713 345560 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 60MM AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345565 SUP HCPCS C1713 345565 - SCREW BONE PTHRD 4MM 65MM HEXAGONAL DRIVE AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $16.20 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $24.30 $40.50 $8.44 $40.50 N/A N/A 345570 SUP HCPCS C1713 345570 - SCREW BONE PTHRD 4MM 70MM HEXAGONAL DRIVE AXSOS STAINLESS BOTH IP/OP $40.50 $30.00 $8.04 $40.50 $18.23 $18.23 $18.23 $18.23 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $40.50 $40.50 $40.50 $8.44 $40.50 $40.50 $23.96 $40.50 $40.50 $40.50 $40.50 $30.38 $40.50 $40.50 $40.50 $20.25 $20.25 $32.08 $40.50 $32.40 $18.23 $8.04 N/A $23.49 $40.50 $40.50 $40.50 $8.44 $40.50 N/A N/A 345575 SUP HCPCS C1713 345575 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 75MM AXSOS STAINLESS BOTH IP/OP $46.50 $34.00 $9.23 $46.50 $20.93 $20.93 $20.93 $20.93 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $46.50 $46.50 $46.50 $9.69 $46.50 $18.60 $27.50 $46.50 $46.50 $46.50 $46.50 $34.88 $46.50 $46.50 $46.50 $23.25 $23.25 $36.83 $46.50 $37.20 $20.93 $9.23 N/A $26.97 $46.50 $27.90 $46.50 $9.69 $46.50 N/A N/A 345580 SUP HCPCS C1713 345580 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 80MM AXSOS STAINLESS BOTH IP/OP $46.50 $34.00 $9.23 $46.50 $20.93 $20.93 $20.93 $20.93 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $46.50 $46.50 $46.50 $9.69 $46.50 $18.60 $27.50 $46.50 $46.50 $46.50 $46.50 $34.88 $46.50 $46.50 $46.50 $23.25 $23.25 $36.83 $46.50 $37.20 $20.93 $9.23 N/A $26.97 $46.50 $27.90 $46.50 $9.69 $46.50 N/A N/A 345585 SUP HCPCS C1713 345585 - SCREW BONE 4MM 85MM 16MM ISO STAINLESS STEEL CANCELLOUS BOTH IP/OP $46.50 $34.00 $9.23 $46.50 $20.93 $20.93 $20.93 $20.93 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $27.50 $46.50 $46.50 $46.50 $46.50 $34.88 $46.50 $46.50 $46.50 $23.25 $23.25 $36.83 $46.50 $37.20 $20.93 $9.23 N/A $26.97 $46.50 $27.90 $46.50 $9.69 $46.50 N/A N/A 345590 SUP HCPCS C1713 345590 - SCREW BONE 2.5MM PTHRD HEXAGON 4MM 90MM AXSOS STAINLESS BOTH IP/OP $46.50 $34.00 $9.23 $46.50 $20.93 $20.93 $20.93 $20.93 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $27.50 $46.50 $46.50 $46.50 $46.50 $34.88 $46.50 $46.50 $46.50 $23.25 $23.25 $36.83 $46.50 $37.20 $20.93 $9.23 N/A $26.97 $46.50 $27.90 $46.50 $9.69 $46.50 N/A N/A 345595 SUP HCPCS C1713 345595 - SCREW BONE 4MM 95MM LOCKING PTHRD AXSOS STAINLESS STEEL BOTH IP/OP $46.50 $34.00 $9.23 $46.50 $20.93 $20.93 $20.93 $20.93 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $27.50 $46.50 $46.50 $46.50 $46.50 $34.88 $46.50 $46.50 $46.50 $23.25 $23.25 $36.83 $46.50 $37.20 $20.93 $9.23 N/A $26.97 $46.50 $27.90 $46.50 $9.69 $46.50 N/A N/A 345600 SUP HCPCS C1713 345600 - SCREW BONE 4MM 100MM 16MM ISO STAINLESS STEEL CANCELLOUS BOTH IP/OP $46.50 $34.00 $9.23 $46.50 $20.93 $20.93 $20.93 $20.93 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $46.50 $46.50 $46.50 $9.69 $46.50 $46.50 $27.50 $46.50 $46.50 $46.50 $46.50 $34.88 $46.50 $46.50 $46.50 $23.25 $23.25 $36.83 $46.50 $37.20 $20.93 $9.23 N/A $26.97 $46.50 $27.90 $46.50 $9.69 $46.50 N/A N/A 346366 SUP HCPCS C1898 346366 - LEAD PACING 15MM STR RING 7.2FR 53CM BIPOL PASSIVE FIX 1IS-1 BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 346368 SUP HCPCS C1898 346368 - LEAD PACING 15CM TIP TO RING J 7.2FR 53CM BIPOL PASSIVE FIX BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 346369 SUP HCPCS C1898 346369 - LEAD PACING 15CM TIP TO RING J 7.2FR 45CM BIPOL PASSIVE FIX BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 348446 SUP HCPCS C1900 348446 - PACEMAKER CARDIAC IMPLTABLE PHILOS II DR ATRIAL VENTRICULAR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 349799 SUP HCPCS C1900 349799 - PACEMAKER CARDIAC THK6.4MM 57X42MM 2 CHAMBER RATE RESPONSIVE BOTH IP/OP "$8,500.00" "$6,290.00" "$1,687.04" "$8,500.00" "$3,825.00" "$3,825.00" "$3,825.00" "$3,825.00" "$8,500.00" "$8,500.00" "$8,500.00" "$1,771.61" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$1,771.49" "$8,500.00" "$8,500.00" "$4,190.50" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$6,375.00" "$8,500.00" "$8,500.00" "$8,500.00" "$4,250.00" "$4,250.00" "$6,732.00" "$8,500.00" "$6,800.00" "$3,825.00" "$1,687.04" N/A "$4,930.00" "$8,500.00" "$8,500.00" "$8,500.00" "$1,771.40" "$8,500.00" N/A N/A 349811 SUP HCPCS C1900 349811 - PACEMAKER CARDIAC THK6.4MM 57X39MM IMPLTABLE 1 CHAMBER RATE BOTH IP/OP "$8,500.00" "$6,290.00" "$1,687.04" "$8,500.00" "$3,825.00" "$3,825.00" "$3,825.00" "$3,825.00" "$8,500.00" "$8,500.00" "$8,500.00" "$1,771.61" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$1,771.49" "$8,500.00" "$8,500.00" "$4,190.50" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$6,375.00" "$8,500.00" "$8,500.00" "$8,500.00" "$4,250.00" "$4,250.00" "$6,732.00" "$8,500.00" "$6,800.00" "$3,825.00" "$1,687.04" N/A "$4,930.00" "$8,500.00" "$8,500.00" "$8,500.00" "$1,771.40" "$8,500.00" N/A N/A 350053 SUP HCPCS C1895 350053 - LEAD PACING 11MM STR 7.8FR 65CM 16CM 2DF-1 1IS-1 QUADRAPOLAR BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 350056 SUP HCPCS C1895 350056 - LEAD PACING 11MM STR 7.8FR 75CM 18CM 2DF-1 1IS-1 QUADRAPOLAR BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 350974 SUP HCPCS C1895 350974 - LEAD PACING 10MM J STR 6.7FR 53CM BIPOL ACTIVE FIX IS-1 BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $506.25 $506.25 $506.25 $506.25 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 $223.28 N/A $652.50 "$1,125.00" "$1,125.00" "$1,125.00" $234.45 "$1,125.00" N/A N/A 350975 SUP HCPCS C1895 350975 - LEAD PACING 10MM TIP TO RING STR 6.6FR 60CM BIPOL ACTIVE FIX BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $506.25 $506.25 $506.25 $506.25 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 $223.28 N/A $652.50 "$1,125.00" "$1,125.00" "$1,125.00" $234.45 "$1,125.00" N/A N/A 351333 SUP HCPCS C1777 351333 - LEAD PACING 17MM TIP TO RING STR 7.8FR 65CM TRIPOLAR ACTIVE BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 351334 SUP HCPCS C1777 351334 - LEAD PACING 17MM TIP TO RING STR 7.8FR 75CM TRIPOLAR ACTIVE BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 351337 SUP HCPCS C1895 351337 - LEAD PACING 9MM STR 7.8FR 65CM 16CM 2DF-1 1 BIPOL IS-1 1IS-1 BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 351353 SUP HCPCS C1777 351353 - LEAD PACING 9MM TIP TO RING STR 7.8FR 65CM 16CM TRIPOLAR BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 353440 SUP Custom 27203010 353440 - PUNCH AORTIC STANDARD FULL LENGTH 4MM 7IN LATEX FREE CLEAR BOTH IP/OP $336.00 $249.00 $59.79 $335.90 $335.90 $335.90 $335.90 $335.90 $335.90 $335.90 $59.79 $335.90 $335.90 $249.30 $249.30 $258.91 $175.00 $70.01 $335.90 $134.36 $335.90 $335.90 $335.90 $335.90 $335.90 $252.00 $335.90 $335.90 $335.90 $167.95 $167.95 $266.03 $335.90 $268.72 $218.34 $335.90 N/A $194.88 $335.90 $201.54 $335.90 $335.90 $335.90 N/A N/A 354805 SUP HCPCS C1900 354805 - LEAD PACING 18MM TIP TO RING 2 CURVE 5.4FR 77CM BIPOL BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 354807 SUP HCPCS C1900 354807 - LEAD PACING 18MM 2 CURVE HELIX 5.4FR 87CM BIPOL PASSIVE FIX BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 355148 SUP HCPCS C1900 355148 - LEAD PACING 18MM TIP TO RING BENT 5.4FR 77CM BIPOL PASSIVE BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 355149 SUP HCPCS C1900 355149 - LEAD PACING 18MM BENT HELIX 5.4FR 87CM BIPOL PASSIVE FIX OTW BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 356053 SUP HCPCS C1900 356053 - PACEMAKER CARDIAC 1 CHAMBER IMPLTABLE CYLOS VR BIVENTRICULAR BOTH IP/OP "$9,500.00" "$7,030.00" "$1,885.51" "$9,500.00" "$4,275.00" "$4,275.00" "$4,275.00" "$4,275.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,980.04" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.90" "$9,500.00" "$9,500.00" "$4,683.50" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$7,125.00" "$9,500.00" "$9,500.00" "$9,500.00" "$4,750.00" "$4,750.00" "$7,524.00" "$9,500.00" "$7,600.00" "$4,275.00" "$1,885.51" N/A "$5,510.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.80" "$9,500.00" N/A N/A 359654 SUP HCPCS C1721 359654 - DEFIBRILLATOR CARDIAC THK13MM 3.2V 40 JOULES 55X66MM BOTH IP/OP "$46,450.00" "$34,373.00" "$9,680.69" "$46,450.00" "$46,450.00" "$46,450.00" "$46,450.00" "$46,450.00" "$46,450.00" "$46,450.00" "$46,450.00" "$46,450.00" "$46,450.00" "$46,450.00" "$46,450.00" "$46,450.00" "$46,450.00" "$9,680.69" "$46,450.00" "$18,580.00" "$46,450.00" "$46,450.00" "$46,450.00" "$46,450.00" "$46,450.00" "$34,837.50" "$46,450.00" "$46,450.00" "$46,450.00" "$23,225.00" "$23,225.00" "$36,788.40" "$46,450.00" "$37,160.00" "$20,902.50" "$46,450.00" N/A "$26,941.00" "$46,450.00" "$27,870.00" "$46,450.00" "$46,450.00" "$46,450.00" N/A N/A 359655 SUP HCPCS C1721 359655 - DEFIBRILLATOR CARDIAC THK13MM 66MMX55MM IMPLTABLE 2 CHAMBER BOTH IP/OP "$56,450.00" "$41,773.00" "$11,764.80" "$56,450.00" "$56,450.00" "$56,450.00" "$56,450.00" "$56,450.00" "$56,450.00" "$56,450.00" "$56,450.00" "$56,450.00" "$56,450.00" "$56,450.00" "$56,450.00" "$56,450.00" "$56,450.00" "$11,764.80" "$56,450.00" "$22,580.00" "$56,450.00" "$56,450.00" "$56,450.00" "$56,450.00" "$56,450.00" "$42,337.50" "$56,450.00" "$56,450.00" "$56,450.00" "$28,225.00" "$28,225.00" "$44,708.40" "$56,450.00" "$45,160.00" "$25,402.50" "$56,450.00" N/A "$32,741.00" "$56,450.00" "$33,870.00" "$56,450.00" "$56,450.00" "$56,450.00" N/A N/A 359656 SUP HCPCS C1721 359656 - DEFIBRILLATOR CARDIAC THK13MM 3.2V 40 JOULES 55X66MM BOTH IP/OP "$51,450.00" "$38,073.00" "$10,722.75" "$51,450.00" "$51,450.00" "$51,450.00" "$51,450.00" "$51,450.00" "$51,450.00" "$51,450.00" "$51,450.00" "$51,450.00" "$51,450.00" "$51,450.00" "$51,450.00" "$51,450.00" "$51,450.00" "$10,722.75" "$51,450.00" "$20,580.00" "$51,450.00" "$51,450.00" "$51,450.00" "$51,450.00" "$51,450.00" "$38,587.50" "$51,450.00" "$51,450.00" "$51,450.00" "$25,725.00" "$25,725.00" "$40,748.40" "$51,450.00" "$41,160.00" "$23,152.50" "$51,450.00" N/A "$29,841.00" "$51,450.00" "$30,870.00" "$51,450.00" "$51,450.00" "$51,450.00" N/A N/A 359659 SUP HCPCS C1882 359659 - DEFIBRILLATOR CARDIAC THK13MM 66MMX59MM IMPLTABLE 3 CHAMBER BOTH IP/OP "$72,600.00" "$53,724.00" "$7,712.84" "$72,600.00" "$32,670.00" "$32,670.00" "$32,670.00" "$32,670.00" "$72,600.00" "$72,600.00" "$72,600.00" "$9,417.94" "$72,600.00" "$72,600.00" "$72,600.00" "$72,600.00" "$72,600.00" "$15,130.64" "$72,600.00" "$72,600.00" "$35,791.80" "$72,600.00" "$72,600.00" "$72,600.00" "$72,600.00" "$54,450.00" "$72,600.00" "$72,600.00" "$72,600.00" "$36,300.00" "$36,300.00" "$57,499.20" "$72,600.00" "$58,080.00" "$32,670.00" "$7,712.84" N/A "$42,108.00" "$72,600.00" "$72,600.00" "$72,600.00" "$8,098.48" "$72,600.00" N/A N/A 359662 SUP HCPCS C1882 359662 - DEFIBRILLATOR CARDIAC THK13MM 3.2V 40 JOULES 66X59MM BOTH IP/OP "$67,600.00" "$50,024.00" "$7,712.84" "$67,600.00" "$30,420.00" "$30,420.00" "$30,420.00" "$30,420.00" "$67,600.00" "$67,600.00" "$67,600.00" "$9,417.94" "$67,600.00" "$67,600.00" "$67,600.00" "$67,600.00" "$67,600.00" "$14,088.58" "$67,600.00" "$67,600.00" "$33,326.80" "$67,600.00" "$67,600.00" "$67,600.00" "$67,600.00" "$50,700.00" "$67,600.00" "$67,600.00" "$67,600.00" "$33,800.00" "$33,800.00" "$53,539.20" "$67,600.00" "$54,080.00" "$30,420.00" "$7,712.84" N/A "$39,208.00" "$67,600.00" "$67,600.00" "$67,600.00" "$8,098.48" "$67,600.00" N/A N/A 359664 SUP HCPCS C1786 359664 - DEFIBRILLATOR CARDIAC THK13MM 3.2V 40 JOULES 66X59MM BOTH IP/OP "$42,700.00" "$31,598.00" "$7,712.84" "$42,700.00" "$19,215.00" "$19,215.00" "$19,215.00" "$19,215.00" "$42,700.00" "$42,700.00" "$42,700.00" "$8,899.75" "$42,700.00" "$42,700.00" "$42,700.00" "$42,700.00" "$42,700.00" "$8,899.15" "$42,700.00" "$42,700.00" "$21,051.10" "$42,700.00" "$42,700.00" "$42,700.00" "$42,700.00" "$32,025.00" "$42,700.00" "$42,700.00" "$42,700.00" "$21,350.00" "$21,350.00" "$33,818.40" "$42,700.00" "$34,160.00" "$19,215.00" "$7,712.84" N/A "$24,766.00" "$42,700.00" "$42,700.00" "$42,700.00" "$8,098.48" "$42,700.00" N/A N/A 359665 SUP HCPCS C1786 359665 - DEFIBRILLATOR CARDIAC THK13MM 3.2V 40 JOULES 66X59MM BOTH IP/OP "$52,700.00" "$38,998.00" "$7,712.84" "$52,700.00" "$23,715.00" "$23,715.00" "$23,715.00" "$23,715.00" "$52,700.00" "$52,700.00" "$52,700.00" "$9,417.94" "$52,700.00" "$52,700.00" "$52,700.00" "$52,700.00" "$52,700.00" "$10,983.26" "$52,700.00" "$52,700.00" "$25,981.10" "$52,700.00" "$52,700.00" "$52,700.00" "$52,700.00" "$39,525.00" "$52,700.00" "$52,700.00" "$52,700.00" "$26,350.00" "$26,350.00" "$41,738.40" "$52,700.00" "$42,160.00" "$23,715.00" "$7,712.84" N/A "$30,566.00" "$52,700.00" "$52,700.00" "$52,700.00" "$8,098.48" "$52,700.00" N/A N/A 359666 SUP HCPCS C1874 359666 - DEFIBRILLATOR CARDIAC THK13MM 3.2V 40 JOULES 66X59MM BOTH IP/OP "$47,700.00" "$35,298.00" "$7,712.84" "$47,700.00" "$21,465.00" "$21,465.00" "$21,465.00" "$21,465.00" "$47,700.00" "$47,700.00" "$47,700.00" "$9,417.94" "$47,700.00" "$47,700.00" "$47,700.00" "$47,700.00" "$47,700.00" "$9,941.20" "$47,700.00" "$47,700.00" "$23,516.10" "$47,700.00" "$47,700.00" "$47,700.00" "$47,700.00" "$35,775.00" "$47,700.00" "$47,700.00" "$47,700.00" "$23,850.00" "$23,850.00" "$37,778.40" "$47,700.00" "$38,160.00" "$21,465.00" "$7,712.84" N/A "$27,666.00" "$47,700.00" "$47,700.00" "$47,700.00" "$8,098.48" "$47,700.00" N/A N/A 360101 SUP Custom 27203010 360101 - DEVICE SPEC RTRVL .018IN 10MM 10CM INTLK DTCH COIL BOTH IP/OP $455.50 $337.00 $81.08 $455.50 $455.50 $455.50 $455.50 $455.50 $455.50 $455.50 $81.08 $455.50 $455.50 $338.07 $338.07 $351.10 $237.32 $94.93 $455.50 $182.20 $455.50 $455.50 $455.50 $455.50 $455.50 $341.63 $455.50 $455.50 $455.50 $227.75 $227.75 $360.76 $455.50 $364.40 $296.08 $455.50 N/A $264.19 $455.50 $273.30 $455.50 $455.50 $455.50 N/A N/A Jun-98 SUP Custom 27803010 06-2898 - HEAD FEM -3MM OFST CTPR 28MM LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 365501 SUP HCPCS C1900 365501 - LEAD PACING 65CM 17CM IS-1 CONCTR BIPOL FIX SCREW BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 370001 SUP Custom 27803010 370001 - INSERT ACETAB 3MM LOCK HIP BOTH IP/OP $71.50 $53.00 $12.67 $71.20 $71.20 $71.20 $71.20 $71.20 $71.20 $71.20 $12.67 $71.20 $71.20 $71.20 $71.20 $71.20 $71.20 $14.84 $71.20 $28.48 $71.20 $71.20 $71.20 $71.20 $71.20 $53.63 $71.20 $71.20 $71.20 $35.60 $35.60 $56.39 $71.20 $56.96 $32.04 $71.20 N/A $41.47 $71.20 $42.72 $71.20 $71.20 $71.20 N/A N/A 370002 SUP Custom 27803010 370002 - INSERT TIBIAL 4MM LOCK AXSOS STAINLESS STEEL FEMUR DISTAL BOTH IP/OP $78.50 $58.00 $13.96 $78.40 $78.40 $78.40 $78.40 $78.40 $78.40 $78.40 $13.96 $78.40 $78.40 $78.40 $78.40 $78.40 $78.40 $16.34 $78.40 $31.36 $78.40 $78.40 $78.40 $78.40 $78.40 $58.88 $78.40 $78.40 $78.40 $39.20 $39.20 $62.09 $78.40 $62.72 $35.28 $78.40 N/A $45.53 $78.40 $47.04 $78.40 $78.40 $78.40 N/A N/A 370003 SUP Custom 27803010 370003 - INSERT TIBIAL 5MM LOCK AXSOS STAINLESS STEEL FEMUR LATERAL BOTH IP/OP $96.50 $71.00 $17.13 $96.25 $96.25 $96.25 $96.25 $96.25 $96.25 $96.25 $17.13 $96.25 $96.25 $96.25 $96.25 $96.25 $96.25 $20.06 $96.25 $38.50 $96.25 $96.25 $96.25 $96.25 $96.25 $72.38 $96.25 $96.25 $96.25 $48.13 $48.13 $76.23 $96.25 $77.00 $43.31 $96.25 N/A $55.97 $96.25 $57.75 $96.25 $96.25 $96.25 N/A N/A 370004 SUP HCPCS C1713 370004 - PLUG CABLE 4MM AXSOS STAINLESS STEEL SMALL FRAGMENT BOTH IP/OP $78.50 $58.00 $15.56 $78.40 $35.28 $35.28 $35.28 $35.28 $78.40 $78.40 $78.40 $16.34 $78.40 $78.40 $78.40 $78.40 $78.40 $16.34 $78.40 $31.36 $46.37 $78.40 $78.40 $78.40 $78.40 $58.88 $78.40 $78.40 $78.40 $39.20 $39.20 $62.09 $78.40 $62.72 $35.28 $15.56 N/A $45.53 $78.40 $78.40 $78.40 $16.34 $78.40 N/A N/A 370005 SUP HCPCS C1713 370005 - PLUG CABLE 5MM AXSOS STAINLESS STEEL FEMUR DISTAL LATERAL BOTH IP/OP $102.50 $76.00 $20.32 $102.40 $46.08 $46.08 $46.08 $46.08 $102.40 $102.40 $102.40 $21.34 $102.40 $102.40 $102.40 $102.40 $102.40 $21.34 $102.40 $40.96 $60.57 $102.40 $102.40 $102.40 $102.40 $76.88 $102.40 $102.40 $102.40 $51.20 $51.20 $81.10 $102.40 $81.92 $46.08 $20.32 N/A $59.45 $102.40 $102.40 $102.40 $21.34 $102.40 N/A N/A 370008 SUP HCPCS C1713 370008 - SCREW BONE 3MM 8MM LOCK ORTHOPEDIC BOTH IP/OP $132.00 $98.00 $26.20 $132.00 $59.40 $59.40 $59.40 $59.40 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $78.08 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $59.40 $26.20 N/A $76.56 $132.00 $132.00 $132.00 $27.51 $132.00 N/A N/A 370010 SUP HCPCS C1713 370010 - SCREW BONE 3MM 10MM LOCK ORTHOPEDIC BOTH IP/OP $132.00 $98.00 $26.20 $132.00 $59.40 $59.40 $59.40 $59.40 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $78.08 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $59.40 $26.20 N/A $76.56 $132.00 $132.00 $132.00 $27.51 $132.00 N/A N/A 370012 SUP HCPCS C1713 370012 - SCREW BONE 3MM 12MM T8 DRIVE LOCKING SLFTAP AXSOS STAINLESS BOTH IP/OP $132.00 $98.00 $26.20 $132.00 $59.40 $59.40 $59.40 $59.40 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $78.08 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $59.40 $26.20 N/A $76.56 $132.00 $132.00 $132.00 $27.51 $132.00 N/A N/A 370014 SUP HCPCS C1713 370014 - SCREW BONE 3MM 14MM T8 DRIVE LOCKING SLFTAP AXSOS STAINLESS BOTH IP/OP $132.00 $98.00 $26.20 $132.00 $59.40 $59.40 $59.40 $59.40 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $78.08 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $59.40 $26.20 N/A $76.56 $132.00 $132.00 $132.00 $27.51 $132.00 N/A N/A 370016 SUP HCPCS C1713 370016 - SCREW BONE T8 3MM 16MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $132.00 $98.00 $26.20 $132.00 $59.40 $59.40 $59.40 $59.40 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $132.00 $132.00 $132.00 $27.51 $132.00 $52.80 $78.08 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $59.40 $26.20 N/A $76.56 $132.00 $132.00 $132.00 $27.51 $132.00 N/A N/A 370018 SUP HCPCS C1713 370018 - SCREW BONE T8 3MM 18MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $132.00 $98.00 $26.20 $132.00 $59.40 $59.40 $59.40 $59.40 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $78.08 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $59.40 $26.20 N/A $76.56 $132.00 $79.20 $132.00 $27.51 $132.00 N/A N/A 370020 SUP HCPCS C1713 370020 - SCREW BONE 3MM 20MM LOCK ORTHOPEDIC BOTH IP/OP $132.00 $98.00 $26.20 $132.00 $59.40 $59.40 $59.40 $59.40 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $132.00 $132.00 $132.00 $27.51 $132.00 $52.80 $78.08 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $59.40 $26.20 N/A $76.56 $132.00 $132.00 $132.00 $27.51 $132.00 N/A N/A 370022 SUP HCPCS C1713 370022 - SCREW BONE 3MM 22MM LOCK ORTHOPEDIC BOTH IP/OP $132.00 $98.00 $26.20 $132.00 $59.40 $59.40 $59.40 $59.40 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $132.00 $132.00 $132.00 $27.51 $132.00 $52.80 $78.08 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $59.40 $26.20 N/A $76.56 $132.00 $79.20 $132.00 $27.51 $132.00 N/A N/A 370024 SUP HCPCS C1713 370024 - SCREW BONE 3MM 24MM T8 DRIVE LOCKING SLFTAP AXSOS STAINLESS BOTH IP/OP $132.00 $98.00 $26.20 $132.00 $59.40 $59.40 $59.40 $59.40 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $132.00 $132.00 $132.00 $27.51 $132.00 $52.80 $78.08 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $59.40 $26.20 N/A $76.56 $132.00 $79.20 $132.00 $27.51 $132.00 N/A N/A 370026 SUP HCPCS C1713 370026 - SCREW BONE T8 3MM 26MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $132.00 $98.00 $26.20 $132.00 $59.40 $59.40 $59.40 $59.40 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $132.00 $132.00 $132.00 $27.51 $132.00 $52.80 $78.08 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $59.40 $26.20 N/A $76.56 $132.00 $79.20 $132.00 $27.51 $132.00 N/A N/A 370028 SUP HCPCS C1713 370028 - SCREW BONE T8 3MM 28MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $132.00 $98.00 $26.20 $132.00 $59.40 $59.40 $59.40 $59.40 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $132.00 $132.00 $132.00 $27.51 $132.00 $52.80 $78.08 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $59.40 $26.20 N/A $76.56 $132.00 $79.20 $132.00 $27.51 $132.00 N/A N/A 370030 SUP HCPCS C1713 370030 - SCREW BONE 3MM 30MM T8 DRIVE LOCKING SLFTAP AXSOS STAINLESS BOTH IP/OP $132.00 $98.00 $26.20 $132.00 $59.40 $59.40 $59.40 $59.40 $132.00 $132.00 $132.00 $27.51 $132.00 $132.00 $132.00 $132.00 $132.00 $27.51 $132.00 $52.80 $78.08 $132.00 $132.00 $132.00 $132.00 $99.00 $132.00 $132.00 $132.00 $66.00 $66.00 $104.54 $132.00 $105.60 $59.40 $26.20 N/A $76.56 $132.00 $79.20 $132.00 $27.51 $132.00 N/A N/A 370110 SUP HCPCS C1713 370110 - SCREW BONE T20 5MM 10MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $261.00 $193.00 $51.76 $260.80 $117.36 $117.36 $117.36 $117.36 $260.80 $260.80 $260.80 $54.36 $260.80 $260.80 $260.80 $260.80 $260.80 $54.35 $260.80 $260.80 $154.26 $260.80 $260.80 $260.80 $260.80 $195.75 $260.80 $260.80 $260.80 $130.40 $130.40 $206.55 $260.80 $208.64 $117.36 $51.76 N/A $151.38 $260.80 $260.80 $260.80 $54.35 $260.80 N/A N/A 370112 SUP HCPCS C1713 370112 - SCREW BONE T20 5MM 12MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $261.00 $193.00 $51.76 $260.80 $117.36 $117.36 $117.36 $117.36 $260.80 $260.80 $260.80 $54.36 $260.80 $260.80 $260.80 $260.80 $260.80 $54.35 $260.80 $260.80 $154.26 $260.80 $260.80 $260.80 $260.80 $195.75 $260.80 $260.80 $260.80 $130.40 $130.40 $206.55 $260.80 $208.64 $117.36 $51.76 N/A $151.38 $260.80 $260.80 $260.80 $54.35 $260.80 N/A N/A 370114 SUP HCPCS C1713 370114 - SCREW BONE T20 5MM 14MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $261.00 $193.00 $51.76 $260.80 $117.36 $117.36 $117.36 $117.36 $260.80 $260.80 $260.80 $54.36 $260.80 $260.80 $260.80 $260.80 $260.80 $54.35 $260.80 $260.80 $154.26 $260.80 $260.80 $260.80 $260.80 $195.75 $260.80 $260.80 $260.80 $130.40 $130.40 $206.55 $260.80 $208.64 $117.36 $51.76 N/A $151.38 $260.80 $260.80 $260.80 $54.35 $260.80 N/A N/A 370116 SUP HCPCS C1713 370116 - SCREW BONE T20 5MM 16MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $261.00 $193.00 $51.76 $260.80 $117.36 $117.36 $117.36 $117.36 $260.80 $260.80 $260.80 $54.36 $260.80 $260.80 $260.80 $260.80 $260.80 $54.35 $260.80 $104.32 $154.26 $260.80 $260.80 $260.80 $260.80 $195.75 $260.80 $260.80 $260.80 $130.40 $130.40 $206.55 $260.80 $208.64 $117.36 $51.76 N/A $151.38 $260.80 $260.80 $260.80 $54.35 $260.80 N/A N/A 370118 SUP HCPCS C1713 370118 - SCREW BONE T20 5MM 18MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $261.00 $193.00 $51.76 $260.80 $117.36 $117.36 $117.36 $117.36 $260.80 $260.80 $260.80 $54.36 $260.80 $260.80 $260.80 $260.80 $260.80 $54.35 $260.80 $104.32 $154.26 $260.80 $260.80 $260.80 $260.80 $195.75 $260.80 $260.80 $260.80 $130.40 $130.40 $206.55 $260.80 $208.64 $117.36 $51.76 N/A $151.38 $260.80 $260.80 $260.80 $54.35 $260.80 N/A N/A 370120 SUP HCPCS C1713 370120 - SCREW BONE T20 5MM 20MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $261.00 $193.00 $51.76 $260.80 $117.36 $117.36 $117.36 $117.36 $260.80 $260.80 $260.80 $54.36 $260.80 $260.80 $260.80 $260.80 $260.80 $54.35 $260.80 $104.32 $154.26 $260.80 $260.80 $260.80 $260.80 $195.75 $260.80 $260.80 $260.80 $130.40 $130.40 $206.55 $260.80 $208.64 $117.36 $51.76 N/A $151.38 $260.80 $156.48 $260.80 $54.35 $260.80 N/A N/A 370314 SUP HCPCS C1713 370314 - SCREW BONE T20 5MM 14MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $199.38 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $119.63 $199.38 $41.55 $199.38 N/A N/A 370316 SUP HCPCS C1713 370316 - SCREW BONE 5MM 16MM LOCK ORTHOPEDIC BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370318 SUP HCPCS C1713 370318 - SCREW BONE 5MM 18MM T20 DRIVE SLFTAP LOCKING AXSOS STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $199.38 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370320 SUP HCPCS C1713 370320 - SCREW BONE T20 5MM 20MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $199.38 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370322 SUP HCPCS C1713 370322 - SCREW BONE T20 5MM 22MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $199.38 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370324 SUP HCPCS C1713 370324 - SCREW BONE T20 5MM 24MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370326 SUP HCPCS C1713 370326 - SCREW BONE 5MM 26MM SLFTAP LOCKING PERIPROSTHETIC AXSOS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $199.38 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $119.63 $199.38 $41.55 $199.38 N/A N/A 370328 SUP HCPCS C1713 370328 - SCREW BONE 5MM 28MM T20 DRIVE SLFTAP LOCKING AXSOS STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $199.38 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $119.63 $199.38 $41.55 $199.38 N/A N/A 370330 SUP HCPCS C1713 370330 - SCREW BONE T20 5MM 30MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $199.38 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $119.63 $199.38 $41.55 $199.38 N/A N/A 370332 SUP HCPCS C1713 370332 - SCREW BONE T20 5MM 32MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370334 SUP HCPCS C1713 370334 - SCREW BONE T20 5MM 34MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370336 SUP HCPCS C1713 370336 - SCREW BONE T20 5MM 36MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $199.38 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $119.63 $199.38 $41.55 $199.38 N/A N/A 370338 SUP HCPCS C1713 370338 - SCREW BONE T20 5MM 38MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370340 SUP HCPCS C1713 370340 - SCREW BONE 5MM 40MM T20 DRIVE SLFTAP LOCKING AXSOS STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $119.63 $199.38 $41.55 $199.38 N/A N/A 370342 SUP HCPCS C1713 370342 - SCREW BONE T20 5MM 42MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370344 SUP HCPCS C1713 370344 - SCREW BONE 5MM 44MM T20 DRIVE SLFTAP LOCKING AXSOS STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370346 SUP HCPCS C1713 370346 - SCREW BONE 5MM 46MM T20 DRIVE SLFTAP LOCKING AXSOS STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370348 SUP HCPCS C1713 370348 - SCREW BONE 5MM 48MM T20 DRIVE SLFTAP LOCKING AXSOS STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370350 SUP HCPCS C1713 370350 - SCREW BONE T20 5MM 50MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $119.63 $199.38 $41.55 $199.38 N/A N/A 370355 SUP HCPCS C1713 370355 - SCREW BONE T20 5MM 55MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370360 SUP HCPCS C1713 370360 - SCREW BONE T20 5MM 60MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $119.63 $199.38 $41.55 $199.38 N/A N/A 370365 SUP HCPCS C1713 370365 - SCREW BONE T20 5MM 65MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370370 SUP HCPCS C1713 370370 - SCREW BONE T20 5MM 70MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 370375 SUP HCPCS C1713 370375 - SCREW BONE T20 5MM 75MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $119.63 $199.38 $41.55 $199.38 N/A N/A 370380 SUP HCPCS C1713 370380 - SCREW BONE T20 5MM 80MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $119.63 $199.38 $41.55 $199.38 N/A N/A 370385 SUP HCPCS C1713 370385 - SCREW BONE T20 5MM 85MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $119.63 $199.38 $41.55 $199.38 N/A N/A 370390 SUP HCPCS C1713 370390 - SCREW BONE T20 5MM 90MM SELF TAP LOCK AXSOS OMEGA3 STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $119.63 $199.38 $41.55 $199.38 N/A N/A 370395 SUP HCPCS C1713 370395 - SCREW BONE 5MM 95MM T20 DRIVE SLFTAP LOCKING AXSOS STAINLESS BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $119.63 $199.38 $41.55 $199.38 N/A N/A 370400 SUP HCPCS C1713 370400 - SCREW BONE 5MM 100MM LOCK ORTHOPEDIC BOTH IP/OP $197.00 $146.00 $39.03 $196.63 $88.48 $88.48 $88.48 $88.48 $196.63 $196.63 $196.63 $40.98 $196.63 $196.63 $196.63 $196.63 $196.63 $40.98 $196.63 $196.63 $116.31 $196.63 $196.63 $196.63 $196.63 $147.75 $196.63 $196.63 $196.63 $98.32 $98.32 $155.73 $196.63 $157.30 $88.48 $39.03 N/A $114.26 $196.63 $117.98 $196.63 $40.98 $196.63 N/A N/A 370405 SUP HCPCS C1713 370405 - SCREW BONE 5MM 105MM LOCK ORTHOPEDIC BOTH IP/OP $197.00 $146.00 $39.03 $196.63 $88.48 $88.48 $88.48 $88.48 $196.63 $196.63 $196.63 $40.98 $196.63 $196.63 $196.63 $196.63 $196.63 $40.98 $196.63 $78.65 $116.31 $196.63 $196.63 $196.63 $196.63 $147.75 $196.63 $196.63 $196.63 $98.32 $98.32 $155.73 $196.63 $157.30 $88.48 $39.03 N/A $114.26 $196.63 $117.98 $196.63 $40.98 $196.63 N/A N/A 370410 SUP HCPCS C1713 370410 - SCREW BONE 5MM 110MM SLFTAP LOCKING PERIPROSTHETIC AXSOS BOTH IP/OP $197.00 $146.00 $114.26 $147.75 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $147.75 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $114.26 N/A N/A N/A N/A N/A N/A N/A 370415 SUP HCPCS C1713 370415 - SCREW BONE 5MM 115MM LOCK ORTHOPEDIC BOTH IP/OP $197.00 $146.00 $39.03 $196.63 $88.48 $88.48 $88.48 $88.48 $196.63 $196.63 $196.63 $40.98 $196.63 $196.63 $196.63 $196.63 $196.63 $40.98 $196.63 $78.65 $116.31 $196.63 $196.63 $196.63 $196.63 $147.75 $196.63 $196.63 $196.63 $98.32 $98.32 $155.73 $196.63 $157.30 $88.48 $39.03 N/A $114.26 $196.63 $117.98 $196.63 $40.98 $196.63 N/A N/A 370420 SUP HCPCS C1713 370420 - SCREW BONE 5MM 120MM SLFTAP LOCKING PERIPROSTHETIC AXSOS BOTH IP/OP $197.00 $146.00 $39.03 $196.63 $88.48 $88.48 $88.48 $88.48 $196.63 $196.63 $196.63 $40.98 $196.63 $196.63 $196.63 $196.63 $196.63 $40.98 $196.63 $78.65 $116.31 $196.63 $196.63 $196.63 $196.63 $147.75 $196.63 $196.63 $196.63 $98.32 $98.32 $155.73 $196.63 $157.30 $88.48 $39.03 N/A $114.26 $196.63 $117.98 $196.63 $40.98 $196.63 N/A N/A 370514 SUP HCPCS C1713 370514 - SCREW BONE T15 4MM 14MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370516 SUP HCPCS C1713 370516 - SCREW BONE T15 4MM 16MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370518 SUP HCPCS C1713 370518 - SCREW BONE T15 4MM 18MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370520 SUP HCPCS C1713 370520 - SCREW BONE T15 4MM 20MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370522 SUP HCPCS C1713 370522 - SCREW BONE T15 4MM 22MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370524 SUP HCPCS C1713 370524 - SCREW BONE T15 4MM 24MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370526 SUP HCPCS C1713 370526 - SCREW BONE T15 4MM 26MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370528 SUP HCPCS C1713 370528 - SCREW BONE T15 4MM 28MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370530 SUP HCPCS C1713 370530 - SCREW BONE T15 4MM 30MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $185.63 $185.63 $38.69 $185.63 N/A N/A 370532 SUP HCPCS C1713 370532 - SCREW BONE T15 4MM 32MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370534 SUP HCPCS C1713 370534 - SCREW BONE T15 4MM 34MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $185.63 $185.63 $38.69 $185.63 N/A N/A 370536 SUP HCPCS C1713 370536 - SCREW BONE T15 4MM 36MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $185.63 $185.63 $38.69 $185.63 N/A N/A 370538 SUP HCPCS C1713 370538 - SCREW BONE T15 4MM 38MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $185.63 $185.63 $38.69 $185.63 N/A N/A 370540 SUP HCPCS C1713 370540 - SCREW BONE T15 4MM 40MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $185.63 $185.63 $38.69 $185.63 N/A N/A 370542 SUP HCPCS C1713 370542 - SCREW BONE T15 4MM 42MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370544 SUP HCPCS C1713 370544 - SCREW BONE T15 4MM 44MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370546 SUP HCPCS C1713 370546 - SCREW BONE T15 4MM 46MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370548 SUP HCPCS C1713 370548 - SCREW BONE T15 4MM 48MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370550 SUP HCPCS C1713 370550 - SCREW BONE T15 4MM 50MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $185.63 $185.63 $38.69 $185.63 N/A N/A 370555 SUP HCPCS C1713 370555 - SCREW BONE T15 4MM 55MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $185.63 $185.63 $38.69 $185.63 N/A N/A 370560 SUP HCPCS C1713 370560 - SCREW BONE T15 4MM 60MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $185.63 $185.63 $38.69 $185.63 N/A N/A 370565 SUP HCPCS C1713 370565 - SCREW BONE T15 4MM 65MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370570 SUP HCPCS C1713 370570 - SCREW BONE T15 4MM 70MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370575 SUP HCPCS C1713 370575 - SCREW BONE T15 4MM 75MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370580 SUP HCPCS C1713 370580 - SCREW BONE T15 4MM 80MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370585 SUP HCPCS C1713 370585 - SCREW BONE T15 4MM 85MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370590 SUP HCPCS C1713 370590 - SCREW BONE T15 4MM 90MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370595 SUP HCPCS C1713 370595 - SCREW BONE 4MM 95MM T15 DRIVE SLFTAP LOCKING AXSOS STAINLESS BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370600 SUP HCPCS C1713 370600 - SCREW BONE 4MM 100MM LOCK ORTHOPEDIC BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370605 SUP HCPCS C1713 370605 - SCREW BONE 4MM 105MM LOCK ORTHOPEDIC BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $185.63 $185.63 $38.69 $185.63 N/A N/A 370610 SUP HCPCS C1713 370610 - SCREW BONE 4MM 110MM LOCK ORTHOPEDIC BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370615 SUP HCPCS C1713 370615 - SCREW BONE 4MM 115MM LOCK ORTHOPEDIC BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 370620 SUP HCPCS C1713 370620 - SCREW BONE 4MM 120MM LOCK ORTHOPEDIC BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $185.63 $185.63 N/A N/A 371008 SUP HCPCS C1713 371008 - SCREW BONE 3MM 8MM T8 DRIVE LOCKING SLFTAP AXSOS BOTH IP/OP $123.50 $91.00 $24.45 $123.20 $55.44 $55.44 $55.44 $55.44 $123.20 $123.20 $123.20 $25.68 $123.20 $123.20 $123.20 $123.20 $123.20 $25.68 $123.20 $49.28 $72.87 $123.20 $123.20 $123.20 $123.20 $92.63 $123.20 $123.20 $123.20 $61.60 $61.60 $97.57 $123.20 $98.56 $55.44 $24.45 N/A $71.63 $123.20 $123.20 $123.20 $25.67 $123.20 N/A N/A 371010 SUP HCPCS C1713 371010 - SCREW BONE 3MM 10MM LOCKING SLFTAP T8 DRIVE AXSOS STAINLESS BOTH IP/OP $123.50 $91.00 $24.45 $123.20 $55.44 $55.44 $55.44 $55.44 $123.20 $123.20 $123.20 $25.68 $123.20 $123.20 $123.20 $123.20 $123.20 $25.68 $123.20 $49.28 $72.87 $123.20 $123.20 $123.20 $123.20 $92.63 $123.20 $123.20 $123.20 $61.60 $61.60 $97.57 $123.20 $98.56 $55.44 $24.45 N/A $71.63 $123.20 $73.92 $123.20 $25.67 $123.20 N/A N/A 371012 SUP HCPCS C1713 371012 - SCREW BONE 3MM 12MM LOCK AXSOS BOTH IP/OP $123.50 $91.00 $24.45 $123.20 $55.44 $55.44 $55.44 $55.44 $123.20 $123.20 $123.20 $25.68 $123.20 $123.20 $123.20 $123.20 $123.20 $25.68 $123.20 $49.28 $72.87 $123.20 $123.20 $123.20 $123.20 $92.63 $123.20 $123.20 $123.20 $61.60 $61.60 $97.57 $123.20 $98.56 $55.44 $24.45 N/A $71.63 $123.20 $123.20 $123.20 $25.67 $123.20 N/A N/A 371014 SUP HCPCS C1713 371014 - SCREW BONE 3MM 14MM T8 DRIVE SLFTAP LOCKING AXSOS STAINLESS BOTH IP/OP $123.50 $91.00 $24.45 $123.20 $55.44 $55.44 $55.44 $55.44 $123.20 $123.20 $123.20 $25.68 $123.20 $123.20 $123.20 $123.20 $123.20 $25.68 $123.20 $49.28 $72.87 $123.20 $123.20 $123.20 $123.20 $92.63 $123.20 $123.20 $123.20 $61.60 $61.60 $97.57 $123.20 $98.56 $55.44 $24.45 N/A $71.63 $123.20 $123.20 $123.20 $25.67 $123.20 N/A N/A 371016 SUP HCPCS C1713 371016 - SCREW BONE 3MM 16MM T8 DRIVE SLFTAP LOCKING AXSOS STAINLESS BOTH IP/OP $123.50 $91.00 $24.45 $123.20 $55.44 $55.44 $55.44 $55.44 $123.20 $123.20 $123.20 $25.68 $123.20 $123.20 $123.20 $123.20 $123.20 $25.68 $123.20 $49.28 $72.87 $123.20 $123.20 $123.20 $123.20 $92.63 $123.20 $123.20 $123.20 $61.60 $61.60 $97.57 $123.20 $98.56 $55.44 $24.45 N/A $71.63 $123.20 $73.92 $123.20 $25.67 $123.20 N/A N/A 371018 SUP HCPCS C1713 371018 - SCREW BONE 3MM 18MM T8 DRIVE SLFTAP LOCKING AXSOS STAINLESS BOTH IP/OP $123.50 $91.00 $24.45 $123.20 $55.44 $55.44 $55.44 $55.44 $123.20 $123.20 $123.20 $25.68 $123.20 $123.20 $123.20 $123.20 $123.20 $25.68 $123.20 $123.20 $72.87 $123.20 $123.20 $123.20 $123.20 $92.63 $123.20 $123.20 $123.20 $61.60 $61.60 $97.57 $123.20 $98.56 $55.44 $24.45 N/A $71.63 $123.20 $73.92 $123.20 $25.67 $123.20 N/A N/A 371020 SUP HCPCS C1713 371020 - SCREW BONE 3MM 20MM T8 DRIVE LOCKING SLFTAP AXSOS STAINLESS BOTH IP/OP $123.50 $91.00 $24.45 $123.20 $55.44 $55.44 $55.44 $55.44 $123.20 $123.20 $123.20 $25.68 $123.20 $123.20 $123.20 $123.20 $123.20 $25.68 $123.20 $49.28 $72.87 $123.20 $123.20 $123.20 $123.20 $92.63 $123.20 $123.20 $123.20 $61.60 $61.60 $97.57 $123.20 $98.56 $55.44 $24.45 N/A $71.63 $123.20 $73.92 $123.20 $25.67 $123.20 N/A N/A 371022 SUP HCPCS C1713 371022 - SCREW BONE 3MM 22MM LOCKING SLFTAP T8 DRIVE AXSOS STAINLESS BOTH IP/OP $123.50 $91.00 $24.45 $123.20 $55.44 $55.44 $55.44 $55.44 $123.20 $123.20 $123.20 $25.68 $123.20 $123.20 $123.20 $123.20 $123.20 $25.68 $123.20 $49.28 $72.87 $123.20 $123.20 $123.20 $123.20 $92.63 $123.20 $123.20 $123.20 $61.60 $61.60 $97.57 $123.20 $98.56 $55.44 $24.45 N/A $71.63 $123.20 $123.20 $123.20 $25.67 $123.20 N/A N/A 371024 SUP HCPCS C1713 371024 - SCREW BONE 3MM 24MM T8 DRIVE LOCKING SLFTAP AXSOS BOTH IP/OP $123.50 $91.00 $24.45 $123.20 $55.44 $55.44 $55.44 $55.44 $123.20 $123.20 $123.20 $25.68 $123.20 $123.20 $123.20 $123.20 $123.20 $25.68 $123.20 $123.20 $72.87 $123.20 $123.20 $123.20 $123.20 $92.63 $123.20 $123.20 $123.20 $61.60 $61.60 $97.57 $123.20 $98.56 $55.44 $24.45 N/A $71.63 $123.20 $73.92 $123.20 $25.67 $123.20 N/A N/A 371026 SUP HCPCS C1713 371026 - SCREW BONE 3MM 26MM T8 DRIVE LOCKING SLFTAP AXSOS BOTH IP/OP $123.50 $91.00 $24.45 $123.20 $55.44 $55.44 $55.44 $55.44 $123.20 $123.20 $123.20 $25.68 $123.20 $123.20 $123.20 $123.20 $123.20 $25.68 $123.20 $49.28 $72.87 $123.20 $123.20 $123.20 $123.20 $92.63 $123.20 $123.20 $123.20 $61.60 $61.60 $97.57 $123.20 $98.56 $55.44 $24.45 N/A $71.63 $123.20 $73.92 $123.20 $25.67 $123.20 N/A N/A 371028 SUP HCPCS C1713 371028 - SCREW BONE 3MM 28MM T8 DRIVE LOCKING SLFTAP AXSOS BOTH IP/OP $123.50 $91.00 $24.45 $123.20 $55.44 $55.44 $55.44 $55.44 $123.20 $123.20 $123.20 $25.68 $123.20 $123.20 $123.20 $123.20 $123.20 $25.68 $123.20 $49.28 $72.87 $123.20 $123.20 $123.20 $123.20 $92.63 $123.20 $123.20 $123.20 $61.60 $61.60 $97.57 $123.20 $98.56 $55.44 $24.45 N/A $71.63 $123.20 $123.20 $123.20 $25.67 $123.20 N/A N/A 371030 SUP HCPCS C1713 371030 - SCREW BONE 3MM 30MM LOCKING SLFTAP T8 DRIVE AXSOS STAINLESS BOTH IP/OP $123.50 $91.00 $24.45 $123.20 $55.44 $55.44 $55.44 $55.44 $123.20 $123.20 $123.20 $25.68 $123.20 $123.20 $123.20 $123.20 $123.20 $25.68 $123.20 $49.28 $72.87 $123.20 $123.20 $123.20 $123.20 $92.63 $123.20 $123.20 $123.20 $61.60 $61.60 $97.57 $123.20 $98.56 $55.44 $24.45 N/A $71.63 $123.20 $73.92 $123.20 $25.67 $123.20 N/A N/A 371314 SUP HCPCS C1713 371314 - SCREW BONE 5MM 14MM SELF TAP LOCK T20 DRIVE AXSOS STAINLESS BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $228.00 $228.00 N/A N/A 371316 SUP HCPCS C1713 371316 - SCREW BONE LP 5MM 16MM LOCK SELF TAP T20 DRIVE AXSOS BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $228.00 $228.00 N/A N/A 371318 SUP HCPCS C1713 371318 - SCREW BONE T20 5MM 18MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $47.52 $228.00 N/A N/A 371320 SUP HCPCS C1713 371320 - SCREW BONE 5MM 20MM LOCKING SLFTAP T20 DRIVE AXSOS STAINLESS BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $228.00 $228.00 $47.52 $228.00 N/A N/A 371322 SUP HCPCS C1713 371322 - SCREW BONE 5MM 22MM LOCK BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $47.52 $228.00 N/A N/A 371324 SUP HCPCS C1713 371324 - SCREW BONE 5MM 24MM LOCKING SLFTAP T20 DRIVE AXSOS STAINLESS BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $228.00 $228.00 N/A N/A 371326 SUP HCPCS C1713 371326 - SCREW BONE 5MM 26MM LOCKING SLFTAP T20 DRIVE AXSOS STAINLESS BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $228.00 $228.00 N/A N/A 371328 SUP HCPCS C1713 371328 - SCREW BONE T20 5MM 28MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $47.52 $228.00 N/A N/A 371330 SUP HCPCS C1713 371330 - SCREW BONE T20 5MM 30MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $228.00 $228.00 N/A N/A 371332 SUP HCPCS C1713 371332 - SCREW BONE T20 5MM 32MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $228.00 $228.00 N/A N/A 371334 SUP HCPCS C1713 371334 - SCREW BONE 5MM 34MM T20 DRIVE SLFTAP LOCKING AXSOS STAINLESS BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $47.52 $228.00 N/A N/A 371336 SUP HCPCS C1713 371336 - SCREW BONE T20 5MM 36MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $47.52 $228.00 N/A N/A 371338 SUP HCPCS C1713 371338 - SCREW BONE T20 5MM 38MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $228.00 $228.00 $47.52 $228.00 N/A N/A 371340 SUP HCPCS C1713 371340 - SCREW BONE T20 5MM 40MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $47.52 $228.00 N/A N/A 371342 SUP HCPCS C1713 371342 - SCREW BONE T20 5MM 42MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $47.52 $228.00 N/A N/A 371344 SUP HCPCS C1713 371344 - SCREW BONE T20 5MM 44MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $47.52 $228.00 N/A N/A 371346 SUP HCPCS C1713 371346 - SCREW BONE T20 5MM 46MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $47.52 $228.00 N/A N/A 371348 SUP HCPCS C1713 371348 - SCREW BONE T20 5MM 48MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $47.52 $228.00 N/A N/A 371350 SUP HCPCS C1713 371350 - SCREW BONE T20 5MM 50MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $228.00 $228.00 $47.52 $228.00 N/A N/A 371355 SUP HCPCS C1713 371355 - SCREW BONE T20 5MM 55MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $228.00 $228.00 $47.52 $228.00 N/A N/A 371360 SUP HCPCS C1713 371360 - SCREW BONE T20 5MM 60MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $228.00 $228.00 $47.52 $228.00 N/A N/A 371365 SUP HCPCS C1713 371365 - SCREW BONE T20 5MM 65MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $47.52 $228.00 N/A N/A 371370 SUP HCPCS C1713 371370 - SCREW BONE T20 5MM 70MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $228.00 $228.00 N/A N/A 371375 SUP HCPCS C1713 371375 - SCREW BONE T20 5MM 75MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $228.00 $228.00 $47.52 $228.00 N/A N/A 371380 SUP HCPCS C1713 371380 - SCREW BONE T20 5MM 80MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $136.80 $228.00 $228.00 $228.00 N/A N/A 371385 SUP HCPCS C1713 371385 - SCREW BONE T20 5MM 85MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $91.20 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $228.00 $228.00 $47.52 $228.00 N/A N/A 371390 SUP HCPCS C1713 371390 - SCREW BONE T20 5MM 90MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $228.00 $228.00 $47.52 $228.00 N/A N/A 371395 SUP HCPCS C1713 371395 - SCREW BONE 5MM 95MM LOCKING SLFTAP T20 DRIVE AXSOS STAINLESS BOTH IP/OP $228.00 $169.00 $45.25 $228.00 $102.60 $102.60 $102.60 $102.60 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $228.00 $228.00 $228.00 $47.52 $228.00 $228.00 $134.86 $228.00 $228.00 $228.00 $228.00 $171.00 $228.00 $228.00 $228.00 $114.00 $114.00 $180.58 $228.00 $182.40 $102.60 $45.25 N/A $132.24 $228.00 $228.00 $228.00 $47.52 $228.00 N/A N/A 371514 SUP HCPCS C1713 371514 - SCREW BONE T15 4MM 14MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $204.80 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371516 SUP HCPCS C1713 371516 - SCREW BONE T15 4MM 16MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $204.80 $204.80 N/A N/A 371518 SUP HCPCS C1713 371518 - SCREW BONE T15 4MM 18MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $204.80 $204.80 N/A N/A 371520 SUP HCPCS C1713 371520 - SCREW BN T15 4MM 20MM NS ST LCK SS AXSOS SM FRAG SET XTRMT BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $204.80 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $204.80 $204.80 $42.68 $204.80 N/A N/A 371522 SUP HCPCS C1713 371522 - SCREW BN T15 4MM 22MM NS ST LCK SS AXSOS SM FRAG SET XTRMT BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $204.80 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371524 SUP HCPCS C1713 371524 - SCREW BN T15 4MM 24MM NS ST LCK SS AXSOS SM FRAG SET XTRMT BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $204.80 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $204.80 $204.80 N/A N/A 371526 SUP HCPCS C1713 371526 - SCREW BN T15 4MM 26MM NS ST LCK SS AXSOS SM FRAG SET XTRMT BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $204.80 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $204.80 $204.80 N/A N/A 371528 SUP HCPCS C1713 371528 - SCREW BN T15 4MM 28MM NS ST LCK SS AXSOS SM FRAG SET XTRMT BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $204.80 $204.80 N/A N/A 371530 SUP HCPCS C1713 371530 - SCREW BN T15 4MM 30MM NS ST LCK SS AXSOS SM FRAG SET XTRMT BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371532 SUP HCPCS C1713 371532 - SCREW BN T15 4MM 32MM NS ST LCK SS AXSOS SM FRAG SET XTRMT BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $204.80 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $204.80 $204.80 N/A N/A 371534 SUP HCPCS C1713 371534 - SCREW BN T15 4MM 34MM NS ST LCK SS AXSOS SM FRAG SET XTRMT BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $204.80 $204.80 N/A N/A 371536 SUP HCPCS C1713 371536 - SCREW BN T15 4MM 36MM NS ST LCK SS AXSOS SM FRAG SET XTRMT BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371538 SUP HCPCS C1713 371538 - SCREW BN T15 4MM 38MM NS ST LCK SS AXSOS SM FRAG SET XTRMT BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371540 SUP HCPCS C1713 371540 - SCREW BONE T15 4MM 40MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371542 SUP HCPCS C1713 371542 - SCREW BONE T15 4MM 42MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371544 SUP HCPCS C1713 371544 - SCREW BONE T15 4MM 44MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $204.80 $204.80 $42.68 $204.80 N/A N/A 371546 SUP HCPCS C1713 371546 - SCREW BONE T15 4MM 46MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $204.80 $204.80 N/A N/A 371548 SUP HCPCS C1713 371548 - SCREW BN T15 4MM 48MM NS ST LCK SS AXSOS SM FRAG SET XTRMT BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $204.80 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371550 SUP HCPCS C1713 371550 - SCREW BONE T15 4MM 50MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371555 SUP HCPCS C1713 371555 - SCREW BONE T15 4MM 55MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371560 SUP HCPCS C1713 371560 - SCREW BONE T15 4MM 60MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371565 SUP HCPCS C1713 371565 - SCREW BONE 4MM 65MM SELF TAP LOCK T15 STARDRIVE RECESS AXSOS BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $204.80 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $204.80 $204.80 $42.68 $204.80 N/A N/A 371570 SUP HCPCS C1713 371570 - SCREW BONE T15 4MM 70MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371575 SUP HCPCS C1713 371575 - SCREW BONE T15 4MM 75MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371580 SUP HCPCS C1713 371580 - SCREW BONE T15 4MM 80MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371585 SUP HCPCS C1713 371585 - SCREW BONE T15 4MM 85MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371590 SUP HCPCS C1713 371590 - SCREW BONE T15 4MM 90MM SELF TAP LOCK AXSOS STAINLESS STEEL BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $122.88 $204.80 $42.68 $204.80 N/A N/A 371595 SUP HCPCS C1713 371595 - SCREW BONE 4MM 9MM LOCK AXSOS BOTH IP/OP $205.00 $152.00 $40.65 $204.80 $92.16 $92.16 $92.16 $92.16 $204.80 $204.80 $204.80 $42.69 $204.80 $204.80 $204.80 $204.80 $204.80 $42.68 $204.80 $81.92 $121.14 $204.80 $204.80 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $92.16 $40.65 N/A $118.90 $204.80 $204.80 $204.80 $204.80 $204.80 N/A N/A 372615 SUP HCPCS C1713 372615 - SCALPEL SURG 15 1 HAND ACTIVATION LOCK RETRACTABLE SHIELD BOTH IP/OP $36.50 $27.00 $7.24 $41.15 $16.42 $16.42 $16.42 $16.42 $36.48 $36.48 $36.48 $7.60 $36.48 $36.48 $36.48 $36.48 $36.48 $7.60 $36.48 $16.46 $21.58 $36.48 $41.15 $36.48 $36.48 $27.38 $36.48 $36.48 $36.48 $18.24 $18.24 $28.89 $36.48 $29.18 $16.42 $7.24 N/A $21.17 $36.48 $36.48 $36.48 $7.60 $36.48 N/A N/A 373741 SUP Custom 27203010 373741 - KNIFE OPHTHALMIC 45D ANGLED 4.1MM BEVEL UP PHACO SLIT MATTE BOTH IP/OP $30.50 $23.00 $5.35 $30.07 $30.07 $30.07 $30.07 $30.07 $30.07 $30.07 $5.35 $30.07 $30.07 $22.32 $22.32 $23.18 $15.67 $6.27 $30.07 $12.03 $30.07 $30.07 $30.07 $30.07 $30.07 $22.88 $30.07 $30.07 $30.07 $15.04 $15.04 $23.82 $30.07 $24.06 $19.55 $30.07 N/A $17.69 $30.07 $18.04 $30.07 $30.07 $30.07 N/A N/A 373808 SUP Custom 27203010 373808 - SCALPEL SURG 2.5MM 2.5MM STR ROUND TIP CRESCENT OPHTHALMIC BOTH IP/OP $34.50 $26.00 $6.11 $34.30 $34.30 $34.30 $34.30 $34.30 $34.30 $34.30 $6.11 $34.30 $34.30 $25.46 $25.46 $26.44 $17.87 $7.15 $34.30 $13.72 $34.30 $34.30 $34.30 $34.30 $34.30 $25.88 $34.30 $34.30 $34.30 $17.15 $17.15 $27.17 $34.30 $27.44 $22.30 $34.30 N/A $20.01 $34.30 $20.58 $34.30 $34.30 $34.30 N/A N/A 373808 SUP Custom 27203010 373808 - KNIFE OPTH STRG CRSNT RND BVL UP 2.5MM STRL LF BVR XSTAR BOTH IP/OP $58.50 $43.00 $6.11 $43.88 $34.30 $34.30 $34.30 $34.30 $34.30 $34.30 $6.11 $34.30 $34.30 $25.46 $25.46 $26.44 $17.87 $7.15 $34.30 $13.72 $34.30 $34.30 $34.30 $34.30 $34.30 $43.88 $34.30 $34.30 $34.30 $17.15 $17.15 $27.17 $34.30 $27.44 $22.30 $34.30 N/A $33.93 $34.30 $20.58 $34.30 $34.30 $34.30 N/A N/A 378227 SUP Custom 27203010 378227 - KNIFE OPHTHALMIC 45D BEVEL 2.75MM BLADE MATTE FINISH SLIT BD BOTH IP/OP $36.00 $27.00 $6.34 $35.63 $35.63 $35.63 $35.63 $35.63 $35.63 $35.63 $6.34 $35.63 $35.63 $26.44 $26.44 $27.46 $18.56 $7.43 $35.63 $14.25 $35.63 $35.63 $35.63 $35.63 $35.63 $27.00 $35.63 $35.63 $35.63 $17.82 $17.82 $28.22 $35.63 $28.50 $23.16 $35.63 N/A $20.88 $35.63 $21.38 $35.63 $35.63 $35.63 N/A N/A 378230 SUP Custom 27203010 378230 - KNIFE OPHTHALMIC 45D BEVEL 3MM PHACO SLIT SAFETY MATTE BOTH IP/OP $36.00 $27.00 $6.34 $35.63 $35.63 $35.63 $35.63 $35.63 $35.63 $35.63 $6.34 $35.63 $35.63 $26.44 $26.44 $27.46 $18.56 $7.43 $35.63 $14.25 $35.63 $35.63 $35.63 $35.63 $35.63 $27.00 $35.63 $35.63 $35.63 $17.82 $17.82 $28.22 $35.63 $28.50 $23.16 $35.63 N/A $20.88 $35.63 $21.38 $35.63 $35.63 $35.63 N/A N/A 378231 SUP Custom 27203010 378231 - KNIFE OPHTHALMIC 20D .9MM 3MM SAFETY SIDEPORT RETRACTABLE BOTH IP/OP $49.00 $36.00 $8.67 $48.69 $48.69 $48.69 $48.69 $48.69 $48.69 $48.69 $8.67 $48.69 $48.69 $36.14 $36.14 $37.53 $25.37 $10.15 $48.69 $19.48 $48.69 $48.69 $48.69 $48.69 $48.69 $36.75 $48.69 $48.69 $48.69 $24.35 $24.35 $38.56 $48.69 $38.95 $31.65 $48.69 N/A $28.42 $48.69 $29.21 $48.69 $48.69 $48.69 N/A N/A 378231 SUP Custom 27203010 378231 - KNIFE OPTH 20D .9MM 3MM BLK GRY STRL LF BVR EDGHD SF SDPRT BOTH IP/OP $49.00 $36.00 $8.67 $48.69 $48.69 $48.69 $48.69 $48.69 $48.69 $48.69 $8.67 $48.69 $48.69 $36.14 $36.14 $37.53 $25.37 $10.15 $48.69 $19.48 $48.69 $48.69 $48.69 $48.69 $48.69 $36.75 $48.69 $48.69 $48.69 $24.35 $24.35 $38.56 $48.69 $38.95 $31.65 $48.69 N/A $28.42 $48.69 $29.21 $48.69 $48.69 $48.69 N/A N/A 381112 SUP HCPCS C1729 CATHETER IV 24GA .75IN RADIOPQ YLW ANGCTH TFLN STRL LF BOTH IP/OP $4.50 $3.00 $0.88 $4.45 $2.42 $2.42 $2.42 $2.42 $4.45 $4.45 $4.45 $0.93 $4.45 $3.30 $3.30 $3.43 $2.32 $0.93 $4.45 $4.45 $2.63 $4.45 $4.45 $4.45 $4.45 $3.38 $4.45 $4.45 $4.45 $2.23 $2.23 $3.52 $4.45 $3.56 $2.89 $0.88 N/A $2.61 $4.45 $4.45 $4.45 $0.93 $4.45 N/A N/A 381137 SUP HCPCS C1729 CATHETER IV 20GA 1.88IN RADIOPQ PNK ANGCTH TFLN STRL LF BOTH IP/OP $9.50 $7.00 $1.82 $9.18 $4.98 $4.98 $4.98 $4.98 $9.18 $9.18 $9.18 $1.91 $9.18 $6.81 $6.81 $7.08 $4.78 $1.91 $9.18 $9.18 $5.43 $9.18 $9.18 $9.18 $9.18 $7.13 $9.18 $9.18 $9.18 $4.59 $4.59 $7.27 $9.18 $7.34 $5.97 $1.82 N/A $5.51 $9.18 $9.18 $9.18 $1.91 $9.18 N/A N/A 381144 SUP HCPCS C1729 CATHETER IV 18GA 1.16IN RADIOPQ GRN ANGCTH TFLN STRL LF BOTH IP/OP $10.00 $7.00 $1.97 $9.93 $5.39 $5.39 $5.39 $5.39 $9.93 $9.93 $9.93 $2.07 $9.93 $7.37 $7.37 $7.65 $5.17 $2.07 $9.93 $9.93 $5.87 $9.93 $9.93 $9.93 $9.93 $7.50 $9.93 $9.93 $9.93 $4.97 $4.97 $7.86 $9.93 $7.94 $6.45 $1.97 N/A $5.80 $9.93 $9.93 $9.93 $2.07 $9.93 N/A N/A 381167 SUP HCPCS C1887 381167 - CATHETER IV STD 14GA 1.88IN ORNG STRL LF ANGCTH RADOPQ BOTH IP/OP $9.50 $7.00 $1.86 $9.38 $5.09 $5.09 $5.09 $5.09 $9.38 $9.38 $9.38 $1.96 $9.38 $6.96 $6.96 $7.23 $4.89 $1.95 $9.38 $9.38 $5.55 $9.38 $9.38 $9.38 $9.38 $7.13 $9.38 $9.38 $9.38 $4.69 $4.69 $7.43 $9.38 $7.50 $6.10 $1.86 N/A $5.51 $9.38 $9.38 $9.38 $1.95 $9.38 N/A N/A 381511 SUP HCPCS C1729 CATHETER IV 24GA .56IN RADIOPQ SFSHLD WNG YLW INST-N ATGRD BOTH IP/OP $7.00 $5.00 $1.32 $6.65 $3.61 $3.61 $3.61 $3.61 $6.65 $6.65 $6.65 $1.39 $6.65 $4.94 $4.94 $5.13 $3.46 $1.39 $6.65 $6.65 $3.93 $6.65 $6.65 $6.65 $6.65 $5.25 $6.65 $6.65 $6.65 $3.33 $3.33 $5.27 $6.65 $5.32 $4.32 $1.32 N/A $4.06 $6.65 $6.65 $6.65 $1.39 $6.65 N/A N/A 382259 SUP HCPCS C1729 CATHETER IV 16GA 5.25IN RADIOPQ YLW ANGCTH TFLN STRL LF BOTH IP/OP $28.50 $21.00 $6.55 $33.00 $17.92 $17.92 $17.92 $17.92 $33.00 $33.00 $33.00 $6.88 $33.00 $24.49 $24.49 $25.44 $17.19 $6.88 $33.00 $33.00 $19.52 $33.00 $33.00 $33.00 $33.00 $21.38 $33.00 $33.00 $33.00 $16.50 $16.50 $26.14 $33.00 $26.40 $21.45 $6.55 N/A $16.53 $33.00 $33.00 $33.00 $6.88 $33.00 N/A N/A 382259 SUP HCPCS C1751 382259 - CATHETER INTRAVENOUS 16GA 5.25IN RADIOPQ DEHP FREE LATEX BOTH IP/OP $33.00 $24.00 $6.55 $33.00 $17.92 $17.92 $17.92 $17.92 $33.00 $33.00 $33.00 $6.88 $33.00 $24.49 $24.49 $25.44 $17.19 $6.88 $33.00 $33.00 $19.52 $33.00 $33.00 $33.00 $33.00 $24.75 $33.00 $33.00 $33.00 $16.50 $16.50 $26.14 $33.00 $26.40 $21.45 $6.55 N/A $19.14 $33.00 $33.00 $33.00 $6.88 $33.00 N/A N/A 382269 SUP HCPCS C1729 CATHETER IV 14GA 5.25IN RADIOPQ SFSHLD ORNG ANGCTH TFLN STRL BOTH IP/OP $28.50 $21.00 $6.55 $33.00 $17.92 $17.92 $17.92 $17.92 $33.00 $33.00 $33.00 $6.88 $33.00 $24.49 $24.49 $25.44 $17.19 $6.88 $33.00 $33.00 $19.52 $33.00 $33.00 $33.00 $33.00 $21.38 $33.00 $33.00 $33.00 $16.50 $16.50 $26.14 $33.00 $26.40 $21.45 $6.55 N/A $16.53 $33.00 $33.00 $33.00 $6.88 $33.00 N/A N/A 382269 SUP HCPCS C1751 382269 - CATHETER INTRAVENOUS 219ML/MIN 14GA .0822-.0838IN BOTH IP/OP $33.00 $24.00 $6.55 $33.00 $17.92 $17.92 $17.92 $17.92 $33.00 $33.00 $33.00 $6.88 $33.00 $24.49 $24.49 $25.44 $17.19 $6.88 $33.00 $33.00 $19.52 $33.00 $33.00 $33.00 $33.00 $24.75 $33.00 $33.00 $33.00 $16.50 $16.50 $26.14 $33.00 $26.40 $21.45 $6.55 N/A $19.14 $33.00 $33.00 $33.00 $6.88 $33.00 N/A N/A 382861 SUP HCPCS C1898 "382861 - Passive fixation pacing lead, J-shape, silicone insulation," BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 382866 SUP HCPCS C1898 "382866 - Passive fixation pacing lead, J-shape, silicone insulation," BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 382872 SUP HCPCS C1898 "382872 - Passive fixation pacing lead, straight, silicone insulation," BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 382878 SUP HCPCS C1898 "382878 - Passive fixation pacing lead, straight, silicone insulation," BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 382884 SUP HCPCS C1898 382884 - LEAD PCNG HLX 45CM SIL ATR TILDA BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 382889 SUP HCPCS C1895 382889 - LEAD PCNG HLX 53CM SIL ATR TILDA BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $506.25 $506.25 $506.25 $506.25 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 $223.28 N/A $652.50 "$1,125.00" "$1,125.00" "$1,125.00" $234.45 "$1,125.00" N/A N/A 382895 SUP HCPCS C1895 382895 - LEAD PCNG HLX 60CM SIL VNTRC TILDA BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $506.25 $506.25 $506.25 $506.25 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 $223.28 N/A $652.50 "$1,125.00" "$1,125.00" "$1,125.00" $234.45 "$1,125.00" N/A N/A 382903 SUP HCPCS C1777 382903 - LEAD PCNG 65CM VIGILA BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 382918 SUP HCPCS C1721 "382918 - Passive fixation, dual coil, silicone insulation, 65 cm, 18" BOTH IP/OP "$10,000.00" "$7,400.00" "$2,084.11" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 382924 SUP HCPCS C1721 "382924 - Active fixation, dual coil, silicone insulation, 60 cm, 16 c" BOTH IP/OP "$10,000.00" "$7,400.00" "$2,084.11" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 382936 SUP HCPCS C1721 "382936 - Active fixation, dual coil, silicone insulation, 65 cm, 18 c" BOTH IP/OP "$10,000.00" "$7,400.00" "$2,084.11" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 382961 SUP HCPCS C1900 382961 - Left ventricular lead with 3D pre-shaped helix at distal end BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 382972 SUP HCPCS C1900 382972 - Left ventricular lead with pre-shaped bend and thread fixati BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 383395 SUP HCPCS C1900 "383395 - Left ventricular lead with 2D pre-shaped bend at distal end," BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 390016 SUP HCPCS C1713 390016 - WASHER ORTHOPEDIC 6.6MM 8IN CANN ASNIS III STAINLESS STEEL BOTH IP/OP $59.50 $44.00 $11.74 $59.13 $26.61 $26.61 $26.61 $26.61 $59.13 $59.13 $59.13 $12.32 $59.13 $59.13 $59.13 $59.13 $59.13 $12.32 $59.13 $23.65 $34.98 $59.13 $59.13 $59.13 $59.13 $44.63 $59.13 $59.13 $59.13 $29.57 $29.57 $46.83 $59.13 $47.30 $26.61 $11.74 N/A $34.51 $59.13 $59.13 $59.13 $12.32 $59.13 N/A N/A 390017 SUP HCPCS C1713 390017 - WASHER ORTHOPEDIC 5MM ASNIS III STAINLESS STEEL 7MM CANN BOTH IP/OP $47.00 $35.00 $9.28 $46.75 $21.04 $21.04 $21.04 $21.04 $46.75 $46.75 $46.75 $9.74 $46.75 $46.75 $46.75 $46.75 $46.75 $9.74 $46.75 $18.70 $27.65 $46.75 $46.75 $46.75 $46.75 $35.25 $46.75 $46.75 $46.75 $23.38 $23.38 $37.03 $46.75 $37.40 $21.04 $9.28 N/A $27.26 $46.75 $46.75 $46.75 $9.74 $46.75 N/A N/A 390018 SUP HCPCS C1713 390018 - WASHER ORTHOPEDIC 8MM ASNIS III STAINLESS STEEL 7MM CANN BOTH IP/OP $47.00 $35.00 $9.28 $46.75 $21.04 $21.04 $21.04 $21.04 $46.75 $46.75 $46.75 $9.74 $46.75 $46.75 $46.75 $46.75 $46.75 $9.74 $46.75 $18.70 $27.65 $46.75 $46.75 $46.75 $46.75 $35.25 $46.75 $46.75 $46.75 $23.38 $23.38 $37.03 $46.75 $37.40 $21.04 $9.28 N/A $27.26 $46.75 $46.75 $46.75 $9.74 $46.75 N/A N/A 390019 SUP HCPCS C1713 390019 - WASHER ORTHOPEDIC 9MM 8IN ASNIS III STAINLESS STEEL 3.5MM BOTH IP/OP $51.00 $38.00 $10.10 $50.88 $22.90 $22.90 $22.90 $22.90 $50.88 $50.88 $50.88 $10.60 $50.88 $50.88 $50.88 $50.88 $50.88 $10.60 $50.88 $20.35 $30.10 $50.88 $50.88 $50.88 $50.88 $38.25 $50.88 $50.88 $50.88 $25.44 $25.44 $40.30 $50.88 $40.70 $22.90 $10.10 N/A $29.58 $50.88 $50.88 $50.88 $10.60 $50.88 N/A N/A 390083 SUP HCPCS C1713 390083 - PIN HOLDING 5MM 150MM REDX ORTHOPEDIC BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 390084 SUP HCPCS C1713 390084 - PIN HOLDING 5MM 180MM REDX STAINLESS STEEL BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $148.50 $247.50 $51.58 $247.50 N/A N/A 390086 SUP HCPCS C1713 390086 - PIN HALF 6MM 150MM SELF CUT REDX STAINLESS STEEL PELVIC BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $148.50 $247.50 $51.58 $247.50 N/A N/A 390087 SUP HCPCS C1713 390087 - PIN HOLDING 6MM 180MM REDX BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $148.50 $247.50 $51.58 $247.50 N/A N/A 390181 SUP HCPCS C1713 390181 - WIRE FX 2.5MM 285MM NS KRSH TROC PNT SS BOTH IP/OP $136.00 $101.00 $26.99 $136.00 $61.20 $61.20 $61.20 $61.20 $136.00 $136.00 $136.00 $28.35 $136.00 $136.00 $136.00 $136.00 $136.00 $28.34 $136.00 $136.00 $80.44 $136.00 $136.00 $136.00 $136.00 $102.00 $136.00 $136.00 $136.00 $68.00 $68.00 $107.71 $136.00 $108.80 $61.20 $26.99 N/A $78.88 $136.00 $81.60 $136.00 $28.34 $136.00 N/A N/A 390195 SUP HCPCS C1713 390195 - WIRE FX 3MM 285MM NS KRSH TROC PNT SS BOTH IP/OP $129.50 $96.00 $25.65 $129.25 $58.16 $58.16 $58.16 $58.16 $129.25 $129.25 $129.25 $26.94 $129.25 $129.25 $129.25 $129.25 $129.25 $26.94 $129.25 $129.25 $76.45 $129.25 $129.25 $129.25 $129.25 $97.13 $129.25 $129.25 $129.25 $64.63 $64.63 $102.37 $129.25 $103.40 $58.16 $25.65 N/A $75.11 $129.25 $77.55 $129.25 $26.94 $129.25 N/A N/A 397003 SUP HCPCS C1713 397003 - CEMENT BONE INJECTABLE SELF SETTING OSTEOCONDUCTIVE HYDROSET BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" "$2,047.50" "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$1,228.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A 397005 SUP HCPCS C1713 397005 - CEMENT BONE SELF SETTING INJECTABLE BIOCOMPATIBLE BOTH IP/OP "$3,285.00" "$2,431.00" $651.99 "$3,285.00" "$1,478.25" "$1,478.25" "$1,478.25" "$1,478.25" "$3,285.00" "$3,285.00" "$3,285.00" $684.68 "$3,285.00" "$3,285.00" "$3,285.00" "$3,285.00" "$3,285.00" $684.63 "$3,285.00" "$1,314.00" "$1,619.51" "$3,285.00" "$3,285.00" "$3,285.00" "$3,285.00" "$2,463.75" "$3,285.00" "$3,285.00" "$3,285.00" "$1,642.50" "$1,642.50" "$2,601.72" "$3,285.00" "$2,628.00" "$1,478.25" $651.99 N/A "$1,905.30" "$3,285.00" "$1,971.00" "$3,285.00" $684.59 "$3,285.00" N/A N/A 397010 SUP HCPCS C1713 397010 - CEMENT BONE SELF SETTING INJECTABLE BIOCOMPATIBLE BOTH IP/OP "$6,252.50" "$4,627.00" "$1,240.96" "$6,252.50" "$2,813.63" "$2,813.63" "$2,813.63" "$2,813.63" "$6,252.50" "$6,252.50" "$6,252.50" "$1,303.18" "$6,252.50" "$6,252.50" "$6,252.50" "$6,252.50" "$6,252.50" "$1,303.09" "$6,252.50" "$2,501.00" "$3,082.48" "$6,252.50" "$6,252.50" "$6,252.50" "$6,252.50" "$4,689.38" "$6,252.50" "$6,252.50" "$6,252.50" "$3,126.25" "$3,126.25" "$4,951.98" "$6,252.50" "$5,002.00" "$2,813.63" "$1,240.96" N/A "$3,626.45" "$6,252.50" "$3,751.50" "$6,252.50" "$1,303.02" "$6,252.50" N/A N/A 397015 SUP HCPCS C1713 397015 - CEMENT BONE INJECTABLE HYDROSET CALCIUM PHOSPHATE 15ML BONE BOTH IP/OP "$8,971.00" "$6,639.00" "$1,780.51" "$8,970.95" "$4,036.92" "$4,036.92" "$4,036.92" "$4,036.92" "$8,970.94" "$8,970.94" "$8,970.94" "$1,869.77" "$8,970.94" "$8,970.94" "$8,970.94" "$8,970.94" "$8,970.94" "$1,869.64" "$8,970.94" "$3,588.38" "$4,422.67" "$8,970.94" "$8,970.95" "$8,970.94" "$8,970.94" "$6,728.25" "$8,970.94" "$8,970.94" "$8,970.94" "$4,485.47" "$4,485.47" "$7,104.98" "$8,970.94" "$7,176.75" "$4,036.92" "$1,780.51" N/A "$5,203.18" "$8,970.94" "$5,382.56" "$8,970.94" "$1,869.54" "$8,970.94" N/A N/A 400077 SUP Custom 27203010 400077 - SEAL CNN 8MM DVNC EWRST DISP BOTH IP/OP $4.00 $3.00 $0.67 $3.75 $3.75 $3.75 $3.75 $3.75 $3.75 $3.75 $0.67 $3.75 $3.75 $2.78 $2.78 $2.89 $1.95 $0.78 $3.75 $1.50 $3.75 $3.75 $3.75 $3.75 $3.75 $3.00 $3.75 $3.75 $3.75 $1.88 $1.88 $2.97 $3.75 $3.00 $2.44 $3.75 N/A $2.32 $3.75 $2.25 $3.75 $3.75 $3.75 N/A N/A 400180 SUP Custom 27203010 400180 - COVER ESCP TIP 8MM STD HOT SHR DVNC EWRST CAUT MNPLR DISP BOTH IP/OP $50.00 $37.00 $8.90 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $8.90 $50.00 $50.00 $37.11 $37.11 $38.54 $26.05 $10.42 $50.00 $20.00 $50.00 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $32.50 $50.00 N/A $29.00 $50.00 $30.00 $50.00 $50.00 $50.00 N/A N/A 400427 SUP Custom 27203010 400427 - PACKING NSL 2.5X.9X2CM MRCL BRN SIN-PK STNG SLIM PRFL BOTH IP/OP $19.00 $14.00 $3.38 $18.98 $18.98 $18.98 $18.98 $18.98 $18.98 $18.98 $3.38 $18.98 $18.98 $14.09 $14.09 $14.63 $9.89 $3.96 $18.98 $7.59 $18.98 $18.98 $18.98 $18.98 $18.98 $14.25 $18.98 $18.98 $18.98 $9.49 $9.49 $15.03 $18.98 $15.18 $12.34 $18.98 N/A $11.02 $18.98 $11.39 $18.98 $18.98 $18.98 N/A N/A 401531 SUP Custom 27203010 401531 - BAG OST SFN MINI 1.75IN 5IN 2 SIDE COROVIN LATEX FREE DISP BOTH IP/OP $1.50 $1.00 $0.27 $1.50 $1.50 $1.50 $1.50 $1.50 $1.50 $1.50 $0.27 $1.50 $1.50 $1.11 $1.11 $1.16 $0.78 $0.31 $1.50 $0.60 $1.50 $1.50 $1.50 $1.50 $1.50 $1.13 $1.50 $1.50 $1.50 $0.75 $0.75 $1.19 $1.50 $1.20 $0.98 $1.50 N/A $0.87 $1.50 $0.90 $1.50 $1.50 $1.50 N/A N/A 401552 SUP Custom 27203010 KIT 1.5IN UROS STD SRFT BOTH IP/OP $4.00 $3.00 $0.71 $4.00 $4.00 $4.00 $4.00 $4.00 $4.00 $4.00 $0.71 $4.00 $4.00 $2.97 $2.97 $3.08 $2.08 $0.83 $4.00 $1.60 $4.00 $4.00 $4.00 $4.00 $4.00 $3.00 $4.00 $4.00 $4.00 $2.00 $2.00 $3.17 $4.00 $3.20 $2.60 $4.00 N/A $2.32 $4.00 $2.40 $4.00 $4.00 $4.00 N/A N/A 401575 SUP HCPCS C1730 401575 - CATHETER EP 1MM 2-5-2MM SPC 6FR 115CM LVWR DCAPL ROT DIAL BOTH IP/OP "$1,000.00" $740.00 $580.00 $750.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $750.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $580.00 N/A N/A N/A N/A N/A N/A N/A 402025 SUP HCPCS Q4116 402025 - MATRIX TISSUE THIN 7X4CM ALLOGRAFT REGENERATIVE FREEZE DRIED BOTH IP/OP $101.00 $75.00 $19.95 $100.54 $45.24 $45.24 $45.24 $45.24 $100.54 $100.54 $100.54 $20.96 $100.54 $100.54 $100.54 $100.54 $100.54 $20.95 $100.54 $64.73 $59.47 $100.54 $64.73 $100.54 $100.54 $75.75 $100.54 $100.54 $100.54 $50.27 $50.27 $79.63 $100.54 $80.43 $45.24 $19.95 N/A $58.58 $100.54 $100.54 $100.54 $20.95 $100.54 N/A N/A 402045 SUP HCPCS Q4116 402045 - MATRIX TISSUE THIN 12X4CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $100.50 $74.00 $19.88 $100.16 $45.07 $45.07 $45.07 $45.07 $100.16 $100.16 $100.16 $20.88 $100.16 $100.16 $100.16 $100.16 $100.16 $20.87 $100.16 $64.58 $59.24 $100.16 $64.58 $100.16 $100.16 $75.38 $100.16 $100.16 $100.16 $50.08 $50.08 $79.33 $100.16 $80.13 $45.07 $19.88 N/A $58.29 $100.16 $100.16 $100.16 $20.87 $100.16 N/A N/A 402432 SUP Custom 27803010 402432 - CEMENT BN LG STRL HVISC CBLT 40GM BOTH IP/OP $292.50 $216.00 $52.07 $292.50 $292.50 $292.50 $292.50 $292.50 $292.50 $292.50 $52.07 $292.50 $292.50 $292.50 $292.50 $292.50 $292.50 $60.96 $292.50 $117.00 $292.50 $292.50 $292.50 $292.50 $292.50 $219.38 $292.50 $292.50 $292.50 $146.25 $146.25 $231.66 $292.50 $234.00 $131.63 $292.50 N/A $169.65 $292.50 $175.50 $292.50 $292.50 $292.50 N/A N/A 402433 SUP Custom 27803010 402433 - CEMENT BN STRL HVISC CBLT GNTA 40GM BOTH IP/OP "$1,057.50" $783.00 $188.24 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $188.24 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" $423.00 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 "$1,057.50" N/A $613.35 "$1,057.50" $634.50 "$1,057.50" "$1,057.50" "$1,057.50" N/A N/A 403326 SUP Custom 27203010 DRESSING DUODERM 4X4 SIGNAL BOTH IP/OP $7.00 $5.00 $1.17 $6.60 $6.60 $6.60 $6.60 $6.60 $6.60 $6.60 $1.17 $6.60 $6.60 $4.90 $4.90 $5.09 $3.44 $1.38 $6.60 $2.64 $6.60 $6.60 $6.60 $6.60 $6.60 $5.25 $6.60 $6.60 $6.60 $3.30 $3.30 $5.23 $6.60 $5.28 $4.29 $6.60 N/A $4.06 $6.60 $3.96 $6.60 $6.60 $6.60 N/A N/A 403711 SUP Custom 27203010 403711 - DRESSING WOUND RECTANGLE 10X8IN STRONGER GREATER ABSORBENCY BOTH IP/OP $82.50 $61.00 $14.65 $82.33 $82.33 $82.33 $82.33 $82.33 $82.33 $82.33 $14.65 $82.33 $82.33 $61.11 $61.11 $63.46 $42.89 $17.16 $82.33 $32.93 $82.33 $82.33 $82.33 $82.33 $82.33 $61.88 $82.33 $82.33 $82.33 $41.17 $41.17 $65.21 $82.33 $65.86 $53.51 $82.33 N/A $47.85 $82.33 $49.40 $82.33 $82.33 $82.33 N/A N/A 405100 SUP HCPCS C1758 CATHETER DUAL LUMEN URETERAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $67.20 $67.20 $67.20 $67.20 $123.75 $123.75 $123.75 $25.79 $123.75 $91.85 $91.85 $95.39 $64.47 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $80.44 $24.56 $123.75 $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 405416 SUP HCPCS C1892 405416 - INTROD SHTH 9FR 14CM HMSTS GWIRE PLWY .038IN TRNSPT BOTH IP/OP $8.00 $6.00 $4.64 "$9,500.00" "$4,275.00" "$4,275.00" "$4,275.00" "$4,275.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,980.04" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.90" "$9,500.00" "$9,500.00" "$4,683.50" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" $6.00 "$9,500.00" "$9,500.00" "$9,500.00" "$4,750.00" "$4,750.00" "$7,524.00" "$9,500.00" "$7,600.00" "$4,275.00" "$1,885.51" N/A $4.64 "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.80" "$9,500.00" N/A N/A 405416 SUP HCPCS C1786 405416 - Etrinsa SR-T System with CLS with Home Monitoring BOTH IP/OP "$9,500.00" "$7,030.00" "$1,885.51" "$9,500.00" "$4,275.00" "$4,275.00" "$4,275.00" "$4,275.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,980.04" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.90" "$9,500.00" "$9,500.00" "$4,683.50" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$7,125.00" "$9,500.00" "$9,500.00" "$9,500.00" "$4,750.00" "$4,750.00" "$7,524.00" "$9,500.00" "$7,600.00" "$4,275.00" "$1,885.51" N/A "$5,510.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.80" "$9,500.00" N/A N/A 406136 SUP HCPCS C1894 406136 - INTRODUCER SHEATH .038IN STR 14FR 12CM LARGE LUMEN BOTH IP/OP $43.00 $32.00 $8.48 $42.75 $23.21 $23.21 $23.21 $23.21 $42.75 $42.75 $42.75 $8.91 $42.75 $31.73 $31.73 $32.95 $22.27 $8.91 $42.75 $42.75 $25.29 $42.75 $42.75 $42.75 $42.75 $32.25 $42.75 $42.75 $42.75 $21.38 $21.38 $33.86 $42.75 $34.20 $27.79 $8.48 N/A $24.94 $42.75 $42.75 $42.75 $8.91 $42.75 N/A N/A 406701 SUP HCPCS C1894 406701 - INTRODUCER SHTH .038IN STD 6FR 12CM 50CM FSTCTH CTHLK HMSTS BOTH IP/OP $0.50 $0.00 $0.29 $2.75 $1.49 $1.49 $1.49 $1.49 $2.75 $2.75 $2.75 $0.57 $2.75 $2.04 $2.04 $2.12 $1.43 $0.57 $2.75 $2.75 $1.63 $2.75 $2.75 $2.75 $2.75 $0.38 $2.75 $2.75 $2.75 $1.38 $1.38 $2.18 $2.75 $2.20 $1.79 $0.55 N/A $0.29 $2.75 $2.75 $2.75 $0.57 $2.75 N/A N/A 406701 SUP HCPCS C1894 406701 - INTRODUCER SHEATH .038IN STANDARD 6FR 12CM 50CM 2 DISTAL BOTH IP/OP $3.00 $2.00 $0.55 $2.75 $1.49 $1.49 $1.49 $1.49 $2.75 $2.75 $2.75 $0.57 $2.75 $2.04 $2.04 $2.12 $1.43 $0.57 $2.75 $2.75 $1.63 $2.75 $2.75 $2.75 $2.75 $2.25 $2.75 $2.75 $2.75 $1.38 $1.38 $2.18 $2.75 $2.20 $1.79 $0.55 N/A $1.74 $2.75 $2.75 $2.75 $0.57 $2.75 N/A N/A 407145 SUP HCPCS C1785 407145 - PACEMAKER CRD SM 48X40X6.5MM 10CC EDORA PROMRI 1 CHMBR RT BOTH IP/OP "$15,250.00" "$11,285.00" "$3,026.74" "$15,250.00" "$6,862.50" "$6,862.50" "$6,862.50" "$6,862.50" "$15,250.00" "$15,250.00" "$15,250.00" "$3,178.48" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$3,178.27" "$15,250.00" "$15,250.00" "$7,518.25" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$11,437.50" "$15,250.00" "$15,250.00" "$15,250.00" "$7,625.00" "$7,625.00" "$12,078.00" "$15,250.00" "$12,200.00" "$6,862.50" "$3,026.74" N/A "$8,845.00" "$15,250.00" "$15,250.00" "$15,250.00" "$3,178.10" "$15,250.00" N/A N/A 407157 SUP HCPCS C1786 407157 - PACEMAKER CRD SM 48X40X6.5MM 10CC EDORA PROMRI 1 CHMBR RT BOTH IP/OP "$13,375.00" "$9,898.00" "$2,654.60" "$13,375.00" "$6,018.75" "$6,018.75" "$6,018.75" "$6,018.75" "$13,375.00" "$13,375.00" "$13,375.00" "$2,787.68" "$13,375.00" "$13,375.00" "$13,375.00" "$13,375.00" "$13,375.00" "$2,787.50" "$13,375.00" "$13,375.00" "$6,593.88" "$13,375.00" "$13,375.00" "$13,375.00" "$13,375.00" "$10,031.25" "$13,375.00" "$13,375.00" "$13,375.00" "$6,687.50" "$6,687.50" "$10,593.00" "$13,375.00" "$10,700.00" "$6,018.75" "$2,654.60" N/A "$7,757.50" "$13,375.00" "$13,375.00" "$13,375.00" "$2,787.35" "$13,375.00" N/A N/A 410298 SUP Custom 27803010 410298 - STAPLER INTNL 14MM 45MM NS LF DVNC SI EWRST RPSB 50 FRNG BOTH IP/OP "$17,500.00" "$12,950.00" "$3,115.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$3,115.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$3,647.19" "$17,500.00" "$7,000.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$13,125.00" "$17,500.00" "$17,500.00" "$17,500.00" "$8,750.00" "$8,750.00" "$13,860.00" "$17,500.00" "$14,000.00" "$7,875.00" "$17,500.00" N/A "$10,150.00" "$17,500.00" "$10,500.00" "$17,500.00" "$17,500.00" "$17,500.00" N/A N/A 410322 SUP Custom 27203010 410322 - TIP CAUT 8MM 1 DVNC SI EWRST VSL SLR DISP BOTH IP/OP "$8,925.00" "$6,605.00" "$1,588.65" "$8,925.00" "$8,925.00" "$8,925.00" "$8,925.00" "$8,925.00" "$8,925.00" "$8,925.00" "$1,588.65" "$8,925.00" "$8,925.00" "$4,181.12" "$4,181.12" "$6,879.39" "$2,060.15" "$1,860.07" "$8,925.00" "$3,570.00" "$8,925.00" "$8,925.00" "$8,925.00" "$8,925.00" "$8,925.00" "$6,693.75" "$8,925.00" "$8,925.00" "$8,925.00" "$4,462.50" "$4,462.50" "$7,068.60" "$8,925.00" "$7,140.00" "$5,801.25" "$8,925.00" N/A "$5,176.50" "$8,925.00" "$5,355.00" "$8,925.00" "$8,925.00" "$8,925.00" N/A N/A 410370 SUP Custom 27203010 410370 - SHEATH LAPSCP 45MM STPLR BOTH IP/OP $50.00 $37.00 $8.90 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $8.90 $50.00 $50.00 $37.11 $37.11 $38.54 $26.05 $10.42 $50.00 $20.00 $50.00 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $32.50 $50.00 N/A $29.00 $50.00 $30.00 $50.00 $50.00 $50.00 N/A N/A 410500 SUP Custom 27203010 410500 - DRESSING HYDROCOLLOID TAPER 7.8X7.5IN ABSORBENT FLEXIBLE BOTH IP/OP $29.50 $22.00 $5.22 $29.32 $29.32 $29.32 $29.32 $29.32 $29.32 $29.32 $5.22 $29.32 $29.32 $21.76 $21.76 $22.60 $15.28 $6.11 $29.32 $11.73 $29.32 $29.32 $29.32 $29.32 $29.32 $22.13 $29.32 $29.32 $29.32 $14.66 $14.66 $23.22 $29.32 $23.46 $19.06 $29.32 N/A $17.11 $29.32 $17.59 $29.32 $29.32 $29.32 N/A N/A 410614 SUP Custom 27203010 410614 - DRESSING FOAM 8X8IN GELLING LATEX FREE VERSIVA XC BOTH IP/OP $34.00 $25.00 $6.05 $33.99 $33.99 $33.99 $33.99 $33.99 $33.99 $33.99 $6.05 $33.99 $33.99 $25.23 $25.23 $26.20 $17.71 $7.08 $33.99 $13.60 $33.99 $33.99 $33.99 $33.99 $33.99 $25.50 $33.99 $33.99 $33.99 $17.00 $17.00 $26.92 $33.99 $27.19 $22.09 $33.99 N/A $19.72 $33.99 $20.39 $33.99 $33.99 $33.99 N/A N/A 411250 SUP HCPCS C1762 411250 - GRAFT SOFT TISSUE 4-5MM 50MM ALLOGRAFT NATURAL CONNECT BOTH IP/OP "$10,437.50" "$7,724.00" "$2,071.58" "$13,167.50" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.44" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.29" "$10,437.50" "$13,167.50" "$5,145.69" "$10,437.50" "$12,542.50" "$10,437.50" "$10,437.50" "$7,828.13" "$10,437.50" "$10,437.50" "$10,437.50" "$5,218.75" "$5,218.75" "$8,266.50" "$10,437.50" "$8,350.00" "$4,696.88" "$2,071.58" N/A "$6,053.75" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.18" "$10,437.50" N/A N/A 411270 SUP HCPCS C1768 "411270 - Graft, Avance Nerve, 4-5mm x 70mm" BOTH IP/OP "$16,105.00" "$11,918.00" "$3,196.44" "$17,050.00" "$7,247.25" "$7,247.25" "$7,247.25" "$7,247.25" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.68" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.46" "$16,105.00" "$17,050.00" "$7,939.77" "$16,105.00" "$16,425.00" "$16,105.00" "$16,105.00" "$12,078.75" "$16,105.00" "$16,105.00" "$16,105.00" "$8,052.50" "$8,052.50" "$12,755.16" "$16,105.00" "$12,884.00" "$7,247.25" "$3,196.44" N/A "$9,340.90" "$16,105.00" "$16,105.00" "$16,105.00" "$3,356.28" "$16,105.00" N/A N/A 415807 SUP Custom 27203010 415807 - CANNULA PERFUSION 7MM 3MM 11.4IN BALLOON RIGHT ANGLED LATEX BOTH IP/OP $982.50 $727.00 $174.89 $982.50 $982.50 $982.50 $982.50 $982.50 $982.50 $982.50 $174.89 $982.50 $982.50 $729.21 $729.21 $757.31 $511.88 $204.76 $982.50 $393.00 $982.50 $982.50 $982.50 $982.50 $982.50 $736.88 $982.50 $982.50 $982.50 $491.25 $491.25 $778.14 $982.50 $786.00 $638.63 $982.50 N/A $569.85 $982.50 $589.50 $982.50 $982.50 $982.50 N/A N/A 417300 SUP Custom 27803010 417300 - SYSTEM BN CMNT STRL OPTVC SHRT XTD CRTDG NRM CPC 3 VAC MX BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A 419588 SUP HCPCS C1898 419588 - LEAD PACING 5FR 88CM UNIPOLAR DEPLOYABLE LOBES FIX IS-1 BOTH IP/OP "$3,492.50" "$2,584.00" $727.88 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 419678 SUP HCPCS C1898 419678 - LEAD PACING 2 CURVE 4FR 78CM BIPOL IS-1 ATTAIN ABILITY BOTH IP/OP "$3,492.50" "$2,584.00" $727.88 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 419688 SUP HCPCS C1898 419688 - LEAD PACING 4FR 88CM OTW TRACKABILITY STEERABLE BIPOL BOTH IP/OP "$3,492.50" "$2,584.00" $727.88 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 420006 SUP Custom 27203010 420006 - DRIVER NDL 0-30D LG 8MM 54.4CM 1CM S/SI EWRST 10 USES BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$4,082.10" "$4,082.10" "$4,239.40" "$2,060.15" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$3,575.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 420024 SUP Custom 27203010 420024 - OBTURATOR LAPSCP LNG 8MM STRL DVNC S/SI EWRST DISP BOTH IP/OP $62.50 $46.00 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A 420049 SUP Custom 27203010 420049 - FORCEPS LAPSCP 8MM STRL DVNC S/SI EWRST CADIERE FNGRTP CNTRL BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$3,711.00" "$3,711.00" "$3,854.00" "$2,060.15" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$3,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 420206 SUP Custom 27203010 420206 - SEAL ENDSCP INSTR 8.5-13MM S/SI EWRST CANNU HD SD BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $400.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A 420275 SUP Custom 27203010 420275 - SHEARS SURG 8MM DVNC S/SI EWRST HRMN A CURVE BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,041.05" "$2,041.05" "$2,119.70" "$1,432.75" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,787.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 420290 SUP Custom 27203010 420290 - KIT ACC 8MM DVNC SI 3 ARM CAM CNN SL INST DRP DISP BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 420291 SUP Custom 27203010 420291 - KIT 8MM 4 ARM CAM CANNU SL INSTR DRP ACC DVNC SI BOTH IP/OP "$3,250.00" "$2,405.00" $578.50 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $578.50 "$3,250.00" "$3,250.00" "$2,412.15" "$2,412.15" "$2,505.10" "$1,693.25" $677.34 "$3,250.00" "$1,300.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$2,112.50" "$3,250.00" N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" "$3,250.00" "$3,250.00" N/A N/A 422298 SUP Custom 27203010 422298 - DRESSING WOUND SQUARE 6X6IN 2 LAYER ABSORBENT NONWOVEN SOFT BOTH IP/OP $55.50 $41.00 $9.88 $55.48 $55.48 $55.48 $55.48 $55.48 $55.48 $55.48 $9.88 $55.48 $55.48 $41.18 $41.18 $42.76 $28.91 $11.56 $55.48 $22.19 $55.48 $55.48 $55.48 $55.48 $55.48 $41.63 $55.48 $55.48 $55.48 $27.74 $27.74 $43.94 $55.48 $44.38 $36.06 $55.48 N/A $32.19 $55.48 $33.29 $55.48 $55.48 $55.48 N/A N/A 422300 SUP Custom 27203010 422300 - DRESSING HYDROFIBER AQUACEL 0.75IN X 18IN SILVER BOTH IP/OP $30.00 $22.00 $5.25 $29.52 $29.52 $29.52 $29.52 $29.52 $29.52 $29.52 $5.25 $29.52 $29.52 $21.91 $21.91 $22.75 $15.38 $6.15 $29.52 $11.81 $29.52 $29.52 $29.52 $29.52 $29.52 $22.50 $29.52 $29.52 $29.52 $14.76 $14.76 $23.38 $29.52 $23.62 $19.19 $29.52 N/A $17.40 $29.52 $17.71 $29.52 $29.52 $29.52 N/A N/A 425304 SUP HCPCS C1713 425304 - PLATE PELVIS 108MM RADIUS BOTH IP/OP $285.00 $211.00 $56.49 $284.63 $128.08 $128.08 $128.08 $128.08 $284.63 $284.63 $284.63 $59.32 $284.63 $284.63 $284.63 $284.63 $284.63 $59.32 $284.63 $284.63 $168.36 $284.63 $284.63 $284.63 $284.63 $213.75 $284.63 $284.63 $284.63 $142.32 $142.32 $225.43 $284.63 $227.70 $128.08 $56.49 N/A $165.30 $284.63 $170.78 $284.63 $59.32 $284.63 N/A N/A 425306 SUP HCPCS C1713 425306 - PLATE PELVIS 108MM RADIUS BOTH IP/OP $362.00 $268.00 $71.77 $361.63 $162.73 $162.73 $162.73 $162.73 $361.63 $361.63 $361.63 $75.37 $361.63 $361.63 $361.63 $361.63 $361.63 $75.37 $361.63 $144.65 $213.90 $361.63 $361.63 $361.63 $361.63 $271.50 $361.63 $361.63 $361.63 $180.82 $180.82 $286.41 $361.63 $289.30 $162.73 $71.77 N/A $209.96 $361.63 $216.98 $361.63 $75.36 $361.63 N/A N/A 425308 SUP HCPCS C1713 425308 - PLATE PELVIS 108MM RADIUS BOTH IP/OP $355.00 $263.00 $70.41 $354.75 $159.64 $159.64 $159.64 $159.64 $354.75 $354.75 $354.75 $73.94 $354.75 $354.75 $354.75 $354.75 $354.75 $73.93 $354.75 $354.75 $209.83 $354.75 $354.75 $354.75 $354.75 $266.25 $354.75 $354.75 $354.75 $177.38 $177.38 $280.96 $354.75 $283.80 $159.64 $70.41 N/A $205.90 $354.75 $354.75 $354.75 $73.93 $354.75 N/A N/A 425310 SUP HCPCS C1713 425310 - PLATE PELVIS 108MM RADIUS BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $391.88 $391.88 N/A N/A 425312 SUP HCPCS C1713 425312 - PLATE PELVIS 108MM RADIUS BOTH IP/OP $419.50 $310.00 $83.24 $419.38 $188.72 $188.72 $188.72 $188.72 $419.38 $419.38 $419.38 $87.41 $419.38 $419.38 $419.38 $419.38 $419.38 $87.40 $419.38 $419.38 $248.06 $419.38 $419.38 $419.38 $419.38 $314.63 $419.38 $419.38 $419.38 $209.69 $209.69 $332.15 $419.38 $335.50 $188.72 $83.24 N/A $243.31 $419.38 $419.38 $419.38 $419.38 $419.38 N/A N/A 425406 SUP HCPCS C1713 425406 - PLATE PELVIS 88MM RADIUS BOTH IP/OP $329.00 $243.00 $65.22 $328.63 $147.88 $147.88 $147.88 $147.88 $328.63 $328.63 $328.63 $68.49 $328.63 $328.63 $328.63 $328.63 $328.63 $68.49 $328.63 $328.63 $194.38 $328.63 $328.63 $328.63 $328.63 $246.75 $328.63 $328.63 $328.63 $164.32 $164.32 $260.27 $328.63 $262.90 $147.88 $65.22 N/A $190.82 $328.63 $328.63 $328.63 $68.49 $328.63 N/A N/A 425408 SUP HCPCS C1713 425408 - PLATE PELVIS 88MM RADIUS BOTH IP/OP $349.50 $259.00 $69.32 $349.25 $157.16 $157.16 $157.16 $157.16 $349.25 $349.25 $349.25 $72.79 $349.25 $349.25 $349.25 $349.25 $349.25 $72.79 $349.25 $349.25 $206.58 $349.25 $349.25 $349.25 $349.25 $262.13 $349.25 $349.25 $349.25 $174.63 $174.63 $276.61 $349.25 $279.40 $157.16 $69.32 N/A $202.71 $349.25 $349.25 $349.25 $72.78 $349.25 N/A N/A 425410 SUP HCPCS C1713 425410 - PLATE PELVIS 88MM RADIUS BOTH IP/OP $389.50 $288.00 $77.23 $389.13 $175.11 $175.11 $175.11 $175.11 $389.13 $389.13 $389.13 $81.10 $389.13 $389.13 $389.13 $389.13 $389.13 $81.10 $389.13 $155.65 $230.17 $389.13 $389.13 $389.13 $389.13 $292.13 $389.13 $389.13 $389.13 $194.57 $194.57 $308.19 $389.13 $311.30 $175.11 $77.23 N/A $225.91 $389.13 $389.13 $389.13 $81.09 $389.13 N/A N/A 425412 SUP HCPCS C1713 425412 - PLATE PELVIS 88MM RADIUS BOTH IP/OP $419.50 $310.00 $83.24 $419.38 $188.72 $188.72 $188.72 $188.72 $419.38 $419.38 $419.38 $87.41 $419.38 $419.38 $419.38 $419.38 $419.38 $87.40 $419.38 $419.38 $248.06 $419.38 $419.38 $419.38 $419.38 $314.63 $419.38 $419.38 $419.38 $209.69 $209.69 $332.15 $419.38 $335.50 $188.72 $83.24 N/A $243.31 $419.38 $419.38 $419.38 $419.38 $419.38 N/A N/A 425504 SUP HCPCS C1713 425504 - PELVIC PLATE STRAIGHT 4H/64MM BOTH IP/OP $234.00 $173.00 $46.39 $233.75 $105.19 $105.19 $105.19 $105.19 $233.75 $233.75 $233.75 $48.72 $233.75 $233.75 $233.75 $233.75 $233.75 $48.72 $233.75 $93.50 $138.26 $233.75 $233.75 $233.75 $233.75 $175.50 $233.75 $233.75 $233.75 $116.88 $116.88 $185.13 $233.75 $187.00 $105.19 $46.39 N/A $135.72 $233.75 $233.75 $233.75 $48.71 $233.75 N/A N/A 425506 SUP HCPCS C1713 425506 - PLATE PELVIS STRAIGHT BOTH IP/OP $268.50 $199.00 $53.22 $268.13 $120.66 $120.66 $120.66 $120.66 $268.13 $268.13 $268.13 $55.88 $268.13 $268.13 $268.13 $268.13 $268.13 $55.88 $268.13 $268.13 $158.60 $268.13 $268.13 $268.13 $268.13 $201.38 $268.13 $268.13 $268.13 $134.07 $134.07 $212.36 $268.13 $214.50 $120.66 $53.22 N/A $155.73 $268.13 $268.13 $268.13 $268.13 $268.13 N/A N/A 425509 SUP HCPCS C1713 425509 - PELVIC PLATE STRAIGHT 9H/154MM BOTH IP/OP $338.50 $250.00 $67.13 $338.25 $152.21 $152.21 $152.21 $152.21 $338.25 $338.25 $338.25 $70.50 $338.25 $338.25 $338.25 $338.25 $338.25 $70.50 $338.25 $135.30 $200.07 $338.25 $338.25 $338.25 $338.25 $253.88 $338.25 $338.25 $338.25 $169.13 $169.13 $267.89 $338.25 $270.60 $152.21 $67.13 N/A $196.33 $338.25 $338.25 $338.25 $70.49 $338.25 N/A N/A 425512 SUP HCPCS C1713 425512 - PLATE. PELVIS. STRAIGHT BOTH IP/OP $399.00 $295.00 $79.14 $398.75 $179.44 $179.44 $179.44 $179.44 $398.75 $398.75 $398.75 $83.11 $398.75 $398.75 $398.75 $398.75 $398.75 $83.10 $398.75 $398.75 $235.86 $398.75 $398.75 $398.75 $398.75 $299.25 $398.75 $398.75 $398.75 $199.38 $199.38 $315.81 $398.75 $319.00 $179.44 $79.14 N/A $231.42 $398.75 $398.75 $398.75 $83.10 $398.75 N/A N/A 425602 SUP HCPCS C1713 425602 - PLATE BONE 108MM RAD 26.5MM 2 HOLE CVD MATTA PELVIC BOTH IP/OP $384.00 $284.00 $76.14 $383.63 $172.63 $172.63 $172.63 $172.63 $383.63 $383.63 $383.63 $79.96 $383.63 $383.63 $383.63 $383.63 $383.63 $79.95 $383.63 $153.45 $226.92 $383.63 $383.63 $383.63 $383.63 $288.00 $383.63 $383.63 $383.63 $191.82 $191.82 $303.83 $383.63 $306.90 $172.63 $76.14 N/A $222.72 $383.63 $230.18 $383.63 $79.95 $383.63 N/A N/A 425603 SUP HCPCS C1713 425603 - PLATE BONE 108MM RAD 42.5MM 3 HOLE CVD MATTA PELVIC BOTH IP/OP $426.50 $316.00 $84.60 $426.25 $191.81 $191.81 $191.81 $191.81 $426.25 $426.25 $426.25 $88.84 $426.25 $426.25 $426.25 $426.25 $426.25 $88.84 $426.25 $170.50 $252.13 $426.25 $426.25 $426.25 $426.25 $319.88 $426.25 $426.25 $426.25 $213.13 $213.13 $337.59 $426.25 $341.00 $191.81 $84.60 N/A $247.37 $426.25 $255.75 $426.25 $88.83 $426.25 N/A N/A 425604 SUP HCPCS C1713 425604 - PLATE BONE 108MM RAD 58.5MM 4 HOLE CVD MATTA STAINLESS STEEL BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $726.60 $726.60 $151.42 $726.60 N/A N/A 425605 SUP HCPCS C1713 425605 - PLATE BONE 108MM 74.5MM 5 HOLE CVD PELVIC BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $726.60 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 425606 SUP HCPCS C1713 425606 - PLATE BONE 108MM RAD 90.5MM 6 HOLE CVD MPS STAINLESS STEEL BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $799.40 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $479.64 $799.40 $166.59 $799.40 N/A N/A 425607 SUP HCPCS C1713 425607 - PLATE BONE 108MM 106.5MM 5 HOLE CVD PELVIC BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $799.40 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $799.40 $799.40 $166.59 $799.40 N/A N/A 425608 SUP HCPCS C1713 425608 - PLATE BONE 108MM RAD 122.5MM 8 HOLE CVD MPS STAINLESS STEEL BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $319.76 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $479.64 $799.40 $166.59 $799.40 N/A N/A 425609 SUP HCPCS C1713 425609 - PLATE BONE 108MM RAD 138.5X10.5X2.5MM 9 HOLE SHAFT CVD MATTA BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $319.76 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $479.64 $799.40 $166.59 $799.40 N/A N/A 425610 SUP HCPCS C1713 425610 - PLATE BN CRV 154.5MM MPS 10 HL SS R108 BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $799.40 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $799.40 $799.40 $166.59 $799.40 N/A N/A 425611 SUP HCPCS C1713 425611 - PLATE BONE 108MM RAD 170.5X10.5X2.5MM 11 HOLE SHAFT CVD BOTH IP/OP $881.00 $652.00 $174.78 $880.60 $396.27 $396.27 $396.27 $396.27 $880.60 $880.60 $880.60 $183.54 $880.60 $880.60 $880.60 $880.60 $880.60 $183.53 $880.60 $352.24 $520.87 $880.60 $880.60 $880.60 $880.60 $660.75 $880.60 $880.60 $880.60 $440.30 $440.30 $697.44 $880.60 $704.48 $396.27 $174.78 N/A $510.98 $880.60 $528.36 $880.60 $183.52 $880.60 N/A N/A 425612 SUP HCPCS C1713 425612 - PLATE BONE 186.5MM 108MM 12 HOLE CVD MPS STAINLESS STEEL BOTH IP/OP $881.00 $652.00 $174.78 $880.60 $396.27 $396.27 $396.27 $396.27 $880.60 $880.60 $880.60 $183.54 $880.60 $880.60 $880.60 $880.60 $880.60 $183.53 $880.60 $352.24 $520.87 $880.60 $880.60 $880.60 $880.60 $660.75 $880.60 $880.60 $880.60 $440.30 $440.30 $697.44 $880.60 $704.48 $396.27 $174.78 N/A $510.98 $880.60 $528.36 $880.60 $183.52 $880.60 N/A N/A 425613 SUP HCPCS C1713 425613 - PLATE BONE 108MM RAD 202.5X10.5X2.5MM 13 HOLE SHAFT CVD BOTH IP/OP $881.00 $652.00 $174.78 $880.60 $396.27 $396.27 $396.27 $396.27 $880.60 $880.60 $880.60 $183.54 $880.60 $880.60 $880.60 $880.60 $880.60 $183.53 $880.60 $352.24 $520.87 $880.60 $880.60 $880.60 $880.60 $660.75 $880.60 $880.60 $880.60 $440.30 $440.30 $697.44 $880.60 $704.48 $396.27 $174.78 N/A $510.98 $880.60 $880.60 $880.60 $183.52 $880.60 N/A N/A 425614 SUP HCPCS C1713 425614 - PLATE BONE 218.5MM 108MM 14 HOLE CVD MPS STAINLESS STEEL BOTH IP/OP $881.00 $652.00 $174.78 $880.60 $396.27 $396.27 $396.27 $396.27 $880.60 $880.60 $880.60 $183.54 $880.60 $880.60 $880.60 $880.60 $880.60 $183.53 $880.60 $352.24 $520.87 $880.60 $880.60 $880.60 $880.60 $660.75 $880.60 $880.60 $880.60 $440.30 $440.30 $697.44 $880.60 $704.48 $396.27 $174.78 N/A $510.98 $880.60 $528.36 $880.60 $183.52 $880.60 N/A N/A 425615 SUP HCPCS C1713 425615 - PLATE BONE 108MM RAD 234.5X10.5X2.5MM 15 HOLE SHAFT CVD BOTH IP/OP $881.00 $652.00 $174.78 $880.60 $396.27 $396.27 $396.27 $396.27 $880.60 $880.60 $880.60 $183.54 $880.60 $880.60 $880.60 $880.60 $880.60 $183.53 $880.60 $352.24 $520.87 $880.60 $880.60 $880.60 $880.60 $660.75 $880.60 $880.60 $880.60 $440.30 $440.30 $697.44 $880.60 $704.48 $396.27 $174.78 N/A $510.98 $880.60 $528.36 $880.60 $183.52 $880.60 N/A N/A 425616 SUP HCPCS C1713 425616 - PLATE BONE 108MM RAD 250.5MM 16 HOLE CVD MATTA PELVIC BOTH IP/OP $967.00 $716.00 $191.87 $966.70 $435.02 $435.02 $435.02 $435.02 $966.70 $966.70 $966.70 $201.48 $966.70 $966.70 $966.70 $966.70 $966.70 $201.47 $966.70 $966.70 $571.80 $966.70 $966.70 $966.70 $966.70 $725.25 $966.70 $966.70 $966.70 $483.35 $483.35 $765.63 $966.70 $773.36 $435.02 $191.87 N/A $560.86 $966.70 $580.02 $966.70 $201.46 $966.70 N/A N/A 425618 SUP HCPCS C1713 425618 - PLATE BONE 108MM RAD 282.5X10.5X2.5MM 18 HOLE SHAFT CVD BOTH IP/OP $967.00 $716.00 $191.87 $966.70 $435.02 $435.02 $435.02 $435.02 $966.70 $966.70 $966.70 $201.48 $966.70 $966.70 $966.70 $966.70 $966.70 $201.47 $966.70 $966.70 $571.80 $966.70 $966.70 $966.70 $966.70 $725.25 $966.70 $966.70 $966.70 $483.35 $483.35 $765.63 $966.70 $773.36 $435.02 $191.87 N/A $560.86 $966.70 $966.70 $966.70 $201.46 $966.70 N/A N/A 425620 SUP HCPCS C1713 425620 - PLATE BONE 108MM RAD 314.5X10.5X2.5MM 20 HOLE SHAFT CVD BOTH IP/OP "$1,012.00" $749.00 $200.86 "$1,012.00" $455.40 $455.40 $455.40 $455.40 "$1,012.00" "$1,012.00" "$1,012.00" $210.93 "$1,012.00" "$1,012.00" "$1,012.00" "$1,012.00" "$1,012.00" $210.91 "$1,012.00" "$1,012.00" $598.60 "$1,012.00" "$1,012.00" "$1,012.00" "$1,012.00" $759.00 "$1,012.00" "$1,012.00" "$1,012.00" $506.00 $506.00 $801.50 "$1,012.00" $809.60 $455.40 $200.86 N/A $586.96 "$1,012.00" $607.20 "$1,012.00" $210.90 "$1,012.00" N/A N/A 425653 SUP HCPCS C1713 425653 - PLATE BONE 88MM RAD 42.5MM 3 HOLE CVD MATTA PELVIC BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 425654 SUP HCPCS C1713 425654 - PLATE BONE 88MM RAD 58.8MM 4 HOLE CVD MPS STAINLESS STEEL BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 425655 SUP HCPCS C1713 425655 - PLATE BN 88MM RDS CRV 74.5MM NS MATTA 5 HL SS PLV BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 425656 SUP HCPCS C1713 425656 - PLATE BONE 88MM RAD 90.5MM 6 HOLE CVD MPS STAINLESS STEEL BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $319.76 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $799.40 $799.40 $166.59 $799.40 N/A N/A 425657 SUP HCPCS C1713 425657 - PLATE BONE 88MM 106.5MM 7 HOLE CVD PELVIC BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $319.76 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $479.64 $799.40 $166.59 $799.40 N/A N/A 425658 SUP HCPCS C1713 425658 - PLATE BONE 122.5MM 88MM 8 HOLE CVD STAINLESS STEEL PELVIC BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $319.76 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $479.64 $799.40 $166.59 $799.40 N/A N/A 425659 SUP HCPCS C1713 425659 - PLATE BONE 88MM RAD 138.5MM 9 HOLE CVD MATTA PELVIC BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $319.76 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $479.64 $799.40 $166.59 $799.40 N/A N/A 425660 SUP HCPCS C1713 425660 - PLATE BONE 154.5MM 88MM 10 HOLE CVD MPS STAINLESS STEEL BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $319.76 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $479.64 $799.40 $166.59 $799.40 N/A N/A 425661 SUP HCPCS C1713 425661 - PLATE BONE 88MM RAD 170.5MM 11 HOLE CVD MATTA PELVIC BOTH IP/OP $881.00 $652.00 $174.78 $880.60 $396.27 $396.27 $396.27 $396.27 $880.60 $880.60 $880.60 $183.54 $880.60 $880.60 $880.60 $880.60 $880.60 $183.53 $880.60 $352.24 $520.87 $880.60 $880.60 $880.60 $880.60 $660.75 $880.60 $880.60 $880.60 $440.30 $440.30 $697.44 $880.60 $704.48 $396.27 $174.78 N/A $510.98 $880.60 $880.60 $880.60 $183.52 $880.60 N/A N/A 425662 SUP HCPCS C1713 425662 - PLATE BONE 186.5MM 88MM 12 HOLE CVD MPS STAINLESS STEEL BOTH IP/OP $881.00 $652.00 $174.78 $880.60 $396.27 $396.27 $396.27 $396.27 $880.60 $880.60 $880.60 $183.54 $880.60 $880.60 $880.60 $880.60 $880.60 $183.53 $880.60 $880.60 $520.87 $880.60 $880.60 $880.60 $880.60 $660.75 $880.60 $880.60 $880.60 $440.30 $440.30 $697.44 $880.60 $704.48 $396.27 $174.78 N/A $510.98 $880.60 $880.60 $880.60 $183.52 $880.60 N/A N/A 425663 SUP HCPCS C1713 425663 - PLATE BONE 88MM RAD 202.5MM 13 HOLE CVD MATTA PELVIC BOTH IP/OP $881.00 $652.00 $174.78 $880.60 $396.27 $396.27 $396.27 $396.27 $880.60 $880.60 $880.60 $183.54 $880.60 $880.60 $880.60 $880.60 $880.60 $183.53 $880.60 $352.24 $520.87 $880.60 $880.60 $880.60 $880.60 $660.75 $880.60 $880.60 $880.60 $440.30 $440.30 $697.44 $880.60 $704.48 $396.27 $174.78 N/A $510.98 $880.60 $528.36 $880.60 $183.52 $880.60 N/A N/A 425664 SUP HCPCS C1713 425664 - PLATE BONE 218.5MM 88MM 14 HOLE CVD MPS STAINLESS STEEL BOTH IP/OP $881.00 $652.00 $174.78 $880.60 $396.27 $396.27 $396.27 $396.27 $880.60 $880.60 $880.60 $183.54 $880.60 $880.60 $880.60 $880.60 $880.60 $183.53 $880.60 $352.24 $520.87 $880.60 $880.60 $880.60 $880.60 $660.75 $880.60 $880.60 $880.60 $440.30 $440.30 $697.44 $880.60 $704.48 $396.27 $174.78 N/A $510.98 $880.60 $528.36 $880.60 $183.52 $880.60 N/A N/A 425665 SUP HCPCS C1713 425665 - PLATE BONE 88MM RAD 234.5MM 15 HOLE CVD MATTA PELVIC BOTH IP/OP $881.00 $652.00 $174.78 $880.60 $396.27 $396.27 $396.27 $396.27 $880.60 $880.60 $880.60 $183.54 $880.60 $880.60 $880.60 $880.60 $880.60 $183.53 $880.60 $880.60 $520.87 $880.60 $880.60 $880.60 $880.60 $660.75 $880.60 $880.60 $880.60 $440.30 $440.30 $697.44 $880.60 $704.48 $396.27 $174.78 N/A $510.98 $880.60 $528.36 $880.60 $183.52 $880.60 N/A N/A 425666 SUP HCPCS C1713 425666 - PLATE BONE 88MM RAD 250.5MM 16 HOLE CVD MATTA PELVIC BOTH IP/OP $881.00 $652.00 $174.78 $880.60 $396.27 $396.27 $396.27 $396.27 $880.60 $880.60 $880.60 $183.54 $880.60 $880.60 $880.60 $880.60 $880.60 $183.53 $880.60 $880.60 $520.87 $880.60 $880.60 $880.60 $880.60 $660.75 $880.60 $880.60 $880.60 $440.30 $440.30 $697.44 $880.60 $704.48 $396.27 $174.78 N/A $510.98 $880.60 $528.36 $880.60 $183.52 $880.60 N/A N/A 425667 SUP HCPCS C1713 425667 - PLATE BONE 88MM RAD 266.5MM 17 HOLE CVD MATTA PELVIC BOTH IP/OP $833.50 $617.00 $165.38 $833.25 $374.96 $374.96 $374.96 $374.96 $833.25 $833.25 $833.25 $173.67 $833.25 $833.25 $833.25 $833.25 $833.25 $173.66 $833.25 $333.30 $492.87 $833.25 $833.25 $833.25 $833.25 $625.13 $833.25 $833.25 $833.25 $416.63 $416.63 $659.93 $833.25 $666.60 $374.96 $165.38 N/A $483.43 $833.25 $499.95 $833.25 $173.65 $833.25 N/A N/A 425668 SUP HCPCS C1713 425668 - PLATE BONE 88MM RAD 282.5MM 18 HOLE CVD MATTA PELVIC BOTH IP/OP $881.00 $652.00 $174.78 $880.60 $396.27 $396.27 $396.27 $396.27 $880.60 $880.60 $880.60 $183.54 $880.60 $880.60 $880.60 $880.60 $880.60 $183.53 $880.60 $352.24 $520.87 $880.60 $880.60 $880.60 $880.60 $660.75 $880.60 $880.60 $880.60 $440.30 $440.30 $697.44 $880.60 $704.48 $396.27 $174.78 N/A $510.98 $880.60 $528.36 $880.60 $183.52 $880.60 N/A N/A 425670 SUP HCPCS C1713 425670 - PLATE BONE 88MM RAD 314.5MM 20 HOLE CVD MATTA PELVIC BOTH IP/OP $975.00 $722.00 $193.50 $974.95 $438.73 $438.73 $438.73 $438.73 $974.95 $974.95 $974.95 $203.20 $974.95 $974.95 $974.95 $974.95 $974.95 $203.19 $974.95 $389.98 $576.68 $974.95 $974.95 $974.95 $974.95 $731.25 $974.95 $974.95 $974.95 $487.48 $487.48 $772.16 $974.95 $779.96 $438.73 $193.50 N/A $565.50 $974.95 $974.95 $974.95 $203.18 $974.95 N/A N/A 425672 SUP HCPCS C1713 425672 - PLATE BONE 88MM RAD 346.5MM 22 HOLE CVD MATTA PELVIC BOTH IP/OP "$1,012.00" $749.00 $200.86 "$1,012.00" $455.40 $455.40 $455.40 $455.40 "$1,012.00" "$1,012.00" "$1,012.00" $210.93 "$1,012.00" "$1,012.00" "$1,012.00" "$1,012.00" "$1,012.00" $210.91 "$1,012.00" "$1,012.00" $598.60 "$1,012.00" "$1,012.00" "$1,012.00" "$1,012.00" $759.00 "$1,012.00" "$1,012.00" "$1,012.00" $506.00 $506.00 $801.50 "$1,012.00" $809.60 $455.40 $200.86 N/A $586.96 "$1,012.00" $607.20 "$1,012.00" $210.90 "$1,012.00" N/A N/A 425674 SUP HCPCS C1713 425674 - PLATE BONE 88MM RAD 378.5MM 24 HOLE CVD MATTA PELVIC BOTH IP/OP "$1,012.00" $749.00 $200.86 "$1,012.00" $455.40 $455.40 $455.40 $455.40 "$1,012.00" "$1,012.00" "$1,012.00" $210.93 "$1,012.00" "$1,012.00" "$1,012.00" "$1,012.00" "$1,012.00" $210.91 "$1,012.00" "$1,012.00" $598.60 "$1,012.00" "$1,012.00" "$1,012.00" "$1,012.00" $759.00 "$1,012.00" "$1,012.00" "$1,012.00" $506.00 $506.00 $801.50 "$1,012.00" $809.60 $455.40 $200.86 N/A $586.96 "$1,012.00" "$1,012.00" "$1,012.00" $210.90 "$1,012.00" N/A N/A 425676 SUP HCPCS C1713 425676 - PLATE BONE 88MM RAD 410.5MM 26 HOLE CVD MATTA PELVIC BOTH IP/OP "$1,067.00" $790.00 $211.77 "$1,067.00" $480.15 $480.15 $480.15 $480.15 "$1,067.00" "$1,067.00" "$1,067.00" $222.39 "$1,067.00" "$1,067.00" "$1,067.00" "$1,067.00" "$1,067.00" $222.37 "$1,067.00" $426.80 $631.13 "$1,067.00" "$1,067.00" "$1,067.00" "$1,067.00" $800.25 "$1,067.00" "$1,067.00" "$1,067.00" $533.50 $533.50 $845.06 "$1,067.00" $853.60 $480.15 $211.77 N/A $618.86 "$1,067.00" "$1,067.00" "$1,067.00" $222.36 "$1,067.00" N/A N/A 425678 SUP HCPCS C1713 425678 - PLATE BONE 442.5MM 88MM 28 HOLE CVD PELVIC BOTH IP/OP "$1,067.00" $790.00 $211.77 "$1,067.00" $480.15 $480.15 $480.15 $480.15 "$1,067.00" "$1,067.00" "$1,067.00" $222.39 "$1,067.00" "$1,067.00" "$1,067.00" "$1,067.00" "$1,067.00" $222.37 "$1,067.00" $426.80 $631.13 "$1,067.00" "$1,067.00" "$1,067.00" "$1,067.00" $800.25 "$1,067.00" "$1,067.00" "$1,067.00" $533.50 $533.50 $845.06 "$1,067.00" $853.60 $480.15 $211.77 N/A $618.86 "$1,067.00" $640.20 "$1,067.00" $222.36 "$1,067.00" N/A N/A 425680 SUP HCPCS C1713 425680 - PLATE BONE 88MM RAD 474.5MM 30 HOLE CVD MATTA PELVIC BOTH IP/OP "$1,067.00" $790.00 $211.77 "$1,067.00" $480.15 $480.15 $480.15 $480.15 "$1,067.00" "$1,067.00" "$1,067.00" $222.39 "$1,067.00" "$1,067.00" "$1,067.00" "$1,067.00" "$1,067.00" $222.37 "$1,067.00" $426.80 $631.13 "$1,067.00" "$1,067.00" "$1,067.00" "$1,067.00" $800.25 "$1,067.00" "$1,067.00" "$1,067.00" $533.50 $533.50 $845.06 "$1,067.00" $853.60 $480.15 $211.77 N/A $618.86 "$1,067.00" $640.20 "$1,067.00" $222.36 "$1,067.00" N/A N/A 425702 SUP HCPCS C1713 425702 - PLATE BONE 26.5MMX10.5MMX2.5M 2 HOLE STR MATTA STAINLESS BOTH IP/OP $659.50 $488.00 $130.87 $659.40 $296.73 $296.73 $296.73 $296.73 $659.40 $659.40 $659.40 $137.44 $659.40 $659.40 $659.40 $659.40 $659.40 $137.43 $659.40 $263.76 $390.04 $659.40 $659.40 $659.40 $659.40 $494.63 $659.40 $659.40 $659.40 $329.70 $329.70 $522.24 $659.40 $527.52 $296.73 $130.87 N/A $382.51 $659.40 $659.40 $659.40 $137.42 $659.40 N/A N/A 425703 SUP HCPCS C1713 425703 - PLATE BONE 42.5MM 3 HOLE STR STAINLESS STEEL PELVIC BOTH IP/OP $659.50 $488.00 $130.87 $659.40 $296.73 $296.73 $296.73 $296.73 $659.40 $659.40 $659.40 $137.44 $659.40 $659.40 $659.40 $659.40 $659.40 $137.43 $659.40 $659.40 $390.04 $659.40 $659.40 $659.40 $659.40 $494.63 $659.40 $659.40 $659.40 $329.70 $329.70 $522.24 $659.40 $527.52 $296.73 $130.87 N/A $382.51 $659.40 $659.40 $659.40 $137.42 $659.40 N/A N/A 425704 SUP HCPCS C1713 425704 - PLATE BONE 58.5MM 4 HOLE STR MPS STAINLESS STEEL PELVIC BOTH IP/OP $659.50 $488.00 $130.87 $659.40 $296.73 $296.73 $296.73 $296.73 $659.40 $659.40 $659.40 $137.44 $659.40 $659.40 $659.40 $659.40 $659.40 $137.43 $659.40 $263.76 $390.04 $659.40 $659.40 $659.40 $659.40 $494.63 $659.40 $659.40 $659.40 $329.70 $329.70 $522.24 $659.40 $527.52 $296.73 $130.87 N/A $382.51 $659.40 $659.40 $659.40 $137.42 $659.40 N/A N/A 425705 SUP HCPCS C1713 425705 - PLATE BONE 74.5MM 5 HOLE SHAFT STR MATTA PELVIC BOTH IP/OP $659.50 $488.00 $130.87 $659.40 $296.73 $296.73 $296.73 $296.73 $659.40 $659.40 $659.40 $137.44 $659.40 $659.40 $659.40 $659.40 $659.40 $137.43 $659.40 $263.76 $390.04 $659.40 $659.40 $659.40 $659.40 $494.63 $659.40 $659.40 $659.40 $329.70 $329.70 $522.24 $659.40 $527.52 $296.73 $130.87 N/A $382.51 $659.40 $659.40 $659.40 $137.42 $659.40 N/A N/A 425706 SUP HCPCS C1713 425706 - PLATE BONE 90.5MM 6 HOLE STR MPS STAINLESS STEEL PELVIC BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $726.60 $726.60 $151.42 $726.60 N/A N/A 425707 SUP HCPCS C1713 425707 - PLATE BONE 106.5MM 7 HOLE SHAFT STR MATTA PELVIC BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $726.60 $726.60 $151.42 $726.60 N/A N/A 425708 SUP HCPCS C1713 425708 - PLATE BONE 122.5MM 8 HOLE STR MPS STAINLESS STEEL PELVIC BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $726.60 $726.60 $151.42 $726.60 N/A N/A 425709 SUP HCPCS C1713 425709 - PLATE BONE 138.5MM 9 HOLE SHAFT STR MATTA PELVIC BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 425710 SUP HCPCS C1713 425710 - PLATE BONE 154.5MM 10 HOLE STR MPS STAINLESS STEEL PELVIC BOTH IP/OP $727.00 $538.00 $144.21 $726.60 $326.97 $326.97 $326.97 $326.97 $726.60 $726.60 $726.60 $151.44 $726.60 $726.60 $726.60 $726.60 $726.60 $151.43 $726.60 $290.64 $429.78 $726.60 $726.60 $726.60 $726.60 $545.25 $726.60 $726.60 $726.60 $363.30 $363.30 $575.47 $726.60 $581.28 $326.97 $144.21 N/A $421.66 $726.60 $435.96 $726.60 $151.42 $726.60 N/A N/A 425711 SUP HCPCS C1713 425711 - PLATE BONE 170.5MM 11 HOLE SHAFT STR MATTA PELVIC BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $799.40 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $479.64 $799.40 $166.59 $799.40 N/A N/A 425712 SUP HCPCS C1713 425712 - PLATE BONE 186.5MM 12 HOLE STR MATTA MPS STAINLESS STEEL BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $319.76 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $799.40 $799.40 $166.59 $799.40 N/A N/A 425713 SUP HCPCS C1713 425713 - PLATE BONE 202.5MM 13 HOLE SHAFT STR MATTA PELVIC BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $319.76 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $799.40 $799.40 $166.59 $799.40 N/A N/A 425714 SUP HCPCS C1713 425714 - PLATE BONE 218.5MM 14 HOLE STR MATTA STAINLESS STEEL PELVIC BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $319.76 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $799.40 $799.40 $166.59 $799.40 N/A N/A 425715 SUP HCPCS C1713 425715 - PLATE BONE 234.5MM 15 HOLE SHAFT STR MATTA PELVIC BOTH IP/OP $799.50 $592.00 $158.66 $799.40 $359.73 $359.73 $359.73 $359.73 $799.40 $799.40 $799.40 $166.61 $799.40 $799.40 $799.40 $799.40 $799.40 $166.60 $799.40 $319.76 $472.85 $799.40 $799.40 $799.40 $799.40 $599.63 $799.40 $799.40 $799.40 $399.70 $399.70 $633.12 $799.40 $639.52 $359.73 $158.66 N/A $463.71 $799.40 $799.40 $799.40 $166.59 $799.40 N/A N/A 425716 SUP HCPCS C1713 425716 - PLATE BONE 250.5MMX10.5MMX2.5M 16 HOLE STR MATTA STAINLESS BOTH IP/OP $878.00 $650.00 $174.22 $877.80 $395.01 $395.01 $395.01 $395.01 $877.80 $877.80 $877.80 $182.96 $877.80 $877.80 $877.80 $877.80 $877.80 $182.94 $877.80 $877.80 $519.22 $877.80 $877.80 $877.80 $877.80 $658.50 $877.80 $877.80 $877.80 $438.90 $438.90 $695.22 $877.80 $702.24 $395.01 $174.22 N/A $509.24 $877.80 $877.80 $877.80 $182.93 $877.80 N/A N/A 425718 SUP HCPCS C1713 425718 - PLATE BONE 282.5MM 18 HOLE SHAFT STR MATTA PELVIC BOTH IP/OP $878.00 $650.00 $174.22 $877.80 $395.01 $395.01 $395.01 $395.01 $877.80 $877.80 $877.80 $182.96 $877.80 $877.80 $877.80 $877.80 $877.80 $182.94 $877.80 $877.80 $519.22 $877.80 $877.80 $877.80 $877.80 $658.50 $877.80 $877.80 $877.80 $438.90 $438.90 $695.22 $877.80 $702.24 $395.01 $174.22 N/A $509.24 $877.80 $526.68 $877.80 $182.93 $877.80 N/A N/A 425720 SUP HCPCS C1713 425720 - PLATE BONE 314.5MM 20 HOLE SHAFT STR MATTA PELVIC BOTH IP/OP $902.00 $667.00 $179.02 $902.00 $405.90 $405.90 $405.90 $405.90 $902.00 $902.00 $902.00 $188.00 $902.00 $902.00 $902.00 $902.00 $902.00 $187.99 $902.00 $902.00 $533.53 $902.00 $902.00 $902.00 $902.00 $676.50 $902.00 $902.00 $902.00 $451.00 $451.00 $714.38 $902.00 $721.60 $405.90 $179.02 N/A $523.16 $902.00 $541.20 $902.00 $187.98 $902.00 N/A N/A 425752 SUP HCPCS C1713 425752 - PLATE BONE 22.5MM 2 HOLE STR ACETAB BOTH IP/OP $374.00 $277.00 $74.23 $374.00 $168.30 $168.30 $168.30 $168.30 $374.00 $374.00 $374.00 $77.95 $374.00 $374.00 $374.00 $374.00 $374.00 $77.95 $374.00 $149.60 $221.22 $374.00 $374.00 $374.00 $374.00 $280.50 $374.00 $374.00 $374.00 $187.00 $187.00 $296.21 $374.00 $299.20 $168.30 $74.23 N/A $216.92 $374.00 $224.40 $374.00 $77.94 $374.00 N/A N/A 425753 SUP HCPCS C1713 425753 - PLATE BONE 34.5MM 3 HOLE STR ACETAB BOTH IP/OP $762.50 $564.00 $151.30 $762.30 $343.04 $343.04 $343.04 $343.04 $762.30 $762.30 $762.30 $158.88 $762.30 $762.30 $762.30 $762.30 $762.30 $158.87 $762.30 $304.92 $450.90 $762.30 $762.30 $762.30 $762.30 $571.88 $762.30 $762.30 $762.30 $381.15 $381.15 $603.74 $762.30 $609.84 $343.04 $151.30 N/A $442.25 $762.30 $762.30 $762.30 $158.86 $762.30 N/A N/A 425754 SUP HCPCS C1713 425754 - PLATE BONE 46.5MM 4 HOLE STR MPS STAINLESS STEEL ACETAB BOTH IP/OP $762.50 $564.00 $151.30 $762.30 $343.04 $343.04 $343.04 $343.04 $762.30 $762.30 $762.30 $158.88 $762.30 $762.30 $762.30 $762.30 $762.30 $158.87 $762.30 $304.92 $450.90 $762.30 $762.30 $762.30 $762.30 $571.88 $762.30 $762.30 $762.30 $381.15 $381.15 $603.74 $762.30 $609.84 $343.04 $151.30 N/A $442.25 $762.30 $762.30 $762.30 $158.86 $762.30 N/A N/A 425755 SUP HCPCS C1713 425755 - PLATE BONE 58.5MM 5 HOLE STR ACETAB BOTH IP/OP $762.50 $564.00 $151.30 $762.30 $343.04 $343.04 $343.04 $343.04 $762.30 $762.30 $762.30 $158.88 $762.30 $762.30 $762.30 $762.30 $762.30 $158.87 $762.30 $762.30 $450.90 $762.30 $762.30 $762.30 $762.30 $571.88 $762.30 $762.30 $762.30 $381.15 $381.15 $603.74 $762.30 $609.84 $343.04 $151.30 N/A $442.25 $762.30 $457.38 $762.30 $158.86 $762.30 N/A N/A 425756 SUP HCPCS C1713 425756 - PLATE BONE 70.5MM 6 HOLE STR MPS STAINLESS STEEL ACETAB BOTH IP/OP $838.00 $620.00 $166.30 $837.90 $377.06 $377.06 $377.06 $377.06 $837.90 $837.90 $837.90 $174.64 $837.90 $837.90 $837.90 $837.90 $837.90 $174.63 $837.90 $335.16 $495.62 $837.90 $837.90 $837.90 $837.90 $628.50 $837.90 $837.90 $837.90 $418.95 $418.95 $663.62 $837.90 $670.32 $377.06 $166.30 N/A $486.04 $837.90 $837.90 $837.90 $174.62 $837.90 N/A N/A 425757 SUP HCPCS C1713 425757 - PLATE BONE 82.5MM 7 HOLE STR ACETAB BOTH IP/OP $838.00 $620.00 $166.30 $837.90 $377.06 $377.06 $377.06 $377.06 $837.90 $837.90 $837.90 $174.64 $837.90 $837.90 $837.90 $837.90 $837.90 $174.63 $837.90 $335.16 $495.62 $837.90 $837.90 $837.90 $837.90 $628.50 $837.90 $837.90 $837.90 $418.95 $418.95 $663.62 $837.90 $670.32 $377.06 $166.30 N/A $486.04 $837.90 $502.74 $837.90 $174.62 $837.90 N/A N/A 425758 SUP HCPCS C1713 425758 - PLATE BONE 94.5MM 8 HOLE STR MPS STAINLESS STEEL ACETAB BOTH IP/OP $838.00 $620.00 $166.30 $837.90 $377.06 $377.06 $377.06 $377.06 $837.90 $837.90 $837.90 $174.64 $837.90 $837.90 $837.90 $837.90 $837.90 $174.63 $837.90 $837.90 $495.62 $837.90 $837.90 $837.90 $837.90 $628.50 $837.90 $837.90 $837.90 $418.95 $418.95 $663.62 $837.90 $670.32 $377.06 $166.30 N/A $486.04 $837.90 $502.74 $837.90 $174.62 $837.90 N/A N/A 425759 SUP HCPCS C1713 425759 - PLATE BONE 106.5MM 9 HOLE STR ACETAB BOTH IP/OP $838.00 $620.00 $166.30 $837.90 $377.06 $377.06 $377.06 $377.06 $837.90 $837.90 $837.90 $174.64 $837.90 $837.90 $837.90 $837.90 $837.90 $174.63 $837.90 $335.16 $495.62 $837.90 $837.90 $837.90 $837.90 $628.50 $837.90 $837.90 $837.90 $418.95 $418.95 $663.62 $837.90 $670.32 $377.06 $166.30 N/A $486.04 $837.90 $502.74 $837.90 $174.62 $837.90 N/A N/A 425760 SUP HCPCS C1713 425760 - PLATE BONE 118.5MM 10 HOLE STR MPS STAINLESS STEEL ACETAB BOTH IP/OP $838.00 $620.00 $166.30 $837.90 $377.06 $377.06 $377.06 $377.06 $837.90 $837.90 $837.90 $174.64 $837.90 $837.90 $837.90 $837.90 $837.90 $174.63 $837.90 $335.16 $495.62 $837.90 $837.90 $837.90 $837.90 $628.50 $837.90 $837.90 $837.90 $418.95 $418.95 $663.62 $837.90 $670.32 $377.06 $166.30 N/A $486.04 $837.90 $837.90 $837.90 $174.62 $837.90 N/A N/A 425761 SUP HCPCS C1713 425761 - PLATE BONE 130.5MM 11 HOLE STR ACETAB BOTH IP/OP $925.00 $685.00 $183.53 $924.70 $416.12 $416.12 $416.12 $416.12 $924.70 $924.70 $924.70 $192.73 $924.70 $924.70 $924.70 $924.70 $924.70 $192.72 $924.70 $369.88 $546.96 $924.70 $924.70 $924.70 $924.70 $693.75 $924.70 $924.70 $924.70 $462.35 $462.35 $732.36 $924.70 $739.76 $416.12 $183.53 N/A $536.50 $924.70 $554.82 $924.70 $192.71 $924.70 N/A N/A 425762 SUP HCPCS C1713 425762 - PLATE BONE 142.5MM 12 HOLE STR MATTA MPS STAINLESS STEEL BOTH IP/OP $925.00 $685.00 $183.53 $924.70 $416.12 $416.12 $416.12 $416.12 $924.70 $924.70 $924.70 $192.73 $924.70 $924.70 $924.70 $924.70 $924.70 $192.72 $924.70 $369.88 $546.96 $924.70 $924.70 $924.70 $924.70 $693.75 $924.70 $924.70 $924.70 $462.35 $462.35 $732.36 $924.70 $739.76 $416.12 $183.53 N/A $536.50 $924.70 $554.82 $924.70 $192.71 $924.70 N/A N/A 425763 SUP HCPCS C1713 425763 - PLATE BONE 154.5MM 13 HOLE STR ACETAB BOTH IP/OP $925.00 $685.00 $183.53 $924.70 $416.12 $416.12 $416.12 $416.12 $924.70 $924.70 $924.70 $192.73 $924.70 $924.70 $924.70 $924.70 $924.70 $192.72 $924.70 $369.88 $546.96 $924.70 $924.70 $924.70 $924.70 $693.75 $924.70 $924.70 $924.70 $462.35 $462.35 $732.36 $924.70 $739.76 $416.12 $183.53 N/A $536.50 $924.70 $554.82 $924.70 $192.71 $924.70 N/A N/A 425764 SUP HCPCS C1713 425764 - PLATE BONE 166.5MM 14 HOLE STR MATTA MPS STAINLESS STEEL BOTH IP/OP $925.00 $685.00 $183.53 $924.70 $416.12 $416.12 $416.12 $416.12 $924.70 $924.70 $924.70 $192.73 $924.70 $924.70 $924.70 $924.70 $924.70 $192.72 $924.70 $924.70 $546.96 $924.70 $924.70 $924.70 $924.70 $693.75 $924.70 $924.70 $924.70 $462.35 $462.35 $732.36 $924.70 $739.76 $416.12 $183.53 N/A $536.50 $924.70 $554.82 $924.70 $192.71 $924.70 N/A N/A 425765 SUP HCPCS C1713 425765 - PLATE BONE 178.5MM 15 HOLE STR ACETAB BOTH IP/OP $925.00 $685.00 $183.53 $924.70 $416.12 $416.12 $416.12 $416.12 $924.70 $924.70 $924.70 $192.73 $924.70 $924.70 $924.70 $924.70 $924.70 $192.72 $924.70 $369.88 $546.96 $924.70 $924.70 $924.70 $924.70 $693.75 $924.70 $924.70 $924.70 $462.35 $462.35 $732.36 $924.70 $739.76 $416.12 $183.53 N/A $536.50 $924.70 $924.70 $924.70 $192.71 $924.70 N/A N/A 425766 SUP HCPCS C1713 425766 - PLATE BONE 190.5MM 16 HOLE STR STAINLESS STEEL ACETAB BOTH IP/OP "$1,014.50" $751.00 $201.31 "$1,014.30" $456.44 $456.44 $456.44 $456.44 "$1,014.30" "$1,014.30" "$1,014.30" $211.41 "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" $211.39 "$1,014.30" $405.72 $599.96 "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" $760.88 "$1,014.30" "$1,014.30" "$1,014.30" $507.15 $507.15 $803.33 "$1,014.30" $811.44 $456.44 $201.31 N/A $588.41 "$1,014.30" "$1,014.30" "$1,014.30" $211.38 "$1,014.30" N/A N/A 425767 SUP HCPCS C1713 425767 - PLATE BONE 202.5MM 17 HOLE STR ACETAB BOTH IP/OP "$1,014.50" $751.00 $201.31 "$1,014.30" $456.44 $456.44 $456.44 $456.44 "$1,014.30" "$1,014.30" "$1,014.30" $211.41 "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" $211.39 "$1,014.30" $405.72 $599.96 "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" $760.88 "$1,014.30" "$1,014.30" "$1,014.30" $507.15 $507.15 $803.33 "$1,014.30" $811.44 $456.44 $201.31 N/A $588.41 "$1,014.30" "$1,014.30" "$1,014.30" $211.38 "$1,014.30" N/A N/A 425768 SUP HCPCS C1713 425768 - PLATE BONE 214.5MM 18 HOLE STR ACETAB BOTH IP/OP "$1,014.50" $751.00 $201.31 "$1,014.30" $456.44 $456.44 $456.44 $456.44 "$1,014.30" "$1,014.30" "$1,014.30" $211.41 "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" $211.39 "$1,014.30" $405.72 $599.96 "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" $760.88 "$1,014.30" "$1,014.30" "$1,014.30" $507.15 $507.15 $803.33 "$1,014.30" $811.44 $456.44 $201.31 N/A $588.41 "$1,014.30" "$1,014.30" "$1,014.30" $211.38 "$1,014.30" N/A N/A 425769 SUP HCPCS C1713 425769 - PLATE BONE 226.5MM 19 HOLE STR ACETAB BOTH IP/OP $961.50 $712.00 $190.76 $961.13 $432.51 $432.51 $432.51 $432.51 $961.13 $961.13 $961.13 $200.32 $961.13 $961.13 $961.13 $961.13 $961.13 $200.31 $961.13 $961.13 $568.51 $961.13 $961.13 $961.13 $961.13 $721.13 $961.13 $961.13 $961.13 $480.57 $480.57 $761.21 $961.13 $768.90 $432.51 $190.76 N/A $557.67 $961.13 $576.68 $961.13 $200.30 $961.13 N/A N/A 425770 SUP HCPCS C1713 425770 - PLATE BONE 238.5MM 20 HOLE STR ACETAB BOTH IP/OP "$1,014.50" $751.00 $201.31 "$1,014.30" $456.44 $456.44 $456.44 $456.44 "$1,014.30" "$1,014.30" "$1,014.30" $211.41 "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" $211.39 "$1,014.30" $405.72 $599.96 "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" $760.88 "$1,014.30" "$1,014.30" "$1,014.30" $507.15 $507.15 $803.33 "$1,014.30" $811.44 $456.44 $201.31 N/A $588.41 "$1,014.30" "$1,014.30" "$1,014.30" $211.38 "$1,014.30" N/A N/A 425772 SUP HCPCS C1713 425772 - PLATE BONE 262.5MM 22 HOLE STR ACETAB BOTH IP/OP "$1,014.50" $751.00 $201.31 "$1,014.30" $456.44 $456.44 $456.44 $456.44 "$1,014.30" "$1,014.30" "$1,014.30" $211.41 "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" $211.39 "$1,014.30" $405.72 $599.96 "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" $760.88 "$1,014.30" "$1,014.30" "$1,014.30" $507.15 $507.15 $803.33 "$1,014.30" $811.44 $456.44 $201.31 N/A $588.41 "$1,014.30" $608.58 "$1,014.30" $211.38 "$1,014.30" N/A N/A 425774 SUP HCPCS C1713 425774 - PLATE BONE 286.5MM 24 HOLE STR ACETAB BOTH IP/OP $961.50 $712.00 $190.76 $961.13 $432.51 $432.51 $432.51 $432.51 $961.13 $961.13 $961.13 $200.32 $961.13 $961.13 $961.13 $961.13 $961.13 $200.31 $961.13 $384.45 $568.51 $961.13 $961.13 $961.13 $961.13 $721.13 $961.13 $961.13 $961.13 $480.57 $480.57 $761.21 $961.13 $768.90 $432.51 $190.76 N/A $557.67 $961.13 $576.68 $961.13 $200.30 $961.13 N/A N/A 425776 SUP HCPCS C1713 425776 - PLATE BONE 310.5MM 26 HOLE STR ACETAB BOTH IP/OP $961.50 $712.00 $190.76 $961.13 $432.51 $432.51 $432.51 $432.51 $961.13 $961.13 $961.13 $200.32 $961.13 $961.13 $961.13 $961.13 $961.13 $200.31 $961.13 $384.45 $568.51 $961.13 $961.13 $961.13 $961.13 $721.13 $961.13 $961.13 $961.13 $480.57 $480.57 $761.21 $961.13 $768.90 $432.51 $190.76 N/A $557.67 $961.13 $576.68 $961.13 $200.30 $961.13 N/A N/A 425778 SUP HCPCS C1713 425778 - PLATE BONE 334.5MM 28 HOLE STR ACETAB BOTH IP/OP $961.50 $712.00 $190.76 $961.13 $432.51 $432.51 $432.51 $432.51 $961.13 $961.13 $961.13 $200.32 $961.13 $961.13 $961.13 $961.13 $961.13 $200.31 $961.13 $384.45 $568.51 $961.13 $961.13 $961.13 $961.13 $721.13 $961.13 $961.13 $961.13 $480.57 $480.57 $761.21 $961.13 $768.90 $432.51 $190.76 N/A $557.67 $961.13 $576.68 $961.13 $200.30 $961.13 N/A N/A 425780 SUP HCPCS C1713 425780 - PLATE BONE 358.5MM 30 HOLE STR ACETAB BOTH IP/OP "$1,014.50" $751.00 $201.31 "$1,014.30" $456.44 $456.44 $456.44 $456.44 "$1,014.30" "$1,014.30" "$1,014.30" $211.41 "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" $211.39 "$1,014.30" $405.72 $599.96 "$1,014.30" "$1,014.30" "$1,014.30" "$1,014.30" $760.88 "$1,014.30" "$1,014.30" "$1,014.30" $507.15 $507.15 $803.33 "$1,014.30" $811.44 $456.44 $201.31 N/A $588.41 "$1,014.30" $608.58 "$1,014.30" $211.38 "$1,014.30" N/A N/A 425794 SUP HCPCS C1713 425794 - PLATE BN 60.5MM MPS 4 HL SS R75 BOTH IP/OP "$1,120.00" $829.00 $222.29 "$1,120.00" $504.00 $504.00 $504.00 $504.00 "$1,120.00" "$1,120.00" "$1,120.00" $233.44 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $233.42 "$1,120.00" $448.00 $662.48 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $840.00 "$1,120.00" "$1,120.00" "$1,120.00" $560.00 $560.00 $887.04 "$1,120.00" $896.00 $504.00 $222.29 N/A $649.60 "$1,120.00" $672.00 "$1,120.00" $233.41 "$1,120.00" N/A N/A 425796 SUP HCPCS C1713 425796 - PLATE BN 92.5MM MPS 6 HL SS R75 BOTH IP/OP "$1,187.50" $879.00 $235.63 "$1,187.20" $534.24 $534.24 $534.24 $534.24 "$1,187.20" "$1,187.20" "$1,187.20" $247.44 "$1,187.20" "$1,187.20" "$1,187.20" "$1,187.20" "$1,187.20" $247.43 "$1,187.20" $474.88 $702.23 "$1,187.20" "$1,187.20" "$1,187.20" "$1,187.20" $890.63 "$1,187.20" "$1,187.20" "$1,187.20" $593.60 $593.60 $940.26 "$1,187.20" $949.76 $534.24 $235.63 N/A $688.75 "$1,187.20" $712.32 "$1,187.20" $247.41 "$1,187.20" N/A N/A 425798 SUP HCPCS C1713 425798 - PLATE BONE 75MM RAD 124.5MM 8 HOLE PUBIS SYMPHYSIS BOTH IP/OP "$1,122.00" $830.00 $222.69 "$1,122.00" $504.90 $504.90 $504.90 $504.90 "$1,122.00" "$1,122.00" "$1,122.00" $233.85 "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" $233.84 "$1,122.00" "$1,122.00" $663.66 "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" $841.50 "$1,122.00" "$1,122.00" "$1,122.00" $561.00 $561.00 $888.62 "$1,122.00" $897.60 $504.90 $222.69 N/A $650.76 "$1,122.00" $673.20 "$1,122.00" $233.82 "$1,122.00" N/A N/A 427002 SUP HCPCS C1713 427002 - PLATE BONE 32MM 2 HOLE LOCK COMPRESSION AXSOS STAINLESS BOTH IP/OP $182.50 $135.00 $36.20 $182.40 $82.08 $82.08 $82.08 $82.08 $182.40 $182.40 $182.40 $38.02 $182.40 $182.40 $182.40 $182.40 $182.40 $38.01 $182.40 $72.96 $107.89 $182.40 $182.40 $182.40 $182.40 $136.88 $182.40 $182.40 $182.40 $91.20 $91.20 $144.46 $182.40 $145.92 $82.08 $36.20 N/A $105.85 $182.40 $182.40 $182.40 $38.01 $182.40 N/A N/A 427003 SUP HCPCS C1713 427003 - PLATE BONE 45MM 3 HOLE LOCK COMPRESSION AXSOS STAINLESS BOTH IP/OP $182.50 $135.00 $36.20 $182.40 $82.08 $82.08 $82.08 $82.08 $182.40 $182.40 $182.40 $38.02 $182.40 $182.40 $182.40 $182.40 $182.40 $38.01 $182.40 $72.96 $107.89 $182.40 $182.40 $182.40 $182.40 $136.88 $182.40 $182.40 $182.40 $91.20 $91.20 $144.46 $182.40 $145.92 $82.08 $36.20 N/A $105.85 $182.40 $109.44 $182.40 $38.01 $182.40 N/A N/A 427004 SUP HCPCS C1713 427004 - PLATE BONE 58MM 4 HOLE WAISTED COMPRESSION LOCKING AXSOS BOTH IP/OP $182.50 $135.00 $36.20 $182.40 $82.08 $82.08 $82.08 $82.08 $182.40 $182.40 $182.40 $38.02 $182.40 $182.40 $182.40 $182.40 $182.40 $38.01 $182.40 $72.96 $107.89 $182.40 $182.40 $182.40 $182.40 $136.88 $182.40 $182.40 $182.40 $91.20 $91.20 $144.46 $182.40 $145.92 $82.08 $36.20 N/A $105.85 $182.40 $109.44 $182.40 $38.01 $182.40 N/A N/A 427005 SUP HCPCS C1713 427005 - PLATE BN 71MM NS AXSOS 5 HL LCK CMPR SS WST 4MM SCR SM FRAG BOTH IP/OP $234.00 $173.00 $46.36 $233.60 $105.12 $105.12 $105.12 $105.12 $233.60 $233.60 $233.60 $48.69 $233.60 $233.60 $233.60 $233.60 $233.60 $48.68 $233.60 $93.44 $138.17 $233.60 $233.60 $233.60 $233.60 $175.50 $233.60 $233.60 $233.60 $116.80 $116.80 $185.01 $233.60 $186.88 $105.12 $46.36 N/A $135.72 $233.60 $140.16 $233.60 $48.68 $233.60 N/A N/A 427006 SUP HCPCS C1713 427006 - PLATE BN 84MM NS AXSOS 6 HL LCK CMPR SS WST 4MM SCR SM FRAG BOTH IP/OP $234.00 $173.00 $46.36 $233.60 $105.12 $105.12 $105.12 $105.12 $233.60 $233.60 $233.60 $48.69 $233.60 $233.60 $233.60 $233.60 $233.60 $48.68 $233.60 $93.44 $138.17 $233.60 $233.60 $233.60 $233.60 $175.50 $233.60 $233.60 $233.60 $116.80 $116.80 $185.01 $233.60 $186.88 $105.12 $46.36 N/A $135.72 $233.60 $140.16 $233.60 $48.68 $233.60 N/A N/A 427007 SUP HCPCS C1713 427007 - PLATE BN 97MM NS AXSOS 7 HL LCK CMPR SS WST 4MM SCR SM FRAG BOTH IP/OP $234.00 $173.00 $46.36 $233.60 $105.12 $105.12 $105.12 $105.12 $233.60 $233.60 $233.60 $48.69 $233.60 $233.60 $233.60 $233.60 $233.60 $48.68 $233.60 $93.44 $138.17 $233.60 $233.60 $233.60 $233.60 $175.50 $233.60 $233.60 $233.60 $116.80 $116.80 $185.01 $233.60 $186.88 $105.12 $46.36 N/A $135.72 $233.60 $140.16 $233.60 $48.68 $233.60 N/A N/A 427008 SUP HCPCS C1713 427008 - PLATE BONE 110MM 8 HOLE WAISTED COMPRESSION LOCKING AXSOS BOTH IP/OP $260.00 $192.00 $51.60 $260.00 $117.00 $117.00 $117.00 $117.00 $260.00 $260.00 $260.00 $54.19 $260.00 $260.00 $260.00 $260.00 $260.00 $54.19 $260.00 $104.00 $153.79 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $117.00 $51.60 N/A $150.80 $260.00 $156.00 $260.00 $54.18 $260.00 N/A N/A 427009 SUP HCPCS C1713 427009 - PLATE BONE 123MM 29 HOLE WAISTED COMPRESSION LOCKING AXSOS BOTH IP/OP $260.00 $192.00 $51.60 $260.00 $117.00 $117.00 $117.00 $117.00 $260.00 $260.00 $260.00 $54.19 $260.00 $260.00 $260.00 $260.00 $260.00 $54.19 $260.00 $104.00 $153.79 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $117.00 $51.60 N/A $150.80 $260.00 $156.00 $260.00 $54.18 $260.00 N/A N/A 427010 SUP HCPCS C1713 427010 - PLATE BONE 136MM 10 HOLE LOCKING COMPRESSION WAISTED SMALL BOTH IP/OP $260.00 $192.00 $51.60 $260.00 $117.00 $117.00 $117.00 $117.00 $260.00 $260.00 $260.00 $54.19 $260.00 $260.00 $260.00 $260.00 $260.00 $54.19 $260.00 $104.00 $153.79 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $117.00 $51.60 N/A $150.80 $260.00 $156.00 $260.00 $54.18 $260.00 N/A N/A 427011 SUP HCPCS C1713 427011 - PLATE BONE 149MM 11 HOLE WAISTED COMPRESSION LOCKING AXSOS BOTH IP/OP $260.00 $192.00 $51.60 $260.00 $117.00 $117.00 $117.00 $117.00 $260.00 $260.00 $260.00 $54.19 $260.00 $260.00 $260.00 $260.00 $260.00 $54.19 $260.00 $104.00 $153.79 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $117.00 $51.60 N/A $150.80 $260.00 $156.00 $260.00 $54.18 $260.00 N/A N/A 427012 SUP HCPCS C1713 427012 - PLATE BN 162MM NS AXSOS 12 HL LCK CMPR SS WST 4MM SCR SM BOTH IP/OP $260.00 $192.00 $51.60 $260.00 $117.00 $117.00 $117.00 $117.00 $260.00 $260.00 $260.00 $54.19 $260.00 $260.00 $260.00 $260.00 $260.00 $54.19 $260.00 $104.00 $153.79 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $117.00 $51.60 N/A $150.80 $260.00 $156.00 $260.00 $54.18 $260.00 N/A N/A 427014 SUP HCPCS C1713 427014 - PLATE BONE 4MM 188MM 14 HOLE COMPRESSION WAISTED LOCKING BOTH IP/OP $311.50 $231.00 $61.77 $311.20 $140.04 $140.04 $140.04 $140.04 $311.20 $311.20 $311.20 $64.86 $311.20 $311.20 $311.20 $311.20 $311.20 $64.86 $311.20 $124.48 $184.07 $311.20 $311.20 $311.20 $311.20 $233.63 $311.20 $311.20 $311.20 $155.60 $155.60 $246.47 $311.20 $248.96 $140.04 $61.77 N/A $180.67 $311.20 $186.72 $311.20 $64.85 $311.20 N/A N/A 427016 SUP HCPCS C1713 427016 - PLATE BONE 4MM 241MM 16 HOLE WAISTED COMPRESSION STAINLESS BOTH IP/OP $311.50 $231.00 $61.77 $311.20 $140.04 $140.04 $140.04 $140.04 $311.20 $311.20 $311.20 $64.86 $311.20 $311.20 $311.20 $311.20 $311.20 $64.86 $311.20 $311.20 $184.07 $311.20 $311.20 $311.20 $311.20 $233.63 $311.20 $311.20 $311.20 $155.60 $155.60 $246.47 $311.20 $248.96 $140.04 $61.77 N/A $180.67 $311.20 $186.72 $311.20 $64.85 $311.20 N/A N/A 427018 SUP HCPCS C1713 427018 - PLATE BONE 240MM 18 HOLE WAISTED COMPRESSION LOCKING AXSOS BOTH IP/OP $363.50 $269.00 $72.09 $363.20 $163.44 $163.44 $163.44 $163.44 $363.20 $363.20 $363.20 $75.70 $363.20 $363.20 $363.20 $363.20 $363.20 $75.69 $363.20 $363.20 $214.83 $363.20 $363.20 $363.20 $363.20 $272.63 $363.20 $363.20 $363.20 $181.60 $181.60 $287.65 $363.20 $290.56 $163.44 $72.09 N/A $210.83 $363.20 $217.92 $363.20 $75.69 $363.20 N/A N/A 427020 SUP HCPCS C1713 427020 - PLATE BONE 266MM 20 HOLE WAISTED COMPRESSION LOCKING AXSOS BOTH IP/OP $363.50 $269.00 $72.09 $363.20 $163.44 $163.44 $163.44 $163.44 $363.20 $363.20 $363.20 $75.70 $363.20 $363.20 $363.20 $363.20 $363.20 $75.69 $363.20 $363.20 $214.83 $363.20 $363.20 $363.20 $363.20 $272.63 $363.20 $363.20 $363.20 $181.60 $181.60 $287.65 $363.20 $290.56 $163.44 $72.09 N/A $210.83 $363.20 $217.92 $363.20 $75.69 $363.20 N/A N/A 427062 SUP HCPCS C1713 427062 - PLATE BONE 24MM 2 HOLE 1/3 TUBULAR LOCKING SYSTEM AXSOS BOTH IP/OP $179.50 $133.00 $35.57 $179.20 $80.64 $80.64 $80.64 $80.64 $179.20 $179.20 $179.20 $37.35 $179.20 $179.20 $179.20 $179.20 $179.20 $37.35 $179.20 $71.68 $106.00 $179.20 $179.20 $179.20 $179.20 $134.63 $179.20 $179.20 $179.20 $89.60 $89.60 $141.93 $179.20 $143.36 $80.64 $35.57 N/A $104.11 $179.20 $107.52 $179.20 $37.35 $179.20 N/A N/A 427063 SUP HCPCS C1713 427063 - PLATE BONE 3MM 37MM 3 HOLE ONE THIRD TUBULAR STAINLESS STEEL BOTH IP/OP $190.50 $141.00 $37.79 $190.40 $85.68 $85.68 $85.68 $85.68 $190.40 $190.40 $190.40 $39.68 $190.40 $190.40 $190.40 $190.40 $190.40 $39.68 $190.40 $76.16 $112.62 $190.40 $190.40 $190.40 $190.40 $142.88 $190.40 $190.40 $190.40 $95.20 $95.20 $150.80 $190.40 $152.32 $85.68 $37.79 N/A $110.49 $190.40 $114.24 $190.40 $39.68 $190.40 N/A N/A 427064 SUP HCPCS C1713 427064 - PLATE BONE 50MM 4 HOLE 1/3 TUBULAR LOCKING AXSOS STAINLESS BOTH IP/OP $218.50 $162.00 $43.35 $218.40 $98.28 $98.28 $98.28 $98.28 $218.40 $218.40 $218.40 $45.52 $218.40 $218.40 $218.40 $218.40 $218.40 $45.52 $218.40 $218.40 $129.18 $218.40 $218.40 $218.40 $218.40 $163.88 $218.40 $218.40 $218.40 $109.20 $109.20 $172.97 $218.40 $174.72 $98.28 $43.35 N/A $126.73 $218.40 $218.40 $218.40 $45.51 $218.40 N/A N/A 427065 SUP HCPCS C1713 427065 - PLATE BONE 3MM 63MM 5 HOLE ONE THIRD TUBULAR SMALL FRAGMENT BOTH IP/OP $218.50 $162.00 $43.35 $218.40 $98.28 $98.28 $98.28 $98.28 $218.40 $218.40 $218.40 $45.52 $218.40 $218.40 $218.40 $218.40 $218.40 $45.52 $218.40 $87.36 $129.18 $218.40 $218.40 $218.40 $218.40 $163.88 $218.40 $218.40 $218.40 $109.20 $109.20 $172.97 $218.40 $174.72 $98.28 $43.35 N/A $126.73 $218.40 $218.40 $218.40 $45.51 $218.40 N/A N/A 427066 SUP HCPCS C1713 427066 - PLATE BN 1/3 TBLR 76MM NS AXSOS 6 HL LCK SS 3MM SCR SM FRAG BOTH IP/OP $218.50 $162.00 $43.35 $218.40 $98.28 $98.28 $98.28 $98.28 $218.40 $218.40 $218.40 $45.52 $218.40 $218.40 $218.40 $218.40 $218.40 $45.52 $218.40 $87.36 $129.18 $218.40 $218.40 $218.40 $218.40 $163.88 $218.40 $218.40 $218.40 $109.20 $109.20 $172.97 $218.40 $174.72 $98.28 $43.35 N/A $126.73 $218.40 $131.04 $218.40 $45.51 $218.40 N/A N/A 427067 SUP HCPCS C1713 427067 - PLATE BONE 89MM 7 HOLE ONE THIRD TUBULAR LOCKING AXSOS BOTH IP/OP $223.50 $165.00 $44.30 $223.20 $100.44 $100.44 $100.44 $100.44 $223.20 $223.20 $223.20 $46.52 $223.20 $223.20 $223.20 $223.20 $223.20 $46.52 $223.20 $89.28 $132.02 $223.20 $223.20 $223.20 $223.20 $167.63 $223.20 $223.20 $223.20 $111.60 $111.60 $176.77 $223.20 $178.56 $100.44 $44.30 N/A $129.63 $223.20 $133.92 $223.20 $46.51 $223.20 N/A N/A 427068 SUP HCPCS C1713 427068 - PLATE BN 1/3 TBLR 102MM NS AXSOS 8 HL LCK SS 3MM SCR SM FRAG BOTH IP/OP $237.00 $175.00 $47.00 $236.80 $106.56 $106.56 $106.56 $106.56 $236.80 $236.80 $236.80 $49.36 $236.80 $236.80 $236.80 $236.80 $236.80 $49.35 $236.80 $94.72 $140.07 $236.80 $236.80 $236.80 $236.80 $177.75 $236.80 $236.80 $236.80 $118.40 $118.40 $187.55 $236.80 $189.44 $106.56 $47.00 N/A $137.46 $236.80 $142.08 $236.80 $49.35 $236.80 N/A N/A 427070 SUP HCPCS C1713 427070 - PLATE BONE 3MM 128MM 10 HOLE ONE THIRD TUBULAR SMALL BOTH IP/OP $237.00 $175.00 $47.00 $236.80 $106.56 $106.56 $106.56 $106.56 $236.80 $236.80 $236.80 $49.36 $236.80 $236.80 $236.80 $236.80 $236.80 $49.35 $236.80 $94.72 $140.07 $236.80 $236.80 $236.80 $236.80 $177.75 $236.80 $236.80 $236.80 $118.40 $118.40 $187.55 $236.80 $189.44 $106.56 $47.00 N/A $137.46 $236.80 $142.08 $236.80 $49.35 $236.80 N/A N/A 427072 SUP HCPCS C1713 427072 - PLATE BONE 1/3 TUBE 154MM 12 HOLE LOCK AXSOS STAINLESS STEEL BOTH IP/OP $243.50 $180.00 $48.27 $243.20 $109.44 $109.44 $109.44 $109.44 $243.20 $243.20 $243.20 $50.69 $243.20 $243.20 $243.20 $243.20 $243.20 $50.69 $243.20 $97.28 $143.85 $243.20 $243.20 $243.20 $243.20 $182.63 $243.20 $243.20 $243.20 $121.60 $121.60 $192.61 $243.20 $194.56 $109.44 $48.27 N/A $141.23 $243.20 $145.92 $243.20 $50.68 $243.20 N/A N/A 427074 SUP HCPCS C1713 427074 - PLATE BONE 180MM 14 HOLE 1/3 TUBULAR LOCKING AXSOS STAINLESS BOTH IP/OP $247.50 $183.00 $49.06 $247.20 $111.24 $111.24 $111.24 $111.24 $247.20 $247.20 $247.20 $51.52 $247.20 $247.20 $247.20 $247.20 $247.20 $51.52 $247.20 $247.20 $146.22 $247.20 $247.20 $247.20 $247.20 $185.63 $247.20 $247.20 $247.20 $123.60 $123.60 $195.78 $247.20 $197.76 $111.24 $49.06 N/A $143.55 $247.20 $148.32 $247.20 $51.52 $247.20 N/A N/A 427102 SUP HCPCS C1713 427102 - PLATE BONE NARROW 43MM 2 HOLE LOCK COMPRESSION AXSOS BOTH IP/OP $246.00 $182.00 $48.75 $245.60 $110.52 $110.52 $110.52 $110.52 $245.60 $245.60 $245.60 $51.19 $245.60 $245.60 $245.60 $245.60 $245.60 $51.19 $245.60 $245.60 $145.27 $245.60 $245.60 $245.60 $245.60 $184.50 $245.60 $245.60 $245.60 $122.80 $122.80 $194.52 $245.60 $196.48 $110.52 $48.75 N/A $142.68 $245.60 $147.36 $245.60 $51.18 $245.60 N/A N/A 427103 SUP HCPCS C1713 427103 - PLATE BONE NARROW 61MM 3 HOLE LOCK COMPRESSION AXSOS BOTH IP/OP $246.00 $182.00 $48.75 $245.60 $110.52 $110.52 $110.52 $110.52 $245.60 $245.60 $245.60 $51.19 $245.60 $245.60 $245.60 $245.60 $245.60 $51.19 $245.60 $245.60 $145.27 $245.60 $245.60 $245.60 $245.60 $184.50 $245.60 $245.60 $245.60 $122.80 $122.80 $194.52 $245.60 $196.48 $110.52 $48.75 N/A $142.68 $245.60 $147.36 $245.60 $51.18 $245.60 N/A N/A 427104 SUP HCPCS C1713 427104 - PLATE BONE NARROW 79MM 4 HOLE WAISTED COMPRESSION LOCKING BOTH IP/OP $246.00 $182.00 $48.75 $245.60 $110.52 $110.52 $110.52 $110.52 $245.60 $245.60 $245.60 $51.19 $245.60 $245.60 $245.60 $245.60 $245.60 $51.19 $245.60 $245.60 $145.27 $245.60 $245.60 $245.60 $245.60 $184.50 $245.60 $245.60 $245.60 $122.80 $122.80 $194.52 $245.60 $196.48 $110.52 $48.75 N/A $142.68 $245.60 $147.36 $245.60 $51.18 $245.60 N/A N/A 427105 SUP HCPCS C1713 427105 - PLATE BONE NARROW 97MM 5 HOLE LOCK COMPRESSION AXSOS BOTH IP/OP $246.00 $182.00 $48.75 $245.60 $110.52 $110.52 $110.52 $110.52 $245.60 $245.60 $245.60 $51.19 $245.60 $245.60 $245.60 $245.60 $245.60 $51.19 $245.60 $245.60 $145.27 $245.60 $245.60 $245.60 $245.60 $184.50 $245.60 $245.60 $245.60 $122.80 $122.80 $194.52 $245.60 $196.48 $110.52 $48.75 N/A $142.68 $245.60 $147.36 $245.60 $51.18 $245.60 N/A N/A 427106 SUP HCPCS C1713 427106 - PLATE BONE NARROW 115MM 6 HOLE LOCK COMPRESSION AXSOS BOTH IP/OP $246.00 $182.00 $48.75 $245.60 $110.52 $110.52 $110.52 $110.52 $245.60 $245.60 $245.60 $51.19 $245.60 $245.60 $245.60 $245.60 $245.60 $51.19 $245.60 $98.24 $145.27 $245.60 $245.60 $245.60 $245.60 $184.50 $245.60 $245.60 $245.60 $122.80 $122.80 $194.52 $245.60 $196.48 $110.52 $48.75 N/A $142.68 $245.60 $147.36 $245.60 $51.18 $245.60 N/A N/A 427107 SUP HCPCS C1713 427107 - PLATE BONE NARROW 5MM 133MM 7 HOLE WAISTED COMPRESSION BOTH IP/OP $294.00 $218.00 $58.27 $293.60 $132.12 $132.12 $132.12 $132.12 $293.60 $293.60 $293.60 $61.19 $293.60 $293.60 $293.60 $293.60 $293.60 $61.19 $293.60 $117.44 $173.66 $293.60 $293.60 $293.60 $293.60 $220.50 $293.60 $293.60 $293.60 $146.80 $146.80 $232.53 $293.60 $234.88 $132.12 $58.27 N/A $170.52 $293.60 $176.16 $293.60 $61.19 $293.60 N/A N/A 427108 SUP HCPCS C1713 427108 - PLATE BN NAR 151MM NS AXSOS 8 HL LCK CMPR SS WST 5MM SCR BSC BOTH IP/OP $294.00 $218.00 $58.27 $293.60 $132.12 $132.12 $132.12 $132.12 $293.60 $293.60 $293.60 $61.19 $293.60 $293.60 $293.60 $293.60 $293.60 $61.19 $293.60 $117.44 $173.66 $293.60 $293.60 $293.60 $293.60 $220.50 $293.60 $293.60 $293.60 $146.80 $146.80 $232.53 $293.60 $234.88 $132.12 $58.27 N/A $170.52 $293.60 $176.16 $293.60 $61.19 $293.60 N/A N/A 427109 SUP HCPCS C1713 427109 - PLATE BONE NARROW 169MM 9 HOLE LOCKING COMPRESSION AXSOS BOTH IP/OP $294.00 $218.00 $58.27 $293.60 $132.12 $132.12 $132.12 $132.12 $293.60 $293.60 $293.60 $61.19 $293.60 $293.60 $293.60 $293.60 $293.60 $61.19 $293.60 $293.60 $173.66 $293.60 $293.60 $293.60 $293.60 $220.50 $293.60 $293.60 $293.60 $146.80 $146.80 $232.53 $293.60 $234.88 $132.12 $58.27 N/A $170.52 $293.60 $176.16 $293.60 $61.19 $293.60 N/A N/A 427110 SUP HCPCS C1713 427110 - PLATE BONE NARROW 187MM 10 HOLE WAISTED COMPRESSION LOCKING BOTH IP/OP $294.00 $218.00 $58.27 $293.60 $132.12 $132.12 $132.12 $132.12 $293.60 $293.60 $293.60 $61.19 $293.60 $293.60 $293.60 $293.60 $293.60 $61.19 $293.60 $293.60 $173.66 $293.60 $293.60 $293.60 $293.60 $220.50 $293.60 $293.60 $293.60 $146.80 $146.80 $232.53 $293.60 $234.88 $132.12 $58.27 N/A $170.52 $293.60 $293.60 $293.60 $61.19 $293.60 N/A N/A 427112 SUP HCPCS C1713 427112 - PLATE BONE NARROW 223MM 12 HOLE WAISTED COMPRESSION LOCKING BOTH IP/OP $351.50 $260.00 $69.70 $351.20 $158.04 $158.04 $158.04 $158.04 $351.20 $351.20 $351.20 $73.20 $351.20 $351.20 $351.20 $351.20 $351.20 $73.19 $351.20 $140.48 $207.73 $351.20 $351.20 $351.20 $351.20 $263.63 $351.20 $351.20 $351.20 $175.60 $175.60 $278.15 $351.20 $280.96 $158.04 $69.70 N/A $203.87 $351.20 $210.72 $351.20 $73.19 $351.20 N/A N/A 427114 SUP HCPCS C1713 427114 - PLATE BN NAR 259MM NS AXSOS 14 HL LCK CMPR SS WST 5MM SCR BOTH IP/OP $351.50 $260.00 $69.70 $351.20 $158.04 $158.04 $158.04 $158.04 $351.20 $351.20 $351.20 $73.20 $351.20 $351.20 $351.20 $351.20 $351.20 $73.19 $351.20 $140.48 $207.73 $351.20 $351.20 $351.20 $351.20 $263.63 $351.20 $351.20 $351.20 $175.60 $175.60 $278.15 $351.20 $280.96 $158.04 $69.70 N/A $203.87 $351.20 $210.72 $351.20 $73.19 $351.20 N/A N/A 427116 SUP HCPCS C1713 427116 - PLATE BONE NARROW 295MM 16 HOLE WAISTED COMPRESSION LOCKING BOTH IP/OP $378.50 $280.00 $75.10 $378.40 $170.28 $170.28 $170.28 $170.28 $378.40 $378.40 $378.40 $78.87 $378.40 $378.40 $378.40 $378.40 $378.40 $78.86 $378.40 $151.36 $223.82 $378.40 $378.40 $378.40 $378.40 $283.88 $378.40 $378.40 $378.40 $189.20 $189.20 $299.69 $378.40 $302.72 $170.28 $75.10 N/A $219.53 $378.40 $227.04 $378.40 $78.86 $378.40 N/A N/A 427118 SUP HCPCS C1713 427118 - PLATE BONE NARROW 331MM 18 HOLE WAISTED COMPRESSION LOCKING BOTH IP/OP $418.50 $310.00 $83.04 $418.40 $188.28 $188.28 $188.28 $188.28 $418.40 $418.40 $418.40 $87.21 $418.40 $418.40 $418.40 $418.40 $418.40 $87.20 $418.40 $418.40 $247.48 $418.40 $418.40 $418.40 $418.40 $313.88 $418.40 $418.40 $418.40 $209.20 $209.20 $331.37 $418.40 $334.72 $188.28 $83.04 N/A $242.73 $418.40 $418.40 $418.40 $87.19 $418.40 N/A N/A 427120 SUP HCPCS C1713 427120 - PLATE BONE NARROW 367MM 20 HOLE LOCK COMPRESSION AXSOS BOTH IP/OP $636.00 $471.00 $126.23 $636.00 $286.20 $286.20 $286.20 $286.20 $636.00 $636.00 $636.00 $132.56 $636.00 $636.00 $636.00 $636.00 $636.00 $132.55 $636.00 $254.40 $376.19 $636.00 $636.00 $636.00 $636.00 $477.00 $636.00 $636.00 $636.00 $318.00 $318.00 $503.71 $636.00 $508.80 $286.20 $126.23 N/A $368.88 $636.00 $381.60 $636.00 $132.54 $636.00 N/A N/A 427122 SUP HCPCS C1713 427122 - PLATE BONE NARROW 403MM 22 HOLE WAISTED COMPRESSION LOCKING BOTH IP/OP $636.00 $471.00 $126.23 $636.00 $286.20 $286.20 $286.20 $286.20 $636.00 $636.00 $636.00 $132.56 $636.00 $636.00 $636.00 $636.00 $636.00 $132.55 $636.00 $254.40 $376.19 $636.00 $636.00 $636.00 $636.00 $477.00 $636.00 $636.00 $636.00 $318.00 $318.00 $503.71 $636.00 $508.80 $286.20 $126.23 N/A $368.88 $636.00 $381.60 $636.00 $132.54 $636.00 N/A N/A 427136 SUP HCPCS C1713 427136 - PLATE BONE BROAD 119MM 6 HOLE LOCKING COMPRESSION AXSOS BOTH IP/OP $341.00 $252.00 $67.64 $340.80 $153.36 $153.36 $153.36 $153.36 $340.80 $340.80 $340.80 $71.03 $340.80 $340.80 $340.80 $340.80 $340.80 $71.03 $340.80 $136.32 $201.58 $340.80 $340.80 $340.80 $340.80 $255.75 $340.80 $340.80 $340.80 $170.40 $170.40 $269.91 $340.80 $272.64 $153.36 $67.64 N/A $197.78 $340.80 $204.48 $340.80 $71.02 $340.80 N/A N/A 427137 SUP HCPCS C1713 427137 - PLATE BONE BROAD 137MM 7 HOLE LOCK COMPRESSION AXSOS BOTH IP/OP $358.50 $265.00 $71.13 $358.40 $161.28 $161.28 $161.28 $161.28 $358.40 $358.40 $358.40 $74.70 $358.40 $358.40 $358.40 $358.40 $358.40 $74.69 $358.40 $358.40 $211.99 $358.40 $358.40 $358.40 $358.40 $268.88 $358.40 $358.40 $358.40 $179.20 $179.20 $283.85 $358.40 $286.72 $161.28 $71.13 N/A $207.93 $358.40 $215.04 $358.40 $74.69 $358.40 N/A N/A 427138 SUP HCPCS C1713 427138 - PLATE BN BRD 155MM NS AXSOS 8 HL LCK CMPR SS WST 5MM SCR BSC BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $152.32 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $228.48 $380.80 $79.36 $380.80 N/A N/A 427139 SUP HCPCS C1713 427139 - PLATE BONE BROAD 173MM 9 HOLE LOCK COMPRESSION AXSOS BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $152.32 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $380.80 $380.80 $79.36 $380.80 N/A N/A 427140 SUP HCPCS C1713 427140 - PLATE BN BRD 191MM NS AXSOS 10 HL LCK CMPR SS WST 5MM SCR BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $152.32 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $228.48 $380.80 $79.36 $380.80 N/A N/A 427141 SUP HCPCS C1713 427141 - PLATE BONE BROAD 209MM 11 HOLE LOCK COMPRESSION AXSOS BOTH IP/OP $417.00 $309.00 $82.72 $416.80 $187.56 $187.56 $187.56 $187.56 $416.80 $416.80 $416.80 $86.87 $416.80 $416.80 $416.80 $416.80 $416.80 $86.87 $416.80 $416.80 $246.54 $416.80 $416.80 $416.80 $416.80 $312.75 $416.80 $416.80 $416.80 $208.40 $208.40 $330.11 $416.80 $333.44 $187.56 $82.72 N/A $241.86 $416.80 $250.08 $416.80 $86.86 $416.80 N/A N/A 427142 SUP HCPCS C1713 427142 - PLATE BONE BROAD 227MM 12 HOLE LOCK COMPRESSION AXSOS BOTH IP/OP $417.00 $309.00 $82.72 $416.80 $187.56 $187.56 $187.56 $187.56 $416.80 $416.80 $416.80 $86.87 $416.80 $416.80 $416.80 $416.80 $416.80 $86.87 $416.80 $166.72 $246.54 $416.80 $416.80 $416.80 $416.80 $312.75 $416.80 $416.80 $416.80 $208.40 $208.40 $330.11 $416.80 $333.44 $187.56 $82.72 N/A $241.86 $416.80 $250.08 $416.80 $86.86 $416.80 N/A N/A 427143 SUP HCPCS C1713 427143 - PLATE BONE BROAD 245MM 13 HOLE LOCK COMPRESSION AXSOS BOTH IP/OP $417.00 $309.00 $82.72 $416.80 $187.56 $187.56 $187.56 $187.56 $416.80 $416.80 $416.80 $86.87 $416.80 $416.80 $416.80 $416.80 $416.80 $86.87 $416.80 $166.72 $246.54 $416.80 $416.80 $416.80 $416.80 $312.75 $416.80 $416.80 $416.80 $208.40 $208.40 $330.11 $416.80 $333.44 $187.56 $82.72 N/A $241.86 $416.80 $250.08 $416.80 $86.86 $416.80 N/A N/A 427144 SUP HCPCS C1713 427144 - PLATE BONE BROAD 263MM 14 HOLE LOCK COMPRESSION AXSOS BOTH IP/OP $417.00 $309.00 $82.72 $416.80 $187.56 $187.56 $187.56 $187.56 $416.80 $416.80 $416.80 $86.87 $416.80 $416.80 $416.80 $416.80 $416.80 $86.87 $416.80 $166.72 $246.54 $416.80 $416.80 $416.80 $416.80 $312.75 $416.80 $416.80 $416.80 $208.40 $208.40 $330.11 $416.80 $333.44 $187.56 $82.72 N/A $241.86 $416.80 $416.80 $416.80 $86.86 $416.80 N/A N/A 427146 SUP HCPCS C1713 427146 - PLATE BONE BROAD 299MM 16 HOLE LOCK COMPRESSION AXSOS BOTH IP/OP $446.50 $330.00 $88.60 $446.40 $200.88 $200.88 $200.88 $200.88 $446.40 $446.40 $446.40 $93.04 $446.40 $446.40 $446.40 $446.40 $446.40 $93.03 $446.40 $446.40 $264.05 $446.40 $446.40 $446.40 $446.40 $334.88 $446.40 $446.40 $446.40 $223.20 $223.20 $353.55 $446.40 $357.12 $200.88 $88.60 N/A $258.97 $446.40 $267.84 $446.40 $93.03 $446.40 N/A N/A 427148 SUP HCPCS C1713 427148 - PLATE BONE BROAD 335MM 18 HOLE LOCK COMPRESSION AXSOS BOTH IP/OP $446.50 $330.00 $88.60 $446.40 $200.88 $200.88 $200.88 $200.88 $446.40 $446.40 $446.40 $93.04 $446.40 $446.40 $446.40 $446.40 $446.40 $93.03 $446.40 $178.56 $264.05 $446.40 $446.40 $446.40 $446.40 $334.88 $446.40 $446.40 $446.40 $223.20 $223.20 $353.55 $446.40 $357.12 $200.88 $88.60 N/A $258.97 $446.40 $267.84 $446.40 $93.03 $446.40 N/A N/A 427150 SUP HCPCS C1713 427150 - PLATE BONE BROAD 371MM 20 HOLE LOCK COMPRESSION AXSOS BOTH IP/OP $598.00 $443.00 $118.61 $597.60 $268.92 $268.92 $268.92 $268.92 $597.60 $597.60 $597.60 $124.55 $597.60 $597.60 $597.60 $597.60 $597.60 $124.55 $597.60 $239.04 $353.48 $597.60 $597.60 $597.60 $597.60 $448.50 $597.60 $597.60 $597.60 $298.80 $298.80 $473.30 $597.60 $478.08 $268.92 $118.61 N/A $346.84 $597.60 $358.56 $597.60 $124.54 $597.60 N/A N/A 427152 SUP HCPCS C1713 427152 - PLATE BONE BROAD 407MM 22 HOLE WAISTED COMPRESSION LOCKING BOTH IP/OP $598.00 $443.00 $118.61 $597.60 $268.92 $268.92 $268.92 $268.92 $597.60 $597.60 $597.60 $124.55 $597.60 $597.60 $597.60 $597.60 $597.60 $124.55 $597.60 $239.04 $353.48 $597.60 $597.60 $597.60 $597.60 $448.50 $597.60 $597.60 $597.60 $298.80 $298.80 $473.30 $597.60 $478.08 $268.92 $118.61 N/A $346.84 $597.60 $597.60 $597.60 $124.54 $597.60 N/A N/A 429688 SUP HCPCS C1900 429688 - LEAD PACING 2 CURVE 5.3FR 88CM BIPOL 2 ELECTRODE 2 FIX IS-1 BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 430009 SUP HCPCS C1713 430009 - PLATE BONE 117MM 9 HOLE WAISTED COMPRESSION SPS STAINLESS BOTH IP/OP $204.00 $151.00 $40.49 $204.00 $91.80 $91.80 $91.80 $91.80 $204.00 $204.00 $204.00 $42.52 $204.00 $204.00 $204.00 $204.00 $204.00 $42.52 $204.00 $81.60 $120.67 $204.00 $204.00 $204.00 $204.00 $153.00 $204.00 $204.00 $204.00 $102.00 $102.00 $161.57 $204.00 $163.20 $91.80 $40.49 N/A $118.32 $204.00 $122.40 $204.00 $42.51 $204.00 N/A N/A 430012 SUP HCPCS C1713 430012 - PLATE BONE 156MM 12 HOLE WAISTED COMPRESSION STAINLESS STEEL BOTH IP/OP $287.50 $213.00 $57.01 $287.25 $129.26 $129.26 $129.26 $129.26 $287.25 $287.25 $287.25 $59.87 $287.25 $287.25 $287.25 $287.25 $287.25 $59.87 $287.25 $114.90 $169.91 $287.25 $287.25 $287.25 $287.25 $215.63 $287.25 $287.25 $287.25 $143.63 $143.63 $227.50 $287.25 $229.80 $129.26 $57.01 N/A $166.75 $287.25 $172.35 $287.25 $59.86 $287.25 N/A N/A 430014 SUP HCPCS C1713 430014 - PLATE BONE 182MM 14 HOLE WAISTED COMPRESSION SPS STAINLESS BOTH IP/OP $306.50 $227.00 $60.81 $306.40 $137.88 $137.88 $137.88 $137.88 $306.40 $306.40 $306.40 $63.86 $306.40 $306.40 $306.40 $306.40 $306.40 $63.86 $306.40 $122.56 $181.24 $306.40 $306.40 $306.40 $306.40 $229.88 $306.40 $306.40 $306.40 $153.20 $153.20 $242.67 $306.40 $245.12 $137.88 $60.81 N/A $177.77 $306.40 $306.40 $306.40 $63.85 $306.40 N/A N/A 430016 SUP HCPCS C1713 430016 - PLATE BONE 208MM 16 HOLE WAISTED COMPRESSION SPS STAINLESS BOTH IP/OP $510.00 $377.00 $101.14 $509.60 $229.32 $229.32 $229.32 $229.32 $509.60 $509.60 $509.60 $106.21 $509.60 $509.60 $509.60 $509.60 $509.60 $106.21 $509.60 $203.84 $301.43 $509.60 $509.60 $509.60 $509.60 $382.50 $509.60 $509.60 $509.60 $254.80 $254.80 $403.60 $509.60 $407.68 $229.32 $101.14 N/A $295.80 $509.60 $305.76 $509.60 $106.20 $509.60 N/A N/A 430018 SUP HCPCS C1713 430018 - PLATE BONE 234X10.3X3.2MM 18 HOLE COMPRESSION WAISTED BOTH IP/OP $612.00 $453.00 $121.47 $612.00 $275.40 $275.40 $275.40 $275.40 $612.00 $612.00 $612.00 $127.56 $612.00 $612.00 $612.00 $612.00 $612.00 $127.55 $612.00 $244.80 $362.00 $612.00 $612.00 $612.00 $612.00 $459.00 $612.00 $612.00 $612.00 $306.00 $306.00 $484.70 $612.00 $489.60 $275.40 $121.47 N/A $354.96 $612.00 $367.20 $612.00 $127.54 $612.00 N/A N/A 430055 SUP HCPCS C1713 430055 - PLATE BONE STANDARD 65MM 5 HOLE COMPRESSION SPS STAINLESS BOTH IP/OP $191.50 $142.00 $37.93 $191.13 $86.01 $86.01 $86.01 $86.01 $191.13 $191.13 $191.13 $39.84 $191.13 $191.13 $191.13 $191.13 $191.13 $39.83 $191.13 $191.13 $113.05 $191.13 $191.13 $191.13 $191.13 $143.63 $191.13 $191.13 $191.13 $95.57 $95.57 $151.37 $191.13 $152.90 $86.01 $37.93 N/A $111.07 $191.13 $191.13 $191.13 $39.83 $191.13 N/A N/A 430056 SUP HCPCS C1713 430056 - PLATE BONE STANDARD 78MM 6 HOLE COMPRESSION STAINLESS STEEL BOTH IP/OP $191.50 $142.00 $37.96 $191.25 $86.06 $86.06 $86.06 $86.06 $191.25 $191.25 $191.25 $39.86 $191.25 $191.25 $191.25 $191.25 $191.25 $39.86 $191.25 $76.50 $113.12 $191.25 $191.25 $191.25 $191.25 $143.63 $191.25 $191.25 $191.25 $95.63 $95.63 $151.47 $191.25 $153.00 $86.06 $37.96 N/A $111.07 $191.25 $191.25 $191.25 $39.86 $191.25 N/A N/A 430060 SUP HCPCS C1713 430060 - PLATE BONE STANDARD 130MM 10 HOLE COMPRESSION SPS STAINLESS BOTH IP/OP $191.50 $142.00 $37.96 $191.25 $86.06 $86.06 $86.06 $86.06 $191.25 $191.25 $191.25 $39.86 $191.25 $191.25 $191.25 $191.25 $191.25 $39.86 $191.25 $191.25 $113.12 $191.25 $191.25 $191.25 $191.25 $143.63 $191.25 $191.25 $191.25 $95.63 $95.63 $151.47 $191.25 $153.00 $86.06 $37.96 N/A $111.07 $191.25 $114.75 $191.25 $39.86 $191.25 N/A N/A 431748 SUP HCPCS C1785 431748 - PACEMAKER CRD EDORA PROMRI CLS HOME MNTR DR-T BOTH IP/OP "$17,750.00" "$13,135.00" "$3,522.93" "$17,750.00" "$7,987.50" "$7,987.50" "$7,987.50" "$7,987.50" "$17,750.00" "$17,750.00" "$17,750.00" "$3,699.54" "$17,750.00" "$17,750.00" "$17,750.00" "$17,750.00" "$17,750.00" "$3,699.30" "$17,750.00" "$17,750.00" "$8,750.75" "$17,750.00" "$17,750.00" "$17,750.00" "$17,750.00" "$13,312.50" "$17,750.00" "$17,750.00" "$17,750.00" "$8,875.00" "$8,875.00" "$14,058.00" "$17,750.00" "$14,200.00" "$7,987.50" "$3,522.93" N/A "$10,295.00" "$17,750.00" "$17,750.00" "$17,750.00" "$3,699.10" "$17,750.00" N/A N/A 431749 SUP HCPCS C1786 431749 - PACEMAKER CRD EDORA PROMRI CLS HOME MNTR SR-T BOTH IP/OP "$14,500.00" "$10,730.00" "$2,877.89" "$14,500.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,022.16" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.96" "$14,500.00" "$14,500.00" "$7,148.50" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$10,875.00" "$14,500.00" "$14,500.00" "$14,500.00" "$7,250.00" "$7,250.00" "$11,484.00" "$14,500.00" "$11,600.00" "$6,525.00" "$2,877.89" N/A "$8,410.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.80" "$14,500.00" N/A N/A 432203 SUP HCPCS C1713 432203 - PLATE BONE 46MM 3 HOLE RECONSTRUCTION SPS STAINLESS STEEL BOTH IP/OP $313.00 $232.00 $62.08 $312.80 $140.76 $140.76 $140.76 $140.76 $312.80 $312.80 $312.80 $65.20 $312.80 $312.80 $312.80 $312.80 $312.80 $65.19 $312.80 $125.12 $185.02 $312.80 $312.80 $312.80 $312.80 $234.75 $312.80 $312.80 $312.80 $156.40 $156.40 $247.74 $312.80 $250.24 $140.76 $62.08 N/A $181.54 $312.80 $187.68 $312.80 $65.19 $312.80 N/A N/A 432204 SUP HCPCS C1713 432204 - PLATE BONE 62MM 4 HOLE SHAFT RECONSTRUCTION STAINLESS STEEL BOTH IP/OP $358.50 $265.00 $71.13 $358.40 $161.28 $161.28 $161.28 $161.28 $358.40 $358.40 $358.40 $74.70 $358.40 $358.40 $358.40 $358.40 $358.40 $74.69 $358.40 $143.36 $211.99 $358.40 $358.40 $358.40 $358.40 $268.88 $358.40 $358.40 $358.40 $179.20 $179.20 $283.85 $358.40 $286.72 $161.28 $71.13 N/A $207.93 $358.40 $215.04 $358.40 $74.69 $358.40 N/A N/A 432205 SUP HCPCS C1713 432205 - PLATE BONE 78MM 5 HOLE RECONSTRUCTION SPS STAINLESS STEEL BOTH IP/OP $393.00 $291.00 $77.96 $392.80 $176.76 $176.76 $176.76 $176.76 $392.80 $392.80 $392.80 $81.87 $392.80 $392.80 $392.80 $392.80 $392.80 $81.86 $392.80 $157.12 $232.34 $392.80 $392.80 $392.80 $392.80 $294.75 $392.80 $392.80 $392.80 $196.40 $196.40 $311.10 $392.80 $314.24 $176.76 $77.96 N/A $227.94 $392.80 $235.68 $392.80 $81.86 $392.80 N/A N/A 432206 SUP HCPCS C1713 432206 - PLATE BONE 94MM 6 HOLE SHAFT RECONSTRUCTION STAINLESS STEEL BOTH IP/OP $419.50 $310.00 $83.20 $419.20 $188.64 $188.64 $188.64 $188.64 $419.20 $419.20 $419.20 $87.37 $419.20 $419.20 $419.20 $419.20 $419.20 $87.37 $419.20 $167.68 $247.96 $419.20 $419.20 $419.20 $419.20 $314.63 $419.20 $419.20 $419.20 $209.60 $209.60 $332.01 $419.20 $335.36 $188.64 $83.20 N/A $243.31 $419.20 $251.52 $419.20 $87.36 $419.20 N/A N/A 432207 SUP HCPCS C1713 432207 - PLATE BONE 110MM 7 HOLE RECONSTRUCTION SPS STAINLESS STEEL BOTH IP/OP $436.00 $323.00 $86.54 $436.00 $196.20 $196.20 $196.20 $196.20 $436.00 $436.00 $436.00 $90.87 $436.00 $436.00 $436.00 $436.00 $436.00 $90.87 $436.00 $174.40 $257.89 $436.00 $436.00 $436.00 $436.00 $327.00 $436.00 $436.00 $436.00 $218.00 $218.00 $345.31 $436.00 $348.80 $196.20 $86.54 N/A $252.88 $436.00 $436.00 $436.00 $90.86 $436.00 N/A N/A 432208 SUP HCPCS C1713 432208 - PLATE BONE 126MM 8 HOLE SHAFT RECONSTRUCTION STAINLESS STEEL BOTH IP/OP $454.50 $336.00 $90.19 $454.40 $204.48 $204.48 $204.48 $204.48 $454.40 $454.40 $454.40 $94.71 $454.40 $454.40 $454.40 $454.40 $454.40 $94.70 $454.40 $181.76 $268.78 $454.40 $454.40 $454.40 $454.40 $340.88 $454.40 $454.40 $454.40 $227.20 $227.20 $359.88 $454.40 $363.52 $204.48 $90.19 N/A $263.61 $454.40 $272.64 $454.40 $94.70 $454.40 N/A N/A 432209 SUP HCPCS C1713 432209 - PLATE BONE 142MM 9 HOLE RECONSTRUCTION SPS STAINLESS STEEL BOTH IP/OP $486.00 $360.00 $96.38 $485.60 $218.52 $218.52 $218.52 $218.52 $485.60 $485.60 $485.60 $101.21 $485.60 $485.60 $485.60 $485.60 $485.60 $101.20 $485.60 $485.60 $287.23 $485.60 $485.60 $485.60 $485.60 $364.50 $485.60 $485.60 $485.60 $242.80 $242.80 $384.60 $485.60 $388.48 $218.52 $96.38 N/A $281.88 $485.60 $291.36 $485.60 $485.60 $485.60 N/A N/A 432210 SUP HCPCS C1713 432210 - PLATE BONE 158MM 10 HOLE RECONSTRUCTION STAINLESS STEEL 4.5 BOTH IP/OP $503.50 $373.00 $99.87 $503.20 $226.44 $226.44 $226.44 $226.44 $503.20 $503.20 $503.20 $104.88 $503.20 $503.20 $503.20 $503.20 $503.20 $104.87 $503.20 $201.28 $297.64 $503.20 $503.20 $503.20 $503.20 $377.63 $503.20 $503.20 $503.20 $251.60 $251.60 $398.53 $503.20 $402.56 $226.44 $99.87 N/A $292.03 $503.20 $301.92 $503.20 $503.20 $503.20 N/A N/A 432211 SUP HCPCS C1713 432211 - PLATE BONE 174MM 11 HOLE RECONSTRUCTION SPS STAINLESS STEEL BOTH IP/OP $529.50 $392.00 $105.09 $529.50 $238.28 $238.28 $238.28 $238.28 $529.50 $529.50 $529.50 $110.36 $529.50 $529.50 $529.50 $529.50 $529.50 $110.35 $529.50 $211.80 $313.20 $529.50 $529.50 $529.50 $529.50 $397.13 $529.50 $529.50 $529.50 $264.75 $264.75 $419.36 $529.50 $423.60 $238.28 $105.09 N/A $307.11 $529.50 $529.50 $529.50 $110.35 $529.50 N/A N/A 432212 SUP HCPCS C1713 432212 - PLATE BONE 190MM 12 HOLE RECONSTRUCTION STAINLESS STEEL 4.5 BOTH IP/OP $566.50 $419.00 $112.42 $566.40 $254.88 $254.88 $254.88 $254.88 $566.40 $566.40 $566.40 $118.05 $566.40 $566.40 $566.40 $566.40 $566.40 $118.04 $566.40 $226.56 $335.03 $566.40 $566.40 $566.40 $566.40 $424.88 $566.40 $566.40 $566.40 $283.20 $283.20 $448.59 $566.40 $453.12 $254.88 $112.42 N/A $328.57 $566.40 $339.84 $566.40 $118.04 $566.40 N/A N/A 432213 SUP HCPCS C1713 432213 - PLATE BONE 206MM 13 HOLE RECONSTRUCTION SPS STAINLESS STEEL BOTH IP/OP $587.50 $435.00 $116.54 $587.20 $264.24 $264.24 $264.24 $264.24 $587.20 $587.20 $587.20 $122.39 $587.20 $587.20 $587.20 $587.20 $587.20 $122.38 $587.20 $234.88 $347.33 $587.20 $587.20 $587.20 $587.20 $440.63 $587.20 $587.20 $587.20 $293.60 $293.60 $465.06 $587.20 $469.76 $264.24 $116.54 N/A $340.75 $587.20 $352.32 $587.20 $122.37 $587.20 N/A N/A 432214 SUP HCPCS C1713 432214 - PLATE BONE 222MM 14 HOLE SHAFT RECONSTRUCTION STAINLESS BOTH IP/OP $591.50 $438.00 $117.34 $591.20 $266.04 $266.04 $266.04 $266.04 $591.20 $591.20 $591.20 $123.22 $591.20 $591.20 $591.20 $591.20 $591.20 $123.21 $591.20 $236.48 $349.69 $591.20 $591.20 $591.20 $591.20 $443.63 $591.20 $591.20 $591.20 $295.60 $295.60 $468.23 $591.20 $472.96 $266.04 $117.34 N/A $343.07 $591.20 $354.72 $591.20 $123.21 $591.20 N/A N/A 432215 SUP HCPCS C1713 432215 - PLATE BONE 238MM 15 HOLE RECONSTRUCTION SPS STAINLESS STEEL BOTH IP/OP $592.00 $438.00 $117.50 $592.00 $266.40 $266.40 $266.40 $266.40 $592.00 $592.00 $592.00 $123.39 $592.00 $592.00 $592.00 $592.00 $592.00 $123.38 $592.00 $236.80 $350.17 $592.00 $592.00 $592.00 $592.00 $444.00 $592.00 $592.00 $592.00 $296.00 $296.00 $468.86 $592.00 $473.60 $266.40 $117.50 N/A $343.36 $592.00 $355.20 $592.00 $123.37 $592.00 N/A N/A 432216 SUP HCPCS C1713 432216 - PLATE BONE 254MM 16 HOLE SHAFT RECONSTRUCTION STAINLESS BOTH IP/OP $626.00 $463.00 $124.17 $625.60 $281.52 $281.52 $281.52 $281.52 $625.60 $625.60 $625.60 $130.39 $625.60 $625.60 $625.60 $625.60 $625.60 $130.38 $625.60 $250.24 $370.04 $625.60 $625.60 $625.60 $625.60 $469.50 $625.60 $625.60 $625.60 $312.80 $312.80 $495.48 $625.60 $500.48 $281.52 $124.17 N/A $363.08 $625.60 $625.60 $625.60 $625.60 $625.60 N/A N/A 433165 SUP Custom 27803010 433165 - MOLD CMNT UNV 65MM STRL STG1 SPCR CRCTE SACRIFICE AGC STY BOTH IP/OP "$2,330.00" "$1,724.00" $414.74 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $414.74 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" $932.00 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" "$2,330.00" N/A "$1,351.40" "$2,330.00" "$1,398.00" "$2,330.00" "$2,330.00" "$2,330.00" N/A N/A 436003 SUP HCPCS C1713 436003 - PLATE BONE 3 HOLE LEFT DISTAL VOLAR RADIAL BOTH IP/OP "$1,174.50" $869.00 $233.09 "$1,174.40" $528.48 $528.48 $528.48 $528.48 "$1,174.40" "$1,174.40" "$1,174.40" $244.77 "$1,174.40" "$1,174.40" "$1,174.40" "$1,174.40" "$1,174.40" $244.76 "$1,174.40" $469.76 $694.66 "$1,174.40" "$1,174.40" "$1,174.40" "$1,174.40" $880.88 "$1,174.40" "$1,174.40" "$1,174.40" $587.20 $587.20 $930.12 "$1,174.40" $939.52 $528.48 $233.09 N/A $681.21 "$1,174.40" $704.64 "$1,174.40" "$1,174.40" "$1,174.40" N/A N/A 436004 SUP HCPCS C1713 436004 - PLATE BONE 4 HOLE LEFT DISTAL VOLAR RAD BOTH IP/OP "$1,174.50" $869.00 $233.09 "$1,174.40" $528.48 $528.48 $528.48 $528.48 "$1,174.40" "$1,174.40" "$1,174.40" $244.77 "$1,174.40" "$1,174.40" "$1,174.40" "$1,174.40" "$1,174.40" $244.76 "$1,174.40" $469.76 $694.66 "$1,174.40" "$1,174.40" "$1,174.40" "$1,174.40" $880.88 "$1,174.40" "$1,174.40" "$1,174.40" $587.20 $587.20 $930.12 "$1,174.40" $939.52 $528.48 $233.09 N/A $681.21 "$1,174.40" $704.64 "$1,174.40" $244.74 "$1,174.40" N/A N/A 436006 SUP HCPCS C1713 436006 - PLATE BONE 6 HOLE LEFT DISTAL VOLAR RAD BOTH IP/OP "$1,031.50" $763.00 $204.68 "$1,031.25" $464.06 $464.06 $464.06 $464.06 "$1,031.25" "$1,031.25" "$1,031.25" $214.94 "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" $214.92 "$1,031.25" "$1,031.25" $609.98 "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" $773.63 "$1,031.25" "$1,031.25" "$1,031.25" $515.63 $515.63 $816.75 "$1,031.25" $825.00 $464.06 $204.68 N/A $598.27 "$1,031.25" $618.75 "$1,031.25" $214.91 "$1,031.25" N/A N/A 436008 SUP HCPCS C1713 436008 - DISTAL VOLAR RADIUS 8 HOLE LT BOTH IP/OP "$1,031.50" $763.00 $204.68 "$1,031.25" $464.06 $464.06 $464.06 $464.06 "$1,031.25" "$1,031.25" "$1,031.25" $214.94 "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" $214.92 "$1,031.25" $412.50 $609.98 "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" $773.63 "$1,031.25" "$1,031.25" "$1,031.25" $515.63 $515.63 $816.75 "$1,031.25" $825.00 $464.06 $204.68 N/A $598.27 "$1,031.25" $618.75 "$1,031.25" "$1,031.25" "$1,031.25" N/A N/A 436010 SUP HCPCS C1713 436010 - PLATE BONE 10 HOLE LEFT DISTAL VOLAR RADIAL BOTH IP/OP "$1,031.50" $763.00 $204.68 "$1,031.25" $464.06 $464.06 $464.06 $464.06 "$1,031.25" "$1,031.25" "$1,031.25" $214.94 "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" $214.92 "$1,031.25" $412.50 $609.98 "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" $773.63 "$1,031.25" "$1,031.25" "$1,031.25" $515.63 $515.63 $816.75 "$1,031.25" $825.00 $464.06 $204.68 N/A $598.27 "$1,031.25" $618.75 "$1,031.25" $214.91 "$1,031.25" N/A N/A 436023 SUP HCPCS C1713 436023 - PLATE BONE 3 HOLE RIGHT DISTAL VOLAR RAD BOTH IP/OP "$1,174.50" $869.00 $233.09 "$1,174.40" $528.48 $528.48 $528.48 $528.48 "$1,174.40" "$1,174.40" "$1,174.40" $244.77 "$1,174.40" "$1,174.40" "$1,174.40" "$1,174.40" "$1,174.40" $244.76 "$1,174.40" "$1,174.40" $694.66 "$1,174.40" "$1,174.40" "$1,174.40" "$1,174.40" $880.88 "$1,174.40" "$1,174.40" "$1,174.40" $587.20 $587.20 $930.12 "$1,174.40" $939.52 $528.48 $233.09 N/A $681.21 "$1,174.40" $704.64 "$1,174.40" "$1,174.40" "$1,174.40" N/A N/A 436024 SUP HCPCS C1713 436024 - PLATE BONE 4 HOLE RIGHT DISTAL VOLAR RAD BOTH IP/OP "$1,174.50" $869.00 $233.09 "$1,174.40" $528.48 $528.48 $528.48 $528.48 "$1,174.40" "$1,174.40" "$1,174.40" $244.77 "$1,174.40" "$1,174.40" "$1,174.40" "$1,174.40" "$1,174.40" $244.76 "$1,174.40" "$1,174.40" $694.66 "$1,174.40" "$1,174.40" "$1,174.40" "$1,174.40" $880.88 "$1,174.40" "$1,174.40" "$1,174.40" $587.20 $587.20 $930.12 "$1,174.40" $939.52 $528.48 $233.09 N/A $681.21 "$1,174.40" $704.64 "$1,174.40" $244.74 "$1,174.40" N/A N/A 436026 SUP HCPCS C1713 436026 - PLATE BONE 6 HOLE RIGHT DISTAL VOLAR RAD BOTH IP/OP "$1,031.50" $763.00 $204.68 "$1,031.25" $464.06 $464.06 $464.06 $464.06 "$1,031.25" "$1,031.25" "$1,031.25" $214.94 "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" $214.92 "$1,031.25" $412.50 $609.98 "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" $773.63 "$1,031.25" "$1,031.25" "$1,031.25" $515.63 $515.63 $816.75 "$1,031.25" $825.00 $464.06 $204.68 N/A $598.27 "$1,031.25" $618.75 "$1,031.25" $214.91 "$1,031.25" N/A N/A 436028 SUP HCPCS C1713 436028 - PLATE BONE 8 HOLE RIGHT DISTAL VOLAR RADIAL BOTH IP/OP "$1,031.50" $763.00 $204.68 "$1,031.25" $464.06 $464.06 $464.06 $464.06 "$1,031.25" "$1,031.25" "$1,031.25" $214.94 "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" $214.92 "$1,031.25" $412.50 $609.98 "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" $773.63 "$1,031.25" "$1,031.25" "$1,031.25" $515.63 $515.63 $816.75 "$1,031.25" $825.00 $464.06 $204.68 N/A $598.27 "$1,031.25" $618.75 "$1,031.25" "$1,031.25" "$1,031.25" N/A N/A 436030 SUP HCPCS C1713 436030 - PLATE BONE 10 HOLE RIGHT DISTAL VOLAR RADIAL BOTH IP/OP "$1,031.50" $763.00 $204.68 "$1,031.25" $464.06 $464.06 $464.06 $464.06 "$1,031.25" "$1,031.25" "$1,031.25" $214.94 "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" $214.92 "$1,031.25" $412.50 $609.98 "$1,031.25" "$1,031.25" "$1,031.25" "$1,031.25" $773.63 "$1,031.25" "$1,031.25" "$1,031.25" $515.63 $515.63 $816.75 "$1,031.25" $825.00 $464.06 $204.68 N/A $598.27 "$1,031.25" $618.75 "$1,031.25" $214.91 "$1,031.25" N/A N/A 436103 SUP HCPCS C1713 436103 - PLATE BONE 86MM 5 HOLE STAINLESS STEEL LEFT PROXIMAL LATERAL BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" "$1,980.00" "$1,980.00" N/A N/A 436105 SUP HCPCS C1713 436105 - PLATE BONE 5 HOLE HUMERUS LEFT PROXIMAL LATERAL BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" N/A N/A 436108 SUP HCPCS C1713 436108 - PLATE BONE 150MM 8 HOLE STAINLESS STEEL LEFT PROXIMAL BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" "$1,980.00" "$1,980.00" N/A N/A 436123 SUP HCPCS C1713 436123 - PLATE BONE 86MM 5 HOLE STAINLESS STEEL RIGHT PROXIMAL BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 436125 SUP HCPCS C1713 436125 - PLATE BONE 112MM 5 HOLE STAINLESS STEEL RIGHT PROXIMAL BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 436128 SUP HCPCS C1713 436128 - PLATE BONE 4MM 112MM 8 HOLE LOCKING PERIARTICULAR RIGHT BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" N/A N/A 436204 SUP HCPCS C1713 436204 - PLATE BONE 94MM 4 SHAFT HOLE AXSOS STAINLESS STEEL TIBIA BOTH IP/OP "$1,814.00" "$1,342.00" $359.96 "$1,813.63" $816.13 $816.13 $816.13 $816.13 "$1,813.63" "$1,813.63" "$1,813.63" $378.01 "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" $377.98 "$1,813.63" $725.45 "$1,072.76" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,360.50" "$1,813.63" "$1,813.63" "$1,813.63" $906.82 $906.82 "$1,436.39" "$1,813.63" "$1,450.90" $816.13 $359.96 N/A "$1,052.12" "$1,813.63" "$1,088.18" "$1,813.63" $377.96 "$1,813.63" N/A N/A 436206 SUP HCPCS C1713 436206 - PLATE BONE 6 HOLE TIBIA LEFT DISTAL MEDIAL BOTH IP/OP "$1,814.00" "$1,342.00" $359.96 "$1,813.63" $816.13 $816.13 $816.13 $816.13 "$1,813.63" "$1,813.63" "$1,813.63" $378.01 "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" $377.98 "$1,813.63" $725.45 "$1,072.76" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,360.50" "$1,813.63" "$1,813.63" "$1,813.63" $906.82 $906.82 "$1,436.39" "$1,813.63" "$1,450.90" $816.13 $359.96 N/A "$1,052.12" "$1,813.63" "$1,088.18" "$1,813.63" $377.96 "$1,813.63" N/A N/A 436208 SUP HCPCS C1713 436208 - PLATE BONE 8 HOLE TIBIA LEFT DISTAL MEDIAL BOTH IP/OP "$1,814.00" "$1,342.00" $359.96 "$1,813.63" $816.13 $816.13 $816.13 $816.13 "$1,813.63" "$1,813.63" "$1,813.63" $378.01 "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" $377.98 "$1,813.63" $725.45 "$1,072.76" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,360.50" "$1,813.63" "$1,813.63" "$1,813.63" $906.82 $906.82 "$1,436.39" "$1,813.63" "$1,450.90" $816.13 $359.96 N/A "$1,052.12" "$1,813.63" "$1,088.18" "$1,813.63" $377.96 "$1,813.63" N/A N/A 436210 SUP HCPCS C1713 436210 - PLATE BONE 172MM 10 HOLE STAINLESS STEEL TIBIA LEFT DISTAL BOTH IP/OP "$1,814.00" "$1,342.00" $359.96 "$1,813.63" $816.13 $816.13 $816.13 $816.13 "$1,813.63" "$1,813.63" "$1,813.63" $378.01 "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" $377.98 "$1,813.63" $725.45 "$1,072.76" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,360.50" "$1,813.63" "$1,813.63" "$1,813.63" $906.82 $906.82 "$1,436.39" "$1,813.63" "$1,450.90" $816.13 $359.96 N/A "$1,052.12" "$1,813.63" "$1,088.18" "$1,813.63" $377.96 "$1,813.63" N/A N/A 436212 SUP HCPCS C1713 436212 - PLATE BONE 198MM 12 HOLE STAINLESS STEEL TIBIA LEFT DISTAL BOTH IP/OP "$2,144.00" "$1,587.00" $425.46 "$2,143.63" $964.63 $964.63 $964.63 $964.63 "$2,143.63" "$2,143.63" "$2,143.63" $446.79 "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" $446.76 "$2,143.63" "$2,143.63" "$1,267.96" "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" "$1,608.00" "$2,143.63" "$2,143.63" "$2,143.63" "$1,071.82" "$1,071.82" "$1,697.75" "$2,143.63" "$1,714.90" $964.63 $425.46 N/A "$1,243.52" "$2,143.63" "$1,286.18" "$2,143.63" $446.73 "$2,143.63" N/A N/A 436214 SUP HCPCS C1713 436214 - PLATE BONE 4MM 3.5MM 224MM 14 SHAFT HOLE LOCKING STAINLESS BOTH IP/OP "$2,144.00" "$1,587.00" $425.46 "$2,143.63" $964.63 $964.63 $964.63 $964.63 "$2,143.63" "$2,143.63" "$2,143.63" $446.79 "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" $446.76 "$2,143.63" "$2,143.63" "$1,267.96" "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" "$1,608.00" "$2,143.63" "$2,143.63" "$2,143.63" "$1,071.82" "$1,071.82" "$1,697.75" "$2,143.63" "$1,714.90" $964.63 $425.46 N/A "$1,243.52" "$2,143.63" "$1,286.18" "$2,143.63" $446.73 "$2,143.63" N/A N/A 436216 SUP HCPCS C1713 436216 - PLATE BONE 250MM 16 HOLE STAINLESS STEEL TIBIA LEFT DISTAL BOTH IP/OP "$2,144.00" "$1,587.00" $425.46 "$2,143.63" $964.63 $964.63 $964.63 $964.63 "$2,143.63" "$2,143.63" "$2,143.63" $446.79 "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" $446.76 "$2,143.63" $857.45 "$1,267.96" "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" "$1,608.00" "$2,143.63" "$2,143.63" "$2,143.63" "$1,071.82" "$1,071.82" "$1,697.75" "$2,143.63" "$1,714.90" $964.63 $425.46 N/A "$1,243.52" "$2,143.63" "$1,286.18" "$2,143.63" $446.73 "$2,143.63" N/A N/A 436224 SUP HCPCS C1713 436224 - PLATE BONE 4 HOLE TIBIA RIGHT DISTAL MEDIAL BOTH IP/OP "$1,814.00" "$1,342.00" $359.96 "$1,813.63" $816.13 $816.13 $816.13 $816.13 "$1,813.63" "$1,813.63" "$1,813.63" $378.01 "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" $377.98 "$1,813.63" $725.45 "$1,072.76" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,360.50" "$1,813.63" "$1,813.63" "$1,813.63" $906.82 $906.82 "$1,436.39" "$1,813.63" "$1,450.90" $816.13 $359.96 N/A "$1,052.12" "$1,813.63" "$1,088.18" "$1,813.63" $377.96 "$1,813.63" N/A N/A 436226 SUP HCPCS C1713 436226 - PLATE BONE 120MM 6 SHAFT HOLE AXSOS STAINLESS STEEL TIBIA BOTH IP/OP "$1,814.00" "$1,342.00" $359.96 "$1,813.63" $816.13 $816.13 $816.13 $816.13 "$1,813.63" "$1,813.63" "$1,813.63" $378.01 "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" $377.98 "$1,813.63" $725.45 "$1,072.76" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,360.50" "$1,813.63" "$1,813.63" "$1,813.63" $906.82 $906.82 "$1,436.39" "$1,813.63" "$1,450.90" $816.13 $359.96 N/A "$1,052.12" "$1,813.63" "$1,088.18" "$1,813.63" "$1,813.63" "$1,813.63" N/A N/A 436228 SUP HCPCS C1713 436228 - PLATE BONE 8 HOLE TIBIA RIGHT DISTAL MEDIAL BOTH IP/OP "$1,814.00" "$1,342.00" $359.96 "$1,813.63" $816.13 $816.13 $816.13 $816.13 "$1,813.63" "$1,813.63" "$1,813.63" $378.01 "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" $377.98 "$1,813.63" "$1,813.63" "$1,072.76" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,360.50" "$1,813.63" "$1,813.63" "$1,813.63" $906.82 $906.82 "$1,436.39" "$1,813.63" "$1,450.90" $816.13 $359.96 N/A "$1,052.12" "$1,813.63" "$1,088.18" "$1,813.63" "$1,813.63" "$1,813.63" N/A N/A 436230 SUP HCPCS C1713 436230 - PLATE BONE 172MM 10 HOLE STAINLESS STEEL TIBIA RIGHT DISTAL BOTH IP/OP "$1,814.00" "$1,342.00" $359.96 "$1,813.63" $816.13 $816.13 $816.13 $816.13 "$1,813.63" "$1,813.63" "$1,813.63" $378.01 "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" $377.98 "$1,813.63" "$1,813.63" "$1,072.76" "$1,813.63" "$1,813.63" "$1,813.63" "$1,813.63" "$1,360.50" "$1,813.63" "$1,813.63" "$1,813.63" $906.82 $906.82 "$1,436.39" "$1,813.63" "$1,450.90" $816.13 $359.96 N/A "$1,052.12" "$1,813.63" "$1,088.18" "$1,813.63" $377.96 "$1,813.63" N/A N/A 436232 SUP HCPCS C1713 436232 - PLATE BONE 4MM 3.5MM 198MM 12 SHAFT HOLE LOCKING STAINLESS BOTH IP/OP "$2,144.00" "$1,587.00" $425.46 "$2,143.63" $964.63 $964.63 $964.63 $964.63 "$2,143.63" "$2,143.63" "$2,143.63" $446.79 "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" $446.76 "$2,143.63" $857.45 "$1,267.96" "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" "$1,608.00" "$2,143.63" "$2,143.63" "$2,143.63" "$1,071.82" "$1,071.82" "$1,697.75" "$2,143.63" "$1,714.90" $964.63 $425.46 N/A "$1,243.52" "$2,143.63" "$2,143.63" "$2,143.63" $446.73 "$2,143.63" N/A N/A 436234 SUP HCPCS C1713 436234 - PLATE BONE 224MM 14 HOLE SHAFT LOCKING IMPLANT AXSOS BOTH IP/OP "$2,144.00" "$1,587.00" $425.46 "$2,143.63" $964.63 $964.63 $964.63 $964.63 "$2,143.63" "$2,143.63" "$2,143.63" $446.79 "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" $446.76 "$2,143.63" $857.45 "$1,267.96" "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" "$1,608.00" "$2,143.63" "$2,143.63" "$2,143.63" "$1,071.82" "$1,071.82" "$1,697.75" "$2,143.63" "$1,714.90" $964.63 $425.46 N/A "$1,243.52" "$2,143.63" "$1,286.18" "$2,143.63" $446.73 "$2,143.63" N/A N/A 436236 SUP HCPCS C1713 436236 - PLATE BONE 250MM 16 HOLE SHAFT LOCKING IMPLANT AXSOS BOTH IP/OP "$2,144.00" "$1,587.00" $425.46 "$2,143.63" $964.63 $964.63 $964.63 $964.63 "$2,143.63" "$2,143.63" "$2,143.63" $446.79 "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" $446.76 "$2,143.63" $857.45 "$1,267.96" "$2,143.63" "$2,143.63" "$2,143.63" "$2,143.63" "$1,608.00" "$2,143.63" "$2,143.63" "$2,143.63" "$1,071.82" "$1,071.82" "$1,697.75" "$2,143.63" "$1,714.90" $964.63 $425.46 N/A "$1,243.52" "$2,143.63" "$1,286.18" "$2,143.63" $446.73 "$2,143.63" N/A N/A 436302 SUP HCPCS C1713 436302 - PLATE BONE 2 HOLE TIBIA LEFT PROXIMAL LATERAL BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" "$1,731.13" "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" $360.77 "$1,731.13" N/A N/A 436304 SUP HCPCS C1713 436304 - PLATE BONE 4 HOLE TIBIA LEFT PROXIMAL LATERAL BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" "$1,731.13" "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" $360.77 "$1,731.13" N/A N/A 436306 SUP HCPCS C1713 436306 - PLATE BONE 6 HOLE TIBIA LEFT PROXIMAL LATERAL BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" "$1,731.13" "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" $360.77 "$1,731.13" N/A N/A 436308 SUP HCPCS C1713 436308 - PLATE BONE 8 HOLE TIBIA LEFT PROXIMAL LATERAL BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" "$1,731.13" "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" $360.77 "$1,731.13" N/A N/A 436310 SUP HCPCS C1713 436310 - PLATE BONE 10 HOLE TIBIA LEFT PROXIMAL LATERAL BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" "$1,731.13" "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" $360.77 "$1,731.13" N/A N/A 436312 SUP HCPCS C1713 436312 - PLATE BONE 12 HOLE TIBIA LEFT PROXIMAL LATERAL BOTH IP/OP "$1,874.50" "$1,387.00" $371.97 "$1,874.13" $843.36 $843.36 $843.36 $843.36 "$1,874.13" "$1,874.13" "$1,874.13" $390.62 "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" $390.59 "$1,874.13" "$1,874.13" "$1,108.55" "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" "$1,405.88" "$1,874.13" "$1,874.13" "$1,874.13" $937.07 $937.07 "$1,484.31" "$1,874.13" "$1,499.30" $843.36 $371.97 N/A "$1,087.21" "$1,874.13" "$1,124.48" "$1,874.13" $390.57 "$1,874.13" N/A N/A 436314 SUP HCPCS C1713 436314 - PLATE BONE 14 HOLE TIBIA LEFT PROXIMAL LATERAL BOTH IP/OP "$2,061.50" "$1,526.00" $409.08 "$2,061.13" $927.51 $927.51 $927.51 $927.51 "$2,061.13" "$2,061.13" "$2,061.13" $429.59 "$2,061.13" "$2,061.13" "$2,061.13" "$2,061.13" "$2,061.13" $429.56 "$2,061.13" "$2,061.13" "$1,219.16" "$2,061.13" "$2,061.13" "$2,061.13" "$2,061.13" "$1,546.13" "$2,061.13" "$2,061.13" "$2,061.13" "$1,030.57" "$1,030.57" "$1,632.41" "$2,061.13" "$1,648.90" $927.51 $409.08 N/A "$1,195.67" "$2,061.13" "$1,236.68" "$2,061.13" $429.54 "$2,061.13" N/A N/A 436322 SUP HCPCS C1713 436322 - PLATE BONE 2 HOLE TIBIA RIGHT PROXIMAL LATERAL BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" "$1,731.13" "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" $360.77 "$1,731.13" N/A N/A 436324 SUP HCPCS C1713 436324 - PLATE BONE 4 HOLE TIBIA RIGHT PROXIMAL LATERAL BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" "$1,731.13" "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,731.13" "$1,731.13" $360.77 "$1,731.13" N/A N/A 436326 SUP HCPCS C1713 436326 - PLATE BONE 6 HOLE TIBIA RIGHT PROXIMAL LATERAL BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" "$1,731.13" "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" $360.77 "$1,731.13" N/A N/A 436328 SUP HCPCS C1713 436328 - PLATE BONE 8 HOLE TIBIA RIGHT PROXIMAL LATERAL BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" "$1,731.13" "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" "$1,731.13" "$1,731.13" N/A N/A 436330 SUP HCPCS C1713 436330 - PLATE BONE 10 HOLE TIBIA RIGHT PROXIMAL LATERAL BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" "$1,731.13" "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" "$1,731.13" "$1,731.13" N/A N/A 436332 SUP HCPCS C1713 436332 - PLATE BONE 12 HOLE TIBIA RIGHT PROXIMAL LATERAL BOTH IP/OP "$2,061.50" "$1,526.00" $409.08 "$2,061.13" $927.51 $927.51 $927.51 $927.51 "$2,061.13" "$2,061.13" "$2,061.13" $429.59 "$2,061.13" "$2,061.13" "$2,061.13" "$2,061.13" "$2,061.13" $429.56 "$2,061.13" "$2,061.13" "$1,219.16" "$2,061.13" "$2,061.13" "$2,061.13" "$2,061.13" "$1,546.13" "$2,061.13" "$2,061.13" "$2,061.13" "$1,030.57" "$1,030.57" "$1,632.41" "$2,061.13" "$1,648.90" $927.51 $409.08 N/A "$1,195.67" "$2,061.13" "$1,236.68" "$2,061.13" $429.54 "$2,061.13" N/A N/A 436334 SUP HCPCS C1713 436334 - PLATE BONE 14 HOLE TIBIA RIGHT PROXIMAL LATERAL BOTH IP/OP "$1,874.50" "$1,387.00" $371.97 "$1,874.13" $843.36 $843.36 $843.36 $843.36 "$1,874.13" "$1,874.13" "$1,874.13" $390.62 "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" $390.59 "$1,874.13" "$1,874.13" "$1,108.55" "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" "$1,405.88" "$1,874.13" "$1,874.13" "$1,874.13" $937.07 $937.07 "$1,484.31" "$1,874.13" "$1,499.30" $843.36 $371.97 N/A "$1,087.21" "$1,874.13" "$1,124.48" "$1,874.13" $390.57 "$1,874.13" N/A N/A 436342 SUP HCPCS C1713 436342 - PLATE BONE 95MM 2 SHAFT HOLE 5 LOCKING HOLE STAINLESS STEEL BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" "$1,731.13" "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" $360.77 "$1,731.13" N/A N/A 436344 SUP HCPCS C1713 436344 - PLATE BONE 121MM 4 HOLE LOCKING AXSOS PERIARTICULAR LEFT BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" "$1,731.13" "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" "$1,731.13" "$1,731.13" N/A N/A 436346 SUP HCPCS C1713 436346 - PLATE BONE 147MM 6 HOLE SHAFT LOCKING TIBIA LEFT PROXIMAL BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" "$1,731.13" "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" N/A N/A 436348 SUP HCPCS C1713 436348 - PLATE BONE 173MM 8 SHAFT HOLE 5 LOCKING HOLE STAINLESS STEEL BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" "$1,731.13" "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" $360.77 "$1,731.13" N/A N/A 436350 SUP HCPCS C1713 436350 - PLATE BONE 199MM 10X5 HOLE LOCKING AXSOS PERIARTICULAR LEFT BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" $692.45 "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" "$1,731.13" "$1,731.13" N/A N/A 436352 SUP HCPCS C1713 436352 - PLATE BONE 225MM 12X5 HOLE LOCKING AXSOS PERIARTICULAR LEFT BOTH IP/OP "$2,061.50" "$1,526.00" $409.08 "$2,061.13" $927.51 $927.51 $927.51 $927.51 "$2,061.13" "$2,061.13" "$2,061.13" $429.59 "$2,061.13" "$2,061.13" "$2,061.13" "$2,061.13" "$2,061.13" $429.56 "$2,061.13" "$2,061.13" "$1,219.16" "$2,061.13" "$2,061.13" "$2,061.13" "$2,061.13" "$1,546.13" "$2,061.13" "$2,061.13" "$2,061.13" "$1,030.57" "$1,030.57" "$1,632.41" "$2,061.13" "$1,648.90" $927.51 $409.08 N/A "$1,195.67" "$2,061.13" "$2,061.13" "$2,061.13" "$2,061.13" "$2,061.13" N/A N/A 436354 SUP HCPCS C1713 436354 - PLATE BONE 4MM 251MM 15 HOLE LOCKING PERIARTICULAR RIGHT BOTH IP/OP "$1,874.50" "$1,387.00" $371.97 "$1,874.13" $843.36 $843.36 $843.36 $843.36 "$1,874.13" "$1,874.13" "$1,874.13" $390.62 "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" $390.59 "$1,874.13" "$1,874.13" "$1,108.55" "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" "$1,405.88" "$1,874.13" "$1,874.13" "$1,874.13" $937.07 $937.07 "$1,484.31" "$1,874.13" "$1,499.30" $843.36 $371.97 N/A "$1,087.21" "$1,874.13" "$1,124.48" "$1,874.13" $390.57 "$1,874.13" N/A N/A 436362 SUP HCPCS C1713 436362 - PLATE BONE 2 HOLE TIBIA RIGHT PROXIMAL BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" $692.45 "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" $360.77 "$1,731.13" N/A N/A 436364 SUP HCPCS C1713 436364 - PLATE BONE 121MM 4X5 HOLE LOCKING AXSOS PERIARTICULAR RIGHT BOTH IP/OP "$1,574.50" "$1,165.00" $312.48 "$1,574.38" $708.47 $708.47 $708.47 $708.47 "$1,574.38" "$1,574.38" "$1,574.38" $328.14 "$1,574.38" "$1,574.38" "$1,574.38" "$1,574.38" "$1,574.38" $328.12 "$1,574.38" "$1,574.38" $931.25 "$1,574.38" "$1,574.38" "$1,574.38" "$1,574.38" "$1,180.88" "$1,574.38" "$1,574.38" "$1,574.38" $787.19 $787.19 "$1,246.91" "$1,574.38" "$1,259.50" $708.47 $312.48 N/A $913.21 "$1,574.38" $944.63 "$1,574.38" $328.10 "$1,574.38" N/A N/A 436366 SUP HCPCS C1713 436366 - PLATE BONE 147MM 6X5 HOLE LOCKING AXSOS PERIARTICULAR RIGHT BOTH IP/OP "$1,731.50" "$1,281.00" $343.59 "$1,731.13" $779.01 $779.01 $779.01 $779.01 "$1,731.13" "$1,731.13" "$1,731.13" $360.81 "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" $360.79 "$1,731.13" $692.45 "$1,023.96" "$1,731.13" "$1,731.13" "$1,731.13" "$1,731.13" "$1,298.63" "$1,731.13" "$1,731.13" "$1,731.13" $865.57 $865.57 "$1,371.05" "$1,731.13" "$1,384.90" $779.01 $343.59 N/A "$1,004.27" "$1,731.13" "$1,038.68" "$1,731.13" $360.77 "$1,731.13" N/A N/A 436368 SUP HCPCS C1713 436368 - PLATE BONE 173MM 8X5 HOLE LOCKING AXSOS PERIARTICULAR RIGHT BOTH IP/OP "$1,574.50" "$1,165.00" $312.48 "$1,574.38" $708.47 $708.47 $708.47 $708.47 "$1,574.38" "$1,574.38" "$1,574.38" $328.14 "$1,574.38" "$1,574.38" "$1,574.38" "$1,574.38" "$1,574.38" $328.12 "$1,574.38" "$1,574.38" $931.25 "$1,574.38" "$1,574.38" "$1,574.38" "$1,574.38" "$1,180.88" "$1,574.38" "$1,574.38" "$1,574.38" $787.19 $787.19 "$1,246.91" "$1,574.38" "$1,259.50" $708.47 $312.48 N/A $913.21 "$1,574.38" $944.63 "$1,574.38" $328.10 "$1,574.38" N/A N/A 436370 SUP HCPCS C1713 436370 - PLATE BONE 199MM 10X5 HOLE LOCKING AXSOS PERIARTICULAR RIGHT BOTH IP/OP "$1,574.50" "$1,165.00" $312.48 "$1,574.38" $708.47 $708.47 $708.47 $708.47 "$1,574.38" "$1,574.38" "$1,574.38" $328.14 "$1,574.38" "$1,574.38" "$1,574.38" "$1,574.38" "$1,574.38" $328.12 "$1,574.38" $629.75 $931.25 "$1,574.38" "$1,574.38" "$1,574.38" "$1,574.38" "$1,180.88" "$1,574.38" "$1,574.38" "$1,574.38" $787.19 $787.19 "$1,246.91" "$1,574.38" "$1,259.50" $708.47 $312.48 N/A $913.21 "$1,574.38" $944.63 "$1,574.38" $328.10 "$1,574.38" N/A N/A 436372 SUP HCPCS C1713 436372 - PLATE BONE 225MM 12X5 HOLE LOCKING AXSOS PERIARTICULAR RIGHT BOTH IP/OP "$1,874.50" "$1,387.00" $371.97 "$1,874.13" $843.36 $843.36 $843.36 $843.36 "$1,874.13" "$1,874.13" "$1,874.13" $390.62 "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" $390.59 "$1,874.13" $749.65 "$1,108.55" "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" "$1,405.88" "$1,874.13" "$1,874.13" "$1,874.13" $937.07 $937.07 "$1,484.31" "$1,874.13" "$1,499.30" $843.36 $371.97 N/A "$1,087.21" "$1,874.13" "$1,124.48" "$1,874.13" $390.57 "$1,874.13" N/A N/A 436374 SUP HCPCS C1713 436374 - PLATE BONE 251MM 14 HOLE SHAFT LOCKING RIGHT PROXIMAL BOTH IP/OP "$1,874.50" "$1,387.00" $371.97 "$1,874.13" $843.36 $843.36 $843.36 $843.36 "$1,874.13" "$1,874.13" "$1,874.13" $390.62 "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" $390.59 "$1,874.13" "$1,874.13" "$1,108.55" "$1,874.13" "$1,874.13" "$1,874.13" "$1,874.13" "$1,405.88" "$1,874.13" "$1,874.13" "$1,874.13" $937.07 $937.07 "$1,484.31" "$1,874.13" "$1,499.30" $843.36 $371.97 N/A "$1,087.21" "$1,874.13" "$1,124.48" "$1,874.13" $390.57 "$1,874.13" N/A N/A 436404 SUP HCPCS C1713 436404 - PLATE BONE 4 HOLE TIBIA LEFT DISTAL ANTERIOR LATERAL BOTH IP/OP "$2,309.00" "$1,709.00" $458.21 "$2,308.63" "$1,038.88" "$1,038.88" "$1,038.88" "$1,038.88" "$2,308.63" "$2,308.63" "$2,308.63" $481.18 "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" $481.14 "$2,308.63" $923.45 "$1,365.55" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$1,731.75" "$2,308.63" "$2,308.63" "$2,308.63" "$1,154.32" "$1,154.32" "$1,828.43" "$2,308.63" "$1,846.90" "$1,038.88" $458.21 N/A "$1,339.22" "$2,308.63" "$1,385.18" "$2,308.63" $481.12 "$2,308.63" N/A N/A 436406 SUP HCPCS C1713 436406 - PLATE BONE 123MM 6 HOLE SHAFT LOCKING IMPLANT AXSOS BOTH IP/OP "$2,309.00" "$1,709.00" $458.21 "$2,308.63" "$1,038.88" "$1,038.88" "$1,038.88" "$1,038.88" "$2,308.63" "$2,308.63" "$2,308.63" $481.18 "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" $481.14 "$2,308.63" $923.45 "$1,365.55" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$1,731.75" "$2,308.63" "$2,308.63" "$2,308.63" "$1,154.32" "$1,154.32" "$1,828.43" "$2,308.63" "$1,846.90" "$1,038.88" $458.21 N/A "$1,339.22" "$2,308.63" "$1,385.18" "$2,308.63" $481.12 "$2,308.63" N/A N/A 436408 SUP HCPCS C1713 436408 - PLATE BONE 149MM 8 HOLE SHAFT LOCKING IMPLANT AXSOS BOTH IP/OP "$2,309.00" "$1,709.00" $458.21 "$2,308.63" "$1,038.88" "$1,038.88" "$1,038.88" "$1,038.88" "$2,308.63" "$2,308.63" "$2,308.63" $481.18 "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" $481.14 "$2,308.63" $923.45 "$1,365.55" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$1,731.75" "$2,308.63" "$2,308.63" "$2,308.63" "$1,154.32" "$1,154.32" "$1,828.43" "$2,308.63" "$1,846.90" "$1,038.88" $458.21 N/A "$1,339.22" "$2,308.63" "$1,385.18" "$2,308.63" $481.12 "$2,308.63" N/A N/A 436410 SUP HCPCS C1713 436410 - PLATE BONE 10 HOLE TIBIA LEFT DISTAL ANTLAT BOTH IP/OP "$2,309.00" "$1,709.00" $458.21 "$2,308.63" "$1,038.88" "$1,038.88" "$1,038.88" "$1,038.88" "$2,308.63" "$2,308.63" "$2,308.63" $481.18 "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" $481.14 "$2,308.63" $923.45 "$1,365.55" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$1,731.75" "$2,308.63" "$2,308.63" "$2,308.63" "$1,154.32" "$1,154.32" "$1,828.43" "$2,308.63" "$1,846.90" "$1,038.88" $458.21 N/A "$1,339.22" "$2,308.63" "$1,385.18" "$2,308.63" $481.12 "$2,308.63" N/A N/A 436412 SUP HCPCS C1713 436412 - PLATE BONE 12 HOLE TIBIA LEFT DISTAL ANTLAT BOTH IP/OP "$2,639.00" "$1,953.00" $523.70 "$2,638.63" "$1,187.38" "$1,187.38" "$1,187.38" "$1,187.38" "$2,638.63" "$2,638.63" "$2,638.63" $549.96 "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" $549.92 "$2,638.63" "$1,055.45" "$1,300.84" "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" "$1,979.25" "$2,638.63" "$2,638.63" "$2,638.63" "$1,319.32" "$1,319.32" "$2,089.79" "$2,638.63" "$2,110.90" "$1,187.38" $523.70 N/A "$1,530.62" "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" N/A N/A 436414 SUP HCPCS C1713 436414 - PLATE BONE 14 HOLE TIBIA LEFT DISTAL ANTERIOR LATERAL BOTH IP/OP "$2,639.00" "$1,953.00" $523.70 "$2,638.63" "$1,187.38" "$1,187.38" "$1,187.38" "$1,187.38" "$2,638.63" "$2,638.63" "$2,638.63" $549.96 "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" $549.92 "$2,638.63" "$1,055.45" "$1,300.84" "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" "$1,979.25" "$2,638.63" "$2,638.63" "$2,638.63" "$1,319.32" "$1,319.32" "$2,089.79" "$2,638.63" "$2,110.90" "$1,187.38" $523.70 N/A "$1,530.62" "$2,638.63" "$1,583.18" "$2,638.63" $549.89 "$2,638.63" N/A N/A 436416 SUP HCPCS C1713 436416 - PLATE BONE 16 HOLE TIBIA LEFT DISTAL ANTLAT BOTH IP/OP "$2,639.00" "$1,953.00" $523.70 "$2,638.63" "$1,187.38" "$1,187.38" "$1,187.38" "$1,187.38" "$2,638.63" "$2,638.63" "$2,638.63" $549.96 "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" $549.92 "$2,638.63" "$1,055.45" "$1,300.84" "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" "$1,979.25" "$2,638.63" "$2,638.63" "$2,638.63" "$1,319.32" "$1,319.32" "$2,089.79" "$2,638.63" "$2,110.90" "$1,187.38" $523.70 N/A "$1,530.62" "$2,638.63" "$1,583.18" "$2,638.63" $549.89 "$2,638.63" N/A N/A 436424 SUP HCPCS C1713 436424 - PLATE BONE 4 HOLE TIBIA RIGHT DISTAL LATERAL ANTERIOR BOTH IP/OP "$2,309.00" "$1,709.00" $458.21 "$2,308.63" "$1,038.88" "$1,038.88" "$1,038.88" "$1,038.88" "$2,308.63" "$2,308.63" "$2,308.63" $481.18 "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" $481.14 "$2,308.63" $923.45 "$1,365.55" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$1,731.75" "$2,308.63" "$2,308.63" "$2,308.63" "$1,154.32" "$1,154.32" "$1,828.43" "$2,308.63" "$1,846.90" "$1,038.88" $458.21 N/A "$1,339.22" "$2,308.63" "$1,385.18" "$2,308.63" $481.12 "$2,308.63" N/A N/A 436426 SUP HCPCS C1713 436426 - PLATE BONE 123MM 6 HOLE SHAFT LOCKING IMPLANT AXSOS BOTH IP/OP "$2,309.00" "$1,709.00" $458.21 "$2,308.63" "$1,038.88" "$1,038.88" "$1,038.88" "$1,038.88" "$2,308.63" "$2,308.63" "$2,308.63" $481.18 "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" $481.14 "$2,308.63" $923.45 "$1,365.55" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$1,731.75" "$2,308.63" "$2,308.63" "$2,308.63" "$1,154.32" "$1,154.32" "$1,828.43" "$2,308.63" "$1,846.90" "$1,038.88" $458.21 N/A "$1,339.22" "$2,308.63" "$1,385.18" "$2,308.63" $481.12 "$2,308.63" N/A N/A 436428 SUP HCPCS C1713 436428 - PLATE BONE 149MM 8 HOLE SHAFT LOCKING IMPLANT AXSOS BOTH IP/OP "$2,309.00" "$1,709.00" $458.21 "$2,308.63" "$1,038.88" "$1,038.88" "$1,038.88" "$1,038.88" "$2,308.63" "$2,308.63" "$2,308.63" $481.18 "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" $481.14 "$2,308.63" $923.45 "$1,365.55" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$1,731.75" "$2,308.63" "$2,308.63" "$2,308.63" "$1,154.32" "$1,154.32" "$1,828.43" "$2,308.63" "$1,846.90" "$1,038.88" $458.21 N/A "$1,339.22" "$2,308.63" "$1,385.18" "$2,308.63" $481.12 "$2,308.63" N/A N/A 436430 SUP HCPCS C1713 436430 - PLATE BONE 4 HOLE TIBIA RIGHT DISTAL LATERAL ANTERIOR BOTH IP/OP "$2,309.00" "$1,709.00" $458.21 "$2,308.63" "$1,038.88" "$1,038.88" "$1,038.88" "$1,038.88" "$2,308.63" "$2,308.63" "$2,308.63" $481.18 "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" $481.14 "$2,308.63" $923.45 "$1,365.55" "$2,308.63" "$2,308.63" "$2,308.63" "$2,308.63" "$1,731.75" "$2,308.63" "$2,308.63" "$2,308.63" "$1,154.32" "$1,154.32" "$1,828.43" "$2,308.63" "$1,846.90" "$1,038.88" $458.21 N/A "$1,339.22" "$2,308.63" "$1,385.18" "$2,308.63" $481.12 "$2,308.63" N/A N/A 436432 SUP HCPCS C1713 436432 - PLATE BONE 12 HOLE TIBIA RIGHT DISTAL LATERAL ANTERIOR BOTH IP/OP "$2,639.00" "$1,953.00" $523.70 "$2,638.63" "$1,187.38" "$1,187.38" "$1,187.38" "$1,187.38" "$2,638.63" "$2,638.63" "$2,638.63" $549.96 "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" $549.92 "$2,638.63" "$1,055.45" "$1,300.84" "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" "$1,979.25" "$2,638.63" "$2,638.63" "$2,638.63" "$1,319.32" "$1,319.32" "$2,089.79" "$2,638.63" "$2,110.90" "$1,187.38" $523.70 N/A "$1,530.62" "$2,638.63" "$1,583.18" "$2,638.63" $549.89 "$2,638.63" N/A N/A 436434 SUP HCPCS C1713 436434 - PLATE BONE 14 HOLE TIBIA RIGHT DISTAL LATERAL ANTERIOR BOTH IP/OP "$2,639.00" "$1,953.00" $523.70 "$2,638.63" "$1,187.38" "$1,187.38" "$1,187.38" "$1,187.38" "$2,638.63" "$2,638.63" "$2,638.63" $549.96 "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" $549.92 "$2,638.63" "$1,055.45" "$1,300.84" "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" "$1,979.25" "$2,638.63" "$2,638.63" "$2,638.63" "$1,319.32" "$1,319.32" "$2,089.79" "$2,638.63" "$2,110.90" "$1,187.38" $523.70 N/A "$1,530.62" "$2,638.63" "$1,583.18" "$2,638.63" $549.89 "$2,638.63" N/A N/A 436436 SUP HCPCS C1713 436436 - PLATE BONE 16 HOLE TIBIA RIGHT DISTAL LATERAL ANTERIOR BOTH IP/OP "$2,639.00" "$1,953.00" $523.70 "$2,638.63" "$1,187.38" "$1,187.38" "$1,187.38" "$1,187.38" "$2,638.63" "$2,638.63" "$2,638.63" $549.96 "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" $549.92 "$2,638.63" "$2,638.63" "$1,300.84" "$2,638.63" "$2,638.63" "$2,638.63" "$2,638.63" "$1,979.25" "$2,638.63" "$2,638.63" "$2,638.63" "$1,319.32" "$1,319.32" "$2,089.79" "$2,638.63" "$2,110.90" "$1,187.38" $523.70 N/A "$1,530.62" "$2,638.63" "$1,583.18" "$2,638.63" $549.89 "$2,638.63" N/A N/A 436504 SUP HCPCS C1713 436504 - PLATE BONE 130MM 4 HOLE LOCKING AXSOS STAINLESS STEEL BOTH IP/OP "$1,930.50" "$1,429.00" $383.16 "$1,930.50" $868.73 $868.73 $868.73 $868.73 "$1,930.50" "$1,930.50" "$1,930.50" $402.36 "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" $402.34 "$1,930.50" "$1,930.50" "$1,141.89" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,447.88" "$1,930.50" "$1,930.50" "$1,930.50" $965.25 $965.25 "$1,528.96" "$1,930.50" "$1,544.40" $868.73 $383.16 N/A "$1,119.69" "$1,930.50" "$1,158.30" "$1,930.50" "$1,930.50" "$1,930.50" N/A N/A 436506 SUP HCPCS C1713 436506 - PLATE BONE 6 HOLE FEMUR LEFT DISTAL LATERAL BOTH IP/OP "$1,930.50" "$1,429.00" $383.16 "$1,930.50" $868.73 $868.73 $868.73 $868.73 "$1,930.50" "$1,930.50" "$1,930.50" $402.36 "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" $402.34 "$1,930.50" "$1,930.50" "$1,141.89" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,447.88" "$1,930.50" "$1,930.50" "$1,930.50" $965.25 $965.25 "$1,528.96" "$1,930.50" "$1,544.40" $868.73 $383.16 N/A "$1,119.69" "$1,930.50" "$1,158.30" "$1,930.50" $402.32 "$1,930.50" N/A N/A 436508 SUP HCPCS C1713 436508 - PLATE BONE 202MM 8 HOLE SHAFT LOCKING IMPLANT AXSOS BOTH IP/OP "$1,930.50" "$1,429.00" $383.16 "$1,930.50" $868.73 $868.73 $868.73 $868.73 "$1,930.50" "$1,930.50" "$1,930.50" $402.36 "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" $402.34 "$1,930.50" $772.20 "$1,141.89" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,447.88" "$1,930.50" "$1,930.50" "$1,930.50" $965.25 $965.25 "$1,528.96" "$1,930.50" "$1,544.40" $868.73 $383.16 N/A "$1,119.69" "$1,930.50" "$1,158.30" "$1,930.50" $402.32 "$1,930.50" N/A N/A 436510 SUP HCPCS C1713 436510 - PLATE BONE 238MM 10 HOLE LOCKING AXSOS STAINLESS STEEL BOTH IP/OP "$1,930.50" "$1,429.00" $383.16 "$1,930.50" $868.73 $868.73 $868.73 $868.73 "$1,930.50" "$1,930.50" "$1,930.50" $402.36 "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" $402.34 "$1,930.50" "$1,930.50" "$1,141.89" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,447.88" "$1,930.50" "$1,930.50" "$1,930.50" $965.25 $965.25 "$1,528.96" "$1,930.50" "$1,544.40" $868.73 $383.16 N/A "$1,119.69" "$1,930.50" "$1,158.30" "$1,930.50" $402.32 "$1,930.50" N/A N/A 436512 SUP HCPCS C1713 436512 - PLATE BONE 274MM 12 HOLE SHAFT LOCKING AXSOS STAINLESS STEEL BOTH IP/OP "$1,930.50" "$1,429.00" $383.16 "$1,930.50" $868.73 $868.73 $868.73 $868.73 "$1,930.50" "$1,930.50" "$1,930.50" $402.36 "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" $402.34 "$1,930.50" $772.20 "$1,141.89" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,447.88" "$1,930.50" "$1,930.50" "$1,930.50" $965.25 $965.25 "$1,528.96" "$1,930.50" "$1,544.40" $868.73 $383.16 N/A "$1,119.69" "$1,930.50" "$1,158.30" "$1,930.50" $402.32 "$1,930.50" N/A N/A 436514 SUP HCPCS C1713 436514 - PLATE BONE 310MM 14 HOLE SHAFT LOCKING IMPLANT AXSOS BOTH IP/OP "$1,930.50" "$1,429.00" $383.16 "$1,930.50" $868.73 $868.73 $868.73 $868.73 "$1,930.50" "$1,930.50" "$1,930.50" $402.36 "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" $402.34 "$1,930.50" $772.20 "$1,141.89" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,447.88" "$1,930.50" "$1,930.50" "$1,930.50" $965.25 $965.25 "$1,528.96" "$1,930.50" "$1,544.40" $868.73 $383.16 N/A "$1,119.69" "$1,930.50" "$1,158.30" "$1,930.50" $402.32 "$1,930.50" N/A N/A 436516 SUP HCPCS C1713 436516 - PLATE BONE 343MM 16 HOLE SHAFT LOCKING AXSOS STAINLESS STEEL BOTH IP/OP "$1,930.50" "$1,429.00" $383.16 "$1,930.50" $868.73 $868.73 $868.73 $868.73 "$1,930.50" "$1,930.50" "$1,930.50" $402.36 "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" $402.34 "$1,930.50" "$1,930.50" "$1,141.89" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,447.88" "$1,930.50" "$1,930.50" "$1,930.50" $965.25 $965.25 "$1,528.96" "$1,930.50" "$1,544.40" $868.73 $383.16 N/A "$1,119.69" "$1,930.50" "$1,158.30" "$1,930.50" $402.32 "$1,930.50" N/A N/A 436524 SUP HCPCS C1713 436524 - PLATE BONE 130MM 4X5 HOLE LOCKING AXSOS STAINLESS STEEL BOTH IP/OP "$1,930.50" "$1,429.00" $383.16 "$1,930.50" $868.73 $868.73 $868.73 $868.73 "$1,930.50" "$1,930.50" "$1,930.50" $402.36 "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" $402.34 "$1,930.50" "$1,930.50" "$1,141.89" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,447.88" "$1,930.50" "$1,930.50" "$1,930.50" $965.25 $965.25 "$1,528.96" "$1,930.50" "$1,544.40" $868.73 $383.16 N/A "$1,119.69" "$1,930.50" "$1,158.30" "$1,930.50" $402.32 "$1,930.50" N/A N/A 436526 SUP HCPCS C1713 436526 - PLATE BONE 166MM 6X5 HOLE LOCKING AXSOS STAINLESS STEEL BOTH IP/OP "$1,930.50" "$1,429.00" $383.16 "$1,930.50" $868.73 $868.73 $868.73 $868.73 "$1,930.50" "$1,930.50" "$1,930.50" $402.36 "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" $402.34 "$1,930.50" $772.20 "$1,141.89" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,447.88" "$1,930.50" "$1,930.50" "$1,930.50" $965.25 $965.25 "$1,528.96" "$1,930.50" "$1,544.40" $868.73 $383.16 N/A "$1,119.69" "$1,930.50" "$1,158.30" "$1,930.50" $402.32 "$1,930.50" N/A N/A 436528 SUP HCPCS C1713 436528 - PLATE BONE 8 HOLE FEMUR RIGHT DISTAL LATERAL BOTH IP/OP "$1,930.50" "$1,429.00" $383.16 "$1,930.50" $868.73 $868.73 $868.73 $868.73 "$1,930.50" "$1,930.50" "$1,930.50" $402.36 "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" $402.34 "$1,930.50" "$1,930.50" "$1,141.89" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,447.88" "$1,930.50" "$1,930.50" "$1,930.50" $965.25 $965.25 "$1,528.96" "$1,930.50" "$1,544.40" $868.73 $383.16 N/A "$1,119.69" "$1,930.50" "$1,158.30" "$1,930.50" $402.32 "$1,930.50" N/A N/A 436530 SUP HCPCS C1713 436530 - PLATE BONE 10 SHAFT HOLE 5 LOCKING HOLE STAINLESS STEEL BOTH IP/OP "$1,930.50" "$1,429.00" $383.16 "$1,930.50" $868.73 $868.73 $868.73 $868.73 "$1,930.50" "$1,930.50" "$1,930.50" $402.36 "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" $402.34 "$1,930.50" $772.20 "$1,141.89" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,447.88" "$1,930.50" "$1,930.50" "$1,930.50" $965.25 $965.25 "$1,528.96" "$1,930.50" "$1,544.40" $868.73 $383.16 N/A "$1,119.69" "$1,930.50" "$1,158.30" "$1,930.50" $402.32 "$1,930.50" N/A N/A 436532 SUP HCPCS C1713 436532 - PLATE BONE 274MM 12X5 HOLE LOCKING AXSOS STAINLESS STEEL BOTH IP/OP "$1,930.50" "$1,429.00" $383.16 "$1,930.50" $868.73 $868.73 $868.73 $868.73 "$1,930.50" "$1,930.50" "$1,930.50" $402.36 "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" $402.34 "$1,930.50" $772.20 "$1,141.89" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,447.88" "$1,930.50" "$1,930.50" "$1,930.50" $965.25 $965.25 "$1,528.96" "$1,930.50" "$1,544.40" $868.73 $383.16 N/A "$1,119.69" "$1,930.50" "$1,158.30" "$1,930.50" $402.32 "$1,930.50" N/A N/A 436534 SUP HCPCS C1713 436534 - PLATE BONE 14 HOLE FEMUR RIGHT DISTAL LATERAL BOTH IP/OP "$1,930.50" "$1,429.00" $383.16 "$1,930.50" $868.73 $868.73 $868.73 $868.73 "$1,930.50" "$1,930.50" "$1,930.50" $402.36 "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" $402.34 "$1,930.50" $772.20 "$1,141.89" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,447.88" "$1,930.50" "$1,930.50" "$1,930.50" $965.25 $965.25 "$1,528.96" "$1,930.50" "$1,544.40" $868.73 $383.16 N/A "$1,119.69" "$1,930.50" "$1,158.30" "$1,930.50" $402.32 "$1,930.50" N/A N/A 436536 SUP HCPCS C1713 436536 - PLATE BONE 343MM 16X5 HOLE LOCKING AXSOS STAINLESS STEEL BOTH IP/OP "$1,930.50" "$1,429.00" $383.16 "$1,930.50" $868.73 $868.73 $868.73 $868.73 "$1,930.50" "$1,930.50" "$1,930.50" $402.36 "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" $402.34 "$1,930.50" "$1,930.50" "$1,141.89" "$1,930.50" "$1,930.50" "$1,930.50" "$1,930.50" "$1,447.88" "$1,930.50" "$1,930.50" "$1,930.50" $965.25 $965.25 "$1,528.96" "$1,930.50" "$1,544.40" $868.73 $383.16 N/A "$1,119.69" "$1,930.50" "$1,158.30" "$1,930.50" $402.32 "$1,930.50" N/A N/A 437103 SUP HCPCS C1713 437103 - PLATE BN 86MM NS AXSOS 3X7X 1 HL LCK SS HUM LT PROX 3.5/4MM BOTH IP/OP "$2,319.50" "$1,716.00" $460.30 "$2,319.20" "$1,043.64" "$1,043.64" "$1,043.64" "$1,043.64" "$2,319.20" "$2,319.20" "$2,319.20" $483.38 "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" $483.35 "$2,319.20" $927.68 "$1,371.81" "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" "$1,739.63" "$2,319.20" "$2,319.20" "$2,319.20" "$1,159.60" "$1,159.60" "$1,836.81" "$2,319.20" "$1,855.36" "$1,043.64" $460.30 N/A "$1,345.31" "$2,319.20" "$1,391.52" "$2,319.20" $483.32 "$2,319.20" N/A N/A 437105 SUP HCPCS C1713 437105 - PLATE BN 112MM NS AXSOS 5X7X 2 HL LCK SS HUM LT PROX 3.5/4MM BOTH IP/OP "$2,319.50" "$1,716.00" $460.30 "$2,319.20" "$1,043.64" "$1,043.64" "$1,043.64" "$1,043.64" "$2,319.20" "$2,319.20" "$2,319.20" $483.38 "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" $483.35 "$2,319.20" "$2,319.20" "$1,371.81" "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" "$1,739.63" "$2,319.20" "$2,319.20" "$2,319.20" "$1,159.60" "$1,159.60" "$1,836.81" "$2,319.20" "$1,855.36" "$1,043.64" $460.30 N/A "$1,345.31" "$2,319.20" "$1,391.52" "$2,319.20" $483.32 "$2,319.20" N/A N/A 437108 SUP HCPCS C1713 437108 - PLATE BONE 150MM 8 SHAFT HOLE LOCKING THREADED LEFT PROXIMAL BOTH IP/OP "$2,319.50" "$1,716.00" $460.30 "$2,319.20" "$1,043.64" "$1,043.64" "$1,043.64" "$1,043.64" "$2,319.20" "$2,319.20" "$2,319.20" $483.38 "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" $483.35 "$2,319.20" $927.68 "$1,371.81" "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" "$1,739.63" "$2,319.20" "$2,319.20" "$2,319.20" "$1,159.60" "$1,159.60" "$1,836.81" "$2,319.20" "$1,855.36" "$1,043.64" $460.30 N/A "$1,345.31" "$2,319.20" "$1,391.52" "$2,319.20" $483.32 "$2,319.20" N/A N/A 437123 SUP HCPCS C1713 437123 - PLATE BN 86MM NS AXSOS 3X7X 1 HL LCK SS HUM RT PROX 3.5/4MM BOTH IP/OP "$2,319.50" "$1,716.00" $460.30 "$2,319.20" "$1,043.64" "$1,043.64" "$1,043.64" "$1,043.64" "$2,319.20" "$2,319.20" "$2,319.20" $483.38 "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" $483.35 "$2,319.20" "$2,319.20" "$1,371.81" "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" "$1,739.63" "$2,319.20" "$2,319.20" "$2,319.20" "$1,159.60" "$1,159.60" "$1,836.81" "$2,319.20" "$1,855.36" "$1,043.64" $460.30 N/A "$1,345.31" "$2,319.20" "$1,391.52" "$2,319.20" "$2,319.20" "$2,319.20" N/A N/A 437125 SUP HCPCS C1713 437125 - PLATE BN 112MM NS AXSOS 5X7X 2 HL LCK SS HUM RT PROX 3.5/4MM BOTH IP/OP "$2,319.50" "$1,716.00" $460.30 "$2,319.20" "$1,043.64" "$1,043.64" "$1,043.64" "$1,043.64" "$2,319.20" "$2,319.20" "$2,319.20" $483.38 "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" $483.35 "$2,319.20" "$2,319.20" "$1,371.81" "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" "$1,739.63" "$2,319.20" "$2,319.20" "$2,319.20" "$1,159.60" "$1,159.60" "$1,836.81" "$2,319.20" "$1,855.36" "$1,043.64" $460.30 N/A "$1,345.31" "$2,319.20" "$1,391.52" "$2,319.20" $483.32 "$2,319.20" N/A N/A 437128 SUP HCPCS C1713 437128 - PLATE BN 150MM NS AXSOS 8X7X 4 HL LCK SS HUM RT PROX 3.5/4MM BOTH IP/OP "$2,319.50" "$1,716.00" $460.30 "$2,319.20" "$1,043.64" "$1,043.64" "$1,043.64" "$1,043.64" "$2,319.20" "$2,319.20" "$2,319.20" $483.38 "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" $483.35 "$2,319.20" $927.68 "$1,371.81" "$2,319.20" "$2,319.20" "$2,319.20" "$2,319.20" "$1,739.63" "$2,319.20" "$2,319.20" "$2,319.20" "$1,159.60" "$1,159.60" "$1,836.81" "$2,319.20" "$1,855.36" "$1,043.64" $460.30 N/A "$1,345.31" "$2,319.20" "$1,391.52" "$2,319.20" $483.32 "$2,319.20" N/A N/A 437204 SUP HCPCS C1713 437204 - PLATE BN 94MM NS AXSOS 4X4X 2 HL LCK SS TIB LT DIST MDL BOTH IP/OP "$2,050.00" "$1,517.00" $406.79 "$2,049.60" $922.32 $922.32 $922.32 $922.32 "$2,049.60" "$2,049.60" "$2,049.60" $427.19 "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" $427.16 "$2,049.60" $819.84 "$1,212.34" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$1,537.50" "$2,049.60" "$2,049.60" "$2,049.60" "$1,024.80" "$1,024.80" "$1,623.28" "$2,049.60" "$1,639.68" $922.32 $406.79 N/A "$1,189.00" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" N/A N/A 437206 SUP HCPCS C1713 437206 - PLATE BN 120MM NS AXSOS 6X4X 3 HL LCK SS TIB LT DIST MDL BOTH IP/OP "$2,050.00" "$1,517.00" $406.79 "$2,049.60" $922.32 $922.32 $922.32 $922.32 "$2,049.60" "$2,049.60" "$2,049.60" $427.19 "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" $427.16 "$2,049.60" $819.84 "$1,212.34" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$1,537.50" "$2,049.60" "$2,049.60" "$2,049.60" "$1,024.80" "$1,024.80" "$1,623.28" "$2,049.60" "$1,639.68" $922.32 $406.79 N/A "$1,189.00" "$2,049.60" "$2,049.60" "$2,049.60" $427.14 "$2,049.60" N/A N/A 437208 SUP HCPCS C1713 437208 - PLATE BN 146MM NS AXSOS 8X4X 4 HL LCK SS TIB LT DIST MDL BOTH IP/OP "$2,050.00" "$1,517.00" $406.79 "$2,049.60" $922.32 $922.32 $922.32 $922.32 "$2,049.60" "$2,049.60" "$2,049.60" $427.19 "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" $427.16 "$2,049.60" $819.84 "$1,212.34" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$1,537.50" "$2,049.60" "$2,049.60" "$2,049.60" "$1,024.80" "$1,024.80" "$1,623.28" "$2,049.60" "$1,639.68" $922.32 $406.79 N/A "$1,189.00" "$2,049.60" "$1,229.76" "$2,049.60" $427.14 "$2,049.60" N/A N/A 437210 SUP HCPCS C1713 437210 - PLATE BONE 172MM 10X4X 5 HOLE LOCKING THREADED SHAFT HOLE BOTH IP/OP "$2,050.00" "$1,517.00" $406.79 "$2,049.60" $922.32 $922.32 $922.32 $922.32 "$2,049.60" "$2,049.60" "$2,049.60" $427.19 "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" $427.16 "$2,049.60" $819.84 "$1,212.34" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$1,537.50" "$2,049.60" "$2,049.60" "$2,049.60" "$1,024.80" "$1,024.80" "$1,623.28" "$2,049.60" "$1,639.68" $922.32 $406.79 N/A "$1,189.00" "$2,049.60" "$1,229.76" "$2,049.60" $427.14 "$2,049.60" N/A N/A 437212 SUP HCPCS C1713 437212 - PLATE BONE 198MM 12 SHAFT HOLE LOCKING THREADED LEFT DISTAL BOTH IP/OP "$2,050.00" "$1,517.00" $406.79 "$2,049.60" $922.32 $922.32 $922.32 $922.32 "$2,049.60" "$2,049.60" "$2,049.60" $427.19 "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" $427.16 "$2,049.60" $819.84 "$1,212.34" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$1,537.50" "$2,049.60" "$2,049.60" "$2,049.60" "$1,024.80" "$1,024.80" "$1,623.28" "$2,049.60" "$1,639.68" $922.32 $406.79 N/A "$1,189.00" "$2,049.60" "$1,229.76" "$2,049.60" $427.14 "$2,049.60" N/A N/A 437214 SUP HCPCS C1713 437214 - PLATE BN 224MM NS AXSOS 14X4X 7 HL LCK SS TIB LT DIST MDL BOTH IP/OP "$2,050.00" "$1,517.00" $406.79 "$2,049.60" $922.32 $922.32 $922.32 $922.32 "$2,049.60" "$2,049.60" "$2,049.60" $427.19 "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" $427.16 "$2,049.60" "$2,049.60" "$1,212.34" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$1,537.50" "$2,049.60" "$2,049.60" "$2,049.60" "$1,024.80" "$1,024.80" "$1,623.28" "$2,049.60" "$1,639.68" $922.32 $406.79 N/A "$1,189.00" "$2,049.60" "$2,049.60" "$2,049.60" $427.14 "$2,049.60" N/A N/A 437216 SUP HCPCS C1713 437216 - PLATE BONE 16 HOLE SHAFT TIBIA DISTAL MEDIAL BOTH IP/OP "$2,050.00" "$1,517.00" $406.79 "$2,049.60" $922.32 $922.32 $922.32 $922.32 "$2,049.60" "$2,049.60" "$2,049.60" $427.19 "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" $427.16 "$2,049.60" "$2,049.60" "$1,212.34" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$1,537.50" "$2,049.60" "$2,049.60" "$2,049.60" "$1,024.80" "$1,024.80" "$1,623.28" "$2,049.60" "$1,639.68" $922.32 $406.79 N/A "$1,189.00" "$2,049.60" "$1,229.76" "$2,049.60" $427.14 "$2,049.60" N/A N/A 437224 SUP HCPCS C1713 437224 - PLATE BN 94MM NS AXSOS 4X4X 2 HL LCK SS TIB RT DIST MDL BOTH IP/OP "$2,050.00" "$1,517.00" $406.79 "$2,049.60" $922.32 $922.32 $922.32 $922.32 "$2,049.60" "$2,049.60" "$2,049.60" $427.19 "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" $427.16 "$2,049.60" "$2,049.60" "$1,212.34" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$1,537.50" "$2,049.60" "$2,049.60" "$2,049.60" "$1,024.80" "$1,024.80" "$1,623.28" "$2,049.60" "$1,639.68" $922.32 $406.79 N/A "$1,189.00" "$2,049.60" "$1,229.76" "$2,049.60" "$2,049.60" "$2,049.60" N/A N/A 437226 SUP HCPCS C1713 437226 - PLATE BN 120MM NS AXSOS 6X4X 3 HL LCK SS TIB RT DIST MDL BOTH IP/OP "$2,050.00" "$1,517.00" $406.79 "$2,049.60" $922.32 $922.32 $922.32 $922.32 "$2,049.60" "$2,049.60" "$2,049.60" $427.19 "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" $427.16 "$2,049.60" "$2,049.60" "$1,212.34" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$1,537.50" "$2,049.60" "$2,049.60" "$2,049.60" "$1,024.80" "$1,024.80" "$1,623.28" "$2,049.60" "$1,639.68" $922.32 $406.79 N/A "$1,189.00" "$2,049.60" "$1,229.76" "$2,049.60" "$2,049.60" "$2,049.60" N/A N/A 437228 SUP HCPCS C1713 437228 - PLATE BN 146MM NS AXSOS 8X4X 4 HL SS TIB RT DIST MDL 4/3.5MM BOTH IP/OP "$2,050.00" "$1,517.00" $406.79 "$2,049.60" $922.32 $922.32 $922.32 $922.32 "$2,049.60" "$2,049.60" "$2,049.60" $427.19 "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" $427.16 "$2,049.60" $819.84 "$1,212.34" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$1,537.50" "$2,049.60" "$2,049.60" "$2,049.60" "$1,024.80" "$1,024.80" "$1,623.28" "$2,049.60" "$1,639.68" $922.32 $406.79 N/A "$1,189.00" "$2,049.60" "$1,229.76" "$2,049.60" $427.14 "$2,049.60" N/A N/A 437230 SUP HCPCS C1713 437230 - PLATE BN 172MM NS AXSOS 10X4X 5 HL LCK SS TIB RT DIST MDL BOTH IP/OP "$2,050.00" "$1,517.00" $406.79 "$2,049.60" $922.32 $922.32 $922.32 $922.32 "$2,049.60" "$2,049.60" "$2,049.60" $427.19 "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" $427.16 "$2,049.60" $819.84 "$1,212.34" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$1,537.50" "$2,049.60" "$2,049.60" "$2,049.60" "$1,024.80" "$1,024.80" "$1,623.28" "$2,049.60" "$1,639.68" $922.32 $406.79 N/A "$1,189.00" "$2,049.60" "$1,229.76" "$2,049.60" $427.14 "$2,049.60" N/A N/A 437232 SUP HCPCS C1713 437232 - PLATE BN 198MM NS AXSOS 12X4X 6 HL LCK SS TIB RT DIST MDL BOTH IP/OP "$2,050.00" "$1,517.00" $406.79 "$2,049.60" $922.32 $922.32 $922.32 $922.32 "$2,049.60" "$2,049.60" "$2,049.60" $427.19 "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" $427.16 "$2,049.60" $819.84 "$1,212.34" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$1,537.50" "$2,049.60" "$2,049.60" "$2,049.60" "$1,024.80" "$1,024.80" "$1,623.28" "$2,049.60" "$1,639.68" $922.32 $406.79 N/A "$1,189.00" "$2,049.60" "$1,229.76" "$2,049.60" $427.14 "$2,049.60" N/A N/A 437234 SUP HCPCS C1713 437234 - PLATE BONE 14 HOLE TOT STABILIZED AXSOS STAINLESS STEEL BOTH IP/OP "$2,050.00" "$1,517.00" $406.79 "$2,049.60" $922.32 $922.32 $922.32 $922.32 "$2,049.60" "$2,049.60" "$2,049.60" $427.19 "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" $427.16 "$2,049.60" $819.84 "$1,212.34" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$1,537.50" "$2,049.60" "$2,049.60" "$2,049.60" "$1,024.80" "$1,024.80" "$1,623.28" "$2,049.60" "$1,639.68" $922.32 $406.79 N/A "$1,189.00" "$2,049.60" "$1,229.76" "$2,049.60" $427.14 "$2,049.60" N/A N/A 437236 SUP HCPCS C1713 437236 - PLATE BONE 250MM TIBIA RIGHT DISTAL MEDIAL BOTH IP/OP "$2,050.00" "$1,517.00" $406.79 "$2,049.60" $922.32 $922.32 $922.32 $922.32 "$2,049.60" "$2,049.60" "$2,049.60" $427.19 "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" $427.16 "$2,049.60" $819.84 "$1,212.34" "$2,049.60" "$2,049.60" "$2,049.60" "$2,049.60" "$1,537.50" "$2,049.60" "$2,049.60" "$2,049.60" "$1,024.80" "$1,024.80" "$1,623.28" "$2,049.60" "$1,639.68" $922.32 $406.79 N/A "$1,189.00" "$2,049.60" "$1,229.76" "$2,049.60" $427.14 "$2,049.60" N/A N/A 437302 SUP HCPCS C1713 437302 - PLATE BN 95MM NS AXSOS 2X5X 1 HL SS TIB LT PROX LAT 3.5/4MM BOTH IP/OP "$2,026.00" "$1,499.00" $402.03 "$2,025.60" $911.52 $911.52 $911.52 $911.52 "$2,025.60" "$2,025.60" "$2,025.60" $422.19 "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" $422.16 "$2,025.60" $810.24 "$1,198.14" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$1,519.50" "$2,025.60" "$2,025.60" "$2,025.60" "$1,012.80" "$1,012.80" "$1,604.28" "$2,025.60" "$1,620.48" $911.52 $402.03 N/A "$1,175.08" "$2,025.60" "$1,215.36" "$2,025.60" $422.14 "$2,025.60" N/A N/A 437304 SUP HCPCS C1713 437304 - PLATE BN 121MM NS AXSOS 4X5X 2 HL SS TIB LT PROX LAT 3.5/4MM BOTH IP/OP "$2,026.00" "$1,499.00" $402.03 "$2,025.60" $911.52 $911.52 $911.52 $911.52 "$2,025.60" "$2,025.60" "$2,025.60" $422.19 "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" $422.16 "$2,025.60" "$2,025.60" "$1,198.14" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$1,519.50" "$2,025.60" "$2,025.60" "$2,025.60" "$1,012.80" "$1,012.80" "$1,604.28" "$2,025.60" "$1,620.48" $911.52 $402.03 N/A "$1,175.08" "$2,025.60" "$1,215.36" "$2,025.60" $422.14 "$2,025.60" N/A N/A 437306 SUP HCPCS C1713 437306 - PLATE BN 147MM NS AXSOS 6X5X 3 HL SS TIB LT PROX LAT 3.5/4MM BOTH IP/OP "$2,026.00" "$1,499.00" $402.03 "$2,025.60" $911.52 $911.52 $911.52 $911.52 "$2,025.60" "$2,025.60" "$2,025.60" $422.19 "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" $422.16 "$2,025.60" $810.24 "$1,198.14" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$1,519.50" "$2,025.60" "$2,025.60" "$2,025.60" "$1,012.80" "$1,012.80" "$1,604.28" "$2,025.60" "$1,620.48" $911.52 $402.03 N/A "$1,175.08" "$2,025.60" "$1,215.36" "$2,025.60" $422.14 "$2,025.60" N/A N/A 437308 SUP HCPCS C1713 437308 - PLATE BN 173MM NS AXSOS 8X5X 4 HL SS TIB LT PROX LAT 3.5/4MM BOTH IP/OP "$2,026.00" "$1,499.00" $402.03 "$2,025.60" $911.52 $911.52 $911.52 $911.52 "$2,025.60" "$2,025.60" "$2,025.60" $422.19 "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" $422.16 "$2,025.60" $810.24 "$1,198.14" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$1,519.50" "$2,025.60" "$2,025.60" "$2,025.60" "$1,012.80" "$1,012.80" "$1,604.28" "$2,025.60" "$1,620.48" $911.52 $402.03 N/A "$1,175.08" "$2,025.60" "$1,215.36" "$2,025.60" $422.14 "$2,025.60" N/A N/A 437310 SUP HCPCS C1713 437310 - PLATE BN 199MM NS AXSOS 10X5X 5 HL SS TIB LT PROX LAT 3.5/4 BOTH IP/OP "$2,026.00" "$1,499.00" $402.03 "$2,025.60" $911.52 $911.52 $911.52 $911.52 "$2,025.60" "$2,025.60" "$2,025.60" $422.19 "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" $422.16 "$2,025.60" $810.24 "$1,198.14" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$1,519.50" "$2,025.60" "$2,025.60" "$2,025.60" "$1,012.80" "$1,012.80" "$1,604.28" "$2,025.60" "$1,620.48" $911.52 $402.03 N/A "$1,175.08" "$2,025.60" "$1,215.36" "$2,025.60" $422.14 "$2,025.60" N/A N/A 437312 SUP HCPCS C1713 437312 - PLATE BN 225MM NS AXSOS 12X5X 6 HL SS TIB LT PROX LAT 3.5/4 BOTH IP/OP "$2,026.00" "$1,499.00" $402.03 "$2,025.60" $911.52 $911.52 $911.52 $911.52 "$2,025.60" "$2,025.60" "$2,025.60" $422.19 "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" $422.16 "$2,025.60" $810.24 "$1,198.14" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$1,519.50" "$2,025.60" "$2,025.60" "$2,025.60" "$1,012.80" "$1,012.80" "$1,604.28" "$2,025.60" "$1,620.48" $911.52 $402.03 N/A "$1,175.08" "$2,025.60" "$2,025.60" "$2,025.60" $422.14 "$2,025.60" N/A N/A 437314 SUP HCPCS C1713 437314 - PLATE BONE 251MM 14 SHAFT HOLE LOCKING THREADED BOTH IP/OP "$2,026.00" "$1,499.00" $402.03 "$2,025.60" $911.52 $911.52 $911.52 $911.52 "$2,025.60" "$2,025.60" "$2,025.60" $422.19 "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" $422.16 "$2,025.60" $810.24 "$1,198.14" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$1,519.50" "$2,025.60" "$2,025.60" "$2,025.60" "$1,012.80" "$1,012.80" "$1,604.28" "$2,025.60" "$1,620.48" $911.52 $402.03 N/A "$1,175.08" "$2,025.60" "$1,215.36" "$2,025.60" $422.14 "$2,025.60" N/A N/A 437322 SUP HCPCS C1713 437322 - PLATE BN 95MM NS AXSOS 2X5X 1 HL SS TIB RT PROX LAT 3.5/4MM BOTH IP/OP "$2,026.00" "$1,499.00" $402.03 "$2,025.60" $911.52 $911.52 $911.52 $911.52 "$2,025.60" "$2,025.60" "$2,025.60" $422.19 "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" $422.16 "$2,025.60" $810.24 "$1,198.14" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$1,519.50" "$2,025.60" "$2,025.60" "$2,025.60" "$1,012.80" "$1,012.80" "$1,604.28" "$2,025.60" "$1,620.48" $911.52 $402.03 N/A "$1,175.08" "$2,025.60" "$1,215.36" "$2,025.60" $422.14 "$2,025.60" N/A N/A 437324 SUP HCPCS C1713 437324 - PLATE BN 121MM NS AXSOS 4X5X 2 HL SS TIB RT PROX LAT 3.5/4MM BOTH IP/OP "$2,026.00" "$1,499.00" $402.03 "$2,025.60" $911.52 $911.52 $911.52 $911.52 "$2,025.60" "$2,025.60" "$2,025.60" $422.19 "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" $422.16 "$2,025.60" "$2,025.60" "$1,198.14" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$1,519.50" "$2,025.60" "$2,025.60" "$2,025.60" "$1,012.80" "$1,012.80" "$1,604.28" "$2,025.60" "$1,620.48" $911.52 $402.03 N/A "$1,175.08" "$2,025.60" "$2,025.60" "$2,025.60" $422.14 "$2,025.60" N/A N/A 437326 SUP HCPCS C1713 437326 - PLATE BN 147MM NS AXSOS 6X5X 3 HL SS TIB RT PROX LAT 3.5/4MM BOTH IP/OP "$2,026.00" "$1,499.00" $402.03 "$2,025.60" $911.52 $911.52 $911.52 $911.52 "$2,025.60" "$2,025.60" "$2,025.60" $422.19 "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" $422.16 "$2,025.60" "$2,025.60" "$1,198.14" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$1,519.50" "$2,025.60" "$2,025.60" "$2,025.60" "$1,012.80" "$1,012.80" "$1,604.28" "$2,025.60" "$1,620.48" $911.52 $402.03 N/A "$1,175.08" "$2,025.60" "$1,215.36" "$2,025.60" $422.14 "$2,025.60" N/A N/A 437328 SUP HCPCS C1713 437328 - PLATE BN 173MM NS AXSOS 8X5X 4 HL SS TIB RT PROX LAT 3.5/4MM BOTH IP/OP "$2,026.00" "$1,499.00" $402.03 "$2,025.60" $911.52 $911.52 $911.52 $911.52 "$2,025.60" "$2,025.60" "$2,025.60" $422.19 "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" $422.16 "$2,025.60" "$2,025.60" "$1,198.14" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$1,519.50" "$2,025.60" "$2,025.60" "$2,025.60" "$1,012.80" "$1,012.80" "$1,604.28" "$2,025.60" "$1,620.48" $911.52 $402.03 N/A "$1,175.08" "$2,025.60" "$1,215.36" "$2,025.60" $422.14 "$2,025.60" N/A N/A 437330 SUP HCPCS C1713 437330 - PLATE BN 199MM NS AXSOS 10X5X 5 HL SS TIB RT PROX LAT 3.5/4 BOTH IP/OP "$2,026.00" "$1,499.00" $402.03 "$2,025.60" $911.52 $911.52 $911.52 $911.52 "$2,025.60" "$2,025.60" "$2,025.60" $422.19 "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" $422.16 "$2,025.60" "$2,025.60" "$1,198.14" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$1,519.50" "$2,025.60" "$2,025.60" "$2,025.60" "$1,012.80" "$1,012.80" "$1,604.28" "$2,025.60" "$1,620.48" $911.52 $402.03 N/A "$1,175.08" "$2,025.60" "$1,215.36" "$2,025.60" $422.14 "$2,025.60" N/A N/A 437332 SUP HCPCS C1713 437332 - PLATE BN 225MM NS AXSOS 12X5X 6 HL SS TIB RT PROX LAT 3.5/4 BOTH IP/OP "$2,026.00" "$1,499.00" $402.03 "$2,025.60" $911.52 $911.52 $911.52 $911.52 "$2,025.60" "$2,025.60" "$2,025.60" $422.19 "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" $422.16 "$2,025.60" $810.24 "$1,198.14" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$1,519.50" "$2,025.60" "$2,025.60" "$2,025.60" "$1,012.80" "$1,012.80" "$1,604.28" "$2,025.60" "$1,620.48" $911.52 $402.03 N/A "$1,175.08" "$2,025.60" "$1,215.36" "$2,025.60" $422.14 "$2,025.60" N/A N/A 437334 SUP HCPCS C1713 437334 - PLATE BONE 251MM 14 SHAFT HOLE LOCKING THREADED BOTH IP/OP "$2,026.00" "$1,499.00" $402.03 "$2,025.60" $911.52 $911.52 $911.52 $911.52 "$2,025.60" "$2,025.60" "$2,025.60" $422.19 "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" $422.16 "$2,025.60" $810.24 "$1,198.14" "$2,025.60" "$2,025.60" "$2,025.60" "$2,025.60" "$1,519.50" "$2,025.60" "$2,025.60" "$2,025.60" "$1,012.80" "$1,012.80" "$1,604.28" "$2,025.60" "$1,620.48" $911.52 $402.03 N/A "$1,175.08" "$2,025.60" "$1,215.36" "$2,025.60" $422.14 "$2,025.60" N/A N/A 437404 SUP HCPCS C1713 437404 - PLATE BN 95MM NS AXSOS 4X3X 2 HL SS TIB LT DIST ALAT 3.5/4MM BOTH IP/OP "$2,126.50" "$1,574.00" $422.04 "$2,126.40" $956.88 $956.88 $956.88 $956.88 "$2,126.40" "$2,126.40" "$2,126.40" $443.19 "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" $443.17 "$2,126.40" $850.56 "$1,257.77" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$1,594.88" "$2,126.40" "$2,126.40" "$2,126.40" "$1,063.20" "$1,063.20" "$1,684.11" "$2,126.40" "$1,701.12" $956.88 $422.04 N/A "$1,233.37" "$2,126.40" "$2,126.40" "$2,126.40" $443.14 "$2,126.40" N/A N/A 437406 SUP HCPCS C1713 437406 - PLATE BN 123MM NS AXSOS 6X3X 3 HL SS TIB LT DIST ALAT 3.5/4 BOTH IP/OP "$2,126.50" "$1,574.00" $422.04 "$2,126.40" $956.88 $956.88 $956.88 $956.88 "$2,126.40" "$2,126.40" "$2,126.40" $443.19 "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" $443.17 "$2,126.40" "$2,126.40" "$1,257.77" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$1,594.88" "$2,126.40" "$2,126.40" "$2,126.40" "$1,063.20" "$1,063.20" "$1,684.11" "$2,126.40" "$1,701.12" $956.88 $422.04 N/A "$1,233.37" "$2,126.40" "$1,275.84" "$2,126.40" $443.14 "$2,126.40" N/A N/A 437408 SUP HCPCS C1713 437408 - PLATE BN 149MM NS AXSOS 8X3X 4 HL SS TIB LT DIST ALAT 3.5/4 BOTH IP/OP "$2,126.50" "$1,574.00" $422.04 "$2,126.40" $956.88 $956.88 $956.88 $956.88 "$2,126.40" "$2,126.40" "$2,126.40" $443.19 "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" $443.17 "$2,126.40" $850.56 "$1,257.77" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$1,594.88" "$2,126.40" "$2,126.40" "$2,126.40" "$1,063.20" "$1,063.20" "$1,684.11" "$2,126.40" "$1,701.12" $956.88 $422.04 N/A "$1,233.37" "$2,126.40" "$1,275.84" "$2,126.40" $443.14 "$2,126.40" N/A N/A 437410 SUP HCPCS C1713 437410 - PLATE BN 175MM NS AXSOS 10X3X 5 HL SS TIB LT DIST ALAT 3.5/4 BOTH IP/OP "$2,126.50" "$1,574.00" $422.04 "$2,126.40" $956.88 $956.88 $956.88 $956.88 "$2,126.40" "$2,126.40" "$2,126.40" $443.19 "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" $443.17 "$2,126.40" $850.56 "$1,257.77" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$1,594.88" "$2,126.40" "$2,126.40" "$2,126.40" "$1,063.20" "$1,063.20" "$1,684.11" "$2,126.40" "$1,701.12" $956.88 $422.04 N/A "$1,233.37" "$2,126.40" "$1,275.84" "$2,126.40" $443.14 "$2,126.40" N/A N/A 437412 SUP HCPCS C1713 437412 - PLATE BONE 12 HOLE SHAFT TIBIA ANTLAT DISTAL BOTH IP/OP "$2,232.00" "$1,652.00" $443.00 "$2,232.00" "$1,004.40" "$1,004.40" "$1,004.40" "$1,004.40" "$2,232.00" "$2,232.00" "$2,232.00" $465.20 "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" $465.17 "$2,232.00" $892.80 "$1,320.23" "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" "$1,674.00" "$2,232.00" "$2,232.00" "$2,232.00" "$1,116.00" "$1,116.00" "$1,767.74" "$2,232.00" "$1,785.60" "$1,004.40" $443.00 N/A "$1,294.56" "$2,232.00" "$1,339.20" "$2,232.00" $465.15 "$2,232.00" N/A N/A 437414 SUP HCPCS C1713 437414 - PLATE BONE 14 HOLE SHAFT TIBIA ANTLAT DISTAL BOTH IP/OP "$2,232.00" "$1,652.00" $443.00 "$2,232.00" "$1,004.40" "$1,004.40" "$1,004.40" "$1,004.40" "$2,232.00" "$2,232.00" "$2,232.00" $465.20 "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" $465.17 "$2,232.00" $892.80 "$1,320.23" "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" "$1,674.00" "$2,232.00" "$2,232.00" "$2,232.00" "$1,116.00" "$1,116.00" "$1,767.74" "$2,232.00" "$1,785.60" "$1,004.40" $443.00 N/A "$1,294.56" "$2,232.00" "$1,339.20" "$2,232.00" $465.15 "$2,232.00" N/A N/A 437416 SUP HCPCS C1713 437416 - PLATE BONE 16 HOLE SHAFT TIBIA ANTLAT DISTAL BOTH IP/OP "$2,232.00" "$1,652.00" $443.00 "$2,232.00" "$1,004.40" "$1,004.40" "$1,004.40" "$1,004.40" "$2,232.00" "$2,232.00" "$2,232.00" $465.20 "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" $465.17 "$2,232.00" $892.80 "$1,320.23" "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" "$1,674.00" "$2,232.00" "$2,232.00" "$2,232.00" "$1,116.00" "$1,116.00" "$1,767.74" "$2,232.00" "$1,785.60" "$1,004.40" $443.00 N/A "$1,294.56" "$2,232.00" "$1,339.20" "$2,232.00" $465.15 "$2,232.00" N/A N/A 437424 SUP HCPCS C1713 437424 - PLATE BN 95MM NS AXSOS 4X3X 2 HL SS TIB RT DIST ALAT 3.5/4MM BOTH IP/OP "$2,126.50" "$1,574.00" $422.04 "$2,126.40" $956.88 $956.88 $956.88 $956.88 "$2,126.40" "$2,126.40" "$2,126.40" $443.19 "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" $443.17 "$2,126.40" $850.56 "$1,257.77" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$1,594.88" "$2,126.40" "$2,126.40" "$2,126.40" "$1,063.20" "$1,063.20" "$1,684.11" "$2,126.40" "$1,701.12" $956.88 $422.04 N/A "$1,233.37" "$2,126.40" "$1,275.84" "$2,126.40" $443.14 "$2,126.40" N/A N/A 437426 SUP HCPCS C1713 437426 - PLATE BONE 123MM REFLEX STAINLESS STEEL RIGHT ANTLAT TIBIA BOTH IP/OP "$2,126.50" "$1,574.00" $422.04 "$2,126.40" $956.88 $956.88 $956.88 $956.88 "$2,126.40" "$2,126.40" "$2,126.40" $443.19 "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" $443.17 "$2,126.40" $850.56 "$1,257.77" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$1,594.88" "$2,126.40" "$2,126.40" "$2,126.40" "$1,063.20" "$1,063.20" "$1,684.11" "$2,126.40" "$1,701.12" $956.88 $422.04 N/A "$1,233.37" "$2,126.40" "$2,126.40" "$2,126.40" $443.14 "$2,126.40" N/A N/A 437428 SUP HCPCS C1713 437428 - PLATE BN 149MM NS AXSOS 8X3X 4 HL SS TIB RT DIST ALAT 4/3.5 BOTH IP/OP "$2,126.50" "$1,574.00" $422.04 "$2,126.40" $956.88 $956.88 $956.88 $956.88 "$2,126.40" "$2,126.40" "$2,126.40" $443.19 "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" $443.17 "$2,126.40" $850.56 "$1,257.77" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$1,594.88" "$2,126.40" "$2,126.40" "$2,126.40" "$1,063.20" "$1,063.20" "$1,684.11" "$2,126.40" "$1,701.12" $956.88 $422.04 N/A "$1,233.37" "$2,126.40" "$1,275.84" "$2,126.40" $443.14 "$2,126.40" N/A N/A 437430 SUP HCPCS C1713 437430 - PLATE BONE 10 HOLE SHAFT TIBIA ANTLAT DISTAL BOTH IP/OP "$2,126.50" "$1,574.00" $422.04 "$2,126.40" $956.88 $956.88 $956.88 $956.88 "$2,126.40" "$2,126.40" "$2,126.40" $443.19 "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" $443.17 "$2,126.40" $850.56 "$1,257.77" "$2,126.40" "$2,126.40" "$2,126.40" "$2,126.40" "$1,594.88" "$2,126.40" "$2,126.40" "$2,126.40" "$1,063.20" "$1,063.20" "$1,684.11" "$2,126.40" "$1,701.12" $956.88 $422.04 N/A "$1,233.37" "$2,126.40" "$1,275.84" "$2,126.40" $443.14 "$2,126.40" N/A N/A 437432 SUP HCPCS C1713 437432 - PLATE BONE 201MM 12 HOLE AXSOS STAINLESS STEEL TIBIA RIGHT BOTH IP/OP "$2,232.00" "$1,652.00" $443.00 "$2,232.00" "$1,004.40" "$1,004.40" "$1,004.40" "$1,004.40" "$2,232.00" "$2,232.00" "$2,232.00" $465.20 "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" $465.17 "$2,232.00" $892.80 "$1,320.23" "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" "$1,674.00" "$2,232.00" "$2,232.00" "$2,232.00" "$1,116.00" "$1,116.00" "$1,767.74" "$2,232.00" "$1,785.60" "$1,004.40" $443.00 N/A "$1,294.56" "$2,232.00" "$1,339.20" "$2,232.00" $465.15 "$2,232.00" N/A N/A 437434 SUP HCPCS C1713 437434 - PLATE BN 14 HL SHFT TIB RT ALAT DIST BOTH IP/OP "$2,232.00" "$1,652.00" $443.00 "$2,232.00" "$1,004.40" "$1,004.40" "$1,004.40" "$1,004.40" "$2,232.00" "$2,232.00" "$2,232.00" $465.20 "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" $465.17 "$2,232.00" $892.80 "$1,320.23" "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" "$1,674.00" "$2,232.00" "$2,232.00" "$2,232.00" "$1,116.00" "$1,116.00" "$1,767.74" "$2,232.00" "$1,785.60" "$1,004.40" $443.00 N/A "$1,294.56" "$2,232.00" "$1,339.20" "$2,232.00" $465.15 "$2,232.00" N/A N/A 437436 SUP HCPCS C1713 437436 - PLATE BONE 16 HOLE SHAFT TIBIA ANTLAT DISTAL BOTH IP/OP "$2,232.00" "$1,652.00" $443.00 "$2,232.00" "$1,004.40" "$1,004.40" "$1,004.40" "$1,004.40" "$2,232.00" "$2,232.00" "$2,232.00" $465.20 "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" $465.17 "$2,232.00" $892.80 "$1,320.23" "$2,232.00" "$2,232.00" "$2,232.00" "$2,232.00" "$1,674.00" "$2,232.00" "$2,232.00" "$2,232.00" "$1,116.00" "$1,116.00" "$1,767.74" "$2,232.00" "$1,785.60" "$1,004.40" $443.00 N/A "$1,294.56" "$2,232.00" "$1,339.20" "$2,232.00" $465.15 "$2,232.00" N/A N/A 437504 SUP HCPCS C1713 437504 - PLATE BN 130MM NS AXSOS 4X5X 2 HL SS FEM LT DIST LAT BOTH IP/OP "$2,439.50" "$1,805.00" $484.12 "$2,439.20" "$1,097.64" "$1,097.64" "$1,097.64" "$1,097.64" "$2,439.20" "$2,439.20" "$2,439.20" $508.39 "$2,439.20" "$2,439.20" "$2,439.20" "$2,439.20" "$2,439.20" $508.36 "$2,439.20" $975.68 "$1,442.79" "$2,439.20" "$2,439.20" "$2,439.20" "$2,439.20" "$1,829.63" "$2,439.20" "$2,439.20" "$2,439.20" "$1,219.60" "$1,219.60" "$1,931.85" "$2,439.20" "$1,951.36" "$1,097.64" $484.12 N/A "$1,414.91" "$2,439.20" "$1,463.52" "$2,439.20" $508.33 "$2,439.20" N/A N/A 437506 SUP HCPCS C1713 437506 - PLATE BN 166MM NS AXSOS 6X5X 3 HL SS FEM LT DIST LAT BOTH IP/OP "$2,439.50" "$1,805.00" $484.12 "$2,439.20" "$1,097.64" "$1,097.64" "$1,097.64" "$1,097.64" "$2,439.20" "$2,439.20" "$2,439.20" $508.39 "$2,439.20" "$2,439.20" "$2,439.20" "$2,439.20" "$2,439.20" $508.36 "$2,439.20" "$2,439.20" "$1,442.79" "$2,439.20" "$2,439.20" "$2,439.20" "$2,439.20" "$1,829.63" "$2,439.20" "$2,439.20" "$2,439.20" "$1,219.60" "$1,219.60" "$1,931.85" "$2,439.20" "$1,951.36" "$1,097.64" $484.12 N/A "$1,414.91" "$2,439.20" "$1,463.52" "$2,439.20" $508.33 "$2,439.20" N/A N/A 437508 SUP HCPCS C1713 437508 - PLATE BN 202MM NS AXSOS 8X5X 4 HL SS FEM LT DIST LAT BOTH IP/OP "$2,450.00" "$1,813.00" $486.18 "$2,449.60" "$1,102.32" "$1,102.32" "$1,102.32" "$1,102.32" "$2,449.60" "$2,449.60" "$2,449.60" $510.56 "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" $510.52 "$2,449.60" $979.84 "$1,448.94" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$1,837.50" "$2,449.60" "$2,449.60" "$2,449.60" "$1,224.80" "$1,224.80" "$1,940.08" "$2,449.60" "$1,959.68" "$1,102.32" $486.18 N/A "$1,421.00" "$2,449.60" "$1,469.76" "$2,449.60" $510.50 "$2,449.60" N/A N/A 437510 SUP HCPCS C1713 437510 - PLATE BN 238MM NS AXSOS 10X5X 5 HL SS FEM LT DIST LAT BOTH IP/OP "$2,450.00" "$1,813.00" $486.18 "$2,449.60" "$1,102.32" "$1,102.32" "$1,102.32" "$1,102.32" "$2,449.60" "$2,449.60" "$2,449.60" $510.56 "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" $510.52 "$2,449.60" $979.84 "$1,448.94" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$1,837.50" "$2,449.60" "$2,449.60" "$2,449.60" "$1,224.80" "$1,224.80" "$1,940.08" "$2,449.60" "$1,959.68" "$1,102.32" $486.18 N/A "$1,421.00" "$2,449.60" "$2,449.60" "$2,449.60" $510.50 "$2,449.60" N/A N/A 437512 SUP HCPCS C1713 437512 - PLATE BONE 274MM 12 HOLE SHAFT TOT STABILIZE AXSOS STAINLESS BOTH IP/OP "$2,450.00" "$1,813.00" $486.18 "$2,449.60" "$1,102.32" "$1,102.32" "$1,102.32" "$1,102.32" "$2,449.60" "$2,449.60" "$2,449.60" $510.56 "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" $510.52 "$2,449.60" "$2,449.60" "$1,448.94" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$1,837.50" "$2,449.60" "$2,449.60" "$2,449.60" "$1,224.80" "$1,224.80" "$1,940.08" "$2,449.60" "$1,959.68" "$1,102.32" $486.18 N/A "$1,421.00" "$2,449.60" "$1,469.76" "$2,449.60" $510.50 "$2,449.60" N/A N/A 437514 SUP HCPCS C1713 437514 - PLATE BN 310MM NS AXSOS 10X5X 7 HL SS FEM LT DIST LAT BOTH IP/OP "$2,450.00" "$1,813.00" $486.18 "$2,449.60" "$1,102.32" "$1,102.32" "$1,102.32" "$1,102.32" "$2,449.60" "$2,449.60" "$2,449.60" $510.56 "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" $510.52 "$2,449.60" $979.84 "$1,448.94" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$1,837.50" "$2,449.60" "$2,449.60" "$2,449.60" "$1,224.80" "$1,224.80" "$1,940.08" "$2,449.60" "$1,959.68" "$1,102.32" $486.18 N/A "$1,421.00" "$2,449.60" "$2,449.60" "$2,449.60" $510.50 "$2,449.60" N/A N/A 437516 SUP HCPCS C1713 437516 - PLATE BN 343MM NS AXSOS 16X5X 8 HL SS FEM LT DIST LAT BOTH IP/OP "$2,450.00" "$1,813.00" $486.18 "$2,449.60" "$1,102.32" "$1,102.32" "$1,102.32" "$1,102.32" "$2,449.60" "$2,449.60" "$2,449.60" $510.56 "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" $510.52 "$2,449.60" $979.84 "$1,448.94" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$1,837.50" "$2,449.60" "$2,449.60" "$2,449.60" "$1,224.80" "$1,224.80" "$1,940.08" "$2,449.60" "$1,959.68" "$1,102.32" $486.18 N/A "$1,421.00" "$2,449.60" "$1,469.76" "$2,449.60" $510.50 "$2,449.60" N/A N/A 437524 SUP HCPCS C1713 437524 - PLATE BN 130MM NS AXSOS 4X5X 2 HL SS FEM RT DIST LAT BOTH IP/OP "$2,439.50" "$1,805.00" $484.12 "$2,439.20" "$1,097.64" "$1,097.64" "$1,097.64" "$1,097.64" "$2,439.20" "$2,439.20" "$2,439.20" $508.39 "$2,439.20" "$2,439.20" "$2,439.20" "$2,439.20" "$2,439.20" $508.36 "$2,439.20" $975.68 "$1,442.79" "$2,439.20" "$2,439.20" "$2,439.20" "$2,439.20" "$1,829.63" "$2,439.20" "$2,439.20" "$2,439.20" "$1,219.60" "$1,219.60" "$1,931.85" "$2,439.20" "$1,951.36" "$1,097.64" $484.12 N/A "$1,414.91" "$2,439.20" "$1,463.52" "$2,439.20" $508.33 "$2,439.20" N/A N/A 437526 SUP HCPCS C1713 437526 - PLATE BN 166MM NS AXSOS 6X5X 3 HL SS FEM RT DIST LAT BOTH IP/OP "$2,439.50" "$1,805.00" $484.12 "$2,439.20" "$1,097.64" "$1,097.64" "$1,097.64" "$1,097.64" "$2,439.20" "$2,439.20" "$2,439.20" $508.39 "$2,439.20" "$2,439.20" "$2,439.20" "$2,439.20" "$2,439.20" $508.36 "$2,439.20" $975.68 "$1,442.79" "$2,439.20" "$2,439.20" "$2,439.20" "$2,439.20" "$1,829.63" "$2,439.20" "$2,439.20" "$2,439.20" "$1,219.60" "$1,219.60" "$1,931.85" "$2,439.20" "$1,951.36" "$1,097.64" $484.12 N/A "$1,414.91" "$2,439.20" "$1,463.52" "$2,439.20" $508.33 "$2,439.20" N/A N/A 437528 SUP HCPCS C1713 437528 - PLATE BN 202MM NS AXSOS 8X5X 4 HL SS FEM RT DIST LAT BOTH IP/OP "$2,450.00" "$1,813.00" $486.18 "$2,449.60" "$1,102.32" "$1,102.32" "$1,102.32" "$1,102.32" "$2,449.60" "$2,449.60" "$2,449.60" $510.56 "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" $510.52 "$2,449.60" $979.84 "$1,448.94" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$1,837.50" "$2,449.60" "$2,449.60" "$2,449.60" "$1,224.80" "$1,224.80" "$1,940.08" "$2,449.60" "$1,959.68" "$1,102.32" $486.18 N/A "$1,421.00" "$2,449.60" "$1,469.76" "$2,449.60" $510.50 "$2,449.60" N/A N/A 437530 SUP HCPCS C1713 437530 - PLATE BN 238MM NS AXSOS 10X5X 5 HL SS FEM RT DIST LAT BOTH IP/OP "$2,450.00" "$1,813.00" $486.18 "$2,449.60" "$1,102.32" "$1,102.32" "$1,102.32" "$1,102.32" "$2,449.60" "$2,449.60" "$2,449.60" $510.56 "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" $510.52 "$2,449.60" "$2,449.60" "$1,448.94" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$1,837.50" "$2,449.60" "$2,449.60" "$2,449.60" "$1,224.80" "$1,224.80" "$1,940.08" "$2,449.60" "$1,959.68" "$1,102.32" $486.18 N/A "$1,421.00" "$2,449.60" "$1,469.76" "$2,449.60" $510.50 "$2,449.60" N/A N/A 437532 SUP HCPCS C1713 437532 - PLATE BN 274MM NS AXSOS 12X5X 6 HL SS FEM RT DIST LAT BOTH IP/OP "$2,450.00" "$1,813.00" $486.18 "$2,449.60" "$1,102.32" "$1,102.32" "$1,102.32" "$1,102.32" "$2,449.60" "$2,449.60" "$2,449.60" $510.56 "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" $510.52 "$2,449.60" "$2,449.60" "$1,448.94" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$1,837.50" "$2,449.60" "$2,449.60" "$2,449.60" "$1,224.80" "$1,224.80" "$1,940.08" "$2,449.60" "$1,959.68" "$1,102.32" $486.18 N/A "$1,421.00" "$2,449.60" "$1,469.76" "$2,449.60" $510.50 "$2,449.60" N/A N/A 437534 SUP HCPCS C1713 437534 - PLATE BONE 310MM 14X5X 7 HOLE TOT STABILIZED AXSOS STAINLESS BOTH IP/OP "$2,450.00" "$1,813.00" $486.18 "$2,449.60" "$1,102.32" "$1,102.32" "$1,102.32" "$1,102.32" "$2,449.60" "$2,449.60" "$2,449.60" $510.56 "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" $510.52 "$2,449.60" "$2,449.60" "$1,448.94" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$1,837.50" "$2,449.60" "$2,449.60" "$2,449.60" "$1,224.80" "$1,224.80" "$1,940.08" "$2,449.60" "$1,959.68" "$1,102.32" $486.18 N/A "$1,421.00" "$2,449.60" "$1,469.76" "$2,449.60" "$2,449.60" "$2,449.60" N/A N/A 437536 SUP HCPCS C1713 437536 - PLATE BN 343MM NS AXSOS 16X5X 8 HL SS FEM RT DIST LAT BOTH IP/OP "$2,450.00" "$1,813.00" $486.18 "$2,449.60" "$1,102.32" "$1,102.32" "$1,102.32" "$1,102.32" "$2,449.60" "$2,449.60" "$2,449.60" $510.56 "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" $510.52 "$2,449.60" $979.84 "$1,448.94" "$2,449.60" "$2,449.60" "$2,449.60" "$2,449.60" "$1,837.50" "$2,449.60" "$2,449.60" "$2,449.60" "$1,224.80" "$1,224.80" "$1,940.08" "$2,449.60" "$1,959.68" "$1,102.32" $486.18 N/A "$1,421.00" "$2,449.60" "$1,469.76" "$2,449.60" "$2,449.60" "$2,449.60" N/A N/A 439678 SUP HCPCS C1900 439678 - LEAD PACING STR 4FR 78CM 2 ELECTRODE TINES IS-1 ATTAIN BOTH IP/OP "$3,562.50" "$2,636.00" $707.07 "$3,562.50" "$1,603.13" "$1,603.13" "$1,603.13" "$1,603.13" "$3,562.50" "$3,562.50" "$3,562.50" $742.51 "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" $742.46 "$3,562.50" "$3,492.50" "$1,756.31" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$2,671.88" "$3,562.50" "$3,562.50" "$3,562.50" "$1,781.25" "$1,781.25" "$2,821.50" "$3,562.50" "$2,850.00" "$1,603.13" $707.07 N/A "$2,066.25" "$3,562.50" "$3,562.50" "$3,562.50" $742.43 "$3,562.50" N/A N/A 439688 SUP HCPCS C1900 439688 - LEAD PACING STR 4FR 88CM 2 ELECTRODE TINES IS-1 ATTAIN BOTH IP/OP "$3,562.50" "$2,636.00" $707.07 "$3,562.50" "$1,603.13" "$1,603.13" "$1,603.13" "$1,603.13" "$3,562.50" "$3,562.50" "$3,562.50" $742.51 "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" $742.46 "$3,562.50" "$3,492.50" "$1,756.31" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$2,671.88" "$3,562.50" "$3,562.50" "$3,562.50" "$1,781.25" "$1,781.25" "$2,821.50" "$3,562.50" "$2,850.00" "$1,603.13" $707.07 N/A "$2,066.25" "$3,562.50" "$3,562.50" "$3,562.50" $742.43 "$3,562.50" N/A N/A 439878 SUP Custom 27203010 439878 - LEAD PACING .014-.018IN 5.3FR 5.1FR 78CM QUADRIPOLAR BOTH IP/OP "$4,042.50" "$2,991.00" $719.57 "$4,042.50" "$4,042.50" "$4,042.50" "$4,042.50" "$4,042.50" "$4,042.50" "$4,042.50" $719.57 "$4,042.50" "$4,042.50" "$3,000.34" "$3,000.34" "$3,115.96" "$2,060.15" $842.50 "$4,042.50" "$1,500.00" "$4,042.50" "$4,042.50" "$3,750.00" "$4,042.50" "$4,042.50" "$3,031.88" "$4,042.50" "$4,042.50" "$4,042.50" "$2,021.25" "$2,021.25" "$3,201.66" "$4,042.50" "$3,234.00" "$2,627.63" "$4,042.50" N/A "$2,344.65" "$4,042.50" "$2,425.50" "$4,042.50" "$4,042.50" "$4,042.50" N/A N/A 439888 SUP HCPCS C1900 439888 - LEAD PACING ATTAIN STARFIX LEFT VENTRICLE BOTH IP/OP "$4,042.50" "$2,991.00" $802.34 "$4,042.50" "$1,819.13" "$1,819.13" "$1,819.13" "$1,819.13" "$4,042.50" "$4,042.50" "$4,042.50" $842.56 "$4,042.50" "$4,042.50" "$4,042.50" "$4,042.50" "$4,042.50" $842.50 "$4,042.50" "$3,750.00" "$1,992.95" "$4,042.50" "$3,750.00" "$4,042.50" "$4,042.50" "$3,031.88" "$4,042.50" "$4,042.50" "$4,042.50" "$2,021.25" "$2,021.25" "$3,201.66" "$4,042.50" "$3,234.00" "$1,819.13" $802.34 N/A "$2,344.65" "$4,042.50" "$4,042.50" "$4,042.50" $842.46 "$4,042.50" N/A N/A 440400 SUP Custom 27203010 440400 - DRESSING NSL THK1.5CM STD 4.5CM WHT STRL LF MRCL TMPN SPT BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A 440402 SUP Custom 27203010 440402 - DRESSING NSL STD 8CM WHT STRL LF MRCL CMPR DRWSTRG SPT DISP BOTH IP/OP $44.50 $33.00 $7.92 $44.50 $44.50 $44.50 $44.50 $44.50 $44.50 $44.50 $7.92 $44.50 $44.50 $33.03 $33.03 $34.30 $23.18 $9.27 $44.50 $17.80 $44.50 $44.50 $44.50 $44.50 $44.50 $33.38 $44.50 $44.50 $44.50 $22.25 $22.25 $35.24 $44.50 $35.60 $28.93 $44.50 N/A $25.81 $44.50 $26.70 $44.50 $44.50 $44.50 N/A N/A 453547 SUP HCPCS C1751 453547 - CATHETER IV 26GA .75IN STRL LF ABCTH-T ISO CLR CD TFLN BOTH IP/OP $9.00 $7.00 $1.72 $8.68 $3.91 $3.91 $3.91 $3.91 $8.68 $8.68 $8.68 $1.81 $8.68 $8.68 $8.68 $8.68 $8.68 $1.81 $8.68 $8.68 $5.13 $8.68 $8.68 $8.68 $8.68 $6.75 $8.68 $8.68 $8.68 $4.34 $4.34 $6.87 $8.68 $6.94 $3.91 $1.72 N/A $5.22 $8.68 $8.68 $8.68 $1.81 $8.68 N/A N/A 459878 SUP HCPCS C1900 459878 - LEAD PACING .014-.018IN OFFST S 5.3FR 5.1FR 78CM QUADRIPOLAR BOTH IP/OP "$4,042.50" "$2,991.00" $802.34 "$4,042.50" "$1,819.13" "$1,819.13" "$1,819.13" "$1,819.13" "$4,042.50" "$4,042.50" "$4,042.50" $842.56 "$4,042.50" "$4,042.50" "$4,042.50" "$4,042.50" "$4,042.50" $842.50 "$4,042.50" "$3,750.00" "$1,992.95" "$4,042.50" "$3,750.00" "$4,042.50" "$4,042.50" "$3,031.88" "$4,042.50" "$4,042.50" "$4,042.50" "$2,021.25" "$2,021.25" "$3,201.66" "$4,042.50" "$3,234.00" "$1,819.13" $802.34 N/A "$2,344.65" "$4,042.50" "$4,042.50" "$4,042.50" $842.46 "$4,042.50" N/A N/A 459888 SUP HCPCS C1900 459888 - LEAD PCNG 5.3FR 5.1FR 78CM STRL LF 88CM ATN PRFM QDPL ELTRD BOTH IP/OP "$4,042.50" "$2,991.00" $802.34 "$4,042.50" "$1,819.13" "$1,819.13" "$1,819.13" "$1,819.13" "$4,042.50" "$4,042.50" "$4,042.50" $842.56 "$4,042.50" "$4,042.50" "$4,042.50" "$4,042.50" "$4,042.50" $842.50 "$4,042.50" "$3,750.00" "$1,992.95" "$4,042.50" "$3,750.00" "$4,042.50" "$4,042.50" "$3,031.88" "$4,042.50" "$4,042.50" "$4,042.50" "$2,021.25" "$2,021.25" "$3,201.66" "$4,042.50" "$3,234.00" "$1,819.13" $802.34 N/A "$2,344.65" "$4,042.50" "$4,042.50" "$4,042.50" $842.46 "$4,042.50" N/A N/A 472620 SUP CPT® Q4128 472620 - GRAFT SKIN THK1.8+ MM ULTRATHICK 20X16CM ALLOGRAFT HYDRATE BOTH IP/OP "$21,021.00" "$15,556.00" "$4,381.01" "$21,021.00" "$21,021.00" "$21,021.00" "$21,021.00" "$21,021.00" "$21,021.00" "$21,021.00" "$21,021.00" "$21,021.00" "$21,021.00" "$21,021.00" "$21,021.00" "$21,021.00" "$21,021.00" "$4,381.01" "$21,021.00" "$8,408.40" "$21,021.00" "$21,021.00" "$21,021.00" "$21,021.00" "$21,021.00" "$15,765.75" "$21,021.00" "$21,021.00" "$21,021.00" "$10,510.50" "$10,510.50" "$16,648.63" "$21,021.00" "$16,816.80" "$9,459.45" "$21,021.00" N/A "$12,192.18" "$21,021.00" "$12,612.60" "$21,021.00" "$21,021.00" "$21,021.00" N/A N/A Jan-00 SUP Custom 27803010 01-3200 - HEAD FEMORAL +0MM 32MM MORSE TAPER LFIT COCR HIP BOTH IP/OP "$1,795.00" "$1,328.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $374.10 "$1,795.00" $718.00 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,346.25" "$1,795.00" "$1,795.00" "$1,795.00" $897.50 $897.50 "$1,421.64" "$1,795.00" "$1,436.00" $807.75 "$1,795.00" N/A "$1,041.10" "$1,795.00" "$1,077.00" "$1,795.00" "$1,795.00" "$1,795.00" N/A N/A Jun-00 SUP Custom 27803010 06-3200 - HEAD FEMORAL 0 32MM C TAPER LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A Jan-05 SUP Custom 27803010 01-3205 - HEAD FEMORAL +5MM MORSE TAPER 32MM LFIT COCR HIP BOTH IP/OP "$1,795.00" "$1,328.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $374.10 "$1,795.00" $718.00 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,346.25" "$1,795.00" "$1,795.00" "$1,795.00" $897.50 $897.50 "$1,421.64" "$1,795.00" "$1,436.00" $807.75 "$1,795.00" N/A "$1,041.10" "$1,795.00" "$1,077.00" "$1,795.00" "$1,795.00" "$1,795.00" N/A N/A Jan-06 SUP HCPCS C1713 1-3206 - SPACER SPNL 6MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$3,363.00" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A Jan-08 SUP HCPCS C1713 1-3208 - SPACER SPNL 8MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$3,363.00" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A Jan-10 SUP Custom 27803010 01-3210 - HEAD FEMORAL 10MM MORSE TAPER 32MM MORSE TAPER LFIT HIP BOTH IP/OP "$1,795.00" "$1,328.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $374.10 "$1,795.00" $718.00 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,346.25" "$1,795.00" "$1,795.00" "$1,795.00" $897.50 $897.50 "$1,421.64" "$1,795.00" "$1,436.00" $807.75 "$1,795.00" N/A "$1,041.10" "$1,795.00" "$1,077.00" "$1,795.00" "$1,795.00" "$1,795.00" N/A N/A Jan-10 SUP HCPCS C1713 1-3210 - SPACER SPNL 10MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS BOTH IP/OP "$8,407.50" "$6,222.00" $319.51 "$6,305.63" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $374.10 "$1,795.00" $718.00 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$6,305.63" "$1,795.00" "$1,795.00" "$1,795.00" $897.50 $897.50 "$1,421.64" "$1,795.00" "$1,436.00" $807.75 "$1,795.00" N/A "$4,876.35" "$1,795.00" "$1,077.00" "$1,795.00" "$1,795.00" "$1,795.00" N/A N/A Jun-10 SUP Custom 27803010 06-3210 - HEAD FEM +10MM OFST CTPR 32MM STRL LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A Jan-12 SUP HCPCS C1713 1-3212 - SPACER SPNL 12MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$8,407.50" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A Jan-14 SUP HCPCS C1713 1-3214 - SPACER SPNL 14MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$8,407.50" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A Jan-16 SUP HCPCS C1713 1-3216 - SPACER SPNL 16MM X-STP PEEK LMBR INTERSPINOUS PRC DCMPRS BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$8,407.50" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 482047 SUP HCPCS C1763 482047 - IMPL URO PLVCL BCMPT VERSATILITY DRBLTY STRTH ACLR CLGN MTRX BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $506.25 $506.25 $506.25 $506.25 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 $223.28 N/A $652.50 "$1,125.00" "$1,125.00" "$1,125.00" $234.45 "$1,125.00" N/A N/A 502452 SUP HCPCS C1769 502452 - GUIDEWIRE VASC 3MM RDS J .025IN 260CM STRL LF 7CM CRDS EMRLD BOTH IP/OP $23.00 $17.00 $4.48 $65.00 $12.26 $12.26 $12.26 $12.26 $22.58 $22.58 $22.58 $4.71 $22.58 $16.76 $16.76 $17.40 $11.76 $4.71 $22.58 $65.00 $13.36 $22.58 $65.00 $22.58 $22.58 $17.25 $22.58 $22.58 $22.58 $11.29 $11.29 $17.88 $22.58 $18.06 $14.68 $4.48 N/A $13.34 $22.58 $22.58 $22.58 $4.71 $22.58 N/A N/A 502455 SUP HCPCS C1769 502455 - GUIDEWIRE VASC 3MM RDS J .035IN 260CM STRL LF 7CM CRDS EMRLD BOTH IP/OP $23.00 $17.00 $4.48 $65.00 $12.26 $12.26 $12.26 $12.26 $22.58 $22.58 $22.58 $4.71 $22.58 $16.76 $16.76 $17.40 $11.76 $4.71 $22.58 $65.00 $13.36 $22.58 $65.00 $22.58 $22.58 $17.25 $22.58 $22.58 $22.58 $11.29 $11.29 $17.88 $22.58 $18.06 $14.68 $4.48 N/A $13.34 $22.58 $22.58 $22.58 $4.71 $22.58 N/A N/A 502521 SUP HCPCS C1769 502521 - GUIDEWIRE VASC 3MM RDS J .035IN 150CM STRL LF 7CM CRDS EMRLD BOTH IP/OP $14.50 $11.00 $2.87 $65.00 $7.85 $7.85 $7.85 $7.85 $14.45 $14.45 $14.45 $3.01 $14.45 $10.72 $10.72 $11.14 $7.53 $3.01 $14.45 $65.00 $8.55 $14.45 $65.00 $14.45 $14.45 $10.88 $14.45 $14.45 $14.45 $7.23 $7.23 $11.44 $14.45 $11.56 $9.39 $2.87 N/A $8.41 $14.45 $14.45 $14.45 $3.01 $14.45 N/A N/A 502542 SUP HCPCS C1769 502542 - GUIDEWIRE VASC STRG .035IN 150CM STRL LF 7CM CRDS EMRLD FLXB BOTH IP/OP $14.50 $11.00 $2.87 $65.00 $7.85 $7.85 $7.85 $7.85 $14.45 $14.45 $14.45 $3.01 $14.45 $10.72 $10.72 $11.14 $7.53 $3.01 $14.45 $65.00 $8.55 $14.45 $65.00 $14.45 $14.45 $10.88 $14.45 $14.45 $14.45 $7.23 $7.23 $11.44 $14.45 $11.56 $9.39 $2.87 N/A $8.41 $14.45 $14.45 $14.45 $3.01 $14.45 N/A N/A 510414 SUP HCPCS A4351 510414 - CATHETER URETHRAL ROBINSON RUBBER NEONATE PEDIATRIC L40 CM O BOTH IP/OP $11.00 $8.00 $2.10 $10.58 $5.74 $5.74 $5.74 $5.74 $10.58 $10.58 $10.58 $2.21 $10.58 $7.85 $7.85 $8.16 $5.51 $2.20 $10.58 $10.58 $6.26 $10.58 $10.58 $10.58 $10.58 $8.25 $10.58 $10.58 $10.58 $5.29 $5.29 $8.38 $10.58 $8.46 $6.88 $2.10 N/A $6.38 $10.58 $10.58 $10.58 $2.20 $10.58 N/A N/A 510422 SUP HCPCS A4351 510422 - CATHETER URETHRAL 22FR 16IN 2 STAGGERED EYE RADIOPQ LATEX BOTH IP/OP $11.00 $8.00 $2.10 $10.58 $5.74 $5.74 $5.74 $5.74 $10.58 $10.58 $10.58 $2.21 $10.58 $7.85 $7.85 $8.16 $5.51 $2.20 $10.58 $10.58 $6.26 $10.58 $10.58 $10.58 $10.58 $8.25 $10.58 $10.58 $10.58 $5.29 $5.29 $8.38 $10.58 $8.46 $6.88 $2.10 N/A $6.38 $10.58 $10.58 $10.58 $2.20 $10.58 N/A N/A 510426 SUP HCPCS C2627 510426 - CATHETER URTH 26FR 16IN RD STRL LTX RUSCH RBNSN 2 STGR EYE BOTH IP/OP $106.00 $78.00 $20.99 $105.75 $57.42 $57.42 $57.42 $57.42 $105.75 $105.75 $105.75 $22.04 $105.75 $78.49 $78.49 $81.51 $55.10 $22.04 $105.75 $105.75 $62.55 $105.75 $105.75 $105.75 $105.75 $79.50 $105.75 $105.75 $105.75 $52.88 $52.88 $83.75 $105.75 $84.60 $68.74 $20.99 N/A $61.48 $105.75 $105.75 $105.75 $22.04 $105.75 N/A N/A 510428 SUP HCPCS C1758 510428 - CATHETER URTH 28FR 16IN RD STRL LTX 2 STGR EYE RADOPQ RBR BOTH IP/OP $11.00 $8.00 $2.10 $10.58 $5.74 $5.74 $5.74 $5.74 $10.58 $10.58 $10.58 $2.21 $10.58 $7.85 $7.85 $8.16 $5.51 $2.20 $10.58 $4.23 $6.26 $10.58 $10.58 $10.58 $10.58 $8.25 $10.58 $10.58 $10.58 $5.29 $5.29 $8.38 $10.58 $8.46 $6.88 $2.10 N/A $6.38 $10.58 $10.58 $10.58 $2.20 $10.58 N/A N/A 510428 SUP HCPCS C1758 510428 - CATHETER URTH 28FR 16IN RD STRL LTX 2 STGR EYE RADOPQ RBR BOTH IP/OP $11.00 $8.00 $2.10 $10.58 $5.74 $5.74 $5.74 $5.74 $10.58 $10.58 $10.58 $2.21 $10.58 $7.85 $7.85 $8.16 $5.51 $2.20 $10.58 $4.23 $6.26 $10.58 $10.58 $10.58 $10.58 $8.25 $10.58 $10.58 $10.58 $5.29 $5.29 $8.38 $10.58 $8.46 $6.88 $2.10 N/A $6.38 $10.58 $10.58 $10.58 $2.20 $10.58 N/A N/A Jan-99 SUP Custom 27803010 01-3299 - HEAD FEMORAL -5MM 32MM MORSE TAPER LFIT COCR HIP BOTH IP/OP "$1,795.00" "$1,328.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $319.51 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" $374.10 "$1,795.00" $718.00 "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,795.00" "$1,346.25" "$1,795.00" "$1,795.00" "$1,795.00" $897.50 $897.50 "$1,421.64" "$1,795.00" "$1,436.00" $807.75 "$1,795.00" N/A "$1,041.10" "$1,795.00" "$1,077.00" "$1,795.00" "$1,795.00" "$1,795.00" N/A N/A Jun-99 SUP Custom 27203010 06-3299 - HEAD FEM -5MM OFST CTPR 32MM STRL LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $640.15 $640.15 $664.82 $449.36 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $560.63 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 511212 SUP HCPCS C1898 511212 - LEAD PACING 54CM BIPOL ACTIVE FIX IS-1 VS-1 MYOPORE SILICONE BOTH IP/OP $680.00 $503.00 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 N/A $394.40 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 511212 SUP HCPCS C1898 "511212 - IS-1, Silicone, 54cm, V placement" BOTH IP/OP "$1,125.00" $833.00 $141.72 $843.75 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $843.75 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 N/A $652.50 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 516001 SUP HCPCS Q4130 0516001 - MATRIX TISSUE 16X5CM RECONSTRUCTIVE STRATTICE PIG DERMIS BOTH IP/OP "$24,997.50" "$18,498.00" "$2,030.00" "$24,997.50" "$24,997.50" "$24,997.50" "$24,997.50" "$24,997.50" "$24,997.50" "$24,997.50" "$24,997.50" "$24,997.50" "$24,997.50" "$24,997.50" "$24,997.50" "$24,997.50" "$24,997.50" "$5,209.75" "$24,997.50" "$2,030.00" "$24,997.50" "$24,997.50" "$24,997.50" "$24,997.50" "$24,997.50" "$18,748.13" "$24,997.50" "$24,997.50" "$24,997.50" "$12,498.75" "$12,498.75" "$19,798.02" "$24,997.50" "$19,998.00" "$11,248.88" "$24,997.50" N/A "$14,498.55" "$24,997.50" "$14,998.50" "$24,997.50" "$24,997.50" "$24,997.50" N/A N/A 520368 SUP HCPCS C1713 520368 - SCREW BN 2MM CMPR HEX SCKT BOTH IP/OP $38.50 $28.00 $7.62 $38.40 $17.28 $17.28 $17.28 $17.28 $38.40 $38.40 $38.40 $8.00 $38.40 $38.40 $38.40 $38.40 $38.40 $8.00 $38.40 $15.36 $22.71 $38.40 $38.40 $38.40 $38.40 $28.88 $38.40 $38.40 $38.40 $19.20 $19.20 $30.41 $38.40 $30.72 $17.28 $7.62 N/A $22.33 $38.40 $23.04 $38.40 $8.00 $38.40 N/A N/A 522022 SUP HCPCS C1776 522022 - HEAD FEM +0MM 11/13 TPR 22MM STRL SR COCR HIP MDLR SYS BOTH IP/OP "$3,187.50" "$2,359.00" $632.64 "$3,187.50" "$1,434.38" "$1,434.38" "$1,434.38" "$1,434.38" "$3,187.50" "$3,187.50" "$3,187.50" $664.35 "$3,187.50" "$3,187.50" "$3,187.50" "$3,187.50" "$3,187.50" $664.31 "$3,187.50" "$1,275.00" "$1,571.44" "$3,187.50" "$3,187.50" "$3,187.50" "$3,187.50" "$2,390.63" "$3,187.50" "$3,187.50" "$3,187.50" "$1,593.75" "$1,593.75" "$2,524.50" "$3,187.50" "$2,550.00" "$1,434.38" $632.64 N/A "$1,848.75" "$3,187.50" "$3,187.50" "$3,187.50" $664.28 "$3,187.50" N/A N/A 528341 SUP Custom 27203010 528341 - PILLING SURGILUX H/L VAR. 10-75 MM BOTH IP/OP "$2,400.00" "$1,776.00" $427.20 "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" $427.20 "$2,400.00" "$2,400.00" "$1,781.28" "$1,781.28" "$1,849.92" "$1,250.40" $500.19 "$2,400.00" $960.00 "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$1,800.00" "$2,400.00" "$2,400.00" "$2,400.00" "$1,200.00" "$1,200.00" "$1,900.80" "$2,400.00" "$1,920.00" "$1,560.00" "$2,400.00" N/A "$1,392.00" "$2,400.00" "$1,440.00" "$2,400.00" "$2,400.00" "$2,400.00" N/A N/A 532644 SUP HCPCS C1725 532644 - CATHETER ANGIO MP A2 CRV 6FR 125CM ST BRD ATRM SLCT 2 SH PU BOTH IP/OP $21.50 $16.00 $4.19 $21.13 $11.47 $11.47 $11.47 $11.47 $21.13 $21.13 $21.13 $4.40 $21.13 $15.68 $15.68 $16.29 $11.01 $4.40 $21.13 $21.13 $12.50 $21.13 $21.13 $21.13 $21.13 $16.13 $21.13 $21.13 $21.13 $10.57 $10.57 $16.73 $21.13 $16.90 $13.73 $4.19 N/A $12.47 $21.13 $21.13 $21.13 $4.40 $21.13 N/A N/A 535070 SUP Custom 27203010 535070 - KIT TRACHEOSTOMY 9.6MM 7MM 82MM 2 DECK TRAY DILAT OBTURATOR BOTH IP/OP $677.00 $501.00 $120.51 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $120.51 $677.00 $677.00 $502.47 $502.47 $521.83 $352.72 $141.09 $677.00 $270.80 $677.00 $677.00 $677.00 $677.00 $677.00 $507.75 $677.00 $677.00 $677.00 $338.50 $338.50 $536.18 $677.00 $541.60 $440.05 $677.00 N/A $392.66 $677.00 $406.20 $677.00 $677.00 $677.00 N/A N/A 535080 SUP Custom 27203010 535080 - KIT TRCH 10.9MM 8MM 86MM STRL LTX PRFT PRTX 2 DECK TRY DIL BOTH IP/OP $677.00 $501.00 $120.51 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $120.51 $677.00 $677.00 $502.47 $502.47 $521.83 $352.72 $141.09 $677.00 $259.71 $677.00 $677.00 $649.28 $677.00 $677.00 $507.75 $677.00 $677.00 $677.00 $338.50 $338.50 $536.18 $677.00 $541.60 $440.05 $677.00 N/A $392.66 $677.00 $406.20 $677.00 $677.00 $677.00 N/A N/A 535090 SUP Custom 27203010 535090 - KIT TRACHEOSTOMY 12.3MM 9MM COMPLETE SET INNER CANNU BOTH IP/OP $677.00 $501.00 $120.51 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $120.51 $677.00 $677.00 $502.47 $502.47 $521.83 $352.72 $141.09 $677.00 $270.80 $677.00 $677.00 $677.00 $677.00 $677.00 $507.75 $677.00 $677.00 $677.00 $338.50 $338.50 $536.18 $677.00 $541.60 $440.05 $677.00 N/A $392.66 $677.00 $406.20 $677.00 $677.00 $677.00 N/A N/A 540015 SUP Custom 27203010 540015 - DRILL SURG MICRO CORE BOTH IP/OP "$13,026.00" "$9,639.00" "$2,060.15" "$13,025.75" "$13,025.75" "$13,025.75" "$13,025.75" "$13,025.75" "$13,025.75" "$13,025.75" "$2,318.58" "$13,025.75" "$13,025.75" "$4,181.12" "$4,181.12" "$10,040.25" "$2,060.15" "$2,714.71" "$13,025.75" "$5,210.30" "$13,025.75" "$13,025.75" "$13,025.75" "$13,025.75" "$13,025.75" "$9,769.50" "$13,025.75" "$13,025.75" "$13,025.75" "$6,512.88" "$6,512.88" "$10,316.39" "$13,025.75" "$10,420.60" "$8,466.74" "$13,025.75" N/A "$7,555.08" "$13,025.75" "$7,815.45" "$13,025.75" "$13,025.75" "$13,025.75" N/A N/A 544230 SUP Custom 27803010 544230 - CLIP INTNL MED LG CHEVRON HRT GRN STRL LF WECK HEM-O-LOK LGT BOTH IP/OP $87.00 $64.00 $15.42 $86.61 $86.61 $86.61 $86.61 $86.61 $86.61 $86.61 $15.42 $86.61 $86.61 $86.61 $86.61 $86.61 $86.61 $18.05 $86.61 $34.64 $86.61 $86.61 $86.61 $86.61 $86.61 $65.25 $86.61 $86.61 $86.61 $43.31 $43.31 $68.60 $86.61 $69.29 $38.97 $86.61 N/A $50.46 $86.61 $51.97 $86.61 $86.61 $86.61 N/A N/A 544240 SUP Custom 27803010 544240 - CLIP INTERNAL LARGE LIGATE CARTRIDGE LATEX FREE WECK BOTH IP/OP $87.00 $64.00 $15.42 $86.61 $86.61 $86.61 $86.61 $86.61 $86.61 $86.61 $15.42 $86.61 $86.61 $86.61 $86.61 $86.61 $86.61 $18.05 $86.61 $61.64 $86.61 $86.61 $86.61 $86.61 $86.61 $65.25 $86.61 $86.61 $86.61 $43.31 $43.31 $68.60 $86.61 $69.29 $38.97 $86.61 N/A $50.46 $86.61 $51.97 $86.61 $86.61 $86.61 N/A N/A 544250 SUP Custom 27803010 544250 - CLIP INTERNAL XL LIGATE LATEX FREE WECK HEM-O-LOK GOLD BOTH IP/OP $82.00 $61.00 $14.55 $81.75 $81.75 $81.75 $81.75 $81.75 $81.75 $81.75 $14.55 $81.75 $81.75 $81.75 $81.75 $81.75 $81.75 $17.04 $81.75 $32.70 $81.75 $81.75 $81.75 $81.75 $81.75 $61.50 $81.75 $81.75 $81.75 $40.88 $40.88 $64.75 $81.75 $65.40 $36.79 $81.75 N/A $47.56 $81.75 $49.05 $81.75 $81.75 $81.75 N/A N/A 570624 SUP HCPCS C1729 570624 - CATH URTH SMPLS 24FR 16IN FOLEY 3W CVLR TIP 30ML STRL LATEX BOTH IP/OP $84.50 $63.00 $16.77 $84.50 $45.88 $45.88 $45.88 $45.88 $84.50 $84.50 $84.50 $17.61 $84.50 $62.72 $62.72 $65.13 $44.02 $17.61 $84.50 $84.50 $49.98 $84.50 $84.50 $84.50 $84.50 $63.38 $84.50 $84.50 $84.50 $42.25 $42.25 $66.92 $84.50 $67.60 $54.93 $16.77 N/A $49.01 $84.50 $84.50 $84.50 $17.61 $84.50 N/A N/A 573030 SUP HCPCS C1725 573030 - CATH BALDILAT .014IN 3MM 145CM 10MM OTW NC DRLN NC RPTR BOTH IP/OP $598.00 $443.00 $118.60 $597.55 $324.47 $324.47 $324.47 $324.47 $597.55 $597.55 $597.55 $124.54 $597.55 $443.50 $443.50 $460.59 $311.32 $124.54 $597.55 $597.55 $353.45 $597.55 $597.55 $597.55 $597.55 $448.50 $597.55 $597.55 $597.55 $298.78 $298.78 $473.26 $597.55 $478.04 $388.41 $118.60 N/A $346.84 $597.55 $597.55 $597.55 $124.53 $597.55 N/A N/A 581033 SUP Custom 27203010 581033 - GLIDE LEN THK.6MM 2.5MM RDS 35X5MM STRL LF VSTC SHT MN NUC BOTH IP/OP $6.00 $4.00 $1.06 $5.96 $5.96 $5.96 $5.96 $5.96 $5.96 $5.96 $1.06 $5.96 $5.96 $4.42 $4.42 $4.59 $3.11 $1.24 $5.96 $2.38 $5.96 $5.96 $5.96 $5.96 $5.96 $4.50 $5.96 $5.96 $5.96 $2.98 $2.98 $4.72 $5.96 $4.77 $3.87 $5.96 N/A $3.48 $5.96 $3.58 $5.96 $5.96 $5.96 N/A N/A 585040 SUP Custom 27203010 585040 - CANNULA OPHTHALMIC 40D 1.1MM 25MM 8MM SMOOTH TIP AIR INJEC BOTH IP/OP $199.00 $147.00 $35.39 $209.95 $198.83 $198.83 $198.83 $198.83 $198.83 $198.83 $35.39 $198.83 $198.83 $147.57 $147.57 $153.26 $103.59 $41.44 $198.83 $83.98 $198.83 $198.83 $209.95 $198.83 $198.83 $149.25 $198.83 $198.83 $198.83 $99.42 $99.42 $157.47 $198.83 $159.06 $129.24 $198.83 N/A $115.42 $198.83 $119.30 $198.83 $198.83 $198.83 N/A N/A 585047 SUP Custom 27203010 585047 - CANNULA IRR 23GA .8IN .4IN .3MM STRL LF SMC ASP PORT THNWL BOTH IP/OP $69.50 $51.00 $12.34 $69.33 $69.33 $69.33 $69.33 $69.33 $69.33 $69.33 $12.34 $69.33 $69.33 $51.46 $51.46 $53.44 $36.12 $14.45 $69.33 $27.73 $69.33 $69.33 $69.33 $69.33 $69.33 $52.13 $69.33 $69.33 $69.33 $34.67 $34.67 $54.91 $69.33 $55.46 $45.06 $69.33 N/A $40.31 $69.33 $41.60 $69.33 $69.33 $69.33 N/A N/A 585047 SUP Custom 27203010 585047 - CANNULA IRRIGATING 23GA .8IN .4IN .3MM ASPIRAT PORT THINWALL BOTH IP/OP $135.00 $100.00 $12.34 $101.25 $69.33 $69.33 $69.33 $69.33 $69.33 $69.33 $12.34 $69.33 $69.33 $51.46 $51.46 $53.44 $36.12 $14.45 $69.33 $27.73 $69.33 $69.33 $69.33 $69.33 $69.33 $101.25 $69.33 $69.33 $69.33 $34.67 $34.67 $54.91 $69.33 $55.46 $45.06 $69.33 N/A $78.30 $69.33 $41.60 $69.33 $69.33 $69.33 N/A N/A 585119 SUP Custom 27203010 585119 - CANNULA OPHTHALMIC 45D ULTRATHIN WALL BEVEL 20GA 4MM INFUS BOTH IP/OP $256.00 $189.00 $45.57 $256.00 $256.00 $256.00 $256.00 $256.00 $256.00 $256.00 $45.57 $256.00 $256.00 $190.00 $190.00 $197.32 $133.38 $53.35 $256.00 $102.40 $256.00 $256.00 $256.00 $256.00 $256.00 $192.00 $256.00 $256.00 $256.00 $128.00 $128.00 $202.75 $256.00 $204.80 $166.40 $256.00 N/A $148.48 $256.00 $153.60 $256.00 $256.00 $256.00 N/A N/A 600040 SUP HCPCS C1751 0600040 - CATHETER CV 2 BRCH 2.7FR .9MM .5MM 71CM STRL LTX BRVC 1 LUM BOTH IP/OP $195.50 $145.00 $7.40 $191.04 $85.97 $85.97 $85.97 $85.97 $191.04 $191.04 $191.04 $39.82 $191.04 $7.70 $7.70 $7.99 $7.40 $8.69 $191.04 $191.04 $113.00 $191.04 $191.04 $191.04 $191.04 $146.63 $191.04 $191.04 $191.04 $95.52 $95.52 $151.30 $191.04 $152.83 $85.97 $8.28 $191.04 $113.39 $191.04 $191.04 $191.04 $8.28 $191.04 N/A N/A 600125 SUP Custom 27203010 0600125 - APPLICATOR ENDSCP FLSL BXTR NRFL COMP CANNU COMP BOTH IP/OP $133.00 $98.00 $23.67 $133.00 $133.00 $133.00 $133.00 $133.00 $133.00 $133.00 $23.67 $133.00 $133.00 $98.71 $98.71 $102.52 $69.29 $27.72 $133.00 $53.20 $133.00 $133.00 $133.00 $133.00 $133.00 $99.75 $133.00 $133.00 $133.00 $66.50 $66.50 $105.34 $133.00 $106.40 $86.45 $133.00 N/A $77.14 $133.00 $79.80 $133.00 $133.00 $133.00 N/A N/A 600544 SUP HCPCS C1751 0600544 - KIT CATH 6.6FR 57CM STRL LF BRVC 1 LUM LOPRFL ADPR SIL PED BOTH IP/OP $371.50 $275.00 $3.77 $278.63 $21.17 $21.17 $21.17 $21.17 $21.17 $21.17 $3.77 $21.17 $21.17 $15.71 $15.71 $16.32 $11.03 $4.41 $21.17 $8.47 $21.17 $21.17 $21.17 $21.17 $21.17 $278.63 $21.17 $21.17 $21.17 $10.59 $10.59 $16.77 $21.17 $16.94 $13.76 $21.17 $21.17 $215.47 $21.17 $12.70 $21.17 $21.17 $21.17 N/A N/A 600560 SUP HCPCS C1751 0600560 - CATHETER CEN VEN 9.6FR 3.2MM 1.6MM 90CM 1 LUMEN TISSUE BOTH IP/OP $61.50 $46.00 $1.05 $52.00 $23.40 $23.40 $23.40 $23.40 $52.00 $52.00 $52.00 $1.05 $52.00 $4.62 $4.62 $4.80 $4.44 $5.22 $52.00 $52.00 $30.76 $52.00 $52.00 $52.00 $52.00 $46.13 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $4.97 $52.00 $35.67 $52.00 $52.00 $52.00 $4.97 $52.00 N/A N/A 600600 SUP HCPCS C1751 0600600 - KIT CATH 9FR 54CM STRL LF HKMN PEEL-APART 2 LUM LOPRFL ADPR BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $192.77 $192.77 $192.77 $192.77 $355.00 $355.00 $355.00 $73.99 $355.00 $263.48 $263.48 $273.63 $184.96 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $230.75 $70.46 N/A $205.90 $355.00 $355.00 $355.00 $73.98 $355.00 N/A N/A 601600 SUP HCPCS C1751 0601600 - KIT CATH REPR 2.7FR .9MM .5MM 71CM .15ML WHT STRL LTX BRVC 1 BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 601610 SUP HCPCS C1751 0601610 - KIT CATH REPR 4.2FR 1.4MM .7MM 71CM .3ML WHT STRL LF BRVC 1 BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 601648 SUP HCPCS C1713 601648 - SCREW BONE PTHRD 5MM 48MM CANN LP HEAD REVERSE CUTTING FLUTE BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $299.75 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 602230 SUP HCPCS C1788 0602230 - PORT IMPLTABLE INFUS LARGE 9.6FR 31.7X14.5MM 1 LUMEN BOTH IP/OP "$2,109.00" "$1,561.00" $418.52 "$2,108.70" $948.92 $948.92 $948.92 $948.92 "$2,108.70" "$2,108.70" "$2,108.70" $439.51 "$2,108.70" "$2,108.70" "$2,108.70" "$2,108.70" "$2,108.70" $439.48 "$2,108.70" "$2,108.70" "$1,247.30" "$2,108.70" "$2,108.70" "$2,108.70" "$2,108.70" "$1,581.75" "$2,108.70" "$2,108.70" "$2,108.70" "$1,054.35" "$1,054.35" "$1,670.09" "$2,108.70" "$1,686.96" $948.92 $418.52 N/A "$1,223.22" "$2,108.70" "$2,108.70" "$2,108.70" $439.45 "$2,108.70" N/A N/A 602645 SUP HCPCS C1713 602645 - SCREW BN 6.5MM 45MM STRL 20MM ASNS III ST SLFDRL CNN TI ORTH BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 602650 SUP HCPCS C1713 602650 - SCREW BN 6.5MM 50MM STRL 20MM ASNS III ST SLF DRL CNN TI HIP BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 602660 SUP HCPCS C1713 602660 - SCREW BN 6.5MM 60MM STRL 20MM ASNS III SLF DRL ST CNN TI LNG BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 602885 SUP HCPCS C1713 602885 - SCREW BN LOPRFL REVCT FLUT 6.5MM 85MM NS 40MM ASNS III CNN BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 603020 SUP HCPCS Q4116 603020 - MATRIX TISSUE INJECTABLE CYMETRA MAT ACELLULAR DERMIS 2ML BOTH IP/OP $374.00 $277.00 $74.18 $373.75 $168.19 $168.19 $168.19 $168.19 $373.75 $373.75 $373.75 $77.90 $373.75 $373.75 $373.75 $373.75 $373.75 $77.89 $373.75 $373.75 $221.07 $373.75 $373.75 $373.75 $373.75 $280.50 $373.75 $373.75 $373.75 $186.88 $186.88 $296.01 $373.75 $299.00 $168.19 $74.18 N/A $216.92 $373.75 $373.75 $373.75 $77.89 $373.75 N/A N/A 606008 SUP HCPCS Q4130 0606008 - MATRIX TISSUE 6X6MM RECONSTRUCTIVE STRATTICE PIG DERMIS BOTH IP/OP "$2,512.50" "$1,859.00" $523.63 "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" $523.63 "$2,512.50" "$1,005.00" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$1,884.38" "$2,512.50" "$2,512.50" "$2,512.50" "$1,256.25" "$1,256.25" "$1,989.90" "$2,512.50" "$2,010.00" "$1,130.63" "$2,512.50" N/A "$1,457.25" "$2,512.50" "$1,507.50" "$2,512.50" "$2,512.50" "$2,512.50" N/A N/A 606560 SUP HCPCS C1751 0606560 - KIT CATH 10FR 59CM STRL LF HKMN 3 LUM LOPRFL ADPR PLAPRT BOTH IP/OP $455.50 $337.00 $90.32 $455.05 $247.09 $247.09 $247.09 $247.09 $455.05 $455.05 $455.05 $94.84 $455.05 $337.74 $337.74 $350.75 $237.08 $94.84 $455.05 $455.05 $269.16 $455.05 $455.05 $455.05 $455.05 $341.63 $455.05 $455.05 $455.05 $227.53 $227.53 $360.40 $455.05 $364.04 $295.78 $90.32 N/A $264.19 $455.05 $455.05 $455.05 $94.83 $455.05 N/A N/A 608001 SUP HCPCS Q4130 0608001 - MATRIX TISS 8X6CM STRL STRATTICE RECON PRCN DERM BOTH IP/OP "$4,270.00" "$3,160.00" $889.91 "$4,270.00" "$4,270.00" "$4,270.00" "$4,270.00" "$4,270.00" "$4,270.00" "$4,270.00" "$4,270.00" "$4,270.00" "$4,270.00" "$4,270.00" "$4,270.00" "$4,270.00" "$4,270.00" $889.91 "$4,270.00" "$1,130.00" "$4,270.00" "$4,270.00" "$2,825.00" "$4,270.00" "$4,270.00" "$3,202.50" "$4,270.00" "$4,270.00" "$4,270.00" "$2,135.00" "$2,135.00" "$3,381.84" "$4,270.00" "$3,416.00" "$1,921.50" "$4,270.00" N/A "$2,476.60" "$4,270.00" "$2,562.00" "$4,270.00" "$4,270.00" "$4,270.00" N/A N/A 609002 SUP Custom 27803010 609002 - TISSUE 609002 2MM FACET SHIM BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 609003 SUP Custom 27803010 609003 - TISSUE 609003 3MM FACET SHIM BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 609004 SUP HCPCS C1763 609004 - GRAFT SFT SHIM 4 MM BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 609404 SUP HCPCS C1763 609404 - GRAFT SFT TIS 10X8X4MM FACET BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 609604 SUP HCPCS C1763 609604 - GRAFT SFT TIS WDG 8X8X4MM LF BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 610008 SUP HCPCS Q4130 0610008 - MATRIX TISSUE 10X6CM RECONSTRUCTIVE STRATTICE PIG DERMIS BOTH IP/OP "$5,720.00" "$4,233.00" "$1,192.11" "$5,720.00" "$5,720.00" "$5,720.00" "$5,720.00" "$5,720.00" "$5,720.00" "$5,720.00" "$5,720.00" "$5,720.00" "$5,720.00" "$5,720.00" "$5,720.00" "$5,720.00" "$5,720.00" "$1,192.11" "$5,720.00" "$1,514.00" "$5,720.00" "$5,720.00" "$3,785.00" "$5,720.00" "$5,720.00" "$4,290.00" "$5,720.00" "$5,720.00" "$5,720.00" "$2,860.00" "$2,860.00" "$4,530.24" "$5,720.00" "$4,576.00" "$2,574.00" "$5,720.00" N/A "$3,317.60" "$5,720.00" "$3,432.00" "$5,720.00" "$5,720.00" "$5,720.00" N/A N/A 610130 SUP HCPCS C1760 610130 - DEVICE CLSR 6FR .035IN 70CM STRL LF ANGSL VIP BONDEK-+ HMST BOTH IP/OP $525.00 $389.00 $104.20 $840.00 $236.25 $236.25 $236.25 $236.25 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $525.00 $525.00 $525.00 $109.42 $525.00 $840.00 $310.54 $525.00 $840.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $236.25 $104.20 N/A $304.50 $525.00 $525.00 $525.00 $109.41 $525.00 N/A N/A 610131 SUP HCPCS C1760 610131 - DEVICE CLOSURE 8FR .038IN 70CM HEMOSTATIC BIOABSORBABLE BOTH IP/OP $525.00 $389.00 $104.20 $840.00 $285.08 $285.08 $285.08 $285.08 $525.00 $525.00 $525.00 $109.42 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $840.00 $310.54 $525.00 $840.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $104.20 N/A $304.50 $525.00 $525.00 $525.00 $109.41 $525.00 N/A N/A 611125 SUP HCPCS C1713 611125 - SCREW BONE 8MM 125MM 25MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 611130 SUP HCPCS C1713 611130 - SCREW BONE 8MM 130MM 25MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 611335 SUP HCPCS C1713 611335 - SCREW BONE FULTHRD 8MM 135MM CANN ASNIS III TITANIUM NONSTRL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 611340 SUP HCPCS C1713 611340 - SCREW BONE FULTHRD 8MM 140MM CANN ASNIS III TITANIUM NONSTRL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 611345 SUP HCPCS C1713 611345 - SCREW BONE FULTHRD 8MM 145MM CANN ASNIS III TITANIUM NONSTRL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 611350 SUP HCPCS C1713 611350 - SCREW BONE FULTHRD 8MM 150MM CANN ASNIS III TITANIUM NONSTRL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $391.88 $391.88 N/A N/A 612602 SUP HCPCS C1894 612602 - KIT INTRO .038IN 6FR 16CM 19CM INTRDN TRAW GW SHTH ADPR DIL BOTH IP/OP $72.50 $54.00 $14.38 $72.44 $39.33 $39.33 $39.33 $39.33 $72.44 $72.44 $72.44 $15.10 $72.44 $53.76 $53.76 $55.84 $37.74 $15.10 $72.44 $72.44 $42.85 $72.44 $72.44 $72.44 $72.44 $54.38 $72.44 $72.44 $72.44 $36.22 $36.22 $57.37 $72.44 $57.95 $47.09 $14.38 N/A $42.05 $72.44 $72.44 $72.44 $15.10 $72.44 N/A N/A 612602 SUP HCPCS C1894 612602 - KIT INTRO .038IN 6FR 14CM 19CM INTRDN SPNLK TRAW GW SHTH BOTH IP/OP $89.50 $66.00 $14.38 $72.44 $39.33 $39.33 $39.33 $39.33 $72.44 $72.44 $72.44 $15.10 $72.44 $53.76 $53.76 $55.84 $37.74 $15.10 $72.44 $72.44 $42.85 $72.44 $72.44 $72.44 $72.44 $67.13 $72.44 $72.44 $72.44 $36.22 $36.22 $57.37 $72.44 $57.95 $47.09 $14.38 N/A $51.91 $72.44 $72.44 $72.44 $15.10 $72.44 N/A N/A 612603 SUP HCPCS C1894 612603 - KIT SHTH .038IN 7FR 16CM 19CM INTRDN TRAW BOTH IP/OP $72.50 $54.00 $14.38 $72.44 $39.33 $39.33 $39.33 $39.33 $72.44 $72.44 $72.44 $15.10 $72.44 $53.76 $53.76 $55.84 $37.74 $15.10 $72.44 $72.44 $42.85 $72.44 $72.44 $72.44 $72.44 $54.38 $72.44 $72.44 $72.44 $36.22 $36.22 $57.37 $72.44 $57.95 $47.09 $14.38 N/A $42.05 $72.44 $72.44 $72.44 $15.10 $72.44 N/A N/A 612606 SUP HCPCS C1892 612606 - SHEATH INTRO 9FR 14CM INTRDN TRAW BOTH IP/OP $72.50 $54.00 $14.38 $72.44 $39.33 $39.33 $39.33 $39.33 $72.44 $72.44 $72.44 $15.10 $72.44 $53.76 $53.76 $55.84 $37.74 $15.10 $72.44 $72.44 $42.85 $72.44 $72.44 $72.44 $72.44 $54.38 $72.44 $72.44 $72.44 $36.22 $36.22 $57.37 $72.44 $57.95 $47.09 $14.38 N/A $42.05 $72.44 $72.44 $72.44 $15.10 $72.44 N/A N/A 612628 SUP HCPCS C1894 612628 - KIT INTRO .035IN 9FR 30CM INTRDN SPNLK TRAW LCK CLIP PTFE BOTH IP/OP $123.50 $91.00 $24.43 $123.10 $66.84 $66.84 $66.84 $66.84 $123.10 $123.10 $123.10 $25.66 $123.10 $91.36 $91.36 $94.89 $64.14 $25.66 $123.10 $123.10 $72.81 $123.10 $123.10 $123.10 $123.10 $92.63 $123.10 $123.10 $123.10 $61.55 $61.55 $97.50 $123.10 $98.48 $80.02 $24.43 N/A $71.63 $123.10 $123.10 $123.10 $25.65 $123.10 N/A N/A 614508 SUP HCPCS C1713 614508 - SCREW BONE 2.7MM 8MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614510 SUP HCPCS C1713 614510 - SCREW BONE 2.7MM 10MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614512 SUP HCPCS C1713 614512 - SCREW BONE 2.7MM 12MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614514 SUP HCPCS C1713 614514 - SCREW BONE 2.7MM 14MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614516 SUP HCPCS C1713 614516 - SCREW BONE 2.7MM 16MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614518 SUP HCPCS C1713 614518 - SCREW BONE 2.7MM 18MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614520 SUP HCPCS C1713 614520 - SCREW BONE 2.7MM 20MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614522 SUP HCPCS C1713 614522 - SCREW BONE 2.7MM 22MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614524 SUP HCPCS C1713 614524 - SCREW BONE 2.7MM 24MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614526 SUP HCPCS C1713 614526 - SCREW BONE 2.7MM 26MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614528 SUP HCPCS C1713 614528 - SCREW BONE 2.7MM 28MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614530 SUP HCPCS C1713 614530 - SCREW BONE 2.7MM 30MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614532 SUP HCPCS C1713 614532 - SCREW BONE 2.7MM 32MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614534 SUP HCPCS C1713 614534 - SCREW BONE 2.7MM 34MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614536 SUP HCPCS C1713 614536 - SCREW BONE 2.7MM 36MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614538 SUP HCPCS C1713 614538 - SCREW BONE 2.7MM 38MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614540 SUP HCPCS C1713 614540 - SCREW BONE 2.7MM 40MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614542 SUP HCPCS C1713 614542 - SCREW BONE 2.7MM 42MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $143.55 "$1,131.05" $523.90 $523.90 $523.90 $523.90 $964.83 $964.83 $964.83 $201.09 $964.83 $716.10 $716.10 $743.69 $502.68 $201.08 $964.83 "$1,131.05" $570.70 $964.83 $964.83 $964.83 $964.83 $185.63 $964.83 $964.83 $964.83 $482.42 $482.42 $764.15 $964.83 $771.86 $627.14 $191.49 N/A $143.55 $964.83 $964.83 $964.83 $201.07 $964.83 N/A N/A 614542 SUP HCPCS C1769 614542 - GUIDEWIRE ESCP .016IN 175CM 44CM AGL STRBL SFT TPR STRG TIP BOTH IP/OP $965.00 $714.00 $191.49 "$1,131.05" $523.90 $523.90 $523.90 $523.90 $964.83 $964.83 $964.83 $201.09 $964.83 $716.10 $716.10 $743.69 $502.68 $201.08 $964.83 "$1,131.05" $570.70 $964.83 $964.83 $964.83 $964.83 $723.75 $964.83 $964.83 $964.83 $482.42 $482.42 $764.15 $964.83 $771.86 $627.14 $191.49 N/A $559.70 $964.83 $964.83 $964.83 $201.07 $964.83 N/A N/A 614544 SUP HCPCS C1713 614544 - SCREW BONE 2.7MM 44MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614546 SUP HCPCS C1713 614546 - SCREW BONE 2.7MM 46MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614548 SUP HCPCS C1713 614548 - SCREW BONE 2.7MM 48MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614550 SUP HCPCS C1713 614550 - SCREW BONE 2.7MM 50MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614555 SUP HCPCS C1713 614555 - SCREW BONE 2.7MM 55MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614560 SUP HCPCS C1713 614560 - SCREW BONE 2.7MM 60MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614565 SUP HCPCS C1713 614565 - SCREW BONE 2.7MM 65MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614570 SUP HCPCS C1713 614570 - SCREW BONE 2.7MM 70MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 614608 SUP HCPCS C1713 614608 - SCREW BONE 3.5MM 8MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614610 SUP HCPCS C1713 614610 - SCREW BONE 3.5MM 10MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614612 SUP HCPCS C1713 614612 - SCREW BONE 3.5MM 12MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614614 SUP HCPCS C1713 614614 - SCREW BONE 3.5MM 14MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 614616 SUP HCPCS C1713 614616 - SCREW BONE 3.5MM 16MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 614618 SUP HCPCS C1713 614618 - SCREW BONE 3.5MM 18MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614620 SUP HCPCS C1713 614620 - SCREW BONE 3.5MM 20MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 614622 SUP HCPCS C1713 614622 - SCREW BONE 3.5MM 22MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614624 SUP HCPCS C1713 614624 - SCREW BONE 3.5MM 24MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614626 SUP HCPCS C1713 614626 - SCREW BONE 3.5MM 26MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 614628 SUP HCPCS C1713 614628 - SCREW BONE 3.5MM 28MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 614630 SUP HCPCS C1713 614630 - SCREW BONE 3.5MM 30MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 614632 SUP HCPCS C1713 614632 - SCREW BONE 3.5MM 32MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614634 SUP HCPCS C1713 614634 - SCREW BONE 3.5MM 34MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 614636 SUP HCPCS C1713 614636 - SCREW BONE 3.5MM 5MM 36MM LOCKING SLFTAP COLOR CODED VARIAX BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614638 SUP HCPCS C1713 614638 - SCREW BONE 3.5MM 38MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614640 SUP HCPCS C1713 614640 - SCREW BONE 3.5MM 40MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 614642 SUP HCPCS C1713 614642 - SCREW BONE 3.5MM 42MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614644 SUP HCPCS C1713 614644 - SCREW BONE 3.5MM 44MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614646 SUP HCPCS C1713 614646 - SCREW BONE 3.5MM 46MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614648 SUP HCPCS C1713 614648 - SCREW BONE 3.5MM 48MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614650 SUP HCPCS C1713 614650 - SCREW BONE 3.5MM 50MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614655 SUP HCPCS C1713 614655 - SCREW BONE 3.5MM 55MM SLFTAP LOCKING VARIAX STAINLESS STEEL BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614660 SUP HCPCS C1713 614660 - SCREW BONE 3.5MM 60MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614665 SUP HCPCS C1713 614665 - SCREW BONE 3.5MM 65MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614670 SUP HCPCS C1713 614670 - SCREW BONE 3.5MM 70MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 614708 SUP HCPCS C1713 614708 - SCREW BONE 2.7MM 8MM SLFTAP VARIAX TITANIUM ELBOW PLATE BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614710 SUP HCPCS C1713 614710 - SCREW BONE 2.7MM 10MM SLFTAP VARIAX TITANIUM ELBOW PLATE BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614712 SUP HCPCS C1713 614712 - SCREW BONE 2.7MM 12MM SLFTAP VARIAX TITANIUM ELBOW PLATE BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614714 SUP HCPCS C1713 614714 - SCREW BONE 2.7MM 14MM SLFTAP VARIAX TITANIUM ELBOW PLATE BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614716 SUP HCPCS C1713 614716 - SCREW BONE 2.7MM 16MM SLFTAP VARIAX TITANIUM ELBOW NONSTRL BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614718 SUP HCPCS C1713 614718 - SCREW BONE 2.7MM 18MM SLFTAP VARIAX BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $111.30 $111.30 N/A N/A 614720 SUP HCPCS C1713 614720 - SCREW BONE 2.7MM 20MM SLFTAP VARIAX TITANIUM ELBOW PLATE BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614722 SUP HCPCS C1713 614722 - SCREW BONE 2.7MM 22MM SLFTAP VARIAX TITANIUM ELBOW PLATE BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614724 SUP HCPCS C1713 614724 - SCREW BONE 2.7MM 24MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614726 SUP HCPCS C1713 614726 - SCREW BONE 2.7MM 26MM SLFTAP VARIAX TITANIUM ELBOW PLATE BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614728 SUP HCPCS C1713 614728 - SCREW BONE 2.7MM 28MM SLFTAP VARIAX TITANIUM ELBOW PLATE BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614730 SUP HCPCS C1713 614730 - SCREW BONE 2.7MM 30MM SLFTAP VARIAX TITANIUM ELBOW PLATE BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614732 SUP HCPCS C1713 614732 - SCREW BONE 2.7MM 32MM SLFTAP VARIAX TITANIUM ELBOW PLATE BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614734 SUP HCPCS C1713 614734 - SCREW BONE 2.7MM 34MM SELF TAP LOCK VARIAX TITANIUM ELBOW BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614736 SUP HCPCS C1713 614736 - SCREW BONE 2.7MM 36MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614738 SUP HCPCS C1713 614738 - SCREW BONE 2.7MM 38MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614740 SUP HCPCS C1713 614740 - SCREW BONE 2.7MM 40MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614742 SUP HCPCS C1713 614742 - SCREW BONE 2.7MM 42MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $111.30 $111.30 N/A N/A 614744 SUP HCPCS C1713 614744 - SCREW BONE 2.7MM 44MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $111.30 $111.30 N/A N/A 614746 SUP HCPCS C1713 614746 - SCREW BONE 2.7MM 46MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614748 SUP HCPCS C1713 614748 - SCREW BONE 2.7MM 48MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614750 SUP HCPCS C1713 614750 - SCREW BONE 2.7MM 50MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614755 SUP HCPCS C1713 614755 - SCREW BONE 2.7MM 55MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614760 SUP HCPCS C1713 614760 - SCREW BONE 2.7MM 60MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $44.52 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614765 SUP HCPCS C1713 614765 - SCREW BONE 2.7MM 65MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614770 SUP HCPCS C1713 614770 - SCREW BONE 2.7MM 70MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $111.50 $83.00 $22.09 $111.30 $50.09 $50.09 $50.09 $50.09 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $111.30 $111.30 $111.30 $23.20 $111.30 $111.30 $65.83 $111.30 $111.30 $111.30 $111.30 $83.63 $111.30 $111.30 $111.30 $55.65 $55.65 $88.15 $111.30 $89.04 $50.09 $22.09 N/A $64.67 $111.30 $111.30 $111.30 $23.19 $111.30 N/A N/A 614808 SUP HCPCS C1713 614808 - SCREW BONE 3.5MM 8MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614810 SUP HCPCS C1713 614810 - SCREW BONE 3.5MM 10MM SELF TAP VARIAX TITANIUM ELBOW NONSTRL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614812 SUP HCPCS C1713 614812 - SCREW BONE 3.5MM 12MM SELF TAP VARIAX TITANIUM ELBOW NONSTRL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614814 SUP HCPCS C1713 614814 - SCREW BONE 3.5MM 14MM SELF TAP VARIAX TITANIUM ELBOW NONSTRL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614816 SUP HCPCS C1713 614816 - SCREW BONE 3.5MM 16MM SELF TAP VARIAX TITANIUM ELBOW NONSTRL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614818 SUP HCPCS C1713 614818 - SCREW BONE 3.5MM 18MM SELF TAP VARIAX TITANIUM ELBOW NONSTRL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614820 SUP HCPCS C1713 614820 - SCREW BONE 3.5MM 20MM SELF TAP VARIAX TITANIUM ELBOW NONSTRL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614822 SUP HCPCS C1713 614822 - SCREW BONE 3.5MM 22MM SELF TAP VARIAX TITANIUM ELBOW NONSTRL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614824 SUP HCPCS C1713 614824 - SCREW BONE 3.5MM 24MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614828 SUP HCPCS C1713 614828 - SCREW BONE 3.5MM 28MM SELF TAP VARIAX TITANIUM ELBOW NONSTRL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 614830 SUP HCPCS C1713 614830 - SCREW BONE 3.5MM 30MM SLFTAP VARIAX TITANIUM ELBOW NONSTRL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614832 SUP HCPCS C1713 614832 - SCREW BONE 3.5MM 32MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614834 SUP HCPCS C1713 614834 - SCREW BONE 3.5MM 34MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614836 SUP HCPCS C1713 614836 - SCREW BONE 3.5MM 5MM 36MM SLFTAP COLOR CODED VARIAX TITANIUM BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614838 SUP HCPCS C1713 614838 - SCREW BONE 3.5MM 38MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614840 SUP HCPCS C1713 614840 - SCREW BONE 3.5MM 40MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614842 SUP HCPCS C1713 614842 - SCREW BONE 3.5MM 42MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614844 SUP HCPCS C1713 614844 - SCREW BONE 3.5MM 44MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614846 SUP HCPCS C1713 614846 - SCREW BONE 3.5MM 46MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 614848 SUP HCPCS C1713 614848 - SCREW BONE 3.5MM 48MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 614850 SUP HCPCS C1713 614850 - SCREW BONE 3.5MM 50MM SELF TAP VARIAX TITANIUM ELBOW NONSTRL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 614855 SUP HCPCS C1713 614855 - SCREW BONE 3.5MM 55MM LOCKING SLFTAP VARIAX TITANIUM ELBOW BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 614860 SUP HCPCS C1713 614860 - SCREW BONE 3.5MM 60MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 614865 SUP HCPCS C1713 614865 - SCREW BONE 3.5MM 65MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 614870 SUP HCPCS C1713 614870 - SCREW BONE 3.5MM 70MM SLFTAP LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 616002 SUP HCPCS Q4130 0616002 - MATRIX TISSUE 16X6CM RECONSTRUCTIVE STRATTICE PIG DERMIS BOTH IP/OP $89.00 $66.00 $18.54 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $18.54 $88.98 $23.55 $88.98 $88.98 $58.88 $88.98 $88.98 $66.75 $88.98 $88.98 $88.98 $44.49 $44.49 $70.47 $88.98 $71.18 $40.04 $88.98 N/A $51.62 $88.98 $53.39 $88.98 $88.98 $88.98 N/A N/A Jun-00 SUP Custom 27803010 06-3600 - HEAD FEM +0MM OFST CTPR 36MM STRL LFIT ANTM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 621552 SUP HCPCS C1713 621552 - PLATE BONE LONG 50MM TITANIUM CALCANEUS BOTH IP/OP $705.50 $522.00 $140.00 $705.38 $317.42 $317.42 $317.42 $317.42 $705.38 $705.38 $705.38 $147.02 $705.38 $705.38 $705.38 $705.38 $705.38 $147.01 $705.38 $705.38 $417.23 $705.38 $705.38 $705.38 $705.38 $529.13 $705.38 $705.38 $705.38 $352.69 $352.69 $558.66 $705.38 $564.30 $317.42 $140.00 N/A $409.19 $705.38 $423.23 $705.38 $147.00 $705.38 N/A N/A 621553 SUP HCPCS C1713 621553 - PLATE BONE LONG 60MM TITANIUM CALCANEUS BOTH IP/OP $705.50 $522.00 $140.00 $705.38 $317.42 $317.42 $317.42 $317.42 $705.38 $705.38 $705.38 $147.02 $705.38 $705.38 $705.38 $705.38 $705.38 $147.01 $705.38 $705.38 $417.23 $705.38 $705.38 $705.38 $705.38 $529.13 $705.38 $705.38 $705.38 $352.69 $352.69 $558.66 $705.38 $564.30 $317.42 $140.00 N/A $409.19 $705.38 $423.23 $705.38 $147.00 $705.38 N/A N/A 621554 SUP HCPCS C1713 621554 - PLATE BONE LONG 70MM TITANIUM CALCANEUS BOTH IP/OP $705.50 $522.00 $140.00 $705.38 $317.42 $317.42 $317.42 $317.42 $705.38 $705.38 $705.38 $147.02 $705.38 $705.38 $705.38 $705.38 $705.38 $147.01 $705.38 $705.38 $417.23 $705.38 $705.38 $705.38 $705.38 $529.13 $705.38 $705.38 $705.38 $352.69 $352.69 $558.66 $705.38 $564.30 $317.42 $140.00 N/A $409.19 $705.38 $423.23 $705.38 $147.00 $705.38 N/A N/A 621555 SUP HCPCS C1713 621555 - PLATE BONE LONG 80MM TITANIUM CALCANEUS BOTH IP/OP $542.00 $401.00 $107.52 $541.75 $243.79 $243.79 $243.79 $243.79 $541.75 $541.75 $541.75 $112.91 $541.75 $541.75 $541.75 $541.75 $541.75 $112.91 $541.75 $541.75 $320.45 $541.75 $541.75 $541.75 $541.75 $406.50 $541.75 $541.75 $541.75 $270.88 $270.88 $429.07 $541.75 $433.40 $243.79 $107.52 N/A $314.36 $541.75 $325.05 $541.75 $112.90 $541.75 N/A N/A 626001 SUP HCPCS C1713 626001 - PLATE BONE LONG LEVEL 1 RPS SPN BOTH IP/OP "$2,831.00" "$2,095.00" $561.80 "$2,830.60" "$1,273.77" "$1,273.77" "$1,273.77" "$1,273.77" "$2,830.60" "$2,830.60" "$2,830.60" $589.97 "$2,830.60" "$2,830.60" "$2,830.60" "$2,830.60" "$2,830.60" $589.93 "$2,830.60" "$1,132.24" "$1,395.49" "$2,830.60" "$2,830.60" "$2,830.60" "$2,830.60" "$2,123.25" "$2,830.60" "$2,830.60" "$2,830.60" "$1,415.30" "$1,415.30" "$2,241.84" "$2,830.60" "$2,264.48" "$1,273.77" $561.80 N/A "$1,641.98" "$2,830.60" "$1,698.36" "$2,830.60" $589.90 "$2,830.60" N/A N/A 626002 SUP HCPCS C1713 626002 - PLATE BONE LONG 2 LEVEL TITANIUM ORTHOPEDIC BOTH IP/OP "$3,125.00" "$2,313.00" $620.21 "$3,124.90" "$1,406.21" "$1,406.21" "$1,406.21" "$1,406.21" "$3,124.90" "$3,124.90" "$3,124.90" $651.31 "$3,124.90" "$3,124.90" "$3,124.90" "$3,124.90" "$3,124.90" $651.26 "$3,124.90" "$1,249.96" "$1,540.58" "$3,124.90" "$3,124.90" "$3,124.90" "$3,124.90" "$2,343.75" "$3,124.90" "$3,124.90" "$3,124.90" "$1,562.45" "$1,562.45" "$2,474.92" "$3,124.90" "$2,499.92" "$1,406.21" $620.21 N/A "$1,812.50" "$3,124.90" "$1,874.94" "$3,124.90" $651.23 "$3,124.90" N/A N/A 626011 SUP HCPCS C1713 626011 - PLATE BONE SHORT LEVEL 1 RPS SPN BOTH IP/OP "$2,831.00" "$2,095.00" $561.80 "$2,830.60" "$1,273.77" "$1,273.77" "$1,273.77" "$1,273.77" "$2,830.60" "$2,830.60" "$2,830.60" $589.97 "$2,830.60" "$2,830.60" "$2,830.60" "$2,830.60" "$2,830.60" $589.93 "$2,830.60" "$1,132.24" "$1,395.49" "$2,830.60" "$2,830.60" "$2,830.60" "$2,830.60" "$2,123.25" "$2,830.60" "$2,830.60" "$2,830.60" "$1,415.30" "$1,415.30" "$2,241.84" "$2,830.60" "$2,264.48" "$1,273.77" $561.80 N/A "$1,641.98" "$2,830.60" "$2,830.60" "$2,830.60" $589.90 "$2,830.60" N/A N/A 626300 SUP Custom 27803010 626300 - CONNECTOR ROD FIX RPS SAC SPN BOTH IP/OP "$2,123.00" "$1,571.00" $377.88 "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" $377.88 "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" $442.44 "$2,122.93" $849.17 "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$1,592.25" "$2,122.93" "$2,122.93" "$2,122.93" "$1,061.47" "$1,061.47" "$1,681.36" "$2,122.93" "$1,698.34" $955.32 "$2,122.93" N/A "$1,231.34" "$2,122.93" "$1,273.76" "$2,122.93" "$2,122.93" "$2,122.93" N/A N/A 629004 SUP HCPCS C1713 629004 - PLATE BN 4 HL HUM DIST LAT BOTH IP/OP "$1,485.00" "$1,099.00" $294.74 "$1,485.00" $668.25 $668.25 $668.25 $668.25 "$1,485.00" "$1,485.00" "$1,485.00" $309.51 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" $594.00 $878.38 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 $294.74 N/A $861.30 "$1,485.00" "$1,485.00" "$1,485.00" $309.47 "$1,485.00" N/A N/A 629006 SUP HCPCS C1713 629006 - PLATE BN 6 HL HUM LT DIST LAT BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" "$1,650.00" "$1,650.00" N/A N/A 629008 SUP HCPCS C1713 629008 - PLATE BN 8 HL HUM LT DIST LAT BOTH IP/OP "$1,815.00" "$1,343.00" $360.23 "$1,815.00" $816.75 $816.75 $816.75 $816.75 "$1,815.00" "$1,815.00" "$1,815.00" $378.29 "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" $378.27 "$1,815.00" "$1,815.00" "$1,073.57" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,361.25" "$1,815.00" "$1,815.00" "$1,815.00" $907.50 $907.50 "$1,437.48" "$1,815.00" "$1,452.00" $816.75 $360.23 N/A "$1,052.70" "$1,815.00" "$1,089.00" "$1,815.00" "$1,815.00" "$1,815.00" N/A N/A 629024 SUP HCPCS C1713 629024 - PLATE BN 4 HL HUM RT DIST LAT BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,121.40" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629026 SUP HCPCS C1713 629026 - PLATE BN 6 HL HUM RT DIST LAT BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" "$1,650.00" "$1,650.00" $343.86 "$1,650.00" N/A N/A 629028 SUP HCPCS C1713 629028 - PLATE BN 8 HL HUM RT DIST LAT BOTH IP/OP "$1,815.00" "$1,343.00" $360.23 "$1,815.00" $816.75 $816.75 $816.75 $816.75 "$1,815.00" "$1,815.00" "$1,815.00" $378.29 "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" $378.27 "$1,815.00" $726.00 "$1,073.57" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,361.25" "$1,815.00" "$1,815.00" "$1,815.00" $907.50 $907.50 "$1,437.48" "$1,815.00" "$1,452.00" $816.75 $360.23 N/A "$1,052.70" "$1,815.00" "$1,815.00" "$1,815.00" $378.25 "$1,815.00" N/A N/A 629044 SUP HCPCS C1713 629044 - PLATE BN 4 HL HUM DP LAT BOTH IP/OP "$1,485.00" "$1,099.00" $294.74 "$1,485.00" $668.25 $668.25 $668.25 $668.25 "$1,485.00" "$1,485.00" "$1,485.00" $309.51 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" "$1,485.00" $878.38 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 $294.74 N/A $861.30 "$1,485.00" "$1,485.00" "$1,485.00" $309.47 "$1,485.00" N/A N/A 629046 SUP HCPCS C1713 629046 - PLATE BN 6 HL HUM L/L POST DIST BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" "$1,650.00" "$1,650.00" $343.86 "$1,650.00" N/A N/A 629048 SUP HCPCS C1713 629048 - PLATE BN 8 HL HUM L/L POST DIST BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629064 SUP HCPCS C1713 629064 - PLATE BN 4 HL HUM RL POST DIST BOTH IP/OP "$1,485.00" "$1,099.00" $294.74 "$1,485.00" $668.25 $668.25 $668.25 $668.25 "$1,485.00" "$1,485.00" "$1,485.00" $309.51 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" $594.00 $878.38 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 $294.74 N/A $861.30 "$1,485.00" $891.00 "$1,485.00" $309.47 "$1,485.00" N/A N/A 629066 SUP HCPCS C1713 629066 - PLATE BN 6 HL HUM RL POST DIST BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 629068 SUP HCPCS C1713 629068 - PLATE BN 8 HL HUM DP LAT BOTH IP/OP "$1,815.00" "$1,343.00" $360.23 "$1,815.00" $816.75 $816.75 $816.75 $816.75 "$1,815.00" "$1,815.00" "$1,815.00" $378.29 "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" $378.27 "$1,815.00" $726.00 "$1,073.57" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,361.25" "$1,815.00" "$1,815.00" "$1,815.00" $907.50 $907.50 "$1,437.48" "$1,815.00" "$1,452.00" $816.75 $360.23 N/A "$1,052.70" "$1,815.00" "$1,089.00" "$1,815.00" "$1,815.00" "$1,815.00" N/A N/A 629084 SUP HCPCS C1713 629084 - PLATE BN XTD HUM DIST MDL BOTH IP/OP "$1,485.00" "$1,099.00" $294.74 "$1,485.00" $668.25 $668.25 $668.25 $668.25 "$1,485.00" "$1,485.00" "$1,485.00" $309.51 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" "$1,485.00" $878.38 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 $294.74 N/A $861.30 "$1,485.00" $891.00 "$1,485.00" $309.47 "$1,485.00" N/A N/A 629086 SUP HCPCS C1713 629086 - PLATE BN 6 HL XTD HUM DIST MDL BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" "$1,650.00" "$1,650.00" $343.86 "$1,650.00" N/A N/A 629088 SUP HCPCS C1713 629088 - PLATE BN XTD HUM DIST MDL BOTH IP/OP "$1,815.00" "$1,343.00" $360.23 "$1,815.00" $816.75 $816.75 $816.75 $816.75 "$1,815.00" "$1,815.00" "$1,815.00" $378.29 "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" $378.27 "$1,815.00" "$1,815.00" "$1,073.57" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,361.25" "$1,815.00" "$1,815.00" "$1,815.00" $907.50 $907.50 "$1,437.48" "$1,815.00" "$1,452.00" $816.75 $360.23 N/A "$1,052.70" "$1,815.00" "$1,089.00" "$1,815.00" $378.25 "$1,815.00" N/A N/A 629104 SUP HCPCS C1713 629104 - PLATE BN 4 HL HUM MDL POST DIST BOTH IP/OP "$1,485.00" "$1,099.00" $294.74 "$1,485.00" $668.25 $668.25 $668.25 $668.25 "$1,485.00" "$1,485.00" "$1,485.00" $309.51 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" $594.00 $878.38 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 $294.74 N/A $861.30 "$1,485.00" $891.00 "$1,485.00" $309.47 "$1,485.00" N/A N/A 629106 SUP HCPCS C1713 629106 - DIST. POST. MED. HUM. PL. 6 HOLE / LEFT BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" "$1,650.00" "$1,650.00" $343.86 "$1,650.00" N/A N/A 629108 SUP HCPCS C1713 629108 - PLATE BN 8 HL HUM MDL POST DIST BOTH IP/OP "$1,815.00" "$1,343.00" $360.23 "$1,815.00" $816.75 $816.75 $816.75 $816.75 "$1,815.00" "$1,815.00" "$1,815.00" $378.29 "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" $378.27 "$1,815.00" $726.00 "$1,073.57" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,361.25" "$1,815.00" "$1,815.00" "$1,815.00" $907.50 $907.50 "$1,437.48" "$1,815.00" "$1,452.00" $816.75 $360.23 N/A "$1,052.70" "$1,815.00" "$1,815.00" "$1,815.00" $378.25 "$1,815.00" N/A N/A 629124 SUP HCPCS C1713 629124 - PLATE BN 4 HL HUM MDL POST DIST BOTH IP/OP "$1,485.00" "$1,099.00" $294.74 "$1,485.00" $668.25 $668.25 $668.25 $668.25 "$1,485.00" "$1,485.00" "$1,485.00" $309.51 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" "$1,485.00" $878.38 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 $294.74 N/A $861.30 "$1,485.00" "$1,485.00" "$1,485.00" $309.47 "$1,485.00" N/A N/A 629126 SUP HCPCS C1713 629126 - PLATE BN 6 HL HUM MDL POST DIST BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 629128 SUP HCPCS C1713 629128 - PLATE BN 8 HL HUM MDL POST DIST BOTH IP/OP "$1,815.00" "$1,343.00" $360.23 "$1,815.00" $816.75 $816.75 $816.75 $816.75 "$1,815.00" "$1,815.00" "$1,815.00" $378.29 "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" $378.27 "$1,815.00" $726.00 "$1,073.57" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,361.25" "$1,815.00" "$1,815.00" "$1,815.00" $907.50 $907.50 "$1,437.48" "$1,815.00" "$1,452.00" $816.75 $360.23 N/A "$1,052.70" "$1,815.00" "$1,815.00" "$1,815.00" $378.25 "$1,815.00" N/A N/A 629144 SUP HCPCS C1713 629144 - PLATE BN 4 HL LT OLCRN BOTH IP/OP "$1,485.00" "$1,099.00" $294.74 "$1,485.00" $668.25 $668.25 $668.25 $668.25 "$1,485.00" "$1,485.00" "$1,485.00" $309.51 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" $594.00 $878.38 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 $294.74 N/A $861.30 "$1,485.00" "$1,485.00" "$1,485.00" $309.47 "$1,485.00" N/A N/A 629146 SUP HCPCS C1713 629146 - PLATE BN 6 HL LT OLCRN BOTH IP/OP "$1,567.50" "$1,160.00" $311.11 "$1,567.50" $705.38 $705.38 $705.38 $705.38 "$1,567.50" "$1,567.50" "$1,567.50" $326.71 "$1,567.50" "$1,567.50" "$1,567.50" "$1,567.50" "$1,567.50" $326.68 "$1,567.50" $627.00 $927.18 "$1,567.50" "$1,567.50" "$1,567.50" "$1,567.50" "$1,175.63" "$1,567.50" "$1,567.50" "$1,567.50" $783.75 $783.75 "$1,241.46" "$1,567.50" "$1,254.00" $705.38 $311.11 N/A $909.15 "$1,567.50" $940.50 "$1,567.50" $326.67 "$1,567.50" N/A N/A 629148 SUP HCPCS C1713 629148 - PLATE BN 8 HL LT OLCRN BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" "$1,650.00" "$1,650.00" $343.86 "$1,650.00" N/A N/A 629164 SUP HCPCS C1713 629164 - OLECRANON PLATE 4 HOLE / RIGHT BOTH IP/OP "$1,485.00" "$1,099.00" $294.74 "$1,485.00" $668.25 $668.25 $668.25 $668.25 "$1,485.00" "$1,485.00" "$1,485.00" $309.51 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" "$1,485.00" $878.38 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 $294.74 N/A $861.30 "$1,485.00" $891.00 "$1,485.00" $309.47 "$1,485.00" N/A N/A 629166 SUP HCPCS C1713 629166 - PLATE BONE 6 HOLE LOCKING STAINLESS STEEL OLECRANON BOTH IP/OP "$1,567.50" "$1,160.00" $311.11 "$1,567.50" $705.38 $705.38 $705.38 $705.38 "$1,567.50" "$1,567.50" "$1,567.50" $326.71 "$1,567.50" "$1,567.50" "$1,567.50" "$1,567.50" "$1,567.50" $326.68 "$1,567.50" "$1,567.50" $927.18 "$1,567.50" "$1,567.50" "$1,567.50" "$1,567.50" "$1,175.63" "$1,567.50" "$1,567.50" "$1,567.50" $783.75 $783.75 "$1,241.46" "$1,567.50" "$1,254.00" $705.38 $311.11 N/A $909.15 "$1,567.50" $940.50 "$1,567.50" $326.67 "$1,567.50" N/A N/A 629168 SUP HCPCS C1713 629168 - PLATE BN 8 HL RT OLCRN BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" "$1,650.00" "$1,650.00" $343.86 "$1,650.00" N/A N/A 629184 SUP HCPCS C1713 629184 - PLATE BN 4 HL HUM DIST MDL BOTH IP/OP "$1,485.00" "$1,099.00" $294.74 "$1,485.00" $668.25 $668.25 $668.25 $668.25 "$1,485.00" "$1,485.00" "$1,485.00" $309.51 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" "$1,485.00" $878.38 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 $294.74 N/A $861.30 "$1,485.00" $891.00 "$1,485.00" $309.47 "$1,485.00" N/A N/A 629186 SUP HCPCS C1713 629186 - DIST. MED. HUM. PLATE 6 HOLE BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 629188 SUP HCPCS C1713 629188 - PLATE BN 8 HL HUM DIST MDL BOTH IP/OP "$1,815.00" "$1,343.00" $360.23 "$1,815.00" $816.75 $816.75 $816.75 $816.75 "$1,815.00" "$1,815.00" "$1,815.00" $378.29 "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" $378.27 "$1,815.00" "$1,815.00" "$1,073.57" "$1,815.00" "$1,815.00" "$1,815.00" "$1,815.00" "$1,361.25" "$1,815.00" "$1,815.00" "$1,815.00" $907.50 $907.50 "$1,437.48" "$1,815.00" "$1,452.00" $816.75 $360.23 N/A "$1,052.70" "$1,815.00" "$1,815.00" "$1,815.00" $378.25 "$1,815.00" N/A N/A 629204 SUP HCPCS C1713 629204 - PLATE BN 109MM NS VARIAX 4 HL TI HUM LT DIST LAT BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" "$1,869.00" "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,121.40" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629206 SUP HCPCS C1713 629206 - PLATE BN 132MM NS VARIAX 6 HL TI HUM LT DIST LAT BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" "$1,869.00" "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,121.40" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629208 SUP HCPCS C1713 629208 - PLATE BN 156MM NS VARIAX 8 HL TI HUM LT DIST LAT BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" "$2,384.00" "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629224 SUP HCPCS C1713 629224 - PLATE BN 109MM NS VARIAX 4 HL TI HUM RT DIST LAT BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" "$1,869.00" "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,121.40" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629226 SUP HCPCS C1713 629226 - PLATE BN 132MM NS VARIAX 6 HL TI HUM RT DIST LAT BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" "$1,869.00" "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,121.40" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629228 SUP HCPCS C1713 629228 - PLATE BN 156MM NS VARIAX 8 HL TI HUM RT DIST LAT BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" "$2,384.00" "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629244 SUP HCPCS C1713 629244 - PLATE BN 105MM NS VARIAX 4 HL TI HUM LT P/L BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,869.00" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629246 SUP HCPCS C1713 629246 - PLATE BN 128MM NS VARIAX 6 HL TI HUM LT P/L BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,869.00" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629248 SUP HCPCS C1713 629248 - PLATE BN 150MM NS VARIAX 8 HL TI HUM LT P/L BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" "$2,384.00" "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629264 SUP HCPCS C1713 629264 - PLATE BN 105MM NS VARIAX 4 HL TI HUM RT P/L BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,869.00" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629266 SUP HCPCS C1713 629266 - PLATE BN 128MM NS VARIAX 6 HL TI HUM RT P/L BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,121.40" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629268 SUP HCPCS C1713 629268 - PLATE BN 150MM NS VARIAX 8 HL TI HUM RT P/L BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629284 SUP HCPCS C1713 629284 - PLATE BN 96MM NS VARIAX 4 HL XTD TI HUM DIST MDL BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" "$1,869.00" "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,121.40" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629286 SUP HCPCS C1713 629286 - PLATE BN 120MM NS VARIAX 6 HL XTD TI HUM DIST MDL BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,121.40" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629288 SUP HCPCS C1713 629288 - PLATE BN 143MM NS VARIAX 8 HL XTD TI HUM DIST MDL BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629304 SUP HCPCS C1713 629304 - PLATE BONE 104MM 4 SHAFT HOLE VARIAX TITANIUM LEFT POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,869.00" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629306 SUP HCPCS C1713 629306 - PLATE BONE 128MM 6 SHAFT HOLE VARIAX TITANIUM LEFT POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,121.40" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629308 SUP HCPCS C1713 629308 - PLATE BONE 151MM 8 SHAFT HOLE VARIAX TITANIUM LEFT POSTERIOR BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629324 SUP HCPCS C1713 629324 - PLATE BONE 104MM 4 SHAFT HOLE VARIAX TITANIUM RIGHT BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,869.00" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629326 SUP HCPCS C1713 629326 - PLATE BONE 128MM 6 SHAFT HOLE VARIAX TITANIUM RIGHT BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,869.00" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629328 SUP HCPCS C1713 629328 - PLATE BONE 151MM 8 SHAFT HOLE VARIAX TITANIUM RIGHT BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629344 SUP HCPCS C1713 629344 - PLATE BN 89MM NS VARIAX 4 HL TI OLCRN LT BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,869.00" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629346 SUP HCPCS C1713 629346 - PLATE BN 113MM NS VARIAX 6 HL TI OLCRN LT BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,869.00" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629348 SUP HCPCS C1713 629348 - PLATE BN 137MM NS VARIAX 8 HL TI OLCRN LT BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629364 SUP HCPCS C1713 629364 - PLATE BN 89MM NS VARIAX 4 HL TI OLCRN RT BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,869.00" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629366 SUP HCPCS C1713 629366 - PLATE BN 113MM NS VARIAX 6 HL TI OLCRN RT BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" N/A N/A 629368 SUP HCPCS C1713 629368 - PLATE BN 137MM NS VARIAX 8 HL TI OLCRN RT BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" N/A N/A 629384 SUP HCPCS C1713 629384 - PLATE BN 92MM NS VARIAX 4 HL TI HUM DIST MDL BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,121.40" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629385 SUP Custom 27203010 629385 - STYLET LEAD STR BALL TAPER .016IN 85CM KIT EXTEND KNOB BOTH IP/OP $16.00 $12.00 $2.85 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $16.00 $2.85 $16.00 $16.00 $11.88 $11.88 $12.33 $8.34 $3.33 $16.00 $6.40 $16.00 $16.00 $16.00 $16.00 $16.00 $12.00 $16.00 $16.00 $16.00 $8.00 $8.00 $12.67 $16.00 $12.80 $10.40 $16.00 N/A $9.28 $16.00 $9.60 $16.00 $16.00 $16.00 N/A N/A 629386 SUP HCPCS C1713 629386 - PLATE BN 116MM NS VARIAX 6 HL TI HUM DIST MDL BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" "$1,869.00" "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,121.40" "$1,869.00" $389.50 "$1,869.00" N/A N/A 629388 SUP HCPCS C1713 629388 - PLATE BN 139MM NS VARIAX 8 HL TI HUM DIST MDL BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A Jun-25 SUP Custom 27803010 06-3625 - HEAD FEM +2.5MM OFST CTPR 36MM STRL LFIT ANTM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 631400 SUP Custom 27203010 631400 - PARTICLES EMBL TRFL KT LQ SYS NBCA 2GM BOTH IP/OP "$10,375.00" "$7,678.00" "$1,846.75" "$10,375.00" "$10,375.00" "$10,375.00" "$10,375.00" "$10,375.00" "$10,375.00" "$10,375.00" "$1,846.75" "$10,375.00" "$10,375.00" "$4,181.12" "$4,181.12" "$7,997.05" "$2,060.15" "$2,162.26" "$10,375.00" "$6,302.30" "$10,375.00" "$10,375.00" "$10,375.00" "$10,375.00" "$10,375.00" "$7,781.25" "$10,375.00" "$10,375.00" "$10,375.00" "$5,187.50" "$5,187.50" "$8,217.00" "$10,375.00" "$8,300.00" "$6,743.75" "$10,375.00" N/A "$6,017.50" "$10,375.00" "$6,225.00" "$10,375.00" "$10,375.00" "$10,375.00" N/A N/A 631500 SUP Custom 27203010 631500 - PARTICLES EMBL TRFL KT LQ SYS NBCA 1GM BOTH IP/OP "$8,100.00" "$5,994.00" "$1,441.74" "$8,099.68" "$8,099.68" "$8,099.68" "$8,099.68" "$8,099.68" "$8,099.68" "$8,099.68" "$1,441.74" "$8,099.68" "$8,099.68" "$4,181.12" "$4,181.12" "$6,243.23" "$2,060.15" "$1,688.06" "$8,099.68" "$3,610.61" "$8,099.68" "$8,099.68" "$8,099.68" "$8,099.68" "$8,099.68" "$6,075.00" "$8,099.68" "$8,099.68" "$8,099.68" "$4,049.84" "$4,049.84" "$6,414.95" "$8,099.68" "$6,479.74" "$5,264.79" "$8,099.68" N/A "$4,698.00" "$8,099.68" "$4,859.81" "$8,099.68" "$8,099.68" "$8,099.68" N/A N/A 635002 SUP Custom 27803010 635002 - SYRINGE INFLAT/DEFLATION INDEFLATOR TRUFILL DCS II PLATINUM BOTH IP/OP $674.50 $499.00 $120.04 $674.40 $674.40 $674.40 $674.40 $674.40 $674.40 $674.40 $120.04 $674.40 $674.40 $674.40 $674.40 $674.40 $674.40 $140.55 $674.40 $269.58 $674.40 $674.40 $674.40 $674.40 $674.40 $505.88 $674.40 $674.40 $674.40 $337.20 $337.20 $534.12 $674.40 $539.52 $303.48 $674.40 N/A $391.21 $674.40 $404.64 $674.40 $674.40 $674.40 N/A N/A 636032 SUP HCPCS C1713 636032 - SPACER SPINAL XS 13X12X10MM LUMBAR INTERBODY FUSION BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636053 SUP HCPCS C1713 636053 - SPACER SPINAL XS 15X13X10MM LUMBAR INTERBODY FUSION BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636132 SUP HCPCS C1713 636132 - SPACER SPINAL XS 13X12X11MM LUMBAR INTERBODY FUSION BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636153 SUP HCPCS C1713 636153 - SPACER SPINAL XS 15X13X11MM LUMBAR INTERBODY FUSION BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636232 SUP HCPCS C1713 636232 - SPACER SPINAL XS 13X12X12MM LUMBAR INTERBODY FUSION BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636253 SUP HCPCS C1713 636253 - SPACER SPINAL XS 15X13X12MM LUMBAR INTERBODY FUSION BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636532 SUP HCPCS C1713 636532 - SPACER SPINAL XS 13X12X5MM LUMBAR INTERBODY FUSION PERIMETER BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636553 SUP HCPCS C1713 636553 - SPACER SPINAL XS 15X13X5MM LUMBAR INTERBODY FUSION PERIMETER BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636632 SUP HCPCS C1713 636632 - SPACER SPINAL XS 13X12X6MM LUMBAR INTERBODY FUSION PERIMETER BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636653 SUP HCPCS C1713 636653 - SPACER SPINAL XS 15X13X6MM PERIMETER PEEK-OPTIMA LUMBAR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636732 SUP HCPCS C1713 636732 - SPACER SPINAL XS 13X12X7MM LUMBAR INTERBODY FUSION PERIMETER BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636753 SUP HCPCS C1713 636753 - SPACER SPINAL XS 15X13X7MM LUMBAR INTERBODY FUSION PERIMETER BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636832 SUP HCPCS C1713 636832 - SPACER SPINAL XS 13X12X8MM LUMBAR INTERBODY FUSION PERIMETER BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636853 SUP HCPCS C1713 636853 - SPACER SPINAL XS 15X13X8MM LUMBAR INTERBODY FUSION PERIMETER BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636932 SUP HCPCS C1713 636932 - SPACER SPINAL XS 13X12X9MM LUMBAR INTERBODY FUSION PERIMETER BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 636953 SUP HCPCS C1713 636953 - SPACER SPNL XS 15X13X9MM PRIMTR PEEK-OPTM LMBR INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A Jun-75 SUP Custom 27803010 06-3675 - HEAD FEM +7.5MM OFST CTPR 36MM STRL LFIT ANTM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 650944 SUP Custom 27203010 650944 - BANDAGE COMPRESSION 10YDX4IN 5YDX4IN 1 SELF ADHERENT ELAST BOTH IP/OP $26.00 $19.00 $4.57 $25.68 $25.68 $25.68 $25.68 $25.68 $25.68 $25.68 $4.57 $25.68 $25.68 $19.06 $19.06 $19.79 $13.38 $5.35 $25.68 $10.27 $25.68 $25.68 $25.68 $25.68 $25.68 $19.50 $25.68 $25.68 $25.68 $12.84 $12.84 $20.34 $25.68 $20.54 $16.69 $25.68 N/A $15.08 $25.68 $15.41 $25.68 $25.68 $25.68 N/A N/A 653050 SUP HCPCS C1762 653050 - GRAFT BONE SHORT 5X2.5CM DEMINERALIZED BONE MATRIX BOTH IP/OP "$6,800.00" "$5,032.00" "$1,349.63" "$6,800.00" "$3,060.00" "$3,060.00" "$3,060.00" "$3,060.00" "$6,800.00" "$6,800.00" "$6,800.00" "$1,417.29" "$6,800.00" "$6,800.00" "$6,800.00" "$6,800.00" "$6,800.00" "$1,417.19" "$6,800.00" "$6,800.00" "$3,352.40" "$6,800.00" "$6,800.00" "$6,800.00" "$6,800.00" "$5,100.00" "$6,800.00" "$6,800.00" "$6,800.00" "$3,400.00" "$3,400.00" "$5,385.60" "$6,800.00" "$5,440.00" "$3,060.00" "$1,349.63" N/A "$3,944.00" "$6,800.00" "$6,800.00" "$6,800.00" "$1,417.12" "$6,800.00" N/A N/A 653100 SUP HCPCS C1762 653100 - GRAFT BONE BIO BOAT ALLOGRAFT DEMINERALIZED BONE MATRIX 20ML BOTH IP/OP "$10,975.00" "$8,122.00" "$2,178.26" "$10,975.00" "$4,938.75" "$4,938.75" "$4,938.75" "$4,938.75" "$10,975.00" "$10,975.00" "$10,975.00" "$2,287.46" "$10,975.00" "$10,975.00" "$10,975.00" "$10,975.00" "$10,975.00" "$2,287.31" "$10,975.00" "$10,975.00" "$5,410.68" "$10,975.00" "$10,975.00" "$10,975.00" "$10,975.00" "$8,231.25" "$10,975.00" "$10,975.00" "$10,975.00" "$5,487.50" "$5,487.50" "$8,692.20" "$10,975.00" "$8,780.00" "$4,938.75" "$2,178.26" N/A "$6,365.50" "$10,975.00" "$10,975.00" "$10,975.00" "$2,287.19" "$10,975.00" N/A N/A Jun-97 SUP Custom 27803010 06-3697 - HEAD FEMORAL C TAPER LOW FRICTION HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A Jun-99 SUP Custom 27803010 06-3699 - HEAD FEMORAL -5 36MM C TAPER ANATOMIC LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 665040 SUP Custom 27803010 665040 - ROD SPINAL 6MM 40MM UNION DIAPASON TITANIUM THORACOLUMBAR BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665050 SUP Custom 27803010 665050 - ROD SPINAL 6MM 50MM UNION DIAPASON TITANIUM THORACOLUMBAR BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665060 SUP Custom 27803010 665060 - ROD SPINAL 6MM 60MM UNION DIAPASON TITANIUM THORACOLUMBAR BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665070 SUP Custom 27803010 665070 - ROD SPINAL 6MM 70MM UNION TRIO THORACOLUMBAR BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665080 SUP Custom 27803010 665080 - ROD SPINAL 6MM 80MM UNION DIAPASON TITANIUM THORACOLUMBAR BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665090 SUP Custom 27803010 665090 - ROD SPINAL 6MM 90MM UNION TRIO THORACOLUMBAR BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665100 SUP Custom 27803010 665100 - ROD SPINAL 6MM 100MM UNION DIAPASON TITANIUM THORACOLUMBAR BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665110 SUP Custom 27803010 665110 - ROD SPINAL 6MM 110MM UNION DIAPASON TITANIUM THORACOLUMBAR BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665120 SUP Custom 27803010 665120 - ROD SPINAL 6MM 120MM UNION DIAPASON OSS TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665130 SUP Custom 27803010 665130 - ROD SPINAL 6MM 130MM UNION DIAPASON TITANIUM THORACOLUMBAR BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665140 SUP Custom 27803010 665140 - ROD SPINAL 6MM 140MM UNION TOP LOADING TRIO THORACOLUMBAR BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665150 SUP Custom 27803010 665150 - ROD SPINAL 6MM 150MM UNION DIAPASON TITANIUM THORACOLUMBAR BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665160 SUP Custom 27803010 665160 - ROD SPINAL 6MM 160MM UNION DIAPASON OSS TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665170 SUP Custom 27803010 665170 - ROD SPINAL 6MM 170MM UNION DIAPASON TITANIUM THORACOLUMBAR BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665180 SUP Custom 27803010 665180 - ROD SPINAL 6MM 180MM UNION DIAPASON OSS TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665190 SUP Custom 27803010 665190 - ROD SPINAL 190MM UNION DIAPASON TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665200 SUP Custom 27803010 665200 - ROD SPINAL 6MM 200MM UNION DIAPASON TITANIUM PEDICLE BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 665210 SUP Custom 27803010 665210 - ROD SPINAL 210MM UNION DIAPASON OSS TITANIUM BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 665250 SUP Custom 27803010 665250 - ROD SPINAL 250MM UNION DIAPASON OSS TITANIUM BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 665270 SUP Custom 27803010 665270 - ROD SPINAL 270MM UNION DIAPASON OSS TITANIUM BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 665300 SUP Custom 27803010 665300 - ROD SPINAL 300MM UNION DIAPASON OSS TITANIUM BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 665350 SUP Custom 27803010 665350 - ROD SPINAL 6MM 350MM UNION TRIO THORACOLUMBAR BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 665400 SUP Custom 27803010 665400 - ROD SPINAL 6MM 400MM UNION DIAPASON TITANIUM PEDICLE BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 665480 SUP Custom 27803010 665480 - ROD SPINAL 6MM 480MM UNION DIAPASON TITANIUM BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 670001 SUP HCPCS C1713 670001 - SCREW BONE 6.7MM 35MM CONICAL OPUS SPN BOTH IP/OP "$1,676.00" "$1,240.00" $332.62 "$1,675.90" $754.16 $754.16 $754.16 $754.16 "$1,675.90" "$1,675.90" "$1,675.90" $349.30 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" $349.28 "$1,675.90" $670.36 $991.29 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,257.00" "$1,675.90" "$1,675.90" "$1,675.90" $837.95 $837.95 "$1,327.31" "$1,675.90" "$1,340.72" $754.16 $332.62 N/A $972.08 "$1,675.90" "$1,005.54" "$1,675.90" $349.26 "$1,675.90" N/A N/A 670002 SUP HCPCS C1713 670002 - SCREW BONE CONE 6.7MM 40MM OPUS SPN BOTH IP/OP "$1,676.00" "$1,240.00" $332.62 "$1,675.90" $754.16 $754.16 $754.16 $754.16 "$1,675.90" "$1,675.90" "$1,675.90" $349.30 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" $349.28 "$1,675.90" "$1,675.90" $991.29 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,257.00" "$1,675.90" "$1,675.90" "$1,675.90" $837.95 $837.95 "$1,327.31" "$1,675.90" "$1,340.72" $754.16 $332.62 N/A $972.08 "$1,675.90" "$1,675.90" "$1,675.90" $349.26 "$1,675.90" N/A N/A 670003 SUP HCPCS C1713 670003 - SCREW BONE CONE 6.7MM 45MM OPUS SPN BOTH IP/OP "$1,676.00" "$1,240.00" $332.62 "$1,675.90" $754.16 $754.16 $754.16 $754.16 "$1,675.90" "$1,675.90" "$1,675.90" $349.30 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" $349.28 "$1,675.90" "$1,675.90" $991.29 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,257.00" "$1,675.90" "$1,675.90" "$1,675.90" $837.95 $837.95 "$1,327.31" "$1,675.90" "$1,340.72" $754.16 $332.62 N/A $972.08 "$1,675.90" "$1,005.54" "$1,675.90" $349.26 "$1,675.90" N/A N/A 670004 SUP HCPCS C1713 670004 - SCREW BONE CONE 6.5MM 50MM OPUS SPN BOTH IP/OP "$1,676.00" "$1,240.00" $332.62 "$1,675.90" $754.16 $754.16 $754.16 $754.16 "$1,675.90" "$1,675.90" "$1,675.90" $349.30 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" $349.28 "$1,675.90" $670.36 $991.29 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,257.00" "$1,675.90" "$1,675.90" "$1,675.90" $837.95 $837.95 "$1,327.31" "$1,675.90" "$1,340.72" $754.16 $332.62 N/A $972.08 "$1,675.90" "$1,675.90" "$1,675.90" $349.26 "$1,675.90" N/A N/A 670005 SUP HCPCS C1713 670005 - SCREW BONE 7.5MM 35MM CONICAL OPUS SPN BOTH IP/OP "$1,676.00" "$1,240.00" $332.62 "$1,675.90" $754.16 $754.16 $754.16 $754.16 "$1,675.90" "$1,675.90" "$1,675.90" $349.30 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" $349.28 "$1,675.90" $670.36 $991.29 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,257.00" "$1,675.90" "$1,675.90" "$1,675.90" $837.95 $837.95 "$1,327.31" "$1,675.90" "$1,340.72" $754.16 $332.62 N/A $972.08 "$1,675.90" "$1,675.90" "$1,675.90" $349.26 "$1,675.90" N/A N/A 670006 SUP HCPCS C1713 670006 - SCREW BONE 7.5MM 40MM CONICAL OPUS SPN BOTH IP/OP "$1,676.00" "$1,240.00" $332.62 "$1,675.90" $754.16 $754.16 $754.16 $754.16 "$1,675.90" "$1,675.90" "$1,675.90" $349.30 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" $349.28 "$1,675.90" "$1,675.90" $991.29 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,257.00" "$1,675.90" "$1,675.90" "$1,675.90" $837.95 $837.95 "$1,327.31" "$1,675.90" "$1,340.72" $754.16 $332.62 N/A $972.08 "$1,675.90" "$1,005.54" "$1,675.90" $349.26 "$1,675.90" N/A N/A 670007 SUP HCPCS C1713 670007 - SCREW BONE 7.5MM 45MM CONICAL OPUS SPN BOTH IP/OP "$1,676.00" "$1,240.00" $332.62 "$1,675.90" $754.16 $754.16 $754.16 $754.16 "$1,675.90" "$1,675.90" "$1,675.90" $349.30 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" $349.28 "$1,675.90" "$1,675.90" $991.29 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,257.00" "$1,675.90" "$1,675.90" "$1,675.90" $837.95 $837.95 "$1,327.31" "$1,675.90" "$1,340.72" $754.16 $332.62 N/A $972.08 "$1,675.90" "$1,005.54" "$1,675.90" $349.26 "$1,675.90" N/A N/A 670008 SUP HCPCS C1713 670008 - SCREW BONE 7.5MM 50MM CONICAL OPUS SPN BOTH IP/OP "$1,676.00" "$1,240.00" $332.62 "$1,675.90" $754.16 $754.16 $754.16 $754.16 "$1,675.90" "$1,675.90" "$1,675.90" $349.30 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" $349.28 "$1,675.90" $670.36 $991.29 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,257.00" "$1,675.90" "$1,675.90" "$1,675.90" $837.95 $837.95 "$1,327.31" "$1,675.90" "$1,340.72" $754.16 $332.62 N/A $972.08 "$1,675.90" "$1,005.54" "$1,675.90" $349.26 "$1,675.90" N/A N/A 670009 SUP HCPCS C1713 670009 - SCREW BONE 7.5MM 55MM CONICAL OPUS SPN BOTH IP/OP "$1,676.00" "$1,240.00" $332.62 "$1,675.90" $754.16 $754.16 $754.16 $754.16 "$1,675.90" "$1,675.90" "$1,675.90" $349.30 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" $349.28 "$1,675.90" $670.36 $991.29 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,257.00" "$1,675.90" "$1,675.90" "$1,675.90" $837.95 $837.95 "$1,327.31" "$1,675.90" "$1,340.72" $754.16 $332.62 N/A $972.08 "$1,675.90" "$1,675.90" "$1,675.90" $349.26 "$1,675.90" N/A N/A 670015 SUP HCPCS C1713 670015 - SCREW BONE 6.5MM 55MM CYLND OPUS SPN BOTH IP/OP "$1,505.50" "$1,114.00" $298.73 "$1,505.15" $677.32 $677.32 $677.32 $677.32 "$1,505.15" "$1,505.15" "$1,505.15" $313.71 "$1,505.15" "$1,505.15" "$1,505.15" "$1,505.15" "$1,505.15" $313.69 "$1,505.15" $602.06 $890.30 "$1,505.15" "$1,505.15" "$1,505.15" "$1,505.15" "$1,129.13" "$1,505.15" "$1,505.15" "$1,505.15" $752.58 $752.58 "$1,192.08" "$1,505.15" "$1,204.12" $677.32 $298.73 N/A $873.19 "$1,505.15" "$1,505.15" "$1,505.15" $313.67 "$1,505.15" N/A N/A 670062 SUP HCPCS C1713 670062 - SCREW BONE LONG 5.5MM 35MM HEXAGONAL CONICAL OPUS SPN BOTH IP/OP "$1,074.00" $795.00 $213.13 "$1,073.85" $483.23 $483.23 $483.23 $483.23 "$1,073.85" "$1,073.85" "$1,073.85" $223.82 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $223.80 "$1,073.85" "$1,073.85" $635.18 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $805.50 "$1,073.85" "$1,073.85" "$1,073.85" $536.93 $536.93 $850.49 "$1,073.85" $859.08 $483.23 $213.13 N/A $622.92 "$1,073.85" $644.31 "$1,073.85" $223.79 "$1,073.85" N/A N/A 670063 SUP HCPCS C1713 670063 - SCREW BONE LONG 5.5MM 40MM HEXAGONAL CONICAL OPUS SPN BOTH IP/OP "$1,074.00" $795.00 $213.13 "$1,073.85" $483.23 $483.23 $483.23 $483.23 "$1,073.85" "$1,073.85" "$1,073.85" $223.82 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $223.80 "$1,073.85" "$1,073.85" $635.18 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $805.50 "$1,073.85" "$1,073.85" "$1,073.85" $536.93 $536.93 $850.49 "$1,073.85" $859.08 $483.23 $213.13 N/A $622.92 "$1,073.85" $644.31 "$1,073.85" $223.79 "$1,073.85" N/A N/A 670071 SUP HCPCS C1713 670071 - SCREW BONE LONG 6.5MM 35MM HEXAGONAL CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" $626.32 $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" "$1,565.80" "$1,565.80" $326.31 "$1,565.80" N/A N/A 670072 SUP HCPCS C1713 670072 - SCREW BONE LONG 6.5MM 40MM HEXAGONAL CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" $626.32 $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" "$1,565.80" "$1,565.80" $326.31 "$1,565.80" N/A N/A 670073 SUP HCPCS C1713 670073 - SCREW BONE LONG 6.5MM 45MM HEXAGONAL CONICAL OPUS SPN BOTH IP/OP "$1,644.50" "$1,217.00" $326.38 "$1,644.45" $740.00 $740.00 $740.00 $740.00 "$1,644.45" "$1,644.45" "$1,644.45" $342.74 "$1,644.45" "$1,644.45" "$1,644.45" "$1,644.45" "$1,644.45" $342.72 "$1,644.45" $657.78 $972.69 "$1,644.45" "$1,644.45" "$1,644.45" "$1,644.45" "$1,233.38" "$1,644.45" "$1,644.45" "$1,644.45" $822.23 $822.23 "$1,302.40" "$1,644.45" "$1,315.56" $740.00 $326.38 N/A $953.81 "$1,644.45" "$1,644.45" "$1,644.45" $342.70 "$1,644.45" N/A N/A 670074 SUP HCPCS C1713 670074 - SCREW BONE LONG 6.5MM 50MM HEXAGONAL CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" $626.32 $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" N/A N/A 670075 SUP HCPCS C1713 670075 - SCREW BONE LONG 6.5MM 55MM HEXAGONAL CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" $626.32 $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" N/A N/A 670081 SUP HCPCS C1713 670081 - SCREW BONE LONG 7.5MM 35MM HEXAGONAL CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" "$1,565.80" $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" N/A N/A 670082 SUP HCPCS C1713 670082 - SCREW BONE LONG 7.5MM 40MM HEXAGONAL CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" "$1,565.80" $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" "$1,565.80" "$1,565.80" $326.31 "$1,565.80" N/A N/A 670083 SUP HCPCS C1713 670083 - SCREW BONE LONG 7.5MM 45MM HEXAGONAL CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" "$1,565.80" $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" "$1,565.80" "$1,565.80" $326.31 "$1,565.80" N/A N/A 670084 SUP HCPCS C1713 670084 - SCREW BONE LONG 7.5MM 50MM HEXAGONAL CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" "$1,565.80" $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" "$1,565.80" "$1,565.80" $326.31 "$1,565.80" N/A N/A 670086 SUP HCPCS C1713 670086 - SCREW BONE LONG 7.5MM 55MM HEXAGONAL CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" "$1,565.80" $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" "$1,565.80" "$1,565.80" $326.31 "$1,565.80" N/A N/A 670102 SUP HCPCS C1713 670102 - SCREW BONE 8MM 40MM CONICAL OPUS SPN BOTH IP/OP "$1,027.00" $760.00 $203.76 "$1,026.65" $461.99 $461.99 $461.99 $461.99 "$1,026.65" "$1,026.65" "$1,026.65" $213.98 "$1,026.65" "$1,026.65" "$1,026.65" "$1,026.65" "$1,026.65" $213.97 "$1,026.65" $410.66 $607.26 "$1,026.65" "$1,026.65" "$1,026.65" "$1,026.65" $770.25 "$1,026.65" "$1,026.65" "$1,026.65" $513.33 $513.33 $813.11 "$1,026.65" $821.32 $461.99 $203.76 N/A $595.66 "$1,026.65" "$1,026.65" "$1,026.65" $213.95 "$1,026.65" N/A N/A 670103 SUP HCPCS C1713 670103 - SCREW BONE 8MM 45MM CONICAL OPUS SPN BOTH IP/OP "$1,027.00" $760.00 $203.76 "$1,026.65" $461.99 $461.99 $461.99 $461.99 "$1,026.65" "$1,026.65" "$1,026.65" $213.98 "$1,026.65" "$1,026.65" "$1,026.65" "$1,026.65" "$1,026.65" $213.97 "$1,026.65" $410.66 $607.26 "$1,026.65" "$1,026.65" "$1,026.65" "$1,026.65" $770.25 "$1,026.65" "$1,026.65" "$1,026.65" $513.33 $513.33 $813.11 "$1,026.65" $821.32 $461.99 $203.76 N/A $595.66 "$1,026.65" "$1,026.65" "$1,026.65" $213.95 "$1,026.65" N/A N/A 670111 SUP HCPCS C1713 670111 - SCREW BONE 9MM 35MM CONICAL OPUS SPN BOTH IP/OP "$1,063.00" $787.00 $210.90 "$1,062.58" $478.16 $478.16 $478.16 $478.16 "$1,062.58" "$1,062.58" "$1,062.58" $221.47 "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" $221.45 "$1,062.58" $425.03 $628.52 "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" $797.25 "$1,062.58" "$1,062.58" "$1,062.58" $531.29 $531.29 $841.56 "$1,062.58" $850.06 $478.16 $210.90 N/A $616.54 "$1,062.58" "$1,062.58" "$1,062.58" $221.44 "$1,062.58" N/A N/A 670112 SUP HCPCS C1713 670112 - SCREW BONE 9MM 40MM CONICAL OPUS SPN BOTH IP/OP "$1,063.00" $787.00 $210.90 "$1,062.58" $478.16 $478.16 $478.16 $478.16 "$1,062.58" "$1,062.58" "$1,062.58" $221.47 "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" $221.45 "$1,062.58" $425.03 $628.52 "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" $797.25 "$1,062.58" "$1,062.58" "$1,062.58" $531.29 $531.29 $841.56 "$1,062.58" $850.06 $478.16 $210.90 N/A $616.54 "$1,062.58" "$1,062.58" "$1,062.58" $221.44 "$1,062.58" N/A N/A 670113 SUP HCPCS C1713 670113 - SCREW BONE 9MM 45MM CONICAL OPUS SPN BOTH IP/OP "$1,063.00" $787.00 $210.90 "$1,062.58" $478.16 $478.16 $478.16 $478.16 "$1,062.58" "$1,062.58" "$1,062.58" $221.47 "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" $221.45 "$1,062.58" "$1,062.58" $628.52 "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" $797.25 "$1,062.58" "$1,062.58" "$1,062.58" $531.29 $531.29 $841.56 "$1,062.58" $850.06 $478.16 $210.90 N/A $616.54 "$1,062.58" "$1,062.58" "$1,062.58" $221.44 "$1,062.58" N/A N/A 670114 SUP HCPCS C1713 670114 - SCREW BONE 9MM 50MM CONICAL OPUS SPN BOTH IP/OP "$1,063.00" $787.00 $210.90 "$1,062.58" $478.16 $478.16 $478.16 $478.16 "$1,062.58" "$1,062.58" "$1,062.58" $221.47 "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" $221.45 "$1,062.58" "$1,062.58" $628.52 "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" $797.25 "$1,062.58" "$1,062.58" "$1,062.58" $531.29 $531.29 $841.56 "$1,062.58" $850.06 $478.16 $210.90 N/A $616.54 "$1,062.58" "$1,062.58" "$1,062.58" $221.44 "$1,062.58" N/A N/A 670115 SUP HCPCS C1713 670115 - SCREW BONE 9MM 55MM CONICAL OPUS SPN BOTH IP/OP "$1,063.00" $787.00 $210.90 "$1,062.58" $478.16 $478.16 $478.16 $478.16 "$1,062.58" "$1,062.58" "$1,062.58" $221.47 "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" $221.45 "$1,062.58" "$1,062.58" $628.52 "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" $797.25 "$1,062.58" "$1,062.58" "$1,062.58" $531.29 $531.29 $841.56 "$1,062.58" $850.06 $478.16 $210.90 N/A $616.54 "$1,062.58" "$1,062.58" "$1,062.58" $221.44 "$1,062.58" N/A N/A 670213 SUP HCPCS C1713 670213 - SCREW BONE 5.5MM 35MM 2 CUT SAGITTAL OPUS SPN BOTH IP/OP "$1,505.50" "$1,114.00" $298.73 "$1,505.15" $677.32 $677.32 $677.32 $677.32 "$1,505.15" "$1,505.15" "$1,505.15" $313.71 "$1,505.15" "$1,505.15" "$1,505.15" "$1,505.15" "$1,505.15" $313.69 "$1,505.15" "$1,505.15" $890.30 "$1,505.15" "$1,505.15" "$1,505.15" "$1,505.15" "$1,129.13" "$1,505.15" "$1,505.15" "$1,505.15" $752.58 $752.58 "$1,192.08" "$1,505.15" "$1,204.12" $677.32 $298.73 N/A $873.19 "$1,505.15" "$1,505.15" "$1,505.15" $313.67 "$1,505.15" N/A N/A 670214 SUP HCPCS C1713 670214 - SCREW BONE CONE 5.5MM 40MM OPUS SPN BOTH IP/OP "$1,676.00" "$1,240.00" $332.62 "$1,675.90" $754.16 $754.16 $754.16 $754.16 "$1,675.90" "$1,675.90" "$1,675.90" $349.30 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" $349.28 "$1,675.90" "$1,675.90" $991.29 "$1,675.90" "$1,675.90" "$1,675.90" "$1,675.90" "$1,257.00" "$1,675.90" "$1,675.90" "$1,675.90" $837.95 $837.95 "$1,327.31" "$1,675.90" "$1,340.72" $754.16 $332.62 N/A $972.08 "$1,675.90" "$1,675.90" "$1,675.90" $349.26 "$1,675.90" N/A N/A 670221 SUP HCPCS C1713 670221 - PLATE BONE LONG 35MM 2 HOLE OPUS SPN BOTH IP/OP "$2,619.50" "$1,938.00" $519.90 "$2,619.45" "$1,178.75" "$1,178.75" "$1,178.75" "$1,178.75" "$2,619.45" "$2,619.45" "$2,619.45" $545.96 "$2,619.45" "$2,619.45" "$2,619.45" "$2,619.45" "$2,619.45" $545.92 "$2,619.45" "$1,047.78" "$1,291.39" "$2,619.45" "$2,619.45" "$2,619.45" "$2,619.45" "$1,964.63" "$2,619.45" "$2,619.45" "$2,619.45" "$1,309.73" "$1,309.73" "$2,074.60" "$2,619.45" "$2,095.56" "$1,178.75" $519.90 N/A "$1,519.31" "$2,619.45" "$2,619.45" "$2,619.45" $545.89 "$2,619.45" N/A N/A 670222 SUP HCPCS C1713 670222 - PLATE BONE SHORT 2 HOLE OPUS SPN BOTH IP/OP "$2,619.50" "$1,938.00" $519.90 "$2,619.45" "$1,178.75" "$1,178.75" "$1,178.75" "$1,178.75" "$2,619.45" "$2,619.45" "$2,619.45" $545.96 "$2,619.45" "$2,619.45" "$2,619.45" "$2,619.45" "$2,619.45" $545.92 "$2,619.45" "$2,619.45" "$1,291.39" "$2,619.45" "$2,619.45" "$2,619.45" "$2,619.45" "$1,964.63" "$2,619.45" "$2,619.45" "$2,619.45" "$1,309.73" "$1,309.73" "$2,074.60" "$2,619.45" "$2,095.56" "$1,178.75" $519.90 N/A "$1,519.31" "$2,619.45" "$2,619.45" "$2,619.45" $545.89 "$2,619.45" N/A N/A 670223 SUP HCPCS C1713 670223 - PLATE BONE LONG 3 HOLE OPUS SPN BOTH IP/OP "$2,772.50" "$2,052.00" $550.21 "$2,772.18" "$1,247.48" "$1,247.48" "$1,247.48" "$1,247.48" "$2,772.18" "$2,772.18" "$2,772.18" $577.79 "$2,772.18" "$2,772.18" "$2,772.18" "$2,772.18" "$2,772.18" $577.75 "$2,772.18" "$1,108.87" "$1,366.68" "$2,772.18" "$2,772.18" "$2,772.18" "$2,772.18" "$2,079.38" "$2,772.18" "$2,772.18" "$2,772.18" "$1,386.09" "$1,386.09" "$2,195.57" "$2,772.18" "$2,217.74" "$1,247.48" $550.21 N/A "$1,608.05" "$2,772.18" "$2,772.18" "$2,772.18" $577.72 "$2,772.18" N/A N/A 670224 SUP HCPCS C1713 670224 - PLATE BONE 90MM OPUS SPN BOTH IP/OP "$2,622.00" "$1,940.00" $520.34 "$2,621.70" "$1,179.77" "$1,179.77" "$1,179.77" "$1,179.77" "$2,621.70" "$2,621.70" "$2,621.70" $546.43 "$2,621.70" "$2,621.70" "$2,621.70" "$2,621.70" "$2,621.70" $546.39 "$2,621.70" "$1,048.68" "$1,292.50" "$2,621.70" "$2,621.70" "$2,621.70" "$2,621.70" "$1,966.50" "$2,621.70" "$2,621.70" "$2,621.70" "$1,310.85" "$1,310.85" "$2,076.39" "$2,621.70" "$2,097.36" "$1,179.77" $520.34 N/A "$1,520.76" "$2,621.70" "$2,621.70" "$2,621.70" $546.36 "$2,621.70" N/A N/A 670225 SUP HCPCS C1713 670225 - PLATE BONE 105MM OPUS SPN BOTH IP/OP "$2,496.00" "$1,847.00" $495.37 "$2,495.88" "$1,123.15" "$1,123.15" "$1,123.15" "$1,123.15" "$2,495.88" "$2,495.88" "$2,495.88" $520.20 "$2,495.88" "$2,495.88" "$2,495.88" "$2,495.88" "$2,495.88" $520.17 "$2,495.88" "$2,495.88" "$1,476.31" "$2,495.88" "$2,495.88" "$2,495.88" "$2,495.88" "$1,872.00" "$2,495.88" "$2,495.88" "$2,495.88" "$1,247.94" "$1,247.94" "$1,976.74" "$2,495.88" "$1,996.70" "$1,123.15" $495.37 N/A "$1,447.68" "$2,495.88" "$1,497.53" "$2,495.88" $520.14 "$2,495.88" N/A N/A 670226 SUP HCPCS C1713 670226 - PLATE BONE 120MM OPUS SPN BOTH IP/OP "$2,496.00" "$1,847.00" $495.37 "$2,495.88" "$1,123.15" "$1,123.15" "$1,123.15" "$1,123.15" "$2,495.88" "$2,495.88" "$2,495.88" $520.20 "$2,495.88" "$2,495.88" "$2,495.88" "$2,495.88" "$2,495.88" $520.17 "$2,495.88" $998.35 "$1,476.31" "$2,495.88" "$2,495.88" "$2,495.88" "$2,495.88" "$1,872.00" "$2,495.88" "$2,495.88" "$2,495.88" "$1,247.94" "$1,247.94" "$1,976.74" "$2,495.88" "$1,996.70" "$1,123.15" $495.37 N/A "$1,447.68" "$2,495.88" "$2,495.88" "$2,495.88" $520.14 "$2,495.88" N/A N/A 670282 SUP Custom 27803010 670282 - CONNECTOR ROD 5.5MM 35MM LONGTOP OPUS SPN BOTH IP/OP "$1,121.50" $830.00 $199.54 "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" $199.54 "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" $233.63 "$1,121.03" $448.41 "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" $841.13 "$1,121.03" "$1,121.03" "$1,121.03" $560.52 $560.52 $887.86 "$1,121.03" $896.82 $504.46 "$1,121.03" N/A $650.47 "$1,121.03" $672.62 "$1,121.03" "$1,121.03" "$1,121.03" N/A N/A 670283 SUP Custom 27803010 670283 - CONNECTOR ROD 5.5MM 40MM LONGTOP OPUS SPN BOTH IP/OP "$1,121.50" $830.00 $199.54 "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" $199.54 "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" $233.63 "$1,121.03" $448.41 "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" "$1,121.03" $841.13 "$1,121.03" "$1,121.03" "$1,121.03" $560.52 $560.52 $887.86 "$1,121.03" $896.82 $504.46 "$1,121.03" N/A $650.47 "$1,121.03" $672.62 "$1,121.03" "$1,121.03" "$1,121.03" N/A N/A 670301 SUP HCPCS C1713 670301 - SCREW BONE 6.5MM 35MM LONG TOP CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" "$1,565.80" $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" "$1,565.80" "$1,565.80" $326.31 "$1,565.80" N/A N/A 670302 SUP HCPCS C1713 670302 - SCREW BONE 6.5MM 40MM LONG TOP CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" "$1,565.80" $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" "$1,565.80" "$1,565.80" $326.31 "$1,565.80" N/A N/A 670303 SUP HCPCS C1713 670303 - SCREW BONE 6.5MM 45MM LONG TOP CONICAL OPUS SPN BOTH IP/OP "$1,644.50" "$1,217.00" $326.38 "$1,644.45" $740.00 $740.00 $740.00 $740.00 "$1,644.45" "$1,644.45" "$1,644.45" $342.74 "$1,644.45" "$1,644.45" "$1,644.45" "$1,644.45" "$1,644.45" $342.72 "$1,644.45" "$1,644.45" $972.69 "$1,644.45" "$1,644.45" "$1,644.45" "$1,644.45" "$1,233.38" "$1,644.45" "$1,644.45" "$1,644.45" $822.23 $822.23 "$1,302.40" "$1,644.45" "$1,315.56" $740.00 $326.38 N/A $953.81 "$1,644.45" "$1,644.45" "$1,644.45" $342.70 "$1,644.45" N/A N/A 670304 SUP HCPCS C1713 670304 - SCREW BONE 6.5MM 50MM LONG TOP CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" "$1,565.80" $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" $939.48 "$1,565.80" $326.31 "$1,565.80" N/A N/A 670305 SUP HCPCS C1713 670305 - SCREW BONE 6.5MM 55MM LONG TOP CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" "$1,565.80" $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" $939.48 "$1,565.80" $326.31 "$1,565.80" N/A N/A 670311 SUP HCPCS C1713 670311 - SCREW BONE 7.5MM 35MM LONG TOP CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" "$1,565.80" $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" $939.48 "$1,565.80" $326.31 "$1,565.80" N/A N/A 670312 SUP HCPCS C1713 670312 - SCREW BONE 7.5MM 40MM LONG TOP CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" "$1,565.80" $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" "$1,565.80" "$1,565.80" $326.31 "$1,565.80" N/A N/A 670313 SUP HCPCS C1713 670313 - SCREW BONE 7.5MM 45MM LONG TOP CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" "$1,565.80" $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" "$1,565.80" "$1,565.80" $326.31 "$1,565.80" N/A N/A 670314 SUP HCPCS C1713 670314 - SCREW BONE 7.5MM 50MM LONG TOP CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" "$1,565.80" $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" $939.48 "$1,565.80" $326.31 "$1,565.80" N/A N/A 670315 SUP HCPCS C1713 670315 - SCREW BONE 7.5MM 55MM LONG TOP CONICAL OPUS SPN BOTH IP/OP "$1,566.00" "$1,159.00" $310.77 "$1,565.80" $704.61 $704.61 $704.61 $704.61 "$1,565.80" "$1,565.80" "$1,565.80" $326.35 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" $326.33 "$1,565.80" "$1,565.80" $926.17 "$1,565.80" "$1,565.80" "$1,565.80" "$1,565.80" "$1,174.50" "$1,565.80" "$1,565.80" "$1,565.80" $782.90 $782.90 "$1,240.11" "$1,565.80" "$1,252.64" $704.61 $310.77 N/A $908.28 "$1,565.80" $939.48 "$1,565.80" $326.31 "$1,565.80" N/A N/A 670371 SUP HCPCS C1713 670371 - SCREW BONE 6.5MM 35MM LONG TOP LONG HEX CONICAL OPUS SPN BOTH IP/OP "$1,074.00" $795.00 $213.13 "$1,073.85" $483.23 $483.23 $483.23 $483.23 "$1,073.85" "$1,073.85" "$1,073.85" $223.82 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $223.80 "$1,073.85" "$1,073.85" $635.18 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $805.50 "$1,073.85" "$1,073.85" "$1,073.85" $536.93 $536.93 $850.49 "$1,073.85" $859.08 $483.23 $213.13 N/A $622.92 "$1,073.85" "$1,073.85" "$1,073.85" $223.79 "$1,073.85" N/A N/A 670372 SUP HCPCS C1713 670372 - SCREW BONE 6.5MM 40MM LONG TOP LONG HEX CONICAL OPUS SPN BOTH IP/OP "$1,074.00" $795.00 $213.13 "$1,073.85" $483.23 $483.23 $483.23 $483.23 "$1,073.85" "$1,073.85" "$1,073.85" $223.82 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $223.80 "$1,073.85" "$1,073.85" $635.18 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $805.50 "$1,073.85" "$1,073.85" "$1,073.85" $536.93 $536.93 $850.49 "$1,073.85" $859.08 $483.23 $213.13 N/A $622.92 "$1,073.85" $644.31 "$1,073.85" $223.79 "$1,073.85" N/A N/A 670373 SUP HCPCS C1713 670373 - SCREW BONE 6.5MM 45MM LONG TOP LONG HEX CONICAL OPUS SPN BOTH IP/OP "$1,074.00" $795.00 $213.13 "$1,073.85" $483.23 $483.23 $483.23 $483.23 "$1,073.85" "$1,073.85" "$1,073.85" $223.82 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $223.80 "$1,073.85" "$1,073.85" $635.18 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $805.50 "$1,073.85" "$1,073.85" "$1,073.85" $536.93 $536.93 $850.49 "$1,073.85" $859.08 $483.23 $213.13 N/A $622.92 "$1,073.85" $644.31 "$1,073.85" $223.79 "$1,073.85" N/A N/A 670374 SUP HCPCS C1713 670374 - SCREW BONE 6.5MM 50MM LONG TOP LONG HEX CONICAL OPUS SPN BOTH IP/OP "$1,074.00" $795.00 $213.13 "$1,073.85" $483.23 $483.23 $483.23 $483.23 "$1,073.85" "$1,073.85" "$1,073.85" $223.82 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $223.80 "$1,073.85" "$1,073.85" $635.18 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $805.50 "$1,073.85" "$1,073.85" "$1,073.85" $536.93 $536.93 $850.49 "$1,073.85" $859.08 $483.23 $213.13 N/A $622.92 "$1,073.85" $644.31 "$1,073.85" $223.79 "$1,073.85" N/A N/A 670381 SUP HCPCS C1713 670381 - SCREW BONE 7.5MM 35MM LONG TOP LONG HEX CONICAL OPUS SPN BOTH IP/OP "$1,074.00" $795.00 $213.13 "$1,073.85" $483.23 $483.23 $483.23 $483.23 "$1,073.85" "$1,073.85" "$1,073.85" $223.82 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $223.80 "$1,073.85" $429.54 $635.18 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $805.50 "$1,073.85" "$1,073.85" "$1,073.85" $536.93 $536.93 $850.49 "$1,073.85" $859.08 $483.23 $213.13 N/A $622.92 "$1,073.85" $644.31 "$1,073.85" $223.79 "$1,073.85" N/A N/A 670382 SUP HCPCS C1713 670382 - SCREW BONE 7.5MM 40MM LONG TOP LONG HEX CONICAL OPUS SPN BOTH IP/OP "$1,074.00" $795.00 $213.13 "$1,073.85" $483.23 $483.23 $483.23 $483.23 "$1,073.85" "$1,073.85" "$1,073.85" $223.82 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $223.80 "$1,073.85" $429.54 $635.18 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $805.50 "$1,073.85" "$1,073.85" "$1,073.85" $536.93 $536.93 $850.49 "$1,073.85" $859.08 $483.23 $213.13 N/A $622.92 "$1,073.85" "$1,073.85" "$1,073.85" $223.79 "$1,073.85" N/A N/A 670383 SUP HCPCS C1713 670383 - SCREW BONE 7.5MM 45MM LONG TOP LONG HEX CONICAL OPUS SPN BOTH IP/OP "$1,074.00" $795.00 $213.13 "$1,073.85" $483.23 $483.23 $483.23 $483.23 "$1,073.85" "$1,073.85" "$1,073.85" $223.82 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $223.80 "$1,073.85" "$1,073.85" $635.18 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $805.50 "$1,073.85" "$1,073.85" "$1,073.85" $536.93 $536.93 $850.49 "$1,073.85" $859.08 $483.23 $213.13 N/A $622.92 "$1,073.85" $644.31 "$1,073.85" $223.79 "$1,073.85" N/A N/A 670384 SUP HCPCS C1713 670384 - SCREW BONE 7.5MM 50MM LONG TOP LONG HEX CONICAL OPUS SPN BOTH IP/OP "$1,074.00" $795.00 $213.13 "$1,073.85" $483.23 $483.23 $483.23 $483.23 "$1,073.85" "$1,073.85" "$1,073.85" $223.82 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $223.80 "$1,073.85" "$1,073.85" $635.18 "$1,073.85" "$1,073.85" "$1,073.85" "$1,073.85" $805.50 "$1,073.85" "$1,073.85" "$1,073.85" $536.93 $536.93 $850.49 "$1,073.85" $859.08 $483.23 $213.13 N/A $622.92 "$1,073.85" $644.31 "$1,073.85" $223.79 "$1,073.85" N/A N/A 670501 SUP HCPCS C1713 670501 - OPUS WASHER BOTH IP/OP $142.00 $105.00 $28.09 $141.55 $63.70 $63.70 $63.70 $63.70 $141.55 $141.55 $141.55 $29.50 $141.55 $141.55 $141.55 $141.55 $141.55 $29.50 $141.55 $141.55 $83.73 $141.55 $141.55 $141.55 $141.55 $106.50 $141.55 $141.55 $141.55 $70.78 $70.78 $112.11 $141.55 $113.24 $63.70 $28.09 N/A $82.36 $141.55 $84.93 $141.55 $29.50 $141.55 N/A N/A 670504 SUP HCPCS C1713 670504 - NUT LOCK PLATE OPUS SPN BOTH IP/OP $142.00 $105.00 $28.09 $141.55 $63.70 $63.70 $63.70 $63.70 $141.55 $141.55 $141.55 $29.50 $141.55 $141.55 $141.55 $141.55 $141.55 $29.50 $141.55 $141.55 $83.73 $141.55 $141.55 $141.55 $141.55 $106.50 $141.55 $141.55 $141.55 $70.78 $70.78 $112.11 $141.55 $113.24 $63.70 $28.09 N/A $82.36 $141.55 $84.93 $141.55 $29.50 $141.55 N/A N/A 670600 SUP Custom 27803010 670600 - CONNECTOR ROD OPUS SPN BOTH IP/OP "$1,063.00" $787.00 $189.14 "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" $189.14 "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" $221.45 "$1,062.58" $425.03 "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" "$1,062.58" $797.25 "$1,062.58" "$1,062.58" "$1,062.58" $531.29 $531.29 $841.56 "$1,062.58" $850.06 $478.16 "$1,062.58" N/A $616.54 "$1,062.58" $637.55 "$1,062.58" "$1,062.58" "$1,062.58" N/A N/A 670604 SUP HCPCS C1713 670604 - NUT LOCK ROD OPUS SPN BOTH IP/OP $200.00 $148.00 $39.69 $199.95 $89.98 $89.98 $89.98 $89.98 $199.95 $199.95 $199.95 $41.67 $199.95 $199.95 $199.95 $199.95 $199.95 $41.67 $199.95 $199.95 $118.27 $199.95 $199.95 $199.95 $199.95 $150.00 $199.95 $199.95 $199.95 $99.98 $99.98 $158.36 $199.95 $159.96 $89.98 $39.69 N/A $116.00 $199.95 $119.97 $199.95 $41.67 $199.95 N/A N/A 670610 SUP Custom 27803010 670610 - CONNECTOR ROD OFFST OPUS SPN BOTH IP/OP "$1,251.50" $926.00 $222.73 "$1,251.28" "$1,251.28" "$1,251.28" "$1,251.28" "$1,251.28" "$1,251.28" "$1,251.28" $222.73 "$1,251.28" "$1,251.28" "$1,251.28" "$1,251.28" "$1,251.28" "$1,251.28" $260.78 "$1,251.28" $500.51 "$1,251.28" "$1,251.28" "$1,251.28" "$1,251.28" "$1,251.28" $938.63 "$1,251.28" "$1,251.28" "$1,251.28" $625.64 $625.64 $991.01 "$1,251.28" "$1,001.02" $563.08 "$1,251.28" N/A $725.87 "$1,251.28" $750.77 "$1,251.28" "$1,251.28" "$1,251.28" N/A N/A 671040 SUP Custom 27803010 671040 - ROD SPINAL 40MM OPUS BOTH IP/OP $708.00 $524.00 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $147.48 $707.65 $283.06 $707.65 $707.65 $707.65 $707.65 $707.65 $531.00 $707.65 $707.65 $707.65 $353.83 $353.83 $560.46 $707.65 $566.12 $318.44 $707.65 N/A $410.64 $707.65 $424.59 $707.65 $707.65 $707.65 N/A N/A 671050 SUP Custom 27803010 671050 - ROD SPINAL 50MM OPUS BOTH IP/OP $708.00 $524.00 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $147.48 $707.65 $283.06 $707.65 $707.65 $707.65 $707.65 $707.65 $531.00 $707.65 $707.65 $707.65 $353.83 $353.83 $560.46 $707.65 $566.12 $318.44 $707.65 N/A $410.64 $707.65 $424.59 $707.65 $707.65 $707.65 N/A N/A 671060 SUP Custom 27803010 671060 - ROD SPINAL 60MM OPUS BOTH IP/OP $708.00 $524.00 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $147.48 $707.65 $283.06 $707.65 $707.65 $707.65 $707.65 $707.65 $531.00 $707.65 $707.65 $707.65 $353.83 $353.83 $560.46 $707.65 $566.12 $318.44 $707.65 N/A $410.64 $707.65 $424.59 $707.65 $707.65 $707.65 N/A N/A 671070 SUP Custom 27803010 671070 - ROD SPINAL 70MM OPUS BOTH IP/OP $708.00 $524.00 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $147.48 $707.65 $283.06 $707.65 $707.65 $707.65 $707.65 $707.65 $531.00 $707.65 $707.65 $707.65 $353.83 $353.83 $560.46 $707.65 $566.12 $318.44 $707.65 N/A $410.64 $707.65 $424.59 $707.65 $707.65 $707.65 N/A N/A 671080 SUP Custom 27803010 671080 - ROD SPINAL 80MM OPUS BOTH IP/OP $708.00 $524.00 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $147.48 $707.65 $283.06 $707.65 $707.65 $707.65 $707.65 $707.65 $531.00 $707.65 $707.65 $707.65 $353.83 $353.83 $560.46 $707.65 $566.12 $318.44 $707.65 N/A $410.64 $707.65 $424.59 $707.65 $707.65 $707.65 N/A N/A 671090 SUP Custom 27803010 671090 - ROD SPINAL 90MM OPUS BOTH IP/OP $708.00 $524.00 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $147.48 $707.65 $283.06 $707.65 $707.65 $707.65 $707.65 $707.65 $531.00 $707.65 $707.65 $707.65 $353.83 $353.83 $560.46 $707.65 $566.12 $318.44 $707.65 N/A $410.64 $707.65 $424.59 $707.65 $707.65 $707.65 N/A N/A 671100 SUP Custom 27803010 671100 - ROD SPINAL 100MM OPUS BOTH IP/OP $708.00 $524.00 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $147.48 $707.65 $283.06 $707.65 $707.65 $707.65 $707.65 $707.65 $531.00 $707.65 $707.65 $707.65 $353.83 $353.83 $560.46 $707.65 $566.12 $318.44 $707.65 N/A $410.64 $707.65 $424.59 $707.65 $707.65 $707.65 N/A N/A 671110 SUP Custom 27803010 671110 - ROD SPINAL 110MM OPUS BOTH IP/OP $708.00 $524.00 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $147.48 $707.65 $283.06 $707.65 $707.65 $707.65 $707.65 $707.65 $531.00 $707.65 $707.65 $707.65 $353.83 $353.83 $560.46 $707.65 $566.12 $318.44 $707.65 N/A $410.64 $707.65 $424.59 $707.65 $707.65 $707.65 N/A N/A 671120 SUP Custom 27803010 671120 - ROD SPINAL 120MM OPUS BOTH IP/OP $708.00 $524.00 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $147.48 $707.65 $283.06 $707.65 $707.65 $707.65 $707.65 $707.65 $531.00 $707.65 $707.65 $707.65 $353.83 $353.83 $560.46 $707.65 $566.12 $318.44 $707.65 N/A $410.64 $707.65 $424.59 $707.65 $707.65 $707.65 N/A N/A 671140 SUP Custom 27803010 671140 - ROD SPINAL 140MM OPUS BOTH IP/OP $458.50 $339.00 $81.58 $458.30 $458.30 $458.30 $458.30 $458.30 $458.30 $458.30 $81.58 $458.30 $458.30 $458.30 $458.30 $458.30 $458.30 $95.51 $458.30 $183.32 $458.30 $458.30 $458.30 $458.30 $458.30 $343.88 $458.30 $458.30 $458.30 $229.15 $229.15 $362.97 $458.30 $366.64 $206.24 $458.30 N/A $265.93 $458.30 $274.98 $458.30 $458.30 $458.30 N/A N/A 671150 SUP Custom 27803010 671150 - ROD SPINAL 150MM OPUS BOTH IP/OP $708.00 $524.00 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $147.48 $707.65 $283.06 $707.65 $707.65 $707.65 $707.65 $707.65 $531.00 $707.65 $707.65 $707.65 $353.83 $353.83 $560.46 $707.65 $566.12 $318.44 $707.65 N/A $410.64 $707.65 $424.59 $707.65 $707.65 $707.65 N/A N/A 671180 SUP Custom 27803010 671180 - ROD SPINAL 180MM OPUS BOTH IP/OP $708.00 $524.00 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $147.48 $707.65 $283.06 $707.65 $707.65 $707.65 $707.65 $707.65 $531.00 $707.65 $707.65 $707.65 $353.83 $353.83 $560.46 $707.65 $566.12 $318.44 $707.65 N/A $410.64 $707.65 $424.59 $707.65 $707.65 $707.65 N/A N/A 671190 SUP Custom 27803010 671190 - ROD SPINAL 190MM OPUS TITANIUM BOTH IP/OP $708.00 $524.00 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $125.96 $707.65 $707.65 $707.65 $707.65 $707.65 $707.65 $147.48 $707.65 $283.06 $707.65 $707.65 $707.65 $707.65 $707.65 $531.00 $707.65 $707.65 $707.65 $353.83 $353.83 $560.46 $707.65 $566.12 $318.44 $707.65 N/A $410.64 $707.65 $424.59 $707.65 $707.65 $707.65 N/A N/A 671210 SUP Custom 27803010 671210 - ROD SPINAL 210MM OPUS BOTH IP/OP $669.50 $495.00 $119.17 $669.48 $669.48 $669.48 $669.48 $669.48 $669.48 $669.48 $119.17 $669.48 $669.48 $669.48 $669.48 $669.48 $669.48 $139.53 $669.48 $267.79 $669.48 $669.48 $669.48 $669.48 $669.48 $502.13 $669.48 $669.48 $669.48 $334.74 $334.74 $530.23 $669.48 $535.58 $301.27 $669.48 N/A $388.31 $669.48 $401.69 $669.48 $669.48 $669.48 N/A N/A 671240 SUP Custom 27803010 671240 - ROD SPINAL 240MM OPUS BOTH IP/OP $638.50 $472.00 $113.57 $638.03 $638.03 $638.03 $638.03 $638.03 $638.03 $638.03 $113.57 $638.03 $638.03 $638.03 $638.03 $638.03 $638.03 $132.97 $638.03 $255.21 $638.03 $638.03 $638.03 $638.03 $638.03 $478.88 $638.03 $638.03 $638.03 $319.02 $319.02 $505.32 $638.03 $510.42 $287.11 $638.03 N/A $370.33 $638.03 $382.82 $638.03 $638.03 $638.03 N/A N/A 671270 SUP Custom 27803010 671270 - ROD SPINAL 270MM OPUS BOTH IP/OP $638.50 $472.00 $113.57 $638.03 $638.03 $638.03 $638.03 $638.03 $638.03 $638.03 $113.57 $638.03 $638.03 $638.03 $638.03 $638.03 $638.03 $132.97 $638.03 $255.21 $638.03 $638.03 $638.03 $638.03 $638.03 $478.88 $638.03 $638.03 $638.03 $319.02 $319.02 $505.32 $638.03 $510.42 $287.11 $638.03 N/A $370.33 $638.03 $382.82 $638.03 $638.03 $638.03 N/A N/A 671300 SUP Custom 27803010 671300 - ROD SPINAL 300MM OPUS BOTH IP/OP $638.50 $472.00 $113.57 $638.03 $638.03 $638.03 $638.03 $638.03 $638.03 $638.03 $113.57 $638.03 $638.03 $638.03 $638.03 $638.03 $638.03 $132.97 $638.03 $255.21 $638.03 $638.03 $638.03 $638.03 $638.03 $478.88 $638.03 $638.03 $638.03 $319.02 $319.02 $505.32 $638.03 $510.42 $287.11 $638.03 N/A $370.33 $638.03 $382.82 $638.03 $638.03 $638.03 N/A N/A 671600 SUP Custom 27803010 671600 - ROD SPINAL 600MM OPUS BOTH IP/OP $436.00 $323.00 $77.58 $435.83 $435.83 $435.83 $435.83 $435.83 $435.83 $435.83 $77.58 $435.83 $435.83 $435.83 $435.83 $435.83 $435.83 $90.83 $435.83 $174.33 $435.83 $435.83 $435.83 $435.83 $435.83 $327.00 $435.83 $435.83 $435.83 $217.92 $217.92 $345.18 $435.83 $348.66 $196.12 $435.83 N/A $252.88 $435.83 $261.50 $435.83 $435.83 $435.83 N/A N/A 695305 SUP Custom 27803010 695305 - CONNECTOR ROD OFFST DIAPASON OSS SPN BOTH IP/OP $660.50 $489.00 $117.57 $660.48 $660.48 $660.48 $660.48 $660.48 $660.48 $660.48 $117.57 $660.48 $660.48 $660.48 $660.48 $660.48 $660.48 $137.65 $660.48 $264.19 $660.48 $660.48 $660.48 $660.48 $660.48 $495.38 $660.48 $660.48 $660.48 $330.24 $330.24 $523.10 $660.48 $528.38 $297.22 $660.48 N/A $383.09 $660.48 $396.29 $660.48 $660.48 $660.48 N/A N/A 700351 SUP Custom 27203010 700351 - BIT DRILL 2.5MM 180MM CALIBRATED AO FITTING SPS STERILE BOTH IP/OP $287.50 $213.00 $51.15 $287.38 $287.38 $287.38 $287.38 $287.38 $287.38 $287.38 $51.15 $287.38 $287.38 $213.29 $213.29 $221.51 $149.72 $59.89 $287.38 $114.95 $287.38 $287.38 $287.38 $287.38 $287.38 $215.63 $287.38 $287.38 $287.38 $143.69 $143.69 $227.60 $287.38 $229.90 $186.80 $287.38 N/A $166.75 $287.38 $172.43 $287.38 $287.38 $287.38 N/A N/A 700353 SUP Custom 27203010 700353 - BIT DRILL STANDARD TWIST 3.5MM 180MM AO FIT SPS AXSOS BOTH IP/OP $287.50 $213.00 $51.15 $287.38 $287.38 $287.38 $287.38 $287.38 $287.38 $287.38 $51.15 $287.38 $287.38 $213.29 $213.29 $221.51 $149.72 $59.89 $287.38 $114.95 $287.38 $287.38 $287.38 $287.38 $287.38 $215.63 $287.38 $287.38 $287.38 $143.69 $143.69 $227.60 $287.38 $229.90 $186.80 $287.38 N/A $166.75 $287.38 $172.43 $287.38 $287.38 $287.38 N/A N/A 700354 SUP Custom 27203010 700354 - DRILL TWST LNG 4.5MM 195MM STRL AO FIT BOTH IP/OP $287.50 $213.00 $51.15 $287.38 $287.38 $287.38 $287.38 $287.38 $287.38 $287.38 $51.15 $287.38 $287.38 $213.29 $213.29 $221.51 $149.72 $59.89 $287.38 $114.95 $287.38 $287.38 $287.38 $287.38 $287.38 $215.63 $287.38 $287.38 $287.38 $143.69 $143.69 $227.60 $287.38 $229.90 $186.80 $287.38 N/A $166.75 $287.38 $172.43 $287.38 $287.38 $287.38 N/A N/A 700355 SUP Custom 27203010 700355 - BIT DRILL 2.5MM 230MM TWIST AO FITTING SPS NONSTRL 4MM SCREW BOTH IP/OP $287.50 $213.00 $51.15 $287.38 $287.38 $287.38 $287.38 $287.38 $287.38 $287.38 $51.15 $287.38 $287.38 $213.29 $213.29 $221.51 $149.72 $59.89 $287.38 $114.95 $287.38 $287.38 $287.38 $287.38 $287.38 $215.63 $287.38 $287.38 $287.38 $143.69 $143.69 $227.60 $287.38 $229.90 $186.80 $287.38 N/A $166.75 $287.38 $172.43 $287.38 $287.38 $287.38 N/A N/A 700356 SUP Custom 27203010 700356 - BIT DRILL 3.2MM 180MM CALIBRATED AO FITTING NONSTRL BOTH IP/OP $287.50 $213.00 $51.15 $287.38 $287.38 $287.38 $287.38 $287.38 $287.38 $287.38 $51.15 $287.38 $287.38 $213.29 $213.29 $221.51 $149.72 $59.89 $287.38 $114.95 $287.38 $287.38 $287.38 $287.38 $287.38 $215.63 $287.38 $287.38 $287.38 $143.69 $143.69 $227.60 $287.38 $229.90 $186.80 $287.38 N/A $166.75 $287.38 $172.43 $287.38 $287.38 $287.38 N/A N/A 700357 SUP Custom 27203010 700357 - BIT DRILL STANDARD TWIST 3.2MM 230MM CALIBRATE AO FIT SPS BOTH IP/OP $287.50 $213.00 $51.15 $287.38 $287.38 $287.38 $287.38 $287.38 $287.38 $287.38 $51.15 $287.38 $287.38 $213.29 $213.29 $221.51 $149.72 $59.89 $287.38 $114.95 $287.38 $287.38 $287.38 $287.38 $287.38 $215.63 $287.38 $287.38 $287.38 $143.69 $143.69 $227.60 $287.38 $229.90 $186.80 $287.38 N/A $166.75 $287.38 $172.43 $287.38 $287.38 $287.38 N/A N/A 700371 SUP Custom 27203010 700371 - BIT DRILL 2MM TWIST AO FITTING BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A 700373 SUP Custom 27203010 700373 - BIT DRL 2.7MM OSTN TWST AO FIT BOTH IP/OP $197.00 $146.00 $35.00 $196.63 $196.63 $196.63 $196.63 $196.63 $196.63 $196.63 $35.00 $196.63 $196.63 $145.94 $145.94 $151.56 $102.44 $40.98 $196.63 $78.65 $196.63 $196.63 $196.63 $196.63 $196.63 $147.75 $196.63 $196.63 $196.63 $98.32 $98.32 $155.73 $196.63 $157.30 $127.81 $196.63 N/A $114.26 $196.63 $117.98 $196.63 $196.63 $196.63 N/A N/A 700374 SUP Custom 27203010 700374 - 3.2MM AO FIT.TWIST DRILL BIT BOTH IP/OP $162.50 $120.00 $28.88 $162.25 $162.25 $162.25 $162.25 $162.25 $162.25 $162.25 $28.88 $162.25 $162.25 $120.42 $120.42 $125.06 $84.53 $33.81 $162.25 $64.90 $162.25 $162.25 $162.25 $162.25 $162.25 $121.88 $162.25 $162.25 $162.25 $81.13 $81.13 $128.50 $162.25 $129.80 $105.46 $162.25 N/A $94.25 $162.25 $97.35 $162.25 $162.25 $162.25 N/A N/A 700375 SUP Custom 27203010 700375 - BIT DRILL 3.5MM TWIST AO FITTING BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A 700436 SUP Custom 27203010 700436 - TAP SRG OD2.7 MM CORT SCR BOTH IP/OP $179.00 $132.00 $31.82 $178.75 $178.75 $178.75 $178.75 $178.75 $178.75 $178.75 $31.82 $178.75 $178.75 $132.67 $132.67 $137.78 $93.13 $37.25 $178.75 $71.50 $178.75 $178.75 $178.75 $178.75 $178.75 $134.25 $178.75 $178.75 $178.75 $89.38 $89.38 $141.57 $178.75 $143.00 $116.19 $178.75 N/A $103.82 $178.75 $107.25 $178.75 $178.75 $178.75 N/A N/A 700438 SUP Custom 27203010 700438 - TAP SRG OD4.5 MM CANC SCR BOTH IP/OP $179.00 $132.00 $31.82 $178.75 $178.75 $178.75 $178.75 $178.75 $178.75 $178.75 $31.82 $178.75 $178.75 $132.67 $132.67 $137.78 $93.13 $37.25 $178.75 $71.50 $178.75 $178.75 $178.75 $178.75 $178.75 $134.25 $178.75 $178.75 $178.75 $89.38 $89.38 $141.57 $178.75 $143.00 $116.19 $178.75 N/A $103.82 $178.75 $107.25 $178.75 $178.75 $178.75 N/A N/A 700443 SUP Custom 27203010 700443 - TAP SRG OSTEO FIT OD4.5 MM SCR BOTH IP/OP $342.50 $253.00 $60.94 $342.38 $342.38 $342.38 $342.38 $342.38 $342.38 $342.38 $60.94 $342.38 $342.38 $254.11 $254.11 $263.91 $178.38 $71.36 $342.38 $136.95 $342.38 $342.38 $342.38 $342.38 $342.38 $256.88 $342.38 $342.38 $342.38 $171.19 $171.19 $271.16 $342.38 $273.90 $222.55 $342.38 N/A $198.65 $342.38 $205.43 $342.38 $342.38 $342.38 N/A N/A 700447 SUP Custom 27203010 700447 - TAP SURG FITTING 6.5 MM SCREW BOTH IP/OP $516.00 $382.00 $91.78 $515.63 $515.63 $515.63 $515.63 $515.63 $515.63 $515.63 $91.78 $515.63 $515.63 $382.70 $382.70 $397.45 $268.64 $107.46 $515.63 $206.25 $515.63 $515.63 $515.63 $515.63 $515.63 $387.00 $515.63 $515.63 $515.63 $257.82 $257.82 $408.38 $515.63 $412.50 $335.16 $515.63 N/A $299.28 $515.63 $309.38 $515.63 $515.63 $515.63 N/A N/A 700448 SUP Custom 27203010 700448 - TAP SURG FITTING 6.5 MM SCREW BOTH IP/OP $619.00 $458.00 $110.14 $618.75 $618.75 $618.75 $618.75 $618.75 $618.75 $618.75 $110.14 $618.75 $618.75 $459.24 $459.24 $476.93 $322.37 $128.95 $618.75 $247.50 $618.75 $618.75 $618.75 $618.75 $618.75 $464.25 $618.75 $618.75 $618.75 $309.38 $309.38 $490.05 $618.75 $495.00 $402.19 $618.75 N/A $359.02 $618.75 $371.25 $618.75 $618.75 $618.75 N/A N/A 700708 SUP Custom 27203010 700708 - TAP SURG LAG SCREW OHS HIP BOTH IP/OP "$2,014.50" "$1,491.00" $358.56 "$2,014.38" "$2,014.38" "$2,014.38" "$2,014.38" "$2,014.38" "$2,014.38" "$2,014.38" $358.56 "$2,014.38" "$2,014.38" "$1,495.07" "$1,495.07" "$1,552.68" "$1,049.49" $419.82 "$2,014.38" $805.75 "$2,014.38" "$2,014.38" "$2,014.38" "$2,014.38" "$2,014.38" "$1,510.88" "$2,014.38" "$2,014.38" "$2,014.38" "$1,007.19" "$1,007.19" "$1,595.39" "$2,014.38" "$1,611.50" "$1,309.35" "$2,014.38" N/A "$1,168.41" "$2,014.38" "$1,208.63" "$2,014.38" "$2,014.38" "$2,014.38" N/A N/A 700721 SUP Custom 27203010 700721 - TAP SURG OCS LAG SCREW BOTH IP/OP "$1,561.00" "$1,155.00" $277.79 "$1,560.63" "$1,560.63" "$1,560.63" "$1,560.63" "$1,560.63" "$1,560.63" "$1,560.63" $277.79 "$1,560.63" "$1,560.63" "$1,158.30" "$1,158.30" "$1,202.93" $813.09 $325.25 "$1,560.63" $624.25 "$1,560.63" "$1,560.63" "$1,560.63" "$1,560.63" "$1,560.63" "$1,170.75" "$1,560.63" "$1,560.63" "$1,560.63" $780.32 $780.32 "$1,236.02" "$1,560.63" "$1,248.50" "$1,014.41" "$1,560.63" N/A $905.38 "$1,560.63" $936.38 "$1,560.63" "$1,560.63" "$1,560.63" N/A N/A 702346 SUP Custom 27203010 702346 - BIT DRL 3.5MM BOTH IP/OP $243.50 $180.00 $43.32 $243.38 $243.38 $243.38 $243.38 $243.38 $243.38 $243.38 $43.32 $243.38 $243.38 $180.64 $180.64 $187.60 $126.80 $50.72 $243.38 $97.35 $243.38 $243.38 $243.38 $243.38 $243.38 $182.63 $243.38 $243.38 $243.38 $121.69 $121.69 $192.76 $243.38 $194.70 $158.20 $243.38 N/A $141.23 $243.38 $146.03 $243.38 $243.38 $243.38 N/A N/A 702347 SUP Custom 27203010 702347 - BIT DRILL 5MM 220MM TWIST AO FITTING STERILE BOTH IP/OP $231.00 $171.00 $41.12 $231.00 $231.00 $231.00 $231.00 $231.00 $231.00 $231.00 $41.12 $231.00 $231.00 $171.45 $171.45 $178.05 $120.35 $48.14 $231.00 $92.40 $231.00 $231.00 $231.00 $231.00 $231.00 $173.25 $231.00 $231.00 $231.00 $115.50 $115.50 $182.95 $231.00 $184.80 $150.15 $231.00 N/A $133.98 $231.00 $138.60 $231.00 $231.00 $231.00 N/A N/A 702348 SUP Custom 27203010 702348 - DRILL TWIST 1.5MM 3.5MM AO FITTING BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A 702350 SUP Custom 27203010 702350 - BIT DRILL 4.2MM 235MM STERILE BOTH IP/OP $243.50 $180.00 $43.32 $243.38 $243.38 $243.38 $243.38 $243.38 $243.38 $243.38 $43.32 $243.38 $243.38 $180.64 $180.64 $187.60 $126.80 $50.72 $243.38 $97.35 $243.38 $243.38 $243.38 $243.38 $243.38 $182.63 $243.38 $243.38 $243.38 $121.69 $121.69 $192.76 $243.38 $194.70 $158.20 $243.38 N/A $141.23 $243.38 $146.03 $243.38 $243.38 $243.38 N/A N/A 702446 SUP Custom 27203010 702446 - DRILL SRG 4MM NS CNN AO CPLNG TWST BOTH IP/OP $507.50 $376.00 $90.33 $507.45 $507.45 $507.45 $507.45 $507.45 $507.45 $507.45 $90.33 $507.45 $507.45 $376.63 $376.63 $391.14 $264.38 $105.76 $507.45 $202.98 $507.45 $507.45 $507.45 $507.45 $507.45 $380.63 $507.45 $507.45 $507.45 $253.73 $253.73 $401.90 $507.45 $405.96 $329.84 $507.45 N/A $294.35 $507.45 $304.47 $507.45 $507.45 $507.45 N/A N/A 702447 SUP Custom 27203010 702447 - BIT DRILL 5MM CANN TWIST AO BOTH IP/OP $551.50 $408.00 $98.15 $551.38 $551.38 $551.38 $551.38 $551.38 $551.38 $551.38 $98.15 $551.38 $551.38 $409.23 $409.23 $425.00 $287.27 $114.91 $551.38 $220.55 $551.38 $551.38 $551.38 $551.38 $551.38 $413.63 $551.38 $551.38 $551.38 $275.69 $275.69 $436.69 $551.38 $441.10 $358.40 $551.38 N/A $319.87 $551.38 $330.83 $551.38 $551.38 $551.38 N/A N/A 702448 SUP Custom 27203010 702448 - BIT DRILL 1.4MM 150MM NONSTRL DISPOSABLE BOTH IP/OP $305.50 $226.00 $54.33 $305.25 $305.25 $305.25 $305.25 $305.25 $305.25 $305.25 $54.33 $305.25 $305.25 $226.56 $226.56 $235.29 $159.04 $63.62 $305.25 $122.10 $305.25 $305.25 $305.25 $305.25 $305.25 $229.13 $305.25 $305.25 $305.25 $152.63 $152.63 $241.76 $305.25 $244.20 $198.41 $305.25 N/A $177.19 $305.25 $183.15 $305.25 $305.25 $305.25 N/A N/A 702453 SUP Custom 27203010 702453 - BIT DRILL 2MM 150MM CANN ASNIS III STERILE 5MM SCREW BOTH IP/OP $272.50 $202.00 $48.46 $272.25 $272.25 $272.25 $272.25 $272.25 $272.25 $272.25 $48.46 $272.25 $272.25 $202.06 $202.06 $209.85 $141.84 $56.74 $272.25 $108.90 $272.25 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $176.96 $272.25 N/A $158.05 $272.25 $163.35 $272.25 $272.25 $272.25 N/A N/A 702459 SUP HCPCS C1769 702459 - GUIDEWIRE ORTHOPEDIC 1.2MM 150MM THREAD ASNIS III FEMUR HIP BOTH IP/OP $109.50 $81.00 $21.73 $109.50 $59.46 $59.46 $59.46 $59.46 $109.50 $109.50 $109.50 $22.82 $109.50 $81.27 $81.27 $84.40 $57.05 $22.82 $109.50 $109.50 $64.77 $109.50 $109.50 $109.50 $109.50 $82.13 $109.50 $109.50 $109.50 $54.75 $54.75 $86.72 $109.50 $87.60 $71.18 $21.73 N/A $63.51 $109.50 $109.50 $109.50 $22.82 $109.50 N/A N/A 702460 SUP HCPCS C1769 702460 - GUIDEWIRE ORTH 2MM 150MM ASNS III THRD HIP FEM 5MM SCR BOTH IP/OP $109.50 $81.00 $21.73 $109.50 $59.46 $59.46 $59.46 $59.46 $109.50 $109.50 $109.50 $22.82 $109.50 $81.27 $81.27 $84.40 $57.05 $22.82 $109.50 $109.50 $64.77 $109.50 $109.50 $109.50 $109.50 $82.13 $109.50 $109.50 $109.50 $54.75 $54.75 $86.72 $109.50 $87.60 $71.18 $21.73 N/A $63.51 $109.50 $109.50 $109.50 $22.82 $109.50 N/A N/A 702461 SUP HCPCS C1769 702461 - GUIDEWIRE ORTHOPEDIC 3MM 300MM THREAD ASNIS III HIP FEMUR BOTH IP/OP $62.00 $46.00 $12.28 $61.88 $33.60 $33.60 $33.60 $33.60 $61.88 $61.88 $61.88 $12.90 $61.88 $45.93 $45.93 $47.70 $32.24 $12.90 $61.88 $61.88 $36.60 $61.88 $61.88 $61.88 $61.88 $46.50 $61.88 $61.88 $61.88 $30.94 $30.94 $49.01 $61.88 $49.50 $40.22 $12.28 N/A $35.96 $61.88 $61.88 $61.88 $12.90 $61.88 N/A N/A 702462 SUP HCPCS C1769 702462 - GUIDEWIRE ORTHOPEDIC 3.2MM 300MM THREAD ASNIS III CANN SCREW BOTH IP/OP $76.00 $56.00 $15.01 $75.63 $41.07 $41.07 $41.07 $41.07 $75.63 $75.63 $75.63 $15.76 $75.63 $56.13 $56.13 $58.30 $39.40 $15.76 $75.63 $75.63 $44.74 $75.63 $75.63 $75.63 $75.63 $57.00 $75.63 $75.63 $75.63 $37.82 $37.82 $59.90 $75.63 $60.50 $49.16 $15.01 N/A $44.08 $75.63 $75.63 $75.63 $15.76 $75.63 N/A N/A 702463 SUP HCPCS C1769 702463 - GUIDEWIRE ORTHOPEDIC 3.2MM 300MM 5MM ASNIS III FEMUR HIP BOTH IP/OP $76.00 $56.00 $15.01 $75.63 $41.07 $41.07 $41.07 $41.07 $75.63 $75.63 $75.63 $15.76 $75.63 $56.13 $56.13 $58.30 $39.40 $15.76 $75.63 $75.63 $44.74 $75.63 $75.63 $75.63 $75.63 $57.00 $75.63 $75.63 $75.63 $37.82 $37.82 $59.90 $75.63 $60.50 $49.16 $15.01 N/A $44.08 $75.63 $75.63 $75.63 $15.76 $75.63 N/A N/A 702739 SUP Custom 27203010 702739 - BIT DRL 4MM 180MM AO FIT BOTH IP/OP $729.00 $539.00 $129.72 $728.75 $728.75 $728.75 $728.75 $728.75 $728.75 $728.75 $129.72 $728.75 $728.75 $540.88 $540.88 $561.72 $379.68 $151.88 $728.75 $291.50 $728.75 $728.75 $728.75 $728.75 $728.75 $546.75 $728.75 $728.75 $728.75 $364.38 $364.38 $577.17 $728.75 $583.00 $473.69 $728.75 N/A $422.82 $728.75 $437.25 $728.75 $728.75 $728.75 N/A N/A 702741 SUP Custom 27203010 702741 - BIT DRILL 2.3MM 125MM CALIBRATE AXSOS NONSTRL BOTH IP/OP $175.00 $130.00 $31.08 $174.63 $174.63 $174.63 $174.63 $174.63 $174.63 $174.63 $31.08 $174.63 $174.63 $129.61 $129.61 $134.60 $90.98 $36.39 $174.63 $69.85 $174.63 $174.63 $174.63 $174.63 $174.63 $131.25 $174.63 $174.63 $174.63 $87.32 $87.32 $138.31 $174.63 $139.70 $113.51 $174.63 N/A $101.50 $174.63 $104.78 $174.63 $174.63 $174.63 N/A N/A 702742 SUP Custom 27203010 702742 - BIT DRILL 3.1MM 204MM CALIBRATE AXSOS 4MM SCREW BOTH IP/OP $205.50 $152.00 $36.58 $205.50 $205.50 $205.50 $205.50 $205.50 $205.50 $205.50 $36.58 $205.50 $205.50 $152.52 $152.52 $158.40 $107.07 $42.83 $205.50 $82.20 $205.50 $205.50 $205.50 $205.50 $205.50 $154.13 $205.50 $205.50 $205.50 $102.75 $102.75 $162.76 $205.50 $164.40 $133.58 $205.50 N/A $119.19 $205.50 $123.30 $205.50 $205.50 $205.50 N/A N/A 702743 SUP Custom 27203010 702743 - BIT DRILL 4.3MM 289MM CALIBRATE AXSOS BOTH IP/OP $223.00 $165.00 $39.65 $222.75 $222.75 $222.75 $222.75 $222.75 $222.75 $222.75 $39.65 $222.75 $222.75 $165.33 $165.33 $171.70 $116.05 $46.42 $222.75 $89.10 $222.75 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $144.79 $222.75 N/A $129.34 $222.75 $133.65 $222.75 $222.75 $222.75 N/A N/A 702771 SUP Custom 27803010 702771 - TAP SURG 3MM 130MM BOTH IP/OP $173.00 $128.00 $30.71 $172.55 $172.55 $172.55 $172.55 $172.55 $172.55 $172.55 $30.71 $172.55 $172.55 $172.55 $172.55 $172.55 $172.55 $35.96 $172.55 $69.02 $172.55 $172.55 $172.55 $172.55 $172.55 $129.75 $172.55 $172.55 $172.55 $86.28 $86.28 $136.66 $172.55 $138.04 $77.65 $172.55 N/A $100.34 $172.55 $103.53 $172.55 $172.55 $172.55 N/A N/A 702772 SUP Custom 27803010 702772 - TAP SURG 4MM 140MM LOCK BOTH IP/OP $208.00 $154.00 $36.96 $207.63 $207.63 $207.63 $207.63 $207.63 $207.63 $207.63 $36.96 $207.63 $207.63 $207.63 $207.63 $207.63 $207.63 $43.27 $207.63 $83.05 $207.63 $207.63 $207.63 $207.63 $207.63 $156.00 $207.63 $207.63 $207.63 $103.82 $103.82 $164.44 $207.63 $166.10 $93.43 $207.63 N/A $120.64 $207.63 $124.58 $207.63 $207.63 $207.63 N/A N/A 702773 SUP Custom 27803010 702773 - TAP SURG 5MM 140MM LOCK AXSOS BOTH IP/OP $236.50 $175.00 $42.10 $236.50 $236.50 $236.50 $236.50 $236.50 $236.50 $236.50 $42.10 $236.50 $236.50 $236.50 $236.50 $236.50 $236.50 $49.29 $236.50 $94.60 $236.50 $236.50 $236.50 $236.50 $236.50 $177.38 $236.50 $236.50 $236.50 $118.25 $118.25 $187.31 $236.50 $189.20 $106.43 $236.50 N/A $137.17 $236.50 $141.90 $236.50 $236.50 $236.50 N/A N/A 702804 SUP Custom 27803010 702804 - TAP SURG 3.5MM AXSOS BOTH IP/OP $642.00 $475.00 $114.28 $642.00 $642.00 $642.00 $642.00 $642.00 $642.00 $642.00 $114.28 $642.00 $642.00 $642.00 $642.00 $642.00 $642.00 $133.80 $642.00 $256.80 $642.00 $642.00 $642.00 $642.00 $642.00 $481.50 $642.00 $642.00 $642.00 $321.00 $321.00 $508.46 $642.00 $513.60 $288.90 $642.00 N/A $372.36 $642.00 $385.20 $642.00 $642.00 $642.00 N/A N/A 702806 SUP Custom 27803010 702806 - TAP SURG 4.5MM 180MM AO FITTING BOTH IP/OP $730.50 $541.00 $130.03 $730.50 $730.50 $730.50 $730.50 $730.50 $730.50 $730.50 $130.03 $730.50 $730.50 $730.50 $730.50 $730.50 $730.50 $152.24 $730.50 $292.20 $730.50 $730.50 $730.50 $730.50 $730.50 $547.88 $730.50 $730.50 $730.50 $365.25 $365.25 $578.56 $730.50 $584.40 $328.73 $730.50 N/A $423.69 $730.50 $438.30 $730.50 $730.50 $730.50 N/A N/A 702807 SUP Custom 27803010 702807 - TAP SURG 6.5MM 180MM AO FITTING CORTICAL BOTH IP/OP $819.00 $606.00 $145.78 $819.00 $819.00 $819.00 $819.00 $819.00 $819.00 $819.00 $145.78 $819.00 $819.00 $819.00 $819.00 $819.00 $819.00 $170.69 $819.00 $327.60 $819.00 $819.00 $819.00 $819.00 $819.00 $614.25 $819.00 $819.00 $819.00 $409.50 $409.50 $648.65 $819.00 $655.20 $368.55 $819.00 N/A $475.02 $819.00 $491.40 $819.00 $819.00 $819.00 N/A N/A 702808 SUP Custom 27803010 702808 - TAP SURG SHORT 4.5MM 145MM AO FITTING CORTICAL BOTH IP/OP $247.50 $183.00 $44.06 $247.50 $247.50 $247.50 $247.50 $247.50 $247.50 $247.50 $44.06 $247.50 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $247.50 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $247.50 N/A $143.55 $247.50 $148.50 $247.50 $247.50 $247.50 N/A N/A 702809 SUP Custom 27803010 702809 - TAP SURG SHORT 6.5MM 145MM AO FITTING CANCELLOUS BOTH IP/OP $272.50 $202.00 $48.46 $272.25 $272.25 $272.25 $272.25 $272.25 $272.25 $272.25 $48.46 $272.25 $272.25 $272.25 $272.25 $272.25 $272.25 $56.74 $272.25 $108.90 $272.25 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $122.51 $272.25 N/A $158.05 $272.25 $163.35 $272.25 $272.25 $272.25 N/A N/A 702930 SUP Custom 27203010 702930 - FORCEPS SURG REPOSITIONING 2X1 JAW PELVIC BOTH IP/OP "$2,457.50" "$1,819.00" $437.37 "$2,457.13" "$2,457.13" "$2,457.13" "$2,457.13" "$2,457.13" "$2,457.13" "$2,457.13" $437.37 "$2,457.13" "$2,457.13" "$1,823.68" "$1,823.68" "$1,893.96" "$1,280.16" $512.09 "$2,457.13" $982.85 "$2,457.13" "$2,457.13" "$2,457.13" "$2,457.13" "$2,457.13" "$1,843.13" "$2,457.13" "$2,457.13" "$2,457.13" "$1,228.57" "$1,228.57" "$1,946.05" "$2,457.13" "$1,965.70" "$1,597.13" "$2,457.13" N/A "$1,425.35" "$2,457.13" "$1,474.28" "$2,457.13" "$2,457.13" "$2,457.13" N/A N/A 702996 SUP Custom 27203010 702996 - BIT DRL 2.5MM 285MM AO CLBRT BOTH IP/OP $153.00 $113.00 $27.17 $152.63 $152.63 $152.63 $152.63 $152.63 $152.63 $152.63 $27.17 $152.63 $152.63 $113.28 $113.28 $117.65 $79.52 $31.81 $152.63 $61.05 $152.63 $152.63 $152.63 $152.63 $152.63 $114.75 $152.63 $152.63 $152.63 $76.32 $76.32 $120.88 $152.63 $122.10 $99.21 $152.63 N/A $88.74 $152.63 $91.58 $152.63 $152.63 $152.63 N/A N/A 702997 SUP Custom 27203010 702997 - BIT DRILL 3.1MM 285MM CALIBRATE BOTH IP/OP $176.00 $130.00 $31.33 $176.00 $176.00 $176.00 $176.00 $176.00 $176.00 $176.00 $31.33 $176.00 $176.00 $130.63 $130.63 $135.66 $91.70 $36.68 $176.00 $70.40 $176.00 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $114.40 $176.00 N/A $102.08 $176.00 $105.60 $176.00 $176.00 $176.00 N/A N/A 703176 SUP Custom 27203010 703176 - BIT DRILL 4.2MM 325MM AO FITTING STERILE BOTH IP/OP $243.50 $180.00 $43.32 $243.38 $243.38 $243.38 $243.38 $243.38 $243.38 $243.38 $43.32 $243.38 $243.38 $180.64 $180.64 $187.60 $126.80 $50.72 $243.38 $97.35 $243.38 $243.38 $243.38 $243.38 $243.38 $182.63 $243.38 $243.38 $243.38 $121.69 $121.69 $192.76 $243.38 $194.70 $158.20 $243.38 N/A $141.23 $243.38 $146.03 $243.38 $243.38 $243.38 N/A N/A 703178 SUP Custom 27203010 703178 - BIT DRILL 4.2MM TROCAR POINT AO STERILE BOTH IP/OP $243.50 $180.00 $43.32 $243.38 $243.38 $243.38 $243.38 $243.38 $243.38 $243.38 $43.32 $243.38 $243.38 $180.64 $180.64 $187.60 $126.80 $50.72 $243.38 $97.35 $243.38 $243.38 $243.38 $243.38 $243.38 $182.63 $243.38 $243.38 $243.38 $121.69 $121.69 $192.76 $243.38 $194.70 $158.20 $243.38 N/A $141.23 $243.38 $146.03 $243.38 $243.38 $243.38 N/A N/A 703541 SUP Custom 27203010 703541 - BIT DRILL 4.3MM 310MM CALIBRATED AO FITTING BOTH IP/OP $331.50 $245.00 $58.99 $331.38 $331.38 $331.38 $331.38 $331.38 $331.38 $331.38 $58.99 $331.38 $331.38 $245.95 $245.95 $255.43 $172.65 $69.06 $331.38 $132.55 $331.38 $331.38 $331.38 $331.38 $331.38 $248.63 $331.38 $331.38 $331.38 $165.69 $165.69 $262.45 $331.38 $265.10 $215.40 $331.38 N/A $192.27 $331.38 $198.83 $331.38 $331.38 $331.38 N/A N/A 703542 SUP Custom 27203010 703542 - BIT DRILL 3.2MM 310MM CALIBRATED AO FITTING BOTH IP/OP $320.50 $237.00 $57.03 $320.38 $320.38 $320.38 $320.38 $320.38 $320.38 $320.38 $57.03 $320.38 $320.38 $237.79 $237.79 $246.95 $166.92 $66.77 $320.38 $128.15 $320.38 $320.38 $320.38 $320.38 $320.38 $240.38 $320.38 $320.38 $320.38 $160.19 $160.19 $253.74 $320.38 $256.30 $208.25 $320.38 N/A $185.89 $320.38 $192.23 $320.38 $320.38 $320.38 N/A N/A 703543 SUP Custom 27203010 703543 - SET ORTHOPEDIC 4.5MM AO BOTH IP/OP $337.00 $249.00 $59.96 $336.88 $336.88 $336.88 $336.88 $336.88 $336.88 $336.88 $59.96 $336.88 $336.88 $250.03 $250.03 $259.67 $175.51 $70.21 $336.88 $134.75 $336.88 $336.88 $336.88 $336.88 $336.88 $252.75 $336.88 $336.88 $336.88 $168.44 $168.44 $266.81 $336.88 $269.50 $218.97 $336.88 N/A $195.46 $336.88 $202.13 $336.88 $336.88 $336.88 N/A N/A 703551 SUP Custom 27803010 703551 - TAP SURG 4.5MM 295MM AO FITTING AXSOS CORTICAL BOTH IP/OP $476.00 $352.00 $84.68 $475.75 $475.75 $475.75 $475.75 $475.75 $475.75 $475.75 $84.68 $475.75 $475.75 $475.75 $475.75 $475.75 $475.75 $99.15 $475.75 $190.30 $475.75 $475.75 $475.75 $475.75 $475.75 $357.00 $475.75 $475.75 $475.75 $237.88 $237.88 $376.79 $475.75 $380.60 $214.09 $475.75 N/A $276.08 $475.75 $285.45 $475.75 $475.75 $475.75 N/A N/A 703553 SUP Custom 27803010 703553 - TAP SURG 6.5MM 295MM AO FITTING AXSOS CANCELLOUS BOTH IP/OP $490.50 $363.00 $87.30 $490.45 $490.45 $490.45 $490.45 $490.45 $490.45 $490.45 $87.30 $490.45 $490.45 $490.45 $490.45 $490.45 $490.45 $102.22 $490.45 $196.18 $490.45 $490.45 $490.45 $490.45 $490.45 $367.88 $490.45 $490.45 $490.45 $245.23 $245.23 $388.44 $490.45 $392.36 $220.70 $490.45 N/A $284.49 $490.45 $294.27 $490.45 $490.45 $490.45 N/A N/A 703554 SUP Custom 27803010 703554 - TAP SURG 5MM 295MM LOCK BOTH IP/OP $489.50 $362.00 $87.13 $489.50 $489.50 $489.50 $489.50 $489.50 $489.50 $489.50 $87.13 $489.50 $489.50 $489.50 $489.50 $489.50 $489.50 $102.02 $489.50 $195.80 $489.50 $489.50 $489.50 $489.50 $489.50 $367.13 $489.50 $489.50 $489.50 $244.75 $244.75 $387.68 $489.50 $391.60 $220.28 $489.50 N/A $283.91 $489.50 $293.70 $489.50 $489.50 $489.50 N/A N/A 703561 SUP HCPCS C1713 703561 - WIRE FX 2MM 315MM KRSH DRL TIP BOTH IP/OP $109.00 $81.00 $21.56 $108.63 $48.88 $48.88 $48.88 $48.88 $108.63 $108.63 $108.63 $22.64 $108.63 $108.63 $108.63 $108.63 $108.63 $22.64 $108.63 $108.63 $64.25 $108.63 $108.63 $108.63 $108.63 $81.75 $108.63 $108.63 $108.63 $54.32 $54.32 $86.03 $108.63 $86.90 $48.88 $21.56 N/A $63.22 $108.63 $108.63 $108.63 $22.64 $108.63 N/A N/A 703574 SUP HCPCS C1713 703574 - TAP BN LCK SPHRCL TIP 4 MM SCR BOTH IP/OP $606.50 $449.00 $120.35 $606.38 $272.87 $272.87 $272.87 $272.87 $606.38 $606.38 $606.38 $126.38 $606.38 $606.38 $606.38 $606.38 $606.38 $126.38 $606.38 $242.55 $358.67 $606.38 $606.38 $606.38 $606.38 $454.88 $606.38 $606.38 $606.38 $303.19 $303.19 $480.25 $606.38 $485.10 $272.87 $120.35 N/A $351.77 $606.38 $606.38 $606.38 $126.37 $606.38 N/A N/A 703583 SUP HCPCS C1713 703583 - WIRE FX 2MM 285MM KRSH DRL TIP BOTH IP/OP $167.50 $124.00 $33.23 $167.45 $75.35 $75.35 $75.35 $75.35 $167.45 $167.45 $167.45 $34.90 $167.45 $167.45 $167.45 $167.45 $167.45 $34.90 $167.45 $167.45 $99.05 $167.45 $167.45 $167.45 $167.45 $125.63 $167.45 $167.45 $167.45 $83.73 $83.73 $132.62 $167.45 $133.96 $75.35 $33.23 N/A $97.15 $167.45 $167.45 $167.45 $34.90 $167.45 N/A N/A 703585 SUP Custom 27203010 703585 - BIT DRILL 3.1MM 285MM CALIBRATED SAMLL AO AXSOS TIBIA BOTH IP/OP $323.50 $239.00 $57.52 $323.13 $323.13 $323.13 $323.13 $323.13 $323.13 $323.13 $57.52 $323.13 $323.13 $239.83 $239.83 $249.07 $168.35 $67.34 $323.13 $129.25 $323.13 $323.13 $323.13 $323.13 $323.13 $242.63 $323.13 $323.13 $323.13 $161.57 $161.57 $255.92 $323.13 $258.50 $210.03 $323.13 N/A $187.63 $323.13 $193.88 $323.13 $323.13 $323.13 N/A N/A 703586 SUP Custom 27203010 703586 - BIT DRL 2.5MM CLBRT AO BOTH IP/OP $323.50 $239.00 $57.52 $323.13 $323.13 $323.13 $323.13 $323.13 $323.13 $323.13 $57.52 $323.13 $323.13 $239.83 $239.83 $249.07 $168.35 $67.34 $323.13 $129.25 $323.13 $323.13 $323.13 $323.13 $323.13 $242.63 $323.13 $323.13 $323.13 $161.57 $161.57 $255.92 $323.13 $258.50 $210.03 $323.13 N/A $187.63 $323.13 $193.88 $323.13 $323.13 $323.13 N/A N/A 703588 SUP Custom 27803010 703588 - TAP SURG 3.5MM AXSOS CORTICAL BOTH IP/OP $575.50 $426.00 $102.43 $575.45 $575.45 $575.45 $575.45 $575.45 $575.45 $575.45 $102.43 $575.45 $575.45 $575.45 $575.45 $575.45 $575.45 $119.93 $575.45 $230.18 $575.45 $575.45 $575.45 $575.45 $575.45 $431.63 $575.45 $575.45 $575.45 $287.73 $287.73 $455.76 $575.45 $460.36 $258.95 $575.45 N/A $333.79 $575.45 $345.27 $575.45 $575.45 $575.45 N/A N/A 703589 SUP Custom 27803010 703589 - TAP SURG AXSOS 4 MM CANCELLOUS SCREW BOTH IP/OP $575.50 $426.00 $102.43 $575.45 $575.45 $575.45 $575.45 $575.45 $575.45 $575.45 $102.43 $575.45 $575.45 $575.45 $575.45 $575.45 $575.45 $119.93 $575.45 $230.18 $575.45 $575.45 $575.45 $575.45 $575.45 $431.63 $575.45 $575.45 $575.45 $287.73 $287.73 $455.76 $575.45 $460.36 $258.95 $575.45 N/A $333.79 $575.45 $345.27 $575.45 $575.45 $575.45 N/A N/A 703590 SUP Custom 27203010 703590 - DRILL SURG SMALL 3.5MM AO BOTH IP/OP $289.00 $214.00 $51.40 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $51.40 $288.75 $288.75 $214.31 $214.31 $222.57 $150.44 $60.18 $288.75 $115.50 $288.75 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $187.69 $288.75 N/A $167.62 $288.75 $173.25 $288.75 $288.75 $288.75 N/A N/A 703615 SUP Custom 27203010 703615 - BIT DRL 4.3MM 264MM CLBRT BOTH IP/OP $277.50 $205.00 $49.40 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $49.40 $277.50 $277.50 $205.96 $205.96 $213.90 $144.58 $57.83 $277.50 $111.00 $277.50 $277.50 $277.50 $277.50 $277.50 $208.13 $277.50 $277.50 $277.50 $138.75 $138.75 $219.78 $277.50 $222.00 $180.38 $277.50 N/A $160.95 $277.50 $166.50 $277.50 $277.50 $277.50 N/A N/A 703616 SUP Custom 27203010 703616 - BIT DRL 3.1MM 205MM CLBRT BOTH IP/OP $259.50 $192.00 $46.19 $259.50 $259.50 $259.50 $259.50 $259.50 $259.50 $259.50 $46.19 $259.50 $259.50 $192.60 $192.60 $200.02 $135.20 $54.08 $259.50 $103.80 $259.50 $259.50 $259.50 $259.50 $259.50 $194.63 $259.50 $259.50 $259.50 $129.75 $129.75 $205.52 $259.50 $207.60 $168.68 $259.50 N/A $150.51 $259.50 $155.70 $259.50 $259.50 $259.50 N/A N/A 703617 SUP Custom 27203010 703617 - CALIBRATED DRILL BIT 03.1 X 285mm BOTH IP/OP $280.00 $207.00 $49.80 $279.75 $279.75 $279.75 $279.75 $279.75 $279.75 $279.75 $49.80 $279.75 $279.75 $207.63 $207.63 $215.63 $145.75 $58.30 $279.75 $111.90 $279.75 $279.75 $279.75 $279.75 $279.75 $210.00 $279.75 $279.75 $279.75 $139.88 $139.88 $221.56 $279.75 $223.80 $181.84 $279.75 N/A $162.40 $279.75 $167.85 $279.75 $279.75 $279.75 N/A N/A 703618 SUP Custom 27203010 703618 - CALIBRATED DRILL BIT 04.3 X 315mm BOTH IP/OP $364.00 $269.00 $64.76 $363.80 $363.80 $363.80 $363.80 $363.80 $363.80 $363.80 $64.76 $363.80 $363.80 $270.01 $270.01 $280.42 $189.54 $75.82 $363.80 $145.52 $363.80 $363.80 $363.80 $363.80 $363.80 $273.00 $363.80 $363.80 $363.80 $181.90 $181.90 $288.13 $363.80 $291.04 $236.47 $363.80 N/A $211.12 $363.80 $218.28 $363.80 $363.80 $363.80 N/A N/A 703701 SUP Custom 27203010 703701 - DRILL SURG 2MM AO CONNECT 2.7MM SCREW BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A 703702 SUP Custom 27203010 703702 - DRILL SURG 2.6MM AO CONNECT NONSTRL 3.5MM SCREW BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A 703703 SUP Custom 27203010 703703 - DRILL SURG OVER AO CONNECT 2.7 MM SCREW BOTH IP/OP $233.00 $172.00 $41.46 $232.90 $232.90 $232.90 $232.90 $232.90 $232.90 $232.90 $41.46 $232.90 $232.90 $172.86 $172.86 $179.52 $121.34 $48.54 $232.90 $93.16 $232.90 $232.90 $232.90 $232.90 $232.90 $174.75 $232.90 $232.90 $232.90 $116.45 $116.45 $184.46 $232.90 $186.32 $151.39 $232.90 N/A $135.14 $232.90 $139.74 $232.90 $232.90 $232.90 N/A N/A 703704 SUP Custom 27203010 703704 - BIT DRL 3.5MM STRL DISP BOTH IP/OP $233.00 $172.00 $41.46 $232.90 $232.90 $232.90 $232.90 $232.90 $232.90 $232.90 $41.46 $232.90 $232.90 $172.86 $172.86 $179.52 $121.34 $48.54 $232.90 $93.16 $232.90 $232.90 $232.90 $232.90 $232.90 $174.75 $232.90 $232.90 $232.90 $116.45 $116.45 $184.46 $232.90 $186.32 $151.39 $232.90 N/A $135.14 $232.90 $139.74 $232.90 $232.90 $232.90 N/A N/A 703705 SUP Custom 27803010 703705 - TAP SURG AO CONNECT VARIAX NONSTRL 2.7 MM SCREW BOTH IP/OP $289.00 $214.00 $51.40 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $51.40 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $60.18 $288.75 $115.50 $288.75 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $129.94 $288.75 N/A $167.62 $288.75 $173.25 $288.75 $288.75 $288.75 N/A N/A 703706 SUP Custom 27803010 703706 - TAP SURG AO CONNECT 3.5 MM SCREW BOTH IP/OP $289.00 $214.00 $51.40 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $51.40 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $60.18 $288.75 $115.50 $288.75 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $129.94 $288.75 N/A $167.62 $288.75 $173.25 $288.75 $288.75 $288.75 N/A N/A 704501 SUP Custom 27203010 704501 - DRILL SURG SHORT 6.7MM 246MM CANN JACOBS FITTING HANSSON BOTH IP/OP $681.00 $504.00 $121.15 $680.63 $680.63 $680.63 $680.63 $680.63 $680.63 $680.63 $121.15 $680.63 $680.63 $505.16 $505.16 $524.63 $354.61 $141.85 $680.63 $272.25 $680.63 $680.63 $680.63 $680.63 $680.63 $510.75 $680.63 $680.63 $680.63 $340.32 $340.32 $539.06 $680.63 $544.50 $442.41 $680.63 N/A $394.98 $680.63 $408.38 $680.63 $680.63 $680.63 N/A N/A 704502 SUP Custom 27203010 704502 - DRILL SURG LONG 6.7MM 276MM CANN JACOBS FITTING HANSSON BOTH IP/OP $681.00 $504.00 $121.15 $680.63 $680.63 $680.63 $680.63 $680.63 $680.63 $680.63 $121.15 $680.63 $680.63 $505.16 $505.16 $524.63 $354.61 $141.85 $680.63 $272.25 $680.63 $680.63 $680.63 $680.63 $680.63 $510.75 $680.63 $680.63 $680.63 $340.32 $340.32 $539.06 $680.63 $544.50 $442.41 $680.63 N/A $394.98 $680.63 $408.38 $680.63 $680.63 $680.63 N/A N/A 711050 SUP Custom 27203010 00711050 - DEVICE SPECIMEN RETRIEVAL STANDARD 2.5MM 230CM 6X3CM STRONG BOTH IP/OP $222.50 $165.00 $39.61 $222.50 $222.50 $222.50 $222.50 $222.50 $222.50 $222.50 $39.61 $222.50 $222.50 $165.14 $165.14 $171.50 $115.92 $46.37 $222.50 $89.00 $222.50 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $144.63 $222.50 N/A $129.05 $222.50 $133.50 $222.50 $222.50 $222.50 N/A N/A 712001 SUP Custom 27203010 712001 - CLIP PMP IRR MDNXT BOTH IP/OP $140.00 $104.00 $24.92 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $24.92 $140.00 $140.00 $103.91 $103.91 $107.91 $72.94 $29.18 $140.00 $56.00 $140.00 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $91.00 $140.00 N/A $81.20 $140.00 $84.00 $140.00 $140.00 $140.00 N/A N/A 733008 SUP HCPCS C1768 733008 - GRAFT CARDIO STR 8MM 30CM SUTURE RETENTION UNIQUE BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 733010 SUP HCPCS C1768 733010 - GRAFT CV STRG 10MM 30CM GLWV SUT RTNT UNQ HYDROLYZABLE GELTN BOTH IP/OP "$1,202.50" $890.00 $238.62 "$1,202.25" $541.01 $541.01 $541.01 $541.01 "$1,202.25" "$1,202.25" "$1,202.25" $250.58 "$1,202.25" "$1,202.25" "$1,202.25" "$1,202.25" "$1,202.25" $250.56 "$1,202.25" "$1,202.25" $711.13 "$1,202.25" "$1,202.25" "$1,202.25" "$1,202.25" $901.88 "$1,202.25" "$1,202.25" "$1,202.25" $601.13 $601.13 $952.18 "$1,202.25" $961.80 $541.01 $238.62 N/A $697.45 "$1,202.25" "$1,202.25" "$1,202.25" $250.55 "$1,202.25" N/A N/A 733026 SUP HCPCS C1768 733026 - GRAFT CARDIO STR 26MM 30CM WOVEN VASCUTEK GELWEAVE THORAX BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 733028 SUP HCPCS C1768 733028 - GRAFT CARDIO STR 28MM 30CM SUTURE RETENTION UNIQUE BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 733030 SUP HCPCS C1768 733030 - GRAFT CARDIO STR 30MM 30CM SUTURE RETENTION UNIQUE BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 733032 SUP HCPCS C1768 733032 - GRAFT CARDIO STR 32MM 30CM SUTURE RETENTION UNIQUE BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 740026 SUP Custom 27203010 740026 - DEVICE PSTN STRL THE SEC AST 2 ADJ CLP BT FTBRD PLS KN DISP BOTH IP/OP $497.50 $368.00 $88.56 $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $88.56 $497.50 $497.50 $369.24 $369.24 $383.47 $259.20 $103.68 $497.50 $199.00 $497.50 $497.50 $497.50 $497.50 $497.50 $373.13 $497.50 $497.50 $497.50 $248.75 $248.75 $394.02 $497.50 $398.00 $323.38 $497.50 N/A $288.55 $497.50 $298.50 $497.50 $497.50 $497.50 N/A N/A Jun-00 SUP Custom 27803010 06-4000 - HEAD FEM +0MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A Jun-05 SUP Custom 27803010 06-4005 - HEAD FEM +5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 3/11/4010 SUP HCPCS C1713 03-11-4010 - SCREW BONE 4MM 10MM FIX ANGLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/12/4010 SUP HCPCS C1713 03-12-4010 - SCREW BONE 4MM 10MM VAR ANG TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A Jun-10 SUP Custom 27803010 06-4010 - HEAD FEMORAL +10 40MM C TAPER ANATOMIC OFFST LFIT COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 3/11/4011 SUP HCPCS C1713 03-11-4011 - SCREW BONE 4MM 11MM FIX ANGLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/12/4011 SUP HCPCS C1713 03-12-4011 - SCREW BONE 4MM 11MM VAR ANG TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 3/11/4012 SUP HCPCS C1713 03-11-4012 - SCREW BONE 4MM 12MM FIX ANGLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 3/12/4012 SUP HCPCS C1713 03-12-4012 - SCREW BONE 4MM 12MM VAR ANG TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 3/11/4013 SUP HCPCS C1713 03-11-4013 - SCREW BONE 4MM 13MM FIX ANGLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/12/4013 SUP HCPCS C1713 03-12-4013 - SCREW BONE 4MM 13MM VAR ANG TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 3/11/4014 SUP HCPCS C1713 03-11-4014 - SCREW BONE 4MM 14MM FIX ANGLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 3/12/4014 SUP HCPCS C1713 03-12-4014 - SCREW BONE 4MM 14MM VAR ANG TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/11/4015 SUP HCPCS C1713 03-11-4015 - SCREW BONE 4MM 15MM FIX ANGLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/12/4015 SUP HCPCS C1713 03-12-4015 - SCREW BONE 4MM 15MM VAR ANG TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/11/4016 SUP HCPCS C1713 03-11-4016 - SCREW BONE 4MM 16MM FIX ANGLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/12/4016 SUP HCPCS C1713 03-12-4016 - SCREW BONE 4MM 16MM VAR ANG TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/11/4017 SUP HCPCS C1713 03-11-4017 - SCREW BONE 4MM 17MM FIX ANGLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/12/4017 SUP HCPCS C1713 03-12-4017 - SCREW BONE 4MM 17MM VAR ANG TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 3/11/4018 SUP HCPCS C1713 03-11-4018 - SCREW BONE 4MM 18MM FIX ANGLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/12/4018 SUP HCPCS C1713 03-12-4018 - SCREW BONE 4MM 18MM VAR ANG TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 3/11/4019 SUP HCPCS C1713 03-11-4019 - SCREW BONE 4MM 19MM FIX ANGLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/12/4019 SUP HCPCS C1713 03-12-4019 - SCREW BONE 4MM 19MM VAR ANG TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/11/4020 SUP HCPCS C1713 03-11-4020 - SCREW BONE 4MM 20MM FIX ANGLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/12/4020 SUP HCPCS C1713 03-12-4020 - SCREW BONE 4MM 20MM VAR ANG TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A Jun-25 SUP Custom 27803010 06-4025 - HEAD FEM +2.5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A Jun-75 SUP Custom 27803010 06-4075 - HEAD FEM +7.5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 800070 SUP Custom 27203010 800070 - SLIDE INSTRUCTIONAL HMRHD THD SYS BOTH IP/OP "$1,307.50" $968.00 $120.40 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $232.74 "$1,307.50" "$1,307.50" $970.43 $970.43 "$1,007.82" $681.21 $272.50 "$1,307.50" $120.40 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $980.63 "$1,307.50" "$1,307.50" "$1,307.50" $653.75 $653.75 "$1,035.54" "$1,307.50" "$1,046.00" $849.88 "$1,307.50" N/A $758.35 "$1,307.50" $784.50 "$1,307.50" "$1,307.50" "$1,307.50" N/A N/A Jun-97 SUP Custom 27803010 06-4097 - HEAD FEM -2.5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A Jun-99 SUP Custom 27803010 06-4099 - HEAD FEM -5MM OFST CTPR 40MM STRL LFIT ANTM COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 807603 SUP Custom 27203010 807603 - FORCEPS BIPOL .5MM SMALL 8IN IRRIGATION DISPOSABLE BOTH IP/OP "$1,088.00" $805.00 $193.66 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $193.66 "$1,088.00" "$1,088.00" $807.51 $807.51 $838.63 $566.85 $226.75 "$1,088.00" $435.20 "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" "$1,088.00" $816.00 "$1,088.00" "$1,088.00" "$1,088.00" $544.00 $544.00 $861.70 "$1,088.00" $870.40 $707.20 "$1,088.00" N/A $631.04 "$1,088.00" $652.80 "$1,088.00" "$1,088.00" "$1,088.00" N/A N/A 808006 SUP HCPCS Q4130 0808006 - MATRIX TISSUE 8X8CM RECONSTRUCTIVE STRATTICE PIG DERMIS BOTH IP/OP "$4,617.50" "$3,417.00" $962.34 "$4,617.50" "$4,617.50" "$4,617.50" "$4,617.50" "$4,617.50" "$4,617.50" "$4,617.50" "$4,617.50" "$4,617.50" "$4,617.50" "$4,617.50" "$4,617.50" "$4,617.50" "$4,617.50" $962.34 "$4,617.50" "$1,222.00" "$4,617.50" "$4,617.50" "$3,055.00" "$4,617.50" "$4,617.50" "$3,463.13" "$4,617.50" "$4,617.50" "$4,617.50" "$2,308.75" "$2,308.75" "$3,657.06" "$4,617.50" "$3,694.00" "$2,077.88" "$4,617.50" N/A "$2,678.15" "$4,617.50" "$2,770.50" "$4,617.50" "$4,617.50" "$4,617.50" N/A N/A 810051 SUP HCPCS C1771 810051 - INTRODUCER ENDSCP 5MM HANDLE TVT REUSABLE GYNECARE BOTH IP/OP "$1,362.50" "$1,008.00" $270.42 "$1,362.50" $613.13 $613.13 $613.13 $613.13 "$1,362.50" "$1,362.50" "$1,362.50" $283.98 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" "$1,362.50" $805.92 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 $270.42 N/A $790.25 "$1,362.50" "$1,362.50" "$1,362.50" $283.95 "$1,362.50" N/A N/A 810061 SUP HCPCS C1769 810061 - GUIDE CATHETER 7FR 100CM RIGID TAPE TVT FMALE VAGINA BOTH IP/OP $348.00 $258.00 $69.00 $347.63 $188.76 $188.76 $188.76 $188.76 $347.63 $347.63 $347.63 $72.45 $347.63 $258.01 $258.01 $267.95 $181.12 $72.45 $347.63 $347.63 $205.62 $347.63 $347.63 $347.63 $347.63 $261.00 $347.63 $347.63 $347.63 $173.82 $173.82 $275.32 $347.63 $278.10 $225.96 $69.00 N/A $201.84 $347.63 $347.63 $347.63 $72.45 $347.63 N/A N/A 811558 SUP Custom 27803010 811558 - X-10 CROSSLINK BOTH IP/OP "$4,640.50" "$3,434.00" $825.97 "$4,640.30" "$4,640.30" "$4,640.30" "$4,640.30" "$4,640.30" "$4,640.30" "$4,640.30" $825.97 "$4,640.30" "$4,640.30" "$4,640.30" "$4,640.30" "$4,640.30" "$4,640.30" $967.09 "$4,640.30" "$1,856.12" "$4,640.30" "$4,640.30" "$4,640.30" "$4,640.30" "$4,640.30" "$3,480.38" "$4,640.30" "$4,640.30" "$4,640.30" "$2,320.15" "$2,320.15" "$3,675.12" "$4,640.30" "$3,712.24" "$2,088.14" "$4,640.30" N/A "$2,691.49" "$4,640.30" "$2,784.18" "$4,640.30" "$4,640.30" "$4,640.30" N/A N/A 815009 SUP HCPCS Q4130 815009 - MATRIX TISSUE 15X8CM RECONSTRUCTIVE STRATTICE PIG DERMIS BOTH IP/OP "$7,235.00" "$5,354.00" "$1,507.85" "$7,235.00" "$7,235.00" "$7,235.00" "$7,235.00" "$7,235.00" "$7,235.00" "$7,235.00" "$7,235.00" "$7,235.00" "$7,235.00" "$7,235.00" "$7,235.00" "$7,235.00" "$7,235.00" "$1,507.85" "$7,235.00" "$2,894.00" "$7,235.00" "$7,235.00" "$7,235.00" "$7,235.00" "$7,235.00" "$5,426.25" "$7,235.00" "$7,235.00" "$7,235.00" "$3,617.50" "$3,617.50" "$5,730.12" "$7,235.00" "$5,788.00" "$3,255.75" "$7,235.00" N/A "$4,196.30" "$7,235.00" "$4,341.00" "$7,235.00" "$7,235.00" "$7,235.00" N/A N/A 816001 SUP HCPCS Q4130 0816001 - MATRIX TISSUE 16X8CM RECONSTRUCTIVE PLIABLE STRATTICE PIG BOTH IP/OP "$8,120.00" "$6,009.00" "$1,692.30" "$8,120.00" "$8,120.00" "$8,120.00" "$8,120.00" "$8,120.00" "$8,120.00" "$8,120.00" "$8,120.00" "$8,120.00" "$8,120.00" "$8,120.00" "$8,120.00" "$8,120.00" "$8,120.00" "$1,692.30" "$8,120.00" "$3,248.00" "$8,120.00" "$8,120.00" "$8,120.00" "$8,120.00" "$8,120.00" "$6,090.00" "$8,120.00" "$8,120.00" "$8,120.00" "$4,060.00" "$4,060.00" "$6,431.04" "$8,120.00" "$6,496.00" "$3,654.00" "$8,120.00" N/A "$4,709.60" "$8,120.00" "$4,872.00" "$8,120.00" "$8,120.00" "$8,120.00" N/A N/A 816458 SUP HCPCS C1713 816458 - CROSSLINK X-10/58MM BOTH IP/OP "$4,640.50" "$3,434.00" $920.98 "$4,640.30" "$2,088.14" "$2,088.14" "$2,088.14" "$2,088.14" "$4,640.30" "$4,640.30" "$4,640.30" $967.15 "$4,640.30" "$4,640.30" "$4,640.30" "$4,640.30" "$4,640.30" $967.09 "$4,640.30" "$1,856.12" "$2,287.67" "$4,640.30" "$4,640.30" "$4,640.30" "$4,640.30" "$3,480.38" "$4,640.30" "$4,640.30" "$4,640.30" "$2,320.15" "$2,320.15" "$3,675.12" "$4,640.30" "$3,712.24" "$2,088.14" $920.98 N/A "$2,691.49" "$4,640.30" "$2,784.18" "$4,640.30" "$4,640.30" "$4,640.30" N/A N/A 821707 SUP Custom 27203010 821707 - KIT XTRN DRN CDMN CATH LMBR BOTH IP/OP $527.50 $390.00 $93.81 $527.05 $527.05 $527.05 $527.05 $527.05 $527.05 $527.05 $93.81 $527.05 $527.05 $391.18 $391.18 $406.25 $274.59 $109.84 $527.05 $210.82 $527.05 $527.05 $527.05 $527.05 $527.05 $395.63 $527.05 $527.05 $527.05 $263.53 $263.53 $417.42 $527.05 $421.64 $342.58 $527.05 N/A $305.95 $527.05 $316.23 $527.05 $527.05 $527.05 N/A N/A 821750 SUP HCPCS C1729 821750 - CATHETER EXTERNAL DRAIN LARGE 1.9MM LATEX FREE BACTISEAL EVD BOTH IP/OP "$1,206.00" $892.00 $239.27 "$1,241.73" $654.61 $654.61 $654.61 $654.61 "$1,205.55" "$1,205.55" "$1,205.55" $251.27 "$1,205.55" $894.76 $894.76 $929.24 $628.09 $251.25 "$1,205.55" "$1,241.73" $713.08 "$1,205.55" "$1,241.73" "$1,205.55" "$1,205.55" $904.50 "$1,205.55" "$1,205.55" "$1,205.55" $602.78 $602.78 $954.80 "$1,205.55" $964.44 $783.61 $239.27 N/A $699.48 "$1,205.55" "$1,205.55" "$1,205.55" $251.24 "$1,205.55" N/A N/A 826614 SUP Custom 27803010 826614 - KIT CRANIOTOMY CRANIAL ACCES CODMAN BOTH IP/OP $722.00 $534.00 $128.45 $721.63 $721.63 $721.63 $721.63 $721.63 $721.63 $721.63 $128.45 $721.63 $721.63 $721.63 $721.63 $721.63 $721.63 $150.40 $721.63 $277.02 $721.63 $721.63 $692.55 $721.63 $721.63 $541.50 $721.63 $721.63 $721.63 $360.82 $360.82 $571.53 $721.63 $577.30 $324.73 $721.63 N/A $418.76 $721.63 $432.98 $721.63 $721.63 $721.63 N/A N/A 858445 SUP HCPCS C1713 858445 - SCREW BONE 4.5MM 45MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858450 SUP HCPCS C1713 858450 - SCREW BONE 4.5MM 50MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 862309 SUP Custom 27203010 862309 - ELECTRODE MONOPOLAR 24.5FR 26FR HOOK BIPOL BOTH IP/OP $721.50 $534.00 $128.36 $721.13 $721.13 $721.13 $721.13 $721.13 $721.13 $721.13 $128.36 $721.13 $721.13 $535.22 $535.22 $555.85 $375.71 $150.29 $721.13 $288.45 $721.13 $721.13 $721.13 $721.13 $721.13 $541.13 $721.13 $721.13 $721.13 $360.57 $360.57 $571.13 $721.13 $576.90 $468.73 $721.13 N/A $418.47 $721.13 $432.68 $721.13 $721.13 $721.13 N/A N/A 873011 SUP Custom 27203010 873011 - SPREADER SURG DURA MATER BOTH IP/OP $398.50 $295.00 $70.86 $398.08 $398.08 $398.08 $398.08 $398.08 $398.08 $398.08 $70.86 $398.08 $398.08 $295.45 $295.45 $306.84 $207.40 $82.96 $398.08 $159.23 $398.08 $398.08 $398.08 $398.08 $398.08 $298.88 $398.08 $398.08 $398.08 $199.04 $199.04 $315.28 $398.08 $318.46 $258.75 $398.08 N/A $231.13 $398.08 $238.85 $398.08 $398.08 $398.08 N/A N/A 874002 SUP Custom 27803010 874002 - PIN DISTRACTION 10MM RELIANCE STERILE C BOTH IP/OP $825.00 $611.00 $146.85 $825.00 $825.00 $825.00 $825.00 $825.00 $825.00 $825.00 $146.85 $825.00 $825.00 $825.00 $825.00 $825.00 $825.00 $171.94 $825.00 $330.00 $825.00 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $371.25 $825.00 N/A $478.50 $825.00 $495.00 $825.00 $825.00 $825.00 N/A N/A 898716 SUP Custom 27203010 898716 - TRAY CATH 16FR 350ML FOLEY URMTR LATEX BOTH IP/OP $40.50 $30.00 $7.13 $40.06 $40.06 $40.06 $40.06 $40.06 $40.06 $40.06 $7.13 $40.06 $40.06 $29.73 $29.73 $30.88 $20.87 $8.35 $40.06 $16.02 $40.06 $40.06 $40.06 $40.06 $40.06 $30.38 $40.06 $40.06 $40.06 $20.03 $20.03 $31.73 $40.06 $32.05 $26.04 $40.06 N/A $23.49 $40.06 $24.04 $40.06 $40.06 $40.06 N/A N/A 900284 SUP Custom 27203010 900284 - SUTURE NABSB 2 KHC-5 BLU MXBRD BRAID BOTH IP/OP $65.00 $48.00 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 N/A $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 900334 SUP Custom 27203010 900334 - SUTURE NABSB 2 C-2 BLU MXBRD BRAID BOTH IP/OP $65.00 $48.00 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 N/A $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 900339 SUP Custom 27203010 900339 - DEVICE FX MAXFIRE REPR ZIPLOOP TCH MNSCS BOTH IP/OP "$1,085.00" $803.00 $193.13 "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" $193.13 "$1,085.00" "$1,085.00" $805.29 $805.29 $836.32 $565.29 $226.13 "$1,085.00" $434.00 "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" "$1,085.00" $813.75 "$1,085.00" "$1,085.00" "$1,085.00" $542.50 $542.50 $859.32 "$1,085.00" $868.00 $705.25 "$1,085.00" N/A $629.30 "$1,085.00" $651.00 "$1,085.00" "$1,085.00" "$1,085.00" N/A N/A 901124 SUP HCPCS C1894 901124 - INTRO SHTH PRTNL BOTH IP/OP $777.50 $575.00 $154.31 $777.50 $422.18 $422.18 $422.18 $422.18 $777.50 $777.50 $777.50 $162.05 $777.50 $577.06 $577.06 $599.30 $405.08 $162.04 $777.50 $777.50 $459.89 $777.50 $777.50 $777.50 $777.50 $583.13 $777.50 $777.50 $777.50 $388.75 $388.75 $615.78 $777.50 $622.00 $505.38 $154.31 N/A $450.95 $777.50 $777.50 $777.50 $162.03 $777.50 N/A N/A 904754 SUP Custom 27803010 904754 - DEVICE FX 7 50IN TOGGLELOC ZIPLOOP LNG LOOP XTD PE FEM BOTH IP/OP "$1,452.50" "$1,075.00" $258.55 "$1,452.50" "$1,452.50" "$1,452.50" "$1,452.50" "$1,452.50" "$1,452.50" "$1,452.50" $258.55 "$1,452.50" "$1,452.50" "$1,452.50" "$1,452.50" "$1,452.50" "$1,452.50" $302.72 "$1,452.50" $581.00 "$1,452.50" "$1,452.50" "$1,452.50" "$1,452.50" "$1,452.50" "$1,089.38" "$1,452.50" "$1,452.50" "$1,452.50" $726.25 $726.25 "$1,150.38" "$1,452.50" "$1,162.00" $653.63 "$1,452.50" N/A $842.45 "$1,452.50" $871.50 "$1,452.50" "$1,452.50" "$1,452.50" N/A N/A 905256 SUP HCPCS C1713 905256 - SCREW INTFR 9MM 25MM COMPOSITCP RND HD BOTH IP/OP "$1,122.50" $831.00 $222.79 "$1,122.50" $505.13 $505.13 $505.13 $505.13 "$1,122.50" "$1,122.50" "$1,122.50" $233.96 "$1,122.50" "$1,122.50" "$1,122.50" "$1,122.50" "$1,122.50" $233.94 "$1,122.50" "$1,122.50" $663.96 "$1,122.50" "$1,122.50" "$1,122.50" "$1,122.50" $841.88 "$1,122.50" "$1,122.50" "$1,122.50" $561.25 $561.25 $889.02 "$1,122.50" $898.00 $505.13 $222.79 N/A $651.05 "$1,122.50" $673.50 "$1,122.50" $233.93 "$1,122.50" N/A N/A 905257 SUP HCPCS C1713 905257 - SCREW BABSR 9MM 30MM COMPOSITCP RND HD BOTH IP/OP "$1,122.50" $831.00 $222.79 "$1,122.50" $505.13 $505.13 $505.13 $505.13 "$1,122.50" "$1,122.50" "$1,122.50" $233.96 "$1,122.50" "$1,122.50" "$1,122.50" "$1,122.50" "$1,122.50" $233.94 "$1,122.50" "$1,122.50" $663.96 "$1,122.50" "$1,122.50" "$1,122.50" "$1,122.50" $841.88 "$1,122.50" "$1,122.50" "$1,122.50" $561.25 $561.25 $889.02 "$1,122.50" $898.00 $505.13 $222.79 N/A $651.05 "$1,122.50" $673.50 "$1,122.50" $233.93 "$1,122.50" N/A N/A 905261 SUP HCPCS C1713 905261 - SCREW INTFR FT 10MM 30MM COMPOSITCP BOTH IP/OP "$1,122.50" $831.00 $222.79 "$1,122.50" $505.13 $505.13 $505.13 $505.13 "$1,122.50" "$1,122.50" "$1,122.50" $233.96 "$1,122.50" "$1,122.50" "$1,122.50" "$1,122.50" "$1,122.50" $233.94 "$1,122.50" "$1,122.50" $663.96 "$1,122.50" "$1,122.50" "$1,122.50" "$1,122.50" $841.88 "$1,122.50" "$1,122.50" "$1,122.50" $561.25 $561.25 $889.02 "$1,122.50" $898.00 $505.13 $222.79 N/A $651.05 "$1,122.50" $673.50 "$1,122.50" $233.93 "$1,122.50" N/A N/A 905263 SUP HCPCS C1713 905263 - SCREW INTFR FT 11MM 30MM COMPOSITCP BOTH IP/OP "$1,122.50" $831.00 $222.79 "$1,122.50" $505.13 $505.13 $505.13 $505.13 "$1,122.50" "$1,122.50" "$1,122.50" $233.96 "$1,122.50" "$1,122.50" "$1,122.50" "$1,122.50" "$1,122.50" $233.94 "$1,122.50" "$1,122.50" $663.96 "$1,122.50" "$1,122.50" "$1,122.50" "$1,122.50" $841.88 "$1,122.50" "$1,122.50" "$1,122.50" $561.25 $561.25 $889.02 "$1,122.50" $898.00 $505.13 $222.79 N/A $651.05 "$1,122.50" $673.50 "$1,122.50" $233.93 "$1,122.50" N/A N/A 905732 SUP Custom 27203010 905732 - CUTTER SRG 203MM MAXFIRE DISP BOTH IP/OP $460.00 $340.00 $81.88 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $81.88 $460.00 $460.00 $341.41 $341.41 $354.57 $239.66 $95.87 $460.00 $184.00 $460.00 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $299.00 $460.00 N/A $266.80 $460.00 $276.00 $460.00 $460.00 $460.00 N/A N/A 908469 SUP HCPCS C1713 908469 - WASHER ORTH SPK 16MM WSHRLC XTD TIP TI TIB BOTH IP/OP "$1,450.00" "$1,073.00" $287.79 "$1,450.00" $652.50 $652.50 $652.50 $652.50 "$1,450.00" "$1,450.00" "$1,450.00" $302.22 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" $302.20 "$1,450.00" "$1,450.00" $857.68 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,087.50" "$1,450.00" "$1,450.00" "$1,450.00" $725.00 $725.00 "$1,148.40" "$1,450.00" "$1,160.00" $652.50 $287.79 N/A $841.00 "$1,450.00" $870.00 "$1,450.00" $302.18 "$1,450.00" N/A N/A 908846 SUP HCPCS C1713 908846 - SCREW BN 6MM 46MM STRL WSHRLC TI ACL/PCL CANC ASCP BOTH IP/OP $502.50 $372.00 $99.73 $502.50 $226.13 $226.13 $226.13 $226.13 $502.50 $502.50 $502.50 $104.73 $502.50 $502.50 $502.50 $502.50 $502.50 $104.73 $502.50 $502.50 $297.23 $502.50 $502.50 $502.50 $502.50 $376.88 $502.50 $502.50 $502.50 $251.25 $251.25 $397.98 $502.50 $402.00 $226.13 $99.73 N/A $291.45 $502.50 $502.50 $502.50 $104.72 $502.50 N/A N/A 908850 SUP HCPCS C1713 908850 - SCREW BN 6MM 50MM STRL WSHRLC TI ACL/PCL CANC ASCP BOTH IP/OP $502.50 $372.00 $99.73 $502.50 $226.13 $226.13 $226.13 $226.13 $502.50 $502.50 $502.50 $104.73 $502.50 $502.50 $502.50 $502.50 $502.50 $104.73 $502.50 $502.50 $297.23 $502.50 $502.50 $502.50 $502.50 $376.88 $502.50 $502.50 $502.50 $251.25 $251.25 $397.98 $502.50 $402.00 $226.13 $99.73 N/A $291.45 $502.50 $301.50 $502.50 $104.72 $502.50 N/A N/A 908860 SUP HCPCS C1713 908860 - SCREW BN 6MM 60MM STRL WSHRLC TI ACL/PCL CANC ASCP BOTH IP/OP $502.50 $372.00 $99.73 $502.50 $226.13 $226.13 $226.13 $226.13 $502.50 $502.50 $502.50 $104.73 $502.50 $502.50 $502.50 $502.50 $502.50 $104.73 $502.50 $502.50 $297.23 $502.50 $502.50 $502.50 $502.50 $376.88 $502.50 $502.50 $502.50 $251.25 $251.25 $397.98 $502.50 $402.00 $226.13 $99.73 N/A $291.45 $502.50 $301.50 $502.50 $104.72 $502.50 N/A N/A 909848 SUP Custom 27203010 909848 - KIT ASCP FX TOGGLELOC ZIPLOOP BOTH IP/OP "$3,657.50" "$2,707.00" $651.04 "$3,657.50" "$3,657.50" "$3,657.50" "$3,657.50" "$3,657.50" "$3,657.50" "$3,657.50" $651.04 "$3,657.50" "$3,657.50" "$2,714.60" "$2,714.60" "$2,819.20" "$1,905.56" $762.26 "$3,657.50" "$1,463.00" "$3,657.50" "$3,657.50" "$3,657.50" "$3,657.50" "$3,657.50" "$2,743.13" "$3,657.50" "$3,657.50" "$3,657.50" "$1,828.75" "$1,828.75" "$2,896.74" "$3,657.50" "$2,926.00" "$2,377.38" "$3,657.50" N/A "$2,121.35" "$3,657.50" "$2,194.50" "$3,657.50" "$3,657.50" "$3,657.50" N/A N/A 912076 SUP HCPCS C1713 912076 - ANCHOR SUT JUGGERKNOT SFT TIS BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $396.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $594.00 $990.00 $206.32 $990.00 N/A N/A Jun-00 SUP Custom 27803010 06-4400 - HEAD FEM +0MM OFST CTPR 44MM STRL LFIT ANTM COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A Jun-05 SUP Custom 27803010 06-4405 - HEAD FEM +5MM OFST CTPR 44MM STRL LFIT ANTM COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A Jun-10 SUP Custom 27803010 06-4410 - HEAD FEMORAL +10MM 44MM C TAPER LFIT COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 921031 SUP HCPCS C9250 921031 - SET SPRAY 2 LUMEN CONCTR HOSE STERILE FILTER 1 HEAD CLIP BOTH IP/OP $112.00 $83.00 $22.17 $180.54 $50.26 $50.26 $50.26 $50.26 $156.84 $156.84 $156.84 $23.28 $156.84 $111.69 $111.69 $111.69 $111.69 $23.28 $156.84 $180.54 $66.06 $156.84 $111.69 $156.84 $164.68 $84.00 $156.84 $156.84 $156.84 $55.85 $55.85 $88.46 $156.84 $89.35 $50.26 $22.17 N/A $64.96 $164.68 $111.69 $156.84 $23.28 $156.84 N/A N/A Jun-25 SUP Custom 27803010 06-4425 - HEAD FEMORAL +2.5MM 44MM C TAPER LFIT COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 928950 SUP HCPCS C1894 0928950 - KIT MICROINTRODUCER 5FR 7CM 50CM GWIRE BEVEL A NEEDLE SMOOTH BOTH IP/OP $78.50 $58.00 $15.58 $78.50 $42.63 $42.63 $42.63 $42.63 $78.50 $78.50 $78.50 $16.36 $78.50 $58.26 $58.26 $60.51 $40.90 $16.36 $78.50 $78.50 $46.43 $78.50 $78.50 $78.50 $78.50 $58.88 $78.50 $78.50 $78.50 $39.25 $39.25 $62.17 $78.50 $62.80 $51.03 $15.58 N/A $45.53 $78.50 $78.50 $78.50 $16.36 $78.50 N/A N/A Jun-75 SUP Custom 27803010 06-4475 - HEAD FEMORAL +7.5MM 44MM C TAPER LFIT COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A Jun-97 SUP Custom 27803010 06-4497 - HEAD FEMORAL -2.5MM 44MM C TAPER LFIT COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A Jun-99 SUP Custom 27803010 06-4499 - HEAD FEMORAL -5MM 44MM C TAPER ANATOMIC LFIT V40 COCR BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 3/11/4513 SUP HCPCS C1713 03-11-4513 - SCREW BONE 4.5MM 13MM FIX ANGLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/12/4513 SUP HCPCS C1713 03-12-4513 - SCREW BONE 4.5MM 13MM VAR ANG TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/11/4515 SUP HCPCS C1713 03-11-4515 - SCREW BONE 4.5MM 15MM FIX ANGLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/12/4515 SUP HCPCS C1713 03-12-4515 - SCREW BONE 4.5MM 15MM VAR ANG TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/11/4517 SUP HCPCS C1713 03-11-4517 - SCREW BONE 4.5MM 17MM FIX ANGLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3/12/4517 SUP HCPCS C1713 03-12-4517 - SCREW BONE 4.5MM 17MM VAR ANG TITANIUM SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 982001 SUP HCPCS Q4116 982001 - GRAFT SKN XTHICK 1X1CM ALDRM BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $140.00 $128.65 $217.50 $140.00 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $217.50 $217.50 $45.33 $217.50 N/A N/A 982003 SUP HCPCS Q4116 982003 - GRAFT SKN 2X1CM ALDRM RGNRT ACLR DRML MTRX BOTH IP/OP $547.50 $405.00 $108.67 $547.50 $246.38 $246.38 $246.38 $246.38 $547.50 $547.50 $547.50 $114.11 $547.50 $547.50 $547.50 $547.50 $547.50 $114.11 $547.50 $355.00 $323.85 $547.50 $355.00 $547.50 $547.50 $410.63 $547.50 $547.50 $547.50 $273.75 $273.75 $433.62 $547.50 $438.00 $246.38 $108.67 N/A $317.55 $547.50 $547.50 $547.50 $114.10 $547.50 N/A N/A 982007 SUP HCPCS Q4116 982007 - MATRIX TISSUE XTHICK 4X1CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $230.00 $170.00 $45.65 $230.00 $103.50 $103.50 $103.50 $103.50 $230.00 $230.00 $230.00 $47.94 $230.00 $230.00 $230.00 $230.00 $230.00 $47.93 $230.00 $148.13 $136.05 $230.00 $148.13 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $103.50 $45.65 N/A $133.40 $230.00 $230.00 $230.00 $47.93 $230.00 N/A N/A 982011 SUP HCPCS Q4116 982011 - MATRIX TISSUE XTHICK 4X2CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP "$1,600.00" "$1,184.00" $317.56 "$1,600.00" $720.00 $720.00 $720.00 $720.00 "$1,600.00" "$1,600.00" "$1,600.00" $333.48 "$1,600.00" "$1,600.00" "$1,600.00" "$1,600.00" "$1,600.00" $333.46 "$1,600.00" "$1,030.00" $946.40 "$1,600.00" "$1,030.00" "$1,600.00" "$1,600.00" "$1,200.00" "$1,600.00" "$1,600.00" "$1,600.00" $800.00 $800.00 "$1,267.20" "$1,600.00" "$1,280.00" $720.00 $317.56 N/A $928.00 "$1,600.00" "$1,600.00" "$1,600.00" $333.44 "$1,600.00" N/A N/A 982021 SUP HCPCS Q4116 982021 - MATRIX TISSUE XTHICK 7X3CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $129.50 $96.00 $25.68 $129.40 $58.23 $58.23 $58.23 $58.23 $129.40 $129.40 $129.40 $26.97 $129.40 $129.40 $129.40 $129.40 $129.40 $26.97 $129.40 $83.45 $76.54 $129.40 $83.45 $129.40 $129.40 $97.13 $129.40 $129.40 $129.40 $64.70 $64.70 $102.48 $129.40 $103.52 $58.23 $25.68 N/A $75.11 $129.40 $129.40 $129.40 $26.97 $129.40 N/A N/A 982024 SUP HCPCS Q4116 982024 - GRAFT SKN XTHICK 12X2CM ALDRM BOTH IP/OP "$2,337.50" "$1,730.00" $463.94 "$2,337.50" "$1,051.88" "$1,051.88" "$1,051.88" "$1,051.88" "$2,337.50" "$2,337.50" "$2,337.50" $487.19 "$2,337.50" "$2,337.50" "$2,337.50" "$2,337.50" "$2,337.50" $487.16 "$2,337.50" "$1,507.50" "$1,382.63" "$2,337.50" "$1,507.50" "$2,337.50" "$2,337.50" "$1,753.13" "$2,337.50" "$2,337.50" "$2,337.50" "$1,168.75" "$1,168.75" "$1,851.30" "$2,337.50" "$1,870.00" "$1,051.88" $463.94 N/A "$1,355.75" "$2,337.50" "$2,337.50" "$2,337.50" $487.14 "$2,337.50" N/A N/A 982028 SUP HCPCS Q4116 982028 - MATRIX TISSUE XTHICK 7X4CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $101.00 $75.00 $19.95 $100.54 $45.24 $45.24 $45.24 $45.24 $100.54 $100.54 $100.54 $20.96 $100.54 $100.54 $100.54 $100.54 $100.54 $20.95 $100.54 $64.73 $59.47 $100.54 $64.73 $100.54 $100.54 $75.75 $100.54 $100.54 $100.54 $50.27 $50.27 $79.63 $100.54 $80.43 $45.24 $19.95 N/A $58.58 $100.54 $100.54 $100.54 $20.95 $100.54 N/A N/A 982048 SUP HCPCS Q4116 982048 - MATRIX TISSUE XTHICK 12X4CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 982060 SUP HCPCS Q4116 982060 - MATRIX TISSUE XTHICK 10CMX5CMX2.3-3.3MM ALLOGRAFT BOTH IP/OP $100.50 $74.00 $19.89 $100.20 $45.09 $45.09 $45.09 $45.09 $100.20 $100.20 $100.20 $20.88 $100.20 $100.20 $100.20 $100.20 $100.20 $20.88 $100.20 $64.55 $59.27 $100.20 $64.55 $100.20 $100.20 $75.38 $100.20 $100.20 $100.20 $50.10 $50.10 $79.36 $100.20 $80.16 $45.09 $19.89 N/A $58.29 $100.20 $100.20 $100.20 $20.88 $100.20 N/A N/A 982070 SUP HCPCS Q4116 982070 - MATRIX TISSUE XTHICK 12X6CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $71.00 $53.00 $14.05 $70.80 $31.86 $31.86 $31.86 $31.86 $70.80 $70.80 $70.80 $14.76 $70.80 $70.80 $70.80 $70.80 $70.80 $14.76 $70.80 $70.80 $41.88 $70.80 $70.80 $70.80 $70.80 $53.25 $70.80 $70.80 $70.80 $35.40 $35.40 $56.07 $70.80 $56.64 $31.86 $14.05 N/A $41.18 $70.80 $70.80 $70.80 $14.75 $70.80 N/A N/A 982080 SUP HCPCS Q4116 982080 - MATRIX TISSUE XTHICK 16X4CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $78.50 $58.00 $15.50 $78.09 $35.14 $35.14 $35.14 $35.14 $78.09 $78.09 $78.09 $16.28 $78.09 $78.09 $78.09 $78.09 $78.09 $16.27 $78.09 $70.82 $46.19 $78.09 $78.09 $78.09 $78.09 $58.88 $78.09 $78.09 $78.09 $39.05 $39.05 $61.85 $78.09 $62.47 $35.14 $15.50 N/A $45.53 $78.09 $78.09 $78.09 $16.27 $78.09 N/A N/A 982096 SUP HCPCS Q4116 982096 - MATRIX TISSUE XTHICK 12X8CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $78.50 $58.00 $15.50 $78.10 $35.15 $35.15 $35.15 $35.15 $78.10 $78.10 $78.10 $16.28 $78.10 $78.10 $78.10 $78.10 $78.10 $16.28 $78.10 $74.84 $46.20 $78.10 $78.10 $78.10 $78.10 $58.88 $78.10 $78.10 $78.10 $39.05 $39.05 $61.86 $78.10 $62.48 $35.15 $15.50 N/A $45.53 $78.10 $78.10 $78.10 $16.28 $78.10 N/A N/A 982108 SUP HCPCS Q4116 982108 - MATRIX TISSUE XTHICK 18X6CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $93.00 $69.00 $18.37 $92.57 $41.66 $41.66 $41.66 $41.66 $92.57 $92.57 $92.57 $19.29 $92.57 $92.57 $92.57 $92.57 $92.57 $19.29 $92.57 $74.61 $54.76 $92.57 $92.57 $92.57 $92.57 $69.75 $92.57 $92.57 $92.57 $46.29 $46.29 $73.32 $92.57 $74.06 $41.66 $18.37 N/A $53.94 $92.57 $92.57 $92.57 $19.29 $92.57 N/A N/A 982128 SUP HCPCS Q4116 982128 - MATRIX TISSUE XTHICK 16X8CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $78.50 $58.00 $15.50 $78.11 $35.15 $35.15 $35.15 $35.15 $78.11 $78.11 $78.11 $16.28 $78.11 $78.11 $78.11 $78.11 $78.11 $16.28 $78.11 $74.82 $46.20 $78.11 $78.11 $78.11 $78.11 $58.88 $78.11 $78.11 $78.11 $39.06 $39.06 $61.86 $78.11 $62.49 $35.15 $15.50 N/A $45.53 $78.11 $78.11 $78.11 $16.28 $78.11 N/A N/A 982144 SUP HCPCS Q4116 982144 - MATRIX TISSUE XTHICK 12X12CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $106.00 $78.00 $21.01 $105.87 $47.64 $47.64 $47.64 $47.64 $105.87 $105.87 $105.87 $22.07 $105.87 $105.87 $105.87 $105.87 $105.87 $22.06 $105.87 $68.23 $62.62 $105.87 $68.23 $105.87 $105.87 $79.50 $105.87 $105.87 $105.87 $52.94 $52.94 $83.85 $105.87 $84.70 $47.64 $21.01 N/A $61.48 $105.87 $105.87 $105.87 $22.06 $105.87 N/A N/A 982196 SUP HCPCS Q4116 982196 - MATRIX TISSUE XTHICK 16X6CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $78.50 $58.00 $15.50 $78.10 $35.15 $35.15 $35.15 $35.15 $78.10 $78.10 $78.10 $16.28 $78.10 $78.10 $78.10 $78.10 $78.10 $16.28 $78.10 $74.84 $46.20 $78.10 $78.10 $78.10 $78.10 $58.88 $78.10 $78.10 $78.10 $39.05 $39.05 $61.86 $78.10 $62.48 $35.15 $15.50 N/A $45.53 $78.10 $78.10 $78.10 $16.28 $78.10 N/A N/A 982320 SUP HCPCS Q4116 982320 - MATRIX TISSUE XTHICK 20X16CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $78.50 $58.00 $15.50 $78.12 $35.15 $35.15 $35.15 $35.15 $78.12 $78.12 $78.12 $16.28 $78.12 $78.12 $78.12 $78.12 $78.12 $16.28 $78.12 $74.84 $46.21 $78.12 $78.12 $78.12 $78.12 $58.88 $78.12 $78.12 $78.12 $39.06 $39.06 $61.87 $78.12 $62.50 $35.15 $15.50 N/A $45.53 $78.12 $78.12 $78.12 $16.28 $78.12 N/A N/A 983104 SUP HCPCS L0150 983104 - COLLAR CERV 3-6YR REGULAR 37-48IN CHIN DOT TRACHEOSTOMY OPEN BOTH IP/OP $82.00 $61.00 $17.06 $84.30 $81.85 $81.85 $81.85 $81.85 $81.85 $81.85 $73.13 $81.85 $81.85 $81.85 $81.85 $81.85 $81.85 $17.06 $81.85 $33.72 $81.85 $81.85 $84.30 $81.85 $81.85 $61.50 $81.85 $81.85 $81.85 $40.93 $40.93 $64.83 $81.85 $65.48 $36.83 $81.85 N/A $47.56 $81.85 $49.11 $81.85 $81.85 $81.85 N/A N/A 983106 SUP HCPCS L0113 983106 - COLLAR CERV 1-3YR TOT 33-40IN CHIN DOT TRACHEOSTOMY OPEN BOTH IP/OP $82.00 $61.00 $17.06 $185.17 $81.85 $81.85 $81.85 $81.85 $81.85 $81.85 $185.17 $81.85 $81.85 $81.85 $81.85 $81.85 $81.85 $17.06 $81.85 $33.72 $81.85 $81.85 $84.30 $81.85 $81.85 $61.50 $81.85 $81.85 $81.85 $40.93 $40.93 $64.83 $81.85 $65.48 $36.83 $81.85 N/A $47.56 $81.85 $49.11 $81.85 $81.85 $81.85 N/A N/A 983108 SUP HCPCS L0172 983108 - COLLAR CERV SHORT LATEX FREE ADULT BOTH IP/OP $69.50 $51.00 $14.48 $112.86 $31.28 $31.28 $31.28 $31.28 $69.50 $69.50 $86.19 $112.86 $69.50 $69.50 $69.50 $69.50 $69.50 $14.48 $69.50 $27.80 $41.11 $69.50 $69.50 $69.50 $69.50 $52.13 $69.50 $69.50 $69.50 $34.75 $34.75 $55.04 $69.50 $55.60 $31.28 $69.50 N/A $40.31 $69.50 $41.70 $69.50 $109.67 $69.50 N/A N/A 983110 SUP HCPCS L0172 983110 - COLLAR CERV REGULAR CHIN REST TRACHEOSTOMY OPENING BOTH IP/OP $69.50 $51.00 $14.48 $112.86 $31.28 $31.28 $31.28 $31.28 $69.50 $69.50 $86.19 $112.86 $69.50 $69.50 $69.50 $69.50 $69.50 $14.48 $69.50 $27.80 $41.11 $69.50 $69.50 $69.50 $69.50 $52.13 $69.50 $69.50 $69.50 $34.75 $34.75 $55.04 $69.50 $55.60 $31.28 $69.50 N/A $40.31 $69.50 $41.70 $69.50 $109.67 $69.50 N/A N/A 983114 SUP HCPCS L0172 983114 - COLLAR CERV XTALL CHIN REST TRACHEOSTOMY OPENING ADJUSTABLE BOTH IP/OP $69.50 $51.00 $14.48 $112.86 $31.28 $31.28 $31.28 $31.28 $69.50 $69.50 $86.19 $112.86 $69.50 $69.50 $69.50 $69.50 $69.50 $14.48 $69.50 $27.80 $41.11 $69.50 $69.50 $69.50 $69.50 $52.13 $69.50 $69.50 $69.50 $34.75 $34.75 $55.04 $69.50 $55.60 $31.28 $69.50 N/A $40.31 $69.50 $41.70 $69.50 $109.67 $69.50 N/A N/A 983119 SUP HCPCS L0172 983119 - PANEL CERV COLLAR LARGE 15-25IN BACK LATEX FREE ASPEN ADULT BOTH IP/OP $27.50 $20.00 $5.73 $112.86 $12.38 $12.38 $12.38 $12.38 $27.50 $27.50 $86.19 $112.86 $27.50 $27.50 $27.50 $27.50 $27.50 $5.73 $27.50 $11.00 $16.27 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $12.38 $27.50 N/A $15.95 $27.50 $16.50 $27.50 $109.67 $27.50 N/A N/A 983195 SUP HCPCS L0172 983195 - COLLAR CERV 9-24 MONTH REGULAR 29-37IN CHIN DOT TRACHEOSTOMY BOTH IP/OP $82.00 $61.00 $17.06 $112.86 $36.83 $36.83 $36.83 $36.83 $81.85 $81.85 $86.19 $112.86 $81.85 $81.85 $81.85 $81.85 $81.85 $17.06 $81.85 $33.72 $48.41 $81.85 $84.30 $81.85 $81.85 $61.50 $81.85 $81.85 $81.85 $40.93 $40.93 $64.83 $81.85 $65.48 $36.83 $81.85 N/A $47.56 $81.85 $49.11 $81.85 $109.67 $81.85 N/A N/A 992003 SUP HCPCS Q4116 992003 - MATRIX TISSUE THIN 2X1CM ALLOGRAFT REGENERATIVE FREEZE DRIED BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $170.00 $155.27 $262.50 $170.00 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $262.50 $262.50 $54.71 $262.50 N/A N/A 992128 SUP HCPCS Q4116 992128 - MATRIX TISSUE MEDIUM 16X8CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $78.50 $58.00 $15.50 $78.11 $35.15 $35.15 $35.15 $35.15 $78.11 $78.11 $78.11 $16.28 $78.11 $78.11 $78.11 $78.11 $78.11 $16.28 $78.11 $74.82 $46.20 $78.11 $78.11 $78.11 $78.11 $58.88 $78.11 $78.11 $78.11 $39.06 $39.06 $61.86 $78.11 $62.49 $35.15 $15.50 N/A $45.53 $78.11 $78.11 $78.11 $16.28 $78.11 N/A N/A 992196 SUP HCPCS Q4116 992196 - MATRIX TISSUE THIN 16X6CM ALLOGRAFT REGENERATIVE FREEZE BOTH IP/OP $78.50 $58.00 $15.50 $78.10 $35.15 $35.15 $35.15 $35.15 $78.10 $78.10 $78.10 $16.28 $78.10 $78.10 $78.10 $78.10 $78.10 $16.28 $78.10 $74.84 $46.20 $78.10 $78.10 $78.10 $78.10 $58.88 $78.10 $78.10 $78.10 $39.05 $39.05 $61.86 $78.10 $62.48 $35.15 $15.50 N/A $45.53 $78.10 $78.10 $78.10 $16.28 $78.10 N/A N/A 1001740 SUP HCPCS C1769 1001740 - GUIDEWIRE VASCULAR STR .014IN 190CM 3CM RADIOPQ HI-TORQUE BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $96.38 $96.38 $96.38 $96.38 $177.50 $177.50 $177.50 $37.00 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A 1001741 SUP HCPCS C1769 1001741 - GUIDEWIRE VASCULAR STR .014IN 300CM 3CM HI-TORQUE ALL STAR BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $96.38 $96.38 $96.38 $96.38 $177.50 $177.50 $177.50 $37.00 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A 1002005 SUP Custom 27203010 1002005 - BIT DRILL LATEX FREE FACETLINX BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1004722 SUP Custom 27804086 1004722 - GRAFT BN 11X11X5MM TRD CSPN BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 1004723 SUP Custom 27804086 1004723 - GRAFT BN 11X11X6MM TRD CSPN BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 1004724 SUP Custom 27804086 1004724 - GRAFT BN 11X11X7MM TRD CSPN BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 1004725 SUP Custom 27804086 1004725 - GRAFT BN 11X11X8MM TRD CSPN BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 1004726 SUP Custom 27804086 1004726 - GRAFT BN 11X11X9MM TRD CSPN BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 1004727 SUP Custom 27804086 1004727 - GRAFT BN 11X11X10MM TRD CSPN BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 1004728 SUP Custom 27804086 1004728 - GRAFT BN 11X11X11IN ALGRF SPNE BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 1004732 SUP Custom 27804086 1004732 - GRAFT BN 14X11X5MM TRD CSPN BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 1004733 SUP Custom 27804086 1004733 - GRAFT BN 14X11X6MM TRD CSPN BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 1004734 SUP Custom 27804086 1004734 - GRAFT BN 7X11X14MM TRD CSPN BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 1004735 SUP Custom 27804086 1004735 - GRAFT BN 14X11X8MM TRD CSPN BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 1004736 SUP Custom 27804086 1004736 - GRAFT BN 14X11X9MM TRD CSPN BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 1004737 SUP Custom 27804086 1004737 - GRAFT BN 14X11X10MM TRD CSPN BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 1004772 SUP Custom 27804086 1004772 - GRAFT BN 20X9X8MM TRD PLIF BOTH IP/OP "$5,257.50" "$3,891.00" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$1,095.72" "$5,257.50" "$2,103.00" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$3,943.13" "$5,257.50" "$5,257.50" "$5,257.50" "$2,628.75" "$2,628.75" "$4,163.94" "$5,257.50" "$4,206.00" "$2,365.88" "$5,257.50" N/A "$3,049.35" "$5,257.50" "$3,154.50" "$5,257.50" "$5,257.50" "$5,257.50" N/A N/A 1004773 SUP Custom 27804086 1004773 - GRAFT BN 20X9X10MM TRD PLIF ALGRF BOTH IP/OP "$5,257.50" "$3,891.00" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$1,095.72" "$5,257.50" "$2,103.00" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$3,943.13" "$5,257.50" "$5,257.50" "$5,257.50" "$2,628.75" "$2,628.75" "$4,163.94" "$5,257.50" "$4,206.00" "$2,365.88" "$5,257.50" N/A "$3,049.35" "$5,257.50" "$3,154.50" "$5,257.50" "$5,257.50" "$5,257.50" N/A N/A 1004774 SUP Custom 27804086 1004774 - GRAFT BN 20X9X12MM TRD PLIF ALGRF BOTH IP/OP "$5,257.50" "$3,891.00" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$1,095.72" "$5,257.50" "$2,103.00" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$3,943.13" "$5,257.50" "$5,257.50" "$5,257.50" "$2,628.75" "$2,628.75" "$4,163.94" "$5,257.50" "$4,206.00" "$2,365.88" "$5,257.50" N/A "$3,049.35" "$5,257.50" "$3,154.50" "$5,257.50" "$5,257.50" "$5,257.50" N/A N/A 1004775 SUP Custom 27804086 1004775 - GRAFT BN 20X9X14MM TRD PLIF BOTH IP/OP "$5,257.50" "$3,891.00" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$1,095.72" "$5,257.50" "$2,103.00" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$3,943.13" "$5,257.50" "$5,257.50" "$5,257.50" "$2,628.75" "$2,628.75" "$4,163.94" "$5,257.50" "$4,206.00" "$2,365.88" "$5,257.50" N/A "$3,049.35" "$5,257.50" "$3,154.50" "$5,257.50" "$5,257.50" "$5,257.50" N/A N/A 1004782 SUP Custom 27804086 1004782 - GRAFT BN 20X11X8MM TRD TLIF BOTH IP/OP "$7,017.50" "$5,193.00" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,462.52" "$7,017.50" "$2,807.00" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$5,263.13" "$7,017.50" "$7,017.50" "$7,017.50" "$3,508.75" "$3,508.75" "$5,557.86" "$7,017.50" "$5,614.00" "$3,157.88" "$7,017.50" N/A "$4,070.15" "$7,017.50" "$4,210.50" "$7,017.50" "$7,017.50" "$7,017.50" N/A N/A 1004783 SUP Custom 27804086 1004783 - GRAFT BN 20X11X10MM TRD TLIF BOTH IP/OP "$7,017.50" "$5,193.00" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,462.52" "$7,017.50" "$2,807.00" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$5,263.13" "$7,017.50" "$7,017.50" "$7,017.50" "$3,508.75" "$3,508.75" "$5,557.86" "$7,017.50" "$5,614.00" "$3,157.88" "$7,017.50" N/A "$4,070.15" "$7,017.50" "$4,210.50" "$7,017.50" "$7,017.50" "$7,017.50" N/A N/A 1004784 SUP Custom 27804086 1004784 - GRAFT BN 20X11X12MM TRD TLIF BOTH IP/OP "$7,017.50" "$5,193.00" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,462.52" "$7,017.50" "$2,807.00" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$5,263.13" "$7,017.50" "$7,017.50" "$7,017.50" "$3,508.75" "$3,508.75" "$5,557.86" "$7,017.50" "$5,614.00" "$3,157.88" "$7,017.50" N/A "$4,070.15" "$7,017.50" "$4,210.50" "$7,017.50" "$7,017.50" "$7,017.50" N/A N/A 1004785 SUP Custom 27804086 1004785 - GRAFT BN 20X11X14MM TRD TLIF BOTH IP/OP "$7,017.50" "$5,193.00" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,462.52" "$7,017.50" "$2,807.00" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$5,263.13" "$7,017.50" "$7,017.50" "$7,017.50" "$3,508.75" "$3,508.75" "$5,557.86" "$7,017.50" "$5,614.00" "$3,157.88" "$7,017.50" N/A "$4,070.15" "$7,017.50" "$4,210.50" "$7,017.50" "$7,017.50" "$7,017.50" N/A N/A 1004792 SUP Custom 27804086 1004792 - GRAFT BN 25X9X8MM TRD PLIF ALGRF BOTH IP/OP "$5,257.50" "$3,891.00" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$1,095.72" "$5,257.50" "$2,103.00" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$3,943.13" "$5,257.50" "$5,257.50" "$5,257.50" "$2,628.75" "$2,628.75" "$4,163.94" "$5,257.50" "$4,206.00" "$2,365.88" "$5,257.50" N/A "$3,049.35" "$5,257.50" "$3,154.50" "$5,257.50" "$5,257.50" "$5,257.50" N/A N/A 1004793 SUP Custom 27804086 1004793 - GRAFT BN 25X9X10MM TRD PLIF ALGRF BOTH IP/OP "$5,257.50" "$3,891.00" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$1,095.72" "$5,257.50" "$2,103.00" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$3,943.13" "$5,257.50" "$5,257.50" "$5,257.50" "$2,628.75" "$2,628.75" "$4,163.94" "$5,257.50" "$4,206.00" "$2,365.88" "$5,257.50" N/A "$3,049.35" "$5,257.50" "$3,154.50" "$5,257.50" "$5,257.50" "$5,257.50" N/A N/A 1004794 SUP Custom 27804086 1004794 - GRAFT BN 25X9X12MM TRD PLIF BOTH IP/OP "$5,257.50" "$3,891.00" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$1,095.72" "$5,257.50" "$2,103.00" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$3,943.13" "$5,257.50" "$5,257.50" "$5,257.50" "$2,628.75" "$2,628.75" "$4,163.94" "$5,257.50" "$4,206.00" "$2,365.88" "$5,257.50" N/A "$3,049.35" "$5,257.50" "$3,154.50" "$5,257.50" "$5,257.50" "$5,257.50" N/A N/A 1004795 SUP Custom 27804086 1004795 - GRAFT BN 25X9X14MM TRD PLIF BOTH IP/OP "$5,257.50" "$3,891.00" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" $935.84 "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$1,095.72" "$5,257.50" "$2,103.00" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$5,257.50" "$3,943.13" "$5,257.50" "$5,257.50" "$5,257.50" "$2,628.75" "$2,628.75" "$4,163.94" "$5,257.50" "$4,206.00" "$2,365.88" "$5,257.50" N/A "$3,049.35" "$5,257.50" "$3,154.50" "$5,257.50" "$5,257.50" "$5,257.50" N/A N/A 1004802 SUP Custom 27804086 1004802 - GRAFT BN 25X11X8MM TRD TLIF BOTH IP/OP "$7,017.50" "$5,193.00" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,462.52" "$7,017.50" "$2,807.00" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$5,263.13" "$7,017.50" "$7,017.50" "$7,017.50" "$3,508.75" "$3,508.75" "$5,557.86" "$7,017.50" "$5,614.00" "$3,157.88" "$7,017.50" N/A "$4,070.15" "$7,017.50" "$4,210.50" "$7,017.50" "$7,017.50" "$7,017.50" N/A N/A 1004803 SUP Custom 27804086 1004803 - GRAFT BN 25X11X10MM TLIF BOTH IP/OP "$7,017.50" "$5,193.00" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,462.52" "$7,017.50" "$2,807.00" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$5,263.13" "$7,017.50" "$7,017.50" "$7,017.50" "$3,508.75" "$3,508.75" "$5,557.86" "$7,017.50" "$5,614.00" "$3,157.88" "$7,017.50" N/A "$4,070.15" "$7,017.50" "$4,210.50" "$7,017.50" "$7,017.50" "$7,017.50" N/A N/A 1004804 SUP Custom 27804086 1004804 - GRAFT BN 25X11X12MM TRD TLIF ALGRF BOTH IP/OP "$7,017.50" "$5,193.00" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,462.52" "$7,017.50" "$2,807.00" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$5,263.13" "$7,017.50" "$7,017.50" "$7,017.50" "$3,508.75" "$3,508.75" "$5,557.86" "$7,017.50" "$5,614.00" "$3,157.88" "$7,017.50" N/A "$4,070.15" "$7,017.50" "$4,210.50" "$7,017.50" "$7,017.50" "$7,017.50" N/A N/A 1004805 SUP Custom 27804086 1004805 - GRAFT BN 25X11X14MM TLIF BOTH IP/OP "$7,017.50" "$5,193.00" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,249.12" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$1,462.52" "$7,017.50" "$2,807.00" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$7,017.50" "$5,263.13" "$7,017.50" "$7,017.50" "$7,017.50" "$3,508.75" "$3,508.75" "$5,557.86" "$7,017.50" "$5,614.00" "$3,157.88" "$7,017.50" N/A "$4,070.15" "$7,017.50" "$4,210.50" "$7,017.50" "$7,017.50" "$7,017.50" N/A N/A 1005203 SUP HCPCS C1769 1005203 - GUIDEWIRE VASCULAR STR .014IN 300CM 5CM STEERABLE CORE TO BOTH IP/OP $207.50 $154.00 $41.18 $207.50 $112.67 $112.67 $112.67 $112.67 $207.50 $207.50 $207.50 $43.25 $207.50 $154.01 $154.01 $159.94 $108.11 $43.25 $207.50 $207.50 $122.74 $207.50 $207.50 $207.50 $207.50 $155.63 $207.50 $207.50 $207.50 $103.75 $103.75 $164.34 $207.50 $166.00 $134.88 $41.18 N/A $120.35 $207.50 $207.50 $207.50 $43.24 $207.50 N/A N/A 1007633 SUP HCPCS C1713 1007633 - MESH SRG 10X6MM SPNE BOTH IP/OP "$2,617.50" "$1,937.00" $519.51 "$2,617.50" "$1,177.88" "$1,177.88" "$1,177.88" "$1,177.88" "$2,617.50" "$2,617.50" "$2,617.50" $545.55 "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" $545.52 "$2,617.50" "$1,047.00" "$1,290.43" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$1,963.13" "$2,617.50" "$2,617.50" "$2,617.50" "$1,308.75" "$1,308.75" "$2,073.06" "$2,617.50" "$2,094.00" "$1,177.88" $519.51 N/A "$1,518.15" "$2,617.50" "$2,617.50" "$2,617.50" $545.49 "$2,617.50" N/A N/A 1007634 SUP HCPCS C1713 1007634 - MESH SRG 10X7MM SPNE BOTH IP/OP "$2,617.50" "$1,937.00" $519.51 "$2,617.50" "$1,177.88" "$1,177.88" "$1,177.88" "$1,177.88" "$2,617.50" "$2,617.50" "$2,617.50" $545.55 "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" $545.52 "$2,617.50" "$1,047.00" "$1,290.43" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$1,963.13" "$2,617.50" "$2,617.50" "$2,617.50" "$1,308.75" "$1,308.75" "$2,073.06" "$2,617.50" "$2,094.00" "$1,177.88" $519.51 N/A "$1,518.15" "$2,617.50" "$2,617.50" "$2,617.50" $545.49 "$2,617.50" N/A N/A 1007635 SUP HCPCS C1713 1007635 - MESH SRG 10X8MM SPNE BOTH IP/OP "$2,617.50" "$1,937.00" $519.51 "$2,617.50" "$1,177.88" "$1,177.88" "$1,177.88" "$1,177.88" "$2,617.50" "$2,617.50" "$2,617.50" $545.55 "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" $545.52 "$2,617.50" "$1,047.00" "$1,290.43" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$1,963.13" "$2,617.50" "$2,617.50" "$2,617.50" "$1,308.75" "$1,308.75" "$2,073.06" "$2,617.50" "$2,094.00" "$1,177.88" $519.51 N/A "$1,518.15" "$2,617.50" "$1,570.50" "$2,617.50" $545.49 "$2,617.50" N/A N/A 1007636 SUP HCPCS C1713 1007636 - MESH SRG 10X9MM SPNE BOTH IP/OP "$2,617.50" "$1,937.00" $519.51 "$2,617.50" "$1,177.88" "$1,177.88" "$1,177.88" "$1,177.88" "$2,617.50" "$2,617.50" "$2,617.50" $545.55 "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" $545.52 "$2,617.50" "$1,047.00" "$1,290.43" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$1,963.13" "$2,617.50" "$2,617.50" "$2,617.50" "$1,308.75" "$1,308.75" "$2,073.06" "$2,617.50" "$2,094.00" "$1,177.88" $519.51 N/A "$1,518.15" "$2,617.50" "$1,570.50" "$2,617.50" $545.49 "$2,617.50" N/A N/A 1007637 SUP HCPCS C1713 1007637 - MESH SRG 10X10MM SPNE BOTH IP/OP "$2,617.50" "$1,937.00" $519.51 "$2,617.50" "$1,177.88" "$1,177.88" "$1,177.88" "$1,177.88" "$2,617.50" "$2,617.50" "$2,617.50" $545.55 "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" $545.52 "$2,617.50" "$1,047.00" "$1,290.43" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$1,963.13" "$2,617.50" "$2,617.50" "$2,617.50" "$1,308.75" "$1,308.75" "$2,073.06" "$2,617.50" "$2,094.00" "$1,177.88" $519.51 N/A "$1,518.15" "$2,617.50" "$1,570.50" "$2,617.50" $545.49 "$2,617.50" N/A N/A 1007639 SUP HCPCS C1713 1007639 - MESH SRG 12X10MM SPNE BOTH IP/OP "$2,617.50" "$1,937.00" $519.51 "$2,617.50" "$1,177.88" "$1,177.88" "$1,177.88" "$1,177.88" "$2,617.50" "$2,617.50" "$2,617.50" $545.55 "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" $545.52 "$2,617.50" "$1,047.00" "$1,290.43" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$1,963.13" "$2,617.50" "$2,617.50" "$2,617.50" "$1,308.75" "$1,308.75" "$2,073.06" "$2,617.50" "$2,094.00" "$1,177.88" $519.51 N/A "$1,518.15" "$2,617.50" "$2,617.50" "$2,617.50" $545.49 "$2,617.50" N/A N/A 1007640 SUP HCPCS C1713 1007640 - MESH SRG 10X14MM SPNE BOTH IP/OP "$2,617.50" "$1,937.00" $519.51 "$2,617.50" "$1,177.88" "$1,177.88" "$1,177.88" "$1,177.88" "$2,617.50" "$2,617.50" "$2,617.50" $545.55 "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" $545.52 "$2,617.50" "$1,047.00" "$1,290.43" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$1,963.13" "$2,617.50" "$2,617.50" "$2,617.50" "$1,308.75" "$1,308.75" "$2,073.06" "$2,617.50" "$2,094.00" "$1,177.88" $519.51 N/A "$1,518.15" "$2,617.50" "$1,570.50" "$2,617.50" $545.49 "$2,617.50" N/A N/A 1007643 SUP HCPCS C1713 1007643 - MESH SRG 50X10MM SPNE BOTH IP/OP "$6,322.50" "$4,679.00" "$1,254.86" "$6,322.50" "$2,845.13" "$2,845.13" "$2,845.13" "$2,845.13" "$6,322.50" "$6,322.50" "$6,322.50" "$1,317.77" "$6,322.50" "$6,322.50" "$6,322.50" "$6,322.50" "$6,322.50" "$1,317.68" "$6,322.50" "$2,529.00" "$3,116.99" "$6,322.50" "$6,322.50" "$6,322.50" "$6,322.50" "$4,741.88" "$6,322.50" "$6,322.50" "$6,322.50" "$3,161.25" "$3,161.25" "$5,007.42" "$6,322.50" "$5,058.00" "$2,845.13" "$1,254.86" N/A "$3,667.05" "$6,322.50" "$6,322.50" "$6,322.50" "$1,317.61" "$6,322.50" N/A N/A 1007653 SUP HCPCS C1713 1007653 - MESH SRG 12X6MM SPNE BOTH IP/OP "$2,617.50" "$1,937.00" $519.51 "$2,617.50" "$1,177.88" "$1,177.88" "$1,177.88" "$1,177.88" "$2,617.50" "$2,617.50" "$2,617.50" $545.55 "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" $545.52 "$2,617.50" "$2,617.50" "$1,290.43" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$1,963.13" "$2,617.50" "$2,617.50" "$2,617.50" "$1,308.75" "$1,308.75" "$2,073.06" "$2,617.50" "$2,094.00" "$1,177.88" $519.51 N/A "$1,518.15" "$2,617.50" "$2,617.50" "$2,617.50" $545.49 "$2,617.50" N/A N/A 1007654 SUP HCPCS C1713 1007654 - MESH SRG 12X7MM SPNE BOTH IP/OP "$2,617.50" "$1,937.00" $519.51 "$2,617.50" "$1,177.88" "$1,177.88" "$1,177.88" "$1,177.88" "$2,617.50" "$2,617.50" "$2,617.50" $545.55 "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" $545.52 "$2,617.50" "$1,047.00" "$1,290.43" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$1,963.13" "$2,617.50" "$2,617.50" "$2,617.50" "$1,308.75" "$1,308.75" "$2,073.06" "$2,617.50" "$2,094.00" "$1,177.88" $519.51 N/A "$1,518.15" "$2,617.50" "$2,617.50" "$2,617.50" $545.49 "$2,617.50" N/A N/A 1007655 SUP HCPCS C1713 1007655 - MESH SRG 12X8MM SPNE BOTH IP/OP "$2,617.50" "$1,937.00" $519.51 "$2,617.50" "$1,177.88" "$1,177.88" "$1,177.88" "$1,177.88" "$2,617.50" "$2,617.50" "$2,617.50" $545.55 "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" $545.52 "$2,617.50" "$1,047.00" "$1,290.43" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$1,963.13" "$2,617.50" "$2,617.50" "$2,617.50" "$1,308.75" "$1,308.75" "$2,073.06" "$2,617.50" "$2,094.00" "$1,177.88" $519.51 N/A "$1,518.15" "$2,617.50" "$2,617.50" "$2,617.50" $545.49 "$2,617.50" N/A N/A 1007656 SUP HCPCS C1713 1007656 - MESH SRG 12X9MM SPNE BOTH IP/OP "$2,617.50" "$1,937.00" $519.51 "$2,617.50" "$1,177.88" "$1,177.88" "$1,177.88" "$1,177.88" "$2,617.50" "$2,617.50" "$2,617.50" $545.55 "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" $545.52 "$2,617.50" "$2,617.50" "$1,290.43" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$1,963.13" "$2,617.50" "$2,617.50" "$2,617.50" "$1,308.75" "$1,308.75" "$2,073.06" "$2,617.50" "$2,094.00" "$1,177.88" $519.51 N/A "$1,518.15" "$2,617.50" "$2,617.50" "$2,617.50" $545.49 "$2,617.50" N/A N/A 1007657 SUP HCPCS C1713 1007657 - MESH SRG 10X12MM SPNE BOTH IP/OP "$2,617.50" "$1,937.00" $519.51 "$2,617.50" "$1,177.88" "$1,177.88" "$1,177.88" "$1,177.88" "$2,617.50" "$2,617.50" "$2,617.50" $545.55 "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" $545.52 "$2,617.50" "$2,617.50" "$1,290.43" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$1,963.13" "$2,617.50" "$2,617.50" "$2,617.50" "$1,308.75" "$1,308.75" "$2,073.06" "$2,617.50" "$2,094.00" "$1,177.88" $519.51 N/A "$1,518.15" "$2,617.50" "$2,617.50" "$2,617.50" $545.49 "$2,617.50" N/A N/A 1007659 SUP HCPCS C1713 1007659 - MESH SRG 12X12MM SPNE BOTH IP/OP "$2,617.50" "$1,937.00" $519.51 "$2,617.50" "$1,177.88" "$1,177.88" "$1,177.88" "$1,177.88" "$2,617.50" "$2,617.50" "$2,617.50" $545.55 "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" $545.52 "$2,617.50" "$2,617.50" "$1,290.43" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$1,963.13" "$2,617.50" "$2,617.50" "$2,617.50" "$1,308.75" "$1,308.75" "$2,073.06" "$2,617.50" "$2,094.00" "$1,177.88" $519.51 N/A "$1,518.15" "$2,617.50" "$2,617.50" "$2,617.50" $545.49 "$2,617.50" N/A N/A 1007660 SUP HCPCS C1713 1007660 - MESH SRG 12X14MM SPNE BOTH IP/OP "$2,617.50" "$1,937.00" $519.51 "$2,617.50" "$1,177.88" "$1,177.88" "$1,177.88" "$1,177.88" "$2,617.50" "$2,617.50" "$2,617.50" $545.55 "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" $545.52 "$2,617.50" "$2,617.50" "$1,290.43" "$2,617.50" "$2,617.50" "$2,617.50" "$2,617.50" "$1,963.13" "$2,617.50" "$2,617.50" "$2,617.50" "$1,308.75" "$1,308.75" "$2,073.06" "$2,617.50" "$2,094.00" "$1,177.88" $519.51 N/A "$1,518.15" "$2,617.50" "$2,617.50" "$2,617.50" $545.49 "$2,617.50" N/A N/A 1007663 SUP HCPCS C1713 1007663 - MESH SRG 50X12MM SPNE BOTH IP/OP "$7,227.50" "$5,348.00" "$1,434.48" "$7,227.50" "$3,252.38" "$3,252.38" "$3,252.38" "$3,252.38" "$7,227.50" "$7,227.50" "$7,227.50" "$1,506.39" "$7,227.50" "$7,227.50" "$7,227.50" "$7,227.50" "$7,227.50" "$1,506.29" "$7,227.50" "$2,891.00" "$3,563.16" "$7,227.50" "$7,227.50" "$7,227.50" "$7,227.50" "$5,420.63" "$7,227.50" "$7,227.50" "$7,227.50" "$3,613.75" "$3,613.75" "$5,724.18" "$7,227.50" "$5,782.00" "$3,252.38" "$1,434.48" N/A "$4,191.95" "$7,227.50" "$7,227.50" "$7,227.50" "$1,506.21" "$7,227.50" N/A N/A 1007673 SUP HCPCS C1713 1007673 - MESH SRG 14X6MM SPNE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 1007674 SUP HCPCS C1713 1007674 - MESH SRG 14X7MM SPNE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 1007675 SUP HCPCS C1713 1007675 - MESH SRG 14X8MM SPNE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" "$2,625.00" "$2,625.00" N/A N/A 1007676 SUP HCPCS C1713 1007676 - MESH SRG 14X9MM SPNE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 1007677 SUP HCPCS C1713 1007677 - MESH SRG 14X10MM SPNE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 1007679 SUP HCPCS C1713 1007679 - MESH SRG 14X12MM SPNE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 1007680 SUP HCPCS C1713 1007680 - MESH SRG 14X14MM SPNE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 1007683 SUP HCPCS C1713 1007683 - MESH SRG 50X14MM TI SPNE BOTH IP/OP "$8,132.50" "$6,018.00" "$1,614.10" "$8,132.50" "$3,659.63" "$3,659.63" "$3,659.63" "$3,659.63" "$8,132.50" "$8,132.50" "$8,132.50" "$1,695.02" "$8,132.50" "$8,132.50" "$8,132.50" "$8,132.50" "$8,132.50" "$1,694.90" "$8,132.50" "$8,132.50" "$4,009.32" "$8,132.50" "$8,132.50" "$8,132.50" "$8,132.50" "$6,099.38" "$8,132.50" "$8,132.50" "$8,132.50" "$4,066.25" "$4,066.25" "$6,440.94" "$8,132.50" "$6,506.00" "$3,659.63" "$1,614.10" N/A "$4,716.85" "$8,132.50" "$4,879.50" "$8,132.50" "$1,694.81" "$8,132.50" N/A N/A 1007693 SUP HCPCS C1713 1007693 - MESH SRG 16X6MM SPNE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 1007694 SUP HCPCS C1713 1007694 - MESH SRG 16X7MM SPNE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 1007695 SUP HCPCS C1713 1007695 - MESH SRG 16X8MM SPNE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 1007696 SUP HCPCS C1713 1007696 - MESH SRG 16X9MM SPNE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 1007697 SUP HCPCS C1713 1007697 - MESH SRG 16X10MM SPNE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 1007699 SUP HCPCS C1713 1007699 - MESH SRG 16X12MM SPNE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 1007700 SUP HCPCS C1713 1007700 - MESH SRG 16X14MM SPNE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 1007703 SUP HCPCS C1713 1007703 - CAGE SPNL 16MM 50MM MESH BOTH IP/OP "$8,132.50" "$6,018.00" "$1,614.10" "$8,132.50" "$3,659.63" "$3,659.63" "$3,659.63" "$3,659.63" "$8,132.50" "$8,132.50" "$8,132.50" "$1,695.02" "$8,132.50" "$8,132.50" "$8,132.50" "$8,132.50" "$8,132.50" "$1,694.90" "$8,132.50" "$8,132.50" "$4,009.32" "$8,132.50" "$8,132.50" "$8,132.50" "$8,132.50" "$6,099.38" "$8,132.50" "$8,132.50" "$8,132.50" "$4,066.25" "$4,066.25" "$6,440.94" "$8,132.50" "$6,506.00" "$3,659.63" "$1,614.10" N/A "$4,716.85" "$8,132.50" "$8,132.50" "$8,132.50" "$1,694.81" "$8,132.50" N/A N/A 1007704 SUP HCPCS C1713 1007704 - MESH SRG 90X16MM SPNE BOTH IP/OP "$10,122.50" "$7,491.00" "$2,009.06" "$10,122.50" "$4,555.13" "$4,555.13" "$4,555.13" "$4,555.13" "$10,122.50" "$10,122.50" "$10,122.50" "$2,109.78" "$10,122.50" "$10,122.50" "$10,122.50" "$10,122.50" "$10,122.50" "$2,109.64" "$10,122.50" "$10,122.50" "$4,990.39" "$10,122.50" "$10,122.50" "$10,122.50" "$10,122.50" "$7,591.88" "$10,122.50" "$10,122.50" "$10,122.50" "$5,061.25" "$5,061.25" "$8,017.02" "$10,122.50" "$8,098.00" "$4,555.13" "$2,009.06" N/A "$5,871.05" "$10,122.50" "$10,122.50" "$10,122.50" "$2,109.53" "$10,122.50" N/A N/A 1009660 SUP HCPCS C1769 1009660 - GUIDEWIRE VASCULAR STR .014IN 190CM 3CM MARKER TIP HI-TORQUE BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $96.38 $96.38 $96.38 $96.38 $177.50 $177.50 $177.50 $37.00 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A 1010008 SUP HCPCS Q4130 1010008 - SUBSTITUTE TISS 10X10CM STRATTICE MESH RECON TISS MTRX PRCN BOTH IP/OP "$6,825.00" "$5,051.00" "$1,422.41" "$6,825.00" "$6,825.00" "$6,825.00" "$6,825.00" "$6,825.00" "$6,825.00" "$6,825.00" "$6,825.00" "$6,825.00" "$6,825.00" "$6,825.00" "$6,825.00" "$6,825.00" "$6,825.00" "$1,422.41" "$6,825.00" "$2,730.00" "$6,825.00" "$6,825.00" "$6,825.00" "$6,825.00" "$6,825.00" "$5,118.75" "$6,825.00" "$6,825.00" "$6,825.00" "$3,412.50" "$3,412.50" "$5,405.40" "$6,825.00" "$5,460.00" "$3,071.25" "$6,825.00" N/A "$3,958.50" "$6,825.00" "$4,095.00" "$6,825.00" "$6,825.00" "$6,825.00" N/A N/A 1010020 SUP Custom 27203010 1010020 - AGENT HEMOSTATIC MICROFIBRILLAR FLOUR LATEX FREE AVITENE BOTH IP/OP $256.50 $190.00 $45.59 $256.15 $256.15 $256.15 $256.15 $256.15 $256.15 $256.15 $45.59 $256.15 $256.15 $190.11 $190.11 $197.44 $133.45 $53.38 $256.15 N/A $256.15 $256.15 $256.15 $256.15 $256.15 $192.38 $256.15 $256.15 $256.15 $128.08 $128.08 $202.87 $256.15 $204.92 $166.50 $256.15 N/A $148.77 $256.15 $153.69 $256.15 $256.15 $256.15 N/A N/A 1010150 SUP Custom 27203010 1010150 - AGENT HEMOSTATIC 10MM 42CM 50X15X1MM PRELOAD APPLICATOR BOTH IP/OP $245.50 $182.00 $43.65 $245.25 $245.25 $245.25 $245.25 $245.25 $245.25 $245.25 $43.65 $245.25 $245.25 $182.02 $182.02 $189.04 $127.78 $51.11 $245.25 N/A $245.25 $245.25 $245.25 $245.25 $245.25 $184.13 $245.25 $245.25 $245.25 $122.63 $122.63 $194.24 $245.25 $196.20 $159.41 $245.25 N/A $142.39 $245.25 $147.15 $245.25 $245.25 $245.25 N/A N/A 1011132 SUP HCPCS C1713 1011132 - MESH SRG 30X20MM SPNE BOTH IP/OP "$6,012.50" "$4,449.00" "$1,193.33" "$6,012.50" "$2,705.63" "$2,705.63" "$2,705.63" "$2,705.63" "$6,012.50" "$6,012.50" "$6,012.50" "$1,253.16" "$6,012.50" "$6,012.50" "$6,012.50" "$6,012.50" "$6,012.50" "$1,253.07" "$6,012.50" "$6,012.50" "$2,964.16" "$6,012.50" "$6,012.50" "$6,012.50" "$6,012.50" "$4,509.38" "$6,012.50" "$6,012.50" "$6,012.50" "$3,006.25" "$3,006.25" "$4,761.90" "$6,012.50" "$4,810.00" "$2,705.63" "$1,193.33" N/A "$3,487.25" "$6,012.50" "$6,012.50" "$6,012.50" "$1,253.01" "$6,012.50" N/A N/A 1011134 SUP HCPCS C1713 1011134 - MESH SRG 60X20MM SPNE BOTH IP/OP "$8,495.00" "$6,286.00" "$1,686.05" "$8,495.00" "$3,822.75" "$3,822.75" "$3,822.75" "$3,822.75" "$8,495.00" "$8,495.00" "$8,495.00" "$1,770.57" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$1,770.45" "$8,495.00" "$3,398.00" "$4,188.04" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$6,371.25" "$8,495.00" "$8,495.00" "$8,495.00" "$4,247.50" "$4,247.50" "$6,728.04" "$8,495.00" "$6,796.00" "$3,822.75" "$1,686.05" N/A "$4,927.10" "$8,495.00" "$5,097.00" "$8,495.00" "$1,770.36" "$8,495.00" N/A N/A 1011135 SUP HCPCS C1713 1011135 - MESH SRG 90X20MM SPNE BOTH IP/OP "$10,662.50" "$7,890.00" "$2,116.24" "$10,662.50" "$4,798.13" "$4,798.13" "$4,798.13" "$4,798.13" "$10,662.50" "$10,662.50" "$10,662.50" "$2,222.33" "$10,662.50" "$10,662.50" "$10,662.50" "$10,662.50" "$10,662.50" "$2,222.18" "$10,662.50" "$10,662.50" "$5,256.61" "$10,662.50" "$10,662.50" "$10,662.50" "$10,662.50" "$7,996.88" "$10,662.50" "$10,662.50" "$10,662.50" "$5,331.25" "$5,331.25" "$8,444.70" "$10,662.50" "$8,530.00" "$4,798.13" "$2,116.24" N/A "$6,184.25" "$10,662.50" "$6,397.50" "$10,662.50" "$2,222.07" "$10,662.50" N/A N/A 1011152 SUP HCPCS C1713 1011152 - MESH SRG 30X24MM SPNE BOTH IP/OP "$6,012.50" "$4,449.00" "$1,193.33" "$6,012.50" "$2,705.63" "$2,705.63" "$2,705.63" "$2,705.63" "$6,012.50" "$6,012.50" "$6,012.50" "$1,253.16" "$6,012.50" "$6,012.50" "$6,012.50" "$6,012.50" "$6,012.50" "$1,253.07" "$6,012.50" "$2,405.00" "$2,964.16" "$6,012.50" "$6,012.50" "$6,012.50" "$6,012.50" "$4,509.38" "$6,012.50" "$6,012.50" "$6,012.50" "$3,006.25" "$3,006.25" "$4,761.90" "$6,012.50" "$4,810.00" "$2,705.63" "$1,193.33" N/A "$3,487.25" "$6,012.50" "$3,607.50" "$6,012.50" "$1,253.01" "$6,012.50" N/A N/A 1011154 SUP HCPCS C1713 1011154 - MESH SRG 60X24MM SPNE BOTH IP/OP "$9,035.00" "$6,686.00" "$1,793.22" "$9,035.00" "$4,065.75" "$4,065.75" "$4,065.75" "$4,065.75" "$9,035.00" "$9,035.00" "$9,035.00" "$1,883.12" "$9,035.00" "$9,035.00" "$9,035.00" "$9,035.00" "$9,035.00" "$1,882.99" "$9,035.00" "$9,035.00" "$4,454.26" "$9,035.00" "$9,035.00" "$9,035.00" "$9,035.00" "$6,776.25" "$9,035.00" "$9,035.00" "$9,035.00" "$4,517.50" "$4,517.50" "$7,155.72" "$9,035.00" "$7,228.00" "$4,065.75" "$1,793.22" N/A "$5,240.30" "$9,035.00" "$5,421.00" "$9,035.00" "$1,882.89" "$9,035.00" N/A N/A 1011155 SUP HCPCS C1713 1011155 - MESH SRG 90X24MM SPNE BOTH IP/OP "$11,207.50" "$8,294.00" "$2,224.41" "$11,207.50" "$5,043.38" "$5,043.38" "$5,043.38" "$5,043.38" "$11,207.50" "$11,207.50" "$11,207.50" "$2,335.92" "$11,207.50" "$11,207.50" "$11,207.50" "$11,207.50" "$11,207.50" "$2,335.77" "$11,207.50" "$4,483.00" "$5,525.30" "$11,207.50" "$11,207.50" "$11,207.50" "$11,207.50" "$8,405.63" "$11,207.50" "$11,207.50" "$11,207.50" "$5,603.75" "$5,603.75" "$8,876.34" "$11,207.50" "$8,966.00" "$5,043.38" "$2,224.41" N/A "$6,500.35" "$11,207.50" "$6,724.50" "$11,207.50" "$2,335.64" "$11,207.50" N/A N/A 1013317 SUP HCPCS C1769 1013317 - GUIDEWIRE VASC STRG .014IN 190CM STRL LF 3CM HTORQ VERSATURN BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $96.38 $96.38 $96.38 $96.38 $177.50 $177.50 $177.50 $37.00 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A 1013319 SUP HCPCS C1769 1013319 - GUIDEWIRE VASC STRG .014IN 190CM STRL LF 3CM HTORQ VERSATURN BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $96.38 $96.38 $96.38 $96.38 $177.50 $177.50 $177.50 $37.00 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A 1016002 SUP HCPCS Q4130 1016002 - MATRIX TISSUE 16X10CM RECONSTRUCTIVE STRATTICE PIG DERMIS BOTH IP/OP $89.00 $66.00 $18.54 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $18.54 $88.98 $23.55 $88.98 $88.98 $58.88 $88.98 $88.98 $66.75 $88.98 $88.98 $88.98 $44.49 $44.49 $70.47 $88.98 $71.18 $40.04 $88.98 N/A $51.62 $88.98 $53.39 $88.98 $88.98 $88.98 N/A N/A 1020009 SUP HCPCS C1769 1020009 - GUIDEWIRE VASC STRG .014IN 190CM STRL LF 3CM HTORQ TURNTRAC BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $96.38 $96.38 $96.38 $96.38 $177.50 $177.50 $177.50 $37.00 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A 1020011 SUP HCPCS C1769 1020011 - GUIDEWIRE VASC STRG .014IN 300CM STRL LF 3CM HTORQ TURNTRAC BOTH IP/OP $215.00 $159.00 $42.67 $215.00 $116.75 $116.75 $116.75 $116.75 $215.00 $215.00 $215.00 $44.81 $215.00 $159.57 $159.57 $165.72 $112.02 $44.81 $215.00 $215.00 $127.17 $215.00 $215.00 $215.00 $215.00 $161.25 $215.00 $215.00 $215.00 $107.50 $107.50 $170.28 $215.00 $172.00 $139.75 $42.67 N/A $124.70 $215.00 $215.00 $215.00 $44.81 $215.00 N/A N/A 1020013 SUP HCPCS C1769 1020013 - GUIDEWIRE VASC STRG .014IN 190CM STRL LF 3CM HTORQ TURNTRAC BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $96.38 $96.38 $96.38 $96.38 $177.50 $177.50 $177.50 $37.00 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A 1020014 SUP HCPCS C1769 1020014 - GUIDEWIRE VASC STRG .014IN 190CM STRL LF 3CM HTORQ TURNTRAC BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $96.38 $96.38 $96.38 $96.38 $177.50 $177.50 $177.50 $37.00 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A 1020015 SUP HCPCS C1769 1020015 - GUIDEWIRE VASC STRG .014IN 300CM STRL LF 3CM HTORQ TURNTRAC BOTH IP/OP $215.00 $159.00 $42.67 $215.00 $116.75 $116.75 $116.75 $116.75 $215.00 $215.00 $215.00 $44.81 $215.00 $159.57 $159.57 $165.72 $112.02 $44.81 $215.00 $215.00 $127.17 $215.00 $215.00 $215.00 $215.00 $161.25 $215.00 $215.00 $215.00 $107.50 $107.50 $170.28 $215.00 $172.00 $139.75 $42.67 N/A $124.70 $215.00 $215.00 $215.00 $44.81 $215.00 N/A N/A 1020016 SUP HCPCS C1769 1020016 - GUIDEWIRE VASC STRG .014IN 300CM STRL LF 3CM HTORQ TURNTRAC BOTH IP/OP $215.00 $159.00 $42.67 $215.00 $116.75 $116.75 $116.75 $116.75 $215.00 $215.00 $215.00 $44.81 $215.00 $159.57 $159.57 $165.72 $112.02 $44.81 $215.00 $215.00 $127.17 $215.00 $215.00 $215.00 $215.00 $161.25 $215.00 $215.00 $215.00 $107.50 $107.50 $170.28 $215.00 $172.00 $139.75 $42.67 N/A $124.70 $215.00 $215.00 $215.00 $44.81 $215.00 N/A N/A 1025002 SUP HCPCS Q4130 1025002 - MATRIX TISSUE 25X10CM RECONSTRUCTIVE STRATTICE PIG DERMIS BOTH IP/OP "$22,245.00" "$16,461.00" "$4,636.10" "$22,245.00" "$22,245.00" "$22,245.00" "$22,245.00" "$22,245.00" "$22,245.00" "$22,245.00" "$22,245.00" "$22,245.00" "$22,245.00" "$22,245.00" "$22,245.00" "$22,245.00" "$22,245.00" "$4,636.10" "$22,245.00" "$5,888.00" "$22,245.00" "$22,245.00" "$14,720.00" "$22,245.00" "$22,245.00" "$16,683.75" "$22,245.00" "$22,245.00" "$22,245.00" "$11,122.50" "$11,122.50" "$17,618.04" "$22,245.00" "$17,796.00" "$10,010.25" "$22,245.00" N/A "$12,902.10" "$22,245.00" "$13,347.00" "$22,245.00" "$22,245.00" "$22,245.00" N/A N/A 1040014 SUP Custom 27803010 1040014 - TUBE VNT 1.14MM 3.6MM 1.3MM GRN POPE GRMT BVL FLRPLAS EAR BOTH IP/OP $44.50 $33.00 $7.88 $44.25 $44.25 $44.25 $44.25 $44.25 $44.25 $44.25 $7.88 $44.25 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $17.70 $44.25 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $44.25 N/A $25.81 $44.25 $26.55 $44.25 $44.25 $44.25 N/A N/A 1044594 SUP HCPCS C1769 1044594 - GUIDEWIRE VASC STRG .014IN 190CM STRL LF 3CM HTORQ POWERTURN BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $96.38 $96.38 $96.38 $96.38 $177.50 $177.50 $177.50 $37.00 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A 1044595 SUP HCPCS C1769 1044595 - GUIDEWIRE VASC STRG .014IN 300CM STRL LF 3CM HTORQ POWERTURN BOTH IP/OP $215.00 $159.00 $42.67 $215.00 $116.75 $116.75 $116.75 $116.75 $215.00 $215.00 $215.00 $44.81 $215.00 $159.57 $159.57 $165.72 $112.02 $44.81 $215.00 $215.00 $127.17 $215.00 $215.00 $215.00 $215.00 $161.25 $215.00 $215.00 $215.00 $107.50 $107.50 $170.28 $215.00 $172.00 $139.75 $42.67 N/A $124.70 $215.00 $215.00 $215.00 $44.81 $215.00 N/A N/A 1050044 SUP Custom 27203010 1050044 - ADHESIVE SKNCLS .5ML BLU FOIL PCH BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A 1112095 SUP HCPCS C1713 1112095 - PROSTHESIS OSS 90D RND 4MM 1.1MM 5MM FULL CNN SHFT OFF CNTR BOTH IP/OP $442.50 $327.00 $87.83 $442.50 $199.13 $199.13 $199.13 $199.13 $442.50 $442.50 $442.50 $92.23 $442.50 $442.50 $442.50 $442.50 $442.50 $92.22 $442.50 $442.50 $261.74 $442.50 $442.50 $442.50 $442.50 $331.88 $442.50 $442.50 $442.50 $221.25 $221.25 $350.46 $442.50 $354.00 $199.13 $87.83 N/A $256.65 $442.50 $442.50 $442.50 $92.22 $442.50 N/A N/A 1135510 SUP HCPCS C1713 "1135510 - RELINE MAS ROD, 100MM" BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1151015 SUP HCPCS C1781 1151015 - GRAFT PRCN RECT 5.9X3.9IN STRL XENMATRIX AB NONCROSSLINK BOTH IP/OP "$11,445.00" "$8,469.00" "$2,271.55" "$11,445.00" "$5,150.25" "$5,150.25" "$5,150.25" "$5,150.25" "$11,445.00" "$11,445.00" "$11,445.00" "$2,385.42" "$11,445.00" "$11,445.00" "$11,445.00" "$11,445.00" "$11,445.00" "$2,385.26" "$11,445.00" "$11,445.00" "$5,642.39" "$11,445.00" "$11,445.00" "$11,445.00" "$11,445.00" "$8,583.75" "$11,445.00" "$11,445.00" "$11,445.00" "$5,722.50" "$5,722.50" "$9,064.44" "$11,445.00" "$9,156.00" "$5,150.25" "$2,271.55" N/A "$6,638.10" "$11,445.00" "$11,445.00" "$11,445.00" "$2,385.14" "$11,445.00" N/A N/A 1151928 SUP HCPCS C1781 1151928 - GRAFT PRCN RECT 11X7.5IN STRL XENMATRIX AB RGNRT BOTH IP/OP "$22,877.00" "$16,929.00" "$4,540.51" "$22,877.00" "$10,294.65" "$10,294.65" "$10,294.65" "$10,294.65" "$22,877.00" "$22,877.00" "$22,877.00" "$4,768.14" "$22,877.00" "$22,877.00" "$22,877.00" "$22,877.00" "$22,877.00" "$4,767.82" "$22,877.00" "$22,877.00" "$11,278.36" "$22,877.00" "$22,877.00" "$22,877.00" "$22,877.00" "$17,157.75" "$22,877.00" "$22,877.00" "$22,877.00" "$11,438.50" "$11,438.50" "$18,118.58" "$22,877.00" "$18,301.60" "$10,294.65" "$4,540.51" N/A "$13,268.66" "$22,877.00" "$22,877.00" "$22,877.00" "$4,767.57" "$22,877.00" N/A N/A 1161015 SUP HCPCS C1781 1161015 - GRAFT PIG THK1.8-2.5MM 5.9X3.9IN REGENERATIVE XENMATRIX BOTH IP/OP "$10,374.00" "$7,677.00" "$2,058.98" "$10,374.00" "$4,668.30" "$4,668.30" "$4,668.30" "$4,668.30" "$10,374.00" "$10,374.00" "$10,374.00" "$2,162.20" "$10,374.00" "$10,374.00" "$10,374.00" "$10,374.00" "$10,374.00" "$2,162.06" "$10,374.00" "$10,374.00" "$5,114.38" "$10,374.00" "$10,374.00" "$10,374.00" "$10,374.00" "$7,780.50" "$10,374.00" "$10,374.00" "$10,374.00" "$5,187.00" "$5,187.00" "$8,216.21" "$10,374.00" "$8,299.20" "$4,668.30" "$2,058.98" N/A "$6,016.92" "$10,374.00" "$10,374.00" "$10,374.00" "$2,161.94" "$10,374.00" N/A N/A 1161520 SUP HCPCS C1781 1161520 - GRAFT PIG THK1.8-2.5MM 7.9X5.9IN REGENERATIVE XENMATRIX BOTH IP/OP "$20,748.00" "$15,354.00" "$4,117.96" "$20,748.00" "$9,336.60" "$9,336.60" "$9,336.60" "$9,336.60" "$20,748.00" "$20,748.00" "$20,748.00" "$4,324.40" "$20,748.00" "$20,748.00" "$20,748.00" "$20,748.00" "$20,748.00" "$4,324.11" "$20,748.00" "$20,748.00" "$10,228.76" "$20,748.00" "$20,748.00" "$20,748.00" "$20,748.00" "$15,561.00" "$20,748.00" "$20,748.00" "$20,748.00" "$10,374.00" "$10,374.00" "$16,432.42" "$20,748.00" "$16,598.40" "$9,336.60" "$4,117.96" N/A "$12,033.84" "$20,748.00" "$20,748.00" "$20,748.00" "$4,323.88" "$20,748.00" N/A N/A 1161928 SUP HCPCS C1781 1161928 - GRAFT SURG 11X7.5IN REGENERATIVE XENMATRIX COLLAGEN MATRIX BOTH IP/OP "$35,480.00" "$26,255.00" "$7,041.81" "$35,479.60" "$15,965.82" "$15,965.82" "$15,965.82" "$15,965.82" "$35,479.60" "$35,479.60" "$35,479.60" "$7,394.84" "$35,479.60" "$35,479.60" "$35,479.60" "$35,479.60" "$35,479.60" "$7,394.34" "$35,479.60" "$35,479.60" "$17,491.44" "$35,479.60" "$35,479.60" "$35,479.60" "$35,479.60" "$26,610.00" "$35,479.60" "$35,479.60" "$35,479.60" "$17,739.80" "$17,739.80" "$28,099.84" "$35,479.60" "$28,383.68" "$15,965.82" "$7,041.81" N/A "$20,578.40" "$35,479.60" "$35,479.60" "$35,479.60" "$7,393.95" "$35,479.60" N/A N/A 1190602 SUP HCPCS C1781 1190602 - PLUG SURG LARGE 1.9X1.5IN MONOFILAMENT MESH PLEATED EDGE BOTH IP/OP "$1,572.50" "$1,164.00" $312.05 "$1,572.25" $707.51 $707.51 $707.51 $707.51 "$1,572.25" "$1,572.25" "$1,572.25" $327.70 "$1,572.25" "$1,572.25" "$1,572.25" "$1,572.25" "$1,572.25" $327.67 "$1,572.25" "$1,572.25" $929.99 "$1,572.25" "$1,572.25" "$1,572.25" "$1,572.25" "$1,179.38" "$1,572.25" "$1,572.25" "$1,572.25" $786.13 $786.13 "$1,245.22" "$1,572.25" "$1,257.80" $707.51 $312.05 N/A $912.05 "$1,572.25" "$1,572.25" "$1,572.25" $327.66 "$1,572.25" N/A N/A 1190603 SUP HCPCS C1781 1190603 - PLUG SURG XL 1.6X1.3IN MESH MULTILAYER PHASIX BOTH IP/OP "$1,586.00" "$1,174.00" $314.73 "$1,585.75" $713.59 $713.59 $713.59 $713.59 "$1,585.75" "$1,585.75" "$1,585.75" $330.51 "$1,585.75" "$1,585.75" "$1,585.75" "$1,585.75" "$1,585.75" $330.49 "$1,585.75" "$1,585.75" $937.97 "$1,585.75" "$1,585.75" "$1,585.75" "$1,585.75" "$1,189.50" "$1,585.75" "$1,585.75" "$1,585.75" $792.88 $792.88 "$1,255.91" "$1,585.75" "$1,268.60" $713.59 $314.73 N/A $919.88 "$1,585.75" "$1,585.75" "$1,585.75" $330.47 "$1,585.75" N/A N/A 1303346 SUP Custom 27203010 1303346 - SPONGE ABSORBABLE 50 HEMOSTATIC AGENT POWDER GELFOAM GELATIN BOTH IP/OP $422.00 $312.00 $75.11 $421.96 $421.96 $421.96 $421.96 $421.96 $421.96 $421.96 $75.11 $421.96 $421.96 $313.18 $313.18 $325.25 $219.84 $87.94 $421.96 $168.78 $421.96 $421.96 $421.96 $421.96 $421.96 $316.50 $421.96 $421.96 $421.96 $210.98 $210.98 $334.19 $421.96 $337.57 $274.27 $421.96 N/A $244.76 $421.96 $253.18 $421.96 $421.96 $421.96 N/A N/A Oct-10 SUP Custom 27203010 10-5510 - DRESSING GZE 36X36IN STRL LF 1-+ 17 PLY W MESH 1 LYR BOTH IP/OP $37.50 $28.00 $6.64 $37.32 $37.32 $37.32 $37.32 $37.32 $37.32 $37.32 $6.64 $37.32 $37.32 $27.70 $27.70 $28.77 $19.44 $7.78 $37.32 $14.93 $37.32 $37.32 $37.32 $37.32 $37.32 $28.13 $37.32 $37.32 $37.32 $18.66 $18.66 $29.56 $37.32 $29.86 $24.26 $37.32 N/A $21.75 $37.32 $22.39 $37.32 $37.32 $37.32 N/A N/A 6/11/5537 SUP HCPCS C1776 5537-6/11 - STEM HUMERAL 6 135MM PRESS FIT ANATOMIC TITANIUM NONSTRL BOTH IP/OP "$6,567.00" "$4,860.00" "$1,303.33" "$6,566.70" "$2,955.02" "$2,955.02" "$2,955.02" "$2,955.02" "$6,566.70" "$6,566.70" "$6,566.70" "$1,368.66" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$1,368.57" "$6,566.70" "$2,626.68" "$3,237.38" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$4,925.25" "$6,566.70" "$6,566.70" "$6,566.70" "$3,283.35" "$3,283.35" "$5,200.83" "$6,566.70" "$5,253.36" "$2,955.02" "$1,303.33" N/A "$3,808.86" "$6,566.70" "$6,566.70" "$6,566.70" "$1,368.50" "$6,566.70" N/A N/A 8/12/5537 SUP HCPCS C1776 5537-8/12 - STEM HUMERAL 8 120MM PRESS FIT ANATOMIC SELF CENTERING EPOCA BOTH IP/OP "$6,567.00" "$4,860.00" "$1,303.33" "$6,566.70" "$2,955.02" "$2,955.02" "$2,955.02" "$2,955.02" "$6,566.70" "$6,566.70" "$6,566.70" "$1,368.66" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$1,368.57" "$6,566.70" "$2,626.68" "$3,237.38" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$4,925.25" "$6,566.70" "$6,566.70" "$6,566.70" "$3,283.35" "$3,283.35" "$5,200.83" "$6,566.70" "$5,253.36" "$2,955.02" "$1,303.33" N/A "$3,808.86" "$6,566.70" "$6,566.70" "$6,566.70" "$1,368.50" "$6,566.70" N/A N/A 10/12/5537 SUP HCPCS C1776 5537-10/12 - STEM HUMERAL 10 125MM PRESS FIT ANATOMIC SELF CENTERING BOTH IP/OP "$6,567.00" "$4,860.00" "$1,303.33" "$6,566.70" "$2,955.02" "$2,955.02" "$2,955.02" "$2,955.02" "$6,566.70" "$6,566.70" "$6,566.70" "$1,368.66" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$1,368.57" "$6,566.70" "$6,566.70" "$3,237.38" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$4,925.25" "$6,566.70" "$6,566.70" "$6,566.70" "$3,283.35" "$3,283.35" "$5,200.83" "$6,566.70" "$5,253.36" "$2,955.02" "$1,303.33" N/A "$3,808.86" "$6,566.70" "$3,940.02" "$6,566.70" "$1,368.50" "$6,566.70" N/A N/A 12/13/5537 SUP HCPCS C1776 5537-12/13 - STEM HUMERAL 12MM 130MM PRESS FIT TITANIUM NONSTRL BOTH IP/OP "$6,567.00" "$4,860.00" "$1,303.33" "$6,566.70" "$2,955.02" "$2,955.02" "$2,955.02" "$2,955.02" "$6,566.70" "$6,566.70" "$6,566.70" "$1,368.66" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$1,368.57" "$6,566.70" "$6,566.70" "$3,237.38" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$4,925.25" "$6,566.70" "$6,566.70" "$6,566.70" "$3,283.35" "$3,283.35" "$5,200.83" "$6,566.70" "$5,253.36" "$2,955.02" "$1,303.33" N/A "$3,808.86" "$6,566.70" "$6,566.70" "$6,566.70" "$1,368.50" "$6,566.70" N/A N/A 6/11/5540 SUP HCPCS C1776 5540-6/11 - STEM HUMERAL 6MM 115MM PRESS FIT TITANIUM HA STERILE BOTH IP/OP "$6,943.00" "$5,138.00" "$1,378.01" "$6,943.00" "$3,124.35" "$3,124.35" "$3,124.35" "$3,124.35" "$6,943.00" "$6,943.00" "$6,943.00" "$1,447.09" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$1,447.00" "$6,943.00" "$2,777.20" "$3,422.90" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$5,207.25" "$6,943.00" "$6,943.00" "$6,943.00" "$3,471.50" "$3,471.50" "$5,498.86" "$6,943.00" "$5,554.40" "$3,124.35" "$1,378.01" N/A "$4,026.94" "$6,943.00" "$4,165.80" "$6,943.00" "$1,446.92" "$6,943.00" N/A N/A 8/12/5540 SUP HCPCS C1776 5540-8/12 - STEM HUMERAL 8MM 120MM PRESS FIT EPOCA TITANIUM HA SHOULDER BOTH IP/OP "$6,943.00" "$5,138.00" "$1,378.01" "$6,943.00" "$3,124.35" "$3,124.35" "$3,124.35" "$3,124.35" "$6,943.00" "$6,943.00" "$6,943.00" "$1,447.09" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$1,447.00" "$6,943.00" "$2,777.20" "$3,422.90" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$5,207.25" "$6,943.00" "$6,943.00" "$6,943.00" "$3,471.50" "$3,471.50" "$5,498.86" "$6,943.00" "$5,554.40" "$3,124.35" "$1,378.01" N/A "$4,026.94" "$6,943.00" "$6,943.00" "$6,943.00" "$1,446.92" "$6,943.00" N/A N/A 10/12/5540 SUP HCPCS C1776 5540-10/12 - STEM HUMERAL 10 125MM PRESS FIT IMPLANT TITANIUM HA SHOULDER BOTH IP/OP "$6,943.00" "$5,138.00" "$1,378.01" "$6,943.00" "$3,124.35" "$3,124.35" "$3,124.35" "$3,124.35" "$6,943.00" "$6,943.00" "$6,943.00" "$1,447.09" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$1,447.00" "$6,943.00" "$2,777.20" "$3,422.90" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$5,207.25" "$6,943.00" "$6,943.00" "$6,943.00" "$3,471.50" "$3,471.50" "$5,498.86" "$6,943.00" "$5,554.40" "$3,124.35" "$1,378.01" N/A "$4,026.94" "$6,943.00" "$6,943.00" "$6,943.00" "$1,446.92" "$6,943.00" N/A N/A 12/13/5540 SUP HCPCS C1776 5540-12/13 - STEM HUMERAL 12MM 130MM PRESS FIT TITANIUM HA STERILE BOTH IP/OP "$6,943.00" "$5,138.00" "$1,378.01" "$6,943.00" "$3,124.35" "$3,124.35" "$3,124.35" "$3,124.35" "$6,943.00" "$6,943.00" "$6,943.00" "$1,447.09" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$1,447.00" "$6,943.00" "$6,943.00" "$3,422.90" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$5,207.25" "$6,943.00" "$6,943.00" "$6,943.00" "$3,471.50" "$3,471.50" "$5,498.86" "$6,943.00" "$5,554.40" "$3,124.35" "$1,378.01" N/A "$4,026.94" "$6,943.00" "$4,165.80" "$6,943.00" "$1,446.92" "$6,943.00" N/A N/A 6/11/5624 SUP HCPCS C1776 5624-6/11 - STEM HUMERAL 8MM 115MM CEMENT EPOCA COCR SHOULDER STERILE BOTH IP/OP "$5,769.50" "$4,269.00" "$1,145.01" "$5,769.05" "$2,596.07" "$2,596.07" "$2,596.07" "$2,596.07" "$5,769.05" "$5,769.05" "$5,769.05" "$1,202.41" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$1,202.33" "$5,769.05" "$2,307.62" "$2,844.14" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$4,327.13" "$5,769.05" "$5,769.05" "$5,769.05" "$2,884.53" "$2,884.53" "$4,569.09" "$5,769.05" "$4,615.24" "$2,596.07" "$1,145.01" N/A "$3,346.31" "$5,769.05" "$3,461.43" "$5,769.05" "$1,202.27" "$5,769.05" N/A N/A 8/12/5624 SUP HCPCS C1776 5624-8/12 - STEM HUMERAL 8MM 120MM CEMENTED ANATOMIC SELF CENTERING BOTH IP/OP "$5,769.50" "$4,269.00" "$1,145.01" "$5,769.05" "$2,596.07" "$2,596.07" "$2,596.07" "$2,596.07" "$5,769.05" "$5,769.05" "$5,769.05" "$1,202.41" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$1,202.33" "$5,769.05" "$2,307.62" "$2,844.14" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$4,327.13" "$5,769.05" "$5,769.05" "$5,769.05" "$2,884.53" "$2,884.53" "$4,569.09" "$5,769.05" "$4,615.24" "$2,596.07" "$1,145.01" N/A "$3,346.31" "$5,769.05" "$5,769.05" "$5,769.05" "$1,202.27" "$5,769.05" N/A N/A 10/12/5624 SUP HCPCS C1776 5624-10/12 - STEM HUMERAL 10 125MM CEMENTED ANATOMIC COCR STERILE BOTH IP/OP "$5,769.50" "$4,269.00" "$1,145.01" "$5,769.05" "$2,596.07" "$2,596.07" "$2,596.07" "$2,596.07" "$5,769.05" "$5,769.05" "$5,769.05" "$1,202.41" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$1,202.33" "$5,769.05" "$2,307.62" "$2,844.14" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$4,327.13" "$5,769.05" "$5,769.05" "$5,769.05" "$2,884.53" "$2,884.53" "$4,569.09" "$5,769.05" "$4,615.24" "$2,596.07" "$1,145.01" N/A "$3,346.31" "$5,769.05" "$5,769.05" "$5,769.05" "$1,202.27" "$5,769.05" N/A N/A 12/13/5624 SUP HCPCS C1776 5624-12/13 - STEM HUMERAL 12 130MM CEMENTED ANATOMIC COCR STERILE BOTH IP/OP "$5,769.50" "$4,269.00" "$1,145.01" "$5,769.05" "$2,596.07" "$2,596.07" "$2,596.07" "$2,596.07" "$5,769.05" "$5,769.05" "$5,769.05" "$1,202.41" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$1,202.33" "$5,769.05" "$2,307.62" "$2,844.14" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$4,327.13" "$5,769.05" "$5,769.05" "$5,769.05" "$2,884.53" "$2,884.53" "$4,569.09" "$5,769.05" "$4,615.24" "$2,596.07" "$1,145.01" N/A "$3,346.31" "$5,769.05" "$5,769.05" "$5,769.05" "$1,202.27" "$5,769.05" N/A N/A 1372301 SUP Custom 27203010 1372301 - SET ADM 110IN 0.2 MH NVNT ADON BOTH IP/OP $38.50 $28.00 $6.83 $38.38 $38.38 $38.38 $38.38 $38.38 $38.38 $38.38 $6.83 $38.38 $38.38 $28.49 $28.49 $29.58 $20.00 $8.00 $38.38 $15.35 $38.38 $38.38 $38.38 $38.38 $38.38 $28.88 $38.38 $38.38 $38.38 $19.19 $19.19 $30.40 $38.38 $30.70 $24.95 $38.38 N/A $22.33 $38.38 $23.03 $38.38 $38.38 $38.38 N/A N/A 1500181 SUP Custom 27203010 1500181 - APPLICATOR ENDSCP 5MM 35CM NONREFLECTIVE CANNU TROCAR BOTH IP/OP $148.00 $110.00 $26.30 $147.78 $147.78 $147.78 $147.78 $147.78 $147.78 $147.78 $26.30 $147.78 $147.78 $109.68 $109.68 $113.91 $76.99 $30.80 $147.78 $59.11 $147.78 $147.78 $147.78 $147.78 $147.78 $111.00 $147.78 $147.78 $147.78 $73.89 $73.89 $117.04 $147.78 $118.22 $96.06 $147.78 N/A $85.84 $147.78 $88.67 $147.78 $147.78 $147.78 N/A N/A 1501262 SUP HCPCS C9250 1501262 - KIT TISSUE CLOSURE 1 PREFILL SYRINGE PLUNGER 2 PULL STRAP BOTH IP/OP $386.00 $286.00 $76.53 $385.60 $173.52 $173.52 $173.52 $173.52 $156.84 $156.84 $156.84 $80.37 $156.84 $385.60 $385.60 $385.60 $385.60 $80.36 $156.84 $180.54 $228.08 $156.84 $385.60 $156.84 $164.68 $289.50 $156.84 $156.84 $156.84 $192.80 $192.80 $305.40 $156.84 $308.48 $173.52 $76.53 N/A $223.88 $164.68 $227.42 $156.84 $80.36 $156.84 N/A N/A 1501263 SUP HCPCS C9250 1501263 - KIT TISSUE CLOSURE 1 PREFILL SYRINGE PLUNGER 2 PULL STRAP BOTH IP/OP $946.50 $700.00 $156.84 $946.28 $425.83 $425.83 $425.83 $425.83 $156.84 $156.84 $156.84 $197.23 $156.84 $946.28 $946.28 $946.28 $946.28 $197.22 $156.84 $180.54 $559.72 $156.84 $946.28 $156.84 $164.68 $709.88 $156.84 $156.84 $156.84 $473.14 $473.14 $749.45 $156.84 $757.02 $425.83 $187.81 N/A $548.97 $164.68 $227.42 $156.84 $197.20 $156.84 N/A N/A 1518128 SUP HCPCS Q4116 1518128 - MATRIX TISS THK.4-1.6MM 128SQ CM MED RECT 16X8CM ALDRM SLCT BOTH IP/OP "$13,550.00" "$10,027.00" "$2,689.34" "$13,550.00" "$6,097.50" "$6,097.50" "$6,097.50" "$6,097.50" "$13,550.00" "$13,550.00" "$13,550.00" "$2,824.16" "$13,550.00" "$13,550.00" "$13,550.00" "$13,550.00" "$13,550.00" "$2,823.97" "$13,550.00" "$8,732.50" "$6,680.15" "$13,550.00" "$8,732.50" "$13,550.00" "$13,550.00" "$10,162.50" "$13,550.00" "$13,550.00" "$13,550.00" "$6,775.00" "$6,775.00" "$10,731.60" "$13,550.00" "$10,840.00" "$6,097.50" "$2,689.34" N/A "$7,859.00" "$13,550.00" "$13,550.00" "$13,550.00" "$2,823.82" "$13,550.00" N/A N/A 1518320 SUP HCPCS Q4116 1518320 - MATRIX TISS THK.4-1.6MM 320SQ CM MED RECT 20X16CM ALDRM SLCT BOTH IP/OP "$33,875.00" "$25,068.00" "$6,723.34" "$33,875.00" "$15,243.75" "$15,243.75" "$15,243.75" "$15,243.75" "$33,875.00" "$33,875.00" "$33,875.00" "$7,060.40" "$33,875.00" "$33,875.00" "$33,875.00" "$33,875.00" "$33,875.00" "$7,059.92" "$33,875.00" "$21,832.50" "$16,700.38" "$33,875.00" "$21,832.50" "$33,875.00" "$33,875.00" "$25,406.25" "$33,875.00" "$33,875.00" "$33,875.00" "$16,937.50" "$16,937.50" "$26,829.00" "$33,875.00" "$27,100.00" "$15,243.75" "$6,723.34" N/A "$19,647.50" "$33,875.00" "$33,875.00" "$33,875.00" "$7,059.55" "$33,875.00" N/A N/A 1520128 SUP HCPCS Q4116 1520128 - MATRIX TISS THK1.2-2.8MM THK 16X8CM ALDRM SLCT ALGRF RGNRT BOTH IP/OP "$13,550.00" "$10,027.00" "$2,689.34" "$13,550.00" "$6,097.50" "$6,097.50" "$6,097.50" "$6,097.50" "$13,550.00" "$13,550.00" "$13,550.00" "$2,824.16" "$13,550.00" "$13,550.00" "$13,550.00" "$13,550.00" "$13,550.00" "$2,823.97" "$13,550.00" "$8,732.50" "$6,680.15" "$13,550.00" "$8,732.50" "$13,550.00" "$13,550.00" "$10,162.50" "$13,550.00" "$13,550.00" "$13,550.00" "$6,775.00" "$6,775.00" "$10,731.60" "$13,550.00" "$10,840.00" "$6,097.50" "$2,689.34" N/A "$7,859.00" "$13,550.00" "$13,550.00" "$13,550.00" "$2,823.82" "$13,550.00" N/A N/A 1520616 SUP HCPCS Q4116 1520616 - MATRIX TISS THK.4-1.6MM MED 16X6CM ALDRM SLCT ALGRF RGNRT BOTH IP/OP "$7,497.50" "$5,548.00" "$1,488.07" "$7,497.50" "$3,373.88" "$3,373.88" "$3,373.88" "$3,373.88" "$7,497.50" "$7,497.50" "$7,497.50" "$1,562.67" "$7,497.50" "$7,497.50" "$7,497.50" "$7,497.50" "$7,497.50" "$1,562.56" "$7,497.50" "$6,550.00" "$3,696.27" "$7,497.50" "$6,550.00" "$7,497.50" "$7,497.50" "$5,623.13" "$7,497.50" "$7,497.50" "$7,497.50" "$3,748.75" "$3,748.75" "$5,938.02" "$7,497.50" "$5,998.00" "$3,373.88" "$1,488.07" N/A "$4,348.55" "$7,497.50" "$7,497.50" "$7,497.50" "$1,562.48" "$7,497.50" N/A N/A 1523901 SUP Custom 27203010 1523901 - SET IRRIGATION .28IN 85IN 4 LEAD 3Y CONCTR SIGHT CHAMBER BOTH IP/OP $386.00 $286.00 $68.66 $385.75 $385.75 $385.75 $385.75 $385.75 $385.75 $385.75 $68.66 $385.75 $385.75 $286.30 $286.30 $297.34 $200.98 $80.39 $385.75 $154.30 $385.75 $385.75 $385.75 $385.75 $385.75 $289.50 $385.75 $385.75 $385.75 $192.88 $192.88 $305.51 $385.75 $308.60 $250.74 $385.75 N/A $223.88 $385.75 $231.45 $385.75 $385.75 $385.75 N/A N/A 1524055 SUP Custom 27203010 1524055 - SPLINT NSL WHT STRL LF DYLE II CMPR ANT TIP INTGR ARWY SIL BOTH IP/OP $122.50 $91.00 $21.81 $122.50 $122.50 $122.50 $122.50 $122.50 $122.50 $122.50 $21.81 $122.50 $122.50 $90.92 $90.92 $94.42 $63.82 $25.53 $122.50 $49.00 $122.50 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $79.63 $122.50 N/A $71.05 $122.50 $73.50 $122.50 $122.50 $122.50 N/A N/A 1525002 SUP HCPCS Q4130 1525002 - MATRIX TISSUE 25X15CM RECONSTRUCTIVE STRATTICE PIG DERMIS BOTH IP/OP "$33,367.50" "$24,692.00" "$6,954.15" "$33,367.50" "$33,367.50" "$33,367.50" "$33,367.50" "$33,367.50" "$33,367.50" "$33,367.50" "$33,367.50" "$33,367.50" "$33,367.50" "$33,367.50" "$33,367.50" "$33,367.50" "$33,367.50" "$6,954.15" "$33,367.50" "$8,832.00" "$33,367.50" "$33,367.50" "$22,080.00" "$33,367.50" "$33,367.50" "$25,025.63" "$33,367.50" "$33,367.50" "$33,367.50" "$16,683.75" "$16,683.75" "$26,427.06" "$33,367.50" "$26,694.00" "$15,015.38" "$33,367.50" N/A "$19,353.15" "$33,367.50" "$20,020.50" "$33,367.50" "$33,367.50" "$33,367.50" N/A N/A 1527005 SUP Custom 27803010 1527005 - SPLINT NSL THK.5MM STD REUT PREPUNCH HL FLRPLAS SPT BOTH IP/OP $74.50 $55.00 $13.26 $74.50 $74.50 $74.50 $74.50 $74.50 $74.50 $74.50 $13.26 $74.50 $74.50 $74.50 $74.50 $74.50 $74.50 $15.53 $74.50 $29.80 $74.50 $74.50 $74.50 $74.50 $74.50 $55.88 $74.50 $74.50 $74.50 $37.25 $37.25 $59.00 $74.50 $59.60 $33.53 $74.50 N/A $43.21 $74.50 $44.70 $74.50 $74.50 $74.50 N/A N/A 1527010 SUP HCPCS C1713 1527010 - SPLINT NASAL .25MM THIN PREPUNCHED HOLE LATEX FREE REUTER BOTH IP/OP $100.00 $74.00 $19.85 $100.00 $45.00 $45.00 $45.00 $45.00 $100.00 $100.00 $100.00 $20.84 $100.00 $100.00 $100.00 $100.00 $100.00 $20.84 $100.00 $40.00 $59.15 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $45.00 $19.85 N/A $58.00 $100.00 $60.00 $100.00 $20.84 $100.00 N/A N/A 1527020 SUP Custom 27803010 1527020 - SPLINT NASAL THK.5MM OVERSIZE PREPUNCHED HOLE SLIT REUTER BOTH IP/OP $100.00 $74.00 $17.80 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $17.80 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $20.84 $100.00 $40.00 $100.00 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $45.00 $100.00 N/A $58.00 $100.00 $60.00 $100.00 $100.00 $100.00 N/A N/A 1528120 SUP Custom 27203010 1528120 - SPLINT NASAL MEDIUM REGULAR 2.38X1.53IN EXTERNAL RUBBER FOAM BOTH IP/OP "$2,912.50" "$2,155.00" $518.43 "$2,912.50" "$2,912.50" "$2,912.50" "$2,912.50" "$2,912.50" "$2,912.50" "$2,912.50" $518.43 "$2,912.50" "$2,912.50" "$2,161.66" "$2,161.66" "$2,244.96" "$1,517.41" $607.00 "$2,912.50" "$1,165.00" "$2,912.50" "$2,912.50" "$2,912.50" "$2,912.50" "$2,912.50" "$2,184.38" "$2,912.50" "$2,912.50" "$2,912.50" "$1,456.25" "$1,456.25" "$2,306.70" "$2,912.50" "$2,330.00" "$1,893.13" "$2,912.50" N/A "$1,689.25" "$2,912.50" "$1,747.50" "$2,912.50" "$2,912.50" "$2,912.50" N/A N/A 1528126 SUP Custom 27203010 1528126 - SPLINT NSL MED 2.38X1.53IN WHT STRL LF XTRN KT FM RBR SPT BOTH IP/OP $93.50 $69.00 $16.64 $93.50 $93.50 $93.50 $93.50 $93.50 $93.50 $93.50 $16.64 $93.50 $93.50 $69.40 $69.40 $72.07 $48.71 $19.49 $93.50 $37.40 $93.50 $93.50 $93.50 $93.50 $93.50 $70.13 $93.50 $93.50 $93.50 $46.75 $46.75 $74.05 $93.50 $74.80 $60.78 $93.50 N/A $54.23 $93.50 $56.10 $93.50 $93.50 $93.50 N/A N/A 1528136 SUP Custom 27203010 1528136 - SPLINT NSL LG KT XTRN LTWT STRNG WTR RS ADH FM AL SPT BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 1528137 SUP Custom 27203010 1528137 - SPLINT NASAL LARGE 2.63INX1.73IN ADHERENT EXTERNAL STRONG BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,135.68" "$2,135.68" "$2,217.98" "$1,499.18" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,870.38" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1529010 SUP Custom 27803010 1529010 - SPLINT NSL MED 2.38X1.53IN WHT STRL LF THRMSPLNT KT XTRN BOTH IP/OP $8.00 $6.00 $1.39 $7.80 $7.80 $7.80 $7.80 $7.80 $7.80 $7.80 $1.39 $7.80 $7.80 $7.80 $7.80 $7.80 $7.80 $1.63 $7.80 $3.12 $7.80 $7.80 $7.80 $7.80 $7.80 $6.00 $7.80 $7.80 $7.80 $3.90 $3.90 $6.18 $7.80 $6.24 $3.51 $7.80 N/A $4.64 $7.80 $4.68 $7.80 $7.80 $7.80 N/A N/A 1529020 SUP Custom 27203010 1529020 - SPLINT NSL LG 2.63INX1.73IN WHT STRL LF THRMSPLNT KT XTRN BOTH IP/OP $57.00 $42.00 $10.10 $56.75 $56.75 $56.75 $56.75 $56.75 $56.75 $56.75 $10.10 $56.75 $56.75 $42.12 $42.12 $43.74 $29.57 $11.83 $56.75 $22.70 $56.75 $56.75 $56.75 $56.75 $56.75 $42.75 $56.75 $56.75 $56.75 $28.38 $28.38 $44.95 $56.75 $45.40 $36.89 $56.75 N/A $33.06 $56.75 $34.05 $56.75 $56.75 $56.75 N/A N/A 1608695 SUP Custom 27203010 1608695 - BURR SURG ROUND .157MM 2.13IN DIAMOND MEDIUM GRIT BOTH IP/OP $210.00 $155.00 $37.38 $210.00 $210.00 $210.00 $210.00 $210.00 $210.00 $210.00 $37.38 $210.00 $210.00 $155.86 $155.86 $161.87 $109.41 $43.77 $210.00 $84.00 $210.00 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $136.50 $210.00 N/A $121.80 $210.00 $126.00 $210.00 $210.00 $210.00 N/A N/A 1620002 SUP HCPCS Q4130 1620002 - MATRIX TISSUE 20X16CM RECONSTRUCTIVE STRATTICE PIG DERMIS BOTH IP/OP $89.00 $66.00 $18.54 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $88.98 $18.54 $88.98 $23.55 $88.98 $88.98 $58.88 $88.98 $88.98 $66.75 $88.98 $88.98 $88.98 $44.49 $44.49 $70.47 $88.98 $71.18 $40.04 $88.98 N/A $51.62 $88.98 $53.39 $88.98 $88.98 $88.98 N/A N/A 1664017 SUP HCPCS C1713 1664017 - SET SCREW 1664017 4.75 SOL PERC MULTI S BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 1677545 SUP HCPCS C1713 1677545 - SCREW BN 7.5MM 45MM NS PRCPT PA CR SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 1677550 SUP HCPCS C1713 1677550 - SCREW BN 7.5MM 50MM NS PRCPT PA CR SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 1801303 SUP HCPCS C1713 1801303 - ENDPLATE SPNL 3D MED NS INFIX TI THORLMBR ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 1801306 SUP HCPCS C1713 1801306 - ENDPLATE SPNL 6D MED NS INFIX TI THORLMBR ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 1803205 SUP HCPCS C1776 1803205 - DOME PTLR RND 38MM RSRFC KN MCK SYS BOTH IP/OP "$2,192.50" "$1,622.00" $435.16 "$2,192.50" $986.63 $986.63 $986.63 $986.63 "$2,192.50" "$2,192.50" "$2,192.50" $456.97 "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" $456.94 "$2,192.50" "$2,192.50" "$1,296.86" "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" "$1,644.38" "$2,192.50" "$2,192.50" "$2,192.50" "$1,096.25" "$1,096.25" "$1,736.46" "$2,192.50" "$1,754.00" $986.63 $435.16 N/A "$1,271.65" "$2,192.50" "$2,192.50" "$2,192.50" $456.92 "$2,192.50" N/A N/A 1804308 SUP HCPCS C1713 1804308 - STRUT SPNL MED 8MM BLU NS INFIX TI THORLMBR ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 1807052 SUP HCPCS C1776 1807052 - INSERT TIB 5 9MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 1807081 SUP HCPCS C1776 1807081 - INSERT TIB 8 8MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 1850300 SUP HCPCS C1894 1850300 - SHEATH ENDSCP CLEAN 25D 4MM 170MM LENS SYSTEM LATEX FREE BOTH IP/OP $502.50 $372.00 $99.73 $502.50 $272.86 $272.86 $272.86 $272.86 $502.50 $502.50 $502.50 $104.73 $502.50 $372.96 $372.96 $387.33 $261.80 $104.73 $502.50 $502.50 $297.23 $502.50 $502.50 $502.50 $502.50 $376.88 $502.50 $502.50 $502.50 $251.25 $251.25 $397.98 $502.50 $402.00 $326.63 $99.73 N/A $291.45 $502.50 $502.50 $502.50 $104.72 $502.50 N/A N/A Jan-33 SUP HCPCS C1713 01-7033 - PLATE BONE 100D MEDIUM 3X3 HOLE L TITANIUM RIGHT MIDFAC 1.5 BOTH IP/OP $467.50 $346.00 $92.79 $467.50 $210.38 $210.38 $210.38 $210.38 $467.50 $467.50 $467.50 $97.44 $467.50 $467.50 $467.50 $467.50 $467.50 $97.43 $467.50 $187.00 $276.53 $467.50 $467.50 $467.50 $467.50 $350.63 $467.50 $467.50 $467.50 $233.75 $233.75 $370.26 $467.50 $374.00 $210.38 $92.79 N/A $271.15 $467.50 $467.50 $467.50 $467.50 $467.50 N/A N/A Jan-38 SUP HCPCS C1713 01-7038 - PLATE BONE 1.5MM REGULAR L SILVER LEFT MIDFAC BOTH IP/OP $910.00 $673.00 $180.61 $910.00 $409.50 $409.50 $409.50 $409.50 $910.00 $910.00 $910.00 $189.67 $910.00 $910.00 $910.00 $910.00 $910.00 $189.65 $910.00 $364.00 $538.27 $910.00 $910.00 $910.00 $910.00 $682.50 $910.00 $910.00 $910.00 $455.00 $455.00 $720.72 $910.00 $728.00 $409.50 $180.61 N/A $527.80 $910.00 $910.00 $910.00 $189.64 $910.00 N/A N/A Jan-40 SUP HCPCS C1713 01-7040 - PLATE BONE REGULAR STR 16MMX.6MM 4 HOLE TRAUMAONE LORENZ BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $132.75 $132.75 $132.75 $132.75 $295.00 $295.00 $295.00 $61.49 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $118.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $58.55 N/A $171.10 $295.00 $295.00 $295.00 $295.00 $295.00 N/A N/A Jan-45 SUP HCPCS C1713 01-7045 - PLATE BONE MEDIUM STR 17MMX.6MM 4 HOLE SILVER TITANIUM BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $132.75 $132.75 $132.75 $132.75 $295.00 $295.00 $295.00 $61.49 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $295.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $58.55 N/A $171.10 $295.00 $177.00 $295.00 $61.48 $295.00 N/A N/A Jan-47 SUP HCPCS C1713 01-7047 - PLATE BONE LONG STR 4 HOLE GRADE II TRAUMAONE LORENZ SILVER BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $132.75 $132.75 $132.75 $132.75 $295.00 $295.00 $295.00 $61.49 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $118.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $58.55 N/A $171.10 $295.00 $295.00 $295.00 $61.48 $295.00 N/A N/A Jan-50 SUP HCPCS C1713 01-7050 - PLATE BONE REGULAR STR 6 HOLE TRAUMAONE LORENZ SILVER BOTH IP/OP $447.50 $331.00 $88.82 $447.50 $201.38 $201.38 $201.38 $201.38 $447.50 $447.50 $447.50 $93.27 $447.50 $447.50 $447.50 $447.50 $447.50 $93.26 $447.50 $179.00 $264.70 $447.50 $447.50 $447.50 $447.50 $335.63 $447.50 $447.50 $447.50 $223.75 $223.75 $354.42 $447.50 $358.00 $201.38 $88.82 N/A $259.55 $447.50 $447.50 $447.50 $447.50 $447.50 N/A N/A Jan-65 SUP HCPCS C1713 01-7065 - PLATE BONE MESH SIDE PROFILE PRECONTOUR 163X115X.3MM ULTRA BOTH IP/OP "$10,742.50" "$7,949.00" "$2,132.12" "$10,742.50" "$4,834.13" "$4,834.13" "$4,834.13" "$4,834.13" "$10,742.50" "$10,742.50" "$10,742.50" "$2,239.01" "$10,742.50" "$10,742.50" "$10,742.50" "$10,742.50" "$10,742.50" "$2,238.86" "$10,742.50" "$4,297.00" "$5,296.05" "$10,742.50" "$10,742.50" "$10,742.50" "$10,742.50" "$8,056.88" "$10,742.50" "$10,742.50" "$10,742.50" "$5,371.25" "$5,371.25" "$8,508.06" "$10,742.50" "$8,594.00" "$4,834.13" "$2,132.12" N/A "$6,230.65" "$10,742.50" "$6,445.50" "$10,742.50" "$2,238.74" "$10,742.50" N/A N/A Jan-66 SUP HCPCS C1713 01-7066 - PLATE BONE 16 HOLE STR LORENZ TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" $423.00 $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" N/A N/A Jan-92 SUP HCPCS C1713 01-7092 - PLATE BONE MED 2T CRNMXF TI 1.5MM SCR BOTH IP/OP $710.00 $525.00 $140.92 $710.00 $319.50 $319.50 $319.50 $319.50 $710.00 $710.00 $710.00 $147.98 $710.00 $710.00 $710.00 $710.00 $710.00 $147.97 $710.00 $284.00 $419.97 $710.00 $710.00 $710.00 $710.00 $532.50 $710.00 $710.00 $710.00 $355.00 $355.00 $562.32 $710.00 $568.00 $319.50 $140.92 N/A $411.80 $710.00 $426.00 $710.00 $147.96 $710.00 N/A N/A Jan-02 SUP HCPCS C1713 01-7102 - PLATE BONE LONG REGULAR Y 5 HOLE TRAUMAONE LORENZ SILVER BOTH IP/OP $840.00 $622.00 $166.72 $840.00 $378.00 $378.00 $378.00 $378.00 $840.00 $840.00 $840.00 $175.08 $840.00 $840.00 $840.00 $840.00 $840.00 $175.07 $840.00 $336.00 $496.86 $840.00 $840.00 $840.00 $840.00 $630.00 $840.00 $840.00 $840.00 $420.00 $420.00 $665.28 $840.00 $672.00 $378.00 $166.72 N/A $487.20 $840.00 $504.00 $840.00 $175.06 $840.00 N/A N/A Jan-04 SUP HCPCS C1713 01-7104 - PLATE BONE XL Y 19MMX.6MM 5 HOLE LORENZ SILVER TITANIUM BOTH IP/OP $710.00 $525.00 $140.92 $710.00 $319.50 $319.50 $319.50 $319.50 $710.00 $710.00 $710.00 $147.98 $710.00 $710.00 $710.00 $710.00 $710.00 $147.97 $710.00 $710.00 $419.97 $710.00 $710.00 $710.00 $710.00 $532.50 $710.00 $710.00 $710.00 $355.00 $355.00 $562.32 $710.00 $568.00 $319.50 $140.92 N/A $411.80 $710.00 $426.00 $710.00 $147.96 $710.00 N/A N/A Jan-06 SUP HCPCS C1713 01-7106 - PLATE BONE SMALL PREFORM TITANIUM ORBTL FLOOR BOTH IP/OP "$3,112.50" "$2,303.00" $617.75 "$3,112.50" "$1,400.63" "$1,400.63" "$1,400.63" "$1,400.63" "$3,112.50" "$3,112.50" "$3,112.50" $648.72 "$3,112.50" "$3,112.50" "$3,112.50" "$3,112.50" "$3,112.50" $648.68 "$3,112.50" "$1,245.00" "$1,534.46" "$3,112.50" "$3,112.50" "$3,112.50" "$3,112.50" "$2,334.38" "$3,112.50" "$3,112.50" "$3,112.50" "$1,556.25" "$1,556.25" "$2,465.10" "$3,112.50" "$2,490.00" "$1,400.63" $617.75 N/A "$1,805.25" "$3,112.50" "$1,867.50" "$3,112.50" $648.65 "$3,112.50" N/A N/A Jan-07 SUP HCPCS C1713 01-7107 - PLATE BONE MEDIUM .3MM PREFORM TRAUMAONE LORENZ GOLD BOTH IP/OP "$3,112.50" "$2,303.00" $617.75 "$3,112.50" "$1,400.63" "$1,400.63" "$1,400.63" "$1,400.63" "$3,112.50" "$3,112.50" "$3,112.50" $648.72 "$3,112.50" "$3,112.50" "$3,112.50" "$3,112.50" "$3,112.50" $648.68 "$3,112.50" "$3,112.50" "$1,534.46" "$3,112.50" "$3,112.50" "$3,112.50" "$3,112.50" "$2,334.38" "$3,112.50" "$3,112.50" "$3,112.50" "$1,556.25" "$1,556.25" "$2,465.10" "$3,112.50" "$2,490.00" "$1,400.63" $617.75 N/A "$1,805.25" "$3,112.50" "$1,867.50" "$3,112.50" $648.65 "$3,112.50" N/A N/A 1901819 SUP HCPCS C1713 1901819 - PLATE BONE MED ORBTL FLR TI MESH BOTH IP/OP "$2,500,000.00" "$1,850,000.00" $617.75 "$1,875,000.00" "$1,400.63" "$1,400.63" "$1,400.63" "$1,400.63" "$3,112.50" "$3,112.50" "$3,112.50" $648.72 "$3,112.50" "$3,112.50" "$3,112.50" "$3,112.50" "$3,112.50" $648.68 "$3,112.50" "$3,112.50" "$1,534.46" "$3,112.50" "$3,112.50" "$3,112.50" "$3,112.50" "$1,875,000.00" "$3,112.50" "$3,112.50" "$3,112.50" "$1,556.25" "$1,556.25" "$2,465.10" "$3,112.50" "$2,490.00" "$1,400.63" $617.75 N/A "$1,450,000.00" "$3,112.50" "$1,867.50" "$3,112.50" $648.65 "$3,112.50" N/A N/A Jan-08 SUP HCPCS C1713 01-7108 - PLATE BONE LARGE .3MM PREFORM TITANIUM ORBTL FLOOR STERILE BOTH IP/OP "$3,242.50" "$2,399.00" $643.56 "$3,242.50" "$1,459.13" "$1,459.13" "$1,459.13" "$1,459.13" "$3,242.50" "$3,242.50" "$3,242.50" $675.82 "$3,242.50" "$3,242.50" "$3,242.50" "$3,242.50" "$3,242.50" $675.77 "$3,242.50" "$1,297.00" "$1,598.55" "$3,242.50" "$3,242.50" "$3,242.50" "$3,242.50" "$2,431.88" "$3,242.50" "$3,242.50" "$3,242.50" "$1,621.25" "$1,621.25" "$2,568.06" "$3,242.50" "$2,594.00" "$1,459.13" $643.56 N/A "$1,880.65" "$3,242.50" "$3,242.50" "$3,242.50" "$3,242.50" "$3,242.50" N/A N/A Jan-09 SUP HCPCS C1713 01-7109 - PLATE BONE .3MM GRADE IV PREFORME TRAUMAONE LORENZ GOLD BOTH IP/OP "$2,835.00" "$2,098.00" $562.68 "$2,835.00" "$1,275.75" "$1,275.75" "$1,275.75" "$1,275.75" "$2,835.00" "$2,835.00" "$2,835.00" $590.88 "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" $590.85 "$2,835.00" "$1,134.00" "$1,397.66" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,126.25" "$2,835.00" "$2,835.00" "$2,835.00" "$1,417.50" "$1,417.50" "$2,245.32" "$2,835.00" "$2,268.00" "$1,275.75" $562.68 N/A "$1,644.30" "$2,835.00" "$1,701.00" "$2,835.00" "$2,835.00" "$2,835.00" N/A N/A Jan-10 SUP HCPCS C1713 01-7110 - PLATE BN REG 2Y 6 HL TI MDFC 1.5MM SCR BOTH IP/OP $760.00 $562.00 $150.84 $760.00 $342.00 $342.00 $342.00 $342.00 $760.00 $760.00 $760.00 $158.40 $760.00 $760.00 $760.00 $760.00 $760.00 $158.39 $760.00 $304.00 $449.54 $760.00 $760.00 $760.00 $760.00 $570.00 $760.00 $760.00 $760.00 $380.00 $380.00 $601.92 $760.00 $608.00 $342.00 $150.84 N/A $440.80 $760.00 $456.00 $760.00 $158.38 $760.00 N/A N/A Jan-12 SUP HCPCS C1713 01-7112 - PLATE BONE LONG 6 HOLE 2Y TITANIUM MIDFAC 1.5MM SCREWS BOTH IP/OP $850.00 $629.00 $168.70 $850.00 $382.50 $382.50 $382.50 $382.50 $850.00 $850.00 $850.00 $177.16 $850.00 $850.00 $850.00 $850.00 $850.00 $177.15 $850.00 $340.00 $502.78 $850.00 $850.00 $850.00 $850.00 $637.50 $850.00 $850.00 $850.00 $425.00 $425.00 $673.20 $850.00 $680.00 $382.50 $168.70 N/A $493.00 $850.00 $510.00 $850.00 $177.14 $850.00 N/A N/A Jan-14 SUP HCPCS C1713 01-7114 - PLATE BONE XLONG 2Y TITANIUM CRANIOMAXILLOFACIAL 1.5MM SCREW BOTH IP/OP $745.00 $551.00 $147.86 $745.00 $335.25 $335.25 $335.25 $335.25 $745.00 $745.00 $745.00 $155.28 $745.00 $745.00 $745.00 $745.00 $745.00 $155.27 $745.00 $298.00 $440.67 $745.00 $745.00 $745.00 $745.00 $558.75 $745.00 $745.00 $745.00 $372.50 $372.50 $590.04 $745.00 $596.00 $335.25 $147.86 N/A $432.10 $745.00 $447.00 $745.00 $155.26 $745.00 N/A N/A Jan-20 SUP HCPCS C1713 01-7120 - PLATE BONE REGULAR X TITANIUM CRANIOMAXILLOFACIAL STERILE BOTH IP/OP $840.00 $622.00 $166.72 $840.00 $378.00 $378.00 $378.00 $378.00 $840.00 $840.00 $840.00 $175.08 $840.00 $840.00 $840.00 $840.00 $840.00 $175.07 $840.00 $336.00 $496.86 $840.00 $840.00 $840.00 $840.00 $630.00 $840.00 $840.00 $840.00 $420.00 $420.00 $665.28 $840.00 $672.00 $378.00 $166.72 N/A $487.20 $840.00 $504.00 $840.00 $175.06 $840.00 N/A N/A Jan-21 SUP HCPCS C1713 01-7121 - PLATE BONE 6 HOLE CVD TRAUMAONE GREEN ORBTL MIDFAC BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" $720.00 "$1,200.00" $250.08 "$1,200.00" N/A N/A Jan-22 SUP HCPCS C1713 01-7122 - PLATE BONE 18 HOLE CVD TRAUMAONE GREEN ORBTL MIDFAC BOTH IP/OP "$1,570.00" "$1,162.00" $311.61 "$1,570.00" $706.50 $706.50 $706.50 $706.50 "$1,570.00" "$1,570.00" "$1,570.00" $327.23 "$1,570.00" "$1,570.00" "$1,570.00" "$1,570.00" "$1,570.00" $327.21 "$1,570.00" $628.00 $928.66 "$1,570.00" "$1,570.00" "$1,570.00" "$1,570.00" "$1,177.50" "$1,570.00" "$1,570.00" "$1,570.00" $785.00 $785.00 "$1,243.44" "$1,570.00" "$1,256.00" $706.50 $311.61 N/A $910.60 "$1,570.00" $942.00 "$1,570.00" "$1,570.00" "$1,570.00" N/A N/A Jan-23 SUP HCPCS C1713 01-7123 - PLATE BONE 4 HOLE CVD TRAUMAONE GREEN ORBTL MIDFAC BOTH IP/OP $932.50 $690.00 $185.08 $932.50 $419.63 $419.63 $419.63 $419.63 $932.50 $932.50 $932.50 $194.36 $932.50 $932.50 $932.50 $932.50 $932.50 $194.34 $932.50 $373.00 $551.57 $932.50 $932.50 $932.50 $932.50 $699.38 $932.50 $932.50 $932.50 $466.25 $466.25 $738.54 $932.50 $746.00 $419.63 $185.08 N/A $540.85 $932.50 $559.50 $932.50 $932.50 $932.50 N/A N/A Jan-26 SUP HCPCS C1713 01-7126 - PLATE BONE REGULAR CURVE 6 HOLE GRADE II TRAUMAONE LORENZ BOTH IP/OP $857.50 $635.00 $170.19 $857.50 $385.88 $385.88 $385.88 $385.88 $857.50 $857.50 $857.50 $178.72 $857.50 $857.50 $857.50 $857.50 $857.50 $178.71 $857.50 $343.00 $507.21 $857.50 $857.50 $857.50 $857.50 $643.13 $857.50 $857.50 $857.50 $428.75 $428.75 $679.14 $857.50 $686.00 $385.88 $170.19 N/A $497.35 $857.50 $514.50 $857.50 $178.70 $857.50 N/A N/A Jan-28 SUP HCPCS C1713 01-7128 - PLATE BONE REGULAR CURVE .6MM 8 HOLE TRAUMAONE LORENZ SILVER BOTH IP/OP $540.00 $400.00 $107.18 $745.00 $243.00 $243.00 $243.00 $243.00 $540.00 $540.00 $540.00 $112.55 $540.00 $540.00 $540.00 $540.00 $540.00 $112.54 $540.00 $298.00 $319.41 $540.00 $745.00 $540.00 $540.00 $405.00 $540.00 $540.00 $540.00 $270.00 $270.00 $427.68 $540.00 $432.00 $243.00 $107.18 N/A $313.20 $540.00 $324.00 $540.00 $112.54 $540.00 N/A N/A Jan-31 SUP HCPCS C1713 01-7131 - PLATE BN SQ 12MM LORENZ 4 HL NEURO 1.5MM SCR BOTH IP/OP $760.00 $562.00 $150.84 $760.00 $342.00 $342.00 $342.00 $342.00 $760.00 $760.00 $760.00 $158.40 $760.00 $760.00 $760.00 $760.00 $760.00 $158.39 $760.00 $304.00 $449.54 $760.00 $760.00 $760.00 $760.00 $570.00 $760.00 $760.00 $760.00 $380.00 $380.00 $601.92 $760.00 $608.00 $342.00 $150.84 N/A $440.80 $760.00 $760.00 $760.00 $158.38 $760.00 N/A N/A 1912000 SUP HCPCS C1894 1912000 - SHEATH ENDSCP CLEAN 0D 4MM LENS SOFTWARE CONTROL ENDO-SCRUB BOTH IP/OP $33.00 $24.00 $6.51 $32.80 $17.81 $17.81 $17.81 $17.81 $32.80 $32.80 $32.80 $6.84 $32.80 $24.34 $24.34 $25.28 $17.09 $6.84 $32.80 $32.80 $19.40 $32.80 $32.80 $32.80 $32.80 $24.75 $32.80 $32.80 $32.80 $16.40 $16.40 $25.98 $32.80 $26.24 $21.32 $6.51 N/A $19.14 $32.80 $32.80 $32.80 $6.84 $32.80 N/A N/A 1912010 SUP HCPCS C1892 1912010 - SHEATH ENDSCP CLEAN 30D 4MM LENS ENDO-SCRUB 2 KARL STORZ BOTH IP/OP $27.50 $20.00 $5.46 $27.50 $14.93 $14.93 $14.93 $14.93 $27.50 $27.50 $27.50 $5.73 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $27.50 $16.27 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $5.46 N/A $15.95 $27.50 $27.50 $27.50 $5.73 $27.50 N/A N/A Jan-36 SUP HCPCS C1713 01-7136 - PLATE BONE RECTANGLE 2X3 HOLE TRAUMAONE MATRIX SILVER BOTH IP/OP $950.00 $703.00 $188.55 $950.00 $427.50 $427.50 $427.50 $427.50 $950.00 $950.00 $950.00 $198.00 $950.00 $950.00 $950.00 $950.00 $950.00 $197.99 $950.00 $380.00 $561.93 $950.00 $950.00 $950.00 $950.00 $712.50 $950.00 $950.00 $950.00 $475.00 $475.00 $752.40 $950.00 $760.00 $427.50 $188.55 N/A $551.00 $950.00 $570.00 $950.00 $197.98 $950.00 N/A N/A Jan-37 SUP HCPCS C1713 01-7137 - PLATE BONE 2X4 HOLE RECTANGULAR LORENZ TITANIUM BOTH IP/OP $950.00 $703.00 $188.55 $950.00 $427.50 $427.50 $427.50 $427.50 $950.00 $950.00 $950.00 $198.00 $950.00 $950.00 $950.00 $950.00 $950.00 $197.99 $950.00 $950.00 $561.93 $950.00 $950.00 $950.00 $950.00 $712.50 $950.00 $950.00 $950.00 $475.00 $475.00 $752.40 $950.00 $760.00 $427.50 $188.55 N/A $551.00 $950.00 $570.00 $950.00 $197.98 $950.00 N/A N/A Jan-42 SUP Custom 27203010 01-7142 - DRILL TWIST 5MM STOP 1MM 50MM LORENZ MANDIB BOTH IP/OP $447.50 $331.00 $79.66 $447.50 $447.50 $447.50 $447.50 $447.50 $447.50 $447.50 $79.66 $447.50 $447.50 $332.13 $332.13 $344.93 $233.15 $93.26 $447.50 $179.00 $447.50 $447.50 $447.50 $447.50 $447.50 $335.63 $447.50 $447.50 $447.50 $223.75 $223.75 $354.42 $447.50 $358.00 $290.88 $447.50 N/A $259.55 $447.50 $268.50 $447.50 $447.50 $447.50 N/A N/A Jan-44 SUP Custom 27203010 01-7144 - DRILL TWIST 1.1MM 50MM 7MM STOP LORENZ 1.5MM SCREW MIDAS REX BOTH IP/OP $447.50 $331.00 $79.66 $447.50 $447.50 $447.50 $447.50 $447.50 $447.50 $447.50 $79.66 $447.50 $447.50 $332.13 $332.13 $344.93 $233.15 $93.26 $447.50 $179.00 $447.50 $447.50 $447.50 $447.50 $447.50 $335.63 $447.50 $447.50 $447.50 $223.75 $223.75 $354.42 $447.50 $358.00 $290.88 $447.50 N/A $259.55 $447.50 $268.50 $447.50 $447.50 $447.50 N/A N/A Jan-46 SUP Custom 27203010 01-7146 - DRILL TWIST 1.1MM 50MM 9MM STOP BOTH IP/OP $447.50 $331.00 $79.66 $447.50 $447.50 $447.50 $447.50 $447.50 $447.50 $447.50 $79.66 $447.50 $447.50 $332.13 $332.13 $344.93 $233.15 $93.26 $447.50 $179.00 $447.50 $447.50 $447.50 $447.50 $447.50 $335.63 $447.50 $447.50 $447.50 $223.75 $223.75 $354.42 $447.50 $358.00 $290.88 $447.50 N/A $259.55 $447.50 $268.50 $447.50 $447.50 $447.50 N/A N/A Jan-48 SUP Custom 27203010 01-7148 - DRILL TWIST 1.1MM 50MM 15MM STOP BOTH IP/OP $447.50 $331.00 $79.66 $447.50 $447.50 $447.50 $447.50 $447.50 $447.50 $447.50 $79.66 $447.50 $447.50 $332.13 $332.13 $344.93 $233.15 $93.26 $447.50 $179.00 $447.50 $447.50 $447.50 $447.50 $447.50 $335.63 $447.50 $447.50 $447.50 $223.75 $223.75 $354.42 $447.50 $358.00 $290.88 $447.50 N/A $259.55 $447.50 $268.50 $447.50 $447.50 $447.50 N/A N/A 1924542 SUP Custom 27803010 1924542 - ROD SPNL 5.5MM 200MM SPRL R90D HEX END TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 1924543 SUP Custom 27803010 1924543 - ROD SPNL 5.5MM 400MM SPRL R90D HEX END BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 1924547 SUP HCPCS C1713 1924547 - SCREW BN 6.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$1,346.00" $996.00 $267.08 "$1,345.68" $605.56 $605.56 $605.56 $605.56 "$1,345.68" "$1,345.68" "$1,345.68" $280.47 "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" $280.45 "$1,345.68" $538.27 $795.97 "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,009.50" "$1,345.68" "$1,345.68" "$1,345.68" $672.84 $672.84 "$1,065.78" "$1,345.68" "$1,076.54" $605.56 $267.08 N/A $780.68 "$1,345.68" "$1,345.68" "$1,345.68" $280.44 "$1,345.68" N/A N/A 1924548 SUP HCPCS C1713 1924548 - SCREW BN 6.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$1,346.00" $996.00 $267.08 "$1,345.68" $605.56 $605.56 $605.56 $605.56 "$1,345.68" "$1,345.68" "$1,345.68" $280.47 "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" $280.45 "$1,345.68" $538.27 $795.97 "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,009.50" "$1,345.68" "$1,345.68" "$1,345.68" $672.84 $672.84 "$1,065.78" "$1,345.68" "$1,076.54" $605.56 $267.08 N/A $780.68 "$1,345.68" "$1,345.68" "$1,345.68" $280.44 "$1,345.68" N/A N/A 1924549 SUP HCPCS C1713 1924549 - SCREW BN 6.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$1,346.00" $996.00 $267.08 "$1,345.68" $605.56 $605.56 $605.56 $605.56 "$1,345.68" "$1,345.68" "$1,345.68" $280.47 "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" $280.45 "$1,345.68" $538.27 $795.97 "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,009.50" "$1,345.68" "$1,345.68" "$1,345.68" $672.84 $672.84 "$1,065.78" "$1,345.68" "$1,076.54" $605.56 $267.08 N/A $780.68 "$1,345.68" "$1,345.68" "$1,345.68" $280.44 "$1,345.68" N/A N/A 1924550 SUP HCPCS C1713 1924550 - SCREW BN 6.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$1,346.00" $996.00 $267.08 "$1,345.68" $605.56 $605.56 $605.56 $605.56 "$1,345.68" "$1,345.68" "$1,345.68" $280.47 "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" $280.45 "$1,345.68" $538.27 $795.97 "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,009.50" "$1,345.68" "$1,345.68" "$1,345.68" $672.84 $672.84 "$1,065.78" "$1,345.68" "$1,076.54" $605.56 $267.08 N/A $780.68 "$1,345.68" $807.41 "$1,345.68" $280.44 "$1,345.68" N/A N/A 1924551 SUP HCPCS C1713 1924551 - SCREW BN 6.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$1,346.00" $996.00 $267.08 "$1,345.68" $605.56 $605.56 $605.56 $605.56 "$1,345.68" "$1,345.68" "$1,345.68" $280.47 "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" $280.45 "$1,345.68" $538.27 $795.97 "$1,345.68" "$1,345.68" "$1,345.68" "$1,345.68" "$1,009.50" "$1,345.68" "$1,345.68" "$1,345.68" $672.84 $672.84 "$1,065.78" "$1,345.68" "$1,076.54" $605.56 $267.08 N/A $780.68 "$1,345.68" $807.41 "$1,345.68" $280.44 "$1,345.68" N/A N/A 1924552 SUP Custom 27803010 1924552 - ROD SPNL 5.5MM 200MM SPRL R90D SCRL EYE TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 1924553 SUP Custom 27803010 1924553 - ROD SPNL 5.5MM 400MM SPRL R90D SCRL EYE TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 1924900 SUP Custom 27803010 1924900 - ROD SPNL 5.5MM 40MM SPRL R90D NONHEXAGONAL TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 1924901 SUP Custom 27803010 1924901 - ROD SPNL 5.5MM 50MM SPRL R90D NONHEXAGONAL TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 1924902 SUP Custom 27803010 1924902 - ROD SPNL 5.5MM 60MM SPRL R90D TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 1924903 SUP Custom 27803010 1924903 - ROD SPNL 5.5MM 70MM SPRL R90D NONHEXAGONAL TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 1924904 SUP Custom 27803010 1924904 - ROD SPNL 5.5MM 80MM SPRL R90D NONHEXAGONAL TI SPNE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 1924905 SUP Custom 27803010 1924905 - ROD SPNL 5.5MM 90MM SPRL R90D NONHEXAGONAL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 1924906 SUP Custom 27803010 1924906 - ROD SPNL 5.5MM 100MM SPRL R90D NONHEXAGONAL TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 1924907 SUP Custom 27803010 1924907 - ROD SPNL 5.5MM 110MM SPRL R90D NONHEXAGONAL TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 1924908 SUP Custom 27803010 1924908 - ROD SPNL 5.5MM 120MM SPRL R90D NONHEXAGONAL TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 1924909 SUP Custom 27803010 1924909 - ROD SPNL 5.5MM 600MM SPRL R90D HEX TI BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A Jan-80 SUP HCPCS C1713 01-7180 - PLATE BN REG 80X53X.6MM SLVR LORENZ GRID MESH PNL TI CRNMXF BOTH IP/OP "$4,182.50" "$3,095.00" $830.12 "$4,182.50" "$1,882.13" "$1,882.13" "$1,882.13" "$1,882.13" "$4,182.50" "$4,182.50" "$4,182.50" $871.74 "$4,182.50" "$4,182.50" "$4,182.50" "$4,182.50" "$4,182.50" $871.68 "$4,182.50" "$4,182.50" "$2,061.97" "$4,182.50" "$4,182.50" "$4,182.50" "$4,182.50" "$3,136.88" "$4,182.50" "$4,182.50" "$4,182.50" "$2,091.25" "$2,091.25" "$3,312.54" "$4,182.50" "$3,346.00" "$1,882.13" $830.12 N/A "$2,425.85" "$4,182.50" "$2,509.50" "$4,182.50" "$4,182.50" "$4,182.50" N/A N/A Jan-82 SUP HCPCS C1713 01-7182 - PLATE BONE SMALL 85X53X.6MM GRID MESH PANEL LORENZ SILVER BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$1,650.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 N/A "$2,392.50" "$4,125.00" "$2,475.00" "$4,125.00" "$4,125.00" "$4,125.00" N/A N/A Jan-85 SUP HCPCS C1713 01-7185 - PLATE BONE SMALL 85X53X.3MM GRID MESH PANEL LORENZ SILVER BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$1,650.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 N/A "$2,392.50" "$4,125.00" "$2,475.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A Jan-49 SUP HCPCS C1713 01-7249 - PLATE BONE 100X100X.6MM CONTUR MESH LORENZ STERILE 1.5MM BOTH IP/OP "$6,692.50" "$4,952.00" "$1,328.29" "$6,692.50" "$3,011.63" "$3,011.63" "$3,011.63" "$3,011.63" "$6,692.50" "$6,692.50" "$6,692.50" "$1,394.88" "$6,692.50" "$6,692.50" "$6,692.50" "$6,692.50" "$6,692.50" "$1,394.79" "$6,692.50" "$2,677.00" "$3,299.40" "$6,692.50" "$6,692.50" "$6,692.50" "$6,692.50" "$5,019.38" "$6,692.50" "$6,692.50" "$6,692.50" "$3,346.25" "$3,346.25" "$5,300.46" "$6,692.50" "$5,354.00" "$3,011.63" "$1,328.29" N/A "$3,881.65" "$6,692.50" "$4,015.50" "$6,692.50" "$1,394.72" "$6,692.50" N/A N/A Jan-05 SUP HCPCS C1713 01-7305 - PLATE BONE LORENZ TITANIUM H.5 MM OD18.5 MM CRANIOMAXILLOFAC BOTH IP/OP $800.00 $592.00 $158.78 $800.00 $360.00 $360.00 $360.00 $360.00 $800.00 $800.00 $800.00 $166.74 $800.00 $800.00 $800.00 $800.00 $800.00 $166.73 $800.00 $800.00 $473.20 $800.00 $800.00 $800.00 $800.00 $600.00 $800.00 $800.00 $800.00 $400.00 $400.00 $633.60 $800.00 $640.00 $360.00 $158.78 N/A $464.00 $800.00 $480.00 $800.00 $166.72 $800.00 N/A N/A Jan-06 SUP HCPCS C1713 01-7306 - PLATE BONE 18.5MM .5MM BURR HOLE LORENZ TITANIUM BOTH IP/OP $800.00 $592.00 $158.78 $800.00 $360.00 $360.00 $360.00 $360.00 $800.00 $800.00 $800.00 $166.74 $800.00 $800.00 $800.00 $800.00 $800.00 $166.73 $800.00 $800.00 $473.20 $800.00 $800.00 $800.00 $800.00 $600.00 $800.00 $800.00 $800.00 $400.00 $400.00 $633.60 $800.00 $640.00 $360.00 $158.78 N/A $464.00 $800.00 $800.00 $800.00 $166.72 $800.00 N/A N/A Jan-08 SUP HCPCS C1713 01-7308 - PLATE BONE 18.5MM BURR HOLE TITANIUM MIDFAC 1.5MM SCREWS BOTH IP/OP $800.00 $592.00 $158.78 $800.00 $360.00 $360.00 $360.00 $360.00 $800.00 $800.00 $800.00 $166.74 $800.00 $800.00 $800.00 $800.00 $800.00 $166.73 $800.00 $320.00 $473.20 $800.00 $800.00 $800.00 $800.00 $600.00 $800.00 $800.00 $800.00 $400.00 $400.00 $633.60 $800.00 $640.00 $360.00 $158.78 N/A $464.00 $800.00 $800.00 $800.00 $166.72 $800.00 N/A N/A Jan-09 SUP HCPCS C1713 01-7309 - PLATE BONE 22MM .5MM BURR HOLE LORENZ TITANIUM BOTH IP/OP $800.00 $592.00 $158.78 $800.00 $360.00 $360.00 $360.00 $360.00 $800.00 $800.00 $800.00 $166.74 $800.00 $800.00 $800.00 $800.00 $800.00 $166.73 $800.00 $320.00 $473.20 $800.00 $800.00 $800.00 $800.00 $600.00 $800.00 $800.00 $800.00 $400.00 $400.00 $633.60 $800.00 $640.00 $360.00 $158.78 N/A $464.00 $800.00 $480.00 $800.00 $166.72 $800.00 N/A N/A Jan-40 SUP HCPCS C1713 01-7340 - PLATE BONE 1/1.5MM 85X50X.2MM HEXAGONAL PANEL LORENZ BOTH IP/OP "$4,022.50" "$2,977.00" $798.37 "$4,022.50" "$1,810.13" "$1,810.13" "$1,810.13" "$1,810.13" "$4,022.50" "$4,022.50" "$4,022.50" $838.39 "$4,022.50" "$4,022.50" "$4,022.50" "$4,022.50" "$4,022.50" $838.33 "$4,022.50" "$4,022.50" "$1,983.09" "$4,022.50" "$4,022.50" "$4,022.50" "$4,022.50" "$3,016.88" "$4,022.50" "$4,022.50" "$4,022.50" "$2,011.25" "$2,011.25" "$3,185.82" "$4,022.50" "$3,218.00" "$1,810.13" $798.37 N/A "$2,333.05" "$4,022.50" "$2,413.50" "$4,022.50" $838.29 "$4,022.50" N/A N/A Jan-45 SUP HCPCS C1713 01-7345 - PLATE BONE MEDIUM 2 HOLE STR TITANIUM MIDFAC 1.5MM SCREWS BOTH IP/OP $165.00 $122.00 $32.75 $165.00 $74.25 $74.25 $74.25 $74.25 $165.00 $165.00 $165.00 $34.39 $165.00 $165.00 $165.00 $165.00 $165.00 $34.39 $165.00 $66.00 $97.60 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $74.25 $32.75 N/A $95.70 $165.00 $99.00 $165.00 $34.39 $165.00 N/A N/A Jan-47 SUP HCPCS C1713 01-7347 - PLATE BONE LONG STR .6MM 2 HOLE TRAUMAONE LORENZ SILVER BOTH IP/OP $165.00 $122.00 $32.75 $165.00 $74.25 $74.25 $74.25 $74.25 $165.00 $165.00 $165.00 $34.39 $165.00 $165.00 $165.00 $165.00 $165.00 $34.39 $165.00 $66.00 $97.60 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $74.25 $32.75 N/A $95.70 $165.00 $99.00 $165.00 $34.39 $165.00 N/A N/A Jan-51 SUP HCPCS C1713 01-7351 - PLATE BN 25MM LORENZ 6 HL GAP NEURO 1.5MM SCR BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,062.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A Jan-53 SUP HCPCS C1713 01-7353 - PLATE BONE MEDIUM 35MMX.5MM 6 HOLE GAP LORENZ TITANIUM BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,062.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A Jan-55 SUP HCPCS C1713 01-7355 - PLATE BN 45MMX.5MM LORENZ 6 HL GAP TI CRNM 1.5MM SCR BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,062.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" "$1,062.50" "$1,062.50" N/A N/A 2010027 SUP Custom 27203010 2010027 - ELECTRODE EMG DMD STRL LF I-PAS III SPRINGLESS DISP BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 2010028 SUP Custom 27203010 2010028 - SET SPINAL INSULATED PEDICLE ACCES SYSTEM DIAMOND TIP I-PAS BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 2010029 SUP Custom 27203010 2010029 - SET SPINAL INSULATED PEDICLE ACCES SYSTEM BEVELED TIP I-PAS BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 2010036 SUP Custom 27011340 2010036 - STIMULATOR NRV STRL LF NVJJB DYNMC DISP BOTH IP/OP $182.50 $135.00 $32.49 $182.50 $182.50 $182.50 $182.50 $182.50 $182.50 $182.50 $32.49 $182.50 $182.50 $135.45 $135.45 $140.67 $95.08 $38.04 $182.50 $73.00 $182.50 $182.50 $182.50 $182.50 $182.50 $136.88 $182.50 $182.50 $182.50 $91.25 $91.25 $144.54 $182.50 $146.00 $118.63 $182.50 N/A $105.85 $182.50 $109.50 $182.50 $182.50 $182.50 N/A N/A 2010037 SUP Custom 27203010 2010037 - ELECTRODE EMG BVL STRL LF I-PAS III SPRINGLESS DISP BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 2011202 SUP Custom 27203010 2011202 - RETRACTOR SRG SHTH NRV ROOT BOTH IP/OP "$1,205.00" $892.00 $214.49 "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" $214.49 "$1,205.00" "$1,205.00" $894.35 $894.35 $928.81 $627.81 $251.14 "$1,205.00" $482.00 "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" $903.75 "$1,205.00" "$1,205.00" "$1,205.00" $602.50 $602.50 $954.36 "$1,205.00" $964.00 $783.25 "$1,205.00" N/A $698.90 "$1,205.00" $723.00 "$1,205.00" "$1,205.00" "$1,205.00" N/A N/A 2012021 SUP Custom 27011340 2012021 - PROBE EMG STM HNDPC NV M5 BOTH IP/OP $712.50 $527.00 $126.83 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $126.83 $712.50 $712.50 $528.82 $528.82 $549.20 $371.21 $148.49 $712.50 $285.00 $712.50 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $463.13 $712.50 N/A $413.25 $712.50 $427.50 $712.50 $712.50 $712.50 N/A N/A Oct-08 SUP Custom 27203010 10-7408 - BANDAGE COMPRESSION 7 TUBULAR 42-52IN 10YD ELAST DRESSING BOTH IP/OP $29.50 $22.00 $5.22 $115.76 $29.31 $29.31 $29.31 $29.31 $29.31 $29.31 $5.22 $29.31 $29.31 $21.75 $21.75 $22.59 $15.27 $6.11 $29.31 $46.30 $29.31 $29.31 $115.76 $29.31 $29.31 $22.13 $29.31 $29.31 $29.31 $14.66 $14.66 $23.21 $29.31 $23.45 $19.05 $29.31 N/A $17.11 $29.31 $17.59 $29.31 $29.31 $29.31 N/A N/A Oct-09 SUP Custom 27203010 10-7409 - RETAINER DRESSING 8 TUBULAR 52-58IN 10YD ELAST LATEX SAFE BOTH IP/OP $40.00 $30.00 $7.11 $164.30 $39.97 $39.97 $39.97 $39.97 $39.97 $39.97 $7.11 $39.97 $39.97 $29.67 $29.67 $30.81 $20.82 $8.33 $39.97 $65.72 $39.97 $39.97 $164.30 $39.97 $39.97 $30.00 $39.97 $39.97 $39.97 $19.99 $19.99 $31.66 $39.97 $31.98 $25.98 $39.97 N/A $23.20 $39.97 $23.98 $39.97 $39.97 $39.97 N/A N/A Oct-13 SUP Custom 27203010 10-7413 - RETAINER DRESSING 12 10YD ELAST LATEX SAFE STRETCHED TUBULAR BOTH IP/OP $65.50 $48.00 $11.61 $65.24 $65.24 $65.24 $65.24 $65.24 $65.24 $65.24 $11.61 $65.24 $65.24 $48.42 $48.42 $50.29 $33.99 $13.60 $65.24 $26.10 $65.24 $65.24 $65.24 $65.24 $65.24 $49.13 $65.24 $65.24 $65.24 $32.62 $32.62 $51.67 $65.24 $52.19 $42.41 $65.24 N/A $37.99 $65.24 $39.14 $65.24 $65.24 $65.24 N/A N/A 2020000 SUP HCPCS Q4130 2020000 - MATRIX TISSUE 20X20CM RECONSTRUCTIVE STRATTICE PIG DERMIS BOTH IP/OP $65.50 $48.00 $13.59 $65.23 $65.23 $65.23 $65.23 $65.23 $65.23 $65.23 $65.23 $65.23 $65.23 $65.23 $65.23 $65.23 $65.23 $13.59 $65.23 $26.09 $65.23 $65.23 $65.23 $65.23 $65.23 $49.13 $65.23 $65.23 $65.23 $32.62 $32.62 $51.66 $65.23 $52.18 $29.35 $65.23 N/A $37.99 $65.23 $39.14 $65.23 $65.23 $65.23 N/A N/A 2020002 SUP HCPCS Q4130 2020002 - MATRIX TISSUE 20X20CM RECONSTRUCTIVE STRATTICE PIG DERMIS BOTH IP/OP "$35,592.50" "$26,338.00" "$7,417.87" "$35,592.50" "$35,592.50" "$35,592.50" "$35,592.50" "$35,592.50" "$35,592.50" "$35,592.50" "$35,592.50" "$35,592.50" "$35,592.50" "$35,592.50" "$35,592.50" "$35,592.50" "$35,592.50" "$7,417.87" "$35,592.50" "$9,421.00" "$35,592.50" "$35,592.50" "$23,552.50" "$35,592.50" "$35,592.50" "$26,694.38" "$35,592.50" "$35,592.50" "$35,592.50" "$17,796.25" "$17,796.25" "$28,189.26" "$35,592.50" "$28,474.00" "$16,016.63" "$35,592.50" N/A "$20,643.65" "$35,592.50" "$21,355.50" "$35,592.50" "$35,592.50" "$35,592.50" N/A N/A 2025002 SUP HCPCS Q4130 2025002 - MATRIX TISSUE 25X20CM RECONSTRUCTIVE STRATTICE PIG DERMIS BOTH IP/OP "$44,490.00" "$32,923.00" "$9,272.21" "$44,490.00" "$44,490.00" "$44,490.00" "$44,490.00" "$44,490.00" "$44,490.00" "$44,490.00" "$44,490.00" "$44,490.00" "$44,490.00" "$44,490.00" "$44,490.00" "$44,490.00" "$44,490.00" "$9,272.21" "$44,490.00" "$11,776.00" "$44,490.00" "$44,490.00" "$29,440.00" "$44,490.00" "$44,490.00" "$33,367.50" "$44,490.00" "$44,490.00" "$44,490.00" "$22,245.00" "$22,245.00" "$35,236.08" "$44,490.00" "$35,592.00" "$20,020.50" "$44,490.00" N/A "$25,804.20" "$44,490.00" "$26,694.00" "$44,490.00" "$44,490.00" "$44,490.00" N/A N/A 2029950 SUP Custom 27803010 2029950 - KIT SPINAL DILAT XLIF NEUROVISION DISPOSABLE M5 BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 2040001 SUP HCPCS C1713 2040001 - DIGITIZER INST BENDINI ROD BNDRG ARY BOTH IP/OP "$5,660.00" "$4,188.00" "$1,123.37" "$5,660.00" "$2,547.00" "$2,547.00" "$2,547.00" "$2,547.00" "$5,660.00" "$5,660.00" "$5,660.00" "$1,179.69" "$5,660.00" "$5,660.00" "$5,660.00" "$5,660.00" "$5,660.00" "$1,179.61" "$5,660.00" "$2,264.00" "$2,790.38" "$5,660.00" "$5,660.00" "$5,660.00" "$5,660.00" "$4,245.00" "$5,660.00" "$5,660.00" "$5,660.00" "$2,830.00" "$2,830.00" "$4,482.72" "$5,660.00" "$4,528.00" "$2,547.00" "$1,123.37" N/A "$3,282.80" "$5,660.00" "$3,396.00" "$5,660.00" "$1,179.54" "$5,660.00" N/A N/A 2078175 SUP HCPCS C1769 2078175 - GUIDEWIRE VASCULAR .014IN 300CM 3CM SHAPEABLE TIP STEERABLE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $203.63 $203.63 $203.63 $203.63 $375.00 $375.00 $375.00 $78.16 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 2110140 SUP HCPCS C1713 2110140 - SPACER SPNL 0D 40X20X8MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110145 SUP HCPCS C1713 2110145 - SPACER SPNL 0D 45X20X8MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110150 SUP HCPCS C1713 2110150 - SPACER SPNL 0D 50X20X8MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110155 SUP HCPCS C1713 2110155 - SPACER SPNL 0D 55X20X8MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110160 SUP HCPCS C1713 2110160 - SPACER SPNL 0D 60X20X8MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110240 SUP HCPCS C1713 2110240 - SPACER SPNL 0D 40X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110245 SUP HCPCS C1713 2110245 - SPACER SPNL 0D 45X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110250 SUP HCPCS C1713 2110250 - SPACER SPNL 0D 50X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110255 SUP HCPCS C1713 2110255 - SPACER SPNL 0D 55X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110260 SUP HCPCS C1713 2110260 - SPACER SPNL 0D 60X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110340 SUP HCPCS C1713 2110340 - SPACER SPNL 0D 40X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110345 SUP HCPCS C1713 2110345 - SPACER SPNL 0D 45X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110350 SUP HCPCS C1713 2110350 - SPACER SPNL 0D 50X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110355 SUP HCPCS C1713 2110355 - SPACER SPNL 0D 55X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110360 SUP HCPCS C1713 2110360 - SPACER SPNL 0D 60X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110440 SUP HCPCS C1713 2110440 - SPACER SPNL 0D 40X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110445 SUP HCPCS C1713 2110445 - SPACER SPNL 0D 45X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110450 SUP HCPCS C1713 2110450 - SPACER SPNL 0D 50X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110455 SUP HCPCS C1713 2110455 - SPACER SPNL 0D 55X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110460 SUP HCPCS C1713 2110460 - SPACER SPNL 0D 60X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110540 SUP HCPCS C1713 2110540 - SPACER SPNL 0D 40X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110545 SUP HCPCS C1713 2110545 - SPACER SPNL 0D 45X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110550 SUP HCPCS C1713 2110550 - SPACER SPNL 0D 50X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110555 SUP HCPCS C1713 2110555 - SPACER SPNL 0D 55X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2110560 SUP HCPCS C1713 2110560 - SPACER SPNL 0D 60X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111140 SUP HCPCS C1713 2111140 - SPACER SPNL 6D 40X20X8MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111145 SUP HCPCS C1713 2111145 - SPACER SPNL 6D 45X20X8MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111150 SUP HCPCS C1713 2111150 - SPACER SPNL 6D 50X20X8MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111155 SUP HCPCS C1713 2111155 - SPACER SPNL 6D 55X20X8MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111160 SUP HCPCS C1713 2111160 - SPACER SPNL 6D 60X20X8MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111240 SUP HCPCS C1713 2111240 - SPACER SPNL 6D 40X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111245 SUP HCPCS C1713 2111245 - SPACER SPNL 6D 45X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111250 SUP HCPCS C1713 2111250 - SPACER SPNL 6D 50X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111255 SUP HCPCS C1713 2111255 - SPACER SPNL 6D 55X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111260 SUP HCPCS C1713 2111260 - SPACER SPNL 6D 60X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111340 SUP HCPCS C1713 2111340 - SPACER SPNL 6D 40X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111345 SUP HCPCS C1713 2111345 - SPACER SPNL 6D 45X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111350 SUP HCPCS C1713 2111350 - SPACER SPNL 6D 50X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111355 SUP HCPCS C1713 2111355 - SPACER SPNL 6D 55X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111360 SUP HCPCS C1713 2111360 - SPACER SPNL 6D 60X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111440 SUP HCPCS C1713 2111440 - SPACER SPNL 6D 40X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111445 SUP HCPCS C1713 2111445 - SPACER SPNL 6D 45X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111450 SUP HCPCS C1713 2111450 - SPACER SPNL 6D 50X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111455 SUP HCPCS C1713 2111455 - SPACER SPNL 6D 55X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111460 SUP HCPCS C1713 2111460 - SPACER SPNL 6D 60X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111540 SUP HCPCS C1713 2111540 - SPACER SPNL 6D 40X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111545 SUP HCPCS C1713 2111545 - SPACER SPNL 6D 45X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111550 SUP HCPCS C1713 2111550 - SPACER SPNL 6D 50X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111555 SUP HCPCS C1713 2111555 - SPACER SPNL 6D 55X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2111560 SUP HCPCS C1713 2111560 - SPACER SPNL 6D 60X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112240 SUP HCPCS C1713 2112240 - SPACER SPNL 12D 40X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112245 SUP HCPCS C1713 2112245 - SPACER SPNL 12D 45X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112250 SUP HCPCS C1713 2112250 - SPACER SPNL 12D 50X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112255 SUP HCPCS C1713 2112255 - SPACER SPNL 12D 55X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112260 SUP HCPCS C1713 2112260 - SPACER SPNL 12D 60X20X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112340 SUP HCPCS C1713 2112340 - SPACER SPNL 12D 40X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112345 SUP HCPCS C1713 2112345 - SPACER SPNL 12D 45X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112350 SUP HCPCS C1713 2112350 - SPACER SPNL 12D 50X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112355 SUP HCPCS C1713 2112355 - SPACER SPNL 12D 55X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112360 SUP HCPCS C1713 2112360 - SPACER SPNL 12D 60X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112440 SUP HCPCS C1713 2112440 - SPACER SPNL 12D 40X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112445 SUP HCPCS C1713 2112445 - SPACER SPNL 12D 45X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112450 SUP HCPCS C1713 2112450 - SPACER SPNL 12D 50X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112455 SUP HCPCS C1713 2112455 - SPACER SPNL 12D 55X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112460 SUP HCPCS C1713 2112460 - SPACER SPNL 12D 60X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112540 SUP HCPCS C1713 2112540 - SPACER SPNL 12D 40X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112545 SUP HCPCS C1713 2112545 - SPACER SPNL 12D 45X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112550 SUP HCPCS C1713 2112550 - SPACER SPNL 12D 50X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112555 SUP HCPCS C1713 2112555 - SPACER SPNL 12D 55X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112560 SUP HCPCS C1713 2112560 - SPACER SPNL 12D 60X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112640 SUP HCPCS C1713 2112640 - SPACER SPNL 12D 40X20X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112645 SUP HCPCS C1713 2112645 - SPACER SPNL 12D 45X20X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112650 SUP HCPCS C1713 2112650 - SPACER SPNL 12D 50X20X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112655 SUP HCPCS C1713 2112655 - SPACER SPNL 12D 55X20X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2112660 SUP HCPCS C1713 2112660 - SPACER SPNL 12D 60X20X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113340 SUP HCPCS C1713 2113340 - SPACER SPNL 18D 40X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113345 SUP HCPCS C1713 2113345 - SPACER SPNL 18D 45X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113350 SUP HCPCS C1713 2113350 - SPACER SPNL 18D 50X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113355 SUP HCPCS C1713 2113355 - SPACER SPNL 18D 55X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113360 SUP HCPCS C1713 2113360 - SPACER SPNL 18D 60X20X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113440 SUP HCPCS C1713 2113440 - SPACER SPNL 18D 40X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113445 SUP HCPCS C1713 2113445 - SPACER SPNL 18D 45X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113450 SUP HCPCS C1713 2113450 - SPACER SPNL 18D 50X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113455 SUP HCPCS C1713 2113455 - SPACER SPNL 18D 55X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113460 SUP HCPCS C1713 2113460 - SPACER SPNL 18D 60X20X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113540 SUP HCPCS C1713 2113540 - SPACER SPNL 18D 40X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113545 SUP HCPCS C1713 2113545 - SPACER SPNL 18D 45X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113550 SUP HCPCS C1713 2113550 - SPACER SPNL 18D 50X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113555 SUP HCPCS C1713 2113555 - SPACER SPNL 18D 55X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113560 SUP HCPCS C1713 2113560 - SPACER SPNL 18D 60X20X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113640 SUP HCPCS C1713 2113640 - SPACER SPNL 18D 40X20X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113645 SUP HCPCS C1713 2113645 - SPACER SPNL 18D 45X20X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113650 SUP HCPCS C1713 2113650 - SPACER SPNL 18D 50X20X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113655 SUP HCPCS C1713 2113655 - SPACER SPNL 18D 55X20X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2113660 SUP HCPCS C1713 2113660 - SPACER SPNL 18D 60X20X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131240 SUP HCPCS C1713 2131240 - SPACER SPNL 6D 40X27X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131245 SUP HCPCS C1713 2131245 - SPACER SPNL 6D 45X27X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131250 SUP HCPCS C1713 2131250 - SPACER SPNL 6D 50X27X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131255 SUP HCPCS C1713 2131255 - SPACER SPNL 6D 55X27X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131260 SUP HCPCS C1713 2131260 - SPACER SPNL 6D 60X27X10MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131340 SUP HCPCS C1713 2131340 - SPACER SPNL 6D 40X27X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131345 SUP HCPCS C1713 2131345 - SPACER SPNL 6D 45X27X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131350 SUP HCPCS C1713 2131350 - SPACER SPNL 6D 50X27X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131355 SUP HCPCS C1713 2131355 - SPACER SPNL 6D 55X27X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131360 SUP HCPCS C1713 2131360 - SPACER SPNL 6D 60X27X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131440 SUP HCPCS C1713 2131440 - SPACER SPNL 6D 40X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131445 SUP HCPCS C1713 2131445 - SPACER SPNL 6D 45X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131450 SUP HCPCS C1713 2131450 - SPACER SPNL 6D 50X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131455 SUP HCPCS C1713 2131455 - SPACER SPNL 6D 55X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131460 SUP HCPCS C1713 2131460 - SPACER SPNL 6D 60X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131540 SUP HCPCS C1713 2131540 - SPACER SPNL 6D 40X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131545 SUP HCPCS C1713 2131545 - SPACER SPNL 6D 45X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131550 SUP HCPCS C1713 2131550 - SPACER SPNL 6D 50X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131555 SUP HCPCS C1713 2131555 - SPACER SPNL 6D 55X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2131560 SUP HCPCS C1713 2131560 - SPACER SPNL 6D 60X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132340 SUP HCPCS C1713 2132340 - SPACER SPNL 12D 40X27X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132345 SUP HCPCS C1713 2132345 - SPACER SPNL 12D 45X27X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132350 SUP HCPCS C1713 2132350 - SPACER SPNL 12D 50X27X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132355 SUP HCPCS C1713 2132355 - SPACER SPNL 12D 55X27X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132360 SUP HCPCS C1713 2132360 - SPACER SPNL 12D 60X27X12MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132440 SUP HCPCS C1713 2132440 - SPACER SPNL 12D 40X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132445 SUP HCPCS C1713 2132445 - SPACER SPNL 12D 45X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132450 SUP HCPCS C1713 2132450 - SPACER SPNL 12D 50X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132455 SUP HCPCS C1713 2132455 - SPACER SPNL 12D 55X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132460 SUP HCPCS C1713 2132460 - SPACER SPNL 12D 60X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132540 SUP HCPCS C1713 2132540 - SPACER SPNL 12D 40X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132545 SUP HCPCS C1713 2132545 - SPACER SPNL 12D 45X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132550 SUP HCPCS C1713 2132550 - SPACER SPNL 12D 50X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132555 SUP HCPCS C1713 2132555 - SPACER SPNL 12D 55X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132560 SUP HCPCS C1713 2132560 - SPACER SPNL 12D 60X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132640 SUP HCPCS C1713 2132640 - SPACER SPNL 12D 40X27X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132645 SUP HCPCS C1713 2132645 - SPACER SPNL 12D 45X27X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132650 SUP HCPCS C1713 2132650 - SPACER SPNL 12D 50X27X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132655 SUP HCPCS C1713 2132655 - SPACER SPNL 12D 55X27X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2132660 SUP HCPCS C1713 2132660 - SPACER SPNL 12D 60X27X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133440 SUP HCPCS C1713 2133440 - SPACER SPNL 18D 40X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133445 SUP HCPCS C1713 2133445 - SPACER SPNL 18D 45X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133450 SUP HCPCS C1713 2133450 - SPACER SPNL 18D 50X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133455 SUP HCPCS C1713 2133455 - SPACER SPNL 18D 55X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133460 SUP HCPCS C1713 2133460 - SPACER SPNL 18D 60X27X14MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133540 SUP HCPCS C1713 2133540 - SPACER SPNL 18D 40X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133545 SUP HCPCS C1713 2133545 - SPACER SPNL 18D 45X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133550 SUP HCPCS C1713 2133550 - SPACER SPNL 18D 50X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133555 SUP HCPCS C1713 2133555 - SPACER SPNL 18D 55X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133560 SUP HCPCS C1713 2133560 - SPACER SPNL 18D 60X27X16MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133640 SUP HCPCS C1713 2133640 - SPACER SPNL 18D 40X27X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133645 SUP HCPCS C1713 2133645 - SPACER SPNL 18D 45X27X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133650 SUP HCPCS C1713 2133650 - SPACER SPNL 18D 50X27X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133655 SUP HCPCS C1713 2133655 - SPACER SPNL 18D 55X27X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2133660 SUP HCPCS C1713 2133660 - SPACER SPNL 18D 60X27X18MM PIVOX LAT OLIF25 BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2140001 SUP HCPCS C1713 2140001 - PLATE SPNL SM 2 HOLE OLIF25 STRL BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$3,795.00" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 2140002 SUP HCPCS C1713 2140002 - PLATE SPNL LG 2 HOLE OLIF25 STRL BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 2140120 SUP HCPCS C1713 2140120 - SCREW BONE 5.5MM 20MM LMBR SPN STRL BOTH IP/OP "$1,209.00" $895.00 $239.96 "$1,209.00" $544.05 $544.05 $544.05 $544.05 "$1,209.00" "$1,209.00" "$1,209.00" $251.99 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $251.97 "$1,209.00" "$1,209.00" $715.12 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $906.75 "$1,209.00" "$1,209.00" "$1,209.00" $604.50 $604.50 $957.53 "$1,209.00" $967.20 $544.05 $239.96 N/A $701.22 "$1,209.00" $725.40 "$1,209.00" $251.96 "$1,209.00" N/A N/A 2140125 SUP HCPCS C1713 2140125 - SCREW BONE 5.5MM 25MM LMBR SPN STRL BOTH IP/OP "$1,209.00" $895.00 $239.96 "$1,209.00" $544.05 $544.05 $544.05 $544.05 "$1,209.00" "$1,209.00" "$1,209.00" $251.99 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $251.97 "$1,209.00" $483.60 $715.12 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $906.75 "$1,209.00" "$1,209.00" "$1,209.00" $604.50 $604.50 $957.53 "$1,209.00" $967.20 $544.05 $239.96 N/A $701.22 "$1,209.00" $725.40 "$1,209.00" $251.96 "$1,209.00" N/A N/A 2140130 SUP HCPCS C1713 2140130 - SCREW BONE 5.5MM 30MM LMBR SPN STRL BOTH IP/OP "$1,209.00" $895.00 $239.96 "$1,209.00" $544.05 $544.05 $544.05 $544.05 "$1,209.00" "$1,209.00" "$1,209.00" $251.99 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $251.97 "$1,209.00" $483.60 $715.12 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $906.75 "$1,209.00" "$1,209.00" "$1,209.00" $604.50 $604.50 $957.53 "$1,209.00" $967.20 $544.05 $239.96 N/A $701.22 "$1,209.00" "$1,209.00" "$1,209.00" $251.96 "$1,209.00" N/A N/A 2140135 SUP HCPCS C1713 2140135 - SCREW BONE 5.5MM 35MM LMBR SPN STRL BOTH IP/OP "$1,209.00" $895.00 $239.96 "$1,209.00" $544.05 $544.05 $544.05 $544.05 "$1,209.00" "$1,209.00" "$1,209.00" $251.99 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $251.97 "$1,209.00" "$1,209.00" $715.12 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $906.75 "$1,209.00" "$1,209.00" "$1,209.00" $604.50 $604.50 $957.53 "$1,209.00" $967.20 $544.05 $239.96 N/A $701.22 "$1,209.00" $725.40 "$1,209.00" $251.96 "$1,209.00" N/A N/A 2140140 SUP HCPCS C1713 2140140 - SCREW BONE 5.5MM 40MM LMBR SPN STRL BOTH IP/OP "$1,209.00" $895.00 $239.96 "$1,209.00" $544.05 $544.05 $544.05 $544.05 "$1,209.00" "$1,209.00" "$1,209.00" $251.99 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $251.97 "$1,209.00" $483.60 $715.12 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $906.75 "$1,209.00" "$1,209.00" "$1,209.00" $604.50 $604.50 $957.53 "$1,209.00" $967.20 $544.05 $239.96 N/A $701.22 "$1,209.00" $725.40 "$1,209.00" $251.96 "$1,209.00" N/A N/A 2140145 SUP HCPCS C1713 2140145 - SCREW BONE 5.5MM 45MM LMBR SPN STRL BOTH IP/OP "$1,209.00" $895.00 $239.96 "$1,209.00" $544.05 $544.05 $544.05 $544.05 "$1,209.00" "$1,209.00" "$1,209.00" $251.99 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $251.97 "$1,209.00" "$1,209.00" $715.12 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $906.75 "$1,209.00" "$1,209.00" "$1,209.00" $604.50 $604.50 $957.53 "$1,209.00" $967.20 $544.05 $239.96 N/A $701.22 "$1,209.00" $725.40 "$1,209.00" $251.96 "$1,209.00" N/A N/A 2140150 SUP HCPCS C1713 2140150 - SCREW BONE 5.5MM 50MM LMBR SPN STRL BOTH IP/OP "$1,209.00" $895.00 $239.96 "$1,209.00" $544.05 $544.05 $544.05 $544.05 "$1,209.00" "$1,209.00" "$1,209.00" $251.99 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $251.97 "$1,209.00" $483.60 $715.12 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $906.75 "$1,209.00" "$1,209.00" "$1,209.00" $604.50 $604.50 $957.53 "$1,209.00" $967.20 $544.05 $239.96 N/A $701.22 "$1,209.00" "$1,209.00" "$1,209.00" $251.96 "$1,209.00" N/A N/A 2150010 SUP HCPCS C1713 2150010 - PLATE SPNL 10MM DIVERGENCE-L OLIF51 BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$3,795.00" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 2150012 SUP HCPCS C1713 2150012 - PLATE SPNL 12MM DIVERGENCE-L OLIF51 BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$3,795.00" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 2150014 SUP HCPCS C1713 2150014 - PLATE SPNL 14MM DIVERGENCE-L OLIF51 BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 2150016 SUP HCPCS C1713 2150016 - PLATE SPNL 16MM DIVERGENCE-L OLIF51 BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 2150018 SUP HCPCS C1713 2150018 - PLATE SPNL 18MM DIVERGENCE-L OLIF51 BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 2150020 SUP HCPCS C1713 2150020 - PLATE SPNL 20MM DIVERGENCE-L OLIF51 BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 2150120 SUP HCPCS C1713 2150120 - SCREW BONE 20MM DIVERGENCE-L SPN BOTH IP/OP "$1,209.00" $895.00 $239.96 "$1,209.00" $544.05 $544.05 $544.05 $544.05 "$1,209.00" "$1,209.00" "$1,209.00" $251.99 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $251.97 "$1,209.00" $483.60 $715.12 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $906.75 "$1,209.00" "$1,209.00" "$1,209.00" $604.50 $604.50 $957.53 "$1,209.00" $967.20 $544.05 $239.96 N/A $701.22 "$1,209.00" $725.40 "$1,209.00" $251.96 "$1,209.00" N/A N/A 2150125 SUP HCPCS C1713 2150125 - SCREW BONE 25MM DIVERGENCE-L SPN BOTH IP/OP "$1,209.00" $895.00 $239.96 "$1,209.00" $544.05 $544.05 $544.05 $544.05 "$1,209.00" "$1,209.00" "$1,209.00" $251.99 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $251.97 "$1,209.00" $483.60 $715.12 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $906.75 "$1,209.00" "$1,209.00" "$1,209.00" $604.50 $604.50 $957.53 "$1,209.00" $967.20 $544.05 $239.96 N/A $701.22 "$1,209.00" $725.40 "$1,209.00" $251.96 "$1,209.00" N/A N/A 2150130 SUP HCPCS C1713 2150130 - SCREW BONE 6.5MM 30MM DIVERGENCE-L SPN BOTH IP/OP "$1,209.00" $895.00 $239.96 "$1,209.00" $544.05 $544.05 $544.05 $544.05 "$1,209.00" "$1,209.00" "$1,209.00" $251.99 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $251.97 "$1,209.00" "$1,209.00" $715.12 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $906.75 "$1,209.00" "$1,209.00" "$1,209.00" $604.50 $604.50 $957.53 "$1,209.00" $967.20 $544.05 $239.96 N/A $701.22 "$1,209.00" $725.40 "$1,209.00" $251.96 "$1,209.00" N/A N/A 2150135 SUP HCPCS C1713 2150135 - SCREW BONE 6.5MM 35MM DIVERGENCE-L SPN BOTH IP/OP "$1,209.00" $895.00 $239.96 "$1,209.00" $544.05 $544.05 $544.05 $544.05 "$1,209.00" "$1,209.00" "$1,209.00" $251.99 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $251.97 "$1,209.00" "$1,209.00" $715.12 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $906.75 "$1,209.00" "$1,209.00" "$1,209.00" $604.50 $604.50 $957.53 "$1,209.00" $967.20 $544.05 $239.96 N/A $701.22 "$1,209.00" $725.40 "$1,209.00" $251.96 "$1,209.00" N/A N/A 2150140 SUP HCPCS C1713 2150140 - SCREW BONE 6.5MM 40MM DIVERGENCE-L SPN BOTH IP/OP "$1,209.00" $895.00 $239.96 "$1,209.00" $544.05 $544.05 $544.05 $544.05 "$1,209.00" "$1,209.00" "$1,209.00" $251.99 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $251.97 "$1,209.00" $483.60 $715.12 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $906.75 "$1,209.00" "$1,209.00" "$1,209.00" $604.50 $604.50 $957.53 "$1,209.00" $967.20 $544.05 $239.96 N/A $701.22 "$1,209.00" "$1,209.00" "$1,209.00" $251.96 "$1,209.00" N/A N/A 2151110 SUP HCPCS C1713 2151110 - CAGE SPNL 6D SM 32X25X10MM DIVERGENCE-L ANT OBLQ LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151112 SUP HCPCS C1713 2151112 - CAGE SPNL 32X25X12MM DIVERGENCE-L 6D SM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151114 SUP HCPCS C1713 2151114 - CAGE SPNL 6D SM 32X25X14MM DIVERGENCE-L ANT OBLQ LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151116 SUP HCPCS C1713 2151116 - CAGE SPNL 6D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151118 SUP HCPCS C1713 2151118 - CAGE SPNL 6D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151120 SUP HCPCS C1713 2151120 - CAGE SPNL 6D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151210 SUP HCPCS C1713 2151210 - CAGE SPNL 6D MED 37X29X10MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151212 SUP HCPCS C1713 2151212 - CAGE SPNL 6D MED 37X29X12MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151214 SUP HCPCS C1713 2151214 - CAGE SPNL 6D MED 37X29X14MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151216 SUP HCPCS C1713 2151216 - CAGE SPNL 6D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151218 SUP HCPCS C1713 2151218 - CAGE SPNL 6D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151220 SUP HCPCS C1713 2151220 - CAGE SPNL 6D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151310 SUP HCPCS C1713 2151310 - CAGE SPNL 6D LG 42X32X10MM DIVERGENCE-L ANT OBLQ LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151312 SUP HCPCS C1713 2151312 - CAGE SPNL 6D LG 42X32X12MM DIVERGENCE-L ANT OBLQ LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151314 SUP HCPCS C1713 2151314 - CAGE SPNL 6D LG 42X32X14MM DIVERGENCE-L ANT OBLQ LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151316 SUP HCPCS C1713 2151316 - CAGE SPNL 6D LG 42X32X16MM DIVERGENCE-L ANT OBLQ LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151318 SUP HCPCS C1713 2151318 - CAGE SPNL 6D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2151320 SUP HCPCS C1713 2151320 - CAGE SPNL 6D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152110 SUP HCPCS C1713 2152110 - CAGE SPNL 12D SM 32X25X10MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152112 SUP HCPCS C1713 2152112 - CAGE SPNL 12D SM 32X25X12MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152114 SUP HCPCS C1713 2152114 - CAGE SPNL 12D SM 32X25X14MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152116 SUP HCPCS C1713 2152116 - CAGE SPNL 12D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152118 SUP HCPCS C1713 2152118 - CAGE SPNL 12D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152120 SUP HCPCS C1713 2152120 - CAGE SPNL 12D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152210 SUP HCPCS C1713 2152210 - CAGE SPNL 12D MED 37X29X10MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152212 SUP HCPCS C1713 2152212 - CAGE SPNL 12D MED 37X29X12MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152214 SUP HCPCS C1713 2152214 - CAGE SPNL 12D MED 37X29X14MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152216 SUP HCPCS C1713 2152216 - CAGE SPNL 12D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152218 SUP HCPCS C1713 2152218 - CAGE SPNL 12D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152220 SUP HCPCS C1713 2152220 - CAGE SPNL 12D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152312 SUP HCPCS C1713 2152312 - CAGE SPNL 12D LG 42X32X12MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152314 SUP HCPCS C1713 2152314 - CAGE SPNL 12D LG 42X32X14MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152316 SUP HCPCS C1713 2152316 - CAGE SPNL 12D LG 42X32X16MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152318 SUP HCPCS C1713 2152318 - CAGE SPNL 12D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2152320 SUP HCPCS C1713 2152320 - CAGE SPNL 12D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2153112 SUP HCPCS C1713 2153112 - CAGE SPNL 18D SM 32X25X12MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2153114 SUP HCPCS C1713 2153114 - CAGE SPNL 18D SM 32X25X14MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2153116 SUP HCPCS C1713 2153116 - CAGE SPNL 18D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2153118 SUP HCPCS C1713 2153118 - CAGE SPNL 18D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2153120 SUP HCPCS C1713 2153120 - CAGE SPNL 18D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2153214 SUP HCPCS C1713 2153214 - CAGE SPNL 18D MED 37X29X14MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2153216 SUP HCPCS C1713 2153216 - CAGE SPNL 18D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2153218 SUP HCPCS C1713 2153218 - CAGE SPNL 18D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2153220 SUP HCPCS C1713 2153220 - CAGE SPNL 18D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2153316 SUP HCPCS C1713 2153316 - CAGE SPNL 18D LG 42X32X16MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2153318 SUP HCPCS C1713 2153318 - CAGE SPNL 18D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2153320 SUP HCPCS C1713 2153320 - CAGE SPNL 18D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2154116 SUP HCPCS C1713 2154116 - CAGE SPNL 24D SM 32X25X16MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2154118 SUP HCPCS C1713 2154118 - CAGE SPNL 24D SM 32X25X18MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2154120 SUP HCPCS C1713 2154120 - CAGE SPNL 24D SM 32X25X20MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2154216 SUP HCPCS C1713 2154216 - CAGE SPNL 24D MED 37X29X16MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2154218 SUP HCPCS C1713 2154218 - CAGE SPNL 24D MED 37X29X18MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2154220 SUP HCPCS C1713 2154220 - CAGE SPNL 24D MED 37X29X20MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2154318 SUP HCPCS C1713 2154318 - CAGE SPNL 24D LG 42X32X18MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2154320 SUP HCPCS C1713 2154320 - CAGE SPNL 24D LG 42X32X20MM DIVERGENCE-L ANT OBLQ LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2160010 SUP HCPCS C1713 2160010 - PLATE SPNL 10MM DIVERGENCE-L ALIF BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$3,795.00" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 2160012 SUP HCPCS C1713 2160012 - PLATE SPNL 12MM DIVERGENCE-L ALIF BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$3,795.00" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A Jan-11 SUP HCPCS C1713 01-8611 - PLATE BN SM MESH CNTR ANTM EZ MODIFICATION MN SHRP EDG RT BOTH IP/OP "$4,677.50" "$3,461.00" $928.37 "$4,677.50" "$2,104.88" "$2,104.88" "$2,104.88" "$2,104.88" "$4,677.50" "$4,677.50" "$4,677.50" $974.91 "$4,677.50" "$4,677.50" "$4,677.50" "$4,677.50" "$4,677.50" $974.84 "$4,677.50" "$1,871.00" "$2,306.01" "$4,677.50" "$4,677.50" "$4,677.50" "$4,677.50" "$3,508.13" "$4,677.50" "$4,677.50" "$4,677.50" "$2,338.75" "$2,338.75" "$3,704.58" "$4,677.50" "$3,742.00" "$2,104.88" $928.37 N/A "$2,712.95" "$4,677.50" "$4,677.50" "$4,677.50" $974.79 "$4,677.50" N/A N/A Jan-12 SUP HCPCS C1713 01-8612 - PLATE BN LG MESH CNTR ANTM EZ MODIFICATION MN SHRP EDG LT BOTH IP/OP "$4,837.50" "$3,580.00" $960.12 "$4,837.50" "$2,176.88" "$2,176.88" "$2,176.88" "$2,176.88" "$4,837.50" "$4,837.50" "$4,837.50" "$1,008.26" "$4,837.50" "$4,837.50" "$4,837.50" "$4,837.50" "$4,837.50" "$1,008.19" "$4,837.50" "$1,935.00" "$2,384.89" "$4,837.50" "$4,837.50" "$4,837.50" "$4,837.50" "$3,628.13" "$4,837.50" "$4,837.50" "$4,837.50" "$2,418.75" "$2,418.75" "$3,831.30" "$4,837.50" "$3,870.00" "$2,176.88" $960.12 N/A "$2,805.75" "$4,837.50" "$2,902.50" "$4,837.50" "$1,008.14" "$4,837.50" N/A N/A Jan-36 SUP HCPCS C1713 01-8636 - PLATE BONE LONG 3X3 HOLE L RIGID DELTA GOLD LEFT BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A Jan-62 SUP HCPCS C1713 01-8662 - PLATE BONE 8 HOLE STR RIGID TRAUMAONE GOLD TITANIUM MIDFAC BOTH IP/OP $872.50 $646.00 $173.17 $872.50 $392.63 $392.63 $392.63 $392.63 $872.50 $872.50 $872.50 $181.85 $872.50 $872.50 $872.50 $872.50 $872.50 $181.84 $872.50 $872.50 $516.08 $872.50 $872.50 $872.50 $872.50 $654.38 $872.50 $872.50 $872.50 $436.25 $436.25 $691.02 $872.50 $698.00 $392.63 $173.17 N/A $506.05 $872.50 $523.50 $872.50 $181.83 $872.50 N/A N/A Jan-64 SUP HCPCS C1713 01-8664 - PLATE BONE 4 HOLE STR RIGID TRAUMAONE GOLD TITANIUM MIDFAC BOTH IP/OP $872.50 $646.00 $173.17 $872.50 $392.63 $392.63 $392.63 $392.63 $872.50 $872.50 $872.50 $181.85 $872.50 $872.50 $872.50 $872.50 $872.50 $181.84 $872.50 $872.50 $516.08 $872.50 $872.50 $872.50 $872.50 $654.38 $872.50 $872.50 $872.50 $436.25 $436.25 $691.02 $872.50 $698.00 $392.63 $173.17 N/A $506.05 $872.50 $872.50 $872.50 $181.83 $872.50 N/A N/A Jan-70 SUP HCPCS C1713 01-8670 - PLATE BONE LONG STR 20 HOLE RIGID SYSTEM LORENZ TRAUMAONE BOTH IP/OP "$1,510.00" "$1,117.00" $299.70 "$1,510.00" $679.50 $679.50 $679.50 $679.50 "$1,510.00" "$1,510.00" "$1,510.00" $314.72 "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" $314.70 "$1,510.00" "$1,510.00" $893.17 "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" "$1,132.50" "$1,510.00" "$1,510.00" "$1,510.00" $755.00 $755.00 "$1,195.92" "$1,510.00" "$1,208.00" $679.50 $299.70 N/A $875.80 "$1,510.00" $906.00 "$1,510.00" $314.68 "$1,510.00" N/A N/A Jan-78 SUP HCPCS C1713 01-8678 - PLATE BONE 2X2 HOLE L RIGID LORENZ TRAUMAONE GOLD LEFT BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A Jan-79 SUP HCPCS C1713 01-8679 - PLATE BONE 2X2 HOLE L RIGID LORENZ TRAUMAONE GOLD RIGHT BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A Jan-80 SUP HCPCS C1713 01-8680 - PLATE BONE LONG 4X6 HOLE L RIGID TRAUMAONE GOLD TITANIUM BOTH IP/OP "$1,015.00" $751.00 $201.45 "$1,015.00" $456.75 $456.75 $456.75 $456.75 "$1,015.00" "$1,015.00" "$1,015.00" $211.55 "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" $211.54 "$1,015.00" "$1,015.00" $600.37 "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" $761.25 "$1,015.00" "$1,015.00" "$1,015.00" $507.50 $507.50 $803.88 "$1,015.00" $812.00 $456.75 $201.45 N/A $588.70 "$1,015.00" $609.00 "$1,015.00" $211.53 "$1,015.00" N/A N/A Jan-81 SUP HCPCS C1713 01-8681 - PLATE BONE LONG 4X6 HOLE L RIGID TRAUMAONE GOLD TITANIUM BOTH IP/OP "$1,015.00" $751.00 $201.45 "$1,015.00" $456.75 $456.75 $456.75 $456.75 "$1,015.00" "$1,015.00" "$1,015.00" $211.55 "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" $211.54 "$1,015.00" $406.00 $600.37 "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" $761.25 "$1,015.00" "$1,015.00" "$1,015.00" $507.50 $507.50 $803.88 "$1,015.00" $812.00 $456.75 $201.45 N/A $588.70 "$1,015.00" $609.00 "$1,015.00" $211.53 "$1,015.00" N/A N/A Jan-89 SUP HCPCS C1713 01-8689 - PLATE BONE LONG 14 HOLE CVD RIGID TRAUMAONE GOLD TITANIUM BOTH IP/OP "$1,102.50" $816.00 $218.82 "$1,102.50" $496.13 $496.13 $496.13 $496.13 "$1,102.50" "$1,102.50" "$1,102.50" $229.79 "$1,102.50" "$1,102.50" "$1,102.50" "$1,102.50" "$1,102.50" $229.77 "$1,102.50" "$1,102.50" $652.13 "$1,102.50" "$1,102.50" "$1,102.50" "$1,102.50" $826.88 "$1,102.50" "$1,102.50" "$1,102.50" $551.25 $551.25 $873.18 "$1,102.50" $882.00 $496.13 $218.82 N/A $639.45 "$1,102.50" "$1,102.50" "$1,102.50" $229.76 "$1,102.50" N/A N/A Jan-92 SUP Custom 27203010 01-9192 - TW DRILL 1.5X50MM 5MM STP W/NT BOTH IP/OP $435.00 $322.00 $77.43 $435.00 $435.00 $435.00 $435.00 $435.00 $435.00 $435.00 $77.43 $435.00 $435.00 $322.86 $322.86 $335.30 $226.64 $90.66 $435.00 $174.00 $435.00 $435.00 $435.00 $435.00 $435.00 $326.25 $435.00 $435.00 $435.00 $217.50 $217.50 $344.52 $435.00 $348.00 $282.75 $435.00 N/A $252.30 $435.00 $261.00 $435.00 $435.00 $435.00 N/A N/A Jan-93 SUP Custom 27203010 01-9193 - DRILL TWIST 1.5MM 50MM 7MM STOP TRAUMAONE BOTH IP/OP $435.00 $322.00 $77.43 $435.00 $435.00 $435.00 $435.00 $435.00 $435.00 $435.00 $77.43 $435.00 $435.00 $322.86 $322.86 $335.30 $226.64 $90.66 $435.00 $174.00 $435.00 $435.00 $435.00 $435.00 $435.00 $326.25 $435.00 $435.00 $435.00 $217.50 $217.50 $344.52 $435.00 $348.00 $282.75 $435.00 N/A $252.30 $435.00 $261.00 $435.00 $435.00 $435.00 N/A N/A Jan-20 SUP HCPCS C1781 01-9520 - MESH SURG SMALL .6MM ETCHED LABEL ANATOMIC AESTHETIC BOTH IP/OP "$16,200.00" "$11,988.00" "$3,215.30" "$16,200.00" "$7,290.00" "$7,290.00" "$7,290.00" "$7,290.00" "$16,200.00" "$16,200.00" "$16,200.00" "$3,376.49" "$16,200.00" "$16,200.00" "$16,200.00" "$16,200.00" "$16,200.00" "$3,376.26" "$16,200.00" "$16,200.00" "$7,986.60" "$16,200.00" "$16,200.00" "$16,200.00" "$16,200.00" "$12,150.00" "$16,200.00" "$16,200.00" "$16,200.00" "$8,100.00" "$8,100.00" "$12,830.40" "$16,200.00" "$12,960.00" "$7,290.00" "$3,215.30" N/A "$9,396.00" "$16,200.00" "$16,200.00" "$16,200.00" "$3,376.08" "$16,200.00" N/A N/A Jan-21 SUP HCPCS C1781 01-9521 - MESH SURG SMALL .6MM ETCHED LABEL ANATOMIC AESTHETIC BOTH IP/OP "$18,900.00" "$13,986.00" "$3,751.18" "$18,900.00" "$8,505.00" "$8,505.00" "$8,505.00" "$8,505.00" "$18,900.00" "$18,900.00" "$18,900.00" "$3,939.23" "$18,900.00" "$18,900.00" "$18,900.00" "$18,900.00" "$18,900.00" "$3,938.97" "$18,900.00" "$18,900.00" "$9,317.70" "$18,900.00" "$18,900.00" "$18,900.00" "$18,900.00" "$14,175.00" "$18,900.00" "$18,900.00" "$18,900.00" "$9,450.00" "$9,450.00" "$14,968.80" "$18,900.00" "$15,120.00" "$8,505.00" "$3,751.18" N/A "$10,962.00" "$18,900.00" "$18,900.00" "$18,900.00" "$3,938.76" "$18,900.00" N/A N/A Jan-22 SUP HCPCS C1781 01-9522 - MESH SURG SMALL .6MM ETCHED LABEL ANATOMIC AESTHETIC BOTH IP/OP "$18,900.00" "$13,986.00" "$3,751.18" "$18,900.00" "$8,505.00" "$8,505.00" "$8,505.00" "$8,505.00" "$18,900.00" "$18,900.00" "$18,900.00" "$3,939.23" "$18,900.00" "$18,900.00" "$18,900.00" "$18,900.00" "$18,900.00" "$3,938.97" "$18,900.00" "$18,900.00" "$9,317.70" "$18,900.00" "$18,900.00" "$18,900.00" "$18,900.00" "$14,175.00" "$18,900.00" "$18,900.00" "$18,900.00" "$9,450.00" "$9,450.00" "$14,968.80" "$18,900.00" "$15,120.00" "$8,505.00" "$3,751.18" N/A "$10,962.00" "$18,900.00" "$18,900.00" "$18,900.00" "$3,938.76" "$18,900.00" N/A N/A Jan-23 SUP HCPCS C1781 01-9523 - MESH SURG LARGE .6MM ETCHED LABEL ANATOMIC AESTHETIC BOTH IP/OP "$21,060.00" "$15,584.00" "$4,179.88" "$21,060.00" "$9,477.00" "$9,477.00" "$9,477.00" "$9,477.00" "$21,060.00" "$21,060.00" "$21,060.00" "$4,389.43" "$21,060.00" "$21,060.00" "$21,060.00" "$21,060.00" "$21,060.00" "$4,389.14" "$21,060.00" "$21,060.00" "$10,382.58" "$21,060.00" "$21,060.00" "$21,060.00" "$21,060.00" "$15,795.00" "$21,060.00" "$21,060.00" "$21,060.00" "$10,530.00" "$10,530.00" "$16,679.52" "$21,060.00" "$16,848.00" "$9,477.00" "$4,179.88" N/A "$12,214.80" "$21,060.00" "$21,060.00" "$21,060.00" "$4,388.90" "$21,060.00" N/A N/A Jan-24 SUP HCPCS C1781 01-9524 - MESH SURG LARGE .6MM ETCHED LABEL ANATOMIC AESTHETIC BOTH IP/OP "$21,060.00" "$15,584.00" "$4,179.88" "$21,060.00" "$9,477.00" "$9,477.00" "$9,477.00" "$9,477.00" "$21,060.00" "$21,060.00" "$21,060.00" "$4,389.43" "$21,060.00" "$21,060.00" "$21,060.00" "$21,060.00" "$21,060.00" "$4,389.14" "$21,060.00" "$21,060.00" "$10,382.58" "$21,060.00" "$21,060.00" "$21,060.00" "$21,060.00" "$15,795.00" "$21,060.00" "$21,060.00" "$21,060.00" "$10,530.00" "$10,530.00" "$16,679.52" "$21,060.00" "$16,848.00" "$9,477.00" "$4,179.88" N/A "$12,214.80" "$21,060.00" "$21,060.00" "$21,060.00" "$4,388.90" "$21,060.00" N/A N/A 2800724 SUP HCPCS C1713 2800724 - CAGE SPNL 0D 24MMX7MM STRL FUSE TI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2800824 SUP HCPCS C1713 2800824 - CAGE SPNL 0D 24MMX8MM STRL FUSE TI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2840924 SUP HCPCS C1713 2840924 - CAGE SPNL 4D 24MMX9MM STRL FUSE TI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2841024 SUP HCPCS C1713 2841024 - CAGE SPNL 4D 24MMX10MM STRL FUSE TI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2841124 SUP HCPCS C1713 2841124 - CAGE SPNL 4D 24MMX11MM STRL FUSE TI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2841224 SUP HCPCS C1713 2841224 - CAGE SPNL 4D 24MMX12MM STRL FUSE TI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2841324 SUP HCPCS C1713 2841324 - CAGE SPNL 4D 24MMX13MM STRL FUSE TI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2841424 SUP HCPCS C1713 2841424 - CAGE SPNL 4D 24MMX14MM STRL FUSE TI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2880924 SUP HCPCS C1713 2880924 - CAGE SPNL 8D 24MMX9MM FUSE TI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2881024 SUP HCPCS C1713 2881024 - CAGE SPNL 8D 24MMX10MM FUSE TI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2881124 SUP HCPCS C1713 2881124 - CAGE SPNL 8D 24MMX11MM FUSE TI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2881224 SUP HCPCS C1713 2881224 - CAGE SPNL 8D 24MMX12MM FUSE TI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2881324 SUP HCPCS C1713 2881324 - CAGE SPNL 8D 24MMX13MM FUSE TI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2881424 SUP HCPCS C1713 2881424 - CAGE SPNL 8D 24MMX14MM FUSE TI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 2920040 SUP Custom 27803010 2920040 - CAGE SPNL 0D 40X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920045 SUP Custom 27803010 2920045 - CAGE SPNL 0D 45X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920050 SUP Custom 27803010 2920050 - CAGE SPNL 0D 50X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920055 SUP Custom 27803010 2920055 - CAGE SPNL 0D 55X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920060 SUP Custom 27803010 2920060 - CAGE SPNL 0D 60X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920240 SUP Custom 27803010 2920240 - CAGE SPNL 0D 40X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920245 SUP Custom 27803010 2920245 - CAGE SPNL 0D 45X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920250 SUP Custom 27803010 2920250 - CAGE SPNL 0D 50X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920255 SUP Custom 27803010 2920255 - CAGE SPNL 0D 55X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920260 SUP Custom 27803010 2920260 - CAGE SPNL 0D 60X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920440 SUP Custom 27803010 2920440 - CAGE SPNL 0D 40X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920445 SUP Custom 27803010 2920445 - CAGE SPNL 0D 45X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920450 SUP Custom 27803010 2920450 - CAGE SPNL 0D 50X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920455 SUP Custom 27803010 2920455 - CAGE SPNL 0D 55X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920460 SUP Custom 27803010 2920460 - CAGE SPNL 0D 60X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920640 SUP Custom 27803010 2920640 - CAGE SPNL 0D 40X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920645 SUP Custom 27803010 2920645 - CAGE SPNL 0D 45X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920650 SUP Custom 27803010 2920650 - CAGE SPNL 0D 50X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920655 SUP Custom 27803010 2920655 - CAGE SPNL 0D 55X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920660 SUP Custom 27803010 2920660 - CAGE SPNL 0D 60X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920840 SUP Custom 27803010 2920840 - CAGE SPNL 0D 40X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920845 SUP Custom 27803010 2920845 - CAGE SPNL 0D 45X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920850 SUP Custom 27803010 2920850 - CAGE SPNL 0D 50X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920855 SUP Custom 27803010 2920855 - CAGE SPNL 0D 55X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2920860 SUP Custom 27803010 2920860 - CAGE SPNL 0D 60X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922040 SUP Custom 27803010 2922040 - CAGE SPNL 12D 40X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922045 SUP Custom 27803010 2922045 - CAGE SPNL 12D 45X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922050 SUP Custom 27803010 2922050 - CAGE SPNL 12D 50X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922055 SUP Custom 27803010 2922055 - CAGE SPNL 12D 55X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922060 SUP Custom 27803010 2922060 - CAGE SPNL 12D 60X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922240 SUP Custom 27803010 2922240 - CAGE SPNL 12D 40X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922245 SUP Custom 27803010 2922245 - CAGE SPNL 12D 45X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922250 SUP Custom 27803010 2922250 - CAGE SPNL 12D 50X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922255 SUP Custom 27803010 2922255 - CAGE SPNL 12D 55X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922260 SUP Custom 27803010 2922260 - CAGE SPNL 12D 60X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922440 SUP Custom 27803010 2922440 - CAGE SPNL 12D 40X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922445 SUP Custom 27803010 2922445 - CAGE SPNL 12D 45X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922450 SUP Custom 27803010 2922450 - CAGE SPNL 12D 50X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922455 SUP Custom 27803010 2922455 - CAGE SPNL 12D 55X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922460 SUP Custom 27803010 2922460 - CAGE SPNL 12D 60X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922640 SUP Custom 27803010 2922640 - CAGE SPNL 12D 40X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922645 SUP Custom 27803010 2922645 - CAGE SPNL 12D 45X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922650 SUP Custom 27803010 2922650 - CAGE SPNL 12D 50X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922655 SUP Custom 27803010 2922655 - CAGE SPNL 12D 55X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2922660 SUP Custom 27803010 2922660 - CAGE SPNL 12D 60X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926040 SUP Custom 27803010 2926040 - CAGE SPNL 6D 40X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926045 SUP Custom 27803010 2926045 - CAGE SPNL 6D 45X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926050 SUP Custom 27803010 2926050 - CAGE SPNL 6D 50X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926055 SUP Custom 27803010 2926055 - CAGE SPNL 6D 55X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926060 SUP Custom 27803010 2926060 - CAGE SPNL 6D 60X22X10MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926240 SUP Custom 27803010 2926240 - CAGE SPNL 6D 40X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926245 SUP Custom 27803010 2926245 - CAGE SPNL 6D 45X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926250 SUP Custom 27803010 2926250 - CAGE SPNL 6D 50X22X12MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926255 SUP Custom 27803010 2926255 - CAGE SPNL 6D 22X12X55MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926260 SUP Custom 27803010 2926260 - CAGE SPNL 6D 60X12X22MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926440 SUP Custom 27803010 2926440 - CAGE SPNL 6D 40X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926445 SUP Custom 27803010 2926445 - CAGE SPNL 6D 45X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926450 SUP Custom 27803010 2926450 - CAGE SPNL 6D 50X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926455 SUP Custom 27803010 2926455 - CAGE SPNL 6D 55X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926460 SUP Custom 27803010 2926460 - CAGE SPNL 6D 60X22X14MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926640 SUP Custom 27803010 2926640 - CAGE SPNL 6D 40X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926645 SUP Custom 27803010 2926645 - CAGE SPNL 6D 45X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926650 SUP Custom 27803010 2926650 - CAGE SPNL 6D 50X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926655 SUP Custom 27803010 2926655 - CAGE SPNL 6D 55X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926660 SUP Custom 27803010 2926660 - CAGE SPNL 6D 60X22X16MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926840 SUP Custom 27803010 2926840 - CAGE SPNL 6D 40X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926845 SUP Custom 27803010 2926845 - CAGE SPNL 6D 45X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926850 SUP Custom 27803010 2926850 - CAGE SPNL 6D 50X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926855 SUP Custom 27803010 2926855 - CAGE SPNL 6D 55X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2926860 SUP Custom 27803010 2926860 - CAGE SPNL 6D 60X22X8MM STRL CLYDESDALE RADOPQ PEEK LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2960822 SUP Custom 27803010 2960822 - SPACER SPNL 22MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 2960826 SUP HCPCS C1713 2960826 - SPACER SPNL 26MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2960832 SUP Custom 27803010 2960832 - SPACER SPNL 32MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2960836 SUP Custom 27803010 2960836 - SPACER SPNL 36MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2961022 SUP Custom 27803010 2961022 - SPACER SPNL 22MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 2961026 SUP HCPCS C1713 2961026 - SPACER SPNL 26MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2961032 SUP Custom 27803010 2961032 - SPACER SPNL 32MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2961036 SUP Custom 27803010 2961036 - SPACER SPNL 36MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2961222 SUP Custom 27803010 2961222 - SPACER SPNL 22MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 2961226 SUP Custom 27803010 2961226 - SPACER SPNL 26MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2961232 SUP Custom 27803010 2961232 - SPACER SPNL 32MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2961236 SUP Custom 27803010 2961236 - SPACER SPNL 36MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2961422 SUP Custom 27803010 2961422 - SPACER SPNL 22MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 2961426 SUP Custom 27803010 2961426 - SPACER SPNL 26X14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2961432 SUP Custom 27803010 2961432 - SPACER SPNL 32MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2961436 SUP Custom 27803010 2961436 - SPACER SPNL 36X14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2962036 SUP HCPCS C1713 2962036 - SPACER SPNL 36MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2962040 SUP HCPCS C1713 2962040 - SPACER SPNL 40MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2962044 SUP HCPCS C1713 2962044 - SPACER SPNL 44MMX10MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2962236 SUP HCPCS C1713 2962236 - SPACER SPNL 36MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2962240 SUP HCPCS C1713 2962240 - SPACER SPNL 40MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2962244 SUP HCPCS C1713 2962244 - SPACER SPNL 44MMX12MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2962436 SUP HCPCS C1713 2962436 - SPACER SPNL 36MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2962440 SUP HCPCS C1713 2962440 - SPACER SPNL 40MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2962444 SUP HCPCS C1713 2962444 - SPACER SPNL 44MMX14MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2962836 SUP HCPCS C1713 2962836 - SPACER SPNL 36MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2962840 SUP HCPCS C1713 2962840 - SPACER SPNL 40MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2962844 SUP HCPCS C1713 2962844 - SPACER SPNL 44MMX8MM VRTSTCK CPSTN END PC PEEK-OPTM LMBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$8,750.00" "$4,313.75" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 2968040 SUP Custom 27803010 2968040 - CAGE SPNL 6D 40MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968045 SUP Custom 27803010 2968045 - CAGE SPNL 6D 45MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968050 SUP Custom 27803010 2968050 - CAGE SPNL 6D 50MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968055 SUP Custom 27803010 2968055 - CAGE SPNL 6D 55MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968060 SUP Custom 27803010 2968060 - CAGE SPNL 6D 60MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968240 SUP Custom 27803010 2968240 - CAGE SPNL 6D 40MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968245 SUP Custom 27803010 2968245 - CAGE SPNL 6D 45MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968250 SUP Custom 27803010 2968250 - CAGE SPNL 6D 50MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968255 SUP Custom 27803010 2968255 - CAGE SPNL 6D 55MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968260 SUP Custom 27803010 2968260 - CAGE SPNL 6D 60MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968440 SUP Custom 27803010 2968440 - CAGE SPNL 6D 40MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968445 SUP Custom 27803010 2968445 - CAGE SPNL 6D 45MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968450 SUP Custom 27803010 2968450 - CAGE SPNL 6D 50MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968455 SUP Custom 27803010 2968455 - CAGE SPNL 6D 55MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968460 SUP Custom 27803010 2968460 - CAGE SPNL 6D 60MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968640 SUP Custom 27803010 2968640 - CAGE SPNL 6D 40MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968645 SUP Custom 27803010 2968645 - CAGE SPNL 6D 45MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968650 SUP Custom 27803010 2968650 - CAGE SPNL 6D 50MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968655 SUP Custom 27803010 2968655 - CAGE SPNL 6D 55MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968660 SUP Custom 27803010 2968660 - CAGE SPNL 6D 60MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968840 SUP Custom 27803010 2968840 - CAGE SPNL 6D 40MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968845 SUP Custom 27803010 2968845 - CAGE SPNL 6D 45MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968850 SUP Custom 27803010 2968850 - CAGE SPNL 6D 50MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968855 SUP Custom 27803010 2968855 - CAGE SPNL 6D 55MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2968860 SUP Custom 27803010 2968860 - CAGE SPNL 6D 60MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969040 SUP Custom 27803010 2969040 - CAGE SPNL 0D 40MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969045 SUP Custom 27803010 2969045 - CAGE SPNL 0D 45MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969050 SUP Custom 27803010 2969050 - CAGE SPNL 0D 50MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969055 SUP Custom 27803010 2969055 - CAGE SPNL 0D 55MMX10MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969240 SUP Custom 27803010 2969240 - CAGE SPNL 0D 40MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969245 SUP Custom 27803010 2969245 - CAGE SPNL 0D 45MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969250 SUP Custom 27803010 2969250 - CAGE SPNL 0D 50MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969255 SUP Custom 27803010 2969255 - CAGE SPNL 0D 55MMX12MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969440 SUP Custom 27803010 2969440 - CAGE SPNL 0D 40MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969445 SUP Custom 27803010 2969445 - CAGE SPNL 0D 45MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969450 SUP Custom 27803010 2969450 - CAGE SPNL 0D 50MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969455 SUP Custom 27803010 2969455 - CAGE SPNL 0D 55MMX14MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969640 SUP Custom 27803010 2969640 - CAGE SPNL 0D 40MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969645 SUP Custom 27803010 2969645 - CAGE SPNL 0D 45MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969650 SUP Custom 27803010 2969650 - CAGE SPNL 0D 50MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969655 SUP Custom 27803010 2969655 - CAGE SPNL 0D 55MMX16MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969840 SUP Custom 27803010 2969840 - CAGE SPNL 0D 40MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969845 SUP Custom 27803010 2969845 - CAGE SPNL 0D 45MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969850 SUP Custom 27803010 2969850 - CAGE SPNL 0D 50MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2969855 SUP Custom 27803010 2969855 - CAGE SPNL 0D 55MMX8MM LF CLYDESDALE RADOPQ HLW PEEK-OPTM BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 2990622 SUP HCPCS C1713 2990622 - SPACER SPNL 22MMX6MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2990626 SUP HCPCS C1713 2990626 - SPACER SPNL 26MMX6MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2990722 SUP HCPCS C1713 2990722 - SPACER SPNL 22MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2990726 SUP HCPCS C1713 2990726 - SPACER SPNL 26MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2990732 SUP HCPCS C1713 2990732 - SPACER SPNL 32MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2990736 SUP HCPCS C1713 2990736 - SPACER SPNL 36MMX7MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2990822 SUP Custom 27803010 2990822 - SPACER SPNL 22MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 2990826 SUP Custom 27803010 2990826 - SPACER SPNL 26MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2990832 SUP Custom 27803010 2990832 - SPACER SPNL 32MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2990836 SUP Custom 27803010 2990836 - SPACER SPNL 36MMX8MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2990922 SUP HCPCS C1713 2990922 - SPACER SPNL 22MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2990926 SUP HCPCS C1713 2990926 - SPACER SPNL 26MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2990932 SUP HCPCS C1713 2990932 - SPACER SPNL 32MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2990936 SUP HCPCS C1713 2990936 - SPACER SPNL 36MMX9MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM LMBR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2991022 SUP Custom 27803010 2991022 - SPACER SPNL 22MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 2991026 SUP Custom 27803010 2991026 - SPACER SPNL 26MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2991032 SUP Custom 27803010 2991032 - SPACER SPNL 32MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2991036 SUP Custom 27803010 2991036 - SPACER SPNL 36MMX10MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2991122 SUP HCPCS C1713 2991122 - SPACER SPNL 22MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2991126 SUP HCPCS C1713 2991126 - SPACER SPNL 26MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2991132 SUP HCPCS C1713 2991132 - SPACER SPNL 32MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2991136 SUP HCPCS C1713 2991136 - SPACER SPNL 36MMX11MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2991222 SUP Custom 27803010 2991222 - SPACER SPNL 22MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 2991226 SUP Custom 27803010 2991226 - SPACER SPNL 26MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2991232 SUP Custom 27803010 2991232 - SPACER SPNL 32MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2991236 SUP Custom 27803010 2991236 - SPACER SPNL 36MMX12MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2991322 SUP HCPCS C1713 2991322 - SPACER SPNL 22MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2991326 SUP HCPCS C1713 2991326 - SPACER SPNL 26MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2991332 SUP HCPCS C1713 2991332 - SPACER SPNL 32MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2991336 SUP HCPCS C1713 2991336 - SPACER SPNL 36MMX13MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2991422 SUP Custom 27803010 2991422 - SPACER SPNL 22MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 2991426 SUP Custom 27803010 2991426 - SPACER SPNL 26MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2991432 SUP Custom 27803010 2991432 - SPACER SPNL 32MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2991436 SUP Custom 27803010 2991436 - SPACER SPNL 36MMX14MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2991522 SUP HCPCS C1713 2991522 - SPACER SPNL 22MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2991526 SUP HCPCS C1713 2991526 - SPACER SPNL 26MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2991532 SUP HCPCS C1713 2991532 - SPACER SPNL 32MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2991536 SUP HCPCS C1713 2991536 - SPACER SPNL 36MMX15MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 2991622 SUP Custom 27803010 2991622 - SPACER SPNL 22MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 2991626 SUP Custom 27803010 2991626 - SPACER SPNL 26MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2991632 SUP Custom 27803010 2991632 - SPACER SPNL 32MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 2991636 SUP Custom 27803010 2991636 - SPACER SPNL 36MMX16MM STRL LF CPSTN SLF DSTRCT PEEK-OPTM BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 3001015 SUP HCPCS C1713 3001015 - PLATE BN 15MM ZEVO 1 LVL TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3001017 SUP HCPCS C1713 3001017 - PLATE BN 17MM ZEVO 1 LVL TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3001019 SUP HCPCS C1713 3001019 - PLATE BN 19MM ZEVO 1 LVL TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 3001021 SUP HCPCS C1713 3001021 - PLATE BN 21MM ZEVO 1 LVL TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3001023 SUP HCPCS C1713 3001023 - PLATE BN 23MM ZEVO 1 LVL TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3001027 SUP HCPCS C1713 3001027 - PLATE 27MM TI LVL 1 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3001029 SUP HCPCS C1713 3001029 - PLATE 29MM TI LVL 1 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3001031 SUP HCPCS C1713 3001031 - PLATE 31MM TI LVL 1 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3002035 SUP HCPCS C1713 3002035 - PLATE BN 35MM ZEVO 2 LVL TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3002039 SUP HCPCS C1713 3002039 - PLATE BN 39MM ZEVO 2 LVL TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3002043 SUP HCPCS C1713 3002043 - PLATE 43MM TI LVL 2 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 3002045 SUP HCPCS C1713 3002045 - PLATE BN 45MM ZEVO 2 LVL TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 3002047 SUP HCPCS C1713 3002047 - PLATE 47MM TI LVL 2 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 3002048 SUP HCPCS C1713 3002048 - PLATE BN 48MM ZEVO 2 LVL TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 3002049 SUP HCPCS C1713 3002049 - PLATE 49MM TI LVL 2 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 3002051 SUP HCPCS C1713 3002051 - PLATE BN 51MM ZEVO 2 LVL TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 3002053 SUP HCPCS C1713 3002053 - PLATE 53MM TI LVL 2 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 3003047 SUP HCPCS C1713 3003047 - PLATE BN 47MM ZEVO 3 LVL TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 3003049 SUP HCPCS C1713 3003049 - PLATE 49MM TI LVL 3 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 3003055 SUP HCPCS C1713 3003055 - PLATE BN 55MM ZEVO LVL 3 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 3003063 SUP HCPCS C1713 3003063 - PLATE BN 63MM ZEVO LVL 3 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 3003065 SUP HCPCS C1713 3003065 - PLATE 65MM TI LVL 3 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 3003067 SUP HCPCS C1713 3003067 - PLATE 67MM TI LVL 3 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 3003068 SUP HCPCS C1713 3003068 - PLATE 68MM TI LVL 3 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 3003069 SUP HCPCS C1713 3003069 - PLATE 69MM TI LVL 3 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 3003071 SUP HCPCS C1713 3003071 - PLATE 71MM TI LVL 3 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 3004071 SUP HCPCS C1713 3004071 - PLATE 71MM TI LVL 4 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 3004073 SUP HCPCS C1713 3004073 - PLATE BN 73MM ZEVO 4 LVL TI SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 3004075 SUP HCPCS C1713 3004075 - PLATE BN 75MM ZEVO 4 LVL TI SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 3004077 SUP HCPCS C1713 3004077 - PLATE 77MM TI LVL 4 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 3004078 SUP HCPCS C1713 3004078 - PLATE BN 78MM ZEVO 4 LVL TI SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 3004079 SUP HCPCS C1713 3004079 - PLATE 79MM TI LVL 4 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 3004081 SUP HCPCS C1713 3004081 - PLATE 81MM TI LVL 4 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 3004083 SUP HCPCS C1713 3004083 - PLATE 83MM TI LVL 4 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 3004085 SUP HCPCS C1713 3004085 - PLATE 85MM TI LVL 4 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 3004086 SUP HCPCS C1713 3004086 - PLATE 86MM TI LVL 4 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 3004087 SUP HCPCS C1713 3004087 - PLATE 87MM TI LVL 4 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 3004089 SUP HCPCS C1713 3004089 - PLATE 89MM TI LVL 4 ZEVO BONE SPN CERV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 3005075 SUP HCPCS C1713 3005075 - PLATE 75MM TI LVL 5 ZEVO BONE SPN CERV ANT BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 3005077 SUP HCPCS C1713 3005077 - PLATE 77MM TI LVL 5 ZEVO BONE SPN CERV ANT BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$1,200.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 3005079 SUP HCPCS C1713 3005079 - PLATE 79MM TI LVL 5 ZEVO BONE SPN CERV ANT BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$1,200.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 3005081 SUP HCPCS C1713 3005081 - PLATE 81MM TI LVL 5 ZEVO BONE SPN CERV ANT BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$1,200.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 3005085 SUP HCPCS C1713 3005085 - PLATE 85MM TI LVL 5 ZEVO BONE SPN CERV ANT BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$1,200.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 3005090 SUP HCPCS C1713 3005090 - PLATE 90MM TI LVL 5 ZEVO BONE SPN CERV ANT BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$1,200.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 3005095 SUP HCPCS C1713 3005095 - PLATE 95MM TI LVL 5 ZEVO BONE SPN CERV ANT BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 3005100 SUP HCPCS C1713 3005100 - PLATE 100MM TI LVL 5 ZEVO BONE SPN CERV ANT BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 3005105 SUP HCPCS C1713 3005105 - PLATE 105MM TI LVL 5 ZEVO BONE SPN CERV ANT BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 3005108 SUP HCPCS C1713 3005108 - PLATE 108MM TI LVL 5 ZEVO BONE SPN CERV ANT BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$1,200.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 3034001 SUP Custom 27203010 3034001 - DRILL BIT 3034001 ADJUSTABLE STERILE BOTH IP/OP $501.00 $371.00 $89.18 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $89.18 $501.00 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $200.40 $501.00 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $501.00 N/A $290.58 $501.00 $300.60 $501.00 $501.00 $501.00 N/A N/A 3120211 SUP HCPCS C1713 3120211 - SCREW BN 4MM 11MM NS ATLNTS ST FX ANG TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120212 SUP HCPCS C1713 3120212 - SCREW BONE 4MM 12MM FIX ANGLE SELF TAP ATLANTIS TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120213 SUP HCPCS C1713 3120213 - SCREW BONE 4MM 13MM FIX ANGLE SELF TAP ATLANTIS TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3120214 SUP HCPCS C1713 3120214 - SCREW BONE 4MM 14MM SELF TAP FIX ANGLE ATLANTIS TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3120215 SUP HCPCS C1713 3120215 - SCREW BN 4MM 15MM NS ATLNTS ST FX ANG TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120216 SUP HCPCS C1713 3120216 - SCREW BONE 4MM 16MM FIX ANGLE SELF TAP ATLANTIS TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120217 SUP HCPCS C1713 3120217 - SCREW BN 4MM 17MM NS ATLNTS ST FX ANG TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120218 SUP HCPCS C1713 3120218 - SCREW BONE 4MM 18MM SLFTAP FIX ATLANTIS TRANSLATIONAL BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120219 SUP HCPCS C1713 3120219 - SCREW BONE 4MM 19MM SLFTAP FIX SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120220 SUP HCPCS C1713 3120220 - SCREW BONE 4MM 20MM SLFTAP FIX SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120311 SUP HCPCS C1713 3120311 - SCREW BN 4MM 11MM NS ATLNTS ST VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120312 SUP HCPCS C1713 3120312 - SCREW BONE 4MM 12MM SELF TAP VAR ANG ATLANTIS TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120313 SUP HCPCS C1713 3120313 - SCREW BONE 4MM 13MM VAR ANG SELF TAP ATLANTIS TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120314 SUP HCPCS C1713 3120314 - SCREW BN 4MM 14MM NS ATLNTS ST VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120315 SUP HCPCS C1713 3120315 - SCREW BN 4MM 15MM NS ATLNTS ST VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120316 SUP HCPCS C1713 3120316 - SCREW BN 4MM 16MM NS ATLNTS ST VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120317 SUP HCPCS C1713 3120317 - SCREW BN 4MM 17MM NS ATLNTS ST VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3120318 SUP HCPCS C1713 3120318 - SCREW BONE 4MM 18MM SELF TAP VAR ANG SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120319 SUP HCPCS C1713 3120319 - SCREW BONE 4MM 19MM SELF TAP VAR ANG SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120320 SUP HCPCS C1713 3120320 - SCREW BONE 4MM 20MM SLFTAP VAR ANG SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120411 SUP HCPCS C1713 3120411 - SCREW BONE 4MM 11MM SELF DRILL FIX ANGLE ATLANTIS TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120412 SUP HCPCS C1713 3120412 - SCREW BN 4MM 12MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3120413 SUP HCPCS C1713 3120413 - SCREW BN 4MM 13MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120414 SUP HCPCS C1713 3120414 - SCREW BN 4MM 14MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120415 SUP HCPCS C1713 3120415 - SCREW BN 4MM 15MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120416 SUP HCPCS C1713 3120416 - SCREW BN 4MM 16MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3120417 SUP HCPCS C1713 3120417 - SCREW BONE 4MM 17MM SELF DRILL FIX ANGLE ATLANTIS TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120419 SUP HCPCS C1713 3120419 - SCREW BONE ANGLE FIX 1MM 19MM SELF DRILL ATLANTIS TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120420 SUP HCPCS C1713 3120420 - SCREW BONE ANGLE FIX 1MM 20MM SELF DRILL ATLANTIS TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120511 SUP HCPCS C1713 3120511 - SCREW BN 4MM 11MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120512 SUP HCPCS C1713 3120512 - SCREW BN 4MM 12MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120513 SUP HCPCS C1713 3120513 - SCREW BN 4MM 13MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120514 SUP HCPCS C1713 3120514 - SCREW BN 4MM 14MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120515 SUP HCPCS C1713 3120515 - SCREW BN 4MM 15MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120516 SUP HCPCS C1713 3120516 - SCREW BN 4MM 16MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120517 SUP HCPCS C1713 3120517 - SCREW BN 4MM 17MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3120518 SUP HCPCS C1713 3120518 - SCREW BONE 4MM 18MM SLFDRILL VAR ANG SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120519 SUP HCPCS C1713 3120519 - SCREW BONE 4MM 19MM SLFDRILL VAR ANG SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3120520 SUP HCPCS C1713 3120520 - SCREW BONE 4MM 20MM SLFDRILL VAR ANG SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3125211 SUP HCPCS C1713 3125211 - SCREW BONE 4.5MM 11MM FIX ANGLE SELF TAP ATLANTIS TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3125213 SUP HCPCS C1713 3125213 - SCREW BONE 4.5MM 13MM FIX ANGLE SELF TAP ATLANTIS TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3125215 SUP HCPCS C1713 3125215 - SCREW BONE 4.5MM 15MM FIX ANGLE SELF TAP ATLANTIS TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3125217 SUP HCPCS C1713 3125217 - SCREW BN 4.5MM 17MM NS ATLNTS ST FX ANG TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3125311 SUP HCPCS C1713 3125311 - SCREW BONE 4.5MM 11MM VAR ANG SELF TAP ATLANTIS TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3125313 SUP HCPCS C1713 3125313 - SCREW BONE 4.5MM 13MM VAR ANG SELF TAP ATLANTIS TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3125315 SUP HCPCS C1713 3125315 - SCREW BONE 4.5MM 15MM SELF TAP VAR ANG ATLANTIS TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3125317 SUP HCPCS C1713 3125317 - SCREW BONE 4.5MM 17MM VAR ANG SELF TAP ATLANTIS TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3125411 SUP HCPCS C1713 3125411 - SCREW BONE 4.5MM 11MM FIX ANGLE SELF DRILL ATLANTIS TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3125413 SUP HCPCS C1713 3125413 - SCREW BN 4.5MM 13MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3125415 SUP HCPCS C1713 3125415 - SCREW BN 4.5MM 15MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3125417 SUP HCPCS C1713 3125417 - SCREW BN 4.5MM 17MM NS ATLNTS SLF DRL FX ANG TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3125511 SUP HCPCS C1713 3125511 - SCREW BONE 4.5MM 11MM VAR ANG SELF DRILL ATLANTIS TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3125513 SUP HCPCS C1713 3125513 - SCREW BN 4.5MM 13MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3125515 SUP HCPCS C1713 3125515 - SCREW BN 4.5MM 15MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 3125517 SUP HCPCS C1713 3125517 - SCREW BN 4.5MM 17MM NS ATLNTS SLF DRL VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3125520 SUP HCPCS C1713 3125520 - SCREW BONE 4.5MM 20MM VAR ANG SELF DRILL ATLANTIS TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 3155648 SUP Custom 27203010 3155648 - BURR SURG .8MM LOW FRICTION SLEEVE BEARING OTO-FLEX SKEETER BOTH IP/OP $507.50 $376.00 $90.34 $507.50 $507.50 $507.50 $507.50 $507.50 $507.50 $507.50 $90.34 $507.50 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $203.00 $507.50 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $507.50 N/A $294.35 $507.50 $304.50 $507.50 $507.50 $507.50 N/A N/A 3200028 SUP Custom 27203010 3200028 - KIT SPNL MAXCESS SHIM FX BOTH IP/OP $920.00 $681.00 $163.76 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $920.00 $163.76 $920.00 $920.00 $682.82 $682.82 $709.14 $479.32 $191.74 $920.00 $368.00 $920.00 $920.00 $920.00 $920.00 $920.00 $690.00 $920.00 $920.00 $920.00 $460.00 $460.00 $728.64 $920.00 $736.00 $598.00 $920.00 N/A $533.60 $920.00 $552.00 $920.00 $920.00 $920.00 N/A N/A 3200060 SUP Custom 27203010 3200060 - KIT SPINAL MODULE MAXCESS STERILE DISPOSABLE BOTH IP/OP "$3,765.00" "$2,786.00" $670.17 "$3,765.00" "$3,765.00" "$3,765.00" "$3,765.00" "$3,765.00" "$3,765.00" "$3,765.00" $670.17 "$3,765.00" "$3,765.00" "$2,794.38" "$2,794.38" "$2,902.06" "$1,961.57" $784.67 "$3,765.00" "$1,506.00" "$3,765.00" "$3,765.00" "$3,765.00" "$3,765.00" "$3,765.00" "$2,823.75" "$3,765.00" "$3,765.00" "$3,765.00" "$1,882.50" "$1,882.50" "$2,981.88" "$3,765.00" "$3,012.00" "$2,447.25" "$3,765.00" N/A "$2,183.70" "$3,765.00" "$2,259.00" "$3,765.00" "$3,765.00" "$3,765.00" N/A N/A 3230101 SUP HCPCS C1713 3230101 - WIRE FIX 13.5IN KWIRE SPN BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $49.00 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $73.50 $122.50 $25.53 $122.50 N/A N/A 3240060 SUP Custom 27803010 3240060 - RETRACTOR SURG MAXCESS 4 DISPOSABLE BOTH IP/OP "$4,000.00" "$2,960.00" $712.00 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $712.00 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$1,600.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" "$4,000.00" N/A "$2,320.00" "$4,000.00" "$2,400.00" "$4,000.00" "$4,000.00" "$4,000.00" N/A N/A 3240061 SUP Custom 27203010 3240061 - KIT SPNL MAXCESS4 SHIM DISP BOTH IP/OP "$2,957.50" "$2,189.00" $526.44 "$2,957.50" "$2,957.50" "$2,957.50" "$2,957.50" "$2,957.50" "$2,957.50" "$2,957.50" $526.44 "$2,957.50" "$2,957.50" "$2,195.06" "$2,195.06" "$2,279.64" "$1,540.86" $616.38 "$2,957.50" "$1,183.00" "$2,957.50" "$2,957.50" "$2,957.50" "$2,957.50" "$2,957.50" "$2,218.13" "$2,957.50" "$2,957.50" "$2,957.50" "$1,478.75" "$1,478.75" "$2,342.34" "$2,957.50" "$2,366.00" "$1,922.38" "$2,957.50" N/A "$1,715.35" "$2,957.50" "$1,774.50" "$2,957.50" "$2,957.50" "$2,957.50" N/A N/A 3391208 SUP HCPCS C1713 3391208 - SPACER SPNL 4D SM 8MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3391210 SUP HCPCS C1713 3391210 - SPACER SPNL 4D SM 10MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3391212 SUP HCPCS C1713 3391212 - SPACER SPNL 4D SM 12MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3391214 SUP HCPCS C1713 3391214 - SPACER SPNL 4D SM 14MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3392308 SUP Custom 27803010 3392308 - SPACER SPNL 8D MED 8MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 3392310 SUP Custom 27803010 3392310 - SPACER SPNL 8D MED 10MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 3392312 SUP Custom 27803010 3392312 - SPACER SPNL 8D MED 12MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 3392314 SUP Custom 27803010 3392314 - SPACER SPNL 8D MED 14MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 3392316 SUP Custom 27803010 3392316 - SPACER SPNL 8D MED 16MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 3392318 SUP HCPCS C1713 3392318 - SPACER SPNL 8D MED 18MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3392320 SUP HCPCS C1713 3392320 - SPACER SPNL 8D MED 20MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3393308 SUP Custom 27803010 3393308 - SPACER SPNL 8D LG 8MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 3393310 SUP Custom 27803010 3393310 - SPACER SPNL 8D LG 10MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 3393312 SUP Custom 27803010 3393312 - SPACER SPNL 8D LG 12MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 3393314 SUP Custom 27803010 3393314 - SPACER SPNL 8D LG 14MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 3393316 SUP Custom 27803010 3393316 - SPACER SPNL 8D LG 16MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 3393318 SUP HCPCS C1713 3393318 - SPACER SPNL 8D LG 18MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3393320 SUP HCPCS C1713 3393320 - SPACER SPNL 8D LG 20MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3393412 SUP Custom 27803010 3393412 - SPACER SPNL 12D LG 12MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 3393414 SUP Custom 27803010 3393414 - SPACER SPNL 12D LG 14MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 3393416 SUP Custom 27803010 3393416 - SPACER SPNL 12D LG 16MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 3393418 SUP HCPCS C1713 3393418 - SPACER SPNL 12D LG 18MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3393420 SUP HCPCS C1713 3393420 - SPACER SPNL 12D LG 20MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3394310 SUP HCPCS C1713 3394310 - SPACER SPNL 8D XL 8MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3394312 SUP HCPCS C1713 3394312 - SPACER SPNL 8D XL 12MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3394314 SUP HCPCS C1713 3394314 - SPACER SPNL 8D XL 14MM PRIMTR ADON PEEK-OPTM ALIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3400014 SUP HCPCS C1713 3400014 - SPACER SPNL TLIF HOOD SHIM BOTH IP/OP $920.00 $681.00 $182.60 $920.00 $414.00 $414.00 $414.00 $414.00 $920.00 $920.00 $920.00 $191.75 $920.00 $920.00 $920.00 $920.00 $920.00 $191.74 $920.00 $920.00 $544.18 $920.00 $920.00 $920.00 $920.00 $690.00 $920.00 $920.00 $920.00 $460.00 $460.00 $728.64 $920.00 $736.00 $414.00 $182.60 N/A $533.60 $920.00 $552.00 $920.00 $191.73 $920.00 N/A N/A 3400033 SUP Custom 27203010 3400033 - KIT SPNL MAS LGHT CBL SLFRET TLIF BOTH IP/OP "$1,087.50" $805.00 $193.58 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $193.58 "$1,087.50" "$1,087.50" $807.14 $807.14 $838.25 $566.59 $226.65 "$1,087.50" $435.00 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $706.88 "$1,087.50" N/A $630.75 "$1,087.50" $652.50 "$1,087.50" "$1,087.50" "$1,087.50" N/A N/A 3491208 SUP HCPCS C1713 3491208 - SPACER SPNL 4D LRDTC SM 8MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3491210 SUP HCPCS C1713 3491210 - SPACER SPNL 4D LRDTC SM 10MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3491212 SUP HCPCS C1713 3491212 - SPACER SPNL 4D LRDTC SM 12MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3491214 SUP HCPCS C1713 3491214 - SPACER SPNL 4D LRDTC SM 14MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3491216 SUP HCPCS C1713 3491216 - SPACER SPNL 4D LRDTC SM 16MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3491218 SUP HCPCS C1713 3491218 - SPACER SPNL 4D LRDTC SM 18MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3491220 SUP HCPCS C1713 3491220 - SPACER SPNL 4D LRDTC SM 20MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3492308 SUP HCPCS C1713 3492308 - SPACER SPNL 8D LRDTC MED 8MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3492310 SUP HCPCS C1713 3492310 - SPACER SPNL 8D LRDTC MED 10MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3492312 SUP HCPCS C1713 3492312 - SPACER SPNL 8D LRDTC MED 12MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3492314 SUP HCPCS C1713 3492314 - SPACER SPNL 8D LRDTC MED 14MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3492316 SUP HCPCS C1713 3492316 - SPACER SPNL 8D LRDTC MED 16MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3492318 SUP HCPCS C1713 3492318 - SPACER SPNL 8D LRDTC MED 18MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3492320 SUP HCPCS C1713 3492320 - SPACER SPNL 8D LRDTC MED 20MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493308 SUP HCPCS C1713 3493308 - SPACER SPNL 8D LRDTC LG 8MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493310 SUP HCPCS C1713 3493310 - SPACER SPNL 8D LRDTC LG 10MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493312 SUP HCPCS C1713 3493312 - SPACER SPNL 8D LRDTC LG 12MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493314 SUP HCPCS C1713 3493314 - SPACER SPNL 8D LRDTC LG 14MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493316 SUP HCPCS C1713 3493316 - SPACER SPNL 8D LRDTC LG 16MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493318 SUP HCPCS C1713 3493318 - SPACER SPNL 8D LRDTC LG 18MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493320 SUP HCPCS C1713 3493320 - SPACER SPNL 8D LRDTC LG 20MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493412 SUP HCPCS C1713 3493412 - SPACER SPNL 12D LRDTC LG 12MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493414 SUP HCPCS C1713 3493414 - SPACER SPNL 12D LRDTC LG 14MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493416 SUP HCPCS C1713 3493416 - SPACER SPNL 12D LRDTC LG 16MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493418 SUP HCPCS C1713 3493418 - SPACER SPNL 12D LRDTC LG 18MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493420 SUP HCPCS C1713 3493420 - SPACER SPNL 12D LRDTC LG 20MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493512 SUP HCPCS C1713 3493512 - SPACER SPNL 15D LRDTC LG 12MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493514 SUP HCPCS C1713 3493514 - SPACER SPNL 15D LRDTC LG 14MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493516 SUP HCPCS C1713 3493516 - SPACER SPNL 15D LRDTC LG 16MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493518 SUP HCPCS C1713 3493518 - SPACER SPNL 15D LRDTC LG 18MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3493520 SUP HCPCS C1713 3493520 - SPACER SPNL 15D LRDTC LG 20MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3494310 SUP HCPCS C1713 3494310 - SPACER SPNL 8D LRDTC XL 10MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3494312 SUP HCPCS C1713 3494312 - SPACER SPNL 8D LRDTC XL 12MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3494314 SUP HCPCS C1713 3494314 - SPACER SPNL 8D LRDTC XL 14MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3494316 SUP HCPCS C1713 3494316 - SPACER SPNL 8D LRDTC XL 16MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3494318 SUP HCPCS C1713 3494318 - SPACER SPNL 8D LRDTC XL 18MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3494320 SUP HCPCS C1713 3494320 - SPACER SPNL 8D LRDTC XL 20MM PRIMTR VERT BD REPL BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3549213 SUP HCPCS C1789 3549213 - EXPANDER TISS P7CM CNTR PRFL MED HT 12.7X10.8CM 450ML CPX4 BOTH IP/OP "$2,937.50" "$2,174.00" $583.02 "$2,937.50" "$1,321.88" "$1,321.88" "$1,321.88" "$1,321.88" "$2,937.50" "$2,937.50" "$2,937.50" $612.25 "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" $612.21 "$2,937.50" "$2,937.50" "$1,448.19" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,203.13" "$2,937.50" "$2,937.50" "$2,937.50" "$1,468.75" "$1,468.75" "$2,326.50" "$2,937.50" "$2,350.00" "$1,321.88" $583.02 N/A "$1,703.75" "$2,937.50" "$2,937.50" "$2,937.50" $612.18 "$2,937.50" N/A N/A 3549214 SUP HCPCS C1789 3549214 - EXPANDER TISS P7.4CM CNTR PRFL MED HT 13.5X11.7CM 550ML CPX4 BOTH IP/OP "$2,937.50" "$2,174.00" $583.02 "$2,937.50" "$1,321.88" "$1,321.88" "$1,321.88" "$1,321.88" "$2,937.50" "$2,937.50" "$2,937.50" $612.25 "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" $612.21 "$2,937.50" "$2,937.50" "$1,448.19" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,203.13" "$2,937.50" "$2,937.50" "$2,937.50" "$1,468.75" "$1,468.75" "$2,326.50" "$2,937.50" "$2,350.00" "$1,321.88" $583.02 N/A "$1,703.75" "$2,937.50" "$2,937.50" "$2,937.50" $612.18 "$2,937.50" N/A N/A 3549215 SUP HCPCS C1789 3549215 - EXPANDER TISS P7.6CM CNTR PRFL MED HT 14.6X12.6CM 650ML CPX4 BOTH IP/OP "$2,937.50" "$2,174.00" $583.02 "$2,937.50" "$1,321.88" "$1,321.88" "$1,321.88" "$1,321.88" "$2,937.50" "$2,937.50" "$2,937.50" $612.25 "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" $612.21 "$2,937.50" "$2,937.50" "$1,448.19" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,203.13" "$2,937.50" "$2,937.50" "$2,937.50" "$1,468.75" "$1,468.75" "$2,326.50" "$2,937.50" "$2,350.00" "$1,321.88" $583.02 N/A "$1,703.75" "$2,937.50" "$2,937.50" "$2,937.50" $612.18 "$2,937.50" N/A N/A 3549216 SUP HCPCS C1789 3549216 - EXPANDER TISS P8CM CNTR PRFL MED HT 15.6X13.3CM 800ML CPX4 BOTH IP/OP "$2,937.50" "$2,174.00" $583.02 "$2,937.50" "$1,321.88" "$1,321.88" "$1,321.88" "$1,321.88" "$2,937.50" "$2,937.50" "$2,937.50" $612.25 "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" $612.21 "$2,937.50" "$2,937.50" "$1,448.19" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,203.13" "$2,937.50" "$2,937.50" "$2,937.50" "$1,468.75" "$1,468.75" "$2,326.50" "$2,937.50" "$2,350.00" "$1,321.88" $583.02 N/A "$1,703.75" "$2,937.50" "$2,937.50" "$2,937.50" $612.18 "$2,937.50" N/A N/A 3600200 SUP HCPCS C1713 3600200 - ROD SPNL 3.5MM 200MM ADJ TI OCT BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,980.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 3600201 SUP HCPCS C1713 3600201 - ROD SPNL 3.5MM 200MM PRECURVE BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 3600210 SUP HCPCS C1713 3600210 - ROD SPNL 3.5MM 200MM ADJ COCRMO OCT BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,980.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 3600211 SUP HCPCS C1713 3600211 - ROD SPNL 3.5MM 200MM PRECURVE COCRMO BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 3600300 SUP HCPCS C1713 3600300 - CONNECTOR ROD STD EYLT SPNE OCT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3600301 SUP HCPCS C1713 3600301 - CONNECTOR ROD OFST EYLT SPNE OCT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3600315 SUP HCPCS C1713 3600315 - SCREW SET STD SPNE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 3600406 SUP HCPCS C1713 3600406 - SCREW BN 4.5MM 6MM SPNE OCT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $719.00 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 3600408 SUP HCPCS C1713 3600408 - SCREW BN 4.5MM 8MM SPNE OCT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $719.00 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 3600410 SUP HCPCS C1713 3600410 - SCREW BN 4.5MM 10MM SPNE OCT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $719.00 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 3600412 SUP HCPCS C1713 3600412 - SCREW BN 4.5MM 12MM SPNE OCT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $719.00 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 3600414 SUP HCPCS C1713 3600414 - SCREW BN 4.5MM 14MM SPNE OCT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $287.60 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 3600506 SUP HCPCS C1713 3600506 - SCREW BN 5MM 6MM SPNE OCT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $287.60 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 3600508 SUP HCPCS C1713 3600508 - SCREW BN 5MM 8MM SPNE OCT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $287.60 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 3600510 SUP HCPCS C1713 3600510 - SCREW BN 5MM 10MM SPNE OCT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $719.00 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 3600512 SUP HCPCS C1713 3600512 - SCREW BN 5MM 12MM SPNE OCT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $719.00 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 3600514 SUP HCPCS C1713 3600514 - SCREW BN 5MM 14MM SPNE OCT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $287.60 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 3600600 SUP HCPCS C1713 3600600 - PLATE BN SM ADJ SPNE OCT BOTH IP/OP "$7,095.00" "$5,250.00" "$1,408.18" "$7,095.00" "$3,192.75" "$3,192.75" "$3,192.75" "$3,192.75" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.78" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.68" "$7,095.00" "$7,095.00" "$3,497.84" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$5,321.25" "$7,095.00" "$7,095.00" "$7,095.00" "$3,547.50" "$3,547.50" "$5,619.24" "$7,095.00" "$5,676.00" "$3,192.75" "$1,408.18" N/A "$4,115.10" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.60" "$7,095.00" N/A N/A 3600601 SUP HCPCS C1713 3600601 - PLATE BN ADJ SPNE OCT BOTH IP/OP "$7,095.00" "$5,250.00" "$1,408.18" "$7,095.00" "$3,192.75" "$3,192.75" "$3,192.75" "$3,192.75" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.78" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.68" "$7,095.00" "$2,838.00" "$3,497.84" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$5,321.25" "$7,095.00" "$7,095.00" "$7,095.00" "$3,547.50" "$3,547.50" "$5,619.24" "$7,095.00" "$5,676.00" "$3,192.75" "$1,408.18" N/A "$4,115.10" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.60" "$7,095.00" N/A N/A 3601350 SUP HCPCS C1713 3601350 - CONNECTOR ROD OFST DMN SPNE 3.5/5.5MM ROD BOTH IP/OP "$1,458.00" "$1,079.00" $289.38 "$1,458.00" $656.10 $656.10 $656.10 $656.10 "$1,458.00" "$1,458.00" "$1,458.00" $303.88 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" "$1,458.00" $862.41 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 $289.38 N/A $845.64 "$1,458.00" "$1,458.00" "$1,458.00" $303.85 "$1,458.00" N/A N/A 3601475 SUP HCPCS C1713 3601475 - CONNECTOR ROD OFST DMN SPNE 3.5-4.75MM ROD BOTH IP/OP "$1,458.00" "$1,079.00" $289.38 "$1,458.00" $656.10 $656.10 $656.10 $656.10 "$1,458.00" "$1,458.00" "$1,458.00" $303.88 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" "$1,458.00" $862.41 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 $289.38 N/A $845.64 "$1,458.00" "$1,458.00" "$1,458.00" $303.85 "$1,458.00" N/A N/A 3601510 SUP HCPCS C1713 3601510 - CONNECTOR ROD 10MM CLS SPNE LAT BOTH IP/OP "$1,018.50" $754.00 $202.15 "$1,018.50" $458.33 $458.33 $458.33 $458.33 "$1,018.50" "$1,018.50" "$1,018.50" $212.28 "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" $212.27 "$1,018.50" "$1,018.50" $602.44 "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" $763.88 "$1,018.50" "$1,018.50" "$1,018.50" $509.25 $509.25 $806.65 "$1,018.50" $814.80 $458.33 $202.15 N/A $590.73 "$1,018.50" "$1,018.50" "$1,018.50" $212.26 "$1,018.50" N/A N/A 3601550 SUP HCPCS C1713 3601550 - CONNECTOR ROD OFST DMN SPNE 3.5-5.5/6MM ROD BOTH IP/OP "$1,458.00" "$1,079.00" $289.38 "$1,458.00" $656.10 $656.10 $656.10 $656.10 "$1,458.00" "$1,458.00" "$1,458.00" $303.88 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" "$1,458.00" $862.41 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 $289.38 N/A $845.64 "$1,458.00" "$1,458.00" "$1,458.00" $303.85 "$1,458.00" N/A N/A 3602240 SUP HCPCS C1713 3602240 - ROD SPNL STD 3.2MM 240MM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 3602510 SUP HCPCS C1713 3602510 - CONNECTOR ROD 10MM OPN SPNE LAT BOTH IP/OP "$1,077.00" $797.00 $213.76 "$1,077.00" $484.65 $484.65 $484.65 $484.65 "$1,077.00" "$1,077.00" "$1,077.00" $224.47 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $224.46 "$1,077.00" "$1,077.00" $637.05 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $807.75 "$1,077.00" "$1,077.00" "$1,077.00" $538.50 $538.50 $852.98 "$1,077.00" $861.60 $484.65 $213.76 N/A $624.66 "$1,077.00" "$1,077.00" "$1,077.00" $224.45 "$1,077.00" N/A N/A 3602526 SUP HCPCS C1713 3602526 - CONNECTOR ROD MED MAS TO MAS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3602536 SUP HCPCS C1713 3602536 - CONNECTOR ROD MED ROD TO ROD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3602615 SUP HCPCS C1713 3602615 - SCREW SET FLT CNCT SPNE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 3603350 SUP HCPCS C1713 3603350 - CONNECTOR ROD OFST DMN SPNE 3.5-3.5MM ROD BOTH IP/OP "$1,458.00" "$1,079.00" $289.38 "$1,458.00" $656.10 $656.10 $656.10 $656.10 "$1,458.00" "$1,458.00" "$1,458.00" $303.88 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" "$1,458.00" $862.41 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 $289.38 N/A $845.64 "$1,458.00" "$1,458.00" "$1,458.00" $303.85 "$1,458.00" N/A N/A 3603475 SUP HCPCS C1713 3603475 - CONNECTOR ROD OFST DMN SPNE 3.5-4.75MM ROD BOTH IP/OP "$1,458.00" "$1,079.00" $289.38 "$1,458.00" $656.10 $656.10 $656.10 $656.10 "$1,458.00" "$1,458.00" "$1,458.00" $303.88 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" $583.20 $862.41 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 $289.38 N/A $845.64 "$1,458.00" "$1,458.00" "$1,458.00" $303.85 "$1,458.00" N/A N/A 3603512 SUP HCPCS C1713 3603512 - SCREW BN 3.5MM 12MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3603514 SUP HCPCS C1713 3603514 - SCREW BN 3.5MM 14MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3603516 SUP HCPCS C1713 3603516 - SCREW BN 3.5MM 16MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3603520 SUP HCPCS C1713 3603520 - SCREW BN 3.5MM 20MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3603522 SUP HCPCS C1713 3603522 - SCREW BN 3.5MM 22MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3603524 SUP HCPCS C1713 3603524 - SCREW BN 3.5MM 24MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3603526 SUP HCPCS C1713 3603526 - SCREW BN 3.5MM 26MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3603528 SUP HCPCS C1713 3603528 - SCREW BN 3.5MM 28MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3603530 SUP HCPCS C1713 3603530 - SCREW BN 3.5MM 30MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3603532 SUP HCPCS C1713 3603532 - SCREW BN 3.5MM 32MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3603534 SUP HCPCS C1713 3603534 - SCREW BN 3.5MM 34MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3603635 SUP HCPCS C1713 3603635 - CONNECTOR ROD OFST DMN SPNE 5.5/6/6.35MM ROD BOTH IP/OP "$1,458.00" "$1,079.00" $289.38 "$1,458.00" $656.10 $656.10 $656.10 $656.10 "$1,458.00" "$1,458.00" "$1,458.00" $303.88 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" "$1,458.00" $862.41 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 $289.38 N/A $845.64 "$1,458.00" "$1,458.00" "$1,458.00" $303.85 "$1,458.00" N/A N/A 3603706 SUP HCPCS C1713 3603706 - ROD SPNL TPR 4.75MM 420MM 3.5MM SCR BOTH IP/OP "$2,103.00" "$1,556.00" $417.39 "$2,103.00" $946.35 $946.35 $946.35 $946.35 "$2,103.00" "$2,103.00" "$2,103.00" $438.32 "$2,103.00" "$2,103.00" "$2,103.00" "$2,103.00" "$2,103.00" $438.29 "$2,103.00" $841.20 "$1,243.92" "$2,103.00" "$2,103.00" "$2,103.00" "$2,103.00" "$1,577.25" "$2,103.00" "$2,103.00" "$2,103.00" "$1,051.50" "$1,051.50" "$1,665.58" "$2,103.00" "$1,682.40" $946.35 $417.39 N/A "$1,219.74" "$2,103.00" "$2,103.00" "$2,103.00" $438.27 "$2,103.00" N/A N/A 3603707 SUP HCPCS C1713 3603707 - ROD SPNL TPR 5.5 420MM 3.5MM SCR BOTH IP/OP "$2,103.00" "$1,556.00" $417.39 "$2,103.00" $946.35 $946.35 $946.35 $946.35 "$2,103.00" "$2,103.00" "$2,103.00" $438.32 "$2,103.00" "$2,103.00" "$2,103.00" "$2,103.00" "$2,103.00" $438.29 "$2,103.00" "$2,103.00" "$1,243.92" "$2,103.00" "$2,103.00" "$2,103.00" "$2,103.00" "$1,577.25" "$2,103.00" "$2,103.00" "$2,103.00" "$1,051.50" "$1,051.50" "$1,665.58" "$2,103.00" "$1,682.40" $946.35 $417.39 N/A "$1,219.74" "$2,103.00" "$2,103.00" "$2,103.00" $438.27 "$2,103.00" N/A N/A 3603725 SUP HCPCS C1713 3603725 - ROD SPNL 3.5MM 25MM PCUT BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 3603730 SUP HCPCS C1713 3603730 - ROD SPNL 3.5MM 30MM PCUT BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 3603740 SUP HCPCS C1713 3603740 - ROD SPNL 3.5MM 40MM PCUT BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 3603750 SUP HCPCS C1713 3603750 - ROD SPNL 3.5MM 50MM PCUT BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 3603760 SUP HCPCS C1713 3603760 - ROD SPNL 3.5MM 60MM PCUT BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 3603770 SUP HCPCS C1713 3603770 - ROD SPNL 3.5MM 70MM PCUT BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 3603780 SUP HCPCS C1713 3603780 - ROD SPNL 3.5MM 80MM PCUT BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 3603806 SUP HCPCS C1713 3603806 - ROD SPNL TPR 4.75MM 420MM COCRMO 3.5MM SCR BOTH IP/OP "$2,362.50" "$1,748.00" $468.90 "$2,362.50" "$1,063.13" "$1,063.13" "$1,063.13" "$1,063.13" "$2,362.50" "$2,362.50" "$2,362.50" $492.40 "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" $492.37 "$2,362.50" $945.00 "$1,397.42" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$1,771.88" "$2,362.50" "$2,362.50" "$2,362.50" "$1,181.25" "$1,181.25" "$1,871.10" "$2,362.50" "$1,890.00" "$1,063.13" $468.90 N/A "$1,370.25" "$2,362.50" "$2,362.50" "$2,362.50" $492.35 "$2,362.50" N/A N/A 3603807 SUP HCPCS C1713 3603807 - ROD SPNL TPR 5.5MM 420MM COCRMO 3.5MM SCR BOTH IP/OP "$2,362.50" "$1,748.00" $468.90 "$2,362.50" "$1,063.13" "$1,063.13" "$1,063.13" "$1,063.13" "$2,362.50" "$2,362.50" "$2,362.50" $492.40 "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" $492.37 "$2,362.50" "$2,362.50" "$1,397.42" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$1,771.88" "$2,362.50" "$2,362.50" "$2,362.50" "$1,181.25" "$1,181.25" "$1,871.10" "$2,362.50" "$1,890.00" "$1,063.13" $468.90 N/A "$1,370.25" "$2,362.50" "$2,362.50" "$2,362.50" $492.35 "$2,362.50" N/A N/A 3604012 SUP HCPCS C1713 3604012 - SCREW BN 4MM 12MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604014 SUP HCPCS C1713 3604014 - SCREW BN 4MM 14MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604016 SUP HCPCS C1713 3604016 - SCREW BN 4MM 16MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604018 SUP HCPCS C1713 3604018 - SCREW BN 4MM 18MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604020 SUP HCPCS C1713 3604020 - SCREW BN 4MM 20MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604022 SUP HCPCS C1713 3604022 - SCREW BN 4MM 22MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604024 SUP HCPCS C1713 3604024 - SCREW BN 4MM 24MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604026 SUP HCPCS C1713 3604026 - SCREW BN 4MM 26MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604028 SUP HCPCS C1713 3604028 - SCREW BN 4MM 28MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604030 SUP HCPCS C1713 3604030 - SCREW BN 4MM 30MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604032 SUP HCPCS C1713 3604032 - SCREW BN 4MM 32MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604034 SUP HCPCS C1713 3604034 - SCREW BN 4MM 34MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604522 SUP HCPCS C1713 3604522 - SCREW BN 4.5MM 22MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604524 SUP HCPCS C1713 3604524 - SCREW BN 4.5MM 24MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604526 SUP HCPCS C1713 3604526 - SCREW BN 4.5MM 26MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604528 SUP HCPCS C1713 3604528 - SCREW BN 4.5MM 28MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604530 SUP HCPCS C1713 3604530 - SCREW BN 4.5MM 30MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604532 SUP HCPCS C1713 3604532 - SCREW BN 4.5MM 32MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3604534 SUP HCPCS C1713 3604534 - SCREW BN 4.5MM 34MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3605240 SUP HCPCS C1713 3605240 - ROD SPNL STD 3.5MM 240MM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 3756230 SUP HCPCS C1713 03756230 - SCREW SET BUTTRESS BLOCKER XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" $652.50 "$1,087.50" $226.64 "$1,087.50" N/A N/A 3800750 SUP HCPCS C1713 03800750 - SCREW BONE 7.5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801530 SUP HCPCS C1713 03801530 - SCREW BONE 5.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801535 SUP HCPCS C1713 03801535 - SCREW BONE 5.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801540 SUP HCPCS C1713 03801540 - SCREW BONE 5.5MM 40MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801545 SUP HCPCS C1713 03801545 - SCREW BONE 5.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801550 SUP HCPCS C1713 03801550 - SCREW BONE 5.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801555 SUP HCPCS C1713 03801555 - SCREW BONE 5.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801630 SUP HCPCS C1713 03801630 - SCREW BONE 6.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801635 SUP HCPCS C1713 03801635 - SCREW BONE 6.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801640 SUP HCPCS C1713 03801640 - SCREW BONE 6.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801645 SUP HCPCS C1713 03801645 - SCREW BONE 6.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801650 SUP HCPCS C1713 03801650 - SCREW BONE 6.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801655 SUP HCPCS C1713 03801655 - SCREW BONE 6.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801660 SUP HCPCS C1713 03801660 - SCREW BONE 6.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801730 SUP HCPCS C1713 03801730 - SCREW BONE 7.5MM 30MM POLYAX XIA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801735 SUP HCPCS C1713 03801735 - SCREW BONE 7.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801740 SUP HCPCS C1713 03801740 - SCREW BONE 7.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801745 SUP HCPCS C1713 03801745 - SCREW BONE 7.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801750 SUP HCPCS C1713 03801750 - SCREW BONE 7.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801755 SUP HCPCS C1713 03801755 - SCREW BONE 7.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801760 SUP HCPCS C1713 03801760 - SCREW BONE 7.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3801800 SUP HCPCS C1713 03801800 - SCREW BONE 8.5MM 100MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3801830 SUP HCPCS C1713 03801830 - SCREW BONE 8.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3801835 SUP HCPCS C1713 03801835 - SCREW BONE 8.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3801840 SUP HCPCS C1713 03801840 - SCREW BONE 8.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3801845 SUP HCPCS C1713 03801845 - SCREW BONE 8.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3801850 SUP HCPCS C1713 03801850 - SCREW BONE 8.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3801855 SUP HCPCS C1713 03801855 - SCREW BONE 8.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3801860 SUP HCPCS C1713 03801860 - SCREW BONE 8.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3801870 SUP HCPCS C1713 03801870 - SCREW BONE 8.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3801880 SUP HCPCS C1713 03801880 - SCREW BONE 8.5MM 80MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3801890 SUP HCPCS C1713 03801890 - SCREW BONE 8.5MM 90MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3801900 SUP HCPCS C1713 03801900 - SCREW BONE 9.5MM 100MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,162.50" $860.00 $230.73 "$1,162.50" $523.13 $523.13 $523.13 $523.13 "$1,162.50" "$1,162.50" "$1,162.50" $242.29 "$1,162.50" "$1,162.50" "$1,162.50" "$1,162.50" "$1,162.50" $242.28 "$1,162.50" "$1,162.50" $687.62 "$1,162.50" "$1,162.50" "$1,162.50" "$1,162.50" $871.88 "$1,162.50" "$1,162.50" "$1,162.50" $581.25 $581.25 $920.70 "$1,162.50" $930.00 $523.13 $230.73 N/A $674.25 "$1,162.50" "$1,162.50" "$1,162.50" $242.27 "$1,162.50" N/A N/A 3801960 SUP HCPCS C1713 03801960 - SCREW BONE 9.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,162.50" $860.00 $230.73 "$1,162.50" $523.13 $523.13 $523.13 $523.13 "$1,162.50" "$1,162.50" "$1,162.50" $242.29 "$1,162.50" "$1,162.50" "$1,162.50" "$1,162.50" "$1,162.50" $242.28 "$1,162.50" $465.00 $687.62 "$1,162.50" "$1,162.50" "$1,162.50" "$1,162.50" $871.88 "$1,162.50" "$1,162.50" "$1,162.50" $581.25 $581.25 $920.70 "$1,162.50" $930.00 $523.13 $230.73 N/A $674.25 "$1,162.50" "$1,162.50" "$1,162.50" $242.27 "$1,162.50" N/A N/A 3801970 SUP HCPCS C1713 03801970 - SCREW BONE 9.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 3801980 SUP HCPCS C1713 03801980 - SCREW BONE 9.5MM 80MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$4,437.50" "$3,284.00" $880.73 "$4,437.50" "$1,996.88" "$1,996.88" "$1,996.88" "$1,996.88" "$4,437.50" "$4,437.50" "$4,437.50" $924.89 "$4,437.50" "$4,437.50" "$4,437.50" "$4,437.50" "$4,437.50" $924.82 "$4,437.50" "$1,775.00" "$2,187.69" "$4,437.50" "$4,437.50" "$4,437.50" "$4,437.50" "$3,328.13" "$4,437.50" "$4,437.50" "$4,437.50" "$2,218.75" "$2,218.75" "$3,514.50" "$4,437.50" "$3,550.00" "$1,996.88" $880.73 N/A "$2,573.75" "$4,437.50" "$4,437.50" "$4,437.50" $924.78 "$4,437.50" N/A N/A 3801990 SUP HCPCS C1713 03801990 - SCREW BONE 9.5MM 90MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3802070 SUP Custom 27803010 03802070 - ROD SPINAL 6MM 70MM CENTRL POST XIA TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 3802110 SUP Custom 27803010 03802110 - ROD SPINAL 6MM 110MM CENTRL POST XIA TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 3802480 SUP Custom 27803010 03802480 - ROD SPINAL 6MM 480MM XIA TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 3804025 SUP Custom 27803010 03804025 - CONNECTOR ROD XIA SPN I BOTH IP/OP $992.00 $734.00 $176.52 $991.68 $991.68 $991.68 $991.68 $991.68 $991.68 $991.68 $176.52 $991.68 $991.68 $991.68 $991.68 $991.68 $991.68 $206.68 $991.68 $396.67 $991.68 $991.68 $991.68 $991.68 $991.68 $744.00 $991.68 $991.68 $991.68 $495.84 $495.84 $785.41 $991.68 $793.34 $446.26 $991.68 N/A $575.36 $991.68 $595.01 $991.68 $991.68 $991.68 N/A N/A 3804120 SUP Custom 27803010 03804120 - CONNECTOR ROD ADAPTER XIA SPN BOTH IP/OP $992.00 $734.00 $176.52 $991.68 $991.68 $991.68 $991.68 $991.68 $991.68 $991.68 $176.52 $991.68 $991.68 $991.68 $991.68 $991.68 $991.68 $206.68 $991.68 $396.67 $991.68 $991.68 $991.68 $991.68 $991.68 $744.00 $991.68 $991.68 $991.68 $495.84 $495.84 $785.41 $991.68 $793.34 $446.26 $991.68 N/A $575.36 $991.68 $595.01 $991.68 $991.68 $991.68 N/A N/A 3805000 SUP Custom 27803010 03805000 - BLOCK SPINAL XIA TITANIUM SACRAL BOTH IP/OP "$4,082.50" "$3,021.00" $726.69 "$4,082.50" "$4,082.50" "$4,082.50" "$4,082.50" "$4,082.50" "$4,082.50" "$4,082.50" $726.69 "$4,082.50" "$4,082.50" "$4,082.50" "$4,082.50" "$4,082.50" "$4,082.50" $850.84 "$4,082.50" "$1,633.00" "$4,082.50" "$4,082.50" "$4,082.50" "$4,082.50" "$4,082.50" "$3,061.88" "$4,082.50" "$4,082.50" "$4,082.50" "$2,041.25" "$2,041.25" "$3,233.34" "$4,082.50" "$3,266.00" "$1,837.13" "$4,082.50" N/A "$2,367.85" "$4,082.50" "$2,449.50" "$4,082.50" "$4,082.50" "$4,082.50" N/A N/A 3805001 SUP Custom 27803010 03805001 - CLAMP SPINAL ROD TO ROD PARALLEL XIA TITANIUM BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 3805002 SUP Custom 27803010 03805002 - CLAMP SPINAL AXIAL XIA TITANIUM BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 3805025 SUP HCPCS C1713 03805025 - SCREW BONE 6.5MM 25MM XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,400.00" "$1,776.00" $476.34 "$2,400.00" "$1,080.00" "$1,080.00" "$1,080.00" "$1,080.00" "$2,400.00" "$2,400.00" "$2,400.00" $500.22 "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" $500.19 "$2,400.00" $960.00 "$1,419.60" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$1,800.00" "$2,400.00" "$2,400.00" "$2,400.00" "$1,200.00" "$1,200.00" "$1,900.80" "$2,400.00" "$1,920.00" "$1,080.00" $476.34 N/A "$1,392.00" "$2,400.00" "$2,400.00" "$2,400.00" $500.16 "$2,400.00" N/A N/A 3805030 SUP HCPCS C1713 03805030 - SCREW BONE 6.5MM 30MM XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,400.00" "$1,776.00" $476.34 "$2,400.00" "$1,080.00" "$1,080.00" "$1,080.00" "$1,080.00" "$2,400.00" "$2,400.00" "$2,400.00" $500.22 "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" $500.19 "$2,400.00" $960.00 "$1,419.60" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$1,800.00" "$2,400.00" "$2,400.00" "$2,400.00" "$1,200.00" "$1,200.00" "$1,900.80" "$2,400.00" "$1,920.00" "$1,080.00" $476.34 N/A "$1,392.00" "$2,400.00" "$2,400.00" "$2,400.00" $500.16 "$2,400.00" N/A N/A 3805035 SUP HCPCS C1713 03805035 - SCREW BONE 6.5MM 35MM XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3806001 SUP Custom 27803010 03806001 - HOOK SPINAL LARGE XIA TITANIUM LAMINA BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 3806002 SUP Custom 27803010 03806002 - HOOK SPINAL MEDIUM XIA TITANIUM LAMINA BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 3806003 SUP Custom 27803010 03806003 - HOOK SPINAL SMALL XIA TITANIUM LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 3806006 SUP Custom 27803010 03806006 - HOOK SPINAL LEFT EXTEND BODY XIA TITANIUM LAMINA BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 3806007 SUP Custom 27803010 03806007 - HOOK SPINAL RIGHT EXTEND BODY XIA TITANIUM LAMINA BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 3806009 SUP Custom 27803010 03806009 - HOOK SPINAL LARGE ANGLE LEFT XIA TITANIUM LAMINA BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 3806012 SUP Custom 27803010 03806012 - HOOK SPINAL SMALL XIA GOLD TITANIUM PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 3820100 SUP HCPCS C1713 03820100 - WASHER SPINAL LP XIA II TITANIUM BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 3820101 SUP Custom 27803010 03820101 - CONCTR ROD XIA OFFST SCR TI THORLMBR SPN BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 3820104 SUP HCPCS C1713 03820104 - STAPLE BONE 1 HOLE XIA TITANIUM SPN ANTERIOR BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 3820110 SUP HCPCS C1713 03820110 - STAPLE BONE SMALL 2 DIAPASON OSS XIA TITANIUM SPN CAUDAL BOTH IP/OP "$4,750.00" "$3,515.00" $942.76 "$4,750.00" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$4,750.00" "$4,750.00" "$4,750.00" $990.02 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$2,341.75" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" $942.76 N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" $989.90 "$4,750.00" N/A N/A 3820111 SUP HCPCS C1713 03820111 - STAPLE BONE SMALL 2 DIAPASON OSS XIA TITANIUM SPN ROSTRAL BOTH IP/OP "$4,750.00" "$3,515.00" $942.76 "$4,750.00" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$4,750.00" "$4,750.00" "$4,750.00" $990.02 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$4,750.00" "$2,341.75" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" $942.76 N/A "$2,755.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.90 "$4,750.00" N/A N/A 3820112 SUP HCPCS C1713 03820112 - STAPLE BONE MEDIUM 2 DIAPASON OSS XIA TITANIUM SPN CAUDAL BOTH IP/OP "$4,750.00" "$3,515.00" $942.76 "$4,750.00" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$4,750.00" "$4,750.00" "$4,750.00" $990.02 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$4,750.00" "$2,341.75" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" $942.76 N/A "$2,755.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.90 "$4,750.00" N/A N/A 3820113 SUP HCPCS C1713 03820113 - STAPLE BONE MEDIUM 2 DIAPASON OSS XIA TITANIUM SPN ROSTRAL BOTH IP/OP "$4,750.00" "$3,515.00" $942.76 "$4,750.00" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$4,750.00" "$4,750.00" "$4,750.00" $990.02 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$4,750.00" "$2,341.75" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" $942.76 N/A "$2,755.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.90 "$4,750.00" N/A N/A 3820114 SUP HCPCS C1713 03820114 - STAPLE BONE LARGE 2 DIAPASON OSS XIA TITANIUM SPN CAUDAL BOTH IP/OP "$4,750.00" "$3,515.00" $942.76 "$4,750.00" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$4,750.00" "$4,750.00" "$4,750.00" $990.02 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$4,750.00" "$2,341.75" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" $942.76 N/A "$2,755.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.90 "$4,750.00" N/A N/A 3820115 SUP HCPCS C1713 03820115 - STAPLE BONE LARGE 2 DIAPASON OSS XIA TITANIUM SPN ROSTRAL BOTH IP/OP "$4,750.00" "$3,515.00" $942.76 "$4,750.00" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$4,750.00" "$4,750.00" "$4,750.00" $990.02 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$2,341.75" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" $942.76 N/A "$2,755.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.90 "$4,750.00" N/A N/A 3820120 SUP HCPCS C1713 03820120 - WASHER SPINAL 4.5MM LP XIA TITANIUM BOTH IP/OP $223.50 $165.00 $44.34 $223.38 $100.52 $100.52 $100.52 $100.52 $223.38 $223.38 $223.38 $46.56 $223.38 $223.38 $223.38 $223.38 $223.38 $46.55 $223.38 $89.35 $132.13 $223.38 $223.38 $223.38 $223.38 $167.63 $223.38 $223.38 $223.38 $111.69 $111.69 $176.92 $223.38 $178.70 $100.52 $44.34 N/A $129.63 $223.38 $223.38 $223.38 $46.55 $223.38 N/A N/A 3820124 SUP HCPCS C1713 03820124 - WASHER SPINAL 8.5MM LP XIA TITANIUM BOTH IP/OP $223.50 $165.00 $44.34 $223.38 $100.52 $100.52 $100.52 $100.52 $223.38 $223.38 $223.38 $46.56 $223.38 $223.38 $223.38 $223.38 $223.38 $46.55 $223.38 $223.38 $132.13 $223.38 $223.38 $223.38 $223.38 $167.63 $223.38 $223.38 $223.38 $111.69 $111.69 $176.92 $223.38 $178.70 $100.52 $44.34 N/A $129.63 $223.38 $223.38 $223.38 $46.55 $223.38 N/A N/A 3820130 SUP Custom 27803010 03820130 - CONNECTOR ROD 75D XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 3820131 SUP Custom 27803010 03820131 - CONNECTOR ROD 0D PLATE XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 3820132 SUP Custom 27803010 03820132 - CONNECTOR ROD 105D OFFST PLATE XIA TITANIUM SPN BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 3820133 SUP Custom 27803010 03820133 - CONNECTOR ROD NEUTRAL 80MM OFFST XIA 3 TITANIUM STAINLESS BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 3820134 SUP Custom 27803010 03820134 - CONNECTOR ROD 0D SMALL XIA TITANIUM SPN BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 3820135 SUP Custom 27803010 03820135 - CONNECTOR ROD 30D SMALL XIA TITANIUM SPN BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 3820136 SUP Custom 27803010 03820136 - CONNECTOR ROD 0D LARGE XIA TITANIUM SPN BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 3820137 SUP Custom 27803010 03820137 - CONNECTOR ROD 30D LARGE XIA TITANIUM SPN BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 3820200 SUP Custom 27803010 03820200 - HOOK SPINAL SMALL STANDARD BLADE XIA TITANIUM LAMINA BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820201 SUP Custom 27803010 03820201 - HOOK SPINAL SMALL NARROW XIA TITANIUM LAMINA BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820202 SUP Custom 27803010 03820202 - HOOK SPINAL LARGE STANDARD BLADE XIA TITANIUM LAMINA BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820203 SUP Custom 27803010 03820203 - HOOK SPINAL LARGE LEGENDARY BLADE XIA II TITANIUM LAMINA BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820204 SUP Custom 27803010 03820204 - HOOK SPINAL EXTEND XIA TITANIUM LAMINA BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820206 SUP Custom 27803010 03820206 - HOOK SPINAL RIGHT OFFST XIA TITANIUM LAMINA BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820207 SUP Custom 27803010 03820207 - HOOK SPINAL LEFT OFFST XIA TITANIUM LAMINA BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820208 SUP Custom 27803010 03820208 - HOOK SPINAL ANGLE BLADE XIA TITANIUM LAMINA BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820210 SUP Custom 27803010 03820210 - HOOK SPINAL STANDARD BLADE XIA TITANIUM LMNR THORACIC BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820211 SUP Custom 27803010 03820211 - HOOK SPINAL SMALL NARROW BLADE XIA TITANIUM THORAX LAMINA BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820212 SUP Custom 27803010 03820212 - HOOK SPINAL SMALL RIGHT OFFST XIA TITANIUM THORACOLUMBAR BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820213 SUP Custom 27803010 03820213 - HOOK SPINAL SMALL LEFT OFFST XIA TITANIUM THORACOLUMBAR BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820214 SUP Custom 27803010 03820214 - HOOK SPINAL LARGE RIGHT OFFST XIA TITANIUM THORAX LAMINA BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820215 SUP Custom 27803010 03820215 - HOOK SPINAL LARGE LEFT OFFST XIA TITANIUM THORAX LAMINA BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820220 SUP Custom 27803010 03820220 - HOOK SPINAL SMALL LOCK XIA TITANIUM PEDICLE BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820221 SUP Custom 27803010 03820221 - HOOK SPINAL LARGE XIA TITANIUM PEDICLE BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820230 SUP Custom 27803010 03820230 - HOOK SPINAL RIGHT OFFST XIA TITANIUM TRNSVRS PROCESS BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820231 SUP Custom 27803010 03820231 - HOOK SPINAL LEFT OFFST XIA II TITANIUM TRNSVRS PROCESS BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820240 SUP Custom 27803010 03820240 - HOOK SPINAL NARROW ANGLE REDUCE BLADE XIA TITANIUM LAMINA BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820241 SUP Custom 27803010 03820241 - HOOK SPINAL WIDE ANGLE REDUCE BLADE XIA TITANIUM LAMINA BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820242 SUP Custom 27803010 03820242 - HOOK SPINAL ANGLE REDUCE XIA TITANIUM LAMINA BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820243 SUP Custom 27803010 03820243 - HOOK SPINAL NARROW ANGLE REDUCE BLADE XIA TITANIUM THORAX BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820244 SUP Custom 27803010 03820244 - HOOK SPINAL LP RED BLADE XIA TITANIUM PEDIATRIC PEDICLE BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3820425 SUP HCPCS C1713 03820425 - SCREW BONE 4.5MM 25MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820430 SUP HCPCS C1713 03820430 - SCREW BONE 4.5MM 30MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820435 SUP HCPCS C1713 03820435 - SCREW BONE 4.5MM 35MM MNOAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820440 SUP HCPCS C1713 03820440 - SCREW BONE 4.5MM 40MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820445 SUP HCPCS C1713 03820445 - SCREW BONE 4.5MM 45MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820525 SUP HCPCS C1713 03820525 - SCREW BONE 5.5MM 25MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820530 SUP HCPCS C1713 03820530 - SCREW BONE 5.5MM 30MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820535 SUP HCPCS C1713 03820535 - SCREW BONE 5.5MM 35MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820540 SUP HCPCS C1713 03820540 - SCREW BONE 5.5MM 40MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820545 SUP HCPCS C1713 03820545 - SCREW BONE 5.5MM 45MM XIA SPNL MNOAX BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820550 SUP HCPCS C1713 03820550 - SCREW BONE 5.5MM 50MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820555 SUP HCPCS C1713 03820555 - SCREW BONE 5.5MM 55MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820600 SUP HCPCS C1713 03820600 - SCREW BONE 6.5MM 100MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820630 SUP HCPCS C1713 03820630 - SCREW BONE 6.5MM 30MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820635 SUP HCPCS C1713 03820635 - SCREW BONE 6.5MM 35MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820640 SUP HCPCS C1713 03820640 - SCREW BONE 6.5MM 40MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820645 SUP HCPCS C1713 03820645 - SCREW BONE 6.5MM 45MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820650 SUP HCPCS C1713 03820650 - SCREW BONE 6.5MM 50MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820655 SUP HCPCS C1713 03820655 - SCREW BONE 6.5MM 55MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820660 SUP HCPCS C1713 03820660 - SCREW BONE 6.5MM 60MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820670 SUP HCPCS C1713 03820670 - SCREW BONE 6.5MM 70MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820680 SUP HCPCS C1713 03820680 - SCREW BONE 6.5MM 80MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820690 SUP HCPCS C1713 03820690 - SCREW BONE 6.5MM 90MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820700 SUP HCPCS C1713 03820700 - SCREW BONE 7.5MM 100MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820730 SUP HCPCS C1713 03820730 - SCREW BONE 7.5MM 30MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820735 SUP HCPCS C1713 03820735 - SCREW BONE 7.5MM 35MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820740 SUP HCPCS C1713 03820740 - SCREW BONE 7.5MM 40MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820745 SUP HCPCS C1713 03820745 - SCREW BONE 7.5MM 45MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820750 SUP HCPCS C1713 03820750 - SCREW BONE 7.5MM 50MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820755 SUP HCPCS C1713 03820755 - SCREW BONE 7.5MM 55MM XIA TI SPNL MNOAX BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820760 SUP HCPCS C1713 03820760 - SCREW BONE 7.5MM 60MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820770 SUP HCPCS C1713 03820770 - SCREW BONE 7.5MM 70MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820780 SUP HCPCS C1713 03820780 - SCREW BONE 7.5MM 80MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820790 SUP HCPCS C1713 03820790 - SCREW BONE 7.5MM 90MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820800 SUP HCPCS C1713 03820800 - SCREW BONE 8.5MM 100MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820830 SUP HCPCS C1713 03820830 - SCREW BONE 8.5MM 30MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820835 SUP HCPCS C1713 03820835 - SCREW BONE 8.5MM 35MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820840 SUP HCPCS C1713 03820840 - SCREW BONE 8.5MM 40MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820845 SUP HCPCS C1713 03820845 - SCREW BONE 8.5MM 45MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820850 SUP HCPCS C1713 03820850 - SCREW BONE 8.5MM 50MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820855 SUP HCPCS C1713 03820855 - SCREW BONE 8.5MM 55MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820860 SUP HCPCS C1713 03820860 - SCREW BONE 8.5MM 60MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820870 SUP HCPCS C1713 03820870 - SCREW BONE 8.5MM 70MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3820880 SUP HCPCS C1713 03820880 - SCREW BONE 8.5MM 80MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$6,300.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 3820890 SUP HCPCS C1713 03820890 - SCREW BONE 8.5MM 90MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820900 SUP HCPCS C1713 03820900 - SCREW BONE 9.5MM 100MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820960 SUP HCPCS C1713 03820960 - SCREW BONE 9.5MM 60MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820970 SUP HCPCS C1713 03820970 - SCREW BONE 9.5MM 70MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820980 SUP HCPCS C1713 03820980 - SCREW BONE 9.5MM 80MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3820990 SUP HCPCS C1713 03820990 - SCREW BONE 9.5MM 90MM MNOAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 3821015 SUP Custom 27803010 03821015 - CONNECTOR ROD 15MM CROSSLINK XIA MAC TITANIUM THORACOLUMBAR BOTH IP/OP "$5,875.00" "$4,348.00" "$1,045.75" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,045.75" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$5,875.00" N/A "$3,407.50" "$5,875.00" "$3,525.00" "$5,875.00" "$5,875.00" "$5,875.00" N/A N/A 3821016 SUP Custom 27803010 03821016 - CONNECTOR ROD 16MM MULTIAX CROSSLINK XIA MAC TITANIUM BOTH IP/OP "$5,875.00" "$4,348.00" "$1,045.75" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,045.75" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$5,875.00" N/A "$3,407.50" "$5,875.00" "$3,525.00" "$5,875.00" "$5,875.00" "$5,875.00" N/A N/A 3821017 SUP Custom 27803010 03821017 - CONNECTOR ROD 17MM MULTIAX CROSSLINK XIA MAC TITANIUM BOTH IP/OP "$5,875.00" "$4,348.00" "$1,045.75" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,045.75" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$5,875.00" N/A "$3,407.50" "$5,875.00" "$3,525.00" "$5,875.00" "$5,875.00" "$5,875.00" N/A N/A 3821018 SUP Custom 27803010 03821018 - CONNECTOR ROD 18MM MULTIAX CROSSLINK XIA MAC TITANIUM BOTH IP/OP "$5,875.00" "$4,348.00" "$1,045.75" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,045.75" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$5,875.00" N/A "$3,407.50" "$5,875.00" "$3,525.00" "$5,875.00" "$5,875.00" "$5,875.00" N/A N/A 3821019 SUP Custom 27803010 03821019 - CONNECTOR ROD 19MM MULTIAX CROSSLINK XIA MAC TITANIUM BOTH IP/OP "$5,875.00" "$4,348.00" "$1,045.75" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,045.75" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$5,875.00" N/A "$3,407.50" "$5,875.00" "$3,525.00" "$5,875.00" "$5,875.00" "$5,875.00" N/A N/A 3821020 SUP Custom 27803010 03821020 - CONNECTOR ROD 20MM MULTIAX CROSSLINK XIA MAC TITANIUM BOTH IP/OP "$5,875.00" "$4,348.00" "$1,045.75" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,045.75" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$5,875.00" N/A "$3,407.50" "$5,875.00" "$3,525.00" "$5,875.00" "$5,875.00" "$5,875.00" N/A N/A 3821425 SUP HCPCS C1713 03821425 - SCREW BONE 4.5MM 25MM XIA TI THORLMBR SPN POLYAX BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 3821430 SUP HCPCS C1713 03821430 - SCREW BONE 4.5MM 30MM XIA TI THORLMBR SPN POLYAX BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 3821435 SUP HCPCS C1713 03821435 - SCREW BONE 4.5MM 35MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821440 SUP HCPCS C1713 03821440 - SCREW BONE 4.5MM 40MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821445 SUP HCPCS C1713 03821445 - SCREW BONE 4.5MM 45MM FIX XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821525 SUP HCPCS C1713 03821525 - SCREW BONE 5.5MM 25MM XIA TI SPNL POLYAX BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3821530 SUP HCPCS C1713 03821530 - SCREW BONE 5.5MM 30MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821535 SUP HCPCS C1713 03821535 - SCREW BONE 5.5MM 30MM XIA TI SPNL POLYAX LP BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 3821540 SUP HCPCS C1713 03821540 - SCREW BONE 5.5MM 40MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821545 SUP HCPCS C1713 03821545 - SCREW BONE 5.5MM 45MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821550 SUP HCPCS C1713 03821550 - SCREW BONE 5.5MM 50MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821555 SUP HCPCS C1713 03821555 - SCREW BONE 5.5MM 55MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821600 SUP HCPCS C1713 03821600 - SCREW BONE 6.5MM 100MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821630 SUP HCPCS C1713 03821630 - SCREW BONE 6.5MM 30MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821635 SUP HCPCS C1713 03821635 - SCREW BONE 6.5MM 35MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821640 SUP HCPCS C1713 03821640 - SCREW BONE 6.5MM 40MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821645 SUP HCPCS C1713 03821645 - SCREW BONE 6.5MM 45MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821650 SUP HCPCS C1713 03821650 - SCREW BONE 6.5MM 50MM XIA TI THORLMBR SPN POLYAX BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 3821655 SUP HCPCS C1713 03821655 - SCREW BONE 6.5MM 55MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821660 SUP HCPCS C1713 03821660 - SCREW BONE 6.5MM 60MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821670 SUP HCPCS C1713 03821670 - SCREW BONE 6.5MM 70MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3821680 SUP HCPCS C1713 03821680 - SCREW BONE 6.5MM 80MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3821690 SUP HCPCS C1713 03821690 - SCREW BONE 6.5MM 90MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3821700 SUP HCPCS C1713 03821700 - SCREW BONE 7.5MM 100MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3821730 SUP HCPCS C1713 03821730 - SCREW BONE 7.5MM 30MM POLYAX XIA SPN BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3821735 SUP HCPCS C1713 03821735 - SCREW BONE 7.5MM 35MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3821740 SUP HCPCS C1713 03821740 - SCREW BONE 7.5MM 40MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3821745 SUP HCPCS C1713 03821745 - SCREW BONE 7.5MM 45MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3821750 SUP HCPCS C1713 03821750 - SCREW BONE 7.5MM 50MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3821755 SUP HCPCS C1713 03821755 - SCREW BONE 7.5MM 55MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3821760 SUP HCPCS C1713 03821760 - SCREW BONE 7.5MM 60MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3821770 SUP HCPCS C1713 03821770 - SCREW BONE 7.5MM 70MM POLYAX XIA II SPN BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3821780 SUP HCPCS C1713 03821780 - SCREW BONE 7.5MM 80MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3821790 SUP HCPCS C1713 03821790 - SCREW BONE 7.5MM 90MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3822601 SUP Custom 27803010 03822601 - ROD SPINAL 6MM 600MM XIA VITALLIUM BOTH IP/OP "$2,357.00" "$1,744.00" $419.47 "$2,356.58" "$2,356.58" "$2,356.58" "$2,356.58" "$2,356.58" "$2,356.58" "$2,356.58" $419.47 "$2,356.58" "$2,356.58" "$2,356.58" "$2,356.58" "$2,356.58" "$2,356.58" $491.14 "$2,356.58" $942.63 "$2,356.58" "$2,356.58" "$2,356.58" "$2,356.58" "$2,356.58" "$1,767.75" "$2,356.58" "$2,356.58" "$2,356.58" "$1,178.29" "$1,178.29" "$1,866.41" "$2,356.58" "$1,885.26" "$1,060.46" "$2,356.58" N/A "$1,367.06" "$2,356.58" "$1,413.95" "$2,356.58" "$2,356.58" "$2,356.58" N/A N/A 3827201 SUP Custom 27803010 03827201 - HOOK SPINAL SMALL NARROW BLADE LMNR BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3827202 SUP Custom 27803010 03827202 - HOOK SPINAL LARGE STANDARD BLADE LMNR BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3827203 SUP Custom 27803010 03827203 - HOOK SPINAL LARGE NARROW BLADE LMNR BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3827211 SUP Custom 27803010 03827211 - HOOK SPINAL STANDARD BLADE LMNR BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3827220 SUP Custom 27803010 03827220 - HOOK SPINAL SMALL LONG ARM PEDICLE BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 3828425 SUP HCPCS C1713 03828425 - SCREW BONE LONG ARM 4.5MM 25MM MNOAX XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828430 SUP HCPCS C1713 03828430 - SCREW BONE LONG ARM 4.5MM 30MM MNOAX XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828435 SUP HCPCS C1713 03828435 - SCREW BONE LONG ARM 4.5MM 35MM MNOAX XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828440 SUP HCPCS C1713 03828440 - SCREW BONE LONG ARM 4.5MM 40MM MNOAX XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828445 SUP HCPCS C1713 03828445 - SCREW BONE LONG ARM 4.5MM 45MM MNOAX XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828530 SUP HCPCS C1713 03828530 - SCREW BONE 5.5MM 30MM MNOAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828535 SUP HCPCS C1713 03828535 - SCREW BONE 5.5MM 35MM MNOAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828540 SUP HCPCS C1713 03828540 - SCREW BONE 5.5MM 40MM MNOAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828545 SUP HCPCS C1713 03828545 - SCREW BONE 5.5MM 45MM MNOAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828550 SUP HCPCS C1713 03828550 - SCREW BONE LONG ARM 5.5MM 50MM MNOAX XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828555 SUP HCPCS C1713 03828555 - SCREW BONE LONG ARM 5.5MM 55MM MNOAX XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828630 SUP HCPCS C1713 03828630 - SCREW BONE 6.5MM 30MM MNOAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828635 SUP HCPCS C1713 03828635 - SCREW BONE 6.5MM 35MM MNOAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828640 SUP HCPCS C1713 03828640 - SCREW BONE 6.5MM 40MM MNOAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828645 SUP HCPCS C1713 03828645 - SCREW BONE 6.5MM 45MM MNOAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828650 SUP HCPCS C1713 03828650 - SCREW BONE 6.5MM 50MM MNOAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828655 SUP HCPCS C1713 03828655 - SCREW BONE 6.5MM 55MM MNOAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828660 SUP HCPCS C1713 03828660 - SCREW BONE LONG ARM 6.5MM 60MM MNOAX XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828730 SUP HCPCS C1713 03828730 - SCREW BONE 7.5MM 30MM MNOAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828735 SUP HCPCS C1713 03828735 - SCREW BONE 7.5MM 35MM MNOAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828740 SUP HCPCS C1713 03828740 - SCREW BONE 7.5MM 40MM MNOAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828745 SUP HCPCS C1713 03828745 - SCREW BONE 7.5MM 45MM MNOAX REDX XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828750 SUP HCPCS C1713 03828750 - SCREW BONE 7.5MM 50MM MULTIAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828755 SUP HCPCS C1713 03828755 - SCREW BONE LONG ARM 7.5MM 55MM MNOAX XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3828760 SUP HCPCS C1713 03828760 - SCREW BONE LONG ARM 7.5MM 60MM MNOAX XIA TITANIUM SPN BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 3829425 SUP HCPCS C1713 03829425 - SCREW BONE LONG ARM 4.5MM 25MM POLYAX XIA TITANIUM SPN BOTH IP/OP "$4,750.00" "$3,515.00" $942.76 "$4,750.00" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$4,750.00" "$4,750.00" "$4,750.00" $990.02 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$4,750.00" "$2,341.75" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" $942.76 N/A "$2,755.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.90 "$4,750.00" N/A N/A 3829430 SUP HCPCS C1713 03829430 - SCREW BONE LONG ARM 4.5MM 30MM POLYAX XIA TITANIUM SPN BOTH IP/OP "$4,750.00" "$3,515.00" $942.76 "$4,750.00" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$4,750.00" "$4,750.00" "$4,750.00" $990.02 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$4,750.00" "$2,341.75" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" $942.76 N/A "$2,755.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.90 "$4,750.00" N/A N/A 3829435 SUP HCPCS C1713 03829435 - SCREW BONE LONG ARM 4.5MM 35MM POLYAX XIA TITANIUM SPN BOTH IP/OP "$4,750.00" "$3,515.00" $942.76 "$4,750.00" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$4,750.00" "$4,750.00" "$4,750.00" $990.02 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$4,750.00" "$2,341.75" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" $942.76 N/A "$2,755.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.90 "$4,750.00" N/A N/A 3829440 SUP HCPCS C1713 03829440 - SCREW BONE LONG ARM 4.5MM 40MM POLYAX XIA TITANIUM SPN BOTH IP/OP "$4,750.00" "$3,515.00" $942.76 "$4,750.00" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$4,750.00" "$4,750.00" "$4,750.00" $990.02 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$4,750.00" "$2,341.75" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" $942.76 N/A "$2,755.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.90 "$4,750.00" N/A N/A 3829445 SUP HCPCS C1713 03829445 - SCREW BONE LONG ARM 4.5MM 45MM POLYAX XIA TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 3829530 SUP HCPCS C1713 03829530 - SCREW BONE 5.5MM 30MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 3829535 SUP HCPCS C1713 03829535 - SCREW BONE 5.5MM 35MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP $825.00 $611.00 $163.74 $825.00 $371.25 $371.25 $371.25 $371.25 $825.00 $825.00 $825.00 $171.95 $825.00 $825.00 $825.00 $825.00 $825.00 $171.94 $825.00 $330.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $371.25 $163.74 N/A $478.50 $825.00 $825.00 $825.00 $171.93 $825.00 N/A N/A 3829540 SUP HCPCS C1713 03829540 - SCREW BONE 5.5MM 40MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829550 SUP HCPCS C1713 03829550 - SCREW BONE 5.5MM 50MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829555 SUP HCPCS C1713 03829555 - SCREW BONE LONG ARM 5.5MM 55MM POLYAX XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829630 SUP HCPCS C1713 03829630 - SCREW BONE 6.5MM 30MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829635 SUP HCPCS C1713 03829635 - SCREW BONE 6.5MM 35MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829640 SUP HCPCS C1713 03829640 - SCREW BONE 6.5MM 40MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829645 SUP HCPCS C1713 03829645 - SCREW BONE 6.5MM 45MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829650 SUP HCPCS C1713 03829650 - SCREW BONE 6.5MM 50MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829655 SUP HCPCS C1713 03829655 - SCREW BONE 6.5MM 55MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829660 SUP HCPCS C1713 03829660 - SCREW BONE LONG ARM 6.5MM 60MM POLYAX XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829730 SUP HCPCS C1713 03829730 - SCREW BONE 7.5MM 30MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829735 SUP HCPCS C1713 03829735 - SCREW BONE 7.5MM 35MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829740 SUP HCPCS C1713 03829740 - SCREW BONE 7.5MM 40MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829745 SUP HCPCS C1713 03829745 - SCREW BONE 7.5MM 45MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829750 SUP HCPCS C1713 03829750 - SCREW BONE 7.5MM 50MM POLYAX LONG ARM XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829755 SUP HCPCS C1713 03829755 - SCREW BONE LONG ARM 7.5MM 55MM POLYAX XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3829760 SUP HCPCS C1713 03829760 - SCREW BONE LONG ARM 7.5MM 60MM POLYAX XIA TITANIUM SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 3992206 SUP HCPCS C1713 3992206 - SPACER SPNL 0D 27MMX6MM STRL LF CPSTN CNTRL PEEK INTRBD FS BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3992207 SUP HCPCS C1713 3992207 - SPACER SPNL 22MMX7MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3992208 SUP HCPCS C1713 3992208 - SPACER SPNL 22MMX8MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3992209 SUP HCPCS C1713 3992209 - SPACER SPNL 22MMX9MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3992210 SUP HCPCS C1713 3992210 - SPACER SPNL 22MMX10MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3992211 SUP HCPCS C1713 3992211 - SPACER SPNL 22MMX11MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3992212 SUP HCPCS C1713 3992212 - SPACER SPNL 22MMX12MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3992213 SUP HCPCS C1713 3992213 - SPACER SPNL 22MMX13MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3992214 SUP HCPCS C1713 3992214 - SPACER SPNL 22MMX14MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3992215 SUP HCPCS C1713 3992215 - SPACER SPNL 22MMX15MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3992216 SUP HCPCS C1713 3992216 - SPACER SPNL 22MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 3992606 SUP HCPCS C1713 3992606 - SPACER SPNL 26MMX6MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3992607 SUP HCPCS C1713 3992607 - SPACER SPNL 26MMX7MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3992608 SUP HCPCS C1713 3992608 - SPACER SPNL 26MMX8MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3992609 SUP HCPCS C1713 3992609 - SPACER SPNL 26MMX9MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3992610 SUP HCPCS C1713 3992610 - SPACER SPNL 26MMX10MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3992611 SUP HCPCS C1713 3992611 - SPACER SPNL 26MMX11MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3992612 SUP HCPCS C1713 3992612 - SPACER SPNL 26MMX12MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3992613 SUP HCPCS C1713 3992613 - SPACER SPNL 26MMX13MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3992614 SUP HCPCS C1713 3992614 - SPACER SPNL 26X14MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3992615 SUP HCPCS C1713 3992615 - SPACER SPNL 26MMX15MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3992616 SUP HCPCS C1713 3992616 - SPACER SPNL 26MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3993207 SUP HCPCS C1713 3993207 - SPACER SPNL 32MMX7MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3993208 SUP HCPCS C1713 3993208 - SPACER SPNL 32MMX8MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3993209 SUP HCPCS C1713 3993209 - SPACER SPNL 32MMX9MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3993210 SUP HCPCS C1713 3993210 - SPACER SPNL 32MMX10MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3993211 SUP HCPCS C1713 3993211 - SPACER SPNL 32MMX11MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3993212 SUP HCPCS C1713 3993212 - SPACER SPNL 32MMX12MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3993213 SUP HCPCS C1713 3993213 - SPACER SPNL 32MMX13MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3993214 SUP HCPCS C1713 3993214 - SPACER SPNL 32MMX14MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3993215 SUP HCPCS C1713 3993215 - SPACER SPNL 32MMX15MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3993216 SUP HCPCS C1713 3993216 - SPACER SPNL 32MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 3993616 SUP HCPCS C1713 3993616 - SPACER SPNL 36MMX16MM STRL LF CPSTN PTC PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 4001122 SUP HCPCS C1713 4001122 - SPACER SPNL 6D 22MMX11MM STRL LF CPSTN CNTRL PEEK INTRBD FS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4001227 SUP HCPCS C1713 4001227 - SPACER SPNL 6D 27MMX12MM STRL LF CPSTN CNTRL PEEK INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 4001322 SUP HCPCS C1713 4001322 - SPACER SPNL 6D 22MMX13MM STRL LF CPSTN CNTRL PEEK INTRBD FS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4011022 SUP HCPCS C1713 4011022 - SPACER SPNL 12D 22MMX10MM STRL LF CPSTN CNTRL PEEK INTRBD FS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4011222 SUP HCPCS C1713 4011222 - SPACER SPNL 12D 22MMX12MM CPSTN CNTRL BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4098545 SUP HCPCS C1713 4098545 - SCREW BONE CYLINDER 8.5MM 45MM OSS SPN BOTH IP/OP "$1,213.50" $898.00 $240.78 "$1,213.13" $545.91 $545.91 $545.91 $545.91 "$1,213.13" "$1,213.13" "$1,213.13" $252.85 "$1,213.13" "$1,213.13" "$1,213.13" "$1,213.13" "$1,213.13" $252.83 "$1,213.13" $485.25 $717.57 "$1,213.13" "$1,213.13" "$1,213.13" "$1,213.13" $910.13 "$1,213.13" "$1,213.13" "$1,213.13" $606.57 $606.57 $960.80 "$1,213.13" $970.50 $545.91 $240.78 N/A $703.83 "$1,213.13" "$1,213.13" "$1,213.13" $252.82 "$1,213.13" N/A N/A 4098550 SUP HCPCS C1713 4098550 - SCREW BONE CYLINDER 8.5MM 50MM OSS SPN BOTH IP/OP "$1,213.50" $898.00 $240.78 "$1,213.13" $545.91 $545.91 $545.91 $545.91 "$1,213.13" "$1,213.13" "$1,213.13" $252.85 "$1,213.13" "$1,213.13" "$1,213.13" "$1,213.13" "$1,213.13" $252.83 "$1,213.13" "$1,213.13" $717.57 "$1,213.13" "$1,213.13" "$1,213.13" "$1,213.13" $910.13 "$1,213.13" "$1,213.13" "$1,213.13" $606.57 $606.57 $960.80 "$1,213.13" $970.50 $545.91 $240.78 N/A $703.83 "$1,213.13" $727.88 "$1,213.13" $252.82 "$1,213.13" N/A N/A 4105535 SUP HCPCS C1713 4105535 - SCREW BONE 5.5MM 35MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4105540 SUP HCPCS C1713 4105540 - SCREW BONE 5.5MM 40MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4105545 SUP HCPCS C1713 4105545 - SCREW BONE 5.5MM 45MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4106535 SUP HCPCS C1713 4106535 - SCREW BONE 6.5MM 35MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4106540 SUP HCPCS C1713 4106540 - SCREW BONE 6.5MM 40MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4106550 SUP HCPCS C1713 4106550 - SCREW BONE 6.5MM 50MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4106555 SUP HCPCS C1713 4106555 - SCREW BONE 6.5MM 55MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4106560 SUP HCPCS C1713 4106560 - SCREW BONE 6.5MM 60MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4107017 SUP Custom 27803010 4107017 - CONNECTOR ROD 17MM MULTIAX CROSS XIA CROSSLINK TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4107020 SUP Custom 27803010 4107020 - CONNECTOR ROD 20MM MULTIAX CROSS XIA CROSSLINK TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4107023 SUP Custom 27803010 4107023 - CONNECTOR ROD 23MM CROSSLINK XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4107026 SUP Custom 27803010 4107026 - CONNECTOR ROD 26MM CROSSLINK XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4107029 SUP Custom 27803010 4107029 - CONNECTOR ROD 29-31MM MULTIAX CROSS XIA SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4107031 SUP Custom 27803010 4107031 - CONNECTOR ROD 31-34MM MULTIAX MAC CROSSLINK TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4107035 SUP Custom 27803010 4107035 - CONNECTOR ROD 35MM CROSSLINK XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4107038 SUP Custom 27803010 4107038 - CONNECTOR ROD 38-43MM MULTIAX CROSSLINK XIA TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4107042 SUP Custom 27803010 4107042 - CONNECTOR ROD 42-51MM MULTIAX CROSSLINK MAC SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4107050 SUP Custom 27803010 4107050 - CONNECTOR ROD 50-67MM MULTIAX CROSSLINK XIA TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4107066 SUP Custom 27803010 4107066 - CONNECTOR ROD 66-99MM MULTIAX CROSS XIA MAC TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4107535 SUP HCPCS C1713 4107535 - SCREW BONE 7.5MM 35MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4107545 SUP HCPCS C1713 4107545 - SCREW BONE 7.5MM 45MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4107555 SUP HCPCS C1713 4107555 - SCREW BONE 7.5MM 55MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4107560 SUP HCPCS C1713 4107560 - SCREW BONE 7.5MM 60MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4108535 SUP HCPCS C1713 4108535 - SCREW BONE 8.5MM 35MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4108540 SUP HCPCS C1713 4108540 - SCREW BONE 8.5MM 40MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4108560 SUP HCPCS C1713 4108560 - SCREW BONE 8.5MM 60MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4109040 SUP HCPCS C1713 4109040 - SCREW BONE 9MM 40MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4109045 SUP HCPCS C1713 4109045 - SCREW BONE 9MM 45MM OSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 4110101 SUP Custom 27803010 4110101 - HOOK SPINAL OSS LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4110102 SUP Custom 27803010 4110102 - HOOK SPINAL LONG OSS LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4110113 SUP Custom 27803010 4110113 - HOOK SPINAL SMALL OSS LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4110118 SUP Custom 27803010 4110118 - HOOK SPINAL LARGE OSS LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4110201 SUP Custom 27803010 4110201 - HOOK SPINAL CENTERED OSS TITANIUM LMNR LUMBAR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4110202 SUP Custom 27803010 4110202 - HOOK SPINAL LARGE OSS LMNR LUMBAR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4110203 SUP Custom 27803010 4110203 - HOOK SPINAL OSS RIGHT LMNR LUMBAR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4110204 SUP Custom 27803010 4110204 - HOOK SPINAL CENTERING OSS LEFT LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4110223 SUP Custom 27803010 4110223 - HOOK SPINAL OSS RIGHT INFERIOR LMNR LUMBAR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4110224 SUP Custom 27803010 4110224 - HOOK SPINAL OSS LEFT INFERIOR LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4110231 SUP Custom 27803010 4110231 - HOOK SPINAL SMALL LOWER RIGHT OFFST OSS BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4110232 SUP Custom 27803010 4110232 - HOOK SPINAL SMALL LOWER LEFT OFFST OSS BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4110302 SUP Custom 27803010 4110302 - HOOK SPINAL LONG BLADE OSS TITANIUM PEDICLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 4123010 SUP Custom 27803010 4123010 - RING SPINAL OSS BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 4123021 SUP HCPCS C1713 4123021 - CAP SCREW OSS SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 4125303 SUP Custom 27803010 4125303 - RING SPINAL XL OSS BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 4195103 SUP HCPCS C1898 4195103 - LEAD PACING 5FR 103CM UNIPOLAR DEPLOYABLE LOBES FIX IS-1 BOTH IP/OP "$3,562.50" "$2,636.00" $742.46 "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" $742.46 "$3,562.50" "$1,425.00" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$2,671.88" "$3,562.50" "$3,562.50" "$3,562.50" "$1,781.25" "$1,781.25" "$2,821.50" "$3,562.50" "$2,850.00" "$1,603.13" "$3,562.50" N/A "$2,066.25" "$3,562.50" "$2,137.50" "$3,562.50" "$3,562.50" "$3,562.50" N/A N/A 4200015 SUP HCPCS C1762 4200015 - GRAFT SOFT TISSUE DELIVERY UNCRIMPED BOTH IP/OP "$1,415.50" "$1,047.00" $280.90 "$1,415.30" $636.89 $636.89 $636.89 $636.89 "$1,415.30" "$1,415.30" "$1,415.30" $294.98 "$1,415.30" "$1,415.30" "$1,415.30" "$1,415.30" "$1,415.30" $294.96 "$1,415.30" "$1,415.30" $837.15 "$1,415.30" "$1,415.30" "$1,415.30" "$1,415.30" "$1,061.63" "$1,415.30" "$1,415.30" "$1,415.30" $707.65 $707.65 "$1,120.92" "$1,415.30" "$1,132.24" $636.89 $280.90 N/A $820.99 "$1,415.30" "$1,415.30" "$1,415.30" $294.95 "$1,415.30" N/A N/A 4210564 SUP Custom 27803010 4210564 - SPACER SPNL 14MM 16X5MM STRL PRVL STNDALN PEEK-OPTM CRV BOTH IP/OP "$5,775.00" "$4,274.00" "$1,027.95" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$1,027.95" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$1,203.57" "$5,775.00" "$2,310.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$4,331.25" "$5,775.00" "$5,775.00" "$5,775.00" "$2,887.50" "$2,887.50" "$4,573.80" "$5,775.00" "$4,620.00" "$2,598.75" "$5,775.00" N/A "$3,349.50" "$5,775.00" "$3,465.00" "$5,775.00" "$5,775.00" "$5,775.00" N/A N/A 4210664 SUP Custom 27803010 4210664 - SPACER SPNL 14MM 16X6MM STRL PRVL STNDALN PEEK-OPTM CRV BOTH IP/OP "$5,775.00" "$4,274.00" "$1,027.95" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$1,027.95" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$1,203.57" "$5,775.00" "$2,310.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$4,331.25" "$5,775.00" "$5,775.00" "$5,775.00" "$2,887.50" "$2,887.50" "$4,573.80" "$5,775.00" "$4,620.00" "$2,598.75" "$5,775.00" N/A "$3,349.50" "$5,775.00" "$3,465.00" "$5,775.00" "$5,775.00" "$5,775.00" N/A N/A 4210764 SUP Custom 27803010 4210764 - SPACER SPNL 14MM 16X7MM STRL PRVL STNDALN PEEK-OPTM CRV BOTH IP/OP "$5,775.00" "$4,274.00" "$1,027.95" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$1,027.95" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$1,203.57" "$5,775.00" "$2,310.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$4,331.25" "$5,775.00" "$5,775.00" "$5,775.00" "$2,887.50" "$2,887.50" "$4,573.80" "$5,775.00" "$4,620.00" "$2,598.75" "$5,775.00" N/A "$3,349.50" "$5,775.00" "$3,465.00" "$5,775.00" "$5,775.00" "$5,775.00" N/A N/A 4210864 SUP Custom 27803010 4210864 - SPACER SPNL 14MM 16X8MM STRL PRVL STNDALN PEEK-OPTM CRV BOTH IP/OP "$5,775.00" "$4,274.00" "$1,027.95" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$1,027.95" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$1,203.57" "$5,775.00" "$2,310.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$4,331.25" "$5,775.00" "$5,775.00" "$5,775.00" "$2,887.50" "$2,887.50" "$4,573.80" "$5,775.00" "$4,620.00" "$2,598.75" "$5,775.00" N/A "$3,349.50" "$5,775.00" "$3,465.00" "$5,775.00" "$5,775.00" "$5,775.00" N/A N/A 4210964 SUP Custom 27803010 4210964 - SPACER SPNL 14MM 16X9MM STRL PRVL STNDALN PEEK-OPTM CRV BOTH IP/OP "$5,775.00" "$4,274.00" "$1,027.95" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$1,027.95" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$1,203.57" "$5,775.00" "$2,310.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$5,775.00" "$4,331.25" "$5,775.00" "$5,775.00" "$5,775.00" "$2,887.50" "$2,887.50" "$4,573.80" "$5,775.00" "$4,620.00" "$2,598.75" "$5,775.00" N/A "$3,349.50" "$5,775.00" "$3,465.00" "$5,775.00" "$5,775.00" "$5,775.00" N/A N/A 4240041 SUP Custom 27803010 4240041 - CAGE SPNL 11MM 14X10MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240064 SUP Custom 27803010 4240064 - CAGE SPNL 14MM 16X10MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240086 SUP Custom 27803010 4240086 - CAGE SPNL 16MM 18X10MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240141 SUP Custom 27803010 4240141 - CAGE SPNL 11MM 14X11MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240164 SUP Custom 27803010 4240164 - CAGE SPNL 14MM 16X11MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240186 SUP Custom 27803010 4240186 - CAGE SPNL 16MM 18X11MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240241 SUP Custom 27803010 4240241 - CAGE SPNL 11MM 14X12MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240264 SUP Custom 27803010 4240264 - CAGE SPNL 14MM 16X12MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240286 SUP Custom 27803010 4240286 - CAGE SPNL 16MM 18X12MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240341 SUP Custom 27803010 4240341 - CAGE SPNL 11MM 14X13MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240364 SUP Custom 27803010 4240364 - CAGE SPNL 14MM 16X13MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240386 SUP Custom 27803010 4240386 - CAGE SPNL 16MM 18X13MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240441 SUP Custom 27803010 4240441 - CAGE SPNL 11MM 14X14MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240464 SUP Custom 27803010 4240464 - CAGE SPNL 14MM 16X14MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240486 SUP Custom 27803010 4240486 - CAGE SPNL 16MM 18X14MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240541 SUP Custom 27803010 4240541 - CAGE SPNL 11MM 14X5MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240564 SUP Custom 27803010 4240564 - CAGE SPNL 14MM 16X5MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240586 SUP Custom 27803010 4240586 - CAGE SPNL 16MM 18X5MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240641 SUP Custom 27803010 4240641 - CAGE SPNL 11MM 14X6MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240664 SUP Custom 27803010 4240664 - CAGE SPNL 14MM 16X6MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240686 SUP Custom 27803010 4240686 - CAGE SPNL 16MM 18X6MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240741 SUP Custom 27803010 4240741 - CAGE SPNL 11MM 14X7MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240764 SUP Custom 27803010 4240764 - CAGE SPNL 14MM 16X7MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240786 SUP Custom 27803010 4240786 - CAGE SPNL 16MM 18X7MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240841 SUP Custom 27803010 4240841 - CAGE SPNL 11MM 14X8MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240864 SUP Custom 27803010 4240864 - CAGE SPNL 14MM 16X8MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240886 SUP Custom 27803010 4240886 - CAGE SPNL 16MM 18X8MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240941 SUP Custom 27803010 4240941 - CAGE SPNL 11MM 14X9MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240964 SUP Custom 27803010 4240964 - CAGE SPNL 14MM 16X9MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4240986 SUP Custom 27803010 4240986 - CAGE SPNL 16MM 18X9MM STRL ANTM RADOPQ PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 4302208 SUP HCPCS C1713 4302208 - SPACER SPINAL 0D 22MMX8MM END PIECE TELAMON-P PEEK-OPTIMA BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4302210 SUP HCPCS C1713 4302210 - SPACER SPINAL 0D 22MMX10MM END PIECE TELAMON-P PEEK-OPTIMA BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4302212 SUP HCPCS C1713 4302212 - SPACER SPINAL 0D 22MMX12MM END PIECE TELAMON-P PEEK-OPTIMA BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4302214 SUP HCPCS C1713 4302214 - SPACER SPINAL 0D 22MMX14MM END PIECE TELAMON-P PEEK-OPTIMA BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4302608 SUP HCPCS C1713 4302608 - SPACER SPINAL 0D 26MMX8MM END PIECE TELAMON-P PEEK-OPTIMA BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4302610 SUP HCPCS C1713 4302610 - SPACER SPINAL 0D 26MMX10MM END PIECE TELAMON-P PEEK-OPTIMA BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4302612 SUP HCPCS C1713 4302612 - SPACER SPINAL 0D 26MMX12MM END PIECE TELAMON-P PEEK-OPTIMA BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4302614 SUP Custom 27803010 4302614 - SPACER SPINAL 0D 26MMX14MM END PIECE TELAMON-P PEEK-OPTIMA BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 4332208 SUP HCPCS C1713 4332208 - SPACER SPNL 3D 22MMX8MM TLMN-PPEEK-OPTM END PC VERT BD REPL BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4332210 SUP HCPCS C1713 4332210 - SPACER SPNL 3D 22MMX10MM TLMN-PPEEK-OPTM END PC VERT BD REPL BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4332212 SUP HCPCS C1713 4332212 - SPACER SPINAL 3D 22MMX12MM END PIECE TELAMON-P PEEK-OPTIMA BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4332214 SUP HCPCS C1713 4332214 - SPACER SPINAL 3D 22MMX14MM END PIECE TELAMON-P PEEK-OPTIMA BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4332608 SUP HCPCS C1713 4332608 - SPACER SPINAL 3D 26MMX8MM END PIECE TELAMON-P PEEK-OPTIMA BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4332610 SUP HCPCS C1713 4332610 - SPACER SPINAL 3D 26MMX10MM END PIECE TELAMON-P PEEK-OPTIMA BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4332612 SUP HCPCS C1713 4332612 - SPACER SPNL 3D 26MMX12MM TLMN-PPEEK-OPTM END PC VERT BD REPL BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4332614 SUP HCPCS C1713 4332614 - SPACER SPINAL 3D 26MMX14MM END PIECE TELAMON-P PEEK-OPTIMA BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 4360130 SUP HCPCS C1713 4360130 - ENDCAP 4360130 13MM 0 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360135 SUP HCPCS C1713 4360135 - ENDCAP 4360135 13MM 15 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360138 SUP HCPCS C1713 4360138 - ENDCAP 4360138 13MM 8 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360160 SUP HCPCS C1713 4360160 - ENDCAP 4360160 16MM 0 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360165 SUP HCPCS C1713 4360165 - ENDCAP 4360165 16MM 15 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360168 SUP HCPCS C1713 4360168 - ENDCAP 4360168 16MM 8 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360200 SUP HCPCS C1713 4360200 - ENDCAP 4360200 20MM 0 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360205 SUP HCPCS C1713 4360205 - ENDCAP 4360205 20MM 15 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360208 SUP HCPCS C1713 4360208 - ENDCAP 4360208 20MM 8 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360220 SUP HCPCS C1713 4360220 - ENDCAP 4360220 22MM 0 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360225 SUP HCPCS C1713 4360225 - ENDCAP 4360225 22MM 15 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360228 SUP HCPCS C1713 4360228 - ENDCAP 4360228 22MM 8 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 4360250 SUP HCPCS C1713 4360250 - ENDCAP 4360250 25MM 0 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360255 SUP HCPCS C1713 4360255 - ENDCAP 4360255 25MM 15 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360258 SUP HCPCS C1713 4360258 - ENDCAP 4360258 25MM 8 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360300 SUP HCPCS C1713 4360300 - ENDCAP 4360300 30MM 0 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4360305 SUP HCPCS C1713 4360305 - ENDCAP 4360305 30MM 15 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 4360308 SUP HCPCS C1713 4360308 - ENDCAP 4360308 30MM 8 DEGREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 4361130 SUP HCPCS C1713 4361130 - ENDCAP 4361130 13MM 0 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $907.50 $907.50 N/A N/A 4361135 SUP HCPCS C1713 4361135 - ENDCAP 4361135 13MM 15 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $907.50 $907.50 N/A N/A 4361138 SUP HCPCS C1713 4361138 - ENDCAP 4361138 13MM 8 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4361160 SUP HCPCS C1713 4361160 - ENDCAP 4361160 16MM 0 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $907.50 $907.50 N/A N/A 4361165 SUP HCPCS C1713 4361165 - ENDCAP 4361165 16MM 15 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $907.50 $907.50 N/A N/A 4361168 SUP HCPCS C1713 4361168 - ENDCAP 4361168 16MM 8 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 4361200 SUP HCPCS C1713 4361200 - ENDCAP 4361200 20MM 0 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4361205 SUP HCPCS C1713 4361205 - ENDCAP 4361205 20MM 15 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4361208 SUP HCPCS C1713 4361208 - ENDCAP 4361208 20MM 8 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $907.50 $907.50 N/A N/A 4361220 SUP HCPCS C1713 4361220 - ENDCAP 4361220 22MM 0 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $907.50 $907.50 N/A N/A 4361225 SUP HCPCS C1713 4361225 - ENDCAP 4361225 22MM 15 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4361228 SUP HCPCS C1713 4361228 - ENDCAP 4361228 22MM 8 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4361250 SUP HCPCS C1713 4361250 - ENDCAP 4361250 25MM 0 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4361255 SUP HCPCS C1713 4361255 - ENDCAP 4361255 25MM 15 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4361258 SUP HCPCS C1713 4361258 - ENDCAP 4361258 25MM 8 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4361300 SUP HCPCS C1713 4361300 - ENDCAP 4361300 30MM 0 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4361305 SUP HCPCS C1713 4361305 - ENDCAP 4361305 30MM 15 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4361308 SUP HCPCS C1713 4361308 - ENDCAP 4361308 30MM 8 DEGREE STERILE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 4484525 SUP HCPCS C1713 4484525 - SCREW BN 4.5MM 25MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4484530 SUP HCPCS C1713 4484530 - SCREW BN 4.5MM 30MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4484535 SUP HCPCS C1713 4484535 - SCREW BN 4.5MM 35MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4484540 SUP HCPCS C1713 4484540 - SCREW BN 4.5MM 40MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 4484545 SUP HCPCS C1713 4484545 - SCREW BN 4.5MM 45MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 4484550 SUP HCPCS C1713 4484550 - SCREW BN 4.5MM 50MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 4484555 SUP HCPCS C1713 4484555 - SCREW BN 4.5MM 55MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4484560 SUP HCPCS C1713 4484560 - SCREW BN 4.5MM 60MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 4484565 SUP HCPCS C1713 4484565 - SCREW BN 4.5MM 65MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 4484570 SUP HCPCS C1713 4484570 - SCREW BN 4.5MM 70MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4484575 SUP HCPCS C1713 4484575 - SCREW BN 4.5MM 75MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4484580 SUP HCPCS C1713 4484580 - SCREW BN 4.5MM 80MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4485525 SUP HCPCS C1713 4485525 - SCREW BN 5.5MM 25MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4485530 SUP HCPCS C1713 4485530 - SCREW BN 5.5MM 30MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4485535 SUP HCPCS C1713 4485535 - SCREW BN 5.5MM 35MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4485540 SUP HCPCS C1713 4485540 - SCREW BN 5.5MM 40MM NS DBR III SPHERX CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4485545 SUP HCPCS C1713 4485545 - SCREW BN 5.5MM 45MM NS DBR III SPHERX CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4485550 SUP HCPCS C1713 4485550 - SCREW BN 5.5MM 50MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4485555 SUP HCPCS C1713 4485555 - SCREW BN 5.5MM 55MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4485560 SUP HCPCS C1713 4485560 - SCREW BN 5.5MM 60MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4485565 SUP HCPCS C1713 4485565 - SCREW BN 5.5MM 65MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4485570 SUP HCPCS C1713 4485570 - SCREW BN 5.5MM 70MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4485575 SUP HCPCS C1713 4485575 - SCREW BN 5.5MM 75MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4485580 SUP HCPCS C1713 4485580 - SCREW BN 5.5MM 80MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486510 SUP HCPCS C1713 4486510 - SCREW BN 6.5MM 100MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486511 SUP HCPCS C1713 4486511 - SCREW BN 6.5MM 105MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486512 SUP HCPCS C1713 4486512 - SCREW BN 6.5MM 110MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486513 SUP HCPCS C1713 4486513 - SCREW BN 6.5MM 115MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486514 SUP HCPCS C1713 4486514 - SCREW BN 6.5MM 120MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486525 SUP HCPCS C1713 4486525 - SCREW BN 6.5MM 25MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486530 SUP HCPCS C1713 4486530 - SCREW BN 6.5MM 30MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486535 SUP HCPCS C1713 4486535 - SCREW BN 6.5MM 35MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486540 SUP HCPCS C1713 4486540 - SCREW BN 6.5MM 40MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486545 SUP HCPCS C1713 4486545 - SCREW BN 6.5MM 45MM NS DBR III SPHERX CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486550 SUP HCPCS C1713 4486550 - SCREW BN 6.5MM 50MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486555 SUP HCPCS C1713 4486555 - SCREW BN 6.5MM 55MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486560 SUP HCPCS C1713 4486560 - SCREW BN 6.5MM 60MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486565 SUP HCPCS C1713 4486565 - SCREW BN 6.5MM 65MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486570 SUP HCPCS C1713 4486570 - SCREW BN 6.5MM 70MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486575 SUP HCPCS C1713 4486575 - SCREW BN 6.5MM 75MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486580 SUP HCPCS C1713 4486580 - SCREW BN 6.5MM 80MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486585 SUP HCPCS C1713 4486585 - SCREW BN 6.5MM 85MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486590 SUP HCPCS C1713 4486590 - SCREW BN 6.5MM 90MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4486595 SUP HCPCS C1713 4486595 - SCREW BN 6.5MM 95MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487510 SUP HCPCS C1713 4487510 - SCREW BN 7.5MM 100MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487511 SUP HCPCS C1713 4487511 - SCREW BN 7.5MM 105MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487512 SUP HCPCS C1713 4487512 - SCREW BN 7.5MM 110MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487513 SUP HCPCS C1713 4487513 - SCREW BN 7.5MM 115MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487514 SUP HCPCS C1713 4487514 - SCREW BN 7.5MM 120MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487525 SUP HCPCS C1713 4487525 - SCREW BN 7.5MM 25MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487530 SUP HCPCS C1713 4487530 - SCREW BN 7.5MM 30MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487535 SUP HCPCS C1713 4487535 - SCREW BN 7.5MM 35MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487540 SUP HCPCS C1713 4487540 - SCREW BN 7.5MM 40MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487545 SUP HCPCS C1713 4487545 - SCREW BN 7.5MM 45MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487550 SUP HCPCS C1713 4487550 - SCREW BN 7.5MM 50MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487555 SUP HCPCS C1713 4487555 - SCREW BN 7.5MM 55MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487560 SUP HCPCS C1713 4487560 - SCREW BN 7.5MM 60MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487565 SUP HCPCS C1713 4487565 - SCREW BN 7.5MM 65MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487570 SUP HCPCS C1713 4487570 - SCREW BN 7.5MM 70MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487575 SUP HCPCS C1713 4487575 - SCREW BN 7.5MM 75MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487580 SUP HCPCS C1713 4487580 - SCREW BN 7.5MM 80MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487585 SUP HCPCS C1713 4487585 - SCREW BN 7.5MM 85MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487590 SUP HCPCS C1713 4487590 - SCREW BN 7.5MM 90MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4487595 SUP HCPCS C1713 4487595 - SCREW BN 7.5MM 95MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488510 SUP HCPCS C1713 4488510 - SCREW BN 8.5MM 100MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488511 SUP HCPCS C1713 4488511 - SCREW BN 8.5MM 105MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488512 SUP HCPCS C1713 4488512 - SCREW BN 8.5MM 110MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488513 SUP HCPCS C1713 4488513 - SCREW BN 8.5MM 115MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 4488514 SUP HCPCS C1713 4488514 - SCREW BN 8.5MM 120MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 4488525 SUP HCPCS C1713 4488525 - SCREW BN 8.5MM 25MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488530 SUP HCPCS C1713 4488530 - SCREW BN 8.5MM 30MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 4488535 SUP HCPCS C1713 4488535 - SCREW BN 8.5MM 35MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488540 SUP HCPCS C1713 4488540 - SCREW BN 8.5MM 40MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488545 SUP HCPCS C1713 4488545 - SCREW BN 8.5MM 45MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488550 SUP HCPCS C1713 4488550 - SCREW BN 8.5MM 50MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488555 SUP HCPCS C1713 4488555 - SCREW BN 8.5MM 55MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488560 SUP HCPCS C1713 4488560 - SCREW BN 8.5MM 60MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488565 SUP HCPCS C1713 4488565 - SCREW BN 8.5MM 65MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488570 SUP HCPCS C1713 4488570 - SCREW BN 8.5MM 70MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488575 SUP HCPCS C1713 4488575 - SCREW BN 8.5MM 75MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488580 SUP HCPCS C1713 4488580 - SCREW BN 8.5MM 80MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488585 SUP HCPCS C1713 4488585 - SCREW BN 8.5MM 85MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 4488590 SUP HCPCS C1713 4488590 - SCREW BN 8.5MM 90MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 4488595 SUP HCPCS C1713 4488595 - SCREW BN 8.5MM 95MM DBR III CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 4527020 SUP Custom 27203010 4527020 - BIT DRILL 2MM 102MM AO SHAFT BOTH IP/OP $306.50 $227.00 $54.52 $306.30 $306.30 $306.30 $306.30 $306.30 $306.30 $306.30 $54.52 $306.30 $306.30 $227.34 $227.34 $236.10 $159.58 $63.84 $306.30 $122.52 $306.30 $306.30 $306.30 $306.30 $306.30 $229.88 $306.30 $306.30 $306.30 $153.15 $153.15 $242.59 $306.30 $245.04 $199.10 $306.30 N/A $177.77 $306.30 $183.78 $306.30 $306.30 $306.30 N/A N/A 4535020 SUP Custom 27203010 4535020 - BIT DRL 3.6MM RD YLW AO FIT 3.5MM VARIAX LCK PLT SYSTE BOTH IP/OP $306.50 $227.00 $54.52 $306.30 $306.30 $306.30 $306.30 $306.30 $306.30 $306.30 $54.52 $306.30 $306.30 $227.34 $227.34 $236.10 $159.58 $63.84 $306.30 $122.52 $306.30 $306.30 $306.30 $306.30 $306.30 $229.88 $306.30 $306.30 $306.30 $153.15 $153.15 $242.59 $306.30 $245.04 $199.10 $306.30 N/A $177.77 $306.30 $183.78 $306.30 $306.30 $306.30 N/A N/A 4920040 SUP HCPCS C1713 4920040 - CAGE SPNL 0D 40X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920045 SUP HCPCS C1713 4920045 - CAGE SPNL 0D 45X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920050 SUP HCPCS C1713 4920050 - CAGE SPNL 0D 50X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920055 SUP HCPCS C1713 4920055 - CAGE SPNL 0D 55X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920060 SUP HCPCS C1713 4920060 - CAGE SPNL 0D 60X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920240 SUP HCPCS C1713 4920240 - CAGE SPNL 0D 40X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920245 SUP HCPCS C1713 4920245 - CAGE SPNL 0D 45X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920250 SUP HCPCS C1713 4920250 - CAGE SPNL 0D 50X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920255 SUP HCPCS C1713 4920255 - CAGE SPNL 0D 55X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920260 SUP HCPCS C1713 4920260 - CAGE SPNL 0D 60X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920440 SUP HCPCS C1713 4920440 - CAGE SPNL 0D 40X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920445 SUP HCPCS C1713 4920445 - CAGE SPNL 0D 45X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920450 SUP HCPCS C1713 4920450 - CAGE SPNL 0D 50X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920455 SUP HCPCS C1713 4920455 - CAGE SPNL 0D 55X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920460 SUP HCPCS C1713 4920460 - CAGE SPNL 0D 60X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920640 SUP HCPCS C1713 4920640 - CAGE SPNL 0D 40X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920645 SUP HCPCS C1713 4920645 - CAGE SPNL 0D 45X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920650 SUP HCPCS C1713 4920650 - CAGE SPNL 0D 50X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920655 SUP HCPCS C1713 4920655 - CAGE SPNL 0D 55X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920660 SUP HCPCS C1713 4920660 - CAGE SPNL 0D 60X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920840 SUP HCPCS C1713 4920840 - CAGE SPNL 0D 40X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920845 SUP HCPCS C1713 4920845 - CAGE SPNL 0D 45X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920850 SUP HCPCS C1713 4920850 - CAGE SPNL 0D 50X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920855 SUP HCPCS C1713 4920855 - CAGE SPNL 0D 55X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4920860 SUP HCPCS C1713 4920860 - CAGE SPNL 0D 60X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922040 SUP HCPCS C1713 4922040 - CAGE SPNL 12D 40X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922045 SUP HCPCS C1713 4922045 - CAGE SPNL 12D 45X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922050 SUP HCPCS C1713 4922050 - CAGE SPNL 12D 50X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922055 SUP HCPCS C1713 4922055 - CAGE SPNL 12D 55X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922060 SUP HCPCS C1713 4922060 - CAGE SPNL 12D 60X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922240 SUP HCPCS C1713 4922240 - CAGE SPNL 12D 40X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922245 SUP HCPCS C1713 4922245 - CAGE SPNL 12D 45X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922250 SUP HCPCS C1713 4922250 - CAGE SPNL 12D 50X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922255 SUP HCPCS C1713 4922255 - CAGE SPNL 12D 55X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922260 SUP HCPCS C1713 4922260 - CAGE SPNL 12D 60X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922440 SUP HCPCS C1713 4922440 - CAGE SPNL 12D 40X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922445 SUP HCPCS C1713 4922445 - CAGE SPNL 12D 45X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922450 SUP HCPCS C1713 4922450 - CAGE SPNL 12D 50X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922455 SUP HCPCS C1713 4922455 - CAGE SPNL 12D 55X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922460 SUP HCPCS C1713 4922460 - CAGE SPNL 12D 60X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922640 SUP HCPCS C1713 4922640 - CAGE SPNL 12D 40X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922645 SUP HCPCS C1713 4922645 - CAGE SPNL 12D 45X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922650 SUP HCPCS C1713 4922650 - CAGE SPNL 12D 50X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922655 SUP HCPCS C1713 4922655 - CAGE SPNL 12D 55X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4922660 SUP HCPCS C1713 4922660 - CAGE SPNL 12D 60X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926040 SUP HCPCS C1713 4926040 - CAGE SPNL 6D 40X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926045 SUP HCPCS C1713 4926045 - CAGE SPNL 6D 45X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926050 SUP HCPCS C1713 4926050 - CAGE SPNL 6D 50X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926055 SUP HCPCS C1713 4926055 - CAGE SPNL 6D 55X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926060 SUP HCPCS C1713 4926060 - CAGE SPNL 6D 60X22X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926240 SUP HCPCS C1713 4926240 - CAGE SPNL 6D 40X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926245 SUP HCPCS C1713 4926245 - CAGE SPNL 6D 45X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926250 SUP HCPCS C1713 4926250 - CAGE SPNL 6D 50X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926255 SUP HCPCS C1713 4926255 - CAGE SPNL 6D 55X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926260 SUP HCPCS C1713 4926260 - CAGE SPNL 6D 60X22X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926440 SUP HCPCS C1713 4926440 - CAGE SPNL 6D 40X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926445 SUP HCPCS C1713 4926445 - CAGE SPNL 6D 45X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926450 SUP HCPCS C1713 4926450 - CAGE SPNL 6D 50X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926455 SUP HCPCS C1713 4926455 - CAGE SPNL 6D 55X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926460 SUP HCPCS C1713 4926460 - CAGE SPNL 6D 60X22X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926640 SUP HCPCS C1713 4926640 - CAGE SPNL 6D 40X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926645 SUP HCPCS C1713 4926645 - CAGE SPNL 6D 45X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926650 SUP HCPCS C1713 4926650 - CAGE SPNL 6D 50X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926655 SUP HCPCS C1713 4926655 - CAGE SPNL 6D 55X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926660 SUP HCPCS C1713 4926660 - CAGE SPNL 6D 60X22X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926840 SUP HCPCS C1713 4926840 - CAGE SPNL 6D 40X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926845 SUP HCPCS C1713 4926845 - CAGE SPNL 6D 45X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926850 SUP HCPCS C1713 4926850 - CAGE SPNL 6D 50X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926855 SUP HCPCS C1713 4926855 - CAGE SPNL 6D 55X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4926860 SUP HCPCS C1713 4926860 - CAGE SPNL 6D 60X22X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980040 SUP HCPCS C1713 4980040 - CAGE SPNL 0D 40X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980045 SUP HCPCS C1713 4980045 - CAGE SPNL 0D 45X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980050 SUP HCPCS C1713 4980050 - CAGE SPNL 0D 50X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980055 SUP HCPCS C1713 4980055 - CAGE SPNL 0D 55X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980240 SUP HCPCS C1713 4980240 - CAGE SPNL 0D 40X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980245 SUP HCPCS C1713 4980245 - CAGE SPNL 0D 45X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980250 SUP HCPCS C1713 4980250 - CAGE SPNL 0D 50X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980255 SUP HCPCS C1713 4980255 - CAGE SPNL 0D 55X12X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980440 SUP HCPCS C1713 4980440 - CAGE SPNL 0D 40X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980445 SUP HCPCS C1713 4980445 - CAGE SPNL 0D 45X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980450 SUP HCPCS C1713 4980450 - CAGE SPNL 0D 50X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980455 SUP HCPCS C1713 4980455 - CAGE SPNL 0D 55X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980640 SUP HCPCS C1713 4980640 - CAGE SPNL 0D 40X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980645 SUP HCPCS C1713 4980645 - CAGE SPNL 0D 45X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980650 SUP HCPCS C1713 4980650 - CAGE SPNL 0D 50X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980655 SUP HCPCS C1713 4980655 - CAGE SPNL 0D 55X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980840 SUP HCPCS C1713 4980840 - CAGE SPNL 0D 40X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980845 SUP HCPCS C1713 4980845 - CAGE SPNL 0D 45X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980850 SUP HCPCS C1713 4980850 - CAGE SPNL 0D 50X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4980855 SUP HCPCS C1713 4980855 - CAGE SPNL 0D 55X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986040 SUP HCPCS C1713 4986040 - CAGE SPNL 6D 40X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986045 SUP HCPCS C1713 4986045 - CAGE SPNL 6D 45X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986050 SUP HCPCS C1713 4986050 - CAGE SPNL 6D 50X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986055 SUP HCPCS C1713 4986055 - CAGE SPNL 6D 55X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986060 SUP HCPCS C1713 4986060 - CAGE SPNL 6D 60X18X10MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986240 SUP HCPCS C1713 4986240 - CAGE SPNL 6D 40X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986245 SUP HCPCS C1713 4986245 - CAGE SPNL 6D 45X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986250 SUP HCPCS C1713 4986250 - CAGE SPNL 6D 50X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986255 SUP HCPCS C1713 4986255 - CAGE SPNL 6D 55X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986260 SUP HCPCS C1713 4986260 - CAGE SPNL 6D 60X18X12MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986440 SUP HCPCS C1713 4986440 - CAGE SPNL 6D 40X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986445 SUP HCPCS C1713 4986445 - CAGE SPNL 6D 45X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986450 SUP HCPCS C1713 4986450 - CAGE SPNL 6D 50X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986455 SUP HCPCS C1713 4986455 - CAGE SPNL 6D 55X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986460 SUP HCPCS C1713 4986460 - CAGE SPNL 6D 60X18X14MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986640 SUP HCPCS C1713 4986640 - CAGE SPNL 6D 40X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986645 SUP HCPCS C1713 4986645 - CAGE SPNL 6D 45X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986650 SUP HCPCS C1713 4986650 - CAGE SPNL 6D 50X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986655 SUP HCPCS C1713 4986655 - CAGE SPNL 6D 55X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986660 SUP HCPCS C1713 4986660 - CAGE SPNL 6D 60X18X16MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986840 SUP HCPCS C1713 4986840 - CAGE SPNL 6D 40X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986845 SUP HCPCS C1713 4986845 - CAGE SPNL 6D 45X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986850 SUP HCPCS C1713 4986850 - CAGE SPNL 6D 50X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986855 SUP HCPCS C1713 4986855 - CAGE SPNL 6D 55X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 4986860 SUP HCPCS C1713 4986860 - CAGE SPNL 6D 60X18X8MM CLYDESDALE PTC RADOPQ PEEK TI LMBR BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 5010001 SUP HCPCS C1788 5010001 - DEVICE BX 6 PORT ASP BN MRW BOTH IP/OP $347.50 $257.00 $68.97 $347.50 $156.38 $156.38 $156.38 $156.38 $347.50 $347.50 $347.50 $72.43 $347.50 $347.50 $347.50 $347.50 $347.50 $72.42 $347.50 $347.50 $205.55 $347.50 $347.50 $347.50 $347.50 $260.63 $347.50 $347.50 $347.50 $173.75 $173.75 $275.22 $347.50 $278.00 $156.38 $68.97 N/A $201.55 $347.50 $347.50 $347.50 $72.42 $347.50 N/A N/A 5010005 SUP Custom 27804086 5010005 - SUBSTITUTE BNGF 5ML STRL FORMAGRAFT GRNL BVN CLGN MTRX TCP BOTH IP/OP "$1,990.00" "$1,473.00" $354.22 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" $354.22 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" $414.74 "$1,990.00" $796.00 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,492.50" "$1,990.00" "$1,990.00" "$1,990.00" $995.00 $995.00 "$1,576.08" "$1,990.00" "$1,592.00" $895.50 "$1,990.00" N/A "$1,154.20" "$1,990.00" "$1,194.00" "$1,990.00" "$1,990.00" "$1,990.00" N/A N/A 5010008 SUP Custom 27203010 5010008 - NEEDLE SPNL 8IN ASP PORT BOTH IP/OP $347.50 $257.00 $61.86 $347.50 $347.50 $347.50 $347.50 $347.50 $347.50 $347.50 $61.86 $347.50 $347.50 $257.91 $257.91 $267.85 $181.05 $72.42 $347.50 $139.00 $347.50 $347.50 $347.50 $347.50 $347.50 $260.63 $347.50 $347.50 $347.50 $173.75 $173.75 $275.22 $347.50 $278.00 $225.88 $347.50 N/A $201.55 $347.50 $208.50 $347.50 $347.50 $347.50 N/A N/A 5010010 SUP Custom 27804086 5010010 - SUBSTITUTE BNGF 10ML STRL FORMAGRAFT GRNL BVN CLGN MTRX BOTH IP/OP "$3,505.00" "$2,594.00" $623.89 "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" $623.89 "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" $730.48 "$3,505.00" "$1,402.00" "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" "$2,628.75" "$3,505.00" "$3,505.00" "$3,505.00" "$1,752.50" "$1,752.50" "$2,775.96" "$3,505.00" "$2,804.00" "$1,577.25" "$3,505.00" N/A "$2,032.90" "$3,505.00" "$2,103.00" "$3,505.00" "$3,505.00" "$3,505.00" N/A N/A 5010020 SUP Custom 27804086 5010020 - SUBSTITUTE BNGF 20ML STRL FORMAGRAFT GRNL BVN CLGN MTRX TCP BOTH IP/OP "$3,505.00" "$2,594.00" $623.89 "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" $623.89 "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" $730.48 "$3,505.00" "$1,402.00" "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" "$3,505.00" "$2,628.75" "$3,505.00" "$3,505.00" "$3,505.00" "$1,752.50" "$1,752.50" "$2,775.96" "$3,505.00" "$2,804.00" "$1,577.25" "$3,505.00" N/A "$2,032.90" "$3,505.00" "$2,103.00" "$3,505.00" "$3,505.00" "$3,505.00" N/A N/A 5010024 SUP HCPCS C1884 5010024 - FILTER CV .035IN LOPRFL CONE 9FR 70CM VNTC LP PROVEN DSGN BOTH IP/OP "$2,926.00" "$2,165.00" $580.66 "$2,925.60" "$1,316.52" "$1,316.52" "$1,316.52" "$1,316.52" "$2,925.60" "$2,925.60" "$2,925.60" $609.77 "$2,925.60" "$2,925.60" "$2,925.60" "$2,925.60" "$2,925.60" $609.73 "$2,925.60" "$2,925.60" "$1,442.32" "$2,925.60" "$2,925.60" "$2,925.60" "$2,925.60" "$2,194.50" "$2,925.60" "$2,925.60" "$2,925.60" "$1,462.80" "$1,462.80" "$2,317.08" "$2,925.60" "$2,340.48" "$1,316.52" $580.66 N/A "$1,697.08" "$2,925.60" "$2,925.60" "$2,925.60" $609.70 "$2,925.60" N/A N/A 5010085 SUP Custom 27804086 5010085 - SUBSTITUTE BNGF SM STRL FORMAGRAFT BLCK BVN CLGN MTRX TCP BOTH IP/OP "$4,130.00" "$3,056.00" $735.14 "$4,130.00" "$4,130.00" "$4,130.00" "$4,130.00" "$4,130.00" "$4,130.00" "$4,130.00" $735.14 "$4,130.00" "$4,130.00" "$4,130.00" "$4,130.00" "$4,130.00" "$4,130.00" $860.74 "$4,130.00" "$1,652.00" "$4,130.00" "$4,130.00" "$4,130.00" "$4,130.00" "$4,130.00" "$3,097.50" "$4,130.00" "$4,130.00" "$4,130.00" "$2,065.00" "$2,065.00" "$3,270.96" "$4,130.00" "$3,304.00" "$1,858.50" "$4,130.00" N/A "$2,395.40" "$4,130.00" "$2,478.00" "$4,130.00" "$4,130.00" "$4,130.00" N/A N/A 5010125 SUP HCPCS C1713 5010125 - SUBSTITUTE BNGF LG STRL FORMAGRAFT BLCK BVN CLGN MTRX TCP BOTH IP/OP "$4,462.50" "$3,302.00" $885.69 "$4,462.50" "$2,008.13" "$2,008.13" "$2,008.13" "$2,008.13" "$4,462.50" "$4,462.50" "$4,462.50" $930.10 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$2,200.01" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" $885.69 N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" $929.99 "$4,462.50" N/A N/A 5010205 SUP Custom 27804086 5010205 - SUBSTITUTE BNGF 5ML STRL FORMAGRAFT STRP BVN CLGN MTRX TCP BOTH IP/OP "$1,990.00" "$1,473.00" $354.22 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" $354.22 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" $414.74 "$1,990.00" $796.00 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,492.50" "$1,990.00" "$1,990.00" "$1,990.00" $995.00 $995.00 "$1,576.08" "$1,990.00" "$1,592.00" $895.50 "$1,990.00" N/A "$1,154.20" "$1,990.00" "$1,194.00" "$1,990.00" "$1,990.00" "$1,990.00" N/A N/A 5013001 SUP Custom 27803010 5013001 - GRAFT BN 1ML OSTEOCEL + CLLR BN MTRX BOTH IP/OP "$1,222.50" $905.00 $217.61 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $217.61 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $254.78 "$1,222.50" $489.00 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $916.88 "$1,222.50" "$1,222.50" "$1,222.50" $611.25 $611.25 $968.22 "$1,222.50" $978.00 $550.13 "$1,222.50" N/A $709.05 "$1,222.50" $733.50 "$1,222.50" "$1,222.50" "$1,222.50" N/A N/A 5013005 SUP Custom 27803010 5013005 - GRAFT BN 5ML OSTEOCEL + CLLR BN MTRX BOTH IP/OP "$5,750.00" "$4,255.00" "$1,023.50" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,023.50" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$2,300.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$5,750.00" N/A "$3,335.00" "$5,750.00" "$3,450.00" "$5,750.00" "$5,750.00" "$5,750.00" N/A N/A 5013010 SUP Custom 27804086 5013010 - GRAFT BN 10ML OSTEOCEL + CLLR BN MTRX BOTH IP/OP "$9,625.00" "$7,123.00" "$1,713.25" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$1,713.25" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$2,005.96" "$9,625.00" "$3,850.00" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$7,218.75" "$9,625.00" "$9,625.00" "$9,625.00" "$4,812.50" "$4,812.50" "$7,623.00" "$9,625.00" "$7,700.00" "$4,331.25" "$9,625.00" N/A "$5,582.50" "$9,625.00" "$5,775.00" "$9,625.00" "$9,625.00" "$9,625.00" N/A N/A 5013015 SUP HCPCS C1762 5013015 - GRAFT BONE OSTEOCEL PLUS CELLULAR BONE MATRIX 15ML BOTH IP/OP "$11,475.00" "$8,492.00" "$2,277.50" "$11,475.00" "$5,163.75" "$5,163.75" "$5,163.75" "$5,163.75" "$11,475.00" "$11,475.00" "$11,475.00" "$2,391.68" "$11,475.00" "$11,475.00" "$11,475.00" "$11,475.00" "$11,475.00" "$2,391.52" "$11,475.00" "$11,475.00" "$5,657.18" "$11,475.00" "$11,475.00" "$11,475.00" "$11,475.00" "$8,606.25" "$11,475.00" "$11,475.00" "$11,475.00" "$5,737.50" "$5,737.50" "$9,088.20" "$11,475.00" "$9,180.00" "$5,163.75" "$2,277.50" N/A "$6,655.50" "$11,475.00" "$11,475.00" "$11,475.00" "$2,391.39" "$11,475.00" N/A N/A 5016001 SUP HCPCS C1762 5016001 - GRAFT BONE OSTEOCEL CLLR BONE MTRX 1ML BOTH IP/OP "$1,345.00" $995.00 $266.95 "$1,345.00" $605.25 $605.25 $605.25 $605.25 "$1,345.00" "$1,345.00" "$1,345.00" $280.33 "$1,345.00" "$1,345.00" "$1,345.00" "$1,345.00" "$1,345.00" $280.31 "$1,345.00" "$1,345.00" $795.57 "$1,345.00" "$1,345.00" "$1,345.00" "$1,345.00" "$1,008.75" "$1,345.00" "$1,345.00" "$1,345.00" $672.50 $672.50 "$1,065.24" "$1,345.00" "$1,076.00" $605.25 $266.95 N/A $780.10 "$1,345.00" "$1,345.00" "$1,345.00" $280.30 "$1,345.00" N/A N/A 5016005 SUP HCPCS C1762 5016005 - GRAFT BONE OSTEOCEL CLLR BONE MTRX 5ML BOTH IP/OP "$6,195.00" "$4,584.00" "$1,229.55" "$6,195.00" "$2,787.75" "$2,787.75" "$2,787.75" "$2,787.75" "$6,195.00" "$6,195.00" "$6,195.00" "$1,291.19" "$6,195.00" "$6,195.00" "$6,195.00" "$6,195.00" "$6,195.00" "$1,291.11" "$6,195.00" "$6,195.00" "$3,054.14" "$6,195.00" "$6,195.00" "$6,195.00" "$6,195.00" "$4,646.25" "$6,195.00" "$6,195.00" "$6,195.00" "$3,097.50" "$3,097.50" "$4,906.44" "$6,195.00" "$4,956.00" "$2,787.75" "$1,229.55" N/A "$3,593.10" "$6,195.00" "$6,195.00" "$6,195.00" "$1,291.04" "$6,195.00" N/A N/A 5016010 SUP Custom 27804086 5016010 - GRAFT BONE OSTEOCEL CLLR BONE MTRX 10ML BOTH IP/OP "$9,625.00" "$7,123.00" "$1,713.25" "$10,652.50" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$1,713.25" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$2,005.96" "$9,625.00" "$10,652.50" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$7,218.75" "$9,625.00" "$9,625.00" "$9,625.00" "$4,812.50" "$4,812.50" "$7,623.00" "$9,625.00" "$7,700.00" "$4,331.25" "$9,625.00" N/A "$5,582.50" "$9,625.00" "$5,775.00" "$9,625.00" "$9,625.00" "$9,625.00" N/A N/A 5017905 SUP HCPCS C1713 5017905 - SCREW BN 1.7MM 5MM NS LEIBINGER UNV 2 SLF DRL XPN TI MDFC BOTH IP/OP $103.50 $77.00 $20.52 $103.40 $46.53 $46.53 $46.53 $46.53 $103.40 $103.40 $103.40 $21.55 $103.40 $103.40 $103.40 $103.40 $103.40 $21.55 $103.40 $103.40 $61.16 $103.40 $103.40 $103.40 $103.40 $77.63 $103.40 $103.40 $103.40 $51.70 $51.70 $81.89 $103.40 $82.72 $46.53 $20.52 N/A $60.03 $103.40 $62.04 $103.40 $21.55 $103.40 N/A N/A 5020001 SUP HCPCS C1713 5020001 - GRAFT BN SM STRL LF PROPEL ALGRF PTTY BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $287.50 $287.50 N/A N/A 5020005 SUP HCPCS C1713 5020005 - GRAFT BN MED STRL LF PROPEL ALGRF PTTY BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 5020010 SUP HCPCS C1713 5020010 - GRAFT BN LG STRL LF PROPEL ALGRF PTTY BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 5020404 SUP HCPCS C1713 5020404 - SCREW BN 2MM 4MM AU NS LEIBINGER UNV 2 ST XPN TI MXLFCL BOTH IP/OP $87.50 $65.00 $17.35 $87.40 $39.33 $39.33 $39.33 $39.33 $87.40 $87.40 $87.40 $18.22 $87.40 $87.40 $87.40 $87.40 $87.40 $18.22 $87.40 $87.40 $51.70 $87.40 $87.40 $87.40 $87.40 $65.63 $87.40 $87.40 $87.40 $43.70 $43.70 $69.22 $87.40 $69.92 $39.33 $17.35 N/A $50.75 $87.40 $52.44 $87.40 $18.21 $87.40 N/A N/A 5022105 SUP HCPCS C1713 5022105 - GRAFT BN MED PROPEL ALGRF DBM FBR BOTH IP/OP "$1,450.00" "$1,073.00" $287.79 "$1,450.00" $652.50 $652.50 $652.50 $652.50 "$1,450.00" "$1,450.00" "$1,450.00" $302.22 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" $302.20 "$1,450.00" $580.00 $857.68 "$1,450.00" "$1,450.00" "$1,450.00" "$1,450.00" "$1,087.50" "$1,450.00" "$1,450.00" "$1,450.00" $725.00 $725.00 "$1,148.40" "$1,450.00" "$1,160.00" $652.50 $287.79 N/A $841.00 "$1,450.00" "$1,450.00" "$1,450.00" $302.18 "$1,450.00" N/A N/A 5022112 SUP HCPCS C1713 5022112 - GRAFT BN SM BOAT PROPEL ALGRF DBM FBR BOTH IP/OP "$1,625.00" "$1,203.00" $322.52 "$1,625.00" $731.25 $731.25 $731.25 $731.25 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" $650.00 $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 $322.52 N/A $942.50 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" N/A N/A 5022113 SUP HCPCS C1713 5022113 - GRAFT BN LG BOAT PROPEL ALGRF DBM FBR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 5030641 SUP HCPCS C1713 5030641 - CAGE SPNL 11MM 14MMX6MM STRL ANTM RADOPQ PTC CRV INTRBD FS BOTH IP/OP "$5,940.00" "$4,396.00" "$1,178.94" "$5,940.00" "$2,673.00" "$2,673.00" "$2,673.00" "$2,673.00" "$5,940.00" "$5,940.00" "$5,940.00" "$1,238.04" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$1,237.96" "$5,940.00" "$5,940.00" "$2,928.42" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$4,455.00" "$5,940.00" "$5,940.00" "$5,940.00" "$2,970.00" "$2,970.00" "$4,704.48" "$5,940.00" "$4,752.00" "$2,673.00" "$1,178.94" N/A "$3,445.20" "$5,940.00" "$5,940.00" "$5,940.00" "$1,237.90" "$5,940.00" N/A N/A 5101302 SUP HCPCS C1713 5101302 - CAGE SPNL 12D 30X11X10MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5101308 SUP HCPCS C1713 5101308 - CAGE SPNL 8D 30X11X10MM NS LF CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5104308 SUP HCPCS C1713 5104308 - CAGE SPNL 8D 30MMX14MMX10 NS LF CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5109308 SUP HCPCS C1713 5109308 - CAGE SPNL 8D 30X10X9MM NS LF CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5111308 SUP HCPCS C1713 5111308 - CAGE SPNL 8D 30X11X11MM NS LF CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5119308 SUP HCPCS C1713 5119308 - CAGE SPNL 8D 30X11X9MM NS LF CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5121308 SUP HCPCS C1713 5121308 - CAGE SPNL 8D 30X12X11MM NS LF CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5129308 SUP HCPCS C1713 5129308 - CAGE SPNL 8D 30X12X9MM NS LF CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5149308 SUP HCPCS C1713 5149308 - CAGE SPNL 8D 30X14X9MM NS LF CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5161600 SUP Custom 27803010 5161600 - ENDCAP 16MM RND 0 DEG OD16 TI XCORE 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 5161604 SUP Custom 27803010 5161604 - ENDCAP 16MM RND 4 DEG OD16 TI XCORE 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 5161608 SUP Custom 27803010 5161608 - ENDCAP 16MM RND 8 DEG OD16 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 5161612 SUP Custom 27803010 5161612 - ENDCAP 16MM RND 12 DEG XCORE 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 5163000 SUP Custom 27803010 5163000 - ENDCAP OD16X16X30MM 0 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 5163004 SUP Custom 27803010 5163004 - ENDCAPÿ OD16X16X30MM 4 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 5163014 SUP Custom 27803010 5163014 - ENDCAP OD16X16X30MM -4 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 5164000 SUP Custom 27803010 5164000 - ENDCAP OD16X16X40MM 0 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 5164004 SUP Custom 27803010 5164004 - ENDCAP OD16X16X40MM 4 DEG TI XCORE TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 5164014 SUP Custom 27803010 5164014 - ENDCAP OD16X16X40MM -4 DEG TI OD16 TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 5181308 SUP HCPCS C1713 5181308 - CAGE SPNL 8D 30X11X8MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5181800 SUP Custom 27803010 5181800 - ENDCAP 18MM RND 0 DEG OD16 TI XCORE 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 5181804 SUP Custom 27803010 5181804 - ENDCAP 18MM RND 4 DEG OD16 TI XCORE 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 5181808 SUP Custom 27803010 5181808 - ENDCAP 18MM RND 8 DEG OD16 TI XCORE 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 5181812 SUP Custom 27803010 5181812 - ENDCAP 18MM RND 12 DEG OD18 TI XCORE 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 5189300 SUP HCPCS C1713 5189300 - CAGE SPNL 0D 30X9X8MM NS LF CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5189302 SUP HCPCS C1713 5189302 - CAGE SPNL 12D 30X9X8MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5191302 SUP HCPCS C1713 5191302 - CAGE SPNL 12D 30X11X9MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5191308 SUP HCPCS C1713 5191308 - CAGE SPNL 8D 30X11X9MM NS LF CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5199300 SUP HCPCS C1713 5199300 - CAGE SPNL 0D 30X9X9MM NS LF CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5199302 SUP HCPCS C1713 5199302 - CAGE SPNL 12D 30X9X9MM NS LF CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5289308 SUP HCPCS C1713 5289308 - CAGE SPNL 8D 30X9X8MM NS LF TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5300252 SUP HCPCS C1713 5300252 - CAGE SPNL 12D OBLQ 25X10X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5300254 SUP HCPCS C1713 5300254 - CAGE SPNL 4D OBLQ 25X10X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5300302 SUP HCPCS C1713 5300302 - CAGE SPNL 12D OBLQ 30X10X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5300304 SUP HCPCS C1713 5300304 - CAGE SPNL 4D OBLQ 30X10X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5300354 SUP HCPCS C1713 5300354 - CAGE SPNL 4D OBLQ 35X10X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5304252 SUP HCPCS C1713 5304252 - CAGE SPNL 12D OBLQ 25X10X14MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5304254 SUP HCPCS C1713 5304254 - CAGE SPNL 4D OBLQ 25X10X14MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5304302 SUP HCPCS C1713 5304302 - CAGE SPNL 12D OBLQ 30X10X14MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5304304 SUP HCPCS C1713 5304304 - CAGE SPNL 4D OBLQ 30X10X14MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5320252 SUP HCPCS C1713 5320252 - CAGE SPNL 12D OBLQ 25X12X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5320254 SUP HCPCS C1713 5320254 - CAGE SPNL 4D OBLQ 25X12X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5320302 SUP HCPCS C1713 5320302 - CAGE SPNL 12D OBLQ 30X12X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5320304 SUP HCPCS C1713 5320304 - CAGE SPNL 4D OBLQ 30X12X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5320354 SUP HCPCS C1713 5320354 - CAGE SPNL 4D OBLQ 35X12X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5324252 SUP HCPCS C1713 5324252 - CAGE SPNL 12D OBLQ 25X12X14MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5324254 SUP HCPCS C1713 5324254 - CAGE SPNL 4D OBLQ 25X12X14MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5324302 SUP HCPCS C1713 5324302 - CAGE SPNL 12D OBLQ 30X12X14MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5324304 SUP HCPCS C1713 5324304 - CAGE SPNL 4D OBLQ 30X12X14MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5340252 SUP HCPCS C1713 5340252 - CAGE SPNL 12D OBLQ 25X14X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5340254 SUP HCPCS C1713 5340254 - CAGE SPNL 4D OBLQ 25X14X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5340302 SUP HCPCS C1713 5340302 - CAGE SPNL 12D OBLQ 30X14X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5340304 SUP HCPCS C1713 5340304 - CAGE SPNL 4D OBLQ 30X14X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5340354 SUP HCPCS C1713 5340354 - CAGE SPNL 4D OBLQ 35X14X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5380252 SUP HCPCS C1713 5380252 - CAGE SPNL 12D OBLQ 25X8X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5380254 SUP HCPCS C1713 5380254 - CAGE SPNL 4D OBLQ 25X8X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5380302 SUP HCPCS C1713 5380302 - CAGE SPNL 12D OBLQ 30X8X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5380304 SUP HCPCS C1713 5380304 - CAGE SPNL 4D OBLQ 30X8X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5380354 SUP HCPCS C1713 5380354 - CAGE SPNL 4D OBLQ 35X8X10MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5384252 SUP HCPCS C1713 5384252 - CAGE SPNL 12D OBLQ 25X8X14MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5384254 SUP HCPCS C1713 5384254 - CAGE SPNL 4D OBLQ 25X8X14MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5384302 SUP HCPCS C1713 5384302 - CAGE SPNL 12D OBLQ 30X8X14MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5384304 SUP HCPCS C1713 5384304 - CAGE SPNL 4D OBLQ 30X8X14MM TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5400250 SUP HCPCS C1713 5400250 - CAGE SPNL 0D OBLQ 25X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5400252 SUP HCPCS C1713 5400252 - CAGE SPNL 12D OBLQ 25X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5400254 SUP HCPCS C1713 5400254 - CAGE SPNL 4D OBLQ 25X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5400255 SUP HCPCS C1713 5400255 - CAGE SPNL 15D OBLQ 25X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5400258 SUP HCPCS C1713 5400258 - CAGE SPNL 8D OBLQ 25X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5400300 SUP HCPCS C1713 5400300 - CAGE SPNL 0D OBLQ 30X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5400302 SUP HCPCS C1713 5400302 - CAGE SPNL 12D OBLQ 30X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5400304 SUP HCPCS C1713 5400304 - CAGE SPNL 4D OBLQ 30X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5400305 SUP HCPCS C1713 5400305 - CAGE SPNL 15D OBLQ 30X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5400308 SUP HCPCS C1713 5400308 - CAGE SPNL 8D OBLQ 30X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5400350 SUP HCPCS C1713 5400350 - CAGE SPNL 0D OBLQ 35X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5400352 SUP HCPCS C1713 5400352 - CAGE SPNL 12D OBLQ 35X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5400354 SUP HCPCS C1713 5400354 - CAGE SPNL 4D OBLQ 35X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5400355 SUP HCPCS C1713 5400355 - CAGE SPNL 15D OBLQ 35X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5400358 SUP HCPCS C1713 5400358 - CAGE SPNL 8D OBLQ 35X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5400400 SUP HCPCS C1713 5400400 - CAGE SPNL 0D OBLQ 40X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5400402 SUP HCPCS C1713 5400402 - CAGE SPNL 12D OBLQ 40X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5400404 SUP HCPCS C1713 5400404 - CAGE SPNL 4D OBLQ 40X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5400405 SUP HCPCS C1713 5400405 - CAGE SPNL 15D OBLQ 40X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5400408 SUP HCPCS C1713 5400408 - CAGE SPNL 8D OBLQ 40X10X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404250 SUP HCPCS C1713 5404250 - CAGE SPNL 0D OBLQ 25X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404252 SUP HCPCS C1713 5404252 - CAGE SPNL 12D OBLQ 25X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5404254 SUP HCPCS C1713 5404254 - CAGE SPNL 4D OBLQ 25X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5404255 SUP HCPCS C1713 5404255 - CAGE SPNL 15D OBLQ 25X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404258 SUP HCPCS C1713 5404258 - CAGE SPNL 8D OBLQ 25X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404300 SUP HCPCS C1713 5404300 - CAGE SPNL 0D OBLQ 30X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404302 SUP HCPCS C1713 5404302 - CAGE SPNL 12D OBLQ 30X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404304 SUP HCPCS C1713 5404304 - CAGE SPNL 4D OBLQ 30X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5404305 SUP HCPCS C1713 5404305 - CAGE SPNL 15D OBLQ 30X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404308 SUP HCPCS C1713 5404308 - CAGE SPNL 8D OBLQ 30X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404350 SUP HCPCS C1713 5404350 - CAGE SPNL 0D OBLQ 35X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404352 SUP HCPCS C1713 5404352 - CAGE SPNL 12D OBLQ 35X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404354 SUP HCPCS C1713 5404354 - CAGE SPNL 4D OBLQ 35X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404355 SUP HCPCS C1713 5404355 - CAGE SPNL 15D OBLQ 35X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404358 SUP HCPCS C1713 5404358 - CAGE SPNL 8D OBLQ 35X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404400 SUP HCPCS C1713 5404400 - CAGE SPNL 0D OBLQ 40X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404402 SUP HCPCS C1713 5404402 - CAGE SPNL 12D OBLQ 40X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404404 SUP HCPCS C1713 5404404 - CAGE SPNL 4D OBLQ 40X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404405 SUP HCPCS C1713 5404405 - CAGE SPNL 15D OBLQ 40X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5404408 SUP HCPCS C1713 5404408 - CAGE SPNL 8D OBLQ 40X14X10MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410250 SUP HCPCS C1713 5410250 - CAGE SPNL 0D OBLQ 25X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410252 SUP HCPCS C1713 5410252 - CAGE SPNL 12D OBLQ 25X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410254 SUP HCPCS C1713 5410254 - CAGE SPNL 4D OBLQ 25X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410255 SUP HCPCS C1713 5410255 - CAGE SPNL 15D OBLQ 25X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410258 SUP HCPCS C1713 5410258 - CAGE SPNL 8D OBLQ 25X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410300 SUP HCPCS C1713 5410300 - CAGE SPNL 0D OBLQ 30X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410302 SUP HCPCS C1713 5410302 - CAGE SPNL 12D OBLQ 30X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410304 SUP HCPCS C1713 5410304 - CAGE SPNL 4D OBLQ 30X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410305 SUP HCPCS C1713 5410305 - CAGE SPNL 15D OBLQ 30X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410308 SUP HCPCS C1713 5410308 - CAGE SPNL 8D OBLQ 30X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410350 SUP HCPCS C1713 5410350 - CAGE SPNL 0D OBLQ 35X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410352 SUP HCPCS C1713 5410352 - CAGE SPNL 12D OBLQ 35X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410354 SUP HCPCS C1713 5410354 - CAGE SPNL 4D OBLQ 35X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410355 SUP HCPCS C1713 5410355 - CAGE SPNL 15D OBLQ 35X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410358 SUP HCPCS C1713 5410358 - CAGE SPNL 8D OBLQ 35X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410400 SUP HCPCS C1713 5410400 - CAGE SPNL 0D OBLQ 40X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410402 SUP HCPCS C1713 5410402 - CAGE SPNL 12D OBLQ 40X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410404 SUP HCPCS C1713 5410404 - CAGE SPNL 4D OBLQ 40X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410405 SUP HCPCS C1713 5410405 - CAGE SPNL 15D OBLQ 40X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5410408 SUP HCPCS C1713 5410408 - CAGE SPNL 8D OBLQ 40X10X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414250 SUP HCPCS C1713 5414250 - CAGE SPNL 0D OBLQ 25X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414252 SUP HCPCS C1713 5414252 - CAGE SPNL 12D OBLQ 25X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414254 SUP HCPCS C1713 5414254 - CAGE SPNL 4D OBLQ 25X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414255 SUP HCPCS C1713 5414255 - CAGE SPNL 15D OBLQ 25X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414258 SUP HCPCS C1713 5414258 - CAGE SPNL 8D OBLQ 25X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414300 SUP HCPCS C1713 5414300 - CAGE SPNL 0D OBLQ 30X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414302 SUP HCPCS C1713 5414302 - CAGE SPNL 12D OBLQ 30X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414304 SUP HCPCS C1713 5414304 - CAGE SPNL 4D OBLQ 30X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414305 SUP HCPCS C1713 5414305 - CAGE SPNL 15D OBLQ 30X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414308 SUP HCPCS C1713 5414308 - CAGE SPNL 8D OBLQ 30X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414350 SUP HCPCS C1713 5414350 - CAGE SPNL 0D OBLQ 35X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5414352 SUP HCPCS C1713 5414352 - CAGE SPNL 12D OBLQ 35X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414355 SUP HCPCS C1713 5414355 - CAGE SPNL 15D OBLQ 35X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414358 SUP HCPCS C1713 5414358 - CAGE SPNL 8D OBLQ 35X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414400 SUP HCPCS C1713 5414400 - CAGE SPNL 0D OBLQ 40X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414402 SUP HCPCS C1713 5414402 - CAGE SPNL 12D OBLQ 40X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414404 SUP HCPCS C1713 5414404 - CAGE SPNL 4D OBLQ 40X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414405 SUP HCPCS C1713 5414405 - CAGE SPNL 15D OBLQ 40X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5414408 SUP HCPCS C1713 5414408 - CAGE SPNL 8D OBLQ 40X14X11MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420250 SUP HCPCS C1713 5420250 - CAGE SPNL 0D OBLQ 25X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420252 SUP HCPCS C1713 5420252 - CAGE SPNL 12D OBLQ 25X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5420254 SUP HCPCS C1713 5420254 - CAGE SPNL 4D OBLQ 25X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5420255 SUP HCPCS C1713 5420255 - CAGE SPNL 15D OBLQ 25X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420258 SUP HCPCS C1713 5420258 - CAGE SPNL 8D OBLQ 25X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420300 SUP HCPCS C1713 5420300 - CAGE SPNL 0D OBLQ 30X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420302 SUP HCPCS C1713 5420302 - CAGE SPNL 12D OBLQ 30X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5420304 SUP HCPCS C1713 5420304 - CAGE SPNL 4D OBLQ 30X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5420305 SUP HCPCS C1713 5420305 - CAGE SPNL 15D OBLQ 30X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420308 SUP HCPCS C1713 5420308 - CAGE SPNL 8D OBLQ 30X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420350 SUP HCPCS C1713 5420350 - CAGE SPNL 0D OBLQ 35X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420352 SUP HCPCS C1713 5420352 - CAGE SPNL 12D OBLQ 35X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420354 SUP HCPCS C1713 5420354 - CAGE SPNL 4D OBLQ 35X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5420355 SUP HCPCS C1713 5420355 - CAGE SPNL 15D OBLQ 35X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420358 SUP HCPCS C1713 5420358 - CAGE SPNL 8D OBLQ 35X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420400 SUP HCPCS C1713 5420400 - CAGE SPNL 0D OBLQ 40X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420402 SUP HCPCS C1713 5420402 - CAGE SPNL 12D OBLQ 40X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420404 SUP HCPCS C1713 5420404 - CAGE SPNL 4D OBLQ 40X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420405 SUP HCPCS C1713 5420405 - CAGE SPNL 15D OBLQ 40X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5420408 SUP HCPCS C1713 5420408 - CAGE SPNL 8D OBLQ 40X10X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424250 SUP HCPCS C1713 5424250 - CAGE SPNL 0D OBLQ 25X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424252 SUP HCPCS C1713 5424252 - CAGE SPNL 12D OBLQ 25X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5424254 SUP HCPCS C1713 5424254 - CAGE SPNL 4D OBLQ 25X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5424255 SUP HCPCS C1713 5424255 - CAGE SPNL 15D OBLQ 25X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424258 SUP HCPCS C1713 5424258 - CAGE SPNL 8D OBLQ 25X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424300 SUP HCPCS C1713 5424300 - CAGE SPNL 0D OBLQ 30X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424302 SUP HCPCS C1713 5424302 - CAGE SPNL 12D OBLQ 30X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424304 SUP HCPCS C1713 5424304 - CAGE SPNL 4D OBLQ 30X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5424305 SUP HCPCS C1713 5424305 - CAGE SPNL 15D OBLQ 30X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424308 SUP HCPCS C1713 5424308 - CAGE SPNL 8D OBLQ 30X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424350 SUP HCPCS C1713 5424350 - CAGE SPNL 0D OBLQ 35X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424352 SUP HCPCS C1713 5424352 - CAGE SPNL 12D OBLQ 35X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424354 SUP HCPCS C1713 5424354 - CAGE SPNL 4D OBLQ 35X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424355 SUP HCPCS C1713 5424355 - CAGE SPNL 15D OBLQ 35X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424358 SUP HCPCS C1713 5424358 - CAGE SPNL 8D OBLQ 35X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424400 SUP HCPCS C1713 5424400 - CAGE SPNL 0D OBLQ 40X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424402 SUP HCPCS C1713 5424402 - CAGE SPNL 12D OBLQ 40X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424404 SUP HCPCS C1713 5424404 - CAGE SPNL 4D OBLQ 40X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424405 SUP HCPCS C1713 5424405 - CAGE SPNL 15D OBLQ 40X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5424408 SUP HCPCS C1713 5424408 - CAGE SPNL 8D OBLQ 40X14X12MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430250 SUP HCPCS C1713 5430250 - CAGE SPNL 0D OBLQ 25X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430252 SUP HCPCS C1713 5430252 - CAGE SPNL 12D OBLQ 25X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430254 SUP HCPCS C1713 5430254 - CAGE SPNL 4D OBLQ 25X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430255 SUP HCPCS C1713 5430255 - CAGE SPNL 15D OBLQ 25X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430258 SUP HCPCS C1713 5430258 - CAGE SPNL 8D OBLQ 25X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430300 SUP HCPCS C1713 5430300 - CAGE SPNL 0D OBLQ 30X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430302 SUP HCPCS C1713 5430302 - CAGE SPNL 12D OBLQ 30X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430304 SUP HCPCS C1713 5430304 - CAGE SPNL 4D OBLQ 30X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430305 SUP HCPCS C1713 5430305 - CAGE SPNL 15D OBLQ 30X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430308 SUP HCPCS C1713 5430308 - CAGE SPNL 8D OBLQ 30X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430350 SUP HCPCS C1713 5430350 - CAGE SPNL 0D OBLQ 35X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430352 SUP HCPCS C1713 5430352 - CAGE SPNL 12D OBLQ 35X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430354 SUP HCPCS C1713 5430354 - CAGE SPNL 4D OBLQ 35X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430355 SUP HCPCS C1713 5430355 - CAGE SPNL 15D OBLQ 35X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430358 SUP HCPCS C1713 5430358 - CAGE SPNL 8D OBLQ 35X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430400 SUP HCPCS C1713 5430400 - CAGE SPNL 0D OBLQ 40X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430402 SUP HCPCS C1713 5430402 - CAGE SPNL 12D OBLQ 40X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430404 SUP HCPCS C1713 5430404 - CAGE SPNL 4D OBLQ 40X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430405 SUP HCPCS C1713 5430405 - CAGE SPNL 15D OBLQ 40X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5430408 SUP HCPCS C1713 5430408 - CAGE SPNL 8D OBLQ 40X10X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434250 SUP HCPCS C1713 5434250 - CAGE SPNL 0D OBLQ 25X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434252 SUP HCPCS C1713 5434252 - CAGE SPNL 12D OBLQ 25X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434254 SUP HCPCS C1713 5434254 - CAGE SPNL 4D OBLQ 25X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434255 SUP HCPCS C1713 5434255 - CAGE SPNL 15D OBLQ 25X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434258 SUP HCPCS C1713 5434258 - CAGE SPNL 8D OBLQ 25X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434300 SUP HCPCS C1713 5434300 - CAGE SPNL 0D OBLQ 30X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434302 SUP HCPCS C1713 5434302 - CAGE SPNL 12D OBLQ 30X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434304 SUP HCPCS C1713 5434304 - CAGE SPNL 4D OBLQ 30X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434305 SUP HCPCS C1713 5434305 - CAGE SPNL 15D OBLQ 30X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434308 SUP HCPCS C1713 5434308 - CAGE SPNL 8D OBLQ 30X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434350 SUP HCPCS C1713 5434350 - CAGE SPNL 0D OBLQ 35X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434352 SUP HCPCS C1713 5434352 - CAGE SPNL 12D OBLQ 35X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434354 SUP HCPCS C1713 5434354 - CAGE SPNL 4D OBLQ 35X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434355 SUP HCPCS C1713 5434355 - CAGE SPNL 15D OBLQ 35X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434358 SUP HCPCS C1713 5434358 - CAGE SPNL 8D OBLQ 35X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434400 SUP HCPCS C1713 5434400 - CAGE SPNL 0D OBLQ 40X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434402 SUP HCPCS C1713 5434402 - CAGE SPNL 12D OBLQ 40X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434404 SUP HCPCS C1713 5434404 - CAGE SPNL 4D OBLQ 40X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434405 SUP HCPCS C1713 5434405 - CAGE SPNL 15D OBLQ 40X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5434408 SUP HCPCS C1713 5434408 - CAGE SPNL 8D OBLQ 40X14X13MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440030 SUP HCPCS C1713 5440030 - SCREW SET 4.75MM TITANIUM SPN NONSTRL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 5440130 SUP HCPCS C1713 5440130 - SCREW SET NONBREAK OFF CD HORIZON TITANIUM SPN NONSTRL 4.75 BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 5440230 SUP HCPCS C1713 5440230 - SCREW SET BREAK OFF REDX SOLERA TITANIUM SPN NONSTRL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 5440250 SUP HCPCS C1713 5440250 - CAGE SPNL 0D OBLQ 25X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440252 SUP HCPCS C1713 5440252 - CAGE SPNL 12D OBLQ 25X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5440254 SUP HCPCS C1713 5440254 - CAGE SPNL 4D OBLQ 25X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5440255 SUP HCPCS C1713 5440255 - CAGE SPNL 15D OBLQ 25X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440258 SUP HCPCS C1713 5440258 - CAGE SPNL 8D OBLQ 25X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440300 SUP HCPCS C1713 5440300 - CAGE SPNL 0D OBLQ 30X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440302 SUP HCPCS C1713 5440302 - CAGE SPNL 12D OBLQ 30X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5440304 SUP HCPCS C1713 5440304 - CAGE SPNL 4D OBLQ 30X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5440305 SUP HCPCS C1713 5440305 - CAGE SPNL 15D OBLQ 30X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440308 SUP HCPCS C1713 5440308 - CAGE SPNL 8D OBLQ 30X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440350 SUP HCPCS C1713 5440350 - CAGE SPNL 0D OBLQ 35X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440352 SUP HCPCS C1713 5440352 - CAGE SPNL 12D OBLQ 35X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440355 SUP HCPCS C1713 5440355 - CAGE SPNL 15D OBLQ 35X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440358 SUP HCPCS C1713 5440358 - CAGE SPNL 8D OBLQ 35X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440400 SUP HCPCS C1713 5440400 - CAGE SPNL 0D OBLQ 40X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440402 SUP HCPCS C1713 5440402 - CAGE SPNL 12D OBLQ 40X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440404 SUP HCPCS C1713 5440404 - CAGE SPNL 4D OBLQ 40X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440405 SUP HCPCS C1713 5440405 - CAGE SPNL 15D OBLQ 40X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440408 SUP HCPCS C1713 5440408 - CAGE SPNL 8D OBLQ 40X10X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5440430 SUP HCPCS C1713 5440430 - SCREW SET BREAKOFF SOLERA SEXTANT CD HORIZON TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 5441101 SUP HCPCS C1713 5441101 - HOOK SPINAL XS COLOR CODED SOLERA CD HORIZON TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441102 SUP HCPCS C1713 5441102 - HOOK SPINAL SMALL COLOR CODED ARTICULAR PROCESS SOLERA CD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441103 SUP HCPCS C1713 5441103 - HOOK SPINAL MEDIUM COLOR CODED ARTICULAR PROCESS SOLERA CD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441104 SUP HCPCS C1713 5441104 - HOOK SPINAL LARGE COLOR CODED ARTICULAR PROCESS SOLERA CD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441112 SUP HCPCS C1713 5441112 - HOOK SPINAL SMALL WIDE COLOR CODED BLADE TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441113 SUP HCPCS C1713 5441113 - HOOK SPINAL MEDIUM WIDE COLOR CODED BLADE TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441114 SUP HCPCS C1713 5441114 - HOOK SPINAL LARGE WIDE COLOR CODED BLADE TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441122 SUP HCPCS C1713 5441122 - HOOK SPINAL SMALL NARROW COLOR CODED BLADE TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441123 SUP HCPCS C1713 5441123 - HOOK SPINAL MEDIUM NARROW COLOR CODED BLADE TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441124 SUP HCPCS C1713 5441124 - HOOK SPINAL LARGE NARROW COLOR CODED BLADE TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441133 SUP HCPCS C1713 5441133 - HOOK SPINAL MEDIUM WIDE COLOR CODED BLADE RAMP TRNSVRS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441142 SUP HCPCS C1713 5441142 - HOOK SPINAL SMALL NARROW COLOR CODED BLADE RAMP TRNSVRS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441143 SUP HCPCS C1713 5441143 - HOOK SPINAL MEDIUM NARROW COLOR CODED BLADE RAMP TRNSVRS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441172 SUP HCPCS C1713 5441172 - HOOK SPINAL SMALL COLOR CODED EXTEND BODY TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441173 SUP HCPCS C1713 5441173 - HOOK SPINAL MEDIUM COLOR CODED EXTEND BODY TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441174 SUP HCPCS C1713 5441174 - HOOK SPINAL LARGE COLOR CODED EXTEND BODY TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441196 SUP HCPCS C1713 5441196 - HOOK SPINAL SMALL RIGHT OFFST COLOR CODED TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441197 SUP HCPCS C1713 5441197 - HOOK SPINAL SMALL LEFT OFFST COLOR CODED TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441198 SUP HCPCS C1713 5441198 - HOOK SPINAL LARGE RIGHT OFFST COLOR CODED TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441199 SUP HCPCS C1713 5441199 - HOOK SPINAL LARGE LEFT OFFST COLOR CODED TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441302 SUP HCPCS C1713 5441302 - HOOK SPINAL SMALL TOT ANATOMIC COLOR CODED ARTICULAR PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441303 SUP HCPCS C1713 5441303 - HOOK SPINAL MEDIUM TOT ANATOMIC COLOR CODED ARTICULAR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441342 SUP HCPCS C1713 5441342 - HOOK SPINAL SMALL TOT ANATOMIC COLOR CODED TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5441343 SUP HCPCS C1713 5441343 - HOOK SPINAL MEDIUM TOT ANATOMIC COLOR CODED TRNSVRS PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 5442016 SUP HCPCS C1713 5442016 - PLATE BONE 16MM FIX SOLERA X10 CROSSLINK CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442019 SUP HCPCS C1713 5442019 - PLATE BONE 19MM FIX SOLERA X10 CROSSLINK CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442022 SUP HCPCS C1713 5442022 - PLATE BONE 22MM FIX SOLERA X10 CROSSLINK CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442025 SUP HCPCS C1713 5442025 - PLATE BONE 25MM FIX SOLERA X10 CROSSLINK CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442028 SUP HCPCS C1713 5442028 - PLATE BONE 28MM FIX SOLERA X10 CROSSLINK CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442031 SUP HCPCS C1713 5442031 - PLATE BONE 31MM FIX SOLERA X10 CROSSLINK CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442034 SUP HCPCS C1713 5442034 - PLATE BONE 34MM FIX SOLERA X10 CROSSLINK CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442037 SUP HCPCS C1713 5442037 - PLATE BONE 37MM FIX SOLERA X10 CROSSLINK CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442130 SUP HCPCS C1713 5442130 - PLATE BN 30-32MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442132 SUP HCPCS C1713 5442132 - PLATE BN 32-37MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442136 SUP HCPCS C1713 5442136 - PLATE BN 36-38MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442138 SUP HCPCS C1713 5442138 - PLATE BN 38-42MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442141 SUP HCPCS C1713 5442141 - PLATE BN 41-48MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442144 SUP HCPCS C1713 5442144 - PLATE BONE 44-54MM SOLERA MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442147 SUP HCPCS C1713 5442147 - PLATE BN 47-60MM NS SOLERA X10 XLNK CD HZN MLSPN TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442152 SUP HCPCS C1713 5442152 - PLATE BONE 52-70MM SOLERA MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5442160 SUP HCPCS C1713 5442160 - PLATE BONE 60-86MM SOLERA MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 5443110 SUP Custom 27803010 5443110 - CONNECTOR ROD 10MM CLOSE TITANIUM ILIUM NONSTRL 475 635 BOTH IP/OP "$1,929.00" "$1,427.00" $343.36 "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" $343.36 "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" $402.02 "$1,929.00" $771.60 "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,446.75" "$1,929.00" "$1,929.00" "$1,929.00" $964.50 $964.50 "$1,527.77" "$1,929.00" "$1,543.20" $868.05 "$1,929.00" N/A "$1,118.82" "$1,929.00" "$1,157.40" "$1,929.00" "$1,929.00" "$1,929.00" N/A N/A 5443120 SUP Custom 27803010 5443120 - CONNECTOR ROD 20MM CLOSE TITANIUM ILIUM 475 635 BOTH IP/OP "$1,929.00" "$1,427.00" $343.36 "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" $343.36 "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" $402.02 "$1,929.00" $771.60 "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,446.75" "$1,929.00" "$1,929.00" "$1,929.00" $964.50 $964.50 "$1,527.77" "$1,929.00" "$1,543.20" $868.05 "$1,929.00" N/A "$1,118.82" "$1,929.00" "$1,157.40" "$1,929.00" "$1,929.00" "$1,929.00" N/A N/A 5443130 SUP Custom 27803010 5443130 - CONNECTOR ROD 30MM CLOSE CD HORIZON TITANIUM ILIUM 475 635 BOTH IP/OP "$1,929.00" "$1,427.00" $343.36 "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" $343.36 "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" $402.02 "$1,929.00" $771.60 "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,446.75" "$1,929.00" "$1,929.00" "$1,929.00" $964.50 $964.50 "$1,527.77" "$1,929.00" "$1,543.20" $868.05 "$1,929.00" N/A "$1,118.82" "$1,929.00" "$1,157.40" "$1,929.00" "$1,929.00" "$1,929.00" N/A N/A 5443160 SUP Custom 27803010 5443160 - CONNECTOR ROD 60MM CLOSE CD HORIZON TITANIUM ILIUM 475 635 BOTH IP/OP "$1,929.00" "$1,427.00" $343.36 "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" $343.36 "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" $402.02 "$1,929.00" $771.60 "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,929.00" "$1,446.75" "$1,929.00" "$1,929.00" "$1,929.00" $964.50 $964.50 "$1,527.77" "$1,929.00" "$1,543.20" $868.05 "$1,929.00" N/A "$1,118.82" "$1,929.00" "$1,157.40" "$1,929.00" "$1,929.00" "$1,929.00" N/A N/A 5444250 SUP HCPCS C1713 5444250 - CAGE SPNL 0D OBLQ 25X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444252 SUP HCPCS C1713 5444252 - CAGE SPNL 12D OBLQ 25X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444254 SUP HCPCS C1713 5444254 - CAGE SPNL 4D OBLQ 25X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444255 SUP HCPCS C1713 5444255 - CAGE SPNL 15D OBLQ 25X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444258 SUP HCPCS C1713 5444258 - CAGE SPNL 8D OBLQ 25X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444300 SUP HCPCS C1713 5444300 - CAGE SPNL 0D OBLQ 30X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444302 SUP HCPCS C1713 5444302 - CAGE SPNL 12D OBLQ 30X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444304 SUP HCPCS C1713 5444304 - CAGE SPNL 4D OBLQ 30X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444305 SUP HCPCS C1713 5444305 - CAGE SPNL 15D OBLQ 30X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444308 SUP HCPCS C1713 5444308 - CAGE SPNL 8D OBLQ 30X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444350 SUP HCPCS C1713 5444350 - CAGE SPNL 0D OBLQ 35X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444352 SUP HCPCS C1713 5444352 - CAGE SPNL 12D OBLQ 35X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444354 SUP HCPCS C1713 5444354 - CAGE SPNL 4D OBLQ 35X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444355 SUP HCPCS C1713 5444355 - CAGE SPNL 15D OBLQ 35X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444358 SUP HCPCS C1713 5444358 - CAGE SPNL 8D OBLQ 35X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444400 SUP HCPCS C1713 5444400 - CAGE SPNL 0D OBLQ 40X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444402 SUP HCPCS C1713 5444402 - CAGE SPNL 12D OBLQ 40X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444404 SUP HCPCS C1713 5444404 - CAGE SPNL 4D OBLQ 40X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444405 SUP HCPCS C1713 5444405 - CAGE SPNL 15D OBLQ 40X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5444408 SUP HCPCS C1713 5444408 - CAGE SPNL 8D OBLQ 40X14X14MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5460250 SUP HCPCS C1713 5460250 - CAGE SPNL 0D OBLQ 25X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5460252 SUP HCPCS C1713 5460252 - CAGE SPNL 12D OBLQ 25X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5460254 SUP HCPCS C1713 5460254 - CAGE SPNL 4D OBLQ 25X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5460255 SUP HCPCS C1713 5460255 - CAGE SPNL 15D OBLQ 25X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5460258 SUP HCPCS C1713 5460258 - CAGE SPNL 8D OBLQ 25X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5460300 SUP HCPCS C1713 5460300 - CAGE SPNL 0D OBLQ 30X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5460302 SUP HCPCS C1713 5460302 - CAGE SPNL 12D OBLQ 30X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5460304 SUP HCPCS C1713 5460304 - CAGE SPNL 4D OBLQ 30X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5460305 SUP HCPCS C1713 5460305 - CAGE SPNL 15D OBLQ 30X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5460308 SUP HCPCS C1713 5460308 - CAGE SPNL 8D OBLQ 30X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5460350 SUP HCPCS C1713 5460350 - CAGE SPNL 0D OBLQ 35X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5460352 SUP HCPCS C1713 5460352 - CAGE SPNL 12D OBLQ 35X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5460354 SUP HCPCS C1713 5460354 - CAGE SPNL 4D OBLQ 35X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5460355 SUP HCPCS C1713 5460355 - CAGE SPNL 15D OBLQ 35X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5460358 SUP HCPCS C1713 5460358 - CAGE SPNL 8D OBLQ 35X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5460400 SUP HCPCS C1713 5460400 - CAGE SPNL 0D OBLQ 40X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5460402 SUP HCPCS C1713 5460402 - CAGE SPNL 12D OBLQ 40X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5460404 SUP HCPCS C1713 5460404 - CAGE SPNL 4D OBLQ 40X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5460405 SUP HCPCS C1713 5460405 - CAGE SPNL 15D OBLQ 40X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5460408 SUP HCPCS C1713 5460408 - CAGE SPNL 8D OBLQ 40X10X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464250 SUP HCPCS C1713 5464250 - CAGE SPNL 0D OBLQ 25X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464252 SUP HCPCS C1713 5464252 - CAGE SPNL 12D OBLQ 25X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464254 SUP HCPCS C1713 5464254 - CAGE SPNL 4D OBLQ 25X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464255 SUP HCPCS C1713 5464255 - CAGE SPNL 15D OBLQ 25X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464258 SUP HCPCS C1713 5464258 - CAGE SPNL 8D OBLQ 25X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464300 SUP HCPCS C1713 5464300 - CAGE SPNL 0D OBLQ 30X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464302 SUP HCPCS C1713 5464302 - CAGE SPNL 12D OBLQ 30X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464304 SUP HCPCS C1713 5464304 - CAGE SPNL 4D OBLQ 30X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464305 SUP HCPCS C1713 5464305 - CAGE SPNL 15D OBLQ 30X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464308 SUP HCPCS C1713 5464308 - CAGE SPNL 8D OBLQ 30X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464350 SUP HCPCS C1713 5464350 - CAGE SPNL 0D OBLQ 35X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464352 SUP HCPCS C1713 5464352 - CAGE SPNL 12D OBLQ 35X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464354 SUP HCPCS C1713 5464354 - CAGE SPNL 4D OBLQ 35X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464355 SUP HCPCS C1713 5464355 - CAGE SPNL 15D OBLQ 35X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464358 SUP HCPCS C1713 5464358 - CAGE SPNL 8D OBLQ 35X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464400 SUP HCPCS C1713 5464400 - CAGE SPNL 0D OBLQ 40X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464402 SUP HCPCS C1713 5464402 - CAGE SPNL 12D OBLQ 40X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464404 SUP HCPCS C1713 5464404 - CAGE SPNL 4D OBLQ 40X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464405 SUP HCPCS C1713 5464405 - CAGE SPNL 15D OBLQ 40X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5464408 SUP HCPCS C1713 5464408 - CAGE SPNL 8D OBLQ 40X14X6MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470250 SUP HCPCS C1713 5470250 - CAGE SPNL 0D OBLQ 25X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5470252 SUP HCPCS C1713 5470252 - CAGE SPNL 12D OBLQ 25X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470254 SUP HCPCS C1713 5470254 - CAGE SPNL 4D OBLQ 25X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470255 SUP HCPCS C1713 5470255 - CAGE SPNL 15D OBLQ 25X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470258 SUP HCPCS C1713 5470258 - CAGE SPNL 8D OBLQ 25X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470300 SUP HCPCS C1713 5470300 - CAGE SPNL 0D OBLQ 30X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5470302 SUP HCPCS C1713 5470302 - CAGE SPNL 12D OBLQ 30X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470304 SUP HCPCS C1713 5470304 - CAGE SPNL 4D OBLQ 30X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470305 SUP HCPCS C1713 5470305 - CAGE SPNL 15D OBLQ 30X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470308 SUP HCPCS C1713 5470308 - CAGE SPNL 8D OBLQ 30X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470350 SUP HCPCS C1713 5470350 - CAGE SPNL 0D OBLQ 35X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470352 SUP HCPCS C1713 5470352 - CAGE SPNL 12D OBLQ 35X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470354 SUP HCPCS C1713 5470354 - CAGE SPNL 4D OBLQ 35X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470355 SUP HCPCS C1713 5470355 - CAGE SPNL 15D OBLQ 35X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470358 SUP HCPCS C1713 5470358 - CAGE SPNL 8D OBLQ 35X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470400 SUP HCPCS C1713 5470400 - CAGE SPNL 0D OBLQ 40X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470402 SUP HCPCS C1713 5470402 - CAGE SPNL 12D OBLQ 40X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470404 SUP HCPCS C1713 5470404 - CAGE SPNL 4D OBLQ 40X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470405 SUP HCPCS C1713 5470405 - CAGE SPNL 15D OBLQ 40X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5470408 SUP HCPCS C1713 5470408 - CAGE SPNL 8D OBLQ 40X10X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474250 SUP HCPCS C1713 5474250 - CAGE SPNL 0D OBLQ 25X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474252 SUP HCPCS C1713 5474252 - CAGE SPNL 12D OBLQ 25X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474254 SUP HCPCS C1713 5474254 - CAGE SPNL 4D OBLQ 25X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474255 SUP HCPCS C1713 5474255 - CAGE SPNL 15D OBLQ 25X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474258 SUP HCPCS C1713 5474258 - CAGE SPNL 8D OBLQ 25X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474300 SUP HCPCS C1713 5474300 - CAGE SPNL 0D OBLQ 30X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474302 SUP HCPCS C1713 5474302 - CAGE SPNL 12D OBLQ 30X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474304 SUP HCPCS C1713 5474304 - CAGE SPNL 4D OBLQ 30X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474305 SUP HCPCS C1713 5474305 - CAGE SPNL 15D OBLQ 30X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474308 SUP HCPCS C1713 5474308 - CAGE SPNL 8D OBLQ 30X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474350 SUP HCPCS C1713 5474350 - CAGE SPNL 0D OBLQ 35X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474352 SUP HCPCS C1713 5474352 - CAGE SPNL 12D OBLQ 35X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474355 SUP HCPCS C1713 5474355 - CAGE SPNL 15D OBLQ 35X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474358 SUP HCPCS C1713 5474358 - CAGE SPNL 8D OBLQ 35X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474400 SUP HCPCS C1713 5474400 - CAGE SPNL 0D OBLQ 40X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474402 SUP HCPCS C1713 5474402 - CAGE SPNL 12D OBLQ 40X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474404 SUP HCPCS C1713 5474404 - CAGE SPNL 4D OBLQ 40X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474405 SUP HCPCS C1713 5474405 - CAGE SPNL 15D OBLQ 40X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5474408 SUP HCPCS C1713 5474408 - CAGE SPNL 8D OBLQ 40X14X7MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5475525 SUP HCPCS C1713 5475525 - SCREW BN 5.5MM 25MM NS CRNT FX ANG SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5475540 SUP HCPCS C1713 5475540 - SCREW BN 5.5MM 40MM NS CRNT FX ANG SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5475545 SUP HCPCS C1713 5475545 - SCREW BN 5.5MM 45MM NS CRNT FX ANG SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5475550 SUP HCPCS C1713 5475550 - SCREW BN 5.5MM 50MM NS CRNT FX ANG SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5475555 SUP HCPCS C1713 5475555 - SCREW BN 5.5MM 55MM NS CRNT FX ANG SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5475560 SUP HCPCS C1713 5475560 - SCREW BN 5.5MM 60MM NS CRNT FX ANG SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5475565 SUP HCPCS C1713 5475565 - SCREW BN 5.5MM 65MM CRNT XLIF FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5475570 SUP HCPCS C1713 5475570 - SCREW BN 5.5MM 70MM CRNT XLIF FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5476525 SUP HCPCS C1713 5476525 - SCREW BN 6.5MM 25MM CRNT XLIF FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5476540 SUP HCPCS C1713 5476540 - SCREW BN 6.5MM 40MM CRNT XLIF FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5476545 SUP HCPCS C1713 5476545 - SCREW BN 6.5MM 45MM CRNT XLIF FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5476550 SUP HCPCS C1713 5476550 - SCREW BN 6.5MM 50MM CRNT XLIF FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5476555 SUP HCPCS C1713 5476555 - SCREW BN 6.5MM 55MM FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5476560 SUP HCPCS C1713 5476560 - SCREW BN 6.5MM 60MM CRNT XLIF FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5476565 SUP HCPCS C1713 5476565 - SCREW BN 6.5MM 65MM CRNT XLIF FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5476570 SUP HCPCS C1713 5476570 - SCREW BN 6.5MM 70MM CRNT XLIF FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5480250 SUP HCPCS C1713 5480250 - CAGE SPNL 0D OBLQ 25X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5480252 SUP HCPCS C1713 5480252 - CAGE SPNL 12D OBLQ 25X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5480254 SUP HCPCS C1713 5480254 - CAGE SPNL 4D OBLQ 25X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5480255 SUP HCPCS C1713 5480255 - CAGE SPNL 15D OBLQ 25X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5480258 SUP HCPCS C1713 5480258 - CAGE SPNL 8D OBLQ 25X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5480300 SUP HCPCS C1713 5480300 - CAGE SPNL 0D OBLQ 30X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5480302 SUP HCPCS C1713 5480302 - CAGE SPNL 12D OBLQ 30X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5480304 SUP HCPCS C1713 5480304 - CAGE SPNL 4D OBLQ 30X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5480305 SUP HCPCS C1713 5480305 - CAGE SPNL 15D OBLQ 30X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5480308 SUP HCPCS C1713 5480308 - CAGE SPNL 8D OBLQ 30X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5480350 SUP HCPCS C1713 5480350 - CAGE SPNL 0D OBLQ 35X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5480352 SUP HCPCS C1713 5480352 - CAGE SPNL 12D OBLQ 35X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5480354 SUP HCPCS C1713 5480354 - CAGE SPNL 4D OBLQ 35X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5480355 SUP HCPCS C1713 5480355 - CAGE SPNL 15D OBLQ 35X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5480358 SUP HCPCS C1713 5480358 - CAGE SPNL 8D OBLQ 35X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5480400 SUP HCPCS C1713 5480400 - CAGE SPNL 0D OBLQ 40X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5480402 SUP HCPCS C1713 5480402 - CAGE SPNL 12D OBLQ 40X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5480404 SUP HCPCS C1713 5480404 - CAGE SPNL 4D OBLQ 40X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5480405 SUP HCPCS C1713 5480405 - CAGE SPNL 15D OBLQ 40X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5480408 SUP HCPCS C1713 5480408 - CAGE SPNL 8D OBLQ 40X10X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5484250 SUP HCPCS C1713 5484250 - CAGE SPNL 0D OBLQ 25X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5484252 SUP HCPCS C1713 5484252 - CAGE SPNL 12D OBLQ 25X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5484254 SUP HCPCS C1713 5484254 - CAGE SPNL 4D OBLQ 25X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5484258 SUP HCPCS C1713 5484258 - CAGE SPNL 8D OBLQ 25X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5484300 SUP HCPCS C1713 5484300 - CAGE SPNL 0D OBLQ 30X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5484350 SUP HCPCS C1713 5484350 - CAGE SPNL 0D OBLQ 35X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5484352 SUP HCPCS C1713 5484352 - CAGE SPNL 12D OBLQ 35X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5484354 SUP HCPCS C1713 5484354 - CAGE SPNL 4D OBLQ 35X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5484355 SUP HCPCS C1713 5484355 - CAGE SPNL 15D OBLQ 35X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5484358 SUP HCPCS C1713 5484358 - CAGE SPNL 8D OBLQ 35X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5484400 SUP HCPCS C1713 5484400 - CAGE SPNL 0D OBLQ 40X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5484402 SUP HCPCS C1713 5484402 - CAGE SPNL 12D OBLQ 40X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5484404 SUP HCPCS C1713 5484404 - CAGE SPNL 4D OBLQ 40X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5484405 SUP HCPCS C1713 5484405 - CAGE SPNL 15D OBLQ 40X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5484408 SUP HCPCS C1713 5484408 - CAGE SPNL 8D OBLQ 40X14X8MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5485525 SUP HCPCS C1713 5485525 - SCREW BONE 5.5MM 25MM VARIABLE COROENT XLF SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5485540 SUP HCPCS C1713 5485540 - SCREW BN 5.5MM 40MM NS CRNT VA SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5485545 SUP HCPCS C1713 5485545 - SCREW BN 5.5MM 45MM NS CRNT VA SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5485550 SUP HCPCS C1713 5485550 - SCREW BN 5.5MM 50MM CRNT XLF VA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5485555 SUP HCPCS C1713 5485555 - SCREW BN 5.5MM 55MM NS CRNT VA SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5485560 SUP HCPCS C1713 5485560 - SCREW BN 5.5MM 60MM NS CRNT VA SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5485565 SUP HCPCS C1713 5485565 - SCREW BN 5.5MM 65MM NS CRNT VA SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 5485570 SUP HCPCS C1713 5485570 - SCREW BN 5.5MM 70MM CRNT XLF VAR SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 5486525 SUP HCPCS C1713 5486525 - SCREW BN 6.5MM 25MM NS CRNT VA SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5486540 SUP HCPCS C1713 5486540 - SCREW BN 6.5MM 40MM NS CRNT VA SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5486545 SUP HCPCS C1713 5486545 - SCREW BN 6.5MM 45MM NS CRNT VA SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5486550 SUP HCPCS C1713 5486550 - SCREW BN 6.5MM 50MM NS CRNT VA SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5486555 SUP HCPCS C1713 5486555 - SCREW BN 6.5MM 55MM NS CRNT VA SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5486560 SUP HCPCS C1713 5486560 - SCREW BN 6.5MM 60MM NS CRNT VA SPNE XLF SYS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5486565 SUP HCPCS C1713 5486565 - SCREW BN 6.5MM 65MM CRNT XLF VAR SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5486570 SUP HCPCS C1713 5486570 - SCREW BN 6.5MM 70MM CRNT XLF VAR SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5490250 SUP HCPCS C1713 5490250 - CAGE SPNL 0D OBLQ 25X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5490252 SUP HCPCS C1713 5490252 - CAGE SPNL 12D OBLQ 25X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490254 SUP HCPCS C1713 5490254 - CAGE SPNL 4D OBLQ 25X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490255 SUP HCPCS C1713 5490255 - CAGE SPNL 15D OBLQ 25X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490258 SUP HCPCS C1713 5490258 - CAGE SPNL 8D OBLQ 25X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490300 SUP HCPCS C1713 5490300 - CAGE SPNL 0D OBLQ 30X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5490302 SUP HCPCS C1713 5490302 - CAGE SPNL 12D OBLQ 30X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490304 SUP HCPCS C1713 5490304 - CAGE SPNL 4D OBLQ 30X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490305 SUP HCPCS C1713 5490305 - CAGE SPNL 15D OBLQ 30X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490308 SUP HCPCS C1713 5490308 - CAGE SPNL 8D OBLQ 30X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490350 SUP HCPCS C1713 5490350 - CAGE SPNL 0D OBLQ 35X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490352 SUP HCPCS C1713 5490352 - CAGE SPNL 12D OBLQ 35X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490354 SUP HCPCS C1713 5490354 - CAGE SPNL 4D OBLQ 35X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490355 SUP HCPCS C1713 5490355 - CAGE SPNL 15D OBLQ 35X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490358 SUP HCPCS C1713 5490358 - CAGE SPNL 8D OBLQ 35X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490400 SUP HCPCS C1713 5490400 - CAGE SPNL 0D OBLQ 40X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490402 SUP HCPCS C1713 5490402 - CAGE SPNL 12D OBLQ 40X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490404 SUP HCPCS C1713 5490404 - CAGE SPNL 4D OBLQ 40X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490405 SUP HCPCS C1713 5490405 - CAGE SPNL 15D OBLQ 40X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5490408 SUP HCPCS C1713 5490408 - CAGE SPNL 8D OBLQ 40X10X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494250 SUP HCPCS C1713 5494250 - CAGE SPNL 0D OBLQ 25X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494252 SUP HCPCS C1713 5494252 - CAGE SPNL 12D OBLQ 25X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494254 SUP HCPCS C1713 5494254 - CAGE SPNL 4D OBLQ 25X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5494255 SUP HCPCS C1713 5494255 - CAGE SPNL 15D OBLQ 25X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494258 SUP HCPCS C1713 5494258 - CAGE SPNL 8D OBLQ 25X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494300 SUP HCPCS C1713 5494300 - CAGE SPNL 0D OBLQ 30X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494302 SUP HCPCS C1713 5494302 - CAGE SPNL 12D OBLQ 30X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494304 SUP HCPCS C1713 5494304 - CAGE SPNL 4D OBLQ 30X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494305 SUP HCPCS C1713 5494305 - CAGE SPNL 15D OBLQ 30X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5494308 SUP HCPCS C1713 5494308 - CAGE SPNL 8D OBLQ 30X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 5494350 SUP HCPCS C1713 5494350 - CAGE SPNL 0D OBLQ 35X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494352 SUP HCPCS C1713 5494352 - CAGE SPNL 12D OBLQ 35X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494354 SUP HCPCS C1713 5494354 - CAGE SPNL 4D OBLQ 35X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494355 SUP HCPCS C1713 5494355 - CAGE SPNL 15D OBLQ 35X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494358 SUP HCPCS C1713 5494358 - CAGE SPNL 8D OBLQ 35X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494400 SUP HCPCS C1713 5494400 - CAGE SPNL 0D OBLQ 40X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494402 SUP HCPCS C1713 5494402 - CAGE SPNL 12D OBLQ 40X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494404 SUP HCPCS C1713 5494404 - CAGE SPNL 4D OBLQ 40X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494405 SUP HCPCS C1713 5494405 - CAGE SPNL 15D OBLQ 40X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5494408 SUP HCPCS C1713 5494408 - CAGE SPNL 8D OBLQ 40X14X9MM NS LF CRNT TI TLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 5500803 SUP HCPCS C1769 05500803 - GUIDEWIRE ANGIOGRAPHIC STR BENTSON CURVE .038IN 150CM FIX BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A 5513150 SUP HCPCS C1894 5513150 - INTRODUCER CATH 15FR 13CM ARGD VLV HMDIAL BOTH IP/OP $245.00 $181.00 $48.63 $245.00 $133.04 $133.04 $133.04 $133.04 $245.00 $245.00 $245.00 $51.06 $245.00 $181.84 $181.84 $188.85 $127.65 $51.06 $245.00 $245.00 $144.92 $245.00 $245.00 $245.00 $245.00 $183.75 $245.00 $245.00 $245.00 $122.50 $122.50 $194.04 $245.00 $196.00 $159.25 $48.63 N/A $142.10 $245.00 $245.00 $245.00 $51.06 $245.00 N/A N/A 5534010 SUP HCPCS C1713 5534010 - SPACER ALGRF 30X10X2MM EXTENSURE SPNE BOTH IP/OP "$5,577.50" "$4,127.00" "$1,106.99" "$5,577.50" "$2,509.88" "$2,509.88" "$2,509.88" "$2,509.88" "$5,577.50" "$5,577.50" "$5,577.50" "$1,162.49" "$5,577.50" "$5,577.50" "$5,577.50" "$5,577.50" "$5,577.50" "$1,162.41" "$5,577.50" "$2,231.00" "$2,749.71" "$5,577.50" "$5,577.50" "$5,577.50" "$5,577.50" "$4,183.13" "$5,577.50" "$5,577.50" "$5,577.50" "$2,788.75" "$2,788.75" "$4,417.38" "$5,577.50" "$4,462.00" "$2,509.88" "$1,106.99" N/A "$3,234.95" "$5,577.50" "$3,346.50" "$5,577.50" "$1,162.35" "$5,577.50" N/A N/A 5534012 SUP HCPCS C1713 5534012 - SPACER ALGRF 30X12X2MM EXTENSURE SPNE BOTH IP/OP "$5,577.50" "$4,127.00" "$1,106.99" "$5,577.50" "$2,509.88" "$2,509.88" "$2,509.88" "$2,509.88" "$5,577.50" "$5,577.50" "$5,577.50" "$1,162.49" "$5,577.50" "$5,577.50" "$5,577.50" "$5,577.50" "$5,577.50" "$1,162.41" "$5,577.50" "$2,231.00" "$2,749.71" "$5,577.50" "$5,577.50" "$5,577.50" "$5,577.50" "$4,183.13" "$5,577.50" "$5,577.50" "$5,577.50" "$2,788.75" "$2,788.75" "$4,417.38" "$5,577.50" "$4,462.00" "$2,509.88" "$1,106.99" N/A "$3,234.95" "$5,577.50" "$3,346.50" "$5,577.50" "$1,162.35" "$5,577.50" N/A N/A 5534014 SUP HCPCS C1713 5534014 - SPACER ALGRF 30X14X2MM EXTENSURE SPNE BOTH IP/OP "$5,577.50" "$4,127.00" "$1,106.99" "$5,577.50" "$2,509.88" "$2,509.88" "$2,509.88" "$2,509.88" "$5,577.50" "$5,577.50" "$5,577.50" "$1,162.49" "$5,577.50" "$5,577.50" "$5,577.50" "$5,577.50" "$5,577.50" "$1,162.41" "$5,577.50" "$2,231.00" "$2,749.71" "$5,577.50" "$5,577.50" "$5,577.50" "$5,577.50" "$4,183.13" "$5,577.50" "$5,577.50" "$5,577.50" "$2,788.75" "$2,788.75" "$4,417.38" "$5,577.50" "$4,462.00" "$2,509.88" "$1,106.99" N/A "$3,234.95" "$5,577.50" "$5,577.50" "$5,577.50" "$1,162.35" "$5,577.50" N/A N/A 5534018 SUP HCPCS C1713 5534018 - SPACER SPNL 30X18X2MM EXTENSURE ALGRF BOTH IP/OP "$5,577.50" "$4,127.00" "$1,106.99" "$5,577.50" "$2,509.88" "$2,509.88" "$2,509.88" "$2,509.88" "$5,577.50" "$5,577.50" "$5,577.50" "$1,162.49" "$5,577.50" "$5,577.50" "$5,577.50" "$5,577.50" "$5,577.50" "$1,162.41" "$5,577.50" "$5,577.50" "$2,749.71" "$5,577.50" "$5,577.50" "$5,577.50" "$5,577.50" "$4,183.13" "$5,577.50" "$5,577.50" "$5,577.50" "$2,788.75" "$2,788.75" "$4,417.38" "$5,577.50" "$4,462.00" "$2,509.88" "$1,106.99" N/A "$3,234.95" "$5,577.50" "$5,577.50" "$5,577.50" "$1,162.35" "$5,577.50" N/A N/A 5540030 SUP HCPCS C1713 5540030 - SCREW SET BREAK OFF CD HORIZON TITANIUM SPINAL NONSTRL 5.5 BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 5540130 SUP HCPCS C1713 5540130 - SCREW SET 5.5-6MM NONBREAK OFF CD HORIZON TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 5540230 SUP HCPCS C1713 5540230 - SCREW SET 5.5-6MM REDX TITANIUM SPN NONSTRL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 5540430 SUP HCPCS C1713 5540430 - SCREW SET 5.5-6MM SOLERA SEXTANT CD HORIZON TITANIUM NONSTRL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 5560001 SUP Custom 27804086 5560001 - GRAFT BN 13MMX5MM FACET DWL SPNE BOTH IP/OP "$3,177.50" "$2,351.00" $565.60 "$3,177.50" "$3,177.50" "$3,177.50" "$3,177.50" "$3,177.50" "$3,177.50" "$3,177.50" $565.60 "$3,177.50" "$3,177.50" "$3,177.50" "$3,177.50" "$3,177.50" "$3,177.50" $662.23 "$3,177.50" "$1,271.00" "$3,177.50" "$3,177.50" "$3,177.50" "$3,177.50" "$3,177.50" "$2,383.13" "$3,177.50" "$3,177.50" "$3,177.50" "$1,588.75" "$1,588.75" "$2,516.58" "$3,177.50" "$2,542.00" "$1,429.88" "$3,177.50" N/A "$1,842.95" "$3,177.50" "$1,906.50" "$3,177.50" "$3,177.50" "$3,177.50" N/A N/A 5587000 SUP HCPCS C1750 5587000 - KIT CATH REPR REPL CNCT PU HMDIAL BOTH IP/OP $325.50 $241.00 $64.56 $325.28 $146.38 $146.38 $146.38 $146.38 $325.28 $325.28 $325.28 $67.80 $325.28 $325.28 $325.28 $325.28 $325.28 $67.79 $325.28 $325.28 $192.40 $325.28 $325.28 $325.28 $325.28 $244.13 $325.28 $325.28 $325.28 $162.64 $162.64 $257.62 $325.28 $260.22 $146.38 $64.56 N/A $188.79 $325.28 $325.28 $325.28 $67.79 $325.28 N/A N/A 5688000 SUP Custom 27203010 5688000 - TUNNELER SRG 30MM 8IN HMSPLT HMSPLT XK MLBL TPR BOTH IP/OP $61.50 $46.00 $10.90 $61.25 $61.25 $61.25 $61.25 $61.25 $61.25 $61.25 $10.90 $61.25 $61.25 $45.46 $45.46 $47.21 $31.91 $12.77 $61.25 $24.50 $61.25 $61.25 $61.25 $61.25 $61.25 $46.13 $61.25 $61.25 $61.25 $30.63 $30.63 $48.51 $61.25 $49.00 $39.81 $61.25 N/A $35.67 $61.25 $36.75 $61.25 $61.25 $61.25 N/A N/A 5740105 SUP Custom 27804086 5740105 - GRAFT BN LRDTC 14X11X5MM SPNE BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 5740106 SUP Custom 27804086 5740106 - GRAFT BONE 14X11X6MM ALLOGRAFT TRIAD CANCELLOUS CORTICAL SPN BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 5740107 SUP Custom 27804086 5740107 - GRAFT BONE LORDOSIS 14X7X11MM ALLOGRAFT TRAID CANCELLOUS BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 5740109 SUP Custom 27804086 5740109 - GRAFT BN LRDTC 14X11X9MM TRD ALGRF CORT CNC BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 5740110 SUP Custom 27804086 5740110 - GRAFT BN LRDTC 14X11X10MM ALGRF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 5750005 SUP Custom 27804086 5750005 - GRAFT BN 14X11X5MM TRD ALGRF SPNE CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 5750006 SUP Custom 27803010 5750006 - GRAFT BN 14X11X6MM TRD ALGRF SPNE CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 5750007 SUP HCPCS C1713 "5750007 - TRIAD CR ALLOGRAFT, 7X 11X 14MM" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 5750008 SUP Custom 27803010 5750008 - GRAFT BN 14X11X8MM TRD ALGRF SPNE CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 5750009 SUP Custom 27803010 5750009 - GRAFT BN 14X11X9MM TRD ALGRF SPNE CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 5750010 SUP Custom 27804086 5750010 - GRAFT BN 14X11X10MM TRD ALGRF SPNE CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 5950007 SUP HCPCS C1781 5950007 - PATCH SURG SMALL CIR 1.7IN STRAP VENTRALEX ST SEPRA BOTH IP/OP "$1,769.50" "$1,309.00" $351.20 "$1,769.50" $796.28 $796.28 $796.28 $796.28 "$1,769.50" "$1,769.50" "$1,769.50" $368.81 "$1,769.50" "$1,769.50" "$1,769.50" "$1,769.50" "$1,769.50" $368.78 "$1,769.50" "$1,769.50" "$1,046.66" "$1,769.50" "$1,769.50" "$1,769.50" "$1,769.50" "$1,327.13" "$1,769.50" "$1,769.50" "$1,769.50" $884.75 $884.75 "$1,401.44" "$1,769.50" "$1,415.60" $796.28 $351.20 N/A "$1,026.31" "$1,769.50" "$1,769.50" "$1,769.50" $368.76 "$1,769.50" N/A N/A 5950008 SUP HCPCS C1781 5950008 - PATCH SURG MEDIUM CIR 2.5IN STRAP VENTRALEX ST SEPRA BOTH IP/OP "$2,117.00" "$1,567.00" $420.17 "$2,117.00" $952.65 $952.65 $952.65 $952.65 "$2,117.00" "$2,117.00" "$2,117.00" $441.24 "$2,117.00" "$2,117.00" "$2,117.00" "$2,117.00" "$2,117.00" $441.21 "$2,117.00" "$2,117.00" "$1,252.21" "$2,117.00" "$2,117.00" "$2,117.00" "$2,117.00" "$1,587.75" "$2,117.00" "$2,117.00" "$2,117.00" "$1,058.50" "$1,058.50" "$1,676.66" "$2,117.00" "$1,693.60" $952.65 $420.17 N/A "$1,227.86" "$2,117.00" "$2,117.00" "$2,117.00" $441.18 "$2,117.00" N/A N/A 5950009 SUP HCPCS C1781 5950009 - PATCH SRG LG CRC 3.2IN STRL VNTRLX ST SEPRA SORBAFLEX SPRG BOTH IP/OP "$2,405.50" "$1,780.00" $477.43 "$2,405.50" "$1,082.48" "$1,082.48" "$1,082.48" "$1,082.48" "$2,405.50" "$2,405.50" "$2,405.50" $501.37 "$2,405.50" "$2,405.50" "$2,405.50" "$2,405.50" "$2,405.50" $501.33 "$2,405.50" "$2,405.50" "$1,422.85" "$2,405.50" "$2,405.50" "$2,405.50" "$2,405.50" "$1,804.13" "$2,405.50" "$2,405.50" "$2,405.50" "$1,202.75" "$1,202.75" "$1,905.16" "$2,405.50" "$1,924.40" "$1,082.48" $477.43 N/A "$1,395.19" "$2,405.50" "$2,405.50" "$2,405.50" $501.31 "$2,405.50" N/A N/A 5950020 SUP HCPCS C1781 5950020 - PATCH SURG LARGE CIR 4.5IN SELF EXPAND VENTRIO ST SORBAFLEX BOTH IP/OP "$2,761.00" "$2,043.00" $547.94 "$2,760.75" "$1,242.34" "$1,242.34" "$1,242.34" "$1,242.34" "$2,760.75" "$2,760.75" "$2,760.75" $575.41 "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" $575.37 "$2,760.75" "$2,760.75" "$1,361.05" "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" "$2,070.75" "$2,760.75" "$2,760.75" "$2,760.75" "$1,380.38" "$1,380.38" "$2,186.51" "$2,760.75" "$2,208.60" "$1,242.34" $547.94 N/A "$1,601.38" "$2,760.75" "$2,760.75" "$2,760.75" $575.34 "$2,760.75" N/A N/A 5950030 SUP HCPCS C1781 5950030 - PATCH SURG SMALL OVAL 4.7X3.1IN SELF EXPAND VENTRIO ST BOTH IP/OP "$1,213.50" $898.00 $240.83 "$1,213.38" $546.02 $546.02 $546.02 $546.02 "$1,213.38" "$1,213.38" "$1,213.38" $252.90 "$1,213.38" "$1,213.38" "$1,213.38" "$1,213.38" "$1,213.38" $252.88 "$1,213.38" "$1,213.38" $717.71 "$1,213.38" "$1,213.38" "$1,213.38" "$1,213.38" $910.13 "$1,213.38" "$1,213.38" "$1,213.38" $606.69 $606.69 $961.00 "$1,213.38" $970.70 $546.02 $240.83 N/A $703.83 "$1,213.38" "$1,213.38" "$1,213.38" $252.87 "$1,213.38" N/A N/A 5950040 SUP HCPCS C1781 5950040 - PATCH SURG MEDIUM OVAL 5.5X4.3IN SELF EXPAND VENTRIO ST BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$3,610.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$3,610.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A 5950050 SUP HCPCS C1781 5950050 - PATCH SURG LARGE OVAL 7X5.4IN SELF EXPAND VENTRIO ST BOTH IP/OP "$4,550.50" "$3,367.00" $903.11 "$4,550.25" "$2,047.61" "$2,047.61" "$2,047.61" "$2,047.61" "$4,550.25" "$4,550.25" "$4,550.25" $948.39 "$4,550.25" "$4,550.25" "$4,550.25" "$4,550.25" "$4,550.25" $948.32 "$4,550.25" "$4,550.25" "$2,243.27" "$4,550.25" "$4,550.25" "$4,550.25" "$4,550.25" "$3,412.88" "$4,550.25" "$4,550.25" "$4,550.25" "$2,275.13" "$2,275.13" "$3,603.80" "$4,550.25" "$3,640.20" "$2,047.61" $903.11 N/A "$2,639.29" "$4,550.25" "$4,550.25" "$4,550.25" $948.27 "$4,550.25" N/A N/A 5950070 SUP HCPCS C1781 5950070 - PATCH SURG XL CIR 9.7X7.7IN SELF EXPAND VENTRIO ST SORBAFLEX BOTH IP/OP "$6,143.00" "$4,546.00" "$1,219.23" "$6,143.00" "$2,764.35" "$2,764.35" "$2,764.35" "$2,764.35" "$6,143.00" "$6,143.00" "$6,143.00" "$1,280.35" "$6,143.00" "$6,143.00" "$6,143.00" "$6,143.00" "$6,143.00" "$1,280.27" "$6,143.00" "$6,143.00" "$3,028.50" "$6,143.00" "$6,143.00" "$6,143.00" "$6,143.00" "$4,607.25" "$6,143.00" "$6,143.00" "$6,143.00" "$3,071.50" "$3,071.50" "$4,865.26" "$6,143.00" "$4,914.40" "$2,764.35" "$1,219.23" N/A "$3,562.94" "$6,143.00" "$6,143.00" "$6,143.00" "$1,280.20" "$6,143.00" N/A N/A 5950080 SUP HCPCS C1781 5950080 - PATCH SURG XL CIR 10.7X8.7IN SELF EXPAND VENTRIO ST BOTH IP/OP "$7,356.50" "$5,444.00" "$1,460.03" "$7,356.25" "$3,310.31" "$3,310.31" "$3,310.31" "$3,310.31" "$7,356.25" "$7,356.25" "$7,356.25" "$1,533.23" "$7,356.25" "$7,356.25" "$7,356.25" "$7,356.25" "$7,356.25" "$1,533.12" "$7,356.25" "$7,356.25" "$3,626.63" "$7,356.25" "$7,356.25" "$7,356.25" "$7,356.25" "$5,517.38" "$7,356.25" "$7,356.25" "$7,356.25" "$3,678.13" "$3,678.13" "$5,826.15" "$7,356.25" "$5,885.00" "$3,310.31" "$1,460.03" N/A "$4,266.77" "$7,356.25" "$7,356.25" "$7,356.25" "$1,533.04" "$7,356.25" N/A N/A 5960011 SUP HCPCS C1713 5960011 - SCREW SET UNIVERSAL END CAP SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 5960033 SUP HCPCS C1713 5960033 - SCREW BN 12MM X-COR MN VBR LCK TI SPNE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 5960034 SUP HCPCS C1713 5960034 - SCREW BONE 14MM X-CORE MINI VBR TI SPN LOCK BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 5960200 SUP HCPCS C1713 5960200 - END CAP SPNL PRLL 12MM 14MM NS X-COR MN BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5960400 SUP HCPCS C1713 5960400 - END CAP SPNL 16MM PRLL 14MM CORE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$3,740.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5962152 SUP HCPCS C1713 5962152 - CAGE SPNL 12MM 15-20MM NS LF X-COR MN XPD VERT BD REPL BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$6,747.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 5962172 SUP Custom 27803010 5962172 - CAGE SPNL 12MM 17-24MM NS LF X-COR MN XPD VERT BD REPL BOTH IP/OP "$11,245.00" "$8,321.00" "$2,001.61" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,001.61" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$11,245.00" N/A "$6,522.10" "$11,245.00" "$6,747.00" "$11,245.00" "$11,245.00" "$11,245.00" N/A N/A 5962223 SUP HCPCS C1713 5962223 - CAGE SPNL 12MM 22-34MM NS LF X-COR MN BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$6,747.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 5962253 SUP HCPCS C1713 5962253 - CAGE SPNL 12MM 25-40MM NS LF X-COR MN BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$11,245.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$6,747.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 5962294 SUP HCPCS C1713 5962294 - CAGE SPNL 12MM 29-48MM NS LF X-COR MN BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$6,747.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 5962366 SUP HCPCS C1713 5962366 - CAGE SPNL 12MM 36-62MM NS LF X-COR MN BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 5962427 SUP HCPCS C1713 5962427 - CAGE SPNL 12MM 42-74MM NS LF X-COR MN BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$11,245.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 5962520 SUP Custom 27803010 5962520 - ENDCAP SPINAL 12MM 15MM PARALLEL TITANIUM 12MM CORE BOTH IP/OP "$3,740.00" "$2,768.00" $665.72 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $665.72 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" "$3,740.00" N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 5962521 SUP Custom 27803010 5962521 - ENDCAP SPINAL CONVEX 12MM 15X12MM TOP X-CORE BOTH IP/OP "$3,740.00" "$2,768.00" $665.72 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $665.72 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" "$3,740.00" N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 5962526 SUP Custom 27803010 5962526 - ENDCAP SPINAL 7D 12MM 15MM BOTTOM TITANIUM 12MM CORE BOTH IP/OP "$3,740.00" "$2,768.00" $665.72 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $665.72 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" "$3,740.00" N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 5962527 SUP Custom 27803010 5962527 - ENDCAP SPINAL 7D 12MM 15MM TOP TITANIUM 12MM CORE BOTH IP/OP "$3,740.00" "$2,768.00" $665.72 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $665.72 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" "$3,740.00" N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 5962740 SUP HCPCS C1713 5962740 - END CAP SPNL PRLL 12MM 17MM NS 14MM X-COR MN TI BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$3,740.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5962741 SUP HCPCS C1713 5962741 - END CAP SPNL 12MM 17MM NS 14MM X-COR MN CNTR TOP TI BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$3,740.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5962746 SUP HCPCS C1713 5962746 - END CAP SPNL 7D 12MM 17MM NS 14MM X-COR MN LRDTC BTM TI BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5962747 SUP HCPCS C1713 5962747 - END CAP SPNL 7D 12MM 17MM NS 14MM X-COR MN LRDTC TOP TI BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5963740 SUP HCPCS C1713 5963740 - END CAP SPNL ANG 14MM 17MM PRLL TOP TI 14MM COR BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$3,740.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5963745 SUP HCPCS C1713 5963745 - END CAP SPNL ANG 14MM 17MM PRLL BTM TI 14MM COR BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5963746 SUP HCPCS C1713 5963746 - END CAP SPNL 4D KYPHOTIC 14MM 17X14MM X-COR BTM BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5963747 SUP HCPCS C1713 5963747 - END CAP SPNL 4D KYPHOTIC 14MM 17X14MM X-COR TOP BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5963960 SUP HCPCS C1713 5963960 - END CAP SPNL ANG 16MM 19MM PRLL TOP TI 14MM COR BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5963965 SUP HCPCS C1713 5963965 - END CAP SPNL ANG 16MM 19MM PRLL BTM TI 14MM COR BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5963966 SUP HCPCS C1713 5963966 - END CAP SPNL 4D KYPHOTIC 14MM 19X16MM X-COR BTM BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$3,740.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5963967 SUP HCPCS C1713 5963967 - END CAP SPNL 4D KYPHOTIC 14MM 19X16MM X-COR TOP BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$3,740.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5964152 SUP HCPCS C1713 5964152 - CAGE SPNL 14MM 15-20MM NS LF X-COR MN BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$6,747.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 5964172 SUP Custom 27803010 5964172 - CAGE SPNL 14MM 17-24MM NS LF X-COR MN XPD VERT BD REPL BOTH IP/OP "$11,245.00" "$8,321.00" "$2,001.61" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,001.61" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$11,245.00" N/A "$6,522.10" "$11,245.00" "$6,747.00" "$11,245.00" "$11,245.00" "$11,245.00" N/A N/A 5964223 SUP HCPCS C1713 5964223 - CAGE SPNL 14MM 22-34MM NS LF X-COR MN XPD VERT BD REPL BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$6,747.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 5964253 SUP HCPCS C1713 5964253 - CAGE SPNL 14MM 25-40MM NS LF X-COR MN BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$6,747.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 5964294 SUP HCPCS C1713 5964294 - CAGE SPNL 14MM 29-48MM NS LF X-COR MN BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$6,747.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 5964366 SUP HCPCS C1713 5964366 - CAGE SPNL 14MM 36-62MM NS LF X-COR MN BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 5964427 SUP HCPCS C1713 5964427 - CAGE SPNL 14MM 42-74MM NS LF X-COR MN BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$11,245.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$6,747.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 5964740 SUP HCPCS C1713 5964740 - END CAP SPNL PRLL 14MM 17MM NS 14MM X-COR MN TI BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5964741 SUP HCPCS C1713 5964741 - END CAP SPNL 14MM 17MM NS 14MM X-COR MN CNTR TOP TI BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5964746 SUP HCPCS C1713 5964746 - END CAP SPNL 7D LRDTC 14MM 17MM NS 14MM X-COR MN TI BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5964747 SUP HCPCS C1713 5964747 - END CAP SPNL 7D LRDTC 14MM 17MM NS 14MM X-COR MN TI BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5964960 SUP HCPCS C1713 5964960 - END CAP SPNL PRLL 14MM 19MM NS 14MM X-COR MN TI BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5964966 SUP HCPCS C1713 5964966 - END CAP SPNL 7D LRDTC 14MM 19MM NS 16MM X-COR MN TI BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$3,740.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5964967 SUP HCPCS C1713 5964967 - END CAP SPNL 7D LRDTC 14MM 19MM NS 16MM X-COR MN TI BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 5975730 SUP HCPCS C1713 5975730 - VUE POINT 435 X 30 BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6014908 SUP Custom 27203010 6014908 - DRILL TWST 1.4MM 18MM 8MM WL BOTH IP/OP $760.00 $562.00 $135.28 $760.00 $760.00 $760.00 $760.00 $760.00 $760.00 $760.00 $135.28 $760.00 $760.00 $564.07 $564.07 $585.81 $395.96 $158.39 $760.00 $304.00 $760.00 $760.00 $760.00 $760.00 $760.00 $570.00 $760.00 $760.00 $760.00 $380.00 $380.00 $601.92 $760.00 $608.00 $494.00 $760.00 N/A $440.80 $760.00 $456.00 $760.00 $760.00 $760.00 N/A N/A 6019135 SUP Custom 27203010 6019135 - DRILL TWST 1.9MM 115MM LF BOTH IP/OP $617.50 $457.00 $109.83 $617.05 $617.05 $617.05 $617.05 $617.05 $617.05 $617.05 $109.83 $617.05 $617.05 $457.97 $457.97 $475.62 $321.48 $128.60 $617.05 $246.82 $617.05 $617.05 $617.05 $617.05 $617.05 $463.13 $617.05 $617.05 $617.05 $308.53 $308.53 $488.70 $617.05 $493.64 $401.08 $617.05 N/A $358.15 $617.05 $370.23 $617.05 $617.05 $617.05 N/A N/A 6046385 SUP HCPCS C1713 "6046385 - 4.0 CANNULATED, 38MM" BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 6101045 SUP HCPCS C1713 6101045 - SPACER SPNL XL STD 45X18X10CM C-THRU PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101050 SUP HCPCS C1713 6101050 - CAGE SPNL XL 50X18X10MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101055 SUP HCPCS C1713 6101055 - CAGE SPNL XL STD 55X18X10MM CRNT CT4 BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101060 SUP HCPCS C1713 6101060 - CAGE SPNL XL STD 60X18X10MM CRNT CT4 BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101245 SUP HCPCS C1713 6101245 - SPACER SPNL 45X18X12MM CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101250 SUP HCPCS C1713 6101250 - CAGE SPNL XL CRNL TPR 50X18X12MM CRNT PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101255 SUP HCPCS C1713 6101255 - CAGE SPNL XL CRNL TPR 55X18X12MM CRNT PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101260 SUP HCPCS C1713 6101260 - CAGE SPNL XL CRNL TPR 60X18X12MM CRNT PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101445 SUP HCPCS C1713 6101445 - CAGE SPNL XL CRNL TPR 45X18X14MM CRNT PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101450 SUP HCPCS C1713 6101450 - CAGE SPNL XL CRNL TPR 50X18X14MM CRNT PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101455 SUP HCPCS C1713 6101455 - CAGE SPNL XL CRNL TPR 55X18X14MM CRNT PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101460 SUP HCPCS C1713 6101460 - CAGE SPNL XL CRNL TPR 60X18X14MM CRNT PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101645 SUP HCPCS C1713 6101645 - CAGE SPNL XL CRNL TPR 45X18X16MM CRNT PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101650 SUP HCPCS C1713 6101650 - CAGE SPNL XL CRNL TPR 50X18X16MM CRNT PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101655 SUP HCPCS C1713 6101655 - CAGE SPNL XL CRNL TPR 55X18X16MM CRNT PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6101660 SUP HCPCS C1713 6101660 - CAGE SPNL XL CRNL TPR 60X18X16MM CRNT PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111045 SUP HCPCS C1713 6111045 - CAGE SPNL 10D LRDTC 45X18X10MM CRNT XLIF PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111050 SUP HCPCS C1713 6111050 - CAGE SPNL 10D LRDTC 50X18X10MM CRNT XLIF PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111055 SUP HCPCS C1713 6111055 - CAGE SPNL 10D LRDTC 55X18X10MM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111060 SUP HCPCS C1713 6111060 - CAGE SPNL 10D LRDTC 60X18X10MM CRNT XLIF PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111245 SUP HCPCS C1713 6111245 - CAGE SPNL 10D LRDTC 45X18X12MM CRNT XLIF PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111250 SUP HCPCS C1713 6111250 - CAGE SPNL XL 10D 50X18X12MM CRNT COALITION PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111255 SUP HCPCS C1713 6111255 - CAGE SPNL 10D XL CRNL TPR 55X18X12MM CRNT PEEK-OPTM IM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111260 SUP HCPCS C1713 6111260 - SPACER SPNL 10D XL 60X18X12MM PEEK BCK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111445 SUP HCPCS C1713 6111445 - CAGE SPNL 10D XL CRNL TPR 45X18X14MM CRNT PEEK-OPTM IM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111450 SUP HCPCS C1713 6111450 - CAGE SPNL 10D XL CRNL TPR 50X18X14MM CRNT PEEK-OPTM IM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111455 SUP HCPCS C1713 6111455 - CAGE SPNL XL CRNL TPR 55X18X14MM CRNT PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111460 SUP HCPCS C1713 6111460 - CAGE SPNL 10D XL CRNL TPR 60X18X14MM CRNT PEEK-OPTM IM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111645 SUP HCPCS C1713 6111645 - CAGE SPNL 10D XL CRNL TPR 45X18X16MM CRNT PEEK-OPTM IM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111650 SUP HCPCS C1713 6111650 - CAGE SPNL 10D XL CRNL TPR 50X18X16MM CRNT PEEK-OPTM IM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111655 SUP HCPCS C1713 6111655 - CAGE SPNL 10D XL CRNL TPR 55X18X16MM CRNT PEEK-OPTM IM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6111660 SUP HCPCS C1713 6111660 - CAGE SPNL 10D XL CRNL TPR 60X18X16MM CRNT PEEK-OPTM IM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6160850 SUP HCPCS C1713 6160850 - CAGE SPNL XL W 50X22X8MM CRNT FX BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6160855 SUP HCPCS C1713 6160855 - CAGE SPNL XL W 55X22X8MM CRNT FX BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6160860 SUP HCPCS C1713 6160860 - CAGE SPNL XL W 60X22X8MM CRNT FX BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6161045 SUP HCPCS C1713 6161045 - CAGE SPNL XL 45X22X10MM NS LF CRNT W FTPRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6161050 SUP HCPCS C1713 6161050 - CAGE SPNL XL W 50X22X10MM CRNT FX BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6161055 SUP HCPCS C1713 6161055 - CAGE SPNL XL W 55X22X10MM CRNT FX BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6161060 SUP HCPCS C1713 6161060 - CAGE SPNL XL W 60X22X10MM CRNT FX BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6161255 SUP HCPCS C1713 6161255 - CAGE SPNL XL W 55X22X12MM CRNT FSN BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6161260 SUP HCPCS C1713 6161260 - CAGE SPNL XL W 60X22X12MM CRNT FSN BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6161450 SUP HCPCS C1713 6161450 - CAGE SPNL XL W 50X22X14MM CRNT FSN BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6161455 SUP HCPCS C1713 6161455 - CAGE SPNL XL W 55X22X14MM CRNT FSN BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6161460 SUP HCPCS C1713 6161460 - CAGE SPNL XL W 60X22X14MM CRNT FSN BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6170850 SUP HCPCS C1713 6170850 - CAGE SPNL XL W LRDTC 50X22X8MM CRNT FSN BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6170855 SUP HCPCS C1713 6170855 - CAGE SPNL XL LRDTC 55X22X8MM NS LF CRNT W FTPRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6170860 SUP HCPCS C1713 6170860 - CAGE SPNL XL LRDTC 60X22X8MM NS LF CRNT W FTPRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6171050 SUP HCPCS C1713 6171050 - SPACER SPNL XL W LRDTC 50X22X10MM CRNT FSN BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6171055 SUP HCPCS C1713 6171055 - CAGE SPNL XL LRDTC 55X22X10MM NS LF CRNT W FTPRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6171060 SUP HCPCS C1713 6171060 - CAGE SPNL XL LRDTC 60X22X10MM NS LF CRNT W FTPRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6171250 SUP HCPCS C1713 6171250 - CAGE SPNL XL W LRDTC 50X22X12MM CRNT FSN BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6171255 SUP HCPCS C1713 6171255 - CAGE SPNL XL LRDTC 55X22X12MM NS LF CRNT W FTPRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6171260 SUP HCPCS C1713 6171260 - CAGE SPNL XL LRDTC 60X22X12MM NS LF CRNT W FTPRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6171450 SUP HCPCS C1713 6171450 - CAGE SPNL XL W LRDTC 50X22X14MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6171455 SUP HCPCS C1713 6171455 - CAGE SPNL XL W LRDTC 55X22X14MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6171460 SUP HCPCS C1713 6171460 - CAGE SPNL XL W LRDTC 60X22X14MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6181800 SUP Custom 27803010 6181800 - ENDCAP 18MM RND 0 DEG OD18 TI XCORE 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 6181804 SUP Custom 27803010 6181804 - ENDCAP 18MM RND 4 DEG OD18 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 6181808 SUP Custom 27803010 6181808 - ENDCAP 18MM RND 8 DEG XCORE 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 6183000 SUP Custom 27803010 6183000 - ENDCAP OD18X18X30MM 0 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6183004 SUP Custom 27803010 6183004 - ENDCAP OD18X18X30MM 4 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6183008 SUP Custom 27803010 6183008 - ENDCAP OD18X18X30MM 8 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6183014 SUP Custom 27803010 6183014 - ENDCAP OD18X18X30MM 4 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6184000 SUP Custom 27803010 6184000 - ENDCAP OD18X18X40MM 0 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6184004 SUP Custom 27803010 6184004 - ENDCAP OD18X18X40MM 4 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6184008 SUP Custom 27803010 6184008 - ENDCAP OD18X18X40MM 8 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6184014 SUP Custom 27803010 6184014 - ENDCAP OD18X18X40MM 4 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6185000 SUP Custom 27803010 6185000 - ENDCAP OD18X18X50MM 0 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6185004 SUP Custom 27803010 6185004 - ENDCAP OD18X18X50MM 4 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6185008 SUP Custom 27803010 6185008 - ENDCAP OD18X18X50MM 8 DEG TI XCORE TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6185014 SUP Custom 27803010 6185014 - ENDCAP OD18X18X50MM 4 DEG TI OD18 TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6200240 SUP HCPCS C1713 6200240 - CAGE SPNL 20D XL HYPERLORDOTIC 40X22X2MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200245 SUP HCPCS C1713 6200245 - CAGE SPNL 20D XL 45X22X2MM CRNT PEEK BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200250 SUP HCPCS C1713 6200250 - CAGE SPNL 20D XL 50X22X2MM CRNT PEEK BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200255 SUP HCPCS C1713 6200255 - CAGE SPNL 20D XL 55X22X2MM CRNT PEEK BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200260 SUP HCPCS C1713 6200260 - CAGE SPNL 20D XL 60X22X2MM CRNT PEEK BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200265 SUP HCPCS C1713 6200265 - CAGE SPNL 20D XL HYPERLORDOTIC 65X22X2MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200440 SUP HCPCS C1713 6200440 - CAGE SPNL 20D XL HYPERLORDOTIC 40X22X4MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200445 SUP HCPCS C1713 6200445 - CAGE SPNL 20D XL 45X22X4MM CRNT PEEK BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200450 SUP HCPCS C1713 6200450 - CAGE SPNL 20D XL 50X22X4MM PEEK BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200455 SUP HCPCS C1713 6200455 - CAGE SPNL 20D XL 55X22X4MM PEEK BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200460 SUP HCPCS C1713 6200460 - CAGE SPNL 20D XL 60X22X4MM CRNT PEEK BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200465 SUP HCPCS C1713 6200465 - CAGE SPNL 20D XL HYPERLORDOTIC 65X22X4MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200640 SUP HCPCS C1713 6200640 - CAGE SPNL 20D XL HYPERLORDOTIC 40X22X6MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6200645 SUP HCPCS C1713 6200645 - CAGE SPNL 20D XL 45X22X6MM CRNT PEEK BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6200650 SUP HCPCS C1713 6200650 - CAGE SPNL 20D XL 50X22X6MM CRNT PEEK BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200655 SUP HCPCS C1713 6200655 - CAGE SPNL 20D XL HYPERLORDOTIC 55X22X6MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200660 SUP HCPCS C1713 6200660 - CAGE SPNL 20D XL HYPERLORDOTIC 60X22X6MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200665 SUP HCPCS C1713 6200665 - CAGE SPNL 20D XL HYPERLORDOTIC 65X22X6MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200840 SUP HCPCS C1713 6200840 - CAGE SPNL 20D XL HYPERLORDOTIC 40X22X8MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200845 SUP HCPCS C1713 6200845 - CAGE SPNL 20D XL HYPERLORDOTIC 45X22X8MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6200850 SUP HCPCS C1713 6200850 - CAGE SPNL 20D XL HYPERLORDOTIC 50X22X8MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200855 SUP HCPCS C1713 6200855 - CAGE SPNL 20D XL HYPERLORDOTIC 55X22X8MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200860 SUP HCPCS C1713 6200860 - CAGE SPNL 20D XL HYPERLORDOTIC 60X22X8MM NS LF CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6200865 SUP HCPCS C1713 6200865 - CAGE SPNL 20D XL HYPERLORDOTIC 65X22X8MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6201040 SUP HCPCS C1713 6201040 - CAGE SPNL 20D XL HYPERLORDOTIC 40X22X10MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6201045 SUP HCPCS C1713 6201045 - CAGE SPNL 20D XL HYPERLORDOTIC 45X22X10MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6201050 SUP HCPCS C1713 6201050 - CAGE SPNL 20D XL HYPERLORDOTIC 50X22X10MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6201055 SUP HCPCS C1713 6201055 - CAGE SPNL 20D XL HYPERLORDOTIC 55X22X10MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6201060 SUP HCPCS C1713 6201060 - CAGE SPNL 20D XL HYPERLORDOTIC 60X22X10MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6201065 SUP HCPCS C1713 6201065 - CAGE SPNL 20D XL HYPERLORDOTIC 65X22X10MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6208045 SUP HCPCS C1713 6208045 - CAGE SPNL XL XW 45X26X8MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6208050 SUP HCPCS C1713 6208050 - CAGE SPNL XL XW 50X26X8MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6208055 SUP HCPCS C1713 6208055 - CAGE SPNL XL XW 55X26X8MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6208060 SUP HCPCS C1713 6208060 - CAGE SPNL XL XW 60X26X8MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6208145 SUP HCPCS C1713 6208145 - CAGE SPNL 10D XL XW 45X26X8MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6208150 SUP HCPCS C1713 6208150 - CAGE SPNL 10D XL XW 50X26X8MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6208155 SUP HCPCS C1713 6208155 - CAGE SPNL 10D XL XW 55X26X8MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6208160 SUP HCPCS C1713 6208160 - CAGE SPNL 10D XL XW 60X26X8MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6210045 SUP HCPCS C1713 6210045 - CAGE SPNL XL XW 45X26X10MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6210050 SUP HCPCS C1713 6210050 - CAGE SPNL XL XW 50X26X10MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6210055 SUP HCPCS C1713 6210055 - CAGE SPNL XL XW 55X26X10MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6210060 SUP HCPCS C1713 6210060 - CAGE SPNL XL XW 60X26X10MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6210145 SUP HCPCS C1713 6210145 - CAGE SPNL 10D XL XW 45X26X10MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6210150 SUP HCPCS C1713 6210150 - CAGE SPNL 10D XL XW 50X26X10MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6210155 SUP HCPCS C1713 6210155 - CAGE SPNL 10D XL XW 55X26X10MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6212045 SUP HCPCS C1713 6212045 - CAGE SPNL XL XW 45X26X12MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6212050 SUP HCPCS C1713 6212050 - CAGE SPNL XL XW 50X26X12MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6212055 SUP HCPCS C1713 6212055 - CAGE SPNL XL XW 55X26X12MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6212060 SUP HCPCS C1713 6212060 - CAGE SPNL XL XW 60X26X12MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6212145 SUP HCPCS C1713 6212145 - CAGE SPNL 10D XL XW 45X26X12MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6212150 SUP HCPCS C1713 6212150 - CAGE SPNL 10D XL XW LRDTC 50X26X12MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6212155 SUP HCPCS C1713 6212155 - CAGE SPNL 10D XL XW LRDTC 55X26X12MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6212160 SUP HCPCS C1713 6212160 - CAGE SPNL 10D XL XW 60X26X12MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6214045 SUP HCPCS C1713 6214045 - CAGE SPNL XL XW 45X26X14MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6214050 SUP HCPCS C1713 6214050 - CAGE SPNL XL XW 50X26X14MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6214055 SUP HCPCS C1713 6214055 - CAGE SPNL XL XW 55X26X14MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6214060 SUP HCPCS C1713 6214060 - CAGE SPNL XL XW 60X26X14MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6214145 SUP HCPCS C1713 6214145 - CAGE SPNL 10D XL XW 45X26X14MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6214150 SUP HCPCS C1713 6214150 - CAGE SPNL 10D XL XW 50X26X14MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6214155 SUP HCPCS C1713 6214155 - CAGE SPNL 10D XL XW 55X26X14MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6214160 SUP HCPCS C1713 6214160 - CAGE SPNL 10D XL XW 60X26X14MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6216045 SUP HCPCS C1713 6216045 - CAGE SPNL XL XW 45X26X16MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6216050 SUP HCPCS C1713 6216050 - CAGE SPNL XL XW 50X26X16MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6216055 SUP HCPCS C1713 6216055 - CAGE SPNL XL XW 55X26X16MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6216060 SUP HCPCS C1713 6216060 - CAGE SPNL XL XW 60X26X16MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6216145 SUP HCPCS C1713 6216145 - CAGE SPNL 10D XL XW 45X26X16MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6216150 SUP HCPCS C1713 6216150 - CAGE SPNL 10D XL XW 50X26X16MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6216155 SUP HCPCS C1713 6216155 - CAGE SPNL 10D XL XW 55X26X16MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6216160 SUP HCPCS C1713 6216160 - CAGE SPNL 10D XL XW 60X26X16MM CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6222200 SUP Custom 27803010 6222200 - ENDCAP 22MM RND 0 DEG OD18 TI XCORE 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 6222204 SUP Custom 27803010 6222204 - ENDCAP 22MM RND 4 DEG OD18 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 6222208 SUP Custom 27803010 6222208 - ENDCAP 22MM RND 8 DEG XCORE 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 6223000 SUP Custom 27803010 6223000 - ENDCAP OD18X22X30MM 0 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6223004 SUP HCPCS C1713 6223004 - END CAP SPNL 4D 18MM 30MM NS 22MM X-COR 2 TI BOTH IP/OP "$3,157.50" "$2,337.00" $626.68 "$3,157.50" "$1,420.88" "$1,420.88" "$1,420.88" "$1,420.88" "$3,157.50" "$3,157.50" "$3,157.50" $658.10 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$1,556.65" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" $626.68 N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" $658.02 "$3,157.50" N/A N/A 6223008 SUP Custom 27803010 6223008 - ENDCAP OD18X22X30MM 8 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6223012 SUP Custom 27803010 6223012 - ENDCAP OD18X22X30MM 12 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6224000 SUP Custom 27803010 6224000 - ENDCAP OD18X22X40MM 0 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6224004 SUP Custom 27803010 6224004 - ENDCAP OD18X22X40MM 4 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6224008 SUP Custom 27803010 6224008 - ENDCAP OD18X22X40MM 8 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6224012 SUP Custom 27803010 6224012 - ENDCAP OD18X22X40MM 12 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6225000 SUP Custom 27803010 6225000 - ENDCAP OD18X22X50MM 0 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6225004 SUP Custom 27803010 6225004 - ENDCAP OD18X22X50MM 4 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6225008 SUP Custom 27803010 6225008 - ENDCAP OD18X22X50MM 8 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6225012 SUP Custom 27803010 6225012 - ENDCAP OD18X22X50MM 12 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6226000 SUP Custom 27803010 6226000 - ENDCAP OD18X22X60MM 0 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6226004 SUP Custom 27803010 6226004 - ENDCAP OD18X22X60MM 4 DEG TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6226008 SUP Custom 27803010 6226008 - ENDCAP OD18X22X60MM 8 DEG TI XCORE TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6226012 SUP Custom 27803010 6226012 - ENDCAP OD18X22X60MM 12 DEG TI OD18 TI XCORE 2 BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 6240041 SUP Custom 27803010 6240041 - SPACER SPNL 11MM 14X10MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240064 SUP Custom 27803010 6240064 - SPACER SPNL 6MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240086 SUP Custom 27803010 6240086 - SPACER SPNL 16MM 18X10MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240141 SUP Custom 27803010 6240141 - SPACER SPNL 11MM 14X11MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240164 SUP Custom 27803010 6240164 - SPACER SPNL 14MM 16X11MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240186 SUP Custom 27803010 6240186 - SPACER SPNL 16MM 18X11MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240241 SUP Custom 27803010 6240241 - SPACER SPNL 12MM 11X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240264 SUP Custom 27803010 6240264 - SPACER SPNL 14MM 16X12MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240286 SUP Custom 27803010 6240286 - SPACER SPNL 16MM 18X12MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240341 SUP Custom 27803010 6240341 - SPACER SPNL 13MM 11X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240364 SUP Custom 27803010 6240364 - SPACER SPNL 14MM 16X13MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240386 SUP Custom 27803010 6240386 - SPACER SPNL 16MM 18X13MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240441 SUP Custom 27803010 6240441 - SPACER SPNL 14MM 11X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240464 SUP Custom 27803010 6240464 - SPACER SPNL 14MM 16X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240486 SUP Custom 27803010 6240486 - SPACER SPNL 16MM 18X14MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240541 SUP Custom 27803010 6240541 - SPACER SPNL 11MM 14X5MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240564 SUP Custom 27803010 6240564 - SPACER SPNL 5MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240586 SUP Custom 27803010 6240586 - SPACER SPNL 16MM 18X5MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240641 SUP Custom 27803010 6240641 - SPACER SPNL 11MM 14X6MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240664 SUP Custom 27803010 6240664 - SPACER SPNL 6MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240686 SUP Custom 27803010 6240686 - SPACER SPNL 16MM 18X6MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240741 SUP Custom 27803010 6240741 - SPACER SPNL 11MM 14X7MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240764 SUP Custom 27803010 6240764 - SPACER SPNL 7MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240786 SUP Custom 27803010 6240786 - SPACER SPNL 16MM 18X7MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240841 SUP HCPCS C1713 6240841 - SPACER SPNL 11MM 14X8MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6240864 SUP Custom 27803010 6240864 - SPACER SPNL 8MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240886 SUP Custom 27803010 6240886 - SPACER SPNL 16MM 18X8MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240941 SUP Custom 27803010 6240941 - SPACER SPNL 11MM 14X9MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240964 SUP Custom 27803010 6240964 - SPACER SPNL 9MM 14X16MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6240986 SUP Custom 27803010 6240986 - SPACER SPNL 16MM 18X9MM VRTSTCK CRSTN PSR PEEK-OPTM CRV BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6241041 SUP HCPCS C1713 6241041 - STRUT SPNL 11MM 14X5MM VRTSTCK HDRSRB PEEK-OPTM CRV BOTH IP/OP "$5,445.00" "$4,029.00" "$1,080.70" "$5,445.00" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.87" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.80" "$5,445.00" "$2,178.00" "$2,684.39" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$4,083.75" "$5,445.00" "$5,445.00" "$5,445.00" "$2,722.50" "$2,722.50" "$4,312.44" "$5,445.00" "$4,356.00" "$2,450.25" "$1,080.70" N/A "$3,158.10" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.74" "$5,445.00" N/A N/A 6241064 SUP HCPCS C1713 6241064 - STRUT SPNL 14MM 16X5MM VRTSTCK HDRSRB PEEK-OPTM CRV BOTH IP/OP "$5,445.00" "$4,029.00" "$1,080.70" "$5,445.00" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.87" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.80" "$5,445.00" "$2,178.00" "$2,684.39" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$4,083.75" "$5,445.00" "$5,445.00" "$5,445.00" "$2,722.50" "$2,722.50" "$4,312.44" "$5,445.00" "$4,356.00" "$2,450.25" "$1,080.70" N/A "$3,158.10" "$5,445.00" "$3,267.00" "$5,445.00" "$1,134.74" "$5,445.00" N/A N/A 6241086 SUP HCPCS C1713 6241086 - STRUT SPNL 16MM 18X5MM VRTSTCK HDRSRB PEEK-OPTM CRV BOTH IP/OP "$5,445.00" "$4,029.00" "$1,080.70" "$5,445.00" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.87" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.80" "$5,445.00" "$2,178.00" "$2,684.39" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$4,083.75" "$5,445.00" "$5,445.00" "$5,445.00" "$2,722.50" "$2,722.50" "$4,312.44" "$5,445.00" "$4,356.00" "$2,450.25" "$1,080.70" N/A "$3,158.10" "$5,445.00" "$3,267.00" "$5,445.00" "$1,134.74" "$5,445.00" N/A N/A 6242041 SUP HCPCS C1713 6242041 - STRUT SPNL 11MM 14X24MM VRTSTCK HDRSRB PEEK-OPTM CRV BOTH IP/OP "$5,445.00" "$4,029.00" "$1,080.70" "$5,445.00" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.87" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.80" "$5,445.00" "$2,178.00" "$2,684.39" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$4,083.75" "$5,445.00" "$5,445.00" "$5,445.00" "$2,722.50" "$2,722.50" "$4,312.44" "$5,445.00" "$4,356.00" "$2,450.25" "$1,080.70" N/A "$3,158.10" "$5,445.00" "$3,267.00" "$5,445.00" "$1,134.74" "$5,445.00" N/A N/A 6242064 SUP HCPCS C1713 6242064 - STRUT SPNL 14MM 16X24MM VRTSTCK HDRSRB PEEK-OPTM CRV BOTH IP/OP "$5,445.00" "$4,029.00" "$1,080.70" "$5,445.00" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.87" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.80" "$5,445.00" "$2,178.00" "$2,684.39" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$4,083.75" "$5,445.00" "$5,445.00" "$5,445.00" "$2,722.50" "$2,722.50" "$4,312.44" "$5,445.00" "$4,356.00" "$2,450.25" "$1,080.70" N/A "$3,158.10" "$5,445.00" "$3,267.00" "$5,445.00" "$1,134.74" "$5,445.00" N/A N/A 6242086 SUP HCPCS C1713 6242086 - STRUT SPNL 16MM 18X24MM VRTSTCK HDRSRB PEEK-OPTM CRV BOTH IP/OP "$5,445.00" "$4,029.00" "$1,080.70" "$5,445.00" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.87" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.80" "$5,445.00" "$2,178.00" "$2,684.39" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$4,083.75" "$5,445.00" "$5,445.00" "$5,445.00" "$2,722.50" "$2,722.50" "$4,312.44" "$5,445.00" "$4,356.00" "$2,450.25" "$1,080.70" N/A "$3,158.10" "$5,445.00" "$3,267.00" "$5,445.00" "$1,134.74" "$5,445.00" N/A N/A 6260535 SUP HCPCS C1713 6260535 - SCREW BONE 5MM 35MM FIX ANGLE RPS SAC SPN BOTH IP/OP "$2,123.00" "$1,571.00" $421.35 "$2,122.93" $955.32 $955.32 $955.32 $955.32 "$2,122.93" "$2,122.93" "$2,122.93" $442.47 "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" $442.44 "$2,122.93" "$2,122.93" "$1,255.71" "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$1,592.25" "$2,122.93" "$2,122.93" "$2,122.93" "$1,061.47" "$1,061.47" "$1,681.36" "$2,122.93" "$1,698.34" $955.32 $421.35 N/A "$1,231.34" "$2,122.93" "$1,273.76" "$2,122.93" $442.42 "$2,122.93" N/A N/A 6260540 SUP HCPCS C1713 6260540 - SCREW BONE 5MM 40MM FIX ANGLE RPS SAC SPN BOTH IP/OP "$2,123.00" "$1,571.00" $421.35 "$2,122.93" $955.32 $955.32 $955.32 $955.32 "$2,122.93" "$2,122.93" "$2,122.93" $442.47 "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" $442.44 "$2,122.93" "$2,122.93" "$1,255.71" "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$1,592.25" "$2,122.93" "$2,122.93" "$2,122.93" "$1,061.47" "$1,061.47" "$1,681.36" "$2,122.93" "$1,698.34" $955.32 $421.35 N/A "$1,231.34" "$2,122.93" "$1,273.76" "$2,122.93" $442.42 "$2,122.93" N/A N/A 6260555 SUP HCPCS C1713 6260555 - SCREW BONE 5MM 55MM FIX ANGLE RPS SAC SPN BOTH IP/OP "$2,123.00" "$1,571.00" $421.35 "$2,122.93" $955.32 $955.32 $955.32 $955.32 "$2,122.93" "$2,122.93" "$2,122.93" $442.47 "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" $442.44 "$2,122.93" "$2,122.93" "$1,255.71" "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$1,592.25" "$2,122.93" "$2,122.93" "$2,122.93" "$1,061.47" "$1,061.47" "$1,681.36" "$2,122.93" "$1,698.34" $955.32 $421.35 N/A "$1,231.34" "$2,122.93" "$2,122.93" "$2,122.93" $442.42 "$2,122.93" N/A N/A 6260560 SUP HCPCS C1713 6260560 - SCREW BONE 5MM 60MM FIX ANGLE RPS SAC SPN BOTH IP/OP "$2,123.00" "$1,571.00" $421.35 "$2,122.93" $955.32 $955.32 $955.32 $955.32 "$2,122.93" "$2,122.93" "$2,122.93" $442.47 "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" $442.44 "$2,122.93" $849.17 "$1,255.71" "$2,122.93" "$2,122.93" "$2,122.93" "$2,122.93" "$1,592.25" "$2,122.93" "$2,122.93" "$2,122.93" "$1,061.47" "$1,061.47" "$1,681.36" "$2,122.93" "$1,698.34" $955.32 $421.35 N/A "$1,231.34" "$2,122.93" "$1,273.76" "$2,122.93" $442.42 "$2,122.93" N/A N/A 6260625 SUP HCPCS C1713 6260625 - SCREW BONE 6MM 25MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$1,293.10" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$1,939.65" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6260630 SUP HCPCS C1713 6260630 - SCREW BONE 6MM 30MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$1,293.10" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$1,939.65" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6260635 SUP HCPCS C1713 6260635 - SCREW BONE 6MM 35MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$3,232.75" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$3,232.75" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6260640 SUP HCPCS C1713 6260640 - SCREW BONE 6MM 40MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$3,232.75" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$1,939.65" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6260645 SUP HCPCS C1713 6260645 - SCREW BONE 6MM 44MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$1,293.10" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$1,939.65" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6260650 SUP HCPCS C1713 6260650 - SCREW BONE 6MM 50MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$1,293.10" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$1,939.65" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6260655 SUP HCPCS C1713 6260655 - SCREW BONE 6MM 55MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$1,293.10" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$1,939.65" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6260660 SUP HCPCS C1713 6260660 - SCREW BONE 6MM 60MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$1,293.10" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$1,939.65" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6262525 SUP HCPCS C1713 6262525 - SCREW BONE 5MM 25MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$1,293.10" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$1,939.65" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6262530 SUP HCPCS C1713 6262530 - SCREW BONE 5MM 30MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$1,293.10" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$1,939.65" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6262535 SUP HCPCS C1713 6262535 - SCREW BONE 5MM 35MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$1,293.10" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$1,939.65" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6262540 SUP HCPCS C1713 6262540 - SCREW BONE 5MM 40MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$3,232.75" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$1,939.65" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6262545 SUP HCPCS C1713 6262545 - SCREW BONE 5MM 45MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$3,232.75" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$1,939.65" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6262550 SUP HCPCS C1713 6262550 - SCREW BONE 5MM 50MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$1,293.10" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$3,232.75" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6262555 SUP HCPCS C1713 6262555 - SCREW BONE 5MM 55MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$1,293.10" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$3,232.75" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6262560 SUP HCPCS C1713 6262560 - SCREW BONE 5MM 60MM TECHTONIX TITANIUM SPN BOTH IP/OP "$3,233.00" "$2,392.00" $641.62 "$3,232.75" "$1,454.74" "$1,454.74" "$1,454.74" "$1,454.74" "$3,232.75" "$3,232.75" "$3,232.75" $673.79 "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" $673.74 "$3,232.75" "$1,293.10" "$1,593.75" "$3,232.75" "$3,232.75" "$3,232.75" "$3,232.75" "$2,424.75" "$3,232.75" "$3,232.75" "$3,232.75" "$1,616.38" "$1,616.38" "$2,560.34" "$3,232.75" "$2,586.20" "$1,454.74" $641.62 N/A "$1,875.14" "$3,232.75" "$1,939.65" "$3,232.75" $673.71 "$3,232.75" N/A N/A 6262600 SUP Custom 27803010 6262600 - ENDCAP 26MM RND 0 DEG OD18 TI XCORE 2 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 6262604 SUP Custom 27803010 6262604 - ENDCAP 26MM RND 4 DEG OD18 BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 6262608 SUP Custom 27803010 6262608 - ENDCAP 26MM RND 8 DEG BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 6271044 SUP HCPCS C1713 6271044 - SPACER SPNL 11MM 11X44MM STRL LF VRTSTCK CRSTN PSR STRUT BOTH IP/OP "$4,992.00" "$3,694.00" $990.79 "$4,992.00" "$2,246.40" "$2,246.40" "$2,246.40" "$2,246.40" "$4,992.00" "$4,992.00" "$4,992.00" "$1,040.46" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$1,040.39" "$4,992.00" "$1,996.80" "$2,461.06" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$3,744.00" "$4,992.00" "$4,992.00" "$4,992.00" "$2,496.00" "$2,496.00" "$3,953.66" "$4,992.00" "$3,993.60" "$2,246.40" $990.79 N/A "$2,895.36" "$4,992.00" "$2,995.20" "$4,992.00" "$1,040.33" "$4,992.00" N/A N/A 6272044 SUP Custom 27803010 6272044 - SPACER SPNL 11MM 14X44MM STRL LF VRTSTCK CRSTN PSR STRUT BOTH IP/OP "$4,992.00" "$3,694.00" $888.58 "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" $888.58 "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$1,040.39" "$4,992.00" "$1,996.80" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$3,744.00" "$4,992.00" "$4,992.00" "$4,992.00" "$2,496.00" "$2,496.00" "$3,953.66" "$4,992.00" "$3,993.60" "$2,246.40" "$4,992.00" N/A "$2,895.36" "$4,992.00" "$2,995.20" "$4,992.00" "$4,992.00" "$4,992.00" N/A N/A 6273044 SUP Custom 27803010 6273044 - SPACER SPNL 14MM 14X44MM STRL LF VRTSTCK CRSTN PSR STRUT BOTH IP/OP "$4,992.00" "$3,694.00" $888.58 "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" $888.58 "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$1,040.39" "$4,992.00" "$1,996.80" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$3,744.00" "$4,992.00" "$4,992.00" "$4,992.00" "$2,496.00" "$2,496.00" "$3,953.66" "$4,992.00" "$3,993.60" "$2,246.40" "$4,992.00" N/A "$2,895.36" "$4,992.00" "$2,995.20" "$4,992.00" "$4,992.00" "$4,992.00" N/A N/A 6276011 SUP HCPCS C1713 6276011 - SPACER SPNL 11MM 11X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6276025 SUP HCPCS C1713 6276025 - SPACER SPNL 11MM 11X25MM STRL LF VRTSTCK CRSTN PSR STRUT BOTH IP/OP "$4,992.00" "$3,694.00" $990.79 "$4,992.00" "$2,246.40" "$2,246.40" "$2,246.40" "$2,246.40" "$4,992.00" "$4,992.00" "$4,992.00" "$1,040.46" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$1,040.39" "$4,992.00" "$4,992.00" "$2,461.06" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$3,744.00" "$4,992.00" "$4,992.00" "$4,992.00" "$2,496.00" "$2,496.00" "$3,953.66" "$4,992.00" "$3,993.60" "$2,246.40" $990.79 N/A "$2,895.36" "$4,992.00" "$2,995.20" "$4,992.00" "$1,040.33" "$4,992.00" N/A N/A 6276111 SUP HCPCS C1713 6276111 - SPACER SPNL 11MM 11X11MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6276211 SUP HCPCS C1713 6276211 - SPACER SPNL 12MM 11X12MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6276311 SUP HCPCS C1713 6276311 - SPACER SPNL 11MM 11X13MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6276411 SUP HCPCS C1713 6276411 - SPACER SPNL 11MM 11X4MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6276511 SUP HCPCS C1713 6276511 - SPACER SPNL 11MM 11X5MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6276611 SUP HCPCS C1713 6276611 - SPACER SPNL 11MM 11X6MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6276711 SUP HCPCS C1713 6276711 - SPACER SPNL 11MM 11X7MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6276811 SUP HCPCS C1713 6276811 - SPACER SPNL 11MM 11X8MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6276911 SUP HCPCS C1713 6276911 - SPACER SPNL 11MM 11X9MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6277006 SUP HCPCS C1713 6277006 - SPACER SPNL 11MM 14X6MM STRL LF VRTSTCK CRSTN PSR STRUT BOTH IP/OP "$4,992.00" "$3,694.00" $990.79 "$4,992.00" "$2,246.40" "$2,246.40" "$2,246.40" "$2,246.40" "$4,992.00" "$4,992.00" "$4,992.00" "$1,040.46" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$1,040.39" "$4,992.00" "$4,992.00" "$2,461.06" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$3,744.00" "$4,992.00" "$4,992.00" "$4,992.00" "$2,496.00" "$2,496.00" "$3,953.66" "$4,992.00" "$3,993.60" "$2,246.40" $990.79 N/A "$2,895.36" "$4,992.00" "$2,995.20" "$4,992.00" "$1,040.33" "$4,992.00" N/A N/A 6277025 SUP Custom 27803010 6277025 - SPACER SPNL 11MM 14X25MM STRL LF VRTSTCK CRSTN PSR STRUT BOTH IP/OP "$4,992.00" "$3,694.00" $888.58 "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" $888.58 "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$1,040.39" "$4,992.00" "$1,996.80" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$3,744.00" "$4,992.00" "$4,992.00" "$4,992.00" "$2,496.00" "$2,496.00" "$3,953.66" "$4,992.00" "$3,993.60" "$2,246.40" "$4,992.00" N/A "$2,895.36" "$4,992.00" "$2,995.20" "$4,992.00" "$4,992.00" "$4,992.00" N/A N/A 6277041 SUP HCPCS C1713 6277041 - SPACER SPNL 11MM 14X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6277141 SUP HCPCS C1713 6277141 - SPACER SPNL 11MM 14X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6277241 SUP Custom 27803010 6277241 - SPACER SPNL 11MM 14X12MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6277341 SUP Custom 27803010 6277341 - SPACER SPNL 11MM 14X13MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6277441 SUP Custom 27803010 6277441 - SPACER SPNL 11MM 14X4MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6277541 SUP HCPCS C1713 6277541 - SPACER SPNL 11MM 14X5MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6277641 SUP HCPCS C1713 6277641 - SPACER SPNL 11MM 14X6MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6277741 SUP HCPCS C1713 6277741 - SPACER SPNL 11MM 14X7MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6277841 SUP HCPCS C1713 6277841 - SPACER SPNL 11MM 14X8MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6277941 SUP HCPCS C1713 6277941 - SPACER SPNL 11MM 14X9MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6278006 SUP Custom 27803010 6278006 - SPACER SPNL 14MM 14X6MM STRL LF VRTSTCK CRSTN PSR STRUT BOTH IP/OP "$4,992.00" "$3,694.00" $888.58 "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" $888.58 "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$1,040.39" "$4,992.00" "$1,996.80" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$3,744.00" "$4,992.00" "$4,992.00" "$4,992.00" "$2,496.00" "$2,496.00" "$3,953.66" "$4,992.00" "$3,993.60" "$2,246.40" "$4,992.00" N/A "$2,895.36" "$4,992.00" "$2,995.20" "$4,992.00" "$4,992.00" "$4,992.00" N/A N/A 6278025 SUP Custom 27803010 6278025 - SPACER SPNL 14MM 14X25MM STRL LF VRTSTCK CRSTN PSR STRUT BOTH IP/OP "$4,992.00" "$3,694.00" $888.58 "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" $888.58 "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$1,040.39" "$4,992.00" "$1,996.80" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$4,992.00" "$3,744.00" "$4,992.00" "$4,992.00" "$4,992.00" "$2,496.00" "$2,496.00" "$3,953.66" "$4,992.00" "$3,993.60" "$2,246.40" "$4,992.00" N/A "$2,895.36" "$4,992.00" "$2,995.20" "$4,992.00" "$4,992.00" "$4,992.00" N/A N/A 6278044 SUP Custom 27803010 6278044 - SPACER SPNL 14MM 14X10MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6278144 SUP Custom 27803010 6278144 - SPACER SPNL 14MM 14X11MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6278244 SUP Custom 27803010 6278244 - SPACER SPNL 14MM 14X12MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6278344 SUP Custom 27803010 6278344 - SPACER SPNL 14MM 14X13MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6278444 SUP Custom 27803010 6278444 - SPACER SPNL 14MM 14X4MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6278544 SUP Custom 27803010 6278544 - SPACER SPNL 14MM 14X5MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6278644 SUP Custom 27803010 6278644 - SPACER SPNL 14MM 14X6MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6278744 SUP Custom 27803010 6278744 - SPACER SPNL 14MM 14X7MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6278844 SUP Custom 27803010 6278844 - SPACER SPNL 14MM 14X8MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6278944 SUP Custom 27803010 6278944 - SPACER SPNL 14MM 14X9MM STRL LF VRTSTCK CRSTN PSR PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6284011 SUP HCPCS C1713 6284011 - SPACER SPNL 11MM 11X10MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284041 SUP HCPCS C1713 6284041 - SPACER SPNL 11MM 14X10MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284044 SUP HCPCS C1713 6284044 - SPACER SPNL 14MM 14X10MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284111 SUP HCPCS C1713 6284111 - SPACER SPNL 11MM 11X11MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284141 SUP HCPCS C1713 6284141 - SPACER SPNL 11MM 14X11MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284144 SUP HCPCS C1713 6284144 - SPACER SPNL 14MM 14X11MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284211 SUP HCPCS C1713 6284211 - SPACER SPNL 11MM 11X12MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284241 SUP HCPCS C1713 6284241 - SPACER SPNL 11MM 14X12MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284244 SUP HCPCS C1713 6284244 - SPACER SPNL 14MM 14X12MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284311 SUP HCPCS C1713 6284311 - SPACER SPNL 11MM 11X13MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284511 SUP HCPCS C1713 6284511 - SPACER SPNL 11MM 11X5MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284541 SUP HCPCS C1713 6284541 - SPACER SPNL 11MM 14X5MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284544 SUP HCPCS C1713 6284544 - SPACER SPNL 14MM 14X5MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284611 SUP HCPCS C1713 6284611 - SPACER SPNL 11MM 11X6MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284641 SUP HCPCS C1713 6284641 - SPACER SPNL 11MM 14X6MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284644 SUP HCPCS C1713 6284644 - SPACER SPNL 14MM 14X6MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284711 SUP HCPCS C1713 6284711 - SPACER SPNL 11MM 11X7MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284741 SUP HCPCS C1713 6284741 - SPACER SPNL 11MM 14X7MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284744 SUP HCPCS C1713 6284744 - SPACER SPNL 14MM 14X7MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284811 SUP HCPCS C1713 6284811 - SPACER SPNL 11MM 11X8MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284841 SUP HCPCS C1713 6284841 - SPACER SPNL 11MM 14X8MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284844 SUP HCPCS C1713 6284844 - SPACER SPNL 14MM 14X8MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284911 SUP HCPCS C1713 6284911 - SPACER SPNL 11MM 11X9MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284941 SUP HCPCS C1713 6284941 - SPACER SPNL 11MM 14X9MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6284944 SUP HCPCS C1713 6284944 - SPACER SPNL 14MM 14X9MM CRSTN PSR PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6286011 SUP HCPCS C1713 6286011 - SPACER SPNL 11MM 11X10MM VRTSTCK CRSTN PSR LAT PORT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6286111 SUP HCPCS C1713 6286111 - SPACER SPNL 11MM 11X11MM VRTSTCK CRSTN PSR LAT PORT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6286211 SUP HCPCS C1713 6286211 - SPACER SPNL 11MM 11X12MM VRTSTCK CRSTN PSR LAT PORT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6286311 SUP HCPCS C1713 6286311 - SPACER SPNL 11MM 11X13MM VRTSTCK CRSTN PSR LAT PORT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6286511 SUP HCPCS C1713 6286511 - SPACER SPNL 11MM 11X5MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6286611 SUP HCPCS C1713 6286611 - SPACER SPNL 11MM 11X6MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6286711 SUP HCPCS C1713 6286711 - SPACER SPNL 11MM 11X7MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6286811 SUP HCPCS C1713 6286811 - SPACER SPNL 11MM 11X8MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6286911 SUP HCPCS C1713 6286911 - SPACER SPNL 11MM 11X9MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6287041 SUP HCPCS C1713 6287041 - SPACER SPNL 11MM 14X10MM VRTSTCK CRSTN PSR LAT PORT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6287141 SUP HCPCS C1713 6287141 - SPACER SPNL 11MM 14X11MM VRTSTCK CRSTN PSR LAT PORT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6287241 SUP HCPCS C1713 6287241 - SPACER SPNL 11MM 14X12MM VRTSTCK CRSTN PSR LAT PORT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6287341 SUP HCPCS C1713 6287341 - SPACER SPNL 11MM 14X13MM VRTSTCK CRSTN PSR LAT PORT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6287541 SUP HCPCS C1713 6287541 - SPACER SPNL 11MM 14X5MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6287641 SUP HCPCS C1713 6287641 - SPACER SPNL 11MM 14X6MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6287741 SUP HCPCS C1713 6287741 - SPACER SPNL 11MM 14X7MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6287841 SUP HCPCS C1713 6287841 - SPACER SPNL 11MM 14X8MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6287941 SUP HCPCS C1713 6287941 - SPACER SPNL 11MM 14X9MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6288044 SUP HCPCS C1713 6288044 - SPACER SPNL 14MM 14X10MM VRTSTCK CRSTN PSR LAT PORT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6288144 SUP HCPCS C1713 6288144 - SPACER SPNL 14MM 14X11MM VRTSTCK CRSTN PSR LAT PORT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6288244 SUP HCPCS C1713 6288244 - SPACER SPNL 14MM 14X12MM VRTSTCK CRSTN PSR LAT PORT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6288344 SUP HCPCS C1713 6288344 - SPACER SPNL 14MM 14X13MM VRTSTCK CRSTN PSR LAT PORT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6288544 SUP HCPCS C1713 6288544 - SPACER SPNL 14MM 14X5MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6288644 SUP HCPCS C1713 6288644 - SPACER SPNL 14MM 14X6MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6288744 SUP HCPCS C1713 6288744 - SPACER SPNL 14MM 14X7MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6288844 SUP HCPCS C1713 6288844 - SPACER SPNL 14MM 14X8MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6288944 SUP HCPCS C1713 6288944 - SPACER SPNL 14MM 14X9MM VRTSTCK CRSTN PSR LAT PORT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6300240 SUP HCPCS C1713 6300240 - CAGE SPNL 30D XL HYPERLORDOTIC 40X22X2MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300245 SUP HCPCS C1713 6300245 - CAGE SPNL 30D XL HYPERLORDOTIC 45X22X2MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300250 SUP HCPCS C1713 6300250 - CAGE SPNL 30D XL HYPERLORDOTIC 50X22X2MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300255 SUP HCPCS C1713 6300255 - CAGE SPNL 30D XL HYPERLORDOTIC 55X22X2MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300260 SUP HCPCS C1713 6300260 - CAGE SPNL 30D XL HYPERLORDOTIC 60X22X2MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300265 SUP HCPCS C1713 6300265 - CAGE SPNL 30D XL HYPERLORDOTIC 65X22X2MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300440 SUP HCPCS C1713 6300440 - CAGE SPNL 30D XL HYPERLORDOTIC 40X22X4MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300445 SUP HCPCS C1713 6300445 - CAGE SPNL 30D XL HYPERLORDOTIC 45X22X4MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300450 SUP HCPCS C1713 6300450 - CAGE SPNL 30D XL HYPERLORDOTIC 50X22X4MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300455 SUP HCPCS C1713 6300455 - CAGE SPNL 30D XL HYPERLORDOTIC 55X22X4MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300460 SUP HCPCS C1713 6300460 - CAGE SPNL 30D XL HYPERLORDOTIC 60X22X4MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300465 SUP HCPCS C1713 6300465 - CAGE SPNL 30D XL HYPERLORDOTIC 65X22X4MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300640 SUP HCPCS C1713 6300640 - CAGE SPNL 30D XL HYPERLORDOTIC 40X22X6MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300645 SUP HCPCS C1713 6300645 - CAGE SPNL 30D XL HYPERLORDOTIC 45X22X6MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300650 SUP HCPCS C1713 6300650 - CAGE SPNL 30D XL HYPERLORDOTIC 50X22X6MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300655 SUP HCPCS C1713 6300655 - CAGE SPNL 30D LRDTC HI BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300660 SUP HCPCS C1713 6300660 - CAGE SPNL 30D XL HYPERLORDOTIC 60X22X6MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300665 SUP HCPCS C1713 6300665 - CAGE SPNL 30D XL HYPERLORDOTIC 65X22X6MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6300840 SUP HCPCS C1713 6300840 - CAGE SPNL 30D XL HYPERLORDOTIC 40X22X8MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6300845 SUP HCPCS C1713 6300845 - CAGE SPNL 30D XL HYPERLORDOTIC 45X22X8MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300850 SUP HCPCS C1713 6300850 - CAGE SPNL 30D XL HYPERLORDOTIC 50X22X8MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300855 SUP HCPCS C1713 6300855 - CAGE SPNL 30D XL HYPERLORDOTIC 55X22X8MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300860 SUP HCPCS C1713 6300860 - CAGE SPNL 30D XL HYPERLORDOTIC 60X22X8MM NS LF CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6300865 SUP HCPCS C1713 6300865 - CAGE SPNL 30D XL HYPERLORDOTIC 65X22X8MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6301040 SUP HCPCS C1713 6301040 - CAGE SPNL 30D XL HYPERLORDOTIC 40X22X10MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6301045 SUP HCPCS C1713 6301045 - CAGE SPNL 30D XL HYPERLORDOTIC 45X22X10MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6301050 SUP HCPCS C1713 6301050 - CAGE SPNL 30D XL HYPERLORDOTIC 50X22X10MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6301055 SUP HCPCS C1713 6301055 - CAGE SPNL 30D XL HYPERLORDOTIC 55X22X10MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6301060 SUP HCPCS C1713 6301060 - CAGE SPNL 30D XL HYPERLORDOTIC 60X22X10MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A 6301065 SUP HCPCS C1713 6301065 - CAGE SPNL 30D XL HYPERLORDOTIC 65X22X10MM CRNT BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$6,500.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$9,750.00" "$16,250.00" "$16,250.00" "$16,250.00" N/A N/A 6360032 SUP HCPCS C1713 6360032 - SPACER SPNL XS 13X12X10MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360053 SUP HCPCS C1713 6360053 - SPACER SPNL XS 15X13X10MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360132 SUP HCPCS C1713 6360132 - SPACER SPNL XS 13X12X11MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360153 SUP HCPCS C1713 6360153 - SPACER SPNL XS 15X13X11MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360232 SUP HCPCS C1713 6360232 - SPACER SPNL XS 13X12X12MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360253 SUP HCPCS C1713 6360253 - SPACER SPNL XS 15X13X12MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360532 SUP HCPCS C1713 6360532 - SPACER SPNL XS 13X12X5MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360553 SUP HCPCS C1713 6360553 - SPACER SPNL XS 15X13X5MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360632 SUP HCPCS C1713 6360632 - SPACER SPNL XS 13X12X6MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360653 SUP HCPCS C1713 6360653 - SPACER SPNL XS 15X6X3MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360732 SUP HCPCS C1713 6360732 - SPACER SPNL XS 13X12X7MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360753 SUP HCPCS C1713 6360753 - SPACER SPNL XS 15X13X7MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360832 SUP HCPCS C1713 6360832 - SPACER SPNL XS 13X12X8MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360853 SUP HCPCS C1713 6360853 - SPACER SPNL XS 15X13X8MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360932 SUP HCPCS C1713 6360932 - SPACER SPNL XS 13X12X9MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6360953 SUP HCPCS C1713 6360953 - SPACER SPNL XS 15X13X9MM PRIMTR C PEEK-OPTM CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6390206 SUP Custom 27803010 6390206 - CAGE SPNL CYL LRDTC TPR 6MM 12MM AFF CLS CHMFR EDG MLT THR BOTH IP/OP "$6,988.50" "$5,171.00" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,456.48" "$6,988.50" "$2,795.40" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$5,241.38" "$6,988.50" "$6,988.50" "$6,988.50" "$3,494.25" "$3,494.25" "$5,534.89" "$6,988.50" "$5,590.80" "$3,144.83" "$6,988.50" N/A "$4,053.33" "$6,988.50" "$4,193.10" "$6,988.50" "$6,988.50" "$6,988.50" N/A N/A 6390207 SUP Custom 27803010 6390207 - CAGE SPNL CYL LRDTC TPR 7MM 12MM AFF CLS CHMFR EDG MLT THR BOTH IP/OP "$6,988.50" "$5,171.00" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,456.48" "$6,988.50" "$2,795.40" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$5,241.38" "$6,988.50" "$6,988.50" "$6,988.50" "$3,494.25" "$3,494.25" "$5,534.89" "$6,988.50" "$5,590.80" "$3,144.83" "$6,988.50" N/A "$4,053.33" "$6,988.50" "$4,193.10" "$6,988.50" "$6,988.50" "$6,988.50" N/A N/A 6390208 SUP Custom 27803010 6390208 - CAGE SPNL CYL LRDTC TPR 8MM 12MM AFF CLS CHMFR EDG MLT THR BOTH IP/OP "$6,988.50" "$5,171.00" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,456.48" "$6,988.50" "$2,795.40" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$5,241.38" "$6,988.50" "$6,988.50" "$6,988.50" "$3,494.25" "$3,494.25" "$5,534.89" "$6,988.50" "$5,590.80" "$3,144.83" "$6,988.50" N/A "$4,053.33" "$6,988.50" "$4,193.10" "$6,988.50" "$6,988.50" "$6,988.50" N/A N/A 6390209 SUP Custom 27803010 6390209 - CAGE SPNL CYL LRDTC TPR 9MM 12MM AFF CLS CHMFR EDG MLT THR BOTH IP/OP "$6,988.50" "$5,171.00" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,456.48" "$6,988.50" "$2,795.40" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$5,241.38" "$6,988.50" "$6,988.50" "$6,988.50" "$3,494.25" "$3,494.25" "$5,534.89" "$6,988.50" "$5,590.80" "$3,144.83" "$6,988.50" N/A "$4,053.33" "$6,988.50" "$4,193.10" "$6,988.50" "$6,988.50" "$6,988.50" N/A N/A 6390210 SUP Custom 27803010 6390210 - CAGE SPNL CYL LRDTC TPR 10MM 12MM AFF CLS CHMFR EDG MLT THR BOTH IP/OP "$6,988.50" "$5,171.00" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,456.48" "$6,988.50" "$2,795.40" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$5,241.38" "$6,988.50" "$6,988.50" "$6,988.50" "$3,494.25" "$3,494.25" "$5,534.89" "$6,988.50" "$5,590.80" "$3,144.83" "$6,988.50" N/A "$4,053.33" "$6,988.50" "$4,193.10" "$6,988.50" "$6,988.50" "$6,988.50" N/A N/A 6390211 SUP Custom 27803010 6390211 - CAGE SPNL CYL LRDTC TPR 11MM 12MM AFF CLS CHMFR EDG MLT THR BOTH IP/OP "$6,988.50" "$5,171.00" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,456.48" "$6,988.50" "$2,795.40" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$5,241.38" "$6,988.50" "$6,988.50" "$6,988.50" "$3,494.25" "$3,494.25" "$5,534.89" "$6,988.50" "$5,590.80" "$3,144.83" "$6,988.50" N/A "$4,053.33" "$6,988.50" "$4,193.10" "$6,988.50" "$6,988.50" "$6,988.50" N/A N/A 6390212 SUP Custom 27803010 6390212 - CAGE SPNL CYL LRDTC TPR 12MM 12MM AFF CLS CHMFR EDG MLT THR BOTH IP/OP "$6,988.50" "$5,171.00" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,456.48" "$6,988.50" "$2,795.40" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$5,241.38" "$6,988.50" "$6,988.50" "$6,988.50" "$3,494.25" "$3,494.25" "$5,534.89" "$6,988.50" "$5,590.80" "$3,144.83" "$6,988.50" N/A "$4,053.33" "$6,988.50" "$4,193.10" "$6,988.50" "$6,988.50" "$6,988.50" N/A N/A 6390406 SUP Custom 27803010 6390406 - CAGE SPNL CYL LRDTC TPR 6MM 14MM AFF CLS CHMFR EDG MLT THR BOTH IP/OP "$6,988.50" "$5,171.00" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,456.48" "$6,988.50" "$2,795.40" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$5,241.38" "$6,988.50" "$6,988.50" "$6,988.50" "$3,494.25" "$3,494.25" "$5,534.89" "$6,988.50" "$5,590.80" "$3,144.83" "$6,988.50" N/A "$4,053.33" "$6,988.50" "$4,193.10" "$6,988.50" "$6,988.50" "$6,988.50" N/A N/A 6390407 SUP Custom 27803010 6390407 - CAGE SPNL CYL LRDTC TPR 7MM 14MM AFF CLS CHMFR EDG MLT THR BOTH IP/OP "$6,988.50" "$5,171.00" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,456.48" "$6,988.50" "$2,795.40" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$5,241.38" "$6,988.50" "$6,988.50" "$6,988.50" "$3,494.25" "$3,494.25" "$5,534.89" "$6,988.50" "$5,590.80" "$3,144.83" "$6,988.50" N/A "$4,053.33" "$6,988.50" "$4,193.10" "$6,988.50" "$6,988.50" "$6,988.50" N/A N/A 6390408 SUP Custom 27803010 6390408 - CAGE SPNL CYL LRDTC TPR 8MM 14MM AFF CLS CHMFR EDG MLT THR BOTH IP/OP "$6,988.50" "$5,171.00" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,456.48" "$6,988.50" "$2,795.40" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$5,241.38" "$6,988.50" "$6,988.50" "$6,988.50" "$3,494.25" "$3,494.25" "$5,534.89" "$6,988.50" "$5,590.80" "$3,144.83" "$6,988.50" N/A "$4,053.33" "$6,988.50" "$4,193.10" "$6,988.50" "$6,988.50" "$6,988.50" N/A N/A 6390409 SUP Custom 27803010 6390409 - CAGE SPNL CYL LRDTC TPR 9MM 14MM AFF CLS CHMFR EDG MLT THR BOTH IP/OP "$6,988.50" "$5,171.00" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,456.48" "$6,988.50" "$2,795.40" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$5,241.38" "$6,988.50" "$6,988.50" "$6,988.50" "$3,494.25" "$3,494.25" "$5,534.89" "$6,988.50" "$5,590.80" "$3,144.83" "$6,988.50" N/A "$4,053.33" "$6,988.50" "$4,193.10" "$6,988.50" "$6,988.50" "$6,988.50" N/A N/A 6390410 SUP Custom 27803010 6390410 - CAGE SPNL CYL LRDTC TPR 10MM 14MM AFF CLS CHMFR EDG MLT THR BOTH IP/OP "$6,988.50" "$5,171.00" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,456.48" "$6,988.50" "$2,795.40" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$5,241.38" "$6,988.50" "$6,988.50" "$6,988.50" "$3,494.25" "$3,494.25" "$5,534.89" "$6,988.50" "$5,590.80" "$3,144.83" "$6,988.50" N/A "$4,053.33" "$6,988.50" "$4,193.10" "$6,988.50" "$6,988.50" "$6,988.50" N/A N/A 6390411 SUP Custom 27803010 6390411 - CAGE SPNL CYL LRDTC TPR 11MM 14MM AFF CLS CHMFR EDG MLT THR BOTH IP/OP "$6,988.50" "$5,171.00" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,456.48" "$6,988.50" "$2,795.40" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$5,241.38" "$6,988.50" "$6,988.50" "$6,988.50" "$3,494.25" "$3,494.25" "$5,534.89" "$6,988.50" "$5,590.80" "$3,144.83" "$6,988.50" N/A "$4,053.33" "$6,988.50" "$4,193.10" "$6,988.50" "$6,988.50" "$6,988.50" N/A N/A 6390412 SUP Custom 27803010 6390412 - CAGE SPNL CYL LRDTC TPR 12MM 14MM AFF CLS CHMFR EDG MLT THR BOTH IP/OP "$6,988.50" "$5,171.00" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,243.95" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$1,456.48" "$6,988.50" "$2,795.40" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$6,988.50" "$5,241.38" "$6,988.50" "$6,988.50" "$6,988.50" "$3,494.25" "$3,494.25" "$5,534.89" "$6,988.50" "$5,590.80" "$3,144.83" "$6,988.50" N/A "$4,053.33" "$6,988.50" "$4,193.10" "$6,988.50" "$6,988.50" "$6,988.50" N/A N/A 6430530 SUP HCPCS C1713 6430530 - SCREW SET TI 4.75MM SPN PERC SOLERA CD HZN STRL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 6440530 SUP HCPCS C1713 6440530 - SET SCREW 6440530 4.75 SOLERA PERC TI BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 6470314 SUP Custom 27203010 "6470314 - BRYAN CERVICAL DISC, 14MM" BOTH IP/OP "$8,850.00" "$6,549.00" "$1,575.30" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$1,575.30" "$8,850.00" "$8,850.00" "$4,181.12" "$4,181.12" "$6,821.58" "$2,060.15" "$1,844.44" "$8,850.00" "$3,540.00" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$6,637.50" "$8,850.00" "$8,850.00" "$8,850.00" "$4,425.00" "$4,425.00" "$7,009.20" "$8,850.00" "$7,080.00" "$5,752.50" "$8,850.00" N/A "$5,133.00" "$8,850.00" "$5,310.00" "$8,850.00" "$8,850.00" "$8,850.00" N/A N/A 6470315 SUP Custom 27803010 6470315 - DISK SPINAL 15MM MOTION BRYAN CERV BOTH IP/OP "$8,850.00" "$6,549.00" "$1,575.30" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$1,575.30" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$1,844.44" "$8,850.00" "$3,540.00" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$8,850.00" "$6,637.50" "$8,850.00" "$8,850.00" "$8,850.00" "$4,425.00" "$4,425.00" "$7,009.20" "$8,850.00" "$7,080.00" "$3,982.50" "$8,850.00" N/A "$5,133.00" "$8,850.00" "$5,310.00" "$8,850.00" "$8,850.00" "$8,850.00" N/A N/A 6474024 SUP HCPCS C1713 6474024 - PIN DISTRACTION 3.5MM 14MM REUSABLE BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $330.00 $330.00 $68.77 $330.00 N/A N/A 6474176 SUP Custom 27203010 6474176 - BIT DRILL SPN BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A 6474524 SUP Custom 27203010 6474524 - BRYAN DISC CUTTER 14MM BOTH IP/OP "$1,350.00" $999.00 $240.30 "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" $240.30 "$1,350.00" "$1,350.00" "$1,001.97" "$1,001.97" "$1,040.58" $703.35 $281.35 "$1,350.00" $540.00 "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,012.50" "$1,350.00" "$1,350.00" "$1,350.00" $675.00 $675.00 "$1,069.20" "$1,350.00" "$1,080.00" $877.50 "$1,350.00" N/A $783.00 "$1,350.00" $810.00 "$1,350.00" "$1,350.00" "$1,350.00" N/A N/A 6533131 SUP HCPCS C1713 6533131 - END CAP SPNL 0D 30X18MM VBR EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 6533141 SUP HCPCS C1713 6533141 - END CAP SPNL 0D 40X18MM VBR EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 6533151 SUP HCPCS C1713 6533151 - CAGE SPNL 0D 50X18MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 6533231 SUP HCPCS C1713 6533231 - END CAP SPNL 4D 30X18MM VBR EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 6533241 SUP HCPCS C1713 6533241 - CAGE SPNL 4D 40X18MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 6533251 SUP HCPCS C1713 6533251 - END CAP SPNL 4D 50X18MM VBR EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 6533331 SUP HCPCS C1713 6533331 - CAGE SPNL 8D 30X18MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$3,740.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 6533341 SUP HCPCS C1713 6533341 - CAGE SPNL 8D 40X18MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 6533351 SUP HCPCS C1713 6533351 - CAGE SPNL 8D 50X18MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 6533431 SUP HCPCS C1713 6533431 - END CAP SPNL -4D 30X18MM VBR EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 6533441 SUP HCPCS C1713 6533441 - CAGE SPNL -4D 40X18MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 6533451 SUP HCPCS C1713 6533451 - CAGE SPNL -4D 50X18MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 6535241 SUP HCPCS C1713 6535241 - CAGE SPNL 0D 40X22MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 6535251 SUP HCPCS C1713 6535251 - CAGE SPNL 0D 50X22MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 6535261 SUP HCPCS C1713 6535261 - CAGE SPNL 0D 60X22MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 6535341 SUP HCPCS C1713 6535341 - CAGE SPNL 4D 40X22MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 6535351 SUP HCPCS C1713 6535351 - CAGE SPNL 4D 50X22MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 6535361 SUP HCPCS C1713 6535361 - CAGE SPNL 4D 60X22MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 6535441 SUP HCPCS C1713 6535441 - CAGE SPNL 8D 40X22MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 6535451 SUP HCPCS C1713 6535451 - CAGE SPNL 8D 50X22MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$3,740.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 6535461 SUP HCPCS C1713 6535461 - CAGE SPNL 8D 60X22MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 6535541 SUP HCPCS C1713 6535541 - CAGE SPNL 12D 40X22MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 6535551 SUP HCPCS C1713 6535551 - CAGE SPNL 12D 50X22MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$3,740.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" "$3,740.00" "$3,740.00" N/A N/A 6535561 SUP HCPCS C1713 6535561 - CAGE SPNL 12D 60X22MM VBR ENDCP EXPANDABLE BOTH IP/OP "$3,740.00" "$2,768.00" $742.30 "$3,740.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.51 "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" $779.46 "$3,740.00" "$1,496.00" "$1,843.82" "$3,740.00" "$3,740.00" "$3,740.00" "$3,740.00" "$2,805.00" "$3,740.00" "$3,740.00" "$3,740.00" "$1,870.00" "$1,870.00" "$2,962.08" "$3,740.00" "$2,992.00" "$1,683.00" $742.30 N/A "$2,169.20" "$3,740.00" "$2,244.00" "$3,740.00" $779.42 "$3,740.00" N/A N/A 6537124 SUP HCPCS C1713 6537124 - END CAP SPNL 0D RND 18MM 22MM VBR EXPANDABLE BOTH IP/OP "$2,352.50" "$1,741.00" $466.91 "$2,352.50" "$1,058.63" "$1,058.63" "$1,058.63" "$1,058.63" "$2,352.50" "$2,352.50" "$2,352.50" $490.32 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" "$2,352.50" "$1,391.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" $466.91 N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" $490.26 "$2,352.50" N/A N/A 6537125 SUP HCPCS C1713 6537125 - CAGE SPNL 0D RND 18MM 26MM VBR ENDCP EXPANDABLE BOTH IP/OP "$2,352.50" "$1,741.00" $466.91 "$2,352.50" "$1,058.63" "$1,058.63" "$1,058.63" "$1,058.63" "$2,352.50" "$2,352.50" "$2,352.50" $490.32 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$1,391.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" $466.91 N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" $490.26 "$2,352.50" N/A N/A 6537134 SUP HCPCS C1713 6537134 - END CAP SPNL 8D RND 18MM 22MM VBR EXPANDABLE BOTH IP/OP "$2,352.50" "$1,741.00" $466.91 "$2,352.50" "$1,058.63" "$1,058.63" "$1,058.63" "$1,058.63" "$2,352.50" "$2,352.50" "$2,352.50" $490.32 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" "$2,352.50" "$1,391.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" $466.91 N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" $490.26 "$2,352.50" N/A N/A 6537135 SUP HCPCS C1713 6537135 - CAGE SPNL 8D RND 18MM 26MM VBR ENDCP EXPANDABLE BOTH IP/OP "$2,352.50" "$1,741.00" $466.91 "$2,352.50" "$1,058.63" "$1,058.63" "$1,058.63" "$1,058.63" "$2,352.50" "$2,352.50" "$2,352.50" $490.32 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" "$2,352.50" "$1,391.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" $466.91 N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" $490.26 "$2,352.50" N/A N/A 6537225 SUP HCPCS C1713 6537225 - CAGE SPNL 0D RND 22MM 26MM VBR ENDCP EXPANDABLE BOTH IP/OP "$2,352.50" "$1,741.00" $466.91 "$2,352.50" "$1,058.63" "$1,058.63" "$1,058.63" "$1,058.63" "$2,352.50" "$2,352.50" "$2,352.50" $490.32 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" "$2,352.50" "$1,391.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" $466.91 N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" $490.26 "$2,352.50" N/A N/A 6537226 SUP HCPCS C1713 6537226 - CAGE SPNL 0D RND 22MM 30MM VBR ENDCP EXPANDABLE BOTH IP/OP "$2,352.50" "$1,741.00" $466.91 "$2,352.50" "$1,058.63" "$1,058.63" "$1,058.63" "$1,058.63" "$2,352.50" "$2,352.50" "$2,352.50" $490.32 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" "$2,352.50" "$1,391.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" $466.91 N/A "$1,364.45" "$2,352.50" "$2,352.50" "$2,352.50" $490.26 "$2,352.50" N/A N/A 6537235 SUP HCPCS C1713 6537235 - CAGE SPNL 8D RND 18MM 26MM VBR ENDCP EXPANDABLE BOTH IP/OP "$2,352.50" "$1,741.00" $466.91 "$2,352.50" "$1,058.63" "$1,058.63" "$1,058.63" "$1,058.63" "$2,352.50" "$2,352.50" "$2,352.50" $490.32 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" "$2,352.50" "$1,391.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" $466.91 N/A "$1,364.45" "$2,352.50" "$2,352.50" "$2,352.50" $490.26 "$2,352.50" N/A N/A 6537236 SUP HCPCS C1713 6537236 - CAGE SPNL 8D RND 22MM 30MM VBR ENDCP EXPANDABLE BOTH IP/OP "$2,352.50" "$1,741.00" $466.91 "$2,352.50" "$1,058.63" "$1,058.63" "$1,058.63" "$1,058.63" "$2,352.50" "$2,352.50" "$2,352.50" $490.32 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" "$2,352.50" "$1,391.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" $466.91 N/A "$1,364.45" "$2,352.50" "$2,352.50" "$2,352.50" $490.26 "$2,352.50" N/A N/A 6539001 SUP HCPCS C1713 6539001 - SCREW BN SM VBR EXPANDABLE LCK SPNE BOTH IP/OP $620.00 $459.00 $123.05 $620.00 $279.00 $279.00 $279.00 $279.00 $620.00 $620.00 $620.00 $129.22 $620.00 $620.00 $620.00 $620.00 $620.00 $129.21 $620.00 $620.00 $366.73 $620.00 $620.00 $620.00 $620.00 $465.00 $620.00 $620.00 $620.00 $310.00 $310.00 $491.04 $620.00 $496.00 $279.00 $123.05 N/A $359.60 $620.00 $620.00 $620.00 $129.21 $620.00 N/A N/A 6539002 SUP HCPCS C1713 6539002 - SCREW BN LG VBR LCK EXPANDABLE SPNE BOTH IP/OP $620.00 $459.00 $123.05 $620.00 $279.00 $279.00 $279.00 $279.00 $620.00 $620.00 $620.00 $129.22 $620.00 $620.00 $620.00 $620.00 $620.00 $129.21 $620.00 $620.00 $366.73 $620.00 $620.00 $620.00 $620.00 $465.00 $620.00 $620.00 $620.00 $310.00 $310.00 $491.04 $620.00 $496.00 $279.00 $123.05 N/A $359.60 $620.00 $620.00 $620.00 $129.21 $620.00 N/A N/A 6540530 SUP HCPCS C1713 6540530 - SCREW SET 5.5/6MM NS LF CD HZN SOLERAL VYGR BOTH IP/OP $912.50 $675.00 $181.11 $912.50 $410.63 $410.63 $410.63 $410.63 $912.50 $912.50 $912.50 $190.19 $912.50 $912.50 $912.50 $912.50 $912.50 $190.18 $912.50 $365.00 $539.74 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $410.63 $181.11 N/A $529.25 $912.50 $912.50 $912.50 $190.17 $912.50 N/A N/A 6541019 SUP HCPCS C1713 6541019 - STAPLE BONE 19MM CD HORIZON LEGACY ANTERIOR ROSTRAL SPN BOTH IP/OP "$2,932.50" "$2,170.00" $581.95 "$2,932.13" "$1,319.46" "$1,319.46" "$1,319.46" "$1,319.46" "$2,932.13" "$2,932.13" "$2,932.13" $611.13 "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" $611.09 "$2,932.13" "$2,932.13" "$1,445.54" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,199.38" "$2,932.13" "$2,932.13" "$2,932.13" "$1,466.07" "$1,466.07" "$2,322.25" "$2,932.13" "$2,345.70" "$1,319.46" $581.95 N/A "$1,700.85" "$2,932.13" "$1,759.28" "$2,932.13" $611.06 "$2,932.13" N/A N/A 6541021 SUP HCPCS C1713 6541021 - STAPLE BONE 21MM CD HORIZON LEGACY ANTERIOR ROSTRAL SPN BOTH IP/OP "$2,932.50" "$2,170.00" $581.95 "$2,932.13" "$1,319.46" "$1,319.46" "$1,319.46" "$1,319.46" "$2,932.13" "$2,932.13" "$2,932.13" $611.13 "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" $611.09 "$2,932.13" "$2,932.13" "$1,445.54" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,199.38" "$2,932.13" "$2,932.13" "$2,932.13" "$1,466.07" "$1,466.07" "$2,322.25" "$2,932.13" "$2,345.70" "$1,319.46" $581.95 N/A "$1,700.85" "$2,932.13" "$1,759.28" "$2,932.13" $611.06 "$2,932.13" N/A N/A 6541023 SUP HCPCS C1713 6541023 - STAPLE BONE 23MM CD HORIZON LEGACY ANTERIOR ROSTRAL SPN BOTH IP/OP "$2,932.50" "$2,170.00" $581.95 "$2,932.13" "$1,319.46" "$1,319.46" "$1,319.46" "$1,319.46" "$2,932.13" "$2,932.13" "$2,932.13" $611.13 "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" $611.09 "$2,932.13" "$2,932.13" "$1,445.54" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,199.38" "$2,932.13" "$2,932.13" "$2,932.13" "$1,466.07" "$1,466.07" "$2,322.25" "$2,932.13" "$2,345.70" "$1,319.46" $581.95 N/A "$1,700.85" "$2,932.13" "$1,759.28" "$2,932.13" $611.06 "$2,932.13" N/A N/A 6541025 SUP HCPCS C1713 6541025 - STAPLE BONE 25MM CD HORIZON LEGACY ANTERIOR ROSTRAL SPN BOTH IP/OP "$2,932.50" "$2,170.00" $581.95 "$2,932.13" "$1,319.46" "$1,319.46" "$1,319.46" "$1,319.46" "$2,932.13" "$2,932.13" "$2,932.13" $611.13 "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" $611.09 "$2,932.13" "$2,932.13" "$1,445.54" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,199.38" "$2,932.13" "$2,932.13" "$2,932.13" "$1,466.07" "$1,466.07" "$2,322.25" "$2,932.13" "$2,345.70" "$1,319.46" $581.95 N/A "$1,700.85" "$2,932.13" "$1,759.28" "$2,932.13" $611.06 "$2,932.13" N/A N/A 6541119 SUP HCPCS C1713 6541119 - STAPLE BONE 19MM CD HORIZON LEGACY ANTERIOR CAUDAL SPN BOTH IP/OP "$2,932.50" "$2,170.00" $581.95 "$2,932.13" "$1,319.46" "$1,319.46" "$1,319.46" "$1,319.46" "$2,932.13" "$2,932.13" "$2,932.13" $611.13 "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" $611.09 "$2,932.13" "$2,932.13" "$1,445.54" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,199.38" "$2,932.13" "$2,932.13" "$2,932.13" "$1,466.07" "$1,466.07" "$2,322.25" "$2,932.13" "$2,345.70" "$1,319.46" $581.95 N/A "$1,700.85" "$2,932.13" "$1,759.28" "$2,932.13" $611.06 "$2,932.13" N/A N/A 6541121 SUP HCPCS C1713 6541121 - STAPLE BONE 21MM CD HORIZON LEGACY ANTERIOR CAUDAL SPN BOTH IP/OP "$2,932.50" "$2,170.00" $581.95 "$2,932.13" "$1,319.46" "$1,319.46" "$1,319.46" "$1,319.46" "$2,932.13" "$2,932.13" "$2,932.13" $611.13 "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" $611.09 "$2,932.13" "$2,932.13" "$1,445.54" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,199.38" "$2,932.13" "$2,932.13" "$2,932.13" "$1,466.07" "$1,466.07" "$2,322.25" "$2,932.13" "$2,345.70" "$1,319.46" $581.95 N/A "$1,700.85" "$2,932.13" "$2,932.13" "$2,932.13" $611.06 "$2,932.13" N/A N/A 6541123 SUP HCPCS C1713 6541123 - STAPLE BONE 23MM CD HORIZON LEGACY ANTERIOR CAUDAL SPN BOTH IP/OP "$2,932.50" "$2,170.00" $581.95 "$2,932.13" "$1,319.46" "$1,319.46" "$1,319.46" "$1,319.46" "$2,932.13" "$2,932.13" "$2,932.13" $611.13 "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" $611.09 "$2,932.13" "$2,932.13" "$1,445.54" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,199.38" "$2,932.13" "$2,932.13" "$2,932.13" "$1,466.07" "$1,466.07" "$2,322.25" "$2,932.13" "$2,345.70" "$1,319.46" $581.95 N/A "$1,700.85" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" N/A N/A 6541125 SUP HCPCS C1713 6541125 - STAPLE BONE 25MM CD HORIZON LEGACY ANTERIOR CAUDAL SPN BOTH IP/OP "$2,932.50" "$2,170.00" $581.95 "$2,932.13" "$1,319.46" "$1,319.46" "$1,319.46" "$1,319.46" "$2,932.13" "$2,932.13" "$2,932.13" $611.13 "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" $611.09 "$2,932.13" "$2,932.13" "$1,445.54" "$2,932.13" "$2,932.13" "$2,932.13" "$2,932.13" "$2,199.38" "$2,932.13" "$2,932.13" "$2,932.13" "$1,466.07" "$1,466.07" "$2,322.25" "$2,932.13" "$2,345.70" "$1,319.46" $581.95 N/A "$1,700.85" "$2,932.13" "$1,759.28" "$2,932.13" "$2,932.13" "$2,932.13" N/A N/A 6541213 SUP HCPCS C1713 6541213 - STAPLE BONE 13MM CD HORIZON LEGACY ANTERIOR SPN BOTH IP/OP "$1,465.50" "$1,084.00" $290.87 "$1,465.50" $659.48 $659.48 $659.48 $659.48 "$1,465.50" "$1,465.50" "$1,465.50" $305.45 "$1,465.50" "$1,465.50" "$1,465.50" "$1,465.50" "$1,465.50" $305.43 "$1,465.50" "$1,465.50" $866.84 "$1,465.50" "$1,465.50" "$1,465.50" "$1,465.50" "$1,099.13" "$1,465.50" "$1,465.50" "$1,465.50" $732.75 $732.75 "$1,160.68" "$1,465.50" "$1,172.40" $659.48 $290.87 N/A $849.99 "$1,465.50" $879.30 "$1,465.50" "$1,465.50" "$1,465.50" N/A N/A 6541215 SUP HCPCS C1713 6541215 - STAPLE BONE 15MM CD HORIZON LEGACY SPN BOTH IP/OP "$1,465.50" "$1,084.00" $290.87 "$1,465.50" $659.48 $659.48 $659.48 $659.48 "$1,465.50" "$1,465.50" "$1,465.50" $305.45 "$1,465.50" "$1,465.50" "$1,465.50" "$1,465.50" "$1,465.50" $305.43 "$1,465.50" "$1,465.50" $866.84 "$1,465.50" "$1,465.50" "$1,465.50" "$1,465.50" "$1,099.13" "$1,465.50" "$1,465.50" "$1,465.50" $732.75 $732.75 "$1,160.68" "$1,465.50" "$1,172.40" $659.48 $290.87 N/A $849.99 "$1,465.50" $879.30 "$1,465.50" $305.41 "$1,465.50" N/A N/A 6541217 SUP HCPCS C1713 6541217 - STAPLE BONE 17MM CD HORIZON LEGACY ANTERIOR SPN BOTH IP/OP "$1,465.50" "$1,084.00" $290.87 "$1,465.50" $659.48 $659.48 $659.48 $659.48 "$1,465.50" "$1,465.50" "$1,465.50" $305.45 "$1,465.50" "$1,465.50" "$1,465.50" "$1,465.50" "$1,465.50" $305.43 "$1,465.50" "$1,465.50" $866.84 "$1,465.50" "$1,465.50" "$1,465.50" "$1,465.50" "$1,099.13" "$1,465.50" "$1,465.50" "$1,465.50" $732.75 $732.75 "$1,160.68" "$1,465.50" "$1,172.40" $659.48 $290.87 N/A $849.99 "$1,465.50" "$1,465.50" "$1,465.50" $305.41 "$1,465.50" N/A N/A 6543420 SUP HCPCS C1713 6543420 - SCREW BONE LARGE 4.5MM 20MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543425 SUP HCPCS C1713 6543425 - SCREW BONE LARGE 4.5MM 25MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543430 SUP HCPCS C1713 6543430 - SCREW BONE LARGE 4.5MM 30MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543435 SUP HCPCS C1713 6543435 - SCREW BONE LARGE 4.5MM 35MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543440 SUP HCPCS C1713 6543440 - SCREW BONE LARGE 4.5MM 40MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543445 SUP HCPCS C1713 6543445 - SCREW BONE LARGE 4.5MM 45MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543450 SUP HCPCS C1713 6543450 - SCREW BONE LARGE 4.5MM 50MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,980.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543520 SUP HCPCS C1713 6543520 - SCREW BONE LARGE 5.5MM 20MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,980.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543525 SUP HCPCS C1713 6543525 - SCREW BONE LARGE 5.5MM 25MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,980.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543530 SUP HCPCS C1713 6543530 - SCREW BONE LARGE 5.5MM 30MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543535 SUP HCPCS C1713 6543535 - SCREW BONE LARGE 5.5MM 35MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,980.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543540 SUP HCPCS C1713 6543540 - SCREW BONE LARGE 5.5MM 40MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543545 SUP HCPCS C1713 6543545 - SCREW BONE LARGE 5.5MM 45MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543550 SUP HCPCS C1713 6543550 - SCREW BONE LARGE 5.5MM 50MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543620 SUP HCPCS C1713 6543620 - SCREW BONE LARGE 6.5MM 20MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,980.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543625 SUP HCPCS C1713 6543625 - SCREW BONE LARGE 6.5MM 25MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543630 SUP HCPCS C1713 6543630 - SCREW BONE LARGE 6.5MM 30MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543635 SUP HCPCS C1713 6543635 - SCREW BONE LARGE 6.5MM 35MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543640 SUP HCPCS C1713 6543640 - SCREW BONE LARGE 6.5MM 40MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543645 SUP HCPCS C1713 6543645 - SCREW BONE LARGE 6.5MM 45MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543650 SUP HCPCS C1713 6543650 - SCREW BONE LARGE 6.5MM 50MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543655 SUP HCPCS C1713 6543655 - SCREW BONE LARGE 6.5MM 55MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543660 SUP HCPCS C1713 6543660 - SCREW BONE LARGE 6.5MM 60MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543720 SUP HCPCS C1713 6543720 - SCREW BONE LARGE 7.5MM 20MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543725 SUP HCPCS C1713 6543725 - SCREW BONE LARGE 7.5MM 25MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543730 SUP HCPCS C1713 6543730 - SCREW BONE LARGE 7.5MM 30MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543735 SUP HCPCS C1713 6543735 - SCREW BONE LARGE 7.5MM 35MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543740 SUP HCPCS C1713 6543740 - SCREW BONE LARGE 7.5MM 40MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543745 SUP HCPCS C1713 6543745 - SCREW BONE LARGE 7.5MM 45MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543750 SUP HCPCS C1713 6543750 - SCREW BONE LARGE 7.5MM 50MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543755 SUP HCPCS C1713 6543755 - SCREW BONE LARGE 7.5MM 55MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543760 SUP HCPCS C1713 6543760 - SCREW BONE LARGE 7.5MM 60MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,980.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543820 SUP HCPCS C1713 6543820 - SCREW BONE LARGE 8.5MM 20MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543825 SUP HCPCS C1713 6543825 - SCREW BONE LARGE 8.5MM 25MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543830 SUP HCPCS C1713 6543830 - SCREW BONE LARGE 8.5MM 30MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543835 SUP HCPCS C1713 6543835 - SCREW BONE LARGE 8.5MM 35MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543840 SUP HCPCS C1713 6543840 - SCREW BONE LARGE 8.5MM 40MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,980.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543845 SUP HCPCS C1713 6543845 - SCREW BONE LARGE 8.5MM 45MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543850 SUP HCPCS C1713 6543850 - SCREW BONE LARGE 8.5MM 50MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543855 SUP HCPCS C1713 6543855 - SCREW BONE LARGE 8.5MM 55MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6543860 SUP HCPCS C1713 6543860 - SCREW BONE LARGE 8.5MM 60MM FIX ANGLE TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 6591011 SUP HCPCS C1713 6591011 - CAGE SPNL 18MM 20-22MM VBR EXPANDABLE BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 6591012 SUP HCPCS C1713 6591012 - CAGE SPNL 18MM 21-25MM VBR EXPANDABLE BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 6591013 SUP HCPCS C1713 6591013 - CAGE SPNL 18MM 24-31MM VBR COR XPD BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 6591014 SUP HCPCS C1713 6591014 - CAGE SPNL 18MM 28-40MM VBR EXPANDABLE BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 6591015 SUP HCPCS C1713 6591015 - CAGE SPNL 18MM 35-52MM VBR EXPANDABLE BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 6591016 SUP HCPCS C1713 6591016 - CAGE SPNL 18MM 41-65MM VBR EXPANDABLE BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 6591017 SUP HCPCS C1713 6591017 - CAGE SPNL 18MM 47-75MM VBR EXPANDABLE BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 6591021 SUP HCPCS C1713 6591021 - CAGE SPNL 22MM 20-22MM VBR EXPANDABLE BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 6591022 SUP HCPCS C1713 6591022 - CAGE SPNL 22MM 21-25MM VBR EXPANDABLE BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 6591023 SUP HCPCS C1713 6591023 - CAGE SPNL 22MM 24-31MM VBR EXPANDABLE BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$11,245.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 6591024 SUP HCPCS C1713 6591024 - CAGE SPNL 22MM 28-40MM VBR EXPANDABLE BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 6591025 SUP HCPCS C1713 6591025 - CAGE SPNL 22MM 35-52MM VBR EXPANDABLE BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 6591026 SUP HCPCS C1713 6591026 - CAGE SPNL 22MM 41-65MM VBR EXPANDABLE BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$11,245.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 6591027 SUP HCPCS C1713 6591027 - CAGE SPNL 22MM 47-75MM VBR EXPANDABLE BOTH IP/OP "$11,245.00" "$8,321.00" "$2,231.85" "$11,245.00" "$5,060.25" "$5,060.25" "$5,060.25" "$5,060.25" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.74" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.58" "$11,245.00" "$4,498.00" "$5,543.79" "$11,245.00" "$11,245.00" "$11,245.00" "$11,245.00" "$8,433.75" "$11,245.00" "$11,245.00" "$11,245.00" "$5,622.50" "$5,622.50" "$8,906.04" "$11,245.00" "$8,996.00" "$5,060.25" "$2,231.85" N/A "$6,522.10" "$11,245.00" "$11,245.00" "$11,245.00" "$2,343.46" "$11,245.00" N/A N/A 6608125 SUP HCPCS C1713 6608125 - CAGE SPNL 8D LG CNTR 25X11X8MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6608925 SUP HCPCS C1713 6608925 - CAGE SPNL 8D LG CNTR 25X9X8MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6609125 SUP HCPCS C1713 6609125 - CAGE SPNL LG 25X11X9MM CNTR PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6609925 SUP HCPCS C1713 6609925 - CAGE SPNL 8 25X9X9MM PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6610125 SUP HCPCS C1713 6610125 - CAGE SPNL 8D LG CNTR 25X11X10MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6610925 SUP HCPCS C1713 6610925 - CAGE SPNL 8D LG CNTR 25X10X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6611125 SUP HCPCS C1713 6611125 - SPACER SPNL LG 25X11X11MM CNTR PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6611925 SUP Custom 27803010 6611925 - CAGE SPNL 8D LG CNTR 25X9X11MM NS LF CRNT PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 6612125 SUP HCPCS C1713 6612125 - CAGE SPNL 8D LG CNTR 25X12X11MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6612925 SUP HCPCS C1713 6612925 - CAGE SPNL 8D LG CNTR 25X12X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6613125 SUP HCPCS C1713 6613125 - SPACER SPNL 25X11X13MM PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6613925 SUP HCPCS C1713 6613925 - CAGE SPNL 8D LG CNTR 25X9X13MM NS LF CRNT PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6614125 SUP HCPCS C1713 6614125 - CAGE SPNL 8D LG CNTR 25X14X11MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6614925 SUP HCPCS C1713 6614925 - CAGE SPNL 8D LG CNTR 25X14X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6615125 SUP HCPCS C1713 6615125 - SPACER SPNL LG 25X11X15MM CRNT PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6615925 SUP HCPCS C1713 6615925 - CAGE SPNL 8D LG 25X9X15MM PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6616125 SUP HCPCS C1713 6616125 - CAGE SPNL LG 25X11X16MM PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6616925 SUP HCPCS C1713 6616925 - CAGE SPNL 8D LG 25X9X16MM PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6660725 SUP HCPCS C1713 6660725 - SPACER SPNL 6D 25X10X7MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6660730 SUP HCPCS C1713 6660730 - SPACER SPNL 6D 30X10X7MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6660736 SUP HCPCS C1713 6660736 - SPACER SPNL 6D 36X10X7MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 6660825 SUP HCPCS C1713 6660825 - SPACER SPNL 6D 25X10X8MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 6660830 SUP HCPCS C1713 6660830 - SPACER SPNL 6D 30X10X8MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6660836 SUP HCPCS C1713 6660836 - SPACER SPNL 6D 36X10X8MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6660925 SUP HCPCS C1713 6660925 - SPACER SPNL 6D 25X10X9MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6660930 SUP HCPCS C1713 6660930 - SPACER SPNL 6D 30X10X9MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 6660936 SUP HCPCS C1713 6660936 - SPACER SPNL 6D 36X10X9MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 6661025 SUP HCPCS C1713 6661025 - SPACER SPNL 6D 25X10X10MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661030 SUP HCPCS C1713 6661030 - SPACER SPNL 6D 30X10X10MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661036 SUP HCPCS C1713 6661036 - SPACER SPNL 6D 36X10X10MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661125 SUP HCPCS C1713 6661125 - SPACER SPNL 6D 25X10X11MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661130 SUP HCPCS C1713 6661130 - SPACER SPNL 6D 30X10X11MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661136 SUP HCPCS C1713 6661136 - SPACER SPNL 6D 36X10X11MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661225 SUP HCPCS C1713 6661225 - SPACER SPNL 6D 25X10X12MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 6661230 SUP HCPCS C1713 6661230 - SPACER SPNL 6D 30X10X12MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661236 SUP HCPCS C1713 6661236 - SPACER SPNL 6D 36X10X12MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661325 SUP HCPCS C1713 6661325 - SPACER SPNL 6D 25X10X13MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661330 SUP HCPCS C1713 6661330 - SPACER SPNL 6D 30X10X13MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661336 SUP HCPCS C1713 6661336 - SPACER SPNL 6D 36X10X13MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661425 SUP HCPCS C1713 6661425 - SPACER SPNL 6D 25X10X14MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661430 SUP HCPCS C1713 6661430 - SPACER SPNL 6D 30X10X14MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661436 SUP HCPCS C1713 6661436 - SPACER SPNL 6D 36X10X14MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661525 SUP HCPCS C1713 6661525 - SPACER SPNL 6D 25X10X15MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661530 SUP HCPCS C1713 6661530 - SPACER SPNL 6D 30X10X15MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661536 SUP HCPCS C1713 6661536 - SPACER SPNL 6D 36X10X15MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661625 SUP HCPCS C1713 6661625 - SPACER SPNL 6D 25X10X16MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661630 SUP HCPCS C1713 6661630 - SPACER SPNL 6D 30X10X16MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6661636 SUP HCPCS C1713 6661636 - SPACER SPNL 6D 36X10X16MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6670725 SUP HCPCS C1713 6670725 - SPACER SPNL W 25X10X7MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6670730 SUP HCPCS C1713 6670730 - SPACER SPNL W 30X10X7MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6670736 SUP HCPCS C1713 6670736 - SPACER SPNL W 36X10X7MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6670825 SUP HCPCS C1713 6670825 - SPACER SPNL W 25X10X8MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6670830 SUP HCPCS C1713 6670830 - SPACER SPNL W 30X10X8MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6670836 SUP HCPCS C1713 6670836 - SPACER SPNL W 36X10X8MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6670925 SUP HCPCS C1713 6670925 - SPACER SPNL W 25X10X9MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6670930 SUP HCPCS C1713 6670930 - SPACER SPNL W 30X10X9MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6670936 SUP HCPCS C1713 6670936 - SPACER SPNL W 36X10X9MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671025 SUP HCPCS C1713 6671025 - SPACER SPNL W 25X10X10MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671030 SUP HCPCS C1713 6671030 - SPACER SPNL W 30X10X10MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671036 SUP HCPCS C1713 6671036 - SPACER SPNL W 36X10X10MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671125 SUP HCPCS C1713 6671125 - SPACER SPNL W 25X10X11MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671130 SUP HCPCS C1713 6671130 - SPACER SPNL W 30X10X11MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671136 SUP HCPCS C1713 6671136 - SPACER SPNL W 36X10X11MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671225 SUP HCPCS C1713 6671225 - SPACER SPNL W 25X10X12MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671230 SUP HCPCS C1713 6671230 - SPACER SPNL W 30X10X12MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671236 SUP HCPCS C1713 6671236 - SPACER SPNL W 36X10X12MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671325 SUP HCPCS C1713 6671325 - SPACER SPNL W 25X10X13MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671330 SUP HCPCS C1713 6671330 - SPACER SPNL W 30X10X13MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671336 SUP HCPCS C1713 6671336 - SPACER SPNL W 36X10X13MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671425 SUP HCPCS C1713 6671425 - SPACER SPNL W 25X10X14MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671430 SUP HCPCS C1713 6671430 - SPACER SPNL W 30X10X14MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671436 SUP HCPCS C1713 6671436 - SPACER SPNL W 36X10X14MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671525 SUP HCPCS C1713 6671525 - SPACER SPNL W 25X10X15MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671530 SUP HCPCS C1713 6671530 - SPACER SPNL W 30X10X15MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671536 SUP HCPCS C1713 6671536 - SPACER SPNL W 36X10X15MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671625 SUP HCPCS C1713 6671625 - SPACER SPNL W 25X10X16MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671630 SUP HCPCS C1713 6671630 - SPACER SPNL W 30X10X16MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6671636 SUP HCPCS C1713 6671636 - SPACER SPNL W 36X10X16MM STRL CRSNT TI BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 6708120 SUP HCPCS C1713 6708120 - CAGE SPNL 4D LG IMPCT 20X11X8MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6708126 SUP Custom 27803010 6708126 - CAGE SPNL 4D LG IMPCT 26X11X8MM NS LF CRNT PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 6708132 SUP HCPCS C1713 6708132 - CAGE SPNL 4D LG IMPCT 32X11X8MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6708520 SUP HCPCS C1713 6708520 - SPACER SPNL 20X9X8MM CRNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6708820 SUP HCPCS C1713 6708820 - SPACER SPNL 8D LG 20X9X8MM CRNT THORLMBR INTRBD FS TPR PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6708926 SUP Custom 27803010 6708926 - CAGE SPNL 4D LG IMPCT 26X9X8MM NS LF CRNT PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 6708932 SUP HCPCS C1713 6708932 - CAGE SPNL 4D LG IMPCT 32X9X8MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6709120 SUP HCPCS C1713 6709120 - CAGE SPNL 4D LG IMPCT 20X11X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6709126 SUP HCPCS C1713 6709126 - CAGE SPNL 4D LG IMPCT 26X11X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6709132 SUP HCPCS C1713 6709132 - CAGE SPNL 4D LG IMPCT 32X11X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6709920 SUP HCPCS C1713 6709920 - CAGE SPNL 4D LG IMPCT 20X9X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6709926 SUP Custom 27803010 6709926 - CAGE SPNL 4D LG IMPCT 26X9X9MM NS LF CRNT PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 6709932 SUP Custom 27803010 6709932 - CAGE SPNL 4D LG IMPCT 32X9X9MM NS LF CRNT PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 6710120 SUP HCPCS C1713 6710120 - CAGE SPNL 4D LG IMPCT 20X11X10MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6710126 SUP HCPCS C1713 6710126 - CAGE SPNL 4D LG IMPCT 26X11X10MM NS LF CRNT PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6710132 SUP HCPCS C1713 6710132 - CAGE SPNL 4D LG IMPCT 32X11X10MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6710520 SUP HCPCS C1713 6710520 - SPACER SPNL 20X10X9MM PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6710820 SUP HCPCS C1713 6710820 - SPACER SPNL 20X10X8MM CRNT THORLMBR INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6710920 SUP HCPCS C1713 6710920 - CAGE SPNL 20X10X9MM CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6710926 SUP Custom 27803010 6710926 - CAGE SPNL 4D LG IMPCT 26X9X10MM NS LF CRNT PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 6710932 SUP HCPCS C1713 6710932 - CAGE SPNL 4D LG IMPCT 32X9X10MM NS LF CRNT PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6711120 SUP HCPCS C1713 6711120 - CAGE SPNL 4D LG IMPCT 20X11X11MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6711126 SUP HCPCS C1713 6711126 - CAGE SPNL 4D LG IMPCT 26X11X11MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6711132 SUP HCPCS C1713 6711132 - CAGE SPNL 4D LG IMPCT 32X11X11MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6711920 SUP HCPCS C1713 6711920 - CAGE SPNL 4D LG IMPCT 20X11X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6711926 SUP HCPCS C1713 6711926 - CAGE SPNL 4D LG IMPCT 26X11X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6711932 SUP HCPCS C1713 6711932 - CAGE SPNL 4D LG IMPCT 32X11X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6712120 SUP HCPCS C1713 6712120 - CAGE SPNL 4D LG IMPCT 20X12X11MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6712126 SUP HCPCS C1713 6712126 - CAGE SPNL 4D LG IMPCT 26X12X11MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6712132 SUP HCPCS C1713 6712132 - CAGE SPNL 4D LG IMPCT 32X12X11MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6712520 SUP HCPCS C1713 6712520 - SPACER SPNL 12MM 15MM INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6712820 SUP HCPCS C1713 6712820 - CAGE SPNL 8D LG 20X9X12MM CRNT TPR PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6712920 SUP HCPCS C1713 6712920 - CAGE SPNL 4D LG IMPCT 20X12X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6712926 SUP HCPCS C1713 6712926 - CAGE SPNL 4D LG IMPCT 26X12X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6712932 SUP HCPCS C1713 6712932 - CAGE SPNL 4D LG IMPCT 32X12X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6713120 SUP HCPCS C1713 6713120 - CAGE SPNL 4D LG IMPCT 20X13X11MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6713126 SUP HCPCS C1713 6713126 - CAGE SPNL 4D LG IMPCT 26X13X11MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6713132 SUP HCPCS C1713 6713132 - CAGE SPNL 4D LG IMPCT 32X13X11MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6713920 SUP HCPCS C1713 6713920 - CAGE SPNL 4D LG IMPCT 20X13X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6713926 SUP HCPCS C1713 6713926 - CAGE SPNL 4D LG IMPCT 26X13X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6713932 SUP HCPCS C1713 6713932 - CAGE SPNL 4D LG IMPCT 32X13X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6714120 SUP HCPCS C1713 6714120 - CAGE SPNL 4D LG IMPCT 20X14X11MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6714126 SUP HCPCS C1713 6714126 - CAGE SPNL 4D LG IMPCT 26X14X11MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6714132 SUP HCPCS C1713 6714132 - CAGE SPNL 4D LG IMPCT 32X14X11MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6714820 SUP HCPCS C1713 6714820 - SPACER SPNL 20X14X9MM INTRBD FS TPR PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6714920 SUP HCPCS C1713 6714920 - CAGE SPNL 4D LG IMPCT 20X14X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6714926 SUP HCPCS C1713 6714926 - CAGE SPNL 4D LG IMPCT 26X14X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6714932 SUP HCPCS C1713 6714932 - CAGE SPNL 4D LG IMPCT 32X14X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6733206 SUP HCPCS C1713 6733206 - CAGE SPNL 10D SM 16X19X6MM NS LF CRNT ACR RADOPQ BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$1,200.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 6733209 SUP HCPCS C1713 6733209 - CAGE SPNL 10D SM 16X19X9MM NS LF CRNT ACR RADOPQ BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$1,200.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 6736207 SUP HCPCS C1713 6736207 - CAGE SPNL 10D 7X17X14MM NS CRNT ACR TA SM INTLK RADOPQ BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$1,200.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 6790151 SUP Custom 27203010 6790151 - BIT DRL SM 12-16MM INTLK DISP B BOTH IP/OP $575.00 $426.00 $102.35 $575.00 $575.00 $575.00 $575.00 $575.00 $575.00 $575.00 $102.35 $575.00 $575.00 $426.77 $426.77 $443.21 $299.58 $119.84 $575.00 $230.00 $575.00 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $373.75 $575.00 N/A $333.50 $575.00 $345.00 $575.00 $575.00 $575.00 N/A N/A 6790152 SUP Custom 27203010 6790152 - TAP SRG 12MM TEMP SPNE DISP BOTH IP/OP $575.00 $426.00 $102.35 $575.00 $575.00 $575.00 $575.00 $575.00 $575.00 $575.00 $102.35 $575.00 $575.00 $426.77 $426.77 $443.21 $299.58 $119.84 $575.00 $230.00 $575.00 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $373.75 $575.00 N/A $333.50 $575.00 $345.00 $575.00 $575.00 $575.00 N/A N/A 6790225 SUP HCPCS C1713 6790225 - CAGE SPNL 5MM CRNT INTLK CRV BOTH IP/OP "$4,832.50" "$3,576.00" $959.13 "$4,832.50" "$2,174.63" "$2,174.63" "$2,174.63" "$2,174.63" "$4,832.50" "$4,832.50" "$4,832.50" "$1,007.21" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$1,007.15" "$4,832.50" "$1,933.00" "$2,382.42" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$3,624.38" "$4,832.50" "$4,832.50" "$4,832.50" "$2,416.25" "$2,416.25" "$3,827.34" "$4,832.50" "$3,866.00" "$2,174.63" $959.13 N/A "$2,802.85" "$4,832.50" "$4,832.50" "$4,832.50" "$1,007.09" "$4,832.50" N/A N/A 6790228 SUP HCPCS C1713 6790228 - CAGE SPNL 7D SM 17X14X8MM NS LF CRNT INTLK CRV BOTH IP/OP "$4,832.50" "$3,576.00" $959.13 "$4,832.50" "$2,174.63" "$2,174.63" "$2,174.63" "$2,174.63" "$4,832.50" "$4,832.50" "$4,832.50" "$1,007.21" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$1,007.15" "$4,832.50" "$4,832.50" "$2,382.42" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$3,624.38" "$4,832.50" "$4,832.50" "$4,832.50" "$2,416.25" "$2,416.25" "$3,827.34" "$4,832.50" "$3,866.00" "$2,174.63" $959.13 N/A "$2,802.85" "$4,832.50" "$2,899.50" "$4,832.50" "$1,007.09" "$4,832.50" N/A N/A 6790229 SUP HCPCS C1713 6790229 - CAGE SPNL 9MM CRNT INTLK CRV BOTH IP/OP "$4,832.50" "$3,576.00" $959.13 "$4,832.50" "$2,174.63" "$2,174.63" "$2,174.63" "$2,174.63" "$4,832.50" "$4,832.50" "$4,832.50" "$1,007.21" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$1,007.15" "$4,832.50" "$1,933.00" "$2,382.42" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$3,624.38" "$4,832.50" "$4,832.50" "$4,832.50" "$2,416.25" "$2,416.25" "$3,827.34" "$4,832.50" "$3,866.00" "$2,174.63" $959.13 N/A "$2,802.85" "$4,832.50" "$2,899.50" "$4,832.50" "$1,007.09" "$4,832.50" N/A N/A 6790230 SUP HCPCS C1713 6790230 - CAGE SPNL 10MM CRNT INTLK CRV BOTH IP/OP "$4,832.50" "$3,576.00" $959.13 "$4,832.50" "$2,174.63" "$2,174.63" "$2,174.63" "$2,174.63" "$4,832.50" "$4,832.50" "$4,832.50" "$1,007.21" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$1,007.15" "$4,832.50" "$1,933.00" "$2,382.42" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$3,624.38" "$4,832.50" "$4,832.50" "$4,832.50" "$2,416.25" "$2,416.25" "$3,827.34" "$4,832.50" "$3,866.00" "$2,174.63" $959.13 N/A "$2,802.85" "$4,832.50" "$2,899.50" "$4,832.50" "$1,007.09" "$4,832.50" N/A N/A 6790231 SUP HCPCS C1713 6790231 - CAGE SPNL 11MM CRNT INTLK CRV BOTH IP/OP "$4,832.50" "$3,576.00" $959.13 "$4,832.50" "$2,174.63" "$2,174.63" "$2,174.63" "$2,174.63" "$4,832.50" "$4,832.50" "$4,832.50" "$1,007.21" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$1,007.15" "$4,832.50" "$4,832.50" "$2,382.42" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$3,624.38" "$4,832.50" "$4,832.50" "$4,832.50" "$2,416.25" "$2,416.25" "$3,827.34" "$4,832.50" "$3,866.00" "$2,174.63" $959.13 N/A "$2,802.85" "$4,832.50" "$4,832.50" "$4,832.50" "$1,007.09" "$4,832.50" N/A N/A 6790232 SUP HCPCS C1713 6790232 - CAGE SPNL 12MM CRNT INTLK CRV BOTH IP/OP "$4,832.50" "$3,576.00" $959.13 "$4,832.50" "$2,174.63" "$2,174.63" "$2,174.63" "$2,174.63" "$4,832.50" "$4,832.50" "$4,832.50" "$1,007.21" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$1,007.15" "$4,832.50" "$1,933.00" "$2,382.42" "$4,832.50" "$4,832.50" "$4,832.50" "$4,832.50" "$3,624.38" "$4,832.50" "$4,832.50" "$4,832.50" "$2,416.25" "$2,416.25" "$3,827.34" "$4,832.50" "$3,866.00" "$2,174.63" $959.13 N/A "$2,802.85" "$4,832.50" "$2,899.50" "$4,832.50" "$1,007.09" "$4,832.50" N/A N/A 6791512 SUP HCPCS C1713 6791512 - SCREW BN 4MM 12MM CRNT SLF DRL SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791513 SUP HCPCS C1713 6791513 - SCREW BN 4MM 13MM CRNT SLF DRL SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791514 SUP HCPCS C1713 6791514 - SCREW BN 4MM 14MM CRNT SLF DRL SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791515 SUP HCPCS C1713 6791515 - SCREW BN 4MM 15MM CRNT SLF DRL SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $148.49 $712.50 N/A N/A 6791516 SUP HCPCS C1713 6791516 - SCREW BN 4MM 16MM CRNT SLF DRL SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791612 SUP HCPCS C1713 6791612 - SCREW BN 4.5MM 12MM CRNT SM INTLK SLF DRL SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791613 SUP HCPCS C1713 6791613 - SCREW BN 4.5MM 13MM CRNT SM INTLK SLF DRL SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791614 SUP HCPCS C1713 6791614 - SCREW BN 4.5MM 14MM CRNT SM INTLK SLF DRL SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791615 SUP HCPCS C1713 6791615 - SCREW BN 4.5MM 15MM CRNT SM INTLK SLF DRL SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $148.49 $712.50 N/A N/A 6791616 SUP HCPCS C1713 6791616 - SCREW BN 4.5MM 16MM CRNT SM INTLK SLF DRL SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791712 SUP HCPCS C1713 6791712 - SCREW BN 4MM 12MM SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791713 SUP HCPCS C1713 6791713 - SCREW BN 4MM 13MM RSC SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791714 SUP HCPCS C1713 6791714 - SCREW BN 4MM 14MM RSC SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791715 SUP HCPCS C1713 6791715 - SCREW BN 4MM 15MM SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791716 SUP HCPCS C1713 6791716 - SCREW BN 4MM 16MM SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791812 SUP HCPCS C1713 6791812 - SCREW BN 4.5MM 12MM RSC SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791813 SUP HCPCS C1713 6791813 - SCREW BN 4.5MM 13MM RSC SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791814 SUP HCPCS C1713 6791814 - SCREW BN 4.5MM 14MM RSC SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6791816 SUP HCPCS C1713 6791816 - SCREW BN 4.5MM 16MM RSC SPNE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 6805115 SUP HCPCS C1713 6805115 - CAGE SPNL SM 14X11X5MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6805714 SUP HCPCS C1713 6805714 - CAGE SPNL 5D SM LRDTC 14X11X5MM NS LF CRNT RDLCNT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6805815 SUP HCPCS C1713 6805815 - CAGE SPNL SM LRDTC + 15X13X5MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6806115 SUP HCPCS C1713 6806115 - CAGE SPNL SM 14X11X6MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6806714 SUP HCPCS C1713 6806714 - CAGE SPNL 5D SM LRDTC 14X11X6MM NS LF CRNT RDLCNT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6806815 SUP Custom 27803010 6806815 - CAGE SPNL SM LRDTC + 15X13X6MM NS LF CRNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6807115 SUP HCPCS C1713 6807115 - CAGE SPNL SM 14X11X7MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6807714 SUP HCPCS C1713 6807714 - CAGE SPNL 5D SM LRDTC 14X11X7MM NS LF CRNT RDLCNT PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6807815 SUP HCPCS C1713 6807815 - CAGE SPNL 5D SM LRDTC + 15X13X7MM NS LF CRNT RDLCNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6808115 SUP HCPCS C1713 6808115 - CAGE SPNL SM 14X11X8MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6808125 SUP HCPCS C1713 6808125 - SPACER SPNL 25X11X8MM CRNT THORLMBR INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6808130 SUP HCPCS C1713 6808130 - RESTRICTOR CMNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6808240 SUP HCPCS C1713 6808240 - SPACER SPNL XL W 40X22X8MM PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6808340 SUP HCPCS C1713 6808340 - SPACER SPNL XL 10 40X22X8MM PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6808815 SUP Custom 27803010 6808815 - CAGE SPNL SM LRDTC + 15X13X8MM NS LF CRNT PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6808925 SUP HCPCS C1713 6808925 - SPACER SPNL 25X9X8MM INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6808930 SUP HCPCS C1713 6808930 - SPACER SPNL 30X9X8MM INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6809115 SUP HCPCS C1713 6809115 - CAGE SPNL SM 14X11X9MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6809714 SUP HCPCS C1713 6809714 - CAGE SPNL 5D SM LRDTC 14X11X9MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6809925 SUP HCPCS C1713 6809925 - SPACER SPNL 25X9X9MM STRL CRNT LMBR INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6810115 SUP HCPCS C1713 6810115 - CAGE SPNL SM 14X11X10MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6810125 SUP HCPCS C1713 6810125 - SPACER SPNL 25X11X10MM STRL CRNT LMBR INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6810130 SUP HCPCS C1713 6810130 - SPACER SPNL 30INX11INX10MM STRL CRNT LMBR INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6810240 SUP HCPCS C1713 6810240 - SPACER SPNL XL W 40X22X10MM PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6810340 SUP HCPCS C1713 6810340 - SPACER SPNL 10D XL W LRDTC 40X22X10MM PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6810714 SUP HCPCS C1713 6810714 - CAGE SPNL 5D SM LRDTC 14X11X10MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6810815 SUP HCPCS C1713 6810815 - CAGE SPNL SM LRDTC + 15X13X10MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6810925 SUP HCPCS C1713 6810925 - SPACER SPNL NAR 25X10X9MM INTRBD FS PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6810930 SUP HCPCS C1713 6810930 - SPACER SPNL NAR 30X10X9MM INTRBD FS PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6811115 SUP HCPCS C1713 6811115 - CAGE SPNL SM 14X11X11MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6811714 SUP HCPCS C1713 6811714 - CAGE SPNL 5D SM LRDTC 14X11X11MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6811815 SUP HCPCS C1713 6811815 - CAGE SPNL SM LRDTC + 15X13X11MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6811925 SUP HCPCS C1713 6811925 - SPACER SPNL 25X11X9MM STRL CRNT LMBR INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 6812115 SUP HCPCS C1713 6812115 - CAGE SPNL SM 14X11X11MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6812125 SUP HCPCS C1713 6812125 - SPACER SPNL LG 25X12X11MM CRNT THORLMBR INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 6812130 SUP HCPCS C1713 6812130 - CAGE SPNL LG 30X12X10MM CRNT THORLMBR INTRBD FS RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6812240 SUP HCPCS C1713 6812240 - SPACER SPNL XL W 40X22X12MM PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6812340 SUP HCPCS C1713 6812340 - SPACER SPNL 10 XL W LRDTC 40X22X12MM PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6812714 SUP HCPCS C1713 6812714 - CAGE SPNL 5D SM LRDTC 14X11X11MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6812815 SUP HCPCS C1713 6812815 - CAGE SPNL SM LRDTC + 15X13X10MM NS LF CRNT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6812925 SUP HCPCS C1713 6812925 - SPACER SPNL 25X12X9MM CRNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6812930 SUP HCPCS C1713 6812930 - SPACER SPNL 30X12X9MM STRL CRNT LMBR INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6813815 SUP HCPCS C1713 6813815 - SPACER SPNL SM 15X13X13MM LOPRFL PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6813925 SUP HCPCS C1713 6813925 - SPACER SPNL LG NAR 25X13X9MM CRNT LMBR INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6814125 SUP HCPCS C1713 6814125 - SPACER SPNL LG 25X14X11MM CRNT THORLMBR INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6814130 SUP HCPCS C1713 6814130 - SPACER SPNL LG W 14X11X30MM CRNT LMBR INTRBD FS RDLCNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6814240 SUP HCPCS C1713 6814240 - SPACER SPNL XL W 40X22X14MM PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6814340 SUP HCPCS C1713 6814340 - SPACER SPNL 10D XL W LRDTC 40X22X14MM PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6814815 SUP HCPCS C1713 6814815 - SPACER SPNL SM 15X14X13MM LOPRFL PEEK-OPTM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6814925 SUP HCPCS C1713 6814925 - SPACER SPNL 25X14X9MM CRNT LMBR INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6814930 SUP HCPCS C1713 6814930 - CAGE SPNL LG NAR 30X9X14MM CRNT PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6816240 SUP HCPCS C1713 6816240 - SPACER SPNL XL W 40X22X16MM PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6816340 SUP HCPCS C1713 6816340 - SPACER SPNL 10D XL W LRDTC 40X22X16MM PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6850810 SUP HCPCS C1713 6850810 - SPACER SPNL GRN CRNT LMBR OBLQ BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6850811 SUP HCPCS C1713 6850811 - CAGE SPNL 5D LG 30X10X8MM CRNT OBLQ PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6850813 SUP HCPCS C1713 6850813 - CAGE SPNL LG 40X10X8MM GRN OBLQ PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6851012 SUP HCPCS C1713 6851012 - CAGE SPNL 5D LG 35X10X10MM CRNT OBLQ PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6851013 SUP HCPCS C1713 6851013 - CAGE SPNL 5D LG 40X10X10MM CRNT OBLQ PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6851211 SUP HCPCS C1713 6851211 - CAGE SPNL 30X12X10MM CRNT PEEK LRDTC 5 BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6851212 SUP HCPCS C1713 6851212 - SPACER SPNL 5D LG 35X12X10MM CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6851213 SUP HCPCS C1713 6851213 - CAGE SPNL 5D LG 40X10X12MM CRNT OBLQ PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6851411 SUP HCPCS C1713 6851411 - SPACER SPNL 5D LG 30X14X10MM CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6851412 SUP HCPCS C1713 6851412 - CAGE SPNL 5D LG OBLQ 35X14X10MM CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6851413 SUP Custom 27804086 6851413 - GRAFT BN LG CRNT PEEK SPNE 5DE BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 6860010 SUP HCPCS C1713 6860010 - SCREW BN 4MM 10MM PRMR ST TI CANC ANT CSPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 6860011 SUP HCPCS C1713 6860011 - SCREW BN 4MM 11MM NS PRMR VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 6860012 SUP HCPCS C1713 6860012 - SCREW BN 4MM 12MM NS PRMR VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 6860013 SUP HCPCS C1713 6860013 - SCREW BN 4MM 13MM NS PRMR VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 6860014 SUP HCPCS C1713 6860014 - SCREW BN 4MM 14MM NS PRMR VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 6860015 SUP HCPCS C1713 6860015 - SCREW BN 4MM 15MM NS PRMR VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 6860016 SUP HCPCS C1713 6860016 - SCREW BN 4MM 16MM NS PRMR VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 6860017 SUP HCPCS C1713 6860017 - SCREW BN 4MM 17MM NS PRMR VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 6860018 SUP HCPCS C1713 6860018 - SCREW BN 4MM 18MM NS PRMR VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 6860019 SUP HCPCS C1713 6860019 - SCREW BN 4MM 19MM STRL PRMR ST TI CANC ANT CSPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 6860020 SUP HCPCS C1713 6860020 - SCREW BN 4MM 20MM NS PRMR VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 6860053 SUP HCPCS C1713 6860053 - SCREW BN 4.5MM 13MM NS PRMR VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 6860055 SUP HCPCS C1713 6860055 - SCREW BN 4.5MM 15MM NS PRMR VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 6860057 SUP HCPCS C1713 6860057 - SCREW BN 4.5MM 17MM NS PRMR VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 6860123 SUP HCPCS C1713 6860123 - PLATE BONE LORDOTIC CURVATURE 23MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6860125 SUP HCPCS C1713 6860125 - PLATE BONE LORDOTIC CURVATURE 25MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6860127 SUP HCPCS C1713 6860127 - PLATE BONE LORDOTIC CURVATURE 27.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6860130 SUP HCPCS C1713 6860130 - PLATE BONE LORDOTIC CURVATURE 30MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6860132 SUP HCPCS C1713 6860132 - PLATE BONE LORDOTIC CURVATURE 32.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6860135 SUP HCPCS C1713 6860135 - PLATE BONE LORDOTIC CURVATURE 35MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6860137 SUP HCPCS C1713 6860137 - PLATE BONE LORDOTIC CURVATURE 37.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6860140 SUP HCPCS C1713 6860140 - PLATE BONE LORDOTIC CURVATURE 40MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6860142 SUP HCPCS C1713 6860142 - PLATE BONE LORDOTIC CURVATURE 42.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6860145 SUP HCPCS C1713 6860145 - PLATE BONE LORDOTIC CURVATURE 45MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6860147 SUP HCPCS C1713 6860147 - PLATE BONE LORDOTIC CURVATURE 47.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6860150 SUP HCPCS C1713 6860150 - PLATE BONE LORDOTIC CURVATURE 50MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6860152 SUP HCPCS C1713 6860152 - PLATE BONE LORDOTIC CURVATURE 52.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6860155 SUP HCPCS C1713 6860155 - PLATE BONE LORDOTIC CURVATURE 55MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 6860157 SUP HCPCS C1713 6860157 - PLATE BONE LORDOTIC CURVATURE 57.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6860160 SUP HCPCS C1713 6860160 - PLATE BONE LORDOTIC CURVATURE 60MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6860162 SUP HCPCS C1713 6860162 - PLATE BONE LORDOTIC CURVATURE 62.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6860165 SUP HCPCS C1713 6860165 - PLATE BONE LORDOTIC CURVATURE 65MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6860167 SUP HCPCS C1713 6860167 - PLATE BONE LORDOTIC CURVATURE 67.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6860170 SUP HCPCS C1713 6860170 - PLATE BONE LORDOTIC CURVATURE 70MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 6860172 SUP HCPCS C1713 6860172 - PLATE BONE LORDOTIC CURVATURE 72.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 6860175 SUP HCPCS C1713 6860175 - PLATE BONE LORDOTIC CURVATURE 75MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 6860177 SUP HCPCS C1713 6860177 - PLATE BONE LORDOTIC CURVATURE 77.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 6860180 SUP HCPCS C1713 6860180 - PLATE BONE LORDOTIC CURVATURE 80MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 6860182 SUP HCPCS C1713 6860182 - PLATE BONE LORDOTIC CURVATURE 82.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 6860185 SUP HCPCS C1713 6860185 - PLATE BONE LORDOTIC CURVATURE 85MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 6860187 SUP HCPCS C1713 6860187 - PLATE BONE LORDOTIC CURVATURE 87.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$4,266.00" "$3,157.00" $846.69 "$4,266.00" "$1,919.70" "$1,919.70" "$1,919.70" "$1,919.70" "$4,266.00" "$4,266.00" "$4,266.00" $889.14 "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" $889.08 "$4,266.00" "$4,266.00" "$2,103.14" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$3,199.50" "$4,266.00" "$4,266.00" "$4,266.00" "$2,133.00" "$2,133.00" "$3,378.67" "$4,266.00" "$3,412.80" "$1,919.70" $846.69 N/A "$2,474.28" "$4,266.00" "$2,559.60" "$4,266.00" $889.03 "$4,266.00" N/A N/A 6860190 SUP HCPCS C1713 6860190 - PLATE BONE LORDOTIC CURVATURE 90MM PRECOMPRESSION SLIDE BOTH IP/OP "$4,266.00" "$3,157.00" $846.69 "$4,266.00" "$1,919.70" "$1,919.70" "$1,919.70" "$1,919.70" "$4,266.00" "$4,266.00" "$4,266.00" $889.14 "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" $889.08 "$4,266.00" "$1,706.40" "$2,103.14" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$3,199.50" "$4,266.00" "$4,266.00" "$4,266.00" "$2,133.00" "$2,133.00" "$3,378.67" "$4,266.00" "$3,412.80" "$1,919.70" $846.69 N/A "$2,474.28" "$4,266.00" "$2,559.60" "$4,266.00" "$4,266.00" "$4,266.00" N/A N/A 6860195 SUP HCPCS C1713 6860195 - PLATE BONE LORDOTIC CURVATURE 95MM PRECOMPRESSION SLIDE BOTH IP/OP "$4,266.00" "$3,157.00" $846.69 "$4,266.00" "$1,919.70" "$1,919.70" "$1,919.70" "$1,919.70" "$4,266.00" "$4,266.00" "$4,266.00" $889.14 "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" $889.08 "$4,266.00" "$4,266.00" "$2,103.14" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$3,199.50" "$4,266.00" "$4,266.00" "$4,266.00" "$2,133.00" "$2,133.00" "$3,378.67" "$4,266.00" "$3,412.80" "$1,919.70" $846.69 N/A "$2,474.28" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" N/A N/A 6860200 SUP HCPCS C1713 6860200 - PLATE BONE LORDOTIC CURVATURE 100MM PRECOMPRESSION SLIDE BOTH IP/OP "$4,266.00" "$3,157.00" $846.69 "$4,266.00" "$1,919.70" "$1,919.70" "$1,919.70" "$1,919.70" "$4,266.00" "$4,266.00" "$4,266.00" $889.14 "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" $889.08 "$4,266.00" "$1,706.40" "$2,103.14" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$3,199.50" "$4,266.00" "$4,266.00" "$4,266.00" "$2,133.00" "$2,133.00" "$3,378.67" "$4,266.00" "$3,412.80" "$1,919.70" $846.69 N/A "$2,474.28" "$4,266.00" "$2,559.60" "$4,266.00" $889.03 "$4,266.00" N/A N/A 6860205 SUP HCPCS C1713 6860205 - PLATE BONE LORDOTIC CURVATURE 105MM PRECOMPRESSION SLIDE BOTH IP/OP "$4,266.00" "$3,157.00" $846.69 "$4,266.00" "$1,919.70" "$1,919.70" "$1,919.70" "$1,919.70" "$4,266.00" "$4,266.00" "$4,266.00" $889.14 "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" $889.08 "$4,266.00" "$4,266.00" "$2,103.14" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$3,199.50" "$4,266.00" "$4,266.00" "$4,266.00" "$2,133.00" "$2,133.00" "$3,378.67" "$4,266.00" "$3,412.80" "$1,919.70" $846.69 N/A "$2,474.28" "$4,266.00" "$2,559.60" "$4,266.00" $889.03 "$4,266.00" N/A N/A 6860210 SUP HCPCS C1713 6860210 - PLATE BONE LORDOTIC CURVATURE 110MM PRECOMPRESSION SLIDE BOTH IP/OP "$4,266.00" "$3,157.00" $846.69 "$4,266.00" "$1,919.70" "$1,919.70" "$1,919.70" "$1,919.70" "$4,266.00" "$4,266.00" "$4,266.00" $889.14 "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" $889.08 "$4,266.00" "$4,266.00" "$2,103.14" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$3,199.50" "$4,266.00" "$4,266.00" "$4,266.00" "$2,133.00" "$2,133.00" "$3,378.67" "$4,266.00" "$3,412.80" "$1,919.70" $846.69 N/A "$2,474.28" "$4,266.00" "$2,559.60" "$4,266.00" $889.03 "$4,266.00" N/A N/A 6860405 SUP Custom 27803010 6860405 - PIN HOLDING 4.5MM PREMIER MIDLINE FIX BOTH IP/OP $177.00 $131.00 $31.51 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $31.51 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $36.89 $177.00 $70.80 $177.00 $177.00 $177.00 $177.00 $177.00 $132.75 $177.00 $177.00 $177.00 $88.50 $88.50 $140.18 $177.00 $141.60 $79.65 $177.00 N/A $102.66 $177.00 $106.20 $177.00 $177.00 $177.00 N/A N/A 6861130 SUP HCPCS C1713 6861130 - PLATE BONE LORDOTIC CURVATURE 30MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6861137 SUP HCPCS C1713 6861137 - PLATE BONE LORDOTIC CURVATURE 37.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6861150 SUP HCPCS C1713 6861150 - PLATE BONE LORDOTIC CURVATURE 50MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6861157 SUP HCPCS C1713 6861157 - PLATE BONE LORDOTIC CURVATURE 57.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6861165 SUP HCPCS C1713 6861165 - PLATE BONE LORDOTIC CURVATURE 65MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6861167 SUP HCPCS C1713 6861167 - PLATE BONE LORDOTIC CURVATURE 67.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6861175 SUP HCPCS C1713 6861175 - PLATE BONE LORDOTIC CURVATURE 75MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 6861177 SUP HCPCS C1713 6861177 - PLATE BONE LORDOTIC CURVATURE 77.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 6861182 SUP HCPCS C1713 6861182 - PLATE BONE LORDOTIC CURVATURE 82.5MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 6861185 SUP HCPCS C1713 6861185 - PLATE BONE LORDOTIC CURVATURE 85MM PRECOMPRESSION SLIDE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 6861200 SUP HCPCS C1713 6861200 - PLATE BONE LORDOTIC CURVATURE 100MM PRECOMPRESSION SLIDE BOTH IP/OP "$4,266.00" "$3,157.00" $846.69 "$4,266.00" "$1,919.70" "$1,919.70" "$1,919.70" "$1,919.70" "$4,266.00" "$4,266.00" "$4,266.00" $889.14 "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" $889.08 "$4,266.00" "$1,706.40" "$2,103.14" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$3,199.50" "$4,266.00" "$4,266.00" "$4,266.00" "$2,133.00" "$2,133.00" "$3,378.67" "$4,266.00" "$3,412.80" "$1,919.70" $846.69 N/A "$2,474.28" "$4,266.00" "$4,266.00" "$4,266.00" $889.03 "$4,266.00" N/A N/A 6861223 SUP HCPCS C1713 6861223 - PLATE BONE 23MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6861225 SUP HCPCS C1713 6861225 - PLATE BONE 25MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6861227 SUP HCPCS C1713 6861227 - PLATE BONE 27.5MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6861230 SUP HCPCS C1713 6861230 - PLATE BONE 30MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 6861232 SUP HCPCS C1713 6861232 - PLATE BONE 32.5MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 6861235 SUP HCPCS C1713 6861235 - PLATE BONE 35MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6861237 SUP HCPCS C1713 6861237 - PLATE BONE 37.5MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6861240 SUP HCPCS C1713 6861240 - PLATE BONE 40MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6861242 SUP HCPCS C1713 6861242 - PLATE BONE 42.5MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6861245 SUP HCPCS C1713 6861245 - PLATE BONE 45MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6861247 SUP HCPCS C1713 6861247 - PLATE BONE 47.5MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 6861250 SUP HCPCS C1713 6861250 - PLATE BONE 50MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6861252 SUP HCPCS C1713 6861252 - PLATE BONE 52.5MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6861255 SUP HCPCS C1713 6861255 - PLATE BONE 55MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6861257 SUP HCPCS C1713 6861257 - PLATE BONE 57.5MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6861260 SUP HCPCS C1713 6861260 - PLATE BONE 60MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6861262 SUP HCPCS C1713 6861262 - PLATE BONE 62.5MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 6861265 SUP HCPCS C1713 6861265 - PLATE BONE 65MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 6861267 SUP HCPCS C1713 6861267 - PLATE BONE 67.5MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 6861270 SUP HCPCS C1713 6861270 - PLATE BONE 70MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 6861272 SUP HCPCS C1713 6861272 - PLATE BONE 72.5MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 6861275 SUP HCPCS C1713 6861275 - PLATE BONE 75MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 6861277 SUP HCPCS C1713 6861277 - PLATE BONE 77.5MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 6861280 SUP HCPCS C1713 6861280 - PLATE BONE 80MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 6861282 SUP HCPCS C1713 6861282 - PLATE BONE 82.5MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 6861285 SUP HCPCS C1713 6861285 - PLATE BONE 85MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 6861287 SUP HCPCS C1713 6861287 - PLATE BONE 87.5MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$4,266.00" "$3,157.00" $846.69 "$4,266.00" "$1,919.70" "$1,919.70" "$1,919.70" "$1,919.70" "$4,266.00" "$4,266.00" "$4,266.00" $889.14 "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" $889.08 "$4,266.00" "$4,266.00" "$2,103.14" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$3,199.50" "$4,266.00" "$4,266.00" "$4,266.00" "$2,133.00" "$2,133.00" "$3,378.67" "$4,266.00" "$3,412.80" "$1,919.70" $846.69 N/A "$2,474.28" "$4,266.00" "$4,266.00" "$4,266.00" $889.03 "$4,266.00" N/A N/A 6861290 SUP HCPCS C1713 6861290 - PLATE BONE 90MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$4,266.00" "$3,157.00" $846.69 "$4,266.00" "$1,919.70" "$1,919.70" "$1,919.70" "$1,919.70" "$4,266.00" "$4,266.00" "$4,266.00" $889.14 "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" $889.08 "$4,266.00" "$4,266.00" "$2,103.14" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$3,199.50" "$4,266.00" "$4,266.00" "$4,266.00" "$2,133.00" "$2,133.00" "$3,378.67" "$4,266.00" "$3,412.80" "$1,919.70" $846.69 N/A "$2,474.28" "$4,266.00" "$4,266.00" "$4,266.00" $889.03 "$4,266.00" N/A N/A 6861295 SUP HCPCS C1713 6861295 - PLATE BONE 95MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$4,266.00" "$3,157.00" $846.69 "$4,266.00" "$1,919.70" "$1,919.70" "$1,919.70" "$1,919.70" "$4,266.00" "$4,266.00" "$4,266.00" $889.14 "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" $889.08 "$4,266.00" "$4,266.00" "$2,103.14" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$3,199.50" "$4,266.00" "$4,266.00" "$4,266.00" "$2,133.00" "$2,133.00" "$3,378.67" "$4,266.00" "$3,412.80" "$1,919.70" $846.69 N/A "$2,474.28" "$4,266.00" "$2,559.60" "$4,266.00" $889.03 "$4,266.00" N/A N/A 6861300 SUP HCPCS C1713 6861300 - PLATE BONE 100MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$4,266.00" "$3,157.00" $846.69 "$4,266.00" "$1,919.70" "$1,919.70" "$1,919.70" "$1,919.70" "$4,266.00" "$4,266.00" "$4,266.00" $889.14 "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" $889.08 "$4,266.00" "$4,266.00" "$2,103.14" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$3,199.50" "$4,266.00" "$4,266.00" "$4,266.00" "$2,133.00" "$2,133.00" "$3,378.67" "$4,266.00" "$3,412.80" "$1,919.70" $846.69 N/A "$2,474.28" "$4,266.00" "$2,559.60" "$4,266.00" $889.03 "$4,266.00" N/A N/A 6861305 SUP HCPCS C1713 6861305 - PLATE BONE 105MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$4,266.00" "$3,157.00" $846.69 "$4,266.00" "$1,919.70" "$1,919.70" "$1,919.70" "$1,919.70" "$4,266.00" "$4,266.00" "$4,266.00" $889.14 "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" $889.08 "$4,266.00" "$4,266.00" "$2,103.14" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$3,199.50" "$4,266.00" "$4,266.00" "$4,266.00" "$2,133.00" "$2,133.00" "$3,378.67" "$4,266.00" "$3,412.80" "$1,919.70" $846.69 N/A "$2,474.28" "$4,266.00" "$2,559.60" "$4,266.00" $889.03 "$4,266.00" N/A N/A 6861310 SUP HCPCS C1713 6861310 - PLATE BONE 110MM 1 HOLE TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$4,266.00" "$3,157.00" $846.69 "$4,266.00" "$1,919.70" "$1,919.70" "$1,919.70" "$1,919.70" "$4,266.00" "$4,266.00" "$4,266.00" $889.14 "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" $889.08 "$4,266.00" "$4,266.00" "$2,103.14" "$4,266.00" "$4,266.00" "$4,266.00" "$4,266.00" "$3,199.50" "$4,266.00" "$4,266.00" "$4,266.00" "$2,133.00" "$2,133.00" "$3,378.67" "$4,266.00" "$3,412.80" "$1,919.70" $846.69 N/A "$2,474.28" "$4,266.00" "$2,559.60" "$4,266.00" $889.03 "$4,266.00" N/A N/A 6900120 SUP HCPCS C1713 6900120 - ROD SPNL SHRT 3.2MM 120MM VRTX MX CNCT PNT TI RECON SYS BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 6900240 SUP HCPCS C1713 6900240 - ROD SPINAL STANDARD 3.2MM 240MM PCVD VERTEX MAX TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 6900241 SUP Custom 27203010 6900241 - TEMPLATE ROD 3.2MM 240MM VERTEX MAX TITANIUM SPN NONSTRL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 6900270 SUP HCPCS C1713 6900270 - ROD SPINAL PRECURVE 3.2MM 100MM VERTEX OCCPTL PLATE BOTH IP/OP "$4,216.50" "$3,120.00" $836.87 "$4,216.50" "$1,897.43" "$1,897.43" "$1,897.43" "$1,897.43" "$4,216.50" "$4,216.50" "$4,216.50" $878.82 "$4,216.50" "$4,216.50" "$4,216.50" "$4,216.50" "$4,216.50" $878.76 "$4,216.50" "$1,686.60" "$2,078.73" "$4,216.50" "$4,216.50" "$4,216.50" "$4,216.50" "$3,162.38" "$4,216.50" "$4,216.50" "$4,216.50" "$2,108.25" "$2,108.25" "$3,339.47" "$4,216.50" "$3,373.20" "$1,897.43" $836.87 N/A "$2,445.57" "$4,216.50" "$2,529.90" "$4,216.50" $878.72 "$4,216.50" N/A N/A 6900280 SUP HCPCS C1713 6900280 - ROD SPINAL STANDARD 3.2MM 200MM PCVD VERTEX TITANIUM OCCPTL BOTH IP/OP "$4,216.50" "$3,120.00" $836.87 "$4,216.50" "$1,897.43" "$1,897.43" "$1,897.43" "$1,897.43" "$4,216.50" "$4,216.50" "$4,216.50" $878.82 "$4,216.50" "$4,216.50" "$4,216.50" "$4,216.50" "$4,216.50" $878.76 "$4,216.50" "$4,216.50" "$2,078.73" "$4,216.50" "$4,216.50" "$4,216.50" "$4,216.50" "$3,162.38" "$4,216.50" "$4,216.50" "$4,216.50" "$2,108.25" "$2,108.25" "$3,339.47" "$4,216.50" "$3,373.20" "$1,897.43" $836.87 N/A "$2,445.57" "$4,216.50" "$2,529.90" "$4,216.50" $878.72 "$4,216.50" N/A N/A 6900506 SUP HCPCS C1713 6900506 - SCREW BN 3.5MM 6MM NTR STRL VRTX MA VA TI SPNE THOR CANC BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900508 SUP HCPCS C1713 6900508 - SCREW BN 3.5MM 8MM NTR STRL VRTX MA VA TI SPNE THOR CANC BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $696.00 $696.00 $145.05 $696.00 N/A N/A 6900510 SUP HCPCS C1713 6900510 - SCREW BN 3.5MM 10MM NTR STRL VRTX MA VA TI SPNE THOR CANC BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900512 SUP HCPCS C1713 6900512 - SCREW BONE 3.5MM 12MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900514 SUP HCPCS C1713 6900514 - SCREW BONE 3.5MM 14MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900516 SUP HCPCS C1713 6900516 - SCREW BONE 3.5MM 16MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $696.00 $696.00 $145.05 $696.00 N/A N/A 6900518 SUP HCPCS C1713 6900518 - SCREW BONE 3.5MM 18MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900520 SUP HCPCS C1713 6900520 - SCREW BONE 3.5MM 20MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900522 SUP HCPCS C1713 6900522 - SCREW BONE 3.5MM 22MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900524 SUP HCPCS C1713 6900524 - SCREW BONE 3.5MM 24MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $278.40 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $696.00 $696.00 $145.05 $696.00 N/A N/A 6900606 SUP HCPCS C1713 6900606 - SCREW BN 4MM 6MM NTR STRL VRTX MA VA TI SPNE THOR CANC BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900608 SUP HCPCS C1713 6900608 - SCREW BN 4MM 8MM NTR STRL VRTX MA VA TI SPNE THOR CANC BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $278.40 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900610 SUP HCPCS C1713 6900610 - SCREW BN 4MM 10MM NTR STRL VRTX MA VA TI SPNE THOR CANC BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900612 SUP HCPCS C1713 6900612 - SCREW BONE 4MM 12MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $278.40 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900614 SUP HCPCS C1713 6900614 - SCREW BONE 4MM 14MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900616 SUP HCPCS C1713 6900616 - SCREW BONE 4MM 16MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900618 SUP HCPCS C1713 6900618 - SCREW BONE 4MM 18MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $278.40 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $696.00 $696.00 $145.05 $696.00 N/A N/A 6900620 SUP HCPCS C1713 6900620 - SCREW BONE 4MM 20MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900622 SUP HCPCS C1713 6900622 - SCREW BONE 4MM 22MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $278.40 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900624 SUP HCPCS C1713 6900624 - SCREW BONE 4MM 24MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900626 SUP HCPCS C1713 6900626 - SCREW BONE 4MM 26MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $278.40 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $145.05 $696.00 N/A N/A 6900628 SUP HCPCS C1713 6900628 - SCREW BONE 4MM 28MM MULTIAX VAR ANG VERTEX TITANIUM SPN BOTH IP/OP $696.00 $515.00 $138.14 $696.00 $313.20 $313.20 $313.20 $313.20 $696.00 $696.00 $696.00 $145.06 $696.00 $696.00 $696.00 $696.00 $696.00 $145.05 $696.00 $696.00 $411.68 $696.00 $696.00 $696.00 $696.00 $522.00 $696.00 $696.00 $696.00 $348.00 $348.00 $551.23 $696.00 $556.80 $313.20 $138.14 N/A $403.68 $696.00 $417.60 $696.00 $696.00 $696.00 N/A N/A 6901000 SUP Custom 27803010 6901000 - CONNECTOR SCREW 10MM 100MM TITANIUM VERTEX MAX BOTH IP/OP $963.50 $713.00 $171.48 $963.38 $963.38 $963.38 $963.38 $963.38 $963.38 $963.38 $171.48 $963.38 $963.38 $963.38 $963.38 $963.38 $963.38 $200.78 $963.38 $385.35 $963.38 $963.38 $963.38 $963.38 $963.38 $722.63 $963.38 $963.38 $963.38 $481.69 $481.69 $763.00 $963.38 $770.70 $433.52 $963.38 N/A $558.83 $963.38 $578.03 $963.38 $963.38 $963.38 N/A N/A 6902130 SUP Custom 27803010 6902130 - CONNECTOR ROD 10MM SCREW CLOSE VERTEX TITANIUM LATERAL BOTH IP/OP $963.50 $713.00 $171.48 $963.38 $963.38 $963.38 $963.38 $963.38 $963.38 $963.38 $171.48 $963.38 $963.38 $963.38 $963.38 $963.38 $963.38 $200.78 $963.38 $385.35 $963.38 $963.38 $963.38 $963.38 $963.38 $722.63 $963.38 $963.38 $963.38 $481.69 $481.69 $763.00 $963.38 $770.70 $433.52 $963.38 N/A $558.83 $963.38 $578.03 $963.38 $963.38 $963.38 N/A N/A 6902131 SUP Custom 27803010 6902131 - CONNECTOR ROD 13MM CLOSE OFFST TITANIUM SPN LATERAL BOTH IP/OP $963.50 $713.00 $171.48 $963.38 $963.38 $963.38 $963.38 $963.38 $963.38 $963.38 $171.48 $963.38 $963.38 $963.38 $963.38 $963.38 $963.38 $200.78 $963.38 $385.35 $963.38 $963.38 $963.38 $963.38 $963.38 $722.63 $963.38 $963.38 $963.38 $481.69 $481.69 $763.00 $963.38 $770.70 $433.52 $963.38 N/A $558.83 $963.38 $578.03 $963.38 $963.38 $963.38 N/A N/A 6902135 SUP Custom 27803010 6902135 - CONNECTOR ROD 10MM 10MM OPENING VERTEX TITANIUM SPN LATERAL BOTH IP/OP $963.50 $713.00 $171.48 $963.38 $963.38 $963.38 $963.38 $963.38 $963.38 $963.38 $171.48 $963.38 $963.38 $963.38 $963.38 $963.38 $963.38 $200.78 $963.38 $385.35 $963.38 $963.38 $963.38 $963.38 $963.38 $722.63 $963.38 $963.38 $963.38 $481.69 $481.69 $763.00 $963.38 $770.70 $433.52 $963.38 N/A $558.83 $963.38 $578.03 $963.38 $963.38 $963.38 N/A N/A 6902200 SUP Custom 27803010 6902200 - CONNECTOR ROD SHORT CNTOUR 3.2-5.5MM THREAD CONNECT POINT BOTH IP/OP "$1,389.00" "$1,028.00" $247.24 "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" $247.24 "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" $289.48 "$1,389.00" $555.60 "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,041.75" "$1,389.00" "$1,389.00" "$1,389.00" $694.50 $694.50 "$1,100.09" "$1,389.00" "$1,111.20" $625.05 "$1,389.00" N/A $805.62 "$1,389.00" $833.40 "$1,389.00" "$1,389.00" "$1,389.00" N/A N/A 6902220 SUP Custom 27803010 6902220 - CONNECTOR ROD 3.2-4.5MM THREADED EASILY CNTOUR SHORT CONNECT BOTH IP/OP "$1,389.00" "$1,028.00" $247.24 "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" $247.24 "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" $289.48 "$1,389.00" $555.60 "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,389.00" "$1,041.75" "$1,389.00" "$1,389.00" "$1,389.00" $694.50 $694.50 "$1,100.09" "$1,389.00" "$1,111.20" $625.05 "$1,389.00" N/A $805.62 "$1,389.00" $833.40 "$1,389.00" "$1,389.00" "$1,389.00" N/A N/A 6902525 SUP HCPCS C1713 6902525 - CONNECTOR ROD CLIP FLAP VERTEX CROSSLINK TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6902530 SUP HCPCS C1713 6902530 - CONNECTOR ROD BAR VERTEX CROSSLINK TITANIUM SPN STERILE BOTH IP/OP $276.00 $204.00 $54.78 $276.00 $124.20 $124.20 $124.20 $124.20 $276.00 $276.00 $276.00 $57.53 $276.00 $276.00 $276.00 $276.00 $276.00 $57.52 $276.00 $110.40 $163.25 $276.00 $276.00 $276.00 $276.00 $207.00 $276.00 $276.00 $276.00 $138.00 $138.00 $218.59 $276.00 $220.80 $124.20 $54.78 N/A $160.08 $276.00 $165.60 $276.00 $57.52 $276.00 N/A N/A 6904045 SUP HCPCS C1713 6904045 - HOOK SPINAL STANDARD 4.5MM VERTEX PURPLE TITANIUM LAMINA BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 6904060 SUP HCPCS C1713 6904060 - HOOK SPINAL STANDARD 6MM RECONSTRUCTION SYSTEM VERTEX GREEN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 6904075 SUP HCPCS C1713 6904075 - HOOK SPINAL 7.5MM LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 6904090 SUP HCPCS C1713 6904090 - HOOK SPINAL LORDOTIC LMNR 9 MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 6908245 SUP HCPCS C1713 6908245 - CAGE SPNL XL W 45X22X8MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6908250 SUP HCPCS C1713 6908250 - CAGE SPNL XL W 50X22X8MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6908255 SUP HCPCS C1713 6908255 - CAGE SPNL XL W 55X22X8MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6908260 SUP HCPCS C1713 6908260 - CAGE SPNL XL W 60X22X8MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6908840 SUP HCPCS C1713 6908840 - SPACER SPNL XL 40X18X8MM CRNT LMBR INTRBD FS PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6908845 SUP HCPCS C1713 6908845 - CAGE SPNL XL 45X18X8MM NS LF CRNT PEEK LMBR INTRBD FS BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6908850 SUP HCPCS C1713 6908850 - CAGE SPNL XL 50X18X8MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6908855 SUP HCPCS C1713 6908855 - CAGE SPNL XL 55X18X8MM NS LF CRNT PEEK LMBR INTRBD FS BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6908860 SUP HCPCS C1713 6908860 - CAGE SPNL XL 60X18X8MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6910245 SUP HCPCS C1713 6910245 - CAGE SPNL XL W 45X22X10MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6910250 SUP HCPCS C1713 6910250 - CAGE SPNL XL W 50X22X10MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6910255 SUP Custom 27803010 6910255 - CAGE SPNL XL W 55X22X10MM NS LF CRNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,314.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,314.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$13,000.00" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6910260 SUP HCPCS C1713 6910260 - CAGE SPNL XL W 60X22X10MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6910840 SUP HCPCS C1713 6910840 - SPACER SPNL XL 40X18X10MM CRNT THORLMBR INTRBD FS RDLCNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6910845 SUP HCPCS C1713 6910845 - CAGE SPNL XL 45X18X10MM NS LF CRNT RADOPQ PEEK TLIF BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6910850 SUP HCPCS C1713 6910850 - CAGE SPNL XL 50X18X10MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6910855 SUP HCPCS C1713 6910855 - CAGE SPNL XL 55X18X10MM NS LF CRNT RADOPQ PEEK TLIF BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6910860 SUP HCPCS C1713 6910860 - CAGE SPNL XL 60X18X10MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6912245 SUP HCPCS C1713 6912245 - CAGE SPNL XL W 45X22X12MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6912250 SUP HCPCS C1713 6912250 - CAGE SPNL XL W 50X22X12MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6912255 SUP HCPCS C1713 6912255 - CAGE SPNL XL W 55X22X12MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6912260 SUP HCPCS C1713 6912260 - CAGE SPNL XL W 60X22X12MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6912840 SUP HCPCS C1713 6912840 - SPACER SPNL XL 40X18X12MM CRNT LMBR INTRBD FS PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6912845 SUP HCPCS C1713 6912845 - CAGE SPNL XL 45X18X12MM NS LF CRNT RADOPQ PEEK LMBR INTRBD BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6912850 SUP HCPCS C1713 6912850 - CAGE SPNL XL 50X18X12MM NS LF CRNT RADOPQ PEEK LMBR INTRBD BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6912855 SUP Custom 27803010 6912855 - CAGE SPNL XL 55X18X12MM NS LF CRNT RADOPQ PEEK LMBR INTRBD BOTH IP/OP "$11,250.00" "$8,325.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$11,250.00" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$11,250.00" "$11,250.00" N/A N/A 6912860 SUP HCPCS C1713 6912860 - CAGE SPNL XL 60X18X12MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6914245 SUP HCPCS C1713 6914245 - SPACER SPNL XL W 45X22X14MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6914250 SUP HCPCS C1713 6914250 - CAGE SPNL XL W 50X22X14MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6914255 SUP HCPCS C1713 6914255 - SPACER SPNL XL W 55X22X14MM CRNT LMBR INTRBD FS RDLCNT PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6914260 SUP HCPCS C1713 6914260 - CAGE SPNL XL 60X22X14MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6914840 SUP HCPCS C1713 6914840 - SPACER SPNL 40X18X14MM INTRBD FS GFT RSTRC BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6914845 SUP HCPCS C1713 6914845 - SPACER SPNL XL 45X18X14MM STRL CRNT LMBR INTRBD FS PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6914850 SUP HCPCS C1713 6914850 - CAGE SPNL XL 50X18X14MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6914855 SUP HCPCS C1713 6914855 - CAGE SPNL XL 55X18X14MM NS LF CRNT PEEK LMBR INTRBD FS BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6914860 SUP HCPCS C1713 6914860 - CAGE SPNL 10D XL 60X18X14MM XLIF CRNT PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6916245 SUP HCPCS C1713 6916245 - SPACER SPNL XL W 45X22X16MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6916250 SUP HCPCS C1713 6916250 - CAGE SPNL XL W 50X22X16MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6916255 SUP HCPCS C1713 6916255 - SPACER SPNL XL W 55X22X16MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6916260 SUP HCPCS C1713 6916260 - SPACER SPNL XL W 60X22X16MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6916840 SUP HCPCS C1713 6916840 - SPACER SPNL XL 40X18X16MM CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6916845 SUP HCPCS C1713 6916845 - SPACER SPNL XL 45X18X16MM CRNT THORLMBR INTRBD FS PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6916850 SUP HCPCS C1713 6916850 - CAGE SPNL XL 50X18X16MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6916855 SUP HCPCS C1713 6916855 - SPACER SPNL XL 55X18X16MM CRNT THORLMBR INTRBD FS PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6916860 SUP HCPCS C1713 6916860 - SPACER SPNL 10D XL 60X18X16MM XLIF CRNT PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6920845 SUP HCPCS C1713 6920845 - CAGE SPNL XL W LRDTC 45X22X8MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6920855 SUP HCPCS C1713 6920855 - CAGE SPNL XL W LRDTC 55X22X8MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6920860 SUP HCPCS C1713 6920860 - CAGE SPNL XL W LRDTC 60X22X8MM NS LF CRNT PEEK-OPTM BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921044 SUP HCPCS C1713 6921044 - CAGE SPNL 8D XL 24X34X10MM CRNT RND PEEK-OPTM BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6921045 SUP HCPCS C1713 6921045 - CAGE SPNL XL W LRDTC 45X22X10MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921050 SUP HCPCS C1713 6921050 - CAGE SPNL XL W LRDTC 50X22X10MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921055 SUP HCPCS C1713 6921055 - CAGE SPNL XL W LRDTC 55X22X10MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921088 SUP HCPCS C1713 6921088 - SPACER SPNL 8D XL 38X28X10MM CRNT PEEK-OPTM BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$15,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6921244 SUP HCPCS C1713 6921244 - SPACER SPNL XL 12X34X24MM CRNT LMBR INTRBD FS PEEK BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$15,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6921245 SUP HCPCS C1713 6921245 - CAGE SPNL XL W LRDTC 45X22X12MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921255 SUP HCPCS C1713 6921255 - CAGE SPNL XL W LRDTC 55X22X12MM NS LF CRNT PEEK LMBR INTRBD BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921260 SUP HCPCS C1713 6921260 - CAGE SPNL XL W LRDTC 60X22X12MM NS LF CRNT BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921288 SUP HCPCS C1713 6921288 - CAGE SPNL 8D XL 28X38X12MM CRNT RND PEEK-OPTM BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6921444 SUP HCPCS C1713 6921444 - CAGE SPNL 8D XL 24X34X14MM CRNT RND PEEK-OPTM BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$15,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6921445 SUP HCPCS C1713 6921445 - SPACER SPNL 10D LRDTC XL W 45X22X14MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921450 SUP HCPCS C1713 6921450 - SPACER SPNL 10D LRDTC XL W 50X22X14MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921455 SUP HCPCS C1713 6921455 - SPACER SPNL 10D LRDTC XL W 55X22X14MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921460 SUP HCPCS C1713 6921460 - SPACER SPNL 10D LRDTC XL W 60X22X14MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921488 SUP HCPCS C1713 6921488 - SPACER SPNL 8D XL 38X28X114MM LMBR INTRBD FS RDLCNT PEEK BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6921644 SUP HCPCS C1713 6921644 - SPACER SPNL 8D XL 34X24X16MM CRNT PEEK BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6921645 SUP HCPCS C1713 6921645 - SPACER SPNL 10D LRDTC XL W 45X22X16MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921650 SUP HCPCS C1713 6921650 - SPACER SPNL 10D LRDTC XL W 50X22X16MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921655 SUP HCPCS C1713 6921655 - SPACER SPNL 10D LRDTC XL W 55X22X16MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921660 SUP HCPCS C1713 6921660 - SPACER SPNL 10D LRDTC XL W 60X22X16MM PEEK BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6921688 SUP HCPCS C1713 6921688 - SPACER SPNL 8D XL 38X28X16MM CRNT LMBR INTRBD FS PEEK BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$15,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6921844 SUP HCPCS C1713 6921844 - SPACER SPNL 8D XL 34X24X18MM LMBR INTRBD FS RDLCNT PEEK-OPTM BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6921888 SUP HCPCS C1713 6921888 - SPACER SPNL 8D XL 38X28X18MM LMBR INTRBD FS RDLCNT PEEK BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6922044 SUP HCPCS C1713 6922044 - SPACER SPNL 8D XL 34X24X20MM LMBR INTRBD FS RDLCNT PEEK BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6922088 SUP HCPCS C1713 6922088 - SPACER SPNL 8D XL 38X28X20MM LMBR INTRBD FS RDLCNT PEEK BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6931288 SUP HCPCS C1713 6931288 - CAGE SPNL 15D XL 28X38X12MM CRNT RND PEEK-OPTM BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6931488 SUP HCPCS C1713 6931488 - CAGE SPNL 15D XL 28X38X14MM CRNT RND PEEK-OPTM BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$15,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6931688 SUP HCPCS C1713 6931688 - SPACER SPNL XL 38X28X16MM CRNT INTRBD FS PEEK BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$15,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6931888 SUP HCPCS C1713 6931888 - SPACER SPNL 15D XL 38X28X18MM CRNT LMBR INTRBD FS PEEK BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6932088 SUP HCPCS C1713 6932088 - SPACER SPNL 15D XL 38X28X20MM TLIF RDLCNT PEEK-OPTM BOTH IP/OP "$15,000.00" "$11,100.00" "$2,977.13" "$15,000.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.38" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$7,395.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$2,977.13" N/A "$8,700.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.00" "$15,000.00" N/A N/A 6940664 SUP HCPCS C1713 6940664 - GRAFT BN 16X14X6MM SPCR ANTM SPNE CRV BOTH IP/OP "$2,875.00" "$2,128.00" $570.62 "$2,875.00" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$2,875.00" "$2,875.00" "$2,875.00" $599.22 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$1,150.00" "$1,417.38" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" $570.62 N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" $599.15 "$2,875.00" N/A N/A 6940764 SUP HCPCS C1713 6940764 - SPACER ALGRF 16X14X7MM SPNE CRV BOTH IP/OP "$2,875.00" "$2,128.00" $570.62 "$2,875.00" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$2,875.00" "$2,875.00" "$2,875.00" $599.22 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$2,875.00" "$1,417.38" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" $570.62 N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" $599.15 "$2,875.00" N/A N/A 6940864 SUP HCPCS C1713 6940864 - SPACER ALGRF 16X14X8MM SPNE CRV BOTH IP/OP "$2,875.00" "$2,128.00" $570.62 "$2,875.00" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$2,875.00" "$2,875.00" "$2,875.00" $599.22 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$1,150.00" "$1,417.38" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" $570.62 N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" "$2,875.00" "$2,875.00" N/A N/A 6940964 SUP HCPCS C1713 6940964 - SPACER ALGRF 16X14X9MM SPNE CRV BOTH IP/OP "$2,875.00" "$2,128.00" $570.62 "$2,875.00" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$2,875.00" "$2,875.00" "$2,875.00" $599.22 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$1,150.00" "$1,417.38" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" $570.62 N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" "$2,875.00" "$2,875.00" N/A N/A 6941034 SUP HCPCS C1713 6941034 - CAGE SPNL 8D 34X24X10MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$13,782.50" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6941038 SUP HCPCS C1713 6941038 - CAGE SPNL 8D 38X28X10MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6941042 SUP HCPCS C1713 6941042 - CAGE SPNL 8D 42X30X10MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6941234 SUP HCPCS C1713 6941234 - CAGE SPNL 8D 34X24X12MM NS LF BRIGADE TI BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6941238 SUP HCPCS C1713 6941238 - CAGE SPNL 8D 38X28X12MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6941242 SUP HCPCS C1713 6941242 - CAGE SPNL 8D 42X30X12MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6941434 SUP HCPCS C1713 6941434 - CAGE SPNL 8D 34X24X14MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6941438 SUP HCPCS C1713 6941438 - CAGE SPNL 8D 38X28X14MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6941442 SUP HCPCS C1713 6941442 - CAGE SPNL 8D 42X30X14MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6941634 SUP HCPCS C1713 6941634 - CAGE SPNL 8D 34X24X16MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6941638 SUP HCPCS C1713 6941638 - CAGE SPNL 8D 38X28X16MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6941642 SUP HCPCS C1713 6941642 - CAGE SPNL 8D 42X30X16MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6941834 SUP HCPCS C1713 6941834 - CAGE SPNL 8D 34X24X18MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6941838 SUP HCPCS C1713 6941838 - CAGE SPNL 8D 38X28X18MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$13,782.50" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6941842 SUP HCPCS C1713 6941842 - CAGE SPNL 8D 42X30X18MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$13,782.50" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6942034 SUP HCPCS C1713 6942034 - CAGE SPNL 8D 34X24X20MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$13,782.50" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6942038 SUP HCPCS C1713 6942038 - CAGE SPNL 8D 38X28X20MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6942042 SUP HCPCS C1713 6942042 - CAGE SPNL 8D 42X30X20MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6950305 SUP HCPCS C1713 6950305 - SCREW BN 3.5MM 5MM LGHT BLU NS VRTX MX 3 RLF NTCH ST TOP LD BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $250.00 $250.00 N/A N/A 6950315 SUP HCPCS C1713 6950315 - SCREW SET M6 BUTTRESS THREAD VERTEX MAX TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 6951034 SUP HCPCS C1713 6951034 - CAGE SPNL 12D 34X24X10MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$13,782.50" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6951234 SUP HCPCS C1713 6951234 - CAGE SPNL 12D 34X24X12MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6951238 SUP HCPCS C1713 6951238 - CAGE SPNL 12D 38X28X12MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6951242 SUP HCPCS C1713 6951242 - CAGE SPNL 12D 42X30X12MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6951434 SUP HCPCS C1713 6951434 - CAGE SPNL 12D 34X24X14MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6951438 SUP HCPCS C1713 6951438 - CAGE SPNL 12D 38X28X14MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6951442 SUP HCPCS C1713 6951442 - CAGE SPNL 12D 42X30X14MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$13,782.50" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6951634 SUP HCPCS C1713 6951634 - CAGE SPNL 12D 34X24X16MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6951638 SUP HCPCS C1713 6951638 - CAGE SPNL 12D 38X28X16MM NS LF BRIGADE TI BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$13,782.50" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6951642 SUP HCPCS C1713 6951642 - CAGE SPNL 12D 42X30X16MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6951834 SUP HCPCS C1713 6951834 - CAGE SPNL 12D 34X24X18MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6951838 SUP HCPCS C1713 6951838 - CAGE SPNL 12D 38X28X18MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6951842 SUP HCPCS C1713 6951842 - CAGE SPNL 12D 42X30X18MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6952034 SUP HCPCS C1713 6952034 - CAGE SPNL 12D 34X24X20MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$13,782.50" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6952038 SUP HCPCS C1713 6952038 - CAGE SPNL 12D 38X28X20MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6952042 SUP HCPCS C1713 6952042 - CAGE SPNL 12D 42X30X20MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6955240 SUP Custom 27803010 6955240 - ROD SPINAL SHORT 3.2MM 240MM THREAD CONNECT POINT VERTEX MAX BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 6955245 SUP HCPCS C1713 6955245 - ROD SPNL 4.5MM 360MM VRTX MX THRD TI RECON SYS BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A 6955255 SUP HCPCS C1713 6955255 - ROD SPNL 5.5MM 360MM VRTX MX THRD TI OCPTL RECON SYS BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 6955260 SUP HCPCS C1713 6955260 - ROD SPINAL PRECURVE 3.2MM 100MM PCVD TITANIUM OCCPTL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 6955270 SUP HCPCS C1713 6955270 - ROD SPINAL 3.2MM 100MM PCVD VERTEX MAX TITANIUM OCCPTL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 6955273 SUP HCPCS C1713 6955273 - PLATE BONE SMALL KEEL VERTEX MAX TITANIUM SPN OCCPTL BOTH IP/OP "$6,735.00" "$4,984.00" "$1,336.73" "$6,735.00" "$3,030.75" "$3,030.75" "$3,030.75" "$3,030.75" "$6,735.00" "$6,735.00" "$6,735.00" "$1,403.74" "$6,735.00" "$6,735.00" "$6,735.00" "$6,735.00" "$6,735.00" "$1,403.65" "$6,735.00" "$6,735.00" "$3,320.36" "$6,735.00" "$6,735.00" "$6,735.00" "$6,735.00" "$5,051.25" "$6,735.00" "$6,735.00" "$6,735.00" "$3,367.50" "$3,367.50" "$5,334.12" "$6,735.00" "$5,388.00" "$3,030.75" "$1,336.73" N/A "$3,906.30" "$6,735.00" "$4,041.00" "$6,735.00" "$1,403.57" "$6,735.00" N/A N/A 6955274 SUP HCPCS C1713 6955274 - PLATE BONE MEDIUM KEEL VERTEX MAX TITANIUM SPN OCCPTL BOTH IP/OP "$6,735.00" "$4,984.00" "$1,336.73" "$6,735.00" "$3,030.75" "$3,030.75" "$3,030.75" "$3,030.75" "$6,735.00" "$6,735.00" "$6,735.00" "$1,403.74" "$6,735.00" "$6,735.00" "$6,735.00" "$6,735.00" "$6,735.00" "$1,403.65" "$6,735.00" "$6,735.00" "$3,320.36" "$6,735.00" "$6,735.00" "$6,735.00" "$6,735.00" "$5,051.25" "$6,735.00" "$6,735.00" "$6,735.00" "$3,367.50" "$3,367.50" "$5,334.12" "$6,735.00" "$5,388.00" "$3,030.75" "$1,336.73" N/A "$3,906.30" "$6,735.00" "$6,735.00" "$6,735.00" "$1,403.57" "$6,735.00" N/A N/A 6955275 SUP HCPCS C1713 6955275 - PLATE BONE LARGE KEEL VERTEX MAX TITANIUM SPN OCCPTL BOTH IP/OP "$6,735.00" "$4,984.00" "$1,336.73" "$6,735.00" "$3,030.75" "$3,030.75" "$3,030.75" "$3,030.75" "$6,735.00" "$6,735.00" "$6,735.00" "$1,403.74" "$6,735.00" "$6,735.00" "$6,735.00" "$6,735.00" "$6,735.00" "$1,403.65" "$6,735.00" "$6,735.00" "$3,320.36" "$6,735.00" "$6,735.00" "$6,735.00" "$6,735.00" "$5,051.25" "$6,735.00" "$6,735.00" "$6,735.00" "$3,367.50" "$3,367.50" "$5,334.12" "$6,735.00" "$5,388.00" "$3,030.75" "$1,336.73" N/A "$3,906.30" "$6,735.00" "$4,041.00" "$6,735.00" "$1,403.57" "$6,735.00" N/A N/A 6955406 SUP HCPCS C1713 6955406 - SCREW BONE 4MM 6MM 3 RELIEF NOTCH SELF TAP TOP LOAD THREAD BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $694.88 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $144.81 $694.88 N/A N/A 6955408 SUP HCPCS C1713 6955408 - SCREW BONE 4MM 8MM 3 RELIEF NOTCH SELF TAP TOP LOAD THREAD BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $277.95 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $144.81 $694.88 N/A N/A 6955410 SUP HCPCS C1713 6955410 - SCREW BONE 4MM 10MM 3 RELIEF NOTCH SELF TAP TOP LOAD THREAD BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $277.95 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $144.81 $694.88 N/A N/A 6955412 SUP HCPCS C1713 6955412 - SCREW BONE 0-45D 4MM 3MM 12MM 3 RELIEF NOTCH TOP LOAD SELF BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $694.88 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $694.88 $694.88 N/A N/A 6955414 SUP HCPCS C1713 6955414 - SCREW BONE 4MM 14MM 3 RELIEF NOTCH SELF TAP TOP LOAD THREAD BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $694.88 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $694.88 $694.88 N/A N/A 6955416 SUP HCPCS C1713 6955416 - SCREW BONE 4MM 16MM 3 RELIEF NOTCH SELF TAP TOP LOAD THREAD BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $277.95 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $144.81 $694.88 N/A N/A 6955418 SUP HCPCS C1713 6955418 - SCREW BONE 4MM 18MM 3 RELIEF NOTCH SELF TAP TOP LOAD THREAD BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $277.95 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $144.81 $694.88 N/A N/A 6955506 SUP HCPCS C1713 6955506 - SCREW BONE 0-45D 4.5MM 3.5MM 6MM 3 RELIEF NOTCH TOP LOADING BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $277.95 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $694.88 $694.88 $144.81 $694.88 N/A N/A 6955508 SUP HCPCS C1713 6955508 - SCREW BONE 4.5MM 8MM 3 RELIEF NOTCH SELF TAP TOP LOAD THREAD BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $277.95 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $144.81 $694.88 N/A N/A 6955510 SUP HCPCS C1713 6955510 - SCREW BONE 4.5MM 10MM 3 RELIEF NOTCH SELF TAP TOP LOAD BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $277.95 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $144.81 $694.88 N/A N/A 6955512 SUP HCPCS C1713 6955512 - SCREW BONE 4.5MM 12MM THREAD VERTEX MAX GRAY TITANIUM BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $694.88 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $144.81 $694.88 N/A N/A 6955514 SUP HCPCS C1713 6955514 - SCREW BONE 4.5MM 14MM 3 RELIEF NOTCH SELF TAP TOP LOAD BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $694.88 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $144.81 $694.88 N/A N/A 6955516 SUP HCPCS C1713 6955516 - SCREW BONE 4.5MM 16MM 3 RELIEF NOTCH SELF TAP TOP LOAD BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $277.95 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $144.81 $694.88 N/A N/A 6955518 SUP HCPCS C1713 6955518 - SCREW BONE 4.5MM 18MM 3 RELIEF NOTCH SELF TAP TOP LOAD BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $277.95 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $144.81 $694.88 N/A N/A 6955520 SUP HCPCS C1713 6955520 - SCREW BONE 4.5MM 20MM 3 RELIEF NOTCH SELF TAP TOP LOAD BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $277.95 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $144.81 $694.88 N/A N/A 6955524 SUP HCPCS C1713 6955524 - SCREW BONE 4.5MM 24MM 3 RELIEF NOTCH SELF TAP TOP LOAD BOTH IP/OP $695.00 $514.00 $137.92 $694.88 $312.70 $312.70 $312.70 $312.70 $694.88 $694.88 $694.88 $144.83 $694.88 $694.88 $694.88 $694.88 $694.88 $144.82 $694.88 $277.95 $411.02 $694.88 $694.88 $694.88 $694.88 $521.25 $694.88 $694.88 $694.88 $347.44 $347.44 $550.34 $694.88 $555.90 $312.70 $137.92 N/A $403.10 $694.88 $416.93 $694.88 $144.81 $694.88 N/A N/A 6955710 SUP HCPCS C1713 6955710 - SCREW BN 3.5MM 10MM GRN VRTX MX MA ST ROT SDL TI THOR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 6955712 SUP HCPCS C1713 6955712 - SCREW BN 3.5MM 12MM STRL VRTX MA TI THOR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 6955714 SUP HCPCS C1713 6955714 - SCREW BN 3.5MM 14MM GRN VRTX MX MA ST ROT SDL TI THOR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 6955718 SUP HCPCS C1713 6955718 - SCREW BN 3.5MM 18MM GRN VRTX MX MA ST ROT SDL TI THOR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 6955826 SUP HCPCS C1713 6955826 - SCREW BN 4MM 26MM BLU VRTX MX MA ST ROT SDL TI THOR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 6955830 SUP HCPCS C1713 6955830 - SCREW BN 4MM 30MM AU VRTX MX MA ST ROT SDL TI THOR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 6955926 SUP HCPCS C1713 6955926 - SCREW BN 4.5MM 26MM MAG VRTX MX MA ST ROT SDL TI THOR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 6955960 SUP Custom 27803010 6955960 - CONNECTOR ROD 10MM OPEN OFFST SIDE LOADING VERTEX MAX BOTH IP/OP $970.50 $718.00 $172.75 $970.50 $970.50 $970.50 $970.50 $970.50 $970.50 $970.50 $172.75 $970.50 $970.50 $970.50 $970.50 $970.50 $970.50 $202.26 $970.50 $388.20 $970.50 $970.50 $970.50 $970.50 $970.50 $727.88 $970.50 $970.50 $970.50 $485.25 $485.25 $768.64 $970.50 $776.40 $436.73 $970.50 N/A $562.89 $970.50 $582.30 $970.50 $970.50 $970.50 N/A N/A 6955965 SUP Custom 27803010 6955965 - CONNECTOR ROD 13MM OPEN OFFST SIDE LOADING VERTEX MAX BOTH IP/OP $970.50 $718.00 $172.75 $970.50 $970.50 $970.50 $970.50 $970.50 $970.50 $970.50 $172.75 $970.50 $970.50 $970.50 $970.50 $970.50 $970.50 $202.26 $970.50 $388.20 $970.50 $970.50 $970.50 $970.50 $970.50 $727.88 $970.50 $970.50 $970.50 $485.25 $485.25 $768.64 $970.50 $776.40 $436.73 $970.50 N/A $562.89 $970.50 $582.30 $970.50 $970.50 $970.50 N/A N/A 6955973 SUP HCPCS C1713 6955973 - HOOK SPNL 4.5MM NS VRTX MX TI LMN RECON SYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 6955974 SUP HCPCS C1713 6955974 - HOOK SPINAL 6MM VERTEX MAX TITANIUM LAMINA NONSTRL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 6956010 SUP Custom 27203010 6956010 - BIT DRL 2.4MM STRL VRTX DISP BOTH IP/OP $649.50 $481.00 $115.61 $649.50 $649.50 $649.50 $649.50 $649.50 $649.50 $649.50 $115.61 $649.50 $649.50 $482.06 $482.06 $500.63 $338.39 $135.36 $649.50 $259.80 $649.50 $649.50 $649.50 $649.50 $649.50 $487.13 $649.50 $649.50 $649.50 $324.75 $324.75 $514.40 $649.50 $519.60 $422.18 $649.50 N/A $376.71 $649.50 $389.70 $649.50 $649.50 $649.50 N/A N/A 6956011 SUP Custom 27203010 6956011 - BIT DRILL 2.9MM 26-52MM VERTEX MAX GOLD STERILE DISPOSABLE BOTH IP/OP $649.50 $481.00 $115.61 $649.50 $649.50 $649.50 $649.50 $649.50 $649.50 $649.50 $115.61 $649.50 $649.50 $482.06 $482.06 $500.63 $338.39 $135.36 $649.50 $259.80 $649.50 $649.50 $649.50 $649.50 $649.50 $487.13 $649.50 $649.50 $649.50 $324.75 $324.75 $514.40 $649.50 $519.60 $422.18 $649.50 N/A $376.71 $649.50 $389.70 $649.50 $649.50 $649.50 N/A N/A 6956035 SUP HCPCS C1713 6956035 - TAP SURG 3.5MM 10-24MM VERTEX MAX BOTH IP/OP $385.50 $285.00 $76.51 $385.50 $173.48 $173.48 $173.48 $173.48 $385.50 $385.50 $385.50 $80.35 $385.50 $385.50 $385.50 $385.50 $385.50 $80.34 $385.50 $154.20 $228.02 $385.50 $385.50 $385.50 $385.50 $289.13 $385.50 $385.50 $385.50 $192.75 $192.75 $305.32 $385.50 $308.40 $173.48 $76.51 N/A $223.59 $385.50 $231.30 $385.50 $80.34 $385.50 N/A N/A 6957314 SUP HCPCS C1769 6957314 - GUIDEWIRE ORTHOPEDIC 720MM THREAD SPN BOTH IP/OP $261.00 $193.00 $51.80 $261.00 $141.72 $141.72 $141.72 $141.72 $261.00 $261.00 $261.00 $54.40 $261.00 $193.71 $193.71 $201.18 $135.98 $54.40 $261.00 $261.00 $154.38 $261.00 $261.00 $261.00 $261.00 $195.75 $261.00 $261.00 $261.00 $130.50 $130.50 $206.71 $261.00 $208.80 $169.65 $51.80 N/A $151.38 $261.00 $261.00 $261.00 $54.39 $261.00 N/A N/A 6957315 SUP HCPCS C1769 6957315 - GUIDEWIRE ORTHOPEDIC 3MM 720MM CANN BOTH IP/OP $261.00 $193.00 $51.80 $261.00 $141.72 $141.72 $141.72 $141.72 $261.00 $261.00 $261.00 $54.40 $261.00 $193.71 $193.71 $201.18 $135.98 $54.40 $261.00 $261.00 $154.38 $261.00 $261.00 $261.00 $261.00 $195.75 $261.00 $261.00 $261.00 $130.50 $130.50 $206.71 $261.00 $208.80 $169.65 $51.80 N/A $151.38 $261.00 $261.00 $261.00 $54.39 $261.00 N/A N/A 6958710 SUP HCPCS C1713 6958710 - SCREW BN 3.5MM 10MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958712 SUP HCPCS C1713 6958712 - SCREW BN 3.5MM 12MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958714 SUP HCPCS C1713 6958714 - SCREW BN 3.5MM 14MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958716 SUP HCPCS C1713 6958716 - SCREW BN 3.5MM 16MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958718 SUP HCPCS C1713 6958718 - SCREW BN 3.5MM 18MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958720 SUP HCPCS C1713 6958720 - SCREW BN 3.5MM 20MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958722 SUP HCPCS C1713 6958722 - SCREW BN 3.5MM 22MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 6958724 SUP HCPCS C1713 6958724 - SCREW BN 3.5MM 24MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958726 SUP HCPCS C1713 6958726 - SCREW BN 3.5MM 26MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958728 SUP HCPCS C1713 6958728 - SCREW BN 3.5MM 28MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958730 SUP HCPCS C1713 6958730 - SCREW BN 3.5MM 30MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958732 SUP HCPCS C1713 6958732 - SCREW BN 3.5MM 32MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958734 SUP HCPCS C1713 6958734 - SCREW BN 3.5MM 34MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958736 SUP HCPCS C1713 6958736 - SCREW BN 3.5MM 36MM GRN NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958738 SUP HCPCS C1713 6958738 - SCREW BN 3.5MM 38MM GRN NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958740 SUP HCPCS C1713 6958740 - SCREW BN 3.5MM 40MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958742 SUP HCPCS C1713 6958742 - SCREW BN 3.5MM 42MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958744 SUP HCPCS C1713 6958744 - SCREW BN 3.5MM 44MM GRN VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958746 SUP HCPCS C1713 6958746 - SCREW BN 3.5MM 46MM GRN VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958748 SUP HCPCS C1713 6958748 - SCREW BN 3.5MM 48MM GRN VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958750 SUP HCPCS C1713 6958750 - SCREW BN 3.5MM 50MM GRN VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958752 SUP HCPCS C1713 6958752 - SCREW BN 3.5MM 52MM GRN VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958810 SUP HCPCS C1713 6958810 - SCREW BN 4MM 10MM BLU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958812 SUP HCPCS C1713 6958812 - SCREW BONE 4MM 12MM MULTIAX VERTEX MAX BLUE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958814 SUP HCPCS C1713 6958814 - SCREW BN 4MM 14MM BLU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958816 SUP HCPCS C1713 6958816 - SCREW BN 4MM 16MM BLU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958818 SUP HCPCS C1713 6958818 - SCREW BN 4MM 18MM BLU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958820 SUP HCPCS C1713 6958820 - SCREW BN 4MM 20MM BLU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958822 SUP HCPCS C1713 6958822 - SCREW BN 4MM 22MM BLU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958824 SUP HCPCS C1713 6958824 - SCREW BN 4MM 24MM BLU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958826 SUP HCPCS C1713 6958826 - SCREW BN 4MM 26MM AU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958828 SUP HCPCS C1713 6958828 - SCREW BN 4MM 28MM AU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958830 SUP HCPCS C1713 6958830 - SCREW BN 4MM 30MM AU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958832 SUP HCPCS C1713 6958832 - SCREW BN 4MM 32MM AU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958834 SUP HCPCS C1713 6958834 - SCREW BN 4MM 34MM AU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958836 SUP HCPCS C1713 6958836 - SCREW BN 4MM 36MM AU VRTX MX MA ST ROT SDL TI THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958838 SUP HCPCS C1713 6958838 - SCREW BN 4MM 38MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958840 SUP HCPCS C1713 6958840 - SCREW BN 4MM 40MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958842 SUP HCPCS C1713 6958842 - SCREW BN 4MM 42MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958844 SUP HCPCS C1713 6958844 - SCREW BN 4MM 44MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958846 SUP HCPCS C1713 6958846 - SCREW BN 4MM 46MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958848 SUP HCPCS C1713 6958848 - SCREW BN 4MM 48MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958850 SUP HCPCS C1713 6958850 - SCREW BN 4MM 50MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958852 SUP HCPCS C1713 6958852 - SCREW BN 4MM 52MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958910 SUP HCPCS C1713 6958910 - SCREW BN 4.5MM 10MM MAG NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958912 SUP HCPCS C1713 6958912 - SCREW BN 4.5MM 12MM MAG NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958914 SUP HCPCS C1713 6958914 - SCREW BN 4.5MM 14MM MAG NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958916 SUP HCPCS C1713 6958916 - SCREW BN 4.5MM 16MM MAG NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958918 SUP HCPCS C1713 6958918 - SCREW BN 4.5MM 18MM MAG NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958920 SUP HCPCS C1713 6958920 - SCREW BN 4.5MM 20MM MAG NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958922 SUP HCPCS C1713 6958922 - SCREW BN 4.5MM 22MM MAG NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958924 SUP HCPCS C1713 6958924 - SCREW BN 4.5MM 24MM MAG NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958926 SUP HCPCS C1713 6958926 - SCREW BN 4.5MM 26MM MAG NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958928 SUP HCPCS C1713 6958928 - SCREW BN 4.5MM 28MM MAG NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958930 SUP HCPCS C1713 6958930 - SCREW BN 4.5MM 30MM MAG NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958932 SUP HCPCS C1713 6958932 - SCREW BN 4.5MM 32MM MAG NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958934 SUP HCPCS C1713 6958934 - SCREW BN 4.5MM 34MM MAG NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958936 SUP HCPCS C1713 6958936 - SCREW BN 4.5MM 36MM MAG NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958938 SUP HCPCS C1713 6958938 - SCREW BN 4.5MM 38MM MAG NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958940 SUP HCPCS C1713 6958940 - SCREW BN 4.5MM 40MM MAG NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958942 SUP HCPCS C1713 6958942 - SCREW BN 4.5MM 42MM MAG NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958944 SUP HCPCS C1713 6958944 - SCREW BONE 4.5MM 44MM MULTIAX VERTEX MAX MAGENTA TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958946 SUP HCPCS C1713 6958946 - SCREW BONE 4.5MM 46MM MULTIAX VERTEX MAX MAGENTA TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958948 SUP HCPCS C1713 6958948 - SCREW BONE 4.5MM 48MM MULTIAX VERTEX MAX MAGENTA TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958950 SUP HCPCS C1713 6958950 - SCREW BONE 4.5MM 50MM MULTIAX VERTEX MAX MAGENTA TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 6958952 SUP HCPCS C1713 6958952 - SCREW BONE 4.5MM 52MM MULTIAX VERTEX MAX MAGENTA TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 6959418 SUP HCPCS C1713 6959418 - SCREW BN 4MM 18MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959420 SUP HCPCS C1713 6959420 - SCREW BN 4MM 20MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959422 SUP HCPCS C1713 6959422 - SCREW BN 4MM 22MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959424 SUP HCPCS C1713 6959424 - SCREW BN 4MM 24MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959426 SUP HCPCS C1713 6959426 - SCREW BN 4MM 26MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959430 SUP HCPCS C1713 6959430 - SCREW BN 4MM 30MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959432 SUP HCPCS C1713 6959432 - SCREW BN 4MM 32MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959434 SUP HCPCS C1713 6959434 - SCREW BN 4MM 34MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959436 SUP HCPCS C1713 6959436 - SCREW BN 4MM 36MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959438 SUP HCPCS C1713 6959438 - SCREW BN 4MM 38MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959440 SUP HCPCS C1713 6959440 - SCREW BN 4MM 40MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959442 SUP HCPCS C1713 6959442 - SCREW BN 4MM 42MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959444 SUP HCPCS C1713 6959444 - SCREW BN 4MM 44MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959446 SUP HCPCS C1713 6959446 - SCREW BN 4MM 46MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959448 SUP HCPCS C1713 6959448 - SCREW BN 4MM 48MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959450 SUP HCPCS C1713 6959450 - SCREW BN 4MM 50MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959452 SUP HCPCS C1713 6959452 - SCREW BN 4MM 52MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959510 SUP HCPCS C1713 6959510 - SCREW BN 4.5MM 10MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959512 SUP HCPCS C1713 6959512 - SCREW BN 4.5MM 12MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959514 SUP HCPCS C1713 6959514 - SCREW BN 4.5MM 14MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959516 SUP HCPCS C1713 6959516 - SCREW BN 4.5MM 16MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959518 SUP HCPCS C1713 6959518 - SCREW BN 4.5MM 18MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959520 SUP HCPCS C1713 6959520 - SCREW BN 4.5MM 20MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959522 SUP HCPCS C1713 6959522 - SCREW BN 4.5MM 22MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959524 SUP HCPCS C1713 6959524 - SCREW BN 4.5MM 24MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959526 SUP HCPCS C1713 6959526 - SCREW BN 4.5MM 26MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959528 SUP HCPCS C1713 6959528 - SCREW BN 4.5MM 28MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959530 SUP HCPCS C1713 6959530 - SCREW BN 4.5MM 30MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959532 SUP HCPCS C1713 6959532 - SCREW BN 4.5MM 32MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959534 SUP HCPCS C1713 6959534 - SCREW BN 4.5MM 34MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959536 SUP HCPCS C1713 6959536 - SCREW BN 4.5MM 36MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959538 SUP HCPCS C1713 6959538 - SCREW BN 4.5MM 38MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959540 SUP HCPCS C1713 6959540 - SCREW BN 4.5MM 40MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959542 SUP HCPCS C1713 6959542 - SCREW BN 4.5MM 42MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959544 SUP HCPCS C1713 6959544 - SCREW BN 4.5MM 44MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959546 SUP HCPCS C1713 6959546 - SCREW BN 4.5MM 46MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959548 SUP HCPCS C1713 6959548 - SCREW BN 4.5MM 48MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959550 SUP HCPCS C1713 6959550 - SCREW BN 4.5MM 50MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959552 SUP HCPCS C1713 6959552 - SCREW BN 4.5MM 52MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959970 SUP HCPCS C1713 6959970 - PLATE BONE SMALL LP KEEL SPN OCCPTL BOTH IP/OP "$7,095.00" "$5,250.00" "$1,408.18" "$7,095.00" "$3,192.75" "$3,192.75" "$3,192.75" "$3,192.75" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.78" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.68" "$7,095.00" "$2,838.00" "$3,497.84" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$5,321.25" "$7,095.00" "$7,095.00" "$7,095.00" "$3,547.50" "$3,547.50" "$5,619.24" "$7,095.00" "$5,676.00" "$3,192.75" "$1,408.18" N/A "$4,115.10" "$7,095.00" "$4,257.00" "$7,095.00" "$1,478.60" "$7,095.00" N/A N/A 6959971 SUP HCPCS C1713 6959971 - PLATE BONE MEDIUM LP KEEL SPN OCCPTL BOTH IP/OP "$7,095.00" "$5,250.00" "$1,408.18" "$7,095.00" "$3,192.75" "$3,192.75" "$3,192.75" "$3,192.75" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.78" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.68" "$7,095.00" "$7,095.00" "$3,497.84" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$5,321.25" "$7,095.00" "$7,095.00" "$7,095.00" "$3,547.50" "$3,547.50" "$5,619.24" "$7,095.00" "$5,676.00" "$3,192.75" "$1,408.18" N/A "$4,115.10" "$7,095.00" "$4,257.00" "$7,095.00" "$1,478.60" "$7,095.00" N/A N/A 6959972 SUP HCPCS C1713 6959972 - PLATE BONE LARGE LP KEEL SPN OCCPTL BOTH IP/OP "$7,095.00" "$5,250.00" "$1,408.18" "$7,095.00" "$3,192.75" "$3,192.75" "$3,192.75" "$3,192.75" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.78" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.68" "$7,095.00" "$7,095.00" "$3,497.84" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$5,321.25" "$7,095.00" "$7,095.00" "$7,095.00" "$3,547.50" "$3,547.50" "$5,619.24" "$7,095.00" "$5,676.00" "$3,192.75" "$1,408.18" N/A "$4,115.10" "$7,095.00" "$4,257.00" "$7,095.00" "$1,478.60" "$7,095.00" N/A N/A 6960013 SUP HCPCS C1713 6960013 - SCREW BONE 4MM 13MM SLFTAP PRESTIGE CERV SPN BOTH IP/OP $633.00 $468.00 $125.63 $633.00 $284.85 $284.85 $284.85 $284.85 $633.00 $633.00 $633.00 $131.93 $633.00 $633.00 $633.00 $633.00 $633.00 $131.92 $633.00 $253.20 $374.42 $633.00 $633.00 $633.00 $633.00 $474.75 $633.00 $633.00 $633.00 $316.50 $316.50 $501.34 $633.00 $506.40 $284.85 $125.63 N/A $367.14 $633.00 $379.80 $633.00 $131.92 $633.00 N/A N/A 6960015 SUP HCPCS C1713 6960015 - SCREW BONE 4MM 15MM SLFTAP PRESTIGE CERV SPN BOTH IP/OP $633.00 $468.00 $125.63 $633.00 $284.85 $284.85 $284.85 $284.85 $633.00 $633.00 $633.00 $131.93 $633.00 $633.00 $633.00 $633.00 $633.00 $131.92 $633.00 $253.20 $374.42 $633.00 $633.00 $633.00 $633.00 $474.75 $633.00 $633.00 $633.00 $316.50 $316.50 $501.34 $633.00 $506.40 $284.85 $125.63 N/A $367.14 $633.00 $379.80 $633.00 $131.92 $633.00 N/A N/A 6960113 SUP HCPCS C1713 6960113 - SCREW BONE 4.5MM 13MM SELF TAP PRESTIGE SPN CERV BOTH IP/OP $810.00 $599.00 $160.76 $810.00 $364.50 $364.50 $364.50 $364.50 $810.00 $810.00 $810.00 $168.82 $810.00 $810.00 $810.00 $810.00 $810.00 $168.81 $810.00 $810.00 $479.12 $810.00 $810.00 $810.00 $810.00 $607.50 $810.00 $810.00 $810.00 $405.00 $405.00 $641.52 $810.00 $648.00 $364.50 $160.76 N/A $469.80 $810.00 $486.00 $810.00 $168.80 $810.00 N/A N/A 6960120 SUP HCPCS C1713 6960120 - SCREW BONE 4.5MM 20MM SELF TAP PRESTIGE SPN CERV BOTH IP/OP $268.50 $199.00 $53.29 $268.50 $120.83 $120.83 $120.83 $120.83 $268.50 $268.50 $268.50 $55.96 $268.50 $268.50 $268.50 $268.50 $268.50 $55.96 $268.50 $268.50 $158.82 $268.50 $268.50 $268.50 $268.50 $201.38 $268.50 $268.50 $268.50 $134.25 $134.25 $212.65 $268.50 $214.80 $120.83 $53.29 N/A $155.73 $268.50 $161.10 $268.50 $55.96 $268.50 N/A N/A 6961038 SUP HCPCS C1713 6961038 - CAGE SPNL 8D 38X32X10MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$13,782.50" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6961238 SUP HCPCS C1713 6961238 - CAGE SPNL 8D 38X32X12MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6961260 SUP Custom 27803010 6961260 - DISK ARTIFICIAL 6MM 12MM PRESTIGE STAINLESS STEEL CERVIX SPN BOTH IP/OP "$7,342.50" "$5,433.00" "$1,306.97" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$1,306.97" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$1,530.26" "$7,342.50" "$2,937.00" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$5,506.88" "$7,342.50" "$7,342.50" "$7,342.50" "$3,671.25" "$3,671.25" "$5,815.26" "$7,342.50" "$5,874.00" "$3,304.13" "$7,342.50" N/A "$4,258.65" "$7,342.50" "$4,405.50" "$7,342.50" "$7,342.50" "$7,342.50" N/A N/A 6961438 SUP HCPCS C1713 6961438 - CAGE SPNL 8D 38X32X14MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6961460 SUP Custom 27203010 6961460 - DISK ARTIFICIAL 6MM 14MM PRESTIGE STAINLESS STEEL CERVIX SPN BOTH IP/OP "$7,342.50" "$5,433.00" "$1,306.97" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$1,306.97" "$7,342.50" "$7,342.50" "$4,181.12" "$4,181.12" "$5,659.60" "$2,060.15" "$1,530.26" "$7,342.50" "$2,937.00" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$5,506.88" "$7,342.50" "$7,342.50" "$7,342.50" "$3,671.25" "$3,671.25" "$5,815.26" "$7,342.50" "$5,874.00" "$4,772.63" "$7,342.50" N/A "$4,258.65" "$7,342.50" "$4,405.50" "$7,342.50" "$7,342.50" "$7,342.50" N/A N/A 6961470 SUP Custom 27203010 6961470 - DISK ARTIFICIAL 7MM 14MM SLIDING CORE PRESTIGE STAINLESS BOTH IP/OP "$7,342.50" "$5,433.00" "$1,306.97" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$1,306.97" "$7,342.50" "$7,342.50" "$4,181.12" "$4,181.12" "$5,659.60" "$2,060.15" "$1,530.26" "$7,342.50" "$2,937.00" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$5,506.88" "$7,342.50" "$7,342.50" "$7,342.50" "$3,671.25" "$3,671.25" "$5,815.26" "$7,342.50" "$5,874.00" "$4,772.63" "$7,342.50" N/A "$4,258.65" "$7,342.50" "$4,405.50" "$7,342.50" "$7,342.50" "$7,342.50" N/A N/A 6961638 SUP HCPCS C1713 6961638 - CAGE SPNL 8D 38X32X16MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$13,782.50" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6961660 SUP Custom 27203010 6961660 - DISK ARTIFICIAL 6MM 16MM PRESTIGE STAINLESS STEEL CERV SPN BOTH IP/OP "$7,342.50" "$5,433.00" "$1,306.97" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$1,306.97" "$7,342.50" "$7,342.50" "$4,181.12" "$4,181.12" "$5,659.60" "$2,060.15" "$1,530.26" "$7,342.50" "$2,937.00" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$5,506.88" "$7,342.50" "$7,342.50" "$7,342.50" "$3,671.25" "$3,671.25" "$5,815.26" "$7,342.50" "$5,874.00" "$4,772.63" "$7,342.50" N/A "$4,258.65" "$7,342.50" "$4,405.50" "$7,342.50" "$7,342.50" "$7,342.50" N/A N/A 6961670 SUP Custom 27203010 6961670 - DISK ARTIFICIAL 7MM 16MM PRESTIGE STAINLESS STEEL CERV SPN BOTH IP/OP "$7,342.50" "$5,433.00" "$1,306.97" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$1,306.97" "$7,342.50" "$7,342.50" "$4,181.12" "$4,181.12" "$5,659.60" "$2,060.15" "$1,530.26" "$7,342.50" "$2,937.00" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$5,506.88" "$7,342.50" "$7,342.50" "$7,342.50" "$3,671.25" "$3,671.25" "$5,815.26" "$7,342.50" "$5,874.00" "$4,772.63" "$7,342.50" N/A "$4,258.65" "$7,342.50" "$4,405.50" "$7,342.50" "$7,342.50" "$7,342.50" N/A N/A 6961838 SUP HCPCS C1713 6961838 - CAGE SPNL 8D 38X32X18MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6961870 SUP Custom 27203010 6961870 - DISK ARTIFICIAL 7MM 18MM ASMBLY PRESTIGE STAINLESS STEEL BOTH IP/OP "$7,342.50" "$5,433.00" "$1,306.97" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$1,306.97" "$7,342.50" "$7,342.50" "$4,181.12" "$4,181.12" "$5,659.60" "$2,060.15" "$1,530.26" "$7,342.50" "$2,937.00" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$7,342.50" "$5,506.88" "$7,342.50" "$7,342.50" "$7,342.50" "$3,671.25" "$3,671.25" "$5,815.26" "$7,342.50" "$5,874.00" "$4,772.63" "$7,342.50" N/A "$4,258.65" "$7,342.50" "$4,405.50" "$7,342.50" "$7,342.50" "$7,342.50" N/A N/A 6962038 SUP HCPCS C1713 6962038 - CAGE SPNL 8D 38X32X20MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6971238 SUP HCPCS C1713 6971238 - CAGE SPNL 12D 38X32X12MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$13,782.50" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6971250 SUP HCPCS C1713 6971250 - DISC ARTF 12MM 5MM CERV BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971260 SUP HCPCS C1713 6971260 - DISC ARTF 12MM 6MM CERV MTN BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971270 SUP HCPCS C1713 6971270 - DISC ARTF 12MM 7MM CERV MTN BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971438 SUP HCPCS C1713 6971438 - CAGE SPNL 12D 38X32X14MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$13,782.50" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6971450 SUP HCPCS C1713 6971450 - DISC ARTF 14MM 5MM CERV BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971460 SUP HCPCS C1713 6971460 - DISC ARTF 14MM 6MM CERV MTN BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971470 SUP HCPCS C1713 6971470 - DISC ARTF 14MM 7MM CERV MTN BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971480 SUP HCPCS C1713 6971480 - DISC ARTF 14MM 8MM CERV MTN BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971638 SUP HCPCS C1713 6971638 - CAGE SPNL 12D 38X32X16MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6971650 SUP HCPCS C1713 6971650 - DISC 6971650 CERVICAL 5MM X 16MM BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971660 SUP HCPCS C1713 6971660 - DISC ARTF 16MM 6MM CERV MTN BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971670 SUP HCPCS C1713 6971670 - DISC ARTF 16MM 7MM CERV MTN BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971680 SUP HCPCS C1713 6971680 - DISC ARTF 16MM 8MM CERV MTN BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971838 SUP HCPCS C1713 6971838 - CAGE SPNL 12D 38X32X18MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6971870 SUP HCPCS C1713 6971870 - DISC ARTF 18MM 7MM CERV MTN BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$10,200.00" "$10,200.00" N/A N/A 6971880 SUP HCPCS C1713 6971880 - DISC ARTF 18MM 8MM CERV MTN BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6972038 SUP HCPCS C1713 6972038 - CAGE SPNL 12D 38X32X20MM NS LF BRIGADE BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$5,513.00" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$2,872.27" "$13,782.50" N/A N/A 6972118 SUP Custom 27203010 6972118 - BIT DRL DMD 1.5MM STRL RAIL CTR DISP BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A 6972250 SUP HCPCS C1713 6972250 - DISC 6972250 PRESTIGE BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6972260 SUP HCPCS C1713 6972260 - DISC INTVRTB 12MM 6MM PSTG LP CERV SPN TI BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6972270 SUP HCPCS C1713 6972270 - DISC INTVRTB 12MM 7MM PSTG LP CERV SPN TI BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6972450 SUP HCPCS C1713 6972450 - DISC INTVRTB 14MM 4MM PSTG LP CERV SPN TI BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6972460 SUP HCPCS C1713 6972460 - DISC INTVRTB 14MM 6MM PSTG LP CERV SPN TI BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6972470 SUP HCPCS C1713 6972470 - DISC INTVRTB 14MM 7MM PSTG LP CERV SPN TI BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6972480 SUP HCPCS C1713 6972480 - DISC INTVRTB 14MM 8MM PSTG LP CERV SPN TI BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6972650 SUP HCPCS C1713 6972650 - DISC INTVRTB 16MM 5MM PSTG LP CERV SPN TI BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6972660 SUP HCPCS C1713 6972660 - DISC INTVRTB 16MM 6MM PSTG LP CERV SPN TI BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6972670 SUP HCPCS C1713 6972670 - DISC INTVRTB 16MM 7MM PSTG LP CERV SPN TI BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6972680 SUP HCPCS C1713 6972680 - DISC INTVRTB 16MM 8MM PSTG LP CERV SPN TI BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6972860 SUP HCPCS C1713 6972860 - DISC INTVRTB 18MM 6MM PSTG LP CERV SPN TI BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6972870 SUP HCPCS C1713 6972870 - DISC INTVRTB 18MM 7MM PSTG LP CERV SPN TI BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6972880 SUP HCPCS C1713 6972880 - DISC INTVRTB 18MM 8MM PSTG LP CERV SPN TI BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6980840 SUP HCPCS C1713 6980840 - SPACER SPNL 40X18X8MM LMBR INTRBD FS PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6980850 SUP HCPCS C1713 6980850 - CAGE SPNL 10D XL 50X18X8MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6980855 SUP HCPCS C1713 6980855 - CAGE SPNL 10D XL 55X18X8MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6980860 SUP HCPCS C1713 6980860 - CAGE SPNL 10D XL 60X18X8MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981040 SUP HCPCS C1713 6981040 - CAGE SPNL 40X18X10MM PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981045 SUP Custom 27803010 6981045 - CAGE SPNL 10D XL 45X18X10MM NS LF CRNT PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$11,250.00" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$11,250.00" "$11,250.00" N/A N/A 6981050 SUP HCPCS C1713 6981050 - CAGE SPNL 10D XL 50X18X10MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981055 SUP HCPCS C1713 6981055 - CAGE SPNL 10D XL 55X18X10MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981060 SUP HCPCS C1713 6981060 - CAGE SPNL 10D XL 60X18X10MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981240 SUP HCPCS C1713 6981240 - SPACER SPNL LRDTC XL 40X18X12MM CRNT PEEK LMBR INTRBD FS BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981245 SUP Custom 27803010 6981245 - CAGE SPNL 10D XL 45X18X12MM NS LF CRNT PEEK LMBR INTRBD FS BOTH IP/OP "$11,250.00" "$8,325.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$11,250.00" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$11,250.00" "$11,250.00" N/A N/A 6981250 SUP HCPCS C1713 6981250 - CAGE SPNL 10D XL 50X18X12MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981255 SUP Custom 27803010 6981255 - CAGE SPNL 10D XL 55X18X12MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$11,250.00" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$11,250.00" "$11,250.00" N/A N/A 6981260 SUP HCPCS C1713 6981260 - CAGE SPNL 10D XL 60X18X12MM NS LF CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981440 SUP HCPCS C1713 6981440 - SPACER SPNL XL 40X18X14MM CRNT LMBR INTRBD FS PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981445 SUP HCPCS C1713 6981445 - CAGE SPNL 10D XL 45X18X14MM CRNT PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981455 SUP HCPCS C1713 6981455 - CAGE SPNL 55X18X14MM CRNT THORLMBR INTRBD FS RDLCNT PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981460 SUP HCPCS C1713 6981460 - CAGE SPNL 10D XL 60X18X14MM CRNT PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981640 SUP HCPCS C1713 6981640 - SPACER SPNL XL 40X18X16MM INTRBD FS PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981645 SUP HCPCS C1713 6981645 - CAGE SPNL 10D XL 45X18X16MM CRNT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981650 SUP HCPCS C1713 6981650 - CAGE SPNL 10D XL 50X18X16MM CRNT PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981655 SUP HCPCS C1713 6981655 - CAGE SPNL 55X18X16MM CRNT THORLMBR INTRBD FS PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$11,250.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6981660 SUP HCPCS C1713 6981660 - CAGE SPNL XL LRDTC 60X18X14MM CRNT PEEK BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A 6990625 SUP HCPCS C1713 6990625 - CAGE SPNL XL 25X16X6MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6990630 SUP HCPCS C1713 6990630 - CAGE SPNL XL 30X16X6MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6990635 SUP HCPCS C1713 6990635 - CAGE SPNL XL 35X16X6MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6990640 SUP HCPCS C1713 6990640 - CAGE SPNL XL 40X16X6MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6990825 SUP HCPCS C1713 6990825 - CAGE SPNL XL 25X16X8MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6990830 SUP HCPCS C1713 6990830 - CAGE SPNL XL 30X16X8MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6990835 SUP HCPCS C1713 6990835 - CAGE SPNL XL 35X16X8MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6990840 SUP HCPCS C1713 6990840 - CAGE SPNL XL 40X16X8MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6991025 SUP HCPCS C1713 6991025 - CAGE SPNL XL 25X16X10MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6991030 SUP HCPCS C1713 6991030 - CAGE SPNL XL 30X16X10MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6991035 SUP HCPCS C1713 6991035 - CAGE SPNL XL 35X16X10MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6991040 SUP HCPCS C1713 6991040 - CAGE SPNL XL 40X16X10MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$7,800.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6991225 SUP HCPCS C1713 6991225 - CAGE SPNL XL 25X16X12MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6991230 SUP HCPCS C1713 6991230 - CAGE SPNL XL 30X16X12MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 6991235 SUP HCPCS C1713 6991235 - CAGE SPNL XL 35X16X12MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$5,200.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.20" "$13,000.00" N/A N/A 6991240 SUP HCPCS C1713 6991240 - CAGE SPNL XL 40X16X12MM NS LF CRNT THOR BOTH IP/OP "$13,000.00" "$9,620.00" "$2,580.18" "$13,000.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.53" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$2,709.34" "$13,000.00" "$13,000.00" "$6,409.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$9,750.00" "$13,000.00" "$13,000.00" "$13,000.00" "$6,500.00" "$6,500.00" "$10,296.00" "$13,000.00" "$10,400.00" "$5,850.00" "$2,580.18" N/A "$7,540.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" "$13,000.00" N/A N/A 7002500 SUP HCPCS C1713 7002500 - SCREW SET CROSSLINK SPN 5.5 MM ROD BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7002525 SUP HCPCS C1713 7002525 - LINK SPINAL SMALL PLATE CONCTR CROSSLINK VERTEX MAX TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7002526 SUP HCPCS C1713 7002526 - CONNECTOR SPINAL MEDIUM PLATE CROSSLINK VERTEX MAX TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7002527 SUP Custom 27803010 7002527 - CONNECTOR ROD LARGE PLATE ADJUSTABLE VERTEX MAX CROSSLINK BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7020500 SUP HCPCS C1713 7020500 - SCREW BONE 5.5MM 100MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020535 SUP HCPCS C1713 7020535 - SCREW BONE 5.5MM 35MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020540 SUP HCPCS C1713 7020540 - SCREW BONE 5.5MM 40MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020545 SUP HCPCS C1713 7020545 - SCREW BONE 5.5MM 45MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020550 SUP HCPCS C1713 7020550 - SCREW BONE 5.5MM 50MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020555 SUP HCPCS C1713 7020555 - SCREW BONE 5.5MM 55MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020560 SUP HCPCS C1713 7020560 - SCREW BONE 5.5MM 60MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020570 SUP HCPCS C1713 7020570 - SCREW BONE 5.5MM 70MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020580 SUP HCPCS C1713 7020580 - SCREW BONE 5.5MM 80MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020590 SUP HCPCS C1713 7020590 - SCREW BONE 5.5MM 90MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020600 SUP HCPCS C1713 7020600 - SCREW BONE 6.5MM 100MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020635 SUP HCPCS C1713 7020635 - SCREW BONE 6.5MM 35MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020640 SUP HCPCS C1713 7020640 - SCREW BONE 6.5MM 40MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7020645 SUP HCPCS C1713 7020645 - SCREW BONE 6.5MM 45MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7020650 SUP HCPCS C1713 7020650 - SCREW BONE 6.5MM 50MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020655 SUP HCPCS C1713 7020655 - SCREW BONE 6.5MM 55MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020660 SUP HCPCS C1713 7020660 - SCREW BONE 6.5MM 60MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020670 SUP HCPCS C1713 7020670 - SCREW BONE 6.5MM 70MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020680 SUP HCPCS C1713 7020680 - SCREW BONE 6.5MM 80MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020690 SUP HCPCS C1713 7020690 - SCREW BONE 6.5MM 90MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020700 SUP HCPCS C1713 7020700 - SCREW BONE 7.5MM 100MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020735 SUP HCPCS C1713 7020735 - SCREW BONE 7.5MM 35MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020740 SUP HCPCS C1713 7020740 - SCREW BONE 7.5MM 40MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020745 SUP HCPCS C1713 7020745 - SCREW BONE 7.5MM 45MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020750 SUP HCPCS C1713 7020750 - SCREW BONE 7.5MM 50MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020755 SUP HCPCS C1713 7020755 - SCREW BONE 7.5MM 55MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020760 SUP HCPCS C1713 7020760 - SCREW BONE 7.5MM 60MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7020770 SUP HCPCS C1713 7020770 - SCREW BONE 7.5MM 70MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7020780 SUP HCPCS C1713 7020780 - SCREW BONE 7.5MM 80MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7020790 SUP HCPCS C1713 7020790 - SCREW BONE 7.5MM 90MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020800 SUP HCPCS C1713 7020800 - SCREW BONE 8.5MM 100MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020835 SUP HCPCS C1713 7020835 - SCREW BONE 8.5MM 35MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020840 SUP HCPCS C1713 7020840 - SCREW BONE 8.5MM 40MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020845 SUP HCPCS C1713 7020845 - SCREW BONE 8.5MM 45MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020850 SUP HCPCS C1713 7020850 - SCREW BONE 8.5MM 50MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7020860 SUP HCPCS C1713 7020860 - SCREW BONE 8.5MM 60MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7020870 SUP HCPCS C1713 7020870 - SCREW BONE 8.5MM 70MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7020880 SUP HCPCS C1713 7020880 - SCREW BONE 8.5MM 80MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7020890 SUP HCPCS C1713 7020890 - SCREW BONE 8.5MM 90MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021210 SUP Custom 27803010 7021210 - CONNECTOR ROD 4.5/6.35MM 10MM CLOSE OFFST CD HORIZON LEGACY BOTH IP/OP "$1,730.50" "$1,281.00" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $360.59 "$1,730.18" $692.07 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,297.88" "$1,730.18" "$1,730.18" "$1,730.18" $865.09 $865.09 "$1,370.30" "$1,730.18" "$1,384.14" $778.58 "$1,730.18" N/A "$1,003.69" "$1,730.18" "$1,038.11" "$1,730.18" "$1,730.18" "$1,730.18" N/A N/A 7021220 SUP Custom 27803010 7021220 - CONNECTOR ROD 4.5/6.35MM 20MM CLOSE OFFST CD HORIZON LEGACY BOTH IP/OP "$1,730.50" "$1,281.00" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $360.59 "$1,730.18" $692.07 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,297.88" "$1,730.18" "$1,730.18" "$1,730.18" $865.09 $865.09 "$1,370.30" "$1,730.18" "$1,384.14" $778.58 "$1,730.18" N/A "$1,003.69" "$1,730.18" "$1,038.11" "$1,730.18" "$1,730.18" "$1,730.18" N/A N/A 7021230 SUP Custom 27803010 7021230 - CONNECTOR ROD 4.5/6.35MM 30MM CLOSE OFFST CD HORIZON LEGACY BOTH IP/OP "$1,730.50" "$1,281.00" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $360.59 "$1,730.18" $692.07 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,297.88" "$1,730.18" "$1,730.18" "$1,730.18" $865.09 $865.09 "$1,370.30" "$1,730.18" "$1,384.14" $778.58 "$1,730.18" N/A "$1,003.69" "$1,730.18" "$1,038.11" "$1,730.18" "$1,730.18" "$1,730.18" N/A N/A 7021310 SUP Custom 27803010 7021310 - CONNECTOR ROD 5.5/6.35MM 10MM CLOSE OFFST CD HORIZON LEGACY BOTH IP/OP "$1,730.50" "$1,281.00" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $360.59 "$1,730.18" $692.07 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,297.88" "$1,730.18" "$1,730.18" "$1,730.18" $865.09 $865.09 "$1,370.30" "$1,730.18" "$1,384.14" $778.58 "$1,730.18" N/A "$1,003.69" "$1,730.18" "$1,038.11" "$1,730.18" "$1,730.18" "$1,730.18" N/A N/A 7021320 SUP Custom 27803010 7021320 - CONNECTOR ROD 5.5/6.35MM 20MM CLOSE CD HORIZON LEGACY BOTH IP/OP "$1,730.50" "$1,281.00" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $360.59 "$1,730.18" $692.07 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,297.88" "$1,730.18" "$1,730.18" "$1,730.18" $865.09 $865.09 "$1,370.30" "$1,730.18" "$1,384.14" $778.58 "$1,730.18" N/A "$1,003.69" "$1,730.18" "$1,038.11" "$1,730.18" "$1,730.18" "$1,730.18" N/A N/A 7021330 SUP Custom 27803010 7021330 - CONNECTOR ROD OFFST 5.5/6.35MM 30MM CLOSE CD HORIZON LEGACY BOTH IP/OP "$1,730.50" "$1,281.00" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $360.59 "$1,730.18" $692.07 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,297.88" "$1,730.18" "$1,730.18" "$1,730.18" $865.09 $865.09 "$1,370.30" "$1,730.18" "$1,384.14" $778.58 "$1,730.18" N/A "$1,003.69" "$1,730.18" "$1,038.11" "$1,730.18" "$1,730.18" "$1,730.18" N/A N/A 7021360 SUP Custom 27803010 7021360 - CONNECTOR ROD OFFST 5.5/6.35MM 60MM CLOSE CD HORIZON LEGACY BOTH IP/OP "$1,730.50" "$1,281.00" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $360.59 "$1,730.18" $692.07 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,297.88" "$1,730.18" "$1,730.18" "$1,730.18" $865.09 $865.09 "$1,370.30" "$1,730.18" "$1,384.14" $778.58 "$1,730.18" N/A "$1,003.69" "$1,730.18" "$1,038.11" "$1,730.18" "$1,730.18" "$1,730.18" N/A N/A 7021410 SUP Custom 27803010 7021410 - CONNECTOR ROD OFFST 6.35MM 10MM CLOSE CD HORIZON LEGACY BOTH IP/OP "$1,730.50" "$1,281.00" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $360.59 "$1,730.18" $692.07 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,297.88" "$1,730.18" "$1,730.18" "$1,730.18" $865.09 $865.09 "$1,370.30" "$1,730.18" "$1,384.14" $778.58 "$1,730.18" N/A "$1,003.69" "$1,730.18" "$1,038.11" "$1,730.18" "$1,730.18" "$1,730.18" N/A N/A 7021420 SUP Custom 27803010 7021420 - CONNECTOR ROD OFFST 6.35MM 20MM CLOSE CD HORIZON LEGACY BOTH IP/OP "$1,730.50" "$1,281.00" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $360.59 "$1,730.18" $692.07 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,297.88" "$1,730.18" "$1,730.18" "$1,730.18" $865.09 $865.09 "$1,370.30" "$1,730.18" "$1,384.14" $778.58 "$1,730.18" N/A "$1,003.69" "$1,730.18" "$1,038.11" "$1,730.18" "$1,730.18" "$1,730.18" N/A N/A 7021430 SUP Custom 27803010 7021430 - CONNECTOR ROD 6.35MM 30MM CLOSE END CD HORIZON LEGACY BOTH IP/OP "$1,730.50" "$1,281.00" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $360.59 "$1,730.18" $692.07 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,297.88" "$1,730.18" "$1,730.18" "$1,730.18" $865.09 $865.09 "$1,370.30" "$1,730.18" "$1,384.14" $778.58 "$1,730.18" N/A "$1,003.69" "$1,730.18" "$1,038.11" "$1,730.18" "$1,730.18" "$1,730.18" N/A N/A 7021460 SUP Custom 27803010 7021460 - CONNECTOR ROD 6.35MM 60MM CLOSE STAINLESS STEEL SPN LATERAL BOTH IP/OP "$1,730.50" "$1,281.00" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $307.97 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" $360.59 "$1,730.18" $692.07 "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,730.18" "$1,297.88" "$1,730.18" "$1,730.18" "$1,730.18" $865.09 $865.09 "$1,370.30" "$1,730.18" "$1,384.14" $778.58 "$1,730.18" N/A "$1,003.69" "$1,730.18" "$1,038.11" "$1,730.18" "$1,730.18" "$1,730.18" N/A N/A 7021600 SUP HCPCS C1713 7021600 - SCREW BONE 10D 6.5MM 100MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021635 SUP HCPCS C1713 7021635 - SCREW BONE 10D 6.5MM 35MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021640 SUP HCPCS C1713 7021640 - SCREW BONE 10D 6.5MM 40MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021645 SUP HCPCS C1713 7021645 - SCREW BONE 10D 6.5MM 45MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021650 SUP HCPCS C1713 7021650 - SCREW BONE 10D 6.5MM 50MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021655 SUP HCPCS C1713 7021655 - SCREW BONE 10D 6.5MM 55MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021660 SUP HCPCS C1713 7021660 - SCREW BONE 10D 6.5MM 60MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021670 SUP HCPCS C1713 7021670 - SCREW BONE 10D 6.5MM 70MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021680 SUP HCPCS C1713 7021680 - SCREW BONE 10D 6.5MM 80MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021690 SUP HCPCS C1713 7021690 - SCREW BONE 10D 6.5MM 90MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021700 SUP HCPCS C1713 7021700 - SCREW BONE 10D 7.5MM 100MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021735 SUP HCPCS C1713 7021735 - SCREW BONE 10D 7.5MM 35MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021740 SUP HCPCS C1713 7021740 - SCREW BONE 10D 7.5MM 40MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021745 SUP HCPCS C1713 7021745 - SCREW BONE 10D 7.5MM 45MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021750 SUP HCPCS C1713 7021750 - SCREW BONE 10D 7.5MM 50MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021755 SUP HCPCS C1713 7021755 - SCREW BONE 10D 7.5MM 55MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021760 SUP HCPCS C1713 7021760 - SCREW BONE 10D 7.5MM 60MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7021770 SUP HCPCS C1713 7021770 - SCREW BONE 10D 7.5MM 70MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021780 SUP HCPCS C1713 7021780 - SCREW BONE 10D 7.5MM 80MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021790 SUP HCPCS C1713 7021790 - SCREW BONE 10D 7.5MM 90MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021800 SUP HCPCS C1713 7021800 - SCREW BONE 10D 8.5MM 100MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021835 SUP HCPCS C1713 7021835 - SCREW BONE 10D 8.5MM 35MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021840 SUP HCPCS C1713 7021840 - SCREW BONE 10D 8.5MM 40MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021845 SUP HCPCS C1713 7021845 - SCREW BONE 10D 8.5MM 45MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021850 SUP HCPCS C1713 7021850 - SCREW BONE 10D 8.5MM 50MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021855 SUP HCPCS C1713 7021855 - SCREW BONE 10D 8.5MM 55MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021860 SUP HCPCS C1713 7021860 - SCREW BONE 10D 8.5MM 60MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021870 SUP HCPCS C1713 7021870 - SCREW BONE 10D 8.5MM 70MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021880 SUP HCPCS C1713 7021880 - SCREW BONE 10D 8.5MM 80MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7021890 SUP HCPCS C1713 7021890 - SCREW BONE 10D 8.5MM 90MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7022210 SUP Custom 27803010 7022210 - CONNECTOR ROD 4.5MM 12MM STAINLESS STEEL LATERAL SPN BOTH IP/OP "$1,982.00" "$1,467.00" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $413.04 "$1,981.85" $792.74 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,486.50" "$1,981.85" "$1,981.85" "$1,981.85" $990.93 $990.93 "$1,569.63" "$1,981.85" "$1,585.48" $891.83 "$1,981.85" N/A "$1,149.56" "$1,981.85" "$1,189.11" "$1,981.85" "$1,981.85" "$1,981.85" N/A N/A 7022230 SUP Custom 27803010 7022230 - CONNECTOR ROD 4.5MM 32MM STAINLESS STEEL LATERAL SPN BOTH IP/OP "$1,982.00" "$1,467.00" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $413.04 "$1,981.85" $792.74 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,486.50" "$1,981.85" "$1,981.85" "$1,981.85" $990.93 $990.93 "$1,569.63" "$1,981.85" "$1,585.48" $891.83 "$1,981.85" N/A "$1,149.56" "$1,981.85" "$1,189.11" "$1,981.85" "$1,981.85" "$1,981.85" N/A N/A 7022310 SUP Custom 27803010 7022310 - CONNECTOR ROD 5.5MM 12MM STAINLESS STEEL LATERAL SPN BOTH IP/OP "$1,982.00" "$1,467.00" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $413.04 "$1,981.85" $792.74 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,486.50" "$1,981.85" "$1,981.85" "$1,981.85" $990.93 $990.93 "$1,569.63" "$1,981.85" "$1,585.48" $891.83 "$1,981.85" N/A "$1,149.56" "$1,981.85" "$1,189.11" "$1,981.85" "$1,981.85" "$1,981.85" N/A N/A 7022330 SUP Custom 27803010 7022330 - CONNECTOR ROD 5.5MM 32MM STAINLESS STEEL LATERAL SPN BOTH IP/OP "$1,982.00" "$1,467.00" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $413.04 "$1,981.85" $792.74 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,486.50" "$1,981.85" "$1,981.85" "$1,981.85" $990.93 $990.93 "$1,569.63" "$1,981.85" "$1,585.48" $891.83 "$1,981.85" N/A "$1,149.56" "$1,981.85" "$1,189.11" "$1,981.85" "$1,981.85" "$1,981.85" N/A N/A 7022410 SUP Custom 27803010 7022410 - CONNECTOR SPINAL 6.35MM 12MM CD HORIZON STAINLESS STEEL BOTH IP/OP "$1,982.00" "$1,467.00" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $413.04 "$1,981.85" $792.74 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,486.50" "$1,981.85" "$1,981.85" "$1,981.85" $990.93 $990.93 "$1,569.63" "$1,981.85" "$1,585.48" $891.83 "$1,981.85" N/A "$1,149.56" "$1,981.85" "$1,189.11" "$1,981.85" "$1,981.85" "$1,981.85" N/A N/A 7022430 SUP Custom 27803010 7022430 - CONNECTOR ROD 6.35MM 32MM STAINLESS STEEL LATERAL BOTH IP/OP "$1,982.00" "$1,467.00" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $413.04 "$1,981.85" $792.74 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,486.50" "$1,981.85" "$1,981.85" "$1,981.85" $990.93 $990.93 "$1,569.63" "$1,981.85" "$1,585.48" $891.83 "$1,981.85" N/A "$1,149.56" "$1,981.85" "$1,189.11" "$1,981.85" "$1,981.85" "$1,981.85" N/A N/A 7022600 SUP HCPCS C1713 7022600 - SCREW BONE 20D 6.5MM 100MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022635 SUP HCPCS C1713 7022635 - SCREW BONE 20D 6.5MM 35MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022640 SUP HCPCS C1713 7022640 - SCREW BONE 20D 6.5MM 40MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022645 SUP HCPCS C1713 7022645 - SCREW BONE 20D 6.5MM 45MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022650 SUP HCPCS C1713 7022650 - SCREW BONE 20D 6.5MM 50MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022655 SUP HCPCS C1713 7022655 - SCREW BONE 20D 6.5MM 55MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022660 SUP HCPCS C1713 7022660 - SCREW BONE 20D 6.5MM 60MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022670 SUP HCPCS C1713 7022670 - SCREW BONE 20D 6.5MM 70MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022680 SUP HCPCS C1713 7022680 - SCREW BONE 20D 6.5MM 80MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022690 SUP HCPCS C1713 7022690 - SCREW BONE 20D 6.5MM 90MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022700 SUP HCPCS C1713 7022700 - SCREW BONE 20D 7.5MM 100MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022735 SUP HCPCS C1713 7022735 - SCREW BONE 20D 7.5MM 35MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022740 SUP HCPCS C1713 7022740 - SCREW BONE 20D 7.5MM 40MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022750 SUP HCPCS C1713 7022750 - SCREW BONE 20D 7.5MM 50MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022755 SUP HCPCS C1713 7022755 - SCREW BONE 20D 7.5MM 55MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022760 SUP HCPCS C1713 7022760 - SCREW BONE 20D 7.5MM 60MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022770 SUP HCPCS C1713 7022770 - SCREW BONE 20D 7.5MM 70MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7022780 SUP HCPCS C1713 7022780 - SCREW BONE 20D 7.5MM 80MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022790 SUP HCPCS C1713 7022790 - SCREW BONE 20D 7.5MM 90MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7022800 SUP HCPCS C1713 7022800 - SCREW BONE 20D 8.5MM 100MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022835 SUP HCPCS C1713 7022835 - SCREW BONE 20D 8.5MM 35MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022840 SUP HCPCS C1713 7022840 - SCREW BONE 20D 8.5MM 40MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7022845 SUP HCPCS C1713 7022845 - SCREW BONE 20D 8.5MM 45MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7022850 SUP HCPCS C1713 7022850 - SCREW BONE 20D 8.5MM 50MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022855 SUP HCPCS C1713 7022855 - SCREW BONE 20D 8.5MM 55MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7022860 SUP HCPCS C1713 7022860 - SCREW BONE 20D 8.5MM 60MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7022870 SUP HCPCS C1713 7022870 - SCREW BONE 20D 8.5MM 70MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7022880 SUP HCPCS C1713 7022880 - SCREW BONE 20D 8.5MM 80MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7022890 SUP HCPCS C1713 7022890 - SCREW BONE 20D 8.5MM 90MM LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7023130 SUP Custom 27203010 7023130 - CASE STERILIZATION ILIAC SCREW SET BOTH IP/OP $409.50 $303.00 $72.89 $409.50 $409.50 $409.50 $409.50 $409.50 $409.50 $409.50 $72.89 $409.50 $409.50 $303.93 $303.93 $315.64 $213.35 $85.34 $409.50 $163.80 $409.50 $409.50 $409.50 $409.50 $409.50 $307.13 $409.50 $409.50 $409.50 $204.75 $204.75 $324.32 $409.50 $327.60 $266.18 $409.50 N/A $237.51 $409.50 $245.70 $409.50 $409.50 $409.50 N/A N/A 7024855 SUP HCPCS C1713 7024855 - SCREW SET 32 THREAD .25IN BREAKOFF CD HORIZON LEGACY BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7025855 SUP HCPCS C1713 7025855 - SCREW SET 32 THREAD .25IN BREAKOFF STAINLESS STEEL SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 7030500 SUP HCPCS C1713 7030500 - SCREW BONE 5.5MM 100MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7030550 SUP HCPCS C1713 7030550 - SCREW BONE 5.5MM 50MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7030555 SUP HCPCS C1713 7030555 - SCREW BONE 5.5MM 55MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7030560 SUP HCPCS C1713 7030560 - SCREW BONE 5.5MM 60MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$2,134.10" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7030570 SUP HCPCS C1713 7030570 - SCREW BONE 5.5MM 70MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7030580 SUP HCPCS C1713 7030580 - SCREW BONE 5.5MM 80MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" "$2,134.10" "$2,134.10" N/A N/A 7030590 SUP HCPCS C1713 7030590 - SCREW BONE 5.5MM 90MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7030600 SUP HCPCS C1713 7030600 - SCREW BONE 6.5MM 100MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7030655 SUP HCPCS C1713 7030655 - SCREW BONE 6.5MM 55MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7030680 SUP HCPCS C1713 7030680 - SCREW BONE 6.5MM 80MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7030690 SUP HCPCS C1713 7030690 - SCREW BONE 6.5MM 90MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7030750 SUP HCPCS C1713 7030750 - SCREW BONE 7.5MM 50MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7030755 SUP HCPCS C1713 7030755 - SCREW BONE 7.5MM 55MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7030850 SUP HCPCS C1713 7030850 - SCREW BONE 8.5MM 50MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" "$2,134.10" "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7030855 SUP HCPCS C1713 7030855 - SCREW BONE 8.5MM 55MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7030860 SUP HCPCS C1713 7030860 - SCREW BONE 8.5MM 60MM LEGACY CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$2,134.50" "$1,580.00" $423.57 "$2,134.10" $960.35 $960.35 $960.35 $960.35 "$2,134.10" "$2,134.10" "$2,134.10" $444.80 "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" $444.77 "$2,134.10" $853.64 "$1,262.32" "$2,134.10" "$2,134.10" "$2,134.10" "$2,134.10" "$1,600.88" "$2,134.10" "$2,134.10" "$2,134.10" "$1,067.05" "$1,067.05" "$1,690.21" "$2,134.10" "$1,707.28" $960.35 $423.57 N/A "$1,238.01" "$2,134.10" "$1,280.46" "$2,134.10" $444.75 "$2,134.10" N/A N/A 7040500 SUP HCPCS C1713 7040500 - SCREW BONE 5.5MM 100MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040535 SUP HCPCS C1713 7040535 - SCREW BONE 5.5MM 35MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040540 SUP HCPCS C1713 7040540 - SCREW BONE 5.5MM 40MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040545 SUP HCPCS C1713 7040545 - SCREW BONE 5.5MM 45MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040550 SUP HCPCS C1713 7040550 - SCREW BONE 5.5MM 50MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040555 SUP HCPCS C1713 7040555 - SCREW BONE 5.5MM 55MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040570 SUP HCPCS C1713 7040570 - SCREW BONE 5.5MM 70MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040580 SUP HCPCS C1713 7040580 - SCREW BONE 5.5MM 80MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040590 SUP HCPCS C1713 7040590 - SCREW BONE 5.5MM 90MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040600 SUP HCPCS C1713 7040600 - SCREW BONE 6.5MM 100MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7040635 SUP HCPCS C1713 7040635 - SCREW BONE 6.5MM 35MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040640 SUP HCPCS C1713 7040640 - SCREW BONE 6.5MM 40MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040645 SUP HCPCS C1713 7040645 - SCREW BONE 6.5MM 45MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040650 SUP HCPCS C1713 7040650 - SCREW BONE 6.5MM 50MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040655 SUP HCPCS C1713 7040655 - SCREW BONE 6.5MM 55MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040660 SUP HCPCS C1713 7040660 - SCREW BONE 6.5MM 60MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040670 SUP HCPCS C1713 7040670 - SCREW BONE 6.5MM 70MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040680 SUP HCPCS C1713 7040680 - SCREW BONE 6.5MM 80MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040690 SUP HCPCS C1713 7040690 - SCREW BONE 6.5MM 90MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040700 SUP HCPCS C1713 7040700 - SCREW BONE 7.5MM 100MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040740 SUP HCPCS C1713 7040740 - SCREW BONE 7.5MM 40MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040745 SUP HCPCS C1713 7040745 - SCREW BONE 7.5MM 45MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040750 SUP HCPCS C1713 7040750 - SCREW BONE 7.5MM 50MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7040755 SUP HCPCS C1713 7040755 - SCREW BONE 7.5MM 55MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7040760 SUP HCPCS C1713 7040760 - SCREW BONE 7.5MM 60MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040770 SUP HCPCS C1713 7040770 - SCREW BONE 7.5MM 70MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040780 SUP HCPCS C1713 7040780 - SCREW BONE 7.5MM 80MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040790 SUP HCPCS C1713 7040790 - SCREW BONE 7.5MM 90MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040800 SUP HCPCS C1713 7040800 - SCREW BONE 8.5MM 100MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040835 SUP HCPCS C1713 7040835 - SCREW BONE 8.5MM 35MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040840 SUP HCPCS C1713 7040840 - SCREW BONE 8.5MM 40MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040845 SUP HCPCS C1713 7040845 - SCREW BONE 8.5MM 45MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040850 SUP HCPCS C1713 7040850 - SCREW BONE 8.5MM 50MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040860 SUP HCPCS C1713 7040860 - SCREW BONE 8.5MM 60MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7040870 SUP HCPCS C1713 7040870 - SCREW BONE 8.5MM 70MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7040880 SUP HCPCS C1713 7040880 - SCREW BONE 8.5MM 80MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7040890 SUP HCPCS C1713 7040890 - SCREW BONE 8.5MM 90MM LEGACY CD HORIZON TITANIUM SPN ILIAC BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041210 SUP Custom 27803010 7041210 - CONNECTOR ROD 10MM CLOSE OFFST CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,844.00" "$1,365.00" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $384.23 "$1,843.63" $737.45 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,383.00" "$1,843.63" "$1,843.63" "$1,843.63" $921.82 $921.82 "$1,460.15" "$1,843.63" "$1,474.90" $829.63 "$1,843.63" N/A "$1,069.52" "$1,843.63" "$1,106.18" "$1,843.63" "$1,843.63" "$1,843.63" N/A N/A 7041220 SUP Custom 27803010 7041220 - CONNECTOR ROD 20MM CLOSE OFFST CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,844.00" "$1,365.00" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $384.23 "$1,843.63" $737.45 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,383.00" "$1,843.63" "$1,843.63" "$1,843.63" $921.82 $921.82 "$1,460.15" "$1,843.63" "$1,474.90" $829.63 "$1,843.63" N/A "$1,069.52" "$1,843.63" "$1,106.18" "$1,843.63" "$1,843.63" "$1,843.63" N/A N/A 7041230 SUP Custom 27803010 7041230 - CONNECTOR ROD 30MM CLOSE OFFST CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,844.00" "$1,365.00" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $384.23 "$1,843.63" $737.45 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,383.00" "$1,843.63" "$1,843.63" "$1,843.63" $921.82 $921.82 "$1,460.15" "$1,843.63" "$1,474.90" $829.63 "$1,843.63" N/A "$1,069.52" "$1,843.63" "$1,106.18" "$1,843.63" "$1,843.63" "$1,843.63" N/A N/A 7041310 SUP Custom 27803010 7041310 - CONNECTOR ROD OFFST 10MM CLOSE CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,844.00" "$1,365.00" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $384.23 "$1,843.63" $737.45 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,383.00" "$1,843.63" "$1,843.63" "$1,843.63" $921.82 $921.82 "$1,460.15" "$1,843.63" "$1,474.90" $829.63 "$1,843.63" N/A "$1,069.52" "$1,843.63" "$1,106.18" "$1,843.63" "$1,843.63" "$1,843.63" N/A N/A 7041320 SUP Custom 27803010 7041320 - CONNECTOR ROD OFFST 20MM CLOSE CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,844.00" "$1,365.00" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $384.23 "$1,843.63" $737.45 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,383.00" "$1,843.63" "$1,843.63" "$1,843.63" $921.82 $921.82 "$1,460.15" "$1,843.63" "$1,474.90" $829.63 "$1,843.63" N/A "$1,069.52" "$1,843.63" "$1,106.18" "$1,843.63" "$1,843.63" "$1,843.63" N/A N/A 7041330 SUP Custom 27803010 7041330 - CONNECTOR ROD 5.5-6.35MM 30MM CLOSE CD HORIZON LEGACY BOTH IP/OP "$1,844.00" "$1,365.00" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $384.23 "$1,843.63" $737.45 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,383.00" "$1,843.63" "$1,843.63" "$1,843.63" $921.82 $921.82 "$1,460.15" "$1,843.63" "$1,474.90" $829.63 "$1,843.63" N/A "$1,069.52" "$1,843.63" "$1,106.18" "$1,843.63" "$1,843.63" "$1,843.63" N/A N/A 7041360 SUP Custom 27803010 7041360 - CONNECTOR ROD OFFST 60MM CLOSE CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,844.00" "$1,365.00" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $384.23 "$1,843.63" $737.45 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,383.00" "$1,843.63" "$1,843.63" "$1,843.63" $921.82 $921.82 "$1,460.15" "$1,843.63" "$1,474.90" $829.63 "$1,843.63" N/A "$1,069.52" "$1,843.63" "$1,106.18" "$1,843.63" "$1,843.63" "$1,843.63" N/A N/A 7041410 SUP Custom 27803010 7041410 - CONNECTOR ROD OFFST 10MM CLOSE CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,844.00" "$1,365.00" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $384.23 "$1,843.63" $737.45 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,383.00" "$1,843.63" "$1,843.63" "$1,843.63" $921.82 $921.82 "$1,460.15" "$1,843.63" "$1,474.90" $829.63 "$1,843.63" N/A "$1,069.52" "$1,843.63" "$1,106.18" "$1,843.63" "$1,843.63" "$1,843.63" N/A N/A 7041420 SUP Custom 27803010 7041420 - CONNECTOR ROD 6.35MM 20MM CLOSE CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,844.00" "$1,365.00" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $384.23 "$1,843.63" $737.45 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,383.00" "$1,843.63" "$1,843.63" "$1,843.63" $921.82 $921.82 "$1,460.15" "$1,843.63" "$1,474.90" $829.63 "$1,843.63" N/A "$1,069.52" "$1,843.63" "$1,106.18" "$1,843.63" "$1,843.63" "$1,843.63" N/A N/A 7041430 SUP Custom 27803010 7041430 - CONNECTOR ROD OFFST 30MM CLOSE CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,844.00" "$1,365.00" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $384.23 "$1,843.63" $737.45 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,383.00" "$1,843.63" "$1,843.63" "$1,843.63" $921.82 $921.82 "$1,460.15" "$1,843.63" "$1,474.90" $829.63 "$1,843.63" N/A "$1,069.52" "$1,843.63" "$1,106.18" "$1,843.63" "$1,843.63" "$1,843.63" N/A N/A 7041460 SUP Custom 27803010 7041460 - CONNECTOR ROD OFFST 60MM CLOSE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,844.00" "$1,365.00" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $328.17 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" $384.23 "$1,843.63" $737.45 "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,843.63" "$1,383.00" "$1,843.63" "$1,843.63" "$1,843.63" $921.82 $921.82 "$1,460.15" "$1,843.63" "$1,474.90" $829.63 "$1,843.63" N/A "$1,069.52" "$1,843.63" "$1,106.18" "$1,843.63" "$1,843.63" "$1,843.63" N/A N/A 7041600 SUP HCPCS C1713 7041600 - SCREW BONE 10D 6.5MM 100MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041635 SUP HCPCS C1713 7041635 - SCREW BONE 10D 6.5MM 35MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041640 SUP HCPCS C1713 7041640 - SCREW BONE 10D 6.5MM 40MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7041645 SUP HCPCS C1713 7041645 - SCREW BONE 10D 6.5MM 45MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7041650 SUP HCPCS C1713 7041650 - SCREW BONE 10D 6.5MM 50MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041655 SUP HCPCS C1713 7041655 - SCREW BONE 10D 6.5MM 55MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041660 SUP HCPCS C1713 7041660 - SCREW BONE 10D 6.5MM 60MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041670 SUP HCPCS C1713 7041670 - SCREW BONE 10D 6.5MM 70MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041680 SUP HCPCS C1713 7041680 - SCREW BONE 10D 6.5MM 80MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041690 SUP HCPCS C1713 7041690 - SCREW BONE 10D 6.5MM 90MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041700 SUP HCPCS C1713 7041700 - SCREW BONE 10D 7.5MM 100MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041735 SUP HCPCS C1713 7041735 - SCREW BONE 10D 7.5MM 35MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041740 SUP HCPCS C1713 7041740 - SCREW BONE 10D 7.5MM 40MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041745 SUP HCPCS C1713 7041745 - SCREW BONE 10D 7.5MM 45MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041750 SUP HCPCS C1713 7041750 - SCREW BONE 10D 7.5MM 50MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041755 SUP HCPCS C1713 7041755 - SCREW BONE 10D 7.5MM 55MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041760 SUP HCPCS C1713 7041760 - SCREW BONE 10D 7.5MM 60MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041770 SUP HCPCS C1713 7041770 - SCREW BONE 10D 7.5MM 70MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041780 SUP HCPCS C1713 7041780 - SCREW BONE 10D 7.5MM 80MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041790 SUP HCPCS C1713 7041790 - SCREW BONE 10D 7.5MM 90MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041800 SUP HCPCS C1713 7041800 - SCREW BONE 10D 8.5MM 100MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041835 SUP HCPCS C1713 7041835 - SCREW BONE 10D 8.5MM 35MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041840 SUP HCPCS C1713 7041840 - SCREW BONE 10D 8.5MM 40MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041845 SUP HCPCS C1713 7041845 - SCREW BONE 10D 8.5MM 45MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041850 SUP HCPCS C1713 7041850 - SCREW BONE 10D 8.5MM 50MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7041855 SUP HCPCS C1713 7041855 - SCREW BONE 10D 8.5MM 55MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7041860 SUP HCPCS C1713 7041860 - SCREW BONE 10D 8.5MM 60MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7041870 SUP HCPCS C1713 7041870 - SCREW BONE 10D 8.5MM 70MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7041880 SUP HCPCS C1713 7041880 - SCREW BONE 10D 8.5MM 80MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7041890 SUP HCPCS C1713 7041890 - SCREW BONE 10D 8.5MM 90MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042210 SUP Custom 27803010 7042210 - CONNECTOR ROD 4.5MM 12MM TITANIUM LATERAL SPN BOTH IP/OP "$2,176.00" "$1,610.00" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $453.49 "$2,175.95" $870.38 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$1,632.00" "$2,175.95" "$2,175.95" "$2,175.95" "$1,087.98" "$1,087.98" "$1,723.35" "$2,175.95" "$1,740.76" $979.18 "$2,175.95" N/A "$1,262.08" "$2,175.95" "$1,305.57" "$2,175.95" "$2,175.95" "$2,175.95" N/A N/A 7042230 SUP Custom 27803010 7042230 - CONNECTOR ROD 4.5MM 32MM TITANIUM LATERAL SPN BOTH IP/OP "$2,176.00" "$1,610.00" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $453.49 "$2,175.95" $870.38 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$1,632.00" "$2,175.95" "$2,175.95" "$2,175.95" "$1,087.98" "$1,087.98" "$1,723.35" "$2,175.95" "$1,740.76" $979.18 "$2,175.95" N/A "$1,262.08" "$2,175.95" "$1,305.57" "$2,175.95" "$2,175.95" "$2,175.95" N/A N/A 7042310 SUP Custom 27803010 7042310 - CONNECTOR ROD 5.5MM 12MM OFFST DOMINO TITANIUM LATERAL SPN BOTH IP/OP "$2,176.00" "$1,610.00" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $453.49 "$2,175.95" $870.38 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$1,632.00" "$2,175.95" "$2,175.95" "$2,175.95" "$1,087.98" "$1,087.98" "$1,723.35" "$2,175.95" "$1,740.76" $979.18 "$2,175.95" N/A "$1,262.08" "$2,175.95" "$1,305.57" "$2,175.95" "$2,175.95" "$2,175.95" N/A N/A 7042320 SUP Custom 27803010 7042320 - CONNECTOR ROD 5.5MM 22MM TITANIUM LATERAL SPN BOTH IP/OP "$2,176.00" "$1,610.00" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $453.49 "$2,175.95" $870.38 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$1,632.00" "$2,175.95" "$2,175.95" "$2,175.95" "$1,087.98" "$1,087.98" "$1,723.35" "$2,175.95" "$1,740.76" $979.18 "$2,175.95" N/A "$1,262.08" "$2,175.95" "$1,305.57" "$2,175.95" "$2,175.95" "$2,175.95" N/A N/A 7042330 SUP Custom 27803010 7042330 - CONNECTOR ROD 5.5MM 32MM OFFST DOMINO TITANIUM LATERAL BOTH IP/OP "$2,176.00" "$1,610.00" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $453.49 "$2,175.95" $870.38 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$1,632.00" "$2,175.95" "$2,175.95" "$2,175.95" "$1,087.98" "$1,087.98" "$1,723.35" "$2,175.95" "$1,740.76" $979.18 "$2,175.95" N/A "$1,262.08" "$2,175.95" "$1,305.57" "$2,175.95" "$2,175.95" "$2,175.95" N/A N/A 7042410 SUP Custom 27803010 7042410 - CONNECTOR ROD 6.35MM 12MM TITANIUM LATERAL BOTH IP/OP "$2,176.00" "$1,610.00" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $453.49 "$2,175.95" $870.38 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$1,632.00" "$2,175.95" "$2,175.95" "$2,175.95" "$1,087.98" "$1,087.98" "$1,723.35" "$2,175.95" "$1,740.76" $979.18 "$2,175.95" N/A "$1,262.08" "$2,175.95" "$1,305.57" "$2,175.95" "$2,175.95" "$2,175.95" N/A N/A 7042430 SUP Custom 27803010 7042430 - CONNECTOR ROD 6.35MM 32MM TITANIUM LATERAL SPN BOTH IP/OP "$2,176.00" "$1,610.00" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $453.49 "$2,175.95" $870.38 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$1,632.00" "$2,175.95" "$2,175.95" "$2,175.95" "$1,087.98" "$1,087.98" "$1,723.35" "$2,175.95" "$1,740.76" $979.18 "$2,175.95" N/A "$1,262.08" "$2,175.95" "$1,305.57" "$2,175.95" "$2,175.95" "$2,175.95" N/A N/A 7042600 SUP HCPCS C1713 7042600 - SCREW BONE 20D 6.5MM 100MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042635 SUP HCPCS C1713 7042635 - SCREW BONE 20D 6.5MM 35MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042640 SUP HCPCS C1713 7042640 - SCREW BONE 20D 6.5MM 40MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042645 SUP HCPCS C1713 7042645 - SCREW BONE 20D 6.5MM 45MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042650 SUP HCPCS C1713 7042650 - SCREW BONE 20D 6.5MM 50MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042655 SUP HCPCS C1713 7042655 - SCREW BONE 20D 6.5MM 55MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042660 SUP HCPCS C1713 7042660 - SCREW BONE 20D 6.5MM 60MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042670 SUP HCPCS C1713 7042670 - SCREW BONE 20D 6.5MM 70MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7042680 SUP HCPCS C1713 7042680 - SCREW BONE 20D 6.5MM 80MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7042690 SUP HCPCS C1713 7042690 - SCREW BONE 20D 6.5MM 90MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042700 SUP HCPCS C1713 7042700 - SCREW BONE 20D 7.5MM 100MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042735 SUP HCPCS C1713 7042735 - SCREW BONE 20D 7.5MM 35MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042740 SUP HCPCS C1713 7042740 - SCREW BONE 20D 7.5MM 40MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042745 SUP HCPCS C1713 7042745 - SCREW BONE 20D 7.5MM 45MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042750 SUP HCPCS C1713 7042750 - SCREW BONE 20D 7.5MM 50MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042755 SUP HCPCS C1713 7042755 - SCREW BONE 20D 7.5MM 55MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042760 SUP HCPCS C1713 7042760 - SCREW BONE 20D 7.5MM 60MM LEGACY TITANIUM ILIAC SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042770 SUP HCPCS C1713 7042770 - SCREW BONE 20D 7.5MM 70MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042780 SUP HCPCS C1713 7042780 - SCREW BONE 20D 7.5MM 80MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7042790 SUP HCPCS C1713 7042790 - SCREW BONE 20D 7.5MM 90MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7042800 SUP HCPCS C1713 7042800 - SCREW BONE 20D 8.5MM 100MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7042835 SUP HCPCS C1713 7042835 - SCREW BONE 20D 8.5MM 35MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042840 SUP HCPCS C1713 7042840 - SCREW BONE 20D 8.5MM 40MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042845 SUP HCPCS C1713 7042845 - SCREW BONE 20D 8.5MM 45MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042850 SUP HCPCS C1713 7042850 - SCREW BONE 20D 8.5MM 50MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7042855 SUP HCPCS C1713 7042855 - SCREW BONE 20D 8.5MM 55MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7042860 SUP HCPCS C1713 7042860 - SCREW BONE 20D 8.5MM 60MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042870 SUP HCPCS C1713 7042870 - SCREW BONE 20D 8.5MM 70MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042880 SUP HCPCS C1713 7042880 - SCREW BONE 20D 8.5MM 80MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7042890 SUP HCPCS C1713 7042890 - SCREW BONE 20D 8.5MM 90MM LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7045855 SUP HCPCS C1713 7045855 - SCREW SET .25MM 32MM BREAK OFF CD HORIZON LEGACY TITANIUM BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7049855 SUP HCPCS C1713 7049855 - SCREW SET .25MM 32MM BREAKOFF HEXAGONAL HEAD TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7050500 SUP HCPCS C1713 7050500 - SCREW BONE 5.5MM 100MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7050550 SUP HCPCS C1713 7050550 - SCREW BONE 5.5MM 50MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7050555 SUP HCPCS C1713 7050555 - SCREW BONE 5.5MM 55MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7050560 SUP HCPCS C1713 7050560 - SCREW BONE 5.5MM 60MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7050570 SUP HCPCS C1713 7050570 - SCREW BONE 5.5MM 70MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7050580 SUP HCPCS C1713 7050580 - SCREW BONE 5.5MM 80MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7050590 SUP HCPCS C1713 7050590 - SCREW BONE 5.5MM 90MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7050600 SUP HCPCS C1713 7050600 - SCREW BONE 6.5MM 100MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7050655 SUP HCPCS C1713 7050655 - SCREW BONE 6.5MM 55MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7050680 SUP HCPCS C1713 7050680 - SCREW BONE 6.5MM 80MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7050690 SUP HCPCS C1713 7050690 - SCREW BONE 6.5MM 90MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7050750 SUP HCPCS C1713 7050750 - SCREW BONE 7.5MM 50MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7050755 SUP HCPCS C1713 7050755 - SCREW BONE 7.5MM 55MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7050850 SUP HCPCS C1713 7050850 - SCREW BONE 8.5MM 50MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7050855 SUP HCPCS C1713 7050855 - SCREW BONE 8.5MM 55MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" $909.40 "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" $473.80 "$2,273.50" N/A N/A 7050860 SUP HCPCS C1713 7050860 - SCREW BONE 8.5MM 60MM TITANIUM SPN PROXIMAL BOTH IP/OP "$2,273.50" "$1,682.00" $451.23 "$2,273.50" "$1,023.08" "$1,023.08" "$1,023.08" "$1,023.08" "$2,273.50" "$2,273.50" "$2,273.50" $473.85 "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" $473.82 "$2,273.50" "$2,273.50" "$1,344.78" "$2,273.50" "$2,273.50" "$2,273.50" "$2,273.50" "$1,705.13" "$2,273.50" "$2,273.50" "$2,273.50" "$1,136.75" "$1,136.75" "$1,800.61" "$2,273.50" "$1,818.80" "$1,023.08" $451.23 N/A "$1,318.63" "$2,273.50" "$1,364.10" "$2,273.50" "$2,273.50" "$2,273.50" N/A N/A 7060300 SUP Custom 27803010 7060300 - TUBE ET 9MM 6MM STRL LSRSHLD II CUF WRP REFLC SIL AL FLRPLAS BOTH IP/OP $445.00 $329.00 $79.21 $445.00 $445.00 $445.00 $445.00 $445.00 $445.00 $445.00 $79.21 $445.00 $445.00 $445.00 $445.00 $445.00 $445.00 $92.74 $445.00 $178.00 $445.00 $445.00 $445.00 $445.00 $445.00 $333.75 $445.00 $445.00 $445.00 $222.50 $222.50 $352.44 $445.00 $356.00 $200.25 $445.00 N/A $258.10 $445.00 $267.00 $445.00 $445.00 $445.00 N/A N/A 7060400 SUP Custom 27803010 7060400 - TUBE ET 10.5MM 7MM STRL LSRSHLD II CUF WRP REFLC SIL AL BOTH IP/OP $445.00 $329.00 $79.21 $445.00 $445.00 $445.00 $445.00 $445.00 $445.00 $445.00 $79.21 $445.00 $445.00 $445.00 $445.00 $445.00 $445.00 $92.74 $445.00 $178.00 $445.00 $445.00 $445.00 $445.00 $445.00 $333.75 $445.00 $445.00 $445.00 $222.50 $222.50 $352.44 $445.00 $356.00 $200.25 $445.00 N/A $258.10 $445.00 $267.00 $445.00 $445.00 $445.00 N/A N/A 7060500 SUP Custom 27803010 7060500 - TUBE ET 11.5MM 8MM STRL LF LSRSHLD II DISP BOTH IP/OP $420.00 $311.00 $74.76 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $74.76 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $87.53 $420.00 $168.00 $420.00 $420.00 $420.00 $420.00 $420.00 $315.00 $420.00 $420.00 $420.00 $210.00 $210.00 $332.64 $420.00 $336.00 $189.00 $420.00 N/A $243.60 $420.00 $252.00 $420.00 $420.00 $420.00 N/A N/A 7070501 SUP Custom 27203010 7070501 - DRILL SRG 4.5MM NS LF DISP MAS PLIF BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 7070502 SUP Custom 27203010 7070502 - DRILL SRG 5MM DISP MAS PLIF BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 7070503 SUP Custom 27203010 7070503 - DRILL SRG 5.5MM DISP MAS PLIF BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 7080510 SUP Custom 27203010 7080510 - BIT DRL 11MM STRL DISP BOTH IP/OP $501.00 $371.00 $89.18 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $89.18 $501.00 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $200.40 $501.00 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $501.00 N/A $290.58 $501.00 $300.60 $501.00 $501.00 $501.00 N/A N/A 7080513 SUP Custom 27203010 7080513 - BIT DRL 13MM STRL DISP BOTH IP/OP $501.00 $371.00 $89.18 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $89.18 $501.00 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $200.40 $501.00 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $501.00 N/A $290.58 $501.00 $300.60 $501.00 $501.00 $501.00 N/A N/A 7096530 SUP HCPCS C1713 7096530 - SCREW BN 6.5MM 30MM MAS PLIF BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7110001 SUP HCPCS C1713 7110001 - SCREW LOCK DIA 16 CORE VBR 2 BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $50.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $75.00 $125.00 $26.05 $125.00 N/A N/A 7110003 SUP HCPCS C1713 7110003 - SCREW LOCK CORE DIA 18 DIA 22 XCORE 2 TI BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $50.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $75.00 $125.00 $26.05 $125.00 N/A N/A 7124540 SUP HCPCS C1713 7124540 - SCREW BN 4.5MM 40MM SPNE MAS PLIF BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7125025 SUP HCPCS C1713 7125025 - SCREW BN 5MM 25MM NS MAS PA SPNE 3Z PLIF BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7125035 SUP HCPCS C1713 7125035 - SCREW BN 5MM 35MM SPNE MAS PLIF BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7125525 SUP HCPCS C1713 7125525 - SCREW BN 5.5MM 25MM SPNE MAS PLIF BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7125535 SUP HCPCS C1713 7125535 - SCREW BN 5.5MM 35MM SPNE MAS PLIF BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7135100 SUP Custom 27203010 7135100 - KIT AUTOTRANSFUSION BOWL SMALL ASMBLY LOW VOLUME CENTRIFUGE BOTH IP/OP "$1,379.00" "$1,020.00" $245.45 "$1,378.93" "$1,378.93" "$1,378.93" "$1,378.93" "$1,378.93" "$1,378.93" "$1,378.93" $245.45 "$1,378.93" "$1,378.93" "$1,023.44" "$1,023.44" "$1,062.88" $718.42 $287.38 "$1,378.93" $551.57 "$1,378.93" "$1,378.93" "$1,378.93" "$1,378.93" "$1,378.93" "$1,034.25" "$1,378.93" "$1,378.93" "$1,378.93" $689.47 $689.47 "$1,092.11" "$1,378.93" "$1,103.14" $896.30 "$1,378.93" N/A $799.82 "$1,378.93" $827.36 "$1,378.93" "$1,378.93" "$1,378.93" N/A N/A 7140208 SUP HCPCS C1713 7140208 - PLATE BN 8 NS DECADE 2 HL SPNE XLIF BOTH IP/OP "$9,005.00" "$6,664.00" "$1,787.27" "$9,005.00" "$4,052.25" "$4,052.25" "$4,052.25" "$4,052.25" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.87" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.74" "$9,005.00" "$3,602.00" "$4,439.47" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$6,753.75" "$9,005.00" "$9,005.00" "$9,005.00" "$4,502.50" "$4,502.50" "$7,131.96" "$9,005.00" "$7,204.00" "$4,052.25" "$1,787.27" N/A "$5,222.90" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.64" "$9,005.00" N/A N/A 7140210 SUP HCPCS C1713 7140210 - PLATE BN 10 NS DECADE 2 HL SPNE XLIF BOTH IP/OP "$9,005.00" "$6,664.00" "$1,787.27" "$9,005.00" "$4,052.25" "$4,052.25" "$4,052.25" "$4,052.25" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.87" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.74" "$9,005.00" "$3,602.00" "$4,439.47" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$6,753.75" "$9,005.00" "$9,005.00" "$9,005.00" "$4,502.50" "$4,502.50" "$7,131.96" "$9,005.00" "$7,204.00" "$4,052.25" "$1,787.27" N/A "$5,222.90" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.64" "$9,005.00" N/A N/A 7140212 SUP HCPCS C1713 7140212 - PLATE BN 12 NS DECADE 2 HL SPNE XLIF BOTH IP/OP "$9,005.00" "$6,664.00" "$1,787.27" "$9,005.00" "$4,052.25" "$4,052.25" "$4,052.25" "$4,052.25" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.87" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.74" "$9,005.00" "$9,005.00" "$4,439.47" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$6,753.75" "$9,005.00" "$9,005.00" "$9,005.00" "$4,502.50" "$4,502.50" "$7,131.96" "$9,005.00" "$7,204.00" "$4,052.25" "$1,787.27" N/A "$5,222.90" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.64" "$9,005.00" N/A N/A 7140214 SUP HCPCS C1713 7140214 - PLATE BN 14 NS DECADE 2 HL SPNE XLIF BOTH IP/OP "$9,005.00" "$6,664.00" "$1,787.27" "$9,005.00" "$4,052.25" "$4,052.25" "$4,052.25" "$4,052.25" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.87" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.74" "$9,005.00" "$9,005.00" "$4,439.47" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$6,753.75" "$9,005.00" "$9,005.00" "$9,005.00" "$4,502.50" "$4,502.50" "$7,131.96" "$9,005.00" "$7,204.00" "$4,052.25" "$1,787.27" N/A "$5,222.90" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.64" "$9,005.00" N/A N/A 7140216 SUP HCPCS C1713 7140216 - PLATE BN 16 NS DECADE 2 HL SPNE XLIF BOTH IP/OP "$9,005.00" "$6,664.00" "$1,787.27" "$9,005.00" "$4,052.25" "$4,052.25" "$4,052.25" "$4,052.25" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.87" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.74" "$9,005.00" "$3,602.00" "$4,439.47" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$6,753.75" "$9,005.00" "$9,005.00" "$9,005.00" "$4,502.50" "$4,502.50" "$7,131.96" "$9,005.00" "$7,204.00" "$4,052.25" "$1,787.27" N/A "$5,222.90" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.64" "$9,005.00" N/A N/A 7140218 SUP HCPCS C1713 7140218 - PLATE BN 18 NS DECADE 2 HL SPNE XLIF BOTH IP/OP "$9,005.00" "$6,664.00" "$1,787.27" "$9,005.00" "$4,052.25" "$4,052.25" "$4,052.25" "$4,052.25" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.87" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.74" "$9,005.00" "$3,602.00" "$4,439.47" "$9,005.00" "$9,005.00" "$9,005.00" "$9,005.00" "$6,753.75" "$9,005.00" "$9,005.00" "$9,005.00" "$4,502.50" "$4,502.50" "$7,131.96" "$9,005.00" "$7,204.00" "$4,052.25" "$1,787.27" N/A "$5,222.90" "$9,005.00" "$9,005.00" "$9,005.00" "$1,876.64" "$9,005.00" N/A N/A 7140408 SUP HCPCS C1713 7140408 - PLATE BN 8 NS DECADE 4 HL SPNE XLIF BOTH IP/OP "$9,642.50" "$7,135.00" "$1,913.80" "$9,642.50" "$4,339.13" "$4,339.13" "$4,339.13" "$4,339.13" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.74" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.60" "$9,642.50" "$9,642.50" "$4,753.75" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$7,231.88" "$9,642.50" "$9,642.50" "$9,642.50" "$4,821.25" "$4,821.25" "$7,636.86" "$9,642.50" "$7,714.00" "$4,339.13" "$1,913.80" N/A "$5,592.65" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.50" "$9,642.50" N/A N/A 7140410 SUP HCPCS C1713 7140410 - PLATE BN 10 NS DECADE 4 HL SPNE XLIF BOTH IP/OP "$9,642.50" "$7,135.00" "$1,913.80" "$9,642.50" "$4,339.13" "$4,339.13" "$4,339.13" "$4,339.13" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.74" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.60" "$9,642.50" "$3,857.00" "$4,753.75" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$7,231.88" "$9,642.50" "$9,642.50" "$9,642.50" "$4,821.25" "$4,821.25" "$7,636.86" "$9,642.50" "$7,714.00" "$4,339.13" "$1,913.80" N/A "$5,592.65" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.50" "$9,642.50" N/A N/A 7140412 SUP HCPCS C1713 7140412 - PLATE BN 12 NS DECADE 4 HL SPNE XLIF BOTH IP/OP "$9,642.50" "$7,135.00" "$1,913.80" "$9,642.50" "$4,339.13" "$4,339.13" "$4,339.13" "$4,339.13" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.74" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.60" "$9,642.50" "$3,857.00" "$4,753.75" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$7,231.88" "$9,642.50" "$9,642.50" "$9,642.50" "$4,821.25" "$4,821.25" "$7,636.86" "$9,642.50" "$7,714.00" "$4,339.13" "$1,913.80" N/A "$5,592.65" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.50" "$9,642.50" N/A N/A 7140414 SUP HCPCS C1713 7140414 - PLATE BN 14 NS DECADE 4 HL SPNE XLIF BOTH IP/OP "$9,642.50" "$7,135.00" "$1,913.80" "$9,642.50" "$4,339.13" "$4,339.13" "$4,339.13" "$4,339.13" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.74" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.60" "$9,642.50" "$9,642.50" "$4,753.75" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$7,231.88" "$9,642.50" "$9,642.50" "$9,642.50" "$4,821.25" "$4,821.25" "$7,636.86" "$9,642.50" "$7,714.00" "$4,339.13" "$1,913.80" N/A "$5,592.65" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.50" "$9,642.50" N/A N/A 7140416 SUP HCPCS C1713 7140416 - PLATE BN 16 NS DECADE 4 HL SPNE XLIF BOTH IP/OP "$9,642.50" "$7,135.00" "$1,913.80" "$9,642.50" "$4,339.13" "$4,339.13" "$4,339.13" "$4,339.13" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.74" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.60" "$9,642.50" "$9,642.50" "$4,753.75" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$7,231.88" "$9,642.50" "$9,642.50" "$9,642.50" "$4,821.25" "$4,821.25" "$7,636.86" "$9,642.50" "$7,714.00" "$4,339.13" "$1,913.80" N/A "$5,592.65" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.50" "$9,642.50" N/A N/A 7140418 SUP HCPCS C1713 7140418 - PLATE BN 18 NS DECADE 4 HL SPNE XLIF BOTH IP/OP "$9,642.50" "$7,135.00" "$1,913.80" "$9,642.50" "$4,339.13" "$4,339.13" "$4,339.13" "$4,339.13" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.74" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.60" "$9,642.50" "$9,642.50" "$4,753.75" "$9,642.50" "$9,642.50" "$9,642.50" "$9,642.50" "$7,231.88" "$9,642.50" "$9,642.50" "$9,642.50" "$4,821.25" "$4,821.25" "$7,636.86" "$9,642.50" "$7,714.00" "$4,339.13" "$1,913.80" N/A "$5,592.65" "$9,642.50" "$9,642.50" "$9,642.50" "$2,009.50" "$9,642.50" N/A N/A 7141112 SUP Custom 27203010 7141112 - GUIDE PIN ORTH 100MM DECADE SPNE XLIF BOTH IP/OP $262.50 $194.00 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $46.73 $262.50 $262.50 $194.83 $194.83 $202.34 $136.76 $54.71 $262.50 $105.00 $262.50 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $170.63 $262.50 N/A $152.25 $262.50 $157.50 $262.50 $262.50 $262.50 N/A N/A 7141113 SUP HCPCS C1713 7141113 - PIN FX DECADE SCR XLIF BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $262.50 $262.50 $54.71 $262.50 N/A N/A 7141230 SUP HCPCS C1713 7141230 - BOLT SPNL SM 5MM 30MM DECADE IMPACTABLE XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7141240 SUP HCPCS C1713 7141240 - BOLT SPNL SM 5MM 40MM DECADE IMPACTABLE XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" "$2,407.50" "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7141250 SUP HCPCS C1713 7141250 - BOLT SPNL SM 5MM 50MM DECADE IMPACTABLE XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145030 SUP HCPCS C1713 7145030 - BOLT SPNL SM 5MM 30MM NS DECADE THRD PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145035 SUP HCPCS C1713 7145035 - BOLT SPNL SM 5MM 35MM NS DECADE THRD PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" "$2,407.50" "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145040 SUP HCPCS C1713 7145040 - BOLT SPNL SM 5MM 40MM NS DECADE THRD PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145045 SUP HCPCS C1713 7145045 - BOLT SPNL SM 5MM 45MM NS DECADE THRD PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145050 SUP HCPCS C1713 7145050 - BOLT SPNL SM 5MM 50MM NS DECADE THRD PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145055 SUP HCPCS C1713 7145055 - BOLT SPNL SM 5MM 55MM NS DECADE THRD PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145060 SUP HCPCS C1713 7145060 - BOLT SPNL SM 5MM 60MM NS DECADE THRD PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145130 SUP HCPCS C1713 7145130 - BOLT SPNL SM 5.5MM 30MM NS DECADE THRD PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" "$2,407.50" "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145140 SUP HCPCS C1713 7145140 - BOLT SPNL SM 5.5MM 40MM NS DECADE THRD PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145150 SUP HCPCS C1713 7145150 - BOLT SPNL SM 5.5MM 50MM NS DECADE THRD PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145525 SUP HCPCS C1713 7145525 - BOLT SPNL LG 5.5MM 25MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" "$2,407.50" "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145530 SUP HCPCS C1713 7145530 - BOLT SPNL LG 5.5MM 30MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145535 SUP HCPCS C1713 7145535 - BOLT SPNL LG 5.5MM 35MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145540 SUP HCPCS C1713 7145540 - BOLT SPNL LG 5.5MM 40MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145545 SUP HCPCS C1713 7145545 - BOLT SPNL LG 5.5MM 45MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145550 SUP HCPCS C1713 7145550 - BOLT SPNL LG 5.5MM 50MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145555 SUP HCPCS C1713 7145555 - BOLT SPNL LG 5.5MM 55MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" "$2,407.50" "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7145560 SUP HCPCS C1713 7145560 - BOLT SPNL LG 5.5MM 60MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" "$2,407.50" "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$1,444.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7146525 SUP HCPCS C1713 7146525 - BOLT SPNL LG 6.5MM 25MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" "$2,407.50" "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$1,444.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7146530 SUP HCPCS C1713 7146530 - BOLT SPNL LG 6.5MM 30MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$1,444.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7146535 SUP HCPCS C1713 7146535 - BOLT SPNL LG 6.5MM 35MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$1,444.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7146540 SUP HCPCS C1713 7146540 - BOLT SPNL LG 6.5MM 40MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" "$2,407.50" "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$1,444.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7146545 SUP HCPCS C1713 7146545 - BOLT SPNL LG 6.5MM 45MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" "$2,407.50" "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$2,407.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7146550 SUP HCPCS C1713 7146550 - BOLT SPNL LG 6.5MM 50MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$1,444.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7146555 SUP HCPCS C1713 7146555 - BOLT SPNL LG 6.5MM 55MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" $963.00 "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$1,444.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7146560 SUP HCPCS C1713 7146560 - BOLT SPNL LG 6.5MM 60MM NS DECADE PLT XLIF BOTH IP/OP "$2,407.50" "$1,782.00" $477.83 "$2,407.50" "$1,083.38" "$1,083.38" "$1,083.38" "$1,083.38" "$2,407.50" "$2,407.50" "$2,407.50" $501.78 "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" $501.75 "$2,407.50" "$2,407.50" "$1,424.04" "$2,407.50" "$2,407.50" "$2,407.50" "$2,407.50" "$1,805.63" "$2,407.50" "$2,407.50" "$2,407.50" "$1,203.75" "$1,203.75" "$1,906.74" "$2,407.50" "$1,926.00" "$1,083.38" $477.83 N/A "$1,396.35" "$2,407.50" "$1,444.50" "$2,407.50" $501.72 "$2,407.50" N/A N/A 7160012 SUP Custom 27803010 7160012 - CAGE SPNL 16MM 12MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7160014 SUP Custom 27803010 7160014 - CAGE SPNL 16MM 14MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7160022 SUP Custom 27803010 7160022 - CAGE SPNL 16MM 16-22MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7160025 SUP Custom 27803010 7160025 - CAGE SPNL 16MM 18-25MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7160035 SUP Custom 27803010 7160035 - CAGE SPNL 16MM 23-35MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7160041 SUP Custom 27803010 7160041 - CAGE SPNL 16MM 26-41MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7160049 SUP Custom 27803010 7160049 - CAGE SPNL 16MM 30-49MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7160063 SUP Custom 27803010 7160063 - CAGE SPNL 16MM 37-63MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7160075 SUP Custom 27803010 7160075 - CAGE SPNL 16MM 43-75MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7162000 SUP HCPCS C1713 7162000 - SCREW LOCK ENDCAP XCORE 2 TI BOTH IP/OP $620.00 $459.00 $123.05 $620.00 $279.00 $279.00 $279.00 $279.00 $620.00 $620.00 $620.00 $129.22 $620.00 $620.00 $620.00 $620.00 $620.00 $129.21 $620.00 $248.00 $366.73 $620.00 $620.00 $620.00 $620.00 $465.00 $620.00 $620.00 $620.00 $310.00 $310.00 $491.04 $620.00 $496.00 $279.00 $123.05 N/A $359.60 $620.00 $620.00 $620.00 $129.21 $620.00 N/A N/A 7164565 SUP HCPCS C1713 7164565 - 5.0X 65MM SCREW BOTH IP/OP $648.00 $480.00 $128.61 $648.00 $291.60 $291.60 $291.60 $291.60 $648.00 $648.00 $648.00 $135.06 $648.00 $648.00 $648.00 $648.00 $648.00 $135.05 $648.00 $259.20 $383.29 $648.00 $648.00 $648.00 $648.00 $486.00 $648.00 $648.00 $648.00 $324.00 $324.00 $513.22 $648.00 $518.40 $291.60 $128.61 N/A $375.84 $648.00 $388.80 $648.00 $135.04 $648.00 N/A N/A 7180016 SUP Custom 27803010 7180016 - CAGE SPNL 18MM 16MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7180018 SUP Custom 27803010 7180018 - CAGE SPNL 18MM 18MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7180025 SUP Custom 27803010 7180025 - CAGE SPNL 18MM 20-25MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7180027 SUP Custom 27803010 7180027 - CAGE SPNL 18MM 21-27MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7180033 SUP Custom 27803010 7180033 - CAGE SPNL 18MM 24-33MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7180041 SUP Custom 27803010 7180041 - CAGE SPNL 18MM 28-41MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7180055 SUP Custom 27803010 7180055 - CAGE SPINAL 18X35-55MM X-CORE 2 TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7180067 SUP Custom 27803010 7180067 - CAGE SPNL 18MM 41-67MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7180079 SUP Custom 27803010 7180079 - CAGE SPNL 18MM 47-79MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7180121 SUP Custom 27803010 7180121 - CAGE SPNL 18MM 68-121MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7191525 SUP HCPCS C1713 7191525 - SCREW BONE 5.5MM 25MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191530 SUP HCPCS C1713 7191530 - SCREW BONE 5.5MM 30MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7191535 SUP HCPCS C1713 7191535 - SCREW BN 5.5MM 35MM STRL CD HZN LGC MA HA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191540 SUP HCPCS C1713 7191540 - SCREW BN 5.5MM 40MM STRL CD HZN LGC MA HA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191545 SUP HCPCS C1713 7191545 - SCREW BONE 5.5MM 45MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191550 SUP HCPCS C1713 7191550 - SCREW BONE 5.5MM 50MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191555 SUP HCPCS C1713 7191555 - SCREW BONE 5.5MM 55MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191560 SUP HCPCS C1713 7191560 - SCREW BONE 5.5MM 60MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191625 SUP HCPCS C1713 7191625 - SCREW BONE 6.5MM 25MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191630 SUP HCPCS C1713 7191630 - SCREW BONE 6.5MM 30MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191635 SUP HCPCS C1713 7191635 - SCREW BN 6.5MM 35MM STRL CD HZN LGC MA HA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7191640 SUP HCPCS C1713 7191640 - SCREW BN 6.5MM 40MM STRL CD HZN LGC MA HA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191645 SUP HCPCS C1713 7191645 - SCREW BN 6.5MM 45MM STRL CD HZN LGC MA HA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191650 SUP HCPCS C1713 7191650 - SCREW BONE 6.5MM 50MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191655 SUP HCPCS C1713 7191655 - SCREW BONE 6.5MM 55MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191660 SUP HCPCS C1713 7191660 - SCREW BONE 6.5MM 60MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191665 SUP HCPCS C1713 7191665 - SCREW BONE 6.5MM 65MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191725 SUP HCPCS C1713 7191725 - SCREW BONE 7.5MM 25MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191730 SUP HCPCS C1713 7191730 - SCREW BONE 7.5MM 30MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191735 SUP HCPCS C1713 7191735 - SCREW BONE 7.5MM 35MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191740 SUP HCPCS C1713 7191740 - SCREW BN 7.5MM 40MM STRL CD HZN LGC MA HA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191745 SUP HCPCS C1713 7191745 - SCREW BONE 7.5MM 45MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7191750 SUP HCPCS C1713 7191750 - SCREW BONE 7.5MM 50MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7191755 SUP HCPCS C1713 7191755 - SCREW BONE 7.5MM 55MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191760 SUP HCPCS C1713 7191760 - SCREW BONE 7.5MM 60MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191765 SUP HCPCS C1713 7191765 - SCREW BONE 7.5MM 65MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191770 SUP HCPCS C1713 7191770 - SCREW BONE 7.5MM 70MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191825 SUP HCPCS C1713 7191825 - SCREW BONE 8.5MM 25MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7191830 SUP HCPCS C1713 7191830 - SCREW BONE 8.5MM 30MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191835 SUP HCPCS C1713 7191835 - SCREW BONE 8.5MM 35MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7191840 SUP HCPCS C1713 7191840 - SCREW BONE 8.5MM 40MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7191845 SUP HCPCS C1713 7191845 - SCREW BONE 8.5MM 45MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7191850 SUP HCPCS C1713 7191850 - SCREW BONE 8.5MM 50MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7191855 SUP HCPCS C1713 7191855 - SCREW BONE 8.5MM 55MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7191860 SUP HCPCS C1713 7191860 - SCREW BONE 8.5MM 60MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7191865 SUP HCPCS C1713 7191865 - SCREW BONE 8.5MM 65MM MULTIAX CD HORIZON HA SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7195535 SUP HCPCS C1713 7195535 - SCREW BN 5.5MM 35MM SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7195540 SUP HCPCS C1713 7195540 - SCREW BN 5.5MM 40MM 2 LD CNN SPNE PDCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7195545 SUP HCPCS C1713 7195545 - SCREW BN 5.5MM 45MM SPHERX II 2 LCK SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7195550 SUP HCPCS C1713 7195550 - SCREW BN 5.5MM 50MM 2 LD CNN SPNE PDCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7195555 SUP HCPCS C1713 7195555 - SCREW BN 5.5MM 55MM 2 LD CNN SPNE PDCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7196535 SUP HCPCS C1713 7196535 - SCREW BN 6.5MM 35MM SPHERX II SPNE DLS BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7196540 SUP HCPCS C1713 7196540 - SCREW BN 6.5MM 40MM SPHERX II 2 LCK SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7196545 SUP HCPCS C1713 7196545 - SCREW BN 6.5MM 45MM SPHERX II 2 SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7196550 SUP HCPCS C1713 7196550 - SCREW BN 6.5MM 50MM SPHERX II 2 LCK SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7196555 SUP HCPCS C1713 7196555 - SCREW BN 6.5MM 55MM SPHERX II 2 LCK SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7197535 SUP HCPCS C1713 7197535 - SCREW BN 7.5MM 40MM SPHERX II 2 LCK SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7197540 SUP HCPCS C1713 7197540 - SCREW BN 7.5MM 40MM SPHERX II 2 LCK SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7197545 SUP HCPCS C1713 7197545 - SCREW BN 7.5MM 45MM 2 LD SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7197550 SUP HCPCS C1713 7197550 - SCREW BN 7.5MM 50MM 2 LD SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7197555 SUP HCPCS C1713 7197555 - SCREW BN 7.5MM 55MM SPHERX II PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7200019 SUP HCPCS C1713 7200019 - PLATE BN 19MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7200021 SUP HCPCS C1713 7200021 - PLATE BN 21MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7200023 SUP HCPCS C1713 7200023 - PLATE BN 23MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7200025 SUP HCPCS C1713 7200025 - PLATE BN 25MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7200027 SUP HCPCS C1713 7200027 - PLATE BN 27.5MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7200030 SUP HCPCS C1713 7200030 - PLATE BN 30MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7200032 SUP HCPCS C1713 7200032 - PLATE BONE 32.5MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7200035 SUP HCPCS C1713 7200035 - PLATE BN 35MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 7200037 SUP HCPCS C1713 7200037 - PLATE BN 37.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 7200040 SUP HCPCS C1713 7200040 - PLATE BN 40MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7200042 SUP HCPCS C1713 7200042 - PLATE BN 42.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7200045 SUP HCPCS C1713 7200045 - PLATE BN 45MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7200047 SUP HCPCS C1713 7200047 - PLATE BN 47.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7200050 SUP HCPCS C1713 7200050 - PLATE BONE 50MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7200052 SUP HCPCS C1713 7200052 - PLATE BN 52.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7200055 SUP HCPCS C1713 7200055 - PLATE BN 55MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7200057 SUP HCPCS C1713 7200057 - PLATE BN 57.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7200060 SUP HCPCS C1713 7200060 - PLATE BN 60MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7200062 SUP HCPCS C1713 7200062 - PLATE BN 62.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 7200065 SUP HCPCS C1713 7200065 - PLATE BN 65MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 7200067 SUP HCPCS C1713 7200067 - PLATE BN 67.5MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7200070 SUP HCPCS C1713 7200070 - PLATE BONE 70MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7200072 SUP HCPCS C1713 7200072 - PLATE BONE 72.5MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 7200075 SUP HCPCS C1713 7200075 - PLATE BONE 75MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7200077 SUP HCPCS C1713 7200077 - PLATE BONE 77.5MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 7200080 SUP HCPCS C1713 7200080 - PLATE BN 80MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 7200082 SUP HCPCS C1713 7200082 - PLATE BN 82.5MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7200085 SUP HCPCS C1713 7200085 - PLATE BONE 85MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7200087 SUP HCPCS C1713 7200087 - PLATE BONE 87.5MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$4,492.00" "$3,324.00" $891.55 "$4,492.00" "$2,021.40" "$2,021.40" "$2,021.40" "$2,021.40" "$4,492.00" "$4,492.00" "$4,492.00" $936.25 "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" $936.18 "$4,492.00" "$4,492.00" "$2,214.56" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$3,369.00" "$4,492.00" "$4,492.00" "$4,492.00" "$2,246.00" "$2,246.00" "$3,557.66" "$4,492.00" "$3,593.60" "$2,021.40" $891.55 N/A "$2,605.36" "$4,492.00" "$2,695.20" "$4,492.00" $936.13 "$4,492.00" N/A N/A 7200090 SUP HCPCS C1713 7200090 - PLATE BONE 90MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$4,492.00" "$3,324.00" $891.55 "$4,492.00" "$2,021.40" "$2,021.40" "$2,021.40" "$2,021.40" "$4,492.00" "$4,492.00" "$4,492.00" $936.25 "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" $936.18 "$4,492.00" "$4,492.00" "$2,214.56" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$3,369.00" "$4,492.00" "$4,492.00" "$4,492.00" "$2,246.00" "$2,246.00" "$3,557.66" "$4,492.00" "$3,593.60" "$2,021.40" $891.55 N/A "$2,605.36" "$4,492.00" "$2,695.20" "$4,492.00" $936.13 "$4,492.00" N/A N/A 7200095 SUP HCPCS C1713 7200095 - PLATE BN 95MM NS ATL VS ELT 5 LVL TI SPNE CRV ANT BOTH IP/OP "$4,492.00" "$3,324.00" $891.55 "$4,492.00" "$2,021.40" "$2,021.40" "$2,021.40" "$2,021.40" "$4,492.00" "$4,492.00" "$4,492.00" $936.25 "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" $936.18 "$4,492.00" "$4,492.00" "$2,214.56" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$3,369.00" "$4,492.00" "$4,492.00" "$4,492.00" "$2,246.00" "$2,246.00" "$3,557.66" "$4,492.00" "$3,593.60" "$2,021.40" $891.55 N/A "$2,605.36" "$4,492.00" "$2,695.20" "$4,492.00" $936.13 "$4,492.00" N/A N/A 7200100 SUP HCPCS C1713 7200100 - PLATE BONE 100MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$4,492.00" "$3,324.00" $891.55 "$4,492.00" "$2,021.40" "$2,021.40" "$2,021.40" "$2,021.40" "$4,492.00" "$4,492.00" "$4,492.00" $936.25 "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" $936.18 "$4,492.00" "$4,492.00" "$2,214.56" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$3,369.00" "$4,492.00" "$4,492.00" "$4,492.00" "$2,246.00" "$2,246.00" "$3,557.66" "$4,492.00" "$3,593.60" "$2,021.40" $891.55 N/A "$2,605.36" "$4,492.00" "$4,492.00" "$4,492.00" $936.13 "$4,492.00" N/A N/A 7200105 SUP HCPCS C1713 7200105 - PLATE BONE 105MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$4,492.00" "$3,324.00" $891.55 "$4,492.00" "$2,021.40" "$2,021.40" "$2,021.40" "$2,021.40" "$4,492.00" "$4,492.00" "$4,492.00" $936.25 "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" $936.18 "$4,492.00" "$4,492.00" "$2,214.56" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$3,369.00" "$4,492.00" "$4,492.00" "$4,492.00" "$2,246.00" "$2,246.00" "$3,557.66" "$4,492.00" "$3,593.60" "$2,021.40" $891.55 N/A "$2,605.36" "$4,492.00" "$2,695.20" "$4,492.00" $936.13 "$4,492.00" N/A N/A 7200110 SUP HCPCS C1713 7200110 - PLATE BONE 110MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$4,492.00" "$3,324.00" $891.55 "$4,492.00" "$2,021.40" "$2,021.40" "$2,021.40" "$2,021.40" "$4,492.00" "$4,492.00" "$4,492.00" $936.25 "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" $936.18 "$4,492.00" "$4,492.00" "$2,214.56" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$3,369.00" "$4,492.00" "$4,492.00" "$4,492.00" "$2,246.00" "$2,246.00" "$3,557.66" "$4,492.00" "$3,593.60" "$2,021.40" $891.55 N/A "$2,605.36" "$4,492.00" "$2,695.20" "$4,492.00" $936.13 "$4,492.00" N/A N/A 7200130 SUP HCPCS C1713 7200130 - PLATE BONE 30MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7200132 SUP HCPCS C1713 7200132 - PLATE BN 32.5MM NS ATL VS ELT 1 LVL TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7200145 SUP HCPCS C1713 7200145 - PLATE BN 45MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7200147 SUP HCPCS C1713 7200147 - PLATE BONE 47.5MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7200150 SUP HCPCS C1713 7200150 - PLATE BN 50MM NS ATL VS ELT 3 LVL TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7200152 SUP HCPCS C1713 7200152 - PLATE BN 52.5MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7200155 SUP HCPCS C1713 7200155 - PLATE BN 55MM NS ATL VS ELT 2 LVL TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7200167 SUP HCPCS C1713 7200167 - PLATE BONE 67.5MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7200170 SUP HCPCS C1713 7200170 - PLATE BN 70MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 7200172 SUP HCPCS C1713 7200172 - PLATE BN 72.5MM NS ATL VS ELT 4 LVL TI SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 7200180 SUP HCPCS C1713 7200180 - PLATE BN 80MM NS ATL VS ELT 5 LVL TI SPNE CRV ANT BOTH IP/OP "$4,492.00" "$3,324.00" $891.55 "$4,492.00" "$2,021.40" "$2,021.40" "$2,021.40" "$2,021.40" "$4,492.00" "$4,492.00" "$4,492.00" $936.25 "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" $936.18 "$4,492.00" "$4,492.00" "$2,214.56" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$3,369.00" "$4,492.00" "$4,492.00" "$4,492.00" "$2,246.00" "$2,246.00" "$3,557.66" "$4,492.00" "$3,593.60" "$2,021.40" $891.55 N/A "$2,605.36" "$4,492.00" "$2,695.20" "$4,492.00" $936.13 "$4,492.00" N/A N/A 7200182 SUP HCPCS C1713 7200182 - PLATE BONE 82.5MM ATLANTIS VISION ELITE TITANIUM SPN CERV BOTH IP/OP "$4,492.00" "$3,324.00" $891.55 "$4,492.00" "$2,021.40" "$2,021.40" "$2,021.40" "$2,021.40" "$4,492.00" "$4,492.00" "$4,492.00" $936.25 "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" $936.18 "$4,492.00" "$4,492.00" "$2,214.56" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$3,369.00" "$4,492.00" "$4,492.00" "$4,492.00" "$2,246.00" "$2,246.00" "$3,557.66" "$4,492.00" "$3,593.60" "$2,021.40" $891.55 N/A "$2,605.36" "$4,492.00" "$2,695.20" "$4,492.00" $936.13 "$4,492.00" N/A N/A 7200185 SUP HCPCS C1713 7200185 - PLATE BN 85MM NS ATL VS ELT 5 LVL TI SPNE CRV ANT BOTH IP/OP "$4,492.00" "$3,324.00" $891.55 "$4,492.00" "$2,021.40" "$2,021.40" "$2,021.40" "$2,021.40" "$4,492.00" "$4,492.00" "$4,492.00" $936.25 "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" $936.18 "$4,492.00" "$4,492.00" "$2,214.56" "$4,492.00" "$4,492.00" "$4,492.00" "$4,492.00" "$3,369.00" "$4,492.00" "$4,492.00" "$4,492.00" "$2,246.00" "$2,246.00" "$3,557.66" "$4,492.00" "$3,593.60" "$2,021.40" $891.55 N/A "$2,605.36" "$4,492.00" "$2,695.20" "$4,492.00" $936.13 "$4,492.00" N/A N/A 7200502 SUP HCPCS C1713 7200502 - WIRE FX LNG KRSH SS ORTH BOTH IP/OP $197.50 $146.00 $39.20 $197.50 $88.88 $88.88 $88.88 $88.88 $197.50 $197.50 $197.50 $41.16 $197.50 $197.50 $197.50 $197.50 $197.50 $41.16 $197.50 $197.50 $116.82 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $88.88 $39.20 N/A $114.55 $197.50 $197.50 $197.50 $41.16 $197.50 N/A N/A 7209984 SUP Custom 27203010 7209984 - CANNULA ARTHRO 8.5MM 72MM OBTURATOR THREADED LATEX FREE BOTH IP/OP $61.50 $46.00 $10.90 $61.26 $61.26 $61.26 $61.26 $61.26 $61.26 $61.26 $10.90 $61.26 $61.26 $45.47 $45.47 $47.22 $31.92 $12.77 $61.26 $24.50 $61.26 $61.26 $61.26 $61.26 $61.26 $46.13 $61.26 $61.26 $61.26 $30.63 $30.63 $48.52 $61.26 $49.01 $39.82 $61.26 N/A $35.67 $61.26 $36.76 $61.26 $61.26 $61.26 N/A N/A 7209985 SUP Custom 27203010 7209985 - CANNULA ENDSCP 7MM 72MM OBTURATOR THREADED LATEX FREE BOTH IP/OP $61.50 $46.00 $10.90 $61.26 $61.26 $61.26 $61.26 $61.26 $61.26 $61.26 $10.90 $61.26 $61.26 $45.47 $45.47 $47.22 $31.92 $12.77 $61.26 $24.50 $61.26 $61.26 $61.26 $61.26 $61.26 $46.13 $61.26 $61.26 $61.26 $30.63 $30.63 $48.52 $61.26 $49.01 $39.82 $61.26 N/A $35.67 $61.26 $36.76 $61.26 $61.26 $61.26 N/A N/A 7217020 SUP HCPCS C1713 7217020 - ROD SPNL PREBNT 20MM BOTH IP/OP "$1,247.50" $923.00 $247.60 "$1,247.50" $561.38 $561.38 $561.38 $561.38 "$1,247.50" "$1,247.50" "$1,247.50" $260.01 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" "$1,247.50" $737.90 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 $247.60 N/A $723.55 "$1,247.50" "$1,247.50" "$1,247.50" $259.98 "$1,247.50" N/A N/A 7217025 SUP HCPCS C1713 7217025 - ROD SPNL PREBNT 6MM 25MM SPHERX TI BOTH IP/OP "$1,247.50" $923.00 $247.60 "$1,247.50" $561.38 $561.38 $561.38 $561.38 "$1,247.50" "$1,247.50" "$1,247.50" $260.01 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" "$1,247.50" $737.90 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 $247.60 N/A $723.55 "$1,247.50" "$1,247.50" "$1,247.50" $259.98 "$1,247.50" N/A N/A 7217030 SUP HCPCS C1713 7217030 - ROD SPNL PREBNT 6MM 30MM SPHERX DBR II TI BOTH IP/OP "$1,247.50" $923.00 $247.60 "$1,247.50" $561.38 $561.38 $561.38 $561.38 "$1,247.50" "$1,247.50" "$1,247.50" $260.01 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" $499.00 $737.90 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 $247.60 N/A $723.55 "$1,247.50" "$1,247.50" "$1,247.50" $259.98 "$1,247.50" N/A N/A 7217035 SUP HCPCS C1713 7217035 - ROD SPNL PREBNT 6MM 35MM TI BOTH IP/OP "$1,247.50" $923.00 $247.60 "$1,247.50" $561.38 $561.38 $561.38 $561.38 "$1,247.50" "$1,247.50" "$1,247.50" $260.01 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" $499.00 $737.90 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 $247.60 N/A $723.55 "$1,247.50" $748.50 "$1,247.50" $259.98 "$1,247.50" N/A N/A 7217040 SUP HCPCS C1713 7217040 - ROD SPNL PREBNT 40MM SPHERX DBR II TI BOTH IP/OP "$1,247.50" $923.00 $247.60 "$1,247.50" $561.38 $561.38 $561.38 $561.38 "$1,247.50" "$1,247.50" "$1,247.50" $260.01 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" $499.00 $737.90 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 $247.60 N/A $723.55 "$1,247.50" "$1,247.50" "$1,247.50" $259.98 "$1,247.50" N/A N/A 7217045 SUP HCPCS C1713 7217045 - ROD SPNL PREBNT 45MM BOTH IP/OP "$1,247.50" $923.00 $247.60 "$1,247.50" $561.38 $561.38 $561.38 $561.38 "$1,247.50" "$1,247.50" "$1,247.50" $260.01 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" $499.00 $737.90 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 $247.60 N/A $723.55 "$1,247.50" $748.50 "$1,247.50" $259.98 "$1,247.50" N/A N/A 7217050 SUP HCPCS C1713 7217050 - ROD SPNL PREBNT 6MM 50MM TI BOTH IP/OP "$1,247.50" $923.00 $247.60 "$1,247.50" $561.38 $561.38 $561.38 $561.38 "$1,247.50" "$1,247.50" "$1,247.50" $260.01 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" "$1,247.50" $737.90 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 $247.60 N/A $723.55 "$1,247.50" $748.50 "$1,247.50" $259.98 "$1,247.50" N/A N/A 7217055 SUP HCPCS C1713 7217055 - ROD SPNL PREBNT 55MM NS SPHERX DBR II TI BOTH IP/OP "$1,247.50" $923.00 $247.60 "$1,247.50" $561.38 $561.38 $561.38 $561.38 "$1,247.50" "$1,247.50" "$1,247.50" $260.01 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" $499.00 $737.90 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 $247.60 N/A $723.55 "$1,247.50" $748.50 "$1,247.50" $259.98 "$1,247.50" N/A N/A 7217060 SUP HCPCS C1713 7217060 - ROD SPNL PREBNT 60MM SPHERX DBR II TI BOTH IP/OP "$1,247.50" $923.00 $247.60 "$1,247.50" $561.38 $561.38 $561.38 $561.38 "$1,247.50" "$1,247.50" "$1,247.50" $260.01 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" "$1,247.50" $737.90 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 $247.60 N/A $723.55 "$1,247.50" "$1,247.50" "$1,247.50" $259.98 "$1,247.50" N/A N/A 7217065 SUP HCPCS C1713 7217065 - ROD SPNL PREBNT 65MM SPHERX DBR II TI BOTH IP/OP "$1,247.50" $923.00 $247.60 "$1,247.50" $561.38 $561.38 $561.38 $561.38 "$1,247.50" "$1,247.50" "$1,247.50" $260.01 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" $499.00 $737.90 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 $247.60 N/A $723.55 "$1,247.50" "$1,247.50" "$1,247.50" $259.98 "$1,247.50" N/A N/A 7217070 SUP HCPCS C1713 7217070 - ROD SPNL PREBNT 70MM SPHERX DBR II TI BOTH IP/OP "$1,247.50" $923.00 $247.60 "$1,247.50" $561.38 $561.38 $561.38 $561.38 "$1,247.50" "$1,247.50" "$1,247.50" $260.01 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" $499.00 $737.90 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 $247.60 N/A $723.55 "$1,247.50" "$1,247.50" "$1,247.50" $259.98 "$1,247.50" N/A N/A 7217075 SUP HCPCS C1713 7217075 - ROD SPNL PREBNT 75MM SPHERX DBR II TI BOTH IP/OP "$1,247.50" $923.00 $247.60 "$1,247.50" $561.38 $561.38 $561.38 $561.38 "$1,247.50" "$1,247.50" "$1,247.50" $260.01 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" $499.00 $737.90 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 $247.60 N/A $723.55 "$1,247.50" "$1,247.50" "$1,247.50" $259.98 "$1,247.50" N/A N/A 7217080 SUP HCPCS C1713 7217080 - ROD SPNL PREBNT 80MM SPHERX DBR II TI BOTH IP/OP "$1,247.50" $923.00 $247.60 "$1,247.50" $561.38 $561.38 $561.38 $561.38 "$1,247.50" "$1,247.50" "$1,247.50" $260.01 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" $499.00 $737.90 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 $247.60 N/A $723.55 "$1,247.50" "$1,247.50" "$1,247.50" $259.98 "$1,247.50" N/A N/A 7217085 SUP HCPCS C1713 7217085 - ROD SPNL PREBNT 85MM SPHERX DBR II BOTH IP/OP "$1,425.00" "$1,055.00" $282.83 "$1,425.00" $641.25 $641.25 $641.25 $641.25 "$1,425.00" "$1,425.00" "$1,425.00" $297.01 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" $296.99 "$1,425.00" $570.00 $842.89 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,068.75" "$1,425.00" "$1,425.00" "$1,425.00" $712.50 $712.50 "$1,128.60" "$1,425.00" "$1,140.00" $641.25 $282.83 N/A $826.50 "$1,425.00" "$1,425.00" "$1,425.00" $296.97 "$1,425.00" N/A N/A 7217090 SUP HCPCS C1713 7217090 - ROD SPNL PREBNT 90MM SPHERX DBR II BOTH IP/OP "$1,425.00" "$1,055.00" $282.83 "$1,425.00" $641.25 $641.25 $641.25 $641.25 "$1,425.00" "$1,425.00" "$1,425.00" $297.01 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" $296.99 "$1,425.00" $570.00 $842.89 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,068.75" "$1,425.00" "$1,425.00" "$1,425.00" $712.50 $712.50 "$1,128.60" "$1,425.00" "$1,140.00" $641.25 $282.83 N/A $826.50 "$1,425.00" $855.00 "$1,425.00" $296.97 "$1,425.00" N/A N/A 7217095 SUP HCPCS C1713 7217095 - ROD SPNL PREBNT 95MM SPHERX DBR II BOTH IP/OP "$1,425.00" "$1,055.00" $282.83 "$1,425.00" $641.25 $641.25 $641.25 $641.25 "$1,425.00" "$1,425.00" "$1,425.00" $297.01 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" $296.99 "$1,425.00" $570.00 $842.89 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,068.75" "$1,425.00" "$1,425.00" "$1,425.00" $712.50 $712.50 "$1,128.60" "$1,425.00" "$1,140.00" $641.25 $282.83 N/A $826.50 "$1,425.00" $855.00 "$1,425.00" $296.97 "$1,425.00" N/A N/A 7217100 SUP HCPCS C1713 7217100 - ROD SPNL PREBNT 100MM SPHERX DBR II BOTH IP/OP "$1,425.00" "$1,055.00" $282.83 "$1,425.00" $641.25 $641.25 $641.25 $641.25 "$1,425.00" "$1,425.00" "$1,425.00" $297.01 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" $296.99 "$1,425.00" $570.00 $842.89 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,068.75" "$1,425.00" "$1,425.00" "$1,425.00" $712.50 $712.50 "$1,128.60" "$1,425.00" "$1,140.00" $641.25 $282.83 N/A $826.50 "$1,425.00" $855.00 "$1,425.00" $296.97 "$1,425.00" N/A N/A 7217105 SUP HCPCS C1713 7217105 - ROD SPNL PREBNT 105MM SPHERX DBR II BOTH IP/OP "$1,425.00" "$1,055.00" $282.83 "$1,425.00" $641.25 $641.25 $641.25 $641.25 "$1,425.00" "$1,425.00" "$1,425.00" $297.01 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" $296.99 "$1,425.00" $570.00 $842.89 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,068.75" "$1,425.00" "$1,425.00" "$1,425.00" $712.50 $712.50 "$1,128.60" "$1,425.00" "$1,140.00" $641.25 $282.83 N/A $826.50 "$1,425.00" $855.00 "$1,425.00" $296.97 "$1,425.00" N/A N/A 7217110 SUP HCPCS C1713 7217110 - ROD SPNL PREBNT 110MM SPHERX DBR II TI BOTH IP/OP "$1,425.00" "$1,055.00" $282.83 "$1,425.00" $641.25 $641.25 $641.25 $641.25 "$1,425.00" "$1,425.00" "$1,425.00" $297.01 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" $296.99 "$1,425.00" $570.00 $842.89 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,068.75" "$1,425.00" "$1,425.00" "$1,425.00" $712.50 $712.50 "$1,128.60" "$1,425.00" "$1,140.00" $641.25 $282.83 N/A $826.50 "$1,425.00" $855.00 "$1,425.00" $296.97 "$1,425.00" N/A N/A 7217120 SUP HCPCS C1713 7217120 - ROD SPNL PREBNT 120MM SPHERX DBR II TI BOTH IP/OP "$1,425.00" "$1,055.00" $282.83 "$1,425.00" $641.25 $641.25 $641.25 $641.25 "$1,425.00" "$1,425.00" "$1,425.00" $297.01 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" $296.99 "$1,425.00" "$1,425.00" $842.89 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,068.75" "$1,425.00" "$1,425.00" "$1,425.00" $712.50 $712.50 "$1,128.60" "$1,425.00" "$1,140.00" $641.25 $282.83 N/A $826.50 "$1,425.00" "$1,425.00" "$1,425.00" $296.97 "$1,425.00" N/A N/A 7217130 SUP HCPCS C1713 7217130 - ROD SPNL PREBNT 130MM SPHERX DBR II BOTH IP/OP "$1,425.00" "$1,055.00" $282.83 "$1,425.00" $641.25 $641.25 $641.25 $641.25 "$1,425.00" "$1,425.00" "$1,425.00" $297.01 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" $296.99 "$1,425.00" $570.00 $842.89 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,068.75" "$1,425.00" "$1,425.00" "$1,425.00" $712.50 $712.50 "$1,128.60" "$1,425.00" "$1,140.00" $641.25 $282.83 N/A $826.50 "$1,425.00" "$1,425.00" "$1,425.00" $296.97 "$1,425.00" N/A N/A 7217140 SUP HCPCS C1713 7217140 - ROD SPNL PREBNT 140MM SPHERX II DBR BOTH IP/OP "$1,425.00" "$1,055.00" $282.83 "$1,425.00" $641.25 $641.25 $641.25 $641.25 "$1,425.00" "$1,425.00" "$1,425.00" $297.01 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" $296.99 "$1,425.00" $570.00 $842.89 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,068.75" "$1,425.00" "$1,425.00" "$1,425.00" $712.50 $712.50 "$1,128.60" "$1,425.00" "$1,140.00" $641.25 $282.83 N/A $826.50 "$1,425.00" $855.00 "$1,425.00" $296.97 "$1,425.00" N/A N/A 7217150 SUP HCPCS C1713 7217150 - ROD SPNL PREBNT 150MM SPHERX DBR II BOTH IP/OP "$1,425.00" "$1,055.00" $282.83 "$1,425.00" $641.25 $641.25 $641.25 $641.25 "$1,425.00" "$1,425.00" "$1,425.00" $297.01 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" $296.99 "$1,425.00" "$1,425.00" $842.89 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,068.75" "$1,425.00" "$1,425.00" "$1,425.00" $712.50 $712.50 "$1,128.60" "$1,425.00" "$1,140.00" $641.25 $282.83 N/A $826.50 "$1,425.00" $855.00 "$1,425.00" $296.97 "$1,425.00" N/A N/A 7220016 SUP Custom 27803010 7220016 - CAGE SPNL 22MM 16MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7220018 SUP Custom 27803010 7220018 - CAGE SPNL 22MM 18MM NS LF X-COR 2 STC FTPRNT TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7220025 SUP Custom 27803010 7220025 - CAGE SPNL 22MM 20-25MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7220027 SUP Custom 27803010 7220027 - CAGE SPINAL 22X21-27MM X-CORE 2 TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7220033 SUP Custom 27803010 7220033 - CAGE SPNL 22MM 24-33MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7220041 SUP Custom 27803010 7220041 - CAGE SPNL 22MM 28-41MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7220055 SUP Custom 27803010 7220055 - CAGE SPNL 22MM 35-55MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7220067 SUP Custom 27803010 7220067 - CAGE SPNL 22MM 41-67MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7220079 SUP Custom 27803010 7220079 - CAGE SPNL 22MM 47-79MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7220121 SUP Custom 27803010 7220121 - CAGE SPNL 22MM 68-121MM NS LF X-COR 2 XPD TI VERT BD REPL BOTH IP/OP "$13,962.50" "$10,332.00" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,485.33" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$13,962.50" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$13,962.50" "$13,962.50" N/A N/A 7220850 SUP HCPCS C1713 7220850 - SCREW SET EXTERNAL HEXAGONAL HEAD CD HORIZON LEGACY PEEK SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 7222200 SUP Custom 27803010 7222200 - ENDCAP SPNL 22MM RND 0 DEG OD 22 XCORE 2 TI BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 7222204 SUP Custom 27803010 7222204 - ENDCAP SPNL 22MM RND 4 DEG OD 22 XCORE 2 TI BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 7222208 SUP Custom 27803010 7222208 - ENDCAP SPNL 22MM RND 8 DEG OD 22 XCORE 2 TI BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 7222212 SUP Custom 27803010 7222212 - ENDCAP SPNL 22MM RND 12 DEG OD 22 XCORE 2 TI BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 7224000 SUP Custom 27803010 7224000 - ENDCAP SPNL OD 22X22X40MM 0 DEG XCORE 2 TI BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 7224004 SUP Custom 27803010 7224004 - ENDCAP SPNL OD 22X22X40MM 4 DEG XCORE 2 TI BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 7224008 SUP Custom 27803010 7224008 - ENDCAP SPNL OD 22X22X40MM 8 DEG XCORE 2 TI BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 7224012 SUP Custom 27803010 7224012 - ENDCAP SPNL OD 22X22X40MM 12 DEG XCORE 2 TI BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 7225000 SUP Custom 27803010 7225000 - ENDCAP SPNL OD 22X22X50MM 0 DEG XCORE 2 TI BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 7225004 SUP Custom 27803010 7225004 - ENDCAP SPNL OD 22X22X50MM 4 DEG XCORE 2 TI BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 7225008 SUP Custom 27803010 7225008 - ENDCAP SPNL OD 22X22X50MM 8 DEG XCORE 2 TI BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 7225012 SUP Custom 27803010 7225012 - ENDCAP SPNL OD 22X22X50MM 12 DEG XCORE 2 TI BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 7226000 SUP Custom 27803010 7226000 - ENDCAP SPNL OD 22X22X60MM 0 DEG XCORE 2 TI BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 7226004 SUP Custom 27803010 7226004 - ENDCAP SPNL OD 22X22X60MM 4 DEG XCORE 2 TI BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 7226008 SUP Custom 27803010 7226008 - ENDCAP SPNL OD 22X22X60MM 8 DEG XCORE 2 TI BOTH IP/OP "$3,157.50" "$2,337.00" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $562.04 "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" $658.06 "$3,157.50" "$1,263.00" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$3,157.50" "$2,368.13" "$3,157.50" "$3,157.50" "$3,157.50" "$1,578.75" "$1,578.75" "$2,500.74" "$3,157.50" "$2,526.00" "$1,420.88" "$3,157.50" N/A "$1,831.35" "$3,157.50" "$1,894.50" "$3,157.50" "$3,157.50" "$3,157.50" N/A N/A 7240033 SUP HCPCS C1713 7240033 - TEMPLATE ROD 250MM BOTH IP/OP "$1,012.50" $749.00 $200.96 "$1,012.50" $455.63 $455.63 $455.63 $455.63 "$1,012.50" "$1,012.50" "$1,012.50" $211.03 "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" $211.02 "$1,012.50" $405.00 $598.89 "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" $759.38 "$1,012.50" "$1,012.50" "$1,012.50" $506.25 $506.25 $801.90 "$1,012.50" $810.00 $455.63 $200.96 N/A $587.25 "$1,012.50" $607.50 "$1,012.50" $211.01 "$1,012.50" N/A N/A 7240034 SUP HCPCS C1713 7240034 - TEMPLATE ROD 500MM SPHERX II TITANIUM BOTH IP/OP "$1,187.50" $879.00 $235.69 "$1,187.50" $534.38 $534.38 $534.38 $534.38 "$1,187.50" "$1,187.50" "$1,187.50" $247.50 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $475.00 $702.41 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 $235.69 N/A $688.75 "$1,187.50" $712.50 "$1,187.50" $247.48 "$1,187.50" N/A N/A 7241045 SUP HCPCS C1713 7241045 - CONNECTOR ROD 45-60MM SPHERX II TRNSV TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241055 SUP HCPCS C1713 7241055 - CONNECTOR ROD 55-81MM SPHERX II TRNSV TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241075 SUP HCPCS C1713 7241075 - CONNECTOR ROD 74-85MM SPHERX II TRNSV TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241100 SUP HCPCS C1713 7241100 - SCREW BN SM 1.5MM 10MM SPHERX DBR II LCK TI SPNE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7241102 SUP HCPCS C1713 7241102 - HOOK SPNL SM SPHERX II TI PDCL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241103 SUP HCPCS C1713 7241103 - HOOK SPNL MED SPHERX II TI PDCL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241104 SUP HCPCS C1713 7241104 - HOOK SPNL 6MM SPHERX II NAR BLDE TI LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241105 SUP HCPCS C1713 7241105 - HOOK SPNL 8MM SPHERX II NAR BLDE TI LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241106 SUP HCPCS C1713 7241106 - HOOK SPNL 10MM SPHERX II NAR BLDE TI LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241107 SUP HCPCS C1713 7241107 - HOOK SPNL 6MM SPHERX II W BLDE ANG LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241108 SUP HCPCS C1713 7241108 - HOOK SPNL 8MM SPHERX II W BLDE ANG LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241109 SUP HCPCS C1713 7241109 - HOOK SPNL 10MM SPHERX II W BLDE ANG LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241110 SUP HCPCS C1713 7241110 - HOOK SPNL 6MM SPHERX II NAR BLDE ANG RDC TIP LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241111 SUP HCPCS C1713 7241111 - HOOK SPNL 8MM SPHERX II NAR BLDE ANG RDC TIP LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241112 SUP HCPCS C1713 7241112 - HOOK SPNL 10MM SPHERX II NAR BLDE ANG RDC TIP LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241113 SUP HCPCS C1713 7241113 - HOOK SPNL 6MM SPHERX II WA RDC TIP LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241114 SUP HCPCS C1713 7241114 - HOOK SPNL 8MM SPHERX II W BLDE ANG RDC TIP LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241115 SUP HCPCS C1713 7241115 - HOOK SPNL 10MM SPHERX II W BLDE ANG RDC TIP LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241116 SUP HCPCS C1713 7241116 - HOOK SPNL 6MM SPHERX II NAR BLDE DN ANG LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241117 SUP HCPCS C1713 7241117 - HOOK SPNL 8MM SPHERX II NAR BLDE DN ANG LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241118 SUP HCPCS C1713 7241118 - HOOK SPNL 10MM SPHERX II NAR BLDE DN ANG LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241119 SUP HCPCS C1713 7241119 - HOOK SPNL 6MM SPHERX II NAR BLDE ANG XTD LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241120 SUP HCPCS C1713 7241120 - HOOK SPNL 8MM SPHERX II NAR BLDE ANG XTD LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241121 SUP HCPCS C1713 7241121 - HOOK SPNL 45D SPHERX II NAR BLDE ANG BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241122 SUP HCPCS C1713 7241122 - HOOK SPNL SPHERX II NAR BLDE ANG RT OFST BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241123 SUP HCPCS C1713 7241123 - HOOK SPNL SPHERX II NAR BLDE ANG LT OFST BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241124 SUP HCPCS C1713 7241124 - HOOK SPNL SPHERX II NAR BLDE ANG RT OFST BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241125 SUP HCPCS C1713 7241125 - HOOK SPNL SPHERX II NAR BLDE ANG LT OFST BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241131 SUP HCPCS C1713 7241131 - HOOK SPNL 6MM SPHERX II ANG UP LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241132 SUP HCPCS C1713 7241132 - HOOK SPNL 8MM SPHERX II ANG UP LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241133 SUP HCPCS C1713 7241133 - HOOK SPNL 10MM SPHERX II ANG UP LMR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 7241200 SUP HCPCS C1713 7241200 - CONNECTOR ROD 20MM SPHERX II TRNSV FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241225 SUP HCPCS C1713 7241225 - CONNECTOR ROD 22MM SPHERX II TRNSV FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241250 SUP HCPCS C1713 7241250 - CONNECTOR ROD 25MM SPHERX II TRNSV FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241275 SUP HCPCS C1713 7241275 - CONNECTOR ROD 27MM SPHERX II TRNSV FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241300 SUP HCPCS C1713 7241300 - CONNECTOR ROD 30MM TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241325 SUP HCPCS C1713 7241325 - CONNECTOR ROD 32.5MM TRNSV FX SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241350 SUP HCPCS C1713 7241350 - CONNECTOR ROD 35MM SPHERX II TRNSV FA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241375 SUP HCPCS C1713 7241375 - CONNECTOR ROD 37.5MM SPHERX II TRNSV FA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241400 SUP HCPCS C1713 7241400 - CONNECTOR ROD 40MM SPHERX II TRNSV FA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241450 SUP HCPCS C1713 7241450 - CONNECTOR ROD 45MM SPHERX II TRNSV FA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241500 SUP HCPCS C1713 7241500 - CONNECTOR ROD 50MM SPHERX II TRNSV FA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241550 SUP HCPCS C1713 7241550 - CONNECTOR ROD 55MM SPHERX II TRNSV FA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7241600 SUP HCPCS C1713 7241600 - CONNECTOR ROD 60MM SPHERX II TRNSV FA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7242020 SUP HCPCS C1713 7242020 - ROD SPNL PREBNT 20MM SPHERX II BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7242030 SUP HCPCS C1713 7242030 - ROD SPNL PREBNT 30MM SPHERX II BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7242035 SUP HCPCS C1713 7242035 - ROD SPNL PREBNT 35MM SPHERX II BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7242040 SUP HCPCS C1713 7242040 - ROD SPINAL 40MM PREBENT CONVENTIONAL SPHERX II BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 7242050 SUP HCPCS C1713 7242050 - ROD SPNL PREBNT 50MM SPHERX II BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7242055 SUP HCPCS C1713 7242055 - ROD SPNL PREBNT 55MM NS SPHERX II MAS PLIF BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7242060 SUP HCPCS C1713 7242060 - ROD SPNL PREBNT 60MM SPHERX II BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7242065 SUP HCPCS C1713 7242065 - ROD SPNL PREBNT 65MM SPHERX II BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7242070 SUP HCPCS C1713 7242070 - ROD SPNL PREBNT 70MM SPHERX II BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7242075 SUP HCPCS C1713 7242075 - ROD SPINAL 75MM PREBENT CONVENTIONAL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 7242080 SUP HCPCS C1713 7242080 - ROD SPNL PREBNT 80MM NS SPHERX II MAS PLIF BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7242085 SUP HCPCS C1713 7242085 - ROD SPNL PREBNT 85MM SPHERX II BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7242095 SUP HCPCS C1713 7242095 - ROD SPNL PREBNT 95MM SPHERX II BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7242110 SUP HCPCS C1713 7242110 - ROD SPNL PREBNT 110MM SPHERX II BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7243045 SUP HCPCS C1713 7243045 - TRANSCONNECTOR ROD PREBNT 45-50MM ADJ ARCH SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7243050 SUP HCPCS C1713 7243050 - CONNECTOR ROD 50-60MM TRNSV SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7243060 SUP HCPCS C1713 7243060 - TRANSCONNECTOR ROD 60-70MM ADJ ARCH VAR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7243070 SUP HCPCS C1713 7243070 - CONNECTOR ROD 70-85MM VAR ADJ TRANSVRS BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7245525 SUP HCPCS C1713 7245525 - SCREW BN 5.5MM 25MM SPHERX DBR II PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7245530 SUP HCPCS C1713 7245530 - SCREW BN 5.5MM 30MM SPHERX DBR II PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7245535 SUP HCPCS C1713 7245535 - SCREW BN 5.5MM 35MM SPHERX DBR II PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7245540 SUP HCPCS C1713 7245540 - SCREW BN 5.5MM 40MM PA SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7245545 SUP HCPCS C1713 7245545 - SCREW BN 5.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7245550 SUP HCPCS C1713 7245550 - SCREW BN 5.5MM 50MM SPHERX DBR II PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7245555 SUP HCPCS C1713 7245555 - SCREW BN 5.5MM 55MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7245560 SUP HCPCS C1713 7245560 - SCREW BN 5.5MM 60MM SPHERX II PA SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 7246510 SUP HCPCS C1713 7246510 - SCREW BN 6.5MM 100MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 7246525 SUP HCPCS C1713 7246525 - SCREW BN 6.5MM 25MM SPHERX II PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 7246530 SUP HCPCS C1713 7246530 - SCREW BN 6.5MM 30MM SPHERX DBR II PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7246535 SUP HCPCS C1713 7246535 - SCREW BN 6.5MM 35MM SPHERX DBR II PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7246540 SUP HCPCS C1713 7246540 - SCREW BN 6.5MM 40MM SPHERX DBR II PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7246545 SUP HCPCS C1713 7246545 - SCREW BN 6.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7246550 SUP HCPCS C1713 7246550 - SCREW BN 6.5MM 50MM SPHERX DBR II PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7246555 SUP HCPCS C1713 7246555 - SCREW BN 6.5MM 55MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7246560 SUP HCPCS C1713 7246560 - SCREW BN 6.5MM 60MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7246565 SUP HCPCS C1713 7246565 - SCREW BN 6.5MM 65MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7246570 SUP HCPCS C1713 7246570 - SCREW BN 6.5MM 70MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 7246575 SUP HCPCS C1713 7246575 - SCREW BN 6.5MM 75MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 7246580 SUP HCPCS C1713 7246580 - SCREW BN 6.5MM 80MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7246585 SUP HCPCS C1713 7246585 - SCREW BN 6.5MM 85MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7246590 SUP HCPCS C1713 7246590 - SCREW BN 6.5MM 90MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7246595 SUP HCPCS C1713 7246595 - SCREW BN 6.5MM 95MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247510 SUP HCPCS C1713 7247510 - SCREW BN 7.5MM 100MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247525 SUP HCPCS C1713 7247525 - SCREW BN 7.5MM 25MM SPHERX II PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247530 SUP HCPCS C1713 7247530 - SCREW BN 7.5MM 30MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247535 SUP HCPCS C1713 7247535 - SCREW BN 7.5MM 35MM SPHERX DBR II PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247540 SUP HCPCS C1713 7247540 - SCREW BN 7.5MM 40MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247545 SUP HCPCS C1713 7247545 - SCREW BN 7.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247550 SUP HCPCS C1713 7247550 - SCREW BN 7.5MM 50MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247555 SUP HCPCS C1713 7247555 - SCREW BN 7.5MM 55MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247560 SUP HCPCS C1713 7247560 - SCREW BN 7.5MM 60MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247565 SUP HCPCS C1713 7247565 - SCREW BN 7.5MM 65MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247570 SUP HCPCS C1713 7247570 - SCREW BN 7.5MM 70MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247575 SUP HCPCS C1713 7247575 - SCREW BN 7.5MM 75MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247580 SUP HCPCS C1713 7247580 - SCREW BN 7.5MM 80MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247585 SUP HCPCS C1713 7247585 - SCREW BN 7.5MM 85MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247590 SUP HCPCS C1713 7247590 - SCREW BN 7.5MM 90MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7247595 SUP HCPCS C1713 7247595 - SCREW BN 7.5MM 95MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248025 SUP HCPCS C1713 7248025 - ROD SPNL 25MM SPHERX II CNV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A 7248030 SUP HCPCS C1713 7248030 - ROD SPNL 30MM SPHERX II CNV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A 7248035 SUP HCPCS C1713 7248035 - ROD SPNL 35MM SPHERX II CNV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7248040 SUP HCPCS C1713 7248040 - ROD SPNL 40MM SPHERX II CNV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A 7248045 SUP HCPCS C1713 7248045 - ROD SPNL 45MM SPHERX II CNV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A 7248050 SUP HCPCS C1713 7248050 - ROD SPNL 50MM SPHERX II CNV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7248055 SUP HCPCS C1713 7248055 - ROD SPNL 55MM SPHERX II CNV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A 7248060 SUP HCPCS C1713 7248060 - ROD SPNL 60MM SPHERX II CNV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A 7248065 SUP HCPCS C1713 7248065 - ROD SPNL 65MM SPHERX II CNV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7248070 SUP HCPCS C1713 7248070 - ROD SPNL 70MM SPHERX II CNV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7248075 SUP HCPCS C1713 7248075 - ROD SPNL 75MM SPHERX II CNV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7248080 SUP HCPCS C1713 7248080 - ROD SPNL 80MM SPHERX DBR II THOR BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 7248085 SUP HCPCS C1713 7248085 - ROD SPNL 85MM SPHERX II CNV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7248090 SUP HCPCS C1713 7248090 - ROD SPNL 90MM SPHERX II CNV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7248095 SUP HCPCS C1713 7248095 - ROD SPNL 95MM SPHERX II CNV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7248100 SUP HCPCS C1713 7248100 - ROD SPNL 100MM SPHERX II CNV BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $600.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A 7248105 SUP HCPCS C1713 7248105 - ROD SPNL 105MM SPHERX II CNV BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A 7248110 SUP HCPCS C1713 7248110 - ROD SPNL 110MM SPHERX II CNV BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A 7248115 SUP HCPCS C1713 7248115 - ROD SPNL 115MM SPHERX II CNV BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A 7248120 SUP HCPCS C1713 7248120 - ROD SPNL 120MM SPHERX II CNV BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $600.00 $600.00 $125.04 $600.00 N/A N/A 7248125 SUP HCPCS C1713 7248125 - ROD SPNL 125MM SPHERX II CNV BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $600.00 $600.00 $125.04 $600.00 N/A N/A 7248130 SUP HCPCS C1713 7248130 - ROD SPNL 130MM SPHERX II CNV BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $600.00 $600.00 $125.04 $600.00 N/A N/A 7248135 SUP HCPCS C1713 7248135 - ROD SPNL 135MM SPHERX II CNV BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $600.00 $600.00 $125.04 $600.00 N/A N/A 7248140 SUP HCPCS C1713 7248140 - ROD SPNL 140MM SPHERX II CNV BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $600.00 $600.00 $125.04 $600.00 N/A N/A 7248145 SUP HCPCS C1713 7248145 - ROD SPNL 145MM SPHERX II CNV BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $600.00 $600.00 $125.04 $600.00 N/A N/A 7248150 SUP HCPCS C1713 7248150 - ROD SPNL 150MM SPHERX II CNV BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A 7248300 SUP HCPCS C1713 7248300 - ROD SPNL 300MM SPHERX II CNV BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A 7248500 SUP HCPCS C1713 7248500 - ROD SPNL 500MM SPHERX II CNV BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A 7248510 SUP HCPCS C1713 7248510 - SCREW BN 8.5MM 100MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248525 SUP HCPCS C1713 7248525 - SCREW BN 8.5MM 25MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248530 SUP HCPCS C1713 7248530 - SCREW BN 8.5MM 30MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248535 SUP HCPCS C1713 7248535 - SCREW BN 8.5MM 35MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248540 SUP HCPCS C1713 7248540 - SCREW BN 8.5MM 40MM SPHERX DBR II PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248545 SUP HCPCS C1713 7248545 - SCREW BN 8.5MM 45MM SPHERX DBR II PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248550 SUP HCPCS C1713 7248550 - SCREW BN 8.5MM 50MM SPHERX DBR II PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248555 SUP HCPCS C1713 7248555 - SCREW BN 8.5MM 55MM PA SPNE PDCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248560 SUP HCPCS C1713 7248560 - SCREW BN 8.5MM 60MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248565 SUP HCPCS C1713 7248565 - SCREW BN 8.5MM 65MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248570 SUP HCPCS C1713 7248570 - SCREW BN 8.5MM 70MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248575 SUP HCPCS C1713 7248575 - SCREW BN 8.5MM 75MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248580 SUP HCPCS C1713 7248580 - SCREW BN 8.5MM 80MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248585 SUP HCPCS C1713 7248585 - SCREW BN 8.5MM 85MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248590 SUP HCPCS C1713 7248590 - SCREW BN 8.5MM 90MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7248595 SUP HCPCS C1713 7248595 - SCREW BN 8.5MM 95MM PA ILIUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7249310 SUP HCPCS C1713 7249310 - CONNECTOR ROD OFST 100MM SPNE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" $585.00 $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A 7249335 SUP HCPCS C1713 7249335 - CONNECTOR ROD OFST 35MM SPHERX II SPNE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A 7249350 SUP HCPCS C1713 7249350 - CONNECTOR ROD OFST 50MM SPNE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A 7251526 SUP HCPCS C1713 7251526 - STAPLE BN SM INFR ANT THOR SPNL BOTH IP/OP "$2,162.50" "$1,600.00" $429.20 "$2,162.50" $973.13 $973.13 $973.13 $973.13 "$2,162.50" "$2,162.50" "$2,162.50" $450.72 "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" $450.69 "$2,162.50" "$2,162.50" "$1,279.12" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$1,621.88" "$2,162.50" "$2,162.50" "$2,162.50" "$1,081.25" "$1,081.25" "$1,712.70" "$2,162.50" "$1,730.00" $973.13 $429.20 N/A "$1,254.25" "$2,162.50" "$2,162.50" "$2,162.50" $450.67 "$2,162.50" N/A N/A 7251528 SUP HCPCS C1713 7251528 - STAPLE BN MED INFR ANT THOR SPNL BOTH IP/OP "$2,162.50" "$1,600.00" $429.20 "$2,162.50" $973.13 $973.13 $973.13 $973.13 "$2,162.50" "$2,162.50" "$2,162.50" $450.72 "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" $450.69 "$2,162.50" "$2,162.50" "$1,279.12" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$1,621.88" "$2,162.50" "$2,162.50" "$2,162.50" "$1,081.25" "$1,081.25" "$1,712.70" "$2,162.50" "$1,730.00" $973.13 $429.20 N/A "$1,254.25" "$2,162.50" "$2,162.50" "$2,162.50" $450.67 "$2,162.50" N/A N/A 7251530 SUP HCPCS C1713 7251530 - STAPLE BN LG INFR ANT THOR SPNL BOTH IP/OP "$2,162.50" "$1,600.00" $429.20 "$2,162.50" $973.13 $973.13 $973.13 $973.13 "$2,162.50" "$2,162.50" "$2,162.50" $450.72 "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" $450.69 "$2,162.50" $865.00 "$1,279.12" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$1,621.88" "$2,162.50" "$2,162.50" "$2,162.50" "$1,081.25" "$1,081.25" "$1,712.70" "$2,162.50" "$1,730.00" $973.13 $429.20 N/A "$1,254.25" "$2,162.50" "$2,162.50" "$2,162.50" $450.67 "$2,162.50" N/A N/A 7251626 SUP HCPCS C1713 7251626 - STAPLE BN SM SUP ANT THOR SPNL BOTH IP/OP "$2,162.50" "$1,600.00" $429.20 "$2,162.50" $973.13 $973.13 $973.13 $973.13 "$2,162.50" "$2,162.50" "$2,162.50" $450.72 "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" $450.69 "$2,162.50" $865.00 "$1,279.12" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$1,621.88" "$2,162.50" "$2,162.50" "$2,162.50" "$1,081.25" "$1,081.25" "$1,712.70" "$2,162.50" "$1,730.00" $973.13 $429.20 N/A "$1,254.25" "$2,162.50" "$2,162.50" "$2,162.50" $450.67 "$2,162.50" N/A N/A 7251628 SUP HCPCS C1713 7251628 - STAPLE BN MED SUP ANT THOR SPNL BOTH IP/OP "$2,162.50" "$1,600.00" $429.20 "$2,162.50" $973.13 $973.13 $973.13 $973.13 "$2,162.50" "$2,162.50" "$2,162.50" $450.72 "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" $450.69 "$2,162.50" "$2,162.50" "$1,279.12" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$1,621.88" "$2,162.50" "$2,162.50" "$2,162.50" "$1,081.25" "$1,081.25" "$1,712.70" "$2,162.50" "$1,730.00" $973.13 $429.20 N/A "$1,254.25" "$2,162.50" "$2,162.50" "$2,162.50" $450.67 "$2,162.50" N/A N/A 7251630 SUP HCPCS C1713 7251630 - STAPLE BN LG SUP ANT THOR SPNL BOTH IP/OP "$2,162.50" "$1,600.00" $429.20 "$2,162.50" $973.13 $973.13 $973.13 $973.13 "$2,162.50" "$2,162.50" "$2,162.50" $450.72 "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" $450.69 "$2,162.50" $865.00 "$1,279.12" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$1,621.88" "$2,162.50" "$2,162.50" "$2,162.50" "$1,081.25" "$1,081.25" "$1,712.70" "$2,162.50" "$1,730.00" $973.13 $429.20 N/A "$1,254.25" "$2,162.50" "$2,162.50" "$2,162.50" $450.67 "$2,162.50" N/A N/A 7253012 SUP HCPCS C1713 7253012 - STAPLE BN SM 1 HL BOTH IP/OP $947.50 $701.00 $188.06 $947.50 $426.38 $426.38 $426.38 $426.38 $947.50 $947.50 $947.50 $197.48 $947.50 $947.50 $947.50 $947.50 $947.50 $197.47 $947.50 $947.50 $560.45 $947.50 $947.50 $947.50 $947.50 $710.63 $947.50 $947.50 $947.50 $473.75 $473.75 $750.42 $947.50 $758.00 $426.38 $188.06 N/A $549.55 $947.50 $947.50 $947.50 $197.46 $947.50 N/A N/A 7253014 SUP HCPCS C1713 7253014 - STAPLE BN MED 1 HL BOTH IP/OP $947.50 $701.00 $188.06 $947.50 $426.38 $426.38 $426.38 $426.38 $947.50 $947.50 $947.50 $197.48 $947.50 $947.50 $947.50 $947.50 $947.50 $197.47 $947.50 $379.00 $560.45 $947.50 $947.50 $947.50 $947.50 $710.63 $947.50 $947.50 $947.50 $473.75 $473.75 $750.42 $947.50 $758.00 $426.38 $188.06 N/A $549.55 $947.50 $947.50 $947.50 $197.46 $947.50 N/A N/A 7253016 SUP HCPCS C1713 7253016 - STAPLE BN LG 1 HL BOTH IP/OP $947.50 $701.00 $188.06 $947.50 $426.38 $426.38 $426.38 $426.38 $947.50 $947.50 $947.50 $197.48 $947.50 $947.50 $947.50 $947.50 $947.50 $197.47 $947.50 $379.00 $560.45 $947.50 $947.50 $947.50 $947.50 $710.63 $947.50 $947.50 $947.50 $473.75 $473.75 $750.42 $947.50 $758.00 $426.38 $188.06 N/A $549.55 $947.50 $947.50 $947.50 $197.46 $947.50 N/A N/A 7253112 SUP HCPCS C1713 7253112 - WASHER SPNL SM BOTH IP/OP $387.50 $287.00 $76.91 $387.50 $174.38 $174.38 $174.38 $174.38 $387.50 $387.50 $387.50 $80.76 $387.50 $387.50 $387.50 $387.50 $387.50 $80.76 $387.50 $155.00 $229.21 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $174.38 $76.91 N/A $224.75 $387.50 $387.50 $387.50 $80.76 $387.50 N/A N/A 7253114 SUP HCPCS C1713 7253114 - WASHER SPNL MED BOTH IP/OP $387.50 $287.00 $76.91 $387.50 $174.38 $174.38 $174.38 $174.38 $387.50 $387.50 $387.50 $80.76 $387.50 $387.50 $387.50 $387.50 $387.50 $80.76 $387.50 $387.50 $229.21 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $174.38 $76.91 N/A $224.75 $387.50 $387.50 $387.50 $80.76 $387.50 N/A N/A 7253116 SUP HCPCS C1713 7253116 - WASHER SPNL LG BOTH IP/OP $387.50 $287.00 $76.91 $387.50 $174.38 $174.38 $174.38 $174.38 $387.50 $387.50 $387.50 $80.76 $387.50 $387.50 $387.50 $387.50 $387.50 $80.76 $387.50 $155.00 $229.21 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $174.38 $76.91 N/A $224.75 $387.50 $387.50 $387.50 $80.76 $387.50 N/A N/A 7254022 SUP HCPCS C1713 7254022 - CONNECTOR ROD 22MM SPHERX II FX SPNE ANT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7254525 SUP HCPCS C1713 7254525 - SCREW BN 4.5MM 25MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7254530 SUP HCPCS C1713 7254530 - SCREW BN 4.5MM 30MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7254535 SUP HCPCS C1713 7254535 - SCREW BN 4.5MM 35MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7254540 SUP HCPCS C1713 7254540 - SCREW BN 4.5MM 40MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7254545 SUP HCPCS C1713 7254545 - SCREW BN 4.5MM 45MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7254550 SUP HCPCS C1713 7254550 - SCREW BN 4.5MM 50MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7255525 SUP HCPCS C1713 7255525 - SCREW BN 5.5MM 25MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7255530 SUP HCPCS C1713 7255530 - SCREW BN 5.5MM 30MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7255535 SUP HCPCS C1713 7255535 - SCREW BN 5.5MM 35MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7255540 SUP HCPCS C1713 7255540 - SCREW BN 5.5MM 40MM SPHERX DBR II FX ANG TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7255545 SUP HCPCS C1713 7255545 - SCREW BN 5.5MM 45MM SPHERX DBR II FX ANG TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7255550 SUP HCPCS C1713 7255550 - SCREW BN 5.5MM 50MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7255555 SUP HCPCS C1713 7255555 - SCREW BN 5.5MM 55MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7255560 SUP HCPCS C1713 7255560 - SCREW BN 5.5MM 60MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256012 SUP HCPCS C1713 7256012 - CONNECTOR ROD 12MM SPHERX II FX SPNE ANT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256013 SUP HCPCS C1713 7256013 - CONNECTOR ROD 13MM SPHERX II FX SPNE ANT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256014 SUP HCPCS C1713 7256014 - CONNECTOR ROD 14MM SPHERX II FX SPNE ANT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256015 SUP HCPCS C1713 7256015 - CONNECTOR ROD 15MM SPHERX II FX SPNE ANT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256016 SUP HCPCS C1713 7256016 - CONNECTOR ROD 16MM SPHERX II FX SPNE ANT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256017 SUP HCPCS C1713 7256017 - CONNECTOR ROD 17MM SPHERX II FX SPNE ANT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256018 SUP HCPCS C1713 7256018 - CONNECTOR ROD 18MM SPHERX II FX SPNE ANT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256019 SUP HCPCS C1713 7256019 - CONNECTOR ROD 19MM TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256020 SUP HCPCS C1713 7256020 - CONNECTOR ROD 20MM TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256021 SUP HCPCS C1713 7256021 - CONNECTOR ROD 21MM SPHERX II FX SPNE ANT BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256530 SUP HCPCS C1713 7256530 - SCREW BN 6.5MM 30MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256535 SUP HCPCS C1713 7256535 - SCREW BN 6.5MM 35MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256540 SUP HCPCS C1713 7256540 - SCREW BN 6.5MM 40MM SPHERX DBR II FX ANG TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256545 SUP HCPCS C1713 7256545 - SCREW BN 6.5MM 45MM SPHERX II FX BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256550 SUP HCPCS C1713 7256550 - SCREW BN 6.5MM 50MM SPHERX DBR II FX ANG TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256555 SUP HCPCS C1713 7256555 - SCREW BN 6.5MM 55MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7256560 SUP HCPCS C1713 7256560 - SCREW BN 6.5MM 60MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7257530 SUP HCPCS C1713 7257530 - SCREW BN 7.5MM 30MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7257535 SUP HCPCS C1713 7257535 - SCREW BN 7.5MM 35MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7257540 SUP HCPCS C1713 7257540 - SCREW BN 7.5IN 40MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7257545 SUP HCPCS C1713 7257545 - SCREW BN 7.5MM 45MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7257550 SUP HCPCS C1713 7257550 - SCREW BN 7.5MM 50MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7257555 SUP HCPCS C1713 7257555 - SCREW BN 7.5MM 55MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7257560 SUP HCPCS C1713 7257560 - SCREW BN 7.5MM 60MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7258530 SUP HCPCS C1713 7258530 - SCREW BN 8.5MM 30MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7258535 SUP HCPCS C1713 7258535 - SCREW BN 8.5MM 35MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7258540 SUP HCPCS C1713 7258540 - SCREW BN 8.5MM 40MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7258545 SUP HCPCS C1713 7258545 - SCREW BN 8.5MM 45MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7258550 SUP HCPCS C1713 7258550 - SCREW BN 8.5MM 50MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7258555 SUP HCPCS C1713 7258555 - SCREW BN 8.5MM 55MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7258560 SUP HCPCS C1713 7258560 - SCREW BN 8.5MM 60MM SPHERX II FA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7262600 SUP Custom 27803010 7262600 - ENDCAP SPNL 26MM RND 0 DEG OD 22 XCORE 2 TI BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 7262604 SUP Custom 27803010 7262604 - ENDCAP SPNL 26MM RND 4 DEG OD 22 XCORE 2 TI BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 7262608 SUP Custom 27803010 7262608 - ENDCAP SPNL 26MM RND 8 DEG OD 22 XCORE 2 TI BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 7262612 SUP Custom 27803010 7262612 - ENDCAP SPNL 26MM RND 12 DEG OD 22 XCORE 2 TI BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 7265535 SUP HCPCS C1713 7265535 - SCREW BN 5.5MM 35MM RDC PA SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7265540 SUP HCPCS C1713 7265540 - SCREW BN 5.5MM 40MM PA RDC SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7265545 SUP HCPCS C1713 7265545 - SCREW BN 5.5MM 45MM PA RDC SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7265550 SUP HCPCS C1713 7265550 - SCREW BN 5.5MM 50MM SPHERX PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7265555 SUP HCPCS C1713 7265555 - SCREW BN 5.5MM 55MM SPHERX PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7266535 SUP HCPCS C1713 7266535 - SCREW BN 6.5MM 35MM SPHERX PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7266540 SUP HCPCS C1713 7266540 - SCREW BN 6.5MM 40MM SPHERX RDC SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7266545 SUP HCPCS C1713 7266545 - SCREW BN 6.5MM 45MM SPHERX II RDC PA SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7266550 SUP HCPCS C1713 7266550 - SCREW BN 6.5MM 50MM SPHERX PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7266555 SUP HCPCS C1713 7266555 - SCREW BN 6.5MM 55MM SPHERX PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7267535 SUP HCPCS C1713 7267535 - SCREW BN 7.5MM 35MM SPHERX PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7267540 SUP HCPCS C1713 7267540 - SCREW BN 7.5MM 40MM RDC PA SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7267545 SUP HCPCS C1713 7267545 - SCREW BN 7.5MM 45MM SPHERX PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7267550 SUP HCPCS C1713 7267550 - SCREW BN 7.5MM 50MM SPHERX PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7267555 SUP HCPCS C1713 7267555 - SCREW BN 7.5MM 55MM SPHERX PA SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7270100 SUP HCPCS C1713 7270100 - WIRE FX KRSH BVL TIP BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $90.00 $90.00 $90.00 $90.00 $200.00 $200.00 $200.00 $41.69 $200.00 $200.00 $200.00 $200.00 $200.00 $41.68 $200.00 $80.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $90.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 7270200 SUP HCPCS C1713 7270200 - WIRE FX KRSH THRD BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $90.00 $90.00 $90.00 $90.00 $200.00 $200.00 $200.00 $41.69 $200.00 $200.00 $200.00 $200.00 $200.00 $41.68 $200.00 $80.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $90.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 7270300 SUP HCPCS C1713 7270300 - WIRE FX XLNG KRSH THRD TIP BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $90.00 $90.00 $90.00 $90.00 $200.00 $200.00 $200.00 $41.69 $200.00 $200.00 $200.00 $200.00 $200.00 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $90.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 7270411 SUP HCPCS C1713 7270411 - SPACER SPNL 11MM 11X4MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270441 SUP HCPCS C1713 7270441 - SPACER SPNL 11MM 14X4MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270444 SUP HCPCS C1713 7270444 - SPACER SPNL 14MM 14X4MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270511 SUP HCPCS C1713 7270511 - SPACER SPNL 11MM 11X5MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270541 SUP HCPCS C1713 7270541 - SPACER SPNL 11MM 14X5MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270544 SUP HCPCS C1713 7270544 - SPACER SPNL 14MM 14X5MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270611 SUP HCPCS C1713 7270611 - SPACER SPNL 11MM 11X6MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270641 SUP HCPCS C1713 7270641 - SPACER SPNL 11MM 14X6MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270644 SUP HCPCS C1713 7270644 - SPACER SPNL 14MM 14X6MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270711 SUP HCPCS C1713 7270711 - SPACER SPNL 11MM 11X7MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270741 SUP HCPCS C1713 7270741 - SPACER SPNL 11MM 14X7MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270744 SUP HCPCS C1713 7270744 - SPACER SPNL 14MM 14X7MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270811 SUP HCPCS C1713 7270811 - SPACER SPNL 11MM 11X8MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 7270841 SUP HCPCS C1713 7270841 - SPACER SPNL 11MM 14X8MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 7270844 SUP HCPCS C1713 7270844 - SPACER SPNL 14MM 14X8MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270911 SUP HCPCS C1713 7270911 - SPACER SPNL 11MM 11X9MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270941 SUP HCPCS C1713 7270941 - SPACER SPNL 11MM 14X9MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7270944 SUP HCPCS C1713 7270944 - SPACER SPNL 14MM 14X9MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7271011 SUP HCPCS C1713 7271011 - SPACER SPNL 11MM 11X10MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7271041 SUP HCPCS C1713 7271041 - SPACER SPNL 11MM 14X10MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 7271044 SUP HCPCS C1713 7271044 - SPACER SPNL 14MM 14X10MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 7271111 SUP HCPCS C1713 7271111 - SPACER SPNL 11MM 11X11MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7271141 SUP HCPCS C1713 7271141 - SPACER SPNL 11MM 14X11MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7271144 SUP HCPCS C1713 7271144 - SPACER SPNL 14MM 14X11MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7271211 SUP HCPCS C1713 7271211 - SPACER SPNL 11MM 11X12MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7271241 SUP HCPCS C1713 7271241 - SPACER SPNL 11MM 14X12MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7271244 SUP HCPCS C1713 7271244 - SPACER SPNL 14MM 14X12MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7271311 SUP HCPCS C1713 7271311 - SPACER SPNL 11MM 11X13MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7271341 SUP HCPCS C1713 7271341 - SPACER SPNL 11MM 14X13MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7271344 SUP HCPCS C1713 7271344 - SPACER SPNL 14MM 14X13MM STRL VRTSTCK CRSTN PSR RADOPQ PEEK BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 7284525 SUP HCPCS C1713 7284525 - SCREW BN 4.5MM 25MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7284530 SUP HCPCS C1713 7284530 - SCREW BN 4.5MM 30MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7284535 SUP HCPCS C1713 7284535 - SCREW BN 4.5MM 35MM PA SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7284540 SUP HCPCS C1713 7284540 - SCREW BN 4.5MM 40MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7284545 SUP HCPCS C1713 7284545 - SCREW BN 4.5MM 45MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7284550 SUP HCPCS C1713 7284550 - SCREW BN 4.5MM 50MM SPHERX II PA TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7291025 SUP HCPCS C1713 7291025 - ROD SPNL 5.5MM 25MM SPHERX II TI BOTH IP/OP $782.50 $579.00 $155.31 $782.50 $352.13 $352.13 $352.13 $352.13 $782.50 $782.50 $782.50 $163.09 $782.50 $782.50 $782.50 $782.50 $782.50 $163.08 $782.50 $313.00 $462.85 $782.50 $782.50 $782.50 $782.50 $586.88 $782.50 $782.50 $782.50 $391.25 $391.25 $619.74 $782.50 $626.00 $352.13 $155.31 N/A $453.85 $782.50 $782.50 $782.50 $163.07 $782.50 N/A N/A 7291030 SUP HCPCS C1713 7291030 - ROD SPNL 5.5MM 30MM SPHERX II TI BOTH IP/OP $782.50 $579.00 $155.31 $782.50 $352.13 $352.13 $352.13 $352.13 $782.50 $782.50 $782.50 $163.09 $782.50 $782.50 $782.50 $782.50 $782.50 $163.08 $782.50 $313.00 $462.85 $782.50 $782.50 $782.50 $782.50 $586.88 $782.50 $782.50 $782.50 $391.25 $391.25 $619.74 $782.50 $626.00 $352.13 $155.31 N/A $453.85 $782.50 $469.50 $782.50 $163.07 $782.50 N/A N/A 7291035 SUP HCPCS C1713 7291035 - ROD SPNL 5.5MM 35MM 1 BALL BOTH IP/OP $782.50 $579.00 $155.31 $782.50 $352.13 $352.13 $352.13 $352.13 $782.50 $782.50 $782.50 $163.09 $782.50 $782.50 $782.50 $782.50 $782.50 $163.08 $782.50 $313.00 $462.85 $782.50 $782.50 $782.50 $782.50 $586.88 $782.50 $782.50 $782.50 $391.25 $391.25 $619.74 $782.50 $626.00 $352.13 $155.31 N/A $453.85 $782.50 $782.50 $782.50 $163.07 $782.50 N/A N/A 7291040 SUP HCPCS C1713 7291040 - ROD SPNL PREBNT 5.5MM 40MM SPHERX II 1 BALL BOTH IP/OP $782.50 $579.00 $155.31 $782.50 $352.13 $352.13 $352.13 $352.13 $782.50 $782.50 $782.50 $163.09 $782.50 $782.50 $782.50 $782.50 $782.50 $163.08 $782.50 $313.00 $462.85 $782.50 $782.50 $782.50 $782.50 $586.88 $782.50 $782.50 $782.50 $391.25 $391.25 $619.74 $782.50 $626.00 $352.13 $155.31 N/A $453.85 $782.50 $469.50 $782.50 $163.07 $782.50 N/A N/A 7291045 SUP HCPCS C1713 7291045 - ROD SPNL 5.5MM 45MM SPHERX II TI BOTH IP/OP $860.00 $636.00 $170.69 $860.00 $387.00 $387.00 $387.00 $387.00 $860.00 $860.00 $860.00 $179.25 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $344.00 $508.69 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $170.69 N/A $498.80 $860.00 $860.00 $860.00 $179.22 $860.00 N/A N/A 7291050 SUP HCPCS C1713 7291050 - ROD SPNL 5.5MM 50MM SPHERX II TI BOTH IP/OP $860.00 $636.00 $170.69 $860.00 $387.00 $387.00 $387.00 $387.00 $860.00 $860.00 $860.00 $179.25 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $344.00 $508.69 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $170.69 N/A $498.80 $860.00 $516.00 $860.00 $179.22 $860.00 N/A N/A 7291055 SUP HCPCS C1713 7291055 - ROD SPNL 5.5MM 55MM SPHERX II TI BOTH IP/OP $860.00 $636.00 $170.69 $860.00 $387.00 $387.00 $387.00 $387.00 $860.00 $860.00 $860.00 $179.25 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $860.00 $508.69 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $170.69 N/A $498.80 $860.00 $860.00 $860.00 $179.22 $860.00 N/A N/A 7291060 SUP HCPCS C1713 7291060 - ROD SPNL 5.5MM 60MM SPHERX II TI BOTH IP/OP $860.00 $636.00 $170.69 $860.00 $387.00 $387.00 $387.00 $387.00 $860.00 $860.00 $860.00 $179.25 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $344.00 $508.69 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $170.69 N/A $498.80 $860.00 $860.00 $860.00 $179.22 $860.00 N/A N/A 7291065 SUP HCPCS C1713 7291065 - ROD SPNL 5.5MM 65MM SPHERX II TI BOTH IP/OP $860.00 $636.00 $170.69 $860.00 $387.00 $387.00 $387.00 $387.00 $860.00 $860.00 $860.00 $179.25 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $344.00 $508.69 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $170.69 N/A $498.80 $860.00 $860.00 $860.00 $179.22 $860.00 N/A N/A 7291070 SUP HCPCS C1713 7291070 - ROD SPNL 5.5MM 70MM SPHERX II TI BOTH IP/OP $860.00 $636.00 $170.69 $860.00 $387.00 $387.00 $387.00 $387.00 $860.00 $860.00 $860.00 $179.25 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $344.00 $508.69 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $170.69 N/A $498.80 $860.00 $860.00 $860.00 $179.22 $860.00 N/A N/A 7291075 SUP HCPCS C1713 7291075 - ROD SPNL 5.5MM 75MM SPHERX II TI BOTH IP/OP $860.00 $636.00 $170.69 $860.00 $387.00 $387.00 $387.00 $387.00 $860.00 $860.00 $860.00 $179.25 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $344.00 $508.69 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $170.69 N/A $498.80 $860.00 $860.00 $860.00 $179.22 $860.00 N/A N/A 7291080 SUP HCPCS C1713 7291080 - ROD SPNL 5.5MM 80MM SPHERX II TI BOTH IP/OP $860.00 $636.00 $170.69 $860.00 $387.00 $387.00 $387.00 $387.00 $860.00 $860.00 $860.00 $179.25 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $344.00 $508.69 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $170.69 N/A $498.80 $860.00 $860.00 $860.00 $179.22 $860.00 N/A N/A 7291085 SUP HCPCS C1713 7291085 - ROD SPNL 5.5MM 85MM SPHERX II TI BOTH IP/OP $860.00 $636.00 $170.69 $860.00 $387.00 $387.00 $387.00 $387.00 $860.00 $860.00 $860.00 $179.25 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $860.00 $508.69 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $170.69 N/A $498.80 $860.00 $860.00 $860.00 $179.22 $860.00 N/A N/A 7291090 SUP HCPCS C1713 7291090 - ROD SPNL 5.5MM 90MM SPHERX II TI BOTH IP/OP $860.00 $636.00 $170.69 $860.00 $387.00 $387.00 $387.00 $387.00 $860.00 $860.00 $860.00 $179.25 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $344.00 $508.69 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $170.69 N/A $498.80 $860.00 $860.00 $860.00 $179.22 $860.00 N/A N/A 7291095 SUP HCPCS C1713 7291095 - ROD SPNL 5.5MM 95MM SPHERX II TI BOTH IP/OP $917.50 $679.00 $182.10 $917.50 $412.88 $412.88 $412.88 $412.88 $917.50 $917.50 $917.50 $191.23 $917.50 $917.50 $917.50 $917.50 $917.50 $191.22 $917.50 $917.50 $542.70 $917.50 $917.50 $917.50 $917.50 $688.13 $917.50 $917.50 $917.50 $458.75 $458.75 $726.66 $917.50 $734.00 $412.88 $182.10 N/A $532.15 $917.50 $917.50 $917.50 $917.50 $917.50 N/A N/A 7291100 SUP HCPCS C1713 7291100 - ROD SPNL 5.5MM 100MM SPHERX II TI BOTH IP/OP $917.50 $679.00 $182.10 $917.50 $412.88 $412.88 $412.88 $412.88 $917.50 $917.50 $917.50 $191.23 $917.50 $917.50 $917.50 $917.50 $917.50 $191.22 $917.50 $367.00 $542.70 $917.50 $917.50 $917.50 $917.50 $688.13 $917.50 $917.50 $917.50 $458.75 $458.75 $726.66 $917.50 $734.00 $412.88 $182.10 N/A $532.15 $917.50 $917.50 $917.50 $191.21 $917.50 N/A N/A 7291110 SUP HCPCS C1713 7291110 - ROD SPNL 5.5MM 110MM SPHERX II TI BOTH IP/OP $917.50 $679.00 $182.10 $917.50 $412.88 $412.88 $412.88 $412.88 $917.50 $917.50 $917.50 $191.23 $917.50 $917.50 $917.50 $917.50 $917.50 $191.22 $917.50 $367.00 $542.70 $917.50 $917.50 $917.50 $917.50 $688.13 $917.50 $917.50 $917.50 $458.75 $458.75 $726.66 $917.50 $734.00 $412.88 $182.10 N/A $532.15 $917.50 $917.50 $917.50 $191.21 $917.50 N/A N/A 7291120 SUP HCPCS C1713 7291120 - ROD SPNL PREBNT 5.5MM 120MM SPHERX II TI BOTH IP/OP $917.50 $679.00 $182.10 $917.50 $412.88 $412.88 $412.88 $412.88 $917.50 $917.50 $917.50 $191.23 $917.50 $917.50 $917.50 $917.50 $917.50 $191.22 $917.50 $367.00 $542.70 $917.50 $917.50 $917.50 $917.50 $688.13 $917.50 $917.50 $917.50 $458.75 $458.75 $726.66 $917.50 $734.00 $412.88 $182.10 N/A $532.15 $917.50 $917.50 $917.50 $191.21 $917.50 N/A N/A 7291130 SUP HCPCS C1713 7291130 - ROD SPNL 5.5MM 400MM SPHERX II TI BOTH IP/OP $917.50 $679.00 $182.10 $917.50 $412.88 $412.88 $412.88 $412.88 $917.50 $917.50 $917.50 $191.23 $917.50 $917.50 $917.50 $917.50 $917.50 $191.22 $917.50 $367.00 $542.70 $917.50 $917.50 $917.50 $917.50 $688.13 $917.50 $917.50 $917.50 $458.75 $458.75 $726.66 $917.50 $734.00 $412.88 $182.10 N/A $532.15 $917.50 $917.50 $917.50 $917.50 $917.50 N/A N/A 7291140 SUP HCPCS C1713 7291140 - ROD SPNL PREBNT 5.5MM 140MM SPHERX II TI BOTH IP/OP $917.50 $679.00 $182.10 $917.50 $412.88 $412.88 $412.88 $412.88 $917.50 $917.50 $917.50 $191.23 $917.50 $917.50 $917.50 $917.50 $917.50 $191.22 $917.50 $917.50 $542.70 $917.50 $917.50 $917.50 $917.50 $688.13 $917.50 $917.50 $917.50 $458.75 $458.75 $726.66 $917.50 $734.00 $412.88 $182.10 N/A $532.15 $917.50 $917.50 $917.50 $191.21 $917.50 N/A N/A 7291150 SUP HCPCS C1713 7291150 - ROD SPNL 150MM MAS PLIF BOTH IP/OP $917.50 $679.00 $182.10 $917.50 $412.88 $412.88 $412.88 $412.88 $917.50 $917.50 $917.50 $191.23 $917.50 $917.50 $917.50 $917.50 $917.50 $191.22 $917.50 $367.00 $542.70 $917.50 $917.50 $917.50 $917.50 $688.13 $917.50 $917.50 $917.50 $458.75 $458.75 $726.66 $917.50 $734.00 $412.88 $182.10 N/A $532.15 $917.50 $917.50 $917.50 $917.50 $917.50 N/A N/A 7291160 SUP HCPCS C1713 7291160 - ROD SPNL PREBNT 5.5MM 160MM SPHERX II TI BOTH IP/OP $917.50 $679.00 $182.10 $917.50 $412.88 $412.88 $412.88 $412.88 $917.50 $917.50 $917.50 $191.23 $917.50 $917.50 $917.50 $917.50 $917.50 $191.22 $917.50 $917.50 $542.70 $917.50 $917.50 $917.50 $917.50 $688.13 $917.50 $917.50 $917.50 $458.75 $458.75 $726.66 $917.50 $734.00 $412.88 $182.10 N/A $532.15 $917.50 $917.50 $917.50 $191.21 $917.50 N/A N/A 7291180 SUP HCPCS C1713 7291180 - ROD SPNL PREBNT 5.5MM 180MM SPHERX II TI BOTH IP/OP $917.50 $679.00 $182.10 $917.50 $412.88 $412.88 $412.88 $412.88 $917.50 $917.50 $917.50 $191.23 $917.50 $917.50 $917.50 $917.50 $917.50 $191.22 $917.50 $367.00 $542.70 $917.50 $917.50 $917.50 $917.50 $688.13 $917.50 $917.50 $917.50 $458.75 $458.75 $726.66 $917.50 $734.00 $412.88 $182.10 N/A $532.15 $917.50 $917.50 $917.50 $191.21 $917.50 N/A N/A 7291200 SUP HCPCS C1713 7291200 - ROD SPNL PREBNT 5.5MM 200MM SPHERX II TI BOTH IP/OP $917.50 $679.00 $182.10 $917.50 $412.88 $412.88 $412.88 $412.88 $917.50 $917.50 $917.50 $191.23 $917.50 $917.50 $917.50 $917.50 $917.50 $191.22 $917.50 $917.50 $542.70 $917.50 $917.50 $917.50 $917.50 $688.13 $917.50 $917.50 $917.50 $458.75 $458.75 $726.66 $917.50 $734.00 $412.88 $182.10 N/A $532.15 $917.50 $917.50 $917.50 $191.21 $917.50 N/A N/A 7291300 SUP HCPCS C1713 7291300 - ROD SPNL PREBNT 5.5MM 300MM SPHERX DBR II TI BOTH IP/OP $917.50 $679.00 $182.10 $917.50 $412.88 $412.88 $412.88 $412.88 $917.50 $917.50 $917.50 $191.23 $917.50 $917.50 $917.50 $917.50 $917.50 $191.22 $917.50 $367.00 $542.70 $917.50 $917.50 $917.50 $917.50 $688.13 $917.50 $917.50 $917.50 $458.75 $458.75 $726.66 $917.50 $734.00 $412.88 $182.10 N/A $532.15 $917.50 $917.50 $917.50 $191.21 $917.50 N/A N/A 7291500 SUP HCPCS C1713 7291500 - ROD SPNL PREBNT 5.5MM 500MM SPHERX II TI BOTH IP/OP "$1,052.50" $779.00 $208.89 "$1,052.50" $473.63 $473.63 $473.63 $473.63 "$1,052.50" "$1,052.50" "$1,052.50" $219.37 "$1,052.50" "$1,052.50" "$1,052.50" "$1,052.50" "$1,052.50" $219.35 "$1,052.50" "$1,052.50" $622.55 "$1,052.50" "$1,052.50" "$1,052.50" "$1,052.50" $789.38 "$1,052.50" "$1,052.50" "$1,052.50" $526.25 $526.25 $833.58 "$1,052.50" $842.00 $473.63 $208.89 N/A $610.45 "$1,052.50" "$1,052.50" "$1,052.50" $219.34 "$1,052.50" N/A N/A 7292025 SUP HCPCS C1713 7292025 - ROD SPNL PREBNT 5.5MM 25MM SPHERX II TI BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" $537.00 $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" "$1,342.50" "$1,342.50" $279.78 "$1,342.50" N/A N/A 7292030 SUP HCPCS C1713 7292030 - ROD SPNL PREBNT 5.5MM 30MM SPHERX II BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" $537.00 $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" "$1,342.50" "$1,342.50" $279.78 "$1,342.50" N/A N/A 7292040 SUP HCPCS C1713 7292040 - ROD SPNL PREBNT 5.5MM 40MM SPHERX II TI BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" "$1,342.50" $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" "$1,342.50" "$1,342.50" $279.78 "$1,342.50" N/A N/A 7292050 SUP HCPCS C1713 7292050 - ROD SPNL PREBNT 5.5MM 50MM SPHERX II TI BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" "$1,342.50" $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" "$1,342.50" "$1,342.50" $279.78 "$1,342.50" N/A N/A 7292060 SUP HCPCS C1713 7292060 - ROD SPNL PREBNT 5.5MM 60MM SPHERX II TI BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" "$1,342.50" $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" "$1,342.50" "$1,342.50" $279.78 "$1,342.50" N/A N/A 7292065 SUP HCPCS C1713 7292065 - ROD SPNL PREBNT 5.5MM 65MM SPHERX II TI BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" "$1,342.50" $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" "$1,342.50" "$1,342.50" $279.78 "$1,342.50" N/A N/A 7292070 SUP HCPCS C1713 7292070 - ROD SPNL PREBNT 5.5MM 70MM SPHERX II BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" $537.00 $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" "$1,342.50" "$1,342.50" $279.78 "$1,342.50" N/A N/A 7292080 SUP HCPCS C1713 7292080 - ROD SPNL PREBNT 5.5MM 80MM BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" "$1,342.50" $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" "$1,342.50" "$1,342.50" $279.78 "$1,342.50" N/A N/A 7292085 SUP HCPCS C1713 7292085 - ROD SPNL PREBNT 5.5MM 85MM BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" $537.00 $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" "$1,342.50" "$1,342.50" $279.78 "$1,342.50" N/A N/A 7292090 SUP HCPCS C1713 7292090 - ROD SPNL PREBNT 5.5MM 90MM BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" "$1,342.50" $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" "$1,342.50" "$1,342.50" $279.78 "$1,342.50" N/A N/A 7292095 SUP HCPCS C1713 7292095 - ROD SPNL PREBNT 5.5MM 95MM BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" $537.00 $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" "$1,342.50" "$1,342.50" $279.78 "$1,342.50" N/A N/A 7292100 SUP HCPCS C1713 7292100 - ROD SPNL PREBNT 5.5MM 100MM SPHERX II TI BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" "$1,342.50" $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" "$1,342.50" "$1,342.50" $279.78 "$1,342.50" N/A N/A 7292120 SUP HCPCS C1713 7292120 - ROD SPNL PREBNT 120MM SPHERX BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" $537.00 $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" "$1,342.50" "$1,342.50" $279.78 "$1,342.50" N/A N/A 7303000 SUP Custom 27803010 7303000 - ENDCAP SPNL 30MM RND 0 DEG OD 22 XCORE 2 TI BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 7303004 SUP Custom 27803010 7303004 - ENDCAP SPNL 30MM RND 4 DEG OD 22 XCORE 2 TI BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 7303008 SUP Custom 27803010 7303008 - ENDCAP SPNL 30MM RND 8 DEG OD 22 XCORE 2 TI BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 7303012 SUP Custom 27803010 7303012 - ENDCAP SPNL 30MM RND 12 DEG OD 22 XCORE 2 TI BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 7340000 SUP HCPCS C1713 7340000 - SCREW SET BREAKOFF BUTTRESS THREAD CD HORIZON M6 LEGACY SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 7340300 SUP HCPCS C1713 7340300 - ROD SPINAL 3.5MM 300MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 7340500 SUP HCPCS C1713 7340500 - ROD SPINAL 3.5MM 500MM LORDOTIC TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7341101 SUP HCPCS C1713 7341101 - HOOK SPINAL LORDOTIC PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 7341111 SUP HCPCS C1713 7341111 - HOOK SPINAL SMALL LORDOTIC LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7341112 SUP HCPCS C1713 7341112 - HOOK SPINAL MEDIUM LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7341113 SUP HCPCS C1713 7341113 - HOOK SPINAL LARGE LORDOTIC LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7341142 SUP HCPCS C1713 7341142 - HOOK SPINAL LORDOTIC NARROW BLADE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7341171 SUP HCPCS C1713 7341171 - HOOK SPINAL LORDOTIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7342410 SUP HCPCS C1713 7342410 - SCREW BONE 4MM 10MM FIX ANGLE LEGACY SPN 3.5MM ROD BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" $783.60 "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7342415 SUP HCPCS C1713 7342415 - SCREW BONE 4MM 15MM FIX ANGLE LEGACY SPN 3.5MM ROD BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" "$1,959.00" "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7342420 SUP HCPCS C1713 7342420 - SCREW BONE 4MM 20MM FIX ANGLE LEGACY SPN 3.5MM ROD BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" "$1,959.00" "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7342425 SUP HCPCS C1713 7342425 - SCREW BONE 4MM 25MM FIX ANGLE LEGACY SPN 3.5MM ROD BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" "$1,959.00" "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7342430 SUP HCPCS C1713 7342430 - SCREW BONE 4MM 30MM FIX ANGLE LEGACY SPN 3.5MM ROD BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" "$1,959.00" "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7342435 SUP HCPCS C1713 7342435 - SCREW BONE 4MM 35MM FIX ANGLE LEGACY SPN 3.5MM ROD BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" "$1,959.00" "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,959.00" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7342440 SUP HCPCS C1713 7342440 - SCREW BONE 4MM 40MM FIX ANGLE LEGACY SPN 3.5MM ROD BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" "$1,959.00" "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7343310 SUP HCPCS C1713 7343310 - SCREW BONE 3.5MM 10MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" "$1,959.00" "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7343315 SUP HCPCS C1713 7343315 - SCREW BONE 3.5MM 15MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" "$1,959.00" "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7343320 SUP HCPCS C1713 7343320 - SCREW BONE 3.5MM 20MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" "$1,959.00" "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7343325 SUP HCPCS C1713 7343325 - SCREW BONE 3.5MM 25MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" $783.60 "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7343330 SUP HCPCS C1713 7343330 - SCREW BONE 3.5MM 30MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" $783.60 "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7343415 SUP HCPCS C1713 7343415 - SCREW BONE 4.5MM 15MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" $783.60 "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7343420 SUP HCPCS C1713 7343420 - SCREW BONE 4.5MM 20MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" $783.60 "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,959.00" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7343425 SUP HCPCS C1713 7343425 - SCREW BONE 4.5MM 25MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" $783.60 "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7343430 SUP HCPCS C1713 7343430 - SCREW BONE 4.5MM 30MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" $783.60 "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7343435 SUP HCPCS C1713 7343435 - SCREW BONE 4.5MM 35MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" $783.60 "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" "$1,959.00" "$1,959.00" N/A N/A 7343440 SUP HCPCS C1713 7343440 - SCREW BONE 4.5MM 40MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" $783.60 "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7343520 SUP HCPCS C1713 7343520 - SCREW BONE 5.5MM 20MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" $783.60 "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7343525 SUP HCPCS C1713 7343525 - SCREW BONE 5.5MM 25MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" "$1,959.00" "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" N/A N/A 7343530 SUP HCPCS C1713 7343530 - SCREW BONE 5.5MM 30MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" "$1,959.00" "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7343535 SUP HCPCS C1713 7343535 - SCREW BONE 5.5MM 35MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" "$1,959.00" "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" "$1,959.00" "$1,959.00" N/A N/A 7343540 SUP HCPCS C1713 7343540 - SCREW BONE 5.5MM 40MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" "$1,959.00" "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" "$1,959.00" "$1,959.00" N/A N/A 7343545 SUP HCPCS C1713 7343545 - SCREW BONE 5.5MM 45MM FIX ANGLE LEGACY SPN BOTH IP/OP "$1,959.00" "$1,450.00" $388.81 "$1,959.00" $881.55 $881.55 $881.55 $881.55 "$1,959.00" "$1,959.00" "$1,959.00" $408.30 "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" $408.28 "$1,959.00" "$1,959.00" "$1,158.75" "$1,959.00" "$1,959.00" "$1,959.00" "$1,959.00" "$1,469.25" "$1,959.00" "$1,959.00" "$1,959.00" $979.50 $979.50 "$1,551.53" "$1,959.00" "$1,567.20" $881.55 $388.81 N/A "$1,136.22" "$1,959.00" "$1,175.40" "$1,959.00" $408.26 "$1,959.00" N/A N/A 7360000 SUP HCPCS C1713 7360000 - SCREW SET M6 BREAKOFF BUTTRESS THREAD STAINLESS STEEL SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7360300 SUP HCPCS C1713 7360300 - ROD SPINAL 3.5MM 300MM STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7360500 SUP HCPCS C1713 7360500 - ROD SPINAL 3.5MM 500MM STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7361101 SUP HCPCS C1713 7361101 - HOOK SPINAL 3.5MM STAINLESS STEEL PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7361111 SUP HCPCS C1713 7361111 - HOOK SPINAL 3.5MM STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7361112 SUP HCPCS C1713 7361112 - HOOK SPINAL MEDIUM 3.5MM STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 7361113 SUP HCPCS C1713 7361113 - HOOK SPINAL LARGE 3.5MM STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 7361142 SUP HCPCS C1713 7361142 - HOOK SPINAL 3.5MM RAMPED NARROW BLADE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 7361171 SUP HCPCS C1713 7361171 - HOOK SPINAL EXTENDED BODY STAINLESS STEEL PEDICLE 3.5 MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7362410 SUP HCPCS C1713 7362410 - SCREW BONE 4MM 10MM FIX ANGLE STAINLESS STEEL SPN 3.5MM ROD BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" $730.20 "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" "$1,825.50" "$1,825.50" N/A N/A 7362415 SUP HCPCS C1713 7362415 - SCREW BONE 4MM 15MM FIX ANGLE STAINLESS STEEL SPN 3.5MM ROD BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" $730.20 "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" N/A N/A 7362420 SUP HCPCS C1713 7362420 - SCREW BONE 4MM 20MM FIX ANGLE STAINLESS STEEL SPN 3.5MM ROD BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" $730.20 "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" "$1,825.50" "$1,825.50" N/A N/A 7362425 SUP HCPCS C1713 7362425 - SCREW BONE 4MM 25MM FIX ANGLE STAINLESS STEEL SPN 3.5MM ROD BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7362430 SUP HCPCS C1713 7362430 - SCREW BONE 4MM 30MM FIX ANGLE STAINLESS STEEL SPN 3.5MM ROD BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7362435 SUP HCPCS C1713 7362435 - SCREW BONE 4MM 35MM FIX ANGLE STAINLESS STEEL SPN 3.5MM ROD BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,825.50" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7362440 SUP HCPCS C1713 7362440 - SCREW BONE 4MM 40MM FIX ANGLE STAINLESS STEEL SPN 3.5MM ROD BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" "$1,825.50" "$1,825.50" N/A N/A 7363310 SUP HCPCS C1713 7363310 - SCREW BONE 3.5MM 10MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" "$1,825.50" "$1,825.50" N/A N/A 7363315 SUP HCPCS C1713 7363315 - SCREW BONE 3.5MM 15MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7363320 SUP HCPCS C1713 7363320 - SCREW BONE 3.5MM 20MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" $730.20 "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" "$1,825.50" "$1,825.50" N/A N/A 7363325 SUP HCPCS C1713 7363325 - SCREW BONE 3.5MM 25MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" $730.20 "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7363330 SUP HCPCS C1713 7363330 - SCREW BONE 3.5MM 30MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7363415 SUP HCPCS C1713 7363415 - SCREW BONE 4.5MM 15MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" $730.20 "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,825.50" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7363420 SUP HCPCS C1713 7363420 - SCREW BONE 4.5MM 20MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7363425 SUP HCPCS C1713 7363425 - SCREW BONE 4.5MM 25MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" $730.20 "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" "$1,825.50" "$1,825.50" N/A N/A 7363430 SUP HCPCS C1713 7363430 - SCREW BONE 4.5MM 30MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7363435 SUP HCPCS C1713 7363435 - SCREW BONE 4.5MM 35MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" N/A N/A 7363440 SUP HCPCS C1713 7363440 - SCREW BONE 4.5MM 40MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7363520 SUP HCPCS C1713 7363520 - SCREW BONE 5.5MM 20MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7363525 SUP HCPCS C1713 7363525 - SCREW BONE 5.5MM 25MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" N/A N/A 7363530 SUP HCPCS C1713 7363530 - SCREW BONE 5.5MM 30MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7363535 SUP HCPCS C1713 7363535 - SCREW BONE 5.5MM 35MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7363540 SUP HCPCS C1713 7363540 - SCREW BONE 5.5MM 40MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" "$1,825.50" "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7363545 SUP HCPCS C1713 7363545 - SCREW BONE 5.5MM 45MM FIX ANGLE STAINLESS STEEL SPN BOTH IP/OP "$1,825.50" "$1,351.00" $362.32 "$1,825.50" $821.48 $821.48 $821.48 $821.48 "$1,825.50" "$1,825.50" "$1,825.50" $380.48 "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" $380.45 "$1,825.50" $730.20 "$1,079.78" "$1,825.50" "$1,825.50" "$1,825.50" "$1,825.50" "$1,369.13" "$1,825.50" "$1,825.50" "$1,825.50" $912.75 $912.75 "$1,445.80" "$1,825.50" "$1,460.40" $821.48 $362.32 N/A "$1,058.79" "$1,825.50" "$1,095.30" "$1,825.50" $380.43 "$1,825.50" N/A N/A 7370100 SUP HCPCS C1713 7370100 - SCREW BONE .5MM 10MM LOCK SPHERX DBR II TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7375530 SUP HCPCS C1713 7375530 - SCREW BN 5.5MM 30MM SPHERX II PA CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7375535 SUP HCPCS C1713 7375535 - SCREW BN 5.5MM 35MM SPHERX DBR II PA CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7375540 SUP HCPCS C1713 7375540 - SCREW BN 5.5MM 40MM PA CNN CANC SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7375545 SUP HCPCS C1713 7375545 - SCREW BN 5.5MM 45MM PA CNN CANC SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7375550 SUP HCPCS C1713 7375550 - SCREW BN 5.5MM 50MM SPHERX DBR II PA CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7375555 SUP HCPCS C1713 7375555 - SCREW BN 5.5MM 55MM SPHERX DBR II PA CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7376530 SUP HCPCS C1713 7376530 - SCREW BN 6.5MM 30MM SPHERX DBR II PA CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7376535 SUP HCPCS C1713 7376535 - SCREW BN 6.5MM 35MM PA CANC SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7376540 SUP HCPCS C1713 7376540 - SCREW BN 6.5MM 40MM SPHERX DBR II PA CNN TI SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7376550 SUP HCPCS C1713 7376550 - SCREW BN 6.5MM 50MM SPHERX DBR II PA CNN TI SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7376555 SUP HCPCS C1713 7376555 - SCREW BN 6.5MM 55MM SPHERX DBR II PA CNN TI SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7377530 SUP HCPCS C1713 7377530 - SCREW BN 7.5MM 30MM SPHERX DBR II PA CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7377535 SUP HCPCS C1713 7377535 - SCREW BN 7.5MM 35MM SPHERX DBR II PA CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7377540 SUP HCPCS C1713 7377540 - SCREW BN 7.5MM 40MM SPHERX DBR II PA CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7377545 SUP HCPCS C1713 7377545 - SCREW BN 7.5MM 45MM SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7377550 SUP HCPCS C1713 7377550 - SCREW BN 7.5MM 50MM SPHERX DBR II PA CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7377555 SUP HCPCS C1713 7377555 - SCREW BN 7.5MM 55MM SPHERX DBR II PA CNN SPNE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 7440020 SUP HCPCS C1713 7440020 - SCREW SET 4.5MM BREAKOFF TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 7440030 SUP HCPCS C1713 7440030 - SCREW SET UNIVERSAL G4 BREAKOFF INTERNAL HEXAGONAL HEAD BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7440100 SUP HCPCS C1713 7440100 - SCREW SET NONBREAKOFF TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7440120 SUP HCPCS C1713 7440120 - SCREW SET 20MM NONBREAKOFF TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7440122 SUP HCPCS C1713 7440122 - PLATE BN 22MM NS GRDNT + 1 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440124 SUP HCPCS C1713 7440124 - PLATE BN 24MM NS GRDNT + 1 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440126 SUP HCPCS C1713 7440126 - PLATE BN 26MM NS GRDNT + 1 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440128 SUP HCPCS C1713 7440128 - PLATE BN 28MM NS GRDNT + 1 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440130 SUP HCPCS C1713 7440130 - PLATE BN 30MM NS GRDNT + 1 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440132 SUP HCPCS C1713 7440132 - PLATE BN 32MM NS GRDNT + 1 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440134 SUP HCPCS C1713 7440134 - PLATE BN 34MM NS GRDNT + 1 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440136 SUP HCPCS C1713 7440136 - PLATE BN 36MM NS GRDNT + 1 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440236 SUP HCPCS C1713 7440236 - PLATE BN 36MM NS GRDNT + 2 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440238 SUP HCPCS C1713 7440238 - PLATE BN 38MM NS GRDNT + 2 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440240 SUP HCPCS C1713 7440240 - PLATE BN 40MM NS GRDNT + 2 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440242 SUP HCPCS C1713 7440242 - PLATE BN 42MM NS GRDNT + 2 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440244 SUP HCPCS C1713 7440244 - PLATE BN 44MM NS GRDNT + 2 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440246 SUP HCPCS C1713 7440246 - PLATE BN 46MM NS GRDNT + 2 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440248 SUP HCPCS C1713 7440248 - PLATE BN 48MM NS GRDNT + 2 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440250 SUP HCPCS C1713 7440250 - PLATE BN 50MM NS GRDNT + 2 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440252 SUP HCPCS C1713 7440252 - PLATE BN 52MM NS GRDNT + 2 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440254 SUP HCPCS C1713 7440254 - PLATE BN 54MM NS GRDNT + 2 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440354 SUP HCPCS C1713 7440354 - PLATE BN 54MM NS GRDNT + 3 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440356 SUP HCPCS C1713 7440356 - PLATE BN 56MM NS GRDNT + 3 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440358 SUP HCPCS C1713 7440358 - PLATE BN 58MM NS GRDNT + 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440360 SUP HCPCS C1713 7440360 - PLATE BN 60MM NS GRDNT + 3 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440362 SUP HCPCS C1713 7440362 - PLATE BN 62MM NS GRDNT + 3 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440364 SUP HCPCS C1713 7440364 - PLATE BN 64MM NS GRDNT + 3 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440366 SUP HCPCS C1713 7440366 - PLATE BN 66MM NS GRDNT + 3 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440368 SUP HCPCS C1713 7440368 - PLATE BN 68MM NS GRDNT + 3 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440468 SUP HCPCS C1713 7440468 - PLATE BN 68MM NS GRDNT + 4 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440470 SUP HCPCS C1713 7440470 - PLATE BN 70MM NS GRDNT + 4 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440474 SUP HCPCS C1713 7440474 - PLATE BN 74MM NS GRDNT + 4 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440478 SUP HCPCS C1713 7440478 - PLATE BN 78MM NS GRDNT + 4 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440482 SUP HCPCS C1713 7440482 - PLATE BN 82MM NS GRDNT + 4 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440486 SUP HCPCS C1713 7440486 - PLATE BN 86MM NS GRDNT + 4 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440490 SUP HCPCS C1713 7440490 - PLATE BN 90MM NS GRDNT + 4 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7440500 SUP HCPCS C1713 7440500 - PLATE BN RND HL CVR TI SPNE CRV ANT BOTH IP/OP $377.50 $279.00 $74.92 $377.50 $169.88 $169.88 $169.88 $169.88 $377.50 $377.50 $377.50 $78.68 $377.50 $377.50 $377.50 $377.50 $377.50 $78.68 $377.50 $377.50 $223.29 $377.50 $377.50 $377.50 $377.50 $283.13 $377.50 $377.50 $377.50 $188.75 $188.75 $298.98 $377.50 $302.00 $169.88 $74.92 N/A $218.95 $377.50 $377.50 $377.50 $78.67 $377.50 N/A N/A 7440918 SUP Custom 27203010 7440918 - BIT DRL MN 10MM HLX ACP SPNE BOTH IP/OP $570.00 $422.00 $101.46 $570.00 $570.00 $570.00 $570.00 $570.00 $570.00 $570.00 $101.46 $570.00 $570.00 $423.05 $423.05 $439.36 $296.97 $118.79 $570.00 $228.00 $570.00 $570.00 $570.00 $570.00 $570.00 $427.50 $570.00 $570.00 $570.00 $285.00 $285.00 $451.44 $570.00 $456.00 $370.50 $570.00 N/A $330.60 $570.00 $342.00 $570.00 $570.00 $570.00 N/A N/A 7441102 SUP HCPCS C1713 7441102 - HOOK SPINAL LORDOTIC CD HORIZON LEGACY TITANIUM PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7441112 SUP HCPCS C1713 7441112 - HOOK SPINAL SMALL WIDE BLADE TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7441113 SUP HCPCS C1713 7441113 - HOOK SPINAL MEDIUM LORDOTIC WIDE BLADE TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7441114 SUP HCPCS C1713 7441114 - HOOK SPINAL LARGE LORDOTIC WIDE BLADE TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7441122 SUP HCPCS C1713 7441122 - HOOK SPINAL NARROW BLADE TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7441142 SUP HCPCS C1713 7441142 - HOOK SPINAL LORDOTIC TITANIUM THORACIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7441162 SUP HCPCS C1713 7441162 - HOOK SPINAL LORDOTIC TITANIUM LUMBAR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7441172 SUP HCPCS C1713 7441172 - HOOK SPINAL EXTENDED BODY TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7441198 SUP HCPCS C1713 7441198 - HOOK SPINAL LORDOTIC OFFST TITANIUM RIGHT BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7441199 SUP HCPCS C1713 7441199 - HOOK SPINAL LORDOTIC OFFST TITANIUM LEFT BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7442420 SUP HCPCS C1713 7442420 - SCREW BONE 4MM 20MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442425 SUP HCPCS C1713 7442425 - SCREW BONE 4MM 25MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442430 SUP HCPCS C1713 7442430 - SCREW BONE 4MM 30MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,864.50" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442435 SUP HCPCS C1713 7442435 - SCREW BONE 4MM 35MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442440 SUP HCPCS C1713 7442440 - SCREW BONE 4MM 40MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442525 SUP HCPCS C1713 7442525 - SCREW BONE 5MM 25MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442528 SUP HCPCS C1713 7442528 - SCREW BONE 5MM 27.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442530 SUP HCPCS C1713 7442530 - SCREW BONE 5MM 30MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442533 SUP HCPCS C1713 7442533 - SCREW BONE 5MM 32.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442535 SUP HCPCS C1713 7442535 - SCREW BONE 5MM 35MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442538 SUP HCPCS C1713 7442538 - SCREW BONE 5MM 37.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,864.50" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442540 SUP HCPCS C1713 7442540 - SCREW BONE 5MM 40MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442545 SUP HCPCS C1713 7442545 - SCREW BONE 5MM 45MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442550 SUP HCPCS C1713 7442550 - SCREW BONE 5MM 50MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442625 SUP HCPCS C1713 7442625 - SCREW BONE 6MM 25MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,864.50" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442628 SUP HCPCS C1713 7442628 - SCREW BONE 6MM 27.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442630 SUP HCPCS C1713 7442630 - SCREW BONE 6MM 30MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442633 SUP HCPCS C1713 7442633 - SCREW BONE 6MM 32.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442635 SUP HCPCS C1713 7442635 - SCREW BONE 6MM 35MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442638 SUP HCPCS C1713 7442638 - SCREW BONE 6MM 37.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442640 SUP HCPCS C1713 7442640 - SCREW BONE 6MM 40MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442645 SUP HCPCS C1713 7442645 - SCREW BONE 6MM 45MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7442650 SUP HCPCS C1713 7442650 - SCREW BONE 6MM 50MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443425 SUP HCPCS C1713 7443425 - SCREW BONE 4.5MM 25MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443428 SUP HCPCS C1713 7443428 - SCREW BONE 4.5MM 27.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,864.50" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443430 SUP HCPCS C1713 7443430 - SCREW BONE 4.5MM 30MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443433 SUP HCPCS C1713 7443433 - SCREW BONE 4.5MM 32.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443435 SUP HCPCS C1713 7443435 - SCREW BONE 4.5MM 35MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,864.50" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443438 SUP HCPCS C1713 7443438 - SCREW BONE 4.5MM 37.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443440 SUP HCPCS C1713 7443440 - SCREW BONE 4.5MM 40MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443445 SUP HCPCS C1713 7443445 - SCREW BONE 4.5MM 45MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,864.50" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443450 SUP HCPCS C1713 7443450 - SCREW BONE 4.5MM 50MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443525 SUP HCPCS C1713 7443525 - SCREW BONE 5.5MM 25MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443528 SUP HCPCS C1713 7443528 - SCREW BONE 5.5MM 27.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443530 SUP HCPCS C1713 7443530 - SCREW BONE 5.5MM 30MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443533 SUP HCPCS C1713 7443533 - SCREW BONE 5.5MM 32.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,864.50" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443535 SUP HCPCS C1713 7443535 - SCREW BONE 5.5MM 35MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443538 SUP HCPCS C1713 7443538 - SCREW BONE 5.5MM 37.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443540 SUP HCPCS C1713 7443540 - SCREW BONE 5.5MM 40MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443545 SUP HCPCS C1713 7443545 - SCREW BONE 5.5MM 45MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,864.50" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443550 SUP HCPCS C1713 7443550 - SCREW BONE 5.5MM 50MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443625 SUP HCPCS C1713 7443625 - SCREW BONE 6.5MM 25MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443628 SUP HCPCS C1713 7443628 - SCREW BONE 6.5MM 27.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443630 SUP HCPCS C1713 7443630 - SCREW BONE 6.5MM 30MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,864.50" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443633 SUP HCPCS C1713 7443633 - SCREW BONE 6.5MM 32.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443635 SUP HCPCS C1713 7443635 - SCREW BONE 6.5MM 35MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443638 SUP HCPCS C1713 7443638 - SCREW BONE 6.5MM 37.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,864.50" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443640 SUP HCPCS C1713 7443640 - SCREW BONE 6.5MM 40MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443645 SUP HCPCS C1713 7443645 - SCREW BONE 6.5MM 45MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443650 SUP HCPCS C1713 7443650 - SCREW BONE 6.5MM 50MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443655 SUP HCPCS C1713 7443655 - SCREW BONE 6.5MM 55MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443725 SUP HCPCS C1713 7443725 - SCREW BONE 7.5MM 25MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,864.50" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443728 SUP HCPCS C1713 7443728 - SCREW BONE 7.5MM 27.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" $745.80 "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,864.50" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443730 SUP HCPCS C1713 7443730 - SCREW BONE 7.5MM 30MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443733 SUP HCPCS C1713 7443733 - SCREW BONE 7.5MM 32.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443735 SUP HCPCS C1713 7443735 - SCREW BONE 7.5MM 35MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443738 SUP HCPCS C1713 7443738 - SCREW BONE 7.5MM 37.5MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443740 SUP HCPCS C1713 7443740 - SCREW BONE 7.5MM 40MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443745 SUP HCPCS C1713 7443745 - SCREW BONE 7.5MM 45MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,864.50" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443750 SUP HCPCS C1713 7443750 - SCREW BONE 7.5MM 50MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7443755 SUP HCPCS C1713 7443755 - SCREW BONE 7.5MM 55MM FIX ANGLE TITANIUM SPN BOTH IP/OP "$1,864.50" "$1,380.00" $370.06 "$1,864.50" $839.03 $839.03 $839.03 $839.03 "$1,864.50" "$1,864.50" "$1,864.50" $388.61 "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" $388.58 "$1,864.50" "$1,864.50" "$1,102.85" "$1,864.50" "$1,864.50" "$1,864.50" "$1,864.50" "$1,398.38" "$1,864.50" "$1,864.50" "$1,864.50" $932.25 $932.25 "$1,476.68" "$1,864.50" "$1,491.60" $839.03 $370.06 N/A "$1,081.41" "$1,864.50" "$1,118.70" "$1,864.50" $388.56 "$1,864.50" N/A N/A 7450122 SUP HCPCS C1713 7450122 - PLATE BN 22MM GRDNT + 1 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450124 SUP HCPCS C1713 7450124 - PLATE BN 24MM GRDNT + 1 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450126 SUP HCPCS C1713 7450126 - PLATE BN 26MM GRDNT + 1 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450128 SUP HCPCS C1713 7450128 - PLATE BN 28MM GRDNT + 1 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450130 SUP HCPCS C1713 7450130 - PLATE BN 30MM GRDNT + 1 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450132 SUP HCPCS C1713 7450132 - PLATE BN 32MM GRDNT + 1 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450134 SUP HCPCS C1713 7450134 - PLATE BN 34MM GRDNT + 1 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450136 SUP HCPCS C1713 7450136 - PLATE BN 36MM GRDNT + 1 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450236 SUP HCPCS C1713 7450236 - PLATE BN 36MM GRDNT + 2 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450238 SUP HCPCS C1713 7450238 - PLATE BN 38MM GRDNT + 2 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450240 SUP HCPCS C1713 7450240 - PLATE BN 40MM GRDNT + 2 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450242 SUP HCPCS C1713 7450242 - PLATE BN 42MM GRDNT + 2 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450244 SUP HCPCS C1713 7450244 - PLATE BN 44MM GRDNT + 2 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450246 SUP HCPCS C1713 7450246 - PLATE BN 46MM GRDNT + 2 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450248 SUP HCPCS C1713 7450248 - PLATE BN 48MM GRDNT + 2 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450250 SUP HCPCS C1713 7450250 - PLATE BN 50MM GRDNT + LVL 2 FX ANG TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450252 SUP HCPCS C1713 7450252 - PLATE BN 52MM GRDNT + LVL 2 FX ANG TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450254 SUP HCPCS C1713 7450254 - PLATE BN 54MM GRDNT + 2 LVL FX SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7450354 SUP HCPCS C1713 7450354 - PLATE BN 54MM GRDNT + 3 LVL FX SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450356 SUP HCPCS C1713 7450356 - PLATE BN 56MM GRDNT + LVL 3 FX ANG TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450358 SUP HCPCS C1713 7450358 - PLATE BN 58MM GRDNT + 3 LVL FX SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450360 SUP HCPCS C1713 7450360 - PLATE BN 60MM GRDNT + 3 LVL FX SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450362 SUP HCPCS C1713 7450362 - PLATE BN 62MM GRDNT + 3 LVL FX SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450364 SUP HCPCS C1713 7450364 - PLATE BN 64MM GRDNT + 3 LVL FX SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450366 SUP HCPCS C1713 7450366 - PLATE BN 66MM GRDNT + 3 LVL FX SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450368 SUP HCPCS C1713 7450368 - PLATE BN 68MM GRDNT + 3 LVL FX SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450468 SUP HCPCS C1713 7450468 - PLATE BN 68MM GRDNT + 4 LVL FX SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450470 SUP HCPCS C1713 7450470 - PLATE BN 70MM GRDNT + 4 LVL FX SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450474 SUP HCPCS C1713 7450474 - PLATE BN 74MM GRDNT + 4 LVL FX SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450478 SUP HCPCS C1713 7450478 - PLATE BN 78MM GRDNT + 4 LVL FX SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450482 SUP HCPCS C1713 7450482 - PLATE BN 82MM GRDNT + 4 LVL FX SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450486 SUP HCPCS C1713 7450486 - PLATE BN 86MM GRDNT + 4 LVL FX SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450490 SUP HCPCS C1713 7450490 - PLATE BN 90MM GRDNT + LVL 4 FX ANG TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450500 SUP HCPCS C1713 7450500 - PLATE BN 100MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450505 SUP HCPCS C1713 7450505 - PLATE BN 105MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450510 SUP HCPCS C1713 7450510 - PLATE BN 110MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450595 SUP HCPCS C1713 7450595 - PLATE BN 95MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7450610 SUP HCPCS C1713 7450610 - SCREW BN 4MM 10MM NS GRDNT + FX ANG SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7450612 SUP HCPCS C1713 7450612 - SCREW BN 4MM 12MM NS GRDNT + FX ANG SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7450614 SUP HCPCS C1713 7450614 - SCREW BN 4MM 14MM NS GRDNT + FX ANG SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7450616 SUP HCPCS C1713 7450616 - SCREW BN 4MM FA ANT CSPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7450710 SUP HCPCS C1713 7450710 - SCREW BN 4.5MM 10MM NS GRDNT + FX ANG SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7450712 SUP HCPCS C1713 7450712 - SCREW BN 4.5MM 12MM NS GRDNT + FX ANG SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7450714 SUP HCPCS C1713 7450714 - SCREW BN 4.5MM 14MM NS GRDNT + FX ANG SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7450716 SUP HCPCS C1713 7450716 - SCREW BN 4.5MM 16MM GRDNT + FA ANT CSPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7450800 SUP Custom 27803010 7450800 - HOLDER IMPL VLCK TEMP FX TACK BOTH IP/OP $377.50 $279.00 $67.20 $377.50 $377.50 $377.50 $377.50 $377.50 $377.50 $377.50 $67.20 $377.50 $377.50 $377.50 $377.50 $377.50 $377.50 $78.68 $377.50 $151.00 $377.50 $377.50 $377.50 $377.50 $377.50 $283.13 $377.50 $377.50 $377.50 $188.75 $188.75 $298.98 $377.50 $302.00 $169.88 $377.50 N/A $218.95 $377.50 $226.50 $377.50 $377.50 $377.50 N/A N/A 7451500 SUP HCPCS C1713 7451500 - PLATE BN NS GRDNT + SLOT HL CVR TI SPNE BOTH IP/OP $377.50 $279.00 $74.92 $377.50 $169.88 $169.88 $169.88 $169.88 $377.50 $377.50 $377.50 $78.68 $377.50 $377.50 $377.50 $377.50 $377.50 $78.68 $377.50 $377.50 $223.29 $377.50 $377.50 $377.50 $377.50 $283.13 $377.50 $377.50 $377.50 $188.75 $188.75 $298.98 $377.50 $302.00 $169.88 $74.92 N/A $218.95 $377.50 $377.50 $377.50 $78.67 $377.50 N/A N/A 7451501 SUP HCPCS C1713 7451501 - PLATE BN NS GRDNT + RND HL CVR TI SPNE BOTH IP/OP $377.50 $279.00 $74.92 $377.50 $169.88 $169.88 $169.88 $169.88 $377.50 $377.50 $377.50 $78.68 $377.50 $377.50 $377.50 $377.50 $377.50 $78.68 $377.50 $151.00 $223.29 $377.50 $377.50 $377.50 $377.50 $283.13 $377.50 $377.50 $377.50 $188.75 $188.75 $298.98 $377.50 $302.00 $169.88 $74.92 N/A $218.95 $377.50 $377.50 $377.50 $78.67 $377.50 N/A N/A 7460020 SUP HCPCS C1713 7460020 - SCREW SET BREAKOFF STAINLESS STEEL SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 7460120 SUP HCPCS C1713 7460120 - SCREW SET NONBREAKOFF STAINLESS STEEL SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7460500 SUP HCPCS C1713 7460500 - PLATE BN 100MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7460505 SUP HCPCS C1713 7460505 - PLATE BN 105MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7460510 SUP HCPCS C1713 7460510 - PLATE BN 110MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7460595 SUP HCPCS C1713 7460595 - PLATE BN 95MM GRDNT + LVL 5 FX ANG TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7460610 SUP HCPCS C1713 7460610 - SCREW BN 4MM 10MM NS GRDNT + SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7460612 SUP HCPCS C1713 7460612 - SCREW BN 4MM 12MM NS GRDNT + SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7460614 SUP HCPCS C1713 7460614 - SCREW BN 4MM 14MM NS GRDNT + SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7460616 SUP HCPCS C1713 7460616 - SCREW BN 4MM 16MM GRDNT + VA TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7460710 SUP HCPCS C1713 7460710 - SCREW BN 4.5MM 10MM NS GRDNT + SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7460712 SUP HCPCS C1713 7460712 - SCREW BN 4.5MM 12MM NS GRDNT + SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7460714 SUP HCPCS C1713 7460714 - SCREW BN 4.5MM 14MM NS GRDNT + SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7460716 SUP HCPCS C1713 7460716 - SCREW BN 4.5MM 16MM GRDNT + VA ANT CSPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7461102 SUP HCPCS C1713 7461102 - HOOK SPINAL STAINLESS STEEL PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7461112 SUP HCPCS C1713 7461112 - HOOK SPINAL SMALL LORDOTIC WIDE BLADE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7461113 SUP HCPCS C1713 7461113 - HOOK SPINAL MEDIUM LORDOSIS WIDE BLADE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7461114 SUP HCPCS C1713 7461114 - HOOK SPINAL LARGE LORDOTIC WIDE BLADE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7461122 SUP HCPCS C1713 7461122 - HOOK SPINAL LORDOTIC NARROW BLADE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7461142 SUP HCPCS C1713 7461142 - HOOK SPINAL LORDOTIC RAMPED STAINLESS STEEL THORACIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7461162 SUP HCPCS C1713 7461162 - HOOK SPINAL LORDOTIC ANGLED BODY STAINLESS STEEL LUMBAR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7461172 SUP HCPCS C1713 7461172 - HOOK SPINAL LORDOTIC EXTENDED BODY STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7461198 SUP HCPCS C1713 7461198 - HOOK SPINAL LORDOTIC RIGHT OFFST STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7461199 SUP HCPCS C1713 7461199 - HOOK SPINAL LORDOTIC LEFT OFFST STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7461500 SUP HCPCS C1713 7461500 - PLATE BN NS GRDNT + SLOT HL CVR TI SPNE BOTH IP/OP $377.50 $279.00 $74.92 $377.50 $169.88 $169.88 $169.88 $169.88 $377.50 $377.50 $377.50 $78.68 $377.50 $377.50 $377.50 $377.50 $377.50 $78.68 $377.50 $377.50 $223.29 $377.50 $377.50 $377.50 $377.50 $283.13 $377.50 $377.50 $377.50 $188.75 $188.75 $298.98 $377.50 $302.00 $169.88 $74.92 N/A $218.95 $377.50 $377.50 $377.50 $78.67 $377.50 N/A N/A 7461501 SUP HCPCS C1713 7461501 - PLATE BN NS GRDNT + RND HL CVR TI SPNE BOTH IP/OP $377.50 $279.00 $74.92 $377.50 $169.88 $169.88 $169.88 $169.88 $377.50 $377.50 $377.50 $78.68 $377.50 $377.50 $377.50 $377.50 $377.50 $78.68 $377.50 $151.00 $223.29 $377.50 $377.50 $377.50 $377.50 $283.13 $377.50 $377.50 $377.50 $188.75 $188.75 $298.98 $377.50 $302.00 $169.88 $74.92 N/A $218.95 $377.50 $377.50 $377.50 $78.67 $377.50 N/A N/A 7462420 SUP HCPCS C1713 7462420 - SCREW BONE 4MM 20MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462425 SUP HCPCS C1713 7462425 - SCREW BONE 4MM 25MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462430 SUP HCPCS C1713 7462430 - SCREW BONE 4MM 30MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462435 SUP HCPCS C1713 7462435 - SCREW BONE 4MM 35MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462440 SUP HCPCS C1713 7462440 - SCREW BONE 4MM 40MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462525 SUP HCPCS C1713 7462525 - SCREW BONE 5MM 25MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462528 SUP HCPCS C1713 7462528 - SCREW BONE 5MM 27.5MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462530 SUP HCPCS C1713 7462530 - SCREW BONE 5MM 30MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462533 SUP HCPCS C1713 7462533 - SCREW BONE 5MM 32.5MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462535 SUP HCPCS C1713 7462535 - SCREW BONE 5MM 35MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462538 SUP HCPCS C1713 7462538 - SCREW BONE 5MM 37.5MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462540 SUP HCPCS C1713 7462540 - SCREW BONE 5MM 40MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462545 SUP HCPCS C1713 7462545 - SCREW BONE 5MM 45MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462550 SUP HCPCS C1713 7462550 - SCREW BONE 5MM 50MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462625 SUP HCPCS C1713 7462625 - SCREW BONE 6MM 25MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462628 SUP HCPCS C1713 7462628 - SCREW BONE 6MM 27.5MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462630 SUP HCPCS C1713 7462630 - SCREW BONE 6MM 30MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462633 SUP HCPCS C1713 7462633 - SCREW BONE 6MM 32.5MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462635 SUP HCPCS C1713 7462635 - SCREW BONE 6MM 35MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" "$1,666.50" "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462638 SUP HCPCS C1713 7462638 - SCREW BONE 6MM 37.5MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462640 SUP HCPCS C1713 7462640 - SCREW BONE 6MM 40MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462645 SUP HCPCS C1713 7462645 - SCREW BONE 6MM 45MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" "$1,666.50" "$1,666.50" $347.30 "$1,666.50" N/A N/A 7462650 SUP HCPCS C1713 7462650 - SCREW BONE 6MM 50MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463425 SUP HCPCS C1713 7463425 - SCREW BONE 4.5MM 25MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463428 SUP HCPCS C1713 7463428 - SCREW BONE 4.5MM 27.5MM FIX ANGLE LEGACY CD HORIZON BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" "$1,666.50" "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463430 SUP HCPCS C1713 7463430 - SCREW BONE 4.5MM 30MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463433 SUP HCPCS C1713 7463433 - SCREW BONE 4.5MM 32.5MM FIX ANGLE LEGACY CD HORIZON BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463435 SUP HCPCS C1713 7463435 - SCREW BONE 4.5MM 35MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463438 SUP HCPCS C1713 7463438 - SCREW BONE 4.5MM 37.5MM FIX ANGLE LEGACY CD HORIZON BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" "$1,666.50" "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463440 SUP HCPCS C1713 7463440 - SCREW BONE 4.5MM 40MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463445 SUP HCPCS C1713 7463445 - SCREW BONE 4.5MM 45MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463450 SUP HCPCS C1713 7463450 - SCREW BONE 4.5MM 50MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" "$1,666.50" "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463525 SUP HCPCS C1713 7463525 - SCREW BONE 5.5MM 25MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463528 SUP HCPCS C1713 7463528 - SCREW BONE 5.5MM 27.5MM FIX ANGLE LEGACY CD HORIZON BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463530 SUP HCPCS C1713 7463530 - SCREW BONE 5.5MM 30MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463533 SUP HCPCS C1713 7463533 - SCREW BONE 5.5MM 32.5MM FIX ANGLE LEGACY CD HORIZON BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463535 SUP HCPCS C1713 7463535 - SCREW BONE 5.5MM 35MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463538 SUP HCPCS C1713 7463538 - SCREW BONE 5.5MM 37.5MM FIX ANGLE LEGACY CD HORIZON BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463540 SUP HCPCS C1713 7463540 - SCREW BONE 5.5MM 40MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" "$1,666.50" "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463545 SUP HCPCS C1713 7463545 - SCREW BONE 5.5MM 45MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" $666.60 $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" "$1,666.50" "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463550 SUP HCPCS C1713 7463550 - SCREW BONE 5.5MM 50MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" "$1,666.50" "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463625 SUP HCPCS C1713 7463625 - SCREW BONE 6.5MM 25MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463628 SUP HCPCS C1713 7463628 - SCREW BONE 6.5MM 27.5MM FIX ANGLE LEGACY CD HORIZON BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463630 SUP HCPCS C1713 7463630 - SCREW BONE 6.5MM 30MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463633 SUP HCPCS C1713 7463633 - SCREW BONE 6.5MM 32.5MM FIX ANGLE LEGACY CD HORIZON BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" "$1,666.50" "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463635 SUP HCPCS C1713 7463635 - SCREW BONE 6.5MM 35MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463638 SUP HCPCS C1713 7463638 - SCREW BONE 6.5MM 37.5MM FIX ANGLE LEGACY CD HORIZON BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463640 SUP HCPCS C1713 7463640 - SCREW BONE 6.5MM 40MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463645 SUP HCPCS C1713 7463645 - SCREW BONE 6.5MM 45MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" "$1,666.50" "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463650 SUP HCPCS C1713 7463650 - SCREW BONE 6.5MM 50MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463655 SUP HCPCS C1713 7463655 - SCREW BONE 6.5MM 55MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463725 SUP HCPCS C1713 7463725 - SCREW BONE 7.5MM 25MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463728 SUP HCPCS C1713 7463728 - SCREW BONE 7.5MM 27.5MM FIX ANGLE LEGACY CD HORIZON BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" "$1,666.50" "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463730 SUP HCPCS C1713 7463730 - SCREW BONE 7.5MM 30MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463733 SUP HCPCS C1713 7463733 - SCREW BONE 7.5MM 32.5MM FIX ANGLE LEGACY CD HORIZON BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463735 SUP HCPCS C1713 7463735 - SCREW BONE 7.5MM 35MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463738 SUP HCPCS C1713 7463738 - SCREW BONE 7.5MM 37.5MM FIX ANGLE LEGACY CD HORIZON BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" "$1,666.50" "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463740 SUP HCPCS C1713 7463740 - SCREW BONE 7.5MM 40MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463745 SUP HCPCS C1713 7463745 - SCREW BONE 7.5MM 45MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463750 SUP HCPCS C1713 7463750 - SCREW BONE 7.5MM 50MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" "$1,666.50" "$1,666.50" $347.30 "$1,666.50" N/A N/A 7463755 SUP HCPCS C1713 7463755 - SCREW BONE 7.5MM 55MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,666.50" "$1,233.00" $330.76 "$1,666.50" $749.93 $749.93 $749.93 $749.93 "$1,666.50" "$1,666.50" "$1,666.50" $347.34 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" $347.32 "$1,666.50" "$1,666.50" $985.73 "$1,666.50" "$1,666.50" "$1,666.50" "$1,666.50" "$1,249.88" "$1,666.50" "$1,666.50" "$1,666.50" $833.25 $833.25 "$1,319.87" "$1,666.50" "$1,333.20" $749.93 $330.76 N/A $966.57 "$1,666.50" $999.90 "$1,666.50" $347.30 "$1,666.50" N/A N/A 7490122 SUP HCPCS C1713 7490122 - PLATE BN 22MM GRDNT + 1 LVL FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7490124 SUP HCPCS C1713 7490124 - PLATE BN 24MM GRDNT + 1 LVL FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7490126 SUP HCPCS C1713 7490126 - PLATE BN 26MM GRDNT + 1 LVL FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7490128 SUP HCPCS C1713 7490128 - PLATE BN 28MM GRDNT + 1 LVL FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7490236 SUP HCPCS C1713 7490236 - PLATE BN 36MM NS GRDNT + 2 LVL SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7490238 SUP HCPCS C1713 7490238 - PLATE BN 38MM NS GRDNT + 2 LVL SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7490240 SUP HCPCS C1713 7490240 - PLATE BN 40MM GRDNT + 2 LVL FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7490242 SUP HCPCS C1713 7490242 - PLATE BN 42MM GRDNT + 2 LVL FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7490244 SUP HCPCS C1713 7490244 - PLATE BN 44MM GRDNT + 2 LVL FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7490246 SUP HCPCS C1713 7490246 - PLATE BN 46MM GRDNT + 2 LVL FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7490248 SUP HCPCS C1713 7490248 - PLATE BN 48MM GRDNT + 2 LVL FX SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7490354 SUP HCPCS C1713 7490354 - PLATE BN 54MM GRDNT + 3 LVL FX SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7490356 SUP HCPCS C1713 7490356 - PLATE BN 56MM GRDNT + 3 LVL FX SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7490358 SUP HCPCS C1713 7490358 - PLATE BN 58MM GRDNT + 3 LVL FX SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7490360 SUP HCPCS C1713 7490360 - PLATE BN 60MM GRDNT + 3 LVL FX SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7490362 SUP HCPCS C1713 7490362 - PLATE BN 62MM GRDNT + 3 LVL FX SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7490364 SUP HCPCS C1713 7490364 - PLATE BN 64MM GRDNT + 3 LVL FX SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7490366 SUP HCPCS C1713 7490366 - PLATE BN 66MM GRDNT + 3 LVL FX SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7490468 SUP HCPCS C1713 7490468 - PLATE BN 68MM GRDNT + 4 LVL FX SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7490470 SUP HCPCS C1713 7490470 - PLATE BN 70MM GRDNT + 4 LVL FX SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7490474 SUP HCPCS C1713 7490474 - PLATE BN 74MM GRDNT + 4 LVL FX SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7490478 SUP HCPCS C1713 7490478 - PLATE BN 78MM GRDNT + 4 LVL FX SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7490482 SUP HCPCS C1713 7490482 - PLATE BN 82MM GRDNT + 4 LVL FX SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7490486 SUP HCPCS C1713 7490486 - PLATE BN 86MM GRDNT + 4 LVL FX SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7502073 SUP HCPCS C1713 7502073 - CAGE SPNL 20D HYPERLORDOTIC 34X6X24MM CRNT BRIGADE BOTH IP/OP "$18,375.00" "$13,598.00" "$3,646.98" "$18,375.00" "$8,268.75" "$8,268.75" "$8,268.75" "$8,268.75" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.81" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.55" "$18,375.00" "$7,350.00" "$9,058.88" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$13,781.25" "$18,375.00" "$18,375.00" "$18,375.00" "$9,187.50" "$9,187.50" "$14,553.00" "$18,375.00" "$14,700.00" "$8,268.75" "$3,646.98" N/A "$10,657.50" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.35" "$18,375.00" N/A N/A 7502077 SUP HCPCS C1713 7502077 - CAGE SPNL 20D HYPERLORDOTIC 34X10X24MM NS BRIGADE BOTH IP/OP "$18,375.00" "$13,598.00" "$3,646.98" "$18,375.00" "$8,268.75" "$8,268.75" "$8,268.75" "$8,268.75" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.81" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.55" "$18,375.00" "$7,350.00" "$9,058.88" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$13,781.25" "$18,375.00" "$18,375.00" "$18,375.00" "$9,187.50" "$9,187.50" "$14,553.00" "$18,375.00" "$14,700.00" "$8,268.75" "$3,646.98" N/A "$10,657.50" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.35" "$18,375.00" N/A N/A 7502100 SUP HCPCS C1713 7502100 - CAGE SPNL 20D HYPERLORDOTIC 38X28X6MM NS LF BRIGADE BOTH IP/OP "$18,375.00" "$13,598.00" "$3,646.98" "$18,375.00" "$8,268.75" "$8,268.75" "$8,268.75" "$8,268.75" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.81" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.55" "$18,375.00" "$7,350.00" "$9,058.88" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$13,781.25" "$18,375.00" "$18,375.00" "$18,375.00" "$9,187.50" "$9,187.50" "$14,553.00" "$18,375.00" "$14,700.00" "$8,268.75" "$3,646.98" N/A "$10,657.50" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.35" "$18,375.00" N/A N/A 7502102 SUP HCPCS C1713 7502102 - CAGE SPNL 20D HYPERLORDOTIC 38X28X8MM NS LF BRIGADE BOTH IP/OP "$18,375.00" "$13,598.00" "$3,646.98" "$18,375.00" "$8,268.75" "$8,268.75" "$8,268.75" "$8,268.75" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.81" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.55" "$18,375.00" "$18,375.00" "$9,058.88" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$13,781.25" "$18,375.00" "$18,375.00" "$18,375.00" "$9,187.50" "$9,187.50" "$14,553.00" "$18,375.00" "$14,700.00" "$8,268.75" "$3,646.98" N/A "$10,657.50" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.35" "$18,375.00" N/A N/A 7502104 SUP HCPCS C1713 7502104 - CAGE SPNL 20D HYPERLORDOTIC 38X28X10MM NS LF BRIGADE BOTH IP/OP "$18,375.00" "$13,598.00" "$3,646.98" "$18,375.00" "$8,268.75" "$8,268.75" "$8,268.75" "$8,268.75" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.81" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.55" "$18,375.00" "$7,350.00" "$9,058.88" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$13,781.25" "$18,375.00" "$18,375.00" "$18,375.00" "$9,187.50" "$9,187.50" "$14,553.00" "$18,375.00" "$14,700.00" "$8,268.75" "$3,646.98" N/A "$10,657.50" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.35" "$18,375.00" N/A N/A 7502219 SUP HCPCS C1713 7502219 - CAGE SPNL 20D HYPERLORDOTIC 34X8X24MM CRNT BRIGADE BOTH IP/OP "$18,375.00" "$13,598.00" "$3,646.98" "$18,375.00" "$8,268.75" "$8,268.75" "$8,268.75" "$8,268.75" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.81" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.55" "$18,375.00" "$7,350.00" "$9,058.88" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$13,781.25" "$18,375.00" "$18,375.00" "$18,375.00" "$9,187.50" "$9,187.50" "$14,553.00" "$18,375.00" "$14,700.00" "$8,268.75" "$3,646.98" N/A "$10,657.50" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.35" "$18,375.00" N/A N/A 7502221 SUP HCPCS C1713 7502221 - CAGE SPNL 30D HYPERLORDOTIC 34X10X24MM CRNT BRIGADE BOTH IP/OP "$18,375.00" "$13,598.00" "$3,646.98" "$18,375.00" "$8,268.75" "$8,268.75" "$8,268.75" "$8,268.75" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.81" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.55" "$18,375.00" "$18,375.00" "$9,058.88" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$13,781.25" "$18,375.00" "$18,375.00" "$18,375.00" "$9,187.50" "$9,187.50" "$14,553.00" "$18,375.00" "$14,700.00" "$8,268.75" "$3,646.98" N/A "$10,657.50" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.35" "$18,375.00" N/A N/A 7502244 SUP HCPCS C1713 7502244 - CAGE SPNL 30D HYPERLORDOTIC 38X6X28MM CRNT BRIGADE BOTH IP/OP "$18,375.00" "$13,598.00" "$3,646.98" "$18,375.00" "$8,268.75" "$8,268.75" "$8,268.75" "$8,268.75" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.81" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.55" "$18,375.00" "$7,350.00" "$9,058.88" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$13,781.25" "$18,375.00" "$18,375.00" "$18,375.00" "$9,187.50" "$9,187.50" "$14,553.00" "$18,375.00" "$14,700.00" "$8,268.75" "$3,646.98" N/A "$10,657.50" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.35" "$18,375.00" N/A N/A 7502246 SUP HCPCS C1713 7502246 - CAGE SPNL 30D HYPERLORDOTIC 38X28X8MM NS LF BRIGADE BOTH IP/OP "$18,375.00" "$13,598.00" "$3,646.98" "$18,375.00" "$8,268.75" "$8,268.75" "$8,268.75" "$8,268.75" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.81" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.55" "$18,375.00" "$7,350.00" "$9,058.88" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$13,781.25" "$18,375.00" "$18,375.00" "$18,375.00" "$9,187.50" "$9,187.50" "$14,553.00" "$18,375.00" "$14,700.00" "$8,268.75" "$3,646.98" N/A "$10,657.50" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.35" "$18,375.00" N/A N/A 7502248 SUP HCPCS C1713 7502248 - CAGE SPNL 30D HYPERLORDOTIC 38X28X10MM NS LF BRIGADE BOTH IP/OP "$18,375.00" "$13,598.00" "$3,646.98" "$18,375.00" "$8,268.75" "$8,268.75" "$8,268.75" "$8,268.75" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.81" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.55" "$18,375.00" "$18,375.00" "$9,058.88" "$18,375.00" "$18,375.00" "$18,375.00" "$18,375.00" "$13,781.25" "$18,375.00" "$18,375.00" "$18,375.00" "$9,187.50" "$9,187.50" "$14,553.00" "$18,375.00" "$14,700.00" "$8,268.75" "$3,646.98" N/A "$10,657.50" "$18,375.00" "$18,375.00" "$18,375.00" "$3,829.35" "$18,375.00" N/A N/A 7509145 SUP Custom 27804086 7509145 - GRAFT BN 5X1.75CM MAGNIFUSE DBM BOTH IP/OP "$6,875.00" "$5,088.00" "$1,223.75" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$1,223.75" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.83" "$6,875.00" "$2,750.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$3,093.75" "$6,875.00" N/A "$3,987.50" "$6,875.00" "$4,125.00" "$6,875.00" "$6,875.00" "$6,875.00" N/A N/A 7509211 SUP Custom 27804086 7509211 - GRAFT BN 10X1CM MAGNIFUSE DBM BOTH IP/OP "$6,500.00" "$4,810.00" "$1,157.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,157.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.67" "$6,500.00" "$2,600.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$4,875.00" "$6,500.00" "$6,500.00" "$6,500.00" "$3,250.00" "$3,250.00" "$5,148.00" "$6,500.00" "$5,200.00" "$2,925.00" "$6,500.00" N/A "$3,770.00" "$6,500.00" "$3,900.00" "$6,500.00" "$6,500.00" "$6,500.00" N/A N/A 7509215 SUP Custom 27804086 7509215 - GRAFT BN 5X1CM MAGNIFUSE DBM SPNE CRV POST BOTH IP/OP "$3,937.50" "$2,914.00" $700.88 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $700.88 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$1,575.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" "$3,937.50" N/A "$2,283.75" "$3,937.50" "$2,362.50" "$3,937.50" "$3,937.50" "$3,937.50" N/A N/A 7510001 SUP HCPCS C1713 7510001 - NUT LCK 5.5MM LAT PLT SPNE BOTH IP/OP $317.50 $235.00 $63.02 $317.50 $142.88 $142.88 $142.88 $142.88 $317.50 $317.50 $317.50 $66.17 $317.50 $317.50 $317.50 $317.50 $317.50 $66.17 $317.50 $317.50 $187.80 $317.50 $317.50 $317.50 $317.50 $238.13 $317.50 $317.50 $317.50 $158.75 $158.75 $251.46 $317.50 $254.00 $142.88 $63.02 N/A $184.15 $317.50 $317.50 $317.50 $66.17 $317.50 N/A N/A 7510050 SUP HCPCS C1713 7510050 - GRAFT BONE 2XS 12MM 20MM ABSORBABLE SPONGE STERILE WATER BOTH IP/OP "$2,387.50" "$1,767.00" $473.86 "$2,387.50" "$1,074.38" "$1,074.38" "$1,074.38" "$1,074.38" "$2,387.50" "$2,387.50" "$2,387.50" $497.61 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" $497.58 "$2,387.50" $955.00 "$1,412.21" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$1,790.63" "$2,387.50" "$2,387.50" "$2,387.50" "$1,193.75" "$1,193.75" "$1,890.90" "$2,387.50" "$1,910.00" "$1,074.38" $473.86 N/A "$1,384.75" "$2,387.50" "$2,387.50" "$2,387.50" $497.56 "$2,387.50" N/A N/A 7510100 SUP HCPCS C1713 7510100 - GRAFT BONE XS KIT INFUSE BOVINE COLLAGEN RHBMP-2 LUMBAR BOTH IP/OP "$4,762.50" "$3,524.00" $945.24 "$4,762.50" "$2,143.13" "$2,143.13" "$2,143.13" "$2,143.13" "$4,762.50" "$4,762.50" "$4,762.50" $992.62 "$4,762.50" "$4,762.50" "$4,762.50" "$4,762.50" "$4,762.50" $992.56 "$4,762.50" "$1,905.00" "$2,347.91" "$4,762.50" "$4,762.50" "$4,762.50" "$4,762.50" "$3,571.88" "$4,762.50" "$4,762.50" "$4,762.50" "$2,381.25" "$2,381.25" "$3,771.90" "$4,762.50" "$3,810.00" "$2,143.13" $945.24 N/A "$2,762.25" "$4,762.50" "$2,857.50" "$4,762.50" $992.51 "$4,762.50" N/A N/A 7510200 SUP HCPCS C1713 7510200 - GRAFT BONE SMALL 14MM 23MM ABSORBABLE SPONGE STERILE WATER BOTH IP/OP "$9,512.50" "$7,039.00" "$1,887.99" "$9,512.50" "$4,280.63" "$4,280.63" "$4,280.63" "$4,280.63" "$9,512.50" "$9,512.50" "$9,512.50" "$1,982.64" "$9,512.50" "$9,512.50" "$9,512.50" "$9,512.50" "$9,512.50" "$1,982.51" "$9,512.50" "$9,512.50" "$4,689.66" "$9,512.50" "$9,512.50" "$9,512.50" "$9,512.50" "$7,134.38" "$9,512.50" "$9,512.50" "$9,512.50" "$4,756.25" "$4,756.25" "$7,533.90" "$9,512.50" "$7,610.00" "$4,280.63" "$1,887.99" N/A "$5,517.25" "$9,512.50" "$5,707.50" "$9,512.50" "$1,982.41" "$9,512.50" N/A N/A 7510400 SUP HCPCS C1713 7510400 - GRAFT BONE MEDIUM 20GA 2X1IN VIAL ABSORBABLE COLLAGEN SPONGE BOTH IP/OP "$13,250.00" "$9,805.00" "$2,629.79" "$13,250.00" "$5,962.50" "$5,962.50" "$5,962.50" "$5,962.50" "$13,250.00" "$13,250.00" "$13,250.00" "$2,761.63" "$13,250.00" "$13,250.00" "$13,250.00" "$13,250.00" "$13,250.00" "$2,761.45" "$13,250.00" "$13,250.00" "$6,532.25" "$13,250.00" "$13,250.00" "$13,250.00" "$13,250.00" "$9,937.50" "$13,250.00" "$13,250.00" "$13,250.00" "$6,625.00" "$6,625.00" "$10,494.00" "$13,250.00" "$10,600.00" "$5,962.50" "$2,629.79" N/A "$7,685.00" "$13,250.00" "$7,950.00" "$13,250.00" "$2,761.30" "$13,250.00" N/A N/A 7510800 SUP HCPCS C1713 7510800 - GRAFT BONE LARGE II 18MM 26MM ABSORBABLE SPONGE STERILE BOTH IP/OP "$14,775.00" "$10,934.00" "$2,932.47" "$14,775.00" "$6,648.75" "$6,648.75" "$6,648.75" "$6,648.75" "$14,775.00" "$14,775.00" "$14,775.00" "$3,079.48" "$14,775.00" "$14,775.00" "$14,775.00" "$14,775.00" "$14,775.00" "$3,079.27" "$14,775.00" "$5,910.00" "$7,284.08" "$14,775.00" "$14,775.00" "$14,775.00" "$14,775.00" "$11,081.25" "$14,775.00" "$14,775.00" "$14,775.00" "$7,387.50" "$7,387.50" "$11,701.80" "$14,775.00" "$11,820.00" "$6,648.75" "$2,932.47" N/A "$8,569.50" "$14,775.00" "$14,775.00" "$14,775.00" "$3,079.11" "$14,775.00" N/A N/A 7521006 SUP HCPCS C1713 7521006 - PLATE BN 6MM XLP 2 HL TI SPNE LAT BOTH IP/OP "$7,022.50" "$5,197.00" "$1,393.79" "$7,022.50" "$3,160.13" "$3,160.13" "$3,160.13" "$3,160.13" "$7,022.50" "$7,022.50" "$7,022.50" "$1,463.66" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$1,463.57" "$7,022.50" "$7,022.50" "$3,462.09" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$5,266.88" "$7,022.50" "$7,022.50" "$7,022.50" "$3,511.25" "$3,511.25" "$5,561.82" "$7,022.50" "$5,618.00" "$3,160.13" "$1,393.79" N/A "$4,073.05" "$7,022.50" "$4,213.50" "$7,022.50" "$1,463.49" "$7,022.50" N/A N/A 7521008 SUP HCPCS C1713 7521008 - PLATE BN 8MM XLP 2 HL TI SPNE LAT BOTH IP/OP "$7,022.50" "$5,197.00" "$1,393.79" "$7,022.50" "$3,160.13" "$3,160.13" "$3,160.13" "$3,160.13" "$7,022.50" "$7,022.50" "$7,022.50" "$1,463.66" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$1,463.57" "$7,022.50" "$2,809.00" "$3,462.09" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$5,266.88" "$7,022.50" "$7,022.50" "$7,022.50" "$3,511.25" "$3,511.25" "$5,561.82" "$7,022.50" "$5,618.00" "$3,160.13" "$1,393.79" N/A "$4,073.05" "$7,022.50" "$7,022.50" "$7,022.50" "$1,463.49" "$7,022.50" N/A N/A 7521012 SUP HCPCS C1713 7521012 - PLATE BN 12MM XLP 2 HL TI SPNE LAT BOTH IP/OP "$7,022.50" "$5,197.00" "$1,393.79" "$7,022.50" "$3,160.13" "$3,160.13" "$3,160.13" "$3,160.13" "$7,022.50" "$7,022.50" "$7,022.50" "$1,463.66" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$1,463.57" "$7,022.50" "$2,809.00" "$3,462.09" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$5,266.88" "$7,022.50" "$7,022.50" "$7,022.50" "$3,511.25" "$3,511.25" "$5,561.82" "$7,022.50" "$5,618.00" "$3,160.13" "$1,393.79" N/A "$4,073.05" "$7,022.50" "$7,022.50" "$7,022.50" "$1,463.49" "$7,022.50" N/A N/A 7521014 SUP HCPCS C1713 7521014 - PLATE BN 14MM XLP 2 HL TI SPNE LAT BOTH IP/OP "$7,022.50" "$5,197.00" "$1,393.79" "$7,022.50" "$3,160.13" "$3,160.13" "$3,160.13" "$3,160.13" "$7,022.50" "$7,022.50" "$7,022.50" "$1,463.66" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$1,463.57" "$7,022.50" "$7,022.50" "$3,462.09" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$5,266.88" "$7,022.50" "$7,022.50" "$7,022.50" "$3,511.25" "$3,511.25" "$5,561.82" "$7,022.50" "$5,618.00" "$3,160.13" "$1,393.79" N/A "$4,073.05" "$7,022.50" "$7,022.50" "$7,022.50" "$1,463.49" "$7,022.50" N/A N/A 7521016 SUP HCPCS C1713 7521016 - PLATE BN 16MM XLP 2 HL TI SPNE LAT BOTH IP/OP "$7,022.50" "$5,197.00" "$1,393.79" "$7,022.50" "$3,160.13" "$3,160.13" "$3,160.13" "$3,160.13" "$7,022.50" "$7,022.50" "$7,022.50" "$1,463.66" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$1,463.57" "$7,022.50" "$2,809.00" "$3,462.09" "$7,022.50" "$7,022.50" "$7,022.50" "$7,022.50" "$5,266.88" "$7,022.50" "$7,022.50" "$7,022.50" "$3,511.25" "$3,511.25" "$5,561.82" "$7,022.50" "$5,618.00" "$3,160.13" "$1,393.79" N/A "$4,073.05" "$7,022.50" "$7,022.50" "$7,022.50" "$1,463.49" "$7,022.50" N/A N/A 7533006 SUP HCPCS C1713 7533006 - PLATE BN 6MM XLP + 4 HL SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7533008 SUP HCPCS C1713 7533008 - PLATE BN 8MM XLP + 4 HL SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7533010 SUP HCPCS C1713 7533010 - PLATE BN 10MM XLP + 4 HL SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7533012 SUP HCPCS C1713 7533012 - PLATE BN 12MM XLP + 4 HL SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7533014 SUP HCPCS C1713 7533014 - PLATE BN 14MM XLP + 4 HL SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$7,887.50" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7533016 SUP HCPCS C1713 7533016 - PLATE BN 16MM XLP + 4 HL SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7534006 SUP HCPCS C1713 7534006 - PLATE BN 6MM XLP + 2X2 HL SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7534008 SUP HCPCS C1713 7534008 - PLATE BN 8MM XLP + 2X2 HL SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7534010 SUP HCPCS C1713 7534010 - PLATE BN 10MM XLP + 2X2 HL SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7534012 SUP HCPCS C1713 7534012 - PLATE BN 12MM XLP + 2X2 HL SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7534014 SUP HCPCS C1713 7534014 - PLATE BN 14MM XLP + 2X2 HL SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$7,887.50" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7534016 SUP HCPCS C1713 7534016 - PLATE BN 16MM XLP + 2X2 HL SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7539006 SUP HCPCS C1713 7539006 - PLATE BN ANG FAVORED 6MM XLP + SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7539008 SUP HCPCS C1713 7539008 - PLATE BN ANG FAVORED 8MM XLP + SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$7,887.50" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7539010 SUP HCPCS C1713 7539010 - PLATE BN ANG FAVORED 10MM XLP + SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7539012 SUP HCPCS C1713 7539012 - PLATE BN ANG FAVORED 12MM XLP + SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7539014 SUP HCPCS C1713 7539014 - PLATE BN ANG FAVORED 14MM XLP + SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7539016 SUP HCPCS C1713 7539016 - PLATE BN ANG FAVORED 16MM XLP + SPNE BOTH IP/OP "$7,887.50" "$5,837.00" "$1,565.47" "$7,887.50" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.95" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.84" "$7,887.50" "$3,155.00" "$3,888.54" "$7,887.50" "$7,887.50" "$7,887.50" "$7,887.50" "$5,915.63" "$7,887.50" "$7,887.50" "$7,887.50" "$3,943.75" "$3,943.75" "$6,246.90" "$7,887.50" "$6,310.00" "$3,549.38" "$1,565.47" N/A "$4,574.75" "$7,887.50" "$7,887.50" "$7,887.50" "$1,643.76" "$7,887.50" N/A N/A 7540020 SUP HCPCS C1713 7540020 - SCREW SET ANGLE REVERSE BREAKOFF LEGACY CD HORIZON TITANIUM BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7540120 SUP HCPCS C1713 7540120 - SCREW SET NONBREAKOFF REVERSE ANGLE THREAD CD HORIZON LEGACY BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7540220 SUP HCPCS C1713 7540220 - SCREW SET BREAKOFF CD HORIZON LEGACY TITANIUM SPN PEDICLE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 7541102 SUP HCPCS C1713 7541102 - HOOK SPINAL SMALL LIP 5.5MM BIFID BLADE ARTICULAR PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541103 SUP HCPCS C1713 7541103 - HOOK SPINAL MEDIUM LIP 5.5MM BIFID BLADE ARTICULAR PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541104 SUP HCPCS C1713 7541104 - HOOK SPINAL LARGE LIP 5.5MM BIFID BLADE ARTICULAR PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541112 SUP HCPCS C1713 7541112 - HOOK SPINAL SMALL 5.5MM WIDE BLADE CD HORIZON LEGACY BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541113 SUP HCPCS C1713 7541113 - HOOK SPINAL MEDIUM WIDE LIP 5.5MM BLADE ARTICULAR PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541114 SUP HCPCS C1713 7541114 - HOOK SPINAL LARGE WIDE BLADE LIPPED DESIGN CD HORIZON LEGACY BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541122 SUP HCPCS C1713 7541122 - HOOK SPINAL SMALL NARROW LIP 5.5MM BLADE ARTICULAR PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541123 SUP HCPCS C1713 7541123 - HOOK SPINAL MEDIUM NARROW LIP 5.5MM BLADE ARTICULAR PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541124 SUP HCPCS C1713 7541124 - HOOK SPINAL LARGE NARROW LIP 5.5MM BLADE ARTICULAR PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541133 SUP HCPCS C1713 7541133 - HOOK SPINAL MEDIUM WIDE LIP 5.5MM BLADE ARTICULAR PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541142 SUP HCPCS C1713 7541142 - HOOK SPINAL SMALL 5.5MM RAMPED NARROW BLADE CD HORIZON BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541143 SUP HCPCS C1713 7541143 - HOOK SPINAL MEDIUM 5.5MM RAMPED NARROW BLADE CD HORIZON BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541153 SUP HCPCS C1713 7541153 - HOOK SPINAL MEDIUM WIDE BLADE CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541162 SUP HCPCS C1713 7541162 - HOOK SPINAL SMALL ANGLED CD HORIZON LEGACY TITANIUM LUMBAR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541163 SUP HCPCS C1713 7541163 - HOOK SPINAL MEDIUM ANGLED CD HORIZON LEGACY TITANIUM LUMBAR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541172 SUP HCPCS C1713 7541172 - HOOK SPINAL SMALL EXTENDED BODY CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541173 SUP HCPCS C1713 7541173 - HOOK SPINAL MEDIUM EXTENDED BODY CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541174 SUP HCPCS C1713 7541174 - HOOK SPINAL LARGE EXTENDED BODY CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541188 SUP HCPCS C1713 7541188 - HOOK SPINAL 5.5MM ANGLED BLADE CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541189 SUP HCPCS C1713 7541189 - HOOK SPINAL 5.5MM ANGLED BLADE CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541198 SUP HCPCS C1713 7541198 - HOOK SPINAL OFFST CD HORIZON LEGACY TITANIUM RIGHT 5.55 MM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541199 SUP HCPCS C1713 7541199 - HOOK SPINAL LEFT OFFST CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541203 SUP HCPCS C1713 7541203 - HOOK SPINAL MEDIUM LIP TITANIUM PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541213 SUP HCPCS C1713 7541213 - HOOK SPINAL MEDIUM LIP WIDE BLADE TITANIUM PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541223 SUP HCPCS C1713 7541223 - HOOK SPINAL MEDIUM NARROW LIP 5.5MM BLADE ARTICULAR PROCESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541302 SUP HCPCS C1713 7541302 - HOOK SPINAL SMALL LORDOTIC TITANIUM THORACIC PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541303 SUP HCPCS C1713 7541303 - HOOK SPINAL MEDIUM TITANIUM THORACIC PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541304 SUP HCPCS C1713 7541304 - HOOK SPINAL LARGE LORDOTIC TITANIUM THORACIC PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541312 SUP HCPCS C1713 7541312 - HOOK SPINAL SMALL LORDOTIC TITANIUM SUPRA LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541313 SUP HCPCS C1713 7541313 - HOOK SPINAL MEDIUM TITANIUM SUPRA LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541314 SUP HCPCS C1713 7541314 - HOOK SPINAL LARGE LORDOTIC TITANIUM SUPRA LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541322 SUP HCPCS C1713 7541322 - HOOK SPINAL SMALL LORDOTIC TITANIUM INFRA LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541323 SUP HCPCS C1713 7541323 - HOOK SPINAL MEDIUM TITANIUM INFRA LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541324 SUP HCPCS C1713 7541324 - HOOK SPINAL LARGE LORDOTIC TITANIUM INFRA LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541342 SUP HCPCS C1713 7541342 - HOOK SPINAL SMALL LORDOTIC TRNSVRS PROCESS THORACIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541343 SUP HCPCS C1713 7541343 - HOOK SPINAL MEDIUM TRNSVRS PROCESS THORACIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7541344 SUP HCPCS C1713 7541344 - HOOK SPINAL LARGE TRNSVRS PROCESS TITANIUM THORACIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7542420 SUP HCPCS C1713 7542420 - SCREW BONE 4MM 20MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542425 SUP HCPCS C1713 7542425 - SCREW BONE 4MM 25MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542430 SUP HCPCS C1713 7542430 - SCREW BONE 4MM 30MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542435 SUP HCPCS C1713 7542435 - SCREW BONE 4MM 35MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542440 SUP HCPCS C1713 7542440 - SCREW BONE 4MM 40MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542445 SUP HCPCS C1713 7542445 - SCREW BONE 4MM 45MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542450 SUP HCPCS C1713 7542450 - SCREW BONE 4MM 50MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542455 SUP HCPCS C1713 7542455 - SCREW BONE 4MM 55MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542520 SUP HCPCS C1713 7542520 - SCREW BONE 5MM 20MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542525 SUP HCPCS C1713 7542525 - SCREW BN 5MM 25MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542530 SUP HCPCS C1713 7542530 - SCREW BN 5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542535 SUP HCPCS C1713 7542535 - SCREW BN 5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542540 SUP HCPCS C1713 7542540 - SCREW BN 5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542545 SUP HCPCS C1713 7542545 - SCREW BN 5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM ROD BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542550 SUP HCPCS C1713 7542550 - SCREW BONE 5MM 50MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542555 SUP HCPCS C1713 7542555 - SCREW BONE 5MM 55MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542625 SUP HCPCS C1713 7542625 - SCREW BONE 6MM 25MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542630 SUP HCPCS C1713 7542630 - SCREW BONE 6MM 30MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542635 SUP HCPCS C1713 7542635 - SCREW BONE 6MM 35MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542640 SUP HCPCS C1713 7542640 - SCREW BONE 6MM 40MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542645 SUP HCPCS C1713 7542645 - SCREW BONE 6MM 45MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542650 SUP HCPCS C1713 7542650 - SCREW BONE 6MM 50MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542655 SUP HCPCS C1713 7542655 - SCREW BONE 6MM 55MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7542660 SUP HCPCS C1713 7542660 - SCREW BONE 6MM 60MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543420 SUP HCPCS C1713 7543420 - SCREW BONE 4.5MM 20MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543425 SUP HCPCS C1713 7543425 - SCREW BN 4.5MM 25MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543430 SUP HCPCS C1713 7543430 - SCREW BN 4.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543435 SUP HCPCS C1713 7543435 - SCREW BN 4.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543440 SUP HCPCS C1713 7543440 - SCREW BN 4.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543445 SUP HCPCS C1713 7543445 - SCREW BN 4.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543450 SUP HCPCS C1713 7543450 - SCREW BONE 4.5MM 50MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543455 SUP HCPCS C1713 7543455 - SCREW BONE 4.5MM 55MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543525 SUP HCPCS C1713 7543525 - SCREW BN 5.5MM 25MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543530 SUP HCPCS C1713 7543530 - SCREW BN 5.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543535 SUP HCPCS C1713 7543535 - SCREW BN 5.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543540 SUP HCPCS C1713 7543540 - SCREW BN 5.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543545 SUP HCPCS C1713 7543545 - SCREW BN 5.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543550 SUP HCPCS C1713 7543550 - SCREW BN 5.5MM 50MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543555 SUP HCPCS C1713 7543555 - SCREW BONE 5.5MM 55MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543560 SUP HCPCS C1713 7543560 - SCREW BONE 5.5MM 60MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543625 SUP HCPCS C1713 7543625 - SCREW BONE 6.5MM 25MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543630 SUP HCPCS C1713 7543630 - SCREW BN 6.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543635 SUP HCPCS C1713 7543635 - SCREW BN 6.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543640 SUP HCPCS C1713 7543640 - SCREW BN 6.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543645 SUP HCPCS C1713 7543645 - SCREW BN 6.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543650 SUP HCPCS C1713 7543650 - SCREW BN 6.5MM 50MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543655 SUP HCPCS C1713 7543655 - SCREW BN 6.5MM 55MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543660 SUP HCPCS C1713 7543660 - SCREW BONE 6.5MM 60MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543725 SUP HCPCS C1713 7543725 - SCREW BONE 7.5MM 25MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543730 SUP HCPCS C1713 7543730 - SCREW BN 7.5MM 30MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543735 SUP HCPCS C1713 7543735 - SCREW BN 7.5MM 35MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543740 SUP HCPCS C1713 7543740 - SCREW BN 7.5MM 40MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543745 SUP HCPCS C1713 7543745 - SCREW BN 7.5MM 45MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543750 SUP HCPCS C1713 7543750 - SCREW BN 7.5MM 50MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543755 SUP HCPCS C1713 7543755 - SCREW BN 7.5MM 55MM CD HZN LGC FX ANG CLR CD TI SPNE 5.5MM BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,896.00" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543760 SUP HCPCS C1713 7543760 - SCREW BONE 7.5MM 60MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" $758.40 "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7543765 SUP HCPCS C1713 7543765 - SCREW BONE 7.5MM 65MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$1,896.00" "$1,403.00" $376.31 "$1,896.00" $853.20 $853.20 $853.20 $853.20 "$1,896.00" "$1,896.00" "$1,896.00" $395.17 "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" $395.15 "$1,896.00" "$1,896.00" "$1,121.48" "$1,896.00" "$1,896.00" "$1,896.00" "$1,896.00" "$1,422.00" "$1,896.00" "$1,896.00" "$1,896.00" $948.00 $948.00 "$1,501.63" "$1,896.00" "$1,516.80" $853.20 $376.31 N/A "$1,099.68" "$1,896.00" "$1,137.60" "$1,896.00" $395.13 "$1,896.00" N/A N/A 7544035 SUP HCPCS C1713 7544035 - SCREW BN 4MM 35MM CD HZN LGC MA TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7555025 SUP HCPCS C1713 7555025 - BOLT SPNL 5.5MM 25MM PLT BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7555030 SUP HCPCS C1713 7555030 - BOLT SPNL 5.5MM 30MM TI BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7555035 SUP HCPCS C1713 7555035 - BOLT SPNL 5MM 35MM TI BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7555040 SUP HCPCS C1713 7555040 - BOLT SPNL 5.5MM 40MM TI BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7555050 SUP HCPCS C1713 7555050 - BOLT SPNL 5.5MM 50MM TI BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7555055 SUP HCPCS C1713 7555055 - BOLT SPNL 5.5MM 55MM XLP BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7555060 SUP HCPCS C1713 7555060 - BOLT SPNL 5.5MM 60MM BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7555065 SUP HCPCS C1713 7555065 - BOLT SPNL 5.5MM 65MM TI BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7560020 SUP HCPCS C1713 7560020 - SCREW SET BREAKOFF REVERSE ANGLE THREAD CD HORIZON LEGACY BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7560120 SUP HCPCS C1713 7560120 - SCREW SET NONBREAKOFF REVERSE ANGLE THREAD CD HORIZON LEGACY BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 7560220 SUP HCPCS C1713 7560220 - SCREW SET BREAKOFF CD HORIZON LEGACY STAINLESS STEEL SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7561102 SUP HCPCS C1713 7561102 - HOOK SPINAL SMALL BIFID BLADE CD HORIZON LEGACY STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561103 SUP HCPCS C1713 7561103 - HOOK SPINAL MEDIUM BIFID BLADE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561104 SUP HCPCS C1713 7561104 - HOOK SPINAL LARGE BIFID BLADE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561112 SUP HCPCS C1713 7561112 - HOOK SPINAL SMALL WIDE BLADE CD HORIZON LEGACY STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561113 SUP HCPCS C1713 7561113 - HOOK SPINAL MEDIUM WIDE BLADE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561114 SUP HCPCS C1713 7561114 - HOOK SPINAL LARGE WIDE BLADE CD HORIZON LEGACY STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561122 SUP HCPCS C1713 7561122 - HOOK SPINAL SMALL NARROW BLADE CD HORIZON LEGACY STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561123 SUP HCPCS C1713 7561123 - HOOK SPINAL MEDIUM NARROW BLADE CD HORIZON LEGACY STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561124 SUP HCPCS C1713 7561124 - HOOK SPINAL LARGE NARROW BLADE CD HORIZON LEGACY STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561133 SUP HCPCS C1713 7561133 - HOOK SPNL MED CD HZN LGC RAMP W BLDE SS THOR 5.5MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561142 SUP HCPCS C1713 7561142 - HOOK SPINAL SMALL RAMPED NARROW BLADE CD HORIZON LEGACY BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561143 SUP HCPCS C1713 7561143 - HOOK SPINAL MEDIUM RAMPED NARROW BLADE CD HORIZON LEGACY BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561153 SUP HCPCS C1713 7561153 - HOOK SPINAL MEDIUM CD HORIZON LEGACY STAINLESS STEEL LUMBAR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561162 SUP HCPCS C1713 7561162 - HOOK SPINAL SMALL ANGLED BLADE CD HORIZON LEGACY STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561163 SUP HCPCS C1713 7561163 - HOOK SPINAL MEDIUM ANGLED BLADE CD HORIZON LEGACY STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561172 SUP HCPCS C1713 7561172 - HOOK SPINAL SMALL EXTENDED BODY CD HORIZON LEGACY STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561173 SUP HCPCS C1713 7561173 - HOOK SPINAL MEDIUM EXTENDED BODY CD HORIZON LEGACY STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561174 SUP HCPCS C1713 7561174 - HOOK SPINAL LARGE EXTENDED BODY CD HORIZON LEGACY STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561188 SUP HCPCS C1713 7561188 - HOOK SPINAL RIGHT OFFST ANGLED BLADE CD HORIZON LEGACY BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561189 SUP HCPCS C1713 7561189 - HOOK SPINAL LEFT OFFST ANGLED BLADE CD HORIZON LEGACY BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561198 SUP HCPCS C1713 7561198 - HOOK SPINAL RIGHT OFFST LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561199 SUP HCPCS C1713 7561199 - HOOK SPINAL LEFT OFFST CD HORIZON LEGACY STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561203 SUP HCPCS C1713 7561203 - HOOK SPINAL MEDIUM LIP LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561213 SUP HCPCS C1713 7561213 - HOOK SPINAL MEDIUM WIDE BLADE LIP LEGACY CD HORIZON BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7561223 SUP HCPCS C1713 7561223 - HOOK SPINAL MEDIUM NARROW BLADE LIP LEGACY CD HORIZON BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7562420 SUP HCPCS C1713 7562420 - SCREW BONE 4MM 20MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562425 SUP HCPCS C1713 7562425 - SCREW BONE 4MM 25MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562430 SUP HCPCS C1713 7562430 - SCREW BONE 4MM 30MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562435 SUP HCPCS C1713 7562435 - SCREW BONE 4MM 35MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562440 SUP HCPCS C1713 7562440 - SCREW BONE 4MM 40MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562445 SUP HCPCS C1713 7562445 - SCREW BONE 4MM 45MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562450 SUP HCPCS C1713 7562450 - SCREW BONE 4MM 50MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562455 SUP HCPCS C1713 7562455 - SCREW BONE 4MM 55MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562520 SUP HCPCS C1713 7562520 - SCREW BONE 5MM 20MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562525 SUP HCPCS C1713 7562525 - SCREW BONE 5MM 25MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562530 SUP HCPCS C1713 7562530 - SCREW BONE 5MM 30MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562535 SUP HCPCS C1713 7562535 - SCREW BONE 5MM 35MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562540 SUP HCPCS C1713 7562540 - SCREW BONE 5MM 40MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562545 SUP HCPCS C1713 7562545 - SCREW BONE 5MM 45MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562550 SUP HCPCS C1713 7562550 - SCREW BONE 5MM 50MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562555 SUP HCPCS C1713 7562555 - SCREW BONE 5MM 55MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562625 SUP HCPCS C1713 7562625 - SCREW BONE 6MM 25MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562630 SUP HCPCS C1713 7562630 - SCREW BONE 6MM 30MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562635 SUP HCPCS C1713 7562635 - SCREW BONE 6MM 35MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562640 SUP HCPCS C1713 7562640 - SCREW BONE 6MM 40MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562645 SUP HCPCS C1713 7562645 - SCREW BONE 6MM 45MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562650 SUP HCPCS C1713 7562650 - SCREW BONE 6MM 50MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562655 SUP HCPCS C1713 7562655 - SCREW BONE 6MM 55MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7562660 SUP HCPCS C1713 7562660 - SCREW BONE 6MM 60MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563420 SUP HCPCS C1713 7563420 - SCREW BONE 4.5MM 20MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563425 SUP HCPCS C1713 7563425 - SCREW BONE 4.5MM 25MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563430 SUP HCPCS C1713 7563430 - SCREW BONE 4.5MM 30MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563435 SUP HCPCS C1713 7563435 - SCREW BONE 4.5MM 35MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563440 SUP HCPCS C1713 7563440 - SCREW BONE 4.5MM 40MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563445 SUP HCPCS C1713 7563445 - SCREW BONE 4.5MM 45MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563450 SUP HCPCS C1713 7563450 - SCREW BONE 4.5MM 50MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563455 SUP HCPCS C1713 7563455 - SCREW BONE 4.5MM 55MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563525 SUP HCPCS C1713 7563525 - SCREW BONE 5.5MM 25MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563530 SUP HCPCS C1713 7563530 - SCREW BONE 5.5MM 30MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563535 SUP HCPCS C1713 7563535 - SCREW BONE 5.5MM 35MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563540 SUP HCPCS C1713 7563540 - SCREW BONE 5.5MM 40MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563545 SUP HCPCS C1713 7563545 - SCREW BONE 5.5MM 45MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563550 SUP HCPCS C1713 7563550 - SCREW BONE 5.5MM 50MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563555 SUP HCPCS C1713 7563555 - SCREW BONE 5.5MM 55MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563560 SUP HCPCS C1713 7563560 - SCREW BONE 5.5MM 60MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563625 SUP HCPCS C1713 7563625 - SCREW BONE 6.5MM 25MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563630 SUP HCPCS C1713 7563630 - SCREW BONE 6.5MM 30MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563635 SUP HCPCS C1713 7563635 - SCREW BONE 6.5MM 35MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563640 SUP HCPCS C1713 7563640 - SCREW BONE 6.5MM 40MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563645 SUP HCPCS C1713 7563645 - SCREW BONE 6.5MM 45MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563650 SUP HCPCS C1713 7563650 - SCREW BONE 6.5MM 50MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563655 SUP HCPCS C1713 7563655 - SCREW BONE 6.5MM 55MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563660 SUP HCPCS C1713 7563660 - SCREW BONE 6.5MM 60MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563725 SUP HCPCS C1713 7563725 - SCREW BONE 7.5MM 25MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563730 SUP HCPCS C1713 7563730 - SCREW BONE 7.5MM 30MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563735 SUP HCPCS C1713 7563735 - SCREW BONE 7.5MM 35MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563740 SUP HCPCS C1713 7563740 - SCREW BONE 7.5MM 40MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563745 SUP HCPCS C1713 7563745 - SCREW BONE 7.5MM 45MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$2,036.15" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563750 SUP HCPCS C1713 7563750 - SCREW BONE 7.5MM 50MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563755 SUP HCPCS C1713 7563755 - SCREW BONE 7.5MM 55MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563760 SUP HCPCS C1713 7563760 - SCREW BONE 7.5MM 60MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" "$2,036.15" "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7563765 SUP HCPCS C1713 7563765 - SCREW BONE 7.5MM 65MM G4 TECHNOLOGY FIX ANGLE COLOR CODED BOTH IP/OP "$2,036.50" "$1,507.00" $404.12 "$2,036.15" $916.27 $916.27 $916.27 $916.27 "$2,036.15" "$2,036.15" "$2,036.15" $424.38 "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" $424.36 "$2,036.15" $814.46 "$1,204.38" "$2,036.15" "$2,036.15" "$2,036.15" "$2,036.15" "$1,527.38" "$2,036.15" "$2,036.15" "$2,036.15" "$1,018.08" "$1,018.08" "$1,612.63" "$2,036.15" "$1,628.92" $916.27 $404.12 N/A "$1,181.17" "$2,036.15" "$1,221.69" "$2,036.15" $424.33 "$2,036.15" N/A N/A 7565025 SUP HCPCS C1713 7565025 - BOLT SPNL 6.5MM 25MM PLT BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7565030 SUP HCPCS C1713 7565030 - BOLT SPNL 6.5MM 30MM BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7565035 SUP HCPCS C1713 7565035 - BOLT SPNL 6.5MM 35MM BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7565040 SUP HCPCS C1713 7565040 - BOLT SPNL 6.5MM 40MM XLP BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7565045 SUP HCPCS C1713 7565045 - BOLT SPNL 6.5MM 45MM TI BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7565050 SUP HCPCS C1713 7565050 - BOLT SPNL 6.5MM 50MM TI BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7565055 SUP HCPCS C1713 7565055 - BOLT SPNL 6.5MM 55MM TI BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7565060 SUP HCPCS C1713 7565060 - BOLT SPNL 6.5MM 60MM BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7565065 SUP HCPCS C1713 7565065 - BOLT SPNL 6.5MM 65MM BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7570955 SUP HCPCS C1713 7570955 - SCREW SET CD HZN SXTNT II BRKOF SS SPNE PDCL ROD INS BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 7571030 SUP HCPCS C1713 7571030 - ROD SPINAL 5.5MM 30MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571035 SUP HCPCS C1713 7571035 - PLATE BN 35MM AFFIX II SPNE SPINOUS PRC BOTH IP/OP "$8,730.00" "$6,460.00" "$1,732.69" "$8,730.00" "$3,928.50" "$3,928.50" "$3,928.50" "$3,928.50" "$8,730.00" "$8,730.00" "$8,730.00" "$1,819.55" "$8,730.00" "$8,730.00" "$8,730.00" "$8,730.00" "$8,730.00" "$1,819.43" "$8,730.00" "$3,492.00" "$4,303.89" "$8,730.00" "$8,730.00" "$8,730.00" "$8,730.00" "$6,547.50" "$8,730.00" "$8,730.00" "$8,730.00" "$4,365.00" "$4,365.00" "$6,914.16" "$8,730.00" "$6,984.00" "$3,928.50" "$1,732.69" N/A "$5,063.40" "$8,730.00" "$8,730.00" "$8,730.00" "$1,819.33" "$8,730.00" N/A N/A 7571040 SUP HCPCS C1713 7571040 - ROD SPINAL STR 5.5MM 40MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571045 SUP HCPCS C1713 7571045 - PLATE BN 45MM XLIF AFFIX XTRM SPNE BOTH IP/OP "$8,730.00" "$6,460.00" "$1,732.69" "$8,730.00" "$3,928.50" "$3,928.50" "$3,928.50" "$3,928.50" "$8,730.00" "$8,730.00" "$8,730.00" "$1,819.55" "$8,730.00" "$8,730.00" "$8,730.00" "$8,730.00" "$8,730.00" "$1,819.43" "$8,730.00" "$3,492.00" "$4,303.89" "$8,730.00" "$8,730.00" "$8,730.00" "$8,730.00" "$6,547.50" "$8,730.00" "$8,730.00" "$8,730.00" "$4,365.00" "$4,365.00" "$6,914.16" "$8,730.00" "$6,984.00" "$3,928.50" "$1,732.69" N/A "$5,063.40" "$8,730.00" "$8,730.00" "$8,730.00" "$1,819.33" "$8,730.00" N/A N/A 7571050 SUP HCPCS C1713 7571050 - ROD SPINAL STR 5.5MM 50MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571055 SUP HCPCS C1713 7571055 - PLATE BN 55MM AFFIX II SPNE SPINOUS PRC BOTH IP/OP "$8,730.00" "$6,460.00" "$1,732.69" "$8,730.00" "$3,928.50" "$3,928.50" "$3,928.50" "$3,928.50" "$8,730.00" "$8,730.00" "$8,730.00" "$1,819.55" "$8,730.00" "$8,730.00" "$8,730.00" "$8,730.00" "$8,730.00" "$1,819.43" "$8,730.00" "$3,492.00" "$4,303.89" "$8,730.00" "$8,730.00" "$8,730.00" "$8,730.00" "$6,547.50" "$8,730.00" "$8,730.00" "$8,730.00" "$4,365.00" "$4,365.00" "$6,914.16" "$8,730.00" "$6,984.00" "$3,928.50" "$1,732.69" N/A "$5,063.40" "$8,730.00" "$8,730.00" "$8,730.00" "$1,819.33" "$8,730.00" N/A N/A 7571060 SUP HCPCS C1713 7571060 - ROD SPINAL STR 5.5MM 60MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571070 SUP HCPCS C1713 7571070 - ROD SPINAL STR 5.5MM 70MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571080 SUP HCPCS C1713 7571080 - ROD SPINAL STR 5.5MM 80MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571090 SUP HCPCS C1713 7571090 - ROD SPINAL STR 5.5MM 90MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571100 SUP HCPCS C1713 7571100 - ROD SPINAL STR 5.5MM 100MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571110 SUP HCPCS C1713 7571110 - ROD SPINAL STR 5.5MM 110MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571120 SUP HCPCS C1713 7571120 - ROD SPINAL STR 5.5MM 120MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571130 SUP HCPCS C1713 7571130 - ROD SPINAL STR 5.5MM 130MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571140 SUP HCPCS C1713 7571140 - ROD SPINAL STR 5.5MM 140MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571150 SUP HCPCS C1713 7571150 - ROD SPINAL STR 5.5MM 150MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571160 SUP HCPCS C1713 7571160 - ROD SPINAL STR 5.5MM 160MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571170 SUP HCPCS C1713 7571170 - ROD SPINAL STR 5.5MM 170MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571180 SUP HCPCS C1713 7571180 - ROD SPINAL STR 5.5MM 180MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571190 SUP HCPCS C1713 7571190 - ROD SPINAL STR 5.5MM 190MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571200 SUP HCPCS C1713 7571200 - ROD SPINAL STR 5.5MM 200MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571210 SUP HCPCS C1713 7571210 - ROD SPINAL 5.5MM 210MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571220 SUP HCPCS C1713 7571220 - ROD SPINAL STR 5.5MM 220MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571230 SUP HCPCS C1713 7571230 - ROD SPINAL 5.5MM 230MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571240 SUP HCPCS C1713 7571240 - ROD SPINAL STR 5.5MM 240MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571250 SUP HCPCS C1713 7571250 - ROD SPINAL 5.5MM 250MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571260 SUP HCPCS C1713 7571260 - ROD SPINAL STR 5.5MM 260MM LONGITUDE CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571270 SUP HCPCS C1713 7571270 - ROD SPINAL 5.5MM 270MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571280 SUP HCPCS C1713 7571280 - ROD SPINAL 5.5MM 280MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571290 SUP HCPCS C1713 7571290 - ROD SPINAL 5.5MM 290MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571300 SUP HCPCS C1713 7571300 - ROD SPINAL 5.5MM 300MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571310 SUP HCPCS C1713 7571310 - ROD SPINAL 5.5MM 310MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571320 SUP HCPCS C1713 7571320 - ROD SPINAL 5.5MM 320MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571330 SUP HCPCS C1713 7571330 - ROD SPINAL 5.5MM 320MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571340 SUP HCPCS C1713 7571340 - ROD SPINAL 5.5MM 340MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571350 SUP HCPCS C1713 7571350 - ROD SPINAL 5.5MM 350MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571360 SUP HCPCS C1713 7571360 - ROD SPINAL 5.5MM 360MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571370 SUP HCPCS C1713 7571370 - ROD SPINAL 5.5MM 370MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571380 SUP HCPCS C1713 7571380 - ROD SPINAL 5.5MM 380MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571390 SUP HCPCS C1713 7571390 - ROD SPINAL 5.5MM 390MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571400 SUP HCPCS C1713 7571400 - ROD SPINAL 5.5MM 400MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571410 SUP HCPCS C1713 7571410 - ROD SPINAL 5.5MM 410MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571420 SUP HCPCS C1713 7571420 - ROD SPINAL 5.5MM 420MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571430 SUP HCPCS C1713 7571430 - ROD SPINAL 5.5MM 430MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571440 SUP HCPCS C1713 7571440 - ROD SPINAL 5.5MM 440MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571450 SUP HCPCS C1713 7571450 - ROD SPINAL 5.5MM 450MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571460 SUP HCPCS C1713 7571460 - ROD SPINAL 5.5MM 460MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7571470 SUP HCPCS C1713 7571470 - ROD SPINAL 5.5MM 470MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571480 SUP HCPCS C1713 7571480 - ROD SPINAL 5.5MM 480MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571490 SUP HCPCS C1713 7571490 - ROD SPINAL 5.5MM 490MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7571500 SUP HCPCS C1713 7571500 - ROD SPINAL 5.5MM 500MM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7575535 SUP HCPCS C1713 7575535 - SCREW BN 5.5MM 35MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD BOTH IP/OP "$6,185.00" "$4,577.00" "$1,227.57" "$6,185.00" "$2,783.25" "$2,783.25" "$2,783.25" "$2,783.25" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.11" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.02" "$6,185.00" "$2,474.00" "$3,049.21" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$4,638.75" "$6,185.00" "$6,185.00" "$6,185.00" "$3,092.50" "$3,092.50" "$4,898.52" "$6,185.00" "$4,948.00" "$2,783.25" "$1,227.57" N/A "$3,587.30" "$6,185.00" "$6,185.00" "$6,185.00" "$1,288.95" "$6,185.00" N/A N/A 7575540 SUP HCPCS C1713 7575540 - SCREW BN 5.5MM 40MM CD HZN LGC MA CNN TI SPNE PDCL 5.5MM ROD BOTH IP/OP "$6,185.00" "$4,577.00" "$1,227.57" "$6,185.00" "$2,783.25" "$2,783.25" "$2,783.25" "$2,783.25" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.11" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.02" "$6,185.00" "$6,185.00" "$3,049.21" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$4,638.75" "$6,185.00" "$6,185.00" "$6,185.00" "$3,092.50" "$3,092.50" "$4,898.52" "$6,185.00" "$4,948.00" "$2,783.25" "$1,227.57" N/A "$3,587.30" "$6,185.00" "$3,711.00" "$6,185.00" "$1,288.95" "$6,185.00" N/A N/A 7575545 SUP HCPCS C1713 7575545 - SCREW BN 5.5MM 45MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD BOTH IP/OP "$6,185.00" "$4,577.00" "$1,227.57" "$6,185.00" "$2,783.25" "$2,783.25" "$2,783.25" "$2,783.25" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.11" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.02" "$6,185.00" "$2,474.00" "$3,049.21" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$4,638.75" "$6,185.00" "$6,185.00" "$6,185.00" "$3,092.50" "$3,092.50" "$4,898.52" "$6,185.00" "$4,948.00" "$2,783.25" "$1,227.57" N/A "$3,587.30" "$6,185.00" "$6,185.00" "$6,185.00" "$1,288.95" "$6,185.00" N/A N/A 7575550 SUP HCPCS C1713 7575550 - SCREW BN 5.5MM 50MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD BOTH IP/OP "$6,185.00" "$4,577.00" "$1,227.57" "$6,185.00" "$2,783.25" "$2,783.25" "$2,783.25" "$2,783.25" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.11" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.02" "$6,185.00" "$6,185.00" "$3,049.21" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$4,638.75" "$6,185.00" "$6,185.00" "$6,185.00" "$3,092.50" "$3,092.50" "$4,898.52" "$6,185.00" "$4,948.00" "$2,783.25" "$1,227.57" N/A "$3,587.30" "$6,185.00" "$6,185.00" "$6,185.00" "$1,288.95" "$6,185.00" N/A N/A 7576309 SUP Custom 27203010 7576309 - MANIPULATOR SURG TALL REDUX NUT BOTH IP/OP $726.00 $537.00 $129.23 $726.00 $726.00 $726.00 $726.00 $726.00 $726.00 $726.00 $129.23 $726.00 $726.00 $538.84 $538.84 $559.60 $378.25 $151.31 $726.00 $290.40 $726.00 $726.00 $726.00 $726.00 $726.00 $544.50 $726.00 $726.00 $726.00 $363.00 $363.00 $574.99 $726.00 $580.80 $471.90 $726.00 N/A $421.08 $726.00 $435.60 $726.00 $726.00 $726.00 N/A N/A 7576535 SUP HCPCS C1713 7576535 - SCREW BN 6.5MM 35MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD BOTH IP/OP "$6,185.00" "$4,577.00" "$1,227.57" "$6,185.00" "$2,783.25" "$2,783.25" "$2,783.25" "$2,783.25" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.11" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.02" "$6,185.00" "$6,185.00" "$3,049.21" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$4,638.75" "$6,185.00" "$6,185.00" "$6,185.00" "$3,092.50" "$3,092.50" "$4,898.52" "$6,185.00" "$4,948.00" "$2,783.25" "$1,227.57" N/A "$3,587.30" "$6,185.00" "$3,711.00" "$6,185.00" "$1,288.95" "$6,185.00" N/A N/A 7576540 SUP HCPCS C1713 7576540 - SCREW BN 6.5MM 40MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD BOTH IP/OP "$6,185.00" "$4,577.00" "$1,227.57" "$6,185.00" "$2,783.25" "$2,783.25" "$2,783.25" "$2,783.25" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.11" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.02" "$6,185.00" "$6,185.00" "$3,049.21" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$4,638.75" "$6,185.00" "$6,185.00" "$6,185.00" "$3,092.50" "$3,092.50" "$4,898.52" "$6,185.00" "$4,948.00" "$2,783.25" "$1,227.57" N/A "$3,587.30" "$6,185.00" "$3,711.00" "$6,185.00" "$1,288.95" "$6,185.00" N/A N/A 7576545 SUP HCPCS C1713 7576545 - SCREW BN 6.5MM 45MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD BOTH IP/OP "$6,185.00" "$4,577.00" "$1,227.57" "$6,185.00" "$2,783.25" "$2,783.25" "$2,783.25" "$2,783.25" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.11" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.02" "$6,185.00" "$6,185.00" "$3,049.21" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$4,638.75" "$6,185.00" "$6,185.00" "$6,185.00" "$3,092.50" "$3,092.50" "$4,898.52" "$6,185.00" "$4,948.00" "$2,783.25" "$1,227.57" N/A "$3,587.30" "$6,185.00" "$3,711.00" "$6,185.00" "$1,288.95" "$6,185.00" N/A N/A 7576550 SUP HCPCS C1713 7576550 - SCREW BN 6.5MM 50MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD BOTH IP/OP "$6,185.00" "$4,577.00" "$1,227.57" "$6,185.00" "$2,783.25" "$2,783.25" "$2,783.25" "$2,783.25" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.11" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.02" "$6,185.00" "$6,185.00" "$3,049.21" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$4,638.75" "$6,185.00" "$6,185.00" "$6,185.00" "$3,092.50" "$3,092.50" "$4,898.52" "$6,185.00" "$4,948.00" "$2,783.25" "$1,227.57" N/A "$3,587.30" "$6,185.00" "$6,185.00" "$6,185.00" "$1,288.95" "$6,185.00" N/A N/A 7576555 SUP HCPCS C1713 7576555 - SCREW BN 6.5MM 55MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD BOTH IP/OP "$6,185.00" "$4,577.00" "$1,227.57" "$6,185.00" "$2,783.25" "$2,783.25" "$2,783.25" "$2,783.25" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.11" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.02" "$6,185.00" "$6,185.00" "$3,049.21" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$4,638.75" "$6,185.00" "$6,185.00" "$6,185.00" "$3,092.50" "$3,092.50" "$4,898.52" "$6,185.00" "$4,948.00" "$2,783.25" "$1,227.57" N/A "$3,587.30" "$6,185.00" "$6,185.00" "$6,185.00" "$1,288.95" "$6,185.00" N/A N/A 7577025 SUP HCPCS C1713 7577025 - PLATE BN MN 25MM NS AFFIX II SPNE LMBR BOTH IP/OP "$9,162.50" "$6,780.00" "$1,818.53" "$9,162.50" "$4,123.13" "$4,123.13" "$4,123.13" "$4,123.13" "$9,162.50" "$9,162.50" "$9,162.50" "$1,909.69" "$9,162.50" "$9,162.50" "$9,162.50" "$9,162.50" "$9,162.50" "$1,909.57" "$9,162.50" "$3,665.00" "$4,517.11" "$9,162.50" "$9,162.50" "$9,162.50" "$9,162.50" "$6,871.88" "$9,162.50" "$9,162.50" "$9,162.50" "$4,581.25" "$4,581.25" "$7,256.70" "$9,162.50" "$7,330.00" "$4,123.13" "$1,818.53" N/A "$5,314.25" "$9,162.50" "$9,162.50" "$9,162.50" "$1,909.47" "$9,162.50" N/A N/A 7577035 SUP HCPCS C1713 7577035 - PLATE BN 35MM NS AFFIX II SPNE LMBR BOTH IP/OP "$9,162.50" "$6,780.00" "$1,818.53" "$9,162.50" "$4,123.13" "$4,123.13" "$4,123.13" "$4,123.13" "$9,162.50" "$9,162.50" "$9,162.50" "$1,909.69" "$9,162.50" "$9,162.50" "$9,162.50" "$9,162.50" "$9,162.50" "$1,909.57" "$9,162.50" "$3,665.00" "$4,517.11" "$9,162.50" "$9,162.50" "$9,162.50" "$9,162.50" "$6,871.88" "$9,162.50" "$9,162.50" "$9,162.50" "$4,581.25" "$4,581.25" "$7,256.70" "$9,162.50" "$7,330.00" "$4,123.13" "$1,818.53" N/A "$5,314.25" "$9,162.50" "$9,162.50" "$9,162.50" "$1,909.47" "$9,162.50" N/A N/A 7577045 SUP HCPCS C1713 7577045 - PLATE BN 45MM NS AFFIX II SPNE LMBR BOTH IP/OP "$9,162.50" "$6,780.00" "$1,818.53" "$9,162.50" "$4,123.13" "$4,123.13" "$4,123.13" "$4,123.13" "$9,162.50" "$9,162.50" "$9,162.50" "$1,909.69" "$9,162.50" "$9,162.50" "$9,162.50" "$9,162.50" "$9,162.50" "$1,909.57" "$9,162.50" "$3,665.00" "$4,517.11" "$9,162.50" "$9,162.50" "$9,162.50" "$9,162.50" "$6,871.88" "$9,162.50" "$9,162.50" "$9,162.50" "$4,581.25" "$4,581.25" "$7,256.70" "$9,162.50" "$7,330.00" "$4,123.13" "$1,818.53" N/A "$5,314.25" "$9,162.50" "$9,162.50" "$9,162.50" "$1,909.47" "$9,162.50" N/A N/A 7577055 SUP HCPCS C1713 7577055 - PLATE BN 55MM NS AFFIX II SPNE LMBR BOTH IP/OP "$9,162.50" "$6,780.00" "$1,818.53" "$9,162.50" "$4,123.13" "$4,123.13" "$4,123.13" "$4,123.13" "$9,162.50" "$9,162.50" "$9,162.50" "$1,909.69" "$9,162.50" "$9,162.50" "$9,162.50" "$9,162.50" "$9,162.50" "$1,909.57" "$9,162.50" "$3,665.00" "$4,517.11" "$9,162.50" "$9,162.50" "$9,162.50" "$9,162.50" "$6,871.88" "$9,162.50" "$9,162.50" "$9,162.50" "$4,581.25" "$4,581.25" "$7,256.70" "$9,162.50" "$7,330.00" "$4,123.13" "$1,818.53" N/A "$5,314.25" "$9,162.50" "$9,162.50" "$9,162.50" "$1,909.47" "$9,162.50" N/A N/A 7577530 SUP HCPCS C1713 7577530 - SCREW BN 7.5MM 30MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD BOTH IP/OP "$6,185.00" "$4,577.00" "$1,227.57" "$6,185.00" "$2,783.25" "$2,783.25" "$2,783.25" "$2,783.25" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.11" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.02" "$6,185.00" "$2,474.00" "$3,049.21" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$4,638.75" "$6,185.00" "$6,185.00" "$6,185.00" "$3,092.50" "$3,092.50" "$4,898.52" "$6,185.00" "$4,948.00" "$2,783.25" "$1,227.57" N/A "$3,587.30" "$6,185.00" "$3,711.00" "$6,185.00" "$1,288.95" "$6,185.00" N/A N/A 7577535 SUP HCPCS C1713 7577535 - SCREW BN 7.5MM 35MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD BOTH IP/OP "$6,185.00" "$4,577.00" "$1,227.57" "$6,185.00" "$2,783.25" "$2,783.25" "$2,783.25" "$2,783.25" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.11" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.02" "$6,185.00" "$6,185.00" "$3,049.21" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$4,638.75" "$6,185.00" "$6,185.00" "$6,185.00" "$3,092.50" "$3,092.50" "$4,898.52" "$6,185.00" "$4,948.00" "$2,783.25" "$1,227.57" N/A "$3,587.30" "$6,185.00" "$3,711.00" "$6,185.00" "$1,288.95" "$6,185.00" N/A N/A 7577540 SUP HCPCS C1713 7577540 - SCREW BN 7.5MM 40MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD BOTH IP/OP "$6,185.00" "$4,577.00" "$1,227.57" "$6,185.00" "$2,783.25" "$2,783.25" "$2,783.25" "$2,783.25" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.11" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.02" "$6,185.00" "$6,185.00" "$3,049.21" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$4,638.75" "$6,185.00" "$6,185.00" "$6,185.00" "$3,092.50" "$3,092.50" "$4,898.52" "$6,185.00" "$4,948.00" "$2,783.25" "$1,227.57" N/A "$3,587.30" "$6,185.00" "$6,185.00" "$6,185.00" "$1,288.95" "$6,185.00" N/A N/A 7577545 SUP HCPCS C1713 7577545 - SCREW BN 7.5MM 45MM LGC CD HZN MA CNN TI SPNE PDCL 5.5MM ROD BOTH IP/OP "$6,185.00" "$4,577.00" "$1,227.57" "$6,185.00" "$2,783.25" "$2,783.25" "$2,783.25" "$2,783.25" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.11" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$1,289.02" "$6,185.00" "$6,185.00" "$3,049.21" "$6,185.00" "$6,185.00" "$6,185.00" "$6,185.00" "$4,638.75" "$6,185.00" "$6,185.00" "$6,185.00" "$3,092.50" "$3,092.50" "$4,898.52" "$6,185.00" "$4,948.00" "$2,783.25" "$1,227.57" N/A "$3,587.30" "$6,185.00" "$6,185.00" "$6,185.00" "$1,288.95" "$6,185.00" N/A N/A 7600320 SUP HCPCS C1713 7600320 - SUBSTITUTE BNGFT MATRIX PUTTY VOID FILR MASTERGRAFT CALCIUM BOTH IP/OP "$3,575.00" "$2,646.00" $709.55 "$3,575.00" "$1,608.75" "$1,608.75" "$1,608.75" "$1,608.75" "$3,575.00" "$3,575.00" "$3,575.00" $745.12 "$3,575.00" "$3,575.00" "$3,575.00" "$3,575.00" "$3,575.00" $745.07 "$3,575.00" "$3,575.00" "$1,762.48" "$3,575.00" "$3,575.00" "$3,575.00" "$3,575.00" "$2,681.25" "$3,575.00" "$3,575.00" "$3,575.00" "$1,787.50" "$1,787.50" "$2,831.40" "$3,575.00" "$2,860.00" "$1,608.75" $709.55 N/A "$2,073.50" "$3,575.00" "$3,575.00" "$3,575.00" $745.03 "$3,575.00" N/A N/A 7640120 SUP HCPCS C1713 7640120 - SCREW SET LEGACY CD HORIZON TITANIUM SPN 6.35 MM ROD BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7640220 SUP HCPCS C1713 7640220 - SCREW SET BREAKOFF CD HORIZON LEGACY TITANIUM SPN PEDICLE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7641102 SUP HCPCS C1713 7641102 - HOOK SPINAL SMALL TITANIUM PEDICLE 6.35MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641103 SUP HCPCS C1713 7641103 - HOOK SPINAL MEDIUM LORDOTIC TITANIUM PEDICLE 6.35MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641104 SUP HCPCS C1713 7641104 - HOOK SPINAL LARGE TITANIUM PEDICLE 6.35MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641112 SUP HCPCS C1713 7641112 - HOOK SPINAL SMALL WIDE BLADE TITANIUM 6.35MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641113 SUP HCPCS C1713 7641113 - HOOK SPINAL MEDIUM LORDOTIC WIDE BLADE TITANIUM PEDICLE 6.35 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641114 SUP HCPCS C1713 7641114 - HOOK SPINAL LARGE WIDE BLADE TITANIUM 6.35MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641122 SUP HCPCS C1713 7641122 - HOOK SPINAL SMALL NARROW BLADE TITANIUM 6.35MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641123 SUP HCPCS C1713 7641123 - HOOK SPINAL MEDIUM LORDOTIC NARROW BLADE TITANIUM PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641124 SUP HCPCS C1713 7641124 - HOOK SPINAL LARGE NARROW BLADE TITANIUM 6.35MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641133 SUP HCPCS C1713 7641133 - HOOK SPINAL MEDIUM WIDE BLADE CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641142 SUP HCPCS C1713 7641142 - HOOK SPINAL MEDIUM NARROW BLADE RAMP TRNSVRS PROCESS LEGACY BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641143 SUP HCPCS C1713 7641143 - HOOK SPINAL MEDIUM NARROW BLADE RAMPED CD HORIZON LEGACY BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641162 SUP HCPCS C1713 7641162 - HOOK SPINAL SMALL LORDOTIC TITANIUM LUMBAR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641163 SUP HCPCS C1713 7641163 - HOOK SPINAL MEDIUM LORDOTIC TITANIUM LUMBAR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641173 SUP HCPCS C1713 7641173 - HOOK SPINAL MEDIUM EXTENDED BODY CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641174 SUP HCPCS C1713 7641174 - HOOK SPINAL LARGE EXTENDED BODY CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641188 SUP HCPCS C1713 7641188 - HOOK SPINAL 6.35MM ANGLED BLADE CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641189 SUP HCPCS C1713 7641189 - HOOK SPINAL 6.35MM ANGLED BLADE CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641198 SUP HCPCS C1713 7641198 - HOOK SPINAL OPEN RIGHT OFFST CD HORIZON LEGACY TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641199 SUP HCPCS C1713 7641199 - HOOK SPINAL OPEN LEFT OFFST CD HORIZON LEGACY TITANIUM LEFT BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641202 SUP HCPCS C1713 7641202 - HOOK SPINAL SMALL LIP TRNSVRS PROCESS LEGACY CD HORIZON BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641203 SUP HCPCS C1713 7641203 - HOOK SPINAL MEDIUM LIPPED LIPPED TITANIUM PEDICLE 6.35MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641204 SUP HCPCS C1713 7641204 - HOOK SPINAL LARGE LIPPED LIPPED TITANIUM PEDICLE 6.35MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641212 SUP HCPCS C1713 7641212 - HOOK SPINAL SMALL WIDE BLADE LIPPED LIPPED TITANIUM 6.35MM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641213 SUP HCPCS C1713 7641213 - HOOK SPINAL MEDIUM WIDE LIP BLADE TRNSVRS PROCESS LEGACY CD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641214 SUP HCPCS C1713 7641214 - HOOK SPINAL LARGE WIDE LIP BLADE TRNSVRS PROCESS LEGACY CD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641222 SUP HCPCS C1713 7641222 - HOOK SPINAL SMALL NARROW BLADE LIPPED CD HORIZON LEGACY BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641223 SUP HCPCS C1713 7641223 - HOOK SPINAL MEDIUM NARROW BLADE LIPPED SHELF LEGACY CD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7641224 SUP HCPCS C1713 7641224 - HOOK SPINAL LARGE NARROW BLADE LIPPED CD HORIZON LEGACY BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7642420 SUP HCPCS C1713 7642420 - SCREW BONE 4MM 20MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,160.10" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642425 SUP HCPCS C1713 7642425 - SCREW BONE 4MM 25MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,160.10" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642430 SUP HCPCS C1713 7642430 - SCREW BONE 4MM 30MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642435 SUP HCPCS C1713 7642435 - SCREW BONE 4MM 35MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642440 SUP HCPCS C1713 7642440 - SCREW BONE 4MM 40MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,160.10" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642445 SUP HCPCS C1713 7642445 - SCREW BONE 4MM 45MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,160.10" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642450 SUP HCPCS C1713 7642450 - SCREW BONE 4MM 50MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642455 SUP HCPCS C1713 7642455 - SCREW BONE 4MM 55MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,160.10" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642520 SUP HCPCS C1713 7642520 - SCREW BONE 5MM 20MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642525 SUP HCPCS C1713 7642525 - SCREW BONE 5MM 25MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642530 SUP HCPCS C1713 7642530 - SCREW BONE 5MM 30MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642535 SUP HCPCS C1713 7642535 - SCREW BONE 5MM 35MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642540 SUP HCPCS C1713 7642540 - SCREW BONE 5MM 40MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642545 SUP HCPCS C1713 7642545 - SCREW BONE 5MM 45MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642550 SUP HCPCS C1713 7642550 - SCREW BONE 5MM 50MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642555 SUP HCPCS C1713 7642555 - SCREW BONE 5MM 55MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642625 SUP HCPCS C1713 7642625 - SCREW BONE 6MM 25MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642630 SUP HCPCS C1713 7642630 - SCREW BONE 6MM 30MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642635 SUP HCPCS C1713 7642635 - SCREW BONE 6MM 35MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642640 SUP HCPCS C1713 7642640 - SCREW BONE 6MM 40MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642645 SUP HCPCS C1713 7642645 - SCREW BONE 6MM 45MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642650 SUP HCPCS C1713 7642650 - SCREW BONE 6MM 50MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642655 SUP HCPCS C1713 7642655 - SCREW BONE 6MM 55MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7642660 SUP HCPCS C1713 7642660 - SCREW BONE 6MM 60MM FIX ANGLE LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643420 SUP HCPCS C1713 7643420 - SCREW BONE 4.5MM 20MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643425 SUP HCPCS C1713 7643425 - SCREW BONE 4.5MM 25MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643430 SUP HCPCS C1713 7643430 - SCREW BONE 4.5MM 30MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643435 SUP HCPCS C1713 7643435 - SCREW BONE 4.5MM 35MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643440 SUP HCPCS C1713 7643440 - SCREW BONE 4.5MM 40MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643445 SUP HCPCS C1713 7643445 - SCREW BONE 4.5MM 45MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643450 SUP HCPCS C1713 7643450 - SCREW BONE 4.5MM 50MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643455 SUP HCPCS C1713 7643455 - SCREW BONE 4.5MM 55MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643525 SUP HCPCS C1713 7643525 - SCREW BONE 5.5MM 25MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643530 SUP HCPCS C1713 7643530 - SCREW BONE 5.5MM 30MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643535 SUP HCPCS C1713 7643535 - SCREW BONE 5.5MM 35MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643540 SUP HCPCS C1713 7643540 - SCREW BONE 5.5MM 40MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643545 SUP HCPCS C1713 7643545 - SCREW BONE 5.5MM 45MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643550 SUP HCPCS C1713 7643550 - SCREW BONE 5.5MM 50MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643555 SUP HCPCS C1713 7643555 - SCREW BONE 5.5MM 55MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643560 SUP HCPCS C1713 7643560 - SCREW BONE 5.5MM 60MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643625 SUP HCPCS C1713 7643625 - SCREW BONE 6.5MM 25MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643630 SUP HCPCS C1713 7643630 - SCREW BONE 6.5MM 30MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643635 SUP HCPCS C1713 7643635 - SCREW BONE 6.5MM 35MM FIXANG CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643640 SUP HCPCS C1713 7643640 - SCREW BONE 6.5MM 40MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643645 SUP HCPCS C1713 7643645 - SCREW BONE 6.5MM 45MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643650 SUP HCPCS C1713 7643650 - SCREW BONE 6.5MM 50MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643655 SUP HCPCS C1713 7643655 - SCREW BONE 6.5MM 55MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643660 SUP HCPCS C1713 7643660 - SCREW BONE 6.5MM 60MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643665 SUP HCPCS C1713 7643665 - SCREW BONE 6.5MM 65MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643670 SUP HCPCS C1713 7643670 - SCREW BONE 6.5MM 70MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,160.10" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643725 SUP HCPCS C1713 7643725 - SCREW BONE 7.5MM 25MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643730 SUP HCPCS C1713 7643730 - SCREW BONE 7.5MM 30MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643735 SUP HCPCS C1713 7643735 - SCREW BONE 7.5MM 35MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643740 SUP HCPCS C1713 7643740 - SCREW BONE 7.5MM 40MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643745 SUP HCPCS C1713 7643745 - SCREW BONE 7.5MM 45MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643750 SUP HCPCS C1713 7643750 - SCREW BONE 7.5MM 50MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643755 SUP HCPCS C1713 7643755 - SCREW BONE 7.5MM 55MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" $773.40 "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643760 SUP HCPCS C1713 7643760 - SCREW BONE 7.5MM 60MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7643765 SUP HCPCS C1713 7643765 - SCREW BONE 7.5MM 65MM FIX ANGLE LEGACY CD HORIZON TITANIUM BOTH IP/OP "$1,933.50" "$1,431.00" $383.75 "$1,933.50" $870.08 $870.08 $870.08 $870.08 "$1,933.50" "$1,933.50" "$1,933.50" $402.99 "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" $402.96 "$1,933.50" "$1,933.50" "$1,143.67" "$1,933.50" "$1,933.50" "$1,933.50" "$1,933.50" "$1,450.13" "$1,933.50" "$1,933.50" "$1,933.50" $966.75 $966.75 "$1,531.33" "$1,933.50" "$1,546.80" $870.08 $383.75 N/A "$1,121.43" "$1,933.50" "$1,933.50" "$1,933.50" $402.94 "$1,933.50" N/A N/A 7650008 SUP HCPCS C1713 7650008 - PLATE BONE SMALL 8MM TRADITIONAL SPN CERV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" "$2,212.50" "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$2,212.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650009 SUP HCPCS C1713 7650009 - PLATE BONE MEDIUM 9.5MM TRADITIONAL SPN CERV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" "$2,212.50" "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$1,327.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650011 SUP HCPCS C1713 7650011 - PLATE BONE LARGE 11MM TRADITIONAL SPN CERV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" $885.00 "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$1,327.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650012 SUP HCPCS C1713 7650012 - PLATE BN XL 12.5MM NS LVRG TRD SPNE CRV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" "$2,212.50" "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$1,327.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650108 SUP HCPCS C1713 7650108 - PLATE BN SM 8MM NS LVRG TRD SPNE CRV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" $885.00 "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$2,212.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650109 SUP HCPCS C1713 7650109 - PLATE MED 9.5MM TRD BONE SPN CERV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" $885.00 "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$1,327.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650111 SUP HCPCS C1713 7650111 - PLATE BN LG 11MM NS LVRG TRD SPNE CRV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" $885.00 "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$2,212.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650112 SUP HCPCS C1713 7650112 - PLATE BN XL 12.5MM NS LVRG TRD SPNE CRV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" $885.00 "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$2,212.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650208 SUP HCPCS C1713 7650208 - PLATE BONE SMALL 8MM GRAFT SPN CERV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" $885.00 "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$1,327.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650209 SUP HCPCS C1713 7650209 - PLATE BONE MEDIUM 9.5MM GRAFT SPN CERV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" "$2,212.50" "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$1,327.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650211 SUP HCPCS C1713 7650211 - PLATE BN LG 11MM NS LVRG GFT SPNE CRV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" "$2,212.50" "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$2,212.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650212 SUP HCPCS C1713 7650212 - PLATE BN XL 12.5MM GFT SPNE CRV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" "$2,212.50" "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$1,327.50" "$2,212.50" "$2,212.50" "$2,212.50" N/A N/A 7650308 SUP HCPCS C1713 7650308 - PLATE BN SM 8MM NS LVRG GFT SPNE CRV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" $885.00 "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$2,212.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650309 SUP HCPCS C1713 7650309 - PLATE BN MED 9.5MM NS LVRG GFT SPNE CRV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" $885.00 "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$2,212.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650311 SUP HCPCS C1713 7650311 - PLATE BN LG 11MM NS LVRG GFT SPNE CRV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" "$2,212.50" "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$2,212.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650312 SUP HCPCS C1713 7650312 - PLATE BN XL 12.5MM NS LVRG GFT SPNE CRV BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" "$2,212.50" "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" N/A N/A 7650408 SUP HCPCS C1713 7650408 - PLATE BN SM 8MM NS LVRG SPNE CRV LMN BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" "$2,212.50" "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$2,212.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650409 SUP HCPCS C1713 7650409 - PLATE BN MED 9.5MM NS LVRG SPNE CRV LMN BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" $885.00 "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$2,212.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650411 SUP HCPCS C1713 7650411 - PLATE BN LG 11MM NS LVRG SPNE CRV LMN BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" $885.00 "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$2,212.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650412 SUP HCPCS C1713 7650412 - PLATE BN XL 12.5MM NS LVRG SPNE CRV LMN BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" "$2,212.50" "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$2,212.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A 7650505 SUP HCPCS C1713 7650505 - SCREW BONE 2.6MM 5MM LATERAL MASS CERV BOTH IP/OP $410.00 $303.00 $81.37 $410.00 $184.50 $184.50 $184.50 $184.50 $410.00 $410.00 $410.00 $85.45 $410.00 $410.00 $410.00 $410.00 $410.00 $85.45 $410.00 $164.00 $242.52 $410.00 $410.00 $410.00 $410.00 $307.50 $410.00 $410.00 $410.00 $205.00 $205.00 $324.72 $410.00 $328.00 $184.50 $81.37 N/A $237.80 $410.00 $410.00 $410.00 $85.44 $410.00 N/A N/A 7650506 SUP HCPCS C1713 7650506 - SCREW BONE 2.6MM 6MM LATERAL MASS SPN CERV BOTH IP/OP $410.00 $303.00 $81.37 $410.00 $184.50 $184.50 $184.50 $184.50 $410.00 $410.00 $410.00 $85.45 $410.00 $410.00 $410.00 $410.00 $410.00 $85.45 $410.00 $164.00 $242.52 $410.00 $410.00 $410.00 $410.00 $307.50 $410.00 $410.00 $410.00 $205.00 $205.00 $324.72 $410.00 $328.00 $184.50 $81.37 N/A $237.80 $410.00 $246.00 $410.00 $85.44 $410.00 N/A N/A 7650507 SUP HCPCS C1713 7650507 - SCREW BONE 2.6MM 7MM LATERAL MASS SPN CERV BOTH IP/OP $410.00 $303.00 $81.37 $410.00 $184.50 $184.50 $184.50 $184.50 $410.00 $410.00 $410.00 $85.45 $410.00 $410.00 $410.00 $410.00 $410.00 $85.45 $410.00 $410.00 $242.52 $410.00 $410.00 $410.00 $410.00 $307.50 $410.00 $410.00 $410.00 $205.00 $205.00 $324.72 $410.00 $328.00 $184.50 $81.37 N/A $237.80 $410.00 $246.00 $410.00 $85.44 $410.00 N/A N/A 7650508 SUP HCPCS C1713 "7650508 - LATERAL MASS SCREW, 2.6X8MM" BOTH IP/OP $410.00 $303.00 $81.37 $410.00 $184.50 $184.50 $184.50 $184.50 $410.00 $410.00 $410.00 $85.45 $410.00 $410.00 $410.00 $410.00 $410.00 $85.45 $410.00 $410.00 $242.52 $410.00 $410.00 $410.00 $410.00 $307.50 $410.00 $410.00 $410.00 $205.00 $205.00 $324.72 $410.00 $328.00 $184.50 $81.37 N/A $237.80 $410.00 $410.00 $410.00 $85.44 $410.00 N/A N/A 7650605 SUP HCPCS C1713 7650605 - SCREW BONE 3MM 5MM LATERAL MASS CERV BOTH IP/OP $410.00 $303.00 $81.37 $410.00 $184.50 $184.50 $184.50 $184.50 $410.00 $410.00 $410.00 $85.45 $410.00 $410.00 $410.00 $410.00 $410.00 $85.45 $410.00 $164.00 $242.52 $410.00 $410.00 $410.00 $410.00 $307.50 $410.00 $410.00 $410.00 $205.00 $205.00 $324.72 $410.00 $328.00 $184.50 $81.37 N/A $237.80 $410.00 $246.00 $410.00 $85.44 $410.00 N/A N/A 7650607 SUP HCPCS C1713 7650607 - SCREW BONE 3MM 7MM LATERAL MASS SPN CERV BOTH IP/OP $410.00 $303.00 $81.37 $410.00 $184.50 $184.50 $184.50 $184.50 $410.00 $410.00 $410.00 $85.45 $410.00 $410.00 $410.00 $410.00 $410.00 $85.45 $410.00 $164.00 $242.52 $410.00 $410.00 $410.00 $410.00 $307.50 $410.00 $410.00 $410.00 $205.00 $205.00 $324.72 $410.00 $328.00 $184.50 $81.37 N/A $237.80 $410.00 $246.00 $410.00 $85.44 $410.00 N/A N/A 7650608 SUP HCPCS C1713 7650608 - SCREW BN 3MM 8MM NS LVRG LAT MASS SPNE CRV BOTH IP/OP $410.00 $303.00 $81.37 $410.00 $184.50 $184.50 $184.50 $184.50 $410.00 $410.00 $410.00 $85.45 $410.00 $410.00 $410.00 $410.00 $410.00 $85.45 $410.00 $164.00 $242.52 $410.00 $410.00 $410.00 $410.00 $307.50 $410.00 $410.00 $410.00 $205.00 $205.00 $324.72 $410.00 $328.00 $184.50 $81.37 N/A $237.80 $410.00 $410.00 $410.00 $85.44 $410.00 N/A N/A 7650705 SUP HCPCS C1713 7650705 - SCREW BONE 2.6MM 5MM SPN CERV LAMINA BOTH IP/OP $575.00 $426.00 $114.12 $575.00 $258.75 $258.75 $258.75 $258.75 $575.00 $575.00 $575.00 $119.84 $575.00 $575.00 $575.00 $575.00 $575.00 $119.84 $575.00 $230.00 $340.11 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $258.75 $114.12 N/A $333.50 $575.00 $345.00 $575.00 $119.83 $575.00 N/A N/A 7650753 SUP Custom 27203010 7650753 - BIT DRILL 3MM SHAFT SPN DISPOSABLE BOTH IP/OP $615.00 $455.00 $109.47 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $109.47 $615.00 $615.00 $456.45 $456.45 $474.04 $320.42 $128.17 $615.00 $246.00 $615.00 $615.00 $615.00 $615.00 $615.00 $461.25 $615.00 $615.00 $615.00 $307.50 $307.50 $487.08 $615.00 $492.00 $399.75 $615.00 N/A $356.70 $615.00 $369.00 $615.00 $615.00 $615.00 N/A N/A 7650755 SUP Custom 27203010 7650755 - BIT DRILL 5MM SHAFT SPN DISPOSABLE BOTH IP/OP $615.00 $455.00 $109.47 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $109.47 $615.00 $615.00 $456.45 $456.45 $474.04 $320.42 $128.17 $615.00 $246.00 $615.00 $615.00 $615.00 $615.00 $615.00 $461.25 $615.00 $615.00 $615.00 $307.50 $307.50 $487.08 $615.00 $492.00 $399.75 $615.00 N/A $356.70 $615.00 $369.00 $615.00 $615.00 $615.00 N/A N/A 7650756 SUP Custom 27203010 7650756 - BIT DRILL 6MM SHAFT SPN DISPOSABLE BOTH IP/OP $615.00 $455.00 $109.47 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $109.47 $615.00 $615.00 $456.45 $456.45 $474.04 $320.42 $128.17 $615.00 $246.00 $615.00 $615.00 $615.00 $615.00 $615.00 $461.25 $615.00 $615.00 $615.00 $307.50 $307.50 $487.08 $615.00 $492.00 $399.75 $615.00 N/A $356.70 $615.00 $369.00 $615.00 $615.00 $615.00 N/A N/A 7650757 SUP Custom 27203010 7650757 - BIT DRILL 7MM SHAFT DISPOSABLE LVG LFS BOTH IP/OP $615.00 $455.00 $109.47 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $109.47 $615.00 $615.00 $456.45 $456.45 $474.04 $320.42 $128.17 $615.00 $246.00 $615.00 $615.00 $615.00 $615.00 $615.00 $461.25 $615.00 $615.00 $615.00 $307.50 $307.50 $487.08 $615.00 $492.00 $399.75 $615.00 N/A $356.70 $615.00 $369.00 $615.00 $615.00 $615.00 N/A N/A 7650758 SUP Custom 27203010 "7650758 - LAMINOPLASTY DRILL BIT, 8MM" BOTH IP/OP $615.00 $455.00 $109.47 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $109.47 $615.00 $615.00 $456.45 $456.45 $474.04 $320.42 $128.17 $615.00 $246.00 $615.00 $615.00 $615.00 $615.00 $615.00 $461.25 $615.00 $615.00 $615.00 $307.50 $307.50 $487.08 $615.00 $492.00 $399.75 $615.00 N/A $356.70 $615.00 $369.00 $615.00 $615.00 $615.00 N/A N/A 7650805 SUP HCPCS C1713 7650805 - SCREW BONE 3MM 5MM LAMINA CERV SPN BOTH IP/OP $575.00 $426.00 $114.12 $575.00 $258.75 $258.75 $258.75 $258.75 $575.00 $575.00 $575.00 $119.84 $575.00 $575.00 $575.00 $575.00 $575.00 $119.84 $575.00 $230.00 $340.11 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $258.75 $114.12 N/A $333.50 $575.00 $345.00 $575.00 $119.83 $575.00 N/A N/A 7650811 SUP HCPCS C1713 7650811 - CAGE SPNL 11MM ALGRF XLIF BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7650812 SUP HCPCS C1713 7650812 - CAGE SPNL 12.5MM ALGRF XLIF BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7660020 SUP HCPCS C1713 7660020 - SCREW SET BREAKOFF CD HORIZON LEGACY STAINLESS STEEL SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 7660120 SUP HCPCS C1713 7660120 - SCREW SET 5.5MM 120MM NONBREAKOFF CD HORIZON LEGACY BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 7660220 SUP HCPCS C1713 7660220 - SCREW SET REDX CD HORIZON LEGACY STAINLESS STEEL SPN PEDICLE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 7661102 SUP HCPCS C1713 7661102 - HOOK SPINAL SMALL STAINLESS STEEL PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661103 SUP HCPCS C1713 7661103 - HOOK SPINAL MEDIUM LORDOTIC STAINLESS STEEL PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661104 SUP HCPCS C1713 7661104 - HOOK SPINAL LARGE LORDOTIC STAINLESS STEEL PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661112 SUP HCPCS C1713 7661112 - HOOK SPINAL SMALL WIDE BLADE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661113 SUP HCPCS C1713 7661113 - HOOK SPINAL MEDIUM LORDOTIC WIDE BLADE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661114 SUP HCPCS C1713 7661114 - HOOK SPINAL LARGE WIDE BLADE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661122 SUP HCPCS C1713 7661122 - HOOK SPINAL SMALL NARROW BLADE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661123 SUP HCPCS C1713 7661123 - HOOK SPINAL MEDIUM LORDOTIC NARROW BLADE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661124 SUP HCPCS C1713 7661124 - HOOK SPINAL LARGE NARROW BLADE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661133 SUP HCPCS C1713 7661133 - HOOK SPINAL MEDIUM WIDE BLADE RAMPED LEGACY CD HORIZON BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661142 SUP HCPCS C1713 7661142 - HOOK SPINAL SMALL LORDOTIC NARROW BLADE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661143 SUP HCPCS C1713 7661143 - HOOK SPINAL MEDIUM RAMPED NARROW BLADE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661162 SUP HCPCS C1713 7661162 - HOOK SPINAL ANGLE SMALL BLADE TRNSVRS PROCESS LEGACY CD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661163 SUP HCPCS C1713 7661163 - HOOK SPINAL MEDIUM LORDOTIC STAINLESS STEEL LUMBAR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661173 SUP HCPCS C1713 7661173 - HOOK SPINAL MEDIUM EXTENDED BODY STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661174 SUP HCPCS C1713 7661174 - HOOK SPINAL LARGE EXTENDED BODY CD HORIZON LEGACY STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661188 SUP HCPCS C1713 7661188 - HOOK SPINAL LORDOTIC STAINLESS STEEL THORACIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661189 SUP HCPCS C1713 7661189 - HOOK SPINAL LEFT ANGLE STAINLESS STEEL THORACIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661198 SUP HCPCS C1713 7661198 - HOOK SPINAL RIGHT OFFST CD HORIZON LEGACY STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661199 SUP HCPCS C1713 7661199 - HOOK SPINAL LEFT OFFST CD HORIZON LEGACY STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661202 SUP HCPCS C1713 7661202 - HOOK SPINAL SMALL BIFID BLADE LIPPED DESIGN CD HORIZON BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661203 SUP HCPCS C1713 7661203 - HOOK SPINAL MEDIUM LIPPED LEGACY STAINLESS STEEL PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661204 SUP HCPCS C1713 7661204 - HOOK SPINAL LARGE LIPPED LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661212 SUP HCPCS C1713 7661212 - HOOK SPINAL SMALL WIDE BLADE LIPPED LEGACY CD HORIZON BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661213 SUP HCPCS C1713 7661213 - HOOK SPINAL MEDIUM LIPPED WIDE BLADE CD HORIZON LEGACY BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661214 SUP HCPCS C1713 7661214 - HOOK SPINAL LARGE WIDE LIP BLADE TRNSVRS PROCESS LEGACY CD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661222 SUP HCPCS C1713 7661222 - HOOK SPINAL SMALL LORDOTIC NARROW BLADE STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661223 SUP HCPCS C1713 7661223 - HOOK SPINAL MEDIUM 6.5MM LIPPED NARROW BLADE LEGACY CD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7661224 SUP HCPCS C1713 7661224 - HOOK SPINAL LARGE NARROW BLADE LIPPED DESIGN LEGACY CD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7662420 SUP HCPCS C1713 7662420 - SCREW BONE 4MM 20MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" $705.00 "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662425 SUP HCPCS C1713 7662425 - SCREW BONE 4MM 25MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662430 SUP HCPCS C1713 7662430 - SCREW BONE 4MM 30MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662435 SUP HCPCS C1713 7662435 - SCREW BONE 4MM 35MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" $705.00 "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662440 SUP HCPCS C1713 7662440 - SCREW BONE 4MM 40MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662445 SUP HCPCS C1713 7662445 - SCREW BONE 4MM 45MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" $705.00 "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662450 SUP HCPCS C1713 7662450 - SCREW BONE 4MM 50MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" $705.00 "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662455 SUP HCPCS C1713 7662455 - SCREW BONE 4MM 55MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662520 SUP HCPCS C1713 7662520 - SCREW BONE 5MM 20MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662525 SUP HCPCS C1713 7662525 - SCREW BONE 5MM 25MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" $705.00 "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662530 SUP HCPCS C1713 7662530 - SCREW BONE 5MM 30MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662535 SUP HCPCS C1713 7662535 - SCREW BONE 5MM 35MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" $705.00 "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662540 SUP HCPCS C1713 7662540 - SCREW BONE 5MM 40MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662545 SUP HCPCS C1713 7662545 - SCREW BONE 5MM 45MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" $705.00 "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662550 SUP HCPCS C1713 7662550 - SCREW BONE 5MM 50MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662555 SUP HCPCS C1713 7662555 - SCREW BONE 5MM 55MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" $705.00 "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662625 SUP HCPCS C1713 7662625 - SCREW BONE 6MM 25MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" $705.00 "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662630 SUP HCPCS C1713 7662630 - SCREW BONE 6MM 30MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662635 SUP HCPCS C1713 7662635 - SCREW BONE 6MM 35MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" $705.00 "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662640 SUP HCPCS C1713 7662640 - SCREW BONE 6MM 40MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662645 SUP HCPCS C1713 7662645 - SCREW BONE 6MM 45MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662650 SUP HCPCS C1713 7662650 - SCREW BONE 6MM 50MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662655 SUP HCPCS C1713 7662655 - SCREW BONE 6MM 55MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7662660 SUP HCPCS C1713 7662660 - SCREW BONE 6MM 60MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663420 SUP HCPCS C1713 7663420 - SCREW BONE 4.5MM 20MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663425 SUP HCPCS C1713 7663425 - SCREW BONE 4.5MM 25MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663430 SUP HCPCS C1713 7663430 - SCREW BONE 4.5MM 30MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663435 SUP HCPCS C1713 7663435 - SCREW BONE 4.5MM 35MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663440 SUP HCPCS C1713 7663440 - SCREW BONE 4.5MM 40MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663445 SUP HCPCS C1713 7663445 - SCREW BONE 4.5MM 45MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663450 SUP HCPCS C1713 7663450 - SCREW BONE 4.5MM 50MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663455 SUP HCPCS C1713 7663455 - SCREW BONE 4.5MM 55MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663525 SUP HCPCS C1713 7663525 - SCREW BONE 5.5MM 25MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663530 SUP HCPCS C1713 7663530 - SCREW BONE 5.5MM 30MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" $705.00 "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663535 SUP HCPCS C1713 7663535 - SCREW BONE 5.5MM 35MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" $705.00 "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663540 SUP HCPCS C1713 7663540 - SCREW BONE 5.5MM 40MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" $705.00 "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663545 SUP HCPCS C1713 7663545 - SCREW BONE 5.5MM 45MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663550 SUP HCPCS C1713 7663550 - SCREW BONE 5.5MM 50MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663555 SUP HCPCS C1713 7663555 - SCREW BONE 5.5MM 55MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663560 SUP HCPCS C1713 7663560 - SCREW BONE 5.5MM 60MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663625 SUP HCPCS C1713 7663625 - SCREW BONE 6.5MM 25MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663630 SUP HCPCS C1713 7663630 - SCREW BONE 6.5MM 30MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663635 SUP HCPCS C1713 7663635 - SCREW BONE 6.5MM 35MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663640 SUP HCPCS C1713 7663640 - SCREW BONE 6.5MM 40MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663645 SUP HCPCS C1713 7663645 - SCREW BONE 6.5MM 45MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663650 SUP HCPCS C1713 7663650 - SCREW BONE 6.5MM 50MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663655 SUP HCPCS C1713 7663655 - SCREW BONE 6.5MM 55MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663660 SUP HCPCS C1713 7663660 - SCREW BONE 6.5MM 60MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663665 SUP HCPCS C1713 7663665 - SCREW BONE 6.5MM 65MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663670 SUP HCPCS C1713 7663670 - SCREW BONE 6.5MM 70MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663725 SUP HCPCS C1713 7663725 - SCREW BONE 7.5MM 25MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663730 SUP HCPCS C1713 7663730 - SCREW BONE 7.5MM 30MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,057.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663735 SUP HCPCS C1713 7663735 - SCREW BONE 7.5MM 35MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663740 SUP HCPCS C1713 7663740 - SCREW BONE 7.5MM 40MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" $705.00 "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663745 SUP HCPCS C1713 7663745 - SCREW BONE 7.5MM 45MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663750 SUP HCPCS C1713 7663750 - SCREW BONE 7.5MM 50MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663755 SUP HCPCS C1713 7663755 - SCREW BONE 7.5MM 55MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663760 SUP HCPCS C1713 7663760 - SCREW BONE 7.5MM 60MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7663765 SUP HCPCS C1713 7663765 - SCREW BONE 7.5MM 65MM FIX ANGLE LEGACY CD HORIZON STAINLESS BOTH IP/OP "$1,762.50" "$1,304.00" $349.81 "$1,762.50" $793.13 $793.13 $793.13 $793.13 "$1,762.50" "$1,762.50" "$1,762.50" $367.35 "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" $367.32 "$1,762.50" "$1,762.50" "$1,042.52" "$1,762.50" "$1,762.50" "$1,762.50" "$1,762.50" "$1,321.88" "$1,762.50" "$1,762.50" "$1,762.50" $881.25 $881.25 "$1,395.90" "$1,762.50" "$1,410.00" $793.13 $349.81 N/A "$1,022.25" "$1,762.50" "$1,762.50" "$1,762.50" $367.31 "$1,762.50" N/A N/A 7670212 SUP HCPCS C1713 7670212 - 12MM CASPAR PINS BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $145.00 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $217.50 $362.50 $75.55 $362.50 N/A N/A 7670214 SUP HCPCS C1713 7670214 - SCREW DSTRCT 14MM PCM SPNE BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $145.00 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A 7680265 SUP Custom 27803010 7680265 - DISK SPNL SM 6.5MM PCM CRV BOTH IP/OP "$13,077.50" "$9,677.00" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,725.49" "$13,077.50" "$5,231.00" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$9,808.13" "$13,077.50" "$13,077.50" "$13,077.50" "$6,538.75" "$6,538.75" "$10,357.38" "$13,077.50" "$10,462.00" "$5,884.88" "$13,077.50" N/A "$7,584.95" "$13,077.50" "$7,846.50" "$13,077.50" "$13,077.50" "$13,077.50" N/A N/A 7680272 SUP Custom 27803010 7680272 - DISC INTVRTB 14MM SM 17X7.2MM STRL LF PCM ARTF SPNE CRV BOTH IP/OP "$13,077.50" "$9,677.00" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,725.49" "$13,077.50" "$5,231.00" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$9,808.13" "$13,077.50" "$13,077.50" "$13,077.50" "$6,538.75" "$6,538.75" "$10,357.38" "$13,077.50" "$10,462.00" "$5,884.88" "$13,077.50" N/A "$7,584.95" "$13,077.50" "$7,846.50" "$13,077.50" "$13,077.50" "$13,077.50" N/A N/A 7680280 SUP Custom 27803010 7680280 - DISK SPNL SM 8MM PCM CRV BOTH IP/OP "$13,077.50" "$9,677.00" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,725.49" "$13,077.50" "$5,231.00" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$9,808.13" "$13,077.50" "$13,077.50" "$13,077.50" "$6,538.75" "$6,538.75" "$10,357.38" "$13,077.50" "$10,462.00" "$5,884.88" "$13,077.50" N/A "$7,584.95" "$13,077.50" "$7,846.50" "$13,077.50" "$13,077.50" "$13,077.50" N/A N/A 7680372 SUP Custom 27803010 7680372 - DISK SPNL MED 7.2MM PCM CRV BOTH IP/OP "$13,077.50" "$9,677.00" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,725.49" "$13,077.50" "$5,231.00" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$9,808.13" "$13,077.50" "$13,077.50" "$13,077.50" "$6,538.75" "$6,538.75" "$10,357.38" "$13,077.50" "$10,462.00" "$5,884.88" "$13,077.50" N/A "$7,584.95" "$13,077.50" "$7,846.50" "$13,077.50" "$13,077.50" "$13,077.50" N/A N/A 7680380 SUP Custom 27803010 7680380 - DISK SPNL MED 8MM PCM CRV BOTH IP/OP "$13,077.50" "$9,677.00" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,725.49" "$13,077.50" "$5,231.00" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$9,808.13" "$13,077.50" "$13,077.50" "$13,077.50" "$6,538.75" "$6,538.75" "$10,357.38" "$13,077.50" "$10,462.00" "$5,884.88" "$13,077.50" N/A "$7,584.95" "$13,077.50" "$7,846.50" "$13,077.50" "$13,077.50" "$13,077.50" N/A N/A 7680465 SUP Custom 27803010 7680465 - DISK SPNL LG 6.5MM PCM CRV BOTH IP/OP "$13,077.50" "$9,677.00" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,725.49" "$13,077.50" "$5,231.00" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$9,808.13" "$13,077.50" "$13,077.50" "$13,077.50" "$6,538.75" "$6,538.75" "$10,357.38" "$13,077.50" "$10,462.00" "$5,884.88" "$13,077.50" N/A "$7,584.95" "$13,077.50" "$7,846.50" "$13,077.50" "$13,077.50" "$13,077.50" N/A N/A 7680472 SUP Custom 27803010 7680472 - DISK SPNL LG 7.2MM PCM CRV BOTH IP/OP "$13,077.50" "$9,677.00" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,725.49" "$13,077.50" "$5,231.00" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$9,808.13" "$13,077.50" "$13,077.50" "$13,077.50" "$6,538.75" "$6,538.75" "$10,357.38" "$13,077.50" "$10,462.00" "$5,884.88" "$13,077.50" N/A "$7,584.95" "$13,077.50" "$7,846.50" "$13,077.50" "$13,077.50" "$13,077.50" N/A N/A 7680480 SUP Custom 27803010 7680480 - DISK SPNL LG 8MM PCM CRV BOTH IP/OP "$13,077.50" "$9,677.00" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,327.80" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$2,725.49" "$13,077.50" "$5,231.00" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$13,077.50" "$9,808.13" "$13,077.50" "$13,077.50" "$13,077.50" "$6,538.75" "$6,538.75" "$10,357.38" "$13,077.50" "$10,462.00" "$5,884.88" "$13,077.50" N/A "$7,584.95" "$13,077.50" "$7,846.50" "$13,077.50" "$13,077.50" "$13,077.50" N/A N/A 7710635 SUP HCPCS C1713 7710635 - CAGE SPNL 6MM CRNT LO CX PRFL PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 7710835 SUP HCPCS C1713 7710835 - CAGE SPNL 8MM CRNT LO CX PRFL PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 7711055 SUP HCPCS C1713 7711055 - CAGE SPNL 10MM CRNT LO CX PRFL PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 7711275 SUP HCPCS C1713 7711275 - CAGE SPNL 12MM CRNT LX BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 7711495 SUP HCPCS C1713 7711495 - SPACER SPNL 14MM CRNT LX EXTENSURE BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 7711615 SUP HCPCS C1713 7711615 - SPACER SPNL 16MM CRNT LX EXTENSURE BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 7711835 SUP HCPCS C1713 7711835 - SPACER SPNL 18MM CRNT LX EXTENSURE BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 7712055 SUP HCPCS C1713 7712055 - SPACER SPNL 20MM CRNT LX EXTENSURE LMBR INTRBD FS PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 7713510 SUP HCPCS C1713 7713510 - SCREW BONE 3.5MM 10MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7713511 SUP HCPCS C1713 7713511 - SCREW BONE 3.5MM 11MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7713512 SUP HCPCS C1713 7713512 - SCREW BONE 3.5MM 12MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7713514 SUP HCPCS C1713 7713514 - SCREW BONE 3.5MM 14MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7713515 SUP HCPCS C1713 7713515 - SCREW BONE 3.5MM 15MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7713516 SUP HCPCS C1713 7713516 - SCREW BONE 3.5MM 16MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7713517 SUP HCPCS C1713 7713517 - SCREW BONE 3.5MM 17MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7713518 SUP HCPCS C1713 7713518 - SCREW BONE 3.5MM 18MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7713519 SUP HCPCS C1713 7713519 - SCREW BONE 3.5MM 19MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7713520 SUP HCPCS C1713 7713520 - SCREW BONE 3.5MM 20MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7713521 SUP HCPCS C1713 7713521 - SCREW BONE 3.5MM 21MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7713522 SUP HCPCS C1713 7713522 - SCREW BONE 3.5MM 22MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7713523 SUP HCPCS C1713 7713523 - SCREW BONE 3.5MM 23MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7713524 SUP HCPCS C1713 7713524 - SCREW BONE 3.5MM 24MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7714010 SUP HCPCS C1713 7714010 - SCREW BONE 4MM 10MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7714011 SUP HCPCS C1713 7714011 - SCREW BONE 4MM 11MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7714012 SUP HCPCS C1713 7714012 - SCREW BONE 4MM 12MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7714014 SUP HCPCS C1713 7714014 - SCREW BONE 4MM 14MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7714016 SUP HCPCS C1713 7714016 - SCREW BONE 4MM 16MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 7714018 SUP HCPCS C1713 7714018 - SCREW BONE 4MM 18MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7714019 SUP HCPCS C1713 7714019 - SCREW BONE 4MM 19MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 7714020 SUP HCPCS C1713 7714020 - SCREW BONE 4MM 20MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 7714021 SUP HCPCS C1713 7714021 - SCREW BONE 4MM 21MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7714022 SUP HCPCS C1713 7714022 - SCREW BONE 4MM 22MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 7714023 SUP HCPCS C1713 7714023 - SCREW BONE 4MM 23MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7714024 SUP HCPCS C1713 7714024 - SCREW BONE 4MM 24MM ZEVO TI SPN CERV ANT VAR SLF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7723510 SUP HCPCS C1713 7723510 - SCREW BONE 3.5MM 10MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 7723511 SUP HCPCS C1713 7723511 - SCREW BONE 3.5MM 11MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7723512 SUP HCPCS C1713 7723512 - SCREW BONE 3.5MM 12MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7723514 SUP HCPCS C1713 7723514 - SCREW BN 3.5MM 14MM ZEVO VAR ST TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7723515 SUP HCPCS C1713 7723515 - SCREW BN 3.5MM 15MM ZEVO VAR ST TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7723516 SUP HCPCS C1713 7723516 - SCREW BONE 3.5MM 16MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7723517 SUP HCPCS C1713 7723517 - SCREW BONE 3.5MM 17MM VARIABLE SELF TAP ZEVO TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7723518 SUP HCPCS C1713 7723518 - SCREW BONE 3.5MM 18MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7723519 SUP HCPCS C1713 7723519 - SCREW BONE 3.5MM 19MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7723520 SUP HCPCS C1713 7723520 - SCREW BONE 3.5MM 20MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7723521 SUP HCPCS C1713 7723521 - SCREW BONE 3.5MM 21MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7723522 SUP HCPCS C1713 7723522 - SCREW BONE 3.5MM 22MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7723523 SUP HCPCS C1713 7723523 - SCREW BONE 3.5MM 23MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7723524 SUP HCPCS C1713 7723524 - SCREW BONE 3.5MM 24MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7724010 SUP HCPCS C1713 7724010 - SCREW BONE 4MM 10MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7724011 SUP HCPCS C1713 7724011 - SCREW BONE 4MM 11MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7724012 SUP HCPCS C1713 7724012 - SCREW BONE 4MM 12MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7724014 SUP HCPCS C1713 7724014 - SCREW BONE 4MM 14MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 7724016 SUP HCPCS C1713 7724016 - SCREW BONE 4MM 16MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7724017 SUP HCPCS C1713 7724017 - SCREW BN 4MM 17MM ZEVO VAR ST TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7724018 SUP HCPCS C1713 7724018 - SCREW BONE 4MM 18MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 7724019 SUP HCPCS C1713 7724019 - SCREW BONE 4MM 19MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 7724020 SUP HCPCS C1713 7724020 - SCREW BONE 4MM 20MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7724021 SUP HCPCS C1713 7724021 - SCREW BONE 4MM 21MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 7724022 SUP HCPCS C1713 7724022 - SCREW BONE 4MM 22MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 7724023 SUP HCPCS C1713 7724023 - SCREW BONE 4MM 23MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7724024 SUP HCPCS C1713 7724024 - SCREW BONE 4MM 24MM ZEVO TI SPN CERV ANT VAR ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 7730016 SUP Custom 27203010 7730016 - BIT DRL 13MM STRL HLX ACP SPNE BOTH IP/OP $535.00 $396.00 $95.23 $535.00 $535.00 $535.00 $535.00 $535.00 $535.00 $535.00 $95.23 $535.00 $535.00 $397.08 $397.08 $412.38 $278.74 $111.50 $535.00 $214.00 $535.00 $535.00 $535.00 $535.00 $535.00 $401.25 $535.00 $535.00 $535.00 $267.50 $267.50 $423.72 $535.00 $428.00 $347.75 $535.00 N/A $310.30 $535.00 $321.00 $535.00 $535.00 $535.00 N/A N/A 7732111 SUP HCPCS C1713 7732111 - SCREW BN 4MM 11MM NS HLX ACP SLF DRL FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7732113 SUP HCPCS C1713 7732113 - SCREW BN 4MM 13MM NS HLX-T SLF DRL FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7732115 SUP HCPCS C1713 7732115 - SCREW BN 4MM 15MM NS HLX-T SLF DRL FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7733111 SUP HCPCS C1713 7733111 - SCREW BN 4MM 11MM NS HLX ACP ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7733119 SUP HCPCS C1713 7733119 - SCREW BN 4MM 19MM NS HLX ACP ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7734111 SUP HCPCS C1713 7734111 - SCREW BN 4MM 11MM NS HLX-T ACP ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7734113 SUP HCPCS C1713 7734113 - SCREW BN 4MM 13MM NS HLX-T ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7734115 SUP HCPCS C1713 7734115 - SCREW BN 4MM 15MM NS HLX-T ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7734117 SUP HCPCS C1713 7734117 - SCREW BN 4MM 17MM NS HLX-T ACP ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7734119 SUP HCPCS C1713 7734119 - SCREW BN 4MM 19MM NS HLX-T ACP ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7735111 SUP HCPCS C1713 7735111 - SCREW BN 4.5MM 11MM HLX ACP VA ST SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7735113 SUP HCPCS C1713 7735113 - SCREW BN 4.5MM 13MM NS HLX-T ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7735115 SUP HCPCS C1713 7735115 - SCREW BN 4.5MM 15MM NS HLX-T ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7735117 SUP HCPCS C1713 7735117 - SCREW BN 4.5MM 17MM NS HLX ACP ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7735119 SUP HCPCS C1713 7735119 - SCREW BN 4.5MM 19MM NS HLX ACP ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7736113 SUP HCPCS C1713 7736113 - SCREW BN 4.5MM 13MM NS HLX-T ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7736115 SUP HCPCS C1713 7736115 - SCREW BN 4.5MM 15MM NS HLX-T ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7736117 SUP HCPCS C1713 7736117 - SCREW BN 4.5MM 17MM NS HLX ACP ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7737110 SUP Custom 27203010 7737110 - HOLDER IMPL NS HLX ACP TEMP TACK SPNE BOTH IP/OP $535.00 $396.00 $95.23 $535.00 $535.00 $535.00 $535.00 $535.00 $535.00 $535.00 $95.23 $535.00 $535.00 $397.08 $397.08 $412.38 $278.74 $111.50 $535.00 $214.00 $535.00 $535.00 $535.00 $535.00 $535.00 $401.25 $535.00 $535.00 $535.00 $267.50 $267.50 $423.72 $535.00 $428.00 $347.75 $535.00 N/A $310.30 $535.00 $321.00 $535.00 $535.00 $535.00 N/A N/A 7738120 SUP HCPCS C1713 7738120 - PLATE BN 20MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738122 SUP HCPCS C1713 7738122 - PLATE BN 22MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738124 SUP HCPCS C1713 7738124 - PLATE BN 24MM HLX ACP 1 LVL TI ANT CSPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738126 SUP HCPCS C1713 7738126 - PLATE BN 26MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738128 SUP HCPCS C1713 7738128 - PLATE BN 28MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738130 SUP HCPCS C1713 7738130 - PLATE BN 30MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738132 SUP HCPCS C1713 7738132 - PLATE BN 32MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738134 SUP HCPCS C1713 7738134 - PLATE BN 34MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738236 SUP HCPCS C1713 7738236 - PLATE BN 36MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738238 SUP HCPCS C1713 7738238 - PLATE BN 38MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738240 SUP HCPCS C1713 7738240 - PLATE BN 40MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738242 SUP HCPCS C1713 7738242 - PLATE BN 42MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738244 SUP HCPCS C1713 7738244 - PLATE BN 44MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738246 SUP HCPCS C1713 7738246 - PLATE BN 46MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738248 SUP HCPCS C1713 7738248 - PLATE BN 48MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738250 SUP HCPCS C1713 7738250 - PLATE BN 50MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738252 SUP HCPCS C1713 7738252 - PLATE BN 52MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738254 SUP HCPCS C1713 7738254 - PLATE BN 54MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7738356 SUP HCPCS C1713 7738356 - PLATE BN 56MM HLX LVL 3 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738358 SUP HCPCS C1713 7738358 - PLATE BN 58MM HLX LVL 3 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738360 SUP HCPCS C1713 7738360 - PLATE BN 60MM HLX LVL 3 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738362 SUP HCPCS C1713 7738362 - PLATE BN 62MM HLX LVL 3 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738364 SUP HCPCS C1713 7738364 - PLATE BN 64MM HLX LVL 3 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738366 SUP HCPCS C1713 7738366 - PLATE BN 66MM HLX LVL 3 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738368 SUP HCPCS C1713 7738368 - PLATE BN 68MM HLX LVL 3 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738470 SUP HCPCS C1713 7738470 - PLATE BN 70MM HLX LVL 4 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738474 SUP HCPCS C1713 7738474 - PLATE BN 74MM HLX LVL 4 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738478 SUP HCPCS C1713 7738478 - PLATE BN 78MM HLX LVL 4 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738482 SUP HCPCS C1713 7738482 - PLATE BN 82MM HLX LVL 4 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738486 SUP HCPCS C1713 7738486 - PLATE BN 86MM HLX LVL 4 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738490 SUP HCPCS C1713 7738490 - PLATE BN 90MM HLX LVL 4 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738500 SUP HCPCS C1713 7738500 - PLATE BN 100MM HLX LVL 5 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738505 SUP HCPCS C1713 7738505 - PLATE BN 105MM HLX LVL 5 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738510 SUP HCPCS C1713 7738510 - PLATE BN 110MM HLX LVL 5 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7738595 SUP HCPCS C1713 7738595 - PLATE BN 95MM HLX LVL 5 TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7739111 SUP HCPCS C1713 7739111 - SCREW BN 4MM 11MM NS HLX ACP SLF DRL VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7739113 SUP HCPCS C1713 7739113 - SCREW BN 4MM 13MM NS HLX-T SLF DRL VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7739115 SUP HCPCS C1713 7739115 - SCREW BN 4MM 15MM NS HLX-T SLF DRL VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7739213 SUP HCPCS C1713 7739213 - SCREW BN 4MM 13MM NS HLX-T ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7739215 SUP HCPCS C1713 7739215 - SCREW BN 4MM 15MM NS HLX-T ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7739217 SUP HCPCS C1713 7739217 - SCREW BN 4MM 17MM NS HLX ACP ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7740120 SUP HCPCS C1713 7740120 - PLATE BN MN 20MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7740122 SUP HCPCS C1713 7740122 - PLATE BN MN 22MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7740124 SUP HCPCS C1713 7740124 - PLATE BN MN 24MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7740126 SUP HCPCS C1713 7740126 - PLATE BN MN 26MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7740128 SUP HCPCS C1713 7740128 - PLATE BN MN 28MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7740130 SUP HCPCS C1713 7740130 - PLATE BN MN 30MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7740132 SUP HCPCS C1713 7740132 - PLATE BN MN 32MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7740134 SUP HCPCS C1713 7740134 - PLATE BN MN 34MM HLX LVL 1 TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7740236 SUP HCPCS C1713 7740236 - PLATE BN MN 36MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7740238 SUP HCPCS C1713 7740238 - PLATE BN MN 38MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7740240 SUP HCPCS C1713 7740240 - PLATE BONE MINI 40MM LEVEL 2 HELIX TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7740242 SUP HCPCS C1713 7740242 - PLATE BN MN 42MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7740244 SUP HCPCS C1713 7740244 - PLATE BN MN 44MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7740246 SUP HCPCS C1713 7740246 - PLATE BN MN 46MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7740248 SUP HCPCS C1713 7740248 - PLATE BN MN 48MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7740250 SUP HCPCS C1713 7740250 - PLATE BN MN 50MM HLX LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7741111 SUP HCPCS C1713 7741111 - SCREW BN HEX 4MM 11MM VA SLF DRL SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7741113 SUP HCPCS C1713 7741113 - SCREW BN HEX 4MM 13MM VA SLF DRL SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7741115 SUP HCPCS C1713 7741115 - SCREW BN HEX 4MM 15MM VA SLF DRL SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7742111 SUP HCPCS C1713 7742111 - SCREW BN 4MM 11MM FX ANG SLF DRL SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7742113 SUP HCPCS C1713 7742113 - SCREW BN 4MM 13MM FX ANG SLF DRL SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7742115 SUP HCPCS C1713 7742115 - SCREW BN 4MM 15MM FX ANG SLF DRL SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7746111 SUP HCPCS C1713 7746111 - SCREW BN 4.5MM 11MM FX ANG ST SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7746113 SUP HCPCS C1713 7746113 - SCREW BN 4.5MM 13MM FX ANG ST SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 7746115 SUP HCPCS C1713 7746115 - SCREW BN 4.5MM 15MM FX ANG ST SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 7747111 SUP HCPCS C1713 7747111 - SCREW BN 4MM 11MM FX ANG ST SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7747113 SUP HCPCS C1713 7747113 - SCREW BONE 4MM 13MM FIX ANGLE SELF TAP SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7747115 SUP HCPCS C1713 7747115 - SCREW BN 4MM 15MM FX ANG ST SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7748111 SUP HCPCS C1713 7748111 - SCREW BN 4MM 11MM VA ST SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7748113 SUP HCPCS C1713 7748113 - SCREW BONE 4MM 13MM VAR ANG SELF TAP SPN CERV ANTERIOR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7748115 SUP HCPCS C1713 7748115 - SCREW BN 4MM 15MM VA ST SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 7750010 SUP HCPCS C1713 7750010 - ROD SPINAL 3.5MM 120MM VERTEX SELECT TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7750015 SUP HCPCS C1713 7750015 - ROD SPINAL 3.5MM 240MM VERTEX BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7750020 SUP HCPCS C1713 7750020 - ROD SPINAL 3.5MM 300MM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7750086 SUP HCPCS C1713 7750086 - ROD SPINAL 3.5MM 120MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7750087 SUP HCPCS C1713 7750087 - ROD SPINAL 3.5MM 240MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7750088 SUP HCPCS C1713 7750088 - ROD SPINAL 3.5MM 300MM VERTEX COCR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7750346 SUP Custom 27803010 7750346 - CONNECTOR ROD 3.2/3.5MM AXIAL DOMINO SPN BOTH IP/OP "$1,458.00" "$1,079.00" $259.52 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $259.52 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" $583.20 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 "$1,458.00" N/A $845.64 "$1,458.00" $874.80 "$1,458.00" "$1,458.00" "$1,458.00" N/A N/A 7750347 SUP Custom 27803010 7750347 - CONNECTOR ROD 3.5/4-4.5MM AXIAL DOMINO SPN BOTH IP/OP "$1,458.00" "$1,079.00" $259.52 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $259.52 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" $583.20 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 "$1,458.00" N/A $845.64 "$1,458.00" $874.80 "$1,458.00" "$1,458.00" "$1,458.00" N/A N/A 7750348 SUP Custom 27803010 7750348 - CONNECTOR ROD 3.5MM 4-5.5MM AXIAL DOMINO VERTEX TITANIUM SPN BOTH IP/OP "$1,458.00" "$1,079.00" $259.52 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $259.52 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" $583.20 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 "$1,458.00" N/A $845.64 "$1,458.00" $874.80 "$1,458.00" "$1,458.00" "$1,458.00" N/A N/A 7750443 SUP HCPCS C1713 7750443 - CONNECTOR ROD 3.2/3.5MM OFFST DOMINO SPN BOTH IP/OP "$1,458.00" "$1,079.00" $289.38 "$1,458.00" $656.10 $656.10 $656.10 $656.10 "$1,458.00" "$1,458.00" "$1,458.00" $303.88 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" "$1,458.00" $862.41 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 $289.38 N/A $845.64 "$1,458.00" "$1,458.00" "$1,458.00" $303.85 "$1,458.00" N/A N/A 7750444 SUP HCPCS C1713 7750444 - CONNECTOR ROD 3.2/3.5-4.5MM OFFST DOMINO SPN BOTH IP/OP "$1,458.00" "$1,079.00" $289.38 "$1,458.00" $656.10 $656.10 $656.10 $656.10 "$1,458.00" "$1,458.00" "$1,458.00" $303.88 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" "$1,458.00" $862.41 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 $289.38 N/A $845.64 "$1,458.00" "$1,458.00" "$1,458.00" $303.85 "$1,458.00" N/A N/A 7750445 SUP HCPCS C1713 7750445 - CONNECTOR ROD TRNSVRS VERTEX SPN BOTH IP/OP "$1,458.00" "$1,079.00" $289.38 "$1,458.00" $656.10 $656.10 $656.10 $656.10 "$1,458.00" "$1,458.00" "$1,458.00" $303.88 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" "$1,458.00" $862.41 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 $289.38 N/A $845.64 "$1,458.00" "$1,458.00" "$1,458.00" $303.85 "$1,458.00" N/A N/A 7750506 SUP HCPCS C1713 7750506 - SCREW BN 4.5MM 6MM VRTX SLCT TI SPNE OCPTL BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $287.60 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 7750508 SUP HCPCS C1713 7750508 - SCREW BN 4.5MM 8MM VRTX SLCT TI SPNE OCPTL BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $287.60 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 7750510 SUP HCPCS C1713 7750510 - SCREW BN 4.5MM 10MM VRTX TI SPNE CRV OCPTL CORT ANT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $287.60 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $431.40 $719.00 $149.84 $719.00 N/A N/A 7750512 SUP HCPCS C1713 7750512 - SCREW BN 4.5MM 12MM VRTX SLCT TI SPNE OCPTL BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $719.00 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $431.40 $719.00 $149.84 $719.00 N/A N/A 7750514 SUP HCPCS C1713 7750514 - SCREW BN 4.5MM 14MM VRTX TI SPNE CRV OCPTL CORT ANT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $719.00 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 7750516 SUP HCPCS C1713 7750516 - SCREW BN 4.5MM 16MM VRTX TI SPNE CRV OCPTL CORT ANT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $287.60 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 7750518 SUP HCPCS C1713 7750518 - SCREW BN 4.5MM 18MM VRTX TI SPNE CRV OCPTL CORT ANT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $287.60 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 7750606 SUP HCPCS C1713 7750606 - SCREW BN 5MM 6MM VRTX TI SPNE CRV OCPTL CORT ANT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $719.00 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 7750608 SUP HCPCS C1713 7750608 - SCREW BONE 5MM 8MM VERTEX TITANIUM SPN CERV OCCPTL CORTICAL BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $287.60 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 7750610 SUP HCPCS C1713 7750610 - SCREW BN 5MM 10MM VRTX TI SPNE CRV OCPTL CORT ANT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $287.60 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 7750612 SUP HCPCS C1713 7750612 - SCREW BN 5MM 12MM VRTX TI SPNE CRV OCPTL CORT ANT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $287.60 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 7750614 SUP HCPCS C1713 7750614 - SCREW BN 5MM 14MM VRTX TI SPNE CRV OCPTL CORT ANT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $719.00 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 7750616 SUP HCPCS C1713 7750616 - SCREW BN 5MM 16MM VRTX TI SPNE CRV OCPTL CORT ANT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $287.60 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 7750618 SUP HCPCS C1713 7750618 - SCREW BN 5MM 18MM VRTX TI SPNE CRV OCPTL CORT ANT BOTH IP/OP $719.00 $532.00 $142.70 $719.00 $323.55 $323.55 $323.55 $323.55 $719.00 $719.00 $719.00 $149.86 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $719.00 $425.29 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $142.70 N/A $417.02 $719.00 $719.00 $719.00 $149.84 $719.00 N/A N/A 7751101 SUP HCPCS C1713 7751101 - SCREW BONE SMALL POST CONCTR SPN BOTH IP/OP "$1,794.00" "$1,328.00" $356.06 "$1,794.00" $807.30 $807.30 $807.30 $807.30 "$1,794.00" "$1,794.00" "$1,794.00" $373.91 "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" $373.89 "$1,794.00" "$1,794.00" "$1,061.15" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,345.50" "$1,794.00" "$1,794.00" "$1,794.00" $897.00 $897.00 "$1,420.85" "$1,794.00" "$1,435.20" $807.30 $356.06 N/A "$1,040.52" "$1,794.00" "$1,794.00" "$1,794.00" $373.87 "$1,794.00" N/A N/A 7751103 SUP HCPCS C1713 7751103 - SCREW BONE MEDIUM POST CONCTR SPN BOTH IP/OP "$1,794.00" "$1,328.00" $356.06 "$1,794.00" $807.30 $807.30 $807.30 $807.30 "$1,794.00" "$1,794.00" "$1,794.00" $373.91 "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" $373.89 "$1,794.00" "$1,794.00" "$1,061.15" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,345.50" "$1,794.00" "$1,794.00" "$1,794.00" $897.00 $897.00 "$1,420.85" "$1,794.00" "$1,435.20" $807.30 $356.06 N/A "$1,040.52" "$1,794.00" "$1,794.00" "$1,794.00" $373.87 "$1,794.00" N/A N/A 7751105 SUP HCPCS C1713 7751105 - CONNECTOR ROD LARGE POSTED SCREW SPN BOTH IP/OP "$1,794.00" "$1,328.00" $356.06 "$1,794.00" $807.30 $807.30 $807.30 $807.30 "$1,794.00" "$1,794.00" "$1,794.00" $373.91 "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" $373.89 "$1,794.00" "$1,794.00" "$1,061.15" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,345.50" "$1,794.00" "$1,794.00" "$1,794.00" $897.00 $897.00 "$1,420.85" "$1,794.00" "$1,435.20" $807.30 $356.06 N/A "$1,040.52" "$1,794.00" "$1,794.00" "$1,794.00" $373.87 "$1,794.00" N/A N/A 7751110 SUP Custom 27803010 7751110 - CONNECTOR ROD OPEN CABLE VERTEX BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $519.75 "$1,155.00" N/A $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 7751710 SUP HCPCS C1713 7751710 - SCREW BONE 3.5MM 10MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751712 SUP HCPCS C1713 7751712 - SCREW BONE 3.5MM 12MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751714 SUP HCPCS C1713 7751714 - SCREW BONE 3.5MM 14MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751716 SUP HCPCS C1713 7751716 - SCREW BONE 3.5MM 16MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751718 SUP HCPCS C1713 7751718 - SCREW BONE 3.5MM 18MM POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751720 SUP HCPCS C1713 7751720 - SCREW BONE 3.5MM 20MM POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751722 SUP HCPCS C1713 7751722 - SCREW BONE 3.5MM 22MM POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751724 SUP HCPCS C1713 7751724 - SCREW BONE 3.5MM 22MM POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751726 SUP HCPCS C1713 7751726 - SCREW BONE 3.5MM 26MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751728 SUP HCPCS C1713 7751728 - SCREW BONE 3.5MM 28MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751730 SUP HCPCS C1713 7751730 - SCREW BONE 3.5MM 30MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751732 SUP HCPCS C1713 7751732 - SCREW BONE 3.5MM 32MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751734 SUP HCPCS C1713 7751734 - SCREW BONE 3.5MM 34MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751810 SUP HCPCS C1713 7751810 - SCREW BONE 4MM 10MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751812 SUP HCPCS C1713 7751812 - SCREW BONE 4MM 12MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751814 SUP HCPCS C1713 7751814 - SCREW BONE 4MM 14MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751816 SUP HCPCS C1713 7751816 - SCREW BONE 4MM 16MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751818 SUP HCPCS C1713 7751818 - SCREW BONE 4MM 18MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751820 SUP HCPCS C1713 7751820 - SCREW BONE 4MM 20MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751822 SUP HCPCS C1713 7751822 - SCREW BONE 4MM 22MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751824 SUP HCPCS C1713 7751824 - SCREW BONE 4MM 24MM POSTED VERTEX SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751826 SUP HCPCS C1713 7751826 - SCREW BONE 4MM 26MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751828 SUP HCPCS C1713 7751828 - SCREW BONE 4MM 28MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751830 SUP HCPCS C1713 7751830 - SCREW BONE 4MM 30MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751832 SUP HCPCS C1713 7751832 - SCREW BONE 4MM 32MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751834 SUP HCPCS C1713 7751834 - SCREW BONE 4MM 34MM POSTED VERTEX TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751924 SUP HCPCS C1713 7751924 - SCREW BONE 4.5MM 24MM POSTED VERTEX TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751926 SUP HCPCS C1713 7751926 - SCREW BONE 4.5MM 26MM POSTED VERTEX TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751928 SUP HCPCS C1713 7751928 - SCREW BONE 4.5MM 28MM POSTED VERTEX TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751930 SUP HCPCS C1713 7751930 - SCREW BONE 4.5MM 30MM POSTED VERTEX TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751932 SUP HCPCS C1713 7751932 - SCREW BONE 4.5MM 32MM POSTED VERTEX TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751934 SUP HCPCS C1713 7751934 - SCREW BONE 4.5MM 34MM POSTED VERTEX TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7752510 SUP HCPCS C1713 7752510 - SCREW SET VERTEX CROSSLINK SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 7752515 SUP HCPCS C1713 7752515 - SCREW SET FLAT CONCTR SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7752525 SUP HCPCS C1713 7752525 - CONNECTOR ROD SMALL MULTIAX SCREW CROSSLINK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7752526 SUP HCPCS C1713 7752526 - CONNECTOR ROD MEDIUM MULTIAX SCREW CROSSLINK SPN MAS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7752527 SUP HCPCS C1713 7752527 - CONNECTOR ROD LARGE CROSSLINK SPN MAS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7752528 SUP Custom 27803010 7752528 - CONNECTOR ROD MAS CROSSLINK SPN BOTH IP/OP $719.00 $532.00 $127.98 $719.00 $719.00 $719.00 $719.00 $719.00 $719.00 $719.00 $127.98 $719.00 $719.00 $719.00 $719.00 $719.00 $719.00 $149.85 $719.00 $287.60 $719.00 $719.00 $719.00 $719.00 $719.00 $539.25 $719.00 $719.00 $719.00 $359.50 $359.50 $569.45 $719.00 $575.20 $323.55 $719.00 N/A $417.02 $719.00 $431.40 $719.00 $719.00 $719.00 N/A N/A 7752529 SUP HCPCS C1713 7752529 - SCREW SET LOCKING CROSSLINK SPN MAS CONCTR BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7752535 SUP HCPCS C1713 7752535 - ROD SPINAL SMALL MEDIUM CROSSLINK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7752536 SUP HCPCS C1713 7752536 - CONNECTOR ROD MEDIUM CROSSLINK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7752537 SUP HCPCS C1713 7752537 - CONNECTOR ROD LARGE CROSSLINK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7753500 SUP HCPCS C1713 7753500 - SCREW SET MULTIAX CONCTR RECONSTRUCTION VERTEX SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7753520 SUP HCPCS C1713 7753520 - SCREW SET MULTIAX EXTN LATERAL CONCTR VERTEX SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7753730 SUP HCPCS C1713 7753730 - ROD SPINAL 3.5MM 30MM PRECUT VERTEX NONSTRL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7753740 SUP HCPCS C1713 7753740 - ROD SPNL 40MM 3.5MM VRTX PCUT BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 7753750 SUP HCPCS C1713 7753750 - ROD SPINAL 3.5MM 50MM PRECUT VERTEX NONSTRL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7753760 SUP HCPCS C1713 7753760 - ROD SPINAL 3.5MM 60MM PRECUT VERTEX SELECT BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7753770 SUP HCPCS C1713 7753770 - ROD SPINAL 3.5MM 70MM PRECUT CCM PLUS BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7753780 SUP HCPCS C1713 7753780 - ROD SPINAL 3.5MM 80MM PRECUT TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7753806 SUP HCPCS C1713 7753806 - ROD SPINAL 4.75MM 3.5MM 420MM CCM PLUS STAINLESS STEEL BOTH IP/OP "$2,362.50" "$1,748.00" $468.90 "$2,362.50" "$1,063.13" "$1,063.13" "$1,063.13" "$1,063.13" "$2,362.50" "$2,362.50" "$2,362.50" $492.40 "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" $492.37 "$2,362.50" $945.00 "$1,397.42" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$1,771.88" "$2,362.50" "$2,362.50" "$2,362.50" "$1,181.25" "$1,181.25" "$1,871.10" "$2,362.50" "$1,890.00" "$1,063.13" $468.90 N/A "$1,370.25" "$2,362.50" "$2,362.50" "$2,362.50" $492.35 "$2,362.50" N/A N/A 7753880 SUP HCPCS C1713 7753880 - ROD SPINAL 3.5MM 80MM PRECUT CCM PLUS BOTH IP/OP "$1,252.50" $927.00 $248.59 "$1,252.50" $563.63 $563.63 $563.63 $563.63 "$1,252.50" "$1,252.50" "$1,252.50" $261.05 "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" $261.03 "$1,252.50" $501.00 $740.85 "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" $939.38 "$1,252.50" "$1,252.50" "$1,252.50" $626.25 $626.25 $991.98 "$1,252.50" "$1,002.00" $563.63 $248.59 N/A $726.45 "$1,252.50" $751.50 "$1,252.50" $261.02 "$1,252.50" N/A N/A 7753890 SUP HCPCS C1713 7753890 - ROD SPINAL 3.5MM 90MM PRECUT CCM PLUS BOTH IP/OP "$1,252.50" $927.00 $248.59 "$1,252.50" $563.63 $563.63 $563.63 $563.63 "$1,252.50" "$1,252.50" "$1,252.50" $261.05 "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" $261.03 "$1,252.50" $501.00 $740.85 "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" $939.38 "$1,252.50" "$1,252.50" "$1,252.50" $626.25 $626.25 $991.98 "$1,252.50" "$1,002.00" $563.63 $248.59 N/A $726.45 "$1,252.50" $751.50 "$1,252.50" $261.02 "$1,252.50" N/A N/A 7753900 SUP HCPCS C1713 7753900 - ROD SPINAL 3.5MM 100MM PRECUT CCM PLUS BOTH IP/OP "$1,252.50" $927.00 $248.59 "$1,252.50" $563.63 $563.63 $563.63 $563.63 "$1,252.50" "$1,252.50" "$1,252.50" $261.05 "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" $261.03 "$1,252.50" $501.00 $740.85 "$1,252.50" "$1,252.50" "$1,252.50" "$1,252.50" $939.38 "$1,252.50" "$1,252.50" "$1,252.50" $626.25 $626.25 $991.98 "$1,252.50" "$1,002.00" $563.63 $248.59 N/A $726.45 "$1,252.50" $751.50 "$1,252.50" $261.02 "$1,252.50" N/A N/A 7754525 SUP HCPCS C1713 7754525 - SCREW BN 4.5MM 25MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7754530 SUP HCPCS C1713 7754530 - SCREW BN 4.5MM 35MM SHNK PPS SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7754535 SUP HCPCS C1713 7754535 - SCREW BN 4.5MM 35MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7754540 SUP HCPCS C1713 7754540 - SCREW BN 4.5MM 40MM HLX-REV ACP SHNK PLYP-PHENYLENE SLF SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7754545 SUP HCPCS C1713 7754545 - SCREW BN 4.5MM 45MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7754550 SUP HCPCS C1713 7754550 - SCREW BN 4.5MM 50MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7755120 SUP HCPCS C1713 7755120 - ROD SPNL 3.5MM HNG BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7755122 SUP HCPCS C1713 7755122 - ROD SPNL 3.2/3.5MM 120MM HNG ADJ OCPTL BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 7755123 SUP HCPCS C1713 7755123 - ROD SPNL 3.5MM 3.2MM 220MM ADJ OCPTL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7755124 SUP HCPCS C1713 7755124 - ROD SPNL 3.5MM 220MM STRL VRTX ADJ TI OCPTL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7755217 SUP HCPCS C1713 7755217 - VERTEX SELECT PRE-CURVED OC ROD BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7755231 SUP HCPCS C1713 7755231 - ROD SPNL 3.5MM 100MM OCPTL PLT BOTH IP/OP "$4,426.50" "$3,276.00" $878.55 "$4,426.50" "$1,991.93" "$1,991.93" "$1,991.93" "$1,991.93" "$4,426.50" "$4,426.50" "$4,426.50" $922.59 "$4,426.50" "$4,426.50" "$4,426.50" "$4,426.50" "$4,426.50" $922.53 "$4,426.50" "$4,426.50" "$2,182.26" "$4,426.50" "$4,426.50" "$4,426.50" "$4,426.50" "$3,319.88" "$4,426.50" "$4,426.50" "$4,426.50" "$2,213.25" "$2,213.25" "$3,505.79" "$4,426.50" "$3,541.20" "$1,991.93" $878.55 N/A "$2,567.37" "$4,426.50" "$2,655.90" "$4,426.50" $922.48 "$4,426.50" N/A N/A 7755232 SUP HCPCS C1713 7755232 - ROD SPNL 3.5MM 200MM PCRV PLT OCPTL BOTH IP/OP "$4,426.50" "$3,276.00" $878.55 "$4,426.50" "$1,991.93" "$1,991.93" "$1,991.93" "$1,991.93" "$4,426.50" "$4,426.50" "$4,426.50" $922.59 "$4,426.50" "$4,426.50" "$4,426.50" "$4,426.50" "$4,426.50" $922.53 "$4,426.50" "$1,770.60" "$2,182.26" "$4,426.50" "$4,426.50" "$4,426.50" "$4,426.50" "$3,319.88" "$4,426.50" "$4,426.50" "$4,426.50" "$2,213.25" "$2,213.25" "$3,505.79" "$4,426.50" "$3,541.20" "$1,991.93" $878.55 N/A "$2,567.37" "$4,426.50" "$2,655.90" "$4,426.50" $922.48 "$4,426.50" N/A N/A 7755240 SUP HCPCS C1713 7755240 - ROD SPNL 3.5MM 240MM VRTX THRD BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7755245 SUP HCPCS C1713 7755245 - ROD THRD 4.5MM 360MM SPNE BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7755247 SUP HCPCS C1713 7755247 - ROD SPNL 5.5MM 360MM VRTX THRD BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7755266 SUP HCPCS C1713 7755266 - ROD SPNL P/T 4.75MM 360MM CIRC BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7755270 SUP HCPCS C1713 7755270 - ROD SPNL 3.5MM 100MM PCRV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7755271 SUP HCPCS C1713 7755271 - ROD SPNL 3.5MM 200MM VRTX PCRV BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 7755274 SUP HCPCS C1713 7755274 - ROD SPINAL 3.5MM 100MM PCVD CHROMALOY PLUS BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7755275 SUP HCPCS C1713 7755275 - ROD SPNL CRV 3.5MM 200MM NS CHROMALOY + BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7755278 SUP HCPCS C1713 7755278 - PLATE BN 50MM NS VRTX SLCT ADJ SPNE OCPTL RECON SYS BOTH IP/OP "$8,085.00" "$5,983.00" "$1,604.67" "$8,085.00" "$3,638.25" "$3,638.25" "$3,638.25" "$3,638.25" "$8,085.00" "$8,085.00" "$8,085.00" "$1,685.12" "$8,085.00" "$8,085.00" "$8,085.00" "$8,085.00" "$8,085.00" "$1,685.00" "$8,085.00" "$3,234.00" "$3,985.91" "$8,085.00" "$8,085.00" "$8,085.00" "$8,085.00" "$6,063.75" "$8,085.00" "$8,085.00" "$8,085.00" "$4,042.50" "$4,042.50" "$6,403.32" "$8,085.00" "$6,468.00" "$3,638.25" "$1,604.67" N/A "$4,689.30" "$8,085.00" "$4,851.00" "$8,085.00" "$1,684.91" "$8,085.00" N/A N/A 7755325 SUP HCPCS C1713 7755325 - CONNECTOR ROD SM LOPRFL SCR OCPTL SPNE BOTH IP/OP "$1,794.00" "$1,328.00" $356.06 "$1,794.00" $807.30 $807.30 $807.30 $807.30 "$1,794.00" "$1,794.00" "$1,794.00" $373.91 "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" $373.89 "$1,794.00" $717.60 "$1,061.15" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,345.50" "$1,794.00" "$1,794.00" "$1,794.00" $897.00 $897.00 "$1,420.85" "$1,794.00" "$1,435.20" $807.30 $356.06 N/A "$1,040.52" "$1,794.00" "$1,794.00" "$1,794.00" $373.87 "$1,794.00" N/A N/A 7755327 SUP HCPCS C1713 7755327 - SCREW BN OFST 27MM CNCT SPNE OCPTL BOTH IP/OP "$1,794.00" "$1,328.00" $356.06 "$1,794.00" $807.30 $807.30 $807.30 $807.30 "$1,794.00" "$1,794.00" "$1,794.00" $373.91 "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" $373.89 "$1,794.00" $717.60 "$1,061.15" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,345.50" "$1,794.00" "$1,794.00" "$1,794.00" $897.00 $897.00 "$1,420.85" "$1,794.00" "$1,435.20" $807.30 $356.06 N/A "$1,040.52" "$1,794.00" "$1,076.40" "$1,794.00" $373.87 "$1,794.00" N/A N/A 7755530 SUP HCPCS C1713 7755530 - SCREW BN 5.5MM 30MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7755535 SUP HCPCS C1713 7755535 - SCREW BN 5.5MM 35MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7755540 SUP HCPCS C1713 7755540 - SCREW BN 5.5MM 40MM CNN TI SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7755545 SUP HCPCS C1713 7755545 - SCREW BN 5.5MM 45MM CNN TI SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7755550 SUP HCPCS C1713 7755550 - SCREW BN 5.5MM 50MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7755555 SUP HCPCS C1713 7755555 - SCREW BN 5.5MM 55MM HLX-REV ACP SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7756007 SUP Custom 27203010 7756007 - BIT DRILL 2.4MM BOTH IP/OP $660.00 $488.00 $117.48 $660.00 $660.00 $660.00 $660.00 $660.00 $660.00 $660.00 $117.48 $660.00 $660.00 $489.85 $489.85 $508.73 $343.86 $137.55 $660.00 $264.00 $660.00 $660.00 $660.00 $660.00 $660.00 $495.00 $660.00 $660.00 $660.00 $330.00 $330.00 $522.72 $660.00 $528.00 $429.00 $660.00 N/A $382.80 $660.00 $396.00 $660.00 $660.00 $660.00 N/A N/A 7756010 SUP Custom 27203010 7756010 - BIT DRL 2.4MM STRL VRTX SLCT DISP BOTH IP/OP $660.00 $488.00 $117.48 $660.00 $660.00 $660.00 $660.00 $660.00 $660.00 $660.00 $117.48 $660.00 $660.00 $489.85 $489.85 $508.73 $343.86 $137.55 $660.00 $264.00 $660.00 $660.00 $660.00 $660.00 $660.00 $495.00 $660.00 $660.00 $660.00 $330.00 $330.00 $522.72 $660.00 $528.00 $429.00 $660.00 N/A $382.80 $660.00 $396.00 $660.00 $660.00 $660.00 N/A N/A 7756035 SUP Custom 27203010 7756035 - TAP SURG 3.5MM INSTR BOTH IP/OP "$1,038.00" $768.00 $184.76 "$1,038.00" "$1,038.00" "$1,038.00" "$1,038.00" "$1,038.00" "$1,038.00" "$1,038.00" $184.76 "$1,038.00" "$1,038.00" $770.40 $770.40 $800.09 $540.80 $216.33 "$1,038.00" $415.20 "$1,038.00" "$1,038.00" "$1,038.00" "$1,038.00" "$1,038.00" $778.50 "$1,038.00" "$1,038.00" "$1,038.00" $519.00 $519.00 $822.10 "$1,038.00" $830.40 $674.70 "$1,038.00" N/A $602.04 "$1,038.00" $622.80 "$1,038.00" "$1,038.00" "$1,038.00" N/A N/A 7756064 SUP Custom 27803010 7756064 - CONNECTOR ROD 10MM OPEN LATERAL BOTH IP/OP "$1,077.00" $797.00 $191.71 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $191.71 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $224.46 "$1,077.00" $430.80 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $807.75 "$1,077.00" "$1,077.00" "$1,077.00" $538.50 $538.50 $852.98 "$1,077.00" $861.60 $484.65 "$1,077.00" N/A $624.66 "$1,077.00" $646.20 "$1,077.00" "$1,077.00" "$1,077.00" N/A N/A 7756066 SUP Custom 27803010 7756066 - CONNECTOR ROD 13MM OPEN LATERAL BOTH IP/OP "$1,077.00" $797.00 $191.71 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $191.71 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $224.46 "$1,077.00" $430.80 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $807.75 "$1,077.00" "$1,077.00" "$1,077.00" $538.50 $538.50 $852.98 "$1,077.00" $861.60 $484.65 "$1,077.00" N/A $624.66 "$1,077.00" $646.20 "$1,077.00" "$1,077.00" "$1,077.00" N/A N/A 7756067 SUP Custom 27803010 7756067 - CONNECTOR SPINAL 10MM CLOSE VERTEX LATERAL BOTH IP/OP "$1,018.50" $754.00 $181.29 "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" $181.29 "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" $212.27 "$1,018.50" $407.40 "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" $763.88 "$1,018.50" "$1,018.50" "$1,018.50" $509.25 $509.25 $806.65 "$1,018.50" $814.80 $458.33 "$1,018.50" N/A $590.73 "$1,018.50" $611.10 "$1,018.50" "$1,018.50" "$1,018.50" N/A N/A 7756068 SUP Custom 27803010 7756068 - CONNECTOR ROD 13MM CLOSE SPN LATERAL BOTH IP/OP "$1,018.50" $754.00 $181.29 "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" $181.29 "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" $212.27 "$1,018.50" $407.40 "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" $763.88 "$1,018.50" "$1,018.50" "$1,018.50" $509.25 $509.25 $806.65 "$1,018.50" $814.80 $458.33 "$1,018.50" N/A $590.73 "$1,018.50" $611.10 "$1,018.50" "$1,018.50" "$1,018.50" N/A N/A 7756069 SUP Custom 27803010 7756069 - CONNECTOR ROD 3.2MM 3.5MM EXTN SPN MAS BOTH IP/OP "$1,077.00" $797.00 $191.71 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $191.71 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $224.46 "$1,077.00" $430.80 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $807.75 "$1,077.00" "$1,077.00" "$1,077.00" $538.50 $538.50 $852.98 "$1,077.00" $861.60 $484.65 "$1,077.00" N/A $624.66 "$1,077.00" $646.20 "$1,077.00" "$1,077.00" "$1,077.00" N/A N/A 7756071 SUP Custom 27803010 7756071 - CONNECTOR ROD 4.5MM EXTN MAS SPN BOTH IP/OP "$1,077.00" $797.00 $191.71 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $191.71 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $224.46 "$1,077.00" $430.80 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $807.75 "$1,077.00" "$1,077.00" "$1,077.00" $538.50 $538.50 $852.98 "$1,077.00" $861.60 $484.65 "$1,077.00" N/A $624.66 "$1,077.00" $646.20 "$1,077.00" "$1,077.00" "$1,077.00" N/A N/A 7756072 SUP Custom 27803010 7756072 - CONNECTOR ROD 5.5MM EXTN MULTIAX SCREW SPN BOTH IP/OP "$1,077.00" $797.00 $191.71 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $191.71 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $224.46 "$1,077.00" $430.80 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $807.75 "$1,077.00" "$1,077.00" "$1,077.00" $538.50 $538.50 $852.98 "$1,077.00" $861.60 $484.65 "$1,077.00" N/A $624.66 "$1,077.00" $646.20 "$1,077.00" "$1,077.00" "$1,077.00" N/A N/A 7756073 SUP HCPCS C1713 7756073 - HOOK SPINAL 4.5MM LAMINA BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7756074 SUP HCPCS C1713 7756074 - HOOK SPINAL 6MM LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7756131 SUP Custom 27203010 7756131 - BIT DRILL 3.2MM OCCPTL BOTH IP/OP $676.50 $501.00 $120.42 $676.50 $676.50 $676.50 $676.50 $676.50 $676.50 $676.50 $120.42 $676.50 $676.50 $502.10 $502.10 $521.45 $352.46 $140.99 $676.50 $270.60 $676.50 $676.50 $676.50 $676.50 $676.50 $507.38 $676.50 $676.50 $676.50 $338.25 $338.25 $535.79 $676.50 $541.20 $439.73 $676.50 N/A $392.37 $676.50 $405.90 $676.50 $676.50 $676.50 N/A N/A 7756133 SUP Custom 27203010 7756133 - BIT DRILL 3.2MM BOTH IP/OP $676.50 $501.00 $120.42 $676.50 $676.50 $676.50 $676.50 $676.50 $676.50 $676.50 $120.42 $676.50 $676.50 $502.10 $502.10 $521.45 $352.46 $140.99 $676.50 $270.60 $676.50 $676.50 $676.50 $676.50 $676.50 $507.38 $676.50 $676.50 $676.50 $338.25 $338.25 $535.79 $676.50 $541.20 $439.73 $676.50 N/A $392.37 $676.50 $405.90 $676.50 $676.50 $676.50 N/A N/A 7756300 SUP Custom 27203010 7756300 - TAP SPINAL 3MM VERTEX SELECT BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" $890.64 $890.64 $924.96 $625.20 $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $780.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 7756530 SUP HCPCS C1713 7756530 - SCREW BN 6.5MM 30MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7756535 SUP HCPCS C1713 7756535 - SCREW BN 6.5MM 35MM CNN TI SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7756540 SUP HCPCS C1713 7756540 - SCREW BN 6.5MM 40MM CNN TI SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 7756545 SUP HCPCS C1713 7756545 - SCREW BN 6.5MM 45MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7756550 SUP HCPCS C1713 7756550 - SCREW BN 6.5MM 50MM CNN TI SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 7756555 SUP HCPCS C1713 7756555 - SCREW BN 6.5MM 55MM NEURO SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7757530 SUP HCPCS C1713 7757530 - SCREW BN 7.5MM 30MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7757535 SUP HCPCS C1713 7757535 - SCREW BN 7.5MM 35MM SHNK CNN SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7757540 SUP HCPCS C1713 7757540 - SCREW BN 7.5MM 40MM CNN TI SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7757545 SUP HCPCS C1713 7757545 - SCREW BN 7.5MM 45MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7757550 SUP HCPCS C1713 7757550 - SCREW BN 7.5MM 50MM SPHERX PPS CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7757555 SUP HCPCS C1713 7757555 - SCREW BN 7.5MM 55MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7758535 SUP HCPCS C1713 7758535 - SCREW BN 8.5MM 35MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7758540 SUP HCPCS C1713 7758540 - SCREW BN 8.5MM 40MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7758545 SUP HCPCS C1713 7758545 - SCREW BN 8.5MM 45MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7758550 SUP HCPCS C1713 7758550 - SCREW BN 8.5MM 50MM CNN SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7759970 SUP HCPCS C1713 7759970 - PLATE BN SM LOPRFL VRTX SLCT LCK SLCT SPNE OC BOTH IP/OP "$7,095.00" "$5,250.00" "$1,408.18" "$7,095.00" "$3,192.75" "$3,192.75" "$3,192.75" "$3,192.75" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.78" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.68" "$7,095.00" "$2,838.00" "$3,497.84" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$5,321.25" "$7,095.00" "$7,095.00" "$7,095.00" "$3,547.50" "$3,547.50" "$5,619.24" "$7,095.00" "$5,676.00" "$3,192.75" "$1,408.18" N/A "$4,115.10" "$7,095.00" "$4,257.00" "$7,095.00" "$1,478.60" "$7,095.00" N/A N/A 7759971 SUP HCPCS C1713 7759971 - PLATE BN MED LOPRFL VRTX SLCT LCK SLCT SPNE OC BOTH IP/OP "$7,095.00" "$5,250.00" "$1,408.18" "$7,095.00" "$3,192.75" "$3,192.75" "$3,192.75" "$3,192.75" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.78" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.68" "$7,095.00" "$7,095.00" "$3,497.84" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$5,321.25" "$7,095.00" "$7,095.00" "$7,095.00" "$3,547.50" "$3,547.50" "$5,619.24" "$7,095.00" "$5,676.00" "$3,192.75" "$1,408.18" N/A "$4,115.10" "$7,095.00" "$4,257.00" "$7,095.00" "$1,478.60" "$7,095.00" N/A N/A 7759972 SUP HCPCS C1713 7759972 - PLATE BN LG LOPRFL VRTX SLCT LCK SLCT SPNE OC BOTH IP/OP "$7,095.00" "$5,250.00" "$1,408.18" "$7,095.00" "$3,192.75" "$3,192.75" "$3,192.75" "$3,192.75" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.78" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$1,478.68" "$7,095.00" "$7,095.00" "$3,497.84" "$7,095.00" "$7,095.00" "$7,095.00" "$7,095.00" "$5,321.25" "$7,095.00" "$7,095.00" "$7,095.00" "$3,547.50" "$3,547.50" "$5,619.24" "$7,095.00" "$5,676.00" "$3,192.75" "$1,408.18" N/A "$4,115.10" "$7,095.00" "$4,257.00" "$7,095.00" "$1,478.60" "$7,095.00" N/A N/A 7764525 SUP HCPCS C1713 7764525 - SCREW BN 4.5MM 25MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7764530 SUP HCPCS C1713 7764530 - SCREW BN 4.5MM 30MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7764535 SUP HCPCS C1713 7764535 - SCREW BN 4.5MM 35MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 7764540 SUP HCPCS C1713 7764540 - SCREW BN 4.5MM 40MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 7764545 SUP HCPCS C1713 7764545 - SCREW BN 4.5MM 45MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 7765530 SUP HCPCS C1713 7765530 - SCREW BN 5.5MM 30MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 7765535 SUP HCPCS C1713 7765535 - SCREW BN 5.5MM 35MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 7765540 SUP HCPCS C1713 7765540 - SCREW BN 5.5MM 40MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 7765545 SUP HCPCS C1713 7765545 - SCREW BN 5.5MM 45MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7765550 SUP HCPCS C1713 7765550 - SCREW BN 5.5MM 50MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7765555 SUP HCPCS C1713 7765555 - SCREW BN 5.5MM 55MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7765560 SUP HCPCS C1713 7765560 - SCREW BN 5.5MM 60MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7766530 SUP HCPCS C1713 7766530 - SCREW BN 6.5MM 30MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7766535 SUP HCPCS C1713 7766535 - SCREW BN 6.5MM 35MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7766540 SUP HCPCS C1713 7766540 - SCREW BN 6.5MM 40MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7766545 SUP HCPCS C1713 7766545 - SCREW BN 6.5MM 45MM TI SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7766550 SUP HCPCS C1713 7766550 - SCREW BN 6.5MM 50MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7766555 SUP HCPCS C1713 7766555 - SCREW BN 6.5MM 55MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7766560 SUP HCPCS C1713 7766560 - SCREW BN 6.5MM 60MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7767530 SUP HCPCS C1713 7767530 - SCREW BN 7.5MM 30MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7767535 SUP HCPCS C1713 7767535 - SCREW BN 7.5MM 35MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7767540 SUP HCPCS C1713 7767540 - SCREW BN 7.5MM 40MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7767545 SUP HCPCS C1713 7767545 - SCREW BN 7.5MM 45MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7767550 SUP HCPCS C1713 7767550 - SCREW BN 7.5MM 50MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7767555 SUP HCPCS C1713 7767555 - SCREW BN 7.5MM 55MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7767560 SUP HCPCS C1713 7767560 - SCREW BN 7.5MM 60MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7768535 SUP HCPCS C1713 7768535 - SCREW BN 8.5MM 35MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 7768540 SUP HCPCS C1713 7768540 - SCREW BN 8.5MM 40MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7768545 SUP HCPCS C1713 7768545 - SCREW BN 8.5MM 45MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7768550 SUP HCPCS C1713 7768550 - SCREW BN 8.5MM 50MM NCLNLT SHNK SPNE BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 7770723 SUP HCPCS C1713 7770723 - SPACER SPNL XLORDOTIC 23MMX7MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$11,698.50" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7770728 SUP HCPCS C1713 7770728 - SPACER SPNL XLORDOTIC 28MMX7MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$11,698.50" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7770732 SUP HCPCS C1713 7770732 - SPACER SPNL XLORDOTIC 32MMX7MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$11,698.50" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7770823 SUP HCPCS C1713 7770823 - SPACER SPNL STD 23MMX8MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$11,698.50" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$11,698.50" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7770828 SUP HCPCS C1713 7770828 - SPACER SPNL STD 28MMX8MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$11,698.50" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7770832 SUP HCPCS C1713 7770832 - SPACER SPNL STD 32MMX8MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7770923 SUP HCPCS C1713 7770923 - SPACER SPNL STD 23MMX9MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7770928 SUP HCPCS C1713 7770928 - SPACER SPNL STD 28MMX9MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7770932 SUP HCPCS C1713 7770932 - SPACER SPNL STD 32MMX9MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$11,698.50" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7771023 SUP HCPCS C1713 7771023 - SPACER SPNL STD 23MMX10MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7771028 SUP HCPCS C1713 7771028 - SPACER SPNL STD 28MMX10MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7771032 SUP HCPCS C1713 7771032 - SPACER SPNL STD 32MMX10MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7771123 SUP HCPCS C1713 7771123 - SPACER SPNL STD 23MMX11MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7771128 SUP HCPCS C1713 7771128 - SPACER SPNL STD 28MMX11MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7771132 SUP HCPCS C1713 7771132 - SPACER SPNL STD 32MMX11MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 7771174 SUP Custom 27203010 7771174 - SLEEVE SPNL SPHERX PRODUCTIVE PPS BOTH IP/OP $137.50 $102.00 $24.48 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $24.48 $137.50 $137.50 $102.05 $102.05 $105.99 $71.64 $28.66 $137.50 $55.00 $137.50 $137.50 $137.50 $137.50 $137.50 $103.13 $137.50 $137.50 $137.50 $68.75 $68.75 $108.90 $137.50 $110.00 $89.38 $137.50 N/A $79.75 $137.50 $82.50 $137.50 $137.50 $137.50 N/A N/A 7772001 SUP HCPCS C1713 7772001 - SCREW BN TULIP LCK SPNE 6.25 MM ROD BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 7781120 SUP HCPCS C1713 7781120 - PLATE BN 20MM NS HLX-T 1 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 7781122 SUP HCPCS C1713 7781122 - PLATE BN 22MM NS HLX-T 1 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 7781124 SUP HCPCS C1713 7781124 - PLATE BN 24MM NS HLX-T 1 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781126 SUP HCPCS C1713 7781126 - PLATE BN 26MM NS HLX-T 1 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 7781128 SUP HCPCS C1713 7781128 - PLATE BN 28MM NS HLX-T 1 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 7781130 SUP HCPCS C1713 7781130 - PLATE BN 30MM NS HLX-T 1 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781132 SUP HCPCS C1713 7781132 - PLATE BN 32MM NS HLX-T 1 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781134 SUP HCPCS C1713 7781134 - PLATE BN 34MM NS HLX-T 1 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781234 SUP HCPCS C1713 7781234 - PLATE BN 34MM NS HLX-T 2 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781236 SUP HCPCS C1713 7781236 - PLATE BN 36MM NS HLX-T 2 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781238 SUP HCPCS C1713 7781238 - PLATE BN 38MM NS HLX-T 2 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781240 SUP HCPCS C1713 7781240 - PLATE BN 40MM NS HLX-T 2 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781242 SUP HCPCS C1713 7781242 - PLATE BN 42MM NS HLX-T 2 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781244 SUP HCPCS C1713 7781244 - PLATE BN 44MM NS HLX-T 2 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781246 SUP HCPCS C1713 7781246 - PLATE BN 46MM NS HLX-T 2 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781248 SUP HCPCS C1713 7781248 - PLATE BN 48MM NS HLX-T 2 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781250 SUP HCPCS C1713 7781250 - PLATE BN 50MM NS HLX-T 2 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781252 SUP HCPCS C1713 7781252 - PLATE BN 52MM NS HLX-T 2 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781254 SUP HCPCS C1713 7781254 - PLATE BN 54MM NS HLX-T 2 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781354 SUP HCPCS C1713 7781354 - PLATE BN 54MM NS HLX-T 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781356 SUP HCPCS C1713 7781356 - PLATE BN 56MM NS HLX-T 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781358 SUP HCPCS C1713 7781358 - PLATE BN 58MM NS HLX-T 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781360 SUP HCPCS C1713 7781360 - PLATE BN 60MM NS HLX-T 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781362 SUP HCPCS C1713 7781362 - PLATE BN 62MM NS HLX-T 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781364 SUP HCPCS C1713 7781364 - PLATE BN 64MM NS HLX-T 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781366 SUP HCPCS C1713 7781366 - PLATE BN 66MM NS HLX-T 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781368 SUP HCPCS C1713 7781368 - PLATE BN 68MM NS HLX-T 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781470 SUP HCPCS C1713 7781470 - PLATE BN 70MM NS HLX-T 4 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781474 SUP HCPCS C1713 7781474 - PLATE BN 74MM NS HLX-T 4 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781478 SUP HCPCS C1713 7781478 - PLATE BN 78MM NS HLX-T 4 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781482 SUP HCPCS C1713 7781482 - PLATE BN 82MM NS HLX-T 4 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781486 SUP HCPCS C1713 7781486 - PLATE BN 86MM NS HLX-T 4 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781490 SUP HCPCS C1713 7781490 - PLATE BN 90MM NS HLX-T 4 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781501 SUP HCPCS C1713 7781501 - PLATE BN T 100MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781505 SUP HCPCS C1713 7781505 - PLATE BN T 105MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7781510 SUP HCPCS C1713 7781510 - PLATE BN T 110MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 7781595 SUP HCPCS C1713 7781595 - PLATE BN T 95MM HLX LVL 5 TRANSLATIONAL SS SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 7782001 SUP HCPCS C1713 7782001 - SCREW LCK 5.5MM SPHERX PPS SPNE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 7782300 SUP HCPCS C1713 7782300 - ROD SPNL 5.5MM 300MM STRL SPHERX XTN BOTH IP/OP "$1,540.00" "$1,140.00" $305.65 "$1,540.00" $693.00 $693.00 $693.00 $693.00 "$1,540.00" "$1,540.00" "$1,540.00" $320.97 "$1,540.00" "$1,540.00" "$1,540.00" "$1,540.00" "$1,540.00" $320.95 "$1,540.00" $616.00 $910.91 "$1,540.00" "$1,540.00" "$1,540.00" "$1,540.00" "$1,155.00" "$1,540.00" "$1,540.00" "$1,540.00" $770.00 $770.00 "$1,219.68" "$1,540.00" "$1,232.00" $693.00 $305.65 N/A $893.20 "$1,540.00" "$1,540.00" "$1,540.00" $320.94 "$1,540.00" N/A N/A 7782500 SUP HCPCS C1713 7782500 - ROD SPNL 5.5MM 500MM SPHERX XTN BOTH IP/OP "$1,540.00" "$1,140.00" $305.65 "$1,540.00" $693.00 $693.00 $693.00 $693.00 "$1,540.00" "$1,540.00" "$1,540.00" $320.97 "$1,540.00" "$1,540.00" "$1,540.00" "$1,540.00" "$1,540.00" $320.95 "$1,540.00" "$1,540.00" $910.91 "$1,540.00" "$1,540.00" "$1,540.00" "$1,540.00" "$1,155.00" "$1,540.00" "$1,540.00" "$1,540.00" $770.00 $770.00 "$1,219.68" "$1,540.00" "$1,232.00" $693.00 $305.65 N/A $893.20 "$1,540.00" "$1,540.00" "$1,540.00" $320.94 "$1,540.00" N/A N/A 7783025 SUP HCPCS C1713 7783025 - ROD SPNL PREBNT 5.5MM 25MM SPHERX XTN BOTH IP/OP "$1,790.00" "$1,325.00" $355.27 "$1,790.00" $805.50 $805.50 $805.50 $805.50 "$1,790.00" "$1,790.00" "$1,790.00" $373.08 "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" $373.06 "$1,790.00" "$1,790.00" "$1,058.79" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,342.50" "$1,790.00" "$1,790.00" "$1,790.00" $895.00 $895.00 "$1,417.68" "$1,790.00" "$1,432.00" $805.50 $355.27 N/A "$1,038.20" "$1,790.00" "$1,790.00" "$1,790.00" $373.04 "$1,790.00" N/A N/A 7783030 SUP HCPCS C1713 7783030 - ROD SPNL PREBNT 5.5MM 30MM SPHERX XTN BOTH IP/OP "$1,790.00" "$1,325.00" $355.27 "$1,790.00" $805.50 $805.50 $805.50 $805.50 "$1,790.00" "$1,790.00" "$1,790.00" $373.08 "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" $373.06 "$1,790.00" $716.00 "$1,058.79" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,342.50" "$1,790.00" "$1,790.00" "$1,790.00" $895.00 $895.00 "$1,417.68" "$1,790.00" "$1,432.00" $805.50 $355.27 N/A "$1,038.20" "$1,790.00" "$1,790.00" "$1,790.00" $373.04 "$1,790.00" N/A N/A 7783035 SUP HCPCS C1713 7783035 - ROD SPNL PREBNT 5.5MM 35MM SPHERX XTN BOTH IP/OP "$1,790.00" "$1,325.00" $355.27 "$1,790.00" $805.50 $805.50 $805.50 $805.50 "$1,790.00" "$1,790.00" "$1,790.00" $373.08 "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" $373.06 "$1,790.00" $716.00 "$1,058.79" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,342.50" "$1,790.00" "$1,790.00" "$1,790.00" $895.00 $895.00 "$1,417.68" "$1,790.00" "$1,432.00" $805.50 $355.27 N/A "$1,038.20" "$1,790.00" "$1,790.00" "$1,790.00" $373.04 "$1,790.00" N/A N/A 7783040 SUP HCPCS C1713 7783040 - ROD SPNL PREBNT 5.5MM 40MM SPHERX XTN BOTH IP/OP "$1,790.00" "$1,325.00" $355.27 "$1,790.00" $805.50 $805.50 $805.50 $805.50 "$1,790.00" "$1,790.00" "$1,790.00" $373.08 "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" $373.06 "$1,790.00" "$1,790.00" "$1,058.79" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,342.50" "$1,790.00" "$1,790.00" "$1,790.00" $895.00 $895.00 "$1,417.68" "$1,790.00" "$1,432.00" $805.50 $355.27 N/A "$1,038.20" "$1,790.00" "$1,790.00" "$1,790.00" $373.04 "$1,790.00" N/A N/A 7783045 SUP HCPCS C1713 7783045 - ROD SPNL PREBNT 5.5MM 45MM SPHERX XTN BOTH IP/OP "$1,790.00" "$1,325.00" $355.27 "$1,790.00" $805.50 $805.50 $805.50 $805.50 "$1,790.00" "$1,790.00" "$1,790.00" $373.08 "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" $373.06 "$1,790.00" "$1,790.00" "$1,058.79" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,342.50" "$1,790.00" "$1,790.00" "$1,790.00" $895.00 $895.00 "$1,417.68" "$1,790.00" "$1,432.00" $805.50 $355.27 N/A "$1,038.20" "$1,790.00" "$1,790.00" "$1,790.00" $373.04 "$1,790.00" N/A N/A 7783050 SUP HCPCS C1713 7783050 - ROD SPNL PREBNT 5.5MM 50MM SPHERX XTN BOTH IP/OP "$1,790.00" "$1,325.00" $355.27 "$1,790.00" $805.50 $805.50 $805.50 $805.50 "$1,790.00" "$1,790.00" "$1,790.00" $373.08 "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" $373.06 "$1,790.00" $716.00 "$1,058.79" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,342.50" "$1,790.00" "$1,790.00" "$1,790.00" $895.00 $895.00 "$1,417.68" "$1,790.00" "$1,432.00" $805.50 $355.27 N/A "$1,038.20" "$1,790.00" "$1,790.00" "$1,790.00" $373.04 "$1,790.00" N/A N/A 7783055 SUP HCPCS C1713 7783055 - ROD SPNL PREBNT 5.5MM 55MM SPHERX XTN BOTH IP/OP "$1,790.00" "$1,325.00" $355.27 "$1,790.00" $805.50 $805.50 $805.50 $805.50 "$1,790.00" "$1,790.00" "$1,790.00" $373.08 "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" $373.06 "$1,790.00" $716.00 "$1,058.79" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,342.50" "$1,790.00" "$1,790.00" "$1,790.00" $895.00 $895.00 "$1,417.68" "$1,790.00" "$1,432.00" $805.50 $355.27 N/A "$1,038.20" "$1,790.00" "$1,790.00" "$1,790.00" $373.04 "$1,790.00" N/A N/A 7783060 SUP HCPCS C1713 7783060 - ROD SPNL PREBNT 5.5MM 60MM SPHERX XTN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" $789.00 "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,972.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 7783065 SUP HCPCS C1713 7783065 - ROD SPNL PREBNT 5.5MM 65MM SPHERX XTN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,972.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 7783070 SUP HCPCS C1713 7783070 - ROD SPNL PREBNT 5.5MM 70MM SPHERX PPS XTN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,972.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 7783075 SUP HCPCS C1713 7783075 - ROD SPNL PREBNT 5.5MM 75MM SPHERX XTN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,972.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 7783080 SUP HCPCS C1713 7783080 - ROD SPNL PREBNT 5.5MM 90MM SPHERX XTN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,972.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 7783085 SUP HCPCS C1713 7783085 - ROD SPNL PREBNT 5.5MM 85MM SPHERX XTN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,972.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 7783090 SUP HCPCS C1713 7783090 - ROD SPNL PREBNT 5.5MM 90MM SPHERX XTN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,972.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 7783095 SUP HCPCS C1713 7783095 - ROD SPNL PREBNT 5.5MM 95MM SPHERX XTN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,972.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 7783100 SUP HCPCS C1713 7783100 - ROD SPNL PREBNT 5.5MM 100MM SPHERX XTN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,972.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 7783110 SUP HCPCS C1713 7783110 - ROD SPNL PREBNT 5.5MM 110MM SPHERX XTN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,972.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 7783120 SUP HCPCS C1713 7783120 - ROD SPNL PREBNT 5.5MM 120MM SPHERX XTN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,972.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 7783150 SUP HCPCS C1713 7783150 - ROD SPNL PREBNT 5.5MM 150MM SPHERX XTN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,972.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 7783300 SUP HCPCS C1713 7783300 - ROD SPNL PREBNT 5.5MM 300MM SPHERX XTN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,972.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 7783500 SUP HCPCS C1713 7783500 - ROD SPNL PREBNT 5.5MM 500MM SPHERX XTN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,972.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 7800015 SUP HCPCS C1713 7800015 - PIN FX HLX TEMP SLFCNTR TACK SPNE BOTH IP/OP $535.00 $396.00 $106.18 $535.00 $240.75 $240.75 $240.75 $240.75 $535.00 $535.00 $535.00 $111.51 $535.00 $535.00 $535.00 $535.00 $535.00 $111.50 $535.00 $535.00 $316.45 $535.00 $535.00 $535.00 $535.00 $401.25 $535.00 $535.00 $535.00 $267.50 $267.50 $423.72 $535.00 $428.00 $240.75 $106.18 N/A $310.30 $535.00 $535.00 $535.00 $111.49 $535.00 N/A N/A 7800120 SUP HCPCS C1713 7800120 - PLATE BONE T 20MM LEVEL 1 HELIX STAINLESS STEEL SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7800122 SUP HCPCS C1713 7800122 - PLATE BONE T 22MM LEVEL 1 HELIX STAINLESS STEEL SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7800124 SUP HCPCS C1713 7800124 - PLATE BN 24MM NS HLX R 1 LVL SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7800126 SUP HCPCS C1713 7800126 - PLATE BN 26MM NS HLX R 1 LVL SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7800128 SUP HCPCS C1713 7800128 - PLATE BN 28MM NS HLX R 1 LVL SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7800130 SUP HCPCS C1713 7800130 - PLATE BN 30MM NS HLX R 1 LVL SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7800132 SUP HCPCS C1713 7800132 - PLATE BN 32MM NS HLX R 1 LVL SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7800134 SUP HCPCS C1713 7800134 - PLATE BN 34MM NS HLX R 1 LVL SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7800232 SUP HCPCS C1713 7800232 - PLATE BN 32MM NS HLX R 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7800234 SUP HCPCS C1713 7800234 - PLATE BN 34MM NS HLX R 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7800236 SUP HCPCS C1713 7800236 - PLATE BN 36MM NS HLX R 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7800238 SUP HCPCS C1713 7800238 - PLATE BONE 38MM LEVEL 2 HELIX-REVOLUTION SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7800240 SUP HCPCS C1713 7800240 - PLATE BONE 40MM LEVEL 1 HELIX-REVOLUTION SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7800242 SUP HCPCS C1713 7800242 - PLATE BN 42MM NS HLX R 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7800244 SUP HCPCS C1713 7800244 - PLATE BN 44MM NS HLX R 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7800246 SUP HCPCS C1713 7800246 - PLATE BN 46MM NS HLX R 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7800248 SUP HCPCS C1713 7800248 - PLATE BN 48MM NS HLX R 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7800250 SUP HCPCS C1713 7800250 - PLATE BN 50MM NS HLX R 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7800252 SUP HCPCS C1713 7800252 - PLATE BN 52MM NS HLX R 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7800254 SUP HCPCS C1713 7800254 - PLATE BN 54MM NS HLX R 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 7800350 SUP HCPCS C1713 7800350 - PLATE BN 50MM NS HLX R 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7800352 SUP HCPCS C1713 7800352 - PLATE BN 52MM NS HLX R 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7800354 SUP HCPCS C1713 7800354 - PLATE BN 54MM NS HLX R 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7800356 SUP HCPCS C1713 7800356 - PLATE BN 56MM NS HLX R 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7800358 SUP HCPCS C1713 7800358 - PLATE BN 58MM NS HLX R 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7800360 SUP HCPCS C1713 7800360 - PLATE BN 60MM NS HLX R 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7800362 SUP HCPCS C1713 7800362 - PLATE BN 62MM NS HLX R 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7800364 SUP HCPCS C1713 7800364 - PLATE BN 64MM NS HLX R 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7800366 SUP HCPCS C1713 7800366 - PLATE BN 66MM NS HLX R 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7800368 SUP HCPCS C1713 7800368 - PLATE BN 68MM NS HLX R 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 7800466 SUP HCPCS C1713 7800466 - PLATE BN 66MM NS HLX R 4 LVL SPNE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7800468 SUP HCPCS C1713 7800468 - PLATE BN 68MM NS HLX R 4 LVL SPNE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7800470 SUP HCPCS C1713 7800470 - PLATE BN 70MM NS HLX R 4 LVL SPNE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7800474 SUP HCPCS C1713 7800474 - PLATE BN 74MM NS HLX R 4 LVL SPNE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7800478 SUP HCPCS C1713 7800478 - PLATE BN 78MM NS HLX R 4 LVL SPNE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7800482 SUP HCPCS C1713 7800482 - PLATE BN 82MM NS HLX R 4 LVL SPNE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7800486 SUP HCPCS C1713 7800486 - PLATE BN 86MM NS HLX R 4 LVL SPNE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7800490 SUP HCPCS C1713 7800490 - PLATE BN 90MM NS HLX R 4 LVL SPNE BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7800500 SUP HCPCS C1713 7800500 - PLATE BN 100MM HLX-REV LVL 5 SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7800505 SUP HCPCS C1713 7800505 - PLATE BN 105MM HLX-REV LVL 5 SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7800510 SUP HCPCS C1713 7800510 - PLATE BN 110MM HLX-REV LVL 5 SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7800590 SUP HCPCS C1713 7800590 - PLATE BN 90MM HLX-REV LVL 5 SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7800595 SUP HCPCS C1713 7800595 - PLATE BN 95MM HLX-REV LVL 5 SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 7801111 SUP HCPCS C1713 7801111 - SCREW BN 4MM 11MM NS HLX R SLF DRL VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7801113 SUP HCPCS C1713 7801113 - SCREW BONE 4MM 13MM VAR ANG SELF DRILL HELIX-REVOLUTION ACP BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7801115 SUP HCPCS C1713 7801115 - SCREW BONE 4MM 15MM VAR ANG SELF DRILL HELIX-REVOLUTION ACP BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7801117 SUP HCPCS C1713 7801117 - SCREW BN 4MM 17MM HLX REV ACP SLF DRL VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7802211 SUP HCPCS C1713 7802211 - SCREW BN 4MM 11MM NS HLX R SLF DRL FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7802213 SUP HCPCS C1713 7802213 - SCREW BONE 4MM 13MM FIX ANGLE SELF DRILL HELIX-REVOLUTION BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7802215 SUP HCPCS C1713 7802215 - SCREW BONE 4MM 15MM FIX ANGLE SELF DRILL HELIX-REVOLUTION BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7803111 SUP HCPCS C1713 7803111 - SCREW BN 4MM 11MM NS HLX R ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7803113 SUP HCPCS C1713 7803113 - SCREW BONE 4MM 13MM VAR ANG SELF TAP HELIX-REVOLUTION ACP BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7803115 SUP HCPCS C1713 7803115 - SCREW BONE 4MM 15MM VAR ANG SELF TAP HELIX-REVOLUTION ACP BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7803117 SUP HCPCS C1713 7803117 - SCREW BN 4MM 17MM NS HLX R ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7803119 SUP HCPCS C1713 7803119 - SCREW BN 4MM 19MM NS HLX R ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7804211 SUP HCPCS C1713 7804211 - SCREW BN 4MM 11MM NS HLX R ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7804213 SUP HCPCS C1713 7804213 - SCREW BONE 4MM 13MM FIX ANGLE SELF TAP HELIX-REVOLUTION ACP BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7804215 SUP HCPCS C1713 7804215 - SCREW BN 4MM 15MM NS HLX R ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7804217 SUP HCPCS C1713 7804217 - SCREW BN 4MM 17MM NS HLX R ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7804219 SUP HCPCS C1713 7804219 - SCREW BN 4MM 19MM NS HLX R ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7805111 SUP HCPCS C1713 7805111 - SCREW BN 4.5MM 11MM NS HLX R ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7805113 SUP HCPCS C1713 7805113 - SCREW BN 4.5MM 13MM NS HLX R ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7805114 SUP HCPCS C1713 7805114 - SCREW BN 4.5MM 14MM VAR ST SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7805115 SUP HCPCS C1713 7805115 - SCREW BN 4.5MM 15MM NS HLX R ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7805117 SUP HCPCS C1713 7805117 - SCREW BN 4.5MM 17MM NS HLX R ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7805119 SUP HCPCS C1713 7805119 - SCREW BN 4.5MM 19MM NS HLX R ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7806211 SUP HCPCS C1713 7806211 - SCREW BN 4.5MM 11MM NS HLX R ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7806213 SUP HCPCS C1713 7806213 - SCREW BN 4.5MM 13MM NS HLX R ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7806215 SUP HCPCS C1713 7806215 - SCREW BONE 4.5MM 15MM FIX ANGLE SELF TAP HELIX-REVOLUTION BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7806217 SUP HCPCS C1713 7806217 - SCREW BN 4.5MM 17MM NS HLX R ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7806219 SUP HCPCS C1713 7806219 - SCREW BN 4.5MM 19MM NS HLX R ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 7807110 SUP Custom 27203010 7807110 - PIN FIX TEMPORARY HELIX BOTH IP/OP $535.00 $396.00 $95.23 $535.00 $535.00 $535.00 $535.00 $535.00 $535.00 $535.00 $95.23 $535.00 $535.00 $397.08 $397.08 $412.38 $278.74 $111.50 $535.00 $214.00 $535.00 $535.00 $535.00 $535.00 $535.00 $401.25 $535.00 $535.00 $535.00 $267.50 $267.50 $423.72 $535.00 $428.00 $347.75 $535.00 N/A $310.30 $535.00 $321.00 $535.00 $535.00 $535.00 N/A N/A 7812025 SUP Custom 27203010 7812025 - BIT DRILL 10MM BOTH IP/OP $535.00 $396.00 $95.23 $535.00 $535.00 $535.00 $535.00 $535.00 $535.00 $535.00 $95.23 $535.00 $535.00 $397.08 $397.08 $412.38 $278.74 $111.50 $535.00 $214.00 $535.00 $535.00 $535.00 $535.00 $535.00 $401.25 $535.00 $535.00 $535.00 $267.50 $267.50 $423.72 $535.00 $428.00 $347.75 $535.00 N/A $310.30 $535.00 $321.00 $535.00 $535.00 $535.00 N/A N/A 7820015 SUP HCPCS C1713 7820015 - PLATE BONE 15MM FIX TRAVERSE SPN BOTH IP/OP "$10,232.50" "$7,572.00" "$2,030.90" "$10,232.50" "$4,604.63" "$4,604.63" "$4,604.63" "$4,604.63" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.71" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.57" "$10,232.50" "$4,093.00" "$5,044.62" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$7,674.38" "$10,232.50" "$10,232.50" "$10,232.50" "$5,116.25" "$5,116.25" "$8,104.14" "$10,232.50" "$8,186.00" "$4,604.63" "$2,030.90" N/A "$5,934.85" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.45" "$10,232.50" N/A N/A 7820020 SUP HCPCS C1713 7820020 - PLATE BN 20MM FX TRAVERSE SPNE BOTH IP/OP "$10,232.50" "$7,572.00" "$2,030.90" "$10,232.50" "$4,604.63" "$4,604.63" "$4,604.63" "$4,604.63" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.71" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.57" "$10,232.50" "$4,093.00" "$5,044.62" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$7,674.38" "$10,232.50" "$10,232.50" "$10,232.50" "$5,116.25" "$5,116.25" "$8,104.14" "$10,232.50" "$8,186.00" "$4,604.63" "$2,030.90" N/A "$5,934.85" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.45" "$10,232.50" N/A N/A 7820025 SUP HCPCS C1713 7820025 - PLATE BN 25MM FX TRAVERSE SPNE BOTH IP/OP "$10,232.50" "$7,572.00" "$2,030.90" "$10,232.50" "$4,604.63" "$4,604.63" "$4,604.63" "$4,604.63" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.71" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.57" "$10,232.50" "$4,093.00" "$5,044.62" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$7,674.38" "$10,232.50" "$10,232.50" "$10,232.50" "$5,116.25" "$5,116.25" "$8,104.14" "$10,232.50" "$8,186.00" "$4,604.63" "$2,030.90" N/A "$5,934.85" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.45" "$10,232.50" N/A N/A 7820030 SUP HCPCS C1713 7820030 - PLATE BONE 30MM FIX TRAVERSE SPN BOTH IP/OP "$10,232.50" "$7,572.00" "$2,030.90" "$10,232.50" "$4,604.63" "$4,604.63" "$4,604.63" "$4,604.63" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.71" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.57" "$10,232.50" "$10,232.50" "$5,044.62" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$7,674.38" "$10,232.50" "$10,232.50" "$10,232.50" "$5,116.25" "$5,116.25" "$8,104.14" "$10,232.50" "$8,186.00" "$4,604.63" "$2,030.90" N/A "$5,934.85" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.45" "$10,232.50" N/A N/A 7820040 SUP HCPCS C1713 7820040 - PLATE BONE 40MM FIX TRAVERSE SPN BOTH IP/OP "$10,232.50" "$7,572.00" "$2,030.90" "$10,232.50" "$4,604.63" "$4,604.63" "$4,604.63" "$4,604.63" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.71" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.57" "$10,232.50" "$4,093.00" "$5,044.62" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$7,674.38" "$10,232.50" "$10,232.50" "$10,232.50" "$5,116.25" "$5,116.25" "$8,104.14" "$10,232.50" "$8,186.00" "$4,604.63" "$2,030.90" N/A "$5,934.85" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.45" "$10,232.50" N/A N/A 7820045 SUP HCPCS C1713 7820045 - PLATE BN 45MM NS TRAVERSE FX SPNE BOTH IP/OP "$10,232.50" "$7,572.00" "$2,030.90" "$10,232.50" "$4,604.63" "$4,604.63" "$4,604.63" "$4,604.63" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.71" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.57" "$10,232.50" "$4,093.00" "$5,044.62" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$7,674.38" "$10,232.50" "$10,232.50" "$10,232.50" "$5,116.25" "$5,116.25" "$8,104.14" "$10,232.50" "$8,186.00" "$4,604.63" "$2,030.90" N/A "$5,934.85" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.45" "$10,232.50" N/A N/A 7820050 SUP HCPCS C1713 7820050 - PLATE BN 50MM NS TRAVERSE FX SPNE BOTH IP/OP "$10,232.50" "$7,572.00" "$2,030.90" "$10,232.50" "$4,604.63" "$4,604.63" "$4,604.63" "$4,604.63" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.71" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.57" "$10,232.50" "$4,093.00" "$5,044.62" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$7,674.38" "$10,232.50" "$10,232.50" "$10,232.50" "$5,116.25" "$5,116.25" "$8,104.14" "$10,232.50" "$8,186.00" "$4,604.63" "$2,030.90" N/A "$5,934.85" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.45" "$10,232.50" N/A N/A 7820055 SUP HCPCS C1713 7820055 - PLATE BN 55MM NS TRAVERSE FX SPNE BOTH IP/OP "$10,232.50" "$7,572.00" "$2,030.90" "$10,232.50" "$4,604.63" "$4,604.63" "$4,604.63" "$4,604.63" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.71" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.57" "$10,232.50" "$10,232.50" "$5,044.62" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$7,674.38" "$10,232.50" "$10,232.50" "$10,232.50" "$5,116.25" "$5,116.25" "$8,104.14" "$10,232.50" "$8,186.00" "$4,604.63" "$2,030.90" N/A "$5,934.85" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.45" "$10,232.50" N/A N/A 7820060 SUP HCPCS C1713 7820060 - PLATE BN 60MM NS TRAVERSE FX SPNE BOTH IP/OP "$10,232.50" "$7,572.00" "$2,030.90" "$10,232.50" "$4,604.63" "$4,604.63" "$4,604.63" "$4,604.63" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.71" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.57" "$10,232.50" "$4,093.00" "$5,044.62" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$7,674.38" "$10,232.50" "$10,232.50" "$10,232.50" "$5,116.25" "$5,116.25" "$8,104.14" "$10,232.50" "$8,186.00" "$4,604.63" "$2,030.90" N/A "$5,934.85" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.45" "$10,232.50" N/A N/A 7820065 SUP HCPCS C1713 7820065 - PLATE BN 65MM NS TRAVERSE FX SPNE BOTH IP/OP "$10,232.50" "$7,572.00" "$2,030.90" "$10,232.50" "$4,604.63" "$4,604.63" "$4,604.63" "$4,604.63" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.71" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.57" "$10,232.50" "$4,093.00" "$5,044.62" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$7,674.38" "$10,232.50" "$10,232.50" "$10,232.50" "$5,116.25" "$5,116.25" "$8,104.14" "$10,232.50" "$8,186.00" "$4,604.63" "$2,030.90" N/A "$5,934.85" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.45" "$10,232.50" N/A N/A 7820070 SUP HCPCS C1713 7820070 - PLATE BN 70MM NS TRAVERSE FX SPNE BOTH IP/OP "$10,232.50" "$7,572.00" "$2,030.90" "$10,232.50" "$4,604.63" "$4,604.63" "$4,604.63" "$4,604.63" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.71" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.57" "$10,232.50" "$4,093.00" "$5,044.62" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$7,674.38" "$10,232.50" "$10,232.50" "$10,232.50" "$5,116.25" "$5,116.25" "$8,104.14" "$10,232.50" "$8,186.00" "$4,604.63" "$2,030.90" N/A "$5,934.85" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.45" "$10,232.50" N/A N/A 7820080 SUP HCPCS C1713 7820080 - PLATE BN 80MM NS TRAVERSE FX SPNE BOTH IP/OP "$10,232.50" "$7,572.00" "$2,030.90" "$10,232.50" "$4,604.63" "$4,604.63" "$4,604.63" "$4,604.63" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.71" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.57" "$10,232.50" "$4,093.00" "$5,044.62" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$7,674.38" "$10,232.50" "$10,232.50" "$10,232.50" "$5,116.25" "$5,116.25" "$8,104.14" "$10,232.50" "$8,186.00" "$4,604.63" "$2,030.90" N/A "$5,934.85" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.45" "$10,232.50" N/A N/A 7820090 SUP HCPCS C1713 7820090 - PLATE BN 90MM NS TRAVERSE FX SPNE BOTH IP/OP "$10,232.50" "$7,572.00" "$2,030.90" "$10,232.50" "$4,604.63" "$4,604.63" "$4,604.63" "$4,604.63" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.71" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.57" "$10,232.50" "$4,093.00" "$5,044.62" "$10,232.50" "$10,232.50" "$10,232.50" "$10,232.50" "$7,674.38" "$10,232.50" "$10,232.50" "$10,232.50" "$5,116.25" "$5,116.25" "$8,104.14" "$10,232.50" "$8,186.00" "$4,604.63" "$2,030.90" N/A "$5,934.85" "$10,232.50" "$10,232.50" "$10,232.50" "$2,132.45" "$10,232.50" N/A N/A 7821045 SUP HCPCS C1713 7821045 - PLATE BN 45MM NS TRAVERSE CMPR SPNE BOTH IP/OP "$11,560.00" "$8,554.00" "$2,294.37" "$11,560.00" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.39" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.23" "$11,560.00" "$4,624.00" "$5,699.08" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$8,670.00" "$11,560.00" "$11,560.00" "$11,560.00" "$5,780.00" "$5,780.00" "$9,155.52" "$11,560.00" "$9,248.00" "$5,202.00" "$2,294.37" N/A "$6,704.80" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.10" "$11,560.00" N/A N/A 7821050 SUP HCPCS C1713 7821050 - PLATE BN 50MM NS TRAVERSE CMPR SPNE BOTH IP/OP "$11,560.00" "$8,554.00" "$2,294.37" "$11,560.00" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.39" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.23" "$11,560.00" "$4,624.00" "$5,699.08" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$8,670.00" "$11,560.00" "$11,560.00" "$11,560.00" "$5,780.00" "$5,780.00" "$9,155.52" "$11,560.00" "$9,248.00" "$5,202.00" "$2,294.37" N/A "$6,704.80" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.10" "$11,560.00" N/A N/A 7821055 SUP HCPCS C1713 7821055 - PLATE BN 55MM NS TRAVERSE CMPR SPNE BOTH IP/OP "$11,560.00" "$8,554.00" "$2,294.37" "$11,560.00" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.39" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.23" "$11,560.00" "$11,560.00" "$5,699.08" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$8,670.00" "$11,560.00" "$11,560.00" "$11,560.00" "$5,780.00" "$5,780.00" "$9,155.52" "$11,560.00" "$9,248.00" "$5,202.00" "$2,294.37" N/A "$6,704.80" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.10" "$11,560.00" N/A N/A 7821060 SUP HCPCS C1713 7821060 - PLATE BN 60MM NS TRAVERSE CMPR SPNE BOTH IP/OP "$11,560.00" "$8,554.00" "$2,294.37" "$11,560.00" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.39" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.23" "$11,560.00" "$4,624.00" "$5,699.08" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$8,670.00" "$11,560.00" "$11,560.00" "$11,560.00" "$5,780.00" "$5,780.00" "$9,155.52" "$11,560.00" "$9,248.00" "$5,202.00" "$2,294.37" N/A "$6,704.80" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.10" "$11,560.00" N/A N/A 7821065 SUP HCPCS C1713 7821065 - PLATE BN 65MM NS TRAVERSE CMPR SPNE BOTH IP/OP "$11,560.00" "$8,554.00" "$2,294.37" "$11,560.00" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.39" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.23" "$11,560.00" "$4,624.00" "$5,699.08" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$8,670.00" "$11,560.00" "$11,560.00" "$11,560.00" "$5,780.00" "$5,780.00" "$9,155.52" "$11,560.00" "$9,248.00" "$5,202.00" "$2,294.37" N/A "$6,704.80" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.10" "$11,560.00" N/A N/A 7821070 SUP HCPCS C1713 7821070 - PLATE BN 70MM NS TRAVERSE CMPR SPNE BOTH IP/OP "$11,560.00" "$8,554.00" "$2,294.37" "$11,560.00" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.39" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.23" "$11,560.00" "$11,560.00" "$5,699.08" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$8,670.00" "$11,560.00" "$11,560.00" "$11,560.00" "$5,780.00" "$5,780.00" "$9,155.52" "$11,560.00" "$9,248.00" "$5,202.00" "$2,294.37" N/A "$6,704.80" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.10" "$11,560.00" N/A N/A 7821075 SUP HCPCS C1713 7821075 - PLATE BN 75MM NS TRAVERSE CMPR SPNE BOTH IP/OP "$11,560.00" "$8,554.00" "$2,294.37" "$11,560.00" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.39" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.23" "$11,560.00" "$4,624.00" "$5,699.08" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$8,670.00" "$11,560.00" "$11,560.00" "$11,560.00" "$5,780.00" "$5,780.00" "$9,155.52" "$11,560.00" "$9,248.00" "$5,202.00" "$2,294.37" N/A "$6,704.80" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.10" "$11,560.00" N/A N/A 7821080 SUP HCPCS C1713 7821080 - PLATE BN 80MM NS TRAVERSE CMPR SPNE BOTH IP/OP "$11,560.00" "$8,554.00" "$2,294.37" "$11,560.00" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.39" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.23" "$11,560.00" "$4,624.00" "$5,699.08" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$8,670.00" "$11,560.00" "$11,560.00" "$11,560.00" "$5,780.00" "$5,780.00" "$9,155.52" "$11,560.00" "$9,248.00" "$5,202.00" "$2,294.37" N/A "$6,704.80" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.10" "$11,560.00" N/A N/A 7821085 SUP HCPCS C1713 7821085 - PLATE BN 85MM NS TRAVERSE CMPR SPNE BOTH IP/OP "$11,560.00" "$8,554.00" "$2,294.37" "$11,560.00" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.39" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.23" "$11,560.00" "$11,560.00" "$5,699.08" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$8,670.00" "$11,560.00" "$11,560.00" "$11,560.00" "$5,780.00" "$5,780.00" "$9,155.52" "$11,560.00" "$9,248.00" "$5,202.00" "$2,294.37" N/A "$6,704.80" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.10" "$11,560.00" N/A N/A 7821095 SUP HCPCS C1713 7821095 - PLATE BN 95MM NS TRAVERSE CMPR SPNE BOTH IP/OP "$11,560.00" "$8,554.00" "$2,294.37" "$11,560.00" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.39" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.23" "$11,560.00" "$4,624.00" "$5,699.08" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$8,670.00" "$11,560.00" "$11,560.00" "$11,560.00" "$5,780.00" "$5,780.00" "$9,155.52" "$11,560.00" "$9,248.00" "$5,202.00" "$2,294.37" N/A "$6,704.80" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.10" "$11,560.00" N/A N/A 7821105 SUP HCPCS C1713 7821105 - PLATE BN 105MM NS TRAVERSE CMPR SPNE BOTH IP/OP "$11,560.00" "$8,554.00" "$2,294.37" "$11,560.00" "$5,202.00" "$5,202.00" "$5,202.00" "$5,202.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.39" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.23" "$11,560.00" "$4,624.00" "$5,699.08" "$11,560.00" "$11,560.00" "$11,560.00" "$11,560.00" "$8,670.00" "$11,560.00" "$11,560.00" "$11,560.00" "$5,780.00" "$5,780.00" "$9,155.52" "$11,560.00" "$9,248.00" "$5,202.00" "$2,294.37" N/A "$6,704.80" "$11,560.00" "$11,560.00" "$11,560.00" "$2,409.10" "$11,560.00" N/A N/A 7822035 SUP HCPCS C1713 7822035 - PLATE BN 35MM NS TRAVERSE 2 BOLT SPNE BOTH IP/OP "$9,747.50" "$7,213.00" "$1,934.64" "$9,747.50" "$4,386.38" "$4,386.38" "$4,386.38" "$4,386.38" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.62" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.49" "$9,747.50" "$3,899.00" "$4,805.52" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$7,310.63" "$9,747.50" "$9,747.50" "$9,747.50" "$4,873.75" "$4,873.75" "$7,720.02" "$9,747.50" "$7,798.00" "$4,386.38" "$1,934.64" N/A "$5,653.55" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.38" "$9,747.50" N/A N/A 7822040 SUP HCPCS C1713 7822040 - PLATE BN 40MM NS TRAVERSE 2 BOLT SPNE BOTH IP/OP "$9,747.50" "$7,213.00" "$1,934.64" "$9,747.50" "$4,386.38" "$4,386.38" "$4,386.38" "$4,386.38" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.62" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.49" "$9,747.50" "$3,899.00" "$4,805.52" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$7,310.63" "$9,747.50" "$9,747.50" "$9,747.50" "$4,873.75" "$4,873.75" "$7,720.02" "$9,747.50" "$7,798.00" "$4,386.38" "$1,934.64" N/A "$5,653.55" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.38" "$9,747.50" N/A N/A 7822045 SUP HCPCS C1713 7822045 - PLATE BN 45MM NS TRAVERSE 2 BOLT SPNE BOTH IP/OP "$9,747.50" "$7,213.00" "$1,934.64" "$9,747.50" "$4,386.38" "$4,386.38" "$4,386.38" "$4,386.38" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.62" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.49" "$9,747.50" "$3,899.00" "$4,805.52" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$7,310.63" "$9,747.50" "$9,747.50" "$9,747.50" "$4,873.75" "$4,873.75" "$7,720.02" "$9,747.50" "$7,798.00" "$4,386.38" "$1,934.64" N/A "$5,653.55" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.38" "$9,747.50" N/A N/A 7822050 SUP HCPCS C1713 7822050 - PLATE BN 50MM NS TRAVERSE 2 BOLT SPNE BOTH IP/OP "$9,747.50" "$7,213.00" "$1,934.64" "$9,747.50" "$4,386.38" "$4,386.38" "$4,386.38" "$4,386.38" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.62" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.49" "$9,747.50" "$9,747.50" "$4,805.52" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$7,310.63" "$9,747.50" "$9,747.50" "$9,747.50" "$4,873.75" "$4,873.75" "$7,720.02" "$9,747.50" "$7,798.00" "$4,386.38" "$1,934.64" N/A "$5,653.55" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.38" "$9,747.50" N/A N/A 7822055 SUP HCPCS C1713 7822055 - PLATE BN 55MM NS TRAVERSE 2 BOLT SPNE BOTH IP/OP "$9,747.50" "$7,213.00" "$1,934.64" "$9,747.50" "$4,386.38" "$4,386.38" "$4,386.38" "$4,386.38" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.62" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.49" "$9,747.50" "$9,747.50" "$4,805.52" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$7,310.63" "$9,747.50" "$9,747.50" "$9,747.50" "$4,873.75" "$4,873.75" "$7,720.02" "$9,747.50" "$7,798.00" "$4,386.38" "$1,934.64" N/A "$5,653.55" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.38" "$9,747.50" N/A N/A 7822060 SUP HCPCS C1713 7822060 - PLATE BONE 60MM 2 BOLT TRAVERSE SPN BOTH IP/OP "$9,747.50" "$7,213.00" "$1,934.64" "$9,747.50" "$4,386.38" "$4,386.38" "$4,386.38" "$4,386.38" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.62" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.49" "$9,747.50" "$3,899.00" "$4,805.52" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$7,310.63" "$9,747.50" "$9,747.50" "$9,747.50" "$4,873.75" "$4,873.75" "$7,720.02" "$9,747.50" "$7,798.00" "$4,386.38" "$1,934.64" N/A "$5,653.55" "$9,747.50" "$5,848.50" "$9,747.50" "$2,031.38" "$9,747.50" N/A N/A 7822065 SUP HCPCS C1713 7822065 - PLATE BONE 65MM 2 BOLT TRAVERSE SPN BOTH IP/OP "$9,747.50" "$7,213.00" "$1,934.64" "$9,747.50" "$4,386.38" "$4,386.38" "$4,386.38" "$4,386.38" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.62" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.49" "$9,747.50" "$3,899.00" "$4,805.52" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$7,310.63" "$9,747.50" "$9,747.50" "$9,747.50" "$4,873.75" "$4,873.75" "$7,720.02" "$9,747.50" "$7,798.00" "$4,386.38" "$1,934.64" N/A "$5,653.55" "$9,747.50" "$5,848.50" "$9,747.50" "$2,031.38" "$9,747.50" N/A N/A 7822070 SUP HCPCS C1713 7822070 - PLATE BN 70MM 2 BOLT TRAVERSE SPNE BOTH IP/OP "$9,747.50" "$7,213.00" "$1,934.64" "$9,747.50" "$4,386.38" "$4,386.38" "$4,386.38" "$4,386.38" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.62" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.49" "$9,747.50" "$9,747.50" "$4,805.52" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$7,310.63" "$9,747.50" "$9,747.50" "$9,747.50" "$4,873.75" "$4,873.75" "$7,720.02" "$9,747.50" "$7,798.00" "$4,386.38" "$1,934.64" N/A "$5,653.55" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.38" "$9,747.50" N/A N/A 7822075 SUP HCPCS C1713 7822075 - PLATE BN 75MM 2 BOLT TRAVERSE SPNE BOTH IP/OP "$9,747.50" "$7,213.00" "$1,934.64" "$9,747.50" "$4,386.38" "$4,386.38" "$4,386.38" "$4,386.38" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.62" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.49" "$9,747.50" "$9,747.50" "$4,805.52" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$7,310.63" "$9,747.50" "$9,747.50" "$9,747.50" "$4,873.75" "$4,873.75" "$7,720.02" "$9,747.50" "$7,798.00" "$4,386.38" "$1,934.64" N/A "$5,653.55" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.38" "$9,747.50" N/A N/A 7822080 SUP HCPCS C1713 7822080 - PLATE BN 80MM 2 BOLT TRAVERSE SPNE BOTH IP/OP "$9,747.50" "$7,213.00" "$1,934.64" "$9,747.50" "$4,386.38" "$4,386.38" "$4,386.38" "$4,386.38" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.62" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.49" "$9,747.50" "$3,899.00" "$4,805.52" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$7,310.63" "$9,747.50" "$9,747.50" "$9,747.50" "$4,873.75" "$4,873.75" "$7,720.02" "$9,747.50" "$7,798.00" "$4,386.38" "$1,934.64" N/A "$5,653.55" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.38" "$9,747.50" N/A N/A 7822085 SUP HCPCS C1713 7822085 - PLATE BN 85MM 2 BOLT TRAVERSE SPNE BOTH IP/OP "$9,747.50" "$7,213.00" "$1,934.64" "$9,747.50" "$4,386.38" "$4,386.38" "$4,386.38" "$4,386.38" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.62" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.49" "$9,747.50" "$3,899.00" "$4,805.52" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$7,310.63" "$9,747.50" "$9,747.50" "$9,747.50" "$4,873.75" "$4,873.75" "$7,720.02" "$9,747.50" "$7,798.00" "$4,386.38" "$1,934.64" N/A "$5,653.55" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.38" "$9,747.50" N/A N/A 7822095 SUP HCPCS C1713 7822095 - PLATE BN 95MM 2 BOLT TRAVERSE SPNE BOTH IP/OP "$9,747.50" "$7,213.00" "$1,934.64" "$9,747.50" "$4,386.38" "$4,386.38" "$4,386.38" "$4,386.38" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.62" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.49" "$9,747.50" "$9,747.50" "$4,805.52" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$7,310.63" "$9,747.50" "$9,747.50" "$9,747.50" "$4,873.75" "$4,873.75" "$7,720.02" "$9,747.50" "$7,798.00" "$4,386.38" "$1,934.64" N/A "$5,653.55" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.38" "$9,747.50" N/A N/A 7822105 SUP HCPCS C1713 7822105 - PLATE BN 105MM 2 BOLT TRAVERSE SPNE BOTH IP/OP "$9,747.50" "$7,213.00" "$1,934.64" "$9,747.50" "$4,386.38" "$4,386.38" "$4,386.38" "$4,386.38" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.62" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.49" "$9,747.50" "$9,747.50" "$4,805.52" "$9,747.50" "$9,747.50" "$9,747.50" "$9,747.50" "$7,310.63" "$9,747.50" "$9,747.50" "$9,747.50" "$4,873.75" "$4,873.75" "$7,720.02" "$9,747.50" "$7,798.00" "$4,386.38" "$1,934.64" N/A "$5,653.55" "$9,747.50" "$9,747.50" "$9,747.50" "$2,031.38" "$9,747.50" N/A N/A 7830002 SUP HCPCS C1713 7830002 - SCREW BONE NUT LOCKING TITANIUM SPN BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 7835525 SUP HCPCS C1713 7835525 - SCREW BONE 5.5MM 25MM ASMBLY TRAVERSE SPN BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" $403.00 $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" "$1,007.50" "$1,007.50" $209.96 "$1,007.50" N/A N/A 7835530 SUP HCPCS C1713 7835530 - SCREW BONE 5.5MM 30MM TRAVERSE SPN BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" $403.00 $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" "$1,007.50" "$1,007.50" $209.96 "$1,007.50" N/A N/A 7835535 SUP HCPCS C1713 7835535 - SCREW BONE 5.5MM 35MM TRAVERSE SPN BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" "$1,007.50" $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" $604.50 "$1,007.50" $209.96 "$1,007.50" N/A N/A 7835540 SUP HCPCS C1713 7835540 - SCREW BN 5.5MM 40MM NS TRAVERSE SPNE BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" $403.00 $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" "$1,007.50" "$1,007.50" $209.96 "$1,007.50" N/A N/A 7835545 SUP HCPCS C1713 7835545 - SCREW BN 5.5MM 45MM NS TRAVERSE SPNE BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" $403.00 $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" "$1,007.50" "$1,007.50" $209.96 "$1,007.50" N/A N/A 7835550 SUP HCPCS C1713 7835550 - SCREW BONE 5.5MM 50MM TRAVERSE SPN BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" $403.00 $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" $604.50 "$1,007.50" $209.96 "$1,007.50" N/A N/A 7835555 SUP HCPCS C1713 7835555 - SCREW BN 5.5MM 55MM NS TRAVERSE SPNE BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" $403.00 $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" "$1,007.50" "$1,007.50" $209.96 "$1,007.50" N/A N/A 7835560 SUP HCPCS C1713 7835560 - SCREW BN 5.5MM 60MM NS TRAVERSE SPNE BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" $403.00 $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" "$1,007.50" "$1,007.50" $209.96 "$1,007.50" N/A N/A 7835565 SUP HCPCS C1713 7835565 - SCREW BN 5.5MM 65MM NS TRAVERSE SPNE BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" $403.00 $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" "$1,007.50" "$1,007.50" $209.96 "$1,007.50" N/A N/A 7846525 SUP HCPCS C1713 7846525 - SCREW BN 6.5MM 25MM NS TRAVERSE SPNE BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" $403.00 $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" "$1,007.50" "$1,007.50" $209.96 "$1,007.50" N/A N/A 7846530 SUP HCPCS C1713 7846530 - SCREW BONE 6.5MM 30MM TRAVERSE SPN BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" "$1,007.50" $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" $604.50 "$1,007.50" $209.96 "$1,007.50" N/A N/A 7846535 SUP HCPCS C1713 7846535 - SCREW BN 6.5MM 35MM NS TRAVERSE SPNE BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" "$1,007.50" $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" "$1,007.50" "$1,007.50" $209.96 "$1,007.50" N/A N/A 7846540 SUP HCPCS C1713 7846540 - SCREW BN 6.5MM 40MM NS TRAVERSE SPNE BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" $403.00 $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" "$1,007.50" "$1,007.50" $209.96 "$1,007.50" N/A N/A 7846545 SUP HCPCS C1713 7846545 - TRAVERSE 6.5X 45MM VARIABLE SCREW BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" $403.00 $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" $604.50 "$1,007.50" $209.96 "$1,007.50" N/A N/A 7846550 SUP HCPCS C1713 7846550 - TRAVERSE 6.5X 50MM VARIABLE SCREW BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" $403.00 $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" $604.50 "$1,007.50" $209.96 "$1,007.50" N/A N/A 7846555 SUP HCPCS C1713 7846555 - SCREW BN 6.5MM 55MM NS TRAVERSE SPNE BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" $403.00 $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" "$1,007.50" "$1,007.50" $209.96 "$1,007.50" N/A N/A 7846560 SUP HCPCS C1713 7846560 - SCREW BN 6.5MM 60MM NS TRAVERSE SPNE BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" "$1,007.50" $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" "$1,007.50" "$1,007.50" $209.96 "$1,007.50" N/A N/A 7846565 SUP HCPCS C1713 7846565 - SCREW BN 6.5MM 65MM NS TRAVERSE SPNE BOTH IP/OP "$1,007.50" $746.00 $199.96 "$1,007.50" $453.38 $453.38 $453.38 $453.38 "$1,007.50" "$1,007.50" "$1,007.50" $209.99 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $209.97 "$1,007.50" "$1,007.50" $595.94 "$1,007.50" "$1,007.50" "$1,007.50" "$1,007.50" $755.63 "$1,007.50" "$1,007.50" "$1,007.50" $503.75 $503.75 $797.94 "$1,007.50" $806.00 $453.38 $199.96 N/A $584.35 "$1,007.50" "$1,007.50" "$1,007.50" $209.96 "$1,007.50" N/A N/A 7856525 SUP HCPCS C1713 7856525 - BOLT SPNL 6.5MM 25MM NS TRAVERSE PLT BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" "$1,487.50" $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" N/A N/A 7856530 SUP HCPCS C1713 7856530 - BOLT SPINAL 6.5MM 30MM BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" $892.50 "$1,487.50" $310.00 "$1,487.50" N/A N/A 7856535 SUP HCPCS C1713 7856535 - BOLT SPINAL 6.5MM 35MM BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" $892.50 "$1,487.50" $310.00 "$1,487.50" N/A N/A 7856540 SUP HCPCS C1713 7856540 - BOLT SPNL 6.5MM 40MM NS TRAVERSE PLT BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A 7856545 SUP HCPCS C1713 7856545 - BOLT SPINAL 6.5MM 45MM TITANIUM BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" $892.50 "$1,487.50" $310.00 "$1,487.50" N/A N/A 7856550 SUP HCPCS C1713 7856550 - BOLT SPINAL 6.5MM 50MM BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" "$1,487.50" $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" $892.50 "$1,487.50" $310.00 "$1,487.50" N/A N/A 7856555 SUP HCPCS C1713 7856555 - BOLT SPNL 6.5MM 55MM NS TRAVERSE PLT BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A 7856560 SUP HCPCS C1713 7856560 - BOLT SPNL 6.5MM 60MM NS TRAVERSE PLT BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" "$1,487.50" $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A 7856565 SUP HCPCS C1713 7856565 - BOLT SPNL 6.5MM 65MM NS TRAVERSE PLT BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A 7860845 SUP HCPCS C1713 7860845 - CAGE SPNL 45X18X8MM CRNT XLIF BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7860850 SUP HCPCS C1713 7860850 - CAGE SPNL XL 50X18X8MM NS LF CRNT BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7860855 SUP HCPCS C1713 7860855 - CAGE SPNL XL 55X18X8MM NS LF CRNT BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7860860 SUP HCPCS C1713 7860860 - CAGE SPNL 10D LRDTC 60X18X8MM CRNT XLIF PEEK-OPTM BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 7861045 SUP HCPCS C1713 7861045 - SPACER SPNL 45X18X10MM CRNT BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7861050 SUP HCPCS C1713 7861050 - CAGE SPNL XL 50X18X10MM NS LF CRNT BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 7861055 SUP HCPCS C1713 7861055 - CAGE SPNL XL 55X18X10MM NS LF CRNT BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 7861060 SUP HCPCS C1713 7861060 - CAGE SPNL STD XL 60X10MM PLT FSN PEEK BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 7861245 SUP HCPCS C1713 7861245 - SPACER SPNL XL 45X18X12MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 7861250 SUP HCPCS C1713 7861250 - CAGE SPNL XL 50X12X12MM NS LF CRNT BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 7861255 SUP HCPCS C1713 7861255 - CAGE SPNL XL 55X12X12MM NS LF CRNT BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7861260 SUP HCPCS C1713 7861260 - SPACER SPNL XL 60X18X12MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7861445 SUP HCPCS C1713 7861445 - SPACER SPNL XL 45X18X14MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 7861450 SUP HCPCS C1713 7861450 - SPACER SPNL XL 50X18X14MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7861455 SUP HCPCS C1713 7861455 - IMPLANT SPNL 55X18X14MM XLIF CRNT BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7861460 SUP HCPCS C1713 7861460 - SPACER SPNL XL 60X18X14MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7861645 SUP HCPCS C1713 7861645 - SPACER SPNL XL 45X18X16MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 7861650 SUP HCPCS C1713 7861650 - SPACER SPNL XL 50X18X16MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 7861655 SUP HCPCS C1713 7861655 - SPACER SPNL XL 55X18X16MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7861660 SUP HCPCS C1713 7861660 - SPACER SPNL XL 60X18X16MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7861845 SUP HCPCS C1713 7861845 - CAGE SPNL XL 45X18X18MM NS LF CRNT PEEK-OPTM 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$8,250.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7861850 SUP HCPCS C1713 7861850 - CAGE SPNL 10D LRDTC 50X18X10MM CRNT XLIF PEEK-OPTM BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7861855 SUP HCPCS C1713 7861855 - SPACER SPNL XL 55X18X18MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7861860 SUP HCPCS C1713 7861860 - CAGE SPNL 10D LRDTC 60X18X8MM CRNT XLIF PEEK-OPTM BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7867525 SUP HCPCS C1713 7867525 - BOLT SPNL 7.5MM 25MM NS TRAVERSE PLT BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A 7867530 SUP HCPCS C1713 7867530 - BOLT SPNL 7.5MM 30MM NS TRAVERSE PLT BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A 7867535 SUP HCPCS C1713 7867535 - BOLT SPNL 7.5MM 35MM NS TRAVERSE PLT BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A 7867540 SUP HCPCS C1713 7867540 - BOLT SPNL 7.5MM 40MM NS TRAVERSE PLT BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" N/A N/A 7867545 SUP HCPCS C1713 7867545 - BOLT SPNL 7.5MM 45MM NS TRAVERSE PLT BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A 7867550 SUP HCPCS C1713 7867550 - BOLT SPNL 7.5MM 50MM NS TRAVERSE PLT BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A 7867555 SUP HCPCS C1713 7867555 - BOLT SPNL 7.5MM 55MM NS TRAVERSE PLT BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A 7867560 SUP HCPCS C1713 7867560 - BOLT SPNL 7.5MM 60MM NS TRAVERSE PLT BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" N/A N/A 7867565 SUP HCPCS C1713 7867565 - BOLT SPNL 7.5MM 65MM NS TRAVERSE PLT BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" N/A N/A 7870845 SUP HCPCS C1713 7870845 - SPACER SPNL 10D XL 45X18X8MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7870850 SUP HCPCS C1713 7870850 - CAGE SPNL 10D XL 50X18X8MM NS LF CRNT BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7870855 SUP HCPCS C1713 7870855 - CAGE SPNL 10D XL 55X18X8MM NS LF CRNT BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7870860 SUP HCPCS C1713 7870860 - CAGE SPNL 10D LRDTC 60X18X8MM CRNT XLIF PEEK-OPTM BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871055 SUP HCPCS C1713 7871055 - CAGE SPNL 10D XL 55X18X10MM NS LF CRNT BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 7871060 SUP HCPCS C1713 7871060 - CAGE SPNL 10D LRDTC 60X18X10MM CRNT XLIF PEEK-OPTM BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 7871245 SUP HCPCS C1713 7871245 - SPACER SPNL XL 45X18X12MM CRNT FSN BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" N/A N/A 7871250 SUP HCPCS C1713 7871250 - CAGE SPNL 10D XL 50X18X10MM NS LF CRNT BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871255 SUP HCPCS C1713 7871255 - CAGE SPNL 10D XL 55X18X12MM NS LF CRNT BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871260 SUP HCPCS C1713 7871260 - CAGE SPNL 10D LRDTC 60X18X12MM CRNT XLIF PEEK-OPTM BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871445 SUP HCPCS C1713 7871445 - SPACER SPNL 10D XL 45X18X14MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871450 SUP HCPCS C1713 7871450 - SPACER SPNL 10D XL 50X18X14MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871455 SUP HCPCS C1713 7871455 - CAGE SPNL 10D LRDTC 55X18X14MM CRNT XLIF PEEK-OPTM BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871460 SUP HCPCS C1713 7871460 - CAGE SPNL 10D LRDTC 60X18X14MM CRNT XLIF PEEK-OPTM BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871645 SUP HCPCS C1713 7871645 - SPACER SPNL 10D XL 45X18X16MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871650 SUP HCPCS C1713 7871650 - SPACER SPNL 10D XL 50X18X16MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871655 SUP HCPCS C1713 7871655 - SPACER SPNL 10D XL 55X18X16MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871660 SUP HCPCS C1713 7871660 - SPACER SPNL 10D XL 60X18X16MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871845 SUP HCPCS C1713 7871845 - SPACER SPNL 10D XL 45X18X18MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871850 SUP HCPCS C1713 7871850 - SPACER SPNL 10D XL 50X18X18MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871855 SUP HCPCS C1713 7871855 - SPACER SPNL 10D XL 55X18X18MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7871860 SUP HCPCS C1713 7871860 - SPACER SPNL 10D XL 60X18X18MM CRNT 1ST LAT APRCH BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 7875520 SUP HCPCS C1713 7875520 - SCREW BN 5.5MM 20MM HALO SPNE BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" $423.00 $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7875522 SUP HCPCS C1713 7875522 - SCREW BN 5.5MM 22MM HALO SPNE BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" $423.00 $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7875524 SUP HCPCS C1713 7875524 - SCREW BN 5.5MM 24MM HALO SPNE BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" "$1,057.50" $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7875526 SUP HCPCS C1713 7875526 - SCREW BN 5.5MM 26MM HALO SPNE BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" "$1,057.50" $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7875528 SUP HCPCS C1713 7875528 - SCREW BN 5.5MM 28MM HALO SPNE BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" "$1,057.50" $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7875530 SUP HCPCS C1713 7875530 - SCREW BN 5.5MM 30MM HALO SPNE LMBR ANT BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" "$1,057.50" $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7875532 SUP HCPCS C1713 7875532 - SCREW BN 5.5MM 32MM HALO SPNE LMBR ANT BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" $423.00 $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7875534 SUP HCPCS C1713 7875534 - SCREW BN 5.5MM 34MM HALO SPNE LMBR ANT BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" $423.00 $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7876520 SUP HCPCS C1713 7876520 - SCREW BN 6.5MM 20MM HALO SPNE LMBR ANT BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" "$1,057.50" $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7876522 SUP HCPCS C1713 7876522 - SCREW BN 6.5MM 22MM HALO SPNE BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" $423.00 $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7876526 SUP HCPCS C1713 7876526 - SCREW BN 6.5MM 26MM HALO ANT LMBR SPNE PLT BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" $423.00 $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7876528 SUP HCPCS C1713 7876528 - SCREW BN 6.5MM 28MM HALO PLT ANT LMBR SPNE BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" $423.00 $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7876530 SUP HCPCS C1713 7876530 - SCREW BN 6.5MM 30MM HALO SPNE LMBR ANT BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" "$1,057.50" $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7876532 SUP HCPCS C1713 7876532 - SCREW BN 6.5MM 32MM HALO SPNE LMBR ANT BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" $423.00 $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7876534 SUP HCPCS C1713 7876534 - SCREW BN 6.5MM 34MM HALO SPNE LMBR ANT BOTH IP/OP "$1,057.50" $783.00 $209.89 "$1,057.50" $475.88 $475.88 $475.88 $475.88 "$1,057.50" "$1,057.50" "$1,057.50" $220.41 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $220.39 "$1,057.50" "$1,057.50" $625.51 "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" $793.13 "$1,057.50" "$1,057.50" "$1,057.50" $528.75 $528.75 $837.54 "$1,057.50" $846.00 $475.88 $209.89 N/A $613.35 "$1,057.50" "$1,057.50" "$1,057.50" $220.38 "$1,057.50" N/A N/A 7890030 SUP HCPCS C1713 7890030 - PIN SKL HALO SLV ANT LMBR SPNE BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A 7891032 SUP HCPCS C1713 7891032 - PLATE BN 32MM HALO TI SPNE LMBR ANT BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$3,363.00" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 7891034 SUP HCPCS C1713 7891034 - PLATE BN 34MM HALO TI SPNE LMBR ANT BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$8,407.50" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 7891036 SUP HCPCS C1713 7891036 - PLATE BN 36MM HALO TI SPNE LMBR ANT BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$8,407.50" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 7891038 SUP HCPCS C1713 7891038 - PLATE BN 38MM HALO TI SPNE LMBR ANT BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$3,363.00" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 7891040 SUP HCPCS C1713 7891040 - PLATE BN 40MM HALO TI SPNE LMBR ANT BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$3,363.00" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 7891042 SUP HCPCS C1713 7891042 - PLATE BN 42MM HALO TI SPNE LMBR ANT BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$3,363.00" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 7891044 SUP HCPCS C1713 7891044 - PLATE BN 44MM HALO TI SPNE LMBR ANT BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$3,363.00" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 7891046 SUP HCPCS C1713 7891046 - PLATE BN 46MM HALO TI SPNE LMBR ANT BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$3,363.00" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 7892032 SUP HCPCS C1713 7892032 - PLATE BN 32MM HALO TI SPNE SCRM ANT BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$3,363.00" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 7892034 SUP HCPCS C1713 7892034 - PLATE BN 34MM HALO TI SPNE SCRM ANT BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$3,363.00" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 7892038 SUP HCPCS C1713 7892038 - PLATE BN 38MM HALO TI SPNE SCRM ANT BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$3,363.00" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 7892042 SUP HCPCS C1713 7892042 - PLATE BN 42MM HALO TI SPNE SCRM ANT BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$8,407.50" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 7892044 SUP HCPCS C1713 7892044 - PLATE BN 44MM HALO TI SPNE SCRM ANT BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$3,363.00" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 7892046 SUP HCPCS C1713 7892046 - PLATE BN 46MM HALO TI SPNE SCRM ANT BOTH IP/OP "$8,407.50" "$6,222.00" "$1,668.68" "$8,407.50" "$3,783.38" "$3,783.38" "$3,783.38" "$3,783.38" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.33" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.22" "$8,407.50" "$3,363.00" "$4,144.90" "$8,407.50" "$8,407.50" "$8,407.50" "$8,407.50" "$6,305.63" "$8,407.50" "$8,407.50" "$8,407.50" "$4,203.75" "$4,203.75" "$6,658.74" "$8,407.50" "$6,726.00" "$3,783.38" "$1,668.68" N/A "$4,876.35" "$8,407.50" "$8,407.50" "$8,407.50" "$1,752.12" "$8,407.50" N/A N/A 7892525 SUP HCPCS C1713 7892525 - SCREW BONE 5.5MM 25MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892530 SUP HCPCS C1713 7892530 - SCREW BONE 5.5MM 30MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892535 SUP HCPCS C1713 7892535 - SCREW BONE 5.5MM 35MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892540 SUP HCPCS C1713 7892540 - SCREW BONE 5.5MM 40MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892545 SUP HCPCS C1713 7892545 - SCREW BONE 5.5MM 45MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892550 SUP HCPCS C1713 7892550 - SCREW BONE 5.5MM 50MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892555 SUP HCPCS C1713 7892555 - SCREW BONE 5.5MM 55MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892560 SUP HCPCS C1713 7892560 - SCREW BONE 5.5MM 60MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892625 SUP HCPCS C1713 7892625 - SCREW BONE 6.5MM 25MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892630 SUP HCPCS C1713 7892630 - SCREW BONE 6.5MM 30MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892635 SUP HCPCS C1713 7892635 - SCREW BONE 6.5MM 35MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892640 SUP HCPCS C1713 7892640 - SCREW BONE 6.5MM 40MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892645 SUP HCPCS C1713 7892645 - SCREW BONE 6.5MM 45MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892650 SUP HCPCS C1713 7892650 - SCREW BONE 6.5MM 50MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892655 SUP HCPCS C1713 7892655 - SCREW BONE 6.5MM 55MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892660 SUP HCPCS C1713 7892660 - SCREW BONE 6.5MM 60MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892665 SUP HCPCS C1713 7892665 - SCREW BONE 6.5MM 65MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892725 SUP HCPCS C1713 7892725 - SCREW BONE 7.5MM 25MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892730 SUP HCPCS C1713 7892730 - SCREW BONE 7.5MM 30MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892735 SUP HCPCS C1713 7892735 - SCREW BONE 7.5MM 35MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892740 SUP HCPCS C1713 7892740 - SCREW BN 7.5MM 40MM STRL CD HZN LGC MA PEEK HA SPNE PDCL 5.5 BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892745 SUP HCPCS C1713 7892745 - SCREW BN 7.5MM 45MM STRL CD HZN LGC MA PEEK HA SPNE PDCL 5.5 BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892750 SUP HCPCS C1713 7892750 - SCREW BONE 7.5MM 50MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892755 SUP HCPCS C1713 7892755 - SCREW BONE 7.5MM 55MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892760 SUP HCPCS C1713 7892760 - SCREW BONE 7.5MM 60MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892765 SUP HCPCS C1713 7892765 - SCREW BONE 7.5MM 65MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892770 SUP HCPCS C1713 7892770 - SCREW BONE 7.5MM 70MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892825 SUP HCPCS C1713 7892825 - SCREW BONE 8.5MM 25MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892830 SUP HCPCS C1713 7892830 - SCREW BONE 8.5MM 30MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892835 SUP HCPCS C1713 7892835 - SCREW BONE 8.5MM 35MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892840 SUP HCPCS C1713 7892840 - SCREW BONE 8.5MM 40MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892845 SUP HCPCS C1713 7892845 - SCREW BONE 8.5MM 45MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892850 SUP HCPCS C1713 7892850 - SCREW BONE 8.5MM 50MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892855 SUP HCPCS C1713 7892855 - SCREW BONE 8.5MM 55MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892860 SUP HCPCS C1713 7892860 - SCREW BONE 8.5MM 60MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7892865 SUP HCPCS C1713 7892865 - SCREW BONE 8.5MM 65MM MULTIAX LEGACY CD HORIZON PEEK HA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7893025 SUP HCPCS C1713 7893025 - ROD SPINAL 6.35MM 25MM CD HORIZON LEGACY PEEK TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 7893030 SUP HCPCS C1713 7893030 - ROD SPINAL 6.35MM 30MM PEEK-OPTIMA PEDICLE BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 7893035 SUP HCPCS C1713 7893035 - ROD SPINAL 6.35MM 35MM LEGACY CD HORIZON PEEK-OPTIMA PEDICLE BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 7893040 SUP HCPCS C1713 7893040 - ROD SPINAL 6.35MM 40MM LEGACY CD HORIZON PEEK-OPTIMA PEDICLE BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 7893045 SUP HCPCS C1713 7893045 - ROD SPINAL 45MM PEEK-OPTIMA BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 7893050 SUP HCPCS C1713 7893050 - ROD SPINAL 6.35MM 50MM PEEK-OPTIMA PEDICLE BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7893055 SUP HCPCS C1713 7893055 - ROD SPINAL 6.35MM 55MM CD HORIZON LEGACY PEEK TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7893060 SUP HCPCS C1713 7893060 - ROD SPINAL 6.35MM 60MM LEGACY CD HORIZON PEEK-OPTIMA PEDICLE BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7893065 SUP HCPCS C1713 7893065 - ROD SPINAL 6.35MM 65MM CD HORIZON LEGACY PEEK TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 7893070 SUP HCPCS C1713 7893070 - ROD SPINAL 6.35MM 70MM LEGACY CD HORIZON PEEK-OPTIMA PEDICLE BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 7893075 SUP HCPCS C1713 7893075 - ROD SPINAL 6.35MM 75MM CD HORIZON LEGACY PEEK TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 7893076 SUP HCPCS C1713 7893076 - PLATE BN 76MM HALO LVL 2 TI SPNE LMBR ANT BOTH IP/OP "$11,927.50" "$8,826.00" "$2,367.31" "$11,927.50" "$5,367.38" "$5,367.38" "$5,367.38" "$5,367.38" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.99" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.82" "$11,927.50" "$4,771.00" "$5,880.26" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$8,945.63" "$11,927.50" "$11,927.50" "$11,927.50" "$5,963.75" "$5,963.75" "$9,446.58" "$11,927.50" "$9,542.00" "$5,367.38" "$2,367.31" N/A "$6,917.95" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.69" "$11,927.50" N/A N/A 7893080 SUP HCPCS C1713 7893080 - PLATE BN 80MM HALO LVL 2 TI SPNE LMBR ANT BOTH IP/OP "$11,927.50" "$8,826.00" "$2,367.31" "$11,927.50" "$5,367.38" "$5,367.38" "$5,367.38" "$5,367.38" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.99" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.82" "$11,927.50" "$4,771.00" "$5,880.26" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$8,945.63" "$11,927.50" "$11,927.50" "$11,927.50" "$5,963.75" "$5,963.75" "$9,446.58" "$11,927.50" "$9,542.00" "$5,367.38" "$2,367.31" N/A "$6,917.95" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.69" "$11,927.50" N/A N/A 7893080 SUP HCPCS C1713 7893080 - ROD SPINAL 6.35MM 80MM PEEK-OPTIMA PEDICLE BOTH IP/OP "$11,927.50" "$8,826.00" "$2,367.31" "$11,927.50" "$5,367.38" "$5,367.38" "$5,367.38" "$5,367.38" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.99" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.82" "$11,927.50" "$4,771.00" "$5,880.26" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$8,945.63" "$11,927.50" "$11,927.50" "$11,927.50" "$5,963.75" "$5,963.75" "$9,446.58" "$11,927.50" "$9,542.00" "$5,367.38" "$2,367.31" N/A "$6,917.95" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.69" "$11,927.50" N/A N/A 7893084 SUP HCPCS C1713 7893084 - PLATE BN 84MM HALO LVL 2 TI SPNE LMBR ANT BOTH IP/OP "$11,927.50" "$8,826.00" "$2,367.31" "$11,927.50" "$5,367.38" "$5,367.38" "$5,367.38" "$5,367.38" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.99" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.82" "$11,927.50" "$4,771.00" "$5,880.26" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$8,945.63" "$11,927.50" "$11,927.50" "$11,927.50" "$5,963.75" "$5,963.75" "$9,446.58" "$11,927.50" "$9,542.00" "$5,367.38" "$2,367.31" N/A "$6,917.95" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.69" "$11,927.50" N/A N/A 7893085 SUP HCPCS C1713 7893085 - ROD SPINAL 6.35MM 85MM CD HORIZON LEGACY PEEK TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7893088 SUP HCPCS C1713 7893088 - PLATE BN 88MM HALO LVL 2 TI SPNE LMBR ANT BOTH IP/OP "$11,927.50" "$8,826.00" "$2,367.31" "$11,927.50" "$5,367.38" "$5,367.38" "$5,367.38" "$5,367.38" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.99" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.82" "$11,927.50" "$4,771.00" "$5,880.26" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$8,945.63" "$11,927.50" "$11,927.50" "$11,927.50" "$5,963.75" "$5,963.75" "$9,446.58" "$11,927.50" "$9,542.00" "$5,367.38" "$2,367.31" N/A "$6,917.95" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.69" "$11,927.50" N/A N/A 7893090 SUP HCPCS C1713 7893090 - ROD SPINAL 6.35MM 90MM PEEK-OPTIMA PEDICLE BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 7893092 SUP HCPCS C1713 7893092 - PLATE BN 92MM HALO LVL 2 TI SPNE LMBR ANT BOTH IP/OP "$11,927.50" "$8,826.00" "$2,367.31" "$11,927.50" "$5,367.38" "$5,367.38" "$5,367.38" "$5,367.38" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.99" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.82" "$11,927.50" "$11,927.50" "$5,880.26" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$8,945.63" "$11,927.50" "$11,927.50" "$11,927.50" "$5,963.75" "$5,963.75" "$9,446.58" "$11,927.50" "$9,542.00" "$5,367.38" "$2,367.31" N/A "$6,917.95" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.69" "$11,927.50" N/A N/A 7893095 SUP HCPCS C1713 7893095 - ROD SPINAL 6.35MM 95MM CD HORIZON LEGACY PEEK TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7893096 SUP HCPCS C1713 7893096 - PLATE BN 96MM HALO LVL 2 TI SPNE LMBR ANT BOTH IP/OP "$11,927.50" "$8,826.00" "$2,367.31" "$11,927.50" "$5,367.38" "$5,367.38" "$5,367.38" "$5,367.38" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.99" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.82" "$11,927.50" "$4,771.00" "$5,880.26" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$8,945.63" "$11,927.50" "$11,927.50" "$11,927.50" "$5,963.75" "$5,963.75" "$9,446.58" "$11,927.50" "$9,542.00" "$5,367.38" "$2,367.31" N/A "$6,917.95" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.69" "$11,927.50" N/A N/A 7893100 SUP HCPCS C1713 7893100 - PLATE BN 100MM HALO LVL 2 TI SPNE LMBR ANT BOTH IP/OP "$11,927.50" "$8,826.00" "$2,367.31" "$11,927.50" "$5,367.38" "$5,367.38" "$5,367.38" "$5,367.38" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.99" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.82" "$11,927.50" "$4,771.00" "$5,880.26" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$8,945.63" "$11,927.50" "$11,927.50" "$11,927.50" "$5,963.75" "$5,963.75" "$9,446.58" "$11,927.50" "$9,542.00" "$5,367.38" "$2,367.31" N/A "$6,917.95" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.69" "$11,927.50" N/A N/A 7893100 SUP HCPCS C1713 7893100 - ROD SPINAL 100MM PREBENT PEEK-OPTIMA BOTH IP/OP "$11,927.50" "$8,826.00" "$2,367.31" "$11,927.50" "$5,367.38" "$5,367.38" "$5,367.38" "$5,367.38" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.99" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.82" "$11,927.50" "$4,771.00" "$5,880.26" "$11,927.50" "$11,927.50" "$11,927.50" "$11,927.50" "$8,945.63" "$11,927.50" "$11,927.50" "$11,927.50" "$5,963.75" "$5,963.75" "$9,446.58" "$11,927.50" "$9,542.00" "$5,367.38" "$2,367.31" N/A "$6,917.95" "$11,927.50" "$11,927.50" "$11,927.50" "$2,485.69" "$11,927.50" N/A N/A 7893105 SUP HCPCS C1713 7893105 - ROD SPINAL 6.35MM 105MM CD HORIZON LEGACY PEEK TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 7893110 SUP HCPCS C1713 7893110 - ROD SPINAL 110MM PREBENT PEEK-OPTIMA BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7893115 SUP HCPCS C1713 7893115 - ROD SPINAL 6.35MM 115MM CD HORIZON LEGACY PEEK TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7893120 SUP HCPCS C1713 7893120 - ROD SPINAL 6.35MM 120MM PEEK-OPTIMA PEDICLE BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 7893125 SUP HCPCS C1713 7893125 - ROD SPINAL 6.35MM 125MM CD HORIZON LEGACY PEEK TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 7893130 SUP HCPCS C1713 7893130 - ROD SPINAL 6.35MM 130MM CD HORIZON LEGACY PEEK TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 7894525 SUP HCPCS C1713 7894525 - SCREW BONE 4.5MM 25MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7894530 SUP HCPCS C1713 7894530 - SCREW BONE 4.5MM 30MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7894535 SUP HCPCS C1713 7894535 - SCREW BONE 4.5MM 35MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7894540 SUP HCPCS C1713 7894540 - SCREW BONE 4.5MM 40MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7894545 SUP HCPCS C1713 7894545 - SCREW BONE 4.5MM 45MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7894550 SUP HCPCS C1713 7894550 - SCREW BONE 4.5MM 50MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7895525 SUP HCPCS C1713 7895525 - SCREW BONE 5.5MM 25MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7895530 SUP HCPCS C1713 7895530 - SCREW BONE 5.5MM 30MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7895535 SUP HCPCS C1713 7895535 - SCREW BONE 5.5MM 35MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7895540 SUP HCPCS C1713 7895540 - SCREW BONE 5.5MM 40MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7895545 SUP HCPCS C1713 7895545 - SCREW BN 5.5MM 45MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7895550 SUP HCPCS C1713 7895550 - SCREW BONE 5.5MM 50MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7895555 SUP HCPCS C1713 7895555 - SCREW BONE 5.5MM 55MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7895560 SUP HCPCS C1713 7895560 - SCREW BONE 5.5MM 60MM NONCANNULATED CD HORIZON PEEK-OPTIMA BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7896525 SUP HCPCS C1713 7896525 - SCREW BONE 6.5MM 25MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7896530 SUP HCPCS C1713 7896530 - SCREW BONE 6.5MM 30MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7896535 SUP HCPCS C1713 7896535 - SCREW BN 6.5MM 35MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7896540 SUP HCPCS C1713 7896540 - SCREW BN 6.5MM 40MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7896545 SUP HCPCS C1713 7896545 - SCREW BN 6.5MM 45MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7896550 SUP HCPCS C1713 7896550 - SCREW BN 6.5MM 50MM STRL CD HZN LGC MA PEEK SPNE PDCL 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7896555 SUP HCPCS C1713 7896555 - SCREW BONE 6.5MM 55MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7896560 SUP HCPCS C1713 7896560 - SCREW BONE 6.5MM 60MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7896565 SUP HCPCS C1713 7896565 - SCREW BONE 6.5MM 65MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7897530 SUP HCPCS C1713 7897530 - SCREW BONE 7.5MM 30MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7897535 SUP HCPCS C1713 7897535 - SCREW BONE 7.5MM 35MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7897540 SUP HCPCS C1713 7897540 - SCREW BONE 7.5MM 40MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7897545 SUP HCPCS C1713 7897545 - SCREW BONE 7.5MM 45MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7897550 SUP HCPCS C1713 7897550 - SCREW BONE 7.5MM 50MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7897555 SUP HCPCS C1713 7897555 - SCREW BONE 7.5MM 55MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7897560 SUP HCPCS C1713 7897560 - SCREW BONE 7.5MM 60MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7897565 SUP HCPCS C1713 7897565 - SCREW BONE 7.5MM 65MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7897570 SUP HCPCS C1713 7897570 - SCREW BONE 7.5MM 70MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7898530 SUP HCPCS C1713 7898530 - SCREW BONE 8.5MM 30MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7898535 SUP HCPCS C1713 7898535 - SCREW BONE 8.5MM 35MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7898540 SUP HCPCS C1713 7898540 - SCREW BONE 8.5MM 40MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7898545 SUP HCPCS C1713 7898545 - SCREW BONE 8.5MM 45MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7898550 SUP HCPCS C1713 7898550 - SCREW BONE 8.5MM 50MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7898555 SUP HCPCS C1713 7898555 - SCREW BONE 8.5MM 55MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7898560 SUP HCPCS C1713 7898560 - SCREW BONE 8.5MM 60MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7898565 SUP HCPCS C1713 7898565 - SCREW BONE 8.5MM 65MM MULTIAX LEGACY CD HORIZON PEEK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905310 SUP HCPCS C1713 7905310 - SCREW BONE 3.5MM 10MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905312 SUP HCPCS C1713 7905312 - SCREW BONE 3.5MM 12MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905314 SUP HCPCS C1713 7905314 - SCREW BONE 3.5MM 14MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905316 SUP HCPCS C1713 7905316 - SCREW BONE 3.5MM 16MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905318 SUP HCPCS C1713 7905318 - SCREW BONE 3.5MM 18MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905320 SUP HCPCS C1713 7905320 - SCREW BONE 3.5MM 20MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905322 SUP HCPCS C1713 7905322 - SCREW BONE 3.5MM 22MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905324 SUP HCPCS C1713 7905324 - SCREW BONE 3.5MM 24MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905326 SUP HCPCS C1713 7905326 - SCREW BONE 3.5MM 26MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905328 SUP HCPCS C1713 7905328 - SCREW BONE 3.5MM 28MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905330 SUP HCPCS C1713 7905330 - SCREW BONE 3.5MM 30MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905332 SUP HCPCS C1713 7905332 - SCREW BONE 3.5MM 32MM MULTIAX SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905334 SUP HCPCS C1713 7905334 - SCREW BONE 3.5MM 34MM MULTIAX VUEPOINT SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905410 SUP HCPCS C1713 7905410 - SCREW BONE 4MM 10MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905412 SUP HCPCS C1713 7905412 - SCREW BONE 4MM 12MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905414 SUP HCPCS C1713 7905414 - SCREW BONE 4MM 14MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905416 SUP HCPCS C1713 7905416 - SCREW BONE 4MM 16MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905418 SUP HCPCS C1713 7905418 - SCREW BONE 4MM 18MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905420 SUP HCPCS C1713 7905420 - SCREW BONE 4MM 20MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905422 SUP HCPCS C1713 7905422 - SCREW BONE 4MM 22MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905424 SUP HCPCS C1713 7905424 - SCREW BONE 4MM 24MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905426 SUP HCPCS C1713 7905426 - SCREW BONE 4MM 26MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905428 SUP HCPCS C1713 7905428 - SCREW BONE 4MM 28MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905430 SUP HCPCS C1713 7905430 - SCREW BONE 4MM 30MM MULTIAX VUEPOINT TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905432 SUP HCPCS C1713 7905432 - SCREW BONE 4MM 32MM MULTIAX SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905434 SUP HCPCS C1713 7905434 - SCREW BONE 4MM 34MM MULTIAX SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905436 SUP HCPCS C1713 7905436 - SCREW BONE 4MM 36MM MULTIAX SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905438 SUP HCPCS C1713 7905438 - SCREW BONE 4MM 38MM MULTIAX SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905440 SUP HCPCS C1713 7905440 - SCREW BONE 4MM 40MM MULTIAX SYSTEM VUEPOINT POSTERIOR CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905510 SUP HCPCS C1713 7905510 - SCREW BONE 3.5MM 10MM MULTIAX FAVOR ANGLE VUEPOINT TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905512 SUP HCPCS C1713 7905512 - SCREW BONE 3.5MM 12MM MULTIAX FAVOR ANGLE VUEPOINT TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905514 SUP HCPCS C1713 7905514 - SCREW BONE 3.5MM 14MM MULTIAX FAVOR ANGLE VUEPOINT TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905516 SUP HCPCS C1713 7905516 - SCREW BONE 3.5MM 16MM MULTIAX FAVOR ANGLE VUEPOINT TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905518 SUP HCPCS C1713 7905518 - SCREW BONE 3.5MM 18MM MULTIAX FAVORED ANGLE SYSTEM VUEPOINT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905520 SUP HCPCS C1713 7905520 - SCREW BONE 3.5MM 20MM MULTIAX FAVORED ANGLE SYSTEM VUEPOINT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905522 SUP HCPCS C1713 7905522 - SCREW BONE FULTHD FAVORED ANGLE 22MM 35MM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905524 SUP HCPCS C1713 7905524 - SCREW BONE 3.5MM 24MM MULTIAX FAVORED ANGLE SYSTEM VUEPOINT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905526 SUP HCPCS C1713 7905526 - SCREW BONE 3.5MM 26MM MULTIAX FAVORED ANGLE SYSTEM VUEPOINT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905528 SUP HCPCS C1713 7905528 - SCREW BONE FAVORED ANGLE 3.5MM 28MM MULTIAX SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905530 SUP HCPCS C1713 7905530 - SCREW BONE 3.5MM 30MM MULTIAX FAVOR ANGLE VUEPOINT TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905532 SUP HCPCS C1713 7905532 - SCREW BONE FAVORED ANGLE 3.5MM 32MM MULTIAX SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905534 SUP HCPCS C1713 7905534 - SCREW BONE 3.5MM 34MM MULTIAX FAVORED ANGLE SYSTEM VUEPOINT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905610 SUP HCPCS C1713 7905610 - SCREW BONE FAVORED ANGLE 4MM 10MM TULIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905612 SUP HCPCS C1713 7905612 - SCREW BONE 4MM 12MM FAVORED ANGLE TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905614 SUP HCPCS C1713 7905614 - SCREW BONE FAVORED ANGLE 4MM 14MM TULIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905616 SUP HCPCS C1713 7905616 - SCREW BONE FAVORED ANGLE 4MM 20MM TULIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905618 SUP HCPCS C1713 7905618 - SCREW BONE FAVORED ANGLE 4MM 18MM TULIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905620 SUP HCPCS C1713 7905620 - SCREW BONE FAVORED ANGLE 4MM 20MM TULIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905622 SUP HCPCS C1713 7905622 - SCREW BONE FAVORED ANGLE 4MM 22MM TULIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905624 SUP HCPCS C1713 7905624 - SCREW BONE FAVORED ANGLE 4MM 24MM TULIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905626 SUP HCPCS C1713 7905626 - SCREW BONE FAVORED ANGLE 4MM 26MM TULIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905628 SUP HCPCS C1713 7905628 - SCREW BONE FAVORED ANGLE 4MM 28MM TULIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905630 SUP HCPCS C1713 7905630 - SCREW BONE 4MM 30MM FAVORED ANGLE SYSTEM VUEPOINT TULIP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905632 SUP HCPCS C1713 7905632 - SCREW BONE FAVORED ANGLE 4MM 32MM TULIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905634 SUP HCPCS C1713 7905634 - SCREW BONE FAVORED ANGLE 4MM 34MM TULIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905636 SUP HCPCS C1713 7905636 - SCREW BONE FAVORED ANGLE 4MM 36MM TULIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905638 SUP HCPCS C1713 7905638 - SCREW BONE FAVORED ANGLE 4MM 38MM TULIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905640 SUP HCPCS C1713 7905640 - SCREW BONE FAVORED ANGLE 4MM 40MM TULIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905710 SUP HCPCS C1713 7905710 - SCREW BONE LARGE 4.5MM 10MM MULTIAX SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905712 SUP HCPCS C1713 7905712 - SCREW BONE 4.5MM 12MM VUEPOINT SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905714 SUP HCPCS C1713 7905714 - SCREW BONE LARGE 4.5MM 14MM MULTIAX VUEPOINT SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905716 SUP HCPCS C1713 7905716 - SCREW BONE LARGE 4.5MM 16MM MULTIAX VUEPOINT SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905718 SUP HCPCS C1713 7905718 - SCREW BONE 4.5MM 18MM MULTIAX SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905720 SUP HCPCS C1713 7905720 - SCREW BONE LARGE 4.5MM 20MM MULTIAX VUEPOINT SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905722 SUP HCPCS C1713 7905722 - SCREW BONE 4.5MM 22MM MULTIAX SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905724 SUP HCPCS C1713 7905724 - SCREW BONE LARGE 4.5MM 24MM MULTIAX VUEPOINT SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905726 SUP HCPCS C1713 7905726 - SCREW BONE LARGE 4.5MM 26MM MULTIAX VUEPOINT SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905728 SUP HCPCS C1713 7905728 - SCREW BONE LARGE 4.5MM 28MM MULTIAX VUEPOINT SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905730 SUP HCPCS C1713 7905730 - SCREW BONE LARGE 4.5MM 30MM MULTIAX VUEPOINT SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905732 SUP HCPCS C1713 7905732 - SCREW BONE 4.5MM 32MM MULTIAX VUEPOINT POSTERIOR CERV SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905734 SUP HCPCS C1713 7905734 - SCREW BONE LARGE 4.5MM 34MM MULTIAX VUEPOINT SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905736 SUP HCPCS C1713 7905736 - SCREW BONE LARGE 4.5MM 36MM MULTIAX VUEPOINT SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905738 SUP HCPCS C1713 7905738 - SCREW BONE LARGE 4.5MM 38MM MULTIAX VUEPOINT SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905740 SUP HCPCS C1713 7905740 - SCREW BONE LARGE 4.5MM 40MM MULTIAX SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905824 SUP HCPCS C1713 7905824 - SCREW BONE PTHRD FAVORED ANGLE 3.5MM 24MM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905826 SUP HCPCS C1713 7905826 - SCREW BONE PTHRD FOVORED ANGLE 3.5MM 26MM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905828 SUP HCPCS C1713 7905828 - SCREW BONE ANGLED PTHRD 3.5MM 28MM FAVORED VUEPOINT SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905830 SUP HCPCS C1713 7905830 - SCREW BONE 3.5MM 30MM FAVORED ANGLE PTTHRD VUEPOINT TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905832 SUP HCPCS C1713 7905832 - SCREW BONE 3.5MM 32MM FAVORED ANGLE PTTHRD SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 7905834 SUP HCPCS C1713 7905834 - SCREW BONE 3.5MM 14MM FAVORED ANGLE SYSTEM PTTHRD VUEPOINT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7905836 SUP HCPCS C1713 7905836 - SCREW BONE PTHRD 3.5MM 36MM FAVORED ANGLE VUEPOINT POSTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7906000 SUP HCPCS C1713 7906000 - SCREW SET TULIP LMNR HOOK VUEPOINT SPN CERV POSTERIOR BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 7906005 SUP Custom 27803010 7906005 - HOOK SPINAL 5MM LMNR BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 7906007 SUP Custom 27803010 7906007 - HOOK SPINAL 7MM LMNR BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 7906008 SUP HCPCS C1713 7906008 - SCREW BONE OFFST 11MM CONCTR OPEN VUEPOINT SPN CERV BOTH IP/OP "$1,022.50" $757.00 $202.94 "$1,022.50" $460.13 $460.13 $460.13 $460.13 "$1,022.50" "$1,022.50" "$1,022.50" $213.11 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $213.10 "$1,022.50" $409.00 $604.81 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $766.88 "$1,022.50" "$1,022.50" "$1,022.50" $511.25 $511.25 $809.82 "$1,022.50" $818.00 $460.13 $202.94 N/A $593.05 "$1,022.50" "$1,022.50" "$1,022.50" $213.09 "$1,022.50" N/A N/A 7906022 SUP HCPCS C1713 7906022 - SCREW BONE LARGE 25MM SYSTEM OFFST CONCTR OPEN VUEPOINT BOTH IP/OP "$1,240.00" $918.00 $246.11 "$1,240.00" $558.00 $558.00 $558.00 $558.00 "$1,240.00" "$1,240.00" "$1,240.00" $258.45 "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" $258.43 "$1,240.00" $496.00 $733.46 "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" $930.00 "$1,240.00" "$1,240.00" "$1,240.00" $620.00 $620.00 $982.08 "$1,240.00" $992.00 $558.00 $246.11 N/A $719.20 "$1,240.00" $744.00 "$1,240.00" "$1,240.00" "$1,240.00" N/A N/A 7906025 SUP HCPCS C1713 7906025 - CONNECTOR ROD ANGLED ACUTE OFFST SPN BOTH IP/OP "$1,240.00" $918.00 $246.11 "$1,240.00" $558.00 $558.00 $558.00 $558.00 "$1,240.00" "$1,240.00" "$1,240.00" $258.45 "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" $258.43 "$1,240.00" $496.00 $733.46 "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" $930.00 "$1,240.00" "$1,240.00" "$1,240.00" $620.00 $620.00 $982.08 "$1,240.00" $992.00 $558.00 $246.11 N/A $719.20 "$1,240.00" $744.00 "$1,240.00" "$1,240.00" "$1,240.00" N/A N/A 7906035 SUP HCPCS C1713 7906035 - CONNECTOR ROD 3.5MM INLINE SPN BOTH IP/OP "$1,830.00" "$1,354.00" $363.21 "$1,830.00" $823.50 $823.50 $823.50 $823.50 "$1,830.00" "$1,830.00" "$1,830.00" $381.42 "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" $381.39 "$1,830.00" $732.00 "$1,082.45" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,372.50" "$1,830.00" "$1,830.00" "$1,830.00" $915.00 $915.00 "$1,449.36" "$1,830.00" "$1,464.00" $823.50 $363.21 N/A "$1,061.40" "$1,830.00" "$1,830.00" "$1,830.00" $381.37 "$1,830.00" N/A N/A 7906045 SUP HCPCS C1713 7906045 - CONNECTOR ROD 3.5-4.5MM INLINE SPN BOTH IP/OP "$1,830.00" "$1,354.00" $363.21 "$1,830.00" $823.50 $823.50 $823.50 $823.50 "$1,830.00" "$1,830.00" "$1,830.00" $381.42 "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" $381.39 "$1,830.00" "$1,830.00" "$1,082.45" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,372.50" "$1,830.00" "$1,830.00" "$1,830.00" $915.00 $915.00 "$1,449.36" "$1,830.00" "$1,464.00" $823.50 $363.21 N/A "$1,061.40" "$1,830.00" "$1,098.00" "$1,830.00" $381.37 "$1,830.00" N/A N/A 7906055 SUP HCPCS C1713 7906055 - CONNECTOR ROD 3.5MM 5.5MM INLINE SPN BOTH IP/OP "$1,830.00" "$1,354.00" $363.21 "$1,830.00" $823.50 $823.50 $823.50 $823.50 "$1,830.00" "$1,830.00" "$1,830.00" $381.42 "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" $381.39 "$1,830.00" $732.00 "$1,082.45" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,372.50" "$1,830.00" "$1,830.00" "$1,830.00" $915.00 $915.00 "$1,449.36" "$1,830.00" "$1,464.00" $823.50 $363.21 N/A "$1,061.40" "$1,830.00" "$1,098.00" "$1,830.00" $381.37 "$1,830.00" N/A N/A 7906065 SUP HCPCS C1713 7906065 - CONNECTOR ROD 3.5MM 6.5MM INLINE SPN BOTH IP/OP "$1,830.00" "$1,354.00" $363.21 "$1,830.00" $823.50 $823.50 $823.50 $823.50 "$1,830.00" "$1,830.00" "$1,830.00" $381.42 "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" $381.39 "$1,830.00" $732.00 "$1,082.45" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,372.50" "$1,830.00" "$1,830.00" "$1,830.00" $915.00 $915.00 "$1,449.36" "$1,830.00" "$1,464.00" $823.50 $363.21 N/A "$1,061.40" "$1,830.00" "$1,098.00" "$1,830.00" $381.37 "$1,830.00" N/A N/A 7906120 SUP HCPCS C1713 7906120 - CONNECTOR ROD 3.5MM 120MM VUEPOINT POSTERIOR CERV SPN BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7906126 SUP HCPCS C1713 7906126 - CONNECTOR ROD 26MM FIX CROSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7906128 SUP HCPCS C1713 7906128 - CONNECTOR ROD 28MM CROSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7906130 SUP HCPCS C1713 7906130 - CONNECTOR ROD 30MM FIX CROSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7906132 SUP HCPCS C1713 7906132 - CONNECTOR ROD 32MM FIX CROSS TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7906134 SUP HCPCS C1713 7906134 - CONNECTOR ROD 34MM CROSS FIX SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7906136 SUP HCPCS C1713 7906136 - CONNECTOR ROD 36MM CROSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7906138 SUP HCPCS C1713 7906138 - CONNECTOR ROD 38MM FIX CROSS SYSTEM VUEPOINT POSTERIOR CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7906140 SUP HCPCS C1713 7906140 - CONNECTOR ROD 40MM CROSS FIX SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7906142 SUP HCPCS C1713 7906142 - CONNECTOR ROD 42MM CROSSLINK SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7906144 SUP HCPCS C1713 7906144 - CONNECTOR ROD 44MM CROSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7906146 SUP HCPCS C1713 7906146 - CONNECTOR ROD 46MM CROSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7906148 SUP HCPCS C1713 7906148 - CONNECTOR ROD 48MM CROSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7906150 SUP HCPCS C1713 7906150 - CONNECTOR ROD 50MM CROSS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 7906160 SUP HCPCS C1713 7906160 - CONNECTOR ROD 3.5MM 60MM SYSTEM VUEPOINT POSTERIOR CERV SPN BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7906240 SUP HCPCS C1713 7906240 - ROD SPNL 240MM 3.5MM BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $600.00 $600.00 $125.04 $600.00 N/A N/A 7906300 SUP HCPCS C1713 7906300 - ROD SPINAL 45D PRECURVE BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 7906302 SUP Custom 27203010 7906302 - CONNECTOR ROD EYELET OCCIPUT SPN BOTH IP/OP "$1,277.50" $945.00 $227.40 "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" $227.40 "$1,277.50" "$1,277.50" $948.16 $948.16 $984.70 $665.58 $266.25 "$1,277.50" $511.00 "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" $958.13 "$1,277.50" "$1,277.50" "$1,277.50" $638.75 $638.75 "$1,011.78" "$1,277.50" "$1,022.00" $830.38 "$1,277.50" N/A $740.95 "$1,277.50" $766.50 "$1,277.50" "$1,277.50" "$1,277.50" N/A N/A 7906306 SUP HCPCS C1713 7906306 - SCREW BONE 4.5MM 6MM VUEPOINT SPN CERV OCCPTL CORTICAL BOTH IP/OP $680.00 $503.00 $134.96 $680.00 $306.00 $306.00 $306.00 $306.00 $680.00 $680.00 $680.00 $141.73 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $402.22 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $134.96 N/A $394.40 $680.00 $680.00 $680.00 $141.71 $680.00 N/A N/A 7906308 SUP HCPCS C1713 7906308 - SCREW BONE 4.5MM 8MM VUEPOINT SPN CERV OCCPTL CORTICAL BOTH IP/OP $680.00 $503.00 $134.96 $680.00 $306.00 $306.00 $306.00 $306.00 $680.00 $680.00 $680.00 $141.73 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $402.22 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $134.96 N/A $394.40 $680.00 $680.00 $680.00 $141.71 $680.00 N/A N/A 7906310 SUP HCPCS C1713 7906310 - SCREW BONE 4.5MM 10MM VUEPOINT SPN CERV OCCPTL CORTICAL BOTH IP/OP $680.00 $503.00 $134.96 $680.00 $306.00 $306.00 $306.00 $306.00 $680.00 $680.00 $680.00 $141.73 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $402.22 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $134.96 N/A $394.40 $680.00 $680.00 $680.00 $141.71 $680.00 N/A N/A 7906312 SUP HCPCS C1713 7906312 - SCREW BONE 4.5MM 12MM VUEPOINT SPN CERV OCCPTL CORTICAL BOTH IP/OP $680.00 $503.00 $134.96 $680.00 $306.00 $306.00 $306.00 $306.00 $680.00 $680.00 $680.00 $141.73 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $402.22 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $134.96 N/A $394.40 $680.00 $680.00 $680.00 $141.71 $680.00 N/A N/A 7906314 SUP HCPCS C1713 7906314 - SCREW BONE 4.5MM 14MM SYSTEM VUEPOINT POSTERIOR CERV SPN BOTH IP/OP $680.00 $503.00 $134.96 $680.00 $306.00 $306.00 $306.00 $306.00 $680.00 $680.00 $680.00 $141.73 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $402.22 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $134.96 N/A $394.40 $680.00 $680.00 $680.00 $141.71 $680.00 N/A N/A 7906335 SUP HCPCS C1713 7906335 - PLATE BONE 35MM KEEL VUEPOINT SPN CERV POSTERIOR BOTH IP/OP "$6,355.00" "$4,703.00" "$1,261.31" "$6,355.00" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$6,355.00" "$6,355.00" "$6,355.00" "$1,324.54" "$6,355.00" "$6,355.00" "$6,355.00" "$6,355.00" "$6,355.00" "$1,324.45" "$6,355.00" "$2,542.00" "$3,133.02" "$6,355.00" "$6,355.00" "$6,355.00" "$6,355.00" "$4,766.25" "$6,355.00" "$6,355.00" "$6,355.00" "$3,177.50" "$3,177.50" "$5,033.16" "$6,355.00" "$5,084.00" "$2,859.75" "$1,261.31" N/A "$3,685.90" "$6,355.00" "$3,813.00" "$6,355.00" "$1,324.38" "$6,355.00" N/A N/A 7906340 SUP HCPCS C1713 7906340 - PLATE BONE 40MM KEEL VUEPOINT SPN CERV POSTERIOR BOTH IP/OP "$6,355.00" "$4,703.00" "$1,261.31" "$6,355.00" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$6,355.00" "$6,355.00" "$6,355.00" "$1,324.54" "$6,355.00" "$6,355.00" "$6,355.00" "$6,355.00" "$6,355.00" "$1,324.45" "$6,355.00" "$2,542.00" "$3,133.02" "$6,355.00" "$6,355.00" "$6,355.00" "$6,355.00" "$4,766.25" "$6,355.00" "$6,355.00" "$6,355.00" "$3,177.50" "$3,177.50" "$5,033.16" "$6,355.00" "$5,084.00" "$2,859.75" "$1,261.31" N/A "$3,685.90" "$6,355.00" "$3,813.00" "$6,355.00" "$1,324.38" "$6,355.00" N/A N/A 7906345 SUP HCPCS C1713 7906345 - PLATE BONE 45MM KEEL VUEPOINT SPN CERV POSTERIOR BOTH IP/OP "$6,355.00" "$4,703.00" "$1,261.31" "$6,355.00" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$6,355.00" "$6,355.00" "$6,355.00" "$1,324.54" "$6,355.00" "$6,355.00" "$6,355.00" "$6,355.00" "$6,355.00" "$1,324.45" "$6,355.00" "$2,542.00" "$3,133.02" "$6,355.00" "$6,355.00" "$6,355.00" "$6,355.00" "$4,766.25" "$6,355.00" "$6,355.00" "$6,355.00" "$3,177.50" "$3,177.50" "$5,033.16" "$6,355.00" "$5,084.00" "$2,859.75" "$1,261.31" N/A "$3,685.90" "$6,355.00" "$6,355.00" "$6,355.00" "$1,324.38" "$6,355.00" N/A N/A 7906355 SUP HCPCS C1713 7906355 - ROD SPINAL 3.5-5.5MM TRANSITION VUEPOINT BOTH IP/OP "$1,830.00" "$1,354.00" $363.21 "$1,830.00" $823.50 $823.50 $823.50 $823.50 "$1,830.00" "$1,830.00" "$1,830.00" $381.42 "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" $381.39 "$1,830.00" $732.00 "$1,082.45" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,372.50" "$1,830.00" "$1,830.00" "$1,830.00" $915.00 $915.00 "$1,449.36" "$1,830.00" "$1,464.00" $823.50 $363.21 N/A "$1,061.40" "$1,830.00" "$1,098.00" "$1,830.00" $381.37 "$1,830.00" N/A N/A 7906356 SUP HCPCS C1713 7906356 - SCREW BONE 5MM 6MM SYSTEM VUEPOINT POSTERIOR CERV SPN OCCPTL BOTH IP/OP $680.00 $503.00 $134.96 $680.00 $306.00 $306.00 $306.00 $306.00 $680.00 $680.00 $680.00 $141.73 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $402.22 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $134.96 N/A $394.40 $680.00 $408.00 $680.00 $141.71 $680.00 N/A N/A 7906358 SUP HCPCS C1713 7906358 - SCREW BONE 5MM 8MM SYSTEM VUEPOINT POSTERIOR CERV SPN OCCPTL BOTH IP/OP $680.00 $503.00 $134.96 $680.00 $306.00 $306.00 $306.00 $306.00 $680.00 $680.00 $680.00 $141.73 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $402.22 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $134.96 N/A $394.40 $680.00 $680.00 $680.00 $141.71 $680.00 N/A N/A 7906360 SUP HCPCS C1713 7906360 - SCREW BONE 5MM 10MM SPN LEFT OCCPTL CORTICAL BOTH IP/OP $680.00 $503.00 $134.96 $680.00 $306.00 $306.00 $306.00 $306.00 $680.00 $680.00 $680.00 $141.73 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $402.22 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $134.96 N/A $394.40 $680.00 $408.00 $680.00 $141.71 $680.00 N/A N/A 7906362 SUP HCPCS C1713 7906362 - SCREW BONE 5MM 12MM SYSTEM VUEPOINT POSTERIOR CERV SPN BOTH IP/OP $680.00 $503.00 $134.96 $680.00 $306.00 $306.00 $306.00 $306.00 $680.00 $680.00 $680.00 $141.73 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $402.22 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $134.96 N/A $394.40 $680.00 $408.00 $680.00 $141.71 $680.00 N/A N/A 7906364 SUP HCPCS C1713 7906364 - SCREW BONE 5MM 14MM OCCPTL CORTICAL LEFT BOTH IP/OP $680.00 $503.00 $134.96 $680.00 $306.00 $306.00 $306.00 $306.00 $680.00 $680.00 $680.00 $141.73 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $402.22 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $134.96 N/A $394.40 $680.00 $680.00 $680.00 $141.71 $680.00 N/A N/A 7906435 SUP HCPCS C1713 7906435 - CONNECTOR ROD OFFST 35MM SPN BOTH IP/OP "$1,830.00" "$1,354.00" $363.21 "$1,830.00" $823.50 $823.50 $823.50 $823.50 "$1,830.00" "$1,830.00" "$1,830.00" $381.42 "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" $381.39 "$1,830.00" $732.00 "$1,082.45" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,372.50" "$1,830.00" "$1,830.00" "$1,830.00" $915.00 $915.00 "$1,449.36" "$1,830.00" "$1,464.00" $823.50 $363.21 N/A "$1,061.40" "$1,830.00" "$1,098.00" "$1,830.00" $381.37 "$1,830.00" N/A N/A 7906445 SUP HCPCS C1713 7906445 - CONNECTOR ROD OFFST 3.5MM 4.5MM SPN BOTH IP/OP "$1,830.00" "$1,354.00" $363.21 "$1,830.00" $823.50 $823.50 $823.50 $823.50 "$1,830.00" "$1,830.00" "$1,830.00" $381.42 "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" $381.39 "$1,830.00" $732.00 "$1,082.45" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,372.50" "$1,830.00" "$1,830.00" "$1,830.00" $915.00 $915.00 "$1,449.36" "$1,830.00" "$1,464.00" $823.50 $363.21 N/A "$1,061.40" "$1,830.00" "$1,098.00" "$1,830.00" $381.37 "$1,830.00" N/A N/A 7906455 SUP HCPCS C1713 7906455 - CONNECTOR ROD OFFST 3.5MM 5.5MM SPN BOTH IP/OP "$1,830.00" "$1,354.00" $363.21 "$1,830.00" $823.50 $823.50 $823.50 $823.50 "$1,830.00" "$1,830.00" "$1,830.00" $381.42 "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" $381.39 "$1,830.00" "$1,830.00" "$1,082.45" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,372.50" "$1,830.00" "$1,830.00" "$1,830.00" $915.00 $915.00 "$1,449.36" "$1,830.00" "$1,464.00" $823.50 $363.21 N/A "$1,061.40" "$1,830.00" "$1,830.00" "$1,830.00" $381.37 "$1,830.00" N/A N/A 7906465 SUP HCPCS C1713 7906465 - CONNECTOR ROD OFFST 3.5MM 6.25MM SPN BOTH IP/OP "$1,830.00" "$1,354.00" $363.21 "$1,830.00" $823.50 $823.50 $823.50 $823.50 "$1,830.00" "$1,830.00" "$1,830.00" $381.42 "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" $381.39 "$1,830.00" $732.00 "$1,082.45" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,372.50" "$1,830.00" "$1,830.00" "$1,830.00" $915.00 $915.00 "$1,449.36" "$1,830.00" "$1,464.00" $823.50 $363.21 N/A "$1,061.40" "$1,830.00" "$1,098.00" "$1,830.00" "$1,830.00" "$1,830.00" N/A N/A 7907010 SUP Custom 27203010 7907010 - BIT DRILL 2.05MM SYSTEM VUEPOINT POSTERIOR CERV SPN BOTH IP/OP $647.50 $479.00 $115.26 $647.50 $647.50 $647.50 $647.50 $647.50 $647.50 $647.50 $115.26 $647.50 $647.50 $480.57 $480.57 $499.09 $337.35 $134.95 $647.50 $259.00 $647.50 $647.50 $647.50 $647.50 $647.50 $485.63 $647.50 $647.50 $647.50 $323.75 $323.75 $512.82 $647.50 $518.00 $420.88 $647.50 N/A $375.55 $647.50 $388.50 $647.50 $647.50 $647.50 N/A N/A 7907012 SUP Custom 27203010 7907012 - BIT DRILL 2.05MM BOTH IP/OP $647.50 $479.00 $115.26 $647.50 $647.50 $647.50 $647.50 $647.50 $647.50 $647.50 $115.26 $647.50 $647.50 $480.57 $480.57 $499.09 $337.35 $134.95 $647.50 $259.00 $647.50 $647.50 $647.50 $647.50 $647.50 $485.63 $647.50 $647.50 $647.50 $323.75 $323.75 $512.82 $647.50 $518.00 $420.88 $647.50 N/A $375.55 $647.50 $388.50 $647.50 $647.50 $647.50 N/A N/A 7907220 SUP HCPCS C1713 7907220 - TEMPLATE SZ 120MM ROD BOTH IP/OP $137.50 $102.00 $27.29 $137.50 $61.88 $61.88 $61.88 $61.88 $137.50 $137.50 $137.50 $28.66 $137.50 $137.50 $137.50 $137.50 $137.50 $28.66 $137.50 $137.50 $81.33 $137.50 $137.50 $137.50 $137.50 $103.13 $137.50 $137.50 $137.50 $68.75 $68.75 $108.90 $137.50 $110.00 $61.88 $27.29 N/A $79.75 $137.50 $82.50 $137.50 $28.66 $137.50 N/A N/A 7907240 SUP HCPCS C1713 7907240 - TEMPLATE ROD 240MM VUEPOINT POSTERIOR CERV SPN BOTH IP/OP $157.50 $117.00 $31.26 $157.50 $70.88 $70.88 $70.88 $70.88 $157.50 $157.50 $157.50 $32.83 $157.50 $157.50 $157.50 $157.50 $157.50 $32.82 $157.50 $157.50 $93.16 $157.50 $157.50 $157.50 $157.50 $118.13 $157.50 $157.50 $157.50 $78.75 $78.75 $124.74 $157.50 $126.00 $70.88 $31.26 N/A $91.35 $157.50 $94.50 $157.50 $32.82 $157.50 N/A N/A 7908300 SUP HCPCS C1713 7908300 - ROD SPINAL 45D PREBENT VUEPOINT COCR BOTH IP/OP "$1,680.00" "$1,243.00" $333.44 "$1,680.00" $756.00 $756.00 $756.00 $756.00 "$1,680.00" "$1,680.00" "$1,680.00" $350.15 "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" $350.13 "$1,680.00" "$1,680.00" $993.72 "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" "$1,260.00" "$1,680.00" "$1,680.00" "$1,680.00" $840.00 $840.00 "$1,330.56" "$1,680.00" "$1,344.00" $756.00 $333.44 N/A $974.40 "$1,680.00" "$1,680.00" "$1,680.00" $350.11 "$1,680.00" N/A N/A 7908355 SUP HCPCS C1713 7908355 - ROD SPINAL 5.5MM TRANSITION COCR BOTH IP/OP "$3,150.00" "$2,331.00" $625.20 "$3,150.00" "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$3,150.00" "$3,150.00" "$3,150.00" $656.54 "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" $656.49 "$3,150.00" "$3,150.00" "$1,552.95" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$2,362.50" "$3,150.00" "$3,150.00" "$3,150.00" "$1,575.00" "$1,575.00" "$2,494.80" "$3,150.00" "$2,520.00" "$1,417.50" $625.20 N/A "$1,827.00" "$3,150.00" "$1,890.00" "$3,150.00" $656.46 "$3,150.00" N/A N/A 7965520 SUP HCPCS C1713 7965520 - SCREW BONE 5.5MM 20MM SELF TAP SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $396.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $594.00 $990.00 $206.32 $990.00 N/A N/A 7965525 SUP HCPCS C1713 7965525 - SCREW BONE 5.5MM 25MM SELF TAP SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $990.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $990.00 $990.00 $206.32 $990.00 N/A N/A 7965530 SUP HCPCS C1713 7965530 - SCREW BONE 5.5MM 30MM SELF TAP SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $396.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $594.00 $990.00 $206.32 $990.00 N/A N/A 7965535 SUP HCPCS C1713 7965535 - SCREW BONE 5.5MM 35MM SELF TAP SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $396.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $594.00 $990.00 $206.32 $990.00 N/A N/A 7966020 SUP HCPCS C1713 7966020 - SCREW BONE 6MM 20MM SELF TAP SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $396.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $594.00 $990.00 $206.32 $990.00 N/A N/A 7966025 SUP HCPCS C1713 7966025 - SCREW BONE 6MM 25MM SELF TAP SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $990.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $594.00 $990.00 $206.32 $990.00 N/A N/A 7966030 SUP HCPCS C1713 7966030 - SCREW BONE 6MM 30MM SELF TAP SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $990.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $594.00 $990.00 $206.32 $990.00 N/A N/A 7966035 SUP HCPCS C1713 7966035 - SCREW BONE 6MM 35MM SELF TAP SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $990.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $990.00 $990.00 $206.32 $990.00 N/A N/A 7967210 SUP HCPCS C1713 7967210 - SPACER SPNL 12D SM 32X23X10MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7967212 SUP HCPCS C1713 7967212 - SPACER SPNL 12D SM 32X23X12MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$8,514.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7967214 SUP HCPCS C1713 7967214 - SPACER SPNL 12D SM 32X23X14MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$8,514.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7967216 SUP HCPCS C1713 7967216 - SPACER SPNL 12D SM 32X23X16MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$8,514.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7967218 SUP HCPCS C1713 7967218 - SPACER SPNL 12D SM 32X23X18MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7967220 SUP HCPCS C1713 7967220 - SPACER SPNL 12D SM 32X23X20MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7967810 SUP HCPCS C1713 7967810 - SPACER SPNL 8D SM 32X23X10MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7967812 SUP HCPCS C1713 7967812 - SPACER SPNL 8D SM 32X23X12MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7967814 SUP HCPCS C1713 7967814 - SPACER SPNL 8D SM 32X23X14MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7967816 SUP HCPCS C1713 7967816 - SPACER SPNL 8D SM 32X23X16MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7967818 SUP HCPCS C1713 7967818 - SPACER SPNL 8D SM 32X23X18MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$8,514.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7967820 SUP HCPCS C1713 7967820 - SPACER SPNL 8D SM 32X23X20MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$8,514.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7968210 SUP HCPCS C1713 7968210 - SPACER SPNL 12D MED 37X27X10MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$8,514.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7968212 SUP HCPCS C1713 7968212 - SPACER SPNL 12D MED 37X27X12MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$5,676.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$8,514.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7968214 SUP HCPCS C1713 7968214 - SPACER SPNL 12D MED 37X27X14MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$5,676.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$8,514.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7968216 SUP HCPCS C1713 7968216 - SPACER SPNL 12D MED 37X27X16MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7968218 SUP HCPCS C1713 7968218 - SPACER SPNL 12D MED 37X27X18MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$5,676.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7968220 SUP HCPCS C1713 7968220 - SPACER SPNL 12D MED 37X27X20MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7968810 SUP HCPCS C1713 7968810 - SPACER SPNL 8D MED 37X27X10MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$5,676.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$8,514.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7968812 SUP HCPCS C1713 7968812 - SPACER SPNL 8D MED 37X27X12MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7968814 SUP HCPCS C1713 7968814 - SPACER SPNL 8D MED 37X27X14MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$8,514.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7968816 SUP HCPCS C1713 7968816 - SPACER SPNL 8D MED 37X27X16MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$8,514.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7968818 SUP HCPCS C1713 7968818 - SPACER SPNL 8D MED 37X27X18MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$8,514.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7968820 SUP HCPCS C1713 7968820 - SPACER SPNL 8D MED 37X27X20MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$8,514.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7969210 SUP HCPCS C1713 7969210 - SPACER SPNL 12D LG 42X30X10MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$8,514.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7969212 SUP HCPCS C1713 7969212 - SPACER SPNL 12D LG 42X30X12MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7969214 SUP HCPCS C1713 7969214 - SPACER SPNL 12D LG 42X30X14MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7969216 SUP HCPCS C1713 7969216 - SPACER SPNL 12D LG 42X30X16MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7969218 SUP HCPCS C1713 7969218 - SPACER SPNL 12D LG 42X30X18MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$5,676.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7969220 SUP HCPCS C1713 7969220 - SPACER SPNL 12D LG 42X30X20MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7969810 SUP HCPCS C1713 7969810 - SPACER SPNL 8D LG 42X30X10MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7969812 SUP HCPCS C1713 7969812 - SPACER SPNL 8D LG 42X30X12MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$5,676.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7969814 SUP HCPCS C1713 7969814 - SPACER SPNL 8D LG 42X30X14MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$5,676.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7969816 SUP HCPCS C1713 7969816 - SPACER SPNL 8D LG 42X30X16MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$14,190.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7969818 SUP HCPCS C1713 7969818 - SPACER SPNL 8D LG 42X30X18MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$5,676.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7969820 SUP HCPCS C1713 7969820 - SPACER SPNL 8D LG 42X30X20MM STRL CRSNT SVRGN CVR PLT PEEK BOTH IP/OP "$14,190.00" "$10,501.00" "$2,816.36" "$14,190.00" "$6,385.50" "$6,385.50" "$6,385.50" "$6,385.50" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.55" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.35" "$14,190.00" "$5,676.00" "$6,995.67" "$14,190.00" "$14,190.00" "$14,190.00" "$14,190.00" "$10,642.50" "$14,190.00" "$14,190.00" "$14,190.00" "$7,095.00" "$7,095.00" "$11,238.48" "$14,190.00" "$11,352.00" "$6,385.50" "$2,816.36" N/A "$8,230.20" "$14,190.00" "$14,190.00" "$14,190.00" "$2,957.20" "$14,190.00" N/A N/A 7975520 SUP HCPCS C1713 7975520 - SCREW BONE 5.5MM 20MM FIXANG SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $396.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $990.00 $990.00 $206.32 $990.00 N/A N/A 7975525 SUP HCPCS C1713 7975525 - SCREW BONE 5.5MM 25MM FIXANG SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $396.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $990.00 $990.00 $206.32 $990.00 N/A N/A 7975530 SUP HCPCS C1713 7975530 - SCREW BONE 5.5MM 30MM FIXANG SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $396.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $990.00 $990.00 $206.32 $990.00 N/A N/A 7975535 SUP HCPCS C1713 7975535 - SCREW BONE 5.5MM 35MM FIXANG SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $990.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $594.00 $990.00 $206.32 $990.00 N/A N/A 7976020 SUP HCPCS C1713 7976020 - SCREW BONE 6MM 20MM FIXANG SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $396.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $594.00 $990.00 $206.32 $990.00 N/A N/A 7976025 SUP HCPCS C1713 7976025 - SCREW BONE 6MM 25MM FIXANG SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $990.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $594.00 $990.00 $206.32 $990.00 N/A N/A 7976030 SUP HCPCS C1713 7976030 - SCREW BONE 6MM 30MM FIXANG SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $396.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $990.00 $990.00 $206.32 $990.00 N/A N/A 7976035 SUP HCPCS C1713 7976035 - SCREW BONE 6MM 35MM FIXANG SOVEREIGN SPN BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $990.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $990.00 $990.00 $206.32 $990.00 N/A N/A 8001501 SUP Custom 27203010 8001501 - TRAY STERILIZATION 1.5 MM SLFTAP SCREW BOTH IP/OP "$4,637.00" "$3,431.00" $825.34 "$4,636.75" "$4,636.75" "$4,636.75" "$4,636.75" "$4,636.75" "$4,636.75" "$4,636.75" $825.34 "$4,636.75" "$4,636.75" "$3,441.40" "$3,441.40" "$3,574.01" "$2,060.15" $966.35 "$4,636.75" "$1,854.70" "$4,636.75" "$4,636.75" "$4,636.75" "$4,636.75" "$4,636.75" "$3,477.75" "$4,636.75" "$4,636.75" "$4,636.75" "$2,318.38" "$2,318.38" "$3,672.31" "$4,636.75" "$3,709.40" "$3,013.89" "$4,636.75" N/A "$2,689.46" "$4,636.75" "$2,782.05" "$4,636.75" "$4,636.75" "$4,636.75" N/A N/A 8001505 SUP HCPCS C1713 8001505 - CADDY STERILIZATION 1.5 MM SLFDRILL SCREW BOTH IP/OP "$1,177.50" $871.00 $233.65 "$1,177.25" $529.76 $529.76 $529.76 $529.76 "$1,177.25" "$1,177.25" "$1,177.25" $245.37 "$1,177.25" "$1,177.25" "$1,177.25" "$1,177.25" "$1,177.25" $245.35 "$1,177.25" "$1,177.25" $696.34 "$1,177.25" "$1,177.25" "$1,177.25" "$1,177.25" $883.13 "$1,177.25" "$1,177.25" "$1,177.25" $588.63 $588.63 $932.38 "$1,177.25" $941.80 $529.76 $233.65 N/A $682.95 "$1,177.25" "$1,177.25" "$1,177.25" $245.34 "$1,177.25" N/A N/A 8001601 SUP HCPCS C1713 8001601 - CADDY STERILIZATION 1.6 MM SLFDRILL SCREW BOTH IP/OP $931.00 $689.00 $184.73 $930.75 $418.84 $418.84 $418.84 $418.84 $930.75 $930.75 $930.75 $193.99 $930.75 $930.75 $930.75 $930.75 $930.75 $193.98 $930.75 $930.75 $550.54 $930.75 $930.75 $930.75 $930.75 $698.25 $930.75 $930.75 $930.75 $465.38 $465.38 $737.15 $930.75 $744.60 $418.84 $184.73 N/A $539.98 $930.75 $930.75 $930.75 $193.97 $930.75 N/A N/A 8001602 SUP Custom 27203010 8001602 - TRAY STERILIZATION 1.6 MM SLFDRILL SCREW BOTH IP/OP "$4,637.00" "$3,431.00" $825.34 "$4,636.75" "$4,636.75" "$4,636.75" "$4,636.75" "$4,636.75" "$4,636.75" "$4,636.75" $825.34 "$4,636.75" "$4,636.75" "$3,441.40" "$3,441.40" "$3,574.01" "$2,060.15" $966.35 "$4,636.75" "$1,854.70" "$4,636.75" "$4,636.75" "$4,636.75" "$4,636.75" "$4,636.75" "$3,477.75" "$4,636.75" "$4,636.75" "$4,636.75" "$2,318.38" "$2,318.38" "$3,672.31" "$4,636.75" "$3,709.40" "$3,013.89" "$4,636.75" N/A "$2,689.46" "$4,636.75" "$2,782.05" "$4,636.75" "$4,636.75" "$4,636.75" N/A N/A 8001605 SUP HCPCS C1713 8001605 - CADDY SCREW 1.6MM SLFDRILL TIMESH TITANIUM BOTH IP/OP "$1,247.50" $923.00 $247.57 "$1,247.38" $561.32 $561.32 $561.32 $561.32 "$1,247.38" "$1,247.38" "$1,247.38" $259.99 "$1,247.38" "$1,247.38" "$1,247.38" "$1,247.38" "$1,247.38" $259.97 "$1,247.38" $498.95 $737.83 "$1,247.38" "$1,247.38" "$1,247.38" "$1,247.38" $935.63 "$1,247.38" "$1,247.38" "$1,247.38" $623.69 $623.69 $987.92 "$1,247.38" $997.90 $561.32 $247.57 N/A $723.55 "$1,247.38" "$1,247.38" "$1,247.38" $259.95 "$1,247.38" N/A N/A 8001830 SUP HCPCS C1713 8001830 - SCREW BONE 1.8MM 3MM SELF DRILL CRUCIATE RES-CUE SPN BOTH IP/OP $119.50 $88.00 $23.69 $119.35 $53.71 $53.71 $53.71 $53.71 $119.35 $119.35 $119.35 $24.88 $119.35 $119.35 $119.35 $119.35 $119.35 $24.87 $119.35 $119.35 $70.60 $119.35 $119.35 $119.35 $119.35 $89.63 $119.35 $119.35 $119.35 $59.68 $59.68 $94.53 $119.35 $95.48 $53.71 $23.69 N/A $69.31 $119.35 $71.61 $119.35 $24.87 $119.35 N/A N/A 8002635 SUP HCPCS C1713 8002635 - SCREW BONE 1.6MM 3.5MM SLFDRILL TIMESH TITANIUM CRANIUM BOTH IP/OP $126.50 $94.00 $25.02 $126.08 $56.74 $56.74 $56.74 $56.74 $126.08 $126.08 $126.08 $26.28 $126.08 $126.08 $126.08 $126.08 $126.08 $26.28 $126.08 $126.08 $74.58 $126.08 $126.08 $126.08 $126.08 $94.88 $126.08 $126.08 $126.08 $63.04 $63.04 $99.86 $126.08 $100.86 $56.74 $25.02 N/A $73.37 $126.08 $75.65 $126.08 $26.28 $126.08 N/A N/A 8004200 SUP Custom 27203010 8004200 - TRAY INSTR BATTERY POWERED DRIVER BOTH IP/OP $897.00 $664.00 $159.62 $896.75 $896.75 $896.75 $896.75 $896.75 $896.75 $896.75 $159.62 $896.75 $896.75 $665.57 $665.57 $691.21 $467.21 $186.89 $896.75 $358.70 $896.75 $896.75 $896.75 $896.75 $896.75 $672.75 $896.75 $896.75 $896.75 $448.38 $448.38 $710.23 $896.75 $717.40 $582.89 $896.75 N/A $520.26 $896.75 $538.05 $896.75 $896.75 $896.75 N/A N/A 8009000 SUP Custom 27803010 8009000 - LID STERILIZATION 1.5MM/1.6MM STERILE BOTH IP/OP "$1,545.00" "$1,143.00" $274.99 "$1,544.88" "$1,544.88" "$1,544.88" "$1,544.88" "$1,544.88" "$1,544.88" "$1,544.88" $274.99 "$1,544.88" "$1,544.88" "$1,544.88" "$1,544.88" "$1,544.88" "$1,544.88" $321.97 "$1,544.88" $617.95 "$1,544.88" "$1,544.88" "$1,544.88" "$1,544.88" "$1,544.88" "$1,158.75" "$1,544.88" "$1,544.88" "$1,544.88" $772.44 $772.44 "$1,223.54" "$1,544.88" "$1,235.90" $695.20 "$1,544.88" N/A $896.10 "$1,544.88" $926.93 "$1,544.88" "$1,544.88" "$1,544.88" N/A N/A 8009002 SUP HCPCS C1713 8009002 - CADDY STERILIZATION PLATE TIMESH CRANIAL PLATING SYSTEM BOTH IP/OP $773.50 $572.00 $153.52 $773.50 $348.08 $348.08 $348.08 $348.08 $773.50 $773.50 $773.50 $161.22 $773.50 $773.50 $773.50 $773.50 $773.50 $161.21 $773.50 $773.50 $457.53 $773.50 $773.50 $773.50 $773.50 $580.13 $773.50 $773.50 $773.50 $386.75 $386.75 $612.61 $773.50 $618.80 $348.08 $153.52 N/A $448.63 $773.50 $464.10 $773.50 $161.20 $773.50 N/A N/A 8009220 SUP Custom 27803010 8009220 - TRAY INSTR COMBO BASE TIMESH CRANIAL FIX CASE BOTH IP/OP $810.00 $599.00 $144.11 $809.63 $809.63 $809.63 $809.63 $809.63 $809.63 $809.63 $144.11 $809.63 $809.63 $809.63 $809.63 $809.63 $809.63 $168.74 $809.63 $323.85 $809.63 $809.63 $809.63 $809.63 $809.63 $607.50 $809.63 $809.63 $809.63 $404.82 $404.82 $641.23 $809.63 $647.70 $364.33 $809.63 N/A $469.80 $809.63 $485.78 $809.63 $809.63 $809.63 N/A N/A 8010050 SUP Custom 27203010 8010050 - ELECTRODE EEG 2 NDL MNTR PK SPNE BOTH IP/OP $387.50 $287.00 $68.98 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $68.98 $387.50 $387.50 $287.60 $287.60 $298.69 $201.89 $80.76 $387.50 $155.00 $387.50 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $251.88 $387.50 N/A $224.75 $387.50 $232.50 $387.50 $387.50 $387.50 N/A N/A 8011830 SUP HCPCS C1713 8011830 - SCREW BONE 1.8MM 3MM RESCUE SLFTAP CRUCIATE TIMESH TITANIUM BOTH IP/OP $140.50 $104.00 $27.84 $140.25 $63.11 $63.11 $63.11 $63.11 $140.25 $140.25 $140.25 $29.23 $140.25 $140.25 $140.25 $140.25 $140.25 $29.23 $140.25 $56.10 $82.96 $140.25 $140.25 $140.25 $140.25 $105.38 $140.25 $140.25 $140.25 $70.13 $70.13 $111.08 $140.25 $112.20 $63.11 $27.84 N/A $81.49 $140.25 $140.25 $140.25 $29.23 $140.25 N/A N/A 8011850 SUP HCPCS C1713 8011850 - SCREW BONE 1.8MM 5MM RESCUE SLFTAP CRUCIATE TIMESH TITANIUM BOTH IP/OP $140.50 $104.00 $27.84 $140.25 $63.11 $63.11 $63.11 $63.11 $140.25 $140.25 $140.25 $29.23 $140.25 $140.25 $140.25 $140.25 $140.25 $29.23 $140.25 $56.10 $82.96 $140.25 $140.25 $140.25 $140.25 $105.38 $140.25 $140.25 $140.25 $70.13 $70.13 $111.08 $140.25 $112.20 $63.11 $27.84 N/A $81.49 $140.25 $140.25 $140.25 $29.23 $140.25 N/A N/A 8012635 SUP HCPCS C1713 8012635 - SCREW BONE 1.6MM 3.5MM CRUCIATE SDS BOTH IP/OP $142.50 $105.00 $28.26 $142.38 $64.07 $64.07 $64.07 $64.07 $142.38 $142.38 $142.38 $29.68 $142.38 $142.38 $142.38 $142.38 $142.38 $29.67 $142.38 $56.95 $84.22 $142.38 $142.38 $142.38 $142.38 $106.88 $142.38 $142.38 $142.38 $71.19 $71.19 $112.76 $142.38 $113.90 $64.07 $28.26 N/A $82.65 $142.38 $142.38 $142.38 $29.67 $142.38 N/A N/A 8012640 SUP HCPCS C1713 8012640 - SCREW BONE 1.6MM 4MM SLFDRILL CRUCIATE TITANIUM SPN BOTH IP/OP $142.50 $105.00 $28.26 $142.38 $64.07 $64.07 $64.07 $64.07 $142.38 $142.38 $142.38 $29.68 $142.38 $142.38 $142.38 $142.38 $142.38 $29.67 $142.38 $56.95 $84.22 $142.38 $142.38 $142.38 $142.38 $106.88 $142.38 $142.38 $142.38 $71.19 $71.19 $112.76 $142.38 $113.90 $64.07 $28.26 N/A $82.65 $142.38 $142.38 $142.38 $29.67 $142.38 N/A N/A 8020016 SUP Custom 27011340 8020016 - PROBE EMG M5 MOD BOTH IP/OP "$3,377.50" "$2,499.00" $601.20 "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" $601.20 "$3,377.50" "$3,377.50" "$2,506.78" "$2,506.78" "$2,603.38" "$1,759.68" $703.91 "$3,377.50" "$1,351.00" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$2,533.13" "$3,377.50" "$3,377.50" "$3,377.50" "$1,688.75" "$1,688.75" "$2,674.98" "$3,377.50" "$2,702.00" "$2,195.38" "$3,377.50" N/A "$1,958.95" "$3,377.50" "$2,026.50" "$3,377.50" "$3,377.50" "$3,377.50" N/A N/A 8020018 SUP Custom 27203010 8020018 - ELECTRODE EMG SRFC MOD CLIP NVM5 BOTH IP/OP "$3,377.50" "$2,499.00" $601.20 "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" $601.20 "$3,377.50" "$3,377.50" "$2,506.78" "$2,506.78" "$2,603.38" "$1,759.68" $703.91 "$3,377.50" "$1,351.00" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$2,533.13" "$3,377.50" "$3,377.50" "$3,377.50" "$1,688.75" "$1,688.75" "$2,674.98" "$3,377.50" "$2,702.00" "$2,195.38" "$3,377.50" N/A "$1,958.95" "$3,377.50" "$2,026.50" "$3,377.50" "$3,377.50" "$3,377.50" N/A N/A 8020020 SUP Custom 27203010 8020020 - ELECTRODE EMG NRVSN MOD CLIP PRB BOTH IP/OP "$4,140.00" "$3,064.00" $736.92 "$4,140.00" "$4,140.00" "$4,140.00" "$4,140.00" "$4,140.00" "$4,140.00" "$4,140.00" $736.92 "$4,140.00" "$4,140.00" "$3,072.71" "$3,072.71" "$3,191.11" "$2,060.15" $862.82 "$4,140.00" "$1,656.00" "$4,140.00" "$4,140.00" "$4,140.00" "$4,140.00" "$4,140.00" "$3,105.00" "$4,140.00" "$4,140.00" "$4,140.00" "$2,070.00" "$2,070.00" "$3,278.88" "$4,140.00" "$3,312.00" "$2,691.00" "$4,140.00" N/A "$2,401.20" "$4,140.00" "$2,484.00" "$4,140.00" "$4,140.00" "$4,140.00" N/A N/A 8020021 SUP Custom 27203010 8020021 - ELECTRODE EMG MOD CLIP SHTH NVM5 BOTH IP/OP "$3,367.50" "$2,492.00" $599.42 "$3,367.50" "$3,367.50" "$3,367.50" "$3,367.50" "$3,367.50" "$3,367.50" "$3,367.50" $599.42 "$3,367.50" "$3,367.50" "$2,499.36" "$2,499.36" "$2,595.67" "$1,754.47" $701.82 "$3,367.50" "$1,347.00" "$3,367.50" "$3,367.50" "$3,367.50" "$3,367.50" "$3,367.50" "$2,525.63" "$3,367.50" "$3,367.50" "$3,367.50" "$1,683.75" "$1,683.75" "$2,667.06" "$3,367.50" "$2,694.00" "$2,188.88" "$3,367.50" N/A "$1,953.15" "$3,367.50" "$2,020.50" "$3,367.50" "$3,367.50" "$3,367.50" N/A N/A 8020029 SUP Custom 27203010 8020029 - KIT EMG XLIF NVM5 BOTH IP/OP "$4,442.50" "$3,287.00" $790.77 "$4,442.50" "$4,442.50" "$4,442.50" "$4,442.50" "$4,442.50" "$4,442.50" "$4,442.50" $790.77 "$4,442.50" "$4,442.50" "$3,297.22" "$3,297.22" "$3,424.28" "$2,060.15" $925.87 "$4,442.50" "$1,777.00" "$4,442.50" "$4,442.50" "$4,442.50" "$4,442.50" "$4,442.50" "$3,331.88" "$4,442.50" "$4,442.50" "$4,442.50" "$2,221.25" "$2,221.25" "$3,518.46" "$4,442.50" "$3,554.00" "$2,887.63" "$4,442.50" N/A "$2,576.65" "$4,442.50" "$2,665.50" "$4,442.50" "$4,442.50" "$4,442.50" N/A N/A 8020215 SUP Custom 27203010 8020215 - ELECTRODE EMG MODULE NEUROVISION M5 BOTH IP/OP "$3,572.50" "$2,644.00" $635.91 "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" $635.91 "$3,572.50" "$3,572.50" "$2,651.51" "$2,651.51" "$2,753.68" "$1,861.27" $744.55 "$3,572.50" "$1,429.00" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$2,679.38" "$3,572.50" "$3,572.50" "$3,572.50" "$1,786.25" "$1,786.25" "$2,829.42" "$3,572.50" "$2,858.00" "$2,322.13" "$3,572.50" N/A "$2,072.05" "$3,572.50" "$2,143.50" "$3,572.50" "$3,572.50" "$3,572.50" N/A N/A 8050015 SUP Custom 27203010 8050015 - ELECTRODE EMG 15MM NEEDLE MODULE PROBE NEUROVISION M5 BOTH IP/OP "$2,687.50" "$1,989.00" $478.38 "$2,687.50" "$2,687.50" "$2,687.50" "$2,687.50" "$2,687.50" "$2,687.50" "$2,687.50" $478.38 "$2,687.50" "$2,687.50" "$1,994.66" "$1,994.66" "$2,071.53" "$1,400.19" $560.10 "$2,687.50" "$1,075.00" "$2,687.50" "$2,687.50" "$2,687.50" "$2,687.50" "$2,687.50" "$2,015.63" "$2,687.50" "$2,687.50" "$2,687.50" "$1,343.75" "$1,343.75" "$2,128.50" "$2,687.50" "$2,150.00" "$1,746.88" "$2,687.50" N/A "$1,558.75" "$2,687.50" "$1,612.50" "$2,687.50" "$2,687.50" "$2,687.50" N/A N/A 8050016 SUP Custom 27203010 8050016 - MODULE EMG NDL PRB M5 BOTH IP/OP "$3,377.50" "$2,499.00" $601.20 "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" $601.20 "$3,377.50" "$3,377.50" "$2,506.78" "$2,506.78" "$2,603.38" "$1,759.68" $703.91 "$3,377.50" "$1,351.00" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$2,533.13" "$3,377.50" "$3,377.50" "$3,377.50" "$1,688.75" "$1,688.75" "$2,674.98" "$3,377.50" "$2,702.00" "$2,195.38" "$3,377.50" N/A "$1,958.95" "$3,377.50" "$2,026.50" "$3,377.50" "$3,377.50" "$3,377.50" N/A N/A 8050018 SUP Custom 27203010 8050018 - MODULE SPNL M5 NDL EMG CLIP BOTH IP/OP "$3,377.50" "$2,499.00" $601.20 "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" $601.20 "$3,377.50" "$3,377.50" "$2,506.78" "$2,506.78" "$2,603.38" "$1,759.68" $703.91 "$3,377.50" "$1,351.00" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$3,377.50" "$2,533.13" "$3,377.50" "$3,377.50" "$3,377.50" "$1,688.75" "$1,688.75" "$2,674.98" "$3,377.50" "$2,702.00" "$2,195.38" "$3,377.50" N/A "$1,958.95" "$3,377.50" "$2,026.50" "$3,377.50" "$3,377.50" "$3,377.50" N/A N/A 8050020 SUP Custom 27203010 8050020 - ELECTRODE EMG 20MM NRVSN M5 NDL MOD PRB BOTH IP/OP "$4,140.00" "$3,064.00" $736.92 "$4,140.00" "$4,140.00" "$4,140.00" "$4,140.00" "$4,140.00" "$4,140.00" "$4,140.00" $736.92 "$4,140.00" "$4,140.00" "$3,072.71" "$3,072.71" "$3,191.11" "$2,060.15" $862.82 "$4,140.00" "$1,656.00" "$4,140.00" "$4,140.00" "$4,140.00" "$4,140.00" "$4,140.00" "$3,105.00" "$4,140.00" "$4,140.00" "$4,140.00" "$2,070.00" "$2,070.00" "$3,278.88" "$4,140.00" "$3,312.00" "$2,691.00" "$4,140.00" N/A "$2,401.20" "$4,140.00" "$2,484.00" "$4,140.00" "$4,140.00" "$4,140.00" N/A N/A 8050021 SUP Custom 27203010 8050021 - MODULE SPNL M5 NDL EMG CLIP SHTH BOTH IP/OP "$3,367.50" "$2,492.00" $599.42 "$3,367.50" "$3,367.50" "$3,367.50" "$3,367.50" "$3,367.50" "$3,367.50" "$3,367.50" $599.42 "$3,367.50" "$3,367.50" "$2,499.36" "$2,499.36" "$2,595.67" "$1,754.47" $701.82 "$3,367.50" "$1,347.00" "$3,367.50" "$3,367.50" "$3,367.50" "$3,367.50" "$3,367.50" "$2,525.63" "$3,367.50" "$3,367.50" "$3,367.50" "$1,683.75" "$1,683.75" "$2,667.06" "$3,367.50" "$2,694.00" "$2,188.88" "$3,367.50" N/A "$1,953.15" "$3,367.50" "$2,020.50" "$3,367.50" "$3,367.50" "$3,367.50" N/A N/A 8050029 SUP Custom 27203010 8050029 - MODULE SPNL M5 NDL EMG XLIF KT BOTH IP/OP "$4,442.50" "$3,287.00" $790.77 "$4,442.50" "$4,442.50" "$4,442.50" "$4,442.50" "$4,442.50" "$4,442.50" "$4,442.50" $790.77 "$4,442.50" "$4,442.50" "$3,297.22" "$3,297.22" "$3,424.28" "$2,060.15" $925.87 "$4,442.50" "$1,777.00" "$4,442.50" "$4,442.50" "$4,442.50" "$4,442.50" "$4,442.50" "$3,331.88" "$4,442.50" "$4,442.50" "$4,442.50" "$2,221.25" "$2,221.25" "$3,518.46" "$4,442.50" "$3,554.00" "$2,887.63" "$4,442.50" N/A "$2,576.65" "$4,442.50" "$2,665.50" "$4,442.50" "$4,442.50" "$4,442.50" N/A N/A 8050215 SUP Custom 27011340 8050215 - ELECTRODE EMG 15MM NEEDLE MODULE PROBE NEUROVISION M5 BOTH IP/OP "$3,572.50" "$2,644.00" $635.91 "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" $635.91 "$3,572.50" "$3,572.50" "$2,651.51" "$2,651.51" "$2,753.68" "$1,861.27" $744.55 "$3,572.50" "$1,429.00" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$2,679.38" "$3,572.50" "$3,572.50" "$3,572.50" "$1,786.25" "$1,786.25" "$2,829.42" "$3,572.50" "$2,858.00" "$2,322.13" "$3,572.50" N/A "$2,072.05" "$3,572.50" "$2,143.50" "$3,572.50" "$3,572.50" "$3,572.50" N/A N/A 8051100 SUP HCPCS C1713 8051100 - SCREW BONE 100MM LOCK CLOSE TULIP TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8052025 SUP HCPCS C1713 8052025 - ROD SPINAL PREBENT 5.5MM 25MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8052030 SUP HCPCS C1713 8052030 - ROD SPINAL PREBENT 5.5MM 30MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8052035 SUP HCPCS C1713 8052035 - ROD SPINAL PREBENT 5.5MM 35MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A 8052040 SUP HCPCS C1713 8052040 - ROD SPINAL 5.5MM 40MM PREBENT ARMADA TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8052045 SUP HCPCS C1713 8052045 - ROD SPINAL 5.5MM 45MM PREBENT ARMADA TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8052050 SUP HCPCS C1713 8052050 - ROD SPINAL PREBENT 5.5MM 50MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8052055 SUP HCPCS C1713 8052055 - ROD SPINAL PREBENT 5.5MM 55MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8052060 SUP HCPCS C1713 8052060 - ROD SPINAL PREBENT 5.5MM 60MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8052065 SUP HCPCS C1713 8052065 - ROD SPINAL 5.5MM 65MM PREBENT TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8052070 SUP HCPCS C1713 8052070 - ROD SPINAL 5.5MM 70MM PREBENT TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8052075 SUP HCPCS C1713 8052075 - ROD SPINAL PREBENT 5.5MM 75MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8052080 SUP HCPCS C1713 8052080 - ROD SPINAL PREBENT 5.5MM 80MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 8052085 SUP HCPCS C1713 8052085 - ROD SPINAL PREBENT 5.5MM 85MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 8052090 SUP HCPCS C1713 8052090 - ROD SPINAL 5.5MM 90MM PREBENT CONVENTIONAL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8052095 SUP HCPCS C1713 8052095 - ROD SPINAL 5.5MM 95MM PREBENT TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8052100 SUP HCPCS C1713 8052100 - ROD SPINAL 5.5MM 100MM PREBENT TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8052110 SUP HCPCS C1713 8052110 - ROD SPINAL PREBENT 5.5MM 110MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8052120 SUP HCPCS C1713 8052120 - ROD SPINAL PREBENT 5.5MM 120MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8052200 SUP HCPCS C1713 8052200 - ROD SPNL PREBNT 5.5MM 200MM ARMADA TI BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8060040 SUP Custom 27011340 8060040 - PLANER SRG NUVAMAP BOTH IP/OP "$2,990.00" "$2,213.00" $532.22 "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" $532.22 "$2,990.00" "$2,990.00" "$2,219.18" "$2,219.18" "$2,304.69" "$1,557.79" $623.15 "$2,990.00" "$1,196.00" "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" "$2,242.50" "$2,990.00" "$2,990.00" "$2,990.00" "$1,495.00" "$1,495.00" "$2,368.08" "$2,990.00" "$2,392.00" "$1,943.50" "$2,990.00" N/A "$1,734.20" "$2,990.00" "$1,794.00" "$2,990.00" "$2,990.00" "$2,990.00" N/A N/A 8100845 SUP HCPCS C1713 8100845 - SCREW SET 32 THREAD .19IN BREAKOFF CROSSLINK SPN PEDICLE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 8100855 SUP HCPCS C1713 8100855 - SCREW SET BREAKOFF X10 CROSSLINK STAINLESS STEEL SPN PEDICLE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 8103500 SUP HCPCS C1713 8103500 - SCREW SET BREAKOFF X10 CROSSLINK STAINLESS STEEL SPN PEDICLE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8103513 SUP HCPCS C1713 8103513 - PLATE BONE LORDOTIC 13MM X10 CROSSLINK TITANIUM SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8103517 SUP HCPCS C1713 8103517 - PLATE BONE LORDOTIC 17MM X10 CROSSLINK TITANIUM SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8103521 SUP HCPCS C1713 8103521 - PLATE BONE LORDOTIC 21MM X10 CROSSLINK TITANIUM SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8103525 SUP HCPCS C1713 8103525 - PLATE BONE LORDOTIC 25MM X10 CROSSLINK TITANIUM SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8103529 SUP HCPCS C1713 8103529 - PLATE BONE LORDOTIC 29MM X10 CROSSLINK TITANIUM SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8103533 SUP HCPCS C1713 8103533 - PLATE BONE LORDOTIC 33MM X10 CROSSLINK TITANIUM SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8103537 SUP HCPCS C1713 8103537 - PLATE BONE LORDOTIC 37MM X10 CROSSLINK TITANIUM SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8104516 SUP HCPCS C1713 8104516 - PLATE BONE 16MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8104519 SUP HCPCS C1713 8104519 - PLATE BONE 19MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8104522 SUP HCPCS C1713 8104522 - PLATE BONE 22MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8104525 SUP HCPCS C1713 8104525 - PLATE BONE 25MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8104528 SUP HCPCS C1713 8104528 - PLATE BONE 28MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8104531 SUP HCPCS C1713 8104531 - PLATE BONE 31MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8104534 SUP HCPCS C1713 8104534 - PLATE BONE 34MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8104537 SUP HCPCS C1713 8104537 - PLATE BONE 37MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8104540 SUP HCPCS C1713 8104540 - PLATE BONE 40MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8105516 SUP HCPCS C1713 8105516 - PLATE BONE LP 16MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8105519 SUP HCPCS C1713 8105519 - PLATE BONE LP 19MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8105522 SUP HCPCS C1713 8105522 - PLATE BONE LP 22MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8105525 SUP HCPCS C1713 8105525 - PLATE BONE LP 25MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8105527 SUP HCPCS C1713 8105527 - PLATE BONE LP 28MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8105528 SUP HCPCS C1713 8105528 - PLATE BONE 28-30MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8105530 SUP HCPCS C1713 8105530 - PLATE BONE 30-34MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8105531 SUP HCPCS C1713 8105531 - PLATE BONE LP 31MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8105534 SUP HCPCS C1713 8105534 - PLATE BONE 34-36MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8105536 SUP HCPCS C1713 8105536 - PLATE BONE 36-39MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8105539 SUP HCPCS C1713 8105539 - PLATE BONE 39-45MM CD HORIZON LEGACY X10 CROSSLINK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8105545 SUP HCPCS C1713 8105545 - PLATE BONE 45-57MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8105558 SUP HCPCS C1713 8105558 - PLATE BONE 58-81MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8106416 SUP HCPCS C1713 8106416 - PLATE BONE 16MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8106419 SUP HCPCS C1713 8106419 - PLATE BONE 19MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8106422 SUP HCPCS C1713 8106422 - PLATE BONE 22MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8106425 SUP HCPCS C1713 8106425 - PLATE BONE 25MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8106427 SUP HCPCS C1713 8106427 - PLATE BONE 28MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8106428 SUP HCPCS C1713 8106428 - PLATE BONE 28-30MM FIX LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8106430 SUP HCPCS C1713 8106430 - PLATE BONE 30-34MM FIX LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8106431 SUP HCPCS C1713 8106431 - PLATE BONE 31MM FIX LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8106434 SUP HCPCS C1713 8106434 - PLATE BONE 34-36MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8106436 SUP HCPCS C1713 8106436 - PLATE BONE 36-39MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8106439 SUP HCPCS C1713 8106439 - PLATE BONE 39-45MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8106445 SUP HCPCS C1713 8106445 - PLATE BONE 45-58MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8106458 SUP HCPCS C1713 8106458 - PLATE BONE 58-81MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8110450 SUP HCPCS C1713 8110450 - SCREW BONE SET CROSSLINK TITANIUM BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8110614 SUP HCPCS C1713 8110614 - PLATE BONE 14MM FIX ANTARES CROSSLINK CD HORIZON TITANIUM BOTH IP/OP "$4,155.00" "$3,075.00" $824.66 "$4,155.00" "$1,869.75" "$1,869.75" "$1,869.75" "$1,869.75" "$4,155.00" "$4,155.00" "$4,155.00" $866.01 "$4,155.00" "$4,155.00" "$4,155.00" "$4,155.00" "$4,155.00" $865.95 "$4,155.00" "$4,155.00" "$2,048.42" "$4,155.00" "$4,155.00" "$4,155.00" "$4,155.00" "$3,116.25" "$4,155.00" "$4,155.00" "$4,155.00" "$2,077.50" "$2,077.50" "$3,290.76" "$4,155.00" "$3,324.00" "$1,869.75" $824.66 N/A "$2,409.90" "$4,155.00" "$2,493.00" "$4,155.00" $865.90 "$4,155.00" N/A N/A 8110713 SUP HCPCS C1713 8110713 - PLATE BONE 13MM LEGACY CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8110714 SUP HCPCS C1713 8110714 - PLATE BONE 14MM LEGACY CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8110715 SUP HCPCS C1713 8110715 - PLATE BONE 15MM LEGACY CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8110716 SUP HCPCS C1713 8110716 - PLATE BONE 16MM LEGACY CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8110717 SUP HCPCS C1713 8110717 - PLATE BONE 17MM LEGACY CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8110718 SUP HCPCS C1713 8110718 - PLATE BONE 18MM LEGACY CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8110719 SUP HCPCS C1713 8110719 - PLATE BONE 19MM LEGACY CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8110845 SUP HCPCS C1713 8110845 - SCREW SET 8MM 45MM BREAKOFF SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 8110855 SUP HCPCS C1713 8110855 - SCREW SET BREAKOFF REVERSE ANGLE THREAD X10 CROSSLINK BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8113500 SUP HCPCS C1713 8113500 - SCREW BONE 3.5MM 10MM TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 8113513 SUP HCPCS C1713 8113513 - PLATE BONE LORDOTIC 13MM X10 CROSSLINK TITANIUM SPN 3.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8113517 SUP HCPCS C1713 8113517 - PLATE BONE LORDOTIC 17MM X10 CROSSLINK TITANIUM SPN 3.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8113521 SUP HCPCS C1713 8113521 - PLATE BONE LORDOTIC 21MM X10 CROSSLINK TITANIUM SPN 3.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8113525 SUP HCPCS C1713 8113525 - PLATE BONE LORDOTIC 25MM X10 CROSSLINK TITANIUM SPN 3.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8113529 SUP HCPCS C1713 8113529 - PLATE BONE LORDOTIC 29MM X10 CROSSLINK TITANIUM SPN 3.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8113533 SUP HCPCS C1713 8113533 - PLATE BONE LORDOTIC 33MM X10 CROSSLINK TITANIUM SPN 3.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8113537 SUP HCPCS C1713 8113537 - PLATE BONE LORDOTIC 37MM X10 CROSSLINK TITANIUM SPN 3.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8114516 SUP HCPCS C1713 8114516 - PLATE BONE 16MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8114519 SUP HCPCS C1713 8114519 - PLATE BONE 19MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8114522 SUP HCPCS C1713 8114522 - PLATE BONE 22MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8114525 SUP HCPCS C1713 8114525 - PLATE BONE 25MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8114528 SUP HCPCS C1713 8114528 - PLATE BONE 28MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8114531 SUP HCPCS C1713 8114531 - PLATE BONE 31MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8114534 SUP HCPCS C1713 8114534 - PLATE BONE 34MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8114537 SUP HCPCS C1713 8114537 - PLATE BONE 37MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8114540 SUP HCPCS C1713 8114540 - PLATE BONE 40MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8115516 SUP HCPCS C1713 8115516 - PLATE BN 16MM STRL LG X10 XLNK CD HZN LOPRFL FX TI SPNE 5.5 BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8115519 SUP HCPCS C1713 8115519 - PLATE BN 19MM STRL LG X10 XLNK CD HZN LOPRFL FX TI SPNE 5.5 BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8115522 SUP HCPCS C1713 8115522 - PLATE BONE LP 22MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8115525 SUP HCPCS C1713 8115525 - PLATE BN 25MM STRL LG X10 XLNK CD HZN LOPRFL FX TI SPNE 5.5 BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8115527 SUP HCPCS C1713 8115527 - PLATE BONE LP 28MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8115528 SUP HCPCS C1713 8115528 - PLATE BN 28-30MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8115530 SUP HCPCS C1713 8115530 - PLATE BN 30-34MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8115531 SUP HCPCS C1713 8115531 - PLATE BONE LP 31MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8115534 SUP HCPCS C1713 8115534 - PLATE BN 34-36MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8115536 SUP HCPCS C1713 8115536 - PLATE BN 36-39MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8115539 SUP HCPCS C1713 8115539 - PLATE BN 39-45MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8115545 SUP HCPCS C1713 8115545 - PLATE BN 45-58MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8115558 SUP HCPCS C1713 8115558 - PLATE BN 58-81MM STRL LGC MLSPN X10 XLNK CD HZN LOPRFL TI BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8116416 SUP HCPCS C1713 8116416 - PLATE BONE LP 16MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8116419 SUP HCPCS C1713 8116419 - PLATE BONE LP 16MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8116422 SUP HCPCS C1713 8116422 - PLATE BONE LP 16MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8116425 SUP HCPCS C1713 8116425 - PLATE BONE LP 16MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8116427 SUP HCPCS C1713 8116427 - PLATE BONE LP 16MM FIX LEGACY X10 CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8116428 SUP HCPCS C1713 8116428 - PLATE BONE LP 28-30MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8116430 SUP HCPCS C1713 8116430 - PLATE BONE LP 30-34MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8116431 SUP HCPCS C1713 8116431 - PLATE BONE LP 31MM FIX LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8116434 SUP HCPCS C1713 8116434 - PLATE BONE LP 34-36MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8116436 SUP HCPCS C1713 8116436 - PLATE BONE LP 36-39MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8116439 SUP HCPCS C1713 8116439 - PLATE BONE LP 39-45MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8116445 SUP HCPCS C1713 8116445 - PLATE BONE LP 45-57MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8116458 SUP HCPCS C1713 8116458 - PLATE BONE LP 58-81MM LEGACY MULTI-SPAN X10 CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8151100 SUP HCPCS C1713 8151100 - SCREW BONE TULIP LOCK CLOSE HEAD STAINLESS STEEL SPN BOTH IP/OP $757.50 $561.00 $150.34 $757.50 $340.88 $340.88 $340.88 $340.88 $757.50 $757.50 $757.50 $157.88 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $303.00 $448.06 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $150.34 N/A $439.35 $757.50 $454.50 $757.50 $157.86 $757.50 N/A N/A 8162102 SUP HCPCS C1713 8162102 - STAPLE BONE 9X2MM 2 PRONG SMA SPN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,183.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 8162103 SUP HCPCS C1713 8162103 - STAPLE BONE 9X3MM 2 PRONG SMA SPN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,183.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 8162104 SUP HCPCS C1713 8162104 - STAPLE BONE 10X4MM 2 PRONG SMA TITANIUM SPN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,183.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 8162106 SUP HCPCS C1713 8162106 - STAPLE BONE 11X6MM 2 PRONG SMA SPN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,183.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 8162108 SUP HCPCS C1713 8162108 - STAPLE BONE 12X8MM 2 PRONG SMA SPN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,183.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 8162110 SUP HCPCS C1713 8162110 - STAPLE BONE 13X10MM 2 PRONG SMA SPN BOTH IP/OP "$1,972.50" "$1,460.00" $391.49 "$1,972.50" $887.63 $887.63 $887.63 $887.63 "$1,972.50" "$1,972.50" "$1,972.50" $411.12 "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" $411.09 "$1,972.50" "$1,972.50" "$1,166.73" "$1,972.50" "$1,972.50" "$1,972.50" "$1,972.50" "$1,479.38" "$1,972.50" "$1,972.50" "$1,972.50" $986.25 $986.25 "$1,562.22" "$1,972.50" "$1,578.00" $887.63 $391.49 N/A "$1,144.05" "$1,972.50" "$1,183.50" "$1,972.50" $411.07 "$1,972.50" N/A N/A 8164604 SUP HCPCS C1713 8164604 - STAPLE BONE 10X4MM 4 PRONG SMA TITANIUM SPN BOTH IP/OP "$6,301.00" "$4,663.00" "$1,250.52" "$6,300.65" "$2,835.29" "$2,835.29" "$2,835.29" "$2,835.29" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.21" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.12" "$6,300.65" "$6,300.65" "$3,106.22" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$4,725.75" "$6,300.65" "$6,300.65" "$6,300.65" "$3,150.33" "$3,150.33" "$4,990.11" "$6,300.65" "$5,040.52" "$2,835.29" "$1,250.52" N/A "$3,654.58" "$6,300.65" "$3,780.39" "$6,300.65" "$1,313.06" "$6,300.65" N/A N/A 8164605 SUP HCPCS C1713 8164605 - STAPLE BONE 10X5MM 4 PRONG SMA TITANIUM SPN BOTH IP/OP "$6,301.00" "$4,663.00" "$1,250.52" "$6,300.65" "$2,835.29" "$2,835.29" "$2,835.29" "$2,835.29" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.21" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.12" "$6,300.65" "$6,300.65" "$3,106.22" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$4,725.75" "$6,300.65" "$6,300.65" "$6,300.65" "$3,150.33" "$3,150.33" "$4,990.11" "$6,300.65" "$5,040.52" "$2,835.29" "$1,250.52" N/A "$3,654.58" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.06" "$6,300.65" N/A N/A 8164606 SUP HCPCS C1713 8164606 - STAPLE BONE SMALL 11X6MM 2 4 PRONG SMA TITANIUM SPN BOTH IP/OP "$6,301.00" "$4,663.00" "$1,250.52" "$6,300.65" "$2,835.29" "$2,835.29" "$2,835.29" "$2,835.29" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.21" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.12" "$6,300.65" "$6,300.65" "$3,106.22" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$4,725.75" "$6,300.65" "$6,300.65" "$6,300.65" "$3,150.33" "$3,150.33" "$4,990.11" "$6,300.65" "$5,040.52" "$2,835.29" "$1,250.52" N/A "$3,654.58" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.06" "$6,300.65" N/A N/A 8164608 SUP HCPCS C1713 8164608 - STAPLE BONE SMALL 12X8MM 2 4 PRONG SMA TITANIUM SPN BOTH IP/OP "$6,301.00" "$4,663.00" "$1,250.52" "$6,300.65" "$2,835.29" "$2,835.29" "$2,835.29" "$2,835.29" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.21" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.12" "$6,300.65" "$6,300.65" "$3,106.22" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$4,725.75" "$6,300.65" "$6,300.65" "$6,300.65" "$3,150.33" "$3,150.33" "$4,990.11" "$6,300.65" "$5,040.52" "$2,835.29" "$1,250.52" N/A "$3,654.58" "$6,300.65" "$3,780.39" "$6,300.65" "$1,313.06" "$6,300.65" N/A N/A 8164610 SUP HCPCS C1713 8164610 - STAPLE BONE SMALL 13X10MM 2 4 PRONG SMA TITANIUM SPN BOTH IP/OP "$6,301.00" "$4,663.00" "$1,250.52" "$6,300.65" "$2,835.29" "$2,835.29" "$2,835.29" "$2,835.29" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.21" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.12" "$6,300.65" "$6,300.65" "$3,106.22" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$4,725.75" "$6,300.65" "$6,300.65" "$6,300.65" "$3,150.33" "$3,150.33" "$4,990.11" "$6,300.65" "$5,040.52" "$2,835.29" "$1,250.52" N/A "$3,654.58" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.06" "$6,300.65" N/A N/A 8164612 SUP HCPCS C1713 8164612 - STAPLE BONE 14X12MM 4 PRONG SMA SPN BOTH IP/OP "$6,301.00" "$4,663.00" "$1,250.52" "$6,300.65" "$2,835.29" "$2,835.29" "$2,835.29" "$2,835.29" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.21" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.12" "$6,300.65" "$6,300.65" "$3,106.22" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$4,725.75" "$6,300.65" "$6,300.65" "$6,300.65" "$3,150.33" "$3,150.33" "$4,990.11" "$6,300.65" "$5,040.52" "$2,835.29" "$1,250.52" N/A "$3,654.58" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.06" "$6,300.65" N/A N/A 8164614 SUP HCPCS C1713 8164614 - STAPLE BONE 15X14MM 4 PRONG SMA SMA SPN BOTH IP/OP "$6,301.00" "$4,663.00" "$1,250.52" "$6,300.65" "$2,835.29" "$2,835.29" "$2,835.29" "$2,835.29" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.21" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$1,313.12" "$6,300.65" "$6,300.65" "$3,106.22" "$6,300.65" "$6,300.65" "$6,300.65" "$6,300.65" "$4,725.75" "$6,300.65" "$6,300.65" "$6,300.65" "$3,150.33" "$3,150.33" "$4,990.11" "$6,300.65" "$5,040.52" "$2,835.29" "$1,250.52" N/A "$3,654.58" "$6,300.65" "$3,780.39" "$6,300.65" "$1,313.06" "$6,300.65" N/A N/A 8200001 SUP HCPCS C1713 8200001 - CLIP SPNL LG NUVASIVE INC BOTH IP/OP "$2,282.50" "$1,689.00" $453.02 "$2,282.50" "$1,027.13" "$1,027.13" "$1,027.13" "$1,027.13" "$2,282.50" "$2,282.50" "$2,282.50" $475.73 "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" $475.70 "$2,282.50" $913.00 "$1,350.10" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$1,711.88" "$2,282.50" "$2,282.50" "$2,282.50" "$1,141.25" "$1,141.25" "$1,807.74" "$2,282.50" "$1,826.00" "$1,027.13" $453.02 N/A "$1,323.85" "$2,282.50" "$2,282.50" "$2,282.50" $475.67 "$2,282.50" N/A N/A 8200003 SUP HCPCS C1769 8200003 - WIRE FX KRSH MAXCESS MOD BOTH IP/OP "$1,857.50" "$1,375.00" $368.67 "$1,857.50" "$1,008.62" "$1,008.62" "$1,008.62" "$1,008.62" "$1,857.50" "$1,857.50" "$1,857.50" $387.15 "$1,857.50" "$1,378.64" "$1,378.64" "$1,431.76" $967.76 $387.12 "$1,857.50" "$1,857.50" "$1,098.71" "$1,857.50" "$1,857.50" "$1,857.50" "$1,857.50" "$1,393.13" "$1,857.50" "$1,857.50" "$1,857.50" $928.75 $928.75 "$1,471.14" "$1,857.50" "$1,486.00" "$1,207.38" $368.67 N/A "$1,077.35" "$1,857.50" "$1,857.50" "$1,857.50" $387.10 "$1,857.50" N/A N/A 8200010 SUP Custom 27203010 8200010 - KIT SPNL STRL MAXCESS SHIM DISP BOTH IP/OP "$3,572.50" "$2,644.00" $635.91 "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" $635.91 "$3,572.50" "$3,572.50" "$2,651.51" "$2,651.51" "$2,753.68" "$1,861.27" $744.55 "$3,572.50" "$1,429.00" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$3,572.50" "$2,679.38" "$3,572.50" "$3,572.50" "$3,572.50" "$1,786.25" "$1,786.25" "$2,829.42" "$3,572.50" "$2,858.00" "$2,322.13" "$3,572.50" N/A "$2,072.05" "$3,572.50" "$2,143.50" "$3,572.50" "$3,572.50" "$3,572.50" N/A N/A 8200011 SUP Custom 27203010 8200011 - KIT SPNL STRL MAXCESS MOD DISP BOTH IP/OP "$5,115.00" "$3,785.00" $910.47 "$5,115.00" "$5,115.00" "$5,115.00" "$5,115.00" "$5,115.00" "$5,115.00" "$5,115.00" $910.47 "$5,115.00" "$5,115.00" "$3,796.35" "$3,796.35" "$3,942.64" "$2,060.15" "$1,066.02" "$5,115.00" "$2,046.00" "$5,115.00" "$5,115.00" "$5,115.00" "$5,115.00" "$5,115.00" "$3,836.25" "$5,115.00" "$5,115.00" "$5,115.00" "$2,557.50" "$2,557.50" "$4,051.08" "$5,115.00" "$4,092.00" "$3,324.75" "$5,115.00" N/A "$2,966.70" "$5,115.00" "$3,069.00" "$5,115.00" "$5,115.00" "$5,115.00" N/A N/A 8200200 SUP HCPCS C1713 8200200 - SCREW BN MA MOD TLIF SPNE DISP BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A 8200201 SUP HCPCS C1713 8200201 - SCREW BN MA HP SHIM LGHT CBL SPNE TLIF BOTH IP/OP "$4,662.50" "$3,450.00" $925.39 "$4,662.50" "$2,098.13" "$2,098.13" "$2,098.13" "$2,098.13" "$4,662.50" "$4,662.50" "$4,662.50" $971.78 "$4,662.50" "$4,662.50" "$4,662.50" "$4,662.50" "$4,662.50" $971.72 "$4,662.50" "$1,865.00" "$2,298.61" "$4,662.50" "$4,662.50" "$4,662.50" "$4,662.50" "$3,496.88" "$4,662.50" "$4,662.50" "$4,662.50" "$2,331.25" "$2,331.25" "$3,692.70" "$4,662.50" "$3,730.00" "$2,098.13" $925.39 N/A "$2,704.25" "$4,662.50" "$4,662.50" "$4,662.50" $971.67 "$4,662.50" N/A N/A 8200202 SUP HCPCS C1713 8200202 - SCREW BN MA MOD TLIF HP SHIM SPNE BOTH IP/OP "$3,575.00" "$2,646.00" $709.55 "$3,575.00" "$1,608.75" "$1,608.75" "$1,608.75" "$1,608.75" "$3,575.00" "$3,575.00" "$3,575.00" $745.12 "$3,575.00" "$3,575.00" "$3,575.00" "$3,575.00" "$3,575.00" $745.07 "$3,575.00" "$3,575.00" "$1,762.48" "$3,575.00" "$3,575.00" "$3,575.00" "$3,575.00" "$2,681.25" "$3,575.00" "$3,575.00" "$3,575.00" "$1,787.50" "$1,787.50" "$2,831.40" "$3,575.00" "$2,860.00" "$1,608.75" $709.55 N/A "$2,073.50" "$3,575.00" "$3,575.00" "$3,575.00" $745.03 "$3,575.00" N/A N/A 8203030 SUP Custom 27203010 8203030 - AIRWAY PHARYNGEAL 3 SMALL 15MM CONCTR NONINFLATABLE CUFF BOTH IP/OP $23.50 $17.00 $4.10 $23.05 $23.05 $23.05 $23.05 $23.05 $23.05 $23.05 $4.10 $23.05 $23.05 $17.11 $17.11 $17.77 $12.01 $4.80 $23.05 $9.22 $23.05 $23.05 $23.05 $23.05 $23.05 $17.63 $23.05 $23.05 $23.05 $11.53 $11.53 $18.26 $23.05 $18.44 $14.98 $23.05 N/A $13.63 $23.05 $13.83 $23.05 $23.05 $23.05 N/A N/A 8227103 SUP HCPCS C1898 8227103 - ELECTRODE EMG 4MM 12MM 2MM 2 CHANNEL NEEDLE LANCET TIP BOTH IP/OP $227.50 $168.00 $47.41 $227.50 $227.50 $227.50 $227.50 $227.50 $227.50 $227.50 $227.50 $227.50 $227.50 $227.50 $227.50 $227.50 $227.50 $47.41 $227.50 $91.00 $227.50 $227.50 $227.50 $227.50 $227.50 $170.63 $227.50 $227.50 $227.50 $113.75 $113.75 $180.18 $227.50 $182.00 $102.38 $227.50 N/A $131.95 $227.50 $136.50 $227.50 $227.50 $227.50 N/A N/A 8229507 SUP Custom 27203010 8229507 - TUBE ENDOTRACHEAL NIM STAINLESS STEEL PVC OD10.5 MM ID7.0 MM BOTH IP/OP $960.00 $710.00 $170.88 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $170.88 $960.00 $960.00 $712.51 $712.51 $739.97 $500.16 $200.07 $960.00 $384.00 $960.00 $960.00 $960.00 $960.00 $960.00 $720.00 $960.00 $960.00 $960.00 $480.00 $480.00 $760.32 $960.00 $768.00 $624.00 $960.00 N/A $556.80 $960.00 $576.00 $960.00 $960.00 $960.00 N/A N/A 8229706 SUP Custom 27803010 8229706 - TUBE ENDOTRAC STANDARD LP 8.2MM 6MM DEPH FREE NONREINFORCED BOTH IP/OP $924.00 $684.00 $164.45 "$1,014.13" $923.88 $923.88 $923.88 $923.88 $923.88 $923.88 $164.45 $923.88 $923.88 $923.88 $923.88 $923.88 $923.88 $192.55 $923.88 $405.65 $923.88 $923.88 "$1,014.13" $923.88 $923.88 $693.00 $923.88 $923.88 $923.88 $461.94 $461.94 $731.71 $923.88 $739.10 $415.75 $923.88 N/A $535.92 $923.88 $554.33 $923.88 $923.88 $923.88 N/A N/A 8229707 SUP Custom 27803010 8229707 - TUBE ET STD LOPRFL 9.5MM 7MM STRL NIM TRIVANTAGE DEPH FR BOTH IP/OP $924.00 $684.00 $164.45 "$1,014.13" $923.88 $923.88 $923.88 $923.88 $923.88 $923.88 $164.45 $923.88 $923.88 $923.88 $923.88 $923.88 $923.88 $192.55 $923.88 $405.65 $923.88 $923.88 "$1,014.13" $923.88 $923.88 $693.00 $923.88 $923.88 $923.88 $461.94 $461.94 $731.71 $923.88 $739.10 $415.75 $923.88 N/A $535.92 $923.88 $554.33 $923.88 $923.88 $923.88 N/A N/A 8229708 SUP Custom 27803010 8229708 - TUBE ENDOTRAC STANDARD LP 10.7MM 8MM DEPH FREE NONREINFORCED BOTH IP/OP $853.00 $631.00 $151.77 $852.63 $852.63 $852.63 $852.63 $852.63 $852.63 $852.63 $151.77 $852.63 $852.63 $852.63 $852.63 $852.63 $852.63 $177.70 $852.63 $341.05 $852.63 $852.63 $852.63 $852.63 $852.63 $639.75 $852.63 $852.63 $852.63 $426.32 $426.32 $675.28 $852.63 $682.10 $383.68 $852.63 N/A $494.74 $852.63 $511.58 $852.63 $852.63 $852.63 N/A N/A 8240001 SUP Custom 27203010 8240001 - KIT SPINAL 4 MAXCESS BOTH IP/OP "$2,385.00" "$1,765.00" $424.53 "$2,385.00" "$2,385.00" "$2,385.00" "$2,385.00" "$2,385.00" "$2,385.00" "$2,385.00" $424.53 "$2,385.00" "$2,385.00" "$1,770.15" "$1,770.15" "$1,838.36" "$1,242.59" $497.06 "$2,385.00" $954.00 "$2,385.00" "$2,385.00" "$2,385.00" "$2,385.00" "$2,385.00" "$1,788.75" "$2,385.00" "$2,385.00" "$2,385.00" "$1,192.50" "$1,192.50" "$1,888.92" "$2,385.00" "$1,908.00" "$1,550.25" "$2,385.00" N/A "$1,383.30" "$2,385.00" "$1,431.00" "$2,385.00" "$2,385.00" "$2,385.00" N/A N/A 8240060 SUP Custom 27203010 8240060 - MODULE SPNL 4 MAXCESS BOTH IP/OP "$5,850.50" "$4,329.00" "$1,041.34" "$5,850.25" "$5,850.25" "$5,850.25" "$5,850.25" "$5,850.25" "$5,850.25" "$5,850.25" "$1,041.34" "$5,850.25" "$5,850.25" "$4,181.12" "$4,181.12" "$4,509.37" "$2,060.15" "$1,219.26" "$5,850.25" "$2,340.10" "$5,850.25" "$5,850.25" "$5,850.25" "$5,850.25" "$5,850.25" "$4,387.88" "$5,850.25" "$5,850.25" "$5,850.25" "$2,925.13" "$2,925.13" "$4,633.40" "$5,850.25" "$4,680.20" "$3,802.66" "$5,850.25" N/A "$3,393.29" "$5,850.25" "$3,510.15" "$5,850.25" "$5,850.25" "$5,850.25" N/A N/A 8240061 SUP Custom 27203010 8240061 - MODULE SPNL 4 MAXCESS SHIM BOTH IP/OP "$4,695.50" "$3,475.00" $835.75 "$4,695.25" "$4,695.25" "$4,695.25" "$4,695.25" "$4,695.25" "$4,695.25" "$4,695.25" $835.75 "$4,695.25" "$4,695.25" "$3,484.81" "$3,484.81" "$3,619.10" "$2,060.15" $978.54 "$4,695.25" "$1,878.10" "$4,695.25" "$4,695.25" "$4,695.25" "$4,695.25" "$4,695.25" "$3,521.63" "$4,695.25" "$4,695.25" "$4,695.25" "$2,347.63" "$2,347.63" "$3,718.64" "$4,695.25" "$3,756.20" "$3,051.91" "$4,695.25" N/A "$2,723.39" "$4,695.25" "$2,817.15" "$4,695.25" "$4,695.25" "$4,695.25" N/A N/A 8275525 SUP HCPCS C1713 8275525 - SCREW BN 5.5MM 25MM RDC TI SPNE 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$3,257.50" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$3,257.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8275530 SUP HCPCS C1713 8275530 - SCREW BN 5.5MM 30MM RDC TI SPNE 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$3,257.50" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$3,257.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8275535 SUP HCPCS C1713 8275535 - SCREW BN 5.5MM 35MM RDC TI SPNE 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$1,303.00" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$3,257.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8275540 SUP HCPCS C1713 8275540 - SCREW BONE 5.5MM 40MM REDX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$3,257.50" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$1,954.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8275545 SUP HCPCS C1713 8275545 - SCREW BN 5.5MM 45MM RDC TI SPNE 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$1,303.00" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$3,257.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8275550 SUP HCPCS C1713 8275550 - SCREW BN 5.5MM 50MM RDC TI SPNE 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$1,303.00" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$3,257.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8275555 SUP HCPCS C1713 8275555 - SCREW BN 5.5MM 55MM RDC TI SPNE 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$1,303.00" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$3,257.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8276530 SUP HCPCS C1713 8276530 - SCREW BN 6.5MM 30MM RDC TI SPNE 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$1,303.00" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$3,257.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8276535 SUP HCPCS C1713 8276535 - SCREW BN 6.5MM 35MM RDC TI SPNE 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$3,257.50" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$3,257.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8276545 SUP HCPCS C1713 8276545 - SCREW BN 6.5MM 45MM RDC TI SPNE 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$3,257.50" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$3,257.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8276555 SUP HCPCS C1713 8276555 - SCREW BN 6.5MM 55MM RDC TI SPNE 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$3,257.50" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$3,257.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8277530 SUP HCPCS C1713 8277530 - SCREW BN 7.5MM 30MM RDC TI SPNE 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$1,303.00" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$3,257.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8277535 SUP HCPCS C1713 8277535 - SCREW BN 7.5MM 35MM RDC TI SPNE 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$1,303.00" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$3,257.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8277540 SUP HCPCS C1713 8277540 - SCREW BN 7.5MM 40MM RDC TI SPNE 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$3,257.50" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$3,257.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8277550 SUP HCPCS C1713 8277550 - SCREW BN 7.5MM 50MM RDC TI SPNE 5.5MM ROD BOTH IP/OP "$3,257.50" "$2,411.00" $646.53 "$3,257.50" "$1,465.88" "$1,465.88" "$1,465.88" "$1,465.88" "$3,257.50" "$3,257.50" "$3,257.50" $678.94 "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" $678.90 "$3,257.50" "$3,257.50" "$1,605.95" "$3,257.50" "$3,257.50" "$3,257.50" "$3,257.50" "$2,443.13" "$3,257.50" "$3,257.50" "$3,257.50" "$1,628.75" "$1,628.75" "$2,579.94" "$3,257.50" "$2,606.00" "$1,465.88" $646.53 N/A "$1,889.35" "$3,257.50" "$3,257.50" "$3,257.50" $678.86 "$3,257.50" N/A N/A 8281190 SUP HCPCS C1713 8281190 - SCREW BONE .25IN 32MM LOCK SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8281246 SUP HCPCS C1713 8281246 - SCREW SET .25IN 2 HEXAGONAL BREAKOFF TSRH-3D TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8281248 SUP HCPCS C1713 8281248 - SCREW SET 32 THREAD .25IN BREAKOFF LOCKING TSRH-3D TITANIUM BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8350424 SUP Custom 27203010 8350424 - TAP SURG 5.5MM OSTEOGRIP BOTH IP/OP $790.50 $585.00 $140.71 $790.50 $790.50 $790.50 $790.50 $790.50 $790.50 $790.50 $140.71 $790.50 $790.50 $586.71 $586.71 $609.32 $411.85 $164.75 $790.50 $316.20 $790.50 $790.50 $790.50 $790.50 $790.50 $592.88 $790.50 $790.50 $790.50 $395.25 $395.25 $626.08 $790.50 $632.40 $513.83 $790.50 N/A $458.49 $790.50 $474.30 $790.50 $790.50 $790.50 N/A N/A 8350426 SUP Custom 27203010 8350426 - TAP SURG 6.5MM OSTEOGRIP BOTH IP/OP $790.50 $585.00 $140.71 $790.50 $790.50 $790.50 $790.50 $790.50 $790.50 $790.50 $140.71 $790.50 $790.50 $586.71 $586.71 $609.32 $411.85 $164.75 $790.50 $316.20 $790.50 $790.50 $790.50 $790.50 $790.50 $592.88 $790.50 $790.50 $790.50 $395.25 $395.25 $626.08 $790.50 $632.40 $513.83 $790.50 N/A $458.49 $790.50 $474.30 $790.50 $790.50 $790.50 N/A N/A 8351500 SUP HCPCS C1713 8351500 - CONNECTOR ROD SMALL TSRH SPN 3DX BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8351502 SUP HCPCS C1713 8351502 - SCREW SET NONBREAKOFF TSRH-3DX SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8351520 SUP Custom 27803010 8351520 - CONNECTOR ROD SMALL TSRH TITANIUM SPN 3DX BOTH IP/OP "$2,317.00" "$1,715.00" $412.38 "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" $412.38 "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" $482.84 "$2,316.75" $926.70 "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$1,737.75" "$2,316.75" "$2,316.75" "$2,316.75" "$1,158.38" "$1,158.38" "$1,834.87" "$2,316.75" "$1,853.40" "$1,042.54" "$2,316.75" N/A "$1,343.86" "$2,316.75" "$1,390.05" "$2,316.75" "$2,316.75" "$2,316.75" N/A N/A 8351521 SUP Custom 27803010 8351521 - CONNECTOR ROD MEDIUM TSRH TITANIUM SPN 3DX BOTH IP/OP "$2,317.00" "$1,715.00" $412.38 "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" $412.38 "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" $482.84 "$2,316.75" $926.70 "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$1,737.75" "$2,316.75" "$2,316.75" "$2,316.75" "$1,158.38" "$1,158.38" "$1,834.87" "$2,316.75" "$1,853.40" "$1,042.54" "$2,316.75" N/A "$1,343.86" "$2,316.75" "$1,390.05" "$2,316.75" "$2,316.75" "$2,316.75" N/A N/A 8351522 SUP Custom 27803010 8351522 - CONNECTOR ROD LARGE TSRH TITANIUM SPN 3DX BOTH IP/OP "$2,317.00" "$1,715.00" $412.38 "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" $412.38 "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" $482.84 "$2,316.75" $926.70 "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$1,737.75" "$2,316.75" "$2,316.75" "$2,316.75" "$1,158.38" "$1,158.38" "$1,834.87" "$2,316.75" "$1,853.40" "$1,042.54" "$2,316.75" N/A "$1,343.86" "$2,316.75" "$1,390.05" "$2,316.75" "$2,316.75" "$2,316.75" N/A N/A 8351523 SUP Custom 27803010 8351523 - CONNECTOR ROD 90D OFFST TSRH 3DX BOTH IP/OP "$2,317.00" "$1,715.00" $412.38 "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" $412.38 "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" $482.84 "$2,316.75" $926.70 "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$2,316.75" "$1,737.75" "$2,316.75" "$2,316.75" "$2,316.75" "$1,158.38" "$1,158.38" "$1,834.87" "$2,316.75" "$1,853.40" "$1,042.54" "$2,316.75" N/A "$1,343.86" "$2,316.75" "$1,390.05" "$2,316.75" "$2,316.75" "$2,316.75" N/A N/A 8352200 SUP HCPCS C1713 8352200 - ROD SPINAL 5MM 200MM USS BOTH IP/OP "$2,017.50" "$1,493.00" $400.42 "$2,017.50" $907.88 $907.88 $907.88 $907.88 "$2,017.50" "$2,017.50" "$2,017.50" $420.50 "$2,017.50" "$2,017.50" "$2,017.50" "$2,017.50" "$2,017.50" $420.47 "$2,017.50" $807.00 "$1,193.35" "$2,017.50" "$2,017.50" "$2,017.50" "$2,017.50" "$1,513.13" "$2,017.50" "$2,017.50" "$2,017.50" "$1,008.75" "$1,008.75" "$1,597.86" "$2,017.50" "$1,614.00" $907.88 $400.42 N/A "$1,170.15" "$2,017.50" "$1,210.50" "$2,017.50" $420.45 "$2,017.50" N/A N/A 8352300 SUP HCPCS C1713 8352300 - ROD SPINAL 5MM 300MM USS BOTH IP/OP "$2,275.00" "$1,684.00" $451.53 "$2,275.00" "$1,023.75" "$1,023.75" "$1,023.75" "$1,023.75" "$2,275.00" "$2,275.00" "$2,275.00" $474.17 "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" $474.14 "$2,275.00" $910.00 "$1,345.66" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$1,706.25" "$2,275.00" "$2,275.00" "$2,275.00" "$1,137.50" "$1,137.50" "$1,801.80" "$2,275.00" "$1,820.00" "$1,023.75" $451.53 N/A "$1,319.50" "$2,275.00" "$1,365.00" "$2,275.00" $474.11 "$2,275.00" N/A N/A 8352500 SUP HCPCS C1713 8352500 - ROD SPINAL 5.5MM 500MM USS BOTH IP/OP "$2,502.50" "$1,852.00" $496.68 "$2,502.50" "$1,126.13" "$1,126.13" "$1,126.13" "$1,126.13" "$2,502.50" "$2,502.50" "$2,502.50" $521.58 "$2,502.50" "$2,502.50" "$2,502.50" "$2,502.50" "$2,502.50" $521.55 "$2,502.50" "$1,001.00" "$1,233.73" "$2,502.50" "$2,502.50" "$2,502.50" "$2,502.50" "$1,876.88" "$2,502.50" "$2,502.50" "$2,502.50" "$1,251.25" "$1,251.25" "$1,981.98" "$2,502.50" "$2,002.00" "$1,126.13" $496.68 N/A "$1,451.45" "$2,502.50" "$1,501.50" "$2,502.50" $521.52 "$2,502.50" N/A N/A 8352510 SUP Custom 27803010 8352510 - CONNECTOR ROD 5.5MM SLOTTED TITANIUM SPN BOTH IP/OP "$2,031.00" "$1,503.00" $361.52 "$2,031.00" "$2,031.00" "$2,031.00" "$2,031.00" "$2,031.00" "$2,031.00" "$2,031.00" $361.52 "$2,031.00" "$2,031.00" "$2,031.00" "$2,031.00" "$2,031.00" "$2,031.00" $423.28 "$2,031.00" $812.40 "$2,031.00" "$2,031.00" "$2,031.00" "$2,031.00" "$2,031.00" "$1,523.25" "$2,031.00" "$2,031.00" "$2,031.00" "$1,015.50" "$1,015.50" "$1,608.55" "$2,031.00" "$1,624.80" $913.95 "$2,031.00" N/A "$1,177.98" "$2,031.00" "$1,218.60" "$2,031.00" "$2,031.00" "$2,031.00" N/A N/A 8354525 SUP HCPCS C1713 8354525 - SCREW BONE 4.5MM 25MM LOCK STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$2,203.00" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8354530 SUP HCPCS C1713 8354530 - SCREW BONE 4.5MM 30MM LOCK STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$3,304.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8354535 SUP HCPCS C1713 8354535 - SCREW BONE 4.5MM 35MM LOCK STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8354540 SUP HCPCS C1713 8354540 - SCREW BONE 4.5MM 40MM LOCK STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$2,203.00" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8355530 SUP HCPCS C1713 8355530 - SCREW BONE 5.5MM 30MM LOCK STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$2,203.00" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8355535 SUP HCPCS C1713 8355535 - SCREW BONE 5.5MM 35MM LOCK STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$2,203.00" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8355540 SUP HCPCS C1713 8355540 - SCREW BONE 5.5MM 40MM LOCK STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$3,304.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8355545 SUP HCPCS C1713 8355545 - SCREW BONE 5.5MM 45MM LOCK STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$3,304.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8356535 SUP HCPCS C1713 8356535 - SCREW BONE 6.5MM 35MM LOCK STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$3,304.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8356540 SUP HCPCS C1713 8356540 - SCREW BONE 6.5MM 40MM LOCK STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$3,304.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8356545 SUP HCPCS C1713 8356545 - SCREW BONE 6.5MM 45MM LOCK STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8364525 SUP HCPCS C1713 8364525 - SCREW BONE 4.5MM 25MM SPNL LCK 6.35MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$3,304.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8364530 SUP HCPCS C1713 8364530 - SCREW BONE 4.5MM 30MM SPNL LCK 6.35MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8364535 SUP HCPCS C1713 8364535 - SCREW BONE 4.5MM 35MM SPNL LCK 6.35MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8364540 SUP HCPCS C1713 8364540 - SCREW BONE 4.5MM 40MM SPNL LCK 6.35MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$3,304.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8364545 SUP HCPCS C1713 8364545 - SCREW BONE 4.5MM 45MM SPNL LCK 6.35MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$2,203.00" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8365530 SUP HCPCS C1713 8365530 - SCREW BONE 5.5MM 30MM SPNL LCK 6.35MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" N/A N/A 8365535 SUP HCPCS C1713 8365535 - SCREW BONE 5.5MM 35MM SPNL LCK 6.35MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$2,203.00" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" N/A N/A 8365540 SUP HCPCS C1713 8365540 - SCREW BONE 5.5MM 40MM SPNL LCK 6.35MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$3,304.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8365545 SUP HCPCS C1713 8365545 - SCREW BONE 5.5MM 45MM SPNL LCK 6.35MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$2,203.00" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$3,304.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8366535 SUP HCPCS C1713 8366535 - SCREW BONE 6.5MM 35MM SPNL LCK 6.35MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$3,304.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8366540 SUP HCPCS C1713 8366540 - SCREW BONE 6.5MM 40MM SPNL LCK 6.35MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$2,203.00" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$3,304.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8366545 SUP HCPCS C1713 8366545 - SCREW BONE 6.5MM 45MM SPNL LCK 6.35MM ROD BOTH IP/OP "$5,507.50" "$4,076.00" "$1,093.10" "$5,507.50" "$2,478.38" "$2,478.38" "$2,478.38" "$2,478.38" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.90" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$1,147.82" "$5,507.50" "$5,507.50" "$2,715.20" "$5,507.50" "$5,507.50" "$5,507.50" "$5,507.50" "$4,130.63" "$5,507.50" "$5,507.50" "$5,507.50" "$2,753.75" "$2,753.75" "$4,361.94" "$5,507.50" "$4,406.00" "$2,478.38" "$1,093.10" N/A "$3,194.35" "$5,507.50" "$3,304.50" "$5,507.50" "$1,147.76" "$5,507.50" N/A N/A 8367645 SUP HCPCS C1713 8367645 - EXTRACTOR SURG 4.5 MM BONE SCREW BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" $455.40 $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367650 SUP HCPCS C1713 8367650 - EXTRACTOR SURG 5 MM BONE SCREW BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" $455.40 $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" $683.10 "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367655 SUP HCPCS C1713 8367655 - EXTRACTOR SURG 5.5 MM BONE SCREWS BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" "$1,138.50" $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" $683.10 "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367660 SUP HCPCS C1713 8367660 - EXTRACTOR SURG 6.5MM BONE SCREW BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" "$1,138.50" $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367665 SUP HCPCS C1713 8367665 - EXTRACTOR SURG 6.5MM BONE SCREW BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" "$1,138.50" $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" $683.10 "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367670 SUP HCPCS C1713 8367670 - EXTRACTOR SURG 7MM BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" $455.40 $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" $683.10 "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367675 SUP HCPCS C1713 8367675 - EXTRACTOR SURG 7.5MM BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" "$1,138.50" $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367680 SUP HCPCS C1713 8367680 - EXTRACTOR SURG 8 MM BONE SCREW BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" "$1,138.50" $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" $683.10 "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367745 SUP HCPCS C1713 8367745 - TREPHINE SURG SPN 4.5 MM BONE SCREW BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" "$1,138.50" $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" $683.10 "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367750 SUP HCPCS C1713 8367750 - TREPHINE SURG SPN 5 MM BONE SCREW BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" "$1,138.50" $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" $683.10 "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367755 SUP HCPCS C1713 8367755 - TREPHINE SURG SPN 5.5 MM BONE SCREW BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" "$1,138.50" $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" $683.10 "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367760 SUP HCPCS C1713 8367760 - TREPHINE SURG SPN 6.5MM BONE SCREW BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" $455.40 $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" $683.10 "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367765 SUP HCPCS C1713 8367765 - TREPHINE SURG SPN 6.5MM BONE SCREW BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" "$1,138.50" $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367770 SUP HCPCS C1713 8367770 - TREPHINE SURG SPN 7 MM BONE SCREW BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" $455.40 $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367775 SUP HCPCS C1713 8367775 - TREPHINE SURG SPN 7.5 MM BONE SCREW BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" "$1,138.50" $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" $683.10 "$1,138.50" $237.26 "$1,138.50" N/A N/A 8367780 SUP HCPCS C1713 8367780 - TREPHINE SURG SPN 8 MM BONE SCREW BOTH IP/OP "$1,138.50" $842.00 $225.96 "$1,138.50" $512.33 $512.33 $512.33 $512.33 "$1,138.50" "$1,138.50" "$1,138.50" $237.29 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $237.28 "$1,138.50" "$1,138.50" $673.42 "$1,138.50" "$1,138.50" "$1,138.50" "$1,138.50" $853.88 "$1,138.50" "$1,138.50" "$1,138.50" $569.25 $569.25 $901.69 "$1,138.50" $910.80 $512.33 $225.96 N/A $660.33 "$1,138.50" $683.10 "$1,138.50" $237.26 "$1,138.50" N/A N/A 8370030 SUP HCPCS C1713 8370030 - ROD SPINAL 5.5MM 30MM PRECUT CNTOUR TSRH-3D TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8370035 SUP HCPCS C1713 8370035 - ROD SPINAL CNTOUR PREBENT PRECUT 5.5MM 3.5CM TSRH-3D BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8370040 SUP HCPCS C1713 8370040 - ROD SPINAL CNTOUR PREBENT PRECUT 5.5MM 40MM TSRH-3D TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8370045 SUP HCPCS C1713 8370045 - ROD SPINAL CNTOUR PREBENT PRECUT 5.5MM 4.5CM TSRH-3D BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8370050 SUP HCPCS C1713 8370050 - ROD SPINAL STANDARD 5.5MM 5CM PRECUT CNTOUR TSRH-3D TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8370055 SUP HCPCS C1713 8370055 - ROD SPINAL 5.5MM 550MM PREBENT PRECUT TSRH-3D TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8370060 SUP HCPCS C1713 8370060 - ROD SPINAL CNTOUR PREBENT PRECUT 5.5MM 60MM TSRH-3D TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8370065 SUP HCPCS C1713 8370065 - ROD SPINAL 5.5MM 650MM PREBENT PRECUT TSRH-3D TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8370070 SUP HCPCS C1713 8370070 - ROD SPINAL 5.5MM 7CM BENT PRECUT TSRH-3D TITANIUM PEDICLE BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8370080 SUP HCPCS C1713 8370080 - ROD SPINAL CNTOUR PREBENT PRECUT 5.5MM 80MM TSRH-3D TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8370090 SUP HCPCS C1713 8370090 - ROD SPINAL STANDARD 5.5MM 9CM PREBENT PRECUT CNTOUR TSRH BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8370095 SUP HCPCS C1713 8370095 - ROD SPINAL 5.5MM 950MM PREBENT PRECUT TSRH-3D TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8370100 SUP HCPCS C1713 8370100 - ROD SPINAL CNTOUR PREBENT PRECUT 5.5MM 100MM TSRH-3D BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8370420 SUP HCPCS C1713 8370420 - SCREW BONE SHORT POST 4.5MM 20MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8370425 SUP HCPCS C1713 8370425 - SCREW BONE SHORT POST 4.5MM 25MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8370430 SUP HCPCS C1713 8370430 - SCREW BONE SHORT POST 4.5MM 30MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $984.00 $984.00 $205.07 $984.00 N/A N/A 8370435 SUP HCPCS C1713 8370435 - SCREW BONE SHORT POST 4.5MM 35MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8370440 SUP HCPCS C1713 8370440 - SCREW BONE SHORT POST 4.5MM 40MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8370445 SUP HCPCS C1713 8370445 - SCREW BONE SHORT POST 4.5MM 45MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8370450 SUP HCPCS C1713 8370450 - SCREW BONE SHORT POST 4.5MM 50MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8370455 SUP HCPCS C1713 8370455 - SCREW BONE SHORT POST 4.5MM 55MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $984.00 $984.00 $205.07 $984.00 N/A N/A 8371030 SUP HCPCS C1713 8371030 - ROD SPINAL 6.35MM 30MM PREBENT PRECUT TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8371035 SUP HCPCS C1713 8371035 - ROD SPINAL CNTOUR PREBENT PRECUT 6.35MM 3.5CM TSRH-3D BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8371040 SUP HCPCS C1713 8371040 - ROD SPINAL 6.35MM 40MM PREBENT PRECUT TSRH-3D TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8371050 SUP HCPCS C1713 8371050 - ROD SPINAL 6.35MM 50MM PREBENT PRECUT TSRH-3D TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8371060 SUP HCPCS C1713 8371060 - ROD SPINAL CNTOUR BENT 6.35MM 60MM INSERT PRECUT TSRH-3D BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8371070 SUP HCPCS C1713 8371070 - ROD SPINAL CNTOUR PREBENT PRECUT 6.35MM 70MM TSRH-3D BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8371080 SUP HCPCS C1713 8371080 - ROD SPINAL 6.35MM 80MM PREBENT PRECUT TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8371090 SUP HCPCS C1713 8371090 - ROD SPINAL CNTOUR BENT 6.35MM 9CM PRECUT TSRH-2D BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8371100 SUP HCPCS C1713 8371100 - ROD SPINAL 6.35MM 100MM PREBENT PRECUT TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8371530 SUP HCPCS C1713 8371530 - SCREW BONE 5.5MM 30MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" "$1,191.00" "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371535 SUP HCPCS C1713 8371535 - SCREW BONE 5.5MM 35MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" "$1,191.00" "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371540 SUP HCPCS C1713 8371540 - SCREW BONE 5.5MM 40MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" "$1,191.00" "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371545 SUP HCPCS C1713 8371545 - SCREW BONE 5.5MM 45MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" "$1,191.00" "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371550 SUP HCPCS C1713 8371550 - SCREW BONE 5.5MM 50MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" "$1,191.00" "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371630 SUP HCPCS C1713 8371630 - SCREW BONE 6.5MM 30MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" "$1,191.00" "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371635 SUP HCPCS C1713 8371635 - SCREW BONE 6.5MM 35MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" "$1,191.00" "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371640 SUP HCPCS C1713 8371640 - SCREW BONE 6.5MM 40MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371645 SUP HCPCS C1713 8371645 - SCREW BONE 6.5MM 45MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371650 SUP HCPCS C1713 8371650 - SCREW BONE 6.5MM 50MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371655 SUP HCPCS C1713 8371655 - SCREW BONE 6.5MM 55MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371660 SUP HCPCS C1713 8371660 - SCREW BONE 6.5MM 60MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" "$1,191.00" "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371730 SUP HCPCS C1713 8371730 - SCREW BONE 7.5MM 30MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371735 SUP HCPCS C1713 8371735 - SCREW BONE 7.5MM 35MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371740 SUP HCPCS C1713 8371740 - SCREW BONE 7.5MM 40MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371745 SUP HCPCS C1713 8371745 - SCREW BONE 7.5MM 45MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371750 SUP HCPCS C1713 8371750 - SCREW BONE 7.5MM 50MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" "$1,191.00" "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371755 SUP HCPCS C1713 8371755 - SCREW BONE 7.5MM 55MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371760 SUP HCPCS C1713 8371760 - SCREW BONE 7.5MM 60MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371830 SUP HCPCS C1713 8371830 - SCREW BONE 8.5MM 30MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371835 SUP HCPCS C1713 8371835 - SCREW BONE 8.5MM 35MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" "$1,191.00" "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371840 SUP HCPCS C1713 8371840 - SCREW BONE 8.5MM 40MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371845 SUP HCPCS C1713 8371845 - SCREW BONE 8.5MM 45MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371850 SUP HCPCS C1713 8371850 - SCREW BONE 8.5MM 50MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371855 SUP HCPCS C1713 8371855 - SCREW BONE 8.5MM 55MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" "$1,191.00" $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" "$1,191.00" "$1,191.00" $248.20 "$1,191.00" N/A N/A 8371860 SUP HCPCS C1713 8371860 - SCREW BONE 8.5MM 60MM THREAD POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,191.00" $881.00 $236.38 "$1,191.00" $535.95 $535.95 $535.95 $535.95 "$1,191.00" "$1,191.00" "$1,191.00" $248.23 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 $704.48 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 $236.38 N/A $690.78 "$1,191.00" $714.60 "$1,191.00" $248.20 "$1,191.00" N/A N/A 8372520 SUP HCPCS C1713 8372520 - SCREW BONE SHORT POST 5.5MM 20MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372525 SUP HCPCS C1713 8372525 - SCREW BONE SHORT POST 5.5MM 25MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372530 SUP HCPCS C1713 8372530 - SCREW BONE SHORT POST 5.5MM 30MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $984.00 $984.00 $205.07 $984.00 N/A N/A 8372535 SUP HCPCS C1713 8372535 - SCREW BONE SHORT POST 5.5MM 35MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372540 SUP HCPCS C1713 8372540 - SCREW BONE SHORT POST 5.5MM 40MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372545 SUP HCPCS C1713 8372545 - SCREW BONE SHORT POST 5.5MM 45MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372550 SUP HCPCS C1713 8372550 - SCREW BONE SHORT POST 5.5MM 50MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372555 SUP HCPCS C1713 8372555 - SCREW BONE SHORT POST 5.5MM 55MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372620 SUP HCPCS C1713 8372620 - SCREW BONE SHORT POST 6.5MM 20MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372625 SUP HCPCS C1713 8372625 - SCREW BONE SHORT POST 6.5MM 25MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372630 SUP HCPCS C1713 8372630 - SCREW BONE SHORT POST 6.5MM 30MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372635 SUP HCPCS C1713 8372635 - SCREW BONE SHORT POST 6.5MM 35MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372640 SUP HCPCS C1713 8372640 - SCREW BONE SHORT POST 6.5MM 40MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372645 SUP HCPCS C1713 8372645 - SCREW BONE SHORT POST 6.5MM 45MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372650 SUP HCPCS C1713 8372650 - SCREW BONE SHORT POST 6.5MM 50MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $984.00 $984.00 $205.07 $984.00 N/A N/A 8372655 SUP HCPCS C1713 8372655 - SCREW BONE SHORT POST 6.5MM 55MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372660 SUP HCPCS C1713 8372660 - SCREW BONE SHORT POST 6.5MM 60MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372720 SUP HCPCS C1713 8372720 - SCREW BONE SHORT POST 7.5MM 20MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372725 SUP HCPCS C1713 8372725 - SCREW BONE SHORT POST 7.5MM 25MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372730 SUP HCPCS C1713 8372730 - SCREW BONE SHORT POST 7.5MM 30MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372735 SUP HCPCS C1713 8372735 - SCREW BONE SHORT POST 7.5MM 35MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $984.00 $984.00 $205.07 $984.00 N/A N/A 8372740 SUP HCPCS C1713 8372740 - SCREW BONE SHORT 7.5MM 40MM TSRH-3D TITANIUM SPN PEDICLE BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372745 SUP HCPCS C1713 8372745 - SCREW BONE SHORT POST 7.5MM 45MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372750 SUP HCPCS C1713 8372750 - SCREW BONE SHORT POST 7.5MM 50MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372755 SUP HCPCS C1713 8372755 - SCREW BONE SHORT POST 7.5MM 55MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372760 SUP HCPCS C1713 8372760 - SCREW BONE SHORT POST 7.5MM 60MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372820 SUP HCPCS C1713 8372820 - SCREW BONE SHORT POST 8.5MM 20MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372825 SUP HCPCS C1713 8372825 - SCREW BONE SHORT POST 8.5MM 25MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372830 SUP HCPCS C1713 8372830 - SCREW BONE SHORT POST 8.5MM 30MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372835 SUP HCPCS C1713 8372835 - SCREW BONE SHORT POST 8.5MM 35MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372840 SUP HCPCS C1713 8372840 - SCREW BONE SHORT POST 8.5MM 40MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372845 SUP HCPCS C1713 8372845 - SCREW BONE SHORT POST 8.5MM 45MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372850 SUP HCPCS C1713 8372850 - SCREW BONE SHORT POST 8.5MM 50MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372855 SUP HCPCS C1713 8372855 - SCREW BONE SHORT POST 8.5MM 55MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8372860 SUP HCPCS C1713 8372860 - SCREW BONE SHORT POST 8.5MM 60MM TSRH-3D TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8373745 SUP HCPCS C1713 8373745 - SCREW BONE 7.5MM 45MM SPN SACRUM BOTH IP/OP "$1,122.00" $830.00 $222.69 "$1,122.00" $504.90 $504.90 $504.90 $504.90 "$1,122.00" "$1,122.00" "$1,122.00" $233.85 "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" $233.84 "$1,122.00" $448.80 $663.66 "$1,122.00" "$1,122.00" "$1,122.00" "$1,122.00" $841.50 "$1,122.00" "$1,122.00" "$1,122.00" $561.00 $561.00 $888.62 "$1,122.00" $897.60 $504.90 $222.69 N/A $650.76 "$1,122.00" $673.20 "$1,122.00" $233.82 "$1,122.00" N/A N/A 8374535 SUP HCPCS C1713 8374535 - SCREW BONE 4.5MM 35MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8374540 SUP HCPCS C1713 8374540 - SCREW BONE 4.5MM 40MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$5,220.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8374545 SUP HCPCS C1713 8374545 - SCREW BONE 4.5MM 45MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8375530 SUP HCPCS C1713 8375530 - SCREW BONE 5.5MM 30MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$5,220.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8375535 SUP HCPCS C1713 8375535 - SCREW BONE 5.5MM 35MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8375540 SUP HCPCS C1713 8375540 - SCREW BONE 5.5MM 40MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8375545 SUP HCPCS C1713 8375545 - SCREW BONE 5.5MM 45MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$5,220.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8375550 SUP HCPCS C1713 8375550 - SCREW BONE 5.5MM 50MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$5,220.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$5,220.00" "$5,220.00" N/A N/A 8376520 SUP HCPCS C1713 8376520 - SCREW BONE MINI SHORT POST 5.5MM 20MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" $511.80 $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376525 SUP HCPCS C1713 8376525 - SCREW BONE MINI SHORT POST 5.5MM 25MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" "$1,279.50" $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376530 SUP HCPCS C1713 8376530 - SCREW BONE MINI SHORT POST 5.5MM 30MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" $511.80 $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376535 SUP HCPCS C1713 8376535 - SCREW BONE MINI SHORT POST 5.5MM 35MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" "$1,279.50" $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376540 SUP HCPCS C1713 8376540 - SCREW BONE 6.5MM 40MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$5,220.00" "$5,220.00" N/A N/A 8376545 SUP HCPCS C1713 8376545 - SCREW BONE 6.5MM 45MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8376550 SUP HCPCS C1713 8376550 - SCREW BONE 6.5MM 50MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8376555 SUP HCPCS C1713 8376555 - SCREW BONE 6.5MM 55MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8376620 SUP HCPCS C1713 8376620 - SCREW BONE MINI SHORT POST 6.5MM 20MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" "$1,279.50" $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376625 SUP HCPCS C1713 8376625 - SCREW BONE MINI SHORT POST 6.5MM 25MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" $511.80 $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376630 SUP HCPCS C1713 8376630 - SCREW BONE MINI SHORT POST 6.5MM 30MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" "$1,279.50" $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376635 SUP HCPCS C1713 8376635 - SCREW BONE MINI SHORT POST 6.5MM 35MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" $511.80 $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376640 SUP HCPCS C1713 8376640 - SCREW BONE MINI SHORT POST 6.5MM 40MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" $511.80 $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376645 SUP HCPCS C1713 8376645 - SCREW BONE MINI SHORT POST 6.5MM 45MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" "$1,279.50" $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376650 SUP HCPCS C1713 8376650 - SCREW BONE MINI SHORT POST 6.5MM 50MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" $511.80 $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376655 SUP HCPCS C1713 8376655 - SCREW BONE MINI SHORT POST 6.5MM 55MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" "$1,279.50" $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376660 SUP HCPCS C1713 8376660 - SCREW BONE MINI SHORT POST 6.5MM 60MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" "$1,279.50" $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376720 SUP HCPCS C1713 8376720 - SCREW BONE MINI SHORT POST 7.5MM 20MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" $511.80 $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376725 SUP HCPCS C1713 8376725 - SCREW BONE MINI SHORT POST 7.5MM 25MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" "$1,279.50" $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376730 SUP HCPCS C1713 8376730 - SCREW BONE MINI SHORT POST 7.5MM 30MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" $511.80 $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376735 SUP HCPCS C1713 8376735 - SCREW BONE MINI SHORT POST 7.5MM 35MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" $511.80 $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376740 SUP HCPCS C1713 8376740 - SCREW BONE MINI SHORT POST 7.5MM 40MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" "$1,279.50" $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376745 SUP HCPCS C1713 8376745 - SCREW BONE MINI SHORT POST 7.5MM 45MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" $511.80 $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376750 SUP HCPCS C1713 8376750 - SCREW BONE MINI SHORT POST 7.5MM 50MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" $511.80 $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376755 SUP HCPCS C1713 8376755 - SCREW BONE MINI SHORT POST 7.5MM 55MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" "$1,279.50" $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8376760 SUP HCPCS C1713 8376760 - SCREW BONE MINI SHORT POST 7.5MM 60MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,279.50" $947.00 $253.95 "$1,279.50" $575.78 $575.78 $575.78 $575.78 "$1,279.50" "$1,279.50" "$1,279.50" $266.68 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $266.66 "$1,279.50" $511.80 $756.82 "$1,279.50" "$1,279.50" "$1,279.50" "$1,279.50" $959.63 "$1,279.50" "$1,279.50" "$1,279.50" $639.75 $639.75 "$1,013.36" "$1,279.50" "$1,023.60" $575.78 $253.95 N/A $742.11 "$1,279.50" $767.70 "$1,279.50" $266.65 "$1,279.50" N/A N/A 8377530 SUP HCPCS C1713 8377530 - SCREW BONE MINI LONG POST 5.5MM 30MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" $619.80 $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" $929.70 "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377535 SUP HCPCS C1713 8377535 - SCREW BONE MINI LONG POST 5.5MM 35MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" "$1,549.50" $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" $929.70 "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377540 SUP HCPCS C1713 8377540 - SCREW BONE 7.5MM 40MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8377545 SUP HCPCS C1713 8377545 - SCREW BONE 7.5MM 45MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8377550 SUP HCPCS C1713 8377550 - SCREW BONE 7.5MM 50MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$5,220.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8377555 SUP HCPCS C1713 8377555 - SCREW BONE 7.5MM 55MM REDX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8377630 SUP HCPCS C1713 8377630 - SCREW BONE MINI LONG POST 6.5MM 30MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" $619.80 $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" "$1,549.50" "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377635 SUP HCPCS C1713 8377635 - SCREW BONE MINI LONG POST 6.5MM 35MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" "$1,549.50" $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" $929.70 "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377640 SUP HCPCS C1713 8377640 - SCREW BONE MINI LONG POST 6.5MM 40MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" $619.80 $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" $929.70 "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377645 SUP HCPCS C1713 8377645 - SCREW BONE MINI LONG POST 6.5MM 45MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" "$1,549.50" $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" $929.70 "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377650 SUP HCPCS C1713 8377650 - SCREW BONE MINI LONG POST 6.5MM 50MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" "$1,549.50" $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" $929.70 "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377655 SUP HCPCS C1713 8377655 - SCREW BONE MINI LONG POST 6.5MM 55MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" $619.80 $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" "$1,549.50" "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377660 SUP HCPCS C1713 8377660 - SCREW BONE MINI LONG POST 6.5MM 60MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" "$1,549.50" $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" $929.70 "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377730 SUP HCPCS C1713 8377730 - SCREW BONE MINI LONG POST 7.5MM 30MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" $619.80 $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" $929.70 "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377735 SUP HCPCS C1713 8377735 - SCREW BONE MINI LONG POST 7.5MM 35MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" $619.80 $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" $929.70 "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377740 SUP HCPCS C1713 8377740 - SCREW BONE MINI LONG POST 7.5MM 40MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" $619.80 $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" "$1,549.50" "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377745 SUP HCPCS C1713 8377745 - SCREW BONE MINI LONG POST 7.5MM 45MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" "$1,549.50" $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" $929.70 "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377750 SUP HCPCS C1713 8377750 - SCREW BONE MINI LONG POST 7.5MM 50MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" $619.80 $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" $929.70 "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377755 SUP HCPCS C1713 8377755 - SCREW BONE MINI LONG POST 7.5MM 55MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" "$1,549.50" $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" $929.70 "$1,549.50" $322.92 "$1,549.50" N/A N/A 8377760 SUP HCPCS C1713 8377760 - SCREW BONE MINI LONG POST 7.5MM 60MM POLYAX MPA TSRH-3D BOTH IP/OP "$1,549.50" "$1,147.00" $307.54 "$1,549.50" $697.28 $697.28 $697.28 $697.28 "$1,549.50" "$1,549.50" "$1,549.50" $322.95 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" $322.93 "$1,549.50" "$1,549.50" $916.53 "$1,549.50" "$1,549.50" "$1,549.50" "$1,549.50" "$1,162.13" "$1,549.50" "$1,549.50" "$1,549.50" $774.75 $774.75 "$1,227.20" "$1,549.50" "$1,239.60" $697.28 $307.54 N/A $898.71 "$1,549.50" $929.70 "$1,549.50" $322.92 "$1,549.50" N/A N/A 8379120 SUP Custom 27803010 8379120 - CONNECTOR ROD SMALL 5.5MM OPEN TSRH-3D TITANIUM SPN PEDICLE BOTH IP/OP "$2,166.00" "$1,603.00" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $451.35 "$2,165.65" $866.26 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$1,624.50" "$2,165.65" "$2,165.65" "$2,165.65" "$1,082.83" "$1,082.83" "$1,715.19" "$2,165.65" "$1,732.52" $974.54 "$2,165.65" N/A "$1,256.28" "$2,165.65" "$1,299.39" "$2,165.65" "$2,165.65" "$2,165.65" N/A N/A 8379121 SUP Custom 27803010 8379121 - CONNECTOR ROD MEDIUM OFFST 5.5MM OPEN TSRH-3D TITANIUM SPN BOTH IP/OP "$2,166.00" "$1,603.00" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $451.35 "$2,165.65" $866.26 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$1,624.50" "$2,165.65" "$2,165.65" "$2,165.65" "$1,082.83" "$1,082.83" "$1,715.19" "$2,165.65" "$1,732.52" $974.54 "$2,165.65" N/A "$1,256.28" "$2,165.65" "$1,299.39" "$2,165.65" "$2,165.65" "$2,165.65" N/A N/A 8379122 SUP Custom 27803010 8379122 - CONNECTOR ROD LARGE 5.5MM OPEN OFFST TSRH-3D TITANIUM SPN BOTH IP/OP "$2,166.00" "$1,603.00" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $451.35 "$2,165.65" $866.26 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$1,624.50" "$2,165.65" "$2,165.65" "$2,165.65" "$1,082.83" "$1,082.83" "$1,715.19" "$2,165.65" "$1,732.52" $974.54 "$2,165.65" N/A "$1,256.28" "$2,165.65" "$1,299.39" "$2,165.65" "$2,165.65" "$2,165.65" N/A N/A 8379124 SUP Custom 27803010 8379124 - CONNECTOR ROD 90D OFFST 5.5MM OPEN TSRH-3D TITANIUM SPN BOTH IP/OP "$2,166.00" "$1,603.00" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $451.35 "$2,165.65" $866.26 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$1,624.50" "$2,165.65" "$2,165.65" "$2,165.65" "$1,082.83" "$1,082.83" "$1,715.19" "$2,165.65" "$1,732.52" $974.54 "$2,165.65" N/A "$1,256.28" "$2,165.65" "$1,299.39" "$2,165.65" "$2,165.65" "$2,165.65" N/A N/A 8379130 SUP Custom 27803010 8379130 - CONNECTOR ROD SMALL OFFST 6.35MM OPEN TSRH-3D TITANIUM SPN BOTH IP/OP "$2,166.00" "$1,603.00" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $451.35 "$2,165.65" $866.26 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$1,624.50" "$2,165.65" "$2,165.65" "$2,165.65" "$1,082.83" "$1,082.83" "$1,715.19" "$2,165.65" "$1,732.52" $974.54 "$2,165.65" N/A "$1,256.28" "$2,165.65" "$1,299.39" "$2,165.65" "$2,165.65" "$2,165.65" N/A N/A 8379131 SUP Custom 27803010 8379131 - CONNECTOR ROD MEDIUM OFFST 6.35MM TSRH-3D TITANIUM SPN BOTH IP/OP "$2,166.00" "$1,603.00" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $451.35 "$2,165.65" $866.26 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$1,624.50" "$2,165.65" "$2,165.65" "$2,165.65" "$1,082.83" "$1,082.83" "$1,715.19" "$2,165.65" "$1,732.52" $974.54 "$2,165.65" N/A "$1,256.28" "$2,165.65" "$1,299.39" "$2,165.65" "$2,165.65" "$2,165.65" N/A N/A 8379132 SUP Custom 27803010 8379132 - CONNECTOR ROD LARGE 6.35MM OFFST TSRH-3D TITANIUM SPN BOTH IP/OP "$2,166.00" "$1,603.00" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $451.35 "$2,165.65" $866.26 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$1,624.50" "$2,165.65" "$2,165.65" "$2,165.65" "$1,082.83" "$1,082.83" "$1,715.19" "$2,165.65" "$1,732.52" $974.54 "$2,165.65" N/A "$1,256.28" "$2,165.65" "$1,299.39" "$2,165.65" "$2,165.65" "$2,165.65" N/A N/A 8379134 SUP Custom 27803010 8379134 - CONNECTOR ROD 90D 6.35MM OFFST LOCK SCREW TSRH-3D TITANIUM BOTH IP/OP "$2,166.00" "$1,603.00" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $451.35 "$2,165.65" $866.26 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$1,624.50" "$2,165.65" "$2,165.65" "$2,165.65" "$1,082.83" "$1,082.83" "$1,715.19" "$2,165.65" "$1,732.52" $974.54 "$2,165.65" N/A "$1,256.28" "$2,165.65" "$1,299.39" "$2,165.65" "$2,165.65" "$2,165.65" N/A N/A 8379140 SUP Custom 27803010 8379140 - CONNECTOR ROD SMALL 6.35MM CLOSE OFFST TSRH-3D TITANIUM SPN BOTH IP/OP "$2,166.00" "$1,603.00" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $451.35 "$2,165.65" $866.26 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$1,624.50" "$2,165.65" "$2,165.65" "$2,165.65" "$1,082.83" "$1,082.83" "$1,715.19" "$2,165.65" "$1,732.52" $974.54 "$2,165.65" N/A "$1,256.28" "$2,165.65" "$1,299.39" "$2,165.65" "$2,165.65" "$2,165.65" N/A N/A 8379141 SUP Custom 27803010 8379141 - CONNECTOR ROD MEDIUM 6.35MM CLOSE OFFST TSRH-3D TITANIUM SPN BOTH IP/OP "$2,166.00" "$1,603.00" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $451.35 "$2,165.65" $866.26 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$1,624.50" "$2,165.65" "$2,165.65" "$2,165.65" "$1,082.83" "$1,082.83" "$1,715.19" "$2,165.65" "$1,732.52" $974.54 "$2,165.65" N/A "$1,256.28" "$2,165.65" "$1,299.39" "$2,165.65" "$2,165.65" "$2,165.65" N/A N/A 8379142 SUP Custom 27803010 8379142 - CONNECTOR ROD LARGE 6.35MM CLOSE OFFST TSRH-3D TITANIUM SPN BOTH IP/OP "$2,166.00" "$1,603.00" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $451.35 "$2,165.65" $866.26 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$1,624.50" "$2,165.65" "$2,165.65" "$2,165.65" "$1,082.83" "$1,082.83" "$1,715.19" "$2,165.65" "$1,732.52" $974.54 "$2,165.65" N/A "$1,256.28" "$2,165.65" "$1,299.39" "$2,165.65" "$2,165.65" "$2,165.65" N/A N/A 8384535 SUP HCPCS C1713 8384535 - SCREW BONE 4.5MM 35MM SPNL REDX 6.35MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8384540 SUP HCPCS C1713 8384540 - SCREW BONE 4.5MM 40MM SPNL REDX 6.35MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8384545 SUP HCPCS C1713 8384545 - SCREW BONE 4.5MM 45MM SPNL REDX 6.35MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8385040 SUP HCPCS C1713 8385040 - SCREW BONE 5MM 40MM SPNL REDX 6.35MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$5,220.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8385045 SUP HCPCS C1713 8385045 - SCREW BONE 5MM 45MM SPNL REDX 6.35MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$5,220.00" "$5,220.00" N/A N/A 8385050 SUP HCPCS C1713 8385050 - SCREW BONE 5MM 50MM SPNL REDX 6.35MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$5,220.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$5,220.00" "$5,220.00" N/A N/A 8386535 SUP HCPCS C1713 8386535 - SCREW BONE 6.5MM 35MM SPNL REDX 6.35MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" N/A N/A 8386540 SUP HCPCS C1713 8386540 - SCREW BONE 6.5MM 40MM SPNL REDX 6.35MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$2,088.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8386545 SUP HCPCS C1713 8386545 - SCREW BONE 6.5MM 45MM SPNL REDX 6.35MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$5,220.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8386550 SUP HCPCS C1713 8386550 - SCREW BONE 6.5MM 50MM SPNL REDX 6.35MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$5,220.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$5,220.00" "$5,220.00" N/A N/A 8387540 SUP HCPCS C1713 8387540 - SCREW BONE 7.5MM 40MM SPNL REDX 6.35MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$5,220.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$5,220.00" "$5,220.00" N/A N/A 8387545 SUP HCPCS C1713 8387545 - SCREW BONE 7.5MM 45MM SPNL REDX 6.35MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$5,220.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8387550 SUP HCPCS C1713 8387550 - SCREW BONE 7.5MM 50MM SPNL REDX 6.35MM ROD BOTH IP/OP "$5,220.00" "$3,863.00" "$1,036.04" "$5,220.00" "$2,349.00" "$2,349.00" "$2,349.00" "$2,349.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.98" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$1,087.91" "$5,220.00" "$5,220.00" "$2,573.46" "$5,220.00" "$5,220.00" "$5,220.00" "$5,220.00" "$3,915.00" "$5,220.00" "$5,220.00" "$5,220.00" "$2,610.00" "$2,610.00" "$4,134.24" "$5,220.00" "$4,176.00" "$2,349.00" "$1,036.04" N/A "$3,027.60" "$5,220.00" "$3,132.00" "$5,220.00" "$1,087.85" "$5,220.00" N/A N/A 8436510 SUP HCPCS C1713 8436510 - SCREW BN 6.5MM 100MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8436560 SUP HCPCS C1713 8436560 - SCREW BN 6.5MM 60MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8436570 SUP HCPCS C1713 8436570 - SCREW BN 6.5MM 70MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8436580 SUP HCPCS C1713 8436580 - SCREW BN 6.5MM 80MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8436590 SUP HCPCS C1713 8436590 - SCREW BN 6.5MM 90MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8437510 SUP HCPCS C1713 8437510 - SCREW BONE 7.5MM 100MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8437560 SUP HCPCS C1713 8437560 - SCREW BONE 7.5MM 60MM SPN SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8437570 SUP HCPCS C1713 8437570 - SCREW BONE 7.5MM 70MM SPN SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8437580 SUP HCPCS C1713 8437580 - SCREW BONE 7.5MM 80MM SPN SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8437590 SUP HCPCS C1713 8437590 - SCREW BONE 7.5MM 90MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8438510 SUP HCPCS C1713 8438510 - SCREW BONE 8.5MM 100MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8438560 SUP HCPCS C1713 8438560 - SCREW BONE 8.5MM 60MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8438570 SUP HCPCS C1713 8438570 - SCREW BONE 8.5MM 70MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8438580 SUP HCPCS C1713 8438580 - SCREW BONE 8.5MM 80MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8438590 SUP HCPCS C1713 8438590 - SCREW BONE 8.5MM 90MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8439510 SUP HCPCS C1713 8439510 - SCREW BONE 9.5MM 100MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8439560 SUP HCPCS C1713 8439560 - SCREW BONE 9.5MM 60MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8439570 SUP HCPCS C1713 8439570 - SCREW BONE 9.5MM 70MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8439580 SUP HCPCS C1713 8439580 - SCREW BONE 9.5MM 80MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8439590 SUP HCPCS C1713 8439590 - SCREW BONE 9.5MM 90MM SACROILIAC 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8446510 SUP HCPCS C1713 8446510 - SCREW BONE 6.5MM 100MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8446560 SUP HCPCS C1713 8446560 - SCREW BONE 6.5MM 60MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8446570 SUP HCPCS C1713 8446570 - SCREW BONE 6.5MM 70MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8446580 SUP HCPCS C1713 8446580 - SCREW BONE 6.5MM 80MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8446590 SUP HCPCS C1713 8446590 - SCREW BONE 6.5MM 90MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8447510 SUP HCPCS C1713 8447510 - SCREW BONE 7.5MM 100MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8447560 SUP HCPCS C1713 8447560 - SCREW BONE 7.5MM 60MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8447570 SUP HCPCS C1713 8447570 - SCREW BONE 7.5MM 70MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8447580 SUP HCPCS C1713 8447580 - SCREW BONE 7.5MM 80MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8447590 SUP HCPCS C1713 8447590 - SCREW BONE 7.5MM 90MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8448510 SUP HCPCS C1713 8448510 - SCREW BONE 8.5MM 100MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8448560 SUP HCPCS C1713 8448560 - SCREW BONE 8.5MM 60MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8448570 SUP HCPCS C1713 8448570 - SCREW BONE 8.5MM 70MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8448580 SUP HCPCS C1713 8448580 - SCREW BONE 8.5MM 80MM SPN ILIAC BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8448590 SUP HCPCS C1713 8448590 - SCREW BONE 8.5MM 90MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8449510 SUP HCPCS C1713 8449510 - SCREW BONE 9.5MM 100MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8449560 SUP HCPCS C1713 8449560 - SCREW BONE 9.5MM 60MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8449570 SUP HCPCS C1713 8449570 - SCREW BONE 9.5MM 70MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8449580 SUP HCPCS C1713 8449580 - SCREW BONE 9.5MM 80MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8449590 SUP HCPCS C1713 8449590 - SCREW BONE 9.5MM 90MM SLOTTED ILIUM 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8450120 SUP HCPCS C1713 8450120 - CONNECTOR ROD 5.5MM 20MM FIX CROSS TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450122 SUP HCPCS C1713 8450122 - CONNECTOR ROD 5.5MM 22MM FIX CROSS TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450125 SUP HCPCS C1713 8450125 - CONNECTOR ROD 5.5MM 25MM FIX CROSS TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450127 SUP HCPCS C1713 8450127 - CONNECTOR ROD 27.5MM CROSS BEACON BONE SPINAL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450130 SUP HCPCS C1713 8450130 - CONNECTOR ROD 5.5MM 30MM FIX CROSS TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450132 SUP HCPCS C1713 8450132 - CONNECTOR ROD 5.5MM 32.5MM CROSS ARMADA SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450135 SUP HCPCS C1713 8450135 - CONNECTOR ROD 5.5MM 35MM FIX CROSS TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450137 SUP HCPCS C1713 8450137 - CONNECTOR ROD 5.5MM 37MM FIX CROSS TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450140 SUP HCPCS C1713 8450140 - CONNECTOR ROD 5.5MM 40MM FIX CROSS TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450145 SUP HCPCS C1713 8450145 - CONNECTOR ROD 5.5MM 45MM FIX CROSS TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450150 SUP HCPCS C1713 8450150 - CONNECTOR ROD 5.5MM 50MM FIX CROSS TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450155 SUP HCPCS C1713 8450155 - CONNECTOR ROD 5.5MM 55MM FIX CROSS TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450160 SUP HCPCS C1713 8450160 - CONNECTOR ROD 5.5MM 60MM FIX CROSS TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450245 SUP HCPCS C1713 8450245 - TRANSCONNECTOR ROD 45-50MM ADJUSTABLE ARCH SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450250 SUP HCPCS C1713 8450250 - CONNECTOR ROD 50-60MM ADJUSTABLE TRNSVRS SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8450260 SUP HCPCS C1713 8450260 - TRANSCONNECTOR ROD 60-70MM ADJUSTABLE ARCH SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8451188 SUP HCPCS C1713 8451188 - CLIP POSITIONING CONCTR SPN 5.5 MM ROD BOTH IP/OP $37.50 $28.00 $7.44 $37.50 $16.88 $16.88 $16.88 $16.88 $37.50 $37.50 $37.50 $7.82 $37.50 $37.50 $37.50 $37.50 $37.50 $7.82 $37.50 $37.50 $22.18 $37.50 $37.50 $37.50 $37.50 $28.13 $37.50 $37.50 $37.50 $18.75 $18.75 $29.70 $37.50 $30.00 $16.88 $7.44 N/A $21.75 $37.50 $22.50 $37.50 $7.82 $37.50 N/A N/A 8451302 SUP HCPCS C1713 8451302 - CONNECTOR ROD 5.5MM INLN TI BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8451402 SUP HCPCS C1713 8451402 - CONNECTOR ROD T PARALLEL 5.5MM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8451530 SUP HCPCS C1713 8451530 - SCREW BONE 10.5MM 30MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8451535 SUP HCPCS C1713 8451535 - SCREW BONE 10.5MM 35MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8451540 SUP HCPCS C1713 8451540 - SCREW BONE 10.5MM 40MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8451545 SUP HCPCS C1713 8451545 - SCREW BONE 10.5MM 45MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8451550 SUP HCPCS C1713 8451550 - SCREW BONE 10.5MM 50MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8451555 SUP HCPCS C1713 8451555 - SCREW BONE 10.5MM 55MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8451602 SUP HCPCS C1713 8451602 - CONNECTOR ROD 5.5MM 4 HOLE TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8452004 SUP HCPCS C1713 8452004 - ROD SPINAL LATERAL OFFST ARMADA BOTH IP/OP "$2,350.00" "$1,739.00" $466.42 "$2,350.00" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$2,350.00" "$2,350.00" "$2,350.00" $489.80 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" "$2,350.00" "$1,390.03" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" $466.42 N/A "$1,363.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.74 "$2,350.00" N/A N/A 8452025 SUP HCPCS C1713 8452025 - ROD SPINAL 5.5MM 25MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8452030 SUP HCPCS C1713 8452030 - ROD SPINAL 5.5MM 30MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8452035 SUP HCPCS C1713 8452035 - ROD SPINAL 5.5MM 35MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8452040 SUP HCPCS C1713 8452040 - ROD SPINAL 5.5MM 40MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8452045 SUP HCPCS C1713 8452045 - ROD SPINAL 5.5MM 45MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8452050 SUP HCPCS C1713 8452050 - ROD SPINAL 5.5MM 50MM ARMADA TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8452055 SUP HCPCS C1713 8452055 - ROD SPINAL 5.5MM 55MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8452060 SUP HCPCS C1713 8452060 - ROD SPINAL 5.5MM 60MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8452065 SUP HCPCS C1713 8452065 - ROD SPINAL 5.5MM 65MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8452070 SUP HCPCS C1713 8452070 - ROD SPINAL 5.5MM 70MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8452075 SUP HCPCS C1713 8452075 - ROD SPNL 5.5MM 75MM TI BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8452080 SUP HCPCS C1713 8452080 - ROD SPINAL 5.5MM 80MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8452090 SUP HCPCS C1713 8452090 - ROD SPINAL 5.5MM 90MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8452100 SUP HCPCS C1713 8452100 - ROD SPINAL 5.5MM 100MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8452120 SUP HCPCS C1713 8452120 - ROD SPINAL 5.5MM 120MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8452140 SUP HCPCS C1713 8452140 - ROD SPINAL 5.5MM 140MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8452152 SUP HCPCS C1713 8452152 - CONNECTOR ROD 5.5MM ROD TO ROD ASF15T SPN 5.5MM BOTH IP/OP "$3,530.00" "$2,612.00" $700.62 "$3,530.00" "$1,588.50" "$1,588.50" "$1,588.50" "$1,588.50" "$3,530.00" "$3,530.00" "$3,530.00" $735.74 "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" $735.69 "$3,530.00" "$1,412.00" "$1,740.29" "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" "$2,647.50" "$3,530.00" "$3,530.00" "$3,530.00" "$1,765.00" "$1,765.00" "$2,795.76" "$3,530.00" "$2,824.00" "$1,588.50" $700.62 N/A "$2,047.40" "$3,530.00" "$2,118.00" "$3,530.00" $735.65 "$3,530.00" N/A N/A 8452156 SUP HCPCS C1713 8452156 - CONNECTOR ROD 6.35MM ROD TO ROD ASF15T SPN 5.5MM BOTH IP/OP "$3,530.00" "$2,612.00" $700.62 "$3,530.00" "$1,588.50" "$1,588.50" "$1,588.50" "$1,588.50" "$3,530.00" "$3,530.00" "$3,530.00" $735.74 "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" $735.69 "$3,530.00" "$3,530.00" "$1,740.29" "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" "$2,647.50" "$3,530.00" "$3,530.00" "$3,530.00" "$1,765.00" "$1,765.00" "$2,795.76" "$3,530.00" "$2,824.00" "$1,588.50" $700.62 N/A "$2,047.40" "$3,530.00" "$2,118.00" "$3,530.00" $735.65 "$3,530.00" N/A N/A 8452160 SUP HCPCS C1713 8452160 - ROD SPINAL 5.5MM 160MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8452166 SUP HCPCS C1713 8452166 - CONNECTOR ROD 6.35MM ROD TO ROD SPN 6.35MM BOTH IP/OP "$3,530.00" "$2,612.00" $700.62 "$3,530.00" "$1,588.50" "$1,588.50" "$1,588.50" "$1,588.50" "$3,530.00" "$3,530.00" "$3,530.00" $735.74 "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" $735.69 "$3,530.00" "$3,530.00" "$1,740.29" "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" "$2,647.50" "$3,530.00" "$3,530.00" "$3,530.00" "$1,765.00" "$1,765.00" "$2,795.76" "$3,530.00" "$2,824.00" "$1,588.50" $700.62 N/A "$2,047.40" "$3,530.00" "$2,118.00" "$3,530.00" $735.65 "$3,530.00" N/A N/A 8452200 SUP HCPCS C1713 8452200 - ROD SPINAL 5.5MM 200MM ARMADA TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8452255 SUP HCPCS C1713 8452255 - CONNECTOR ROD 5.5MM ROD TO ROD SPN 5.5MM BOTH IP/OP "$3,530.00" "$2,612.00" $700.62 "$3,530.00" "$1,588.50" "$1,588.50" "$1,588.50" "$1,588.50" "$3,530.00" "$3,530.00" "$3,530.00" $735.74 "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" $735.69 "$3,530.00" "$1,412.00" "$1,740.29" "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" "$2,647.50" "$3,530.00" "$3,530.00" "$3,530.00" "$1,765.00" "$1,765.00" "$2,795.76" "$3,530.00" "$2,824.00" "$1,588.50" $700.62 N/A "$2,047.40" "$3,530.00" "$2,118.00" "$3,530.00" $735.65 "$3,530.00" N/A N/A 8452256 SUP HCPCS C1713 8452256 - CONNECTOR ROD 6.35MM ROD TO ROD SPN 5.5MM BOTH IP/OP "$3,530.00" "$2,612.00" $700.62 "$3,530.00" "$1,588.50" "$1,588.50" "$1,588.50" "$1,588.50" "$3,530.00" "$3,530.00" "$3,530.00" $735.74 "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" $735.69 "$3,530.00" "$1,412.00" "$1,740.29" "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" "$2,647.50" "$3,530.00" "$3,530.00" "$3,530.00" "$1,765.00" "$1,765.00" "$2,795.76" "$3,530.00" "$2,824.00" "$1,588.50" $700.62 N/A "$2,047.40" "$3,530.00" "$2,118.00" "$3,530.00" $735.65 "$3,530.00" N/A N/A 8452266 SUP HCPCS C1713 8452266 - CONNECTOR ROD 6.35MM ROD TO ROD SPN 6.35MM BOTH IP/OP "$3,530.00" "$2,612.00" $700.62 "$3,530.00" "$1,588.50" "$1,588.50" "$1,588.50" "$1,588.50" "$3,530.00" "$3,530.00" "$3,530.00" $735.74 "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" $735.69 "$3,530.00" "$1,412.00" "$1,740.29" "$3,530.00" "$3,530.00" "$3,530.00" "$3,530.00" "$2,647.50" "$3,530.00" "$3,530.00" "$3,530.00" "$1,765.00" "$1,765.00" "$2,795.76" "$3,530.00" "$2,824.00" "$1,588.50" $700.62 N/A "$2,047.40" "$3,530.00" "$3,530.00" "$3,530.00" $735.65 "$3,530.00" N/A N/A 8452300 SUP HCPCS C1713 8452300 - ROD SPNL 300MM NS ARMADA ARM15T BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8452355 SUP HCPCS C1713 8452355 - CONNECTOR ROD 90D 5.5MM OPEN CLOSE BOTH IP/OP "$3,845.00" "$2,845.00" $763.14 "$3,845.00" "$1,730.25" "$1,730.25" "$1,730.25" "$1,730.25" "$3,845.00" "$3,845.00" "$3,845.00" $801.39 "$3,845.00" "$3,845.00" "$3,845.00" "$3,845.00" "$3,845.00" $801.34 "$3,845.00" "$3,845.00" "$1,895.59" "$3,845.00" "$3,845.00" "$3,845.00" "$3,845.00" "$2,883.75" "$3,845.00" "$3,845.00" "$3,845.00" "$1,922.50" "$1,922.50" "$3,045.24" "$3,845.00" "$3,076.00" "$1,730.25" $763.14 N/A "$2,230.10" "$3,845.00" "$2,307.00" "$3,845.00" $801.30 "$3,845.00" N/A N/A 8452356 SUP HCPCS C1713 8452356 - CONNECTOR ROD 90D 5.5MM 6.35MM OPEN CLOSE BOTH IP/OP "$3,845.00" "$2,845.00" $763.14 "$3,845.00" "$1,730.25" "$1,730.25" "$1,730.25" "$1,730.25" "$3,845.00" "$3,845.00" "$3,845.00" $801.39 "$3,845.00" "$3,845.00" "$3,845.00" "$3,845.00" "$3,845.00" $801.34 "$3,845.00" "$3,845.00" "$1,895.59" "$3,845.00" "$3,845.00" "$3,845.00" "$3,845.00" "$2,883.75" "$3,845.00" "$3,845.00" "$3,845.00" "$1,922.50" "$1,922.50" "$3,045.24" "$3,845.00" "$3,076.00" "$1,730.25" $763.14 N/A "$2,230.10" "$3,845.00" "$3,845.00" "$3,845.00" $801.30 "$3,845.00" N/A N/A 8452365 SUP HCPCS C1713 8452365 - CONNECTOR ROD 90D 5.5MM 6.35MM OPEN CLOSE BOTH IP/OP "$3,845.00" "$2,845.00" $763.14 "$3,845.00" "$1,730.25" "$1,730.25" "$1,730.25" "$1,730.25" "$3,845.00" "$3,845.00" "$3,845.00" $801.39 "$3,845.00" "$3,845.00" "$3,845.00" "$3,845.00" "$3,845.00" $801.34 "$3,845.00" "$3,845.00" "$1,895.59" "$3,845.00" "$3,845.00" "$3,845.00" "$3,845.00" "$2,883.75" "$3,845.00" "$3,845.00" "$3,845.00" "$1,922.50" "$1,922.50" "$3,045.24" "$3,845.00" "$3,076.00" "$1,730.25" $763.14 N/A "$2,230.10" "$3,845.00" "$2,307.00" "$3,845.00" $801.30 "$3,845.00" N/A N/A 8452366 SUP HCPCS C1713 8452366 - CONNECTOR ROD 90D 6.35MM OPEN CLOSE BOTH IP/OP "$3,845.00" "$2,845.00" $763.14 "$3,845.00" "$1,730.25" "$1,730.25" "$1,730.25" "$1,730.25" "$3,845.00" "$3,845.00" "$3,845.00" $801.39 "$3,845.00" "$3,845.00" "$3,845.00" "$3,845.00" "$3,845.00" $801.34 "$3,845.00" "$3,845.00" "$1,895.59" "$3,845.00" "$3,845.00" "$3,845.00" "$3,845.00" "$2,883.75" "$3,845.00" "$3,845.00" "$3,845.00" "$1,922.50" "$1,922.50" "$3,045.24" "$3,845.00" "$3,076.00" "$1,730.25" $763.14 N/A "$2,230.10" "$3,845.00" "$2,307.00" "$3,845.00" $801.30 "$3,845.00" N/A N/A 8452412 SUP HCPCS C1713 8452412 - CONNECTOR ROD 5.5MM 15MM 200MM LEFT HAND SPN BOTH IP/OP "$5,105.00" "$3,778.00" "$1,013.21" "$5,105.00" "$2,297.25" "$2,297.25" "$2,297.25" "$2,297.25" "$5,105.00" "$5,105.00" "$5,105.00" "$1,064.01" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$1,063.94" "$5,105.00" "$2,042.00" "$2,516.77" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$3,828.75" "$5,105.00" "$5,105.00" "$5,105.00" "$2,552.50" "$2,552.50" "$4,043.16" "$5,105.00" "$4,084.00" "$2,297.25" "$1,013.21" N/A "$2,960.90" "$5,105.00" "$3,063.00" "$5,105.00" "$1,063.88" "$5,105.00" N/A N/A 8452422 SUP HCPCS C1713 8452422 - CONNECTOR ROD 5.5MM 25MM 200MM LEFT HAND SPN BOTH IP/OP "$5,105.00" "$3,778.00" "$1,013.21" "$5,105.00" "$2,297.25" "$2,297.25" "$2,297.25" "$2,297.25" "$5,105.00" "$5,105.00" "$5,105.00" "$1,064.01" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$1,063.94" "$5,105.00" "$2,042.00" "$2,516.77" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$3,828.75" "$5,105.00" "$5,105.00" "$5,105.00" "$2,552.50" "$2,552.50" "$4,043.16" "$5,105.00" "$4,084.00" "$2,297.25" "$1,013.21" N/A "$2,960.90" "$5,105.00" "$3,063.00" "$5,105.00" "$1,063.88" "$5,105.00" N/A N/A 8452432 SUP HCPCS C1713 8452432 - CONNECTOR ROD 5.5MM 35MM 200MM LEFT HAND SPN BOTH IP/OP "$5,105.00" "$3,778.00" "$1,013.21" "$5,105.00" "$2,297.25" "$2,297.25" "$2,297.25" "$2,297.25" "$5,105.00" "$5,105.00" "$5,105.00" "$1,064.01" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$1,063.94" "$5,105.00" "$5,105.00" "$2,516.77" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$3,828.75" "$5,105.00" "$5,105.00" "$5,105.00" "$2,552.50" "$2,552.50" "$4,043.16" "$5,105.00" "$4,084.00" "$2,297.25" "$1,013.21" N/A "$2,960.90" "$5,105.00" "$3,063.00" "$5,105.00" "$1,063.88" "$5,105.00" N/A N/A 8452442 SUP HCPCS C1713 8452442 - CONNECTOR ROD 5.5MM 40MM 200MM LEFT HAND SPN BOTH IP/OP "$5,105.00" "$3,778.00" "$1,013.21" "$5,105.00" "$2,297.25" "$2,297.25" "$2,297.25" "$2,297.25" "$5,105.00" "$5,105.00" "$5,105.00" "$1,064.01" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$1,063.94" "$5,105.00" "$5,105.00" "$2,516.77" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$3,828.75" "$5,105.00" "$5,105.00" "$5,105.00" "$2,552.50" "$2,552.50" "$4,043.16" "$5,105.00" "$4,084.00" "$2,297.25" "$1,013.21" N/A "$2,960.90" "$5,105.00" "$3,063.00" "$5,105.00" "$1,063.88" "$5,105.00" N/A N/A 8452500 SUP HCPCS C1713 8452500 - ROD SPINAL 5.5MM 500MM TITANIUM BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A 8452512 SUP HCPCS C1713 8452512 - CONNECTOR ROD 5.5MM 15MM 200MM RIGHT HAND SPN BOTH IP/OP "$5,105.00" "$3,778.00" "$1,013.21" "$5,105.00" "$2,297.25" "$2,297.25" "$2,297.25" "$2,297.25" "$5,105.00" "$5,105.00" "$5,105.00" "$1,064.01" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$1,063.94" "$5,105.00" "$2,042.00" "$2,516.77" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$3,828.75" "$5,105.00" "$5,105.00" "$5,105.00" "$2,552.50" "$2,552.50" "$4,043.16" "$5,105.00" "$4,084.00" "$2,297.25" "$1,013.21" N/A "$2,960.90" "$5,105.00" "$3,063.00" "$5,105.00" "$1,063.88" "$5,105.00" N/A N/A 8452522 SUP HCPCS C1713 8452522 - CONNECTOR ROD 5.5MM 25MM 200MM RIGHT HAND ARMADA SPN BOTH IP/OP "$5,105.00" "$3,778.00" "$1,013.21" "$5,105.00" "$2,297.25" "$2,297.25" "$2,297.25" "$2,297.25" "$5,105.00" "$5,105.00" "$5,105.00" "$1,064.01" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$1,063.94" "$5,105.00" "$5,105.00" "$2,516.77" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$3,828.75" "$5,105.00" "$5,105.00" "$5,105.00" "$2,552.50" "$2,552.50" "$4,043.16" "$5,105.00" "$4,084.00" "$2,297.25" "$1,013.21" N/A "$2,960.90" "$5,105.00" "$3,063.00" "$5,105.00" "$1,063.88" "$5,105.00" N/A N/A 8452532 SUP HCPCS C1713 8452532 - CONNECTOR ROD 5.5MM 35MM 200MM RIGHT HAND SPN BOTH IP/OP "$5,105.00" "$3,778.00" "$1,013.21" "$5,105.00" "$2,297.25" "$2,297.25" "$2,297.25" "$2,297.25" "$5,105.00" "$5,105.00" "$5,105.00" "$1,064.01" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$1,063.94" "$5,105.00" "$2,042.00" "$2,516.77" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$3,828.75" "$5,105.00" "$5,105.00" "$5,105.00" "$2,552.50" "$2,552.50" "$4,043.16" "$5,105.00" "$4,084.00" "$2,297.25" "$1,013.21" N/A "$2,960.90" "$5,105.00" "$5,105.00" "$5,105.00" "$1,063.88" "$5,105.00" N/A N/A 8452542 SUP HCPCS C1713 8452542 - CONNECTOR ROD 5.5MM 40MM 200MM RIGHT HAND SPN BOTH IP/OP "$5,105.00" "$3,778.00" "$1,013.21" "$5,105.00" "$2,297.25" "$2,297.25" "$2,297.25" "$2,297.25" "$5,105.00" "$5,105.00" "$5,105.00" "$1,064.01" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$1,063.94" "$5,105.00" "$2,042.00" "$2,516.77" "$5,105.00" "$5,105.00" "$5,105.00" "$5,105.00" "$3,828.75" "$5,105.00" "$5,105.00" "$5,105.00" "$2,552.50" "$2,552.50" "$4,043.16" "$5,105.00" "$4,084.00" "$2,297.25" "$1,013.21" N/A "$2,960.90" "$5,105.00" "$3,063.00" "$5,105.00" "$1,063.88" "$5,105.00" N/A N/A 8453101 SUP Custom 27803010 8453101 - HOOK SPINAL SMALL 5.5MM TITANIUM PEDICLE BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 8453102 SUP Custom 27803010 8453102 - HOOK SPINAL MEDIUM 5.5MM TITANIUM PEDICLE BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 8453112 SUP Custom 27803010 8453112 - HOOK SPINAL 5.5MM 6MM RED TITANIUM LAMINA BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 8453113 SUP Custom 27803010 8453113 - HOOK SPINAL 5.5MM 8MM RED TITANIUM LAMINA BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 8453114 SUP Custom 27803010 8453114 - HOOK SPINAL 5.5MM 10MM RED LMNR BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 8453121 SUP Custom 27803010 8453121 - HOOK SPINAL ANGLED 5.5MM TITANIUM RIGHT BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 8453122 SUP Custom 27803010 8453122 - HOOK SPINAL ANGLED 5.5MM TITANIUM LEFT BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 8453123 SUP Custom 27803010 8453123 - HOOK SPINAL RIGHT OFFST 5.5MM TITANIUM BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 8453124 SUP Custom 27803010 8453124 - HOOK SPINAL LEFT OFFST 5.5MM TITANIUM BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 8454025 SUP HCPCS C1713 8454025 - SCREW BONE 4MM 25MM POLYAX SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8454030 SUP HCPCS C1713 8454030 - SCREW BONE 4MM 30MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8454035 SUP HCPCS C1713 8454035 - SCREW BONE 4MM 35MM POLYAX SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8454040 SUP HCPCS C1713 8454040 - SCREW BONE 4MM 40MM POLYAX SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8454045 SUP HCPCS C1713 8454045 - SCREW BONE 4MM 45MM POLYAX SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8454402 SUP HCPCS C1713 8454402 - CONNECTOR ROD PARALLEL 5.5MM CLOSE TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8454404 SUP HCPCS C1713 8454404 - CONNECTOR ROD 5.5MM NS ARMADA PRLL SPNE ASF25T BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8454525 SUP HCPCS C1713 8454525 - SCREW BONE 4.5MM 25MM POLYAX SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8454530 SUP HCPCS C1713 8454530 - SCREW BONE 4.5MM 30MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8454535 SUP HCPCS C1713 8454535 - SCREW BONE 4.5MM 35MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8454540 SUP HCPCS C1713 8454540 - SCREW BONE 4.5MM 40MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8454545 SUP HCPCS C1713 8454545 - SCREW BONE 4.5MM 45MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8454602 SUP HCPCS C1713 8454602 - CONNECTOR ROD 5.5MM 4 HOLE TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8454604 SUP HCPCS C1713 8454604 - CONNECTOR ROD 5.5MM NS ARMADA 4 HL PRLL SPNE ASF25T BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8455025 SUP HCPCS C1713 8455025 - SCREW BONE 5MM 25MM POLYAX SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8455030 SUP HCPCS C1713 8455030 - SCREW BONE 5MM 30MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8455035 SUP HCPCS C1713 8455035 - SCREW BONE 5MM 35MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8455040 SUP HCPCS C1713 8455040 - SCREW BONE 5MM 40MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8455045 SUP HCPCS C1713 8455045 - SCREW BONE 5MM 45MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8455050 SUP HCPCS C1713 8455050 - SCREW BONE 5MM 50MM POLYAX SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8455525 SUP HCPCS C1713 8455525 - SCREW BONE 5.5MM 25MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8455530 SUP HCPCS C1713 8455530 - SCREW BONE 5.5MM 30MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8455535 SUP HCPCS C1713 8455535 - SCREW BONE 5.5MM 35MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8455540 SUP HCPCS C1713 8455540 - SCREW BONE 5.5MM 40MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8455545 SUP HCPCS C1713 8455545 - SCREW BONE 5.5MM 45MM POLYAX SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8455550 SUP HCPCS C1713 8455550 - SCREW BONE 5.5MM 50MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8455555 SUP HCPCS C1713 8455555 - SCREW BONE 5.5MM 55MM POLYAX SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8456530 SUP HCPCS C1713 8456530 - SCREW BONE 6.5MM 30MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8456535 SUP HCPCS C1713 8456535 - SCREW BONE 6.5MM 35MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8456540 SUP HCPCS C1713 8456540 - SCREW BN 6.5MM 40MM NS ARMADA PA TI SPNE ARM15T BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8456545 SUP HCPCS C1713 8456545 - SCREW BN 6.5MM 45MM NS ARMADA PA TI SPNE ARM15T BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8456550 SUP HCPCS C1713 8456550 - SCREW BN 6.5MM 50MM NS ARMADA PA TI SPNE ARM15T BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8456555 SUP HCPCS C1713 8456555 - SCREW BN 6.5MM 55MM NS ARMADA PA TI SPNE ARM15T BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8456560 SUP HCPCS C1713 8456560 - SCREW BONE 6.5MM 60MM POLYAX SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8457530 SUP HCPCS C1713 8457530 - SCREW BONE 7.5MM 30MM POLYAX SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8457535 SUP HCPCS C1713 8457535 - SCREW BONE 7.5MM 35MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8457540 SUP HCPCS C1713 8457540 - SCREW BN 7.5MM 40MM NS ARMADA PA TI SPNE ARM15T BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8457545 SUP HCPCS C1713 8457545 - SCREW BN 7.5MM 45MM NS ARMADA PA TI SPNE ARM15T BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8457550 SUP HCPCS C1713 8457550 - SCREW BN 7.5MM 50MM NS ARMADA PA TI SPNE ARM15T BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8457555 SUP HCPCS C1713 8457555 - SCREW BN 7.5MM 55MM NS ARMADA PA TI SPNE ARM15T BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8457560 SUP HCPCS C1713 8457560 - SCREW BN 7.5MM 60MM NS ARMADA PA TI SPNE ARM15T BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8458530 SUP HCPCS C1713 8458530 - SCREW BONE 8.5MM 30MM POLYAX SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8458535 SUP HCPCS C1713 8458535 - SCREW BONE 8.5MM 35MM POLYAX SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8458540 SUP HCPCS C1713 8458540 - SCREW BONE 8.5MM 40MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8458545 SUP HCPCS C1713 8458545 - SCREW BONE 8.5MM 45MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8458550 SUP HCPCS C1713 8458550 - SCREW BN 8.5MM 50MM NS ARMADA PA TI SPNE ARM15T BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8459530 SUP HCPCS C1713 8459530 - SCREW BONE 9.5MM 30MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8459535 SUP HCPCS C1713 8459535 - SCREW BONE 9.5MM 35MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8459540 SUP HCPCS C1713 8459540 - SCREW BONE 9.5MM 40MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8459545 SUP HCPCS C1713 8459545 - SCREW BONE 9.5MM 45MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8459550 SUP HCPCS C1713 8459550 - SCREW BONE 9.5MM 50MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8459555 SUP HCPCS C1713 8459555 - SCREW BONE 9.5MM 55MM POLYAX TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8461100 SUP HCPCS C1713 8461100 - SCREW BN 5.5MM 100MM NS ARMADA LCK OPN TULIP TI SPNE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8461302 SUP HCPCS C1713 8461302 - CONNECTOR ROD 5.5MM 6.25MM INLN TI BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8461402 SUP HCPCS C1713 8461402 - CONNECTOR ROD PARALLEL 6.25/5.5MM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8461602 SUP HCPCS C1713 8461602 - CONNECTOR ROD 6.25/5.5MM 4 HOLE TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8464402 SUP HCPCS C1713 8464402 - CONNECTOR ROD PARALLEL 5.5MM 6.35MM CLOSE TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8464404 SUP HCPCS C1713 8464404 - CONNECTOR ROD 5.5-6.35MM NS ARMADA PRLL SPNE ASF26T BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8464602 SUP HCPCS C1713 8464602 - CONNECTOR ROD PARALLEL 5.5MM 6.35MM 4 HOLE TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8464604 SUP HCPCS C1713 8464604 - CONNECTOR ROD 5.5-6.35MM NS ARMADA 4 HL PRLL SPNE ASF26T BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8480511 SUP HCPCS C1713 8480511 - STAPLE BONE 12MM 3 PRONG CD HORIZON TITANIUM SPN BOTH IP/OP $579.00 $428.00 $114.92 $579.00 $260.55 $260.55 $260.55 $260.55 $579.00 $579.00 $579.00 $120.68 $579.00 $579.00 $579.00 $579.00 $579.00 $120.67 $579.00 $579.00 $342.48 $579.00 $579.00 $579.00 $579.00 $434.25 $579.00 $579.00 $579.00 $289.50 $289.50 $458.57 $579.00 $463.20 $260.55 $114.92 N/A $335.82 $579.00 $347.40 $579.00 $120.66 $579.00 N/A N/A 8480512 SUP HCPCS C1713 8480512 - STAPLE BONE 12MM 3 PRONG CD HORIZON TITANIUM SPN BOTH IP/OP $579.00 $428.00 $114.92 $579.00 $260.55 $260.55 $260.55 $260.55 $579.00 $579.00 $579.00 $120.68 $579.00 $579.00 $579.00 $579.00 $579.00 $120.67 $579.00 $231.60 $342.48 $579.00 $579.00 $579.00 $579.00 $434.25 $579.00 $579.00 $579.00 $289.50 $289.50 $458.57 $579.00 $463.20 $260.55 $114.92 N/A $335.82 $579.00 $347.40 $579.00 $120.66 $579.00 N/A N/A 8481623 SUP HCPCS C1713 8481623 - SCREW BONE 6.5MM 22.5MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481625 SUP HCPCS C1713 8481625 - SCREW BONE 6.5MM 25MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481628 SUP HCPCS C1713 8481628 - SCREW BONE 6.5MM 27.5MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481630 SUP HCPCS C1713 8481630 - SCREW BONE 6.5MM 30MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481633 SUP HCPCS C1713 8481633 - SCREW BONE 6.5MM 32.5MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481635 SUP HCPCS C1713 8481635 - SCREW BONE 6.5MM 35MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481638 SUP HCPCS C1713 8481638 - SCREW BONE 6.5MM 38MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481640 SUP HCPCS C1713 8481640 - SCREW BONE 6.5MM 40MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481643 SUP HCPCS C1713 8481643 - SCREW BONE 6.5MM 43MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481645 SUP HCPCS C1713 8481645 - SCREW BONE 6.5MM 45MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481648 SUP HCPCS C1713 8481648 - SCREW BONE 6.5MM 48MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481650 SUP HCPCS C1713 8481650 - SCREW BONE 6.5MM 50MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481653 SUP HCPCS C1713 8481653 - SCREW BONE 6.5MM 53MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481655 SUP HCPCS C1713 8481655 - SCREW BONE 6.5MM 55MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481723 SUP HCPCS C1713 8481723 - SCREW BONE 7.5MM 22.5MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481725 SUP HCPCS C1713 8481725 - SCREW BONE 7.5MM 25MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481728 SUP HCPCS C1713 8481728 - SCREW BONE 7.5MM 27.5MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481730 SUP HCPCS C1713 8481730 - SCREW BONE 7.5MM 30MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481733 SUP HCPCS C1713 8481733 - SCREW BONE 7.5MM 32.5MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481735 SUP HCPCS C1713 8481735 - SCREW BONE 7.5MM 35MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481738 SUP HCPCS C1713 8481738 - SCREW BONE 7.5MM 37.5MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481743 SUP HCPCS C1713 8481743 - SCREW BONE 7.5MM 43MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481745 SUP HCPCS C1713 8481745 - SCREW BONE 7.5MM 45MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481748 SUP HCPCS C1713 8481748 - SCREW BONE 7.5MM 48MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481750 SUP HCPCS C1713 8481750 - SCREW BONE 7.5MM 50MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481753 SUP HCPCS C1713 8481753 - SCREW BONE 7.5MM 53MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481755 SUP HCPCS C1713 8481755 - SCREW BONE 7.5MM 55MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481823 SUP HCPCS C1713 8481823 - SCREW BONE 8.5MM 23MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481825 SUP HCPCS C1713 8481825 - SCREW BONE 8.5MM 25MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481828 SUP HCPCS C1713 8481828 - SCREW BONE 8.5MM 28MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$2,352.00" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481830 SUP HCPCS C1713 8481830 - SCREW BONE 8.5MM 30MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481833 SUP HCPCS C1713 8481833 - SCREW BONE 8.5MM 33MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481835 SUP HCPCS C1713 8481835 - SCREW BONE 8.5MM 35MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481838 SUP HCPCS C1713 8481838 - SCREW BONE 8.5MM 38MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481840 SUP HCPCS C1713 8481840 - SCREW BONE 8.5MM 40MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481843 SUP HCPCS C1713 8481843 - SCREW BONE 8.5MM 43MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$2,352.00" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481845 SUP HCPCS C1713 8481845 - SCREW BONE 8.5MM 45MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481848 SUP HCPCS C1713 8481848 - SCREW BONE 8.5MM 48MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481850 SUP HCPCS C1713 8481850 - SCREW BONE 8.5MM 50MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481853 SUP HCPCS C1713 8481853 - SCREW BONE 8.5MM 53MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481855 SUP HCPCS C1713 8481855 - SCREW BONE 8.5MM 55MM CANN TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 8481910 SUP Custom 27203010 8481910 - TAP SURG 6.5MM CANN CD HORIZON ECLIPSE SPN BOTH IP/OP $945.00 $699.00 $168.21 $945.00 $945.00 $945.00 $945.00 $945.00 $945.00 $945.00 $168.21 $945.00 $945.00 $701.38 $701.38 $728.41 $492.35 $196.95 $945.00 $378.00 $945.00 $945.00 $945.00 $945.00 $945.00 $708.75 $945.00 $945.00 $945.00 $472.50 $472.50 $748.44 $945.00 $756.00 $614.25 $945.00 N/A $548.10 $945.00 $567.00 $945.00 $945.00 $945.00 N/A N/A 8481912 SUP Custom 27203010 8481912 - TAP SURG 7.5MM CANN CD HORIZON ECLIPSE SPN BOTH IP/OP $945.00 $699.00 $168.21 $945.00 $945.00 $945.00 $945.00 $945.00 $945.00 $945.00 $168.21 $945.00 $945.00 $701.38 $701.38 $728.41 $492.35 $196.95 $945.00 $378.00 $945.00 $945.00 $945.00 $945.00 $945.00 $708.75 $945.00 $945.00 $945.00 $472.50 $472.50 $748.44 $945.00 $756.00 $614.25 $945.00 N/A $548.10 $945.00 $567.00 $945.00 $945.00 $945.00 N/A N/A 8482623 SUP HCPCS C1713 8482623 - SCREW BONE 2 HEXAGON 6.5MM 22.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482625 SUP HCPCS C1713 8482625 - SCREW BONE 2 HEXAGON 6.5MM 25MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482628 SUP HCPCS C1713 8482628 - SCREW BONE 2 HEXAGON 6.5MM 27.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482630 SUP HCPCS C1713 8482630 - SCREW BONE 2 HEXAGON 6.5MM 30MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482633 SUP HCPCS C1713 8482633 - SCREW BONE 2 HEXAGON 6.5MM 32.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482635 SUP HCPCS C1713 8482635 - SCREW BONE 2 HEXAGON 6.5MM 35MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482638 SUP HCPCS C1713 8482638 - SCREW BONE 2 HEXAGON 6.5MM 37.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482640 SUP HCPCS C1713 8482640 - SCREW BONE 2 HEXAGON 6.5MM 40MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482643 SUP HCPCS C1713 8482643 - SCREW BONE 2 HEXAGON 6.5MM 42.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482645 SUP HCPCS C1713 8482645 - SCREW BONE 2 HEXAGON 6.5MM 45MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482648 SUP HCPCS C1713 8482648 - SCREW BONE 2 HEXAGON 6.5MM 47.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$1,156.20" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482650 SUP HCPCS C1713 8482650 - SCREW BONE 2 HEXAGON 6.5MM 50MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$1,156.20" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482653 SUP HCPCS C1713 8482653 - SCREW BONE 2 HEXAGON 6.5MM 52.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$1,156.20" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482655 SUP HCPCS C1713 8482655 - SCREW BONE 2 HEXAGON 6.5MM 55MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482723 SUP HCPCS C1713 8482723 - SCREW BONE 2 HEXAGON 7.5MM 22.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482725 SUP HCPCS C1713 8482725 - SCREW BONE 2 HEXAGON 7.5MM 25MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$2,890.50" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482728 SUP HCPCS C1713 8482728 - SCREW BONE 2 HEXAGON 7.5MM 27.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482730 SUP HCPCS C1713 8482730 - SCREW BONE 2 HEXAGON 7.5MM 30MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$1,156.20" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$2,890.50" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482733 SUP HCPCS C1713 8482733 - SCREW BONE 2 HEXAGON 7.5MM 32.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$1,156.20" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482735 SUP HCPCS C1713 8482735 - SCREW BONE 2 HEXAGON 7.5MM 35MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$1,156.20" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482738 SUP HCPCS C1713 8482738 - SCREW BONE 2 HEXAGON 7.5MM 37.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$1,156.20" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482740 SUP HCPCS C1713 8482740 - SCREW BONE 2 HEXAGON 7.5MM 40MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$2,890.50" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482743 SUP HCPCS C1713 8482743 - SCREW BONE 2 HEXAGON 7.5MM 42.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$1,156.20" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$2,890.50" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482745 SUP HCPCS C1713 8482745 - SCREW BONE 2 HEXAGON 7.5MM 45MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$1,156.20" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482748 SUP HCPCS C1713 8482748 - SCREW BONE 2 HEXAGON 7.5MM 47.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482750 SUP HCPCS C1713 8482750 - SCREW BONE 2 HEXAGON 7.5MM 50MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$2,890.50" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482753 SUP HCPCS C1713 8482753 - SCREW BONE 2 HEXAGON 7.5MM 52.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482755 SUP HCPCS C1713 8482755 - SCREW BONE 2 HEXAGON 7.5MM 55MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482823 SUP HCPCS C1713 8482823 - SCREW BONE 2 HEXAGON 8.5MM 22.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482825 SUP HCPCS C1713 8482825 - SCREW BONE 2 HEXAGON 8.5MM 25MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482828 SUP HCPCS C1713 8482828 - SCREW BONE 2 HEXAGON 8.5MM 27.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482830 SUP HCPCS C1713 8482830 - SCREW BONE 2 HEXAGON 8.5MM 30MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$1,156.20" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482833 SUP HCPCS C1713 8482833 - SCREW BONE 2 HEXAGON 8.5MM 32.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$1,156.20" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$2,890.50" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482835 SUP HCPCS C1713 8482835 - SCREW BONE 2 HEXAGON 8.5MM 35MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$1,156.20" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$2,890.50" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482838 SUP HCPCS C1713 8482838 - SCREW BONE 2 HEXAGON 8.5MM 37.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482840 SUP HCPCS C1713 8482840 - SCREW BONE 2 HEXAGON 8.5MM 40MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482843 SUP HCPCS C1713 8482843 - SCREW BONE 2 HEXAGON 8.5MM 42.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482845 SUP HCPCS C1713 8482845 - SCREW BONE 2 HEXAGON 8.5MM 45MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" "$2,890.50" "$2,890.50" N/A N/A 8482848 SUP HCPCS C1713 8482848 - SCREW BONE 2 HEXAGON 8.5MM 47.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$1,734.30" "$2,890.50" "$2,890.50" "$2,890.50" N/A N/A 8482850 SUP HCPCS C1713 8482850 - SCREW BONE 2 HEXAGON 8.5MM 50MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$2,890.50" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482853 SUP HCPCS C1713 8482853 - SCREW BONE 2 HEXAGON 8.5MM 52.5MM ECLIPSE CD HORIZON BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$2,890.50" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8482855 SUP HCPCS C1713 8482855 - SCREW BONE 2 HEXAGON 8.5MM 55MM ECLIPSE CD HORIZON TITANIUM BOTH IP/OP "$2,890.50" "$2,139.00" $573.69 "$2,890.50" "$1,300.73" "$1,300.73" "$1,300.73" "$1,300.73" "$2,890.50" "$2,890.50" "$2,890.50" $602.45 "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" $602.41 "$2,890.50" "$2,890.50" "$1,425.02" "$2,890.50" "$2,890.50" "$2,890.50" "$2,890.50" "$2,167.88" "$2,890.50" "$2,890.50" "$2,890.50" "$1,445.25" "$1,445.25" "$2,289.28" "$2,890.50" "$2,312.40" "$1,300.73" $573.69 N/A "$1,676.49" "$2,890.50" "$2,890.50" "$2,890.50" $602.38 "$2,890.50" N/A N/A 8530000 SUP HCPCS C1713 8530000 - PLATE BONE ANGLE SMALL HINGE TROUGH CENTERPIECE TITANIUM SPN BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" "$1,093.50" $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" "$1,093.50" "$1,093.50" $227.89 "$1,093.50" N/A N/A 8530008 SUP HCPCS C1713 8530008 - PLATE BONE PRECONTOUR 8MM MULTIPLE HOLE OPEN DOOR PRECUT BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" "$1,093.50" "$1,093.50" $227.89 "$1,093.50" N/A N/A 8530408 SUP HCPCS C1713 8530408 - PLATE BN 8MM NS CENTERPIECE GFT SPNE BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" "$1,093.50" "$1,093.50" $227.89 "$1,093.50" N/A N/A 8530605 SUP Custom 27203010 8530605 - BIT DRL 1.9MM STRL 3 FLT DISP BOTH IP/OP $349.50 $259.00 $62.21 $349.50 $349.50 $349.50 $349.50 $349.50 $349.50 $349.50 $62.21 $349.50 $349.50 $259.40 $259.40 $269.39 $182.09 $72.84 $349.50 $139.80 $349.50 $349.50 $349.50 $349.50 $349.50 $262.13 $349.50 $349.50 $349.50 $174.75 $174.75 $276.80 $349.50 $279.60 $227.18 $349.50 N/A $202.71 $349.50 $209.70 $349.50 $349.50 $349.50 N/A N/A 8536510 SUP HCPCS C1713 8536510 - SCREW BONE 6.5MM 100MM STAINLESS STEEL SPN SACROILIAC 5.5MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$3,361.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8536560 SUP HCPCS C1713 8536560 - SCREW BONE 6.5MM 60MM STAINLESS STEEL SPN SACROILIAC 5.5MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$3,361.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8536570 SUP HCPCS C1713 8536570 - SCREW BONE 6.5MM 70MM STAINLESS STEEL SPN SACROILIAC 5.5MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$3,361.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8536580 SUP HCPCS C1713 8536580 - SCREW BONE 6.5MM 80MM STAINLESS STEEL SPN SACROILIAC 5.5MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$3,361.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8536590 SUP HCPCS C1713 8536590 - SCREW BONE 6.5MM 90MM STAINLESS STEEL SPN SACROILIAC 5.5MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8537510 SUP HCPCS C1713 8537510 - SCREW BONE 7.5MM 100MM STAINLESS STEEL SPN SACROILIAC 5.5MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8537570 SUP HCPCS C1713 8537570 - SCREW BONE 7.5MM 70MM STAINLESS STEEL SPN SACROILIAC 5.5MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$3,361.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8537580 SUP HCPCS C1713 8537580 - SCREW BONE 7.5MM 80MM STAINLESS STEEL SPN SACROILIAC 5.5MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$3,361.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8537590 SUP HCPCS C1713 8537590 - SCREW BONE 7.5MM 90MM STAINLESS STEEL SPN SACROILIAC 5.5MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$3,361.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8538510 SUP HCPCS C1713 8538510 - SCREW BONE 8.5MM 100MM STAINLESS STEEL SPN SACROILIAC 5.5MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8538570 SUP HCPCS C1713 8538570 - SCREW BONE 8.5MM 70MM STAINLESS STEEL SPN SACROILIAC 5.5MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$2,241.00" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8538580 SUP HCPCS C1713 8538580 - SCREW BONE 8.5MM 80MM STAINLESS STEEL SPN SACROILIAC 5.5MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$2,241.00" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8538590 SUP HCPCS C1713 8538590 - SCREW BONE 8.5MM 90MM STAINLESS STEEL SPN SACROILIAC 5.5MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8540611 SUP HCPCS C1713 8540611 - PLATE BONE LP 11MM LEGACY CD HORIZON TITANIUM SPN ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8540612 SUP HCPCS C1713 8540612 - PLATE BONE LP 12MM LEGACY CD HORIZON TITANIUM SPN ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8540613 SUP HCPCS C1713 8540613 - PLATE BONE LP 13MM LEGACY CD HORIZON TITANIUM SPN ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8540614 SUP HCPCS C1713 8540614 - PLATE BONE LP 14MM LEGACY CD HORIZON TITANIUM SPN ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8540615 SUP HCPCS C1713 8540615 - PLATE BONE LP 15MM LEGACY CD HORIZON TITANIUM SPN ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8540616 SUP HCPCS C1713 8540616 - PLATE BONE LP 16MM LEGACY CD HORIZON TITANIUM SPN ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8540617 SUP HCPCS C1713 8540617 - PLATE BONE LP 17MM LEGACY CD HORIZON TITANIUM SPN ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8548498 SUP HCPCS C1713 8548498 - STAPLE BONE 19MM 2 HOLE CD HORIZON TITANIUM CAUDAL SPN BOTH IP/OP "$2,518.50" "$1,864.00" $499.86 "$2,518.50" "$1,133.33" "$1,133.33" "$1,133.33" "$1,133.33" "$2,518.50" "$2,518.50" "$2,518.50" $524.92 "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" $524.88 "$2,518.50" "$2,518.50" "$1,241.62" "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" "$1,888.88" "$2,518.50" "$2,518.50" "$2,518.50" "$1,259.25" "$1,259.25" "$1,994.65" "$2,518.50" "$2,014.80" "$1,133.33" $499.86 N/A "$1,460.73" "$2,518.50" "$1,511.10" "$2,518.50" $524.86 "$2,518.50" N/A N/A 8548499 SUP HCPCS C1713 8548499 - STAPLE BONE 19MM 2 HOLE CD HORIZON TITANIUM ROSTRAL SPN BOTH IP/OP "$2,518.50" "$1,864.00" $499.86 "$2,518.50" "$1,133.33" "$1,133.33" "$1,133.33" "$1,133.33" "$2,518.50" "$2,518.50" "$2,518.50" $524.92 "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" $524.88 "$2,518.50" "$2,518.50" "$1,241.62" "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" "$1,888.88" "$2,518.50" "$2,518.50" "$2,518.50" "$1,259.25" "$1,259.25" "$1,994.65" "$2,518.50" "$2,014.80" "$1,133.33" $499.86 N/A "$1,460.73" "$2,518.50" "$1,511.10" "$2,518.50" $524.86 "$2,518.50" N/A N/A 8548500 SUP HCPCS C1713 8548500 - STAPLE BONE 21MM 2 HOLE CD HORIZON TITANIUM CAUDAL SPN BOTH IP/OP "$2,518.50" "$1,864.00" $499.86 "$2,518.50" "$1,133.33" "$1,133.33" "$1,133.33" "$1,133.33" "$2,518.50" "$2,518.50" "$2,518.50" $524.92 "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" $524.88 "$2,518.50" "$2,518.50" "$1,241.62" "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" "$1,888.88" "$2,518.50" "$2,518.50" "$2,518.50" "$1,259.25" "$1,259.25" "$1,994.65" "$2,518.50" "$2,014.80" "$1,133.33" $499.86 N/A "$1,460.73" "$2,518.50" "$1,511.10" "$2,518.50" $524.86 "$2,518.50" N/A N/A 8548501 SUP HCPCS C1713 8548501 - STAPLE BONE 21MM 2 HOLE CD HORIZON TITANIUM ROSTRAL SPN BOTH IP/OP "$2,518.50" "$1,864.00" $499.86 "$2,518.50" "$1,133.33" "$1,133.33" "$1,133.33" "$1,133.33" "$2,518.50" "$2,518.50" "$2,518.50" $524.92 "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" $524.88 "$2,518.50" "$2,518.50" "$1,241.62" "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" "$1,888.88" "$2,518.50" "$2,518.50" "$2,518.50" "$1,259.25" "$1,259.25" "$1,994.65" "$2,518.50" "$2,014.80" "$1,133.33" $499.86 N/A "$1,460.73" "$2,518.50" "$1,511.10" "$2,518.50" $524.86 "$2,518.50" N/A N/A 8549008 SUP HCPCS C1713 8549008 - PLATE BONE LP 19MM FIX LEGACY CD HORIZON TITANIUM SPN 4.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8549009 SUP HCPCS C1713 8549009 - PLATE BONE LP 19MM FIX LEGACY CD HORIZON TITANIUM SPN 4.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8549010 SUP HCPCS C1713 8549010 - PLATE BONE LP 22MM FIX LEGACY CD HORIZON TITANIUM SPN 4.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8549011 SUP HCPCS C1713 8549011 - PLATE BONE LP 25MM FIX LEGACY CD HORIZON TITANIUM SPN 4.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8549012 SUP HCPCS C1713 8549012 - PLATE BONE LP 29MM FIX LEGACY CD HORIZON TITANIUM SPN 4.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8549013 SUP HCPCS C1713 8549013 - PLATE BONE LP 32MM FIX LEGACY CD HORIZON TITANIUM SPN 4.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8549014 SUP HCPCS C1713 8549014 - CROSSLINK SPINAL LP 35MM CD HORIZON LEGACY TITANIUM 4.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8549015 SUP HCPCS C1713 8549015 - CROSSLINK SPINAL LP 38MM CD HORIZON LEGACY TITANIUM 4.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8549016 SUP HCPCS C1713 8549016 - PLATE BONE SMALL LP LEGACY MULTI-SPAN CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8549017 SUP HCPCS C1713 8549017 - PLATE BONE MEDIUM LP LEGACY MULTI-SPAN CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8549018 SUP HCPCS C1713 8549018 - PLATE BONE MEDIUM LP LEGACY MULTI-SPAN CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8549300 SUP Custom 27803010 8549300 - CONNECTOR ROD 4.5/4.5MM OPEN DOMINO TITANIUM SPN BOTH IP/OP "$1,831.50" "$1,355.00" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $381.64 "$1,831.18" $732.47 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,373.63" "$1,831.18" "$1,831.18" "$1,831.18" $915.59 $915.59 "$1,450.29" "$1,831.18" "$1,464.94" $824.03 "$1,831.18" N/A "$1,062.27" "$1,831.18" "$1,098.71" "$1,831.18" "$1,831.18" "$1,831.18" N/A N/A 8549301 SUP Custom 27803010 8549301 - CONNECTOR ROD 4.5/5.5MM OPEN DOMINO TITANIUM SPN BOTH IP/OP "$1,831.50" "$1,355.00" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $381.64 "$1,831.18" $732.47 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,373.63" "$1,831.18" "$1,831.18" "$1,831.18" $915.59 $915.59 "$1,450.29" "$1,831.18" "$1,464.94" $824.03 "$1,831.18" N/A "$1,062.27" "$1,831.18" "$1,098.71" "$1,831.18" "$1,831.18" "$1,831.18" N/A N/A 8549305 SUP Custom 27803010 8549305 - CONNECTOR ROD 4.5/4.5MM DOMINO TITANIUM SPN BOTH IP/OP "$1,831.50" "$1,355.00" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $381.64 "$1,831.18" $732.47 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,373.63" "$1,831.18" "$1,831.18" "$1,831.18" $915.59 $915.59 "$1,450.29" "$1,831.18" "$1,464.94" $824.03 "$1,831.18" N/A "$1,062.27" "$1,831.18" "$1,098.71" "$1,831.18" "$1,831.18" "$1,831.18" N/A N/A 8549306 SUP Custom 27803010 8549306 - CONNECTOR ROD 4.5/5.5MM DOMINO TITANIUM SPN BOTH IP/OP "$1,831.50" "$1,355.00" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $381.64 "$1,831.18" $732.47 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,373.63" "$1,831.18" "$1,831.18" "$1,831.18" $915.59 $915.59 "$1,450.29" "$1,831.18" "$1,464.94" $824.03 "$1,831.18" N/A "$1,062.27" "$1,831.18" "$1,098.71" "$1,831.18" "$1,831.18" "$1,831.18" N/A N/A 8550120 SUP HCPCS C1713 8550120 - CONNECTOR ROD 5.5MM 20MM FIX CROSS STAINLESS STEEL SPN BOTH IP/OP "$3,630.00" "$2,686.00" $720.46 "$3,630.00" "$1,633.50" "$1,633.50" "$1,633.50" "$1,633.50" "$3,630.00" "$3,630.00" "$3,630.00" $756.58 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $756.53 "$3,630.00" "$3,630.00" "$1,789.59" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$1,633.50" $720.46 N/A "$2,105.40" "$3,630.00" "$3,630.00" "$3,630.00" $756.49 "$3,630.00" N/A N/A 8550122 SUP HCPCS C1713 8550122 - CONNECTOR ROD 5.5MM 22.5MM FIX CROSS STAINLESS STEEL SPN BOTH IP/OP "$3,630.00" "$2,686.00" $720.46 "$3,630.00" "$1,633.50" "$1,633.50" "$1,633.50" "$1,633.50" "$3,630.00" "$3,630.00" "$3,630.00" $756.58 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $756.53 "$3,630.00" "$1,452.00" "$1,789.59" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$1,633.50" $720.46 N/A "$2,105.40" "$3,630.00" "$3,630.00" "$3,630.00" $756.49 "$3,630.00" N/A N/A 8550125 SUP HCPCS C1713 8550125 - CONNECTOR ROD 5.5MM 25MM FIX CROSS STAINLESS STEEL SPN BOTH IP/OP "$3,630.00" "$2,686.00" $720.46 "$3,630.00" "$1,633.50" "$1,633.50" "$1,633.50" "$1,633.50" "$3,630.00" "$3,630.00" "$3,630.00" $756.58 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $756.53 "$3,630.00" "$3,630.00" "$1,789.59" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$1,633.50" $720.46 N/A "$2,105.40" "$3,630.00" "$3,630.00" "$3,630.00" $756.49 "$3,630.00" N/A N/A 8550127 SUP HCPCS C1713 8550127 - CONNECTOR ROD 5.5MM 27.5MM FIX CROSS STAINLESS STEEL SPN BOTH IP/OP "$3,630.00" "$2,686.00" $720.46 "$3,630.00" "$1,633.50" "$1,633.50" "$1,633.50" "$1,633.50" "$3,630.00" "$3,630.00" "$3,630.00" $756.58 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $756.53 "$3,630.00" "$1,452.00" "$1,789.59" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$1,633.50" $720.46 N/A "$2,105.40" "$3,630.00" "$2,178.00" "$3,630.00" $756.49 "$3,630.00" N/A N/A 8550130 SUP HCPCS C1713 8550130 - CONNECTOR ROD 5.5MM 30MM FIX CROSS STAINLESS STEEL SPN BOTH IP/OP "$3,630.00" "$2,686.00" $720.46 "$3,630.00" "$1,633.50" "$1,633.50" "$1,633.50" "$1,633.50" "$3,630.00" "$3,630.00" "$3,630.00" $756.58 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $756.53 "$3,630.00" "$3,630.00" "$1,789.59" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$1,633.50" $720.46 N/A "$2,105.40" "$3,630.00" "$2,178.00" "$3,630.00" $756.49 "$3,630.00" N/A N/A 8550132 SUP HCPCS C1713 8550132 - CONNECTOR ROD 5.5MM 32.5MM FIX CROSS STAINLESS STEEL SPN BOTH IP/OP "$3,630.00" "$2,686.00" $720.46 "$3,630.00" "$1,633.50" "$1,633.50" "$1,633.50" "$1,633.50" "$3,630.00" "$3,630.00" "$3,630.00" $756.58 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $756.53 "$3,630.00" "$1,452.00" "$1,789.59" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$1,633.50" $720.46 N/A "$2,105.40" "$3,630.00" "$3,630.00" "$3,630.00" $756.49 "$3,630.00" N/A N/A 8550135 SUP HCPCS C1713 8550135 - CONNECTOR ROD 5.5MM 35MM FIX CROSS STAINLESS STEEL SPN BOTH IP/OP "$3,630.00" "$2,686.00" $720.46 "$3,630.00" "$1,633.50" "$1,633.50" "$1,633.50" "$1,633.50" "$3,630.00" "$3,630.00" "$3,630.00" $756.58 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $756.53 "$3,630.00" "$3,630.00" "$1,789.59" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$1,633.50" $720.46 N/A "$2,105.40" "$3,630.00" "$2,178.00" "$3,630.00" $756.49 "$3,630.00" N/A N/A 8550137 SUP HCPCS C1713 8550137 - CONNECTOR ROD 5.5MM 37.5MM FIX CROSS STAINLESS STEEL SPN BOTH IP/OP "$3,630.00" "$2,686.00" $720.46 "$3,630.00" "$1,633.50" "$1,633.50" "$1,633.50" "$1,633.50" "$3,630.00" "$3,630.00" "$3,630.00" $756.58 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $756.53 "$3,630.00" "$1,452.00" "$1,789.59" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$1,633.50" $720.46 N/A "$2,105.40" "$3,630.00" "$2,178.00" "$3,630.00" $756.49 "$3,630.00" N/A N/A 8550140 SUP HCPCS C1713 8550140 - CONNECTOR ROD 5.5MM 40MM FIX CROSS STAINLESS STEEL SPN BOTH IP/OP "$3,630.00" "$2,686.00" $720.46 "$3,630.00" "$1,633.50" "$1,633.50" "$1,633.50" "$1,633.50" "$3,630.00" "$3,630.00" "$3,630.00" $756.58 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $756.53 "$3,630.00" "$3,630.00" "$1,789.59" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$1,633.50" $720.46 N/A "$2,105.40" "$3,630.00" "$2,178.00" "$3,630.00" $756.49 "$3,630.00" N/A N/A 8550145 SUP HCPCS C1713 8550145 - CONNECTOR ROD 5.5MM 45MM FIX CROSS STAINLESS STEEL SPN BOTH IP/OP "$3,630.00" "$2,686.00" $720.46 "$3,630.00" "$1,633.50" "$1,633.50" "$1,633.50" "$1,633.50" "$3,630.00" "$3,630.00" "$3,630.00" $756.58 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $756.53 "$3,630.00" "$1,452.00" "$1,789.59" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$1,633.50" $720.46 N/A "$2,105.40" "$3,630.00" "$3,630.00" "$3,630.00" $756.49 "$3,630.00" N/A N/A 8550150 SUP HCPCS C1713 8550150 - CONNECTOR ROD 5.5MM 50MM FIX CROSS STAINLESS STEEL SPN BOTH IP/OP "$3,630.00" "$2,686.00" $720.46 "$3,630.00" "$1,633.50" "$1,633.50" "$1,633.50" "$1,633.50" "$3,630.00" "$3,630.00" "$3,630.00" $756.58 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $756.53 "$3,630.00" "$3,630.00" "$1,789.59" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$1,633.50" $720.46 N/A "$2,105.40" "$3,630.00" "$2,178.00" "$3,630.00" $756.49 "$3,630.00" N/A N/A 8550245 SUP HCPCS C1713 8550245 - CONNECTOR ROD 5.5MM 45-50MM CROSS STAINLESS STEEL SPN BOTH IP/OP "$4,905.00" "$3,630.00" $973.52 "$4,905.00" "$2,207.25" "$2,207.25" "$2,207.25" "$2,207.25" "$4,905.00" "$4,905.00" "$4,905.00" "$1,022.32" "$4,905.00" "$4,905.00" "$4,905.00" "$4,905.00" "$4,905.00" "$1,022.26" "$4,905.00" "$1,962.00" "$2,418.17" "$4,905.00" "$4,905.00" "$4,905.00" "$4,905.00" "$3,678.75" "$4,905.00" "$4,905.00" "$4,905.00" "$2,452.50" "$2,452.50" "$3,884.76" "$4,905.00" "$3,924.00" "$2,207.25" $973.52 N/A "$2,844.90" "$4,905.00" "$2,943.00" "$4,905.00" "$1,022.20" "$4,905.00" N/A N/A 8550250 SUP HCPCS C1713 8550250 - CONNECTOR ROD 5.5MM 50-60MM CROSS STAINLESS STEEL SPN BOTH IP/OP "$4,905.00" "$3,630.00" $973.52 "$4,905.00" "$2,207.25" "$2,207.25" "$2,207.25" "$2,207.25" "$4,905.00" "$4,905.00" "$4,905.00" "$1,022.32" "$4,905.00" "$4,905.00" "$4,905.00" "$4,905.00" "$4,905.00" "$1,022.26" "$4,905.00" "$4,905.00" "$2,418.17" "$4,905.00" "$4,905.00" "$4,905.00" "$4,905.00" "$3,678.75" "$4,905.00" "$4,905.00" "$4,905.00" "$2,452.50" "$2,452.50" "$3,884.76" "$4,905.00" "$3,924.00" "$2,207.25" $973.52 N/A "$2,844.90" "$4,905.00" "$2,943.00" "$4,905.00" "$1,022.20" "$4,905.00" N/A N/A 8550260 SUP HCPCS C1713 8550260 - CONNECTOR ROD 5.5MM 60-70MM CROSS STAINLESS STEEL SPN BOTH IP/OP "$4,905.00" "$3,630.00" $973.52 "$4,905.00" "$2,207.25" "$2,207.25" "$2,207.25" "$2,207.25" "$4,905.00" "$4,905.00" "$4,905.00" "$1,022.32" "$4,905.00" "$4,905.00" "$4,905.00" "$4,905.00" "$4,905.00" "$1,022.26" "$4,905.00" "$1,962.00" "$2,418.17" "$4,905.00" "$4,905.00" "$4,905.00" "$4,905.00" "$3,678.75" "$4,905.00" "$4,905.00" "$4,905.00" "$2,452.50" "$2,452.50" "$3,884.76" "$4,905.00" "$3,924.00" "$2,207.25" $973.52 N/A "$2,844.90" "$4,905.00" "$2,943.00" "$4,905.00" "$1,022.20" "$4,905.00" N/A N/A 8550270 SUP HCPCS C1713 8550270 - CONNECTOR ROD 5.5MM 70-85MM CROSS STAINLESS STEEL SPN BOTH IP/OP "$4,905.00" "$3,630.00" $973.52 "$4,905.00" "$2,207.25" "$2,207.25" "$2,207.25" "$2,207.25" "$4,905.00" "$4,905.00" "$4,905.00" "$1,022.32" "$4,905.00" "$4,905.00" "$4,905.00" "$4,905.00" "$4,905.00" "$1,022.26" "$4,905.00" "$4,905.00" "$2,418.17" "$4,905.00" "$4,905.00" "$4,905.00" "$4,905.00" "$3,678.75" "$4,905.00" "$4,905.00" "$4,905.00" "$2,452.50" "$2,452.50" "$3,884.76" "$4,905.00" "$3,924.00" "$2,207.25" $973.52 N/A "$2,844.90" "$4,905.00" "$4,905.00" "$4,905.00" "$1,022.20" "$4,905.00" N/A N/A 8550302 SUP HCPCS C1713 8550302 - CONNECTOR ROD 5.5MM INLINE STAINLESS STEEL SPN BOTH IP/OP "$2,880.00" "$2,131.00" $571.61 "$2,880.00" "$1,296.00" "$1,296.00" "$1,296.00" "$1,296.00" "$2,880.00" "$2,880.00" "$2,880.00" $600.26 "$2,880.00" "$2,880.00" "$2,880.00" "$2,880.00" "$2,880.00" $600.22 "$2,880.00" "$1,152.00" "$1,419.84" "$2,880.00" "$2,880.00" "$2,880.00" "$2,880.00" "$2,160.00" "$2,880.00" "$2,880.00" "$2,880.00" "$1,440.00" "$1,440.00" "$2,280.96" "$2,880.00" "$2,304.00" "$1,296.00" $571.61 N/A "$1,670.40" "$2,880.00" "$2,880.00" "$2,880.00" $600.19 "$2,880.00" N/A N/A 8550402 SUP HCPCS C1713 8550402 - CONNECTOR ROD PARALLEL 5.5MM STAINLESS STEEL SPN BOTH IP/OP "$2,880.00" "$2,131.00" $571.61 "$2,880.00" "$1,296.00" "$1,296.00" "$1,296.00" "$1,296.00" "$2,880.00" "$2,880.00" "$2,880.00" $600.26 "$2,880.00" "$2,880.00" "$2,880.00" "$2,880.00" "$2,880.00" $600.22 "$2,880.00" "$2,880.00" "$1,419.84" "$2,880.00" "$2,880.00" "$2,880.00" "$2,880.00" "$2,160.00" "$2,880.00" "$2,880.00" "$2,880.00" "$1,440.00" "$1,440.00" "$2,280.96" "$2,880.00" "$2,304.00" "$1,296.00" $571.61 N/A "$1,670.40" "$2,880.00" "$1,728.00" "$2,880.00" $600.19 "$2,880.00" N/A N/A 8550602 SUP HCPCS C1713 8550602 - CONNECTOR ROD 5.5MM 4 HOLE STAINLESS STEEL SPN BOTH IP/OP "$3,617.50" "$2,677.00" $717.98 "$3,617.50" "$1,627.88" "$1,627.88" "$1,627.88" "$1,627.88" "$3,617.50" "$3,617.50" "$3,617.50" $753.98 "$3,617.50" "$3,617.50" "$3,617.50" "$3,617.50" "$3,617.50" $753.93 "$3,617.50" "$1,447.00" "$1,783.43" "$3,617.50" "$3,617.50" "$3,617.50" "$3,617.50" "$2,713.13" "$3,617.50" "$3,617.50" "$3,617.50" "$1,808.75" "$1,808.75" "$2,865.06" "$3,617.50" "$2,894.00" "$1,627.88" $717.98 N/A "$2,098.15" "$3,617.50" "$2,170.50" "$3,617.50" $753.89 "$3,617.50" N/A N/A 8552200 SUP HCPCS C1713 8552200 - ROD SPINAL 5.5MM 200MM STAINLESS STEEL BOTH IP/OP "$1,295.00" $958.00 $257.03 "$1,295.00" $582.75 $582.75 $582.75 $582.75 "$1,295.00" "$1,295.00" "$1,295.00" $269.91 "$1,295.00" "$1,295.00" "$1,295.00" "$1,295.00" "$1,295.00" $269.89 "$1,295.00" "$1,295.00" $765.99 "$1,295.00" "$1,295.00" "$1,295.00" "$1,295.00" $971.25 "$1,295.00" "$1,295.00" "$1,295.00" $647.50 $647.50 "$1,025.64" "$1,295.00" "$1,036.00" $582.75 $257.03 N/A $751.10 "$1,295.00" $777.00 "$1,295.00" $269.88 "$1,295.00" N/A N/A 8552300 SUP HCPCS C1713 8552300 - ROD SPINAL 5.5MM 300MM STAINLESS STEEL BOTH IP/OP "$1,860.00" "$1,376.00" $369.16 "$1,860.00" $837.00 $837.00 $837.00 $837.00 "$1,860.00" "$1,860.00" "$1,860.00" $387.67 "$1,860.00" "$1,860.00" "$1,860.00" "$1,860.00" "$1,860.00" $387.64 "$1,860.00" $744.00 "$1,100.19" "$1,860.00" "$1,860.00" "$1,860.00" "$1,860.00" "$1,395.00" "$1,860.00" "$1,860.00" "$1,860.00" $930.00 $930.00 "$1,473.12" "$1,860.00" "$1,488.00" $837.00 $369.16 N/A "$1,078.80" "$1,860.00" "$1,116.00" "$1,860.00" $387.62 "$1,860.00" N/A N/A 8552500 SUP HCPCS C1713 8552500 - ROD SPINAL 5.5MM 500MM STAINLESS STEEL BOTH IP/OP "$1,922.50" "$1,423.00" $381.57 "$1,922.50" $865.13 $865.13 $865.13 $865.13 "$1,922.50" "$1,922.50" "$1,922.50" $400.70 "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" $400.67 "$1,922.50" "$1,922.50" "$1,137.16" "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" "$1,441.88" "$1,922.50" "$1,922.50" "$1,922.50" $961.25 $961.25 "$1,522.62" "$1,922.50" "$1,538.00" $865.13 $381.57 N/A "$1,115.05" "$1,922.50" "$1,922.50" "$1,922.50" $400.65 "$1,922.50" N/A N/A 8553101 SUP Custom 27803010 8553101 - HOOK SPINAL SMALL 5.5MM STAINLESS STEEL PEDICLE BOTH IP/OP "$3,115.00" "$2,305.00" $554.47 "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" $554.47 "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" $649.20 "$3,115.00" "$1,246.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$2,336.25" "$3,115.00" "$3,115.00" "$3,115.00" "$1,557.50" "$1,557.50" "$2,467.08" "$3,115.00" "$2,492.00" "$1,401.75" "$3,115.00" N/A "$1,806.70" "$3,115.00" "$1,869.00" "$3,115.00" "$3,115.00" "$3,115.00" N/A N/A 8553102 SUP Custom 27803010 8553102 - HOOK SPINAL MEDIUM 5.5MM STAINLESS STEEL PEDICLE BOTH IP/OP "$3,115.00" "$2,305.00" $554.47 "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" $554.47 "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" $649.20 "$3,115.00" "$1,246.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$2,336.25" "$3,115.00" "$3,115.00" "$3,115.00" "$1,557.50" "$1,557.50" "$2,467.08" "$3,115.00" "$2,492.00" "$1,401.75" "$3,115.00" N/A "$1,806.70" "$3,115.00" "$1,869.00" "$3,115.00" "$3,115.00" "$3,115.00" N/A N/A 8553112 SUP Custom 27803010 8553112 - HOOK SPINAL 6MM REDUCE STAINLESS STEEL LAMINA 5.5MM ROD BOTH IP/OP "$3,115.00" "$2,305.00" $554.47 "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" $554.47 "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" $649.20 "$3,115.00" "$1,246.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$2,336.25" "$3,115.00" "$3,115.00" "$3,115.00" "$1,557.50" "$1,557.50" "$2,467.08" "$3,115.00" "$2,492.00" "$1,401.75" "$3,115.00" N/A "$1,806.70" "$3,115.00" "$1,869.00" "$3,115.00" "$3,115.00" "$3,115.00" N/A N/A 8553113 SUP Custom 27803010 8553113 - HOOK SPINAL 8MM REDUCE STAINLESS STEEL LAMINA 5.5MM ROD BOTH IP/OP "$3,115.00" "$2,305.00" $554.47 "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" $554.47 "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" $649.20 "$3,115.00" "$1,246.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$2,336.25" "$3,115.00" "$3,115.00" "$3,115.00" "$1,557.50" "$1,557.50" "$2,467.08" "$3,115.00" "$2,492.00" "$1,401.75" "$3,115.00" N/A "$1,806.70" "$3,115.00" "$1,869.00" "$3,115.00" "$3,115.00" "$3,115.00" N/A N/A 8553114 SUP Custom 27803010 8553114 - HOOK SPINAL 10MM REDUCE STAINLESS STEEL LAMINA 5.5MM ROD BOTH IP/OP "$3,115.00" "$2,305.00" $554.47 "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" $554.47 "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" $649.20 "$3,115.00" "$1,246.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$2,336.25" "$3,115.00" "$3,115.00" "$3,115.00" "$1,557.50" "$1,557.50" "$2,467.08" "$3,115.00" "$2,492.00" "$1,401.75" "$3,115.00" N/A "$1,806.70" "$3,115.00" "$1,869.00" "$3,115.00" "$3,115.00" "$3,115.00" N/A N/A 8553121 SUP Custom 27803010 8553121 - HOOK SPINAL ANGLE RIGHT STAINLESS STEEL 5.5MM ROD BOTH IP/OP "$3,950.00" "$2,923.00" $703.10 "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" $703.10 "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" $823.22 "$3,950.00" "$1,580.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$2,962.50" "$3,950.00" "$3,950.00" "$3,950.00" "$1,975.00" "$1,975.00" "$3,128.40" "$3,950.00" "$3,160.00" "$1,777.50" "$3,950.00" N/A "$2,291.00" "$3,950.00" "$2,370.00" "$3,950.00" "$3,950.00" "$3,950.00" N/A N/A 8553122 SUP Custom 27803010 8553122 - HOOK SPINAL ANGLE LEFT STAINLESS STEEL 5.5MM ROD BOTH IP/OP "$3,950.00" "$2,923.00" $703.10 "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" $703.10 "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" $823.22 "$3,950.00" "$1,580.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$2,962.50" "$3,950.00" "$3,950.00" "$3,950.00" "$1,975.00" "$1,975.00" "$3,128.40" "$3,950.00" "$3,160.00" "$1,777.50" "$3,950.00" N/A "$2,291.00" "$3,950.00" "$2,370.00" "$3,950.00" "$3,950.00" "$3,950.00" N/A N/A 8553123 SUP Custom 27803010 8553123 - HOOK SPINAL RIGHT OFFST STAINLESS STEEL 5.5MM ROD BOTH IP/OP "$3,950.00" "$2,923.00" $703.10 "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" $703.10 "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" $823.22 "$3,950.00" "$1,580.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$2,962.50" "$3,950.00" "$3,950.00" "$3,950.00" "$1,975.00" "$1,975.00" "$3,128.40" "$3,950.00" "$3,160.00" "$1,777.50" "$3,950.00" N/A "$2,291.00" "$3,950.00" "$2,370.00" "$3,950.00" "$3,950.00" "$3,950.00" N/A N/A 8553124 SUP Custom 27803010 8553124 - HOOK SPINAL LEFT OFFST STAINLESS STEEL 5.5MM ROD BOTH IP/OP "$3,950.00" "$2,923.00" $703.10 "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" $703.10 "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" $823.22 "$3,950.00" "$1,580.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$3,950.00" "$2,962.50" "$3,950.00" "$3,950.00" "$3,950.00" "$1,975.00" "$1,975.00" "$3,128.40" "$3,950.00" "$3,160.00" "$1,777.50" "$3,950.00" N/A "$2,291.00" "$3,950.00" "$2,370.00" "$3,950.00" "$3,950.00" "$3,950.00" N/A N/A 8554025 SUP HCPCS C1713 8554025 - SCREW BONE 4MM 25MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8554030 SUP HCPCS C1713 8554030 - SCREW BONE 4MM 30MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8554035 SUP HCPCS C1713 8554035 - SCREW BONE 4MM 35MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8554040 SUP HCPCS C1713 8554040 - SCREW BONE 4MM 40MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8554525 SUP HCPCS C1713 8554525 - SCREW BONE 4.5MM 25MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8554530 SUP HCPCS C1713 8554530 - SCREW BONE 4.5MM 30MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8554535 SUP HCPCS C1713 8554535 - SCREW BONE 4.5MM 35MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" "$4,607.50" "$4,607.50" N/A N/A 8554540 SUP HCPCS C1713 8554540 - SCREW BONE 4.5MM 40MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8554545 SUP HCPCS C1713 8554545 - SCREW BONE 4.5MM 45MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8555025 SUP HCPCS C1713 8555025 - SCREW BONE 5MM 25MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8555030 SUP HCPCS C1713 8555030 - SCREW BONE 5MM 30MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8555035 SUP HCPCS C1713 8555035 - SCREW BONE 5MM 35MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8555040 SUP HCPCS C1713 8555040 - SCREW BONE 5MM 40MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8555045 SUP HCPCS C1713 8555045 - SCREW BONE 5MM 45MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8555530 SUP HCPCS C1713 8555530 - SCREW BONE 5.5MM 30MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8555535 SUP HCPCS C1713 8555535 - SCREW BONE 5.5MM 35MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8555540 SUP HCPCS C1713 8555540 - SCREW BONE 5.5MM 40MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8555545 SUP HCPCS C1713 8555545 - SCREW BONE 5.5MM 45MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8555550 SUP HCPCS C1713 8555550 - SCREW BONE 5.5MM 50MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8555555 SUP HCPCS C1713 8555555 - SCREW BONE 5.5MM 55MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8556535 SUP HCPCS C1713 8556535 - SCREW BONE 6.5MM 35MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8556540 SUP HCPCS C1713 8556540 - SCREW BONE 6.5MM 40MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8556545 SUP HCPCS C1713 8556545 - SCREW BONE 6.5MM 45MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8556550 SUP HCPCS C1713 8556550 - SCREW BONE 6.5MM 50MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8556555 SUP HCPCS C1713 8556555 - SCREW BONE 6.5MM 55MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8557535 SUP HCPCS C1713 8557535 - SCREW BONE 7.5MM 35MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8557540 SUP HCPCS C1713 8557540 - SCREW BONE 7.5MM 40MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8557545 SUP HCPCS C1713 8557545 - SCREW BONE 7.5MM 45MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8557550 SUP HCPCS C1713 8557550 - SCREW BONE 7.5MM 50MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8557555 SUP HCPCS C1713 8557555 - SCREW BONE 7.5MM 55MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8558540 SUP HCPCS C1713 8558540 - SCREW BONE 8.5MM 40MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8558545 SUP HCPCS C1713 8558545 - SCREW BONE 8.5MM 45MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8558550 SUP HCPCS C1713 8558550 - SCREW BONE 8.5MM 50MM POLYAX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" N/A N/A 8560302 SUP HCPCS C1713 8560302 - CONNECTOR ROD 6.35MM 5.5MM INLINE STAINLESS STEEL SPN BOTH IP/OP "$2,880.00" "$2,131.00" $571.61 "$2,880.00" "$1,296.00" "$1,296.00" "$1,296.00" "$1,296.00" "$2,880.00" "$2,880.00" "$2,880.00" $600.26 "$2,880.00" "$2,880.00" "$2,880.00" "$2,880.00" "$2,880.00" $600.22 "$2,880.00" "$1,152.00" "$1,419.84" "$2,880.00" "$2,880.00" "$2,880.00" "$2,880.00" "$2,160.00" "$2,880.00" "$2,880.00" "$2,880.00" "$1,440.00" "$1,440.00" "$2,280.96" "$2,880.00" "$2,304.00" "$1,296.00" $571.61 N/A "$1,670.40" "$2,880.00" "$2,880.00" "$2,880.00" "$2,880.00" "$2,880.00" N/A N/A 8560402 SUP HCPCS C1713 8560402 - CONNECTOR ROD PARALLEL 6.35MM 5.5MM STAINLESS STEEL SPN BOTH IP/OP "$2,880.00" "$2,131.00" $571.61 "$2,880.00" "$1,296.00" "$1,296.00" "$1,296.00" "$1,296.00" "$2,880.00" "$2,880.00" "$2,880.00" $600.26 "$2,880.00" "$2,880.00" "$2,880.00" "$2,880.00" "$2,880.00" $600.22 "$2,880.00" "$1,152.00" "$1,419.84" "$2,880.00" "$2,880.00" "$2,880.00" "$2,880.00" "$2,160.00" "$2,880.00" "$2,880.00" "$2,880.00" "$1,440.00" "$1,440.00" "$2,280.96" "$2,880.00" "$2,304.00" "$1,296.00" $571.61 N/A "$1,670.40" "$2,880.00" "$2,880.00" "$2,880.00" $600.19 "$2,880.00" N/A N/A 8560602 SUP HCPCS C1713 8560602 - CONNECTOR ROD 6.35MM 4 HOLE STAINLESS STEEL SPN BOTH IP/OP "$3,617.50" "$2,677.00" $717.98 "$3,617.50" "$1,627.88" "$1,627.88" "$1,627.88" "$1,627.88" "$3,617.50" "$3,617.50" "$3,617.50" $753.98 "$3,617.50" "$3,617.50" "$3,617.50" "$3,617.50" "$3,617.50" $753.93 "$3,617.50" "$1,447.00" "$1,783.43" "$3,617.50" "$3,617.50" "$3,617.50" "$3,617.50" "$2,713.13" "$3,617.50" "$3,617.50" "$3,617.50" "$1,808.75" "$1,808.75" "$2,865.06" "$3,617.50" "$2,894.00" "$1,627.88" $717.98 N/A "$2,098.15" "$3,617.50" "$3,617.50" "$3,617.50" $753.89 "$3,617.50" N/A N/A 8561100 SUP HCPCS C1713 8561100 - SCREW BONE LOCK ARMADA STAINLESS STEEL SPN BOTH IP/OP $910.00 $673.00 $180.61 $910.00 $409.50 $409.50 $409.50 $409.50 $910.00 $910.00 $910.00 $189.67 $910.00 $910.00 $910.00 $910.00 $910.00 $189.65 $910.00 $910.00 $538.27 $910.00 $910.00 $910.00 $910.00 $682.50 $910.00 $910.00 $910.00 $455.00 $455.00 $720.72 $910.00 $728.00 $409.50 $180.61 N/A $527.80 $910.00 $910.00 $910.00 $189.64 $910.00 N/A N/A 8561300 SUP HCPCS C1713 8561300 - CONCTR ROD ROD TO ROD LCK SCR SIDE SPNL BOTH IP/OP $757.50 $561.00 $150.34 $757.50 $340.88 $340.88 $340.88 $340.88 $757.50 $757.50 $757.50 $157.88 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $757.50 $448.06 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $150.34 N/A $439.35 $757.50 $757.50 $757.50 $157.86 $757.50 N/A N/A 8562010 SUP Custom 27203010 8562010 - STIMULATOR NRV STD VRSTIM3 HNDHLD LCTR SUBDERMIS BOTH IP/OP $205.00 $152.00 $36.45 $204.75 $204.75 $204.75 $204.75 $204.75 $204.75 $204.75 $36.45 $204.75 $204.75 $151.97 $151.97 $157.82 $106.67 $42.67 $204.75 $81.90 $204.75 $204.75 $204.75 $204.75 $204.75 $153.75 $204.75 $204.75 $204.75 $102.38 $102.38 $162.16 $204.75 $163.80 $133.09 $204.75 N/A $118.90 $204.75 $122.85 $204.75 $204.75 $204.75 N/A N/A 8562250 SUP HCPCS C1713 8562250 - ROD SPNL 250MM 6.35MM SS BOTH IP/OP "$1,860.00" "$1,376.00" $369.16 "$1,860.00" $837.00 $837.00 $837.00 $837.00 "$1,860.00" "$1,860.00" "$1,860.00" $387.67 "$1,860.00" "$1,860.00" "$1,860.00" "$1,860.00" "$1,860.00" $387.64 "$1,860.00" "$1,860.00" "$1,100.19" "$1,860.00" "$1,860.00" "$1,860.00" "$1,860.00" "$1,395.00" "$1,860.00" "$1,860.00" "$1,860.00" $930.00 $930.00 "$1,473.12" "$1,860.00" "$1,488.00" $837.00 $369.16 N/A "$1,078.80" "$1,860.00" "$1,860.00" "$1,860.00" $387.62 "$1,860.00" N/A N/A 8562500 SUP HCPCS C1713 8562500 - ROD SPNL 500MM 6.35MM SS BOTH IP/OP "$2,017.50" "$1,493.00" $400.42 "$2,017.50" $907.88 $907.88 $907.88 $907.88 "$2,017.50" "$2,017.50" "$2,017.50" $420.50 "$2,017.50" "$2,017.50" "$2,017.50" "$2,017.50" "$2,017.50" $420.47 "$2,017.50" "$2,017.50" "$1,193.35" "$2,017.50" "$2,017.50" "$2,017.50" "$2,017.50" "$1,513.13" "$2,017.50" "$2,017.50" "$2,017.50" "$1,008.75" "$1,008.75" "$1,597.86" "$2,017.50" "$1,614.00" $907.88 $400.42 N/A "$1,170.15" "$2,017.50" "$2,017.50" "$2,017.50" $420.45 "$2,017.50" N/A N/A 8564525 SUP HCPCS C1713 8564525 - SCREW BONE 4.5MM 25MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" N/A N/A 8564530 SUP HCPCS C1713 8564530 - SCREW BONE 4.5MM 30MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" N/A N/A 8564535 SUP HCPCS C1713 8564535 - SCREW BONE 4.5MM 35MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8564540 SUP HCPCS C1713 8564540 - SCREW BONE 4.5MM 40MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8564545 SUP HCPCS C1713 8564545 - SCREW BONE 4.5MM 45MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8565530 SUP HCPCS C1713 8565530 - SCREW BONE 5.5MM 30MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8565535 SUP HCPCS C1713 8565535 - SCREW BONE 5.5MM 35MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8565540 SUP HCPCS C1713 8565540 - SCREW BONE 5.5MM 40MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8565545 SUP HCPCS C1713 8565545 - SCREW BONE 5.5MM 45MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8565550 SUP HCPCS C1713 8565550 - SCREW BONE 5.5MM 50MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8565555 SUP HCPCS C1713 8565555 - SCREW BONE 5.5MM 55MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8566530 SUP HCPCS C1713 8566530 - SCREW BONE 6.5MM 30MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8566535 SUP HCPCS C1713 8566535 - SCREW BONE 6.5MM 35MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8566540 SUP HCPCS C1713 8566540 - SCREW BONE 6.5MM 40MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8566545 SUP HCPCS C1713 8566545 - SCREW BONE 6.5MM 45MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8566550 SUP HCPCS C1713 8566550 - SCREW BONE 6.5MM 50MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8566555 SUP HCPCS C1713 8566555 - SCREW BONE 6.5MM 55MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$1,843.00" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8567535 SUP HCPCS C1713 8567535 - SCREW BONE 7.5MM 35MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8567540 SUP HCPCS C1713 8567540 - SCREW BONE 7.5MM 40MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8567545 SUP HCPCS C1713 8567545 - SCREW BONE 7.5MM 45MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$2,764.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8567550 SUP HCPCS C1713 8567550 - SCREW BONE 7.5MM 50MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8567555 SUP HCPCS C1713 8567555 - SCREW BONE 7.5MM 55MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8568535 SUP HCPCS C1713 8568535 - SCREW BONE 8.5MM 35MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8568540 SUP HCPCS C1713 8568540 - SCREW BONE 8.5MM 40MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8568545 SUP HCPCS C1713 8568545 - SCREW BONE 8.5MM 45MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8568550 SUP HCPCS C1713 8568550 - SCREW BONE 8.5MM 50MM SPNL POLYAX 6.35MM ROD BOTH IP/OP "$4,607.50" "$3,410.00" $914.47 "$4,607.50" "$2,073.38" "$2,073.38" "$2,073.38" "$2,073.38" "$4,607.50" "$4,607.50" "$4,607.50" $960.32 "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" $960.25 "$4,607.50" "$4,607.50" "$2,271.50" "$4,607.50" "$4,607.50" "$4,607.50" "$4,607.50" "$3,455.63" "$4,607.50" "$4,607.50" "$4,607.50" "$2,303.75" "$2,303.75" "$3,649.14" "$4,607.50" "$3,686.00" "$2,073.38" $914.47 N/A "$2,672.35" "$4,607.50" "$4,607.50" "$4,607.50" $960.20 "$4,607.50" N/A N/A 8570611 SUP HCPCS C1713 8570611 - ROD SPINAL 4.5MM 11MM 2 OPENING CROSSLINK STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8570612 SUP HCPCS C1713 8570612 - ROD SPINAL 4.5MM 12MM 2 OPENING CROSSLINK STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8570613 SUP HCPCS C1713 8570613 - ROD SPINAL 4.5MM 13MM 2 OPENING CROSSLINK STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8570614 SUP HCPCS C1713 8570614 - ROD SPINAL 4.5MM 14MM 2 OPENING CROSSLINK STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8570615 SUP HCPCS C1713 8570615 - ROD SPINAL 4.5MM 15MM 2 OPENING CROSSLINK STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8570616 SUP HCPCS C1713 8570616 - ROD SPINAL 4.5MM 16MM 2 OPENING CROSSLINK STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8570617 SUP HCPCS C1713 8570617 - ROD SPINAL 4.5MM 17MM 2 OPENING CROSSLINK STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8576510 SUP HCPCS C1713 8576510 - SCREW BONE 6.5MM 80MM ILC SPNL 6.35MM ROD BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8576570 SUP HCPCS C1713 8576570 - SCREW BONE 6.5MM 70MM ILC SPNL 6.35MM ROD BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$2,241.00" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8576580 SUP HCPCS C1713 8576580 - SCREW BONE 6.5MM 80MM ILC SPNL 6.35MM ROD BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$2,241.00" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8576590 SUP HCPCS C1713 8576590 - SCREW BONE 6.5MM 90MM ILC SPNL 6.35MM ROD BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8577510 SUP HCPCS C1713 8577510 - SCREW BONE 7.5MM 100MM ILC SPNL 6.3MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8577570 SUP HCPCS C1713 8577570 - SCREW BONE 7.5MM 70MM ILC SPNL 6.35MM ROD BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8577580 SUP HCPCS C1713 8577580 - SCREW BONE 7.5MM 80MM ILC SPNL 6.35MM ROD BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$3,361.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8577590 SUP HCPCS C1713 8577590 - SCREW BONE 7.5MM 90MM ILC SPNL 6.35MM ROD BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8578510 SUP HCPCS C1713 8578510 - SCREW BONE 8.5MM 100MM ILC SPNL 6.3MM BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$5,602.50" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8578570 SUP HCPCS C1713 8578570 - SCREW BONE 8.5MM 70MM ILC SPNL 6.35MM ROD BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$2,241.00" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8578580 SUP HCPCS C1713 8578580 - SCREW BONE 8.5MM 80MM ILC SPNL 6.35MM ROD BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$2,241.00" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8578590 SUP HCPCS C1713 8578590 - SCREW BONE 8.5MM 90MM ILC SPNL 6.35MM ROD BOTH IP/OP "$5,602.50" "$4,146.00" "$1,111.96" "$5,602.50" "$2,521.13" "$2,521.13" "$2,521.13" "$2,521.13" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.70" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.62" "$5,602.50" "$2,241.00" "$2,762.03" "$5,602.50" "$5,602.50" "$5,602.50" "$5,602.50" "$4,201.88" "$5,602.50" "$5,602.50" "$5,602.50" "$2,801.25" "$2,801.25" "$4,437.18" "$5,602.50" "$4,482.00" "$2,521.13" "$1,111.96" N/A "$3,249.45" "$5,602.50" "$5,602.50" "$5,602.50" "$1,167.56" "$5,602.50" N/A N/A 8579008 SUP HCPCS C1713 8579008 - PLATE BONE LP .625IN LEGACY CROSSLINK CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8579009 SUP HCPCS C1713 8579009 - PLATE BONE LP .75IN LEGACY CROSSLINK CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8579010 SUP HCPCS C1713 8579010 - PLATE BONE LP .875IN LEGACY CROSSLINK CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8579011 SUP HCPCS C1713 8579011 - PLATE BONE LP 1IN LEGACY CROSSLINK CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8579012 SUP HCPCS C1713 8579012 - PLATE BONE LP 1.125IN LEGACY CROSSLINK CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8579013 SUP HCPCS C1713 8579013 - PLATE BONE LP 1.25IN LEGACY CROSSLINK CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8579014 SUP HCPCS C1713 8579014 - PLATE BONE LP 1.375IN LEGACY CROSSLINK CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8579015 SUP HCPCS C1713 8579015 - PLATE BONE LP 1.5IN LEGACY CROSSLINK CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8579016 SUP HCPCS C1713 8579016 - PLATE BONE LP 1.55-1.75IN LEGACY CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8579017 SUP HCPCS C1713 8579017 - PLATE BONE LP 1.75-2.15IN LEGACY CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8579018 SUP HCPCS C1713 8579018 - PLATE BONE LP 2.15-2.95IN LEGACY CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 8579300 SUP Custom 27803010 8579300 - CONNECTOR ROD 4.5/4.5MM DOMINO SPN BOTH IP/OP "$1,797.00" "$1,330.00" $319.79 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" $319.79 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" $374.43 "$1,796.58" $718.63 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,347.75" "$1,796.58" "$1,796.58" "$1,796.58" $898.29 $898.29 "$1,422.89" "$1,796.58" "$1,437.26" $808.46 "$1,796.58" N/A "$1,042.26" "$1,796.58" "$1,077.95" "$1,796.58" "$1,796.58" "$1,796.58" N/A N/A 8579301 SUP Custom 27803010 8579301 - CONNECTOR ROD 4.5/4.5MM DOMINO SPN BOTH IP/OP "$1,797.00" "$1,330.00" $319.79 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" $319.79 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" $374.43 "$1,796.58" $718.63 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,347.75" "$1,796.58" "$1,796.58" "$1,796.58" $898.29 $898.29 "$1,422.89" "$1,796.58" "$1,437.26" $808.46 "$1,796.58" N/A "$1,042.26" "$1,796.58" "$1,077.95" "$1,796.58" "$1,796.58" "$1,796.58" N/A N/A 8580858 SUP HCPCS C1713 8580858 - SCREW SET CD HORIZON M8 STAINLESS STEEL SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8590855 SUP HCPCS C1713 8590855 - SCREW SET BREAKOFF CD HORIZON M8 TITANIUM SPN 5.5 MM ROD BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8590858 SUP HCPCS C1713 8590858 - SCREW SET BREAKOFF CD HORIZON M8 TITANIUM SPN PEDICLE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8594520 SUP HCPCS C1713 8594520 - SCREW BN 4.5MM 20MM NS BRIGADE CRNT SPNE XLRF SYS BOTH IP/OP "$1,957.50" "$1,449.00" $388.51 "$1,957.50" $880.88 $880.88 $880.88 $880.88 "$1,957.50" "$1,957.50" "$1,957.50" $407.99 "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" $407.96 "$1,957.50" $783.00 "$1,157.86" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,468.13" "$1,957.50" "$1,957.50" "$1,957.50" $978.75 $978.75 "$1,550.34" "$1,957.50" "$1,566.00" $880.88 $388.51 N/A "$1,135.35" "$1,957.50" "$1,174.50" "$1,957.50" $407.94 "$1,957.50" N/A N/A 8594522 SUP HCPCS C1713 8594522 - SCREW BN 4.5MM 22.5MM NS BRIGADE CRNT SPNE XLRF SYS BOTH IP/OP "$1,957.50" "$1,449.00" $388.51 "$1,957.50" $880.88 $880.88 $880.88 $880.88 "$1,957.50" "$1,957.50" "$1,957.50" $407.99 "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" $407.96 "$1,957.50" $783.00 "$1,157.86" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,468.13" "$1,957.50" "$1,957.50" "$1,957.50" $978.75 $978.75 "$1,550.34" "$1,957.50" "$1,566.00" $880.88 $388.51 N/A "$1,135.35" "$1,957.50" "$1,957.50" "$1,957.50" $407.94 "$1,957.50" N/A N/A 8594525 SUP HCPCS C1713 8594525 - SCREW BONE 4.5MM 25MM POLYAX BRIGADE SPN BOTH IP/OP "$1,957.50" "$1,449.00" $388.51 "$1,957.50" $880.88 $880.88 $880.88 $880.88 "$1,957.50" "$1,957.50" "$1,957.50" $407.99 "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" $407.96 "$1,957.50" $783.00 "$1,157.86" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,468.13" "$1,957.50" "$1,957.50" "$1,957.50" $978.75 $978.75 "$1,550.34" "$1,957.50" "$1,566.00" $880.88 $388.51 N/A "$1,135.35" "$1,957.50" "$1,174.50" "$1,957.50" $407.94 "$1,957.50" N/A N/A 8594527 SUP HCPCS C1713 8594527 - SCREW BN 4.5MM 27.5MM NS BRIGADE CRNT SPNE XLRF SYS BOTH IP/OP "$1,957.50" "$1,449.00" $388.51 "$1,957.50" $880.88 $880.88 $880.88 $880.88 "$1,957.50" "$1,957.50" "$1,957.50" $407.99 "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" $407.96 "$1,957.50" $783.00 "$1,157.86" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,468.13" "$1,957.50" "$1,957.50" "$1,957.50" $978.75 $978.75 "$1,550.34" "$1,957.50" "$1,566.00" $880.88 $388.51 N/A "$1,135.35" "$1,957.50" "$1,957.50" "$1,957.50" $407.94 "$1,957.50" N/A N/A 8594530 SUP HCPCS C1713 8594530 - SCREW BN 4.5MM 30MM NS BRIGADE CRNT SPNE XLRF SYS BOTH IP/OP "$1,957.50" "$1,449.00" $388.51 "$1,957.50" $880.88 $880.88 $880.88 $880.88 "$1,957.50" "$1,957.50" "$1,957.50" $407.99 "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" $407.96 "$1,957.50" $783.00 "$1,157.86" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,468.13" "$1,957.50" "$1,957.50" "$1,957.50" $978.75 $978.75 "$1,550.34" "$1,957.50" "$1,566.00" $880.88 $388.51 N/A "$1,135.35" "$1,957.50" "$1,957.50" "$1,957.50" $407.94 "$1,957.50" N/A N/A 8594535 SUP HCPCS C1713 8594535 - SCREW BN 4.5MM 35MM NS BRIGADE CRNT SPNE XLRF SYS BOTH IP/OP "$1,957.50" "$1,449.00" $388.51 "$1,957.50" $880.88 $880.88 $880.88 $880.88 "$1,957.50" "$1,957.50" "$1,957.50" $407.99 "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" $407.96 "$1,957.50" $783.00 "$1,157.86" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,468.13" "$1,957.50" "$1,957.50" "$1,957.50" $978.75 $978.75 "$1,550.34" "$1,957.50" "$1,566.00" $880.88 $388.51 N/A "$1,135.35" "$1,957.50" "$1,174.50" "$1,957.50" $407.94 "$1,957.50" N/A N/A 8595520 SUP HCPCS C1713 8595520 - SCREW BN 5.5MM 20MM NS BRIGADE CRNT SPNE XLRF SYS BOTH IP/OP "$1,957.50" "$1,449.00" $388.51 "$1,957.50" $880.88 $880.88 $880.88 $880.88 "$1,957.50" "$1,957.50" "$1,957.50" $407.99 "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" $407.96 "$1,957.50" $783.00 "$1,157.86" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,468.13" "$1,957.50" "$1,957.50" "$1,957.50" $978.75 $978.75 "$1,550.34" "$1,957.50" "$1,566.00" $880.88 $388.51 N/A "$1,135.35" "$1,957.50" "$1,957.50" "$1,957.50" $407.94 "$1,957.50" N/A N/A 8595522 SUP HCPCS C1713 8595522 - SCREW BN 5.5MM 22.5MM NS BRIGADE CRNT SPNE XLRF SYS BOTH IP/OP "$1,957.50" "$1,449.00" $388.51 "$1,957.50" $880.88 $880.88 $880.88 $880.88 "$1,957.50" "$1,957.50" "$1,957.50" $407.99 "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" $407.96 "$1,957.50" $783.00 "$1,157.86" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,468.13" "$1,957.50" "$1,957.50" "$1,957.50" $978.75 $978.75 "$1,550.34" "$1,957.50" "$1,566.00" $880.88 $388.51 N/A "$1,135.35" "$1,957.50" "$1,957.50" "$1,957.50" $407.94 "$1,957.50" N/A N/A 8595525 SUP HCPCS C1713 8595525 - SCREW BN 5.5MM 25MM NS BRIGADE CRNT SPNE XLRF SYS BOTH IP/OP "$1,957.50" "$1,449.00" $388.51 "$1,957.50" $880.88 $880.88 $880.88 $880.88 "$1,957.50" "$1,957.50" "$1,957.50" $407.99 "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" $407.96 "$1,957.50" $783.00 "$1,157.86" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,468.13" "$1,957.50" "$1,957.50" "$1,957.50" $978.75 $978.75 "$1,550.34" "$1,957.50" "$1,566.00" $880.88 $388.51 N/A "$1,135.35" "$1,957.50" "$1,957.50" "$1,957.50" $407.94 "$1,957.50" N/A N/A 8595527 SUP HCPCS C1713 8595527 - SCREW BN 5.5MM 27.5MM NS BRIGADE CRNT SPNE XLRF SYS BOTH IP/OP "$1,957.50" "$1,449.00" $388.51 "$1,957.50" $880.88 $880.88 $880.88 $880.88 "$1,957.50" "$1,957.50" "$1,957.50" $407.99 "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" $407.96 "$1,957.50" "$1,957.50" "$1,157.86" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,468.13" "$1,957.50" "$1,957.50" "$1,957.50" $978.75 $978.75 "$1,550.34" "$1,957.50" "$1,566.00" $880.88 $388.51 N/A "$1,135.35" "$1,957.50" "$1,957.50" "$1,957.50" $407.94 "$1,957.50" N/A N/A 8595530 SUP HCPCS C1713 8595530 - SCREW BN 5.5MM 30MM NS BRIGADE CRNT SPNE XLRF SYS BOTH IP/OP "$1,957.50" "$1,449.00" $388.51 "$1,957.50" $880.88 $880.88 $880.88 $880.88 "$1,957.50" "$1,957.50" "$1,957.50" $407.99 "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" $407.96 "$1,957.50" $783.00 "$1,157.86" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,468.13" "$1,957.50" "$1,957.50" "$1,957.50" $978.75 $978.75 "$1,550.34" "$1,957.50" "$1,566.00" $880.88 $388.51 N/A "$1,135.35" "$1,957.50" "$1,957.50" "$1,957.50" $407.94 "$1,957.50" N/A N/A 8595535 SUP HCPCS C1713 8595535 - SCREW BN 5.5MM 35MM NS BRIGADE CRNT SPNE XLRF SYS BOTH IP/OP "$1,957.50" "$1,449.00" $388.51 "$1,957.50" $880.88 $880.88 $880.88 $880.88 "$1,957.50" "$1,957.50" "$1,957.50" $407.99 "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" $407.96 "$1,957.50" $783.00 "$1,157.86" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,468.13" "$1,957.50" "$1,957.50" "$1,957.50" $978.75 $978.75 "$1,550.34" "$1,957.50" "$1,566.00" $880.88 $388.51 N/A "$1,135.35" "$1,957.50" "$1,957.50" "$1,957.50" $407.94 "$1,957.50" N/A N/A 8610425 SUP HCPCS C1713 8610425 - SCREW BONE 4.5MM 25MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$2,517.00" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610430 SUP HCPCS C1713 8610430 - SCREW BONE 4.5MM 30MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610435 SUP HCPCS C1713 8610435 - SCREW BONE 4.5MM 35MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610440 SUP HCPCS C1713 8610440 - SCREW BONE 4.5MM 40MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$1,006.80" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610445 SUP HCPCS C1713 8610445 - SCREW BONE 4.5MM 45MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$1,006.80" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610525 SUP HCPCS C1713 8610525 - SCREW BONE 5.5MM 25MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610530 SUP HCPCS C1713 8610530 - SCREW BONE 5.5MM 30MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610535 SUP HCPCS C1713 8610535 - SCREW BONE 5.5MM 35MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610540 SUP HCPCS C1713 8610540 - SCREW BONE 5.5MM 40MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$1,006.80" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610545 SUP HCPCS C1713 8610545 - SCREW BONE 5.5MM 45MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$1,006.80" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610550 SUP HCPCS C1713 8610550 - SCREW BONE 5.5MM 50MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610555 SUP HCPCS C1713 8610555 - SCREW BONE 5.5MM 55MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610630 SUP HCPCS C1713 8610630 - SCREW BONE 6.5MM 30MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610635 SUP HCPCS C1713 8610635 - SCREW BONE 6.5MM 35MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610640 SUP HCPCS C1713 8610640 - SCREW BONE 6.5MM 40MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610645 SUP HCPCS C1713 8610645 - SCREW BONE 6.5MM 45MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610650 SUP HCPCS C1713 8610650 - SCREW BONE 6.5MM 50MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610655 SUP HCPCS C1713 8610655 - SCREW BONE 6.5MM 55MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" N/A N/A 8610735 SUP HCPCS C1713 8610735 - SCREW BONE 7.5MM 35MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610740 SUP HCPCS C1713 8610740 - SCREW BONE 7.5MM 40MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" "$2,517.00" "$2,517.00" N/A N/A 8610745 SUP HCPCS C1713 8610745 - SCREW BONE 7.5MM 45MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$2,517.00" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$2,517.00" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8610750 SUP HCPCS C1713 8610750 - SCREW BONE 7.5MM 50MM TITANIUM SPN BOTH IP/OP "$2,517.00" "$1,863.00" $499.56 "$2,517.00" "$1,132.65" "$1,132.65" "$1,132.65" "$1,132.65" "$2,517.00" "$2,517.00" "$2,517.00" $524.61 "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" $524.57 "$2,517.00" "$1,006.80" "$1,240.88" "$2,517.00" "$2,517.00" "$2,517.00" "$2,517.00" "$1,887.75" "$2,517.00" "$2,517.00" "$2,517.00" "$1,258.50" "$1,258.50" "$1,993.46" "$2,517.00" "$2,013.60" "$1,132.65" $499.56 N/A "$1,459.86" "$2,517.00" "$1,510.20" "$2,517.00" $524.54 "$2,517.00" N/A N/A 8611102 SUP HCPCS C1713 8611102 - HOOK SPINAL SMALL TITANIUM PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 8611104 SUP HCPCS C1713 8611104 - HOOK SPINAL LARGE TITANIUM PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 8611202 SUP HCPCS C1713 8611202 - HOOK SPINAL SMALL GROOVE TITANIUM LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 8611203 SUP HCPCS C1713 8611203 - HOOK SPINAL MEDIUM TITANIUM LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 8611204 SUP HCPCS C1713 8611204 - HOOK SPINAL LARGE TITANIUM LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 8611300 SUP HCPCS C1713 8611300 - STAPLE BONE TITANIUM SPN PEDICLE HOOKS BOTH IP/OP $873.00 $646.00 $173.27 $873.00 $392.85 $392.85 $392.85 $392.85 $873.00 $873.00 $873.00 $181.96 $873.00 $873.00 $873.00 $873.00 $873.00 $181.94 $873.00 $349.20 $516.38 $873.00 $873.00 $873.00 $873.00 $654.75 $873.00 $873.00 $873.00 $436.50 $436.50 $691.42 $873.00 $698.40 $392.85 $173.27 N/A $506.34 $873.00 $523.80 $873.00 $181.93 $873.00 N/A N/A 8611402 SUP HCPCS C1713 8611402 - HOOK SPINAL CLOSE TITANIUM LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 8612055 SUP HCPCS C1713 8612055 - SCREW BONE 7MM 55MM TITANIUM SPN ILIOSACRAL BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" "$1,594.50" $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" N/A N/A 8612060 SUP HCPCS C1713 8612060 - SCREW BONE 7MM 60MM TITANIUM SPN ILIOSACRAL BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" "$1,594.50" $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" $956.70 "$1,594.50" "$1,594.50" "$1,594.50" N/A N/A 8612065 SUP HCPCS C1713 8612065 - SCREW BONE 7MM 65MM TITANIUM SPN ILIOSACRAL BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" "$1,594.50" $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" $956.70 "$1,594.50" $332.29 "$1,594.50" N/A N/A 8612070 SUP HCPCS C1713 8612070 - SCREW BONE 7MM 70MM TITANIUM SPN ILIOSACRAL BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" "$1,594.50" $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" $956.70 "$1,594.50" "$1,594.50" "$1,594.50" N/A N/A 8612075 SUP HCPCS C1713 8612075 - SCREW BONE 7MM 75MM TITANIUM SPN ILIOSACRAL BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" "$1,594.50" $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" $956.70 "$1,594.50" "$1,594.50" "$1,594.50" N/A N/A 8612080 SUP HCPCS C1713 8612080 - SCREW BONE 7MM 80MM TITANIUM SPN ILIOSACRAL BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" "$1,594.50" $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" $956.70 "$1,594.50" $332.29 "$1,594.50" N/A N/A 8612230 SUP HCPCS C1713 8612230 - SCREW BONE 6.5MM 30MM TITANIUM SPN SACRUM BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" $637.80 $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" "$1,594.50" "$1,594.50" $332.29 "$1,594.50" N/A N/A 8612235 SUP HCPCS C1713 8612235 - SCREW BONE 6.5MM 35MM TITANIUM SPN SACRUM BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" "$1,594.50" $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" $956.70 "$1,594.50" "$1,594.50" "$1,594.50" N/A N/A 8612240 SUP HCPCS C1713 8612240 - SCREW BONE 6.5MM 40MM TITANIUM SPN SACRUM BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" "$1,594.50" $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" $956.70 "$1,594.50" $332.29 "$1,594.50" N/A N/A 8612245 SUP HCPCS C1713 8612245 - SCREW BONE 6.5MM 45MM TITANIUM SPN SACRUM BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" $637.80 $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" $956.70 "$1,594.50" "$1,594.50" "$1,594.50" N/A N/A 8612250 SUP HCPCS C1713 8612250 - SCREW BONE 6.5MM 50MM TITANIUM SPN SACRUM BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" "$1,594.50" $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" N/A N/A 8612255 SUP HCPCS C1713 8612255 - SCREW BONE 6.5MM 55MM TITANIUM SPN SACRUM BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" "$1,594.50" $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" $956.70 "$1,594.50" $332.29 "$1,594.50" N/A N/A 8612260 SUP HCPCS C1713 8612260 - SCREW BONE 6.5MM 60MM TITANIUM SPN SACRUM BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" "$1,594.50" $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" $956.70 "$1,594.50" $332.29 "$1,594.50" N/A N/A 8612265 SUP HCPCS C1713 8612265 - SCREW BONE 6.5MM 65MM TITANIUM SPN SACRUM BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" "$1,594.50" $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" $956.70 "$1,594.50" $332.29 "$1,594.50" N/A N/A 8612270 SUP HCPCS C1713 8612270 - SCREW BONE 6.5MM 70MM TITANIUM SPN SACRUM BOTH IP/OP "$1,594.50" "$1,180.00" $316.47 "$1,594.50" $717.53 $717.53 $717.53 $717.53 "$1,594.50" "$1,594.50" "$1,594.50" $332.33 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" $332.31 "$1,594.50" "$1,594.50" $943.15 "$1,594.50" "$1,594.50" "$1,594.50" "$1,594.50" "$1,195.88" "$1,594.50" "$1,594.50" "$1,594.50" $797.25 $797.25 "$1,262.84" "$1,594.50" "$1,275.60" $717.53 $316.47 N/A $924.81 "$1,594.50" $956.70 "$1,594.50" $332.29 "$1,594.50" N/A N/A 8613505 SUP HCPCS C1713 8613505 - ROD SPINAL 5MM 50MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8613506 SUP HCPCS C1713 8613506 - ROD SPINAL 5MM 60MM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8613507 SUP HCPCS C1713 8613507 - ROD SPINAL 5MM 70MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 8613508 SUP HCPCS C1713 8613508 - ROD SPINAL 5MM 80MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8613509 SUP HCPCS C1713 8613509 - ROD SPINAL 5MM 90MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8613510 SUP HCPCS C1713 8613510 - ROD SPINAL 5MM 100MM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 8613511 SUP HCPCS C1713 8613511 - ROD SPINAL 5MM 110MM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8613512 SUP HCPCS C1713 8613512 - ROD SPINAL 5MM 120MM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A 8613514 SUP HCPCS C1713 8613514 - ROD SPINAL 5MM 140MM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A 8613516 SUP HCPCS C1713 8613516 - ROD SPINAL 5MM 160MM CYLND BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8613518 SUP HCPCS C1713 8613518 - ROD SPINAL 5MM 180MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8613520 SUP HCPCS C1713 8613520 - ROD SPINAL 5MM 200MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8613522 SUP HCPCS C1713 8613522 - ROD SPINAL 5MM 220MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8613524 SUP HCPCS C1713 8613524 - ROD SPINAL 5MM 240MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8613526 SUP HCPCS C1713 8613526 - ROD SPINAL 5MM 260MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8613528 SUP HCPCS C1713 8613528 - ROD SPINAL 5MM 280MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8613530 SUP HCPCS C1713 8613530 - ROD SPINAL 5MM 300MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8613532 SUP HCPCS C1713 8613532 - ROD SPINAL 5MM 320MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A 8613534 SUP HCPCS C1713 8613534 - ROD SPINAL 5MM 340MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8613536 SUP HCPCS C1713 8613536 - ROD SPINAL 5MM 360MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8613538 SUP HCPCS C1713 8613538 - ROD SPINAL 5MM 380MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 8613544 SUP HCPCS C1713 8613544 - ROD SPINAL 5MM 440MM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8613560 SUP HCPCS C1713 8613560 - ROD SPINAL 5MM 600MM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 8614100 SUP Custom 27803010 8614100 - CLAMP SPINAL COLORADO 2 STAINLESS STEEL BOTH IP/OP "$1,255.50" $929.00 $223.48 "$1,255.50" "$1,255.50" "$1,255.50" "$1,255.50" "$1,255.50" "$1,255.50" "$1,255.50" $223.48 "$1,255.50" "$1,255.50" "$1,255.50" "$1,255.50" "$1,255.50" "$1,255.50" $261.66 "$1,255.50" $502.20 "$1,255.50" "$1,255.50" "$1,255.50" "$1,255.50" "$1,255.50" $941.63 "$1,255.50" "$1,255.50" "$1,255.50" $627.75 $627.75 $994.36 "$1,255.50" "$1,004.40" $564.98 "$1,255.50" N/A $728.19 "$1,255.50" $753.30 "$1,255.50" "$1,255.50" "$1,255.50" N/A N/A 8614110 SUP Custom 27803010 8614110 - CONNECTOR ROD PLATE ILIOSACRAL SPN BOTH IP/OP "$1,710.00" "$1,265.00" $304.38 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" $304.38 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" $356.38 "$1,710.00" $684.00 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,282.50" "$1,710.00" "$1,710.00" "$1,710.00" $855.00 $855.00 "$1,354.32" "$1,710.00" "$1,368.00" $769.50 "$1,710.00" N/A $991.80 "$1,710.00" "$1,026.00" "$1,710.00" "$1,710.00" "$1,710.00" N/A N/A 8614111 SUP HCPCS C1713 8614111 - NUT LOCK BREAKOFF SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8614120 SUP HCPCS C1713 8614120 - SCREW SET BREAKOFF CROSSLINK TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 8614200 SUP Custom 27803010 8614200 - CONNECTOR ROD OFFST SPN BOTH IP/OP "$1,870.50" "$1,384.00" $332.95 "$1,870.50" "$1,870.50" "$1,870.50" "$1,870.50" "$1,870.50" "$1,870.50" "$1,870.50" $332.95 "$1,870.50" "$1,870.50" "$1,870.50" "$1,870.50" "$1,870.50" "$1,870.50" $389.83 "$1,870.50" $748.20 "$1,870.50" "$1,870.50" "$1,870.50" "$1,870.50" "$1,870.50" "$1,402.88" "$1,870.50" "$1,870.50" "$1,870.50" $935.25 $935.25 "$1,481.44" "$1,870.50" "$1,496.40" $841.73 "$1,870.50" N/A "$1,084.89" "$1,870.50" "$1,122.30" "$1,870.50" "$1,870.50" "$1,870.50" N/A N/A 8615400 SUP Custom 27803010 8615400 - CONNECTOR ROD 5/5MM AXIAL SPN BOTH IP/OP "$2,631.50" "$1,947.00" $468.41 "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" $468.41 "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" $548.43 "$2,631.50" "$1,052.60" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$1,973.63" "$2,631.50" "$2,631.50" "$2,631.50" "$1,315.75" "$1,315.75" "$2,084.15" "$2,631.50" "$2,105.20" "$1,184.18" "$2,631.50" N/A "$1,526.27" "$2,631.50" "$1,578.90" "$2,631.50" "$2,631.50" "$2,631.50" N/A N/A 8615405 SUP HCPCS C1713 8615405 - SCREW SET 5.5MM 5MM BREAKOFF AXIAL CLOSE HOOK SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8615410 SUP Custom 27803010 8615410 - CONNECTOR ROD 5/5MM OFFST AXIAL SPN LATERAL BOTH IP/OP "$2,631.50" "$1,947.00" $468.41 "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" $468.41 "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" $548.43 "$2,631.50" "$1,052.60" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$1,973.63" "$2,631.50" "$2,631.50" "$2,631.50" "$1,315.75" "$1,315.75" "$2,084.15" "$2,631.50" "$2,105.20" "$1,184.18" "$2,631.50" N/A "$1,526.27" "$2,631.50" "$1,578.90" "$2,631.50" "$2,631.50" "$2,631.50" N/A N/A 8615420 SUP Custom 27803010 8615420 - CONNECTOR ROD 5/5.5MM AXIAL SPN BOTH IP/OP "$2,833.50" "$2,097.00" $504.36 "$2,833.50" "$2,833.50" "$2,833.50" "$2,833.50" "$2,833.50" "$2,833.50" "$2,833.50" $504.36 "$2,833.50" "$2,833.50" "$2,833.50" "$2,833.50" "$2,833.50" "$2,833.50" $590.53 "$2,833.50" "$1,133.40" "$2,833.50" "$2,833.50" "$2,833.50" "$2,833.50" "$2,833.50" "$2,125.13" "$2,833.50" "$2,833.50" "$2,833.50" "$1,416.75" "$1,416.75" "$2,244.13" "$2,833.50" "$2,266.80" "$1,275.08" "$2,833.50" N/A "$1,643.43" "$2,833.50" "$1,700.10" "$2,833.50" "$2,833.50" "$2,833.50" N/A N/A 8615440 SUP Custom 27803010 8615440 - CONNECTOR ROD 5/7MM AXIAL BOTH IP/OP "$2,631.50" "$1,947.00" $468.41 "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" $468.41 "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" $548.43 "$2,631.50" "$1,052.60" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$2,631.50" "$1,973.63" "$2,631.50" "$2,631.50" "$2,631.50" "$1,315.75" "$1,315.75" "$2,084.15" "$2,631.50" "$2,105.20" "$1,184.18" "$2,631.50" N/A "$1,526.27" "$2,631.50" "$1,578.90" "$2,631.50" "$2,631.50" "$2,631.50" N/A N/A 8619110 SUP HCPCS C1713 8619110 - PLATE BONE TITANIUM SPN RIGHT SACRUM BOTH IP/OP "$3,873.00" "$2,866.00" $768.69 "$3,873.00" "$1,742.85" "$1,742.85" "$1,742.85" "$1,742.85" "$3,873.00" "$3,873.00" "$3,873.00" $807.23 "$3,873.00" "$3,873.00" "$3,873.00" "$3,873.00" "$3,873.00" $807.18 "$3,873.00" "$3,873.00" "$1,909.39" "$3,873.00" "$3,873.00" "$3,873.00" "$3,873.00" "$2,904.75" "$3,873.00" "$3,873.00" "$3,873.00" "$1,936.50" "$1,936.50" "$3,067.42" "$3,873.00" "$3,098.40" "$1,742.85" $768.69 N/A "$2,246.34" "$3,873.00" "$3,873.00" "$3,873.00" $807.13 "$3,873.00" N/A N/A 8619120 SUP HCPCS C1713 8619120 - PLATE BONE TITANIUM SPN LEFT SACRUM BOTH IP/OP "$3,873.00" "$2,866.00" $768.69 "$3,873.00" "$1,742.85" "$1,742.85" "$1,742.85" "$1,742.85" "$3,873.00" "$3,873.00" "$3,873.00" $807.23 "$3,873.00" "$3,873.00" "$3,873.00" "$3,873.00" "$3,873.00" $807.18 "$3,873.00" "$3,873.00" "$1,909.39" "$3,873.00" "$3,873.00" "$3,873.00" "$3,873.00" "$2,904.75" "$3,873.00" "$3,873.00" "$3,873.00" "$1,936.50" "$1,936.50" "$3,067.42" "$3,873.00" "$3,098.40" "$1,742.85" $768.69 N/A "$2,246.34" "$3,873.00" "$2,323.80" "$3,873.00" $807.13 "$3,873.00" N/A N/A 8619210 SUP HCPCS C1713 8619210 - PLATE BONE TITANIUM SPN RIGHT ILIOSACRUM BOTH IP/OP "$4,800.00" "$3,552.00" $952.68 "$4,800.00" "$2,160.00" "$2,160.00" "$2,160.00" "$2,160.00" "$4,800.00" "$4,800.00" "$4,800.00" "$1,000.44" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$1,000.37" "$4,800.00" "$1,920.00" "$2,366.40" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$3,600.00" "$4,800.00" "$4,800.00" "$4,800.00" "$2,400.00" "$2,400.00" "$3,801.60" "$4,800.00" "$3,840.00" "$2,160.00" $952.68 N/A "$2,784.00" "$4,800.00" "$2,880.00" "$4,800.00" "$1,000.32" "$4,800.00" N/A N/A 8619220 SUP HCPCS C1713 8619220 - PLATE BONE TITANIUM SPN LEFT ILIOSACRUM BOTH IP/OP "$4,800.00" "$3,552.00" $952.68 "$4,800.00" "$2,160.00" "$2,160.00" "$2,160.00" "$2,160.00" "$4,800.00" "$4,800.00" "$4,800.00" "$1,000.44" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$1,000.37" "$4,800.00" "$1,920.00" "$2,366.40" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$3,600.00" "$4,800.00" "$4,800.00" "$4,800.00" "$2,400.00" "$2,400.00" "$3,801.60" "$4,800.00" "$3,840.00" "$2,160.00" $952.68 N/A "$2,784.00" "$4,800.00" "$2,880.00" "$4,800.00" "$1,000.32" "$4,800.00" N/A N/A 8619300 SUP HCPCS C1713 8619300 - SCREW SET COLORADO 2 STAINLESS STEEL SPN SACRAL SACROILIAC BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 8619400 SUP HCPCS C1713 8619400 - STAPLE BONE STAINLESS STEEL ANTERIOR SPN BOTH IP/OP $873.00 $646.00 $173.27 $873.00 $392.85 $392.85 $392.85 $392.85 $873.00 $873.00 $873.00 $181.96 $873.00 $873.00 $873.00 $873.00 $873.00 $181.94 $873.00 $349.20 $516.38 $873.00 $873.00 $873.00 $873.00 $654.75 $873.00 $873.00 $873.00 $436.50 $436.50 $691.42 $873.00 $698.40 $392.85 $173.27 N/A $506.34 $873.00 $523.80 $873.00 $873.00 $873.00 N/A N/A 8619654 SUP HCPCS C1713 8619654 - PLATE BONE 54MM SPN INTERPEDICULAR BOTH IP/OP "$2,187.00" "$1,618.00" $434.06 "$2,187.00" $984.15 $984.15 $984.15 $984.15 "$2,187.00" "$2,187.00" "$2,187.00" $455.83 "$2,187.00" "$2,187.00" "$2,187.00" "$2,187.00" "$2,187.00" $455.79 "$2,187.00" "$2,187.00" "$1,293.61" "$2,187.00" "$2,187.00" "$2,187.00" "$2,187.00" "$1,640.25" "$2,187.00" "$2,187.00" "$2,187.00" "$1,093.50" "$1,093.50" "$1,732.10" "$2,187.00" "$1,749.60" $984.15 $434.06 N/A "$1,268.46" "$2,187.00" "$1,312.20" "$2,187.00" $455.77 "$2,187.00" N/A N/A 8624110 SUP Custom 27803010 8624110 - PLATE BONE TITANIUM SPN ILIOSACRUM 5.5 MM ROD BOTH IP/OP "$1,710.00" "$1,265.00" $304.38 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" $304.38 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" $356.38 "$1,710.00" $684.00 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,282.50" "$1,710.00" "$1,710.00" "$1,710.00" $855.00 $855.00 "$1,354.32" "$1,710.00" "$1,368.00" $769.50 "$1,710.00" N/A $991.80 "$1,710.00" "$1,026.00" "$1,710.00" "$1,710.00" "$1,710.00" N/A N/A 8630540 SUP HCPCS C1713 8630540 - SCREW BONE 5.5MM 40MM COLORADO 2 TITANIUM SPN BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" "$2,818.50" "$2,818.50" N/A N/A 8630550 SUP HCPCS C1713 8630550 - SCREW BONE 5.5MM 50MM COLORADO 2 TITANIUM SPN BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8630645 SUP HCPCS C1713 8630645 - SCREW BONE 6.5MM 45MM COLORADO 2 TITANIUM SPN BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$1,127.40" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8630650 SUP HCPCS C1713 8630650 - SCREW BONE 6.5MM 50MM COLORADO 2 TITANIUM SPN BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$1,127.40" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8631203 SUP HCPCS C1713 8631203 - HOOK SPINAL MEDIUM TITANIUM LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 8631300 SUP HCPCS C1713 8631300 - STAPLE BONE TITANIUM SPN BOTH IP/OP $988.50 $731.00 $196.19 $988.50 $444.83 $444.83 $444.83 $444.83 $988.50 $988.50 $988.50 $206.03 $988.50 $988.50 $988.50 $988.50 $988.50 $206.01 $988.50 $988.50 $584.70 $988.50 $988.50 $988.50 $988.50 $741.38 $988.50 $988.50 $988.50 $494.25 $494.25 $782.89 $988.50 $790.80 $444.83 $196.19 N/A $573.33 $988.50 $593.10 $988.50 $988.50 $988.50 N/A N/A 8631402 SUP HCPCS C1713 8631402 - HOOK SPINAL CLOSE TITANIUM THORACOLUMBAR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 8632050 SUP HCPCS C1713 8632050 - SCREW BONE 7MM 50MM COLORADO 2 TITANIUM SPN ILIOSACRAL BOTH IP/OP "$1,812.00" "$1,341.00" $359.56 "$1,811.63" $815.23 $815.23 $815.23 $815.23 "$1,811.63" "$1,811.63" "$1,811.63" $377.59 "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" $377.56 "$1,811.63" "$1,811.63" "$1,071.58" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,359.00" "$1,811.63" "$1,811.63" "$1,811.63" $905.82 $905.82 "$1,434.81" "$1,811.63" "$1,449.30" $815.23 $359.56 N/A "$1,050.96" "$1,811.63" "$1,086.98" "$1,811.63" $377.54 "$1,811.63" N/A N/A 8632055 SUP HCPCS C1713 8632055 - SCREW BONE 7MM 55MM COLORADO 2 TITANIUM SPN ILIOSACRAL BOTH IP/OP "$1,821.50" "$1,348.00" $361.47 "$1,821.23" $819.55 $819.55 $819.55 $819.55 "$1,821.23" "$1,821.23" "$1,821.23" $379.59 "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" $379.56 "$1,821.23" "$1,821.23" "$1,077.26" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,366.13" "$1,821.23" "$1,821.23" "$1,821.23" $910.62 $910.62 "$1,442.41" "$1,821.23" "$1,456.98" $819.55 $361.47 N/A "$1,056.47" "$1,821.23" "$1,092.74" "$1,821.23" $379.54 "$1,821.23" N/A N/A 8632060 SUP HCPCS C1713 8632060 - SCREW BONE 7MM 60MM COLORADO 2 TITANIUM ILIOSACRAL BOTH IP/OP "$1,821.50" "$1,348.00" $361.47 "$1,821.23" $819.55 $819.55 $819.55 $819.55 "$1,821.23" "$1,821.23" "$1,821.23" $379.59 "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" $379.56 "$1,821.23" "$1,821.23" "$1,077.26" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,366.13" "$1,821.23" "$1,821.23" "$1,821.23" $910.62 $910.62 "$1,442.41" "$1,821.23" "$1,456.98" $819.55 $361.47 N/A "$1,056.47" "$1,821.23" "$1,092.74" "$1,821.23" $379.54 "$1,821.23" N/A N/A 8632065 SUP HCPCS C1713 8632065 - SCREW BONE 7MM 65MM COLORADO 2 TITANIUM ILIOSACRAL BOTH IP/OP "$1,821.50" "$1,348.00" $361.47 "$1,821.23" $819.55 $819.55 $819.55 $819.55 "$1,821.23" "$1,821.23" "$1,821.23" $379.59 "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" $379.56 "$1,821.23" $728.49 "$1,077.26" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,366.13" "$1,821.23" "$1,821.23" "$1,821.23" $910.62 $910.62 "$1,442.41" "$1,821.23" "$1,456.98" $819.55 $361.47 N/A "$1,056.47" "$1,821.23" "$1,092.74" "$1,821.23" $379.54 "$1,821.23" N/A N/A 8632070 SUP HCPCS C1713 8632070 - SCREW BONE 7MM 70MM COLORADO 2 TITANIUM ILIOSACRAL BOTH IP/OP "$1,821.50" "$1,348.00" $361.47 "$1,821.23" $819.55 $819.55 $819.55 $819.55 "$1,821.23" "$1,821.23" "$1,821.23" $379.59 "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" $379.56 "$1,821.23" $728.49 "$1,077.26" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,366.13" "$1,821.23" "$1,821.23" "$1,821.23" $910.62 $910.62 "$1,442.41" "$1,821.23" "$1,456.98" $819.55 $361.47 N/A "$1,056.47" "$1,821.23" "$1,092.74" "$1,821.23" $379.54 "$1,821.23" N/A N/A 8632075 SUP HCPCS C1713 8632075 - SCREW BONE 7MM 75MM COLORADO 2 TITANIUM SPN ILIOSACRAL BOTH IP/OP "$1,812.00" "$1,341.00" $359.56 "$1,811.63" $815.23 $815.23 $815.23 $815.23 "$1,811.63" "$1,811.63" "$1,811.63" $377.59 "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" $377.56 "$1,811.63" "$1,811.63" "$1,071.58" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,359.00" "$1,811.63" "$1,811.63" "$1,811.63" $905.82 $905.82 "$1,434.81" "$1,811.63" "$1,449.30" $815.23 $359.56 N/A "$1,050.96" "$1,811.63" "$1,086.98" "$1,811.63" $377.54 "$1,811.63" N/A N/A 8632080 SUP HCPCS C1713 8632080 - SCREW BONE 7MM 80MM COLORADO 2 TITANIUM SPN ILIOSACRAL BOTH IP/OP "$1,812.00" "$1,341.00" $359.56 "$1,811.63" $815.23 $815.23 $815.23 $815.23 "$1,811.63" "$1,811.63" "$1,811.63" $377.59 "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" $377.56 "$1,811.63" "$1,811.63" "$1,071.58" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,359.00" "$1,811.63" "$1,811.63" "$1,811.63" $905.82 $905.82 "$1,434.81" "$1,811.63" "$1,449.30" $815.23 $359.56 N/A "$1,050.96" "$1,811.63" "$1,086.98" "$1,811.63" $377.54 "$1,811.63" N/A N/A 8632230 SUP HCPCS C1713 8632230 - SCREW BONE 6.5MM 30MM COLORADO 2 TITANIUM SACRUM BOTH IP/OP "$1,821.50" "$1,348.00" $361.47 "$1,821.23" $819.55 $819.55 $819.55 $819.55 "$1,821.23" "$1,821.23" "$1,821.23" $379.59 "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" $379.56 "$1,821.23" "$1,821.23" "$1,077.26" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,366.13" "$1,821.23" "$1,821.23" "$1,821.23" $910.62 $910.62 "$1,442.41" "$1,821.23" "$1,456.98" $819.55 $361.47 N/A "$1,056.47" "$1,821.23" "$1,092.74" "$1,821.23" "$1,821.23" "$1,821.23" N/A N/A 8632235 SUP HCPCS C1713 8632235 - SCREW BONE 6.5MM 35MM COLORADO 2 TITANIUM SACRUM BOTH IP/OP "$1,821.50" "$1,348.00" $361.47 "$1,821.23" $819.55 $819.55 $819.55 $819.55 "$1,821.23" "$1,821.23" "$1,821.23" $379.59 "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" $379.56 "$1,821.23" "$1,821.23" "$1,077.26" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,366.13" "$1,821.23" "$1,821.23" "$1,821.23" $910.62 $910.62 "$1,442.41" "$1,821.23" "$1,456.98" $819.55 $361.47 N/A "$1,056.47" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" N/A N/A 8632240 SUP HCPCS C1713 8632240 - SCREW BONE 6.5MM 40MM COLORADO 2 TITANIUM SACRUM BOTH IP/OP "$1,821.50" "$1,348.00" $361.47 "$1,821.23" $819.55 $819.55 $819.55 $819.55 "$1,821.23" "$1,821.23" "$1,821.23" $379.59 "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" $379.56 "$1,821.23" "$1,821.23" "$1,077.26" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,366.13" "$1,821.23" "$1,821.23" "$1,821.23" $910.62 $910.62 "$1,442.41" "$1,821.23" "$1,456.98" $819.55 $361.47 N/A "$1,056.47" "$1,821.23" "$1,092.74" "$1,821.23" $379.54 "$1,821.23" N/A N/A 8632245 SUP HCPCS C1713 8632245 - SCREW BONE 6.5MM 45MM COLORADO 2 TITANIUM SACRUM BOTH IP/OP "$1,821.50" "$1,348.00" $361.47 "$1,821.23" $819.55 $819.55 $819.55 $819.55 "$1,821.23" "$1,821.23" "$1,821.23" $379.59 "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" $379.56 "$1,821.23" "$1,821.23" "$1,077.26" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,366.13" "$1,821.23" "$1,821.23" "$1,821.23" $910.62 $910.62 "$1,442.41" "$1,821.23" "$1,456.98" $819.55 $361.47 N/A "$1,056.47" "$1,821.23" "$1,092.74" "$1,821.23" $379.54 "$1,821.23" N/A N/A 8632250 SUP HCPCS C1713 8632250 - SCREW BONE 6.5MM 50MM COLORADO 2 TITANIUM SACRUM BOTH IP/OP "$1,821.50" "$1,348.00" $361.47 "$1,821.23" $819.55 $819.55 $819.55 $819.55 "$1,821.23" "$1,821.23" "$1,821.23" $379.59 "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" $379.56 "$1,821.23" "$1,821.23" "$1,077.26" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,366.13" "$1,821.23" "$1,821.23" "$1,821.23" $910.62 $910.62 "$1,442.41" "$1,821.23" "$1,456.98" $819.55 $361.47 N/A "$1,056.47" "$1,821.23" "$1,092.74" "$1,821.23" $379.54 "$1,821.23" N/A N/A 8632255 SUP HCPCS C1713 8632255 - SCREW BONE 6.5MM 55MM COLORADO 2 TITANIUM SACRUM BOTH IP/OP "$1,821.50" "$1,348.00" $361.47 "$1,821.23" $819.55 $819.55 $819.55 $819.55 "$1,821.23" "$1,821.23" "$1,821.23" $379.59 "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" $379.56 "$1,821.23" "$1,821.23" "$1,077.26" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,366.13" "$1,821.23" "$1,821.23" "$1,821.23" $910.62 $910.62 "$1,442.41" "$1,821.23" "$1,456.98" $819.55 $361.47 N/A "$1,056.47" "$1,821.23" "$1,092.74" "$1,821.23" $379.54 "$1,821.23" N/A N/A 8632260 SUP HCPCS C1713 8632260 - SCREW BONE 6.5MM 60MM COLORADO 2 TITANIUM SACRUM BOTH IP/OP "$1,821.50" "$1,348.00" $361.47 "$1,821.23" $819.55 $819.55 $819.55 $819.55 "$1,821.23" "$1,821.23" "$1,821.23" $379.59 "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" $379.56 "$1,821.23" "$1,821.23" "$1,077.26" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,366.13" "$1,821.23" "$1,821.23" "$1,821.23" $910.62 $910.62 "$1,442.41" "$1,821.23" "$1,456.98" $819.55 $361.47 N/A "$1,056.47" "$1,821.23" "$1,092.74" "$1,821.23" $379.54 "$1,821.23" N/A N/A 8632265 SUP HCPCS C1713 8632265 - SCREW BONE 6.5MM 65MM COLORADO 2 TITANIUM SACRUM BOTH IP/OP "$1,821.50" "$1,348.00" $361.47 "$1,821.23" $819.55 $819.55 $819.55 $819.55 "$1,821.23" "$1,821.23" "$1,821.23" $379.59 "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" $379.56 "$1,821.23" "$1,821.23" "$1,077.26" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,366.13" "$1,821.23" "$1,821.23" "$1,821.23" $910.62 $910.62 "$1,442.41" "$1,821.23" "$1,456.98" $819.55 $361.47 N/A "$1,056.47" "$1,821.23" "$1,092.74" "$1,821.23" $379.54 "$1,821.23" N/A N/A 8632270 SUP HCPCS C1713 8632270 - SCREW BONE 6.5MM 70MM COLORADO 2 TITANIUM SACRUM BOTH IP/OP "$1,821.50" "$1,348.00" $361.47 "$1,821.23" $819.55 $819.55 $819.55 $819.55 "$1,821.23" "$1,821.23" "$1,821.23" $379.59 "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" $379.56 "$1,821.23" "$1,821.23" "$1,077.26" "$1,821.23" "$1,821.23" "$1,821.23" "$1,821.23" "$1,366.13" "$1,821.23" "$1,821.23" "$1,821.23" $910.62 $910.62 "$1,442.41" "$1,821.23" "$1,456.98" $819.55 $361.47 N/A "$1,056.47" "$1,821.23" "$1,092.74" "$1,821.23" $379.54 "$1,821.23" N/A N/A 8632330 SUP HCPCS C1713 8632330 - SCREW BONE 7MM 30MM COLORADO 2 TITANIUM SPN SACRUM BOTH IP/OP "$1,812.00" "$1,341.00" $359.56 "$1,811.63" $815.23 $815.23 $815.23 $815.23 "$1,811.63" "$1,811.63" "$1,811.63" $377.59 "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" $377.56 "$1,811.63" "$1,811.63" "$1,071.58" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,359.00" "$1,811.63" "$1,811.63" "$1,811.63" $905.82 $905.82 "$1,434.81" "$1,811.63" "$1,449.30" $815.23 $359.56 N/A "$1,050.96" "$1,811.63" "$1,086.98" "$1,811.63" $377.54 "$1,811.63" N/A N/A 8632335 SUP HCPCS C1713 8632335 - SCREW BONE 7MM 35MM COLORADO 2 TITANIUM SPN SACRUM BOTH IP/OP "$1,812.00" "$1,341.00" $359.56 "$1,811.63" $815.23 $815.23 $815.23 $815.23 "$1,811.63" "$1,811.63" "$1,811.63" $377.59 "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" $377.56 "$1,811.63" "$1,811.63" "$1,071.58" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,359.00" "$1,811.63" "$1,811.63" "$1,811.63" $905.82 $905.82 "$1,434.81" "$1,811.63" "$1,449.30" $815.23 $359.56 N/A "$1,050.96" "$1,811.63" "$1,811.63" "$1,811.63" $377.54 "$1,811.63" N/A N/A 8632340 SUP HCPCS C1713 8632340 - SCREW BONE 7MM 40MM COLORADO 2 TITANIUM SPN SACRUM BOTH IP/OP "$1,812.00" "$1,341.00" $359.56 "$1,811.63" $815.23 $815.23 $815.23 $815.23 "$1,811.63" "$1,811.63" "$1,811.63" $377.59 "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" $377.56 "$1,811.63" "$1,811.63" "$1,071.58" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,359.00" "$1,811.63" "$1,811.63" "$1,811.63" $905.82 $905.82 "$1,434.81" "$1,811.63" "$1,449.30" $815.23 $359.56 N/A "$1,050.96" "$1,811.63" "$1,086.98" "$1,811.63" $377.54 "$1,811.63" N/A N/A 8632345 SUP HCPCS C1713 8632345 - SCREW BONE 7MM 45MM COLORADO 2 TITANIUM SPN SACRUM BOTH IP/OP "$1,812.00" "$1,341.00" $359.56 "$1,811.63" $815.23 $815.23 $815.23 $815.23 "$1,811.63" "$1,811.63" "$1,811.63" $377.59 "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" $377.56 "$1,811.63" "$1,811.63" "$1,071.58" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,359.00" "$1,811.63" "$1,811.63" "$1,811.63" $905.82 $905.82 "$1,434.81" "$1,811.63" "$1,449.30" $815.23 $359.56 N/A "$1,050.96" "$1,811.63" "$1,086.98" "$1,811.63" $377.54 "$1,811.63" N/A N/A 8632350 SUP HCPCS C1713 8632350 - SCREW BONE 7MM 50MM COLORADO 2 TITANIUM SPN SACRUM BOTH IP/OP "$1,812.00" "$1,341.00" $359.56 "$1,811.63" $815.23 $815.23 $815.23 $815.23 "$1,811.63" "$1,811.63" "$1,811.63" $377.59 "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" $377.56 "$1,811.63" $724.65 "$1,071.58" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,359.00" "$1,811.63" "$1,811.63" "$1,811.63" $905.82 $905.82 "$1,434.81" "$1,811.63" "$1,449.30" $815.23 $359.56 N/A "$1,050.96" "$1,811.63" "$1,086.98" "$1,811.63" $377.54 "$1,811.63" N/A N/A 8632355 SUP HCPCS C1713 8632355 - SCREW BONE 7MM 55MM COLORADO 2 TITANIUM SPN SACRUM BOTH IP/OP "$1,812.00" "$1,341.00" $359.56 "$1,811.63" $815.23 $815.23 $815.23 $815.23 "$1,811.63" "$1,811.63" "$1,811.63" $377.59 "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" $377.56 "$1,811.63" $724.65 "$1,071.58" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,359.00" "$1,811.63" "$1,811.63" "$1,811.63" $905.82 $905.82 "$1,434.81" "$1,811.63" "$1,449.30" $815.23 $359.56 N/A "$1,050.96" "$1,811.63" "$1,086.98" "$1,811.63" $377.54 "$1,811.63" N/A N/A 8632360 SUP HCPCS C1713 8632360 - SCREW BONE 7MM 60MM COLORADO 2 TITANIUM SPN SACRUM BOTH IP/OP "$1,812.00" "$1,341.00" $359.56 "$1,811.63" $815.23 $815.23 $815.23 $815.23 "$1,811.63" "$1,811.63" "$1,811.63" $377.59 "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" $377.56 "$1,811.63" $724.65 "$1,071.58" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,359.00" "$1,811.63" "$1,811.63" "$1,811.63" $905.82 $905.82 "$1,434.81" "$1,811.63" "$1,449.30" $815.23 $359.56 N/A "$1,050.96" "$1,811.63" "$1,086.98" "$1,811.63" $377.54 "$1,811.63" N/A N/A 8632365 SUP HCPCS C1713 8632365 - SCREW BONE 7MM 65MM COLORADO 2 TITANIUM SPN SACRUM BOTH IP/OP "$1,812.00" "$1,341.00" $359.56 "$1,811.63" $815.23 $815.23 $815.23 $815.23 "$1,811.63" "$1,811.63" "$1,811.63" $377.59 "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" $377.56 "$1,811.63" $724.65 "$1,071.58" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,359.00" "$1,811.63" "$1,811.63" "$1,811.63" $905.82 $905.82 "$1,434.81" "$1,811.63" "$1,449.30" $815.23 $359.56 N/A "$1,050.96" "$1,811.63" "$1,086.98" "$1,811.63" $377.54 "$1,811.63" N/A N/A 8632370 SUP HCPCS C1713 8632370 - SCREW BONE 7MM 70MM COLORADO 2 TITANIUM SPN SACRUM BOTH IP/OP "$1,812.00" "$1,341.00" $359.56 "$1,811.63" $815.23 $815.23 $815.23 $815.23 "$1,811.63" "$1,811.63" "$1,811.63" $377.59 "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" $377.56 "$1,811.63" $724.65 "$1,071.58" "$1,811.63" "$1,811.63" "$1,811.63" "$1,811.63" "$1,359.00" "$1,811.63" "$1,811.63" "$1,811.63" $905.82 $905.82 "$1,434.81" "$1,811.63" "$1,449.30" $815.23 $359.56 N/A "$1,050.96" "$1,811.63" "$1,086.98" "$1,811.63" $377.54 "$1,811.63" N/A N/A 8634100 SUP Custom 27803010 8634100 - CLAMP SPINAL COLORADO 2 TITANIUM BOTH IP/OP "$1,453.50" "$1,076.00" $258.72 "$1,453.50" "$1,453.50" "$1,453.50" "$1,453.50" "$1,453.50" "$1,453.50" "$1,453.50" $258.72 "$1,453.50" "$1,453.50" "$1,453.50" "$1,453.50" "$1,453.50" "$1,453.50" $302.93 "$1,453.50" $581.40 "$1,453.50" "$1,453.50" "$1,453.50" "$1,453.50" "$1,453.50" "$1,090.13" "$1,453.50" "$1,453.50" "$1,453.50" $726.75 $726.75 "$1,151.17" "$1,453.50" "$1,162.80" $654.08 "$1,453.50" N/A $843.03 "$1,453.50" $872.10 "$1,453.50" "$1,453.50" "$1,453.50" N/A N/A 8634110 SUP Custom 27803010 8634110 - CONNECTOR ROD PLATE ILIOSACRAL SPN BOTH IP/OP "$1,935.50" "$1,432.00" $344.52 "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" $344.52 "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" $403.38 "$1,935.50" $774.20 "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,451.63" "$1,935.50" "$1,935.50" "$1,935.50" $967.75 $967.75 "$1,532.92" "$1,935.50" "$1,548.40" $870.98 "$1,935.50" N/A "$1,122.59" "$1,935.50" "$1,161.30" "$1,935.50" "$1,935.50" "$1,935.50" N/A N/A 8634111 SUP HCPCS C1713 8634111 - NUT LOCK BREAKOFF COLORADO 2 SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8634200 SUP Custom 27803010 8634200 - CLAMP SPINAL BOTH IP/OP "$1,935.50" "$1,432.00" $344.52 "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" $344.52 "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" $403.38 "$1,935.50" $774.20 "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,451.63" "$1,935.50" "$1,935.50" "$1,935.50" $967.75 $967.75 "$1,532.92" "$1,935.50" "$1,548.40" $870.98 "$1,935.50" N/A "$1,122.59" "$1,935.50" "$1,161.30" "$1,935.50" "$1,935.50" "$1,935.50" N/A N/A 8635400 SUP Custom 27803010 8635400 - CLAMP EXFIX 5.5X5.5 LATERAL CLOSE BOTH IP/OP "$2,818.50" "$2,086.00" $501.69 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $501.69 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$1,127.40" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" "$2,818.50" N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" "$2,818.50" "$2,818.50" N/A N/A 8635405 SUP HCPCS C1713 8635405 - SCREW BONE 4MM 5MM COLORADO 2 SPN PEDICLE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8635430 SUP Custom 27803010 8635430 - CONNECTOR ROD CLOSE LATERAL BOTH IP/OP "$2,818.50" "$2,086.00" $501.69 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $501.69 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$1,127.40" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" "$2,818.50" N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" "$2,818.50" "$2,818.50" N/A N/A 8638102 SUP HCPCS C1713 8638102 - HOOK SPINAL SMALL GROOVE TITANIUM PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 8638104 SUP HCPCS C1713 8638104 - HOOK SPINAL LARGE GROOVE TITANIUM PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 8638110 SUP HCPCS C1713 8638110 - PLATE BONE TITANIUM SPN RIGHT SACRUM BOTH IP/OP "$3,873.00" "$2,866.00" $768.69 "$3,873.00" "$1,742.85" "$1,742.85" "$1,742.85" "$1,742.85" "$3,873.00" "$3,873.00" "$3,873.00" $807.23 "$3,873.00" "$3,873.00" "$3,873.00" "$3,873.00" "$3,873.00" $807.18 "$3,873.00" "$3,873.00" "$1,909.39" "$3,873.00" "$3,873.00" "$3,873.00" "$3,873.00" "$2,904.75" "$3,873.00" "$3,873.00" "$3,873.00" "$1,936.50" "$1,936.50" "$3,067.42" "$3,873.00" "$3,098.40" "$1,742.85" $768.69 N/A "$2,246.34" "$3,873.00" "$2,323.80" "$3,873.00" $807.13 "$3,873.00" N/A N/A 8638120 SUP HCPCS C1713 8638120 - PLATE BONE TITANIUM SPN LEFT SACRUM BOTH IP/OP "$3,873.00" "$2,866.00" $768.69 "$3,873.00" "$1,742.85" "$1,742.85" "$1,742.85" "$1,742.85" "$3,873.00" "$3,873.00" "$3,873.00" $807.23 "$3,873.00" "$3,873.00" "$3,873.00" "$3,873.00" "$3,873.00" $807.18 "$3,873.00" "$3,873.00" "$1,909.39" "$3,873.00" "$3,873.00" "$3,873.00" "$3,873.00" "$2,904.75" "$3,873.00" "$3,873.00" "$3,873.00" "$1,936.50" "$1,936.50" "$3,067.42" "$3,873.00" "$3,098.40" "$1,742.85" $768.69 N/A "$2,246.34" "$3,873.00" "$2,323.80" "$3,873.00" $807.13 "$3,873.00" N/A N/A 8638203 SUP HCPCS C1713 8638203 - HOOK SPINAL MEDIUM GROOVE LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 8638210 SUP HCPCS C1713 8638210 - PLATE BONE TITANIUM SPN RIGHT ILIOSACRUM BOTH IP/OP "$4,938.00" "$3,654.00" $980.07 "$4,938.00" "$2,222.10" "$2,222.10" "$2,222.10" "$2,222.10" "$4,938.00" "$4,938.00" "$4,938.00" "$1,029.20" "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" "$1,029.13" "$4,938.00" "$1,975.20" "$2,434.43" "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" "$3,703.50" "$4,938.00" "$4,938.00" "$4,938.00" "$2,469.00" "$2,469.00" "$3,910.90" "$4,938.00" "$3,950.40" "$2,222.10" $980.07 N/A "$2,864.04" "$4,938.00" "$2,962.80" "$4,938.00" "$1,029.08" "$4,938.00" N/A N/A 8638220 SUP HCPCS C1713 8638220 - PLATE BONE TITANIUM SPN LEFT ILIOSACRUM BOTH IP/OP "$4,938.00" "$3,654.00" $980.07 "$4,938.00" "$2,222.10" "$2,222.10" "$2,222.10" "$2,222.10" "$4,938.00" "$4,938.00" "$4,938.00" "$1,029.20" "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" "$1,029.13" "$4,938.00" "$4,938.00" "$2,434.43" "$4,938.00" "$4,938.00" "$4,938.00" "$4,938.00" "$3,703.50" "$4,938.00" "$4,938.00" "$4,938.00" "$2,469.00" "$2,469.00" "$3,910.90" "$4,938.00" "$3,950.40" "$2,222.10" $980.07 N/A "$2,864.04" "$4,938.00" "$2,962.80" "$4,938.00" "$1,029.08" "$4,938.00" N/A N/A 8638425 SUP HCPCS C1713 8638425 - SCREW BONE 4.5MM 25MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638430 SUP HCPCS C1713 8638430 - SCREW BONE 4.5MM 30MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$2,818.50" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638435 SUP HCPCS C1713 8638435 - SCREW BONE 4.5MM 35MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$1,127.40" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638440 SUP HCPCS C1713 8638440 - SCREW BONE 4.5MM 40MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$1,127.40" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638445 SUP HCPCS C1713 8638445 - SCREW BONE 4.5MM 45MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$1,127.40" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638525 SUP HCPCS C1713 8638525 - SCREW BONE 5.5MM 25MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$1,127.40" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638530 SUP HCPCS C1713 8638530 - SCREW BONE 5.5MM 30MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$1,127.40" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638535 SUP HCPCS C1713 8638535 - SCREW BONE 5.5MM 35MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$1,127.40" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638540 SUP HCPCS C1713 8638540 - SCREW BONE 5.5MM 40MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638545 SUP HCPCS C1713 8638545 - SCREW BONE 5.5MM 45MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$2,818.50" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638550 SUP HCPCS C1713 8638550 - SCREW BONE 5.5MM 50MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638555 SUP HCPCS C1713 8638555 - SCREW BONE 5.5MM 55MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638625 SUP HCPCS C1713 8638625 - SCREW BONE 6.5MM 25MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638630 SUP HCPCS C1713 8638630 - SCREW BONE 6.5MM 30MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638635 SUP HCPCS C1713 8638635 - SCREW BN 6.5MM 35MM CO2 SPNE PDCL BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638640 SUP HCPCS C1713 8638640 - SCREW BN 6.5MM 35MM CO2 SPNE PDCL BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638645 SUP HCPCS C1713 8638645 - SCREW BONE 6.5MM 45MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638650 SUP HCPCS C1713 8638650 - SCREW BONE 6.5MM 50MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638655 SUP HCPCS C1713 8638655 - SCREW BONE 6.5MM 55MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$2,818.50" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638660 SUP HCPCS C1713 8638660 - SCREW BONE 6.5MM 60MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638665 SUP HCPCS C1713 8638665 - SCREW BONE 6.5MM 65MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638725 SUP HCPCS C1713 8638725 - SCREW BONE 7.5MM 25MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638730 SUP HCPCS C1713 8638730 - SCREW BONE 7.5MM 30MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638735 SUP HCPCS C1713 8638735 - SCREW BONE 7.5MM 35MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638740 SUP HCPCS C1713 8638740 - SCREW BONE 7.5MM 40MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$2,818.50" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638745 SUP HCPCS C1713 8638745 - SCREW BONE 7.5MM 45MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638750 SUP HCPCS C1713 8638750 - SCREW BONE 7.5MM 50MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638755 SUP HCPCS C1713 8638755 - SCREW BONE 7.5MM 55MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638760 SUP HCPCS C1713 8638760 - SCREW BONE 7.5MM 60MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" $587.38 "$2,818.50" N/A N/A 8638765 SUP HCPCS C1713 8638765 - SCREW BONE 7.5MM 65MM COLORADO 2 SPN PEDICLE BOTH IP/OP "$2,818.50" "$2,086.00" $559.40 "$2,818.50" "$1,268.33" "$1,268.33" "$1,268.33" "$1,268.33" "$2,818.50" "$2,818.50" "$2,818.50" $587.45 "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" $587.41 "$2,818.50" "$2,818.50" "$1,389.52" "$2,818.50" "$2,818.50" "$2,818.50" "$2,818.50" "$2,113.88" "$2,818.50" "$2,818.50" "$2,818.50" "$1,409.25" "$1,409.25" "$2,232.25" "$2,818.50" "$2,254.80" "$1,268.33" $559.40 N/A "$1,634.73" "$2,818.50" "$1,691.10" "$2,818.50" "$2,818.50" "$2,818.50" N/A N/A 8639300 SUP HCPCS C1713 8639300 - SCREW SET LOCK COLORADO 2 TITANIUM ILIOSACRAL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 8639400 SUP HCPCS C1713 8639400 - STAPLE BONE COLORADO 2 TITANIUM ANTERIOR SPN BOTH IP/OP $988.50 $731.00 $196.19 $988.50 $444.83 $444.83 $444.83 $444.83 $988.50 $988.50 $988.50 $206.03 $988.50 $988.50 $988.50 $988.50 $988.50 $206.01 $988.50 $988.50 $584.70 $988.50 $988.50 $988.50 $988.50 $741.38 $988.50 $988.50 $988.50 $494.25 $494.25 $782.89 $988.50 $790.80 $444.83 $196.19 N/A $573.33 $988.50 $593.10 $988.50 $206.00 $988.50 N/A N/A 8644525 SUP HCPCS C1713 8644525 - SCREW BN 4.5MM 25MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8644530 SUP HCPCS C1713 8644530 - SCREW BN 4.5MM 30MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8644535 SUP HCPCS C1713 8644535 - SCREW BN 4.5MM 35MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8644540 SUP HCPCS C1713 8644540 - SCREW BN 4.5MM 40MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8644545 SUP HCPCS C1713 8644545 - SCREW BN 4.5MM 45MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8645025 SUP HCPCS C1713 8645025 - SCREW BN 5MM 25MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8645030 SUP HCPCS C1713 8645030 - SCREW BN 5MM 30MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8645035 SUP HCPCS C1713 8645035 - SCREW BN 5MM 35MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8645040 SUP HCPCS C1713 8645040 - SCREW BN 5MM 40MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8645045 SUP HCPCS C1713 8645045 - SCREW BN 5MM 45MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8645050 SUP HCPCS C1713 8645050 - SCREW BN 6MM 55MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8646030 SUP HCPCS C1713 8646030 - SCREW BN 5MM 50MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8646035 SUP HCPCS C1713 8646035 - SCREW BN 6MM 30MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8646040 SUP HCPCS C1713 8646040 - SCREW BN 6MM 35MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8646045 SUP HCPCS C1713 8646045 - SCREW BN 6MM 40MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8646050 SUP HCPCS C1713 8646050 - SCREW BN 6MM 45MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8646055 SUP HCPCS C1713 8646055 - SCREW BN 6MM 50MM UNIPLANAR TI SPNE 5.5MM ROD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 8650520 SUP HCPCS C1713 8650520 - CONNECTOR ROD 20MM OFFST OPEN ARM15T TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,655.00" "$1,225.00" $328.48 "$1,655.00" $744.75 $744.75 $744.75 $744.75 "$1,655.00" "$1,655.00" "$1,655.00" $344.94 "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" $344.92 "$1,655.00" $662.00 $978.93 "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" "$1,241.25" "$1,655.00" "$1,655.00" "$1,655.00" $827.50 $827.50 "$1,310.76" "$1,655.00" "$1,324.00" $744.75 $328.48 N/A $959.90 "$1,655.00" "$1,655.00" "$1,655.00" $344.90 "$1,655.00" N/A N/A 8650530 SUP HCPCS C1713 8650530 - CONNECTOR ROD OFFST 5.5MM 30MM TITANIUM SPN BOTH IP/OP "$1,655.00" "$1,225.00" $328.48 "$1,655.00" $744.75 $744.75 $744.75 $744.75 "$1,655.00" "$1,655.00" "$1,655.00" $344.94 "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" $344.92 "$1,655.00" $662.00 $978.93 "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" "$1,241.25" "$1,655.00" "$1,655.00" "$1,655.00" $827.50 $827.50 "$1,310.76" "$1,655.00" "$1,324.00" $744.75 $328.48 N/A $959.90 "$1,655.00" "$1,655.00" "$1,655.00" $344.90 "$1,655.00" N/A N/A 8650560 SUP HCPCS C1713 8650560 - CONNECTOR ROD OFFST 5.5MM 60MM TITANIUM SPN BOTH IP/OP "$1,655.00" "$1,225.00" $328.48 "$1,655.00" $744.75 $744.75 $744.75 $744.75 "$1,655.00" "$1,655.00" "$1,655.00" $344.94 "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" $344.92 "$1,655.00" $662.00 $978.93 "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" "$1,241.25" "$1,655.00" "$1,655.00" "$1,655.00" $827.50 $827.50 "$1,310.76" "$1,655.00" "$1,324.00" $744.75 $328.48 N/A $959.90 "$1,655.00" "$1,655.00" "$1,655.00" $344.90 "$1,655.00" N/A N/A 8651520 SUP HCPCS C1713 8651520 - CONNECTOR ROD OFFST 5.5MM CLOSE TITANIUM SPN BOTH IP/OP "$1,655.00" "$1,225.00" $328.48 "$1,655.00" $744.75 $744.75 $744.75 $744.75 "$1,655.00" "$1,655.00" "$1,655.00" $344.94 "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" $344.92 "$1,655.00" $662.00 $978.93 "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" "$1,241.25" "$1,655.00" "$1,655.00" "$1,655.00" $827.50 $827.50 "$1,310.76" "$1,655.00" "$1,324.00" $744.75 $328.48 N/A $959.90 "$1,655.00" "$1,655.00" "$1,655.00" $344.90 "$1,655.00" N/A N/A 8651530 SUP HCPCS C1713 8651530 - CONNECTOR ROD OFFST 5.5MM CLOSE TITANIUM SPN BOTH IP/OP "$1,655.00" "$1,225.00" $328.48 "$1,655.00" $744.75 $744.75 $744.75 $744.75 "$1,655.00" "$1,655.00" "$1,655.00" $344.94 "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" $344.92 "$1,655.00" $662.00 $978.93 "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" "$1,241.25" "$1,655.00" "$1,655.00" "$1,655.00" $827.50 $827.50 "$1,310.76" "$1,655.00" "$1,324.00" $744.75 $328.48 N/A $959.90 "$1,655.00" $993.00 "$1,655.00" $344.90 "$1,655.00" N/A N/A 8651560 SUP HCPCS C1713 8651560 - CONNECTOR ROD OFFST 5.5MM CLOSE TITANIUM SPN BOTH IP/OP "$1,655.00" "$1,225.00" $328.48 "$1,655.00" $744.75 $744.75 $744.75 $744.75 "$1,655.00" "$1,655.00" "$1,655.00" $344.94 "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" $344.92 "$1,655.00" $662.00 $978.93 "$1,655.00" "$1,655.00" "$1,655.00" "$1,655.00" "$1,241.25" "$1,655.00" "$1,655.00" "$1,655.00" $827.50 $827.50 "$1,310.76" "$1,655.00" "$1,324.00" $744.75 $328.48 N/A $959.90 "$1,655.00" $993.00 "$1,655.00" $344.90 "$1,655.00" N/A N/A 8664110 SUP Custom 27803010 8664110 - CONNECTOR ROD 6.35MM STAINLESS STEEL SACRAL SPN BOTH IP/OP "$1,710.00" "$1,265.00" $304.38 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" $304.38 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" $356.38 "$1,710.00" $684.00 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,282.50" "$1,710.00" "$1,710.00" "$1,710.00" $855.00 $855.00 "$1,354.32" "$1,710.00" "$1,368.00" $769.50 "$1,710.00" N/A $991.80 "$1,710.00" "$1,026.00" "$1,710.00" "$1,710.00" "$1,710.00" N/A N/A 8664111 SUP HCPCS C1713 8664111 - SCREW SET BREAKOFF COLORADO 2 STAINLESS STEEL SPN SACRAL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 8670001 SUP HCPCS C1769 8670001 - GUIDEWIRE ORTHOPEDIC BLUNT INSTR SEXTANT TITANIUM SPN BOTH IP/OP $151.50 $112.00 $30.07 $151.50 $82.26 $82.26 $82.26 $82.26 $151.50 $151.50 $151.50 $31.58 $151.50 $112.44 $112.44 $116.78 $78.93 $31.57 $151.50 $151.50 $89.61 $151.50 $151.50 $151.50 $151.50 $113.63 $151.50 $151.50 $151.50 $75.75 $75.75 $119.99 $151.50 $121.20 $98.48 $30.07 N/A $87.87 $151.50 $151.50 $151.50 $31.57 $151.50 N/A N/A 8670002 SUP HCPCS C1769 8670002 - GUIDEWIRE ORTHOPEDIC SHARP CD HORIZON TITANIUM SPN BOTH IP/OP $151.50 $112.00 $30.07 $151.50 $82.26 $82.26 $82.26 $82.26 $151.50 $151.50 $151.50 $31.58 $151.50 $112.44 $112.44 $116.78 $78.93 $31.57 $151.50 $151.50 $89.61 $151.50 $151.50 $151.50 $151.50 $113.63 $151.50 $151.50 $151.50 $75.75 $75.75 $119.99 $151.50 $121.20 $98.48 $30.07 N/A $87.87 $151.50 $151.50 $151.50 $31.57 $151.50 N/A N/A 8672030 SUP HCPCS C1713 8672030 - ROD SPNL STD PREBNT CNTR 5.5MM 30MM SXTNT CD HZN TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" $829.00 "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$2,072.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8672035 SUP HCPCS C1713 8672035 - ROD SPNL PREBNT 5.5MM 35MM SXTNT CD HZN TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" $829.00 "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$1,243.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8672040 SUP HCPCS C1713 8672040 - ROD SPNL STD CNTR PREBNT 5.5MM 40MM CD HZN SXTNT PCUT TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" $829.00 "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$1,243.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8672045 SUP HCPCS C1713 8672045 - ROD SPNL STD CNTR PREBNT 5.5MM 45MM CD HZN SXTNT PCUT TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" $829.00 "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$1,243.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8672050 SUP HCPCS C1713 8672050 - ROD SPNL STD CNTR PREBNT 5.5MM 50MM CD HZN SXTNT PCUT TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" "$2,072.50" "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$1,243.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8672055 SUP HCPCS C1713 8672055 - ROD SPNL STD PREBNT PCUT CNTR 5.5MM 55MM SXTNT CD HZN TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" $829.00 "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$1,243.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8672060 SUP HCPCS C1713 8672060 - ROD SPNL STD CNTR PREBNT 5.5MM 60MM CD HZN SXTNT PCUT TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" $829.00 "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$1,243.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8672065 SUP HCPCS C1713 8672065 - ROD SPNL STD CNTR PREBNT 5.5MM 65MM CD HZN SXTNT PCUT TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" $829.00 "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$2,072.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8672070 SUP HCPCS C1713 8672070 - ROD SPNL STD CNTR PREBNT 5.5MM 70MM CD HZN SXTNT PCUT TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" "$2,072.50" "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$1,243.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8672075 SUP HCPCS C1713 8672075 - ROD SPNL STD CNTR PREBNT 5.5MM 75MM CD HZN SXTNT PCUT TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" "$2,072.50" "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$1,243.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8672080 SUP HCPCS C1713 8672080 - ROD SPNL STD CNTR PREBNT 5.5MM 80MM CD HZN SXTNT PCUT TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" "$2,072.50" "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$1,243.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8672085 SUP HCPCS C1713 8672085 - ROD SPNL STD PREBNT PCUT CNTR 5.5MM 85MM SXTNT CD HZN TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" "$2,072.50" "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$1,243.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8672090 SUP HCPCS C1713 8672090 - ROD SPNL STD PREBNT CNTR 5.5MM 90MM SXTNT CD HZN TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" "$2,072.50" "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$2,072.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8672095 SUP HCPCS C1713 8672095 - ROD SPNL STD CNTR PREBNT 5.5MM 95MM CD HZN SXTNT PCUT TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" "$2,072.50" "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$1,243.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8672100 SUP HCPCS C1713 8672100 - ROD SPNL STD CNTR PREBNT 5.5MM 100MM CD HZN SXTNT PCUT TI BOTH IP/OP "$2,072.50" "$1,534.00" $411.34 "$2,072.50" $932.63 $932.63 $932.63 $932.63 "$2,072.50" "$2,072.50" "$2,072.50" $431.96 "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" $431.93 "$2,072.50" "$2,072.50" "$1,225.88" "$2,072.50" "$2,072.50" "$2,072.50" "$2,072.50" "$1,554.38" "$2,072.50" "$2,072.50" "$2,072.50" "$1,036.25" "$1,036.25" "$1,641.42" "$2,072.50" "$1,658.00" $932.63 $411.34 N/A "$1,202.05" "$2,072.50" "$1,243.50" "$2,072.50" $431.91 "$2,072.50" N/A N/A 8674110 SUP Custom 27803010 8674110 - CONNECTOR ROD 6.35MM TITANIUM SACRAL SPN BOTH IP/OP "$1,935.50" "$1,432.00" $344.52 "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" $344.52 "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" $403.38 "$1,935.50" $774.20 "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,935.50" "$1,451.63" "$1,935.50" "$1,935.50" "$1,935.50" $967.75 $967.75 "$1,532.92" "$1,935.50" "$1,548.40" $870.98 "$1,935.50" N/A "$1,122.59" "$1,935.50" "$1,161.30" "$1,935.50" "$1,935.50" "$1,935.50" N/A N/A 8674111 SUP HCPCS C1713 8674111 - SCREW SET BREAKOFF COLORADO 2 TITANIUM SPN SACRAL SACROILIAC BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8680853 SUP HCPCS C1713 8680853 - SCREW BONE 8.5MM 53MM PLUG REDX CD HORIZON M8 STAINLESS BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8688498 SUP HCPCS C1713 8688498 - STAPLE BONE SMALL 19MM 2 ROD LEGACY CD HORIZON M8 TITANIUM BOTH IP/OP "$2,173.50" "$1,608.00" $431.39 "$2,173.50" $978.08 $978.08 $978.08 $978.08 "$2,173.50" "$2,173.50" "$2,173.50" $453.01 "$2,173.50" "$2,173.50" "$2,173.50" "$2,173.50" "$2,173.50" $452.98 "$2,173.50" "$2,173.50" "$1,285.63" "$2,173.50" "$2,173.50" "$2,173.50" "$2,173.50" "$1,630.13" "$2,173.50" "$2,173.50" "$2,173.50" "$1,086.75" "$1,086.75" "$1,721.41" "$2,173.50" "$1,738.80" $978.08 $431.39 N/A "$1,260.63" "$2,173.50" "$1,304.10" "$2,173.50" $452.96 "$2,173.50" N/A N/A 8688499 SUP HCPCS C1713 8688499 - STAPLE BONE SMALL 19MM 2 ROD LEGACY CD HORIZON M8 TITANIUM BOTH IP/OP "$2,173.50" "$1,608.00" $431.39 "$2,173.50" $978.08 $978.08 $978.08 $978.08 "$2,173.50" "$2,173.50" "$2,173.50" $453.01 "$2,173.50" "$2,173.50" "$2,173.50" "$2,173.50" "$2,173.50" $452.98 "$2,173.50" "$2,173.50" "$1,285.63" "$2,173.50" "$2,173.50" "$2,173.50" "$2,173.50" "$1,630.13" "$2,173.50" "$2,173.50" "$2,173.50" "$1,086.75" "$1,086.75" "$1,721.41" "$2,173.50" "$1,738.80" $978.08 $431.39 N/A "$1,260.63" "$2,173.50" "$1,304.10" "$2,173.50" $452.96 "$2,173.50" N/A N/A 8688500 SUP HCPCS C1713 8688500 - STAPLE BONE SMALL 21MM 2 ROD LEGACY CD HORIZON M8 TITANIUM BOTH IP/OP "$2,173.50" "$1,608.00" $431.39 "$2,173.50" $978.08 $978.08 $978.08 $978.08 "$2,173.50" "$2,173.50" "$2,173.50" $453.01 "$2,173.50" "$2,173.50" "$2,173.50" "$2,173.50" "$2,173.50" $452.98 "$2,173.50" "$2,173.50" "$1,285.63" "$2,173.50" "$2,173.50" "$2,173.50" "$2,173.50" "$1,630.13" "$2,173.50" "$2,173.50" "$2,173.50" "$1,086.75" "$1,086.75" "$1,721.41" "$2,173.50" "$1,738.80" $978.08 $431.39 N/A "$1,260.63" "$2,173.50" "$1,304.10" "$2,173.50" $452.96 "$2,173.50" N/A N/A 8688501 SUP HCPCS C1713 8688501 - STAPLE BONE SMALL 21MM 2 ROD LEGACY CD HORIZON M8 TITANIUM BOTH IP/OP "$2,173.50" "$1,608.00" $431.39 "$2,173.50" $978.08 $978.08 $978.08 $978.08 "$2,173.50" "$2,173.50" "$2,173.50" $453.01 "$2,173.50" "$2,173.50" "$2,173.50" "$2,173.50" "$2,173.50" $452.98 "$2,173.50" "$2,173.50" "$1,285.63" "$2,173.50" "$2,173.50" "$2,173.50" "$2,173.50" "$1,630.13" "$2,173.50" "$2,173.50" "$2,173.50" "$1,086.75" "$1,086.75" "$1,721.41" "$2,173.50" "$1,738.80" $978.08 $431.39 N/A "$1,260.63" "$2,173.50" "$1,304.10" "$2,173.50" "$2,173.50" "$2,173.50" N/A N/A 8690024 SUP HCPCS C1713 8690024 - ROD SPINAL STR 5.5MM 500MM 3DX TSRH CHROMALOY BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 8690030 SUP HCPCS C1713 8690030 - ROD SPNL PREBNT 5.5MM 30MM CD HZN TI CP BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8690035 SUP HCPCS C1713 8690035 - ROD SPINAL 5.5MM 35MM PREBENT LEGACY TITANIUM STERILE CP BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 8690040 SUP HCPCS C1713 8690040 - ROD SPNL PREBNT 5.5MM 40MM LGC CD HZN TI CP BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8690045 SUP HCPCS C1713 8690045 - ROD SPINAL 5.5MM 45MM PREBENT CD HORIZON LEGACY TITANIUM CP BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8690050 SUP HCPCS C1713 8690050 - ROD SPNL PCUT PREBNT 5.5MM 50MM LGC CD HZN TI CP BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8690055 SUP HCPCS C1713 8690055 - ROD SPINAL 5.5MM 55MM PREBENT CD HORIZON LEGACY TITANIUM CP BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8690060 SUP HCPCS C1713 8690060 - ROD SPNL PREBNT 5.5MM 60MM CD HZN LGC CNTR POST TI THRX BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8690065 SUP HCPCS C1713 8690065 - ROD SPINAL 5.5MM 65MM PREBENT CD HORIZON LEGACY TITANIUM CP BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A 8690070 SUP HCPCS C1713 8690070 - ROD SPNL PREBNT 5.5MM 70MM CD HZN LGC CNTR POST TI BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8690075 SUP HCPCS C1713 8690075 - ROD SPINAL 5.5MM 75MM PREBENT CD HORIZON LEGACY TITANIUM CP BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 8690080 SUP HCPCS C1713 8690080 - ROD SPINAL PREBENT 5.5MM 80MM LEGACY CD HORIZON TITANIUM CP BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8690085 SUP HCPCS C1713 8690085 - ROD SPINAL PREBENT 5.5MM 85MM CD HORIZON LEGACY TITANIUM CP BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 8690090 SUP HCPCS C1713 8690090 - ROD SPNL PREBNT 5.5MM 90MM CD HZN LGC CNTR POST TI BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8690095 SUP HCPCS C1713 8690095 - ROD SPINAL PREBENT 5.5MM 95MM CD HORIZON LEGACY TITANIUM CP BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8690100 SUP HCPCS C1713 8690100 - ROD SPNL PREBNT 5.5MM 100MM LGC CD HZN TI CP BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8690105 SUP HCPCS C1713 8690105 - ROD SPINAL 5.5MM 105MM PREBENT TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A 8690110 SUP HCPCS C1713 8690110 - ROD SPINAL 5.5MM 110MM PREBENT CD HORIZON LEGACY TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 8690115 SUP HCPCS C1713 8690115 - ROD SPINAL 5.5MM 115MM PREBENT TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8690120 SUP HCPCS C1713 8690120 - ROD SPINAL 5.5MM 120MM PREBENT DEGENERATIVE CD HORIZON BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8690853 SUP HCPCS C1713 8690853 - SCREW BONE 8.5MM 53MM PLUG REDX CD HORIZON M8 TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8690878 SUP HCPCS C1713 8690878 - SCREW SET BREAKOFF REDX PLUG CD HORIZON M8 TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8691530 SUP HCPCS C1713 8691530 - SCREW BONE 5.5MM 30MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$1,417.44" "$2,362.40" "$2,362.40" "$2,362.40" N/A N/A 8691535 SUP HCPCS C1713 8691535 - SCREW BONE 5.5MM 35MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" N/A N/A 8691540 SUP HCPCS C1713 8691540 - SCREW BONE 5.5MM 40MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$1,417.44" "$2,362.40" $492.32 "$2,362.40" N/A N/A 8691545 SUP HCPCS C1713 8691545 - SCREW BONE 5.5MM 45MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$1,417.44" "$2,362.40" "$2,362.40" "$2,362.40" N/A N/A 8691550 SUP HCPCS C1713 8691550 - SCREW BONE 5.5MM 50MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$1,417.44" "$2,362.40" "$2,362.40" "$2,362.40" N/A N/A 8691630 SUP HCPCS C1713 8691630 - SCREW BONE 6.5MM 30MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$2,362.40" "$2,362.40" $492.32 "$2,362.40" N/A N/A 8691635 SUP HCPCS C1713 8691635 - SCREW BONE 6.5MM 35MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$1,417.44" "$2,362.40" $492.32 "$2,362.40" N/A N/A 8691640 SUP HCPCS C1713 8691640 - SCREW BONE 6.5MM 40MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$1,417.44" "$2,362.40" $492.32 "$2,362.40" N/A N/A 8691645 SUP HCPCS C1713 8691645 - SCREW BONE 6.5MM 45MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$1,417.44" "$2,362.40" "$2,362.40" "$2,362.40" N/A N/A 8691650 SUP HCPCS C1713 8691650 - SCREW BONE 6.5MM 50MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$1,417.44" "$2,362.40" "$2,362.40" "$2,362.40" N/A N/A 8691655 SUP HCPCS C1713 8691655 - SCREW BONE 6.5MM 55MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" N/A N/A 8691730 SUP HCPCS C1713 8691730 - SCREW BONE 7.5MM 30MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$1,417.44" "$2,362.40" $492.32 "$2,362.40" N/A N/A 8691735 SUP HCPCS C1713 8691735 - SCREW BONE 7.5MM 35MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$1,417.44" "$2,362.40" "$2,362.40" "$2,362.40" N/A N/A 8691745 SUP HCPCS C1713 8691745 - SCREW BONE 7.5MM 45MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$1,417.44" "$2,362.40" "$2,362.40" "$2,362.40" N/A N/A 8691750 SUP HCPCS C1713 8691750 - SCREW BONE 7.5MM 50MM FIX ANGLE REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,362.50" "$1,748.00" $468.88 "$2,362.40" "$1,063.08" "$1,063.08" "$1,063.08" "$1,063.08" "$2,362.40" "$2,362.40" "$2,362.40" $492.38 "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" $492.35 "$2,362.40" "$2,362.40" "$1,397.36" "$2,362.40" "$2,362.40" "$2,362.40" "$2,362.40" "$1,771.88" "$2,362.40" "$2,362.40" "$2,362.40" "$1,181.20" "$1,181.20" "$1,871.02" "$2,362.40" "$1,889.92" "$1,063.08" $468.88 N/A "$1,370.25" "$2,362.40" "$1,417.44" "$2,362.40" $492.32 "$2,362.40" N/A N/A 8692150 SUP HCPCS C1713 8692150 - HOOK SPINAL REDX RAMPED STANDARD BLADE CD HORIZON M8 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 8692152 SUP HCPCS C1713 8692152 - HOOK SPINAL RAMPED REDX NARROW BLADE CD HORIZON M8 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 8698501 SUP HCPCS C1713 8698501 - STAPLE BONE SMALL 21MM 2 ROD ANTARES CD HORIZON TITANIUM SPN BOTH IP/OP "$4,240.00" "$3,138.00" $841.53 "$4,240.00" "$1,908.00" "$1,908.00" "$1,908.00" "$1,908.00" "$4,240.00" "$4,240.00" "$4,240.00" $883.72 "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" $883.66 "$4,240.00" "$4,240.00" "$2,090.32" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$3,180.00" "$4,240.00" "$4,240.00" "$4,240.00" "$2,120.00" "$2,120.00" "$3,358.08" "$4,240.00" "$3,392.00" "$1,908.00" $841.53 N/A "$2,459.20" "$4,240.00" "$4,240.00" "$4,240.00" $883.62 "$4,240.00" N/A N/A 8698502 SUP HCPCS C1713 8698502 - STAPLE BONE MEDIUM 2 ROD CD HORIZON ANTARES TITANIUM CAUDAL BOTH IP/OP "$4,240.00" "$3,138.00" $841.53 "$4,240.00" "$1,908.00" "$1,908.00" "$1,908.00" "$1,908.00" "$4,240.00" "$4,240.00" "$4,240.00" $883.72 "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" $883.66 "$4,240.00" "$4,240.00" "$2,090.32" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$3,180.00" "$4,240.00" "$4,240.00" "$4,240.00" "$2,120.00" "$2,120.00" "$3,358.08" "$4,240.00" "$3,392.00" "$1,908.00" $841.53 N/A "$2,459.20" "$4,240.00" "$4,240.00" "$4,240.00" $883.62 "$4,240.00" N/A N/A 8699050 SUP HCPCS C1713 8699050 - ROD SPINAL 5.5MM 50CM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8699055 SUP HCPCS C1713 8699055 - ROD SPINAL 5.5MM 55CM STR CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8699060 SUP HCPCS C1713 8699060 - ROD SPINAL 5.5MM 60CM STR CENTRL POST CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8699065 SUP HCPCS C1713 8699065 - ROD SPINAL 5.5MM 65CM STR CD HORIZON BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8699070 SUP HCPCS C1713 8699070 - ROD SPINAL 70MM STR TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8699075 SUP HCPCS C1713 8699075 - ROD SPINAL 5.5MM 75CM STR CENTRL POST CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8699080 SUP HCPCS C1713 8699080 - ROD SPINAL 80MM STR TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8699085 SUP HCPCS C1713 8699085 - ROD SPINAL 85MM STR TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8699090 SUP HCPCS C1713 8699090 - ROD SPINAL 5.5MM 90CM STR CENTRL POST CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8699095 SUP HCPCS C1713 8699095 - ROD SPINAL 5.5MM 95CM STR CENTRL POST CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8699100 SUP HCPCS C1713 8699100 - ROD SPINAL 5.5MM 100CM STR CENTRL POST CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8730006 SUP Custom 27203010 8730006 - BIT DRILL CANN UCSS STERILE BOTH IP/OP "$1,099.50" $814.00 $195.71 "$1,099.50" "$1,099.50" "$1,099.50" "$1,099.50" "$1,099.50" "$1,099.50" "$1,099.50" $195.71 "$1,099.50" "$1,099.50" $816.05 $816.05 $847.49 $572.84 $229.15 "$1,099.50" $439.80 "$1,099.50" "$1,099.50" "$1,099.50" "$1,099.50" "$1,099.50" $824.63 "$1,099.50" "$1,099.50" "$1,099.50" $549.75 $549.75 $870.80 "$1,099.50" $879.60 $714.68 "$1,099.50" N/A $637.71 "$1,099.50" $659.70 "$1,099.50" "$1,099.50" "$1,099.50" N/A N/A 8750520 SUP HCPCS C1713 8750520 - CONNECTOR ROD OFFST 5.5MM 20MM STAINLESS STEEL SPN BOTH IP/OP "$2,482.50" "$1,837.00" $492.71 "$2,482.50" "$1,117.13" "$1,117.13" "$1,117.13" "$1,117.13" "$2,482.50" "$2,482.50" "$2,482.50" $517.42 "$2,482.50" "$2,482.50" "$2,482.50" "$2,482.50" "$2,482.50" $517.38 "$2,482.50" $993.00 "$1,468.40" "$2,482.50" "$2,482.50" "$2,482.50" "$2,482.50" "$1,861.88" "$2,482.50" "$2,482.50" "$2,482.50" "$1,241.25" "$1,241.25" "$1,966.14" "$2,482.50" "$1,986.00" "$1,117.13" $492.71 N/A "$1,439.85" "$2,482.50" "$1,489.50" "$2,482.50" $517.35 "$2,482.50" N/A N/A 8750530 SUP HCPCS C1713 8750530 - CONNECTOR ROD OFFST 5.5MM 30MM STAINLESS STEEL SPN BOTH IP/OP "$2,482.50" "$1,837.00" $492.71 "$2,482.50" "$1,117.13" "$1,117.13" "$1,117.13" "$1,117.13" "$2,482.50" "$2,482.50" "$2,482.50" $517.42 "$2,482.50" "$2,482.50" "$2,482.50" "$2,482.50" "$2,482.50" $517.38 "$2,482.50" $993.00 "$1,468.40" "$2,482.50" "$2,482.50" "$2,482.50" "$2,482.50" "$1,861.88" "$2,482.50" "$2,482.50" "$2,482.50" "$1,241.25" "$1,241.25" "$1,966.14" "$2,482.50" "$1,986.00" "$1,117.13" $492.71 N/A "$1,439.85" "$2,482.50" "$2,482.50" "$2,482.50" $517.35 "$2,482.50" N/A N/A 8750560 SUP HCPCS C1713 8750560 - CONNECTOR ROD OFFST 5.5MM 60MM STAINLESS STEEL SPN BOTH IP/OP "$2,482.50" "$1,837.00" $492.71 "$2,482.50" "$1,117.13" "$1,117.13" "$1,117.13" "$1,117.13" "$2,482.50" "$2,482.50" "$2,482.50" $517.42 "$2,482.50" "$2,482.50" "$2,482.50" "$2,482.50" "$2,482.50" $517.38 "$2,482.50" $993.00 "$1,468.40" "$2,482.50" "$2,482.50" "$2,482.50" "$2,482.50" "$1,861.88" "$2,482.50" "$2,482.50" "$2,482.50" "$1,241.25" "$1,241.25" "$1,966.14" "$2,482.50" "$1,986.00" "$1,117.13" $492.71 N/A "$1,439.85" "$2,482.50" "$2,482.50" "$2,482.50" $517.35 "$2,482.50" N/A N/A 8754025 SUP HCPCS C1713 8754025 - SCREW BONE 4MM 25MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8754030 SUP HCPCS C1713 8754030 - SCREW BONE 4MM 30MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8754035 SUP HCPCS C1713 8754035 - SCREW BONE 4MM 35MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8754040 SUP HCPCS C1713 8754040 - SCREW BONE 4MM 40MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8754045 SUP HCPCS C1713 8754045 - SCREW BONE 4MM 45MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8754525 SUP HCPCS C1713 8754525 - SCREW BONE 4.5MM 25MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8754530 SUP HCPCS C1713 8754530 - SCREW BONE 4.5MM 30MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8754535 SUP HCPCS C1713 8754535 - SCREW BONE 4.5MM 35MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8754540 SUP HCPCS C1713 8754540 - SCREW BONE 4.5MM 40MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8754545 SUP HCPCS C1713 8754545 - SCREW BONE 4.5MM 45MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8754550 SUP HCPCS C1713 8754550 - SCREW BONE 4.5MM 50MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755025 SUP HCPCS C1713 8755025 - SCREW BONE 5MM 25MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755030 SUP HCPCS C1713 8755030 - SCREW BONE 5MM 30MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755035 SUP HCPCS C1713 8755035 - SCREW BONE 5MM 35MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755040 SUP HCPCS C1713 8755040 - SCREW BONE 5MM 40MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755045 SUP HCPCS C1713 8755045 - SCREW BONE 5MM 45MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755050 SUP HCPCS C1713 8755050 - SCREW BONE 5MM 50MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755525 SUP HCPCS C1713 8755525 - SCREW BONE 5.5MM 25MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755530 SUP HCPCS C1713 8755530 - SCREW BONE 5.5MM 30MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755535 SUP HCPCS C1713 8755535 - SCREW BONE 5.5MM 35MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755540 SUP HCPCS C1713 8755540 - SCREW BONE 5.5MM 40MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755545 SUP HCPCS C1713 8755545 - SCREW BONE 5.5MM 45MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755550 SUP HCPCS C1713 8755550 - SCREW BONE 5.5MM 50MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755555 SUP HCPCS C1713 8755555 - SCREW BONE 5.5MM 55MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755560 SUP HCPCS C1713 8755560 - SCREW BONE 5.5MM 60MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8755565 SUP HCPCS C1713 8755565 - SCREW BONE 5.5MM 65MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8756025 SUP HCPCS C1713 8756025 - SCREW BONE 6MM 25MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8756030 SUP HCPCS C1713 8756030 - SCREW BONE 6MM 30MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8756035 SUP HCPCS C1713 8756035 - SCREW BONE 6MM 35MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8756040 SUP HCPCS C1713 8756040 - SCREW BONE 6MM 40MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8756045 SUP HCPCS C1713 8756045 - SCREW BONE 6MM 45MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8756050 SUP HCPCS C1713 8756050 - SCREW BONE 6MM 50MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8756055 SUP HCPCS C1713 8756055 - SCREW BONE 6MM 55MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8756060 SUP HCPCS C1713 8756060 - SCREW BONE 6MM 60MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$5,192.50" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8756065 SUP HCPCS C1713 8756065 - SCREW BONE 6MM 65MM UNIPLNR STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$5,192.50" "$3,842.00" "$1,030.58" "$5,192.50" "$2,336.63" "$2,336.63" "$2,336.63" "$2,336.63" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.25" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$1,082.17" "$5,192.50" "$2,077.00" "$2,559.90" "$5,192.50" "$5,192.50" "$5,192.50" "$5,192.50" "$3,894.38" "$5,192.50" "$5,192.50" "$5,192.50" "$2,596.25" "$2,596.25" "$4,112.46" "$5,192.50" "$4,154.00" "$2,336.63" "$1,030.58" N/A "$3,011.65" "$5,192.50" "$3,115.50" "$5,192.50" "$1,082.12" "$5,192.50" N/A N/A 8780111 SUP HCPCS C1713 8780111 - SCREW BN 4MM 11MM ARCHON SLF DRL FX ANG SPNE DEGENERATIVE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780113 SUP HCPCS C1713 8780113 - SCREW BN 4MM 13MM ARCHON SLF DRL FX ANG SPNE DEGENERATIVE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780115 SUP HCPCS C1713 8780115 - SCREW BN 4MM 15MM ARCHON SLF DRL FX ANG SPNE DEGENERATIVE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780211 SUP HCPCS C1713 8780211 - SCREW BN 4MM 11MM NS ARCHON SLF DRL VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780213 SUP HCPCS C1713 8780213 - SCREW BN 4MM 13MM ARCHON SLF DRL VA SPNE DEGENERATIVE DISC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780215 SUP HCPCS C1713 8780215 - SCREW BN 4MM 15MM NS ARCHON SLF DRL VA SPNE DEGENERATIVE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8780216 SUP HCPCS C1713 8780216 - SCREW BN 4MM 16MM SLF DRL VAR BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8780311 SUP HCPCS C1713 8780311 - SCREW BN 4MM 11MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8780313 SUP HCPCS C1713 8780313 - SCREW BN 4MM 13MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780319 SUP HCPCS C1713 8780319 - SCREW BN 4MM 19MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780411 SUP HCPCS C1713 8780411 - SCREW BN 4MM 11MM NS ARCHON SLF DRL VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780511 SUP HCPCS C1713 8780511 - SCREW BN 4.5MM 11MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780515 SUP HCPCS C1713 8780515 - SCREW BN 4.5MM 15MM NS ARCHON ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780517 SUP HCPCS C1713 8780517 - SCREW BN 4.5MM 17MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8780519 SUP HCPCS C1713 8780519 - SCREW BN 4.5MM 19MM ARCHON ST FX ANG SPNE DEGENERATIVE DISC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780613 SUP HCPCS C1713 8780613 - SCREW BN 4.5MM 13MM NS ARCHON ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780617 SUP HCPCS C1713 8780617 - SCREW BN 4.5MM 17MM NS ARCHON SLF DRL VA SPNE DEGENERATIVE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8780619 SUP HCPCS C1713 8780619 - SCREW BN 4.5MM 19MM NS ARCHON ST VA SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780711 SUP HCPCS C1713 8780711 - SCREW BN 4MM 11MM NS ARCHON SLF DRL FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780715 SUP HCPCS C1713 8780715 - SCREW BN 4MM 15MM NS ARCHON SLF DRL FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780811 SUP HCPCS C1713 8780811 - SCREW BN 4MM 11MM NS ARCHON ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780813 SUP HCPCS C1713 8780813 - SCREW BN 4MM 13MM NS ARCHON ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780815 SUP HCPCS C1713 8780815 - SCREW BN 4MM 15MM NS ARCHON ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780817 SUP HCPCS C1713 8780817 - SCREW BN 4MM 17MM NS ARCHON ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8780819 SUP HCPCS C1713 8780819 - SCREW BN 4MM 19MM NS ARCHON ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780911 SUP HCPCS C1713 8780911 - SCREW BN 4.5MM 11MM NS ARCHON ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780913 SUP HCPCS C1713 8780913 - SCREW BN 4.5MM 13MM NS ARCHON ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780915 SUP HCPCS C1713 8780915 - SCREW BN 4.5MM 15MM NS ARCHON ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8780917 SUP HCPCS C1713 8780917 - SCREW BN 4.5MM 17MM NS ARCHON SLF DRL FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8780919 SUP HCPCS C1713 8780919 - SCREW BN 4.5MM 19MM NS ARCHON ST FX ANG SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 8787118 SUP HCPCS C1713 8787118 - Archon 18mm plate BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8787120 SUP HCPCS C1713 8787120 - PLATE BN 20MM ARCHON 1 LVL SPNE DEGENERATIVE DISC BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8787128 SUP HCPCS C1713 8787128 - PLATE BN 28MM NS ARCHON 1 LVL SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8787130 SUP HCPCS C1713 8787130 - PLATE BN 30MM NS ARCHON 1 LVL SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8787132 SUP HCPCS C1713 8787132 - PLATE BN 32MM NS ARCHON 1 LVL SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8787234 SUP HCPCS C1713 8787234 - PLATE BN 34MM NS ARCHON 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8787236 SUP HCPCS C1713 8787236 - PLATE BN 36MM NS ARCHON 2 LVL SPNE DEGENERATIVE DISC BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8787238 SUP HCPCS C1713 8787238 - ARCHON 2 LEVEL PLATE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8787240 SUP HCPCS C1713 "8787240 - ARCHON LEVEL2, CERVICAL PLATE" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8787242 SUP HCPCS C1713 8787242 - PLATE BN 42MM ARCHON 2 LVL SPNE DEGENERATIVE DISC BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8787244 SUP HCPCS C1713 "8787244 - ARCHON PLATE, 2 LEVEL, 44MM" BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8787246 SUP HCPCS C1713 8787246 - PLATE BN 46MM NS ARCHON 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8787248 SUP HCPCS C1713 8787248 - PLATE BN 48MM NS ARCHON 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8787250 SUP HCPCS C1713 8787250 - PLATE BN 50MM NS ARCHON 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8787252 SUP HCPCS C1713 8787252 - PLATE BN 52MM NS ARCHON 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 8787254 SUP HCPCS C1713 8787254 - PLATE BN 54MM NS ARCHON 2 LVL SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8787350 SUP HCPCS C1713 8787350 - PLATE BN 50MM NS ARCHON 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8787352 SUP HCPCS C1713 8787352 - PLATE BN 52MM NS ARCHON 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8787356 SUP HCPCS C1713 8787356 - PLATE BN 56MM NS ARCHON 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8787364 SUP HCPCS C1713 8787364 - PLATE BN 64MM NS ARCHON 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8787366 SUP HCPCS C1713 8787366 - PLATE BN 66MM NS ARCHON 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8787368 SUP HCPCS C1713 8787368 - PLATE BN 68MM NS ARCHON 3 LVL SPNE BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8787468 SUP HCPCS C1713 8787468 - PLATE BN 68MM ARCHON 4 LVL SPNE DEGENERATIVE DISC BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 8787474 SUP HCPCS C1713 8787474 - PLATE BN 74MM ARCHON 4 LVL SPNE DEGENERATIVE DISC BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 8787486 SUP HCPCS C1713 8787486 - PLATE BN 86MM ARCHON 4 LVL SPNE DEGENERATIVE DISC BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 8787500 SUP HCPCS C1713 8787500 - PLATE BN 100MM ARCHON 5 LVL SPNE DEGENERATIVE DISC BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$1,200.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 8787510 SUP HCPCS C1713 8787510 - PLATE BN 110MM ARCHON 5 LVL SPNE DEGENERATIVE DISC BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A 8792111 SUP HCPCS C1713 8792111 - SCREW BONE 3.5MM 11MM SELF TAP ZEPHIR TITANIUM SPN CERV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8792113 SUP HCPCS C1713 8792113 - SCREW BONE 3.5MM 13MM SELF TAP ZEPHIR TITANIUM SPN CERV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8792115 SUP HCPCS C1713 8792115 - SCREW BONE 3.5MM 15MM SELF TAP ZEPHIR TITANIUM SPN CERV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8792117 SUP HCPCS C1713 8792117 - SCREW BONE 3.5MM 17MM SELF TAP ZEPHIR TITANIUM SPN CERV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8792711 SUP HCPCS C1713 8792711 - SCREW BONE 4MM 11MM VAR ANG SELF TAP ZEPHIR TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8792713 SUP HCPCS C1713 8792713 - SCREW BONE 4MM 13MM VAR ANG SELF TAP ZEPHIR TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8792715 SUP HCPCS C1713 8792715 - SCREW BONE 4MM 15MM VAR ANG SELF TAP ZEPHIR TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8792717 SUP HCPCS C1713 8792717 - SCREW BONE 4MM 17MM VAR ANG SELF TAP ZEPHIR TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8792811 SUP HCPCS C1713 8792811 - SCREW BONE 3.5MM 11MM VAR ANG SELF DRILL ZEPHIR TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8792813 SUP HCPCS C1713 8792813 - SCREW BONE 3.5MM 13MM VARAX SLFDRILL ZEPHIR SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8792815 SUP HCPCS C1713 8792815 - SCREW BN 3.5MM 15MM NS ZPHR VA SLF DRL TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8792817 SUP HCPCS C1713 8792817 - SCREW BONE 3.5MM 17MM VAR ANG SELF DRILL ZEPHIR TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8792911 SUP HCPCS C1713 8792911 - SCREW BONE SMALL 4MM 11MM VAR ANG SELF DRILL ZEPHIR TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8792913 SUP HCPCS C1713 8792913 - SCREW BONE SMALL 4MM 13MM VAR ANG SELF DRILL ZEPHIR TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 8792915 SUP HCPCS C1713 8792915 - SCREW BN 4MM 15MM NS ZPHR VA SLF DRL TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 8792917 SUP HCPCS C1713 8792917 - SCREW BONE SMALL 4MM 17MM VAR ANG SELF DRILL ZEPHIR TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A 8799022 SUP HCPCS C1713 8799022 - PLATE BONE 22.5MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8799025 SUP HCPCS C1713 8799025 - PLATE BONE 25MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8799027 SUP HCPCS C1713 8799027 - PLATE BONE 27.5MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8799130 SUP HCPCS C1713 8799130 - PLATE BONE 30MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8799132 SUP HCPCS C1713 8799132 - PLATE BONE 32.5MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8799135 SUP HCPCS C1713 8799135 - PLATE BONE 35MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8799137 SUP HCPCS C1713 8799137 - PLATE BONE 37.5MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8799140 SUP HCPCS C1713 8799140 - PLATE BONE 40MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8799142 SUP HCPCS C1713 8799142 - PLATE BONE 42.5MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8799145 SUP HCPCS C1713 8799145 - PLATE BONE 45MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8799147 SUP HCPCS C1713 8799147 - PLATE BONE 47.5MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8799150 SUP HCPCS C1713 8799150 - PLATE BONE 50MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8799152 SUP HCPCS C1713 8799152 - PLATE BONE 52.5MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799155 SUP HCPCS C1713 8799155 - PLATE BONE 55MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM SPN BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799157 SUP HCPCS C1713 8799157 - PLATE BONE 57.5MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799160 SUP HCPCS C1713 8799160 - PLATE BONE 60MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM SPN BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799162 SUP HCPCS C1713 8799162 - PLATE BONE 62.5MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799165 SUP HCPCS C1713 8799165 - PLATE BONE 65MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM SPN BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799167 SUP HCPCS C1713 8799167 - PLATE BONE 67.5MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799170 SUP HCPCS C1713 8799170 - PLATE BONE 70MM INTEGRATE LOCK MECHANISM ZEPHIR TITANIUM SPN BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799180 SUP HCPCS C1713 8799180 - PLATE BONE LORDOTIC 22MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8799190 SUP HCPCS C1713 8799190 - PLATE BONE LORDOTIC 25MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8799200 SUP HCPCS C1713 8799200 - PLATE BONE LORDOTIC 27MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8799230 SUP HCPCS C1713 8799230 - PLATE BONE LORDOTIC 30MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8799232 SUP HCPCS C1713 8799232 - PLATE BONE LORDOTIC 32.5MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8799235 SUP HCPCS C1713 8799235 - PLATE BONE LORDOTIC 35MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8799237 SUP HCPCS C1713 8799237 - PLATE BONE LORDOTIC 37.5MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8799245 SUP HCPCS C1713 8799245 - PLATE BONE LORDOTIC 45MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8799247 SUP HCPCS C1713 8799247 - PLATE BONE LORDOTIC 47.5MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8799250 SUP HCPCS C1713 8799250 - PLATE BONE LORDOTIC 50MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8799252 SUP HCPCS C1713 8799252 - PLATE BONE LORDOTIC 52.5MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799255 SUP HCPCS C1713 8799255 - PLATE BONE LORDOTIC 55MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799257 SUP HCPCS C1713 8799257 - PLATE BONE LORDOTIC 57.5MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799260 SUP HCPCS C1713 8799260 - PLATE BONE LORDOTIC 60MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799262 SUP HCPCS C1713 8799262 - PLATE BONE LORDOTIC 62.5MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799265 SUP HCPCS C1713 8799265 - PLATE BONE LORDOTIC 65MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799267 SUP HCPCS C1713 8799267 - PLATE BONE LORDOTIC 67.5MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8799270 SUP HCPCS C1713 8799270 - PLATE BONE LORDOTIC 70MM 2 HOLE ZEPHIR TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 8800000 SUP HCPCS C1713 8800000 - SCREW SET LOCK MULTIAX PRECEPT SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8801054 SUP Custom 27203010 8801054 - MARKER SRG STRL NDI 4 SPHR IN TRY STD MNT POST DISP BOTH IP/OP $65.00 $48.00 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 N/A $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A 8801068 SUP HCPCS C1769 8801068 - WIRE FIX THREAD PRECEPT KWIRE NITINOL SPN BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 8801269 SUP HCPCS C1713 8801269 - WIRE FX LNG PRCPT GSB MAS KRSH BVL TIP NTNL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 8804525 SUP HCPCS C1713 8804525 - SCREW BONE 4.5MM 25MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8804530 SUP HCPCS C1713 8804530 - SCREW BONE 4.5MM 30MM POLYAX PRECEPT SPN BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 8804535 SUP HCPCS C1713 8804535 - SCREW BONE 4.5MM 35MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8804540 SUP HCPCS C1713 8804540 - SCREW BONE 4.5MM 40MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8804545 SUP HCPCS C1713 8804545 - SCREW BONE 4.5MM 45MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805530 SUP HCPCS C1713 8805530 - SCREW BONE 5.5MM 30MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805535 SUP HCPCS C1713 8805535 - SCREW BONE 5.5MM 35MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805540 SUP HCPCS C1713 8805540 - SCREW BONE 5.5MM 40MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805545 SUP HCPCS C1713 8805545 - SCREW BONE 5.5MM 45MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805550 SUP HCPCS C1713 8805550 - SCREW BONE 5.5MM 50MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805555 SUP HCPCS C1713 8805555 - SCREW BONE 5.5MM 55MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806530 SUP HCPCS C1713 8806530 - SCREW BONE 6.5MM 30MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806535 SUP HCPCS C1713 8806535 - SCREW BONE 6.5MM 35MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806540 SUP HCPCS C1713 8806540 - SCREW BONE 6.5MM 40MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806545 SUP HCPCS C1713 8806545 - SCREW BONE 6.5MM 45MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806550 SUP HCPCS C1713 8806550 - SCREW BONE 6.5MM 50MM MULTIAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806555 SUP HCPCS C1713 8806555 - SCREW BONE 6.5MM 55MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807500 SUP HCPCS C1713 8807500 - SCREW BONE 7.5MM 100MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807530 SUP HCPCS C1713 8807530 - SCREW BONE 7.5MM 30MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807535 SUP HCPCS C1713 8807535 - SCREW BONE 7.5MM 35MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807540 SUP HCPCS C1713 8807540 - SCREW BONE 7.5MM 40MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807545 SUP HCPCS C1713 8807545 - SCREW BONE 7.5MM 45MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807550 SUP HCPCS C1713 8807550 - SCREW BONE 7.5MM 50MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807555 SUP HCPCS C1713 8807555 - SCREW BONE 7.5MM 55MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807560 SUP HCPCS C1713 8807560 - SCREW BONE 7.5MM 60MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807570 SUP HCPCS C1713 8807570 - SCREW BONE 7.5MM 70MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807580 SUP HCPCS C1713 8807580 - SCREW BONE 7.5MM 80MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807590 SUP HCPCS C1713 8807590 - SCREW BONE 7.5MM 90MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808500 SUP HCPCS C1713 8808500 - SCREW BONE 8.5MM 100MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808535 SUP HCPCS C1713 8808535 - SCREW BONE 8.5MM 35MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808540 SUP HCPCS C1713 8808540 - SCREW BONE 8.5MM 40MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808545 SUP HCPCS C1713 8808545 - SCREW BONE 8.5MM 45MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808550 SUP HCPCS C1713 8808550 - SCREW BONE 8.5MM 50MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808555 SUP HCPCS C1713 8808555 - SCREW BONE 8.5MM 55MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808560 SUP HCPCS C1713 8808560 - SCREW BONE 8.5MM 60MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808570 SUP HCPCS C1713 8808570 - SCREW BONE 8.5MM 70MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808580 SUP HCPCS C1713 8808580 - SCREW BONE 8.5MM 80MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808590 SUP HCPCS C1713 8808590 - SCREW BONE 8.5MM 90MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8824525 SUP HCPCS C1713 8824525 - SCREW BN 4.5MM 25MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8824530 SUP HCPCS C1713 8824530 - SCREW BN 4.5MM 30MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8824535 SUP HCPCS C1713 8824535 - SCREW BN 4.5MM 35MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8824540 SUP HCPCS C1713 8824540 - SCREW BN 4.5MM 40MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8824545 SUP HCPCS C1713 8824545 - SCREW BN 4.5MM 45MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8825530 SUP HCPCS C1713 8825530 - SCREW BN 7.5MM 35MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8825545 SUP HCPCS C1713 8825545 - SCREW BN 7.5MM 50MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8825550 SUP HCPCS C1713 8825550 - SCREW BN 7.5MM 55MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8825555 SUP HCPCS C1713 8825555 - SCREW BN 6.5MM 40MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8826530 SUP HCPCS C1713 8826530 - SCREW BN 6.5MM 45MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8826540 SUP HCPCS C1713 8826540 - SCREW BN 6.5MM 40MM NS PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8826550 SUP HCPCS C1713 8826550 - SCREW BN 5.5MM 30MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8826555 SUP HCPCS C1713 8826555 - SCREW BN 5.5MM 35MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8827500 SUP HCPCS C1713 8827500 - SCREW BN 7.5MM 100MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8827530 SUP HCPCS C1713 8827530 - SCREW BN 5.5MM 40MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8827535 SUP HCPCS C1713 8827535 - SCREW BN 5.5MM 45MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8827550 SUP HCPCS C1713 8827550 - SCREW BN 6.5MM 30MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8827555 SUP HCPCS C1713 8827555 - SCREW BN 6.5MM 35MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8827560 SUP HCPCS C1713 8827560 - SCREW BN 7.5MM 60MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8827570 SUP HCPCS C1713 8827570 - SCREW BN 7.5MM 70MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8827580 SUP HCPCS C1713 8827580 - SCREW BN 7.5MM 80MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8827590 SUP HCPCS C1713 8827590 - SCREW BN 7.5MM 90MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8828500 SUP HCPCS C1713 8828500 - SCREW BN 8.5MM 100MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8828535 SUP HCPCS C1713 8828535 - SCREW BN 8.5MM 35MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8828540 SUP HCPCS C1713 8828540 - SCREW BN 8.5MM 40MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8828545 SUP HCPCS C1713 8828545 - SCREW BN 8.5MM 45MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8828550 SUP HCPCS C1713 8828550 - SCREW BN 8.5MM 50MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8828555 SUP HCPCS C1713 8828555 - SCREW BN 8.5MM 55MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8828560 SUP HCPCS C1713 8828560 - SCREW BN 8.5MM 60MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8828570 SUP HCPCS C1713 8828570 - SCREW BN 8.5MM 70MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8828580 SUP HCPCS C1713 8828580 - SCREW BN 8.5MM 80MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8828590 SUP HCPCS C1713 8828590 - SCREW BN 8.5MM 90MM PRCPT RDC SPNE BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 8847020 SUP HCPCS C1713 8847020 - ROD SPINAL PREBENT LORDOTIC 20MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8847025 SUP HCPCS C1713 8847025 - ROD SPINAL PREBENT LORDOTIC 25MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 8847030 SUP HCPCS C1713 8847030 - ROD SPINAL PREBENT LORDOTIC 30MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8847035 SUP HCPCS C1713 8847035 - ROD SPINAL PREBENT LORDOTIC 35MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8847040 SUP HCPCS C1713 8847040 - ROD SPINAL PREBENT LORDOTIC 40MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8847045 SUP HCPCS C1713 8847045 - ROD SPINAL PREBENT LORDOTIC 45MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 8847050 SUP HCPCS C1713 8847050 - ROD SPINAL PREBENT LORDOTIC 50MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8847055 SUP HCPCS C1713 8847055 - ROD SPINAL PREBENT LORDOTIC 55MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8847060 SUP HCPCS C1713 8847060 - ROD SPINAL LORDOTIC PREBENT 60MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8847065 SUP HCPCS C1713 8847065 - ROD SPINAL PREBENT LORDOTIC 65MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8847070 SUP HCPCS C1713 8847070 - ROD SPINAL LORDOTIC PREBENT 70MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8847075 SUP HCPCS C1713 8847075 - ROD SPINAL 4.7MM 75MM PRECEPT BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8847080 SUP HCPCS C1713 8847080 - ROD SPINAL PREBENT LORDOTIC 80MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8847085 SUP HCPCS C1713 8847085 - ROD SPINAL PREBENT LORDOTIC 5MM 85MM PRECEPT BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 8847090 SUP HCPCS C1713 8847090 - ROD SPINAL PREBENT LORDOTIC 90MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 8847095 SUP HCPCS C1713 8847095 - ROD SPINAL LORDOTIC PREBENT 95MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 8847100 SUP HCPCS C1713 8847100 - ROD SPINAL LORDOTIC PREBENT 100MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 8847110 SUP HCPCS C1713 8847110 - ROD SPINAL 4.7MM 110MM PRECEPT BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8847120 SUP HCPCS C1713 8847120 - ROD SPINAL PREBENT LORDOTIC 120MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8847130 SUP HCPCS C1713 8847130 - ROD SPINAL PREBENT LORDOTIC 130MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8847140 SUP HCPCS C1713 8847140 - ROD SPINAL LORDOTIC PREBENT 140MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 8847150 SUP HCPCS C1713 8847150 - ROD SPINAL PREBENT LORDOTIC 150MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 8847160 SUP HCPCS C1713 8847160 - ROD SPINAL PREBENT LORDOTIC 160MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 8848160 SUP HCPCS C1713 8848160 - ROD SPINAL STR 160MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8848170 SUP HCPCS C1713 8848170 - ROD SPINAL STR 170MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8848180 SUP HCPCS C1713 8848180 - ROD SPINAL STR 180MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 8848190 SUP HCPCS C1713 8848190 - ROD SPINAL STR 190MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8848200 SUP HCPCS C1713 8848200 - ROD SPINAL STR 200MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8848210 SUP HCPCS C1713 8848210 - ROD SPINAL STR 210MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8848220 SUP HCPCS C1713 8848220 - ROD SPINAL STR 220MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8848230 SUP HCPCS C1713 8848230 - ROD SPINAL STR 230MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 8848240 SUP HCPCS C1713 8848240 - ROD SPINAL STR 240MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8848250 SUP HCPCS C1713 8848250 - ROD SPINAL STR 250MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8848300 SUP HCPCS C1713 8848300 - ROD SPINAL STR 300MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8848500 SUP HCPCS C1713 8848500 - ROD SPINAL STR 500MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 8848600 SUP HCPCS C1713 8848600 - ROD SPINAL STR 600MM PRECEPT TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8880823 SUP HCPCS C1713 8880823 - SPACER SPNL XLORDOTIC 23MMX8MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$11,698.50" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 8880828 SUP HCPCS C1713 8880828 - SPACER SPNL XLORDOTIC 28MMX8MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 8880832 SUP HCPCS C1713 8880832 - SPACER SPNL XLORDOTIC 32MMX8MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 8880923 SUP HCPCS C1713 8880923 - SPACER SPNL XLORDOTIC 23MMX9MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 8880928 SUP HCPCS C1713 8880928 - SPACER SPNL 28MMX9MM ELEV XLORDOTIC PEEK TI STRL BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$11,698.50" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 8880932 SUP HCPCS C1713 8880932 - SPACER SPNL XLORDOTIC 32MMX9MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 8881023 SUP HCPCS C1713 8881023 - SPACER SPNL XLORDOTIC 23MMX10MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$11,698.50" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 8881028 SUP HCPCS C1713 8881028 - SPACER SPNL XLORDOTIC 28MMX10MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 8881032 SUP HCPCS C1713 8881032 - SPACER SPNL XLORDOTIC 32MMX10MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 8881123 SUP HCPCS C1713 8881123 - SPACER SPNL XLORDOTIC 23MMX11MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 8881128 SUP HCPCS C1713 8881128 - SPACER SPNL XLORDOTIC 28MMX11MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$4,679.40" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 8881132 SUP HCPCS C1713 8881132 - SPACER SPNL XLORDOTIC 32MMX11MM STRL ELEV PEEK TI BOTH IP/OP "$11,698.50" "$8,657.00" "$2,321.86" "$11,698.50" "$5,264.33" "$5,264.33" "$5,264.33" "$5,264.33" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.26" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$2,438.10" "$11,698.50" "$11,698.50" "$5,767.36" "$11,698.50" "$11,698.50" "$11,698.50" "$11,698.50" "$8,773.88" "$11,698.50" "$11,698.50" "$11,698.50" "$5,849.25" "$5,849.25" "$9,265.21" "$11,698.50" "$9,358.80" "$5,264.33" "$2,321.86" N/A "$6,785.13" "$11,698.50" "$7,019.10" "$11,698.50" "$2,437.97" "$11,698.50" N/A N/A 8896555 SUP HCPCS C1713 8896555 - SCREW BONE 6.5MM 55MM GSB PRCPT SPN MDLR CANN SHNK BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" $400.00 $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" $600.00 "$1,000.00" $208.40 "$1,000.00" N/A N/A 8914000 SUP HCPCS C1713 8914000 - SET SCREW M4 BREAK OFF VERTE-SPAN TITANIUM SPN VETERBRAL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8915008 SUP HCPCS C1713 8915008 - SPACER SPNL SM FLT 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915010 SUP HCPCS C1713 8915010 - SPACER SPNL SM FLT 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915012 SUP HCPCS C1713 8915012 - SPACER SPNL SM FLT 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915014 SUP HCPCS C1713 8915014 - SPACER SPNL SM FLT 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915016 SUP HCPCS C1713 8915016 - SPACER SPNL SM FLT 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915018 SUP HCPCS C1713 8915018 - SPACER SPNL SM FLT 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915020 SUP HCPCS C1713 8915020 - SPACER SPNL SM FLT 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915408 SUP HCPCS C1713 8915408 - SPACER SPNL SM LRDTC 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915410 SUP HCPCS C1713 8915410 - SPACER SPNL SM LRDTC 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915412 SUP HCPCS C1713 8915412 - SPACER SPNL SM LRDTC 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915414 SUP HCPCS C1713 8915414 - SPACER SPNL SM LRDTC 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915416 SUP HCPCS C1713 8915416 - SPACER SPNL SM LRDTC 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915418 SUP HCPCS C1713 8915418 - SPACER SPNL SM LRDTC 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915420 SUP HCPCS C1713 8915420 - SPACER SPNL SM LRDTC 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915805 SUP HCPCS C1713 8915805 - SPACER SPNL SM 5MM STRL VRTSTCK CENTERPIECE PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915810 SUP HCPCS C1713 8915810 - SPACER SPNL SM 10MM STRL VRTSTCK CENTERPIECE PEEK LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915820 SUP HCPCS C1713 8915820 - SPACER SPNL SM 20MM STRL VRTSTCK CENTERPIECE PEEK LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915830 SUP HCPCS C1713 8915830 - SPACER SPNL SM 30MM STRL VRTSTCK CENTERPIECE PEEK LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8915840 SUP HCPCS C1713 8915840 - SPACER SPNL SM 40MM STRL VRTSTCK CENTERPIECE PEEK LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916008 SUP HCPCS C1713 8916008 - SPACER SPNL LG FLT 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916010 SUP HCPCS C1713 8916010 - SPACER SPNL LG FLT 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916012 SUP HCPCS C1713 8916012 - SPACER SPNL LG FLT 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916014 SUP HCPCS C1713 8916014 - SPACER SPNL LG FLT 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916016 SUP HCPCS C1713 8916016 - SPACER SPNL LG FLT 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916018 SUP HCPCS C1713 8916018 - SPACER SPNL LG FLT 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916020 SUP HCPCS C1713 8916020 - SPACER SPNL LG FLT 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916408 SUP HCPCS C1713 8916408 - SPACER SPNL LG LRDTC 8MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916410 SUP HCPCS C1713 8916410 - SPACER SPNL LG LRDTC 10MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916412 SUP HCPCS C1713 8916412 - SPACER SPNL LG LRDTC 12MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916414 SUP HCPCS C1713 8916414 - SPACER SPNL LG LRDTC 14MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916416 SUP HCPCS C1713 8916416 - SPACER SPNL LG LRDTC 16MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916418 SUP HCPCS C1713 8916418 - SPACER SPNL LG LRDTC 18MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916420 SUP HCPCS C1713 8916420 - SPACER SPNL LG LRDTC 20MM STRL VRTSTCK ADON PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916805 SUP HCPCS C1713 8916805 - SPACER SPNL LG 5MM STRL VRTSTCK CENTERPIECE PEEK LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916810 SUP HCPCS C1713 8916810 - SPACER SPNL LG 10MM STRL VRTSTCK CENTERPIECE PEEK LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916820 SUP HCPCS C1713 8916820 - SPACER SPNL LG 20MM STRL VRTSTCK CENTERPIECE PEEK LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916830 SUP HCPCS C1713 8916830 - SPACER SPNL LG 30MM STRL VRTSTCK CENTERPIECE PEEK LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8916840 SUP HCPCS C1713 8916840 - SPACER SPNL LG 40MM STRL VRTSTCK CENTERPIECE PEEK LMBR BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 8941420 SUP Custom 27803010 8941420 - CAGE SPNL 14MM 20X17MM LTCG TI LMBR TPR FSN DEV BOTH IP/OP "$7,226.50" "$5,348.00" "$1,286.27" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$1,286.27" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$1,506.03" "$7,226.25" "$2,890.50" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$5,419.88" "$7,226.25" "$7,226.25" "$7,226.25" "$3,613.13" "$3,613.13" "$5,723.19" "$7,226.25" "$5,781.00" "$3,251.81" "$7,226.25" N/A "$4,191.37" "$7,226.25" "$4,335.75" "$7,226.25" "$7,226.25" "$7,226.25" N/A N/A 8941423 SUP Custom 27803010 8941423 - CAGE SPNL 14MM 23X17.5MM LTCG TI LMBR TPR FSN DEV BOTH IP/OP "$7,226.50" "$5,348.00" "$1,286.27" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$1,286.27" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$1,506.03" "$7,226.25" "$2,890.50" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$5,419.88" "$7,226.25" "$7,226.25" "$7,226.25" "$3,613.13" "$3,613.13" "$5,723.19" "$7,226.25" "$5,781.00" "$3,251.81" "$7,226.25" N/A "$4,191.37" "$7,226.25" "$4,335.75" "$7,226.25" "$7,226.25" "$7,226.25" N/A N/A 8941620 SUP Custom 27803010 8941620 - CAGE SPNL 16MM 20X19MM LTCG TI LMBR TPR FSN DEV BOTH IP/OP "$7,226.50" "$5,348.00" "$1,286.27" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$1,286.27" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$1,506.03" "$7,226.25" "$2,890.50" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$5,419.88" "$7,226.25" "$7,226.25" "$7,226.25" "$3,613.13" "$3,613.13" "$5,723.19" "$7,226.25" "$5,781.00" "$3,251.81" "$7,226.25" N/A "$4,191.37" "$7,226.25" "$4,335.75" "$7,226.25" "$7,226.25" "$7,226.25" N/A N/A 8941623 SUP Custom 27803010 8941623 - CAGE SPNL 16MM 23X19MM LTCG TI LMBR TPR FSN DEV BOTH IP/OP "$7,226.50" "$5,348.00" "$1,286.27" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$1,286.27" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$1,506.03" "$7,226.25" "$2,890.50" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$5,419.88" "$7,226.25" "$7,226.25" "$7,226.25" "$3,613.13" "$3,613.13" "$5,723.19" "$7,226.25" "$5,781.00" "$3,251.81" "$7,226.25" N/A "$4,191.37" "$7,226.25" "$4,335.75" "$7,226.25" "$7,226.25" "$7,226.25" N/A N/A 8941626 SUP Custom 27803010 8941626 - CAGE SPNL 16MM 26X20MM LTCG TI LMBR TPR FSN DEV BOTH IP/OP "$7,226.50" "$5,348.00" "$1,286.27" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$1,286.27" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$1,506.03" "$7,226.25" "$2,890.50" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$5,419.88" "$7,226.25" "$7,226.25" "$7,226.25" "$3,613.13" "$3,613.13" "$5,723.19" "$7,226.25" "$5,781.00" "$3,251.81" "$7,226.25" N/A "$4,191.37" "$7,226.25" "$4,335.75" "$7,226.25" "$7,226.25" "$7,226.25" N/A N/A 8941823 SUP Custom 27803010 8941823 - CAGE SPNL 18MM 23X21.5MM LTCG TI LMBR TPR FSN DEV BOTH IP/OP "$7,226.50" "$5,348.00" "$1,286.27" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$1,286.27" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$1,506.03" "$7,226.25" "$2,890.50" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$5,419.88" "$7,226.25" "$7,226.25" "$7,226.25" "$3,613.13" "$3,613.13" "$5,723.19" "$7,226.25" "$5,781.00" "$3,251.81" "$7,226.25" N/A "$4,191.37" "$7,226.25" "$4,335.75" "$7,226.25" "$7,226.25" "$7,226.25" N/A N/A 8941826 SUP Custom 27803010 8941826 - CAGE SPNL 18MM 26X22MM LTCG TI LMBR TPR FSN DEV BOTH IP/OP "$7,226.50" "$5,348.00" "$1,286.27" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$1,286.27" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$1,506.03" "$7,226.25" "$2,890.50" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$7,226.25" "$5,419.88" "$7,226.25" "$7,226.25" "$7,226.25" "$3,613.13" "$3,613.13" "$5,723.19" "$7,226.25" "$5,781.00" "$3,251.81" "$7,226.25" N/A "$4,191.37" "$7,226.25" "$4,335.75" "$7,226.25" "$7,226.25" "$7,226.25" N/A N/A 8954025 SUP HCPCS C1713 8954025 - SCREW BONE 4MM 25MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8954030 SUP HCPCS C1713 8954030 - SCREW BONE 4MM 30MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8954035 SUP HCPCS C1713 8954035 - SCREW BONE 4MM 35MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$2,802.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8954525 SUP HCPCS C1713 8954525 - SCREW BONE 4.5MM 25MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$2,802.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8954530 SUP HCPCS C1713 8954530 - SCREW BONE 4.5MM 30MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$2,802.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8954535 SUP HCPCS C1713 8954535 - SCREW BONE 4.5MM 35MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$2,802.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8954540 SUP HCPCS C1713 8954540 - SCREW BONE 4.5MM 40MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$2,802.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8954545 SUP HCPCS C1713 8954545 - SCREW BONE 4.5MM 45MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8955530 SUP HCPCS C1713 8955530 - SCREW BONE 5.5MM 30MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8955535 SUP HCPCS C1713 8955535 - SCREW BONE 5.5MM 35MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8955540 SUP HCPCS C1713 8955540 - SCREW BONE 5.5MM 40MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$2,802.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8955545 SUP HCPCS C1713 8955545 - SCREW BONE 5.5MM 45MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$2,802.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8956535 SUP HCPCS C1713 8956535 - SCREW BONE 6.5MM 35MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$2,802.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8956540 SUP HCPCS C1713 8956540 - SCREW BONE 6.5MM 40MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$2,802.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8956545 SUP HCPCS C1713 8956545 - SCREW BONE 6.5MM 45MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$2,802.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8956550 SUP HCPCS C1713 8956550 - SCREW BONE 6.5MM 50MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8957535 SUP HCPCS C1713 8957535 - SCREW BONE 7.5MM 35MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$2,802.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8957540 SUP HCPCS C1713 8957540 - SCREW BONE 7.5MM 40MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8957545 SUP HCPCS C1713 8957545 - SCREW BONE 7.5MM 45MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8957550 SUP HCPCS C1713 8957550 - SCREW BONE 7.5MM 50MM FIX STAINLESS STEEL SPN 5.5MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$2,802.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8964525 SUP HCPCS C1713 8964525 - SCREW BONE 4.5MM 25MM SS SPNL FIX 6.35MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8964530 SUP HCPCS C1713 8964530 - SCREW BONE 4.5MM 30MM SS SPNL FIX 6.35MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8964535 SUP HCPCS C1713 8964535 - SCREW BONE 4.5MM 35MM SS SPNL FIX 6.35MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$2,802.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8964540 SUP HCPCS C1713 8964540 - SCREW BONE 4.5MM 40MM SS SPNL FIX 6.35MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8964545 SUP HCPCS C1713 8964545 - SCREW BONE 4.5MM 45MM SS SPNL FIX 6.35MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8965530 SUP HCPCS C1713 8965530 - SCREW BONE 5.5MM 30MM SS SPNL FIX 6.35MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8965535 SUP HCPCS C1713 8965535 - SCREW BONE 5.5MM 35MM SS SPNL FIX 6.35MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8965540 SUP HCPCS C1713 8965540 - SCREW BONE 5.5MM 40MM SS SPNL FIX 6.35MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8965545 SUP HCPCS C1713 8965545 - SCREW BONE 5.5MM 45MM SS SPNL FIX 6.35MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8966535 SUP HCPCS C1713 8966535 - SCREW BONE 6.5MM 35MM SS SPNL FIX 6.35MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8966540 SUP HCPCS C1713 8966540 - SCREW BONE 6.5MM 40MM SS SPNL FIX 6.35MM ROD BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$1,121.00" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8966545 SUP HCPCS C1713 8966545 - SCREW BONE 6.5MM 6.35MM 45MM SS SPNL FIX BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8966550 SUP HCPCS C1713 8966550 - SCREW BONE 6.5MM 6.35MM 50MM SS SPNL FIX BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8967535 SUP HCPCS C1713 8967535 - SCREW BONE 7.5MM 6.35MM 35MM SS SPNL FIX BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8967540 SUP HCPCS C1713 8967540 - SCREW BONE 7.5MM 6.35MM 40MM SS SPNL FIX BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8967545 SUP HCPCS C1713 8967545 - SCREW BONE 7.5MM 6.35MM 45MM SS SPNL FIX BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8967550 SUP HCPCS C1713 8967550 - SCREW BONE 7.5MM 6.35MM 50MM SS SPNL FIX BOTH IP/OP "$2,802.50" "$2,074.00" $556.23 "$2,802.50" "$1,261.13" "$1,261.13" "$1,261.13" "$1,261.13" "$2,802.50" "$2,802.50" "$2,802.50" $584.11 "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" $584.07 "$2,802.50" "$2,802.50" "$1,381.63" "$2,802.50" "$2,802.50" "$2,802.50" "$2,802.50" "$2,101.88" "$2,802.50" "$2,802.50" "$2,802.50" "$1,401.25" "$1,401.25" "$2,219.58" "$2,802.50" "$2,242.00" "$1,261.13" $556.23 N/A "$1,625.45" "$2,802.50" "$1,681.50" "$2,802.50" $584.04 "$2,802.50" N/A N/A 8968625 SUP HCPCS C1713 8968625 - SCREW BONE 6.5MM 25MM FIX ANGLE PYRAMID TITANIUM SPN CERV BOTH IP/OP $880.50 $652.00 $174.76 $880.50 $396.23 $396.23 $396.23 $396.23 $880.50 $880.50 $880.50 $183.52 $880.50 $880.50 $880.50 $880.50 $880.50 $183.51 $880.50 $352.20 $520.82 $880.50 $880.50 $880.50 $880.50 $660.38 $880.50 $880.50 $880.50 $440.25 $440.25 $697.36 $880.50 $704.40 $396.23 $174.76 N/A $510.69 $880.50 $528.30 $880.50 $183.50 $880.50 N/A N/A 8968630 SUP HCPCS C1713 8968630 - SCREW BONE 6.5MM 30MM FIX ANGLE PYRAMID TITANIUM SPN CERV BOTH IP/OP $880.50 $652.00 $174.76 $880.50 $396.23 $396.23 $396.23 $396.23 $880.50 $880.50 $880.50 $183.52 $880.50 $880.50 $880.50 $880.50 $880.50 $183.51 $880.50 $880.50 $520.82 $880.50 $880.50 $880.50 $880.50 $660.38 $880.50 $880.50 $880.50 $440.25 $440.25 $697.36 $880.50 $704.40 $396.23 $174.76 N/A $510.69 $880.50 $528.30 $880.50 $183.50 $880.50 N/A N/A 8968635 SUP HCPCS C1713 8968635 - SCREW BONE 6.5MM 35MM FIX ANGLE PYRAMID TITANIUM SPN CERV BOTH IP/OP $880.50 $652.00 $174.76 $880.50 $396.23 $396.23 $396.23 $396.23 $880.50 $880.50 $880.50 $183.52 $880.50 $880.50 $880.50 $880.50 $880.50 $183.51 $880.50 $880.50 $520.82 $880.50 $880.50 $880.50 $880.50 $660.38 $880.50 $880.50 $880.50 $440.25 $440.25 $697.36 $880.50 $704.40 $396.23 $174.76 N/A $510.69 $880.50 $528.30 $880.50 $183.50 $880.50 N/A N/A 8969117 SUP HCPCS C1713 8969117 - PLATE BONE TRIANGLE CNTOUR LP 17X29X35MM 1 HOLE SMOOTH BOTH IP/OP "$8,377.50" "$6,199.00" "$1,662.72" "$8,377.50" "$3,769.88" "$3,769.88" "$3,769.88" "$3,769.88" "$8,377.50" "$8,377.50" "$8,377.50" "$1,746.08" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$1,745.96" "$8,377.50" "$8,377.50" "$4,130.11" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$6,283.13" "$8,377.50" "$8,377.50" "$8,377.50" "$4,188.75" "$4,188.75" "$6,634.98" "$8,377.50" "$6,702.00" "$3,769.88" "$1,662.72" N/A "$4,858.95" "$8,377.50" "$5,026.50" "$8,377.50" "$1,745.87" "$8,377.50" N/A N/A 8969119 SUP HCPCS C1713 8969119 - PLATE BONE TRIANGLE CNTOUR LP 19X29X35MM 1 HOLE SMOOTH BOTH IP/OP "$8,377.50" "$6,199.00" "$1,662.72" "$8,377.50" "$3,769.88" "$3,769.88" "$3,769.88" "$3,769.88" "$8,377.50" "$8,377.50" "$8,377.50" "$1,746.08" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$1,745.96" "$8,377.50" "$8,377.50" "$4,130.11" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$6,283.13" "$8,377.50" "$8,377.50" "$8,377.50" "$4,188.75" "$4,188.75" "$6,634.98" "$8,377.50" "$6,702.00" "$3,769.88" "$1,662.72" N/A "$4,858.95" "$8,377.50" "$8,377.50" "$8,377.50" "$1,745.87" "$8,377.50" N/A N/A 8969121 SUP HCPCS C1713 8969121 - PLATE BONE TRIANGLE CNTOUR LP 21X29X35MM 1 HOLE SMOOTH BOTH IP/OP "$8,377.50" "$6,199.00" "$1,662.72" "$8,377.50" "$3,769.88" "$3,769.88" "$3,769.88" "$3,769.88" "$8,377.50" "$8,377.50" "$8,377.50" "$1,746.08" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$1,745.96" "$8,377.50" "$3,351.00" "$4,130.11" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$6,283.13" "$8,377.50" "$8,377.50" "$8,377.50" "$4,188.75" "$4,188.75" "$6,634.98" "$8,377.50" "$6,702.00" "$3,769.88" "$1,662.72" N/A "$4,858.95" "$8,377.50" "$8,377.50" "$8,377.50" "$1,745.87" "$8,377.50" N/A N/A 8969123 SUP HCPCS C1713 8969123 - PLATE BONE TRIANGLE CNTOUR LP 23X29X37MM 1 HOLE SMOOTH BOTH IP/OP "$8,377.50" "$6,199.00" "$1,662.72" "$8,377.50" "$3,769.88" "$3,769.88" "$3,769.88" "$3,769.88" "$8,377.50" "$8,377.50" "$8,377.50" "$1,746.08" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$1,745.96" "$8,377.50" "$3,351.00" "$4,130.11" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$6,283.13" "$8,377.50" "$8,377.50" "$8,377.50" "$4,188.75" "$4,188.75" "$6,634.98" "$8,377.50" "$6,702.00" "$3,769.88" "$1,662.72" N/A "$4,858.95" "$8,377.50" "$5,026.50" "$8,377.50" "$1,745.87" "$8,377.50" N/A N/A 8969125 SUP HCPCS C1713 8969125 - PLATE BONE TRIANGLE CNTOUR LP 25X29X39MM 1 HOLE SMOOTH BOTH IP/OP "$8,377.50" "$6,199.00" "$1,662.72" "$8,377.50" "$3,769.88" "$3,769.88" "$3,769.88" "$3,769.88" "$8,377.50" "$8,377.50" "$8,377.50" "$1,746.08" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$1,745.96" "$8,377.50" "$3,351.00" "$4,130.11" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$6,283.13" "$8,377.50" "$8,377.50" "$8,377.50" "$4,188.75" "$4,188.75" "$6,634.98" "$8,377.50" "$6,702.00" "$3,769.88" "$1,662.72" N/A "$4,858.95" "$8,377.50" "$5,026.50" "$8,377.50" "$1,745.87" "$8,377.50" N/A N/A 8969127 SUP HCPCS C1713 8969127 - PLATE BONE TRIANGLE CNTOUR LP 27X29X39MM 1 HOLE SMOOTH BOTH IP/OP "$8,377.50" "$6,199.00" "$1,662.72" "$8,377.50" "$3,769.88" "$3,769.88" "$3,769.88" "$3,769.88" "$8,377.50" "$8,377.50" "$8,377.50" "$1,746.08" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$1,745.96" "$8,377.50" "$8,377.50" "$4,130.11" "$8,377.50" "$8,377.50" "$8,377.50" "$8,377.50" "$6,283.13" "$8,377.50" "$8,377.50" "$8,377.50" "$4,188.75" "$4,188.75" "$6,634.98" "$8,377.50" "$6,702.00" "$3,769.88" "$1,662.72" N/A "$4,858.95" "$8,377.50" "$8,377.50" "$8,377.50" "$1,745.87" "$8,377.50" N/A N/A 8969201 SUP HCPCS C1713 8969201 - SCREW SET SPN LOCKING PLATE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8969217 SUP HCPCS C1713 8969217 - PLATE BONE TRIANGLE CNTOUR SPIRAL LP 17X29X35MM 2 HOLE BOTH IP/OP "$1,105.50" $818.00 $219.41 "$1,105.50" $497.48 $497.48 $497.48 $497.48 "$1,105.50" "$1,105.50" "$1,105.50" $230.41 "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" $230.40 "$1,105.50" "$1,105.50" $653.90 "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" $829.13 "$1,105.50" "$1,105.50" "$1,105.50" $552.75 $552.75 $875.56 "$1,105.50" $884.40 $497.48 $219.41 N/A $641.19 "$1,105.50" $663.30 "$1,105.50" $230.39 "$1,105.50" N/A N/A 8969219 SUP HCPCS C1713 8969219 - PLATE BONE TRIANGLE CNTOUR SPIRAL LP 19X29X35MM 2 HOLE BOTH IP/OP "$1,105.50" $818.00 $219.41 "$1,105.50" $497.48 $497.48 $497.48 $497.48 "$1,105.50" "$1,105.50" "$1,105.50" $230.41 "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" $230.40 "$1,105.50" "$1,105.50" $653.90 "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" $829.13 "$1,105.50" "$1,105.50" "$1,105.50" $552.75 $552.75 $875.56 "$1,105.50" $884.40 $497.48 $219.41 N/A $641.19 "$1,105.50" $663.30 "$1,105.50" $230.39 "$1,105.50" N/A N/A 8969221 SUP HCPCS C1713 8969221 - PLATE BONE TRIANGLE CNTOUR SPIRAL LP 21X29X35MM 2 HOLE BOTH IP/OP "$1,105.50" $818.00 $219.41 "$1,105.50" $497.48 $497.48 $497.48 $497.48 "$1,105.50" "$1,105.50" "$1,105.50" $230.41 "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" $230.40 "$1,105.50" $442.20 $653.90 "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" $829.13 "$1,105.50" "$1,105.50" "$1,105.50" $552.75 $552.75 $875.56 "$1,105.50" $884.40 $497.48 $219.41 N/A $641.19 "$1,105.50" "$1,105.50" "$1,105.50" $230.39 "$1,105.50" N/A N/A 8969223 SUP HCPCS C1713 8969223 - PLATE BONE TRIANGLE CNTOUR SPIRAL LP 23X29X37MM 2 HOLE BOTH IP/OP "$1,105.50" $818.00 $219.41 "$1,105.50" $497.48 $497.48 $497.48 $497.48 "$1,105.50" "$1,105.50" "$1,105.50" $230.41 "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" $230.40 "$1,105.50" $442.20 $653.90 "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" $829.13 "$1,105.50" "$1,105.50" "$1,105.50" $552.75 $552.75 $875.56 "$1,105.50" $884.40 $497.48 $219.41 N/A $641.19 "$1,105.50" $663.30 "$1,105.50" $230.39 "$1,105.50" N/A N/A 8969225 SUP HCPCS C1713 8969225 - PLATE BONE TRIANGLE CNTOUR SPIRAL LP 25X29X39MM 2 HOLE BOTH IP/OP "$1,105.50" $818.00 $219.41 "$1,105.50" $497.48 $497.48 $497.48 $497.48 "$1,105.50" "$1,105.50" "$1,105.50" $230.41 "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" $230.40 "$1,105.50" $442.20 $653.90 "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" $829.13 "$1,105.50" "$1,105.50" "$1,105.50" $552.75 $552.75 $875.56 "$1,105.50" $884.40 $497.48 $219.41 N/A $641.19 "$1,105.50" $663.30 "$1,105.50" $230.39 "$1,105.50" N/A N/A 8969227 SUP HCPCS C1713 8969227 - PLATE BONE 27MM COVER PYRAMID TITANIUM SPN LUMBAR ANTERIOR BOTH IP/OP "$1,105.50" $818.00 $219.41 "$1,105.50" $497.48 $497.48 $497.48 $497.48 "$1,105.50" "$1,105.50" "$1,105.50" $230.41 "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" $230.40 "$1,105.50" "$1,105.50" $653.90 "$1,105.50" "$1,105.50" "$1,105.50" "$1,105.50" $829.13 "$1,105.50" "$1,105.50" "$1,105.50" $552.75 $552.75 $875.56 "$1,105.50" $884.40 $497.48 $219.41 N/A $641.19 "$1,105.50" $663.30 "$1,105.50" $230.39 "$1,105.50" N/A N/A 8970000 SUP HCPCS C1713 8970000 - SCREW LOCK 2 VUE POINT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8970240 SUP HCPCS C1713 "8970240 - VUE POINT II, ROD TEMPLATE" BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A 8975310 SUP HCPCS C1713 8975310 - SCREW BN 3.5MM 10MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975312 SUP HCPCS C1713 8975312 - SCREW BN 3.5MM 12MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975314 SUP HCPCS C1713 8975314 - SCREW BN 3.5MM 14MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975318 SUP HCPCS C1713 8975318 - SCREW BN 3.5MM 18MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975320 SUP HCPCS C1713 8975320 - SCREW BN 3.5MM 20MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975322 SUP HCPCS C1713 8975322 - SCREW BN 3.5MM 22MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975324 SUP HCPCS C1713 8975324 - SCREW BN 3.5MM 24MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975326 SUP HCPCS C1713 8975326 - SCREW BN 3.5MM 26MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975328 SUP HCPCS C1713 8975328 - SCREW BN 3.5MM 28MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975330 SUP HCPCS C1713 8975330 - SCREW BN 3.5MM 30MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975332 SUP HCPCS C1713 8975332 - SCREW BN 3.5MM 32MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975334 SUP HCPCS C1713 8975334 - SCREW BN 3.5MM 34MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975410 SUP HCPCS C1713 8975410 - SCREW BN 4MM 10MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975412 SUP HCPCS C1713 8975412 - SCREW BN 4MM 12MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975414 SUP HCPCS C1713 8975414 - SCREW BN 4MM 14MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975416 SUP HCPCS C1713 8975416 - SCREW BN 4MM 16MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975418 SUP HCPCS C1713 8975418 - SCREW BN 4MM 18MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975420 SUP HCPCS C1713 8975420 - SCREW BN 4MM 20MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975422 SUP HCPCS C1713 8975422 - SCREW BN 4MM 22MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975424 SUP HCPCS C1713 8975424 - SCREW BN 4MM 24MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975426 SUP HCPCS C1713 8975426 - SCREW BN 4MM 26MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975428 SUP HCPCS C1713 8975428 - SCREW BN 4MM 28MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975430 SUP HCPCS C1713 8975430 - SCREW BN 4MM 30MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975432 SUP HCPCS C1713 8975432 - SCREW BN 4MM 32MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975434 SUP HCPCS C1713 8975434 - SCREW BN 4MM 34MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975436 SUP HCPCS C1713 8975436 - SCREW BN 4MM 36MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975438 SUP HCPCS C1713 8975438 - SCREW BN 4MM 38MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975440 SUP HCPCS C1713 8975440 - SCREW BN 4MM 40MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975510 SUP HCPCS C1713 8975510 - SCREW BONE 3.5MM 10MM FAVORED ANGLE SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975512 SUP HCPCS C1713 8975512 - SCREW BONE 2MM 12MM VUEPOINT POSTERIOR CERV SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975514 SUP HCPCS C1713 8975514 - SCREW BONE 3.5MM 14MM VUEPOINT SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975516 SUP HCPCS C1713 8975516 - SCREW BN 3.5MM 16MM VUEPOINT II FAVOR ANG SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975518 SUP HCPCS C1713 8975518 - SCREW BN 3.5MM 18MM NS VUEPOINT II FAVORED ANG SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975526 SUP HCPCS C1713 8975526 - SCREW BN 3.5MM 26MM NS VUEPOINT II FAVORED ANG SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975528 SUP HCPCS C1713 8975528 - SCREW BN 3.5MM 28MM NS VUEPOINT II FAVORED ANG SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975530 SUP HCPCS C1713 8975530 - SCREW BN 3.5MM 30MM NS VUEPOINT II FAVORED ANG SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975532 SUP HCPCS C1713 8975532 - SCREW BN 3.5MM 32MM NS VUEPOINT II FAVORED ANG SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975534 SUP HCPCS C1713 8975534 - SCREW BN 3.5MM 34MM NS VUEPOINT II FAVORED ANG SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975618 SUP HCPCS C1713 8975618 - SCREW BN 4MM 18MM VUEPOINT II FAVOR ANG SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975622 SUP HCPCS C1713 "8975622 - VUE POINT 2, 4.0X 22MM, FAVORED ANGLE" BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975624 SUP HCPCS C1713 8975624 - VUE POINT 2 4.0X 24MM SCREW BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975636 SUP HCPCS C1713 8975636 - SCREW BN 4MM 36MM NS VUEPOINT II FAVORED ANG SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975638 SUP HCPCS C1713 8975638 - SCREW BN 4MM 38MM NS VUEPOINT II FAVORED ANG SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975640 SUP HCPCS C1713 8975640 - SCREW BN 4MM 40MM NS VUEPOINT II FAVORED ANG SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975710 SUP HCPCS C1713 8975710 - SCREW BN 4.5MM 10MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975712 SUP HCPCS C1713 8975712 - SCREW BN 4.5MM 12MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975716 SUP HCPCS C1713 8975716 - SCREW BN 4.5MM 16MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975718 SUP HCPCS C1713 8975718 - SCREW BN 4.5MM 18MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975720 SUP HCPCS C1713 8975720 - VUE POINT 435 X 20 BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975722 SUP HCPCS C1713 8975722 - SCREW BN 4.5MM 22MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975724 SUP HCPCS C1713 8975724 - SCREW BONE MULTIAX TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975726 SUP HCPCS C1713 8975726 - SCREW BN 4.5MM 26MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975728 SUP HCPCS C1713 8975728 - VUEPOINT 2 MULTI-AXIAL SCREW 4.5 X28 BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975732 SUP HCPCS C1713 "8975732 - VUE POINT II, SCREW 4.5X32MM" BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975734 SUP HCPCS C1713 "8975734 - VUE POINT II, SCREW 4.5X34MM" BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975736 SUP HCPCS C1713 "8975736 - VUE POINT II, SCREW 4.5X36MM" BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975738 SUP HCPCS C1713 "8975738 - VUE POINT II, SCREW 4.5X38MM" BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975740 SUP HCPCS C1713 8975740 - SCREW BN 4.5MM 40MM NS VUEPOINT II MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975824 SUP HCPCS C1713 8975824 - SCREW BN P/T 3.5MM 24MM NS VUEPOINT II FAVORED ANG SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975834 SUP HCPCS C1713 8975834 - SCREW BN P/T 3.5MM 34MM VUEPOINT II FAVOR ANG SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8975838 SUP HCPCS C1713 "8975838 - VUE POINT II, FA/PT SCREW 3.5X38" BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8976006 SUP HCPCS C1713 8976006 - HOOK SPNL 6MM NS VUEPOINT II LMN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8976008 SUP HCPCS C1713 8976008 - HOOK SPNL 8MM NS VUEPOINT II LMN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8976011 SUP HCPCS C1713 8976011 - CONNECTOR ROD 11MM OFST VUEPOINT II OPN SPNE BOTH IP/OP "$1,095.00" $810.00 $217.33 "$1,095.00" $492.75 $492.75 $492.75 $492.75 "$1,095.00" "$1,095.00" "$1,095.00" $228.23 "$1,095.00" "$1,095.00" "$1,095.00" "$1,095.00" "$1,095.00" $228.21 "$1,095.00" "$1,095.00" $647.69 "$1,095.00" "$1,095.00" "$1,095.00" "$1,095.00" $821.25 "$1,095.00" "$1,095.00" "$1,095.00" $547.50 $547.50 $867.24 "$1,095.00" $876.00 $492.75 $217.33 N/A $635.10 "$1,095.00" "$1,095.00" "$1,095.00" $228.20 "$1,095.00" N/A N/A 8976025 SUP HCPCS C1713 8976025 - CONNECTOR ROD 25MM LNG OFST NS VUEPOINT II OPN SPNE BOTH IP/OP "$1,222.50" $905.00 $242.64 "$1,222.50" $550.13 $550.13 $550.13 $550.13 "$1,222.50" "$1,222.50" "$1,222.50" $254.80 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $254.78 "$1,222.50" $489.00 $723.11 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $916.88 "$1,222.50" "$1,222.50" "$1,222.50" $611.25 $611.25 $968.22 "$1,222.50" $978.00 $550.13 $242.64 N/A $709.05 "$1,222.50" "$1,222.50" "$1,222.50" $254.77 "$1,222.50" N/A N/A 8976030 SUP HCPCS C1713 8976030 - CONNECTOR ROD 45D OFST NS VUEPOINT II SPNE BOTH IP/OP "$1,222.50" $905.00 $242.64 "$1,222.50" $550.13 $550.13 $550.13 $550.13 "$1,222.50" "$1,222.50" "$1,222.50" $254.80 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $254.78 "$1,222.50" "$1,222.50" $723.11 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $916.88 "$1,222.50" "$1,222.50" "$1,222.50" $611.25 $611.25 $968.22 "$1,222.50" $978.00 $550.13 $242.64 N/A $709.05 "$1,222.50" "$1,222.50" "$1,222.50" $254.77 "$1,222.50" N/A N/A 8976035 SUP HCPCS C1713 8976035 - CONNECTOR ROD 3.5MM NS VUEPOINT II INLN SPNE BOTH IP/OP "$1,867.50" "$1,382.00" $370.65 "$1,867.50" $840.38 $840.38 $840.38 $840.38 "$1,867.50" "$1,867.50" "$1,867.50" $389.23 "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" $389.21 "$1,867.50" $747.00 "$1,104.63" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,400.63" "$1,867.50" "$1,867.50" "$1,867.50" $933.75 $933.75 "$1,479.06" "$1,867.50" "$1,494.00" $840.38 $370.65 N/A "$1,083.15" "$1,867.50" "$1,120.50" "$1,867.50" $389.19 "$1,867.50" N/A N/A 8976055 SUP HCPCS C1713 8976055 - CONNECTOR ROD 3.5-5.5MM NS VUEPOINT II INLN SPNE BOTH IP/OP "$1,867.50" "$1,382.00" $370.65 "$1,867.50" $840.38 $840.38 $840.38 $840.38 "$1,867.50" "$1,867.50" "$1,867.50" $389.23 "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" $389.21 "$1,867.50" $747.00 "$1,104.63" "$1,867.50" "$1,867.50" "$1,867.50" "$1,867.50" "$1,400.63" "$1,867.50" "$1,867.50" "$1,867.50" $933.75 $933.75 "$1,479.06" "$1,867.50" "$1,494.00" $840.38 $370.65 N/A "$1,083.15" "$1,867.50" "$1,120.50" "$1,867.50" $389.19 "$1,867.50" N/A N/A 8976112 SUP HCPCS C1713 8976112 - ROD SPNL 3.5MM 120MM VUEPOINT II BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8976124 SUP HCPCS C1713 8976124 - ROD 240MM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 8976128 SUP HCPCS C1713 8976128 - CONNECTOR ROD 28MM NS VUEPOINT II FX CX SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8976130 SUP HCPCS C1713 8976130 - CONNECTOR ROD 30MM NS VUEPOINT II FX CX SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8976132 SUP HCPCS C1713 8976132 - VUE POINT 2 32MM FIXED CROSS CONN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8976136 SUP HCPCS C1713 8976136 - CONNECTOR ROD 36MM NS VUEPOINT II FX CX SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8976138 SUP HCPCS C1713 8976138 - CONNECTOR ROD 38MM VUEPOINT II CX STC SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8976160 SUP HCPCS C1713 8976160 - VUE POINT II ROD 60MM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8976165 SUP HCPCS C1713 8976165 - CONNECTOR ROD NS VUEPOINT II X SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8976180 SUP HCPCS C1713 8976180 - ROD SPNL 80MM NS VUEPOINT II PRECONTOUR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8976240 SUP HCPCS C1713 8976240 - ROD SPNL 45D 240MM NS VUEPOINT II PRECURVE BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 8976355 SUP HCPCS C1713 "8976355 - TRANSITION ROD, 3.5X 5.5MM" BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 8976406 SUP HCPCS C1713 8976406 - SCREW BN 4.5MM 6MM VUEPOINT II SPNE OCPTL CORT BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 8976412 SUP HCPCS C1713 8976412 - SCREW BN 4.5MM 12MM NS VUEPOINT II SPNE OCPTL BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 8976414 SUP HCPCS C1713 8976414 - SCREW BN 4.5MM 14MM VUEPOINT II SPNE OCPTL CORT BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 8976435 SUP HCPCS C1713 8976435 - CONNECTOR ROD OFST 3.5MM NS VUEPOINT II SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8976455 SUP HCPCS C1713 8976455 - CONNECTOR ROD OFST 3.5-5.5MM NS VUEPOINT II SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8976506 SUP HCPCS C1713 8976506 - SCREW BN 5MM 6MM VUEPOINT II SPNE OCPTL CORT BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" $652.50 "$1,087.50" $226.64 "$1,087.50" N/A N/A 8976508 SUP HCPCS C1713 8976508 - SCREW BN 5MM 8MM VUEPOINT II SPNE OCPTL CORT BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 8976510 SUP HCPCS C1713 8976510 - SCREW BN 5MM 10MM VUEPOINT II SPNE OCPTL CORT BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 8976512 SUP HCPCS C1713 8976512 - SCREW BN 5MM 12MM VUEPOINT II SPNE OCPTL CORT BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 8976514 SUP HCPCS C1713 8976514 - SCREW BN 5MM 14MM VUEPOINT II SPNE OCPTL CORT BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 8977010 SUP Custom 27203010 8977010 - DRILL BIT VUE POINT 2 2.4MM BOTH IP/OP $712.50 $527.00 $126.83 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $126.83 $712.50 $712.50 $528.82 $528.82 $549.20 $371.21 $148.49 $712.50 $285.00 $712.50 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $463.13 $712.50 N/A $413.25 $712.50 $427.50 $712.50 $712.50 $712.50 N/A N/A 8977035 SUP HCPCS C1713 8977035 - SCREW TAP VUE POINT 3.5MM BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" $720.00 "$1,200.00" $250.08 "$1,200.00" N/A N/A 8977040 SUP HCPCS C1713 8977040 - SCREW TAP VUE POINT 4.0MM BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A 9000027 SUP Custom 27203010 9000027 - GRASPER LAPSCOP FENST SERRATED FLEXIBLE SPIDER DISPOSABLE BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A 9000028 SUP Custom 27203010 9000028 - DISSECTOR LAPSCOP 28CM FLEXIBLE MARYLAND SPIDER DISPOSABLE BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A 9000031 SUP Custom 27203010 9000031 - HOOK ELECTROSURGICAL 31MM FLEXIBLE MONOPOLAR PROBE SUCTION BOTH IP/OP $225.00 $167.00 $40.05 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $40.05 $225.00 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $90.00 $225.00 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $225.00 N/A $130.50 $225.00 $135.00 $225.00 $225.00 $225.00 N/A N/A 9000240 SUP HCPCS C1713 9000240 - SCREW BONE 12MM 40MM CANN TITANIUM SACROILIAC BOTH IP/OP "$11,000.00" "$8,140.00" "$2,183.23" "$11,000.00" "$4,950.00" "$4,950.00" "$4,950.00" "$4,950.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.68" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.52" "$11,000.00" "$11,000.00" "$5,423.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$8,250.00" "$11,000.00" "$11,000.00" "$11,000.00" "$5,500.00" "$5,500.00" "$8,712.00" "$11,000.00" "$8,800.00" "$4,950.00" "$2,183.23" N/A "$6,380.00" "$11,000.00" "$6,600.00" "$11,000.00" "$2,292.40" "$11,000.00" N/A N/A 9000250 SUP HCPCS C1713 9000250 - SCREW BONE 12MM 50MM TI SACROILIAC CANN BOTH IP/OP "$11,000.00" "$8,140.00" "$2,183.23" "$11,000.00" "$4,950.00" "$4,950.00" "$4,950.00" "$4,950.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.68" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.52" "$11,000.00" "$11,000.00" "$5,423.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$8,250.00" "$11,000.00" "$11,000.00" "$11,000.00" "$5,500.00" "$5,500.00" "$8,712.00" "$11,000.00" "$8,800.00" "$4,950.00" "$2,183.23" N/A "$6,380.00" "$11,000.00" "$6,600.00" "$11,000.00" "$2,292.40" "$11,000.00" N/A N/A 9001635 SUP HCPCS C1713 9001635 - SCREW BONE 1.6MM 3.5MM SELF DRILL TIMESH TITANIUM CRANIUM BOTH IP/OP $146.50 $108.00 $29.02 $146.20 $65.79 $65.79 $65.79 $65.79 $146.20 $146.20 $146.20 $30.47 $146.20 $146.20 $146.20 $146.20 $146.20 $30.47 $146.20 $58.48 $86.48 $146.20 $146.20 $146.20 $146.20 $109.88 $146.20 $146.20 $146.20 $73.10 $73.10 $115.79 $146.20 $116.96 $65.79 $29.02 N/A $84.97 $146.20 $87.72 $146.20 $30.47 $146.20 N/A N/A 9001640 SUP HCPCS C1713 9001640 - SCREW BONE 1.6MM 4MM SELF DRILL TIMESH TITANIUM CRANIUM BOTH IP/OP $731.00 $541.00 $145.09 $731.00 $328.95 $328.95 $328.95 $328.95 $731.00 $731.00 $731.00 $152.36 $731.00 $731.00 $731.00 $731.00 $731.00 $152.35 $731.00 $292.40 $432.39 $731.00 $731.00 $731.00 $731.00 $548.25 $731.00 $731.00 $731.00 $365.50 $365.50 $578.95 $731.00 $584.80 $328.95 $145.09 N/A $423.98 $731.00 $438.60 $731.00 $152.34 $731.00 N/A N/A 9002196 SUP Custom 27203010 9002196 - KIT NDL GD 21GA 96IN STRT US BOTH IP/OP $68.50 $51.00 $12.18 $68.43 $68.43 $68.43 $68.43 $68.43 $68.43 $68.43 $12.18 $68.43 $68.43 $50.79 $50.79 $52.75 $35.65 $14.26 $68.43 $27.37 $68.43 $68.43 $68.43 $68.43 $68.43 $51.38 $68.43 $68.43 $68.43 $34.22 $34.22 $54.20 $68.43 $54.74 $44.48 $68.43 N/A $39.73 $68.43 $41.06 $68.43 $68.43 $68.43 N/A N/A 9011221 SUP Custom 27803010 9011221 - CAGE SPNL 12MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9011225 SUP Custom 27803010 9011225 - CAGE SPNL 12MM 25MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9011420 SUP Custom 27803010 9011420 - CAGE SPNL 14MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9011423 SUP Custom 27803010 9011423 - CAGE SPNL 14MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9011426 SUP Custom 27803010 9011426 - CAGE SPNL 14MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9011429 SUP Custom 27803010 9011429 - CAGE SPNL 14MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9011620 SUP Custom 27803010 9011620 - CAGE SPNL 16MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9011623 SUP Custom 27803010 9011623 - CAGE SPNL 16MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9011626 SUP Custom 27803010 9011626 - CAGE SPNL 16MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9011629 SUP Custom 27803010 9011629 - CAGE SPNL 16MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9011635 SUP HCPCS C1713 9011635 - SCREW BONE 1.6MM 3.5MM SELF DRILL CRANIUM BOTH IP/OP $127.50 $94.00 $25.31 $127.50 $57.38 $57.38 $57.38 $57.38 $127.50 $127.50 $127.50 $26.57 $127.50 $127.50 $127.50 $127.50 $127.50 $26.57 $127.50 $51.00 $75.42 $127.50 $127.50 $127.50 $127.50 $95.63 $127.50 $127.50 $127.50 $63.75 $63.75 $100.98 $127.50 $102.00 $57.38 $25.31 N/A $73.95 $127.50 $127.50 $127.50 $26.57 $127.50 N/A N/A 9011640 SUP HCPCS C1713 9011640 - SCREW BONE 1.6MM 4MM SELF DRILL CRANIUM BOTH IP/OP $130.00 $96.00 $25.73 $129.63 $58.33 $58.33 $58.33 $58.33 $129.63 $129.63 $129.63 $27.02 $129.63 $129.63 $129.63 $129.63 $129.63 $27.02 $129.63 $51.85 $76.68 $129.63 $129.63 $129.63 $129.63 $97.50 $129.63 $129.63 $129.63 $64.82 $64.82 $102.67 $129.63 $103.70 $58.33 $25.73 N/A $75.40 $129.63 $129.63 $129.63 $27.01 $129.63 N/A N/A 9011820 SUP Custom 27803010 9011820 - CAGE SPNL 18MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9011823 SUP Custom 27803010 9011823 - CAGE SPNL 18MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9011826 SUP Custom 27803010 9011826 - CAGE SPNL 18MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9011829 SUP Custom 27803010 9011829 - CAGE SPNL 18MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9012020 SUP Custom 27803010 9012020 - CAGE SPNL 20MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9012023 SUP Custom 27803010 9012023 - CAGE SPNL 20MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9012026 SUP Custom 27803010 9012026 - CAGE SPNL 20MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9012029 SUP Custom 27803010 9012029 - CAGE SPNL 20MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9012220 SUP Custom 27803010 9012220 - CAGE SPNL 22MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9012223 SUP Custom 27803010 9012223 - CAGE SPNL 22MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9012226 SUP Custom 27803010 9012226 - CAGE SPNL 22MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9012229 SUP Custom 27803010 9012229 - CAGE SPNL 22MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9012420 SUP Custom 27803010 9012420 - CAGE SPNL 24MM 20MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9012423 SUP Custom 27803010 9012423 - CAGE SPNL 24MM 23MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9012426 SUP Custom 27803010 9012426 - CAGE SPNL 24MM 26MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9012429 SUP Custom 27803010 9012429 - CAGE SPNL 24MM 29MM LF INTRFX RP THRD CNCT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 9050012 SUP HCPCS C1781 9050012 - CAGE SPNL 12MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9050014 SUP HCPCS C1781 9050014 - CAGE SPNL 14MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9050016 SUP HCPCS C1781 9050016 - CAGE SPNL 16MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9050018 SUP HCPCS C1781 9050018 - CAGE SPNL 18MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9050020 SUP HCPCS C1781 9050020 - CAGE SPNL 20MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9050413 SUP HCPCS C1781 9050413 - CAGE SPNL OVOID 14X13X10MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9050414 SUP HCPCS C1781 9050414 - CAGE SPNL OVOID 14X14X10MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9050450 SUP HCPCS C1781 9050450 - MESH SURG ROUND 50X14X10MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 9050513 SUP HCPCS C1781 9050513 - CAGE SPNL OVOID 17X13X13MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9050514 SUP HCPCS C1781 9050514 - CAGE SPNL OVOID 17X13X14MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9050700 SUP Custom 27203010 9050700 - INSERTER SURG ENDCAP PYMSH PYRAMESH TITANIUM BOTH IP/OP "$3,630.00" "$2,686.00" $646.14 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $646.14 "$3,630.00" "$3,630.00" "$2,694.19" "$2,694.19" "$2,798.00" "$1,891.23" $756.53 "$3,630.00" "$1,452.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$2,359.50" "$3,630.00" N/A "$2,105.40" "$3,630.00" "$2,178.00" "$3,630.00" "$3,630.00" "$3,630.00" N/A N/A 9050713 SUP HCPCS C1781 9050713 - ENDCAP SPINAL 13MM LUMBAR INTERBODY FUSION MESH PYRAMESH BOTH IP/OP $858.00 $635.00 $170.29 $858.00 $386.10 $386.10 $386.10 $386.10 $858.00 $858.00 $858.00 $178.83 $858.00 $858.00 $858.00 $858.00 $858.00 $178.82 $858.00 $858.00 $507.51 $858.00 $858.00 $858.00 $858.00 $643.50 $858.00 $858.00 $858.00 $429.00 $429.00 $679.54 $858.00 $686.40 $386.10 $170.29 N/A $497.64 $858.00 $858.00 $858.00 $178.81 $858.00 N/A N/A 9050716 SUP HCPCS C1781 9050716 - ENDCAP SPINAL 16MM PYRAMESH TITANIUM BOTH IP/OP $858.00 $635.00 $170.29 $858.00 $386.10 $386.10 $386.10 $386.10 $858.00 $858.00 $858.00 $178.83 $858.00 $858.00 $858.00 $858.00 $858.00 $178.82 $858.00 $858.00 $507.51 $858.00 $858.00 $858.00 $858.00 $643.50 $858.00 $858.00 $858.00 $429.00 $429.00 $679.54 $858.00 $686.40 $386.10 $170.29 N/A $497.64 $858.00 $858.00 $858.00 $178.81 $858.00 N/A N/A 9050719 SUP HCPCS C1781 9050719 - ENDCAP SPINAL 19MM 22MM PYRAMESH TITANIUM BOTH IP/OP $858.00 $635.00 $170.29 $858.00 $386.10 $386.10 $386.10 $386.10 $858.00 $858.00 $858.00 $178.83 $858.00 $858.00 $858.00 $858.00 $858.00 $178.82 $858.00 $858.00 $507.51 $858.00 $858.00 $858.00 $858.00 $643.50 $858.00 $858.00 $858.00 $429.00 $429.00 $679.54 $858.00 $686.40 $386.10 $170.29 N/A $497.64 $858.00 $858.00 $858.00 $178.81 $858.00 N/A N/A 9050722 SUP HCPCS C1781 9050722 - ENDCAP SPINAL 22MM INTERBODY FUSION MESH PYRAMESH TITANIUM BOTH IP/OP $858.00 $635.00 $170.29 $858.00 $386.10 $386.10 $386.10 $386.10 $858.00 $858.00 $858.00 $178.83 $858.00 $858.00 $858.00 $858.00 $858.00 $178.82 $858.00 $858.00 $507.51 $858.00 $858.00 $858.00 $858.00 $643.50 $858.00 $858.00 $858.00 $429.00 $429.00 $679.54 $858.00 $686.40 $386.10 $170.29 N/A $497.64 $858.00 $858.00 $858.00 $178.81 $858.00 N/A N/A 9050725 SUP HCPCS C1781 9050725 - ENDCAP SPINAL 28MM LUMBAR INTERBODY FUSION PYRAMESH TITANIUM BOTH IP/OP $858.00 $635.00 $170.29 $858.00 $386.10 $386.10 $386.10 $386.10 $858.00 $858.00 $858.00 $178.83 $858.00 $858.00 $858.00 $858.00 $858.00 $178.82 $858.00 $858.00 $507.51 $858.00 $858.00 $858.00 $858.00 $643.50 $858.00 $858.00 $858.00 $429.00 $429.00 $679.54 $858.00 $686.40 $386.10 $170.29 N/A $497.64 $858.00 $858.00 $858.00 $178.81 $858.00 N/A N/A 9050823 SUP HCPCS C1781 9050823 - CAGE SPNL OVOID 24X10X8MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9051009 SUP HCPCS C1781 9051009 - CAGE SPNL RND 10MM 9MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 9051011 SUP HCPCS C1781 9051011 - CAGE SPNL RND 10MM 10MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 9051013 SUP HCPCS C1781 9051013 - CAGE SPNL 13MMX10MM PRMSH LMBR INTRBD FS RND TI BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 9051014 SUP HCPCS C1781 9051014 - CAGE SPNL RND 10MM 14MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 9051023 SUP HCPCS C1781 9051023 - CAGE SPNL RND 10MM 23MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9051050 SUP HCPCS C1781 9051050 - CAGE SPNL RND 10MM 50MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 9051223 SUP HCPCS C1781 9051223 - CAGE SPNL RND 12MM 23MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9051314 SUP HCPCS C1781 9051314 - CAGE SPNL RND 13MM 14MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 9051315 SUP HCPCS C1781 9051315 - CAGE SPNL RND 13MM 15MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 9051350 SUP HCPCS C1781 9051350 - MESH SURG ROUND 50MMX13MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 9051423 SUP HCPCS C1781 9051423 - CAGE SPNL RND 14MM 23MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9051690 SUP HCPCS C1781 9051690 - CAGE SPNL RND 16MM 90MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 9051710 SUP HCPCS C1781 9051710 - CAGE SPNL OVOID 22X17X10MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9051715 SUP HCPCS C1781 9051715 - CAGE SPNL OVOID 22X17X15MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9051730 SUP HCPCS C1781 9051730 - CAGE SPNL RND 22MM 30MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9051750 SUP HCPCS C1781 9051750 - CAGE SPNL OVOID 22X17X50MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 9051770 SUP HCPCS C1781 9051770 - CAGE SPNL OVOID 22X17X70MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 9051790 SUP HCPCS C1781 9051790 - CAGE SPNL OVOID 22X17X90MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 9051915 SUP HCPCS C1781 9051915 - CAGE SPNL RND 15MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9051918 SUP HCPCS C1781 9051918 - CAGE SPNL RND 18MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9052205 SUP HCPCS C1781 9052205 - CAGE SPNL RND 22MM 15MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9052208 SUP HCPCS C1781 9052208 - MESH SURG ANGLE ROUND 22X18X12MM CAGE PYRAMESH TITANIUM BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9052215 SUP HCPCS C1781 9052215 - MESH SURG ROUND 22MMX15MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9052230 SUP HCPCS C1781 9052230 - MESH SURG ROUND 30MMX22MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9052250 SUP HCPCS C1781 9052250 - CAGE SPNL RND 22MM 50MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 9052270 SUP HCPCS C1781 9052270 - MESH SURG ROUND 70MMX22MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 9052290 SUP HCPCS C1781 9052290 - MESH SURG ROUND 90MMX22MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 9052315 SUP HCPCS C1781 9052315 - MESH SURG ANGLE ROUND 27MMX23MM 15MMX10MM CAGE PYRAMESH BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9052318 SUP HCPCS C1781 9052318 - MESH SURG ANGLE ROUND 27MMX25MM 18MMX13MM CAGE PYRAMESH BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9052518 SUP HCPCS C1781 9052518 - MESH SURG ANGLE ROUND 25X13X8MM CAGE PYRAMESH TITANIUM BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9052815 SUP HCPCS C1781 9052815 - MESH SURG ROUND 28X22X15MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 9052830 SUP HCPCS C1781 9052830 - MESH SURG ROUND 30X28X22MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 9052850 SUP HCPCS C1781 9052850 - MESH SRG OVOID 50X28X22MM NS PRMSH CG TI BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 9052870 SUP HCPCS C1781 9052870 - MESH SURG ROUND 70X28X22MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 9052890 SUP HCPCS C1781 9052890 - CAGE SPNL OVOID 28X22X90MM PRMSH HLW CNTR OP-EN TI LMBR BOTH IP/OP "$16,828.00" "$12,453.00" "$3,339.86" "$16,827.60" "$7,572.42" "$7,572.42" "$7,572.42" "$7,572.42" "$16,827.60" "$16,827.60" "$16,827.60" "$3,507.29" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$3,507.06" "$16,827.60" "$16,827.60" "$8,296.01" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$12,621.00" "$16,827.60" "$16,827.60" "$16,827.60" "$8,413.80" "$8,413.80" "$13,327.46" "$16,827.60" "$13,462.08" "$7,572.42" "$3,339.86" N/A "$9,760.24" "$16,827.60" "$16,827.60" "$16,827.60" "$3,506.87" "$16,827.60" N/A N/A 9059104 SUP Custom 27203010 9059104 - CUTTER SURG BLADE MESH DISPOSABLE BOTH IP/OP $412.50 $305.00 $73.43 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $73.43 $412.50 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $165.00 $412.50 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $412.50 N/A $239.25 $412.50 $247.50 $412.50 $412.50 $412.50 N/A N/A 9098526 SUP HCPCS C1713 9098526 - SCREW BONE 4MM 26MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" "$1,384.50" $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" "$1,384.50" "$1,384.50" $288.53 "$1,384.50" N/A N/A 9098530 SUP HCPCS C1713 9098530 - SCREW BONE 4MM 30MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" "$1,384.50" $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" $830.70 "$1,384.50" $288.53 "$1,384.50" N/A N/A 9098534 SUP HCPCS C1713 9098534 - SCREW BONE 4MM 34MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" "$1,384.50" $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" "$1,384.50" "$1,384.50" $288.53 "$1,384.50" N/A N/A 9098538 SUP HCPCS C1713 9098538 - SCREW BONE 4MM 38MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" "$1,384.50" $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" "$1,384.50" "$1,384.50" $288.53 "$1,384.50" N/A N/A 9098540 SUP HCPCS C1713 9098540 - SCREW BONE 4MM 40MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" "$1,384.50" $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" "$1,384.50" "$1,384.50" $288.53 "$1,384.50" N/A N/A 9098542 SUP HCPCS C1713 9098542 - SCREW BONE 4MM 42MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" "$1,384.50" $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" "$1,384.50" "$1,384.50" $288.53 "$1,384.50" N/A N/A 9098544 SUP HCPCS C1713 9098544 - SCREW BONE 4MM 44MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" "$1,384.50" $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" "$1,384.50" "$1,384.50" $288.53 "$1,384.50" N/A N/A 9098546 SUP HCPCS C1713 9098546 - SCREW BONE 4MM 46MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" "$1,384.50" $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" "$1,384.50" "$1,384.50" $288.53 "$1,384.50" N/A N/A 9098548 SUP HCPCS C1713 9098548 - SCREW BONE 4MM 48MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" $553.80 $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" "$1,384.50" "$1,384.50" $288.53 "$1,384.50" N/A N/A 9098550 SUP HCPCS C1713 9098550 - SCREW BONE 4MM 50MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" $553.80 $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" "$1,384.50" "$1,384.50" $288.53 "$1,384.50" N/A N/A 9098552 SUP HCPCS C1713 9098552 - SCREW BONE 4MM 52MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" $553.80 $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" "$1,384.50" "$1,384.50" $288.53 "$1,384.50" N/A N/A 9098554 SUP HCPCS C1713 9098554 - SCREW BONE 4MM 54MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" $553.80 $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" "$1,384.50" "$1,384.50" $288.53 "$1,384.50" N/A N/A 9098556 SUP HCPCS C1713 9098556 - SCREW BONE 4MM 56MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" "$1,384.50" $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" "$1,384.50" "$1,384.50" $288.53 "$1,384.50" N/A N/A 9098558 SUP HCPCS C1713 9098558 - SCREW BONE 4MM 58MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" "$1,384.50" $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" "$1,384.50" "$1,384.50" $288.53 "$1,384.50" N/A N/A 9098560 SUP HCPCS C1713 9098560 - SCREW BONE 4MM 60MM SPN CORTICAL BOTH IP/OP "$1,384.50" "$1,025.00" $274.79 "$1,384.50" $623.03 $623.03 $623.03 $623.03 "$1,384.50" "$1,384.50" "$1,384.50" $288.56 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" $288.55 "$1,384.50" $553.80 $818.93 "$1,384.50" "$1,384.50" "$1,384.50" "$1,384.50" "$1,038.38" "$1,384.50" "$1,384.50" "$1,384.50" $692.25 $692.25 "$1,096.52" "$1,384.50" "$1,107.60" $623.03 $274.79 N/A $803.01 "$1,384.50" "$1,384.50" "$1,384.50" $288.53 "$1,384.50" N/A N/A 9164400 SUP Custom 27803010 9164400 - CONNECTOR ROD 4.5MM CD HORIZON STAINLESS STEEL SPN BOTH IP/OP "$1,506.00" "$1,114.00" $268.07 "$1,506.00" "$1,506.00" "$1,506.00" "$1,506.00" "$1,506.00" "$1,506.00" "$1,506.00" $268.07 "$1,506.00" "$1,506.00" "$1,506.00" "$1,506.00" "$1,506.00" "$1,506.00" $313.87 "$1,506.00" $602.40 "$1,506.00" "$1,506.00" "$1,506.00" "$1,506.00" "$1,506.00" "$1,129.50" "$1,506.00" "$1,506.00" "$1,506.00" $753.00 $753.00 "$1,192.75" "$1,506.00" "$1,204.80" $677.70 "$1,506.00" N/A $873.48 "$1,506.00" $903.60 "$1,506.00" "$1,506.00" "$1,506.00" N/A N/A 9192507 SUP HCPCS C1713 9192507 - SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X7MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9192508 SUP HCPCS C1713 9192508 - SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X8MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9192509 SUP HCPCS C1713 9192509 - SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X9MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9192510 SUP HCPCS C1713 9192510 - SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X10MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9192511 SUP HCPCS C1713 9192511 - SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X11MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9192512 SUP HCPCS C1713 9192512 - SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X12MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9192513 SUP HCPCS C1713 9192513 - SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X13MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9192514 SUP HCPCS C1713 9192514 - SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X14MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9192515 SUP HCPCS C1713 9192515 - SPACER SPNL 6D LRDTC STRG BLT NOSE 25X10X15MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193007 SUP HCPCS C1713 9193007 - SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X7MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193008 SUP HCPCS C1713 9193008 - SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X8MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193009 SUP HCPCS C1713 9193009 - SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X9MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193010 SUP HCPCS C1713 9193010 - SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X10MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193011 SUP HCPCS C1713 9193011 - SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X11MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193012 SUP HCPCS C1713 9193012 - SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X12MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193013 SUP HCPCS C1713 9193013 - SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X13MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193014 SUP HCPCS C1713 9193014 - SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X14MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193015 SUP HCPCS C1713 9193015 - SPACER SPNL 6D LRDTC STRG BLT NOSE 30X10X15MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193607 SUP HCPCS C1713 9193607 - SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X7MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193608 SUP HCPCS C1713 9193608 - SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X8MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193609 SUP HCPCS C1713 9193609 - SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X9MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193610 SUP HCPCS C1713 9193610 - SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X10MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193611 SUP HCPCS C1713 9193611 - SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X11MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193612 SUP HCPCS C1713 9193612 - SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X12MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193613 SUP HCPCS C1713 9193613 - SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X13MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193614 SUP HCPCS C1713 9193614 - SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X14MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9193615 SUP HCPCS C1713 9193615 - SPACER SPNL 6D LRDTC STRG BLT NOSE 36X10X15MM VRTSTCK CRSNT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9206768 SUP HCPCS C1713 9206768 - PLATE BN 90D STD L 4MM 9 HL BAR CRNMXF LT BOTH IP/OP "$1,315.00" $973.00 $260.99 "$1,315.00" $591.75 $591.75 $591.75 $591.75 "$1,315.00" "$1,315.00" "$1,315.00" $274.08 "$1,315.00" "$1,315.00" "$1,315.00" "$1,315.00" "$1,315.00" $274.06 "$1,315.00" $526.00 $777.82 "$1,315.00" "$1,315.00" "$1,315.00" "$1,315.00" $986.25 "$1,315.00" "$1,315.00" "$1,315.00" $657.50 $657.50 "$1,041.48" "$1,315.00" "$1,052.00" $591.75 $260.99 N/A $762.70 "$1,315.00" "$1,315.00" "$1,315.00" $274.05 "$1,315.00" N/A N/A 9240100 SUP HCPCS C1713 9240100 - DEVICE STABILIZATION 45MM SPIRE CD HORIZON SPN PELVIS BOTH IP/OP "$8,608.50" "$6,370.00" "$1,708.57" "$8,608.50" "$3,873.83" "$3,873.83" "$3,873.83" "$3,873.83" "$8,608.50" "$8,608.50" "$8,608.50" "$1,794.23" "$8,608.50" "$8,608.50" "$8,608.50" "$8,608.50" "$8,608.50" "$1,794.11" "$8,608.50" "$8,608.50" "$4,243.99" "$8,608.50" "$8,608.50" "$8,608.50" "$8,608.50" "$6,456.38" "$8,608.50" "$8,608.50" "$8,608.50" "$4,304.25" "$4,304.25" "$6,817.93" "$8,608.50" "$6,886.80" "$3,873.83" "$1,708.57" N/A "$4,992.93" "$8,608.50" "$8,608.50" "$8,608.50" "$1,794.01" "$8,608.50" N/A N/A 9240150 SUP HCPCS C1713 9240150 - SCREW SET 50MM M4 BREAKOFF CD HORIZON SPIRE SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 9240200 SUP HCPCS C1713 9240200 - PLATE BONE 35MM SPIRE TITANIUM SPN BOTH IP/OP "$8,608.50" "$6,370.00" "$1,708.57" "$8,608.50" "$3,873.83" "$3,873.83" "$3,873.83" "$3,873.83" "$8,608.50" "$8,608.50" "$8,608.50" "$1,794.23" "$8,608.50" "$8,608.50" "$8,608.50" "$8,608.50" "$8,608.50" "$1,794.11" "$8,608.50" "$8,608.50" "$4,243.99" "$8,608.50" "$8,608.50" "$8,608.50" "$8,608.50" "$6,456.38" "$8,608.50" "$8,608.50" "$8,608.50" "$4,304.25" "$4,304.25" "$6,817.93" "$8,608.50" "$6,886.80" "$3,873.83" "$1,708.57" N/A "$4,992.93" "$8,608.50" "$8,608.50" "$8,608.50" "$1,794.01" "$8,608.50" N/A N/A 9255562 SUP HCPCS C1713 9255562 - PLATE BN 3D CRV 1.5MM 6X2 HL CRNMXF BOTH IP/OP "$1,965.00" "$1,454.00" $390.00 "$1,965.00" $884.25 $884.25 $884.25 $884.25 "$1,965.00" "$1,965.00" "$1,965.00" $409.56 "$1,965.00" "$1,965.00" "$1,965.00" "$1,965.00" "$1,965.00" $409.53 "$1,965.00" $786.00 "$1,162.30" "$1,965.00" "$1,965.00" "$1,965.00" "$1,965.00" "$1,473.75" "$1,965.00" "$1,965.00" "$1,965.00" $982.50 $982.50 "$1,556.28" "$1,965.00" "$1,572.00" $884.25 $390.00 N/A "$1,139.70" "$1,965.00" "$1,965.00" "$1,965.00" $409.51 "$1,965.00" N/A N/A 9330000 SUP HCPCS C1713 9330000 - NUT LOCK VANTAGE TITANIUM ANTERIOR THORACOLUMBAR SPN STERILE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 9330001 SUP HCPCS C1713 9330001 - STAPLE BONE 2 HOLE LP TOP LOADING INTERCHANGEABLE VANTAGE BOTH IP/OP "$2,805.00" "$2,076.00" $556.72 "$2,805.00" "$1,262.25" "$1,262.25" "$1,262.25" "$1,262.25" "$2,805.00" "$2,805.00" "$2,805.00" $584.63 "$2,805.00" "$2,805.00" "$2,805.00" "$2,805.00" "$2,805.00" $584.59 "$2,805.00" "$2,805.00" "$1,382.87" "$2,805.00" "$2,805.00" "$2,805.00" "$2,805.00" "$2,103.75" "$2,805.00" "$2,805.00" "$2,805.00" "$1,402.50" "$1,402.50" "$2,221.56" "$2,805.00" "$2,244.00" "$1,262.25" $556.72 N/A "$1,626.90" "$2,805.00" "$1,683.00" "$2,805.00" $584.56 "$2,805.00" N/A N/A 9330002 SUP HCPCS C1713 9330002 - STAPLE BONE 2 HOLE LP TOP LOADING INTERCHANGEABLE VANTAGE BOTH IP/OP "$2,805.00" "$2,076.00" $556.72 "$2,805.00" "$1,262.25" "$1,262.25" "$1,262.25" "$1,262.25" "$2,805.00" "$2,805.00" "$2,805.00" $584.63 "$2,805.00" "$2,805.00" "$2,805.00" "$2,805.00" "$2,805.00" $584.59 "$2,805.00" "$2,805.00" "$1,382.87" "$2,805.00" "$2,805.00" "$2,805.00" "$2,805.00" "$2,103.75" "$2,805.00" "$2,805.00" "$2,805.00" "$1,402.50" "$1,402.50" "$2,221.56" "$2,805.00" "$2,244.00" "$1,262.25" $556.72 N/A "$1,626.90" "$2,805.00" "$2,805.00" "$2,805.00" $584.56 "$2,805.00" N/A N/A 9330003 SUP HCPCS C1713 9330003 - STAPLE BONE LP 2 HOLE TOP LOAD INTERCHANGEABLE VANTAGE BOTH IP/OP "$2,805.00" "$2,076.00" $556.72 "$2,805.00" "$1,262.25" "$1,262.25" "$1,262.25" "$1,262.25" "$2,805.00" "$2,805.00" "$2,805.00" $584.63 "$2,805.00" "$2,805.00" "$2,805.00" "$2,805.00" "$2,805.00" $584.59 "$2,805.00" "$2,805.00" "$1,382.87" "$2,805.00" "$2,805.00" "$2,805.00" "$2,805.00" "$2,103.75" "$2,805.00" "$2,805.00" "$2,805.00" "$1,402.50" "$1,402.50" "$2,221.56" "$2,805.00" "$2,244.00" "$1,262.25" $556.72 N/A "$1,626.90" "$2,805.00" "$1,683.00" "$2,805.00" $584.56 "$2,805.00" N/A N/A 9330004 SUP HCPCS C1713 9330004 - STAPLE BONE 2 HOLE LP TOP LOADING INTERCHANGEABLE VANTAGE BOTH IP/OP "$2,805.00" "$2,076.00" $556.72 "$2,805.00" "$1,262.25" "$1,262.25" "$1,262.25" "$1,262.25" "$2,805.00" "$2,805.00" "$2,805.00" $584.63 "$2,805.00" "$2,805.00" "$2,805.00" "$2,805.00" "$2,805.00" $584.59 "$2,805.00" "$2,805.00" "$1,382.87" "$2,805.00" "$2,805.00" "$2,805.00" "$2,805.00" "$2,103.75" "$2,805.00" "$2,805.00" "$2,805.00" "$1,402.50" "$1,402.50" "$2,221.56" "$2,805.00" "$2,244.00" "$1,262.25" $556.72 N/A "$1,626.90" "$2,805.00" "$1,683.00" "$2,805.00" $584.56 "$2,805.00" N/A N/A 9330040 SUP HCPCS C1713 9330040 - PLATE BONE 4CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9330045 SUP HCPCS C1713 9330045 - PLATE BONE 4.5CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9330050 SUP HCPCS C1713 9330050 - PLATE BONE 5CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9330055 SUP HCPCS C1713 9330055 - PLATE BONE 5.5CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9330060 SUP HCPCS C1713 9330060 - PLATE BN 6CM VNTG SMTH TI SPNE THORLMBR ANT BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9330065 SUP HCPCS C1713 9330065 - PLATE BONE 6.5CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9330070 SUP HCPCS C1713 9330070 - PLATE BONE 7CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9330075 SUP HCPCS C1713 9330075 - PLATE BONE 7.5CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9330080 SUP HCPCS C1713 9330080 - PLATE BONE 8CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9330085 SUP HCPCS C1713 9330085 - PLATE BONE 8.5CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9330090 SUP HCPCS C1713 9330090 - PLATE BONE 9CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$2,711.40" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9330095 SUP HCPCS C1713 9330095 - PLATE BONE 9.5CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$2,711.40" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9330100 SUP HCPCS C1713 9330100 - PLATE BONE 10CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9331025 SUP Custom 27803010 9331025 - PLATE BONE 2.5CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,206.57" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,206.57" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$2,711.40" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$6,778.50" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$6,778.50" "$6,778.50" N/A N/A 9331030 SUP HCPCS C1713 9331030 - PLATE BONE 3CM SMOOTH SURFACE VANTAGE TITANIUM SPN THORACIC BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$2,711.40" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9331035 SUP HCPCS C1713 9331035 - PLATE BONE 3.5CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9331040 SUP HCPCS C1713 9331040 - PLATE BONE 4CM SMOOTH SURFACE VANTAGE TITANIUM SPN THORACIC BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9331045 SUP HCPCS C1713 9331045 - PLATE BONE 4.5CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$2,711.40" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9331050 SUP HCPCS C1713 9331050 - PLATE BONE 5CM SMOOTH SURFACE VANTAGE TITANIUM SPN THORACIC BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9331055 SUP HCPCS C1713 9331055 - PLATE BN 5.5CM VNTG SMTH TI SPNE THOR ANT BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$2,711.40" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9331060 SUP HCPCS C1713 9331060 - PLATE BN 6CM VNTG SMTH TI SPNE THOR ANT BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9331065 SUP HCPCS C1713 9331065 - PLATE BONE 6.5CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$2,711.40" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$4,067.10" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9331070 SUP HCPCS C1713 9331070 - PLATE BONE 7CM SMOOTH SURFACE VANTAGE TITANIUM SPN THORACIC BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9331075 SUP HCPCS C1713 9331075 - PLATE BONE 7.5CM SMOOTH SURFACE VANTAGE TITANIUM SPN BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9331080 SUP HCPCS C1713 9331080 - PLATE BONE 8CM SMOOTH SURFACE VANTAGE TITANIUM SPN THORACIC BOTH IP/OP "$6,778.50" "$5,016.00" "$1,345.36" "$6,778.50" "$3,050.33" "$3,050.33" "$3,050.33" "$3,050.33" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.81" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.71" "$6,778.50" "$6,778.50" "$3,341.80" "$6,778.50" "$6,778.50" "$6,778.50" "$6,778.50" "$5,083.88" "$6,778.50" "$6,778.50" "$6,778.50" "$3,389.25" "$3,389.25" "$5,368.57" "$6,778.50" "$5,422.80" "$3,050.33" "$1,345.36" N/A "$3,931.53" "$6,778.50" "$6,778.50" "$6,778.50" "$1,412.64" "$6,778.50" N/A N/A 9335515 SUP HCPCS C1713 9335515 - SCREW BONE FLUTE 5.5MM 15MM SELF TAP INTERNAL HEX COLOR BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" "$1,305.00" $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" "$1,305.00" "$1,305.00" $271.96 "$1,305.00" N/A N/A 9335520 SUP HCPCS C1713 9335520 - SCREW BONE FLUTE 5.5MM 20MM SELF TAP INTERNAL HEX COLOR BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" $522.00 $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" "$1,305.00" "$1,305.00" $271.96 "$1,305.00" N/A N/A 9335525 SUP HCPCS C1713 9335525 - SCREW BONE FLUTE 5.5MM 25MM SELF TAP INTERNAL HEX COLOR BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" $522.00 $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" "$1,305.00" "$1,305.00" $271.96 "$1,305.00" N/A N/A 9335530 SUP HCPCS C1713 9335530 - SCREW BONE FLUTE 5.5MM 30MM SELF TAP INTERNAL HEX COLOR BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" $522.00 $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" $783.00 "$1,305.00" $271.96 "$1,305.00" N/A N/A 9335535 SUP HCPCS C1713 9335535 - SCREW BN 5.5MM 35MM NS VNTG ST INTNL HEX CLR CD CUT TI SPNE BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" "$1,305.00" $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" $783.00 "$1,305.00" $271.96 "$1,305.00" N/A N/A 9335540 SUP HCPCS C1713 9335540 - SCREW BN 5.5MM 40MM NS VNTG ST INTNL HEX CLR CD CUT TI SPNE BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" "$1,305.00" $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" "$1,305.00" "$1,305.00" $271.96 "$1,305.00" N/A N/A 9335545 SUP HCPCS C1713 9335545 - SCREW BONE FLUTE 5.5MM 45MM SELF TAP INTERNAL HEX COLOR BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" "$1,305.00" $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" $783.00 "$1,305.00" $271.96 "$1,305.00" N/A N/A 9335550 SUP HCPCS C1713 9335550 - SCREW BONE FLUTE 5.5MM 50MM SELF TAP INTERNAL HEX COLOR BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" "$1,305.00" $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" $783.00 "$1,305.00" $271.96 "$1,305.00" N/A N/A 9336525 SUP HCPCS C1713 9336525 - SCREW BONE 6.5MM 25MM VANTAGE ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" "$1,305.00" $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" $783.00 "$1,305.00" $271.96 "$1,305.00" N/A N/A 9336530 SUP HCPCS C1713 9336530 - SCREW BONE 6.5MM 30MM VANTAGE ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" $522.00 $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" $783.00 "$1,305.00" $271.96 "$1,305.00" N/A N/A 9336535 SUP HCPCS C1713 9336535 - SCREW BONE 6.5MM 35MM VANTAGE ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" "$1,305.00" $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" $783.00 "$1,305.00" $271.96 "$1,305.00" N/A N/A 9336540 SUP HCPCS C1713 9336540 - SCREW BN 6.5MM 40MM NS ATLNTS VNTG FST CLSR TI SPNE CRV ANT BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" "$1,305.00" $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" $783.00 "$1,305.00" $271.96 "$1,305.00" N/A N/A 9336545 SUP HCPCS C1713 9336545 - SCREW BONE 6.5MM 45MM VANTAGE ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" $522.00 $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" $783.00 "$1,305.00" $271.96 "$1,305.00" N/A N/A 9336550 SUP HCPCS C1713 9336550 - SCREW BONE 6.5MM 50MM VANTAGE ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" "$1,305.00" $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" $783.00 "$1,305.00" $271.96 "$1,305.00" N/A N/A 9336555 SUP HCPCS C1713 9336555 - SCREW BONE 6.5MM 55MM VANTAGE ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" "$1,305.00" $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" $783.00 "$1,305.00" $271.96 "$1,305.00" N/A N/A 9336560 SUP HCPCS C1713 9336560 - SCREW BONE 6.5MM 60MM VANTAGE ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$1,305.00" $966.00 $259.01 "$1,305.00" $587.25 $587.25 $587.25 $587.25 "$1,305.00" "$1,305.00" "$1,305.00" $271.99 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $271.98 "$1,305.00" "$1,305.00" $771.91 "$1,305.00" "$1,305.00" "$1,305.00" "$1,305.00" $978.75 "$1,305.00" "$1,305.00" "$1,305.00" $652.50 $652.50 "$1,033.56" "$1,305.00" "$1,044.00" $587.25 $259.01 N/A $756.90 "$1,305.00" $783.00 "$1,305.00" $271.96 "$1,305.00" N/A N/A 9338020 SUP HCPCS C1713 9338020 - BOLT SPINAL 8MM 20MM VANTAGE TITANIUM ANTERIOR BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$4,525.50" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338025 SUP HCPCS C1713 9338025 - BOLT SPINAL 8MM 25MM VANTAGE TITANIUM 4.5CM BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$1,810.20" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$4,525.50" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338030 SUP HCPCS C1713 9338030 - BOLT SPINAL 8MM 30MM VANTAGE TITANIUM ANTERIOR BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$1,810.20" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$4,525.50" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338035 SUP HCPCS C1713 9338035 - BOLT SPINAL 8MM 35MM SCREW VANTAGE TITANIUM ANTERIOR SPN BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$1,810.20" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338040 SUP HCPCS C1713 9338040 - BOLT SPINAL 8MM 40MM VANTAGE TITANIUM BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$4,525.50" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$4,525.50" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338045 SUP HCPCS C1713 9338045 - BOLT SPINAL 8MM 45MM VANTAGE TITANIUM ANTERIOR SPN BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$4,525.50" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$4,525.50" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338050 SUP HCPCS C1713 9338050 - BOLT SPINAL 8MM 50MM TITANIUM BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$1,810.20" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338055 SUP HCPCS C1713 9338055 - BOLT SPINAL 8MM 55MM TITANIUM BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$1,810.20" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338920 SUP HCPCS C1713 9338920 - BOLT SPINAL 9MM 20MM TITANIUM BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$1,810.20" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338925 SUP HCPCS C1713 9338925 - BOLT SPINAL 9MM 25MM TITANIUM BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$1,810.20" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338930 SUP HCPCS C1713 9338930 - BOLT SPINAL 9MM 30MM TITANIUM BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$1,810.20" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$4,525.50" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338935 SUP HCPCS C1713 9338935 - BOLT SPINAL 9MM 35MM VANTAGE TITANIUM BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$4,525.50" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338940 SUP HCPCS C1713 9338940 - BOLT SPINAL 9MM 40MM VANTAGE TITANIUM BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$4,525.50" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338945 SUP HCPCS C1713 9338945 - BOLT SPINAL 9MM 45MM VANTAGE TITANIUM BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$4,525.50" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338950 SUP HCPCS C1713 9338950 - BOLT SPINAL 9MM 50MM TITANIUM BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$1,810.20" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9338955 SUP HCPCS C1713 9338955 - BOLT SPINAL 9MM 55MM TITANIUM BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$1,810.20" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9391316 SUP HCPCS C1713 9391316 - CAGE SPNL 13MM 16MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$9,969.00" "$7,377.00" "$1,978.55" "$9,968.75" "$4,485.94" "$4,485.94" "$4,485.94" "$4,485.94" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.74" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.60" "$9,968.75" "$3,987.50" "$4,914.59" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$7,476.75" "$9,968.75" "$9,968.75" "$9,968.75" "$4,984.38" "$4,984.38" "$7,895.25" "$9,968.75" "$7,975.00" "$4,485.94" "$1,978.55" N/A "$5,782.02" "$9,968.75" "$5,981.25" "$9,968.75" "$2,077.49" "$9,968.75" N/A N/A 9391319 SUP HCPCS C1713 9391319 - CAGE SPNL 13MM 19MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$9,969.00" "$7,377.00" "$1,978.55" "$9,968.75" "$4,485.94" "$4,485.94" "$4,485.94" "$4,485.94" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.74" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.60" "$9,968.75" "$9,968.75" "$4,914.59" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$7,476.75" "$9,968.75" "$9,968.75" "$9,968.75" "$4,984.38" "$4,984.38" "$7,895.25" "$9,968.75" "$7,975.00" "$4,485.94" "$1,978.55" N/A "$5,782.02" "$9,968.75" "$5,981.25" "$9,968.75" "$2,077.49" "$9,968.75" N/A N/A 9391322 SUP HCPCS C1713 9391322 - CAGE SPNL 13MM 22MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$9,969.00" "$7,377.00" "$1,978.55" "$9,968.75" "$4,485.94" "$4,485.94" "$4,485.94" "$4,485.94" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.74" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.60" "$9,968.75" "$9,968.75" "$4,914.59" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$7,476.75" "$9,968.75" "$9,968.75" "$9,968.75" "$4,984.38" "$4,984.38" "$7,895.25" "$9,968.75" "$7,975.00" "$4,485.94" "$1,978.55" N/A "$5,782.02" "$9,968.75" "$5,981.25" "$9,968.75" "$2,077.49" "$9,968.75" N/A N/A 9391326 SUP HCPCS C1713 9391326 - CAGE SPNL 13MM 26MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$9,969.00" "$7,377.00" "$1,978.55" "$9,968.75" "$4,485.94" "$4,485.94" "$4,485.94" "$4,485.94" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.74" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.60" "$9,968.75" "$9,968.75" "$4,914.59" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$7,476.75" "$9,968.75" "$9,968.75" "$9,968.75" "$4,984.38" "$4,984.38" "$7,895.25" "$9,968.75" "$7,975.00" "$4,485.94" "$1,978.55" N/A "$5,782.02" "$9,968.75" "$5,981.25" "$9,968.75" "$2,077.49" "$9,968.75" N/A N/A 9391332 SUP HCPCS C1713 9391332 - CAGE SPNL 13MM 32MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$11,687.50" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$7,012.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9391341 SUP HCPCS C1713 9391341 - CAGE SPNL 13MM 41MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$11,687.50" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9391617 SUP HCPCS C1713 9391617 - CAGE SPNL 16MM 17MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$9,969.00" "$7,377.00" "$1,978.55" "$9,968.75" "$4,485.94" "$4,485.94" "$4,485.94" "$4,485.94" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.74" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.60" "$9,968.75" "$9,968.75" "$4,914.59" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$7,476.75" "$9,968.75" "$9,968.75" "$9,968.75" "$4,984.38" "$4,984.38" "$7,895.25" "$9,968.75" "$7,975.00" "$4,485.94" "$1,978.55" N/A "$5,782.02" "$9,968.75" "$5,981.25" "$9,968.75" "$2,077.49" "$9,968.75" N/A N/A 9391620 SUP HCPCS C1713 9391620 - PLATE BONE 20MM CENTERPIECE SPN BOTH IP/OP "$9,969.00" "$7,377.00" "$1,978.55" "$9,968.75" "$4,485.94" "$4,485.94" "$4,485.94" "$4,485.94" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.74" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.60" "$9,968.75" "$9,968.75" "$4,914.59" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$7,476.75" "$9,968.75" "$9,968.75" "$9,968.75" "$4,984.38" "$4,984.38" "$7,895.25" "$9,968.75" "$7,975.00" "$4,485.94" "$1,978.55" N/A "$5,782.02" "$9,968.75" "$5,981.25" "$9,968.75" "$2,077.49" "$9,968.75" N/A N/A 9391623 SUP HCPCS C1713 9391623 - CAGE SPNL 16MM 23MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$9,969.00" "$7,377.00" "$1,978.55" "$9,968.75" "$4,485.94" "$4,485.94" "$4,485.94" "$4,485.94" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.74" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.60" "$9,968.75" "$9,968.75" "$4,914.59" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$7,476.75" "$9,968.75" "$9,968.75" "$9,968.75" "$4,984.38" "$4,984.38" "$7,895.25" "$9,968.75" "$7,975.00" "$4,485.94" "$1,978.55" N/A "$5,782.02" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.49" "$9,968.75" N/A N/A 9391628 SUP HCPCS C1713 9391628 - CAGE SPNL 16MM 28MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$9,969.00" "$7,377.00" "$1,978.55" "$9,968.75" "$4,485.94" "$4,485.94" "$4,485.94" "$4,485.94" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.74" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$2,077.60" "$9,968.75" "$9,968.75" "$4,914.59" "$9,968.75" "$9,968.75" "$9,968.75" "$9,968.75" "$7,476.75" "$9,968.75" "$9,968.75" "$9,968.75" "$4,984.38" "$4,984.38" "$7,895.25" "$9,968.75" "$7,975.00" "$4,485.94" "$1,978.55" N/A "$5,782.02" "$9,968.75" "$5,981.25" "$9,968.75" "$2,077.49" "$9,968.75" N/A N/A 9391633 SUP HCPCS C1713 9391633 - CAGE SPNL 16MM 33MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$11,687.50" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$7,012.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9391641 SUP HCPCS C1713 9391641 - CAGE SPNL 16MM 41MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$4,675.00" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$7,012.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9391919 SUP HCPCS C1713 9391919 - CAGE SPNL 19MM 19MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$4,675.00" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9391923 SUP HCPCS C1713 9391923 - CAGE SPNL 19MM 23MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$4,675.00" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9391928 SUP HCPCS C1713 9391928 - CAGE SPNL 19MM 28MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$4,675.00" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$7,012.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9391936 SUP HCPCS C1713 9391936 - CAGE SPNL 19MM 36MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$11,687.50" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$7,012.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9391947 SUP HCPCS C1713 9391947 - CAGE SPNL 19MM 47MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$13,406.50" "$9,921.00" "$2,660.81" "$13,406.25" "$6,032.81" "$6,032.81" "$6,032.81" "$6,032.81" "$13,406.25" "$13,406.25" "$13,406.25" "$2,794.20" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$2,794.01" "$13,406.25" "$13,406.25" "$6,609.28" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$10,054.88" "$13,406.25" "$13,406.25" "$13,406.25" "$6,703.13" "$6,703.13" "$10,617.75" "$13,406.25" "$10,725.00" "$6,032.81" "$2,660.81" N/A "$7,775.77" "$13,406.25" "$8,043.75" "$13,406.25" "$2,793.86" "$13,406.25" N/A N/A 9391969 SUP HCPCS C1713 9391969 - CAGE SPNL 19MM 69MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$13,406.50" "$9,921.00" "$2,660.81" "$13,406.25" "$6,032.81" "$6,032.81" "$6,032.81" "$6,032.81" "$13,406.25" "$13,406.25" "$13,406.25" "$2,794.20" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$2,794.01" "$13,406.25" "$13,406.25" "$6,609.28" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$10,054.88" "$13,406.25" "$13,406.25" "$13,406.25" "$6,703.13" "$6,703.13" "$10,617.75" "$13,406.25" "$10,725.00" "$6,032.81" "$2,660.81" N/A "$7,775.77" "$13,406.25" "$13,406.25" "$13,406.25" "$2,793.86" "$13,406.25" N/A N/A 9392221 SUP HCPCS C1713 9392221 - CAGE SPNL 22MM 21MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$4,675.00" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$7,012.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9392225 SUP HCPCS C1713 9392225 - CAGE SPNL 22MM 25MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$4,675.00" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$7,012.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9392231 SUP HCPCS C1713 9392231 - CAGE SPNL 22MM 31MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$11,687.50" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$7,012.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9392237 SUP HCPCS C1713 9392237 - CAGE SPNL 22MM 37MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$11,687.50" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9392248 SUP HCPCS C1713 9392248 - CAGE SPNL 22MM 48MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$13,406.50" "$9,921.00" "$2,660.81" "$13,406.25" "$6,032.81" "$6,032.81" "$6,032.81" "$6,032.81" "$13,406.25" "$13,406.25" "$13,406.25" "$2,794.20" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$2,794.01" "$13,406.25" "$13,406.25" "$6,609.28" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$10,054.88" "$13,406.25" "$13,406.25" "$13,406.25" "$6,703.13" "$6,703.13" "$10,617.75" "$13,406.25" "$10,725.00" "$6,032.81" "$2,660.81" N/A "$7,775.77" "$13,406.25" "$8,043.75" "$13,406.25" "$2,793.86" "$13,406.25" N/A N/A 9392268 SUP HCPCS C1713 9392268 - CAGE SPNL 22MM 68MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$13,406.50" "$9,921.00" "$2,660.81" "$13,406.25" "$6,032.81" "$6,032.81" "$6,032.81" "$6,032.81" "$13,406.25" "$13,406.25" "$13,406.25" "$2,794.20" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$2,794.01" "$13,406.25" "$13,406.25" "$6,609.28" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$10,054.88" "$13,406.25" "$13,406.25" "$13,406.25" "$6,703.13" "$6,703.13" "$10,617.75" "$13,406.25" "$10,725.00" "$6,032.81" "$2,660.81" N/A "$7,775.77" "$13,406.25" "$8,043.75" "$13,406.25" "$2,793.86" "$13,406.25" N/A N/A 9392507 SUP HCPCS C1713 9392507 - SPACER SPNL 25MMX7MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9392508 SUP HCPCS C1713 9392508 - SPACER SPNL 25MMX8MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9392509 SUP HCPCS C1713 9392509 - SPACER SPNL 25MMX9MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9392510 SUP HCPCS C1713 9392510 - SPACER SPNL 25MMX10MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9392511 SUP HCPCS C1713 9392511 - SPACER SPNL 25MMX11MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9392512 SUP HCPCS C1713 9392512 - SPACER SPNL 25MMX12MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9392513 SUP HCPCS C1713 9392513 - SPACER SPNL 25MMX13MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9392514 SUP HCPCS C1713 9392514 - SPACER SPNL 25MMX14MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9392515 SUP HCPCS C1713 9392515 - SPACER SPNL 25MMX15MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9392521 SUP HCPCS C1713 9392521 - CAGE SPNL 25MM 21MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$11,687.50" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9392525 SUP HCPCS C1713 9392525 - CAGE SPNL 25MM 25MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$11,687.50" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$7,012.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9392531 SUP HCPCS C1713 9392531 - CAGE SPNL 25MM 31MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$11,687.50" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$7,012.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9392537 SUP HCPCS C1713 9392537 - CAGE SPNL 25MM 37MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$11,687.50" "$8,649.00" "$2,319.68" "$11,687.50" "$5,259.38" "$5,259.38" "$5,259.38" "$5,259.38" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.97" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$2,435.80" "$11,687.50" "$11,687.50" "$5,761.94" "$11,687.50" "$11,687.50" "$11,687.50" "$11,687.50" "$8,765.63" "$11,687.50" "$11,687.50" "$11,687.50" "$5,843.75" "$5,843.75" "$9,256.50" "$11,687.50" "$9,350.00" "$5,259.38" "$2,319.68" N/A "$6,778.75" "$11,687.50" "$7,012.50" "$11,687.50" "$2,435.68" "$11,687.50" N/A N/A 9392548 SUP HCPCS C1713 9392548 - CAGE SPNL 25MM 48MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$13,406.50" "$9,921.00" "$2,660.81" "$13,406.25" "$6,032.81" "$6,032.81" "$6,032.81" "$6,032.81" "$13,406.25" "$13,406.25" "$13,406.25" "$2,794.20" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$2,794.01" "$13,406.25" "$13,406.25" "$6,609.28" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$10,054.88" "$13,406.25" "$13,406.25" "$13,406.25" "$6,703.13" "$6,703.13" "$10,617.75" "$13,406.25" "$10,725.00" "$6,032.81" "$2,660.81" N/A "$7,775.77" "$13,406.25" "$8,043.75" "$13,406.25" "$2,793.86" "$13,406.25" N/A N/A 9392568 SUP HCPCS C1713 9392568 - CAGE SPNL 25MM 68MM LF T2 ALTD CENTERPIECE TI COCR NTNL THOR BOTH IP/OP "$13,406.50" "$9,921.00" "$2,660.81" "$13,406.25" "$6,032.81" "$6,032.81" "$6,032.81" "$6,032.81" "$13,406.25" "$13,406.25" "$13,406.25" "$2,794.20" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$2,794.01" "$13,406.25" "$13,406.25" "$6,609.28" "$13,406.25" "$13,406.25" "$13,406.25" "$13,406.25" "$10,054.88" "$13,406.25" "$13,406.25" "$13,406.25" "$6,703.13" "$6,703.13" "$10,617.75" "$13,406.25" "$10,725.00" "$6,032.81" "$2,660.81" N/A "$7,775.77" "$13,406.25" "$8,043.75" "$13,406.25" "$2,793.86" "$13,406.25" N/A N/A 9393007 SUP HCPCS C1713 9393007 - SPACER SPNL 30MMX7MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393008 SUP HCPCS C1713 9393008 - SPACER SPNL 30MMX8MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393009 SUP HCPCS C1713 9393009 - SPACER SPNL 30MMX9MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393010 SUP HCPCS C1713 9393010 - SPACER SPNL 30MMX10MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393011 SUP HCPCS C1713 9393011 - SPACER SPNL 30MMX11MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393012 SUP HCPCS C1713 9393012 - SPACER SPNL 30MMX12MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393013 SUP HCPCS C1713 9393013 - SPACER SPNL 30MMX13MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393014 SUP HCPCS C1713 9393014 - SPACER SPNL 30MMX14MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393015 SUP HCPCS C1713 9393015 - SPACER SPNL 30MMX15MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393607 SUP HCPCS C1713 9393607 - SPACER SPNL 36MMX7MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393608 SUP HCPCS C1713 9393608 - SPACER SPNL 36MMX8MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393609 SUP HCPCS C1713 9393609 - SPACER SPNL 36MMX9MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393610 SUP HCPCS C1713 9393610 - SPACER SPNL 36MMX10MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393611 SUP HCPCS C1713 9393611 - SPACER SPNL 36MMX11MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393612 SUP HCPCS C1713 9393612 - SPACER SPNL 36MMX12MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393613 SUP HCPCS C1713 9393613 - SPACER SPNL 36MMX13MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393614 SUP HCPCS C1713 9393614 - SPACER SPNL 36MMX14MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9393615 SUP HCPCS C1713 9393615 - SPACER SPNL 36MMX15MM LF CRSNT PEEK-OPTM VERT BD REPL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 9401300 SUP HCPCS C1713 9401300 - ENDCAP SPINAL 0D 13MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 9401304 SUP HCPCS C1713 9401304 - ENDCAP SPINAL 4D 13MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 9401308 SUP HCPCS C1713 9401308 - ENDCAP SPINAL 8D 13MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 9401315 SUP HCPCS C1713 9401315 - ENDCAP SPINAL 15D 13MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 9401600 SUP HCPCS C1713 9401600 - ENDCAP SPINAL 0D 16MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 9401604 SUP HCPCS C1713 9401604 - ENDCAP SPINAL 4D 16MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 9401608 SUP HCPCS C1713 9401608 - ENDCAP SPINAL 8D 16MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 9401615 SUP HCPCS C1713 9401615 - ENDCAP SPINAL 15D 16MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 9401900 SUP HCPCS C1713 9401900 - ENDCAP SPINAL 0D 19MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 9401904 SUP HCPCS C1713 9401904 - ENDCAP SPINAL 4D 19MM LATEX FREE BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 9401908 SUP HCPCS C1713 9401908 - ENDCAP SPINAL 8D 19MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 9401915 SUP HCPCS C1713 9401915 - ENDCAP SPINAL 15D 19MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 9402200 SUP HCPCS C1713 9402200 - ENDCAP SPINAL 0D 22MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 9402204 SUP HCPCS C1713 9402204 - CAGE SPNL 4D 22MM T2 XVBR CENTERPIECE END CAP TI COCR NTNL BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 9402208 SUP HCPCS C1713 9402208 - ENDCAP SPINAL 8D 22MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 9402215 SUP HCPCS C1713 9402215 - ENDCAP SPINAL 15D 22MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $363.00 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 9402500 SUP HCPCS C1713 9402500 - ENDCAP SPINAL 0D 25MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 9402504 SUP HCPCS C1713 9402504 - CAGE SPNL 4D 25MM T2 XVBR CENTERPIECE END CAP TI COCR NTNL BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 9402508 SUP HCPCS C1713 9402508 - ENDCAP SPINAL 8D 25MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 9402515 SUP HCPCS C1713 9402515 - ENDCAP SPINAL 15D 25MM BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $907.50 $907.50 $189.12 $907.50 N/A N/A 9450002 SUP Custom 27203010 9450002 - ELECTRODE EKG 22MM LOW IMPEDANCE BOTH IP/OP $669.00 $495.00 $119.08 $669.00 $669.00 $669.00 $669.00 $669.00 $669.00 $669.00 $119.08 $669.00 $669.00 $496.53 $496.53 $515.67 $348.55 $139.43 $669.00 $267.60 $669.00 $669.00 $669.00 $669.00 $669.00 $501.75 $669.00 $669.00 $669.00 $334.50 $334.50 $529.85 $669.00 $535.20 $434.85 $669.00 N/A $388.02 $669.00 $401.40 $669.00 $669.00 $669.00 N/A N/A 9450003 SUP Custom 27203010 9450003 - ELECTRODE ELECTROSURGICAL TWIST 22MM NEEDLE NIM STERILE BOTH IP/OP $936.00 $693.00 $166.61 $936.00 $936.00 $936.00 $936.00 $936.00 $936.00 $936.00 $166.61 $936.00 $936.00 $694.70 $694.70 $721.47 $487.66 $195.07 $936.00 $374.40 $936.00 $936.00 $936.00 $936.00 $936.00 $702.00 $936.00 $936.00 $936.00 $468.00 $468.00 $741.31 $936.00 $748.80 $608.40 $936.00 N/A $542.88 $936.00 $561.60 $936.00 $936.00 $936.00 N/A N/A 9450019 SUP Custom 27203010 9450019 - PROBE NEUROMUSCULAR NIM-SPN PEDIATRIC SPN THORACIC PEDICLE BOTH IP/OP "$1,237.50" $916.00 $220.28 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $220.28 "$1,237.50" "$1,237.50" $918.47 $918.47 $953.87 $644.74 $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $804.38 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A 9450020 SUP Custom 27203010 9450020 - NEEDLE SPNL STRL LF NIM-SPNE ACC PDCL DISP BOTH IP/OP "$1,237.50" $916.00 $220.28 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $220.28 "$1,237.50" "$1,237.50" $918.47 $918.47 $953.87 $644.74 $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $804.38 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A 9450047 SUP Custom 27203010 9450047 - PROBE NERVE STIMULATOR NIM SPN PEDICLE BOTH IP/OP "$1,237.50" $916.00 $220.28 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $220.28 "$1,237.50" "$1,237.50" $918.47 $918.47 $953.87 $644.74 $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $804.38 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A 9450051 SUP Custom 27203010 9450051 - PROBE NERVE STIMULATOR BALL 2.3MM NIM-SPN SPN PEDICLE BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $200.39 $200.39 $208.12 $140.67 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $175.50 $270.00 N/A $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 9560551 SUP Custom 27203010 9560551 - KNIFE SURG SHEATH BLADE METRX STERILE DISPOSABLE BOTH IP/OP $645.00 $477.00 $114.81 $645.00 $645.00 $645.00 $645.00 $645.00 $645.00 $645.00 $114.81 $645.00 $645.00 $478.72 $478.72 $497.17 $336.05 $134.43 $645.00 $258.00 $645.00 $645.00 $645.00 $645.00 $645.00 $483.75 $645.00 $645.00 $645.00 $322.50 $322.50 $510.84 $645.00 $516.00 $419.25 $645.00 N/A $374.10 $645.00 $387.00 $645.00 $645.00 $645.00 N/A N/A 9560658 SUP Custom 27203010 9560658 - SOURCE LIGHT QUADRANT RETRACTOR METRIX RADIANCE BOTH IP/OP "$1,207.50" $894.00 $214.94 "$1,207.50" "$1,207.50" "$1,207.50" "$1,207.50" "$1,207.50" "$1,207.50" "$1,207.50" $214.94 "$1,207.50" "$1,207.50" $896.21 $896.21 $930.74 $629.11 $251.66 "$1,207.50" $483.00 "$1,207.50" "$1,207.50" "$1,207.50" "$1,207.50" "$1,207.50" $905.63 "$1,207.50" "$1,207.50" "$1,207.50" $603.75 $603.75 $956.34 "$1,207.50" $966.00 $784.88 "$1,207.50" N/A $700.35 "$1,207.50" $724.50 "$1,207.50" "$1,207.50" "$1,207.50" N/A N/A 9560659 SUP Custom 27203010 9560659 - KNIFE SRG BYNT STRL MTRX SPNE CRV ANT DISP DSCTMY BOTH IP/OP $781.50 $578.00 $139.11 $781.50 $781.50 $781.50 $781.50 $781.50 $781.50 $781.50 $139.11 $781.50 $781.50 $580.03 $580.03 $602.38 $407.16 $162.87 $781.50 $312.60 $781.50 $781.50 $781.50 $781.50 $781.50 $586.13 $781.50 $781.50 $781.50 $390.75 $390.75 $618.95 $781.50 $625.20 $507.98 $781.50 N/A $453.27 $781.50 $468.90 $781.50 $781.50 $781.50 N/A N/A 9560702 SUP Custom 27203010 9560702 - SOURCE LIGHT 22MM ILLUMINATION METRX RADIANCE DISPOSABLE C-7 BOTH IP/OP "$1,062.00" $786.00 $189.04 "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" $189.04 "$1,062.00" "$1,062.00" $788.22 $788.22 $818.59 $553.30 $221.33 "$1,062.00" $424.80 "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" "$1,062.00" $796.50 "$1,062.00" "$1,062.00" "$1,062.00" $531.00 $531.00 $841.10 "$1,062.00" $849.60 $690.30 "$1,062.00" N/A $615.96 "$1,062.00" $637.20 "$1,062.00" "$1,062.00" "$1,062.00" N/A N/A 9560703 SUP Custom 27203010 9560703 - RETRACTOR ENDSCP 22MM 3CM TUBULAR METRX SPN STERILE BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9560704 SUP Custom 27203010 9560704 - RETRACTOR ENDSCP TUBE 22MM 4CM METRX SPN STERILE DISPOSABLE BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9560705 SUP Custom 27203010 9560705 - RETRACTOR ENDSCP TUBE 22MM 5CM METRX SPN STERILE DISPOSABLE BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9560706 SUP Custom 27203010 9560706 - RETRACTOR ENDSCP TUBE 22MM 6CM LATEX FREE METRX SPN STERILE BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9560707 SUP Custom 27203010 9560707 - RETRACTOR ENDSCP TUBE 22MM 7CM METRX SPN STERILE DISPOSABLE BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9560708 SUP Custom 27203010 9560708 - RETRACTOR ENDSCP 22MM 8CM TUBULAR MICRODISCECTOMY LATEX FREE BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9560709 SUP Custom 27203010 9560709 - RETRACTOR ENDSCP 22MM 9CM TUBULAR METRX SPN STERILE BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9560757 SUP Custom 27203010 9560757 - SOURCE LIGHT RADIANCE X METRX BOTH IP/OP "$1,290.00" $955.00 $229.62 "$1,290.00" "$1,290.00" "$1,290.00" "$1,290.00" "$1,290.00" "$1,290.00" "$1,290.00" $229.62 "$1,290.00" "$1,290.00" $957.44 $957.44 $994.33 $672.09 $268.85 "$1,290.00" $516.00 "$1,290.00" "$1,290.00" "$1,290.00" "$1,290.00" "$1,290.00" $967.50 "$1,290.00" "$1,290.00" "$1,290.00" $645.00 $645.00 "$1,021.68" "$1,290.00" "$1,032.00" $838.50 "$1,290.00" N/A $748.20 "$1,290.00" $774.00 "$1,290.00" "$1,290.00" "$1,290.00" N/A N/A 9560802 SUP Custom 27803010 9560802 - SOURCE LIGHT 18MM ILLUMINATION RADIANCE X METRX X-TUBE BOTH IP/OP $958.50 $709.00 $170.61 $958.50 $958.50 $958.50 $958.50 $958.50 $958.50 $958.50 $170.61 $958.50 $958.50 $958.50 $958.50 $958.50 $958.50 $199.76 $958.50 $383.40 $958.50 $958.50 $958.50 $958.50 $958.50 $718.88 $958.50 $958.50 $958.50 $479.25 $479.25 $759.13 $958.50 $766.80 $431.33 $958.50 N/A $555.93 $958.50 $575.10 $958.50 $958.50 $958.50 N/A N/A 9561424 SUP Custom 27203010 9561424 - DILATOR SURG 20.8MM DL BOTH IP/OP $921.00 $682.00 $163.94 $921.00 $921.00 $921.00 $921.00 $921.00 $921.00 $921.00 $163.94 $921.00 $921.00 $683.57 $683.57 $709.91 $479.84 $191.95 $921.00 $368.40 $921.00 $921.00 $921.00 $921.00 $921.00 $690.75 $921.00 $921.00 $921.00 $460.50 $460.50 $729.43 $921.00 $736.80 $598.65 $921.00 N/A $534.18 $921.00 $552.60 $921.00 $921.00 $921.00 N/A N/A 9561426 SUP Custom 27203010 9561426 - DILATOR SURG 12.8MM METRX BOTH IP/OP $966.00 $715.00 $171.95 $966.00 $966.00 $966.00 $966.00 $966.00 $966.00 $966.00 $171.95 $966.00 $966.00 $716.97 $716.97 $744.59 $503.29 $201.33 $966.00 $386.40 $966.00 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $627.90 $966.00 N/A $560.28 $966.00 $579.60 $966.00 $966.00 $966.00 N/A N/A 9561427 SUP Custom 27203010 9561427 - DILATOR SURG 14.8MM METRX BOTH IP/OP $966.00 $715.00 $171.95 $966.00 $966.00 $966.00 $966.00 $966.00 $966.00 $966.00 $171.95 $966.00 $966.00 $716.97 $716.97 $744.59 $503.29 $201.33 $966.00 $386.40 $966.00 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $627.90 $966.00 N/A $560.28 $966.00 $579.60 $966.00 $966.00 $966.00 N/A N/A 9561428 SUP Custom 27203010 9561428 - DILATOR SURG 16.8MM METRX BOTH IP/OP $966.00 $715.00 $171.95 $966.00 $966.00 $966.00 $966.00 $966.00 $966.00 $966.00 $171.95 $966.00 $966.00 $716.97 $716.97 $744.59 $503.29 $201.33 $966.00 $386.40 $966.00 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $627.90 $966.00 N/A $560.28 $966.00 $579.60 $966.00 $966.00 $966.00 N/A N/A 9561523 SUP Custom 27203010 9561523 - CLAMP BED RAIL BOTH IP/OP "$5,940.00" "$4,396.00" "$1,057.32" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$1,057.32" "$5,940.00" "$5,940.00" "$4,181.12" "$4,181.12" "$4,578.55" "$2,060.15" "$1,237.96" "$5,940.00" "$2,376.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$4,455.00" "$5,940.00" "$5,940.00" "$5,940.00" "$2,970.00" "$2,970.00" "$4,704.48" "$5,940.00" "$4,752.00" "$3,861.00" "$5,940.00" N/A "$3,445.20" "$5,940.00" "$3,564.00" "$5,940.00" "$5,940.00" "$5,940.00" N/A N/A 9561524 SUP Custom 27203010 9561524 - SET SPINAL FLEXIBLE ARM CRANIAL BOTH IP/OP "$8,920.50" "$6,601.00" "$1,587.85" "$8,920.50" "$8,920.50" "$8,920.50" "$8,920.50" "$8,920.50" "$8,920.50" "$8,920.50" "$1,587.85" "$8,920.50" "$8,920.50" "$4,181.12" "$4,181.12" "$6,875.92" "$2,060.15" "$1,859.13" "$8,920.50" "$3,568.20" "$8,920.50" "$8,920.50" "$8,920.50" "$8,920.50" "$8,920.50" "$6,690.38" "$8,920.50" "$8,920.50" "$8,920.50" "$4,460.25" "$4,460.25" "$7,065.04" "$8,920.50" "$7,136.40" "$5,798.33" "$8,920.50" N/A "$5,173.89" "$8,920.50" "$5,352.30" "$8,920.50" "$8,920.50" "$8,920.50" N/A N/A 9561525 SUP Custom 27203010 9561525 - RETRACTOR ENDSCP SELF RETAINING METRX NERVE ROOT BOTH IP/OP "$2,314.50" "$1,713.00" $411.98 "$2,314.50" "$2,314.50" "$2,314.50" "$2,314.50" "$2,314.50" "$2,314.50" "$2,314.50" $411.98 "$2,314.50" "$2,314.50" "$1,717.82" "$1,717.82" "$1,784.02" "$1,205.85" $482.37 "$2,314.50" $925.80 "$2,314.50" "$2,314.50" "$2,314.50" "$2,314.50" "$2,314.50" "$1,735.88" "$2,314.50" "$2,314.50" "$2,314.50" "$1,157.25" "$1,157.25" "$1,833.08" "$2,314.50" "$1,851.60" "$1,504.43" "$2,314.50" N/A "$1,342.41" "$2,314.50" "$1,388.70" "$2,314.50" "$2,314.50" "$2,314.50" N/A N/A 9561526 SUP Custom 27203010 9561526 - POST RETRACTOR SELF RETAINING INSTR SYSTEM METRX II NERVE BOTH IP/OP $252.00 $186.00 $44.86 $252.00 $252.00 $252.00 $252.00 $252.00 $252.00 $252.00 $44.86 $252.00 $252.00 $187.03 $187.03 $194.24 $131.29 $52.52 $252.00 $100.80 $252.00 $252.00 $252.00 $252.00 $252.00 $189.00 $252.00 $252.00 $252.00 $126.00 $126.00 $199.58 $252.00 $201.60 $163.80 $252.00 N/A $146.16 $252.00 $151.20 $252.00 $252.00 $252.00 N/A N/A 9561813 SUP Custom 27203010 9561813 - RETRACTOR SURG 3CMX18MM BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9561814 SUP Custom 27203010 9561814 - RETRACTOR SURG 4CMX18MM BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9561815 SUP Custom 27203010 9561815 - RETRACTOR ENDSCP TUBE 18MM 5CM EXPANDABLE OPENER CLOSER BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9561816 SUP Custom 27203010 9561816 - RETRACTOR ENDSCP 18MM 6CM TUBULAR MICRODISCECTOMY METRX BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9561817 SUP Custom 27203010 9561817 - RETRACTOR SURG 7CMX18MM BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9561818 SUP Custom 27203010 9561818 - RETRACTOR ENDSCP MEDIUM 18MM 8CM 8CMX18MM METRX DISPOSABLE BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9561819 SUP Custom 27203010 9561819 - RETRACTOR SURG 9CMX18MM BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9562613 SUP Custom 27203010 9562613 - RETRACTOR SURG 26MM 3CM TUBE DISPOSABLE BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9562614 SUP Custom 27203010 9562614 - RETRACTOR SURG 4CMX26MM DISPOSABLE BOTH IP/OP $631.50 $467.00 $112.41 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $631.50 $112.41 $631.50 $631.50 $468.70 $468.70 $486.76 $329.01 $131.61 $631.50 $252.60 $631.50 $631.50 $631.50 $631.50 $631.50 $473.63 $631.50 $631.50 $631.50 $315.75 $315.75 $500.15 $631.50 $505.20 $410.48 $631.50 N/A $366.27 $631.50 $378.90 $631.50 $631.50 $631.50 N/A N/A 9562615 SUP Custom 27203010 9562615 - RETRACTOR SURG 5CMX26MM DISPOSABLE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $445.32 $445.32 $462.48 $312.60 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $390.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 9562616 SUP Custom 27203010 9562616 - RETRACTOR ENDSCP TUBE 26MM 6CM METRX SPN STERILE DISPOSABLE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $445.32 $445.32 $462.48 $312.60 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $390.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 9562617 SUP Custom 27203010 9562617 - RETRACTOR ENDSCP TUBE 26MM 7CM METRX SPN STERILE DISPOSABLE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $445.32 $445.32 $462.48 $312.60 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $390.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 9562618 SUP Custom 27203010 9562618 - RETRACTOR ENDSCP TUBE 26MM 8CM METRX SPN STERILE DISPOSABLE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $445.32 $445.32 $462.48 $312.60 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $390.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 9562619 SUP Custom 27203010 9562619 - RETRACTOR ENDSCP TUBE 26MM 9CM METRX SPN STERILE DISPOSABLE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $445.32 $445.32 $462.48 $312.60 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $390.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 9569575 SUP Custom 27203010 9569575 - FORCEPS ELECTROSURGICAL BAYONET METRX STERILE REUSABLE BOTH IP/OP $207.00 $153.00 $36.85 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $207.00 $36.85 $207.00 $207.00 $153.64 $153.64 $159.56 $107.85 $43.14 $207.00 $82.80 $207.00 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $134.55 $207.00 N/A $120.06 $207.00 $124.20 $207.00 $207.00 $207.00 N/A N/A 9569813 SUP Custom 27203010 9569813 - RETRACTOR SURG ANGLED 18MM 3CM TUBULAR DISPOSABLE BOTH IP/OP $681.00 $504.00 $121.22 $681.00 $681.00 $681.00 $681.00 $681.00 $681.00 $681.00 $121.22 $681.00 $681.00 $505.44 $505.44 $524.91 $354.80 $141.93 $681.00 $272.40 $681.00 $681.00 $681.00 $681.00 $681.00 $510.75 $681.00 $681.00 $681.00 $340.50 $340.50 $539.35 $681.00 $544.80 $442.65 $681.00 N/A $394.98 $681.00 $408.60 $681.00 $681.00 $681.00 N/A N/A 9569814 SUP Custom 27203010 9569814 - RETRACTOR ENDSCP ANGLE TUBE 18MM 4CM METRX SPN STERILE BOTH IP/OP $681.00 $504.00 $121.22 $681.00 $681.00 $681.00 $681.00 $681.00 $681.00 $681.00 $121.22 $681.00 $681.00 $505.44 $505.44 $524.91 $354.80 $141.93 $681.00 $272.40 $681.00 $681.00 $681.00 $681.00 $681.00 $510.75 $681.00 $681.00 $681.00 $340.50 $340.50 $539.35 $681.00 $544.80 $442.65 $681.00 N/A $394.98 $681.00 $408.60 $681.00 $681.00 $681.00 N/A N/A 9569815 SUP Custom 27203010 9569815 - RETRACTOR SURG 18MM 5CMX18MM ANGLED TUBULAR METRX SPN BOTH IP/OP $681.00 $504.00 $121.22 $681.00 $681.00 $681.00 $681.00 $681.00 $681.00 $681.00 $121.22 $681.00 $681.00 $505.44 $505.44 $524.91 $354.80 $141.93 $681.00 $272.40 $681.00 $681.00 $681.00 $681.00 $681.00 $510.75 $681.00 $681.00 $681.00 $340.50 $340.50 $539.35 $681.00 $544.80 $442.65 $681.00 N/A $394.98 $681.00 $408.60 $681.00 $681.00 $681.00 N/A N/A 9569816 SUP Custom 27203010 9569816 - RETRACTOR SURG 18MM 6CM ANGLED TUBULAR METRX SPN STERILE BOTH IP/OP $681.00 $504.00 $121.22 $681.00 $681.00 $681.00 $681.00 $681.00 $681.00 $681.00 $121.22 $681.00 $681.00 $505.44 $505.44 $524.91 $354.80 $141.93 $681.00 $272.40 $681.00 $681.00 $681.00 $681.00 $681.00 $510.75 $681.00 $681.00 $681.00 $340.50 $340.50 $539.35 $681.00 $544.80 $442.65 $681.00 N/A $394.98 $681.00 $408.60 $681.00 $681.00 $681.00 N/A N/A 9569817 SUP Custom 27203010 9569817 - RETRACTOR ENDSCP ANGLE TUBE 18MM 7CM METRX SPN STERILE BOTH IP/OP $681.00 $504.00 $121.22 $681.00 $681.00 $681.00 $681.00 $681.00 $681.00 $681.00 $121.22 $681.00 $681.00 $505.44 $505.44 $524.91 $354.80 $141.93 $681.00 $272.40 $681.00 $681.00 $681.00 $681.00 $681.00 $510.75 $681.00 $681.00 $681.00 $340.50 $340.50 $539.35 $681.00 $544.80 $442.65 $681.00 N/A $394.98 $681.00 $408.60 $681.00 $681.00 $681.00 N/A N/A 9569818 SUP Custom 27203010 9569818 - RETRACTOR ENDSCP ANGLE TUBE 18MM 8CM METRX SPN STERILE BOTH IP/OP $681.00 $504.00 $121.22 $681.00 $681.00 $681.00 $681.00 $681.00 $681.00 $681.00 $121.22 $681.00 $681.00 $505.44 $505.44 $524.91 $354.80 $141.93 $681.00 $272.40 $681.00 $681.00 $681.00 $681.00 $681.00 $510.75 $681.00 $681.00 $681.00 $340.50 $340.50 $539.35 $681.00 $544.80 $442.65 $681.00 N/A $394.98 $681.00 $408.60 $681.00 $681.00 $681.00 N/A N/A 9569819 SUP Custom 27203010 9569819 - RETRACTOR ENDSCP ANGLE TUBE 18MM 9CM METRX SPN STERILE BOTH IP/OP $681.00 $504.00 $121.22 $681.00 $681.00 $681.00 $681.00 $681.00 $681.00 $681.00 $121.22 $681.00 $681.00 $505.44 $505.44 $524.91 $354.80 $141.93 $681.00 $272.40 $681.00 $681.00 $681.00 $681.00 $681.00 $510.75 $681.00 $681.00 $681.00 $340.50 $340.50 $539.35 $681.00 $544.80 $442.65 $681.00 N/A $394.98 $681.00 $408.60 $681.00 $681.00 $681.00 N/A N/A 9680050 SUP Custom 27203010 9680050 - SCREWDRIVER SURG MULTIAX M10 SPN BOTH IP/OP "$2,451.00" "$1,814.00" $436.28 "$2,451.00" "$2,451.00" "$2,451.00" "$2,451.00" "$2,451.00" "$2,451.00" "$2,451.00" $436.28 "$2,451.00" "$2,451.00" "$1,819.13" "$1,819.13" "$1,889.23" "$1,276.97" $510.82 "$2,451.00" $980.40 "$2,451.00" "$2,451.00" "$2,451.00" "$2,451.00" "$2,451.00" "$1,838.25" "$2,451.00" "$2,451.00" "$2,451.00" "$1,225.50" "$1,225.50" "$1,941.19" "$2,451.00" "$1,960.80" "$1,593.15" "$2,451.00" N/A "$1,421.58" "$2,451.00" "$1,470.60" "$2,451.00" "$2,451.00" "$2,451.00" N/A N/A 9680853 SUP HCPCS C1713 9680853 - SCREW SET BREAKOFF REDX CD HORIZON M10 STAINLESS STEEL SPN BOTH IP/OP $342.00 $253.00 $67.88 $342.00 $153.90 $153.90 $153.90 $153.90 $342.00 $342.00 $342.00 $71.28 $342.00 $342.00 $342.00 $342.00 $342.00 $71.28 $342.00 $136.80 $202.29 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $153.90 $67.88 N/A $198.36 $342.00 $342.00 $342.00 $71.27 $342.00 N/A N/A 9680854 SUP HCPCS C1713 9680854 - SCREW SET .25 PITCH NONBREAKOFF CD HORIZON M10 STAINLESS BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 9680855 SUP HCPCS C1713 9680855 - SCREW SET .25IN PITCH BREAKOFF MULTIAX M10 CD HORIZON BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 9690030 SUP HCPCS C1713 9690030 - ROD SPINAL 6.35MM 30MM PREBENT PRECUT CD HORIZON LEGACY BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 9690040 SUP HCPCS C1713 9690040 - ROD SPINAL PRECUT PREBENT 6.35MM 40MM LEGACY CD HORIZON BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 9690050 SUP HCPCS C1713 9690050 - ROD SPINAL PRECUT PREBENT 6.35MM 50MM PREBENT PRECUT CD BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 9690060 SUP HCPCS C1713 9690060 - ROD SPINAL PRECUT PREBENT 6.35MM 60CM LEGACY CD HORIZON BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 9690070 SUP HCPCS C1713 9690070 - ROD SPINAL PREBENT 6.35MM 70MM PRECUT CENTRL POST CD HORIZON BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 9690080 SUP HCPCS C1713 9690080 - ROD SPINAL 6.35MM 80CM PREBENT PRECUT CD HORIZON LEGACY BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 9690090 SUP HCPCS C1713 9690090 - ROD SPINAL PREBENT 6.35MM 90MM CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 9690100 SUP HCPCS C1713 9690100 - ROD SPINAL PREBENT 6.35MM 100MM CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 9690110 SUP HCPCS C1713 9690110 - ROD SPINAL 6.35MM PREBENT TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 9690853 SUP HCPCS C1713 9690853 - SCREW SET BREAKOFF REDX CD HORIZON M10 TITANIUM SPN PEDICLE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 9690854 SUP HCPCS C1713 9690854 - SCREW SET .25 PITCH NONBREAKOFF CD HORIZON M10 TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 9690855 SUP HCPCS C1713 9690855 - SCREW SET M10 BREAKOFF MULTIAX CD HORIZON TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 9733065 SUP Custom 27203010 9733065 - SYSTEM GUIDANCE EXTERNAL TRAJECTORY KIT NAVIGUS BOTH IP/OP "$2,937.50" "$2,174.00" $522.88 "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" $522.88 "$2,937.50" "$2,937.50" "$2,180.21" "$2,180.21" "$2,264.23" "$1,530.44" $612.21 "$2,937.50" "$1,175.00" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,203.13" "$2,937.50" "$2,937.50" "$2,937.50" "$1,468.75" "$1,468.75" "$2,326.50" "$2,937.50" "$2,350.00" "$1,909.38" "$2,937.50" N/A "$1,703.75" "$2,937.50" "$1,762.50" "$2,937.50" "$2,937.50" "$2,937.50" N/A N/A 9733068 SUP Custom 27203010 9733068 - KIT BIOP NEEDLE PASSIVE NAVIGUS BOTH IP/OP "$1,562.50" "$1,156.00" $278.13 "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" $278.13 "$1,562.50" "$1,562.50" "$1,159.69" "$1,159.69" "$1,204.38" $814.06 $325.64 "$1,562.50" $625.00 "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" "$1,171.88" "$1,562.50" "$1,562.50" "$1,562.50" $781.25 $781.25 "$1,237.50" "$1,562.50" "$1,250.00" "$1,015.63" "$1,562.50" N/A $906.25 "$1,562.50" $937.50 "$1,562.50" "$1,562.50" "$1,562.50" N/A N/A 9733497 SUP Custom 27203010 9733497 - NEEDLE NERVE STIMULATOR ACCES KIT NIM SPN PEDICLE BOTH IP/OP "$1,642.50" "$1,215.00" $292.37 "$1,642.50" "$1,642.50" "$1,642.50" "$1,642.50" "$1,642.50" "$1,642.50" "$1,642.50" $292.37 "$1,642.50" "$1,642.50" "$1,219.06" "$1,219.06" "$1,266.04" $855.74 $342.32 "$1,642.50" $657.00 "$1,642.50" "$1,642.50" "$1,642.50" "$1,642.50" "$1,642.50" "$1,231.88" "$1,642.50" "$1,642.50" "$1,642.50" $821.25 $821.25 "$1,300.86" "$1,642.50" "$1,314.00" "$1,067.63" "$1,642.50" N/A $952.65 "$1,642.50" $985.50 "$1,642.50" "$1,642.50" "$1,642.50" N/A N/A 9733498 SUP Custom 27203010 9733498 - KIT STRTC STRL LF NAVIGATE ACC SPNE PDCL DISP BOTH IP/OP $907.50 $672.00 $161.54 $907.50 $907.50 $907.50 $907.50 $907.50 $907.50 $907.50 $161.54 $907.50 $907.50 $673.55 $673.55 $699.50 $472.81 $189.13 $907.50 $363.00 $907.50 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $589.88 $907.50 N/A $526.35 $907.50 $544.50 $907.50 $907.50 $907.50 N/A N/A 9734887 SUP Custom 27203010 9734887 - TRACKER NVG STRL LF NINVS DISP BOTH IP/OP $542.50 $401.00 $96.57 $542.50 $542.50 $542.50 $542.50 $542.50 $542.50 $542.50 $96.57 $542.50 $542.50 $402.64 $402.64 $418.16 $282.64 $113.06 $542.50 $217.00 $542.50 $542.50 $542.50 $542.50 $542.50 $406.88 $542.50 $542.50 $542.50 $271.25 $271.25 $429.66 $542.50 $434.00 $352.63 $542.50 N/A $314.65 $542.50 $325.50 $542.50 $542.50 $542.50 N/A N/A 9735317 SUP Custom 27203010 9735317 - SYSTEM STRTC AXIEM TRCR PNTR BOTH IP/OP "$1,420.00" "$1,051.00" $252.76 "$1,420.00" "$1,420.00" "$1,420.00" "$1,420.00" "$1,420.00" "$1,420.00" "$1,420.00" $252.76 "$1,420.00" "$1,420.00" "$1,053.92" "$1,053.92" "$1,094.54" $739.82 $295.94 "$1,420.00" $568.00 "$1,420.00" "$1,420.00" "$1,420.00" "$1,420.00" "$1,420.00" "$1,065.00" "$1,420.00" "$1,420.00" "$1,420.00" $710.00 $710.00 "$1,124.64" "$1,420.00" "$1,136.00" $923.00 "$1,420.00" N/A $823.60 "$1,420.00" $852.00 "$1,420.00" "$1,420.00" "$1,420.00" N/A N/A 9735428 SUP Custom 27203010 9735428 - STYLET NVG STRL LF 2 COIL DISP BOTH IP/OP "$1,420.00" "$1,051.00" $252.76 "$1,420.00" "$1,420.00" "$1,420.00" "$1,420.00" "$1,420.00" "$1,420.00" "$1,420.00" $252.76 "$1,420.00" "$1,420.00" "$1,053.92" "$1,053.92" "$1,094.54" $739.82 $295.94 "$1,420.00" $568.00 "$1,420.00" "$1,420.00" "$1,420.00" "$1,420.00" "$1,420.00" "$1,065.00" "$1,420.00" "$1,420.00" "$1,420.00" $710.00 $710.00 "$1,124.64" "$1,420.00" "$1,136.00" $923.00 "$1,420.00" N/A $823.60 "$1,420.00" $852.00 "$1,420.00" "$1,420.00" "$1,420.00" N/A N/A 9790019 SUP HCPCS C1713 9790019 - PLATE BONE LP 19MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 9790021 SUP HCPCS C1713 9790021 - PLATE BONE LP 21MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 9790023 SUP HCPCS C1713 9790023 - PLATE BN 23MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 9790025 SUP HCPCS C1713 9790025 - PLATE BN 25MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 9790027 SUP HCPCS C1713 9790027 - PLATE BN 27.5MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 9790030 SUP HCPCS C1713 9790030 - PLATE BN 30MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 9790032 SUP HCPCS C1713 9790032 - PLATE BONE LP 32.5MM INTEGRATE LOCK MECHANISM SELF DRILL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 9790035 SUP HCPCS C1713 9790035 - PLATE BONE LP 35MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 9790037 SUP HCPCS C1713 9790037 - PLATE BONE LP 37.5MM INTEGRATE LOCK MECHANISM SELF DRILL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 9790040 SUP HCPCS C1713 9790040 - PLATE BN 40MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 9790042 SUP HCPCS C1713 9790042 - PLATE BONE LP 42.5MM INTEGRATE LOCK MECHANISM SELF DRILL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 9790045 SUP HCPCS C1713 9790045 - PLATE BN 45MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 9790047 SUP HCPCS C1713 9790047 - PLATE BONE LP 475MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 9790050 SUP HCPCS C1713 9790050 - PLATE BN 50MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 9790052 SUP HCPCS C1713 9790052 - PLATE BONE LP 52.5MM INTEGRATE LOCK MECHANISM SELF DRILL BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 9790055 SUP HCPCS C1713 9790055 - PLATE BONE LP 55MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 9790057 SUP HCPCS C1713 9790057 - PLATE BONE LP 57MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 9790060 SUP HCPCS C1713 9790060 - PLATE BONE LP 60MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 9790062 SUP HCPCS C1713 9790062 - PLATE BN 62.5MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 9790065 SUP HCPCS C1713 9790065 - PLATE BN 65MM STRL VNTR INTGR LCK MDLN ALGN NTCH LOPRFL TI BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 9790067 SUP HCPCS C1713 9790067 - PLATE BONE LP 67.5MM INTEGRATE LOCK MECHANISM SELF DRILL BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 9790070 SUP HCPCS C1713 9790070 - PLATE BONE LP 70MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 9790072 SUP HCPCS C1713 9790072 - PLATE BONE LP 72.5MM INTEGRATE LOCK MECHANISM SELF DRILL BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 9790075 SUP HCPCS C1713 9790075 - PLATE BONE LP 75MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 9790077 SUP HCPCS C1713 9790077 - PLATE BONE LP 77.5MM INTEGRATE LOCK MECHANISM SELF DRILL BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 9790080 SUP HCPCS C1713 9790080 - PLATE BONE LP 80MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 9790082 SUP HCPCS C1713 9790082 - PLATE BONE LP 82.5MM INTEGRATE LOCK MECHANISM SELF DRILL BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 9790085 SUP HCPCS C1713 9790085 - PLATE BONE LP 85MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 9790087 SUP HCPCS C1713 9790087 - PLATE BONE LP 87.5MM INTEGRATE LOCK MECHANISM SELF DRILL BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$4,525.50" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9790090 SUP HCPCS C1713 9790090 - PLATE BONE LP 90MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$4,525.50" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$4,525.50" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9790095 SUP HCPCS C1713 9790095 - PLATE BONE LP 95MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$4,525.50" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9790100 SUP HCPCS C1713 9790100 - PLATE BONE LP 100MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$1,810.20" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9790105 SUP HCPCS C1713 9790105 - PLATE BONE LP 105MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$1,810.20" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9790110 SUP HCPCS C1713 9790110 - PLATE BONE LP 110MM INTEGRATE LOCK MECHANISM SELF DRILL SELF BOTH IP/OP "$4,525.50" "$3,349.00" $898.20 "$4,525.50" "$2,036.48" "$2,036.48" "$2,036.48" "$2,036.48" "$4,525.50" "$4,525.50" "$4,525.50" $943.23 "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" $943.16 "$4,525.50" "$4,525.50" "$2,231.07" "$4,525.50" "$4,525.50" "$4,525.50" "$4,525.50" "$3,394.13" "$4,525.50" "$4,525.50" "$4,525.50" "$2,262.75" "$2,262.75" "$3,584.20" "$4,525.50" "$3,620.40" "$2,036.48" $898.20 N/A "$2,624.79" "$4,525.50" "$2,715.30" "$4,525.50" $943.11 "$4,525.50" N/A N/A 9790211 SUP HCPCS C1713 9790211 - SCREW BONE 4MM 11MM FIX ANGLE SELF TAP VENTURE GREEN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9790213 SUP HCPCS C1713 9790213 - SCREW BONE 4MM 13MM FIX ANGLE SELF TAP VENTURE GREEN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 9790215 SUP HCPCS C1713 9790215 - SCREW BN 4MM 15MM NS VNTR ST FX ANG TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9790217 SUP HCPCS C1713 9790217 - SCREW BONE 4MM 17MM FIX ANGLE SELF TAP VENTURE GREEN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 9790219 SUP HCPCS C1713 9790219 - SCREW BONE 4MM 19MM FIX ANGLE SELF TAP VENTURE GREEN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9790221 SUP HCPCS C1713 9790221 - SCREW BONE 4MM 11MM FIX ANGLE SELF DRILL VENTURE GREEN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9790223 SUP HCPCS C1713 9790223 - SCREW BONE 4MM 13MM FIX ANGLE SELF DRILL VENTURE GREEN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9790311 SUP HCPCS C1713 9790311 - SCREW BONE LP 4MM 11MM VAR ANG SELF TAP VENTURE GREEN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9790312 SUP HCPCS C1713 9790312 - SCREW BONE 4MM 12MM SLFTAP VAR ANG VENTURE SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 9790313 SUP HCPCS C1713 9790313 - SCREW BONE LP 4MM 13MM VAR ANG SELF TAP VENTURE GREEN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 9790315 SUP HCPCS C1713 9790315 - SCREW BONE LP 4MM 15MM VAR ANG SELF TAP VENTURE GREEN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 9790317 SUP HCPCS C1713 9790317 - SCREW BONE LP 4MM 17MM VAR ANG SELF TAP VENTURE GREEN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 9790319 SUP HCPCS C1713 9790319 - SCREW BONE LP 4MM 19MM VAR ANG SELF TAP VENTURE GREEN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9790325 SUP HCPCS C1713 9790325 - SCREW BONE 4MM 15MM VAR ANG SELF DRILL VENTURE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9790904 SUP HCPCS C1713 9790904 - PIN HOLDING PREFIXATION TEMPERATURE REUSABLE BOTH IP/OP $291.00 $215.00 $57.76 $291.00 $130.95 $130.95 $130.95 $130.95 $291.00 $291.00 $291.00 $60.65 $291.00 $291.00 $291.00 $291.00 $291.00 $60.65 $291.00 $291.00 $172.13 $291.00 $291.00 $291.00 $291.00 $218.25 $291.00 $291.00 $291.00 $145.50 $145.50 $230.47 $291.00 $232.80 $130.95 $57.76 N/A $168.78 $291.00 $291.00 $291.00 $60.64 $291.00 N/A N/A 9790915 SUP Custom 27203010 9790915 - BIT DRL 11MM STRL DISP BOTH IP/OP $718.50 $532.00 $127.89 $718.50 $718.50 $718.50 $718.50 $718.50 $718.50 $718.50 $127.89 $718.50 $718.50 $533.27 $533.27 $553.82 $374.34 $149.74 $718.50 $287.40 $718.50 $718.50 $718.50 $718.50 $718.50 $538.88 $718.50 $718.50 $718.50 $359.25 $359.25 $569.05 $718.50 $574.80 $467.03 $718.50 N/A $416.73 $718.50 $431.10 $718.50 $718.50 $718.50 N/A N/A 9791030 SUP HCPCS C1713 9791030 - PLATE BONE LP 30MM LEVEL 3 INTEGRATE LOCK MECHANISM SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 9791150 SUP HCPCS C1713 9791150 - PLATE BONE LP 50MM LEVEL 3 INTEGRATE LOCK MECHANISM SELF BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 9791221 SUP HCPCS C1713 9791221 - SCREW BONE 4MM 21MM FIX ANGLE SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9791222 SUP HCPCS C1713 9791222 - SCREW BONE 4MM 12MM FIXANG SLFDRILL ANTERIOR CERV SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9791223 SUP HCPCS C1713 9791223 - SCREW BN 4MM 13MM NS VNTR SLF DRL FX ANG INTGR LCK TI SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9791224 SUP HCPCS C1713 9791224 - SCREW BONE 4MM 14MM SLFDRILL FIXANG SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9791225 SUP HCPCS C1713 9791225 - SCREW BN 4MM 15MM NS VNTR SLF DRL FX ANG INTGR LCK TI SPNE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9791226 SUP HCPCS C1713 9791226 - SCREW BONE 4MM 16MM SLFDRILL FIXANG SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 9791227 SUP HCPCS C1713 9791227 - SCREW BONE 4MM 17MM FIX ANGLE SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9791321 SUP HCPCS C1713 9791321 - SCREW BONE 4MM 11MM VAR ANG SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9791322 SUP HCPCS C1713 9791322 - SCREW BONE 4MM 12MM VAR ANG SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9791323 SUP HCPCS C1713 9791323 - SCREW BN 4MM 13MM NS VNTR SLF DRL VA INTGR LCK TI SPNE CRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9791324 SUP HCPCS C1713 9791324 - SCREW BONE 4MM 14MM SLFTAP VAR ANG VENTURE SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9791325 SUP HCPCS C1713 9791325 - SCREW BN 4MM 15MM NS VNTR SLF DRL VA INTGR LCK TI SPNE CRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9791326 SUP HCPCS C1713 9791326 - SCREW BONE 4MM 16MM VAR ANG SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9791327 SUP HCPCS C1713 9791327 - SCREW SET .25MM 32MM BREAKOFF CD HORIZON LEGACY STAINLESS BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9795211 SUP HCPCS C1713 9795211 - SCREW BONE 4.5MM 11MM FIX ANGLE SELF TAP INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9795213 SUP HCPCS C1713 9795213 - SCREW BONE 4.5MM 13MM FIX ANGLE SELF TAP INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9795215 SUP HCPCS C1713 9795215 - SCREW BONE 4.5MM 15MM FIX ANGLE SELF TAP INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 9795217 SUP HCPCS C1713 9795217 - SCREW BONE 4.5MM 17MM FIX ANGLE SELF TAP INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 9795219 SUP HCPCS C1713 9795219 - SCREW BONE 4.5MM 19MM FIX ANGLE SELF TAP INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 9795221 SUP HCPCS C1713 9795221 - SCREW BONE 4.5MM 11MM FIX ANGLE SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9795223 SUP HCPCS C1713 9795223 - SCREW BONE 4.5MM 13MM FIX ANGLE SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9795225 SUP HCPCS C1713 9795225 - SCREW BONE 4.5MM 15MM FIX ANGLE SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9795227 SUP HCPCS C1713 9795227 - SCREW BONE 4.5MM 17MM FIX ANGLE SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 9795229 SUP HCPCS C1713 9795229 - SCREW BONE 4.5MM 19MM FIX ANGLE SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 9795311 SUP HCPCS C1713 9795311 - SCREW BONE 4.5MM 11MM VAR ANG SELF TAP INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9795313 SUP HCPCS C1713 9795313 - SCREW BONE 4.5MM 13MM VAR ANG SELF TAP INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9795315 SUP HCPCS C1713 9795315 - SCREW BONE 4.5MM 15MM VAR ANG SELF TAP INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9795317 SUP HCPCS C1713 9795317 - SCREW BONE 4.5MM 17MM VAR ANG SELF TAP INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9795319 SUP HCPCS C1713 9795319 - SCREW BONE 4.5MM 19MM VAR ANG SELF TAP INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9795321 SUP HCPCS C1713 9795321 - SCREW BONE 4.5MM 11MM VAR ANG SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9795323 SUP HCPCS C1713 9795323 - SCREW BONE 4.5MM 13MM VAR ANG SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 9795325 SUP HCPCS C1713 9795325 - SCREW BONE 4.5MM 15MM VAR ANG SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9795327 SUP HCPCS C1713 9795327 - SCREW BONE 4.5MM 17MM VAR ANG SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9795329 SUP HCPCS C1713 9795329 - SCREW BONE 4.5MM 19MM VAR ANG SELF DRILL INTEGRATE LOCK BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 9873033 SUP HCPCS C1713 9873033 - PLATE BONE 33MM 3 HOLE PYRAMID TITANIUM SPINAL LUMBAR BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9873035 SUP HCPCS C1713 9873035 - PLATE BONE 35MM 3 HOLE PYRAMID TITANIUM SPINAL LUMBAR BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9873037 SUP HCPCS C1713 9873037 - PLATE BONE 37MM 3 HOLE PYRAMID TITANIUM SPINAL LUMBAR BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9873039 SUP HCPCS C1713 9873039 - PLATE BONE 39MM 3 HOLE PYRAMID TITANIUM SPINAL LUMBAR BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9873041 SUP HCPCS C1713 9873041 - PLATE BONE 41MM 3 HOLE PYRAMID TITANIUM SPINAL LUMBAR BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9873133 SUP HCPCS C1713 9873133 - PLATE BONE 33MM 3 HOLE PYRAMID SPN BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9873135 SUP HCPCS C1713 9873135 - PLATE BONE 35MM 3 HOLE PYRAMID SPN BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$3,795.00" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9873137 SUP HCPCS C1713 9873137 - PLATE BONE 37MM 3 HOLE PYRAMID SPN BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$3,795.00" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9873139 SUP HCPCS C1713 9873139 - PLATE BONE 39MM 3 HOLE PYRAMID TITANIUM SPINAL LUMBAR BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$3,795.00" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9873141 SUP HCPCS C1713 9873141 - PLATE BONE 41MM 3 HOLE PYRAMID TITANIUM SPINAL LUMBAR BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$3,795.00" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9874035 SUP HCPCS C1713 9874035 - PLATE BN 35MM PRMD 4 HL SPNE LMBR ANT BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$3,795.00" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9874037 SUP HCPCS C1713 9874037 - PLATE BN 37MM PRMD 4 HL SPNE LMBR ANT BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9874039 SUP HCPCS C1713 9874039 - PLATE BN 39MM PRMD 4 HL SPNE LMBR ANT BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9874041 SUP HCPCS C1713 9874041 - PLATE BONE 41MM 4 HOLE PYRAMID SPN BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9874043 SUP HCPCS C1713 9874043 - PLATE BONE 43MM 4 HOLE PYRAMID SPN BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 9874045 SUP HCPCS C1713 9874045 - PLATE BONE 45MM 4 HOLE PYRAMID SPN BOTH IP/OP "$9,487.50" "$7,021.00" "$1,883.03" "$9,487.50" "$4,269.38" "$4,269.38" "$4,269.38" "$4,269.38" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.43" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$1,977.30" "$9,487.50" "$9,487.50" "$4,677.34" "$9,487.50" "$9,487.50" "$9,487.50" "$9,487.50" "$7,115.63" "$9,487.50" "$9,487.50" "$9,487.50" "$4,743.75" "$4,743.75" "$7,514.10" "$9,487.50" "$7,590.00" "$4,269.38" "$1,883.03" N/A "$5,502.75" "$9,487.50" "$5,692.50" "$9,487.50" "$1,977.20" "$9,487.50" N/A N/A 10000607 SUP HCPCS C1713 10000607 - WIRE FX RELINE MAS BLNT THRD NTNL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 10055332 SUP HCPCS C1713 10055332 - RELINE FIXED CROSS CONN. 37.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 10055425 SUP HCPCS C1713 10055425 - CONNECTOR ROD 5.5MM 25-30MM RELINE CX ADJ LOPRFL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 10056425 SUP HCPCS C1713 10056425 - CONNECTOR ROD 5.5-6MM 25-30MM RELINE CX ADJ LOPRFL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 10720401 SUP HCPCS C1887 10720401 - CATHETER ANGIOGRAPHIC SOS OMNI 1 CURVE 5FR 80CM HIGH TORQUE BOTH IP/OP $35.00 $26.00 $6.95 $35.00 $19.01 $19.01 $19.01 $19.01 $35.00 $35.00 $35.00 $7.29 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $35.00 $20.70 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $6.95 N/A $20.30 $35.00 $35.00 $35.00 $7.29 $35.00 N/A N/A 10720401 SUP HCPCS C1887 10720401 - CATHETER ANGIO SOS O 1 CRV 5FR 80CM SFVU RADOPQ NONBRAID BOTH IP/OP $35.00 $26.00 $6.95 $35.00 $19.01 $19.01 $19.01 $19.01 $35.00 $35.00 $35.00 $7.29 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $35.00 $20.70 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $6.95 N/A $20.30 $35.00 $35.00 $35.00 $7.29 $35.00 N/A N/A 10800702 SUP HCPCS C1769 SET CATH 20CM .035IN SCHN XL GUIDEWIRE INTROD NDL HMDIAL BOTH IP/OP $245.00 $181.00 $48.63 $245.00 $133.04 $133.04 $133.04 $133.04 $245.00 $245.00 $245.00 $51.06 $245.00 $181.84 $181.84 $188.85 $127.65 $51.06 $245.00 $245.00 $144.92 $245.00 $245.00 $245.00 $245.00 $183.75 $245.00 $245.00 $245.00 $122.50 $122.50 $194.04 $245.00 $196.00 $159.25 $48.63 N/A $142.10 $245.00 $245.00 $245.00 $51.06 $245.00 N/A N/A 10802701 SUP HCPCS C1752 10802701 - SET CATHETER .035IN 15CM 70CM SIDEHOLE REMOVABLE STYLET TIP BOTH IP/OP $355.00 $263.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $142.00 $355.00 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $355.00 N/A $205.90 $355.00 $213.00 $355.00 $355.00 $355.00 N/A N/A 10802703 SUP HCPCS C1752 10802703 - SET CATH 24CM STRL SCHN XL FULL ACUTE HMDIAL BOTH IP/OP $355.00 $263.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $142.00 $355.00 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $355.00 N/A $205.90 $355.00 $213.00 $355.00 $355.00 $355.00 N/A N/A 11355025 SUP HCPCS C1713 11355025 - ROD SPNL LRDTC 5.5MM 25MM NS RELINE TI MAS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 11355030 SUP HCPCS C1713 11355030 - ROD SPNL LRDTC 5.5MM 30MM NS RELINE TI MAS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 11355035 SUP HCPCS C1713 11355035 - ROD SPNL LRDTC 5.5MM 35MM NS RELINE TI MAS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 11355045 SUP HCPCS C1713 11355045 - ROD SPNL LRDTC 5.5MM 45MM NS RELINE TI MAS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 11355050 SUP HCPCS C1713 11355050 - ROD SPNL LRDTC 5.5MM 50MM NS RELINE TI MAS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 11355055 SUP HCPCS C1713 11355055 - ROD SPNL LRDTC 5.5MM 55MM NS RELINE TI MAS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 11355060 SUP HCPCS C1713 11355060 - ROD SPNL LRDTC 5.5MM 60MM NS RELINE TI MAS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 11355070 SUP HCPCS C1713 11355070 - ROD SPNL LRDTC 5.5MM 70MM NS RELINE TI MAS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 11355085 SUP HCPCS C1713 11355085 - RELINE ROD 85MM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 11355090 SUP HCPCS C1713 "11355090 - RELINE ROD, 90MM" BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 11355095 SUP HCPCS C1713 11355095 - ROD SPNL LRDTC 5.5MM 95MM NS RELINE TI MAS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 11355110 SUP HCPCS C1713 11355110 - ROD SPNL LRDTC 5.5MM 110MM NS RELINE TI MAS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 11355150 SUP HCPCS C1713 11355150 - ROD SPNL LRDTC 5.5MM 150MM NS RELINE TI MAS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 11355160 SUP HCPCS C1713 11355160 - ROD SPNL LRDTC 5.5MM 160MM NS RELINE TI MAS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 11403002 SUP Custom 27203010 11403002 - KIT PROCEDURE .035IN 21GA 65CM LONG ACCES GWIRE NEEDLE GOLD BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $400.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A 12401812 SUP HCPCS C1757 12401812 - CATHETER THROMBECTOMY 5FR 135CM 10CM OCCLUDING BALL WIRE BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $237.56 $237.56 $237.56 $237.56 $437.50 $437.50 $437.50 $91.19 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $437.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A 12401813 SUP HCPCS C1729 CATHETER INFUS 5FR 25MM 20CM SLT DSGN FLW THRU HUB OCL WIRE BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $223.99 $223.99 $223.99 $223.99 $412.50 $412.50 $412.50 $85.98 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A 12401813 SUP HCPCS C1757 12401813 - CATHETER THROMBECTOMY 5FR 135CM 20CM OCCLUDING BALL WIRE BOTH IP/OP $437.50 $324.00 $81.87 $412.50 $223.99 $223.99 $223.99 $223.99 $412.50 $412.50 $412.50 $85.98 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $328.13 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $81.87 N/A $253.75 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A 13010545 SUP HCPCS C1713 13010545 - SCREW BN 2S 10.5MM 45MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13014030 SUP HCPCS C1713 13014030 - SCREW BN 2S 4MM 30MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13014040 SUP HCPCS C1713 13014040 - SCREW BN 2S 4MM 40MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13014530 SUP HCPCS C1713 13014530 - SCREW BN 2S 4.5MM 30MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13014540 SUP HCPCS C1713 13014540 - SCREW BN 2S 4.5MM 40MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13015035 SUP HCPCS C1713 13015035 - SCREW BN 2S 5MM 35MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13015045 SUP HCPCS C1713 13015045 - SCREW BN 2S 5MM 45MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13015050 SUP HCPCS C1713 13015050 - SCREW BN 2S 5MM 50MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13015055 SUP HCPCS C1713 13015055 - SCREW BN 2S 5MM 55MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13015525 SUP HCPCS C1713 13015525 - SCREW BN 2S 5.5MM 25MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13015530 SUP HCPCS C1713 13015530 - SCREW BN 2S 5.5MM 30MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13015535 SUP HCPCS C1713 13015535 - SCREW BN 2S 5.5MM 35MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13015540 SUP HCPCS C1713 13015540 - SCREW BN 2S 5.5MM 40MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13015545 SUP HCPCS C1713 13015545 - SCREW BN 2S 5.5MM 45MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13015550 SUP HCPCS C1713 13015550 - SCREW BN 2S 5.5MM 50MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13015555 SUP HCPCS C1713 13015555 - SCREW BN 2S 5.5MM 55MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13016535 SUP HCPCS C1713 13016535 - SCREW BN 2S 6.5MM 35MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13016540 SUP HCPCS C1713 13016540 - SCREW BN 2S 6.5MM 40MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13016545 SUP HCPCS C1713 13016545 - SCREW BN 2S 6.5MM 45MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13016550 SUP HCPCS C1713 13016550 - SCREW BN 2S 6.5MM 50MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13016555 SUP HCPCS C1713 13016555 - SCREW BN 2S 6.5MM 55MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13017535 SUP HCPCS C1713 13017535 - SCREW BN 2S 7.5MM 35MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13017540 SUP HCPCS C1713 13017540 - SCREW BN 2S 7.5MM 40MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13017545 SUP HCPCS C1713 13017545 - SCREW BN 2S 7.5MM 45MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13017550 SUP HCPCS C1713 13017550 - SCREW BN 2S 7.5MM 50MM NS LF RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13017555 SUP HCPCS C1713 13017555 - SCREW BN 2S 7.5MM 55MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13018535 SUP HCPCS C1713 13018535 - SCREW BN 2S 8.5MM 35MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13018540 SUP HCPCS C1713 13018540 - SCREW BN 2S 8.5MM 40MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13018545 SUP HCPCS C1713 13018545 - SCREW BN 2S 8.5MM 45MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13018550 SUP HCPCS C1713 13018550 - SCREW BN 2S 8.5MM 50MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13018555 SUP HCPCS C1713 13018555 - SCREW BN 2S 8.5MM 55MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13018560 SUP HCPCS C1713 13018560 - SCREW BN 2S 8.5MM 60MM NS LF RELINE-O PA SPNE LLIAC BOTH IP/OP "$3,450.00" "$2,553.00" $684.74 "$3,450.00" "$1,552.50" "$1,552.50" "$1,552.50" "$1,552.50" "$3,450.00" "$3,450.00" "$3,450.00" $719.07 "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" $719.02 "$3,450.00" "$1,380.00" "$1,700.85" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" "$2,587.50" "$3,450.00" "$3,450.00" "$3,450.00" "$1,725.00" "$1,725.00" "$2,732.40" "$3,450.00" "$2,760.00" "$1,552.50" $684.74 N/A "$2,001.00" "$3,450.00" "$3,450.00" "$3,450.00" $718.98 "$3,450.00" N/A N/A 13018580 SUP HCPCS C1713 13018580 - SCREW BN 2S 8.5MM 80MM NS RELINE-O PA SPNE LLIAC BOTH IP/OP "$3,450.00" "$2,553.00" $684.74 "$3,450.00" "$1,552.50" "$1,552.50" "$1,552.50" "$1,552.50" "$3,450.00" "$3,450.00" "$3,450.00" $719.07 "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" $719.02 "$3,450.00" "$1,380.00" "$1,700.85" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" "$2,587.50" "$3,450.00" "$3,450.00" "$3,450.00" "$1,725.00" "$1,725.00" "$2,732.40" "$3,450.00" "$2,760.00" "$1,552.50" $684.74 N/A "$2,001.00" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" N/A N/A 13019545 SUP HCPCS C1713 13019545 - SCREW BN 2S 9.5MM 45MM NS RELINE-O PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 13025545 SUP HCPCS C1713 13025545 - SCREW BN 2S 5.5MM 45MM NS RELINE RELINEO RDC SPNE BOTH IP/OP "$3,580.00" "$2,649.00" $710.54 "$3,580.00" "$1,611.00" "$1,611.00" "$1,611.00" "$1,611.00" "$3,580.00" "$3,580.00" "$3,580.00" $746.16 "$3,580.00" "$3,580.00" "$3,580.00" "$3,580.00" "$3,580.00" $746.11 "$3,580.00" "$1,432.00" "$1,764.94" "$3,580.00" "$3,580.00" "$3,580.00" "$3,580.00" "$2,685.00" "$3,580.00" "$3,580.00" "$3,580.00" "$1,790.00" "$1,790.00" "$2,835.36" "$3,580.00" "$2,864.00" "$1,611.00" $710.54 N/A "$2,076.40" "$3,580.00" "$3,580.00" "$3,580.00" $746.07 "$3,580.00" N/A N/A 13025555 SUP HCPCS C1713 13025555 - SCREW BN 2S 5.5MM 55MM NS RELINE RELINEO RDC SPNE BOTH IP/OP "$3,580.00" "$2,649.00" $710.54 "$3,580.00" "$1,611.00" "$1,611.00" "$1,611.00" "$1,611.00" "$3,580.00" "$3,580.00" "$3,580.00" $746.16 "$3,580.00" "$3,580.00" "$3,580.00" "$3,580.00" "$3,580.00" $746.11 "$3,580.00" "$3,580.00" "$1,764.94" "$3,580.00" "$3,580.00" "$3,580.00" "$3,580.00" "$2,685.00" "$3,580.00" "$3,580.00" "$3,580.00" "$1,790.00" "$1,790.00" "$2,835.36" "$3,580.00" "$2,864.00" "$1,611.00" $710.54 N/A "$2,076.40" "$3,580.00" "$3,580.00" "$3,580.00" "$3,580.00" "$3,580.00" N/A N/A 13026545 SUP HCPCS C1713 13026545 - SCREW BN 2S 6.5MM 45MM NS RELINE-O RDC SPNE BOTH IP/OP "$3,580.00" "$2,649.00" $710.54 "$3,580.00" "$1,611.00" "$1,611.00" "$1,611.00" "$1,611.00" "$3,580.00" "$3,580.00" "$3,580.00" $746.16 "$3,580.00" "$3,580.00" "$3,580.00" "$3,580.00" "$3,580.00" $746.11 "$3,580.00" "$1,432.00" "$1,764.94" "$3,580.00" "$3,580.00" "$3,580.00" "$3,580.00" "$2,685.00" "$3,580.00" "$3,580.00" "$3,580.00" "$1,790.00" "$1,790.00" "$2,835.36" "$3,580.00" "$2,864.00" "$1,611.00" $710.54 N/A "$2,076.40" "$3,580.00" "$3,580.00" "$3,580.00" $746.07 "$3,580.00" N/A N/A 13037590 SUP HCPCS C1713 13037590 - SCREW BN 2S 7.5MM 90MM NS RELINE-O CLS PA SPNE ILC BOTH IP/OP "$3,450.00" "$2,553.00" $684.74 "$3,450.00" "$1,552.50" "$1,552.50" "$1,552.50" "$1,552.50" "$3,450.00" "$3,450.00" "$3,450.00" $719.07 "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" $719.02 "$3,450.00" "$3,450.00" "$1,700.85" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" "$2,587.50" "$3,450.00" "$3,450.00" "$3,450.00" "$1,725.00" "$1,725.00" "$2,732.40" "$3,450.00" "$2,760.00" "$1,552.50" $684.74 N/A "$2,001.00" "$3,450.00" "$3,450.00" "$3,450.00" $718.98 "$3,450.00" N/A N/A 13038560 SUP HCPCS C1713 13038560 - SCREW BN 2S 8.5MM 60MM NS RELINE-O CLS SPNE ILC BOTH IP/OP "$3,450.00" "$2,553.00" $684.74 "$3,450.00" "$1,552.50" "$1,552.50" "$1,552.50" "$1,552.50" "$3,450.00" "$3,450.00" "$3,450.00" $719.07 "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" $719.02 "$3,450.00" "$1,380.00" "$1,700.85" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" "$2,587.50" "$3,450.00" "$3,450.00" "$3,450.00" "$1,725.00" "$1,725.00" "$2,732.40" "$3,450.00" "$2,760.00" "$1,552.50" $684.74 N/A "$2,001.00" "$3,450.00" "$3,450.00" "$3,450.00" $718.98 "$3,450.00" N/A N/A 13038580 SUP HCPCS C1713 13038580 - SCREW BN 2S 8.5MM 80MM NS RELINE-O CLS SPNE ILC BOTH IP/OP "$3,450.00" "$2,553.00" $684.74 "$3,450.00" "$1,552.50" "$1,552.50" "$1,552.50" "$1,552.50" "$3,450.00" "$3,450.00" "$3,450.00" $719.07 "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" $719.02 "$3,450.00" "$3,450.00" "$1,700.85" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" "$2,587.50" "$3,450.00" "$3,450.00" "$3,450.00" "$1,725.00" "$1,725.00" "$2,732.40" "$3,450.00" "$2,760.00" "$1,552.50" $684.74 N/A "$2,001.00" "$3,450.00" "$3,450.00" "$3,450.00" $718.98 "$3,450.00" N/A N/A 13039510 SUP HCPCS C1713 13039510 - SCREW BN 2S 9.5MM 100MM NS RELINE-O CLS SPNE ILC BOTH IP/OP "$3,450.00" "$2,553.00" $684.74 "$3,450.00" "$1,552.50" "$1,552.50" "$1,552.50" "$1,552.50" "$3,450.00" "$3,450.00" "$3,450.00" $719.07 "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" $719.02 "$3,450.00" "$1,380.00" "$1,700.85" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" "$2,587.50" "$3,450.00" "$3,450.00" "$3,450.00" "$1,725.00" "$1,725.00" "$2,732.40" "$3,450.00" "$2,760.00" "$1,552.50" $684.74 N/A "$2,001.00" "$3,450.00" "$3,450.00" "$3,450.00" $718.98 "$3,450.00" N/A N/A 13114540 SUP HCPCS C1713 13114540 - SCREW BN 4.5MM 40MM NS RELINE-O PA TRC SPNE BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$3,125.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 13115540 SUP HCPCS C1713 13115540 - SCREW BN 5.5MM 40MM NS RELINE-O PA TRC SPNE BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 13115545 SUP HCPCS C1713 13115545 - SCREW BN 5.5MM 45MM NS RELINE-O PA TRC SPNE BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 13115550 SUP HCPCS C1713 13115550 - SCREW BN 5.5MM 50MM NS RELINE-O PA TRC SPNE BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 13115555 SUP HCPCS C1713 13115555 - SCREW BN 5.5MM 55MM NS RELINE-O PA TRC SPNE BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 13116545 SUP HCPCS C1713 13116545 - SCREW BN 6.5MM 45MM NS RELINE-O PA TRC SPNE BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 13116550 SUP HCPCS C1713 13116550 - SCREW BN 6.5MM 50MM NS RELINE-O PA TRC SPNE BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 13117550 SUP HCPCS C1713 13117550 - SCREW BN 7.5MM 50MM NS RELINE-O PA TRC SPNE BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 13117555 SUP HCPCS C1713 13117555 - SCREW BN 7.5MM 55MM NS RELINE-O PA TRC SPNE BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$3,125.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 13118555 SUP HCPCS C1713 13118555 - SCREW BN 8.5MM 55MM NS RELINE-O PA TRC SPNE BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 13210510 SUP HCPCS C1713 13210510 - SCREW BN 10.5MM 100MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210511 SUP HCPCS C1713 13210511 - SCREW BN 10.5MM 110MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210512 SUP HCPCS C1713 13210512 - SCREW BN 10.5MM 120MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210525 SUP HCPCS C1713 13210525 - SCREW BN 10.5MM 25MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210530 SUP HCPCS C1713 13210530 - SCREW BN 10.5MM 30MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210535 SUP HCPCS C1713 13210535 - SCREW BN 10.5MM 35MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210540 SUP HCPCS C1713 13210540 - SCREW BN 10.5MM 40MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210545 SUP HCPCS C1713 13210545 - SCREW BN 10.5MM 45MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210550 SUP HCPCS C1713 13210550 - SCREW BN 10.5MM 50MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210555 SUP HCPCS C1713 13210555 - SCREW BN 10.5MM 55MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210560 SUP HCPCS C1713 13210560 - SCREW BN 10.5MM 60MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210565 SUP HCPCS C1713 13210565 - SCREW BN 10.5MM 65MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210570 SUP HCPCS C1713 13210570 - SCREW BN 10.5MM 70MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 13210575 SUP HCPCS C1713 13210575 - SCREW BN 10.5MM 75MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 13210580 SUP HCPCS C1713 13210580 - SCREW BN 10.5MM 80MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210585 SUP HCPCS C1713 13210585 - SCREW BN 10.5MM 85MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210590 SUP HCPCS C1713 13210590 - SCREW BN 10.5MM 90MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13210595 SUP HCPCS C1713 13210595 - SCREW BN 10.5MM 95MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13211010 SUP HCPCS C1713 13211010 - SCREW BN 10MM 100MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13219545 SUP HCPCS C1713 13219545 - SCREW BN 9.5MM 45MM NS RELINE PA 2 FENESTRATE SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13550000 SUP HCPCS C1713 13550000 - RELINE LOCK SCREW BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 13600000 SUP HCPCS C1713 13600000 - SCREW BN 6MM NS RELINE LCK OPN TULIP SPNE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 14355030 SUP HCPCS C1713 14355030 - ROD SPNL LRDTC 5.5MM 30MM NS RELINE-O TI BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 14355035 SUP HCPCS C1713 14355035 - ROD SPNL LRDTC 5.5MM 35MM NS RELINE-O TI BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 14355045 SUP HCPCS C1713 "14355045 - RELINE ROD, 45MM" BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 14355050 SUP HCPCS C1713 14355050 - ROD SPNL LRDTC 5.5MM 50MM NS RELINE-O TI BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A 14355055 SUP HCPCS C1713 14355055 - ROD SPNL LRDTC 5.5MM 55MM NS RELINE-O TI BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 14355060 SUP HCPCS C1713 14355060 - ROD SPNL LRDTC 5.5MM 60MM NS RELINE-O TI BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 15355300 SUP HCPCS C1713 "15355300 - RELINE ROD, 300MM" BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 16014520 SUP HCPCS C1713 16014520 - SCREW BN 4.5MM 20MM NS RELINE MAS PA SPNL 2C BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 16015520 SUP HCPCS C1713 16015520 - SCREW BN 5.5MM 20MM NS RELINE MAS PA SPNL 2C BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16015540 SUP HCPCS C1713 16015540 - SCREW BN 2C 5.5MM 40MM NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16016520 SUP HCPCS C1713 16016520 - SCREW BN 6.5MM 20MM NS RELINE MAS PA SPNL 2C BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16016535 SUP HCPCS C1713 16016535 - SCREW BN 2C 6.5MM 35MM NS LF RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16016550 SUP HCPCS C1713 16016550 - SCREW BN 6.5MM 50MM RELINE POLYAX MA SPNE 2C BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16017540 SUP HCPCS C1713 16017540 - SCREW BN 2C 7.5MM 40MM NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 16017545 SUP HCPCS C1713 16017545 - SCREW BN 2C 7.5MM 45MM NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 16018510 SUP HCPCS C1713 16018510 - SCREW BN 2C 8.5MM 100MM NS RELINE PA SPNE ILC MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16018580 SUP HCPCS C1713 16018580 - SCREW BN 2C 8.5MM 80MM NS LF RELINE PA SPNE LLIAC MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 16018590 SUP HCPCS C1713 16018590 - RELINE MAS SCREW 8.5X 90 BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16024530 SUP HCPCS C1713 16024530 - SCREW BN 2C 4.5MM 30MM RD NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16024535 SUP HCPCS C1713 16024535 - SCREW BN 2C 4.5MM 35MM RD NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16024540 SUP HCPCS C1713 16024540 - SCREW BN 2C 4.5MM 40MM RD NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 16024545 SUP HCPCS C1713 16024545 - SCREW BN 2C 4.5MM 45MM RD NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 16025535 SUP HCPCS C1713 16025535 - SCREW BN 2C 5.5MM 35MM RD NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16026540 SUP HCPCS C1713 16026540 - SCREW BN 2C 6.5MM 40MM RD NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16026545 SUP HCPCS C1713 "16026545 - RELINE REDUCTIONSCREW, 6.5 X 45" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16026550 SUP HCPCS C1713 "16026550 - RELINE MAS REDUCTION SCREW, 6.5X 50" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16026555 SUP HCPCS C1713 "16026555 - RELINE MAS REDUCTION SCREW, 6.5X 55" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16027535 SUP HCPCS C1713 16027535 - SCREW BN 2C 7.5MM 35MM RD NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16027555 SUP HCPCS C1713 "16027555 - RELINE REDUCTION SCREW, 7.5X 55" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16028535 SUP HCPCS C1713 16028535 - SCREW BN 2C 8.5MM 35MM RD NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16028540 SUP HCPCS C1713 16028540 - SCREW BN 2C 8.5MM 40MM RD NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16028545 SUP HCPCS C1713 16028545 - SCREW BN 2C 8.5MM 45MM RD NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16028550 SUP HCPCS C1713 16028550 - SCREW BN 2C 8.5MM 50MM RD NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16028555 SUP HCPCS C1713 16028555 - SCREW BN 2C 8.5MM 55MM RD NS RELINE PA SPNE MAS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16084520 SUP HCPCS C1713 16084520 - SCREW BN T 4.5MM 20MM NS RELINE MAS MA SPNL 2C BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 16085520 SUP HCPCS C1713 16085520 - SCREW BN T 5.5MM 20MM NS RELINE MAS MA SPNL 2C BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 16086520 SUP HCPCS C1713 16086520 - SCREW BN T 5.5MM 20MM RELINE MAS MA SPNL BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 18600545 SUP HCPCS C1713 18600545 - SCREW ACTB BOTH IP/OP $70.00 $52.00 $13.89 $70.00 $31.50 $31.50 $31.50 $31.50 $70.00 $70.00 $70.00 $14.59 $70.00 $70.00 $70.00 $70.00 $70.00 $14.59 $70.00 $28.00 $41.41 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $31.50 $13.89 N/A $40.60 $70.00 $70.00 $70.00 $14.59 $70.00 N/A N/A 18600550 SUP HCPCS C1713 18600550 - SCREW ACTB BOTH IP/OP $70.00 $52.00 $13.89 $70.00 $31.50 $31.50 $31.50 $31.50 $70.00 $70.00 $70.00 $14.59 $70.00 $70.00 $70.00 $70.00 $70.00 $14.59 $70.00 $28.00 $41.41 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $31.50 $13.89 N/A $40.60 $70.00 $70.00 $70.00 $14.59 $70.00 N/A N/A 18600555 SUP HCPCS C1713 18600555 - SCREW ACTB BOTH IP/OP $70.00 $52.00 $13.89 $70.00 $31.50 $31.50 $31.50 $31.50 $70.00 $70.00 $70.00 $14.59 $70.00 $70.00 $70.00 $70.00 $70.00 $14.59 $70.00 $70.00 $41.41 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $31.50 $13.89 N/A $40.60 $70.00 $70.00 $70.00 $14.59 $70.00 N/A N/A 18600560 SUP HCPCS C1713 18600560 - SCREW ACTB BOTH IP/OP $70.00 $52.00 $13.89 $70.00 $31.50 $31.50 $31.50 $31.50 $70.00 $70.00 $70.00 $14.59 $70.00 $70.00 $70.00 $70.00 $70.00 $14.59 $70.00 $28.00 $41.41 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $31.50 $13.89 N/A $40.60 $70.00 $70.00 $70.00 $14.59 $70.00 N/A N/A 21074025 SUP Custom 27203010 21074025 - BIT DRILL 4MM 25MM STERILE BOTH IP/OP $367.50 $272.00 $65.42 $367.50 $367.50 $367.50 $367.50 $367.50 $367.50 $367.50 $65.42 $367.50 $367.50 $272.76 $272.76 $283.27 $191.47 $76.59 $367.50 $147.00 $367.50 $367.50 $367.50 $367.50 $367.50 $275.63 $367.50 $367.50 $367.50 $183.75 $183.75 $291.06 $367.50 $294.00 $238.88 $367.50 N/A $213.15 $367.50 $220.50 $367.50 $367.50 $367.50 N/A N/A 23030817 SUP HCPCS C1783 23030817 - DRAIN GLAUCOMA IMNPLANT BAERVELDT SILICONE ANTER CHAM BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 30100101 SUP Custom 27203010 30100101 - BIT DRILL STANDARD 16-24MM CANN BIOTRAK BIOTRACK BOTH IP/OP $542.50 $401.00 $8.15 $650.00 $32.00 $32.00 $32.00 $32.00 $16.30 $16.30 $8.15 $8.15 $16.30 $24.76 $24.76 $25.71 $18.08 $24.09 $26.08 $26.08 $384.48 $16.30 $16.30 $16.30 $650.00 $406.88 $16.30 $16.30 $16.30 $91.12 $91.12 $514.80 $16.30 $520.00 $26.90 $22.94 $16.30 $314.65 $650.00 $23.64 $16.30 $18.02 $16.30 N/A N/A 30100102 SUP Custom 27203010 30100102 - TAP SURG STANDARD 16-24MM CANN BIOTRAK BOTH IP/OP $542.50 $401.00 $6.64 $791.00 $35.44 $35.44 $35.44 $35.44 $24.09 $24.09 $12.05 $10.84 $24.09 $9.12 $9.12 $9.47 $6.66 $8.87 $38.54 $38.54 $467.88 $24.09 $24.09 $24.09 $791.00 $406.88 $24.09 $24.09 $24.09 $33.56 $33.56 $626.47 $24.09 $632.80 $39.75 $8.45 $24.09 $314.65 $791.00 $34.93 $24.09 $6.64 $24.09 N/A N/A 30100151 SUP Custom 27203010 30100151 - BIT DRL MN BIOTRAK BOTH IP/OP $542.50 $401.00 $11.73 $510.00 $37.98 $37.98 $37.98 $37.98 $26.07 $26.07 $13.04 $11.73 $26.07 $29.38 $29.38 $30.51 $21.45 $28.59 $41.71 $41.71 $301.67 $26.07 $26.07 $26.07 $510.00 $406.88 $26.07 $26.07 $26.07 $108.16 $108.16 $403.92 $26.07 $408.00 $43.02 $27.23 $26.07 $314.65 $510.00 $37.80 $26.07 $21.39 $26.07 N/A N/A 30100152 SUP Custom 27203010 30100152 - BIT DRL BIOTRAK TAP BOTH IP/OP $542.50 $401.00 $11.73 $462.00 $37.98 $37.98 $37.98 $37.98 $26.07 $26.07 $13.04 $11.73 $26.07 $29.38 $29.38 $30.51 $21.45 $28.59 $41.71 $41.71 $273.27 $26.07 $26.07 $26.07 $462.00 $406.88 $26.07 $26.07 $26.07 $108.16 $108.16 $365.90 $26.07 $369.60 $43.02 $27.23 $26.07 $314.65 $462.00 $37.80 $26.07 $21.39 $26.07 N/A N/A 30100153 SUP Custom 27203010 30100153 - DRIVER SURG MINI BIOTRAK PLLA HEADLESS RESORB COMPRESSION BOTH IP/OP $542.50 $401.00 $9.49 $406.88 $30.42 $30.42 $30.42 $30.42 $21.09 $21.09 $10.55 $9.49 $21.09 $23.52 $23.52 $24.43 $17.17 $22.90 $33.74 $33.74 $104.10 $21.09 $21.09 $21.09 $176.00 $406.88 $21.09 $21.09 $21.09 $86.60 $86.60 $139.39 $21.09 $140.80 $34.80 $21.81 $21.09 $314.65 $176.00 $30.58 $21.09 $17.13 $21.09 N/A N/A 30100154 SUP Custom 27203010 30100154 - EJTR MINI BLADE BIOTRAK INDIV SET NONSTRL BOTH IP/OP $470.00 $348.00 $83.66 $470.00 $470.00 $470.00 $470.00 $470.00 $470.00 $470.00 $83.66 $470.00 $470.00 $348.83 $348.83 $362.28 $244.87 $97.95 $470.00 $188.00 $470.00 $470.00 $470.00 $470.00 $470.00 $352.50 $470.00 $470.00 $470.00 $235.00 $235.00 $372.24 $470.00 $376.00 $305.50 $470.00 N/A $272.60 $470.00 $282.00 $470.00 $470.00 $470.00 N/A N/A 30100351 SUP Custom 27203010 30100351 - DRILL SRG BIOTRAK BOTH IP/OP $542.50 $401.00 $10.62 $406.88 $41.67 $41.67 $41.67 $41.67 $21.23 $21.23 $10.62 $10.62 $21.23 $32.25 $32.25 $33.49 $23.54 $31.36 $33.97 $33.97 $163.25 $21.23 $21.23 $21.23 $276.00 $406.88 $21.23 $21.23 $21.23 $118.68 $118.68 $218.59 $21.23 $220.80 $35.03 $29.87 $21.23 $314.65 $276.00 $30.78 $21.23 $23.46 $21.23 N/A N/A 31002701 SUP Custom 27803010 31002701 - VALVE MTRL 27MM 35MM 24MM 19MM 14MM MSC CNCH FLXB STNT BOTH IP/OP "$19,500.00" "$14,430.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$4,064.01" "$19,500.00" "$7,800.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$14,625.00" "$19,500.00" "$19,500.00" "$19,500.00" "$9,750.00" "$9,750.00" "$15,444.00" "$19,500.00" "$15,600.00" "$8,775.00" "$19,500.00" N/A "$11,310.00" "$19,500.00" "$11,700.00" "$19,500.00" "$19,500.00" "$19,500.00" N/A N/A 38204020 SUP HCPCS C1713 038204020 - SCREW BONE 4MM 20MM MULTIAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 38204025 SUP HCPCS C1713 038204025 - SCREW BONE 4MM 25MM MULTIAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 38204030 SUP HCPCS C1713 038204030 - SCREW BONE 4MM 30MM MULTIAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 38204035 SUP HCPCS C1713 038204035 - SCREW BONE 4MM 35MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 38204040 SUP HCPCS C1713 038204040 - SCREW BONE 4MM 40MM MULTIAX XIA II TITANIUM SPN BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 38205025 SUP HCPCS C1713 038205025 - SCREW BONE 5MM 25MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 38205030 SUP HCPCS C1713 038205030 - SCREW BONE 5MM 30MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 38205035 SUP HCPCS C1713 038205035 - SCREW BONE 5MM 35MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 38205040 SUP HCPCS C1713 038205040 - SCREW BONE 5MM 40MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 38205045 SUP HCPCS C1713 038205045 - SCREW BONE 5MM 45MM MNOAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 38214020 SUP HCPCS C1713 038214020 - SCREW BONE 4MM 20MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 38214025 SUP HCPCS C1713 038214025 - SCREW BONE 4MM 25MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 38214030 SUP HCPCS C1713 038214030 - SCREW BONE 4MM 30MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 38214035 SUP HCPCS C1713 038214035 - SCREW BONE 4MM 35MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 38214040 SUP HCPCS C1713 038214040 - SCREW BONE 4MM 40MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" N/A N/A 38215025 SUP HCPCS C1713 038215025 - SCREW BONE 5MM 25MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 38215030 SUP HCPCS C1713 038215030 - SCREW BONE 5MM 30MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 38215035 SUP HCPCS C1713 038215035 - SCREW BONE 5MM 35MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 38215040 SUP HCPCS C1713 038215040 - SCREW BONE 5MM 40MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,737.50" "$4,246.00" "$1,138.75" "$5,737.50" "$2,581.88" "$2,581.88" "$2,581.88" "$2,581.88" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.84" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$5,737.50" "$2,828.59" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$1,138.75" N/A "$3,327.75" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.70" "$5,737.50" N/A N/A 38215045 SUP HCPCS C1713 038215045 - SCREW BONE 5MM 45MM POLYAX XIA II TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,737.50" "$4,246.00" "$1,138.75" "$5,737.50" "$2,581.88" "$2,581.88" "$2,581.88" "$2,581.88" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.84" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$5,737.50" "$2,828.59" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$1,138.75" N/A "$3,327.75" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.70" "$5,737.50" N/A N/A 48030022 SUP HCPCS C1713 48030022 - PLATE BONE 22MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$8,793.50" "$6,507.00" "$1,745.29" "$8,793.48" "$3,957.07" "$3,957.07" "$3,957.07" "$3,957.07" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.78" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.66" "$8,793.48" "$8,793.48" "$4,335.19" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$6,595.13" "$8,793.48" "$8,793.48" "$8,793.48" "$4,396.74" "$4,396.74" "$6,964.44" "$8,793.48" "$7,034.78" "$3,957.07" "$1,745.29" N/A "$5,100.23" "$8,793.48" "$5,276.09" "$8,793.48" "$1,832.56" "$8,793.48" N/A N/A 48030025 SUP HCPCS C1713 48030025 - PLATE BONE 25MM NONCOMPRESSION 1 LEVEL THORACIC BOTH IP/OP "$8,793.50" "$6,507.00" "$1,745.29" "$8,793.48" "$3,957.07" "$3,957.07" "$3,957.07" "$3,957.07" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.78" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.66" "$8,793.48" "$8,793.48" "$4,335.19" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$6,595.13" "$8,793.48" "$8,793.48" "$8,793.48" "$4,396.74" "$4,396.74" "$6,964.44" "$8,793.48" "$7,034.78" "$3,957.07" "$1,745.29" N/A "$5,100.23" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.56" "$8,793.48" N/A N/A 48030028 SUP HCPCS C1713 48030028 - PLATE BONE 28MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$8,793.50" "$6,507.00" "$1,745.29" "$8,793.48" "$3,957.07" "$3,957.07" "$3,957.07" "$3,957.07" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.78" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.66" "$8,793.48" "$8,793.48" "$4,335.19" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$6,595.13" "$8,793.48" "$8,793.48" "$8,793.48" "$4,396.74" "$4,396.74" "$6,964.44" "$8,793.48" "$7,034.78" "$3,957.07" "$1,745.29" N/A "$5,100.23" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.56" "$8,793.48" N/A N/A 48030031 SUP HCPCS C1713 48030031 - PLATE BONE 31MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$8,793.50" "$6,507.00" "$1,745.29" "$8,793.48" "$3,957.07" "$3,957.07" "$3,957.07" "$3,957.07" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.78" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.66" "$8,793.48" "$8,793.48" "$4,335.19" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$6,595.13" "$8,793.48" "$8,793.48" "$8,793.48" "$4,396.74" "$4,396.74" "$6,964.44" "$8,793.48" "$7,034.78" "$3,957.07" "$1,745.29" N/A "$5,100.23" "$8,793.48" "$5,276.09" "$8,793.48" "$1,832.56" "$8,793.48" N/A N/A 48030034 SUP HCPCS C1713 48030034 - PLATE BONE 34MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$8,793.50" "$6,507.00" "$1,745.29" "$8,793.48" "$3,957.07" "$3,957.07" "$3,957.07" "$3,957.07" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.78" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.66" "$8,793.48" "$3,517.39" "$4,335.19" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$6,595.13" "$8,793.48" "$8,793.48" "$8,793.48" "$4,396.74" "$4,396.74" "$6,964.44" "$8,793.48" "$7,034.78" "$3,957.07" "$1,745.29" N/A "$5,100.23" "$8,793.48" "$5,276.09" "$8,793.48" "$1,832.56" "$8,793.48" N/A N/A 48030037 SUP HCPCS C1713 48030037 - PLATE BONE 37MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$8,793.50" "$6,507.00" "$1,745.29" "$8,793.48" "$3,957.07" "$3,957.07" "$3,957.07" "$3,957.07" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.78" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.66" "$8,793.48" "$3,517.39" "$4,335.19" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$6,595.13" "$8,793.48" "$8,793.48" "$8,793.48" "$4,396.74" "$4,396.74" "$6,964.44" "$8,793.48" "$7,034.78" "$3,957.07" "$1,745.29" N/A "$5,100.23" "$8,793.48" "$5,276.09" "$8,793.48" "$1,832.56" "$8,793.48" N/A N/A 48030040 SUP HCPCS C1713 48030040 - PLATE BONE 40MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$8,793.50" "$6,507.00" "$1,745.29" "$8,793.48" "$3,957.07" "$3,957.07" "$3,957.07" "$3,957.07" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.78" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.66" "$8,793.48" "$3,517.39" "$4,335.19" "$8,793.48" "$8,793.48" "$8,793.48" "$8,793.48" "$6,595.13" "$8,793.48" "$8,793.48" "$8,793.48" "$4,396.74" "$4,396.74" "$6,964.44" "$8,793.48" "$7,034.78" "$3,957.07" "$1,745.29" N/A "$5,100.23" "$8,793.48" "$8,793.48" "$8,793.48" "$1,832.56" "$8,793.48" N/A N/A 48030225 SUP HCPCS C1713 48030225 - SCREW BONE 6.5MM 22MM COMPRESSION SPN THORACIC BOTH IP/OP "$1,009.00" $747.00 $200.19 "$1,008.65" $453.89 $453.89 $453.89 $453.89 "$1,008.65" "$1,008.65" "$1,008.65" $210.23 "$1,008.65" "$1,008.65" "$1,008.65" "$1,008.65" "$1,008.65" $210.21 "$1,008.65" "$1,008.65" $596.62 "$1,008.65" "$1,008.65" "$1,008.65" "$1,008.65" $756.75 "$1,008.65" "$1,008.65" "$1,008.65" $504.33 $504.33 $798.85 "$1,008.65" $806.92 $453.89 $200.19 N/A $585.22 "$1,008.65" "$1,008.65" "$1,008.65" $210.20 "$1,008.65" N/A N/A 48030265 SUP HCPCS C1713 48030265 - PLATE BONE 65MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$4,886.86" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48030271 SUP HCPCS C1713 48030271 - PLATE BONE 71MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$4,886.86" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48030277 SUP HCPCS C1713 48030277 - PLATE BONE 77MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$4,886.86" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$7,330.29" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48030283 SUP HCPCS C1713 48030283 - PLATE BONE 83MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$12,217.15" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$7,330.29" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48030289 SUP HCPCS C1713 48030289 - PLATE BONE 89MM LEVEL 2 COMPRESSION SPN THORACIC SACRUM BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$12,217.15" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$7,330.29" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48030350 SUP HCPCS C1713 48030350 - SCREW BONE 6MM 35MM COMPRESSION SPN THORACIC BOTH IP/OP "$1,009.00" $747.00 $200.19 "$1,008.65" $453.89 $453.89 $453.89 $453.89 "$1,008.65" "$1,008.65" "$1,008.65" $210.23 "$1,008.65" "$1,008.65" "$1,008.65" "$1,008.65" "$1,008.65" $210.21 "$1,008.65" "$1,008.65" $596.62 "$1,008.65" "$1,008.65" "$1,008.65" "$1,008.65" $756.75 "$1,008.65" "$1,008.65" "$1,008.65" $504.33 $504.33 $798.85 "$1,008.65" $806.92 $453.89 $200.19 N/A $585.22 "$1,008.65" "$1,008.65" "$1,008.65" $210.20 "$1,008.65" N/A N/A 48032040 SUP HCPCS C1713 48032040 - PLATE BONE 40MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$12,217.15" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$7,330.29" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48032044 SUP HCPCS C1713 48032044 - PLATE BONE 44MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$4,886.86" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48032048 SUP HCPCS C1713 48032048 - PLATE BONE 48MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$12,217.15" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$7,330.29" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48032052 SUP HCPCS C1713 48032052 - PLATE BONE 52MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$4,886.86" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48032056 SUP HCPCS C1713 48032056 - PLATE BONE 56MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$12,217.15" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48032060 SUP HCPCS C1713 48032060 - PLATE BONE 60MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$4,886.86" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$7,330.29" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48032064 SUP HCPCS C1713 48032064 - PLATE BONE 64MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$12,217.15" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$7,330.29" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48032068 SUP HCPCS C1713 48032068 - PLATE BONE 68MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$4,886.86" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$7,330.29" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48032072 SUP HCPCS C1713 48032072 - PLATE BONE 72MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$12,217.15" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$7,330.29" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48032076 SUP HCPCS C1713 48032076 - PLATE BONE 76MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$12,217.50" "$9,041.00" "$2,424.80" "$12,217.15" "$5,497.72" "$5,497.72" "$5,497.72" "$5,497.72" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.36" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.19" "$12,217.15" "$4,886.86" "$6,023.05" "$12,217.15" "$12,217.15" "$12,217.15" "$12,217.15" "$9,163.13" "$12,217.15" "$12,217.15" "$12,217.15" "$6,108.58" "$6,108.58" "$9,675.98" "$12,217.15" "$9,773.72" "$5,497.72" "$2,424.80" N/A "$7,086.15" "$12,217.15" "$12,217.15" "$12,217.15" "$2,546.05" "$12,217.15" N/A N/A 48032080 SUP HCPCS C1713 48032080 - PLATE BONE 80MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$13,964.00" "$10,333.00" "$2,771.45" "$13,963.70" "$6,283.67" "$6,283.67" "$6,283.67" "$6,283.67" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.38" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.19" "$13,963.70" "$13,963.70" "$6,884.10" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$10,473.00" "$13,963.70" "$13,963.70" "$13,963.70" "$6,981.85" "$6,981.85" "$11,059.25" "$13,963.70" "$11,170.96" "$6,283.67" "$2,771.45" N/A "$8,099.12" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.04" "$13,963.70" N/A N/A 48032084 SUP HCPCS C1713 48032084 - PLATE BONE 84MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$13,964.00" "$10,333.00" "$2,771.45" "$13,963.70" "$6,283.67" "$6,283.67" "$6,283.67" "$6,283.67" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.38" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.19" "$13,963.70" "$13,963.70" "$6,884.10" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$10,473.00" "$13,963.70" "$13,963.70" "$13,963.70" "$6,981.85" "$6,981.85" "$11,059.25" "$13,963.70" "$11,170.96" "$6,283.67" "$2,771.45" N/A "$8,099.12" "$13,963.70" "$8,378.22" "$13,963.70" "$2,910.04" "$13,963.70" N/A N/A 48032088 SUP HCPCS C1713 48032088 - PLATE BONE 88MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$13,964.00" "$10,333.00" "$2,771.45" "$13,963.70" "$6,283.67" "$6,283.67" "$6,283.67" "$6,283.67" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.38" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.19" "$13,963.70" "$5,585.48" "$6,884.10" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$10,473.00" "$13,963.70" "$13,963.70" "$13,963.70" "$6,981.85" "$6,981.85" "$11,059.25" "$13,963.70" "$11,170.96" "$6,283.67" "$2,771.45" N/A "$8,099.12" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.04" "$13,963.70" N/A N/A 48032092 SUP HCPCS C1713 48032092 - PLATE BONE 92MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$13,964.00" "$10,333.00" "$2,771.45" "$13,963.70" "$6,283.67" "$6,283.67" "$6,283.67" "$6,283.67" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.38" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.19" "$13,963.70" "$13,963.70" "$6,884.10" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$10,473.00" "$13,963.70" "$13,963.70" "$13,963.70" "$6,981.85" "$6,981.85" "$11,059.25" "$13,963.70" "$11,170.96" "$6,283.67" "$2,771.45" N/A "$8,099.12" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.04" "$13,963.70" N/A N/A 48032096 SUP HCPCS C1713 48032096 - PLATE BONE 96MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$13,964.00" "$10,333.00" "$2,771.45" "$13,963.70" "$6,283.67" "$6,283.67" "$6,283.67" "$6,283.67" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.38" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.19" "$13,963.70" "$5,585.48" "$6,884.10" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$10,473.00" "$13,963.70" "$13,963.70" "$13,963.70" "$6,981.85" "$6,981.85" "$11,059.25" "$13,963.70" "$11,170.96" "$6,283.67" "$2,771.45" N/A "$8,099.12" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.04" "$13,963.70" N/A N/A 48032100 SUP HCPCS C1713 48032100 - PLATE BONE 100MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$13,964.00" "$10,333.00" "$2,771.45" "$13,963.70" "$6,283.67" "$6,283.67" "$6,283.67" "$6,283.67" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.38" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$2,910.19" "$13,963.70" "$13,963.70" "$6,884.10" "$13,963.70" "$13,963.70" "$13,963.70" "$13,963.70" "$10,473.00" "$13,963.70" "$13,963.70" "$13,963.70" "$6,981.85" "$6,981.85" "$11,059.25" "$13,963.70" "$11,170.96" "$6,283.67" "$2,771.45" N/A "$8,099.12" "$13,963.70" "$8,378.22" "$13,963.70" "$2,910.04" "$13,963.70" N/A N/A 48034525 SUP HCPCS C1713 48034525 - PLATE BONE 25MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$9,160.50" "$6,779.00" "$1,818.08" "$9,160.23" "$4,122.10" "$4,122.10" "$4,122.10" "$4,122.10" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.22" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.09" "$9,160.23" "$3,664.09" "$4,515.99" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$6,870.38" "$9,160.23" "$9,160.23" "$9,160.23" "$4,580.12" "$4,580.12" "$7,254.90" "$9,160.23" "$7,328.18" "$4,122.10" "$1,818.08" N/A "$5,313.09" "$9,160.23" "$5,496.14" "$9,160.23" "$1,908.99" "$9,160.23" N/A N/A 48034528 SUP HCPCS C1713 48034528 - PLATE BONE 28MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$9,160.50" "$6,779.00" "$1,818.08" "$9,160.23" "$4,122.10" "$4,122.10" "$4,122.10" "$4,122.10" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.22" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.09" "$9,160.23" "$9,160.23" "$4,515.99" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$6,870.38" "$9,160.23" "$9,160.23" "$9,160.23" "$4,580.12" "$4,580.12" "$7,254.90" "$9,160.23" "$7,328.18" "$4,122.10" "$1,818.08" N/A "$5,313.09" "$9,160.23" "$5,496.14" "$9,160.23" "$1,908.99" "$9,160.23" N/A N/A 48034531 SUP HCPCS C1713 48034531 - PLATE BONE 31MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$9,160.50" "$6,779.00" "$1,818.08" "$9,160.23" "$4,122.10" "$4,122.10" "$4,122.10" "$4,122.10" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.22" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.09" "$9,160.23" "$3,664.09" "$4,515.99" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$6,870.38" "$9,160.23" "$9,160.23" "$9,160.23" "$4,580.12" "$4,580.12" "$7,254.90" "$9,160.23" "$7,328.18" "$4,122.10" "$1,818.08" N/A "$5,313.09" "$9,160.23" "$9,160.23" "$9,160.23" "$1,908.99" "$9,160.23" N/A N/A 48034534 SUP HCPCS C1713 48034534 - PLATE BONE 34MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$9,160.50" "$6,779.00" "$1,818.08" "$9,160.23" "$4,122.10" "$4,122.10" "$4,122.10" "$4,122.10" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.22" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.09" "$9,160.23" "$9,160.23" "$4,515.99" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$6,870.38" "$9,160.23" "$9,160.23" "$9,160.23" "$4,580.12" "$4,580.12" "$7,254.90" "$9,160.23" "$7,328.18" "$4,122.10" "$1,818.08" N/A "$5,313.09" "$9,160.23" "$9,160.23" "$9,160.23" "$1,908.99" "$9,160.23" N/A N/A 48034537 SUP HCPCS C1713 48034537 - PLATE BONE 37MM LEVEL 1 COMPRESSION SPN THORACOLUMBAR BOTH IP/OP "$9,160.50" "$6,779.00" "$1,818.08" "$9,160.23" "$4,122.10" "$4,122.10" "$4,122.10" "$4,122.10" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.22" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.09" "$9,160.23" "$9,160.23" "$4,515.99" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$6,870.38" "$9,160.23" "$9,160.23" "$9,160.23" "$4,580.12" "$4,580.12" "$7,254.90" "$9,160.23" "$7,328.18" "$4,122.10" "$1,818.08" N/A "$5,313.09" "$9,160.23" "$9,160.23" "$9,160.23" "$1,908.99" "$9,160.23" N/A N/A 48035125 SUP HCPCS C1713 48035125 - PLATE BONE 25MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM BOTH IP/OP "$9,160.50" "$6,779.00" "$1,818.08" "$9,160.23" "$4,122.10" "$4,122.10" "$4,122.10" "$4,122.10" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.22" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.09" "$9,160.23" "$9,160.23" "$4,515.99" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$6,870.38" "$9,160.23" "$9,160.23" "$9,160.23" "$4,580.12" "$4,580.12" "$7,254.90" "$9,160.23" "$7,328.18" "$4,122.10" "$1,818.08" N/A "$5,313.09" "$9,160.23" "$5,496.14" "$9,160.23" "$1,908.99" "$9,160.23" N/A N/A 48035128 SUP HCPCS C1713 48035128 - PLATE BONE 28MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM BOTH IP/OP "$9,160.50" "$6,779.00" "$1,818.08" "$9,160.23" "$4,122.10" "$4,122.10" "$4,122.10" "$4,122.10" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.22" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.09" "$9,160.23" "$9,160.23" "$4,515.99" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$6,870.38" "$9,160.23" "$9,160.23" "$9,160.23" "$4,580.12" "$4,580.12" "$7,254.90" "$9,160.23" "$7,328.18" "$4,122.10" "$1,818.08" N/A "$5,313.09" "$9,160.23" "$9,160.23" "$9,160.23" "$1,908.99" "$9,160.23" N/A N/A 48035131 SUP HCPCS C1713 48035131 - PLATE BONE 31MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM BOTH IP/OP "$9,160.50" "$6,779.00" "$1,818.08" "$9,160.23" "$4,122.10" "$4,122.10" "$4,122.10" "$4,122.10" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.22" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.09" "$9,160.23" "$9,160.23" "$4,515.99" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$6,870.38" "$9,160.23" "$9,160.23" "$9,160.23" "$4,580.12" "$4,580.12" "$7,254.90" "$9,160.23" "$7,328.18" "$4,122.10" "$1,818.08" N/A "$5,313.09" "$9,160.23" "$9,160.23" "$9,160.23" "$1,908.99" "$9,160.23" N/A N/A 48035134 SUP HCPCS C1713 48035134 - PLATE BONE 34MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM BOTH IP/OP "$9,160.50" "$6,779.00" "$1,818.08" "$9,160.23" "$4,122.10" "$4,122.10" "$4,122.10" "$4,122.10" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.22" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.09" "$9,160.23" "$9,160.23" "$4,515.99" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$6,870.38" "$9,160.23" "$9,160.23" "$9,160.23" "$4,580.12" "$4,580.12" "$7,254.90" "$9,160.23" "$7,328.18" "$4,122.10" "$1,818.08" N/A "$5,313.09" "$9,160.23" "$9,160.23" "$9,160.23" "$1,908.99" "$9,160.23" N/A N/A 48035137 SUP HCPCS C1713 48035137 - PLATE BONE 37MM LEVEL 1 COMPRESSION SPN THORACIC SACRUM BOTH IP/OP "$9,160.50" "$6,779.00" "$1,818.08" "$9,160.23" "$4,122.10" "$4,122.10" "$4,122.10" "$4,122.10" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.22" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$1,909.09" "$9,160.23" "$3,664.09" "$4,515.99" "$9,160.23" "$9,160.23" "$9,160.23" "$9,160.23" "$6,870.38" "$9,160.23" "$9,160.23" "$9,160.23" "$4,580.12" "$4,580.12" "$7,254.90" "$9,160.23" "$7,328.18" "$4,122.10" "$1,818.08" N/A "$5,313.09" "$9,160.23" "$5,496.14" "$9,160.23" "$1,908.99" "$9,160.23" N/A N/A 48035225 SUP HCPCS C1713 48035225 - SCREW BONE 6.5MM 22MM COMPRESSION THORACIC SPN BOTH IP/OP "$1,009.00" $747.00 $200.19 "$1,008.65" $453.89 $453.89 $453.89 $453.89 "$1,008.65" "$1,008.65" "$1,008.65" $210.23 "$1,008.65" "$1,008.65" "$1,008.65" "$1,008.65" "$1,008.65" $210.21 "$1,008.65" "$1,008.65" $596.62 "$1,008.65" "$1,008.65" "$1,008.65" "$1,008.65" $756.75 "$1,008.65" "$1,008.65" "$1,008.65" $504.33 $504.33 $798.85 "$1,008.65" $806.92 $453.89 $200.19 N/A $585.22 "$1,008.65" $605.19 "$1,008.65" $210.20 "$1,008.65" N/A N/A 48035350 SUP HCPCS C1713 48035350 - SCREW BONE 6.5MM 35MM COMPRESSION THORACIC SPN BOTH IP/OP "$1,009.00" $747.00 $200.19 "$1,008.65" $453.89 $453.89 $453.89 $453.89 "$1,008.65" "$1,008.65" "$1,008.65" $210.23 "$1,008.65" "$1,008.65" "$1,008.65" "$1,008.65" "$1,008.65" $210.21 "$1,008.65" $403.46 $596.62 "$1,008.65" "$1,008.65" "$1,008.65" "$1,008.65" $756.75 "$1,008.65" "$1,008.65" "$1,008.65" $504.33 $504.33 $798.85 "$1,008.65" $806.92 $453.89 $200.19 N/A $585.22 "$1,008.65" $605.19 "$1,008.65" $210.20 "$1,008.65" N/A N/A 48130000 SUP Custom 27803010 48130000 - SCREW SET BLOCKER XIA TITANIUM SPN 4.5 MM ROD BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48130110 SUP HCPCS C1713 48130110 - STAPLE BONE SMALL 4.5MM 2 XIA TITANIUM SPN CAUDAL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48130111 SUP HCPCS C1713 48130111 - STAPLE BONE SMALL 4.5MM 2 XIA TITANIUM SPN ROSTRAL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48130112 SUP HCPCS C1713 48130112 - STAPLE BONE LARGE 4.5MM 2 XIA TITANIUM SPN CAUDAL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48130113 SUP HCPCS C1713 48130113 - STAPLE BONE LARGE 4.5MM 2 XIA TITANIUM SPN ROSTRAL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48130201 SUP Custom 27803010 48130201 - HOOK SPINAL SMALL XIA TITANIUM LMNR 4.5MM ROD BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48130202 SUP Custom 27803010 48130202 - HOOK SPINAL MEDIUM XIA TITANIUM LMNR 4.5MM ROD BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48130203 SUP Custom 27803010 48130203 - HOOK SPINAL LARGE XIA TITANIUM LMNR 4.5MM ROD BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48130204 SUP Custom 27803010 48130204 - HOOK SPINAL EXTEND XIA TITANIUM LMNR 4.5 MM ROD BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48130208 SUP Custom 27803010 48130208 - HOOK SPINAL ANGLED BLADE XIA TITANIUM LMNR 4.5 MM ROD BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48130210 SUP Custom 27803010 48130210 - HOOK SPINAL XIA TITANIUM LMNR THORACIC 4.5 MM ROD BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48130212 SUP Custom 27803010 48130212 - HOOK SPINAL RIGHT OFFST XIA TITANIUM LMNR THORACIC 4.5 MM BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48130213 SUP Custom 27803010 48130213 - HOOK SPINAL LEFT OFFST XIA TITANIUM LMNR THORACIC 4.5 MM ROD BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48130214 SUP Custom 27803010 48130214 - HOOK SPINAL RIGHT OFFST XIA TITANIUM SUPRA LMNR 4.5 MM ROD BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48130215 SUP Custom 27803010 48130215 - HOOK SPINAL LEFT OFFST XIA TITANIUM SUPRA LMNR 4.5 MM ROD BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48130220 SUP Custom 27803010 48130220 - HOOK SPINAL SMALL XIA TITANIUM PEDICLE 4.5MM ROD BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48130221 SUP Custom 27803010 48130221 - HOOK SPINAL LARGE XIA TITANIUM PEDICLE 4.5MM ROD BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48130230 SUP Custom 27803010 48130230 - HOOK SPINAL RIGHT OFFST TRNSVRS PROCESS XIA TITANIUM 4.5 MM BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48130231 SUP Custom 27803010 48130231 - HOOK SPINAL LEFT OFFST TRNSVRS PROCESS XIA TITANIUM 4.5 MM BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48132040 SUP HCPCS C1713 48132040 - ROD SPNL STRG 4.5MM 40MM XIA HEX VIT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A 48132090 SUP HCPCS C1713 48132090 - ROD SPNL STRG 4.5MM 90MM XIA HEX VIT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $437.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A 48132100 SUP HCPCS C1713 48132100 - ROD SPNL STRG 4.5MM 100MM XIA HEX VIT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A 48132601 SUP HCPCS C1713 48132601 - ROD SPINAL 4.5MM 600MM XIA VITALLIUM BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $437.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A 48133012 SUP HCPCS C1713 48133012 - SCREW BONE 4.5MM 12MM CONCTR MONOBLOCK XIA TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48133013 SUP HCPCS C1713 48133013 - SCREW BONE 4.5MM 13MM CONCTR MONOBLOCK XIA TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48133014 SUP HCPCS C1713 48133014 - SCREW BONE 4.5MM 14MM CONCTR MONOBLOCK XIA TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48133015 SUP Custom 27803010 48133015 - CROSSLINK SPINAL 15MM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48133016 SUP HCPCS C1713 48133016 - SCREW BONE 4.5MM 16MM CONCTR MONOBLOCK XIA TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48133017 SUP HCPCS C1713 48133017 - SCREW BONE 4.5MM 17MM CONCTR MONOBLOCK XIA TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48133018 SUP HCPCS C1713 48133018 - SCREW BONE 4.5MM 18MM CONCTR MONOBLOCK XIA TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48133019 SUP HCPCS C1713 48133019 - CONNECTOR ROD 4.5MM 19MM MONOBLOCK CROSSLINK XIA SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48133021 SUP HCPCS C1713 48133021 - SCREW BONE 4.5MM 21MM CONCTR MONOBLOCK XIA TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48133023 SUP HCPCS C1713 48133023 - SCREW BONE 4.5MM 23MM CONCTR MONOBLOCK XIA TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48133024 SUP HCPCS C1713 48133024 - SCREW BONE 4.5MM 24MM CONCTR MONOBLOCK XIA TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48133200 SUP Custom 27803010 48133200 - ROD SPINAL 5.5MM 40MM XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48133224 SUP Custom 27803010 48133224 - CONNECTOR ROD SMALL 24-30MM POLYAX CROSS XIA 3 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48133230 SUP Custom 27803010 48133230 - CONNECTOR ROD MEDIUM 30-36MM POLYAX CROSS XIA 3 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48133236 SUP Custom 27803010 48133236 - CONNECTOR ROD LARGE 36-45MM CROSSLINK XIA TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48133245 SUP Custom 27803010 48133245 - CONNECTOR ROD LARGE 45-60MM POLYAX CROSS XIA 3 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48133480 SUP Custom 27803010 48133480 - ROD SPINAL 4.5MM 480MM XIA TITANIUM BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 48134020 SUP HCPCS C1713 48134020 - SCREW BONE 4MM 20MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5 BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48134025 SUP HCPCS C1713 48134025 - SCREW BONE 4MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5 BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48134030 SUP HCPCS C1713 48134030 - SCREW BONE 4MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5 BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48134035 SUP HCPCS C1713 48134035 - SCREW BONE 4MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5 BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48134040 SUP HCPCS C1713 48134040 - SCREW BONE 4MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5 BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48134520 SUP HCPCS C1713 48134520 - SCREW BONE 4.5MM 20MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48134525 SUP HCPCS C1713 48134525 - SCREW BONE 4.5MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48134530 SUP HCPCS C1713 48134530 - SCREW BONE 4.5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48134535 SUP HCPCS C1713 48134535 - SCREW BONE 4.5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48134540 SUP HCPCS C1713 48134540 - SCREW BONE 4.5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48134545 SUP HCPCS C1713 48134545 - SCREW BONE 4.5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135000 SUP Custom 27803010 48135000 - CONNECTOR ROD 4.5MM 30MM ROD TO ROD XIA TITANIUM SPN BOTH IP/OP "$1,820.00" "$1,347.00" $323.90 "$1,819.65" "$1,819.65" "$1,819.65" "$1,819.65" "$1,819.65" "$1,819.65" "$1,819.65" $323.90 "$1,819.65" "$1,819.65" "$1,819.65" "$1,819.65" "$1,819.65" "$1,819.65" $379.24 "$1,819.65" $500.00 "$1,819.65" "$1,819.65" "$1,250.00" "$1,819.65" "$1,819.65" "$1,365.00" "$1,819.65" "$1,819.65" "$1,819.65" $909.83 $909.83 "$1,441.16" "$1,819.65" "$1,455.72" $818.84 "$1,819.65" N/A "$1,055.60" "$1,819.65" "$1,091.79" "$1,819.65" "$1,819.65" "$1,819.65" N/A N/A 48135001 SUP Custom 27803010 48135001 - CONNECTOR ROD 4.5MM 60MM XIA SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48135003 SUP Custom 27803010 48135003 - CONNECTOR ROD 4.5-5.5/6MM ROD TO ROD PARALLEL XIA SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48135004 SUP Custom 27803010 48135004 - CONNECTOR ROD 4.5-6MM ROD TO ROD XIA SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48135005 SUP Custom 27803010 48135005 - CONNECTOR ROD SMALL 4.5MM ROD TO ROD PARALLEL XIA SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48135006 SUP Custom 27803010 48135006 - CONNECTOR ROD LARGE 4.5MM ROD TO ROD PARALLEL XIA SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48135008 SUP Custom 27803010 48135008 - CONNECTOR ROD 4.5-5.5/6MM ROD TO ROD PARALLEL XIA SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48135020 SUP HCPCS C1713 48135020 - SCREW BONE 5MM 20MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135025 SUP HCPCS C1713 48135025 - SCREW BONE 5MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5 BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135030 SUP HCPCS C1713 48135030 - SCREW BONE 5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5 BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135035 SUP HCPCS C1713 48135035 - SCREW BONE 5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5 BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135040 SUP HCPCS C1713 48135040 - SCREW BONE 5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5 BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48135045 SUP HCPCS C1713 48135045 - SCREW BONE 5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5 BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48135050 SUP HCPCS C1713 48135050 - SCREW BONE 5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR 4.5 BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135055 SUP HCPCS C1713 48135055 - SCREW BONE 5MM 55MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135060 SUP HCPCS C1713 48135060 - SCREW BONE 5MM 60MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135070 SUP HCPCS C1713 48135070 - SCREW BONE 5MM 70MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135080 SUP HCPCS C1713 48135080 - SCREW BONE 5MM 80MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135101 SUP Custom 27803010 48135101 - CONNECTOR ROD 4.5MM 30MM OFFST XIA TITANIUM SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48135102 SUP Custom 27803010 48135102 - CONNECTOR ROD 4.5MM 70MM OFFST XIA SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48135103 SUP Custom 27803010 48135103 - CONNECTOR ROD SMALL EXTEND XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$3,033.00" "$2,244.00" $539.83 "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" $539.83 "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" $632.06 "$3,032.78" "$1,213.11" "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" "$2,274.75" "$3,032.78" "$3,032.78" "$3,032.78" "$1,516.39" "$1,516.39" "$2,401.96" "$3,032.78" "$2,426.22" "$1,364.75" "$3,032.78" N/A "$1,759.14" "$3,032.78" "$1,819.67" "$3,032.78" "$3,032.78" "$3,032.78" N/A N/A 48135104 SUP Custom 27803010 48135104 - CONNECTOR ROD LONG 4.5MM EXTEND XIA SPN BOTH IP/OP "$3,033.00" "$2,244.00" $539.83 "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" $539.83 "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" $632.06 "$3,032.78" "$1,213.11" "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" "$3,032.78" "$2,274.75" "$3,032.78" "$3,032.78" "$3,032.78" "$1,516.39" "$1,516.39" "$2,401.96" "$3,032.78" "$2,426.22" "$1,364.75" "$3,032.78" N/A "$1,759.14" "$3,032.78" "$1,819.67" "$3,032.78" "$3,032.78" "$3,032.78" N/A N/A 48135105 SUP Custom 27803010 48135105 - CONNECTOR ROD STR XIA TITANIUM ILIAC SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48135106 SUP Custom 27803010 48135106 - CONNECTOR ROD 15D 4.5MM STR XIA SPN ILIAC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48135107 SUP Custom 27803010 48135107 - CONNECTOR ROD 25D 4.5MM STR XIA SPN ILIAC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48135108 SUP Custom 27803010 48135108 - CONNECTOR ROD 35D 4.5MM STR XIA SPN ILIAC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48135109 SUP Custom 27803010 48135109 - CONNECTOR ROD 45D 4.5MM STR XIA SPN ILIAC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48135520 SUP HCPCS C1713 48135520 - SCREW BONE 5.5MM 20MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135525 SUP HCPCS C1713 48135525 - SCREW BONE 5.5MM 25MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135530 SUP HCPCS C1713 48135530 - SCREW BONE 5.5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48135535 SUP HCPCS C1713 48135535 - SCREW BONE 5.5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135540 SUP HCPCS C1713 48135540 - SCREW BONE 5.5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135545 SUP HCPCS C1713 48135545 - SCREW BONE 5.5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48135550 SUP HCPCS C1713 48135550 - SCREW BONE 5.5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48135555 SUP HCPCS C1713 48135555 - SCREW BONE 5.5MM 55MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48135560 SUP HCPCS C1713 48135560 - SCREW BONE 5.5MM 60MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48135570 SUP HCPCS C1713 48135570 - SCREW BONE 5.5MM 70MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48135580 SUP HCPCS C1713 48135580 - SCREW BONE 5.5MM 80MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48136025 SUP HCPCS C1713 48136025 - SCREW BONE 6MM 25MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48136030 SUP HCPCS C1713 48136030 - SCREW BONE 6MM 30MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136035 SUP HCPCS C1713 48136035 - SCREW BONE 6MM 35MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136040 SUP HCPCS C1713 48136040 - SCREW BONE 6MM 40MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136045 SUP HCPCS C1713 48136045 - SCREW BONE 6MM 45MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136050 SUP HCPCS C1713 48136050 - SCREW BONE 6MM 50MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48136055 SUP HCPCS C1713 48136055 - SCREW BONE 6MM 55MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136060 SUP HCPCS C1713 48136060 - SCREW BONE 6MM 60MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136070 SUP HCPCS C1713 48136070 - SCREW BONE 6MM 70MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136080 SUP HCPCS C1713 48136080 - SCREW BONE 6MM 80MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136530 SUP HCPCS C1713 48136530 - SCREW BONE 6.5MM 30MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136535 SUP HCPCS C1713 48136535 - SCREW BONE 6.5MM 35MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136540 SUP HCPCS C1713 48136540 - SCREW BONE 6.5MM 40MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136545 SUP HCPCS C1713 48136545 - SCREW BONE 6.5MM 45MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136550 SUP HCPCS C1713 48136550 - SCREW BONE 6.5MM 50MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136555 SUP HCPCS C1713 48136555 - SCREW BONE 6.5MM 55MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136560 SUP HCPCS C1713 48136560 - SCREW BONE 6.5MM 60MM MNOAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136570 SUP HCPCS C1713 48136570 - SCREW BONE 6.5MM 70MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48136580 SUP HCPCS C1713 48136580 - SCREW BONE 6.5MM 80MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48137030 SUP HCPCS C1713 48137030 - SCREW BONE 7MM 30MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48137035 SUP HCPCS C1713 48137035 - SCREW BONE 7MM 35MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48137040 SUP HCPCS C1713 48137040 - SCREW BONE 7MM 40MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48137045 SUP HCPCS C1713 48137045 - SCREW BONE 7MM 45MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48137050 SUP HCPCS C1713 48137050 - SCREW BONE 7MM 50MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48137060 SUP HCPCS C1713 48137060 - SCREW BONE 7MM 60MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48137070 SUP HCPCS C1713 48137070 - SCREW BONE 7MM 70MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48137080 SUP HCPCS C1713 48137080 - SCREW BONE 7MM 80MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48137530 SUP HCPCS C1713 48137530 - SCREW BONE 7.5MM 30MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48137535 SUP HCPCS C1713 48137535 - SCREW BONE 7.5MM 35MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48137540 SUP HCPCS C1713 48137540 - SCREW BONE 7.5MM 40MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48137545 SUP HCPCS C1713 48137545 - SCREW BONE 7.5MM 45MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48137550 SUP HCPCS C1713 48137550 - SCREW BONE 7.5MM 50MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48137555 SUP HCPCS C1713 48137555 - SCREW BONE 7.5MM 55MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48137560 SUP HCPCS C1713 48137560 - SCREW BONE 7.5MM 60MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48137570 SUP HCPCS C1713 48137570 - SCREW BONE 7.5MM 70MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 48137580 SUP HCPCS C1713 48137580 - SCREW BONE 7.5MM 80MM MNOAX XIA SPN 4.5MM ROD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 48144020 SUP HCPCS C1713 48144020 - SCREW BONE 4MM 20MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48144025 SUP HCPCS C1713 48144025 - SCREW BONE 4MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48144030 SUP HCPCS C1713 48144030 - SCREW BONE 4MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48144035 SUP HCPCS C1713 48144035 - SCREW BONE 4MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48144040 SUP HCPCS C1713 48144040 - SCREW BONE 4MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48144520 SUP HCPCS C1713 48144520 - SCREW BONE 4.5MM 20MM POLYAX XIA SPN 4.5MM ROD BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48144525 SUP HCPCS C1713 48144525 - SCREW BONE 4.5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48144530 SUP HCPCS C1713 48144530 - SCREW BONE 4.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48144535 SUP HCPCS C1713 48144535 - SCREW BONE 4.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48144540 SUP HCPCS C1713 48144540 - SCREW BONE 4.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48144545 SUP HCPCS C1713 48144545 - SCREW BONE 4.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48144560 SUP HCPCS C1713 48144560 - SCREW BONE 4.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48144570 SUP HCPCS C1713 48144570 - SCREW BONE 4.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145020 SUP HCPCS C1713 48145020 - SCREW BONE 5MM 20MM POLYAX XIA SPN 4.5MM ROD BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145025 SUP HCPCS C1713 48145025 - SCREW BONE 5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145030 SUP HCPCS C1713 48145030 - SCREW BONE 5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145035 SUP HCPCS C1713 48145035 - SCREW BONE 5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145040 SUP HCPCS C1713 48145040 - SCREW BONE 5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145045 SUP HCPCS C1713 48145045 - SCREW BONE 5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145050 SUP HCPCS C1713 48145050 - SCREW BONE 5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145055 SUP HCPCS C1713 48145055 - SCREW BONE 5MM 55MM POLYAX XIA SPN 4.5MM ROD BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145060 SUP HCPCS C1713 48145060 - SCREW BONE 5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145070 SUP HCPCS C1713 48145070 - SCREW BONE 5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145080 SUP HCPCS C1713 48145080 - SCREW BONE 5MM 80MM POLYAX XIA SPN 4.5MM ROD BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145520 SUP HCPCS C1713 48145520 - SCREW BONE 5.5MM 20MM POLYAX XIA SPN 4.5MM ROD BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145525 SUP HCPCS C1713 48145525 - SCREW BONE 5.5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145530 SUP HCPCS C1713 48145530 - SCREW BONE 5.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145535 SUP HCPCS C1713 48145535 - SCREW BONE 5.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145540 SUP HCPCS C1713 48145540 - SCREW BONE 5.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145545 SUP HCPCS C1713 48145545 - SCREW BONE 5.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145550 SUP HCPCS C1713 48145550 - SCREW BONE 5.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145555 SUP HCPCS C1713 48145555 - SCREW BONE 5.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145560 SUP HCPCS C1713 48145560 - SCREW BONE 5.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145570 SUP HCPCS C1713 48145570 - SCREW BONE 5.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48145580 SUP HCPCS C1713 48145580 - SCREW BONE 5.5MM 80MM POLYAX XIA SPN 4.5MM ROD BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146025 SUP HCPCS C1713 48146025 - SCREW BONE 6MM 25MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146030 SUP HCPCS C1713 48146030 - SCREW BONE 6MM 30MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146035 SUP HCPCS C1713 48146035 - SCREW BONE 6MM 35MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146040 SUP HCPCS C1713 48146040 - SCREW BONE 6MM 40MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146045 SUP HCPCS C1713 48146045 - SCREW BONE 6MM 45MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146050 SUP HCPCS C1713 48146050 - SCREW BONE 6MM 50MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146055 SUP HCPCS C1713 48146055 - SCREW BONE 6MM 55MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146060 SUP HCPCS C1713 48146060 - SCREW BONE 6MM 60MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146070 SUP HCPCS C1713 48146070 - SCREW BONE 6MM 70MM POLYAX XIA SPN 4.5MM ROD BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146080 SUP HCPCS C1713 48146080 - SCREW BONE 6MM 80MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146530 SUP HCPCS C1713 48146530 - SCREW BONE 6.5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146535 SUP HCPCS C1713 48146535 - SCREW BONE 6.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146540 SUP HCPCS C1713 48146540 - SCREW BONE 6.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146545 SUP HCPCS C1713 48146545 - SCREW BONE 6.5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146550 SUP HCPCS C1713 48146550 - SCREW BONE 6.5MM 50MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146555 SUP HCPCS C1713 48146555 - SCREW BONE 6.5MM 55MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146560 SUP HCPCS C1713 48146560 - SCREW BONE 6.5MM 60MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146570 SUP HCPCS C1713 48146570 - SCREW BONE 6.5MM 70MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48146580 SUP HCPCS C1713 48146580 - SCREW BONE 6.5MM 80MM POLYAX XIA SPN 4.5MM ROD BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147030 SUP HCPCS C1713 48147030 - SCREW BONE 7MM 30MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147035 SUP HCPCS C1713 48147035 - SCREW BONE 7MM 35MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147040 SUP HCPCS C1713 48147040 - SCREW BONE 7MM 40MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147045 SUP HCPCS C1713 48147045 - SCREW BONE 7MM 45MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147050 SUP HCPCS C1713 48147050 - SCREW BONE 7MM 50MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147055 SUP HCPCS C1713 48147055 - SCREW BONE 7MM 55MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147060 SUP HCPCS C1713 48147060 - SCREW BONE 7MM 60MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147070 SUP HCPCS C1713 48147070 - SCREW BONE 7MM 70MM POLYAX XIA SPN 4.5MM ROD BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147080 SUP HCPCS C1713 48147080 - SCREW BONE 7MM 80MM POLYAX XIA SPN 4.5MM ROD BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147530 SUP HCPCS C1713 48147530 - SCREW BONE 7.5MM 30MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147535 SUP HCPCS C1713 48147535 - SCREW BONE 7.5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147540 SUP HCPCS C1713 48147540 - SCREW BONE 7.5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147545 SUP HCPCS C1713 48147545 - SCREW BONE 7.5MM 45MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147550 SUP HCPCS C1713 48147550 - SCREW BONE 7.5MM 50MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147555 SUP HCPCS C1713 48147555 - SCREW BONE 7.5MM 55MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147560 SUP HCPCS C1713 48147560 - SCREW BONE 7.5MM 60MM POLYAX XIA TITANIUM THORACOLUMBAR SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147570 SUP HCPCS C1713 48147570 - SCREW BONE 7.5MM 70MM POLYAX XIA SPN 4.5MM ROD BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48147580 SUP HCPCS C1713 48147580 - SCREW BONE 7.5MM 80MM POLYAX XIA SPN 4.5MM ROD BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48200000 SUP HCPCS C1713 48200000 - BLOCKER SPINAL BLOCKER TECHTONIX LUMBAR SACRAL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 48200005 SUP Custom 27803010 48200005 - BLOCKER SPINAL 4.5MM BLOCKER TECHTONIX LUMBAR SACRAL BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 48200022 SUP HCPCS C1713 48200022 - PLATE BONE 22MM LEVEL 2 TECHTONIX TITANIUM SPN BOTH IP/OP "$3,306.50" "$2,447.00" $656.20 "$3,306.20" "$1,487.79" "$1,487.79" "$1,487.79" "$1,487.79" "$3,306.20" "$3,306.20" "$3,306.20" $689.09 "$3,306.20" "$3,306.20" "$3,306.20" "$3,306.20" "$3,306.20" $689.05 "$3,306.20" "$3,306.20" "$1,629.96" "$3,306.20" "$3,306.20" "$3,306.20" "$3,306.20" "$2,479.88" "$3,306.20" "$3,306.20" "$3,306.20" "$1,653.10" "$1,653.10" "$2,618.51" "$3,306.20" "$2,644.96" "$1,487.79" $656.20 N/A "$1,917.77" "$3,306.20" "$1,983.72" "$3,306.20" $689.01 "$3,306.20" N/A N/A 48202234 SUP HCPCS C1713 48202234 - PLATE BONE 22-34MM LEVEL 2 TECHTONIX TITANIUM SPN BOTH IP/OP "$3,306.50" "$2,447.00" $656.20 "$3,306.20" "$1,487.79" "$1,487.79" "$1,487.79" "$1,487.79" "$3,306.20" "$3,306.20" "$3,306.20" $689.09 "$3,306.20" "$3,306.20" "$3,306.20" "$3,306.20" "$3,306.20" $689.05 "$3,306.20" "$3,306.20" "$1,629.96" "$3,306.20" "$3,306.20" "$3,306.20" "$3,306.20" "$2,479.88" "$3,306.20" "$3,306.20" "$3,306.20" "$1,653.10" "$1,653.10" "$2,618.51" "$3,306.20" "$2,644.96" "$1,487.79" $656.20 N/A "$1,917.77" "$3,306.20" "$1,983.72" "$3,306.20" $689.01 "$3,306.20" N/A N/A 48202840 SUP HCPCS C1713 48202840 - PLATE BONE 28-40MM LEVEL 2 TECHTONIX TITANIUM SPN BOTH IP/OP "$3,306.50" "$2,447.00" $656.20 "$3,306.20" "$1,487.79" "$1,487.79" "$1,487.79" "$1,487.79" "$3,306.20" "$3,306.20" "$3,306.20" $689.09 "$3,306.20" "$3,306.20" "$3,306.20" "$3,306.20" "$3,306.20" $689.05 "$3,306.20" "$3,306.20" "$1,629.96" "$3,306.20" "$3,306.20" "$3,306.20" "$3,306.20" "$2,479.88" "$3,306.20" "$3,306.20" "$3,306.20" "$1,653.10" "$1,653.10" "$2,618.51" "$3,306.20" "$2,644.96" "$1,487.79" $656.20 N/A "$1,917.77" "$3,306.20" "$1,983.72" "$3,306.20" $689.01 "$3,306.20" N/A N/A 48204658 SUP HCPCS C1713 48204658 - PLATE BONE 46-58MM LEVEL 2 TECHTONIX TITANIUM SPN BOTH IP/OP "$3,730.00" "$2,760.00" $740.28 "$3,729.85" "$1,678.43" "$1,678.43" "$1,678.43" "$1,678.43" "$3,729.85" "$3,729.85" "$3,729.85" $777.39 "$3,729.85" "$3,729.85" "$3,729.85" "$3,729.85" "$3,729.85" $777.34 "$3,729.85" "$3,729.85" "$1,838.82" "$3,729.85" "$3,729.85" "$3,729.85" "$3,729.85" "$2,797.50" "$3,729.85" "$3,729.85" "$3,729.85" "$1,864.93" "$1,864.93" "$2,954.04" "$3,729.85" "$2,983.88" "$1,678.43" $740.28 N/A "$2,163.40" "$3,729.85" "$2,237.91" "$3,729.85" $777.30 "$3,729.85" N/A N/A 48213017 SUP Custom 27803010 48213017 - CONNECTOR ROD 17MM MONOBLOCK MAC TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48213020 SUP Custom 27803010 48213020 - CONNECTOR ROD 20MM MONOBLOCK MAC TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48213023 SUP Custom 27803010 48213023 - CONNECTOR ROD 23MM MULTIAX CROSS XIA MAC TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48213026 SUP Custom 27803010 48213026 - CONNECTOR ROD 26MM MULTIAX CROSS XIA MAC TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48213029 SUP Custom 27803010 48213029 - CONNECTOR ROD 29-31MM CROSS MAC TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48213031 SUP Custom 27803010 48213031 - CONNECTOR ROD SMALL 31-35MM MAC TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48213035 SUP Custom 27803010 48213035 - CONNECTOR ROD SMALL 35-40MM MAC TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48213038 SUP Custom 27803010 48213038 - CONNECTOR ROD STANDARD 39-43MM MAC TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48213042 SUP Custom 27803010 48213042 - CONNECTOR ROD 42MM MULTIAX CROSSLINK MAC TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48213050 SUP Custom 27803010 48213050 - CONNECTOR ROD 50MM MULTIAX CROSSLINK MAC TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48213066 SUP Custom 27803010 48213066 - CONNECTOR ROD 67-99MM MULTIAX CROSS XIA MAC TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48218030 SUP Custom 27803010 48218030 - ROD SPINAL 3.5IN RAD PREBENT 30MM XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48218035 SUP Custom 27803010 48218035 - ROD SPINAL 6MM 35MM RAD XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48218040 SUP Custom 27803010 48218040 - ROD SPINAL 3.5IN 40MM XIA RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48218045 SUP Custom 27803010 48218045 - ROD SPINAL 4.25IN RAD 6MM 45MM RAD XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48218050 SUP Custom 27803010 48218050 - ROD SPINAL 4.25IN RAD 6MM 50MM CVD XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48218060 SUP Custom 27803010 48218060 - ROD SPINAL 4.25IN RAD 6MM 60MM CVD XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48218070 SUP Custom 27803010 48218070 - ROD SPINAL 6MM 70MM RAD XIA RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48218080 SUP Custom 27803010 48218080 - ROD SPINAL 5IN RAD 5IN 80MM XIA BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48218090 SUP Custom 27803010 48218090 - ROD SPINAL 5IN RAD PREBENT 90MM XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48219050 SUP Custom 27803010 48219050 - ROD SPINAL 6MM 50MM RAD XIA TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48219060 SUP Custom 27803010 48219060 - ROD SPINAL 60MM XIA BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48219070 SUP Custom 27803010 48219070 - ROD SPINAL 70MM 2 RAD XIA MAX TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48219080 SUP Custom 27803010 48219080 - ROD SPINAL 80MM 2 RAD XIA TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48220000 SUP Custom 27803010 48220000 - SCREW SET BUTTRESS THREAD BLOCKER XIA STAINLESS STEEL BOTH IP/OP "$2,400.00" "$1,776.00" $427.20 "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" $427.20 "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" $500.19 "$2,400.00" $960.00 "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$1,800.00" "$2,400.00" "$2,400.00" "$2,400.00" "$1,200.00" "$1,200.00" "$1,900.80" "$2,400.00" "$1,920.00" "$1,080.00" "$2,400.00" N/A "$1,392.00" "$2,400.00" "$1,440.00" "$2,400.00" "$2,400.00" "$2,400.00" N/A N/A 48220100 SUP HCPCS C1713 48220100 - WASHER SPINAL XIA STAINLESS STEEL THORACOLUMBAR SPN SCOLIOS BOTH IP/OP $202.50 $150.00 $40.13 $202.18 $90.98 $90.98 $90.98 $90.98 $202.18 $202.18 $202.18 $42.14 $202.18 $202.18 $202.18 $202.18 $202.18 $42.14 $202.18 $202.18 $119.59 $202.18 $202.18 $202.18 $202.18 $151.88 $202.18 $202.18 $202.18 $101.09 $101.09 $160.13 $202.18 $161.74 $90.98 $40.13 N/A $117.45 $202.18 $121.31 $202.18 $42.13 $202.18 N/A N/A 48220101 SUP Custom 27803010 48220101 - CONNECTOR ROD OFFST XIA STAINLESS STEEL SCOLIOS BOTH IP/OP $556.50 $412.00 $99.06 $556.50 $556.50 $556.50 $556.50 $556.50 $556.50 $556.50 $99.06 $556.50 $556.50 $556.50 $556.50 $556.50 $556.50 $115.98 $556.50 $222.60 $556.50 $556.50 $556.50 $556.50 $556.50 $417.38 $556.50 $556.50 $556.50 $278.25 $278.25 $440.75 $556.50 $445.20 $250.43 $556.50 N/A $322.77 $556.50 $333.90 $556.50 $556.50 $556.50 N/A N/A 48220102 SUP Custom 27803010 48220102 - CONNECTOR ROD AXIAL OFFST XIA STAINLESS STEEL THORACOLUMBAR BOTH IP/OP "$1,001.50" $741.00 $178.23 "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" $178.23 "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" $208.68 "$1,001.30" $400.52 "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" $751.13 "$1,001.30" "$1,001.30" "$1,001.30" $500.65 $500.65 $793.03 "$1,001.30" $801.04 $450.59 "$1,001.30" N/A $580.87 "$1,001.30" $600.78 "$1,001.30" "$1,001.30" "$1,001.30" N/A N/A 48220103 SUP Custom 27803010 48220103 - CONNECTOR ROD AXIAL OFFST XIA STAINLESS STEEL THORACOLUMBAR BOTH IP/OP "$1,001.50" $741.00 $178.23 "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" $178.23 "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" $208.68 "$1,001.30" $400.52 "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" "$1,001.30" $751.13 "$1,001.30" "$1,001.30" "$1,001.30" $500.65 $500.65 $793.03 "$1,001.30" $801.04 $450.59 "$1,001.30" N/A $580.87 "$1,001.30" $600.78 "$1,001.30" "$1,001.30" "$1,001.30" N/A N/A 48220104 SUP HCPCS C1713 48220104 - STAPLE BONE XIA STAINLESS STEEL THORACOLUMBAR SPN SCOLIOS BOTH IP/OP $223.50 $165.00 $44.34 $223.38 $100.52 $100.52 $100.52 $100.52 $223.38 $223.38 $223.38 $46.56 $223.38 $223.38 $223.38 $223.38 $223.38 $46.55 $223.38 $89.35 $132.13 $223.38 $223.38 $223.38 $223.38 $167.63 $223.38 $223.38 $223.38 $111.69 $111.69 $176.92 $223.38 $178.70 $100.52 $44.34 N/A $129.63 $223.38 $134.03 $223.38 $46.55 $223.38 N/A N/A 48220110 SUP HCPCS C1713 48220110 - STAPLE BONE SMALL 2 HOLE XIA STAINLESS STEEL ANTERIOR CAUDAL BOTH IP/OP "$2,134.00" "$1,579.00" $423.46 "$2,133.55" $960.10 $960.10 $960.10 $960.10 "$2,133.55" "$2,133.55" "$2,133.55" $444.69 "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" $444.66 "$2,133.55" $853.42 "$1,261.99" "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" "$1,600.50" "$2,133.55" "$2,133.55" "$2,133.55" "$1,066.78" "$1,066.78" "$1,689.77" "$2,133.55" "$1,706.84" $960.10 $423.46 N/A "$1,237.72" "$2,133.55" "$1,280.13" "$2,133.55" $444.63 "$2,133.55" N/A N/A 48220111 SUP HCPCS C1713 48220111 - STAPLE BONE SMALL 2 HOLE XIA STAINLESS STEEL ANTERIOR BOTH IP/OP "$2,134.00" "$1,579.00" $423.46 "$2,133.55" $960.10 $960.10 $960.10 $960.10 "$2,133.55" "$2,133.55" "$2,133.55" $444.69 "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" $444.66 "$2,133.55" "$2,133.55" "$1,261.99" "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" "$1,600.50" "$2,133.55" "$2,133.55" "$2,133.55" "$1,066.78" "$1,066.78" "$1,689.77" "$2,133.55" "$1,706.84" $960.10 $423.46 N/A "$1,237.72" "$2,133.55" "$1,280.13" "$2,133.55" $444.63 "$2,133.55" N/A N/A 48220112 SUP HCPCS C1713 48220112 - STAPLE BONE MEDIUM 2 HOLE XIA STAINLESS STEEL ANTERIOR BOTH IP/OP "$2,134.00" "$1,579.00" $423.46 "$2,133.55" $960.10 $960.10 $960.10 $960.10 "$2,133.55" "$2,133.55" "$2,133.55" $444.69 "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" $444.66 "$2,133.55" "$2,133.55" "$1,261.99" "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" "$1,600.50" "$2,133.55" "$2,133.55" "$2,133.55" "$1,066.78" "$1,066.78" "$1,689.77" "$2,133.55" "$1,706.84" $960.10 $423.46 N/A "$1,237.72" "$2,133.55" "$1,280.13" "$2,133.55" $444.63 "$2,133.55" N/A N/A 48220113 SUP HCPCS C1713 48220113 - STAPLE BONE MEDIUM 2 HOLE XIA STAINLESS STEEL ANTERIOR BOTH IP/OP "$2,134.00" "$1,579.00" $423.46 "$2,133.55" $960.10 $960.10 $960.10 $960.10 "$2,133.55" "$2,133.55" "$2,133.55" $444.69 "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" $444.66 "$2,133.55" "$2,133.55" "$1,261.99" "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" "$1,600.50" "$2,133.55" "$2,133.55" "$2,133.55" "$1,066.78" "$1,066.78" "$1,689.77" "$2,133.55" "$1,706.84" $960.10 $423.46 N/A "$1,237.72" "$2,133.55" "$1,280.13" "$2,133.55" $444.63 "$2,133.55" N/A N/A 48220114 SUP HCPCS C1713 48220114 - STAPLE BONE LARGE 2 HOLE XIA STAINLESS STEEL ANTERIOR CAUDAL BOTH IP/OP "$2,134.00" "$1,579.00" $423.46 "$2,133.55" $960.10 $960.10 $960.10 $960.10 "$2,133.55" "$2,133.55" "$2,133.55" $444.69 "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" $444.66 "$2,133.55" "$2,133.55" "$1,261.99" "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" "$1,600.50" "$2,133.55" "$2,133.55" "$2,133.55" "$1,066.78" "$1,066.78" "$1,689.77" "$2,133.55" "$1,706.84" $960.10 $423.46 N/A "$1,237.72" "$2,133.55" "$1,280.13" "$2,133.55" $444.63 "$2,133.55" N/A N/A 48220115 SUP HCPCS C1713 48220115 - STAPLE BONE LARGE 2 HOLE XIA STAINLESS STEEL ANTERIOR BOTH IP/OP "$2,134.00" "$1,579.00" $423.46 "$2,133.55" $960.10 $960.10 $960.10 $960.10 "$2,133.55" "$2,133.55" "$2,133.55" $444.69 "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" $444.66 "$2,133.55" "$2,133.55" "$1,261.99" "$2,133.55" "$2,133.55" "$2,133.55" "$2,133.55" "$1,600.50" "$2,133.55" "$2,133.55" "$2,133.55" "$1,066.78" "$1,066.78" "$1,689.77" "$2,133.55" "$1,706.84" $960.10 $423.46 N/A "$1,237.72" "$2,133.55" "$2,133.55" "$2,133.55" $444.63 "$2,133.55" N/A N/A 48220130 SUP Custom 27803010 48220130 - CONNECTOR ROD 75D OFFST XIA STAINLESS STEEL SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48220131 SUP Custom 27803010 48220131 - CONNECTOR ROD OFFST STAINLESS STEEL SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48220132 SUP Custom 27803010 48220132 - CONNECTOR ROD 105D OFFST XIA STAINLESS STEEL SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48220133 SUP Custom 27803010 48220133 - CONNECTOR ROD NEUTRAL LONG OFFST XIA STAINLESS STEEL SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48220134 SUP Custom 27803010 48220134 - CONNECTOR ROD 0D SMALL PARALLEL XIA STAINLESS STEEL SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220135 SUP Custom 27803010 48220135 - CONNECTOR ROD 30D SMALL ROD TO ROD XIA STAINLESS STEEL SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220136 SUP Custom 27803010 48220136 - CONNECTOR ROD 0D LARGE ROD TO ROD XIA STAINLESS STEEL SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220137 SUP Custom 27803010 48220137 - CONNECTOR ROD 30D LARGE ROD TO ROD XIA STAINLESS STEEL SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220200 SUP Custom 27803010 48220200 - HOOK SPINAL SMALL STANDARD LAMINATE XIA STAINLESS STEEL LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48220201 SUP Custom 27803010 48220201 - HOOK SPINAL SMALL NARROW XIA STAINLESS STEEL LMNR SCOLIOS BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48220202 SUP Custom 27803010 48220202 - HOOK SPINAL LARGE STANDARD BLADE XIA STAINLESS STEEL LAMINA BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220203 SUP Custom 27203010 48220203 - HOOK SURG LARGE NARROW BLADE XIA STAINLESS STEEL SPINAL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220204 SUP Custom 27803010 48220204 - HOOK SPINAL EXTENDED BODY XIA STAINLESS STEEL LMNR SCOLIOS BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220205 SUP Custom 27803010 48220205 - HOOK SPINAL ANGLED BLADE XIA STAINLESS STEEL LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220206 SUP Custom 27803010 48220206 - HOOK SPINAL OFFST XIA STAINLESS STEEL RIGHT LMNR SCOLIOS BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220207 SUP Custom 27803010 48220207 - HOOK SPINAL OFFST XIA LEFT LMNR SCOLIOS BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220208 SUP Custom 27803010 48220208 - HOOK SPINAL ANGLED BLADE XIA STAINLESS STEEL LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220210 SUP Custom 27803010 48220210 - HOOK SPINAL STANDARD BLADE XIA STAINLESS STEEL LMNR SCOLIOS BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220211 SUP Custom 27803010 48220211 - HOOK SPINAL NARROW BLADE XIA STAINLESS STEEL LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220212 SUP Custom 27803010 48220212 - HOOK SPINAL SMALL RIGHT OFFST XIA STAINLESS STEEL LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48220213 SUP Custom 27803010 48220213 - HOOK SPINAL SMALL LEFT OFFST XIA STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220214 SUP Custom 27803010 48220214 - HOOK SPINAL LARGE STANDARD RIGHT OFFST XIA STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220215 SUP Custom 27803010 48220215 - HOOK SPINAL LARGE LEFT OFFST XIA STAINLESS STEEL LMNR BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220220 SUP Custom 27803010 48220220 - HOOK SPINAL SMALL XIA PEDICLE SCOLIOS BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48220221 SUP Custom 27803010 48220221 - HOOK SPINAL LARGE XIA PEDICLE SCOLIOS BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220230 SUP Custom 27803010 48220230 - HOOK SPINAL STANDARD TRNSVRS PROCESS XIA STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220231 SUP Custom 27803010 48220231 - HOOK SPINAL LEFT OFFST TRNSVRS PROCESS XIA STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48220240 SUP Custom 27203010 48220240 - HOOK RETRACTION WIDE LAMINA RBH BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220241 SUP Custom 27803010 48220241 - HOOK SPINAL WIDE BLADE RED XIA STAINLESS STEEL LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220242 SUP Custom 27203010 48220242 - HOOK RETRACTION ANGLED LP BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220243 SUP Custom 27803010 48220243 - HOOK SPINAL RED NARROW BLADE XIA TITANIUM LMNR THORACIC BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220244 SUP Custom 27803010 48220244 - HOOK SPINAL RED BLADE XIA STAINLESS STEEL PEDICLE SCOLIOS BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48220317 SUP Custom 27803010 48220317 - CONNECTOR ROD 17MM CROSS XIA MAC STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220319 SUP Custom 27803010 48220319 - CONNECTOR ROD 19MM MULTIAX CROSS XIA MAC STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220321 SUP Custom 27803010 48220321 - CONNECTOR ROD 21MM MOMO TYPE XIA MAC STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220323 SUP Custom 27803010 48220323 - CONNECTOR ROD 23MM MULTIAX CROSS XIA STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220326 SUP Custom 27803010 48220326 - CONNECTOR ROD 26MM MOMO TYPE XIA MAC STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220329 SUP Custom 27803010 48220329 - CONNECTOR ROD 29MM MULTIAX MONO XIA STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220331 SUP Custom 27803010 48220331 - CROSSLINK SPINAL 31-34MM MULTIAX XIA STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220335 SUP Custom 27803010 48220335 - CONNECTOR ROD SMALL 35-37MM MULTIAX CROSS XIA STAINLESS BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220338 SUP Custom 27803010 48220338 - CROSSLINK SPINAL 38-43MM MULTIAX XIA STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220342 SUP Custom 27803010 48220342 - CONNECTOR ROD 42-51MM MULTIAX CROSS XIA MAC STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220350 SUP Custom 27803010 48220350 - CONNECTOR ROD 50-67MM CROSSLINK XIA SPN SCOLIOS BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48220425 SUP HCPCS C1713 48220425 - SCREW BONE 4.5MM 25MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220430 SUP HCPCS C1713 48220430 - SCREW BONE 4.5MM 30MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220435 SUP HCPCS C1713 48220435 - SCREW BONE 4.5MM 35MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220440 SUP HCPCS C1713 48220440 - SCREW BONE 4.5MM 40MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220445 SUP HCPCS C1713 48220445 - SCREW BONE 4.5MM 45MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220525 SUP HCPCS C1713 48220525 - SCREW BONE 5.5MM 25MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220530 SUP HCPCS C1713 48220530 - SCREW BONE 5.5MM 30MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$6,300.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$3,780.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48220535 SUP HCPCS C1713 48220535 - SCREW BONE 5.5MM 35MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$6,300.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48220540 SUP HCPCS C1713 48220540 - SCREW BONE 5.5MM 40MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$6,300.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$3,780.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48220545 SUP HCPCS C1713 48220545 - SCREW BONE 5.5MM 45MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220550 SUP HCPCS C1713 48220550 - SCREW BONE 5.5MM 50MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220555 SUP HCPCS C1713 48220555 - SCREW BONE 5.5MM 55MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220600 SUP HCPCS C1713 48220600 - SCREW BONE 6.5MM 100MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220630 SUP HCPCS C1713 48220630 - SCREW BONE 6.5MM 30MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220635 SUP HCPCS C1713 48220635 - SCREW BONE 6.5MM 35MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48220640 SUP HCPCS C1713 48220640 - SCREW BONE 6.5MM 40MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48220645 SUP HCPCS C1713 48220645 - SCREW BONE 6.5MM 45MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$3,780.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48220650 SUP HCPCS C1713 48220650 - SCREW BONE 6.5MM 50MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220655 SUP HCPCS C1713 48220655 - SCREW BONE 6.5MM 55MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 48220660 SUP HCPCS C1713 48220660 - SCREW BONE 6.5MM 60MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 48220670 SUP HCPCS C1713 48220670 - SCREW BONE 6.5MM 70MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220680 SUP HCPCS C1713 48220680 - SCREW BONE 6.5MM 80MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220690 SUP HCPCS C1713 48220690 - SCREW BONE 6.5MM 90MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220700 SUP HCPCS C1713 48220700 - SCREW BONE 7.5MM 100MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220730 SUP HCPCS C1713 48220730 - SCREW BONE 7.5MM 30MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220735 SUP HCPCS C1713 48220735 - SCREW BONE 7.5MM 35MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220740 SUP HCPCS C1713 48220740 - SCREW BONE 7.5MM 40MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$3,780.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48220745 SUP HCPCS C1713 48220745 - SCREW BONE 7.5MM 45MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$3,780.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48220750 SUP HCPCS C1713 48220750 - SCREW BONE 7.5MM 50MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220755 SUP HCPCS C1713 48220755 - SCREW BONE 7.5MM 55MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220760 SUP HCPCS C1713 48220760 - SCREW BONE 7.5MM 60MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220770 SUP HCPCS C1713 48220770 - SCREW BONE 7.5MM 70MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220780 SUP HCPCS C1713 48220780 - SCREW BONE 7.5MM 80MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220790 SUP HCPCS C1713 48220790 - SCREW BONE 7.5MM 90MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220800 SUP HCPCS C1713 48220800 - SCREW BONE 8.5MM 100MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220830 SUP HCPCS C1713 48220830 - SCREW BONE 8.5MM 30MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220835 SUP HCPCS C1713 48220835 - SCREW BONE 8.5MM 35MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220840 SUP HCPCS C1713 48220840 - SCREW BONE 8.5MM 40MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220845 SUP HCPCS C1713 48220845 - SCREW BONE 8.5MM 45MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220850 SUP HCPCS C1713 48220850 - SCREW BONE 8.5MM 50MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220855 SUP HCPCS C1713 48220855 - SCREW BONE 8.5MM 55MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220860 SUP HCPCS C1713 48220860 - SCREW BONE 8.5MM 60MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220870 SUP HCPCS C1713 48220870 - SCREW BONE 8.5MM 70MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220880 SUP HCPCS C1713 48220880 - SCREW BONE 8.5MM 80MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220890 SUP HCPCS C1713 48220890 - SCREW BONE 8.5MM 90MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220900 SUP HCPCS C1713 48220900 - SCREW BONE 9.5MM 100MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220960 SUP HCPCS C1713 48220960 - SCREW BONE 9.5MM 60MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220970 SUP HCPCS C1713 48220970 - SCREW BONE 9.5MM 70MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220980 SUP HCPCS C1713 48220980 - SCREW BONE 9.5MM 80MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48220990 SUP HCPCS C1713 48220990 - SCREW BONE 9.5MM 90MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 48221015 SUP Custom 27803010 48221015 - CONNECTOR ROD 15MM MULTIAX CROSS XIA MAC STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 48221016 SUP Custom 27803010 48221016 - CONNECTOR ROD 16MM MULTIAX CROSS XIA MAC STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 48221017 SUP Custom 27803010 48221017 - CONNECTOR ROD 17MM MULTIAX CROSS XIA MAC STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 48221018 SUP Custom 27803010 48221018 - CONNECTOR ROD 18MM MULTIAX CROSS XIA MAC STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 48221019 SUP Custom 27803010 48221019 - CONNECTOR ROD 19MM MULTIAX CROSS XIA MAC STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 48221020 SUP Custom 27803010 48221020 - CONNECTOR ROD 20MM MULTIAX CROSS XIA MAC STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 48221425 SUP HCPCS C1713 48221425 - SCREW BONE 4.5MM 25MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$5,875.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A 48221430 SUP HCPCS C1713 48221430 - SCREW BONE 4.5MM 30MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$5,875.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A 48221435 SUP HCPCS C1713 48221435 - SCREW BONE 4.5MM 35MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$5,875.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A 48221440 SUP HCPCS C1713 48221440 - SCREW BONE 4.5MM 40MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A 48221445 SUP HCPCS C1713 48221445 - SCREW BONE 4.5MM 45MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,737.50" "$4,246.00" "$1,138.75" "$5,737.50" "$2,581.88" "$2,581.88" "$2,581.88" "$2,581.88" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.84" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$2,828.59" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$1,138.75" N/A "$3,327.75" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.70" "$5,737.50" N/A N/A 48221525 SUP HCPCS C1713 48221525 - SCREW BONE 5.5MM 25MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,737.50" "$4,246.00" "$1,138.75" "$5,737.50" "$2,581.88" "$2,581.88" "$2,581.88" "$2,581.88" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.84" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$5,737.50" "$2,828.59" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$1,138.75" N/A "$3,327.75" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.70" "$5,737.50" N/A N/A 48221530 SUP HCPCS C1713 48221530 - SCREW BONE 5.5MM 30MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,737.50" "$4,246.00" "$1,138.75" "$5,737.50" "$2,581.88" "$2,581.88" "$2,581.88" "$2,581.88" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.84" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$2,828.59" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$1,138.75" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$1,195.70" "$5,737.50" N/A N/A 48221535 SUP HCPCS C1713 48221535 - SCREW BONE 5.5MM 35MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,737.50" "$4,246.00" "$1,138.75" "$5,737.50" "$2,581.88" "$2,581.88" "$2,581.88" "$2,581.88" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.84" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$5,737.50" "$2,828.59" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$1,138.75" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$1,195.70" "$5,737.50" N/A N/A 48221540 SUP HCPCS C1713 48221540 - SCREW BONE 5.5MM 40MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,737.50" "$4,246.00" "$1,138.75" "$5,737.50" "$2,581.88" "$2,581.88" "$2,581.88" "$2,581.88" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.84" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$5,737.50" "$2,828.59" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$1,138.75" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$1,195.70" "$5,737.50" N/A N/A 48221545 SUP HCPCS C1713 48221545 - SCREW BONE 5.5MM 45MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221550 SUP HCPCS C1713 48221550 - SCREW BONE 5.5MM 50MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221555 SUP HCPCS C1713 48221555 - SCREW BONE 5.5MM 55MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221600 SUP HCPCS C1713 48221600 - SCREW BONE 6.5MM 100MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221630 SUP HCPCS C1713 48221630 - SCREW BONE 6.5MM 30MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221635 SUP HCPCS C1713 48221635 - SCREW BONE 6.5MM 35MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221640 SUP HCPCS C1713 48221640 - SCREW BONE 6.5MM 40MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221645 SUP HCPCS C1713 48221645 - SCREW BONE 6.5MM 45MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221650 SUP HCPCS C1713 48221650 - SCREW BONE 6.5MM 50MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221655 SUP HCPCS C1713 48221655 - SCREW BONE 6.5MM 55MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221660 SUP HCPCS C1713 48221660 - SCREW BONE 6.5MM 60MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221670 SUP HCPCS C1713 48221670 - SCREW BONE 6.5MM 70MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221680 SUP HCPCS C1713 48221680 - SCREW BONE 6.5MM 80MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221690 SUP HCPCS C1713 48221690 - SCREW BONE 6.5MM 90MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221700 SUP HCPCS C1713 48221700 - SCREW BONE 7.5MM 100MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221730 SUP HCPCS C1713 48221730 - SCREW BONE 7.5MM 30MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221735 SUP HCPCS C1713 48221735 - SCREW BONE 7.5MM 35MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221740 SUP HCPCS C1713 48221740 - SCREW BONE 7.5MM 40MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221745 SUP HCPCS C1713 48221745 - SCREW BONE 7.5MM 45MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221750 SUP HCPCS C1713 48221750 - SCREW BONE 7.5MM 50MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221755 SUP HCPCS C1713 48221755 - SCREW BONE 7.5MM 55MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221760 SUP HCPCS C1713 48221760 - SCREW BONE 7.5MM 60MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221770 SUP HCPCS C1713 48221770 - SCREW BONE 7.5MM 70MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221780 SUP HCPCS C1713 48221780 - SCREW BONE 7.5MM 80MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48221790 SUP HCPCS C1713 48221790 - SCREW BONE 7.5MM 90MM POLYAX XIA STAINLESS STEEL SPN BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 48222000 SUP Custom 27803010 48222000 - ROD SPINAL STANDARD 5.5MM 480MM XIA STAINLESS STEEL SCOLIOS BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 48222001 SUP Custom 27803010 48222001 - ROD SPINAL STANDARD 5.5MM 480MM STIFF XIA STAINLESS STEEL BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 48222003 SUP Custom 27803010 48222003 - ROD SPNL 5.5MM 480MM NS XIA STF HEX SS BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 48222600 SUP Custom 27803010 48222600 - ROD SPINAL STANDARD 600MM XIA STAINLESS STEEL SCOLIOS BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 48222601 SUP Custom 27803010 48222601 - ROD SPINAL 600MM STIFF XIA STAINLESS STEEL SCOLIOS BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 48222603 SUP Custom 27803010 48222603 - ROD SPNL 5.5MM 600MM NS XIA STF HEX SS BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 48223425 SUP HCPCS C1713 48223425 - SCREW BONE 4.5MM 25MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$6,800.00" "$5,032.00" "$1,349.63" "$6,800.00" "$3,060.00" "$3,060.00" "$3,060.00" "$3,060.00" "$6,800.00" "$6,800.00" "$6,800.00" "$1,417.29" "$6,800.00" "$6,800.00" "$6,800.00" "$6,800.00" "$6,800.00" "$1,417.19" "$6,800.00" "$2,720.00" "$3,352.40" "$6,800.00" "$6,800.00" "$6,800.00" "$6,800.00" "$5,100.00" "$6,800.00" "$6,800.00" "$6,800.00" "$3,400.00" "$3,400.00" "$5,385.60" "$6,800.00" "$5,440.00" "$3,060.00" "$1,349.63" N/A "$3,944.00" "$6,800.00" "$6,800.00" "$6,800.00" "$1,417.12" "$6,800.00" N/A N/A 48223430 SUP HCPCS C1713 48223430 - SCREW BONE 4.5MM 30MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$10,975.00" "$8,122.00" "$2,178.26" "$10,975.00" "$4,938.75" "$4,938.75" "$4,938.75" "$4,938.75" "$10,975.00" "$10,975.00" "$10,975.00" "$2,287.46" "$10,975.00" "$10,975.00" "$10,975.00" "$10,975.00" "$10,975.00" "$2,287.31" "$10,975.00" "$4,390.00" "$5,410.68" "$10,975.00" "$10,975.00" "$10,975.00" "$10,975.00" "$8,231.25" "$10,975.00" "$10,975.00" "$10,975.00" "$5,487.50" "$5,487.50" "$8,692.20" "$10,975.00" "$8,780.00" "$4,938.75" "$2,178.26" N/A "$6,365.50" "$10,975.00" "$10,975.00" "$10,975.00" "$2,287.19" "$10,975.00" N/A N/A 48223435 SUP HCPCS C1713 48223435 - SCREW BONE 4.5MM 35MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48223440 SUP HCPCS C1713 48223440 - SCREW BONE 4.5MM 40MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48223445 SUP HCPCS C1713 48223445 - SCREW BONE 4.5MM 45MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48223530 SUP HCPCS C1713 48223530 - SCREW BONE 5.5MM 30MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48223535 SUP HCPCS C1713 48223535 - SCREW BONE 5.5MM 35MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48223540 SUP HCPCS C1713 48223540 - SCREW BONE 5.5MM 40MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48223545 SUP HCPCS C1713 48223545 - SCREW BONE 5.5MM 45MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48223550 SUP HCPCS C1713 48223550 - SCREW BONE 5.5MM 50MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48223630 SUP HCPCS C1713 48223630 - SCREW BONE 6.5MM 30MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48223635 SUP HCPCS C1713 48223635 - SCREW BONE 6.5MM 35MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48223640 SUP HCPCS C1713 48223640 - SCREW BONE 6.5MM 40MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48223645 SUP HCPCS C1713 48223645 - SCREW BONE 6.5MM 45MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48223650 SUP HCPCS C1713 48223650 - SCREW BONE 6.5MM 50MM UNIPLNR XIA STAINLESS STEEL SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48227201 SUP Custom 27803010 48227201 - HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48227202 SUP Custom 27803010 48227202 - HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48227203 SUP Custom 27803010 48227203 - HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48227211 SUP Custom 27803010 48227211 - HOOK SPINAL LONG ARM REDX STAINLESS STEEL LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48227220 SUP Custom 27803010 48227220 - HOOK SPINAL REDX LONG ARM STAINLESS STEEL PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48228425 SUP HCPCS C1713 48228425 - SCREW BONE 4.5MM 25MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$3,780.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228430 SUP HCPCS C1713 48228430 - SCREW BONE 4.5MM 30MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228435 SUP HCPCS C1713 48228435 - SCREW BONE 4.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228440 SUP HCPCS C1713 48228440 - SCREW BONE 4.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228445 SUP HCPCS C1713 48228445 - SCREW BONE 4.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228530 SUP HCPCS C1713 48228530 - SCREW BONE 5.5MM 30MM REDX MNOAX LONG ARM STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228535 SUP HCPCS C1713 48228535 - SCREW BONE 5.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$6,300.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228540 SUP HCPCS C1713 48228540 - SCREW BONE 5.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228545 SUP HCPCS C1713 48228545 - SCREW BONE 5.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228550 SUP HCPCS C1713 48228550 - SCREW BONE 5.5MM 50MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228555 SUP HCPCS C1713 48228555 - SCREW BONE 5.5MM 55MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228630 SUP HCPCS C1713 48228630 - SCREW BONE 6.5MM 30MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228635 SUP HCPCS C1713 48228635 - SCREW BONE 6.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228640 SUP HCPCS C1713 48228640 - SCREW BONE 6.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228645 SUP HCPCS C1713 48228645 - SCREW BONE 6.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228650 SUP HCPCS C1713 48228650 - SCREW BONE 6.5MM 50MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,300.00" "$4,662.00" "$1,250.39" "$6,300.00" "$2,835.00" "$2,835.00" "$2,835.00" "$2,835.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,313.08" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$3,105.90" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$1,250.39" N/A "$3,654.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.92" "$6,300.00" N/A N/A 48228655 SUP HCPCS C1713 48228655 - SCREW BONE 6.5MM 55MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 48228660 SUP HCPCS C1713 48228660 - SCREW BONE 6.5MM 60MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$3,727.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 48228730 SUP HCPCS C1713 48228730 - SCREW BONE 7.5MM 30MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$3,727.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 48228735 SUP HCPCS C1713 48228735 - SCREW BONE 7.5MM 35MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$3,727.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 48228740 SUP HCPCS C1713 48228740 - SCREW BONE 7.5MM 40MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$3,727.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 48228745 SUP HCPCS C1713 48228745 - SCREW BONE 7.5MM 45MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$3,727.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 48228750 SUP HCPCS C1713 48228750 - SCREW BONE 7.5MM 50MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 48228755 SUP HCPCS C1713 48228755 - SCREW BONE 7.5MM 55MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 48228760 SUP HCPCS C1713 48228760 - SCREW BONE 7.5MM 60MM REDX LONG ARM MNOAX STAINLESS STEEL BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A 48229425 SUP HCPCS C1713 48229425 - SCREW BONE LONG ARM 4.5MM 25MM POLYAX REDX XIA STAINLESS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48229430 SUP HCPCS C1713 48229430 - SCREW BONE 4.5MM 30MM REDX LONG ARM POLYAX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229435 SUP HCPCS C1713 48229435 - SCREW BONE 4.5MM 35MM REDX LONG ARM POLYAX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229440 SUP HCPCS C1713 48229440 - SCREW BONE 4.5MM 40MM REDX LONG ARM POLYAX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229445 SUP HCPCS C1713 48229445 - SCREW BONE LONG ARM 4.5MM 45MM POLYAX REDX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229530 SUP HCPCS C1713 48229530 - SCREW BONE 5.5MM 30MM REDX LONG ARM POLYAX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229535 SUP HCPCS C1713 48229535 - SCREW BONE 5.5MM 35MM REDX LONG ARM POLYAX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229540 SUP HCPCS C1713 48229540 - SCREW BONE 5.5MM 40MM REDX LONG ARM POLYAX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229545 SUP HCPCS C1713 48229545 - SCREW BONE LONG ARM 5.5MM 45MM POLYAX REDX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229550 SUP HCPCS C1713 48229550 - SCREW BONE LONG ARM 5.5MM 50MM POLYAX REDX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229555 SUP HCPCS C1713 48229555 - SCREW BONE LONG ARM 5.5MM 55MM POLYAX REDX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229630 SUP HCPCS C1713 48229630 - SCREW BONE 6.5MM 30MM REDX LONG ARM POLYAX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229635 SUP HCPCS C1713 48229635 - SCREW BONE 6.5MM 35MM REDX LONG ARM POLYAX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229640 SUP HCPCS C1713 48229640 - SCREW BONE 6.5MM 40MM REDX LONG ARM POLYAX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229645 SUP HCPCS C1713 48229645 - SCREW BONE 6.5MM 45MM REDX LONG ARM POLYAX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229650 SUP HCPCS C1713 48229650 - SCREW BONE 6.5MM 50MM REDX LONG ARM POLYAX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229655 SUP HCPCS C1713 48229655 - SCREW BONE 6.5MM 55MM REDX LONG ARM POLYAX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229660 SUP HCPCS C1713 48229660 - SCREW BONE LONG ARM 6.5MM 60MM POLYAX REDX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229730 SUP HCPCS C1713 48229730 - SCREW BONE LONG ARM 7.5MM 30MM POLYAX REDX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229735 SUP HCPCS C1713 48229735 - SCREW BONE LONG ARM 7.5MM 35MM POLYAX REDX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229740 SUP HCPCS C1713 48229740 - SCREW BONE LONG ARM 7.5MM 40MM POLYAX REDX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229745 SUP HCPCS C1713 48229745 - SCREW BONE LONG ARM 7.5MM 45MM POLYAX REDX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229750 SUP HCPCS C1713 48229750 - SCREW BONE LONG ARM 7.5MM 50MM POLYAX REDX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229755 SUP HCPCS C1713 48229755 - SCREW BONE LONG ARM 7.5MM 55MM POLYAX REDX XIA STAINLESS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48229760 SUP HCPCS C1713 48229760 - BLOCKER SPNL XIA 3 TI SPNE BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 48230000 SUP Custom 27803010 48230000 - SCREW SET BLOCKER XIA 3 TITANIUM SPN BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48230133 SUP Custom 27803010 48230133 - CONNECTOR ROD LARGE OFFST ILIAC PELVIC BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48230138 SUP Custom 27803010 48230138 - CONNECTOR ROD SMALL REVISION OFFST ILIOSACRAL SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48230139 SUP Custom 27803010 48230139 - CONNECTOR ROD LONG REVISION OFFST XIA 3 ILIOSACRAL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48230141 SUP Custom 27803010 48230141 - CONNECTOR ROD SMALL 7MM REVISION ROD TO ROD PARALLEL XIA 3 BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48230143 SUP Custom 27803010 48230143 - CONNECTOR ROD REVISION J HOOK OFFST ILIOSACRAL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48230144 SUP Custom 27803010 48230144 - CONNECTOR ROD REVISION OFFST ILIOSACRAL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48230201 SUP Custom 27803010 48230201 - HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230202 SUP Custom 27803010 48230202 - HOOK SPINAL LARGE XIA TITANIUM LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230203 SUP Custom 27803010 48230203 - HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230204 SUP Custom 27803010 48230204 - HOOK SPINAL EXTENDED BODY XIA TITANIUM LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230205 SUP Custom 27803010 48230205 - HOOK SPINAL EXTENDED BODY XIA 3 TITANIUM LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230206 SUP Custom 27803010 48230206 - HOOK SPINAL RIGHT OFFST XIA LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230207 SUP Custom 27803010 48230207 - HOOK SPINAL LEFT OFFST XIA LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230208 SUP Custom 27803010 48230208 - HOOK SPINAL ANGLED BLADE XIA TITANIUM LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230209 SUP Custom 27803010 48230209 - HOOK SPINAL ANGLED BLADE XIA TITANIUM LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230210 SUP Custom 27803010 48230210 - HOOK SPINAL OPEN XIA THORACIC BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230211 SUP Custom 27803010 48230211 - HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR THORACIC BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230212 SUP Custom 27803010 48230212 - HOOK SPINAL XIA RIGHT LMNR THORACIC BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230213 SUP Custom 27803010 48230213 - HOOK SPINAL XIA LEFT LMNR THORACIC BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230214 SUP Custom 27803010 48230214 - HOOK SPINAL LARGE OFFST XIA 3 TITANIUM RIGHT LMNR THORACIC BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230215 SUP Custom 27803010 48230215 - HOOK SPINAL LARGE OFFST XIA 3 TITANIUM LEFT LMNR THORACIC BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230216 SUP Custom 27803010 48230216 - HOOK SPINAL SMALL XIA TITANIUM LMNR THORACIC BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230217 SUP Custom 27803010 48230217 - HOOK SPINAL LARGE RIGHT OFFST XIA TITANIUM BOTH IP/OP "$2,687.50" "$1,989.00" $478.35 "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" $478.35 "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" $560.07 "$2,687.35" "$1,074.94" "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" "$2,015.63" "$2,687.35" "$2,687.35" "$2,687.35" "$1,343.68" "$1,343.68" "$2,128.38" "$2,687.35" "$2,149.88" "$1,209.31" "$2,687.35" N/A "$1,558.75" "$2,687.35" "$1,612.41" "$2,687.35" "$2,687.35" "$2,687.35" N/A N/A 48230218 SUP Custom 27803010 48230218 - HOOK SPINAL LARGE LEFT OFFST XIA TITANIUM BOTH IP/OP "$2,687.50" "$1,989.00" $478.35 "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" $478.35 "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" $560.07 "$2,687.35" "$1,074.94" "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" "$2,687.35" "$2,015.63" "$2,687.35" "$2,687.35" "$2,687.35" "$1,343.68" "$1,343.68" "$2,128.38" "$2,687.35" "$2,149.88" "$1,209.31" "$2,687.35" N/A "$1,558.75" "$2,687.35" "$1,612.41" "$2,687.35" "$2,687.35" "$2,687.35" N/A N/A 48230220 SUP Custom 27803010 48230220 - HOOK SPINAL SMALL XIA TITANIUM PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230221 SUP Custom 27803010 48230221 - HOOK SPINAL MEDIUM XIA TITANIUM PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230222 SUP Custom 27803010 48230222 - HOOK SPINAL LARGE XIA TITANIUM PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230230 SUP HCPCS C1713 48230230 - WIRE FIX SHARP CANN KWIRE SPN BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 48230231 SUP HCPCS C1713 48230231 - WIRE FIX BLUNT KWIRE BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 48230232 SUP Custom 27803010 48230232 - HOOK SPINAL TRNSVRS PROCESS XIA TITANIUM RIGHT BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230233 SUP Custom 27803010 48230233 - HOOK SPINAL TRNSVRS PROCESS XIA TITANIUM LEFT BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230240 SUP Custom 27803010 48230240 - HOOK SPINAL NARROW BLADE XIA TITANIUM LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230241 SUP Custom 27803010 48230241 - HOOK SPINAL XIA TITANIUM LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230250 SUP Custom 27803010 48230250 - HOOK SPINAL MEDIUM LMNR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48230260 SUP Custom 27803010 48230260 - HOOK SPINAL REVISION ILIOSACRAL BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48231535 SUP HCPCS C1713 48231535 - SCREW BONE 5.5MM 35MM CANN XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$1,045.00" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48231540 SUP HCPCS C1713 48231540 - SCREW BONE 5.5MM 40MM CANN XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48231545 SUP HCPCS C1713 48231545 - SCREW BONE 5.5MM 45MM CANN XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48231550 SUP HCPCS C1713 48231550 - SCREW BONE 5.5MM 50MM CANN XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48231630 SUP HCPCS C1713 48231630 - SCREW BONE 6.5MM 30MM CANN XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$1,045.00" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48231635 SUP HCPCS C1713 48231635 - SCREW BONE 6.5MM 35MM CANN XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$1,045.00" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48231640 SUP HCPCS C1713 48231640 - SCREW BONE 6.5MM 40MM CANN XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$1,045.00" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48231645 SUP HCPCS C1713 48231645 - SCREW BONE 6.5MM 45MM CANN XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$1,045.00" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48231650 SUP HCPCS C1713 48231650 - SCREW BONE 6.5MM 50MM CANN XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$1,045.00" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" N/A N/A 48231655 SUP HCPCS C1713 48231655 - SCREW BN 6.5MM 50MM XIA 3 PA TI SPNE THORLMBR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$1,045.00" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48231730 SUP HCPCS C1713 48231730 - SCREW BONE 7.5MM 30MM CANN XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$1,045.00" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48231735 SUP HCPCS C1713 48231735 - SCREW BONE 7.5MM 35MM CANN XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$1,045.00" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48231740 SUP HCPCS C1713 48231740 - SCREW BONE 7.5MM 40MM CANN XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$1,567.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48231745 SUP HCPCS C1713 48231745 - SCREW BN 7.5MM 45MM XIA 3 PA TI SPNE THORLMBR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48231750 SUP HCPCS C1713 48231750 - SCREW BONE 7.5MM 50MM CANN XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48231755 SUP HCPCS C1713 48231755 - SCREW BN 7.5MM 50MM XIA CNN TI SPNE THORLMBR BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$1,567.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A 48232030 SUP Custom 27803010 48232030 - ROD SPINAL 6MM 30MM COMPRESSION XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48232040 SUP Custom 27803010 48232040 - ROD SPINAL 40MM XIA BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48232050 SUP Custom 27803010 48232050 - ROD SPINAL 6MM 50MM COMPRESSION XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48232060 SUP Custom 27803010 48232060 - ROD SPINAL 6MM 60MM COMPRESSION XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48232070 SUP Custom 27803010 48232070 - ROD SPINAL 6MM 70MM COMPRESSION XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48232080 SUP Custom 27803010 48232080 - ROD SPINAL 6MM 80MM COMPRESSION XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48232090 SUP Custom 27803010 48232090 - ROD SPINAL 6MM 90MM COMPRESSION XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48232100 SUP Custom 27803010 48232100 - ROD SPINAL 6MM 100MM COMPRESSION XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48232110 SUP Custom 27803010 48232110 - ROD SPINAL 6MM 110MM COMPRESSION XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48232120 SUP Custom 27803010 48232120 - ROD SPINAL 6MM 120MM COMPRESSION XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48232130 SUP Custom 27803010 48232130 - ROD SPINAL 6MM 130MM COMPRESSION XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48232140 SUP Custom 27803010 48232140 - ROD SPINAL 6MM 140MM COMPRESSION XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48232150 SUP Custom 27803010 48232150 - ROD SPINAL 6MM 30MM XIA 3 TITANIUM RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48232480 SUP Custom 27803010 48232480 - ROD SPINAL 6MM 480MM COMPRESSION XIA TITANIUM BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 48232600 SUP Custom 27803010 48232600 - ROD SPINAL 6MM 600MM COMPRESSION XIA TITANIUM BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 48233030 SUP Custom 27803010 48233030 - ROD SPINAL 6MM 30MM XIA 3 TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48233040 SUP Custom 27803010 48233040 - ROD SPINAL 6MM 40MM XIA 3 TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48233050 SUP Custom 27803010 48233050 - ROD SPINAL 6MM 50MM XIA 3 TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48233060 SUP Custom 27803010 48233060 - ROD SPINAL 6MM 60MM XIA 3 TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48233070 SUP Custom 27803010 48233070 - ROD SPINAL 6MM 70MM XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48233080 SUP Custom 27803010 48233080 - ROD SPINAL 6MM 80MM XIA TITANIUM ALLOY BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48233090 SUP Custom 27803010 48233090 - ROD SPINAL 6MM 90MM XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48233100 SUP Custom 27803010 48233100 - ROD SPINAL 100MM STR DIAPASON XIA BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48233110 SUP Custom 27803010 48233110 - ROD SPINAL 110MM STR DIAPASON XIA BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48233120 SUP Custom 27803010 48233120 - ROD SPINAL 6MM 120MM XIA TITANIUM ALLOY BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48233130 SUP Custom 27803010 48233130 - ROD SPINAL 6MM 13MM XIA TITANIUM ALLOY BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48233140 SUP Custom 27803010 48233140 - ROD SPINAL 6MM 14MM XIA TITANIUM ALLOY BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48233150 SUP Custom 27803010 48233150 - ROD SPINAL 6MM 15MM XIA TITANIUM ALLOY BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48233420 SUP HCPCS C1713 48233420 - SCREW BONE 4.5MM 20MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233425 SUP HCPCS C1713 48233425 - SCREW BONE 4.5MM 25MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233430 SUP HCPCS C1713 48233430 - SCREW BONE 4.5MM 30MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233435 SUP HCPCS C1713 48233435 - SCREW BONE 4.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233440 SUP HCPCS C1713 48233440 - SCREW BONE 4.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233445 SUP HCPCS C1713 48233445 - SCREW BONE 4.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233480 SUP HCPCS C1713 48233480 - ROD SPINAL 6MM 480MM XIA 3 BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $437.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A 48233500 SUP HCPCS C1713 48233500 - SCREW SET M6 NS XIA 3 SPNE BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $50.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $75.00 $125.00 $26.05 $125.00 N/A N/A 48233520 SUP HCPCS C1713 48233520 - SCREW BONE 5.5MM 20MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233525 SUP HCPCS C1713 48233525 - SCREW BONE 5.5MM 25MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233530 SUP HCPCS C1713 48233530 - SCREW BONE 5.5MM 30MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233535 SUP HCPCS C1713 48233535 - SCREW BONE 5.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233540 SUP HCPCS C1713 48233540 - SCREW BONE 5.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233545 SUP HCPCS C1713 48233545 - SCREW BONE 5.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233550 SUP HCPCS C1713 48233550 - SCREW BONE 5.5MM 50MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233555 SUP HCPCS C1713 48233555 - SCREW BONE 5.5MM 55MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233600 SUP Custom 27803010 48233600 - ROD SPINAL 6MM 60MM XIA TITANIUM ALLOY BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 48233625 SUP HCPCS C1713 48233625 - SCREW BONE 6.5MM 25MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233630 SUP HCPCS C1713 48233630 - SCREW BONE 6.5MM 30MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233635 SUP HCPCS C1713 48233635 - SCREW BONE 6.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233640 SUP HCPCS C1713 48233640 - SCREW BONE 6.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233645 SUP HCPCS C1713 48233645 - SCREW BONE 6.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233650 SUP HCPCS C1713 48233650 - SCREW BONE 6.5MM 50MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233655 SUP HCPCS C1713 48233655 - SCREW BONE 6.5MM 55MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233660 SUP HCPCS C1713 48233660 - SCREW BONE 6.5MM 60MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233730 SUP HCPCS C1713 48233730 - SCREW BONE 7.5MM 30MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233735 SUP HCPCS C1713 48233735 - SCREW BONE 7.5MM 35MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233740 SUP HCPCS C1713 48233740 - SCREW BONE 7.5MM 40MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233745 SUP HCPCS C1713 48233745 - SCREW BONE 7.5MM 45MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233750 SUP HCPCS C1713 48233750 - SCREW BONE 7.5MM 50MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233755 SUP HCPCS C1713 48233755 - SCREW BONE 7.5MM 55MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48233760 SUP HCPCS C1713 48233760 - SCREW BONE 7.5MM 60MM 2 MACHINE GROOVE UNIPLNR POLYAX XIA 3 BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48235007 SUP HCPCS C1713 48235007 - SCREW BONE REVISION SPN ILIOSACRAL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A 48235008 SUP Custom 27803010 48235008 - CONNECTOR ROD REVISION ILIOSACRAL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48235009 SUP Custom 27803010 48235009 - CONNECTOR ROD LARGE PARALLEL 11MM XIA 3 TITANIUM SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48235010 SUP HCPCS C1713 48235010 - SCREW BONE REVISION PARALLEL ILIOSACRAL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A 48235011 SUP Custom 27803010 48235011 - CONNECTOR ROD REVISION ROD TO ROD PARALLEL ILIOSACRAL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48235012 SUP Custom 27803010 48235012 - CONNECTOR ROD REVISION ROD TO ROD ILIOSACRAL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48236014 SUP Custom 27803010 48236014 - CROSSLINK SPINAL 14MM MONOBLOCK XIA TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48236015 SUP Custom 27803010 48236015 - CROSSLINK SPINAL 15MM MONOBLOCK XIA 3 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48236016 SUP Custom 27803010 48236016 - CROSSLINK SPINAL 16MM MONOBLOCK XIA 3 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48236017 SUP Custom 27803010 48236017 - CROSSLINK SPINAL 17MM MONOBLOCK XIA 3 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48236018 SUP Custom 27803010 48236018 - CROSSLINK SPINAL 18MM MONOBLOCK XIA 3 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48236019 SUP Custom 27803010 48236019 - CROSSLINK SPINAL 19MM MONOBLOCK XIA 3 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48236020 SUP Custom 27803010 48236020 - CROSSLINK SPINAL 20MM MONOBLOCK XIA 3 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48236022 SUP Custom 27803010 48236022 - CROSSLINK SPINAL 22MM MONOBLOCK XIA 3 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48236024 SUP Custom 27803010 48236024 - CROSSLINK SPINAL 24MM MONOBLOCK XIA TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48236026 SUP HCPCS C1713 48236026 - SCREW BONE 26MM MONOBLOCK SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48236028 SUP Custom 27803010 48236028 - CONNECTOR ROD 28-31MM MULTIAX CROSS XIA 3 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48236030 SUP Custom 27803010 48236030 - CONNECTOR ROD 35-44MM XIA 3 MA CX TI THORLMBR SPNE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48236035 SUP Custom 27803010 48236035 - CONNECTOR ROD 35-44MM MULTIAX CROSS XIA 3 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48236043 SUP Custom 27803010 48236043 - CONNECTOR ROD 70-99MM XIA 3 MA CX TI THORLMBR SPNE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48236053 SUP Custom 27803010 48236053 - CONNECTOR ROD 53-73MM MULTIAX CROSS XIA 3 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48236070 SUP HCPCS C1713 48236070 - CONNECTOR ROD 70-99MM MULTIAX CROSS XIA 3 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48236540 SUP HCPCS C1713 48236540 - SCREW BONE 6.5MM 40MM REVISION ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48236550 SUP HCPCS C1713 48236550 - SCREW BONE 6.5MM 50MM REVISION ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48236560 SUP HCPCS C1713 48236560 - SCREW BONE 6.5MM 60MM REVISION ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48237105 SUP Custom 27203010 48237105 - NEEDLE BIOP 10GA 5IN JAMSHIDI BOTH IP/OP $74.00 $55.00 $13.09 $73.55 $73.55 $73.55 $73.55 $73.55 $73.55 $73.55 $13.09 $73.55 $73.55 $54.59 $54.59 $56.69 $38.32 $15.33 $73.55 $29.42 $73.55 $73.55 $73.55 $73.55 $73.55 $55.50 $73.55 $73.55 $73.55 $36.78 $36.78 $58.25 $73.55 $58.84 $47.81 $73.55 N/A $42.92 $73.55 $44.13 $73.55 $73.55 $73.55 N/A N/A 48237110 SUP Custom 27203010 48237110 - BLADE SURG 10GA 9IN JAMSHIDI BOTH IP/OP $74.00 $55.00 $13.09 $73.55 $73.55 $73.55 $73.55 $73.55 $73.55 $73.55 $13.09 $73.55 $73.55 $54.59 $54.59 $56.69 $38.32 $15.33 $73.55 $29.42 $73.55 $73.55 $73.55 $73.55 $73.55 $55.50 $73.55 $73.55 $73.55 $36.78 $36.78 $58.25 $73.55 $58.84 $47.81 $73.55 N/A $42.92 $73.55 $44.13 $73.55 $73.55 $73.55 N/A N/A 48237115 SUP HCPCS C1713 48237115 - WIRE FIX JAMSHIDI SPN BOTH IP/OP $74.00 $55.00 $14.60 $73.55 $33.10 $33.10 $33.10 $33.10 $73.55 $73.55 $73.55 $15.33 $73.55 $73.55 $73.55 $73.55 $73.55 $15.33 $73.55 $29.42 $43.50 $73.55 $73.55 $73.55 $73.55 $55.50 $73.55 $73.55 $73.55 $36.78 $36.78 $58.25 $73.55 $58.84 $33.10 $14.60 N/A $42.92 $73.55 $73.55 $73.55 $15.33 $73.55 N/A N/A 48237135 SUP Custom 27203010 48237135 - NEEDLE BIOP 13GA 5IN BOTH IP/OP $74.00 $55.00 $13.09 $73.55 $73.55 $73.55 $73.55 $73.55 $73.55 $73.55 $13.09 $73.55 $73.55 $54.59 $54.59 $56.69 $38.32 $15.33 $73.55 $29.42 $73.55 $73.55 $73.55 $73.55 $73.55 $55.50 $73.55 $73.55 $73.55 $36.78 $36.78 $58.25 $73.55 $58.84 $47.81 $73.55 N/A $42.92 $73.55 $44.13 $73.55 $73.55 $73.55 N/A N/A 48237540 SUP HCPCS C1713 48237540 - SCREW BONE 7.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48237550 SUP HCPCS C1713 48237550 - SCREW BONE 7.5MM 50MM REVISION ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48237560 SUP HCPCS C1713 48237560 - SCREW BONE 7.5MM 60MM REVISION ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48238030 SUP Custom 27803010 48238030 - ROD SPINAL 6MM 30MM RADIOLUCENT XIA 3 TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48238035 SUP Custom 27803010 48238035 - ROD SPINAL 6MM 35MM RADIOLUCENT XIA 3 TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48238040 SUP Custom 27803010 48238040 - ROD SPINAL 6MM 40MM RADIOLUCENT XIA 3 TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48238045 SUP Custom 27803010 48238045 - ROD SPINAL 6MM 45MM RADIOLUCENT XIA 3 TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48238050 SUP Custom 27803010 48238050 - ROD SPINAL 6MM 50MM RADIOLUCENT XIA 3 TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48238060 SUP Custom 27803010 48238060 - ROD SPINAL 6MM 60MM RADIOLUCENT XIA 3 TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48238070 SUP Custom 27803010 48238070 - ROD SPINAL 6MM 70MM RADIOLUCENT XIA 3 TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48238080 SUP Custom 27803010 48238080 - ROD SPINAL 6MM 80MM RADIOLUCENT XIA 3 TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48238090 SUP Custom 27803010 48238090 - ROD SPINAL 6MM 90MM RADIOLUCENT XIA 3 TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48238100 SUP Custom 27803010 48238100 - ROD SPINAL 6MM 100MM XIA 3 TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48238110 SUP Custom 27803010 48238110 - ROD SPINAL 6MM 110MM XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48238120 SUP Custom 27803010 48238120 - ROD SPINAL 6MM 120MM XIA TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48238540 SUP HCPCS C1713 48238540 - SCREW BONE 8.5MM 40MM REVISION ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48238550 SUP HCPCS C1713 48238550 - SCREW BONE 8.5MM 50MM REVISION ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48238560 SUP HCPCS C1713 48238560 - SCREW BONE 8.5MM 60MM REVISION ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48239050 SUP Custom 27803010 48239050 - ROD SPNL 50MM XIA 2 BND BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48239060 SUP Custom 27803010 48239060 - ROD SPINAL 60MM MAX XIA BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48239070 SUP Custom 27803010 48239070 - ROD SPINAL 70MM XIA MAX BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48239080 SUP Custom 27803010 48239080 - ROD SPINAL 80MM XIA MAXL BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48239090 SUP Custom 27803010 48239090 - ROD SPINAL 90MM RAD MAX BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48239100 SUP Custom 27803010 48239100 - ROD SPINAL 100MM RAD XIA BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48239110 SUP Custom 27803010 48239110 - ROD SPINAL 110MM RAD XIA BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48239120 SUP Custom 27803010 48239120 - ROD SPINAL 120MM RAD XIA BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48239540 SUP HCPCS C1713 48239540 - SCREW BONE 9.5MM 40MM REVISION ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48239550 SUP HCPCS C1713 48239550 - SCREW BONE 9.5MM 50MM REVISION ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48239560 SUP HCPCS C1713 48239560 - SCREW BONE 9.5MM 60MM REVISION ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48250210 SUP Custom 27203010 48250210 - RETRACTOR FIBER OPTIC LUXOR BOTH IP/OP $597.50 $442.00 $106.29 $597.13 $597.13 $597.13 $597.13 $597.13 $597.13 $597.13 $106.29 $597.13 $597.13 $443.19 $443.19 $460.27 $311.10 $124.45 $597.13 $238.85 $597.13 $597.13 $597.13 $597.13 $597.13 $448.13 $597.13 $597.13 $597.13 $298.57 $298.57 $472.93 $597.13 $477.70 $388.13 $597.13 N/A $346.55 $597.13 $358.28 $597.13 $597.13 $597.13 N/A N/A 48251040 SUP Custom 27803010 48251040 - SLEEVE RB 40MM LUXOR SIL BOTH IP/OP $907.00 $671.00 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $189.02 $906.95 $362.78 $906.95 $906.95 $906.95 $906.95 $906.95 $680.25 $906.95 $906.95 $906.95 $453.48 $453.48 $718.30 $906.95 $725.56 $408.13 $906.95 N/A $526.06 $906.95 $544.17 $906.95 $906.95 $906.95 N/A N/A 48251050 SUP Custom 27803010 48251050 - SLEEVE RB 50MM LUXOR SIL BOTH IP/OP $907.00 $671.00 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $189.02 $906.95 $362.78 $906.95 $906.95 $906.95 $906.95 $906.95 $680.25 $906.95 $906.95 $906.95 $453.48 $453.48 $718.30 $906.95 $725.56 $408.13 $906.95 N/A $526.06 $906.95 $544.17 $906.95 $906.95 $906.95 N/A N/A 48251060 SUP Custom 27803010 48251060 - SPREADER SURG OVAL 60MM SLEEVE LUXOR SILICONE THORACOLUMBAR BOTH IP/OP $907.00 $671.00 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $189.02 $906.95 $362.78 $906.95 $906.95 $906.95 $906.95 $906.95 $680.25 $906.95 $906.95 $906.95 $453.48 $453.48 $718.30 $906.95 $725.56 $408.13 $906.95 N/A $526.06 $906.95 $544.17 $906.95 $906.95 $906.95 N/A N/A 48251070 SUP Custom 27803010 48251070 - SPREADER SURG OVAL 70MM SLEEVE LUXOR SILICONE SPN BOTH IP/OP $907.00 $671.00 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $189.02 $906.95 $362.78 $906.95 $906.95 $906.95 $906.95 $906.95 $680.25 $906.95 $906.95 $906.95 $453.48 $453.48 $718.30 $906.95 $725.56 $408.13 $906.95 N/A $526.06 $906.95 $544.17 $906.95 $906.95 $906.95 N/A N/A 48251080 SUP Custom 27803010 48251080 - SPREADER SURG OVAL 80MM SLEEVE LUXOR SILICONE SPN BOTH IP/OP $907.00 $671.00 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $189.02 $906.95 $362.78 $906.95 $906.95 $906.95 $906.95 $906.95 $680.25 $906.95 $906.95 $906.95 $453.48 $453.48 $718.30 $906.95 $725.56 $408.13 $906.95 N/A $526.06 $906.95 $544.17 $906.95 $906.95 $906.95 N/A N/A 48251090 SUP Custom 27803010 48251090 - SLEEVE RB 90MM LUXOR SIL BOTH IP/OP $907.00 $671.00 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $189.02 $906.95 $362.78 $906.95 $906.95 $906.95 $906.95 $906.95 $680.25 $906.95 $906.95 $906.95 $453.48 $453.48 $718.30 $906.95 $725.56 $408.13 $906.95 N/A $526.06 $906.95 $544.17 $906.95 $906.95 $906.95 N/A N/A 48251105 SUP Custom 27803010 48251105 - SLEEVE RB 105MM LUXOR SIL BOTH IP/OP $907.00 $671.00 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $189.02 $906.95 $362.78 $906.95 $906.95 $906.95 $906.95 $906.95 $680.25 $906.95 $906.95 $906.95 $453.48 $453.48 $718.30 $906.95 $725.56 $408.13 $906.95 N/A $526.06 $906.95 $544.17 $906.95 $906.95 $906.95 N/A N/A 48251120 SUP Custom 27803010 48251120 - SLEEVE RB 120MM LUXOR SIL BOTH IP/OP $907.00 $671.00 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $161.44 $906.95 $906.95 $906.95 $906.95 $906.95 $906.95 $189.02 $906.95 $362.78 $906.95 $906.95 $906.95 $906.95 $906.95 $680.25 $906.95 $906.95 $906.95 $453.48 $453.48 $718.30 $906.95 $725.56 $408.13 $906.95 N/A $526.06 $906.95 $544.17 $906.95 $906.95 $906.95 N/A N/A 48285425 SUP HCPCS C1713 48285425 - SCREW BONE 4.5MM 25MM CANN MANTIS SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285430 SUP HCPCS C1713 48285430 - SCREW BONE 4.5MM 30MM CANN MANTIS SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285435 SUP HCPCS C1713 48285435 - SCREW BONE 4.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285440 SUP HCPCS C1713 48285440 - SCREW BONE 4.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285445 SUP HCPCS C1713 48285445 - SCREW BONE 4.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285530 SUP HCPCS C1713 48285530 - SCREW BONE 5.5MM 30MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285535 SUP HCPCS C1713 48285535 - SCREW BONE 5.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285540 SUP HCPCS C1713 48285540 - SCREW BONE 5.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285545 SUP HCPCS C1713 48285545 - SCREW BONE 5.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285550 SUP HCPCS C1713 48285550 - SCREW BONE 5.5MM 50MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285555 SUP HCPCS C1713 48285555 - SCREW BONE 5.5MM 55MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285630 SUP HCPCS C1713 48285630 - SCREW BONE 6.5MM 30MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285635 SUP HCPCS C1713 48285635 - SCREW BONE 6.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285640 SUP HCPCS C1713 48285640 - SCREW BONE 6.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285645 SUP HCPCS C1713 48285645 - SCREW BONE 6.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285650 SUP HCPCS C1713 48285650 - SCREW BONE 6.5MM 50MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285655 SUP HCPCS C1713 48285655 - SCREW BONE 6.5MM 55MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285660 SUP HCPCS C1713 48285660 - SCREW BONE 6.5MM 60MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285730 SUP HCPCS C1713 48285730 - SCREW BONE 7.5MM 30MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285735 SUP HCPCS C1713 48285735 - SCREW BONE 7.5MM 35MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285740 SUP HCPCS C1713 48285740 - SCREW BONE 7.5MM 40MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285745 SUP HCPCS C1713 48285745 - SCREW BONE 7.5MM 45MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285750 SUP HCPCS C1713 48285750 - SCREW BONE 7.5MM 50MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285755 SUP HCPCS C1713 48285755 - SCREW BONE 7.5MM 55MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48285760 SUP HCPCS C1713 48285760 - SCREW BONE 7.5MM 60MM POLYAX CANN XIA MANTIS SPN PEDICLE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 48286030 SUP Custom 27803010 48286030 - ROD SPINAL 6MM 30MM RADIOPQ MANTIS PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48286035 SUP Custom 27803010 48286035 - ROD SPINAL 6MM 35MM RAD MANTIS TITANIUM PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48286040 SUP Custom 27803010 48286040 - ROD SPINAL 6MM 40MM RAD MANTIS TITANIUM PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48286045 SUP Custom 27803010 48286045 - ROD SPINAL 6MM 45MM RAD MANTIS TITANIUM PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48286050 SUP Custom 27803010 48286050 - ROD SPINAL 6MM 50MM RAD MANTIS TITANIUM PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48286060 SUP Custom 27803010 48286060 - ROD SPINAL 6MM 60MM RAD MANTIS TITANIUM PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48286070 SUP Custom 27803010 48286070 - ROD SPINAL 6MM 70MM RAD MANTIS TITANIUM PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48286080 SUP Custom 27803010 48286080 - ROD SPINAL 6MM 80MM RAD MANTIS TITANIUM PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48286090 SUP Custom 27803010 48286090 - ROD SPINAL 6MM 90MM RAD MANTIS TITANIUM PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48286100 SUP Custom 27803010 48286100 - ROD SPINAL 6MM 100MM RAD MANTIS TITANIUM PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48286110 SUP Custom 27803010 48286110 - ROD SPINAL 6MM 110MM RADIOPQ MANTIS PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48286120 SUP Custom 27803010 48286120 - ROD SPINAL 120MM CVD BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48286130 SUP Custom 27803010 48286130 - ROD SPINAL 6MM 130MM RADIOPQ MANTIS PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48287050 SUP Custom 27803010 48287050 - ROD SPINAL 6MM 50MM RADIOPQ MANTIS PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48287060 SUP Custom 27803010 48287060 - ROD SPINAL 6MM 60MM RADIOPQ MANTIS PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48287070 SUP Custom 27803010 48287070 - ROD SPINAL 6MM 70MM RADIOPQ MANTIS PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48287080 SUP Custom 27803010 48287080 - ROD SPINAL 6MM 80MM RADIOPQ MANTIS PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48287090 SUP Custom 27803010 48287090 - ROD SPINAL 6MM 90MM RADIOPQ MANTIS PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48287100 SUP Custom 27803010 48287100 - ROD SPINAL 6MM 100MM RADIOPQ MANTIS PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48287110 SUP Custom 27803010 48287110 - ROD SPINAL 6MM 110MM RADIOPQ MANTIS PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48287120 SUP Custom 27803010 48287120 - ROD SPINAL 6MM 120MM RADIOPQ MANTIS PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48287130 SUP Custom 27803010 48287130 - ROD SPINAL 6MM 130MM RADIOPQ MANTIS PEDICLE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48287200 SUP Custom 27803010 48287200 - ROD SPINAL 6MM 200MM STR MANTIS PEDICLE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48288030 SUP Custom 27803010 48288030 - ROD SPINAL STR 6MM 30MM MANTIS BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48288040 SUP Custom 27803010 48288040 - ROD SPINAL STR 6MM 40MM MANTIS BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48288050 SUP Custom 27803010 48288050 - ROD SPINAL 6MM 50MM STR MANTIS BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48288060 SUP Custom 27803010 48288060 - ROD SPINAL 6MM 60MM STR MANTIS BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48288070 SUP Custom 27803010 48288070 - ROD SPINAL STR 6MM 70MM MANTIS BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48288080 SUP Custom 27803010 48288080 - ROD SPINAL STR 6MM 80MM MANTIS BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48288090 SUP Custom 27803010 48288090 - ROD SPINAL 6MM 90MM STR MANTIS BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48288100 SUP Custom 27803010 48288100 - ROD SPINAL 6MM 100MM STR MANTIS BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48288110 SUP Custom 27803010 48288110 - ROD SPINAL STR 6MM 110MM MANTIS BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48288120 SUP Custom 27803010 48288120 - ROD SPINAL 6MM 120MM STR MANTIS BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48288130 SUP Custom 27803010 48288130 - ROD SPINAL 6MM 130MM STR MANTIS BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48288480 SUP Custom 27803010 48288480 - ROD SPINAL 6MM 480MM STR MANTIS BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 48290220 SUP Custom 27803010 48290220 - END CAP SPNL 20D 22MM 18MM NS VLIFT TI LMBR INTRBD FS BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48290225 SUP Custom 27803010 48290225 - ENDCAP SPINAL 25D 22MM CLOSE BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48290230 SUP Custom 27803010 48290230 - ENDCAP SPINAL 30D 22MM CLOSE BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48291180 SUP Custom 27803010 48291180 - ENDCAP SPINAL 0D 18MM MODULAR OPEN SNAP EXTERIOR METAL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48291183 SUP Custom 27803010 48291183 - ENDCAP SPINAL 3D 18MM MODULAR OPEN SNAP EXTERIOR METAL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48291188 SUP Custom 27803010 48291188 - ENDCAP SPINAL 8D 18MM 118MM VLIFT BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48291220 SUP Custom 27803010 48291220 - ENDCAP SPINAL 0D 22MM MODULAR OPEN SNAP EXTERIOR METAL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48291223 SUP Custom 27803010 48291223 - ENDCAP SPINAL 3D 22MM MODULAR OPEN SNAP EXTERIOR METAL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48291228 SUP Custom 27803010 48291228 - ENDCAP SPINAL 8D 22MM MODULAR OPEN SNAP EXTERIOR METAL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48291800 SUP HCPCS C1781 48291800 - EXTENSION STEM 18MM VLIFT BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A 48291820 SUP Custom 27803010 48291820 - CAGE SPNL 18MM 20MM NS LF VLIFT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 48291825 SUP Custom 27803010 48291825 - CAGE SPNL 18MM 25MM NS LF VLIFT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 48291832 SUP Custom 27803010 48291832 - CAGE SPNL 18MM 32MM NS LF VLIFT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 48292200 SUP Custom 27803010 48292200 - EXTENSION SPNL 22MM NS LF VLIFT TI LMBR INTRBD FS BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48292215 SUP Custom 27803010 48292215 - ENDCAP SPINAL 15D 22MM MODULAR OPEN SNAP EXTERIOR METAL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48292225 SUP Custom 27803010 48292225 - CAGE SPNL 22MM 25MM NS LF VLIFT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 48292232 SUP Custom 27803010 48292232 - CAGE SPNL 22MM 32MM NS LF VLIFT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 48292237 SUP Custom 27803010 48292237 - CAGE SPNL 22MM 37MM NS LF VLIFT TI LMBR INTRBD FS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 48321060 SUP Custom 27803010 48321060 - CAGE SPNL 0D 12MM RECT 14X6MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321064 SUP Custom 27803010 48321064 - CAGE SPNL 4D 12MM RECT 14X6MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321068 SUP Custom 27803010 48321068 - CAGE SPNL 8D 12MM RECT 14X6MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321070 SUP Custom 27803010 48321070 - CAGE SPNL 0D 12MM RECT 14X7MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321074 SUP Custom 27803010 48321074 - CAGE SPNL 4D 12MM RECT 14X7MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321078 SUP Custom 27803010 48321078 - CAGE SPNL 8D 12MM RECT 14X7MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321080 SUP Custom 27803010 48321080 - CAGE SPNL 0D 12MM RECT 14X8MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321084 SUP Custom 27803010 48321084 - CAGE SPNL 4D 12MM RECT 14X8MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321088 SUP Custom 27803010 48321088 - CAGE SPNL 8D 12MM RECT 14X8MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321090 SUP Custom 27803010 48321090 - CAGE SPNL 0D 12MM RECT 14X9MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321094 SUP Custom 27803010 48321094 - CAGE SPNL 4D 12MM RECT 14X9MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321098 SUP Custom 27803010 48321098 - CAGE SPNL 8D 12MM RECT 14X9MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321100 SUP Custom 27803010 48321100 - CAGE SPNL 0D 12MM RECT 14X10MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321104 SUP Custom 27803010 48321104 - CAGE SPNL 4D 12MM RECT 14X10MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321108 SUP Custom 27803010 48321108 - CAGE SPNL 8D 12MM RECT 14X10MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321110 SUP Custom 27803010 48321110 - CAGE SPNL 0D 12MM RECT 14X11MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321114 SUP Custom 27803010 48321114 - CAGE SPNL 4D 12MM RECT 14X11MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321118 SUP Custom 27803010 48321118 - CAGE SPNL 8D 12MM RECT 14X11MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321120 SUP Custom 27803010 48321120 - CAGE SPNL 0D 12MM RECT 14X12MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321124 SUP Custom 27803010 48321124 - CAGE SPNL 4D 12MM RECT 14X12MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48321128 SUP Custom 27803010 48321128 - CAGE SPNL 8D 12MM RECT 14X12MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48322040 SUP Custom 27803010 48322040 - SPACER SPNL 0D 12MM 14X4MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322044 SUP Custom 27803010 48322044 - SPACER SPNL 4D 12MM 14X4MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322050 SUP Custom 27803010 48322050 - SPACER SPNL 0D 12MM 14X5MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322054 SUP Custom 27803010 48322054 - SPACER SPNL 4D 12MM 14X5MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322060 SUP Custom 27803010 48322060 - SPACER SPNL 0D 12MM 14X6MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322064 SUP Custom 27803010 48322064 - SPACER SPNL 4D 12MM 14X6MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322070 SUP Custom 27803010 48322070 - SPACER SPNL 0D 12MM 14X7MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322074 SUP Custom 27803010 48322074 - SPACER SPNL 4D 12MM 14X7MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322080 SUP Custom 27803010 48322080 - SPACER SPNL 0D 12MM 14X8MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322084 SUP Custom 27803010 48322084 - SPACER SPNL 4D 12MM 14X8MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322090 SUP Custom 27803010 48322090 - SPACER SPNL 0D 12MM 14X9MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322094 SUP Custom 27803010 48322094 - SPACER SPNL 4D 12MM 14X9MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322100 SUP Custom 27803010 48322100 - SPACER SPNL 0D 12MM 14X10MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322104 SUP Custom 27803010 48322104 - SPACER SPNL 4D 12MM 14X10MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322110 SUP Custom 27803010 48322110 - SPACER SPNL 0D 12MM 14X11MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322114 SUP Custom 27803010 48322114 - SPACER SPNL 4D 12MM 14X11MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322120 SUP Custom 27803010 48322120 - SPACER SPNL 0D 12MM 14X12MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322124 SUP Custom 27803010 48322124 - SPACER SPNL 4D 12MM 14X12MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48322204 SUP Custom 27803010 48322204 - SPACER SPNL 4D 12MM 14X20MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 48323060 SUP Custom 27803010 48323060 - CAGE SPNL 0D 14MM RECT 16X6MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323064 SUP Custom 27803010 48323064 - CAGE SPNL 4D 14MM RECT 16X6MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323068 SUP Custom 27803010 48323068 - CAGE SPNL 8D 14MM RECT 16X6MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323070 SUP Custom 27803010 48323070 - CAGE SPNL 0D 14MM RECT 16X7MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323074 SUP Custom 27803010 48323074 - CAGE SPNL 4D 14MM RECT 16X7MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323078 SUP Custom 27803010 48323078 - CAGE SPNL 8D 14MM RECT 16X7MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323080 SUP Custom 27803010 48323080 - CAGE SPNL 0D 14MM RECT 16X8MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323084 SUP Custom 27803010 48323084 - CAGE SPNL 4D 14MM RECT 16X8MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323088 SUP Custom 27803010 48323088 - CAGE SPNL 8D 14MM RECT 16X8MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323090 SUP Custom 27803010 48323090 - CAGE SPNL 0D 14MM RECT 16X9MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323094 SUP Custom 27803010 48323094 - CAGE SPNL 4D 14MM RECT 16X9MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323098 SUP Custom 27803010 48323098 - CAGE SPNL 8D 14MM RECT 16X9MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323100 SUP Custom 27803010 48323100 - CAGE SPNL 0D 14MM RECT 16X10MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323104 SUP Custom 27803010 48323104 - CAGE SPNL 4D 14MM RECT 16X10MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323108 SUP Custom 27803010 48323108 - CAGE SPNL 8D 14MM RECT 16X10MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323110 SUP Custom 27803010 48323110 - CAGE SPNL 0D 14MM RECT 16X11MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323114 SUP Custom 27803010 48323114 - CAGE SPNL 4D 14MM RECT 16X11MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323118 SUP Custom 27803010 48323118 - CAGE SPNL 8D 14MM RECT 16X11MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323120 SUP Custom 27803010 48323120 - CAGE SPNL 0D 14MM RECT 16X12MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323124 SUP Custom 27803010 48323124 - CAGE SPNL 4D 14MM RECT 16X12MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48323128 SUP Custom 27803010 48323128 - CAGE SPNL 8D 14MM RECT 16X12MM NS LF AVS ANCH-C RADOPQ HLW BOTH IP/OP "$3,875.00" "$2,868.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $689.75 "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" $807.59 "$3,875.00" "$1,550.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$3,875.00" "$2,906.25" "$3,875.00" "$3,875.00" "$3,875.00" "$1,937.50" "$1,937.50" "$3,069.00" "$3,875.00" "$3,100.00" "$1,743.75" "$3,875.00" N/A "$2,247.50" "$3,875.00" "$2,325.00" "$3,875.00" "$3,875.00" "$3,875.00" N/A N/A 48324040 SUP Custom 27803010 48324040 - SPACER SPNL 0D 14MM 16X4MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324044 SUP Custom 27803010 48324044 - SPACER SPNL 4D 14MM 16X4MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324050 SUP Custom 27803010 48324050 - SPACER SPNL 0D 14MM 16X5MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324054 SUP Custom 27803010 48324054 - SPACER SPNL 4D 14MM 16X5MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324060 SUP Custom 27803010 48324060 - SPACER SPNL 0D 14MM 16X6MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324064 SUP Custom 27803010 48324064 - SPACER SPNL 4D 14MM 16X6MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324070 SUP Custom 27803010 48324070 - SPACER SPNL 0D 14MM 16X7MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324074 SUP Custom 27803010 48324074 - SPACER SPNL 4D 14MM 16X7MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324080 SUP Custom 27803010 48324080 - SPACER SPNL 0D 14MM 16X8MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324084 SUP Custom 27803010 48324084 - SPACER SPNL 4D 14MM 16X8MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324090 SUP Custom 27803010 48324090 - SPACER SPNL 0D 14MM 16X9MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324094 SUP Custom 27803010 48324094 - SPACER SPNL 4D 14MM 16X9MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324100 SUP Custom 27803010 48324100 - SPACER SPNL 0D 14MM 16X10MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324104 SUP Custom 27803010 48324104 - SPACER SPNL 4D 14MM 16X10MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324110 SUP Custom 27803010 48324110 - SPACER SPNL 0D 14MM 16X11MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324114 SUP Custom 27803010 48324114 - SPACER SPNL 4D 14MM 16X11MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324120 SUP Custom 27803010 48324120 - SPACER SPNL 0D 14MM 16X12MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48324124 SUP Custom 27803010 48324124 - SPACER SPNL 4D 14MM 16X12MM AVS AS PEEK CRV INTRBD FS BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 48325308 SUP HCPCS C1713 48325308 - SCREW BONE 3.5MM 8MM SPNL SLFTAP BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48325310 SUP HCPCS C1713 48325310 - SCREW BONE 3.5MM 10MM SELF TAP AVS ANCHOR-C TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48325312 SUP HCPCS C1713 48325312 - SCREW BONE 3.5MM 12MM SELF TAP AVS ANCHOR-C TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48325314 SUP HCPCS C1713 48325314 - SCREW BONE 3.5MM 14MM SPNL SLFTAP BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48325408 SUP HCPCS C1713 48325408 - SCREW BONE 4MM 8MM SPNL SLFTAP BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48325410 SUP HCPCS C1713 48325410 - SCREW BONE 4MM 10MM SELF TAP AVS ANCHOR-C TITANIUM SPN CERV BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48325412 SUP HCPCS C1713 48325412 - SCREW BONE 4MM 12MM SELF TAP AVS ANCHOR-C TITANIUM SPN CERV BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48325414 SUP HCPCS C1713 48325414 - ANCHOR-C 4.0 X 14MM SELF TAPPING SCREW BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48326084 SUP Custom 27803010 48326084 - SPACER SPNL 4D 28X22X8MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326088 SUP Custom 27803010 48326088 - SPACER SPNL 8D 28X22X8MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326104 SUP Custom 27803010 48326104 - SPACER SPNL 4D 28X22X10MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326108 SUP Custom 27803010 48326108 - SPACER SPNL 8D 28X22X10MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326122 SUP Custom 27803010 48326122 - SPACER SPNL 12D 28X22X12MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326124 SUP Custom 27803010 48326124 - SPACER SPNL 4D 28X22X12MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326126 SUP Custom 27803010 48326126 - SPACER SPNL 16D 28X22X12MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326128 SUP Custom 27803010 48326128 - SPACER SPNL 8D 28X22X12MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326142 SUP Custom 27803010 48326142 - SPACER SPNL 12D 28X22X14MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326144 SUP Custom 27803010 48326144 - SPACER SPNL 4D 28X22X14MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326146 SUP Custom 27803010 48326146 - SPACER SPNL 16D 28X22X14MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326148 SUP Custom 27803010 48326148 - SPACER SPNL 8D 28X22X14MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326162 SUP Custom 27803010 48326162 - SPACER SPNL 12D 28X22X16MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326164 SUP Custom 27803010 48326164 - SPACER SPNL 4D 28X22X16MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326166 SUP Custom 27803010 48326166 - SPACER SPNL 16D 28X22X16MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326168 SUP Custom 27803010 48326168 - SPACER SPNL 8D 28X22X16MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326182 SUP Custom 27803010 48326182 - SPACER SPNL 12D 28X22X18MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326184 SUP Custom 27803010 48326184 - SPACER SPNL 4D 28X22X18MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326186 SUP Custom 27803010 48326186 - SPACER SPNL 16D 28X22X18MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326188 SUP Custom 27803010 48326188 - SPACER SPNL 8D 28X22X18MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326202 SUP Custom 27803010 48326202 - SPACER SPNL 12D 28X22X20MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326204 SUP Custom 27803010 48326204 - SPACER SPNL 4D 28X22X20MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326206 SUP Custom 27803010 48326206 - SPACER SPNL 16D 22X28X20MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48326208 SUP Custom 27803010 48326208 - SPACER SPNL 8D 28X22X20MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328084 SUP Custom 27803010 48328084 - SPACER SPNL 4D 28X33X8MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328088 SUP Custom 27803010 48328088 - SPACER SPNL 8D 28X33X8MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328104 SUP Custom 27803010 48328104 - SPACER SPNL 4D 28X33X10MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328108 SUP Custom 27803010 48328108 - SPACER SPNL 8D 28X33X10MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328122 SUP Custom 27803010 48328122 - SPACER SPNL 12D 28X33X12MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328124 SUP Custom 27803010 48328124 - SPACER SPNL 4D 28X33X12MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328126 SUP Custom 27803010 48328126 - SPACER SPNL 16D 28X33X12MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328128 SUP Custom 27803010 48328128 - SPACER SPNL 8D 28X33X12MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328142 SUP Custom 27803010 48328142 - SPACER SPNL 12D 28X33X14MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328144 SUP Custom 27803010 48328144 - SPACER SPNL 4D 28X33X14MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328146 SUP Custom 27803010 48328146 - SPACER SPNL 16D 28X33X14MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328148 SUP Custom 27803010 48328148 - SPACER SPNL 8D 28X33X14MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328162 SUP Custom 27803010 48328162 - SPACER SPNL 12D 28X33X16MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328164 SUP Custom 27803010 48328164 - SPACER SPNL 4D 28X33X16MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328166 SUP Custom 27803010 48328166 - SPACER SPNL 16D 28X33X16MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328168 SUP Custom 27803010 48328168 - SPACER SPNL 8D 28X33X16MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328182 SUP Custom 27803010 48328182 - SPACER SPNL 12D 28X33X18MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328184 SUP Custom 27803010 48328184 - SPACER SPNL 4D 28X33X18MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328186 SUP Custom 27803010 48328186 - SPACER SPNL 16D 28X33X18MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328188 SUP Custom 27803010 48328188 - SPACER SPNL 8D 28X33X18MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328202 SUP Custom 27803010 48328202 - SPACER SPNL 12D 28X33X20MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328204 SUP Custom 27803010 48328204 - SPACER SPNL 4D 28X33X20MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328206 SUP Custom 27803010 48328206 - SPACER SPNL 16D 33X28X20MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328208 SUP Custom 27803010 48328208 - SPACER SPNL 8D 28X33X20MM AVS AL PEEK ALIF BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 48328908 SUP Custom 27203010 48328908 - BIT DRILL 2.3MM 8MM AVS ANCHOR-C BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48328910 SUP Custom 27203010 48328910 - BIT DRILL 2.3MM 10MM AVS ANCHOR-C BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48328912 SUP Custom 27203010 48328912 - BIT DRILL 2.3MM 12MM AVS ANCHOR-C BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48335308 SUP HCPCS C1713 48335308 - ANCHOR-C 3.5 X 8MM SELF DRILLING SCREW BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48335310 SUP HCPCS C1713 48335310 - ANCHOR-C 3.5 X 10MM SELF DRILLING SCREW BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48335312 SUP HCPCS C1713 48335312 - SCREW BONE 3.5MM 12MM SPNL SLFDRILL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48335314 SUP HCPCS C1713 48335314 - SCREW BONE 3.5MM 14MM SPNL SLFDRILL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48335408 SUP HCPCS C1713 48335408 - SCREW BONE 4MM 8MM BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48335410 SUP HCPCS C1713 48335410 - ANCHOR-C 4.0 X 10MM SELF DRILLING SCREW BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48335412 SUP HCPCS C1713 48335412 - SCREW BONE 4MM 12MM SPNL SLFDRILL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48335414 SUP HCPCS C1713 48335414 - SCREW BONE 4MM 14MM SPNL SLFDRILL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48340074 SUP Custom 27803010 48340074 - SPACER SPNL 4D WDG 20X9X7MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340084 SUP Custom 27803010 48340084 - SPACER SPNL 4D WDG 20X9X8MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340090 SUP Custom 27803010 48340090 - SPACER SPNL 0D RECT 20X9X9MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340094 SUP Custom 27803010 48340094 - SPACER SPNL 4D WDG 20X9X9MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340098 SUP Custom 27803010 48340098 - SPACER SPNL 8D WDG 20X9X9MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340100 SUP Custom 27803010 48340100 - SPACER SPNL 0D RECT 20X9X10MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340104 SUP Custom 27803010 48340104 - SPACER SPNL 4D WDG 20X9X10MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340108 SUP Custom 27803010 48340108 - SPACER SPNL 8D WDG 20X9X10MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340110 SUP Custom 27803010 48340110 - SPACER SPNL 0D RECT 20X9X11MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340114 SUP Custom 27803010 48340114 - SPACER SPNL 4D WDG 20X9X11MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340118 SUP Custom 27803010 48340118 - SPACER SPNL 8D WDG 20X9X11MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340120 SUP Custom 27803010 48340120 - SPACER SPNL 0D RECT 20X9X12MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340124 SUP Custom 27803010 48340124 - SPACER SPNL 4D WDG 20X9X12MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340128 SUP Custom 27803010 48340128 - SPACER SPNL 8D WDG 20X9X12MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340130 SUP Custom 27803010 48340130 - SPACER SPNL 0D RECT 20X9X13MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340134 SUP Custom 27803010 48340134 - SPACER SPNL 4D WDG 20X9X13MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340138 SUP Custom 27803010 48340138 - SPACER SPNL 8D WDG 20X9X13MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340140 SUP Custom 27803010 48340140 - SPACER SPNL 0D RECT 20X9X14MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340144 SUP Custom 27803010 48340144 - SPACER SPNL 4D WDG 20X9X14MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340148 SUP Custom 27803010 48340148 - SPACER SPNL 8D WDG 20X9X14MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340150 SUP Custom 27803010 48340150 - SPACER SPNL 0D RECT 20X9X15MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340154 SUP Custom 27803010 48340154 - SPACER SPNL 4D WDG 20X9X15MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340158 SUP Custom 27803010 48340158 - SPACER SPNL 8D WDG 20X9X15MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340160 SUP Custom 27803010 48340160 - SPACER SPNL 0D RECT 20X9X16MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340164 SUP Custom 27803010 48340164 - SPACER SPNL 4D WDG 20X9X16MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48340168 SUP Custom 27803010 48340168 - SPACER SPNL 8D WDG 20X9X16MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345074 SUP Custom 27803010 48345074 - SPACER SPNL 4D WDG 25X8X7MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345084 SUP Custom 27803010 48345084 - SPACER SPNL 4D WDG 25X8X8MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345090 SUP Custom 27803010 48345090 - SPACER SPNL 0D RECT 25X8X9MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345094 SUP Custom 27803010 48345094 - SPACER SPNL 4D WDG 25X8X9MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345098 SUP Custom 27803010 48345098 - SPACER SPNL 8D WDG 25X8X9MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345100 SUP Custom 27803010 48345100 - SPACER SPNL 0D RECT 25X8X10MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345104 SUP Custom 27803010 48345104 - SPACER SPNL 4D WDG 25X8X10MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345108 SUP Custom 27803010 48345108 - SPACER SPNL 8D WDG 25X8X10MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345110 SUP Custom 27803010 48345110 - SPACER SPNL 0D RECT 25X8X11MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345114 SUP Custom 27803010 48345114 - SPACER SPNL 4D WDG 25X8X11MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345118 SUP Custom 27803010 48345118 - SPACER SPNL 8D WDG 25X8X11MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345120 SUP Custom 27803010 48345120 - SPACER SPNL 0D RECT 25X8X12MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345124 SUP Custom 27803010 48345124 - SPACER SPNL 4D WDG 25X8X12MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345128 SUP Custom 27803010 48345128 - SPACER SPNL 8D WDG 25X8X12MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345130 SUP Custom 27803010 48345130 - SPACER SPNL 0D RECT 25X8X13MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345134 SUP Custom 27803010 48345134 - SPACER SPNL 4D WDG 25X8X13MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345138 SUP Custom 27803010 48345138 - SPACER SPNL 8D WDG 25X8X13MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345140 SUP Custom 27803010 48345140 - SPACER SPNL 0D RECT 25X8X14MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345144 SUP Custom 27803010 48345144 - SPACER SPNL 4D WDG 25X8X14MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345148 SUP Custom 27803010 48345148 - SPACER SPNL 8D WDG 25X8X14MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345150 SUP Custom 27803010 48345150 - SPACER SPNL 0D RECT 25X8X15MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345154 SUP Custom 27803010 48345154 - SPACER SPNL 4D WDG 25X8X15MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345158 SUP Custom 27803010 48345158 - SPACER SPNL 8D WDG 25X8X15MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345160 SUP Custom 27803010 48345160 - SPACER SPNL 0D RECT 25X8X16MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345164 SUP Custom 27803010 48345164 - SPACER SPNL 4D WDG 25X8X16MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48345168 SUP Custom 27803010 48345168 - SPACER SPNL 8D WDG 25X8X16MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48350060 SUP Custom 27803010 48350060 - SPACER SPNL 0D WDG NOSE 20X11X6MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48350064 SUP Custom 27803010 48350064 - SPACER SPNL 4D LRDTC WDG NOSE 20X11X6MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48350070 SUP Custom 27803010 48350070 - SPACER SPNL 0D WDG NOSE 20X11X7MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48350074 SUP Custom 27803010 48350074 - SPACER SPNL 4D LRDTC WDG NOSE 20X11X7MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48350080 SUP Custom 27803010 48350080 - SPACER SPNL 0D WDG NOSE 20X11X8MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48350084 SUP Custom 27803010 48350084 - SPACER SPNL 4D LRDTC WDG NOSE 20X11X8MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48350090 SUP Custom 27803010 48350090 - SPACER SPNL 0D RECT 20X11X9MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48350094 SUP Custom 27803010 48350094 - SPACER SPNL 4D WDG 20X11X9MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48350100 SUP Custom 27803010 48350100 - SPACER SPNL 0D RECT 20X11X10MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48350104 SUP Custom 27803010 48350104 - SPACER SPNL 4D WDG 20X11X10MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48350110 SUP Custom 27803010 48350110 - SPACER SPNL 0D RECT 20X11X11MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48350114 SUP Custom 27803010 48350114 - SPACER SPNL 4D WDG 20X11X11MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48350120 SUP Custom 27803010 48350120 - SPACER SPNL 0D RECT 20X11X12MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48350124 SUP Custom 27803010 48350124 - SPACER SPNL 4D WDG 20X11X12MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48350130 SUP Custom 27803010 48350130 - SPACER SPNL 0D RECT 20X11X13MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48350134 SUP Custom 27803010 48350134 - SPACER SPNL 4D WDG 20X11X13MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48350160 SUP Custom 27803010 48350160 - SPACER SPNL 0D RECT 20X11X16MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48350164 SUP Custom 27803010 48350164 - SPACER SPNL 4D WDG 20X11X16MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48350180 SUP Custom 27803010 48350180 - SPACER SPNL 0D RECT 20X11X18MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48350184 SUP Custom 27803010 48350184 - SPACER SPNL 4D WDG 20X11X18MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48351060 SUP Custom 27803010 48351060 - SPACER SPNL 0D WDG NOSE 30X11X6MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351064 SUP Custom 27803010 48351064 - SPACER SPNL 4D LRDTC WDG NOSE 30X11X6MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351070 SUP Custom 27803010 48351070 - SPACER SPNL 0D WDG NOSE 30X11X7MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351074 SUP Custom 27803010 48351074 - SPACER SPNL 4D LRDTC WDG NOSE 30X11X7MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351080 SUP Custom 27803010 48351080 - SPACER SPNL 0D WDG NOSE 30X11X8MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351084 SUP Custom 27803010 48351084 - SPACER SPNL 4D LRDTC WDG NOSE 30X11X8MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351090 SUP Custom 27803010 48351090 - SPACER SPNL 0D WDG NOSE 30X11X9MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351094 SUP Custom 27803010 48351094 - SPACER SPNL 4D LRDTC WDG NOSE 30X11X9MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351100 SUP Custom 27803010 48351100 - SPACER SPNL 0D WDG NOSE 30X11X10MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351104 SUP Custom 27803010 48351104 - SPACER SPNL 4D LRDTC WDG NOSE 30X11X10MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351110 SUP Custom 27803010 48351110 - SPACER SPNL 0D WDG NOSE 30X11X11MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351114 SUP Custom 27803010 48351114 - SPACER SPNL 4D LRDTC WDG NOSE 30X11X11MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351120 SUP Custom 27803010 48351120 - SPACER SPNL 0D WDG NOSE 30X11X12MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351124 SUP Custom 27803010 48351124 - SPACER SPNL 4D LRDTC WDG NOSE 30X11X12MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351130 SUP Custom 27803010 48351130 - SPACER SPNL 0D WDG NOSE 30X11X13MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351134 SUP Custom 27803010 48351134 - SPACER SPNL 4D LRDTC WDG NOSE 30X11X13MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351140 SUP Custom 27803010 48351140 - SPACER SPNL 0D WDG NOSE 30X11X14MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48351144 SUP Custom 27803010 48351144 - SPACER SPNL 4D LRDTC WDG NOSE 30X11X14MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353060 SUP HCPCS C1713 48353060 - SPACER SPNL 0D WDG NOSE 33X11X6MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" "$1,091.61" "$5,500.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.34" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$2,711.50" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$1,091.61" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$1,146.20" "$5,500.00" N/A N/A 48353064 SUP Custom 27803010 48353064 - SPACER SPNL 4D LRDTC WDG NOSE 33X11X6MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353070 SUP Custom 27803010 48353070 - SPACER SPNL 0D WDG NOSE 33X11X7MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353074 SUP Custom 27803010 48353074 - SPACER SPNL 4D LRDTC WDG NOSE 33X11X7MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353080 SUP Custom 27803010 48353080 - SPACER SPNL 0D WDG NOSE 33X11X8MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353084 SUP Custom 27803010 48353084 - SPACER SPNL 4D LRDTC WDG NOSE 33X11X8MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353090 SUP Custom 27803010 48353090 - SPACER SPNL 0D WDG NOSE 33X11X9MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353094 SUP Custom 27803010 48353094 - SPACER SPNL 4D LRDTC WDG NOSE 33X11X9MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353100 SUP Custom 27803010 48353100 - SPACER SPNL 0D WDG NOSE 33X11X10MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353104 SUP Custom 27803010 48353104 - SPACER SPNL 4D LRDTC WDG NOSE 33X11X10MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353110 SUP Custom 27803010 48353110 - SPACER SPNL 0D WDG NOSE 33X11X11MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353114 SUP Custom 27803010 48353114 - SPACER SPNL 4D LRDTC WDG NOSE 33X11X11MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353120 SUP Custom 27803010 48353120 - SPACER SPNL 0D WDG NOSE 33X11X12MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353124 SUP Custom 27803010 48353124 - SPACER SPNL 4D LRDTC WDG NOSE 33X11X12MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353130 SUP Custom 27803010 48353130 - SPACER SPNL 0D WDG NOSE 33X11X13MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353134 SUP Custom 27803010 48353134 - SPACER SPNL 4D LRDTC WDG NOSE 33X11X13MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353140 SUP Custom 27803010 48353140 - SPACER SPNL 0D WDG NOSE 33X11X14MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48353144 SUP Custom 27803010 48353144 - SPACER SPNL 4D LRDTC WDG NOSE 33X11X14MM AVS UNILIF HLW BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48355060 SUP Custom 27803010 48355060 - SPACER SPNL 0D WDG NOSE 25X11X6MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48355064 SUP Custom 27803010 48355064 - SPACER SPNL 4D LRDTC WDG NOSE 25X11X6MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48355070 SUP Custom 27803010 48355070 - SPACER SPNL 0D WDG NOSE 25X11X7MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48355074 SUP Custom 27803010 48355074 - SPACER SPNL 4D LRDTC WDG NOSE 25X11X7MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48355080 SUP Custom 27803010 48355080 - SPACER SPNL 0D WDG NOSE 25X11X8MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48355084 SUP Custom 27803010 48355084 - SPACER SPNL 4D LRDTC WDG NOSE 25X11X8MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48355090 SUP Custom 27803010 48355090 - SPACER SPNL 0D RECT 25X11X9MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48355094 SUP Custom 27803010 48355094 - SPACER SPNL 4D WDG 25X11X9MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48355100 SUP Custom 27803010 48355100 - SPACER SPNL 0D RECT 25X11X10MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48355104 SUP Custom 27803010 48355104 - SPACER SPNL 4D WDG 25X11X10MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48355110 SUP Custom 27803010 48355110 - SPACER SPNL 0D RECT 25X11X11MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48355114 SUP Custom 27803010 48355114 - SPACER SPNL 4D WDG 25X11X11MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48355120 SUP Custom 27803010 48355120 - SPACER SPNL 0D RECT 25X11X12MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48355124 SUP Custom 27803010 48355124 - SPACER SPNL 4D WDG 25X11X12MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48355130 SUP Custom 27803010 48355130 - SPACER SPNL 0D RECT 25X11X13MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48355134 SUP Custom 27803010 48355134 - SPACER SPNL 4D WDG 25X11X13MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48355164 SUP Custom 27803010 48355164 - SPACER SPNL 4D WDG 25X11X16MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48355180 SUP Custom 27803010 48355180 - SPACER SPNL 0D RECT 25X11X18MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48355184 SUP Custom 27803010 48355184 - SPACER SPNL 4D WDG 25X11X18MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 48370090 SUP Custom 27803010 48370090 - SPACER SPNL 0D PRLL 30X9MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370094 SUP Custom 27803010 48370094 - SPACER SPNL 4D WDG 30X9MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370100 SUP Custom 27803010 48370100 - SPACER SPNL 0D PRLL 30X10MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370104 SUP Custom 27803010 48370104 - SPACER SPNL 4D WDG 30X10MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370110 SUP Custom 27803010 48370110 - SPACER SPNL 0D PRLL 30X11MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370114 SUP Custom 27803010 48370114 - SPACER SPNL 4D WDG 30X11MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370120 SUP Custom 27803010 48370120 - SPACER SPNL 0D PRLL 30X12MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370124 SUP Custom 27803010 48370124 - SPACER SPNL 4D WDG 30X12MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370130 SUP Custom 27803010 48370130 - SPACER SPNL 0D PRLL 30X13MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370134 SUP Custom 27803010 48370134 - SPACER SPNL 4D WDG 30X13MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370140 SUP Custom 27803010 48370140 - SPACER SPNL 0D PRLL 30X14MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370144 SUP Custom 27803010 48370144 - SPACER SPNL 4D WDG 30X14MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370150 SUP Custom 27803010 48370150 - SPACER SPNL 0D PRLL 30X15MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370154 SUP Custom 27803010 48370154 - SPACER SPNL 4D WDG 30X15MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370160 SUP Custom 27803010 48370160 - SPACER SPNL 0D PRLL 30X16MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370164 SUP Custom 27803010 48370164 - SPACER SPNL 4D WDG 30X16MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370170 SUP Custom 27803010 48370170 - SPACER SPNL 0D PRLL 30X17MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370174 SUP Custom 27803010 48370174 - SPACER SPNL 4D WDG 30X17MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370180 SUP Custom 27803010 48370180 - SPACER SPNL 0D PRLL 30X18MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48370184 SUP Custom 27803010 48370184 - SPACER SPNL 4D WDG 30X18MM AVS TL HLW PEEK TLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48375070 SUP Custom 27803010 48375070 - SPACER SPNL 0D PRLL 25X7MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375074 SUP Custom 27803010 48375074 - SPACER SPNL 4D WDG 25X7MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375080 SUP Custom 27803010 48375080 - SPACER SPNL 0D PRLL 25X8MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375084 SUP Custom 27803010 48375084 - SPACER SPNL 4D WDG 25X8MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375090 SUP Custom 27803010 48375090 - SPACER SPNL 0D PRLL 25X9MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375094 SUP Custom 27803010 48375094 - SPACER SPNL 4D WDG 25X9MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375100 SUP Custom 27803010 48375100 - SPACER SPNL 0D PRLL 25X10MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375104 SUP Custom 27803010 48375104 - SPACER SPNL 4D WDG 25X10MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375110 SUP Custom 27803010 48375110 - SPACER SPNL 0D PRLL 25X11MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375114 SUP Custom 27803010 48375114 - SPACER SPNL 4D WDG 25X11MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375120 SUP Custom 27803010 48375120 - SPACER SPNL 0D PRLL 25X12MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375124 SUP Custom 27803010 48375124 - SPACER SPNL 4D WDG 25X12MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375130 SUP Custom 27803010 48375130 - SPACER SPNL 0D PRLL 25X13MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375134 SUP Custom 27803010 48375134 - SPACER SPNL 4D WDG 25X13MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375140 SUP Custom 27803010 48375140 - SPACER SPNL 0D PRLL 25X14MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48375144 SUP Custom 27803010 48375144 - SPACER SPNL 4D WDG 25X14MM AVS TL HLW PEEK TLIF BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390090 SUP Custom 27803010 48390090 - SPACER SPNL 0D WDG NOSE 20X11X9MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390094 SUP Custom 27803010 48390094 - SPACER SPNL 4D LRDTC WDG NOSE 20X11X9MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390101 SUP Custom 27803010 48390101 - SPACER SPNL 0D WDG NOSE 20X11X10MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390104 SUP Custom 27803010 48390104 - SPACER SPNL 4D LRDTC WDG NOSE 20X11X10MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390111 SUP Custom 27803010 48390111 - SPACER SPNL 0D WDG NOSE 20X11X11MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390114 SUP Custom 27803010 48390114 - SPACER SPNL 4D LRDTC WDG NOSE 20X11X11MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390120 SUP Custom 27803010 48390120 - SPACER SPNL 0D WDG NOSE 20X11X12MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390124 SUP Custom 27803010 48390124 - SPACER SPNL 4D LRDTC WDG NOSE 20X11X12MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390130 SUP Custom 27803010 48390130 - SPACER SPNL 0D WDG NOSE 20X11X13MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390134 SUP Custom 27803010 48390134 - SPACER SPNL 4D LRDTC WDG NOSE 20X11X13MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390140 SUP Custom 27803010 48390140 - SPACER SPNL 0D WDG NOSE 20X11X14MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390144 SUP Custom 27803010 48390144 - SPACER SPNL 4D LRDTC WDG NOSE 20X11X14MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390150 SUP Custom 27803010 48390150 - SPACER SPNL 0D WDG NOSE 20X11X15MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390154 SUP Custom 27803010 48390154 - SPACER SPNL 4D LRDTC WDG NOSE 20X11X15MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390160 SUP Custom 27803010 48390160 - SPACER SPNL 0D WDG NOSE 20X11X16MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390164 SUP Custom 27803010 48390164 - SPACER SPNL 4D LRDTC WDG NOSE 20X11X16MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48390180 SUP Custom 27803010 48390180 - SPACER SPNL 0D WDG NOSE 20X11X18MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395090 SUP Custom 27803010 48395090 - SPACER SPNL 0D WDG NOSE 25X11X9MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395094 SUP Custom 27803010 48395094 - SPACER SPNL 4D LRDTC WDG NOSE 25X11X9MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395100 SUP Custom 27803010 48395100 - SPACER SPNL 0D WDG NOSE 25X11X10MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395104 SUP Custom 27803010 48395104 - SPACER SPNL 4D LRDTC WDG NOSE 25X11X10MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395110 SUP Custom 27803010 48395110 - SPACER SPNL 0D WDG NOSE 25X11X11MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395114 SUP Custom 27803010 48395114 - SPACER SPNL 4D LRDTC WDG NOSE 25X11X11MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395120 SUP Custom 27803010 48395120 - SPACER SPNL 0D WDG NOSE 25X11X12MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395124 SUP Custom 27803010 48395124 - SPACER SPNL 4D LRDTC WDG NOSE 25X11X12MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395130 SUP Custom 27803010 48395130 - SPACER SPNL 0D WDG NOSE 25X11X13MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395134 SUP Custom 27803010 48395134 - SPACER SPNL 4D LRDTC WDG NOSE 25X11X13MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395140 SUP Custom 27803010 48395140 - SPACER SPNL 0D WDG NOSE 25X11X14MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395144 SUP Custom 27803010 48395144 - SPACER SPNL 4D LRDTC WDG NOSE 25X11X14MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395150 SUP Custom 27803010 48395150 - SPACER SPNL 0D WDG NOSE 25X11X15MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395154 SUP Custom 27803010 48395154 - SPACER SPNL 4D LRDTC WDG NOSE 25X11X15MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395160 SUP Custom 27803010 48395160 - SPACER SPNL 0D WDG NOSE 25X11X16MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395164 SUP Custom 27803010 48395164 - SPACER SPNL 4D LRDTC WDG NOSE 25X11X16MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395180 SUP Custom 27803010 48395180 - SPACER SPNL 0D WDG NOSE 25X11X18MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48395184 SUP Custom 27803010 48395184 - SPACER SPNL 4D LRDTC WDG NOSE 25X11X18MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480074 SUP Custom 27803010 48480074 - SPACER SPNL 4D LRDTC WDG NOSE 20X9X7MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480084 SUP Custom 27803010 48480084 - SPACER SPNL 4D LRDTC WDG NOSE 20X9X8MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480090 SUP Custom 27803010 48480090 - SPACER SPNL 0D WDG NOSE 20X9X9MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480094 SUP Custom 27803010 48480094 - SPACER SPNL 4D LRDTC WDG NOSE 20X9X9MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480100 SUP Custom 27803010 48480100 - SPACER SPNL 0D WDG NOSE 20X9X10MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480104 SUP Custom 27803010 48480104 - SPACER SPNL 4D LRDTC WDG NOSE 20X9X10MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480110 SUP Custom 27803010 48480110 - SPACER SPNL 0D WDG NOSE 20X9X11MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480114 SUP Custom 27803010 48480114 - SPACER SPNL 4D LRDTC WDG NOSE 20X9X11MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480120 SUP Custom 27803010 48480120 - SPACER SPNL 0D WDG NOSE 20X9X12MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480124 SUP Custom 27803010 48480124 - SPACER SPNL 4D LRDTC WDG NOSE 20X9X12MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480130 SUP Custom 27803010 48480130 - SPACER SPNL 0D WDG NOSE 20X9X13MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480134 SUP Custom 27803010 48480134 - SPACER SPNL 4D LRDTC WDG NOSE 20X9X13MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480140 SUP Custom 27803010 48480140 - SPACER SPNL 0D WDG NOSE 20X9X14MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 48480144 SUP Custom 27803010 48480144 - SPACER SPNL 4D LRDTC WDG NOSE 20X9X14MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480150 SUP Custom 27803010 48480150 - SPACER SPNL 0D WDG NOSE 20X9X15MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480154 SUP Custom 27803010 48480154 - SPACER SPNL 4D LRDTC WDG NOSE 20X9X15MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480160 SUP Custom 27803010 48480160 - SPACER SPNL 0D WDG NOSE 20X9X16MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48480164 SUP Custom 27803010 48480164 - SPACER SPNL 4D LRDTC WDG NOSE 20X9X16MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48482001 SUP HCPCS C1713 48482001 - SCREW BONE COMBO DIAPASON OSS LUMBAR SPN BOTH IP/OP $272.00 $201.00 $53.95 $271.83 $122.32 $122.32 $122.32 $122.32 $271.83 $271.83 $271.83 $56.66 $271.83 $271.83 $271.83 $271.83 $271.83 $56.65 $271.83 $108.73 $160.79 $271.83 $271.83 $271.83 $271.83 $204.00 $271.83 $271.83 $271.83 $135.92 $135.92 $215.29 $271.83 $217.46 $122.32 $53.95 N/A $157.76 $271.83 $163.10 $271.83 $56.65 $271.83 N/A N/A 48482010 SUP HCPCS C1713 48482010 - CAP IMPL DIAPASON OSS BLOCKER SPNE BOTH IP/OP $272.00 $201.00 $53.95 $271.83 $122.32 $122.32 $122.32 $122.32 $271.83 $271.83 $271.83 $56.66 $271.83 $271.83 $271.83 $271.83 $271.83 $56.65 $271.83 $108.73 $160.79 $271.83 $271.83 $271.83 $271.83 $204.00 $271.83 $271.83 $271.83 $135.92 $135.92 $215.29 $271.83 $217.46 $122.32 $53.95 N/A $157.76 $271.83 $163.10 $271.83 $56.65 $271.83 N/A N/A 48482020 SUP HCPCS C1713 48482020 - RING IMPL DIAPASON OSS BLOCKER SPNE BOTH IP/OP $272.00 $201.00 $53.95 $271.83 $122.32 $122.32 $122.32 $122.32 $271.83 $271.83 $271.83 $56.66 $271.83 $271.83 $271.83 $271.83 $271.83 $56.65 $271.83 $108.73 $160.79 $271.83 $271.83 $271.83 $271.83 $204.00 $271.83 $271.83 $271.83 $135.92 $135.92 $215.29 $271.83 $217.46 $122.32 $53.95 N/A $157.76 $271.83 $271.83 $271.83 $56.65 $271.83 N/A N/A 48485074 SUP Custom 27803010 48485074 - SPACER SPNL 4D LRDTC WDG NOSE 25X8X7MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485084 SUP Custom 27803010 48485084 - SPACER SPNL 4D LRDTC WDG NOSE 25X8X8MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485090 SUP Custom 27803010 48485090 - SPACER SPNL 0D WDG NOSE 25X8X9MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485094 SUP Custom 27803010 48485094 - SPACER SPNL 4D LRDTC WDG NOSE 25X8X9MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485100 SUP Custom 27803010 48485100 - SPACER SPNL 0D WDG NOSE 25X8X10MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485104 SUP Custom 27803010 48485104 - SPACER SPNL 4D LRDTC WDG NOSE 25X8X10MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485110 SUP Custom 27803010 48485110 - SPACER SPNL 0D WDG NOSE 25X8X11MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485114 SUP Custom 27803010 48485114 - SPACER SPNL 4D LRDTC WDG NOSE 25X8X11MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485120 SUP Custom 27803010 48485120 - SPACER SPNL 0D WDG NOSE 25X8X12MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485124 SUP Custom 27803010 48485124 - SPACER SPNL 4D LRDTC WDG NOSE 25X8X12MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485130 SUP Custom 27803010 48485130 - SPACER SPNL 0D WDG NOSE 25X8X13MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485134 SUP Custom 27803010 48485134 - SPACER SPNL 4D LRDTC WDG NOSE 25X8X13MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485140 SUP Custom 27803010 48485140 - SPACER SPNL 0D WDG NOSE 25X8X14MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485144 SUP Custom 27803010 48485144 - SPACER SPNL 4D LRDTC WDG NOSE 25X8X14MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485150 SUP Custom 27803010 48485150 - SPACER SPNL 0D WDG NOSE 25X8X15MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485154 SUP Custom 27803010 48485154 - SPACER SPNL 4D LRDTC WDG NOSE 25X8X15MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485160 SUP Custom 27803010 48485160 - SPACER SPNL 0D WDG NOSE 25X8X16MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485164 SUP Custom 27803010 48485164 - SPACER SPNL 4D LRDTC WDG NOSE 25X8X16MM AVS UNILIF HLW BOTH IP/OP "$2,750.00" "$2,035.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $489.50 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 48485530 SUP HCPCS C1713 48485530 - SCREW BONE 5.5MM 30MM DIAPASON OSS TITANIUM SPN THORACIC BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48485535 SUP HCPCS C1713 48485535 - SCREW BONE 5.5MM 35MM DIAPASON OSS TITANIUM SPN THORACIC BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48485540 SUP HCPCS C1713 48485540 - SCREW BONE 5.5MM 40MM DIAPASON OSS TITANIUM SPN THORACIC BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48485545 SUP HCPCS C1713 48485545 - SCREW BONE 5.5MM 45MM DIAPASON OSS TITANIUM SPN THORACIC BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48485550 SUP HCPCS C1713 48485550 - SCREW BONE 5.5MM 50MM DIAPASON OSS TITANIUM SPN THORACIC BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48485555 SUP HCPCS C1713 48485555 - SCREW BONE 5.5MM 55MM DIAPASON OSS TITANIUM SPN THORACIC BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48486730 SUP HCPCS C1713 48486730 - SCREW BONE 6.7MM 30MM DIAPASON OSS TITANIUM SPN LUMBAR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48486735 SUP HCPCS C1713 48486735 - SCREW BONE 6.7MM 35MM DIAPASON OSS TITANIUM SPN THORACIC BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48486740 SUP HCPCS C1713 48486740 - SCREW BONE 6.7MM 40MM DIAPASON OSS TITANIUM SPN LUMBAR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48486745 SUP HCPCS C1713 48486745 - SCREW BONE 6.7MM 45MM DIAPASON OSS TITANIUM SPN LUMBAR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48486750 SUP HCPCS C1713 48486750 - SCREW BONE 6.7MM 50MM DIAPASON OSS TITANIUM SPN LUMBAR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48486755 SUP HCPCS C1713 48486755 - SCREW BONE 6.7MM 55MM DIAPASON OSS TITANIUM SPN LUMBAR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48486760 SUP HCPCS C1713 48486760 - SCREW BONE 6.7MM 60MM DIAPASON OSS TITANIUM SPN LUMBAR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48487730 SUP HCPCS C1713 48487730 - SCREW BONE 7.7MM 30MM DIAPASON OSS TITANIUM SPN LUMBAR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48487735 SUP HCPCS C1713 48487735 - SCREW BONE 7.7MM 35MM DIAPASON OSS TITANIUM SPN LUMBAR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48487740 SUP HCPCS C1713 48487740 - SCREW BONE 7.7MM 40MM DIAPASON OSS TITANIUM SPN LUMBAR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48487745 SUP HCPCS C1713 48487745 - SCREW BONE 7.7MM 45MM DIAPASON OSS TITANIUM SPN LUMBAR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48487750 SUP HCPCS C1713 48487750 - SCREW BONE 7.7MM 50MM DIAPASON OSS TITANIUM SPN LUMBAR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48487755 SUP HCPCS C1713 48487755 - SCREW BONE 7.7MM 55MM DIAPASON OSS TITANIUM SPN LUMBAR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48487760 SUP HCPCS C1713 48487760 - SCREW BONE 7.7MM 60MM DIAPASON OSS TITANIUM SPN LUMBAR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48488035 SUP HCPCS C1713 48488035 - SCREW BONE 8MM 35MM DIAPASON OSS TITANIUM SPN SACRUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48488040 SUP HCPCS C1713 48488040 - SCREW BONE 8MM 40MM DIAPASON OSS TITANIUM SPN SACRUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48488045 SUP HCPCS C1713 48488045 - SCREW BONE 8MM 45MM DIAPASON OSS TITANIUM SPN SACRUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48488050 SUP HCPCS C1713 48488050 - SCREW BONE 8MM 50MM DIAPASON OSS TITANIUM SPN SACRUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48488055 SUP HCPCS C1713 48488055 - SCREW BONE 8MM 55MM DIAPASON OSS TITANIUM SPN SACRUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48489040 SUP HCPCS C1713 48489040 - SCREW BONE 9MM 40MM DIAPASON OSS TITANIUM SPN SACRUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48489045 SUP HCPCS C1713 48489045 - SCREW BONE 9MM 45MM DIAPASON OSS TITANIUM SPN SACRUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48489050 SUP HCPCS C1713 48489050 - SCREW BONE 9MM 50MM DIAPASON OSS TITANIUM SPN SACRUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48489055 SUP HCPCS C1713 48489055 - SCREW BONE 9MM 55MM DIAPASON OSS TITANIUM SPN SACRUM BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48510410 SUP Custom 27203010 48510410 - PIN FIX STANDARD TEMPORARY NAIL REFLEX SPN BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48510420 SUP Custom 27203010 48510420 - PIN FIX LONG REFLEX HYBRID BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48510610 SUP HCPCS C1729 48510610 - BIT DRILL 10MM REFLEX HYBRID STERILE BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $67.88 $67.88 $67.88 $67.88 $125.00 $125.00 $125.00 $26.05 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 48510612 SUP Custom 27203010 48510612 - BIT DRILL 12MM REFLEX HYBRID SPN CERV ANTERIOR STERILE BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48510614 SUP Custom 27203010 48510614 - BIT DRILL 14MM REFLEX HYBRID SPN CERV ANTERIOR STERILE BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48510616 SUP Custom 27203010 48510616 - BIT DRILL 16MM REFLEX HYBRID SPN CERV ANTERIOR STERILE BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48510618 SUP HCPCS C1729 48510618 - BIT DRILL 18MM REFLEX HYBRID SPN CERV ANTERIOR STERILE BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $67.88 $67.88 $67.88 $67.88 $125.00 $125.00 $125.00 $26.05 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 48510620 SUP HCPCS C1729 48510620 - BIT DRILL 20MM BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $142.54 $142.54 $142.54 $142.54 $262.50 $262.50 $262.50 $54.71 $262.50 $194.83 $194.83 $202.34 $136.76 $54.71 $262.50 $262.50 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $170.63 $52.10 N/A $152.25 $262.50 $262.50 $262.50 $54.71 $262.50 N/A N/A 48550260 SUP HCPCS C1713 48550260 - ROD SPNL 60MM 3.5MM OASYS TI BOTH IP/OP $480.50 $356.00 $95.36 $480.48 $216.22 $216.22 $216.22 $216.22 $480.48 $480.48 $480.48 $100.14 $480.48 $480.48 $480.48 $480.48 $480.48 $100.14 $480.48 $192.19 $284.20 $480.48 $480.48 $480.48 $480.48 $360.38 $480.48 $480.48 $480.48 $240.24 $240.24 $380.54 $480.48 $384.38 $216.22 $95.36 N/A $278.69 $480.48 $288.29 $480.48 $100.13 $480.48 N/A N/A 48551000 SUP Custom 27803010 48551000 - SCREW SET BUTTRESS THREAD BLOCKER OASYS TITANIUM BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48551006 SUP HCPCS C1713 48551006 - SCREW SET OASYS SPN CONCTR BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 48551040 SUP HCPCS C1713 48551040 - PLATE BONE 130D STR OASYS TITANIUM SPN THORACIC BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 48551042 SUP HCPCS C1713 48551042 - PLATE BONE 100D STR OASYS TITANIUM SPN THORACIC BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 48551044 SUP HCPCS C1713 48551044 - PLATE BONE SMALL OASYS TITANIUM SPN THORACIC BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 48551045 SUP HCPCS C1713 48551045 - PLATE BONE MEDIUM OASYS TITANIUM SPN THORACIC BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 48551046 SUP HCPCS C1713 48551046 - PLATE BONE LARGE OASYS TITANIUM SPN THORACIC BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 48551047 SUP HCPCS C1713 48551047 - PLATE BONE LARGE LONG OASYS TITANIUM SPN THORACIC BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 48551048 SUP HCPCS C1713 48551048 - PLATE BONE MINI OASYS TITANIUM SPN THORACIC OCCIPITOCERVICAL BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 48551049 SUP Custom 27803010 48551049 - HOOK SPINAL 3.5MM OASYS TITANIUM BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48551050 SUP Custom 27803010 48551050 - HOOK SPINAL SHORT 5MM OASYS TITANIUM BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48551053 SUP Custom 27803010 48551053 - HOOK SPINAL 6.5MM OASYS TITANIUM BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48551055 SUP Custom 27803010 48551055 - HOOK SPINAL STANDARD 8MM TALL OASYS TITANIUM BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48551060 SUP Custom 27803010 48551060 - HOOK SPINAL RIGHT OFFST OASYS TITANIUM BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48551065 SUP Custom 27803010 48551065 - HOOK SPINAL LEFT OFFST OASYS TITANIUM BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 48551070 SUP Custom 27803010 48551070 - CONNECTOR ROD TRNSVRS POLYAX OASYS CROSSLINK SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48551071 SUP Custom 27803010 48551071 - CONNECTOR ROD 60MM TRNSVRS SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48551072 SUP Custom 27803010 48551072 - CONNECTOR ROD 40MM TRNSVRS SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48551073 SUP HCPCS C1713 48551073 - PLATE BONE SMALL CROSS CONCTR OASYS SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48551074 SUP Custom 27203010 48551074 - CONNECTOR ROD MEDIUM 32MM CROSS PLATE OASYS SPN NONSTRL 91 BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48551075 SUP HCPCS C1713 48551075 - PLATE BONE CROSS CONCTR OASYS TITANIUM SPN THORACIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48551080 SUP Custom 27803010 48551080 - CONNECTOR ROD OFFST OASYS SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48551081 SUP Custom 27803010 48551081 - CONNECTOR ROD 12MM CROSS PLATE OASYS CERV SPN NONSTRL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48551084 SUP Custom 27803010 48551084 - CONNECTOR ROD 3.5-4.5MM AXIAL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48551085 SUP Custom 27803010 48551085 - CONNECTOR ROD 3.5/3.5MM AXIAL OASYS SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48551086 SUP Custom 27803010 48551086 - CONNECTOR ROD 3.5/5.5MM AXIAL OASYS SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48551087 SUP Custom 27803010 48551087 - CONNECTOR ROD 3.5/6MM AXIAL OASYS SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48551088 SUP Custom 27803010 48551088 - CONNECTOR ROD 3.5/3.5MM ROD TO ROD OASYS SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48551089 SUP Custom 27803010 48551089 - CONNECTOR ROD 3.5/5.5MM ROD TO ROD OASYS SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48551090 SUP Custom 27803010 48551090 - CONNECTOR ROD 3.5MM 90MM POLYAX ROD TO ROD OASYS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48551091 SUP Custom 27803010 48551091 - CONNECTOR ROD 3.5/4.5MM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48551094 SUP Custom 27803010 48551094 - CONNECTOR ROD SADDLE SCREW OASYS SPN 3.5 MM ROD BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48551240 SUP Custom 27803010 48551240 - ROD SPINAL 3.5MM 240MM OASYS BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 48551350 SUP Custom 27803010 48551350 - ROD SPINAL 3.5MM 350MM BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 48552025 SUP Custom 27803010 48552025 - ROD SPINAL 3.5MM 25MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48552030 SUP Custom 27803010 48552030 - ROD SPINAL 3.5MM 30MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48552040 SUP Custom 27803010 48552040 - ROD SPINAL 3.5MM 40MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48552050 SUP Custom 27803010 48552050 - ROD SPINAL 3.5MM 50MM OASYS TITANIUM OCCIPITO CERVICO BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48552060 SUP Custom 27803010 48552060 - ROD SPINAL 3.5MM 60MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48552070 SUP Custom 27803010 48552070 - ROD SPINAL 3.5MM 70MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48552080 SUP Custom 27803010 48552080 - ROD SPINAL 3.5MM 80MM OASYS TITANIUM OCCIPITOCERVICOTHORACIC BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48552120 SUP Custom 27803010 48552120 - ROD SPINAL 3.5MM 120MM OASYS TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 48552240 SUP Custom 27803010 48552240 - ROD SPINAL 3.5MM 240MM OASYS TITANIUM BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 48552310 SUP HCPCS C1713 48552310 - SCREW BONE 3.5MM 10MM BIAS ANGLE POLYAX OASYS SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552312 SUP HCPCS C1713 48552312 - SCREW BONE LP 3.5MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552314 SUP HCPCS C1713 48552314 - SCREW BONE LP 3.5MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552316 SUP HCPCS C1713 48552316 - SCREW BONE LP 3.5MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552318 SUP HCPCS C1713 48552318 - SCREW BONE LP 3.5MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552320 SUP HCPCS C1713 48552320 - SCREW BONE LP 3.5MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552322 SUP HCPCS C1713 48552322 - SCREW BONE LP 3.5MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552324 SUP HCPCS C1713 48552324 - SCREW BONE LP 3.5MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552326 SUP HCPCS C1713 48552326 - SCREW BONE LP 3.5MM 26MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552328 SUP HCPCS C1713 48552328 - SCREW BONE LP 3.5MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552330 SUP HCPCS C1713 48552330 - SCREW BONE LP 3.5MM 30MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552332 SUP HCPCS C1713 48552332 - SCREW BONE LP 3.5MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552334 SUP HCPCS C1713 48552334 - SCREW BONE LP 3.5MM 34MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552336 SUP HCPCS C1713 48552336 - SCREW BONE 3.5MM 36MM POLYAX OASYS SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552338 SUP HCPCS C1713 48552338 - SCREW BONE 3.5MM 38MM POLYAX OASYS SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552340 SUP HCPCS C1713 48552340 - SCREW BONE 3.5MM 40MM POLYAX OASYS SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552342 SUP HCPCS C1713 48552342 - SCREW BONE 3.5MM 42MM POLYAX OASYS SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552344 SUP HCPCS C1713 48552344 - SCREW BONE 3.5MM 44MM POLYAX OASYS SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552346 SUP HCPCS C1713 48552346 - SCREW BONE 3.5MM 46MM POLYAX OASYS SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552348 SUP HCPCS C1713 48552348 - SCREW BONE 3.5MM 48MM POLYAX OASYS SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552350 SUP HCPCS C1713 48552350 - SCREW BONE 3.5MM 50MM POLYAX OASYS SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552352 SUP HCPCS C1713 48552352 - SCREW BONE 3.5MM 52MM POLYAX OASYS SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552354 SUP HCPCS C1713 48552354 - SCREW BONE 3.5MM 54MM POLYAX OASYS SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552410 SUP HCPCS C1713 48552410 - SCREW BONE LP 4MM 10MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552412 SUP HCPCS C1713 48552412 - SCREW BONE LP 4MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552414 SUP HCPCS C1713 48552414 - SCREW BONE LP 4MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552416 SUP HCPCS C1713 48552416 - SCREW BONE LP 4MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552418 SUP HCPCS C1713 48552418 - SCREW BONE LP 4MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552420 SUP HCPCS C1713 48552420 - SCREW BONE LP 4MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552422 SUP HCPCS C1713 48552422 - SCREW BONE LP 4MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552424 SUP HCPCS C1713 48552424 - SCREW BONE LP 4MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552426 SUP HCPCS C1713 48552426 - SCREW BONE LP 4MM 26MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552428 SUP HCPCS C1713 48552428 - SCREW BONE LP 4MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552430 SUP HCPCS C1713 48552430 - SCREW BONE LP 4MM 30MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552432 SUP HCPCS C1713 48552432 - SCREW BONE LP 4MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552434 SUP HCPCS C1713 48552434 - SCREW BONE LP 4MM 34MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552436 SUP HCPCS C1713 48552436 - SCREW BONE LP 4MM 36MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552438 SUP HCPCS C1713 48552438 - SCREW BONE LP 4MM 38MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552440 SUP HCPCS C1713 48552440 - SCREW BONE LP 4MM 40MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552442 SUP HCPCS C1713 48552442 - SCREW BONE LP 4MM 42MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552446 SUP HCPCS C1713 48552446 - SCREW BONE LP 4MM 46MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48552450 SUP HCPCS C1713 48552450 - SCREW BONE LP 4MM 50MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48553600 SUP Custom 27803010 48553600 - ROD SPINAL 3.5-4.5MM 600MM TRANSITION OASYS TITANIUM BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A 48553602 SUP Custom 27803010 48553602 - ROD SPNL 3.5-4.5MM 600MM NS LF OASYS TRNS VIT BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A 48553604 SUP Custom 27803010 48553604 - ROD SPNL 3.5-5.5MM 600MM NS OASYS TRNS TI BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A 48553606 SUP Custom 27803010 48553606 - ROD SPINAL 3.5-5.5MM TRANSITION OASYS VITALLIUM BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A 48553608 SUP Custom 27803010 48553608 - ROD SPNL 3.5-6MM 600MM NS OASYS TRNS TI BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A 48553610 SUP Custom 27803010 48553610 - ROD SPINAL 3.5-6MM TRANSITION OASYS VITALLIUM BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A 48554306 SUP HCPCS C1713 48554306 - SCREW BONE LP 3.5MM 6MM OASYS TITANIUM SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554308 SUP HCPCS C1713 48554308 - SCREW BONE LP 3.5MM 8MM OASYS TITANIUM SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554310 SUP HCPCS C1713 48554310 - SCREW BONE LP 3.5MM 10MM OASYS TITANIUM SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554312 SUP HCPCS C1713 48554312 - SCREW BONE LP 3.5MM 12MM OASYS TITANIUM SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554314 SUP HCPCS C1713 48554314 - SCREW BONE LP 3.5MM 14MM OASYS TITANIUM SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554316 SUP HCPCS C1713 48554316 - SCREW BONE LP 3.5MM 16MM OASYS TITANIUM SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554406 SUP HCPCS C1713 48554406 - SCREW BONE LP 4MM 6MM OASYS TITANIUM SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554408 SUP HCPCS C1713 48554408 - SCREW BONE LP 4MM 8MM OASYS TITANIUM SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554410 SUP HCPCS C1713 48554410 - SCREW BONE LP 4MM 10MM OASYS TITANIUM SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554412 SUP HCPCS C1713 48554412 - SCREW BONE LP 4MM 12MM OASYS TITANIUM SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554414 SUP HCPCS C1713 48554414 - SCREW BONE LP 4MM 14MM OASYS TITANIUM SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554416 SUP HCPCS C1713 48554416 - SCREW BONE LP 4MM 16MM OASYS TITANIUM SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554506 SUP HCPCS C1713 48554506 - SCREW BONE LP 4.5MM 6MM OASYS TITANIUM SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554508 SUP HCPCS C1713 48554508 - SCREW BONE LP 4.5MM 8MM OASYS TITANIUM SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554510 SUP HCPCS C1713 48554510 - SCREW BONE 4.5MM 10MM OASYS SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A 48554512 SUP HCPCS C1713 48554512 - SCREW BONE 4.5MM 12MM OASYS SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 48554514 SUP HCPCS C1713 48554514 - SCREW BONE 4.5MM 14MM OASYS SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A 48554516 SUP HCPCS C1713 48554516 - SCREW BONE 4.5MM 16MM OASYS SPN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A 48555320 SUP HCPCS C1713 48555320 - SCREW BONE LP 3.5MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48555322 SUP HCPCS C1713 48555322 - SCREW BONE LP 3.5MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48555324 SUP HCPCS C1713 48555324 - SCREW BONE LP 3.5MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48555328 SUP HCPCS C1713 48555328 - SCREW BONE LP 3.5MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48555332 SUP HCPCS C1713 48555332 - SCREW BONE LP 3.5MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48555336 SUP HCPCS C1713 48555336 - SCREW BONE LP 3.5MM 36MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48555340 SUP HCPCS C1713 48555340 - SCREW BONE LP 3.5MM 40MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48555420 SUP HCPCS C1713 48555420 - SCREW BONE LP 4MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48555422 SUP HCPCS C1713 48555422 - SCREW BONE LP 4MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48555424 SUP HCPCS C1713 48555424 - SCREW BONE LP 4MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48555428 SUP HCPCS C1713 48555428 - SCREW BONE LP 4MM 28MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48555432 SUP HCPCS C1713 48555432 - SCREW BONE LP 4MM 32MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48555436 SUP HCPCS C1713 48555436 - SCREW BONE LP 4MM 36MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48555440 SUP HCPCS C1713 48555440 - SCREW BONE LP 4MM 40MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48555444 SUP HCPCS C1713 48555444 - SCREW BONE LP 4MM 44MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48555448 SUP HCPCS C1713 48555448 - SCREW BONE LP 4MM 48MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48555452 SUP HCPCS C1713 48555452 - SCREW BONE LP 4MM 52MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48556322 SUP HCPCS C1713 48556322 - SCREW BONE LP 3.5MM 22MM BIAS ANGLE SMOOTH SHANK OASYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48556324 SUP HCPCS C1713 48556324 - SCREW BONE LP 3.5MM 24MM BIAS ANGLE SMOOTH SHANK OASYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48556326 SUP HCPCS C1713 48556326 - SCREW BONE LP 3.5MM 26MM BIAS ANGLE SMOOTH SHANK OASYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48556328 SUP HCPCS C1713 48556328 - SCREW BONE LP 3.5MM 28MM BIAS ANGLE SMOOTH SHANK OASYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48556330 SUP HCPCS C1713 48556330 - SCREW BONE LP 3.5MM 30MM BIAS ANGLE SMOOTH SHANK OASYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48556332 SUP HCPCS C1713 48556332 - SCREW BONE LP 3.5MM 32MM BIAS ANGLE SMOOTH SHANK OASYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48556334 SUP HCPCS C1713 48556334 - SCREW BONE LP 3.5MM 34MM BIAS ANGLE SMOOTH SHANK OASYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48556336 SUP HCPCS C1713 48556336 - SCREW BONE LP 3.5MM 36MM BIAS ANGLE SMOOTH SHANK OASYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48556338 SUP HCPCS C1713 48556338 - SCREW BONE LP 3.5MM 38MM BIAS ANGLE SMOOTH SHANK OASYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48556340 SUP HCPCS C1713 48556340 - SCREW BONE LP 3.5MM 40MM BIAS ANGLE SMOOTH SHANK OASYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48557310 SUP HCPCS C1713 48557310 - SCREW BONE LP 3.5MM 10MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48557312 SUP HCPCS C1713 48557312 - SCREW BONE LP 3.5MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48557314 SUP HCPCS C1713 48557314 - SCREW BONE LP 3.5MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48557316 SUP HCPCS C1713 48557316 - SCREW BONE LP 3.5MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48557318 SUP HCPCS C1713 48557318 - SCREW BONE LP 3.5MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48557320 SUP HCPCS C1713 48557320 - SCREW BONE LP 3.5MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48557322 SUP HCPCS C1713 48557322 - SCREW BONE LP 3.5MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48557324 SUP HCPCS C1713 48557324 - SCREW BONE LP 3.5MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48557410 SUP HCPCS C1713 48557410 - SCREW BONE LP 4MM 10MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48557412 SUP HCPCS C1713 48557412 - SCREW BONE LP 4MM 12MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48557414 SUP HCPCS C1713 48557414 - SCREW BONE LP 4MM 14MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48557416 SUP HCPCS C1713 48557416 - SCREW BONE LP 4MM 16MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48557418 SUP HCPCS C1713 48557418 - SCREW BONE LP 4MM 18MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48557420 SUP HCPCS C1713 48557420 - SCREW BONE LP 4MM 20MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48557422 SUP HCPCS C1713 48557422 - SCREW BONE LP 4MM 22MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48557424 SUP HCPCS C1713 48557424 - SCREW BONE LP 4MM 24MM BIAS ANGLE POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48558310 SUP HCPCS C1713 48558310 - SCREW BONE LP 3.5MM 10MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558312 SUP HCPCS C1713 48558312 - SCREW BN 3.5MM 12MM FCHSA NS OASYS PA NONBIAS ANG TULIP HD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558314 SUP HCPCS C1713 48558314 - SCREW BN 3.5MM 14MM FCHSA NS OASYS PA NONBIAS ANG TULIP HD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558316 SUP HCPCS C1713 48558316 - SCREW BONE LP 3.5MM 16MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558318 SUP HCPCS C1713 48558318 - SCREW BONE LP 3.5MM 18MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558320 SUP HCPCS C1713 48558320 - SCREW BONE LP 3.5MM 20MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 48558410 SUP HCPCS C1713 48558410 - SCREW BONE LP 4MM 10MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558412 SUP HCPCS C1713 48558412 - SCREW BONE LP 4MM 12MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558414 SUP HCPCS C1713 48558414 - SCREW BONE LP 4MM 14MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558416 SUP HCPCS C1713 48558416 - SCREW BONE LP 4MM 16MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558418 SUP HCPCS C1713 48558418 - SCREW BONE LP 4MM 18MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558420 SUP HCPCS C1713 48558420 - SCREW BONE LP 4MM 20MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558520 SUP HCPCS C1713 48558520 - SCREW BONE LP 4.5MM 20MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558524 SUP HCPCS C1713 48558524 - SCREW BN 4.5MM 24MM FCHSA NS OASYS PA NONBIAS ANG TULIP HD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558528 SUP HCPCS C1713 48558528 - SCREW BONE LP 4.5MM 28MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558532 SUP HCPCS C1713 48558532 - SCREW BONE LP 4.5MM 32MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558536 SUP HCPCS C1713 48558536 - SCREW BONE LP 4.5MM 36MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558540 SUP HCPCS C1713 48558540 - SCREW BONE LP 4.5MM 40MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558544 SUP HCPCS C1713 48558544 - SCREW BONE LP 4.5MM 44MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558548 SUP HCPCS C1713 48558548 - SCREW BONE LP 4.5MM 48MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 48558552 SUP HCPCS C1713 48558552 - SCREW BONE LP 4.5MM 52MM POLYAX OASYS TITANIUM SPN BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 48560314 SUP Custom 27803010 48560314 - TAP SPINAL 3.5MM DRILL BIT OASYS BOTH IP/OP $491.00 $363.00 $87.37 $490.83 $490.83 $490.83 $490.83 $490.83 $490.83 $490.83 $87.37 $490.83 $490.83 $490.83 $490.83 $490.83 $490.83 $102.29 $490.83 $196.33 $490.83 $490.83 $490.83 $490.83 $490.83 $368.25 $490.83 $490.83 $490.83 $245.42 $245.42 $388.74 $490.83 $392.66 $220.87 $490.83 N/A $284.78 $490.83 $294.50 $490.83 $490.83 $490.83 N/A N/A 48560323 SUP Custom 27203010 48560323 - BIT DRL 2.5MM 3.5MM PA SCR BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48560414 SUP HCPCS C1713 48560414 - TAP SURG 4MM OASYS SPN 4MM SCREW BOTH IP/OP $491.00 $363.00 $97.42 $490.83 $220.87 $220.87 $220.87 $220.87 $490.83 $490.83 $490.83 $102.30 $490.83 $490.83 $490.83 $490.83 $490.83 $102.29 $490.83 $196.33 $290.33 $490.83 $490.83 $490.83 $490.83 $368.25 $490.83 $490.83 $490.83 $245.42 $245.42 $388.74 $490.83 $392.66 $220.87 $97.42 N/A $284.78 $490.83 $490.83 $490.83 $102.29 $490.83 N/A N/A 48560423 SUP Custom 27203010 48560423 - DRILL SURG 3MM OASYS SPN STERILE 4MM SCREW BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48560514 SUP HCPCS C1713 48560514 - TAP SPINAL 3.5MM OASYS SPN BOTH IP/OP $425.50 $315.00 $84.41 $425.30 $191.39 $191.39 $191.39 $191.39 $425.30 $425.30 $425.30 $88.64 $425.30 $425.30 $425.30 $425.30 $425.30 $88.64 $425.30 $425.30 $251.56 $425.30 $425.30 $425.30 $425.30 $319.13 $425.30 $425.30 $425.30 $212.65 $212.65 $336.84 $425.30 $340.24 $191.39 $84.41 N/A $246.79 $425.30 $425.30 $425.30 $88.63 $425.30 N/A N/A 48570114 SUP Custom 27203010 48570114 - BIT DRL 4MM ESCALATE LAMINOPLASTY BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48570116 SUP Custom 27203010 48570116 - DRILL SURG 6MM ESCALATE NONSTRL LAMINOPLASTY BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48570118 SUP Custom 27203010 48570118 - DRILL SURG 8MM ESCALATE NONSTRL LAMINOPLASTY BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48570204 SUP HCPCS C1713 48570204 - SCREW BONE 2MM 4MM SELF DRILL ESCALATE MAGENTA SPN CERV BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $50.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $75.00 $125.00 $26.05 $125.00 N/A N/A 48570206 SUP HCPCS C1713 48570206 - SCREW BONE 2MM 6MM SELF DRILL ESCALATE MAGENTA SPN CERV BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $50.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $75.00 $125.00 $26.05 $125.00 N/A N/A 48570208 SUP HCPCS C1713 48570208 - SCREW BONE 2MM 8MM SELF DRILL ESCALATE MAGENTA SPN CERV BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $50.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $75.00 $125.00 $26.05 $125.00 N/A N/A 48570210 SUP HCPCS C1713 48570210 - ESCALATE 2.0 X 10MM SELF DRILLING SCREW BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $75.00 $125.00 $26.05 $125.00 N/A N/A 48570240 SUP HCPCS C1713 48570240 - ESCALATE 2.4 X 10MM SELF TAPPING SCREW BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 48570244 SUP HCPCS C1713 48570244 - ESCALATE 2.4 X 4MM SELF TAPPING SCREW BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 48570246 SUP HCPCS C1713 48570246 - ESCALATE 2.4 X 6MM SELF TAPPING SCREW BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 48570248 SUP HCPCS C1713 48570248 - ESCALATE 2.4 X 8MM SELF TAPPING SCREW BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 48570300 SUP HCPCS C1713 48570300 - PLATE BONE 5MM EXPANDABLE ESCALATE TITANIUM SPN CERV NONSTRL BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" "$1,000.00" $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" $600.00 "$1,000.00" $208.40 "$1,000.00" N/A N/A 48570301 SUP HCPCS C1713 48570301 - PLATE BONE 5MM 2 HOLE BASE ESCALATE TITANIUM SPN CERV BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" "$1,000.00" $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" $600.00 "$1,000.00" $208.40 "$1,000.00" N/A N/A 48610112 SUP HCPCS C1713 48610112 - PLATE BONE 12MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610114 SUP HCPCS C1713 48610114 - PLATE BONE 14MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610116 SUP HCPCS C1713 48610116 - PLATE BONE 16MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610118 SUP HCPCS C1713 48610118 - PLATE BONE 18MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610120 SUP HCPCS C1713 48610120 - PLATE BONE 20MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610122 SUP HCPCS C1713 48610122 - PLATE BONE 22MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610224 SUP HCPCS C1713 48610224 - PLATE BONE 24MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610226 SUP HCPCS C1713 48610226 - PLATE BONE 26MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610228 SUP HCPCS C1713 48610228 - PLATE BONE 28MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610230 SUP HCPCS C1713 48610230 - PLATE BONE 30MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610232 SUP HCPCS C1713 48610232 - PLATE BONE 32MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610234 SUP HCPCS C1713 48610234 - PLATE BONE 34MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610237 SUP HCPCS C1713 48610237 - PLATE BONE 37MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610240 SUP HCPCS C1713 48610240 - PLATE BONE 40MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610243 SUP HCPCS C1713 48610243 - PLATE BONE 43MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610246 SUP HCPCS C1713 48610246 - PLATE BONE 46MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48610339 SUP HCPCS C1713 48610339 - PLATE BONE 39MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610342 SUP HCPCS C1713 48610342 - PLATE BONE 42MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610345 SUP HCPCS C1713 48610345 - PLATE BONE 45MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610348 SUP HCPCS C1713 48610348 - PLATE BONE 48MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610351 SUP HCPCS C1713 48610351 - PLATE BONE 51MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610354 SUP HCPCS C1713 48610354 - PLATE BONE 54MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610357 SUP HCPCS C1713 48610357 - PLATE BONE 57MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610360 SUP HCPCS C1713 48610360 - PLATE BONE 60MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610363 SUP HCPCS C1713 48610363 - PLATE BONE 63MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610366 SUP HCPCS C1713 48610366 - PLATE BONE 66MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610369 SUP HCPCS C1713 48610369 - PLATE BONE 69MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610460 SUP HCPCS C1713 48610460 - PLATE BONE 60MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610464 SUP HCPCS C1713 48610464 - PLATE BONE 64MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610468 SUP HCPCS C1713 48610468 - PLATE BONE 68MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610472 SUP HCPCS C1713 48610472 - PLATE BONE 72MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610476 SUP HCPCS C1713 48610476 - PLATE BONE 76MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610480 SUP HCPCS C1713 48610480 - PLATE BONE 80MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48610484 SUP HCPCS C1713 48610484 - PLATE BONE 84MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 48624010 SUP HCPCS C1713 48624010 - SCREW BONE 4MM 10MM VAR ANG SELF TAP REFLEX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 48624012 SUP HCPCS C1713 48624012 - SCREW BONE 4MM 12MM VAR ANG SELF TAP REFLEX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 48624014 SUP HCPCS C1713 48624014 - SCREW BONE 4MM 14MM VAR ANG SELF TAP REFLEX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 48624016 SUP HCPCS C1713 48624016 - SCREW BONE 4MM 16MM VAR ANG SELF TAP REFLEX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 48624018 SUP HCPCS C1713 48624018 - SCREW BONE 4MM 18MM VAR ANG SELF TAP REFLEX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 48624020 SUP HCPCS C1713 48624020 - SCREW BONE 4MM 20MM VAR ANG SELF TAP REFLEX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 48624022 SUP HCPCS C1713 48624022 - SCREW BONE 4MM 22MM VAR ANG SELF TAP REFLEX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 48624512 SUP HCPCS C1713 48624512 - SCREW BONE 4.5MM 12MM VAR ANG SELF TAP REFLEX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 48624514 SUP HCPCS C1713 48624514 - SCREW BONE 4.5MM 14MM VAR ANG SELF TAP REFLEX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 48624516 SUP HCPCS C1713 48624516 - SCREW BONE 4.5MM 16MM VAR ANG SELF TAP REFLEX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 48624518 SUP HCPCS C1713 48624518 - SCREW BONE 4.5MM 18MM VAR ANG SELF TAP REFLEX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 48624520 SUP HCPCS C1713 48624520 - SCREW BONE 4.5MM 20MM VAR ANG SELF TAP REFLEX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 48624522 SUP HCPCS C1713 48624522 - SCREW BONE 4.5MM 22MM VAR ANG SELF TAP REFLEX TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 48644010 SUP HCPCS C1713 48644010 - SCREW BONE 4MM 10MM RFLX HB TI SPNL SLFDRILL VAR ANG BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 48644012 SUP HCPCS C1713 48644012 - SCREW BONE 4MM 12MM VAR ANG SELF DRILL DYNATRAN REFLEX BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48644014 SUP HCPCS C1713 48644014 - SCREW BONE 4MM 14MM VAR ANG SELF DRILL DYNATRAN REFLEX BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48644016 SUP HCPCS C1713 48644016 - SCREW BONE 4MM 16MM VAR ANG SELF DRILL DYNATRAN REFLEX BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48644018 SUP HCPCS C1713 48644018 - SCREW BONE 4MM 18MM VAR ANG SELF DRILL DYNATRAN REFLEX BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48650228 SUP HCPCS C1713 48650228 - PLATE BN 28MM RFLX HB LVL 2 TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 48651112 SUP HCPCS C1713 48651112 - PLATE BONE 12MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651114 SUP HCPCS C1713 48651114 - PLATE BN 14MM NS RFLX HB LVL 1 TI SPNE CRV ANT BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651116 SUP HCPCS C1713 48651116 - PLATE BONE 16MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651118 SUP HCPCS C1713 48651118 - PLATE BONE 18MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651120 SUP HCPCS C1713 48651120 - PLATE BONE 20MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651122 SUP HCPCS C1713 48651122 - PLATE BONE 22MM LEVEL 1 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651224 SUP HCPCS C1713 48651224 - PLATE BONE 24MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651226 SUP HCPCS C1713 48651226 - PLATE BONE 26MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651228 SUP HCPCS C1713 48651228 - PLATE BN 28MM NS RFLX HB LVL 2 TI SPNE CRV ANT BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651230 SUP HCPCS C1713 48651230 - PLATE BONE 30MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651232 SUP HCPCS C1713 48651232 - PLATE BN 32MM NS RFLX HB LVL 2 TI SPNE CRV ANT BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651234 SUP HCPCS C1713 48651234 - PLATE BONE 34MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651237 SUP HCPCS C1713 48651237 - PLATE BONE 37MM 6 HOLE LEVEL 2 REFLEX HYBRID TITANIUM SPN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651240 SUP HCPCS C1713 48651240 - PLATE BONE 40MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651243 SUP HCPCS C1713 48651243 - PLATE BONE 43MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651246 SUP HCPCS C1713 48651246 - PLATE BONE 46MM LEVEL 2 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48651339 SUP HCPCS C1713 48651339 - PLATE BONE 39MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651342 SUP HCPCS C1713 48651342 - PLATE BONE 42MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651345 SUP HCPCS C1713 48651345 - PLATE BONE 45MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651348 SUP HCPCS C1713 48651348 - PLATE BN 48MM NS RFLX HB LVL 3 TI SPNE CRV ANT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651351 SUP HCPCS C1713 48651351 - PLATE BONE 51MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651354 SUP HCPCS C1713 48651354 - PLATE BONE 54MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651357 SUP HCPCS C1713 48651357 - PLATE BONE 57MM LEVEL 3 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651360 SUP HCPCS C1713 48651360 - PLATE BN 60MM NS RFLX HB LVL 3 TI SPNE CRV ANT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651363 SUP HCPCS C1713 48651363 - PLATE BN 63MM RFLX HB LVL 3 TI SPNE CRV ANT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651366 SUP HCPCS C1713 48651366 - PLATE BN 66MM RFLX HB LVL 3 TI SPNE CRV ANT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651369 SUP HCPCS C1713 48651369 - PLATE BN 69MM RFLX HB LVL 3 TI SPNE CRV ANT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651460 SUP HCPCS C1713 48651460 - PLATE BN 60MM NS RFLX HB LVL 4 TI SPNE CRV ANT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651464 SUP HCPCS C1713 48651464 - PLATE BONE 64MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651468 SUP HCPCS C1713 48651468 - PLATE BONE 68MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651472 SUP HCPCS C1713 48651472 - PLATE BONE 72MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651476 SUP HCPCS C1713 48651476 - PLATE BN 76MM RFLX HB LVL 4 TI SPNE CRV ANT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651480 SUP HCPCS C1713 48651480 - PLATE BN 80MM RFLX HB LVL 4 TI SPNE CRV ANT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651484 SUP HCPCS C1713 48651484 - PLATE BONE 84MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651488 SUP HCPCS C1713 48651488 - PLATE BONE 88MM LEVEL 4 REFLEX HYBRID TITANIUM SPN CERV BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651492 SUP HCPCS C1713 48651492 - PLATE BN 92MM LVL 4 SPNE CRV ANT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48651496 SUP HCPCS C1713 48651496 - PLATE BN 96MM LVL 4 SPNE CRV ANT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48654010 SUP HCPCS C1713 48654010 - SCREW BONE 4MM 10MM FIX ANGLE SELF DRILL DYNATRAN REFLEX BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48654012 SUP HCPCS C1713 48654012 - SCREW BONE 4MM 12MM FIX ANGLE SELF DRILL DYNATRAN REFLEX BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48654014 SUP HCPCS C1713 48654014 - SCREW BONE 4MM 14MM FIX ANGLE SELF DRILL DYNATRAN REFLEX BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48654016 SUP HCPCS C1713 48654016 - SCREW BONE 4MM 16MM FIX ANGLE SELF DRILL DYNATRAN REFLEX BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48654018 SUP HCPCS C1713 48654018 - SCREW BONE 4MM 18MM FIX ANGLE SELF DRILL DYNATRAN REFLEX BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48660112 SUP HCPCS C1713 48660112 - PLATE BONE 12MM LEVEL 1 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,264.00" "$3,155.00" $846.27 "$4,263.88" "$1,918.75" "$1,918.75" "$1,918.75" "$1,918.75" "$4,263.88" "$4,263.88" "$4,263.88" $888.70 "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" $888.64 "$4,263.88" "$1,705.55" "$2,102.09" "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" "$3,198.00" "$4,263.88" "$4,263.88" "$4,263.88" "$2,131.94" "$2,131.94" "$3,376.99" "$4,263.88" "$3,411.10" "$1,918.75" $846.27 N/A "$2,473.12" "$4,263.88" "$4,263.88" "$4,263.88" $888.59 "$4,263.88" N/A N/A 48660114 SUP HCPCS C1713 48660114 - PLATE BONE 14MM LEVEL 1 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,264.00" "$3,155.00" $846.27 "$4,263.88" "$1,918.75" "$1,918.75" "$1,918.75" "$1,918.75" "$4,263.88" "$4,263.88" "$4,263.88" $888.70 "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" $888.64 "$4,263.88" "$1,705.55" "$2,102.09" "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" "$3,198.00" "$4,263.88" "$4,263.88" "$4,263.88" "$2,131.94" "$2,131.94" "$3,376.99" "$4,263.88" "$3,411.10" "$1,918.75" $846.27 N/A "$2,473.12" "$4,263.88" "$4,263.88" "$4,263.88" $888.59 "$4,263.88" N/A N/A 48660116 SUP HCPCS C1713 48660116 - PLATE BONE 16MM LEVEL 1 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,264.00" "$3,155.00" $846.27 "$4,263.88" "$1,918.75" "$1,918.75" "$1,918.75" "$1,918.75" "$4,263.88" "$4,263.88" "$4,263.88" $888.70 "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" $888.64 "$4,263.88" "$1,705.55" "$2,102.09" "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" "$3,198.00" "$4,263.88" "$4,263.88" "$4,263.88" "$2,131.94" "$2,131.94" "$3,376.99" "$4,263.88" "$3,411.10" "$1,918.75" $846.27 N/A "$2,473.12" "$4,263.88" "$4,263.88" "$4,263.88" $888.59 "$4,263.88" N/A N/A 48660118 SUP HCPCS C1713 48660118 - PLATE BONE 18MM LEVEL 1 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,264.00" "$3,155.00" $846.27 "$4,263.88" "$1,918.75" "$1,918.75" "$1,918.75" "$1,918.75" "$4,263.88" "$4,263.88" "$4,263.88" $888.70 "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" $888.64 "$4,263.88" "$4,263.88" "$2,102.09" "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" "$3,198.00" "$4,263.88" "$4,263.88" "$4,263.88" "$2,131.94" "$2,131.94" "$3,376.99" "$4,263.88" "$3,411.10" "$1,918.75" $846.27 N/A "$2,473.12" "$4,263.88" "$4,263.88" "$4,263.88" $888.59 "$4,263.88" N/A N/A 48660120 SUP HCPCS C1713 48660120 - PLATE BONE 20MM LEVEL 1 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,264.00" "$3,155.00" $846.27 "$4,263.88" "$1,918.75" "$1,918.75" "$1,918.75" "$1,918.75" "$4,263.88" "$4,263.88" "$4,263.88" $888.70 "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" $888.64 "$4,263.88" "$4,263.88" "$2,102.09" "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" "$3,198.00" "$4,263.88" "$4,263.88" "$4,263.88" "$2,131.94" "$2,131.94" "$3,376.99" "$4,263.88" "$3,411.10" "$1,918.75" $846.27 N/A "$2,473.12" "$4,263.88" "$4,263.88" "$4,263.88" $888.59 "$4,263.88" N/A N/A 48660122 SUP HCPCS C1713 48660122 - PLATE BONE 22MM LEVEL 1 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,264.00" "$3,155.00" $846.27 "$4,263.88" "$1,918.75" "$1,918.75" "$1,918.75" "$1,918.75" "$4,263.88" "$4,263.88" "$4,263.88" $888.70 "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" $888.64 "$4,263.88" "$1,705.55" "$2,102.09" "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" "$3,198.00" "$4,263.88" "$4,263.88" "$4,263.88" "$2,131.94" "$2,131.94" "$3,376.99" "$4,263.88" "$3,411.10" "$1,918.75" $846.27 N/A "$2,473.12" "$4,263.88" "$4,263.88" "$4,263.88" $888.59 "$4,263.88" N/A N/A 48660124 SUP HCPCS C1713 48660124 - PLATE BONE 24MM LEVEL 1 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,264.00" "$3,155.00" $846.27 "$4,263.88" "$1,918.75" "$1,918.75" "$1,918.75" "$1,918.75" "$4,263.88" "$4,263.88" "$4,263.88" $888.70 "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" $888.64 "$4,263.88" "$1,705.55" "$2,102.09" "$4,263.88" "$4,263.88" "$4,263.88" "$4,263.88" "$3,198.00" "$4,263.88" "$4,263.88" "$4,263.88" "$2,131.94" "$2,131.94" "$3,376.99" "$4,263.88" "$3,411.10" "$1,918.75" $846.27 N/A "$2,473.12" "$4,263.88" "$4,263.88" "$4,263.88" $888.59 "$4,263.88" N/A N/A 48660224 SUP HCPCS C1713 48660224 - PLATE BONE 24MM LEVEL 2 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,477.50" "$3,313.00" $888.63 "$4,477.28" "$2,014.78" "$2,014.78" "$2,014.78" "$2,014.78" "$4,477.28" "$4,477.28" "$4,477.28" $933.18 "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" $933.11 "$4,477.28" "$1,790.91" "$2,207.30" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$3,358.13" "$4,477.28" "$4,477.28" "$4,477.28" "$2,238.64" "$2,238.64" "$3,546.01" "$4,477.28" "$3,581.82" "$2,014.78" $888.63 N/A "$2,596.95" "$4,477.28" "$4,477.28" "$4,477.28" $933.07 "$4,477.28" N/A N/A 48660226 SUP HCPCS C1713 48660226 - PLATE BONE 26MM LEVEL 2 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,477.50" "$3,313.00" $888.63 "$4,477.28" "$2,014.78" "$2,014.78" "$2,014.78" "$2,014.78" "$4,477.28" "$4,477.28" "$4,477.28" $933.18 "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" $933.11 "$4,477.28" "$4,477.28" "$2,207.30" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$3,358.13" "$4,477.28" "$4,477.28" "$4,477.28" "$2,238.64" "$2,238.64" "$3,546.01" "$4,477.28" "$3,581.82" "$2,014.78" $888.63 N/A "$2,596.95" "$4,477.28" "$2,686.37" "$4,477.28" $933.07 "$4,477.28" N/A N/A 48660228 SUP HCPCS C1713 48660228 - PLATE BONE 28MM LEVEL 2 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,477.50" "$3,313.00" $888.63 "$4,477.28" "$2,014.78" "$2,014.78" "$2,014.78" "$2,014.78" "$4,477.28" "$4,477.28" "$4,477.28" $933.18 "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" $933.11 "$4,477.28" "$4,477.28" "$2,207.30" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$3,358.13" "$4,477.28" "$4,477.28" "$4,477.28" "$2,238.64" "$2,238.64" "$3,546.01" "$4,477.28" "$3,581.82" "$2,014.78" $888.63 N/A "$2,596.95" "$4,477.28" "$2,686.37" "$4,477.28" $933.07 "$4,477.28" N/A N/A 48660230 SUP HCPCS C1713 48660230 - PLATE BONE 30MM LEVEL 1 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,477.50" "$3,313.00" $888.63 "$4,477.28" "$2,014.78" "$2,014.78" "$2,014.78" "$2,014.78" "$4,477.28" "$4,477.28" "$4,477.28" $933.18 "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" $933.11 "$4,477.28" "$4,477.28" "$2,207.30" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$3,358.13" "$4,477.28" "$4,477.28" "$4,477.28" "$2,238.64" "$2,238.64" "$3,546.01" "$4,477.28" "$3,581.82" "$2,014.78" $888.63 N/A "$2,596.95" "$4,477.28" "$4,477.28" "$4,477.28" $933.07 "$4,477.28" N/A N/A 48660232 SUP HCPCS C1713 48660232 - PLATE BONE 32MM LEVEL 2 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,477.50" "$3,313.00" $888.63 "$4,477.28" "$2,014.78" "$2,014.78" "$2,014.78" "$2,014.78" "$4,477.28" "$4,477.28" "$4,477.28" $933.18 "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" $933.11 "$4,477.28" "$4,477.28" "$2,207.30" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$3,358.13" "$4,477.28" "$4,477.28" "$4,477.28" "$2,238.64" "$2,238.64" "$3,546.01" "$4,477.28" "$3,581.82" "$2,014.78" $888.63 N/A "$2,596.95" "$4,477.28" "$2,686.37" "$4,477.28" $933.07 "$4,477.28" N/A N/A 48660234 SUP HCPCS C1713 48660234 - PLATE BONE 34MM LEVEL 2 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,477.50" "$3,313.00" $888.63 "$4,477.28" "$2,014.78" "$2,014.78" "$2,014.78" "$2,014.78" "$4,477.28" "$4,477.28" "$4,477.28" $933.18 "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" $933.11 "$4,477.28" "$1,790.91" "$2,207.30" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$3,358.13" "$4,477.28" "$4,477.28" "$4,477.28" "$2,238.64" "$2,238.64" "$3,546.01" "$4,477.28" "$3,581.82" "$2,014.78" $888.63 N/A "$2,596.95" "$4,477.28" "$2,686.37" "$4,477.28" $933.07 "$4,477.28" N/A N/A 48660236 SUP HCPCS C1713 48660236 - PLATE BONE 36MM LEVEL 1 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,477.50" "$3,313.00" $888.63 "$4,477.28" "$2,014.78" "$2,014.78" "$2,014.78" "$2,014.78" "$4,477.28" "$4,477.28" "$4,477.28" $933.18 "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" $933.11 "$4,477.28" "$1,790.91" "$2,207.30" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$3,358.13" "$4,477.28" "$4,477.28" "$4,477.28" "$2,238.64" "$2,238.64" "$3,546.01" "$4,477.28" "$3,581.82" "$2,014.78" $888.63 N/A "$2,596.95" "$4,477.28" "$2,686.37" "$4,477.28" $933.07 "$4,477.28" N/A N/A 48660238 SUP HCPCS C1713 48660238 - PLATE BONE 38MM LEVEL 2 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,477.50" "$3,313.00" $888.63 "$4,477.28" "$2,014.78" "$2,014.78" "$2,014.78" "$2,014.78" "$4,477.28" "$4,477.28" "$4,477.28" $933.18 "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" $933.11 "$4,477.28" "$4,477.28" "$2,207.30" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$3,358.13" "$4,477.28" "$4,477.28" "$4,477.28" "$2,238.64" "$2,238.64" "$3,546.01" "$4,477.28" "$3,581.82" "$2,014.78" $888.63 N/A "$2,596.95" "$4,477.28" "$2,686.37" "$4,477.28" $933.07 "$4,477.28" N/A N/A 48660240 SUP HCPCS C1713 48660240 - PLATE BONE 40MM LEVEL 2 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,477.50" "$3,313.00" $888.63 "$4,477.28" "$2,014.78" "$2,014.78" "$2,014.78" "$2,014.78" "$4,477.28" "$4,477.28" "$4,477.28" $933.18 "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" $933.11 "$4,477.28" "$4,477.28" "$2,207.30" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$3,358.13" "$4,477.28" "$4,477.28" "$4,477.28" "$2,238.64" "$2,238.64" "$3,546.01" "$4,477.28" "$3,581.82" "$2,014.78" $888.63 N/A "$2,596.95" "$4,477.28" "$2,686.37" "$4,477.28" $933.07 "$4,477.28" N/A N/A 48660242 SUP HCPCS C1713 48660242 - PLATE BONE 42MM LEVEL 2 REFLEX ZERO PROFILE TITANIUM SPN BOTH IP/OP "$4,477.50" "$3,313.00" $888.63 "$4,477.28" "$2,014.78" "$2,014.78" "$2,014.78" "$2,014.78" "$4,477.28" "$4,477.28" "$4,477.28" $933.18 "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" $933.11 "$4,477.28" "$4,477.28" "$2,207.30" "$4,477.28" "$4,477.28" "$4,477.28" "$4,477.28" "$3,358.13" "$4,477.28" "$4,477.28" "$4,477.28" "$2,238.64" "$2,238.64" "$3,546.01" "$4,477.28" "$3,581.82" "$2,014.78" $888.63 N/A "$2,596.95" "$4,477.28" "$2,686.37" "$4,477.28" $933.07 "$4,477.28" N/A N/A 48665030 SUP HCPCS C1713 48665030 - SCREW BN 5MM 30MM AVS ANCH-L ST SLF DRL 2 THRD LD CUT FLUT BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 48667000 SUP HCPCS C1713 48667000 - ANCHOR-L LOCKING PLATE BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A 48668142 SUP HCPCS C1713 48668142 - SPACER SPNL 12D RECT 28X40X14MM NS LF AVS ANCH-L RADOPQ HLW BOTH IP/OP "$9,375.00" "$6,938.00" "$1,860.70" "$9,375.00" "$4,218.75" "$4,218.75" "$4,218.75" "$4,218.75" "$9,375.00" "$9,375.00" "$9,375.00" "$1,953.98" "$9,375.00" "$9,375.00" "$9,375.00" "$9,375.00" "$9,375.00" "$1,953.85" "$9,375.00" "$9,375.00" "$4,621.88" "$9,375.00" "$9,375.00" "$9,375.00" "$9,375.00" "$7,031.25" "$9,375.00" "$9,375.00" "$9,375.00" "$4,687.50" "$4,687.50" "$7,425.00" "$9,375.00" "$7,500.00" "$4,218.75" "$1,860.70" N/A "$5,437.50" "$9,375.00" "$5,625.00" "$9,375.00" "$1,953.75" "$9,375.00" N/A N/A 48674010 SUP HCPCS C1713 48674010 - SCREW BONE FLUTE 4MM 10MM FIX ANGLE SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48674012 SUP HCPCS C1713 48674012 - SCREW BONE FLUTE 4MM 12MM FIX ANGLE SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48674014 SUP HCPCS C1713 48674014 - SCREW BONE FLUTE 4MM 14MM FIX ANGLE SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48674016 SUP HCPCS C1713 48674016 - SCREW BONE FLUTE 4MM 16MM FIX ANGLE SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48674018 SUP HCPCS C1713 48674018 - SCREW BONE FLUTE 4MM 18MM FIX ANGLE SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48674020 SUP HCPCS C1713 48674020 - SCREW BONE FLUTE 4MM 20MM FIX ANGLE SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48674512 SUP HCPCS C1713 48674512 - SCREW BONE FLUTE 4.5MM 12MM FIX ANGLE SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48674514 SUP HCPCS C1713 48674514 - SCREW BONE FLUTE 4.5MM 14MM FIX ANGLE SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48674516 SUP HCPCS C1713 48674516 - SCREW BONE FLUTE 4.5MM 16MM FIX ANGLE SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48674518 SUP HCPCS C1713 48674518 - SCREW BONE FLUTE 4.5MM 18MM FIX ANGLE SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48674520 SUP HCPCS C1713 48674520 - SCREW BONE FLUTE 4.5MM 20MM FIX ANGLE SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48694010 SUP HCPCS C1713 48694010 - SCREW BONE FLUTE 4MM 10MM VAR ANG SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48694012 SUP HCPCS C1713 48694012 - SCREW BONE FLUTE 4MM 12MM VAR ANG SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48694014 SUP HCPCS C1713 48694014 - SCREW BONE FLUTE 4MM 14MM VAR ANG SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48694016 SUP HCPCS C1713 48694016 - SCREW BONE FLUTE 4MM 16MM VAR ANG SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48694018 SUP HCPCS C1713 48694018 - SCREW BONE FLUTE 4MM 18MM VAR ANG SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48694020 SUP HCPCS C1713 48694020 - SCREW BONE FLUTE 4MM 20MM VAR ANG SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48694512 SUP HCPCS C1713 48694512 - SCREW BONE FLUTE 4.5MM 12MM VAR ANG SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48694514 SUP HCPCS C1713 48694514 - SCREW BONE FLUTE 4.5MM 14MM VAR ANG SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48694516 SUP HCPCS C1713 48694516 - SCREW BONE FLUTE 4.5MM 16MM VAR ANG SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48694518 SUP HCPCS C1713 48694518 - SCREW BONE FLUTE 4.5MM 18MM VAR ANG SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48694520 SUP HCPCS C1713 48694520 - SCREW BONE FLUTE 4.5MM 20MM VAR ANG SELF TAP COLOR CODED BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48770410 SUP Custom 27203010 48770410 - PIN FIX TEMPORARY AVIATOR BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48770610 SUP Custom 27203010 48770610 - BIT DRILL 10MM AVIATOR BOTH IP/OP $657.00 $486.00 $116.93 $656.90 $656.90 $656.90 $656.90 $656.90 $656.90 $656.90 $116.93 $656.90 $656.90 $487.55 $487.55 $506.34 $342.24 $136.91 $656.90 $262.76 $656.90 $656.90 $656.90 $656.90 $656.90 $492.75 $656.90 $656.90 $656.90 $328.45 $328.45 $520.26 $656.90 $525.52 $426.99 $656.90 N/A $381.06 $656.90 $394.14 $656.90 $656.90 $656.90 N/A N/A 48770612 SUP Custom 27203010 48770612 - BIT DRILL 12MM AVIATOR BOTH IP/OP $657.00 $486.00 $116.93 $656.90 $656.90 $656.90 $656.90 $656.90 $656.90 $656.90 $116.93 $656.90 $656.90 $487.55 $487.55 $506.34 $342.24 $136.91 $656.90 $262.76 $656.90 $656.90 $656.90 $656.90 $656.90 $492.75 $656.90 $656.90 $656.90 $328.45 $328.45 $520.26 $656.90 $525.52 $426.99 $656.90 N/A $381.06 $656.90 $394.14 $656.90 $656.90 $656.90 N/A N/A 48770614 SUP Custom 27203010 48770614 - BIT DRILL 14MM AVIATOR BOTH IP/OP $657.00 $486.00 $116.93 $656.90 $656.90 $656.90 $656.90 $656.90 $656.90 $656.90 $116.93 $656.90 $656.90 $487.55 $487.55 $506.34 $342.24 $136.91 $656.90 $262.76 $656.90 $656.90 $656.90 $656.90 $656.90 $492.75 $656.90 $656.90 $656.90 $328.45 $328.45 $520.26 $656.90 $525.52 $426.99 $656.90 N/A $381.06 $656.90 $394.14 $656.90 $656.90 $656.90 N/A N/A 48770616 SUP Custom 27203010 48770616 - BIT DRILL 16MM AVIATOR BOTH IP/OP $657.00 $486.00 $116.93 $656.90 $656.90 $656.90 $656.90 $656.90 $656.90 $656.90 $116.93 $656.90 $656.90 $487.55 $487.55 $506.34 $342.24 $136.91 $656.90 $262.76 $656.90 $656.90 $656.90 $656.90 $656.90 $492.75 $656.90 $656.90 $656.90 $328.45 $328.45 $520.26 $656.90 $525.52 $426.99 $656.90 N/A $381.06 $656.90 $394.14 $656.90 $656.90 $656.90 N/A N/A 48771610 SUP Custom 27203010 48771610 - BIT DRILL 2.5MM 10MM AVIATOR BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48771612 SUP Custom 27203010 48771612 - BIT DRILL 2.5MM 12MM AVIATOR BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48771614 SUP Custom 27203010 48771614 - BIT DRILL 2.5MM 14MM AVIATOR BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48771616 SUP Custom 27203010 48771616 - BIT DRILL 2.5MM 16MM AVIATOR BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 48811112 SUP HCPCS C1713 48811112 - PLATE BONE 12X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811114 SUP HCPCS C1713 48811114 - PLATE BONE 14X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811116 SUP HCPCS C1713 48811116 - PLATE BONE 16X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811118 SUP HCPCS C1713 48811118 - PLATE BONE 18X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811120 SUP HCPCS C1713 48811120 - PLATE BONE 20X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811122 SUP HCPCS C1713 48811122 - PLATE BONE 22X17.4X2.5MM LEVEL 1 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811224 SUP HCPCS C1713 48811224 - PLATE BONE 24X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811226 SUP HCPCS C1713 48811226 - PLATE BONE 26X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811228 SUP HCPCS C1713 48811228 - PLATE BONE 28X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811230 SUP HCPCS C1713 48811230 - PLATE BONE 30X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811232 SUP HCPCS C1713 48811232 - PLATE BONE 32X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811234 SUP HCPCS C1713 48811234 - PLATE BONE 34X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811237 SUP HCPCS C1713 48811237 - PLATE BONE 37X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811240 SUP HCPCS C1713 48811240 - PLATE BONE 40X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811243 SUP HCPCS C1713 48811243 - PLATE BONE 43X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811246 SUP HCPCS C1713 48811246 - PLATE BONE 46X17.4X2.5MM LEVEL 2 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 48811339 SUP HCPCS C1713 48811339 - PLATE BONE 39X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811342 SUP HCPCS C1713 48811342 - PLATE BONE 42X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811345 SUP HCPCS C1713 48811345 - PLATE BONE 45X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811348 SUP HCPCS C1713 48811348 - PLATE BONE 48X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811351 SUP HCPCS C1713 48811351 - PLATE BONE 51X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811354 SUP HCPCS C1713 48811354 - PLATE BONE 54X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811357 SUP HCPCS C1713 48811357 - PLATE BONE 57X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811360 SUP HCPCS C1713 48811360 - PLATE BONE 60X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811363 SUP HCPCS C1713 48811363 - PLATE BONE 63X17.4X2.5MM LEVEL 3 AUTO LOCK SYSTEM SPRING BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811366 SUP HCPCS C1713 48811366 - PLATE BONE 66MM LEVEL 3 AVIATOR SPN CERV ANTERIOR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811369 SUP HCPCS C1713 48811369 - PLATE BONE 69MM LEVEL 3 AVIATOR SPN CERV ANTERIOR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811456 SUP HCPCS C1713 48811456 - PLATE BONE 56MM LEVEL 4 AVIATOR SPN CERV ANTERIOR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811460 SUP HCPCS C1713 48811460 - PLATE BONE 60MM LEVEL 4 AVIATOR SPN CERV ANTERIOR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811464 SUP HCPCS C1713 48811464 - PLATE BONE 64MM LEVEL 4 AVIATOR SPN CERV ANTERIOR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811468 SUP HCPCS C1713 48811468 - PLATE BONE 68MM LEVEL 4 AVIATOR SPN CERV ANTERIOR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811472 SUP HCPCS C1713 48811472 - PLATE BONE 72MM LEVEL 4 AVIATOR SPN CERV ANTERIOR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811476 SUP HCPCS C1713 48811476 - PLATE BONE 76MM LEVEL 4 AVIATOR SPN CERV ANTERIOR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811480 SUP HCPCS C1713 48811480 - PLATE BONE 80MM LEVEL 4 AVIATOR SPN CERV ANTERIOR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811484 SUP HCPCS C1713 48811484 - PLATE BONE 84MM LEVEL 4 AVIATOR SPN CERV ANTERIOR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811488 SUP HCPCS C1713 48811488 - PLATE BONE 88MM LEVEL 4 AVIATOR SPN CERV ANTERIOR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811492 SUP HCPCS C1713 48811492 - PLATE BONE 92MM LEVEL 4 AVIATOR SPN CERV ANTERIOR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48811496 SUP HCPCS C1713 48811496 - PLATE BONE 96MM LEVEL 4 AVIATOR SPN CERV ANTERIOR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 48814010 SUP HCPCS C1713 48814010 - SCREW BONE 4MM 10MM VAR ANG SELF TAP AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48814012 SUP HCPCS C1713 48814012 - SCREW BONE 4MM 12MM VAR ANG SELF TAP AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48814014 SUP HCPCS C1713 48814014 - SCREW BONE 4MM 14MM VAR ANG SELF TAP AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48814016 SUP HCPCS C1713 48814016 - SCREW BONE 4MM 16MM VAR ANG SELF TAP AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48814018 SUP HCPCS C1713 48814018 - SCREW BONE 4MM 18MM VAR ANG SELF TAP AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48814512 SUP HCPCS C1713 48814512 - SCREW BONE 4.35MM 12MM VAR ANG SELF TAP AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48814514 SUP HCPCS C1713 48814514 - SCREW BONE 4.35MM 14MM VAR ANG SELF TAP AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48814516 SUP HCPCS C1713 48814516 - SCREW BONE 4.35MM 16MM VAR ANG SELF TAP AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48814518 SUP HCPCS C1713 48814518 - SCREW BONE 4.35MM 18MM VAR ANG SELF TAP AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48814520 SUP HCPCS C1713 48814520 - SCREW BONE 4.35MM 20MM VAR ANG SELF TAP AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48815540 SUP HCPCS C1713 48815540 - SCREW POLYAXIAL 5.5x40MM XIA CT BOTH IP/OP "$2,375.00" "$1,758.00" $471.38 "$2,375.00" "$1,068.75" "$1,068.75" "$1,068.75" "$1,068.75" "$2,375.00" "$2,375.00" "$2,375.00" $495.01 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" $950.00 "$1,404.81" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" $471.38 N/A "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" $494.95 "$2,375.00" N/A N/A 48824010 SUP HCPCS C1713 48824010 - SCREW BONE 4MM 10MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48824012 SUP HCPCS C1713 48824012 - SCREW BONE 4MM 12MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48824014 SUP HCPCS C1713 48824014 - SCREW BONE 4MM 14MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48824016 SUP HCPCS C1713 48824016 - SCREW BONE 4MM 16MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48824018 SUP HCPCS C1713 48824018 - SCREW BONE 4MM 18MM VAR ANG SELF DRILL AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 48834010 SUP HCPCS C1713 48834010 - SCREW BONE 4MM 10MM FIX ANGLE SELF TAP AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48834012 SUP HCPCS C1713 48834012 - SCREW BONE 4MM 12MM FIX ANGLE SELF TAP AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48834014 SUP HCPCS C1713 48834014 - SCREW BONE 4MM 14MM FIX ANGLE SELF TAP AVIATOR SPN CERV BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48834016 SUP HCPCS C1713 48834016 - SCREW BONE 4MM 16MM FIX ANGLE SELF TAP AVIATOR TITANIUM SPN BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48834018 SUP HCPCS C1713 48834018 - SCREW BONE 4MM 18MM SPNL FIX SLFDRILL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48834512 SUP HCPCS C1713 48834512 - SCREW BONE 4.35MM 12MM FIX ANGLE SELF TAP AVIATOR TITANIUM BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48834514 SUP HCPCS C1713 48834514 - SCREW BN 4.35MM 14MM AVTR ST FA SPNE BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48834516 SUP HCPCS C1713 48834516 - SCREW BONE 4.35MM 16MM FIX ANGLE SELF TAP AVIATOR TITANIUM BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48834518 SUP HCPCS C1713 48834518 - SCREW BONE 4.35MM 18MM SELF TAP FIX ANGLE AVIATOR SPN CERV BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48834520 SUP HCPCS C1713 48834520 - SCREW BONE 4.35MM 20MM SELF TAP FIX ANGLE AVIATOR SPN CERV BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48844010 SUP HCPCS C1713 48844010 - SCREW BONE 4MM 10MM FIX ANGLE SELF DRILL AVIATOR TITANIUM BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48844012 SUP HCPCS C1713 48844012 - SCREW BONE 4MM 12MM FIX ANGLE SELF DRILL AVIATOR TITANIUM BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48844014 SUP HCPCS C1713 48844014 - SCREW BONE 4MM 14MM FIX ANGLE SELF DRILL AVIATOR TITANIUM BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48844016 SUP HCPCS C1713 48844016 - SCREW BONE 4MM 16MM FIX ANGLE SELF DRILL AVIATOR TITANIUM BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48844018 SUP HCPCS C1713 48844018 - SCREW BONE 4MM 18MM SELF DRILL FIX ANGLE AVIATOR SPN CERV BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 48850000 SUP HCPCS C1713 48850000 - BLOCKER SPNL CORT XIA BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $50.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 48857535 SUP Custom 27203010 48857535 - XIA CT 05.0mmX35mm TAP MARKER BOTH IP/OP $407.00 $301.00 $72.37 $406.58 $406.58 $406.58 $406.58 $406.58 $406.58 $406.58 $72.37 $406.58 $406.58 $301.76 $301.76 $313.39 $211.83 $84.74 $406.58 $162.63 $406.58 $406.58 $406.58 $406.58 $406.58 $305.25 $406.58 $406.58 $406.58 $203.29 $203.29 $322.01 $406.58 $325.26 $264.28 $406.58 N/A $236.06 $406.58 $243.95 $406.58 $406.58 $406.58 N/A N/A 48858435 SUP Custom 27203010 48858435 - XIA CT 04.5mmX35mm TAP MARKER BOTH IP/OP $407.00 $301.00 $72.37 $406.58 $406.58 $406.58 $406.58 $406.58 $406.58 $406.58 $72.37 $406.58 $406.58 $301.76 $301.76 $313.39 $211.83 $84.74 $406.58 $162.63 $406.58 $406.58 $406.58 $406.58 $406.58 $305.25 $406.58 $406.58 $406.58 $203.29 $203.29 $322.01 $406.58 $325.26 $264.28 $406.58 N/A $236.06 $406.58 $243.95 $406.58 $406.58 $406.58 N/A N/A 48858535 SUP Custom 27203010 48858535 - XIA CT 05.5mmX35mm TAP MARKER BOTH IP/OP $407.00 $301.00 $72.37 $406.58 $406.58 $406.58 $406.58 $406.58 $406.58 $406.58 $72.37 $406.58 $406.58 $301.76 $301.76 $313.39 $211.83 $84.74 $406.58 $162.63 $406.58 $406.58 $406.58 $406.58 $406.58 $305.25 $406.58 $406.58 $406.58 $203.29 $203.29 $322.01 $406.58 $325.26 $264.28 $406.58 N/A $236.06 $406.58 $243.95 $406.58 $406.58 $406.58 N/A N/A 48900425 SUP HCPCS C1713 48900425 - SCREW BONE STANDARD POST 4.5MM 25MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48900430 SUP HCPCS C1713 48900430 - SCREW BONE STANDARD POST 4.5MM 30MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48900435 SUP HCPCS C1713 48900435 - SCREW BONE STANDARD POST 4.5MM 35MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48900440 SUP HCPCS C1713 48900440 - SCREW BONE STANDARD POST 4.5MM 40MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48900445 SUP HCPCS C1713 48900445 - SCREW BONE 4.5MM 45MM STANDARD POST TRIO SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48900450 SUP HCPCS C1713 48900450 - SCREW BONE 4.5MM 50MM STANDARD POST TRIO SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48900455 SUP HCPCS C1713 48900455 - SCREW BONE 4.5MM 55MM STANDARD POST TRIO SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48900525 SUP HCPCS C1713 48900525 - SCREW BONE STANDARD POST 5.5MM 25MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900530 SUP HCPCS C1713 48900530 - SCREW BONE STANDARD POST 5.5MM 30MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900535 SUP HCPCS C1713 48900535 - SCREW BONE STANDARD POST 5.5MM 35MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900540 SUP HCPCS C1713 48900540 - SCREW BONE STANDARD POST 5.5MM 40MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900545 SUP HCPCS C1713 48900545 - SCREW BONE STANDARD POST 5.5MM 45MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900550 SUP HCPCS C1713 48900550 - SCREW BONE STANDARD POST 5.5MM 50MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48900555 SUP HCPCS C1713 48900555 - SCREW BONE 5.5MM 55MM STANDARD POST TRIO SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 48900560 SUP HCPCS C1713 48900560 - SCREW BONE 5.5MM 60MM STANDARD POST TRIO SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 48900630 SUP HCPCS C1713 48900630 - SCREW BONE STANDARD POST 6.5MM 30MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900635 SUP HCPCS C1713 48900635 - SCREW BONE STANDARD POST 6.5MM 35MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48900640 SUP HCPCS C1713 48900640 - SCREW BONE STANDARD POST 6.5MM 40MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900645 SUP HCPCS C1713 48900645 - SCREW BONE STANDARD POST 6.5MM 45MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900650 SUP HCPCS C1713 48900650 - SCREW BONE STANDARD POST 6.5MM 50MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900655 SUP HCPCS C1713 48900655 - SCREW BONE STANDARD POST 6.5MM 55MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900660 SUP HCPCS C1713 48900660 - SCREW BONE STANDARD POST 6.5MM 60MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900730 SUP HCPCS C1713 48900730 - SCREW BONE STANDARD POST 7.5MM 30MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900735 SUP HCPCS C1713 48900735 - SCREW BONE STANDARD POST 7.5MM 35MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900740 SUP HCPCS C1713 48900740 - SCREW BONE STANDARD POST 7.5MM 40MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900745 SUP HCPCS C1713 48900745 - SCREW BONE STANDARD POST 7.5MM 45MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900750 SUP HCPCS C1713 48900750 - SCREW BONE STANDARD POST 7.5MM 50MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48900755 SUP HCPCS C1713 48900755 - SCREW BONE STANDARD POST 7.5MM 55MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48900760 SUP HCPCS C1713 48900760 - SCREW BONE STANDARD POST 7.5MM 60MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48900830 SUP HCPCS C1713 48900830 - SCREW BONE STANDARD POST 8.5MM 30MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48900835 SUP HCPCS C1713 48900835 - SCREW BONE STANDARD POST 8.5MM 35MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48900840 SUP HCPCS C1713 48900840 - SCREW BONE STANDARD POST 8.5MM 40MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48900845 SUP HCPCS C1713 48900845 - SCREW BONE STANDARD POST 8.5MM 45MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48900850 SUP HCPCS C1713 48900850 - SCREW BONE STANDARD POST 8.5MM 50MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48900855 SUP HCPCS C1713 48900855 - SCREW BONE STANDARD POST 8.5MM 55MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48900860 SUP HCPCS C1713 48900860 - SCREW BONE STANDARD POST 8.5MM 60MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48901640 SUP HCPCS C1713 48901640 - SCREW BONE LONG POST 6.5MM 40MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48901645 SUP HCPCS C1713 48901645 - SCREW BONE LONG POST 6.5MM 45MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48901650 SUP HCPCS C1713 48901650 - SCREW BONE LONG POST 6.5MM 50MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48901740 SUP HCPCS C1713 48901740 - SCREW BONE LONG POST 7.5MM 40MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48901745 SUP HCPCS C1713 48901745 - SCREW BONE LONG POST 7.5MM 45MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 48901750 SUP HCPCS C1713 48901750 - SCREW BONE LONG POST 7.5MM 50MM TITANIUM SPN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 48902015 SUP Custom 27803010 48902015 - CONNECTOR ROD SMALL OFFST UPGRADE TRIO SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48902025 SUP Custom 27803010 48902025 - CONNECTOR ROD MEDIUM LP SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48902035 SUP Custom 27803010 48902035 - CONNECTOR ROD LARGE LP OFFST SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48902040 SUP Custom 27803010 48902040 - CONNECTOR ROD 2 STEP LOCKING TITANIUM SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48902060 SUP Custom 27803010 48902060 - CONNECTOR ROD RIGHT OFFST BIASED SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48902070 SUP Custom 27803010 48902070 - CONNECTOR ROD LEFT BIASED OFFST TITANIUM SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 48910530 SUP HCPCS C1713 48910530 - SCREW BONE STANDARD POST 5.5MM 30MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" $771.00 "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910535 SUP HCPCS C1713 48910535 - SCREW BONE STANDARD POST 5.5MM 35MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" $514.00 $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" $771.00 "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910540 SUP HCPCS C1713 48910540 - SCREW BONE STANDARD POST 5.5MM 40MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" $514.00 $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" $771.00 "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910545 SUP HCPCS C1713 48910545 - SCREW BONE STANDARD POST 5.5MM 45MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" $514.00 $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" $771.00 "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910550 SUP HCPCS C1713 48910550 - SCREW BONE STANDARD POST 5.5MM 50MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" $771.00 "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910635 SUP HCPCS C1713 48910635 - SCREW BONE STANDARD POST 6.5MM 35MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910640 SUP HCPCS C1713 48910640 - SCREW BONE STANDARD POST 6.5MM 40MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910645 SUP HCPCS C1713 48910645 - SCREW BONE STANDARD POST 6.5MM 45MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" $771.00 "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910655 SUP HCPCS C1713 48910655 - SCREW BONE STANDARD POST 6.5MM 55MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" $514.00 $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910660 SUP HCPCS C1713 48910660 - SCREW BONE STANDARD POST 6.5MM 60MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" $514.00 $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" $771.00 "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910730 SUP HCPCS C1713 48910730 - SCREW BONE STANDARD POST 7.5MM 30MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" $514.00 $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" $771.00 "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910735 SUP HCPCS C1713 48910735 - SCREW BONE STANDARD POST 7.5MM 35MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910740 SUP HCPCS C1713 48910740 - SCREW BONE STANDARD POST 7.5MM 40MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910745 SUP HCPCS C1713 48910745 - SCREW BONE STANDARD POST 7.5MM 45MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910755 SUP HCPCS C1713 48910755 - SCREW BONE STANDARD POST 7.5MM 55MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" $771.00 "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910760 SUP HCPCS C1713 48910760 - SCREW BONE STANDARD POST 7.5MM 60MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" $771.00 "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910830 SUP HCPCS C1713 48910830 - SCREW BONE STANDARD POST 8.5MM 30MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" $514.00 $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910835 SUP HCPCS C1713 48910835 - SCREW BONE STANDARD POST 8.5MM 35MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" $514.00 $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" $771.00 "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910840 SUP HCPCS C1713 48910840 - SCREW BONE STANDARD POST 8.5MM 40MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" $514.00 $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" $771.00 "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910855 SUP HCPCS C1713 48910855 - SCREW BONE STANDARD POST 8.5MM 55MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" $771.00 "$1,285.00" $267.79 "$1,285.00" N/A N/A 48910860 SUP HCPCS C1713 48910860 - SCREW BONE STANDARD POST 8.5MM 60MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" $771.00 "$1,285.00" $267.79 "$1,285.00" N/A N/A 48911640 SUP HCPCS C1713 48911640 - SCREW BONE LONG POST 6.5MM 40MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 48911645 SUP HCPCS C1713 48911645 - SCREW BONE LONG POST 6.5MM 45MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 48911650 SUP HCPCS C1713 48911650 - SCREW BONE LONG POST 6.5MM 50MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 48911740 SUP HCPCS C1713 48911740 - SCREW BONE LONG POST 7.5MM 40MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 48911745 SUP HCPCS C1713 48911745 - SCREW BONE LONG POST 7.5MM 45MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 48911750 SUP HCPCS C1713 48911750 - SCREW BONE LONG POST 7.5MM 50MM TITANIUM SPN POSTERIOR BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 48912035 SUP HCPCS C1713 48912035 - PLATE BONE LORDOTIC 35MM POSTERIOR STABILIZE SPN BOTH IP/OP "$2,867.00" "$2,122.00" $568.93 "$2,866.53" "$1,289.94" "$1,289.94" "$1,289.94" "$1,289.94" "$2,866.53" "$2,866.53" "$2,866.53" $597.46 "$2,866.53" "$2,866.53" "$2,866.53" "$2,866.53" "$2,866.53" $597.42 "$2,866.53" "$1,146.61" "$1,413.20" "$2,866.53" "$2,866.53" "$2,866.53" "$2,866.53" "$2,150.25" "$2,866.53" "$2,866.53" "$2,866.53" "$1,433.27" "$1,433.27" "$2,270.29" "$2,866.53" "$2,293.22" "$1,289.94" $568.93 N/A "$1,662.86" "$2,866.53" "$2,866.53" "$2,866.53" $597.38 "$2,866.53" N/A N/A 48912040 SUP HCPCS C1713 48912040 - PLATE BONE LORDOTIC 40MM POSTERIOR STABILIZE SPN BOTH IP/OP "$2,867.00" "$2,122.00" $568.93 "$2,866.53" "$1,289.94" "$1,289.94" "$1,289.94" "$1,289.94" "$2,866.53" "$2,866.53" "$2,866.53" $597.46 "$2,866.53" "$2,866.53" "$2,866.53" "$2,866.53" "$2,866.53" $597.42 "$2,866.53" "$1,146.61" "$1,413.20" "$2,866.53" "$2,866.53" "$2,866.53" "$2,866.53" "$2,150.25" "$2,866.53" "$2,866.53" "$2,866.53" "$1,433.27" "$1,433.27" "$2,270.29" "$2,866.53" "$2,293.22" "$1,289.94" $568.93 N/A "$1,662.86" "$2,866.53" "$2,866.53" "$2,866.53" $597.38 "$2,866.53" N/A N/A 48912060 SUP HCPCS C1713 48912060 - PLATE BONE LORDOTIC 60MM POSTERIOR STABILIZE SPN BOTH IP/OP "$3,102.50" "$2,296.00" $615.75 "$3,102.43" "$1,396.09" "$1,396.09" "$1,396.09" "$1,396.09" "$3,102.43" "$3,102.43" "$3,102.43" $646.62 "$3,102.43" "$3,102.43" "$3,102.43" "$3,102.43" "$3,102.43" $646.58 "$3,102.43" "$1,240.97" "$1,529.50" "$3,102.43" "$3,102.43" "$3,102.43" "$3,102.43" "$2,326.88" "$3,102.43" "$3,102.43" "$3,102.43" "$1,551.22" "$1,551.22" "$2,457.12" "$3,102.43" "$2,481.94" "$1,396.09" $615.75 N/A "$1,799.45" "$3,102.43" "$1,861.46" "$3,102.43" $646.55 "$3,102.43" N/A N/A 48912070 SUP HCPCS C1713 48912070 - PLATE BONE LORDOTIC 70MM POSTERIOR STABILIZE SPN BOTH IP/OP "$3,102.50" "$2,296.00" $615.75 "$3,102.43" "$1,396.09" "$1,396.09" "$1,396.09" "$1,396.09" "$3,102.43" "$3,102.43" "$3,102.43" $646.62 "$3,102.43" "$3,102.43" "$3,102.43" "$3,102.43" "$3,102.43" $646.58 "$3,102.43" "$3,102.43" "$1,529.50" "$3,102.43" "$3,102.43" "$3,102.43" "$3,102.43" "$2,326.88" "$3,102.43" "$3,102.43" "$3,102.43" "$1,551.22" "$1,551.22" "$2,457.12" "$3,102.43" "$2,481.94" "$1,396.09" $615.75 N/A "$1,799.45" "$3,102.43" "$1,861.46" "$3,102.43" $646.55 "$3,102.43" N/A N/A 48912080 SUP HCPCS C1713 48912080 - PLATE BONE LORDOTIC 80MM POSTERIOR STABILIZE SPN BOTH IP/OP "$3,102.50" "$2,296.00" $615.75 "$3,102.43" "$1,396.09" "$1,396.09" "$1,396.09" "$1,396.09" "$3,102.43" "$3,102.43" "$3,102.43" $646.62 "$3,102.43" "$3,102.43" "$3,102.43" "$3,102.43" "$3,102.43" $646.58 "$3,102.43" "$3,102.43" "$1,529.50" "$3,102.43" "$3,102.43" "$3,102.43" "$3,102.43" "$2,326.88" "$3,102.43" "$3,102.43" "$3,102.43" "$1,551.22" "$1,551.22" "$2,457.12" "$3,102.43" "$2,481.94" "$1,396.09" $615.75 N/A "$1,799.45" "$3,102.43" "$1,861.46" "$3,102.43" $646.55 "$3,102.43" N/A N/A 48912090 SUP HCPCS C1713 48912090 - PLATE BONE LORDOTIC 90MM POSTERIOR STABILIZE SPN BOTH IP/OP "$3,102.50" "$2,296.00" $615.75 "$3,102.43" "$1,396.09" "$1,396.09" "$1,396.09" "$1,396.09" "$3,102.43" "$3,102.43" "$3,102.43" $646.62 "$3,102.43" "$3,102.43" "$3,102.43" "$3,102.43" "$3,102.43" $646.58 "$3,102.43" "$3,102.43" "$1,529.50" "$3,102.43" "$3,102.43" "$3,102.43" "$3,102.43" "$2,326.88" "$3,102.43" "$3,102.43" "$3,102.43" "$1,551.22" "$1,551.22" "$2,457.12" "$3,102.43" "$2,481.94" "$1,396.09" $615.75 N/A "$1,799.45" "$3,102.43" "$3,102.43" "$3,102.43" $646.55 "$3,102.43" N/A N/A 48912105 SUP HCPCS C1713 48912105 - PLATE BONE LORDOTIC 105MM POSTERIOR STABILIZE SPN BOTH IP/OP "$3,338.50" "$2,470.00" $662.58 "$3,338.33" "$1,502.25" "$1,502.25" "$1,502.25" "$1,502.25" "$3,338.33" "$3,338.33" "$3,338.33" $695.79 "$3,338.33" "$3,338.33" "$3,338.33" "$3,338.33" "$3,338.33" $695.74 "$3,338.33" "$1,335.33" "$1,645.80" "$3,338.33" "$3,338.33" "$3,338.33" "$3,338.33" "$2,503.88" "$3,338.33" "$3,338.33" "$3,338.33" "$1,669.17" "$1,669.17" "$2,643.96" "$3,338.33" "$2,670.66" "$1,502.25" $662.58 N/A "$1,936.33" "$3,338.33" "$3,338.33" "$3,338.33" $695.71 "$3,338.33" N/A N/A 48912120 SUP HCPCS C1713 48912120 - PLATE BONE LORDOTIC 120MM POSTERIOR STABILIZE SPN BOTH IP/OP "$3,338.50" "$2,470.00" $662.58 "$3,338.33" "$1,502.25" "$1,502.25" "$1,502.25" "$1,502.25" "$3,338.33" "$3,338.33" "$3,338.33" $695.79 "$3,338.33" "$3,338.33" "$3,338.33" "$3,338.33" "$3,338.33" $695.74 "$3,338.33" "$1,335.33" "$1,645.80" "$3,338.33" "$3,338.33" "$3,338.33" "$3,338.33" "$2,503.88" "$3,338.33" "$3,338.33" "$3,338.33" "$1,669.17" "$1,669.17" "$2,643.96" "$3,338.33" "$2,670.66" "$1,502.25" $662.58 N/A "$1,936.33" "$3,338.33" "$3,338.33" "$3,338.33" $695.71 "$3,338.33" N/A N/A 48912510 SUP Custom 27803010 48912510 - NUT LOCK HEXAGON 9MM POSTERIOR STABILIZE TITANIUM SPN BOTH IP/OP $294.50 $218.00 $52.38 $294.28 $294.28 $294.28 $294.28 $294.28 $294.28 $294.28 $52.38 $294.28 $294.28 $294.28 $294.28 $294.28 $294.28 $61.33 $294.28 $117.71 $294.28 $294.28 $294.28 $294.28 $294.28 $220.88 $294.28 $294.28 $294.28 $147.14 $147.14 $233.07 $294.28 $235.42 $132.43 $294.28 N/A $170.81 $294.28 $176.57 $294.28 $294.28 $294.28 N/A N/A 48912520 SUP HCPCS C1713 48912520 - PLATE BONE 20MM POSTERIOR STABILIZE BENDABLE SPN BOTH IP/OP $225.00 $167.00 $44.59 $224.65 $101.09 $101.09 $101.09 $101.09 $224.65 $224.65 $224.65 $46.82 $224.65 $224.65 $224.65 $224.65 $224.65 $46.82 $224.65 $89.86 $132.88 $224.65 $224.65 $224.65 $224.65 $168.75 $224.65 $224.65 $224.65 $112.33 $112.33 $177.92 $224.65 $179.72 $101.09 $44.59 N/A $130.50 $224.65 $134.79 $224.65 $46.82 $224.65 N/A N/A 48953112 SUP Custom 27803010 48953112 - CAGE SPNL 12D LRDTC 28X11X11MM STRL LF TRITANIUM PLIF BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 48955106 SUP Custom 27203010 48955106 - CAGE SPNL 6D LRDTC 28X11X10MM STRL LF TRITANIUM PLIF BOTH IP/OP "$5,500.00" "$4,070.00" $979.00 "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" $979.00 "$5,500.00" "$5,500.00" "$4,082.10" "$4,082.10" "$4,239.40" "$2,060.15" "$1,146.26" "$5,500.00" "$2,200.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$3,575.00" "$5,500.00" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$5,500.00" "$5,500.00" N/A N/A 48955126 SUP HCPCS C1713 48955126 - POSTERIOR LUMBAR CAGE 12MM X 28MM X 6 - 11MM BOTH IP/OP "$5,500.00" "$4,070.00" "$1,091.61" "$5,500.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.34" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$5,500.00" "$2,711.50" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$1,091.61" N/A "$3,190.00" "$5,500.00" "$3,300.00" "$5,500.00" "$1,146.20" "$5,500.00" N/A N/A 50506000 SUP Custom 27011340 050506000 - CONNECTOR PERFUSION 3/8INX3/8IN 3/8INX3/8IN STR EQUAL BOTH IP/OP $249.00 $184.00 $44.28 $248.78 $248.78 $248.78 $248.78 $248.78 $248.78 $248.78 $44.28 $248.78 $248.78 $184.64 $184.64 $191.76 $129.61 $51.85 $248.78 $99.51 $248.78 $248.78 $248.78 $248.78 $248.78 $186.75 $248.78 $248.78 $248.78 $124.39 $124.39 $197.03 $248.78 $199.02 $161.71 $248.78 N/A $144.42 $248.78 $149.27 $248.78 $248.78 $248.78 N/A N/A 50516000 SUP Custom 27011340 050516000 - CONNECTOR PRFSN .25IN 3/8IN STRL RDCR BOTH IP/OP $281.50 $208.00 $50.11 $281.50 $281.50 $281.50 $281.50 $281.50 $281.50 $281.50 $50.11 $281.50 $281.50 $208.93 $208.93 $216.98 $146.66 $58.67 $281.50 $112.60 $281.50 $281.50 $281.50 $281.50 $281.50 $211.13 $281.50 $281.50 $281.50 $140.75 $140.75 $222.95 $281.50 $225.20 $182.98 $281.50 N/A $163.27 $281.50 $168.90 $281.50 $281.50 $281.50 N/A N/A 50524000 SUP Custom 27011340 050524000 - CONNECTOR PRFSN .25IN X .25IN X .25IN STRL Y EQL BOTH IP/OP $11.50 $9.00 $2.01 $11.28 $11.28 $11.28 $11.28 $11.28 $11.28 $11.28 $2.01 $11.28 $11.28 $8.37 $8.37 $8.69 $5.88 $2.35 $11.28 $4.51 $11.28 $11.28 $11.28 $11.28 $11.28 $8.63 $11.28 $11.28 $11.28 $5.64 $5.64 $8.93 $11.28 $9.02 $7.33 $11.28 N/A $6.67 $11.28 $6.77 $11.28 $11.28 $11.28 N/A N/A 50529000 SUP Custom 27011340 050529000 - CONNECTOR PERFUSION 3/8IN Y 3/8IN .5IN REDUCING WYE STERILE BOTH IP/OP $22.50 $17.00 $3.99 $22.39 $22.39 $22.39 $22.39 $22.39 $22.39 $22.39 $3.99 $22.39 $22.39 $16.62 $16.62 $17.26 $11.67 $4.67 $22.39 $5.33 $22.39 $22.39 $13.33 $22.39 $22.39 $16.88 $22.39 $22.39 $22.39 $11.20 $11.20 $17.73 $22.39 $17.91 $14.55 $22.39 N/A $13.05 $22.39 $13.43 $22.39 $22.39 $22.39 N/A N/A 60060083 SUP Custom 27203010 60060083 - KIT PRSS MNTR CSTM TRNDCR RT HRT BOTH IP/OP $36.00 $27.00 $6.33 $35.57 $35.57 $35.57 $35.57 $35.57 $35.57 $35.57 $6.33 $35.57 $35.57 $26.40 $26.40 $27.42 $18.53 $7.41 $35.57 $14.23 $35.57 $35.57 $35.57 $35.57 $35.57 $27.00 $35.57 $35.57 $35.57 $17.79 $17.79 $28.17 $35.57 $28.46 $23.12 $35.57 N/A $20.88 $35.57 $21.34 $35.57 $35.57 $35.57 N/A N/A 65305001 SUP HCPCS C1762 65305001 - GRAFT BONE DBM 10ML SPNL BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" "$1,000.00" $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.40 "$1,000.00" N/A N/A 66020016 SUP Custom 27203010 66020016 - BANDAGE COMPRESSION 7.25+ IN 4IN MULTILAYER HIGH WOUND BOTH IP/OP $22.00 $16.00 $3.85 $97.58 $21.65 $21.65 $21.65 $21.65 $21.65 $21.65 $3.85 $21.65 $21.65 $16.07 $16.07 $16.69 $11.28 $4.51 $21.65 $39.03 $21.65 $21.65 $97.58 $21.65 $21.65 $16.50 $21.65 $21.65 $21.65 $10.83 $10.83 $17.15 $21.65 $17.32 $14.07 $21.65 N/A $12.76 $21.65 $12.99 $21.65 $21.65 $21.65 N/A N/A 66800433 SUP Custom 27203010 66800433 - DRESSING BRN 16X16IN STRL LF ACTCT FLX 3 ANMC BRR FLXB SFT BOTH IP/OP $151.00 $112.00 $26.81 $150.59 $150.59 $150.59 $150.59 $150.59 $150.59 $150.59 $26.81 $150.59 $150.59 $111.77 $111.77 $116.07 $78.46 $31.38 $150.59 $60.24 $150.59 $150.59 $150.59 $150.59 $150.59 $113.25 $150.59 $150.59 $150.59 $75.30 $75.30 $119.27 $150.59 $120.47 $97.88 $150.59 N/A $87.58 $150.59 $90.35 $150.59 $150.59 $150.59 N/A N/A 66800434 SUP Custom 27203010 66800434 - DRESSING BRN 48X4IN STRL LF ACTCT FLX 3 ANMC BRR 1 LYR KNIT BOTH IP/OP $179.50 $133.00 $31.90 $179.20 $179.20 $179.20 $179.20 $179.20 $179.20 $179.20 $31.90 $179.20 $179.20 $133.00 $133.00 $138.13 $93.36 $37.35 $179.20 $71.68 $179.20 $179.20 $179.20 $179.20 $179.20 $134.63 $179.20 $179.20 $179.20 $89.60 $89.60 $141.93 $179.20 $143.36 $116.48 $179.20 N/A $104.11 $179.20 $107.52 $179.20 $179.20 $179.20 N/A N/A 68304060 SUP Custom 27803010 68304060 - ROD SPINAL 4MM 60MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68304070 SUP Custom 27803010 68304070 - ROD SPINAL 4MM 70MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68304080 SUP Custom 27803010 68304080 - ROD SPINAL 4MM 80MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68304090 SUP Custom 27803010 68304090 - ROD SPINAL 4MM 90MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68304100 SUP Custom 27803010 68304100 - ROD SPINAL 4MM 100MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68304110 SUP Custom 27803010 68304110 - ROD SPINAL 4MM 110MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68304120 SUP Custom 27803010 68304120 - ROD SPINAL 4MM 120MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68304130 SUP Custom 27803010 68304130 - ROD SPINAL 4MM 130MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68304140 SUP Custom 27803010 68304140 - ROD SPINAL 4MM 140MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68304150 SUP Custom 27803010 68304150 - ROD SPINAL 4MM 150MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68304160 SUP Custom 27803010 68304160 - ROD SPINAL 4MM 160MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68306060 SUP Custom 27803010 68306060 - ROD SPINAL 6MM 60MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68306070 SUP Custom 27803010 68306070 - ROD SPINAL 6MM 70MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68306080 SUP Custom 27803010 68306080 - ROD SPINAL 6MM 80MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68306090 SUP Custom 27803010 68306090 - ROD SPINAL 6MM 90MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68306100 SUP Custom 27803010 68306100 - ROD SPINAL 6MM 100MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68306110 SUP Custom 27803010 68306110 - ROD SPINAL 6MM 110MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68306120 SUP Custom 27803010 68306120 - ROD SPINAL 6MM 120MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68306130 SUP Custom 27803010 68306130 - ROD SPINAL 6MM 130MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68306140 SUP Custom 27803010 68306140 - ROD SPINAL 6MM 140MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68306150 SUP Custom 27803010 68306150 - ROD SPINAL 6MM 150MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68306160 SUP Custom 27803010 68306160 - ROD SPINAL 6MM 160MM CENTAUR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 68415525 SUP HCPCS C1713 68415525 - SCREW BONE 5.5MM 25MM PLATE CENTAUR SPN BOTH IP/OP "$1,204.50" $891.00 $238.99 "$1,204.15" $541.87 $541.87 $541.87 $541.87 "$1,204.15" "$1,204.15" "$1,204.15" $250.97 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $250.96 "$1,204.15" "$1,204.15" $712.25 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $903.38 "$1,204.15" "$1,204.15" "$1,204.15" $602.08 $602.08 $953.69 "$1,204.15" $963.32 $541.87 $238.99 N/A $698.61 "$1,204.15" "$1,204.15" "$1,204.15" $250.94 "$1,204.15" N/A N/A 68415530 SUP HCPCS C1713 68415530 - SCREW BONE 5.5MM 30MM PLATE CENTAUR SPN BOTH IP/OP "$1,204.50" $891.00 $238.99 "$1,204.15" $541.87 $541.87 $541.87 $541.87 "$1,204.15" "$1,204.15" "$1,204.15" $250.97 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $250.96 "$1,204.15" "$1,204.15" $712.25 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $903.38 "$1,204.15" "$1,204.15" "$1,204.15" $602.08 $602.08 $953.69 "$1,204.15" $963.32 $541.87 $238.99 N/A $698.61 "$1,204.15" "$1,204.15" "$1,204.15" $250.94 "$1,204.15" N/A N/A 68415535 SUP HCPCS C1713 68415535 - SCREW BONE 5.5MM 35MM PLATE CENTAUR SPN BOTH IP/OP "$1,204.50" $891.00 $238.99 "$1,204.15" $541.87 $541.87 $541.87 $541.87 "$1,204.15" "$1,204.15" "$1,204.15" $250.97 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $250.96 "$1,204.15" "$1,204.15" $712.25 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $903.38 "$1,204.15" "$1,204.15" "$1,204.15" $602.08 $602.08 $953.69 "$1,204.15" $963.32 $541.87 $238.99 N/A $698.61 "$1,204.15" "$1,204.15" "$1,204.15" $250.94 "$1,204.15" N/A N/A 68415540 SUP HCPCS C1713 68415540 - SCREW BONE 5.5MM 40MM PLATE CENTAUR SPN BOTH IP/OP "$1,204.50" $891.00 $238.99 "$1,204.15" $541.87 $541.87 $541.87 $541.87 "$1,204.15" "$1,204.15" "$1,204.15" $250.97 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $250.96 "$1,204.15" "$1,204.15" $712.25 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $903.38 "$1,204.15" "$1,204.15" "$1,204.15" $602.08 $602.08 $953.69 "$1,204.15" $963.32 $541.87 $238.99 N/A $698.61 "$1,204.15" "$1,204.15" "$1,204.15" $250.94 "$1,204.15" N/A N/A 68415545 SUP HCPCS C1713 68415545 - SCREW BONE 5.5MM 45MM PLATE CENTAUR SPN BOTH IP/OP "$1,204.50" $891.00 $238.99 "$1,204.15" $541.87 $541.87 $541.87 $541.87 "$1,204.15" "$1,204.15" "$1,204.15" $250.97 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $250.96 "$1,204.15" "$1,204.15" $712.25 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $903.38 "$1,204.15" "$1,204.15" "$1,204.15" $602.08 $602.08 $953.69 "$1,204.15" $963.32 $541.87 $238.99 N/A $698.61 "$1,204.15" "$1,204.15" "$1,204.15" $250.94 "$1,204.15" N/A N/A 68415550 SUP HCPCS C1713 68415550 - SCREW BONE 5.5MM 50MM PLATE CENTAUR SPN BOTH IP/OP "$1,204.50" $891.00 $238.99 "$1,204.15" $541.87 $541.87 $541.87 $541.87 "$1,204.15" "$1,204.15" "$1,204.15" $250.97 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $250.96 "$1,204.15" "$1,204.15" $712.25 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $903.38 "$1,204.15" "$1,204.15" "$1,204.15" $602.08 $602.08 $953.69 "$1,204.15" $963.32 $541.87 $238.99 N/A $698.61 "$1,204.15" "$1,204.15" "$1,204.15" $250.94 "$1,204.15" N/A N/A 68415555 SUP HCPCS C1713 68415555 - SCREW BONE 5.5MM 55MM PLATE CENTAUR SPN BOTH IP/OP "$1,204.50" $891.00 $238.99 "$1,204.15" $541.87 $541.87 $541.87 $541.87 "$1,204.15" "$1,204.15" "$1,204.15" $250.97 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $250.96 "$1,204.15" "$1,204.15" $712.25 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $903.38 "$1,204.15" "$1,204.15" "$1,204.15" $602.08 $602.08 $953.69 "$1,204.15" $963.32 $541.87 $238.99 N/A $698.61 "$1,204.15" "$1,204.15" "$1,204.15" $250.94 "$1,204.15" N/A N/A 68417025 SUP HCPCS C1713 68417025 - SCREW BONE 7MM 25MM PLATE CENTAUR SPN BOTH IP/OP "$1,204.50" $891.00 $238.99 "$1,204.15" $541.87 $541.87 $541.87 $541.87 "$1,204.15" "$1,204.15" "$1,204.15" $250.97 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $250.96 "$1,204.15" "$1,204.15" $712.25 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $903.38 "$1,204.15" "$1,204.15" "$1,204.15" $602.08 $602.08 $953.69 "$1,204.15" $963.32 $541.87 $238.99 N/A $698.61 "$1,204.15" "$1,204.15" "$1,204.15" $250.94 "$1,204.15" N/A N/A 68417030 SUP HCPCS C1713 68417030 - SCREW BONE 7MM 30MM PLATE CENTAUR SPN BOTH IP/OP "$1,204.50" $891.00 $238.99 "$1,204.15" $541.87 $541.87 $541.87 $541.87 "$1,204.15" "$1,204.15" "$1,204.15" $250.97 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $250.96 "$1,204.15" "$1,204.15" $712.25 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $903.38 "$1,204.15" "$1,204.15" "$1,204.15" $602.08 $602.08 $953.69 "$1,204.15" $963.32 $541.87 $238.99 N/A $698.61 "$1,204.15" $722.49 "$1,204.15" $250.94 "$1,204.15" N/A N/A 68417035 SUP HCPCS C1713 68417035 - SCREW BONE 7MM 35MM PLATE CENTAUR SPN BOTH IP/OP "$1,204.50" $891.00 $238.99 "$1,204.15" $541.87 $541.87 $541.87 $541.87 "$1,204.15" "$1,204.15" "$1,204.15" $250.97 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $250.96 "$1,204.15" "$1,204.15" $712.25 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $903.38 "$1,204.15" "$1,204.15" "$1,204.15" $602.08 $602.08 $953.69 "$1,204.15" $963.32 $541.87 $238.99 N/A $698.61 "$1,204.15" $722.49 "$1,204.15" $250.94 "$1,204.15" N/A N/A 68417040 SUP HCPCS C1713 68417040 - SCREW BONE 7MM 40MM PLATE CENTAUR SPN BOTH IP/OP "$1,204.50" $891.00 $238.99 "$1,204.15" $541.87 $541.87 $541.87 $541.87 "$1,204.15" "$1,204.15" "$1,204.15" $250.97 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $250.96 "$1,204.15" "$1,204.15" $712.25 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $903.38 "$1,204.15" "$1,204.15" "$1,204.15" $602.08 $602.08 $953.69 "$1,204.15" $963.32 $541.87 $238.99 N/A $698.61 "$1,204.15" "$1,204.15" "$1,204.15" $250.94 "$1,204.15" N/A N/A 68417045 SUP HCPCS C1713 68417045 - SCREW BONE 7MM 45MM PLATE CENTAUR SPN BOTH IP/OP "$1,204.50" $891.00 $238.99 "$1,204.15" $541.87 $541.87 $541.87 $541.87 "$1,204.15" "$1,204.15" "$1,204.15" $250.97 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $250.96 "$1,204.15" "$1,204.15" $712.25 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $903.38 "$1,204.15" "$1,204.15" "$1,204.15" $602.08 $602.08 $953.69 "$1,204.15" $963.32 $541.87 $238.99 N/A $698.61 "$1,204.15" $722.49 "$1,204.15" $250.94 "$1,204.15" N/A N/A 68417050 SUP HCPCS C1713 68417050 - SCREW BONE 7MM 50MM PLATE CENTAUR SPN BOTH IP/OP "$1,204.50" $891.00 $238.99 "$1,204.15" $541.87 $541.87 $541.87 $541.87 "$1,204.15" "$1,204.15" "$1,204.15" $250.97 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $250.96 "$1,204.15" $481.66 $712.25 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $903.38 "$1,204.15" "$1,204.15" "$1,204.15" $602.08 $602.08 $953.69 "$1,204.15" $963.32 $541.87 $238.99 N/A $698.61 "$1,204.15" $722.49 "$1,204.15" $250.94 "$1,204.15" N/A N/A 68417055 SUP HCPCS C1713 68417055 - SCREW BONE 7MM 55MM PLATE CENTAUR SPN BOTH IP/OP "$1,204.50" $891.00 $238.99 "$1,204.15" $541.87 $541.87 $541.87 $541.87 "$1,204.15" "$1,204.15" "$1,204.15" $250.97 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $250.96 "$1,204.15" $481.66 $712.25 "$1,204.15" "$1,204.15" "$1,204.15" "$1,204.15" $903.38 "$1,204.15" "$1,204.15" "$1,204.15" $602.08 $602.08 $953.69 "$1,204.15" $963.32 $541.87 $238.99 N/A $698.61 "$1,204.15" $722.49 "$1,204.15" $250.94 "$1,204.15" N/A N/A 68420000 SUP HCPCS C1713 68420000 - PLATE BONE SUPPORT CENTAUR SPN BOTH IP/OP $355.00 $263.00 $70.45 $354.95 $159.73 $159.73 $159.73 $159.73 $354.95 $354.95 $354.95 $73.98 $354.95 $354.95 $354.95 $354.95 $354.95 $73.98 $354.95 $141.98 $209.95 $354.95 $354.95 $354.95 $354.95 $266.25 $354.95 $354.95 $354.95 $177.48 $177.48 $281.12 $354.95 $283.96 $159.73 $70.45 N/A $205.90 $354.95 $212.97 $354.95 $73.97 $354.95 N/A N/A 68425525 SUP HCPCS C1713 68425525 - BOLT SPINAL 5.5MM 25MM CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $276.45 "$1,392.85" $626.78 $626.78 $626.78 $626.78 "$1,392.85" "$1,392.85" "$1,392.85" $290.30 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 $823.87 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 $276.45 N/A $807.94 "$1,392.85" $835.71 "$1,392.85" $290.27 "$1,392.85" N/A N/A 68425530 SUP HCPCS C1713 68425530 - BOLT SPINAL 5.5MM 30MM CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $276.45 "$1,392.85" $626.78 $626.78 $626.78 $626.78 "$1,392.85" "$1,392.85" "$1,392.85" $290.30 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 $823.87 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 $276.45 N/A $807.94 "$1,392.85" "$1,392.85" "$1,392.85" $290.27 "$1,392.85" N/A N/A 68425535 SUP HCPCS C1713 68425535 - BOLT SPINAL 5.5MM 35MM CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $276.45 "$1,392.85" $626.78 $626.78 $626.78 $626.78 "$1,392.85" "$1,392.85" "$1,392.85" $290.30 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 $823.87 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 $276.45 N/A $807.94 "$1,392.85" "$1,392.85" "$1,392.85" $290.27 "$1,392.85" N/A N/A 68425540 SUP HCPCS C1713 68425540 - BOLT SPINAL 5.5MM 40MM CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $276.45 "$1,392.85" $626.78 $626.78 $626.78 $626.78 "$1,392.85" "$1,392.85" "$1,392.85" $290.30 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 $823.87 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 $276.45 N/A $807.94 "$1,392.85" $835.71 "$1,392.85" $290.27 "$1,392.85" N/A N/A 68425545 SUP HCPCS C1713 68425545 - BOLT SPINAL 5.5MM 45MM CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $276.45 "$1,392.85" $626.78 $626.78 $626.78 $626.78 "$1,392.85" "$1,392.85" "$1,392.85" $290.30 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 $823.87 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 $276.45 N/A $807.94 "$1,392.85" $835.71 "$1,392.85" $290.27 "$1,392.85" N/A N/A 68425550 SUP HCPCS C1713 68425550 - BOLT SPINAL 5.5MM 50MM CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $276.45 "$1,392.85" $626.78 $626.78 $626.78 $626.78 "$1,392.85" "$1,392.85" "$1,392.85" $290.30 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 $823.87 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 $276.45 N/A $807.94 "$1,392.85" $835.71 "$1,392.85" $290.27 "$1,392.85" N/A N/A 68425555 SUP HCPCS C1713 68425555 - BOLT SPINAL 5.5MM 55MM CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $276.45 "$1,392.85" $626.78 $626.78 $626.78 $626.78 "$1,392.85" "$1,392.85" "$1,392.85" $290.30 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 $823.87 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 $276.45 N/A $807.94 "$1,392.85" $835.71 "$1,392.85" $290.27 "$1,392.85" N/A N/A 68427025 SUP HCPCS C1713 68427025 - BOLT SPINAL 7MM 25MM CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $276.45 "$1,392.85" $626.78 $626.78 $626.78 $626.78 "$1,392.85" "$1,392.85" "$1,392.85" $290.30 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 $823.87 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 $276.45 N/A $807.94 "$1,392.85" "$1,392.85" "$1,392.85" $290.27 "$1,392.85" N/A N/A 68427030 SUP HCPCS C1713 68427030 - BOLT SPINAL 7MM 30MM CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $276.45 "$1,392.85" $626.78 $626.78 $626.78 $626.78 "$1,392.85" "$1,392.85" "$1,392.85" $290.30 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" "$1,392.85" $823.87 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 $276.45 N/A $807.94 "$1,392.85" "$1,392.85" "$1,392.85" $290.27 "$1,392.85" N/A N/A 68427035 SUP HCPCS C1713 68427035 - BOLT SPINAL 7MM 35MM CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $276.45 "$1,392.85" $626.78 $626.78 $626.78 $626.78 "$1,392.85" "$1,392.85" "$1,392.85" $290.30 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" "$1,392.85" $823.87 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 $276.45 N/A $807.94 "$1,392.85" "$1,392.85" "$1,392.85" $290.27 "$1,392.85" N/A N/A 68427040 SUP HCPCS C1713 68427040 - BOLT SPINAL 7MM 40MM CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $276.45 "$1,392.85" $626.78 $626.78 $626.78 $626.78 "$1,392.85" "$1,392.85" "$1,392.85" $290.30 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" "$1,392.85" $823.87 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 $276.45 N/A $807.94 "$1,392.85" "$1,392.85" "$1,392.85" $290.27 "$1,392.85" N/A N/A 68427045 SUP HCPCS C1713 68427045 - BOLT SPINAL 7MM 45MM CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $276.45 "$1,392.85" $626.78 $626.78 $626.78 $626.78 "$1,392.85" "$1,392.85" "$1,392.85" $290.30 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" "$1,392.85" $823.87 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 $276.45 N/A $807.94 "$1,392.85" $835.71 "$1,392.85" $290.27 "$1,392.85" N/A N/A 68427050 SUP HCPCS C1713 68427050 - BOLT SPINAL 7MM 50MM CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $276.45 "$1,392.85" $626.78 $626.78 $626.78 $626.78 "$1,392.85" "$1,392.85" "$1,392.85" $290.30 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" "$1,392.85" $823.87 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 $276.45 N/A $807.94 "$1,392.85" $835.71 "$1,392.85" $290.27 "$1,392.85" N/A N/A 68427055 SUP HCPCS C1713 68427055 - BOLT SPINAL 7MM 55MM CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $276.45 "$1,392.85" $626.78 $626.78 $626.78 $626.78 "$1,392.85" "$1,392.85" "$1,392.85" $290.30 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" "$1,392.85" $823.87 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 $276.45 N/A $807.94 "$1,392.85" $835.71 "$1,392.85" $290.27 "$1,392.85" N/A N/A 68430000 SUP Custom 27803010 68430000 - CONNECTOR ROD SET CENTAUR SPN BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 68435525 SUP Custom 27803010 68435525 - BOLT SPINAL 5.5MM 25MM ROD CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 "$1,392.85" N/A $807.94 "$1,392.85" $835.71 "$1,392.85" "$1,392.85" "$1,392.85" N/A N/A 68435530 SUP Custom 27803010 68435530 - BOLT SPINAL 5.5MM 30MM ROD CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 "$1,392.85" N/A $807.94 "$1,392.85" $835.71 "$1,392.85" "$1,392.85" "$1,392.85" N/A N/A 68435535 SUP Custom 27803010 68435535 - BOLT SPINAL 5.5MM 35MM ROD CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 "$1,392.85" N/A $807.94 "$1,392.85" $835.71 "$1,392.85" "$1,392.85" "$1,392.85" N/A N/A 68435540 SUP Custom 27803010 68435540 - BOLT SPINAL 5.5MM 40MM ROD CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 "$1,392.85" N/A $807.94 "$1,392.85" $835.71 "$1,392.85" "$1,392.85" "$1,392.85" N/A N/A 68435545 SUP Custom 27803010 68435545 - BOLT SPINAL 5.5MM 45MM ROD CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 "$1,392.85" N/A $807.94 "$1,392.85" $835.71 "$1,392.85" "$1,392.85" "$1,392.85" N/A N/A 68435550 SUP Custom 27803010 68435550 - BOLT SPINAL 5.5MM 50MM ROD CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 "$1,392.85" N/A $807.94 "$1,392.85" $835.71 "$1,392.85" "$1,392.85" "$1,392.85" N/A N/A 68435555 SUP Custom 27803010 68435555 - BOLT SPINAL 5.5MM 55MM ROD CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 "$1,392.85" N/A $807.94 "$1,392.85" $835.71 "$1,392.85" "$1,392.85" "$1,392.85" N/A N/A 68437025 SUP Custom 27803010 68437025 - BOLT SPINAL 7MM 25MM ROD CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 "$1,392.85" N/A $807.94 "$1,392.85" $835.71 "$1,392.85" "$1,392.85" "$1,392.85" N/A N/A 68437030 SUP Custom 27803010 68437030 - BOLT SPINAL 7MM 30MM ROD CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 "$1,392.85" N/A $807.94 "$1,392.85" $835.71 "$1,392.85" "$1,392.85" "$1,392.85" N/A N/A 68437035 SUP Custom 27803010 68437035 - BOLT SPINAL 7MM 35MM ROD CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 "$1,392.85" N/A $807.94 "$1,392.85" $835.71 "$1,392.85" "$1,392.85" "$1,392.85" N/A N/A 68437040 SUP Custom 27803010 68437040 - BOLT SPINAL 7MM 40MM ROD CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 "$1,392.85" N/A $807.94 "$1,392.85" $835.71 "$1,392.85" "$1,392.85" "$1,392.85" N/A N/A 68437045 SUP Custom 27803010 68437045 - BOLT SPINAL 7MM 45MM ROD CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 "$1,392.85" N/A $807.94 "$1,392.85" $835.71 "$1,392.85" "$1,392.85" "$1,392.85" N/A N/A 68437050 SUP Custom 27803010 68437050 - BOLT SPINAL 7MM 50MM ROD CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 "$1,392.85" N/A $807.94 "$1,392.85" $835.71 "$1,392.85" "$1,392.85" "$1,392.85" N/A N/A 68437055 SUP Custom 27803010 68437055 - BOLT SPINAL 7MM 55MM ROD CENTAUR BOTH IP/OP "$1,393.00" "$1,031.00" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $247.93 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" $290.29 "$1,392.85" $557.14 "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,392.85" "$1,044.75" "$1,392.85" "$1,392.85" "$1,392.85" $696.43 $696.43 "$1,103.14" "$1,392.85" "$1,114.28" $626.78 "$1,392.85" N/A $807.94 "$1,392.85" $835.71 "$1,392.85" "$1,392.85" "$1,392.85" N/A N/A 68470030 SUP HCPCS C1713 68470030 - PLATE BONE STR 30MM CENTAUR SPN BOTH IP/OP "$6,274.50" "$4,643.00" "$1,245.33" "$6,274.48" "$2,823.52" "$2,823.52" "$2,823.52" "$2,823.52" "$6,274.48" "$6,274.48" "$6,274.48" "$1,307.76" "$6,274.48" "$6,274.48" "$6,274.48" "$6,274.48" "$6,274.48" "$1,307.67" "$6,274.48" "$6,274.48" "$3,093.32" "$6,274.48" "$6,274.48" "$6,274.48" "$6,274.48" "$4,705.88" "$6,274.48" "$6,274.48" "$6,274.48" "$3,137.24" "$3,137.24" "$4,969.39" "$6,274.48" "$5,019.58" "$2,823.52" "$1,245.33" N/A "$3,639.21" "$6,274.48" "$6,274.48" "$6,274.48" "$1,307.60" "$6,274.48" N/A N/A 68470040 SUP HCPCS C1713 68470040 - PLATE BONE STR 40MM CENTAUR SPN BOTH IP/OP "$6,274.50" "$4,643.00" "$1,245.33" "$6,274.48" "$2,823.52" "$2,823.52" "$2,823.52" "$2,823.52" "$6,274.48" "$6,274.48" "$6,274.48" "$1,307.76" "$6,274.48" "$6,274.48" "$6,274.48" "$6,274.48" "$6,274.48" "$1,307.67" "$6,274.48" "$2,509.79" "$3,093.32" "$6,274.48" "$6,274.48" "$6,274.48" "$6,274.48" "$4,705.88" "$6,274.48" "$6,274.48" "$6,274.48" "$3,137.24" "$3,137.24" "$4,969.39" "$6,274.48" "$5,019.58" "$2,823.52" "$1,245.33" N/A "$3,639.21" "$6,274.48" "$6,274.48" "$6,274.48" "$1,307.60" "$6,274.48" N/A N/A 68470050 SUP HCPCS C1713 68470050 - PLATE BONE STR 50MM CENTAUR SPN BOTH IP/OP "$6,724.00" "$4,976.00" "$1,334.50" "$6,723.78" "$3,025.70" "$3,025.70" "$3,025.70" "$3,025.70" "$6,723.78" "$6,723.78" "$6,723.78" "$1,401.40" "$6,723.78" "$6,723.78" "$6,723.78" "$6,723.78" "$6,723.78" "$1,401.31" "$6,723.78" "$6,723.78" "$3,314.82" "$6,723.78" "$6,723.78" "$6,723.78" "$6,723.78" "$5,043.00" "$6,723.78" "$6,723.78" "$6,723.78" "$3,361.89" "$3,361.89" "$5,325.23" "$6,723.78" "$5,379.02" "$3,025.70" "$1,334.50" N/A "$3,899.92" "$6,723.78" "$6,723.78" "$6,723.78" "$1,401.24" "$6,723.78" N/A N/A 68470060 SUP HCPCS C1713 68470060 - PLATE BONE STR 60MM CENTAUR SPN BOTH IP/OP "$6,724.00" "$4,976.00" "$1,334.50" "$6,723.78" "$3,025.70" "$3,025.70" "$3,025.70" "$3,025.70" "$6,723.78" "$6,723.78" "$6,723.78" "$1,401.40" "$6,723.78" "$6,723.78" "$6,723.78" "$6,723.78" "$6,723.78" "$1,401.31" "$6,723.78" "$2,689.51" "$3,314.82" "$6,723.78" "$6,723.78" "$6,723.78" "$6,723.78" "$5,043.00" "$6,723.78" "$6,723.78" "$6,723.78" "$3,361.89" "$3,361.89" "$5,325.23" "$6,723.78" "$5,379.02" "$3,025.70" "$1,334.50" N/A "$3,899.92" "$6,723.78" "$6,723.78" "$6,723.78" "$1,401.24" "$6,723.78" N/A N/A 68470070 SUP HCPCS C1713 68470070 - PLATE BONE STR 70MM CENTAUR SPN BOTH IP/OP "$7,007.00" "$5,185.00" "$1,390.68" "$7,006.85" "$3,153.08" "$3,153.08" "$3,153.08" "$3,153.08" "$7,006.85" "$7,006.85" "$7,006.85" "$1,460.40" "$7,006.85" "$7,006.85" "$7,006.85" "$7,006.85" "$7,006.85" "$1,460.30" "$7,006.85" "$7,006.85" "$3,454.38" "$7,006.85" "$7,006.85" "$7,006.85" "$7,006.85" "$5,255.25" "$7,006.85" "$7,006.85" "$7,006.85" "$3,503.43" "$3,503.43" "$5,549.43" "$7,006.85" "$5,605.48" "$3,153.08" "$1,390.68" N/A "$4,064.06" "$7,006.85" "$7,006.85" "$7,006.85" "$1,460.23" "$7,006.85" N/A N/A 68470080 SUP HCPCS C1713 68470080 - PLATE BONE STR 80MM CENTAUR SPN BOTH IP/OP "$7,007.00" "$5,185.00" "$1,390.68" "$7,006.85" "$3,153.08" "$3,153.08" "$3,153.08" "$3,153.08" "$7,006.85" "$7,006.85" "$7,006.85" "$1,460.40" "$7,006.85" "$7,006.85" "$7,006.85" "$7,006.85" "$7,006.85" "$1,460.30" "$7,006.85" "$2,802.74" "$3,454.38" "$7,006.85" "$7,006.85" "$7,006.85" "$7,006.85" "$5,255.25" "$7,006.85" "$7,006.85" "$7,006.85" "$3,503.43" "$3,503.43" "$5,549.43" "$7,006.85" "$5,605.48" "$3,153.08" "$1,390.68" N/A "$4,064.06" "$7,006.85" "$7,006.85" "$7,006.85" "$1,460.23" "$7,006.85" N/A N/A 68470090 SUP HCPCS C1713 68470090 - PLATE BONE STR 90MM CENTAUR SPN BOTH IP/OP "$7,465.50" "$5,524.00" "$1,481.64" "$7,465.13" "$3,359.31" "$3,359.31" "$3,359.31" "$3,359.31" "$7,465.13" "$7,465.13" "$7,465.13" "$1,555.92" "$7,465.13" "$7,465.13" "$7,465.13" "$7,465.13" "$7,465.13" "$1,555.82" "$7,465.13" "$7,465.13" "$3,680.31" "$7,465.13" "$7,465.13" "$7,465.13" "$7,465.13" "$5,599.13" "$7,465.13" "$7,465.13" "$7,465.13" "$3,732.57" "$3,732.57" "$5,912.38" "$7,465.13" "$5,972.10" "$3,359.31" "$1,481.64" N/A "$4,329.99" "$7,465.13" "$7,465.13" "$7,465.13" "$1,555.73" "$7,465.13" N/A N/A 68480060 SUP HCPCS C1713 68480060 - PLATE BONE LORDOTIC 60MM CENTAUR SPN BOTH IP/OP "$4,954.00" "$3,666.00" $983.15 "$4,953.53" "$2,229.09" "$2,229.09" "$2,229.09" "$2,229.09" "$4,953.53" "$4,953.53" "$4,953.53" "$1,032.44" "$4,953.53" "$4,953.53" "$4,953.53" "$4,953.53" "$4,953.53" "$1,032.37" "$4,953.53" "$1,981.41" "$2,442.09" "$4,953.53" "$4,953.53" "$4,953.53" "$4,953.53" "$3,715.50" "$4,953.53" "$4,953.53" "$4,953.53" "$2,476.77" "$2,476.77" "$3,923.20" "$4,953.53" "$3,962.82" "$2,229.09" $983.15 N/A "$2,873.32" "$4,953.53" "$4,953.53" "$4,953.53" "$1,032.32" "$4,953.53" N/A N/A 68480070 SUP HCPCS C1713 68480070 - PLATE BONE LORDOTIC 70MM CENTAUR SPN BOTH IP/OP "$5,167.00" "$3,824.00" "$1,025.52" "$5,166.98" "$2,325.14" "$2,325.14" "$2,325.14" "$2,325.14" "$5,166.98" "$5,166.98" "$5,166.98" "$1,076.93" "$5,166.98" "$5,166.98" "$5,166.98" "$5,166.98" "$5,166.98" "$1,076.86" "$5,166.98" "$5,166.98" "$2,547.32" "$5,166.98" "$5,166.98" "$5,166.98" "$5,166.98" "$3,875.25" "$5,166.98" "$5,166.98" "$5,166.98" "$2,583.49" "$2,583.49" "$4,092.25" "$5,166.98" "$4,133.58" "$2,325.14" "$1,025.52" N/A "$2,996.86" "$5,166.98" "$5,166.98" "$5,166.98" "$1,076.80" "$5,166.98" N/A N/A 68480080 SUP HCPCS C1713 68480080 - PLATE BONE LORDOTIC 80MM CENTAUR SPN BOTH IP/OP "$5,367.00" "$3,972.00" "$1,065.19" "$5,366.88" "$2,415.10" "$2,415.10" "$2,415.10" "$2,415.10" "$5,366.88" "$5,366.88" "$5,366.88" "$1,118.59" "$5,366.88" "$5,366.88" "$5,366.88" "$5,366.88" "$5,366.88" "$1,118.52" "$5,366.88" "$2,146.75" "$2,645.87" "$5,366.88" "$5,366.88" "$5,366.88" "$5,366.88" "$4,025.25" "$5,366.88" "$5,366.88" "$5,366.88" "$2,683.44" "$2,683.44" "$4,250.57" "$5,366.88" "$4,293.50" "$2,415.10" "$1,065.19" N/A "$3,112.86" "$5,366.88" "$5,366.88" "$5,366.88" "$1,118.46" "$5,366.88" N/A N/A 68480090 SUP HCPCS C1713 68480090 - PLATE BONE LORDOTIC 90MM CENTAUR SPN BOTH IP/OP "$5,367.00" "$3,972.00" "$1,065.19" "$5,366.88" "$2,415.10" "$2,415.10" "$2,415.10" "$2,415.10" "$5,366.88" "$5,366.88" "$5,366.88" "$1,118.59" "$5,366.88" "$5,366.88" "$5,366.88" "$5,366.88" "$5,366.88" "$1,118.52" "$5,366.88" "$5,366.88" "$2,645.87" "$5,366.88" "$5,366.88" "$5,366.88" "$5,366.88" "$4,025.25" "$5,366.88" "$5,366.88" "$5,366.88" "$2,683.44" "$2,683.44" "$4,250.57" "$5,366.88" "$4,293.50" "$2,415.10" "$1,065.19" N/A "$3,112.86" "$5,366.88" "$5,366.88" "$5,366.88" "$1,118.46" "$5,366.88" N/A N/A 68490050 SUP HCPCS C1713 68490050 - PLATE BONE KYPHOSIS 50MM CENTAUR SPN BOTH IP/OP "$6,818.50" "$5,046.00" "$1,353.23" "$6,818.15" "$3,068.17" "$3,068.17" "$3,068.17" "$3,068.17" "$6,818.15" "$6,818.15" "$6,818.15" "$1,421.07" "$6,818.15" "$6,818.15" "$6,818.15" "$6,818.15" "$6,818.15" "$1,420.98" "$6,818.15" "$2,727.26" "$3,361.35" "$6,818.15" "$6,818.15" "$6,818.15" "$6,818.15" "$5,113.88" "$6,818.15" "$6,818.15" "$6,818.15" "$3,409.08" "$3,409.08" "$5,399.97" "$6,818.15" "$5,454.52" "$3,068.17" "$1,353.23" N/A "$3,954.73" "$6,818.15" "$6,818.15" "$6,818.15" "$1,420.90" "$6,818.15" N/A N/A 68490060 SUP HCPCS C1713 68490060 - PLATE BONE KYPHOSIS 60MM CENTAUR SPN BOTH IP/OP "$7,112.50" "$5,263.00" "$1,411.64" "$7,112.45" "$3,200.60" "$3,200.60" "$3,200.60" "$3,200.60" "$7,112.45" "$7,112.45" "$7,112.45" "$1,482.41" "$7,112.45" "$7,112.45" "$7,112.45" "$7,112.45" "$7,112.45" "$1,482.31" "$7,112.45" "$7,112.45" "$3,506.44" "$7,112.45" "$7,112.45" "$7,112.45" "$7,112.45" "$5,334.38" "$7,112.45" "$7,112.45" "$7,112.45" "$3,556.23" "$3,556.23" "$5,633.06" "$7,112.45" "$5,689.96" "$3,200.60" "$1,411.64" N/A "$4,125.25" "$7,112.45" "$7,112.45" "$7,112.45" "$1,482.23" "$7,112.45" N/A N/A 68490070 SUP HCPCS C1713 68490070 - PLATE BONE KYPHOSIS 70MM CENTAUR SPN BOTH IP/OP "$7,395.50" "$5,473.00" "$1,467.82" "$7,395.48" "$3,327.97" "$3,327.97" "$3,327.97" "$3,327.97" "$7,395.48" "$7,395.48" "$7,395.48" "$1,541.40" "$7,395.48" "$7,395.48" "$7,395.48" "$7,395.48" "$7,395.48" "$1,541.30" "$7,395.48" "$2,958.19" "$3,645.97" "$7,395.48" "$7,395.48" "$7,395.48" "$7,395.48" "$5,546.63" "$7,395.48" "$7,395.48" "$7,395.48" "$3,697.74" "$3,697.74" "$5,857.22" "$7,395.48" "$5,916.38" "$3,327.97" "$1,467.82" N/A "$4,289.39" "$7,395.48" "$7,395.48" "$7,395.48" "$1,541.22" "$7,395.48" N/A N/A 68490080 SUP HCPCS C1713 68490080 - PLATE BONE KYPHOSIS 80MM CENTAUR SPN BOTH IP/OP "$7,831.50" "$5,795.00" "$1,554.33" "$7,831.35" "$3,524.11" "$3,524.11" "$3,524.11" "$3,524.11" "$7,831.35" "$7,831.35" "$7,831.35" "$1,632.25" "$7,831.35" "$7,831.35" "$7,831.35" "$7,831.35" "$7,831.35" "$1,632.14" "$7,831.35" "$7,831.35" "$3,860.86" "$7,831.35" "$7,831.35" "$7,831.35" "$7,831.35" "$5,873.63" "$7,831.35" "$7,831.35" "$7,831.35" "$3,915.68" "$3,915.68" "$6,202.43" "$7,831.35" "$6,265.08" "$3,524.11" "$1,554.33" N/A "$4,542.27" "$7,831.35" "$7,831.35" "$7,831.35" "$1,632.05" "$7,831.35" N/A N/A 68490090 SUP HCPCS C1713 68490090 - PLATE BONE KYPHOSIS 90MM CENTAUR SPN BOTH IP/OP "$8,386.50" "$6,206.00" "$1,664.45" "$8,386.20" "$3,773.79" "$3,773.79" "$3,773.79" "$3,773.79" "$8,386.20" "$8,386.20" "$8,386.20" "$1,747.89" "$8,386.20" "$8,386.20" "$8,386.20" "$8,386.20" "$8,386.20" "$1,747.78" "$8,386.20" "$3,354.48" "$4,134.40" "$8,386.20" "$8,386.20" "$8,386.20" "$8,386.20" "$6,289.88" "$8,386.20" "$8,386.20" "$8,386.20" "$4,193.10" "$4,193.10" "$6,641.87" "$8,386.20" "$6,708.96" "$3,773.79" "$1,664.45" N/A "$4,864.17" "$8,386.20" "$8,386.20" "$8,386.20" "$1,747.68" "$8,386.20" N/A N/A 70035009 SUP Custom 27203010 70035009 - STOPCOCK ANGIO 400 PSI NAMIC 3W ROT ADPR RT PORT BOTH IP/OP $3.00 $2.00 $0.50 $2.80 $2.80 $2.80 $2.80 $2.80 $2.80 $2.80 $0.50 $2.80 $2.80 $2.08 $2.08 $2.16 $1.46 $0.58 $2.80 $1.12 $2.80 $2.80 $2.80 $2.80 $2.80 $2.25 $2.80 $2.80 $2.80 $1.40 $1.40 $2.22 $2.80 $2.24 $1.82 $2.80 N/A $1.74 $2.80 $1.68 $2.80 $2.80 $2.80 N/A N/A 70055017 SUP Custom 27203010 70055017 - STOPCOCK ANGIO 1050 PSI NAMIC 1 WY FX M LL BOTH IP/OP $161.50 $120.00 $28.71 $161.28 $161.28 $161.28 $161.28 $161.28 $161.28 $161.28 $28.71 $161.28 $161.28 $119.70 $119.70 $124.31 $84.03 $33.61 $161.28 $64.51 $161.28 $161.28 $161.28 $161.28 $161.28 $121.13 $161.28 $161.28 $161.28 $80.64 $80.64 $127.73 $161.28 $129.02 $104.83 $161.28 N/A $93.67 $161.28 $96.77 $161.28 $161.28 $161.28 N/A N/A 70245550 SUP HCPCS C1713 70245550 - ROD SPINAL 5.5MM 50MM CLOSE MULTIAX SCREW BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70245560 SUP HCPCS C1713 70245560 - ROD SPINAL 5.5MM 60MM CLOSE MULTIAX SCREW BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70260500 SUP HCPCS C1713 70260500 - SCREW BONE 10.5MM 100MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70260511 SUP HCPCS C1713 70260511 - SCREW BONE 10.5MM 110MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70260580 SUP HCPCS C1713 70260580 - SCREW BONE 10.5MM 80MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70260590 SUP HCPCS C1713 70260590 - SCREW BONE 10.5MM 90MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70265530 SUP HCPCS C1713 70265530 - SCREW BONE 5.5MM 30MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70265535 SUP HCPCS C1713 70265535 - SCREW BONE 5.5MM 35MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70265540 SUP HCPCS C1713 70265540 - SCREW BONE 5.5MM 40MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70265545 SUP HCPCS C1713 70265545 - SCREW BONE 5.5MM 45MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70265550 SUP HCPCS C1713 70265550 - SCREW BONE 5.5MM 50MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70265555 SUP HCPCS C1713 70265555 - SCREW BONE 5.5MM 55MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70265560 SUP HCPCS C1713 70265560 - SCREW BONE 5.5MM 60MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70266535 SUP HCPCS C1713 70266535 - SCREW BONE 6.5MM 35MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70266540 SUP HCPCS C1713 70266540 - SCREW BONE 6.5MM 40MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70266545 SUP HCPCS C1713 70266545 - SCREW BONE 6.5MM 45MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70266550 SUP HCPCS C1713 70266550 - SCREW BONE 6.5MM 50MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70266555 SUP HCPCS C1713 70266555 - SCREW BONE 6.5MM 55MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70266560 SUP HCPCS C1713 70266560 - SCREW BONE 6.5MM 60MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70266570 SUP HCPCS C1713 70266570 - SCREW BONE 6.5MM 70MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70267500 SUP HCPCS C1713 70267500 - SCREW BONE 7.5MM 100MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70267540 SUP HCPCS C1713 70267540 - SCREW BONE 7.5MM 40MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70267545 SUP HCPCS C1713 70267545 - SCREW BONE 7.5MM 45MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70267550 SUP HCPCS C1713 70267550 - SCREW BONE 7.5MM 50MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70267555 SUP HCPCS C1713 70267555 - SCREW BONE 7.5MM 55MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70267560 SUP HCPCS C1713 70267560 - SCREW BONE 7.5MM 60MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70267570 SUP HCPCS C1713 70267570 - SCREW BONE 7.5MM 70MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70267580 SUP HCPCS C1713 70267580 - SCREW BONE 7.5MM 80MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70267590 SUP HCPCS C1713 70267590 - SCREW BONE 7.5MM 90MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70268500 SUP HCPCS C1713 70268500 - SCREW BONE 8.5MM 100MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70268540 SUP HCPCS C1713 70268540 - SCREW BONE 8.5MM 40MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70268545 SUP HCPCS C1713 70268545 - SCREW BONE 8.5MM 45MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70268550 SUP HCPCS C1713 70268550 - SCREW BONE 8.5MM 50MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70268555 SUP HCPCS C1713 70268555 - SCREW BONE 8.5MM 55MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70268560 SUP HCPCS C1713 70268560 - SCREW BONE 8.5MM 60MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70268570 SUP HCPCS C1713 70268570 - SCREW BONE 8.5MM 70MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70268580 SUP HCPCS C1713 70268580 - SCREW BONE 8.5MM 80MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70268590 SUP HCPCS C1713 70268590 - SCREW BN 8.5MM 90MM SOLERA CD HZN LGC MA CLS SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70269500 SUP HCPCS C1713 70269500 - SCREW BONE 9.5MM 100MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70269511 SUP HCPCS C1713 70269511 - SCREW BONE 9.5MM 110MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70269580 SUP HCPCS C1713 70269580 - SCREW BONE 9.5MM 80MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70269590 SUP HCPCS C1713 70269590 - SCREW BONE 9.5MM 90MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 70460500 SUP HCPCS C1713 70460500 - SCREW BONE 10.5MM 100MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$3,091.50" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70460511 SUP HCPCS C1713 70460511 - SCREW BONE 10.5MM 110MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70460580 SUP HCPCS C1713 70460580 - SCREW BONE 10.5MM 80MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70460590 SUP HCPCS C1713 70460590 - SCREW BONE 10.5MM 90MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70465530 SUP HCPCS C1713 70465530 - SCREW BONE 5.5MM 30MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70465535 SUP HCPCS C1713 70465535 - SCREW BONE 5.5MM 35MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$3,091.50" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70465540 SUP HCPCS C1713 70465540 - SCREW BONE 5.5MM 40MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70465545 SUP HCPCS C1713 70465545 - SCREW BONE 5.5MM 45MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70465550 SUP HCPCS C1713 70465550 - SCREW BONE 5.5MM 50MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70465555 SUP HCPCS C1713 70465555 - SCREW BONE 5.5MM 55MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70465560 SUP HCPCS C1713 70465560 - SCREW BONE 5.5MM 60MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70466535 SUP HCPCS C1713 70466535 - SCREW BONE 6.5MM 35MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70466540 SUP HCPCS C1713 70466540 - SCREW BONE 6.5MM 40MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70466545 SUP HCPCS C1713 70466545 - SCREW BONE 6.5MM 45MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70466550 SUP HCPCS C1713 70466550 - SCREW BN 6.5MM 50MM SOLERA CD HZN LGC MA CLS TI SPNE BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70466555 SUP HCPCS C1713 70466555 - SCREW BONE 6.5MM 55MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70466560 SUP HCPCS C1713 70466560 - SCREW BONE 6.5MM 60MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70466570 SUP HCPCS C1713 70466570 - SCREW BN 6.5MM 70MM SOLERA CD HZN LGC MA CLS TI SPNE BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70467500 SUP HCPCS C1713 70467500 - SCREW BONE 7.5MM 100MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70467540 SUP HCPCS C1713 70467540 - SCREW BONE 7.5MM 40MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$3,091.50" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70467545 SUP HCPCS C1713 70467545 - SCREW BONE 7.5MM 45MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70467550 SUP HCPCS C1713 70467550 - SCREW BONE 7.5MM 50MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70467555 SUP HCPCS C1713 70467555 - SCREW BONE 7.5MM 55MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70467560 SUP HCPCS C1713 70467560 - SCREW BN 7.5MM 60MM SOLERA CD HZN LGC MA CLS TI SPNE BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70467570 SUP HCPCS C1713 70467570 - SCREW BONE 7.5MM 70MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70467580 SUP HCPCS C1713 70467580 - SCREW BONE 7.5MM 80MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$3,091.50" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70467590 SUP HCPCS C1713 70467590 - SCREW BONE 7.5MM 90MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70468500 SUP HCPCS C1713 70468500 - SCREW BONE 8.5MM 100MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70468540 SUP HCPCS C1713 70468540 - SCREW BONE 8.5MM 40MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$3,091.50" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70468545 SUP HCPCS C1713 70468545 - SCREW BONE 8.5MM 45MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70468550 SUP HCPCS C1713 70468550 - SCREW BONE 8.5MM 50MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70468555 SUP HCPCS C1713 70468555 - SCREW BONE 8.5MM 55MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70468560 SUP HCPCS C1713 70468560 - SCREW BONE 8.5MM 60MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70468570 SUP HCPCS C1713 70468570 - SCREW BN 8.5MM 70MM SOLERA CD HZN LGC MA CLS TI SPNE BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70468580 SUP HCPCS C1713 70468580 - SCREW BN 8.5MM 80MM SOLERA CD HZN LGC MA CLS TI SPNE BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70468590 SUP HCPCS C1713 70468590 - SCREW BN 8.5MM 90MM SOLERA CD HZN LGC MA CLS TI SPNE BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70469500 SUP HCPCS C1713 70469500 - SCREW BONE 9.5MM 100MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70469511 SUP HCPCS C1713 70469511 - SCREW BONE 9.5MM 110MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70469580 SUP HCPCS C1713 70469580 - SCREW BONE 9.5MM 80MM MULTIAX CLOSE LEGACY CD HORIZON BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$3,091.50" "$3,091.50" $644.27 "$3,091.50" N/A N/A 70469590 SUP HCPCS C1713 70469590 - SCREW BN 9.5MM 90MM SOLERA CD HZN LGC MA CLS TI SPNE BOTH IP/OP "$3,091.50" "$2,288.00" $613.59 "$3,091.50" "$1,391.18" "$1,391.18" "$1,391.18" "$1,391.18" "$3,091.50" "$3,091.50" "$3,091.50" $644.35 "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" $644.30 "$3,091.50" "$3,091.50" "$1,524.11" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$2,318.63" "$3,091.50" "$3,091.50" "$3,091.50" "$1,545.75" "$1,545.75" "$2,448.47" "$3,091.50" "$2,473.20" "$1,391.18" $613.59 N/A "$1,793.07" "$3,091.50" "$1,854.90" "$3,091.50" $644.27 "$3,091.50" N/A N/A 71010705 SUP HCPCS C1713 71010705 - BOLT EXFIX ILZ RSN WIRE BOTH IP/OP $148.00 $110.00 $29.29 $147.60 $66.42 $66.42 $66.42 $66.42 $147.60 $147.60 $147.60 $30.76 $147.60 $147.60 $147.60 $147.60 $147.60 $30.76 $147.60 $59.04 $87.31 $147.60 $147.60 $147.60 $147.60 $111.00 $147.60 $147.60 $147.60 $73.80 $73.80 $116.90 $147.60 $118.08 $66.42 $29.29 N/A $85.84 $147.60 $88.56 $147.60 $30.76 $147.60 N/A N/A 71011002 SUP HCPCS C1713 71011002 - NUT XTRNFX ILZ QCK CNCT CIRC BOTH IP/OP $175.50 $130.00 $34.75 $175.10 $78.80 $78.80 $78.80 $78.80 $175.10 $175.10 $175.10 $36.50 $175.10 $175.10 $175.10 $175.10 $175.10 $36.49 $175.10 $175.10 $103.57 $175.10 $175.10 $175.10 $175.10 $131.63 $175.10 $175.10 $175.10 $87.55 $87.55 $138.68 $175.10 $140.08 $78.80 $34.75 N/A $101.79 $175.10 $105.06 $175.10 $36.49 $175.10 N/A N/A 71011550 SUP HCPCS C1713 71011550 - WASHER ORTH 7MM TI BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 71012000 SUP HCPCS C1713 71012000 - WASHER XTRNFX CNCL CPL SM BN FXTR BOTH IP/OP $192.00 $142.00 $38.11 $192.00 $86.40 $86.40 $86.40 $86.40 $192.00 $192.00 $192.00 $40.02 $192.00 $192.00 $192.00 $192.00 $192.00 $40.01 $192.00 $186.33 $113.57 $192.00 $186.33 $192.00 $192.00 $144.00 $192.00 $192.00 $192.00 $96.00 $96.00 $152.06 $192.00 $153.60 $86.40 $38.11 N/A $111.36 $192.00 $115.20 $192.00 $40.01 $192.00 N/A N/A 71012005 SUP HCPCS C1713 71012005 - NUT XTRNFX CIRC NYL SM BN FXTR BOTH IP/OP $30.00 $22.00 $5.89 $29.70 $13.37 $13.37 $13.37 $13.37 $29.70 $29.70 $29.70 $6.19 $29.70 $29.70 $29.70 $29.70 $29.70 $6.19 $29.70 $28.83 $17.57 $29.70 $28.83 $29.70 $29.70 $22.50 $29.70 $29.70 $29.70 $14.85 $14.85 $23.52 $29.70 $23.76 $13.37 $5.89 N/A $17.40 $29.70 $29.70 $29.70 $6.19 $29.70 N/A N/A 71012502 SUP HCPCS C1713 71012502 - PIN HLF 5MM 180MM ILZ SS ANKL/FT XTRNFXTR BOTH IP/OP $627.50 $464.00 $124.50 $627.30 $282.29 $282.29 $282.29 $282.29 $627.30 $627.30 $627.30 $130.75 $627.30 $627.30 $627.30 $627.30 $627.30 $130.74 $627.30 $250.92 $371.05 $627.30 $627.30 $627.30 $627.30 $470.63 $627.30 $627.30 $627.30 $313.65 $313.65 $496.82 $627.30 $501.84 $282.29 $124.50 N/A $363.95 $627.30 $376.38 $627.30 $130.73 $627.30 N/A N/A 71013000 SUP Custom 27203010 71013000 - BOLT XTRNFX LNG ILZ SLOT WRE BOTH IP/OP $178.50 $132.00 $31.77 $178.50 $178.50 $178.50 $178.50 $178.50 $178.50 $178.50 $31.77 $178.50 $178.50 $132.48 $132.48 $137.59 $93.00 $37.20 $178.50 $71.40 $178.50 $178.50 $178.50 $178.50 $178.50 $133.88 $178.50 $178.50 $178.50 $89.25 $89.25 $141.37 $178.50 $142.80 $116.03 $178.50 N/A $103.53 $178.50 $107.10 $178.50 $178.50 $178.50 N/A N/A 71013204 SUP HCPCS C1713 71013204 - BOLT EXFIX ILIZAROV BOTH IP/OP $148.50 $110.00 $29.44 $148.33 $66.75 $66.75 $66.75 $66.75 $148.33 $148.33 $148.33 $30.92 $148.33 $148.33 $148.33 $148.33 $148.33 $30.91 $148.33 $59.33 $87.74 $148.33 $148.33 $148.33 $148.33 $111.38 $148.33 $148.33 $148.33 $74.17 $74.17 $117.48 $148.33 $118.66 $66.75 $29.44 N/A $86.13 $148.33 $89.00 $148.33 $30.91 $148.33 N/A N/A 71021027 SUP HCPCS C1713 71021027 - PIN HLF 6MM 45MM HXFX TI BOTH IP/OP $473.00 $350.00 $93.80 $472.60 $212.67 $212.67 $212.67 $212.67 $472.60 $472.60 $472.60 $98.50 $472.60 $472.60 $472.60 $472.60 $472.60 $98.50 $472.60 $189.04 $279.54 $472.60 $472.60 $472.60 $472.60 $354.75 $472.60 $472.60 $472.60 $236.30 $236.30 $374.30 $472.60 $378.08 $212.67 $93.80 N/A $274.34 $472.60 $283.56 $472.60 $98.49 $472.60 N/A N/A 71021029 SUP HCPCS C1713 71021029 - PIN HLF 6MM 55MM HXFX TI BOTH IP/OP $473.00 $350.00 $93.80 $472.60 $212.67 $212.67 $212.67 $212.67 $472.60 $472.60 $472.60 $98.50 $472.60 $472.60 $472.60 $472.60 $472.60 $98.50 $472.60 $189.04 $279.54 $472.60 $472.60 $472.60 $472.60 $354.75 $472.60 $472.60 $472.60 $236.30 $236.30 $374.30 $472.60 $378.08 $212.67 $93.80 N/A $274.34 $472.60 $283.56 $472.60 $98.49 $472.60 N/A N/A 71021031 SUP HCPCS C1713 71021031 - PIN HLF 6MM 65MM HXFX TI ORTH XTRNFX SYS BOTH IP/OP $719.50 $532.00 $142.72 $719.10 $323.60 $323.60 $323.60 $323.60 $719.10 $719.10 $719.10 $149.88 $719.10 $719.10 $719.10 $719.10 $719.10 $149.87 $719.10 $287.64 $425.35 $719.10 $719.10 $719.10 $719.10 $539.63 $719.10 $719.10 $719.10 $359.55 $359.55 $569.53 $719.10 $575.28 $323.60 $142.72 N/A $417.31 $719.10 $719.10 $719.10 $719.10 $719.10 N/A N/A 71021033 SUP HCPCS C1713 71021033 - PIN HLF 6MM 75MM HXFX TI ORTH XTRNFX SYS BOTH IP/OP $719.50 $532.00 $142.72 $719.10 $323.60 $323.60 $323.60 $323.60 $719.10 $719.10 $719.10 $149.88 $719.10 $719.10 $719.10 $719.10 $719.10 $149.87 $719.10 $287.64 $425.35 $719.10 $719.10 $719.10 $719.10 $539.63 $719.10 $719.10 $719.10 $359.55 $359.55 $569.53 $719.10 $575.28 $323.60 $142.72 N/A $417.31 $719.10 $719.10 $719.10 $719.10 $719.10 N/A N/A 71021035 SUP HCPCS C1713 71021035 - PIN HLF 6MM 85MM HXFX TI ORTH XTRNFX SYS BOTH IP/OP $719.50 $532.00 $142.72 $719.10 $323.60 $323.60 $323.60 $323.60 $719.10 $719.10 $719.10 $149.88 $719.10 $719.10 $719.10 $719.10 $719.10 $149.87 $719.10 $719.10 $425.35 $719.10 $719.10 $719.10 $719.10 $539.63 $719.10 $719.10 $719.10 $359.55 $359.55 $569.53 $719.10 $575.28 $323.60 $142.72 N/A $417.31 $719.10 $431.46 $719.10 $149.86 $719.10 N/A N/A 71021072 SUP HCPCS C1713 71021072 - PIN HLF 6MM 20MM HXFX SS ORTH XTRNFX SYS BOTH IP/OP $719.50 $532.00 $142.72 $719.10 $323.60 $323.60 $323.60 $323.60 $719.10 $719.10 $719.10 $149.88 $719.10 $719.10 $719.10 $719.10 $719.10 $149.87 $719.10 $287.64 $425.35 $719.10 $719.10 $719.10 $719.10 $539.63 $719.10 $719.10 $719.10 $359.55 $359.55 $569.53 $719.10 $575.28 $323.60 $142.72 N/A $417.31 $719.10 $431.46 $719.10 $149.86 $719.10 N/A N/A 71021073 SUP HCPCS C1713 71021073 - PIN HLF 6MM 25MM HXFX SS BOTH IP/OP $248.50 $184.00 $49.26 $248.20 $111.69 $111.69 $111.69 $111.69 $248.20 $248.20 $248.20 $51.73 $248.20 $248.20 $248.20 $248.20 $248.20 $51.73 $248.20 $248.20 $146.81 $248.20 $248.20 $248.20 $248.20 $186.38 $248.20 $248.20 $248.20 $124.10 $124.10 $196.57 $248.20 $198.56 $111.69 $49.26 N/A $144.13 $248.20 $248.20 $248.20 $51.72 $248.20 N/A N/A 71021074 SUP HCPCS C1713 71021074 - PIN HLF 6MM 30MM HXFX SS BOTH IP/OP $496.50 $367.00 $98.52 $496.40 $223.38 $223.38 $223.38 $223.38 $496.40 $496.40 $496.40 $103.46 $496.40 $496.40 $496.40 $496.40 $496.40 $103.46 $496.40 $198.56 $293.62 $496.40 $496.40 $496.40 $496.40 $372.38 $496.40 $496.40 $496.40 $248.20 $248.20 $393.15 $496.40 $397.12 $223.38 $98.52 N/A $287.97 $496.40 $496.40 $496.40 $103.45 $496.40 N/A N/A 71021075 SUP HCPCS C1713 71021075 - PIN HLF 6MM 35MM HXFX SS BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $112.88 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $169.32 $282.20 $58.81 $282.20 N/A N/A 71021077 SUP HCPCS C1713 71021077 - PIN HLF 6MM 45MM HXFX SS ORTH XTRNFX SYS BOTH IP/OP $719.50 $532.00 $142.72 $719.10 $323.60 $323.60 $323.60 $323.60 $719.10 $719.10 $719.10 $149.88 $719.10 $719.10 $719.10 $719.10 $719.10 $149.87 $719.10 $287.64 $425.35 $719.10 $719.10 $719.10 $719.10 $539.63 $719.10 $719.10 $719.10 $359.55 $359.55 $569.53 $719.10 $575.28 $323.60 $142.72 N/A $417.31 $719.10 $431.46 $719.10 $719.10 $719.10 N/A N/A 71021079 SUP HCPCS C1713 71021079 - PIN HLF 6MM 55MM HXFX SS BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $112.88 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $169.32 $282.20 $58.81 $282.20 N/A N/A 71021081 SUP HCPCS C1713 71021081 - PIN HLF 6MM 65MM HXFX SS ORTH XTRNFX SYS BOTH IP/OP $410.00 $303.00 $81.32 $409.70 $184.37 $184.37 $184.37 $184.37 $409.70 $409.70 $409.70 $85.39 $409.70 $409.70 $409.70 $409.70 $409.70 $85.39 $409.70 $163.88 $242.34 $409.70 $409.70 $409.70 $409.70 $307.50 $409.70 $409.70 $409.70 $204.85 $204.85 $324.48 $409.70 $327.76 $184.37 $81.32 N/A $237.80 $409.70 $409.70 $409.70 $409.70 $409.70 N/A N/A 71021083 SUP HCPCS C1713 71021083 - PIN HLF 6MM 75MM HXFX SS ORTH XTRNFX SYS BOTH IP/OP $410.00 $303.00 $81.32 $409.70 $184.37 $184.37 $184.37 $184.37 $409.70 $409.70 $409.70 $85.39 $409.70 $409.70 $409.70 $409.70 $409.70 $85.39 $409.70 $163.88 $242.34 $409.70 $409.70 $409.70 $409.70 $307.50 $409.70 $409.70 $409.70 $204.85 $204.85 $324.48 $409.70 $327.76 $184.37 $81.32 N/A $237.80 $409.70 $245.82 $409.70 $85.38 $409.70 N/A N/A 71021085 SUP HCPCS C1713 71021085 - PIN HLF 6MM 85MM HXFX SS ORTH XTRNFX SYS BOTH IP/OP $410.00 $303.00 $81.32 $409.70 $184.37 $184.37 $184.37 $184.37 $409.70 $409.70 $409.70 $85.39 $409.70 $409.70 $409.70 $409.70 $409.70 $85.39 $409.70 $163.88 $242.34 $409.70 $409.70 $409.70 $409.70 $307.50 $409.70 $409.70 $409.70 $204.85 $204.85 $324.48 $409.70 $327.76 $184.37 $81.32 N/A $237.80 $409.70 $245.82 $409.70 $85.38 $409.70 N/A N/A 71022001 SUP HCPCS C1713 71022001 - PIN FX 3MM 120MM 16MM COVE PNT ORTH BOTH IP/OP $534.00 $395.00 $105.95 $533.80 $240.21 $240.21 $240.21 $240.21 $533.80 $533.80 $533.80 $111.26 $533.80 $533.80 $533.80 $533.80 $533.80 $111.25 $533.80 $213.52 $315.74 $533.80 $533.80 $533.80 $533.80 $400.50 $533.80 $533.80 $533.80 $266.90 $266.90 $422.77 $533.80 $427.04 $240.21 $105.95 N/A $309.72 $533.80 $320.28 $533.80 $533.80 $533.80 N/A N/A 71022002 SUP HCPCS C1713 71022002 - PIN FX 3MM 120MM 22MM COVE PNT ORTH BOTH IP/OP $534.00 $395.00 $105.95 $533.80 $240.21 $240.21 $240.21 $240.21 $533.80 $533.80 $533.80 $111.26 $533.80 $533.80 $533.80 $533.80 $533.80 $111.25 $533.80 $213.52 $315.74 $533.80 $533.80 $533.80 $533.80 $400.50 $533.80 $533.80 $533.80 $266.90 $266.90 $422.77 $533.80 $427.04 $240.21 $105.95 N/A $309.72 $533.80 $320.28 $533.80 $111.24 $533.80 N/A N/A 71022003 SUP HCPCS C1713 71022003 - PIN HLF 3MM 28MM 28MM COVE PNT DIST RADL BOTH IP/OP $534.00 $395.00 $105.95 $533.80 $240.21 $240.21 $240.21 $240.21 $533.80 $533.80 $533.80 $111.26 $533.80 $533.80 $533.80 $533.80 $533.80 $111.25 $533.80 $533.80 $315.74 $533.80 $533.80 $533.80 $533.80 $400.50 $533.80 $533.80 $533.80 $266.90 $266.90 $422.77 $533.80 $427.04 $240.21 $105.95 N/A $309.72 $533.80 $320.28 $533.80 $533.80 $533.80 N/A N/A 71031033 SUP HCPCS C1713 71031033 - POSITIONER SRG 5MM HXFX CENTERING SLV PIN BOTH IP/OP $692.00 $512.00 $137.32 $691.90 $311.36 $311.36 $311.36 $311.36 $691.90 $691.90 $691.90 $144.21 $691.90 $691.90 $691.90 $691.90 $691.90 $144.20 $691.90 $276.76 $409.26 $691.90 $691.90 $691.90 $691.90 $519.00 $691.90 $691.90 $691.90 $345.95 $345.95 $547.98 $691.90 $553.52 $311.36 $137.32 N/A $401.36 $691.90 $415.14 $691.90 $144.19 $691.90 N/A N/A 71031034 SUP HCPCS C1713 71031034 - POSITIONER SRG 6MM HXFX CENTERING SLV PIN BOTH IP/OP $692.00 $512.00 $137.32 $691.90 $311.36 $311.36 $311.36 $311.36 $691.90 $691.90 $691.90 $144.21 $691.90 $691.90 $691.90 $691.90 $691.90 $144.20 $691.90 $691.90 $409.26 $691.90 $691.90 $691.90 $691.90 $519.00 $691.90 $691.90 $691.90 $345.95 $345.95 $547.98 $691.90 $553.52 $311.36 $137.32 N/A $401.36 $691.90 $415.14 $691.90 $144.19 $691.90 N/A N/A 71031040 SUP Custom 27203010 71031040 - GUIDE SURG HEX-FIX TROCAR BOTH IP/OP "$5,262.50" "$3,894.00" $936.73 "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" $936.73 "$5,262.50" "$5,262.50" "$3,905.83" "$3,905.83" "$4,056.34" "$2,060.15" "$1,096.76" "$5,262.50" "$2,105.00" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$5,262.50" "$3,946.88" "$5,262.50" "$5,262.50" "$5,262.50" "$2,631.25" "$2,631.25" "$4,167.90" "$5,262.50" "$4,210.00" "$3,420.63" "$5,262.50" N/A "$3,052.25" "$5,262.50" "$3,157.50" "$5,262.50" "$5,262.50" "$5,262.50" N/A N/A 71033019 SUP Custom 27203010 71033019 - BIT DRL 2MM DIST RDS SYS BOTH IP/OP $915.00 $677.00 $162.80 $914.60 $914.60 $914.60 $914.60 $914.60 $914.60 $914.60 $162.80 $914.60 $914.60 $678.82 $678.82 $704.97 $476.51 $190.61 $914.60 $365.84 $914.60 $914.60 $914.60 $914.60 $914.60 $686.25 $914.60 $914.60 $914.60 $457.30 $457.30 $724.36 $914.60 $731.68 $594.49 $914.60 N/A $530.70 $914.60 $548.76 $914.60 $914.60 $914.60 N/A N/A 71053002 SUP Custom 27203010 71053002 - BIT DRL 2.8MM BOTH IP/OP "$1,107.00" $819.00 $196.99 "$1,106.70" "$1,106.70" "$1,106.70" "$1,106.70" "$1,106.70" "$1,106.70" "$1,106.70" $196.99 "$1,106.70" "$1,106.70" $821.39 $821.39 $853.04 $576.59 $230.65 "$1,106.70" $442.68 "$1,106.70" "$1,106.70" "$1,106.70" "$1,106.70" "$1,106.70" $830.25 "$1,106.70" "$1,106.70" "$1,106.70" $553.35 $553.35 $876.51 "$1,106.70" $885.36 $719.36 "$1,106.70" N/A $642.06 "$1,106.70" $664.02 "$1,106.70" "$1,106.70" "$1,106.70" N/A N/A 71053004 SUP Custom 27203010 71053004 - BIT DRL 4.8MM BOTH IP/OP "$1,107.00" $819.00 $196.99 "$1,106.70" "$1,106.70" "$1,106.70" "$1,106.70" "$1,106.70" "$1,106.70" "$1,106.70" $196.99 "$1,106.70" "$1,106.70" $821.39 $821.39 $853.04 $576.59 $230.65 "$1,106.70" $442.68 "$1,106.70" "$1,106.70" "$1,106.70" "$1,106.70" "$1,106.70" $830.25 "$1,106.70" "$1,106.70" "$1,106.70" $553.35 $553.35 $876.51 "$1,106.70" $885.36 $719.36 "$1,106.70" N/A $642.06 "$1,106.70" $664.02 "$1,106.70" "$1,106.70" "$1,106.70" N/A N/A 71053033 SUP HCPCS C1713 71053033 - WASHER XTRNFX 8MM CNTR BD LCK BOLT BOTH IP/OP $265.50 $196.00 $52.64 $265.20 $119.34 $119.34 $119.34 $119.34 $265.20 $265.20 $265.20 $55.27 $265.20 $265.20 $265.20 $265.20 $265.20 $55.27 $265.20 $265.20 $156.87 $265.20 $265.20 $265.20 $265.20 $199.13 $265.20 $265.20 $265.20 $132.60 $132.60 $210.04 $265.20 $212.16 $119.34 $52.64 N/A $153.99 $265.20 $159.12 $265.20 $55.27 $265.20 N/A N/A 71053101 SUP HCPCS C1713 71053101 - PIN HLF 3MM 10MM JTX TI ORTH XTRNFX SYS BOTH IP/OP $219.00 $162.00 $43.42 $218.75 $98.44 $98.44 $98.44 $98.44 $218.75 $218.75 $218.75 $45.59 $218.75 $218.75 $218.75 $218.75 $218.75 $45.59 $218.75 $218.75 $129.39 $218.75 $218.75 $218.75 $218.75 $164.25 $218.75 $218.75 $218.75 $109.38 $109.38 $173.25 $218.75 $175.00 $98.44 $43.42 N/A $127.02 $218.75 $131.25 $218.75 $45.59 $218.75 N/A N/A 71053151 SUP HCPCS C1713 71053151 - PIN HLF 3MM 15MM JTX TI ORTH XTRNFX SYS BOTH IP/OP $219.00 $162.00 $43.42 $218.75 $98.44 $98.44 $98.44 $98.44 $218.75 $218.75 $218.75 $45.59 $218.75 $218.75 $218.75 $218.75 $218.75 $45.59 $218.75 $218.75 $129.39 $218.75 $218.75 $218.75 $218.75 $164.25 $218.75 $218.75 $218.75 $109.38 $109.38 $173.25 $218.75 $175.00 $98.44 $43.42 N/A $127.02 $218.75 $131.25 $218.75 $45.59 $218.75 N/A N/A 71053201 SUP HCPCS C1713 71053201 - PIN HLF 3MM 20MM JTX TI ORTH XTRNFX SYS BOTH IP/OP $219.00 $162.00 $43.42 $218.75 $98.44 $98.44 $98.44 $98.44 $218.75 $218.75 $218.75 $45.59 $218.75 $218.75 $218.75 $218.75 $218.75 $45.59 $218.75 $87.50 $129.39 $218.75 $218.75 $218.75 $218.75 $164.25 $218.75 $218.75 $218.75 $109.38 $109.38 $173.25 $218.75 $175.00 $98.44 $43.42 N/A $127.02 $218.75 $131.25 $218.75 $45.59 $218.75 N/A N/A 71053251 SUP HCPCS C1713 71053251 - PIN HLF 3MM 25MM JTX TI ORTH XTRNFX SYS BOTH IP/OP $219.00 $162.00 $43.42 $218.75 $98.44 $98.44 $98.44 $98.44 $218.75 $218.75 $218.75 $45.59 $218.75 $218.75 $218.75 $218.75 $218.75 $45.59 $218.75 $218.75 $129.39 $218.75 $218.75 $218.75 $218.75 $164.25 $218.75 $218.75 $218.75 $109.38 $109.38 $173.25 $218.75 $175.00 $98.44 $43.42 N/A $127.02 $218.75 $131.25 $218.75 $45.59 $218.75 N/A N/A 71054151 SUP HCPCS C1713 71054151 - PIN HLF 4MM 15MM JTX TI ORTH XTRNFX SYS BOTH IP/OP $232.00 $172.00 $46.02 $231.88 $104.35 $104.35 $104.35 $104.35 $231.88 $231.88 $231.88 $48.33 $231.88 $231.88 $231.88 $231.88 $231.88 $48.33 $231.88 $92.75 $137.16 $231.88 $231.88 $231.88 $231.88 $174.00 $231.88 $231.88 $231.88 $115.94 $115.94 $183.65 $231.88 $185.50 $104.35 $46.02 N/A $134.56 $231.88 $139.13 $231.88 $48.32 $231.88 N/A N/A 71054201 SUP HCPCS C1713 71054201 - PIN HLF 4MM 20MM JTX TI ORTH XTRNFX SYS BOTH IP/OP $232.00 $172.00 $46.02 $231.88 $104.35 $104.35 $104.35 $104.35 $231.88 $231.88 $231.88 $48.33 $231.88 $231.88 $231.88 $231.88 $231.88 $48.33 $231.88 $92.75 $137.16 $231.88 $231.88 $231.88 $231.88 $174.00 $231.88 $231.88 $231.88 $115.94 $115.94 $183.65 $231.88 $185.50 $104.35 $46.02 N/A $134.56 $231.88 $139.13 $231.88 $48.32 $231.88 N/A N/A 71054251 SUP HCPCS C1713 71054251 - PIN HLF 4MM 25MM JTX TI ORTH XTRNFX SYS BOTH IP/OP $232.00 $172.00 $46.02 $231.88 $104.35 $104.35 $104.35 $104.35 $231.88 $231.88 $231.88 $48.33 $231.88 $231.88 $231.88 $231.88 $231.88 $48.33 $231.88 $231.88 $137.16 $231.88 $231.88 $231.88 $231.88 $174.00 $231.88 $231.88 $231.88 $115.94 $115.94 $183.65 $231.88 $185.50 $104.35 $46.02 N/A $134.56 $231.88 $139.13 $231.88 $48.32 $231.88 N/A N/A 71054301 SUP HCPCS C1713 71054301 - PIN HLF 4MM 30MM JTX TI ORTH XTRNFX SYS BOTH IP/OP $232.00 $172.00 $46.02 $231.88 $104.35 $104.35 $104.35 $104.35 $231.88 $231.88 $231.88 $48.33 $231.88 $231.88 $231.88 $231.88 $231.88 $48.33 $231.88 $231.88 $137.16 $231.88 $231.88 $231.88 $231.88 $174.00 $231.88 $231.88 $231.88 $115.94 $115.94 $183.65 $231.88 $185.50 $104.35 $46.02 N/A $134.56 $231.88 $139.13 $231.88 $48.32 $231.88 N/A N/A 71054351 SUP HCPCS C1713 71054351 - PIN HLF 4MM 35MM JTX TI ORTH XTRNFX SYS BOTH IP/OP $232.00 $172.00 $46.02 $231.88 $104.35 $104.35 $104.35 $104.35 $231.88 $231.88 $231.88 $48.33 $231.88 $231.88 $231.88 $231.88 $231.88 $48.33 $231.88 $231.88 $137.16 $231.88 $231.88 $231.88 $231.88 $174.00 $231.88 $231.88 $231.88 $115.94 $115.94 $183.65 $231.88 $185.50 $104.35 $46.02 N/A $134.56 $231.88 $139.13 $231.88 $48.32 $231.88 N/A N/A 71055020 SUP HCPCS C1713 71055020 - PIN HLF 5MM 20MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $121.50 $90.00 $24.04 $121.13 $54.51 $54.51 $54.51 $54.51 $121.13 $121.13 $121.13 $25.25 $121.13 $121.13 $121.13 $121.13 $121.13 $25.24 $121.13 $48.45 $71.65 $121.13 $121.13 $121.13 $121.13 $91.13 $121.13 $121.13 $121.13 $60.57 $60.57 $95.93 $121.13 $96.90 $54.51 $24.04 N/A $70.47 $121.13 $72.68 $121.13 $25.24 $121.13 N/A N/A 71055201 SUP HCPCS C1713 71055201 - PIN HLF SHRT 5MM 20MM JTX TI NTRD BOTH IP/OP $254.00 $188.00 $50.36 $253.75 $114.19 $114.19 $114.19 $114.19 $253.75 $253.75 $253.75 $52.89 $253.75 $253.75 $253.75 $253.75 $253.75 $52.88 $253.75 $101.50 $150.09 $253.75 $253.75 $253.75 $253.75 $190.50 $253.75 $253.75 $253.75 $126.88 $126.88 $200.97 $253.75 $203.00 $114.19 $50.36 N/A $147.32 $253.75 $152.25 $253.75 $52.88 $253.75 N/A N/A 71055251 SUP HCPCS C1713 71055251 - PIN HLF SHRT 5MM 25MM JTX TI NTRD BOTH IP/OP $254.00 $188.00 $50.36 $253.75 $114.19 $114.19 $114.19 $114.19 $253.75 $253.75 $253.75 $52.89 $253.75 $253.75 $253.75 $253.75 $253.75 $52.88 $253.75 $101.50 $150.09 $253.75 $253.75 $253.75 $253.75 $190.50 $253.75 $253.75 $253.75 $126.88 $126.88 $200.97 $253.75 $203.00 $114.19 $50.36 N/A $147.32 $253.75 $152.25 $253.75 $52.88 $253.75 N/A N/A 71055301 SUP HCPCS C1713 71055301 - PIN HLF SHRT 5MM 30MM TI BOTH IP/OP $254.00 $188.00 $50.36 $253.75 $114.19 $114.19 $114.19 $114.19 $253.75 $253.75 $253.75 $52.89 $253.75 $253.75 $253.75 $253.75 $253.75 $52.88 $253.75 $101.50 $150.09 $253.75 $253.75 $253.75 $253.75 $190.50 $253.75 $253.75 $253.75 $126.88 $126.88 $200.97 $253.75 $203.00 $114.19 $50.36 N/A $147.32 $253.75 $152.25 $253.75 $52.88 $253.75 N/A N/A 71055351 SUP HCPCS C1713 71055351 - PIN HLF SHRT 5MM 35MM TI BOTH IP/OP $254.00 $188.00 $50.36 $253.75 $114.19 $114.19 $114.19 $114.19 $253.75 $253.75 $253.75 $52.89 $253.75 $253.75 $253.75 $253.75 $253.75 $52.88 $253.75 $101.50 $150.09 $253.75 $253.75 $253.75 $253.75 $190.50 $253.75 $253.75 $253.75 $126.88 $126.88 $200.97 $253.75 $203.00 $114.19 $50.36 N/A $147.32 $253.75 $253.75 $253.75 $52.88 $253.75 N/A N/A 71055401 SUP HCPCS C1713 71055401 - PIN HLF SHRT 5MM 40MM TI BOTH IP/OP $254.00 $188.00 $50.36 $253.75 $114.19 $114.19 $114.19 $114.19 $253.75 $253.75 $253.75 $52.89 $253.75 $253.75 $253.75 $253.75 $253.75 $52.88 $253.75 $101.50 $150.09 $253.75 $253.75 $253.75 $253.75 $190.50 $253.75 $253.75 $253.75 $126.88 $126.88 $200.97 $253.75 $203.00 $114.19 $50.36 N/A $147.32 $253.75 $152.25 $253.75 $52.88 $253.75 N/A N/A 71055451 SUP HCPCS C1713 71055451 - PIN HLF SHRT 5MM 45MM TI BOTH IP/OP $254.00 $188.00 $50.36 $253.75 $114.19 $114.19 $114.19 $114.19 $253.75 $253.75 $253.75 $52.89 $253.75 $253.75 $253.75 $253.75 $253.75 $52.88 $253.75 $101.50 $150.09 $253.75 $253.75 $253.75 $253.75 $190.50 $253.75 $253.75 $253.75 $126.88 $126.88 $200.97 $253.75 $203.00 $114.19 $50.36 N/A $147.32 $253.75 $152.25 $253.75 $52.88 $253.75 N/A N/A 71055501 SUP HCPCS C1713 71055501 - PIN HLF SHRT 5MM 50MM TI BOTH IP/OP $254.00 $188.00 $50.36 $253.75 $114.19 $114.19 $114.19 $114.19 $253.75 $253.75 $253.75 $52.89 $253.75 $253.75 $253.75 $253.75 $253.75 $52.88 $253.75 $101.50 $150.09 $253.75 $253.75 $253.75 $253.75 $190.50 $253.75 $253.75 $253.75 $126.88 $126.88 $200.97 $253.75 $203.00 $114.19 $50.36 N/A $147.32 $253.75 $253.75 $253.75 $52.88 $253.75 N/A N/A 71055502 SUP HCPCS C1713 71055502 - PIN HLF LNG 5MM 50MM TI BOTH IP/OP $234.50 $174.00 $46.54 $234.50 $105.53 $105.53 $105.53 $105.53 $234.50 $234.50 $234.50 $48.88 $234.50 $234.50 $234.50 $234.50 $234.50 $48.87 $234.50 $93.80 $138.71 $234.50 $234.50 $234.50 $234.50 $175.88 $234.50 $234.50 $234.50 $117.25 $117.25 $185.72 $234.50 $187.60 $105.53 $46.54 N/A $136.01 $234.50 $140.70 $234.50 $48.87 $234.50 N/A N/A 71055503 SUP HCPCS C1713 71055503 - PIN HLF 5MM 50MM STRL TI BOTH IP/OP $718.50 $532.00 $142.58 $718.38 $323.27 $323.27 $323.27 $323.27 $718.38 $718.38 $718.38 $149.73 $718.38 $718.38 $718.38 $718.38 $718.38 $149.72 $718.38 $287.35 $424.92 $718.38 $718.38 $718.38 $718.38 $538.88 $718.38 $718.38 $718.38 $359.19 $359.19 $568.96 $718.38 $574.70 $323.27 $142.58 N/A $416.73 $718.38 $431.03 $718.38 $149.71 $718.38 N/A N/A 71055551 SUP HCPCS C1713 71055551 - PIN HLF SHRT 5MM 55MM TI BOTH IP/OP $254.00 $188.00 $50.36 $253.75 $114.19 $114.19 $114.19 $114.19 $253.75 $253.75 $253.75 $52.89 $253.75 $253.75 $253.75 $253.75 $253.75 $52.88 $253.75 $101.50 $150.09 $253.75 $253.75 $253.75 $253.75 $190.50 $253.75 $253.75 $253.75 $126.88 $126.88 $200.97 $253.75 $203.00 $114.19 $50.36 N/A $147.32 $253.75 $152.25 $253.75 $52.88 $253.75 N/A N/A 71055552 SUP HCPCS C1713 71055552 - PIN HLF LNG 5MM 55MM TI BOTH IP/OP $234.50 $174.00 $46.54 $234.50 $105.53 $105.53 $105.53 $105.53 $234.50 $234.50 $234.50 $48.88 $234.50 $234.50 $234.50 $234.50 $234.50 $48.87 $234.50 $234.50 $138.71 $234.50 $234.50 $234.50 $234.50 $175.88 $234.50 $234.50 $234.50 $117.25 $117.25 $185.72 $234.50 $187.60 $105.53 $46.54 N/A $136.01 $234.50 $140.70 $234.50 $48.87 $234.50 N/A N/A 71055601 SUP HCPCS C1713 71055601 - PIN HLF SHRT 5MM 60MM TI BOTH IP/OP $254.00 $188.00 $50.36 $253.75 $114.19 $114.19 $114.19 $114.19 $253.75 $253.75 $253.75 $52.89 $253.75 $253.75 $253.75 $253.75 $253.75 $52.88 $253.75 $253.75 $150.09 $253.75 $253.75 $253.75 $253.75 $190.50 $253.75 $253.75 $253.75 $126.88 $126.88 $200.97 $253.75 $203.00 $114.19 $50.36 N/A $147.32 $253.75 $152.25 $253.75 $52.88 $253.75 N/A N/A 71055602 SUP HCPCS C1713 71055602 - PIN HLF LNG 5MM 60MM TI BOTH IP/OP $234.50 $174.00 $46.54 $234.50 $105.53 $105.53 $105.53 $105.53 $234.50 $234.50 $234.50 $48.88 $234.50 $234.50 $234.50 $234.50 $234.50 $48.87 $234.50 $93.80 $138.71 $234.50 $234.50 $234.50 $234.50 $175.88 $234.50 $234.50 $234.50 $117.25 $117.25 $185.72 $234.50 $187.60 $105.53 $46.54 N/A $136.01 $234.50 $234.50 $234.50 $48.87 $234.50 N/A N/A 71055651 SUP HCPCS C1713 71055651 - PIN HLF SHRT 5MM 65MM TI BOTH IP/OP $254.00 $188.00 $50.36 $253.75 $114.19 $114.19 $114.19 $114.19 $253.75 $253.75 $253.75 $52.89 $253.75 $253.75 $253.75 $253.75 $253.75 $52.88 $253.75 $101.50 $150.09 $253.75 $253.75 $253.75 $253.75 $190.50 $253.75 $253.75 $253.75 $126.88 $126.88 $200.97 $253.75 $203.00 $114.19 $50.36 N/A $147.32 $253.75 $253.75 $253.75 $52.88 $253.75 N/A N/A 71055701 SUP HCPCS C1713 71055701 - PIN HLF SHRT 5MM 70MM TI BOTH IP/OP $254.00 $188.00 $50.36 $253.75 $114.19 $114.19 $114.19 $114.19 $253.75 $253.75 $253.75 $52.89 $253.75 $253.75 $253.75 $253.75 $253.75 $52.88 $253.75 $101.50 $150.09 $253.75 $253.75 $253.75 $253.75 $190.50 $253.75 $253.75 $253.75 $126.88 $126.88 $200.97 $253.75 $203.00 $114.19 $50.36 N/A $147.32 $253.75 $152.25 $253.75 $52.88 $253.75 N/A N/A 71055702 SUP HCPCS C1713 71055702 - PIN HLF LNG 5MM 70MM TI BOTH IP/OP $234.50 $174.00 $46.54 $234.50 $105.53 $105.53 $105.53 $105.53 $234.50 $234.50 $234.50 $48.88 $234.50 $234.50 $234.50 $234.50 $234.50 $48.87 $234.50 $93.80 $138.71 $234.50 $234.50 $234.50 $234.50 $175.88 $234.50 $234.50 $234.50 $117.25 $117.25 $185.72 $234.50 $187.60 $105.53 $46.54 N/A $136.01 $234.50 $140.70 $234.50 $48.87 $234.50 N/A N/A 71056208 SUP HCPCS C1713 71056208 - PIN HLF SHRT 6MM 20MM JTX TI NTRD BOTH IP/OP $259.00 $192.00 $51.41 $259.00 $116.55 $116.55 $116.55 $116.55 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $259.00 $259.00 $259.00 $53.98 $259.00 $103.60 $153.20 $259.00 $259.00 $259.00 $259.00 $194.25 $259.00 $259.00 $259.00 $129.50 $129.50 $205.13 $259.00 $207.20 $116.55 $51.41 N/A $150.22 $259.00 $155.40 $259.00 $53.98 $259.00 N/A N/A 71056209 SUP HCPCS C1713 71056209 - PIN HLF LNG 20MM JTX TI ORTH BOTH IP/OP $248.50 $184.00 $49.32 $248.50 $111.83 $111.83 $111.83 $111.83 $248.50 $248.50 $248.50 $51.79 $248.50 $248.50 $248.50 $248.50 $248.50 $51.79 $248.50 $248.50 $146.99 $248.50 $248.50 $248.50 $248.50 $186.38 $248.50 $248.50 $248.50 $124.25 $124.25 $196.81 $248.50 $198.80 $111.83 $49.32 N/A $144.13 $248.50 $149.10 $248.50 $51.79 $248.50 N/A N/A 71056258 SUP HCPCS C1713 71056258 - PIN HLF SHRT 6MM 25MM JTX TI NTRD BOTH IP/OP $259.00 $192.00 $51.41 $259.00 $116.55 $116.55 $116.55 $116.55 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $153.20 $259.00 $259.00 $259.00 $259.00 $194.25 $259.00 $259.00 $259.00 $129.50 $129.50 $205.13 $259.00 $207.20 $116.55 $51.41 N/A $150.22 $259.00 $259.00 $259.00 $53.98 $259.00 N/A N/A 71056308 SUP HCPCS C1713 71056308 - PIN HLF SHRT 6MM 30MM JTX TI NTRD BOTH IP/OP $259.00 $192.00 $51.41 $259.00 $116.55 $116.55 $116.55 $116.55 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $259.00 $259.00 $259.00 $53.98 $259.00 $103.60 $153.20 $259.00 $259.00 $259.00 $259.00 $194.25 $259.00 $259.00 $259.00 $129.50 $129.50 $205.13 $259.00 $207.20 $116.55 $51.41 N/A $150.22 $259.00 $155.40 $259.00 $53.98 $259.00 N/A N/A 71056309 SUP HCPCS C1713 71056309 - PIN HLF LNG 30MM JTX TI ORTH BOTH IP/OP $248.50 $184.00 $49.32 $248.50 $111.83 $111.83 $111.83 $111.83 $248.50 $248.50 $248.50 $51.79 $248.50 $248.50 $248.50 $248.50 $248.50 $51.79 $248.50 $248.50 $146.99 $248.50 $248.50 $248.50 $248.50 $186.38 $248.50 $248.50 $248.50 $124.25 $124.25 $196.81 $248.50 $198.80 $111.83 $49.32 N/A $144.13 $248.50 $149.10 $248.50 $51.79 $248.50 N/A N/A 71056358 SUP HCPCS C1713 71056358 - PIN HLF SHRT 6MM 35MM JTX TI NTRD BOTH IP/OP $259.00 $192.00 $51.41 $259.00 $116.55 $116.55 $116.55 $116.55 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $259.00 $259.00 $259.00 $53.98 $259.00 $103.60 $153.20 $259.00 $259.00 $259.00 $259.00 $194.25 $259.00 $259.00 $259.00 $129.50 $129.50 $205.13 $259.00 $207.20 $116.55 $51.41 N/A $150.22 $259.00 $155.40 $259.00 $53.98 $259.00 N/A N/A 71056408 SUP HCPCS C1713 71056408 - PIN HLF SHRT 6MM 40MM JTX TI NTRD BOTH IP/OP $259.00 $192.00 $51.41 $259.00 $116.55 $116.55 $116.55 $116.55 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $153.20 $259.00 $259.00 $259.00 $259.00 $194.25 $259.00 $259.00 $259.00 $129.50 $129.50 $205.13 $259.00 $207.20 $116.55 $51.41 N/A $150.22 $259.00 $155.40 $259.00 $53.98 $259.00 N/A N/A 71056409 SUP HCPCS C1713 71056409 - PIN HLF LNG 40MM JTX TI ORTH BOTH IP/OP $248.50 $184.00 $49.32 $248.50 $111.83 $111.83 $111.83 $111.83 $248.50 $248.50 $248.50 $51.79 $248.50 $248.50 $248.50 $248.50 $248.50 $51.79 $248.50 $248.50 $146.99 $248.50 $248.50 $248.50 $248.50 $186.38 $248.50 $248.50 $248.50 $124.25 $124.25 $196.81 $248.50 $198.80 $111.83 $49.32 N/A $144.13 $248.50 $149.10 $248.50 $51.79 $248.50 N/A N/A 71056458 SUP HCPCS C1713 71056458 - PIN HLF SHRT 6MM 45MM JTX TI NTRD BOTH IP/OP $259.00 $192.00 $51.41 $259.00 $116.55 $116.55 $116.55 $116.55 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $153.20 $259.00 $259.00 $259.00 $259.00 $194.25 $259.00 $259.00 $259.00 $129.50 $129.50 $205.13 $259.00 $207.20 $116.55 $51.41 N/A $150.22 $259.00 $155.40 $259.00 $53.98 $259.00 N/A N/A 71056459 SUP HCPCS C1713 71056459 - PIN HLF LNG 45MM JTX TI ORTH BOTH IP/OP $248.50 $184.00 $49.32 $248.50 $111.83 $111.83 $111.83 $111.83 $248.50 $248.50 $248.50 $51.79 $248.50 $248.50 $248.50 $248.50 $248.50 $51.79 $248.50 $248.50 $146.99 $248.50 $248.50 $248.50 $248.50 $186.38 $248.50 $248.50 $248.50 $124.25 $124.25 $196.81 $248.50 $198.80 $111.83 $49.32 N/A $144.13 $248.50 $149.10 $248.50 $51.79 $248.50 N/A N/A 71056508 SUP HCPCS C1713 71056508 - PIN HLF SHRT 6MM 50MM JTX TI NTRD BOTH IP/OP $259.00 $192.00 $51.41 $259.00 $116.55 $116.55 $116.55 $116.55 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $153.20 $259.00 $259.00 $259.00 $259.00 $194.25 $259.00 $259.00 $259.00 $129.50 $129.50 $205.13 $259.00 $207.20 $116.55 $51.41 N/A $150.22 $259.00 $155.40 $259.00 $53.98 $259.00 N/A N/A 71056509 SUP HCPCS C1713 71056509 - PIN HLF LNG 50MM JTX TI ORTH BOTH IP/OP $261.00 $193.00 $51.75 $260.75 $117.34 $117.34 $117.34 $117.34 $260.75 $260.75 $260.75 $54.35 $260.75 $260.75 $260.75 $260.75 $260.75 $54.34 $260.75 $260.75 $154.23 $260.75 $260.75 $260.75 $260.75 $195.75 $260.75 $260.75 $260.75 $130.38 $130.38 $206.51 $260.75 $208.60 $117.34 $51.75 N/A $151.38 $260.75 $156.45 $260.75 $260.75 $260.75 N/A N/A 71056558 SUP HCPCS C1713 71056558 - PIN HLF SHRT 6MM 55MM JTX TI NTRD BOTH IP/OP $259.00 $192.00 $51.41 $259.00 $116.55 $116.55 $116.55 $116.55 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $259.00 $259.00 $259.00 $53.98 $259.00 $103.60 $153.20 $259.00 $259.00 $259.00 $259.00 $194.25 $259.00 $259.00 $259.00 $129.50 $129.50 $205.13 $259.00 $207.20 $116.55 $51.41 N/A $150.22 $259.00 $155.40 $259.00 $53.98 $259.00 N/A N/A 71056608 SUP HCPCS C1713 71056608 - PIN HLF SHRT 6MM 60MM JTX TI NTRD BOTH IP/OP $259.00 $192.00 $51.41 $259.00 $116.55 $116.55 $116.55 $116.55 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $259.00 $259.00 $259.00 $53.98 $259.00 $103.60 $153.20 $259.00 $259.00 $259.00 $259.00 $194.25 $259.00 $259.00 $259.00 $129.50 $129.50 $205.13 $259.00 $207.20 $116.55 $51.41 N/A $150.22 $259.00 $155.40 $259.00 $53.98 $259.00 N/A N/A 71056609 SUP HCPCS C1713 71056609 - PIN HLF 60MM JTX TI ORTH BOTH IP/OP $261.00 $193.00 $51.75 $260.75 $117.34 $117.34 $117.34 $117.34 $260.75 $260.75 $260.75 $54.35 $260.75 $260.75 $260.75 $260.75 $260.75 $54.34 $260.75 $260.75 $154.23 $260.75 $260.75 $260.75 $260.75 $195.75 $260.75 $260.75 $260.75 $130.38 $130.38 $206.51 $260.75 $208.60 $117.34 $51.75 N/A $151.38 $260.75 $260.75 $260.75 $260.75 $260.75 N/A N/A 71056658 SUP HCPCS C1713 71056658 - PIN HLF SHRT 6MM 65MM JTX TI NTRD BOTH IP/OP $259.00 $192.00 $51.41 $259.00 $116.55 $116.55 $116.55 $116.55 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $153.20 $259.00 $259.00 $259.00 $259.00 $194.25 $259.00 $259.00 $259.00 $129.50 $129.50 $205.13 $259.00 $207.20 $116.55 $51.41 N/A $150.22 $259.00 $155.40 $259.00 $53.98 $259.00 N/A N/A 71056708 SUP HCPCS C1713 71056708 - PIN HLF SHRT 6MM 70MM JTX TI NTRD BOTH IP/OP $259.00 $192.00 $51.41 $259.00 $116.55 $116.55 $116.55 $116.55 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $259.00 $259.00 $259.00 $53.98 $259.00 $259.00 $153.20 $259.00 $259.00 $259.00 $259.00 $194.25 $259.00 $259.00 $259.00 $129.50 $129.50 $205.13 $259.00 $207.20 $116.55 $51.41 N/A $150.22 $259.00 $155.40 $259.00 $53.98 $259.00 N/A N/A 71056709 SUP HCPCS C1713 71056709 - PIN HLF LNG 60MM JTX TI ORTH BOTH IP/OP $261.00 $193.00 $51.75 $260.75 $117.34 $117.34 $117.34 $117.34 $260.75 $260.75 $260.75 $54.35 $260.75 $260.75 $260.75 $260.75 $260.75 $54.34 $260.75 $260.75 $154.23 $260.75 $260.75 $260.75 $260.75 $195.75 $260.75 $260.75 $260.75 $130.38 $130.38 $206.51 $260.75 $208.60 $117.34 $51.75 N/A $151.38 $260.75 $156.45 $260.75 $54.34 $260.75 N/A N/A 71061001 SUP HCPCS C1713 71061001 - PIN FX 3.2MM 86MM TROC PNT 1 END ORTH BOTH IP/OP $494.00 $366.00 $98.05 $494.00 $222.30 $222.30 $222.30 $222.30 $494.00 $494.00 $494.00 $102.96 $494.00 $494.00 $494.00 $494.00 $494.00 $102.96 $494.00 $494.00 $292.20 $494.00 $494.00 $494.00 $494.00 $370.50 $494.00 $494.00 $494.00 $247.00 $247.00 $391.25 $494.00 $395.20 $222.30 $98.05 N/A $286.52 $494.00 $296.40 $494.00 $102.95 $494.00 N/A N/A 71062007 SUP HCPCS C1713 71062007 - CAP PCTV 5MM BOTH IP/OP $60.50 $45.00 $11.97 $60.30 $27.14 $27.14 $27.14 $27.14 $60.30 $60.30 $60.30 $12.57 $60.30 $60.30 $60.30 $60.30 $60.30 $12.57 $60.30 $30.63 $35.67 $60.30 $30.63 $60.30 $60.30 $45.38 $60.30 $60.30 $60.30 $30.15 $30.15 $47.76 $60.30 $48.24 $27.14 $11.97 N/A $35.09 $60.30 $36.18 $60.30 $12.57 $60.30 N/A N/A 71062008 SUP HCPCS C1713 71062008 - BAR XTRNFX JTX CAP BOTH IP/OP $69.50 $51.00 $13.71 $69.10 $31.10 $31.10 $31.10 $31.10 $69.10 $69.10 $69.10 $14.40 $69.10 $69.10 $69.10 $69.10 $69.10 $14.40 $69.10 $35.00 $40.87 $69.10 $35.00 $69.10 $69.10 $52.13 $69.10 $69.10 $69.10 $34.55 $34.55 $54.73 $69.10 $55.28 $31.10 $13.71 N/A $40.31 $69.10 $41.46 $69.10 $69.10 $69.10 N/A N/A 71062017 SUP HCPCS C1713 71062017 - CAP END 4MM JTX PIN ORTH XTRNFX SYS BOTH IP/OP $115.50 $85.00 $22.92 $115.50 $51.98 $51.98 $51.98 $51.98 $115.50 $115.50 $115.50 $24.07 $115.50 $115.50 $115.50 $115.50 $115.50 $24.07 $115.50 $23.28 $68.32 $115.50 $58.19 $115.50 $115.50 $86.63 $115.50 $115.50 $115.50 $57.75 $57.75 $91.48 $115.50 $92.40 $51.98 $22.92 N/A $66.99 $115.50 $69.30 $115.50 $115.50 $115.50 N/A N/A 71062200 SUP HCPCS C1713 71062200 - BAR XTRNFX 200MM NS JTX CFBR DISP BOTH IP/OP $401.00 $297.00 $79.54 $400.75 $180.34 $180.34 $180.34 $180.34 $400.75 $400.75 $400.75 $83.53 $400.75 $400.75 $400.75 $400.75 $400.75 $83.52 $400.75 $400.75 $237.04 $400.75 $400.75 $400.75 $400.75 $300.75 $400.75 $400.75 $400.75 $200.38 $200.38 $317.39 $400.75 $320.60 $180.34 $79.54 N/A $232.58 $400.75 $240.45 $400.75 $83.52 $400.75 N/A N/A 71062250 SUP Custom 27203010 71062250 - BAR XTRNFX 250MM NS JTX CFBR DISP BOTH IP/OP $430.50 $319.00 $76.63 $430.50 $430.50 $430.50 $430.50 $430.50 $430.50 $430.50 $76.63 $430.50 $430.50 $319.52 $319.52 $331.83 $224.29 $89.72 $430.50 $172.20 $430.50 $430.50 $430.50 $430.50 $430.50 $322.88 $430.50 $430.50 $430.50 $215.25 $215.25 $340.96 $430.50 $344.40 $279.83 $430.50 N/A $249.69 $430.50 $258.30 $430.50 $430.50 $430.50 N/A N/A 71062300 SUP HCPCS C1713 71062300 - BAR XTRNFX 300MM NS JTX CFBR DISP BOTH IP/OP $430.50 $319.00 $85.44 $430.50 $193.73 $193.73 $193.73 $193.73 $430.50 $430.50 $430.50 $89.73 $430.50 $430.50 $430.50 $430.50 $430.50 $89.72 $430.50 $172.20 $254.64 $430.50 $430.50 $430.50 $430.50 $322.88 $430.50 $430.50 $430.50 $215.25 $215.25 $340.96 $430.50 $344.40 $193.73 $85.44 N/A $249.69 $430.50 $258.30 $430.50 $89.72 $430.50 N/A N/A 71062350 SUP HCPCS C1713 71062350 - BAR XTRNFX 350MM NS JTX CFBR DISP BOTH IP/OP $430.50 $319.00 $85.44 $430.50 $193.73 $193.73 $193.73 $193.73 $430.50 $430.50 $430.50 $89.73 $430.50 $430.50 $430.50 $430.50 $430.50 $89.72 $430.50 $430.50 $254.64 $430.50 $430.50 $430.50 $430.50 $322.88 $430.50 $430.50 $430.50 $215.25 $215.25 $340.96 $430.50 $344.40 $193.73 $85.44 N/A $249.69 $430.50 $258.30 $430.50 $89.72 $430.50 N/A N/A 71062400 SUP HCPCS C1713 71062400 - BAR XTRNFX 400MM NS JTX CFBR DISP BOTH IP/OP $474.50 $351.00 $94.13 $474.25 $213.41 $213.41 $213.41 $213.41 $474.25 $474.25 $474.25 $98.85 $474.25 $474.25 $474.25 $474.25 $474.25 $98.84 $474.25 $474.25 $280.52 $474.25 $474.25 $474.25 $474.25 $355.88 $474.25 $474.25 $474.25 $237.13 $237.13 $375.61 $474.25 $379.40 $213.41 $94.13 N/A $275.21 $474.25 $284.55 $474.25 $98.83 $474.25 N/A N/A 71063006 SUP Custom 27203010 71063006 - BIT DRL 3.5MM STRL JTX AO CNCT BOTH IP/OP $471.00 $349.00 $83.79 $470.75 $470.75 $470.75 $470.75 $470.75 $470.75 $470.75 $83.79 $470.75 $470.75 $349.39 $349.39 $362.85 $245.26 $98.11 $470.75 $188.30 $470.75 $470.75 $470.75 $470.75 $470.75 $353.25 $470.75 $470.75 $470.75 $235.38 $235.38 $372.83 $470.75 $376.60 $305.99 $470.75 N/A $273.18 $470.75 $282.45 $470.75 $470.75 $470.75 N/A N/A 71063011 SUP HCPCS C1769 71063011 - GUIDEWIRE ESCP 1.6MM BOTH IP/OP "$1,877.00" "$1,389.00" $372.51 "$1,876.88" "$1,019.15" "$1,019.15" "$1,019.15" "$1,019.15" "$1,876.88" "$1,876.88" "$1,876.88" $391.19 "$1,876.88" "$1,393.02" "$1,393.02" "$1,446.70" $977.85 $391.16 "$1,876.88" "$1,876.88" "$1,110.17" "$1,876.88" "$1,876.88" "$1,876.88" "$1,876.88" "$1,407.75" "$1,876.88" "$1,876.88" "$1,876.88" $938.44 $938.44 "$1,486.49" "$1,876.88" "$1,501.50" "$1,219.97" $372.51 N/A "$1,088.66" "$1,876.88" "$1,876.88" "$1,876.88" $391.14 "$1,876.88" N/A N/A 71063028 SUP Custom 27203010 71063028 - BIT DRL 3.5MM STRL JTX GRAD STP SHRT HLF PIN BOTH IP/OP $414.00 $306.00 $73.67 $413.88 $413.88 $413.88 $413.88 $413.88 $413.88 $413.88 $73.67 $413.88 $413.88 $307.18 $307.18 $319.02 $215.63 $86.26 $413.88 $165.55 $413.88 $413.88 $413.88 $413.88 $413.88 $310.50 $413.88 $413.88 $413.88 $206.94 $206.94 $327.79 $413.88 $331.10 $269.02 $413.88 N/A $240.12 $413.88 $248.33 $413.88 $413.88 $413.88 N/A N/A 71063152 SUP HCPCS C1713 71063152 - PIN XTRNFX SHRT 3MM 15MM JTX TI NTRD DIST RDS XTRNFX SYS BOTH IP/OP $318.00 $235.00 $63.04 $317.63 $142.93 $142.93 $142.93 $142.93 $317.63 $317.63 $317.63 $66.20 $317.63 $317.63 $317.63 $317.63 $317.63 $66.20 $317.63 $317.63 $187.88 $317.63 $317.63 $317.63 $317.63 $238.50 $317.63 $317.63 $317.63 $158.82 $158.82 $251.56 $317.63 $254.10 $142.93 $63.04 N/A $184.44 $317.63 $190.58 $317.63 $66.19 $317.63 N/A N/A 71063202 SUP HCPCS C1713 71063202 - PIN XTRNFX SHRT 3MM 20MM JTX TI NTRD DIST RDS XTRNFX SYS BOTH IP/OP $318.00 $235.00 $63.04 $317.63 $142.93 $142.93 $142.93 $142.93 $317.63 $317.63 $317.63 $66.20 $317.63 $317.63 $317.63 $317.63 $317.63 $66.20 $317.63 $317.63 $187.88 $317.63 $317.63 $317.63 $317.63 $238.50 $317.63 $317.63 $317.63 $158.82 $158.82 $251.56 $317.63 $254.10 $142.93 $63.04 N/A $184.44 $317.63 $190.58 $317.63 $66.19 $317.63 N/A N/A 71063203 SUP Custom 27203010 71063203 - BIT DRL SHRT 3MM STRL GRAD HLF PIN BOTH IP/OP $388.50 $287.00 $69.15 $388.50 $388.50 $388.50 $388.50 $388.50 $388.50 $388.50 $69.15 $388.50 $388.50 $288.34 $288.34 $299.46 $202.41 $80.97 $388.50 $155.40 $388.50 $388.50 $388.50 $388.50 $388.50 $291.38 $388.50 $388.50 $388.50 $194.25 $194.25 $307.69 $388.50 $310.80 $252.53 $388.50 N/A $225.33 $388.50 $233.10 $388.50 $388.50 $388.50 N/A N/A 71064151 SUP HCPCS C1713 71064151 - PIN HLF 4MM 95MM 15MM JTX SS DIST RDS FT XTRNFX SYS BOTH IP/OP $220.00 $163.00 $43.59 $219.63 $98.83 $98.83 $98.83 $98.83 $219.63 $219.63 $219.63 $45.78 $219.63 $219.63 $219.63 $219.63 $219.63 $45.77 $219.63 $87.85 $129.91 $219.63 $219.63 $219.63 $219.63 $165.00 $219.63 $219.63 $219.63 $109.82 $109.82 $173.95 $219.63 $175.70 $98.83 $43.59 N/A $127.60 $219.63 $131.78 $219.63 $45.77 $219.63 N/A N/A 71064158 SUP HCPCS C1713 71064158 - PIN HLF SHRT 4MM 15MM JTX TI NTRD XTRNFX SYS BOTH IP/OP $220.00 $163.00 $43.59 $219.63 $98.83 $98.83 $98.83 $98.83 $219.63 $219.63 $219.63 $45.78 $219.63 $219.63 $219.63 $219.63 $219.63 $45.77 $219.63 $87.85 $129.91 $219.63 $219.63 $219.63 $219.63 $165.00 $219.63 $219.63 $219.63 $109.82 $109.82 $173.95 $219.63 $175.70 $98.83 $43.59 N/A $127.60 $219.63 $131.78 $219.63 $45.77 $219.63 N/A N/A 71064201 SUP HCPCS C1713 71064201 - PIN HLF 4MM 20MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $220.00 $163.00 $43.59 $219.63 $98.83 $98.83 $98.83 $98.83 $219.63 $219.63 $219.63 $45.78 $219.63 $219.63 $219.63 $219.63 $219.63 $45.77 $219.63 $219.63 $129.91 $219.63 $219.63 $219.63 $219.63 $165.00 $219.63 $219.63 $219.63 $109.82 $109.82 $173.95 $219.63 $175.70 $98.83 $43.59 N/A $127.60 $219.63 $131.78 $219.63 $45.77 $219.63 N/A N/A 71064208 SUP HCPCS C1713 71064208 - PIN HLF SHRT 4MM 20MM JTX TI NTRD XTRNFX SYS BOTH IP/OP $220.00 $163.00 $43.59 $219.63 $98.83 $98.83 $98.83 $98.83 $219.63 $219.63 $219.63 $45.78 $219.63 $219.63 $219.63 $219.63 $219.63 $45.77 $219.63 $87.85 $129.91 $219.63 $219.63 $219.63 $219.63 $165.00 $219.63 $219.63 $219.63 $109.82 $109.82 $173.95 $219.63 $175.70 $98.83 $43.59 N/A $127.60 $219.63 $219.63 $219.63 $45.77 $219.63 N/A N/A 71064251 SUP HCPCS C1713 71064251 - PIN HLF 4MM 25MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $220.00 $163.00 $43.59 $219.63 $98.83 $98.83 $98.83 $98.83 $219.63 $219.63 $219.63 $45.78 $219.63 $219.63 $219.63 $219.63 $219.63 $45.77 $219.63 $87.85 $129.91 $219.63 $219.63 $219.63 $219.63 $165.00 $219.63 $219.63 $219.63 $109.82 $109.82 $173.95 $219.63 $175.70 $98.83 $43.59 N/A $127.60 $219.63 $219.63 $219.63 $45.77 $219.63 N/A N/A 71064258 SUP HCPCS C1713 71064258 - PIN HLF SHRT 4MM 25MM JTX TI NTRD XTRNFX SYS BOTH IP/OP $220.00 $163.00 $43.59 $219.63 $98.83 $98.83 $98.83 $98.83 $219.63 $219.63 $219.63 $45.78 $219.63 $219.63 $219.63 $219.63 $219.63 $45.77 $219.63 $219.63 $129.91 $219.63 $219.63 $219.63 $219.63 $165.00 $219.63 $219.63 $219.63 $109.82 $109.82 $173.95 $219.63 $175.70 $98.83 $43.59 N/A $127.60 $219.63 $131.78 $219.63 $45.77 $219.63 N/A N/A 71064301 SUP HCPCS C1713 71064301 - PIN HLF SHRT 4MM 30MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $220.00 $163.00 $43.59 $219.63 $98.83 $98.83 $98.83 $98.83 $219.63 $219.63 $219.63 $45.78 $219.63 $219.63 $219.63 $219.63 $219.63 $45.77 $219.63 $219.63 $129.91 $219.63 $219.63 $219.63 $219.63 $165.00 $219.63 $219.63 $219.63 $109.82 $109.82 $173.95 $219.63 $175.70 $98.83 $43.59 N/A $127.60 $219.63 $131.78 $219.63 $45.77 $219.63 N/A N/A 71064308 SUP HCPCS C1713 71064308 - PIN HALF SHORT 4MM 30MM JET-X TITANIUM NITRIDE ORTHOPEDIC BOTH IP/OP $220.00 $163.00 $43.59 $219.63 $98.83 $98.83 $98.83 $98.83 $219.63 $219.63 $219.63 $45.78 $219.63 $219.63 $219.63 $219.63 $219.63 $45.77 $219.63 $87.85 $129.91 $219.63 $219.63 $219.63 $219.63 $165.00 $219.63 $219.63 $219.63 $109.82 $109.82 $173.95 $219.63 $175.70 $98.83 $43.59 N/A $127.60 $219.63 $131.78 $219.63 $45.77 $219.63 N/A N/A 71064351 SUP HCPCS C1713 71064351 - PIN HLF 4MM 35MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $220.00 $163.00 $43.59 $219.63 $98.83 $98.83 $98.83 $98.83 $219.63 $219.63 $219.63 $45.78 $219.63 $219.63 $219.63 $219.63 $219.63 $45.77 $219.63 $87.85 $129.91 $219.63 $219.63 $219.63 $219.63 $165.00 $219.63 $219.63 $219.63 $109.82 $109.82 $173.95 $219.63 $175.70 $98.83 $43.59 N/A $127.60 $219.63 $219.63 $219.63 $45.77 $219.63 N/A N/A 71064358 SUP HCPCS C1713 71064358 - PIN HLF SHRT 4MM 35MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $220.00 $163.00 $43.59 $219.63 $98.83 $98.83 $98.83 $98.83 $219.63 $219.63 $219.63 $45.78 $219.63 $219.63 $219.63 $219.63 $219.63 $45.77 $219.63 $87.85 $129.91 $219.63 $219.63 $219.63 $219.63 $165.00 $219.63 $219.63 $219.63 $109.82 $109.82 $173.95 $219.63 $175.70 $98.83 $43.59 N/A $127.60 $219.63 $219.63 $219.63 $45.77 $219.63 N/A N/A 71065301 SUP HCPCS C1713 71065301 - PIN HLF 5MM 17.5CM 30MM JTX SS XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $278.25 $278.25 $57.99 $278.25 N/A N/A 71065302 SUP HCPCS C1713 71065302 - PIN HLF LNG 5MM 255MM 30MM JTX SS XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $166.95 $278.25 $57.99 $278.25 N/A N/A 71065304 SUP HCPCS C1713 71065304 - PIN HLF XSH 5MM 30MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $166.95 $278.25 $57.99 $278.25 N/A N/A 71065309 SUP HCPCS C1713 71065309 - PIN HLF LNG 5MM 30MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $138.60 $138.60 $138.60 $138.60 $308.00 $308.00 $308.00 $64.19 $308.00 $308.00 $308.00 $308.00 $308.00 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $138.60 $61.13 N/A $178.64 $308.00 $184.80 $308.00 $308.00 $308.00 N/A N/A 71065351 SUP HCPCS C1713 71065351 - PIN HLF 5MM 17.5CM 35MM JTX SS XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $166.95 $278.25 $278.25 $278.25 N/A N/A 71065352 SUP HCPCS C1713 71065352 - PIN HLF LNG 5MM 255MM 35MM JTX SS XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $278.25 $278.25 $57.99 $278.25 N/A N/A 71065354 SUP HCPCS C1713 71065354 - PIN HLF XSH 5MM 35MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $278.25 $278.25 $57.99 $278.25 N/A N/A 71065358 SUP HCPCS C1713 71065358 - PIN HLF SHRT 5MM 35MM JTX TI NTRD XTRNFX SYS BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $138.60 $138.60 $138.60 $138.60 $308.00 $308.00 $308.00 $64.19 $308.00 $308.00 $308.00 $308.00 $308.00 $64.19 $308.00 $123.20 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $138.60 $61.13 N/A $178.64 $308.00 $184.80 $308.00 $64.19 $308.00 N/A N/A 71065359 SUP HCPCS C1713 71065359 - PIN HLF LNG 5MM 35MM JTX TI NTRD XTRNFX SYS BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $138.60 $138.60 $138.60 $138.60 $308.00 $308.00 $308.00 $64.19 $308.00 $308.00 $308.00 $308.00 $308.00 $64.19 $308.00 $123.20 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $138.60 $61.13 N/A $178.64 $308.00 $184.80 $308.00 $308.00 $308.00 N/A N/A 71065400 SUP HCPCS C1713 71065400 - PIN HLF 5MM 40MM JTX CNN TI NTRD ORTH XTRNFX SYS BOTH IP/OP $392.00 $290.00 $77.80 $392.00 $176.40 $176.40 $176.40 $176.40 $392.00 $392.00 $392.00 $81.70 $392.00 $392.00 $392.00 $392.00 $392.00 $81.70 $392.00 $156.80 $231.87 $392.00 $392.00 $392.00 $392.00 $294.00 $392.00 $392.00 $392.00 $196.00 $196.00 $310.46 $392.00 $313.60 $176.40 $77.80 N/A $227.36 $392.00 $235.20 $392.00 $392.00 $392.00 N/A N/A 71065401 SUP HCPCS C1713 71065401 - PIN HLF 5MM 17.5CM 40MM JTX SS XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $278.25 $278.25 $57.99 $278.25 N/A N/A 71065402 SUP HCPCS C1713 71065402 - PIN HLF LNG 5MM 225MM 40MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $278.25 $278.25 $57.99 $278.25 N/A N/A 71065404 SUP HCPCS C1713 71065404 - PIN HLF XSH 5MM 40MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $166.95 $278.25 $57.99 $278.25 N/A N/A 71065407 SUP HCPCS C1713 71065407 - PIN HLF XSH 1.6MM 40MM 40MM JTX CNN TI NTRD ORTH XTRNFX SYS BOTH IP/OP $392.00 $290.00 $77.80 $392.00 $176.40 $176.40 $176.40 $176.40 $392.00 $392.00 $392.00 $81.70 $392.00 $392.00 $392.00 $392.00 $392.00 $81.70 $392.00 $156.80 $231.87 $392.00 $392.00 $392.00 $392.00 $294.00 $392.00 $392.00 $392.00 $196.00 $196.00 $310.46 $392.00 $313.60 $176.40 $77.80 N/A $227.36 $392.00 $235.20 $392.00 $81.69 $392.00 N/A N/A 71065408 SUP HCPCS C1713 71065408 - PIN HLF SHRT 5MM 40MM JTX TI NTRD XTRNFX SYS BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $138.60 $138.60 $138.60 $138.60 $308.00 $308.00 $308.00 $64.19 $308.00 $308.00 $308.00 $308.00 $308.00 $64.19 $308.00 $123.20 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $138.60 $61.13 N/A $178.64 $308.00 $184.80 $308.00 $64.19 $308.00 N/A N/A 71065409 SUP HCPCS C1713 71065409 - PIN HLF LNG 5MM 40MM JTX TI NTRD XTRNFX SYS BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $138.60 $138.60 $138.60 $138.60 $308.00 $308.00 $308.00 $64.19 $308.00 $308.00 $308.00 $308.00 $308.00 $64.19 $308.00 $123.20 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $138.60 $61.13 N/A $178.64 $308.00 $184.80 $308.00 $64.19 $308.00 N/A N/A 71065451 SUP HCPCS C1713 71065451 - PIN HLF 5MM 17.5CM 45MM JTX SS XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $166.95 $278.25 $57.99 $278.25 N/A N/A 71065452 SUP HCPCS C1713 71065452 - PIN HLF LNG 5MM 255MM 45MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $166.95 $278.25 $57.99 $278.25 N/A N/A 71065454 SUP HCPCS C1713 71065454 - PIN HLF XSH 5MM 45MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $278.25 $278.25 $57.99 $278.25 N/A N/A 71065458 SUP HCPCS C1713 71065458 - PIN HLF SHRT 5MM 45MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $138.60 $138.60 $138.60 $138.60 $308.00 $308.00 $308.00 $64.19 $308.00 $308.00 $308.00 $308.00 $308.00 $64.19 $308.00 $123.20 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $138.60 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A 71065459 SUP HCPCS C1713 71065459 - PIN HLF LNG 5MM 45MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $138.60 $138.60 $138.60 $138.60 $308.00 $308.00 $308.00 $64.19 $308.00 $308.00 $308.00 $308.00 $308.00 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $138.60 $61.13 N/A $178.64 $308.00 $184.80 $308.00 $64.19 $308.00 N/A N/A 71065501 SUP HCPCS C1713 71065501 - PIN HLF SHRT 5MM 175MM 50MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $166.95 $278.25 $57.99 $278.25 N/A N/A 71065502 SUP HCPCS C1713 71065502 - PIN HLF LNG 5MM 255MM 50MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $166.95 $278.25 $57.99 $278.25 N/A N/A 71065508 SUP HCPCS C1713 71065508 - PIN HLF SHRT 5MM 50MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $234.00 $173.00 $46.37 $233.63 $105.13 $105.13 $105.13 $105.13 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $233.63 $233.63 $233.63 $48.69 $233.63 $93.45 $138.19 $233.63 $233.63 $233.63 $233.63 $175.50 $233.63 $233.63 $233.63 $116.82 $116.82 $185.03 $233.63 $186.90 $105.13 $46.37 N/A $135.72 $233.63 $233.63 $233.63 $48.69 $233.63 N/A N/A 71065509 SUP HCPCS C1713 71065509 - PIN HLF LNG 5MM 50MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $234.00 $173.00 $46.37 $233.63 $105.13 $105.13 $105.13 $105.13 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $138.19 $233.63 $233.63 $233.63 $233.63 $175.50 $233.63 $233.63 $233.63 $116.82 $116.82 $185.03 $233.63 $186.90 $105.13 $46.37 N/A $135.72 $233.63 $140.18 $233.63 $48.69 $233.63 N/A N/A 71065551 SUP HCPCS C1713 71065551 - PIN HLF SHRT 5MM 175MM 55MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $166.95 $278.25 $278.25 $278.25 N/A N/A 71065552 SUP HCPCS C1713 71065552 - PIN HLF LNG 5MM 255MM 55MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $166.95 $278.25 $278.25 $278.25 N/A N/A 71065558 SUP HCPCS C1713 71065558 - PIN HLF SHRT 5MM 55MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $234.00 $173.00 $46.37 $233.63 $105.13 $105.13 $105.13 $105.13 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $233.63 $233.63 $233.63 $48.69 $233.63 $93.45 $138.19 $233.63 $233.63 $233.63 $233.63 $175.50 $233.63 $233.63 $233.63 $116.82 $116.82 $185.03 $233.63 $186.90 $105.13 $46.37 N/A $135.72 $233.63 $140.18 $233.63 $48.69 $233.63 N/A N/A 71065559 SUP HCPCS C1713 71065559 - PIN HLF LNG 5MM 55MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $234.00 $173.00 $46.37 $233.63 $105.13 $105.13 $105.13 $105.13 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $233.63 $233.63 $233.63 $48.69 $233.63 $93.45 $138.19 $233.63 $233.63 $233.63 $233.63 $175.50 $233.63 $233.63 $233.63 $116.82 $116.82 $185.03 $233.63 $186.90 $105.13 $46.37 N/A $135.72 $233.63 $140.18 $233.63 $48.69 $233.63 N/A N/A 71065601 SUP HCPCS C1713 71065601 - PIN HLF SHRT 5MM 60MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $166.95 $278.25 $57.99 $278.25 N/A N/A 71065602 SUP HCPCS C1713 71065602 - PIN HLF LNG 5MM 60MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $166.95 $278.25 $57.99 $278.25 N/A N/A 71065608 SUP HCPCS C1713 71065608 - PIN HLF SHRT 5MM 60MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $234.00 $173.00 $46.37 $233.63 $105.13 $105.13 $105.13 $105.13 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $138.19 $233.63 $233.63 $233.63 $233.63 $175.50 $233.63 $233.63 $233.63 $116.82 $116.82 $185.03 $233.63 $186.90 $105.13 $46.37 N/A $135.72 $233.63 $233.63 $233.63 $48.69 $233.63 N/A N/A 71065609 SUP HCPCS C1713 71065609 - PIN HLF LNG 5MM 60MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $234.00 $173.00 $46.37 $233.63 $105.13 $105.13 $105.13 $105.13 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $233.63 $233.63 $233.63 $48.69 $233.63 $93.45 $138.19 $233.63 $233.63 $233.63 $233.63 $175.50 $233.63 $233.63 $233.63 $116.82 $116.82 $185.03 $233.63 $186.90 $105.13 $46.37 N/A $135.72 $233.63 $140.18 $233.63 $48.69 $233.63 N/A N/A 71065651 SUP HCPCS C1713 71065651 - PIN HLF SHRT 5MM 65MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $166.95 $278.25 $57.99 $278.25 N/A N/A 71065652 SUP HCPCS C1713 71065652 - PIN HLF LNG 5MM 65MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $278.25 $278.25 $57.99 $278.25 N/A N/A 71065658 SUP HCPCS C1713 71065658 - PIN HLF SHRT 5MM 65MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $234.00 $173.00 $46.37 $233.63 $105.13 $105.13 $105.13 $105.13 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $233.63 $233.63 $233.63 $48.69 $233.63 $93.45 $138.19 $233.63 $233.63 $233.63 $233.63 $175.50 $233.63 $233.63 $233.63 $116.82 $116.82 $185.03 $233.63 $186.90 $105.13 $46.37 N/A $135.72 $233.63 $140.18 $233.63 $233.63 $233.63 N/A N/A 71065659 SUP HCPCS C1713 71065659 - PIN HLF LNG 5MM 65MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $230.50 $171.00 $45.68 $230.13 $103.56 $103.56 $103.56 $103.56 $230.13 $230.13 $230.13 $47.96 $230.13 $230.13 $230.13 $230.13 $230.13 $47.96 $230.13 $92.05 $136.12 $230.13 $230.13 $230.13 $230.13 $172.88 $230.13 $230.13 $230.13 $115.07 $115.07 $182.26 $230.13 $184.10 $103.56 $45.68 N/A $133.69 $230.13 $138.08 $230.13 $230.13 $230.13 N/A N/A 71065701 SUP HCPCS C1713 71065701 - PIN HLF SHRT 5MM 70MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $278.25 $278.25 $278.25 $278.25 N/A N/A 71065702 SUP HCPCS C1713 71065702 - PIN HLF LNG 5MM 70MM JTX SS ORTH XTRNFX SYS BOTH IP/OP $278.50 $206.00 $55.23 $278.25 $125.21 $125.21 $125.21 $125.21 $278.25 $278.25 $278.25 $57.99 $278.25 $278.25 $278.25 $278.25 $278.25 $57.99 $278.25 $111.30 $164.58 $278.25 $278.25 $278.25 $278.25 $208.88 $278.25 $278.25 $278.25 $139.13 $139.13 $220.37 $278.25 $222.60 $125.21 $55.23 N/A $161.53 $278.25 $166.95 $278.25 $57.99 $278.25 N/A N/A 71065708 SUP HCPCS C1713 71065708 - PIN HLF SHRT 5MM 70MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $234.00 $173.00 $46.37 $233.63 $105.13 $105.13 $105.13 $105.13 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $138.19 $233.63 $233.63 $233.63 $233.63 $175.50 $233.63 $233.63 $233.63 $116.82 $116.82 $185.03 $233.63 $186.90 $105.13 $46.37 N/A $135.72 $233.63 $140.18 $233.63 $48.69 $233.63 N/A N/A 71065709 SUP HCPCS C1713 71065709 - PIN HLF LNG 5MM 70MM JTX TI NTRD ORTH XTRNFX SYS BOTH IP/OP $234.00 $173.00 $46.37 $233.63 $105.13 $105.13 $105.13 $105.13 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $233.63 $233.63 $233.63 $48.69 $233.63 $93.45 $138.19 $233.63 $233.63 $233.63 $233.63 $175.50 $233.63 $233.63 $233.63 $116.82 $116.82 $185.03 $233.63 $186.90 $105.13 $46.37 N/A $135.72 $233.63 $140.18 $233.63 $48.69 $233.63 N/A N/A 71066409 SUP HCPCS C1713 71066409 - PIN FX LNG 6MM 40MM NS 160MM JTX SLF DRL ST TI NTRD BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $138.60 $138.60 $138.60 $138.60 $308.00 $308.00 $308.00 $64.19 $308.00 $308.00 $308.00 $308.00 $308.00 $64.19 $308.00 $123.20 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $138.60 $61.13 N/A $178.64 $308.00 $184.80 $308.00 $64.19 $308.00 N/A N/A 71066459 SUP HCPCS C1713 71066459 - PIN HLF LNG 6MM 45MM JTX TI NTRD BOTH IP/OP $234.00 $173.00 $46.37 $233.63 $105.13 $105.13 $105.13 $105.13 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $138.19 $233.63 $233.63 $233.63 $233.63 $175.50 $233.63 $233.63 $233.63 $116.82 $116.82 $185.03 $233.63 $186.90 $105.13 $46.37 N/A $135.72 $233.63 $140.18 $233.63 $48.69 $233.63 N/A N/A 71066509 SUP HCPCS C1713 71066509 - PIN HALF 50MM 6MM JTX LNG TI NTRD BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $138.60 $138.60 $138.60 $138.60 $308.00 $308.00 $308.00 $64.19 $308.00 $308.00 $308.00 $308.00 $308.00 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $138.60 $61.13 N/A $178.64 $308.00 $184.80 $308.00 $64.19 $308.00 N/A N/A 71066559 SUP HCPCS C1713 71066559 - PIN HLF LNG 6MM 55MM JTX TI NTRD BOTH IP/OP $234.00 $173.00 $46.37 $233.63 $105.13 $105.13 $105.13 $105.13 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $233.63 $233.63 $233.63 $48.69 $233.63 $233.63 $138.19 $233.63 $233.63 $233.63 $233.63 $175.50 $233.63 $233.63 $233.63 $116.82 $116.82 $185.03 $233.63 $186.90 $105.13 $46.37 N/A $135.72 $233.63 $233.63 $233.63 $48.69 $233.63 N/A N/A 71067315 SUP Custom 27203010 71067315 - BIT DRL 2MM 3MM HLF PIN BOTH IP/OP $570.00 $422.00 $101.39 $569.63 $569.63 $569.63 $569.63 $569.63 $569.63 $569.63 $101.39 $569.63 $569.63 $422.78 $422.78 $439.07 $296.78 $118.72 $569.63 $227.85 $569.63 $569.63 $569.63 $569.63 $569.63 $427.50 $569.63 $569.63 $569.63 $284.82 $284.82 $451.15 $569.63 $455.70 $370.26 $569.63 N/A $330.60 $569.63 $341.78 $569.63 $569.63 $569.63 N/A N/A 71067319 SUP Custom 27203010 71067319 - BIT DRILL LNG 5MM HALF PIN BOTH IP/OP $570.00 $422.00 $101.39 $569.63 $569.63 $569.63 $569.63 $569.63 $569.63 $569.63 $101.39 $569.63 $569.63 $422.78 $422.78 $439.07 $296.78 $118.72 $569.63 $227.85 $569.63 $569.63 $569.63 $569.63 $569.63 $427.50 $569.63 $569.63 $569.63 $284.82 $284.82 $451.15 $569.63 $455.70 $370.26 $569.63 N/A $330.60 $569.63 $341.78 $569.63 $569.63 $569.63 N/A N/A 71067321 SUP Custom 27203010 71067321 - BIT DRILL 6 MM HALF PIN BOTH IP/OP $570.00 $422.00 $101.39 $569.63 $569.63 $569.63 $569.63 $569.63 $569.63 $569.63 $101.39 $569.63 $569.63 $422.78 $422.78 $439.07 $296.78 $118.72 $569.63 $227.85 $569.63 $569.63 $569.63 $569.63 $569.63 $427.50 $569.63 $569.63 $569.63 $284.82 $284.82 $451.15 $569.63 $455.70 $370.26 $569.63 N/A $330.60 $569.63 $341.78 $569.63 $569.63 $569.63 N/A N/A 71067374 SUP HCPCS C1713 71067374 - CLAMP EXFIX 10.5MM 10.5MM QUICK CONNECT BAR TO BAR JET-X BOTH IP/OP "$1,015.00" $751.00 $201.45 "$1,015.00" $456.75 $456.75 $456.75 $456.75 "$1,015.00" "$1,015.00" "$1,015.00" $211.55 "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" $211.54 "$1,015.00" $406.00 $600.37 "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" $761.25 "$1,015.00" "$1,015.00" "$1,015.00" $507.50 $507.50 $803.88 "$1,015.00" $812.00 $456.75 $201.45 N/A $588.70 "$1,015.00" $609.00 "$1,015.00" $211.53 "$1,015.00" N/A N/A 71070113 SUP HCPCS C1713 71070113 - RING EXFIX CIR FULL 130MM TAYLOR SPATIAL FRAME BOTH IP/OP "$3,230.00" "$2,390.00" $641.07 "$3,230.00" "$1,453.50" "$1,453.50" "$1,453.50" "$1,453.50" "$3,230.00" "$3,230.00" "$3,230.00" $673.21 "$3,230.00" "$3,230.00" "$3,230.00" "$3,230.00" "$3,230.00" $673.17 "$3,230.00" "$1,292.00" "$1,592.39" "$3,230.00" "$3,230.00" "$3,230.00" "$3,230.00" "$2,422.50" "$3,230.00" "$3,230.00" "$3,230.00" "$1,615.00" "$1,615.00" "$2,558.16" "$3,230.00" "$2,584.00" "$1,453.50" $641.07 N/A "$1,873.40" "$3,230.00" "$1,938.00" "$3,230.00" $673.13 "$3,230.00" N/A N/A 71070116 SUP HCPCS C1713 71070116 - RING EXFIX FULL 205MM ALUMINUM TAYLOR SPATIAL FRAME BOTH IP/OP "$3,230.00" "$2,390.00" $641.07 "$3,230.00" "$1,453.50" "$1,453.50" "$1,453.50" "$1,453.50" "$3,230.00" "$3,230.00" "$3,230.00" $673.21 "$3,230.00" "$3,230.00" "$3,230.00" "$3,230.00" "$3,230.00" $673.17 "$3,230.00" "$1,292.00" "$1,592.39" "$3,230.00" "$3,230.00" "$3,230.00" "$3,230.00" "$2,422.50" "$3,230.00" "$3,230.00" "$3,230.00" "$1,615.00" "$1,615.00" "$2,558.16" "$3,230.00" "$2,584.00" "$1,453.50" $641.07 N/A "$1,873.40" "$3,230.00" "$1,938.00" "$3,230.00" $673.13 "$3,230.00" N/A N/A 71070117 SUP Custom 27203010 71070117 - RING EXFIX 230MM FULL RING CIRCULAR TAYLOR SPATIAL FRAME BOTH IP/OP "$3,230.00" "$2,390.00" $574.94 "$3,230.00" "$3,230.00" "$3,230.00" "$3,230.00" "$3,230.00" "$3,230.00" "$3,230.00" $574.94 "$3,230.00" "$3,230.00" "$2,397.31" "$2,397.31" "$2,489.68" "$1,682.83" $673.17 "$3,230.00" "$1,292.00" "$3,230.00" "$3,230.00" "$3,230.00" "$3,230.00" "$3,230.00" "$2,422.50" "$3,230.00" "$3,230.00" "$3,230.00" "$1,615.00" "$1,615.00" "$2,558.16" "$3,230.00" "$2,584.00" "$2,099.50" "$3,230.00" N/A "$1,873.40" "$3,230.00" "$1,938.00" "$3,230.00" "$3,230.00" "$3,230.00" N/A N/A 71070124 SUP Custom 27011340 71070124 - RING EXFIX 155MM CIR HALF TLT SP BOTH IP/OP "$3,459.50" "$2,560.00" $615.79 "$3,459.50" "$3,459.50" "$3,459.50" "$3,459.50" "$3,459.50" "$3,459.50" "$3,459.50" $615.79 "$3,459.50" "$3,459.50" "$2,567.64" "$2,567.64" "$2,666.58" "$1,802.40" $721.00 "$3,459.50" "$1,383.80" "$3,459.50" "$3,459.50" "$3,459.50" "$3,459.50" "$3,459.50" "$2,594.63" "$3,459.50" "$3,459.50" "$3,459.50" "$1,729.75" "$1,729.75" "$2,739.92" "$3,459.50" "$2,767.60" "$2,248.68" "$3,459.50" N/A "$2,006.51" "$3,459.50" "$2,075.70" "$3,459.50" "$3,459.50" "$3,459.50" N/A N/A 71070144 SUP Custom 27011340 71070144 - RING EXFIX 155MM LNG CIR FT TLT SP BOTH IP/OP "$4,080.00" "$3,019.00" $726.24 "$4,080.00" "$4,080.00" "$4,080.00" "$4,080.00" "$4,080.00" "$4,080.00" "$4,080.00" $726.24 "$4,080.00" "$4,080.00" "$3,028.18" "$3,028.18" "$3,144.86" "$2,060.15" $850.32 "$4,080.00" "$1,632.00" "$4,080.00" "$4,080.00" "$4,080.00" "$4,080.00" "$4,080.00" "$3,060.00" "$4,080.00" "$4,080.00" "$4,080.00" "$2,040.00" "$2,040.00" "$3,231.36" "$4,080.00" "$3,264.00" "$2,652.00" "$4,080.00" N/A "$2,366.40" "$4,080.00" "$2,448.00" "$4,080.00" "$4,080.00" "$4,080.00" N/A N/A 71070272 SUP HCPCS C1776 71070272 - SLEEVE CENTERING 6MM BOTH IP/OP $406.50 $301.00 $80.64 $406.30 $182.84 $182.84 $182.84 $182.84 $406.30 $406.30 $406.30 $84.68 $406.30 $406.30 $406.30 $406.30 $406.30 $84.68 $406.30 $162.52 $240.33 $406.30 $406.30 $406.30 $406.30 $304.88 $406.30 $406.30 $406.30 $203.15 $203.15 $321.79 $406.30 $325.04 $182.84 $80.64 N/A $235.77 $406.30 $406.30 $406.30 $84.67 $406.30 N/A N/A 71070273 SUP Custom 27011340 71070273 - CUBE XTRNFX ILZ 1 HL POST RNCH SYS BOTH IP/OP $527.00 $390.00 $93.81 $527.00 $527.00 $527.00 $527.00 $527.00 $527.00 $527.00 $93.81 $527.00 $527.00 $391.14 $391.14 $406.21 $274.57 $109.83 $527.00 $210.80 $527.00 $527.00 $527.00 $527.00 $527.00 $395.25 $527.00 $527.00 $527.00 $263.50 $263.50 $417.38 $527.00 $421.60 $342.55 $527.00 N/A $305.66 $527.00 $316.20 $527.00 $527.00 $527.00 N/A N/A 71070282 SUP Custom 27011340 71070282 - CONNECTOR EXFIX 30MM SHRT XTD BOTH IP/OP $406.50 $301.00 $72.32 $406.30 $406.30 $406.30 $406.30 $406.30 $406.30 $406.30 $72.32 $406.30 $406.30 $301.56 $301.56 $313.18 $211.68 $84.68 $406.30 $162.52 $406.30 $406.30 $406.30 $406.30 $406.30 $304.88 $406.30 $406.30 $406.30 $203.15 $203.15 $321.79 $406.30 $325.04 $264.10 $406.30 N/A $235.77 $406.30 $243.78 $406.30 $406.30 $406.30 N/A N/A 71070283 SUP Custom 27011340 71070283 - CONNECTOR ROD 50MM LNG XTD BOTH IP/OP $406.50 $301.00 $72.32 $406.30 $406.30 $406.30 $406.30 $406.30 $406.30 $406.30 $72.32 $406.30 $406.30 $301.56 $301.56 $313.18 $211.68 $84.68 $406.30 $162.52 $406.30 $406.30 $406.30 $406.30 $406.30 $304.88 $406.30 $406.30 $406.30 $203.15 $203.15 $321.79 $406.30 $325.04 $264.10 $406.30 N/A $235.77 $406.30 $243.78 $406.30 $406.30 $406.30 N/A N/A 71070284 SUP HCPCS C1713 71070284 - BOLT XTRNFX ILZ CMBN WRE BOTH IP/OP $191.50 $142.00 $37.95 $191.20 $86.04 $86.04 $86.04 $86.04 $191.20 $191.20 $191.20 $39.85 $191.20 $191.20 $191.20 $191.20 $191.20 $39.85 $191.20 $74.80 $113.09 $191.20 $187.00 $191.20 $191.20 $143.63 $191.20 $191.20 $191.20 $95.60 $95.60 $151.43 $191.20 $152.96 $86.04 $37.95 N/A $111.07 $191.20 $114.72 $191.20 $39.85 $191.20 N/A N/A 71070285 SUP HCPCS C1713 71070285 - NUT ORTH LNG RSN BOTH IP/OP $33.00 $24.00 $6.51 $160.15 $14.76 $14.76 $14.76 $14.76 $32.80 $32.80 $32.80 $6.84 $32.80 $32.80 $32.80 $32.80 $32.80 $6.84 $32.80 $160.15 $19.40 $32.80 $160.15 $32.80 $32.80 $24.75 $32.80 $32.80 $32.80 $16.40 $16.40 $25.98 $32.80 $26.24 $14.76 $6.51 N/A $19.14 $32.80 $19.68 $32.80 $6.84 $32.80 N/A N/A 71070286 SUP HCPCS C1713 71070286 - NUT ORTH 10MM BOTH IP/OP $109.00 $81.00 $21.63 $109.00 $49.05 $49.05 $49.05 $49.05 $109.00 $109.00 $109.00 $22.72 $109.00 $109.00 $109.00 $109.00 $109.00 $22.72 $109.00 $42.50 $64.47 $109.00 $106.25 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $49.05 $21.63 N/A $63.22 $109.00 $109.00 $109.00 $109.00 $109.00 N/A N/A 71070290 SUP HCPCS C1713 71070290 - CAP PIN 6MM HALF HALF ORANGE BOTH IP/OP $80.50 $60.00 $15.94 $80.33 $36.15 $36.15 $36.15 $36.15 $80.33 $80.33 $80.33 $16.74 $80.33 $80.33 $80.33 $80.33 $80.33 $16.74 $80.33 $80.33 $47.52 $80.33 $80.33 $80.33 $80.33 $60.38 $80.33 $80.33 $80.33 $40.17 $40.17 $63.62 $80.33 $64.26 $36.15 $15.94 N/A $46.69 $80.33 $80.33 $80.33 $16.74 $80.33 N/A N/A 71070340 SUP HCPCS C1713 71070340 - KIT XTRNFX FST FX ID BAND STD STRUT BOTH IP/OP "$1,057.50" $783.00 $209.87 "$1,057.40" $475.83 $475.83 $475.83 $475.83 "$1,057.40" "$1,057.40" "$1,057.40" $220.39 "$1,057.40" "$1,057.40" "$1,057.40" "$1,057.40" "$1,057.40" $220.37 "$1,057.40" $422.96 $625.45 "$1,057.40" "$1,057.40" "$1,057.40" "$1,057.40" $793.13 "$1,057.40" "$1,057.40" "$1,057.40" $528.70 $528.70 $837.46 "$1,057.40" $845.92 $475.83 $209.87 N/A $613.35 "$1,057.40" $634.44 "$1,057.40" $220.36 "$1,057.40" N/A N/A 71070345 SUP Custom 27203010 71070345 - DRILL SURG SHORT 3.8MM STEP BOTH IP/OP "$1,073.00" $794.00 $190.94 "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" $190.94 "$1,072.70" "$1,072.70" $796.16 $796.16 $826.84 $558.88 $223.56 "$1,072.70" $429.08 "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" $804.75 "$1,072.70" "$1,072.70" "$1,072.70" $536.35 $536.35 $849.58 "$1,072.70" $858.16 $697.26 "$1,072.70" N/A $622.34 "$1,072.70" $643.62 "$1,072.70" "$1,072.70" "$1,072.70" N/A N/A 71070348 SUP Custom 27203010 71070348 - DRILL SURG LONG 3.8MM STEP BOTH IP/OP "$1,073.00" $794.00 $190.94 "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" $190.94 "$1,072.70" "$1,072.70" $796.16 $796.16 $826.84 $558.88 $223.56 "$1,072.70" $429.08 "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" "$1,072.70" $804.75 "$1,072.70" "$1,072.70" "$1,072.70" $536.35 $536.35 $849.58 "$1,072.70" $858.16 $697.26 "$1,072.70" N/A $622.34 "$1,072.70" $643.62 "$1,072.70" "$1,072.70" "$1,072.70" N/A N/A 71070365 SUP Custom 27011340 71070365 - RING EXFIX 180MM 155MM RCKR BOTH IP/OP "$2,592.50" "$1,918.00" $461.47 "$2,592.50" "$2,592.50" "$2,592.50" "$2,592.50" "$2,592.50" "$2,592.50" "$2,592.50" $461.47 "$2,592.50" "$2,592.50" "$1,924.15" "$1,924.15" "$1,998.30" "$1,350.69" $540.31 "$2,592.50" "$1,037.00" "$2,592.50" "$2,592.50" "$2,592.50" "$2,592.50" "$2,592.50" "$1,944.38" "$2,592.50" "$2,592.50" "$2,592.50" "$1,296.25" "$1,296.25" "$2,053.26" "$2,592.50" "$2,074.00" "$1,685.13" "$2,592.50" N/A "$1,503.65" "$2,592.50" "$1,555.50" "$2,592.50" "$2,592.50" "$2,592.50" N/A N/A 71070515 SUP HCPCS C1713 71070515 - BOLT CNCT 12MM TLT SP BOTH IP/OP $25.00 $19.00 $4.96 $25.00 $11.25 $11.25 $11.25 $11.25 $25.00 $25.00 $25.00 $5.21 $25.00 $25.00 $25.00 $25.00 $25.00 $5.21 $25.00 $9.25 $14.79 $25.00 $23.13 $25.00 $25.00 $18.75 $25.00 $25.00 $25.00 $12.50 $12.50 $19.80 $25.00 $20.00 $11.25 $4.96 N/A $14.50 $25.00 $15.00 $25.00 $5.21 $25.00 N/A N/A 71070720 SUP HCPCS C1713 71070720 - STRUT EXFIX MEDIUM CIR 143-205MM FAST-FIX TAYLOR SPATIAL BOTH IP/OP "$3,332.00" "$2,466.00" $661.32 "$3,332.00" "$1,499.40" "$1,499.40" "$1,499.40" "$1,499.40" "$3,332.00" "$3,332.00" "$3,332.00" $694.47 "$3,332.00" "$3,332.00" "$3,332.00" "$3,332.00" "$3,332.00" $694.43 "$3,332.00" "$3,332.00" "$1,642.68" "$3,332.00" "$3,332.00" "$3,332.00" "$3,332.00" "$2,499.00" "$3,332.00" "$3,332.00" "$3,332.00" "$1,666.00" "$1,666.00" "$2,638.94" "$3,332.00" "$2,665.60" "$1,499.40" $661.32 N/A "$1,932.56" "$3,332.00" "$1,999.20" "$3,332.00" $694.39 "$3,332.00" N/A N/A 71070730 SUP HCPCS C1713 71070730 - STRUT XTRNFX LNG 195-311MM FST FX TLT SP BOTH IP/OP "$3,332.00" "$2,466.00" $661.32 "$3,332.00" "$1,499.40" "$1,499.40" "$1,499.40" "$1,499.40" "$3,332.00" "$3,332.00" "$3,332.00" $694.47 "$3,332.00" "$3,332.00" "$3,332.00" "$3,332.00" "$3,332.00" $694.43 "$3,332.00" "$1,332.80" "$1,642.68" "$3,332.00" "$3,332.00" "$3,332.00" "$3,332.00" "$2,499.00" "$3,332.00" "$3,332.00" "$3,332.00" "$1,666.00" "$1,666.00" "$2,638.94" "$3,332.00" "$2,665.60" "$1,499.40" $661.32 N/A "$1,932.56" "$3,332.00" "$1,999.20" "$3,332.00" $694.39 "$3,332.00" N/A N/A 71070800 SUP HCPCS C1713 71070800 - PIN HLF 6MM 150MM 20MM HA XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $586.50 $586.50 $122.23 $586.50 N/A N/A 71070801 SUP HCPCS C1713 71070801 - PIN HLF 6MM 200MM 20MM HA XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $586.50 $586.50 $586.50 $586.50 N/A N/A 71070802 SUP HCPCS C1713 71070802 - PIN HALF 6MM 150MM 25MM HA EXFIX SYSTEM BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $586.50 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $351.90 $586.50 $122.23 $586.50 N/A N/A 71070803 SUP HCPCS C1713 71070803 - PIN HALF 6MM 200MM 25MM HA ORTHOPEDIC EXFIX SYSTEM BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $586.50 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $351.90 $586.50 $122.23 $586.50 N/A N/A 71070804 SUP HCPCS C1713 71070804 - PIN HALF 6MM 150MM 30MM HA EXFIX SYSTEM BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $586.50 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $351.90 $586.50 $122.23 $586.50 N/A N/A 71070805 SUP HCPCS C1713 71070805 - PIN HLF 6MM 200MM 30MM HA ORTH XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $586.50 $586.50 $122.23 $586.50 N/A N/A 71070806 SUP HCPCS C1713 71070806 - PIN HALF 6MM 150MM 35MM HA EXFIX SYSTEM BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $351.90 $586.50 $122.23 $586.50 N/A N/A 71070808 SUP HCPCS C1713 71070808 - PIN HALF 6MM 150MM 40MM HA EXFIX SYSTEM BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $586.50 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $351.90 $586.50 $122.23 $586.50 N/A N/A 71070809 SUP HCPCS C1713 71070809 - PIN HALF 200MM 6MM HA 40MM EXFIX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $351.90 $586.50 $122.23 $586.50 N/A N/A 71070812 SUP HCPCS C1713 71070812 - PIN HLF 6MM 150MM 55MM HA XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $586.50 $586.50 $586.50 $586.50 N/A N/A 71070814 SUP HCPCS C1713 71070814 - PIN HLF 6MM 150MM 60MM HA XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $586.50 $586.50 $122.23 $586.50 N/A N/A 71070815 SUP HCPCS C1713 71070815 - PIN HLF 6MM 200MM 60MM HAP XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $586.50 $586.50 $122.23 $586.50 N/A N/A 71070816 SUP HCPCS C1713 71070816 - PIN HLF 6MM 150MM 65MM HA XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $586.50 $586.50 $122.23 $586.50 N/A N/A 71070817 SUP HCPCS C1713 71070817 - PIN HLF 6MM 200MM 65MM HAP XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $586.50 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $351.90 $586.50 $122.23 $586.50 N/A N/A 71070818 SUP HCPCS C1713 71070818 - PIN HLF 6MM 150MM 70MM HA XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $586.50 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $351.90 $586.50 $122.23 $586.50 N/A N/A 71070819 SUP HCPCS C1713 71070819 - PIN HLF 6MM 200MM 70MM HAP ORTH XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $351.90 $586.50 $122.23 $586.50 N/A N/A 71070820 SUP HCPCS C1713 71070820 - PIN HLF 6MM 200MM 80MM HA XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $351.90 $586.50 $122.23 $586.50 N/A N/A 71070821 SUP HCPCS C1713 71070821 - PIN HLF 6MM 200MM 90MM HAP ORTH XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $586.50 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $586.50 $586.50 $122.23 $586.50 N/A N/A 71070822 SUP HCPCS C1713 71070822 - PIN HLF 6MM 150MM 20MM HAP ORTH XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $586.50 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $586.50 $586.50 $122.23 $586.50 N/A N/A 71070823 SUP HCPCS C1713 71070823 - PIN HLF 4.5MM 150MM 10MM HA XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $586.50 $586.50 $122.23 $586.50 N/A N/A 71070824 SUP HCPCS C1713 71070824 - PIN HLF 4.5MM 150MM 20MM HA XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $351.90 $586.50 $122.23 $586.50 N/A N/A 71070825 SUP HCPCS C1713 71070825 - PIN HALF 4.5MM 150MM 30MM THREAD HA ORTHOPEDIC EXFIX SYSTEM BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $351.90 $586.50 $122.23 $586.50 N/A N/A 71070826 SUP HCPCS C1713 71070826 - PIN HALF 4.5MM 150MM 40MM THREAD HA ORTHOPEDIC EXFIX SYSTEM BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $351.90 $586.50 $122.23 $586.50 N/A N/A 71070827 SUP HCPCS C1713 71070827 - PIN HLF 4.5MM 150MM 50MM THRD HA ORTH XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $586.50 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $586.50 $586.50 $122.23 $586.50 N/A N/A 71070828 SUP HCPCS C1713 71070828 - PIN HLF 6MM 150MM 15MM HA ORTH XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $351.90 $586.50 $122.23 $586.50 N/A N/A 71070829 SUP HCPCS C1713 71070829 - PIN HLF 6MM 200MM 15MM HAP ORTH XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $234.60 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $586.50 $586.50 $122.23 $586.50 N/A N/A 71070835 SUP HCPCS C1713 71070835 - PIN HLF 6MM 150MM 45MM HA XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $586.50 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $586.50 $586.50 $122.23 $586.50 N/A N/A 71070836 SUP HCPCS C1713 71070836 - PIN HLF 6MM 200MM 45MM HAP XTRNFX SYS BOTH IP/OP $586.50 $434.00 $116.41 $586.50 $263.93 $263.93 $263.93 $263.93 $586.50 $586.50 $586.50 $122.24 $586.50 $586.50 $586.50 $586.50 $586.50 $122.23 $586.50 $586.50 $346.91 $586.50 $586.50 $586.50 $586.50 $439.88 $586.50 $586.50 $586.50 $293.25 $293.25 $464.51 $586.50 $469.20 $263.93 $116.41 N/A $340.17 $586.50 $586.50 $586.50 $122.23 $586.50 N/A N/A 71070844 SUP Custom 27203010 71070844 - BIT DRL LNG 4.8MM HA PIN BOTH IP/OP "$1,238.00" $916.00 $220.29 "$1,237.60" "$1,237.60" "$1,237.60" "$1,237.60" "$1,237.60" "$1,237.60" "$1,237.60" $220.29 "$1,237.60" "$1,237.60" $918.55 $918.55 $953.94 $644.79 $257.93 "$1,237.60" $495.04 "$1,237.60" "$1,237.60" "$1,237.60" "$1,237.60" "$1,237.60" $928.50 "$1,237.60" "$1,237.60" "$1,237.60" $618.80 $618.80 $980.18 "$1,237.60" $990.08 $804.44 "$1,237.60" N/A $718.04 "$1,237.60" $742.56 "$1,237.60" "$1,237.60" "$1,237.60" N/A N/A 71070845 SUP Custom 27203010 71070845 - BIT DRL 1.8MM 4.8MM CNN HA PIN BOTH IP/OP "$1,603.50" "$1,187.00" $285.35 "$1,603.10" "$1,603.10" "$1,603.10" "$1,603.10" "$1,603.10" "$1,603.10" "$1,603.10" $285.35 "$1,603.10" "$1,603.10" "$1,189.82" "$1,189.82" "$1,235.67" $835.22 $334.10 "$1,603.10" $641.24 "$1,603.10" "$1,603.10" "$1,603.10" "$1,603.10" "$1,603.10" "$1,202.63" "$1,603.10" "$1,603.10" "$1,603.10" $801.55 $801.55 "$1,269.66" "$1,603.10" "$1,282.48" "$1,042.02" "$1,603.10" N/A $930.03 "$1,603.10" $961.86 "$1,603.10" "$1,603.10" "$1,603.10" N/A N/A 71070846 SUP Custom 27203010 71070846 - BIT DRL 1.5MM 3.8MM CNN HA PIN BOTH IP/OP "$1,603.50" "$1,187.00" $285.35 "$1,603.10" "$1,603.10" "$1,603.10" "$1,603.10" "$1,603.10" "$1,603.10" "$1,603.10" $285.35 "$1,603.10" "$1,603.10" "$1,189.82" "$1,189.82" "$1,235.67" $835.22 $334.10 "$1,603.10" $641.24 "$1,603.10" "$1,603.10" "$1,603.10" "$1,603.10" "$1,603.10" "$1,202.63" "$1,603.10" "$1,603.10" "$1,603.10" $801.55 $801.55 "$1,269.66" "$1,603.10" "$1,282.48" "$1,042.02" "$1,603.10" N/A $930.03 "$1,603.10" $961.86 "$1,603.10" "$1,603.10" "$1,603.10" N/A N/A 71100045 SUP HCPCS C1713 71100045 - SCREW BN 6.5MM 45MM STRL 32MM CNN ORTH BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 71100050 SUP HCPCS C1713 71100050 - SCREW BN 6.5MM 8MM 3.5MM 50MM STRL 32MM CNN SS HIP ACPT 2.4 BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $531.30 $531.30 $110.72 $531.30 N/A N/A 71100055 SUP HCPCS C1713 71100055 - SCREW BN 6.5MM 8MM 3.5MM 55MM STRL 32MM CNN SS HIP ACPT 2.4 BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $531.30 $531.30 N/A N/A 71100060 SUP HCPCS C1713 71100060 - SCREW BN 6.5MM 8MM 3.5MM 60MM STRL 32MM CNN SS HIP ACPT 2.4 BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $531.30 $531.30 N/A N/A 71100065 SUP HCPCS C1713 71100065 - SCREW BN 6.5MM 8MM 3.5MM 65MM STRL 32MM CNN SS HIP ACPT 2.4 BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $531.30 $531.30 N/A N/A 71100070 SUP HCPCS C1713 71100070 - SCREW BN 6.5MM 8MM 3.5MM 70MM STRL 32MM CNN SS HIP ACPT 2.4 BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $531.30 $531.30 $531.30 $531.30 N/A N/A 71100075 SUP HCPCS C1713 71100075 - SCREW BN 6.5MM 8MM 3.5MM 75MM STRL 32MM CNN SS HIP ACPT 2.4 BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 71100080 SUP HCPCS C1713 71100080 - SCREW BN 6.5MM 8MM 3.5MM 80MM STRL 32MM CNN SS HIP ACPT 2.4 BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $531.30 $531.30 N/A N/A 71100085 SUP HCPCS C1713 71100085 - SCREW BN 6.5MM 8MM 3.5MM 85MM STRL 32MM CNN SS HIP ACPT 2.4 BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 71100090 SUP HCPCS C1713 71100090 - SCREW BN 6.5MM 8MM 3.5MM 90MM STRL 32MM CNN SS HIP ACPT 2.4 BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 71100095 SUP HCPCS C1713 71100095 - SCREW BN 6.5MM 8MM 3.5MM 95MM STRL 32MM CNN SS HIP ACPT 2.4 BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 71100100 SUP HCPCS C1713 71100100 - SCREW BN 6.5MM 8MM 3.5MM 100MM STRL 32MM CNN SS HIP ACPT 2.4 BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $531.30 $531.30 $110.72 $531.30 N/A N/A 71100105 SUP HCPCS C1713 71100105 - SCREW BN 6.5MM 105MM STRL 32MM CNN ORTH BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $531.30 $531.30 $110.72 $531.30 N/A N/A 71100110 SUP HCPCS C1713 71100110 - SCREW BN 6.5MM 8MM 3.5MM 110MM STRL 32MM CNN SS HIP ACPT 2.4 BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $531.30 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $110.72 $531.30 N/A N/A 71100115 SUP HCPCS C1713 71100115 - SCREW BN 6.5MM 115MM STRL 32MM CNN ORTH BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $531.30 $531.30 N/A N/A 71100120 SUP HCPCS C1713 71100120 - SCREW BN 6.5MM 8MM 3.5MM 120MM STRL 32MM CNN SS HIP ACPT 2.4 BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $531.30 $531.30 N/A N/A 71100125 SUP HCPCS C1713 71100125 - SCREW BN 6.5MM 125MM STRL 32MM CNN ORTH BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $531.30 $531.30 N/A N/A 71100130 SUP HCPCS C1713 71100130 - SCREW BN 6.5MM 8MM 3.5MM 130MM STRL 32MM CNN SS HIP ACPT 2.4 BOTH IP/OP $531.50 $393.00 $105.45 $531.30 $239.09 $239.09 $239.09 $239.09 $531.30 $531.30 $531.30 $110.74 $531.30 $531.30 $531.30 $531.30 $531.30 $110.73 $531.30 $212.52 $314.26 $531.30 $531.30 $531.30 $531.30 $398.63 $531.30 $531.30 $531.30 $265.65 $265.65 $420.79 $531.30 $425.04 $239.09 $105.45 N/A $308.27 $531.30 $318.78 $531.30 $531.30 $531.30 N/A N/A 71101000 SUP HCPCS C1713 71101000 - WASHER ORTH 8MM 4MM STRL TI BOTH IP/OP $188.00 $139.00 $37.25 $187.70 $84.47 $84.47 $84.47 $84.47 $187.70 $187.70 $187.70 $39.12 $187.70 $187.70 $187.70 $187.70 $187.70 $39.12 $187.70 $47.67 $111.02 $187.70 $119.18 $187.70 $187.70 $141.00 $187.70 $187.70 $187.70 $93.85 $93.85 $148.66 $187.70 $150.16 $84.47 $37.25 N/A $109.04 $187.70 $112.62 $187.70 $39.12 $187.70 N/A N/A 71101020 SUP HCPCS C1713 71101020 - SCREW BN 4MM 20MM STRL 8MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 71101022 SUP HCPCS C1713 71101022 - SCREW BN 4MM 22MM STRL 10MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $399.00 $399.00 $83.15 $399.00 N/A N/A 71101024 SUP HCPCS C1713 71101024 - SCREW BN 4MM 24MM STRL 12MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 71101026 SUP HCPCS C1713 71101026 - SCREW BN 4MM 26MM STRL 14MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 71101028 SUP HCPCS C1713 71101028 - SCREW BN 4MM 28MM STRL 14MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 71101030 SUP HCPCS C1713 71101030 - SCREW BN 4MM 30MM STRL 14MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 71101032 SUP HCPCS C1713 71101032 - SCREW BN 4MM 32MM STRL 14MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 71101034 SUP HCPCS C1713 71101034 - SCREW BN 4MM 34MM STRL 14MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $399.00 $399.00 $399.00 $399.00 N/A N/A 71101036 SUP HCPCS C1713 71101036 - SCREW BN 4MM 36MM STRL 14MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 71101038 SUP HCPCS C1713 71101038 - SCREW BN 4MM 38MM STRL 14MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 71101040 SUP HCPCS C1713 71101040 - SCREW BN 4MM 40MM STRL 14MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $399.00 $399.00 $399.00 $399.00 N/A N/A 71101042 SUP HCPCS C1713 71101042 - SCREW BN 4MM 42MM STRL 14MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 71101044 SUP HCPCS C1713 71101044 - SCREW BN 4MM 44MM STRL 15MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 71101046 SUP HCPCS C1713 71101046 - SCREW BN 4MM 46MM STRL 15MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 71101048 SUP HCPCS C1713 71101048 - SCREW BN 4MM 48MM STRL 15MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 71101050 SUP HCPCS C1713 71101050 - SCREW BN 4MM 50MM STRL 15MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 71101052 SUP HCPCS C1713 71101052 - SCREW BN 4MM 52MM STRL 15MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 71101054 SUP HCPCS C1713 71101054 - SCREW BN 4MM 54MM STRL 15MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 71101056 SUP HCPCS C1713 71101056 - SCREW BN 4MM 56MM STRL 15MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $399.00 $399.00 $83.15 $399.00 N/A N/A 71101058 SUP HCPCS C1713 71101058 - SCREW BN 4MM 58MM STRL 15MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $399.00 $399.00 $83.15 $399.00 N/A N/A 71101060 SUP HCPCS C1713 71101060 - SCREW BN 4MM 60MM STRL 15MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $399.00 $399.00 $399.00 $399.00 N/A N/A 71101065 SUP HCPCS C1713 71101065 - SCREW BN 4MM 65MM STRL 15MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 71101070 SUP HCPCS C1713 71101070 - SCREW BN 4MM 70MM STRL 15MM CNN TI ORTH BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 71101401 SUP HCPCS C1713 71101401 - CAP PCTV 1.1 MM WRE BOTH IP/OP $31.00 $23.00 $6.09 $30.70 $13.82 $13.82 $13.82 $13.82 $30.70 $30.70 $30.70 $6.40 $30.70 $30.70 $30.70 $30.70 $30.70 $6.40 $30.70 $9.00 $18.16 $30.70 $22.50 $30.70 $30.70 $23.25 $30.70 $30.70 $30.70 $15.35 $15.35 $24.31 $30.70 $24.56 $13.82 $6.09 N/A $17.98 $30.70 $18.42 $30.70 $6.40 $30.70 N/A N/A 71101402 SUP HCPCS C1713 71101402 - CAP PCTV 1.25 MM WRE BOTH IP/OP $31.00 $23.00 $6.09 $30.70 $13.82 $13.82 $13.82 $13.82 $30.70 $30.70 $30.70 $6.40 $30.70 $30.70 $30.70 $30.70 $30.70 $6.40 $30.70 $22.50 $18.16 $30.70 $22.50 $30.70 $30.70 $23.25 $30.70 $30.70 $30.70 $15.35 $15.35 $24.31 $30.70 $24.56 $13.82 $6.09 N/A $17.98 $30.70 $18.42 $30.70 $6.40 $30.70 N/A N/A 71101403 SUP HCPCS C1713 71101403 - CAP PCTV 1.6 MM WRE BOTH IP/OP $31.00 $23.00 $6.09 $30.70 $13.82 $13.82 $13.82 $13.82 $30.70 $30.70 $30.70 $6.40 $30.70 $30.70 $30.70 $30.70 $30.70 $6.40 $30.70 $9.00 $18.16 $30.70 $22.50 $30.70 $30.70 $23.25 $30.70 $30.70 $30.70 $15.35 $15.35 $24.31 $30.70 $24.56 $13.82 $6.09 N/A $17.98 $30.70 $18.42 $30.70 $6.40 $30.70 N/A N/A 71101404 SUP HCPCS C1713 71101404 - CAP PCTV 2 MM WRE BOTH IP/OP $31.00 $23.00 $6.09 $30.70 $13.82 $13.82 $13.82 $13.82 $30.70 $30.70 $30.70 $6.40 $30.70 $30.70 $30.70 $30.70 $30.70 $6.40 $30.70 $22.50 $18.16 $30.70 $22.50 $30.70 $30.70 $23.25 $30.70 $30.70 $30.70 $15.35 $15.35 $24.31 $30.70 $24.56 $13.82 $6.09 N/A $17.98 $30.70 $18.42 $30.70 $6.40 $30.70 N/A N/A 71101501 SUP Custom 27203010 71101501 - WIRE FX 2MM 150MM DRL TIP BOTH IP/OP $145.50 $108.00 $25.90 $145.50 $145.50 $145.50 $145.50 $145.50 $145.50 $145.50 $25.90 $145.50 $145.50 $107.99 $107.99 $112.15 $75.81 $30.32 $145.50 $58.20 $145.50 $145.50 $145.50 $145.50 $145.50 $109.13 $145.50 $145.50 $145.50 $72.75 $72.75 $115.24 $145.50 $116.40 $94.58 $145.50 N/A $84.39 $145.50 $87.30 $145.50 $145.50 $145.50 N/A N/A 71101502 SUP Custom 27203010 71101502 - WIRE FX FLUT 1.6MM 150MM VLP DRL TIP COCR BOTH IP/OP $106.00 $78.00 $18.80 $105.63 $105.63 $105.63 $105.63 $105.63 $105.63 $105.63 $18.80 $105.63 $105.63 $78.40 $78.40 $81.42 $55.03 $22.01 $105.63 $42.25 $105.63 $105.63 $105.63 $105.63 $105.63 $79.50 $105.63 $105.63 $105.63 $52.82 $52.82 $83.66 $105.63 $84.50 $68.66 $105.63 N/A $61.48 $105.63 $63.38 $105.63 $105.63 $105.63 N/A N/A 71101691 SUP HCPCS C1713 71101691 - WASHER ORTH 21.7MM 12.7MM OBLNG SS BOTH IP/OP $109.50 $81.00 $21.67 $109.20 $49.14 $49.14 $49.14 $49.14 $109.20 $109.20 $109.20 $22.76 $109.20 $109.20 $109.20 $109.20 $109.20 $22.76 $109.20 $43.68 $64.59 $109.20 $109.20 $109.20 $109.20 $82.13 $109.20 $109.20 $109.20 $54.60 $54.60 $86.49 $109.20 $87.36 $49.14 $21.67 N/A $63.51 $109.20 $109.20 $109.20 $22.76 $109.20 N/A N/A 71101693 SUP HCPCS C1713 71101693 - WASHER ORTH 21.7MM BTRFLY SS BOTH IP/OP $103.50 $77.00 $20.51 $103.33 $46.50 $46.50 $46.50 $46.50 $103.33 $103.33 $103.33 $21.54 $103.33 $103.33 $103.33 $103.33 $103.33 $21.54 $103.33 $103.33 $61.12 $103.33 $103.33 $103.33 $103.33 $77.63 $103.33 $103.33 $103.33 $51.67 $51.67 $81.84 $103.33 $82.66 $46.50 $20.51 N/A $60.03 $103.33 $62.00 $103.33 $103.33 $103.33 N/A N/A 71102000 SUP HCPCS C1713 71102000 - WASHER ORTH 12.7MM 6.5MM 1MM TI BOTH IP/OP $242.50 $179.00 $48.11 $242.40 $109.08 $109.08 $109.08 $109.08 $242.40 $242.40 $242.40 $50.52 $242.40 $242.40 $242.40 $242.40 $242.40 $50.52 $242.40 $61.11 $143.38 $242.40 $152.78 $242.40 $242.40 $181.88 $242.40 $242.40 $242.40 $121.20 $121.20 $191.98 $242.40 $193.92 $109.08 $48.11 N/A $140.65 $242.40 $145.44 $242.40 $50.52 $242.40 N/A N/A 71102030 SUP HCPCS C1713 71102030 - PIN FX 30MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $296.52 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $154.49 $741.30 N/A N/A 71102035 SUP HCPCS C1713 71102035 - PIN FX 35MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $296.52 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $741.30 $741.30 $741.30 $741.30 N/A N/A 71102040 SUP HCPCS C1713 71102040 - PIN FX 40MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $296.52 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $154.49 $741.30 N/A N/A 71102045 SUP HCPCS C1713 71102045 - PIN FX 45MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $741.30 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $741.30 $741.30 N/A N/A 71102050 SUP HCPCS C1713 71102050 - PIN FX 50MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $741.30 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $741.30 $741.30 N/A N/A 71102055 SUP HCPCS C1713 71102055 - PIN FX 55MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $296.52 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $741.30 $741.30 N/A N/A 71102060 SUP HCPCS C1713 71102060 - PIN FX 60MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $741.30 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $154.49 $741.30 N/A N/A 71102065 SUP HCPCS C1713 71102065 - PIN FX 65MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $296.52 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $154.49 $741.30 N/A N/A 71102070 SUP HCPCS C1713 71102070 - PIN FX 70MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $741.30 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $154.49 $741.30 N/A N/A 71102075 SUP HCPCS C1713 71102075 - PIN FX 75MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $296.52 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $741.30 $741.30 $154.49 $741.30 N/A N/A 71102080 SUP HCPCS C1713 71102080 - PIN FX 80MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $741.30 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $741.30 $741.30 N/A N/A 71102085 SUP HCPCS C1713 71102085 - PIN FX 85MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $741.30 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $741.30 $741.30 N/A N/A 71102090 SUP HCPCS C1713 71102090 - PIN FX 90MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $296.52 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $741.30 $741.30 $154.49 $741.30 N/A N/A 71102095 SUP HCPCS C1713 71102095 - PIN FX 95MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $741.30 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $154.49 $741.30 N/A N/A 71102100 SUP HCPCS C1713 71102100 - PIN FX 100MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $741.30 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $154.49 $741.30 N/A N/A 71102105 SUP HCPCS C1713 71102105 - PIN FX 105MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $296.52 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $154.49 $741.30 N/A N/A 71102110 SUP HCPCS C1713 71102110 - PIN FX 110MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $296.52 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $154.49 $741.30 N/A N/A 71102115 SUP HCPCS C1713 71102115 - PIN FX 115MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $741.30 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $154.49 $741.30 N/A N/A 71102120 SUP HCPCS C1713 71102120 - PIN FX 120MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $741.30 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $741.30 $741.30 N/A N/A 71102125 SUP HCPCS C1713 71102125 - PIN FX 125MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $296.52 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $741.30 $741.30 $741.30 $741.30 N/A N/A 71102130 SUP HCPCS C1713 71102130 - PIN FX 130MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $741.30 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $154.49 $741.30 N/A N/A 71102135 SUP HCPCS C1713 71102135 - PIN FX 135MM 16MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $741.30 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $741.30 $741.30 N/A N/A 71103045 SUP HCPCS C1713 71103045 - PIN FX 45MM 32MM CNN TI HIP BOTH IP/OP $741.50 $549.00 $147.13 $741.30 $333.59 $333.59 $333.59 $333.59 $741.30 $741.30 $741.30 $154.51 $741.30 $741.30 $741.30 $741.30 $741.30 $154.50 $741.30 $741.30 $438.48 $741.30 $741.30 $741.30 $741.30 $556.13 $741.30 $741.30 $741.30 $370.65 $370.65 $587.11 $741.30 $593.04 $333.59 $147.13 N/A $430.07 $741.30 $444.78 $741.30 $741.30 $741.30 N/A N/A 71107030 SUP HCPCS C1713 71107030 - SCREW BN 7MM 30MM STRL 16MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107035 SUP HCPCS C1713 71107035 - SCREW BN 7MM 35MM STRL 16MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $519.75 $519.75 N/A N/A 71107040 SUP HCPCS C1713 71107040 - SCREW BN 7MM 40MM STRL 16MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107045 SUP HCPCS C1713 71107045 - SCREW BN 7MM 45MM 16MM CNN P/T TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107050 SUP HCPCS C1713 71107050 - SCREW BN 7MM 50MM 16MM CNN P/T TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $519.75 $519.75 N/A N/A 71107055 SUP HCPCS C1713 71107055 - SCREW BN 7MM 55MM STRL 16MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107060 SUP HCPCS C1713 71107060 - SCREW BN 7MM 60MM STRL 16MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $519.75 $519.75 N/A N/A 71107065 SUP HCPCS C1713 71107065 - SCREW BN P/T 7MM 65MM STRL 16MM CNN TI BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107070 SUP HCPCS C1713 71107070 - SCREW BN P/T 7MM 70MM STRL 16MM CNN TI BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107075 SUP HCPCS C1713 71107075 - SCREW BN P/T 7MM 75MM STRL 16MM CNN TI BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107080 SUP HCPCS C1713 71107080 - SCREW BN P/T 7MM 80MM STRL 16MM CNN TI BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71107085 SUP HCPCS C1713 71107085 - SCREW BN P/T 7MM 85MM STRL 16MM CNN TI SM BN LNG BN BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71107090 SUP HCPCS C1713 71107090 - SCREW BN P/T 7MM 90MM STRL 16MM CNN TI BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $519.75 $519.75 N/A N/A 71107095 SUP HCPCS C1713 71107095 - SCREW BN P/T 7MM 95MM STRL 16MM CNN TI BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $519.75 $519.75 N/A N/A 71107100 SUP HCPCS C1713 71107100 - SCREW BN P/T 7MM 100MM STRL 16MM CNN TI BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107105 SUP HCPCS C1713 71107105 - SCREW BN P/T 7MM 105MM STRL 16MM CNN TI SM BN LNG BN BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107110 SUP HCPCS C1713 71107110 - SCREW BN 7MM 110MM STRL 16MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107115 SUP HCPCS C1713 71107115 - SCREW BN 7MM 115MM STRL 16MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107120 SUP HCPCS C1713 71107120 - SCREW BN 7MM 120MM STRL 16MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107125 SUP HCPCS C1713 71107125 - SCREW BN 7MM 125MM STRL 16MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107130 SUP HCPCS C1713 71107130 - SCREW BN 7MM 130MM STRL 16MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107135 SUP HCPCS C1713 71107135 - SCREW BN 7MM 135MM STRL 16MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107140 SUP HCPCS C1713 71107140 - SCREW BN 7MM 140MM STRL 16MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71107145 SUP HCPCS C1713 71107145 - SCREW BN 7MM 145MM STRL 16MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $519.75 $519.75 N/A N/A 71107150 SUP HCPCS C1713 71107150 - SCREW BN 7MM 150MM STRL 16MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108045 SUP HCPCS C1713 71108045 - SCREW BN 7MM 45MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $207.90 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108050 SUP HCPCS C1713 71108050 - SCREW BN 7MM 50MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $207.90 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108055 SUP HCPCS C1713 71108055 - SCREW BN 7MM 55MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $207.90 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108060 SUP HCPCS C1713 71108060 - SCREW BN 7MM 60MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108065 SUP HCPCS C1713 71108065 - SCREW BN 7MM 65MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $207.90 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108070 SUP HCPCS C1713 71108070 - SCREW BN 7MM 70MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108075 SUP HCPCS C1713 71108075 - SCREW BN P/T 7MM 75MM STRL 32MM CNN TI BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $207.90 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108080 SUP HCPCS C1713 71108080 - SCREW BN P/T 7MM 80MM STRL 32MM CNN TI BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108085 SUP HCPCS C1713 71108085 - SCREW BN 7MM 85MM 32MM CNN P/T TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108090 SUP HCPCS C1713 71108090 - SCREW BN P/T 7MM 90MM STRL 32MM CNN TI BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108095 SUP HCPCS C1713 71108095 - SCREW BN P/T 7MM 95MM STRL 32MM CNN TI BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108100 SUP HCPCS C1713 71108100 - SCREW BN P/T 7MM 100MM STRL 32MM CNN TI BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108105 SUP HCPCS C1713 71108105 - SCREW BN 7MM 105MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108110 SUP HCPCS C1713 71108110 - SCREW BN 7MM 110MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108115 SUP HCPCS C1713 71108115 - SCREW BN 7MM 115MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108120 SUP HCPCS C1713 71108120 - SCREW BN 7MM 120MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108125 SUP HCPCS C1713 71108125 - SCREW BN 7MM 125MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108130 SUP HCPCS C1713 71108130 - SCREW BN 7MM 130MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108135 SUP HCPCS C1713 71108135 - SCREW BN 7MM 135MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $519.75 $519.75 N/A N/A 71108140 SUP HCPCS C1713 71108140 - SCREW BN 7MM 140MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $519.75 $519.75 N/A N/A 71108145 SUP HCPCS C1713 71108145 - SCREW BN 7MM 145MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71108150 SUP HCPCS C1713 71108150 - SCREW BN 7MM 150MM STRL 32MM CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $519.75 $519.75 N/A N/A 71108670 SUP HCPCS C1713 71108670 - SCREW BN P/T 8MM 170MM 24MM CNN SS CANC BOTH IP/OP $810.00 $599.00 $160.76 $810.00 $364.50 $364.50 $364.50 $364.50 $810.00 $810.00 $810.00 $168.82 $810.00 $810.00 $810.00 $810.00 $810.00 $168.81 $810.00 $810.00 $479.12 $810.00 $810.00 $810.00 $810.00 $607.50 $810.00 $810.00 $810.00 $405.00 $405.00 $641.52 $810.00 $648.00 $364.50 $160.76 N/A $469.80 $810.00 $486.00 $810.00 $168.80 $810.00 N/A N/A 71109030 SUP HCPCS C1713 71109030 - SCREW BN FT 7MM 30MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $207.90 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71109035 SUP HCPCS C1713 71109035 - SCREW BN FT 7MM 35MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $207.90 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71109040 SUP HCPCS C1713 71109040 - SCREW BN FT 7MM 40MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $207.90 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71109045 SUP HCPCS C1713 71109045 - SCREW BN FT 7MM 45MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71109050 SUP HCPCS C1713 71109050 - SCREW BN FT 7MM 50MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71109055 SUP HCPCS C1713 71109055 - SCREW BN FT 7MM 55MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71109060 SUP HCPCS C1713 71109060 - SCREW BN FT 7MM 60MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $207.90 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71109065 SUP HCPCS C1713 71109065 - SCREW BN FT 7MM 65MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $207.90 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71109070 SUP HCPCS C1713 71109070 - SCREW BN FT 7MM 70MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71109075 SUP HCPCS C1713 71109075 - SCREW BN FT 7MM 75MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71109080 SUP HCPCS C1713 71109080 - SCREW BN FT 7MM 80MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $207.90 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $519.75 $519.75 N/A N/A 71109085 SUP HCPCS C1713 71109085 - SCREW BN FT 7MM 85MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $207.90 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $519.75 $519.75 N/A N/A 71109090 SUP HCPCS C1713 71109090 - SCREW BN FT 7MM 90MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71109095 SUP HCPCS C1713 71109095 - SCREW BN FT 7MM 95MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71109100 SUP HCPCS C1713 71109100 - SCREW BN FT 7MM 100MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71109105 SUP HCPCS C1713 71109105 - SCREW BN FT 7MM 105MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71109110 SUP HCPCS C1713 71109110 - SCREW BN FT 7MM 110MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71109115 SUP HCPCS C1713 71109115 - SCREW BN 7MM 115MM STRL CNN FT TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71109120 SUP HCPCS C1713 71109120 - SCREW BN 7MM 120MM STRL CNN FT TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71109125 SUP HCPCS C1713 71109125 - SCREW BN FT 7MM 125MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $207.90 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $311.85 $519.75 $108.32 $519.75 N/A N/A 71109130 SUP HCPCS C1713 71109130 - SCREW BN FT 7MM 130MM STRL CNN TI ORTH BOTH IP/OP $520.00 $385.00 $103.16 $519.75 $233.89 $233.89 $233.89 $233.89 $519.75 $519.75 $519.75 $108.33 $519.75 $519.75 $519.75 $519.75 $519.75 $108.32 $519.75 $519.75 $307.43 $519.75 $519.75 $519.75 $519.75 $390.00 $519.75 $519.75 $519.75 $259.88 $259.88 $411.64 $519.75 $415.80 $233.89 $103.16 N/A $301.60 $519.75 $519.75 $519.75 $108.32 $519.75 N/A N/A 71110027 SUP Custom 27203010 71110027 - BIT DRL 4.5MM TWST BOTH IP/OP $144.00 $107.00 $25.61 $143.85 $143.85 $143.85 $143.85 $143.85 $143.85 $143.85 $25.61 $143.85 $143.85 $106.77 $106.77 $110.88 $74.95 $29.98 $143.85 $57.54 $143.85 $143.85 $143.85 $143.85 $143.85 $108.00 $143.85 $143.85 $143.85 $71.93 $71.93 $113.93 $143.85 $115.08 $93.50 $143.85 N/A $83.52 $143.85 $86.31 $143.85 $143.85 $143.85 N/A N/A 71110045 SUP Custom 27203010 71110045 - BIT DRL 3.5MM TWST BOTH IP/OP $114.50 $85.00 $20.37 $114.45 $114.45 $114.45 $114.45 $114.45 $114.45 $114.45 $20.37 $114.45 $114.45 $84.94 $84.94 $88.22 $59.63 $23.85 $114.45 $45.78 $114.45 $114.45 $114.45 $114.45 $114.45 $85.88 $114.45 $114.45 $114.45 $57.23 $57.23 $90.64 $114.45 $91.56 $74.39 $114.45 N/A $66.41 $114.45 $68.67 $114.45 $114.45 $114.45 N/A N/A 71116060 SUP HCPCS C1713 71116060 - PIN FX 3IN ORTH BOTH IP/OP "$1,459.50" "$1,080.00" $289.67 "$1,459.50" $656.78 $656.78 $656.78 $656.78 "$1,459.50" "$1,459.50" "$1,459.50" $304.20 "$1,459.50" "$1,459.50" "$1,459.50" "$1,459.50" "$1,459.50" $304.18 "$1,459.50" "$1,459.50" $863.29 "$1,459.50" "$1,459.50" "$1,459.50" "$1,459.50" "$1,094.63" "$1,459.50" "$1,459.50" "$1,459.50" $729.75 $729.75 "$1,155.92" "$1,459.50" "$1,167.60" $656.78 $289.67 N/A $846.51 "$1,459.50" $875.70 "$1,459.50" "$1,459.50" "$1,459.50" N/A N/A 71119005 SUP HCPCS C1713 71119005 - WASHER XTRNFX 12.7MM SLV 7MM CNN SCR BOTH IP/OP $309.00 $229.00 $61.27 $308.70 $138.92 $138.92 $138.92 $138.92 $308.70 $308.70 $308.70 $64.34 $308.70 $308.70 $308.70 $308.70 $308.70 $64.34 $308.70 $308.70 $182.60 $308.70 $308.70 $308.70 $308.70 $231.75 $308.70 $308.70 $308.70 $154.35 $154.35 $244.49 $308.70 $246.96 $138.92 $61.27 N/A $179.22 $308.70 $185.22 $308.70 $64.33 $308.70 N/A N/A 71119007 SUP Custom 27203010 71119007 - BIT DRL 4MM STRL CNN BOTH IP/OP $807.50 $598.00 $143.73 $807.45 $807.45 $807.45 $807.45 $807.45 $807.45 $807.45 $143.73 $807.45 $807.45 $599.29 $599.29 $622.38 $420.68 $168.28 $807.45 $322.98 $807.45 $807.45 $807.45 $807.45 $807.45 $605.63 $807.45 $807.45 $807.45 $403.73 $403.73 $639.50 $807.45 $645.96 $524.84 $807.45 N/A $468.35 $807.45 $484.47 $807.45 $807.45 $807.45 N/A N/A 71119106 SUP Custom 27203010 71119106 - BIT DRL 5.2MM STRL CNN 7MM SCR BOTH IP/OP $941.00 $696.00 $167.46 $940.80 $940.80 $940.80 $940.80 $940.80 $940.80 $940.80 $167.46 $940.80 $940.80 $698.26 $698.26 $725.17 $490.16 $196.07 $940.80 $376.32 $940.80 $940.80 $940.80 $940.80 $940.80 $705.75 $940.80 $940.80 $940.80 $470.40 $470.40 $745.11 $940.80 $752.64 $611.52 $940.80 N/A $545.78 $940.80 $564.48 $940.80 $940.80 $940.80 N/A N/A 71120006 SUP HCPCS C1713 71120006 - WASHER ORTH THK1MM 8MM 4MM STRL CNN SS 4MM CNN SCR BOTH IP/OP $122.00 $90.00 $24.19 $121.90 $54.86 $54.86 $54.86 $54.86 $121.90 $121.90 $121.90 $25.41 $121.90 $121.90 $121.90 $121.90 $121.90 $25.41 $121.90 $31.08 $72.10 $121.90 $77.70 $121.90 $121.90 $91.50 $121.90 $121.90 $121.90 $60.95 $60.95 $96.54 $121.90 $97.52 $54.86 $24.19 N/A $70.76 $121.90 $73.14 $121.90 $25.40 $121.90 N/A N/A 71123122 SUP HCPCS C1713 71123122 - PLATE BN 90D 55MM CHS 3 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" $732.90 "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123124 SUP HCPCS C1713 71123124 - PLATE BN 100D 55MM CHS 3 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" $732.90 "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123126 SUP HCPCS C1713 71123126 - PLATE BN 110D 55MM CHS 3 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" $732.90 "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123128 SUP HCPCS C1713 71123128 - PLATE BN 120D 55MM CHS 3 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" $732.90 "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123130 SUP HCPCS C1713 71123130 - PLATE BN 130D 55MM CHS 3 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123132 SUP HCPCS C1713 71123132 - PLATE BN 135D 55MM CHS 3 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" $732.90 "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123134 SUP HCPCS C1713 71123134 - PLATE BN 140D 55MM CHS 3 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123136 SUP HCPCS C1713 71123136 - PLATE BN 145D 55MM CHS 3 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" "$1,832.25" "$1,832.25" N/A N/A 71123138 SUP HCPCS C1713 71123138 - PLATE BN 150D 55MM CHS 3 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" N/A N/A 71123140 SUP HCPCS C1713 71123140 - PLATE BN 90D 76MM CHS 4 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" $732.90 "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123142 SUP HCPCS C1713 71123142 - PLATE BN 100D 76MM CHS 4 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" $732.90 "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123144 SUP HCPCS C1713 71123144 - PLATE BN 110D 76MM CHS 4 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" $732.90 "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,832.25" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123146 SUP HCPCS C1713 71123146 - PLATE BN 120D 76MM CHS 4 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" $732.90 "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123148 SUP HCPCS C1713 71123148 - PLATE BN 130D 76MM CHS 4 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123150 SUP HCPCS C1713 71123150 - PLATE BN 135D 76MM CHS 4 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123152 SUP HCPCS C1713 71123152 - PLATE BN 140D 76MM CHS 4 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123154 SUP HCPCS C1713 71123154 - PLATE BN 145D 76MM CHS 4 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" $732.90 "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123156 SUP HCPCS C1713 71123156 - PLATE BN 150D 76MM CHS 4 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" $732.90 "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123158 SUP HCPCS C1713 71123158 - PLATE BN 90D 102MM CHS 6 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" $732.90 "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123160 SUP HCPCS C1713 71123160 - PLATE BN 100D 102MM CHS 6 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123162 SUP HCPCS C1713 71123162 - PLATE BN 110D 102MM CHS 6 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123164 SUP HCPCS C1713 71123164 - PLATE BN 120D 102MM CHS 6 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123166 SUP HCPCS C1713 71123166 - PLATE BN 130D 102MM CHS 6 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" N/A N/A 71123168 SUP HCPCS C1713 71123168 - PLATE BN 135D 102MM CHS 6 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" "$1,832.25" "$1,832.25" N/A N/A 71123170 SUP HCPCS C1713 71123170 - PLATE BN 140D 102MM CHS 6 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123172 SUP HCPCS C1713 71123172 - PLATE BN 145D 102MM CHS 6 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123174 SUP HCPCS C1713 71123174 - PLATE BN 150D 102MM CHS 6 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" N/A N/A 71123176 SUP HCPCS C1713 71123176 - PLATE BN 130D 127MM CHS 8 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" "$1,832.25" "$1,832.25" N/A N/A 71123178 SUP HCPCS C1713 71123178 - PLATE BN 135D 127MM CHS 8 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123180 SUP HCPCS C1713 71123180 - PLATE BN 140D 127MM CHS 8 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" "$1,832.25" "$1,832.25" N/A N/A 71123182 SUP HCPCS C1713 71123182 - PLATE BN 145D 127MM CHS 8 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" N/A N/A 71123184 SUP HCPCS C1713 71123184 - PLATE BN 150D 127MM CHS 8 HL INTMD SS PED HIP BOTH IP/OP "$1,832.50" "$1,356.00" $363.66 "$1,832.25" $824.51 $824.51 $824.51 $824.51 "$1,832.25" "$1,832.25" "$1,832.25" $381.89 "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" $381.86 "$1,832.25" "$1,832.25" "$1,083.78" "$1,832.25" "$1,832.25" "$1,832.25" "$1,832.25" "$1,374.38" "$1,832.25" "$1,832.25" "$1,832.25" $916.13 $916.13 "$1,451.14" "$1,832.25" "$1,465.80" $824.51 $363.66 N/A "$1,062.85" "$1,832.25" "$1,099.35" "$1,832.25" $381.84 "$1,832.25" N/A N/A 71123186 SUP HCPCS C1713 71123186 - SCREW BN 35MM CHS INTMD LG SS PED HIP BOTH IP/OP "$1,307.50" $968.00 $259.46 "$1,307.25" $588.26 $588.26 $588.26 $588.26 "$1,307.25" "$1,307.25" "$1,307.25" $272.46 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $272.45 "$1,307.25" $522.90 $773.24 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $980.63 "$1,307.25" "$1,307.25" "$1,307.25" $653.63 $653.63 "$1,035.34" "$1,307.25" "$1,045.80" $588.26 $259.46 N/A $758.35 "$1,307.25" $784.35 "$1,307.25" $272.43 "$1,307.25" N/A N/A 71123187 SUP HCPCS C1713 71123187 - SCREW BN 40MM CHS INTMD LG SS PED HIP BOTH IP/OP "$1,307.50" $968.00 $259.46 "$1,307.25" $588.26 $588.26 $588.26 $588.26 "$1,307.25" "$1,307.25" "$1,307.25" $272.46 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $272.45 "$1,307.25" "$1,307.25" $773.24 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $980.63 "$1,307.25" "$1,307.25" "$1,307.25" $653.63 $653.63 "$1,035.34" "$1,307.25" "$1,045.80" $588.26 $259.46 N/A $758.35 "$1,307.25" $784.35 "$1,307.25" $272.43 "$1,307.25" N/A N/A 71123188 SUP HCPCS C1713 71123188 - SCREW BN 45MM CHS INTMD LG SS PED HIP BOTH IP/OP "$1,307.50" $968.00 $259.46 "$1,307.25" $588.26 $588.26 $588.26 $588.26 "$1,307.25" "$1,307.25" "$1,307.25" $272.46 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $272.45 "$1,307.25" $522.90 $773.24 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $980.63 "$1,307.25" "$1,307.25" "$1,307.25" $653.63 $653.63 "$1,035.34" "$1,307.25" "$1,045.80" $588.26 $259.46 N/A $758.35 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" N/A N/A 71123189 SUP HCPCS C1713 71123189 - SCREW BN 50MM CHS INTMD LG SS PED HIP BOTH IP/OP "$1,307.50" $968.00 $259.46 "$1,307.25" $588.26 $588.26 $588.26 $588.26 "$1,307.25" "$1,307.25" "$1,307.25" $272.46 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $272.45 "$1,307.25" $522.90 $773.24 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $980.63 "$1,307.25" "$1,307.25" "$1,307.25" $653.63 $653.63 "$1,035.34" "$1,307.25" "$1,045.80" $588.26 $259.46 N/A $758.35 "$1,307.25" $784.35 "$1,307.25" "$1,307.25" "$1,307.25" N/A N/A 71123190 SUP HCPCS C1713 71123190 - SCREW BN 55MM CHS INTMD LG SS HIP BOTH IP/OP "$1,307.50" $968.00 $259.46 "$1,307.25" $588.26 $588.26 $588.26 $588.26 "$1,307.25" "$1,307.25" "$1,307.25" $272.46 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $272.45 "$1,307.25" $522.90 $773.24 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $980.63 "$1,307.25" "$1,307.25" "$1,307.25" $653.63 $653.63 "$1,035.34" "$1,307.25" "$1,045.80" $588.26 $259.46 N/A $758.35 "$1,307.25" $784.35 "$1,307.25" $272.43 "$1,307.25" N/A N/A 71123191 SUP HCPCS C1713 71123191 - SCREW BN 60MM CHS INTMD LG SS HIP BOTH IP/OP "$1,307.50" $968.00 $259.46 "$1,307.25" $588.26 $588.26 $588.26 $588.26 "$1,307.25" "$1,307.25" "$1,307.25" $272.46 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $272.45 "$1,307.25" $522.90 $773.24 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $980.63 "$1,307.25" "$1,307.25" "$1,307.25" $653.63 $653.63 "$1,035.34" "$1,307.25" "$1,045.80" $588.26 $259.46 N/A $758.35 "$1,307.25" $784.35 "$1,307.25" $272.43 "$1,307.25" N/A N/A 71123192 SUP HCPCS C1713 71123192 - SCREW BN 65MM CHS INTMD LG SS HIP BOTH IP/OP "$1,307.50" $968.00 $259.46 "$1,307.25" $588.26 $588.26 $588.26 $588.26 "$1,307.25" "$1,307.25" "$1,307.25" $272.46 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $272.45 "$1,307.25" "$1,307.25" $773.24 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $980.63 "$1,307.25" "$1,307.25" "$1,307.25" $653.63 $653.63 "$1,035.34" "$1,307.25" "$1,045.80" $588.26 $259.46 N/A $758.35 "$1,307.25" $784.35 "$1,307.25" $272.43 "$1,307.25" N/A N/A 71123193 SUP HCPCS C1713 71123193 - SCREW BN 70MM CHS INTMD LG SS PED HIP BOTH IP/OP "$1,307.50" $968.00 $259.46 "$1,307.25" $588.26 $588.26 $588.26 $588.26 "$1,307.25" "$1,307.25" "$1,307.25" $272.46 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $272.45 "$1,307.25" "$1,307.25" $773.24 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $980.63 "$1,307.25" "$1,307.25" "$1,307.25" $653.63 $653.63 "$1,035.34" "$1,307.25" "$1,045.80" $588.26 $259.46 N/A $758.35 "$1,307.25" $784.35 "$1,307.25" $272.43 "$1,307.25" N/A N/A 71123194 SUP HCPCS C1713 71123194 - SCREW BN 75MM CHS INTMD LG SS HIP BOTH IP/OP "$1,307.50" $968.00 $259.46 "$1,307.25" $588.26 $588.26 $588.26 $588.26 "$1,307.25" "$1,307.25" "$1,307.25" $272.46 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $272.45 "$1,307.25" "$1,307.25" $773.24 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $980.63 "$1,307.25" "$1,307.25" "$1,307.25" $653.63 $653.63 "$1,035.34" "$1,307.25" "$1,045.80" $588.26 $259.46 N/A $758.35 "$1,307.25" $784.35 "$1,307.25" $272.43 "$1,307.25" N/A N/A 71123195 SUP HCPCS C1713 71123195 - SCREW BN 80MM CHS INTMD LG SS HIP BOTH IP/OP "$1,307.50" $968.00 $259.46 "$1,307.25" $588.26 $588.26 $588.26 $588.26 "$1,307.25" "$1,307.25" "$1,307.25" $272.46 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $272.45 "$1,307.25" "$1,307.25" $773.24 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $980.63 "$1,307.25" "$1,307.25" "$1,307.25" $653.63 $653.63 "$1,035.34" "$1,307.25" "$1,045.80" $588.26 $259.46 N/A $758.35 "$1,307.25" $784.35 "$1,307.25" $272.43 "$1,307.25" N/A N/A 71123196 SUP HCPCS C1713 71123196 - SCREW BN 85MM CHS INTMD LG SS HIP BOTH IP/OP "$1,307.50" $968.00 $259.46 "$1,307.25" $588.26 $588.26 $588.26 $588.26 "$1,307.25" "$1,307.25" "$1,307.25" $272.46 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $272.45 "$1,307.25" "$1,307.25" $773.24 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $980.63 "$1,307.25" "$1,307.25" "$1,307.25" $653.63 $653.63 "$1,035.34" "$1,307.25" "$1,045.80" $588.26 $259.46 N/A $758.35 "$1,307.25" $784.35 "$1,307.25" $272.43 "$1,307.25" N/A N/A 71123197 SUP HCPCS C1713 71123197 - SCREW BN 90MM CHS INTMD LG SS HIP BOTH IP/OP "$1,307.50" $968.00 $259.46 "$1,307.25" $588.26 $588.26 $588.26 $588.26 "$1,307.25" "$1,307.25" "$1,307.25" $272.46 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $272.45 "$1,307.25" "$1,307.25" $773.24 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $980.63 "$1,307.25" "$1,307.25" "$1,307.25" $653.63 $653.63 "$1,035.34" "$1,307.25" "$1,045.80" $588.26 $259.46 N/A $758.35 "$1,307.25" "$1,307.25" "$1,307.25" $272.43 "$1,307.25" N/A N/A 71123198 SUP HCPCS C1713 71123198 - SCREW BN 95MM CHS INTMD LG SS HIP BOTH IP/OP "$1,307.50" $968.00 $259.46 "$1,307.25" $588.26 $588.26 $588.26 $588.26 "$1,307.25" "$1,307.25" "$1,307.25" $272.46 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $272.45 "$1,307.25" "$1,307.25" $773.24 "$1,307.25" "$1,307.25" "$1,307.25" "$1,307.25" $980.63 "$1,307.25" "$1,307.25" "$1,307.25" $653.63 $653.63 "$1,035.34" "$1,307.25" "$1,045.80" $588.26 $259.46 N/A $758.35 "$1,307.25" $784.35 "$1,307.25" $272.43 "$1,307.25" N/A N/A 71123199 SUP HCPCS C1713 71123199 - SCREW BN 2.5MM CHS INTMD CMPR HEX HD SS PED HIP BOTH IP/OP $216.50 $160.00 $42.93 $216.30 $97.34 $97.34 $97.34 $97.34 $216.30 $216.30 $216.30 $45.08 $216.30 $216.30 $216.30 $216.30 $216.30 $45.08 $216.30 $216.30 $127.94 $216.30 $216.30 $216.30 $216.30 $162.38 $216.30 $216.30 $216.30 $108.15 $108.15 $171.31 $216.30 $173.04 $97.34 $42.93 N/A $125.57 $216.30 $129.78 $216.30 $45.08 $216.30 N/A N/A 71123228 SUP HCPCS C1713 71123228 - SCREW BN FT 2.7MM 28MM ST PED HIP BOTH IP/OP $41.00 $30.00 $8.08 $40.70 $18.32 $18.32 $18.32 $18.32 $40.70 $40.70 $40.70 $8.48 $40.70 $40.70 $40.70 $40.70 $40.70 $8.48 $40.70 $16.28 $24.07 $40.70 $40.70 $40.70 $40.70 $30.75 $40.70 $40.70 $40.70 $20.35 $20.35 $32.23 $40.70 $32.56 $18.32 $8.08 N/A $23.78 $40.70 $40.70 $40.70 $8.48 $40.70 N/A N/A 71123232 SUP HCPCS C1713 71123232 - SCREW BN 2.7MM 32MM ST HEX HD BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $18.81 $18.81 $18.81 $18.81 $41.80 $41.80 $41.80 $8.71 $41.80 $41.80 $41.80 $41.80 $41.80 $8.71 $41.80 $26.78 $24.72 $41.80 $26.78 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $18.81 $8.30 N/A $24.36 $41.80 $25.08 $41.80 $41.80 $41.80 N/A N/A 71123234 SUP HCPCS C1713 71123234 - SCREW BN 2.7MM 34MM ST HEX HD BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $18.81 $18.81 $18.81 $18.81 $41.80 $41.80 $41.80 $8.71 $41.80 $41.80 $41.80 $41.80 $41.80 $8.71 $41.80 $10.71 $24.72 $41.80 $26.78 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $18.81 $8.30 N/A $24.36 $41.80 $25.08 $41.80 $41.80 $41.80 N/A N/A 71123236 SUP HCPCS C1713 71123236 - SCREW BN 2.7MM 36MM ST HEX HD BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $18.81 $18.81 $18.81 $18.81 $41.80 $41.80 $41.80 $8.71 $41.80 $41.80 $41.80 $41.80 $41.80 $8.71 $41.80 $10.71 $24.72 $41.80 $26.78 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $18.81 $8.30 N/A $24.36 $41.80 $25.08 $41.80 $8.71 $41.80 N/A N/A 71123238 SUP HCPCS C1713 71123238 - SCREW BN 2.7MM 38MM ST HEX HD BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $18.81 $18.81 $18.81 $18.81 $41.80 $41.80 $41.80 $8.71 $41.80 $41.80 $41.80 $41.80 $41.80 $8.71 $41.80 $10.71 $24.72 $41.80 $26.78 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $18.81 $8.30 N/A $24.36 $41.80 $25.08 $41.80 $8.71 $41.80 N/A N/A 71123242 SUP HCPCS C1713 71123242 - PLATE BN 90D 50MM CHS 4 PROX HL SS PED HIP BOTH IP/OP "$2,394.00" "$1,772.00" $475.15 "$2,394.00" "$1,077.30" "$1,077.30" "$1,077.30" "$1,077.30" "$2,394.00" "$2,394.00" "$2,394.00" $498.97 "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" $498.94 "$2,394.00" "$2,394.00" "$1,416.05" "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" "$1,795.50" "$2,394.00" "$2,394.00" "$2,394.00" "$1,197.00" "$1,197.00" "$1,896.05" "$2,394.00" "$1,915.20" "$1,077.30" $475.15 N/A "$1,388.52" "$2,394.00" "$1,436.40" "$2,394.00" "$2,394.00" "$2,394.00" N/A N/A 71123244 SUP HCPCS C1713 71123244 - PLATE BN 100D .385IN CHS 4 PROX HL SS PED HIP BOTH IP/OP "$2,394.00" "$1,772.00" $475.15 "$2,394.00" "$1,077.30" "$1,077.30" "$1,077.30" "$1,077.30" "$2,394.00" "$2,394.00" "$2,394.00" $498.97 "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" $498.94 "$2,394.00" "$2,394.00" "$1,416.05" "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" "$1,795.50" "$2,394.00" "$2,394.00" "$2,394.00" "$1,197.00" "$1,197.00" "$1,896.05" "$2,394.00" "$1,915.20" "$1,077.30" $475.15 N/A "$1,388.52" "$2,394.00" "$1,436.40" "$2,394.00" $498.91 "$2,394.00" N/A N/A 71123246 SUP HCPCS C1713 71123246 - PLATE BN 110D 50MM CHS 4 PROX HL SS PED HIP BOTH IP/OP "$2,394.00" "$1,772.00" $475.15 "$2,394.00" "$1,077.30" "$1,077.30" "$1,077.30" "$1,077.30" "$2,394.00" "$2,394.00" "$2,394.00" $498.97 "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" $498.94 "$2,394.00" "$2,394.00" "$1,416.05" "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" "$1,795.50" "$2,394.00" "$2,394.00" "$2,394.00" "$1,197.00" "$1,197.00" "$1,896.05" "$2,394.00" "$1,915.20" "$1,077.30" $475.15 N/A "$1,388.52" "$2,394.00" "$1,436.40" "$2,394.00" $498.91 "$2,394.00" N/A N/A 71123248 SUP HCPCS C1713 71123248 - PLATE BN 120D 50MM CHS 4 PROX HL SS PED HIP BOTH IP/OP "$2,394.00" "$1,772.00" $475.15 "$2,394.00" "$1,077.30" "$1,077.30" "$1,077.30" "$1,077.30" "$2,394.00" "$2,394.00" "$2,394.00" $498.97 "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" $498.94 "$2,394.00" "$2,394.00" "$1,416.05" "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" "$1,795.50" "$2,394.00" "$2,394.00" "$2,394.00" "$1,197.00" "$1,197.00" "$1,896.05" "$2,394.00" "$1,915.20" "$1,077.30" $475.15 N/A "$1,388.52" "$2,394.00" "$1,436.40" "$2,394.00" "$2,394.00" "$2,394.00" N/A N/A 71123250 SUP HCPCS C1713 71123250 - PLATE BN 130D 50MM CHS 4 PROX HL SS PED HIP BOTH IP/OP "$2,394.00" "$1,772.00" $475.15 "$2,394.00" "$1,077.30" "$1,077.30" "$1,077.30" "$1,077.30" "$2,394.00" "$2,394.00" "$2,394.00" $498.97 "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" $498.94 "$2,394.00" "$2,394.00" "$1,416.05" "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" "$1,795.50" "$2,394.00" "$2,394.00" "$2,394.00" "$1,197.00" "$1,197.00" "$1,896.05" "$2,394.00" "$1,915.20" "$1,077.30" $475.15 N/A "$1,388.52" "$2,394.00" "$1,436.40" "$2,394.00" $498.91 "$2,394.00" N/A N/A 71123252 SUP HCPCS C1713 71123252 - PLATE BN 140D 50MM CHS 4 PROX HL SS PED HIP BOTH IP/OP "$2,394.00" "$1,772.00" $475.15 "$2,394.00" "$1,077.30" "$1,077.30" "$1,077.30" "$1,077.30" "$2,394.00" "$2,394.00" "$2,394.00" $498.97 "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" $498.94 "$2,394.00" "$2,394.00" "$1,416.05" "$2,394.00" "$2,394.00" "$2,394.00" "$2,394.00" "$1,795.50" "$2,394.00" "$2,394.00" "$2,394.00" "$1,197.00" "$1,197.00" "$1,896.05" "$2,394.00" "$1,915.20" "$1,077.30" $475.15 N/A "$1,388.52" "$2,394.00" "$1,436.40" "$2,394.00" "$2,394.00" "$2,394.00" N/A N/A 71123254 SUP HCPCS C1713 71123254 - SCREW BN 22MM CHS LG SS PED HIP BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" "$1,412.25" $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" $847.35 "$1,412.25" $294.31 "$1,412.25" N/A N/A 71123256 SUP HCPCS C1713 71123256 - SCREW BN 25MM CHS LG SS PED HIP BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" "$1,412.25" $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" $847.35 "$1,412.25" "$1,412.25" "$1,412.25" N/A N/A 71123258 SUP HCPCS C1713 71123258 - SCREW BN 28MM CHS LG SS PED HIP BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" "$1,412.25" $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" N/A N/A 71123260 SUP HCPCS C1713 71123260 - SCREW BN 31MM CHS LG SS PED HIP BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" "$1,412.25" $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" $847.35 "$1,412.25" $294.31 "$1,412.25" N/A N/A 71123262 SUP HCPCS C1713 71123262 - SCREW BN 34MM CHS LG SS PED HIP BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" "$1,412.25" $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" $847.35 "$1,412.25" "$1,412.25" "$1,412.25" N/A N/A 71123264 SUP HCPCS C1713 71123264 - SCREW BN 37MM CHS LG SS PED HIP BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" "$1,412.25" $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" $847.35 "$1,412.25" "$1,412.25" "$1,412.25" N/A N/A 71123266 SUP HCPCS C1713 71123266 - SCREW BN 40MM CHS LG SS PED HIP BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" "$1,412.25" $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" $847.35 "$1,412.25" "$1,412.25" "$1,412.25" N/A N/A 71124002 SUP HCPCS C1713 71124002 - NAIL IM 4MM 22CM FRSGHT SET FRARM BOTH IP/OP "$6,380.00" "$4,721.00" "$1,266.27" "$6,380.00" "$2,871.00" "$2,871.00" "$2,871.00" "$2,871.00" "$6,380.00" "$6,380.00" "$6,380.00" "$1,329.75" "$6,380.00" "$6,380.00" "$6,380.00" "$6,380.00" "$6,380.00" "$1,329.66" "$6,380.00" "$6,380.00" "$3,145.34" "$6,380.00" "$6,380.00" "$6,380.00" "$6,380.00" "$4,785.00" "$6,380.00" "$6,380.00" "$6,380.00" "$3,190.00" "$3,190.00" "$5,052.96" "$6,380.00" "$5,104.00" "$2,871.00" "$1,266.27" N/A "$3,700.40" "$6,380.00" "$6,380.00" "$6,380.00" "$1,329.59" "$6,380.00" N/A N/A 71124010 SUP HCPCS C1713 71124010 - SCREW BN 2.7MM 10MM UNICORTICAL BOTH IP/OP $373.50 $276.00 $74.11 $373.40 $168.03 $168.03 $168.03 $168.03 $373.40 $373.40 $373.40 $77.83 $373.40 $373.40 $373.40 $373.40 $373.40 $77.82 $373.40 $149.36 $220.87 $373.40 $373.40 $373.40 $373.40 $280.13 $373.40 $373.40 $373.40 $186.70 $186.70 $295.73 $373.40 $298.72 $168.03 $74.11 N/A $216.63 $373.40 $224.04 $373.40 $77.82 $373.40 N/A N/A 71126130 SUP HCPCS C1713 71126130 - PLATE BN 130D CLS 4 HL CMPR LOPRFL HIP BOTH IP/OP $715.50 $529.00 $141.92 $715.05 $321.77 $321.77 $321.77 $321.77 $715.05 $715.05 $715.05 $149.03 $715.05 $715.05 $715.05 $715.05 $715.05 $149.02 $715.05 $715.05 $422.95 $715.05 $715.05 $715.05 $715.05 $536.63 $715.05 $715.05 $715.05 $357.53 $357.53 $566.32 $715.05 $572.04 $321.77 $141.92 N/A $414.99 $715.05 $715.05 $715.05 $149.02 $715.05 N/A N/A 71126131 SUP HCPCS C1713 71126131 - PLATE BN 135D CLS LP 4 HL BOTH IP/OP $532.50 $394.00 $105.66 $532.35 $239.56 $239.56 $239.56 $239.56 $532.35 $532.35 $532.35 $110.96 $532.35 $532.35 $532.35 $532.35 $532.35 $110.95 $532.35 $532.35 $314.89 $532.35 $532.35 $532.35 $532.35 $399.38 $532.35 $532.35 $532.35 $266.18 $266.18 $421.62 $532.35 $425.88 $239.56 $105.66 N/A $308.85 $532.35 $319.41 $532.35 $110.94 $532.35 N/A N/A 71127030 SUP HCPCS C1713 71127030 - SCREW BN 7MM 30MM STRL 16MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71127035 SUP HCPCS C1713 71127035 - SCREW BN 7MM 35MM STRL 16MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71127040 SUP HCPCS C1713 71127040 - SCREW BN 7MM 40MM STRL 16MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71127045 SUP HCPCS C1713 71127045 - SCREW BN 7MM 45MM STRL 16MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71127050 SUP HCPCS C1713 71127050 - SCREW BN 7MM 50MM STRL 16MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71127055 SUP HCPCS C1713 71127055 - SCREW BN 7MM 55MM STRL 16MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71127060 SUP HCPCS C1713 71127060 - SCREW BN 7MM 60MM STRL 16MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71127065 SUP HCPCS C1713 71127065 - SCREW BN 7MM 65MM STRL 16MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71127070 SUP HCPCS C1713 71127070 - SCREW BN P/T TROC SPHR 7MM 5.2MM 70MM 16MM CNN SLFDRL ST HD BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71127075 SUP HCPCS C1713 71127075 - SCREW BN 7MM 75MM STRL 16MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71127080 SUP HCPCS C1713 71127080 - SCREW BN 7MM 80MM STRL 16MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $487.20 $487.20 $101.53 $487.20 N/A N/A 71127085 SUP HCPCS C1713 71127085 - SCREW BN 7MM 85MM STRL 16MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $487.20 $487.20 $101.53 $487.20 N/A N/A 71127090 SUP HCPCS C1713 71127090 - SCREW BN 7MM 90MM STRL 16MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71127095 SUP HCPCS C1713 71127095 - SCREW BN 7MM 95MM STRL 16MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71127100 SUP HCPCS C1713 71127100 - SCREW BN 7MM 100MM STRL 16MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71127105 SUP HCPCS C1713 71127105 - SCREW BN 7MM 105MM STRL 16MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71127110 SUP HCPCS C1713 71127110 - SCREW BN 7MM 110MM STRL 16MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71127115 SUP HCPCS C1713 71127115 - SCREW BN 7MM 115MM STRL 16MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71127120 SUP HCPCS C1713 71127120 - SCREW BN 7MM 120MM STRL 16MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $487.20 $487.20 $101.53 $487.20 N/A N/A 71127125 SUP HCPCS C1713 71127125 - SCREW BN 7MM 125MM STRL 16MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71127130 SUP HCPCS C1713 71127130 - SCREW BN 7MM 130MM STRL 16MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71127135 SUP HCPCS C1713 71127135 - SCREW BN 7MM 135MM STRL 16MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71127140 SUP HCPCS C1713 71127140 - SCREW BN 7MM 140MM STRL 16MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71127145 SUP HCPCS C1713 71127145 - SCREW BN 7MM 145MM STRL 16MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71127150 SUP HCPCS C1713 71127150 - SCREW BN 7MM 150MM STRL 16MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71128045 SUP HCPCS C1713 71128045 - SCREW BN 7MM 45MM STRL 32MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71128050 SUP HCPCS C1713 71128050 - SCREW BN 7MM 50MM STRL 32MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71128055 SUP HCPCS C1713 71128055 - SCREW BN 7MM 55MM STRL 32MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71128060 SUP HCPCS C1713 71128060 - SCREW BN 7MM 60MM STRL 32MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71128065 SUP HCPCS C1713 71128065 - SCREW BN 7MM 65MM STRL 32MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71128070 SUP HCPCS C1713 71128070 - SCREW BN 7MM 70MM STRL 32MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71128075 SUP HCPCS C1713 71128075 - SCREW BN 7MM 75MM STRL 32MM CNN SET SS ORTH IMPL BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71128080 SUP HCPCS C1713 71128080 - SCREW BN 7MM 80MM STRL 32MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71128085 SUP HCPCS C1713 71128085 - SCREW BN 7MM 85MM STRL 32MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71128090 SUP HCPCS C1713 71128090 - SCREW BN 7MM 90MM STRL 32MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71128095 SUP HCPCS C1713 71128095 - SCREW BN 7MM 95MM STRL 32MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71128100 SUP HCPCS C1713 71128100 - SCREW BN 7MM 100MM STRL 32MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $487.20 $487.20 $101.53 $487.20 N/A N/A 71128105 SUP HCPCS C1713 71128105 - SCREW BN 7MM 105MM STRL 32MM CNN SS CORT BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71128110 SUP HCPCS C1713 71128110 - SCREW BN 7MM 110MM STRL 32MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71128115 SUP HCPCS C1713 71128115 - SCREW BN 7MM 115MM STRL 32MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71128120 SUP HCPCS C1713 71128120 - SCREW BN 7MM 120MM STRL 32MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $487.20 $487.20 $101.53 $487.20 N/A N/A 71128125 SUP HCPCS C1713 71128125 - SCREW BN 7MM 125MM STRL 32MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $487.20 $487.20 $101.53 $487.20 N/A N/A 71128130 SUP HCPCS C1713 71128130 - SCREW BN 7MM 130MM STRL 32MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $487.20 $487.20 $101.53 $487.20 N/A N/A 71128135 SUP HCPCS C1713 71128135 - SCREW BN 7MM 135MM STRL 32MM CNN SS ORTH BOTH IP/OP $467.50 $346.00 $92.74 $467.25 $210.26 $210.26 $210.26 $210.26 $467.25 $467.25 $467.25 $97.39 $467.25 $467.25 $467.25 $467.25 $467.25 $97.38 $467.25 $467.25 $276.38 $467.25 $467.25 $467.25 $467.25 $350.63 $467.25 $467.25 $467.25 $233.63 $233.63 $370.06 $467.25 $373.80 $210.26 $92.74 N/A $271.15 $467.25 $280.35 $467.25 $97.37 $467.25 N/A N/A 71128140 SUP HCPCS C1713 71128140 - SCREW BN 7MM 140MM STRL 32MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71128145 SUP HCPCS C1713 71128145 - SCREW BN 7MM 145MM STRL 32MM CNN SS ORTH BOTH IP/OP $467.50 $346.00 $92.74 $467.25 $210.26 $210.26 $210.26 $210.26 $467.25 $467.25 $467.25 $97.39 $467.25 $467.25 $467.25 $467.25 $467.25 $97.38 $467.25 $467.25 $276.38 $467.25 $467.25 $467.25 $467.25 $350.63 $467.25 $467.25 $467.25 $233.63 $233.63 $370.06 $467.25 $373.80 $210.26 $92.74 N/A $271.15 $467.25 $280.35 $467.25 $97.37 $467.25 N/A N/A 71128150 SUP HCPCS C1713 71128150 - SCREW BN 7MM 150MM STRL 32MM CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71128690 SUP HCPCS C1713 71128690 - STAPLE BN SM 23X10.8MM SPK FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $507.15 $507.15 $105.69 $507.15 N/A N/A 71128691 SUP HCPCS C1713 71128691 - STAPLE BN SM 23X10.8MM FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 71128692 SUP HCPCS C1713 71128692 - STAPLE BN SM 23X12MM SPK FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 71128693 SUP HCPCS C1713 71128693 - STAPLE BN SM 23X12MM FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $507.15 $507.15 $105.69 $507.15 N/A N/A 71128694 SUP HCPCS C1713 71128694 - STAPLE BN MED 23X15MM SPK FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $507.15 $507.15 $105.69 $507.15 N/A N/A 71128695 SUP HCPCS C1713 71128695 - STAPLE BN MED 23X15MM FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 71128696 SUP HCPCS C1713 71128696 - STAPLE BN LG 23X18MM SPK FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $507.15 $507.15 N/A N/A 71128697 SUP HCPCS C1713 71128697 - STAPLE BN LG 23X18MM FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $507.15 $507.15 N/A N/A 71128698 SUP HCPCS C1713 71128698 - STAPLE BN SM 16X13MM TBL FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $507.15 $507.15 N/A N/A 71128699 SUP HCPCS C1713 71128699 - STAPLE BN MED 22X16MM TBL FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $507.15 $507.15 N/A N/A 71128720 SUP HCPCS C1713 71128720 - STAPLE BN SM 15X11MM SPK FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 71128721 SUP HCPCS C1713 71128721 - STAPLE BN SM 15X11MM FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $507.15 $507.15 $105.69 $507.15 N/A N/A 71128722 SUP HCPCS C1713 71128722 - STAPLE BN SM 15X12.5MM SPK FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 71128723 SUP HCPCS C1713 71128723 - STAPLE BN SM 23X12.5MM FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 71128724 SUP HCPCS C1713 71128724 - STAPLE BN SM 16X15MM SPK FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 71128725 SUP HCPCS C1713 71128725 - STAPLE BN SM 16X15MM FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $507.15 $507.15 $105.69 $507.15 N/A N/A 71128726 SUP HCPCS C1713 71128726 - STAPLE BN LG 19X15MM SPK FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 71128727 SUP HCPCS C1713 71128727 - STAPLE BN LG 19X15MM FX BOTH IP/OP $507.50 $376.00 $100.66 $507.15 $228.22 $228.22 $228.22 $228.22 $507.15 $507.15 $507.15 $105.70 $507.15 $507.15 $507.15 $507.15 $507.15 $105.70 $507.15 $202.86 $299.98 $507.15 $507.15 $507.15 $507.15 $380.63 $507.15 $507.15 $507.15 $253.58 $253.58 $401.66 $507.15 $405.72 $228.22 $100.66 N/A $294.35 $507.15 $304.29 $507.15 $105.69 $507.15 N/A N/A 71129030 SUP HCPCS C1713 71129030 - SCREW BN FT 7MM 30MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $487.20 $487.20 $101.53 $487.20 N/A N/A 71129035 SUP HCPCS C1713 71129035 - SCREW BN FT 7MM 35MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71129040 SUP HCPCS C1713 71129040 - SCREW BN FT 7MM 40MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71129045 SUP HCPCS C1713 71129045 - SCREW BN FT 7MM 45MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71129050 SUP HCPCS C1713 71129050 - SCREW BN FT 7MM 50MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $487.20 $487.20 $101.53 $487.20 N/A N/A 71129055 SUP HCPCS C1713 71129055 - SCREW BN FT 7MM 55MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $487.20 $487.20 $101.53 $487.20 N/A N/A 71129060 SUP HCPCS C1713 71129060 - SCREW BN FT 7MM 60MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $194.88 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71129065 SUP HCPCS C1713 71129065 - SCREW BN FT 7MM 65MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71129070 SUP HCPCS C1713 71129070 - SCREW BN FT 7MM 70MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71129075 SUP HCPCS C1713 71129075 - SCREW BN FT 7MM 75MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $487.20 $487.20 $101.53 $487.20 N/A N/A 71129080 SUP HCPCS C1713 71129080 - SCREW BN FT 7MM 80MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $487.20 $487.20 $101.53 $487.20 N/A N/A 71129085 SUP HCPCS C1713 71129085 - SCREW BN FT 7MM 85MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $487.20 $487.20 $101.53 $487.20 N/A N/A 71129090 SUP HCPCS C1713 71129090 - SCREW BN FT 7MM 90MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71129095 SUP HCPCS C1713 71129095 - SCREW BN FT 7MM 95MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71129100 SUP HCPCS C1713 71129100 - SCREW BN FT 7MM 100MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $487.20 $487.20 $101.53 $487.20 N/A N/A 71129105 SUP HCPCS C1713 71129105 - SCREW BN FT 7MM 105MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71129110 SUP HCPCS C1713 71129110 - SCREW BN FT 7MM 110MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $101.53 $487.20 N/A N/A 71129115 SUP HCPCS C1713 71129115 - SCREW BN FT 7MM 115MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71129120 SUP HCPCS C1713 71129120 - SCREW BN FT 7MM 120MM STRL CNN SS ORTH BOTH IP/OP $467.50 $346.00 $92.74 $467.25 $210.26 $210.26 $210.26 $210.26 $467.25 $467.25 $467.25 $97.39 $467.25 $467.25 $467.25 $467.25 $467.25 $97.38 $467.25 $467.25 $276.38 $467.25 $467.25 $467.25 $467.25 $350.63 $467.25 $467.25 $467.25 $233.63 $233.63 $370.06 $467.25 $373.80 $210.26 $92.74 N/A $271.15 $467.25 $467.25 $467.25 $467.25 $467.25 N/A N/A 71129125 SUP HCPCS C1713 71129125 - SCREW BN FT 7MM 125MM STRL CNN SS ORTH BOTH IP/OP $467.50 $346.00 $92.74 $467.25 $210.26 $210.26 $210.26 $210.26 $467.25 $467.25 $467.25 $97.39 $467.25 $467.25 $467.25 $467.25 $467.25 $97.38 $467.25 $467.25 $276.38 $467.25 $467.25 $467.25 $467.25 $350.63 $467.25 $467.25 $467.25 $233.63 $233.63 $370.06 $467.25 $373.80 $210.26 $92.74 N/A $271.15 $467.25 $467.25 $467.25 $97.37 $467.25 N/A N/A 71129130 SUP HCPCS C1713 71129130 - SCREW BN FT 7MM 130MM STRL CNN SS ORTH BOTH IP/OP $487.50 $361.00 $96.70 $487.20 $219.24 $219.24 $219.24 $219.24 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $487.20 $487.20 $487.20 $101.54 $487.20 $487.20 $288.18 $487.20 $487.20 $487.20 $487.20 $365.63 $487.20 $487.20 $487.20 $243.60 $243.60 $385.86 $487.20 $389.76 $219.24 $96.70 N/A $282.75 $487.20 $292.32 $487.20 $487.20 $487.20 N/A N/A 71129212 SUP HCPCS C1713 71129212 - SCREW BN 4.5MM 12MM AMBI CLS ST CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $54.13 $54.13 N/A N/A 71129214 SUP HCPCS C1713 71129214 - SCREW BN 4.5MM 3.2MM 14MM AMBI CLS ST SS CORT HIP PLT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $11.28 $54.13 N/A N/A 71129216 SUP HCPCS C1713 71129216 - SCREW BN 4.5MM 8MM 16MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $11.28 $54.13 N/A N/A 71129218 SUP HCPCS C1713 71129218 - SCREW BN 4.5MM 8MM 18MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $54.13 $54.13 $11.28 $54.13 N/A N/A 71129220 SUP HCPCS C1713 71129220 - SCREW BN 4.5MM 8MM 20MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $54.13 $54.13 $54.13 $54.13 N/A N/A 71129222 SUP HCPCS C1713 71129222 - SCREW BN 4.5MM 8MM 22MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $54.13 $54.13 $54.13 $54.13 N/A N/A 71129224 SUP HCPCS C1713 71129224 - SCREW BN 4.5MM 24MM CHS ST SS CORT HIP PLT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $54.13 $54.13 $11.28 $54.13 N/A N/A 71129226 SUP HCPCS C1713 71129226 - SCREW BN 4.5MM 26MM AMBI CLS ST SS CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $54.13 $54.13 $11.28 $54.13 N/A N/A 71129228 SUP HCPCS C1713 71129228 - SCREW BN 4.5MM 8MM 28MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $54.13 $54.13 $11.28 $54.13 N/A N/A 71129230 SUP HCPCS C1713 71129230 - SCREW BN 4.5MM 3.2MM 30MM ST SS CORT SP CNDL PLT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $11.28 $54.13 N/A N/A 71129232 SUP HCPCS C1713 71129232 - SCREW BN 4.5MM 8MM 32MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $11.28 $54.13 N/A N/A 71129234 SUP HCPCS C1713 71129234 - SCREW BN 4.5MM 34MM IMHS ST SS CORT IM NL BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $11.28 $54.13 N/A N/A 71129236 SUP HCPCS C1713 71129236 - SCREW BN 4.5MM 8MM 36MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $54.13 $54.13 $11.28 $54.13 N/A N/A 71129238 SUP HCPCS C1713 71129238 - SCREW BN 4.5MM 8MM 38MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $11.28 $54.13 N/A N/A 71129240 SUP HCPCS C1713 71129240 - SCREW BN 4.5MM 8MM 40MM ST HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $54.13 $54.13 $11.28 $54.13 N/A N/A 71129242 SUP HCPCS C1713 71129242 - SCREW BN 4.5MM 8MM 42MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $11.28 $54.13 N/A N/A 71129244 SUP HCPCS C1713 71129244 - SCREW BN 4.5MM 8MM 44MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $54.13 $54.13 N/A N/A 71129246 SUP HCPCS C1713 71129246 - SCREW BN 4.5MM 8MM 46MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $54.13 $54.13 N/A N/A 71129248 SUP HCPCS C1713 71129248 - SCREW BN 4.5MM 8MM 48MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $11.28 $54.13 N/A N/A 71129250 SUP HCPCS C1713 71129250 - SCREW BN 4.5MM 8MM 50MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $54.13 $54.13 N/A N/A 71129252 SUP HCPCS C1713 71129252 - SCREW BN 4.5MM 8MM 52MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $54.13 $54.13 N/A N/A 71129254 SUP HCPCS C1713 71129254 - SCREW BN 4.5MM 8MM 54MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $54.13 $54.13 $54.13 $54.13 N/A N/A 71129256 SUP HCPCS C1713 71129256 - SCREW BN 4.5MM 8MM 56MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $11.28 $54.13 N/A N/A 71129258 SUP HCPCS C1713 71129258 - SCREW BN 4.5MM 3.2MM 58MM AMBI CLS ST SS CORT HIP PLT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $11.28 $54.13 N/A N/A 71129260 SUP HCPCS C1713 71129260 - SCREW BN 4.5MM 8MM 60MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $54.13 $54.13 $11.28 $54.13 N/A N/A 71129262 SUP HCPCS C1713 71129262 - SCREW BN 4.5MM 3.2MM 62MM AMBI CLS ST SS CORT HIP PLT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $54.13 $54.13 $11.28 $54.13 N/A N/A 71129264 SUP HCPCS C1713 71129264 - SCREW BN 4.5MM 8MM 64MM AMBI CLS ST SS HIP CORT BOTH IP/OP $54.50 $40.00 $10.74 $54.13 $24.36 $24.36 $24.36 $24.36 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $54.13 $54.13 $54.13 $11.28 $54.13 $54.13 $32.02 $54.13 $54.13 $54.13 $54.13 $40.88 $54.13 $54.13 $54.13 $27.07 $27.07 $42.87 $54.13 $43.30 $24.36 $10.74 N/A $31.61 $54.13 $32.48 $54.13 $54.13 $54.13 N/A N/A 71130205 SUP HCPCS C1713 71130205 - PLATE BN 3.5MM 5 HL CMPR PRV FX 3.5MM SCR SM FRAG SET BOTH IP/OP $359.50 $266.00 $71.27 $359.10 $161.60 $161.60 $161.60 $161.60 $359.10 $359.10 $359.10 $74.85 $359.10 $359.10 $359.10 $359.10 $359.10 $74.84 $359.10 $359.10 $212.41 $359.10 $359.10 $359.10 $359.10 $269.63 $359.10 $359.10 $359.10 $179.55 $179.55 $284.41 $359.10 $287.28 $161.60 $71.27 N/A $208.51 $359.10 $215.46 $359.10 $74.84 $359.10 N/A N/A 71130206 SUP HCPCS C1713 71130206 - PLATE BN 3.5MM 6 HL CMPR PRV FX 3.5MM SCR SM FRAG SET BOTH IP/OP $378.00 $280.00 $75.02 $378.00 $170.10 $170.10 $170.10 $170.10 $378.00 $378.00 $378.00 $78.78 $378.00 $378.00 $378.00 $378.00 $378.00 $78.78 $378.00 $378.00 $223.59 $378.00 $378.00 $378.00 $378.00 $283.50 $378.00 $378.00 $378.00 $189.00 $189.00 $299.38 $378.00 $302.40 $170.10 $75.02 N/A $219.24 $378.00 $226.80 $378.00 $378.00 $378.00 N/A N/A 71130207 SUP HCPCS C1713 71130207 - PLATE BN 3.5MM 7 HL CMPR PRV FX 3.5MM SCR SM FRAG SET BOTH IP/OP $390.00 $289.00 $77.32 $389.55 $175.30 $175.30 $175.30 $175.30 $389.55 $389.55 $389.55 $81.19 $389.55 $389.55 $389.55 $389.55 $389.55 $81.19 $389.55 $389.55 $230.42 $389.55 $389.55 $389.55 $389.55 $292.50 $389.55 $389.55 $389.55 $194.78 $194.78 $308.52 $389.55 $311.64 $175.30 $77.32 N/A $226.20 $389.55 $233.73 $389.55 $389.55 $389.55 N/A N/A 71130208 SUP HCPCS C1713 71130208 - PLATE BN 3.5MM 8 HL CMPR PRV FX 3.5MM SCR SM FRAG SET BOTH IP/OP $412.00 $305.00 $81.69 $411.60 $185.22 $185.22 $185.22 $185.22 $411.60 $411.60 $411.60 $85.79 $411.60 $411.60 $411.60 $411.60 $411.60 $85.78 $411.60 $411.60 $243.46 $411.60 $411.60 $411.60 $411.60 $309.00 $411.60 $411.60 $411.60 $205.80 $205.80 $325.99 $411.60 $329.28 $185.22 $81.69 N/A $238.96 $411.60 $246.96 $411.60 $85.78 $411.60 N/A N/A 71130209 SUP HCPCS C1713 71130209 - PLATE BN 3.5MM 9 HL CMPR PRV FX 3.5MM SCR SM FRAG SET BOTH IP/OP $435.00 $322.00 $86.28 $434.70 $195.62 $195.62 $195.62 $195.62 $434.70 $434.70 $434.70 $90.60 $434.70 $434.70 $434.70 $434.70 $434.70 $90.60 $434.70 $434.70 $257.13 $434.70 $434.70 $434.70 $434.70 $326.25 $434.70 $434.70 $434.70 $217.35 $217.35 $344.28 $434.70 $347.76 $195.62 $86.28 N/A $252.30 $434.70 $260.82 $434.70 $90.59 $434.70 N/A N/A 71130210 SUP HCPCS C1713 71130210 - PLATE BN 3.5MM 10 HL CMPR PRV FX 3.5MM SCR SM FRAG SET BOTH IP/OP $442.50 $327.00 $87.74 $442.05 $198.92 $198.92 $198.92 $198.92 $442.05 $442.05 $442.05 $92.13 $442.05 $442.05 $442.05 $442.05 $442.05 $92.13 $442.05 $442.05 $261.47 $442.05 $442.05 $442.05 $442.05 $331.88 $442.05 $442.05 $442.05 $221.03 $221.03 $350.10 $442.05 $353.64 $198.92 $87.74 N/A $256.65 $442.05 $265.23 $442.05 $92.12 $442.05 N/A N/A 71130303 SUP HCPCS C1713 71130303 - PLATE BN 1/3 TBLR 3 HL COLR PRV FX SM FRAG SET BOTH IP/OP $190.50 $141.00 $37.72 $190.05 $85.52 $85.52 $85.52 $85.52 $190.05 $190.05 $190.05 $39.61 $190.05 $190.05 $190.05 $190.05 $190.05 $39.61 $190.05 $190.05 $112.41 $190.05 $190.05 $190.05 $190.05 $142.88 $190.05 $190.05 $190.05 $95.03 $95.03 $150.52 $190.05 $152.04 $85.52 $37.72 N/A $110.49 $190.05 $114.03 $190.05 $39.61 $190.05 N/A N/A 71130304 SUP HCPCS C1713 71130304 - PLATE BN 1/3 TBLR 4 HL COLR PRV FX SM FRAG SET BOTH IP/OP $205.00 $152.00 $40.64 $204.75 $92.14 $92.14 $92.14 $92.14 $204.75 $204.75 $204.75 $42.68 $204.75 $204.75 $204.75 $204.75 $204.75 $42.67 $204.75 $81.90 $121.11 $204.75 $204.75 $204.75 $204.75 $153.75 $204.75 $204.75 $204.75 $102.38 $102.38 $162.16 $204.75 $163.80 $92.14 $40.64 N/A $118.90 $204.75 $204.75 $204.75 $204.75 $204.75 N/A N/A 71130305 SUP HCPCS C1713 71130305 - PLATE BN 1/3 TBLR 5 HL COLR PRV FX SM FRAG SET BOTH IP/OP $218.50 $162.00 $43.35 $218.40 $98.28 $98.28 $98.28 $98.28 $218.40 $218.40 $218.40 $45.52 $218.40 $218.40 $218.40 $218.40 $218.40 $45.52 $218.40 $218.40 $129.18 $218.40 $218.40 $218.40 $218.40 $163.88 $218.40 $218.40 $218.40 $109.20 $109.20 $172.97 $218.40 $174.72 $98.28 $43.35 N/A $126.73 $218.40 $131.04 $218.40 $218.40 $218.40 N/A N/A 71130306 SUP HCPCS C1713 71130306 - PLATE BN 1/3 TBLR 6 HL COLR PRV FX SM FRAG SET BOTH IP/OP $211.50 $157.00 $41.89 $211.05 $94.97 $94.97 $94.97 $94.97 $211.05 $211.05 $211.05 $43.99 $211.05 $211.05 $211.05 $211.05 $211.05 $43.99 $211.05 $84.42 $124.84 $211.05 $211.05 $211.05 $211.05 $158.63 $211.05 $211.05 $211.05 $105.53 $105.53 $167.15 $211.05 $168.84 $94.97 $41.89 N/A $122.67 $211.05 $126.63 $211.05 $43.98 $211.05 N/A N/A 71130307 SUP HCPCS C1713 71130307 - PLATE BN 1/3 TBLR 7 HL COLR PRV FX SM FRAG SET BOTH IP/OP $228.00 $169.00 $45.22 $227.85 $102.53 $102.53 $102.53 $102.53 $227.85 $227.85 $227.85 $47.49 $227.85 $227.85 $227.85 $227.85 $227.85 $47.49 $227.85 $91.14 $134.77 $227.85 $227.85 $227.85 $227.85 $171.00 $227.85 $227.85 $227.85 $113.93 $113.93 $180.46 $227.85 $182.28 $102.53 $45.22 N/A $132.24 $227.85 $136.71 $227.85 $227.85 $227.85 N/A N/A 71130308 SUP HCPCS C1713 71130308 - PLATE BN 1/3 TBLR 8 HL COLR PRV FX SM FRAG SET BOTH IP/OP $235.50 $174.00 $46.68 $235.20 $105.84 $105.84 $105.84 $105.84 $235.20 $235.20 $235.20 $49.02 $235.20 $235.20 $235.20 $235.20 $235.20 $49.02 $235.20 $94.08 $139.12 $235.20 $235.20 $235.20 $235.20 $176.63 $235.20 $235.20 $235.20 $117.60 $117.60 $186.28 $235.20 $188.16 $105.84 $46.68 N/A $136.59 $235.20 $141.12 $235.20 $235.20 $235.20 N/A N/A 71130310 SUP HCPCS C1713 71130310 - PLATE BN 1/3 TBLR 10 HL COLR PRV FX SM FRAG SET BOTH IP/OP $247.00 $183.00 $48.97 $246.75 $111.04 $111.04 $111.04 $111.04 $246.75 $246.75 $246.75 $51.43 $246.75 $246.75 $246.75 $246.75 $246.75 $51.43 $246.75 $246.75 $145.95 $246.75 $246.75 $246.75 $246.75 $185.25 $246.75 $246.75 $246.75 $123.38 $123.38 $195.43 $246.75 $197.40 $111.04 $48.97 N/A $143.26 $246.75 $246.75 $246.75 $246.75 $246.75 N/A N/A 71130403 SUP HCPCS C1713 71130403 - PLATE BN T SM 3 HL PRV FX SM FRAG SET BOTH IP/OP $353.00 $261.00 $70.02 $352.80 $158.76 $158.76 $158.76 $158.76 $352.80 $352.80 $352.80 $73.53 $352.80 $352.80 $352.80 $352.80 $352.80 $73.53 $352.80 $352.80 $208.68 $352.80 $352.80 $352.80 $352.80 $264.75 $352.80 $352.80 $352.80 $176.40 $176.40 $279.42 $352.80 $282.24 $158.76 $70.02 N/A $204.74 $352.80 $352.80 $352.80 $73.52 $352.80 N/A N/A 71130404 SUP HCPCS C1713 71130404 - PLATE BN T SM 4 HL PRV FX SM FRAG SET BOTH IP/OP $360.50 $267.00 $71.48 $360.15 $162.07 $162.07 $162.07 $162.07 $360.15 $360.15 $360.15 $75.06 $360.15 $360.15 $360.15 $360.15 $360.15 $75.06 $360.15 $360.15 $213.03 $360.15 $360.15 $360.15 $360.15 $270.38 $360.15 $360.15 $360.15 $180.08 $180.08 $285.24 $360.15 $288.12 $162.07 $71.48 N/A $209.09 $360.15 $216.09 $360.15 $360.15 $360.15 N/A N/A 71130405 SUP HCPCS C1713 71130405 - PLATE BN T SM 5 HL PRV FX SM FRAG SET BOTH IP/OP $457.00 $338.00 $90.65 $456.75 $205.54 $205.54 $205.54 $205.54 $456.75 $456.75 $456.75 $95.20 $456.75 $456.75 $456.75 $456.75 $456.75 $95.19 $456.75 $182.70 $270.17 $456.75 $456.75 $456.75 $456.75 $342.75 $456.75 $456.75 $456.75 $228.38 $228.38 $361.75 $456.75 $365.40 $205.54 $90.65 N/A $265.06 $456.75 $274.05 $456.75 $456.75 $456.75 N/A N/A 71130503 SUP HCPCS C1713 71130503 - PLATE BN T OBLQ 3 HL PRV FX SM FRAG SET BOTH IP/OP $582.00 $431.00 $115.45 $581.70 $261.77 $261.77 $261.77 $261.77 $581.70 $581.70 $581.70 $121.24 $581.70 $581.70 $581.70 $581.70 $581.70 $121.23 $581.70 $232.68 $344.08 $581.70 $581.70 $581.70 $581.70 $436.50 $581.70 $581.70 $581.70 $290.85 $290.85 $460.71 $581.70 $465.36 $261.77 $115.45 N/A $337.56 $581.70 $349.02 $581.70 $581.70 $581.70 N/A N/A 71130504 SUP HCPCS C1713 71130504 - PLATE BN T OBLQ 4 HL PRV FX SM FRAG SET BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $630.00 $630.00 $131.29 $630.00 N/A N/A 71130505 SUP HCPCS C1713 71130505 - PLATE BN T OBLQ 5 HL PRV FX SM FRAG SET BOTH IP/OP $640.50 $474.00 $127.12 $640.50 $288.23 $288.23 $288.23 $288.23 $640.50 $640.50 $640.50 $133.50 $640.50 $640.50 $640.50 $640.50 $640.50 $133.49 $640.50 $640.50 $378.86 $640.50 $640.50 $640.50 $640.50 $480.38 $640.50 $640.50 $640.50 $320.25 $320.25 $507.28 $640.50 $512.40 $288.23 $127.12 N/A $371.49 $640.50 $384.30 $640.50 $640.50 $640.50 N/A N/A 71130603 SUP HCPCS C1713 71130603 - PLATE BN CLVRLF 3 HL PRV FX SM FRAG SET BOTH IP/OP $819.00 $606.00 $162.55 $819.00 $368.55 $368.55 $368.55 $368.55 $819.00 $819.00 $819.00 $170.70 $819.00 $819.00 $819.00 $819.00 $819.00 $170.69 $819.00 $819.00 $484.44 $819.00 $819.00 $819.00 $819.00 $614.25 $819.00 $819.00 $819.00 $409.50 $409.50 $648.65 $819.00 $655.20 $368.55 $162.55 N/A $475.02 $819.00 $491.40 $819.00 $819.00 $819.00 N/A N/A 71130804 SUP HCPCS C1713 71130804 - PLATE BN L BTRS 4 HL PRV FX LT LG FRAG SET BOTH IP/OP $923.00 $683.00 $183.18 $922.95 $415.33 $415.33 $415.33 $415.33 $922.95 $922.95 $922.95 $192.37 $922.95 $922.95 $922.95 $922.95 $922.95 $192.35 $922.95 $922.95 $545.92 $922.95 $922.95 $922.95 $922.95 $692.25 $922.95 $922.95 $922.95 $461.48 $461.48 $730.98 $922.95 $738.36 $415.33 $183.18 N/A $535.34 $922.95 $553.77 $922.95 $922.95 $922.95 N/A N/A 71130904 SUP HCPCS C1713 71130904 - PLATE BN L BTRS 4 HL PRV FX RT LG FRAG SET BOTH IP/OP $923.00 $683.00 $183.18 $922.95 $415.33 $415.33 $415.33 $415.33 $922.95 $922.95 $922.95 $192.37 $922.95 $922.95 $922.95 $922.95 $922.95 $192.35 $922.95 $922.95 $545.92 $922.95 $922.95 $922.95 $922.95 $692.25 $922.95 $922.95 $922.95 $461.48 $461.48 $730.98 $922.95 $738.36 $415.33 $183.18 N/A $535.34 $922.95 $553.77 $922.95 $192.34 $922.95 N/A N/A 71131007 SUP HCPCS C1713 71131007 - PLATE BN BTRS 7 HL PRV FX TIBHD RL LG FRAG SET BOTH IP/OP "$1,974.00" "$1,461.00" $391.79 "$1,974.00" $888.30 $888.30 $888.30 $888.30 "$1,974.00" "$1,974.00" "$1,974.00" $411.43 "$1,974.00" "$1,974.00" "$1,974.00" "$1,974.00" "$1,974.00" $411.40 "$1,974.00" $789.60 "$1,167.62" "$1,974.00" "$1,974.00" "$1,974.00" "$1,974.00" "$1,480.50" "$1,974.00" "$1,974.00" "$1,974.00" $987.00 $987.00 "$1,563.41" "$1,974.00" "$1,579.20" $888.30 $391.79 N/A "$1,144.92" "$1,974.00" "$1,184.40" "$1,974.00" "$1,974.00" "$1,974.00" N/A N/A 71131009 SUP HCPCS C1713 71131009 - PLATE BN BTRS 9 HL PRV FX TIBHD RL LG FRAG SET BOTH IP/OP "$2,110.50" "$1,562.00" $418.88 "$2,110.50" $949.73 $949.73 $949.73 $949.73 "$2,110.50" "$2,110.50" "$2,110.50" $439.88 "$2,110.50" "$2,110.50" "$2,110.50" "$2,110.50" "$2,110.50" $439.85 "$2,110.50" $844.20 "$1,248.36" "$2,110.50" "$2,110.50" "$2,110.50" "$2,110.50" "$1,582.88" "$2,110.50" "$2,110.50" "$2,110.50" "$1,055.25" "$1,055.25" "$1,671.52" "$2,110.50" "$1,688.40" $949.73 $418.88 N/A "$1,224.09" "$2,110.50" "$1,266.30" "$2,110.50" "$2,110.50" "$2,110.50" N/A N/A 71131107 SUP HCPCS C1713 71131107 - PLATE BN BTRS 7 HL PRV FX TIBHD L/L LG FRAG SET BOTH IP/OP "$1,974.00" "$1,461.00" $391.79 "$1,974.00" $888.30 $888.30 $888.30 $888.30 "$1,974.00" "$1,974.00" "$1,974.00" $411.43 "$1,974.00" "$1,974.00" "$1,974.00" "$1,974.00" "$1,974.00" $411.40 "$1,974.00" $789.60 "$1,167.62" "$1,974.00" "$1,974.00" "$1,974.00" "$1,974.00" "$1,480.50" "$1,974.00" "$1,974.00" "$1,974.00" $987.00 $987.00 "$1,563.41" "$1,974.00" "$1,579.20" $888.30 $391.79 N/A "$1,144.92" "$1,974.00" "$1,974.00" "$1,974.00" $411.38 "$1,974.00" N/A N/A 71131109 SUP HCPCS C1713 71131109 - PLATE BN BTRS 9 HL PRV FX TIBHD L/L LG FRAG SET BOTH IP/OP "$2,110.50" "$1,562.00" $418.88 "$2,110.50" $949.73 $949.73 $949.73 $949.73 "$2,110.50" "$2,110.50" "$2,110.50" $439.88 "$2,110.50" "$2,110.50" "$2,110.50" "$2,110.50" "$2,110.50" $439.85 "$2,110.50" "$2,110.50" "$1,248.36" "$2,110.50" "$2,110.50" "$2,110.50" "$2,110.50" "$1,582.88" "$2,110.50" "$2,110.50" "$2,110.50" "$1,055.25" "$1,055.25" "$1,671.52" "$2,110.50" "$1,688.40" $949.73 $418.88 N/A "$1,224.09" "$2,110.50" "$1,266.30" "$2,110.50" $439.83 "$2,110.50" N/A N/A 71131206 SUP HCPCS C1713 71131206 - PLATE BN 4.5MM BRD 6 HL PRV FX PERIART MTPHSL 4.5MM SCR LG BOTH IP/OP $703.50 $521.00 $139.63 $703.50 $316.58 $316.58 $316.58 $316.58 $703.50 $703.50 $703.50 $146.63 $703.50 $703.50 $703.50 $703.50 $703.50 $146.62 $703.50 $281.40 $416.12 $703.50 $703.50 $703.50 $703.50 $527.63 $703.50 $703.50 $703.50 $351.75 $351.75 $557.17 $703.50 $562.80 $316.58 $139.63 N/A $408.03 $703.50 $422.10 $703.50 $146.61 $703.50 N/A N/A 71131207 SUP HCPCS C1713 71131207 - PLATE BN 4.5MM BRD 7 HL PRV FX PERIART MTPHSL 4.5MM SCR LG BOTH IP/OP $703.50 $521.00 $139.63 $703.50 $316.58 $316.58 $316.58 $316.58 $703.50 $703.50 $703.50 $146.63 $703.50 $703.50 $703.50 $703.50 $703.50 $146.62 $703.50 $281.40 $416.12 $703.50 $703.50 $703.50 $703.50 $527.63 $703.50 $703.50 $703.50 $351.75 $351.75 $557.17 $703.50 $562.80 $316.58 $139.63 N/A $408.03 $703.50 $422.10 $703.50 $146.61 $703.50 N/A N/A 71131208 SUP HCPCS C1713 71131208 - PLATE BN 4.5MM BRD 8 HL PRV FX PERIART MTPHSL 4.5MM SCR LG BOTH IP/OP $876.00 $648.00 $173.80 $875.70 $394.07 $394.07 $394.07 $394.07 $875.70 $875.70 $875.70 $182.52 $875.70 $875.70 $875.70 $875.70 $875.70 $182.51 $875.70 $350.28 $517.98 $875.70 $875.70 $875.70 $875.70 $657.00 $875.70 $875.70 $875.70 $437.85 $437.85 $693.55 $875.70 $700.56 $394.07 $173.80 N/A $508.08 $875.70 $525.42 $875.70 $182.50 $875.70 N/A N/A 71131209 SUP HCPCS C1713 71131209 - PLATE BN 4.5MM BRD 9 HL PRV FX PERIART MTPHSL 4.5MM SCR LG BOTH IP/OP $876.00 $648.00 $173.80 $875.70 $394.07 $394.07 $394.07 $394.07 $875.70 $875.70 $875.70 $182.52 $875.70 $875.70 $875.70 $875.70 $875.70 $182.51 $875.70 $350.28 $517.98 $875.70 $875.70 $875.70 $875.70 $657.00 $875.70 $875.70 $875.70 $437.85 $437.85 $693.55 $875.70 $700.56 $394.07 $173.80 N/A $508.08 $875.70 $525.42 $875.70 $182.50 $875.70 N/A N/A 71131210 SUP HCPCS C1713 71131210 - PLATE BN 4.5MM BRD 10 HL PRV FX PERIART MTPHSL 4.5MM SCR LG BOTH IP/OP $876.00 $648.00 $173.80 $875.70 $394.07 $394.07 $394.07 $394.07 $875.70 $875.70 $875.70 $182.52 $875.70 $875.70 $875.70 $875.70 $875.70 $182.51 $875.70 $350.28 $517.98 $875.70 $875.70 $875.70 $875.70 $657.00 $875.70 $875.70 $875.70 $437.85 $437.85 $693.55 $875.70 $700.56 $394.07 $173.80 N/A $508.08 $875.70 $875.70 $875.70 $182.50 $875.70 N/A N/A 71131212 SUP HCPCS C1713 71131212 - PLATE BN 4.5MM BRD 12 HL PRV FX PERIART MTPHSL 4.5MM SCR LG BOTH IP/OP $940.00 $696.00 $186.52 $939.75 $422.89 $422.89 $422.89 $422.89 $939.75 $939.75 $939.75 $195.87 $939.75 $939.75 $939.75 $939.75 $939.75 $195.85 $939.75 $375.90 $555.86 $939.75 $939.75 $939.75 $939.75 $705.00 $939.75 $939.75 $939.75 $469.88 $469.88 $744.28 $939.75 $751.80 $422.89 $186.52 N/A $545.20 $939.75 $563.85 $939.75 $195.84 $939.75 N/A N/A 71131214 SUP HCPCS C1713 71131214 - PLATE BN 4.5MM BRD 14 HL PRV FX PERIART MTPHSL 4.5MM SCR LG BOTH IP/OP $940.00 $696.00 $186.52 $939.75 $422.89 $422.89 $422.89 $422.89 $939.75 $939.75 $939.75 $195.87 $939.75 $939.75 $939.75 $939.75 $939.75 $195.85 $939.75 $939.75 $555.86 $939.75 $939.75 $939.75 $939.75 $705.00 $939.75 $939.75 $939.75 $469.88 $469.88 $744.28 $939.75 $751.80 $422.89 $186.52 N/A $545.20 $939.75 $563.85 $939.75 $939.75 $939.75 N/A N/A 71131304 SUP HCPCS C1713 71131304 - PLATE BN SMTB 4 HL PRV FX LG FRAG SET BOTH IP/OP $190.50 $141.00 $37.72 $190.05 $85.52 $85.52 $85.52 $85.52 $190.05 $190.05 $190.05 $39.61 $190.05 $190.05 $190.05 $190.05 $190.05 $39.61 $190.05 $76.02 $112.41 $190.05 $190.05 $190.05 $190.05 $142.88 $190.05 $190.05 $190.05 $95.03 $95.03 $150.52 $190.05 $152.04 $85.52 $37.72 N/A $110.49 $190.05 $114.03 $190.05 $190.05 $190.05 N/A N/A 71131305 SUP HCPCS C1713 71131305 - PLATE BN SMTB 5 HL PRV FX LG FRAG SET BOTH IP/OP $192.50 $142.00 $38.14 $192.15 $86.47 $86.47 $86.47 $86.47 $192.15 $192.15 $192.15 $40.05 $192.15 $192.15 $192.15 $192.15 $192.15 $40.05 $192.15 $76.86 $113.66 $192.15 $192.15 $192.15 $192.15 $144.38 $192.15 $192.15 $192.15 $96.08 $96.08 $152.18 $192.15 $153.72 $86.47 $38.14 N/A $111.65 $192.15 $115.29 $192.15 $40.04 $192.15 N/A N/A 71131306 SUP HCPCS C1713 71131306 - PLATE BN SMTB 6 HL PRV FX LG FRAG SET BOTH IP/OP $211.50 $157.00 $41.89 $211.05 $94.97 $94.97 $94.97 $94.97 $211.05 $211.05 $211.05 $43.99 $211.05 $211.05 $211.05 $211.05 $211.05 $43.99 $211.05 $84.42 $124.84 $211.05 $211.05 $211.05 $211.05 $158.63 $211.05 $211.05 $211.05 $105.53 $105.53 $167.15 $211.05 $168.84 $94.97 $41.89 N/A $122.67 $211.05 $126.63 $211.05 $43.98 $211.05 N/A N/A 71131307 SUP HCPCS C1713 71131307 - PLATE BN SMTB 7 HL PRV FX LG FRAG SET BOTH IP/OP $224.00 $166.00 $44.39 $223.65 $100.64 $100.64 $100.64 $100.64 $223.65 $223.65 $223.65 $46.61 $223.65 $223.65 $223.65 $223.65 $223.65 $46.61 $223.65 $89.46 $132.29 $223.65 $223.65 $223.65 $223.65 $168.00 $223.65 $223.65 $223.65 $111.83 $111.83 $177.13 $223.65 $178.92 $100.64 $44.39 N/A $129.92 $223.65 $134.19 $223.65 $223.65 $223.65 N/A N/A 71131403 SUP HCPCS C1713 71131403 - PLATE BN NAR 3 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG BOTH IP/OP $474.00 $351.00 $93.99 $473.55 $213.10 $213.10 $213.10 $213.10 $473.55 $473.55 $473.55 $98.70 $473.55 $473.55 $473.55 $473.55 $473.55 $98.69 $473.55 $189.42 $280.10 $473.55 $473.55 $473.55 $473.55 $355.50 $473.55 $473.55 $473.55 $236.78 $236.78 $375.05 $473.55 $378.84 $213.10 $93.99 N/A $274.92 $473.55 $284.13 $473.55 $473.55 $473.55 N/A N/A 71131404 SUP HCPCS C1713 71131404 - PLATE BN NAR 4 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG BOTH IP/OP $474.00 $351.00 $93.99 $473.55 $213.10 $213.10 $213.10 $213.10 $473.55 $473.55 $473.55 $98.70 $473.55 $473.55 $473.55 $473.55 $473.55 $98.69 $473.55 $189.42 $280.10 $473.55 $473.55 $473.55 $473.55 $355.50 $473.55 $473.55 $473.55 $236.78 $236.78 $375.05 $473.55 $378.84 $213.10 $93.99 N/A $274.92 $473.55 $284.13 $473.55 $473.55 $473.55 N/A N/A 71131405 SUP HCPCS C1713 71131405 - PLATE BN NAR 5 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG BOTH IP/OP $474.00 $351.00 $93.99 $473.55 $213.10 $213.10 $213.10 $213.10 $473.55 $473.55 $473.55 $98.70 $473.55 $473.55 $473.55 $473.55 $473.55 $98.69 $473.55 $473.55 $280.10 $473.55 $473.55 $473.55 $473.55 $355.50 $473.55 $473.55 $473.55 $236.78 $236.78 $375.05 $473.55 $378.84 $213.10 $93.99 N/A $274.92 $473.55 $284.13 $473.55 $98.69 $473.55 N/A N/A 71131406 SUP HCPCS C1713 71131406 - PLATE BN NAR 6 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $441.00 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $264.60 $441.00 $91.90 $441.00 N/A N/A 71131407 SUP HCPCS C1713 71131407 - PLATE BN NAR 7 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG BOTH IP/OP $526.50 $390.00 $104.41 $526.05 $236.72 $236.72 $236.72 $236.72 $526.05 $526.05 $526.05 $109.64 $526.05 $526.05 $526.05 $526.05 $526.05 $109.63 $526.05 $210.42 $311.16 $526.05 $526.05 $526.05 $526.05 $394.88 $526.05 $526.05 $526.05 $263.03 $263.03 $416.63 $526.05 $420.84 $236.72 $104.41 N/A $305.37 $526.05 $315.63 $526.05 $109.63 $526.05 N/A N/A 71131408 SUP HCPCS C1713 71131408 - PLATE BN NAR 8 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $176.40 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $264.60 $441.00 $441.00 $441.00 N/A N/A 71131409 SUP HCPCS C1713 71131409 - PLATE BN NAR 9 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $176.40 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $264.60 $441.00 $441.00 $441.00 N/A N/A 71131410 SUP HCPCS C1713 71131410 - PLATE BN NAR 10 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG BOTH IP/OP $570.50 $422.00 $113.16 $570.15 $256.57 $256.57 $256.57 $256.57 $570.15 $570.15 $570.15 $118.83 $570.15 $570.15 $570.15 $570.15 $570.15 $118.83 $570.15 $228.06 $337.24 $570.15 $570.15 $570.15 $570.15 $427.88 $570.15 $570.15 $570.15 $285.08 $285.08 $451.56 $570.15 $456.12 $256.57 $113.16 N/A $330.89 $570.15 $342.09 $570.15 $118.82 $570.15 N/A N/A 71131411 SUP HCPCS C1713 71131411 - PLATE BN NAR 11 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG BOTH IP/OP $696.50 $515.00 $138.17 $696.15 $313.27 $313.27 $313.27 $313.27 $696.15 $696.15 $696.15 $145.10 $696.15 $696.15 $696.15 $696.15 $696.15 $145.09 $696.15 $696.15 $411.77 $696.15 $696.15 $696.15 $696.15 $522.38 $696.15 $696.15 $696.15 $348.08 $348.08 $551.35 $696.15 $556.92 $313.27 $138.17 N/A $403.97 $696.15 $417.69 $696.15 $145.08 $696.15 N/A N/A 71131412 SUP HCPCS C1713 71131412 - PLATE BN NAR 12 HL PRV FX PERIART MTPHSL 4.5MM SCR LG FRAG BOTH IP/OP $696.50 $515.00 $138.17 $696.15 $313.27 $313.27 $313.27 $313.27 $696.15 $696.15 $696.15 $145.10 $696.15 $696.15 $696.15 $696.15 $696.15 $145.09 $696.15 $696.15 $411.77 $696.15 $696.15 $696.15 $696.15 $522.38 $696.15 $696.15 $696.15 $348.08 $348.08 $551.35 $696.15 $556.92 $313.27 $138.17 N/A $403.97 $696.15 $417.69 $696.15 $145.08 $696.15 N/A N/A 71131510 SUP HCPCS C1713 71131510 - PIN FX LG ST 2MM 61MM 10MM TRL SS BOTH IP/OP $222.00 $164.00 $43.97 $221.55 $99.70 $99.70 $99.70 $99.70 $221.55 $221.55 $221.55 $46.18 $221.55 $221.55 $221.55 $221.55 $221.55 $46.17 $221.55 $88.62 $131.05 $221.55 $221.55 $221.55 $221.55 $166.50 $221.55 $221.55 $221.55 $110.78 $110.78 $175.47 $221.55 $177.24 $99.70 $43.97 N/A $128.76 $221.55 $221.55 $221.55 $46.17 $221.55 N/A N/A 71131511 SUP HCPCS C1713 71131511 - PIN FX LG MED THRD 2MM 38MM 13MM TRL SS BOTH IP/OP $222.00 $164.00 $43.97 $221.55 $99.70 $99.70 $99.70 $99.70 $221.55 $221.55 $221.55 $46.18 $221.55 $221.55 $221.55 $221.55 $221.55 $46.17 $221.55 $88.62 $131.05 $221.55 $221.55 $221.55 $221.55 $166.50 $221.55 $221.55 $221.55 $110.78 $110.78 $175.47 $221.55 $177.24 $99.70 $43.97 N/A $128.76 $221.55 $132.93 $221.55 $46.17 $221.55 N/A N/A 71131512 SUP HCPCS C1713 71131512 - PIN FX LG L/T 2MM 61MM 23MM TRL SS BOTH IP/OP $235.50 $174.00 $46.68 $235.20 $105.84 $105.84 $105.84 $105.84 $235.20 $235.20 $235.20 $49.02 $235.20 $235.20 $235.20 $235.20 $235.20 $49.02 $235.20 $94.08 $139.12 $235.20 $235.20 $235.20 $235.20 $176.63 $235.20 $235.20 $235.20 $117.60 $117.60 $186.28 $235.20 $188.16 $105.84 $46.68 N/A $136.59 $235.20 $235.20 $235.20 $49.02 $235.20 N/A N/A 71131604 SUP HCPCS C1713 71131604 - PLATE BN T 4 HL PRV FX LG FRAG SET BOTH IP/OP $340.50 $252.00 $67.52 $340.20 $153.09 $153.09 $153.09 $153.09 $340.20 $340.20 $340.20 $70.91 $340.20 $340.20 $340.20 $340.20 $340.20 $70.90 $340.20 $136.08 $201.23 $340.20 $340.20 $340.20 $340.20 $255.38 $340.20 $340.20 $340.20 $170.10 $170.10 $269.44 $340.20 $272.16 $153.09 $67.52 N/A $197.49 $340.20 $204.12 $340.20 $70.90 $340.20 N/A N/A 71131606 SUP HCPCS C1713 71131606 - PLATE BN T 6 HL PRV FX LG FRAG SET BOTH IP/OP $377.00 $279.00 $74.82 $376.95 $169.63 $169.63 $169.63 $169.63 $376.95 $376.95 $376.95 $78.57 $376.95 $376.95 $376.95 $376.95 $376.95 $78.56 $376.95 $150.78 $222.97 $376.95 $376.95 $376.95 $376.95 $282.75 $376.95 $376.95 $376.95 $188.48 $188.48 $298.54 $376.95 $301.56 $169.63 $74.82 N/A $218.66 $376.95 $226.17 $376.95 $78.56 $376.95 N/A N/A 71131608 SUP HCPCS C1713 71131608 - PLATE BN T 8 HL PRV FX LG FRAG SET BOTH IP/OP "$1,118.50" $828.00 $221.94 "$1,118.25" $503.21 $503.21 $503.21 $503.21 "$1,118.25" "$1,118.25" "$1,118.25" $233.07 "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" $233.06 "$1,118.25" $447.30 $661.44 "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" $838.88 "$1,118.25" "$1,118.25" "$1,118.25" $559.13 $559.13 $885.65 "$1,118.25" $894.60 $503.21 $221.94 N/A $648.73 "$1,118.25" "$1,118.25" "$1,118.25" $233.04 "$1,118.25" N/A N/A 71134016 SUP Custom 27203010 71134016 - BIT DRL 2MM TWST PED BOTH IP/OP $91.50 $68.00 $16.27 $91.40 $91.40 $91.40 $91.40 $91.40 $91.40 $91.40 $16.27 $91.40 $91.40 $67.84 $67.84 $70.45 $47.62 $19.05 $91.40 $36.56 $91.40 $91.40 $91.40 $91.40 $91.40 $68.63 $91.40 $91.40 $91.40 $45.70 $45.70 $72.39 $91.40 $73.12 $59.41 $91.40 N/A $53.07 $91.40 $54.84 $91.40 $91.40 $91.40 N/A N/A 71134064 SUP Custom 27203010 71134064 - BIT DRL 2.7MM TWST PED BOTH IP/OP $96.00 $71.00 $17.03 $95.70 $95.70 $95.70 $95.70 $95.70 $95.70 $95.70 $17.03 $95.70 $95.70 $71.03 $71.03 $73.77 $49.86 $19.94 $95.70 $38.28 $95.70 $95.70 $95.70 $95.70 $95.70 $72.00 $95.70 $95.70 $95.70 $47.85 $47.85 $75.79 $95.70 $76.56 $62.21 $95.70 N/A $55.68 $95.70 $57.42 $95.70 $95.70 $95.70 N/A N/A 71140003 SUP HCPCS C1713 71140003 - PLATE BN 45MM TC100 3 HL RECON SS PLVC 4.5MM SCR BOTH IP/OP $798.00 $591.00 $158.38 $798.00 $359.10 $359.10 $359.10 $359.10 $798.00 $798.00 $798.00 $166.32 $798.00 $798.00 $798.00 $798.00 $798.00 $166.31 $798.00 $319.20 $472.02 $798.00 $798.00 $798.00 $798.00 $598.50 $798.00 $798.00 $798.00 $399.00 $399.00 $632.02 $798.00 $638.40 $359.10 $158.38 N/A $462.84 $798.00 $478.80 $798.00 $798.00 $798.00 N/A N/A 71140004 SUP HCPCS C1713 71140004 - PLATE BN 61MM TC100 4 HL RECON SS PLVC 4.5MM SCR BOTH IP/OP $846.50 $626.00 $167.97 $846.30 $380.84 $380.84 $380.84 $380.84 $846.30 $846.30 $846.30 $176.39 $846.30 $846.30 $846.30 $846.30 $846.30 $176.38 $846.30 $338.52 $500.59 $846.30 $846.30 $846.30 $846.30 $634.88 $846.30 $846.30 $846.30 $423.15 $423.15 $670.27 $846.30 $677.04 $380.84 $167.97 N/A $490.97 $846.30 $507.78 $846.30 $176.37 $846.30 N/A N/A 71140005 SUP HCPCS C1713 71140005 - PLATE BN 77MM TC100 5 HL RECON SS PLVC 4.5MM SCR BOTH IP/OP $910.50 $674.00 $180.68 $910.35 $409.66 $409.66 $409.66 $409.66 $910.35 $910.35 $910.35 $189.74 $910.35 $910.35 $910.35 $910.35 $910.35 $189.73 $910.35 $364.14 $538.47 $910.35 $910.35 $910.35 $910.35 $682.88 $910.35 $910.35 $910.35 $455.18 $455.18 $721.00 $910.35 $728.28 $409.66 $180.68 N/A $528.09 $910.35 $546.21 $910.35 $189.72 $910.35 N/A N/A 71140006 SUP HCPCS C1713 71140006 - PLATE BN 93MM TC100 6 HL RECON SS PLVC 4.5MM SCR BOTH IP/OP $972.50 $720.00 $192.98 $972.30 $437.54 $437.54 $437.54 $437.54 $972.30 $972.30 $972.30 $202.65 $972.30 $972.30 $972.30 $972.30 $972.30 $202.64 $972.30 $388.92 $575.12 $972.30 $972.30 $972.30 $972.30 $729.38 $972.30 $972.30 $972.30 $486.15 $486.15 $770.06 $972.30 $777.84 $437.54 $192.98 N/A $564.05 $972.30 $583.38 $972.30 $202.63 $972.30 N/A N/A 71140007 SUP HCPCS C1713 71140007 - PLATE BN 109MM TC100 7 HL RECON SS PLVC 4.5MM SCR BOTH IP/OP "$1,026.00" $759.00 $203.61 "$1,025.85" $461.63 $461.63 $461.63 $461.63 "$1,025.85" "$1,025.85" "$1,025.85" $213.81 "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" $213.80 "$1,025.85" $410.34 $606.79 "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" $769.50 "$1,025.85" "$1,025.85" "$1,025.85" $512.93 $512.93 $812.47 "$1,025.85" $820.68 $461.63 $203.61 N/A $595.08 "$1,025.85" $615.51 "$1,025.85" $213.79 "$1,025.85" N/A N/A 71140008 SUP HCPCS C1713 71140008 - PLATE BN 125MM TC100 8 HL RECON SS PLVC 4.5MM SCR BOTH IP/OP "$1,302.00" $963.00 $258.41 "$1,302.00" $585.90 $585.90 $585.90 $585.90 "$1,302.00" "$1,302.00" "$1,302.00" $271.37 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $271.35 "$1,302.00" $520.80 $770.13 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $976.50 "$1,302.00" "$1,302.00" "$1,302.00" $651.00 $651.00 "$1,031.18" "$1,302.00" "$1,041.60" $585.90 $258.41 N/A $755.16 "$1,302.00" $781.20 "$1,302.00" "$1,302.00" "$1,302.00" N/A N/A 71140009 SUP HCPCS C1713 71140009 - PLATE BN 141MM TC100 9 HL RECON SS PLVC 4.5MM SCR BOTH IP/OP "$1,391.50" "$1,030.00" $276.13 "$1,391.25" $626.06 $626.06 $626.06 $626.06 "$1,391.25" "$1,391.25" "$1,391.25" $289.97 "$1,391.25" "$1,391.25" "$1,391.25" "$1,391.25" "$1,391.25" $289.95 "$1,391.25" $556.50 $822.92 "$1,391.25" "$1,391.25" "$1,391.25" "$1,391.25" "$1,043.63" "$1,391.25" "$1,391.25" "$1,391.25" $695.63 $695.63 "$1,101.87" "$1,391.25" "$1,113.00" $626.06 $276.13 N/A $807.07 "$1,391.25" "$1,391.25" "$1,391.25" "$1,391.25" "$1,391.25" N/A N/A 71140010 SUP HCPCS C1713 71140010 - PLATE BN 157MM TC100 10 HL RECON SS PLVC 4.5MM SCR BOTH IP/OP "$1,465.00" "$1,084.00" $290.72 "$1,464.75" $659.14 $659.14 $659.14 $659.14 "$1,464.75" "$1,464.75" "$1,464.75" $305.29 "$1,464.75" "$1,464.75" "$1,464.75" "$1,464.75" "$1,464.75" $305.27 "$1,464.75" "$1,464.75" $866.40 "$1,464.75" "$1,464.75" "$1,464.75" "$1,464.75" "$1,098.75" "$1,464.75" "$1,464.75" "$1,464.75" $732.38 $732.38 "$1,160.08" "$1,464.75" "$1,171.80" $659.14 $290.72 N/A $849.70 "$1,464.75" "$1,464.75" "$1,464.75" $305.25 "$1,464.75" N/A N/A 71140011 SUP HCPCS C1713 71140011 - PLATE BN 173MM TC100 11 HL RECON SS PLVC 4.5MM SCR BOTH IP/OP "$1,507.00" "$1,115.00" $299.05 "$1,506.75" $678.04 $678.04 $678.04 $678.04 "$1,506.75" "$1,506.75" "$1,506.75" $314.04 "$1,506.75" "$1,506.75" "$1,506.75" "$1,506.75" "$1,506.75" $314.02 "$1,506.75" $602.70 $891.24 "$1,506.75" "$1,506.75" "$1,506.75" "$1,506.75" "$1,130.25" "$1,506.75" "$1,506.75" "$1,506.75" $753.38 $753.38 "$1,193.35" "$1,506.75" "$1,205.40" $678.04 $299.05 N/A $874.06 "$1,506.75" $904.05 "$1,506.75" $314.01 "$1,506.75" N/A N/A 71140012 SUP HCPCS C1713 71140012 - PLATE BN 189MM TC100 12 HL RECON SS PLVC 4.5MM SCR BOTH IP/OP "$1,302.00" $963.00 $258.41 "$1,302.00" $585.90 $585.90 $585.90 $585.90 "$1,302.00" "$1,302.00" "$1,302.00" $271.37 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $271.35 "$1,302.00" $520.80 $770.13 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $976.50 "$1,302.00" "$1,302.00" "$1,302.00" $651.00 $651.00 "$1,031.18" "$1,302.00" "$1,041.60" $585.90 $258.41 N/A $755.16 "$1,302.00" $781.20 "$1,302.00" "$1,302.00" "$1,302.00" N/A N/A 71140013 SUP HCPCS C1713 71140013 - PLATE BN 205MM TC100 13 HL RECON SS PLVC 4.5MM SCR BOTH IP/OP "$1,701.00" "$1,259.00" $337.61 "$1,701.00" $765.45 $765.45 $765.45 $765.45 "$1,701.00" "$1,701.00" "$1,701.00" $354.53 "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" $354.51 "$1,701.00" "$1,701.00" "$1,006.14" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,275.75" "$1,701.00" "$1,701.00" "$1,701.00" $850.50 $850.50 "$1,347.19" "$1,701.00" "$1,360.80" $765.45 $337.61 N/A $986.58 "$1,701.00" "$1,020.60" "$1,701.00" $354.49 "$1,701.00" N/A N/A 71140014 SUP HCPCS C1713 71140014 - PLATE BN 221MM TC100 14 HL RECON SS PLVC 4.5MM SCR BOTH IP/OP "$1,423.00" "$1,053.00" $282.38 "$1,422.75" $640.24 $640.24 $640.24 $640.24 "$1,422.75" "$1,422.75" "$1,422.75" $296.54 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" $296.52 "$1,422.75" "$1,422.75" $841.56 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,067.25" "$1,422.75" "$1,422.75" "$1,422.75" $711.38 $711.38 "$1,126.82" "$1,422.75" "$1,138.20" $640.24 $282.38 N/A $825.34 "$1,422.75" $853.65 "$1,422.75" "$1,422.75" "$1,422.75" N/A N/A 71140015 SUP HCPCS C1713 71140015 - PLATE BN 237MM TC100 15 HL RECON SS PLVC 4.5MM SCR BOTH IP/OP "$1,806.00" "$1,336.00" $358.45 "$1,806.00" $812.70 $812.70 $812.70 $812.70 "$1,806.00" "$1,806.00" "$1,806.00" $376.42 "$1,806.00" "$1,806.00" "$1,806.00" "$1,806.00" "$1,806.00" $376.39 "$1,806.00" "$1,806.00" "$1,068.25" "$1,806.00" "$1,806.00" "$1,806.00" "$1,806.00" "$1,354.50" "$1,806.00" "$1,806.00" "$1,806.00" $903.00 $903.00 "$1,430.35" "$1,806.00" "$1,444.80" $812.70 $358.45 N/A "$1,047.48" "$1,806.00" "$1,083.60" "$1,806.00" "$1,806.00" "$1,806.00" N/A N/A 71140016 SUP HCPCS C1713 71140016 - PLATE BN 253MM TC100 16 HL RECON SS PLVC 4.5MM SCR BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" $747.60 "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,121.40" "$1,869.00" "$1,869.00" "$1,869.00" N/A N/A 71140104 SUP HCPCS C1713 71140104 - PLATE BN 46MM TC100 4 HL RECON SS PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP $876.00 $648.00 $173.80 $875.70 $394.07 $394.07 $394.07 $394.07 $875.70 $875.70 $875.70 $182.52 $875.70 $875.70 $875.70 $875.70 $875.70 $182.51 $875.70 $350.28 $517.98 $875.70 $875.70 $875.70 $875.70 $657.00 $875.70 $875.70 $875.70 $437.85 $437.85 $693.55 $875.70 $700.56 $394.07 $173.80 N/A $508.08 $875.70 $525.42 $875.70 $182.50 $875.70 N/A N/A 71140105 SUP HCPCS C1713 71140105 - PLATE BN 58MM TC100 5 HL RECON SS PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP $813.00 $602.00 $161.30 $812.70 $365.72 $365.72 $365.72 $365.72 $812.70 $812.70 $812.70 $169.39 $812.70 $812.70 $812.70 $812.70 $812.70 $169.38 $812.70 $325.08 $480.71 $812.70 $812.70 $812.70 $812.70 $609.75 $812.70 $812.70 $812.70 $406.35 $406.35 $643.66 $812.70 $650.16 $365.72 $161.30 N/A $471.54 $812.70 $487.62 $812.70 $169.37 $812.70 N/A N/A 71140106 SUP HCPCS C1713 71140106 - PLATE BN 70MM TC100 6 HL RECON SS PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP "$1,023.00" $757.00 $202.98 "$1,022.70" $460.22 $460.22 $460.22 $460.22 "$1,022.70" "$1,022.70" "$1,022.70" $213.16 "$1,022.70" "$1,022.70" "$1,022.70" "$1,022.70" "$1,022.70" $213.14 "$1,022.70" $409.08 $604.93 "$1,022.70" "$1,022.70" "$1,022.70" "$1,022.70" $767.25 "$1,022.70" "$1,022.70" "$1,022.70" $511.35 $511.35 $809.98 "$1,022.70" $818.16 $460.22 $202.98 N/A $593.34 "$1,022.70" $613.62 "$1,022.70" $213.13 "$1,022.70" N/A N/A 71140107 SUP HCPCS C1713 71140107 - PLATE BN 82MM TC100 7 HL RECON SS PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP $974.50 $721.00 $193.39 $974.40 $438.48 $438.48 $438.48 $438.48 $974.40 $974.40 $974.40 $203.09 $974.40 $974.40 $974.40 $974.40 $974.40 $203.08 $974.40 $389.76 $576.36 $974.40 $974.40 $974.40 $974.40 $730.88 $974.40 $974.40 $974.40 $487.20 $487.20 $771.72 $974.40 $779.52 $438.48 $193.39 N/A $565.21 $974.40 $974.40 $974.40 $203.06 $974.40 N/A N/A 71140108 SUP HCPCS C1713 71140108 - PLATE BN 94MM TC100 8 HL RECON SS PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP "$1,118.50" $828.00 $221.94 "$1,118.25" $503.21 $503.21 $503.21 $503.21 "$1,118.25" "$1,118.25" "$1,118.25" $233.07 "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" $233.06 "$1,118.25" "$1,118.25" $661.44 "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" $838.88 "$1,118.25" "$1,118.25" "$1,118.25" $559.13 $559.13 $885.65 "$1,118.25" $894.60 $503.21 $221.94 N/A $648.73 "$1,118.25" $670.95 "$1,118.25" "$1,118.25" "$1,118.25" N/A N/A 71140109 SUP HCPCS C1713 71140109 - PLATE BN 106MM TC100 9 HL RECON SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP "$1,050.00" $777.00 $208.40 "$1,050.00" $472.50 $472.50 $472.50 $472.50 "$1,050.00" "$1,050.00" "$1,050.00" $218.85 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $218.83 "$1,050.00" $420.00 $621.08 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $787.50 "$1,050.00" "$1,050.00" "$1,050.00" $525.00 $525.00 $831.60 "$1,050.00" $840.00 $472.50 $208.40 N/A $609.00 "$1,050.00" $630.00 "$1,050.00" "$1,050.00" "$1,050.00" N/A N/A 71140110 SUP HCPCS C1713 71140110 - PLATE BN 118MM TC100 10 HL RECON SS PLVC 3.5MM SCR BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" $459.90 $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" $689.85 "$1,149.75" "$1,149.75" "$1,149.75" N/A N/A 71140111 SUP HCPCS C1713 71140111 - PLATE BN 130MM TC100 11 HL RECON SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP "$1,118.50" $828.00 $221.94 "$1,118.25" $503.21 $503.21 $503.21 $503.21 "$1,118.25" "$1,118.25" "$1,118.25" $233.07 "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" $233.06 "$1,118.25" "$1,118.25" $661.44 "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" $838.88 "$1,118.25" "$1,118.25" "$1,118.25" $559.13 $559.13 $885.65 "$1,118.25" $894.60 $503.21 $221.94 N/A $648.73 "$1,118.25" $670.95 "$1,118.25" $233.04 "$1,118.25" N/A N/A 71140112 SUP HCPCS C1713 71140112 - PLATE BN 142MM TC100 12 HL RECON SS PLVC 3.5MM SCR BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" "$1,260.00" $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" "$1,260.00" "$1,260.00" N/A N/A 71140113 SUP HCPCS C1713 71140113 - PLATE BN 154MM TC100 13 HL RECON SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP "$1,496.50" "$1,107.00" $296.97 "$1,496.25" $673.31 $673.31 $673.31 $673.31 "$1,496.25" "$1,496.25" "$1,496.25" $311.86 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" $311.83 "$1,496.25" "$1,496.25" $885.03 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,122.38" "$1,496.25" "$1,496.25" "$1,496.25" $748.13 $748.13 "$1,185.03" "$1,496.25" "$1,197.00" $673.31 $296.97 N/A $867.97 "$1,496.25" $897.75 "$1,496.25" "$1,496.25" "$1,496.25" N/A N/A 71140114 SUP HCPCS C1713 71140114 - PLATE BN 166MM TC100 14 HL RECON SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP "$1,381.00" "$1,022.00" $274.04 "$1,380.75" $621.34 $621.34 $621.34 $621.34 "$1,380.75" "$1,380.75" "$1,380.75" $287.78 "$1,380.75" "$1,380.75" "$1,380.75" "$1,380.75" "$1,380.75" $287.76 "$1,380.75" $552.30 $816.71 "$1,380.75" "$1,380.75" "$1,380.75" "$1,380.75" "$1,035.75" "$1,380.75" "$1,380.75" "$1,380.75" $690.38 $690.38 "$1,093.55" "$1,380.75" "$1,104.60" $621.34 $274.04 N/A $800.98 "$1,380.75" $828.45 "$1,380.75" $287.75 "$1,380.75" N/A N/A 71140115 SUP HCPCS C1713 71140115 - PLATE BN 178MM TC100 15 HL RECON SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP "$1,648.50" "$1,220.00" $327.19 "$1,648.50" $741.83 $741.83 $741.83 $741.83 "$1,648.50" "$1,648.50" "$1,648.50" $343.59 "$1,648.50" "$1,648.50" "$1,648.50" "$1,648.50" "$1,648.50" $343.57 "$1,648.50" $659.40 $975.09 "$1,648.50" "$1,648.50" "$1,648.50" "$1,648.50" "$1,236.38" "$1,648.50" "$1,648.50" "$1,648.50" $824.25 $824.25 "$1,305.61" "$1,648.50" "$1,318.80" $741.83 $327.19 N/A $956.13 "$1,648.50" $989.10 "$1,648.50" $343.55 "$1,648.50" N/A N/A 71140116 SUP HCPCS C1713 71140116 - PLATE BN 190MM TC100 16 HL RECON SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP "$1,407.00" "$1,041.00" $279.25 "$1,407.00" $633.15 $633.15 $633.15 $633.15 "$1,407.00" "$1,407.00" "$1,407.00" $293.25 "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" $293.23 "$1,407.00" $562.80 $832.24 "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" "$1,055.25" "$1,407.00" "$1,407.00" "$1,407.00" $703.50 $703.50 "$1,114.34" "$1,407.00" "$1,125.60" $633.15 $279.25 N/A $816.06 "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" N/A N/A 71140118 SUP HCPCS C1713 71140118 - PLATE BN 214MM TC100 18 HL RECON SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP "$1,480.50" "$1,096.00" $293.84 "$1,480.50" $666.23 $666.23 $666.23 $666.23 "$1,480.50" "$1,480.50" "$1,480.50" $308.57 "$1,480.50" "$1,480.50" "$1,480.50" "$1,480.50" "$1,480.50" $308.55 "$1,480.50" "$1,480.50" $875.72 "$1,480.50" "$1,480.50" "$1,480.50" "$1,480.50" "$1,110.38" "$1,480.50" "$1,480.50" "$1,480.50" $740.25 $740.25 "$1,172.56" "$1,480.50" "$1,184.40" $666.23 $293.84 N/A $858.69 "$1,480.50" $888.30 "$1,480.50" "$1,480.50" "$1,480.50" N/A N/A 71140120 SUP HCPCS C1713 71140120 - PLATE BN 238MM TC100 20 HL RECON SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP "$1,801.00" "$1,333.00" $357.40 "$1,800.75" $810.34 $810.34 $810.34 $810.34 "$1,800.75" "$1,800.75" "$1,800.75" $375.32 "$1,800.75" "$1,800.75" "$1,800.75" "$1,800.75" "$1,800.75" $375.30 "$1,800.75" "$1,800.75" "$1,065.14" "$1,800.75" "$1,800.75" "$1,800.75" "$1,800.75" "$1,350.75" "$1,800.75" "$1,800.75" "$1,800.75" $900.38 $900.38 "$1,426.19" "$1,800.75" "$1,440.60" $810.34 $357.40 N/A "$1,044.58" "$1,800.75" "$1,080.45" "$1,800.75" $375.28 "$1,800.75" N/A N/A 71140122 SUP HCPCS C1713 71140122 - PLATE BN 263MM TC100 22 HL RECON SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP "$2,284.00" "$1,690.00" $453.27 "$2,283.75" "$1,027.69" "$1,027.69" "$1,027.69" "$1,027.69" "$2,283.75" "$2,283.75" "$2,283.75" $475.99 "$2,283.75" "$2,283.75" "$2,283.75" "$2,283.75" "$2,283.75" $475.96 "$2,283.75" "$2,283.75" "$1,350.84" "$2,283.75" "$2,283.75" "$2,283.75" "$2,283.75" "$1,713.00" "$2,283.75" "$2,283.75" "$2,283.75" "$1,141.88" "$1,141.88" "$1,808.73" "$2,283.75" "$1,827.00" "$1,027.69" $453.27 N/A "$1,324.72" "$2,283.75" "$1,370.25" "$2,283.75" $475.93 "$2,283.75" N/A N/A 71140202 SUP HCPCS C1713 71140202 - PLATE BN 25MM TC100 2 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP $296.50 $219.00 $58.77 $296.10 $133.25 $133.25 $133.25 $133.25 $296.10 $296.10 $296.10 $61.71 $296.10 $296.10 $296.10 $296.10 $296.10 $61.71 $296.10 $296.10 $175.14 $296.10 $296.10 $296.10 $296.10 $222.38 $296.10 $296.10 $296.10 $148.05 $148.05 $234.51 $296.10 $236.88 $133.25 $58.77 N/A $171.97 $296.10 $177.66 $296.10 $61.71 $296.10 N/A N/A 71140203 SUP HCPCS C1713 71140203 - PLATE BN 37MM TC100 3 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP $310.00 $229.00 $61.48 $309.75 $139.39 $139.39 $139.39 $139.39 $309.75 $309.75 $309.75 $64.56 $309.75 $309.75 $309.75 $309.75 $309.75 $64.56 $309.75 $309.75 $183.22 $309.75 $309.75 $309.75 $309.75 $232.50 $309.75 $309.75 $309.75 $154.88 $154.88 $245.32 $309.75 $247.80 $139.39 $61.48 N/A $179.80 $309.75 $185.85 $309.75 $64.55 $309.75 N/A N/A 71140204 SUP HCPCS C1713 71140204 - PLATE BN 49MM TC100 4 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP $316.50 $234.00 $62.73 $316.05 $142.22 $142.22 $142.22 $142.22 $316.05 $316.05 $316.05 $65.87 $316.05 $316.05 $316.05 $316.05 $316.05 $65.87 $316.05 $316.05 $186.94 $316.05 $316.05 $316.05 $316.05 $237.38 $316.05 $316.05 $316.05 $158.03 $158.03 $250.31 $316.05 $252.84 $142.22 $62.73 N/A $183.57 $316.05 $316.05 $316.05 $65.86 $316.05 N/A N/A 71140205 SUP HCPCS C1713 71140205 - PLATE BN 61MM TC100 5 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP $345.50 $256.00 $68.56 $345.45 $155.45 $155.45 $155.45 $155.45 $345.45 $345.45 $345.45 $72.00 $345.45 $345.45 $345.45 $345.45 $345.45 $72.00 $345.45 $345.45 $204.33 $345.45 $345.45 $345.45 $345.45 $259.13 $345.45 $345.45 $345.45 $172.73 $172.73 $273.60 $345.45 $276.36 $155.45 $68.56 N/A $200.39 $345.45 $207.27 $345.45 $71.99 $345.45 N/A N/A 71140206 SUP HCPCS C1713 71140206 - PLATE BN 73MM TC100 6 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP $361.50 $268.00 $71.69 $361.20 $162.54 $162.54 $162.54 $162.54 $361.20 $361.20 $361.20 $75.28 $361.20 $361.20 $361.20 $361.20 $361.20 $75.28 $361.20 $361.20 $213.65 $361.20 $361.20 $361.20 $361.20 $271.13 $361.20 $361.20 $361.20 $180.60 $180.60 $286.07 $361.20 $288.96 $162.54 $71.69 N/A $209.67 $361.20 $216.72 $361.20 $75.27 $361.20 N/A N/A 71140207 SUP HCPCS C1713 71140207 - PLATE BN 85MM TC100 7 HL CMPR SS PLVC 3.5MM SCR BOTH IP/OP $378.00 $280.00 $75.02 $378.00 $170.10 $170.10 $170.10 $170.10 $378.00 $378.00 $378.00 $78.78 $378.00 $378.00 $378.00 $378.00 $378.00 $78.78 $378.00 $378.00 $223.59 $378.00 $378.00 $378.00 $378.00 $283.50 $378.00 $378.00 $378.00 $189.00 $189.00 $299.38 $378.00 $302.40 $170.10 $75.02 N/A $219.24 $378.00 $226.80 $378.00 $378.00 $378.00 N/A N/A 71140208 SUP HCPCS C1713 71140208 - PLATE BN 97MM 8 HL HIP 3.5MM SCR SM FRAG SET BOTH IP/OP $405.50 $300.00 $80.44 $405.30 $182.39 $182.39 $182.39 $182.39 $405.30 $405.30 $405.30 $84.47 $405.30 $405.30 $405.30 $405.30 $405.30 $84.47 $405.30 $405.30 $239.73 $405.30 $405.30 $405.30 $405.30 $304.13 $405.30 $405.30 $405.30 $202.65 $202.65 $321.00 $405.30 $324.24 $182.39 $80.44 N/A $235.19 $405.30 $243.18 $405.30 $405.30 $405.30 N/A N/A 71140209 SUP HCPCS C1713 71140209 - PLATE BN 109MM TC100 9 HL CMPR SS PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP $415.00 $307.00 $82.32 $414.75 $186.64 $186.64 $186.64 $186.64 $414.75 $414.75 $414.75 $86.44 $414.75 $414.75 $414.75 $414.75 $414.75 $86.44 $414.75 $165.90 $245.32 $414.75 $414.75 $414.75 $414.75 $311.25 $414.75 $414.75 $414.75 $207.38 $207.38 $328.48 $414.75 $331.80 $186.64 $82.32 N/A $240.70 $414.75 $248.85 $414.75 $86.43 $414.75 N/A N/A 71140210 SUP HCPCS C1713 71140210 - PLATE BN 121MM TC100 10 HL CMPR SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP $426.50 $316.00 $84.61 $426.30 $191.84 $191.84 $191.84 $191.84 $426.30 $426.30 $426.30 $88.85 $426.30 $426.30 $426.30 $426.30 $426.30 $88.85 $426.30 $170.52 $252.16 $426.30 $426.30 $426.30 $426.30 $319.88 $426.30 $426.30 $426.30 $213.15 $213.15 $337.63 $426.30 $341.04 $191.84 $84.61 N/A $247.37 $426.30 $255.78 $426.30 $88.84 $426.30 N/A N/A 71140212 SUP HCPCS C1713 71140212 - PLATE BN 145MM TC100 12 HL CMPR SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP $474.00 $351.00 $93.99 $473.55 $213.10 $213.10 $213.10 $213.10 $473.55 $473.55 $473.55 $98.70 $473.55 $473.55 $473.55 $473.55 $473.55 $98.69 $473.55 $189.42 $280.10 $473.55 $473.55 $473.55 $473.55 $355.50 $473.55 $473.55 $473.55 $236.78 $236.78 $375.05 $473.55 $378.84 $213.10 $93.99 N/A $274.92 $473.55 $284.13 $473.55 $98.69 $473.55 N/A N/A 71140214 SUP HCPCS C1713 71140214 - PLATE BN 169MM TC100 14 HL CMPR SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP $889.50 $658.00 $176.51 $889.35 $400.21 $400.21 $400.21 $400.21 $889.35 $889.35 $889.35 $185.36 $889.35 $889.35 $889.35 $889.35 $889.35 $185.35 $889.35 $355.74 $526.05 $889.35 $889.35 $889.35 $889.35 $667.13 $889.35 $889.35 $889.35 $444.68 $444.68 $704.37 $889.35 $711.48 $400.21 $176.51 N/A $515.91 $889.35 $889.35 $889.35 $185.34 $889.35 N/A N/A 71140216 SUP HCPCS C1713 71140216 - PLATE BN 194MM TC100 16 HL CMPR SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP "$1,026.00" $759.00 $203.61 "$1,025.85" $461.63 $461.63 $461.63 $461.63 "$1,025.85" "$1,025.85" "$1,025.85" $213.81 "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" $213.80 "$1,025.85" "$1,025.85" $606.79 "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" $769.50 "$1,025.85" "$1,025.85" "$1,025.85" $512.93 $512.93 $812.47 "$1,025.85" $820.68 $461.63 $203.61 N/A $595.08 "$1,025.85" $615.51 "$1,025.85" $213.79 "$1,025.85" N/A N/A 71140218 SUP HCPCS C1713 71140218 - PLATE BN 217MM TC100 18 HL CMPR SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP "$1,381.00" "$1,022.00" $274.04 "$1,380.75" $621.34 $621.34 $621.34 $621.34 "$1,380.75" "$1,380.75" "$1,380.75" $287.78 "$1,380.75" "$1,380.75" "$1,380.75" "$1,380.75" "$1,380.75" $287.76 "$1,380.75" $552.30 $816.71 "$1,380.75" "$1,380.75" "$1,380.75" "$1,380.75" "$1,035.75" "$1,380.75" "$1,380.75" "$1,380.75" $690.38 $690.38 "$1,093.55" "$1,380.75" "$1,104.60" $621.34 $274.04 N/A $800.98 "$1,380.75" $828.45 "$1,380.75" $287.75 "$1,380.75" N/A N/A 71140220 SUP HCPCS C1713 71140220 - PLATE BN 242MM TC100 20 HL CMPR SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP "$1,270.50" $940.00 $252.16 "$1,270.50" $571.73 $571.73 $571.73 $571.73 "$1,270.50" "$1,270.50" "$1,270.50" $264.80 "$1,270.50" "$1,270.50" "$1,270.50" "$1,270.50" "$1,270.50" $264.79 "$1,270.50" "$1,270.50" $751.50 "$1,270.50" "$1,270.50" "$1,270.50" "$1,270.50" $952.88 "$1,270.50" "$1,270.50" "$1,270.50" $635.25 $635.25 "$1,006.24" "$1,270.50" "$1,016.40" $571.73 $252.16 N/A $736.89 "$1,270.50" $762.30 "$1,270.50" $264.77 "$1,270.50" N/A N/A 71140222 SUP HCPCS C1713 71140222 - PLATE BN 265MM TC100 22 HL CMPR SS PLVC 3.5MM SCR SM FRAG BOTH IP/OP "$1,701.00" "$1,259.00" $337.61 "$1,701.00" $765.45 $765.45 $765.45 $765.45 "$1,701.00" "$1,701.00" "$1,701.00" $354.53 "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" $354.51 "$1,701.00" "$1,701.00" "$1,006.14" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,275.75" "$1,701.00" "$1,701.00" "$1,701.00" $850.50 $850.50 "$1,347.19" "$1,701.00" "$1,360.80" $765.45 $337.61 N/A $986.58 "$1,701.00" "$1,020.60" "$1,701.00" "$1,701.00" "$1,701.00" N/A N/A 71140302 SUP HCPCS C1713 71140302 - PLATE BN 25MM TC100 2 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM BOTH IP/OP $169.50 $125.00 $33.55 $169.05 $76.07 $76.07 $76.07 $76.07 $169.05 $169.05 $169.05 $35.23 $169.05 $169.05 $169.05 $169.05 $169.05 $35.23 $169.05 $169.05 $99.99 $169.05 $169.05 $169.05 $169.05 $127.13 $169.05 $169.05 $169.05 $84.53 $84.53 $133.89 $169.05 $135.24 $76.07 $33.55 N/A $98.31 $169.05 $169.05 $169.05 $169.05 $169.05 N/A N/A 71140303 SUP HCPCS C1713 71140303 - PLATE BN 37MM TC100 3 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM BOTH IP/OP $144.00 $107.00 $28.55 $143.85 $64.73 $64.73 $64.73 $64.73 $143.85 $143.85 $143.85 $29.98 $143.85 $143.85 $143.85 $143.85 $143.85 $29.98 $143.85 $143.85 $85.09 $143.85 $143.85 $143.85 $143.85 $108.00 $143.85 $143.85 $143.85 $71.93 $71.93 $113.93 $143.85 $115.08 $64.73 $28.55 N/A $83.52 $143.85 $143.85 $143.85 $29.98 $143.85 N/A N/A 71140304 SUP HCPCS C1713 71140304 - PLATE BN 49MM TC100 4 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM BOTH IP/OP $169.50 $125.00 $33.55 $169.05 $76.07 $76.07 $76.07 $76.07 $169.05 $169.05 $169.05 $35.23 $169.05 $169.05 $169.05 $169.05 $169.05 $35.23 $169.05 $67.62 $99.99 $169.05 $169.05 $169.05 $169.05 $127.13 $169.05 $169.05 $169.05 $84.53 $84.53 $133.89 $169.05 $135.24 $76.07 $33.55 N/A $98.31 $169.05 $169.05 $169.05 $169.05 $169.05 N/A N/A 71140305 SUP HCPCS C1713 71140305 - PLATE BN 61MM TC100 5 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM BOTH IP/OP $211.50 $157.00 $41.89 $211.05 $94.97 $94.97 $94.97 $94.97 $211.05 $211.05 $211.05 $43.99 $211.05 $211.05 $211.05 $211.05 $211.05 $43.99 $211.05 $84.42 $124.84 $211.05 $211.05 $211.05 $211.05 $158.63 $211.05 $211.05 $211.05 $105.53 $105.53 $167.15 $211.05 $168.84 $94.97 $41.89 N/A $122.67 $211.05 $211.05 $211.05 $211.05 $211.05 N/A N/A 71140306 SUP HCPCS C1713 71140306 - PLATE BN 73MM TC100 6 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM BOTH IP/OP $175.50 $130.00 $34.80 $175.35 $78.91 $78.91 $78.91 $78.91 $175.35 $175.35 $175.35 $36.55 $175.35 $175.35 $175.35 $175.35 $175.35 $36.54 $175.35 $70.14 $103.72 $175.35 $175.35 $175.35 $175.35 $131.63 $175.35 $175.35 $175.35 $87.68 $87.68 $138.88 $175.35 $140.28 $78.91 $34.80 N/A $101.79 $175.35 $175.35 $175.35 $175.35 $175.35 N/A N/A 71140307 SUP HCPCS C1713 71140307 - PLATE BN 1/3 TBLR 85MM NS TC100 7 HL COLR SS PLVC 3.5MM SCR BOTH IP/OP $175.50 $130.00 $34.80 $175.35 $78.91 $78.91 $78.91 $78.91 $175.35 $175.35 $175.35 $36.55 $175.35 $175.35 $175.35 $175.35 $175.35 $36.54 $175.35 $70.14 $103.72 $175.35 $175.35 $175.35 $175.35 $131.63 $175.35 $175.35 $175.35 $87.68 $87.68 $138.88 $175.35 $140.28 $78.91 $34.80 N/A $101.79 $175.35 $175.35 $175.35 $36.54 $175.35 N/A N/A 71140308 SUP HCPCS C1713 71140308 - PLATE BN 97MM TC100 8 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM BOTH IP/OP $177.50 $131.00 $35.22 $177.45 $79.85 $79.85 $79.85 $79.85 $177.45 $177.45 $177.45 $36.99 $177.45 $177.45 $177.45 $177.45 $177.45 $36.98 $177.45 $70.98 $104.96 $177.45 $177.45 $177.45 $177.45 $133.13 $177.45 $177.45 $177.45 $88.73 $88.73 $140.54 $177.45 $141.96 $79.85 $35.22 N/A $102.95 $177.45 $177.45 $177.45 $36.98 $177.45 N/A N/A 71140309 SUP HCPCS C1713 71140309 - PLATE BN 109MM TC100 9 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR SM BOTH IP/OP $177.50 $131.00 $35.22 $177.45 $79.85 $79.85 $79.85 $79.85 $177.45 $177.45 $177.45 $36.99 $177.45 $177.45 $177.45 $177.45 $177.45 $36.98 $177.45 $70.98 $104.96 $177.45 $177.45 $177.45 $177.45 $133.13 $177.45 $177.45 $177.45 $88.73 $88.73 $140.54 $177.45 $141.96 $79.85 $35.22 N/A $102.95 $177.45 $177.45 $177.45 $36.98 $177.45 N/A N/A 71140310 SUP HCPCS C1713 71140310 - PLATE BN 121MM TC100 10 HL 1/3 TBLR COLR SS PLVC 3.5MM SCR BOTH IP/OP $177.50 $131.00 $35.22 $177.45 $79.85 $79.85 $79.85 $79.85 $177.45 $177.45 $177.45 $36.99 $177.45 $177.45 $177.45 $177.45 $177.45 $36.98 $177.45 $70.98 $104.96 $177.45 $177.45 $177.45 $177.45 $133.13 $177.45 $177.45 $177.45 $88.73 $88.73 $140.54 $177.45 $141.96 $79.85 $35.22 N/A $102.95 $177.45 $177.45 $177.45 $36.98 $177.45 N/A N/A 71140312 SUP HCPCS C1713 71140312 - PLATE BN 145MM TC100 12 HL 1/3 TBLR COLR SS ORTH SM FRAG SET BOTH IP/OP $182.00 $135.00 $36.05 $181.65 $81.74 $81.74 $81.74 $81.74 $181.65 $181.65 $181.65 $37.86 $181.65 $181.65 $181.65 $181.65 $181.65 $37.86 $181.65 $72.66 $107.45 $181.65 $181.65 $181.65 $181.65 $136.50 $181.65 $181.65 $181.65 $90.83 $90.83 $143.87 $181.65 $145.32 $81.74 $36.05 N/A $105.56 $181.65 $181.65 $181.65 $37.86 $181.65 N/A N/A 71140403 SUP HCPCS C1713 71140403 - PLATE BN SM T RT ANG 50MM TC100 3X3 HL SS PLVC SM FRAG SET BOTH IP/OP $314.00 $232.00 $62.31 $313.95 $141.28 $141.28 $141.28 $141.28 $313.95 $313.95 $313.95 $65.44 $313.95 $313.95 $313.95 $313.95 $313.95 $65.43 $313.95 $313.95 $185.70 $313.95 $313.95 $313.95 $313.95 $235.50 $313.95 $313.95 $313.95 $156.98 $156.98 $248.65 $313.95 $251.16 $141.28 $62.31 N/A $182.12 $313.95 $313.95 $313.95 $65.43 $313.95 N/A N/A 71140404 SUP HCPCS C1713 71140404 - PLATE BN SM T RT ANG 50MM TC100 4X4 HL SS PLVC SM FRAG SET BOTH IP/OP $320.50 $237.00 $63.56 $320.25 $144.11 $144.11 $144.11 $144.11 $320.25 $320.25 $320.25 $66.75 $320.25 $320.25 $320.25 $320.25 $320.25 $66.74 $320.25 $320.25 $189.43 $320.25 $320.25 $320.25 $320.25 $240.38 $320.25 $320.25 $320.25 $160.13 $160.13 $253.64 $320.25 $256.20 $144.11 $63.56 N/A $185.89 $320.25 $320.25 $320.25 $66.74 $320.25 N/A N/A 71140405 SUP HCPCS C1713 71140405 - PLATE BN SM T RT ANG 50MM TC100 3X5 HL SS PLVC SM FRAG SET BOTH IP/OP $360.50 $267.00 $71.48 $360.15 $162.07 $162.07 $162.07 $162.07 $360.15 $360.15 $360.15 $75.06 $360.15 $360.15 $360.15 $360.15 $360.15 $75.06 $360.15 $360.15 $213.03 $360.15 $360.15 $360.15 $360.15 $270.38 $360.15 $360.15 $360.15 $180.08 $180.08 $285.24 $360.15 $288.12 $162.07 $71.48 N/A $209.09 $360.15 $360.15 $360.15 $360.15 $360.15 N/A N/A 71140406 SUP HCPCS C1713 71140406 - PLATE BN 78MM TC100 4 HLE/HD 6 HL SHFT T RT ANG SS ORTH SM BOTH IP/OP $415.00 $307.00 $82.32 $414.75 $186.64 $186.64 $186.64 $186.64 $414.75 $414.75 $414.75 $86.44 $414.75 $414.75 $414.75 $414.75 $414.75 $86.44 $414.75 $414.75 $245.32 $414.75 $414.75 $414.75 $414.75 $311.25 $414.75 $414.75 $414.75 $207.38 $207.38 $328.48 $414.75 $331.80 $186.64 $82.32 N/A $240.70 $414.75 $414.75 $414.75 $414.75 $414.75 N/A N/A 71140503 SUP HCPCS C1713 71140503 - PLATE BN SM T OBLQ 53MM TC100 3X3 HL SS PLVC SM FRAG SET BOTH IP/OP $564.00 $417.00 $111.91 $563.85 $253.73 $253.73 $253.73 $253.73 $563.85 $563.85 $563.85 $117.52 $563.85 $563.85 $563.85 $563.85 $563.85 $117.51 $563.85 $563.85 $333.52 $563.85 $563.85 $563.85 $563.85 $423.00 $563.85 $563.85 $563.85 $281.93 $281.93 $446.57 $563.85 $451.08 $253.73 $111.91 N/A $327.12 $563.85 $563.85 $563.85 $117.51 $563.85 N/A N/A 71140504 SUP HCPCS C1713 71140504 - PLATE BN SM T OBLQ 53MM TC100 3X4 HL SS PLVC SM FRAG SET BOTH IP/OP $588.00 $435.00 $116.70 $588.00 $264.60 $264.60 $264.60 $264.60 $588.00 $588.00 $588.00 $122.55 $588.00 $588.00 $588.00 $588.00 $588.00 $122.55 $588.00 $588.00 $347.80 $588.00 $588.00 $588.00 $588.00 $441.00 $588.00 $588.00 $588.00 $294.00 $294.00 $465.70 $588.00 $470.40 $264.60 $116.70 N/A $341.04 $588.00 $588.00 $588.00 $588.00 $588.00 N/A N/A 71140505 SUP HCPCS C1713 71140505 - PLATE BN SM T OBLQ 53MM TC100 3X5 HL SS PLVC SM FRAG SET BOTH IP/OP $609.00 $451.00 $120.87 $609.00 $274.05 $274.05 $274.05 $274.05 $609.00 $609.00 $609.00 $126.93 $609.00 $609.00 $609.00 $609.00 $609.00 $126.92 $609.00 $609.00 $360.22 $609.00 $609.00 $609.00 $609.00 $456.75 $609.00 $609.00 $609.00 $304.50 $304.50 $482.33 $609.00 $487.20 $274.05 $120.87 N/A $353.22 $609.00 $609.00 $609.00 $126.92 $609.00 N/A N/A 71140603 SUP HCPCS C1713 71140603 - PLATE BN 88MM TC100 3 HL CLVRLF SS ORTH SM FRAG SET BOTH IP/OP $744.50 $551.00 $147.75 $744.45 $335.00 $335.00 $335.00 $335.00 $744.45 $744.45 $744.45 $155.16 $744.45 $744.45 $744.45 $744.45 $744.45 $155.15 $744.45 $297.78 $440.34 $744.45 $744.45 $744.45 $744.45 $558.38 $744.45 $744.45 $744.45 $372.23 $372.23 $589.60 $744.45 $595.56 $335.00 $147.75 N/A $431.81 $744.45 $744.45 $744.45 $744.45 $744.45 N/A N/A 71140604 SUP HCPCS C1713 71140604 - PLATE BN 104MM TC100 4 HL CLVRLF SS ORTH SM FRAG SET BOTH IP/OP $798.00 $591.00 $158.38 $798.00 $359.10 $359.10 $359.10 $359.10 $798.00 $798.00 $798.00 $166.32 $798.00 $798.00 $798.00 $798.00 $798.00 $166.31 $798.00 $319.20 $472.02 $798.00 $798.00 $798.00 $798.00 $598.50 $798.00 $798.00 $798.00 $399.00 $399.00 $632.02 $798.00 $638.40 $359.10 $158.38 N/A $462.84 $798.00 $478.80 $798.00 $798.00 $798.00 N/A N/A 71140606 SUP HCPCS C1713 71140606 - PLATE BN 70MM TC100 6 HL CRV RECON SS PLVC 3.5MM SCR BOTH IP/OP "$1,039.50" $769.00 $206.31 "$1,039.50" $467.78 $467.78 $467.78 $467.78 "$1,039.50" "$1,039.50" "$1,039.50" $216.66 "$1,039.50" "$1,039.50" "$1,039.50" "$1,039.50" "$1,039.50" $216.64 "$1,039.50" $415.80 $614.86 "$1,039.50" "$1,039.50" "$1,039.50" "$1,039.50" $779.63 "$1,039.50" "$1,039.50" "$1,039.50" $519.75 $519.75 $823.28 "$1,039.50" $831.60 $467.78 $206.31 N/A $602.91 "$1,039.50" $623.70 "$1,039.50" $216.63 "$1,039.50" N/A N/A 71140608 SUP HCPCS C1713 71140608 - PLATE BN 94MM TC100 8 HL CRV RECON SS PLVC 3.5MM SCR BOTH IP/OP "$1,134.00" $839.00 $225.07 "$1,134.00" $510.30 $510.30 $510.30 $510.30 "$1,134.00" "$1,134.00" "$1,134.00" $236.35 "$1,134.00" "$1,134.00" "$1,134.00" "$1,134.00" "$1,134.00" $236.34 "$1,134.00" "$1,134.00" $670.76 "$1,134.00" "$1,134.00" "$1,134.00" "$1,134.00" $850.50 "$1,134.00" "$1,134.00" "$1,134.00" $567.00 $567.00 $898.13 "$1,134.00" $907.20 $510.30 $225.07 N/A $657.72 "$1,134.00" $680.40 "$1,134.00" "$1,134.00" "$1,134.00" N/A N/A 71140610 SUP HCPCS C1713 71140610 - PLATE BN 118MM TC100 10 HL CRV RECON SS PLVC 3.5MM SCR BOTH IP/OP "$1,186.50" $878.00 $235.49 "$1,186.50" $533.93 $533.93 $533.93 $533.93 "$1,186.50" "$1,186.50" "$1,186.50" $247.30 "$1,186.50" "$1,186.50" "$1,186.50" "$1,186.50" "$1,186.50" $247.28 "$1,186.50" $474.60 $701.81 "$1,186.50" "$1,186.50" "$1,186.50" "$1,186.50" $889.88 "$1,186.50" "$1,186.50" "$1,186.50" $593.25 $593.25 $939.71 "$1,186.50" $949.20 $533.93 $235.49 N/A $688.17 "$1,186.50" $711.90 "$1,186.50" "$1,186.50" "$1,186.50" N/A N/A 71140612 SUP HCPCS C1713 71140612 - PLATE BN 142MM TC100 12 HL CRV RECON SS PLVC 3.5MM SCR BOTH IP/OP "$1,244.50" $921.00 $246.95 "$1,244.25" $559.91 $559.91 $559.91 $559.91 "$1,244.25" "$1,244.25" "$1,244.25" $259.33 "$1,244.25" "$1,244.25" "$1,244.25" "$1,244.25" "$1,244.25" $259.32 "$1,244.25" $497.70 $735.97 "$1,244.25" "$1,244.25" "$1,244.25" "$1,244.25" $933.38 "$1,244.25" "$1,244.25" "$1,244.25" $622.13 $622.13 $985.45 "$1,244.25" $995.40 $559.91 $246.95 N/A $721.81 "$1,244.25" $746.55 "$1,244.25" $259.30 "$1,244.25" N/A N/A 71140614 SUP HCPCS C1713 71140614 - PLATE BN 166MM TC100 14 HL CRV RECON SS PLVC 3.5MM SCR BOTH IP/OP "$1,402.00" "$1,037.00" $278.21 "$1,401.75" $630.79 $630.79 $630.79 $630.79 "$1,401.75" "$1,401.75" "$1,401.75" $292.16 "$1,401.75" "$1,401.75" "$1,401.75" "$1,401.75" "$1,401.75" $292.14 "$1,401.75" $560.70 $829.14 "$1,401.75" "$1,401.75" "$1,401.75" "$1,401.75" "$1,051.50" "$1,401.75" "$1,401.75" "$1,401.75" $700.88 $700.88 "$1,110.19" "$1,401.75" "$1,121.40" $630.79 $278.21 N/A $813.16 "$1,401.75" $841.05 "$1,401.75" $292.12 "$1,401.75" N/A N/A 71140616 SUP HCPCS C1713 71140616 - PLATE BN 190MM TC100 16 HL CRV RECON SS PLVC 3.5MM SCR BOTH IP/OP "$1,486.00" "$1,100.00" $294.88 "$1,485.75" $668.59 $668.59 $668.59 $668.59 "$1,485.75" "$1,485.75" "$1,485.75" $309.67 "$1,485.75" "$1,485.75" "$1,485.75" "$1,485.75" "$1,485.75" $309.65 "$1,485.75" "$1,485.75" $878.82 "$1,485.75" "$1,485.75" "$1,485.75" "$1,485.75" "$1,114.50" "$1,485.75" "$1,485.75" "$1,485.75" $742.88 $742.88 "$1,176.71" "$1,485.75" "$1,188.60" $668.59 $294.88 N/A $861.88 "$1,485.75" $891.45 "$1,485.75" $309.63 "$1,485.75" N/A N/A 71140618 SUP HCPCS C1713 71140618 - PLATE BN 214MM TC100 18 HL CRV RECON SS PLVC 3.5MM SCR BOTH IP/OP "$1,601.50" "$1,185.00" $317.81 "$1,601.25" $720.56 $720.56 $720.56 $720.56 "$1,601.25" "$1,601.25" "$1,601.25" $333.74 "$1,601.25" "$1,601.25" "$1,601.25" "$1,601.25" "$1,601.25" $333.72 "$1,601.25" $640.50 $947.14 "$1,601.25" "$1,601.25" "$1,601.25" "$1,601.25" "$1,201.13" "$1,601.25" "$1,601.25" "$1,601.25" $800.63 $800.63 "$1,268.19" "$1,601.25" "$1,281.00" $720.56 $317.81 N/A $928.87 "$1,601.25" $960.75 "$1,601.25" $333.70 "$1,601.25" N/A N/A 71140625 SUP HCPCS C1713 71140625 - PLATE BN 120MM TC100 5 HL CLVRLF SS ORTH SM FRAG SET BOTH IP/OP "$1,013.50" $750.00 $201.10 "$1,013.25" $455.96 $455.96 $455.96 $455.96 "$1,013.25" "$1,013.25" "$1,013.25" $211.19 "$1,013.25" "$1,013.25" "$1,013.25" "$1,013.25" "$1,013.25" $211.17 "$1,013.25" $405.30 $599.34 "$1,013.25" "$1,013.25" "$1,013.25" "$1,013.25" $760.13 "$1,013.25" "$1,013.25" "$1,013.25" $506.63 $506.63 $802.49 "$1,013.25" $810.60 $455.96 $201.10 N/A $587.83 "$1,013.25" $607.95 "$1,013.25" $211.16 "$1,013.25" N/A N/A 71140626 SUP HCPCS C1713 71140626 - PLATE BN 136MM TC100 6 HL CLVRLF SS ORTH SM FRAG SET BOTH IP/OP "$1,113.00" $824.00 $220.90 "$1,113.00" $500.85 $500.85 $500.85 $500.85 "$1,113.00" "$1,113.00" "$1,113.00" $231.98 "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" $231.96 "$1,113.00" $445.20 $658.34 "$1,113.00" "$1,113.00" "$1,113.00" "$1,113.00" $834.75 "$1,113.00" "$1,113.00" "$1,113.00" $556.50 $556.50 $881.50 "$1,113.00" $890.40 $500.85 $220.90 N/A $645.54 "$1,113.00" "$1,113.00" "$1,113.00" $231.95 "$1,113.00" N/A N/A 71140627 SUP HCPCS C1713 71140627 - PLATE BN 152MM TC100 7 HL CLVRLF SS ORTH SM FRAG SET BOTH IP/OP "$1,186.50" $878.00 $235.49 "$1,186.50" $533.93 $533.93 $533.93 $533.93 "$1,186.50" "$1,186.50" "$1,186.50" $247.30 "$1,186.50" "$1,186.50" "$1,186.50" "$1,186.50" "$1,186.50" $247.28 "$1,186.50" $474.60 $701.81 "$1,186.50" "$1,186.50" "$1,186.50" "$1,186.50" $889.88 "$1,186.50" "$1,186.50" "$1,186.50" $593.25 $593.25 $939.71 "$1,186.50" $949.20 $533.93 $235.49 N/A $688.17 "$1,186.50" "$1,186.50" "$1,186.50" "$1,186.50" "$1,186.50" N/A N/A 71140628 SUP HCPCS C1713 71140628 - PLATE BN 168MM TC100 8 HL CLVRLF SS ORTH SM FRAG SET BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" "$1,260.00" $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" "$1,260.00" "$1,260.00" $262.58 "$1,260.00" N/A N/A 71140629 SUP HCPCS C1713 71140629 - PLATE BN 184MM TC100 9 HL CLVRLF SS ORTH SM FRAG SET BOTH IP/OP "$1,365.00" "$1,010.00" $270.92 "$1,365.00" $614.25 $614.25 $614.25 $614.25 "$1,365.00" "$1,365.00" "$1,365.00" $284.50 "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" $284.48 "$1,365.00" $546.00 $807.40 "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,023.75" "$1,365.00" "$1,365.00" "$1,365.00" $682.50 $682.50 "$1,081.08" "$1,365.00" "$1,092.00" $614.25 $270.92 N/A $791.70 "$1,365.00" "$1,365.00" "$1,365.00" $284.47 "$1,365.00" N/A N/A 71140704 SUP HCPCS C1713 71140704 - PLATE BN 80MM TC100 4 HL T BTRS SS ORTH LG FRAG SET BOTH IP/OP $926.50 $686.00 $183.81 $926.10 $416.75 $416.75 $416.75 $416.75 $926.10 $926.10 $926.10 $193.02 $926.10 $926.10 $926.10 $926.10 $926.10 $193.01 $926.10 $370.44 $547.79 $926.10 $926.10 $926.10 $926.10 $694.88 $926.10 $926.10 $926.10 $463.05 $463.05 $733.47 $926.10 $740.88 $416.75 $183.81 N/A $537.37 $926.10 $926.10 $926.10 $193.00 $926.10 N/A N/A 71140705 SUP HCPCS C1713 71140705 - PLATE BN 96MM TC100 5 HL T BTRS SS ORTH LG FRAG SET BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" $459.90 $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" "$1,149.75" "$1,149.75" $239.61 "$1,149.75" N/A N/A 71140706 SUP HCPCS C1713 71140706 - PLATE BN 112MM TC100 6 HL T BTRS SS ORTH LG FRAG SET BOTH IP/OP "$1,249.50" $925.00 $247.99 "$1,249.50" $562.28 $562.28 $562.28 $562.28 "$1,249.50" "$1,249.50" "$1,249.50" $260.43 "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" $260.41 "$1,249.50" "$1,249.50" $739.08 "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" $937.13 "$1,249.50" "$1,249.50" "$1,249.50" $624.75 $624.75 $989.60 "$1,249.50" $999.60 $562.28 $247.99 N/A $724.71 "$1,249.50" "$1,249.50" "$1,249.50" $260.40 "$1,249.50" N/A N/A 71140804 SUP HCPCS C1713 71140804 - PLATE BN 86MM TC100 4 HL L BTRS RT ANG SS TIB LT LG FRAG SET BOTH IP/OP $828.50 $613.00 $164.43 $828.45 $372.80 $372.80 $372.80 $372.80 $828.45 $828.45 $828.45 $172.67 $828.45 $828.45 $828.45 $828.45 $828.45 $172.66 $828.45 $331.38 $490.03 $828.45 $828.45 $828.45 $828.45 $621.38 $828.45 $828.45 $828.45 $414.23 $414.23 $656.13 $828.45 $662.76 $372.80 $164.43 N/A $480.53 $828.45 $828.45 $828.45 $172.65 $828.45 N/A N/A 71140904 SUP HCPCS C1713 71140904 - PLATE BN 86MM TC100 4 HL L BTRS LT ANG SS TIB RT LG FRAG SET BOTH IP/OP $828.50 $613.00 $164.43 $828.45 $372.80 $372.80 $372.80 $372.80 $828.45 $828.45 $828.45 $172.67 $828.45 $828.45 $828.45 $828.45 $828.45 $172.66 $828.45 $828.45 $490.03 $828.45 $828.45 $828.45 $828.45 $621.38 $828.45 $828.45 $828.45 $414.23 $414.23 $656.13 $828.45 $662.76 $372.80 $164.43 N/A $480.53 $828.45 $497.07 $828.45 $172.65 $828.45 N/A N/A 71141003 SUP HCPCS C1713 71141003 - PLATE BN 86.5MM TC100 3 HL BTRS SS TIBHD RL LG FRAG SET BOTH IP/OP "$1,423.00" "$1,053.00" $282.38 "$1,422.75" $640.24 $640.24 $640.24 $640.24 "$1,422.75" "$1,422.75" "$1,422.75" $296.54 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" $296.52 "$1,422.75" $569.10 $841.56 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,067.25" "$1,422.75" "$1,422.75" "$1,422.75" $711.38 $711.38 "$1,126.82" "$1,422.75" "$1,138.20" $640.24 $282.38 N/A $825.34 "$1,422.75" "$1,422.75" "$1,422.75" $296.50 "$1,422.75" N/A N/A 71141005 SUP HCPCS C1713 71141005 - PLATE BN 188MM TC100 5 HL BTRS SS TIBHD RL LG FRAG SET BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71141007 SUP HCPCS C1713 71141007 - PLATE BN 149MM TC100 7 HL BTRS SS TIBHD RL LG FRAG SET BOTH IP/OP "$1,785.00" "$1,321.00" $354.28 "$1,785.00" $803.25 $803.25 $803.25 $803.25 "$1,785.00" "$1,785.00" "$1,785.00" $372.04 "$1,785.00" "$1,785.00" "$1,785.00" "$1,785.00" "$1,785.00" $372.01 "$1,785.00" $714.00 "$1,055.83" "$1,785.00" "$1,785.00" "$1,785.00" "$1,785.00" "$1,338.75" "$1,785.00" "$1,785.00" "$1,785.00" $892.50 $892.50 "$1,413.72" "$1,785.00" "$1,428.00" $803.25 $354.28 N/A "$1,035.30" "$1,785.00" "$1,785.00" "$1,785.00" $371.99 "$1,785.00" N/A N/A 71141009 SUP HCPCS C1713 71141009 - PLATE BN 181MM TC100 9 HL BTRS SS TIBHD RL LG FRAG SET BOTH IP/OP "$1,906.00" "$1,410.00" $378.24 "$1,905.75" $857.59 $857.59 $857.59 $857.59 "$1,905.75" "$1,905.75" "$1,905.75" $397.21 "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" $397.18 "$1,905.75" "$1,905.75" "$1,127.25" "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" "$1,429.50" "$1,905.75" "$1,905.75" "$1,905.75" $952.88 $952.88 "$1,509.35" "$1,905.75" "$1,524.60" $857.59 $378.24 N/A "$1,105.48" "$1,905.75" "$1,905.75" "$1,905.75" $397.16 "$1,905.75" N/A N/A 71141011 SUP HCPCS C1713 71141011 - PLATE BN 214MM TC100 11 HL BTRS SS TIBHD RL LG FRAG SET BOTH IP/OP "$2,499.00" "$1,849.00" $495.99 "$2,499.00" "$1,124.55" "$1,124.55" "$1,124.55" "$1,124.55" "$2,499.00" "$2,499.00" "$2,499.00" $520.85 "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" $520.82 "$2,499.00" $999.60 "$1,478.16" "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" "$1,874.25" "$2,499.00" "$2,499.00" "$2,499.00" "$1,249.50" "$1,249.50" "$1,979.21" "$2,499.00" "$1,999.20" "$1,124.55" $495.99 N/A "$1,449.42" "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" N/A N/A 71141013 SUP HCPCS C1713 71141013 - PLATE BN 246MM TC100 13 HL BTRS SS TIBHD RL LG FRAG SET BOTH IP/OP "$2,593.50" "$1,919.00" $514.74 "$2,593.50" "$1,167.08" "$1,167.08" "$1,167.08" "$1,167.08" "$2,593.50" "$2,593.50" "$2,593.50" $540.55 "$2,593.50" "$2,593.50" "$2,593.50" "$2,593.50" "$2,593.50" $540.51 "$2,593.50" "$1,037.40" "$1,278.60" "$2,593.50" "$2,593.50" "$2,593.50" "$2,593.50" "$1,945.13" "$2,593.50" "$2,593.50" "$2,593.50" "$1,296.75" "$1,296.75" "$2,054.05" "$2,593.50" "$2,074.80" "$1,167.08" $514.74 N/A "$1,504.23" "$2,593.50" "$2,593.50" "$2,593.50" "$2,593.50" "$2,593.50" N/A N/A 71141103 SUP HCPCS C1713 71141103 - PLATE BN 86.5MM TC100 3 HL BTRS SS TIBHD L/L LG FRAG SET BOTH IP/OP "$1,423.00" "$1,053.00" $282.38 "$1,422.75" $640.24 $640.24 $640.24 $640.24 "$1,422.75" "$1,422.75" "$1,422.75" $296.54 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" $296.52 "$1,422.75" "$1,422.75" $841.56 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,067.25" "$1,422.75" "$1,422.75" "$1,422.75" $711.38 $711.38 "$1,126.82" "$1,422.75" "$1,138.20" $640.24 $282.38 N/A $825.34 "$1,422.75" "$1,422.75" "$1,422.75" $296.50 "$1,422.75" N/A N/A 71141105 SUP HCPCS C1713 71141105 - PLATE BN 188MM TC100 5 HL BTRS SS TIBHD L/L LG FRAG SET BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71141107 SUP HCPCS C1713 71141107 - PLATE BN 149MM TC100 7 HL BTRS SS TIBHD L/L LG FRAG SET BOTH IP/OP "$1,785.00" "$1,321.00" $354.28 "$1,785.00" $803.25 $803.25 $803.25 $803.25 "$1,785.00" "$1,785.00" "$1,785.00" $372.04 "$1,785.00" "$1,785.00" "$1,785.00" "$1,785.00" "$1,785.00" $372.01 "$1,785.00" $714.00 "$1,055.83" "$1,785.00" "$1,785.00" "$1,785.00" "$1,785.00" "$1,338.75" "$1,785.00" "$1,785.00" "$1,785.00" $892.50 $892.50 "$1,413.72" "$1,785.00" "$1,428.00" $803.25 $354.28 N/A "$1,035.30" "$1,785.00" "$1,785.00" "$1,785.00" $371.99 "$1,785.00" N/A N/A 71141109 SUP HCPCS C1713 71141109 - PLATE BN 181MM TC100 9 HL BTRS SS TIBHD L/L LG FRAG SET BOTH IP/OP "$1,906.00" "$1,410.00" $378.24 "$1,905.75" $857.59 $857.59 $857.59 $857.59 "$1,905.75" "$1,905.75" "$1,905.75" $397.21 "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" $397.18 "$1,905.75" $762.30 "$1,127.25" "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" "$1,429.50" "$1,905.75" "$1,905.75" "$1,905.75" $952.88 $952.88 "$1,509.35" "$1,905.75" "$1,524.60" $857.59 $378.24 N/A "$1,105.48" "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" N/A N/A 71141111 SUP HCPCS C1713 71141111 - PLATE BN 214MM TC100 11 HL BTRS SS TIBHD L/L LG FRAG SET BOTH IP/OP "$2,499.00" "$1,849.00" $495.99 "$2,499.00" "$1,124.55" "$1,124.55" "$1,124.55" "$1,124.55" "$2,499.00" "$2,499.00" "$2,499.00" $520.85 "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" $520.82 "$2,499.00" "$2,499.00" "$1,478.16" "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" "$1,874.25" "$2,499.00" "$2,499.00" "$2,499.00" "$1,249.50" "$1,249.50" "$1,979.21" "$2,499.00" "$1,999.20" "$1,124.55" $495.99 N/A "$1,449.42" "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" N/A N/A 71141113 SUP HCPCS C1713 71141113 - PLATE BN 246MM TC100 13 HL BTRS SS TIBHD L/L LG FRAG SET BOTH IP/OP "$2,593.50" "$1,919.00" $514.74 "$2,593.50" "$1,167.08" "$1,167.08" "$1,167.08" "$1,167.08" "$2,593.50" "$2,593.50" "$2,593.50" $540.55 "$2,593.50" "$2,593.50" "$2,593.50" "$2,593.50" "$2,593.50" $540.51 "$2,593.50" "$2,593.50" "$1,278.60" "$2,593.50" "$2,593.50" "$2,593.50" "$2,593.50" "$1,945.13" "$2,593.50" "$2,593.50" "$2,593.50" "$1,296.75" "$1,296.75" "$2,054.05" "$2,593.50" "$2,074.80" "$1,167.08" $514.74 N/A "$1,504.23" "$2,593.50" "$2,593.50" "$2,593.50" $540.49 "$2,593.50" N/A N/A 71141206 SUP HCPCS C1713 71141206 - PLATE BN BRD 103MM TC100 6 HL CMPR SS ORTH 4.5MM SCR LG FRAG BOTH IP/OP $546.00 $404.00 $108.37 $546.00 $245.70 $245.70 $245.70 $245.70 $546.00 $546.00 $546.00 $113.80 $546.00 $546.00 $546.00 $546.00 $546.00 $113.79 $546.00 $218.40 $322.96 $546.00 $546.00 $546.00 $546.00 $409.50 $546.00 $546.00 $546.00 $273.00 $273.00 $432.43 $546.00 $436.80 $245.70 $108.37 N/A $316.68 $546.00 $546.00 $546.00 $113.79 $546.00 N/A N/A 71141207 SUP HCPCS C1713 71141207 - PLATE BN BRD 119MM TC100 7 HL CMPR SS ORTH 4.5MM SCR LG FRAG BOTH IP/OP $546.00 $404.00 $108.37 $546.00 $245.70 $245.70 $245.70 $245.70 $546.00 $546.00 $546.00 $113.80 $546.00 $546.00 $546.00 $546.00 $546.00 $113.79 $546.00 $218.40 $322.96 $546.00 $546.00 $546.00 $546.00 $409.50 $546.00 $546.00 $546.00 $273.00 $273.00 $432.43 $546.00 $436.80 $245.70 $108.37 N/A $316.68 $546.00 $546.00 $546.00 $113.79 $546.00 N/A N/A 71141208 SUP HCPCS C1713 71141208 - PLATE BN BRD 135MM TC100 8 HL CMPR SS ORTH 4.5MM SCR LG FRAG BOTH IP/OP $680.50 $504.00 $135.04 $680.40 $306.18 $306.18 $306.18 $306.18 $680.40 $680.40 $680.40 $141.81 $680.40 $680.40 $680.40 $680.40 $680.40 $141.80 $680.40 $272.16 $402.46 $680.40 $680.40 $680.40 $680.40 $510.38 $680.40 $680.40 $680.40 $340.20 $340.20 $538.88 $680.40 $544.32 $306.18 $135.04 N/A $394.69 $680.40 $680.40 $680.40 $141.80 $680.40 N/A N/A 71141209 SUP HCPCS C1713 71141209 - PLATE BN BRD 151MM TC100 9 HL CMPR SS ORTH 4.5MM SCR LG FRAG BOTH IP/OP $680.50 $504.00 $135.04 $680.40 $306.18 $306.18 $306.18 $306.18 $680.40 $680.40 $680.40 $141.81 $680.40 $680.40 $680.40 $680.40 $680.40 $141.80 $680.40 $272.16 $402.46 $680.40 $680.40 $680.40 $680.40 $510.38 $680.40 $680.40 $680.40 $340.20 $340.20 $538.88 $680.40 $544.32 $306.18 $135.04 N/A $394.69 $680.40 $680.40 $680.40 $680.40 $680.40 N/A N/A 71141210 SUP HCPCS C1713 71141210 - PLATE BN BRD 167MM TC100 10 HL CMPR SS 4.5MM SCR LG FRAG SET BOTH IP/OP $680.50 $504.00 $135.04 $680.40 $306.18 $306.18 $306.18 $306.18 $680.40 $680.40 $680.40 $141.81 $680.40 $680.40 $680.40 $680.40 $680.40 $141.80 $680.40 $272.16 $402.46 $680.40 $680.40 $680.40 $680.40 $510.38 $680.40 $680.40 $680.40 $340.20 $340.20 $538.88 $680.40 $544.32 $306.18 $135.04 N/A $394.69 $680.40 $680.40 $680.40 $680.40 $680.40 N/A N/A 71141212 SUP HCPCS C1713 71141212 - PLATE BN BRD 199MM TC100 12 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP $732.00 $542.00 $145.25 $731.85 $329.33 $329.33 $329.33 $329.33 $731.85 $731.85 $731.85 $152.54 $731.85 $731.85 $731.85 $731.85 $731.85 $152.53 $731.85 $292.74 $432.89 $731.85 $731.85 $731.85 $731.85 $549.00 $731.85 $731.85 $731.85 $365.93 $365.93 $579.63 $731.85 $585.48 $329.33 $145.25 N/A $424.56 $731.85 $731.85 $731.85 $152.52 $731.85 N/A N/A 71141214 SUP HCPCS C1713 71141214 - PLATE BN BRD 231MM TC100 14 HL CMPR SS 4.5MM SCR LG FRAG SET BOTH IP/OP $732.00 $542.00 $145.25 $731.85 $329.33 $329.33 $329.33 $329.33 $731.85 $731.85 $731.85 $152.54 $731.85 $731.85 $731.85 $731.85 $731.85 $152.53 $731.85 $292.74 $432.89 $731.85 $731.85 $731.85 $731.85 $549.00 $731.85 $731.85 $731.85 $365.93 $365.93 $579.63 $731.85 $585.48 $329.33 $145.25 N/A $424.56 $731.85 $731.85 $731.85 $152.52 $731.85 N/A N/A 71141216 SUP HCPCS C1713 71141216 - PLATE BN BRD 263MM TC100 16 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP $926.50 $686.00 $183.81 $926.10 $416.75 $416.75 $416.75 $416.75 $926.10 $926.10 $926.10 $193.02 $926.10 $926.10 $926.10 $926.10 $926.10 $193.01 $926.10 $370.44 $547.79 $926.10 $926.10 $926.10 $926.10 $694.88 $926.10 $926.10 $926.10 $463.05 $463.05 $733.47 $926.10 $740.88 $416.75 $183.81 N/A $537.37 $926.10 $926.10 $926.10 $193.00 $926.10 N/A N/A 71141218 SUP HCPCS C1713 71141218 - PLATE BN BRD 295MM TC100 18 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP "$1,023.00" $757.00 $202.98 "$1,022.70" $460.22 $460.22 $460.22 $460.22 "$1,022.70" "$1,022.70" "$1,022.70" $213.16 "$1,022.70" "$1,022.70" "$1,022.70" "$1,022.70" "$1,022.70" $213.14 "$1,022.70" "$1,022.70" $604.93 "$1,022.70" "$1,022.70" "$1,022.70" "$1,022.70" $767.25 "$1,022.70" "$1,022.70" "$1,022.70" $511.35 $511.35 $809.98 "$1,022.70" $818.16 $460.22 $202.98 N/A $593.34 "$1,022.70" "$1,022.70" "$1,022.70" $213.13 "$1,022.70" N/A N/A 71141220 SUP HCPCS C1713 71141220 - PLATE BN BRD 326MM TC100 20 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP "$1,459.50" "$1,080.00" $289.67 "$1,459.50" $656.78 $656.78 $656.78 $656.78 "$1,459.50" "$1,459.50" "$1,459.50" $304.20 "$1,459.50" "$1,459.50" "$1,459.50" "$1,459.50" "$1,459.50" $304.18 "$1,459.50" "$1,459.50" $863.29 "$1,459.50" "$1,459.50" "$1,459.50" "$1,459.50" "$1,094.63" "$1,459.50" "$1,459.50" "$1,459.50" $729.75 $729.75 "$1,155.92" "$1,459.50" "$1,167.60" $656.78 $289.67 N/A $846.51 "$1,459.50" "$1,459.50" "$1,459.50" $304.16 "$1,459.50" N/A N/A 71141222 SUP HCPCS C1713 71141222 - PLATE BN BRD 358MM TC100 22 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP "$1,543.50" "$1,142.00" $306.35 "$1,543.50" $694.58 $694.58 $694.58 $694.58 "$1,543.50" "$1,543.50" "$1,543.50" $321.70 "$1,543.50" "$1,543.50" "$1,543.50" "$1,543.50" "$1,543.50" $321.68 "$1,543.50" $617.40 $912.98 "$1,543.50" "$1,543.50" "$1,543.50" "$1,543.50" "$1,157.63" "$1,543.50" "$1,543.50" "$1,543.50" $771.75 $771.75 "$1,222.45" "$1,543.50" "$1,234.80" $694.58 $306.35 N/A $895.23 "$1,543.50" "$1,543.50" "$1,543.50" $321.67 "$1,543.50" N/A N/A 71141224 SUP HCPCS C1713 71141224 - PLATE BN BRD 390MM TC100 24 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP "$1,711.50" "$1,267.00" $339.69 "$1,711.50" $770.18 $770.18 $770.18 $770.18 "$1,711.50" "$1,711.50" "$1,711.50" $356.72 "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" $356.70 "$1,711.50" $684.60 "$1,012.35" "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" "$1,283.63" "$1,711.50" "$1,711.50" "$1,711.50" $855.75 $855.75 "$1,355.51" "$1,711.50" "$1,369.20" $770.18 $339.69 N/A $992.67 "$1,711.50" "$1,711.50" "$1,711.50" $356.68 "$1,711.50" N/A N/A 71141226 SUP HCPCS C1713 71141226 - PLATE BN BRD 423MM TC100 26 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP "$1,811.50" "$1,341.00" $359.49 "$1,811.25" $815.06 $815.06 $815.06 $815.06 "$1,811.25" "$1,811.25" "$1,811.25" $377.51 "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" $377.48 "$1,811.25" $724.50 "$1,071.35" "$1,811.25" "$1,811.25" "$1,811.25" "$1,811.25" "$1,358.63" "$1,811.25" "$1,811.25" "$1,811.25" $905.63 $905.63 "$1,434.51" "$1,811.25" "$1,449.00" $815.06 $359.49 N/A "$1,050.67" "$1,811.25" "$1,811.25" "$1,811.25" $377.46 "$1,811.25" N/A N/A 71141302 SUP HCPCS C1713 71141302 - PLATE BN 39MM TC100 2 HL SMTB SS ORTH LG FRAG SET BOTH IP/OP $143.00 $106.00 $28.34 $142.80 $64.26 $64.26 $64.26 $64.26 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $142.80 $142.80 $142.80 $29.76 $142.80 $57.12 $84.47 $142.80 $142.80 $142.80 $142.80 $107.25 $142.80 $142.80 $142.80 $71.40 $71.40 $113.10 $142.80 $114.24 $64.26 $28.34 N/A $82.94 $142.80 $142.80 $142.80 $29.76 $142.80 N/A N/A 71141303 SUP HCPCS C1713 71141303 - PLATE BN 55MM TC100 3 HL SMTB SS ORTH LG FRAG SET BOTH IP/OP $147.00 $109.00 $29.18 $147.00 $66.15 $66.15 $66.15 $66.15 $147.00 $147.00 $147.00 $30.64 $147.00 $147.00 $147.00 $147.00 $147.00 $30.64 $147.00 $58.80 $86.95 $147.00 $147.00 $147.00 $147.00 $110.25 $147.00 $147.00 $147.00 $73.50 $73.50 $116.42 $147.00 $117.60 $66.15 $29.18 N/A $85.26 $147.00 $88.20 $147.00 $30.63 $147.00 N/A N/A 71141304 SUP HCPCS C1713 71141304 - PLATE BN 71MM TC100 4 HL SMTB SS ORTH LG FRAG SET BOTH IP/OP $160.00 $118.00 $31.68 $159.60 $71.82 $71.82 $71.82 $71.82 $159.60 $159.60 $159.60 $33.26 $159.60 $159.60 $159.60 $159.60 $159.60 $33.26 $159.60 $63.84 $94.40 $159.60 $159.60 $159.60 $159.60 $120.00 $159.60 $159.60 $159.60 $79.80 $79.80 $126.40 $159.60 $127.68 $71.82 $31.68 N/A $92.80 $159.60 $95.76 $159.60 $33.26 $159.60 N/A N/A 71141305 SUP HCPCS C1713 71141305 - PLATE BN 87MM TC100 5 HL SMTB SS ORTH LG FRAG SET BOTH IP/OP $167.00 $124.00 $33.14 $166.95 $75.13 $75.13 $75.13 $75.13 $166.95 $166.95 $166.95 $34.80 $166.95 $166.95 $166.95 $166.95 $166.95 $34.79 $166.95 $66.78 $98.75 $166.95 $166.95 $166.95 $166.95 $125.25 $166.95 $166.95 $166.95 $83.48 $83.48 $132.22 $166.95 $133.56 $75.13 $33.14 N/A $96.86 $166.95 $100.17 $166.95 $34.79 $166.95 N/A N/A 71141306 SUP HCPCS C1713 71141306 - PLATE BN 103MM TC100 6 HL SMTB SS ORTH LG FRAG SET BOTH IP/OP $177.50 $131.00 $35.22 $177.45 $79.85 $79.85 $79.85 $79.85 $177.45 $177.45 $177.45 $36.99 $177.45 $177.45 $177.45 $177.45 $177.45 $36.98 $177.45 $70.98 $104.96 $177.45 $177.45 $177.45 $177.45 $133.13 $177.45 $177.45 $177.45 $88.73 $88.73 $140.54 $177.45 $141.96 $79.85 $35.22 N/A $102.95 $177.45 $106.47 $177.45 $36.98 $177.45 N/A N/A 71141307 SUP HCPCS C1713 71141307 - PLATE BN 119MM TC100 7 HL SMTB SS ORTH LG FRAG SET BOTH IP/OP $192.50 $142.00 $38.14 $192.15 $86.47 $86.47 $86.47 $86.47 $192.15 $192.15 $192.15 $40.05 $192.15 $192.15 $192.15 $192.15 $192.15 $40.05 $192.15 $192.15 $113.66 $192.15 $192.15 $192.15 $192.15 $144.38 $192.15 $192.15 $192.15 $96.08 $96.08 $152.18 $192.15 $153.72 $86.47 $38.14 N/A $111.65 $192.15 $115.29 $192.15 $40.04 $192.15 N/A N/A 71141308 SUP HCPCS C1713 71141308 - PLATE BN 135MM TC100 8 HL SMTB SS ORTH LG FRAG SET BOTH IP/OP $247.00 $183.00 $48.97 $246.75 $111.04 $111.04 $111.04 $111.04 $246.75 $246.75 $246.75 $51.43 $246.75 $246.75 $246.75 $246.75 $246.75 $51.43 $246.75 $246.75 $145.95 $246.75 $246.75 $246.75 $246.75 $185.25 $246.75 $246.75 $246.75 $123.38 $123.38 $195.43 $246.75 $197.40 $111.04 $48.97 N/A $143.26 $246.75 $148.05 $246.75 $51.42 $246.75 N/A N/A 71141309 SUP HCPCS C1713 71141309 - PLATE BN 151MM TC100 9 HL SMTB SS ORTH LG FRAG SET BOTH IP/OP $218.50 $162.00 $43.35 $218.40 $98.28 $98.28 $98.28 $98.28 $218.40 $218.40 $218.40 $45.52 $218.40 $218.40 $218.40 $218.40 $218.40 $45.52 $218.40 $218.40 $129.18 $218.40 $218.40 $218.40 $218.40 $163.88 $218.40 $218.40 $218.40 $109.20 $109.20 $172.97 $218.40 $174.72 $98.28 $43.35 N/A $126.73 $218.40 $131.04 $218.40 $45.51 $218.40 N/A N/A 71141310 SUP HCPCS C1713 71141310 - PLATE BN 167MM TC100 10 HL SMTB SS ORTH LG FRAG SET BOTH IP/OP $271.00 $201.00 $53.77 $270.90 $121.91 $121.91 $121.91 $121.91 $270.90 $270.90 $270.90 $56.46 $270.90 $270.90 $270.90 $270.90 $270.90 $56.46 $270.90 $270.90 $160.24 $270.90 $270.90 $270.90 $270.90 $203.25 $270.90 $270.90 $270.90 $135.45 $135.45 $214.55 $270.90 $216.72 $121.91 $53.77 N/A $157.18 $270.90 $162.54 $270.90 $270.90 $270.90 N/A N/A 71141311 SUP HCPCS C1713 71141311 - PLATE BN 183MM TC100 11 HL SMTB SS ORTH LG FRAG SET BOTH IP/OP $282.50 $209.00 $56.06 $282.45 $127.10 $127.10 $127.10 $127.10 $282.45 $282.45 $282.45 $58.87 $282.45 $282.45 $282.45 $282.45 $282.45 $58.87 $282.45 $282.45 $167.07 $282.45 $282.45 $282.45 $282.45 $211.88 $282.45 $282.45 $282.45 $141.23 $141.23 $223.70 $282.45 $225.96 $127.10 $56.06 N/A $163.85 $282.45 $169.47 $282.45 $282.45 $282.45 N/A N/A 71141312 SUP HCPCS C1713 71141312 - PLATE BN 199MM TC100 12 HL SMTB SS ORTH LG FRAG SET BOTH IP/OP $289.00 $214.00 $57.31 $288.75 $129.94 $129.94 $129.94 $129.94 $288.75 $288.75 $288.75 $60.18 $288.75 $288.75 $288.75 $288.75 $288.75 $60.18 $288.75 $115.50 $170.80 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $129.94 $57.31 N/A $167.62 $288.75 $288.75 $288.75 $60.18 $288.75 N/A N/A 71141402 SUP HCPCS C1713 71141402 - PLATE BN NAR 39MM TC100 2 HL CMPR SS ORTH 4.5MM SCR BOTH IP/OP $353.00 $261.00 $70.02 $352.80 $158.76 $158.76 $158.76 $158.76 $352.80 $352.80 $352.80 $73.53 $352.80 $352.80 $352.80 $352.80 $352.80 $73.53 $352.80 $141.12 $208.68 $352.80 $352.80 $352.80 $352.80 $264.75 $352.80 $352.80 $352.80 $176.40 $176.40 $279.42 $352.80 $282.24 $158.76 $70.02 N/A $204.74 $352.80 $211.68 $352.80 $73.52 $352.80 N/A N/A 71141403 SUP HCPCS C1713 71141403 - PLATE BN NAR 55MM TC100 3 HL CMPR SS 4.5MM SCR LG FRAG SET BOTH IP/OP $369.00 $273.00 $73.15 $368.55 $165.85 $165.85 $165.85 $165.85 $368.55 $368.55 $368.55 $76.82 $368.55 $368.55 $368.55 $368.55 $368.55 $76.81 $368.55 $147.42 $218.00 $368.55 $368.55 $368.55 $368.55 $276.75 $368.55 $368.55 $368.55 $184.28 $184.28 $291.89 $368.55 $294.84 $165.85 $73.15 N/A $214.02 $368.55 $368.55 $368.55 $368.55 $368.55 N/A N/A 71141404 SUP HCPCS C1713 71141404 - PLATE BN NAR 71MM TC100 4 HL CMPR SS ORTH 4.5MM SCR LG FRAG BOTH IP/OP $369.00 $273.00 $73.15 $368.55 $165.85 $165.85 $165.85 $165.85 $368.55 $368.55 $368.55 $76.82 $368.55 $368.55 $368.55 $368.55 $368.55 $76.81 $368.55 $147.42 $218.00 $368.55 $368.55 $368.55 $368.55 $276.75 $368.55 $368.55 $368.55 $184.28 $184.28 $291.89 $368.55 $294.84 $165.85 $73.15 N/A $214.02 $368.55 $221.13 $368.55 $368.55 $368.55 N/A N/A 71141405 SUP HCPCS C1713 71141405 - PLATE BN NAR 87MM TC100 5 HL CMPR SS ORTH 4.5MM SCR LG FRAG BOTH IP/OP $369.00 $273.00 $73.15 $368.55 $165.85 $165.85 $165.85 $165.85 $368.55 $368.55 $368.55 $76.82 $368.55 $368.55 $368.55 $368.55 $368.55 $76.81 $368.55 $147.42 $218.00 $368.55 $368.55 $368.55 $368.55 $276.75 $368.55 $368.55 $368.55 $184.28 $184.28 $291.89 $368.55 $294.84 $165.85 $73.15 N/A $214.02 $368.55 $221.13 $368.55 $368.55 $368.55 N/A N/A 71141406 SUP HCPCS C1713 71141406 - PLATE BN NAR 103MM TC100 6 HL CMPR SS ORTH 4.5MM SCR LG FRAG BOTH IP/OP $411.00 $304.00 $81.48 $410.55 $184.75 $184.75 $184.75 $184.75 $410.55 $410.55 $410.55 $85.57 $410.55 $410.55 $410.55 $410.55 $410.55 $85.56 $410.55 $164.22 $242.84 $410.55 $410.55 $410.55 $410.55 $308.25 $410.55 $410.55 $410.55 $205.28 $205.28 $325.16 $410.55 $328.44 $184.75 $81.48 N/A $238.38 $410.55 $246.33 $410.55 $85.56 $410.55 N/A N/A 71141407 SUP HCPCS C1713 71141407 - PLATE BN NAR 119MM TC100 7 HL CMPR SS ORTH 4.5MM SCR LG FRAG BOTH IP/OP $411.00 $304.00 $81.48 $410.55 $184.75 $184.75 $184.75 $184.75 $410.55 $410.55 $410.55 $85.57 $410.55 $410.55 $410.55 $410.55 $410.55 $85.56 $410.55 $164.22 $242.84 $410.55 $410.55 $410.55 $410.55 $308.25 $410.55 $410.55 $410.55 $205.28 $205.28 $325.16 $410.55 $328.44 $184.75 $81.48 N/A $238.38 $410.55 $410.55 $410.55 $85.56 $410.55 N/A N/A 71141408 SUP HCPCS C1713 71141408 - PLATE BN NAR 135MM TC100 8 HL CMPR SS ORTH 4.5MM SCR BOTH IP/OP $411.00 $304.00 $81.48 $410.55 $184.75 $184.75 $184.75 $184.75 $410.55 $410.55 $410.55 $85.57 $410.55 $410.55 $410.55 $410.55 $410.55 $85.56 $410.55 $164.22 $242.84 $410.55 $410.55 $410.55 $410.55 $308.25 $410.55 $410.55 $410.55 $205.28 $205.28 $325.16 $410.55 $328.44 $184.75 $81.48 N/A $238.38 $410.55 $246.33 $410.55 $85.56 $410.55 N/A N/A 71141409 SUP HCPCS C1713 71141409 - PLATE BN NAR 151MM TC100 9 HL CMPR SS ORTH 4.5MM SCR LG FRAG BOTH IP/OP $411.00 $304.00 $81.48 $410.55 $184.75 $184.75 $184.75 $184.75 $410.55 $410.55 $410.55 $85.57 $410.55 $410.55 $410.55 $410.55 $410.55 $85.56 $410.55 $164.22 $242.84 $410.55 $410.55 $410.55 $410.55 $308.25 $410.55 $410.55 $410.55 $205.28 $205.28 $325.16 $410.55 $328.44 $184.75 $81.48 N/A $238.38 $410.55 $246.33 $410.55 $85.56 $410.55 N/A N/A 71141410 SUP HCPCS C1713 71141410 - PLATE BN NAR 167MM TC100 10 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $214.20 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $321.30 $535.50 $111.60 $535.50 N/A N/A 71141411 SUP HCPCS C1713 71141411 - PLATE BN NAR 183MM TC100 11 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $535.50 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $111.60 $535.50 N/A N/A 71141412 SUP HCPCS C1713 71141412 - PLATE BN NAR 199MM TC100 12 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $214.20 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $321.30 $535.50 $111.60 $535.50 N/A N/A 71141413 SUP HCPCS C1713 71141413 - PLATE BN NAR 215MM TC100 13 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $131.29 $630.00 N/A N/A 71141414 SUP HCPCS C1713 71141414 - PLATE BN NAR 231MM TC100 14 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP $763.50 $565.00 $151.51 $763.35 $343.51 $343.51 $343.51 $343.51 $763.35 $763.35 $763.35 $159.10 $763.35 $763.35 $763.35 $763.35 $763.35 $159.09 $763.35 $305.34 $451.52 $763.35 $763.35 $763.35 $763.35 $572.63 $763.35 $763.35 $763.35 $381.68 $381.68 $604.57 $763.35 $610.68 $343.51 $151.51 N/A $442.83 $763.35 $458.01 $763.35 $159.08 $763.35 N/A N/A 71141415 SUP HCPCS C1713 71141415 - PLATE BN NAR 247MM TC100 15 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP $805.50 $596.00 $159.84 $805.35 $362.41 $362.41 $362.41 $362.41 $805.35 $805.35 $805.35 $167.86 $805.35 $805.35 $805.35 $805.35 $805.35 $167.84 $805.35 $322.14 $476.36 $805.35 $805.35 $805.35 $805.35 $604.13 $805.35 $805.35 $805.35 $402.68 $402.68 $637.84 $805.35 $644.28 $362.41 $159.84 N/A $467.19 $805.35 $483.21 $805.35 $167.83 $805.35 N/A N/A 71141416 SUP HCPCS C1713 71141416 - PLATE BN NAR 263MM TC100 16 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP $805.50 $596.00 $159.84 $805.35 $362.41 $362.41 $362.41 $362.41 $805.35 $805.35 $805.35 $167.86 $805.35 $805.35 $805.35 $805.35 $805.35 $167.84 $805.35 $322.14 $476.36 $805.35 $805.35 $805.35 $805.35 $604.13 $805.35 $805.35 $805.35 $402.68 $402.68 $637.84 $805.35 $644.28 $362.41 $159.84 N/A $467.19 $805.35 $483.21 $805.35 $167.83 $805.35 N/A N/A 71141418 SUP HCPCS C1713 71141418 - PLATE BN NAR 295MM TC100 18 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" $459.90 $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" $689.85 "$1,149.75" $239.61 "$1,149.75" N/A N/A 71141420 SUP HCPCS C1713 71141420 - PLATE BN NAR 326MM TC100 20 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP "$1,038.50" $768.00 $206.11 "$1,038.45" $467.30 $467.30 $467.30 $467.30 "$1,038.45" "$1,038.45" "$1,038.45" $216.44 "$1,038.45" "$1,038.45" "$1,038.45" "$1,038.45" "$1,038.45" $216.42 "$1,038.45" "$1,038.45" $614.24 "$1,038.45" "$1,038.45" "$1,038.45" "$1,038.45" $778.88 "$1,038.45" "$1,038.45" "$1,038.45" $519.23 $519.23 $822.45 "$1,038.45" $830.76 $467.30 $206.11 N/A $602.33 "$1,038.45" "$1,038.45" "$1,038.45" $216.41 "$1,038.45" N/A N/A 71141422 SUP HCPCS C1713 71141422 - PLATE BN NAR 358MM TC100 22 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP "$1,402.00" "$1,037.00" $278.21 "$1,401.75" $630.79 $630.79 $630.79 $630.79 "$1,401.75" "$1,401.75" "$1,401.75" $292.16 "$1,401.75" "$1,401.75" "$1,401.75" "$1,401.75" "$1,401.75" $292.14 "$1,401.75" $560.70 $829.14 "$1,401.75" "$1,401.75" "$1,401.75" "$1,401.75" "$1,051.50" "$1,401.75" "$1,401.75" "$1,401.75" $700.88 $700.88 "$1,110.19" "$1,401.75" "$1,121.40" $630.79 $278.21 N/A $813.16 "$1,401.75" "$1,401.75" "$1,401.75" $292.12 "$1,401.75" N/A N/A 71141424 SUP HCPCS C1713 71141424 - PLATE BN NAR 390MM TC100 24 HL CMPR SS ORTH 4.5MM SCR LG BOTH IP/OP "$1,517.50" "$1,123.00" $301.14 "$1,517.25" $682.76 $682.76 $682.76 $682.76 "$1,517.25" "$1,517.25" "$1,517.25" $316.23 "$1,517.25" "$1,517.25" "$1,517.25" "$1,517.25" "$1,517.25" $316.21 "$1,517.25" $606.90 $897.45 "$1,517.25" "$1,517.25" "$1,517.25" "$1,517.25" "$1,138.13" "$1,517.25" "$1,517.25" "$1,517.25" $758.63 $758.63 "$1,201.66" "$1,517.25" "$1,213.80" $682.76 $301.14 N/A $880.15 "$1,517.25" $910.35 "$1,517.25" $316.19 "$1,517.25" N/A N/A 71141505 SUP HCPCS C1713 71141505 - PLATE BN 100MM TC100 5 HL SPN SS ORTH 4.5MM SCR LG FRAG SET BOTH IP/OP $866.50 $641.00 $171.93 $866.25 $389.81 $389.81 $389.81 $389.81 $866.25 $866.25 $866.25 $180.55 $866.25 $866.25 $866.25 $866.25 $866.25 $180.54 $866.25 $346.50 $512.39 $866.25 $866.25 $866.25 $866.25 $649.88 $866.25 $866.25 $866.25 $433.13 $433.13 $686.07 $866.25 $693.00 $389.81 $171.93 N/A $502.57 $866.25 $519.75 $866.25 $180.53 $866.25 N/A N/A 71141506 SUP HCPCS C1713 71141506 - PLATE BN 120MM TC100 6 HL SPN SS ORTH 4.5MM SCR LG FRAG SET BOTH IP/OP $754.00 $558.00 $149.63 $753.90 $339.26 $339.26 $339.26 $339.26 $753.90 $753.90 $753.90 $157.13 $753.90 $753.90 $753.90 $753.90 $753.90 $157.12 $753.90 $753.90 $445.93 $753.90 $753.90 $753.90 $753.90 $565.50 $753.90 $753.90 $753.90 $376.95 $376.95 $597.09 $753.90 $603.12 $339.26 $149.63 N/A $437.32 $753.90 $452.34 $753.90 $157.11 $753.90 N/A N/A 71141603 SUP HCPCS C1713 71141603 - PLATE BN 68MM TC100 3 HL T SS ORTH 4.5MM SCR LG FRAG SET BOTH IP/OP $568.50 $421.00 $112.74 $568.05 $255.62 $255.62 $255.62 $255.62 $568.05 $568.05 $568.05 $118.40 $568.05 $568.05 $568.05 $568.05 $568.05 $118.39 $568.05 $568.05 $336.00 $568.05 $568.05 $568.05 $568.05 $426.38 $568.05 $568.05 $568.05 $284.03 $284.03 $449.90 $568.05 $454.44 $255.62 $112.74 N/A $329.73 $568.05 $568.05 $568.05 $118.38 $568.05 N/A N/A 71141604 SUP HCPCS C1713 71141604 - PLATE BN 84MM TC100 4 HL T SS ORTH 4.5MM SCR LG FRAG SET BOTH IP/OP $631.50 $467.00 $125.25 $631.05 $283.97 $283.97 $283.97 $283.97 $631.05 $631.05 $631.05 $131.53 $631.05 $631.05 $631.05 $631.05 $631.05 $131.52 $631.05 $631.05 $373.27 $631.05 $631.05 $631.05 $631.05 $473.63 $631.05 $631.05 $631.05 $315.53 $315.53 $499.79 $631.05 $504.84 $283.97 $125.25 N/A $366.27 $631.05 $631.05 $631.05 $131.51 $631.05 N/A N/A 71141605 SUP HCPCS C1713 71141605 - PLATE BN 100MM TC100 5 HL T SS ORTH 4.5MM SCR LG FRAG SET BOTH IP/OP $671.00 $497.00 $133.17 $670.95 $301.93 $301.93 $301.93 $301.93 $670.95 $670.95 $670.95 $139.84 $670.95 $670.95 $670.95 $670.95 $670.95 $139.83 $670.95 $670.95 $396.87 $670.95 $670.95 $670.95 $670.95 $503.25 $670.95 $670.95 $670.95 $335.48 $335.48 $531.39 $670.95 $536.76 $301.93 $133.17 N/A $389.18 $670.95 $402.57 $670.95 $139.83 $670.95 N/A N/A 71141606 SUP HCPCS C1713 71141606 - PLATE BN 116MM TC100 6 HL T SS ORTH 4.5MM SCR LG FRAG SET BOTH IP/OP $742.50 $549.00 $147.34 $742.35 $334.06 $334.06 $334.06 $334.06 $742.35 $742.35 $742.35 $154.72 $742.35 $742.35 $742.35 $742.35 $742.35 $154.71 $742.35 $742.35 $439.10 $742.35 $742.35 $742.35 $742.35 $556.88 $742.35 $742.35 $742.35 $371.18 $371.18 $587.94 $742.35 $593.88 $334.06 $147.34 N/A $430.65 $742.35 $445.41 $742.35 $154.71 $742.35 N/A N/A 71141608 SUP HCPCS C1713 71141608 - PLATE BN 148MM TC100 8 HL T SS ORTH 4.5MM SCR LG FRAG SET BOTH IP/OP "$1,026.00" $759.00 $203.61 "$1,025.85" $461.63 $461.63 $461.63 $461.63 "$1,025.85" "$1,025.85" "$1,025.85" $213.81 "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" $213.80 "$1,025.85" "$1,025.85" $606.79 "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" $769.50 "$1,025.85" "$1,025.85" "$1,025.85" $512.93 $512.93 $812.47 "$1,025.85" $820.68 $461.63 $203.61 N/A $595.08 "$1,025.85" $615.51 "$1,025.85" "$1,025.85" "$1,025.85" N/A N/A 71141704 SUP HCPCS C1713 71141704 - PLATE BN 123MM TC100 4 HL HK SS ORTH 4.5MM SCR LG FRAG SET BOTH IP/OP "$2,084.50" "$1,543.00" $413.67 "$2,084.25" $937.91 $937.91 $937.91 $937.91 "$2,084.25" "$2,084.25" "$2,084.25" $434.41 "$2,084.25" "$2,084.25" "$2,084.25" "$2,084.25" "$2,084.25" $434.38 "$2,084.25" "$2,084.25" "$1,232.83" "$2,084.25" "$2,084.25" "$2,084.25" "$2,084.25" "$1,563.38" "$2,084.25" "$2,084.25" "$2,084.25" "$1,042.13" "$1,042.13" "$1,650.73" "$2,084.25" "$1,667.40" $937.91 $413.67 N/A "$1,209.01" "$2,084.25" "$2,084.25" "$2,084.25" $434.36 "$2,084.25" N/A N/A 71141809 SUP HCPCS C1713 71141809 - PLATE BN 188MM TC100 9 HL CBR HD SS ORTH 4.5MM SCR LG FRAG BOTH IP/OP $945.00 $699.00 $187.56 $945.00 $425.25 $425.25 $425.25 $425.25 $945.00 $945.00 $945.00 $196.96 $945.00 $945.00 $945.00 $945.00 $945.00 $196.95 $945.00 $945.00 $558.97 $945.00 $945.00 $945.00 $945.00 $708.75 $945.00 $945.00 $945.00 $472.50 $472.50 $748.44 $945.00 $756.00 $425.25 $187.56 N/A $548.10 $945.00 $567.00 $945.00 $945.00 $945.00 N/A N/A 71141900 SUP HCPCS C1713 71141900 - PLATE BN 20MM TC100 2 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET BOTH IP/OP $345.50 $256.00 $68.56 $345.45 $155.45 $155.45 $155.45 $155.45 $345.45 $345.45 $345.45 $72.00 $345.45 $345.45 $345.45 $345.45 $345.45 $72.00 $345.45 $345.45 $204.33 $345.45 $345.45 $345.45 $345.45 $259.13 $345.45 $345.45 $345.45 $172.73 $172.73 $273.60 $345.45 $276.36 $155.45 $68.56 N/A $200.39 $345.45 $207.27 $345.45 $345.45 $345.45 N/A N/A 71141902 SUP HCPCS C1713 71141902 - PLATE BN 26MM TC100 2 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET BOTH IP/OP $411.00 $304.00 $81.48 $410.55 $184.75 $184.75 $184.75 $184.75 $410.55 $410.55 $410.55 $85.57 $410.55 $410.55 $410.55 $410.55 $410.55 $85.56 $410.55 $410.55 $242.84 $410.55 $410.55 $410.55 $410.55 $308.25 $410.55 $410.55 $410.55 $205.28 $205.28 $325.16 $410.55 $328.44 $184.75 $81.48 N/A $238.38 $410.55 $410.55 $410.55 $410.55 $410.55 N/A N/A 71141904 SUP HCPCS C1713 71141904 - PLATE BN 36MM TC100 4 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET BOTH IP/OP $316.50 $234.00 $62.73 $316.05 $142.22 $142.22 $142.22 $142.22 $316.05 $316.05 $316.05 $65.87 $316.05 $316.05 $316.05 $316.05 $316.05 $65.87 $316.05 $316.05 $186.94 $316.05 $316.05 $316.05 $316.05 $237.38 $316.05 $316.05 $316.05 $158.03 $158.03 $250.31 $316.05 $252.84 $142.22 $62.73 N/A $183.57 $316.05 $189.63 $316.05 $65.86 $316.05 N/A N/A 71141905 SUP HCPCS C1713 71141905 - PLATE BN 44MM TC100 5 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET BOTH IP/OP $376.00 $278.00 $74.61 $375.90 $169.16 $169.16 $169.16 $169.16 $375.90 $375.90 $375.90 $78.35 $375.90 $375.90 $375.90 $375.90 $375.90 $78.34 $375.90 $375.90 $222.34 $375.90 $375.90 $375.90 $375.90 $282.00 $375.90 $375.90 $375.90 $187.95 $187.95 $297.71 $375.90 $300.72 $169.16 $74.61 N/A $218.08 $375.90 $225.54 $375.90 $78.34 $375.90 N/A N/A 71141906 SUP HCPCS C1713 71141906 - PLATE BN 52MM 6 HL 2.7MM SCR BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 71141907 SUP HCPCS C1713 71141907 - PLATE BN 60MM TC100 7 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET BOTH IP/OP $453.00 $335.00 $89.82 $452.55 $203.65 $203.65 $203.65 $203.65 $452.55 $452.55 $452.55 $94.32 $452.55 $452.55 $452.55 $452.55 $452.55 $94.32 $452.55 $452.55 $267.68 $452.55 $452.55 $452.55 $452.55 $339.75 $452.55 $452.55 $452.55 $226.28 $226.28 $358.42 $452.55 $362.04 $203.65 $89.82 N/A $262.74 $452.55 $271.53 $452.55 $94.31 $452.55 N/A N/A 71141908 SUP HCPCS C1713 71141908 - PLATE BN 68MM TC100 8 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET BOTH IP/OP $496.00 $367.00 $98.36 $495.60 $223.02 $223.02 $223.02 $223.02 $495.60 $495.60 $495.60 $103.30 $495.60 $495.60 $495.60 $495.60 $495.60 $103.29 $495.60 $495.60 $293.15 $495.60 $495.60 $495.60 $495.60 $372.00 $495.60 $495.60 $495.60 $247.80 $247.80 $392.52 $495.60 $396.48 $223.02 $98.36 N/A $287.68 $495.60 $297.36 $495.60 $103.28 $495.60 N/A N/A 71141909 SUP HCPCS C1713 71141909 - PLATE BN 76MM TC100 9 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET BOTH IP/OP $639.50 $473.00 $126.91 $639.45 $287.75 $287.75 $287.75 $287.75 $639.45 $639.45 $639.45 $133.28 $639.45 $639.45 $639.45 $639.45 $639.45 $133.27 $639.45 $639.45 $378.23 $639.45 $639.45 $639.45 $639.45 $479.63 $639.45 $639.45 $639.45 $319.73 $319.73 $506.44 $639.45 $511.56 $287.75 $126.91 N/A $370.91 $639.45 $383.67 $639.45 $133.26 $639.45 N/A N/A 71141910 SUP HCPCS C1713 71141910 - PLATE BN 84MM TC100 10 HL CMPR SS ORTH 2.7MM SCR SM FRAG SET BOTH IP/OP $701.50 $519.00 $139.21 $701.40 $315.63 $315.63 $315.63 $315.63 $701.40 $701.40 $701.40 $146.19 $701.40 $701.40 $701.40 $701.40 $701.40 $146.18 $701.40 $701.40 $414.88 $701.40 $701.40 $701.40 $701.40 $526.13 $701.40 $701.40 $701.40 $350.70 $350.70 $555.51 $701.40 $561.12 $315.63 $139.21 N/A $406.87 $701.40 $701.40 $701.40 $146.17 $701.40 N/A N/A 71141912 SUP HCPCS C1713 71141912 - PLATE BN 100MM TC100 12 HL CMPR SS ORTH 2.7MM SCR SM FRAG BOTH IP/OP $777.00 $575.00 $154.22 $777.00 $349.65 $349.65 $349.65 $349.65 $777.00 $777.00 $777.00 $161.95 $777.00 $777.00 $777.00 $777.00 $777.00 $161.94 $777.00 $777.00 $459.60 $777.00 $777.00 $777.00 $777.00 $582.75 $777.00 $777.00 $777.00 $388.50 $388.50 $615.38 $777.00 $621.60 $349.65 $154.22 N/A $450.66 $777.00 $466.20 $777.00 $161.93 $777.00 N/A N/A 71142007 SUP HCPCS C1713 71142007 - PLATE BN 158MM TC100 7 HL BTRS SS CNDYL LT 4.5MM SCR LG FRAG BOTH IP/OP "$1,953.00" "$1,445.00" $387.62 "$1,953.00" $878.85 $878.85 $878.85 $878.85 "$1,953.00" "$1,953.00" "$1,953.00" $407.05 "$1,953.00" "$1,953.00" "$1,953.00" "$1,953.00" "$1,953.00" $407.03 "$1,953.00" $781.20 "$1,155.20" "$1,953.00" "$1,953.00" "$1,953.00" "$1,953.00" "$1,464.75" "$1,953.00" "$1,953.00" "$1,953.00" $976.50 $976.50 "$1,546.78" "$1,953.00" "$1,562.40" $878.85 $387.62 N/A "$1,132.74" "$1,953.00" "$1,171.80" "$1,953.00" $407.01 "$1,953.00" N/A N/A 71142009 SUP HCPCS C1713 71142009 - PLATE BN 190MM TC100 9 HL BTRS SS CNDYL LT 4.5MM SCR LG FRAG BOTH IP/OP "$2,026.50" "$1,500.00" $402.21 "$2,026.50" $911.93 $911.93 $911.93 $911.93 "$2,026.50" "$2,026.50" "$2,026.50" $422.37 "$2,026.50" "$2,026.50" "$2,026.50" "$2,026.50" "$2,026.50" $422.34 "$2,026.50" "$2,026.50" "$1,198.67" "$2,026.50" "$2,026.50" "$2,026.50" "$2,026.50" "$1,519.88" "$2,026.50" "$2,026.50" "$2,026.50" "$1,013.25" "$1,013.25" "$1,604.99" "$2,026.50" "$1,621.20" $911.93 $402.21 N/A "$1,175.37" "$2,026.50" "$1,215.90" "$2,026.50" $422.32 "$2,026.50" N/A N/A 71142011 SUP HCPCS C1713 71142011 - PLATE BN 221MM TC100 11 HL BTRS SS CNDYL LT 4.5MM SCR LG BOTH IP/OP "$2,541.00" "$1,880.00" $504.32 "$2,541.00" "$1,143.45" "$1,143.45" "$1,143.45" "$1,143.45" "$2,541.00" "$2,541.00" "$2,541.00" $529.61 "$2,541.00" "$2,541.00" "$2,541.00" "$2,541.00" "$2,541.00" $529.57 "$2,541.00" "$2,541.00" "$1,252.71" "$2,541.00" "$2,541.00" "$2,541.00" "$2,541.00" "$1,905.75" "$2,541.00" "$2,541.00" "$2,541.00" "$1,270.50" "$1,270.50" "$2,012.47" "$2,541.00" "$2,032.80" "$1,143.45" $504.32 N/A "$1,473.78" "$2,541.00" "$2,541.00" "$2,541.00" $529.54 "$2,541.00" N/A N/A 71142013 SUP HCPCS C1713 71142013 - PLATE BN 253MM TC100 13 HL BTRS SS CNDYL LT 4.5MM SCR LG BOTH IP/OP "$2,137.00" "$1,581.00" $424.09 "$2,136.75" $961.54 $961.54 $961.54 $961.54 "$2,136.75" "$2,136.75" "$2,136.75" $445.35 "$2,136.75" "$2,136.75" "$2,136.75" "$2,136.75" "$2,136.75" $445.32 "$2,136.75" $854.70 "$1,263.89" "$2,136.75" "$2,136.75" "$2,136.75" "$2,136.75" "$1,602.75" "$2,136.75" "$2,136.75" "$2,136.75" "$1,068.38" "$1,068.38" "$1,692.31" "$2,136.75" "$1,709.40" $961.54 $424.09 N/A "$1,239.46" "$2,136.75" "$2,136.75" "$2,136.75" $445.30 "$2,136.75" N/A N/A 71142015 SUP HCPCS C1713 71142015 - PLATE BN 285MM TC100 15 HL BTRS SS CNDYL LT 4.5MM SCR LG BOTH IP/OP "$2,683.00" "$1,985.00" $532.46 "$2,682.75" "$1,207.24" "$1,207.24" "$1,207.24" "$1,207.24" "$2,682.75" "$2,682.75" "$2,682.75" $559.15 "$2,682.75" "$2,682.75" "$2,682.75" "$2,682.75" "$2,682.75" $559.11 "$2,682.75" "$1,073.10" "$1,322.60" "$2,682.75" "$2,682.75" "$2,682.75" "$2,682.75" "$2,012.25" "$2,682.75" "$2,682.75" "$2,682.75" "$1,341.38" "$1,341.38" "$2,124.74" "$2,682.75" "$2,146.20" "$1,207.24" $532.46 N/A "$1,556.14" "$2,682.75" "$1,609.65" "$2,682.75" $559.09 "$2,682.75" N/A N/A 71142107 SUP HCPCS C1713 71142107 - PLATE BN 158MM TC100 7 HL BTRS SS CNDYL RT 4.5MM SCR LG FRAG BOTH IP/OP "$2,368.00" "$1,752.00" $469.94 "$2,367.75" "$1,065.49" "$1,065.49" "$1,065.49" "$1,065.49" "$2,367.75" "$2,367.75" "$2,367.75" $493.50 "$2,367.75" "$2,367.75" "$2,367.75" "$2,367.75" "$2,367.75" $493.47 "$2,367.75" "$2,367.75" "$1,400.52" "$2,367.75" "$2,367.75" "$2,367.75" "$2,367.75" "$1,776.00" "$2,367.75" "$2,367.75" "$2,367.75" "$1,183.88" "$1,183.88" "$1,875.26" "$2,367.75" "$1,894.20" "$1,065.49" $469.94 N/A "$1,373.44" "$2,367.75" "$1,420.65" "$2,367.75" $493.44 "$2,367.75" N/A N/A 71142109 SUP HCPCS C1713 71142109 - PLATE BN 190MM TC100 9 HL BTRS SS CNDYL RT 4.5MM SCR LG FRAG BOTH IP/OP "$2,026.50" "$1,500.00" $402.21 "$2,026.50" $911.93 $911.93 $911.93 $911.93 "$2,026.50" "$2,026.50" "$2,026.50" $422.37 "$2,026.50" "$2,026.50" "$2,026.50" "$2,026.50" "$2,026.50" $422.34 "$2,026.50" "$2,026.50" "$1,198.67" "$2,026.50" "$2,026.50" "$2,026.50" "$2,026.50" "$1,519.88" "$2,026.50" "$2,026.50" "$2,026.50" "$1,013.25" "$1,013.25" "$1,604.99" "$2,026.50" "$1,621.20" $911.93 $402.21 N/A "$1,175.37" "$2,026.50" "$1,215.90" "$2,026.50" $422.32 "$2,026.50" N/A N/A 71142111 SUP HCPCS C1713 71142111 - PLATE BN 221MM TC100 11 HL BTRS SS CNDYL RT 4.5MM SCR LG BOTH IP/OP "$2,541.00" "$1,880.00" $504.32 "$2,541.00" "$1,143.45" "$1,143.45" "$1,143.45" "$1,143.45" "$2,541.00" "$2,541.00" "$2,541.00" $529.61 "$2,541.00" "$2,541.00" "$2,541.00" "$2,541.00" "$2,541.00" $529.57 "$2,541.00" "$2,541.00" "$1,252.71" "$2,541.00" "$2,541.00" "$2,541.00" "$2,541.00" "$1,905.75" "$2,541.00" "$2,541.00" "$2,541.00" "$1,270.50" "$1,270.50" "$2,012.47" "$2,541.00" "$2,032.80" "$1,143.45" $504.32 N/A "$1,473.78" "$2,541.00" "$1,524.60" "$2,541.00" $529.54 "$2,541.00" N/A N/A 71142113 SUP HCPCS C1713 71142113 - PLATE BN 253MM TC100 13 HL BTRS SS CNDYL RT 4.5MM SCR LG BOTH IP/OP "$2,604.00" "$1,927.00" $516.83 "$2,604.00" "$1,171.80" "$1,171.80" "$1,171.80" "$1,171.80" "$2,604.00" "$2,604.00" "$2,604.00" $542.74 "$2,604.00" "$2,604.00" "$2,604.00" "$2,604.00" "$2,604.00" $542.70 "$2,604.00" "$2,604.00" "$1,283.77" "$2,604.00" "$2,604.00" "$2,604.00" "$2,604.00" "$1,953.00" "$2,604.00" "$2,604.00" "$2,604.00" "$1,302.00" "$1,302.00" "$2,062.37" "$2,604.00" "$2,083.20" "$1,171.80" $516.83 N/A "$1,510.32" "$2,604.00" "$2,604.00" "$2,604.00" $542.67 "$2,604.00" N/A N/A 71142115 SUP HCPCS C1713 71142115 - PLATE BN 285MM TC100 15 HL BTRS SS CNDYL RT 4.5MM SCR LG BOTH IP/OP "$2,683.00" "$1,985.00" $532.46 "$2,682.75" "$1,207.24" "$1,207.24" "$1,207.24" "$1,207.24" "$2,682.75" "$2,682.75" "$2,682.75" $559.15 "$2,682.75" "$2,682.75" "$2,682.75" "$2,682.75" "$2,682.75" $559.11 "$2,682.75" "$2,682.75" "$1,322.60" "$2,682.75" "$2,682.75" "$2,682.75" "$2,682.75" "$2,012.25" "$2,682.75" "$2,682.75" "$2,682.75" "$1,341.38" "$1,341.38" "$2,124.74" "$2,682.75" "$2,146.20" "$1,207.24" $532.46 N/A "$1,556.14" "$2,682.75" "$2,682.75" "$2,682.75" $559.09 "$2,682.75" N/A N/A 71143004 SUP HCPCS C1713 71143004 - WASHER ORTH 4.5MM 2.2MM STRL TC100 SS BOTH IP/OP $94.50 $70.00 $18.74 $94.40 $42.48 $42.48 $42.48 $42.48 $94.40 $94.40 $94.40 $19.68 $94.40 $94.40 $94.40 $94.40 $94.40 $19.67 $94.40 $67.73 $55.84 $94.40 $67.73 $94.40 $94.40 $70.88 $94.40 $94.40 $94.40 $47.20 $47.20 $74.76 $94.40 $75.52 $42.48 $18.74 N/A $54.81 $94.40 $56.64 $94.40 $19.67 $94.40 N/A N/A 71143007 SUP HCPCS C1713 71143007 - WASHER ORTH 7MM 3.7MM STRL TC100 SS BOTH IP/OP $94.50 $70.00 $18.74 $94.40 $42.48 $42.48 $42.48 $42.48 $94.40 $94.40 $94.40 $19.68 $94.40 $94.40 $94.40 $94.40 $94.40 $19.67 $94.40 $27.09 $55.84 $94.40 $67.73 $94.40 $94.40 $70.88 $94.40 $94.40 $94.40 $47.20 $47.20 $74.76 $94.40 $75.52 $42.48 $18.74 N/A $54.81 $94.40 $56.64 $94.40 $19.67 $94.40 N/A N/A 71143010 SUP HCPCS C1713 71143010 - WASHER ORTH THK2MM 10MM ILZ SPC CIRC BOTH IP/OP $109.00 $81.00 $21.63 $109.00 $49.05 $49.05 $49.05 $49.05 $109.00 $109.00 $109.00 $22.72 $109.00 $109.00 $109.00 $109.00 $109.00 $22.72 $109.00 $78.23 $64.47 $109.00 $78.23 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $49.05 $21.63 N/A $63.22 $109.00 $109.00 $109.00 $22.72 $109.00 N/A N/A 71143013 SUP HCPCS C1713 71143013 - WASHER ORTH 13MM 6.6MM STRL TC100 SS BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $54.00 $54.00 $54.00 $54.00 $120.00 $120.00 $120.00 $25.01 $120.00 $120.00 $120.00 $120.00 $120.00 $25.01 $120.00 $85.58 $70.98 $120.00 $85.58 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $54.00 $23.82 N/A $69.60 $120.00 $72.00 $120.00 $120.00 $120.00 N/A N/A 71143045 SUP HCPCS C1713 71143045 - NUT ORTH STRL TC100 SS 4.5 MM CORT SCR BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $77.55 $77.55 N/A N/A 71143104 SUP HCPCS C1713 71143104 - WASHER ORTH 4.5MM 2.2MM NS TC100 SS BOTH IP/OP $94.50 $70.00 $18.74 $94.40 $42.48 $42.48 $42.48 $42.48 $94.40 $94.40 $94.40 $19.68 $94.40 $94.40 $94.40 $94.40 $94.40 $19.67 $94.40 $67.73 $55.84 $94.40 $67.73 $94.40 $94.40 $70.88 $94.40 $94.40 $94.40 $47.20 $47.20 $74.76 $94.40 $75.52 $42.48 $18.74 N/A $54.81 $94.40 $56.64 $94.40 $94.40 $94.40 N/A N/A 71143107 SUP HCPCS C1713 71143107 - WASHER ORTH HEX 7MM NS TC100 BOTH IP/OP $94.50 $70.00 $18.74 $94.40 $42.48 $42.48 $42.48 $42.48 $94.40 $94.40 $94.40 $19.68 $94.40 $94.40 $94.40 $94.40 $94.40 $19.67 $94.40 $67.73 $55.84 $94.40 $67.73 $94.40 $94.40 $70.88 $94.40 $94.40 $94.40 $47.20 $47.20 $74.76 $94.40 $75.52 $42.48 $18.74 N/A $54.81 $94.40 $56.64 $94.40 $94.40 $94.40 N/A N/A 71143110 SUP HCPCS C1713 71143110 - WASHER ORTH 10MM NS TC100 BOTH IP/OP $109.00 $81.00 $21.63 $109.00 $49.05 $49.05 $49.05 $49.05 $109.00 $109.00 $109.00 $22.72 $109.00 $109.00 $109.00 $109.00 $109.00 $22.72 $109.00 $78.23 $64.47 $109.00 $78.23 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $49.05 $21.63 N/A $63.22 $109.00 $65.40 $109.00 $109.00 $109.00 N/A N/A 71143113 SUP HCPCS C1713 71143113 - WASHER ORTH 13MM NS TC100 SS BOTH IP/OP $94.50 $70.00 $18.74 $94.40 $42.48 $42.48 $42.48 $42.48 $94.40 $94.40 $94.40 $19.68 $94.40 $94.40 $94.40 $94.40 $94.40 $19.67 $94.40 $67.73 $55.84 $94.40 $67.73 $94.40 $94.40 $70.88 $94.40 $94.40 $94.40 $47.20 $47.20 $74.76 $94.40 $75.52 $42.48 $18.74 N/A $54.81 $94.40 $56.64 $94.40 $94.40 $94.40 N/A N/A 71144010 SUP HCPCS C1713 71144010 - PLATE BN 60MM STRL TC100 TMPLT SS CALCANEUS 3.5MM CORT SCR 4 BOTH IP/OP "$1,339.00" $991.00 $265.71 "$1,338.75" $602.44 $602.44 $602.44 $602.44 "$1,338.75" "$1,338.75" "$1,338.75" $279.03 "$1,338.75" "$1,338.75" "$1,338.75" "$1,338.75" "$1,338.75" $279.01 "$1,338.75" $535.50 $791.87 "$1,338.75" "$1,338.75" "$1,338.75" "$1,338.75" "$1,004.25" "$1,338.75" "$1,338.75" "$1,338.75" $669.38 $669.38 "$1,060.29" "$1,338.75" "$1,071.00" $602.44 $265.71 N/A $776.62 "$1,338.75" $803.25 "$1,338.75" "$1,338.75" "$1,338.75" N/A N/A 71144011 SUP HCPCS C1713 71144011 - PLATE BN 70MM STRL TC100 TMPLT SS CALCANEUS 3.5MM CORT SCR 4 BOTH IP/OP "$1,354.50" "$1,002.00" $268.83 "$1,354.50" $609.53 $609.53 $609.53 $609.53 "$1,354.50" "$1,354.50" "$1,354.50" $282.31 "$1,354.50" "$1,354.50" "$1,354.50" "$1,354.50" "$1,354.50" $282.29 "$1,354.50" "$1,354.50" $801.19 "$1,354.50" "$1,354.50" "$1,354.50" "$1,354.50" "$1,015.88" "$1,354.50" "$1,354.50" "$1,354.50" $677.25 $677.25 "$1,072.76" "$1,354.50" "$1,083.60" $609.53 $268.83 N/A $785.61 "$1,354.50" $812.70 "$1,354.50" "$1,354.50" "$1,354.50" N/A N/A 71144012 SUP HCPCS C1713 71144012 - PLATE BN STRL TC100 9 HL BNDRG TMPLT SS CALCANEUS 3.5 MM SCR BOTH IP/OP "$1,559.50" "$1,154.00" $309.47 "$1,559.25" $701.66 $701.66 $701.66 $701.66 "$1,559.25" "$1,559.25" "$1,559.25" $324.99 "$1,559.25" "$1,559.25" "$1,559.25" "$1,559.25" "$1,559.25" $324.96 "$1,559.25" $623.70 $922.30 "$1,559.25" "$1,559.25" "$1,559.25" "$1,559.25" "$1,169.63" "$1,559.25" "$1,559.25" "$1,559.25" $779.63 $779.63 "$1,234.93" "$1,559.25" "$1,247.40" $701.66 $309.47 N/A $904.51 "$1,559.25" "$1,559.25" "$1,559.25" $324.95 "$1,559.25" N/A N/A 71145020 SUP HCPCS C1713 71145020 - PLATE BN 100MM TC100 20 HL STRG SS ORTH 1.5MM SCR MN FRAG BOTH IP/OP $570.50 $422.00 $113.16 $570.15 $256.57 $256.57 $256.57 $256.57 $570.15 $570.15 $570.15 $118.83 $570.15 $570.15 $570.15 $570.15 $570.15 $118.83 $570.15 $570.15 $337.24 $570.15 $570.15 $570.15 $570.15 $427.88 $570.15 $570.15 $570.15 $285.08 $285.08 $451.56 $570.15 $456.12 $256.57 $113.16 N/A $330.89 $570.15 $570.15 $570.15 $118.82 $570.15 N/A N/A 71145022 SUP HCPCS C1713 71145022 - PLATE BN TC100 3 HLE/HD 9 HL SHFT T SS ORTH 1.5 MM SCR MN BOTH IP/OP $504.00 $373.00 $100.03 $504.00 $226.80 $226.80 $226.80 $226.80 $504.00 $504.00 $504.00 $105.05 $504.00 $504.00 $504.00 $504.00 $504.00 $105.04 $504.00 $201.60 $298.12 $504.00 $504.00 $504.00 $504.00 $378.00 $504.00 $504.00 $504.00 $252.00 $252.00 $399.17 $504.00 $403.20 $226.80 $100.03 N/A $292.32 $504.00 $504.00 $504.00 $105.03 $504.00 N/A N/A 71145024 SUP HCPCS C1713 71145024 - PLATE BN TC100 4 HLE/HD 9 HL SHFT T SS ORTH 1.5 MM SCR MN BOTH IP/OP $534.50 $396.00 $106.07 $534.45 $240.50 $240.50 $240.50 $240.50 $534.45 $534.45 $534.45 $111.39 $534.45 $534.45 $534.45 $534.45 $534.45 $111.39 $534.45 $534.45 $316.13 $534.45 $534.45 $534.45 $534.45 $400.88 $534.45 $534.45 $534.45 $267.23 $267.23 $423.28 $534.45 $427.56 $240.50 $106.07 N/A $310.01 $534.45 $534.45 $534.45 $111.38 $534.45 N/A N/A 71145026 SUP HCPCS C1713 71145026 - PLATE BN TC100 7 HL SS CNDYL LT 1.5 MM SCR MN FRAG SET BOTH IP/OP $709.00 $525.00 $140.67 $708.75 $318.94 $318.94 $318.94 $318.94 $708.75 $708.75 $708.75 $147.72 $708.75 $708.75 $708.75 $708.75 $708.75 $147.71 $708.75 $283.50 $419.23 $708.75 $708.75 $708.75 $708.75 $531.75 $708.75 $708.75 $708.75 $354.38 $354.38 $561.33 $708.75 $567.00 $318.94 $140.67 N/A $411.22 $708.75 $708.75 $708.75 $147.70 $708.75 N/A N/A 71145028 SUP HCPCS C1713 71145028 - PLATE BN TC100 7 HL SS CNDYL RT 1.5 MM SCR MN FRAG SET BOTH IP/OP $709.00 $525.00 $140.67 $708.75 $318.94 $318.94 $318.94 $318.94 $708.75 $708.75 $708.75 $147.72 $708.75 $708.75 $708.75 $708.75 $708.75 $147.71 $708.75 $708.75 $419.23 $708.75 $708.75 $708.75 $708.75 $531.75 $708.75 $708.75 $708.75 $354.38 $354.38 $561.33 $708.75 $567.00 $318.94 $140.67 N/A $411.22 $708.75 $708.75 $708.75 $147.70 $708.75 N/A N/A 71145030 SUP HCPCS C1713 71145030 - PLATE BN TC100 4 HL H SS ORTH 1.5 MM SCR MN FRAG SET BOTH IP/OP $406.50 $301.00 $80.65 $406.35 $182.86 $182.86 $182.86 $182.86 $406.35 $406.35 $406.35 $84.69 $406.35 $406.35 $406.35 $406.35 $406.35 $84.69 $406.35 $162.54 $240.36 $406.35 $406.35 $406.35 $406.35 $304.88 $406.35 $406.35 $406.35 $203.18 $203.18 $321.83 $406.35 $325.08 $182.86 $80.65 N/A $235.77 $406.35 $406.35 $406.35 $406.35 $406.35 N/A N/A 71146020 SUP HCPCS C1713 71146020 - PLATE BN 20MM TC100 3 HL STRG SS CNDYL 2MM SCR MN FRAG SET BOTH IP/OP $134.50 $100.00 $26.68 $134.40 $60.48 $60.48 $60.48 $60.48 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $79.50 $134.40 $134.40 $134.40 $134.40 $100.88 $134.40 $134.40 $134.40 $67.20 $67.20 $106.44 $134.40 $107.52 $60.48 $26.68 N/A $78.01 $134.40 $134.40 $134.40 $134.40 $134.40 N/A N/A 71146022 SUP HCPCS C1713 71146022 - PLATE BN 22MM TC100 4 HL STRG SS CNDYL 2MM SCR MN FRAG SET BOTH IP/OP $148.50 $110.00 $29.38 $148.05 $66.62 $66.62 $66.62 $66.62 $148.05 $148.05 $148.05 $30.86 $148.05 $148.05 $148.05 $148.05 $148.05 $30.86 $148.05 $59.22 $87.57 $148.05 $148.05 $148.05 $148.05 $111.38 $148.05 $148.05 $148.05 $74.03 $74.03 $117.26 $148.05 $118.44 $66.62 $29.38 N/A $86.13 $148.05 $148.05 $148.05 $30.85 $148.05 N/A N/A 71146024 SUP HCPCS C1713 71146024 - PLATE BN 24MM TC100 5 HL STRG SS CNDYL 2MM SCR MN FRAG SET BOTH IP/OP $160.00 $118.00 $31.68 $159.60 $71.82 $71.82 $71.82 $71.82 $159.60 $159.60 $159.60 $33.26 $159.60 $159.60 $159.60 $159.60 $159.60 $33.26 $159.60 $159.60 $94.40 $159.60 $159.60 $159.60 $159.60 $120.00 $159.60 $159.60 $159.60 $79.80 $79.80 $126.40 $159.60 $127.68 $71.82 $31.68 N/A $92.80 $159.60 $159.60 $159.60 $33.26 $159.60 N/A N/A 71146026 SUP HCPCS C1713 71146026 - PLATE BN 35MM TC100 6 HL STRG SS ORTH 2MM SCR MN FRAG SET BOTH IP/OP $177.50 $131.00 $35.22 $177.45 $79.85 $79.85 $79.85 $79.85 $177.45 $177.45 $177.45 $36.99 $177.45 $177.45 $177.45 $177.45 $177.45 $36.98 $177.45 $70.98 $104.96 $177.45 $177.45 $177.45 $177.45 $133.13 $177.45 $177.45 $177.45 $88.73 $88.73 $140.54 $177.45 $141.96 $79.85 $35.22 N/A $102.95 $177.45 $177.45 $177.45 $36.98 $177.45 N/A N/A 71146028 SUP HCPCS C1713 71146028 - PLATE BN 28MM TC100 20 HL STRG SS CNDYL 2MM SCR MN FRAG SET BOTH IP/OP $568.50 $421.00 $112.74 $568.05 $255.62 $255.62 $255.62 $255.62 $568.05 $568.05 $568.05 $118.40 $568.05 $568.05 $568.05 $568.05 $568.05 $118.39 $568.05 $568.05 $336.00 $568.05 $568.05 $568.05 $568.05 $426.38 $568.05 $568.05 $568.05 $284.03 $284.03 $449.90 $568.05 $454.44 $255.62 $112.74 N/A $329.73 $568.05 $568.05 $568.05 $118.38 $568.05 N/A N/A 71146030 SUP HCPCS C1713 71146030 - PLATE BN 5X1.2MM TC100 3 HLE/HD 9 HL SHFT T SS CNDYL 2MM SCR BOTH IP/OP $504.00 $373.00 $100.03 $504.00 $226.80 $226.80 $226.80 $226.80 $504.00 $504.00 $504.00 $105.05 $504.00 $504.00 $504.00 $504.00 $504.00 $105.04 $504.00 $504.00 $298.12 $504.00 $504.00 $504.00 $504.00 $378.00 $504.00 $504.00 $504.00 $252.00 $252.00 $399.17 $504.00 $403.20 $226.80 $100.03 N/A $292.32 $504.00 $504.00 $504.00 $504.00 $504.00 N/A N/A 71146032 SUP HCPCS C1713 71146032 - PLATE BN 5X1.2MM TC100 4 HLE/HD 9 HL SHFT T SS CNDYL 2MM SCR BOTH IP/OP $534.50 $396.00 $106.07 $534.45 $240.50 $240.50 $240.50 $240.50 $534.45 $534.45 $534.45 $111.39 $534.45 $534.45 $534.45 $534.45 $534.45 $111.39 $534.45 $213.78 $316.13 $534.45 $534.45 $534.45 $534.45 $400.88 $534.45 $534.45 $534.45 $267.23 $267.23 $423.28 $534.45 $427.56 $240.50 $106.07 N/A $310.01 $534.45 $534.45 $534.45 $534.45 $534.45 N/A N/A 71146034 SUP HCPCS C1713 71146034 - PLATE BN 5X.9MM TC100 2 HLE/HD 2 HL SHFT T SS CNDYL 2MM SCR BOTH IP/OP $134.50 $100.00 $26.68 $134.40 $60.48 $60.48 $60.48 $60.48 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $79.50 $134.40 $134.40 $134.40 $134.40 $100.88 $134.40 $134.40 $134.40 $67.20 $67.20 $106.44 $134.40 $107.52 $60.48 $26.68 N/A $78.01 $134.40 $80.64 $134.40 $134.40 $134.40 N/A N/A 71146036 SUP HCPCS C1713 71146036 - PLATE BN 5X.9MM TC100 2 HL SHFT L RT OBLQ SS CNDYL 2MM SCR BOTH IP/OP $134.50 $100.00 $26.68 $134.40 $60.48 $60.48 $60.48 $60.48 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $134.40 $134.40 $134.40 $28.01 $134.40 $53.76 $79.50 $134.40 $134.40 $134.40 $134.40 $100.88 $134.40 $134.40 $134.40 $67.20 $67.20 $106.44 $134.40 $107.52 $60.48 $26.68 N/A $78.01 $134.40 $80.64 $134.40 $28.01 $134.40 N/A N/A 71146038 SUP HCPCS C1713 71146038 - PLATE BN 5X.9MM TC100 2 HL SHFT L LT OBLQ SS CNDYL 2MM SCR BOTH IP/OP $134.50 $100.00 $26.68 $134.40 $60.48 $60.48 $60.48 $60.48 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $134.40 $134.40 $134.40 $28.01 $134.40 $53.76 $79.50 $134.40 $134.40 $134.40 $134.40 $100.88 $134.40 $134.40 $134.40 $67.20 $67.20 $106.44 $134.40 $107.52 $60.48 $26.68 N/A $78.01 $134.40 $134.40 $134.40 $28.01 $134.40 N/A N/A 71146040 SUP HCPCS C1713 71146040 - PLATE BN TC100 7 HL SS CNDYL LT 2 MM SCR MN FRAG SET BOTH IP/OP $678.50 $502.00 $134.63 $678.30 $305.24 $305.24 $305.24 $305.24 $678.30 $678.30 $678.30 $141.37 $678.30 $678.30 $678.30 $678.30 $678.30 $141.37 $678.30 $678.30 $401.21 $678.30 $678.30 $678.30 $678.30 $508.88 $678.30 $678.30 $678.30 $339.15 $339.15 $537.21 $678.30 $542.64 $305.24 $134.63 N/A $393.53 $678.30 $678.30 $678.30 $141.36 $678.30 N/A N/A 71146042 SUP HCPCS C1713 71146042 - PLATE BN 39X5X12MM TC100 7 HL SS CNDYL RT 2MM SCR MN FRAG BOTH IP/OP $678.50 $502.00 $134.63 $678.30 $305.24 $305.24 $305.24 $305.24 $678.30 $678.30 $678.30 $141.37 $678.30 $678.30 $678.30 $678.30 $678.30 $141.37 $678.30 $271.32 $401.21 $678.30 $678.30 $678.30 $678.30 $508.88 $678.30 $678.30 $678.30 $339.15 $339.15 $537.21 $678.30 $542.64 $305.24 $134.63 N/A $393.53 $678.30 $678.30 $678.30 $141.36 $678.30 N/A N/A 71146044 SUP HCPCS C1713 71146044 - PLATE BN TC100 L SS RT ORTH 2 MM SCR MN FRAG SET BOTH IP/OP $134.50 $100.00 $26.68 $134.40 $60.48 $60.48 $60.48 $60.48 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $79.50 $134.40 $134.40 $134.40 $134.40 $100.88 $134.40 $134.40 $134.40 $67.20 $67.20 $106.44 $134.40 $107.52 $60.48 $26.68 N/A $78.01 $134.40 $134.40 $134.40 $28.01 $134.40 N/A N/A 71146046 SUP HCPCS C1713 71146046 - PLATE BN TC100 L SS LT ORTH 2 MM SCR MN FRAG SET BOTH IP/OP $134.50 $100.00 $26.68 $134.40 $60.48 $60.48 $60.48 $60.48 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $134.40 $134.40 $134.40 $28.01 $134.40 $53.76 $79.50 $134.40 $134.40 $134.40 $134.40 $100.88 $134.40 $134.40 $134.40 $67.20 $67.20 $106.44 $134.40 $107.52 $60.48 $26.68 N/A $78.01 $134.40 $134.40 $134.40 $28.01 $134.40 N/A N/A 71146048 SUP HCPCS C1713 71146048 - PLATE BN TC100 4 HL H SS ORTH 2 MM SCR MN FRAG SET BOTH IP/OP $406.50 $301.00 $80.65 $406.35 $182.86 $182.86 $182.86 $182.86 $406.35 $406.35 $406.35 $84.69 $406.35 $406.35 $406.35 $406.35 $406.35 $84.69 $406.35 $406.35 $240.36 $406.35 $406.35 $406.35 $406.35 $304.88 $406.35 $406.35 $406.35 $203.18 $203.18 $321.83 $406.35 $325.08 $182.86 $80.65 N/A $235.77 $406.35 $406.35 $406.35 $84.68 $406.35 N/A N/A 71147001 SUP HCPCS C1713 71147001 - PLATE BN TC100 L SS RT ORTH 2.7 MM SCR MN FRAG SET BOTH IP/OP $143.00 $106.00 $28.34 $142.80 $64.26 $64.26 $64.26 $64.26 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $142.80 $142.80 $142.80 $29.76 $142.80 $57.12 $84.47 $142.80 $142.80 $142.80 $142.80 $107.25 $142.80 $142.80 $142.80 $71.40 $71.40 $113.10 $142.80 $114.24 $64.26 $28.34 N/A $82.94 $142.80 $142.80 $142.80 $29.76 $142.80 N/A N/A 71147002 SUP HCPCS C1713 71147002 - PLATE BN 35X7X1.2MM TC100 L LT OBLQ SS CNDYL 2.7MM SCR MN BOTH IP/OP $143.00 $106.00 $28.34 $142.80 $64.26 $64.26 $64.26 $64.26 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $142.80 $142.80 $142.80 $29.76 $142.80 $57.12 $84.47 $142.80 $142.80 $142.80 $142.80 $107.25 $142.80 $142.80 $142.80 $71.40 $71.40 $113.10 $142.80 $114.24 $64.26 $28.34 N/A $82.94 $142.80 $142.80 $142.80 $29.76 $142.80 N/A N/A 71147003 SUP HCPCS C1713 71147003 - PLATE BN TC100 L SS LT ORTH 2.7 MM SCR MN FRAG SET BOTH IP/OP $143.00 $106.00 $28.34 $142.80 $64.26 $64.26 $64.26 $64.26 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $142.80 $142.80 $142.80 $29.76 $142.80 $57.12 $84.47 $142.80 $142.80 $142.80 $142.80 $107.25 $142.80 $142.80 $142.80 $71.40 $71.40 $113.10 $142.80 $114.24 $64.26 $28.34 N/A $82.94 $142.80 $142.80 $142.80 $29.76 $142.80 N/A N/A 71147004 SUP HCPCS C1713 71147004 - PLATE BN 35X7X1.2MM TC100 L RT OBLQ SS CNDYL 2.7MM SCR MN BOTH IP/OP $143.00 $106.00 $28.34 $142.80 $64.26 $64.26 $64.26 $64.26 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $142.80 $142.80 $142.80 $29.76 $142.80 $57.12 $84.47 $142.80 $142.80 $142.80 $142.80 $107.25 $142.80 $142.80 $142.80 $71.40 $71.40 $113.10 $142.80 $114.24 $64.26 $28.34 N/A $82.94 $142.80 $142.80 $142.80 $29.76 $142.80 N/A N/A 71147006 SUP HCPCS C1713 71147006 - PLATE BN 32X7X1.2MM TC100 3 HL T SS CNDYL 2.7MM SCR MN FRAG BOTH IP/OP $143.00 $106.00 $28.34 $142.80 $64.26 $64.26 $64.26 $64.26 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $142.80 $142.80 $142.80 $29.76 $142.80 $57.12 $84.47 $142.80 $142.80 $142.80 $142.80 $107.25 $142.80 $142.80 $142.80 $71.40 $71.40 $113.10 $142.80 $114.24 $64.26 $28.34 N/A $82.94 $142.80 $142.80 $142.80 $142.80 $142.80 N/A N/A 71147008 SUP HCPCS C1713 71147008 - PLATE BN 57X7X1.4MM TC100 7 HL SS CNDYL LT 2.7MM SCR MN FRAG BOTH IP/OP $720.50 $533.00 $142.96 $720.30 $324.14 $324.14 $324.14 $324.14 $720.30 $720.30 $720.30 $150.13 $720.30 $720.30 $720.30 $720.30 $720.30 $150.12 $720.30 $288.12 $426.06 $720.30 $720.30 $720.30 $720.30 $540.38 $720.30 $720.30 $720.30 $360.15 $360.15 $570.48 $720.30 $576.24 $324.14 $142.96 N/A $417.89 $720.30 $720.30 $720.30 $720.30 $720.30 N/A N/A 71147010 SUP HCPCS C1713 71147010 - PLATE BN 57X7X1.4MM TC100 7 HL SS CNDYL RT 2.7MM SCR MN FRAG BOTH IP/OP $720.50 $533.00 $142.96 $720.30 $324.14 $324.14 $324.14 $324.14 $720.30 $720.30 $720.30 $150.13 $720.30 $720.30 $720.30 $720.30 $720.30 $150.12 $720.30 $288.12 $426.06 $720.30 $720.30 $720.30 $720.30 $540.38 $720.30 $720.30 $720.30 $360.15 $360.15 $570.48 $720.30 $576.24 $324.14 $142.96 N/A $417.89 $720.30 $720.30 $720.30 $720.30 $720.30 N/A N/A 71147012 SUP HCPCS C1713 71147012 - PLATE BN TC100 7 HL MULTIFRAGMENT SS ORTH 2.7 MM SCR MN FRAG BOTH IP/OP $169.50 $125.00 $33.55 $169.05 $76.07 $76.07 $76.07 $76.07 $169.05 $169.05 $169.05 $35.23 $169.05 $169.05 $169.05 $169.05 $169.05 $35.23 $169.05 $169.05 $99.99 $169.05 $169.05 $169.05 $169.05 $127.13 $169.05 $169.05 $169.05 $84.53 $84.53 $133.89 $169.05 $135.24 $76.07 $33.55 N/A $98.31 $169.05 $169.05 $169.05 $35.23 $169.05 N/A N/A 71148003 SUP HCPCS C1713 71148003 - PLATE BN 23MM TC100 3 HL .25 TBLR SS ORTH 2.7MM SCR MN FRAG BOTH IP/OP $160.00 $118.00 $31.68 $159.60 $71.82 $71.82 $71.82 $71.82 $159.60 $159.60 $159.60 $33.26 $159.60 $159.60 $159.60 $159.60 $159.60 $33.26 $159.60 $63.84 $94.40 $159.60 $159.60 $159.60 $159.60 $120.00 $159.60 $159.60 $159.60 $79.80 $79.80 $126.40 $159.60 $127.68 $71.82 $31.68 N/A $92.80 $159.60 $159.60 $159.60 $33.26 $159.60 N/A N/A 71148004 SUP HCPCS C1713 71148004 - PLATE BN 31MM TC100 4 HL .25 TBLR SS CNDYL 2.7MM SCR MN FRAG BOTH IP/OP $175.50 $130.00 $34.80 $175.35 $78.91 $78.91 $78.91 $78.91 $175.35 $175.35 $175.35 $36.55 $175.35 $175.35 $175.35 $175.35 $175.35 $36.54 $175.35 $175.35 $103.72 $175.35 $175.35 $175.35 $175.35 $131.63 $175.35 $175.35 $175.35 $87.68 $87.68 $138.88 $175.35 $140.28 $78.91 $34.80 N/A $101.79 $175.35 $175.35 $175.35 $36.54 $175.35 N/A N/A 71148005 SUP HCPCS C1713 71148005 - PLATE BN 39MM TC100 5 HL .25 TBLR SS CNDYL 2.7MM SCR MN FRAG BOTH IP/OP $186.00 $138.00 $36.89 $185.85 $83.63 $83.63 $83.63 $83.63 $185.85 $185.85 $185.85 $38.74 $185.85 $185.85 $185.85 $185.85 $185.85 $38.73 $185.85 $74.34 $109.93 $185.85 $185.85 $185.85 $185.85 $139.50 $185.85 $185.85 $185.85 $92.93 $92.93 $147.19 $185.85 $148.68 $83.63 $36.89 N/A $107.88 $185.85 $185.85 $185.85 $38.73 $185.85 N/A N/A 71148006 SUP HCPCS C1713 71148006 - PLATE BN 47MM TC100 6 HL .25 TBLR SS CNDYL 2.7MM SCR MN FRAG BOTH IP/OP $206.00 $152.00 $40.85 $205.80 $92.61 $92.61 $92.61 $92.61 $205.80 $205.80 $205.80 $42.89 $205.80 $205.80 $205.80 $205.80 $205.80 $42.89 $205.80 $205.80 $121.73 $205.80 $205.80 $205.80 $205.80 $154.50 $205.80 $205.80 $205.80 $102.90 $102.90 $162.99 $205.80 $164.64 $92.61 $40.85 N/A $119.48 $205.80 $205.80 $205.80 $42.89 $205.80 N/A N/A 71148007 SUP HCPCS C1713 71148007 - PLATE BN 55MM TC100 7 HL .25 TBLR SS ORTH 2.7MM SCR MN FRAG BOTH IP/OP $214.50 $159.00 $42.51 $214.20 $96.39 $96.39 $96.39 $96.39 $214.20 $214.20 $214.20 $44.64 $214.20 $214.20 $214.20 $214.20 $214.20 $44.64 $214.20 $85.68 $126.70 $214.20 $214.20 $214.20 $214.20 $160.88 $214.20 $214.20 $214.20 $107.10 $107.10 $169.65 $214.20 $171.36 $96.39 $42.51 N/A $124.41 $214.20 $214.20 $214.20 $44.64 $214.20 N/A N/A 71148008 SUP HCPCS C1713 71148008 - PLATE BN 63MM TC100 QT TBLR SS ORTH 2.7MM SCR MN FRAG SET BOTH IP/OP $228.00 $169.00 $45.22 $227.85 $102.53 $102.53 $102.53 $102.53 $227.85 $227.85 $227.85 $47.49 $227.85 $227.85 $227.85 $227.85 $227.85 $47.49 $227.85 $227.85 $134.77 $227.85 $227.85 $227.85 $227.85 $171.00 $227.85 $227.85 $227.85 $113.93 $113.93 $180.46 $227.85 $182.28 $102.53 $45.22 N/A $132.24 $227.85 $227.85 $227.85 $47.48 $227.85 N/A N/A 71149006 SUP HCPCS C1713 71149006 - SCREW BN 1.5MM 6MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149007 SUP HCPCS C1713 71149007 - SCREW BN 1.5MM 7MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149008 SUP HCPCS C1713 71149008 - SCREW BN 1.5MM 8MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149009 SUP HCPCS C1713 71149009 - SCREW BN 1.5MM 9MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $75.70 $75.70 N/A N/A 71149010 SUP HCPCS C1713 71149010 - SCREW BN 1.5MM 10MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149011 SUP HCPCS C1713 71149011 - SCREW BN 1.5MM 11MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149012 SUP HCPCS C1713 71149012 - SCREW BN 1.5MM 12MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149014 SUP HCPCS C1713 71149014 - SCREW BN 1.5MM 14MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 71149016 SUP HCPCS C1713 71149016 - SCREW BN 1.5MM 16MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149018 SUP HCPCS C1713 71149018 - SCREW BN 1.5MM 18MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149020 SUP HCPCS C1713 71149020 - SCREW BN 1.5MM 20MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149022 SUP HCPCS C1713 71149022 - SCREW BN 1.5MM 22MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149024 SUP HCPCS C1713 71149024 - SCREW BN 1.5MM 24MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149106 SUP HCPCS C1713 71149106 - SCREW BN 1.5MM 6MM TC100 ST HEX SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $77.55 $77.55 N/A N/A 71149107 SUP HCPCS C1713 71149107 - SCREW BN 1.5MM 7MM TC100 ST HEX SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149108 SUP HCPCS C1713 71149108 - SCREW BN 1.5MM 8MM TC100 ST HEX SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $77.55 $77.55 N/A N/A 71149109 SUP HCPCS C1713 71149109 - SCREW BN 1.5MM 9MM TC100 ST HEX SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $77.55 $77.55 N/A N/A 71149110 SUP HCPCS C1713 71149110 - SCREW BN 1.5MM 10MM TC100 ST HEX SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $77.55 $77.55 N/A N/A 71149111 SUP HCPCS C1713 71149111 - SCREW BN 1.5MM 11MM TC100 ST HEX SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149112 SUP HCPCS C1713 71149112 - SCREW BN 1.5MM 12MM TC100 ST HEX SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149114 SUP HCPCS C1713 71149114 - SCREW BN 1.5MM 14MM TC100 ST HEX SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149116 SUP HCPCS C1713 71149116 - SCREW BN 1.5MM 16MM TC100 ST HEX SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149118 SUP HCPCS C1713 71149118 - SCREW BN 1.5MM 3MM 18MM TC100 HEX HD ST SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149120 SUP HCPCS C1713 71149120 - SCREW BN 1.5MM 3MM 20MM TC100 HEX HD ST SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149122 SUP HCPCS C1713 71149122 - SCREW BN 1.5MM 3MM 22MM TC100 HEX HD ST SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $77.55 $77.55 N/A N/A 71149124 SUP HCPCS C1713 71149124 - SCREW BN 1.5MM 3MM 24MM TC100 HEX HD ST SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149206 SUP HCPCS C1713 71149206 - SCREW BN 2MM 6MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $77.55 $77.55 N/A N/A 71149208 SUP HCPCS C1713 71149208 - SCREW BN 2MM 8MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149210 SUP HCPCS C1713 71149210 - SCREW BN 2MM 10MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149212 SUP HCPCS C1713 71149212 - SCREW BN 2MM 12MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149214 SUP HCPCS C1713 71149214 - SCREW BN 2MM 14MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149216 SUP HCPCS C1713 71149216 - SCREW BN 2MM 16MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149218 SUP HCPCS C1713 71149218 - SCREW BN 2MM 18MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149220 SUP HCPCS C1713 71149220 - SCREW BN 2MM 20MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149222 SUP HCPCS C1713 71149222 - SCREW BN 2MM 22MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149224 SUP HCPCS C1713 71149224 - SCREW BN 2MM 24MM TC100 ST LTWT MDLR CRCTE HD SS CORT MN BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $77.55 $77.55 N/A N/A 71149226 SUP HCPCS C1713 71149226 - SCREW BN 2MM 26MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149228 SUP HCPCS C1713 71149228 - SCREW BN 2MM 28MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $77.55 $77.55 N/A N/A 71149230 SUP HCPCS C1713 71149230 - SCREW BN 2MM 30MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $77.55 $77.55 N/A N/A 71149232 SUP HCPCS C1713 71149232 - SCREW BN 2MM 32MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $77.55 $77.55 N/A N/A 71149234 SUP HCPCS C1713 71149234 - SCREW BN 2MM 34MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149236 SUP HCPCS C1713 71149236 - SCREW BN 2MM 36MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 71149238 SUP HCPCS C1713 71149238 - SCREW BN 2MM 38MM TC100 ST CRCTE HD SS CORT MN FRAG SET BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $77.55 $77.55 N/A N/A 71149306 SUP HCPCS C1713 71149306 - SCREW BN MN 2MM 4MM 6MM TC100 ST HEX HD SS CORT MN FRAG SYS BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $16.55 $79.43 N/A N/A 71149308 SUP HCPCS C1713 71149308 - SCREW BN 2MM 4MM 8MM TC100 ST HEX HD SS CORT MN FRAG SYS BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $16.55 $79.43 N/A N/A 71149310 SUP HCPCS C1713 71149310 - SCREW BN 2MM 4MM 10MM TC100 ST HEX HD SS CORT MN FRAG SYS BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $79.43 $79.43 $79.43 $79.43 N/A N/A 71149312 SUP HCPCS C1713 71149312 - SCREW BN 2MM 4MM 12MM TC100 ST HEX HD SS CORT MN FRAG SYS BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $16.55 $79.43 N/A N/A 71149314 SUP HCPCS C1713 71149314 - SCREW BN 2MM 4MM 14MM TC100 ST HEX HD SS CORT MN FRAG SYS BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $79.43 $79.43 N/A N/A 71149316 SUP HCPCS C1713 71149316 - SCREW BN 2MM 4MM 16MM TC100 ST HEX HD SS CORT MN FRAG SYS BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $79.43 $79.43 N/A N/A 71149318 SUP HCPCS C1713 71149318 - SCREW BN 2MM 4MM 18MM TC100 ST HEX HD SS CORT MN FRAG SYS BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $79.43 $79.43 N/A N/A 71149320 SUP HCPCS C1713 71149320 - SCREW BN 2MM 4MM 20MM TC100 ST HEX HD SS CORT MN FRAG SYS BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $16.55 $79.43 N/A N/A 71149322 SUP HCPCS C1713 71149322 - SCREW BN 2MM 4MM 22MM TC100 ST HEX HD SS CORT MN FRAG SYS BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $16.55 $79.43 N/A N/A 71149324 SUP HCPCS C1713 71149324 - SCREW BN 2MM 4MM 24MM TC100 ST HEX HD SS CORT MN FRAG SYS BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $79.43 $79.43 N/A N/A 71149326 SUP HCPCS C1713 71149326 - SCREW BN 2MM 26MM TC100 ST CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $79.43 $79.43 N/A N/A 71149328 SUP HCPCS C1713 71149328 - SCREW BN 2MM 28MM TC100 ST CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $16.55 $79.43 N/A N/A 71149330 SUP HCPCS C1713 71149330 - SCREW BN 2MM 30MM TC100 ST CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $16.55 $79.43 N/A N/A 71149332 SUP HCPCS C1713 71149332 - SCREW BN 2MM 32MM TC100 ST CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $16.55 $79.43 N/A N/A 71149334 SUP HCPCS C1713 71149334 - SCREW BN 2MM 34MM TC100 ST CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $79.43 $79.43 $16.55 $79.43 N/A N/A 71149336 SUP HCPCS C1713 71149336 - SCREW BN 2MM 36MM TC100 ST CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $16.55 $79.43 N/A N/A 71149338 SUP HCPCS C1713 71149338 - SCREW BN 2MM 38MM TC100 ST CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $79.43 $79.43 N/A N/A 71149406 SUP HCPCS C1713 71149406 - SCREW BN 2.7MM 5MM 6MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $69.73 $69.73 N/A N/A 71149408 SUP HCPCS C1713 71149408 - SCREW BN 2.7MM 5MM 8MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71149410 SUP HCPCS C1713 71149410 - SCREW BN 2.7MM 5MM 10MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71149412 SUP HCPCS C1713 71149412 - SCREW BN 2.7MM 5MM 12MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71149414 SUP HCPCS C1713 71149414 - SCREW BN 2.7MM 5MM 14MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71149416 SUP HCPCS C1713 71149416 - SCREW BN 2.7MM 5MM 16MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71149418 SUP HCPCS C1713 71149418 - SCREW BN 2.7MM 18MM TC100 ST CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71149420 SUP HCPCS C1713 71149420 - SCREW BN 2.7MM 5MM 20MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71149422 SUP HCPCS C1713 71149422 - SCREW BN 2.7MM 5MM 22MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71149424 SUP HCPCS C1713 71149424 - SCREW BN 2.7MM 5MM 24MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $69.73 $69.73 N/A N/A 71149426 SUP HCPCS C1713 71149426 - SCREW BN 2.7MM 5MM 26MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $69.73 $69.73 N/A N/A 71149428 SUP HCPCS C1713 71149428 - SCREW BN 2.7MM 5MM 28MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71149430 SUP HCPCS C1713 71149430 - SCREW BN 2.7MM 5MM 30MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71149432 SUP HCPCS C1713 71149432 - SCREW BN 2.7MM 5MM 32MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71149434 SUP HCPCS C1713 71149434 - SCREW BN 2.7MM 5MM 34MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71149436 SUP HCPCS C1713 71149436 - SCREW BN 2.7MM 5MM 36MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71149438 SUP HCPCS C1713 71149438 - SCREW BN 2.7MM 5MM 38MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $69.73 $69.73 N/A N/A 71149440 SUP HCPCS C1713 71149440 - SCREW BN 2.7MM 5MM 40MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $69.73 $69.73 N/A N/A 71149445 SUP HCPCS C1713 71149445 - SCREW BN 2.7MM 5MM 45MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71149450 SUP HCPCS C1713 71149450 - SCREW BN 2.7MM 5MM 50MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71149455 SUP HCPCS C1713 71149455 - SCREW BN 2.7MM 5MM 55MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71149460 SUP HCPCS C1713 71149460 - SCREW BN 2.7MM 5MM 60MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71149465 SUP HCPCS C1713 71149465 - SCREW BN 2.7MM 5MM 65MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $69.73 $69.73 N/A N/A 71149470 SUP HCPCS C1713 71149470 - SCREW BN 2.7MM 5MM 70MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $69.73 $69.73 N/A N/A 71149510 SUP HCPCS C1713 71149510 - SCREW BN 3.5MM 6MM 10MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 71149512 SUP HCPCS C1713 71149512 - SCREW BN 3.5MM 6MM 12MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149514 SUP HCPCS C1713 71149514 - SCREW BN 3.5MM 14MM ST DIST CORT VOLR RDS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149516 SUP HCPCS C1713 71149516 - SCREW BN HEX 3.5MM 16MM ST DIST CORT VOLR RDS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 71149518 SUP HCPCS C1713 71149518 - SCREW BN 3.5MM 6MM 18MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149520 SUP HCPCS C1713 71149520 - SCREW BN 3.5MM 6MM 20MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 71149522 SUP HCPCS C1713 71149522 - SCREW BN 3.5MM 6MM 22MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149524 SUP HCPCS C1713 71149524 - SCREW BN 3.5MM 6MM 24MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149526 SUP HCPCS C1713 71149526 - SCREW BN 3.5MM 6MM 26MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149528 SUP HCPCS C1713 71149528 - SCREW BN 3.5MM 6MM 28MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149530 SUP HCPCS C1713 71149530 - SCREW BN 3.5MM 6MM 30MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149532 SUP HCPCS C1713 71149532 - SCREW BN 3.5MM 6MM 32MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149534 SUP HCPCS C1713 71149534 - SCREW BN 3.5MM 6MM 34MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149536 SUP HCPCS C1713 71149536 - SCREW BN 3.5MM 6MM 36MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $75.70 $75.70 N/A N/A 71149538 SUP HCPCS C1713 71149538 - SCREW BN 3.5MM 6MM 38MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149540 SUP HCPCS C1713 71149540 - SCREW BN 3.5MM 6MM 40MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149545 SUP HCPCS C1713 71149545 - SCREW BN 3.5MM 6MM 45MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149550 SUP HCPCS C1713 71149550 - SCREW BN 3.5MM 6MM 50MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149555 SUP HCPCS C1713 71149555 - SCREW BN 3.5MM 6MM 55MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $91.45 $91.45 N/A N/A 71149560 SUP HCPCS C1713 71149560 - SCREW BN 3.5MM 6MM 60MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $19.06 $91.45 N/A N/A 71149565 SUP HCPCS C1713 71149565 - SCREW BN 3.5MM 6MM 65MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $91.45 $91.45 N/A N/A 71149570 SUP HCPCS C1713 71149570 - SCREW BN 3.5MM 6MM 70MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $91.45 $91.45 N/A N/A 71149575 SUP HCPCS C1713 71149575 - SCREW BN 3.5MM 6MM 75MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $91.45 $91.45 N/A N/A 71149580 SUP HCPCS C1713 71149580 - SCREW BN 3.5MM 6MM 80MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $19.06 $91.45 N/A N/A 71149585 SUP HCPCS C1713 71149585 - SCREW BN 3.5MM 6MM 85MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $19.06 $91.45 N/A N/A 71149590 SUP HCPCS C1713 71149590 - SCREW BN 3.5MM 6MM 90MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $91.45 $91.45 $19.06 $91.45 N/A N/A 71149595 SUP HCPCS C1713 71149595 - SCREW BN 3.5MM 6MM 95MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $19.06 $91.45 N/A N/A 71149600 SUP HCPCS C1713 71149600 - SCREW BN 3.5MM 100MM TC100 ST DP HEX HD SS CORT SM FRAG SET BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $19.06 $91.45 N/A N/A 71149605 SUP HCPCS C1713 71149605 - SCREW BN 3.5MM 105MM TC100 ST DP HEX HD SS CORT SM FRAG SET BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $19.06 $91.45 N/A N/A 71149610 SUP HCPCS C1713 71149610 - SCREW BN 3.5MM 110MM TC100 ST DP HEX HD SS CORT SM FRAG SET BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $91.45 $91.45 N/A N/A 71149615 SUP HCPCS C1713 71149615 - SCREW BN 3.5MM 115MM STRL TC100 ST DP HEX HD SS CORT SM FRAG BOTH IP/OP $93.50 $69.00 $18.53 $93.35 $42.01 $42.01 $42.01 $42.01 $93.35 $93.35 $93.35 $19.46 $93.35 $93.35 $93.35 $93.35 $93.35 $19.46 $93.35 $37.34 $55.22 $93.35 $93.35 $93.35 $93.35 $70.13 $93.35 $93.35 $93.35 $46.68 $46.68 $73.93 $93.35 $74.68 $42.01 $18.53 N/A $54.23 $93.35 $56.01 $93.35 $19.45 $93.35 N/A N/A 71149620 SUP HCPCS C1713 71149620 - SCREW BN 3.5MM 120MM STRL TC100 ST DP HEX HD SS CORT SM FRAG BOTH IP/OP $93.50 $69.00 $18.53 $93.35 $42.01 $42.01 $42.01 $42.01 $93.35 $93.35 $93.35 $19.46 $93.35 $93.35 $93.35 $93.35 $93.35 $19.46 $93.35 $93.35 $55.22 $93.35 $93.35 $93.35 $93.35 $70.13 $93.35 $93.35 $93.35 $46.68 $46.68 $73.93 $93.35 $74.68 $42.01 $18.53 N/A $54.23 $93.35 $93.35 $93.35 $19.45 $93.35 N/A N/A 71149625 SUP HCPCS C1713 71149625 - SCREW BN 3.5MM 125MM STRL TC100 ST DP HEX HD SS CORT SM FRAG BOTH IP/OP $93.50 $69.00 $18.53 $93.35 $42.01 $42.01 $42.01 $42.01 $93.35 $93.35 $93.35 $19.46 $93.35 $93.35 $93.35 $93.35 $93.35 $19.46 $93.35 $37.34 $55.22 $93.35 $93.35 $93.35 $93.35 $70.13 $93.35 $93.35 $93.35 $46.68 $46.68 $73.93 $93.35 $74.68 $42.01 $18.53 N/A $54.23 $93.35 $56.01 $93.35 $19.45 $93.35 N/A N/A 71149630 SUP HCPCS C1713 71149630 - SCREW BN 3.5MM 130MM STRL TC100 ST DP HEX HD SS CORT SM FRAG BOTH IP/OP $93.50 $69.00 $18.53 $93.35 $42.01 $42.01 $42.01 $42.01 $93.35 $93.35 $93.35 $19.46 $93.35 $93.35 $93.35 $93.35 $93.35 $19.46 $93.35 $37.34 $55.22 $93.35 $93.35 $93.35 $93.35 $70.13 $93.35 $93.35 $93.35 $46.68 $46.68 $73.93 $93.35 $74.68 $42.01 $18.53 N/A $54.23 $93.35 $56.01 $93.35 $19.45 $93.35 N/A N/A 71149714 SUP HCPCS C1713 71149714 - SCREW BN 4.5MM 14MM TC100 ST HEX SCKT SS CORT LG SCR SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149716 SUP HCPCS C1713 71149716 - SCREW BN 4.5MM 16MM TC100 ST HEX SCKT SS CORT LG FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149718 SUP HCPCS C1713 71149718 - SCREW BN 4.5MM 18MM TC100 ST HEX SCKT SS CORT LG SCR SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149720 SUP HCPCS C1713 71149720 - SCREW BN 4.5MM 20MM TC100 ST HEX SCKT SS CORT LG SCR SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149722 SUP HCPCS C1713 71149722 - SCREW BN 4.5MM 22MM TC100 ST HEX SCKT SS CORT LG FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149724 SUP HCPCS C1713 71149724 - SCREW BN 4.5MM 24MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149726 SUP HCPCS C1713 71149726 - SCREW BN 4.5MM 26MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 71149728 SUP HCPCS C1713 71149728 - SCREW BN 4.5MM 28MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $75.70 $75.70 N/A N/A 71149730 SUP HCPCS C1713 71149730 - SCREW BN 4.5MM 30MM TC100 ST HEX SCKT SS CORT LG FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149732 SUP HCPCS C1713 71149732 - SCREW BN 4.5MM 32MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149734 SUP HCPCS C1713 71149734 - SCREW BN 4.5MM 34MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149736 SUP HCPCS C1713 71149736 - SCREW BN 4.5MM 36MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 71149738 SUP HCPCS C1713 71149738 - SCREW BN 4.5MM 38MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149740 SUP HCPCS C1713 71149740 - SCREW BN 4.5MM 40MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149742 SUP HCPCS C1713 71149742 - SCREW BN HEX 4.5MM 42MM TC100 ST SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149744 SUP HCPCS C1713 71149744 - SCREW BN HEX 4.5MM 44MM TC100 ST SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $75.70 $75.70 N/A N/A 71149746 SUP HCPCS C1713 71149746 - SCREW BN 4.5MM 46MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149748 SUP HCPCS C1713 71149748 - SCREW BN 4.5MM 48MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149750 SUP HCPCS C1713 71149750 - SCREW BN 4.5MM 50MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149752 SUP HCPCS C1713 71149752 - SCREW BN 4.5MM 52MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $75.70 $75.70 N/A N/A 71149754 SUP HCPCS C1713 71149754 - SCREW BN 4.5MM 54MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149756 SUP HCPCS C1713 71149756 - SCREW BN 4.5MM 56MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149758 SUP HCPCS C1713 71149758 - SCREW BN 4.5MM 58MM TC100 ST HEX SCKT SS CORT LG FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 71149760 SUP HCPCS C1713 71149760 - SCREW BN 4.5MM 60MM TC100 ST HEX SCKT SS CORT LG SCR SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149762 SUP HCPCS C1713 71149762 - SCREW BN 4.5MM 62MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149764 SUP HCPCS C1713 71149764 - SCREW BN 4.5MM 64MM TC100 ST HEX SCKT SS CORT LG FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149766 SUP HCPCS C1713 71149766 - SCREW BN 4.5MM 66MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149768 SUP HCPCS C1713 71149768 - SCREW BN 4.5MM 68MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149770 SUP HCPCS C1713 71149770 - SCREW BN 4.5MM 70MM TC100 ST HEX SCKT SS CORT LG FRAG SET BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 71149772 SUP HCPCS C1713 71149772 - SCREW BN 4.5MM 72MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71149776 SUP HCPCS C1713 71149776 - SCREW BN 4.5MM 76MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71149785 SUP HCPCS C1713 71149785 - SCREW BN 4.5MM 85MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71149795 SUP HCPCS C1713 71149795 - SCREW BN 4.5MM 95MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 71149800 SUP HCPCS C1713 71149800 - SCREW BN 4.5MM 100MM TC100 ST HEX HD SS CORT LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 71149805 SUP HCPCS C1713 71149805 - SCREW BN 4.5MM 105MM TC100 ST HEX HD SS CORT LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 71149810 SUP HCPCS C1713 71149810 - SCREW BN 4.5MM 110MM TC100 ST HEX HD SS CORT LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 71149815 SUP HCPCS C1713 71149815 - SCREW BN 4.5MM 115MM TC100 ST HEX HD SS CORT LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 71149820 SUP HCPCS C1713 71149820 - SCREW BN 4.5MM 120MM TC100 ST HEX HD SS CORT LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71149825 SUP HCPCS C1713 71149825 - SCREW BN 4.5MM 125MM TC100 ST HEX HD SS CORT LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71149830 SUP HCPCS C1713 71149830 - SCREW BN 4.5MM 130MM TC100 ST HEX HD SS CORT LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 71149835 SUP HCPCS C1713 71149835 - SCREW BN 4.5MM 135MM TC100 ST HEX HD SS CORT LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71149840 SUP HCPCS C1713 71149840 - SCREW BN 4.5MM 140MM TC100 ST HEX HD SS CORT LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71149845 SUP HCPCS C1713 71149845 - SCREW BN 4.5MM 145MM TC100 ST HEX HD SS CORT LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71160095 SUP HCPCS C1713 71160095 - SCREW BN 95MM LG TI ORTH BOTH IP/OP $690.00 $511.00 $136.92 $689.85 $310.43 $310.43 $310.43 $310.43 $689.85 $689.85 $689.85 $143.78 $689.85 $689.85 $689.85 $689.85 $689.85 $143.77 $689.85 $275.94 $408.05 $689.85 $689.85 $689.85 $689.85 $517.50 $689.85 $689.85 $689.85 $344.93 $344.93 $546.36 $689.85 $551.88 $310.43 $136.92 N/A $400.20 $689.85 $689.85 $689.85 $143.76 $689.85 N/A N/A 71161008 SUP HCPCS C1769 71161008 - WIRE FX .8MM 70MM STRL KRSH TROC PNT 1 END SS ORTH BOTH IP/OP $48.00 $36.00 $9.47 $47.70 $25.90 $25.90 $25.90 $25.90 $47.70 $47.70 $47.70 $9.94 $47.70 $35.40 $35.40 $36.77 $24.85 $9.94 $47.70 $34.13 $28.21 $47.70 $34.13 $47.70 $47.70 $36.00 $47.70 $47.70 $47.70 $23.85 $23.85 $37.78 $47.70 $38.16 $31.01 $9.47 N/A $27.84 $47.70 $47.70 $47.70 $9.94 $47.70 N/A N/A 71161010 SUP HCPCS C1769 71161010 - WIRE FX 1MM 150MM STRL KRSH TROC PNT 1 END SS ORTH BOTH IP/OP $48.00 $36.00 $9.47 $47.70 $25.90 $25.90 $25.90 $25.90 $47.70 $47.70 $47.70 $9.94 $47.70 $35.40 $35.40 $36.77 $24.85 $9.94 $47.70 $13.65 $28.21 $47.70 $34.13 $47.70 $47.70 $36.00 $47.70 $47.70 $47.70 $23.85 $23.85 $37.78 $47.70 $38.16 $31.01 $9.47 N/A $27.84 $47.70 $47.70 $47.70 $9.94 $47.70 N/A N/A 71161020 SUP Custom 27203010 71161020 - WIRE FX 2MM 150MM STRL KRSH TROC PNT SS ORTH DISP BOTH IP/OP $67.50 $50.00 $11.96 $67.20 $67.20 $67.20 $67.20 $67.20 $67.20 $67.20 $11.96 $67.20 $67.20 $49.88 $49.88 $51.80 $35.01 $14.01 $67.20 $26.88 $67.20 $67.20 $67.20 $67.20 $67.20 $50.63 $67.20 $67.20 $67.20 $33.60 $33.60 $53.22 $67.20 $53.76 $43.68 $67.20 N/A $39.15 $67.20 $40.32 $67.20 $67.20 $67.20 N/A N/A 71161040 SUP HCPCS C1713 71161040 - SCREW BN P/T 6.5MM 40MM NS 20MM CNN TI BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $214.20 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $111.60 $535.50 N/A N/A 71161045 SUP HCPCS C1713 71161045 - SCREW BN P/T 6.5MM 45MM NS 20MM CNN TI BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $214.20 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $111.60 $535.50 N/A N/A 71161050 SUP HCPCS C1713 71161050 - SCREW BN P/T 6.5MM 50MM NS 20MM CNN TI BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $535.50 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $111.60 $535.50 N/A N/A 71161055 SUP HCPCS C1713 71161055 - SCREW BN P/T 6.5MM 55MM NS 20MM CNN TI BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $214.20 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $111.60 $535.50 N/A N/A 71161060 SUP HCPCS C1713 71161060 - SCREW BN P/T 6.5MM 60MM NS 20MM CNN TI BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $214.20 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $111.60 $535.50 N/A N/A 71161065 SUP HCPCS C1713 71161065 - SCREW BN P/T 6.5MM 65MM NS 20MM CNN TI BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $535.50 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $111.60 $535.50 N/A N/A 71161066 SUP HCPCS C1769 71161066 - WIRE FX .6MM STRL KRSH BOTH IP/OP $48.00 $36.00 $9.47 $47.70 $25.90 $25.90 $25.90 $25.90 $47.70 $47.70 $47.70 $9.94 $47.70 $35.40 $35.40 $36.77 $24.85 $9.94 $47.70 $34.13 $28.21 $47.70 $34.13 $47.70 $47.70 $36.00 $47.70 $47.70 $47.70 $23.85 $23.85 $37.78 $47.70 $38.16 $31.01 $9.47 N/A $27.84 $47.70 $47.70 $47.70 $9.94 $47.70 N/A N/A 71161070 SUP HCPCS C1713 71161070 - SCREW BN 6.5MM 70MM NS 20MM CNN P/T TI ORTH BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $535.50 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $535.50 $535.50 N/A N/A 71161075 SUP HCPCS C1713 71161075 - SCREW BN 6.5MM 75MM NS 20MM CNN P/T TI ORTH BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $214.20 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $535.50 $535.50 N/A N/A 71161080 SUP HCPCS C1713 71161080 - SCREW BN LG 6.5MM 80MM STRL 20MM CNN THRD TI ORTH BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $214.20 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $111.60 $535.50 N/A N/A 71161085 SUP HCPCS C1713 71161085 - SCREW BN 6.5MM 85MM NS 20MM CNN P/T TI ORTH BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $535.50 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $111.60 $535.50 N/A N/A 71161090 SUP HCPCS C1713 71161090 - SCREW BN 6.5MM 90MM NS 20MM CNN P/T TI ORTH BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $214.20 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $321.30 $535.50 $111.60 $535.50 N/A N/A 71161095 SUP HCPCS C1713 71161095 - SCREW BN 6.5MM 95MM NS 20MM CNN P/T TI ORTH BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $214.20 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $321.30 $535.50 $111.60 $535.50 N/A N/A 71161100 SUP HCPCS C1713 71161100 - SCREW BN 6.5MM 100MM NS 20MM CNN P/T TI ORTH BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $535.50 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $321.30 $535.50 $111.60 $535.50 N/A N/A 71161105 SUP HCPCS C1713 71161105 - SCREW BN 6.5MM 105MM NS 20MM CNN P/T TI ORTH BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $214.20 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $321.30 $535.50 $111.60 $535.50 N/A N/A 71161110 SUP HCPCS C1713 71161110 - SCREW BN 6.5MM 110MM NS 20MM CNN P/T TI ORTH BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $214.20 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $321.30 $535.50 $111.60 $535.50 N/A N/A 71161303 SUP HCPCS C1713 71161303 - PLATE BN 130D CLS 3 HL CMPR TI HIP BOTH IP/OP "$1,423.00" "$1,053.00" $282.38 "$1,422.75" $640.24 $640.24 $640.24 $640.24 "$1,422.75" "$1,422.75" "$1,422.75" $296.54 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" $296.52 "$1,422.75" $569.10 $841.56 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,067.25" "$1,422.75" "$1,422.75" "$1,422.75" $711.38 $711.38 "$1,126.82" "$1,422.75" "$1,138.20" $640.24 $282.38 N/A $825.34 "$1,422.75" "$1,422.75" "$1,422.75" $296.50 "$1,422.75" N/A N/A 71161352 SUP HCPCS C1713 71161352 - PLATE BN 135D CLS 2 HL CMPR TI HIP BOTH IP/OP "$1,423.00" "$1,053.00" $282.38 "$1,422.75" $640.24 $640.24 $640.24 $640.24 "$1,422.75" "$1,422.75" "$1,422.75" $296.54 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" $296.52 "$1,422.75" "$1,422.75" $841.56 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,067.25" "$1,422.75" "$1,422.75" "$1,422.75" $711.38 $711.38 "$1,126.82" "$1,422.75" "$1,138.20" $640.24 $282.38 N/A $825.34 "$1,422.75" "$1,422.75" "$1,422.75" $296.50 "$1,422.75" N/A N/A 71161354 SUP HCPCS C1713 71161354 - PLATE BN 135D CLS 4 HL CMPR TI HIP BOTH IP/OP "$1,423.00" "$1,053.00" $282.38 "$1,422.75" $640.24 $640.24 $640.24 $640.24 "$1,422.75" "$1,422.75" "$1,422.75" $296.54 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" $296.52 "$1,422.75" $569.10 $841.56 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,067.25" "$1,422.75" "$1,422.75" "$1,422.75" $711.38 $711.38 "$1,126.82" "$1,422.75" "$1,138.20" $640.24 $282.38 N/A $825.34 "$1,422.75" "$1,422.75" "$1,422.75" $296.50 "$1,422.75" N/A N/A 71161355 SUP HCPCS C1713 71161355 - PLATE BN 135D CLS 5 HL CMPR TI HIP BOTH IP/OP "$1,423.00" "$1,053.00" $282.38 "$1,422.75" $640.24 $640.24 $640.24 $640.24 "$1,422.75" "$1,422.75" "$1,422.75" $296.54 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" $296.52 "$1,422.75" "$1,422.75" $841.56 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,067.25" "$1,422.75" "$1,422.75" "$1,422.75" $711.38 $711.38 "$1,126.82" "$1,422.75" "$1,138.20" $640.24 $282.38 N/A $825.34 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" N/A N/A 71161404 SUP HCPCS C1713 71161404 - PLATE BN 140D CLS 4 HL CMPR TI HIP BOTH IP/OP "$1,423.00" "$1,053.00" $282.38 "$1,422.75" $640.24 $640.24 $640.24 $640.24 "$1,422.75" "$1,422.75" "$1,422.75" $296.54 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" $296.52 "$1,422.75" $569.10 $841.56 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,067.25" "$1,422.75" "$1,422.75" "$1,422.75" $711.38 $711.38 "$1,126.82" "$1,422.75" "$1,138.20" $640.24 $282.38 N/A $825.34 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" N/A N/A 71161405 SUP HCPCS C1713 71161405 - PLATE BN 140D CLS 5 HL CMPR TI HIP BOTH IP/OP "$1,423.00" "$1,053.00" $282.38 "$1,422.75" $640.24 $640.24 $640.24 $640.24 "$1,422.75" "$1,422.75" "$1,422.75" $296.54 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" $296.52 "$1,422.75" "$1,422.75" $841.56 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,067.25" "$1,422.75" "$1,422.75" "$1,422.75" $711.38 $711.38 "$1,126.82" "$1,422.75" "$1,138.20" $640.24 $282.38 N/A $825.34 "$1,422.75" "$1,422.75" "$1,422.75" $296.50 "$1,422.75" N/A N/A 71161506 SUP HCPCS C1713 71161506 - SCREW BN 1.5MM 6MM TC100 HEX SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71161507 SUP HCPCS C1713 71161507 - SCREW BN 1.5MM 7MM TC100 HEX SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71161508 SUP HCPCS C1713 71161508 - SCREW BN 1.5MM 8MM TC100 HEX SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71161509 SUP HCPCS C1713 71161509 - SCREW BN 1.5MM 9MM TC100 HEX SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $67.53 $67.53 N/A N/A 71161510 SUP HCPCS C1713 71161510 - SCREW BN 1.5MM 10MM TC100 HEX SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $67.53 $67.53 N/A N/A 71161511 SUP HCPCS C1713 71161511 - SCREW BN 1.5MM 11MM TC100 HEX SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71161512 SUP HCPCS C1713 71161512 - SCREW BN 1.5MM 12MM TC100 HEX SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $67.53 $67.53 N/A N/A 71161514 SUP HCPCS C1713 71161514 - SCREW BN 1.5MM 14MM TC100 HEX SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $67.53 $67.53 N/A N/A 71161516 SUP HCPCS C1713 71161516 - SCREW BN 1.5MM 16MM TC100 HEX SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71161518 SUP HCPCS C1713 71161518 - SCREW BN 1.5MM 18MM TC100 HEX SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71161520 SUP HCPCS C1713 71161520 - SCREW BN 1.5MM 20MM TC100 HEX SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71161606 SUP HCPCS C1713 71161606 - SCREW BN MN 1.5MM 6MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71161607 SUP HCPCS C1713 71161607 - SCREW BN MN 1.5MM 7MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71161608 SUP HCPCS C1713 71161608 - SCREW BN MN 1.5MM 8MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $67.53 $67.53 N/A N/A 71161609 SUP HCPCS C1713 71161609 - SCREW BN MN 1.5MM 9MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $67.53 $67.53 N/A N/A 71161610 SUP HCPCS C1713 71161610 - SCREW BN 1.5MM 10MM TC100 CRCTE SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71161611 SUP HCPCS C1713 71161611 - SCREW BN MN 1.5MM 11MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71161612 SUP HCPCS C1713 71161612 - SCREW BN 1.5MM 12MM TC100 CRCTE SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71161614 SUP HCPCS C1713 71161614 - SCREW BN 1.5MM 14MM TC100 CRCTE SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $67.53 $67.53 N/A N/A 71161616 SUP HCPCS C1713 71161616 - SCREW BN 1.5MM 16MM TC100 CRCTE SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71161618 SUP HCPCS C1713 71161618 - SCREW BN 1.5MM 18MM TC100 CRCTE SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $67.53 $67.53 N/A N/A 71161620 SUP HCPCS C1713 71161620 - SCREW BN 1.5MM 20MM TC100 CRCTE SCKT SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71162008 SUP HCPCS C1713 71162008 - SCREW BN 2MM 8MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162010 SUP HCPCS C1713 71162010 - SCREW BN 2MM 10MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $67.53 $67.53 N/A N/A 71162012 SUP HCPCS C1713 71162012 - SCREW BN 2MM 12MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162014 SUP HCPCS C1713 71162014 - SCREW BN 2MM 14MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162016 SUP HCPCS C1713 71162016 - SCREW BN 2MM 16MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162018 SUP HCPCS C1713 71162018 - SCREW BN 2MM 18MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162020 SUP HCPCS C1713 71162020 - SCREW BN 2MM 20MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71162022 SUP HCPCS C1713 71162022 - SCREW BN 2MM 22MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162024 SUP HCPCS C1713 71162024 - SCREW BN 2MM 24MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162026 SUP HCPCS C1713 71162026 - SCREW BN 2MM 26MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $67.53 $67.53 N/A N/A 71162028 SUP HCPCS C1713 71162028 - SCREW BN 2MM 28MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162030 SUP HCPCS C1713 71162030 - SCREW BN 2MM 30MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162032 SUP HCPCS C1713 71162032 - SCREW BN 2MM 32MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $67.53 $67.53 N/A N/A 71162036 SUP HCPCS C1713 71162036 - SCREW BN 2MM 36MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $67.53 $67.53 N/A N/A 71162038 SUP HCPCS C1713 71162038 - SCREW BN 2MM 38MM TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162106 SUP HCPCS C1713 71162106 - SCREW BN 2MM 6MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $67.53 $67.53 N/A N/A 71162108 SUP HCPCS C1713 71162108 - SCREW BN 2MM 8MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $67.53 $67.53 N/A N/A 71162110 SUP HCPCS C1713 71162110 - SCREW BN 2MM 10MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $67.53 $67.53 N/A N/A 71162112 SUP HCPCS C1713 71162112 - SCREW BN 2MM 12MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162114 SUP HCPCS C1713 71162114 - SCREW BN 2MM 14MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $67.53 $67.53 N/A N/A 71162116 SUP HCPCS C1713 71162116 - SCREW BN 2MM 16MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $67.53 $67.53 N/A N/A 71162118 SUP HCPCS C1713 71162118 - SCREW BN 2MM 18MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162120 SUP HCPCS C1713 71162120 - SCREW BN 2MM 20MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162122 SUP HCPCS C1713 71162122 - SCREW BN 2MM 22MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162124 SUP HCPCS C1713 71162124 - SCREW BN 2MM 24MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162126 SUP HCPCS C1713 71162126 - SCREW BN 2MM 26MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162128 SUP HCPCS C1713 71162128 - SCREW BN 2MM 28MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162130 SUP HCPCS C1713 71162130 - SCREW BN 2MM 30MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162132 SUP HCPCS C1713 71162132 - SCREW BN 2MM 32MM TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71162134 SUP HCPCS C1713 71162134 - SCREW BN 2MM 34MM STRL TC100 CRCTE HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71162206 SUP HCPCS C1713 71162206 - SCREW BN 2MM 6MM STRL TC100 HEX HD SS CORT BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71163006 SUP HCPCS C1769 71163006 - WIRE FX .6MM 175MM STRL KRSH CRLGE SS ORTH BOTH IP/OP $50.50 $37.00 $10.00 $50.40 $27.37 $27.37 $27.37 $27.37 $50.40 $50.40 $50.40 $10.50 $50.40 $37.41 $37.41 $38.85 $26.26 $10.50 $50.40 $36.23 $29.81 $50.40 $36.23 $50.40 $50.40 $37.88 $50.40 $50.40 $50.40 $25.20 $25.20 $39.92 $50.40 $40.32 $32.76 $10.00 N/A $29.29 $50.40 $50.40 $50.40 $10.50 $50.40 N/A N/A 71163008 SUP HCPCS C1769 71163008 - WIRE FX .8MM 200MM STRL KRSH CRLGE SS ORTH BOTH IP/OP $50.50 $37.00 $10.00 $50.40 $27.37 $27.37 $27.37 $27.37 $50.40 $50.40 $50.40 $10.50 $50.40 $37.41 $37.41 $38.85 $26.26 $10.50 $50.40 $36.23 $29.81 $50.40 $36.23 $50.40 $50.40 $37.88 $50.40 $50.40 $50.40 $25.20 $25.20 $39.92 $50.40 $40.32 $32.76 $10.00 N/A $29.29 $50.40 $30.24 $50.40 $10.50 $50.40 N/A N/A 71164026 SUP HCPCS C1713 71164026 - SCREW BN 4.5MM 26MM ST CMPR TI CORT HIP BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $24.15 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $36.23 $60.38 $12.58 $60.38 N/A N/A 71164028 SUP HCPCS C1713 71164028 - SCREW BN 4.5MM 28MM ST CMPR TI CORT BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $36.23 $60.38 $12.58 $60.38 N/A N/A 71164030 SUP HCPCS C1713 71164030 - SCREW BN 4.5MM 30MM ST TI ORTH BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $24.15 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $36.23 $60.38 $12.58 $60.38 N/A N/A 71164032 SUP HCPCS C1713 71164032 - SCREW BN 4.5MM 32MM ST CMPR TI CORT BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $24.15 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $36.23 $60.38 $12.58 $60.38 N/A N/A 71164034 SUP HCPCS C1713 71164034 - SCREW BN 4.5MM 34MM ST CMPR TI CORT HIP BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $24.15 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $36.23 $60.38 $60.38 $60.38 N/A N/A 71164036 SUP HCPCS C1713 71164036 - SCREW BN 4.5MM 36MM ST CMPR TI CORT HIP BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $24.15 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $36.23 $60.38 $60.38 $60.38 N/A N/A 71164038 SUP HCPCS C1713 71164038 - SCREW BN 4.5MM 38MM ST CMPR TI CORT BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $24.15 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $36.23 $60.38 $12.58 $60.38 N/A N/A 71164040 SUP HCPCS C1713 71164040 - SCREW BN 4.5MM 40MM ST CMPR TI CORT HIP BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $60.38 $60.38 $60.38 $60.38 N/A N/A 71164042 SUP HCPCS C1713 71164042 - SCREW BN 4.5MM 42MM ST CMPR TI CORT HIP BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $36.23 $60.38 $60.38 $60.38 N/A N/A 71164044 SUP HCPCS C1713 71164044 - SCREW BN 4.5MM 44MM ST CMPR TI CORT HIP BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $24.15 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $36.23 $60.38 $12.58 $60.38 N/A N/A 71164046 SUP HCPCS C1713 71164046 - SCREW BN 4.5MM 46MM ST CMPR TI CORT HIP BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $24.15 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $36.23 $60.38 $12.58 $60.38 N/A N/A 71164048 SUP HCPCS C1713 71164048 - SCREW BN 4.5MM 48MM ST CMPR TI CORT HIP BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $24.15 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $60.38 $60.38 $12.58 $60.38 N/A N/A 71164050 SUP HCPCS C1713 71164050 - SCREW BN 4.5MM 50MM ST CMPR TI CORT HIP BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $24.15 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $36.23 $60.38 $12.58 $60.38 N/A N/A 71164052 SUP HCPCS C1713 71164052 - SCREW BN 4.5MM 52MM ST CMPR TI CORT HIP BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $27.17 $27.17 $27.17 $27.17 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $60.38 $60.38 $60.38 $12.58 $60.38 $60.38 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $27.17 $11.98 N/A $35.09 $60.38 $36.23 $60.38 $12.58 $60.38 N/A N/A 71170001 SUP Custom 27203010 71170001 - BIT DRL 1.1MM QC BOTH IP/OP $164.00 $121.00 $29.16 $163.80 $163.80 $163.80 $163.80 $163.80 $163.80 $163.80 $29.16 $163.80 $163.80 $121.57 $121.57 $126.26 $85.34 $34.14 $163.80 $65.52 $163.80 $163.80 $163.80 $163.80 $163.80 $123.00 $163.80 $163.80 $163.80 $81.90 $81.90 $129.73 $163.80 $131.04 $106.47 $163.80 N/A $95.12 $163.80 $98.28 $163.80 $163.80 $163.80 N/A N/A 71170003 SUP Custom 27203010 71170003 - BIT DRL 1.5MM 85MM STRL 60MM TC100 QC BOTH IP/OP $164.00 $121.00 $29.16 $163.80 $163.80 $163.80 $163.80 $163.80 $163.80 $163.80 $29.16 $163.80 $163.80 $121.57 $121.57 $126.26 $85.34 $34.14 $163.80 $65.52 $163.80 $163.80 $163.80 $163.80 $163.80 $123.00 $163.80 $163.80 $163.80 $81.90 $81.90 $129.73 $163.80 $131.04 $106.47 $163.80 N/A $95.12 $163.80 $98.28 $163.80 $163.80 $163.80 N/A N/A 71170005 SUP Custom 27203010 71170005 - BIT DRL 2MM STRL GLD HL BOTH IP/OP $164.00 $121.00 $29.16 $163.80 $163.80 $163.80 $163.80 $163.80 $163.80 $163.80 $29.16 $163.80 $163.80 $121.57 $121.57 $126.26 $85.34 $34.14 $163.80 $65.52 $163.80 $163.80 $163.80 $163.80 $163.80 $123.00 $163.80 $163.80 $163.80 $81.90 $81.90 $129.73 $163.80 $131.04 $106.47 $163.80 N/A $95.12 $163.80 $98.28 $163.80 $163.80 $163.80 N/A N/A 71170007 SUP Custom 27203010 71170007 - BIT DRL 2.7MM QC BOTH IP/OP $164.00 $121.00 $29.16 $163.80 $163.80 $163.80 $163.80 $163.80 $163.80 $163.80 $29.16 $163.80 $163.80 $121.57 $121.57 $126.26 $85.34 $34.14 $163.80 $65.52 $163.80 $163.80 $163.80 $163.80 $163.80 $123.00 $163.80 $163.80 $163.80 $81.90 $81.90 $129.73 $163.80 $131.04 $106.47 $163.80 N/A $95.12 $163.80 $98.28 $163.80 $163.80 $163.80 N/A N/A 71170071 SUP Custom 27203010 71170071 - BIT DRL 2.5MM 110MM AU STRL QC BOTH IP/OP $271.00 $201.00 $48.22 $270.90 $270.90 $270.90 $270.90 $270.90 $270.90 $270.90 $48.22 $270.90 $270.90 $201.06 $201.06 $208.81 $141.14 $56.46 $270.90 $108.36 $270.90 $270.90 $270.90 $270.90 $270.90 $203.25 $270.90 $270.90 $270.90 $135.45 $135.45 $214.55 $270.90 $216.72 $176.09 $270.90 N/A $157.18 $270.90 $162.54 $270.90 $270.90 $270.90 N/A N/A 71170073 SUP Custom 27203010 71170073 - BIT DRL 3.5MM 110MM STRL QC BOTH IP/OP $236.50 $175.00 $42.05 $236.25 $236.25 $236.25 $236.25 $236.25 $236.25 $236.25 $42.05 $236.25 $236.25 $175.34 $175.34 $182.10 $123.09 $49.24 $236.25 $94.50 $236.25 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $153.56 $236.25 N/A $137.17 $236.25 $141.75 $236.25 $236.25 $236.25 N/A N/A 71170111 SUP Custom 27203010 71170111 - BIT DRL 3.2MM 145MM STRL QC BOTH IP/OP $164.00 $121.00 $29.16 $163.80 $163.80 $163.80 $163.80 $163.80 $163.80 $163.80 $29.16 $163.80 $163.80 $121.57 $121.57 $126.26 $85.34 $34.14 $163.80 $65.52 $163.80 $163.80 $163.80 $163.80 $163.80 $123.00 $163.80 $163.80 $163.80 $81.90 $81.90 $129.73 $163.80 $131.04 $106.47 $163.80 N/A $95.12 $163.80 $98.28 $163.80 $163.80 $163.80 N/A N/A 71170113 SUP Custom 27203010 71170113 - BIT DRL 4.5MM 145MM STRL QC BOTH IP/OP $205.00 $152.00 $36.45 $204.75 $204.75 $204.75 $204.75 $204.75 $204.75 $204.75 $36.45 $204.75 $204.75 $151.97 $151.97 $157.82 $106.67 $42.67 $204.75 $81.90 $204.75 $204.75 $204.75 $204.75 $204.75 $153.75 $204.75 $204.75 $204.75 $102.38 $102.38 $162.16 $204.75 $163.80 $133.09 $204.75 N/A $118.90 $204.75 $122.85 $204.75 $204.75 $204.75 N/A N/A 71170147 SUP Custom 27203010 71170147 - BIT DRL LNG 3.5MM 195MM STRL QC BOTH IP/OP $279.50 $207.00 $49.72 $279.30 $279.30 $279.30 $279.30 $279.30 $279.30 $279.30 $49.72 $279.30 $279.30 $207.30 $207.30 $215.28 $145.52 $58.21 $279.30 $111.72 $279.30 $279.30 $279.30 $279.30 $279.30 $209.63 $279.30 $279.30 $279.30 $139.65 $139.65 $221.21 $279.30 $223.44 $181.55 $279.30 N/A $162.11 $279.30 $167.58 $279.30 $279.30 $279.30 N/A N/A 71170149 SUP Custom 27203010 71170149 - BIT DRL LNG 4.5MM 195MM STRL QC BOTH IP/OP $279.50 $207.00 $49.72 $279.30 $279.30 $279.30 $279.30 $279.30 $279.30 $279.30 $49.72 $279.30 $279.30 $207.30 $207.30 $215.28 $145.52 $58.21 $279.30 $111.72 $279.30 $279.30 $279.30 $279.30 $279.30 $209.63 $279.30 $279.30 $279.30 $139.65 $139.65 $221.21 $279.30 $223.44 $181.55 $279.30 N/A $162.11 $279.30 $167.58 $279.30 $279.30 $279.30 N/A N/A 71170151 SUP Custom 27203010 71170151 - BIT DRL 4.5MM 196MM STRL QC 3 FLT BOTH IP/OP $434.00 $321.00 $77.19 $433.65 $433.65 $433.65 $433.65 $433.65 $433.65 $433.65 $77.19 $433.65 $433.65 $321.86 $321.86 $334.26 $225.93 $90.38 $433.65 $173.46 $433.65 $433.65 $433.65 $433.65 $433.65 $325.50 $433.65 $433.65 $433.65 $216.83 $216.83 $343.45 $433.65 $346.92 $281.87 $433.65 N/A $251.72 $433.65 $260.19 $433.65 $433.65 $433.65 N/A N/A 71170153 SUP Custom 27203010 71170153 - BIT DRL 2.5MM 230MM STRL QC 3 FLT BOTH IP/OP $576.50 $427.00 $102.61 $576.45 $576.45 $576.45 $576.45 $576.45 $576.45 $576.45 $102.61 $576.45 $576.45 $427.84 $427.84 $444.33 $300.33 $120.14 $576.45 $230.58 $576.45 $576.45 $576.45 $576.45 $576.45 $432.38 $576.45 $576.45 $576.45 $288.23 $288.23 $456.55 $576.45 $461.16 $374.69 $576.45 N/A $334.37 $576.45 $345.87 $576.45 $576.45 $576.45 N/A N/A 71170155 SUP Custom 27203010 71170155 - BIT DRL 3.2MM 230MM STRL QC 3 FLT BOTH IP/OP $576.50 $427.00 $102.61 $576.45 $576.45 $576.45 $576.45 $576.45 $576.45 $576.45 $102.61 $576.45 $576.45 $427.84 $427.84 $444.33 $300.33 $120.14 $576.45 $230.58 $576.45 $576.45 $576.45 $576.45 $576.45 $432.38 $576.45 $576.45 $576.45 $288.23 $288.23 $456.55 $576.45 $461.16 $374.69 $576.45 N/A $334.37 $576.45 $345.87 $576.45 $576.45 $576.45 N/A N/A 71170315 SUP HCPCS C1713 71170315 - SCREW BN 6MM 190MM TC100 SCHNZ DMD PT SS ORTH BOTH IP/OP "$1,001.00" $741.00 $198.60 "$1,000.65" $450.29 $450.29 $450.29 $450.29 "$1,000.65" "$1,000.65" "$1,000.65" $208.56 "$1,000.65" "$1,000.65" "$1,000.65" "$1,000.65" "$1,000.65" $208.55 "$1,000.65" $400.26 $591.88 "$1,000.65" "$1,000.65" "$1,000.65" "$1,000.65" $750.75 "$1,000.65" "$1,000.65" "$1,000.65" $500.33 $500.33 $792.51 "$1,000.65" $800.52 $450.29 $198.60 N/A $580.58 "$1,000.65" $600.39 "$1,000.65" $208.54 "$1,000.65" N/A N/A 71173501 SUP Custom 27203010 71173501 - BIT DRILL 2MM 190MM QUICK CONNECT PERI-LOC DISPOSABLE BOTH IP/OP $181.00 $134.00 $32.15 $180.60 $180.60 $180.60 $180.60 $180.60 $180.60 $180.60 $32.15 $180.60 $180.60 $134.04 $134.04 $139.21 $94.09 $37.64 $180.60 $72.24 $180.60 $180.60 $180.60 $180.60 $180.60 $135.75 $180.60 $180.60 $180.60 $90.30 $90.30 $143.04 $180.60 $144.48 $117.39 $180.60 N/A $104.98 $180.60 $108.36 $180.60 $180.60 $180.60 N/A N/A 71173505 SUP Custom 27203010 71173505 - BIT DRL 3.5MM 220MM STRL PRLC AO QCK CNCT CLBRT DISP BOTH IP/OP $280.50 $208.00 $49.90 $280.35 $280.35 $280.35 $280.35 $280.35 $280.35 $280.35 $49.90 $280.35 $280.35 $208.08 $208.08 $216.09 $146.06 $58.43 $280.35 $112.14 $280.35 $280.35 $280.35 $280.35 $280.35 $210.38 $280.35 $280.35 $280.35 $140.18 $140.18 $222.04 $280.35 $224.28 $182.23 $280.35 N/A $162.69 $280.35 $168.21 $280.35 $280.35 $280.35 N/A N/A 71173581 SUP Custom 27203010 71173581 - BIT DRL 2.7MM 155MM CNN DISP BOTH IP/OP $743.50 $550.00 $132.33 $743.40 $743.40 $743.40 $743.40 $743.40 $743.40 $743.40 $132.33 $743.40 $743.40 $551.75 $551.75 $573.01 $387.31 $154.93 $743.40 $297.36 $743.40 $743.40 $743.40 $743.40 $743.40 $557.63 $743.40 $743.40 $743.40 $371.70 $371.70 $588.77 $743.40 $594.72 $483.21 $743.40 N/A $431.23 $743.40 $446.04 $743.40 $743.40 $743.40 N/A N/A 71173807 SUP HCPCS C1713 71173807 - PIN FX 2MM 14MM VLP BOTH IP/OP $307.50 $228.00 $61.03 $307.50 $138.38 $138.38 $138.38 $138.38 $307.50 $307.50 $307.50 $64.09 $307.50 $307.50 $307.50 $307.50 $307.50 $64.09 $307.50 $307.50 $181.89 $307.50 $307.50 $307.50 $307.50 $230.63 $307.50 $307.50 $307.50 $153.75 $153.75 $243.54 $307.50 $246.00 $138.38 $61.03 N/A $178.35 $307.50 $307.50 $307.50 $64.08 $307.50 N/A N/A 71173808 SUP HCPCS C1713 71173808 - PIN FIX 2MM 25MM TRIAL BOTH IP/OP $332.50 $246.00 $65.99 $332.50 $149.63 $149.63 $149.63 $149.63 $332.50 $332.50 $332.50 $69.30 $332.50 $332.50 $332.50 $332.50 $332.50 $69.30 $332.50 $133.00 $196.67 $332.50 $332.50 $332.50 $332.50 $249.38 $332.50 $332.50 $332.50 $166.25 $166.25 $263.34 $332.50 $266.00 $149.63 $65.99 N/A $192.85 $332.50 $199.50 $332.50 $69.29 $332.50 N/A N/A 71174904 SUP HCPCS C1713 71174904 - PIN FX 1.5MM BOTH IP/OP $344.00 $255.00 $68.23 $343.75 $154.69 $154.69 $154.69 $154.69 $343.75 $343.75 $343.75 $71.65 $343.75 $343.75 $343.75 $343.75 $343.75 $71.64 $343.75 $343.75 $203.33 $343.75 $343.75 $343.75 $343.75 $258.00 $343.75 $343.75 $343.75 $171.88 $171.88 $272.25 $343.75 $275.00 $154.69 $68.23 N/A $199.52 $343.75 $206.25 $343.75 $71.64 $343.75 N/A N/A 71174909 SUP HCPCS C1713 71174909 - PIN FX 1.8MM BOTH IP/OP $344.00 $255.00 $68.23 $343.75 $154.69 $154.69 $154.69 $154.69 $343.75 $343.75 $343.75 $71.65 $343.75 $343.75 $343.75 $343.75 $343.75 $71.64 $343.75 $137.50 $203.33 $343.75 $343.75 $343.75 $343.75 $258.00 $343.75 $343.75 $343.75 $171.88 $171.88 $272.25 $343.75 $275.00 $154.69 $68.23 N/A $199.52 $343.75 $343.75 $343.75 $71.64 $343.75 N/A N/A 71174914 SUP HCPCS C1713 71174914 - PIN FX 2MM 30MM EVOS MN BOTH IP/OP $344.00 $255.00 $68.23 $343.75 $154.69 $154.69 $154.69 $154.69 $343.75 $343.75 $343.75 $71.65 $343.75 $343.75 $343.75 $343.75 $343.75 $71.64 $343.75 $137.50 $203.33 $343.75 $343.75 $343.75 $343.75 $258.00 $343.75 $343.75 $343.75 $171.88 $171.88 $272.25 $343.75 $275.00 $154.69 $68.23 N/A $199.52 $343.75 $206.25 $343.75 $71.64 $343.75 N/A N/A 71175022 SUP Custom 27203010 71175022 - DRILL SRG SM LNG 2.5MM STRL LF EVOS AO QCK CNCT REUSE BOTH IP/OP $271.00 $201.00 $48.22 $270.88 $270.88 $270.88 $270.88 $270.88 $270.88 $270.88 $48.22 $270.88 $270.88 $201.05 $201.05 $208.79 $141.13 $56.45 $270.88 $108.35 $270.88 $270.88 $270.88 $270.88 $270.88 $203.25 $270.88 $270.88 $270.88 $135.44 $135.44 $214.54 $270.88 $216.70 $176.07 $270.88 N/A $157.18 $270.88 $162.53 $270.88 $270.88 $270.88 N/A N/A 71175023 SUP Custom 27203010 71175023 - DRILL SRG SM SHRT 2.5MM STRL LF EVOS AO QCK CNCT REUSE BOTH IP/OP $225.50 $167.00 $40.14 $225.50 $225.50 $225.50 $225.50 $225.50 $225.50 $225.50 $40.14 $225.50 $225.50 $167.37 $167.37 $173.82 $117.49 $47.00 $225.50 $90.20 $225.50 $225.50 $225.50 $225.50 $225.50 $169.13 $225.50 $225.50 $225.50 $112.75 $112.75 $178.60 $225.50 $180.40 $146.58 $225.50 N/A $130.79 $225.50 $135.30 $225.50 $225.50 $225.50 N/A N/A 71175027 SUP Custom 27203010 71175027 - SCREW BN 3.5MM 14MM STRL EVOS ST CORT BOTH IP/OP $312.50 $231.00 $55.56 $312.13 $312.13 $312.13 $312.13 $312.13 $312.13 $312.13 $55.56 $312.13 $312.13 $231.66 $231.66 $240.59 $162.62 $65.05 $312.13 $124.85 $312.13 $312.13 $312.13 $312.13 $312.13 $234.38 $312.13 $312.13 $312.13 $156.07 $156.07 $247.21 $312.13 $249.70 $202.88 $312.13 N/A $181.25 $312.13 $187.28 $312.13 $312.13 $312.13 N/A N/A 71175027 SUP Custom 27203010 71175027 - SCREW BN 3.5MM 14MM STRL EVOS ST CORT BOTH IP/OP $312.50 $231.00 $55.56 $312.13 $312.13 $312.13 $312.13 $312.13 $312.13 $312.13 $55.56 $312.13 $312.13 $231.66 $231.66 $240.59 $162.62 $65.05 $312.13 $124.85 $312.13 $312.13 $312.13 $312.13 $312.13 $234.38 $312.13 $312.13 $312.13 $156.07 $156.07 $247.21 $312.13 $249.70 $202.88 $312.13 N/A $181.25 $312.13 $187.28 $312.13 $312.13 $312.13 N/A N/A 71175029 SUP Custom 27203010 71175029 - TAP BN 4.7MM STRL LF EVOS AO QCK CNCT DISP BOTH IP/OP $309.50 $229.00 $55.07 $309.38 $309.38 $309.38 $309.38 $309.38 $309.38 $309.38 $55.07 $309.38 $309.38 $229.62 $229.62 $238.47 $161.19 $64.48 $309.38 $123.75 $309.38 $309.38 $309.38 $309.38 $309.38 $232.13 $309.38 $309.38 $309.38 $154.69 $154.69 $245.03 $309.38 $247.50 $201.10 $309.38 N/A $179.51 $309.38 $185.63 $309.38 $309.38 $309.38 N/A N/A 71175701 SUP HCPCS C1713 71175701 - PIN DRL 3.2MM 358MM DRL TIP BOTH IP/OP $125.00 $93.00 $24.79 $124.88 $56.20 $56.20 $56.20 $56.20 $124.88 $124.88 $124.88 $26.03 $124.88 $124.88 $124.88 $124.88 $124.88 $26.03 $124.88 $124.88 $73.87 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $56.20 $24.79 N/A $72.50 $124.88 $124.88 $124.88 $124.88 $124.88 N/A N/A 71175702 SUP HCPCS C1713 71175702 - PIN FX 4.5MM 80MM PRLC TRL TARGETER DRL TIP BOTH IP/OP $349.00 $258.00 $69.22 $348.75 $156.94 $156.94 $156.94 $156.94 $348.75 $348.75 $348.75 $72.69 $348.75 $348.75 $348.75 $348.75 $348.75 $72.68 $348.75 $348.75 $206.29 $348.75 $348.75 $348.75 $348.75 $261.75 $348.75 $348.75 $348.75 $174.38 $174.38 $276.21 $348.75 $279.00 $156.94 $69.22 N/A $202.42 $348.75 $209.25 $348.75 $72.68 $348.75 N/A N/A 71175703 SUP HCPCS C1713 71175703 - PIN FX 3.5MM 18MM TARGETER BOTH IP/OP $349.00 $258.00 $69.22 $348.75 $156.94 $156.94 $156.94 $156.94 $348.75 $348.75 $348.75 $72.69 $348.75 $348.75 $348.75 $348.75 $348.75 $72.68 $348.75 $348.75 $206.29 $348.75 $348.75 $348.75 $348.75 $261.75 $348.75 $348.75 $348.75 $174.38 $174.38 $276.21 $348.75 $279.00 $156.94 $69.22 N/A $202.42 $348.75 $209.25 $348.75 $72.68 $348.75 N/A N/A 71175705 SUP HCPCS C1713 71175705 - PIN FX SHRT 4.5MM 80MM PRLC TRL DRL TIP BOTH IP/OP $349.00 $258.00 $69.22 $348.75 $156.94 $156.94 $156.94 $156.94 $348.75 $348.75 $348.75 $72.69 $348.75 $348.75 $348.75 $348.75 $348.75 $72.68 $348.75 $348.75 $206.29 $348.75 $348.75 $348.75 $348.75 $261.75 $348.75 $348.75 $348.75 $174.38 $174.38 $276.21 $348.75 $279.00 $156.94 $69.22 N/A $202.42 $348.75 $209.25 $348.75 $72.68 $348.75 N/A N/A 71175706 SUP HCPCS C1713 71175706 - PIN FX SHRT 3.5MM 18MM PRLC TRL DRL TIP BOTH IP/OP $349.00 $258.00 $69.22 $348.75 $156.94 $156.94 $156.94 $156.94 $348.75 $348.75 $348.75 $72.69 $348.75 $348.75 $348.75 $348.75 $348.75 $72.68 $348.75 $348.75 $206.29 $348.75 $348.75 $348.75 $348.75 $261.75 $348.75 $348.75 $348.75 $174.38 $174.38 $276.21 $348.75 $279.00 $156.94 $69.22 N/A $202.42 $348.75 $209.25 $348.75 $72.68 $348.75 N/A N/A 71176011 SUP Custom 27203010 71176011 - BIT DRL 1.1MM 30MM QC BOTH IP/OP $245.00 $181.00 $43.55 $244.65 $244.65 $244.65 $244.65 $244.65 $244.65 $244.65 $43.55 $244.65 $244.65 $181.58 $181.58 $188.58 $127.46 $50.99 $244.65 $97.86 $244.65 $244.65 $244.65 $244.65 $244.65 $183.75 $244.65 $244.65 $244.65 $122.33 $122.33 $193.76 $244.65 $195.72 $159.02 $244.65 N/A $142.10 $244.65 $146.79 $244.65 $244.65 $244.65 N/A N/A 71176015 SUP Custom 27203010 71176015 - BIT DRL 1.5MM 85MM QC BOTH IP/OP $245.00 $181.00 $43.55 $244.65 $244.65 $244.65 $244.65 $244.65 $244.65 $244.65 $43.55 $244.65 $244.65 $181.58 $181.58 $188.58 $127.46 $50.99 $244.65 $97.86 $244.65 $244.65 $244.65 $244.65 $244.65 $183.75 $244.65 $244.65 $244.65 $122.33 $122.33 $193.76 $244.65 $195.72 $159.02 $244.65 N/A $142.10 $244.65 $146.79 $244.65 $244.65 $244.65 N/A N/A 71176016 SUP Custom 27203010 71176016 - BIT DRL 1.5MM 110MM STRL 85MM TC100 QC BOTH IP/OP $262.50 $194.00 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $46.73 $262.50 $262.50 $194.83 $194.83 $202.34 $136.76 $54.71 $262.50 $105.00 $262.50 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $170.63 $262.50 N/A $152.25 $262.50 $157.50 $262.50 $262.50 $262.50 N/A N/A 71176020 SUP Custom 27203010 71176020 - BIT DRL 2MM 100MM QC BOTH IP/OP $236.50 $175.00 $42.05 $236.25 $236.25 $236.25 $236.25 $236.25 $236.25 $236.25 $42.05 $236.25 $236.25 $175.34 $175.34 $182.10 $123.09 $49.24 $236.25 $94.50 $236.25 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $153.56 $236.25 N/A $137.17 $236.25 $141.75 $236.25 $236.25 $236.25 N/A N/A 71176021 SUP Custom 27203010 71176021 - BIT DRL 2MM 125MM QC BOTH IP/OP $257.50 $191.00 $45.79 $257.25 $257.25 $257.25 $257.25 $257.25 $257.25 $257.25 $45.79 $257.25 $257.25 $190.93 $190.93 $198.29 $134.03 $53.61 $257.25 $102.90 $257.25 $257.25 $257.25 $257.25 $257.25 $193.13 $257.25 $257.25 $257.25 $128.63 $128.63 $203.74 $257.25 $205.80 $167.21 $257.25 N/A $149.35 $257.25 $154.35 $257.25 $257.25 $257.25 N/A N/A 71176025 SUP Custom 27203010 71176025 - BIT DRL 2.5MM 110MM AU QC BOTH IP/OP $273.00 $202.00 $48.59 $273.00 $273.00 $273.00 $273.00 $273.00 $273.00 $273.00 $48.59 $273.00 $273.00 $202.62 $202.62 $210.43 $142.23 $56.90 $273.00 $109.20 $273.00 $273.00 $273.00 $273.00 $273.00 $204.75 $273.00 $273.00 $273.00 $136.50 $136.50 $216.22 $273.00 $218.40 $177.45 $273.00 N/A $158.34 $273.00 $163.80 $273.00 $273.00 $273.00 N/A N/A 71176026 SUP Custom 27203010 71176026 - BIT DRL 2.5MM 180MM AU QC BOTH IP/OP $355.00 $263.00 $63.17 $354.90 $354.90 $354.90 $354.90 $354.90 $354.90 $354.90 $63.17 $354.90 $354.90 $263.41 $263.41 $273.56 $184.90 $73.97 $354.90 $141.96 $354.90 $354.90 $354.90 $354.90 $354.90 $266.25 $354.90 $354.90 $354.90 $177.45 $177.45 $281.08 $354.90 $283.92 $230.69 $354.90 N/A $205.90 $354.90 $212.94 $354.90 $354.90 $354.90 N/A N/A 71176027 SUP Custom 27203010 71176027 - BIT DRL 2.7MM 100MM QC BOTH IP/OP $245.00 $181.00 $43.55 $244.65 $244.65 $244.65 $244.65 $244.65 $244.65 $244.65 $43.55 $244.65 $244.65 $181.58 $181.58 $188.58 $127.46 $50.99 $244.65 $97.86 $244.65 $244.65 $244.65 $244.65 $244.65 $183.75 $244.65 $244.65 $244.65 $122.33 $122.33 $193.76 $244.65 $195.72 $159.02 $244.65 N/A $142.10 $244.65 $146.79 $244.65 $244.65 $244.65 N/A N/A 71176028 SUP Custom 27203010 71176028 - BIT DRL 2.7MM 125MM STRL QC BOTH IP/OP $268.00 $198.00 $47.66 $267.75 $267.75 $267.75 $267.75 $267.75 $267.75 $267.75 $47.66 $267.75 $267.75 $198.72 $198.72 $206.38 $139.50 $55.80 $267.75 $107.10 $267.75 $267.75 $267.75 $267.75 $267.75 $201.00 $267.75 $267.75 $267.75 $133.88 $133.88 $212.06 $267.75 $214.20 $174.04 $267.75 N/A $155.44 $267.75 $160.65 $267.75 $267.75 $267.75 N/A N/A 71176032 SUP Custom 27203010 71176032 - BIT DRL 3.2MM 145MM STRL QC BOTH IP/OP $236.50 $175.00 $42.05 $236.25 $236.25 $236.25 $236.25 $236.25 $236.25 $236.25 $42.05 $236.25 $236.25 $175.34 $175.34 $182.10 $123.09 $49.24 $236.25 $94.50 $236.25 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $153.56 $236.25 N/A $137.17 $236.25 $141.75 $236.25 $236.25 $236.25 N/A N/A 71176033 SUP Custom 27203010 71176033 - BIT DRL 3.2MM 195MM QC BOTH IP/OP $355.00 $263.00 $63.17 $354.90 $354.90 $354.90 $354.90 $354.90 $354.90 $354.90 $63.17 $354.90 $354.90 $263.41 $263.41 $273.56 $184.90 $73.97 $354.90 $141.96 $354.90 $354.90 $354.90 $354.90 $354.90 $266.25 $354.90 $354.90 $354.90 $177.45 $177.45 $281.08 $354.90 $283.92 $230.69 $354.90 N/A $205.90 $354.90 $212.94 $354.90 $354.90 $354.90 N/A N/A 71176035 SUP Custom 27203010 71176035 - BIT DRL 3.5MM 110MM QC BOTH IP/OP $236.50 $175.00 $42.05 $236.25 $236.25 $236.25 $236.25 $236.25 $236.25 $236.25 $42.05 $236.25 $236.25 $175.34 $175.34 $182.10 $123.09 $49.24 $236.25 $94.50 $236.25 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $153.56 $236.25 N/A $137.17 $236.25 $141.75 $236.25 $236.25 $236.25 N/A N/A 71176037 SUP Custom 27203010 71176037 - BIT DRL 3.5MM 195MM QC BOTH IP/OP $355.00 $263.00 $63.17 $354.90 $354.90 $354.90 $354.90 $354.90 $354.90 $354.90 $63.17 $354.90 $354.90 $263.41 $263.41 $273.56 $184.90 $73.97 $354.90 $141.96 $354.90 $354.90 $354.90 $354.90 $354.90 $266.25 $354.90 $354.90 $354.90 $177.45 $177.45 $281.08 $354.90 $283.92 $230.69 $354.90 N/A $205.90 $354.90 $212.94 $354.90 $354.90 $354.90 N/A N/A 71176045 SUP Custom 27203010 71176045 - BIT DRL 4.5MM 145MM QC BOTH IP/OP $355.00 $263.00 $63.17 $354.90 $354.90 $354.90 $354.90 $354.90 $354.90 $354.90 $63.17 $354.90 $354.90 $263.41 $263.41 $273.56 $184.90 $73.97 $354.90 $141.96 $354.90 $354.90 $354.90 $354.90 $354.90 $266.25 $354.90 $354.90 $354.90 $177.45 $177.45 $281.08 $354.90 $283.92 $230.69 $354.90 N/A $205.90 $354.90 $212.94 $354.90 $354.90 $354.90 N/A N/A 71176047 SUP Custom 27203010 71176047 - BIT DRL 4.5MM 195MM QC BOTH IP/OP $355.00 $263.00 $63.17 $354.90 $354.90 $354.90 $354.90 $354.90 $354.90 $354.90 $63.17 $354.90 $354.90 $263.41 $263.41 $273.56 $184.90 $73.97 $354.90 $141.96 $354.90 $354.90 $354.90 $354.90 $354.90 $266.25 $354.90 $354.90 $354.90 $177.45 $177.45 $281.08 $354.90 $283.92 $230.69 $354.90 N/A $205.90 $354.90 $212.94 $354.90 $354.90 $354.90 N/A N/A 71176125 SUP Custom 27203010 71176125 - BIT DRL 2.5MM 230MM QC 3 FLT BOTH IP/OP $607.00 $449.00 $108.03 $606.90 $606.90 $606.90 $606.90 $606.90 $606.90 $606.90 $108.03 $606.90 $606.90 $450.44 $450.44 $467.80 $316.19 $126.48 $606.90 $242.76 $606.90 $606.90 $606.90 $606.90 $606.90 $455.25 $606.90 $606.90 $606.90 $303.45 $303.45 $480.66 $606.90 $485.52 $394.49 $606.90 N/A $352.06 $606.90 $364.14 $606.90 $606.90 $606.90 N/A N/A 71176132 SUP Custom 27203010 71176132 - BIT DRL LNG 3.2MM 230MM QC 3 FLT BOTH IP/OP $607.00 $449.00 $108.03 $606.90 $606.90 $606.90 $606.90 $606.90 $606.90 $606.90 $108.03 $606.90 $606.90 $450.44 $450.44 $467.80 $316.19 $126.48 $606.90 $242.76 $606.90 $606.90 $606.90 $606.90 $606.90 $455.25 $606.90 $606.90 $606.90 $303.45 $303.45 $480.66 $606.90 $485.52 $394.49 $606.90 N/A $352.06 $606.90 $364.14 $606.90 $606.90 $606.90 N/A N/A 71176145 SUP Custom 27203010 71176145 - BIT DRL 4.5MM 196MM STRL QC 3 FLT BOTH IP/OP $470.50 $348.00 $83.73 $470.40 $470.40 $470.40 $470.40 $470.40 $470.40 $470.40 $83.73 $470.40 $470.40 $349.13 $349.13 $362.58 $245.08 $98.04 $470.40 $188.16 $470.40 $470.40 $470.40 $470.40 $470.40 $352.88 $470.40 $470.40 $470.40 $235.20 $235.20 $372.56 $470.40 $376.32 $305.76 $470.40 N/A $272.89 $470.40 $282.24 $470.40 $470.40 $470.40 N/A N/A 71176511 SUP Custom 27203010 71176511 - BIT DRL 1.1MM 45MM STRL NQCK CPLNG BOTH IP/OP $233.50 $173.00 $41.49 $233.10 $233.10 $233.10 $233.10 $233.10 $233.10 $233.10 $41.49 $233.10 $233.10 $173.01 $173.01 $179.67 $121.45 $48.58 $233.10 $93.24 $233.10 $233.10 $233.10 $233.10 $233.10 $175.13 $233.10 $233.10 $233.10 $116.55 $116.55 $184.62 $233.10 $186.48 $151.52 $233.10 N/A $135.43 $233.10 $139.86 $233.10 $233.10 $233.10 N/A N/A 71176516 SUP Custom 27203010 71176516 - BIT DRL 1.5MM 95MM STRL NQCK CPLNG BOTH IP/OP $241.50 $179.00 $42.99 $241.50 $241.50 $241.50 $241.50 $241.50 $241.50 $241.50 $42.99 $241.50 $241.50 $179.24 $179.24 $186.15 $125.82 $50.33 $241.50 $96.60 $241.50 $241.50 $241.50 $241.50 $241.50 $181.13 $241.50 $241.50 $241.50 $120.75 $120.75 $191.27 $241.50 $193.20 $156.98 $241.50 N/A $140.07 $241.50 $144.90 $241.50 $241.50 $241.50 N/A N/A 71176521 SUP Custom 27203010 71176521 - BIT DRL 2MM 110MM NQCK CPLNG BOTH IP/OP $281.50 $208.00 $50.09 $281.40 $281.40 $281.40 $281.40 $281.40 $281.40 $281.40 $50.09 $281.40 $281.40 $208.86 $208.86 $216.90 $146.61 $58.65 $281.40 $112.56 $281.40 $281.40 $281.40 $281.40 $281.40 $211.13 $281.40 $281.40 $281.40 $140.70 $140.70 $222.87 $281.40 $225.12 $182.91 $281.40 N/A $163.27 $281.40 $168.84 $281.40 $281.40 $281.40 N/A N/A 71176525 SUP Custom 27203010 71176525 - BIT DRL 2.5MM 95MM AU NQCK CPLNG BOTH IP/OP $296.50 $219.00 $52.71 $296.10 $296.10 $296.10 $296.10 $296.10 $296.10 $296.10 $52.71 $296.10 $296.10 $219.77 $219.77 $228.23 $154.27 $61.71 $296.10 $118.44 $296.10 $296.10 $296.10 $296.10 $296.10 $222.38 $296.10 $296.10 $296.10 $148.05 $148.05 $234.51 $296.10 $236.88 $192.47 $296.10 N/A $171.97 $296.10 $177.66 $296.10 $296.10 $296.10 N/A N/A 71176528 SUP Custom 27203010 71176528 - BIT DRL 2.7MM 110MM NQCK CPLNG BOTH IP/OP $255.50 $189.00 $45.42 $255.15 $255.15 $255.15 $255.15 $255.15 $255.15 $255.15 $45.42 $255.15 $255.15 $189.37 $189.37 $196.67 $132.93 $53.18 $255.15 $102.06 $255.15 $255.15 $255.15 $255.15 $255.15 $191.63 $255.15 $255.15 $255.15 $127.58 $127.58 $202.08 $255.15 $204.12 $165.85 $255.15 N/A $148.19 $255.15 $153.09 $255.15 $255.15 $255.15 N/A N/A 71176532 SUP Custom 27203010 71176532 - BIT DRL 3.2MM 130MM NQCK CPLNG BOTH IP/OP $225.00 $167.00 $40.00 $224.70 $224.70 $224.70 $224.70 $224.70 $224.70 $224.70 $40.00 $224.70 $224.70 $166.77 $166.77 $173.20 $117.07 $46.83 $224.70 $89.88 $224.70 $224.70 $224.70 $224.70 $224.70 $168.75 $224.70 $224.70 $224.70 $112.35 $112.35 $177.96 $224.70 $179.76 $146.06 $224.70 N/A $130.50 $224.70 $134.82 $224.70 $224.70 $224.70 N/A N/A 71176533 SUP Custom 27203010 71176533 - BIT DRL 3.2MM 180MM NQCK CPLNG BOTH IP/OP $353.00 $261.00 $62.80 $352.80 $352.80 $352.80 $352.80 $352.80 $352.80 $352.80 $62.80 $352.80 $352.80 $261.85 $261.85 $271.94 $183.81 $73.53 $352.80 $141.12 $352.80 $352.80 $352.80 $352.80 $352.80 $264.75 $352.80 $352.80 $352.80 $176.40 $176.40 $279.42 $352.80 $282.24 $229.32 $352.80 N/A $204.74 $352.80 $211.68 $352.80 $352.80 $352.80 N/A N/A 71176535 SUP Custom 27203010 71176535 - BIT DRL 3.5MM 95MM NQCK CPLNG BOTH IP/OP $271.00 $201.00 $48.22 $270.90 $270.90 $270.90 $270.90 $270.90 $270.90 $270.90 $48.22 $270.90 $270.90 $201.06 $201.06 $208.81 $141.14 $56.46 $270.90 $108.36 $270.90 $270.90 $270.90 $270.90 $270.90 $203.25 $270.90 $270.90 $270.90 $135.45 $135.45 $214.55 $270.90 $216.72 $176.09 $270.90 N/A $157.18 $270.90 $162.54 $270.90 $270.90 $270.90 N/A N/A 71176537 SUP Custom 27203010 71176537 - BIT DRL 3.5MM 180MM NQCK CPLNG BOTH IP/OP $281.50 $208.00 $50.09 $281.40 $281.40 $281.40 $281.40 $281.40 $281.40 $281.40 $50.09 $281.40 $281.40 $208.86 $208.86 $216.90 $146.61 $58.65 $281.40 $112.56 $281.40 $281.40 $281.40 $281.40 $281.40 $211.13 $281.40 $281.40 $281.40 $140.70 $140.70 $222.87 $281.40 $225.12 $182.91 $281.40 N/A $163.27 $281.40 $168.84 $281.40 $281.40 $281.40 N/A N/A 71176545 SUP Custom 27203010 71176545 - BIT DRL 4.5MM 130MM STRL NQCK CPLNG BOTH IP/OP $271.00 $201.00 $48.22 $270.90 $270.90 $270.90 $270.90 $270.90 $270.90 $270.90 $48.22 $270.90 $270.90 $201.06 $201.06 $208.81 $141.14 $56.46 $270.90 $108.36 $270.90 $270.90 $270.90 $270.90 $270.90 $203.25 $270.90 $270.90 $270.90 $135.45 $135.45 $214.55 $270.90 $216.72 $176.09 $270.90 N/A $157.18 $270.90 $162.54 $270.90 $270.90 $270.90 N/A N/A 71176547 SUP Custom 27203010 71176547 - BIT DRL 4.5MM 180MM NQCK CPLNG BOTH IP/OP $303.50 $225.00 $54.01 $303.45 $303.45 $303.45 $303.45 $303.45 $303.45 $303.45 $54.01 $303.45 $303.45 $225.22 $225.22 $233.90 $158.10 $63.24 $303.45 $121.38 $303.45 $303.45 $303.45 $303.45 $303.45 $227.63 $303.45 $303.45 $303.45 $151.73 $151.73 $240.33 $303.45 $242.76 $197.24 $303.45 N/A $176.03 $303.45 $182.07 $303.45 $303.45 $303.45 N/A N/A 71177134 SUP Custom 27203010 71177134 - BIT DRL 5MM CNN BOTH IP/OP $919.00 $680.00 $163.54 $918.75 $918.75 $918.75 $918.75 $918.75 $918.75 $918.75 $163.54 $918.75 $918.75 $681.90 $681.90 $708.17 $478.67 $191.48 $918.75 $367.50 $918.75 $918.75 $918.75 $918.75 $918.75 $689.25 $918.75 $918.75 $918.75 $459.38 $459.38 $727.65 $918.75 $735.00 $597.19 $918.75 N/A $533.02 $918.75 $551.25 $918.75 $918.75 $918.75 N/A N/A 71177135 SUP Custom 27203010 71177135 - BIT DRL 5.5MM CNN 8MM SCR BOTH IP/OP $919.00 $680.00 $163.54 $918.75 $918.75 $918.75 $918.75 $918.75 $918.75 $918.75 $163.54 $918.75 $918.75 $681.90 $681.90 $708.17 $478.67 $191.48 $918.75 $367.50 $918.75 $918.75 $918.75 $918.75 $918.75 $689.25 $918.75 $918.75 $918.75 $459.38 $459.38 $727.65 $918.75 $735.00 $597.19 $918.75 N/A $533.02 $918.75 $551.25 $918.75 $918.75 $918.75 N/A N/A 71177197 SUP Custom 27203010 71177197 - BIT DRL SHRT 2MM VLP MN-MOD AO QC OVR BOTH IP/OP $242.00 $179.00 $43.08 $242.00 $242.00 $242.00 $242.00 $242.00 $242.00 $242.00 $43.08 $242.00 $242.00 $179.61 $179.61 $186.53 $126.08 $50.44 $242.00 $96.80 $242.00 $242.00 $242.00 $242.00 $242.00 $181.50 $242.00 $242.00 $242.00 $121.00 $121.00 $191.66 $242.00 $193.60 $157.30 $242.00 N/A $140.36 $242.00 $145.20 $242.00 $242.00 $242.00 N/A N/A 71177201 SUP HCPCS C1713 71177201 - PIN GD 3.2MM 300MM THRD BOTH IP/OP $171.00 $127.00 $33.90 $170.80 $76.86 $76.86 $76.86 $76.86 $170.80 $170.80 $170.80 $35.60 $170.80 $170.80 $170.80 $170.80 $170.80 $35.60 $170.80 $107.63 $101.03 $170.80 $107.63 $170.80 $170.80 $128.25 $170.80 $170.80 $170.80 $85.40 $85.40 $135.27 $170.80 $136.64 $76.86 $33.90 N/A $99.18 $170.80 $102.48 $170.80 $170.80 $170.80 N/A N/A 71177202 SUP Custom 27203010 71177202 - BIT DRL 3.2MM 300MM QC BOTH IP/OP $361.50 $268.00 $64.29 $361.20 $361.20 $361.20 $361.20 $361.20 $361.20 $361.20 $64.29 $361.20 $361.20 $268.08 $268.08 $278.41 $188.19 $75.28 $361.20 $144.48 $361.20 $361.20 $361.20 $361.20 $361.20 $271.13 $361.20 $361.20 $361.20 $180.60 $180.60 $286.07 $361.20 $288.96 $234.78 $361.20 N/A $209.67 $361.20 $216.72 $361.20 $361.20 $361.20 N/A N/A 71190808 SUP HCPCS C1713 71190808 - PIN HLF 6MM HAP ORTH BOTH IP/OP $85.00 $63.00 $16.87 $85.00 $38.25 $38.25 $38.25 $38.25 $85.00 $85.00 $85.00 $17.72 $85.00 $85.00 $85.00 $85.00 $85.00 $17.71 $85.00 $85.00 $50.28 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $38.25 $16.87 N/A $49.30 $85.00 $51.00 $85.00 $17.71 $85.00 N/A N/A 71191010 SUP HCPCS C1713 71191010 - TRIAL SRG 3.5MM SMPL LCK PLT HUM LT PROX BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $393.75 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $236.25 $393.75 $393.75 $393.75 N/A N/A 71191019 SUP HCPCS C1713 71191019 - TRIAL SRG SMPL LCK PLT RT OLCRN BOTH IP/OP $501.00 $371.00 $99.41 $500.85 $225.38 $225.38 $225.38 $225.38 $500.85 $500.85 $500.85 $104.39 $500.85 $500.85 $500.85 $500.85 $500.85 $104.38 $500.85 $500.85 $296.25 $500.85 $500.85 $500.85 $500.85 $375.75 $500.85 $500.85 $500.85 $250.43 $250.43 $396.67 $500.85 $400.68 $225.38 $99.41 N/A $290.58 $500.85 $300.51 $500.85 $104.38 $500.85 N/A N/A 71191025 SUP HCPCS C1713 71191025 - TRIAL SRG 10 HL SMPL LCK PLT INFR MDL CLVCL BOTH IP/OP $465.50 $344.00 $92.32 $465.15 $209.32 $209.32 $209.32 $209.32 $465.15 $465.15 $465.15 $96.95 $465.15 $465.15 $465.15 $465.15 $465.15 $96.94 $465.15 $465.15 $275.14 $465.15 $465.15 $465.15 $465.15 $349.13 $465.15 $465.15 $465.15 $232.58 $232.58 $368.40 $465.15 $372.12 $209.32 $92.32 N/A $269.99 $465.15 $279.09 $465.15 $96.94 $465.15 N/A N/A 71192010 SUP HCPCS C1713 71192010 - TRIAL SRG 2.7MM 55MM SMPL LCK SCR CORT BOTH IP/OP $18.50 $14.00 $3.62 $18.23 $8.20 $8.20 $8.20 $8.20 $18.23 $18.23 $18.23 $3.80 $18.23 $18.23 $18.23 $18.23 $18.23 $3.80 $18.23 $7.29 $10.78 $18.23 $18.23 $18.23 $18.23 $13.88 $18.23 $18.23 $18.23 $9.12 $9.12 $14.44 $18.23 $14.58 $8.20 $3.62 N/A $10.73 $18.23 $18.23 $18.23 $3.80 $18.23 N/A N/A 71192011 SUP HCPCS C1713 71192011 - TRIAL SRG 2.7MM 20MM SMPL SCR CORT BOTH IP/OP $18.00 $13.00 $3.50 $17.65 $7.94 $7.94 $7.94 $7.94 $17.65 $17.65 $17.65 $3.68 $17.65 $17.65 $17.65 $17.65 $17.65 $3.68 $17.65 $17.65 $10.44 $17.65 $17.65 $17.65 $17.65 $13.50 $17.65 $17.65 $17.65 $8.83 $8.83 $13.98 $17.65 $14.12 $7.94 $3.50 N/A $10.44 $17.65 $17.65 $17.65 $3.68 $17.65 N/A N/A 71192012 SUP HCPCS C1713 71192012 - TRIAL SRG 2.7MM 55MM SMPL SCR CORT BOTH IP/OP $20.00 $15.00 $3.88 $19.53 $8.79 $8.79 $8.79 $8.79 $19.53 $19.53 $19.53 $4.07 $19.53 $19.53 $19.53 $19.53 $19.53 $4.07 $19.53 $7.81 $11.55 $19.53 $19.53 $19.53 $19.53 $15.00 $19.53 $19.53 $19.53 $9.77 $9.77 $15.47 $19.53 $15.62 $8.79 $3.88 N/A $11.60 $19.53 $11.72 $19.53 $4.07 $19.53 N/A N/A 71192016 SUP HCPCS C1713 71192016 - TRIAL SRG 2.5MM 20MM SMPL SCR CORT BOTH IP/OP $18.00 $13.00 $3.50 $17.65 $7.94 $7.94 $7.94 $7.94 $17.65 $17.65 $17.65 $3.68 $17.65 $17.65 $17.65 $17.65 $17.65 $3.68 $17.65 $17.65 $10.44 $17.65 $17.65 $17.65 $17.65 $13.50 $17.65 $17.65 $17.65 $8.83 $8.83 $13.98 $17.65 $14.12 $7.94 $3.50 N/A $10.44 $17.65 $10.59 $17.65 $3.68 $17.65 N/A N/A 71192535 SUP HCPCS C1713 71192535 - TRIAL SRG 5MM 35MM HEX SCR ORTH SMPL BOTH IP/OP $27.00 $20.00 $5.32 $26.78 $12.05 $12.05 $12.05 $12.05 $26.78 $26.78 $26.78 $5.58 $26.78 $26.78 $26.78 $26.78 $26.78 $5.58 $26.78 $10.71 $15.84 $26.78 $26.78 $26.78 $26.78 $20.25 $26.78 $26.78 $26.78 $13.39 $13.39 $21.21 $26.78 $21.42 $12.05 $5.32 N/A $15.66 $26.78 $16.07 $26.78 $5.58 $26.78 N/A N/A 71192570 SUP HCPCS C1713 71192570 - TRIAL SRG 5MM 70MM HEX SCR ORTH SMPL BOTH IP/OP $39.50 $29.00 $7.81 $39.33 $17.70 $17.70 $17.70 $17.70 $39.33 $39.33 $39.33 $8.20 $39.33 $39.33 $39.33 $39.33 $39.33 $8.20 $39.33 $15.73 $23.26 $39.33 $39.33 $39.33 $39.33 $29.63 $39.33 $39.33 $39.33 $19.67 $19.67 $31.15 $39.33 $31.46 $17.70 $7.81 N/A $22.91 $39.33 $23.60 $39.33 $39.33 $39.33 N/A N/A 71193006 SUP HCPCS C1713 71193006 - SCREW SET ASIAN SMPL HIP IM NL BOTH IP/OP $65.50 $48.00 $12.96 $65.30 $29.39 $29.39 $29.39 $29.39 $65.30 $65.30 $65.30 $13.61 $65.30 $65.30 $65.30 $65.30 $65.30 $13.61 $65.30 $65.30 $38.62 $65.30 $65.30 $65.30 $65.30 $49.13 $65.30 $65.30 $65.30 $32.65 $32.65 $51.72 $65.30 $52.24 $29.39 $12.96 N/A $37.99 $65.30 $39.18 $65.30 $13.61 $65.30 N/A N/A 71193039 SUP HCPCS C1713 71193039 - NAIL IM 11.5MM 40CM TRGN RTRGD TI FEM BOTH IP/OP $179.00 $132.00 $35.50 $178.88 $80.50 $80.50 $80.50 $80.50 $178.88 $178.88 $178.88 $37.28 $178.88 $178.88 $178.88 $178.88 $178.88 $37.28 $178.88 $178.88 $105.81 $178.88 $178.88 $178.88 $178.88 $134.25 $178.88 $178.88 $178.88 $89.44 $89.44 $141.67 $178.88 $143.10 $80.50 $35.50 N/A $103.82 $178.88 $107.33 $178.88 $37.28 $178.88 N/A N/A 71193111 SUP HCPCS C1713 71193111 - TRIAL SRG MT-NL SMPL CAP NL BOTH IP/OP $29.50 $22.00 $5.83 $29.35 $13.21 $13.21 $13.21 $13.21 $29.35 $29.35 $29.35 $6.12 $29.35 $29.35 $29.35 $29.35 $29.35 $6.12 $29.35 $29.35 $17.36 $29.35 $29.35 $29.35 $29.35 $22.13 $29.35 $29.35 $29.35 $14.68 $14.68 $23.25 $29.35 $23.48 $13.21 $5.83 N/A $17.11 $29.35 $17.61 $29.35 $29.35 $29.35 N/A N/A 71193125 SUP HCPCS C1713 71193125 - NAIL IM 11.5MM 25CM TRGN TI FEM BOTH IP/OP $176.50 $131.00 $35.01 $176.40 $79.38 $79.38 $79.38 $79.38 $176.40 $176.40 $176.40 $36.77 $176.40 $176.40 $176.40 $176.40 $176.40 $36.76 $176.40 $176.40 $104.34 $176.40 $176.40 $176.40 $176.40 $132.38 $176.40 $176.40 $176.40 $88.20 $88.20 $139.71 $176.40 $141.12 $79.38 $35.01 N/A $102.37 $176.40 $105.84 $176.40 $36.76 $176.40 N/A N/A 71193632 SUP HCPCS C1713 71193632 - NAIL IM 10MM 32CM TRGN TI TIB DIST BOTH IP/OP $240.00 $178.00 $47.56 $239.63 $107.83 $107.83 $107.83 $107.83 $239.63 $239.63 $239.63 $49.94 $239.63 $239.63 $239.63 $239.63 $239.63 $49.94 $239.63 $239.63 $141.74 $239.63 $239.63 $239.63 $239.63 $180.00 $239.63 $239.63 $239.63 $119.82 $119.82 $189.79 $239.63 $191.70 $107.83 $47.56 N/A $139.20 $239.63 $143.78 $239.63 $49.94 $239.63 N/A N/A 71194828 SUP HCPCS C1713 71194828 - NAIL IM 10/8.5MM 28CM TRGN BNT TI HUM BOTH IP/OP $340.00 $252.00 $67.43 $339.75 $152.89 $152.89 $152.89 $152.89 $339.75 $339.75 $339.75 $70.81 $339.75 $339.75 $339.75 $339.75 $339.75 $70.81 $339.75 $339.75 $200.96 $339.75 $339.75 $339.75 $339.75 $255.00 $339.75 $339.75 $339.75 $169.88 $169.88 $269.08 $339.75 $271.80 $152.89 $67.43 N/A $197.20 $339.75 $203.85 $339.75 $70.80 $339.75 N/A N/A 71220006 SUP HCPCS C1713 71220006 - SCREW BN 2.7MM 6MM TC100 SS CORT MN FRAG SET BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71220008 SUP HCPCS C1713 71220008 - SCREW BN 2.7MM 8MM TC100 SS CORT MN FRAG SET BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71220010 SUP HCPCS C1713 71220010 - SCREW BN MN 2.7MM 10MM TC100 SS CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $57.60 $57.60 $12.00 $57.60 N/A N/A 71220012 SUP HCPCS C1713 71220012 - SCREW BN MN 2.7MM 12MM TC100 SS CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71220014 SUP HCPCS C1713 71220014 - SCREW BN MN 2.7MM 14MM TC100 SS CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71220016 SUP HCPCS C1713 71220016 - SCREW BN MN 2.7MM 16MM TC100 SS CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71220018 SUP HCPCS C1713 71220018 - SCREW BN 2.7MM 18MM TC100 SS CORT MN FRAG SET BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71220020 SUP HCPCS C1713 71220020 - SCREW BN 2.7MM 20MM TC100 SS CORT MN FRAG SET BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71220022 SUP HCPCS C1713 71220022 - SCREW BN 2.7MM 22MM TC100 SS CORT MN FRAG SET BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71220024 SUP HCPCS C1713 71220024 - SCREW BN 2.7MM 24MM TC100 SS CORT MN FRAG SET BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71220026 SUP HCPCS C1713 71220026 - SCREW BN 2.7MM 26MM TC100 SS CORT MN FRAG SET BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71220028 SUP HCPCS C1713 71220028 - SCREW BN 2.7MM 28MM TC100 SS CORT MN FRAG SET BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71220030 SUP HCPCS C1713 71220030 - SCREW BN 2.7MM 30MM TC100 SS CORT MN FRAG SET BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71220032 SUP HCPCS C1713 71220032 - SCREW BN 2.7MM 32MM TC100 SS CORT MN FRAG SET BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71220034 SUP HCPCS C1713 71220034 - SCREW BN MN 2.7MM 34MM TC100 SS CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71220036 SUP HCPCS C1713 71220036 - SCREW BN 2.7MM 36MM TC100 ST HEX HD SS CORT MN FRAG SET BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71220038 SUP HCPCS C1713 71220038 - SCREW BN 2.7MM 38MM TC100 SS CORT MN FRAG SET BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71220040 SUP HCPCS C1713 71220040 - SCREW BN 2.7MM 40MM TC100 SS CORT MN FRAG SET BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71220045 SUP HCPCS C1713 71220045 - SCREW BN MN 2.7MM 45MM TC100 SS CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71220050 SUP HCPCS C1713 71220050 - SCREW BN 2.7MM 50MM STRL TC100 SS CORT MN FRAG SET BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71222010 SUP HCPCS C1713 71222010 - SCREW BN 3.5MM 6MM 10MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $57.60 $57.60 $12.00 $57.60 N/A N/A 71222012 SUP HCPCS C1713 71222012 - SCREW BN 3.5MM 6MM 12MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71222014 SUP HCPCS C1713 71222014 - SCREW BN 3.5MM 6MM 14MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71222016 SUP HCPCS C1713 71222016 - SCREW BN 3.5MM 6MM 16MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71222018 SUP HCPCS C1713 71222018 - SCREW BN 3.5MM 6MM 18MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71222020 SUP HCPCS C1713 71222020 - SCREW BN 3.5MM 6MM 20MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71222022 SUP HCPCS C1713 71222022 - SCREW BN 3.5MM 6MM 22MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $57.60 $57.60 $12.00 $57.60 N/A N/A 71222024 SUP HCPCS C1713 71222024 - SCREW BN 3.5MM 6MM 24MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $57.60 $57.60 $12.00 $57.60 N/A N/A 71222026 SUP HCPCS C1713 71222026 - SCREW BN 3.5MM 6MM 26MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $23.04 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $57.60 $57.60 $12.00 $57.60 N/A N/A 71222028 SUP HCPCS C1713 71222028 - SCREW BN 3.5MM 6MM 28MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $23.04 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71222030 SUP HCPCS C1713 71222030 - SCREW BN 3.5MM 6MM 30MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71222032 SUP HCPCS C1713 71222032 - SCREW BN 3.5MM 6MM 32MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $23.04 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71222034 SUP HCPCS C1713 71222034 - SCREW BN 3.5MM 6MM 34MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $23.04 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $57.60 $57.60 $12.00 $57.60 N/A N/A 71222036 SUP HCPCS C1713 71222036 - SCREW BN 3.5MM 6MM 36MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71222038 SUP HCPCS C1713 71222038 - SCREW BN 3.5MM 6MM 38MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $23.04 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $57.60 $57.60 $57.60 $57.60 N/A N/A 71222040 SUP HCPCS C1713 71222040 - SCREW BN 3.5MM 6MM 40MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71222045 SUP HCPCS C1713 71222045 - SCREW BN 3.5MM 6MM 45MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $23.04 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71222050 SUP HCPCS C1713 71222050 - SCREW BN 3.5MM 6MM 50MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $23.04 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71222055 SUP HCPCS C1713 71222055 - SCREW BN 3.5MM 6MM 55MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $23.04 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71222060 SUP HCPCS C1713 71222060 - SCREW BN 3.5MM 6MM 60MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $89.50 $66.00 $17.74 $89.40 $40.23 $40.23 $40.23 $40.23 $89.40 $89.40 $89.40 $18.63 $89.40 $89.40 $89.40 $89.40 $89.40 $18.63 $89.40 $35.76 $52.88 $89.40 $89.40 $89.40 $89.40 $67.13 $89.40 $89.40 $89.40 $44.70 $44.70 $70.80 $89.40 $71.52 $40.23 $17.74 N/A $51.91 $89.40 $53.64 $89.40 $89.40 $89.40 N/A N/A 71222065 SUP HCPCS C1713 71222065 - SCREW BN 3.5MM 6MM 65MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $89.50 $66.00 $17.74 $89.40 $40.23 $40.23 $40.23 $40.23 $89.40 $89.40 $89.40 $18.63 $89.40 $89.40 $89.40 $89.40 $89.40 $18.63 $89.40 $35.76 $52.88 $89.40 $89.40 $89.40 $89.40 $67.13 $89.40 $89.40 $89.40 $44.70 $44.70 $70.80 $89.40 $71.52 $40.23 $17.74 N/A $51.91 $89.40 $53.64 $89.40 $89.40 $89.40 N/A N/A 71222070 SUP HCPCS C1713 71222070 - SCREW BN 3.5MM 6MM 70MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $89.50 $66.00 $17.74 $89.40 $40.23 $40.23 $40.23 $40.23 $89.40 $89.40 $89.40 $18.63 $89.40 $89.40 $89.40 $89.40 $89.40 $18.63 $89.40 $89.40 $52.88 $89.40 $89.40 $89.40 $89.40 $67.13 $89.40 $89.40 $89.40 $44.70 $44.70 $70.80 $89.40 $71.52 $40.23 $17.74 N/A $51.91 $89.40 $53.64 $89.40 $18.63 $89.40 N/A N/A 71222075 SUP HCPCS C1713 71222075 - SCREW BN 3.5MM 6MM 75MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $89.50 $66.00 $17.74 $89.40 $40.23 $40.23 $40.23 $40.23 $89.40 $89.40 $89.40 $18.63 $89.40 $89.40 $89.40 $89.40 $89.40 $18.63 $89.40 $35.76 $52.88 $89.40 $89.40 $89.40 $89.40 $67.13 $89.40 $89.40 $89.40 $44.70 $44.70 $70.80 $89.40 $71.52 $40.23 $17.74 N/A $51.91 $89.40 $89.40 $89.40 $18.63 $89.40 N/A N/A 71222080 SUP HCPCS C1713 71222080 - SCREW BN 3.5MM 6MM 80MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $89.50 $66.00 $17.74 $89.40 $40.23 $40.23 $40.23 $40.23 $89.40 $89.40 $89.40 $18.63 $89.40 $89.40 $89.40 $89.40 $89.40 $18.63 $89.40 $35.76 $52.88 $89.40 $89.40 $89.40 $89.40 $67.13 $89.40 $89.40 $89.40 $44.70 $44.70 $70.80 $89.40 $71.52 $40.23 $17.74 N/A $51.91 $89.40 $53.64 $89.40 $18.63 $89.40 N/A N/A 71222085 SUP HCPCS C1713 71222085 - SCREW BN 3.5MM 6MM 85MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $89.50 $66.00 $17.74 $89.40 $40.23 $40.23 $40.23 $40.23 $89.40 $89.40 $89.40 $18.63 $89.40 $89.40 $89.40 $89.40 $89.40 $18.63 $89.40 $89.40 $52.88 $89.40 $89.40 $89.40 $89.40 $67.13 $89.40 $89.40 $89.40 $44.70 $44.70 $70.80 $89.40 $71.52 $40.23 $17.74 N/A $51.91 $89.40 $53.64 $89.40 $18.63 $89.40 N/A N/A 71222090 SUP HCPCS C1713 71222090 - SCREW BN 3.5MM 6MM 90MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $89.50 $66.00 $17.74 $89.40 $40.23 $40.23 $40.23 $40.23 $89.40 $89.40 $89.40 $18.63 $89.40 $89.40 $89.40 $89.40 $89.40 $18.63 $89.40 $35.76 $52.88 $89.40 $89.40 $89.40 $89.40 $67.13 $89.40 $89.40 $89.40 $44.70 $44.70 $70.80 $89.40 $71.52 $40.23 $17.74 N/A $51.91 $89.40 $53.64 $89.40 $89.40 $89.40 N/A N/A 71222095 SUP HCPCS C1713 71222095 - SCREW BN 3.5MM 6MM 95MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $89.50 $66.00 $17.74 $89.40 $40.23 $40.23 $40.23 $40.23 $89.40 $89.40 $89.40 $18.63 $89.40 $89.40 $89.40 $89.40 $89.40 $18.63 $89.40 $35.76 $52.88 $89.40 $89.40 $89.40 $89.40 $67.13 $89.40 $89.40 $89.40 $44.70 $44.70 $70.80 $89.40 $71.52 $40.23 $17.74 N/A $51.91 $89.40 $53.64 $89.40 $89.40 $89.40 N/A N/A 71222100 SUP HCPCS C1713 71222100 - SCREW BN 3.5MM 100MM TC100 SS CORT SM FRAG SET BOTH IP/OP $89.50 $66.00 $17.74 $89.40 $40.23 $40.23 $40.23 $40.23 $89.40 $89.40 $89.40 $18.63 $89.40 $89.40 $89.40 $89.40 $89.40 $18.63 $89.40 $35.76 $52.88 $89.40 $89.40 $89.40 $89.40 $67.13 $89.40 $89.40 $89.40 $44.70 $44.70 $70.80 $89.40 $71.52 $40.23 $17.74 N/A $51.91 $89.40 $53.64 $89.40 $18.63 $89.40 N/A N/A 71222105 SUP HCPCS C1713 71222105 - SCREW BN 3.5MM 105MM TC100 SS CORT SM FRAG SET BOTH IP/OP $89.50 $66.00 $17.74 $89.40 $40.23 $40.23 $40.23 $40.23 $89.40 $89.40 $89.40 $18.63 $89.40 $89.40 $89.40 $89.40 $89.40 $18.63 $89.40 $35.76 $52.88 $89.40 $89.40 $89.40 $89.40 $67.13 $89.40 $89.40 $89.40 $44.70 $44.70 $70.80 $89.40 $71.52 $40.23 $17.74 N/A $51.91 $89.40 $89.40 $89.40 $18.63 $89.40 N/A N/A 71222110 SUP HCPCS C1713 71222110 - SCREW BN SM 3.5MM 110MM TC100 SS CORT BOTH IP/OP $89.50 $66.00 $17.74 $89.40 $40.23 $40.23 $40.23 $40.23 $89.40 $89.40 $89.40 $18.63 $89.40 $89.40 $89.40 $89.40 $89.40 $18.63 $89.40 $35.76 $52.88 $89.40 $89.40 $89.40 $89.40 $67.13 $89.40 $89.40 $89.40 $44.70 $44.70 $70.80 $89.40 $71.52 $40.23 $17.74 N/A $51.91 $89.40 $53.64 $89.40 $18.63 $89.40 N/A N/A 71222115 SUP HCPCS C1713 71222115 - SCREW BN 3.5MM 115MM TC100 SS CORT SM FRAG SET BOTH IP/OP $101.50 $75.00 $20.14 $101.48 $45.67 $45.67 $45.67 $45.67 $101.48 $101.48 $101.48 $21.15 $101.48 $101.48 $101.48 $101.48 $101.48 $21.15 $101.48 $101.48 $60.03 $101.48 $101.48 $101.48 $101.48 $76.13 $101.48 $101.48 $101.48 $50.74 $50.74 $80.37 $101.48 $81.18 $45.67 $20.14 N/A $58.87 $101.48 $101.48 $101.48 $101.48 $101.48 N/A N/A 71222120 SUP HCPCS C1713 71222120 - SCREW BN 3.5MM 120MM TC100 SS CORT SM FRAG SET BOTH IP/OP $101.50 $75.00 $20.14 $101.48 $45.67 $45.67 $45.67 $45.67 $101.48 $101.48 $101.48 $21.15 $101.48 $101.48 $101.48 $101.48 $101.48 $21.15 $101.48 $101.48 $60.03 $101.48 $101.48 $101.48 $101.48 $76.13 $101.48 $101.48 $101.48 $50.74 $50.74 $80.37 $101.48 $81.18 $45.67 $20.14 N/A $58.87 $101.48 $60.89 $101.48 $101.48 $101.48 N/A N/A 71222130 SUP HCPCS C1713 71222130 - SCREW BN 3.5MM 130MM TC100 SS CORT SM FRAG SET BOTH IP/OP $101.50 $75.00 $20.14 $101.48 $45.67 $45.67 $45.67 $45.67 $101.48 $101.48 $101.48 $21.15 $101.48 $101.48 $101.48 $101.48 $101.48 $21.15 $101.48 $40.59 $60.03 $101.48 $101.48 $101.48 $101.48 $76.13 $101.48 $101.48 $101.48 $50.74 $50.74 $80.37 $101.48 $81.18 $45.67 $20.14 N/A $58.87 $101.48 $60.89 $101.48 $21.15 $101.48 N/A N/A 71223010 SUP HCPCS C1713 71223010 - SCREW BN FT 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $24.68 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $37.02 $61.70 $12.86 $61.70 N/A N/A 71223012 SUP HCPCS C1713 71223012 - SCREW BN FT 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $24.68 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $37.02 $61.70 $12.86 $61.70 N/A N/A 71223014 SUP HCPCS C1713 71223014 - SCREW BN FT 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $24.68 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $37.02 $61.70 $61.70 $61.70 N/A N/A 71223016 SUP HCPCS C1713 71223016 - SCREW BN FT 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $37.02 $61.70 $61.70 $61.70 N/A N/A 71223018 SUP HCPCS C1713 71223018 - SCREW BN FT 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $61.70 $61.70 $12.86 $61.70 N/A N/A 71223020 SUP HCPCS C1713 71223020 - SCREW BN FT 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $61.70 $61.70 $12.86 $61.70 N/A N/A 71223022 SUP HCPCS C1713 71223022 - SCREW BN FT 4MM 6MM 22MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $37.02 $61.70 $12.86 $61.70 N/A N/A 71223024 SUP HCPCS C1713 71223024 - SCREW BN FT 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $37.02 $61.70 $12.86 $61.70 N/A N/A 71223026 SUP HCPCS C1713 71223026 - SCREW BN FT 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $37.02 $61.70 $12.86 $61.70 N/A N/A 71223028 SUP HCPCS C1713 71223028 - SCREW BN FT 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $61.70 $61.70 $12.86 $61.70 N/A N/A 71223030 SUP HCPCS C1713 71223030 - SCREW BN FT 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $61.70 $61.70 $12.86 $61.70 N/A N/A 71223032 SUP HCPCS C1713 71223032 - SCREW BN FT 4MM 6MM 32MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $61.70 $61.70 $12.86 $61.70 N/A N/A 71223035 SUP HCPCS C1713 71223035 - SCREW BN FT 4MM 6MM 35MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $61.70 $61.70 $12.86 $61.70 N/A N/A 71223036 SUP HCPCS C1713 71223036 - SCREW BN FT 4MM 6MM 36MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $61.70 $61.70 $12.86 $61.70 N/A N/A 71223040 SUP HCPCS C1713 71223040 - SCREW BN FT 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $61.70 $61.70 $12.86 $61.70 N/A N/A 71223045 SUP HCPCS C1713 71223045 - SCREW BN FT 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $61.70 $61.70 $12.86 $61.70 N/A N/A 71223050 SUP HCPCS C1713 71223050 - SCREW BN FT 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $61.70 $61.70 $12.86 $61.70 N/A N/A 71223055 SUP HCPCS C1713 71223055 - SCREW BN FT 4MM 6MM 55MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $61.70 $61.70 $12.86 $61.70 N/A N/A 71223060 SUP HCPCS C1713 71223060 - SCREW BN FT 4MM 6MM 60MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $62.00 $46.00 $12.25 $61.70 $27.77 $27.77 $27.77 $27.77 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $61.70 $61.70 $61.70 $12.86 $61.70 $61.70 $36.50 $61.70 $61.70 $61.70 $61.70 $46.50 $61.70 $61.70 $61.70 $30.85 $30.85 $48.87 $61.70 $49.36 $27.77 $12.25 N/A $35.96 $61.70 $61.70 $61.70 $12.86 $61.70 N/A N/A 71223065 SUP HCPCS C1713 71223065 - SCREW BN FT 4MM 6MM 65MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71223070 SUP HCPCS C1713 71223070 - SCREW BN FT 4MM 6MM 70MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71223075 SUP HCPCS C1713 71223075 - SCREW BN FT 4MM 6MM 75MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71223080 SUP HCPCS C1713 71223080 - SCREW BN FT 4MM 6MM 80MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71223085 SUP HCPCS C1713 71223085 - SCREW BN FT 4MM 6MM 85MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $82.00 $61.00 $16.18 $81.53 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $48.22 $81.53 $81.53 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $48.92 $81.53 $16.99 $81.53 N/A N/A 71223090 SUP HCPCS C1713 71223090 - SCREW BN FT 4MM 6MM 90MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $82.00 $61.00 $16.18 $81.53 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $48.22 $81.53 $81.53 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $48.92 $81.53 $16.99 $81.53 N/A N/A 71223095 SUP HCPCS C1713 71223095 - SCREW BN FT 4MM 6MM 95MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $82.00 $61.00 $16.18 $81.53 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $48.22 $81.53 $81.53 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $48.92 $81.53 $16.99 $81.53 N/A N/A 71223100 SUP HCPCS C1713 71223100 - SCREW BN FT 4MM 100MM TC100 SS CANC SM FRAG SET BOTH IP/OP $82.00 $61.00 $16.18 $81.53 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $48.22 $81.53 $81.53 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $48.92 $81.53 $16.99 $81.53 N/A N/A 71223210 SUP HCPCS C1713 71223210 - SCREW BN P/T 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $35.72 $59.53 $12.41 $59.53 N/A N/A 71223212 SUP HCPCS C1713 71223212 - SCREW BN P/T 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $59.53 $59.53 $12.41 $59.53 N/A N/A 71223214 SUP HCPCS C1713 71223214 - SCREW BN P/T 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $59.53 $59.53 $12.41 $59.53 N/A N/A 71223216 SUP HCPCS C1713 71223216 - SCREW BN P/T 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $59.53 $59.53 $59.53 $59.53 N/A N/A 71223218 SUP HCPCS C1713 71223218 - SCREW BN P/T 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $59.53 $59.53 $59.53 $59.53 N/A N/A 71223220 SUP HCPCS C1713 71223220 - SCREW BN P/T 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $59.53 $59.53 $59.53 $59.53 N/A N/A 71223222 SUP HCPCS C1713 71223222 - SCREW BN P/T 4MM 6MM 22MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $35.72 $59.53 $59.53 $59.53 N/A N/A 71223224 SUP HCPCS C1713 71223224 - SCREW BN P/T 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $59.53 $59.53 $59.53 $59.53 N/A N/A 71223226 SUP HCPCS C1713 71223226 - SCREW BN P/T 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $59.53 $59.53 $59.53 $59.53 N/A N/A 71223228 SUP HCPCS C1713 71223228 - SCREW BN P/T 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $59.53 $59.53 $59.53 $59.53 N/A N/A 71223230 SUP HCPCS C1713 71223230 - SCREW BN P/T 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $59.53 $59.53 $59.53 $59.53 N/A N/A 71223235 SUP HCPCS C1713 71223235 - SCREW BN P/T 4MM 6MM 35MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $59.53 $59.53 $12.41 $59.53 N/A N/A 71223240 SUP HCPCS C1713 71223240 - SCREW BN P/T 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $59.53 $59.53 $12.41 $59.53 N/A N/A 71223245 SUP HCPCS C1713 71223245 - SCREW BN P/T 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $35.72 $59.53 $59.53 $59.53 N/A N/A 71223250 SUP HCPCS C1713 71223250 - SCREW BN P/T 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $35.72 $59.53 $59.53 $59.53 N/A N/A 71223255 SUP HCPCS C1713 71223255 - SCREW BN P/T 4MM 6MM 55MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $35.72 $59.53 $12.41 $59.53 N/A N/A 71223260 SUP HCPCS C1713 71223260 - SCREW BN P/T 4MM 6MM 60MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $60.00 $44.00 $11.82 $59.53 $26.79 $26.79 $26.79 $26.79 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $59.53 $59.53 $59.53 $12.41 $59.53 $59.53 $35.21 $59.53 $59.53 $59.53 $59.53 $45.00 $59.53 $59.53 $59.53 $29.77 $29.77 $47.15 $59.53 $47.62 $26.79 $11.82 N/A $34.80 $59.53 $35.72 $59.53 $12.41 $59.53 N/A N/A 71223265 SUP HCPCS C1713 71223265 - SCREW BN P/T 4MM 6MM 65MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71223270 SUP HCPCS C1713 71223270 - SCREW BN P/T 4MM 6MM 70MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71223275 SUP HCPCS C1713 71223275 - SCREW BN P/T 4MM 6MM 75MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $14.07 $67.53 N/A N/A 71223280 SUP HCPCS C1713 71223280 - SCREW BN P/T 4MM 6MM 80MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71223285 SUP HCPCS C1713 71223285 - SCREW BN P/T 4MM 6MM 85MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71223290 SUP HCPCS C1713 71223290 - SCREW BN P/T 4MM 6MM 90MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71223295 SUP HCPCS C1713 71223295 - SCREW BN P/T 4MM 6MM 95MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71223300 SUP HCPCS C1713 71223300 - SCREW BN 4MM 100MM TC100 P/T SS CANC BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 71225014 SUP HCPCS C1713 71225014 - SCREW BN 4.5MM 14MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225016 SUP HCPCS C1713 71225016 - SCREW BN 4.5MM 16MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71225018 SUP HCPCS C1713 71225018 - SCREW BN 4.5MM 18MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $57.60 $57.60 $12.00 $57.60 N/A N/A 71225020 SUP HCPCS C1713 71225020 - SCREW BN 4.5MM 20MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $57.60 $57.60 $57.60 $57.60 N/A N/A 71225022 SUP HCPCS C1713 71225022 - SCREW BN 4.5MM 22MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $57.60 $57.60 $12.00 $57.60 N/A N/A 71225024 SUP HCPCS C1713 71225024 - SCREW BN 4.5MM 24MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $57.60 $57.60 $12.00 $57.60 N/A N/A 71225026 SUP HCPCS C1713 71225026 - SCREW BN 4.5MM 26MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225028 SUP HCPCS C1713 71225028 - SCREW BN 4.5MM 28MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225030 SUP HCPCS C1713 71225030 - SCREW BN 4.5MM 30MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225032 SUP HCPCS C1713 71225032 - SCREW BN 4.5MM 32MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225034 SUP HCPCS C1713 71225034 - SCREW BN 4.5MM 34MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $57.60 $57.60 $57.60 $57.60 N/A N/A 71225036 SUP HCPCS C1713 71225036 - SCREW BN 4.5MM 36MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71225038 SUP HCPCS C1713 71225038 - SCREW BN 4.5MM 38MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225040 SUP HCPCS C1713 71225040 - SCREW BN 4.5MM 40MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225042 SUP HCPCS C1713 71225042 - SCREW BN 4.5MM 42MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225044 SUP HCPCS C1713 71225044 - SCREW BN 4.5MM 44MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $57.60 $57.60 $12.00 $57.60 N/A N/A 71225046 SUP HCPCS C1713 71225046 - SCREW BN 4.5MM 46MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225048 SUP HCPCS C1713 71225048 - SCREW BN 4.5MM 48MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225050 SUP HCPCS C1713 71225050 - SCREW BN 4.5MM 50MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71225052 SUP HCPCS C1713 71225052 - SCREW BN 4.5MM 52MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71225054 SUP HCPCS C1713 71225054 - SCREW BN 4.5MM 54MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225056 SUP HCPCS C1713 71225056 - SCREW BN 4.5MM 56MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225058 SUP HCPCS C1713 71225058 - SCREW BN 4.5MM 58MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225060 SUP HCPCS C1713 71225060 - SCREW BN 4.5MM 8MM 60MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71225062 SUP HCPCS C1713 71225062 - SCREW BN 4.5MM 62MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71225064 SUP HCPCS C1713 71225064 - SCREW BN 4.5MM 64MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225066 SUP HCPCS C1713 71225066 - SCREW BN 4.5MM 66MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225068 SUP HCPCS C1713 71225068 - SCREW BN 4.5MM 68MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $12.00 $57.60 N/A N/A 71225070 SUP HCPCS C1713 71225070 - SCREW BN 4.5MM 70MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71225072 SUP HCPCS C1713 71225072 - SCREW BN 4.5MM 72MM TC100 CORT BOTH IP/OP $58.00 $43.00 $11.43 $57.60 $25.92 $25.92 $25.92 $25.92 $57.60 $57.60 $57.60 $12.01 $57.60 $57.60 $57.60 $57.60 $57.60 $12.00 $57.60 $57.60 $34.07 $57.60 $57.60 $57.60 $57.60 $43.50 $57.60 $57.60 $57.60 $28.80 $28.80 $45.62 $57.60 $46.08 $25.92 $11.43 N/A $33.64 $57.60 $34.56 $57.60 $57.60 $57.60 N/A N/A 71225076 SUP HCPCS C1713 71225076 - SCREW BN 4.5MM 8MM 76MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $99.50 $74.00 $19.71 $99.33 $44.70 $44.70 $44.70 $44.70 $99.33 $99.33 $99.33 $20.70 $99.33 $99.33 $99.33 $99.33 $99.33 $20.70 $99.33 $99.33 $58.75 $99.33 $99.33 $99.33 $99.33 $74.63 $99.33 $99.33 $99.33 $49.67 $49.67 $78.67 $99.33 $79.46 $44.70 $19.71 N/A $57.71 $99.33 $59.60 $99.33 $20.70 $99.33 N/A N/A 71225080 SUP HCPCS C1713 71225080 - SCREW BN 4.5MM 8MM 80MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $99.50 $74.00 $19.71 $99.33 $44.70 $44.70 $44.70 $44.70 $99.33 $99.33 $99.33 $20.70 $99.33 $99.33 $99.33 $99.33 $99.33 $20.70 $99.33 $99.33 $58.75 $99.33 $99.33 $99.33 $99.33 $74.63 $99.33 $99.33 $99.33 $49.67 $49.67 $78.67 $99.33 $79.46 $44.70 $19.71 N/A $57.71 $99.33 $99.33 $99.33 $20.70 $99.33 N/A N/A 71225085 SUP HCPCS C1713 71225085 - SCREW BN 4.5MM 8MM 85MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $99.50 $74.00 $19.71 $99.33 $44.70 $44.70 $44.70 $44.70 $99.33 $99.33 $99.33 $20.70 $99.33 $99.33 $99.33 $99.33 $99.33 $20.70 $99.33 $39.73 $58.75 $99.33 $99.33 $99.33 $99.33 $74.63 $99.33 $99.33 $99.33 $49.67 $49.67 $78.67 $99.33 $79.46 $44.70 $19.71 N/A $57.71 $99.33 $99.33 $99.33 $20.70 $99.33 N/A N/A 71225090 SUP HCPCS C1713 71225090 - SCREW BN 4.5MM 8MM 90MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $99.50 $74.00 $19.71 $99.33 $44.70 $44.70 $44.70 $44.70 $99.33 $99.33 $99.33 $20.70 $99.33 $99.33 $99.33 $99.33 $99.33 $20.70 $99.33 $39.73 $58.75 $99.33 $99.33 $99.33 $99.33 $74.63 $99.33 $99.33 $99.33 $49.67 $49.67 $78.67 $99.33 $79.46 $44.70 $19.71 N/A $57.71 $99.33 $59.60 $99.33 $99.33 $99.33 N/A N/A 71225095 SUP HCPCS C1713 71225095 - SCREW BN 4.5MM 8MM 95MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $99.50 $74.00 $19.71 $99.33 $44.70 $44.70 $44.70 $44.70 $99.33 $99.33 $99.33 $20.70 $99.33 $99.33 $99.33 $99.33 $99.33 $20.70 $99.33 $99.33 $58.75 $99.33 $99.33 $99.33 $99.33 $74.63 $99.33 $99.33 $99.33 $49.67 $49.67 $78.67 $99.33 $79.46 $44.70 $19.71 N/A $57.71 $99.33 $59.60 $99.33 $99.33 $99.33 N/A N/A 71225100 SUP HCPCS C1713 71225100 - SCREW BN 4.5MM 100MM TC100 SS CORT LG FRAG SET BOTH IP/OP $99.50 $74.00 $19.71 $99.33 $44.70 $44.70 $44.70 $44.70 $99.33 $99.33 $99.33 $20.70 $99.33 $99.33 $99.33 $99.33 $99.33 $20.70 $99.33 $99.33 $58.75 $99.33 $99.33 $99.33 $99.33 $74.63 $99.33 $99.33 $99.33 $49.67 $49.67 $78.67 $99.33 $79.46 $44.70 $19.71 N/A $57.71 $99.33 $59.60 $99.33 $20.70 $99.33 N/A N/A 71225105 SUP HCPCS C1713 71225105 - SCREW BN 4.5MM 105MM TC100 SS CORT LG FRAG SET BOTH IP/OP $99.50 $74.00 $19.71 $99.33 $44.70 $44.70 $44.70 $44.70 $99.33 $99.33 $99.33 $20.70 $99.33 $99.33 $99.33 $99.33 $99.33 $20.70 $99.33 $99.33 $58.75 $99.33 $99.33 $99.33 $99.33 $74.63 $99.33 $99.33 $99.33 $49.67 $49.67 $78.67 $99.33 $79.46 $44.70 $19.71 N/A $57.71 $99.33 $99.33 $99.33 $20.70 $99.33 N/A N/A 71225110 SUP HCPCS C1713 71225110 - SCREW BN LG 4.5MM 110MM TC100 SS CORT BOTH IP/OP $108.50 $80.00 $21.47 $108.15 $48.67 $48.67 $48.67 $48.67 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $63.97 $108.15 $108.15 $108.15 $108.15 $81.38 $108.15 $108.15 $108.15 $54.08 $54.08 $85.65 $108.15 $86.52 $48.67 $21.47 N/A $62.93 $108.15 $108.15 $108.15 $22.54 $108.15 N/A N/A 71225115 SUP HCPCS C1713 71225115 - SCREW BN 4.5MM 115MM TC100 SS CORT LG FRAG SET BOTH IP/OP $108.50 $80.00 $21.47 $108.15 $48.67 $48.67 $48.67 $48.67 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $63.97 $108.15 $108.15 $108.15 $108.15 $81.38 $108.15 $108.15 $108.15 $54.08 $54.08 $85.65 $108.15 $86.52 $48.67 $21.47 N/A $62.93 $108.15 $108.15 $108.15 $108.15 $108.15 N/A N/A 71225120 SUP HCPCS C1713 71225120 - SCREW BN 4.5MM 120MM TC100 SS CORT LG FRAG SET BOTH IP/OP $108.50 $80.00 $21.47 $108.15 $48.67 $48.67 $48.67 $48.67 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $63.97 $108.15 $108.15 $108.15 $108.15 $81.38 $108.15 $108.15 $108.15 $54.08 $54.08 $85.65 $108.15 $86.52 $48.67 $21.47 N/A $62.93 $108.15 $108.15 $108.15 $22.54 $108.15 N/A N/A 71225125 SUP HCPCS C1713 71225125 - SCREW BN 4.5MM 125MM TC100 SS CORT LG FRAG SET BOTH IP/OP $108.50 $80.00 $21.47 $108.15 $48.67 $48.67 $48.67 $48.67 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $63.97 $108.15 $108.15 $108.15 $108.15 $81.38 $108.15 $108.15 $108.15 $54.08 $54.08 $85.65 $108.15 $86.52 $48.67 $21.47 N/A $62.93 $108.15 $64.89 $108.15 $22.54 $108.15 N/A N/A 71225130 SUP HCPCS C1713 71225130 - SCREW BN 4.5MM 130MM TC100 SS CORT LG FRAG SET BOTH IP/OP $108.50 $80.00 $21.47 $108.15 $48.67 $48.67 $48.67 $48.67 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $63.97 $108.15 $108.15 $108.15 $108.15 $81.38 $108.15 $108.15 $108.15 $54.08 $54.08 $85.65 $108.15 $86.52 $48.67 $21.47 N/A $62.93 $108.15 $64.89 $108.15 $22.54 $108.15 N/A N/A 71225135 SUP HCPCS C1713 71225135 - SCREW BN 4.5MM 135MM TC100 SS CORT LG FRAG SET BOTH IP/OP $108.50 $80.00 $21.47 $108.15 $48.67 $48.67 $48.67 $48.67 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $63.97 $108.15 $108.15 $108.15 $108.15 $81.38 $108.15 $108.15 $108.15 $54.08 $54.08 $85.65 $108.15 $86.52 $48.67 $21.47 N/A $62.93 $108.15 $64.89 $108.15 $22.54 $108.15 N/A N/A 71225140 SUP HCPCS C1713 71225140 - SCREW BN 4.5MM 140MM TC100 SS CORT LG FRAG SET BOTH IP/OP $108.50 $80.00 $21.47 $108.15 $48.67 $48.67 $48.67 $48.67 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $63.97 $108.15 $108.15 $108.15 $108.15 $81.38 $108.15 $108.15 $108.15 $54.08 $54.08 $85.65 $108.15 $86.52 $48.67 $21.47 N/A $62.93 $108.15 $64.89 $108.15 $22.54 $108.15 N/A N/A 71225145 SUP HCPCS C1713 71225145 - SCREW BN 4.5MM 145MM TC100 SS CORT LG FRAG SET BOTH IP/OP $108.50 $80.00 $21.47 $108.15 $48.67 $48.67 $48.67 $48.67 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $108.15 $108.15 $108.15 $22.54 $108.15 $108.15 $63.97 $108.15 $108.15 $108.15 $108.15 $81.38 $108.15 $108.15 $108.15 $54.08 $54.08 $85.65 $108.15 $86.52 $48.67 $21.47 N/A $62.93 $108.15 $64.89 $108.15 $108.15 $108.15 N/A N/A 71225225 SUP HCPCS C1713 71225225 - SCREW BN 4.5MM 25MM STRL 12MM TC100 SS MLR LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71225230 SUP HCPCS C1713 71225230 - SCREW BN 4.5MM 30MM STRL 15MM TC100 SS MLR LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71225235 SUP HCPCS C1713 71225235 - SCREW BN 4.5MM 35MM STRL 18MM TC100 SS MLR LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71225240 SUP HCPCS C1713 71225240 - SCREW BN 4.5MM 40MM STRL 20MM TC100 SS MLR LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71225245 SUP HCPCS C1713 71225245 - SCREW BN 4.5MM 45MM STRL 22MM TC100 SS MLR LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $126.00 $126.00 N/A N/A 71225250 SUP HCPCS C1713 71225250 - SCREW BN 4.5MM 50MM STRL 24MM TC100 SS MLR LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $126.00 $126.00 N/A N/A 71225255 SUP HCPCS C1713 71225255 - SCREW BN 4.5MM 55MM STRL 26MM TC100 SS MLR LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71225260 SUP HCPCS C1713 71225260 - SCREW BN 4.5MM 60MM STRL 28MM TC100 SS MLR LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71225265 SUP HCPCS C1713 71225265 - SCREW BN 4.5MM 65MM STRL 30MM TC100 SS MLR LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 71225270 SUP HCPCS C1713 71225270 - SCREW BN 4.5MM 70MM STRL 32MM TC100 SS MLR LG FRAG SET BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 71225320 SUP HCPCS C1713 71225320 - PLATE BN 90D 10MM DSPL 40MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225321 SUP HCPCS C1713 71225321 - PLATE BN 90D 10MM DSPL 50MM TC100 4 HL OSTM SS ADLT PROX FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225322 SUP HCPCS C1713 71225322 - PLATE BN 90D 10MM DSPL 55MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225323 SUP HCPCS C1713 71225323 - PLATE BN 90D 10MM DSPL 60MM TC100 4 HL OSTM SS ADLT PROX FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225324 SUP HCPCS C1713 71225324 - PLATE BN 90D 10MM DSPL 65MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225325 SUP HCPCS C1713 71225325 - PLATE BN 90D 10MM DSPL 70MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225326 SUP HCPCS C1713 71225326 - PLATE BN 90D 10MM DSPL 80MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225327 SUP HCPCS C1713 71225327 - PLATE BN 90D 15MM DSPL 40MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225328 SUP HCPCS C1713 71225328 - PLATE BN 90D 15MM DSPL 50MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225329 SUP HCPCS C1713 71225329 - PLATE BN 90D 15MM DSPL 55MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225330 SUP HCPCS C1713 71225330 - PLATE BN 90D 15MM DSPL 60MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225331 SUP HCPCS C1713 71225331 - PLATE BN 90D 15MM DSPL 65MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225332 SUP HCPCS C1713 71225332 - PLATE BN 90D 15MM DSPL 70MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225333 SUP HCPCS C1713 71225333 - PLATE BN 90D 15MM DSPL 75MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225334 SUP HCPCS C1713 71225334 - PLATE BN 90D 15MM DSPL 80MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225335 SUP HCPCS C1713 71225335 - PLATE BN 90D 20MM DSPL 50MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225336 SUP HCPCS C1713 71225336 - PLATE BN 90D 20MM DSPL 60MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225337 SUP HCPCS C1713 71225337 - PLATE BN 90D 20MM DSPL 70MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225338 SUP HCPCS C1713 71225338 - PLATE BN 90D 20MM DSPL 75MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225339 SUP HCPCS C1713 71225339 - PLATE BN 100D 10MM DSPL 50MM TC100 4 HL OSTM SS ADLT FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225340 SUP HCPCS C1713 71225340 - PLATE BN 100D 10MM DSPL 60MM TC100 4 HL OSTM SS ADLT FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225341 SUP HCPCS C1713 71225341 - PLATE BN 110D 65MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225342 SUP HCPCS C1713 71225342 - PLATE BN 110D 75MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225343 SUP HCPCS C1713 71225343 - PLATE BN 110D 85MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225344 SUP HCPCS C1713 71225344 - PLATE BN 120D 65MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225345 SUP HCPCS C1713 71225345 - PLATE BN 120D 75MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225346 SUP HCPCS C1713 71225346 - PLATE BN 120D 85MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225347 SUP HCPCS C1713 71225347 - PLATE BN 130D 65MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225348 SUP HCPCS C1713 71225348 - PLATE BN 130D 70MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225349 SUP HCPCS C1713 71225349 - PLATE BN 130D 75MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225350 SUP HCPCS C1713 71225350 - PLATE BN 130D 80MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225351 SUP HCPCS C1713 71225351 - PLATE BN 130D 85MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225352 SUP HCPCS C1713 71225352 - PLATE BN 130D 90MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225353 SUP HCPCS C1713 71225353 - PLATE BN 130D 95MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225354 SUP HCPCS C1713 71225354 - PLATE BN 130D 100MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225355 SUP HCPCS C1713 71225355 - PLATE BN 130D 105MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225356 SUP HCPCS C1713 71225356 - PLATE BN 130D 110MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5MM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225400 SUP HCPCS C1713 71225400 - PLATE BN 95D 92MM 50MM TC100 5 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225401 SUP HCPCS C1713 71225401 - PLATE BN 95D 92MM 60MM TC100 5 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225402 SUP HCPCS C1713 71225402 - PLATE BN 95D 92MM 70MM TC100 5 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225403 SUP HCPCS C1713 71225403 - PLATE BN 95D 92MM 80MM TC100 5 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225404 SUP HCPCS C1713 71225404 - PLATE BN 95D 124MM 50MM TC100 7 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225405 SUP HCPCS C1713 71225405 - PLATE BN 95D 124MM 60MM TC100 7 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225406 SUP HCPCS C1713 71225406 - PLATE BN 95D 124MM 70MM TC100 7 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225407 SUP HCPCS C1713 71225407 - PLATE BN 95D 124MM 80MM TC100 7 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225408 SUP HCPCS C1713 71225408 - PLATE BN 95D 156MM 50MM TC100 9 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225409 SUP HCPCS C1713 71225409 - PLATE BN 95D 156MM 60MM TC100 9 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225410 SUP HCPCS C1713 71225410 - PLATE BN 95D 156MM 70MM TC100 9 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,001.70" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225411 SUP HCPCS C1713 71225411 - PLATE BN 95D 156MM 80MM TC100 9 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,001.70" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225412 SUP HCPCS C1713 71225412 - PLATE BN 95D 204MM 50MM TC100 12 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,001.70" "$1,669.50" "$1,669.50" "$1,669.50" N/A N/A 71225413 SUP HCPCS C1713 71225413 - PLATE BN 95D 204MM 60MM TC100 12 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,001.70" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225414 SUP HCPCS C1713 71225414 - PLATE BN 95D 204MM 70MM TC100 12 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,001.70" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225415 SUP HCPCS C1713 71225415 - PLATE BN 95D 204MM 80MM TC100 12 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,001.70" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225416 SUP HCPCS C1713 71225416 - PLATE BN 95D 235MM 50MM TC100 14 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$2,956.00" "$2,187.00" $586.64 "$2,955.75" "$1,330.09" "$1,330.09" "$1,330.09" "$1,330.09" "$2,955.75" "$2,955.75" "$2,955.75" $616.05 "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" $616.01 "$2,955.75" "$1,182.30" "$1,457.18" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,217.00" "$2,955.75" "$2,955.75" "$2,955.75" "$1,477.88" "$1,477.88" "$2,340.95" "$2,955.75" "$2,364.60" "$1,330.09" $586.64 N/A "$1,714.48" "$2,955.75" "$1,773.45" "$2,955.75" $615.98 "$2,955.75" N/A N/A 71225417 SUP HCPCS C1713 71225417 - PLATE BN 95D 235MM 60MM TC100 14 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$2,956.00" "$2,187.00" $586.64 "$2,955.75" "$1,330.09" "$1,330.09" "$1,330.09" "$1,330.09" "$2,955.75" "$2,955.75" "$2,955.75" $616.05 "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" $616.01 "$2,955.75" "$2,955.75" "$1,457.18" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,217.00" "$2,955.75" "$2,955.75" "$2,955.75" "$1,477.88" "$1,477.88" "$2,340.95" "$2,955.75" "$2,364.60" "$1,330.09" $586.64 N/A "$1,714.48" "$2,955.75" "$1,773.45" "$2,955.75" $615.98 "$2,955.75" N/A N/A 71225418 SUP HCPCS C1713 71225418 - PLATE BN 95D 235MM 70MM TC100 14 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$2,956.00" "$2,187.00" $586.64 "$2,955.75" "$1,330.09" "$1,330.09" "$1,330.09" "$1,330.09" "$2,955.75" "$2,955.75" "$2,955.75" $616.05 "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" $616.01 "$2,955.75" "$1,182.30" "$1,457.18" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,217.00" "$2,955.75" "$2,955.75" "$2,955.75" "$1,477.88" "$1,477.88" "$2,340.95" "$2,955.75" "$2,364.60" "$1,330.09" $586.64 N/A "$1,714.48" "$2,955.75" "$1,773.45" "$2,955.75" $615.98 "$2,955.75" N/A N/A 71225419 SUP HCPCS C1713 71225419 - PLATE BN 95D 235MM 80MM TC100 14 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$2,956.00" "$2,187.00" $586.64 "$2,955.75" "$1,330.09" "$1,330.09" "$1,330.09" "$1,330.09" "$2,955.75" "$2,955.75" "$2,955.75" $616.05 "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" $616.01 "$2,955.75" "$2,955.75" "$1,457.18" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,217.00" "$2,955.75" "$2,955.75" "$2,955.75" "$1,477.88" "$1,477.88" "$2,340.95" "$2,955.75" "$2,364.60" "$1,330.09" $586.64 N/A "$1,714.48" "$2,955.75" "$2,955.75" "$2,955.75" $615.98 "$2,955.75" N/A N/A 71225420 SUP HCPCS C1713 71225420 - PLATE BN 95D 267MM 60MM TC100 16 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$2,956.00" "$2,187.00" $586.64 "$2,955.75" "$1,330.09" "$1,330.09" "$1,330.09" "$1,330.09" "$2,955.75" "$2,955.75" "$2,955.75" $616.05 "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" $616.01 "$2,955.75" "$2,955.75" "$1,457.18" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,217.00" "$2,955.75" "$2,955.75" "$2,955.75" "$1,477.88" "$1,477.88" "$2,340.95" "$2,955.75" "$2,364.60" "$1,330.09" $586.64 N/A "$1,714.48" "$2,955.75" "$1,773.45" "$2,955.75" $615.98 "$2,955.75" N/A N/A 71225421 SUP HCPCS C1713 71225421 - PLATE BN 95D 267MM 70MM TC100 16 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$2,956.00" "$2,187.00" $586.64 "$2,955.75" "$1,330.09" "$1,330.09" "$1,330.09" "$1,330.09" "$2,955.75" "$2,955.75" "$2,955.75" $616.05 "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" $616.01 "$2,955.75" "$1,182.30" "$1,457.18" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,217.00" "$2,955.75" "$2,955.75" "$2,955.75" "$1,477.88" "$1,477.88" "$2,340.95" "$2,955.75" "$2,364.60" "$1,330.09" $586.64 N/A "$1,714.48" "$2,955.75" "$1,773.45" "$2,955.75" "$2,955.75" "$2,955.75" N/A N/A 71225422 SUP HCPCS C1713 71225422 - PLATE BN 95D 267MM 80MM TC100 16 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$2,956.00" "$2,187.00" $586.64 "$2,955.75" "$1,330.09" "$1,330.09" "$1,330.09" "$1,330.09" "$2,955.75" "$2,955.75" "$2,955.75" $616.05 "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" $616.01 "$2,955.75" "$2,955.75" "$1,457.18" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,217.00" "$2,955.75" "$2,955.75" "$2,955.75" "$1,477.88" "$1,477.88" "$2,340.95" "$2,955.75" "$2,364.60" "$1,330.09" $586.64 N/A "$1,714.48" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" N/A N/A 71225423 SUP HCPCS C1713 71225423 - PLATE BN 95D 299MM 60MM TC100 18 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$2,956.00" "$2,187.00" $586.64 "$2,955.75" "$1,330.09" "$1,330.09" "$1,330.09" "$1,330.09" "$2,955.75" "$2,955.75" "$2,955.75" $616.05 "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" $616.01 "$2,955.75" "$1,182.30" "$1,457.18" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,217.00" "$2,955.75" "$2,955.75" "$2,955.75" "$1,477.88" "$1,477.88" "$2,340.95" "$2,955.75" "$2,364.60" "$1,330.09" $586.64 N/A "$1,714.48" "$2,955.75" "$1,773.45" "$2,955.75" $615.98 "$2,955.75" N/A N/A 71225424 SUP HCPCS C1713 71225424 - PLATE BN 95D 299MM 70MM TC100 18 HL OSTM SS ADLT CNDYL FEM BOTH IP/OP "$2,956.00" "$2,187.00" $586.64 "$2,955.75" "$1,330.09" "$1,330.09" "$1,330.09" "$1,330.09" "$2,955.75" "$2,955.75" "$2,955.75" $616.05 "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" $616.01 "$2,955.75" "$2,955.75" "$1,457.18" "$2,955.75" "$2,955.75" "$2,955.75" "$2,955.75" "$2,217.00" "$2,955.75" "$2,955.75" "$2,955.75" "$1,477.88" "$1,477.88" "$2,340.95" "$2,955.75" "$2,364.60" "$1,330.09" $586.64 N/A "$1,714.48" "$2,955.75" "$1,773.45" "$2,955.75" $615.98 "$2,955.75" N/A N/A 71225430 SUP HCPCS C1713 71225430 - PLATE BN 95D SM STAT 92MM 40MM TC100 5 HL OSTM SS CNDYL BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 71225431 SUP HCPCS C1713 71225431 - PLATE BN 95D SM STAT 92MM 50MM TC100 5 HL OSTM SS CNDYL BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" "$1,260.00" $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" "$1,260.00" "$1,260.00" $262.58 "$1,260.00" N/A N/A 71225432 SUP HCPCS C1713 71225432 - PLATE BN 95D SM STAT 92MM 60MM TC100 5 HL OSTM SS CNDYL BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" "$1,260.00" "$1,260.00" $262.58 "$1,260.00" N/A N/A 71225433 SUP HCPCS C1713 71225433 - PLATE BN 95D SM STAT 92MM 70MM TC100 5 HL OSTM SS CNDYL BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" "$1,260.00" $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 71225434 SUP HCPCS C1713 71225434 - PLATE BN 95D SM STAT 124MM 40MM TC100 7 HL OSTM SS CNDYL BOTH IP/OP "$1,580.50" "$1,170.00" $313.64 "$1,580.25" $711.11 $711.11 $711.11 $711.11 "$1,580.25" "$1,580.25" "$1,580.25" $329.36 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" $329.34 "$1,580.25" $632.10 $934.72 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,185.38" "$1,580.25" "$1,580.25" "$1,580.25" $790.13 $790.13 "$1,251.56" "$1,580.25" "$1,264.20" $711.11 $313.64 N/A $916.69 "$1,580.25" $948.15 "$1,580.25" $329.32 "$1,580.25" N/A N/A 71225435 SUP HCPCS C1713 71225435 - PLATE BN 95D SM STAT 124MM 50MM TC100 7 HL OSTM SS CNDYL BOTH IP/OP "$1,580.50" "$1,170.00" $313.64 "$1,580.25" $711.11 $711.11 $711.11 $711.11 "$1,580.25" "$1,580.25" "$1,580.25" $329.36 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" $329.34 "$1,580.25" "$1,580.25" $934.72 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,185.38" "$1,580.25" "$1,580.25" "$1,580.25" $790.13 $790.13 "$1,251.56" "$1,580.25" "$1,264.20" $711.11 $313.64 N/A $916.69 "$1,580.25" $948.15 "$1,580.25" $329.32 "$1,580.25" N/A N/A 71225436 SUP HCPCS C1713 71225436 - PLATE BN 95D SM STAT 124MM 60MM TC100 7 HL OSTM SS CNDYL BOTH IP/OP "$1,580.50" "$1,170.00" $313.64 "$1,580.25" $711.11 $711.11 $711.11 $711.11 "$1,580.25" "$1,580.25" "$1,580.25" $329.36 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" $329.34 "$1,580.25" $632.10 $934.72 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,185.38" "$1,580.25" "$1,580.25" "$1,580.25" $790.13 $790.13 "$1,251.56" "$1,580.25" "$1,264.20" $711.11 $313.64 N/A $916.69 "$1,580.25" $948.15 "$1,580.25" $329.32 "$1,580.25" N/A N/A 71225437 SUP HCPCS C1713 71225437 - PLATE BN 95D SM STAT 124MM 70MM TC100 7 HL OSTM SS CNDYL BOTH IP/OP "$1,580.50" "$1,170.00" $313.64 "$1,580.25" $711.11 $711.11 $711.11 $711.11 "$1,580.25" "$1,580.25" "$1,580.25" $329.36 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" $329.34 "$1,580.25" "$1,580.25" $934.72 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,185.38" "$1,580.25" "$1,580.25" "$1,580.25" $790.13 $790.13 "$1,251.56" "$1,580.25" "$1,264.20" $711.11 $313.64 N/A $916.69 "$1,580.25" $948.15 "$1,580.25" $329.32 "$1,580.25" N/A N/A 71225438 SUP HCPCS C1713 71225438 - PLATE BN 95D SM STAT 156MM 40MM TC100 9 HL OSTM SS CNDYL BOTH IP/OP "$1,711.50" "$1,267.00" $339.69 "$1,711.50" $770.18 $770.18 $770.18 $770.18 "$1,711.50" "$1,711.50" "$1,711.50" $356.72 "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" $356.70 "$1,711.50" $684.60 "$1,012.35" "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" "$1,283.63" "$1,711.50" "$1,711.50" "$1,711.50" $855.75 $855.75 "$1,355.51" "$1,711.50" "$1,369.20" $770.18 $339.69 N/A $992.67 "$1,711.50" "$1,026.90" "$1,711.50" $356.68 "$1,711.50" N/A N/A 71225439 SUP HCPCS C1713 71225439 - PLATE BN 95D SM STAT 156MM 50MM TC100 9 HL OSTM SS CNDYL BOTH IP/OP "$1,711.50" "$1,267.00" $339.69 "$1,711.50" $770.18 $770.18 $770.18 $770.18 "$1,711.50" "$1,711.50" "$1,711.50" $356.72 "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" $356.70 "$1,711.50" "$1,711.50" "$1,012.35" "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" "$1,283.63" "$1,711.50" "$1,711.50" "$1,711.50" $855.75 $855.75 "$1,355.51" "$1,711.50" "$1,369.20" $770.18 $339.69 N/A $992.67 "$1,711.50" "$1,026.90" "$1,711.50" $356.68 "$1,711.50" N/A N/A 71225440 SUP HCPCS C1713 71225440 - PLATE BN 95D SM STAT 156MM 60MM TC100 9 HL OSTM SS CNDYL BOTH IP/OP "$1,711.50" "$1,267.00" $339.69 "$1,711.50" $770.18 $770.18 $770.18 $770.18 "$1,711.50" "$1,711.50" "$1,711.50" $356.72 "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" $356.70 "$1,711.50" $684.60 "$1,012.35" "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" "$1,283.63" "$1,711.50" "$1,711.50" "$1,711.50" $855.75 $855.75 "$1,355.51" "$1,711.50" "$1,369.20" $770.18 $339.69 N/A $992.67 "$1,711.50" "$1,026.90" "$1,711.50" "$1,711.50" "$1,711.50" N/A N/A 71225441 SUP HCPCS C1713 71225441 - PLATE BN 95D SM STAT 156MM 70MM TC100 9 HL OSTM SS CNDYL BOTH IP/OP "$1,711.50" "$1,267.00" $339.69 "$1,711.50" $770.18 $770.18 $770.18 $770.18 "$1,711.50" "$1,711.50" "$1,711.50" $356.72 "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" $356.70 "$1,711.50" $684.60 "$1,012.35" "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" "$1,283.63" "$1,711.50" "$1,711.50" "$1,711.50" $855.75 $855.75 "$1,355.51" "$1,711.50" "$1,369.20" $770.18 $339.69 N/A $992.67 "$1,711.50" "$1,026.90" "$1,711.50" "$1,711.50" "$1,711.50" N/A N/A 71225500 SUP HCPCS C1713 71225500 - PLATE BN 130D 50MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5 BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" $564.90 $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" $847.35 "$1,412.25" $294.31 "$1,412.25" N/A N/A 71225501 SUP HCPCS C1713 71225501 - PLATE BN 130D 60MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5 BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" $564.90 $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" $847.35 "$1,412.25" $294.31 "$1,412.25" N/A N/A 71225502 SUP HCPCS C1713 71225502 - PLATE BN 130D 70MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5 BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" "$1,412.25" $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" $847.35 "$1,412.25" $294.31 "$1,412.25" N/A N/A 71225503 SUP HCPCS C1713 71225503 - PLATE BN 130D 75MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5 BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" $564.90 $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" "$1,412.25" "$1,412.25" $294.31 "$1,412.25" N/A N/A 71225504 SUP HCPCS C1713 71225504 - PLATE BN 130D 80MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5 BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" "$1,412.25" $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" $847.35 "$1,412.25" $294.31 "$1,412.25" N/A N/A 71225505 SUP HCPCS C1713 71225505 - PLATE BN 130D 85MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5 BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" "$1,412.25" $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" $847.35 "$1,412.25" "$1,412.25" "$1,412.25" N/A N/A 71225506 SUP HCPCS C1713 71225506 - PLATE BN 130D 90MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5 BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" "$1,412.25" $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" "$1,412.25" "$1,412.25" $294.31 "$1,412.25" N/A N/A 71225507 SUP HCPCS C1713 71225507 - PLATE BN 130D 95MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX 4.5 BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" "$1,412.25" $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" "$1,412.25" "$1,412.25" $294.31 "$1,412.25" N/A N/A 71225508 SUP HCPCS C1713 71225508 - PLATE BN 130D 100MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" "$1,412.25" $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" "$1,412.25" "$1,412.25" $294.31 "$1,412.25" N/A N/A 71225509 SUP HCPCS C1713 71225509 - PLATE BN 130D 105MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" $564.90 $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" "$1,412.25" "$1,412.25" $294.31 "$1,412.25" N/A N/A 71225510 SUP HCPCS C1713 71225510 - PLATE BN 130D 110MM 60MM TC100 4 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,412.50" "$1,045.00" $280.30 "$1,412.25" $635.51 $635.51 $635.51 $635.51 "$1,412.25" "$1,412.25" "$1,412.25" $294.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" $294.33 "$1,412.25" "$1,412.25" $835.35 "$1,412.25" "$1,412.25" "$1,412.25" "$1,412.25" "$1,059.38" "$1,412.25" "$1,412.25" "$1,412.25" $706.13 $706.13 "$1,118.50" "$1,412.25" "$1,129.80" $635.51 $280.30 N/A $819.25 "$1,412.25" "$1,412.25" "$1,412.25" $294.31 "$1,412.25" N/A N/A 71225511 SUP HCPCS C1713 71225511 - PLATE BN 130D 50MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,496.50" "$1,107.00" $296.97 "$1,496.25" $673.31 $673.31 $673.31 $673.31 "$1,496.25" "$1,496.25" "$1,496.25" $311.86 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" $311.83 "$1,496.25" "$1,496.25" $885.03 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,122.38" "$1,496.25" "$1,496.25" "$1,496.25" $748.13 $748.13 "$1,185.03" "$1,496.25" "$1,197.00" $673.31 $296.97 N/A $867.97 "$1,496.25" "$1,496.25" "$1,496.25" $311.82 "$1,496.25" N/A N/A 71225512 SUP HCPCS C1713 71225512 - PLATE BN 130D 60MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,496.50" "$1,107.00" $296.97 "$1,496.25" $673.31 $673.31 $673.31 $673.31 "$1,496.25" "$1,496.25" "$1,496.25" $311.86 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" $311.83 "$1,496.25" "$1,496.25" $885.03 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,122.38" "$1,496.25" "$1,496.25" "$1,496.25" $748.13 $748.13 "$1,185.03" "$1,496.25" "$1,197.00" $673.31 $296.97 N/A $867.97 "$1,496.25" "$1,496.25" "$1,496.25" $311.82 "$1,496.25" N/A N/A 71225513 SUP HCPCS C1713 71225513 - PLATE BN 130D 70MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,496.50" "$1,107.00" $296.97 "$1,496.25" $673.31 $673.31 $673.31 $673.31 "$1,496.25" "$1,496.25" "$1,496.25" $311.86 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" $311.83 "$1,496.25" "$1,496.25" $885.03 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,122.38" "$1,496.25" "$1,496.25" "$1,496.25" $748.13 $748.13 "$1,185.03" "$1,496.25" "$1,197.00" $673.31 $296.97 N/A $867.97 "$1,496.25" "$1,496.25" "$1,496.25" $311.82 "$1,496.25" N/A N/A 71225514 SUP HCPCS C1713 71225514 - PLATE BN 130D 80MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,496.50" "$1,107.00" $296.97 "$1,496.25" $673.31 $673.31 $673.31 $673.31 "$1,496.25" "$1,496.25" "$1,496.25" $311.86 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" $311.83 "$1,496.25" "$1,496.25" $885.03 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,122.38" "$1,496.25" "$1,496.25" "$1,496.25" $748.13 $748.13 "$1,185.03" "$1,496.25" "$1,197.00" $673.31 $296.97 N/A $867.97 "$1,496.25" $897.75 "$1,496.25" "$1,496.25" "$1,496.25" N/A N/A 71225515 SUP HCPCS C1713 71225515 - PLATE BN 130D 90MM 104MM TC100 6 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,496.50" "$1,107.00" $296.97 "$1,496.25" $673.31 $673.31 $673.31 $673.31 "$1,496.25" "$1,496.25" "$1,496.25" $311.86 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" $311.83 "$1,496.25" "$1,496.25" $885.03 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,122.38" "$1,496.25" "$1,496.25" "$1,496.25" $748.13 $748.13 "$1,185.03" "$1,496.25" "$1,197.00" $673.31 $296.97 N/A $867.97 "$1,496.25" $897.75 "$1,496.25" "$1,496.25" "$1,496.25" N/A N/A 71225516 SUP HCPCS C1713 71225516 - PLATE BN 130D 70MM 152MM TC100 9 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225517 SUP HCPCS C1713 71225517 - PLATE BN 130D 80MM 152MM TC100 9 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225518 SUP HCPCS C1713 71225518 - PLATE BN 130D 90MM 152MM TC100 9 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,669.50" "$1,669.50" $347.92 "$1,669.50" N/A N/A 71225519 SUP HCPCS C1713 71225519 - PLATE BN 130D 70MM 200MM TC100 12 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,911.00" "$1,414.00" $379.29 "$1,911.00" $859.95 $859.95 $859.95 $859.95 "$1,911.00" "$1,911.00" "$1,911.00" $398.30 "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" $398.27 "$1,911.00" $764.40 "$1,130.36" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,433.25" "$1,911.00" "$1,911.00" "$1,911.00" $955.50 $955.50 "$1,513.51" "$1,911.00" "$1,528.80" $859.95 $379.29 N/A "$1,108.38" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" N/A N/A 71225520 SUP HCPCS C1713 71225520 - PLATE BN 130D 80MM 200MM TC100 12 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,911.00" "$1,414.00" $379.29 "$1,911.00" $859.95 $859.95 $859.95 $859.95 "$1,911.00" "$1,911.00" "$1,911.00" $398.30 "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" $398.27 "$1,911.00" $764.40 "$1,130.36" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,433.25" "$1,911.00" "$1,911.00" "$1,911.00" $955.50 $955.50 "$1,513.51" "$1,911.00" "$1,528.80" $859.95 $379.29 N/A "$1,108.38" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" N/A N/A 71225521 SUP HCPCS C1713 71225521 - PLATE BN 130D 90MM 200MM TC100 12 HL OSTM SS ADLT FEM PROX BOTH IP/OP "$1,911.00" "$1,414.00" $379.29 "$1,911.00" $859.95 $859.95 $859.95 $859.95 "$1,911.00" "$1,911.00" "$1,911.00" $398.30 "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" $398.27 "$1,911.00" "$1,911.00" "$1,130.36" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,433.25" "$1,911.00" "$1,911.00" "$1,911.00" $955.50 $955.50 "$1,513.51" "$1,911.00" "$1,528.80" $859.95 $379.29 N/A "$1,108.38" "$1,911.00" "$1,911.00" "$1,911.00" $398.25 "$1,911.00" N/A N/A 71225530 SUP HCPCS C1713 71225530 - PLATE BN 130D SM STAT 50MM 60MM TC100 4 HL OSTM SS FEM PROX BOTH IP/OP "$1,580.50" "$1,170.00" $313.64 "$1,580.25" $711.11 $711.11 $711.11 $711.11 "$1,580.25" "$1,580.25" "$1,580.25" $329.36 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" $329.34 "$1,580.25" "$1,580.25" $934.72 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,185.38" "$1,580.25" "$1,580.25" "$1,580.25" $790.13 $790.13 "$1,251.56" "$1,580.25" "$1,264.20" $711.11 $313.64 N/A $916.69 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" N/A N/A 71225531 SUP HCPCS C1713 71225531 - PLATE BN 130D SM STAT 60MM 60MM TC100 4 HL OSTM SS FEM PROX BOTH IP/OP "$1,580.50" "$1,170.00" $313.64 "$1,580.25" $711.11 $711.11 $711.11 $711.11 "$1,580.25" "$1,580.25" "$1,580.25" $329.36 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" $329.34 "$1,580.25" "$1,580.25" $934.72 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,185.38" "$1,580.25" "$1,580.25" "$1,580.25" $790.13 $790.13 "$1,251.56" "$1,580.25" "$1,264.20" $711.11 $313.64 N/A $916.69 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" N/A N/A 71225532 SUP HCPCS C1713 71225532 - PLATE BN 130D SM STAT 70MM 60MM TC100 4 HL OSTM SS FEM PROX BOTH IP/OP "$1,580.50" "$1,170.00" $313.64 "$1,580.25" $711.11 $711.11 $711.11 $711.11 "$1,580.25" "$1,580.25" "$1,580.25" $329.36 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" $329.34 "$1,580.25" $632.10 $934.72 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,185.38" "$1,580.25" "$1,580.25" "$1,580.25" $790.13 $790.13 "$1,251.56" "$1,580.25" "$1,264.20" $711.11 $313.64 N/A $916.69 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" N/A N/A 71225533 SUP HCPCS C1713 71225533 - PLATE BN 130D SM STAT 80MM 60MM TC100 4 HL OSTM SS FEM PROX BOTH IP/OP "$1,580.50" "$1,170.00" $313.64 "$1,580.25" $711.11 $711.11 $711.11 $711.11 "$1,580.25" "$1,580.25" "$1,580.25" $329.36 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" $329.34 "$1,580.25" $632.10 $934.72 "$1,580.25" "$1,580.25" "$1,580.25" "$1,580.25" "$1,185.38" "$1,580.25" "$1,580.25" "$1,580.25" $790.13 $790.13 "$1,251.56" "$1,580.25" "$1,264.20" $711.11 $313.64 N/A $916.69 "$1,580.25" "$1,580.25" "$1,580.25" $329.32 "$1,580.25" N/A N/A 71225534 SUP HCPCS C1713 71225534 - PLATE BN 130D SM STAT 50MM 104MM TC100 6 HL OSTM SS FEM PROX BOTH IP/OP "$1,680.00" "$1,243.00" $333.44 "$1,680.00" $756.00 $756.00 $756.00 $756.00 "$1,680.00" "$1,680.00" "$1,680.00" $350.15 "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" $350.13 "$1,680.00" "$1,680.00" $993.72 "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" "$1,260.00" "$1,680.00" "$1,680.00" "$1,680.00" $840.00 $840.00 "$1,330.56" "$1,680.00" "$1,344.00" $756.00 $333.44 N/A $974.40 "$1,680.00" "$1,680.00" "$1,680.00" $350.11 "$1,680.00" N/A N/A 71225535 SUP HCPCS C1713 71225535 - PLATE BN 130D SM STAT 104MM 70MM TC100 6 HL ANG SS FEM PROX BOTH IP/OP "$1,680.00" "$1,243.00" $333.44 "$1,680.00" $756.00 $756.00 $756.00 $756.00 "$1,680.00" "$1,680.00" "$1,680.00" $350.15 "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" $350.13 "$1,680.00" "$1,680.00" $993.72 "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" "$1,260.00" "$1,680.00" "$1,680.00" "$1,680.00" $840.00 $840.00 "$1,330.56" "$1,680.00" "$1,344.00" $756.00 $333.44 N/A $974.40 "$1,680.00" "$1,680.00" "$1,680.00" $350.11 "$1,680.00" N/A N/A 71225536 SUP HCPCS C1713 71225536 - PLATE BN 130D SM STAT 104MM 60MM TC100 6 HL ANG SS FEM PROX BOTH IP/OP "$1,680.00" "$1,243.00" $333.44 "$1,680.00" $756.00 $756.00 $756.00 $756.00 "$1,680.00" "$1,680.00" "$1,680.00" $350.15 "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" $350.13 "$1,680.00" $672.00 $993.72 "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" "$1,260.00" "$1,680.00" "$1,680.00" "$1,680.00" $840.00 $840.00 "$1,330.56" "$1,680.00" "$1,344.00" $756.00 $333.44 N/A $974.40 "$1,680.00" "$1,680.00" "$1,680.00" $350.11 "$1,680.00" N/A N/A 71225537 SUP HCPCS C1713 71225537 - PLATE BN 130D SM STAT 104MM 80MM TC100 6 HL ANG SS FEM PROX BOTH IP/OP "$1,680.00" "$1,243.00" $333.44 "$1,680.00" $756.00 $756.00 $756.00 $756.00 "$1,680.00" "$1,680.00" "$1,680.00" $350.15 "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" $350.13 "$1,680.00" "$1,680.00" $993.72 "$1,680.00" "$1,680.00" "$1,680.00" "$1,680.00" "$1,260.00" "$1,680.00" "$1,680.00" "$1,680.00" $840.00 $840.00 "$1,330.56" "$1,680.00" "$1,344.00" $756.00 $333.44 N/A $974.40 "$1,680.00" "$1,680.00" "$1,680.00" $350.11 "$1,680.00" N/A N/A 71225539 SUP HCPCS C1713 71225539 - PLATE BN 130D SM STAT 152MM 60MM TC100 9 HL ANG SS FEM PROX BOTH IP/OP "$1,853.50" "$1,372.00" $367.82 "$1,853.25" $833.96 $833.96 $833.96 $833.96 "$1,853.25" "$1,853.25" "$1,853.25" $386.26 "$1,853.25" "$1,853.25" "$1,853.25" "$1,853.25" "$1,853.25" $386.24 "$1,853.25" $741.30 "$1,096.20" "$1,853.25" "$1,853.25" "$1,853.25" "$1,853.25" "$1,390.13" "$1,853.25" "$1,853.25" "$1,853.25" $926.63 $926.63 "$1,467.77" "$1,853.25" "$1,482.60" $833.96 $367.82 N/A "$1,075.03" "$1,853.25" "$1,853.25" "$1,853.25" $386.22 "$1,853.25" N/A N/A 71225540 SUP HCPCS C1713 71225540 - PLATE BN 130D SM STAT 152MM 72MM TC100 9 HL ANG SS FEM PROX BOTH IP/OP "$1,853.50" "$1,372.00" $367.82 "$1,853.25" $833.96 $833.96 $833.96 $833.96 "$1,853.25" "$1,853.25" "$1,853.25" $386.26 "$1,853.25" "$1,853.25" "$1,853.25" "$1,853.25" "$1,853.25" $386.24 "$1,853.25" "$1,853.25" "$1,096.20" "$1,853.25" "$1,853.25" "$1,853.25" "$1,853.25" "$1,390.13" "$1,853.25" "$1,853.25" "$1,853.25" $926.63 $926.63 "$1,467.77" "$1,853.25" "$1,482.60" $833.96 $367.82 N/A "$1,075.03" "$1,853.25" "$1,853.25" "$1,853.25" "$1,853.25" "$1,853.25" N/A N/A 71225541 SUP HCPCS C1713 71225541 - PLATE BN 130D SM STAT 152MM 80MM TC100 9 HL ANG SS FEM PROX BOTH IP/OP "$1,853.50" "$1,372.00" $367.82 "$1,853.25" $833.96 $833.96 $833.96 $833.96 "$1,853.25" "$1,853.25" "$1,853.25" $386.26 "$1,853.25" "$1,853.25" "$1,853.25" "$1,853.25" "$1,853.25" $386.24 "$1,853.25" "$1,853.25" "$1,096.20" "$1,853.25" "$1,853.25" "$1,853.25" "$1,853.25" "$1,390.13" "$1,853.25" "$1,853.25" "$1,853.25" $926.63 $926.63 "$1,467.77" "$1,853.25" "$1,482.60" $833.96 $367.82 N/A "$1,075.03" "$1,853.25" "$1,853.25" "$1,853.25" "$1,853.25" "$1,853.25" N/A N/A 71225600 SUP HCPCS C1713 71225600 - PLATE BN 90D 7MM 25MM TC100 3 HL ANG SS PED PROX FEM 3.5MM BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" "$1,149.75" $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" "$1,149.75" "$1,149.75" $239.61 "$1,149.75" N/A N/A 71225601 SUP HCPCS C1713 71225601 - PLATE BN 90D 12MM 25MM TC100 3 HL ANG SS PED PROX FEM 3.5MM BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" "$1,149.75" $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" $689.85 "$1,149.75" $239.61 "$1,149.75" N/A N/A 71225602 SUP HCPCS C1713 71225602 - PLATE BN 90D 7MM 32MM TC100 3 HL ANG SS PED PROX FEM 3.5MM BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" "$1,149.75" $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" N/A N/A 71225603 SUP HCPCS C1713 71225603 - PLATE BN 90D 12MM 32MM TC100 3 HL ANG SS PED PROX FEM 3.5MM BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" "$1,149.75" $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" N/A N/A 71225610 SUP HCPCS C1713 71225610 - PLATE BN 115D 5MM 30MM TC100 BFUR ANG SS PED FEM PROX 3.5MM BOTH IP/OP $680.50 $504.00 $135.04 $680.40 $306.18 $306.18 $306.18 $306.18 $680.40 $680.40 $680.40 $141.81 $680.40 $680.40 $680.40 $680.40 $680.40 $141.80 $680.40 $680.40 $402.46 $680.40 $680.40 $680.40 $680.40 $510.38 $680.40 $680.40 $680.40 $340.20 $340.20 $538.88 $680.40 $544.32 $306.18 $135.04 N/A $394.69 $680.40 $408.24 $680.40 $680.40 $680.40 N/A N/A 71225611 SUP HCPCS C1713 71225611 - PLATE BN 115D 5MM 35MM TC100 BFUR ANG SS PED FEM PROX 3.5MM BOTH IP/OP $680.50 $504.00 $135.04 $680.40 $306.18 $306.18 $306.18 $306.18 $680.40 $680.40 $680.40 $141.81 $680.40 $680.40 $680.40 $680.40 $680.40 $141.80 $680.40 $272.16 $402.46 $680.40 $680.40 $680.40 $680.40 $510.38 $680.40 $680.40 $680.40 $340.20 $340.20 $538.88 $680.40 $544.32 $306.18 $135.04 N/A $394.69 $680.40 $408.24 $680.40 $141.80 $680.40 N/A N/A 71225620 SUP HCPCS C1713 71225620 - PLATE BN 80D 8MM 35MM TC100 3 HL ANG SS PED PROX FEM 4.5MM BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" $459.90 $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" $689.85 "$1,149.75" $239.61 "$1,149.75" N/A N/A 71225621 SUP HCPCS C1713 71225621 - PLATE BN 80D 8MM 45MM TC100 3 HL ANG SS PED PROX FEM 4.5MM BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" "$1,149.75" $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" $689.85 "$1,149.75" $239.61 "$1,149.75" N/A N/A 71225622 SUP HCPCS C1713 71225622 - PLATE BN 90D 8MM 35MM TC100 3 HL ANG SS PED PROX FEM 4.5MM BOTH IP/OP $951.50 $704.00 $188.81 $951.30 $428.09 $428.09 $428.09 $428.09 $951.30 $951.30 $951.30 $198.27 $951.30 $951.30 $951.30 $951.30 $951.30 $198.26 $951.30 $951.30 $562.69 $951.30 $951.30 $951.30 $951.30 $713.63 $951.30 $951.30 $951.30 $475.65 $475.65 $753.43 $951.30 $761.04 $428.09 $188.81 N/A $551.87 $951.30 $951.30 $951.30 $198.25 $951.30 N/A N/A 71225623 SUP HCPCS C1713 71225623 - PLATE BN 90D 8MM 45MM TC100 3 HL ANG SS PED PROX FEM 4.5MM BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" $459.90 $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" N/A N/A 71225624 SUP HCPCS C1713 71225624 - PLATE BN 100D 8MM 35MM TC100 3 HL ANG SS PED PROX FEM 4.5MM BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" "$1,149.75" $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" $689.85 "$1,149.75" $239.61 "$1,149.75" N/A N/A 71225625 SUP HCPCS C1713 71225625 - PLATE BN 100D 8MM 45MM TC100 3 HL ANG SS PED PROX FEM 4.5MM BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" "$1,149.75" $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" $689.85 "$1,149.75" $239.61 "$1,149.75" N/A N/A 71225640 SUP HCPCS C1713 71225640 - PLATE BN 90D 10MM 40MM TC100 3 HL ANG SS PED PROX FEM 4.5MM BOTH IP/OP "$1,302.00" $963.00 $258.41 "$1,302.00" $585.90 $585.90 $585.90 $585.90 "$1,302.00" "$1,302.00" "$1,302.00" $271.37 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $271.35 "$1,302.00" $520.80 $770.13 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $976.50 "$1,302.00" "$1,302.00" "$1,302.00" $651.00 $651.00 "$1,031.18" "$1,302.00" "$1,041.60" $585.90 $258.41 N/A $755.16 "$1,302.00" $781.20 "$1,302.00" "$1,302.00" "$1,302.00" N/A N/A 71225641 SUP HCPCS C1713 71225641 - PLATE BN 90D 15MM 40MM TC100 3 HL ANG SS PED PROX FEM 4.5MM BOTH IP/OP "$1,302.00" $963.00 $258.41 "$1,302.00" $585.90 $585.90 $585.90 $585.90 "$1,302.00" "$1,302.00" "$1,302.00" $271.37 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $271.35 "$1,302.00" "$1,302.00" $770.13 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $976.50 "$1,302.00" "$1,302.00" "$1,302.00" $651.00 $651.00 "$1,031.18" "$1,302.00" "$1,041.60" $585.90 $258.41 N/A $755.16 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" N/A N/A 71225642 SUP HCPCS C1713 71225642 - PLATE BN 90D 10MM 50MM TC100 3 HL ANG SS PED FEM PROX 4.5MM BOTH IP/OP "$1,302.00" $963.00 $258.41 "$1,302.00" $585.90 $585.90 $585.90 $585.90 "$1,302.00" "$1,302.00" "$1,302.00" $271.37 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $271.35 "$1,302.00" $520.80 $770.13 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $976.50 "$1,302.00" "$1,302.00" "$1,302.00" $651.00 $651.00 "$1,031.18" "$1,302.00" "$1,041.60" $585.90 $258.41 N/A $755.16 "$1,302.00" "$1,302.00" "$1,302.00" $271.34 "$1,302.00" N/A N/A 71225643 SUP HCPCS C1713 71225643 - PLATE BN 90D 15MM 50MM TC100 3 HL ANG SS PED FEM PROX 4.5MM BOTH IP/OP "$1,302.00" $963.00 $258.41 "$1,302.00" $585.90 $585.90 $585.90 $585.90 "$1,302.00" "$1,302.00" "$1,302.00" $271.37 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $271.35 "$1,302.00" $520.80 $770.13 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $976.50 "$1,302.00" "$1,302.00" "$1,302.00" $651.00 $651.00 "$1,031.18" "$1,302.00" "$1,041.60" $585.90 $258.41 N/A $755.16 "$1,302.00" "$1,302.00" "$1,302.00" $271.34 "$1,302.00" N/A N/A 71225644 SUP HCPCS C1713 71225644 - PLATE BN 90D 15MM 60MM TC100 3 HL ANG SS PED FEM PROX 4.5MM BOTH IP/OP "$1,302.00" $963.00 $258.41 "$1,302.00" $585.90 $585.90 $585.90 $585.90 "$1,302.00" "$1,302.00" "$1,302.00" $271.37 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $271.35 "$1,302.00" "$1,302.00" $770.13 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $976.50 "$1,302.00" "$1,302.00" "$1,302.00" $651.00 $651.00 "$1,031.18" "$1,302.00" "$1,041.60" $585.90 $258.41 N/A $755.16 "$1,302.00" $781.20 "$1,302.00" $271.34 "$1,302.00" N/A N/A 71225716 SUP HCPCS C1713 71225716 - SCREW BN 3.5MM 16MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $39.32 $65.53 $13.66 $65.53 N/A N/A 71225718 SUP HCPCS C1713 71225718 - SCREW BN 3.5MM 18MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $26.21 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $39.32 $65.53 $13.66 $65.53 N/A N/A 71225720 SUP HCPCS C1713 71225720 - SCREW BN 3.5MM 20MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $65.53 $65.53 $13.66 $65.53 N/A N/A 71225722 SUP HCPCS C1713 71225722 - SCREW BN 3.5MM 22MM STRL 6MM TC100 ST SHFT SS ORTH SM FRAG BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $65.53 $65.53 $13.66 $65.53 N/A N/A 71225724 SUP HCPCS C1713 71225724 - SCREW BN 3.5MM 24MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $65.53 $65.53 $13.66 $65.53 N/A N/A 71225726 SUP HCPCS C1713 71225726 - SCREW BN 3.5MM 26MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $39.32 $65.53 $13.66 $65.53 N/A N/A 71225728 SUP HCPCS C1713 71225728 - SCREW BN 3.5MM 28MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $39.32 $65.53 $13.66 $65.53 N/A N/A 71225730 SUP HCPCS C1713 71225730 - SCREW BN 3.5MM 30MM STRL 10MM TC100 ST SHFT SS ORTH SM FRAG BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $39.32 $65.53 $13.66 $65.53 N/A N/A 71225732 SUP HCPCS C1713 71225732 - SCREW BN 3.5MM 32MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $65.53 $65.53 $13.66 $65.53 N/A N/A 71225734 SUP HCPCS C1713 71225734 - SCREW BN 3.5MM 34MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $65.53 $65.53 $13.66 $65.53 N/A N/A 71225736 SUP HCPCS C1713 71225736 - SCREW BN 3.5MM 36MM STRL 12MM TC100 ST SS ORTH BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $65.53 $65.53 $13.66 $65.53 N/A N/A 71225738 SUP HCPCS C1713 71225738 - SCREW BN 3.5MM 38MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $65.53 $65.53 $13.66 $65.53 N/A N/A 71225740 SUP HCPCS C1713 71225740 - SCREW BN 3.5MM 40MM STRL 12MM TC100 ST SHFT SS ORTH SM FRAG BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $65.53 $65.53 $13.66 $65.53 N/A N/A 71225745 SUP HCPCS C1713 71225745 - SCREW BN 3.5MM 45MM STRL 15MM TC100 ST SHFT SS ORTH SM FRAG BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $65.53 $65.53 $13.66 $65.53 N/A N/A 71225750 SUP HCPCS C1713 71225750 - SCREW BN 3.5MM 50MM STRL 15MM TC100 ST SHFT SS ORTH SM FRAG BOTH IP/OP $66.00 $49.00 $13.01 $65.53 $29.49 $29.49 $29.49 $29.49 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $65.53 $65.53 $65.53 $13.66 $65.53 $65.53 $38.76 $65.53 $65.53 $65.53 $65.53 $49.50 $65.53 $65.53 $65.53 $32.77 $32.77 $51.90 $65.53 $52.42 $29.49 $13.01 N/A $38.28 $65.53 $65.53 $65.53 $65.53 $65.53 N/A N/A 71225822 SUP HCPCS C1713 71225822 - SCREW BN 4.5MM 22MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71225824 SUP HCPCS C1713 71225824 - SCREW BN 4.5MM 24MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71225826 SUP HCPCS C1713 71225826 - SCREW BN 4.5MM 26MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $67.53 $67.53 N/A N/A 71225828 SUP HCPCS C1713 71225828 - SCREW BN 4.5MM 28MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71225830 SUP HCPCS C1713 71225830 - SCREW BN 4.5MM 30MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $67.53 $67.53 N/A N/A 71225832 SUP HCPCS C1713 71225832 - SCREW BN 4.5MM 32MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $67.53 $67.53 N/A N/A 71225834 SUP HCPCS C1713 71225834 - SCREW BN 4.5MM 34MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $27.01 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71225836 SUP HCPCS C1713 71225836 - SCREW BN 4.5MM 36MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $67.53 $67.53 N/A N/A 71225838 SUP HCPCS C1713 71225838 - SCREW BN 4.5MM 38MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $40.52 $67.53 $67.53 $67.53 N/A N/A 71225840 SUP HCPCS C1713 71225840 - SCREW BN 4.5MM 40MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $68.00 $50.00 $13.40 $67.53 $30.39 $30.39 $30.39 $30.39 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $67.53 $67.53 $67.53 $14.07 $67.53 $67.53 $39.94 $67.53 $67.53 $67.53 $67.53 $51.00 $67.53 $67.53 $67.53 $33.77 $33.77 $53.48 $67.53 $54.02 $30.39 $13.40 N/A $39.44 $67.53 $67.53 $67.53 $14.07 $67.53 N/A N/A 71225842 SUP HCPCS C1713 71225842 - SCREW BN 4.5MM 42MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71225844 SUP HCPCS C1713 71225844 - SCREW BN 4.5MM 44MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71225846 SUP HCPCS C1713 71225846 - SCREW BN 4.5MM 46MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $69.73 $69.73 N/A N/A 71225848 SUP HCPCS C1713 71225848 - SCREW BN 4.5MM 48MM STRL 12MM TC100 ST SS ORTH BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $69.73 $69.73 N/A N/A 71225850 SUP HCPCS C1713 71225850 - SCREW BN 4.5MM 50MM STRL 12MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71225852 SUP HCPCS C1713 71225852 - SCREW BN 4.5MM 52MM STRL 15MM TC100 ST SS ORTH BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71225854 SUP HCPCS C1713 71225854 - SCREW BN 4.5MM 54MM STRL 15MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $69.73 $69.73 N/A N/A 71225856 SUP HCPCS C1713 71225856 - SCREW BN 4.5MM 56MM STRL 15MM TC100 ST SS ORTH BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $69.73 $69.73 N/A N/A 71225858 SUP HCPCS C1713 71225858 - SCREW BN 4.5MM 58MM STRL 15MM TC100 ST SS ORTH BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71225860 SUP HCPCS C1713 71225860 - SCREW BN 4.5MM 60MM STRL 15MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71225864 SUP HCPCS C1713 71225864 - SCREW BN 4.5MM 64MM STRL 18MM TC100 ST SS ORTH BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71225868 SUP HCPCS C1713 71225868 - SCREW BN 4.5MM 68MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71225872 SUP HCPCS C1713 71225872 - SCREW BN 4.5MM 72MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 71225876 SUP HCPCS C1713 71225876 - SCREW BN 4.5MM 76MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 71225880 SUP HCPCS C1713 71225880 - SCREW BN 4.5MM 80MM STRL 18MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 71225885 SUP HCPCS C1713 71225885 - SCREW BN 4.5MM 85MM STRL 22MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 71225890 SUP HCPCS C1713 71225890 - SCREW BN 4.5MM 90MM STRL 22MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 71225895 SUP HCPCS C1713 71225895 - SCREW BN 4.5MM 95MM STRL 26MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 71225900 SUP HCPCS C1713 71225900 - SCREW BN 4.5MM 100MM STRL 26MM TC100 ST SHFT SS ORTH LG FRAG BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 71226030 SUP HCPCS C1713 71226030 - SCREW BN P/T 6.5MM 8MM 30MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $25.82 $123.90 N/A N/A 71226035 SUP HCPCS C1713 71226035 - SCREW BN P/T 6.5MM 8MM 35MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $25.82 $123.90 N/A N/A 71226040 SUP HCPCS C1713 71226040 - SCREW BN P/T 6.5MM 8MM 40MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $25.82 $123.90 N/A N/A 71226045 SUP HCPCS C1713 71226045 - SCREW BN P/T 6.5MM 8MM 45MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $25.82 $123.90 N/A N/A 71226050 SUP HCPCS C1713 71226050 - SCREW BN P/T 6.5MM 8MM 50MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $25.82 $123.90 N/A N/A 71226055 SUP HCPCS C1713 71226055 - SCREW BN P/T 6.5MM 8MM 55MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $25.82 $123.90 N/A N/A 71226060 SUP HCPCS C1713 71226060 - SCREW BN P/T 6.5MM 8MM 60MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $25.82 $123.90 N/A N/A 71226065 SUP HCPCS C1713 71226065 - SCREW BN P/T 6.5MM 8MM 65MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $123.90 $123.90 N/A N/A 71226070 SUP HCPCS C1713 71226070 - SCREW BN P/T 6.5MM 8MM 70MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $123.90 $123.90 N/A N/A 71226075 SUP HCPCS C1713 71226075 - SCREW BN P/T 6.5MM 8MM 75MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $25.82 $123.90 N/A N/A 71226080 SUP HCPCS C1713 71226080 - SCREW BN P/T 6.5MM 8MM 80MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $25.82 $123.90 N/A N/A 71226085 SUP HCPCS C1713 71226085 - SCREW BN P/T 6.5MM 8MM 85MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $135.45 $135.45 $28.23 $135.45 N/A N/A 71226090 SUP HCPCS C1713 71226090 - SCREW BN P/T 6.5MM 8MM 90MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $135.45 $135.45 $28.23 $135.45 N/A N/A 71226095 SUP HCPCS C1713 71226095 - SCREW BN P/T 6.5MM 8MM 95MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $135.45 $135.45 $28.23 $135.45 N/A N/A 71226100 SUP HCPCS C1713 71226100 - SCREW BN 6.5MM 100MM 16MM TC100 THRD SS CANC LG FRAG SET BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $81.27 $135.45 $135.45 $135.45 N/A N/A 71226105 SUP HCPCS C1713 71226105 - SCREW BN 6.5MM 105MM 16MM TC100 SS CANC LG FRAG SET BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $81.27 $135.45 $135.45 $135.45 N/A N/A 71226110 SUP HCPCS C1713 71226110 - SCREW BN 6.5MM 110MM 16MM TC100 THRD SS CANC LG FRAG SET BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $54.18 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $81.27 $135.45 $28.23 $135.45 N/A N/A 71226115 SUP HCPCS C1713 71226115 - SCREW BN 6.5MM 115MM 16MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $69.72 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $36.32 $174.30 N/A N/A 71226120 SUP HCPCS C1713 71226120 - SCREW BN 6.5MM 120MM 16MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $69.72 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $174.30 $174.30 $36.32 $174.30 N/A N/A 71226125 SUP HCPCS C1713 71226125 - SCREW BN 6.5MM 125MM 16MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $69.72 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $36.32 $174.30 N/A N/A 71226130 SUP HCPCS C1713 71226130 - SCREW BN 6.5MM 130MM 16MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $69.72 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $36.32 $174.30 N/A N/A 71226135 SUP HCPCS C1713 71226135 - SCREW BN 6.5MM 135MM 16MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $69.72 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $36.32 $174.30 N/A N/A 71226140 SUP HCPCS C1713 71226140 - SCREW BN 6.5MM 140MM 16MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $69.72 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $174.30 $174.30 $36.32 $174.30 N/A N/A 71226145 SUP HCPCS C1713 71226145 - SCREW BN 6.5MM 145MM 16MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $69.72 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $174.30 $174.30 $36.32 $174.30 N/A N/A 71226150 SUP HCPCS C1713 71226150 - SCREW BN 6.5MM 150MM 16MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $69.72 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $36.32 $174.30 N/A N/A 71228045 SUP HCPCS C1713 71228045 - SCREW BN 6.5MM 45MM 32MM TC100 THRD SS CANC LG FRAG SET BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $49.56 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $25.82 $123.90 N/A N/A 71228050 SUP HCPCS C1713 71228050 - SCREW BN 6.5MM 50MM 32MM TC100 THRD SS CANC LG FRAG SET BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $49.56 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $25.82 $123.90 N/A N/A 71228055 SUP HCPCS C1713 71228055 - SCREW BN 6.5MM 55MM 32MM TC100 THRD SS CANC LG FRAG SET BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $49.56 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $123.90 $123.90 N/A N/A 71228060 SUP HCPCS C1713 71228060 - SCREW BN 6.5MM 60MM 32MM TC100 THRD SS CANC LG FRAG SET BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $49.56 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $123.90 $123.90 N/A N/A 71228065 SUP HCPCS C1713 71228065 - SCREW BN 6.5MM 65MM 32MM TC100 THRD SS CANC LG FRAG SET BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $25.82 $123.90 N/A N/A 71228070 SUP HCPCS C1713 71228070 - SCREW BN 6.5MM 70MM 32MM TC100 THRD SS CANC LG FRAG SET BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $49.56 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $25.82 $123.90 N/A N/A 71228075 SUP HCPCS C1713 71228075 - SCREW BN 6.5MM 75MM 32MM TC100 THRD SS CANC LG FRAG SET BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $49.56 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $25.82 $123.90 N/A N/A 71228080 SUP HCPCS C1713 71228080 - SCREW BN 6.5MM 80MM 32MM TC100 THRD SS CANC LG FRAG SET BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $25.82 $123.90 N/A N/A 71228085 SUP HCPCS C1713 71228085 - SCREW BN 6.5MM 85MM 32MM TC100 THRD SS CANC LG FRAG SET BOTH IP/OP $144.00 $107.00 $28.55 $143.85 $64.73 $64.73 $64.73 $64.73 $143.85 $143.85 $143.85 $29.98 $143.85 $143.85 $143.85 $143.85 $143.85 $29.98 $143.85 $143.85 $85.09 $143.85 $143.85 $143.85 $143.85 $108.00 $143.85 $143.85 $143.85 $71.93 $71.93 $113.93 $143.85 $115.08 $64.73 $28.55 N/A $83.52 $143.85 $86.31 $143.85 $29.98 $143.85 N/A N/A 71228090 SUP HCPCS C1713 71228090 - SCREW BN 6.5MM 90MM 32MM TC100 THRD SS CANC LG FRAG SET BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $135.45 $135.45 $28.23 $135.45 N/A N/A 71228095 SUP HCPCS C1713 71228095 - SCREW BN 6.5MM 95MM 32MM TC100 THRD SS CANC LG FRAG SET BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $54.18 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $135.45 $135.45 $28.23 $135.45 N/A N/A 71228100 SUP HCPCS C1713 71228100 - SCREW BN 6.5MM 100MM 32MM TC100 SS CANC LG FRAG SET BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $54.18 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $135.45 $135.45 $28.23 $135.45 N/A N/A 71228105 SUP HCPCS C1713 71228105 - SCREW BN 6.5MM 105MM 32MM TC100 SS CANC LG FRAG SET BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $135.45 $135.45 $28.23 $135.45 N/A N/A 71228110 SUP HCPCS C1713 71228110 - SCREW BN 6.5MM 110MM 32MM TC100 SS CANC LG FRAG SET BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $135.45 $135.45 $28.23 $135.45 N/A N/A 71228115 SUP HCPCS C1713 71228115 - SCREW BN 6.5MM 115MM 32MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $174.30 $174.30 $36.32 $174.30 N/A N/A 71228120 SUP HCPCS C1713 71228120 - SCREW BN 6.5MM 120MM 32MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $174.30 $174.30 $36.32 $174.30 N/A N/A 71228125 SUP HCPCS C1713 71228125 - SCREW BN 6.5MM 125MM 32MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $69.72 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $174.30 $174.30 $36.32 $174.30 N/A N/A 71228130 SUP HCPCS C1713 71228130 - SCREW BN 6.5MM 130MM 32MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $69.72 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $174.30 $174.30 N/A N/A 71228135 SUP HCPCS C1713 71228135 - SCREW BN 6.5MM 135MM 32MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $174.30 $174.30 N/A N/A 71228140 SUP HCPCS C1713 71228140 - SCREW BN 6.5MM 140MM 32MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $69.72 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $36.32 $174.30 N/A N/A 71228145 SUP HCPCS C1713 71228145 - SCREW BN 6.5MM 145MM 32MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $69.72 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $174.30 $174.30 N/A N/A 71228150 SUP HCPCS C1713 71228150 - SCREW BN 6.5MM 150MM 32MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $36.32 $174.30 N/A N/A 71229025 SUP HCPCS C1713 71229025 - SCREW BN FT 6.5MM 8MM 25MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $25.82 $123.90 N/A N/A 71229030 SUP HCPCS C1713 71229030 - SCREW BN FT 6.5MM 8MM 30MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $49.56 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $123.90 $123.90 N/A N/A 71229035 SUP HCPCS C1713 71229035 - SCREW BN FT 6.5MM 8MM 35MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $49.56 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $25.82 $123.90 N/A N/A 71229040 SUP HCPCS C1713 71229040 - SCREW BN FT 6.5MM 8MM 40MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $25.82 $123.90 N/A N/A 71229045 SUP HCPCS C1713 71229045 - SCREW BN FT 6.5MM 8MM 45MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $49.56 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $25.82 $123.90 N/A N/A 71229050 SUP HCPCS C1713 71229050 - SCREW BN FT 6.5MM 8MM 50MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $49.56 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $25.82 $123.90 N/A N/A 71229055 SUP HCPCS C1713 71229055 - SCREW BN FT 6.5MM 8MM 55MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $25.82 $123.90 N/A N/A 71229060 SUP HCPCS C1713 71229060 - SCREW BN FT 6.5MM 8MM 60MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $25.82 $123.90 N/A N/A 71229065 SUP HCPCS C1713 71229065 - SCREW BN FT 6.5MM 8MM 65MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $74.34 $123.90 $25.82 $123.90 N/A N/A 71229070 SUP HCPCS C1713 71229070 - SCREW BN FT 6.5MM 8MM 70MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $49.56 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $123.90 $123.90 N/A N/A 71229075 SUP HCPCS C1713 71229075 - SCREW BN FT 6.5MM 75MM TC100 CANC BOTH IP/OP $124.00 $92.00 $24.59 $123.90 $55.76 $55.76 $55.76 $55.76 $123.90 $123.90 $123.90 $25.82 $123.90 $123.90 $123.90 $123.90 $123.90 $25.82 $123.90 $49.56 $73.29 $123.90 $123.90 $123.90 $123.90 $93.00 $123.90 $123.90 $123.90 $61.95 $61.95 $98.13 $123.90 $99.12 $55.76 $24.59 N/A $71.92 $123.90 $123.90 $123.90 $123.90 $123.90 N/A N/A 71229080 SUP HCPCS C1713 71229080 - SCREW BN FT 6.5MM 80MM TC100 CANC BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $54.18 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $81.27 $135.45 $28.23 $135.45 N/A N/A 71229085 SUP HCPCS C1713 71229085 - SCREW BN FT 6.5MM 85MM TC100 CANC BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $54.18 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $81.27 $135.45 $28.23 $135.45 N/A N/A 71229090 SUP HCPCS C1713 71229090 - SCREW BN FT 6.5MM 90MM TC100 CANC BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $81.27 $135.45 $28.23 $135.45 N/A N/A 71229095 SUP HCPCS C1713 71229095 - SCREW BN FT 6.5MM 8MM 95MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $81.27 $135.45 $135.45 $135.45 N/A N/A 71229100 SUP HCPCS C1713 71229100 - SCREW BN FT 6.5MM 100MM TC100 SS CANC LG FRAG SET BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $135.45 $135.45 $135.45 $135.45 N/A N/A 71229105 SUP HCPCS C1713 71229105 - SCREW BN FT 6.5MM 105MM TC100 SS CANC LG FRAG SET BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $81.27 $135.45 $28.23 $135.45 N/A N/A 71229110 SUP HCPCS C1713 71229110 - SCREW BN FT 6.5MM 110MM TC100 SS CANC LG FRAG SET BOTH IP/OP $135.50 $100.00 $26.88 $135.45 $60.95 $60.95 $60.95 $60.95 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $135.45 $135.45 $135.45 $28.23 $135.45 $135.45 $80.12 $135.45 $135.45 $135.45 $135.45 $101.63 $135.45 $135.45 $135.45 $67.73 $67.73 $107.28 $135.45 $108.36 $60.95 $26.88 N/A $78.59 $135.45 $81.27 $135.45 $28.23 $135.45 N/A N/A 71229115 SUP HCPCS C1713 71229115 - SCREW BN FT 6.5MM 115MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $36.32 $174.30 N/A N/A 71229120 SUP HCPCS C1713 71229120 - SCREW BN FT 6.5MM 120MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $36.32 $174.30 N/A N/A 71229125 SUP HCPCS C1713 71229125 - SCREW BN FT 6.5MM 125MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $174.30 $174.30 $36.32 $174.30 N/A N/A 71229130 SUP HCPCS C1713 71229130 - SCREW BN FT 6.5MM 130MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $174.30 $174.30 $36.32 $174.30 N/A N/A 71229135 SUP HCPCS C1713 71229135 - SCREW BN FT 6.5MM 135MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $174.30 $174.30 N/A N/A 71229140 SUP HCPCS C1713 71229140 - SCREW BN FT 6.5MM 140MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $36.32 $174.30 N/A N/A 71229145 SUP HCPCS C1713 71229145 - SCREW BN FT 6.5MM 145MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $174.30 $174.30 N/A N/A 71229150 SUP HCPCS C1713 71229150 - SCREW BN FT 6.5MM 150MM TC100 SS CANC LG FRAG SET BOTH IP/OP $174.50 $129.00 $34.59 $174.30 $78.44 $78.44 $78.44 $78.44 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $174.30 $174.30 $174.30 $36.33 $174.30 $174.30 $103.10 $174.30 $174.30 $174.30 $174.30 $130.88 $174.30 $174.30 $174.30 $87.15 $87.15 $138.05 $174.30 $139.44 $78.44 $34.59 N/A $101.21 $174.30 $104.58 $174.30 $174.30 $174.30 N/A N/A 71453122 SUP HCPCS C1776 71453122 - INSERT TIB 5-6 11MM LEGION CR HI FLXN XLPE KN BOTH IP/OP "$10,175.00" "$7,530.00" "$2,019.48" "$10,175.00" "$4,578.75" "$4,578.75" "$4,578.75" "$4,578.75" "$10,175.00" "$10,175.00" "$10,175.00" "$2,120.72" "$10,175.00" "$10,175.00" "$10,175.00" "$10,175.00" "$10,175.00" "$2,120.58" "$10,175.00" "$4,070.00" "$5,016.28" "$10,175.00" "$10,175.00" "$10,175.00" "$10,175.00" "$7,631.25" "$10,175.00" "$10,175.00" "$10,175.00" "$5,087.50" "$5,087.50" "$8,058.60" "$10,175.00" "$8,140.00" "$4,578.75" "$2,019.48" N/A "$5,901.50" "$10,175.00" "$10,175.00" "$10,175.00" "$2,120.47" "$10,175.00" N/A N/A 71525986 SUP HCPCS C1713 71525986 - SCREW BN 5MM 55MM ORTH BOTH IP/OP $306.00 $226.00 $60.73 $306.00 $137.70 $137.70 $137.70 $137.70 $306.00 $306.00 $306.00 $63.78 $306.00 $306.00 $306.00 $306.00 $306.00 $63.77 $306.00 $306.00 $181.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $137.70 $60.73 N/A $177.48 $306.00 $306.00 $306.00 $63.77 $306.00 N/A N/A 71525989 SUP HCPCS C1713 71525989 - SCREW BN 5MM 70MM ORTH BOTH IP/OP $306.00 $226.00 $60.73 $306.00 $137.70 $137.70 $137.70 $137.70 $306.00 $306.00 $306.00 $63.78 $306.00 $306.00 $306.00 $306.00 $306.00 $63.77 $306.00 $122.40 $181.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $137.70 $60.73 N/A $177.48 $306.00 $306.00 $306.00 $63.77 $306.00 N/A N/A 71525990 SUP HCPCS C1713 71525990 - SCREW BN 5MM 75MM ORTH BOTH IP/OP $306.00 $226.00 $60.73 $306.00 $137.70 $137.70 $137.70 $137.70 $306.00 $306.00 $306.00 $63.78 $306.00 $306.00 $306.00 $306.00 $306.00 $63.77 $306.00 $122.40 $181.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $137.70 $60.73 N/A $177.48 $306.00 $306.00 $306.00 $306.00 $306.00 N/A N/A 71525991 SUP HCPCS C1713 71525991 - SCREW BN 5MM 80MM ORTH BOTH IP/OP $306.00 $226.00 $60.73 $306.00 $137.70 $137.70 $137.70 $137.70 $306.00 $306.00 $306.00 $63.78 $306.00 $306.00 $306.00 $306.00 $306.00 $63.77 $306.00 $306.00 $181.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $137.70 $60.73 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 71525993 SUP HCPCS C1713 71525993 - SCREW BN 5MM 90MM ORTH BOTH IP/OP $306.00 $226.00 $60.73 $306.00 $137.70 $137.70 $137.70 $137.70 $306.00 $306.00 $306.00 $63.78 $306.00 $306.00 $306.00 $306.00 $306.00 $63.77 $306.00 $306.00 $181.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $137.70 $60.73 N/A $177.48 $306.00 $183.60 $306.00 $63.77 $306.00 N/A N/A 71525994 SUP HCPCS C1713 71525994 - SCREW BN 5MM 95MM ORTH BOTH IP/OP $306.00 $226.00 $60.73 $306.00 $137.70 $137.70 $137.70 $137.70 $306.00 $306.00 $306.00 $63.78 $306.00 $306.00 $306.00 $306.00 $306.00 $63.77 $306.00 $122.40 $181.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $137.70 $60.73 N/A $177.48 $306.00 $183.60 $306.00 $63.77 $306.00 N/A N/A 71525995 SUP HCPCS C1713 71525995 - SCREW BN 5MM 100MM ORTH BOTH IP/OP $306.00 $226.00 $60.73 $306.00 $137.70 $137.70 $137.70 $137.70 $306.00 $306.00 $306.00 $63.78 $306.00 $306.00 $306.00 $306.00 $306.00 $63.77 $306.00 $306.00 $181.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $137.70 $60.73 N/A $177.48 $306.00 $183.60 $306.00 $63.77 $306.00 N/A N/A 71525996 SUP HCPCS C1713 71525996 - SCREW BN 5MM 105MM ORTH BOTH IP/OP $306.00 $226.00 $60.73 $306.00 $137.70 $137.70 $137.70 $137.70 $306.00 $306.00 $306.00 $63.78 $306.00 $306.00 $306.00 $306.00 $306.00 $63.77 $306.00 $306.00 $181.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $137.70 $60.73 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 71525997 SUP HCPCS C1713 71525997 - SCREW BN 5MM 110MM ORTH BOTH IP/OP $306.00 $226.00 $60.73 $306.00 $137.70 $137.70 $137.70 $137.70 $306.00 $306.00 $306.00 $63.78 $306.00 $306.00 $306.00 $306.00 $306.00 $63.77 $306.00 $306.00 $181.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $137.70 $60.73 N/A $177.48 $306.00 $306.00 $306.00 $306.00 $306.00 N/A N/A 71631035 SUP Custom 27203010 71631035 - DRILL SURG 6.4MM STERILE BOTH IP/OP $587.50 $435.00 $104.53 $587.25 $587.25 $587.25 $587.25 $587.25 $587.25 $587.25 $104.53 $587.25 $587.25 $435.86 $435.86 $452.65 $305.96 $122.39 $587.25 $234.90 $587.25 $587.25 $587.25 $587.25 $587.25 $440.63 $587.25 $587.25 $587.25 $293.63 $293.63 $465.10 $587.25 $469.80 $381.71 $587.25 N/A $340.75 $587.25 $352.35 $587.25 $587.25 $587.25 N/A N/A 71631110 SUP Custom 27203010 71631110 - BIT DRILL LONG 4MM PILOT TRIGEN GOLD STERILE DISPOSABLE BOTH IP/OP $504.00 $373.00 $89.71 $504.00 $504.00 $504.00 $504.00 $504.00 $504.00 $504.00 $89.71 $504.00 $504.00 $374.07 $374.07 $388.48 $262.58 $105.04 $504.00 $201.60 $504.00 $504.00 $504.00 $504.00 $504.00 $378.00 $504.00 $504.00 $504.00 $252.00 $252.00 $399.17 $504.00 $403.20 $327.60 $504.00 N/A $292.32 $504.00 $302.40 $504.00 $504.00 $504.00 N/A N/A 71631112 SUP Custom 27203010 71631112 - BIT DRL SHRT 3.2MM STRL TRGN PILT BOTH IP/OP $148.50 $110.00 $26.43 $148.50 $148.50 $148.50 $148.50 $148.50 $148.50 $148.50 $26.43 $148.50 $148.50 $110.22 $110.22 $114.46 $77.37 $30.95 $148.50 $59.40 $148.50 $148.50 $148.50 $148.50 $148.50 $111.38 $148.50 $148.50 $148.50 $74.25 $74.25 $117.61 $148.50 $118.80 $96.53 $148.50 N/A $86.13 $148.50 $89.10 $148.50 $148.50 $148.50 N/A N/A 71631117 SUP Custom 27203010 71631117 - BIT DRL SHRT 4MM STRL TRGN PILT DISP BOTH IP/OP $341.00 $252.00 $60.68 $340.88 $340.88 $340.88 $340.88 $340.88 $340.88 $340.88 $60.68 $340.88 $340.88 $253.00 $253.00 $262.75 $177.60 $71.04 $340.88 $136.35 $340.88 $340.88 $340.88 $340.88 $340.88 $255.75 $340.88 $340.88 $340.88 $170.44 $170.44 $269.98 $340.88 $272.70 $221.57 $340.88 N/A $197.78 $340.88 $204.53 $340.88 $340.88 $340.88 N/A N/A 71631436 SUP Custom 27203010 71631436 - GUIDE DRILL 3.2MM PIN SURESHOT TAN BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 71631626 SUP HCPCS C1769 71631626 - GUIDE ROD ORTH BALL 3MM 1000MM STRL TRGN BALL TIP SS DISP BOTH IP/OP $433.50 $321.00 $85.97 $433.13 $235.19 $235.19 $235.19 $235.19 $433.13 $433.13 $433.13 $90.28 $433.13 $321.47 $321.47 $333.86 $225.66 $90.27 $433.13 $433.13 $256.20 $433.13 $433.13 $433.13 $433.13 $325.13 $433.13 $433.13 $433.13 $216.57 $216.57 $343.04 $433.13 $346.50 $281.53 $85.97 N/A $251.43 $433.13 $433.13 $433.13 $90.26 $433.13 N/A N/A 71631690 SUP Custom 27203010 71631690 - GUIDEWIRE ORTHOPEDIC THREAD 3.2MM TRIGEN DISTAL FEMUR BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 71632001 SUP HCPCS C1713 71632001 - NUT ORTH 5MM STRL TRGN STBLK LCK STAB 5MM SCR BOTH IP/OP $585.00 $433.00 $116.11 $585.00 $263.25 $263.25 $263.25 $263.25 $585.00 $585.00 $585.00 $121.93 $585.00 $585.00 $585.00 $585.00 $585.00 $121.92 $585.00 $585.00 $346.03 $585.00 $585.00 $585.00 $585.00 $438.75 $585.00 $585.00 $585.00 $292.50 $292.50 $463.32 $585.00 $468.00 $263.25 $116.11 N/A $339.30 $585.00 $351.00 $585.00 $121.91 $585.00 N/A N/A 71632002 SUP HCPCS C1713 71632002 - NUT ORTH 4.5MM STBLK WSHR BOTH IP/OP $304.00 $225.00 $60.29 $303.75 $136.69 $136.69 $136.69 $136.69 $303.75 $303.75 $303.75 $63.31 $303.75 $303.75 $303.75 $303.75 $303.75 $63.30 $303.75 $121.50 $179.67 $303.75 $303.75 $303.75 $303.75 $228.00 $303.75 $303.75 $303.75 $151.88 $151.88 $240.57 $303.75 $243.00 $136.69 $60.29 N/A $176.32 $303.75 $182.25 $303.75 $303.75 $303.75 N/A N/A 71632125 SUP HCPCS C1713 71632125 - SCREW BN 4.5MM 25MM GRY TRGN ST SLFDRL FLUT TIP CPTR TI KN BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $162.90 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $407.25 $407.25 $84.87 $407.25 N/A N/A 71632130 SUP HCPCS C1713 71632130 - SCREW BN 4.5MM 30MM GRY TRGN ST SLFDRL CPTR FLUT TIP TI KN BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $162.90 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $407.25 $407.25 $407.25 $407.25 N/A N/A 71632135 SUP HCPCS C1713 71632135 - SCREW BN 4.5MM 35MM GRY TRGN ST SLFDRL CPTR FLUT TIP TI KN BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $244.35 $407.25 $407.25 $407.25 N/A N/A 71632140 SUP HCPCS C1713 71632140 - SCREW BN 4.5MM 40MM GRY TRGN ST SLFDRL FLUT TIP CPTR TI KN BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $162.90 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $244.35 $407.25 $84.87 $407.25 N/A N/A 71632150 SUP HCPCS C1713 71632150 - SCREW BN 4.5MM 50MM GRY TRGN ST SLFDRL FLUT TIP CPTR TI KN BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $162.90 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $244.35 $407.25 $407.25 $407.25 N/A N/A 71632200 SUP HCPCS C1713 71632200 - SCREW BN 5MM 100MM AU TRGN ST SLFDRL FLUT TIP CPTR TI KN BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $407.25 $407.25 $407.25 $407.25 N/A N/A 71632205 SUP HCPCS C1713 71632205 - SCREW BN 5MM 105MM AU TRGN ST SLFDRL FLUT TIP CPTR TI KN IM BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $407.25 $407.25 $84.87 $407.25 N/A N/A 71632210 SUP HCPCS C1713 71632210 - SCREW BN 5MM 110MM AU TRGN ST SLFDRL FLUT TIP CPTR TI KN IM BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $244.35 $407.25 $84.87 $407.25 N/A N/A 71632220 SUP HCPCS C1713 71632220 - SCREW BN 5MM 20MM AU TRGN ST SLFDRL CPTR FLUT TIP THRD TI KN BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $162.90 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $407.25 $407.25 $84.87 $407.25 N/A N/A 71632230 SUP HCPCS C1713 71632230 - SCREW BN 5MM 30MM AU TRGN FLUT TIP ST DRL CPTR TI KN BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $162.90 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $407.25 $407.25 $84.87 $407.25 N/A N/A 71632260 SUP HCPCS C1713 71632260 - SCREW BN 5MM 60MM AU TRGN CPTR SLF DRL ST TI KN BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $162.90 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $407.25 $407.25 $84.87 $407.25 N/A N/A 71632275 SUP HCPCS C1713 71632275 - SCREW BN 5MM 75MM AU TRGN ST SLF DRL FLUT TIP CPTR TI KN BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $162.90 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $244.35 $407.25 $407.25 $407.25 N/A N/A 71632280 SUP HCPCS C1713 71632280 - SCREW BN 5MM 80MM AU TRGN ST SLF DRL FLUT TIP CPTR TI KN BOTH IP/OP $407.50 $302.00 $80.83 $407.25 $183.26 $183.26 $183.26 $183.26 $407.25 $407.25 $407.25 $84.88 $407.25 $407.25 $407.25 $407.25 $407.25 $84.88 $407.25 $162.90 $240.89 $407.25 $407.25 $407.25 $407.25 $305.63 $407.25 $407.25 $407.25 $203.63 $203.63 $322.54 $407.25 $325.80 $183.26 $80.83 N/A $236.35 $407.25 $244.35 $407.25 $407.25 $407.25 N/A N/A 71632300 SUP HCPCS C1713 71632300 - SCREW BN 6.4MM 100MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM BOTH IP/OP $685.50 $507.00 $135.98 $685.13 $308.31 $308.31 $308.31 $308.31 $685.13 $685.13 $685.13 $142.80 $685.13 $685.13 $685.13 $685.13 $685.13 $142.79 $685.13 $685.13 $405.25 $685.13 $685.13 $685.13 $685.13 $514.13 $685.13 $685.13 $685.13 $342.57 $342.57 $542.62 $685.13 $548.10 $308.31 $135.98 N/A $397.59 $685.13 $411.08 $685.13 $142.78 $685.13 N/A N/A 71632305 SUP HCPCS C1713 71632305 - SCREW BN 6.4MM 105MM BLU TRGN ST SLFDRL CPTR RECON TI KN IM BOTH IP/OP $685.50 $507.00 $135.98 $685.13 $308.31 $308.31 $308.31 $308.31 $685.13 $685.13 $685.13 $142.80 $685.13 $685.13 $685.13 $685.13 $685.13 $142.79 $685.13 $685.13 $405.25 $685.13 $685.13 $685.13 $685.13 $514.13 $685.13 $685.13 $685.13 $342.57 $342.57 $542.62 $685.13 $548.10 $308.31 $135.98 N/A $397.59 $685.13 $411.08 $685.13 $142.78 $685.13 N/A N/A 71632316 SUP HCPCS C1713 71632316 - SCREW BN 6.4MM 115MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM BOTH IP/OP $685.50 $507.00 $135.98 $685.13 $308.31 $308.31 $308.31 $308.31 $685.13 $685.13 $685.13 $142.80 $685.13 $685.13 $685.13 $685.13 $685.13 $142.79 $685.13 $274.05 $405.25 $685.13 $685.13 $685.13 $685.13 $514.13 $685.13 $685.13 $685.13 $342.57 $342.57 $542.62 $685.13 $548.10 $308.31 $135.98 N/A $397.59 $685.13 $685.13 $685.13 $142.78 $685.13 N/A N/A 71632325 SUP HCPCS C1713 71632325 - SCREW BN 6.4MM 125MM BLU TRGN CPTR RECON TI KN IM NL BOTH IP/OP $685.50 $507.00 $135.98 $685.13 $308.31 $308.31 $308.31 $308.31 $685.13 $685.13 $685.13 $142.80 $685.13 $685.13 $685.13 $685.13 $685.13 $142.79 $685.13 $274.05 $405.25 $685.13 $685.13 $685.13 $685.13 $514.13 $685.13 $685.13 $685.13 $342.57 $342.57 $542.62 $685.13 $548.10 $308.31 $135.98 N/A $397.59 $685.13 $685.13 $685.13 $685.13 $685.13 N/A N/A 71632375 SUP HCPCS C1713 71632375 - SCREW BN 6.4MM 75MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM BOTH IP/OP $685.50 $507.00 $135.98 $685.13 $308.31 $308.31 $308.31 $308.31 $685.13 $685.13 $685.13 $142.80 $685.13 $685.13 $685.13 $685.13 $685.13 $142.79 $685.13 $274.05 $405.25 $685.13 $685.13 $685.13 $685.13 $514.13 $685.13 $685.13 $685.13 $342.57 $342.57 $542.62 $685.13 $548.10 $308.31 $135.98 N/A $397.59 $685.13 $685.13 $685.13 $685.13 $685.13 N/A N/A 71632380 SUP HCPCS C1713 71632380 - SCREW BN 6.4MM 80MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM BOTH IP/OP $685.50 $507.00 $135.98 $685.13 $308.31 $308.31 $308.31 $308.31 $685.13 $685.13 $685.13 $142.80 $685.13 $685.13 $685.13 $685.13 $685.13 $142.79 $685.13 $274.05 $405.25 $685.13 $685.13 $685.13 $685.13 $514.13 $685.13 $685.13 $685.13 $342.57 $342.57 $542.62 $685.13 $548.10 $308.31 $135.98 N/A $397.59 $685.13 $685.13 $685.13 $142.78 $685.13 N/A N/A 71632385 SUP HCPCS C1713 71632385 - SCREW BN 6.4MM 85MM BLU TRGN CPTR RECON TI KN IM NL BOTH IP/OP $685.50 $507.00 $135.98 $685.13 $308.31 $308.31 $308.31 $308.31 $685.13 $685.13 $685.13 $142.80 $685.13 $685.13 $685.13 $685.13 $685.13 $142.79 $685.13 $274.05 $405.25 $685.13 $685.13 $685.13 $685.13 $514.13 $685.13 $685.13 $685.13 $342.57 $342.57 $542.62 $685.13 $548.10 $308.31 $135.98 N/A $397.59 $685.13 $685.13 $685.13 $142.78 $685.13 N/A N/A 71632390 SUP HCPCS C1713 71632390 - SCREW BN 6.4MM 90MM BLU TRGN SLF DRL ST CPTR RECON TI KN IM BOTH IP/OP $685.50 $507.00 $135.98 $685.13 $308.31 $308.31 $308.31 $308.31 $685.13 $685.13 $685.13 $142.80 $685.13 $685.13 $685.13 $685.13 $685.13 $142.79 $685.13 $685.13 $405.25 $685.13 $685.13 $685.13 $685.13 $514.13 $685.13 $685.13 $685.13 $342.57 $342.57 $542.62 $685.13 $548.10 $308.31 $135.98 N/A $397.59 $685.13 $685.13 $685.13 $142.78 $685.13 N/A N/A 71632395 SUP HCPCS C1713 71632395 - SCREW BN 6.4MM 95MM BLU TRGN ST SLFDRL CPTR RECON TI KN IM BOTH IP/OP $685.50 $507.00 $135.98 $685.13 $308.31 $308.31 $308.31 $308.31 $685.13 $685.13 $685.13 $142.80 $685.13 $685.13 $685.13 $685.13 $685.13 $142.79 $685.13 $274.05 $405.25 $685.13 $685.13 $685.13 $685.13 $514.13 $685.13 $685.13 $685.13 $342.57 $342.57 $542.62 $685.13 $548.10 $308.31 $135.98 N/A $397.59 $685.13 $685.13 $685.13 $142.78 $685.13 N/A N/A 71633005 SUP HCPCS C1713 71633005 - CAP END 5MM 5MM TRGN XTD TI FEM IM NL BOTH IP/OP $418.50 $310.00 $83.06 $418.50 $188.33 $188.33 $188.33 $188.33 $418.50 $418.50 $418.50 $87.23 $418.50 $418.50 $418.50 $418.50 $418.50 $87.22 $418.50 $418.50 $247.54 $418.50 $418.50 $418.50 $418.50 $313.88 $418.50 $418.50 $418.50 $209.25 $209.25 $331.45 $418.50 $334.80 $188.33 $83.06 N/A $242.73 $418.50 $251.10 $418.50 $87.22 $418.50 N/A N/A 71633010 SUP HCPCS C1713 71633010 - CAP END 10MM 10MM TRGN XTD TI FEM IM NL BOTH IP/OP $418.50 $310.00 $83.06 $418.50 $188.33 $188.33 $188.33 $188.33 $418.50 $418.50 $418.50 $87.23 $418.50 $418.50 $418.50 $418.50 $418.50 $87.22 $418.50 $418.50 $247.54 $418.50 $418.50 $418.50 $418.50 $313.88 $418.50 $418.50 $418.50 $209.25 $209.25 $331.45 $418.50 $334.80 $188.33 $83.06 N/A $242.73 $418.50 $251.10 $418.50 $87.22 $418.50 N/A N/A 71633015 SUP HCPCS C1713 71633015 - CAP END 15MM TRGN TI ORTH IM NL BOTH IP/OP $418.50 $310.00 $83.06 $418.50 $188.33 $188.33 $188.33 $188.33 $418.50 $418.50 $418.50 $87.23 $418.50 $418.50 $418.50 $418.50 $418.50 $87.22 $418.50 $418.50 $247.54 $418.50 $418.50 $418.50 $418.50 $313.88 $418.50 $418.50 $418.50 $209.25 $209.25 $331.45 $418.50 $334.80 $188.33 $83.06 N/A $242.73 $418.50 $418.50 $418.50 $87.22 $418.50 N/A N/A 71633020 SUP HCPCS C1713 71633020 - CAP END 20MM TRGN TI ORTH IM NL BOTH IP/OP $418.50 $310.00 $83.06 $418.50 $188.33 $188.33 $188.33 $188.33 $418.50 $418.50 $418.50 $87.23 $418.50 $418.50 $418.50 $418.50 $418.50 $87.22 $418.50 $167.40 $247.54 $418.50 $418.50 $418.50 $418.50 $313.88 $418.50 $418.50 $418.50 $209.25 $209.25 $331.45 $418.50 $334.80 $188.33 $83.06 N/A $242.73 $418.50 $251.10 $418.50 $418.50 $418.50 N/A N/A 71633315 SUP HCPCS C1713 71633315 - NAIL IM 11.5MM 15CM AU TRGN SET TI KN SP CNDL BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$3,937.50" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$2,362.50" "$3,937.50" "$3,937.50" "$3,937.50" N/A N/A 71633320 SUP HCPCS C1713 71633320 - NAIL IM 11.5MM 20CM AU TRGN TI KN TIB BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$3,937.50" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$2,362.50" "$3,937.50" "$3,937.50" "$3,937.50" N/A N/A 71633325 SUP HCPCS C1713 71633325 - NAIL IM 11.5MM 25CM AU TRGN SET TI KN SP CNDL BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$1,575.00" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$2,362.50" "$3,937.50" $820.58 "$3,937.50" N/A N/A 71633415 SUP HCPCS C1713 71633415 - NAIL IM 13MM 15CM AU TRGN SET TI KN SP CNDL BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$1,575.00" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$3,937.50" "$3,937.50" $820.58 "$3,937.50" N/A N/A 71633420 SUP HCPCS C1713 71633420 - NAIL IM 13MM 20CM AU TRGN SET TI KN SP CNDL BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$3,937.50" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$2,362.50" "$3,937.50" "$3,937.50" "$3,937.50" N/A N/A 71633425 SUP HCPCS C1713 71633425 - NAIL IM 13MM 25CM AU TRGN SET TI KN SP CNDL BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$3,937.50" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$2,362.50" "$3,937.50" $820.58 "$3,937.50" N/A N/A 71633448 SUP HCPCS C1713 71633448 - NAIL IM 13MM 48CM AU TRGN RTRGD ANTGRD TI FEM TIB BOTH IP/OP "$6,490.00" "$4,803.00" "$1,288.10" "$6,490.00" "$2,920.50" "$2,920.50" "$2,920.50" "$2,920.50" "$6,490.00" "$6,490.00" "$6,490.00" "$1,352.68" "$6,490.00" "$6,490.00" "$6,490.00" "$6,490.00" "$6,490.00" "$1,352.59" "$6,490.00" "$2,596.00" "$3,199.57" "$6,490.00" "$6,490.00" "$6,490.00" "$6,490.00" "$4,867.50" "$6,490.00" "$6,490.00" "$6,490.00" "$3,245.00" "$3,245.00" "$5,140.08" "$6,490.00" "$5,192.00" "$2,920.50" "$1,288.10" N/A "$3,764.20" "$6,490.00" "$3,894.00" "$6,490.00" "$1,352.52" "$6,490.00" N/A N/A 71634000 SUP HCPCS C1713 71634000 - CAP END 0MM TRGN SET TI DISP INTNL HEX IM NL BOTH IP/OP $421.00 $312.00 $83.51 $420.75 $189.34 $189.34 $189.34 $189.34 $420.75 $420.75 $420.75 $87.69 $420.75 $420.75 $420.75 $420.75 $420.75 $87.69 $420.75 $168.30 $248.87 $420.75 $420.75 $420.75 $420.75 $315.75 $420.75 $420.75 $420.75 $210.38 $210.38 $333.23 $420.75 $336.60 $189.34 $83.51 N/A $244.18 $420.75 $252.45 $420.75 $420.75 $420.75 N/A N/A 71634005 SUP HCPCS C1713 71634005 - CAP END 5MM TRGN SET TI DISP INTNL HEX IM NL BOTH IP/OP $421.00 $312.00 $83.51 $420.75 $189.34 $189.34 $189.34 $189.34 $420.75 $420.75 $420.75 $87.69 $420.75 $420.75 $420.75 $420.75 $420.75 $87.69 $420.75 $168.30 $248.87 $420.75 $420.75 $420.75 $420.75 $315.75 $420.75 $420.75 $420.75 $210.38 $210.38 $333.23 $420.75 $336.60 $189.34 $83.51 N/A $244.18 $420.75 $252.45 $420.75 $87.68 $420.75 N/A N/A 71634010 SUP HCPCS C1713 71634010 - CAP END 10MM 10MM TRGN TI ORTH IM NL BOTH IP/OP $421.00 $312.00 $83.51 $420.75 $189.34 $189.34 $189.34 $189.34 $420.75 $420.75 $420.75 $87.69 $420.75 $420.75 $420.75 $420.75 $420.75 $87.69 $420.75 $168.30 $248.87 $420.75 $420.75 $420.75 $420.75 $315.75 $420.75 $420.75 $420.75 $210.38 $210.38 $333.23 $420.75 $336.60 $189.34 $83.51 N/A $244.18 $420.75 $252.45 $420.75 $420.75 $420.75 N/A N/A 71634015 SUP HCPCS C1713 71634015 - CAP END 15MM 15MM TRGN ORTH IM NL BOTH IP/OP $421.00 $312.00 $83.51 $420.75 $189.34 $189.34 $189.34 $189.34 $420.75 $420.75 $420.75 $87.69 $420.75 $420.75 $420.75 $420.75 $420.75 $87.69 $420.75 $168.30 $248.87 $420.75 $420.75 $420.75 $420.75 $315.75 $420.75 $420.75 $420.75 $210.38 $210.38 $333.23 $420.75 $336.60 $189.34 $83.51 N/A $244.18 $420.75 $252.45 $420.75 $87.68 $420.75 N/A N/A 71634020 SUP HCPCS C1713 71634020 - CAP END 20MM TRGN TI INTNL HEX IM NL BOTH IP/OP $421.00 $312.00 $83.51 $420.75 $189.34 $189.34 $189.34 $189.34 $420.75 $420.75 $420.75 $87.69 $420.75 $420.75 $420.75 $420.75 $420.75 $87.69 $420.75 $168.30 $248.87 $420.75 $420.75 $420.75 $420.75 $315.75 $420.75 $420.75 $420.75 $210.38 $210.38 $333.23 $420.75 $336.60 $189.34 $83.51 N/A $244.18 $420.75 $420.75 $420.75 $87.68 $420.75 N/A N/A 71634230 SUP HCPCS C1713 71634230 - NAIL IM STD 10MM 30CM LIME TRGN ANTGRD FAN TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$4,044.38" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71634232 SUP HCPCS C1713 71634232 - NAIL IM STD 10MM 32CM LIME TRGN ANTGRD FAN TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71634234 SUP HCPCS C1713 71634234 - NAIL IM STD 10MM 34CM LIME TRGN ANTGRD FAN TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71634236 SUP HCPCS C1713 71634236 - NAIL IM STD 10MM 36CM LIME TRGN ANTGRD FAN TI FEM LT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" "$3,870.00" "$3,870.00" N/A N/A 71634238 SUP HCPCS C1713 71634238 - NAIL IM STD 10MM 38CM LIME TRGN ANTGRD FAN TI FEM LT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$1,548.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" "$3,870.00" "$3,870.00" N/A N/A 71634240 SUP HCPCS C1713 71634240 - NAIL IM STD 10MM 40CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$1,548.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71634242 SUP HCPCS C1713 71634242 - NAIL IM STD 10MM 42CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71634244 SUP HCPCS C1713 71634244 - NAIL IM STD 10MM 44CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71634246 SUP HCPCS C1713 71634246 - NAIL IM STD 10MM 46CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71634248 SUP HCPCS C1713 71634248 - NAIL IM STD 10MM 48CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71634250 SUP HCPCS C1713 71634250 - NAIL IM 10MM 50CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71634330 SUP HCPCS C1713 71634330 - NAIL IM 11.5MM 30CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71634332 SUP HCPCS C1713 71634332 - NAIL IM STD 11.5MM 32CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71634334 SUP HCPCS C1713 71634334 - NAIL IM STD 11.5MM 34CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71634336 SUP HCPCS C1713 71634336 - NAIL IM STD 11.5MM 36CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$1,548.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" "$3,870.00" "$3,870.00" N/A N/A 71634338 SUP HCPCS C1713 71634338 - NAIL IM STD 11.5MM 38CM FAN LIME TRGN ANTGRD RECON TI FEM LT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71634340 SUP HCPCS C1713 71634340 - NAIL IM STD 11.5MM 40CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$1,548.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71634342 SUP HCPCS C1713 71634342 - NAIL IM STD 11.5MM 42CM FAN LIME TRGN ANTGRD TI LT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" "$3,870.00" "$3,870.00" N/A N/A 71634344 SUP HCPCS C1713 71634344 - NAIL IM STD 11.5MM 44CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71634346 SUP HCPCS C1713 71634346 - NAIL IM STD 11.5MM 46CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$4,044.38" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71634348 SUP HCPCS C1713 71634348 - NAIL IM STD 11.5MM 48CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71634350 SUP HCPCS C1713 71634350 - NAIL IM 11.5MM 50CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71634430 SUP HCPCS C1713 71634430 - NAIL IM 13MM 30CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71634432 SUP HCPCS C1713 71634432 - NAIL IM STD 13MM 32CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71634434 SUP HCPCS C1713 71634434 - NAIL IM STD 13MM 34CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71634436 SUP HCPCS C1713 71634436 - NAIL IM STD 13MM 36CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71634438 SUP HCPCS C1713 71634438 - NAIL IM STD 13MM 38CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" "$3,870.00" "$3,870.00" N/A N/A 71634440 SUP HCPCS C1713 71634440 - NAIL IM STD 13MM 40CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" "$3,870.00" "$3,870.00" N/A N/A 71634442 SUP HCPCS C1713 71634442 - NAIL IM STD 13MM 42CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71634444 SUP HCPCS C1713 71634444 - NAIL IM STD 13MM 44CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71634446 SUP HCPCS C1713 71634446 - NAIL IM STD 13MM 46CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71634448 SUP HCPCS C1713 71634448 - NAIL IM STD 13MM 48CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71634450 SUP HCPCS C1713 71634450 - NAIL IM 13MM 50CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71634830 SUP HCPCS C1713 71634830 - NAIL IM 130D 8.5MM 30CM ROSE TN RT BOTH IP/OP "$3,971.50" "$2,939.00" $788.19 "$3,971.25" "$1,787.06" "$1,787.06" "$1,787.06" "$1,787.06" "$3,971.25" "$3,971.25" "$3,971.25" $827.71 "$3,971.25" "$3,971.25" "$3,971.25" "$3,971.25" "$3,971.25" $827.65 "$3,971.25" "$1,588.50" "$1,957.83" "$3,971.25" "$3,971.25" "$3,971.25" "$3,971.25" "$2,978.63" "$3,971.25" "$3,971.25" "$3,971.25" "$1,985.63" "$1,985.63" "$3,145.23" "$3,971.25" "$3,177.00" "$1,787.06" $788.19 N/A "$2,303.47" "$3,971.25" "$2,382.75" "$3,971.25" "$3,971.25" "$3,971.25" N/A N/A 71635230 SUP HCPCS C1713 71635230 - NAIL IM 10MM 30CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635232 SUP HCPCS C1713 71635232 - NAIL IM STD 10MM 32CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635234 SUP HCPCS C1713 71635234 - NAIL IM STD 10MM 34CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635236 SUP HCPCS C1713 71635236 - NAIL IM 130D STD 10MM 36CM ROSE TRGN ANTGRD RND XSECT CNN TI BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71635238 SUP HCPCS C1713 71635238 - NAIL IM STD 10MM 38CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$1,548.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" "$3,870.00" "$3,870.00" N/A N/A 71635240 SUP HCPCS C1713 71635240 - NAIL IM STD 10MM 40CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" "$3,870.00" "$3,870.00" N/A N/A 71635242 SUP HCPCS C1713 71635242 - NAIL IM STD 10MM 42CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71635244 SUP HCPCS C1713 71635244 - NAIL IM STD 10MM 44CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71635246 SUP HCPCS C1713 71635246 - NAIL IM STD 10MM 46CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71635248 SUP HCPCS C1713 71635248 - NAIL IM STD 10MM 48CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635250 SUP HCPCS C1713 71635250 - NAIL IM 10MM 50CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$4,044.38" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635330 SUP HCPCS C1713 71635330 - NAIL IM 11.5MM 30CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71635332 SUP HCPCS C1713 71635332 - NAIL IM STD 11.5MM 32CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71635334 SUP HCPCS C1713 71635334 - NAIL IM STD 11.5MM 34CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635336 SUP HCPCS C1713 71635336 - NAIL IM STD 11.5MM 36CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71635338 SUP HCPCS C1713 71635338 - NAIL IM STD 11.5MM 38CM FAN ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71635340 SUP HCPCS C1713 71635340 - NAIL IM STD 11.5MM 40CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71635342 SUP HCPCS C1713 71635342 - NAIL IM STD 11.5MM 42CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71635344 SUP HCPCS C1713 71635344 - NAIL IM STD 11.5MM 44CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635346 SUP HCPCS C1713 71635346 - NAIL IM STD 11.5MM 46CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635348 SUP HCPCS C1713 71635348 - NAIL IM STD 11.5MM 48CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635350 SUP HCPCS C1713 71635350 - NAIL IM 11.5MM 50CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635430 SUP HCPCS C1713 71635430 - NAIL IM 13MM 30CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635432 SUP HCPCS C1713 71635432 - NAIL IM STD 13MM 32CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635434 SUP HCPCS C1713 71635434 - NAIL IM STD 13MM 34CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71635436 SUP HCPCS C1713 71635436 - NAIL IM STD 13MM 36CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$1,548.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" "$3,870.00" "$3,870.00" N/A N/A 71635438 SUP HCPCS C1713 71635438 - NAIL IM STD 13MM 38CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71635440 SUP HCPCS C1713 71635440 - NAIL IM STD 13MM 40CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71635442 SUP HCPCS C1713 71635442 - NAIL IM STD 13MM 42CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$3,870.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71635444 SUP HCPCS C1713 71635444 - NAIL IM STD 13MM 44CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635446 SUP HCPCS C1713 71635446 - NAIL IM STD 13MM 46CM ROSE TRGN ANTGRD TI FEM LT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635448 SUP HCPCS C1713 71635448 - NAIL IM STD 13MM 48CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71635450 SUP HCPCS C1713 71635450 - NAIL IM 13MM 50CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71636126 SUP HCPCS C1713 71636126 - NAIL IM 8.5IN 26IN GRY TRGN ANTGRD TI FEM BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71636128 SUP HCPCS C1713 71636128 - NAIL IM 8.5MM 28CM GRY TRGN ANTGRD TI FEM BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$3,870.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" "$3,870.00" "$3,870.00" N/A N/A 71636130 SUP HCPCS C1713 71636130 - NAIL IM 10MM 30CM GRY TRGN ANTGRD TI FEM BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" "$4,044.38" "$4,044.38" N/A N/A 71636132 SUP HCPCS C1713 71636132 - NAIL IM 8.5MM 32CM GRY TRGN ANTGRD TI KN FEM BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$1,617.75" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71636134 SUP HCPCS C1713 71636134 - NAIL IM 8.5MM 34CM GRY TRGN CNN ANTGRD TI FEM BOTH IP/OP "$4,044.50" "$2,993.00" $802.71 "$4,044.38" "$1,819.97" "$1,819.97" "$1,819.97" "$1,819.97" "$4,044.38" "$4,044.38" "$4,044.38" $842.95 "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" $842.89 "$4,044.38" "$4,044.38" "$1,993.88" "$4,044.38" "$4,044.38" "$4,044.38" "$4,044.38" "$3,033.38" "$4,044.38" "$4,044.38" "$4,044.38" "$2,022.19" "$2,022.19" "$3,203.15" "$4,044.38" "$3,235.50" "$1,819.97" $802.71 N/A "$2,345.81" "$4,044.38" "$2,426.63" "$4,044.38" $842.85 "$4,044.38" N/A N/A 71636136 SUP HCPCS C1713 71636136 - NAIL IM 8.5MM 36CM GRY TRGN ANTGRD TI FEM BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$1,548.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71636138 SUP HCPCS C1713 71636138 - NAIL IM 8.5MM 38CM GRY TRGN ANTGRD TI FEM BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$1,548.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71636140 SUP HCPCS C1713 71636140 - NAIL IM 8.5MM 40CM GRY TRGN ANTGRD TI FEM BOTH IP/OP "$3,870.00" "$2,864.00" $768.10 "$3,870.00" "$1,741.50" "$1,741.50" "$1,741.50" "$1,741.50" "$3,870.00" "$3,870.00" "$3,870.00" $806.60 "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" $806.55 "$3,870.00" "$1,548.00" "$1,907.91" "$3,870.00" "$3,870.00" "$3,870.00" "$3,870.00" "$2,902.50" "$3,870.00" "$3,870.00" "$3,870.00" "$1,935.00" "$1,935.00" "$3,065.04" "$3,870.00" "$3,096.00" "$1,741.50" $768.10 N/A "$2,244.60" "$3,870.00" "$2,322.00" "$3,870.00" $806.51 "$3,870.00" N/A N/A 71637124 SUP HCPCS C1713 71637124 - NAIL IM 135D 8.5MM 24CM LIME LT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$2,840.63" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$2,840.63" "$2,840.63" $591.99 "$2,840.63" N/A N/A 71637130 SUP HCPCS C1713 71637130 - NAIL IM 135D 8.5MM 30CM LIME LT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$1,136.25" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$2,840.63" "$2,840.63" $591.99 "$2,840.63" N/A N/A 71637132 SUP HCPCS C1713 71637132 - NAIL IM 135D 8.5MM 32CM LIME LT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$2,840.63" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$1,704.38" "$2,840.63" $591.99 "$2,840.63" N/A N/A 71637134 SUP HCPCS C1713 71637134 - NAIL IM 135D 8.5MM 34CM LIME LT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$2,840.63" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$1,704.38" "$2,840.63" "$2,840.63" "$2,840.63" N/A N/A 71637136 SUP HCPCS C1713 71637136 - NAIL IM 135D 8.5MM 36CM LIME LT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$2,840.63" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$1,704.38" "$2,840.63" $591.99 "$2,840.63" N/A N/A 71637138 SUP HCPCS C1713 71637138 - NAIL IM 135D 8.5MM 38CM LIME LT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$2,840.63" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$1,704.38" "$2,840.63" $591.99 "$2,840.63" N/A N/A 71637140 SUP HCPCS C1713 71637140 - NAIL IM 135D 8.5MM 40CM LIME LT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$1,136.25" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$1,704.38" "$2,840.63" $591.99 "$2,840.63" N/A N/A 71637230 SUP HCPCS C1713 71637230 - NAIL IM 135D 10MM 30CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$1,968.75" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637232 SUP HCPCS C1713 71637232 - NAIL IM 135D 10MM 32CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637234 SUP HCPCS C1713 71637234 - NAIL IM 135D 10MM 34MM LGHT LIME TRGN ANTGRD TI LT BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637236 SUP HCPCS C1713 71637236 - NAIL IM 135D 10MM 36MM LGHT LIME TRGN ANTGRD TI LT BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$1,968.75" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637238 SUP HCPCS C1713 71637238 - NAIL IM 135D 10MM 38MM LGHT LIME TRGN ANTGRD TI LT BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$4,696.88" "$4,696.88" $978.83 "$4,696.88" N/A N/A 71637240 SUP HCPCS C1713 71637240 - NAIL IM 135D 10MM 40CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$1,878.75" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" $978.83 "$4,696.88" N/A N/A 71637242 SUP HCPCS C1713 71637242 - NAIL IM 135D 10MM 42CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" "$4,696.88" "$4,696.88" N/A N/A 71637244 SUP HCPCS C1713 71637244 - NAIL IM 135D 10MM 44CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$1,968.75" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71637246 SUP HCPCS C1713 71637246 - NAIL IM 135D 10MM 46CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637248 SUP HCPCS C1713 71637248 - NAIL IM 135D 10MM 48CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$1,968.75" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71637250 SUP HCPCS C1713 71637250 - NAIL IM 135D 10MM 50CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637330 SUP HCPCS C1713 71637330 - NAIL IM 135D 11.5MM 30CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637332 SUP HCPCS C1713 71637332 - NAIL IM 135D 11.5MM 32CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71637334 SUP HCPCS C1713 71637334 - NAIL IM 135D 11.5MM 34CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71637336 SUP HCPCS C1713 71637336 - NAIL IM 135D 11.5MM 36CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$4,696.88" "$4,696.88" $978.83 "$4,696.88" N/A N/A 71637338 SUP HCPCS C1713 71637338 - NAIL IM 135D 11.5MM 38CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" $978.83 "$4,696.88" N/A N/A 71637340 SUP HCPCS C1713 71637340 - NAIL IM 135D 11.5MM 40CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" $978.83 "$4,696.88" N/A N/A 71637342 SUP HCPCS C1713 71637342 - NAIL IM 135D 11.5MM 42CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$4,696.88" "$4,696.88" $978.83 "$4,696.88" N/A N/A 71637344 SUP HCPCS C1713 71637344 - NAIL IM 135D 11.5MM 44CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637346 SUP HCPCS C1713 71637346 - NAIL IM 135D 11.5MM 46CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$1,968.75" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637348 SUP HCPCS C1713 71637348 - NAIL IM 135D 11.5MM 48CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637350 SUP HCPCS C1713 71637350 - NAIL IM 135D 11.5MM 50CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$1,968.75" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637430 SUP HCPCS C1713 71637430 - NAIL IM 135D 13MM 30CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$1,968.75" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637432 SUP HCPCS C1713 71637432 - NAIL IM 135D 13MM 32CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$1,968.75" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637434 SUP HCPCS C1713 71637434 - NAIL IM 135D 13MM 34CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$1,968.75" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637436 SUP HCPCS C1713 71637436 - NAIL IM 135D 13MM 36CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" $978.83 "$4,696.88" N/A N/A 71637438 SUP HCPCS C1713 71637438 - NAIL IM 135D 13MM 38CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" $978.83 "$4,696.88" N/A N/A 71637440 SUP HCPCS C1713 71637440 - NAIL IM 135D 13MM 40CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" $978.83 "$4,696.88" N/A N/A 71637442 SUP HCPCS C1713 71637442 - NAIL IM 135D 13MM 42CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" "$4,696.88" "$4,696.88" N/A N/A 71637444 SUP HCPCS C1713 71637444 - NAIL IM 135D 13MM 44CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71637446 SUP HCPCS C1713 71637446 - NAIL IM 135D 13MM 46CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637448 SUP HCPCS C1713 71637448 - NAIL IM 135D 13MM 48CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71637450 SUP HCPCS C1713 71637450 - NAIL IM 135D 13MM 50CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$1,968.75" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71638124 SUP HCPCS C1713 71638124 - NAIL IM 135D 8.5MM 24CM ROSE RT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$2,840.63" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$1,704.38" "$2,840.63" $591.99 "$2,840.63" N/A N/A 71638128 SUP HCPCS C1713 71638128 - NAIL IM 135D 8.5MM 28CM ROSE RT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$1,136.25" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$1,704.38" "$2,840.63" $591.99 "$2,840.63" N/A N/A 71638130 SUP HCPCS C1713 71638130 - NAIL IM 135D 8.5MM 30CM ROSE RT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$1,136.25" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$1,704.38" "$2,840.63" $591.99 "$2,840.63" N/A N/A 71638132 SUP HCPCS C1713 71638132 - NAIL IM 135D 8.5MM 32CM ROSE RT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$2,840.63" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$1,704.38" "$2,840.63" $591.99 "$2,840.63" N/A N/A 71638134 SUP HCPCS C1713 71638134 - NAIL IM 135D 8.5MM 34CM ROSE RT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$2,840.63" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$2,840.63" "$2,840.63" $591.99 "$2,840.63" N/A N/A 71638136 SUP HCPCS C1713 71638136 - NAIL IM 135D 8.5MM 36CM ROSE RT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$2,840.63" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$1,704.38" "$2,840.63" $591.99 "$2,840.63" N/A N/A 71638138 SUP HCPCS C1713 71638138 - NAIL IM 135D 8.5MM 38CM ROSE RT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$2,840.63" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$1,704.38" "$2,840.63" $591.99 "$2,840.63" N/A N/A 71638140 SUP HCPCS C1713 71638140 - NAIL IM 135D 8.5MM 40CM ROSE RT TROCH BOTH IP/OP "$2,841.00" "$2,102.00" $563.79 "$2,840.63" "$1,278.28" "$1,278.28" "$1,278.28" "$1,278.28" "$2,840.63" "$2,840.63" "$2,840.63" $592.06 "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" $592.02 "$2,840.63" "$2,840.63" "$1,400.43" "$2,840.63" "$2,840.63" "$2,840.63" "$2,840.63" "$2,130.75" "$2,840.63" "$2,840.63" "$2,840.63" "$1,420.32" "$1,420.32" "$2,249.78" "$2,840.63" "$2,272.50" "$1,278.28" $563.79 N/A "$1,647.78" "$2,840.63" "$1,704.38" "$2,840.63" "$2,840.63" "$2,840.63" N/A N/A 71638230 SUP HCPCS C1713 71638230 - NAIL IM 135D 10MM 30CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71638232 SUP HCPCS C1713 71638232 - NAIL IM 135D 10MM 32CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71638234 SUP HCPCS C1713 71638234 - NAIL IM 135D 10MM 34CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71638236 SUP HCPCS C1713 71638236 - NAIL IM 135D 10MM 36CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" "$4,696.88" "$4,696.88" N/A N/A 71638238 SUP HCPCS C1713 71638238 - NAIL IM 135D 10MM 38CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" "$4,696.88" "$4,696.88" N/A N/A 71638240 SUP HCPCS C1713 71638240 - NAIL IM 135D 10MM 40CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" "$4,696.88" "$4,696.88" N/A N/A 71638242 SUP HCPCS C1713 71638242 - NAIL IM 135D 10MM 42CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" $978.83 "$4,696.88" N/A N/A 71638244 SUP HCPCS C1713 71638244 - NAIL IM 135D 10MM 44CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71638246 SUP HCPCS C1713 71638246 - NAIL IM 135D 10MM 46CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71638248 SUP HCPCS C1713 71638248 - NAIL IM 135D 10MM 48CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71638250 SUP HCPCS C1713 71638250 - NAIL IM 135D 10MM 50CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71638330 SUP HCPCS C1713 71638330 - NAIL IM 135D 11.5MM 30CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71638332 SUP HCPCS C1713 71638332 - NAIL IM 135D 11.5MM 32CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71638334 SUP HCPCS C1713 71638334 - NAIL IM 135D 11.5MM 34CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71638336 SUP HCPCS C1713 71638336 - NAIL IM 135D 11.5MM 36CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" $978.83 "$4,696.88" N/A N/A 71638338 SUP HCPCS C1713 71638338 - NAIL IM 135D 11.5MM 38CM ROSE TN TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" $978.83 "$4,696.88" N/A N/A 71638340 SUP HCPCS C1713 71638340 - NAIL IM 135D 11.5MM 40CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" $978.83 "$4,696.88" N/A N/A 71638342 SUP HCPCS C1713 71638342 - NAIL IM 135D 11.5MM 42CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" "$4,696.88" "$4,696.88" N/A N/A 71638344 SUP HCPCS C1713 71638344 - NAIL IM 135D 11.5MM 44CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71638346 SUP HCPCS C1713 71638346 - NAIL IM 135D 11.5MM 46CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71638348 SUP HCPCS C1713 71638348 - NAIL IM 135D 11.5MM 48CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71638350 SUP HCPCS C1713 71638350 - NAIL IM 135D 11.5MM 50CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71638430 SUP HCPCS C1713 71638430 - NAIL IM 135D 13MM 30CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71638432 SUP HCPCS C1713 71638432 - NAIL IM 135D 13MM 32CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71638434 SUP HCPCS C1713 71638434 - NAIL IM 135D 13MM 34CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$4,921.88" "$4,921.88" N/A N/A 71638436 SUP HCPCS C1713 71638436 - NAIL IM 135D 13MM 36CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$1,878.75" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" "$4,696.88" "$4,696.88" N/A N/A 71638438 SUP HCPCS C1713 71638438 - NAIL IM 135D 13MM 38CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$4,696.88" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" $978.83 "$4,696.88" N/A N/A 71638440 SUP HCPCS C1713 71638440 - NAIL IM 135D 13MM 40CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$1,878.75" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" "$4,696.88" "$4,696.88" N/A N/A 71638442 SUP HCPCS C1713 71638442 - NAIL IM 135D 13MM 42CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,697.00" "$3,476.00" $932.21 "$4,696.88" "$2,113.60" "$2,113.60" "$2,113.60" "$2,113.60" "$4,696.88" "$4,696.88" "$4,696.88" $978.95 "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" $978.88 "$4,696.88" "$1,878.75" "$2,315.56" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$3,522.75" "$4,696.88" "$4,696.88" "$4,696.88" "$2,348.44" "$2,348.44" "$3,719.93" "$4,696.88" "$3,757.50" "$2,113.60" $932.21 N/A "$2,724.26" "$4,696.88" "$2,818.13" "$4,696.88" "$4,696.88" "$4,696.88" N/A N/A 71638444 SUP HCPCS C1713 71638444 - NAIL IM 135D 13MM 44CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71638446 SUP HCPCS C1713 71638446 - NAIL IM 135D 13MM 46CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$1,968.75" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71638448 SUP HCPCS C1713 71638448 - NAIL IM 135D 13MM 48CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$1,968.75" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71638450 SUP HCPCS C1713 71638450 - NAIL IM 135D 13MM 50CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$1,968.75" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 71639215 SUP HCPCS C1713 71639215 - NAIL IM SHRT BND 10MM 15CM BLU TRGN ANTGRD TI FEM TROCH BOTH IP/OP "$2,857.50" "$2,115.00" $567.14 "$2,857.50" "$1,285.88" "$1,285.88" "$1,285.88" "$1,285.88" "$2,857.50" "$2,857.50" "$2,857.50" $595.57 "$2,857.50" "$2,857.50" "$2,857.50" "$2,857.50" "$2,857.50" $595.53 "$2,857.50" "$1,143.00" "$1,408.75" "$2,857.50" "$2,857.50" "$2,857.50" "$2,857.50" "$2,143.13" "$2,857.50" "$2,857.50" "$2,857.50" "$1,428.75" "$1,428.75" "$2,263.14" "$2,857.50" "$2,286.00" "$1,285.88" $567.14 N/A "$1,657.35" "$2,857.50" "$1,714.50" "$2,857.50" $595.50 "$2,857.50" N/A N/A 71639315 SUP HCPCS C1713 71639315 - NAIL IM SHRT 11.5MM 15CM BLU TRGN ANTGRD BND TI FEM TROCH BOTH IP/OP "$4,033.50" "$2,985.00" $800.48 "$4,033.13" "$1,814.91" "$1,814.91" "$1,814.91" "$1,814.91" "$4,033.13" "$4,033.13" "$4,033.13" $840.61 "$4,033.13" "$4,033.13" "$4,033.13" "$4,033.13" "$4,033.13" $840.55 "$4,033.13" "$4,033.13" "$1,988.33" "$4,033.13" "$4,033.13" "$4,033.13" "$4,033.13" "$3,025.13" "$4,033.13" "$4,033.13" "$4,033.13" "$2,016.57" "$2,016.57" "$3,194.24" "$4,033.13" "$3,226.50" "$1,814.91" $800.48 N/A "$2,339.43" "$4,033.13" "$2,419.88" "$4,033.13" $840.50 "$4,033.13" N/A N/A 71640530 SUP HCPCS C1713 71640530 - NAIL IM 9MM 30CM ROSE TRGN MT-TN ANTGRD FEM TROCH RT BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640532 SUP HCPCS C1713 71640532 - NAIL IM 9MM 32CM ROSE TRGN MT-TN ANTGRD FEM TROCH RT BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640534 SUP HCPCS C1713 71640534 - NAIL IM 9MM 34CM ROSE TRGN MT-TN ANTGRD FEM TROCH RT BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640536 SUP HCPCS C1713 71640536 - NAIL IM 9MM 36CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640538 SUP HCPCS C1713 71640538 - NAIL IM 9MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640540 SUP HCPCS C1713 71640540 - NAIL IM 9MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$3,526.88" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640542 SUP HCPCS C1713 71640542 - NAIL IM 9MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640544 SUP HCPCS C1713 71640544 - NAIL IM 9MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640546 SUP HCPCS C1713 71640546 - NAIL IM 9MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640548 SUP HCPCS C1713 71640548 - NAIL IM 9MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640550 SUP HCPCS C1713 71640550 - NAIL IM 9MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640630 SUP HCPCS C1713 71640630 - NAIL IM 10MM 30CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$3,526.88" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640632 SUP HCPCS C1713 71640632 - NAIL IM 10MM 32CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640634 SUP HCPCS C1713 71640634 - NAIL IM 10MM 34CM ROSE TRGN MT-TN RT BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640636 SUP HCPCS C1713 71640636 - NAIL IM 10MM 36CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640638 SUP HCPCS C1713 71640638 - NAIL IM 10MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640640 SUP HCPCS C1713 71640640 - NAIL IM 10MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640642 SUP HCPCS C1713 71640642 - NAIL IM 10MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640644 SUP HCPCS C1713 71640644 - NAIL IM 10MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640646 SUP HCPCS C1713 71640646 - NAIL IM 10MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640648 SUP HCPCS C1713 71640648 - NAIL IM 10MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640650 SUP HCPCS C1713 71640650 - NAIL IM 10MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640730 SUP HCPCS C1713 71640730 - NAIL IM 11.5MM 30CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$3,526.88" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640732 SUP HCPCS C1713 71640732 - NAIL IM 11.5MM 32CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640734 SUP HCPCS C1713 71640734 - NAIL IM 11.5MM 34CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640736 SUP HCPCS C1713 71640736 - NAIL IM 11.5MM 36CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640738 SUP HCPCS C1713 71640738 - NAIL IM 11.5MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$3,526.88" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640740 SUP HCPCS C1713 71640740 - NAIL IM 11.5MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640742 SUP HCPCS C1713 71640742 - NAIL IM 11.5MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640744 SUP HCPCS C1713 71640744 - NAIL IM 11.5MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640746 SUP HCPCS C1713 71640746 - NAIL IM 11.5MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$3,526.88" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640748 SUP HCPCS C1713 71640748 - NAIL IM 11.5MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640750 SUP HCPCS C1713 71640750 - NAIL IM 11.5MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640830 SUP HCPCS C1713 71640830 - NAIL IM 13MM 30CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640832 SUP HCPCS C1713 71640832 - NAIL IM 13MM 32CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640834 SUP HCPCS C1713 71640834 - NAIL IM 13MM 34CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640836 SUP HCPCS C1713 71640836 - NAIL IM 13MM 36CM MT-NL TN RT BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640838 SUP HCPCS C1713 71640838 - NAIL IM 13MM 38CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640840 SUP HCPCS C1713 71640840 - NAIL IM 13MM 40CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640842 SUP HCPCS C1713 71640842 - NAIL IM 13MM 42CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640844 SUP HCPCS C1713 71640844 - NAIL IM 13MM 44CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71640846 SUP HCPCS C1713 71640846 - NAIL IM 13MM 46CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640848 SUP HCPCS C1713 71640848 - NAIL IM 13MM 48CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71640850 SUP HCPCS C1713 71640850 - NAIL IM 13MM 50CM ROSE TRGN MT-TN ANTGRD FEM RT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71641123 SUP Custom 27203010 71641123 - BIT DRL SHRT 4MM STRL TRGN AO STP SET DPHSL DISP BOTH IP/OP $225.00 $167.00 $40.05 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $40.05 $225.00 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $90.00 $225.00 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $225.00 N/A $130.50 $225.00 $135.00 $225.00 $225.00 $225.00 N/A N/A 71642120 SUP HCPCS C1713 71642120 - SCREW BN 4.5MM 20MM TRGN CPTR TI ORTH BOTH IP/OP $283.50 $210.00 $56.27 $283.50 $127.58 $127.58 $127.58 $127.58 $283.50 $283.50 $283.50 $59.09 $283.50 $283.50 $283.50 $283.50 $283.50 $59.08 $283.50 $283.50 $167.69 $283.50 $283.50 $283.50 $283.50 $212.63 $283.50 $283.50 $283.50 $141.75 $141.75 $224.53 $283.50 $226.80 $127.58 $56.27 N/A $164.43 $283.50 $283.50 $283.50 $59.08 $283.50 N/A N/A 71642125 SUP HCPCS C1713 71642125 - SCREW BN 4.5MM 25MM GRY TRGN INTNL CPTR HEX TI FEM IM NL BOTH IP/OP $439.00 $325.00 $87.08 $438.75 $197.44 $197.44 $197.44 $197.44 $438.75 $438.75 $438.75 $91.45 $438.75 $438.75 $438.75 $438.75 $438.75 $91.44 $438.75 $175.50 $259.52 $438.75 $438.75 $438.75 $438.75 $329.25 $438.75 $438.75 $438.75 $219.38 $219.38 $347.49 $438.75 $351.00 $197.44 $87.08 N/A $254.62 $438.75 $438.75 $438.75 $438.75 $438.75 N/A N/A 71642130 SUP HCPCS C1713 71642130 - SCREW BN 4.5MM 30MM GRY TRGN INTNL CPTR TI FEM IM NL BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $452.25 $452.25 N/A N/A 71642135 SUP HCPCS C1713 71642135 - SCREW BN HEX 4.5MM 35MM GRY TRGN INTNL CPTR TI FEM IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642140 SUP HCPCS C1713 71642140 - SCREW BN HEX 4.5MM 40MM GRY TRGN INTNL CPTR TI KN TIB IM NL BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642145 SUP HCPCS C1713 71642145 - SCREW BN 4.5MM 45MM GRY TRGN INTNL CPTR TI ORTH IM NL BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642150 SUP HCPCS C1713 71642150 - SCREW BN HEX 4.5MM 50MM GRY TRGN INTNL CPTR TI FEM IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642155 SUP HCPCS C1713 71642155 - SCREW BN FT 4.5MM 55MM GRY TRGN INTNL CPTR HEX HD TI FEM BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642160 SUP HCPCS C1713 71642160 - SCREW BN 4.5MM 60MM GRY TRGN INTNL CPTR HEX HD TI FEM IM NL BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $452.25 $452.25 N/A N/A 71642165 SUP HCPCS C1713 71642165 - SCREW BN 4.5MM 65MM GRY TRGN INTNL CPTR TI ORTH IM NL BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642200 SUP HCPCS C1713 71642200 - SCREW BN HEX 5MM 100MM AU TRGN INTNL CPTR TI FEM IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642205 SUP HCPCS C1713 71642205 - SCREW BN FT 5MM 105MM AU TRGN NTERNAL CPTR HEX HD TI FEM BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642210 SUP HCPCS C1713 71642210 - SCREW BN FT 5MM 110MM AU TRGN INTNL CPTR HEX HD TI FEM BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642220 SUP HCPCS C1713 71642220 - SCREW BN 5MM 20MM TRGN INTNL CPTR HEX HD TI FEM IM NL BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642225 SUP HCPCS C1713 71642225 - SCREW BN 5MM 25MM AU INTNL CPTR HEX TI FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71642230 SUP HCPCS C1713 71642230 - SCREW BN 5MM 30MM AU INTNL CPTR HEX TI FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71642235 SUP HCPCS C1713 71642235 - SCREW BN HEX 5MM 35MM AU TRGN INTNL CPTR TI FEM IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642240 SUP HCPCS C1713 71642240 - SCREW BONE HEXAGON 5MM 40MM INTERNAL CAPTURE TRIGEN GOLD BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71642245 SUP HCPCS C1713 71642245 - SCREW BONE HEXAGON 5MM 45MM INTERNAL CAPTURE TRIGEN GOLD BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642250 SUP HCPCS C1713 71642250 - SCREW BONE HEXAGON 5MM 50MM INTERNAL CAPTURE TRIGEN GOLD BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71642255 SUP HCPCS C1713 71642255 - SCREW BN HEX 5MM 55MM AU TRGN INTNL CPTR TI FEM IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642260 SUP HCPCS C1713 71642260 - SCREW BONE HEXAGON 5MM 60MM INTERNAL CAPTURE TRIGEN GOLD BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71642265 SUP HCPCS C1713 71642265 - SCREW BN HEX 5MM 65MM AU TRGN INTNL CPTR TI FEM IM NL BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642270 SUP HCPCS C1713 71642270 - SCREW BONE HEXAGON 5MM 70MM INTERNAL CAPTURE TRIGEN GOLD BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71642275 SUP HCPCS C1713 71642275 - SCREW BN HEX 5MM 75MM AU TRGN INTNL CPTR TI FEM IM NL BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71642280 SUP HCPCS C1713 71642280 - SCREW BN HEX 5MM 80MM AU TRGN INTNL CPTR TI FEM IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $452.25 $452.25 N/A N/A 71642285 SUP HCPCS C1713 71642285 - SCREW BN HEX 5MM 85MM AU TRGN INTNL CPTR TI FEM IM NL BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $452.25 $452.25 N/A N/A 71642290 SUP HCPCS C1713 71642290 - SCREW BN HEX 5MM 90MM AU TRGN INTNL CPTR TI FEM IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $452.25 $452.25 N/A N/A 71642295 SUP HCPCS C1713 71642295 - SCREW BN HEX 5MM 95MM AU TRGN INTNL CPTR TI FEM IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $452.25 $452.25 N/A N/A 71642300 SUP HCPCS C1713 71642300 - SCREW BONE HEXAGON 6.4MM 100MM INTERNAL CAPTURE BOTH IP/OP $728.00 $539.00 $144.47 $727.88 $327.55 $327.55 $327.55 $327.55 $727.88 $727.88 $727.88 $151.71 $727.88 $727.88 $727.88 $727.88 $727.88 $151.70 $727.88 $291.15 $430.54 $727.88 $727.88 $727.88 $727.88 $546.00 $727.88 $727.88 $727.88 $363.94 $363.94 $576.48 $727.88 $582.30 $327.55 $144.47 N/A $422.24 $727.88 $436.73 $727.88 $151.69 $727.88 N/A N/A 71642305 SUP HCPCS C1713 71642305 - SCREW BONE HEXAGON 6.4MM 105MM INTERNAL CAPTURE BOTH IP/OP $728.00 $539.00 $144.47 $727.88 $327.55 $327.55 $327.55 $327.55 $727.88 $727.88 $727.88 $151.71 $727.88 $727.88 $727.88 $727.88 $727.88 $151.70 $727.88 $727.88 $430.54 $727.88 $727.88 $727.88 $727.88 $546.00 $727.88 $727.88 $727.88 $363.94 $363.94 $576.48 $727.88 $582.30 $327.55 $144.47 N/A $422.24 $727.88 $436.73 $727.88 $151.69 $727.88 N/A N/A 71642320 SUP HCPCS C1713 71642320 - SCREW BN HEX 6.4MM 120MM BLU TRGN INTNL CPTR RECON TI FEM IM BOTH IP/OP $728.00 $539.00 $144.47 $727.88 $327.55 $327.55 $327.55 $327.55 $727.88 $727.88 $727.88 $151.71 $727.88 $727.88 $727.88 $727.88 $727.88 $151.70 $727.88 $727.88 $430.54 $727.88 $727.88 $727.88 $727.88 $546.00 $727.88 $727.88 $727.88 $363.94 $363.94 $576.48 $727.88 $582.30 $327.55 $144.47 N/A $422.24 $727.88 $727.88 $727.88 $151.69 $727.88 N/A N/A 71642325 SUP HCPCS C1713 71642325 - SCREW BN HEX 6.4MM 125MM BLU TRGN INTNL CPTR RECON TI FEM IM BOTH IP/OP $728.00 $539.00 $144.47 $727.88 $327.55 $327.55 $327.55 $327.55 $727.88 $727.88 $727.88 $151.71 $727.88 $727.88 $727.88 $727.88 $727.88 $151.70 $727.88 $727.88 $430.54 $727.88 $727.88 $727.88 $727.88 $546.00 $727.88 $727.88 $727.88 $363.94 $363.94 $576.48 $727.88 $582.30 $327.55 $144.47 N/A $422.24 $727.88 $727.88 $727.88 $727.88 $727.88 N/A N/A 71642365 SUP HCPCS C1713 71642365 - SCREW BN HEX 6.4MM 65MM BLU TRGN INTNL CPTR RECON TI FEM IM BOTH IP/OP $728.00 $539.00 $144.47 $727.88 $327.55 $327.55 $327.55 $327.55 $727.88 $727.88 $727.88 $151.71 $727.88 $727.88 $727.88 $727.88 $727.88 $151.70 $727.88 $727.88 $430.54 $727.88 $727.88 $727.88 $727.88 $546.00 $727.88 $727.88 $727.88 $363.94 $363.94 $576.48 $727.88 $582.30 $327.55 $144.47 N/A $422.24 $727.88 $727.88 $727.88 $151.69 $727.88 N/A N/A 71642370 SUP HCPCS C1713 71642370 - SCREW BONE HEXAGON 6.4MM 70MM INTERNAL CAPTURE BOTH IP/OP $728.00 $539.00 $144.47 $727.88 $327.55 $327.55 $327.55 $327.55 $727.88 $727.88 $727.88 $151.71 $727.88 $727.88 $727.88 $727.88 $727.88 $151.70 $727.88 $291.15 $430.54 $727.88 $727.88 $727.88 $727.88 $546.00 $727.88 $727.88 $727.88 $363.94 $363.94 $576.48 $727.88 $582.30 $327.55 $144.47 N/A $422.24 $727.88 $436.73 $727.88 $151.69 $727.88 N/A N/A 71642375 SUP HCPCS C1713 71642375 - SCREW BONE HEXAGON 6.4MM 75MM INTERNAL CAPTURE BOTH IP/OP $728.00 $539.00 $144.47 $727.88 $327.55 $327.55 $327.55 $327.55 $727.88 $727.88 $727.88 $151.71 $727.88 $727.88 $727.88 $727.88 $727.88 $151.70 $727.88 $291.15 $430.54 $727.88 $727.88 $727.88 $727.88 $546.00 $727.88 $727.88 $727.88 $363.94 $363.94 $576.48 $727.88 $582.30 $327.55 $144.47 N/A $422.24 $727.88 $436.73 $727.88 $151.69 $727.88 N/A N/A 71642380 SUP HCPCS C1713 71642380 - SCREW BONE HEXAGON 6.4MM 80MM INTERNAL CAPTURE BOTH IP/OP $728.00 $539.00 $144.47 $727.88 $327.55 $327.55 $327.55 $327.55 $727.88 $727.88 $727.88 $151.71 $727.88 $727.88 $727.88 $727.88 $727.88 $151.70 $727.88 $727.88 $430.54 $727.88 $727.88 $727.88 $727.88 $546.00 $727.88 $727.88 $727.88 $363.94 $363.94 $576.48 $727.88 $582.30 $327.55 $144.47 N/A $422.24 $727.88 $727.88 $727.88 $151.69 $727.88 N/A N/A 71642385 SUP HCPCS C1713 71642385 - SCREW BONE HEXAGON 6.4MM 85MM INTERNAL CAPTURE BOTH IP/OP $728.00 $539.00 $144.47 $727.88 $327.55 $327.55 $327.55 $327.55 $727.88 $727.88 $727.88 $151.71 $727.88 $727.88 $727.88 $727.88 $727.88 $151.70 $727.88 $727.88 $430.54 $727.88 $727.88 $727.88 $727.88 $546.00 $727.88 $727.88 $727.88 $363.94 $363.94 $576.48 $727.88 $582.30 $327.55 $144.47 N/A $422.24 $727.88 $727.88 $727.88 $151.69 $727.88 N/A N/A 71642390 SUP HCPCS C1713 71642390 - SCREW BN 6.4MM 90MM BLU INTNL CPTR RECON HEX TI TROCH TRGN BOTH IP/OP $728.00 $539.00 $144.47 $727.88 $327.55 $327.55 $327.55 $327.55 $727.88 $727.88 $727.88 $151.71 $727.88 $727.88 $727.88 $727.88 $727.88 $151.70 $727.88 $291.15 $430.54 $727.88 $727.88 $727.88 $727.88 $546.00 $727.88 $727.88 $727.88 $363.94 $363.94 $576.48 $727.88 $582.30 $327.55 $144.47 N/A $422.24 $727.88 $727.88 $727.88 $151.69 $727.88 N/A N/A 71642395 SUP HCPCS C1713 71642395 - SCREW BN 6.4MM 95MM BLU INTNL CPTR RECON HEX TI TROCH TRGN BOTH IP/OP $728.00 $539.00 $144.47 $727.88 $327.55 $327.55 $327.55 $327.55 $727.88 $727.88 $727.88 $151.71 $727.88 $727.88 $727.88 $727.88 $727.88 $151.70 $727.88 $291.15 $430.54 $727.88 $727.88 $727.88 $727.88 $546.00 $727.88 $727.88 $727.88 $363.94 $363.94 $576.48 $727.88 $582.30 $327.55 $144.47 N/A $422.24 $727.88 $436.73 $727.88 $151.69 $727.88 N/A N/A 71642520 SUP HCPCS C1713 71642520 - SCREW BN 5MM 20MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $510.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $106.28 $510.00 N/A N/A 71642527 SUP HCPCS C1713 71642527 - SCREW BN 5MM 27.5MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $204.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $510.00 $510.00 N/A N/A 71642530 SUP HCPCS C1713 71642530 - SCREW BN 5MM 30MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $204.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $306.00 $510.00 $106.28 $510.00 N/A N/A 71642532 SUP HCPCS C1713 71642532 - SCREW BN 5MM 32.5MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $204.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $106.28 $510.00 N/A N/A 71642535 SUP HCPCS C1713 71642535 - SCREW BN 5MM 35MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $204.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $106.28 $510.00 N/A N/A 71642537 SUP HCPCS C1713 71642537 - SCREW BN 5MM 37.5MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $510.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $106.28 $510.00 N/A N/A 71642540 SUP HCPCS C1713 71642540 - SCREW BN 5MM 40MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $510.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $510.00 $510.00 N/A N/A 71642542 SUP HCPCS C1713 71642542 - SCREW BN 5MM 42.5MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $510.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $106.28 $510.00 N/A N/A 71642545 SUP HCPCS C1713 71642545 - SCREW BN 5MM 45MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $204.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $106.28 $510.00 N/A N/A 71642550 SUP HCPCS C1713 71642550 - SCREW BN 5MM 50MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $204.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $106.28 $510.00 N/A N/A 71642552 SUP HCPCS C1713 71642552 - SCREW BN 5MM 52.5MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $204.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $510.00 $510.00 N/A N/A 71642555 SUP HCPCS C1713 71642555 - SCREW BN 5MM 55MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $204.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $510.00 $510.00 N/A N/A 71642557 SUP HCPCS C1713 71642557 - SCREW BN 5MM 57.5MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $204.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $306.00 $510.00 $106.28 $510.00 N/A N/A 71642565 SUP HCPCS C1713 71642565 - SCREW BN 5MM 65MM SURESHOT BOTH IP/OP $357.00 $264.00 $70.78 $356.63 $160.48 $160.48 $160.48 $160.48 $356.63 $356.63 $356.63 $74.33 $356.63 $356.63 $356.63 $356.63 $356.63 $74.33 $356.63 $142.65 $210.95 $356.63 $356.63 $356.63 $356.63 $267.75 $356.63 $356.63 $356.63 $178.32 $178.32 $282.45 $356.63 $285.30 $160.48 $70.78 N/A $207.06 $356.63 $213.98 $356.63 $74.32 $356.63 N/A N/A 71642575 SUP HCPCS C1713 71642575 - SCREW BN 5MM 75MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $204.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $306.00 $510.00 $106.28 $510.00 N/A N/A 71642630 SUP HCPCS C1713 71642630 - SCREW BN 2.5MM 30MM TN SURESHOT LG CMPR TROCH BOTH IP/OP $706.00 $522.00 $140.12 $706.00 $317.70 $317.70 $317.70 $317.70 $706.00 $706.00 $706.00 $147.15 $706.00 $706.00 $706.00 $706.00 $706.00 $147.14 $706.00 $282.40 $417.60 $706.00 $706.00 $706.00 $706.00 $529.50 $706.00 $706.00 $706.00 $353.00 $353.00 $559.15 $706.00 $564.80 $317.70 $140.12 N/A $409.48 $706.00 $706.00 $706.00 $706.00 $706.00 N/A N/A 71642735 SUP HCPCS C1713 71642735 - SCREW SET 0MM TN SURESHOT BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $630.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $630.00 $630.00 N/A N/A 71642736 SUP HCPCS C1713 71642736 - SCREW SET 5MM TN SURESHOT BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $630.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $630.00 $630.00 $131.29 $630.00 N/A N/A 71642737 SUP HCPCS C1713 71642737 - SCREW SET 10MM TN SURESHOT BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $630.00 $630.00 $131.29 $630.00 N/A N/A 71642840 SUP HCPCS C1713 71642840 - SCREW BN 4.5MM 40MM SURESHOT LNG BN BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $204.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $306.00 $510.00 $510.00 $510.00 N/A N/A 71642845 SUP HCPCS C1713 71642845 - SCREW BN 4.5MM 45MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $510.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $306.00 $510.00 $510.00 $510.00 N/A N/A 71642850 SUP HCPCS C1713 71642850 - SCREW BN 4.5MM 50MM SURESHOT BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $510.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $106.28 $510.00 N/A N/A 71642935 SUP HCPCS C1713 71642935 - SCREW BN 35MM MT-TN CMPR FEM BOTH IP/OP $559.50 $414.00 $110.97 $559.13 $251.61 $251.61 $251.61 $251.61 $559.13 $559.13 $559.13 $116.54 $559.13 $559.13 $559.13 $559.13 $559.13 $116.53 $559.13 $223.65 $330.73 $559.13 $559.13 $559.13 $559.13 $419.63 $559.13 $559.13 $559.13 $279.57 $279.57 $442.83 $559.13 $447.30 $251.61 $110.97 N/A $324.51 $559.13 $559.13 $559.13 $116.52 $559.13 N/A N/A 71642936 SUP HCPCS C1713 71642936 - SET SCR MT-TN INTGR CNN BOTH IP/OP $427.50 $316.00 $84.85 $427.50 $192.38 $192.38 $192.38 $192.38 $427.50 $427.50 $427.50 $89.10 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $84.85 N/A $247.95 $427.50 $427.50 $427.50 $427.50 $427.50 N/A N/A 71642937 SUP HCPCS C1713 71642937 - SET SCR 5MM TRGN MT-TN BOTH IP/OP $427.50 $316.00 $84.85 $427.50 $192.38 $192.38 $192.38 $192.38 $427.50 $427.50 $427.50 $89.10 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $84.85 N/A $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A 71642938 SUP HCPCS C1713 71642938 - SCREW SET 10MM MT-TN MT-TN BOTH IP/OP $427.50 $316.00 $84.85 $427.50 $192.38 $192.38 $192.38 $192.38 $427.50 $427.50 $427.50 $89.10 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $84.85 N/A $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A 71644536 SUP HCPCS C1713 71644536 - NAIL IM 14.5MM 36CM LIME ANTGRD FEM BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$2,803.50" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71644538 SUP HCPCS C1713 71644538 - NAIL IM 14.5MM 38CM LIME ANTGRD FEM BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71644540 SUP HCPCS C1713 71644540 - NAIL IM 14.5MM 40CM LIME ANTGRD FEM BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$2,803.50" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71644542 SUP HCPCS C1713 71644542 - NAIL IM 14.5MM 42CM LIME ANTGRD FEM BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$2,803.50" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71644544 SUP HCPCS C1713 71644544 - NAIL IM 14.5MM 44CM LIME ANTGRD FEM BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$7,008.75" "$7,008.75" N/A N/A 71644636 SUP HCPCS C1713 71644636 - NAIL IM 16MM 36CM LIME ANTGRD FEM BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$2,803.50" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71644638 SUP HCPCS C1713 71644638 - NAIL IM 16MM 38CM LIME ANTGRD FEM BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$2,803.50" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$7,008.75" "$7,008.75" N/A N/A 71644640 SUP HCPCS C1713 71644640 - NAIL IM 16MM 40CM LIME ANTGRD FEM BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$7,008.75" "$7,008.75" N/A N/A 71644642 SUP HCPCS C1713 71644642 - NAIL IM 16MM 42CM LIME ANTGRD FEM BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71644644 SUP HCPCS C1713 71644644 - NAIL IM 16MM 44CM LIME TRGN ANTGRD TI FEM LT BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$7,008.75" "$7,008.75" N/A N/A 71645020 SUP HCPCS C1713 71645020 - SCREW BN 5MM 20MM TRGN LOPRFL FEM BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $452.25 $452.25 N/A N/A 71645022 SUP HCPCS C1713 71645022 - SCREW BONE 5MM 22.5MM TRGN FEM LP HEXDRIVER BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645025 SUP HCPCS C1713 71645025 - SCREW BN 5MM 25MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645027 SUP HCPCS C1713 71645027 - SCREW BN 5MM 27MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645030 SUP HCPCS C1713 71645030 - SCREW BN 5MM 30MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645032 SUP HCPCS C1713 71645032 - SCREW BN 5MM 32.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645035 SUP HCPCS C1713 71645035 - SCREW BN 5MM 35MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645037 SUP HCPCS C1713 71645037 - SCREW BN 5MM 37.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645040 SUP HCPCS C1713 71645040 - SCREW BN 5MM 40MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645042 SUP HCPCS C1713 71645042 - SCREW BN 5MM 42.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645045 SUP HCPCS C1713 71645045 - SCREW BN 5MM 45MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645047 SUP HCPCS C1713 71645047 - SCREW BN 5MM 47.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645050 SUP HCPCS C1713 71645050 - SCREW BN 5MM 50MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645052 SUP HCPCS C1713 71645052 - SCREW BN 5MM 52.5MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645055 SUP HCPCS C1713 71645055 - SCREW BN 5MM 55MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645057 SUP HCPCS C1713 71645057 - SCREW BN 5MM 57MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645060 SUP HCPCS C1713 71645060 - SCREW BN 5MM 60MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645062 SUP HCPCS C1713 71645062 - SCREW BONE 5MM 62.5MM LP TRIGEN FEMUR BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645065 SUP HCPCS C1713 71645065 - SCREW BN LOPRFL 5MM 65MM TRGN FEM IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645067 SUP HCPCS C1713 71645067 - SCREW BN 5MM 67MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645070 SUP HCPCS C1713 71645070 - SCREW BN 5MM 70MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645072 SUP HCPCS C1713 71645072 - SCREW BN 5MM 72MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645075 SUP HCPCS C1713 71645075 - SCREW BN 5MM 75MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645077 SUP HCPCS C1713 71645077 - SCREW BONE 5MM 77.5MM LP TRIGEN FEMUR BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645080 SUP HCPCS C1713 71645080 - SCREW BN 5MM 80MM LOPRFL INTNL HEX FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645085 SUP HCPCS C1713 71645085 - SCREW BN LOPRFL 5MM 85MM TRGN FEM IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $452.25 $452.25 N/A N/A 71645090 SUP HCPCS C1713 71645090 - SCREW BN LOPRFL 5MM 90MM TRGN FEM IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645095 SUP HCPCS C1713 71645095 - SCREW BN 5MM 95MM TRGN LOPRFL HEXDRIVER FEM BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645100 SUP HCPCS C1713 71645100 - SCREW BONE 5MM 100MM TRGN FEM LP BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645105 SUP HCPCS C1713 71645105 - SCREW BN 5MM 105MM TRGN LOPRFL IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645110 SUP HCPCS C1713 71645110 - SCREW BN 5MM 110MM TRGN LOPRFL IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645124 SUP HCPCS C1713 71645124 - NAIL IM 130D 8.5MM 24CM LIME TRGN ANTGRD TI ADLT FEM LT BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$3,751.88" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" "$3,751.88" "$3,751.88" N/A N/A 71645126 SUP HCPCS C1713 71645126 - NAIL IM 130D 8.5MM 26CM LIME TRGN ANTGRD TI PED LT TROCH BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$1,500.75" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" $781.89 "$3,751.88" N/A N/A 71645128 SUP HCPCS C1713 71645128 - NAIL IM 130D 8.5MM 28CM TRGN ANTGRD TI PED LT TROCH BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$3,751.88" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" $781.89 "$3,751.88" N/A N/A 71645130 SUP HCPCS C1713 71645130 - NAIL IM 130D 8.5MM 30CM LIME TRGN ANTGRD TI PED LT TROCH BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$3,751.88" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" $781.89 "$3,751.88" N/A N/A 71645132 SUP HCPCS C1713 71645132 - NAIL IM 130D 8.5MM 32CM LIME TRGN ANTGRD PED LT TROCH BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$3,751.88" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" $781.89 "$3,751.88" N/A N/A 71645134 SUP HCPCS C1713 71645134 - NAIL IM 130D 8.5MM 34CM LIME TRGN ANTGRD TI ADLT FEM LT BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$3,751.88" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$3,751.88" "$3,751.88" $781.89 "$3,751.88" N/A N/A 71645136 SUP HCPCS C1713 71645136 - NAIL IM 130D 8.5MM 36CM LIME TRGN ANTGRD SET TI PED LT TROCH BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$3,751.88" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" $781.89 "$3,751.88" N/A N/A 71645138 SUP HCPCS C1713 71645138 - NAIL IM 130D 8.5MM 38CM LIME TRGN ANTGRD TI ADLT FEM LT BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$3,751.88" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" $781.89 "$3,751.88" N/A N/A 71645140 SUP HCPCS C1713 71645140 - NAIL IM 130D 8.5MM 40CM LIME TRGN ANTGRD SET TI PED LT TROCH BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$3,751.88" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" $781.89 "$3,751.88" N/A N/A 71645420 SUP HCPCS C1713 71645420 - SCREW BN 4.5MM 20MM TRGN LOPRFL IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645422 SUP HCPCS C1713 71645422 - SCREW BN 4.5MM 22.5MM TRGN LOPRFL IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645425 SUP HCPCS C1713 71645425 - SCREW BN LOPRFL 4.5MM 25MM TRGN FEM IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645427 SUP HCPCS C1713 71645427 - SCREW BONE 4.5MM 27.5MM TRGN LP IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645430 SUP HCPCS C1713 71645430 - SCREW BN LOPRFL 4.5MM 30MM TRGN FEM IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645432 SUP HCPCS C1713 71645432 - SCREW BN 4.5MM 32.5MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645435 SUP HCPCS C1713 71645435 - SCREW BONE LP 4.5MM 35MM TRIGEN FEMUR INTRAMEDULLARY NAIL BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645437 SUP HCPCS C1713 71645437 - SCREW BN 4.5MM 37.5MM TRGN LOPRFL IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $452.25 $452.25 N/A N/A 71645440 SUP HCPCS C1713 71645440 - SCREW BN 4.5MM 40MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645442 SUP HCPCS C1713 71645442 - SCREW BN 4.5MM 42.5MM TRGN LOPRFL FEM BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645445 SUP HCPCS C1713 71645445 - SCREW BN 4.5MM 45MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645447 SUP HCPCS C1713 71645447 - SCREW BN 4.5MM 47.5MM TRGN LOPRFL IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645450 SUP HCPCS C1713 71645450 - SCREW BN 4.5MM 50MM LOPRFL INTNL CPTR FEM TRGN IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645452 SUP HCPCS C1713 71645452 - SCREW BN 4.5MM 52.5MM TRGN LOPRFL IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645455 SUP HCPCS C1713 71645455 - SCREW BN 4.5MM 55MM TRGN LOPRFL IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645457 SUP HCPCS C1713 71645457 - SCREW BN 4.5MM 57.5MM TRGN LOPRFL IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 71645460 SUP HCPCS C1713 71645460 - SCREW BN 4.5MM 60MM TRGN LOPRFL IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645462 SUP HCPCS C1713 71645462 - SCREW BN 4.5MM 62.5MM TRGN LOPRFL IM NL SYS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645465 SUP HCPCS C1713 71645465 - SCREW BN 4.5MM 6.5MM TRGN LOPRFL FEM BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $180.90 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 71645536 SUP HCPCS C1713 71645536 - NAIL IM 14.5MM 36CM ROSE ANTGRD FEM RT BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71645538 SUP HCPCS C1713 71645538 - NAIL IM 14.5MM 38CM ROSE ANTGRD FEM RT BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71645540 SUP HCPCS C1713 71645540 - NAIL IM 14.5MM 40CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71645542 SUP HCPCS C1713 71645542 - NAIL IM 14.5MM 42CM ROSE ANTGRD FEM RT BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71645544 SUP HCPCS C1713 71645544 - NAIL IM 14.5MM 44CM ROSE ANTGRD FEM RT BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71645636 SUP HCPCS C1713 71645636 - NAIL IM 16MM 36CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71645638 SUP HCPCS C1713 71645638 - NAIL IM 16MM 38CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71645640 SUP HCPCS C1713 71645640 - NAIL IM 16MM 40CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71645642 SUP HCPCS C1713 71645642 - NAIL IM 16MM 42CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$1,460.62" "$7,008.75" N/A N/A 71645644 SUP HCPCS C1713 71645644 - NAIL IM 16MM 44CM ROSE TRGN ANTGRD TI FEM RT BOTH IP/OP "$7,009.00" "$5,187.00" "$1,391.06" "$7,008.75" "$3,153.94" "$3,153.94" "$3,153.94" "$3,153.94" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.80" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$1,460.70" "$7,008.75" "$7,008.75" "$3,455.31" "$7,008.75" "$7,008.75" "$7,008.75" "$7,008.75" "$5,256.75" "$7,008.75" "$7,008.75" "$7,008.75" "$3,504.38" "$3,504.38" "$5,550.93" "$7,008.75" "$5,607.00" "$3,153.94" "$1,391.06" N/A "$4,065.22" "$7,008.75" "$4,205.25" "$7,008.75" "$7,008.75" "$7,008.75" N/A N/A 71646124 SUP HCPCS C1713 71646124 - NAIL IM 130D 8.5MM 24CM ROSE TRGN ANTGRD TI ADLT FEM RT BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$3,751.88" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" "$3,751.88" "$3,751.88" N/A N/A 71646126 SUP HCPCS C1713 71646126 - NAIL IM 130D 8.5MM 26CM ROSE TRGN ANTGRD TI ADLT FEM RT BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$1,500.75" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" $781.89 "$3,751.88" N/A N/A 71646128 SUP HCPCS C1713 71646128 - NAIL IM 130D 8.5MM 28CM ROSE TRGN ANTGRD TI ADLT FEM RT BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$3,751.88" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" N/A N/A 71646130 SUP HCPCS C1713 71646130 - NAIL IM 8.5MM 30CM TN RT BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$1,500.75" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" $781.89 "$3,751.88" N/A N/A 71646132 SUP HCPCS C1713 71646132 - NAIL IM 130D 8.5MM 32CM ROSE TRGN ANTGRD TI ADLT FEM RT BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$3,751.88" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" $781.89 "$3,751.88" N/A N/A 71646134 SUP HCPCS C1713 71646134 - NAIL IM 130D 8.5MM 34CM ROSE TRGN ANTGRD TI ADLT FEM RT BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$3,751.88" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" $781.89 "$3,751.88" N/A N/A 71646136 SUP HCPCS C1713 71646136 - NAIL IM 130D 8.5MM 36CM ROSE TRGN ANTGRD TI ADLT FEM RT BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$1,500.75" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" N/A N/A 71646138 SUP HCPCS C1713 71646138 - NAIL INTRAMEDULLARY 130D 8.5MM 38CM ANTEGRADE TRIGEN ROSE BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$3,751.88" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" $781.89 "$3,751.88" N/A N/A 71646140 SUP HCPCS C1713 71646140 - NAIL IM 130D 8.5MM 40CM ROSE TRGN ANTGRD TI PED RT TROCH BOTH IP/OP "$3,752.00" "$2,776.00" $744.65 "$3,751.88" "$1,688.35" "$1,688.35" "$1,688.35" "$1,688.35" "$3,751.88" "$3,751.88" "$3,751.88" $781.99 "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" $781.93 "$3,751.88" "$1,500.75" "$1,849.68" "$3,751.88" "$3,751.88" "$3,751.88" "$3,751.88" "$2,814.00" "$3,751.88" "$3,751.88" "$3,751.88" "$1,875.94" "$1,875.94" "$2,971.49" "$3,751.88" "$3,001.50" "$1,688.35" $744.65 N/A "$2,176.16" "$3,751.88" "$2,251.13" "$3,751.88" $781.89 "$3,751.88" N/A N/A 71647230 SUP HCPCS C1713 71647230 - NAIL IM 130D 10MM 30CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71647232 SUP HCPCS C1713 71647232 - NAIL IM 130D 10MM 32CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647234 SUP HCPCS C1713 71647234 - NAIL IM 130D 10MM 34CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71647236 SUP HCPCS C1713 71647236 - NAIL INTRAMEDULLARY 130D 10MM 36CM ANTEGRADE TRIGEN LIME BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647238 SUP HCPCS C1713 71647238 - NAIL IM 130D 10MM 38CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71647240 SUP HCPCS C1713 71647240 - NAIL INTRAMEDULLARY 130D 10MM 40CM ANTEGRADE TRIGEN LIME BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647242 SUP HCPCS C1713 71647242 - NAIL IM 130D 10MM 42CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647244 SUP HCPCS C1713 71647244 - NAIL IM 130D 10MM 44CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647246 SUP HCPCS C1713 71647246 - NAIL INTRAMEDULLARY 130D 10MM 46CM ANTEGRADE TRIGEN LIME BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647248 SUP HCPCS C1713 71647248 - NAIL IM 130D 10MM 48CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647250 SUP HCPCS C1713 71647250 - NAIL IM 130D 10MM 50CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647330 SUP HCPCS C1713 71647330 - NAIL IM 130D 11.5MM 30CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647332 SUP HCPCS C1713 71647332 - NAIL IM 130D 11.5MM 32CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647334 SUP HCPCS C1713 71647334 - NAIL IM 130D 11.5MM 34CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647336 SUP HCPCS C1713 71647336 - NAIL IM 130D 11.5MM 36CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647338 SUP HCPCS C1713 71647338 - NAIL INTRAMEDULLARY 130D 11.5MM 38CM 5 HOLE STATIC DYNAMIC BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647340 SUP HCPCS C1713 71647340 - NAIL INTRAMEDULLARY 130D 11.5MM 40CM 5 HOLE STATIC DYNAMIC BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647342 SUP HCPCS C1713 71647342 - NAIL INTRAMEDULLARY 130D 11.5MM 42CM ANTEGRADE TRIGEN LIME BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647346 SUP HCPCS C1713 71647346 - NAIL IM 130D 11.5MM 46CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71647348 SUP HCPCS C1713 71647348 - NAIL IM 130D 11.5MM 48CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647350 SUP HCPCS C1713 71647350 - NAIL IM 130D 11.5MM 50CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647430 SUP HCPCS C1713 71647430 - NAIL IM 130D 13MM 30CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647432 SUP HCPCS C1713 71647432 - NAIL IM 130D 13MM 32CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647434 SUP HCPCS C1713 71647434 - NAIL IM 130D 13MM 34CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647436 SUP HCPCS C1713 71647436 - NAIL IM 130D 13MM 36CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647438 SUP HCPCS C1713 71647438 - NAIL IM 130D 13MM 38CM LIME TRGN ANTGRD TI LT TROCH IM NL BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647440 SUP HCPCS C1713 71647440 - NAIL IM 130D 13MM 40CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647442 SUP HCPCS C1713 71647442 - NAIL IM 130D 13MM 42CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647444 SUP HCPCS C1713 71647444 - NAIL IM 130D 13MM 44CM LIME TRGN TN 5 HL STC DYNMC PROX DIST BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647446 SUP HCPCS C1713 71647446 - NAIL IM 130D 13MM 46CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71647448 SUP HCPCS C1713 71647448 - NAIL IM 130D 13MM 48CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71647450 SUP HCPCS C1713 71647450 - NAIL IM 130D 13MM 50CM LIME TRGN ANTGRD TI LT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648230 SUP HCPCS C1713 71648230 - NAIL IM 130D 10MM 30CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648232 SUP HCPCS C1713 71648232 - NAIL IM 130D 10MM 32CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648234 SUP HCPCS C1713 71648234 - NAIL IM 130D 10MM 34CM ROSE TRGN TN 5 HL STC DYNMC RND XSECT BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648236 SUP HCPCS C1713 71648236 - NAIL INTRAMEDULLARY 130D 10MM 36CM ANTEGRADE TRIGEN ROSE BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648238 SUP HCPCS C1713 71648238 - NAIL INTRAMEDULLARY 130D 10MM 38CM SET ANTEGRADE TRIGEN ROSE BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648240 SUP HCPCS C1713 71648240 - NAIL INTRAMEDULLARY 130D 10MM 40CM ANTEGRADE TRIGEN ROSE BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648242 SUP HCPCS C1713 71648242 - NAIL INTRAMEDULLARY 130D 10MM 42CM ANTEGRADE TRIGEN ROSE BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648244 SUP HCPCS C1713 71648244 - NAIL IM 130D 10MM 44CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648246 SUP HCPCS C1713 71648246 - NAIL IM 130D 10MM 46CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648248 SUP HCPCS C1713 71648248 - NAIL IM 130D 10MM 48CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648250 SUP HCPCS C1713 71648250 - NAIL IM 130D 10MM 50CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648330 SUP HCPCS C1713 71648330 - NAIL IM 130D 11.5MM 30CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648332 SUP HCPCS C1713 71648332 - NAIL IM 130D 11.5MM 32CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648334 SUP HCPCS C1713 71648334 - NAIL INTRAMEDULLARY 130D 11.5MM 34CM ANTEGRADE TRIGEN ROSE BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648336 SUP HCPCS C1713 71648336 - NAIL IM 130D 11.5MM 36CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648338 SUP HCPCS C1713 71648338 - NAIL INTRAMEDULLARY 130D 11.5MM 38CM SET ANTEGRADE TRIGEN BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648340 SUP HCPCS C1713 71648340 - NAIL INTRAMEDULLARY 130D 11.5MM 40CM ANTEGRADE SET TRIGEN BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648342 SUP HCPCS C1713 71648342 - NAIL IM 130D 11.5MM 42CM ROSE STRL TRGN TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648344 SUP HCPCS C1713 71648344 - NAIL INTRAMEDULLARY TRIGEN TITANIUM L44 CM OD11.5 MM TAN BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648348 SUP HCPCS C1713 71648348 - NAIL IM 130D 11.5MM 48CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648350 SUP HCPCS C1713 71648350 - NAIL IM 130D 11.5MM 50CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648430 SUP HCPCS C1713 71648430 - NAIL IM 130D 13MM 30CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648432 SUP HCPCS C1713 71648432 - NAIL IM 130D 13MM 32CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648434 SUP HCPCS C1713 71648434 - NAIL IM 130D 13MM 34CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648436 SUP HCPCS C1713 71648436 - NAIL IM 130D 13MM 36CM ROSE TRGN ANTGRD TN SET TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648438 SUP HCPCS C1713 71648438 - NAIL IM 130D 13MM 38CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648440 SUP HCPCS C1713 71648440 - NAIL IM 130D 13MM 40CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648442 SUP HCPCS C1713 71648442 - NAIL IM 130D 13MM 42CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71648446 SUP HCPCS C1713 71648446 - NAIL IM 130D 13MM 46CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648448 SUP HCPCS C1713 71648448 - NAIL IM 130D 13MM 48CM ROSE TRGN ANTGRD TI RT TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$1,620.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" "$4,050.00" "$4,050.00" N/A N/A 71648450 SUP HCPCS C1713 71648450 - NAIL IM 130D RT ANG 13MM 50CM ROSE TN SET TROCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$2,430.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 71649530 SUP HCPCS C1713 71649530 - NAIL IM 9MM 30CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649532 SUP HCPCS C1713 71649532 - NAIL IM 9MM 32CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71649534 SUP HCPCS C1713 71649534 - NAIL IM 9MM 34CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71649536 SUP HCPCS C1713 71649536 - NAIL IM 9MM 36CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$3,526.88" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649538 SUP HCPCS C1713 71649538 - NAIL IM 9MM 38CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71649540 SUP HCPCS C1713 71649540 - NAIL IM 9MM 40CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71649542 SUP HCPCS C1713 71649542 - NAIL IM 9MM 42MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649544 SUP HCPCS C1713 71649544 - NAIL IM 9MM 44MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649546 SUP HCPCS C1713 71649546 - NAIL IM 9MM 46MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649548 SUP HCPCS C1713 71649548 - NAIL IM 9MM 48MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649550 SUP HCPCS C1713 71649550 - NAIL IM 9MM 50MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649630 SUP HCPCS C1713 71649630 - NAIL IM 10MM 30MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649632 SUP HCPCS C1713 71649632 - NAIL IM 10MM 32MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$3,526.88" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649634 SUP HCPCS C1713 71649634 - NAIL IM 10MM 34CM LIME TRGN MT-TN LT BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649636 SUP HCPCS C1713 71649636 - NAIL IM 10MM 36MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649638 SUP HCPCS C1713 71649638 - NAIL IM 10MM 38MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649640 SUP HCPCS C1713 71649640 - NAIL IM 10MM 40MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649642 SUP HCPCS C1713 71649642 - NAIL IM 10MM 42MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71649644 SUP HCPCS C1713 71649644 - NAIL IM 10MM 44MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71649646 SUP HCPCS C1713 71649646 - NAIL IM 10MM 46MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649648 SUP HCPCS C1713 71649648 - NAIL IM 10MM 48MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649650 SUP HCPCS C1713 71649650 - NAIL IM 10MM 50MM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649730 SUP HCPCS C1713 71649730 - NAIL IM 11.5MM 30CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649732 SUP HCPCS C1713 71649732 - NAIL IM 11.5MM 32CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649734 SUP HCPCS C1713 71649734 - NAIL IM 11.5MM 34CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71649736 SUP HCPCS C1713 71649736 - NAIL IM 11.5MM 36CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649738 SUP HCPCS C1713 71649738 - NAIL IM 11.5MM 38CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71649740 SUP HCPCS C1713 71649740 - NAIL IM 11.5MM 40CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71649742 SUP HCPCS C1713 71649742 - NAIL IM 11.5MM 42CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71649744 SUP HCPCS C1713 71649744 - NAIL IM 11.5MM 44CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71649746 SUP HCPCS C1713 71649746 - NAIL IM 11.5MM 46CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71649748 SUP HCPCS C1713 71649748 - NAIL IM 11.5MM 48CM MT-TN LT BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649750 SUP HCPCS C1713 71649750 - NAIL IM 11.5MM 50CM MT-TN LT BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$3,526.88" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649830 SUP HCPCS C1713 71649830 - NAIL IM 13MM 30CM LIME TRGN MT-TN LT BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71649832 SUP HCPCS C1713 71649832 - NAIL IM 13MM 32CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71649834 SUP HCPCS C1713 71649834 - NAIL IM 13MM 34CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649836 SUP HCPCS C1713 71649836 - NAIL IM 13MM 36CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649838 SUP HCPCS C1713 71649838 - NAIL IM 13MM 38CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649840 SUP HCPCS C1713 71649840 - NAIL IM 13MM 40CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649842 SUP HCPCS C1713 71649842 - NAIL IM 13MM 42CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$3,526.88" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649844 SUP HCPCS C1713 71649844 - NAIL IM 13MM 44CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649846 SUP HCPCS C1713 71649846 - NAIL IM 13MM 46CM LIME TRGN MT-TN ANTGRD FEM LT TROCH BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649848 SUP HCPCS C1713 71649848 - NAIL IM 13MM 48CM MT-TN LT BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$3,526.88" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" $735.00 "$3,526.88" N/A N/A 71649850 SUP HCPCS C1713 71649850 - NAIL IM 13MM 50CM MT-TN LT BOTH IP/OP "$3,527.00" "$2,610.00" $700.00 "$3,526.88" "$1,587.10" "$1,587.10" "$1,587.10" "$1,587.10" "$3,526.88" "$3,526.88" "$3,526.88" $735.09 "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" $735.04 "$3,526.88" "$1,410.75" "$1,738.75" "$3,526.88" "$3,526.88" "$3,526.88" "$3,526.88" "$2,645.25" "$3,526.88" "$3,526.88" "$3,526.88" "$1,763.44" "$1,763.44" "$2,793.29" "$3,526.88" "$2,821.50" "$1,587.10" $700.00 N/A "$2,045.66" "$3,526.88" "$2,116.13" "$3,526.88" "$3,526.88" "$3,526.88" N/A N/A 71653018 SUP HCPCS C1713 71653018 - NAIL IM 10MM 18CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$3,622.50" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653020 SUP HCPCS C1713 71653020 - NAIL IM 10MM 20CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$1,449.00" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653022 SUP HCPCS C1713 71653022 - NAIL IM 10MM 22CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$3,622.50" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" "$3,622.50" "$3,622.50" N/A N/A 71653024 SUP HCPCS C1713 71653024 - NAIL IM 10MM 24CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$1,449.00" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" "$3,622.50" "$3,622.50" N/A N/A 71653026 SUP HCPCS C1713 71653026 - NAIL IM 10MM 26CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$3,622.50" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653028 SUP HCPCS C1713 71653028 - NAIL IM 10MM 28CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$1,449.00" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653030 SUP HCPCS C1713 71653030 - NAIL IM 10MM 30CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$3,622.50" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653032 SUP HCPCS C1713 71653032 - NAIL IM 10MM 32CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$1,449.00" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653034 SUP HCPCS C1713 71653034 - NAIL IM 10MM 34CM AU TRGN MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$3,622.50" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653036 SUP HCPCS C1713 71653036 - NAIL IM 10MM 36CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$1,449.00" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653038 SUP HCPCS C1713 71653038 - NAIL IM 10MM 38CM AU TRGN MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$3,622.50" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653040 SUP HCPCS C1713 71653040 - 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NAIL IM 11.5MM 26CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$1,449.00" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653228 SUP HCPCS C1713 71653228 - NAIL IM 11.5MM 28CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$1,449.00" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$3,622.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653230 SUP HCPCS C1713 71653230 - 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NAIL IM 11.5MM 46CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$1,449.00" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" "$3,622.50" "$3,622.50" N/A N/A 71653248 SUP HCPCS C1713 71653248 - NAIL IM 11.5MM 48CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$1,449.00" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653250 SUP HCPCS C1713 71653250 - NAIL IM 11.5MM 50CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$3,622.50" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" "$3,622.50" "$3,622.50" N/A N/A 71653320 SUP HCPCS C1713 71653320 - NAIL IM 13MM 20CM TRGN TI TIB BOTH IP/OP "$3,510.00" "$2,597.00" $696.65 "$3,510.00" "$1,579.50" "$1,579.50" "$1,579.50" "$1,579.50" "$3,510.00" "$3,510.00" "$3,510.00" $731.57 "$3,510.00" "$3,510.00" "$3,510.00" "$3,510.00" "$3,510.00" $731.52 "$3,510.00" "$3,510.00" "$1,730.43" "$3,510.00" "$3,510.00" "$3,510.00" "$3,510.00" "$2,632.50" "$3,510.00" "$3,510.00" "$3,510.00" "$1,755.00" "$1,755.00" "$2,779.92" "$3,510.00" "$2,808.00" "$1,579.50" $696.65 N/A "$2,035.80" "$3,510.00" "$2,106.00" "$3,510.00" "$3,510.00" "$3,510.00" N/A N/A 71653325 SUP HCPCS C1713 71653325 - NAIL IM 13MM 25CM TRGN TI TIB BOTH IP/OP "$3,510.00" "$2,597.00" $696.65 "$3,510.00" "$1,579.50" "$1,579.50" "$1,579.50" "$1,579.50" "$3,510.00" "$3,510.00" "$3,510.00" $731.57 "$3,510.00" "$3,510.00" "$3,510.00" "$3,510.00" "$3,510.00" $731.52 "$3,510.00" "$1,404.00" "$1,730.43" "$3,510.00" "$3,510.00" "$3,510.00" "$3,510.00" "$2,632.50" "$3,510.00" "$3,510.00" "$3,510.00" "$1,755.00" "$1,755.00" "$2,779.92" "$3,510.00" "$2,808.00" "$1,579.50" $696.65 N/A "$2,035.80" "$3,510.00" "$2,106.00" "$3,510.00" $731.48 "$3,510.00" N/A N/A 71653418 SUP HCPCS C1713 71653418 - NAIL IM 13MM 18CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$1,449.00" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653420 SUP HCPCS C1713 71653420 - NAIL IM 13MM 20CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$3,622.50" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653422 SUP HCPCS C1713 71653422 - NAIL IM 13MM 22CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$1,449.00" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653424 SUP HCPCS C1713 71653424 - NAIL IM 13MM 24CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$3,622.50" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653426 SUP HCPCS C1713 71653426 - NAIL IM 13MM 26CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$1,449.00" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653428 SUP HCPCS C1713 71653428 - NAIL IM 13MM 28CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$3,622.50" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653430 SUP HCPCS C1713 71653430 - NAIL IM 13MM 30CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$1,449.00" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$3,622.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653432 SUP HCPCS C1713 71653432 - NAIL IM 13MM 32CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$3,622.50" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653434 SUP HCPCS C1713 71653434 - NAIL IM 13MM 34CM TRGN MT-NL IMPL SET RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$1,449.00" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" "$3,622.50" "$3,622.50" N/A N/A 71653436 SUP HCPCS C1713 71653436 - 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NAIL IM STD 13MM 40CM AU STRL TRGN MT-NL RTRGD HMR SLT TI BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$3,622.50" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" $754.93 "$3,622.50" N/A N/A 71653442 SUP HCPCS C1713 71653442 - NAIL IM 13MM 42CM MT-NL RTRGD TI FEM BOTH IP/OP "$3,622.50" "$2,681.00" $718.98 "$3,622.50" "$1,630.13" "$1,630.13" "$1,630.13" "$1,630.13" "$3,622.50" "$3,622.50" "$3,622.50" $755.02 "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" $754.97 "$3,622.50" "$3,622.50" "$1,785.89" "$3,622.50" "$3,622.50" "$3,622.50" "$3,622.50" "$2,716.88" "$3,622.50" "$3,622.50" "$3,622.50" "$1,811.25" "$1,811.25" "$2,869.02" "$3,622.50" "$2,898.00" "$1,630.13" $718.98 N/A "$2,101.05" "$3,622.50" "$2,173.50" "$3,622.50" "$3,622.50" "$3,622.50" N/A N/A 71653444 SUP HCPCS C1713 71653444 - 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NAIL IM 8.5MM 35CM MT-NL TI TIB METAPHYSIS BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655036 SUP HCPCS C1713 71655036 - NAIL IM 8.5MM 36CM TRGN MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655037 SUP HCPCS C1713 71655037 - NAIL IM 8.5MM 37CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655038 SUP HCPCS C1713 71655038 - NAIL IM 8.5MM 38CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655039 SUP HCPCS C1713 71655039 - NAIL IM 8.5MM 39CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655040 SUP HCPCS C1713 71655040 - NAIL IM 8.5MM 40CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655041 SUP HCPCS C1713 71655041 - NAIL IM 8.5MM 41CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655042 SUP HCPCS C1713 71655042 - NAIL IM 8.5MM 42CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655043 SUP HCPCS C1713 71655043 - NAIL IM 8.5MM 43CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655044 SUP HCPCS C1713 71655044 - NAIL IM 8.5MM 44CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655046 SUP HCPCS C1713 71655046 - NAIL IM 8.5MM 46CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655048 SUP HCPCS C1713 71655048 - NAIL IM 8.5MM 48CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655050 SUP HCPCS C1713 71655050 - NAIL IM 8.5MM 50CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655116 SUP HCPCS C1713 71655116 - NAIL IM 10MM 16CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655118 SUP HCPCS C1713 71655118 - NAIL IM 10MM 18CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655120 SUP HCPCS C1713 71655120 - NAIL IM 10MM 20CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$3,538.13" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655122 SUP HCPCS C1713 71655122 - NAIL IM 10MM 22CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655124 SUP HCPCS C1713 71655124 - NAIL IM 10MM 24CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655126 SUP HCPCS C1713 71655126 - NAIL IM 10MM 26CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$3,538.13" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655128 SUP HCPCS C1713 71655128 - NAIL IM 10MM 28CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655129 SUP HCPCS C1713 71655129 - NAIL IM 10MM 29CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655130 SUP HCPCS C1713 71655130 - NAIL IM 10MM 30CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655131 SUP HCPCS C1713 71655131 - NAIL IM 10MM 31CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655132 SUP HCPCS C1713 71655132 - NAIL INTRAMEDULLARY 10MM 32CM META-NAIL TITANIUM TIBIA BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$3,538.13" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655133 SUP HCPCS C1713 71655133 - NAIL IM 10MM 33CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655134 SUP HCPCS C1713 71655134 - NAIL INTRAMEDULLARY 10MM 34CM META-NAIL TITANIUM TIBIA BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655135 SUP HCPCS C1713 71655135 - NAIL INTRAMEDULLARY 10MM 35CM META-NAIL TITANIUM TIBIA BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$3,538.13" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655136 SUP HCPCS C1713 71655136 - NAIL INTRAMEDULLARY 10MM 36CM META-NAIL TITANIUM TIBIA BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655137 SUP HCPCS C1713 71655137 - NAIL INTRAMEDULLARY 10MM 37CM META-NAIL TITANIUM TIBIA BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$3,538.13" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655138 SUP HCPCS C1713 71655138 - NAIL INTRAMEDULLARY 10MM 38CM META-NAIL TITANIUM TIBIA BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655139 SUP HCPCS C1713 71655139 - NAIL INTRAMEDULLARY 10MM 39CM META-NAIL TITANIUM TIBIA BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655142 SUP HCPCS C1713 71655142 - NAIL IM 10MM 42CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655143 SUP HCPCS C1713 71655143 - NAIL IM 10MM 43CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655144 SUP HCPCS C1713 71655144 - NAIL IM 10MM 44CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655146 SUP HCPCS C1713 71655146 - NAIL IM 10MM 46CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655148 SUP HCPCS C1713 71655148 - NAIL IM 10MM 48CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$3,538.13" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655150 SUP HCPCS C1713 71655150 - NAIL IM 10MM 50CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655216 SUP HCPCS C1713 71655216 - NAIL IM 11.5MM 16CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655218 SUP HCPCS C1713 71655218 - NAIL IM 11.5MM 18CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655220 SUP HCPCS C1713 71655220 - NAIL IM 11.5MM 20CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655222 SUP HCPCS C1713 71655222 - NAIL IM 11.5MM 22CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655224 SUP HCPCS C1713 71655224 - NAIL IM 11.5MM 24CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655226 SUP HCPCS C1713 71655226 - NAIL IM 11.5MM 26CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655228 SUP HCPCS C1713 71655228 - NAIL IM 11.5MM 28CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655229 SUP HCPCS C1713 71655229 - NAIL IM 11.5MM 29CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655230 SUP HCPCS C1713 71655230 - NAIL IM 11.5MM 30CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655231 SUP HCPCS C1713 71655231 - NAIL IM 11.5MM 31CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655232 SUP HCPCS C1713 71655232 - NAIL IM 11.5MM 32CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655233 SUP HCPCS C1713 71655233 - NAIL IM 11.5MM 33CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655234 SUP HCPCS C1713 71655234 - NAIL IM 11.5MM 34CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655235 SUP HCPCS C1713 71655235 - NAIL IM 11.5MM 35CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655236 SUP HCPCS C1713 71655236 - NAIL 11.5MM 36CM TIB TRGN MT-NAIL IM HMR SLT TI BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655237 SUP HCPCS C1713 71655237 - NAIL IM 11.5MM 37CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655238 SUP HCPCS C1713 71655238 - NAIL IM 11.5MM 38CM AU STRL TRGN MT-NL HMR SLT TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655239 SUP HCPCS C1713 71655239 - NAIL IM 11.5MM 39CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655240 SUP HCPCS C1713 71655240 - NAIL INTRAMEDULLARY 11.5MM 40CM META-NAIL TITANIUM TIBIA BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655241 SUP HCPCS C1713 71655241 - NAIL IM 11.5MM 41CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655242 SUP HCPCS C1713 71655242 - NAIL IM 11.5MM 42CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655243 SUP HCPCS C1713 71655243 - NAIL IM 11.5MM 43CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655244 SUP HCPCS C1713 71655244 - NAIL IM 11.5MM 44CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655246 SUP HCPCS C1713 71655246 - NAIL IM 11.5MM 46CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$1,415.25" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655248 SUP HCPCS C1713 71655248 - NAIL IM 11.5MM 48CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" $737.35 "$3,538.13" N/A N/A 71655250 SUP HCPCS C1713 71655250 - NAIL IM 11.5MM 50CM MT-NL TI TIB BOTH IP/OP "$3,538.50" "$2,618.00" $702.23 "$3,538.13" "$1,592.16" "$1,592.16" "$1,592.16" "$1,592.16" "$3,538.13" "$3,538.13" "$3,538.13" $737.43 "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" $737.39 "$3,538.13" "$3,538.13" "$1,744.30" "$3,538.13" "$3,538.13" "$3,538.13" "$3,538.13" "$2,653.88" "$3,538.13" "$3,538.13" "$3,538.13" "$1,769.07" "$1,769.07" "$2,802.20" "$3,538.13" "$2,830.50" "$1,592.16" $702.23 N/A "$2,052.33" "$3,538.13" "$2,122.88" "$3,538.13" "$3,538.13" "$3,538.13" N/A N/A 71655316 SUP HCPCS C1713 71655316 - NAIL IM 13MM 16CM MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" "$3,487.50" "$3,487.50" N/A N/A 71655318 SUP HCPCS C1713 71655318 - 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NAIL IM 13MM 31CM MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A 71655332 SUP HCPCS C1713 71655332 - NAIL IM 13MM 32CM MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A 71655333 SUP HCPCS C1713 71655333 - NAIL IM 13MM 33CM MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A 71655334 SUP HCPCS C1713 71655334 - NAIL IM RND 13MM 34CM AU MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A 71655335 SUP HCPCS C1713 71655335 - NAIL IM 13MM 35CM MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" "$3,487.50" "$3,487.50" N/A N/A 71655336 SUP HCPCS C1713 71655336 - NAIL IM 13MM 36CM MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" N/A N/A 71655337 SUP HCPCS C1713 71655337 - 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NAIL IM 13MM 39CM MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" "$3,487.50" "$3,487.50" N/A N/A 71655340 SUP HCPCS C1713 71655340 - NAIL IM RND 13MM 40CM AU MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A 71655341 SUP HCPCS C1713 71655341 - NAIL IM 13MM 41CM MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A 71655342 SUP HCPCS C1713 71655342 - NAIL IM 13MM 42CM MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A 71655343 SUP HCPCS C1713 71655343 - NAIL IM 13MM 43CM MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A 71655344 SUP HCPCS C1713 71655344 - NAIL IM 13MM 44CM MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A 71655346 SUP HCPCS C1713 71655346 - NAIL IM 13MM 46CM MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A 71655348 SUP HCPCS C1713 71655348 - NAIL IM 13MM 48CM MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A 71655350 SUP HCPCS C1713 71655350 - NAIL IM 13MM 50CM MT-NL TI TIB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A 71656000 SUP HCPCS C1713 71656000 - CAP END 0MM MT-NL NL SCR SET TI TIB BOTH IP/OP $354.50 $262.00 $70.34 $354.38 $159.47 $159.47 $159.47 $159.47 $354.38 $354.38 $354.38 $73.86 $354.38 $354.38 $354.38 $354.38 $354.38 $73.86 $354.38 $141.75 $209.62 $354.38 $354.38 $354.38 $354.38 $265.88 $354.38 $354.38 $354.38 $177.19 $177.19 $280.67 $354.38 $283.50 $159.47 $70.34 N/A $205.61 $354.38 $212.63 $354.38 $73.85 $354.38 N/A N/A 71661222 SUP HCPCS C1713 71661222 - SCREW BN 4.5MM 22MM IMHS CP LCK CPTR HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $593.25 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $593.25 $593.25 $123.63 $593.25 N/A N/A 71661224 SUP HCPCS C1713 71661224 - SCREW BN 4.5MM 24MM IMHS CP LCK CPTR HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $593.25 $593.25 $593.25 $593.25 N/A N/A 71661226 SUP HCPCS C1713 71661226 - SCREW BN 4.5MM 26MM IMHS CP CPTR LCK HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $593.25 $593.25 $123.63 $593.25 N/A N/A 71661228 SUP HCPCS C1713 71661228 - SCREW BN 4.5MM 28MM IMHS CP LCK CPTR HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $593.25 $593.25 $123.63 $593.25 N/A N/A 71661230 SUP HCPCS C1713 71661230 - SCREW BN 4.5MM 30MM IMHS CP LCK CPTR HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $593.25 $593.25 $123.63 $593.25 N/A N/A 71661232 SUP HCPCS C1713 71661232 - SCREW BN 4.5MM 32MM IMHS CP LCK CPTR HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $593.25 $593.25 $123.63 $593.25 N/A N/A 71661234 SUP HCPCS C1713 71661234 - SCREW BN 4.5MM 34MM IMHS CP LCK CPTR HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $355.95 $593.25 $123.63 $593.25 N/A N/A 71661236 SUP HCPCS C1713 71661236 - SCREW BN 4.5MM 36MM IMHS CP LCK CPTR HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $593.25 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $355.95 $593.25 $123.63 $593.25 N/A N/A 71661238 SUP HCPCS C1713 71661238 - SCREW BN 4.5MM 38MM IMHS CP LCK CPTR HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $593.25 $593.25 $123.63 $593.25 N/A N/A 71661240 SUP HCPCS C1713 71661240 - SCREW BN 4.5MM 40MM IMHS CP LCK CPTR HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $593.25 $593.25 $123.63 $593.25 N/A N/A 71661242 SUP HCPCS C1713 71661242 - SCREW BN 4.5MM 42MM IMHS CP LCK CPTR HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $593.25 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $593.25 $593.25 $593.25 $593.25 N/A N/A 71661244 SUP HCPCS C1713 71661244 - SCREW BN 4.5MM 44MM IMHS CP LCK CPTR HIP IM NL BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $593.25 $593.25 $593.25 $593.25 N/A N/A 71661246 SUP HCPCS C1713 71661246 - SCREW BN 4.5MM 46MM IMHS CP LCK CPTR HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $355.95 $593.25 $593.25 $593.25 N/A N/A 71661248 SUP HCPCS C1713 71661248 - SCREW BN 4.5MM 48MM IMHS CP LCK CPTR HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $355.95 $593.25 $123.63 $593.25 N/A N/A 71661250 SUP HCPCS C1713 71661250 - SCREW BN 4.5MM 50MM IMHS CP LCK CPTR HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $355.95 $593.25 $123.63 $593.25 N/A N/A 71661252 SUP HCPCS C1713 71661252 - SCREW BN 4.5MM 52MM IMHS CP LCK CPTR HIP IM NL BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $593.25 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $355.95 $593.25 $123.63 $593.25 N/A N/A 71661254 SUP HCPCS C1713 71661254 - SCREW BN 4.5MM 54MM IMHS CP LCK CPTR HIP IM NL BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $355.95 $593.25 $123.63 $593.25 N/A N/A 71661256 SUP HCPCS C1713 71661256 - SCREW BN 4.5MM 56MM IMHS CP LCK CPTR HIP IM NL BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $355.95 $593.25 $123.63 $593.25 N/A N/A 71661258 SUP HCPCS C1713 71661258 - SCREW BN 4.5MM 58MM IMHS CP LCK CPTR HIP IM NL SYS BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $355.95 $593.25 $123.63 $593.25 N/A N/A 71661260 SUP HCPCS C1713 71661260 - SCREW BN 4.5MM 60MM IMHS CP LCK CPTR HIP IM NL BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $593.25 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $355.95 $593.25 $593.25 $593.25 N/A N/A 71661262 SUP HCPCS C1713 71661262 - SCREW BN 4.5MM 62MM IMHS CP LCK CPTR HIP IM NL BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $237.30 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $355.95 $593.25 $593.25 $593.25 N/A N/A 71661264 SUP HCPCS C1713 71661264 - SCREW BN 4.5MM 64MM IMHS CP LCK CPTR HIP IM NL BOTH IP/OP $593.50 $439.00 $117.75 $593.25 $266.96 $266.96 $266.96 $266.96 $593.25 $593.25 $593.25 $123.65 $593.25 $593.25 $593.25 $593.25 $593.25 $123.64 $593.25 $593.25 $350.91 $593.25 $593.25 $593.25 $593.25 $445.13 $593.25 $593.25 $593.25 $296.63 $296.63 $469.85 $593.25 $474.60 $266.96 $117.75 N/A $344.23 $593.25 $355.95 $593.25 $123.63 $593.25 N/A N/A 71665026 SUP HCPCS C1769 71665026 - GUIDE ROD ORTHOPEDIC 3MM 600MM BALL TIP TRIGEN DISPOSABLE BOTH IP/OP $491.00 $363.00 $97.43 $490.88 $266.55 $266.55 $266.55 $266.55 $490.88 $490.88 $490.88 $102.31 $490.88 $364.33 $364.33 $378.37 $255.75 $102.30 $490.88 $490.88 $290.36 $490.88 $490.88 $490.88 $490.88 $368.25 $490.88 $490.88 $490.88 $245.44 $245.44 $388.78 $490.88 $392.70 $319.07 $97.43 N/A $284.78 $490.88 $490.88 $490.88 $102.30 $490.88 N/A N/A 71672030 SUP HCPCS C1713 71672030 - SCREW BONE 11MM 30MM COMPRESSION INTERTAN TROCHANTER BOTH IP/OP $659.50 $488.00 $130.84 $659.25 $296.66 $296.66 $296.66 $296.66 $659.25 $659.25 $659.25 $137.40 $659.25 $659.25 $659.25 $659.25 $659.25 $137.39 $659.25 $263.70 $389.95 $659.25 $659.25 $659.25 $659.25 $494.63 $659.25 $659.25 $659.25 $329.63 $329.63 $522.13 $659.25 $527.40 $296.66 $130.84 N/A $382.51 $659.25 $395.55 $659.25 $137.39 $659.25 N/A N/A 71672035 SUP HCPCS C1713 71672035 - SCREW BN 35MM CMPR ORTH BOTH IP/OP $676.00 $500.00 $134.17 $676.00 $304.20 $304.20 $304.20 $304.20 $676.00 $676.00 $676.00 $140.90 $676.00 $676.00 $676.00 $676.00 $676.00 $140.89 $676.00 $676.00 $399.85 $676.00 $676.00 $676.00 $676.00 $507.00 $676.00 $676.00 $676.00 $338.00 $338.00 $535.39 $676.00 $540.80 $304.20 $134.17 N/A $392.08 $676.00 $405.60 $676.00 $140.88 $676.00 N/A N/A 71672040 SUP HCPCS C1713 71672040 - SCREW BN 40MM CMPR ORTH BOTH IP/OP $460.50 $341.00 $91.32 $460.13 $207.06 $207.06 $207.06 $207.06 $460.13 $460.13 $460.13 $95.90 $460.13 $460.13 $460.13 $460.13 $460.13 $95.90 $460.13 $184.05 $272.17 $460.13 $460.13 $460.13 $460.13 $345.38 $460.13 $460.13 $460.13 $230.07 $230.07 $364.42 $460.13 $368.10 $207.06 $91.32 N/A $267.09 $460.13 $460.13 $460.13 $95.89 $460.13 N/A N/A 71673040 SUP HCPCS C1713 71673040 - NAIL IM 130D 10MM 40CM INTERTAN LT TROCH BOTH IP/OP "$3,156.00" "$2,335.00" $626.31 "$3,155.63" "$1,420.03" "$1,420.03" "$1,420.03" "$1,420.03" "$3,155.63" "$3,155.63" "$3,155.63" $657.71 "$3,155.63" "$3,155.63" "$3,155.63" "$3,155.63" "$3,155.63" $657.67 "$3,155.63" "$3,155.63" "$1,555.73" "$3,155.63" "$3,155.63" "$3,155.63" "$3,155.63" "$2,367.00" "$3,155.63" "$3,155.63" "$3,155.63" "$1,577.82" "$1,577.82" "$2,499.26" "$3,155.63" "$2,524.50" "$1,420.03" $626.31 N/A "$1,830.48" "$3,155.63" "$1,893.38" "$3,155.63" $657.63 "$3,155.63" N/A N/A 71673125 SUP HCPCS C1713 71673125 - SCREW BN 11MM 125MM LG BOTH IP/OP $892.00 $660.00 $177.04 $892.00 $401.40 $401.40 $401.40 $401.40 $892.00 $892.00 $892.00 $185.92 $892.00 $892.00 $892.00 $892.00 $892.00 $185.90 $892.00 $892.00 $527.62 $892.00 $892.00 $892.00 $892.00 $669.00 $892.00 $892.00 $892.00 $446.00 $446.00 $706.46 $892.00 $713.60 $401.40 $177.04 N/A $517.36 $892.00 $535.20 $892.00 $185.89 $892.00 N/A N/A 71674034 SUP Custom 27203010 71674034 - GUIDE SURG 7MM 7MM COMPRESSION SCREW TRIGEN INTERTAN BOTH IP/OP $381.50 $282.00 $67.89 $381.38 $381.38 $381.38 $381.38 $381.38 $381.38 $381.38 $67.89 $381.38 $381.38 $283.06 $283.06 $293.97 $198.70 $79.48 $381.38 $152.55 $381.38 $381.38 $381.38 $381.38 $381.38 $286.13 $381.38 $381.38 $381.38 $190.69 $190.69 $302.05 $381.38 $305.10 $247.90 $381.38 N/A $221.27 $381.38 $228.83 $381.38 $381.38 $381.38 N/A N/A 71674130 SUP Custom 27203010 71674130 - GUIDE PIN ORTHOPEDIC 3.2MM 343MM BRAD POINT TIP THREADED BOTH IP/OP $308.50 $228.00 $54.87 $308.25 $308.25 $308.25 $308.25 $308.25 $308.25 $308.25 $54.87 $308.25 $308.25 $228.78 $228.78 $237.60 $160.60 $64.24 $308.25 $123.30 $308.25 $308.25 $308.25 $308.25 $308.25 $231.38 $308.25 $308.25 $308.25 $154.13 $154.13 $244.13 $308.25 $246.60 $200.36 $308.25 N/A $178.93 $308.25 $184.95 $308.25 $308.25 $308.25 N/A N/A 71674540 SUP HCPCS C1713 71674540 - INTERTAN LAG SCREW DRILL BOTH IP/OP "$1,033.00" $764.00 $204.98 "$1,032.75" $464.74 $464.74 $464.74 $464.74 "$1,032.75" "$1,032.75" "$1,032.75" $215.25 "$1,032.75" "$1,032.75" "$1,032.75" "$1,032.75" "$1,032.75" $215.24 "$1,032.75" $413.10 $610.87 "$1,032.75" "$1,032.75" "$1,032.75" "$1,032.75" $774.75 "$1,032.75" "$1,032.75" "$1,032.75" $516.38 $516.38 $817.94 "$1,032.75" $826.20 $464.74 $204.98 N/A $599.14 "$1,032.75" $619.65 "$1,032.75" $215.23 "$1,032.75" N/A N/A 71675030 SUP HCPCS C1713 71675030 - SCREW BN INTERTAN SET BOTH IP/OP $494.00 $366.00 $98.02 $493.88 $222.25 $222.25 $222.25 $222.25 $493.88 $493.88 $493.88 $102.94 $493.88 $493.88 $493.88 $493.88 $493.88 $102.93 $493.88 $197.55 $292.13 $493.88 $493.88 $493.88 $493.88 $370.50 $493.88 $493.88 $493.88 $246.94 $246.94 $391.15 $493.88 $395.10 $222.25 $98.02 N/A $286.52 $493.88 $296.33 $493.88 $102.92 $493.88 N/A N/A 71675040 SUP HCPCS C1713 71675040 - CAP END INTERTAN TROCH IM NL BOTH IP/OP $279.00 $206.00 $55.37 $279.00 $125.55 $125.55 $125.55 $125.55 $279.00 $279.00 $279.00 $58.15 $279.00 $279.00 $279.00 $279.00 $279.00 $58.15 $279.00 $111.60 $165.03 $279.00 $279.00 $279.00 $279.00 $209.25 $279.00 $279.00 $279.00 $139.50 $139.50 $220.97 $279.00 $223.20 $125.55 $55.37 N/A $161.82 $279.00 $167.40 $279.00 $58.14 $279.00 N/A N/A 71675201 SUP HCPCS C1713 71675201 - NAIL IM 125D SHRT 10MM 180MM INTERTAN TI TROCH BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$1,332.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$1,998.00" "$3,330.00" "$3,330.00" "$3,330.00" N/A N/A 71675202 SUP HCPCS C1713 71675202 - NAIL IM 125D 11.5MM 18CM INTERTAN TI TROCH BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$3,330.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$1,998.00" "$3,330.00" "$3,330.00" "$3,330.00" N/A N/A 71675203 SUP HCPCS C1713 71675203 - NAIL IM 125D SHRT 13MM 18CM INTERTAN TI TROCH BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$1,332.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$3,330.00" "$3,330.00" $693.97 "$3,330.00" N/A N/A 71675204 SUP HCPCS C1713 71675204 - NAIL IM 125D 10MM 20CM INTERTAN TI TROCH BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$1,332.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$1,998.00" "$3,330.00" $693.97 "$3,330.00" N/A N/A 71675205 SUP HCPCS C1713 71675205 - NAIL IM 125D 11.5MM 20CM INTERTAN TI TROCH BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$3,330.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$1,998.00" "$3,330.00" "$3,330.00" "$3,330.00" N/A N/A 71675206 SUP HCPCS C1713 71675206 - NAIL IM 125D 13MM 20CM INTERTAN BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$1,332.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$1,998.00" "$3,330.00" "$3,330.00" "$3,330.00" N/A N/A 71675207 SUP HCPCS C1713 71675207 - NAIL IM 130D SHRT 10MM 18CM INTERTAN ANTGRD TI INTST BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$3,330.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$1,998.00" "$3,330.00" $693.97 "$3,330.00" N/A N/A 71675208 SUP HCPCS C1713 71675208 - NAIL IM 130D SHRT 11.5MM 18CM INTERTAN ANTGRD TI INTST BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$3,330.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$1,998.00" "$3,330.00" $693.97 "$3,330.00" N/A N/A 71675209 SUP HCPCS C1713 71675209 - NAIL IM 130D SHRT 13MM 18CM INTERTAN TI TROCH BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$3,330.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$1,998.00" "$3,330.00" $693.97 "$3,330.00" N/A N/A 71675210 SUP HCPCS C1713 71675210 - NAIL IM 130D 10MM 20CM INTERTAN TI ORTH BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$1,332.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$1,998.00" "$3,330.00" $693.97 "$3,330.00" N/A N/A 71675211 SUP HCPCS C1713 71675211 - NAIL IM 130D 11.5MM 20CM INTERTAN TI TROCH BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$1,332.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$1,998.00" "$3,330.00" $693.97 "$3,330.00" N/A N/A 71675212 SUP HCPCS C1713 71675212 - NAIL IM 130D 13MM 20CM INTERTAN TI TROCH BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$3,330.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$3,330.00" "$3,330.00" $693.97 "$3,330.00" N/A N/A 71675213 SUP HCPCS C1713 71675213 - NAIL IM 125D 10MM 26CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675214 SUP HCPCS C1713 71675214 - NAIL IM 125D 10MM 26CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675215 SUP HCPCS C1713 71675215 - NAIL IM 125D 10MM 28CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675216 SUP HCPCS C1713 71675216 - NAIL IM 125D 10MM 28CM INTERTAN TI RT ORTH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675217 SUP HCPCS C1713 71675217 - NAIL IM 125D 10MM 30CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675218 SUP HCPCS C1713 71675218 - NAIL IM 125D 10MM 30CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675219 SUP HCPCS C1713 71675219 - NAIL IM 125D 10MM 32CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675220 SUP HCPCS C1713 71675220 - NAIL IM 125D 10MM 32CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675221 SUP HCPCS C1713 71675221 - NAIL IM 125D LG 10MM 34CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675222 SUP HCPCS C1713 71675222 - NAIL IM 125D 10MM 34CM ROSE INTERTAN TI RT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675223 SUP HCPCS C1713 71675223 - NAIL IM 125D 10MM 36CM LIME INTERTAN TI LT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675224 SUP HCPCS C1713 71675224 - NAIL IM 125D 10MM 36CM ROSE INTERTAN TI RT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675225 SUP HCPCS C1713 71675225 - NAIL IM 125D LG 10MM 38CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675226 SUP HCPCS C1713 71675226 - NAIL IM 125D LG 10MM 38CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675227 SUP HCPCS C1713 71675227 - NAIL IM 125D LG 10MM 40CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675228 SUP HCPCS C1713 71675228 - NAIL IM 125D LG 10MM 400MM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675229 SUP HCPCS C1713 71675229 - NAIL IM 125D 10MM 42CM LIME INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675230 SUP HCPCS C1713 71675230 - NAIL IM 125D 10MM 42CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675231 SUP HCPCS C1713 71675231 - NAIL IM 125D 10MM 44CM INTERTAN LT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675232 SUP HCPCS C1713 71675232 - NAIL IM 125D 10MM 44CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675233 SUP HCPCS C1713 71675233 - NAIL IM 125D 10MM 46CM LIME INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675234 SUP HCPCS C1713 71675234 - NAIL IM 125D 10MM 46CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675235 SUP HCPCS C1713 71675235 - NAIL IM 125D 11.5MM 26CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675236 SUP HCPCS C1713 71675236 - NAIL IM 125D 11.5MM 26CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675237 SUP HCPCS C1713 71675237 - NAIL IM 125D 11.5MM 28CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675238 SUP HCPCS C1713 71675238 - NAIL IM 125D 11.5MM 28CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675239 SUP HCPCS C1713 71675239 - NAIL IM 125D LG 11.5MM 30CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675240 SUP HCPCS C1713 71675240 - NAIL IM 125D 11.5MM 30CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675241 SUP HCPCS C1713 71675241 - NAIL IM 125D 11.5MM 32CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675242 SUP HCPCS C1713 71675242 - NAIL IM 125D 11.5MM 32CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675243 SUP HCPCS C1713 71675243 - NAIL IM 125D LG 11.5MM 34CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675244 SUP HCPCS C1713 71675244 - NAIL IM 125D 11.5MM 34CM ROSE INTERTAN TI RT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675245 SUP HCPCS C1713 71675245 - NAIL IM 125D LG 11.5MM 360MM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675246 SUP HCPCS C1713 71675246 - NAIL IM 125D LG 11.5MM 36CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675247 SUP HCPCS C1713 71675247 - NAIL IM 125D 11.5MM 38CM LIME INTERTAN TI LT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675248 SUP HCPCS C1713 71675248 - NAIL IM 125D LG 11.5MM 380MM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675249 SUP HCPCS C1713 71675249 - NAIL IM 125D LG 11.5MM 40CM LIME TRGN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675250 SUP HCPCS C1713 71675250 - NAIL IM 125D LG 11.5MM 400MM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675251 SUP HCPCS C1713 71675251 - NAIL IM 125D 11.5MM 42CM LIME INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675252 SUP HCPCS C1713 71675252 - NAIL IM 125D 11.5MM 42CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675253 SUP HCPCS C1713 71675253 - NAIL IM 125D 11.5MM 44CM LIME INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675254 SUP HCPCS C1713 71675254 - NAIL IM 125D 11.5MM 44CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675255 SUP HCPCS C1713 71675255 - NAIL IM 125D 11.5MM 46CM LIME INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675256 SUP HCPCS C1713 71675256 - NAIL IM 125D 11.5MM 46CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675257 SUP HCPCS C1713 71675257 - NAIL IM 130D 10MM 26CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675258 SUP HCPCS C1713 71675258 - NAIL IM 130D 10MM 26CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675259 SUP HCPCS C1713 71675259 - NAIL IM 130D 10MM 28CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675260 SUP HCPCS C1713 71675260 - NAIL IM 130D 10MM 28CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675261 SUP HCPCS C1713 71675261 - NAIL IM 130D 10MM 30CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675262 SUP HCPCS C1713 71675262 - NAIL IM 130D 10MM 30CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675263 SUP HCPCS C1713 71675263 - NAIL IM 130D 10MM 32CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675264 SUP HCPCS C1713 71675264 - NAIL IM 130D 10MM 32CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675265 SUP HCPCS C1713 71675265 - NAIL IM 130D LNG 10MM 34CM LIME ROSE INTERTAN TRGN NK ANG LT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675266 SUP HCPCS C1713 71675266 - NAIL IM 130D LNG 10MM 34CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675267 SUP HCPCS C1713 71675267 - NAIL IM 130D LNG 10MM 36CM LIME INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675268 SUP HCPCS C1713 71675268 - NAIL IM 130D LNG 10MM 36CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675269 SUP HCPCS C1713 71675269 - NAIL IM 130D 10MM 38CM LIME INTERTAN TI LT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675270 SUP HCPCS C1713 71675270 - NAIL IM 130D LNG 10MM 380MM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675271 SUP HCPCS C1713 71675271 - NAIL IM 130D LNG 10MM 40CM LIME INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675272 SUP HCPCS C1713 71675272 - NAIL IM 130D LNG 10MM 40CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675273 SUP HCPCS C1713 71675273 - NAIL IM 130D 10MM 42CM INTERTAN LT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675274 SUP HCPCS C1713 71675274 - NAIL IM 130D LNG 10MM 42CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675275 SUP HCPCS C1713 71675275 - NAIL IM 130D 10MM 44CM LIME INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675276 SUP HCPCS C1713 71675276 - NAIL IM 130D 10MM 44CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675277 SUP HCPCS C1713 71675277 - NAIL IM 130D 10MM 46CM LIME INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675278 SUP HCPCS C1713 71675278 - NAIL IM 130D 10MM 46CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675279 SUP HCPCS C1713 71675279 - NAIL IM 130D 11.5MM 26CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675280 SUP HCPCS C1713 71675280 - NAIL IM 130D 11.5MM 26CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675281 SUP HCPCS C1713 71675281 - NAIL IM 130D 11.5MM 28CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675282 SUP HCPCS C1713 71675282 - NAIL IM 130D 11.5MM 28CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675283 SUP HCPCS C1713 71675283 - NAIL IM 130D 11.5MM 30CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675284 SUP HCPCS C1713 71675284 - NAIL IM 130D 11.5MM 30CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675285 SUP HCPCS C1713 71675285 - NAIL IM 130D 11.5MM 32CM INTERTAN LT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675286 SUP HCPCS C1713 71675286 - NAIL IM 130D 11.5MM 32CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675287 SUP HCPCS C1713 71675287 - NAIL IM 130D 11.5MM 34CM INTERTAN ANTGRD TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675288 SUP HCPCS C1713 71675288 - NAIL IM 130D LNG 11.5MM 34CM ROSE INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675289 SUP HCPCS C1713 71675289 - NAIL IM 130D LNG 11.5MM 360MM LIME INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675290 SUP HCPCS C1713 71675290 - NAIL IM 130D LNG 11.5MM 36CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675291 SUP HCPCS C1713 71675291 - NAIL IM 130D LNG 11.5MM 380MM LIME INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675292 SUP HCPCS C1713 71675292 - NAIL IM 130D LNG 11.5MM 380MM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675293 SUP HCPCS C1713 71675293 - NAIL IM 130D LNG 11.5MM 40CM LIME INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675294 SUP HCPCS C1713 71675294 - NAIL IM 130D LNG 11.5MM 40CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675295 SUP HCPCS C1713 71675295 - NAIL IM 130D LNG 11.5MM 42CM LIME INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675361 SUP HCPCS C1713 71675361 - NAIL IM 135D 13MM 26CM INTERTAN TI LT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$1,156.62" "$5,550.00" N/A N/A 71675362 SUP HCPCS C1713 71675362 - NAIL IM 135D 13MM 26CM INTERTAN TI RT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$5,550.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$5,550.00" "$5,550.00" N/A N/A 71675363 SUP HCPCS C1713 71675363 - NAIL IM 135D 13MM 28CM INTERTAN TI LT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$5,550.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$5,550.00" "$5,550.00" N/A N/A 71675364 SUP HCPCS C1713 71675364 - NAIL IM 135D 13MM 28CM INTERTAN TI RT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$1,156.62" "$5,550.00" N/A N/A 71675365 SUP HCPCS C1713 71675365 - NAIL IM 135D 13MM 30CM INTERTAN TI LT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$5,550.00" "$5,550.00" N/A N/A 71675366 SUP HCPCS C1713 71675366 - NAIL IM 135D 13MM 30CM INTERTAN TI RT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$5,550.00" "$5,550.00" N/A N/A 71675367 SUP HCPCS C1713 71675367 - NAIL IM 135D 13MM 32CM INTERTAN TI LT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$1,156.62" "$5,550.00" N/A N/A 71675368 SUP HCPCS C1713 71675368 - NAIL IM 135D 13MM 32CM INTERTAN TI RT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$1,156.62" "$5,550.00" N/A N/A 71675369 SUP HCPCS C1713 71675369 - NAIL IM 135D 13MM 34CM INTERTAN TI LT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$1,156.62" "$5,550.00" N/A N/A 71675370 SUP HCPCS C1713 71675370 - NAIL IM 135D 13MM 34CM INTERTAN TI RT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$5,550.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$1,156.62" "$5,550.00" N/A N/A 71675371 SUP HCPCS C1713 71675371 - NAIL IM 135D 13MM 36CM INTERTAN TI LT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$5,550.00" "$5,550.00" N/A N/A 71675372 SUP HCPCS C1713 71675372 - NAIL IM 135D 13MM 36CM INTERTAN TI RT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$5,550.00" "$5,550.00" N/A N/A 71675373 SUP HCPCS C1713 71675373 - NAIL IM 135D 13MM 38CM INTERTAN TI LT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$1,156.62" "$5,550.00" N/A N/A 71675374 SUP HCPCS C1713 71675374 - NAIL IM 135D 13MM 38CM INTERTAN TI RT TROCH BOTH IP/OP "$6,220.00" "$4,603.00" "$1,234.51" "$6,220.00" "$2,799.00" "$2,799.00" "$2,799.00" "$2,799.00" "$6,220.00" "$6,220.00" "$6,220.00" "$1,296.40" "$6,220.00" "$6,220.00" "$6,220.00" "$6,220.00" "$6,220.00" "$1,296.32" "$6,220.00" "$2,488.00" "$3,066.46" "$6,220.00" "$6,220.00" "$6,220.00" "$6,220.00" "$4,665.00" "$6,220.00" "$6,220.00" "$6,220.00" "$3,110.00" "$3,110.00" "$4,926.24" "$6,220.00" "$4,976.00" "$2,799.00" "$1,234.51" N/A "$3,607.60" "$6,220.00" "$3,732.00" "$6,220.00" "$6,220.00" "$6,220.00" N/A N/A 71675375 SUP HCPCS C1713 71675375 - NAIL IM 135D 13MM 40CM INTERTAN TI LT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.62" "$5,550.00" N/A N/A 71675376 SUP HCPCS C1713 71675376 - NAIL IM 135D 13MM 40CM INTERTAN TI RT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" N/A N/A 71675377 SUP HCPCS C1713 71675377 - NAIL IM 135D 13MM 42CM INTERTAN TI LT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$1,156.62" "$5,550.00" N/A N/A 71675378 SUP HCPCS C1713 71675378 - NAIL IM 135D 13MM 42CM INTERTAN TI RT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$1,156.62" "$5,550.00" N/A N/A 71675379 SUP HCPCS C1713 71675379 - NAIL IM 135D 13MM 44CM INTERTAN TI LT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$1,156.62" "$5,550.00" N/A N/A 71675380 SUP HCPCS C1713 71675380 - NAIL IM 135D 13MM 44CM INTERTAN TI RT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$5,550.00" "$5,550.00" N/A N/A 71675381 SUP HCPCS C1713 71675381 - NAIL IM 135D 13MM 46CM INTERTAN TI LT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$5,550.00" "$5,550.00" N/A N/A 71675382 SUP HCPCS C1713 71675382 - NAIL IM 135D 13MM 46CM INTERTAN TI RT TROCH BOTH IP/OP "$5,550.00" "$4,107.00" "$1,101.54" "$5,550.00" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.76" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$1,156.68" "$5,550.00" "$2,220.00" "$2,736.15" "$5,550.00" "$5,550.00" "$5,550.00" "$5,550.00" "$4,162.50" "$5,550.00" "$5,550.00" "$5,550.00" "$2,775.00" "$2,775.00" "$4,395.60" "$5,550.00" "$4,440.00" "$2,497.50" "$1,101.54" N/A "$3,219.00" "$5,550.00" "$3,330.00" "$5,550.00" "$1,156.62" "$5,550.00" N/A N/A 71675383 SUP HCPCS C1713 71675383 - NAIL IM 125D 10MM 18CM INTERTAN BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$1,332.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$1,998.00" "$3,330.00" $693.97 "$3,330.00" N/A N/A 71675384 SUP HCPCS C1713 71675384 - NAIL IM 130D 10MM 18CM INTERTAN BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$1,332.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$1,998.00" "$3,330.00" $693.97 "$3,330.00" N/A N/A 71675385 SUP HCPCS C1713 71675385 - NAIL IM 125D SHRT 10MM 20CM INTERTAN TROCH BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$1,332.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$3,330.00" "$3,330.00" $693.97 "$3,330.00" N/A N/A 71675386 SUP HCPCS C1713 71675386 - NAIL IM 130D SHRT 10MM 20CM INTERTAN TROCH BOTH IP/OP "$3,330.00" "$2,464.00" $660.92 "$3,330.00" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$3,330.00" "$3,330.00" "$3,330.00" $694.06 "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" $694.01 "$3,330.00" "$1,332.00" "$1,641.69" "$3,330.00" "$3,330.00" "$3,330.00" "$3,330.00" "$2,497.50" "$3,330.00" "$3,330.00" "$3,330.00" "$1,665.00" "$1,665.00" "$2,637.36" "$3,330.00" "$2,664.00" "$1,498.50" $660.92 N/A "$1,931.40" "$3,330.00" "$1,998.00" "$3,330.00" $693.97 "$3,330.00" N/A N/A 71675401 SUP HCPCS C1713 71675401 - NAIL IM 125D 13MM 26CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675402 SUP HCPCS C1713 71675402 - NAIL IM 125D 13MM 26CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675403 SUP HCPCS C1713 71675403 - NAIL IM 125D 13MM 28CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675404 SUP HCPCS C1713 71675404 - NAIL IM 125D 13MM 28CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675405 SUP HCPCS C1713 71675405 - NAIL IM 125D 13MM 30CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675406 SUP HCPCS C1713 71675406 - NAIL IM 125D 13MM 30CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675407 SUP HCPCS C1713 71675407 - NAIL IM 125D LNG 13MM 32CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675408 SUP HCPCS C1713 71675408 - NAIL IM 125D 13MM 32CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675409 SUP HCPCS C1713 71675409 - NAIL IM 125D 13MM 34CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675410 SUP HCPCS C1713 71675410 - NAIL IM 125D 13MM 34CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675411 SUP HCPCS C1713 71675411 - NAIL IM 125D 13MM 36CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675412 SUP HCPCS C1713 71675412 - NAIL IM 125D 13MM 36CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675413 SUP HCPCS C1713 71675413 - NAIL IM 125D 13MM 38CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675414 SUP HCPCS C1713 71675414 - NAIL IM 125D 13MM 38CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675415 SUP HCPCS C1713 71675415 - NAIL IM 125D 13MM 40CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675416 SUP HCPCS C1713 71675416 - NAIL IM 125D 13MM 40CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675417 SUP HCPCS C1713 71675417 - NAIL IM 125D 13MM 42CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675418 SUP HCPCS C1713 71675418 - NAIL IM 125D 13MM 42CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675419 SUP HCPCS C1713 71675419 - NAIL IM 125D 13MM 44CM INTERTAN LT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675420 SUP HCPCS C1713 71675420 - NAIL IM 125D 13MM 44CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675421 SUP HCPCS C1713 71675421 - NAIL IM 125D 13MM 46CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675422 SUP HCPCS C1713 71675422 - NAIL IM 125D 13MM 46CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675423 SUP HCPCS C1713 71675423 - NAIL IM 130D 13MM 26CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675424 SUP HCPCS C1713 71675424 - NAIL IM 130D 13MM 26CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675425 SUP HCPCS C1713 71675425 - NAIL IM 130D 13MM 28CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675426 SUP HCPCS C1713 71675426 - NAIL IM 130D 13MM 28CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675427 SUP HCPCS C1713 71675427 - NAIL IM 130D 13MM 30CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675428 SUP HCPCS C1713 71675428 - NAIL IM 130D 13MM 30CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675429 SUP HCPCS C1713 71675429 - NAIL IM 130D 13MM 32CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675430 SUP HCPCS C1713 71675430 - NAIL IM 130D 13MM 32CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675431 SUP HCPCS C1713 71675431 - NAIL IM 130D 13MM 34CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675432 SUP HCPCS C1713 71675432 - NAIL IM 130D 13MM 34CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675433 SUP HCPCS C1713 71675433 - NAIL IM 130D 13MM 36CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675434 SUP HCPCS C1713 71675434 - NAIL IM 130D 13MM 36CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675435 SUP HCPCS C1713 71675435 - NAIL IM 130D 13MM 38CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675436 SUP HCPCS C1713 71675436 - NAIL IM 130D 13MM 38CM INTERTAN ANTGRD TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675437 SUP HCPCS C1713 71675437 - NAIL IM 130D 13MM 40CM INTERTAN TI LT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675438 SUP HCPCS C1713 71675438 - NAIL IM 130D 13MM 40CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675439 SUP HCPCS C1713 71675439 - NAIL IM 130D 13MM 42CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675440 SUP HCPCS C1713 71675440 - NAIL IM 130D 13MM 42CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675441 SUP HCPCS C1713 71675441 - NAIL IM 130D 13MM 44CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675442 SUP HCPCS C1713 71675442 - NAIL IM 130D 13MM 44CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675443 SUP HCPCS C1713 71675443 - NAIL IM 130D 13MM 46CM INTERTAN TI LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675444 SUP HCPCS C1713 71675444 - NAIL IM 130D 13MM 46CM INTERTAN TI RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675501 SUP HCPCS C1713 71675501 - NAIL IM 125D 10MM 26CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675502 SUP HCPCS C1713 71675502 - NAIL IM 130D 10MM 26CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675503 SUP HCPCS C1713 71675503 - NAIL IM 125D 10MM 28CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675504 SUP HCPCS C1713 71675504 - NAIL IM 130D 10MM 28CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675505 SUP HCPCS C1713 71675505 - NAIL IM 125D 10MM 30CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675506 SUP HCPCS C1713 71675506 - NAIL IM 130D 10MM 30CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675507 SUP HCPCS C1713 71675507 - NAIL IM 125D 10MM 32CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675508 SUP HCPCS C1713 71675508 - NAIL IM 130D 10MM 30CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675509 SUP HCPCS C1713 71675509 - NAIL IM 125D 10MM 34CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675510 SUP HCPCS C1713 71675510 - NAIL IM 130D 10MM 34CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675511 SUP HCPCS C1713 71675511 - NAIL IM 125D 10MM 36CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675512 SUP HCPCS C1713 71675512 - NAIL IM 130D 10MM 36CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675513 SUP HCPCS C1713 71675513 - NAIL IM 125D 10MM 38CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675514 SUP HCPCS C1713 71675514 - NAIL IM 130D 10MM 38CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675515 SUP HCPCS C1713 71675515 - NAIL IM 125D 10MM 40CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675516 SUP HCPCS C1713 71675516 - NAIL IM 130D 10MM 40CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675517 SUP HCPCS C1713 71675517 - NAIL IM 125D 10MM 42CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675518 SUP HCPCS C1713 71675518 - NAIL IM 130D 10MM 42CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675519 SUP HCPCS C1713 71675519 - NAIL IM 125D 10MM 44CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675520 SUP HCPCS C1713 71675520 - NAIL IM 130D 10MM 44CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675521 SUP HCPCS C1713 71675521 - NAIL IM 125D 10MM 46CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675522 SUP HCPCS C1713 71675522 - NAIL IM 130D 10MM 46CM INTERTAN LT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675523 SUP HCPCS C1713 71675523 - NAIL IM 125D 10MM 26CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675524 SUP HCPCS C1713 71675524 - NAIL IM 130D 10MM 26CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675525 SUP HCPCS C1713 71675525 - NAIL IM 125D 10MM 28CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675526 SUP HCPCS C1713 71675526 - NAIL IM 130D 10MM 28CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675527 SUP HCPCS C1713 71675527 - NAIL IM 125D 10MM 30CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675528 SUP HCPCS C1713 71675528 - NAIL IM 130D 10MM 30CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675529 SUP HCPCS C1713 71675529 - NAIL IM 125D 10MM 36CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675530 SUP HCPCS C1713 71675530 - NAIL IM 130D 10MM 32CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675531 SUP HCPCS C1713 71675531 - NAIL IM 125D 10MM 34CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675532 SUP HCPCS C1713 71675532 - NAIL IM 130D 10MM 34CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675533 SUP HCPCS C1713 71675533 - NAIL IM 125D 10MM 36CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675534 SUP HCPCS C1713 71675534 - NAIL IM 130D 10MM 36CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675535 SUP HCPCS C1713 71675535 - NAIL IM 125D 10MM 38CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675536 SUP HCPCS C1713 71675536 - NAIL IM 130D 10MM 38CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675537 SUP HCPCS C1713 71675537 - NAIL IM 125D 10MM 40CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675538 SUP HCPCS C1713 71675538 - NAIL IM 130D 10MM 40CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675539 SUP HCPCS C1713 71675539 - NAIL IM 125D 10MM 42CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71675540 SUP HCPCS C1713 71675540 - NAIL IM 130D 10MM 42CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675541 SUP HCPCS C1713 71675541 - NAIL IM 125D 10MM 44CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675542 SUP HCPCS C1713 71675542 - NAIL IM 130D 10MM 44CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675543 SUP HCPCS C1713 71675543 - NAIL IM 125D 10MM 46CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71675544 SUP HCPCS C1713 71675544 - NAIL IM 130D 10MM 46CM INTERTAN RT TROCH BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676501 SUP HCPCS C1713 71676501 - NAIL IM 125D 1.5MM 26CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676502 SUP HCPCS C1713 71676502 - NAIL IM 125D 1.5MM 26CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676503 SUP HCPCS C1713 71676503 - NAIL IM 125D 1.5MM 28CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676504 SUP HCPCS C1713 71676504 - NAIL IM 125D 1.5MM 10MM 28CM INTERTAN INTERTROCHANTER RT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676505 SUP HCPCS C1713 71676505 - NAIL IM 125D 1.5MM 30CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676506 SUP HCPCS C1713 71676506 - NAIL IM 125D 1.5MM 30CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676507 SUP HCPCS C1713 71676507 - NAIL IM 125D 1.5MM 32CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676508 SUP HCPCS C1713 71676508 - NAIL IM 125D 1.5MM 32CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676509 SUP HCPCS C1713 71676509 - NAIL IM 125D 1.5MM 34CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676510 SUP HCPCS C1713 71676510 - NAIL IM 125D 1.5MM 34CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676511 SUP HCPCS C1713 71676511 - NAIL IM 125D 1.5MM 36CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676512 SUP HCPCS C1713 71676512 - NAIL IM 125D 1.5MM 36CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676513 SUP HCPCS C1713 71676513 - NAIL IM 125D 1.5MM 38CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676514 SUP HCPCS C1713 71676514 - NAIL IM 125D 1.5MM 38CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676515 SUP HCPCS C1713 71676515 - NAIL IM 125D 1.5MM 40CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676516 SUP HCPCS C1713 71676516 - NAIL IM 125D 1.5MM 40CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676517 SUP HCPCS C1713 71676517 - NAIL IM 125D 1.5MM 42CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676518 SUP HCPCS C1713 71676518 - NAIL IM 125D 1.5MM 42CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676519 SUP HCPCS C1713 71676519 - NAIL IM 125D 1.5MM 44CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676520 SUP HCPCS C1713 71676520 - NAIL IM 125D 1.5MM 44CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676521 SUP HCPCS C1713 71676521 - NAIL IM 125D 1.5MM 46CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676522 SUP HCPCS C1713 71676522 - NAIL IM 125D 1.5MM 46CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676523 SUP HCPCS C1713 71676523 - NAIL IM 130D 1.5MM 26CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676524 SUP HCPCS C1713 71676524 - NAIL IM 130D 1.5MM 26CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676525 SUP HCPCS C1713 71676525 - NAIL IM 130D 1.5MM 28CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676526 SUP HCPCS C1713 71676526 - NAIL IM 130D 1.5MM 28CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676527 SUP HCPCS C1713 71676527 - NAIL IM 130D 1.5MM 30CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676528 SUP HCPCS C1713 71676528 - NAIL IM 130D 1.5MM 30CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676529 SUP HCPCS C1713 71676529 - NAIL IM 130D 1.5MM 32CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676530 SUP HCPCS C1713 71676530 - NAIL IM 130D 1.5MM 32CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676531 SUP HCPCS C1713 71676531 - NAIL IM 130D 1.5MM 34CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676532 SUP HCPCS C1713 71676532 - NAIL IM 130D 1.5MM 34CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676533 SUP HCPCS C1713 71676533 - NAIL IM 130D 1.5MM 36CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676534 SUP HCPCS C1713 71676534 - NAIL IM 130D 1.5MM 36CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676535 SUP HCPCS C1713 71676535 - NAIL IM 130D 1.5MM 38CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676536 SUP HCPCS C1713 71676536 - NAIL IM 130D 1.5MM 38CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676537 SUP HCPCS C1713 71676537 - NAIL IM 130D 1.5MM 40CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676538 SUP HCPCS C1713 71676538 - NAIL IM 130D 1.5MM 40CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676539 SUP HCPCS C1713 71676539 - NAIL IM 130D 1.5MM 42CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676540 SUP HCPCS C1713 71676540 - NAIL IM 130D 1.5MM 42CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676541 SUP HCPCS C1713 71676541 - NAIL IM 130D 1.5MM 44CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676542 SUP HCPCS C1713 71676542 - NAIL IM 130D 1.5MM 44CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676543 SUP HCPCS C1713 71676543 - NAIL IM 130D 1.5MM 46CM 10MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676544 SUP HCPCS C1713 71676544 - NAIL IM 130D 1.5MM 46CM 10MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676545 SUP HCPCS C1713 71676545 - NAIL IM 125D 1.5MM 26CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676546 SUP HCPCS C1713 71676546 - NAIL IM 125D 1.5MM 26CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676547 SUP HCPCS C1713 71676547 - NAIL IM 125D 1.5MM 28CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676548 SUP HCPCS C1713 71676548 - NAIL IM 125D 1.5MM 28CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676549 SUP HCPCS C1713 71676549 - NAIL IM 125D 1.5MM 30CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676550 SUP HCPCS C1713 71676550 - NAIL IM 125D 1.5MM 30CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676551 SUP HCPCS C1713 71676551 - NAIL IM 125D 1.5MM 32CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676552 SUP HCPCS C1713 71676552 - NAIL IM 125D 1.5MM 32CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676553 SUP HCPCS C1713 71676553 - NAIL INTRAMEDULLARY 125D 1.5MM 34CM 11.5MM INTERTAN LEFT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676554 SUP HCPCS C1713 71676554 - NAIL IM 125D 1.5MM 34CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676555 SUP HCPCS C1713 71676555 - NAIL IM 125D 1.5MM 36CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676556 SUP HCPCS C1713 71676556 - NAIL IM 125D 1.5MM 36CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676557 SUP HCPCS C1713 71676557 - NAIL IM 125D 1.5MM 38CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676558 SUP HCPCS C1713 71676558 - NAIL INTRAMEDULLARY 125D 1.5MM 38CM 11.5MM INTERTAN RIGHT BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676559 SUP HCPCS C1713 71676559 - NAIL IM 125D 1.5MM 40CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676560 SUP HCPCS C1713 71676560 - NAIL IM 125D 1.5MM 40CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676561 SUP HCPCS C1713 71676561 - NAIL IM 125D 1.5MM 42CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676562 SUP HCPCS C1713 71676562 - NAIL IM 125D 1.5MM 42CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676563 SUP HCPCS C1713 71676563 - NAIL IM 125D 1.5MM 44CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676564 SUP HCPCS C1713 71676564 - NAIL IM 125D 1.5MM 44CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676565 SUP HCPCS C1713 71676565 - NAIL IM 125D 1.5MM 46CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676566 SUP HCPCS C1713 71676566 - NAIL IM 125D 1.5MM 46CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676567 SUP HCPCS C1713 71676567 - NAIL IM 130D 1.5MM 26CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676568 SUP HCPCS C1713 71676568 - NAIL IM 130D 1.5MM 26CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676569 SUP HCPCS C1713 71676569 - NAIL IM 130D 1.5MM 28CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676570 SUP HCPCS C1713 71676570 - NAIL IM 130D 1.5MM 28CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676571 SUP HCPCS C1713 71676571 - NAIL IM 130D 1.5MM 30CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676572 SUP HCPCS C1713 71676572 - NAIL IM 130D 1.5MM 30CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676573 SUP HCPCS C1713 71676573 - NAIL IM 130D 1.5MM 32CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676574 SUP HCPCS C1713 71676574 - NAIL IM 130D 1.5MM 32CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676575 SUP HCPCS C1713 71676575 - NAIL IM 130D 1.5MM 34CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676576 SUP HCPCS C1713 71676576 - NAIL IM 130D 1.5MM 34CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676577 SUP HCPCS C1713 71676577 - NAIL IM 130D 1.5MM 36CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676578 SUP HCPCS C1713 71676578 - NAIL IM 130D 1.5MM 36CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676579 SUP HCPCS C1713 71676579 - NAIL IM 130D 1.5MM 38CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676580 SUP HCPCS C1713 71676580 - NAIL IM 130D 1.5MM 38CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676581 SUP HCPCS C1713 71676581 - NAIL IM 130D 1.5MM 40CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676582 SUP HCPCS C1713 71676582 - NAIL IM 130D 1.5MM 40CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676583 SUP HCPCS C1713 71676583 - NAIL IM 130D 1.5MM 42CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676584 SUP HCPCS C1713 71676584 - NAIL IM 130D 1.5MM 42CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676585 SUP HCPCS C1713 71676585 - NAIL IM 130D 1.5MM 44CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676586 SUP HCPCS C1713 71676586 - NAIL IM 130D 1.5MM 44CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676587 SUP HCPCS C1713 71676587 - NAIL IM 130D 1.5MM 46CM 11.5MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676588 SUP HCPCS C1713 71676588 - NAIL IM 130D 1.5MM 46CM 11.5MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676589 SUP HCPCS C1713 71676589 - NAIL IM 125D 1.5MM 26CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676590 SUP HCPCS C1713 71676590 - NAIL IM 125D 1.5MM 26CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676591 SUP HCPCS C1713 71676591 - NAIL IM 125D 1.5MM 28CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676592 SUP HCPCS C1713 71676592 - NAIL IM 125D 1.5MM 28CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676593 SUP HCPCS C1713 71676593 - NAIL IM 125D 1.5MM 30CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676594 SUP HCPCS C1713 71676594 - NAIL IM 125D 1.5MM 30CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676595 SUP HCPCS C1713 71676595 - NAIL IM 125D 1.5MM 32CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676596 SUP HCPCS C1713 71676596 - NAIL IM 125D 1.5MM 32CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676597 SUP HCPCS C1713 71676597 - NAIL IM 125D 1.5MM 34CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676598 SUP HCPCS C1713 71676598 - NAIL IM 125D 1.5MM 34CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676599 SUP HCPCS C1713 71676599 - NAIL IM 125D 1.5MM 36CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676600 SUP HCPCS C1713 71676600 - NAIL IM 125D 1.5MM 36CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676601 SUP HCPCS C1713 71676601 - NAIL IM 125D 1.5MM 38CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676602 SUP HCPCS C1713 71676602 - NAIL IM 125D 1.5MM 38CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676603 SUP HCPCS C1713 71676603 - NAIL IM 125D 1.5MM 40CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676604 SUP HCPCS C1713 71676604 - NAIL IM 125D 1.5MM 40CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676605 SUP HCPCS C1713 71676605 - NAIL IM 125D 1.5MM 42CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676606 SUP HCPCS C1713 71676606 - NAIL IM 125D 1.5MM 42CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676607 SUP HCPCS C1713 71676607 - NAIL IM 125D 1.5MM 44CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676608 SUP HCPCS C1713 71676608 - NAIL IM 125D 1.5MM 44CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676609 SUP HCPCS C1713 71676609 - NAIL IM 125D 1.5MM 46CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676610 SUP HCPCS C1713 71676610 - NAIL IM 125D 1.5MM 46CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676611 SUP HCPCS C1713 71676611 - NAIL IM 130D 1.5MM 26CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676612 SUP HCPCS C1713 71676612 - NAIL IM 130D 1.5MM 26CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676613 SUP HCPCS C1713 71676613 - NAIL IM 130D 1.5MM 28CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676614 SUP HCPCS C1713 71676614 - NAIL IM 130D 1.5MM 28CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676615 SUP HCPCS C1713 71676615 - NAIL IM 130D 1.5MM 30CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676616 SUP HCPCS C1713 71676616 - NAIL IM 130D 1.5MM 30CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676617 SUP HCPCS C1713 71676617 - NAIL IM 130D 1.5MM 32CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" "$4,443.75" "$4,443.75" N/A N/A 71676618 SUP HCPCS C1713 71676618 - NAIL IM 130D 1.5MM 32CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676619 SUP HCPCS C1713 71676619 - NAIL IM 130D 1.5MM 34CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676620 SUP HCPCS C1713 71676620 - NAIL IM 130D 1.5MM 34CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676621 SUP HCPCS C1713 71676621 - NAIL IM 130D 1.5MM 36CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676622 SUP HCPCS C1713 71676622 - NAIL IM 130D 1.5MM 36CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676623 SUP HCPCS C1713 71676623 - NAIL IM 130D 1.5MM 38CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676624 SUP HCPCS C1713 71676624 - NAIL IM 130D 1.5MM 38CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676625 SUP HCPCS C1713 71676625 - NAIL IM 130D 1.5MM 40CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676626 SUP HCPCS C1713 71676626 - NAIL IM 130D 1.5MM 40CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$4,443.75" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676627 SUP HCPCS C1713 71676627 - NAIL IM 130D 1.5MM 42CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676628 SUP HCPCS C1713 71676628 - NAIL IM 130D 1.5MM 42CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676629 SUP HCPCS C1713 71676629 - NAIL IM 130D 1.5MM 44CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676630 SUP HCPCS C1713 71676630 - NAIL IM 130D 1.5MM 44CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$4,443.75" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676631 SUP HCPCS C1713 71676631 - NAIL IM 130D 1.5MM 46CM 13MM INTERTAN LT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71676632 SUP HCPCS C1713 71676632 - NAIL IM 130D 1.5MM 46CM 13MM INTERTAN RT INTERTROCHANTER BOTH IP/OP "$4,444.00" "$3,289.00" $881.97 "$4,443.75" "$1,999.69" "$1,999.69" "$1,999.69" "$1,999.69" "$4,443.75" "$4,443.75" "$4,443.75" $926.19 "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" $926.13 "$4,443.75" "$1,777.50" "$2,190.77" "$4,443.75" "$4,443.75" "$4,443.75" "$4,443.75" "$3,333.00" "$4,443.75" "$4,443.75" "$4,443.75" "$2,221.88" "$2,221.88" "$3,519.45" "$4,443.75" "$3,555.00" "$1,999.69" $881.97 N/A "$2,577.52" "$4,443.75" "$2,666.25" "$4,443.75" $926.08 "$4,443.75" N/A N/A 71677070 SUP HCPCS C1713 71677070 - SCREW BN 70/65MM INTERTAN LG CMPR TROCH CMBN PK BOTH IP/OP "$1,417.50" "$1,049.00" $281.34 "$1,417.50" $637.88 $637.88 $637.88 $637.88 "$1,417.50" "$1,417.50" "$1,417.50" $295.44 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" $295.42 "$1,417.50" $567.00 $838.45 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,063.13" "$1,417.50" "$1,417.50" "$1,417.50" $708.75 $708.75 "$1,122.66" "$1,417.50" "$1,134.00" $637.88 $281.34 N/A $822.15 "$1,417.50" $850.50 "$1,417.50" $295.41 "$1,417.50" N/A N/A 71677075 SUP HCPCS C1713 71677075 - SCREW BN 75/70MM INTERTAN LG CMPR TROCH CMBN PK BOTH IP/OP "$1,417.50" "$1,049.00" $281.34 "$1,417.50" $637.88 $637.88 $637.88 $637.88 "$1,417.50" "$1,417.50" "$1,417.50" $295.44 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" $295.42 "$1,417.50" $567.00 $838.45 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,063.13" "$1,417.50" "$1,417.50" "$1,417.50" $708.75 $708.75 "$1,122.66" "$1,417.50" "$1,134.00" $637.88 $281.34 N/A $822.15 "$1,417.50" $850.50 "$1,417.50" $295.41 "$1,417.50" N/A N/A 71677080 SUP HCPCS C1713 71677080 - KIT SCR 80MMX70MM INTERTAN LG CMPR TROCH TI CMBN PK BOTH IP/OP "$1,417.50" "$1,049.00" $281.34 "$1,417.50" $637.88 $637.88 $637.88 $637.88 "$1,417.50" "$1,417.50" "$1,417.50" $295.44 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" $295.42 "$1,417.50" $567.00 $838.45 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,063.13" "$1,417.50" "$1,417.50" "$1,417.50" $708.75 $708.75 "$1,122.66" "$1,417.50" "$1,134.00" $637.88 $281.34 N/A $822.15 "$1,417.50" "$1,417.50" "$1,417.50" $295.41 "$1,417.50" N/A N/A 71677085 SUP HCPCS C1713 71677085 - SCREW BN 11MM 7MM 85MM 80MM INTERTAN KT CMPR LG INTGR INTLK BOTH IP/OP "$1,417.50" "$1,049.00" $281.34 "$1,417.50" $637.88 $637.88 $637.88 $637.88 "$1,417.50" "$1,417.50" "$1,417.50" $295.44 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" $295.42 "$1,417.50" $567.00 $838.45 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,063.13" "$1,417.50" "$1,417.50" "$1,417.50" $708.75 $708.75 "$1,122.66" "$1,417.50" "$1,134.00" $637.88 $281.34 N/A $822.15 "$1,417.50" "$1,417.50" "$1,417.50" $295.41 "$1,417.50" N/A N/A 71677090 SUP HCPCS C1713 71677090 - KIT SCREW 4.5MM 90MM 85MM LAG COMPRESSION INTEGRATE BOTH IP/OP "$1,417.50" "$1,049.00" $281.34 "$1,417.50" $637.88 $637.88 $637.88 $637.88 "$1,417.50" "$1,417.50" "$1,417.50" $295.44 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" $295.42 "$1,417.50" $567.00 $838.45 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,063.13" "$1,417.50" "$1,417.50" "$1,417.50" $708.75 $708.75 "$1,122.66" "$1,417.50" "$1,134.00" $637.88 $281.34 N/A $822.15 "$1,417.50" "$1,417.50" "$1,417.50" $295.41 "$1,417.50" N/A N/A 71677095 SUP HCPCS C1713 71677095 - KIT SCREW 4.5MM 95MM 90MM LAG COMPRESSION INTEGRATED INTLCK BOTH IP/OP "$1,417.50" "$1,049.00" $281.34 "$1,417.50" $637.88 $637.88 $637.88 $637.88 "$1,417.50" "$1,417.50" "$1,417.50" $295.44 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" $295.42 "$1,417.50" $567.00 $838.45 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,063.13" "$1,417.50" "$1,417.50" "$1,417.50" $708.75 $708.75 "$1,122.66" "$1,417.50" "$1,134.00" $637.88 $281.34 N/A $822.15 "$1,417.50" $850.50 "$1,417.50" $295.41 "$1,417.50" N/A N/A 71677120 SUP HCPCS C1713 71677120 - SCREW BN 11MM 7MM 120MM 115MM INTERTAN KT CMPR LG INTGR BOTH IP/OP "$1,417.50" "$1,049.00" $281.34 "$1,417.50" $637.88 $637.88 $637.88 $637.88 "$1,417.50" "$1,417.50" "$1,417.50" $295.44 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" $295.42 "$1,417.50" $567.00 $838.45 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,063.13" "$1,417.50" "$1,417.50" "$1,417.50" $708.75 $708.75 "$1,122.66" "$1,417.50" "$1,134.00" $637.88 $281.34 N/A $822.15 "$1,417.50" "$1,417.50" "$1,417.50" $295.41 "$1,417.50" N/A N/A 71677125 SUP HCPCS C1713 71677125 - SCREW BN 125/120MM INTERTAN LG CMPR TROCH CMBN PK BOTH IP/OP "$1,417.50" "$1,049.00" $281.34 "$1,417.50" $637.88 $637.88 $637.88 $637.88 "$1,417.50" "$1,417.50" "$1,417.50" $295.44 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" $295.42 "$1,417.50" $567.00 $838.45 "$1,417.50" "$1,417.50" "$1,417.50" "$1,417.50" "$1,063.13" "$1,417.50" "$1,417.50" "$1,417.50" $708.75 $708.75 "$1,122.66" "$1,417.50" "$1,134.00" $637.88 $281.34 N/A $822.15 "$1,417.50" "$1,417.50" "$1,417.50" $295.41 "$1,417.50" N/A N/A 71678005 SUP HCPCS C1713 71678005 - SCREW BN 11MM 105MM INTERTAN LG TI SUBTROCHANTER BOTH IP/OP "$1,142.00" $845.00 $226.63 "$1,141.88" $513.85 $513.85 $513.85 $513.85 "$1,141.88" "$1,141.88" "$1,141.88" $238.00 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $237.98 "$1,141.88" "$1,141.88" $675.42 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $856.50 "$1,141.88" "$1,141.88" "$1,141.88" $570.94 $570.94 $904.37 "$1,141.88" $913.50 $513.85 $226.63 N/A $662.36 "$1,141.88" "$1,141.88" "$1,141.88" $237.97 "$1,141.88" N/A N/A 71678010 SUP HCPCS C1713 71678010 - SCREW BN 11MM 100MM INTERTAN LG TI SUBTROCHANTER BOTH IP/OP "$1,142.00" $845.00 $226.63 "$1,141.88" $513.85 $513.85 $513.85 $513.85 "$1,141.88" "$1,141.88" "$1,141.88" $238.00 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $237.98 "$1,141.88" $456.75 $675.42 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $856.50 "$1,141.88" "$1,141.88" "$1,141.88" $570.94 $570.94 $904.37 "$1,141.88" $913.50 $513.85 $226.63 N/A $662.36 "$1,141.88" "$1,141.88" "$1,141.88" $237.97 "$1,141.88" N/A N/A 71678011 SUP HCPCS C1713 71678011 - SCREW BN 11MM 110MM INTERTAN LG TI SUBTROCHANTER BOTH IP/OP "$1,142.00" $845.00 $226.63 "$1,141.88" $513.85 $513.85 $513.85 $513.85 "$1,141.88" "$1,141.88" "$1,141.88" $238.00 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $237.98 "$1,141.88" "$1,141.88" $675.42 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $856.50 "$1,141.88" "$1,141.88" "$1,141.88" $570.94 $570.94 $904.37 "$1,141.88" $913.50 $513.85 $226.63 N/A $662.36 "$1,141.88" "$1,141.88" "$1,141.88" $237.97 "$1,141.88" N/A N/A 71678012 SUP HCPCS C1713 71678012 - SCREW BN 11MM 120MM INTERTAN LG TI SUBTROCHANTER BOTH IP/OP "$1,142.00" $845.00 $226.63 "$1,141.88" $513.85 $513.85 $513.85 $513.85 "$1,141.88" "$1,141.88" "$1,141.88" $238.00 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $237.98 "$1,141.88" $456.75 $675.42 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $856.50 "$1,141.88" "$1,141.88" "$1,141.88" $570.94 $570.94 $904.37 "$1,141.88" $913.50 $513.85 $226.63 N/A $662.36 "$1,141.88" "$1,141.88" "$1,141.88" $237.97 "$1,141.88" N/A N/A 71678015 SUP HCPCS C1713 71678015 - SCREW BN 11MM 115MM INTERTAN LG TI SUBTROCHANTER BOTH IP/OP "$1,142.00" $845.00 $226.63 "$1,141.88" $513.85 $513.85 $513.85 $513.85 "$1,141.88" "$1,141.88" "$1,141.88" $238.00 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $237.98 "$1,141.88" $456.75 $675.42 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $856.50 "$1,141.88" "$1,141.88" "$1,141.88" $570.94 $570.94 $904.37 "$1,141.88" $913.50 $513.85 $226.63 N/A $662.36 "$1,141.88" "$1,141.88" "$1,141.88" $237.97 "$1,141.88" N/A N/A 71678025 SUP HCPCS C1713 71678025 - SCREW BN 11MM 125MM INTERTAN LG SBTCH BOTH IP/OP "$1,142.00" $845.00 $226.63 "$1,141.88" $513.85 $513.85 $513.85 $513.85 "$1,141.88" "$1,141.88" "$1,141.88" $238.00 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $237.98 "$1,141.88" $456.75 $675.42 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $856.50 "$1,141.88" "$1,141.88" "$1,141.88" $570.94 $570.94 $904.37 "$1,141.88" $913.50 $513.85 $226.63 N/A $662.36 "$1,141.88" "$1,141.88" "$1,141.88" $237.97 "$1,141.88" N/A N/A 71678070 SUP HCPCS C1713 71678070 - SCREW BN 11MM 70MM INTERTAN LG SBTCH BOTH IP/OP "$1,142.00" $845.00 $226.63 "$1,141.88" $513.85 $513.85 $513.85 $513.85 "$1,141.88" "$1,141.88" "$1,141.88" $238.00 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $237.98 "$1,141.88" "$1,141.88" $675.42 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $856.50 "$1,141.88" "$1,141.88" "$1,141.88" $570.94 $570.94 $904.37 "$1,141.88" $913.50 $513.85 $226.63 N/A $662.36 "$1,141.88" "$1,141.88" "$1,141.88" $237.97 "$1,141.88" N/A N/A 71678075 SUP HCPCS C1713 71678075 - SCREW BN 11MM 75MM INTERTAN LG SBTCH BOTH IP/OP "$1,142.00" $845.00 $226.63 "$1,141.88" $513.85 $513.85 $513.85 $513.85 "$1,141.88" "$1,141.88" "$1,141.88" $238.00 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $237.98 "$1,141.88" $456.75 $675.42 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $856.50 "$1,141.88" "$1,141.88" "$1,141.88" $570.94 $570.94 $904.37 "$1,141.88" $913.50 $513.85 $226.63 N/A $662.36 "$1,141.88" "$1,141.88" "$1,141.88" $237.97 "$1,141.88" N/A N/A 71678080 SUP HCPCS C1713 71678080 - SCREW BN 11MM 80MM INTERTAN LG TI SUBTROCHANTER BOTH IP/OP "$1,142.00" $845.00 $226.63 "$1,141.88" $513.85 $513.85 $513.85 $513.85 "$1,141.88" "$1,141.88" "$1,141.88" $238.00 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $237.98 "$1,141.88" $456.75 $675.42 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $856.50 "$1,141.88" "$1,141.88" "$1,141.88" $570.94 $570.94 $904.37 "$1,141.88" $913.50 $513.85 $226.63 N/A $662.36 "$1,141.88" "$1,141.88" "$1,141.88" $237.97 "$1,141.88" N/A N/A 71678085 SUP HCPCS C1713 71678085 - SCREW BN 11MM 85MM INTERTAN LG TI SUBTROCHANTER BOTH IP/OP "$1,142.00" $845.00 $226.63 "$1,141.88" $513.85 $513.85 $513.85 $513.85 "$1,141.88" "$1,141.88" "$1,141.88" $238.00 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $237.98 "$1,141.88" "$1,141.88" $675.42 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $856.50 "$1,141.88" "$1,141.88" "$1,141.88" $570.94 $570.94 $904.37 "$1,141.88" $913.50 $513.85 $226.63 N/A $662.36 "$1,141.88" "$1,141.88" "$1,141.88" $237.97 "$1,141.88" N/A N/A 71678090 SUP HCPCS C1713 71678090 - SCREW BN 11MM 90MM INTERTAN LG TI SUBTROCHANTER BOTH IP/OP "$1,142.00" $845.00 $226.63 "$1,141.88" $513.85 $513.85 $513.85 $513.85 "$1,141.88" "$1,141.88" "$1,141.88" $238.00 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $237.98 "$1,141.88" $456.75 $675.42 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $856.50 "$1,141.88" "$1,141.88" "$1,141.88" $570.94 $570.94 $904.37 "$1,141.88" $913.50 $513.85 $226.63 N/A $662.36 "$1,141.88" "$1,141.88" "$1,141.88" $237.97 "$1,141.88" N/A N/A 71678095 SUP HCPCS C1713 71678095 - SCREW BN 11MM 95MM INTERTAN LG TI SUBTROCHANTER BOTH IP/OP "$1,142.00" $845.00 $226.63 "$1,141.88" $513.85 $513.85 $513.85 $513.85 "$1,141.88" "$1,141.88" "$1,141.88" $238.00 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $237.98 "$1,141.88" "$1,141.88" $675.42 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $856.50 "$1,141.88" "$1,141.88" "$1,141.88" $570.94 $570.94 $904.37 "$1,141.88" $913.50 $513.85 $226.63 N/A $662.36 "$1,141.88" "$1,141.88" "$1,141.88" $237.97 "$1,141.88" N/A N/A 71679002 SUP HCPCS C1713 71679002 - PLATE BN 127D 80MM INTERTAN CHS 2 HL SS BOTH IP/OP "$2,080.00" "$1,539.00" $412.83 "$2,080.00" $936.00 $936.00 $936.00 $936.00 "$2,080.00" "$2,080.00" "$2,080.00" $433.52 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $433.49 "$2,080.00" $832.00 "$1,230.32" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,560.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,040.00" "$1,040.00" "$1,647.36" "$2,080.00" "$1,664.00" $936.00 $412.83 N/A "$1,206.40" "$2,080.00" "$1,248.00" "$2,080.00" $433.47 "$2,080.00" N/A N/A 71679003 SUP HCPCS C1713 71679003 - PLATE BN 127D 92MM INTERTAN CHS 3 HL SS BOTH IP/OP "$2,080.00" "$1,539.00" $412.83 "$2,080.00" $936.00 $936.00 $936.00 $936.00 "$2,080.00" "$2,080.00" "$2,080.00" $433.52 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $433.49 "$2,080.00" "$2,080.00" "$1,230.32" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,560.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,040.00" "$1,040.00" "$1,647.36" "$2,080.00" "$1,664.00" $936.00 $412.83 N/A "$1,206.40" "$2,080.00" "$1,248.00" "$2,080.00" $433.47 "$2,080.00" N/A N/A 71679004 SUP HCPCS C1713 71679004 - PLATE BN 127D 104MM INTERTAN CHS 4 HL SS BOTH IP/OP "$2,080.00" "$1,539.00" $412.83 "$2,080.00" $936.00 $936.00 $936.00 $936.00 "$2,080.00" "$2,080.00" "$2,080.00" $433.52 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $433.49 "$2,080.00" $832.00 "$1,230.32" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,560.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,040.00" "$1,040.00" "$1,647.36" "$2,080.00" "$1,664.00" $936.00 $412.83 N/A "$1,206.40" "$2,080.00" "$1,248.00" "$2,080.00" "$2,080.00" "$2,080.00" N/A N/A 71679005 SUP HCPCS C1713 71679005 - PLATE BN 127D 116MM INTERTAN CHS 5 HL SS HIP BOTH IP/OP "$2,080.00" "$1,539.00" $412.83 "$2,080.00" $936.00 $936.00 $936.00 $936.00 "$2,080.00" "$2,080.00" "$2,080.00" $433.52 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $433.49 "$2,080.00" "$2,080.00" "$1,230.32" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,560.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,040.00" "$1,040.00" "$1,647.36" "$2,080.00" "$1,664.00" $936.00 $412.83 N/A "$1,206.40" "$2,080.00" "$1,248.00" "$2,080.00" "$2,080.00" "$2,080.00" N/A N/A 71679006 SUP HCPCS C1713 71679006 - PLATE BN 127D 128MM INTERTAN CHS 6 HL SS HIP BOTH IP/OP "$2,080.00" "$1,539.00" $412.83 "$2,080.00" $936.00 $936.00 $936.00 $936.00 "$2,080.00" "$2,080.00" "$2,080.00" $433.52 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $433.49 "$2,080.00" "$2,080.00" "$1,230.32" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,560.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,040.00" "$1,040.00" "$1,647.36" "$2,080.00" "$1,664.00" $936.00 $412.83 N/A "$1,206.40" "$2,080.00" "$1,248.00" "$2,080.00" $433.47 "$2,080.00" N/A N/A 71679102 SUP HCPCS C1713 71679102 - PLATE BN 135D 84MM INTERTAN CHS 2 HL SS BOTH IP/OP "$2,080.00" "$1,539.00" $412.83 "$2,080.00" $936.00 $936.00 $936.00 $936.00 "$2,080.00" "$2,080.00" "$2,080.00" $433.52 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $433.49 "$2,080.00" $832.00 "$1,230.32" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,560.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,040.00" "$1,040.00" "$1,647.36" "$2,080.00" "$1,664.00" $936.00 $412.83 N/A "$1,206.40" "$2,080.00" "$1,248.00" "$2,080.00" $433.47 "$2,080.00" N/A N/A 71679103 SUP HCPCS C1713 71679103 - PLATE BN 135D 96MM INTERTAN CHS 3 HL SS HIP BOTH IP/OP "$2,080.00" "$1,539.00" $412.83 "$2,080.00" $936.00 $936.00 $936.00 $936.00 "$2,080.00" "$2,080.00" "$2,080.00" $433.52 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $433.49 "$2,080.00" $832.00 "$1,230.32" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,560.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,040.00" "$1,040.00" "$1,647.36" "$2,080.00" "$1,664.00" $936.00 $412.83 N/A "$1,206.40" "$2,080.00" "$1,248.00" "$2,080.00" $433.47 "$2,080.00" N/A N/A 71679104 SUP HCPCS C1713 71679104 - PLATE BN 135D 4 HL CMPR ORTH BOTH IP/OP "$2,080.00" "$1,539.00" $412.83 "$2,080.00" $936.00 $936.00 $936.00 $936.00 "$2,080.00" "$2,080.00" "$2,080.00" $433.52 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $433.49 "$2,080.00" "$2,080.00" "$1,230.32" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,560.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,040.00" "$1,040.00" "$1,647.36" "$2,080.00" "$1,664.00" $936.00 $412.83 N/A "$1,206.40" "$2,080.00" "$2,080.00" "$2,080.00" $433.47 "$2,080.00" N/A N/A 71679105 SUP HCPCS C1713 71679105 - PLATE BN 135D 120MM INTERTAN CHS 5 HL SS HIP BOTH IP/OP "$2,080.00" "$1,539.00" $412.83 "$2,080.00" $936.00 $936.00 $936.00 $936.00 "$2,080.00" "$2,080.00" "$2,080.00" $433.52 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $433.49 "$2,080.00" $832.00 "$1,230.32" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,560.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,040.00" "$1,040.00" "$1,647.36" "$2,080.00" "$1,664.00" $936.00 $412.83 N/A "$1,206.40" "$2,080.00" "$2,080.00" "$2,080.00" $433.47 "$2,080.00" N/A N/A 71679106 SUP HCPCS C1713 71679106 - SCREW BN 135D 132MM INTERTAN CHS 6 HL SS BOTH IP/OP "$2,080.00" "$1,539.00" $412.83 "$2,080.00" $936.00 $936.00 $936.00 $936.00 "$2,080.00" "$2,080.00" "$2,080.00" $433.52 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $433.49 "$2,080.00" $832.00 "$1,230.32" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,560.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,040.00" "$1,040.00" "$1,647.36" "$2,080.00" "$1,664.00" $936.00 $412.83 N/A "$1,206.40" "$2,080.00" "$2,080.00" "$2,080.00" $433.47 "$2,080.00" N/A N/A 71679230 SUP HCPCS C1713 71679230 - SCREW BN 30MM INTERTAN CHS CMPR SS BOTH IP/OP $904.00 $669.00 $179.42 $904.00 $406.80 $406.80 $406.80 $406.80 $904.00 $904.00 $904.00 $188.42 $904.00 $904.00 $904.00 $904.00 $904.00 $188.40 $904.00 $361.60 $534.72 $904.00 $904.00 $904.00 $904.00 $678.00 $904.00 $904.00 $904.00 $452.00 $452.00 $715.97 $904.00 $723.20 $406.80 $179.42 N/A $524.32 $904.00 $904.00 $904.00 $188.39 $904.00 N/A N/A 71679265 SUP HCPCS C1713 71679265 - SCREW BN 65/60 INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,642.00" "$1,215.00" $325.90 "$1,642.00" $738.90 $738.90 $738.90 $738.90 "$1,642.00" "$1,642.00" "$1,642.00" $342.23 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" $342.21 "$1,642.00" "$1,642.00" $971.24 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,231.50" "$1,642.00" "$1,642.00" "$1,642.00" $821.00 $821.00 "$1,300.46" "$1,642.00" "$1,313.60" $738.90 $325.90 N/A $952.36 "$1,642.00" "$1,642.00" "$1,642.00" $342.19 "$1,642.00" N/A N/A 71679270 SUP HCPCS C1713 71679270 - SCREW BN 70/65 INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,642.00" "$1,215.00" $325.90 "$1,642.00" $738.90 $738.90 $738.90 $738.90 "$1,642.00" "$1,642.00" "$1,642.00" $342.23 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" $342.21 "$1,642.00" "$1,642.00" $971.24 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,231.50" "$1,642.00" "$1,642.00" "$1,642.00" $821.00 $821.00 "$1,300.46" "$1,642.00" "$1,313.60" $738.90 $325.90 N/A $952.36 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" N/A N/A 71679275 SUP HCPCS C1713 71679275 - SCREW BN 75/70 INTERTAN CHS CMPR LG SS HIP BOTH IP/OP "$1,642.00" "$1,215.00" $325.90 "$1,642.00" $738.90 $738.90 $738.90 $738.90 "$1,642.00" "$1,642.00" "$1,642.00" $342.23 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" $342.21 "$1,642.00" "$1,642.00" $971.24 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,231.50" "$1,642.00" "$1,642.00" "$1,642.00" $821.00 $821.00 "$1,300.46" "$1,642.00" "$1,313.60" $738.90 $325.90 N/A $952.36 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" N/A N/A 71679280 SUP HCPCS C1713 71679280 - SCREW BN 80/75 INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,642.00" "$1,215.00" $325.90 "$1,642.00" $738.90 $738.90 $738.90 $738.90 "$1,642.00" "$1,642.00" "$1,642.00" $342.23 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" $342.21 "$1,642.00" "$1,642.00" $971.24 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,231.50" "$1,642.00" "$1,642.00" "$1,642.00" $821.00 $821.00 "$1,300.46" "$1,642.00" "$1,313.60" $738.90 $325.90 N/A $952.36 "$1,642.00" "$1,642.00" "$1,642.00" $342.19 "$1,642.00" N/A N/A 71679285 SUP HCPCS C1713 71679285 - SCREW BN 85/80 INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,642.00" "$1,215.00" $325.90 "$1,642.00" $738.90 $738.90 $738.90 $738.90 "$1,642.00" "$1,642.00" "$1,642.00" $342.23 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" $342.21 "$1,642.00" "$1,642.00" $971.24 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,231.50" "$1,642.00" "$1,642.00" "$1,642.00" $821.00 $821.00 "$1,300.46" "$1,642.00" "$1,313.60" $738.90 $325.90 N/A $952.36 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" N/A N/A 71679290 SUP HCPCS C1713 71679290 - SCREW BN 90/85 INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,642.00" "$1,215.00" $325.90 "$1,642.00" $738.90 $738.90 $738.90 $738.90 "$1,642.00" "$1,642.00" "$1,642.00" $342.23 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" $342.21 "$1,642.00" "$1,642.00" $971.24 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,231.50" "$1,642.00" "$1,642.00" "$1,642.00" $821.00 $821.00 "$1,300.46" "$1,642.00" "$1,313.60" $738.90 $325.90 N/A $952.36 "$1,642.00" "$1,642.00" "$1,642.00" $342.19 "$1,642.00" N/A N/A 71679295 SUP HCPCS C1713 71679295 - SCREW BN 95/90 INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,642.00" "$1,215.00" $325.90 "$1,642.00" $738.90 $738.90 $738.90 $738.90 "$1,642.00" "$1,642.00" "$1,642.00" $342.23 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" $342.21 "$1,642.00" $656.80 $971.24 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,231.50" "$1,642.00" "$1,642.00" "$1,642.00" $821.00 $821.00 "$1,300.46" "$1,642.00" "$1,313.60" $738.90 $325.90 N/A $952.36 "$1,642.00" "$1,642.00" "$1,642.00" $342.19 "$1,642.00" N/A N/A 71679300 SUP HCPCS C1713 71679300 - SCREW BN 100/95 INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,642.00" "$1,215.00" $325.90 "$1,642.00" $738.90 $738.90 $738.90 $738.90 "$1,642.00" "$1,642.00" "$1,642.00" $342.23 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" $342.21 "$1,642.00" "$1,642.00" $971.24 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,231.50" "$1,642.00" "$1,642.00" "$1,642.00" $821.00 $821.00 "$1,300.46" "$1,642.00" "$1,313.60" $738.90 $325.90 N/A $952.36 "$1,642.00" $985.20 "$1,642.00" $342.19 "$1,642.00" N/A N/A 71679305 SUP HCPCS C1713 71679305 - SCREW BN 105/100 INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,642.00" "$1,215.00" $325.90 "$1,642.00" $738.90 $738.90 $738.90 $738.90 "$1,642.00" "$1,642.00" "$1,642.00" $342.23 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" $342.21 "$1,642.00" "$1,642.00" $971.24 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,231.50" "$1,642.00" "$1,642.00" "$1,642.00" $821.00 $821.00 "$1,300.46" "$1,642.00" "$1,313.60" $738.90 $325.90 N/A $952.36 "$1,642.00" $985.20 "$1,642.00" $342.19 "$1,642.00" N/A N/A 71679310 SUP HCPCS C1713 71679310 - SCREW BN 110/105 INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,642.00" "$1,215.00" $325.90 "$1,642.00" $738.90 $738.90 $738.90 $738.90 "$1,642.00" "$1,642.00" "$1,642.00" $342.23 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" $342.21 "$1,642.00" $656.80 $971.24 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,231.50" "$1,642.00" "$1,642.00" "$1,642.00" $821.00 $821.00 "$1,300.46" "$1,642.00" "$1,313.60" $738.90 $325.90 N/A $952.36 "$1,642.00" "$1,642.00" "$1,642.00" $342.19 "$1,642.00" N/A N/A 71679315 SUP HCPCS C1713 71679315 - SCREW BN 115/110 INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,642.00" "$1,215.00" $325.90 "$1,642.00" $738.90 $738.90 $738.90 $738.90 "$1,642.00" "$1,642.00" "$1,642.00" $342.23 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" $342.21 "$1,642.00" $656.80 $971.24 "$1,642.00" "$1,642.00" "$1,642.00" "$1,642.00" "$1,231.50" "$1,642.00" "$1,642.00" "$1,642.00" $821.00 $821.00 "$1,300.46" "$1,642.00" "$1,313.60" $738.90 $325.90 N/A $952.36 "$1,642.00" $985.20 "$1,642.00" $342.19 "$1,642.00" N/A N/A 71679320 SUP HCPCS C1713 71679320 - SCREW BN 120/115 INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,530.00" "$1,132.00" $303.67 "$1,530.00" $688.50 $688.50 $688.50 $688.50 "$1,530.00" "$1,530.00" "$1,530.00" $318.89 "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" $318.87 "$1,530.00" "$1,530.00" $905.00 "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" "$1,147.50" "$1,530.00" "$1,530.00" "$1,530.00" $765.00 $765.00 "$1,211.76" "$1,530.00" "$1,224.00" $688.50 $303.67 N/A $887.40 "$1,530.00" $918.00 "$1,530.00" $318.85 "$1,530.00" N/A N/A 71679325 SUP HCPCS C1713 71679325 - SCREW BN 125/120 INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,530.00" "$1,132.00" $303.67 "$1,530.00" $688.50 $688.50 $688.50 $688.50 "$1,530.00" "$1,530.00" "$1,530.00" $318.89 "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" $318.87 "$1,530.00" "$1,530.00" $905.00 "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" "$1,147.50" "$1,530.00" "$1,530.00" "$1,530.00" $765.00 $765.00 "$1,211.76" "$1,530.00" "$1,224.00" $688.50 $303.67 N/A $887.40 "$1,530.00" $918.00 "$1,530.00" $318.85 "$1,530.00" N/A N/A 71679330 SUP HCPCS C1713 71679330 - SCREW BN 130/125 INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,530.00" "$1,132.00" $303.67 "$1,530.00" $688.50 $688.50 $688.50 $688.50 "$1,530.00" "$1,530.00" "$1,530.00" $318.89 "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" $318.87 "$1,530.00" $612.00 $905.00 "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" "$1,147.50" "$1,530.00" "$1,530.00" "$1,530.00" $765.00 $765.00 "$1,211.76" "$1,530.00" "$1,224.00" $688.50 $303.67 N/A $887.40 "$1,530.00" $918.00 "$1,530.00" $318.85 "$1,530.00" N/A N/A 71679335 SUP HCPCS C1713 71679335 - SCREW BN 135/130MM INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,530.00" "$1,132.00" $303.67 "$1,530.00" $688.50 $688.50 $688.50 $688.50 "$1,530.00" "$1,530.00" "$1,530.00" $318.89 "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" $318.87 "$1,530.00" $612.00 $905.00 "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" "$1,147.50" "$1,530.00" "$1,530.00" "$1,530.00" $765.00 $765.00 "$1,211.76" "$1,530.00" "$1,224.00" $688.50 $303.67 N/A $887.40 "$1,530.00" $918.00 "$1,530.00" $318.85 "$1,530.00" N/A N/A 71679340 SUP HCPCS C1713 71679340 - SCREW BN 140/135 INTERTAN CHS LG CMPR SS BOTH IP/OP "$1,530.00" "$1,132.00" $303.67 "$1,530.00" $688.50 $688.50 $688.50 $688.50 "$1,530.00" "$1,530.00" "$1,530.00" $318.89 "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" $318.87 "$1,530.00" "$1,530.00" $905.00 "$1,530.00" "$1,530.00" "$1,530.00" "$1,530.00" "$1,147.50" "$1,530.00" "$1,530.00" "$1,530.00" $765.00 $765.00 "$1,211.76" "$1,530.00" "$1,224.00" $688.50 $303.67 N/A $887.40 "$1,530.00" $918.00 "$1,530.00" $318.85 "$1,530.00" N/A N/A 71683935 SUP HCPCS C1713 71683935 - CAP END IMHS CP HIP IM NL BOTH IP/OP $701.00 $519.00 $139.11 $700.88 $315.40 $315.40 $315.40 $315.40 $700.88 $700.88 $700.88 $146.08 $700.88 $700.88 $700.88 $700.88 $700.88 $146.07 $700.88 $700.88 $414.57 $700.88 $700.88 $700.88 $700.88 $525.75 $700.88 $700.88 $700.88 $350.44 $350.44 $555.10 $700.88 $560.70 $315.40 $139.11 N/A $406.58 $700.88 $420.53 $700.88 $146.06 $700.88 N/A N/A 71683940 SUP HCPCS C1713 71683940 - SET SCR IMHS CP CNN INTRAMEDULLARLY HIP SCR BOTH IP/OP $477.00 $353.00 $94.65 $476.88 $214.60 $214.60 $214.60 $214.60 $476.88 $476.88 $476.88 $99.39 $476.88 $476.88 $476.88 $476.88 $476.88 $99.39 $476.88 $190.75 $282.07 $476.88 $476.88 $476.88 $476.88 $357.75 $476.88 $476.88 $476.88 $238.44 $238.44 $377.69 $476.88 $381.50 $214.60 $94.65 N/A $276.66 $476.88 $476.88 $476.88 $99.38 $476.88 N/A N/A 71683945 SUP HCPCS C1713 71683945 - SCREW BN 19MM IMHS CP CPTR CMPR HIP IM NL SYS BOTH IP/OP $600.50 $444.00 $119.13 $600.25 $270.11 $270.11 $270.11 $270.11 $600.25 $600.25 $600.25 $125.11 $600.25 $600.25 $600.25 $600.25 $600.25 $125.10 $600.25 $240.10 $355.05 $600.25 $600.25 $600.25 $600.25 $450.38 $600.25 $600.25 $600.25 $300.13 $300.13 $475.40 $600.25 $480.20 $270.11 $119.13 N/A $348.29 $600.25 $360.15 $600.25 $125.09 $600.25 N/A N/A 71684070 SUP HCPCS C1713 71684070 - SCREW BN 12.7MM 70MM IMHS CP LG SBTCH IM NL BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 71684075 SUP HCPCS C1713 71684075 - SCREW BN 12.7MM 75MM IMHS CP LG SBTCH IM NL BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 71684080 SUP HCPCS C1713 71684080 - SCREW BN 12.7MM 80MM IMHS CP LG SBTCH IM NL BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" "$1,260.00" "$1,260.00" N/A N/A 71684085 SUP HCPCS C1713 71684085 - SCREW BN 12.7MM 85MM IMHS CP LG SUBTROCHANTER IM NL SYS BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" "$1,260.00" $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 71684090 SUP HCPCS C1713 71684090 - SCREW BN 12.7MM 90MM IMHS CP LG SUBTROCHANTER IM NL SYS BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 71684095 SUP HCPCS C1713 71684095 - SCREW BN 12.7MM 95MM IMHS CP LG SBTCH IM NL BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 71684100 SUP HCPCS C1713 71684100 - SCREW BN 12.7MM 100MM IMHS CP LG SUBTROCHANTER IM NL SYS BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" "$1,260.00" $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" "$1,260.00" "$1,260.00" $262.58 "$1,260.00" N/A N/A 71684105 SUP HCPCS C1713 71684105 - SCREW BN 12.7MM 105MM IMHS CP LG SUBTROCHANTER IM NL SYS BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 71684110 SUP HCPCS C1713 71684110 - SCREW BN 12.7MM 110MM IMHS CP LG SUBTROCHANTER IM NL SYS BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 71684115 SUP HCPCS C1713 71684115 - SCREW BN 12.7MM 115MM IMHS CP LG SUBTROCHANTER IM NL SYS BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 71684120 SUP HCPCS C1713 71684120 - SCREW BN 12.7MM 120MM IMHS CP LG SBTCH IM NL BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 71684125 SUP HCPCS C1713 71684125 - SCREW BN 12.7MM 125MM IMHS CP LG SBTCH IM NL BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" "$1,260.00" "$1,260.00" N/A N/A 71684130 SUP HCPCS C1713 71684130 - SCREW BN 12.7MM 130MM IMHS CP LG SBTCH IM NL BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" "$1,260.00" "$1,260.00" N/A N/A 71684135 SUP HCPCS C1713 71684135 - SCREW BN 12.7MM 135MM IMHS CP LG SBTCH IM NL BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 71684140 SUP HCPCS C1713 71684140 - SCREW BN 12.7MM 140MM IMHS CP LG SBTCH IM NL BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" "$1,260.00" "$1,260.00" N/A N/A 71687000 SUP Custom 27203010 71687000 - GUIDE PIN ORTHOPEDIC 3.2MM THREAD TIP IMHS CP INTRAMEDULLARY BOTH IP/OP $189.00 $140.00 $33.64 $189.00 $189.00 $189.00 $189.00 $189.00 $189.00 $189.00 $33.64 $189.00 $189.00 $140.28 $140.28 $145.68 $98.47 $39.39 $189.00 $75.60 $189.00 $189.00 $189.00 $189.00 $189.00 $141.75 $189.00 $189.00 $189.00 $94.50 $94.50 $149.69 $189.00 $151.20 $122.85 $189.00 N/A $109.62 $189.00 $113.40 $189.00 $189.00 $189.00 N/A N/A 71751136 SUP HCPCS C1713 71751136 - TROCAR SRG 3.2MM 3.2MM TRGN PIN HUM DISP BOTH IP/OP $353.50 $262.00 $70.11 $353.25 $158.96 $158.96 $158.96 $158.96 $353.25 $353.25 $353.25 $73.63 $353.25 $353.25 $353.25 $353.25 $353.25 $73.62 $353.25 $353.25 $208.95 $353.25 $353.25 $353.25 $353.25 $265.13 $353.25 $353.25 $353.25 $176.63 $176.63 $279.77 $353.25 $282.60 $158.96 $70.11 N/A $205.03 $353.25 $353.25 $353.25 $353.25 $353.25 N/A N/A 71751148 SUP Custom 27203010 71751148 - BIT DRL SHRT 3.2MM STRL TRGN GRAD BRAD PNT DISP IM NL BOTH IP/OP $505.50 $374.00 $89.91 $505.13 $505.13 $505.13 $505.13 $505.13 $505.13 $505.13 $89.91 $505.13 $505.13 $374.91 $374.91 $389.35 $263.17 $105.27 $505.13 $202.05 $505.13 $505.13 $505.13 $505.13 $505.13 $379.13 $505.13 $505.13 $505.13 $252.57 $252.57 $400.06 $505.13 $404.10 $328.33 $505.13 N/A $293.19 $505.13 $303.08 $505.13 $505.13 $505.13 N/A N/A 71751149 SUP Custom 27203010 71751149 - BIT DRL LNG 3.2MM STRL TRGN GRAD BRAD PNT DISP IM NL BOTH IP/OP $505.50 $374.00 $89.91 $505.13 $505.13 $505.13 $505.13 $505.13 $505.13 $505.13 $89.91 $505.13 $505.13 $374.91 $374.91 $389.35 $263.17 $105.27 $505.13 $202.05 $505.13 $505.13 $505.13 $505.13 $505.13 $379.13 $505.13 $505.13 $505.13 $252.57 $252.57 $400.06 $505.13 $404.10 $328.33 $505.13 N/A $293.19 $505.13 $303.08 $505.13 $505.13 $505.13 N/A N/A 71754020 SUP HCPCS C1713 71754020 - SCREW BN 4MM 20MM TRGN ST TI HUM CORT IM NL SYS BOTH IP/OP $360.00 $266.00 $71.45 $360.00 $162.00 $162.00 $162.00 $162.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $212.94 $360.00 $360.00 $360.00 $360.00 $270.00 $360.00 $360.00 $360.00 $180.00 $180.00 $285.12 $360.00 $288.00 $162.00 $71.45 N/A $208.80 $360.00 $360.00 $360.00 $75.02 $360.00 N/A N/A 71754022 SUP HCPCS C1713 71754022 - SCREW BN 4MM 22MM TRGN ST TI HUM CORT IM NL SYS BOTH IP/OP $360.00 $266.00 $71.45 $360.00 $162.00 $162.00 $162.00 $162.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $360.00 $360.00 $360.00 $75.03 $360.00 $144.00 $212.94 $360.00 $360.00 $360.00 $360.00 $270.00 $360.00 $360.00 $360.00 $180.00 $180.00 $285.12 $360.00 $288.00 $162.00 $71.45 N/A $208.80 $360.00 $216.00 $360.00 $75.02 $360.00 N/A N/A 71754024 SUP HCPCS C1713 71754024 - SCREW BN 4MM 24MM TRGN ST TI HUM CORT IM NL SYS BOTH IP/OP $360.00 $266.00 $71.45 $360.00 $162.00 $162.00 $162.00 $162.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $360.00 $360.00 $360.00 $75.03 $360.00 $144.00 $212.94 $360.00 $360.00 $360.00 $360.00 $270.00 $360.00 $360.00 $360.00 $180.00 $180.00 $285.12 $360.00 $288.00 $162.00 $71.45 N/A $208.80 $360.00 $216.00 $360.00 $75.02 $360.00 N/A N/A 71754026 SUP HCPCS C1713 71754026 - SCREW BN 4MM 26MM TRGN ST TI HUM CORT IM NL SYS BOTH IP/OP $360.00 $266.00 $71.45 $360.00 $162.00 $162.00 $162.00 $162.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $212.94 $360.00 $360.00 $360.00 $360.00 $270.00 $360.00 $360.00 $360.00 $180.00 $180.00 $285.12 $360.00 $288.00 $162.00 $71.45 N/A $208.80 $360.00 $216.00 $360.00 $75.02 $360.00 N/A N/A 71754028 SUP HCPCS C1713 71754028 - SCREW BN 4MM 28MM TRGN ST TI HUM CORT IM NL SYS BOTH IP/OP $360.00 $266.00 $71.45 $360.00 $162.00 $162.00 $162.00 $162.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $212.94 $360.00 $360.00 $360.00 $360.00 $270.00 $360.00 $360.00 $360.00 $180.00 $180.00 $285.12 $360.00 $288.00 $162.00 $71.45 N/A $208.80 $360.00 $360.00 $360.00 $75.02 $360.00 N/A N/A 71754030 SUP HCPCS C1713 71754030 - SCREW BN 4MM 30MM TRGN ST TI HUM CORT IM NL SYS BOTH IP/OP $360.00 $266.00 $71.45 $360.00 $162.00 $162.00 $162.00 $162.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $360.00 $360.00 $360.00 $75.03 $360.00 $144.00 $212.94 $360.00 $360.00 $360.00 $360.00 $270.00 $360.00 $360.00 $360.00 $180.00 $180.00 $285.12 $360.00 $288.00 $162.00 $71.45 N/A $208.80 $360.00 $216.00 $360.00 $75.02 $360.00 N/A N/A 71754032 SUP HCPCS C1713 71754032 - SCREW BN 4MM 32MM TRGN ST TI HUM CORT IM NL SYS BOTH IP/OP $360.00 $266.00 $71.45 $360.00 $162.00 $162.00 $162.00 $162.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $360.00 $360.00 $360.00 $75.03 $360.00 $144.00 $212.94 $360.00 $360.00 $360.00 $360.00 $270.00 $360.00 $360.00 $360.00 $180.00 $180.00 $285.12 $360.00 $288.00 $162.00 $71.45 N/A $208.80 $360.00 $216.00 $360.00 $75.02 $360.00 N/A N/A 71754034 SUP HCPCS C1713 71754034 - SCREW BN 4MM 34MM TRGN ST TI HUM CORT IM NL SYS BOTH IP/OP $360.00 $266.00 $71.45 $360.00 $162.00 $162.00 $162.00 $162.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $212.94 $360.00 $360.00 $360.00 $360.00 $270.00 $360.00 $360.00 $360.00 $180.00 $180.00 $285.12 $360.00 $288.00 $162.00 $71.45 N/A $208.80 $360.00 $216.00 $360.00 $75.02 $360.00 N/A N/A 71754036 SUP HCPCS C1713 71754036 - SCREW BN 4MM 36MM TRGN ST TI HUM CORT IM NL SYS BOTH IP/OP $360.00 $266.00 $71.45 $360.00 $162.00 $162.00 $162.00 $162.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $212.94 $360.00 $360.00 $360.00 $360.00 $270.00 $360.00 $360.00 $360.00 $180.00 $180.00 $285.12 $360.00 $288.00 $162.00 $71.45 N/A $208.80 $360.00 $216.00 $360.00 $75.02 $360.00 N/A N/A 71754038 SUP HCPCS C1713 71754038 - SCREW BN 4MM 38MM TRGN ST TI HUM CORT IM NL SYS BOTH IP/OP $360.00 $266.00 $71.45 $360.00 $162.00 $162.00 $162.00 $162.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $360.00 $360.00 $360.00 $75.03 $360.00 $144.00 $212.94 $360.00 $360.00 $360.00 $360.00 $270.00 $360.00 $360.00 $360.00 $180.00 $180.00 $285.12 $360.00 $288.00 $162.00 $71.45 N/A $208.80 $360.00 $360.00 $360.00 $75.02 $360.00 N/A N/A 71754040 SUP HCPCS C1713 71754040 - SCREW BN 4MM 40MM TRGN ST TI HUM CORT IM NL SYS BOTH IP/OP $360.00 $266.00 $71.45 $360.00 $162.00 $162.00 $162.00 $162.00 $360.00 $360.00 $360.00 $75.03 $360.00 $360.00 $360.00 $360.00 $360.00 $75.03 $360.00 $144.00 $212.94 $360.00 $360.00 $360.00 $360.00 $270.00 $360.00 $360.00 $360.00 $180.00 $180.00 $285.12 $360.00 $288.00 $162.00 $71.45 N/A $208.80 $360.00 $360.00 $360.00 $75.02 $360.00 N/A N/A 71754042 SUP HCPCS C1713 71754042 - SCREW BN 4MM 42MM TRGN ST TI HUM CORT IM NL BOTH IP/OP $342.00 $253.00 $67.88 $342.00 $153.90 $153.90 $153.90 $153.90 $342.00 $342.00 $342.00 $71.28 $342.00 $342.00 $342.00 $342.00 $342.00 $71.28 $342.00 $342.00 $202.29 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $153.90 $67.88 N/A $198.36 $342.00 $342.00 $342.00 $342.00 $342.00 N/A N/A 71754044 SUP HCPCS C1713 71754044 - SCREW BN 4MM 44MM TRGN ST TI HUM CORT IM NL BOTH IP/OP $342.00 $253.00 $67.88 $342.00 $153.90 $153.90 $153.90 $153.90 $342.00 $342.00 $342.00 $71.28 $342.00 $342.00 $342.00 $342.00 $342.00 $71.28 $342.00 $342.00 $202.29 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $153.90 $67.88 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 71754046 SUP HCPCS C1713 71754046 - SCREW BN 4MM 44MM TRGN ST TI HUM CORT IM NL BOTH IP/OP $342.00 $253.00 $67.88 $342.00 $153.90 $153.90 $153.90 $153.90 $342.00 $342.00 $342.00 $71.28 $342.00 $342.00 $342.00 $342.00 $342.00 $71.28 $342.00 $136.80 $202.29 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $153.90 $67.88 N/A $198.36 $342.00 $205.20 $342.00 $71.27 $342.00 N/A N/A 71754048 SUP HCPCS C1713 71754048 - SCREW BN 4MM 48MM TRGN ST TI HUM CORT IM NL BOTH IP/OP $342.00 $253.00 $67.88 $342.00 $153.90 $153.90 $153.90 $153.90 $342.00 $342.00 $342.00 $71.28 $342.00 $342.00 $342.00 $342.00 $342.00 $71.28 $342.00 $136.80 $202.29 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $153.90 $67.88 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 71754050 SUP HCPCS C1713 71754050 - SCREW BN 4MM 50MM TRGN ST TI HUM CORT IM NL BOTH IP/OP $342.00 $253.00 $67.88 $342.00 $153.90 $153.90 $153.90 $153.90 $342.00 $342.00 $342.00 $71.28 $342.00 $342.00 $342.00 $342.00 $342.00 $71.28 $342.00 $342.00 $202.29 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $153.90 $67.88 N/A $198.36 $342.00 $205.20 $342.00 $342.00 $342.00 N/A N/A 71754052 SUP HCPCS C1713 71754052 - SCREW BN 4MM 52MM TRGN ST TI HUM CORT IM NL BOTH IP/OP $310.50 $230.00 $61.63 $310.50 $139.73 $139.73 $139.73 $139.73 $310.50 $310.50 $310.50 $64.72 $310.50 $310.50 $310.50 $310.50 $310.50 $64.71 $310.50 $310.50 $183.66 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $139.73 $61.63 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 71754054 SUP HCPCS C1713 71754054 - SCREW BN 4MM 54MM TRGN ST TI HUM CORT IM NL BOTH IP/OP $342.00 $253.00 $67.88 $342.00 $153.90 $153.90 $153.90 $153.90 $342.00 $342.00 $342.00 $71.28 $342.00 $342.00 $342.00 $342.00 $342.00 $71.28 $342.00 $136.80 $202.29 $342.00 $342.00 $342.00 $342.00 $256.50 $342.00 $342.00 $342.00 $171.00 $171.00 $270.86 $342.00 $273.60 $153.90 $67.88 N/A $198.36 $342.00 $205.20 $342.00 $71.27 $342.00 N/A N/A 71754056 SUP HCPCS C1713 71754056 - SCREW BN 4MM 56MM TRGN ST TI HUM CORT IM NL BOTH IP/OP $310.50 $230.00 $61.63 $310.50 $139.73 $139.73 $139.73 $139.73 $310.50 $310.50 $310.50 $64.72 $310.50 $310.50 $310.50 $310.50 $310.50 $64.71 $310.50 $124.20 $183.66 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $139.73 $61.63 N/A $180.09 $310.50 $186.30 $310.50 $64.71 $310.50 N/A N/A 71754058 SUP HCPCS C1713 71754058 - SCREW BN 4MM 58MM TRGN ST TI HUM CORT IM NL BOTH IP/OP $310.50 $230.00 $61.63 $310.50 $139.73 $139.73 $139.73 $139.73 $310.50 $310.50 $310.50 $64.72 $310.50 $310.50 $310.50 $310.50 $310.50 $64.71 $310.50 $310.50 $183.66 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $139.73 $61.63 N/A $180.09 $310.50 $186.30 $310.50 $64.71 $310.50 N/A N/A 71754060 SUP HCPCS C1713 71754060 - SCREW BN 4MM 60MM TRGN ST TI HUM CORT IM NL BOTH IP/OP $310.50 $230.00 $61.63 $310.50 $139.73 $139.73 $139.73 $139.73 $310.50 $310.50 $310.50 $64.72 $310.50 $310.50 $310.50 $310.50 $310.50 $64.71 $310.50 $310.50 $183.66 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $139.73 $61.63 N/A $180.09 $310.50 $186.30 $310.50 $64.71 $310.50 N/A N/A 71755024 SUP HCPCS C1713 71755024 - SCREW BN 5MM 24MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $91.20 $437.63 N/A N/A 71755026 SUP HCPCS C1713 71755026 - SCREW BN 5MM 26MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $91.20 $437.63 N/A N/A 71755028 SUP HCPCS C1713 71755028 - SCREW BN 5MM 28MM TRGN CNN ST TI HUM CANC IM NL BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $91.20 $437.63 N/A N/A 71755030 SUP HCPCS C1713 71755030 - SCREW BN 5MM 30MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $91.20 $437.63 N/A N/A 71755032 SUP HCPCS C1713 71755032 - SCREW BN 5MM 32MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $91.20 $437.63 N/A N/A 71755034 SUP HCPCS C1713 71755034 - SCREW BN 5MM 34MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $91.20 $437.63 N/A N/A 71755036 SUP HCPCS C1713 71755036 - SCREW BN 5MM 36MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $91.20 $437.63 N/A N/A 71755038 SUP HCPCS C1713 71755038 - SCREW BN 5MM 38MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $91.20 $437.63 N/A N/A 71755040 SUP HCPCS C1713 71755040 - SCREW BN 5MM 40MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $437.63 $437.63 $91.20 $437.63 N/A N/A 71755042 SUP HCPCS C1713 71755042 - SCREW BN 5MM 42MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $437.63 $437.63 $91.20 $437.63 N/A N/A 71755044 SUP HCPCS C1713 71755044 - SCREW BN 5MM 44MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $91.20 $437.63 N/A N/A 71755046 SUP HCPCS C1713 71755046 - SCREW BN 5MM 46MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $91.20 $437.63 N/A N/A 71755048 SUP HCPCS C1713 71755048 - SCREW BN 5MM 48MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $91.20 $437.63 N/A N/A 71755050 SUP HCPCS C1713 71755050 - SCREW BN 5MM 50MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $437.63 $437.63 $91.20 $437.63 N/A N/A 71755052 SUP HCPCS C1713 71755052 - SCREW BN 5MM 52MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $437.63 $437.63 N/A N/A 71755054 SUP HCPCS C1713 71755054 - SCREW BN 5MM 54MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $437.63 $437.63 N/A N/A 71755056 SUP HCPCS C1713 71755056 - SCREW BN 5MM 56MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $91.20 $437.63 N/A N/A 71755058 SUP HCPCS C1713 71755058 - SCREW BN 5MM 58MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $437.63 $437.63 N/A N/A 71755060 SUP HCPCS C1713 71755060 - SCREW BN 5MM 60MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $175.05 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $437.63 $437.63 N/A N/A 71755062 SUP HCPCS C1713 71755062 - SCREW BN 5MM 62MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $437.63 $437.63 $91.20 $437.63 N/A N/A 71755064 SUP HCPCS C1713 71755064 - SCREW BN 5MM 64MM TRGN ST TI HUM CANC IM NL SYS BOTH IP/OP $438.00 $324.00 $86.86 $437.63 $196.93 $196.93 $196.93 $196.93 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $437.63 $437.63 $437.63 $91.21 $437.63 $437.63 $258.86 $437.63 $437.63 $437.63 $437.63 $328.50 $437.63 $437.63 $437.63 $218.82 $218.82 $346.60 $437.63 $350.10 $196.93 $86.86 N/A $254.04 $437.63 $262.58 $437.63 $437.63 $437.63 N/A N/A 71760000 SUP HCPCS C1713 71760000 - CAP END 0MM TRGN HUM IM NL BOTH IP/OP $222.00 $164.00 $43.99 $221.63 $99.73 $99.73 $99.73 $99.73 $221.63 $221.63 $221.63 $46.19 $221.63 $221.63 $221.63 $221.63 $221.63 $46.19 $221.63 $221.63 $131.09 $221.63 $221.63 $221.63 $221.63 $166.50 $221.63 $221.63 $221.63 $110.82 $110.82 $175.53 $221.63 $177.30 $99.73 $43.99 N/A $128.76 $221.63 $221.63 $221.63 $221.63 $221.63 N/A N/A 71760816 SUP HCPCS C1713 71760816 - NAIL IM 8/7MM 16CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$3,656.25" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71760818 SUP HCPCS C1713 71760818 - NAIL IM 8/7MM 18CM TRGN STRG TI HUM BOTH IP/OP "$3,049.00" "$2,256.00" $605.10 "$3,048.75" "$1,371.94" "$1,371.94" "$1,371.94" "$1,371.94" "$3,048.75" "$3,048.75" "$3,048.75" $635.44 "$3,048.75" "$3,048.75" "$3,048.75" "$3,048.75" "$3,048.75" $635.39 "$3,048.75" "$3,048.75" "$1,503.03" "$3,048.75" "$3,048.75" "$3,048.75" "$3,048.75" "$2,286.75" "$3,048.75" "$3,048.75" "$3,048.75" "$1,524.38" "$1,524.38" "$2,414.61" "$3,048.75" "$2,439.00" "$1,371.94" $605.10 N/A "$1,768.42" "$3,048.75" "$1,829.25" "$3,048.75" $635.36 "$3,048.75" N/A N/A 71760820 SUP HCPCS C1713 71760820 - NAIL IM 8/7MM 20CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$3,656.25" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71760822 SUP HCPCS C1713 71760822 - NAIL IM 8/7MM 22CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$3,656.25" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71760826 SUP HCPCS C1713 71760826 - NAIL IM 8/7MM 26CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$3,656.25" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71760828 SUP HCPCS C1713 71760828 - NAIL IM 8/7MM 28CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" "$3,656.25" "$3,656.25" N/A N/A 71760830 SUP HCPCS C1713 71760830 - NAIL IM 8/7MM 30CM HUM BOTH IP/OP "$4,370.00" "$3,234.00" $867.34 "$4,370.00" "$1,966.50" "$1,966.50" "$1,966.50" "$1,966.50" "$4,370.00" "$4,370.00" "$4,370.00" $910.82 "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" $910.76 "$4,370.00" "$1,748.00" "$2,154.41" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$3,277.50" "$4,370.00" "$4,370.00" "$4,370.00" "$2,185.00" "$2,185.00" "$3,461.04" "$4,370.00" "$3,496.00" "$1,966.50" $867.34 N/A "$2,534.60" "$4,370.00" "$2,622.00" "$4,370.00" "$4,370.00" "$4,370.00" N/A N/A 71760918 SUP HCPCS C1713 71760918 - NAIL IM 8/7MM 18CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$3,656.25" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71760920 SUP HCPCS C1713 71760920 - NAIL IM 9/7.5MM 20CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71760922 SUP HCPCS C1713 71760922 - NAIL IM 9/7.5MM 22CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71760924 SUP HCPCS C1713 71760924 - NAIL IM 9/7.5MM 24CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71760926 SUP HCPCS C1713 71760926 - NAIL IM 9/7.5MM 26CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71760928 SUP HCPCS C1713 71760928 - NAIL IM 9/7.5MM 28CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71760930 SUP HCPCS C1713 71760930 - NAIL IM 9/7MM 30CM HUM BOTH IP/OP "$4,370.00" "$3,234.00" $867.34 "$4,370.00" "$1,966.50" "$1,966.50" "$1,966.50" "$1,966.50" "$4,370.00" "$4,370.00" "$4,370.00" $910.82 "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" $910.76 "$4,370.00" "$4,370.00" "$2,154.41" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$3,277.50" "$4,370.00" "$4,370.00" "$4,370.00" "$2,185.00" "$2,185.00" "$3,461.04" "$4,370.00" "$3,496.00" "$1,966.50" $867.34 N/A "$2,534.60" "$4,370.00" "$2,622.00" "$4,370.00" $910.71 "$4,370.00" N/A N/A 71761018 SUP HCPCS C1713 71761018 - NAIL IM 10/8.5MM 18CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71761020 SUP HCPCS C1713 71761020 - NAIL IM 10/8.5MM 20CM TRGN STRG TI HUM BOTH IP/OP "$3,049.00" "$2,256.00" $605.10 "$3,048.75" "$1,371.94" "$1,371.94" "$1,371.94" "$1,371.94" "$3,048.75" "$3,048.75" "$3,048.75" $635.44 "$3,048.75" "$3,048.75" "$3,048.75" "$3,048.75" "$3,048.75" $635.39 "$3,048.75" "$1,219.50" "$1,503.03" "$3,048.75" "$3,048.75" "$3,048.75" "$3,048.75" "$2,286.75" "$3,048.75" "$3,048.75" "$3,048.75" "$1,524.38" "$1,524.38" "$2,414.61" "$3,048.75" "$2,439.00" "$1,371.94" $605.10 N/A "$1,768.42" "$3,048.75" "$3,048.75" "$3,048.75" $635.36 "$3,048.75" N/A N/A 71761022 SUP HCPCS C1713 71761022 - NAIL IM 10/8.5MM 22CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$3,656.25" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71761024 SUP HCPCS C1713 71761024 - NAIL IM 10/8.5MM 24CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71761026 SUP HCPCS C1713 71761026 - NAIL IM 10/8.5MM 26CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71761028 SUP HCPCS C1713 71761028 - NAIL IM 10/8.5MM 28CM TRGN STRG TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71761030 SUP HCPCS C1713 71761030 - NAIL IM 10/8.5MM 30CM HUM BOTH IP/OP "$4,370.00" "$3,234.00" $867.34 "$4,370.00" "$1,966.50" "$1,966.50" "$1,966.50" "$1,966.50" "$4,370.00" "$4,370.00" "$4,370.00" $910.82 "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" $910.76 "$4,370.00" "$1,748.00" "$2,154.41" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$3,277.50" "$4,370.00" "$4,370.00" "$4,370.00" "$2,185.00" "$2,185.00" "$3,461.04" "$4,370.00" "$3,496.00" "$1,966.50" $867.34 N/A "$2,534.60" "$4,370.00" "$4,370.00" "$4,370.00" $910.71 "$4,370.00" N/A N/A 71761118 SUP HCPCS C1713 71761118 - NAIL IM 11/9.5MM 18CM HUM BOTH IP/OP "$4,370.00" "$3,234.00" $867.34 "$4,370.00" "$1,966.50" "$1,966.50" "$1,966.50" "$1,966.50" "$4,370.00" "$4,370.00" "$4,370.00" $910.82 "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" $910.76 "$4,370.00" "$4,370.00" "$2,154.41" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$3,277.50" "$4,370.00" "$4,370.00" "$4,370.00" "$2,185.00" "$2,185.00" "$3,461.04" "$4,370.00" "$3,496.00" "$1,966.50" $867.34 N/A "$2,534.60" "$4,370.00" "$2,622.00" "$4,370.00" $910.71 "$4,370.00" N/A N/A 71761120 SUP HCPCS C1713 71761120 - NAIL IM 11/9.5MM 20CM HUM BOTH IP/OP "$4,370.00" "$3,234.00" $867.34 "$4,370.00" "$1,966.50" "$1,966.50" "$1,966.50" "$1,966.50" "$4,370.00" "$4,370.00" "$4,370.00" $910.82 "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" $910.76 "$4,370.00" "$1,748.00" "$2,154.41" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$3,277.50" "$4,370.00" "$4,370.00" "$4,370.00" "$2,185.00" "$2,185.00" "$3,461.04" "$4,370.00" "$3,496.00" "$1,966.50" $867.34 N/A "$2,534.60" "$4,370.00" "$2,622.00" "$4,370.00" $910.71 "$4,370.00" N/A N/A 71761122 SUP HCPCS C1713 71761122 - NAIL IM 11/9.5MM 22CM HUM BOTH IP/OP "$4,370.00" "$3,234.00" $867.34 "$4,370.00" "$1,966.50" "$1,966.50" "$1,966.50" "$1,966.50" "$4,370.00" "$4,370.00" "$4,370.00" $910.82 "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" $910.76 "$4,370.00" "$1,748.00" "$2,154.41" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$3,277.50" "$4,370.00" "$4,370.00" "$4,370.00" "$2,185.00" "$2,185.00" "$3,461.04" "$4,370.00" "$3,496.00" "$1,966.50" $867.34 N/A "$2,534.60" "$4,370.00" "$2,622.00" "$4,370.00" "$4,370.00" "$4,370.00" N/A N/A 71761124 SUP HCPCS C1713 71761124 - NAIL IM 11/9.5MM 24CM HUM BOTH IP/OP "$4,370.00" "$3,234.00" $867.34 "$4,370.00" "$1,966.50" "$1,966.50" "$1,966.50" "$1,966.50" "$4,370.00" "$4,370.00" "$4,370.00" $910.82 "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" $910.76 "$4,370.00" "$4,370.00" "$2,154.41" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$3,277.50" "$4,370.00" "$4,370.00" "$4,370.00" "$2,185.00" "$2,185.00" "$3,461.04" "$4,370.00" "$3,496.00" "$1,966.50" $867.34 N/A "$2,534.60" "$4,370.00" "$2,622.00" "$4,370.00" "$4,370.00" "$4,370.00" N/A N/A 71761126 SUP HCPCS C1713 71761126 - NAIL IM 11/9.5MM 26CM HUM BOTH IP/OP "$3,049.00" "$2,256.00" $605.10 "$3,048.75" "$1,371.94" "$1,371.94" "$1,371.94" "$1,371.94" "$3,048.75" "$3,048.75" "$3,048.75" $635.44 "$3,048.75" "$3,048.75" "$3,048.75" "$3,048.75" "$3,048.75" $635.39 "$3,048.75" "$3,048.75" "$1,503.03" "$3,048.75" "$3,048.75" "$3,048.75" "$3,048.75" "$2,286.75" "$3,048.75" "$3,048.75" "$3,048.75" "$1,524.38" "$1,524.38" "$2,414.61" "$3,048.75" "$2,439.00" "$1,371.94" $605.10 N/A "$1,768.42" "$3,048.75" "$1,829.25" "$3,048.75" $635.36 "$3,048.75" N/A N/A 71761128 SUP HCPCS C1713 71761128 - NAIL IM 11/9.5MM 28CM HUM BOTH IP/OP "$4,370.00" "$3,234.00" $867.34 "$4,370.00" "$1,966.50" "$1,966.50" "$1,966.50" "$1,966.50" "$4,370.00" "$4,370.00" "$4,370.00" $910.82 "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" $910.76 "$4,370.00" "$4,370.00" "$2,154.41" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$3,277.50" "$4,370.00" "$4,370.00" "$4,370.00" "$2,185.00" "$2,185.00" "$3,461.04" "$4,370.00" "$3,496.00" "$1,966.50" $867.34 N/A "$2,534.60" "$4,370.00" "$2,622.00" "$4,370.00" $910.71 "$4,370.00" N/A N/A 71761130 SUP HCPCS C1713 71761130 - NAIL IM 11/9.5MM 30CM HUM BOTH IP/OP "$4,370.00" "$3,234.00" $867.34 "$4,370.00" "$1,966.50" "$1,966.50" "$1,966.50" "$1,966.50" "$4,370.00" "$4,370.00" "$4,370.00" $910.82 "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" $910.76 "$4,370.00" "$1,748.00" "$2,154.41" "$4,370.00" "$4,370.00" "$4,370.00" "$4,370.00" "$3,277.50" "$4,370.00" "$4,370.00" "$4,370.00" "$2,185.00" "$2,185.00" "$3,461.04" "$4,370.00" "$3,496.00" "$1,966.50" $867.34 N/A "$2,534.60" "$4,370.00" "$4,370.00" "$4,370.00" $910.71 "$4,370.00" N/A N/A 71770816 SUP HCPCS C1713 71770816 - NAIL IM LNG 8/7MM 16CM TRGN IMPL SET BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" "$3,656.25" "$3,656.25" N/A N/A 71770818 SUP HCPCS C1713 71770818 - NAIL IM 8/7MM 18CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" "$3,656.25" "$3,656.25" N/A N/A 71770820 SUP HCPCS C1713 71770820 - NAIL IM 8/7MM 20CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$3,656.25" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71770822 SUP HCPCS C1713 71770822 - NAIL IM 8/7MM 22CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71770824 SUP HCPCS C1713 71770824 - NAIL IM 8/7MM 24CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$3,656.25" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71770826 SUP HCPCS C1713 71770826 - NAIL IM LNG 8/7MM 26CM TRGN IMPL SET BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$3,656.25" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" "$3,656.25" "$3,656.25" N/A N/A 71770828 SUP HCPCS C1713 71770828 - NAIL IM 8/7MM 28CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" "$3,656.25" "$3,656.25" N/A N/A 71770830 SUP HCPCS C1713 71770830 - NAIL IM 8/7MM 30CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71770918 SUP HCPCS C1713 71770918 - NAIL IM 9/7.5MM 18CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$3,656.25" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71770920 SUP HCPCS C1713 71770920 - NAIL IM LNG 9/7.5MM 20CM TRGN IMPL SET BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$3,656.25" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71770922 SUP HCPCS C1713 71770922 - NAIL IM LNG 9/7.5MM 22CM TRGN IMPL SET BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$3,656.25" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" "$3,656.25" "$3,656.25" N/A N/A 71770924 SUP HCPCS C1713 71770924 - NAIL IM LNG 9/7.5MM 24CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$3,656.25" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71770926 SUP HCPCS C1713 71770926 - NAIL IM 9 7.5MM 26CM TRGN SET TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" "$3,656.25" "$3,656.25" N/A N/A 71770928 SUP HCPCS C1713 71770928 - NAIL IM 9/7.5MM 28CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71770930 SUP HCPCS C1713 71770930 - NAIL IM 9/7.5MM 30CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71771018 SUP HCPCS C1713 71771018 - NAIL IM 10/8.5MM 18CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$3,656.25" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71771020 SUP HCPCS C1713 71771020 - NAIL IM 10/8.5MM 20CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$3,656.25" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71771022 SUP HCPCS C1713 71771022 - NAIL IM LNG 10MM 8.5MM 22CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$3,656.25" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71771024 SUP HCPCS C1713 71771024 - NAIL IM 10MM 8.5MM 24CM FRSGHT BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$3,656.25" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71771026 SUP HCPCS C1713 71771026 - NAIL IM 10MM 8.5MM 26CM TRGN IMPL SET TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$3,656.25" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$3,656.25" "$3,656.25" $761.96 "$3,656.25" N/A N/A 71771028 SUP HCPCS C1713 71771028 - NAIL IM 10 8.5MM 28CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$3,656.25" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" "$3,656.25" "$3,656.25" N/A N/A 71771030 SUP HCPCS C1713 71771030 - NAIL IM 10/8.5MM 30CM TRGN BNT TI HUM BOTH IP/OP "$3,656.50" "$2,706.00" $725.67 "$3,656.25" "$1,645.31" "$1,645.31" "$1,645.31" "$1,645.31" "$3,656.25" "$3,656.25" "$3,656.25" $762.05 "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" $762.00 "$3,656.25" "$1,462.50" "$1,802.53" "$3,656.25" "$3,656.25" "$3,656.25" "$3,656.25" "$2,742.38" "$3,656.25" "$3,656.25" "$3,656.25" "$1,828.13" "$1,828.13" "$2,895.75" "$3,656.25" "$2,925.00" "$1,645.31" $725.67 N/A "$2,120.77" "$3,656.25" "$2,193.75" "$3,656.25" "$3,656.25" "$3,656.25" N/A N/A 71771118 SUP HCPCS C1713 71771118 - NAIL IM 11/9.5MM 18CM HUM BOTH IP/OP "$2,576.50" "$1,907.00" $511.32 "$2,576.25" "$1,159.31" "$1,159.31" "$1,159.31" "$1,159.31" "$2,576.25" "$2,576.25" "$2,576.25" $536.95 "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" $536.92 "$2,576.25" "$1,030.50" "$1,270.09" "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" "$1,932.38" "$2,576.25" "$2,576.25" "$2,576.25" "$1,288.13" "$1,288.13" "$2,040.39" "$2,576.25" "$2,061.00" "$1,159.31" $511.32 N/A "$1,494.37" "$2,576.25" "$2,576.25" "$2,576.25" $536.89 "$2,576.25" N/A N/A 71771120 SUP HCPCS C1713 71771120 - NAIL IM 11/9.5MM 20CM HUM BOTH IP/OP "$2,576.50" "$1,907.00" $511.32 "$2,576.25" "$1,159.31" "$1,159.31" "$1,159.31" "$1,159.31" "$2,576.25" "$2,576.25" "$2,576.25" $536.95 "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" $536.92 "$2,576.25" "$1,030.50" "$1,270.09" "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" "$1,932.38" "$2,576.25" "$2,576.25" "$2,576.25" "$1,288.13" "$1,288.13" "$2,040.39" "$2,576.25" "$2,061.00" "$1,159.31" $511.32 N/A "$1,494.37" "$2,576.25" "$1,545.75" "$2,576.25" $536.89 "$2,576.25" N/A N/A 71771122 SUP HCPCS C1713 71771122 - NAIL IM 11/9.5MM 22CM HUM BOTH IP/OP "$2,576.50" "$1,907.00" $511.32 "$2,576.25" "$1,159.31" "$1,159.31" "$1,159.31" "$1,159.31" "$2,576.25" "$2,576.25" "$2,576.25" $536.95 "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" $536.92 "$2,576.25" "$1,030.50" "$1,270.09" "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" "$1,932.38" "$2,576.25" "$2,576.25" "$2,576.25" "$1,288.13" "$1,288.13" "$2,040.39" "$2,576.25" "$2,061.00" "$1,159.31" $511.32 N/A "$1,494.37" "$2,576.25" "$1,545.75" "$2,576.25" "$2,576.25" "$2,576.25" N/A N/A 71771124 SUP HCPCS C1713 71771124 - NAIL IM 11/9.5MM 24CM HUM BOTH IP/OP "$2,576.50" "$1,907.00" $511.32 "$2,576.25" "$1,159.31" "$1,159.31" "$1,159.31" "$1,159.31" "$2,576.25" "$2,576.25" "$2,576.25" $536.95 "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" $536.92 "$2,576.25" "$1,030.50" "$1,270.09" "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" "$1,932.38" "$2,576.25" "$2,576.25" "$2,576.25" "$1,288.13" "$1,288.13" "$2,040.39" "$2,576.25" "$2,061.00" "$1,159.31" $511.32 N/A "$1,494.37" "$2,576.25" "$1,545.75" "$2,576.25" "$2,576.25" "$2,576.25" N/A N/A 71771126 SUP HCPCS C1713 71771126 - NAIL IM 11/9.5MM 26CM HUM BOTH IP/OP "$2,576.50" "$1,907.00" $511.32 "$2,576.25" "$1,159.31" "$1,159.31" "$1,159.31" "$1,159.31" "$2,576.25" "$2,576.25" "$2,576.25" $536.95 "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" $536.92 "$2,576.25" "$1,030.50" "$1,270.09" "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" "$1,932.38" "$2,576.25" "$2,576.25" "$2,576.25" "$1,288.13" "$1,288.13" "$2,040.39" "$2,576.25" "$2,061.00" "$1,159.31" $511.32 N/A "$1,494.37" "$2,576.25" "$2,576.25" "$2,576.25" $536.89 "$2,576.25" N/A N/A 71771128 SUP HCPCS C1713 71771128 - NAIL IM 11/9.5MM 28CM HUM BOTH IP/OP "$2,576.50" "$1,907.00" $511.32 "$2,576.25" "$1,159.31" "$1,159.31" "$1,159.31" "$1,159.31" "$2,576.25" "$2,576.25" "$2,576.25" $536.95 "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" $536.92 "$2,576.25" "$1,030.50" "$1,270.09" "$2,576.25" "$2,576.25" "$2,576.25" "$2,576.25" "$1,932.38" "$2,576.25" "$2,576.25" "$2,576.25" "$1,288.13" "$1,288.13" "$2,040.39" "$2,576.25" "$2,061.00" "$1,159.31" $511.32 N/A "$1,494.37" "$2,576.25" "$1,545.75" "$2,576.25" $536.89 "$2,576.25" N/A N/A 71771130 SUP HCPCS C1713 71771130 - NAIL IM 11/9.5MM 30CM HUM BOTH IP/OP "$3,049.00" "$2,256.00" $605.10 "$3,048.75" "$1,371.94" "$1,371.94" "$1,371.94" "$1,371.94" "$3,048.75" "$3,048.75" "$3,048.75" $635.44 "$3,048.75" "$3,048.75" "$3,048.75" "$3,048.75" "$3,048.75" $635.39 "$3,048.75" "$1,219.50" "$1,503.03" "$3,048.75" "$3,048.75" "$3,048.75" "$3,048.75" "$2,286.75" "$3,048.75" "$3,048.75" "$3,048.75" "$1,524.38" "$1,524.38" "$2,414.61" "$3,048.75" "$2,439.00" "$1,371.94" $605.10 N/A "$1,768.42" "$3,048.75" "$1,829.25" "$3,048.75" $635.36 "$3,048.75" N/A N/A 71800308 SUP HCPCS C1713 71800308 - PLATE BN 165MM PRLC 8 HL LCK SS TIB RT PROX LAT 4.5MM SCR BOTH IP/OP "$3,402.00" "$2,517.00" $675.21 "$3,402.00" "$1,530.90" "$1,530.90" "$1,530.90" "$1,530.90" "$3,402.00" "$3,402.00" "$3,402.00" $709.06 "$3,402.00" "$3,402.00" "$3,402.00" "$3,402.00" "$3,402.00" $709.01 "$3,402.00" "$3,402.00" "$1,677.19" "$3,402.00" "$3,402.00" "$3,402.00" "$3,402.00" "$2,551.50" "$3,402.00" "$3,402.00" "$3,402.00" "$1,701.00" "$1,701.00" "$2,694.38" "$3,402.00" "$2,721.60" "$1,530.90" $675.21 N/A "$1,973.16" "$3,402.00" "$3,402.00" "$3,402.00" $708.98 "$3,402.00" N/A N/A 71800313 SUP HCPCS C1713 71800313 - PLATE BN 255MM PRLC 13 HL LCK SS TIB RT PROX LAT 4.5MM SCR BOTH IP/OP "$3,491.50" "$2,584.00" $692.93 "$3,491.25" "$1,571.06" "$1,571.06" "$1,571.06" "$1,571.06" "$3,491.25" "$3,491.25" "$3,491.25" $727.66 "$3,491.25" "$3,491.25" "$3,491.25" "$3,491.25" "$3,491.25" $727.61 "$3,491.25" "$3,491.25" "$1,721.19" "$3,491.25" "$3,491.25" "$3,491.25" "$3,491.25" "$2,618.63" "$3,491.25" "$3,491.25" "$3,491.25" "$1,745.63" "$1,745.63" "$2,765.07" "$3,491.25" "$2,793.00" "$1,571.06" $692.93 N/A "$2,025.07" "$3,491.25" "$3,491.25" "$3,491.25" $727.58 "$3,491.25" N/A N/A 71800413 SUP HCPCS C1713 71800413 - PLATE BN 187MM PRLC 13 HL LCK SS TIB LT PROX LAT 3.5MM SCR BOTH IP/OP "$3,491.50" "$2,584.00" $692.93 "$3,491.25" "$1,571.06" "$1,571.06" "$1,571.06" "$1,571.06" "$3,491.25" "$3,491.25" "$3,491.25" $727.66 "$3,491.25" "$3,491.25" "$3,491.25" "$3,491.25" "$3,491.25" $727.61 "$3,491.25" "$1,396.50" "$1,721.19" "$3,491.25" "$3,491.25" "$3,491.25" "$3,491.25" "$2,618.63" "$3,491.25" "$3,491.25" "$3,491.25" "$1,745.63" "$1,745.63" "$2,765.07" "$3,491.25" "$2,793.00" "$1,571.06" $692.93 N/A "$2,025.07" "$3,491.25" "$3,491.25" "$3,491.25" $727.58 "$3,491.25" N/A N/A 71800513 SUP HCPCS C1713 71800513 - PLATE BN 187MM PRLC 13 HL LCK SS TIB RT PROX LAT 3.5MM SCR BOTH IP/OP "$3,491.50" "$2,584.00" $692.93 "$3,491.25" "$1,571.06" "$1,571.06" "$1,571.06" "$1,571.06" "$3,491.25" "$3,491.25" "$3,491.25" $727.66 "$3,491.25" "$3,491.25" "$3,491.25" "$3,491.25" "$3,491.25" $727.61 "$3,491.25" "$3,491.25" "$1,721.19" "$3,491.25" "$3,491.25" "$3,491.25" "$3,491.25" "$2,618.63" "$3,491.25" "$3,491.25" "$3,491.25" "$1,745.63" "$1,745.63" "$2,765.07" "$3,491.25" "$2,793.00" "$1,571.06" $692.93 N/A "$2,025.07" "$3,491.25" "$3,491.25" "$3,491.25" $727.58 "$3,491.25" N/A N/A 71801222 SUP HCPCS C1713 71801222 - SCREW BN 3.5MM 22MM STRL PRLC VLP ST LCK FT FIB CORT BOTH IP/OP $245.00 $181.00 $48.56 $244.65 $110.09 $110.09 $110.09 $110.09 $244.65 $244.65 $244.65 $50.99 $244.65 $244.65 $244.65 $244.65 $244.65 $50.99 $244.65 $97.86 $144.71 $244.65 $244.65 $244.65 $244.65 $183.75 $244.65 $244.65 $244.65 $122.33 $122.33 $193.76 $244.65 $195.72 $110.09 $48.56 N/A $142.10 $244.65 $244.65 $244.65 $50.99 $244.65 N/A N/A 71801320 SUP HCPCS C1713 71801320 - SCREW BN HEX LOPRFL 3.5MM 20MM STRL PRLC VLP ST FT CORT BOTH IP/OP $44.00 $33.00 $8.65 $43.58 $19.61 $19.61 $19.61 $19.61 $43.58 $43.58 $43.58 $9.08 $43.58 $43.58 $43.58 $43.58 $43.58 $9.08 $43.58 $43.58 $25.78 $43.58 $43.58 $43.58 $43.58 $33.00 $43.58 $43.58 $43.58 $21.79 $21.79 $34.52 $43.58 $34.86 $19.61 $8.65 N/A $25.52 $43.58 $43.58 $43.58 $9.08 $43.58 N/A N/A 71801328 SUP HCPCS C1713 71801328 - SCREW BN LOPRFL 3.5MM 28MM STRL VLP ST HEX DRV RCS CORT FT BOTH IP/OP $44.00 $33.00 $8.65 $43.58 $19.61 $19.61 $19.61 $19.61 $43.58 $43.58 $43.58 $9.08 $43.58 $43.58 $43.58 $43.58 $43.58 $9.08 $43.58 $17.43 $25.78 $43.58 $43.58 $43.58 $43.58 $33.00 $43.58 $43.58 $43.58 $21.79 $21.79 $34.52 $43.58 $34.86 $19.61 $8.65 N/A $25.52 $43.58 $43.58 $43.58 $43.58 $43.58 N/A N/A 71801332 SUP HCPCS C1713 71801332 - SCREW BN HEX LOPRFL 3.5MM 32MM STRL PRLC VLP ST FT CORT BOTH IP/OP $44.00 $33.00 $8.65 $43.58 $19.61 $19.61 $19.61 $19.61 $43.58 $43.58 $43.58 $9.08 $43.58 $43.58 $43.58 $43.58 $43.58 $9.08 $43.58 $43.58 $25.78 $43.58 $43.58 $43.58 $43.58 $33.00 $43.58 $43.58 $43.58 $21.79 $21.79 $34.52 $43.58 $34.86 $19.61 $8.65 N/A $25.52 $43.58 $43.58 $43.58 $9.08 $43.58 N/A N/A 71801336 SUP HCPCS C1713 71801336 - SCREW BN LOPRFL 3.5MM 36MM STRL VLP ST HEX DRV RCS CORT FT BOTH IP/OP $44.00 $33.00 $8.65 $43.58 $19.61 $19.61 $19.61 $19.61 $43.58 $43.58 $43.58 $9.08 $43.58 $43.58 $43.58 $43.58 $43.58 $9.08 $43.58 $43.58 $25.78 $43.58 $43.58 $43.58 $43.58 $33.00 $43.58 $43.58 $43.58 $21.79 $21.79 $34.52 $43.58 $34.86 $19.61 $8.65 N/A $25.52 $43.58 $43.58 $43.58 $9.08 $43.58 N/A N/A 71801340 SUP HCPCS C1713 71801340 - SCREW BN LOPRFL 3.5MM 40MM STRL VLP ST HEX DRV RCS CORT FT BOTH IP/OP $44.00 $33.00 $8.65 $43.58 $19.61 $19.61 $19.61 $19.61 $43.58 $43.58 $43.58 $9.08 $43.58 $43.58 $43.58 $43.58 $43.58 $9.08 $43.58 $43.58 $25.78 $43.58 $43.58 $43.58 $43.58 $33.00 $43.58 $43.58 $43.58 $21.79 $21.79 $34.52 $43.58 $34.86 $19.61 $8.65 N/A $25.52 $43.58 $43.58 $43.58 $9.08 $43.58 N/A N/A 71801365 SUP HCPCS C1713 71801365 - SCREW BN HEX LOPRFL 3.5MM 65MM STRL PRLC VLP ST FT CORT BOTH IP/OP $44.00 $33.00 $8.65 $43.58 $19.61 $19.61 $19.61 $19.61 $43.58 $43.58 $43.58 $9.08 $43.58 $43.58 $43.58 $43.58 $43.58 $9.08 $43.58 $43.58 $25.78 $43.58 $43.58 $43.58 $43.58 $33.00 $43.58 $43.58 $43.58 $21.79 $21.79 $34.52 $43.58 $34.86 $19.61 $8.65 N/A $25.52 $43.58 $43.58 $43.58 $9.08 $43.58 N/A N/A 71801375 SUP HCPCS C1713 71801375 - SCREW BN HEX LOPRFL 3.5MM 75MM STRL PRLC VLP ST FT CORT BOTH IP/OP $44.00 $33.00 $8.65 $43.58 $19.61 $19.61 $19.61 $19.61 $43.58 $43.58 $43.58 $9.08 $43.58 $43.58 $43.58 $43.58 $43.58 $9.08 $43.58 $43.58 $25.78 $43.58 $43.58 $43.58 $43.58 $33.00 $43.58 $43.58 $43.58 $21.79 $21.79 $34.52 $43.58 $34.86 $19.61 $8.65 N/A $25.52 $43.58 $43.58 $43.58 $9.08 $43.58 N/A N/A 71802506 SUP HCPCS C1713 71802506 - SCREW BN 2.5MM 6MM ST CORT BOTH IP/OP $76.00 $56.00 $15.00 $75.58 $34.01 $34.01 $34.01 $34.01 $75.58 $75.58 $75.58 $15.75 $75.58 $75.58 $75.58 $75.58 $75.58 $15.75 $75.58 $30.23 $44.71 $75.58 $75.58 $75.58 $75.58 $57.00 $75.58 $75.58 $75.58 $37.79 $37.79 $59.86 $75.58 $60.46 $34.01 $15.00 N/A $44.08 $75.58 $45.35 $75.58 $75.58 $75.58 N/A N/A 71802508 SUP HCPCS C1713 71802508 - SCREW BN 2.5MM 8MM ST CORT BOTH IP/OP $76.00 $56.00 $15.00 $75.58 $34.01 $34.01 $34.01 $34.01 $75.58 $75.58 $75.58 $15.75 $75.58 $75.58 $75.58 $75.58 $75.58 $15.75 $75.58 $30.23 $44.71 $75.58 $75.58 $75.58 $75.58 $57.00 $75.58 $75.58 $75.58 $37.79 $37.79 $59.86 $75.58 $60.46 $34.01 $15.00 N/A $44.08 $75.58 $75.58 $75.58 $15.75 $75.58 N/A N/A 71802532 SUP HCPCS C1713 71802532 - SCREW BN 2.5MM 32MM ST CORT BOTH IP/OP $76.00 $56.00 $15.00 $75.58 $34.01 $34.01 $34.01 $34.01 $75.58 $75.58 $75.58 $15.75 $75.58 $75.58 $75.58 $75.58 $75.58 $15.75 $75.58 $30.23 $44.71 $75.58 $75.58 $75.58 $75.58 $57.00 $75.58 $75.58 $75.58 $37.79 $37.79 $59.86 $75.58 $60.46 $34.01 $15.00 N/A $44.08 $75.58 $45.35 $75.58 $75.58 $75.58 N/A N/A 71802534 SUP HCPCS C1713 71802534 - SCREW BN 2.5MM 34MM ST CORT BOTH IP/OP $76.00 $56.00 $15.00 $75.58 $34.01 $34.01 $34.01 $34.01 $75.58 $75.58 $75.58 $15.75 $75.58 $75.58 $75.58 $75.58 $75.58 $15.75 $75.58 $30.23 $44.71 $75.58 $75.58 $75.58 $75.58 $57.00 $75.58 $75.58 $75.58 $37.79 $37.79 $59.86 $75.58 $60.46 $34.01 $15.00 N/A $44.08 $75.58 $45.35 $75.58 $15.75 $75.58 N/A N/A 71802536 SUP HCPCS C1713 71802536 - SCREW BN 2.5MM 36MM ST CORT BOTH IP/OP $76.00 $56.00 $15.00 $75.58 $34.01 $34.01 $34.01 $34.01 $75.58 $75.58 $75.58 $15.75 $75.58 $75.58 $75.58 $75.58 $75.58 $15.75 $75.58 $30.23 $44.71 $75.58 $75.58 $75.58 $75.58 $57.00 $75.58 $75.58 $75.58 $37.79 $37.79 $59.86 $75.58 $60.46 $34.01 $15.00 N/A $44.08 $75.58 $45.35 $75.58 $15.75 $75.58 N/A N/A 71802538 SUP HCPCS C1713 71802538 - SCREW BN 2.5MM 38MM ST CORT BOTH IP/OP $76.00 $56.00 $15.00 $75.58 $34.01 $34.01 $34.01 $34.01 $75.58 $75.58 $75.58 $15.75 $75.58 $75.58 $75.58 $75.58 $75.58 $15.75 $75.58 $75.58 $44.71 $75.58 $75.58 $75.58 $75.58 $57.00 $75.58 $75.58 $75.58 $37.79 $37.79 $59.86 $75.58 $60.46 $34.01 $15.00 N/A $44.08 $75.58 $45.35 $75.58 $15.75 $75.58 N/A N/A 71802540 SUP HCPCS C1713 71802540 - SCREW BN 2.5MM 40MM ST CORT BOTH IP/OP $76.00 $56.00 $15.00 $75.58 $34.01 $34.01 $34.01 $34.01 $75.58 $75.58 $75.58 $15.75 $75.58 $75.58 $75.58 $75.58 $75.58 $15.75 $75.58 $30.23 $44.71 $75.58 $75.58 $75.58 $75.58 $57.00 $75.58 $75.58 $75.58 $37.79 $37.79 $59.86 $75.58 $60.46 $34.01 $15.00 N/A $44.08 $75.58 $45.35 $75.58 $75.58 $75.58 N/A N/A 71802545 SUP HCPCS C1713 71802545 - SCREW BN 2.5MM 45MM ST CORT BOTH IP/OP $76.00 $56.00 $15.00 $75.58 $34.01 $34.01 $34.01 $34.01 $75.58 $75.58 $75.58 $15.75 $75.58 $75.58 $75.58 $75.58 $75.58 $15.75 $75.58 $30.23 $44.71 $75.58 $75.58 $75.58 $75.58 $57.00 $75.58 $75.58 $75.58 $37.79 $37.79 $59.86 $75.58 $60.46 $34.01 $15.00 N/A $44.08 $75.58 $75.58 $75.58 $75.58 $75.58 N/A N/A 71802550 SUP HCPCS C1713 71802550 - SCREW BN 2.5MM 50MM ST CORT BOTH IP/OP $76.00 $56.00 $15.00 $75.58 $34.01 $34.01 $34.01 $34.01 $75.58 $75.58 $75.58 $15.75 $75.58 $75.58 $75.58 $75.58 $75.58 $15.75 $75.58 $75.58 $44.71 $75.58 $75.58 $75.58 $75.58 $57.00 $75.58 $75.58 $75.58 $37.79 $37.79 $59.86 $75.58 $60.46 $34.01 $15.00 N/A $44.08 $75.58 $45.35 $75.58 $15.75 $75.58 N/A N/A 71802606 SUP HCPCS C1713 71802606 - PLATE BN 70MM PRLC 6 HL LCK RECON SS 3.5MM SCR BOTH IP/OP "$1,060.50" $785.00 $210.48 "$1,060.50" $477.23 $477.23 $477.23 $477.23 "$1,060.50" "$1,060.50" "$1,060.50" $221.03 "$1,060.50" "$1,060.50" "$1,060.50" "$1,060.50" "$1,060.50" $221.02 "$1,060.50" $424.20 $627.29 "$1,060.50" "$1,060.50" "$1,060.50" "$1,060.50" $795.38 "$1,060.50" "$1,060.50" "$1,060.50" $530.25 $530.25 $839.92 "$1,060.50" $848.40 $477.23 $210.48 N/A $615.09 "$1,060.50" "$1,060.50" "$1,060.50" $221.01 "$1,060.50" N/A N/A 71803006 SUP HCPCS C1713 71803006 - SCREW BN 2.7MM 6MM STRL ST CORT FOREFOOT MIDFOOT BOTH IP/OP $76.00 $56.00 $15.00 $75.58 $34.01 $34.01 $34.01 $34.01 $75.58 $75.58 $75.58 $15.75 $75.58 $75.58 $75.58 $75.58 $75.58 $15.75 $75.58 $30.23 $44.71 $75.58 $75.58 $75.58 $75.58 $57.00 $75.58 $75.58 $75.58 $37.79 $37.79 $59.86 $75.58 $60.46 $34.01 $15.00 N/A $44.08 $75.58 $45.35 $75.58 $15.75 $75.58 N/A N/A 71809006 SUP HCPCS C1713 71809006 - PLATE BN TBLR RCHRD 6 HL LCK HIP 3.5MM SCR BOTH IP/OP $348.00 $258.00 $68.98 $347.55 $156.40 $156.40 $156.40 $156.40 $347.55 $347.55 $347.55 $72.44 $347.55 $347.55 $347.55 $347.55 $347.55 $72.43 $347.55 $139.02 $205.58 $347.55 $347.55 $347.55 $347.55 $261.00 $347.55 $347.55 $347.55 $173.78 $173.78 $275.26 $347.55 $278.04 $156.40 $68.98 N/A $201.84 $347.55 $347.55 $347.55 $72.43 $347.55 N/A N/A 71823032 SUP HCPCS C1713 71823032 - SCREW BN 2.7MM 32MM ST SS CORT PRLC VLP SM FRAG SYS BOTH IP/OP $45.00 $33.00 $8.91 $44.90 $20.21 $20.21 $20.21 $20.21 $44.90 $44.90 $44.90 $9.36 $44.90 $44.90 $44.90 $44.90 $44.90 $9.36 $44.90 $17.96 $26.56 $44.90 $44.90 $44.90 $44.90 $33.75 $44.90 $44.90 $44.90 $22.45 $22.45 $35.56 $44.90 $35.92 $20.21 $8.91 N/A $26.10 $44.90 $26.94 $44.90 $9.36 $44.90 N/A N/A 71840112 SUP HCPCS C1713 71840112 - TEMPLATE BNDRG TC100 12 HL CMPR LG FRAG PLT BOTH IP/OP $143.00 $106.00 $28.34 $142.80 $64.26 $64.26 $64.26 $64.26 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $142.80 $142.80 $142.80 $29.76 $142.80 $57.12 $84.47 $142.80 $142.80 $142.80 $142.80 $107.25 $142.80 $142.80 $142.80 $71.40 $71.40 $113.10 $142.80 $114.24 $64.26 $28.34 N/A $82.94 $142.80 $85.68 $142.80 $29.76 $142.80 N/A N/A 71840202 SUP HCPCS C1713 71840202 - PLATE BN 26MM 2 HL CMPR 3.5MM SCR SM FRAG SET BOTH IP/OP $333.00 $246.00 $66.06 $332.85 $149.78 $149.78 $149.78 $149.78 $332.85 $332.85 $332.85 $69.37 $332.85 $332.85 $332.85 $332.85 $332.85 $69.37 $332.85 $332.85 $196.88 $332.85 $332.85 $332.85 $332.85 $249.75 $332.85 $332.85 $332.85 $166.43 $166.43 $263.62 $332.85 $266.28 $149.78 $66.06 N/A $193.14 $332.85 $199.71 $332.85 $69.37 $332.85 N/A N/A 71840203 SUP HCPCS C1713 71840203 - PLATE BN 39MM 3 HL CMPR ORTH 3.5MM SCR SM FRAG SET BOTH IP/OP $341.50 $253.00 $67.73 $341.25 $153.56 $153.56 $153.56 $153.56 $341.25 $341.25 $341.25 $71.13 $341.25 $341.25 $341.25 $341.25 $341.25 $71.12 $341.25 $136.50 $201.85 $341.25 $341.25 $341.25 $341.25 $256.13 $341.25 $341.25 $341.25 $170.63 $170.63 $270.27 $341.25 $273.00 $153.56 $67.73 N/A $198.07 $341.25 $204.75 $341.25 $341.25 $341.25 N/A N/A 71840204 SUP HCPCS C1713 71840204 - PLATE BN 52MM TC100 4 HL CMPR PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP $355.00 $263.00 $70.44 $354.90 $159.71 $159.71 $159.71 $159.71 $354.90 $354.90 $354.90 $73.97 $354.90 $354.90 $354.90 $354.90 $354.90 $73.97 $354.90 $354.90 $209.92 $354.90 $354.90 $354.90 $354.90 $266.25 $354.90 $354.90 $354.90 $177.45 $177.45 $281.08 $354.90 $283.92 $159.71 $70.44 N/A $205.90 $354.90 $212.94 $354.90 $354.90 $354.90 N/A N/A 71840205 SUP HCPCS C1713 71840205 - PLATE BN 65MM TC100 5 HL CMPR PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP $382.50 $283.00 $75.86 $382.20 $171.99 $171.99 $171.99 $171.99 $382.20 $382.20 $382.20 $79.66 $382.20 $382.20 $382.20 $382.20 $382.20 $79.65 $382.20 $152.88 $226.07 $382.20 $382.20 $382.20 $382.20 $286.88 $382.20 $382.20 $382.20 $191.10 $191.10 $302.70 $382.20 $305.76 $171.99 $75.86 N/A $221.85 $382.20 $229.32 $382.20 $382.20 $382.20 N/A N/A 71840206 SUP HCPCS C1713 71840206 - PLATE BN 78MM TC100 6 HL CMPR PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $399.00 $399.00 N/A N/A 71840207 SUP HCPCS C1713 71840207 - PLATE BN 91MM TC100 7 HL CMPR PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP $415.00 $307.00 $82.32 $414.75 $186.64 $186.64 $186.64 $186.64 $414.75 $414.75 $414.75 $86.44 $414.75 $414.75 $414.75 $414.75 $414.75 $86.44 $414.75 $414.75 $245.32 $414.75 $414.75 $414.75 $414.75 $311.25 $414.75 $414.75 $414.75 $207.38 $207.38 $328.48 $414.75 $331.80 $186.64 $82.32 N/A $240.70 $414.75 $414.75 $414.75 $86.43 $414.75 N/A N/A 71840208 SUP HCPCS C1713 71840208 - PLATE BN 104MM TC100 8 HL CMPR PLVC 3.5MM SCR SM FRAG SET BOTH IP/OP $446.50 $330.00 $88.57 $446.25 $200.81 $200.81 $200.81 $200.81 $446.25 $446.25 $446.25 $93.01 $446.25 $446.25 $446.25 $446.25 $446.25 $93.00 $446.25 $446.25 $263.96 $446.25 $446.25 $446.25 $446.25 $334.88 $446.25 $446.25 $446.25 $223.13 $223.13 $353.43 $446.25 $357.00 $200.81 $88.57 N/A $258.97 $446.25 $446.25 $446.25 $446.25 $446.25 N/A N/A 71840209 SUP HCPCS C1713 71840209 - PLATE BN 117MM 9 HL CMPR ORTH 3.5MM SCR SM FRAG SET BOTH IP/OP $455.00 $337.00 $90.24 $454.65 $204.59 $204.59 $204.59 $204.59 $454.65 $454.65 $454.65 $94.76 $454.65 $454.65 $454.65 $454.65 $454.65 $94.75 $454.65 $454.65 $268.93 $454.65 $454.65 $454.65 $454.65 $341.25 $454.65 $454.65 $454.65 $227.33 $227.33 $360.08 $454.65 $363.72 $204.59 $90.24 N/A $263.90 $454.65 $272.79 $454.65 $94.75 $454.65 N/A N/A 71840210 SUP HCPCS C1713 71840210 - PLATE BN 130MM 10 HL CMPR ORTH 3.5MM SCR SM FRAG SET BOTH IP/OP $470.50 $348.00 $93.36 $470.40 $211.68 $211.68 $211.68 $211.68 $470.40 $470.40 $470.40 $98.04 $470.40 $470.40 $470.40 $470.40 $470.40 $98.04 $470.40 $470.40 $278.24 $470.40 $470.40 $470.40 $470.40 $352.88 $470.40 $470.40 $470.40 $235.20 $235.20 $372.56 $470.40 $376.32 $211.68 $93.36 N/A $272.89 $470.40 $282.24 $470.40 $98.03 $470.40 N/A N/A 71840211 SUP HCPCS C1713 71840211 - PLATE BN 143MM 11 HL CMPR 3.5MM SCR SM FRAG SET BOTH IP/OP $470.50 $348.00 $93.36 $470.40 $211.68 $211.68 $211.68 $211.68 $470.40 $470.40 $470.40 $98.04 $470.40 $470.40 $470.40 $470.40 $470.40 $98.04 $470.40 $470.40 $278.24 $470.40 $470.40 $470.40 $470.40 $352.88 $470.40 $470.40 $470.40 $235.20 $235.20 $372.56 $470.40 $376.32 $211.68 $93.36 N/A $272.89 $470.40 $282.24 $470.40 $98.03 $470.40 N/A N/A 71840212 SUP HCPCS C1713 71840212 - PLATE BN 156MM 12 HL CMPR 3.5MM SCR SM FRAG SET BOTH IP/OP $521.00 $386.00 $103.37 $520.80 $234.36 $234.36 $234.36 $234.36 $520.80 $520.80 $520.80 $108.55 $520.80 $520.80 $520.80 $520.80 $520.80 $108.54 $520.80 $520.80 $308.05 $520.80 $520.80 $520.80 $520.80 $390.75 $520.80 $520.80 $520.80 $260.40 $260.40 $412.47 $520.80 $416.64 $234.36 $103.37 N/A $302.18 $520.80 $312.48 $520.80 $520.80 $520.80 N/A N/A 71840214 SUP HCPCS C1713 71840214 - PLATE BN 182MM 14 HL CMPR 3.5MM SCR SM FRAG SET BOTH IP/OP "$1,181.50" $874.00 $234.45 "$1,181.25" $531.56 $531.56 $531.56 $531.56 "$1,181.25" "$1,181.25" "$1,181.25" $246.20 "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" $246.19 "$1,181.25" "$1,181.25" $698.71 "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" $886.13 "$1,181.25" "$1,181.25" "$1,181.25" $590.63 $590.63 $935.55 "$1,181.25" $945.00 $531.56 $234.45 N/A $685.27 "$1,181.25" $708.75 "$1,181.25" $246.17 "$1,181.25" N/A N/A 71840215 SUP HCPCS C1713 71840215 - PLATE BN 195MM 15 HL CMPR 3.5MM SCR SM FRAG SET BOTH IP/OP "$1,234.00" $913.00 $244.87 "$1,233.75" $555.19 $555.19 $555.19 $555.19 "$1,233.75" "$1,233.75" "$1,233.75" $257.14 "$1,233.75" "$1,233.75" "$1,233.75" "$1,233.75" "$1,233.75" $257.13 "$1,233.75" "$1,233.75" $729.76 "$1,233.75" "$1,233.75" "$1,233.75" "$1,233.75" $925.50 "$1,233.75" "$1,233.75" "$1,233.75" $616.88 $616.88 $977.13 "$1,233.75" $987.00 $555.19 $244.87 N/A $715.72 "$1,233.75" $740.25 "$1,233.75" $257.11 "$1,233.75" N/A N/A 71840216 SUP HCPCS C1713 71840216 - PLATE BN 208MM 16 HL CMPR 3.5MM SCR SM FRAG SET BOTH IP/OP "$1,360.00" "$1,006.00" $269.88 "$1,359.75" $611.89 $611.89 $611.89 $611.89 "$1,359.75" "$1,359.75" "$1,359.75" $283.41 "$1,359.75" "$1,359.75" "$1,359.75" "$1,359.75" "$1,359.75" $283.39 "$1,359.75" "$1,359.75" $804.29 "$1,359.75" "$1,359.75" "$1,359.75" "$1,359.75" "$1,020.00" "$1,359.75" "$1,359.75" "$1,359.75" $679.88 $679.88 "$1,076.92" "$1,359.75" "$1,087.80" $611.89 $269.88 N/A $788.80 "$1,359.75" $815.85 "$1,359.75" "$1,359.75" "$1,359.75" N/A N/A 71840218 SUP HCPCS C1713 71840218 - PLATE BN 234MM 18 HL CMPR 3.5MM SCR SM FRAG SET BOTH IP/OP "$1,517.50" "$1,123.00" $301.14 "$1,517.25" $682.76 $682.76 $682.76 $682.76 "$1,517.25" "$1,517.25" "$1,517.25" $316.23 "$1,517.25" "$1,517.25" "$1,517.25" "$1,517.25" "$1,517.25" $316.21 "$1,517.25" "$1,517.25" $897.45 "$1,517.25" "$1,517.25" "$1,517.25" "$1,517.25" "$1,138.13" "$1,517.25" "$1,517.25" "$1,517.25" $758.63 $758.63 "$1,201.66" "$1,517.25" "$1,213.80" $682.76 $301.14 N/A $880.15 "$1,517.25" $910.35 "$1,517.25" $316.19 "$1,517.25" N/A N/A 71840220 SUP HCPCS C1713 71840220 - PLATE BN 260MM 20 HL CMPR 3.5MM SCR SM FRAG SET BOTH IP/OP "$1,711.50" "$1,267.00" $339.69 "$1,711.50" $770.18 $770.18 $770.18 $770.18 "$1,711.50" "$1,711.50" "$1,711.50" $356.72 "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" $356.70 "$1,711.50" "$1,711.50" "$1,012.35" "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" "$1,283.63" "$1,711.50" "$1,711.50" "$1,711.50" $855.75 $855.75 "$1,355.51" "$1,711.50" "$1,369.20" $770.18 $339.69 N/A $992.67 "$1,711.50" "$1,026.90" "$1,711.50" $356.68 "$1,711.50" N/A N/A 71841012 SUP HCPCS C1713 71841012 - TEMPLATE BNDRG TC100 12 HL SM FRAG PLT BOTH IP/OP $89.00 $66.00 $17.60 $88.68 $39.91 $39.91 $39.91 $39.91 $88.68 $88.68 $88.68 $18.48 $88.68 $88.68 $88.68 $88.68 $88.68 $18.48 $88.68 $88.68 $52.45 $88.68 $88.68 $88.68 $88.68 $66.75 $88.68 $88.68 $88.68 $44.34 $44.34 $70.23 $88.68 $70.94 $39.91 $17.60 N/A $51.62 $88.68 $53.21 $88.68 $18.48 $88.68 N/A N/A 71841206 SUP HCPCS C1713 71841206 - PLATE BN BRD 108MM 6 HL CMPR 4.5MM SCR BOTH IP/OP $577.50 $427.00 $114.62 $577.50 $259.88 $259.88 $259.88 $259.88 $577.50 $577.50 $577.50 $120.37 $577.50 $577.50 $577.50 $577.50 $577.50 $120.36 $577.50 $577.50 $341.59 $577.50 $577.50 $577.50 $577.50 $433.13 $577.50 $577.50 $577.50 $288.75 $288.75 $457.38 $577.50 $462.00 $259.88 $114.62 N/A $334.95 $577.50 $346.50 $577.50 $120.35 $577.50 N/A N/A 71841207 SUP HCPCS C1713 71841207 - PLATE BN BRD 126MM 7 HL CMPR 4.5MM SCR BOTH IP/OP $577.50 $427.00 $114.62 $577.50 $259.88 $259.88 $259.88 $259.88 $577.50 $577.50 $577.50 $120.37 $577.50 $577.50 $577.50 $577.50 $577.50 $120.36 $577.50 $577.50 $341.59 $577.50 $577.50 $577.50 $577.50 $433.13 $577.50 $577.50 $577.50 $288.75 $288.75 $457.38 $577.50 $462.00 $259.88 $114.62 N/A $334.95 $577.50 $577.50 $577.50 $120.35 $577.50 N/A N/A 71841208 SUP HCPCS C1713 71841208 - PLATE BN BRD 144MM 8 HL CMPR 4.5MM SCR BOTH IP/OP $718.50 $532.00 $142.54 $718.20 $323.19 $323.19 $323.19 $323.19 $718.20 $718.20 $718.20 $149.69 $718.20 $718.20 $718.20 $718.20 $718.20 $149.68 $718.20 $718.20 $424.82 $718.20 $718.20 $718.20 $718.20 $538.88 $718.20 $718.20 $718.20 $359.10 $359.10 $568.81 $718.20 $574.56 $323.19 $142.54 N/A $416.73 $718.20 $718.20 $718.20 $149.67 $718.20 N/A N/A 71841209 SUP HCPCS C1713 71841209 - PLATE BN BRD 162MM 9 HL CMPR 4.5MM SCR BOTH IP/OP $718.50 $532.00 $142.54 $718.20 $323.19 $323.19 $323.19 $323.19 $718.20 $718.20 $718.20 $149.69 $718.20 $718.20 $718.20 $718.20 $718.20 $149.68 $718.20 $718.20 $424.82 $718.20 $718.20 $718.20 $718.20 $538.88 $718.20 $718.20 $718.20 $359.10 $359.10 $568.81 $718.20 $574.56 $323.19 $142.54 N/A $416.73 $718.20 $430.92 $718.20 $718.20 $718.20 N/A N/A 71841210 SUP HCPCS C1713 71841210 - PLATE BN BRD 180MM 10 HL CMPR 4.5MM SCR BOTH IP/OP $718.50 $532.00 $142.54 $718.20 $323.19 $323.19 $323.19 $323.19 $718.20 $718.20 $718.20 $149.69 $718.20 $718.20 $718.20 $718.20 $718.20 $149.68 $718.20 $718.20 $424.82 $718.20 $718.20 $718.20 $718.20 $538.88 $718.20 $718.20 $718.20 $359.10 $359.10 $568.81 $718.20 $574.56 $323.19 $142.54 N/A $416.73 $718.20 $430.92 $718.20 $718.20 $718.20 N/A N/A 71841211 SUP HCPCS C1713 71841211 - PLATE BN BRD 198MM 11 HL CMPR 4.5MM SCR BOTH IP/OP $904.50 $669.00 $179.43 $904.05 $406.82 $406.82 $406.82 $406.82 $904.05 $904.05 $904.05 $188.43 $904.05 $904.05 $904.05 $904.05 $904.05 $188.41 $904.05 $904.05 $534.75 $904.05 $904.05 $904.05 $904.05 $678.38 $904.05 $904.05 $904.05 $452.03 $452.03 $716.01 $904.05 $723.24 $406.82 $179.43 N/A $524.61 $904.05 $542.43 $904.05 $188.40 $904.05 N/A N/A 71841212 SUP HCPCS C1713 71841212 - PLATE BN BRD 216MM 12 HL CMPR ORTH 4.5MM SCR BOTH IP/OP $771.00 $571.00 $152.96 $770.70 $346.82 $346.82 $346.82 $346.82 $770.70 $770.70 $770.70 $160.63 $770.70 $770.70 $770.70 $770.70 $770.70 $160.62 $770.70 $770.70 $455.87 $770.70 $770.70 $770.70 $770.70 $578.25 $770.70 $770.70 $770.70 $385.35 $385.35 $610.39 $770.70 $616.56 $346.82 $152.96 N/A $447.18 $770.70 $462.42 $770.70 $160.61 $770.70 N/A N/A 71841214 SUP HCPCS C1713 71841214 - PLATE BN BRD 252MM 14 HL CMPR 4.5MM SCR BOTH IP/OP $771.00 $571.00 $152.96 $770.70 $346.82 $346.82 $346.82 $346.82 $770.70 $770.70 $770.70 $160.63 $770.70 $770.70 $770.70 $770.70 $770.70 $160.62 $770.70 $770.70 $455.87 $770.70 $770.70 $770.70 $770.70 $578.25 $770.70 $770.70 $770.70 $385.35 $385.35 $610.39 $770.70 $616.56 $346.82 $152.96 N/A $447.18 $770.70 $462.42 $770.70 $160.61 $770.70 N/A N/A 71841218 SUP HCPCS C1713 71841218 - PLATE BN BRD 324MM 18 HL CMPR 4.5MM SCR BOTH IP/OP "$1,139.50" $843.00 $226.11 "$1,139.25" $512.66 $512.66 $512.66 $512.66 "$1,139.25" "$1,139.25" "$1,139.25" $237.45 "$1,139.25" "$1,139.25" "$1,139.25" "$1,139.25" "$1,139.25" $237.43 "$1,139.25" "$1,139.25" $673.87 "$1,139.25" "$1,139.25" "$1,139.25" "$1,139.25" $854.63 "$1,139.25" "$1,139.25" "$1,139.25" $569.63 $569.63 $902.29 "$1,139.25" $911.40 $512.66 $226.11 N/A $660.91 "$1,139.25" $683.55 "$1,139.25" $237.42 "$1,139.25" N/A N/A 71841222 SUP HCPCS C1713 71841222 - PLATE BN BRD 396MM 22 HL CMPR 4.5MM SCR BOTH IP/OP "$1,722.00" "$1,274.00" $341.77 "$1,722.00" $774.90 $774.90 $774.90 $774.90 "$1,722.00" "$1,722.00" "$1,722.00" $358.91 "$1,722.00" "$1,722.00" "$1,722.00" "$1,722.00" "$1,722.00" $358.88 "$1,722.00" $688.80 "$1,018.56" "$1,722.00" "$1,722.00" "$1,722.00" "$1,722.00" "$1,291.50" "$1,722.00" "$1,722.00" "$1,722.00" $861.00 $861.00 "$1,363.82" "$1,722.00" "$1,377.60" $774.90 $341.77 N/A $998.76 "$1,722.00" "$1,033.20" "$1,722.00" $358.86 "$1,722.00" N/A N/A 71841402 SUP HCPCS C1713 71841402 - PLATE BN NAR 36MM 2 HL CMPR 4.5MM SCR BOTH IP/OP $474.00 $351.00 $93.99 $473.55 $213.10 $213.10 $213.10 $213.10 $473.55 $473.55 $473.55 $98.70 $473.55 $473.55 $473.55 $473.55 $473.55 $98.69 $473.55 $189.42 $280.10 $473.55 $473.55 $473.55 $473.55 $355.50 $473.55 $473.55 $473.55 $236.78 $236.78 $375.05 $473.55 $378.84 $213.10 $93.99 N/A $274.92 $473.55 $284.13 $473.55 $98.69 $473.55 N/A N/A 71841403 SUP HCPCS C1713 71841403 - PLATE BN NAR 54MM 3 HL CMPR 4.5MM SCR BOTH IP/OP $387.50 $287.00 $76.90 $387.45 $174.35 $174.35 $174.35 $174.35 $387.45 $387.45 $387.45 $80.75 $387.45 $387.45 $387.45 $387.45 $387.45 $80.75 $387.45 $387.45 $229.18 $387.45 $387.45 $387.45 $387.45 $290.63 $387.45 $387.45 $387.45 $193.73 $193.73 $306.86 $387.45 $309.96 $174.35 $76.90 N/A $224.75 $387.45 $232.47 $387.45 $80.74 $387.45 N/A N/A 71841404 SUP HCPCS C1713 71841404 - PLATE BN NAR 72MM 4 HL CMPR 4.5MM SCR BOTH IP/OP $387.50 $287.00 $76.90 $387.45 $174.35 $174.35 $174.35 $174.35 $387.45 $387.45 $387.45 $80.75 $387.45 $387.45 $387.45 $387.45 $387.45 $80.75 $387.45 $387.45 $229.18 $387.45 $387.45 $387.45 $387.45 $290.63 $387.45 $387.45 $387.45 $193.73 $193.73 $306.86 $387.45 $309.96 $174.35 $76.90 N/A $224.75 $387.45 $232.47 $387.45 $387.45 $387.45 N/A N/A 71841405 SUP HCPCS C1713 71841405 - PLATE BN NAR 90MM 5 HL CMPR 4.5MM SCR BOTH IP/OP $387.50 $287.00 $76.90 $387.45 $174.35 $174.35 $174.35 $174.35 $387.45 $387.45 $387.45 $80.75 $387.45 $387.45 $387.45 $387.45 $387.45 $80.75 $387.45 $387.45 $229.18 $387.45 $387.45 $387.45 $387.45 $290.63 $387.45 $387.45 $387.45 $193.73 $193.73 $306.86 $387.45 $309.96 $174.35 $76.90 N/A $224.75 $387.45 $232.47 $387.45 $387.45 $387.45 N/A N/A 71841406 SUP HCPCS C1713 71841406 - PLATE BN NAR 108MM 6 HL CMPR 4.5MM SCR BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $441.00 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $441.00 $441.00 $91.90 $441.00 N/A N/A 71841407 SUP HCPCS C1713 71841407 - PLATE BN NAR 126MM 7 HL CMPR 4.5MM SCR BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $441.00 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $264.60 $441.00 $91.90 $441.00 N/A N/A 71841408 SUP HCPCS C1713 71841408 - PLATE BN NAR 144MM 8 HL CMPR 4.5MM SCR BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $441.00 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $264.60 $441.00 $91.90 $441.00 N/A N/A 71841409 SUP HCPCS C1713 71841409 - PLATE BN NAR 162MM 9 HL CMPR 4.5MM SCR BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $441.00 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $264.60 $441.00 $441.00 $441.00 N/A N/A 71841410 SUP HCPCS C1713 71841410 - PLATE BN NAR 180MM 10 HL CMPR 4.5MM SCR BOTH IP/OP $568.50 $421.00 $112.74 $568.05 $255.62 $255.62 $255.62 $255.62 $568.05 $568.05 $568.05 $118.40 $568.05 $568.05 $568.05 $568.05 $568.05 $118.39 $568.05 $227.22 $336.00 $568.05 $568.05 $568.05 $568.05 $426.38 $568.05 $568.05 $568.05 $284.03 $284.03 $449.90 $568.05 $454.44 $255.62 $112.74 N/A $329.73 $568.05 $340.83 $568.05 $568.05 $568.05 N/A N/A 71841411 SUP HCPCS C1713 71841411 - PLATE BN NAR 198MM 11 HL CMPR 4.5MM SCR BOTH IP/OP $568.50 $421.00 $112.74 $568.05 $255.62 $255.62 $255.62 $255.62 $568.05 $568.05 $568.05 $118.40 $568.05 $568.05 $568.05 $568.05 $568.05 $118.39 $568.05 $568.05 $336.00 $568.05 $568.05 $568.05 $568.05 $426.38 $568.05 $568.05 $568.05 $284.03 $284.03 $449.90 $568.05 $454.44 $255.62 $112.74 N/A $329.73 $568.05 $340.83 $568.05 $568.05 $568.05 N/A N/A 71841412 SUP HCPCS C1713 71841412 - PLATE BN NAR 216MM 12 HL CMPR 4.5MM SCR BOTH IP/OP $568.50 $421.00 $112.74 $568.05 $255.62 $255.62 $255.62 $255.62 $568.05 $568.05 $568.05 $118.40 $568.05 $568.05 $568.05 $568.05 $568.05 $118.39 $568.05 $227.22 $336.00 $568.05 $568.05 $568.05 $568.05 $426.38 $568.05 $568.05 $568.05 $284.03 $284.03 $449.90 $568.05 $454.44 $255.62 $112.74 N/A $329.73 $568.05 $340.83 $568.05 $118.38 $568.05 N/A N/A 71841413 SUP HCPCS C1713 71841413 - PLATE BN NAR 234MM 13 HL CMPR 4.5MM SCR BOTH IP/OP $820.50 $607.00 $162.76 $820.05 $369.02 $369.02 $369.02 $369.02 $820.05 $820.05 $820.05 $170.92 $820.05 $820.05 $820.05 $820.05 $820.05 $170.91 $820.05 $820.05 $485.06 $820.05 $820.05 $820.05 $820.05 $615.38 $820.05 $820.05 $820.05 $410.03 $410.03 $649.48 $820.05 $656.04 $369.02 $162.76 N/A $475.89 $820.05 $492.03 $820.05 $820.05 $820.05 N/A N/A 71841414 SUP HCPCS C1713 71841414 - PLATE BN NAR 252MM 14 HL CMPR 4.5MM SCR BOTH IP/OP $820.50 $607.00 $162.76 $820.05 $369.02 $369.02 $369.02 $369.02 $820.05 $820.05 $820.05 $170.92 $820.05 $820.05 $820.05 $820.05 $820.05 $170.91 $820.05 $328.02 $485.06 $820.05 $820.05 $820.05 $820.05 $615.38 $820.05 $820.05 $820.05 $410.03 $410.03 $649.48 $820.05 $656.04 $369.02 $162.76 N/A $475.89 $820.05 $492.03 $820.05 $820.05 $820.05 N/A N/A 71841416 SUP HCPCS C1713 71841416 - PLATE BN NAR 288MM 16 HL CMPR 4.5MM SCR BOTH IP/OP $866.50 $641.00 $171.93 $866.25 $389.81 $389.81 $389.81 $389.81 $866.25 $866.25 $866.25 $180.55 $866.25 $866.25 $866.25 $866.25 $866.25 $180.54 $866.25 $346.50 $512.39 $866.25 $866.25 $866.25 $866.25 $649.88 $866.25 $866.25 $866.25 $433.13 $433.13 $686.07 $866.25 $693.00 $389.81 $171.93 N/A $502.57 $866.25 $519.75 $866.25 $866.25 $866.25 N/A N/A 71841418 SUP HCPCS C1713 71841418 - PLATE BN NAR 324MM 18 HL CMPR 4.5MM SCR BOTH IP/OP "$1,270.50" $940.00 $252.16 "$1,270.50" $571.73 $571.73 $571.73 $571.73 "$1,270.50" "$1,270.50" "$1,270.50" $264.80 "$1,270.50" "$1,270.50" "$1,270.50" "$1,270.50" "$1,270.50" $264.79 "$1,270.50" "$1,270.50" $751.50 "$1,270.50" "$1,270.50" "$1,270.50" "$1,270.50" $952.88 "$1,270.50" "$1,270.50" "$1,270.50" $635.25 $635.25 "$1,006.24" "$1,270.50" "$1,016.40" $571.73 $252.16 N/A $736.89 "$1,270.50" $762.30 "$1,270.50" "$1,270.50" "$1,270.50" N/A N/A 71841420 SUP HCPCS C1713 71841420 - PLATE BN NAR 360MM 20 HL CMPR 4.5MM SCR BOTH IP/OP "$1,396.50" "$1,033.00" $277.17 "$1,396.50" $628.43 $628.43 $628.43 $628.43 "$1,396.50" "$1,396.50" "$1,396.50" $291.07 "$1,396.50" "$1,396.50" "$1,396.50" "$1,396.50" "$1,396.50" $291.05 "$1,396.50" $558.60 $826.03 "$1,396.50" "$1,396.50" "$1,396.50" "$1,396.50" "$1,047.38" "$1,396.50" "$1,396.50" "$1,396.50" $698.25 $698.25 "$1,106.03" "$1,396.50" "$1,117.20" $628.43 $277.17 N/A $809.97 "$1,396.50" $837.90 "$1,396.50" $291.03 "$1,396.50" N/A N/A 71925062 SUP Custom 27203010 71925062 - GUIDE PIN ORTHOPEDIC 2.4MM 450MM THREAD BOTH IP/OP "$1,605.00" "$1,188.00" $285.69 "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" $285.69 "$1,605.00" "$1,605.00" "$1,191.23" "$1,191.23" "$1,237.13" $836.21 $334.50 "$1,605.00" $642.00 "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" "$1,605.00" "$1,203.75" "$1,605.00" "$1,605.00" "$1,605.00" $802.50 $802.50 "$1,271.16" "$1,605.00" "$1,284.00" "$1,043.25" "$1,605.00" N/A $930.90 "$1,605.00" $963.00 "$1,605.00" "$1,605.00" "$1,605.00" N/A N/A 71931590 SUP HCPCS C1713 71931590 - NAIL IM 11.5MM 60CM FEM BOTH IP/OP "$6,919.00" "$5,120.00" "$1,373.20" "$6,918.75" "$3,113.44" "$3,113.44" "$3,113.44" "$3,113.44" "$6,918.75" "$6,918.75" "$6,918.75" "$1,442.04" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.94" "$6,918.75" "$2,767.50" "$3,410.94" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$5,189.25" "$6,918.75" "$6,918.75" "$6,918.75" "$3,459.38" "$3,459.38" "$5,479.65" "$6,918.75" "$5,535.00" "$3,113.44" "$1,373.20" N/A "$4,013.02" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.87" "$6,918.75" N/A N/A 71931594 SUP HCPCS C1713 71931594 - NAIL IM 11.5MM 80CM KN RT FEM BOTH IP/OP "$6,919.00" "$5,120.00" "$1,373.20" "$6,918.75" "$3,113.44" "$3,113.44" "$3,113.44" "$3,113.44" "$6,918.75" "$6,918.75" "$6,918.75" "$1,442.04" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.94" "$6,918.75" "$6,918.75" "$3,410.94" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$5,189.25" "$6,918.75" "$6,918.75" "$6,918.75" "$3,459.38" "$3,459.38" "$5,479.65" "$6,918.75" "$5,535.00" "$3,113.44" "$1,373.20" N/A "$4,013.02" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.87" "$6,918.75" N/A N/A 71931602 SUP HCPCS C1713 71931602 - NAIL IM 11.5MM FAN FSN KN BOTH IP/OP "$6,919.00" "$5,120.00" "$1,373.20" "$6,918.75" "$3,113.44" "$3,113.44" "$3,113.44" "$3,113.44" "$6,918.75" "$6,918.75" "$6,918.75" "$1,442.04" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.94" "$6,918.75" "$6,918.75" "$3,410.94" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$5,189.25" "$6,918.75" "$6,918.75" "$6,918.75" "$3,459.38" "$3,459.38" "$5,479.65" "$6,918.75" "$5,535.00" "$3,113.44" "$1,373.20" N/A "$4,013.02" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.87" "$6,918.75" N/A N/A 71931604 SUP HCPCS C1713 71931604 - NAIL IM 11.5MM 85MM LCK FSN FEM BOTH IP/OP "$6,919.00" "$5,120.00" "$1,373.20" "$6,918.75" "$3,113.44" "$3,113.44" "$3,113.44" "$3,113.44" "$6,918.75" "$6,918.75" "$6,918.75" "$1,442.04" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.94" "$6,918.75" "$2,767.50" "$3,410.94" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$5,189.25" "$6,918.75" "$6,918.75" "$6,918.75" "$3,459.38" "$3,459.38" "$5,479.65" "$6,918.75" "$5,535.00" "$3,113.44" "$1,373.20" N/A "$4,013.02" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.87" "$6,918.75" N/A N/A 71931663 SUP HCPCS C1713 71931663 - NAIL IM 13MM 75CM FSN LT KN BOTH IP/OP "$6,919.00" "$5,120.00" "$1,373.20" "$6,918.75" "$3,113.44" "$3,113.44" "$3,113.44" "$3,113.44" "$6,918.75" "$6,918.75" "$6,918.75" "$1,442.04" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.94" "$6,918.75" "$2,767.50" "$3,410.94" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$5,189.25" "$6,918.75" "$6,918.75" "$6,918.75" "$3,459.38" "$3,459.38" "$5,479.65" "$6,918.75" "$5,535.00" "$3,113.44" "$1,373.20" N/A "$4,013.02" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.87" "$6,918.75" N/A N/A 71931664 SUP HCPCS C1713 71931664 - NAIL IM 13MM 80CM KN FEM BOTH IP/OP "$6,919.00" "$5,120.00" "$1,373.20" "$6,918.75" "$3,113.44" "$3,113.44" "$3,113.44" "$3,113.44" "$6,918.75" "$6,918.75" "$6,918.75" "$1,442.04" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.94" "$6,918.75" "$2,767.50" "$3,410.94" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$5,189.25" "$6,918.75" "$6,918.75" "$6,918.75" "$3,459.38" "$3,459.38" "$5,479.65" "$6,918.75" "$5,535.00" "$3,113.44" "$1,373.20" N/A "$4,013.02" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.87" "$6,918.75" N/A N/A 71931665 SUP HCPCS C1713 71931665 - NAIL IM 85CMX13MM ANTGRD FSN LT BOTH IP/OP "$6,919.00" "$5,120.00" "$1,373.20" "$6,918.75" "$3,113.44" "$3,113.44" "$3,113.44" "$3,113.44" "$6,918.75" "$6,918.75" "$6,918.75" "$1,442.04" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.94" "$6,918.75" "$2,767.50" "$3,410.94" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$5,189.25" "$6,918.75" "$6,918.75" "$6,918.75" "$3,459.38" "$3,459.38" "$5,479.65" "$6,918.75" "$5,535.00" "$3,113.44" "$1,373.20" N/A "$4,013.02" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.87" "$6,918.75" N/A N/A 71931672 SUP HCPCS C1713 71931672 - NAIL IM 13MM 75CM KN FEM BOTH IP/OP "$6,919.00" "$5,120.00" "$1,373.20" "$6,918.75" "$3,113.44" "$3,113.44" "$3,113.44" "$3,113.44" "$6,918.75" "$6,918.75" "$6,918.75" "$1,442.04" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.94" "$6,918.75" "$2,767.50" "$3,410.94" "$6,918.75" "$6,918.75" "$6,918.75" "$6,918.75" "$5,189.25" "$6,918.75" "$6,918.75" "$6,918.75" "$3,459.38" "$3,459.38" "$5,479.65" "$6,918.75" "$5,535.00" "$3,113.44" "$1,373.20" N/A "$4,013.02" "$6,918.75" "$6,918.75" "$6,918.75" "$1,441.87" "$6,918.75" N/A N/A 71933134 SUP HCPCS C1713 71933134 - SCREW BN 3MM 4MM 30MM 3MM SM HDLS SCR CNN SCR SYS TI ACPT BOTH IP/OP "$6,283.50" "$4,650.00" "$1,247.04" "$6,283.13" "$2,827.41" "$2,827.41" "$2,827.41" "$2,827.41" "$6,283.13" "$6,283.13" "$6,283.13" "$1,309.56" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$1,309.47" "$6,283.13" "$2,513.25" "$3,097.58" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$4,712.63" "$6,283.13" "$6,283.13" "$6,283.13" "$3,141.57" "$3,141.57" "$4,976.24" "$6,283.13" "$5,026.50" "$2,827.41" "$1,247.04" N/A "$3,644.43" "$6,283.13" "$6,283.13" "$6,283.13" "$1,309.40" "$6,283.13" N/A N/A 71933306 SUP Custom 27203010 71933306 - RING EXFIX 255MM 2/3 RING BOTH IP/OP "$9,400.00" "$6,956.00" "$1,673.20" "$9,400.00" "$9,400.00" "$9,400.00" "$9,400.00" "$9,400.00" "$9,400.00" "$9,400.00" "$1,673.20" "$9,400.00" "$9,400.00" "$4,181.12" "$4,181.12" "$7,245.52" "$2,060.15" "$1,959.06" "$9,400.00" "$3,760.00" "$9,400.00" "$9,400.00" "$9,400.00" "$9,400.00" "$9,400.00" "$7,050.00" "$9,400.00" "$9,400.00" "$9,400.00" "$4,700.00" "$4,700.00" "$7,444.80" "$9,400.00" "$7,520.00" "$6,110.00" "$9,400.00" N/A "$5,452.00" "$9,400.00" "$5,640.00" "$9,400.00" "$9,400.00" "$9,400.00" N/A N/A 71933335 SUP Custom 27203010 71933335 - RAIL XTRNFX STD SEG DIST MDLR SYS BOTH IP/OP "$1,534.50" "$1,136.00" $273.10 "$1,534.25" "$1,534.25" "$1,534.25" "$1,534.25" "$1,534.25" "$1,534.25" "$1,534.25" $273.10 "$1,534.25" "$1,534.25" "$1,138.72" "$1,138.72" "$1,182.60" $799.34 $319.75 "$1,534.25" $613.70 "$1,534.25" "$1,534.25" "$1,534.25" "$1,534.25" "$1,534.25" "$1,150.88" "$1,534.25" "$1,534.25" "$1,534.25" $767.13 $767.13 "$1,215.13" "$1,534.25" "$1,227.40" $997.26 "$1,534.25" N/A $890.01 "$1,534.25" $920.55 "$1,534.25" "$1,534.25" "$1,534.25" N/A N/A 71933336 SUP Custom 27203010 71933336 - ARCH XTRNFX RAIL ROT CNCT BOTH IP/OP "$2,444.00" "$1,809.00" $434.99 "$2,443.75" "$2,443.75" "$2,443.75" "$2,443.75" "$2,443.75" "$2,443.75" "$2,443.75" $434.99 "$2,443.75" "$2,443.75" "$1,813.75" "$1,813.75" "$1,883.64" "$1,273.19" $509.30 "$2,443.75" $977.50 "$2,443.75" "$2,443.75" "$2,443.75" "$2,443.75" "$2,443.75" "$1,833.00" "$2,443.75" "$2,443.75" "$2,443.75" "$1,221.88" "$1,221.88" "$1,935.45" "$2,443.75" "$1,955.00" "$1,588.44" "$2,443.75" N/A "$1,417.52" "$2,443.75" "$1,466.25" "$2,443.75" "$2,443.75" "$2,443.75" N/A N/A 71933338 SUP Custom 27203010 71933338 - ARCH XTRNFX RAIL ROT CNCT BOTH IP/OP "$1,526.00" "$1,129.00" $271.58 "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" $271.58 "$1,525.75" "$1,525.75" "$1,132.41" "$1,132.41" "$1,176.05" $794.92 $317.98 "$1,525.75" $610.30 "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,144.50" "$1,525.75" "$1,525.75" "$1,525.75" $762.88 $762.88 "$1,208.39" "$1,525.75" "$1,220.60" $991.74 "$1,525.75" N/A $885.08 "$1,525.75" $915.45 "$1,525.75" "$1,525.75" "$1,525.75" N/A N/A 71933339 SUP Custom 27203010 71933339 - ARCH XTRNFX RAIL ROT CNCT BOTH IP/OP "$1,324.00" $980.00 $235.65 "$1,323.88" "$1,323.88" "$1,323.88" "$1,323.88" "$1,323.88" "$1,323.88" "$1,323.88" $235.65 "$1,323.88" "$1,323.88" $982.58 $982.58 "$1,020.45" $689.74 $275.91 "$1,323.88" $529.55 "$1,323.88" "$1,323.88" "$1,323.88" "$1,323.88" "$1,323.88" $993.00 "$1,323.88" "$1,323.88" "$1,323.88" $661.94 $661.94 "$1,048.51" "$1,323.88" "$1,059.10" $860.52 "$1,323.88" N/A $767.92 "$1,323.88" $794.33 "$1,323.88" "$1,323.88" "$1,323.88" N/A N/A 71933501 SUP HCPCS C1713 71933501 - SCREW BN 4.5MM 48MM ST CORT BOTH IP/OP $38.50 $28.00 $7.64 $38.50 $17.33 $17.33 $17.33 $17.33 $38.50 $38.50 $38.50 $8.02 $38.50 $38.50 $38.50 $38.50 $38.50 $8.02 $38.50 $15.40 $22.77 $38.50 $38.50 $38.50 $38.50 $28.88 $38.50 $38.50 $38.50 $19.25 $19.25 $30.49 $38.50 $30.80 $17.33 $7.64 N/A $22.33 $38.50 $23.10 $38.50 $8.02 $38.50 N/A N/A 71933626 SUP Custom 27203010 71933626 - CONNECTOR XTRNFX RAIL CLP BOTH IP/OP "$1,039.50" $769.00 $184.97 "$1,039.13" "$1,039.13" "$1,039.13" "$1,039.13" "$1,039.13" "$1,039.13" "$1,039.13" $184.97 "$1,039.13" "$1,039.13" $771.24 $771.24 $800.96 $541.39 $216.57 "$1,039.13" $415.65 "$1,039.13" "$1,039.13" "$1,039.13" "$1,039.13" "$1,039.13" $779.63 "$1,039.13" "$1,039.13" "$1,039.13" $519.57 $519.57 $822.99 "$1,039.13" $831.30 $675.43 "$1,039.13" N/A $602.91 "$1,039.13" $623.48 "$1,039.13" "$1,039.13" "$1,039.13" N/A N/A 71933940 SUP Custom 27203010 71933940 - RAIL XTRNFX SM MDLR RL ARC CNCT BOTH IP/OP "$1,564.00" "$1,157.00" $278.39 "$1,564.00" "$1,564.00" "$1,564.00" "$1,564.00" "$1,564.00" "$1,564.00" "$1,564.00" $278.39 "$1,564.00" "$1,564.00" "$1,160.80" "$1,160.80" "$1,205.53" $814.84 $325.95 "$1,564.00" $625.60 "$1,564.00" "$1,564.00" "$1,564.00" "$1,564.00" "$1,564.00" "$1,173.00" "$1,564.00" "$1,564.00" "$1,564.00" $782.00 $782.00 "$1,238.69" "$1,564.00" "$1,251.20" "$1,016.60" "$1,564.00" N/A $907.12 "$1,564.00" $938.40 "$1,564.00" "$1,564.00" "$1,564.00" N/A N/A 71933941 SUP Custom 27203010 71933941 - RAIL XTRNFX SM BOTH IP/OP "$2,614.00" "$1,934.00" $465.25 "$2,613.75" "$2,613.75" "$2,613.75" "$2,613.75" "$2,613.75" "$2,613.75" "$2,613.75" $465.25 "$2,613.75" "$2,613.75" "$1,939.93" "$1,939.93" "$2,014.68" "$1,361.76" $544.73 "$2,613.75" "$1,045.50" "$2,613.75" "$2,613.75" "$2,613.75" "$2,613.75" "$2,613.75" "$1,960.50" "$2,613.75" "$2,613.75" "$2,613.75" "$1,306.88" "$1,306.88" "$2,070.09" "$2,613.75" "$2,091.00" "$1,698.94" "$2,613.75" N/A "$1,516.12" "$2,613.75" "$1,568.25" "$2,613.75" "$2,613.75" "$2,613.75" N/A N/A 71933943 SUP Custom 27203010 71933943 - RAIL XTRNFX SM ARC ROT CNCT BOTH IP/OP "$1,324.00" $980.00 $235.65 "$1,323.88" "$1,323.88" "$1,323.88" "$1,323.88" "$1,323.88" "$1,323.88" "$1,323.88" $235.65 "$1,323.88" "$1,323.88" $982.58 $982.58 "$1,020.45" $689.74 $275.91 "$1,323.88" $529.55 "$1,323.88" "$1,323.88" "$1,323.88" "$1,323.88" "$1,323.88" $993.00 "$1,323.88" "$1,323.88" "$1,323.88" $661.94 $661.94 "$1,048.51" "$1,323.88" "$1,059.10" $860.52 "$1,323.88" N/A $767.92 "$1,323.88" $794.33 "$1,323.88" "$1,323.88" "$1,323.88" N/A N/A 71934046 SUP Custom 27203010 71934046 - ARCH XTRNFX SHRT MDLR RL SM RAIL BOTH IP/OP "$2,614.00" "$1,934.00" $465.25 "$2,613.75" "$2,613.75" "$2,613.75" "$2,613.75" "$2,613.75" "$2,613.75" "$2,613.75" $465.25 "$2,613.75" "$2,613.75" "$1,939.93" "$1,939.93" "$2,014.68" "$1,361.76" $544.73 "$2,613.75" "$1,045.50" "$2,613.75" "$2,613.75" "$2,613.75" "$2,613.75" "$2,613.75" "$1,960.50" "$2,613.75" "$2,613.75" "$2,613.75" "$1,306.88" "$1,306.88" "$2,070.09" "$2,613.75" "$2,091.00" "$1,698.94" "$2,613.75" N/A "$1,516.12" "$2,613.75" "$1,568.25" "$2,613.75" "$2,613.75" "$2,613.75" N/A N/A 71934155 SUP Custom 27203010 71934155 - RAIL XTRNFX SM ARC PREASSEMBLE BOTH IP/OP "$9,361.00" "$6,927.00" "$1,666.19" "$9,360.63" "$9,360.63" "$9,360.63" "$9,360.63" "$9,360.63" "$9,360.63" "$9,360.63" "$1,666.19" "$9,360.63" "$9,360.63" "$4,181.12" "$4,181.12" "$7,215.17" "$2,060.15" "$1,950.86" "$9,360.63" "$3,744.25" "$9,360.63" "$9,360.63" "$9,360.63" "$9,360.63" "$9,360.63" "$7,020.75" "$9,360.63" "$9,360.63" "$9,360.63" "$4,680.32" "$4,680.32" "$7,413.62" "$9,360.63" "$7,488.50" "$6,084.41" "$9,360.63" N/A "$5,429.38" "$9,360.63" "$5,616.38" "$9,360.63" "$9,360.63" "$9,360.63" N/A N/A 71934479 SUP HCPCS C1713 71934479 - NAIL IM 125D 10MM 24CM TRGN FEM BOTH IP/OP "$3,780.00" "$2,797.00" $750.24 "$3,780.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$3,780.00" "$3,780.00" "$3,780.00" $787.85 "$3,780.00" "$3,780.00" "$3,780.00" "$3,780.00" "$3,780.00" $787.79 "$3,780.00" "$1,512.00" "$1,863.54" "$3,780.00" "$3,780.00" "$3,780.00" "$3,780.00" "$2,835.00" "$3,780.00" "$3,780.00" "$3,780.00" "$1,890.00" "$1,890.00" "$2,993.76" "$3,780.00" "$3,024.00" "$1,701.00" $750.24 N/A "$2,192.40" "$3,780.00" "$3,780.00" "$3,780.00" $787.75 "$3,780.00" N/A N/A 71934482 SUP HCPCS C1713 71934482 - NAIL IM 130D 11.5MM 24CM TRGN FEM BOTH IP/OP "$3,780.00" "$2,797.00" $750.24 "$3,780.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$3,780.00" "$3,780.00" "$3,780.00" $787.85 "$3,780.00" "$3,780.00" "$3,780.00" "$3,780.00" "$3,780.00" $787.79 "$3,780.00" "$1,512.00" "$1,863.54" "$3,780.00" "$3,780.00" "$3,780.00" "$3,780.00" "$2,835.00" "$3,780.00" "$3,780.00" "$3,780.00" "$1,890.00" "$1,890.00" "$2,993.76" "$3,780.00" "$3,024.00" "$1,701.00" $750.24 N/A "$2,192.40" "$3,780.00" "$3,780.00" "$3,780.00" $787.75 "$3,780.00" N/A N/A 71934624 SUP Custom 27203010 71934624 - RAIL XTRNFX ARC CNCT THRD BOTH IP/OP "$1,526.00" "$1,129.00" $271.58 "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" $271.58 "$1,525.75" "$1,525.75" "$1,132.41" "$1,132.41" "$1,176.05" $794.92 $317.98 "$1,525.75" $610.30 "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,144.50" "$1,525.75" "$1,525.75" "$1,525.75" $762.88 $762.88 "$1,208.39" "$1,525.75" "$1,220.60" $991.74 "$1,525.75" N/A $885.08 "$1,525.75" $915.45 "$1,525.75" "$1,525.75" "$1,525.75" N/A N/A 71934625 SUP Custom 27203010 71934625 - RAIL XTRNFX ARC BOTH IP/OP "$2,497.00" "$1,848.00" $444.44 "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" $444.44 "$2,496.88" "$2,496.88" "$1,853.18" "$1,853.18" "$1,924.60" "$1,300.87" $520.38 "$2,496.88" $998.75 "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$1,872.75" "$2,496.88" "$2,496.88" "$2,496.88" "$1,248.44" "$1,248.44" "$1,977.53" "$2,496.88" "$1,997.50" "$1,622.97" "$2,496.88" N/A "$1,448.26" "$2,496.88" "$1,498.13" "$2,496.88" "$2,496.88" "$2,496.88" N/A N/A 71934626 SUP Custom 27203010 71934626 - RAIL XTRNFX SM ARC CNCT THRD BOTH IP/OP "$1,526.00" "$1,129.00" $271.58 "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" $271.58 "$1,525.75" "$1,525.75" "$1,132.41" "$1,132.41" "$1,176.05" $794.92 $317.98 "$1,525.75" $610.30 "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,525.75" "$1,144.50" "$1,525.75" "$1,525.75" "$1,525.75" $762.88 $762.88 "$1,208.39" "$1,525.75" "$1,220.60" $991.74 "$1,525.75" N/A $885.08 "$1,525.75" $915.45 "$1,525.75" "$1,525.75" "$1,525.75" N/A N/A 71934627 SUP Custom 27203010 71934627 - RAIL XTRNFX SM ARC BOTH IP/OP "$2,497.00" "$1,848.00" $444.44 "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" $444.44 "$2,496.88" "$2,496.88" "$1,853.18" "$1,853.18" "$1,924.60" "$1,300.87" $520.38 "$2,496.88" $998.75 "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$1,872.75" "$2,496.88" "$2,496.88" "$2,496.88" "$1,248.44" "$1,248.44" "$1,977.53" "$2,496.88" "$1,997.50" "$1,622.97" "$2,496.88" N/A "$1,448.26" "$2,496.88" "$1,498.13" "$2,496.88" "$2,496.88" "$2,496.88" N/A N/A 71934628 SUP Custom 27203010 71934628 - RAIL XTRNFX SM ARCH BOTH IP/OP "$2,497.00" "$1,848.00" $444.44 "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" $444.44 "$2,496.88" "$2,496.88" "$1,853.18" "$1,853.18" "$1,924.60" "$1,300.87" $520.38 "$2,496.88" $998.75 "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$1,872.75" "$2,496.88" "$2,496.88" "$2,496.88" "$1,248.44" "$1,248.44" "$1,977.53" "$2,496.88" "$1,997.50" "$1,622.97" "$2,496.88" N/A "$1,448.26" "$2,496.88" "$1,498.13" "$2,496.88" "$2,496.88" "$2,496.88" N/A N/A 71934629 SUP Custom 27203010 71934629 - RAIL XTRNFX 180MM ARC BOTH IP/OP "$2,497.00" "$1,848.00" $444.44 "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" $444.44 "$2,496.88" "$2,496.88" "$1,853.18" "$1,853.18" "$1,924.60" "$1,300.87" $520.38 "$2,496.88" $998.75 "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$1,872.75" "$2,496.88" "$2,496.88" "$2,496.88" "$1,248.44" "$1,248.44" "$1,977.53" "$2,496.88" "$1,997.50" "$1,622.97" "$2,496.88" N/A "$1,448.26" "$2,496.88" "$1,498.13" "$2,496.88" "$2,496.88" "$2,496.88" N/A N/A 71934630 SUP Custom 27203010 71934630 - RAIL XTRNFX SM 180MM ARC BOTH IP/OP "$2,497.00" "$1,848.00" $444.44 "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" $444.44 "$2,496.88" "$2,496.88" "$1,853.18" "$1,853.18" "$1,924.60" "$1,300.87" $520.38 "$2,496.88" $998.75 "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$2,496.88" "$1,872.75" "$2,496.88" "$2,496.88" "$2,496.88" "$1,248.44" "$1,248.44" "$1,977.53" "$2,496.88" "$1,997.50" "$1,622.97" "$2,496.88" N/A "$1,448.26" "$2,496.88" "$1,498.13" "$2,496.88" "$2,496.88" "$2,496.88" N/A N/A 71934647 SUP Custom 27203010 71934647 - RAIL XTRNFX 50MM LCK BOTH IP/OP "$1,071.00" $793.00 $190.64 "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" $190.64 "$1,071.00" "$1,071.00" $794.90 $794.90 $825.53 $557.99 $223.21 "$1,071.00" $428.40 "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" $803.25 "$1,071.00" "$1,071.00" "$1,071.00" $535.50 $535.50 $848.23 "$1,071.00" $856.80 $696.15 "$1,071.00" N/A $621.18 "$1,071.00" $642.60 "$1,071.00" "$1,071.00" "$1,071.00" N/A N/A 71934648 SUP Custom 27203010 71934648 - RAIL XTRNFX 60MM LCK BOTH IP/OP "$1,060.50" $785.00 $188.75 "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" $188.75 "$1,060.38" "$1,060.38" $787.01 $787.01 $817.34 $552.46 $220.99 "$1,060.38" $424.15 "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" $795.38 "$1,060.38" "$1,060.38" "$1,060.38" $530.19 $530.19 $839.82 "$1,060.38" $848.30 $689.25 "$1,060.38" N/A $615.09 "$1,060.38" $636.23 "$1,060.38" "$1,060.38" "$1,060.38" N/A N/A 71934649 SUP Custom 27203010 71934649 - RAIL XTRNFX 70MM LCK BOTH IP/OP "$1,071.00" $793.00 $190.64 "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" $190.64 "$1,071.00" "$1,071.00" $794.90 $794.90 $825.53 $557.99 $223.21 "$1,071.00" $428.40 "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" $803.25 "$1,071.00" "$1,071.00" "$1,071.00" $535.50 $535.50 $848.23 "$1,071.00" $856.80 $696.15 "$1,071.00" N/A $621.18 "$1,071.00" $642.60 "$1,071.00" "$1,071.00" "$1,071.00" N/A N/A 71934650 SUP Custom 27203010 71934650 - RAIL XTRNFX 80MM LCK BOTH IP/OP "$1,060.50" $785.00 $188.75 "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" $188.75 "$1,060.38" "$1,060.38" $787.01 $787.01 $817.34 $552.46 $220.99 "$1,060.38" $424.15 "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" $795.38 "$1,060.38" "$1,060.38" "$1,060.38" $530.19 $530.19 $839.82 "$1,060.38" $848.30 $689.25 "$1,060.38" N/A $615.09 "$1,060.38" $636.23 "$1,060.38" "$1,060.38" "$1,060.38" N/A N/A 71934651 SUP Custom 27203010 71934651 - RAIL XTRNFX 90MM LCK BOTH IP/OP "$1,060.50" $785.00 $188.75 "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" $188.75 "$1,060.38" "$1,060.38" $787.01 $787.01 $817.34 $552.46 $220.99 "$1,060.38" $424.15 "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" $795.38 "$1,060.38" "$1,060.38" "$1,060.38" $530.19 $530.19 $839.82 "$1,060.38" $848.30 $689.25 "$1,060.38" N/A $615.09 "$1,060.38" $636.23 "$1,060.38" "$1,060.38" "$1,060.38" N/A N/A 71934652 SUP Custom 27203010 71934652 - RAIL XTRNFX 100MM LCK BOTH IP/OP "$1,060.50" $785.00 $188.75 "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" $188.75 "$1,060.38" "$1,060.38" $787.01 $787.01 $817.34 $552.46 $220.99 "$1,060.38" $424.15 "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" "$1,060.38" $795.38 "$1,060.38" "$1,060.38" "$1,060.38" $530.19 $530.19 $839.82 "$1,060.38" $848.30 $689.25 "$1,060.38" N/A $615.09 "$1,060.38" $636.23 "$1,060.38" "$1,060.38" "$1,060.38" N/A N/A 71934776 SUP HCPCS C1713 71934776 - NAIL 10MM 34CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$4,522.50" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934777 SUP HCPCS C1713 71934777 - NAIL 10MM 36CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934778 SUP HCPCS C1713 71934778 - NAIL 10MM 38CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934779 SUP HCPCS C1713 71934779 - NAIL 10MM 40CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934780 SUP HCPCS C1713 71934780 - NAIL 10MM 42CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934781 SUP HCPCS C1713 71934781 - NAIL 10MM 44CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934782 SUP HCPCS C1713 71934782 - NAIL 10MM 34CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934783 SUP HCPCS C1713 71934783 - NAIL 10MM 36CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934784 SUP HCPCS C1713 71934784 - NAIL 10MM 38CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934785 SUP HCPCS C1713 71934785 - NAIL 10MM 40CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934787 SUP HCPCS C1713 71934787 - NAIL 10MM 44CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$4,522.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934788 SUP HCPCS C1713 71934788 - NAIL 11.5MM 36CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934789 SUP HCPCS C1713 71934789 - NAIL 11.5MM 38CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934790 SUP HCPCS C1713 71934790 - NAIL 11.5MM 40CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934791 SUP HCPCS C1713 71934791 - NAIL 11.5MM 42CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934792 SUP HCPCS C1713 71934792 - NAIL 11.5MM 44CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934793 SUP HCPCS C1713 71934793 - NAIL 11.5MM 46CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$4,522.50" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$4,522.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934794 SUP HCPCS C1713 71934794 - NAIL 11.5MM 36CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$4,522.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934795 SUP HCPCS C1713 71934795 - NAIL 11.5MM 38CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934796 SUP HCPCS C1713 71934796 - NAIL 11.5MM 40CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934797 SUP HCPCS C1713 71934797 - NAIL 11.5MM 42CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$4,522.50" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934798 SUP HCPCS C1713 71934798 - NAIL 11.5MM 44CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$4,522.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934799 SUP HCPCS C1713 71934799 - NAIL 11.5MM 46CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934800 SUP HCPCS C1713 71934800 - NAIL 13MM 36CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934801 SUP HCPCS C1713 71934801 - NAIL 13MM 38CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934802 SUP HCPCS C1713 71934802 - NAIL 13MM 40CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934803 SUP HCPCS C1713 71934803 - NAIL 13MM 42CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$4,522.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934804 SUP HCPCS C1713 71934804 - NAIL 13MM 44CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$4,522.50" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934805 SUP HCPCS C1713 71934805 - NAIL 13MM 46CM FEM LEFT IM 25D ANTGRD LIME BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934806 SUP HCPCS C1713 71934806 - NAIL 13MM 36CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$4,522.50" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934807 SUP HCPCS C1713 71934807 - NAIL 13MM 38CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$4,522.50" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$4,522.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934808 SUP HCPCS C1713 71934808 - NAIL 13MM 40CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934809 SUP HCPCS C1713 71934809 - NAIL 13MM 42CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934810 SUP HCPCS C1713 71934810 - NAIL 13MM 44CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934811 SUP HCPCS C1713 71934811 - NAIL 13MM 46CM FEM RIGHT IM 25D ANTGRD ROSE BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934845 SUP Custom 27203010 71934845 - RAIL XTRNFX 339MM BOTH IP/OP "$2,667.00" "$1,974.00" $474.70 "$2,666.88" "$2,666.88" "$2,666.88" "$2,666.88" "$2,666.88" "$2,666.88" "$2,666.88" $474.70 "$2,666.88" "$2,666.88" "$1,979.36" "$1,979.36" "$2,055.63" "$1,389.44" $555.81 "$2,666.88" "$1,066.75" "$2,666.88" "$2,666.88" "$2,666.88" "$2,666.88" "$2,666.88" "$2,000.25" "$2,666.88" "$2,666.88" "$2,666.88" "$1,333.44" "$1,333.44" "$2,112.17" "$2,666.88" "$2,133.50" "$1,733.47" "$2,666.88" N/A "$1,546.86" "$2,666.88" "$1,600.13" "$2,666.88" "$2,666.88" "$2,666.88" N/A N/A 71934846 SUP Custom 27203010 71934846 - RAIL XTRNFX SM 226MM BOTH IP/OP "$2,667.00" "$1,974.00" $474.70 "$2,666.88" "$2,666.88" "$2,666.88" "$2,666.88" "$2,666.88" "$2,666.88" "$2,666.88" $474.70 "$2,666.88" "$2,666.88" "$1,979.36" "$1,979.36" "$2,055.63" "$1,389.44" $555.81 "$2,666.88" "$1,066.75" "$2,666.88" "$2,666.88" "$2,666.88" "$2,666.88" "$2,666.88" "$2,000.25" "$2,666.88" "$2,666.88" "$2,666.88" "$1,333.44" "$1,333.44" "$2,112.17" "$2,666.88" "$2,133.50" "$1,733.47" "$2,666.88" N/A "$1,546.86" "$2,666.88" "$1,600.13" "$2,666.88" "$2,666.88" "$2,666.88" N/A N/A 71934996 SUP HCPCS C1713 71934996 - NAIL 10MM 46CM LEFT FAN IM 25D LIME DH BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934997 SUP HCPCS C1713 71934997 - NAIL 10MM 46CM RIGHT FAN IM 25D ROSE DH BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$4,522.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934998 SUP HCPCS C1713 71934998 - NAIL 11.5MM 32CM LEFT FAN IM 25D LIME DH BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$4,522.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71934999 SUP HCPCS C1713 71934999 - NAIL 11.5MM 34CM LEFT FAN IM 25D LIME DH BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71935001 SUP HCPCS C1713 71935001 - NAIL 11.5MM 34CM RIGHT FAN IM 25D ROSE DH BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$2,713.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71935002 SUP HCPCS C1713 71935002 - NAIL 13MM 32CM LEFT FAN IM 25D LIME DH BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$4,522.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71935003 SUP HCPCS C1713 71935003 - NAIL 13MM 34CM LEFT FAN IM 25D LIME DH BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$4,522.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71935004 SUP HCPCS C1713 71935004 - NAIL 13MM 32CM RIGHT FAN IM 25D ROSE DH BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$1,809.00" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$4,522.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 71935005 SUP HCPCS C1713 71935005 - NAIL 13MM 34CM RIGHT FAN IM 25D ROSE DH BOTH IP/OP "$4,522.50" "$3,347.00" $897.60 "$4,522.50" "$2,035.13" "$2,035.13" "$2,035.13" "$2,035.13" "$4,522.50" "$4,522.50" "$4,522.50" $942.60 "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" $942.54 "$4,522.50" "$4,522.50" "$2,229.59" "$4,522.50" "$4,522.50" "$4,522.50" "$4,522.50" "$3,391.88" "$4,522.50" "$4,522.50" "$4,522.50" "$2,261.25" "$2,261.25" "$3,581.82" "$4,522.50" "$3,618.00" "$2,035.13" $897.60 N/A "$2,623.05" "$4,522.50" "$4,522.50" "$4,522.50" $942.49 "$4,522.50" N/A N/A 72200634 SUP Custom 27203010 72200634 - PAD PSTN 9IN 1.5IN 11IN SUPN POST HIP PERINEUM DISP BOTH IP/OP $209.00 $155.00 $37.15 $208.70 $208.70 $208.70 $208.70 $208.70 $208.70 $208.70 $37.15 $208.70 $208.70 $154.90 $154.90 $160.87 $108.73 $43.50 $208.70 $83.48 $208.70 $208.70 $208.70 $208.70 $208.70 $156.75 $208.70 $208.70 $208.70 $104.35 $104.35 $165.29 $208.70 $166.96 $135.66 $208.70 N/A $121.22 $208.70 $125.22 $208.70 $208.70 $208.70 N/A N/A 72200683 SUP Custom 27203010 72200683 - PROBE ESURG BLK EFLEX DYNC MNPLR ABLATOR INTGR BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,020.53" "$1,020.53" "$1,059.85" $716.38 $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $893.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 72202468 SUP HCPCS C1713 72202468 - DEVICE FX 360D CRV FSTFX 2 ANCH PRETIE 2-0 5MM SUT MNSCL BOTH IP/OP "$1,164.00" $861.00 $231.01 "$1,163.90" $523.76 $523.76 $523.76 $523.76 "$1,163.90" "$1,163.90" "$1,163.90" $242.59 "$1,163.90" "$1,163.90" "$1,163.90" "$1,163.90" "$1,163.90" $242.57 "$1,163.90" $465.56 $688.45 "$1,163.90" "$1,163.90" "$1,163.90" "$1,163.90" $873.00 "$1,163.90" "$1,163.90" "$1,163.90" $581.95 $581.95 $921.81 "$1,163.90" $931.12 $523.76 $231.01 N/A $675.12 "$1,163.90" $698.34 "$1,163.90" "$1,163.90" "$1,163.90" N/A N/A 72400024 SUP HCPCS C1815 72400024 - IMPLANT UROLOGICAL 61-70CU CM PRESSURE BALLOON AMS 800 BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 72400025 SUP HCPCS C1815 72400025 - IMPLANT UROLOGICAL 71-80CU CM PRESSURE BALLOON AMS 800 BOTH IP/OP "$5,867.50" "$4,342.00" "$1,164.55" "$5,867.50" "$2,640.38" "$2,640.38" "$2,640.38" "$2,640.38" "$5,867.50" "$5,867.50" "$5,867.50" "$1,222.93" "$5,867.50" "$5,867.50" "$5,867.50" "$5,867.50" "$5,867.50" "$1,222.85" "$5,867.50" "$5,867.50" "$2,892.68" "$5,867.50" "$5,867.50" "$5,867.50" "$5,867.50" "$4,400.63" "$5,867.50" "$5,867.50" "$5,867.50" "$2,933.75" "$2,933.75" "$4,647.06" "$5,867.50" "$4,694.00" "$2,640.38" "$1,164.55" N/A "$3,403.15" "$5,867.50" "$5,867.50" "$5,867.50" "$1,222.79" "$5,867.50" N/A N/A 72402006 SUP HCPCS C1713 72402006 - SCREW BN T6 2MM 3MM 6MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $73.50 $73.50 N/A N/A 72402007 SUP HCPCS C1713 72402007 - SCREW BN T6 2MM 3MM 7MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $73.50 $73.50 N/A N/A 72402008 SUP HCPCS C1713 72402008 - SCREW BN T6 2MM 8MM STRL EVOS ST SLFRET DRV SS SM BN LNG BN BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72402009 SUP HCPCS C1713 72402009 - SCREW BN T6 2MM 3MM 9MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72402010 SUP HCPCS C1713 72402010 - SCREW BN T6 2MM 3MM 10MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $73.50 $73.50 N/A N/A 72402011 SUP HCPCS C1713 72402011 - SCREW BN T6 2MM 3MM 11MM EVOS ST CORT MN PLT SYS BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $73.50 $73.50 N/A N/A 72402012 SUP HCPCS C1713 72402012 - SCREW BN T6 2MM 3MM 12MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72402013 SUP HCPCS C1713 72402013 - SCREW BN T6 2MM 3MM 13MM EVOS ST CORT MN PLT SYS BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72402014 SUP HCPCS C1713 72402014 - SCREW BN T6 2MM 3MM 14MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72402015 SUP HCPCS C1713 72402015 - SCREW BN T6 2MM 3MM 15MM STRL EVOS MN ST CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $73.50 $73.50 $15.32 $73.50 N/A N/A 72402016 SUP HCPCS C1713 72402016 - SCREW BN T6 2MM 3MM 16MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72402017 SUP HCPCS C1713 72402017 - SCREW BN T6 2MM 3MM 17MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72402018 SUP HCPCS C1713 72402018 - SCREW BN T6 2MM 3MM 18MM EVOS ST CORT MN PLT SYS BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72402019 SUP HCPCS C1713 72402019 - SCREW BN T6 2MM 3MM 19MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72402020 SUP HCPCS C1713 72402020 - SCREW BN T6 2MM 3MM 20MM EVOS ST CORT MN PLT SYS BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $73.50 $73.50 $15.32 $73.50 N/A N/A 72402021 SUP HCPCS C1713 72402021 - SCREW BN T6 2MM 3MM 21MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $73.50 $73.50 $73.50 $73.50 N/A N/A 72402022 SUP HCPCS C1713 72402022 - SCREW BN T6 2MM 3MM 22MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $73.50 $73.50 $73.50 $73.50 N/A N/A 72402023 SUP HCPCS C1713 72402023 - SCREW BN T6 2MM 3MM 23MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $73.50 $73.50 $15.32 $73.50 N/A N/A 72402024 SUP HCPCS C1713 72402024 - SCREW BN T6 2MM 3MM 24MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72402026 SUP HCPCS C1713 72402026 - SCREW BN T6 2MM 3MM 26MM STRL EVOS MN ST DRVR LNG BN SM BN BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72402028 SUP HCPCS C1713 72402028 - SCREW BN T6 2MM 3MM 28MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72402030 SUP HCPCS C1713 72402030 - SCREW BN T6 2MM 3MM 30MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72402032 SUP HCPCS C1713 72402032 - SCREW BN T6 2MM 3MM 32MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72402034 SUP HCPCS C1713 72402034 - SCREW BN T6 2MM 3MM 34MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $73.50 $73.50 $15.32 $73.50 N/A N/A 72402036 SUP HCPCS C1713 72402036 - SCREW BN T6 2MM 3MM 36MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $73.50 $73.50 $15.32 $73.50 N/A N/A 72402038 SUP HCPCS C1713 72402038 - SCREW BN T6 2MM 3MM 38MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $73.50 $73.50 $15.32 $73.50 N/A N/A 72402040 SUP HCPCS C1713 72402040 - SCREW BN T6 2MM 3MM 40MM STRL SLFRET SCRDRVR ST FLT HD CORT BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $73.50 $73.50 $15.32 $73.50 N/A N/A 72402406 SUP HCPCS C1713 72402406 - SCREW BN 3.5MM T7 2.4MM 3.8MM 6MM STRL SLFRET SCRDRVR ST FLT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402407 SUP HCPCS C1713 72402407 - SCREW BN T7 2.4MM 7MM STRL EVOS MN SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402408 SUP HCPCS C1713 72402408 - SCREW BN 3.5MM T7 2.4MM 3.8MM 8MM STRL SLFRET SCRDRVR ST FLT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 72402409 SUP HCPCS C1713 72402409 - SCREW BN 3.5MM T7 2.4MM 3.8MM 9MM STRL SLFRET SCRDRVR ST FLT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402410 SUP HCPCS C1713 72402410 - SCREW BN 3.5MM T7 2.4MM 3.8MM 10MM STRL SLFRET SCRDRVR ST BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402411 SUP HCPCS C1713 72402411 - SCREW BN T7 2.4MM 3.8MM 11MM STRL EVOS MN ST DRVR LNG BN SM BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 72402412 SUP HCPCS C1713 72402412 - SCREW BN T7 2.4MM 3.8MM 12MM STRL EVOS MN ST DRVR LNG BN SM BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402413 SUP HCPCS C1713 72402413 - SCREW BN T7 2.4MM 3.8MM 13MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402414 SUP HCPCS C1713 72402414 - SCREW BN T7 2.4MM 14MM EVOS ST SLFRET DRV SS SM BN LNG BN BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402415 SUP HCPCS C1713 72402415 - SCREW BN 3.5MM T7 2.4MM 3.8MM 15MM STRL SLFRET SCRDRVR ST BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402416 SUP HCPCS C1713 72402416 - SCREW BN T7 2.4MM 16MM EVOS ST SLFRET DRV SS SM BN LNG BN BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402417 SUP HCPCS C1713 72402417 - SCREW BN 3.5MM T7 2.4MM 3.8MM 17MM STRL SLFRET SCRDRVR ST BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402418 SUP HCPCS C1713 72402418 - SCREW BN T7 2.4MM 3.8MM 18MM STRL EVOS MN ST DRVR LNG BN SM BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402419 SUP HCPCS C1713 72402419 - SCREW BN 3.5MM T7 2.4MM 3.8MM 19MM STRL SLFRET SCRDRVR ST BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402420 SUP HCPCS C1713 72402420 - SCREW BN 3.5MM T7 2.4MM 3.8MM 20MM STRL SLFRET SCRDRVR ST BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402421 SUP HCPCS C1713 72402421 - SCREW BN T7 2.4MM 21MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402422 SUP HCPCS C1713 72402422 - SCREW BN T7 2.4MM 22MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402423 SUP HCPCS C1713 72402423 - SCREW BN T7 2.4MM 23MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402424 SUP HCPCS C1713 72402424 - SCREW BN T7 2.4MM 24MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 72402426 SUP HCPCS C1713 72402426 - SCREW BN T7 2.4MM 26MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402430 SUP HCPCS C1713 72402430 - SCREW BN T7 2.4MM 30MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 72402432 SUP HCPCS C1713 72402432 - SCREW BN T7 2.4MM 32MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402434 SUP HCPCS C1713 72402434 - SCREW BN T7 2.4MM 34MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402436 SUP HCPCS C1713 72402436 - SCREW BN T7 2.4MM 36MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402438 SUP HCPCS C1713 72402438 - SCREW BN T7 2.4MM 38MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402442 SUP HCPCS C1713 72402442 - SCREW BN T7 2.4MM 42MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402444 SUP HCPCS C1713 72402444 - SCREW BN T7 2.4MM 44MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $77.55 $77.55 N/A N/A 72402446 SUP HCPCS C1713 72402446 - SCREW BN T7 2.4MM 46MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $77.55 $77.55 N/A N/A 72402448 SUP HCPCS C1713 72402448 - SCREW BN T7 2.4MM 48MM STRL EVOS MN ST CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402455 SUP HCPCS C1713 72402455 - SCREW BN 3.5MM T7 2.4MM 3.8MM 55MM STRL SLFRET SCRDRVR ST BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $77.55 $77.55 N/A N/A 72402460 SUP HCPCS C1713 72402460 - SCREW BN 3.5MM T7 2.4MM 3.8MM 60MM STRL SLFRET SCRDRVR ST BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 72402465 SUP HCPCS C1713 72402465 - SCREW BN 3.5MM T7 2.4MM 3.8MM 65MM STRL SLFRET SCRDRVR ST BOTH IP/OP $106.50 $79.00 $21.07 $106.15 $47.77 $47.77 $47.77 $47.77 $106.15 $106.15 $106.15 $22.12 $106.15 $106.15 $106.15 $106.15 $106.15 $22.12 $106.15 $42.46 $62.79 $106.15 $106.15 $106.15 $106.15 $79.88 $106.15 $106.15 $106.15 $53.08 $53.08 $84.07 $106.15 $84.92 $47.77 $21.07 N/A $61.77 $106.15 $106.15 $106.15 $22.12 $106.15 N/A N/A 72402470 SUP HCPCS C1713 72402470 - SCREW BN 3.5MM T7 2.4MM 3.8MM 70MM STRL SLFRET SCRDRVR ST BOTH IP/OP $106.50 $79.00 $21.07 $106.15 $47.77 $47.77 $47.77 $47.77 $106.15 $106.15 $106.15 $22.12 $106.15 $106.15 $106.15 $106.15 $106.15 $22.12 $106.15 $106.15 $62.79 $106.15 $106.15 $106.15 $106.15 $79.88 $106.15 $106.15 $106.15 $53.08 $53.08 $84.07 $106.15 $84.92 $47.77 $21.07 N/A $61.77 $106.15 $106.15 $106.15 $106.15 $106.15 N/A N/A 72402475 SUP HCPCS C1713 72402475 - SCREW BN 3.5MM T7 2.4MM 3.8MM 75MM STRL SLFRET SCRDRVR ST BOTH IP/OP $106.50 $79.00 $21.07 $106.15 $47.77 $47.77 $47.77 $47.77 $106.15 $106.15 $106.15 $22.12 $106.15 $106.15 $106.15 $106.15 $106.15 $22.12 $106.15 $42.46 $62.79 $106.15 $106.15 $106.15 $106.15 $79.88 $106.15 $106.15 $106.15 $53.08 $53.08 $84.07 $106.15 $84.92 $47.77 $21.07 N/A $61.77 $106.15 $106.15 $106.15 $106.15 $106.15 N/A N/A 72402480 SUP HCPCS C1713 72402480 - SCREW BN 3.5MM T7 2.4MM 3.8MM 80MM STRL SLFRET SCRDRVR ST BOTH IP/OP $106.50 $79.00 $21.07 $106.15 $47.77 $47.77 $47.77 $47.77 $106.15 $106.15 $106.15 $22.12 $106.15 $106.15 $106.15 $106.15 $106.15 $22.12 $106.15 $106.15 $62.79 $106.15 $106.15 $106.15 $106.15 $79.88 $106.15 $106.15 $106.15 $53.08 $53.08 $84.07 $106.15 $84.92 $47.77 $21.07 N/A $61.77 $106.15 $106.15 $106.15 $22.12 $106.15 N/A N/A 72402706 SUP HCPCS C1713 72402706 - SCREW BN T8 2MM 2.7MM 4.5MM 6MM ST CORT EVOS BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $17.02 $81.68 N/A N/A 72402707 SUP HCPCS C1713 72402707 - SCREW BN T7 2.7MM 4.5MM 7MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $81.68 $81.68 N/A N/A 72402708 SUP HCPCS C1713 72402708 - SCREW BN T8 2.7MM 4.5MM 8MM EVOS ST CORT MN PLT SYS BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $81.68 $81.68 N/A N/A 72402709 SUP HCPCS C1713 72402709 - SCREW BN T8 2.7MM 9MM EVOS ST SLFRET DRV SS SM BN LNG BN BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $17.02 $81.68 N/A N/A 72402710 SUP HCPCS C1713 72402710 - SCREW BN T8 2.7MM 4.5MM 10MM EVOS ST CORT MN PLT SYS BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $17.02 $81.68 N/A N/A 72402711 SUP HCPCS C1713 72402711 - SCREW BN 2.7MM 4.5MM 11MM EVOS T8 DRVR 2 END DRL GD ST CORT BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $17.02 $81.68 N/A N/A 72402712 SUP HCPCS C1713 72402712 - SCREW BN T8 2.7MM 12MM STRL EVOS MN SS CORT BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $81.68 $81.68 N/A N/A 72402713 SUP HCPCS C1713 72402713 - SCREW BN 2.7MM 4.5MM 13MM EVOS T8 DRVR 2 END DRL GD ST CORT BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $81.68 $81.68 N/A N/A 72402714 SUP HCPCS C1713 72402714 - SCREW BN T7 2.7MM 4.5MM 14MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $17.02 $81.68 N/A N/A 72402715 SUP HCPCS C1713 72402715 - SCREW BN T7 2.7MM 4.5MM 15MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $81.68 $81.68 N/A N/A 72402716 SUP HCPCS C1713 72402716 - SCREW BN T8 2.7MM 4.5MM 16MM EVOS ST CORT MN PLT SYS BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $17.02 $81.68 N/A N/A 72402717 SUP HCPCS C1713 72402717 - SCREW BN T8 2.7MM 4.5MM 17MM NS EVOS ST CORT MN PLT SYS BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $17.02 $81.68 N/A N/A 72402718 SUP HCPCS C1713 72402718 - SCREW BN T8 2.7MM 4.5MM 18MM NS EVOS ST CORT MN PLT SYS BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $17.02 $81.68 N/A N/A 72402719 SUP HCPCS C1713 72402719 - SCREW BN T8 2MM 2.7MM 4.5MM 19MM ST CORT EVOS BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $17.02 $81.68 N/A N/A 72402720 SUP HCPCS C1713 72402720 - SCREW BN T7 2.7MM 4.5MM 20MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $81.68 $81.68 N/A N/A 72402721 SUP HCPCS C1713 72402721 - SCREW BN T7 2.7MM 4.5MM 21MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $17.02 $81.68 N/A N/A 72402722 SUP HCPCS C1713 72402722 - SCREW BN T7 2.7MM 4.5MM 22MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $81.68 $81.68 N/A N/A 72402723 SUP HCPCS C1713 72402723 - SCREW BN T7 2.7MM 4.5MM 23MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $17.02 $81.68 N/A N/A 72402724 SUP HCPCS C1713 72402724 - SCREW BN T7 2.7MM 4.5MM 24MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $17.02 $81.68 N/A N/A 72402726 SUP HCPCS C1713 72402726 - SCREW BN T7 2.7MM 4.5MM 26MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $81.68 $81.68 N/A N/A 72402728 SUP HCPCS C1713 72402728 - SCREW BN T8 2MM 2.7MM 4.5MM 28MM ST CORT EVOS BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $17.02 $81.68 N/A N/A 72402730 SUP HCPCS C1713 72402730 - SCREW BN T7 2.7MM 4.5MM 30MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $81.68 $81.68 N/A N/A 72402732 SUP HCPCS C1713 72402732 - SCREW BN T8 2MM 2.7MM 4.5MM 32MM ST CORT EVOS BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $17.02 $81.68 N/A N/A 72402734 SUP HCPCS C1713 72402734 - SCREW BN T7 2.7MM 4.5MM 34MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $17.02 $81.68 N/A N/A 72402736 SUP HCPCS C1713 72402736 - SCREW BN T8 2MM 2.7MM 4.5MM 36MM ST CORT EVOS BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $81.68 $81.68 N/A N/A 72402738 SUP HCPCS C1713 72402738 - SCREW BN T8 2.7MM 4.5MM 38MM STRL EVOS MN ST CORT BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $17.02 $81.68 N/A N/A 72402740 SUP HCPCS C1713 72402740 - SCREW BN T8 2.7MM 4.5MM 40MM STRL EVOS MN ST DRVR LNG BN SM BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $81.68 $81.68 N/A N/A 72402742 SUP HCPCS C1713 72402742 - SCREW BN T7 2.7MM 4.5MM 42MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $81.68 $81.68 N/A N/A 72402744 SUP HCPCS C1713 72402744 - SCREW BN T8 2MM 2.7MM 4.5MM 44MM ST CORT EVOS BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $81.68 $81.68 N/A N/A 72402746 SUP HCPCS C1713 72402746 - SCREW BN T7 2.7MM 4.5MM 46MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $17.02 $81.68 N/A N/A 72402748 SUP HCPCS C1713 72402748 - SCREW BN T7 2.7MM 4.5MM 48MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $32.67 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $17.02 $81.68 N/A N/A 72402750 SUP HCPCS C1713 72402750 - SCREW BN T7 2.7MM 4.5MM 50MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $81.68 $81.68 $81.68 $81.68 N/A N/A 72402755 SUP HCPCS C1713 72402755 - SCREW BN T7 2.7MM 4.5MM 55MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $17.02 $81.68 N/A N/A 72402760 SUP HCPCS C1713 72402760 - SCREW BN T7 2.7MM 4.5MM 60MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $82.00 $61.00 $16.21 $81.68 $36.76 $36.76 $36.76 $36.76 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $81.68 $81.68 $81.68 $17.02 $81.68 $81.68 $48.31 $81.68 $81.68 $81.68 $81.68 $61.50 $81.68 $81.68 $81.68 $40.84 $40.84 $64.69 $81.68 $65.34 $36.76 $16.21 N/A $47.56 $81.68 $49.01 $81.68 $17.02 $81.68 N/A N/A 72402765 SUP HCPCS C1713 72402765 - SCREW BN T7 2.7MM 4.5MM 65MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $110.50 $82.00 $21.89 $110.28 $49.63 $49.63 $49.63 $49.63 $110.28 $110.28 $110.28 $22.99 $110.28 $110.28 $110.28 $110.28 $110.28 $22.98 $110.28 $44.11 $65.23 $110.28 $110.28 $110.28 $110.28 $82.88 $110.28 $110.28 $110.28 $55.14 $55.14 $87.34 $110.28 $88.22 $49.63 $21.89 N/A $64.09 $110.28 $66.17 $110.28 $110.28 $110.28 N/A N/A 72402770 SUP HCPCS C1713 72402770 - SCREW BN T7 2.7MM 4.5MM 70MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $110.50 $82.00 $21.89 $110.28 $49.63 $49.63 $49.63 $49.63 $110.28 $110.28 $110.28 $22.99 $110.28 $110.28 $110.28 $110.28 $110.28 $22.98 $110.28 $44.11 $65.23 $110.28 $110.28 $110.28 $110.28 $82.88 $110.28 $110.28 $110.28 $55.14 $55.14 $87.34 $110.28 $88.22 $49.63 $21.89 N/A $64.09 $110.28 $66.17 $110.28 $22.98 $110.28 N/A N/A 72402775 SUP HCPCS C1713 72402775 - SCREW BN T8 2.7MM 4.5MM 75MM STRL EVOS MN ST DRVR LNG BN SM BOTH IP/OP $110.50 $82.00 $21.89 $110.28 $49.63 $49.63 $49.63 $49.63 $110.28 $110.28 $110.28 $22.99 $110.28 $110.28 $110.28 $110.28 $110.28 $22.98 $110.28 $110.28 $65.23 $110.28 $110.28 $110.28 $110.28 $82.88 $110.28 $110.28 $110.28 $55.14 $55.14 $87.34 $110.28 $88.22 $49.63 $21.89 N/A $64.09 $110.28 $66.17 $110.28 $22.98 $110.28 N/A N/A 72402780 SUP HCPCS C1713 72402780 - SCREW BN T7 2.7MM 4.5MM 80MM STRL SLFRET SCRDRVR ST FLT HD BOTH IP/OP $110.50 $82.00 $21.89 $110.28 $49.63 $49.63 $49.63 $49.63 $110.28 $110.28 $110.28 $22.99 $110.28 $110.28 $110.28 $110.28 $110.28 $22.98 $110.28 $44.11 $65.23 $110.28 $110.28 $110.28 $110.28 $82.88 $110.28 $110.28 $110.28 $55.14 $55.14 $87.34 $110.28 $88.22 $49.63 $21.89 N/A $64.09 $110.28 $66.17 $110.28 $22.98 $110.28 N/A N/A 72403513 SUP HCPCS C1713 72403513 - SCREW BN 1.7MM 5MM ST AX STAB LWR PRFL BOTH IP/OP $59.00 $44.00 $11.66 $58.73 $26.43 $26.43 $26.43 $26.43 $58.73 $58.73 $58.73 $12.24 $58.73 $58.73 $58.73 $58.73 $58.73 $12.24 $58.73 $23.49 $34.74 $58.73 $58.73 $58.73 $58.73 $44.25 $58.73 $58.73 $58.73 $29.37 $29.37 $46.51 $58.73 $46.98 $26.43 $11.66 N/A $34.22 $58.73 $58.73 $58.73 $12.24 $58.73 N/A N/A 72403514 SUP HCPCS C1713 72403514 - SCREW BN 1.7MM 4MM SLF DRL AX STAB LWR PRFL BOTH IP/OP $59.00 $44.00 $11.66 $58.73 $26.43 $26.43 $26.43 $26.43 $58.73 $58.73 $58.73 $12.24 $58.73 $58.73 $58.73 $58.73 $58.73 $12.24 $58.73 $58.73 $34.74 $58.73 $58.73 $58.73 $58.73 $44.25 $58.73 $58.73 $58.73 $29.37 $29.37 $46.51 $58.73 $46.98 $26.43 $11.66 N/A $34.22 $58.73 $58.73 $58.73 $58.73 $58.73 N/A N/A 72403528 SUP HCPCS C1713 72403528 - SCREW BN 3.5MM 28MM STRL EVOS ST CORT BOTH IP/OP $59.00 $44.00 $11.66 $58.73 $26.43 $26.43 $26.43 $26.43 $58.73 $58.73 $58.73 $12.24 $58.73 $58.73 $58.73 $58.73 $58.73 $12.24 $58.73 $58.73 $34.74 $58.73 $58.73 $58.73 $58.73 $44.25 $58.73 $58.73 $58.73 $29.37 $29.37 $46.51 $58.73 $46.98 $26.43 $11.66 N/A $34.22 $58.73 $58.73 $58.73 $12.24 $58.73 N/A N/A 72403540 SUP HCPCS C1713 72403540 - SCREW BN 3.5MM 40MM STRL EVOS ST CORT BOTH IP/OP $59.00 $44.00 $11.66 $58.73 $26.43 $26.43 $26.43 $26.43 $58.73 $58.73 $58.73 $12.24 $58.73 $58.73 $58.73 $58.73 $58.73 $12.24 $58.73 $58.73 $34.74 $58.73 $58.73 $58.73 $58.73 $44.25 $58.73 $58.73 $58.73 $29.37 $29.37 $46.51 $58.73 $46.98 $26.43 $11.66 N/A $34.22 $58.73 $58.73 $58.73 $12.24 $58.73 N/A N/A 72403550 SUP HCPCS C1713 72403550 - SCREW BN 3.5MM 50MM STRL EVOS ST CORT BOTH IP/OP $59.00 $44.00 $11.66 $58.73 $26.43 $26.43 $26.43 $26.43 $58.73 $58.73 $58.73 $12.24 $58.73 $58.73 $58.73 $58.73 $58.73 $12.24 $58.73 $58.73 $34.74 $58.73 $58.73 $58.73 $58.73 $44.25 $58.73 $58.73 $58.73 $29.37 $29.37 $46.51 $58.73 $46.98 $26.43 $11.66 N/A $34.22 $58.73 $58.73 $58.73 $12.24 $58.73 N/A N/A 72403830 SUP HCPCS C1771 72403830 - SLING PUBOVAGINAL HAMMOCK SUTURE MONARC FMALE SUBFASCIAL BOTH IP/OP "$3,177.50" "$2,351.00" $630.65 "$3,177.50" "$1,429.88" "$1,429.88" "$1,429.88" "$1,429.88" "$3,177.50" "$3,177.50" "$3,177.50" $662.27 "$3,177.50" "$3,177.50" "$3,177.50" "$3,177.50" "$3,177.50" $662.23 "$3,177.50" "$3,177.50" "$1,566.51" "$3,177.50" "$3,177.50" "$3,177.50" "$3,177.50" "$2,383.13" "$3,177.50" "$3,177.50" "$3,177.50" "$1,588.75" "$1,588.75" "$2,516.58" "$3,177.50" "$2,542.00" "$1,429.88" $630.65 N/A "$1,842.95" "$3,177.50" "$3,177.50" "$3,177.50" $662.19 "$3,177.50" N/A N/A 72403867 SUP HCPCS C1813 72403867 - PROSTHESIS PENILE KIT AMS 700 ERECTILE RSTOR BOTH IP/OP $725.00 $537.00 $143.89 $725.00 $326.25 $326.25 $326.25 $326.25 $725.00 $725.00 $725.00 $151.11 $725.00 $725.00 $725.00 $725.00 $725.00 $151.10 $725.00 $725.00 $428.84 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $326.25 $143.89 N/A $420.50 $725.00 $725.00 $725.00 $151.09 $725.00 N/A N/A 72404127 SUP HCPCS C1813 72404127 - IMPLANT UROLOGICAL 4.5CM CONTINENCE PUMP AMS 800 INHIBIZONE BOTH IP/OP "$10,500.00" "$7,770.00" "$2,083.99" "$10,500.00" "$4,725.00" "$4,725.00" "$4,725.00" "$4,725.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.46" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.32" "$10,500.00" "$10,500.00" "$5,176.50" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$7,875.00" "$10,500.00" "$10,500.00" "$10,500.00" "$5,250.00" "$5,250.00" "$8,316.00" "$10,500.00" "$8,400.00" "$4,725.00" "$2,083.99" N/A "$6,090.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.20" "$10,500.00" N/A N/A 72404131 SUP HCPCS C1815 72404131 - IMPLANT UROLOGICAL 4.5CM CUFF AMS 800 INHIBIZONE SPHINCTER BOTH IP/OP "$9,011.00" "$6,668.00" "$1,788.38" "$9,010.63" "$4,054.78" "$4,054.78" "$4,054.78" "$4,054.78" "$9,010.63" "$9,010.63" "$9,010.63" "$1,878.04" "$9,010.63" "$9,010.63" "$9,010.63" "$9,010.63" "$9,010.63" "$1,877.91" "$9,010.63" "$9,010.63" "$4,442.24" "$9,010.63" "$9,010.63" "$9,010.63" "$9,010.63" "$6,758.25" "$9,010.63" "$9,010.63" "$9,010.63" "$4,505.32" "$4,505.32" "$7,136.42" "$9,010.63" "$7,208.50" "$4,054.78" "$1,788.38" N/A "$5,226.38" "$9,010.63" "$9,010.63" "$9,010.63" "$1,877.82" "$9,010.63" N/A N/A 72404132 SUP HCPCS C1815 72404132 - IMPLANT UROLOGICAL 5CM CONTINENCE PUMP AMS 800 INHIBIZONE BOTH IP/OP "$12,487.50" "$9,241.00" "$2,478.46" "$12,487.50" "$5,619.38" "$5,619.38" "$5,619.38" "$5,619.38" "$12,487.50" "$12,487.50" "$12,487.50" "$2,602.71" "$12,487.50" "$12,487.50" "$12,487.50" "$12,487.50" "$12,487.50" "$2,602.53" "$12,487.50" "$12,487.50" "$6,156.34" "$12,487.50" "$12,487.50" "$12,487.50" "$12,487.50" "$9,365.63" "$12,487.50" "$12,487.50" "$12,487.50" "$6,243.75" "$6,243.75" "$9,890.10" "$12,487.50" "$9,990.00" "$5,619.38" "$2,478.46" N/A "$7,242.75" "$12,487.50" "$12,487.50" "$12,487.50" "$2,602.40" "$12,487.50" N/A N/A 72404133 SUP HCPCS C1815 72404133 - IMPLANT UROLOGICAL 5.5CM CONTINENCE PUMP AMS 800 INHIBIZONE BOTH IP/OP "$12,487.50" "$9,241.00" "$2,478.46" "$12,487.50" "$5,619.38" "$5,619.38" "$5,619.38" "$5,619.38" "$12,487.50" "$12,487.50" "$12,487.50" "$2,602.71" "$12,487.50" "$12,487.50" "$12,487.50" "$12,487.50" "$12,487.50" "$2,602.53" "$12,487.50" "$12,487.50" "$6,156.34" "$12,487.50" "$12,487.50" "$12,487.50" "$12,487.50" "$9,365.63" "$12,487.50" "$12,487.50" "$12,487.50" "$6,243.75" "$6,243.75" "$9,890.10" "$12,487.50" "$9,990.00" "$5,619.38" "$2,478.46" N/A "$7,242.75" "$12,487.50" "$12,487.50" "$12,487.50" "$2,602.40" "$12,487.50" N/A N/A 72404250 SUP HCPCS C1813 72404250 - PROSTHESIS PENILE 12/12MM PRECONNECT PUMP PRECON MS BOTH IP/OP "$19,557.50" "$14,473.00" "$3,881.67" "$19,557.50" "$8,800.88" "$8,800.88" "$8,800.88" "$8,800.88" "$19,557.50" "$19,557.50" "$19,557.50" "$4,076.27" "$19,557.50" "$19,557.50" "$19,557.50" "$19,557.50" "$19,557.50" "$4,076.00" "$19,557.50" "$19,557.50" "$9,641.85" "$19,557.50" "$19,557.50" "$19,557.50" "$19,557.50" "$14,668.13" "$19,557.50" "$19,557.50" "$19,557.50" "$9,778.75" "$9,778.75" "$15,489.54" "$19,557.50" "$15,646.00" "$8,800.88" "$3,881.67" N/A "$11,343.35" "$19,557.50" "$19,557.50" "$19,557.50" "$4,075.78" "$19,557.50" N/A N/A 72404256 SUP HCPCS C1813 72404256 - PROSTHESIS PENL AMS 700 LGX MS PMP 15CM 3 PC INFL BOTH IP/OP "$23,330.00" "$17,264.00" "$4,630.42" "$23,330.00" "$10,498.50" "$10,498.50" "$10,498.50" "$10,498.50" "$23,330.00" "$23,330.00" "$23,330.00" "$4,862.56" "$23,330.00" "$23,330.00" "$23,330.00" "$23,330.00" "$23,330.00" "$4,862.23" "$23,330.00" "$23,330.00" "$11,501.69" "$23,330.00" "$23,330.00" "$23,330.00" "$23,330.00" "$17,497.50" "$23,330.00" "$23,330.00" "$23,330.00" "$11,665.00" "$11,665.00" "$18,477.36" "$23,330.00" "$18,664.00" "$10,498.50" "$4,630.42" N/A "$13,531.40" "$23,330.00" "$23,330.00" "$23,330.00" "$4,861.97" "$23,330.00" N/A N/A 72404257 SUP HCPCS C1813 72404257 - PROSTHESIS PENILE 18CM INFLATABLE AMS 700 MS PUMP INHIBIZONE BOTH IP/OP "$21,352.50" "$15,801.00" "$4,237.94" "$21,352.50" "$9,608.63" "$9,608.63" "$9,608.63" "$9,608.63" "$21,352.50" "$21,352.50" "$21,352.50" "$4,450.39" "$21,352.50" "$21,352.50" "$21,352.50" "$21,352.50" "$21,352.50" "$4,450.10" "$21,352.50" "$21,352.50" "$10,526.78" "$21,352.50" "$21,352.50" "$21,352.50" "$21,352.50" "$16,014.38" "$21,352.50" "$21,352.50" "$21,352.50" "$10,676.25" "$10,676.25" "$16,911.18" "$21,352.50" "$17,082.00" "$9,608.63" "$4,237.94" N/A "$12,384.45" "$21,352.50" "$21,352.50" "$21,352.50" "$4,449.86" "$21,352.50" N/A N/A 72412006 SUP HCPCS C1713 72412006 - SCREW BN T6 2.7MM 4.5MM 6MM STRL LCK SLFRET SCRDRVR ST FLT BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $98.45 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $246.13 $246.13 $51.29 $246.13 N/A N/A 72412007 SUP HCPCS C1713 72412007 - SCREW BN T6 2MM 3.3MM 7MM STRL LCK SLFRET SCRDRVR ST FLT HD BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $246.13 $246.13 $51.29 $246.13 N/A N/A 72412008 SUP HCPCS C1713 72412008 - SCREW BN T6 2MM 8MM STRL EVOS ST SLFRET DRV SS SM BN LNG BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $51.29 $246.13 N/A N/A 72412009 SUP HCPCS C1713 72412009 - SCREW BN T6 2MM 3.3MM 9MM STRL LCK SLFRET SCRDRVR ST FLT HD BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $98.45 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $51.29 $246.13 N/A N/A 72412010 SUP HCPCS C1713 72412010 - SCREW BN T6 2MM 3.3MM 10MM STRL EVOS MN LCK DRVR LNG BN SM BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $98.45 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $51.29 $246.13 N/A N/A 72412011 SUP HCPCS C1713 72412011 - SCREW BN T6 2MM 3.3MM 11MM STRL LCK SLFRET SCRDRVR ST FLT HD BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $98.45 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $246.13 $246.13 N/A N/A 72412012 SUP HCPCS C1713 72412012 - SCREW BN T6 2MM 3.3MM 12MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $98.45 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $246.13 $246.13 N/A N/A 72412013 SUP HCPCS C1713 72412013 - SCREW BN T6 2MM 3.3MM 13MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $51.29 $246.13 N/A N/A 72412014 SUP HCPCS C1713 72412014 - SCREW BN T6 2MM 3.3MM 14MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $98.45 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $246.13 $246.13 $246.13 $246.13 N/A N/A 72412015 SUP HCPCS C1713 72412015 - SCREW BN T6 2MM 3.3MM 15MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $98.45 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $51.29 $246.13 N/A N/A 72412016 SUP HCPCS C1713 72412016 - SCREW BN T6 2MM 3.3MM 16MM STRL EVOS MN LCK DRVR LNG BN SM BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $98.45 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $51.29 $246.13 N/A N/A 72412017 SUP HCPCS C1713 72412017 - SCREW BN T6 2MM 3.3MM 17MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $98.45 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $246.13 $246.13 $51.29 $246.13 N/A N/A 72412018 SUP HCPCS C1713 72412018 - SCREW BN T6 2MM 3.3MM 18MM STRL EVOS MN LCK DRVR LNG BN SM BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $98.45 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $51.29 $246.13 N/A N/A 72412019 SUP HCPCS C1713 72412019 - SCREW BN T6 2MM 3.3MM 19MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $98.45 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $51.29 $246.13 N/A N/A 72412020 SUP HCPCS C1713 72412020 - SCREW BN T6 2MM 3.3MM 20MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $51.29 $246.13 N/A N/A 72412021 SUP HCPCS C1713 72412021 - SCREW BN T6 2MM 3.3MM 21MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $98.45 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $246.13 $246.13 $51.29 $246.13 N/A N/A 72412022 SUP HCPCS C1713 72412022 - SCREW BN T6 2MM 3.3MM 22MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $51.29 $246.13 N/A N/A 72412023 SUP HCPCS C1713 72412023 - SCREW BN T6 2MM 3.3MM 23MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $246.13 $246.13 N/A N/A 72412024 SUP HCPCS C1713 72412024 - SCREW BN T6 2MM 3.3MM 24MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $246.13 $246.13 N/A N/A 72412026 SUP HCPCS C1713 72412026 - SCREW BN T6 2MM 3.3MM 26MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $246.13 $246.13 $246.13 $246.13 N/A N/A 72412028 SUP HCPCS C1713 72412028 - SCREW BN T6 2MM 3.3MM 28MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $246.13 $246.13 N/A N/A 72412030 SUP HCPCS C1713 72412030 - SCREW BN T6 2MM 3.3MM 30MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $246.13 $246.13 N/A N/A 72412032 SUP HCPCS C1713 72412032 - SCREW BN T6 2MM 3.3MM 32MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $246.13 $246.13 N/A N/A 72412034 SUP HCPCS C1713 72412034 - SCREW BN T6 2MM 3.3MM 34MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $98.45 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $51.29 $246.13 N/A N/A 72412036 SUP HCPCS C1713 72412036 - SCREW BN T6 2MM 3.3MM 36MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $51.29 $246.13 N/A N/A 72412038 SUP HCPCS C1713 72412038 - SCREW BN T6 2MM 3.3MM 38MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $51.29 $246.13 N/A N/A 72412040 SUP HCPCS C1713 72412040 - SCREW BN T6 2MM 3.3MM 40MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $246.50 $182.00 $48.85 $246.13 $110.76 $110.76 $110.76 $110.76 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $246.13 $246.13 $246.13 $51.30 $246.13 $246.13 $145.59 $246.13 $246.13 $246.13 $246.13 $184.88 $246.13 $246.13 $246.13 $123.07 $123.07 $194.93 $246.13 $196.90 $110.76 $48.85 N/A $142.97 $246.13 $147.68 $246.13 $51.29 $246.13 N/A N/A 72412406 SUP HCPCS C1713 72412406 - SCREW BN T7 2.4MM 3.8MM 6MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 72412407 SUP HCPCS C1713 72412407 - SCREW BN T7 2.4MM 3.8MM 7MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 72412408 SUP HCPCS C1713 72412408 - SCREW BN T7 2.4MM 3.8MM 8MM STRL EVOS LCK SM BN LNG BN MN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $251.63 $251.63 N/A N/A 72412409 SUP HCPCS C1713 72412409 - SCREW BN T7 2.4MM 3.8MM 9MM STRL EVOS MN LCK SS LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $251.63 $251.63 N/A N/A 72412410 SUP HCPCS C1713 72412410 - SCREW BN T7 2.4MM 3.8MM 10MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $251.63 $251.63 N/A N/A 72412411 SUP HCPCS C1713 72412411 - SCREW BN T7 2.4MM 3.8MM 11MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $251.63 $251.63 N/A N/A 72412412 SUP HCPCS C1713 72412412 - SCREW BN T7 2.4MM 3.8MM 12MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $251.63 $251.63 N/A N/A 72412413 SUP HCPCS C1713 72412413 - SCREW BN T7 2.4MM 3.8MM 13MM STRL EVOS MN LCK DRVR LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 72412414 SUP HCPCS C1713 72412414 - SCREW BN T7 2.4MM 3.8MM 14MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 72412415 SUP HCPCS C1713 72412415 - SCREW BN T7 2.4MM 3.8MM 15MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 72412416 SUP HCPCS C1713 72412416 - SCREW BN T7 2.4MM 3.8MM 16MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 72412417 SUP HCPCS C1713 72412417 - SCREW BN T7 2.4MM 3.8MM 17MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 72412418 SUP HCPCS C1713 72412418 - SCREW BN T7 2.4MM 3.8MM 18MM STRL EVOS MN LCK DRVR LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $251.63 $251.63 N/A N/A 72412419 SUP HCPCS C1713 72412419 - SCREW BN T7 2.4MM 3.8MM 19MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $251.63 $251.63 N/A N/A 72412420 SUP HCPCS C1713 72412420 - SCREW BN T7 2.4MM 3.8MM 20MM STRL EVOS LCK SM BN LNG BN MN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 72412421 SUP HCPCS C1713 72412421 - SCREW BN T7 2.4MM 3.8MM 21MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 72412422 SUP HCPCS C1713 72412422 - SCREW BN T7 2.4MM 3.8MM 22MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 72412423 SUP HCPCS C1713 72412423 - SCREW BN T7 2.4MM 3.8MM 23MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 72412424 SUP HCPCS C1713 72412424 - SCREW BN T7 2.4MM 3.8MM 24MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 72412426 SUP HCPCS C1713 72412426 - SCREW BN T7 2.4MM 3.8MM 26MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 72412428 SUP HCPCS C1713 72412428 - SCREW BN T7 2.4MM 3.8MM 28MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 72412430 SUP HCPCS C1713 72412430 - SCREW BN T7 2.4MM 3.8MM 30MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $251.63 $251.63 N/A N/A 72412432 SUP HCPCS C1713 72412432 - SCREW BN T7 2.4MM 3.8MM 32MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $251.63 $251.63 N/A N/A 72412434 SUP HCPCS C1713 72412434 - SCREW BN T7 2.4MM 3.8MM 34MM STRL EVOS MN LCK SS LNG BN SM BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $251.63 $251.63 N/A N/A 72412436 SUP HCPCS C1713 72412436 - SCREW BN T7 2.4MM 3.8MM 36MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $251.63 $251.63 N/A N/A 72412438 SUP HCPCS C1713 72412438 - SCREW BN T7 2.4MM 3.8MM 38MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $150.98 $251.63 $52.44 $251.63 N/A N/A 72412440 SUP HCPCS C1713 72412440 - SCREW BN T7 2.4MM 3.8MM 40MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $251.63 $251.63 N/A N/A 72412442 SUP HCPCS C1713 72412442 - SCREW BN T7 2.4MM 3.8MM 42MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 72412444 SUP HCPCS C1713 72412444 - SCREW BN T7 2.4MM 3.8MM 44MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 72412446 SUP HCPCS C1713 72412446 - SCREW BN T7 2.4MM 3.8MM 46MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 72412448 SUP HCPCS C1713 72412448 - SCREW BN T7 2.4MM 3.8MM 48MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $251.63 $251.63 N/A N/A 72412450 SUP HCPCS C1713 72412450 - SCREW BN T7 2.4MM 3.8MM 50MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $251.63 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $251.63 $251.63 N/A N/A 72412455 SUP HCPCS C1713 72412455 - SCREW BN T7 2.4MM 3.8MM 55MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 72412460 SUP HCPCS C1713 72412460 - SCREW BN T7 2.4MM 3.8MM 60MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $252.00 $186.00 $49.94 $251.63 $113.23 $113.23 $113.23 $113.23 $251.63 $251.63 $251.63 $52.45 $251.63 $251.63 $251.63 $251.63 $251.63 $52.44 $251.63 $100.65 $148.84 $251.63 $251.63 $251.63 $251.63 $189.00 $251.63 $251.63 $251.63 $125.82 $125.82 $199.29 $251.63 $201.30 $113.23 $49.94 N/A $146.16 $251.63 $251.63 $251.63 $52.44 $251.63 N/A N/A 72412465 SUP HCPCS C1713 72412465 - SCREW BN T7 2.4MM 3.8MM 65MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $279.50 $207.00 $55.40 $279.13 $125.61 $125.61 $125.61 $125.61 $279.13 $279.13 $279.13 $58.18 $279.13 $279.13 $279.13 $279.13 $279.13 $58.17 $279.13 $111.65 $165.11 $279.13 $279.13 $279.13 $279.13 $209.63 $279.13 $279.13 $279.13 $139.57 $139.57 $221.07 $279.13 $223.30 $125.61 $55.40 N/A $162.11 $279.13 $279.13 $279.13 $58.17 $279.13 N/A N/A 72412470 SUP HCPCS C1713 72412470 - SCREW BN T7 2.4MM 3.8MM 70MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $279.50 $207.00 $55.40 $279.13 $125.61 $125.61 $125.61 $125.61 $279.13 $279.13 $279.13 $58.18 $279.13 $279.13 $279.13 $279.13 $279.13 $58.17 $279.13 $111.65 $165.11 $279.13 $279.13 $279.13 $279.13 $209.63 $279.13 $279.13 $279.13 $139.57 $139.57 $221.07 $279.13 $223.30 $125.61 $55.40 N/A $162.11 $279.13 $279.13 $279.13 $58.17 $279.13 N/A N/A 72412475 SUP HCPCS C1713 72412475 - SCREW BN T7 2.4MM 3.8MM 75MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $279.50 $207.00 $55.40 $279.13 $125.61 $125.61 $125.61 $125.61 $279.13 $279.13 $279.13 $58.18 $279.13 $279.13 $279.13 $279.13 $279.13 $58.17 $279.13 $111.65 $165.11 $279.13 $279.13 $279.13 $279.13 $209.63 $279.13 $279.13 $279.13 $139.57 $139.57 $221.07 $279.13 $223.30 $125.61 $55.40 N/A $162.11 $279.13 $279.13 $279.13 $58.17 $279.13 N/A N/A 72412480 SUP HCPCS C1713 72412480 - SCREW BN T7 2.4MM 3.8MM 80MM STRL EVOS MN LCK LNG BN SM BN BOTH IP/OP $279.50 $207.00 $55.40 $279.13 $125.61 $125.61 $125.61 $125.61 $279.13 $279.13 $279.13 $58.18 $279.13 $279.13 $279.13 $279.13 $279.13 $58.17 $279.13 $279.13 $165.11 $279.13 $279.13 $279.13 $279.13 $209.63 $279.13 $279.13 $279.13 $139.57 $139.57 $221.07 $279.13 $223.30 $125.61 $55.40 N/A $162.11 $279.13 $279.13 $279.13 $58.17 $279.13 N/A N/A 72412706 SUP HCPCS C1713 72412706 - SCREW BN T8 2.7MM 4.5MM 6MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $53.01 $254.38 N/A N/A 72412707 SUP HCPCS C1713 72412707 - SCREW BN T8 2.7MM 4.5MM 7MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $53.01 $254.38 N/A N/A 72412708 SUP HCPCS C1713 72412708 - SCREW BN T8 2.7MM 4.3MM 8MM STRL EVOS LCK SM BN LNG BN MN BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $53.01 $254.38 N/A N/A 72412709 SUP HCPCS C1713 72412709 - SCREW BN T8 2.7MM 4.5MM 9MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $53.01 $254.38 N/A N/A 72412710 SUP HCPCS C1713 72412710 - SCREW BN T8 2.7MM 4.5MM 10MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $53.01 $254.38 N/A N/A 72412711 SUP HCPCS C1713 72412711 - SCREW BN T8 2.7MM 4.5MM 11MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $53.01 $254.38 N/A N/A 72412712 SUP HCPCS C1713 72412712 - SCREW BN T8 2.7MM 4.5MM 12MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $254.38 $254.38 N/A N/A 72412713 SUP HCPCS C1713 72412713 - SCREW BN T8 2.7MM 4.5MM 13MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $254.38 $254.38 N/A N/A 72412714 SUP HCPCS C1713 72412714 - SCREW BN T8 2MM 2.7MM 4.3MM 14MM ST LCK SM BN LNG BN EVOS BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $254.38 $254.38 N/A N/A 72412715 SUP HCPCS C1713 72412715 - SCREW BN T8 2.7MM 4.5MM 15MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $53.01 $254.38 N/A N/A 72412716 SUP HCPCS C1713 72412716 - SCREW BN T8 2MM 2.7MM 4.3MM 16MM ST LCK EVOS BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412717 SUP HCPCS C1713 72412717 - SCREW BN T8 2.7MM 4.5MM 17MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $53.01 $254.38 N/A N/A 72412718 SUP HCPCS C1713 72412718 - SCREW BN T8 2MM 2.7MM 4.3MM 18MM ST LCK SM BN LNG BN EVOS BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412719 SUP HCPCS C1713 72412719 - SCREW BN T8 2.7MM 4.5MM 19MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412720 SUP HCPCS C1713 72412720 - SCREW BN T8 2.7MM 4.5MM 20MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412721 SUP HCPCS C1713 72412721 - SCREW BN T8 2.7MM 4.5MM 21MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412722 SUP HCPCS C1713 72412722 - SCREW BN T8 2.7MM 4.5MM 22MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412723 SUP HCPCS C1713 72412723 - SCREW BN T8 2.7MM 4.5MM 23MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412724 SUP HCPCS C1713 72412724 - SCREW BN T8 2MM 2.7MM 4.3MM 24MM ST LCK EVOS BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $53.01 $254.38 N/A N/A 72412726 SUP HCPCS C1713 72412726 - SCREW BN T8 2.7MM 4.3MM 26MM LCK SLF RTN FLT HD SS LNG BN SM BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $53.01 $254.38 N/A N/A 72412728 SUP HCPCS C1713 72412728 - SCREW BN T8 2.7MM 4.3MM 28MM LCK SLF RTN FLT HD SS LNG BN SM BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412730 SUP HCPCS C1713 72412730 - SCREW BN T8 2.7MM 4.3MM 30MM LCK SLF RTN FLT HD SS LNG BN SM BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412732 SUP HCPCS C1713 72412732 - SCREW BN T8 2.7MM 4.3MM 32MM LCK SLF RTN FLT HD SS LNG BN SM BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412734 SUP HCPCS C1713 72412734 - SCREW BN T8 2.7MM 4.3MM 34MM LCK SLF RTN FLT HD SS LNG BN SM BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $53.01 $254.38 N/A N/A 72412736 SUP HCPCS C1713 72412736 - SCREW BN T8 2.7MM 4.3MM 36MM LCK SLF RTN FLT HD SS LNG BN SM BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412738 SUP HCPCS C1713 72412738 - SCREW BN T8 2.7MM 4.3MM 38MM LCK SLF RTN FLT HD SS LNG BN SM BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412740 SUP HCPCS C1713 72412740 - SCREW BN T8 2.7MM 4.3MM 40MM LCK SLF RTN FLT HD SS LNG BN SM BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412742 SUP HCPCS C1713 72412742 - SCREW BN T8 2.7MM 4.3MM 42MM LCK SLF RTN FLT HD SS LNG BN SM BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $254.38 $254.38 $254.38 $254.38 N/A N/A 72412744 SUP HCPCS C1713 72412744 - SCREW BN T8 2.7MM 4.3MM 44MM LCK SLF RTN FLT HD SS LNG BN SM BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412746 SUP HCPCS C1713 72412746 - SCREW BN T8 2.7MM 4.3MM 46MM LCK SLF RTN FLT HD SS LNG BN SM BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412748 SUP HCPCS C1713 72412748 - SCREW BN T8 2.7MM 4.3MM 48MM LCK SLF RTN FLT HD SS LNG BN SM BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $254.38 $254.38 N/A N/A 72412750 SUP HCPCS C1713 72412750 - SCREW BN T8 2.7MM 4.3MM 50MM LCK SLF RTN FLT HD SS LNG BN SM BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $101.75 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412755 SUP HCPCS C1713 72412755 - SCREW BN T8 2.7MM 4.3MM 55MM LCK SLF RTN FLT HD SS LNG BN SM BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412760 SUP HCPCS C1713 72412760 - SCREW BN T8 2.7MM 4.5MM 60MM STRL EVOS MN ST SS CORT BOTH IP/OP $254.50 $188.00 $50.49 $254.38 $114.47 $114.47 $114.47 $114.47 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $254.38 $254.38 $254.38 $53.02 $254.38 $254.38 $150.47 $254.38 $254.38 $254.38 $254.38 $190.88 $254.38 $254.38 $254.38 $127.19 $127.19 $201.47 $254.38 $203.50 $114.47 $50.49 N/A $147.61 $254.38 $152.63 $254.38 $53.01 $254.38 N/A N/A 72412765 SUP HCPCS C1713 72412765 - SCREW BN T8 2.7MM 4.5MM 65MM STRL EVOS MN ST SS CORT BOTH IP/OP $287.50 $213.00 $57.04 $287.38 $129.32 $129.32 $129.32 $129.32 $287.38 $287.38 $287.38 $59.90 $287.38 $287.38 $287.38 $287.38 $287.38 $59.89 $287.38 $287.38 $169.99 $287.38 $287.38 $287.38 $287.38 $215.63 $287.38 $287.38 $287.38 $143.69 $143.69 $227.60 $287.38 $229.90 $129.32 $57.04 N/A $166.75 $287.38 $287.38 $287.38 $59.89 $287.38 N/A N/A 72412770 SUP HCPCS C1713 72412770 - SCREW BN T8 2.7MM 4.5MM 70MM STRL EVOS MN ST SS CORT BOTH IP/OP $287.50 $213.00 $57.04 $287.38 $129.32 $129.32 $129.32 $129.32 $287.38 $287.38 $287.38 $59.90 $287.38 $287.38 $287.38 $287.38 $287.38 $59.89 $287.38 $287.38 $169.99 $287.38 $287.38 $287.38 $287.38 $215.63 $287.38 $287.38 $287.38 $143.69 $143.69 $227.60 $287.38 $229.90 $129.32 $57.04 N/A $166.75 $287.38 $172.43 $287.38 $59.89 $287.38 N/A N/A 72412775 SUP HCPCS C1713 72412775 - SCREW BN T8 2.7MM 4.5MM 75MM STRL EVOS MN ST SS CORT BOTH IP/OP $287.50 $213.00 $57.04 $287.38 $129.32 $129.32 $129.32 $129.32 $287.38 $287.38 $287.38 $59.90 $287.38 $287.38 $287.38 $287.38 $287.38 $59.89 $287.38 $114.95 $169.99 $287.38 $287.38 $287.38 $287.38 $215.63 $287.38 $287.38 $287.38 $143.69 $143.69 $227.60 $287.38 $229.90 $129.32 $57.04 N/A $166.75 $287.38 $172.43 $287.38 $59.89 $287.38 N/A N/A 72412780 SUP HCPCS C1713 72412780 - SCREW BN T8 2.7MM 4.5MM 80MM STRL EVOS MN ST SS CORT BOTH IP/OP $287.50 $213.00 $57.04 $287.38 $129.32 $129.32 $129.32 $129.32 $287.38 $287.38 $287.38 $59.90 $287.38 $287.38 $287.38 $287.38 $287.38 $59.89 $287.38 $114.95 $169.99 $287.38 $287.38 $287.38 $287.38 $215.63 $287.38 $287.38 $287.38 $143.69 $143.69 $227.60 $287.38 $229.90 $129.32 $57.04 N/A $166.75 $287.38 $172.43 $287.38 $59.89 $287.38 N/A N/A 72413565 SUP HCPCS C1713 72413565 - SCREW BN 3.5MM 65MM STRL EVOS ST LCK BOTH IP/OP $305.50 $226.00 $60.58 $305.25 $137.36 $137.36 $137.36 $137.36 $305.25 $305.25 $305.25 $63.62 $305.25 $305.25 $305.25 $305.25 $305.25 $63.62 $305.25 $305.25 $180.56 $305.25 $305.25 $305.25 $305.25 $229.13 $305.25 $305.25 $305.25 $152.63 $152.63 $241.76 $305.25 $244.20 $137.36 $60.58 N/A $177.19 $305.25 $305.25 $305.25 $63.61 $305.25 N/A N/A 72413570 SUP HCPCS C1713 72413570 - SCREW BN 3.5MM 70MM STRL EVOS ST LCK BOTH IP/OP $305.50 $226.00 $60.58 $305.25 $137.36 $137.36 $137.36 $137.36 $305.25 $305.25 $305.25 $63.62 $305.25 $305.25 $305.25 $305.25 $305.25 $63.62 $305.25 $305.25 $180.56 $305.25 $305.25 $305.25 $305.25 $229.13 $305.25 $305.25 $305.25 $152.63 $152.63 $241.76 $305.25 $244.20 $137.36 $60.58 N/A $177.19 $305.25 $305.25 $305.25 $63.61 $305.25 N/A N/A 72423010 SUP HCPCS C1713 72423010 - SCREW BN T7 3MM 3.8MM 10MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $62.70 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423012 SUP HCPCS C1713 72423012 - SCREW BN T7 3MM 3.8MM 12MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $62.70 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $156.75 $156.75 $32.67 $156.75 N/A N/A 72423014 SUP HCPCS C1713 72423014 - SCREW BN T7 3MM 3.8MM 14MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $62.70 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423016 SUP HCPCS C1713 72423016 - SCREW BN T7 3MM 3.8MM 16MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $62.70 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423018 SUP HCPCS C1713 72423018 - SCREW BN T7 3MM 3.8MM 18MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $62.70 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423020 SUP HCPCS C1713 72423020 - SCREW BN T7 3MM 3.8MM 20MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $62.70 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423022 SUP HCPCS C1713 72423022 - SCREW BN T7 3MM 3.8MM 22MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $62.70 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423024 SUP HCPCS C1713 72423024 - SCREW BN T7 3MM 3.8MM 24MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $62.70 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423026 SUP HCPCS C1713 72423026 - SCREW BN T7 3MM 3.8MM 26MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $62.70 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423028 SUP HCPCS C1713 72423028 - SCREW BN T7 3MM 3.8MM 28MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423030 SUP HCPCS C1713 72423030 - SCREW BN T7 3MM 3.8MM 30MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423032 SUP HCPCS C1713 72423032 - SCREW BN T7 3MM 3.8MM 32MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423034 SUP HCPCS C1713 72423034 - SCREW BN T7 3MM 3.8MM 34MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $62.70 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $156.75 $156.75 $32.67 $156.75 N/A N/A 72423036 SUP HCPCS C1713 72423036 - SCREW BN T7 3MM 3.8MM 36MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423038 SUP HCPCS C1713 72423038 - SCREW BN T7 3MM 3.8MM 38MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423040 SUP HCPCS C1713 72423040 - SCREW BN T7 3MM 3.8MM 40MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423042 SUP HCPCS C1713 72423042 - SCREW BN T7 3MM 3.8MM 42MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423044 SUP HCPCS C1713 72423044 - SCREW BN T7 3MM 3.8MM 44MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423046 SUP HCPCS C1713 72423046 - SCREW BN T7 3MM 3.8MM 46MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $156.75 $156.75 $156.75 $156.75 N/A N/A 72423048 SUP HCPCS C1713 72423048 - SCREW BN T7 3MM 3.8MM 48MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $156.75 $156.75 N/A N/A 72423050 SUP HCPCS C1713 72423050 - SCREW BN T7 3MM 3.8MM 50MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423055 SUP HCPCS C1713 72423055 - SCREW BN T7 3MM 3.8MM 55MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423060 SUP HCPCS C1713 72423060 - SCREW BN T7 3MM 3.8MM 60MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $62.70 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 72423065 SUP HCPCS C1713 72423065 - SCREW BN T7 3MM 3.8MM 65MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72423070 SUP HCPCS C1713 72423070 - SCREW BN T7 3MM 3.8MM 70MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72423075 SUP HCPCS C1713 72423075 - SCREW BN T7 3MM 3.8MM 75MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72423080 SUP HCPCS C1713 72423080 - SCREW BN T7 3MM 3.8MM 80MM STRL EVOS MN SS LNG BN SM BN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424010 SUP HCPCS C1713 72424010 - SCREW BN T8 FT 4MM 4.5MM 10MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424012 SUP HCPCS C1713 72424012 - SCREW BN T8 FT 4MM 4.5MM 12MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424014 SUP HCPCS C1713 72424014 - SCREW BN T8 FT 4MM 4.5MM 14MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424016 SUP HCPCS C1713 72424016 - SCREW BN T8 FT 4MM 4.5MM 16MM SLFRET SCRDRVR EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72424018 SUP HCPCS C1713 72424018 - SCREW BN T8 FT 4MM 4.5MM 18MM SLFRET SCRDRVR EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424020 SUP HCPCS C1713 72424020 - SCREW BN T8 FT 4MM 4.5MM 20MM SLFRET SCRDRVR EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424022 SUP HCPCS C1713 72424022 - SCREW BN T8 FT 4MM 4.5MM 22MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424024 SUP HCPCS C1713 72424024 - SCREW BN T8 FT 4MM 4.5MM 24MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72424026 SUP HCPCS C1713 72424026 - SCREW BN T8 FT 4MM 4.5MM 10MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72424028 SUP HCPCS C1713 72424028 - SCREW BN T8 FT 4MM 4.5MM 10MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72424030 SUP HCPCS C1713 72424030 - SCREW BN T8 FT 4MM 4.5MM 30MM STRL EVOS MN VA SLFRET SCRDRVR BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424032 SUP HCPCS C1713 72424032 - SCREW BN FT T8 4MM 4.5MM 32MM STRL EVOS MN VA SLFRET SCRDRVR BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424034 SUP HCPCS C1713 72424034 - SCREW BN FT T8 4MM 4.5MM 34MM STRL EVOS MN VA SLFRET SCRDRVR BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72424036 SUP HCPCS C1713 72424036 - SCREW BN FT T8 4MM 4.5MM 36MM STRL EVOS MN VA SLFRET SCRDRVR BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72424038 SUP HCPCS C1713 72424038 - SCREW BN FT T8 4MM 4.5MM 38MM STRL EVOS MN VA SLFRET SCRDRVR BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72424040 SUP HCPCS C1713 72424040 - SCREW BN FT T8 4MM 4.5MM 40MM STRL EVOS MN VA SLFRET SCRDRVR BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424042 SUP HCPCS C1713 72424042 - SCREW BN FT T8 4MM 4.5MM 42MM STRL EVOS MN VA SLFRET SCRDRVR BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424044 SUP HCPCS C1713 72424044 - SCREW BN FT T8 4MM 4.5MM 44MM STRL EVOS MN VA SLFRET SCRDRVR BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424046 SUP HCPCS C1713 72424046 - SCREW BN FT T8 4MM 4.5MM 46MM STRL EVOS MN VA SLFRET SCRDRVR BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424048 SUP HCPCS C1713 72424048 - SCREW BN FT T8 4MM 4.5MM 48MM STRL EVOS MN VA SLFRET SCRDRVR BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72424050 SUP HCPCS C1713 72424050 - SCREW BN FT T8 4MM 4.5MM 50MM STRL EVOS MN VA SLFRET SCRDRVR BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424055 SUP HCPCS C1713 72424055 - SCREW BN FT T8 4MM 4.5MM 55MM STRL EVOS MN VA SLFRET SCRDRVR BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424060 SUP HCPCS C1713 72424060 - SCREW BN FT T8 4MM 4.5MM 60MM STRL EVOS MN VA SLFRET SCRDRVR BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $113.03 $188.38 $39.26 $188.38 N/A N/A 72424065 SUP HCPCS C1713 72424065 - SCREW BN FT T8 4MM 4.5MM 65MM STRL EVOS MN VA SLFRET SCRDRVR BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72424070 SUP HCPCS C1713 72424070 - SCREW BN FT T8 4MM 4.5MM 70MM STRL EVOS MN LNG BN SM BN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72424075 SUP HCPCS C1713 72424075 - SCREW BN FT T8 4MM 4.5MM 75MM STRL EVOS MN LNG BN SM BN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72424080 SUP HCPCS C1713 72424080 - SCREW BN FT T8 4MM 4.5MM 80MM STRL EVOS MN LNG BN SM BN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72434026 SUP HCPCS C1713 72434026 - SCREW BN T8 P/T 4MM 4.5MM 26MM SLFRET SCRDRVR EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72434028 SUP HCPCS C1713 72434028 - SCREW BN T8 P/T 4MM 4.5MM 28MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72434030 SUP HCPCS C1713 72434030 - SCREW BN T8 P/T 4MM 4.5MM 30MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72434032 SUP HCPCS C1713 72434032 - SCREW BN T8 P/T 4MM 4.5MM 32MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72434034 SUP HCPCS C1713 72434034 - SCREW BN T8 P/T 4MM 4.5MM 34MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72434036 SUP HCPCS C1713 72434036 - SCREW BN T8 P/T 4MM 4.5MM 36MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72434038 SUP HCPCS C1713 72434038 - SCREW BN T8 P/T 4MM 4.5MM 38MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72434040 SUP HCPCS C1713 72434040 - SCREW BN T8 P/T 4MM 4.5MM 40MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72434042 SUP HCPCS C1713 72434042 - SCREW BN T8 P/T 4MM 4.5MM 42MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72434044 SUP HCPCS C1713 72434044 - SCREW BN T8 P/T 4MM 4.5MM 44MM SLFRET SCRDRVR EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72434046 SUP HCPCS C1713 72434046 - SCREW BN T8 P/T 4MM 4.5MM 46MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $188.38 $188.38 N/A N/A 72434048 SUP HCPCS C1713 72434048 - SCREW BN T8 P/T 4MM 4.5MM 48MM SLFRET SCRDRVR EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $188.38 $188.38 N/A N/A 72434050 SUP HCPCS C1713 72434050 - SCREW BN T8 P/T 4MM 4.5MM 50MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72434055 SUP HCPCS C1713 72434055 - SCREW BN T8 P/T 4MM 4.5MM 55MM SLFRET SCRDRVR EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72434060 SUP HCPCS C1713 72434060 - SCREW BN T8 P/T 4MM 4.5MM 60MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $188.50 $139.00 $37.39 $188.38 $84.77 $84.77 $84.77 $84.77 $188.38 $188.38 $188.38 $39.26 $188.38 $188.38 $188.38 $188.38 $188.38 $39.26 $188.38 $75.35 $111.43 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $84.77 $37.39 N/A $109.33 $188.38 $188.38 $188.38 $39.26 $188.38 N/A N/A 72434065 SUP HCPCS C1713 72434065 - SCREW BN T8 P/T 4MM 4.5MM 65MM SLFRET SCRDRVR EVOS MN BOTH IP/OP $213.50 $158.00 $42.30 $213.13 $95.91 $95.91 $95.91 $95.91 $213.13 $213.13 $213.13 $44.42 $213.13 $213.13 $213.13 $213.13 $213.13 $44.42 $213.13 $85.25 $126.07 $213.13 $213.13 $213.13 $213.13 $160.13 $213.13 $213.13 $213.13 $106.57 $106.57 $168.80 $213.13 $170.50 $95.91 $42.30 N/A $123.83 $213.13 $213.13 $213.13 $44.42 $213.13 N/A N/A 72434070 SUP HCPCS C1713 72434070 - SCREW BN T8 P/T 4MM 4.5MM 70MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $213.50 $158.00 $42.30 $213.13 $95.91 $95.91 $95.91 $95.91 $213.13 $213.13 $213.13 $44.42 $213.13 $213.13 $213.13 $213.13 $213.13 $44.42 $213.13 $85.25 $126.07 $213.13 $213.13 $213.13 $213.13 $160.13 $213.13 $213.13 $213.13 $106.57 $106.57 $168.80 $213.13 $170.50 $95.91 $42.30 N/A $123.83 $213.13 $213.13 $213.13 $44.42 $213.13 N/A N/A 72434075 SUP HCPCS C1713 72434075 - SCREW BN T8 P/T 4MM 4.5MM 75MM SLFRET SCRDRVR TAP EVOS MN BOTH IP/OP $213.50 $158.00 $42.30 $213.13 $95.91 $95.91 $95.91 $95.91 $213.13 $213.13 $213.13 $44.42 $213.13 $213.13 $213.13 $213.13 $213.13 $44.42 $213.13 $85.25 $126.07 $213.13 $213.13 $213.13 $213.13 $160.13 $213.13 $213.13 $213.13 $106.57 $106.57 $168.80 $213.13 $170.50 $95.91 $42.30 N/A $123.83 $213.13 $213.13 $213.13 $44.42 $213.13 N/A N/A 72434080 SUP HCPCS C1713 72434080 - SCREW BN T8 P/T 4MM 4.5MM 80MM SLFRET SCRDRVR EVOS MN BOTH IP/OP $213.50 $158.00 $42.30 $213.13 $95.91 $95.91 $95.91 $95.91 $213.13 $213.13 $213.13 $44.42 $213.13 $213.13 $213.13 $213.13 $213.13 $44.42 $213.13 $85.25 $126.07 $213.13 $213.13 $213.13 $213.13 $160.13 $213.13 $213.13 $213.13 $106.57 $106.57 $168.80 $213.13 $170.50 $95.91 $42.30 N/A $123.83 $213.13 $213.13 $213.13 $44.42 $213.13 N/A N/A 72441010 SUP HCPCS C1713 72441010 - PLATE BN 127MM STRL EVOS 10 HL CMPR 3.5MM SCR BOTH IP/OP $456.50 $338.00 $90.60 $456.50 $205.43 $205.43 $205.43 $205.43 $456.50 $456.50 $456.50 $95.15 $456.50 $456.50 $456.50 $456.50 $456.50 $95.14 $456.50 $456.50 $270.02 $456.50 $456.50 $456.50 $456.50 $342.38 $456.50 $456.50 $456.50 $228.25 $228.25 $361.55 $456.50 $365.20 $205.43 $90.60 N/A $264.77 $456.50 $456.50 $456.50 $95.13 $456.50 N/A N/A 72442050 SUP HCPCS C1713 72442050 - PLATE BN T 36MM EVOS MN 2 HLE/HD 6 HL SHFT LOPRFL VA SS SM BOTH IP/OP "$1,225.50" $907.00 $243.16 "$1,225.13" $551.31 $551.31 $551.31 $551.31 "$1,225.13" "$1,225.13" "$1,225.13" $255.35 "$1,225.13" "$1,225.13" "$1,225.13" "$1,225.13" "$1,225.13" $255.33 "$1,225.13" $490.05 $724.66 "$1,225.13" "$1,225.13" "$1,225.13" "$1,225.13" $919.13 "$1,225.13" "$1,225.13" "$1,225.13" $612.57 $612.57 $970.30 "$1,225.13" $980.10 $551.31 $243.16 N/A $710.79 "$1,225.13" $735.08 "$1,225.13" "$1,225.13" "$1,225.13" N/A N/A 72442052 SUP HCPCS C1713 72442052 - PLATE BN T 46MM EVOS MN 2 HLE/HD 8 HL SHFT LOPRFL VA SS SM BOTH IP/OP "$1,225.50" $907.00 $243.16 "$1,225.13" $551.31 $551.31 $551.31 $551.31 "$1,225.13" "$1,225.13" "$1,225.13" $255.35 "$1,225.13" "$1,225.13" "$1,225.13" "$1,225.13" "$1,225.13" $255.33 "$1,225.13" $490.05 $724.66 "$1,225.13" "$1,225.13" "$1,225.13" "$1,225.13" $919.13 "$1,225.13" "$1,225.13" "$1,225.13" $612.57 $612.57 $970.30 "$1,225.13" $980.10 $551.31 $243.16 N/A $710.79 "$1,225.13" $735.08 "$1,225.13" $255.32 "$1,225.13" N/A N/A 72442054 SUP HCPCS C1713 72442054 - PLATE BN 5MM SPC T 31X5-15.3X1.2MM STRL 71MM EVOS MN 3 BOTH IP/OP "$1,225.50" $907.00 $243.16 "$1,225.13" $551.31 $551.31 $551.31 $551.31 "$1,225.13" "$1,225.13" "$1,225.13" $255.35 "$1,225.13" "$1,225.13" "$1,225.13" "$1,225.13" "$1,225.13" $255.33 "$1,225.13" "$1,225.13" $724.66 "$1,225.13" "$1,225.13" "$1,225.13" "$1,225.13" $919.13 "$1,225.13" "$1,225.13" "$1,225.13" $612.57 $612.57 $970.30 "$1,225.13" $980.10 $551.31 $243.16 N/A $710.79 "$1,225.13" $735.08 "$1,225.13" $255.32 "$1,225.13" N/A N/A 72442056 SUP HCPCS C1713 72442056 - PLATE BN T 51MM EVOS MN 2 HLE/HD 9 HL SHFT LOPRFL VA SS SM BOTH IP/OP "$1,225.50" $907.00 $243.16 "$1,225.13" $551.31 $551.31 $551.31 $551.31 "$1,225.13" "$1,225.13" "$1,225.13" $255.35 "$1,225.13" "$1,225.13" "$1,225.13" "$1,225.13" "$1,225.13" $255.33 "$1,225.13" $490.05 $724.66 "$1,225.13" "$1,225.13" "$1,225.13" "$1,225.13" $919.13 "$1,225.13" "$1,225.13" "$1,225.13" $612.57 $612.57 $970.30 "$1,225.13" $980.10 $551.31 $243.16 N/A $710.79 "$1,225.13" $735.08 "$1,225.13" $255.32 "$1,225.13" N/A N/A 72442058 SUP HCPCS C1713 72442058 - PLATE BN 21MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2MM BOTH IP/OP "$1,266.50" $937.00 $251.34 "$1,266.38" $569.87 $569.87 $569.87 $569.87 "$1,266.38" "$1,266.38" "$1,266.38" $263.95 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $263.93 "$1,266.38" "$1,266.38" $749.06 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $949.88 "$1,266.38" "$1,266.38" "$1,266.38" $633.19 $633.19 "$1,002.97" "$1,266.38" "$1,013.10" $569.87 $251.34 N/A $734.57 "$1,266.38" $759.83 "$1,266.38" $263.91 "$1,266.38" N/A N/A 72442060 SUP HCPCS C1713 72442060 - PLATE BN 5MM SPC 31X5X1.2MM STRL EVOS LOPRFL 6 HL VA FLX SS BOTH IP/OP "$1,266.50" $937.00 $251.34 "$1,266.38" $569.87 $569.87 $569.87 $569.87 "$1,266.38" "$1,266.38" "$1,266.38" $263.95 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $263.93 "$1,266.38" $506.55 $749.06 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $949.88 "$1,266.38" "$1,266.38" "$1,266.38" $633.19 $633.19 "$1,002.97" "$1,266.38" "$1,013.10" $569.87 $251.34 N/A $734.57 "$1,266.38" $759.83 "$1,266.38" $263.91 "$1,266.38" N/A N/A 72442062 SUP HCPCS C1713 72442062 - PLATE BN 41MM EVOS MN 8 HL FLX LOPRFL VA SS SM BN LNG BN 2MM BOTH IP/OP "$1,266.50" $937.00 $251.34 "$1,266.38" $569.87 $569.87 $569.87 $569.87 "$1,266.38" "$1,266.38" "$1,266.38" $263.95 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $263.93 "$1,266.38" "$1,266.38" $749.06 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $949.88 "$1,266.38" "$1,266.38" "$1,266.38" $633.19 $633.19 "$1,002.97" "$1,266.38" "$1,013.10" $569.87 $251.34 N/A $734.57 "$1,266.38" $759.83 "$1,266.38" "$1,266.38" "$1,266.38" N/A N/A 72442064 SUP HCPCS C1713 72442064 - PLATE BN 51MM EVOS MN 10 HL FLX LOPRFL VA SS SM BN LNG BN 2 BOTH IP/OP "$1,266.50" $937.00 $251.34 "$1,266.38" $569.87 $569.87 $569.87 $569.87 "$1,266.38" "$1,266.38" "$1,266.38" $263.95 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $263.93 "$1,266.38" $506.55 $749.06 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $949.88 "$1,266.38" "$1,266.38" "$1,266.38" $633.19 $633.19 "$1,002.97" "$1,266.38" "$1,013.10" $569.87 $251.34 N/A $734.57 "$1,266.38" $759.83 "$1,266.38" "$1,266.38" "$1,266.38" N/A N/A 72442066 SUP HCPCS C1713 72442066 - PLATE BN 101MM EVOS MN 20 HL FLX LOPRFL VA SS SM BN LNG BN 2 BOTH IP/OP "$1,266.50" $937.00 $251.34 "$1,266.38" $569.87 $569.87 $569.87 $569.87 "$1,266.38" "$1,266.38" "$1,266.38" $263.95 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $263.93 "$1,266.38" "$1,266.38" $749.06 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $949.88 "$1,266.38" "$1,266.38" "$1,266.38" $633.19 $633.19 "$1,002.97" "$1,266.38" "$1,013.10" $569.87 $251.34 N/A $734.57 "$1,266.38" $759.83 "$1,266.38" $263.91 "$1,266.38" N/A N/A 72442068 SUP HCPCS C1713 72442068 - PLATE BN 21MM EVOS MN 4 HL STRTH LOPRFL VA SS SM BN LNG BN 2 BOTH IP/OP "$1,266.50" $937.00 $251.34 "$1,266.38" $569.87 $569.87 $569.87 $569.87 "$1,266.38" "$1,266.38" "$1,266.38" $263.95 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $263.93 "$1,266.38" $506.55 $749.06 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $949.88 "$1,266.38" "$1,266.38" "$1,266.38" $633.19 $633.19 "$1,002.97" "$1,266.38" "$1,013.10" $569.87 $251.34 N/A $734.57 "$1,266.38" $759.83 "$1,266.38" "$1,266.38" "$1,266.38" N/A N/A 72442070 SUP HCPCS C1713 72442070 - PLATE BN 31MM EVOS MN 6 HL STRTH LOPRFL VA SS SM BN LNG BN 2 BOTH IP/OP "$1,266.50" $937.00 $251.34 "$1,266.38" $569.87 $569.87 $569.87 $569.87 "$1,266.38" "$1,266.38" "$1,266.38" $263.95 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $263.93 "$1,266.38" "$1,266.38" $749.06 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $949.88 "$1,266.38" "$1,266.38" "$1,266.38" $633.19 $633.19 "$1,002.97" "$1,266.38" "$1,013.10" $569.87 $251.34 N/A $734.57 "$1,266.38" $759.83 "$1,266.38" "$1,266.38" "$1,266.38" N/A N/A 72442072 SUP HCPCS C1713 72442072 - PLATE BN 41MM EVOS MN 8 HL STRTH LOPRFL VA SS SM BN LNG BN 2 BOTH IP/OP "$1,266.50" $937.00 $251.34 "$1,266.38" $569.87 $569.87 $569.87 $569.87 "$1,266.38" "$1,266.38" "$1,266.38" $263.95 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $263.93 "$1,266.38" $506.55 $749.06 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $949.88 "$1,266.38" "$1,266.38" "$1,266.38" $633.19 $633.19 "$1,002.97" "$1,266.38" "$1,013.10" $569.87 $251.34 N/A $734.57 "$1,266.38" $759.83 "$1,266.38" $263.91 "$1,266.38" N/A N/A 72442074 SUP HCPCS C1713 72442074 - PLATE BN 51MM EVOS MN 10 HL STRTH LOPRFL VA SS SM BN LNG BN BOTH IP/OP "$1,266.50" $937.00 $251.34 "$1,266.38" $569.87 $569.87 $569.87 $569.87 "$1,266.38" "$1,266.38" "$1,266.38" $263.95 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $263.93 "$1,266.38" $506.55 $749.06 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $949.88 "$1,266.38" "$1,266.38" "$1,266.38" $633.19 $633.19 "$1,002.97" "$1,266.38" "$1,013.10" $569.87 $251.34 N/A $734.57 "$1,266.38" $759.83 "$1,266.38" $263.91 "$1,266.38" N/A N/A 72442076 SUP HCPCS C1713 72442076 - PLATE BN 101MM EVOS MN 20 HL STRTH LOPRFL VA SS SM BN LNG BN BOTH IP/OP "$1,266.50" $937.00 $251.34 "$1,266.38" $569.87 $569.87 $569.87 $569.87 "$1,266.38" "$1,266.38" "$1,266.38" $263.95 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $263.93 "$1,266.38" "$1,266.38" $749.06 "$1,266.38" "$1,266.38" "$1,266.38" "$1,266.38" $949.88 "$1,266.38" "$1,266.38" "$1,266.38" $633.19 $633.19 "$1,002.97" "$1,266.38" "$1,013.10" $569.87 $251.34 N/A $734.57 "$1,266.38" $759.83 "$1,266.38" $263.91 "$1,266.38" N/A N/A 72442078 SUP HCPCS C1713 72442078 - PLATE BN STRG 28MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG BOTH IP/OP "$1,512.50" "$1,119.00" $300.19 "$1,512.50" $680.63 $680.63 $680.63 $680.63 "$1,512.50" "$1,512.50" "$1,512.50" $315.24 "$1,512.50" "$1,512.50" "$1,512.50" "$1,512.50" "$1,512.50" $315.22 "$1,512.50" "$1,512.50" $894.64 "$1,512.50" "$1,512.50" "$1,512.50" "$1,512.50" "$1,134.38" "$1,512.50" "$1,512.50" "$1,512.50" $756.25 $756.25 "$1,197.90" "$1,512.50" "$1,210.00" $680.63 $300.19 N/A $877.25 "$1,512.50" $907.50 "$1,512.50" $315.21 "$1,512.50" N/A N/A 72442080 SUP HCPCS C1713 72442080 - PLATE BN STRG 38MM EVOS MN 7 HL TINE LOPRFL VA SS SM BN LNG BOTH IP/OP "$1,512.50" "$1,119.00" $300.19 "$1,512.50" $680.63 $680.63 $680.63 $680.63 "$1,512.50" "$1,512.50" "$1,512.50" $315.24 "$1,512.50" "$1,512.50" "$1,512.50" "$1,512.50" "$1,512.50" $315.22 "$1,512.50" "$1,512.50" $894.64 "$1,512.50" "$1,512.50" "$1,512.50" "$1,512.50" "$1,134.38" "$1,512.50" "$1,512.50" "$1,512.50" $756.25 $756.25 "$1,197.90" "$1,512.50" "$1,210.00" $680.63 $300.19 N/A $877.25 "$1,512.50" "$1,512.50" "$1,512.50" $315.21 "$1,512.50" N/A N/A 72442120 SUP HCPCS C1713 72442120 - WASHER ORTH 5MM EVOS 2MM SCR MN PLT SYS BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $73.50 $73.50 N/A N/A 72442124 SUP HCPCS C1713 72442124 - WASHER ORTH 6MM EVOS 2.4MM SCR MN PLT SYS BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $73.50 $73.50 $73.50 $73.50 N/A N/A 72442127 SUP HCPCS C1713 72442127 - WASHER ORTH 7MM EVOS 2.7MM SCR MN PLT SYS BOTH IP/OP $73.50 $54.00 $14.59 $73.50 $33.08 $33.08 $33.08 $33.08 $73.50 $73.50 $73.50 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $43.48 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $14.59 N/A $42.63 $73.50 $44.10 $73.50 $15.32 $73.50 N/A N/A 72442135 SUP HCPCS C1713 72442135 - WASHER ORTH STRL EVOS 3.5 MM SCR BOTH IP/OP $84.00 $62.00 $16.59 $83.60 $37.62 $37.62 $37.62 $37.62 $83.60 $83.60 $83.60 $17.42 $83.60 $83.60 $83.60 $83.60 $83.60 $17.42 $83.60 $33.44 $49.45 $83.60 $83.60 $83.60 $83.60 $63.00 $83.60 $83.60 $83.60 $41.80 $41.80 $66.21 $83.60 $66.88 $37.62 $16.59 N/A $48.72 $83.60 $83.60 $83.60 $17.42 $83.60 N/A N/A 72442220 SUP HCPCS C1713 72442220 - WASHER ORTH 10MM EVOS 2 2.4MM SCR MN PLT SYS BOTH IP/OP $147.50 $109.00 $29.20 $147.13 $66.21 $66.21 $66.21 $66.21 $147.13 $147.13 $147.13 $30.67 $147.13 $147.13 $147.13 $147.13 $147.13 $30.66 $147.13 $147.13 $87.03 $147.13 $147.13 $147.13 $147.13 $110.63 $147.13 $147.13 $147.13 $73.57 $73.57 $116.53 $147.13 $117.70 $66.21 $29.20 N/A $85.55 $147.13 $88.28 $147.13 $30.66 $147.13 N/A N/A 72442224 SUP HCPCS C1713 72442224 - WASHER ORTH 11MM EVOS 2 2.4MM SCR MN PLT SYS BOTH IP/OP $147.50 $109.00 $29.20 $147.13 $66.21 $66.21 $66.21 $66.21 $147.13 $147.13 $147.13 $30.67 $147.13 $147.13 $147.13 $147.13 $147.13 $30.66 $147.13 $147.13 $87.03 $147.13 $147.13 $147.13 $147.13 $110.63 $147.13 $147.13 $147.13 $73.57 $73.57 $116.53 $147.13 $117.70 $66.21 $29.20 N/A $85.55 $147.13 $88.28 $147.13 $30.66 $147.13 N/A N/A 72442227 SUP HCPCS C1713 72442227 - WASHER ORTH 13MM EVOS 2 2.7MM SCR MN PLT SYS BOTH IP/OP $147.50 $109.00 $29.20 $147.13 $66.21 $66.21 $66.21 $66.21 $147.13 $147.13 $147.13 $30.67 $147.13 $147.13 $147.13 $147.13 $147.13 $30.66 $147.13 $58.85 $87.03 $147.13 $147.13 $147.13 $147.13 $110.63 $147.13 $147.13 $147.13 $73.57 $73.57 $116.53 $147.13 $117.70 $66.21 $29.20 N/A $85.55 $147.13 $88.28 $147.13 $147.13 $147.13 N/A N/A 72442450 SUP HCPCS C1713 72442450 - PLATE BN T 43MM EVOS MN 2 HLE/HD 6 HL SHFT LOPRFL VA SS SM BOTH IP/OP "$1,554.00" "$1,150.00" $308.38 "$1,553.75" $699.19 $699.19 $699.19 $699.19 "$1,553.75" "$1,553.75" "$1,553.75" $323.84 "$1,553.75" "$1,553.75" "$1,553.75" "$1,553.75" "$1,553.75" $323.82 "$1,553.75" "$1,553.75" $919.04 "$1,553.75" "$1,553.75" "$1,553.75" "$1,553.75" "$1,165.50" "$1,553.75" "$1,553.75" "$1,553.75" $776.88 $776.88 "$1,230.57" "$1,553.75" "$1,243.00" $699.19 $308.38 N/A $901.32 "$1,553.75" $932.25 "$1,553.75" $323.80 "$1,553.75" N/A N/A 72442452 SUP HCPCS C1713 72442452 - PLATE BN T 55MM EVOS MN 2 HLE/HD 8 HL SHFT LOPRFL VA SS SM BOTH IP/OP "$1,554.00" "$1,150.00" $308.38 "$1,553.75" $699.19 $699.19 $699.19 $699.19 "$1,553.75" "$1,553.75" "$1,553.75" $323.84 "$1,553.75" "$1,553.75" "$1,553.75" "$1,553.75" "$1,553.75" $323.82 "$1,553.75" "$1,553.75" $919.04 "$1,553.75" "$1,553.75" "$1,553.75" "$1,553.75" "$1,165.50" "$1,553.75" "$1,553.75" "$1,553.75" $776.88 $776.88 "$1,230.57" "$1,553.75" "$1,243.00" $699.19 $308.38 N/A $901.32 "$1,553.75" $932.25 "$1,553.75" $323.80 "$1,553.75" N/A N/A 72442454 SUP HCPCS C1713 72442454 - PLATE BN T 37MM EVOS MN 3 HLE/HD 5 HL SHFT LOPRFL VA SS SM BOTH IP/OP "$1,554.00" "$1,150.00" $308.38 "$1,553.75" $699.19 $699.19 $699.19 $699.19 "$1,553.75" "$1,553.75" "$1,553.75" $323.84 "$1,553.75" "$1,553.75" "$1,553.75" "$1,553.75" "$1,553.75" $323.82 "$1,553.75" "$1,553.75" $919.04 "$1,553.75" "$1,553.75" "$1,553.75" "$1,553.75" "$1,165.50" "$1,553.75" "$1,553.75" "$1,553.75" $776.88 $776.88 "$1,230.57" "$1,553.75" "$1,243.00" $699.19 $308.38 N/A $901.32 "$1,553.75" $932.25 "$1,553.75" $323.80 "$1,553.75" N/A N/A 72442456 SUP HCPCS C1713 72442456 - PLATE BN T 61MM EVOS MN 3 HLE/HD 9 HL SHFT LOPRFL VA SS SM BOTH IP/OP "$1,554.00" "$1,150.00" $308.38 "$1,553.75" $699.19 $699.19 $699.19 $699.19 "$1,553.75" "$1,553.75" "$1,553.75" $323.84 "$1,553.75" "$1,553.75" "$1,553.75" "$1,553.75" "$1,553.75" $323.82 "$1,553.75" "$1,553.75" $919.04 "$1,553.75" "$1,553.75" "$1,553.75" "$1,553.75" "$1,165.50" "$1,553.75" "$1,553.75" "$1,553.75" $776.88 $776.88 "$1,230.57" "$1,553.75" "$1,243.00" $699.19 $308.38 N/A $901.32 "$1,553.75" $932.25 "$1,553.75" "$1,553.75" "$1,553.75" N/A N/A 72442458 SUP HCPCS C1713 72442458 - PLATE BN 25MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2.4 BOTH IP/OP "$1,595.00" "$1,180.00" $316.57 "$1,595.00" $717.75 $717.75 $717.75 $717.75 "$1,595.00" "$1,595.00" "$1,595.00" $332.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" $332.42 "$1,595.00" "$1,595.00" $943.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,196.25" "$1,595.00" "$1,595.00" "$1,595.00" $797.50 $797.50 "$1,263.24" "$1,595.00" "$1,276.00" $717.75 $316.57 N/A $925.10 "$1,595.00" "$1,595.00" "$1,595.00" $332.40 "$1,595.00" N/A N/A 72442460 SUP HCPCS C1713 72442460 - PLATE BN 37X6X1.4MM EVOS MN 6 HL FLX LOPRFL VA SS LG BN SM BOTH IP/OP "$1,595.00" "$1,180.00" $316.57 "$1,595.00" $717.75 $717.75 $717.75 $717.75 "$1,595.00" "$1,595.00" "$1,595.00" $332.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" $332.42 "$1,595.00" $638.00 $943.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,196.25" "$1,595.00" "$1,595.00" "$1,595.00" $797.50 $797.50 "$1,263.24" "$1,595.00" "$1,276.00" $717.75 $316.57 N/A $925.10 "$1,595.00" $957.00 "$1,595.00" $332.40 "$1,595.00" N/A N/A 72442462 SUP HCPCS C1713 72442462 - PLATE BN 49MM EVOS MN 8 HL FLX LOPRFL VA SS SM BN LNG BN 2.4 BOTH IP/OP "$1,595.00" "$1,180.00" $316.57 "$1,595.00" $717.75 $717.75 $717.75 $717.75 "$1,595.00" "$1,595.00" "$1,595.00" $332.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" $332.42 "$1,595.00" $638.00 $943.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,196.25" "$1,595.00" "$1,595.00" "$1,595.00" $797.50 $797.50 "$1,263.24" "$1,595.00" "$1,276.00" $717.75 $316.57 N/A $925.10 "$1,595.00" $957.00 "$1,595.00" "$1,595.00" "$1,595.00" N/A N/A 72442464 SUP HCPCS C1713 72442464 - PLATE BN 61MM EVOS MN 10 HL FLX LOPRFL VA SS SM BN LNG BN BOTH IP/OP "$1,595.00" "$1,180.00" $316.57 "$1,595.00" $717.75 $717.75 $717.75 $717.75 "$1,595.00" "$1,595.00" "$1,595.00" $332.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" $332.42 "$1,595.00" "$1,595.00" $943.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,196.25" "$1,595.00" "$1,595.00" "$1,595.00" $797.50 $797.50 "$1,263.24" "$1,595.00" "$1,276.00" $717.75 $316.57 N/A $925.10 "$1,595.00" $957.00 "$1,595.00" $332.40 "$1,595.00" N/A N/A 72442466 SUP HCPCS C1713 72442466 - PLATE BN 121MM EVOS MN 20 HL FLX LOPRFL VA SS SM BN LNG BN BOTH IP/OP "$1,595.00" "$1,180.00" $316.57 "$1,595.00" $717.75 $717.75 $717.75 $717.75 "$1,595.00" "$1,595.00" "$1,595.00" $332.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" $332.42 "$1,595.00" $638.00 $943.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,196.25" "$1,595.00" "$1,595.00" "$1,595.00" $797.50 $797.50 "$1,263.24" "$1,595.00" "$1,276.00" $717.75 $316.57 N/A $925.10 "$1,595.00" $957.00 "$1,595.00" $332.40 "$1,595.00" N/A N/A 72442468 SUP HCPCS C1713 72442468 - PLATE BN 25MM STRL EVOS MN 4 HL LOPRFL VA LCK SS 2.4MM SCR BOTH IP/OP "$1,595.00" "$1,180.00" $316.57 "$1,595.00" $717.75 $717.75 $717.75 $717.75 "$1,595.00" "$1,595.00" "$1,595.00" $332.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" $332.42 "$1,595.00" "$1,595.00" $943.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,196.25" "$1,595.00" "$1,595.00" "$1,595.00" $797.50 $797.50 "$1,263.24" "$1,595.00" "$1,276.00" $717.75 $316.57 N/A $925.10 "$1,595.00" $957.00 "$1,595.00" "$1,595.00" "$1,595.00" N/A N/A 72442470 SUP HCPCS C1713 72442470 - PLATE BN 37MM EVOS MN 6 HL STRTH LOPRFL SS BOTH IP/OP "$1,595.00" "$1,180.00" $316.57 "$1,595.00" $717.75 $717.75 $717.75 $717.75 "$1,595.00" "$1,595.00" "$1,595.00" $332.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" $332.42 "$1,595.00" "$1,595.00" $943.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,196.25" "$1,595.00" "$1,595.00" "$1,595.00" $797.50 $797.50 "$1,263.24" "$1,595.00" "$1,276.00" $717.75 $316.57 N/A $925.10 "$1,595.00" $957.00 "$1,595.00" "$1,595.00" "$1,595.00" N/A N/A 72442472 SUP HCPCS C1713 72442472 - PLATE BN 49MM EVOS MN 20 HL STRENGHT LOPRFL VA SS SM BN LNG BOTH IP/OP "$1,595.00" "$1,180.00" $316.57 "$1,595.00" $717.75 $717.75 $717.75 $717.75 "$1,595.00" "$1,595.00" "$1,595.00" $332.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" $332.42 "$1,595.00" "$1,595.00" $943.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,196.25" "$1,595.00" "$1,595.00" "$1,595.00" $797.50 $797.50 "$1,263.24" "$1,595.00" "$1,276.00" $717.75 $316.57 N/A $925.10 "$1,595.00" $957.00 "$1,595.00" "$1,595.00" "$1,595.00" N/A N/A 72442474 SUP HCPCS C1713 72442474 - PLATE BN 61MM EVOS MN 10 HL STRENGHT LOPRFL VA SS SM BN LNG BOTH IP/OP "$1,595.00" "$1,180.00" $316.57 "$1,595.00" $717.75 $717.75 $717.75 $717.75 "$1,595.00" "$1,595.00" "$1,595.00" $332.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" $332.42 "$1,595.00" "$1,595.00" $943.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,196.25" "$1,595.00" "$1,595.00" "$1,595.00" $797.50 $797.50 "$1,263.24" "$1,595.00" "$1,276.00" $717.75 $316.57 N/A $925.10 "$1,595.00" $957.00 "$1,595.00" $332.40 "$1,595.00" N/A N/A 72442476 SUP HCPCS C1713 72442476 - PLATE BN 121MM EVOS MN 20 HL STRENGHT LOPRFL VA SS SM BN LNG BOTH IP/OP "$1,595.00" "$1,180.00" $316.57 "$1,595.00" $717.75 $717.75 $717.75 $717.75 "$1,595.00" "$1,595.00" "$1,595.00" $332.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" $332.42 "$1,595.00" "$1,595.00" $943.44 "$1,595.00" "$1,595.00" "$1,595.00" "$1,595.00" "$1,196.25" "$1,595.00" "$1,595.00" "$1,595.00" $797.50 $797.50 "$1,263.24" "$1,595.00" "$1,276.00" $717.75 $316.57 N/A $925.10 "$1,595.00" $957.00 "$1,595.00" $332.40 "$1,595.00" N/A N/A 72442478 SUP HCPCS C1713 72442478 - PLATE BN STRG 34MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG BOTH IP/OP "$1,677.50" "$1,241.00" $332.94 "$1,677.50" $754.88 $754.88 $754.88 $754.88 "$1,677.50" "$1,677.50" "$1,677.50" $349.63 "$1,677.50" "$1,677.50" "$1,677.50" "$1,677.50" "$1,677.50" $349.61 "$1,677.50" "$1,677.50" $992.24 "$1,677.50" "$1,677.50" "$1,677.50" "$1,677.50" "$1,258.13" "$1,677.50" "$1,677.50" "$1,677.50" $838.75 $838.75 "$1,328.58" "$1,677.50" "$1,342.00" $754.88 $332.94 N/A $972.95 "$1,677.50" "$1,677.50" "$1,677.50" "$1,677.50" "$1,677.50" N/A N/A 72442482 SUP HCPCS C1713 72442482 - PLATE BN 47MM EVOS MN 5 HL LOPRFL VA SS SM BN LNG BN 2.4MM BOTH IP/OP "$1,753.50" "$1,298.00" $347.95 "$1,753.13" $788.91 $788.91 $788.91 $788.91 "$1,753.13" "$1,753.13" "$1,753.13" $365.40 "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" $365.37 "$1,753.13" $701.25 "$1,036.98" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,315.13" "$1,753.13" "$1,753.13" "$1,753.13" $876.57 $876.57 "$1,388.48" "$1,753.13" "$1,402.50" $788.91 $347.95 N/A "$1,017.03" "$1,753.13" "$1,051.88" "$1,753.13" "$1,753.13" "$1,753.13" N/A N/A 72442484 SUP HCPCS C1713 72442484 - PLATE BN 59MM EVOS MN 7 HL LOPRFL VA SS SM BN LNG BN 2.4MM BOTH IP/OP "$1,753.50" "$1,298.00" $347.95 "$1,753.13" $788.91 $788.91 $788.91 $788.91 "$1,753.13" "$1,753.13" "$1,753.13" $365.40 "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" $365.37 "$1,753.13" "$1,753.13" "$1,036.98" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,315.13" "$1,753.13" "$1,753.13" "$1,753.13" $876.57 $876.57 "$1,388.48" "$1,753.13" "$1,402.50" $788.91 $347.95 N/A "$1,017.03" "$1,753.13" "$1,051.88" "$1,753.13" $365.35 "$1,753.13" N/A N/A 72442486 SUP HCPCS C1713 72442486 - PLATE BN Y 45MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG BN BOTH IP/OP "$1,966.50" "$1,455.00" $390.25 "$1,966.25" $884.81 $884.81 $884.81 $884.81 "$1,966.25" "$1,966.25" "$1,966.25" $409.82 "$1,966.25" "$1,966.25" "$1,966.25" "$1,966.25" "$1,966.25" $409.79 "$1,966.25" $786.50 "$1,163.04" "$1,966.25" "$1,966.25" "$1,966.25" "$1,966.25" "$1,474.88" "$1,966.25" "$1,966.25" "$1,966.25" $983.13 $983.13 "$1,557.27" "$1,966.25" "$1,573.00" $884.81 $390.25 N/A "$1,140.57" "$1,966.25" "$1,179.75" "$1,966.25" $409.77 "$1,966.25" N/A N/A 72442488 SUP HCPCS C1713 72442488 - PLATE BN Y 57MM EVOS MN 7 HL TINE LOPRFL VA SS SM BN LNG BN BOTH IP/OP "$1,966.50" "$1,455.00" $390.25 "$1,966.25" $884.81 $884.81 $884.81 $884.81 "$1,966.25" "$1,966.25" "$1,966.25" $409.82 "$1,966.25" "$1,966.25" "$1,966.25" "$1,966.25" "$1,966.25" $409.79 "$1,966.25" "$1,966.25" "$1,163.04" "$1,966.25" "$1,966.25" "$1,966.25" "$1,966.25" "$1,474.88" "$1,966.25" "$1,966.25" "$1,966.25" $983.13 $983.13 "$1,557.27" "$1,966.25" "$1,573.00" $884.81 $390.25 N/A "$1,140.57" "$1,966.25" "$1,179.75" "$1,966.25" $409.77 "$1,966.25" N/A N/A 72442490 SUP HCPCS C1713 72442490 - PLATE BN 3ANG 55MM EVOS MN 6 HL LOPRFL VA SS SM BN LNG BN BOTH IP/OP "$1,753.50" "$1,298.00" $347.95 "$1,753.13" $788.91 $788.91 $788.91 $788.91 "$1,753.13" "$1,753.13" "$1,753.13" $365.40 "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" $365.37 "$1,753.13" $701.25 "$1,036.98" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,315.13" "$1,753.13" "$1,753.13" "$1,753.13" $876.57 $876.57 "$1,388.48" "$1,753.13" "$1,402.50" $788.91 $347.95 N/A "$1,017.03" "$1,753.13" "$1,051.88" "$1,753.13" $365.35 "$1,753.13" N/A N/A 72442492 SUP HCPCS C1713 72442492 - PLATE BN 3ANG 67MM EVOS MN 8 HL LOPRFL VA SS SM BN LNG BN BOTH IP/OP "$1,753.50" "$1,298.00" $347.95 "$1,753.13" $788.91 $788.91 $788.91 $788.91 "$1,753.13" "$1,753.13" "$1,753.13" $365.40 "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" $365.37 "$1,753.13" "$1,753.13" "$1,036.98" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,315.13" "$1,753.13" "$1,753.13" "$1,753.13" $876.57 $876.57 "$1,388.48" "$1,753.13" "$1,402.50" $788.91 $347.95 N/A "$1,017.03" "$1,753.13" "$1,051.88" "$1,753.13" $365.35 "$1,753.13" N/A N/A 72442494 SUP HCPCS C1713 72442494 - PLATE BN TRPZD 24X18X1.4MM EVOS LOPRFL VA 5 HL SS 2.4MM SCR BOTH IP/OP "$2,001.00" "$1,481.00" $397.08 "$2,000.63" $900.28 $900.28 $900.28 $900.28 "$2,000.63" "$2,000.63" "$2,000.63" $416.98 "$2,000.63" "$2,000.63" "$2,000.63" "$2,000.63" "$2,000.63" $416.95 "$2,000.63" $800.25 "$1,183.37" "$2,000.63" "$2,000.63" "$2,000.63" "$2,000.63" "$1,500.75" "$2,000.63" "$2,000.63" "$2,000.63" "$1,000.32" "$1,000.32" "$1,584.50" "$2,000.63" "$1,600.50" $900.28 $397.08 N/A "$1,160.58" "$2,000.63" "$1,200.38" "$2,000.63" "$2,000.63" "$2,000.63" N/A N/A 72442720 SUP HCPCS C1713 72442720 - PLATE BN T 42X7.5-21.5X1.4MM STRL EVOS MN 3 HLE/HD 5 HL SHFT BOTH IP/OP "$1,719.00" "$1,272.00" $341.13 "$1,718.75" $773.44 $773.44 $773.44 $773.44 "$1,718.75" "$1,718.75" "$1,718.75" $358.23 "$1,718.75" "$1,718.75" "$1,718.75" "$1,718.75" "$1,718.75" $358.21 "$1,718.75" "$1,718.75" "$1,016.64" "$1,718.75" "$1,718.75" "$1,718.75" "$1,718.75" "$1,289.25" "$1,718.75" "$1,718.75" "$1,718.75" $859.38 $859.38 "$1,361.25" "$1,718.75" "$1,375.00" $773.44 $341.13 N/A $997.02 "$1,718.75" "$1,718.75" "$1,718.75" $358.19 "$1,718.75" N/A N/A 72442722 SUP HCPCS C1713 72442722 - PLATE BN T 71MM EVOS MN 3 HLE/HD 9 HL SHFT LOPRFL VA SS SM BOTH IP/OP "$1,719.00" "$1,272.00" $341.13 "$1,718.75" $773.44 $773.44 $773.44 $773.44 "$1,718.75" "$1,718.75" "$1,718.75" $358.23 "$1,718.75" "$1,718.75" "$1,718.75" "$1,718.75" "$1,718.75" $358.21 "$1,718.75" $687.50 "$1,016.64" "$1,718.75" "$1,718.75" "$1,718.75" "$1,718.75" "$1,289.25" "$1,718.75" "$1,718.75" "$1,718.75" $859.38 $859.38 "$1,361.25" "$1,718.75" "$1,375.00" $773.44 $341.13 N/A $997.02 "$1,718.75" "$1,031.25" "$1,718.75" "$1,718.75" "$1,718.75" N/A N/A 72442724 SUP HCPCS C1713 72442724 - PLATE BN 28MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2.7 BOTH IP/OP "$1,753.50" "$1,298.00" $347.95 "$1,753.13" $788.91 $788.91 $788.91 $788.91 "$1,753.13" "$1,753.13" "$1,753.13" $365.40 "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" $365.37 "$1,753.13" "$1,753.13" "$1,036.98" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,315.13" "$1,753.13" "$1,753.13" "$1,753.13" $876.57 $876.57 "$1,388.48" "$1,753.13" "$1,402.50" $788.91 $347.95 N/A "$1,017.03" "$1,753.13" "$1,051.88" "$1,753.13" $365.35 "$1,753.13" N/A N/A 72442726 SUP HCPCS C1713 72442726 - PLATE BN 42MM EVOS MN 4 HL FLX LOPRFL VA SS SM BN LNG BN 2.7 BOTH IP/OP "$1,753.50" "$1,298.00" $347.95 "$1,753.13" $788.91 $788.91 $788.91 $788.91 "$1,753.13" "$1,753.13" "$1,753.13" $365.40 "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" $365.37 "$1,753.13" $701.25 "$1,036.98" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,315.13" "$1,753.13" "$1,753.13" "$1,753.13" $876.57 $876.57 "$1,388.48" "$1,753.13" "$1,402.50" $788.91 $347.95 N/A "$1,017.03" "$1,753.13" "$1,051.88" "$1,753.13" $365.35 "$1,753.13" N/A N/A 72442728 SUP HCPCS C1713 72442728 - PLATE BN 56MM EVOS MN 8 HL FLX LOPRFL VA SS SM BN LNG BN 2.7 BOTH IP/OP "$1,753.50" "$1,298.00" $347.95 "$1,753.13" $788.91 $788.91 $788.91 $788.91 "$1,753.13" "$1,753.13" "$1,753.13" $365.40 "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" $365.37 "$1,753.13" "$1,753.13" "$1,036.98" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,315.13" "$1,753.13" "$1,753.13" "$1,753.13" $876.57 $876.57 "$1,388.48" "$1,753.13" "$1,402.50" $788.91 $347.95 N/A "$1,017.03" "$1,753.13" "$1,051.88" "$1,753.13" $365.35 "$1,753.13" N/A N/A 72442760 SUP HCPCS C1713 72442760 - PLATE BN 70MM EVOS MN 10 HL FLX LOPRFL VA SS SM BN LNG BN BOTH IP/OP "$1,753.50" "$1,298.00" $347.95 "$1,753.13" $788.91 $788.91 $788.91 $788.91 "$1,753.13" "$1,753.13" "$1,753.13" $365.40 "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" $365.37 "$1,753.13" $701.25 "$1,036.98" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,315.13" "$1,753.13" "$1,753.13" "$1,753.13" $876.57 $876.57 "$1,388.48" "$1,753.13" "$1,402.50" $788.91 $347.95 N/A "$1,017.03" "$1,753.13" "$1,051.88" "$1,753.13" $365.35 "$1,753.13" N/A N/A 72442762 SUP HCPCS C1713 72442762 - PLATE BN 140MM EVOS MN 20 HL FLX LOPRFL VA SS SM BN LNG BN BOTH IP/OP "$1,753.50" "$1,298.00" $347.95 "$1,753.13" $788.91 $788.91 $788.91 $788.91 "$1,753.13" "$1,753.13" "$1,753.13" $365.40 "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" $365.37 "$1,753.13" "$1,753.13" "$1,036.98" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,315.13" "$1,753.13" "$1,753.13" "$1,753.13" $876.57 $876.57 "$1,388.48" "$1,753.13" "$1,402.50" $788.91 $347.95 N/A "$1,017.03" "$1,753.13" "$1,051.88" "$1,753.13" "$1,753.13" "$1,753.13" N/A N/A 72442764 SUP HCPCS C1713 72442764 - PLATE BN 28MM EVOS MN 4 HL STRENGHT LOPRFL VA SS SM BN LNG BOTH IP/OP "$1,753.50" "$1,298.00" $347.95 "$1,753.13" $788.91 $788.91 $788.91 $788.91 "$1,753.13" "$1,753.13" "$1,753.13" $365.40 "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" $365.37 "$1,753.13" $701.25 "$1,036.98" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,315.13" "$1,753.13" "$1,753.13" "$1,753.13" $876.57 $876.57 "$1,388.48" "$1,753.13" "$1,402.50" $788.91 $347.95 N/A "$1,017.03" "$1,753.13" "$1,051.88" "$1,753.13" $365.35 "$1,753.13" N/A N/A 72442766 SUP HCPCS C1713 72442766 - PLATE BN 7MM SPC 42X7.5X2.2MM 140MM EVOS MN 6 HL SHFT VA LCK BOTH IP/OP "$1,753.50" "$1,298.00" $347.95 "$1,753.13" $788.91 $788.91 $788.91 $788.91 "$1,753.13" "$1,753.13" "$1,753.13" $365.40 "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" $365.37 "$1,753.13" "$1,753.13" "$1,036.98" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,315.13" "$1,753.13" "$1,753.13" "$1,753.13" $876.57 $876.57 "$1,388.48" "$1,753.13" "$1,402.50" $788.91 $347.95 N/A "$1,017.03" "$1,753.13" "$1,051.88" "$1,753.13" $365.35 "$1,753.13" N/A N/A 72442768 SUP HCPCS C1713 72442768 - PLATE BN 7MM SPC 56X7.5X2.2MM 140MM EVOS MN 6 HL SHFT VA LCK BOTH IP/OP "$1,753.50" "$1,298.00" $347.95 "$1,753.13" $788.91 $788.91 $788.91 $788.91 "$1,753.13" "$1,753.13" "$1,753.13" $365.40 "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" $365.37 "$1,753.13" $701.25 "$1,036.98" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,315.13" "$1,753.13" "$1,753.13" "$1,753.13" $876.57 $876.57 "$1,388.48" "$1,753.13" "$1,402.50" $788.91 $347.95 N/A "$1,017.03" "$1,753.13" "$1,051.88" "$1,753.13" "$1,753.13" "$1,753.13" N/A N/A 72442770 SUP HCPCS C1713 72442770 - PLATE BN 7MM SPC 70X7.5X2.2MM 140MM EVOS MN 6 HL SHFT VA LCK BOTH IP/OP "$1,753.50" "$1,298.00" $347.95 "$1,753.13" $788.91 $788.91 $788.91 $788.91 "$1,753.13" "$1,753.13" "$1,753.13" $365.40 "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" $365.37 "$1,753.13" "$1,753.13" "$1,036.98" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,315.13" "$1,753.13" "$1,753.13" "$1,753.13" $876.57 $876.57 "$1,388.48" "$1,753.13" "$1,402.50" $788.91 $347.95 N/A "$1,017.03" "$1,753.13" "$1,051.88" "$1,753.13" $365.35 "$1,753.13" N/A N/A 72442772 SUP HCPCS C1713 72442772 - PLATE BN 140MM EVOS MN 20 HL STRENGHT LOPRFL VA SS SM BN LNG BOTH IP/OP "$1,753.50" "$1,298.00" $347.95 "$1,753.13" $788.91 $788.91 $788.91 $788.91 "$1,753.13" "$1,753.13" "$1,753.13" $365.40 "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" $365.37 "$1,753.13" $701.25 "$1,036.98" "$1,753.13" "$1,753.13" "$1,753.13" "$1,753.13" "$1,315.13" "$1,753.13" "$1,753.13" "$1,753.13" $876.57 $876.57 "$1,388.48" "$1,753.13" "$1,402.50" $788.91 $347.95 N/A "$1,017.03" "$1,753.13" "$1,051.88" "$1,753.13" $365.35 "$1,753.13" N/A N/A 72442774 SUP HCPCS C1713 72442774 - PLATE BN STRG 38MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG BOTH IP/OP "$1,842.50" "$1,363.00" $365.69 "$1,842.50" $829.13 $829.13 $829.13 $829.13 "$1,842.50" "$1,842.50" "$1,842.50" $384.02 "$1,842.50" "$1,842.50" "$1,842.50" "$1,842.50" "$1,842.50" $384.00 "$1,842.50" $737.00 "$1,089.84" "$1,842.50" "$1,842.50" "$1,842.50" "$1,842.50" "$1,381.88" "$1,842.50" "$1,842.50" "$1,842.50" $921.25 $921.25 "$1,459.26" "$1,842.50" "$1,474.00" $829.13 $365.69 N/A "$1,068.65" "$1,842.50" "$1,105.50" "$1,842.50" $383.98 "$1,842.50" N/A N/A 72442776 SUP HCPCS C1713 72442776 - PLATE BN STRG 52MM EVOS MN 7 HL TINE LOPRFL VA SS SM BN LNG BOTH IP/OP "$1,842.50" "$1,363.00" $365.69 "$1,842.50" $829.13 $829.13 $829.13 $829.13 "$1,842.50" "$1,842.50" "$1,842.50" $384.02 "$1,842.50" "$1,842.50" "$1,842.50" "$1,842.50" "$1,842.50" $384.00 "$1,842.50" $737.00 "$1,089.84" "$1,842.50" "$1,842.50" "$1,842.50" "$1,842.50" "$1,381.88" "$1,842.50" "$1,842.50" "$1,842.50" $921.25 $921.25 "$1,459.26" "$1,842.50" "$1,474.00" $829.13 $365.69 N/A "$1,068.65" "$1,842.50" "$1,105.50" "$1,842.50" $383.98 "$1,842.50" N/A N/A 72442778 SUP HCPCS C1713 72442778 - PLATE BN Y 55MM EVOS MN 5 HL LOPRFL VA SS SM BN LNG BN 2.7MM BOTH IP/OP "$1,932.00" "$1,430.00" $383.43 "$1,931.88" $869.35 $869.35 $869.35 $869.35 "$1,931.88" "$1,931.88" "$1,931.88" $402.65 "$1,931.88" "$1,931.88" "$1,931.88" "$1,931.88" "$1,931.88" $402.63 "$1,931.88" "$1,931.88" "$1,142.71" "$1,931.88" "$1,931.88" "$1,931.88" "$1,931.88" "$1,449.00" "$1,931.88" "$1,931.88" "$1,931.88" $965.94 $965.94 "$1,530.05" "$1,931.88" "$1,545.50" $869.35 $383.43 N/A "$1,120.56" "$1,931.88" "$1,159.13" "$1,931.88" "$1,931.88" "$1,931.88" N/A N/A 72442780 SUP HCPCS C1713 72442780 - PLATE BN Y 69MM EVOS MN 7 HL LOPRFL VA SS SM BN LNG BN 2.7MM BOTH IP/OP "$1,932.00" "$1,430.00" $383.43 "$1,931.88" $869.35 $869.35 $869.35 $869.35 "$1,931.88" "$1,931.88" "$1,931.88" $402.65 "$1,931.88" "$1,931.88" "$1,931.88" "$1,931.88" "$1,931.88" $402.63 "$1,931.88" "$1,931.88" "$1,142.71" "$1,931.88" "$1,931.88" "$1,931.88" "$1,931.88" "$1,449.00" "$1,931.88" "$1,931.88" "$1,931.88" $965.94 $965.94 "$1,530.05" "$1,931.88" "$1,545.50" $869.35 $383.43 N/A "$1,120.56" "$1,931.88" "$1,159.13" "$1,931.88" $402.60 "$1,931.88" N/A N/A 72442782 SUP HCPCS C1713 72442782 - PLATE BN Y 52MM EVOS MN 5 HL TINE LOPRFL VA SS SM BN LNG BN BOTH IP/OP "$2,207.00" "$1,633.00" $438.01 "$2,206.88" $993.10 $993.10 $993.10 $993.10 "$2,206.88" "$2,206.88" "$2,206.88" $459.97 "$2,206.88" "$2,206.88" "$2,206.88" "$2,206.88" "$2,206.88" $459.94 "$2,206.88" $882.75 "$1,305.37" "$2,206.88" "$2,206.88" "$2,206.88" "$2,206.88" "$1,655.25" "$2,206.88" "$2,206.88" "$2,206.88" "$1,103.44" "$1,103.44" "$1,747.85" "$2,206.88" "$1,765.50" $993.10 $438.01 N/A "$1,280.06" "$2,206.88" "$2,206.88" "$2,206.88" "$2,206.88" "$2,206.88" N/A N/A 72442784 SUP HCPCS C1713 72442784 - PLATE BN Y 66MM EVOS MN 7HOLE TINE LOPRFL VA SS SM BN LNG BN BOTH IP/OP "$2,207.00" "$1,633.00" $438.01 "$2,206.88" $993.10 $993.10 $993.10 $993.10 "$2,206.88" "$2,206.88" "$2,206.88" $459.97 "$2,206.88" "$2,206.88" "$2,206.88" "$2,206.88" "$2,206.88" $459.94 "$2,206.88" $882.75 "$1,305.37" "$2,206.88" "$2,206.88" "$2,206.88" "$2,206.88" "$1,655.25" "$2,206.88" "$2,206.88" "$2,206.88" "$1,103.44" "$1,103.44" "$1,747.85" "$2,206.88" "$1,765.50" $993.10 $438.01 N/A "$1,280.06" "$2,206.88" "$1,324.13" "$2,206.88" $459.91 "$2,206.88" N/A N/A 72442786 SUP HCPCS C1713 72442786 - PLATE BN 3ANG 54MM EVOS MN 6 HL LOPRFL VA SS SM BN LNG BN BOTH IP/OP "$1,932.00" "$1,430.00" $383.43 "$1,931.88" $869.35 $869.35 $869.35 $869.35 "$1,931.88" "$1,931.88" "$1,931.88" $402.65 "$1,931.88" "$1,931.88" "$1,931.88" "$1,931.88" "$1,931.88" $402.63 "$1,931.88" $772.75 "$1,142.71" "$1,931.88" "$1,931.88" "$1,931.88" "$1,931.88" "$1,449.00" "$1,931.88" "$1,931.88" "$1,931.88" $965.94 $965.94 "$1,530.05" "$1,931.88" "$1,545.50" $869.35 $383.43 N/A "$1,120.56" "$1,931.88" "$1,159.13" "$1,931.88" $402.60 "$1,931.88" N/A N/A 72442788 SUP HCPCS C1713 72442788 - PLATE BN 3ANG 68MM EVOS MN 8 HL LOPRFL VA SS SM BN LNG BN BOTH IP/OP "$1,932.00" "$1,430.00" $383.43 "$1,931.88" $869.35 $869.35 $869.35 $869.35 "$1,931.88" "$1,931.88" "$1,931.88" $402.65 "$1,931.88" "$1,931.88" "$1,931.88" "$1,931.88" "$1,931.88" $402.63 "$1,931.88" $772.75 "$1,142.71" "$1,931.88" "$1,931.88" "$1,931.88" "$1,931.88" "$1,449.00" "$1,931.88" "$1,931.88" "$1,931.88" $965.94 $965.94 "$1,530.05" "$1,931.88" "$1,545.50" $869.35 $383.43 N/A "$1,120.56" "$1,931.88" "$1,159.13" "$1,931.88" $402.60 "$1,931.88" N/A N/A 72800107 SUP HCPCS C1713 72800107 - PLATE BN 98MM PRLC VLP 7 HL LCK TIB LT POSTEROMEDIAL PROX BOTH IP/OP "$2,158.00" "$1,597.00" $428.26 "$2,157.75" $970.99 $970.99 $970.99 $970.99 "$2,157.75" "$2,157.75" "$2,157.75" $449.73 "$2,157.75" "$2,157.75" "$2,157.75" "$2,157.75" "$2,157.75" $449.70 "$2,157.75" $863.10 "$1,276.31" "$2,157.75" "$2,157.75" "$2,157.75" "$2,157.75" "$1,618.50" "$2,157.75" "$2,157.75" "$2,157.75" "$1,078.88" "$1,078.88" "$1,708.94" "$2,157.75" "$1,726.20" $970.99 $428.26 N/A "$1,251.64" "$2,157.75" "$2,157.75" "$2,157.75" $449.68 "$2,157.75" N/A N/A 72823110 SUP HCPCS C1713 72823110 - SCREW BN 2.7MM 10MM PRLC VLP LCK ST SS CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72823112 SUP HCPCS C1713 72823112 - SCREW BN 2.7MM 12MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $286.25 $286.25 N/A N/A 72823114 SUP HCPCS C1713 72823114 - SCREW BN 2.7MM 14MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $286.25 $286.25 N/A N/A 72823116 SUP HCPCS C1713 72823116 - SCREW BN 2.7MM 16MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72823118 SUP HCPCS C1713 72823118 - SCREW BN 2.7MM 18MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72823120 SUP HCPCS C1713 72823120 - SCREW BN 2.7MM 20MM PRLC VLP ST LCK SS FOREFOOT MIDFOOT CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72823122 SUP HCPCS C1713 72823122 - SCREW BN 2.7MM 22MM VLP LCK ST VA FT CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $286.25 $286.25 N/A N/A 72823124 SUP HCPCS C1713 72823124 - SCREW BN 2.7MM 24MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72823126 SUP HCPCS C1713 72823126 - SCREW BN 2.7MM 26MM PRLC VLP LCK ST CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72823128 SUP HCPCS C1713 72823128 - SCREW BN 2.7MM 28MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72823130 SUP HCPCS C1713 72823130 - SCREW BN 2.7MM 30MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72823132 SUP HCPCS C1713 72823132 - SCREW BN 2.7MM 32MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $286.25 $286.25 N/A N/A 72823134 SUP HCPCS C1713 72823134 - SCREW BN 2.7MM 34MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $286.25 $286.25 N/A N/A 72823136 SUP HCPCS C1713 72823136 - SCREW BN 2.7MM 36MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72823138 SUP HCPCS C1713 72823138 - SCREW BN 2.7MM 38MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72823140 SUP HCPCS C1713 72823140 - SCREW BN 2.7MM 40MM PRLC VLP LCK ST SS FOREFOOT MIDFOOT CORT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $286.25 $286.25 N/A N/A 72823210 SUP HCPCS C1713 72823210 - SCREW BN FT 4MM 10MM PRLC VLP OSTEOPENIA CORT BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $145.00 $145.00 $30.22 $145.00 N/A N/A 72823212 SUP HCPCS C1713 72823212 - SCREW BN FT 4MM 12MM PRLC VLP SS FOREFOOT MIDFOOT CORT BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $58.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $145.00 $145.00 $30.22 $145.00 N/A N/A 72823214 SUP HCPCS C1713 72823214 - SCREW BN FT 4MM 14MM PRLC VLP OSTEOPENIA CORT FT BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $58.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $145.00 $145.00 $30.22 $145.00 N/A N/A 72823216 SUP HCPCS C1713 72823216 - SCREW BN FT 4MM 16MM PRLC VLP OSTEOPENIA CORT BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $145.00 $145.00 $30.22 $145.00 N/A N/A 72823218 SUP HCPCS C1713 72823218 - SCREW BN FT 4MM 18MM PRLC VLP SS FOREFOOT MIDFOOT CORT BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $58.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $145.00 $145.00 $30.22 $145.00 N/A N/A 72823220 SUP HCPCS C1713 72823220 - SCREW BN FT 4MM 20MM PRLC VLP OSTEOPENIA CORT BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $145.00 $145.00 $30.22 $145.00 N/A N/A 72823222 SUP HCPCS C1713 72823222 - SCREW BN 4MM 22MM PRLC VLP FT OSTEOPENIA BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $145.00 $145.00 $30.22 $145.00 N/A N/A 72823224 SUP HCPCS C1713 72823224 - SCREW BN FT 4MM 24MM PRLC VLP OSTEOPENIA CORT BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $58.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $145.00 $145.00 $30.22 $145.00 N/A N/A 72823226 SUP HCPCS C1713 72823226 - SCREW BN FT 4MM 26MM PRLC VLP OSTEOPENIA CORT BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $58.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $145.00 $145.00 $30.22 $145.00 N/A N/A 72823228 SUP HCPCS C1713 72823228 - SCREW BN FT 4MM 28MM PRLC VLP OSTEOPENIA CORT FT BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $58.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $145.00 $145.00 $30.22 $145.00 N/A N/A 72823230 SUP HCPCS C1713 72823230 - SCREW BN FT 4MM 4.9MM 30MM NS LOPRFL HEX FT PRLC VLP BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $58.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $87.00 $145.00 $30.22 $145.00 N/A N/A 72823232 SUP HCPCS C1713 72823232 - SCREW BONE FULTHD 4MM 32MM OSTEOPENIA VAR ANG PERI-LOC VLP BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $87.00 $145.00 $30.22 $145.00 N/A N/A 72823234 SUP HCPCS C1713 72823234 - SCREW BONE 4MM 34MM FULTHRD OSTEOPENIA PERI-LOC VLP BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $87.00 $145.00 $30.22 $145.00 N/A N/A 72823236 SUP HCPCS C1713 72823236 - SCREW BN FT 4MM 36MM PRLC VLP SS FOREFOOT MIDFOOT CORT BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $58.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $145.00 $145.00 $30.22 $145.00 N/A N/A 72823238 SUP HCPCS C1713 72823238 - SCREW BN 4MM 38MM PRLC VLP FT OSTEOPENIA BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $58.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $87.00 $145.00 $30.22 $145.00 N/A N/A 72823240 SUP HCPCS C1713 72823240 - SCREW BN FT 4MM 40MM PRLC VLP SS FOREFOOT MIDFOOT CORT BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $58.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $87.00 $145.00 $30.22 $145.00 N/A N/A 72823410 SUP HCPCS C1713 72823410 - SCREW BN 4MM 10MM PRLC VLP LCK OSTEOPENIA CORT BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $425.00 $425.00 N/A N/A 72823412 SUP HCPCS C1713 72823412 - SCREW BN 4MM 12MM PRLC VLP LCK OSTEOPENIA CORT BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823414 SUP HCPCS C1713 72823414 - SCREW BN 4MM 14MM PRLC VLP LCK OSTEOPENIA CORT BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823416 SUP HCPCS C1713 72823416 - SCREW BN 4MM 16MM PRLC VLP LCK OSTEOPENIA CORT BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $425.00 $425.00 N/A N/A 72823418 SUP HCPCS C1713 72823418 - SCREW BN 4MM 18MM PRLC VLP LCK OSTEOPENIA CORT BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $425.00 $425.00 N/A N/A 72823420 SUP HCPCS C1713 72823420 - SCREW BN 4MM 20MM PRLC VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823422 SUP HCPCS C1713 72823422 - SCREW BN 4MM 22MM PRLC VLP LCK OSTEOPENIA CORT BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 72823424 SUP HCPCS C1713 72823424 - SCREW BN 4MM 24MM PRLC VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $425.00 $425.00 N/A N/A 72823426 SUP HCPCS C1713 72823426 - SCREW BONE 4MM 26MM LOCKING OSTEOPENIA PERI-LOC VLP CORTICAL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823428 SUP HCPCS C1713 72823428 - SCREW BN 4MM 4.9MM 28MM LCK LOPRFL HD FT PRLC VLP OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823430 SUP HCPCS C1713 72823430 - SCREW BONE 4MM 30MM LOCKING OSTEOPENIA PERI-LOC VLP CORTICAL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823432 SUP HCPCS C1713 72823432 - SCREW BONE 4MM 32MM LOCKING OSTEOPENIA PERI-LOC VLP CORTICAL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823434 SUP HCPCS C1713 72823434 - SCREW BN 4MM 34MM PRLC VLP LCK OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823436 SUP HCPCS C1713 72823436 - SCREW BN 4MM 36MM PRLC VLP LCK OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823438 SUP HCPCS C1713 72823438 - SCREW BN 4MM 38MM PRLC VLP LCK OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823440 SUP HCPCS C1713 72823440 - SCREW BN 4MM 40MM PRLC VLP LCK OSTEOPENIA CORT BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823510 SUP HCPCS C1713 72823510 - SCREW BN 15D 2.5MM 5MM 5.4MM 10MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 72823512 SUP HCPCS C1713 72823512 - SCREW BN 15D 2.5MM 5MM 5.4MM 12MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823514 SUP HCPCS C1713 72823514 - SCREW BN 15D 2.5MM 5MM 5.4MM 14MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823516 SUP HCPCS C1713 72823516 - SCREW BN 15D 2.5MM 5MM 5.4MM 16MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 72823518 SUP HCPCS C1713 72823518 - SCREW BN 15D 2.5MM 5MM 5.4MM 18MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823520 SUP HCPCS C1713 72823520 - SCREW BN 15D 2.5MM 5MM 5.4MM 20MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823522 SUP HCPCS C1713 72823522 - SCREW BN 15D 2.5MM 5MM 5.4MM 22MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823524 SUP HCPCS C1713 72823524 - SCREW BN 15D 2.5MM 5MM 5.4MM 24MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823526 SUP HCPCS C1713 72823526 - SCREW BN 15D 2.5MM 5MM 5.4MM 26MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823528 SUP HCPCS C1713 72823528 - SCREW BN 15D 2.5MM 5MM 5.4MM 28MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823530 SUP HCPCS C1713 72823530 - SCREW BN 15D 2.5MM 5MM 5.4MM 30MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823532 SUP HCPCS C1713 72823532 - SCREW BN 15D 2.5MM 5MM 5.4MM 32MM VLP LCK LOPRFL HD HEX RCS BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823534 SUP HCPCS C1713 72823534 - SCREW BN 15D 2.5MM 5MM 5.4MM 34MM VLP LCK LOPRFL HD HEX RCS BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823536 SUP HCPCS C1713 72823536 - SCREW BN 15D 2.5MM 5MM 5.4MM 36MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823538 SUP HCPCS C1713 72823538 - SCREW BN 15D 2.5MM 5MM 5.4MM 38MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823540 SUP HCPCS C1713 72823540 - SCREW BN 15D 2.5MM 5MM 5.4MM 40MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823542 SUP HCPCS C1713 72823542 - SCREW BN 15D 2.5MM 5MM 5.4MM 42MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823544 SUP HCPCS C1713 72823544 - SCREW BN 15D 2.5MM 5MM 5.4MM 44MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823546 SUP HCPCS C1713 72823546 - SCREW BN 15D 2.5MM 5MM 5.4MM 46MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823548 SUP HCPCS C1713 72823548 - SCREW BN 15D 2.5MM 5MM 5.4MM 48MM VLP LCK LOPRFL HD HEX RCS BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823550 SUP HCPCS C1713 72823550 - SCREW BN 15D 2.5MM 5MM 5.4MM 50MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823555 SUP HCPCS C1713 72823555 - SCREW BN 15D 2.5MM 5MM 5.4MM 55MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 72823560 SUP HCPCS C1713 72823560 - SCREW BN 15D 2.5MM 5MM 5.4MM 60MMX3.3MM VLP LCK LOPRFL HD BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 73804026 SUP HCPCS C1713 73804026 - SCREW BN T20 3.5MM 26MM PRLC ST STRDR CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73804028 SUP HCPCS C1713 73804028 - SCREW BN 3.5MM 28MM PRLC ST T20 STRDR RCS CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $19.53 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73804030 SUP HCPCS C1713 73804030 - SCREW BN 3.5MM 30MM PRLC ST T20 STRDR RCS CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73804032 SUP HCPCS C1713 73804032 - SCREW BN 3.5MM 32MM PRLC ST T20 STRDR RCS CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73804034 SUP HCPCS C1713 73804034 - SCREW BN T20 3.5MM 34MM PRLC ST STRDR CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73804038 SUP HCPCS C1713 73804038 - SCREW BN 3.5MM 38MM PRLC ST T20 STRDR RCS CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73804040 SUP HCPCS C1713 73804040 - SCREW BN 3.5MM 40MM PRLC ST T20 STRDR RCS CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $19.53 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73804044 SUP HCPCS C1713 73804044 - SCREW BN 3.5MM 44MM PRLC ST T20 STRDR RCS CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $19.53 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73804050 SUP HCPCS C1713 73804050 - SCREW BN 3.5MM 50MM PRLC ST T20 STRDR RCS CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73805026 SUP HCPCS C1713 73805026 - SCREW BN T20 3.5MM 26MM PRLC ST LCK BOTH IP/OP $254.50 $188.00 $50.43 $254.10 $114.35 $114.35 $114.35 $114.35 $254.10 $254.10 $254.10 $52.96 $254.10 $254.10 $254.10 $254.10 $254.10 $52.96 $254.10 $101.64 $150.30 $254.10 $254.10 $254.10 $254.10 $190.88 $254.10 $254.10 $254.10 $127.05 $127.05 $201.25 $254.10 $203.28 $114.35 $50.43 N/A $147.61 $254.10 $254.10 $254.10 $52.95 $254.10 N/A N/A 73805030 SUP HCPCS C1713 73805030 - SCREW BN 3.5MM 30MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN BOTH IP/OP $254.50 $188.00 $50.43 $254.10 $114.35 $114.35 $114.35 $114.35 $254.10 $254.10 $254.10 $52.96 $254.10 $254.10 $254.10 $254.10 $254.10 $52.96 $254.10 $101.64 $150.30 $254.10 $254.10 $254.10 $254.10 $190.88 $254.10 $254.10 $254.10 $127.05 $127.05 $201.25 $254.10 $203.28 $114.35 $50.43 N/A $147.61 $254.10 $254.10 $254.10 $52.95 $254.10 N/A N/A 73805065 SUP HCPCS C1713 73805065 - SCREW BN 3.5MM 65MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN BOTH IP/OP $293.00 $217.00 $58.14 $292.95 $131.83 $131.83 $131.83 $131.83 $292.95 $292.95 $292.95 $61.06 $292.95 $292.95 $292.95 $292.95 $292.95 $61.05 $292.95 $117.18 $173.28 $292.95 $292.95 $292.95 $292.95 $219.75 $292.95 $292.95 $292.95 $146.48 $146.48 $232.02 $292.95 $234.36 $131.83 $58.14 N/A $169.94 $292.95 $292.95 $292.95 $61.05 $292.95 N/A N/A 73805070 SUP HCPCS C1713 73805070 - SCREW BN 3.5MM 70MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN BOTH IP/OP $293.00 $217.00 $58.14 $292.95 $131.83 $131.83 $131.83 $131.83 $292.95 $292.95 $292.95 $61.06 $292.95 $292.95 $292.95 $292.95 $292.95 $61.05 $292.95 $292.95 $173.28 $292.95 $292.95 $292.95 $292.95 $219.75 $292.95 $292.95 $292.95 $146.48 $146.48 $232.02 $292.95 $234.36 $131.83 $58.14 N/A $169.94 $292.95 $292.95 $292.95 $61.05 $292.95 N/A N/A 73805075 SUP HCPCS C1713 73805075 - SCREW BN 3.5MM 75MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN BOTH IP/OP $293.00 $217.00 $58.14 $292.95 $131.83 $131.83 $131.83 $131.83 $292.95 $292.95 $292.95 $61.06 $292.95 $292.95 $292.95 $292.95 $292.95 $61.05 $292.95 $117.18 $173.28 $292.95 $292.95 $292.95 $292.95 $219.75 $292.95 $292.95 $292.95 $146.48 $146.48 $232.02 $292.95 $234.36 $131.83 $58.14 N/A $169.94 $292.95 $292.95 $292.95 $61.05 $292.95 N/A N/A 73805080 SUP HCPCS C1713 73805080 - SCREW BN 3.5MM 80MM PRLC ST LCK T20 STRDR RCS SM BN LNG BN BOTH IP/OP $293.00 $217.00 $58.14 $292.95 $131.83 $131.83 $131.83 $131.83 $292.95 $292.95 $292.95 $61.06 $292.95 $292.95 $292.95 $292.95 $292.95 $61.05 $292.95 $117.18 $173.28 $292.95 $292.95 $292.95 $292.95 $219.75 $292.95 $292.95 $292.95 $146.48 $146.48 $232.02 $292.95 $234.36 $131.83 $58.14 N/A $169.94 $292.95 $292.95 $292.95 $61.05 $292.95 N/A N/A 73805230 SUP HCPCS C1713 73805230 - SCREW BN FT 4MM 30MM PRLC T20 STRDR RCS CANC BOTH IP/OP $64.50 $48.00 $12.79 $64.43 $28.99 $28.99 $28.99 $28.99 $64.43 $64.43 $64.43 $13.43 $64.43 $64.43 $64.43 $64.43 $64.43 $13.43 $64.43 $64.43 $38.11 $64.43 $64.43 $64.43 $64.43 $48.38 $64.43 $64.43 $64.43 $32.22 $32.22 $51.03 $64.43 $51.54 $28.99 $12.79 N/A $37.41 $64.43 $64.43 $64.43 $13.43 $64.43 N/A N/A 73806024 SUP HCPCS C1713 73806024 - SCREW BN 4.5MM 24MM PRLC ST T25 STRDR RCS FT/ANKL CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73806026 SUP HCPCS C1713 73806026 - SCREW BN 4.5MM 26MM PRLC ST T25 STRDR RCS FT/ANKL CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $19.53 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73806028 SUP HCPCS C1713 73806028 - SCREW BN 4.5MM 28MM PRLC ST T25 STRDR RCS FT/ANKL CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73806030 SUP HCPCS C1713 73806030 - SCREW BN 4.5MM 30MM PRLC ST T25 STRDR RCS FT/ANKL CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $19.53 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73806034 SUP HCPCS C1713 73806034 - SCREW BN 4.5MM 34MM PRLC ST T25 STRDR RCS FT/ANKL CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $19.53 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73806040 SUP HCPCS C1713 73806040 - SCREW BN 4.5MM 40MM PRLC ST T25 STRDR RCS FT/ANKL CORT BOTH IP/OP $49.00 $36.00 $9.69 $48.83 $21.97 $21.97 $21.97 $21.97 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $48.83 $48.83 $48.83 $10.18 $48.83 $48.83 $28.88 $48.83 $48.83 $48.83 $48.83 $36.75 $48.83 $48.83 $48.83 $24.42 $24.42 $38.67 $48.83 $39.06 $21.97 $9.69 N/A $28.42 $48.83 $48.83 $48.83 $10.18 $48.83 N/A N/A 73807060 SUP HCPCS C1713 73807060 - SCREW BN 4.5MM 60MM PRLC ST LCK T25 STRDR RCS ANKL/FT BOTH IP/OP $298.50 $221.00 $59.19 $298.20 $134.19 $134.19 $134.19 $134.19 $298.20 $298.20 $298.20 $62.15 $298.20 $298.20 $298.20 $298.20 $298.20 $62.15 $298.20 $298.20 $176.39 $298.20 $298.20 $298.20 $298.20 $223.88 $298.20 $298.20 $298.20 $149.10 $149.10 $236.17 $298.20 $238.56 $134.19 $59.19 N/A $173.13 $298.20 $298.20 $298.20 $62.14 $298.20 N/A N/A 73807066 SUP HCPCS C1713 73807066 - SCREW BN 4.5MM 66MM PRLC ST LCK T25 STRDR RCS ANKL/FT BOTH IP/OP $298.50 $221.00 $59.19 $298.20 $134.19 $134.19 $134.19 $134.19 $298.20 $298.20 $298.20 $62.15 $298.20 $298.20 $298.20 $298.20 $298.20 $62.15 $298.20 $119.28 $176.39 $298.20 $298.20 $298.20 $298.20 $223.88 $298.20 $298.20 $298.20 $149.10 $149.10 $236.17 $298.20 $238.56 $134.19 $59.19 N/A $173.13 $298.20 $298.20 $298.20 $62.14 $298.20 N/A N/A 73807070 SUP HCPCS C1713 73807070 - SCREW BN 4.5MM 70MM PRLC ST LCK T25 STRDR RCS ANKL/FT BOTH IP/OP $298.50 $221.00 $59.19 $298.20 $134.19 $134.19 $134.19 $134.19 $298.20 $298.20 $298.20 $62.15 $298.20 $298.20 $298.20 $298.20 $298.20 $62.15 $298.20 $119.28 $176.39 $298.20 $298.20 $298.20 $298.20 $223.88 $298.20 $298.20 $298.20 $149.10 $149.10 $236.17 $298.20 $238.56 $134.19 $59.19 N/A $173.13 $298.20 $298.20 $298.20 $62.14 $298.20 N/A N/A 73807074 SUP HCPCS C1713 73807074 - SCREW BN 4.5MM 74MM PRLC ST LCK T25 STRDR RCS ANKL/FT BOTH IP/OP $298.50 $221.00 $59.19 $298.20 $134.19 $134.19 $134.19 $134.19 $298.20 $298.20 $298.20 $62.15 $298.20 $298.20 $298.20 $298.20 $298.20 $62.15 $298.20 $298.20 $176.39 $298.20 $298.20 $298.20 $298.20 $223.88 $298.20 $298.20 $298.20 $149.10 $149.10 $236.17 $298.20 $238.56 $134.19 $59.19 N/A $173.13 $298.20 $298.20 $298.20 $62.14 $298.20 N/A N/A 73807076 SUP HCPCS C1713 73807076 - SCREW BN 4.5MM 76MM PRLC ST LCK T25 STRDR RCS ANKL/FT BOTH IP/OP $298.50 $221.00 $59.19 $298.20 $134.19 $134.19 $134.19 $134.19 $298.20 $298.20 $298.20 $62.15 $298.20 $298.20 $298.20 $298.20 $298.20 $62.15 $298.20 $119.28 $176.39 $298.20 $298.20 $298.20 $298.20 $223.88 $298.20 $298.20 $298.20 $149.10 $149.10 $236.17 $298.20 $238.56 $134.19 $59.19 N/A $173.13 $298.20 $298.20 $298.20 $62.14 $298.20 N/A N/A 73807085 SUP HCPCS C1713 73807085 - SCREW BN 4.5MM 85MM PRLC ST LCK T25 STRDR RCS ANKL/FT BOTH IP/OP $298.50 $221.00 $59.19 $298.20 $134.19 $134.19 $134.19 $134.19 $298.20 $298.20 $298.20 $62.15 $298.20 $298.20 $298.20 $298.20 $298.20 $62.15 $298.20 $298.20 $176.39 $298.20 $298.20 $298.20 $298.20 $223.88 $298.20 $298.20 $298.20 $149.10 $149.10 $236.17 $298.20 $238.56 $134.19 $59.19 N/A $173.13 $298.20 $298.20 $298.20 $62.14 $298.20 N/A N/A 73807090 SUP HCPCS C1713 73807090 - SCREW BN 4.5MM 90MM PRLC ST LCK T25 STRDR RCS ANKL/FT BOTH IP/OP $310.00 $229.00 $61.48 $309.75 $139.39 $139.39 $139.39 $139.39 $309.75 $309.75 $309.75 $64.56 $309.75 $309.75 $309.75 $309.75 $309.75 $64.56 $309.75 $123.90 $183.22 $309.75 $309.75 $309.75 $309.75 $232.50 $309.75 $309.75 $309.75 $154.88 $154.88 $245.32 $309.75 $247.80 $139.39 $61.48 N/A $179.80 $309.75 $309.75 $309.75 $64.55 $309.75 N/A N/A 74132105 SUP HCPCS C1713 74132105 - SCREW BN 6.5MM 105MM 22MM CNN CNCL P/T SS BOTH IP/OP $481.50 $356.00 $95.57 $481.50 $216.68 $216.68 $216.68 $216.68 $481.50 $481.50 $481.50 $100.36 $481.50 $481.50 $481.50 $481.50 $481.50 $100.35 $481.50 $481.50 $284.81 $481.50 $481.50 $481.50 $481.50 $361.13 $481.50 $481.50 $481.50 $240.75 $240.75 $381.35 $481.50 $385.20 $216.68 $95.57 N/A $279.27 $481.50 $481.50 $481.50 $100.34 $481.50 N/A N/A 74133070 SUP HCPCS C1713 74133070 - SCREW BN FT 6.5MM 70MM CNN LCK SS BOTH IP/OP $555.00 $411.00 $110.08 $554.63 $249.58 $249.58 $249.58 $249.58 $554.63 $554.63 $554.63 $115.60 $554.63 $554.63 $554.63 $554.63 $554.63 $115.59 $554.63 $221.85 $328.06 $554.63 $554.63 $554.63 $554.63 $416.25 $554.63 $554.63 $554.63 $277.32 $277.32 $439.27 $554.63 $443.70 $249.58 $110.08 N/A $321.90 $554.63 $554.63 $554.63 $554.63 $554.63 N/A N/A 74133075 SUP HCPCS C1713 74133075 - SCREW BN FT 6.5MM 75MM CNN LCK SS BOTH IP/OP $684.00 $506.00 $135.76 $684.00 $307.80 $307.80 $307.80 $307.80 $684.00 $684.00 $684.00 $142.56 $684.00 $684.00 $684.00 $684.00 $684.00 $142.55 $684.00 $273.60 $404.59 $684.00 $684.00 $684.00 $684.00 $513.00 $684.00 $684.00 $684.00 $342.00 $342.00 $541.73 $684.00 $547.20 $307.80 $135.76 N/A $396.72 $684.00 $410.40 $684.00 $142.55 $684.00 N/A N/A 74133080 SUP HCPCS C1713 74133080 - SCREW BN FT 6.5MM 80MM CNN LCK SS BOTH IP/OP $684.00 $506.00 $135.76 $684.00 $307.80 $307.80 $307.80 $307.80 $684.00 $684.00 $684.00 $142.56 $684.00 $684.00 $684.00 $684.00 $684.00 $142.55 $684.00 $273.60 $404.59 $684.00 $684.00 $684.00 $684.00 $513.00 $684.00 $684.00 $684.00 $342.00 $342.00 $541.73 $684.00 $547.20 $307.80 $135.76 N/A $396.72 $684.00 $410.40 $684.00 $142.55 $684.00 N/A N/A 74133085 SUP HCPCS C1713 74133085 - SCREW BN FT 6.5MM 85MM CNN LCK SS BOTH IP/OP $684.00 $506.00 $135.76 $684.00 $307.80 $307.80 $307.80 $307.80 $684.00 $684.00 $684.00 $142.56 $684.00 $684.00 $684.00 $684.00 $684.00 $142.55 $684.00 $684.00 $404.59 $684.00 $684.00 $684.00 $684.00 $513.00 $684.00 $684.00 $684.00 $342.00 $342.00 $541.73 $684.00 $547.20 $307.80 $135.76 N/A $396.72 $684.00 $410.40 $684.00 $142.55 $684.00 N/A N/A 74133411 SUP HCPCS C1713 74133411 - PIN FX SHRT 4.5MM 80MM PRLC TRL BOTH IP/OP $480.00 $355.00 $95.27 $480.00 $216.00 $216.00 $216.00 $216.00 $480.00 $480.00 $480.00 $100.04 $480.00 $480.00 $480.00 $480.00 $480.00 $100.04 $480.00 $192.00 $283.92 $480.00 $480.00 $480.00 $480.00 $360.00 $480.00 $480.00 $480.00 $240.00 $240.00 $380.16 $480.00 $384.00 $216.00 $95.27 N/A $278.40 $480.00 $288.00 $480.00 $100.03 $480.00 N/A N/A 74133412 SUP HCPCS C1713 74133412 - PIN FX 3.5MM 18MM PRLC BOTH IP/OP $520.00 $385.00 $103.21 $520.00 $234.00 $234.00 $234.00 $234.00 $520.00 $520.00 $520.00 $108.38 $520.00 $520.00 $520.00 $520.00 $520.00 $108.37 $520.00 $520.00 $307.58 $520.00 $520.00 $520.00 $520.00 $390.00 $520.00 $520.00 $520.00 $260.00 $260.00 $411.84 $520.00 $416.00 $234.00 $103.21 N/A $301.60 $520.00 $520.00 $520.00 $108.37 $520.00 N/A N/A 74133413 SUP HCPCS C1713 74133413 - PIN FX SHRT 3.5MM 18MM PRLC PRV FX BOTH IP/OP $520.00 $385.00 $103.21 $520.00 $234.00 $234.00 $234.00 $234.00 $520.00 $520.00 $520.00 $108.38 $520.00 $520.00 $520.00 $520.00 $520.00 $108.37 $520.00 $208.00 $307.58 $520.00 $520.00 $520.00 $520.00 $390.00 $520.00 $520.00 $520.00 $260.00 $260.00 $411.84 $520.00 $416.00 $234.00 $103.21 N/A $301.60 $520.00 $312.00 $520.00 $108.37 $520.00 N/A N/A 74133420 SUP Custom 27203010 74133420 - BIT DRL 2.7MM 358MM TARGETER BOTH IP/OP "$1,102.00" $815.00 $196.16 "$1,102.00" "$1,102.00" "$1,102.00" "$1,102.00" "$1,102.00" "$1,102.00" "$1,102.00" $196.16 "$1,102.00" "$1,102.00" $817.90 $817.90 $849.42 $574.14 $229.67 "$1,102.00" $440.80 "$1,102.00" "$1,102.00" "$1,102.00" "$1,102.00" "$1,102.00" $826.50 "$1,102.00" "$1,102.00" "$1,102.00" $551.00 $551.00 $872.78 "$1,102.00" $881.60 $716.30 "$1,102.00" N/A $639.16 "$1,102.00" $661.20 "$1,102.00" "$1,102.00" "$1,102.00" N/A N/A 74133421 SUP HCPCS C1713 74133421 - PIN FX SHRT 4.5MM 80MM PRLC TARGETER DRL TIP PRV FX BOTH IP/OP $520.00 $385.00 $103.21 $520.00 $234.00 $234.00 $234.00 $234.00 $520.00 $520.00 $520.00 $108.38 $520.00 $520.00 $520.00 $520.00 $520.00 $108.37 $520.00 $208.00 $307.58 $520.00 $520.00 $520.00 $520.00 $390.00 $520.00 $520.00 $520.00 $260.00 $260.00 $411.84 $520.00 $416.00 $234.00 $103.21 N/A $301.60 $520.00 $520.00 $520.00 $108.37 $520.00 N/A N/A 74133424 SUP HCPCS C1713 74133424 - PLATE BN TLL PRLC CBL SDL BOTH IP/OP $363.50 $269.00 $72.12 $363.38 $163.52 $163.52 $163.52 $163.52 $363.38 $363.38 $363.38 $75.74 $363.38 $363.38 $363.38 $363.38 $363.38 $75.73 $363.38 $363.38 $214.94 $363.38 $363.38 $363.38 $363.38 $272.63 $363.38 $363.38 $363.38 $181.69 $181.69 $287.80 $363.38 $290.70 $163.52 $72.12 N/A $210.83 $363.38 $363.38 $363.38 $75.73 $363.38 N/A N/A 74133425 SUP HCPCS C1713 74133425 - SCREW BN PRLC HL FIL BOTH IP/OP $492.00 $364.00 $97.65 $492.00 $221.40 $221.40 $221.40 $221.40 $492.00 $492.00 $492.00 $102.55 $492.00 $492.00 $492.00 $492.00 $492.00 $102.54 $492.00 $492.00 $291.02 $492.00 $492.00 $492.00 $492.00 $369.00 $492.00 $492.00 $492.00 $246.00 $246.00 $389.66 $492.00 $393.60 $221.40 $97.65 N/A $285.36 $492.00 $492.00 $492.00 $102.53 $492.00 N/A N/A 74402001 SUP HCPCS C1713 74402001 - WASHER ORTH VLP 2 MM SCR BOTH IP/OP $146.00 $108.00 $28.98 $146.00 $65.70 $65.70 $65.70 $65.70 $146.00 $146.00 $146.00 $30.43 $146.00 $146.00 $146.00 $146.00 $146.00 $30.43 $146.00 $117.58 $86.36 $146.00 $117.58 $146.00 $146.00 $109.50 $146.00 $146.00 $146.00 $73.00 $73.00 $115.63 $146.00 $116.80 $65.70 $28.98 N/A $84.68 $146.00 $87.60 $146.00 $30.43 $146.00 N/A N/A 74402006 SUP HCPCS C1713 74402006 - SCREW BN T6 2MM 6MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402007 SUP HCPCS C1713 74402007 - SCREW BN T6 2MM 7MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402008 SUP HCPCS C1713 74402008 - SCREW BN T6 2MM 8MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402009 SUP HCPCS C1713 74402009 - SCREW BN T6 2MM 9MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402011 SUP HCPCS C1713 74402011 - SCREW BN T6 2MM 11MM VLP ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402012 SUP HCPCS C1713 74402012 - SCREW BN T6 2MM 12MM VLP ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $112.48 $112.48 N/A N/A 74402013 SUP HCPCS C1713 74402013 - SCREW BN T6 2MM 13MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402014 SUP HCPCS C1713 74402014 - SCREW BN T6 2MM 14MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $112.48 $112.48 N/A N/A 74402015 SUP HCPCS C1713 74402015 - SCREW BN T6 2MM 15MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402016 SUP HCPCS C1713 74402016 - SCREW BN T6 2MM 16MM VLP ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402017 SUP HCPCS C1713 74402017 - SCREW BN T6 2MM 17MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402018 SUP HCPCS C1713 74402018 - SCREW BN T6 2MM 18MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402019 SUP HCPCS C1713 74402019 - SCREW BN T6 2MM 19MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402020 SUP HCPCS C1713 74402020 - SCREW BN T6 2MM 20MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402021 SUP HCPCS C1713 74402021 - SCREW BN T6 2MM 21MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $112.48 $112.48 N/A N/A 74402022 SUP HCPCS C1713 74402022 - SCREW BN T6 2MM 22MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402023 SUP HCPCS C1713 74402023 - SCREW BN T6 2MM 23MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402024 SUP HCPCS C1713 74402024 - SCREW BN T6 2MM 24MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402026 SUP HCPCS C1713 74402026 - SCREW BN T6 2MM 26MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402028 SUP HCPCS C1713 74402028 - SCREW BN T6 2MM 28MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402030 SUP HCPCS C1713 74402030 - SCREW BN T6 2MM 30MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402032 SUP HCPCS C1713 74402032 - SCREW BN T6 2MM 32MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $112.48 $112.48 N/A N/A 74402034 SUP HCPCS C1713 74402034 - SCREW BN T6 2MM 34MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402036 SUP HCPCS C1713 74402036 - SCREW BN T6 2MM 36MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402038 SUP HCPCS C1713 74402038 - SCREW BN T6 2MM 38MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402040 SUP HCPCS C1713 74402040 - SCREW BN T6 2MM 40MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402401 SUP HCPCS C1713 74402401 - WASHER ORTH VLP 2.4 MM T7 SCR BOTH IP/OP $146.00 $108.00 $28.98 $146.00 $65.70 $65.70 $65.70 $65.70 $146.00 $146.00 $146.00 $30.43 $146.00 $146.00 $146.00 $146.00 $146.00 $30.43 $146.00 $117.58 $86.36 $146.00 $117.58 $146.00 $146.00 $109.50 $146.00 $146.00 $146.00 $73.00 $73.00 $115.63 $146.00 $116.80 $65.70 $28.98 N/A $84.68 $146.00 $146.00 $146.00 $30.43 $146.00 N/A N/A 74402406 SUP HCPCS C1713 74402406 - SCREW BN T7 2.4MM 6MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402407 SUP HCPCS C1713 74402407 - SCREW BN T7 2.4MM 7MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402408 SUP HCPCS C1713 74402408 - SCREW BN T7 2.4MM 8MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402409 SUP HCPCS C1713 74402409 - SCREW BN T7 2.4MM 9MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402410 SUP HCPCS C1713 74402410 - SCREW BN T7 2.4MM 10MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402411 SUP HCPCS C1713 74402411 - SCREW BN T7 2.4MM 11MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402412 SUP HCPCS C1713 74402412 - SCREW BN T7 2.4MM 12MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $112.48 $112.48 N/A N/A 74402413 SUP HCPCS C1713 74402413 - SCREW BN T7 2.4MM 13MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402414 SUP HCPCS C1713 74402414 - SCREW BN T7 2.4MM 14MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402415 SUP HCPCS C1713 74402415 - SCREW BN T7 2.4MM 15MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402416 SUP HCPCS C1713 74402416 - SCREW BN T7 2.4MM 16MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402417 SUP HCPCS C1713 74402417 - SCREW BN T7 2.4MM 17MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402418 SUP HCPCS C1713 74402418 - SCREW BN T7 2.4MM 18MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $112.48 $112.48 N/A N/A 74402419 SUP HCPCS C1713 74402419 - SCREW BN T7 2.4MM 19MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402420 SUP HCPCS C1713 74402420 - SCREW BN T7 2.4MM 20MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402421 SUP HCPCS C1713 74402421 - SCREW BN T7 2.4MM 21MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402422 SUP HCPCS C1713 74402422 - SCREW BN T7 2.4MM 22MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402423 SUP HCPCS C1713 74402423 - SCREW BN T7 2.4MM 23MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402424 SUP HCPCS C1713 74402424 - SCREW BN T7 2.4MM 24MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402426 SUP HCPCS C1713 74402426 - SCREW BN T7 2.4MM 26MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402428 SUP HCPCS C1713 74402428 - SCREW BN T7 2.4MM 28MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402430 SUP HCPCS C1713 74402430 - SCREW BN T7 2.4MM 30MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402434 SUP HCPCS C1713 74402434 - SCREW BN T7 2.4MM 34MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402438 SUP HCPCS C1713 74402438 - SCREW BN T7 2.4MM 38MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402440 SUP HCPCS C1713 74402440 - SCREW BN T7 2.4MM 40MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402442 SUP HCPCS C1713 74402442 - SCREW BN T7 2.4MM 42MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402444 SUP HCPCS C1713 74402444 - SCREW BN T7 2.4MM 44MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402446 SUP HCPCS C1713 74402446 - SCREW BN T7 2.4MM 46MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402448 SUP HCPCS C1713 74402448 - SCREW BN T7 2.4MM 48MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402450 SUP HCPCS C1713 74402450 - SCREW BN T7 2.4MM 50MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402455 SUP HCPCS C1713 74402455 - SCREW BN T7 2.4MM 55MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402460 SUP HCPCS C1713 74402460 - SCREW BN T7 2.4MM 60MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402465 SUP HCPCS C1713 74402465 - SCREW BN T7 2.4MM 65MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402470 SUP HCPCS C1713 74402470 - SCREW BN T7 2.4MM 70MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402475 SUP HCPCS C1713 74402475 - SCREW BN T7 2.4MM 75MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402480 SUP HCPCS C1713 74402480 - SCREW BN T7 2.4MM 80MM VLP ST TI FT CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74412007 SUP HCPCS C1713 74412007 - SCREW BN T6 2MM 7MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412008 SUP HCPCS C1713 74412008 - SCREW BN T6 2MM 8MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412011 SUP HCPCS C1713 74412011 - SCREW BN T6 2MM 11MM VLP LCK ST TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412012 SUP HCPCS C1713 74412012 - SCREW BN T6 2MM 12MM NS VLP LCK ST TI SM BN LNG BN BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412014 SUP HCPCS C1713 74412014 - SCREW BN T6 2MM 14MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412015 SUP HCPCS C1713 74412015 - SCREW BN T6 2MM 15MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412016 SUP HCPCS C1713 74412016 - SCREW BN T6 2MM 16MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412017 SUP HCPCS C1713 74412017 - SCREW BN T6 2MM 17MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412018 SUP HCPCS C1713 74412018 - SCREW BN T6 2MM 18MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412019 SUP HCPCS C1713 74412019 - SCREW BN T6 2MM 19MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $237.88 $237.88 N/A N/A 74412020 SUP HCPCS C1713 74412020 - SCREW BN T6 2MM 20MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412021 SUP HCPCS C1713 74412021 - SCREW BN T6 2MM 21MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412022 SUP HCPCS C1713 74412022 - SCREW BN T6 2MM 22MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412023 SUP HCPCS C1713 74412023 - SCREW BN T6 2MM 23MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412024 SUP HCPCS C1713 74412024 - SCREW BN T6 2MM 24MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412026 SUP HCPCS C1713 74412026 - SCREW BN T6 2MM 26MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412028 SUP HCPCS C1713 74412028 - SCREW BN T6 2MM 28MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412030 SUP HCPCS C1713 74412030 - SCREW BN T6 2MM 30MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412032 SUP HCPCS C1713 74412032 - SCREW BN T6 2MM 32MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412034 SUP HCPCS C1713 74412034 - SCREW BN T6 2MM 34MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412036 SUP HCPCS C1713 74412036 - SCREW BN T6 2MM 36MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412038 SUP HCPCS C1713 74412038 - SCREW BN T6 2MM 38MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412040 SUP HCPCS C1713 74412040 - SCREW BN T6 2MM 40MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $237.88 $237.88 N/A N/A 74412406 SUP HCPCS C1713 74412406 - SCREW BN T7 2.4MM 6MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $237.88 $237.88 N/A N/A 74412407 SUP HCPCS C1713 74412407 - SCREW BN T7 2.4MM 7MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412408 SUP HCPCS C1713 74412408 - SCREW BN T7 2.4MM 8MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412409 SUP HCPCS C1713 74412409 - SCREW BN T7 2.4MM 9MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412410 SUP HCPCS C1713 74412410 - SCREW BN T7 2.4MM 10MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412411 SUP HCPCS C1713 74412411 - SCREW BN T7 2.4MM 11MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412412 SUP HCPCS C1713 74412412 - SCREW BN T7 2.4MM 12MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412413 SUP HCPCS C1713 74412413 - SCREW BN 2.4MM 13MM VLP LCK ST T7 DRVR TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412414 SUP HCPCS C1713 74412414 - SCREW BN 2.4MM 14MM VLP LCK ST T7 DRVR TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412415 SUP HCPCS C1713 74412415 - SCREW BN T7 2.4MM 15MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412416 SUP HCPCS C1713 74412416 - SCREW BN T7 2.4MM 16MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412417 SUP HCPCS C1713 74412417 - SCREW BN T7 2.4MM 17MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412418 SUP HCPCS C1713 74412418 - SCREW BN 2.4MM 18MM VLP LCK ST T7 DRVR TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412419 SUP HCPCS C1713 74412419 - SCREW BN T7 2.4MM 19MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412420 SUP HCPCS C1713 74412420 - SCREW BN T7 2.4MM 20MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412421 SUP HCPCS C1713 74412421 - SCREW BN T7 2.4MM 21MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412422 SUP HCPCS C1713 74412422 - SCREW BN 2.4MM 22MM VLP LCK ST T7 DRVR TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412423 SUP HCPCS C1713 74412423 - SCREW BN T7 2.4MM 23MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412424 SUP HCPCS C1713 74412424 - SCREW BN T7 2.4MM 24MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $237.88 $237.88 N/A N/A 74412426 SUP HCPCS C1713 74412426 - SCREW BN T7 2.4MM 26MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412428 SUP HCPCS C1713 74412428 - SCREW BN T7 2.4MM 28MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412430 SUP HCPCS C1713 74412430 - SCREW BN T7 2.4MM 30MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412432 SUP HCPCS C1713 74412432 - SCREW BN T7 2.4MM 32MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $237.88 $237.88 N/A N/A 74412434 SUP HCPCS C1713 74412434 - SCREW BN T7 2.4MM 34MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412436 SUP HCPCS C1713 74412436 - SCREW BN T7 2.4MM 36MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412438 SUP HCPCS C1713 74412438 - SCREW BN T7 2.4MM 38MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412440 SUP HCPCS C1713 74412440 - SCREW BN T7 2.4MM 40MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $237.88 $237.88 N/A N/A 74412442 SUP HCPCS C1713 74412442 - SCREW BN T7 2.4MM 42MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412444 SUP HCPCS C1713 74412444 - SCREW BN T7 2.4MM 44MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412446 SUP HCPCS C1713 74412446 - SCREW BN T7 2.4MM 46MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $237.88 $237.88 N/A N/A 74412448 SUP HCPCS C1713 74412448 - SCREW BN T7 2.4MM 48MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $237.88 $237.88 N/A N/A 74412450 SUP HCPCS C1713 74412450 - SCREW BN T7 2.4MM 50MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $237.88 $237.88 N/A N/A 74412455 SUP HCPCS C1713 74412455 - SCREW BN T7 2.4MM 55MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412460 SUP HCPCS C1713 74412460 - SCREW BN T7 2.4MM 60MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412465 SUP HCPCS C1713 74412465 - SCREW BN T7 2.4MM 65MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412470 SUP HCPCS C1713 74412470 - SCREW BN T7 2.4MM 70MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412475 SUP HCPCS C1713 74412475 - SCREW BN T7 2.4MM 75MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $237.88 $237.88 N/A N/A 74412480 SUP HCPCS C1713 74412480 - SCREW BN T7 2.4MM 80MM VLP LCK ST TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74423010 SUP HCPCS C1713 74423010 - SCREW BN T7 3MM 10MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423012 SUP HCPCS C1713 74423012 - SCREW BN T7 3MM 12MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423014 SUP HCPCS C1713 74423014 - SCREW BN T7 3MM 14MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $176.00 $176.00 $36.68 $176.00 N/A N/A 74423016 SUP HCPCS C1713 74423016 - SCREW BN T7 3MM 16MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $176.00 $176.00 N/A N/A 74423018 SUP HCPCS C1713 74423018 - SCREW BN T7 3MM 18MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423020 SUP HCPCS C1713 74423020 - SCREW BN T7 3MM 20MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $176.00 $176.00 N/A N/A 74423022 SUP HCPCS C1713 74423022 - SCREW BN T7 3MM 22MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423024 SUP HCPCS C1713 74423024 - SCREW BN T7 3MM 24MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423026 SUP HCPCS C1713 74423026 - SCREW BN T7 3MM 26MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423028 SUP HCPCS C1713 74423028 - SCREW BN T7 3MM 28MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423030 SUP HCPCS C1713 74423030 - SCREW BN T7 3MM 30MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423032 SUP HCPCS C1713 74423032 - SCREW BN T7 3MM 32MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $176.00 $176.00 N/A N/A 74423034 SUP HCPCS C1713 74423034 - SCREW BN T7 3MM 34MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $176.00 $176.00 N/A N/A 74423036 SUP HCPCS C1713 74423036 - SCREW BN T7 3MM 36MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423038 SUP HCPCS C1713 74423038 - SCREW BN T7 3MM 38MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423040 SUP HCPCS C1713 74423040 - SCREW BN T7 3MM 40MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $176.00 $176.00 N/A N/A 74423042 SUP HCPCS C1713 74423042 - SCREW BN T7 3MM 42MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $176.00 $176.00 N/A N/A 74423044 SUP HCPCS C1713 74423044 - SCREW BN T7 3MM 44MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423046 SUP HCPCS C1713 74423046 - SCREW BN T7 3MM 46MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $176.00 $176.00 N/A N/A 74423048 SUP HCPCS C1713 74423048 - SCREW BN T7 3MM 48MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423050 SUP HCPCS C1713 74423050 - SCREW BN T7 3MM 50MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423055 SUP HCPCS C1713 74423055 - SCREW BN T7 3MM 55MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423060 SUP HCPCS C1713 74423060 - SCREW BN T7 3MM 60MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423065 SUP HCPCS C1713 74423065 - SCREW BN T7 3MM 65MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423070 SUP HCPCS C1713 74423070 - SCREW BN T7 3MM 70MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423075 SUP HCPCS C1713 74423075 - SCREW BN T7 3MM 75MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $105.60 $176.00 $36.68 $176.00 N/A N/A 74423080 SUP HCPCS C1713 74423080 - SCREW BN T7 3MM 80MM VLP TI FT OSTEOPENIA BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $79.20 $79.20 $79.20 $79.20 $176.00 $176.00 $176.00 $36.68 $176.00 $176.00 $176.00 $176.00 $176.00 $36.68 $176.00 $70.40 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $79.20 $34.93 N/A $102.08 $176.00 $176.00 $176.00 $36.68 $176.00 N/A N/A 74442010 SUP HCPCS C1713 74442010 - PLATE BN Y VLP MN-MOD 6 HL 2MM SCR BOTH IP/OP "$1,609.00" "$1,191.00" $319.30 "$1,608.75" $723.94 $723.94 $723.94 $723.94 "$1,608.75" "$1,608.75" "$1,608.75" $335.30 "$1,608.75" "$1,608.75" "$1,608.75" "$1,608.75" "$1,608.75" $335.28 "$1,608.75" $643.50 $951.58 "$1,608.75" "$1,608.75" "$1,608.75" "$1,608.75" "$1,206.75" "$1,608.75" "$1,608.75" "$1,608.75" $804.38 $804.38 "$1,274.13" "$1,608.75" "$1,287.00" $723.94 $319.30 N/A $933.22 "$1,608.75" $965.25 "$1,608.75" $335.26 "$1,608.75" N/A N/A 74442012 SUP HCPCS C1713 74442012 - PLATE BN Y VLP MN-MOD 8 HL 2MM SCR BOTH IP/OP "$1,925.00" "$1,425.00" $382.06 "$1,925.00" $866.25 $866.25 $866.25 $866.25 "$1,925.00" "$1,925.00" "$1,925.00" $401.22 "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" $401.19 "$1,925.00" $770.00 "$1,138.64" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,443.75" "$1,925.00" "$1,925.00" "$1,925.00" $962.50 $962.50 "$1,524.60" "$1,925.00" "$1,540.00" $866.25 $382.06 N/A "$1,116.50" "$1,925.00" "$1,155.00" "$1,925.00" $401.17 "$1,925.00" N/A N/A 74442014 SUP HCPCS C1713 74442014 - PLATE BN T VLP MN-MOD 2X6 HL 2MM SCR BOTH IP/OP "$1,125.00" $833.00 $223.23 "$1,124.75" $506.14 $506.14 $506.14 $506.14 "$1,124.75" "$1,124.75" "$1,124.75" $234.43 "$1,124.75" "$1,124.75" "$1,124.75" "$1,124.75" "$1,124.75" $234.41 "$1,124.75" "$1,124.75" $665.29 "$1,124.75" "$1,124.75" "$1,124.75" "$1,124.75" $843.75 "$1,124.75" "$1,124.75" "$1,124.75" $562.38 $562.38 $890.80 "$1,124.75" $899.80 $506.14 $223.23 N/A $652.50 "$1,124.75" $674.85 "$1,124.75" $234.40 "$1,124.75" N/A N/A 74442016 SUP HCPCS C1713 74442016 - PLATE BN T 1.2MM VLP MN-MOD 2 HLE/HD 8 HL SHFT TI SM BN 2MM BOTH IP/OP "$1,444.00" "$1,069.00" $286.55 "$1,443.75" $649.69 $649.69 $649.69 $649.69 "$1,443.75" "$1,443.75" "$1,443.75" $300.91 "$1,443.75" "$1,443.75" "$1,443.75" "$1,443.75" "$1,443.75" $300.89 "$1,443.75" "$1,443.75" $853.98 "$1,443.75" "$1,443.75" "$1,443.75" "$1,443.75" "$1,083.00" "$1,443.75" "$1,443.75" "$1,443.75" $721.88 $721.88 "$1,143.45" "$1,443.75" "$1,155.00" $649.69 $286.55 N/A $837.52 "$1,443.75" $866.25 "$1,443.75" "$1,443.75" "$1,443.75" N/A N/A 74442018 SUP HCPCS C1713 74442018 - PLATE BN T VLP MN-MOD 3X6 HL 2MM SCR BOTH IP/OP "$1,609.00" "$1,191.00" $319.30 "$1,608.75" $723.94 $723.94 $723.94 $723.94 "$1,608.75" "$1,608.75" "$1,608.75" $335.30 "$1,608.75" "$1,608.75" "$1,608.75" "$1,608.75" "$1,608.75" $335.28 "$1,608.75" "$1,608.75" $951.58 "$1,608.75" "$1,608.75" "$1,608.75" "$1,608.75" "$1,206.75" "$1,608.75" "$1,608.75" "$1,608.75" $804.38 $804.38 "$1,274.13" "$1,608.75" "$1,287.00" $723.94 $319.30 N/A $933.22 "$1,608.75" $965.25 "$1,608.75" "$1,608.75" "$1,608.75" N/A N/A 74442020 SUP HCPCS C1713 74442020 - PLATE BN T VLP MN-MOD 3X8 HL 2MM SCR BOTH IP/OP "$1,925.00" "$1,425.00" $382.06 "$1,925.00" $866.25 $866.25 $866.25 $866.25 "$1,925.00" "$1,925.00" "$1,925.00" $401.22 "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" $401.19 "$1,925.00" "$1,925.00" "$1,138.64" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,443.75" "$1,925.00" "$1,925.00" "$1,925.00" $962.50 $962.50 "$1,524.60" "$1,925.00" "$1,540.00" $866.25 $382.06 N/A "$1,116.50" "$1,925.00" "$1,155.00" "$1,925.00" $401.17 "$1,925.00" N/A N/A 74442022 SUP HCPCS C1713 74442022 - PLATE BN STRG VLP MN-MOD 6 HL 2MM SCR BOTH IP/OP $965.50 $714.00 $191.58 $965.25 $434.36 $434.36 $434.36 $434.36 $965.25 $965.25 $965.25 $201.18 $965.25 $965.25 $965.25 $965.25 $965.25 $201.17 $965.25 $965.25 $570.95 $965.25 $965.25 $965.25 $965.25 $724.13 $965.25 $965.25 $965.25 $482.63 $482.63 $764.48 $965.25 $772.20 $434.36 $191.58 N/A $559.99 $965.25 $579.15 $965.25 $201.16 $965.25 N/A N/A 74442024 SUP HCPCS C1713 74442024 - PLATE BN STRG VLP MN-MOD 8 HL 2MM SCR BOTH IP/OP "$1,286.00" $952.00 $255.17 "$1,285.63" $578.53 $578.53 $578.53 $578.53 "$1,285.63" "$1,285.63" "$1,285.63" $267.96 "$1,285.63" "$1,285.63" "$1,285.63" "$1,285.63" "$1,285.63" $267.94 "$1,285.63" "$1,285.63" $760.45 "$1,285.63" "$1,285.63" "$1,285.63" "$1,285.63" $964.50 "$1,285.63" "$1,285.63" "$1,285.63" $642.82 $642.82 "$1,018.22" "$1,285.63" "$1,028.50" $578.53 $255.17 N/A $745.88 "$1,285.63" "$1,285.63" "$1,285.63" $267.93 "$1,285.63" N/A N/A 74442028 SUP HCPCS C1713 74442028 - PLATE BN STOUT VLP MN-MOD 6 HL 2MM SCR BOTH IP/OP "$1,125.00" $833.00 $223.23 "$1,124.75" $506.14 $506.14 $506.14 $506.14 "$1,124.75" "$1,124.75" "$1,124.75" $234.43 "$1,124.75" "$1,124.75" "$1,124.75" "$1,124.75" "$1,124.75" $234.41 "$1,124.75" "$1,124.75" $665.29 "$1,124.75" "$1,124.75" "$1,124.75" "$1,124.75" $843.75 "$1,124.75" "$1,124.75" "$1,124.75" $562.38 $562.38 $890.80 "$1,124.75" $899.80 $506.14 $223.23 N/A $652.50 "$1,124.75" $674.85 "$1,124.75" $234.40 "$1,124.75" N/A N/A 74442030 SUP HCPCS C1713 74442030 - PLATE BN STOUT VLP MN-MOD 8 HL 2MM SCR BOTH IP/OP "$1,444.00" "$1,069.00" $286.55 "$1,443.75" $649.69 $649.69 $649.69 $649.69 "$1,443.75" "$1,443.75" "$1,443.75" $300.91 "$1,443.75" "$1,443.75" "$1,443.75" "$1,443.75" "$1,443.75" $300.89 "$1,443.75" "$1,443.75" $853.98 "$1,443.75" "$1,443.75" "$1,443.75" "$1,443.75" "$1,083.00" "$1,443.75" "$1,443.75" "$1,443.75" $721.88 $721.88 "$1,143.45" "$1,443.75" "$1,155.00" $649.69 $286.55 N/A $837.52 "$1,443.75" $866.25 "$1,443.75" $300.88 "$1,443.75" N/A N/A 74442410 SUP HCPCS C1713 74442410 - PLATE BN Y VLP MN-MOD 6 HL 2.4MM SCR BOTH IP/OP "$1,609.00" "$1,191.00" $319.30 "$1,608.75" $723.94 $723.94 $723.94 $723.94 "$1,608.75" "$1,608.75" "$1,608.75" $335.30 "$1,608.75" "$1,608.75" "$1,608.75" "$1,608.75" "$1,608.75" $335.28 "$1,608.75" "$1,608.75" $951.58 "$1,608.75" "$1,608.75" "$1,608.75" "$1,608.75" "$1,206.75" "$1,608.75" "$1,608.75" "$1,608.75" $804.38 $804.38 "$1,274.13" "$1,608.75" "$1,287.00" $723.94 $319.30 N/A $933.22 "$1,608.75" $965.25 "$1,608.75" $335.26 "$1,608.75" N/A N/A 74442412 SUP HCPCS C1713 74442412 - PLATE BN Y VLP MN-MOD 8 HL 2.4MM SCR BOTH IP/OP "$1,925.00" "$1,425.00" $382.06 "$1,925.00" $866.25 $866.25 $866.25 $866.25 "$1,925.00" "$1,925.00" "$1,925.00" $401.22 "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" $401.19 "$1,925.00" "$1,925.00" "$1,138.64" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,443.75" "$1,925.00" "$1,925.00" "$1,925.00" $962.50 $962.50 "$1,524.60" "$1,925.00" "$1,540.00" $866.25 $382.06 N/A "$1,116.50" "$1,925.00" "$1,155.00" "$1,925.00" $401.17 "$1,925.00" N/A N/A 74442414 SUP HCPCS C1713 74442414 - PLATE BN T VLP MN-MOD 2X6 HL SM BN 2.4MM BOTH IP/OP "$1,125.00" $833.00 $223.23 "$1,124.75" $506.14 $506.14 $506.14 $506.14 "$1,124.75" "$1,124.75" "$1,124.75" $234.43 "$1,124.75" "$1,124.75" "$1,124.75" "$1,124.75" "$1,124.75" $234.41 "$1,124.75" "$1,124.75" $665.29 "$1,124.75" "$1,124.75" "$1,124.75" "$1,124.75" $843.75 "$1,124.75" "$1,124.75" "$1,124.75" $562.38 $562.38 $890.80 "$1,124.75" $899.80 $506.14 $223.23 N/A $652.50 "$1,124.75" $674.85 "$1,124.75" $234.40 "$1,124.75" N/A N/A 74442416 SUP HCPCS C1713 74442416 - PLATE BN T VLP MN-MOD 2X8 HL 2.4MM SCR BOTH IP/OP "$1,444.00" "$1,069.00" $286.55 "$1,443.75" $649.69 $649.69 $649.69 $649.69 "$1,443.75" "$1,443.75" "$1,443.75" $300.91 "$1,443.75" "$1,443.75" "$1,443.75" "$1,443.75" "$1,443.75" $300.89 "$1,443.75" "$1,443.75" $853.98 "$1,443.75" "$1,443.75" "$1,443.75" "$1,443.75" "$1,083.00" "$1,443.75" "$1,443.75" "$1,443.75" $721.88 $721.88 "$1,143.45" "$1,443.75" "$1,155.00" $649.69 $286.55 N/A $837.52 "$1,443.75" $866.25 "$1,443.75" $300.88 "$1,443.75" N/A N/A 74442418 SUP HCPCS C1713 74442418 - PLATE BN T VLP MN-MOD 3X6 HL 2.4MM SCR BOTH IP/OP "$1,609.00" "$1,191.00" $319.30 "$1,608.75" $723.94 $723.94 $723.94 $723.94 "$1,608.75" "$1,608.75" "$1,608.75" $335.30 "$1,608.75" "$1,608.75" "$1,608.75" "$1,608.75" "$1,608.75" $335.28 "$1,608.75" "$1,608.75" $951.58 "$1,608.75" "$1,608.75" "$1,608.75" "$1,608.75" "$1,206.75" "$1,608.75" "$1,608.75" "$1,608.75" $804.38 $804.38 "$1,274.13" "$1,608.75" "$1,287.00" $723.94 $319.30 N/A $933.22 "$1,608.75" "$1,608.75" "$1,608.75" $335.26 "$1,608.75" N/A N/A 74442420 SUP HCPCS C1713 74442420 - PLATE BN T VLP MN-MOD 3X8 HL 2.4MM SCR BOTH IP/OP "$1,925.00" "$1,425.00" $382.06 "$1,925.00" $866.25 $866.25 $866.25 $866.25 "$1,925.00" "$1,925.00" "$1,925.00" $401.22 "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" $401.19 "$1,925.00" "$1,925.00" "$1,138.64" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,443.75" "$1,925.00" "$1,925.00" "$1,925.00" $962.50 $962.50 "$1,524.60" "$1,925.00" "$1,540.00" $866.25 $382.06 N/A "$1,116.50" "$1,925.00" "$1,155.00" "$1,925.00" $401.17 "$1,925.00" N/A N/A 74442422 SUP HCPCS C1713 74442422 - PLATE BN STRG VLP MN-MOD 6 HL 2.4MM SCR BOTH IP/OP $965.50 $714.00 $191.58 $965.25 $434.36 $434.36 $434.36 $434.36 $965.25 $965.25 $965.25 $201.18 $965.25 $965.25 $965.25 $965.25 $965.25 $201.17 $965.25 $965.25 $570.95 $965.25 $965.25 $965.25 $965.25 $724.13 $965.25 $965.25 $965.25 $482.63 $482.63 $764.48 $965.25 $772.20 $434.36 $191.58 N/A $559.99 $965.25 $579.15 $965.25 $201.16 $965.25 N/A N/A 74442424 SUP HCPCS C1713 74442424 - PLATE BN STRG VLP MN-MOD 8 HL 2.4MM SCR BOTH IP/OP "$1,286.00" $952.00 $255.17 "$1,285.63" $578.53 $578.53 $578.53 $578.53 "$1,285.63" "$1,285.63" "$1,285.63" $267.96 "$1,285.63" "$1,285.63" "$1,285.63" "$1,285.63" "$1,285.63" $267.94 "$1,285.63" "$1,285.63" $760.45 "$1,285.63" "$1,285.63" "$1,285.63" "$1,285.63" $964.50 "$1,285.63" "$1,285.63" "$1,285.63" $642.82 $642.82 "$1,018.22" "$1,285.63" "$1,028.50" $578.53 $255.17 N/A $745.88 "$1,285.63" $771.38 "$1,285.63" $267.93 "$1,285.63" N/A N/A 74442426 SUP HCPCS C1713 74442426 - PLATE BN STRG VLP MN-MOD 12 HL 2.4MM SCR BOTH IP/OP "$1,925.00" "$1,425.00" $382.06 "$1,925.00" $866.25 $866.25 $866.25 $866.25 "$1,925.00" "$1,925.00" "$1,925.00" $401.22 "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" $401.19 "$1,925.00" "$1,925.00" "$1,138.64" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,443.75" "$1,925.00" "$1,925.00" "$1,925.00" $962.50 $962.50 "$1,524.60" "$1,925.00" "$1,540.00" $866.25 $382.06 N/A "$1,116.50" "$1,925.00" "$1,155.00" "$1,925.00" $401.17 "$1,925.00" N/A N/A 74442428 SUP HCPCS C1713 74442428 - PLATE BN VLP MN-MOD 12X3 HL MESH 2.4 MM SCR BOTH IP/OP "$2,413.50" "$1,786.00" $478.95 "$2,413.13" "$1,085.91" "$1,085.91" "$1,085.91" "$1,085.91" "$2,413.13" "$2,413.13" "$2,413.13" $502.96 "$2,413.13" "$2,413.13" "$2,413.13" "$2,413.13" "$2,413.13" $502.92 "$2,413.13" $965.25 "$1,427.37" "$2,413.13" "$2,413.13" "$2,413.13" "$2,413.13" "$1,810.13" "$2,413.13" "$2,413.13" "$2,413.13" "$1,206.57" "$1,206.57" "$1,911.20" "$2,413.13" "$1,930.50" "$1,085.91" $478.95 N/A "$1,399.83" "$2,413.13" "$2,413.13" "$2,413.13" $502.90 "$2,413.13" N/A N/A 74442430 SUP HCPCS C1713 74442430 - PLATE BN STOUT VLP MN-MOD 6 HL 2.4MM SCR BOTH IP/OP "$1,125.00" $833.00 $223.23 "$1,124.75" $506.14 $506.14 $506.14 $506.14 "$1,124.75" "$1,124.75" "$1,124.75" $234.43 "$1,124.75" "$1,124.75" "$1,124.75" "$1,124.75" "$1,124.75" $234.41 "$1,124.75" $449.90 $665.29 "$1,124.75" "$1,124.75" "$1,124.75" "$1,124.75" $843.75 "$1,124.75" "$1,124.75" "$1,124.75" $562.38 $562.38 $890.80 "$1,124.75" $899.80 $506.14 $223.23 N/A $652.50 "$1,124.75" $674.85 "$1,124.75" $234.40 "$1,124.75" N/A N/A 74442432 SUP HCPCS C1713 74442432 - PLATE BN STOUT VLP MN-MOD 8 HL 2.4MM SCR BOTH IP/OP "$1,444.00" "$1,069.00" $286.55 "$1,443.75" $649.69 $649.69 $649.69 $649.69 "$1,443.75" "$1,443.75" "$1,443.75" $300.91 "$1,443.75" "$1,443.75" "$1,443.75" "$1,443.75" "$1,443.75" $300.89 "$1,443.75" $577.50 $853.98 "$1,443.75" "$1,443.75" "$1,443.75" "$1,443.75" "$1,083.00" "$1,443.75" "$1,443.75" "$1,443.75" $721.88 $721.88 "$1,143.45" "$1,443.75" "$1,155.00" $649.69 $286.55 N/A $837.52 "$1,443.75" $866.25 "$1,443.75" $300.88 "$1,443.75" N/A N/A 74442434 SUP HCPCS C1713 74442434 - PLATE BN STOUT VLP MN-MOD 12 HL 2.4MM SCR BOTH IP/OP "$1,767.00" "$1,308.00" $350.68 "$1,766.88" $795.10 $795.10 $795.10 $795.10 "$1,766.88" "$1,766.88" "$1,766.88" $368.26 "$1,766.88" "$1,766.88" "$1,766.88" "$1,766.88" "$1,766.88" $368.24 "$1,766.88" "$1,766.88" "$1,045.11" "$1,766.88" "$1,766.88" "$1,766.88" "$1,766.88" "$1,325.25" "$1,766.88" "$1,766.88" "$1,766.88" $883.44 $883.44 "$1,399.37" "$1,766.88" "$1,413.50" $795.10 $350.68 N/A "$1,024.86" "$1,766.88" "$1,060.13" "$1,766.88" $368.22 "$1,766.88" N/A N/A 74444020 SUP HCPCS C1713 74444020 - SCREW BONE 4MM 20MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74444025 SUP HCPCS C1713 74444025 - SCREW BN 4MM 25MM LGC CD HZN MA TI SPNE 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74444030 SUP HCPCS C1713 74444030 - SCREW BN 4MM 30MM LGC CD HZN MA TI SPNE 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74444035 SUP HCPCS C1713 74444035 - SCREW BONE 4MM 35MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74444040 SUP HCPCS C1713 74444040 - SCREW BONE 4MM 40MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74444520 SUP HCPCS C1713 74444520 - SCREW BONE 4.5MM 20MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74444525 SUP HCPCS C1713 74444525 - SCREW BONE 4.5MM 25MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74444530 SUP HCPCS C1713 74444530 - SCREW BONE 4.5MM 30MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74444535 SUP HCPCS C1713 74444535 - SCREW BONE 4.5MM 35MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74444540 SUP HCPCS C1713 74444540 - SCREW BONE 4.5MM 45MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74445025 SUP HCPCS C1713 74445025 - SCREW BONE 5MM 25MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74445030 SUP HCPCS C1713 74445030 - SCREW BONE 5MM 30MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74445035 SUP HCPCS C1713 74445035 - SCREW BONE 5MM 35MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74445040 SUP HCPCS C1713 74445040 - SCREW BONE 5MM 40MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74445045 SUP HCPCS C1713 74445045 - SCREW BONE 5MM 45MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74445050 SUP HCPCS C1713 74445050 - SCREW BONE 5MM 50MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74445525 SUP HCPCS C1713 74445525 - SCREW BONE 5.5MM 25MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74445530 SUP HCPCS C1713 74445530 - SCREW BONE 5.5MM 30MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74445535 SUP HCPCS C1713 74445535 - SCREW BONE 5.5MM 35MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74445540 SUP HCPCS C1713 74445540 - SCREW BONE 5.5MM 40MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74445545 SUP HCPCS C1713 74445545 - SCREW BONE 5.5MM 45MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74445550 SUP HCPCS C1713 74445550 - SCREW BONE 5.5MM 50MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74446025 SUP HCPCS C1713 74446025 - SCREW BONE 6MM 25MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74446030 SUP HCPCS C1713 74446030 - SCREW BONE 6MM 30MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74446035 SUP HCPCS C1713 74446035 - SCREW BONE 6MM 35MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74446040 SUP HCPCS C1713 74446040 - SCREW BONE 6MM 40MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74446045 SUP HCPCS C1713 74446045 - SCREW BONE 6MM 45MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74446050 SUP HCPCS C1713 74446050 - SCREW BONE 6MM 50MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74446525 SUP HCPCS C1713 74446525 - SCREW BONE 6.5MM 25MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74446530 SUP HCPCS C1713 74446530 - SCREW BONE 6.5MM 30MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74446535 SUP HCPCS C1713 74446535 - SCREW BONE 6.5MM 35MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74446540 SUP HCPCS C1713 74446540 - SCREW BONE 6.5MM 40MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74446545 SUP HCPCS C1713 74446545 - SCREW BONE 6.5MM 45MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74446550 SUP HCPCS C1713 74446550 - SCREW BONE 6.5MM 50MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74446555 SUP HCPCS C1713 74446555 - SCREW BONE 6.5MM 55MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74447525 SUP HCPCS C1713 74447525 - SCREW BONE 7.5MM 25MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74447530 SUP HCPCS C1713 74447530 - SCREW BONE 7.5MM 30MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74447535 SUP HCPCS C1713 74447535 - SCREW BONE 7.5MM 35MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74447540 SUP HCPCS C1713 74447540 - SCREW BONE 7.5MM 40MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74447545 SUP HCPCS C1713 74447545 - SCREW BONE 7.5MM 45MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74447550 SUP HCPCS C1713 74447550 - SCREW BONE 7.5MM 50MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74447555 SUP HCPCS C1713 74447555 - SCREW BONE 7.5MM 55MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74462002 SUP Custom 27203010 74462002 - BIT DRL SHRT 1.5MM VLP MN-MOD QC BOTH IP/OP $242.00 $179.00 $43.08 $242.00 $242.00 $242.00 $242.00 $242.00 $242.00 $242.00 $43.08 $242.00 $242.00 $179.61 $179.61 $186.53 $126.08 $50.44 $242.00 $96.80 $242.00 $242.00 $242.00 $242.00 $242.00 $181.50 $242.00 $242.00 $242.00 $121.00 $121.00 $191.66 $242.00 $193.60 $157.30 $242.00 N/A $140.36 $242.00 $145.20 $242.00 $242.00 $242.00 N/A N/A 74462004 SUP Custom 27203010 74462004 - BIT DRL LNG 1.5MM VLP MN-MOD QC BOTH IP/OP $282.00 $209.00 $50.17 $281.88 $281.88 $281.88 $281.88 $281.88 $281.88 $281.88 $50.17 $281.88 $281.88 $209.21 $209.21 $217.27 $146.86 $58.75 $281.88 $112.75 $281.88 $281.88 $281.88 $281.88 $281.88 $211.50 $281.88 $281.88 $281.88 $140.94 $140.94 $223.25 $281.88 $225.50 $183.22 $281.88 N/A $163.56 $281.88 $169.13 $281.88 $281.88 $281.88 N/A N/A 74462006 SUP Custom 27203010 74462006 - BIT DRL 2MM VLP MN-MOD QC OVR BOTH IP/OP $242.00 $179.00 $43.08 $242.00 $242.00 $242.00 $242.00 $242.00 $242.00 $242.00 $43.08 $242.00 $242.00 $179.61 $179.61 $186.53 $126.08 $50.44 $242.00 $96.80 $242.00 $242.00 $242.00 $242.00 $242.00 $181.50 $242.00 $242.00 $242.00 $121.00 $121.00 $191.66 $242.00 $193.60 $157.30 $242.00 N/A $140.36 $242.00 $145.20 $242.00 $242.00 $242.00 N/A N/A 74462410 SUP Custom 27203010 74462410 - BIT DRL 2.4MM VLP MN-MOD AO QC OVR BOTH IP/OP $242.00 $179.00 $43.08 $242.00 $242.00 $242.00 $242.00 $242.00 $242.00 $242.00 $43.08 $242.00 $242.00 $179.61 $179.61 $186.53 $126.08 $50.44 $242.00 $96.80 $242.00 $242.00 $242.00 $242.00 $242.00 $181.50 $242.00 $242.00 $242.00 $121.00 $121.00 $191.66 $242.00 $193.60 $157.30 $242.00 N/A $140.36 $242.00 $145.20 $242.00 $242.00 $242.00 N/A N/A 74640132 SUP HCPCS C1713 74640132 - SCREW BN 9MM 32MM TN SURESHOT RT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$2,108.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$5,270.00" "$5,270.00" N/A N/A 74640134 SUP HCPCS C1713 74640134 - SCREW BN 9MM 34MM TN SURESHOT RT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$5,270.00" "$5,270.00" N/A N/A 74640136 SUP HCPCS C1713 74640136 - SCREW BN 9MM 36MM TN SURESHOT RT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$2,108.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74640138 SUP HCPCS C1713 74640138 - SCREW BN 9MM 38MM TN SURESHOT RT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$2,108.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74640234 SUP HCPCS C1713 74640234 - SCREW BN 10MM 34MM TN SURESHOT RT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$2,108.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74640236 SUP HCPCS C1713 74640236 - SCREW BN 10MM 36MM TN SURESHOT RT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$5,270.00" "$5,270.00" N/A N/A 74640238 SUP HCPCS C1713 74640238 - SCREW BN 10MM 38MM TN SURESHOT RT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$2,108.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" N/A N/A 74640240 SUP HCPCS C1713 74640240 - SCREW BN 10MM 40MM TN SURESHOT RT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$2,108.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74640336 SUP HCPCS C1713 74640336 - SCREW BN 11.5MM 36MM TN SURESHOT RT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$2,108.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74640338 SUP HCPCS C1713 74640338 - SCREW BN 11.5MM 38MM TN SURESHOT RT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$5,270.00" "$5,270.00" N/A N/A 74640340 SUP HCPCS C1713 74640340 - SCREW BN 11.5MM 40MM TN SURESHOT RT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$5,270.00" "$5,270.00" N/A N/A 74640342 SUP HCPCS C1713 74640342 - SCREW BN 11.5MM 42MM TN SURESHOT RT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74640440 SUP HCPCS C1713 74640440 - SCREW BN 13MM 40MM TN SURESHOT RT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74640442 SUP HCPCS C1713 74640442 - SCREW BN 13MM 42MM TN SURESHOT RT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74644020 SUP HCPCS C1713 74644020 - SCREW BONE 4MM 20MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74644025 SUP HCPCS C1713 74644025 - SCREW BN 4MM 25MM STRL LGC CD HZN MA SS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74644030 SUP HCPCS C1713 74644030 - SCREW BONE 4MM 30MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74644035 SUP HCPCS C1713 74644035 - SCREW BONE 4MM 35MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74644040 SUP HCPCS C1713 74644040 - SCREW BONE 4MM 40MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74644520 SUP HCPCS C1713 74644520 - SCREW BONE 4.5MM 20MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74644525 SUP HCPCS C1713 74644525 - SCREW BONE 4.5MM 25MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74644530 SUP HCPCS C1713 74644530 - SCREW BONE 4.5MM 30MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74644535 SUP HCPCS C1713 74644535 - SCREW BONE 4.5MM 35MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74644540 SUP HCPCS C1713 74644540 - SCREW BONE 4.5MM 40MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74645025 SUP HCPCS C1713 74645025 - SCREW BONE 5MM 25MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74645030 SUP HCPCS C1713 74645030 - SCREW BONE 5MM 30MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74645035 SUP HCPCS C1713 74645035 - SCREW BONE 5MM 35MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74645040 SUP HCPCS C1713 74645040 - SCREW BONE 5MM 40MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74645045 SUP HCPCS C1713 74645045 - SCREW BONE 5MM 45MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74645050 SUP HCPCS C1713 74645050 - SCREW BONE 5MM 50MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74645525 SUP HCPCS C1713 74645525 - SCREW BONE 5.5MM 25MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74645530 SUP HCPCS C1713 74645530 - SCREW BONE 5.5MM 30MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74645535 SUP HCPCS C1713 74645535 - SCREW BONE 5.5MM 35MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74645540 SUP HCPCS C1713 74645540 - SCREW BONE 5.5MM 40MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74645545 SUP HCPCS C1713 74645545 - SCREW BONE 5.5MM 45MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74645550 SUP HCPCS C1713 74645550 - SCREW BONE 5.5MM 50MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74646025 SUP HCPCS C1713 74646025 - SCREW BONE 6MM 25MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74646030 SUP HCPCS C1713 74646030 - SCREW BONE 6MM 30MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74646035 SUP HCPCS C1713 74646035 - SCREW BONE 6MM 35MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74646040 SUP HCPCS C1713 74646040 - SCREW BONE 6MM 40MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74646045 SUP HCPCS C1713 74646045 - SCREW BONE 6MM 45MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74646050 SUP HCPCS C1713 74646050 - SCREW BONE 6MM 50MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74646525 SUP HCPCS C1713 74646525 - SCREW BONE 6.5MM 25MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74646530 SUP HCPCS C1713 74646530 - SCREW BONE 6.5MM 30MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74646535 SUP HCPCS C1713 74646535 - SCREW BONE 6.5MM 35MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74646540 SUP HCPCS C1713 74646540 - SCREW BONE 6.5MM 40MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74646545 SUP HCPCS C1713 74646545 - SCREW BONE 6.5MM 45MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74646550 SUP HCPCS C1713 74646550 - SCREW BONE 6.5MM 50MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74646555 SUP HCPCS C1713 74646555 - SCREW BONE 6.5MM 55MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74647525 SUP HCPCS C1713 74647525 - SCREW BONE 7.5MM 25MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74647530 SUP HCPCS C1713 74647530 - SCREW BONE 7.5MM 30MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74647535 SUP HCPCS C1713 74647535 - SCREW BONE 7.5MM 35MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74647540 SUP HCPCS C1713 74647540 - SCREW BONE 7.5MM 40MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74647545 SUP HCPCS C1713 74647545 - SCREW BONE 7.5MM 45MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74647550 SUP HCPCS C1713 74647550 - SCREW BONE 7.5MM 50MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74647555 SUP HCPCS C1713 74647555 - SCREW BONE 7.5MM 55MM MULTIAX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 74649132 SUP HCPCS C1713 74649132 - SCREW BN 9MM 32MM SURESHOT TN LT EVAL BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74649134 SUP HCPCS C1713 74649134 - SCREW BN 9MM 34MM TN SURESHOT LT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74649136 SUP HCPCS C1713 74649136 - SCREW BN 9MM 36MM TN SURESHOT LT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74649138 SUP HCPCS C1713 74649138 - SCREW BN 9MM 38MM TN SURESHOT LT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74649234 SUP HCPCS C1713 74649234 - SCREW BN 10MM 34MM TN SURESHOT LT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74649236 SUP HCPCS C1713 74649236 - SCREW BN 10MM 36MM TN SURESHOT LT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$2,108.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$5,270.00" "$5,270.00" N/A N/A 74649238 SUP HCPCS C1713 74649238 - SCREW BN 10MM 38MM TN SURESHOT LT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$2,108.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74649240 SUP HCPCS C1713 74649240 - SCREW BN 10MM 40MM TN SURESHOT LT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$2,108.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$5,270.00" "$5,270.00" N/A N/A 74649336 SUP HCPCS C1713 74649336 - SCREW BN 11.5MM 36MM TN SURESHOT LT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74649338 SUP HCPCS C1713 74649338 - SCREW BN 11.5MM 38MM TN SURESHOT LT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$2,108.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74649340 SUP HCPCS C1713 74649340 - SCREW BN 11.5MM 40MM TN SURESHOT LT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$2,108.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$5,270.00" "$5,270.00" N/A N/A 74649342 SUP HCPCS C1713 74649342 - SCREW BN 11.5MM 42MM TN SURESHOT LT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$2,108.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74649440 SUP HCPCS C1713 74649440 - SCREW BN 13MM 40MM TN SURESHOT LT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74649442 SUP HCPCS C1713 74649442 - SCREW BN 13MM 42MM TN SURESHOT LT TROCH BOTH IP/OP "$5,270.00" "$3,900.00" "$1,045.96" "$5,270.00" "$2,371.50" "$2,371.50" "$2,371.50" "$2,371.50" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.40" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$1,098.33" "$5,270.00" "$5,270.00" "$2,598.11" "$5,270.00" "$5,270.00" "$5,270.00" "$5,270.00" "$3,952.50" "$5,270.00" "$5,270.00" "$5,270.00" "$2,635.00" "$2,635.00" "$4,173.84" "$5,270.00" "$4,216.00" "$2,371.50" "$1,045.96" N/A "$3,056.60" "$5,270.00" "$3,162.00" "$5,270.00" "$1,098.27" "$5,270.00" N/A N/A 74692424 SUP HCPCS C1713 74692424 - SCREW BN 2.4MM 24MM D-RAD SMRT PK LCK ST T7 DRVR TI DIST BOTH IP/OP $183.00 $135.00 $36.26 $182.70 $82.22 $82.22 $82.22 $82.22 $182.70 $182.70 $182.70 $38.08 $182.70 $182.70 $182.70 $182.70 $182.70 $38.08 $182.70 $182.70 $108.07 $182.70 $182.70 $182.70 $182.70 $137.25 $182.70 $182.70 $182.70 $91.35 $91.35 $144.70 $182.70 $146.16 $82.22 $36.26 N/A $106.14 $182.70 $109.62 $182.70 $38.07 $182.70 N/A N/A 74800060 SUP HCPCS C1713 74800060 - SCREW BN CONE 6.5MM 60MM CNN SS PROX FEM BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $222.30 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $555.75 $555.75 $115.82 $555.75 N/A N/A 74800065 SUP HCPCS C1713 74800065 - SCREW BN CONE 6.5MM 65MM CNN SS PROX FEM BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $222.30 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 74800070 SUP HCPCS C1713 74800070 - SCREW BN CONE 6.5MM 70MM CNN SS PROX FEM BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $222.30 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 74800075 SUP HCPCS C1713 74800075 - SCREW BN CONE 6.5MM 75MM CNN SS PROX FEM BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $222.30 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 74800080 SUP HCPCS C1713 74800080 - SCREW BN CONE 6.5MM 80MM CNN SS PROX FEM BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $222.30 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 74800085 SUP HCPCS C1713 74800085 - SCREW BN CONE 6.5MM 85MM CNN SS PROX FEM BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $222.30 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 74800095 SUP HCPCS C1713 74800095 - SCREW BN CONE 6.5MM 95MM CNN SS PROX FEM BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 74800100 SUP HCPCS C1713 74800100 - SCREW BN CONE 6.5MM 100MM CNN SS PROX FEM BOTH IP/OP $559.50 $414.00 $110.97 $559.13 $251.61 $251.61 $251.61 $251.61 $559.13 $559.13 $559.13 $116.54 $559.13 $559.13 $559.13 $559.13 $559.13 $116.53 $559.13 $223.65 $330.73 $559.13 $559.13 $559.13 $559.13 $419.63 $559.13 $559.13 $559.13 $279.57 $279.57 $442.83 $559.13 $447.30 $251.61 $110.97 N/A $324.51 $559.13 $335.48 $559.13 $116.52 $559.13 N/A N/A 74800105 SUP HCPCS C1713 74800105 - SCREW BN CONE 6.5MM 105MM CNN SS PROX FEM BOTH IP/OP $559.50 $414.00 $110.97 $559.13 $251.61 $251.61 $251.61 $251.61 $559.13 $559.13 $559.13 $116.54 $559.13 $559.13 $559.13 $559.13 $559.13 $116.53 $559.13 $223.65 $330.73 $559.13 $559.13 $559.13 $559.13 $419.63 $559.13 $559.13 $559.13 $279.57 $279.57 $442.83 $559.13 $447.30 $251.61 $110.97 N/A $324.51 $559.13 $335.48 $559.13 $116.52 $559.13 N/A N/A 74800110 SUP HCPCS C1713 74800110 - SCREW BN CONE 6.5MM 110MM CNN SS PROX FEM BOTH IP/OP $559.50 $414.00 $110.97 $559.13 $251.61 $251.61 $251.61 $251.61 $559.13 $559.13 $559.13 $116.54 $559.13 $559.13 $559.13 $559.13 $559.13 $116.53 $559.13 $223.65 $330.73 $559.13 $559.13 $559.13 $559.13 $419.63 $559.13 $559.13 $559.13 $279.57 $279.57 $442.83 $559.13 $447.30 $251.61 $110.97 N/A $324.51 $559.13 $335.48 $559.13 $116.52 $559.13 N/A N/A 74800115 SUP HCPCS C1713 74800115 - SCREW BN CONE 6.5MM 115MM CNN SS PROX FEM BOTH IP/OP $559.50 $414.00 $110.97 $559.13 $251.61 $251.61 $251.61 $251.61 $559.13 $559.13 $559.13 $116.54 $559.13 $559.13 $559.13 $559.13 $559.13 $116.53 $559.13 $559.13 $330.73 $559.13 $559.13 $559.13 $559.13 $419.63 $559.13 $559.13 $559.13 $279.57 $279.57 $442.83 $559.13 $447.30 $251.61 $110.97 N/A $324.51 $559.13 $335.48 $559.13 $116.52 $559.13 N/A N/A 74800120 SUP HCPCS C1713 74800120 - SCREW BN CONE 6.5MM 120MM CNN SS PROX FEM BOTH IP/OP $559.50 $414.00 $110.97 $559.13 $251.61 $251.61 $251.61 $251.61 $559.13 $559.13 $559.13 $116.54 $559.13 $559.13 $559.13 $559.13 $559.13 $116.53 $559.13 $223.65 $330.73 $559.13 $559.13 $559.13 $559.13 $419.63 $559.13 $559.13 $559.13 $279.57 $279.57 $442.83 $559.13 $447.30 $251.61 $110.97 N/A $324.51 $559.13 $335.48 $559.13 $116.52 $559.13 N/A N/A 74800125 SUP HCPCS C1713 74800125 - SCREW BN CONE 6.5MM 125MM CNN SS PROX FEM BOTH IP/OP $559.50 $414.00 $110.97 $559.13 $251.61 $251.61 $251.61 $251.61 $559.13 $559.13 $559.13 $116.54 $559.13 $559.13 $559.13 $559.13 $559.13 $116.53 $559.13 $223.65 $330.73 $559.13 $559.13 $559.13 $559.13 $419.63 $559.13 $559.13 $559.13 $279.57 $279.57 $442.83 $559.13 $447.30 $251.61 $110.97 N/A $324.51 $559.13 $335.48 $559.13 $559.13 $559.13 N/A N/A 74800130 SUP HCPCS C1713 74800130 - SCREW BN CONE 6.5MM 130MM CNN SS PROX FEM BOTH IP/OP $559.50 $414.00 $110.97 $559.13 $251.61 $251.61 $251.61 $251.61 $559.13 $559.13 $559.13 $116.54 $559.13 $559.13 $559.13 $559.13 $559.13 $116.53 $559.13 $223.65 $330.73 $559.13 $559.13 $559.13 $559.13 $419.63 $559.13 $559.13 $559.13 $279.57 $279.57 $442.83 $559.13 $447.30 $251.61 $110.97 N/A $324.51 $559.13 $335.48 $559.13 $116.52 $559.13 N/A N/A 74800260 SUP HCPCS C1713 74800260 - SCREW BN 6.5MM 60MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $645.75 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $387.45 $645.75 $134.57 $645.75 N/A N/A 74800265 SUP HCPCS C1713 74800265 - SCREW BN 6.5MM 65MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $258.30 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $387.45 $645.75 $134.57 $645.75 N/A N/A 74800270 SUP HCPCS C1713 74800270 - SCREW BN 6.5MM 70MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $258.30 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $645.75 $645.75 $134.57 $645.75 N/A N/A 74800275 SUP HCPCS C1713 74800275 - SCREW BN 6.5MM 75MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $258.30 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $645.75 $645.75 $134.57 $645.75 N/A N/A 74800280 SUP HCPCS C1713 74800280 - SCREW BN 6.5MM 80MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $258.30 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $645.75 $645.75 $134.57 $645.75 N/A N/A 74800285 SUP HCPCS C1713 74800285 - SCREW BN 6.5MM 85MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $258.30 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $645.75 $645.75 $645.75 $645.75 N/A N/A 74800290 SUP HCPCS C1713 74800290 - SCREW BN 6.5MM 90MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $258.30 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $645.75 $645.75 $645.75 $645.75 N/A N/A 74800295 SUP HCPCS C1713 74800295 - SCREW BN 6.5MM 95MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $258.30 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $645.75 $645.75 $645.75 $645.75 N/A N/A 74800300 SUP HCPCS C1713 74800300 - SCREW BN 6.5MM 100MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $645.75 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $387.45 $645.75 $134.57 $645.75 N/A N/A 74800305 SUP HCPCS C1713 74800305 - SCREW BN 6.5MM 105MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $645.75 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $387.45 $645.75 $645.75 $645.75 N/A N/A 74800310 SUP HCPCS C1713 74800310 - SCREW BN 6.5MM 110MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $645.75 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $387.45 $645.75 $645.75 $645.75 N/A N/A 74800315 SUP HCPCS C1713 74800315 - SCREW BN 6.5MM 115MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $645.75 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $645.75 $645.75 $134.57 $645.75 N/A N/A 74800320 SUP HCPCS C1713 74800320 - SCREW BN 6.5MM 120MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $258.30 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $645.75 $645.75 $134.57 $645.75 N/A N/A 74800325 SUP HCPCS C1713 74800325 - SCREW BN 6.5MM 125MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $258.30 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $387.45 $645.75 $134.57 $645.75 N/A N/A 74800330 SUP HCPCS C1713 74800330 - SCREW BN 6.5MM 130MM CNN LCK SS PROX FEM BOTH IP/OP $646.00 $478.00 $128.17 $645.75 $290.59 $290.59 $290.59 $290.59 $645.75 $645.75 $645.75 $134.59 $645.75 $645.75 $645.75 $645.75 $645.75 $134.58 $645.75 $258.30 $381.96 $645.75 $645.75 $645.75 $645.75 $484.50 $645.75 $645.75 $645.75 $322.88 $322.88 $511.43 $645.75 $516.60 $290.59 $128.17 N/A $374.68 $645.75 $387.45 $645.75 $134.57 $645.75 N/A N/A 74800402 SUP HCPCS C1713 74800402 - PLATE BN 44MM 2 HL LCK SS LT PROX FEM 4.5MM SCR BOTH IP/OP "$3,381.00" "$2,502.00" $670.97 "$3,380.63" "$1,521.28" "$1,521.28" "$1,521.28" "$1,521.28" "$3,380.63" "$3,380.63" "$3,380.63" $704.61 "$3,380.63" "$3,380.63" "$3,380.63" "$3,380.63" "$3,380.63" $704.56 "$3,380.63" "$3,380.63" "$1,666.65" "$3,380.63" "$3,380.63" "$3,380.63" "$3,380.63" "$2,535.75" "$3,380.63" "$3,380.63" "$3,380.63" "$1,690.32" "$1,690.32" "$2,677.46" "$3,380.63" "$2,704.50" "$1,521.28" $670.97 N/A "$1,960.98" "$3,380.63" "$2,028.38" "$3,380.63" $704.52 "$3,380.63" N/A N/A 74800404 SUP HCPCS C1713 74800404 - PLATE BN 144MM 4 HL LCK SS LT PROX FEM 4.5MM SCR BOTH IP/OP "$3,431.50" "$2,539.00" $681.02 "$3,431.25" "$1,544.06" "$1,544.06" "$1,544.06" "$1,544.06" "$3,431.25" "$3,431.25" "$3,431.25" $715.16 "$3,431.25" "$3,431.25" "$3,431.25" "$3,431.25" "$3,431.25" $715.11 "$3,431.25" "$1,372.50" "$1,691.61" "$3,431.25" "$3,431.25" "$3,431.25" "$3,431.25" "$2,573.63" "$3,431.25" "$3,431.25" "$3,431.25" "$1,715.63" "$1,715.63" "$2,717.55" "$3,431.25" "$2,745.00" "$1,544.06" $681.02 N/A "$1,990.27" "$3,431.25" "$2,058.75" "$3,431.25" $715.07 "$3,431.25" N/A N/A 74800406 SUP HCPCS C1713 74800406 - PLATE BN 180MM 6 HL LCK SS LT PROX FEM 4.5MM SCR BOTH IP/OP "$3,499.00" "$2,589.00" $694.41 "$3,498.75" "$1,574.44" "$1,574.44" "$1,574.44" "$1,574.44" "$3,498.75" "$3,498.75" "$3,498.75" $729.23 "$3,498.75" "$3,498.75" "$3,498.75" "$3,498.75" "$3,498.75" $729.18 "$3,498.75" "$1,399.50" "$1,724.88" "$3,498.75" "$3,498.75" "$3,498.75" "$3,498.75" "$2,624.25" "$3,498.75" "$3,498.75" "$3,498.75" "$1,749.38" "$1,749.38" "$2,771.01" "$3,498.75" "$2,799.00" "$1,574.44" $694.41 N/A "$2,029.42" "$3,498.75" "$2,099.25" "$3,498.75" $729.14 "$3,498.75" N/A N/A 74800409 SUP HCPCS C1713 74800409 - PLATE BN 234MM 9 HL LCK SS LT PROX FEM 4.5MM SCR BOTH IP/OP "$3,634.00" "$2,689.00" $721.21 "$3,633.75" "$1,635.19" "$1,635.19" "$1,635.19" "$1,635.19" "$3,633.75" "$3,633.75" "$3,633.75" $757.36 "$3,633.75" "$3,633.75" "$3,633.75" "$3,633.75" "$3,633.75" $757.31 "$3,633.75" "$1,453.50" "$1,791.44" "$3,633.75" "$3,633.75" "$3,633.75" "$3,633.75" "$2,725.50" "$3,633.75" "$3,633.75" "$3,633.75" "$1,816.88" "$1,816.88" "$2,877.93" "$3,633.75" "$2,907.00" "$1,635.19" $721.21 N/A "$2,107.72" "$3,633.75" "$2,180.25" "$3,633.75" $757.27 "$3,633.75" N/A N/A 74800412 SUP HCPCS C1713 74800412 - PLATE BN 288MM 12 HL LCK SS LT PROX FEM 4.5MM SCR BOTH IP/OP "$4,247.00" "$3,143.00" $842.90 "$4,246.88" "$1,911.10" "$1,911.10" "$1,911.10" "$1,911.10" "$4,246.88" "$4,246.88" "$4,246.88" $885.16 "$4,246.88" "$4,246.88" "$4,246.88" "$4,246.88" "$4,246.88" $885.10 "$4,246.88" "$1,698.75" "$2,093.71" "$4,246.88" "$4,246.88" "$4,246.88" "$4,246.88" "$3,185.25" "$4,246.88" "$4,246.88" "$4,246.88" "$2,123.44" "$2,123.44" "$3,363.53" "$4,246.88" "$3,397.50" "$1,911.10" $842.90 N/A "$2,463.26" "$4,246.88" "$2,548.13" "$4,246.88" $885.05 "$4,246.88" N/A N/A 74800415 SUP HCPCS C1713 74800415 - PLATE BN 15MM LCK SS LT PROX FEM BOTH IP/OP "$4,584.50" "$3,393.00" $909.88 "$4,584.38" "$2,062.97" "$2,062.97" "$2,062.97" "$2,062.97" "$4,584.38" "$4,584.38" "$4,584.38" $955.50 "$4,584.38" "$4,584.38" "$4,584.38" "$4,584.38" "$4,584.38" $955.44 "$4,584.38" "$4,584.38" "$2,260.10" "$4,584.38" "$4,584.38" "$4,584.38" "$4,584.38" "$3,438.38" "$4,584.38" "$4,584.38" "$4,584.38" "$2,292.19" "$2,292.19" "$3,630.83" "$4,584.38" "$3,667.50" "$2,062.97" $909.88 N/A "$2,659.01" "$4,584.38" "$4,584.38" "$4,584.38" $955.38 "$4,584.38" N/A N/A 74800418 SUP HCPCS C1713 74800418 - PLATE BN 396MM 18 HL LCK SS LT PROX FEM 4.5MM SCR BOTH IP/OP "$4,922.00" "$3,642.00" $976.87 "$4,921.88" "$2,214.85" "$2,214.85" "$2,214.85" "$2,214.85" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.84" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$1,025.77" "$4,921.88" "$4,921.88" "$2,426.49" "$4,921.88" "$4,921.88" "$4,921.88" "$4,921.88" "$3,691.50" "$4,921.88" "$4,921.88" "$4,921.88" "$2,460.94" "$2,460.94" "$3,898.13" "$4,921.88" "$3,937.50" "$2,214.85" $976.87 N/A "$2,854.76" "$4,921.88" "$2,953.13" "$4,921.88" "$1,025.72" "$4,921.88" N/A N/A 74800502 SUP HCPCS C1713 74800502 - PLATE BN 99MM 2 HL LCK SS RT PROX FEM 4.5MM SCR BOTH IP/OP "$3,381.00" "$2,502.00" $670.97 "$3,380.63" "$1,521.28" "$1,521.28" "$1,521.28" "$1,521.28" "$3,380.63" "$3,380.63" "$3,380.63" $704.61 "$3,380.63" "$3,380.63" "$3,380.63" "$3,380.63" "$3,380.63" $704.56 "$3,380.63" "$3,380.63" "$1,666.65" "$3,380.63" "$3,380.63" "$3,380.63" "$3,380.63" "$2,535.75" "$3,380.63" "$3,380.63" "$3,380.63" "$1,690.32" "$1,690.32" "$2,677.46" "$3,380.63" "$2,704.50" "$1,521.28" $670.97 N/A "$1,960.98" "$3,380.63" "$2,028.38" "$3,380.63" $704.52 "$3,380.63" N/A N/A 74800504 SUP HCPCS C1713 74800504 - PLATE BN 144MM 4 HL LCK SS RT PROX FEM 4.5MM SCR BOTH IP/OP "$3,431.50" "$2,539.00" $681.02 "$3,431.25" "$1,544.06" "$1,544.06" "$1,544.06" "$1,544.06" "$3,431.25" "$3,431.25" "$3,431.25" $715.16 "$3,431.25" "$3,431.25" "$3,431.25" "$3,431.25" "$3,431.25" $715.11 "$3,431.25" "$1,372.50" "$1,691.61" "$3,431.25" "$3,431.25" "$3,431.25" "$3,431.25" "$2,573.63" "$3,431.25" "$3,431.25" "$3,431.25" "$1,715.63" "$1,715.63" "$2,717.55" "$3,431.25" "$2,745.00" "$1,544.06" $681.02 N/A "$1,990.27" "$3,431.25" "$2,058.75" "$3,431.25" $715.07 "$3,431.25" N/A N/A 74800506 SUP HCPCS C1713 74800506 - PLATE BN 180MM 6 HL LCK SS RT PROX FEM 4.5MM SCR BOTH IP/OP "$3,499.00" "$2,589.00" $694.41 "$3,498.75" "$1,574.44" "$1,574.44" "$1,574.44" "$1,574.44" "$3,498.75" "$3,498.75" "$3,498.75" $729.23 "$3,498.75" "$3,498.75" "$3,498.75" "$3,498.75" "$3,498.75" $729.18 "$3,498.75" "$1,399.50" "$1,724.88" "$3,498.75" "$3,498.75" "$3,498.75" "$3,498.75" "$2,624.25" "$3,498.75" "$3,498.75" "$3,498.75" "$1,749.38" "$1,749.38" "$2,771.01" "$3,498.75" "$2,799.00" "$1,574.44" $694.41 N/A "$2,029.42" "$3,498.75" "$2,099.25" "$3,498.75" $729.14 "$3,498.75" N/A N/A 74800509 SUP HCPCS C1713 74800509 - PLATE BN 234MM 9 HL LCK SS RT PROX FEM 4.5MM SCR BOTH IP/OP "$3,634.00" "$2,689.00" $721.21 "$3,633.75" "$1,635.19" "$1,635.19" "$1,635.19" "$1,635.19" "$3,633.75" "$3,633.75" "$3,633.75" $757.36 "$3,633.75" "$3,633.75" "$3,633.75" "$3,633.75" "$3,633.75" $757.31 "$3,633.75" "$1,453.50" "$1,791.44" "$3,633.75" "$3,633.75" "$3,633.75" "$3,633.75" "$2,725.50" "$3,633.75" "$3,633.75" "$3,633.75" "$1,816.88" "$1,816.88" "$2,877.93" "$3,633.75" "$2,907.00" "$1,635.19" $721.21 N/A "$2,107.72" "$3,633.75" "$2,180.25" "$3,633.75" $757.27 "$3,633.75" N/A N/A 74800512 SUP HCPCS C1713 74800512 - PLATE BN 288MM 12 HL LCK SS RT PROX FEM 4.5MM SCR BOTH IP/OP "$4,247.00" "$3,143.00" $842.90 "$4,246.88" "$1,911.10" "$1,911.10" "$1,911.10" "$1,911.10" "$4,246.88" "$4,246.88" "$4,246.88" $885.16 "$4,246.88" "$4,246.88" "$4,246.88" "$4,246.88" "$4,246.88" $885.10 "$4,246.88" "$1,698.75" "$2,093.71" "$4,246.88" "$4,246.88" "$4,246.88" "$4,246.88" "$3,185.25" "$4,246.88" "$4,246.88" "$4,246.88" "$2,123.44" "$2,123.44" "$3,363.53" "$4,246.88" "$3,397.50" "$1,911.10" $842.90 N/A "$2,463.26" "$4,246.88" "$2,548.13" "$4,246.88" $885.05 "$4,246.88" N/A N/A 74800515 SUP HCPCS C1713 74800515 - PLATE BN 342MM 15 HL LCK SS RT PROX FEM 4.5MM SCR BOTH IP/OP "$4,551.00" "$3,368.00" $903.19 "$4,550.63" "$2,047.78" "$2,047.78" "$2,047.78" "$2,047.78" "$4,550.63" "$4,550.63" "$4,550.63" $948.47 "$4,550.63" "$4,550.63" "$4,550.63" "$4,550.63" "$4,550.63" $948.40 "$4,550.63" "$1,820.25" "$2,243.46" "$4,550.63" "$4,550.63" "$4,550.63" "$4,550.63" "$3,413.25" "$4,550.63" "$4,550.63" "$4,550.63" "$2,275.32" "$2,275.32" "$3,604.10" "$4,550.63" "$3,640.50" "$2,047.78" $903.19 N/A "$2,639.58" "$4,550.63" "$2,730.38" "$4,550.63" $948.35 "$4,550.63" N/A N/A 74800518 SUP HCPCS C1713 74800518 - PLATE BN 396MM PRLC 18 HL LCK SS FEM RT PROX 4.5MM SCR BOTH IP/OP "$4,882.50" "$3,613.00" $969.05 "$4,882.50" "$2,197.13" "$2,197.13" "$2,197.13" "$2,197.13" "$4,882.50" "$4,882.50" "$4,882.50" "$1,017.64" "$4,882.50" "$4,882.50" "$4,882.50" "$4,882.50" "$4,882.50" "$1,017.57" "$4,882.50" "$1,953.00" "$2,407.07" "$4,882.50" "$4,882.50" "$4,882.50" "$4,882.50" "$3,661.88" "$4,882.50" "$4,882.50" "$4,882.50" "$2,441.25" "$2,441.25" "$3,866.94" "$4,882.50" "$3,906.00" "$2,197.13" $969.05 N/A "$2,831.85" "$4,882.50" "$2,929.50" "$4,882.50" "$1,017.51" "$4,882.50" N/A N/A 74800601 SUP HCPCS C1713 74800601 - PLATE BN SHRT PRLC CBL SDL SS BOTH IP/OP $408.50 $302.00 $81.05 $408.38 $183.77 $183.77 $183.77 $183.77 $408.38 $408.38 $408.38 $85.12 $408.38 $408.38 $408.38 $408.38 $408.38 $85.11 $408.38 $408.38 $241.56 $408.38 $408.38 $408.38 $408.38 $306.38 $408.38 $408.38 $408.38 $204.19 $204.19 $323.44 $408.38 $326.70 $183.77 $81.05 N/A $236.93 $408.38 $245.03 $408.38 $85.11 $408.38 N/A N/A 74800602 SUP HCPCS C1713 74800602 - PLATE BN TLL PRLC CBL SDL SS BOTH IP/OP $408.50 $302.00 $81.05 $408.38 $183.77 $183.77 $183.77 $183.77 $408.38 $408.38 $408.38 $85.12 $408.38 $408.38 $408.38 $408.38 $408.38 $85.11 $408.38 $163.35 $241.56 $408.38 $408.38 $408.38 $408.38 $306.38 $408.38 $408.38 $408.38 $204.19 $204.19 $323.44 $408.38 $326.70 $183.77 $81.05 N/A $236.93 $408.38 $408.38 $408.38 $408.38 $408.38 N/A N/A 74800603 SUP HCPCS C1713 74800603 - SCREW BN 4.5MM PRLC HL FIL SS FEM PROX BOTH IP/OP $319.50 $236.00 $63.41 $319.50 $143.78 $143.78 $143.78 $143.78 $319.50 $319.50 $319.50 $66.59 $319.50 $319.50 $319.50 $319.50 $319.50 $66.59 $319.50 $319.50 $188.98 $319.50 $319.50 $319.50 $319.50 $239.63 $319.50 $319.50 $319.50 $159.75 $159.75 $253.04 $319.50 $255.60 $143.78 $63.41 N/A $185.31 $319.50 $191.70 $319.50 $66.58 $319.50 N/A N/A 74800607 SUP HCPCS C1713 74800607 - PLATE BN PRLC LCK INS HEX SS HUM 4.5 MM SCR BOTH IP/OP $232.00 $172.00 $46.00 $231.75 $104.29 $104.29 $104.29 $104.29 $231.75 $231.75 $231.75 $48.30 $231.75 $231.75 $231.75 $231.75 $231.75 $48.30 $231.75 $92.70 $137.08 $231.75 $231.75 $231.75 $231.75 $174.00 $231.75 $231.75 $231.75 $115.88 $115.88 $183.55 $231.75 $185.40 $104.29 $46.00 N/A $134.56 $231.75 $231.75 $231.75 $48.30 $231.75 N/A N/A 74820060 SUP HCPCS C1713 74820060 - SCREW BN CONE 6.5MM 60MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 74820065 SUP HCPCS C1713 74820065 - SCREW BN CONE 6.5MM 65MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 74820070 SUP HCPCS C1713 74820070 - SCREW BN CONE 6.5MM 70MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $555.75 $555.75 $115.82 $555.75 N/A N/A 74820075 SUP HCPCS C1713 74820075 - SCREW BN CONE 6.5MM 75MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $555.75 $555.75 $115.82 $555.75 N/A N/A 74820080 SUP HCPCS C1713 74820080 - SCREW BN CONE 6.5MM 80MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $555.75 $555.75 $115.82 $555.75 N/A N/A 74820085 SUP HCPCS C1713 74820085 - SCREW BN CONE 6.5MM 85MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $555.75 $555.75 $115.82 $555.75 N/A N/A 74820090 SUP HCPCS C1713 74820090 - SCREW BN CONE 6.5MM 90MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $555.75 $555.75 $115.82 $555.75 N/A N/A 74820095 SUP HCPCS C1713 74820095 - SCREW BN CONE 6.5MM 95MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $555.75 $555.75 $115.82 $555.75 N/A N/A 74820100 SUP HCPCS C1713 74820100 - SCREW BN CONE 6.5MM 100MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $555.75 $555.75 $115.82 $555.75 N/A N/A 74820105 SUP HCPCS C1713 74820105 - SCREW BN CONE 6.5MM 105MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $555.75 $555.75 $115.82 $555.75 N/A N/A 74820110 SUP HCPCS C1713 74820110 - SCREW BN CONE 6.5MM 110MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $555.75 $555.75 $115.82 $555.75 N/A N/A 74820115 SUP HCPCS C1713 74820115 - SCREW BN CONE 6.5MM 115MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $222.30 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $555.75 $555.75 $115.82 $555.75 N/A N/A 74820120 SUP HCPCS C1713 74820120 - SCREW BN CONE 6.5MM 120MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $222.30 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $555.75 $555.75 $115.82 $555.75 N/A N/A 74820125 SUP HCPCS C1713 74820125 - SCREW BN CONE 6.5MM 125MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $222.30 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 74820130 SUP HCPCS C1713 74820130 - SCREW BN CONE 6.5MM 130MM PRLC CNN SS FEM PROX BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $222.30 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 74820260 SUP HCPCS C1713 74820260 - SCREW BN FT 6.5MM 60MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $637.88 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $382.73 $637.88 $132.93 $637.88 N/A N/A 74820265 SUP HCPCS C1713 74820265 - SCREW BN FT 6.5MM 65MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $637.88 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $637.88 $637.88 $132.93 $637.88 N/A N/A 74820270 SUP HCPCS C1713 74820270 - SCREW BN FT 6.5MM 70MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $637.88 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $637.88 $637.88 $132.93 $637.88 N/A N/A 74820275 SUP HCPCS C1713 74820275 - SCREW BN FT 6.5MM 75MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $637.88 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $637.88 $637.88 $132.93 $637.88 N/A N/A 74820280 SUP HCPCS C1713 74820280 - SCREW BN FT 6.5MM 80MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $637.88 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $382.73 $637.88 $132.93 $637.88 N/A N/A 74820285 SUP HCPCS C1713 74820285 - SCREW BN FT 6.5MM 85MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $255.15 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $382.73 $637.88 $132.93 $637.88 N/A N/A 74820290 SUP HCPCS C1713 74820290 - SCREW BN FT 6.5MM 90MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $255.15 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $637.88 $637.88 $132.93 $637.88 N/A N/A 74820295 SUP HCPCS C1713 74820295 - SCREW BN FT 6.5MM 95MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $255.15 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $382.73 $637.88 $132.93 $637.88 N/A N/A 74820300 SUP HCPCS C1713 74820300 - SCREW BN FT 6.5MM 100MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $255.15 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $382.73 $637.88 $132.93 $637.88 N/A N/A 74820305 SUP HCPCS C1713 74820305 - SCREW BN FT 6.5MM 105MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $637.88 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $382.73 $637.88 $132.93 $637.88 N/A N/A 74820310 SUP HCPCS C1713 74820310 - SCREW BN FT 6.5MM 110MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $255.15 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $382.73 $637.88 $132.93 $637.88 N/A N/A 74820315 SUP HCPCS C1713 74820315 - SCREW BN FT 6.5MM 115MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $637.88 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $382.73 $637.88 $132.93 $637.88 N/A N/A 74820320 SUP HCPCS C1713 74820320 - SCREW BN FT 6.5MM 120MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $255.15 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $382.73 $637.88 $132.93 $637.88 N/A N/A 74820325 SUP HCPCS C1713 74820325 - SCREW BN FT 6.5MM 125MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $637.88 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $637.88 $637.88 $132.93 $637.88 N/A N/A 74820330 SUP HCPCS C1713 74820330 - SCREW BN FT 6.5MM 130MM PRLC LCK CNN SS FEM PROX BOTH IP/OP $638.00 $472.00 $126.60 $637.88 $287.05 $287.05 $287.05 $287.05 $637.88 $637.88 $637.88 $132.95 $637.88 $637.88 $637.88 $637.88 $637.88 $132.94 $637.88 $255.15 $377.31 $637.88 $637.88 $637.88 $637.88 $478.50 $637.88 $637.88 $637.88 $318.94 $318.94 $505.20 $637.88 $510.30 $287.05 $126.60 N/A $370.04 $637.88 $382.73 $637.88 $637.88 $637.88 N/A N/A 74820402 SUP HCPCS C1713 74820402 - PLATE BN 99MMX2MM LCK FEM PROX 4.5MM SCR BOTH IP/OP "$3,493.50" "$2,585.00" $693.30 "$3,493.13" "$1,571.91" "$1,571.91" "$1,571.91" "$1,571.91" "$3,493.13" "$3,493.13" "$3,493.13" $728.06 "$3,493.13" "$3,493.13" "$3,493.13" "$3,493.13" "$3,493.13" $728.01 "$3,493.13" "$1,397.25" "$1,722.11" "$3,493.13" "$3,493.13" "$3,493.13" "$3,493.13" "$2,620.13" "$3,493.13" "$3,493.13" "$3,493.13" "$1,746.57" "$1,746.57" "$2,766.56" "$3,493.13" "$2,794.50" "$1,571.91" $693.30 N/A "$2,026.23" "$3,493.13" "$2,095.88" "$3,493.13" "$3,493.13" "$3,493.13" N/A N/A 74820404 SUP HCPCS C1713 74820404 - PLATE BN 144MM 4 HL LCK LT PROX FEM 4.5MM SCR BOTH IP/OP "$3,549.50" "$2,627.00" $704.46 "$3,549.38" "$1,597.22" "$1,597.22" "$1,597.22" "$1,597.22" "$3,549.38" "$3,549.38" "$3,549.38" $739.78 "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" $739.73 "$3,549.38" "$1,419.75" "$1,749.84" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$2,662.13" "$3,549.38" "$3,549.38" "$3,549.38" "$1,774.69" "$1,774.69" "$2,811.11" "$3,549.38" "$2,839.50" "$1,597.22" $704.46 N/A "$2,058.71" "$3,549.38" "$2,129.63" "$3,549.38" "$3,549.38" "$3,549.38" N/A N/A 74820406 SUP HCPCS C1713 74820406 - PLATE BN 180MMX6MM LCK FEM PROX 4.5MM SCR BOTH IP/OP "$3,611.50" "$2,673.00" $716.74 "$3,611.25" "$1,625.06" "$1,625.06" "$1,625.06" "$1,625.06" "$3,611.25" "$3,611.25" "$3,611.25" $752.67 "$3,611.25" "$3,611.25" "$3,611.25" "$3,611.25" "$3,611.25" $752.62 "$3,611.25" "$1,444.50" "$1,780.35" "$3,611.25" "$3,611.25" "$3,611.25" "$3,611.25" "$2,708.63" "$3,611.25" "$3,611.25" "$3,611.25" "$1,805.63" "$1,805.63" "$2,860.11" "$3,611.25" "$2,889.00" "$1,625.06" $716.74 N/A "$2,094.67" "$3,611.25" "$2,166.75" "$3,611.25" $752.58 "$3,611.25" N/A N/A 74820409 SUP HCPCS C1713 74820409 - PLATE BN 234MM 9 HL LCK FEM PROX 4.5MM SCR BOTH IP/OP "$3,746.50" "$2,772.00" $743.54 "$3,746.25" "$1,685.81" "$1,685.81" "$1,685.81" "$1,685.81" "$3,746.25" "$3,746.25" "$3,746.25" $780.81 "$3,746.25" "$3,746.25" "$3,746.25" "$3,746.25" "$3,746.25" $780.76 "$3,746.25" "$1,498.50" "$1,846.90" "$3,746.25" "$3,746.25" "$3,746.25" "$3,746.25" "$2,809.88" "$3,746.25" "$3,746.25" "$3,746.25" "$1,873.13" "$1,873.13" "$2,967.03" "$3,746.25" "$2,997.00" "$1,685.81" $743.54 N/A "$2,172.97" "$3,746.25" "$2,247.75" "$3,746.25" "$3,746.25" "$3,746.25" N/A N/A 74820412 SUP HCPCS C1713 74820412 - PLATE BN 288MM 12 HL LCK LT PROX FEM 4.5MM SCR BOTH IP/OP "$4,219.00" "$3,122.00" $837.32 "$4,218.75" "$1,898.44" "$1,898.44" "$1,898.44" "$1,898.44" "$4,218.75" "$4,218.75" "$4,218.75" $879.29 "$4,218.75" "$4,218.75" "$4,218.75" "$4,218.75" "$4,218.75" $879.23 "$4,218.75" "$1,687.50" "$2,079.84" "$4,218.75" "$4,218.75" "$4,218.75" "$4,218.75" "$3,164.25" "$4,218.75" "$4,218.75" "$4,218.75" "$2,109.38" "$2,109.38" "$3,341.25" "$4,218.75" "$3,375.00" "$1,898.44" $837.32 N/A "$2,447.02" "$4,218.75" "$2,531.25" "$4,218.75" "$4,218.75" "$4,218.75" N/A N/A 74820502 SUP HCPCS C1713 74820502 - PLATE BN 4.5MM 99MM 2 HL LCK FEM RT BOTH IP/OP "$3,493.50" "$2,585.00" $693.30 "$3,493.13" "$1,571.91" "$1,571.91" "$1,571.91" "$1,571.91" "$3,493.13" "$3,493.13" "$3,493.13" $728.06 "$3,493.13" "$3,493.13" "$3,493.13" "$3,493.13" "$3,493.13" $728.01 "$3,493.13" "$1,397.25" "$1,722.11" "$3,493.13" "$3,493.13" "$3,493.13" "$3,493.13" "$2,620.13" "$3,493.13" "$3,493.13" "$3,493.13" "$1,746.57" "$1,746.57" "$2,766.56" "$3,493.13" "$2,794.50" "$1,571.91" $693.30 N/A "$2,026.23" "$3,493.13" "$2,095.88" "$3,493.13" $727.97 "$3,493.13" N/A N/A 74820504 SUP HCPCS C1713 74820504 - PLATE BN 144MM 4 HL LCK FEM RT PROX 4.5MM SCR BOTH IP/OP "$3,549.50" "$2,627.00" $704.46 "$3,549.38" "$1,597.22" "$1,597.22" "$1,597.22" "$1,597.22" "$3,549.38" "$3,549.38" "$3,549.38" $739.78 "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" $739.73 "$3,549.38" "$1,419.75" "$1,749.84" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$2,662.13" "$3,549.38" "$3,549.38" "$3,549.38" "$1,774.69" "$1,774.69" "$2,811.11" "$3,549.38" "$2,839.50" "$1,597.22" $704.46 N/A "$2,058.71" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" "$3,549.38" N/A N/A 74820506 SUP HCPCS C1713 74820506 - PLATE BN 180MM 6 HL LCK PROX FEM RT 4.5MM SCR BOTH IP/OP "$3,611.50" "$2,673.00" $716.74 "$3,611.25" "$1,625.06" "$1,625.06" "$1,625.06" "$1,625.06" "$3,611.25" "$3,611.25" "$3,611.25" $752.67 "$3,611.25" "$3,611.25" "$3,611.25" "$3,611.25" "$3,611.25" $752.62 "$3,611.25" "$3,611.25" "$1,780.35" "$3,611.25" "$3,611.25" "$3,611.25" "$3,611.25" "$2,708.63" "$3,611.25" "$3,611.25" "$3,611.25" "$1,805.63" "$1,805.63" "$2,860.11" "$3,611.25" "$2,889.00" "$1,625.06" $716.74 N/A "$2,094.67" "$3,611.25" "$2,166.75" "$3,611.25" "$3,611.25" "$3,611.25" N/A N/A 74820509 SUP HCPCS C1713 74820509 - PLATE BN 234MM 9 HL LCK RT PROX FEM 4.5MM SCR BOTH IP/OP "$3,746.50" "$2,772.00" $743.54 "$3,746.25" "$1,685.81" "$1,685.81" "$1,685.81" "$1,685.81" "$3,746.25" "$3,746.25" "$3,746.25" $780.81 "$3,746.25" "$3,746.25" "$3,746.25" "$3,746.25" "$3,746.25" $780.76 "$3,746.25" "$3,746.25" "$1,846.90" "$3,746.25" "$3,746.25" "$3,746.25" "$3,746.25" "$2,809.88" "$3,746.25" "$3,746.25" "$3,746.25" "$1,873.13" "$1,873.13" "$2,967.03" "$3,746.25" "$2,997.00" "$1,685.81" $743.54 N/A "$2,172.97" "$3,746.25" "$2,247.75" "$3,746.25" "$3,746.25" "$3,746.25" N/A N/A 74820512 SUP HCPCS C1713 74820512 - PLATE BN 288MM 12 HL LCK FEM RT PROX 4.5MM SCR BOTH IP/OP "$4,219.00" "$3,122.00" $837.32 "$4,218.75" "$1,898.44" "$1,898.44" "$1,898.44" "$1,898.44" "$4,218.75" "$4,218.75" "$4,218.75" $879.29 "$4,218.75" "$4,218.75" "$4,218.75" "$4,218.75" "$4,218.75" $879.23 "$4,218.75" "$1,687.50" "$2,079.84" "$4,218.75" "$4,218.75" "$4,218.75" "$4,218.75" "$3,164.25" "$4,218.75" "$4,218.75" "$4,218.75" "$2,109.38" "$2,109.38" "$3,341.25" "$4,218.75" "$3,375.00" "$1,898.44" $837.32 N/A "$2,447.02" "$4,218.75" "$4,218.75" "$4,218.75" $879.19 "$4,218.75" N/A N/A 75001233 SUP HCPCS C1713 75001233 - PIN FX 34MM LCK DIST BOTH IP/OP $602.50 $446.00 $119.58 $602.50 $271.13 $271.13 $271.13 $271.13 $602.50 $602.50 $602.50 $125.58 $602.50 $602.50 $602.50 $602.50 $602.50 $125.57 $602.50 $602.50 $356.38 $602.50 $602.50 $602.50 $602.50 $451.88 $602.50 $602.50 $602.50 $301.25 $301.25 $477.18 $602.50 $482.00 $271.13 $119.58 N/A $349.45 $602.50 $361.50 $602.50 $602.50 $602.50 N/A N/A 75001234 SUP HCPCS C1713 75001234 - PIN FX 36MM LCK DIST BOTH IP/OP $602.50 $446.00 $119.58 $602.50 $271.13 $271.13 $271.13 $271.13 $602.50 $602.50 $602.50 $125.58 $602.50 $602.50 $602.50 $602.50 $602.50 $125.57 $602.50 $241.00 $356.38 $602.50 $602.50 $602.50 $602.50 $451.88 $602.50 $602.50 $602.50 $301.25 $301.25 $477.18 $602.50 $482.00 $271.13 $119.58 N/A $349.45 $602.50 $361.50 $602.50 $602.50 $602.50 N/A N/A 75001235 SUP HCPCS C1713 75001235 - PIN FX 38MM LCK DIST BOTH IP/OP $602.50 $446.00 $119.58 $602.50 $271.13 $271.13 $271.13 $271.13 $602.50 $602.50 $602.50 $125.58 $602.50 $602.50 $602.50 $602.50 $602.50 $125.57 $602.50 $241.00 $356.38 $602.50 $602.50 $602.50 $602.50 $451.88 $602.50 $602.50 $602.50 $301.25 $301.25 $477.18 $602.50 $482.00 $271.13 $119.58 N/A $349.45 $602.50 $602.50 $602.50 $602.50 $602.50 N/A N/A 75001236 SUP HCPCS C1713 75001236 - PIN FX 40MM LCK DIST BOTH IP/OP $602.50 $446.00 $119.58 $602.50 $271.13 $271.13 $271.13 $271.13 $602.50 $602.50 $602.50 $125.58 $602.50 $602.50 $602.50 $602.50 $602.50 $125.57 $602.50 $241.00 $356.38 $602.50 $602.50 $602.50 $602.50 $451.88 $602.50 $602.50 $602.50 $301.25 $301.25 $477.18 $602.50 $482.00 $271.13 $119.58 N/A $349.45 $602.50 $361.50 $602.50 $125.56 $602.50 N/A N/A 75001237 SUP HCPCS C1713 75001237 - PIN FX 42MM LCK DIST BOTH IP/OP $602.50 $446.00 $119.58 $602.50 $271.13 $271.13 $271.13 $271.13 $602.50 $602.50 $602.50 $125.58 $602.50 $602.50 $602.50 $602.50 $602.50 $125.57 $602.50 $241.00 $356.38 $602.50 $602.50 $602.50 $602.50 $451.88 $602.50 $602.50 $602.50 $301.25 $301.25 $477.18 $602.50 $482.00 $271.13 $119.58 N/A $349.45 $602.50 $361.50 $602.50 $602.50 $602.50 N/A N/A 75001238 SUP HCPCS C1713 75001238 - PIN FX 44MM LCK DIST BOTH IP/OP $602.50 $446.00 $119.58 $602.50 $271.13 $271.13 $271.13 $271.13 $602.50 $602.50 $602.50 $125.58 $602.50 $602.50 $602.50 $602.50 $602.50 $125.57 $602.50 $241.00 $356.38 $602.50 $602.50 $602.50 $602.50 $451.88 $602.50 $602.50 $602.50 $301.25 $301.25 $477.18 $602.50 $482.00 $271.13 $119.58 N/A $349.45 $602.50 $361.50 $602.50 $602.50 $602.50 N/A N/A 75001239 SUP HCPCS C1713 75001239 - PIN FX 46MM LCK DIST BOTH IP/OP $602.50 $446.00 $119.58 $602.50 $271.13 $271.13 $271.13 $271.13 $602.50 $602.50 $602.50 $125.58 $602.50 $602.50 $602.50 $602.50 $602.50 $125.57 $602.50 $241.00 $356.38 $602.50 $602.50 $602.50 $602.50 $451.88 $602.50 $602.50 $602.50 $301.25 $301.25 $477.18 $602.50 $482.00 $271.13 $119.58 N/A $349.45 $602.50 $361.50 $602.50 $125.56 $602.50 N/A N/A 75001240 SUP HCPCS C1713 75001240 - PIN FX 50MM LCK DIST BOTH IP/OP $602.50 $446.00 $119.58 $602.50 $271.13 $271.13 $271.13 $271.13 $602.50 $602.50 $602.50 $125.58 $602.50 $602.50 $602.50 $602.50 $602.50 $125.57 $602.50 $602.50 $356.38 $602.50 $602.50 $602.50 $602.50 $451.88 $602.50 $602.50 $602.50 $301.25 $301.25 $477.18 $602.50 $482.00 $271.13 $119.58 N/A $349.45 $602.50 $602.50 $602.50 $125.56 $602.50 N/A N/A 75001241 SUP HCPCS C1713 75001241 - PIN FX 60MM LCK DIST BOTH IP/OP $602.50 $446.00 $119.58 $602.50 $271.13 $271.13 $271.13 $271.13 $602.50 $602.50 $602.50 $125.58 $602.50 $602.50 $602.50 $602.50 $602.50 $125.57 $602.50 $602.50 $356.38 $602.50 $602.50 $602.50 $602.50 $451.88 $602.50 $602.50 $602.50 $301.25 $301.25 $477.18 $602.50 $482.00 $271.13 $119.58 N/A $349.45 $602.50 $361.50 $602.50 $125.56 $602.50 N/A N/A 75001242 SUP HCPCS C1713 75001242 - PIN FX 70MM LCK DIST BOTH IP/OP $602.50 $446.00 $119.58 $602.50 $271.13 $271.13 $271.13 $271.13 $602.50 $602.50 $602.50 $125.58 $602.50 $602.50 $602.50 $602.50 $602.50 $125.57 $602.50 $602.50 $356.38 $602.50 $602.50 $602.50 $602.50 $451.88 $602.50 $602.50 $602.50 $301.25 $301.25 $477.18 $602.50 $482.00 $271.13 $119.58 N/A $349.45 $602.50 $602.50 $602.50 $125.56 $602.50 N/A N/A 75405535 SUP HCPCS C1713 75405535 - SCREW BONE 5.5MM 35MM LEGACY OSTEOGRIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75405540 SUP HCPCS C1713 75405540 - SCREW BONE 5.5MM 40MM MULTIAX LEGACY OSTEOGRIP TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75405545 SUP HCPCS C1713 75405545 - SCREW BONE 5.5MM 45MM MULTIAX LEGACY OSTEOGRIP TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75406535 SUP HCPCS C1713 75406535 - SCREW BONE 6.5MM 35MM MAS OSTEOGRIP TITANIUM 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75406540 SUP HCPCS C1713 75406540 - SCREW BONE 6.5MM 40MM LEGACY OSTEOGRIP SPN OSTEOGRIP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75406545 SUP HCPCS C1713 75406545 - SCREW BONE 6.5MM 45MM LEGACY OSTEOGRIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75407535 SUP HCPCS C1713 75407535 - SCREW BONE 7.5MM 35MM LEGACY OSTEOGRIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75407540 SUP HCPCS C1713 75407540 - SCREW BONE 7.5MM 40MM LEGACY OSTEOGRIP SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75407545 SUP HCPCS C1713 75407545 - SCREW BONE 7.5MM 45MM MAS LEGACY OSTEOGRIP TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75407550 SUP HCPCS C1713 75407550 - SCREW BONE 7.5MM 50MM MULTIAX REDX LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75444020 SUP HCPCS C1713 75444020 - SCREW BN FLUT 4MM 20MM STRL LGC CD HZN G4 TCH MA ST LCK MECH BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75444025 SUP HCPCS C1713 75444025 - SCREW BN 4MM 25MM STRL CD HZN LGC MA TI PDCL SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75444030 SUP HCPCS C1713 75444030 - SCREW BN FLUT 4MM 30MM STRL LGC CD HZN G4 TCH MA ST LCK MECH BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75444040 SUP HCPCS C1713 75444040 - SCREW BN FLUT 4MM 40MM STRL LGC CD HZN G4 TCH MA ST LCK MECH BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75444045 SUP HCPCS C1713 75444045 - SCREW BN 4MM 45MM STRL CD HZN LGC MA TI SPNE PDCL 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75444050 SUP HCPCS C1713 75444050 - SCREW BONE FLUTE 4MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75444520 SUP HCPCS C1713 75444520 - SCREW BN FLUT 4.5MM 20MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75444525 SUP HCPCS C1713 75444525 - SCREW BN FLUT 4.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75444530 SUP HCPCS C1713 75444530 - SCREW BN FLUT 4.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75444535 SUP HCPCS C1713 75444535 - SCREW BN FLUT 4.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75444540 SUP HCPCS C1713 75444540 - SCREW BN FLUT 4.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75444545 SUP HCPCS C1713 75444545 - SCREW BN FLUT 4.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75444550 SUP HCPCS C1713 75444550 - SCREW BONE 4.5MM 50MM G4 TECHNOLOGY MULTIAX SLFTAP FLUTE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445020 SUP HCPCS C1713 75445020 - SCREW BONE FLUTE 5MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445025 SUP HCPCS C1713 75445025 - SCREW BN FLUT 5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445030 SUP HCPCS C1713 75445030 - SCREW BN FLUT 5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445035 SUP HCPCS C1713 75445035 - SCREW BN FLUT 5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445040 SUP HCPCS C1713 75445040 - SCREW BN FLUT 5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445045 SUP HCPCS C1713 75445045 - SCREW BN FLUT 5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445050 SUP HCPCS C1713 75445050 - SCREW BN FLUT 5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445520 SUP HCPCS C1713 75445520 - SCREW BONE FLUTE 5.5MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445525 SUP HCPCS C1713 75445525 - SCREW BN FLUT 5.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445530 SUP HCPCS C1713 75445530 - SCREW BN FLUT 5.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445535 SUP HCPCS C1713 75445535 - SCREW BN FLUT 5.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445540 SUP HCPCS C1713 75445540 - SCREW BN FLUT 5.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445545 SUP HCPCS C1713 75445545 - SCREW BN FLUT 5.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445550 SUP HCPCS C1713 75445550 - SCREW BN FLUT 5.5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445555 SUP HCPCS C1713 75445555 - SCREW BN FLUT 5.5MM 55MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75445560 SUP HCPCS C1713 75445560 - SCREW BONE FLUTE 5.5MM 60MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446025 SUP HCPCS C1713 75446025 - SCREW BONE FLUTE 6MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446030 SUP HCPCS C1713 75446030 - SCREW BONE FLUTE 6MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446035 SUP HCPCS C1713 75446035 - SCREW BONE FLUTE 6MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446040 SUP HCPCS C1713 75446040 - SCREW BONE FLUTE 6MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446045 SUP HCPCS C1713 75446045 - SCREW BONE FLUTE 6MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446050 SUP HCPCS C1713 75446050 - SCREW BONE FLUTE 6MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446055 SUP HCPCS C1713 75446055 - SCREW BONE FLUTE 6MM 55MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446060 SUP HCPCS C1713 75446060 - SCREW BONE FLUTE 6MM 60MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446070 SUP HCPCS C1713 75446070 - SCREW BONE FLUTE 6MM 70MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446520 SUP HCPCS C1713 75446520 - SCREW BONE FLUTE 6.5MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446525 SUP HCPCS C1713 75446525 - SCREW BN FLUT 6.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446530 SUP HCPCS C1713 75446530 - SCREW BN FLUT 6.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446535 SUP HCPCS C1713 75446535 - SCREW BN FLUT 6.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446540 SUP HCPCS C1713 75446540 - SCREW BN FLUT 6.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446545 SUP HCPCS C1713 75446545 - SCREW BN FLUT 6.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446550 SUP HCPCS C1713 75446550 - SCREW BN FLUT 6.5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446555 SUP HCPCS C1713 75446555 - SCREW BN FLUT 6.5MM 55MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446560 SUP HCPCS C1713 75446560 - SCREW BN FLUT 6.5MM 60MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75446565 SUP HCPCS C1713 75446565 - SCREW BONE FLUTE 6.5MM 65MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75447525 SUP HCPCS C1713 75447525 - SCREW BN FLUT 7.5MM 25MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75447530 SUP HCPCS C1713 75447530 - SCREW BN FLUT 7.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75447535 SUP HCPCS C1713 75447535 - SCREW BN FLUT 7.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75447540 SUP HCPCS C1713 75447540 - SCREW BN FLUT 7.5MM 40MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75447545 SUP HCPCS C1713 75447545 - SCREW BN FLUT 7.5MM 45MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75447550 SUP HCPCS C1713 75447550 - SCREW BN FLUT 7.5MM 50MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75447555 SUP HCPCS C1713 75447555 - SCREW BN FLUT 7.5MM 55MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75447560 SUP HCPCS C1713 75447560 - SCREW BN FLUT 7.5MM 60MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75447565 SUP HCPCS C1713 75447565 - SCREW BONE FLUTE 7.5MM 65MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75447570 SUP HCPCS C1713 75447570 - SCREW BONE FLUTE 7.5MM 70MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75448525 SUP HCPCS C1713 75448525 - SCREW BONE FLUTE 8.5MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75448530 SUP HCPCS C1713 75448530 - SCREW BN FLUT 8.5MM 30MM STRL LGC CD HZN G4 TCH MA ST LCK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75448535 SUP HCPCS C1713 75448535 - SCREW BONE FLUTE 8.5MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75448540 SUP HCPCS C1713 75448540 - SCREW BONE FLUTE 8.5MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75448545 SUP HCPCS C1713 75448545 - SCREW BONE FLUTE 8.5MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75448550 SUP HCPCS C1713 75448550 - SCREW BONE FLUTE 8.5MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75448555 SUP HCPCS C1713 75448555 - SCREW BONE FLUTE 8.5MM 55MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75448560 SUP HCPCS C1713 75448560 - SCREW BONE FLUTE 8.5MM 60MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75448565 SUP HCPCS C1713 75448565 - SCREW BONE FLUTE 8.5MM 65MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75454020 SUP HCPCS C1713 75454020 - SCREW BONE 4MM 20MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75454025 SUP HCPCS C1713 75454025 - SCREW BONE 4MM 25MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75454030 SUP HCPCS C1713 75454030 - SCREW BONE 4MM 30MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75454035 SUP HCPCS C1713 75454035 - SCREW BONE 4MM 35MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75454040 SUP HCPCS C1713 75454040 - SCREW BONE 4MM 40MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75454045 SUP HCPCS C1713 75454045 - SCREW BONE 4MM 45MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75454050 SUP HCPCS C1713 75454050 - SCREW BONE 4MM 50MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75454520 SUP HCPCS C1713 75454520 - SCREW BONE 4.5MM 20MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75454525 SUP HCPCS C1713 75454525 - SCREW BONE 4.5MM 25MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75454530 SUP HCPCS C1713 75454530 - SCREW BONE 4.5MM 30MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75454535 SUP HCPCS C1713 75454535 - SCREW BONE 4.5MM 35MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75454540 SUP HCPCS C1713 75454540 - SCREW BONE 4.5MM 40MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75454545 SUP HCPCS C1713 75454545 - SCREW BONE 4.5MM 45MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75454550 SUP HCPCS C1713 75454550 - SCREW BONE 4.5MM 50MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455020 SUP HCPCS C1713 75455020 - SCREW BONE 5MM 20MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455025 SUP HCPCS C1713 75455025 - SCREW BONE 5MM 25MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455030 SUP HCPCS C1713 75455030 - SCREW BONE 5MM 30MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455035 SUP HCPCS C1713 75455035 - SCREW BONE 5MM 35MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455040 SUP HCPCS C1713 75455040 - SCREW BONE 5MM 40MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455045 SUP HCPCS C1713 75455045 - SCREW BONE 5MM 45MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455050 SUP HCPCS C1713 75455050 - SCREW BONE 5MM 50MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455520 SUP HCPCS C1713 75455520 - SCREW BONE 5.5MM 20MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455525 SUP HCPCS C1713 75455525 - SCREW BONE 5.5MM 25MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455530 SUP HCPCS C1713 75455530 - SCREW BONE 5.5MM 30MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455535 SUP HCPCS C1713 75455535 - SCREW BONE 5.5MM 35MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455540 SUP HCPCS C1713 75455540 - SCREW BONE 5.5MM 40MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455545 SUP HCPCS C1713 75455545 - SCREW BONE 5.5MM 45MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455550 SUP HCPCS C1713 75455550 - SCREW BONE 5.5MM 50MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455555 SUP HCPCS C1713 75455555 - SCREW BONE 5.5MM 55MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75455560 SUP HCPCS C1713 75455560 - SCREW BONE 5.5MM 60MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456020 SUP HCPCS C1713 75456020 - SCREW BONE 6MM 20MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456025 SUP HCPCS C1713 75456025 - SCREW BONE 6MM 25MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456030 SUP HCPCS C1713 75456030 - SCREW BONE 6MM 30MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456035 SUP HCPCS C1713 75456035 - SCREW BONE 6MM 35MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456040 SUP HCPCS C1713 75456040 - SCREW BONE 6MM 40MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456045 SUP HCPCS C1713 75456045 - SCREW BONE 6MM 45MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456050 SUP HCPCS C1713 75456050 - SCREW BONE 6MM 50MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456055 SUP HCPCS C1713 75456055 - SCREW BONE 6MM 55MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456060 SUP HCPCS C1713 75456060 - SCREW BONE 6MM 60MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456065 SUP HCPCS C1713 75456065 - SCREW BONE 6MM 65MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456070 SUP HCPCS C1713 75456070 - SCREW BONE 6MM 70MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456520 SUP HCPCS C1713 75456520 - SCREW BONE 6.5MM 20MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456525 SUP HCPCS C1713 75456525 - SCREW BONE 6.5MM 25MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456530 SUP HCPCS C1713 75456530 - SCREW BONE 6.5MM 30MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456535 SUP HCPCS C1713 75456535 - SCREW BONE 6.5MM 35MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456540 SUP HCPCS C1713 75456540 - SCREW BONE 6.5MM 40MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456545 SUP HCPCS C1713 75456545 - SCREW BONE 6.5MM 45MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456550 SUP HCPCS C1713 75456550 - SCREW BONE 6.5MM 50MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456555 SUP HCPCS C1713 75456555 - SCREW BONE 6.5MM 55MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456560 SUP HCPCS C1713 75456560 - SCREW BONE 6.5MM 60MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75456565 SUP HCPCS C1713 75456565 - SCREW BONE 6.5MM 65MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75457525 SUP HCPCS C1713 75457525 - SCREW BONE 7.5MM 25MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75457530 SUP HCPCS C1713 75457530 - SCREW BONE 7.5MM 30MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75457535 SUP HCPCS C1713 75457535 - SCREW BONE 7.5MM 35MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75457540 SUP HCPCS C1713 75457540 - SCREW BONE 7.5MM 40MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75457545 SUP HCPCS C1713 75457545 - SCREW BONE 7.5MM 45MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75457550 SUP HCPCS C1713 75457550 - SCREW BONE 7.5MM 50MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75457555 SUP HCPCS C1713 75457555 - SCREW BONE 7.5MM 55MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75457560 SUP HCPCS C1713 75457560 - SCREW BONE 7.5MM 60MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75457565 SUP HCPCS C1713 75457565 - SCREW BONE 7.5MM 65MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75457570 SUP HCPCS C1713 75457570 - SCREW BONE 7.5MM 70MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75458525 SUP HCPCS C1713 75458525 - SCREW BONE 8.5MM 25MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75458530 SUP HCPCS C1713 75458530 - SCREW BONE 8.5MM 30MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75458535 SUP HCPCS C1713 75458535 - SCREW BONE 8.5MM 35MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$1,057.20" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75458540 SUP HCPCS C1713 75458540 - SCREW BONE 8.5MM 40MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75458545 SUP HCPCS C1713 75458545 - SCREW BONE 8.5MM 45MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75458550 SUP HCPCS C1713 75458550 - SCREW BONE 8.5MM 50MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75458555 SUP HCPCS C1713 75458555 - SCREW BONE 8.5MM 55MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$2,643.00" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75458560 SUP HCPCS C1713 75458560 - SCREW BONE 8.5MM 60MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75458565 SUP HCPCS C1713 75458565 - SCREW BONE 8.5MM 65MM UNIAXIAL TITANIUM SPN BOTH IP/OP "$2,643.00" "$1,956.00" $524.57 "$2,643.00" "$1,189.35" "$1,189.35" "$1,189.35" "$1,189.35" "$2,643.00" "$2,643.00" "$2,643.00" $550.87 "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" $550.83 "$2,643.00" "$2,643.00" "$1,303.00" "$2,643.00" "$2,643.00" "$2,643.00" "$2,643.00" "$1,982.25" "$2,643.00" "$2,643.00" "$2,643.00" "$1,321.50" "$1,321.50" "$2,093.26" "$2,643.00" "$2,114.40" "$1,189.35" $524.57 N/A "$1,532.94" "$2,643.00" "$1,585.80" "$2,643.00" $550.80 "$2,643.00" N/A N/A 75464015 SUP HCPCS C1713 75464015 - SCREW BONE 4MM 15MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464020 SUP HCPCS C1713 75464020 - SCREW BONE 4MM 20MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464025 SUP HCPCS C1713 75464025 - SCREW BONE 4MM 25MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464030 SUP HCPCS C1713 75464030 - SCREW BONE 4MM 30MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464035 SUP HCPCS C1713 75464035 - SCREW BONE 4MM 35MM MULTIAX CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464040 SUP HCPCS C1713 75464040 - SCREW BONE 4MM 40MM MULTIAX CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464045 SUP HCPCS C1713 75464045 - SCREW BONE 4MM 45MM MULTIAX CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464050 SUP HCPCS C1713 75464050 - SCREW BONE 4MM 50MM MULTIAX CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464055 SUP HCPCS C1713 75464055 - SCREW BONE 4MM 55MM MULTIAX CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464060 SUP HCPCS C1713 75464060 - SCREW BONE 4MM 60MM MULTIAX CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464515 SUP HCPCS C1713 75464515 - SCREW BONE 4.5MM 15MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464520 SUP HCPCS C1713 75464520 - SCREW BONE 4.5MM 20MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464525 SUP HCPCS C1713 75464525 - SCREW BONE 4.5MM 25MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464530 SUP HCPCS C1713 75464530 - SCREW BONE 4.5MM 30MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464535 SUP HCPCS C1713 75464535 - SCREW BONE 4.5MM 35MM MULTIAX SPN CORTICAL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464540 SUP HCPCS C1713 75464540 - SCREW BONE 4.5MM 40MM MULTIAX SPN CORTICAL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464545 SUP HCPCS C1713 75464545 - SCREW BONE 4.5MM 45MM MULTIAX CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464550 SUP HCPCS C1713 75464550 - SCREW BONE 4.5MM 50MM MULTIAX CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464555 SUP HCPCS C1713 75464555 - SCREW BONE 4.5MM 55MM MULTIAX CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75464560 SUP HCPCS C1713 75464560 - SCREW BONE 4.5MM 60MM MULTIAX CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75465015 SUP HCPCS C1713 75465015 - SCREW BONE 5MM 15MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75465020 SUP HCPCS C1713 75465020 - SCREW BONE 5MM 20MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75465025 SUP HCPCS C1713 75465025 - SCREW BONE 5MM 25MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75465030 SUP HCPCS C1713 75465030 - SCREW BONE 5MM 30MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75465035 SUP HCPCS C1713 75465035 - SCREW BONE 5MM 35MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75465040 SUP HCPCS C1713 75465040 - SCREW BONE 5MM 40MM MULTIAX SPN CORTICAL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75465045 SUP HCPCS C1713 75465045 - SCREW BONE 5MM 45MM MULTIAX CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75465050 SUP HCPCS C1713 75465050 - SCREW BONE 5MM 50MM MULTIAX CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75465055 SUP HCPCS C1713 75465055 - SCREW BONE 5MM 55MM MULTIAX CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75465060 SUP HCPCS C1713 75465060 - SCREW BONE 5MM 60MM MULTIAX CD HORIZON LEGACY TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75465515 SUP HCPCS C1713 75465515 - SCREW BONE 5.5MM 15MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75465520 SUP HCPCS C1713 75465520 - SCREW BONE 5.5MM 20MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75465525 SUP HCPCS C1713 75465525 - SCREW BONE 5.5MM 25MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75465530 SUP HCPCS C1713 75465530 - SCREW BONE 5.5MM 30MM MULTIAX LEGACY CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75470735 SUP Custom 27803010 75470735 - CONNECTOR ROD 35MM SPN BOTH IP/OP $808.50 $598.00 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $168.50 $808.50 $323.40 $808.50 $808.50 $808.50 $808.50 $808.50 $606.38 $808.50 $808.50 $808.50 $404.25 $404.25 $640.33 $808.50 $646.80 $363.83 $808.50 N/A $468.93 $808.50 $485.10 $808.50 $808.50 $808.50 N/A N/A 75470740 SUP Custom 27803010 75470740 - CONNECTOR ROD 40MM SPN BOTH IP/OP $808.50 $598.00 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $168.50 $808.50 $323.40 $808.50 $808.50 $808.50 $808.50 $808.50 $606.38 $808.50 $808.50 $808.50 $404.25 $404.25 $640.33 $808.50 $646.80 $363.83 $808.50 N/A $468.93 $808.50 $485.10 $808.50 $808.50 $808.50 N/A N/A 75470745 SUP Custom 27803010 75470745 - CONNECTOR ROD 45MM SPN BOTH IP/OP $808.50 $598.00 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $168.50 $808.50 $323.40 $808.50 $808.50 $808.50 $808.50 $808.50 $606.38 $808.50 $808.50 $808.50 $404.25 $404.25 $640.33 $808.50 $646.80 $363.83 $808.50 N/A $468.93 $808.50 $485.10 $808.50 $808.50 $808.50 N/A N/A 75470750 SUP Custom 27803010 75470750 - CONNECTOR ROD 50MM SPN BOTH IP/OP $808.50 $598.00 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $168.50 $808.50 $323.40 $808.50 $808.50 $808.50 $808.50 $808.50 $606.38 $808.50 $808.50 $808.50 $404.25 $404.25 $640.33 $808.50 $646.80 $363.83 $808.50 N/A $468.93 $808.50 $485.10 $808.50 $808.50 $808.50 N/A N/A 75470755 SUP Custom 27803010 75470755 - CONNECTOR ROD 55MM SPN BOTH IP/OP $808.50 $598.00 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $168.50 $808.50 $323.40 $808.50 $808.50 $808.50 $808.50 $808.50 $606.38 $808.50 $808.50 $808.50 $404.25 $404.25 $640.33 $808.50 $646.80 $363.83 $808.50 N/A $468.93 $808.50 $485.10 $808.50 $808.50 $808.50 N/A N/A 75470760 SUP Custom 27803010 75470760 - CONNECTOR ROD 60MM SPN BOTH IP/OP $808.50 $598.00 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $168.50 $808.50 $323.40 $808.50 $808.50 $808.50 $808.50 $808.50 $606.38 $808.50 $808.50 $808.50 $404.25 $404.25 $640.33 $808.50 $646.80 $363.83 $808.50 N/A $468.93 $808.50 $485.10 $808.50 $808.50 $808.50 N/A N/A 75470865 SUP Custom 27803010 75470865 - CONNECTOR ROD 65MM SPN BOTH IP/OP $808.50 $598.00 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $168.50 $808.50 $323.40 $808.50 $808.50 $808.50 $808.50 $808.50 $606.38 $808.50 $808.50 $808.50 $404.25 $404.25 $640.33 $808.50 $646.80 $363.83 $808.50 N/A $468.93 $808.50 $485.10 $808.50 $808.50 $808.50 N/A N/A 75470870 SUP Custom 27803010 75470870 - CONNECTOR ROD 70MM SPN BOTH IP/OP $808.50 $598.00 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $168.50 $808.50 $323.40 $808.50 $808.50 $808.50 $808.50 $808.50 $606.38 $808.50 $808.50 $808.50 $404.25 $404.25 $640.33 $808.50 $646.80 $363.83 $808.50 N/A $468.93 $808.50 $485.10 $808.50 $808.50 $808.50 N/A N/A 75470875 SUP Custom 27803010 75470875 - CONNECTOR ROD 75MM SPN BOTH IP/OP $808.50 $598.00 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $143.91 $808.50 $808.50 $808.50 $808.50 $808.50 $808.50 $168.50 $808.50 $323.40 $808.50 $808.50 $808.50 $808.50 $808.50 $606.38 $808.50 $808.50 $808.50 $404.25 $404.25 $640.33 $808.50 $646.80 $363.83 $808.50 N/A $468.93 $808.50 $485.10 $808.50 $808.50 $808.50 N/A N/A 75494520 SUP HCPCS C1713 75494520 - SCREW BONE 4.5MM 20MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75494525 SUP HCPCS C1713 75494525 - SCREW BONE 4.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75494530 SUP HCPCS C1713 75494530 - SCREW BONE 4.5MM 30MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75494535 SUP HCPCS C1713 75494535 - SCREW BONE 4.5MM 35MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75494540 SUP HCPCS C1713 75494540 - SCREW BONE 4.5MM 40MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75494545 SUP HCPCS C1713 75494545 - SCREW BONE 4.5MM 45MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75494550 SUP HCPCS C1713 75494550 - SCREW BONE 4.5MM 50MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495020 SUP HCPCS C1713 75495020 - SCREW BONE 5MM 20MM MULTIAX REDX LEGACY CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495025 SUP HCPCS C1713 75495025 - SCREW BONE 5MM 25MM MULTIAX REDX LEGACY CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495030 SUP HCPCS C1713 75495030 - SCREW BONE 5MM 30MM MULTIAX REDX LEGACY CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495035 SUP HCPCS C1713 75495035 - SCREW BONE 5MM 35MM MULTIAX REDX LEGACY CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495040 SUP HCPCS C1713 75495040 - SCREW BONE 5MM 40MM MULTIAX REDX LEGACY CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495045 SUP HCPCS C1713 75495045 - SCREW BONE 5MM 45MM MULTIAX REDX LEGACY CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495050 SUP HCPCS C1713 75495050 - SCREW BONE 5MM 50MM MULTIAX REDX LEGACY CD HORIZON TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495520 SUP HCPCS C1713 75495520 - SCREW BONE 5.5MM 20MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495525 SUP HCPCS C1713 75495525 - SCREW BONE 5.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495530 SUP HCPCS C1713 75495530 - SCREW BONE 5.5MM 30MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495535 SUP HCPCS C1713 75495535 - SCREW BN 5.5MM 35MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495540 SUP HCPCS C1713 75495540 - SCREW BONE 5.5MM 40MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495545 SUP HCPCS C1713 75495545 - SCREW BONE 5.5MM 45MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495550 SUP HCPCS C1713 75495550 - SCREW BONE 5.5MM 50MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495555 SUP HCPCS C1713 75495555 - SCREW BONE 5.5MM 55MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75495560 SUP HCPCS C1713 75495560 - SCREW BONE 5.5MM 60MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75496520 SUP HCPCS C1713 75496520 - SCREW BONE 6.5MM 20MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75496525 SUP HCPCS C1713 75496525 - SCREW BONE 6.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75496530 SUP HCPCS C1713 75496530 - SCREW BONE 6.5MM 30MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75496535 SUP HCPCS C1713 75496535 - SCREW BN 6.5MM 35MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75496540 SUP HCPCS C1713 75496540 - SCREW BN 6.5MM 40MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75496545 SUP HCPCS C1713 75496545 - SCREW BN 6.5MM 45MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75496550 SUP HCPCS C1713 75496550 - SCREW BN 6.5MM 50MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75496555 SUP HCPCS C1713 75496555 - SCREW BONE 6.5MM 55MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75496560 SUP HCPCS C1713 75496560 - SCREW BONE 6.5MM 60MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75496565 SUP HCPCS C1713 75496565 - SCREW BONE 6.5MM 65MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75497525 SUP HCPCS C1713 75497525 - SCREW BONE 7.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75497530 SUP HCPCS C1713 75497530 - SCREW BONE 7.5MM 30MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75497535 SUP HCPCS C1713 75497535 - SCREW BONE 7.5MM 35MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75497540 SUP HCPCS C1713 75497540 - SCREW BN 7.5MM 40MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75497545 SUP HCPCS C1713 75497545 - SCREW BN 7.5MM 45MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75497550 SUP HCPCS C1713 75497550 - SCREW BN 7.5MM 50MM CD HZN LGC MA RDC TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75497555 SUP HCPCS C1713 75497555 - SCREW BONE 7.5MM 55MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75497560 SUP HCPCS C1713 75497560 - SCREW BONE 7.5MM 60MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75497565 SUP HCPCS C1713 75497565 - SCREW BONE 7.5MM 65MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75497570 SUP HCPCS C1713 75497570 - SCREW BONE 7.5MM 70MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75498525 SUP HCPCS C1713 75498525 - SCREW BONE 8.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75498530 SUP HCPCS C1713 75498530 - SCREW BONE 8.5MM 30MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75498535 SUP HCPCS C1713 75498535 - SCREW BONE 8.5MM 35MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75498540 SUP HCPCS C1713 75498540 - SCREW BONE 8.5MM 40MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75498545 SUP HCPCS C1713 75498545 - SCREW BONE 8.5MM 45MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75498550 SUP HCPCS C1713 75498550 - SCREW BONE 8.5MM 50MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75498555 SUP HCPCS C1713 75498555 - SCREW BONE 8.5MM 55MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75498560 SUP HCPCS C1713 75498560 - SCREW BONE 8.5MM 60MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75498565 SUP HCPCS C1713 75498565 - SCREW BONE 8.5MM 65MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75644020 SUP HCPCS C1713 75644020 - SCREW BONE FLUTE 4MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75644025 SUP HCPCS C1713 75644025 - SCREW BONE FLUTE 4MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75644030 SUP HCPCS C1713 75644030 - SCREW BONE FLUTE 4MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75644035 SUP HCPCS C1713 75644035 - SCREW BONE FLUTE 4MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75644040 SUP HCPCS C1713 75644040 - SCREW BONE FLUTE 4MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75644045 SUP HCPCS C1713 75644045 - SCREW BONE FLUTE 4MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75644050 SUP HCPCS C1713 75644050 - SCREW BONE FLUTE 4MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75644520 SUP HCPCS C1713 75644520 - SCREW BONE FLUTE 4.5MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75644525 SUP HCPCS C1713 75644525 - SCREW BONE FLUTE 4.5MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75644530 SUP HCPCS C1713 75644530 - SCREW BONE FLUTE 4.5MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75644535 SUP HCPCS C1713 75644535 - SCREW BONE FLUTE 4.5MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75644540 SUP HCPCS C1713 75644540 - SCREW BONE FLUTE 4.5MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75644545 SUP HCPCS C1713 75644545 - SCREW BONE FLUTE 4.5MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75644550 SUP HCPCS C1713 75644550 - SCREW BONE FLUTE 4.5MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645020 SUP HCPCS C1713 75645020 - SCREW BONE FLUTE 5MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645025 SUP HCPCS C1713 75645025 - SCREW BONE FLUTE 5MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645030 SUP HCPCS C1713 75645030 - SCREW BN FLUT 5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645035 SUP HCPCS C1713 75645035 - SCREW BN FLUT 5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645040 SUP HCPCS C1713 75645040 - SCREW BONE FLUTE 5MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645045 SUP HCPCS C1713 75645045 - SCREW BONE FLUTE 5MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645050 SUP HCPCS C1713 75645050 - SCREW BONE FLUTE 5MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645520 SUP HCPCS C1713 75645520 - SCREW BONE FLUTE 5.5MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645525 SUP HCPCS C1713 75645525 - SCREW BONE FLUTE 5.5MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645530 SUP HCPCS C1713 75645530 - SCREW BN FLUT 5.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645535 SUP HCPCS C1713 75645535 - SCREW BN FLUT 5.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645540 SUP HCPCS C1713 75645540 - SCREW BONE FLUTE 5.5MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645545 SUP HCPCS C1713 75645545 - SCREW BONE FLUTE 5.5MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645550 SUP HCPCS C1713 75645550 - SCREW BONE FLUTE 5.5MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645555 SUP HCPCS C1713 75645555 - SCREW BONE FLUTE 5.5MM 55MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75645560 SUP HCPCS C1713 75645560 - SCREW BONE FLUTE 5.5MM 60MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646025 SUP HCPCS C1713 75646025 - SCREW BONE FLUTE 6MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646030 SUP HCPCS C1713 75646030 - SCREW BONE FLUTE 6MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646035 SUP HCPCS C1713 75646035 - SCREW BONE FLUTE 6MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646040 SUP HCPCS C1713 75646040 - SCREW BONE FLUTE 6MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646045 SUP HCPCS C1713 75646045 - SCREW BONE FLUTE 6MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646050 SUP HCPCS C1713 75646050 - SCREW BONE FLUTE 6MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646055 SUP HCPCS C1713 75646055 - SCREW BONE FLUTE 6MM 55MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646060 SUP HCPCS C1713 75646060 - SCREW BONE FLUTE 6MM 60MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646065 SUP HCPCS C1713 75646065 - SCREW BONE FLUTE 6MM 65MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646070 SUP HCPCS C1713 75646070 - SCREW BONE FLUTE 6MM 70MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646520 SUP HCPCS C1713 75646520 - SCREW BONE FLUTE 6.5MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646525 SUP HCPCS C1713 75646525 - SCREW BONE FLUTE 6.5MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646530 SUP HCPCS C1713 75646530 - SCREW BN FLUT 6.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646535 SUP HCPCS C1713 75646535 - SCREW BN FLUT 6.5MM 35MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646540 SUP HCPCS C1713 75646540 - SCREW BONE FLUTE 6.5MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646545 SUP HCPCS C1713 75646545 - SCREW BONE FLUTE 6.5MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646550 SUP HCPCS C1713 75646550 - SCREW BONE FLUTE 6.5MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646555 SUP HCPCS C1713 75646555 - SCREW BONE FLUTE 6.5MM 55MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646560 SUP HCPCS C1713 75646560 - SCREW BONE FLUTE 6.5MM 60MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75646565 SUP HCPCS C1713 75646565 - SCREW BN FLUT 6.5MM 65MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75647525 SUP HCPCS C1713 75647525 - SCREW BONE FLUTE 7.5MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75647530 SUP HCPCS C1713 75647530 - SCREW BN FLUT 7.5MM 30MM NS CD HZN LGC MA ST RVRS ANG THRDLK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75647535 SUP HCPCS C1713 75647535 - SCREW BONE FLUTE 7.5MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75647540 SUP HCPCS C1713 75647540 - SCREW BONE FLUTE 7.5MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75647545 SUP HCPCS C1713 75647545 - SCREW BONE FLUTE 7.5MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75647550 SUP HCPCS C1713 75647550 - SCREW BONE FLUTE 7.5MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75647555 SUP HCPCS C1713 75647555 - SCREW BONE FLUTE 7.5MM 55MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75647560 SUP HCPCS C1713 75647560 - SCREW BONE FLUTE 7.5MM 60MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75647565 SUP HCPCS C1713 75647565 - SCREW BONE FLUTE 7.5MM 65MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75647570 SUP HCPCS C1713 75647570 - SCREW BONE FLUTE 7.5MM 70MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75648525 SUP HCPCS C1713 75648525 - SCREW BONE FLUTE 8.5MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75648530 SUP HCPCS C1713 75648530 - SCREW BONE FLUTE 8.5MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75648535 SUP HCPCS C1713 75648535 - SCREW BONE FLUTE 8.5MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75648540 SUP HCPCS C1713 75648540 - SCREW BONE FLUTE 8.5MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75648545 SUP HCPCS C1713 75648545 - SCREW BONE FLUTE 8.5MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75648550 SUP HCPCS C1713 75648550 - SCREW BONE FLUTE 8.5MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75648555 SUP HCPCS C1713 75648555 - SCREW BONE FLUTE 8.5MM 55MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75648560 SUP HCPCS C1713 75648560 - SCREW BONE FLUTE 8.5MM 60MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75648565 SUP HCPCS C1713 75648565 - SCREW BONE FLUTE 8.5MM 65MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75654020 SUP HCPCS C1713 75654020 - SCREW BONE 4MM 20MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75654025 SUP HCPCS C1713 75654025 - SCREW BONE 4MM 25MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75654030 SUP HCPCS C1713 75654030 - SCREW BONE 4MM 30MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75654035 SUP HCPCS C1713 75654035 - SCREW BONE 4MM 35MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$2,452.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75654040 SUP HCPCS C1713 75654040 - SCREW BONE 4MM 40MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$2,452.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75654045 SUP HCPCS C1713 75654045 - SCREW BONE 4MM 45MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75654050 SUP HCPCS C1713 75654050 - SCREW BONE 4MM 50MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75654520 SUP HCPCS C1713 75654520 - SCREW BONE 4.5MM 20MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75654525 SUP HCPCS C1713 75654525 - SCREW BONE 4.5MM 25MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$2,452.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75654530 SUP HCPCS C1713 75654530 - SCREW BONE 4.5MM 30MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$2,452.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75654535 SUP HCPCS C1713 75654535 - SCREW BONE 4.5MM 35MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75654540 SUP HCPCS C1713 75654540 - SCREW BONE 4.5MM 40MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75654545 SUP HCPCS C1713 75654545 - SCREW BONE 4.5MM 45MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75654550 SUP HCPCS C1713 75654550 - SCREW BONE 4.5MM 50MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655020 SUP HCPCS C1713 75655020 - SCREW BONE 5MM 20MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655025 SUP HCPCS C1713 75655025 - SCREW BONE 5MM 25MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$2,452.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655030 SUP HCPCS C1713 75655030 - SCREW BONE 5MM 30MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655035 SUP HCPCS C1713 75655035 - SCREW BONE 5MM 35MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655040 SUP HCPCS C1713 75655040 - SCREW BONE 5MM 40MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655045 SUP HCPCS C1713 75655045 - SCREW BONE 5MM 45MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$2,452.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655050 SUP HCPCS C1713 75655050 - SCREW BONE 5MM 50MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$2,452.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655520 SUP HCPCS C1713 75655520 - SCREW BONE 5.5MM 20MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655525 SUP HCPCS C1713 75655525 - SCREW BONE 5.5MM 25MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655530 SUP HCPCS C1713 75655530 - SCREW BONE 5.5MM 30MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$2,452.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655535 SUP HCPCS C1713 75655535 - SCREW BONE 5.5MM 35MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655540 SUP HCPCS C1713 75655540 - SCREW BONE 5.5MM 40MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655545 SUP HCPCS C1713 75655545 - SCREW BONE 5.5MM 45MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655550 SUP HCPCS C1713 75655550 - SCREW BONE 5.5MM 50MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655555 SUP HCPCS C1713 75655555 - SCREW BONE 5.5MM 55MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75655560 SUP HCPCS C1713 75655560 - SCREW BONE 5.5MM 60MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656020 SUP HCPCS C1713 75656020 - SCREW BONE 6MM 20MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656025 SUP HCPCS C1713 75656025 - SCREW BONE 6MM 25MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656030 SUP HCPCS C1713 75656030 - SCREW BONE 6MM 30MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656035 SUP HCPCS C1713 75656035 - SCREW BONE 6MM 35MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656040 SUP HCPCS C1713 75656040 - SCREW BONE 6MM 40MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656045 SUP HCPCS C1713 75656045 - SCREW BONE 6MM 45MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$2,452.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656050 SUP HCPCS C1713 75656050 - SCREW BONE 6MM 50MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656055 SUP HCPCS C1713 75656055 - SCREW BONE 6MM 55MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656060 SUP HCPCS C1713 75656060 - SCREW BONE 6MM 60MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656065 SUP HCPCS C1713 75656065 - SCREW BONE 6MM 65MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656070 SUP HCPCS C1713 75656070 - SCREW BONE 6MM 70MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656520 SUP HCPCS C1713 75656520 - SCREW BONE 6.5MM 20MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656525 SUP HCPCS C1713 75656525 - SCREW BONE 6.5MM 25MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$2,452.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656530 SUP HCPCS C1713 75656530 - SCREW BONE 6.5MM 30MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656535 SUP HCPCS C1713 75656535 - SCREW BONE 6.5MM 35MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656540 SUP HCPCS C1713 75656540 - SCREW BONE 6.5MM 40MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656545 SUP HCPCS C1713 75656545 - SCREW BONE 6.5MM 45MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656550 SUP HCPCS C1713 75656550 - SCREW BONE 6.5MM 50MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656555 SUP HCPCS C1713 75656555 - SCREW BONE 6.5MM 55MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656560 SUP HCPCS C1713 75656560 - SCREW BONE 6.5MM 60MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75656565 SUP HCPCS C1713 75656565 - SCREW BONE 6.5MM 65MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75657525 SUP HCPCS C1713 75657525 - SCREW BONE 7.5MM 25MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75657530 SUP HCPCS C1713 75657530 - SCREW BONE 7.5MM 30MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$2,452.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75657535 SUP HCPCS C1713 75657535 - SCREW BONE 7.5MM 35MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75657540 SUP HCPCS C1713 75657540 - SCREW BONE 7.5MM 40MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75657545 SUP HCPCS C1713 75657545 - SCREW BONE 7.5MM 45MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75657550 SUP HCPCS C1713 75657550 - SCREW BONE 7.5MM 50MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75657555 SUP HCPCS C1713 75657555 - SCREW BONE 7.5MM 55MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75657560 SUP HCPCS C1713 75657560 - SCREW BONE 7.5MM 60MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75657565 SUP HCPCS C1713 75657565 - SCREW BONE 7.5MM 65MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75657570 SUP HCPCS C1713 75657570 - SCREW BONE 7.5MM 70MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75658525 SUP HCPCS C1713 75658525 - SCREW BONE 8.5MM 25MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75658530 SUP HCPCS C1713 75658530 - SCREW BONE 8.5MM 30MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75658535 SUP HCPCS C1713 75658535 - SCREW BONE 8.5MM 35MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75658540 SUP HCPCS C1713 75658540 - SCREW BONE 8.5MM 40MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$2,452.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75658545 SUP HCPCS C1713 75658545 - SCREW BONE 8.5MM 45MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$2,452.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75658550 SUP HCPCS C1713 75658550 - SCREW BONE 8.5MM 50MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75658555 SUP HCPCS C1713 75658555 - SCREW BONE 8.5MM 55MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75658560 SUP HCPCS C1713 75658560 - SCREW BONE 8.5MM 60MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" $981.00 "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75658565 SUP HCPCS C1713 75658565 - SCREW BONE 8.5MM 65MM SAGITTAL ADJUST LEGACY CD HORIZON BOTH IP/OP "$2,452.50" "$1,815.00" $486.76 "$2,452.50" "$1,103.63" "$1,103.63" "$1,103.63" "$1,103.63" "$2,452.50" "$2,452.50" "$2,452.50" $511.16 "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" $511.13 "$2,452.50" "$2,452.50" "$1,450.65" "$2,452.50" "$2,452.50" "$2,452.50" "$2,452.50" "$1,839.38" "$2,452.50" "$2,452.50" "$2,452.50" "$1,226.25" "$1,226.25" "$1,942.38" "$2,452.50" "$1,962.00" "$1,103.63" $486.76 N/A "$1,422.45" "$2,452.50" "$1,471.50" "$2,452.50" $511.10 "$2,452.50" N/A N/A 75694520 SUP HCPCS C1713 75694520 - SCREW BONE 4.5MM 20MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75694525 SUP HCPCS C1713 75694525 - SCREW BONE 4.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75694530 SUP HCPCS C1713 75694530 - SCREW BONE 4.5MM 30MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75694535 SUP HCPCS C1713 75694535 - SCREW BONE 4.5MM 35MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75694540 SUP HCPCS C1713 75694540 - SCREW BONE 4.5MM 40MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75694545 SUP HCPCS C1713 75694545 - SCREW BONE 4.5MM 45MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75694550 SUP HCPCS C1713 75694550 - SCREW BONE 4.5MM 50MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695020 SUP HCPCS C1713 75695020 - SCREW BONE 5MM 20MM MULTIAX REDX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695025 SUP HCPCS C1713 75695025 - SCREW BONE 5MM 25MM MULTIAX REDX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695030 SUP HCPCS C1713 75695030 - SCREW BONE 5MM 30MM MULTIAX REDX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695035 SUP HCPCS C1713 75695035 - SCREW BONE 5MM 35MM MULTIAX REDX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695040 SUP HCPCS C1713 75695040 - SCREW BONE 5MM 40MM MULTIAX REDX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695045 SUP HCPCS C1713 75695045 - SCREW BONE 5MM 45MM MULTIAX REDX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695050 SUP HCPCS C1713 75695050 - SCREW BONE 5MM 50MM MULTIAX REDX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695520 SUP HCPCS C1713 75695520 - SCREW BONE 5.5MM 20MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695525 SUP HCPCS C1713 75695525 - SCREW BONE 5.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695530 SUP HCPCS C1713 75695530 - SCREW BONE 5.5MM 30MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695535 SUP HCPCS C1713 75695535 - SCREW BONE 5.5MM 35MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695540 SUP HCPCS C1713 75695540 - SCREW BONE 5.5MM 40MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695545 SUP HCPCS C1713 75695545 - SCREW BONE 5.5MM 45MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695550 SUP HCPCS C1713 75695550 - SCREW BONE 5.5MM 50MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695555 SUP HCPCS C1713 75695555 - SCREW BONE 5.5MM 55MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75695560 SUP HCPCS C1713 75695560 - SCREW BONE 5.5MM 60MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75696520 SUP HCPCS C1713 75696520 - SCREW BONE 6.5MM 20MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75696525 SUP HCPCS C1713 75696525 - SCREW BONE 6.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75696530 SUP HCPCS C1713 75696530 - SCREW BN FLUT 6.5MM 30MM CD HZN LGC MA RDC SS SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75696535 SUP HCPCS C1713 75696535 - SCREW BONE 6.5MM 35MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75696540 SUP HCPCS C1713 75696540 - SCREW BONE 6.5MM 40MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75696545 SUP HCPCS C1713 75696545 - SCREW BONE 6.5MM 45MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75696550 SUP HCPCS C1713 75696550 - SCREW BONE 6.5MM 50MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75696555 SUP HCPCS C1713 75696555 - SCREW BONE 6.5MM 55MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75696560 SUP HCPCS C1713 75696560 - SCREW BONE 6.5MM 60MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75696565 SUP HCPCS C1713 75696565 - SCREW BONE 6.5MM 65MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75697525 SUP HCPCS C1713 75697525 - SCREW BONE 7.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75697530 SUP HCPCS C1713 75697530 - SCREW BONE 7.5MM 30MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75697535 SUP HCPCS C1713 75697535 - SCREW BONE 7.5MM 35MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75697540 SUP HCPCS C1713 75697540 - SCREW BONE 7.5MM 40MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75697545 SUP HCPCS C1713 75697545 - SCREW BONE 7.5MM 45MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75697550 SUP HCPCS C1713 75697550 - SCREW BONE 7.5MM 50MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75697555 SUP HCPCS C1713 75697555 - SCREW BONE 7.5MM 55MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75697560 SUP HCPCS C1713 75697560 - SCREW BONE 7.5MM 60MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75697565 SUP HCPCS C1713 75697565 - SCREW BONE 7.5MM 65MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75697570 SUP HCPCS C1713 75697570 - SCREW BONE 7.5MM 70MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75698525 SUP HCPCS C1713 75698525 - SCREW BONE 8.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75698530 SUP HCPCS C1713 75698530 - SCREW BONE 8.5MM 30MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75698535 SUP HCPCS C1713 75698535 - SCREW BONE 8.5MM 35MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75698540 SUP HCPCS C1713 75698540 - SCREW BONE 8.5MM 40MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75698545 SUP HCPCS C1713 75698545 - SCREW BONE 8.5MM 45MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75698550 SUP HCPCS C1713 75698550 - SCREW BONE 8.5MM 50MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75698555 SUP HCPCS C1713 75698555 - SCREW BONE 8.5MM 55MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75698560 SUP HCPCS C1713 75698560 - SCREW BONE 8.5MM 60MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 75698565 SUP HCPCS C1713 75698565 - SCREW BONE 8.5MM 65MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76440020 SUP HCPCS C1713 76440020 - SCREW BONE MULTIAX LEGACY CD HORIZON SPN PEDICLE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 76444020 SUP HCPCS C1713 76444020 - SCREW BONE FLUTE 4MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76444025 SUP HCPCS C1713 76444025 - SCREW BONE FLUTE 4MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76444030 SUP HCPCS C1713 76444030 - SCREW BONE FLUTE 4MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76444035 SUP HCPCS C1713 76444035 - SCREW BONE FLUTE 4MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76444040 SUP HCPCS C1713 76444040 - SCREW BONE FLUTE 4MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76444045 SUP HCPCS C1713 76444045 - SCREW BONE FLUTE 4MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76444050 SUP HCPCS C1713 76444050 - SCREW BONE FLUTE 4MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76444520 SUP HCPCS C1713 76444520 - SCREW BONE FLUTE 4.5MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76444525 SUP HCPCS C1713 76444525 - SCREW BONE FLUTE 4.5MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76444530 SUP HCPCS C1713 76444530 - SCREW BONE FLUTE 4.5MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76444535 SUP HCPCS C1713 76444535 - SCREW BONE FLUTE 4.5MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76444540 SUP HCPCS C1713 76444540 - SCREW BONE FLUTE 4.5MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76444545 SUP HCPCS C1713 76444545 - SCREW BONE FLUTE 4.5MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76444550 SUP HCPCS C1713 76444550 - SCREW BONE FLUTE 4.5MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445020 SUP HCPCS C1713 76445020 - SCREW BONE FLUTE 5MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445025 SUP HCPCS C1713 76445025 - SCREW BONE FLUTE 5MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445030 SUP HCPCS C1713 76445030 - SCREW BONE FLUTE 5MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445035 SUP HCPCS C1713 76445035 - SCREW BONE FLUTE 5MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445040 SUP HCPCS C1713 76445040 - SCREW BONE FLUTE 5MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445045 SUP HCPCS C1713 76445045 - SCREW BONE FLUTE 5MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445050 SUP HCPCS C1713 76445050 - SCREW BONE FLUTE 5MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445520 SUP HCPCS C1713 76445520 - SCREW BONE FLUTE 5.5MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445525 SUP HCPCS C1713 76445525 - SCREW BONE FLUTE 5.5MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445530 SUP HCPCS C1713 76445530 - SCREW BONE FLUTE 5.5MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445535 SUP HCPCS C1713 76445535 - SCREW BONE FLUTE 5.5MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445540 SUP HCPCS C1713 76445540 - SCREW BONE FLUTE 5.5MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445545 SUP HCPCS C1713 76445545 - SCREW BONE FLUTE 5.5MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445550 SUP HCPCS C1713 76445550 - SCREW BONE FLUTE 5.5MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445555 SUP HCPCS C1713 76445555 - SCREW BONE FLUTE 5.5MM 55MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76445560 SUP HCPCS C1713 76445560 - SCREW BONE FLUTE 5.5MM 60MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446025 SUP HCPCS C1713 76446025 - SCREW BONE FLUTE 6MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446030 SUP HCPCS C1713 76446030 - SCREW BONE FLUTE 6MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446035 SUP HCPCS C1713 76446035 - SCREW BONE FLUTE 6MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446040 SUP HCPCS C1713 76446040 - SCREW BONE FLUTE 6MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446045 SUP HCPCS C1713 76446045 - SCREW BONE FLUTE 6MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446050 SUP HCPCS C1713 76446050 - SCREW BONE FLUTE 6MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446055 SUP HCPCS C1713 76446055 - SCREW BONE FLUTE 6MM 55MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446060 SUP HCPCS C1713 76446060 - SCREW BONE FLUTE 6MM 60MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446065 SUP HCPCS C1713 76446065 - SCREW BONE FLUTE 6MM 65MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446070 SUP HCPCS C1713 76446070 - SCREW BONE FLUTE 6MM 70MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446075 SUP HCPCS C1713 76446075 - SCREW BONE FLUTE 6MM 75MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446520 SUP HCPCS C1713 76446520 - SCREW BONE FLUTE 6.5MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446525 SUP HCPCS C1713 76446525 - SCREW BONE FLUTE 6.5MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446530 SUP HCPCS C1713 76446530 - SCREW BONE FLUTE 6.5MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446535 SUP HCPCS C1713 76446535 - SCREW BONE FLUTE 6.5MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446540 SUP HCPCS C1713 76446540 - SCREW BONE FLUTE 6.5MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446545 SUP HCPCS C1713 76446545 - SCREW BONE FLUTE 6.5MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446550 SUP HCPCS C1713 76446550 - SCREW BONE FLUTE 6.5MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446555 SUP HCPCS C1713 76446555 - SCREW BONE FLUTE 6.5MM 55MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446560 SUP HCPCS C1713 76446560 - SCREW BONE FLUTE 6.5MM 60MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446565 SUP HCPCS C1713 76446565 - SCREW BONE FLUTE 6.5MM 65MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446570 SUP HCPCS C1713 76446570 - SCREW BONE FLUTE 6.5MM 70MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76446575 SUP HCPCS C1713 76446575 - SCREW BONE FLUTE 6.5MM 75MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76447525 SUP HCPCS C1713 76447525 - SCREW BONE FLUTE 7.5MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76447530 SUP HCPCS C1713 76447530 - SCREW BONE FLUTE 7.5MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76447535 SUP HCPCS C1713 76447535 - SCREW BONE FLUTE 7.5MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76447540 SUP HCPCS C1713 76447540 - SCREW BONE FLUTE 7.5MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76447545 SUP HCPCS C1713 76447545 - SCREW BONE FLUTE 7.5MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76447550 SUP HCPCS C1713 76447550 - SCREW BONE FLUTE 7.5MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76447555 SUP HCPCS C1713 76447555 - SCREW BONE FLUTE 7.5MM 55MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76447560 SUP HCPCS C1713 76447560 - SCREW BONE FLUTE 7.5MM 60MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76447565 SUP HCPCS C1713 76447565 - SCREW BONE FLUTE 7.5MM 65MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76447570 SUP HCPCS C1713 76447570 - SCREW BONE FLUTE 7.5MM 70MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76447575 SUP HCPCS C1713 76447575 - SCREW BONE FLUTE 7.5MM 75MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76448525 SUP HCPCS C1713 76448525 - SCREW BONE FLUTE 8.5MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76448530 SUP HCPCS C1713 76448530 - SCREW BONE FLUTE 8.5MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76448535 SUP HCPCS C1713 76448535 - SCREW BONE FLUTE 8.5MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76448540 SUP HCPCS C1713 76448540 - SCREW BONE FLUTE 8.5MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76448545 SUP HCPCS C1713 76448545 - SCREW BONE FLUTE 8.5MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76448550 SUP HCPCS C1713 76448550 - SCREW BONE FLUTE 8.5MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76448555 SUP HCPCS C1713 76448555 - SCREW BONE FLUTE 8.5MM 55MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76448560 SUP HCPCS C1713 76448560 - SCREW BONE FLUTE 8.5MM 60MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76448565 SUP HCPCS C1713 76448565 - SCREW BONE FLUTE 8.5MM 65MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76448570 SUP HCPCS C1713 76448570 - SCREW BONE FLUTE 8.5MM 70MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76448575 SUP HCPCS C1713 76448575 - SCREW BONE FLUTE 8.5MM 75MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76494520 SUP HCPCS C1713 76494520 - SCREW BONE 4.5MM 20MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76494525 SUP HCPCS C1713 76494525 - SCREW BONE 4.5MM 25MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76494530 SUP HCPCS C1713 76494530 - SCREW BONE 4.5MM 30MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76494535 SUP HCPCS C1713 76494535 - SCREW BONE 4.5MM 35MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76494540 SUP HCPCS C1713 76494540 - SCREW BONE 4.5MM 40MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76494545 SUP HCPCS C1713 76494545 - SCREW BONE 4.5MM 45MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76494550 SUP HCPCS C1713 76494550 - SCREW BONE 4.5MM 50MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495020 SUP HCPCS C1713 76495020 - SCREW BONE 5MM 20MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495025 SUP HCPCS C1713 76495025 - SCREW BONE 5MM 25MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495030 SUP HCPCS C1713 76495030 - SCREW BONE 5MM 30MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495035 SUP HCPCS C1713 76495035 - SCREW BONE 5MM 35MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495040 SUP HCPCS C1713 76495040 - SCREW BONE 5MM 40MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495045 SUP HCPCS C1713 76495045 - SCREW BONE 5MM 45MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495050 SUP HCPCS C1713 76495050 - SCREW BONE 5MM 50MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495520 SUP HCPCS C1713 76495520 - SCREW BONE 5.5MM 20MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495525 SUP HCPCS C1713 76495525 - SCREW BONE 5.5MM 25MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495530 SUP HCPCS C1713 76495530 - SCREW BONE 5.5MM 30MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495535 SUP HCPCS C1713 76495535 - SCREW BONE 5.5MM 35MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495540 SUP HCPCS C1713 76495540 - SCREW BONE 5.5MM 40MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495545 SUP HCPCS C1713 76495545 - SCREW BONE 5.5MM 45MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495550 SUP HCPCS C1713 76495550 - SCREW BONE 5.5MM 50MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495555 SUP HCPCS C1713 76495555 - SCREW BONE 5.5MM 55MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76495560 SUP HCPCS C1713 76495560 - SCREW BONE 5.5MM 60MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76496525 SUP HCPCS C1713 76496525 - SCREW BONE 6.5MM 25MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76496530 SUP HCPCS C1713 76496530 - SCREW BONE 6.5MM 30MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76496535 SUP HCPCS C1713 76496535 - SCREW BONE 6.5MM 35MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76496540 SUP HCPCS C1713 76496540 - SCREW BONE 6.5MM 40MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76496545 SUP HCPCS C1713 76496545 - SCREW BONE 6.5MM 45MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76496550 SUP HCPCS C1713 76496550 - SCREW BONE 6.5MM 50MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76496555 SUP HCPCS C1713 76496555 - SCREW BONE 6.5MM 55MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76496560 SUP HCPCS C1713 76496560 - SCREW BONE 6.5MM 60MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76496565 SUP HCPCS C1713 76496565 - SCREW BONE 6.5MM 65MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76496570 SUP HCPCS C1713 76496570 - SCREW BONE 6.5MM 70MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76496575 SUP HCPCS C1713 76496575 - SCREW BONE 6.5MM 75MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76497525 SUP HCPCS C1713 76497525 - SCREW BONE 7.5MM 25MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76497530 SUP HCPCS C1713 76497530 - SCREW BONE 7.5MM 30MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76497535 SUP HCPCS C1713 76497535 - SCREW BONE 7.5MM 35MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76497540 SUP HCPCS C1713 76497540 - SCREW BONE 7.5MM 40MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76497545 SUP HCPCS C1713 76497545 - SCREW BONE 7.5MM 45MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76497550 SUP HCPCS C1713 76497550 - SCREW BONE 7.5MM 50MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76497555 SUP HCPCS C1713 76497555 - SCREW BONE 7.5MM 55MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76497560 SUP HCPCS C1713 76497560 - SCREW BONE 7.5MM 60MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76497565 SUP HCPCS C1713 76497565 - SCREW BONE 7.5MM 65MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76497570 SUP HCPCS C1713 76497570 - SCREW BONE 7.5MM 70MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76497575 SUP HCPCS C1713 76497575 - SCREW BONE 7.5MM 75MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76498525 SUP HCPCS C1713 76498525 - SCREW BONE 8.5MM 25MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76498530 SUP HCPCS C1713 76498530 - SCREW BONE 8.5MM 30MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76498535 SUP HCPCS C1713 76498535 - SCREW BONE 8.5MM 35MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76498540 SUP HCPCS C1713 76498540 - SCREW BONE 8.5MM 40MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76498545 SUP HCPCS C1713 76498545 - SCREW BONE 8.5MM 45MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76498550 SUP HCPCS C1713 76498550 - SCREW BONE 8.5MM 50MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76498555 SUP HCPCS C1713 76498555 - SCREW BONE 8.5MM 55MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76498560 SUP HCPCS C1713 76498560 - SCREW BONE 8.5MM 60MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76498565 SUP HCPCS C1713 76498565 - SCREW BONE 8.5MM 65MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76498570 SUP HCPCS C1713 76498570 - SCREW BONE 8.5MM 70MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76498575 SUP HCPCS C1713 76498575 - SCREW BONE 8.5MM 75MM G4 TECHNOLOGY MULTIAX REDX LEGACY CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76644020 SUP HCPCS C1713 76644020 - SCREW BONE FLUTE 4MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76644025 SUP HCPCS C1713 76644025 - SCREW BONE FLUTE 4MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76644030 SUP HCPCS C1713 76644030 - SCREW BONE FLUTE 4MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76644035 SUP HCPCS C1713 76644035 - SCREW BONE FLUTE 4MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76644040 SUP HCPCS C1713 76644040 - SCREW BONE FLUTE 4MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76644045 SUP HCPCS C1713 76644045 - SCREW BONE FLUTE 4MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76644050 SUP HCPCS C1713 76644050 - SCREW BONE FLUTE 4MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76644520 SUP HCPCS C1713 76644520 - SCREW BONE FLUTE 4.5MM 20MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76644525 SUP HCPCS C1713 76644525 - SCREW BONE FLUTE 4.5MM 25MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76644530 SUP HCPCS C1713 76644530 - SCREW BONE FLUTE 4.5MM 30MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76644535 SUP HCPCS C1713 76644535 - SCREW BONE FLUTE 4.5MM 35MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76644540 SUP HCPCS C1713 76644540 - SCREW BONE FLUTE 4.5MM 40MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76644545 SUP HCPCS C1713 76644545 - SCREW BONE FLUTE 4.5MM 45MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76644550 SUP HCPCS C1713 76644550 - SCREW BONE FLUTE 4.5MM 50MM G4 TECHNOLOGY MULTIAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645020 SUP HCPCS C1713 76645020 - SCREW BONE KNURL 5MM 20MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645025 SUP HCPCS C1713 76645025 - SCREW BONE KNURL 5MM 25MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645030 SUP HCPCS C1713 76645030 - SCREW BONE KNURL 5MM 30MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645035 SUP HCPCS C1713 76645035 - SCREW BONE KNURL 5MM 35MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645040 SUP HCPCS C1713 76645040 - SCREW BONE KNURL 5MM 40MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645045 SUP HCPCS C1713 76645045 - SCREW BONE KNURL 5MM 45MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645050 SUP HCPCS C1713 76645050 - SCREW BONE KNURL 5MM 50MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645520 SUP HCPCS C1713 76645520 - SCREW BONE KNURL 5.5MM 20MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645525 SUP HCPCS C1713 76645525 - SCREW BONE KNURL 5.5MM 25MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645530 SUP HCPCS C1713 76645530 - SCREW BONE KNURL 5.5MM 30MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645535 SUP HCPCS C1713 76645535 - SCREW BONE KNURL 5.5MM 35MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645540 SUP HCPCS C1713 76645540 - SCREW BONE KNURL 5.5MM 40MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645545 SUP HCPCS C1713 76645545 - SCREW BONE KNURL 5.5MM 45MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645550 SUP HCPCS C1713 76645550 - SCREW BONE KNURL 5.5MM 50MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645555 SUP HCPCS C1713 76645555 - SCREW BONE KNURL 5.5MM 55MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76645560 SUP HCPCS C1713 76645560 - SCREW BONE KNURL 5.5MM 60MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646025 SUP HCPCS C1713 76646025 - SCREW BONE KNURL 6MM 25MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646030 SUP HCPCS C1713 76646030 - SCREW BONE KNURL 6MM 30MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646035 SUP HCPCS C1713 76646035 - SCREW BONE KNURL 6MM 35MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646040 SUP HCPCS C1713 76646040 - SCREW BONE KNURL 6MM 40MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646045 SUP HCPCS C1713 76646045 - SCREW BONE KNURL 6MM 45MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646050 SUP HCPCS C1713 76646050 - SCREW BONE KNURL 6MM 50MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646055 SUP HCPCS C1713 76646055 - SCREW BONE KNURL 6MM 55MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646060 SUP HCPCS C1713 76646060 - SCREW BONE KNURL 6MM 60MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646065 SUP HCPCS C1713 76646065 - SCREW BONE KNURL 6MM 65MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646070 SUP HCPCS C1713 76646070 - SCREW BONE KNURL 6MM 70MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646075 SUP HCPCS C1713 76646075 - SCREW BONE KNURL 6MM 75MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646525 SUP HCPCS C1713 76646525 - SCREW BONE KNURL 6.5MM 25MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646530 SUP HCPCS C1713 76646530 - SCREW BONE KNURL 6.5MM 30MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646535 SUP HCPCS C1713 76646535 - SCREW BONE KNURL 6.5MM 35MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646540 SUP HCPCS C1713 76646540 - SCREW BONE KNURL 6.5MM 40MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646545 SUP HCPCS C1713 76646545 - SCREW BONE KNURL 6.5MM 45MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646550 SUP HCPCS C1713 76646550 - SCREW BONE KNURL 6.5MM 50MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646555 SUP HCPCS C1713 76646555 - SCREW BONE KNURL 6.5MM 55MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646560 SUP HCPCS C1713 76646560 - SCREW BONE KNURL 6.5MM 60MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646565 SUP HCPCS C1713 76646565 - SCREW BONE KNURL 6.5MM 65MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646570 SUP HCPCS C1713 76646570 - SCREW BONE KNURL 6.5MM 70MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76646575 SUP HCPCS C1713 76646575 - SCREW BONE KNURL 6.5MM 75MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76647525 SUP HCPCS C1713 76647525 - SCREW BONE KNURL 7.5MM 25MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76647530 SUP HCPCS C1713 76647530 - SCREW BONE KNURL 7.5MM 30MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76647535 SUP HCPCS C1713 76647535 - SCREW BONE KNURL 7.5MM 35MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76647540 SUP HCPCS C1713 76647540 - SCREW BONE KNURL 7.5MM 40MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76647545 SUP HCPCS C1713 76647545 - SCREW BONE KNURL 7.5MM 45MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76647550 SUP HCPCS C1713 76647550 - SCREW BONE KNURL 7.5MM 50MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76647555 SUP HCPCS C1713 76647555 - SCREW BONE KNURL 7.5MM 55MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76647560 SUP HCPCS C1713 76647560 - SCREW BONE KNURL 7.5MM 60MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76647565 SUP HCPCS C1713 76647565 - SCREW BONE KNURL 7.5MM 65MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76647570 SUP HCPCS C1713 76647570 - SCREW BONE KNURL 7.5MM 70MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76647575 SUP HCPCS C1713 76647575 - SCREW BONE KNURL 7.5MM 75MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76648525 SUP HCPCS C1713 76648525 - SCREW BONE KNURL 8.5MM 25MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76648530 SUP HCPCS C1713 76648530 - SCREW BONE KNURL 8.5MM 30MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76648535 SUP HCPCS C1713 76648535 - SCREW BONE KNURL 8.5MM 35MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76648540 SUP HCPCS C1713 76648540 - SCREW BONE KNURL 8.5MM 40MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76648545 SUP HCPCS C1713 76648545 - SCREW BONE KNURL 8.5MM 45MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76648550 SUP HCPCS C1713 76648550 - SCREW BONE KNURL 8.5MM 50MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76648555 SUP HCPCS C1713 76648555 - SCREW BONE KNURL 8.5MM 55MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76648560 SUP HCPCS C1713 76648560 - SCREW BONE KNURL 8.5MM 60MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76648565 SUP HCPCS C1713 76648565 - SCREW BONE KNURL 8.5MM 65MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76648570 SUP HCPCS C1713 76648570 - SCREW BONE KNURL 8.5MM 70MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76648575 SUP HCPCS C1713 76648575 - SCREW BONE KNURL 8.5MM 75MM G4 TECHNOLOGY MULTIAX SELF BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76694520 SUP HCPCS C1713 76694520 - SCREW BONE 4.5MM 20MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76694525 SUP HCPCS C1713 76694525 - SCREW BONE 4.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76694530 SUP HCPCS C1713 76694530 - SCREW BONE 4.5MM 30MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76694535 SUP HCPCS C1713 76694535 - SCREW BONE 4.5MM 35MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76694540 SUP HCPCS C1713 76694540 - SCREW BONE 4.5MM 40MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76694545 SUP HCPCS C1713 76694545 - SCREW BONE 4.5MM 45MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76694550 SUP HCPCS C1713 76694550 - SCREW BONE 4.5MM 50MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695020 SUP HCPCS C1713 76695020 - SCREW BONE 5MM 20MM MULTIAX REDX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695025 SUP HCPCS C1713 76695025 - SCREW BONE 5MM 25MM MULTIAX REDX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695030 SUP HCPCS C1713 76695030 - SCREW BONE 5MM 30MM MULTIAX REDX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695035 SUP HCPCS C1713 76695035 - SCREW BONE 5MM 35MM MULTIAX REDX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695040 SUP HCPCS C1713 76695040 - SCREW BONE 5MM 40MM MULTIAX REDX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695045 SUP HCPCS C1713 76695045 - SCREW BONE 5MM 45MM MULTIAX REDX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695050 SUP HCPCS C1713 76695050 - SCREW BONE 5MM 50MM MULTIAX REDX LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695520 SUP HCPCS C1713 76695520 - SCREW BONE 5.5MM 20MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695525 SUP HCPCS C1713 76695525 - SCREW BONE 5.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695530 SUP HCPCS C1713 76695530 - SCREW BONE 5.5MM 30MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695535 SUP HCPCS C1713 76695535 - SCREW BONE 5.5MM 35MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695540 SUP HCPCS C1713 76695540 - SCREW BONE 5.5MM 40MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695545 SUP HCPCS C1713 76695545 - SCREW BONE 5.5MM 45MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695550 SUP HCPCS C1713 76695550 - SCREW BONE 5.5MM 50MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695555 SUP HCPCS C1713 76695555 - SCREW BONE 5.5MM 55MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76695560 SUP HCPCS C1713 76695560 - SCREW BONE 5.5MM 60MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76696525 SUP HCPCS C1713 76696525 - SCREW BONE 6.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76696530 SUP HCPCS C1713 76696530 - SCREW BONE 6.5MM 30MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76696535 SUP HCPCS C1713 76696535 - SCREW BONE 6.5MM 35MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76696540 SUP HCPCS C1713 76696540 - SCREW BONE 6.5MM 40MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76696545 SUP HCPCS C1713 76696545 - SCREW BONE 6.5MM 45MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76696550 SUP HCPCS C1713 76696550 - SCREW BONE 6.5MM 50MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76696555 SUP HCPCS C1713 76696555 - SCREW BONE 6.5MM 55MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76696560 SUP HCPCS C1713 76696560 - SCREW BONE 6.5MM 60MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76696565 SUP HCPCS C1713 76696565 - SCREW BONE 6.5MM 65MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76696570 SUP HCPCS C1713 76696570 - SCREW BONE 6.5MM 70MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76696575 SUP HCPCS C1713 76696575 - SCREW BONE 6.5MM 75MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76697525 SUP HCPCS C1713 76697525 - SCREW BONE 7.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76697530 SUP HCPCS C1713 76697530 - SCREW BONE 7.5MM 30MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76697535 SUP HCPCS C1713 76697535 - SCREW BONE 7.5MM 35MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76697540 SUP HCPCS C1713 76697540 - SCREW BONE 7.5MM 40MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76697545 SUP HCPCS C1713 76697545 - SCREW BONE 7.5MM 45MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76697550 SUP HCPCS C1713 76697550 - SCREW BONE 7.5MM 50MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76697555 SUP HCPCS C1713 76697555 - SCREW BONE 7.5MM 55MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76697560 SUP HCPCS C1713 76697560 - SCREW BONE 7.5MM 60MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76697565 SUP HCPCS C1713 76697565 - SCREW BONE 7.5MM 65MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76697570 SUP HCPCS C1713 76697570 - SCREW BONE 7.5MM 70MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76697575 SUP HCPCS C1713 76697575 - SCREW BONE 7.5MM 75MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76698525 SUP HCPCS C1713 76698525 - SCREW BONE 8.5MM 25MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76698530 SUP HCPCS C1713 76698530 - SCREW BONE 8.5MM 30MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76698535 SUP HCPCS C1713 76698535 - SCREW BONE 8.5MM 35MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76698540 SUP HCPCS C1713 76698540 - SCREW BONE 8.5MM 40MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76698545 SUP HCPCS C1713 76698545 - SCREW BONE 8.5MM 45MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76698550 SUP HCPCS C1713 76698550 - SCREW BONE 8.5MM 50MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76698555 SUP HCPCS C1713 76698555 - SCREW BONE 8.5MM 55MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76698560 SUP HCPCS C1713 76698560 - SCREW BONE 8.5MM 60MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76698565 SUP HCPCS C1713 76698565 - SCREW BONE 8.5MM 65MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76698570 SUP HCPCS C1713 76698570 - SCREW BONE 8.5MM 70MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 76698575 SUP HCPCS C1713 76698575 - SCREW BONE 8.5MM 75MM MULTIAX REDX LEGACY CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 77101050 SUP HCPCS C1762 77101050 - GRAFT SFT TIS ALGRF BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 77101054 SUP Custom 27803010 77101054 - SPACER CMNT 4D 14X12X5MM CERV SPNL BONE PLUG BOTH IP/OP "$6,675.00" "$4,940.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$6,675.00" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$6,675.00" "$6,675.00" N/A N/A 77101060 SUP HCPCS C1713 77101060 - SPACER ALGRF 0D 14X12X6MM BIO AVS OPN PLG CRV BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 77101064 SUP Custom 27803010 77101064 - SPACER CMNT 4D 14X12X6MM CERV SPNL BONE PLUG BOTH IP/OP "$6,675.00" "$4,940.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$6,675.00" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$6,675.00" "$6,675.00" N/A N/A 77101070 SUP HCPCS C1713 77101070 - PLATE 0D 8MM HOLE BONE CERV BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 77101074 SUP HCPCS C1713 77101074 - PLATE 4D 7IN HOLE BONE CERV SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 77101080 SUP HCPCS C1713 77101080 - PLATE 0D 7MM HOLE BONE CERV BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 77101084 SUP HCPCS C1713 77101084 - SCREW BONE 8MM 14MM 12MM SPNL WDG BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 77101090 SUP HCPCS C1713 77101090 - PLATE 0D 9MM HOLE BONE CERV BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 77101094 SUP HCPCS C1713 77101094 - SPACER ALGRF 4D 14X12X9MM BIO AVS OPN PLG CRV BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 77101100 SUP Custom 27803010 77101100 - SPACER SPNL 14X12X10MM AVS 0D CAGE BIO BOTH IP/OP "$6,675.00" "$4,940.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$6,675.00" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$6,675.00" "$6,675.00" N/A N/A 77102050 SUP HCPCS C1713 77102050 - PLATE 0D 14X12IN N LORD CCANC 5 HOLE BONE BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 77102054 SUP Custom 27803010 77102054 - SPACER SPNL 5MM AVS 4D BONE PLUG BABSR BOTH IP/OP "$6,675.00" "$4,940.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$6,675.00" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$6,675.00" "$6,675.00" N/A N/A 77102060 SUP HCPCS C1713 77102060 - PLATE 0D 14X12IN N LORD CCANC 6 HOLE BONE BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 77102064 SUP Custom 27803010 77102064 - SPACER SPNL 6MM AVS 4D BONE PLUG BABSR BOTH IP/OP "$6,675.00" "$4,940.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$6,675.00" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$6,675.00" "$6,675.00" N/A N/A 77102070 SUP HCPCS C1713 77102070 - PLATE 0D 14X12IN N LORD CCANC 7 HOLE BONE BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 77102074 SUP Custom 27803010 77102074 - SPACER SPNL 7MM AVS 4D BONE PLUG BABSR BOTH IP/OP "$6,675.00" "$4,940.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$6,675.00" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$6,675.00" "$6,675.00" N/A N/A 77102084 SUP Custom 27803010 77102084 - SPACER SPNL 8MM AVS 4D BONE PLUG BABSR BOTH IP/OP "$6,675.00" "$4,940.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$6,675.00" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$6,675.00" "$6,675.00" N/A N/A 77102090 SUP HCPCS C1713 77102090 - PLATE 0D 14X12IN N LORD CCANC 9 HOLE BONE BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 77102094 SUP Custom 27803010 77102094 - SPACER ALGRF 4D LORDOSIS 12MM 14X9MM BIO AVS PRESERVON FRZDR BOTH IP/OP "$6,675.00" "$4,940.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$6,675.00" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$6,675.00" "$6,675.00" N/A N/A 77102100 SUP Custom 27803010 77102100 - SPACER ALGRF 4D 14X12X10MM BIO AVS OPN PLG CRV BOTH IP/OP "$6,675.00" "$4,940.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$6,675.00" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$6,675.00" "$6,675.00" N/A N/A 77102104 SUP HCPCS C1713 77102104 - SPACER ALGRF 4D LORDOSIS 12MM 14X10MM BIO AVS FRZDR C PLG 1 BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 77562815 SUP Custom 27203010 77562815 - BIT DRILL 3.2MM FLEXIBLE BOTH IP/OP "$1,072.50" $794.00 $190.91 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $190.91 "$1,072.50" "$1,072.50" $796.01 $796.01 $826.68 $558.77 $223.52 "$1,072.50" $429.00 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $697.13 "$1,072.50" N/A $622.05 "$1,072.50" $643.50 "$1,072.50" "$1,072.50" "$1,072.50" N/A N/A 80100100 SUP HCPCS C1769 80100100 - GUIDEWIRE ORTH .045IN BOTH IP/OP $37.50 $28.00 $7.44 $37.50 $20.36 $20.36 $20.36 $20.36 $37.50 $37.50 $37.50 $7.82 $37.50 $27.83 $27.83 $28.91 $19.54 $7.82 $37.50 $37.50 $22.18 $37.50 $37.50 $37.50 $37.50 $28.13 $37.50 $37.50 $37.50 $18.75 $18.75 $29.70 $37.50 $30.00 $24.38 $7.44 N/A $21.75 $37.50 $37.50 $37.50 $7.82 $37.50 N/A N/A 80100101 SUP HCPCS C1769 80100101 - GUIDEWIRE SRG .035IN BOTH IP/OP $37.50 $28.00 $7.44 $37.50 $20.36 $20.36 $20.36 $20.36 $37.50 $37.50 $37.50 $7.82 $37.50 $27.83 $27.83 $28.91 $19.54 $7.82 $37.50 $37.50 $22.18 $37.50 $37.50 $37.50 $37.50 $28.13 $37.50 $37.50 $37.50 $18.75 $18.75 $29.70 $37.50 $30.00 $24.38 $7.44 N/A $21.75 $37.50 $37.50 $37.50 $7.82 $37.50 N/A N/A 80100102 SUP Custom 27203010 80100102 - WIRE FX .035IN 7IN KRSH STRG BOTH IP/OP $37.50 $28.00 $6.68 $37.50 $37.50 $37.50 $37.50 $37.50 $37.50 $37.50 $6.68 $37.50 $37.50 $27.83 $27.83 $28.91 $19.54 $7.82 $37.50 $15.00 $37.50 $37.50 $37.50 $37.50 $37.50 $28.13 $37.50 $37.50 $37.50 $18.75 $18.75 $29.70 $37.50 $30.00 $24.38 $37.50 N/A $21.75 $37.50 $22.50 $37.50 $37.50 $37.50 N/A N/A 80100103 SUP Custom 27203010 80100103 - WIRE FX .035IN KRSH BIOTRACK BOTH IP/OP $37.50 $28.00 $6.68 $37.50 $37.50 $37.50 $37.50 $37.50 $37.50 $37.50 $6.68 $37.50 $37.50 $27.83 $27.83 $28.91 $19.54 $7.82 $37.50 $15.00 $37.50 $37.50 $37.50 $37.50 $37.50 $28.13 $37.50 $37.50 $37.50 $18.75 $18.75 $29.70 $37.50 $30.00 $24.38 $37.50 N/A $21.75 $37.50 $22.50 $37.50 $37.50 $37.50 N/A N/A 80100125 SUP Custom 27203010 80100125 - HANDLE QRLSE SCRDRVR NONSTRL BOTH IP/OP $730.00 $540.00 $129.94 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $129.94 $730.00 $730.00 $541.81 $541.81 $562.68 $380.33 $152.14 $730.00 $292.00 $730.00 $730.00 $730.00 $730.00 $730.00 $547.50 $730.00 $730.00 $730.00 $365.00 $365.00 $578.16 $730.00 $584.00 $474.50 $730.00 N/A $423.40 $730.00 $438.00 $730.00 $730.00 $730.00 N/A N/A 80200102 SUP HCPCS C1713 80200102 - PIN FIX 203MM 4.8MM RUSH A IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $79.20 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $39.30 N/A $114.84 $198.00 $118.80 $198.00 $41.26 $198.00 N/A N/A 80200103 SUP HCPCS C1713 80200103 - PIN FIX 222MM 4.8MM RUSH B IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $114.84 "$1,183.00" $642.37 $642.37 $642.37 $642.37 "$1,183.00" "$1,183.00" "$1,183.00" $246.57 "$1,183.00" $878.02 $878.02 $911.86 $616.34 $246.55 "$1,183.00" "$1,183.00" $699.74 "$1,183.00" "$1,183.00" "$1,183.00" "$1,183.00" $148.50 "$1,183.00" "$1,183.00" "$1,183.00" $591.50 $591.50 $936.94 "$1,183.00" $946.40 $768.95 $234.80 "$1,183.00" $114.84 "$1,183.00" "$1,183.00" "$1,183.00" $246.54 "$1,183.00" N/A N/A 80200104 SUP HCPCS C1713 80200104 - PIN FIX 241MM 4.8MM RUSH C IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $32.35 $163.00 $88.51 $88.51 $88.51 $88.51 $163.00 $163.00 $163.00 $33.97 $163.00 $120.98 $120.98 $125.64 $84.92 $33.97 $163.00 $163.00 $96.41 $163.00 $163.00 $163.00 $163.00 $148.50 $163.00 $163.00 $163.00 $81.50 $81.50 $129.10 $163.00 $130.40 $105.95 $32.35 $163.00 $114.84 $163.00 $163.00 $163.00 $33.97 $163.00 N/A N/A 80200105 SUP HCPCS C1713 80200105 - PIN FIX 260MM 4.8MM RUSH D IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $17.47 $148.50 $47.78 $47.78 $47.78 $47.78 $88.00 $88.00 $88.00 $18.34 $88.00 $65.31 $65.31 $67.83 $45.85 $18.34 $88.00 $88.00 $52.05 $88.00 $88.00 $88.00 $88.00 $148.50 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $57.20 $17.47 $88.00 $114.84 $88.00 $88.00 $88.00 $18.34 $88.00 N/A N/A 80200106 SUP HCPCS C1713 80200106 - PIN FIX 279MM 4.8MM RUSH E IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $79.20 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $39.30 N/A $114.84 $198.00 $198.00 $198.00 $41.26 $198.00 N/A N/A 80200107 SUP HCPCS C1713 80200107 - PIN FIX 298MM 4.8MM RUSH F IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $39.30 N/A $114.84 $198.00 $118.80 $198.00 $41.26 $198.00 N/A N/A 80200108 SUP HCPCS C1713 80200108 - PIN FIX 318MM 4.8MM RUSH G IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $39.30 N/A $114.84 $198.00 $198.00 $198.00 $41.26 $198.00 N/A N/A 80200109 SUP HCPCS C1713 80200109 - PIN FIX 337MM 4.8MM RUSH H IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $79.20 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $39.30 N/A $114.84 $198.00 $198.00 $198.00 $41.26 $198.00 N/A N/A 80200110 SUP HCPCS C1713 80200110 - PIN FIX 35.6CM 4.8MM RUSH I IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $79.20 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $39.30 N/A $114.84 $198.00 $198.00 $198.00 $41.26 $198.00 N/A N/A 80200111 SUP HCPCS C1713 80200111 - PIN FIX 18.4CM 4.8MM RUSH A1 IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $39.30 N/A $114.84 $198.00 $118.80 $198.00 $41.26 $198.00 N/A N/A 80200112 SUP HCPCS C1713 80200112 - PIN FIX 37.5CM 4.8MM RUSH J IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $79.20 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $39.30 N/A $114.84 $198.00 $198.00 $198.00 $41.26 $198.00 N/A N/A 80200113 SUP HCPCS C1713 80200113 - PIN FIX 39.4CM 4.8MM RUSH K IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $39.30 N/A $114.84 $198.00 $198.00 $198.00 $41.26 $198.00 N/A N/A 80200114 SUP HCPCS C1713 80200114 - PIN FIX 41.3CM 4.8MM RUSH L IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $39.30 N/A $114.84 $198.00 $198.00 $198.00 $41.26 $198.00 N/A N/A 80200115 SUP HCPCS C1713 80200115 - PIN FIX 43.2CM 4.8MM RUSH M IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $39.30 N/A $114.84 $198.00 $198.00 $198.00 $41.26 $198.00 N/A N/A 80200116 SUP HCPCS C1713 80200116 - PIN FIX 45.1CM 4.8MM RUSH N IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $39.30 N/A $114.84 $198.00 $198.00 $198.00 $41.26 $198.00 N/A N/A 80200117 SUP HCPCS C1713 80200117 - PIN FIX 47CM 4.8MM RUSH O IM SS NONSTRL BOTH IP/OP $198.00 $147.00 $39.30 $198.00 $89.10 $89.10 $89.10 $89.10 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $198.00 $198.00 $198.00 $41.27 $198.00 $198.00 $117.12 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $89.10 $39.30 N/A $114.84 $198.00 $198.00 $198.00 $41.26 $198.00 N/A N/A 80202700 SUP HCPCS C1713 80202700 - SET TRAUMA FIX 4.8MM RACK RUSH NONSTRL BOTH IP/OP "$7,028.00" "$5,201.00" "$1,394.88" "$7,028.00" "$3,162.60" "$3,162.60" "$3,162.60" "$3,162.60" "$7,028.00" "$7,028.00" "$7,028.00" "$1,464.81" "$7,028.00" "$7,028.00" "$7,028.00" "$7,028.00" "$7,028.00" "$1,464.71" "$7,028.00" "$7,028.00" "$3,464.80" "$7,028.00" "$7,028.00" "$7,028.00" "$7,028.00" "$5,271.00" "$7,028.00" "$7,028.00" "$7,028.00" "$3,514.00" "$3,514.00" "$5,566.18" "$7,028.00" "$5,622.40" "$3,162.60" "$1,394.88" N/A "$4,076.24" "$7,028.00" "$7,028.00" "$7,028.00" "$1,464.64" "$7,028.00" N/A N/A 80300102 SUP HCPCS C1713 80300102 - PIN FIX 102MM 3.2MM RUSH IM BOTH IP/OP $168.50 $125.00 $33.40 $168.30 $75.74 $75.74 $75.74 $75.74 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $99.55 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $75.74 $33.40 N/A $97.73 $168.30 $168.30 $168.30 $35.07 $168.30 N/A N/A 80300103 SUP HCPCS C1713 80300103 - PIN FX 1/8IN 4.5IN RUSH MDLRY BOTH IP/OP $168.50 $125.00 $33.40 $168.30 $75.74 $75.74 $75.74 $75.74 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $99.55 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $75.74 $33.40 N/A $97.73 $168.30 $168.30 $168.30 $35.07 $168.30 N/A N/A 80300104 SUP HCPCS C1713 80300104 - PIN FIX 127MM 3.2MM RUSH C IM SS NONSTRL BOTH IP/OP $168.50 $125.00 $33.40 $168.30 $75.74 $75.74 $75.74 $75.74 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $99.55 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $75.74 $33.40 N/A $97.73 $168.30 $168.30 $168.30 $35.07 $168.30 N/A N/A 80300105 SUP HCPCS C1713 80300105 - PIN FIX 140MM 3.2MM RUSH D IM SS NONSTRL BOTH IP/OP $168.50 $125.00 $33.40 $168.30 $75.74 $75.74 $75.74 $75.74 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $99.55 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $75.74 $33.40 N/A $97.73 $168.30 $100.98 $168.30 $35.07 $168.30 N/A N/A 80300106 SUP HCPCS C1713 80300106 - PIN FIX 152MM 3.2MM RUSH E IM SS NONSTRL BOTH IP/OP $168.50 $125.00 $33.40 $168.30 $75.74 $75.74 $75.74 $75.74 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $99.55 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $75.74 $33.40 N/A $97.73 $168.30 $100.98 $168.30 $35.07 $168.30 N/A N/A 80300107 SUP HCPCS C1713 80300107 - PIN FIX 165MM 3.2MM RUSH F IM SS NONSTRL BOTH IP/OP $168.50 $125.00 $33.40 $168.30 $75.74 $75.74 $75.74 $75.74 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $99.55 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $75.74 $33.40 N/A $97.73 $168.30 $100.98 $168.30 $35.07 $168.30 N/A N/A 80300108 SUP HCPCS C1713 80300108 - PIN FIX 178MM 3.2MM RUSH G IM SS NONSTRL BOTH IP/OP $168.50 $125.00 $33.40 $168.30 $75.74 $75.74 $75.74 $75.74 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $99.55 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $75.74 $33.40 N/A $97.73 $168.30 $100.98 $168.30 $35.07 $168.30 N/A N/A 80300109 SUP HCPCS C1713 80300109 - PIN FIX 191MM 3.2MM RUSH H IM SS NONSTRL BOTH IP/OP $168.50 $125.00 $33.40 $168.30 $75.74 $75.74 $75.74 $75.74 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $99.55 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $75.74 $33.40 N/A $97.73 $168.30 $100.98 $168.30 $35.07 $168.30 N/A N/A 80300110 SUP HCPCS C1713 80300110 - PIN FIX 203MM 3.2MM RUSH I IM SS NONSTRL BOTH IP/OP $168.50 $125.00 $33.40 $168.30 $75.74 $75.74 $75.74 $75.74 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $99.55 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $75.74 $33.40 N/A $97.73 $168.30 $100.98 $168.30 $35.07 $168.30 N/A N/A 80300111 SUP HCPCS C1713 80300111 - PIN FIX 216MM 3.2MM RUSH J IM SS NONSTRL BOTH IP/OP $168.50 $125.00 $33.40 $168.30 $75.74 $75.74 $75.74 $75.74 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $99.55 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $75.74 $33.40 N/A $97.73 $168.30 $100.98 $168.30 $35.07 $168.30 N/A N/A 80300112 SUP HCPCS C1713 80300112 - PIN FIX 229MM 3.2MM RUSH K IM SS NONSTRL BOTH IP/OP $168.50 $125.00 $33.40 $168.30 $75.74 $75.74 $75.74 $75.74 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $99.55 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $75.74 $33.40 N/A $97.73 $168.30 $100.98 $168.30 $35.07 $168.30 N/A N/A 80300113 SUP HCPCS C1713 80300113 - PIN FIX 241MM 3.2MM RUSH L IM SS NONSTRL BOTH IP/OP $168.50 $125.00 $33.40 $168.30 $75.74 $75.74 $75.74 $75.74 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $99.55 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $75.74 $33.40 N/A $97.73 $168.30 $100.98 $168.30 $35.07 $168.30 N/A N/A 80300114 SUP HCPCS C1713 80300114 - PIN FIX 254MM 3.2MM RUSH M IM SS NONSTRL BOTH IP/OP $168.50 $125.00 $33.40 $168.30 $75.74 $75.74 $75.74 $75.74 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $99.55 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $75.74 $33.40 N/A $97.73 $168.30 $100.98 $168.30 $35.07 $168.30 N/A N/A 80300120 SUP HCPCS C1713 80300120 - PIN FIX 267MM 3.2MM RUSH N IM SS NONSTRL BOTH IP/OP $168.50 $125.00 $33.40 $168.30 $75.74 $75.74 $75.74 $75.74 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $168.30 $168.30 $168.30 $35.08 $168.30 $168.30 $99.55 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $75.74 $33.40 N/A $97.73 $168.30 $100.98 $168.30 $35.07 $168.30 N/A N/A 80302700 SUP HCPCS C1713 80302700 - SET TRAUMA FIX 3.2MM RACK RUSH NONSTRL BOTH IP/OP "$5,604.00" "$4,147.00" "$1,112.25" "$5,604.00" "$2,521.80" "$2,521.80" "$2,521.80" "$2,521.80" "$5,604.00" "$5,604.00" "$5,604.00" "$1,168.01" "$5,604.00" "$5,604.00" "$5,604.00" "$5,604.00" "$5,604.00" "$1,167.94" "$5,604.00" "$5,604.00" "$2,762.77" "$5,604.00" "$5,604.00" "$5,604.00" "$5,604.00" "$4,203.00" "$5,604.00" "$5,604.00" "$5,604.00" "$2,802.00" "$2,802.00" "$4,438.37" "$5,604.00" "$4,483.20" "$2,521.80" "$1,112.25" N/A "$3,250.32" "$5,604.00" "$5,604.00" "$5,604.00" "$1,167.87" "$5,604.00" N/A N/A 80322944 SUP HCPCS C1713 186801020 - PLATE BN 20MM NS SKYLINE 1 LVL SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 80400102 SUP HCPCS C1713 80400102 - PIN FIX 2.5CM 2.4MM RUSH A IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $90.42 $150.70 $31.41 $150.70 N/A N/A 80400103 SUP HCPCS C1713 80400103 - PIN FIX 3.2CM 2.4MM RUSH B IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $90.42 $150.70 $31.41 $150.70 N/A N/A 80400104 SUP HCPCS C1713 80400104 - PIN FIX 3.8CM 2.4MM RUSH C IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $90.42 $150.70 $31.41 $150.70 N/A N/A 80400105 SUP HCPCS C1713 80400105 - PIN FIX 4.5CM 2.4MM RUSH D IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80400106 SUP HCPCS C1713 80400106 - PIN FIX 5.1CM 2.4MM RUSH E IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80400107 SUP HCPCS C1713 80400107 - PIN FIX 5.7CM 2.4MM RUSH F IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80400108 SUP HCPCS C1713 80400108 - PIN FIX 6.4CM 2.4MM RUSH G IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $60.28 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80400109 SUP HCPCS C1713 80400109 - PIN FIX 7CM 2.4MM RUSH H IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $60.28 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80400110 SUP HCPCS C1713 80400110 - PIN FIX 7.6CM 2.4MM RUSH I IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $60.28 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80400111 SUP HCPCS C1713 80400111 - PIN FIX 8.3CM 2.4MM RUSH J IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80400112 SUP HCPCS C1713 80400112 - PIN FIX 8.9CM 2.4MM RUSH K IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80400113 SUP HCPCS C1713 80400113 - PIN FIX 9.5CM 2.4MM RUSH L IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80400114 SUP HCPCS C1713 80400114 - PIN FIX 10.2CM 2.4MM RUSH M IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $60.28 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80402700 SUP HCPCS C1713 80402700 - SET TRAUMA FIX 2.4MM RACK RUSH NONSTRL BOTH IP/OP "$8,110.00" "$6,001.00" "$1,609.63" "$8,110.00" "$3,649.50" "$3,649.50" "$3,649.50" "$3,649.50" "$8,110.00" "$8,110.00" "$8,110.00" "$1,690.33" "$8,110.00" "$8,110.00" "$8,110.00" "$8,110.00" "$8,110.00" "$1,690.21" "$8,110.00" "$3,244.00" "$3,998.23" "$8,110.00" "$8,110.00" "$8,110.00" "$8,110.00" "$6,082.50" "$8,110.00" "$8,110.00" "$8,110.00" "$4,055.00" "$4,055.00" "$6,423.12" "$8,110.00" "$6,488.00" "$3,649.50" "$1,609.63" N/A "$4,703.80" "$8,110.00" "$8,110.00" "$8,110.00" "$1,690.12" "$8,110.00" N/A N/A 80600103 SUP HCPCS C1713 80600103 - PIN FIX 11.4CM 2.4MM RUSH N LNG IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $60.28 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80600104 SUP HCPCS C1713 80600104 - PIN FIX 12.7CM 2.4MM RUSH O LNG IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $60.28 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80600105 SUP HCPCS C1713 80600105 - PIN FIX 14CM 2.4MM RUSH P LNG IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80600106 SUP HCPCS C1713 80600106 - PIN FIX 15.2CM 2.4MM RUSH Q LNG IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $60.28 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80600107 SUP HCPCS C1713 80600107 - PIN FIX 16.5CM 2.4MM RUSH R LNG IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $60.28 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $90.42 $150.70 $31.41 $150.70 N/A N/A 80600108 SUP HCPCS C1713 80600108 - PIN FIX 17.8CM 2.4MM RUSH S LNG IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $90.42 $150.70 $31.41 $150.70 N/A N/A 80600109 SUP HCPCS C1713 80600109 - PIN 19.1CM 2.4MM RUSH T LNG IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80600110 SUP HCPCS C1713 80600110 - PIN FIX 20.3CM 2.4MM RUSH U LNG IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $60.28 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $90.42 $150.70 $31.41 $150.70 N/A N/A 80600111 SUP HCPCS C1713 80600111 - PIN FIX 21.6CM 2.4MM RUSH V LNG IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $60.28 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $90.42 $150.70 $31.41 $150.70 N/A N/A 80600112 SUP HCPCS C1713 80600112 - PIN FIX 22.9CM 2.4MM RUSH W LNG IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $60.28 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $150.70 $150.70 $31.41 $150.70 N/A N/A 80600113 SUP HCPCS C1713 80600113 - PIN FIX 24.1CM 2.4MM RUSH X LNG IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $60.28 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $90.42 $150.70 $31.41 $150.70 N/A N/A 80600114 SUP HCPCS C1713 80600114 - PIN FIX 25.4CM 2.4MM RUSH Y LNG IM SS NONSTRL BOTH IP/OP $151.00 $112.00 $29.91 $150.70 $67.82 $67.82 $67.82 $67.82 $150.70 $150.70 $150.70 $31.41 $150.70 $150.70 $150.70 $150.70 $150.70 $31.41 $150.70 $60.28 $89.14 $150.70 $150.70 $150.70 $150.70 $113.25 $150.70 $150.70 $150.70 $75.35 $75.35 $119.35 $150.70 $120.56 $67.82 $29.91 N/A $87.58 $150.70 $90.42 $150.70 $31.41 $150.70 N/A N/A 83545201 SUP HCPCS C1713 83545201 - SCREW BONE 4.5MM 20MM TSRH OSTEOGRIP TITANIUM BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545251 SUP HCPCS C1713 83545251 - SCREW BONE 4.5MM 25MM TSRH OSTEOGRIP TITANIUM BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545301 SUP HCPCS C1713 83545301 - SCREW BONE 4.5MM 30MM TSRH OSTEOGRIP TITANIUM BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545306 SUP HCPCS C1713 83545306 - SCREW BONE LONG 4.5MM 30MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83545309 SUP HCPCS C1713 83545309 - SCREW BN 4.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545351 SUP HCPCS C1713 83545351 - SCREW BONE 3D 4.5MM 35MM TSRH OSTEOGRIP TITANIUM SPN PEDICLE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545356 SUP HCPCS C1713 83545356 - SCREW BONE LONG 4.5MM 35MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83545359 SUP HCPCS C1713 83545359 - SCREW BN 4.5MM 35MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545401 SUP HCPCS C1713 83545401 - SCREW BONE 3D 4.5MM 40MM TSRH OSTEOGRIP TITANIUM SPN PEDICLE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545406 SUP HCPCS C1713 83545406 - SCREW BONE LONG 4.5MM 40MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83545409 SUP HCPCS C1713 83545409 - SCREW BN 4.5MM 40MM 3DX TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545451 SUP HCPCS C1713 83545451 - SCREW BONE 3D 4.5MM 45MM OSTEOGRIP TITANIUM SPN PEDICLE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545456 SUP HCPCS C1713 83545456 - SCREW BONE LONG 4.5MM 45MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" "$1,650.00" "$1,650.00" $343.86 "$1,650.00" N/A N/A 83545459 SUP HCPCS C1713 83545459 - SCREW BN 4.5MM 45MM TSRH OSTEOGRIP THNLN SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545501 SUP HCPCS C1713 83545501 - SCREW BONE 4.5MM 50MM TSRH OSTEOGRIP TITANIUM BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545506 SUP HCPCS C1713 83545506 - SCREW BONE LONG 4.5MM 50MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83545509 SUP HCPCS C1713 83545509 - SCREW BN 4.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545551 SUP HCPCS C1713 83545551 - SCREW BONE 4.5MM 55MM TITANIUM BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545556 SUP HCPCS C1713 83545556 - SCREW BONE LONG 4.5MM 55MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83545559 SUP HCPCS C1713 83545559 - SCREW BN 4.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545601 SUP HCPCS C1713 83545601 - SCREW BONE 4.5MM 60MM TITANIUM BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83545606 SUP HCPCS C1713 83545606 - SCREW BONE LONG 4.5MM 60MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83545609 SUP HCPCS C1713 83545609 - SCREW BN 4.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555201 SUP HCPCS C1713 83555201 - SCREW BONE 5.5MM 20MM 2 THREAD TSRH-3D TITANIUM SPN BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555251 SUP HCPCS C1713 83555251 - SCREW BONE 5.5MM 25MM TSRH OSTEOGRIP TITANIUM BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555301 SUP HCPCS C1713 83555301 - SCREW BONE 5.5MM 30MM 3DX TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555306 SUP HCPCS C1713 83555306 - SCREW BONE LONG 5.5MM 30MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83555307 SUP HCPCS C1713 83555307 - SCREW BONE LONG 5.5MM 30MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83555308 SUP HCPCS C1713 83555308 - SCREW BONE SHORT 5.5MM 30MM MULTI PLANAR ADJUSTING BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83555309 SUP HCPCS C1713 83555309 - SCREW BN 5.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555351 SUP HCPCS C1713 83555351 - SCREW BONE 5.5MM 35MM TSRH OSTEOGRIP TITANIUM SPN PEDICLE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555356 SUP HCPCS C1713 83555356 - SCREW BONE LONG 5.5MM 35MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83555357 SUP HCPCS C1713 83555357 - SCREW BONE LONG 5.5MM 35MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83555358 SUP HCPCS C1713 83555358 - SCREW BONE SHORT 5.5MM 35MM MULTIPLANAR ADJUST TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83555359 SUP HCPCS C1713 83555359 - SCREW BN 5.5MM 35MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555401 SUP HCPCS C1713 83555401 - SCREW BONE 5.5MM 40MM 3DX TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555406 SUP HCPCS C1713 83555406 - SCREW BONE LONG 5.5MM 40MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" "$1,650.00" "$1,650.00" $343.86 "$1,650.00" N/A N/A 83555407 SUP HCPCS C1713 83555407 - SCREW BONE LONG 5.5MM 40MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83555408 SUP HCPCS C1713 83555408 - SCREW BONE SHORT 5.5MM 40MM MULTIPLANAR ADJUST TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83555409 SUP HCPCS C1713 83555409 - SCREW BN 5.5MM 40MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555451 SUP HCPCS C1713 83555451 - SCREW BONE 5.5MM 45MM 3DX TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555456 SUP HCPCS C1713 83555456 - SCREW BONE LONG 5.5MM 45MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83555457 SUP HCPCS C1713 83555457 - SCREW BONE LONG 5.5MM 45MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83555458 SUP HCPCS C1713 83555458 - SCREW BONE SHORT 5.5MM 45MM MULTIPLANAR ADJUST TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83555459 SUP HCPCS C1713 83555459 - SCREW BN 5.5MM 45MM TSRH THNLN OSTEOGRIP SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555501 SUP HCPCS C1713 83555501 - SCREW BONE 5.5MM 50MM 3DX TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555506 SUP HCPCS C1713 83555506 - SCREW BONE LONG 5.5MM 50MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83555507 SUP HCPCS C1713 83555507 - SCREW BONE LONG 5.5MM 50MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83555508 SUP HCPCS C1713 83555508 - SCREW BONE SHORT 5.5MM 50MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83555509 SUP HCPCS C1713 83555509 - SCREW BN 5.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555551 SUP HCPCS C1713 83555551 - SCREW BONE 5.5MM 55MM TSRH OSTEOGRIP TITANIUM SPN BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555556 SUP HCPCS C1713 83555556 - SCREW BONE LONG 5.5MM 55MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83555557 SUP HCPCS C1713 83555557 - SCREW BONE LONG 5.5MM 55MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83555559 SUP HCPCS C1713 83555559 - SCREW BN 5.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555601 SUP HCPCS C1713 83555601 - SCREW BONE 5.5MM 60MM TSRH OSTEOGRIP TITANIUM BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 83555606 SUP HCPCS C1713 83555606 - SCREW BONE LONG 5.5MM 60MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83555607 SUP HCPCS C1713 83555607 - SCREW BONE LONG 5.5MM 60MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83555608 SUP HCPCS C1713 83555608 - SCREW BONE SHORT 5.5MM 60MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83555609 SUP HCPCS C1713 83555609 - SCREW BN 5.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565201 SUP HCPCS C1713 83565201 - SCREW BONE 6.5MM 20MM 2 THREAD TSRH-3D TITANIUM SPN BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565251 SUP HCPCS C1713 83565251 - SCREW BONE SHORT POST 6.5MM 25MM TSRH OSTEOGRIP TITANIUM SPN BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565259 SUP HCPCS C1713 83565259 - SCREW BONE SHORT POST 6.5MM 25MM TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565301 SUP HCPCS C1713 83565301 - SCREW BONE SHORT POST 6.5MM 30MM OSTEOGRIP TITANIUM SPN BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565306 SUP HCPCS C1713 83565306 - SCREW BONE LONG 6.5MM 30MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83565307 SUP HCPCS C1713 83565307 - SCREW BONE LONG 6.5MM 30MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83565308 SUP HCPCS C1713 83565308 - SCREW BONE 6.5MM 30MM MULTI PLANAR ADJUSTING BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83565309 SUP HCPCS C1713 83565309 - SCREW BONE 6.5MM 30MM TSRH OSTEOGRIP THINLINE TITANIUM SPN BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565351 SUP HCPCS C1713 83565351 - SCREW BONE SHORT POST 6.5MM 35MM TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565356 SUP HCPCS C1713 83565356 - SCREW BONE LONG 6.5MM 35MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" "$1,650.00" "$1,650.00" $343.86 "$1,650.00" N/A N/A 83565357 SUP HCPCS C1713 83565357 - SCREW BONE LONG 6.5MM 35MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83565358 SUP HCPCS C1713 83565358 - SCREW BONE SHORT 6.5MM 35MM MULTIPLANAR ADJUST TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83565359 SUP HCPCS C1713 83565359 - SCREW BONE 6.5MM 35MM TSRH OSTEOGRIP THINLINE TITANIUM SPN BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565401 SUP HCPCS C1713 83565401 - SCREW BONE 6.5MM 40MM 2 THREAD TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565406 SUP HCPCS C1713 83565406 - SCREW BONE LONG 6.5MM 40MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" "$1,650.00" "$1,650.00" $343.86 "$1,650.00" N/A N/A 83565407 SUP HCPCS C1713 83565407 - SCREW BONE LONG 6.5MM 40MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83565408 SUP HCPCS C1713 83565408 - SCREW BONE SHORT 6.5MM 40MM MULTIPLANAR ADJUST TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83565409 SUP HCPCS C1713 83565409 - SCREW BN 6.5MM 40MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565451 SUP HCPCS C1713 83565451 - SCREW BONE SHORT POST 6.5MM 45MM TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565454 SUP HCPCS C1713 83565454 - SCREW BONE 6.5MM 45MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83565456 SUP HCPCS C1713 83565456 - SCREW BONE LONG 6.5MM 45MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" "$1,650.00" "$1,650.00" $343.86 "$1,650.00" N/A N/A 83565457 SUP HCPCS C1713 83565457 - SCREW BONE LONG 6.5MM 45MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83565458 SUP HCPCS C1713 83565458 - SCREW BONE SHORT 6.5MM 45MM MULTIPLANAR ADJUST TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83565459 SUP HCPCS C1713 83565459 - SCREW BN 6.5MM 45MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565501 SUP HCPCS C1713 83565501 - SCREW BONE 6.5MM 50MM 2 THREAD TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565504 SUP HCPCS C1713 83565504 - SCREW BONE SHORT POST 6.5MM 50MM MULTIPLANAR ADJUST TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83565506 SUP HCPCS C1713 83565506 - SCREW BONE LONG 6.5MM 50MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83565507 SUP HCPCS C1713 83565507 - SCREW BONE LONG 6.5MM 50MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83565508 SUP HCPCS C1713 83565508 - SCREW BONE SHORT 6.5MM 50MM MULTIPLANAR ADJUST TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83565509 SUP HCPCS C1713 83565509 - SCREW BONE 6.5MM 50MM TSRH OSTEOGRIP THINLINE TITANIUM SPN BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565551 SUP HCPCS C1713 83565551 - SCREW BONE 6.5MM 55MM TSRH OSTEOGRIP TITANIUM SPN PEDICLE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565554 SUP HCPCS C1713 83565554 - SCREW BONE SHORT POST 6.5MM 55MM MULTIPLANAR ADJUST TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" "$1,520.88" "$1,520.88" $316.95 "$1,520.88" N/A N/A 83565556 SUP HCPCS C1713 83565556 - SCREW BONE LONG 6.5MM 55MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83565557 SUP HCPCS C1713 83565557 - SCREW BONE LONG 6.5MM 55MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83565558 SUP HCPCS C1713 83565558 - SCREW BONE SHORT 6.5MM 55MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83565559 SUP HCPCS C1713 83565559 - SCREW BONE 6.5MM 55MM TSRH OSTEOGRIP THINLINE TITANIUM SPN BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565601 SUP HCPCS C1713 83565601 - SCREW BONE 6.5MM 60MM 2 THREAD TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83565606 SUP HCPCS C1713 83565606 - SCREW BONE LONG 6.5MM 60MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83565607 SUP HCPCS C1713 83565607 - SCREW BONE LONG 6.5MM 60MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83565608 SUP HCPCS C1713 83565608 - SCREW BONE SHORT 6.5MM 60MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83565609 SUP HCPCS C1713 83565609 - SCREW BONE 6.5MM 60MM TSRH OSTEOGRIP THINLINE TITANIUM SPN BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575201 SUP HCPCS C1713 83575201 - SCREW BONE 7.5MM 20MM 2 THREAD TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575251 SUP HCPCS C1713 83575251 - SCREW BONE SHORT POST 7.5MM 25MM TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575301 SUP HCPCS C1713 83575301 - SCREW BONE 7.5MM 30MM 2 THREAD TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575306 SUP HCPCS C1713 83575306 - SCREW BONE LONG 7.5MM 30MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83575307 SUP HCPCS C1713 83575307 - SCREW BONE LONG 7.5MM 30MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83575308 SUP HCPCS C1713 83575308 - SCREW BONE SHORT 7.5MM 30MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83575309 SUP HCPCS C1713 83575309 - SCREW BN 7.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575351 SUP HCPCS C1713 83575351 - SCREW BONE SHORT POST 7.5MM 35MM TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575356 SUP HCPCS C1713 83575356 - SCREW BONE LONG 7.5MM 35MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83575357 SUP HCPCS C1713 83575357 - SCREW BONE LONG 7.5MM 35MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83575358 SUP HCPCS C1713 83575358 - SCREW BONE SHORT 7.5MM 35MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" "$1,520.88" "$1,520.88" $316.95 "$1,520.88" N/A N/A 83575359 SUP HCPCS C1713 83575359 - SCREW BN 7.5MM 35MM TSRH OSTEOGRIP RECON TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575401 SUP HCPCS C1713 83575401 - SCREW BONE 7.5MM 40MM 2 THREAD TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575406 SUP HCPCS C1713 83575406 - SCREW BONE LONG 7.5MM 40MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83575407 SUP HCPCS C1713 83575407 - SCREW BONE LONG 7.5MM 40MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83575408 SUP HCPCS C1713 83575408 - SCREW BONE SHORT 7.5MM 40MM MULTIPLANAR ADJUST TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83575409 SUP HCPCS C1713 83575409 - SCREW BONE 7.5MM 40MM TSRH OSTEOGRIP THNLN SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575451 SUP HCPCS C1713 83575451 - SCREW BONE SHORT POST 7.5MM 45MM TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575456 SUP HCPCS C1713 83575456 - SCREW BONE LONG 7.5MM 45MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83575457 SUP HCPCS C1713 83575457 - SCREW BONE LONG 7.5MM 45MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83575458 SUP HCPCS C1713 83575458 - SCREW BONE SHORT 7.5MM 45MM MULTIPLANAR ADJUST TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" "$1,520.88" "$1,520.88" $316.95 "$1,520.88" N/A N/A 83575459 SUP HCPCS C1713 83575459 - SCREW BN 7.5MM 45MM TSRH OSTEOGRIP THNLN TI SPNE PDCL BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575501 SUP HCPCS C1713 83575501 - SCREW BONE 7.5MM 55MM 2 THREAD TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575506 SUP HCPCS C1713 83575506 - SCREW BONE LONG 7.5MM 50MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83575507 SUP HCPCS C1713 83575507 - SCREW BONE LONG 7.5MM 50MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83575508 SUP HCPCS C1713 83575508 - SCREW BONE SHORT 7.5MM 50MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83575509 SUP HCPCS C1713 83575509 - SCREW BN 7.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575551 SUP HCPCS C1713 83575551 - SCREW BONE SHORT POST 7.5MM 55MM TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575556 SUP HCPCS C1713 83575556 - SCREW BONE LONG 7.5MM 55MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83575557 SUP HCPCS C1713 83575557 - SCREW BONE LONG 7.5MM 55MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83575558 SUP HCPCS C1713 83575558 - SCREW BONE SHORT 7.5MM 55MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83575559 SUP HCPCS C1713 83575559 - SCREW BN 7.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575601 SUP HCPCS C1713 83575601 - SCREW BONE 7.5MM 60MM 2 THREAD TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83575606 SUP HCPCS C1713 83575606 - SCREW BONE LONG 7.5MM 60MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83575607 SUP HCPCS C1713 83575607 - SCREW BONE LONG 7.5MM 60MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83575608 SUP HCPCS C1713 83575608 - SCREW BONE SHORT 7.5MM 60MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 83575609 SUP HCPCS C1713 83575609 - SCREW BN 7.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585201 SUP HCPCS C1713 83585201 - SCREW BONE 8.5MM 20MM 2 THREAD TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585251 SUP HCPCS C1713 83585251 - SCREW BONE SHORT POST 8.5MM 25MM TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585301 SUP HCPCS C1713 83585301 - SCREW BONE 8.5MM 30MM 2 THREAD TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585306 SUP HCPCS C1713 83585306 - SCREW BONE LONG 8.5MM 30MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83585307 SUP HCPCS C1713 83585307 - SCREW BONE LONG 8.5MM 30MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83585309 SUP HCPCS C1713 83585309 - SCREW BN 8.5MM 30MM TSRH OSTEOGRIP THNLN TI SPNE PDCL BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585351 SUP HCPCS C1713 83585351 - SCREW BONE SHORT POST 8.5MM 35MM TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585356 SUP HCPCS C1713 83585356 - SCREW BONE LONG 8.5MM 35MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83585357 SUP HCPCS C1713 83585357 - SCREW BONE LONG 8.5MM 35MM MULTIPLANAR ADJUST TSRH OSTEOGRIP BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83585359 SUP HCPCS C1713 83585359 - SCREW BN 8.5MM 35MM TSRH OSTEOGRIP THNLN SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585401 SUP HCPCS C1713 83585401 - SCREW BONE 8.5MM 40MM 2 THREAD TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585406 SUP HCPCS C1713 83585406 - SCREW BONE LONG 8.5MM 40MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83585407 SUP HCPCS C1713 83585407 - SCREW BONE LONG 8.5MM 40MM TSRH OSTEOGRIP THINLINE SPN BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83585409 SUP HCPCS C1713 83585409 - SCREW BN 8.5MM 40MM TSRH OSTEOGRIP THNLN SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" $429.00 $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585451 SUP HCPCS C1713 83585451 - SCREW BONE SHORT POST 8.5MM 45MM TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585456 SUP HCPCS C1713 83585456 - SCREW BONE LONG 8.5MM 45MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83585457 SUP HCPCS C1713 83585457 - SCREW BONE LONG 8.5MM 45MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83585459 SUP HCPCS C1713 83585459 - SCREW BN 8.5MM 45MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585501 SUP HCPCS C1713 83585501 - SCREW BONE 8.5MM 50MM 2 THREAD TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585506 SUP HCPCS C1713 83585506 - SCREW BONE LONG 8.5MM 50MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83585507 SUP HCPCS C1713 83585507 - SCREW BONE LONG 8.5MM 50MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83585509 SUP HCPCS C1713 83585509 - SCREW BN 8.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585551 SUP HCPCS C1713 83585551 - SCREW BONE SHORT POST 8.5MM 55MM TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585556 SUP HCPCS C1713 83585556 - SCREW BONE LONG 8.5MM 55MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" "$1,650.00" $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83585557 SUP HCPCS C1713 83585557 - SCREW BONE LONG 8.5MM 55MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83585559 SUP HCPCS C1713 83585559 - SCREW BN 8.5MM 55MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585601 SUP HCPCS C1713 83585601 - SCREW BONE 8.5MM 60MM 2 THREAD TSRH OSTEOGRIP THINLINE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" "$1,072.50" "$1,072.50" $223.51 "$1,072.50" N/A N/A 83585606 SUP HCPCS C1713 83585606 - SCREW BONE LONG 8.5MM 60MM TSRH OSTEOGRIP THINLINE TITANIUM BOTH IP/OP "$1,650.00" "$1,221.00" $327.48 "$1,650.00" $742.50 $742.50 $742.50 $742.50 "$1,650.00" "$1,650.00" "$1,650.00" $343.90 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $343.88 "$1,650.00" $660.00 $975.98 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" $742.50 $327.48 N/A $957.00 "$1,650.00" $990.00 "$1,650.00" $343.86 "$1,650.00" N/A N/A 83585607 SUP HCPCS C1713 83585607 - SCREW BONE LONG 8.5MM 60MM MULTI PLANAR ADJUSTING TSRH BOTH IP/OP "$1,800.00" "$1,332.00" $357.26 "$1,800.00" $810.00 $810.00 $810.00 $810.00 "$1,800.00" "$1,800.00" "$1,800.00" $375.17 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" "$1,800.00" "$1,064.70" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 $357.26 N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" $375.12 "$1,800.00" N/A N/A 83585609 SUP HCPCS C1713 83585609 - SCREW BN 8.5MM 60MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$1,072.50" $794.00 $212.86 "$1,072.50" $482.63 $482.63 $482.63 $482.63 "$1,072.50" "$1,072.50" "$1,072.50" $223.54 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $223.52 "$1,072.50" "$1,072.50" $634.38 "$1,072.50" "$1,072.50" "$1,072.50" "$1,072.50" $804.38 "$1,072.50" "$1,072.50" "$1,072.50" $536.25 $536.25 $849.42 "$1,072.50" $858.00 $482.63 $212.86 N/A $622.05 "$1,072.50" $643.50 "$1,072.50" $223.51 "$1,072.50" N/A N/A 86944520 SUP HCPCS C1713 86944520 - SCREW BONE 4.5MM 20MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86944525 SUP HCPCS C1713 86944525 - SCREW BONE 4.5MM 25MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86944530 SUP HCPCS C1713 86944530 - SCREW BONE 4.5MM 30MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86944535 SUP HCPCS C1713 86944535 - SCREW BONE 4.5MM 35MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86944540 SUP HCPCS C1713 86944540 - SCREW BONE 4.5MM 40MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86944545 SUP HCPCS C1713 86944545 - SCREW BONE 4.5MM 45MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86944550 SUP HCPCS C1713 86944550 - SCREW BONE 4.5MM 50MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945020 SUP HCPCS C1713 86945020 - SCREW BONE 5MM 20MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945025 SUP HCPCS C1713 86945025 - SCREW BONE 5MM 25MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945030 SUP HCPCS C1713 86945030 - SCREW BONE 5MM 30MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945035 SUP HCPCS C1713 86945035 - SCREW BONE 5MM 35MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945040 SUP HCPCS C1713 86945040 - SCREW BONE 5MM 40MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945045 SUP HCPCS C1713 86945045 - SCREW BONE 5MM 45MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945050 SUP HCPCS C1713 86945050 - SCREW BONE 5MM 50MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945520 SUP HCPCS C1713 86945520 - SCREW BONE 5.5MM 20MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945525 SUP HCPCS C1713 86945525 - SCREW BONE 5.5MM 25MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945530 SUP HCPCS C1713 86945530 - SCREW BONE 5.5MM 30MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945535 SUP HCPCS C1713 86945535 - SCREW BONE 5.5MM 35MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945540 SUP HCPCS C1713 86945540 - SCREW BONE 5.5MM 40MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945545 SUP HCPCS C1713 86945545 - SCREW BONE 5.5MM 45MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945550 SUP HCPCS C1713 86945550 - SCREW BONE 5.5MM 50MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945555 SUP HCPCS C1713 86945555 - SCREW BONE 5.5MM 55MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945560 SUP HCPCS C1713 86945560 - SCREW BONE 5.5MM 60MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86945565 SUP HCPCS C1713 86945565 - SCREW BONE 5.5MM 65MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86946520 SUP HCPCS C1713 86946520 - SCREW BONE 6.5MM 20MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86946530 SUP HCPCS C1713 86946530 - SCREW BONE 6.5MM 30MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86946535 SUP HCPCS C1713 86946535 - SCREW BONE 6.5MM 35MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86946540 SUP HCPCS C1713 86946540 - SCREW BONE 6.5MM 40MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86946545 SUP HCPCS C1713 86946545 - SCREW BONE 6.5MM 45MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86946550 SUP HCPCS C1713 86946550 - SCREW BONE 6.5MM 50MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86946555 SUP HCPCS C1713 86946555 - SCREW BONE 6.5MM 55MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86946560 SUP HCPCS C1713 86946560 - SCREW BONE 6.5MM 60MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86946565 SUP HCPCS C1713 86946565 - SCREW BONE 6.5MM 65MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86946570 SUP HCPCS C1713 86946570 - SCREW BONE 6.5MM 70MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86946575 SUP HCPCS C1713 86946575 - SCREW BONE 6.5MM 75MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86947520 SUP HCPCS C1713 86947520 - SCREW BONE 7.5MM 20MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86947525 SUP HCPCS C1713 86947525 - SCREW BONE 7.5MM 25MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86947530 SUP HCPCS C1713 86947530 - SCREW BONE 7.5MM 30MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86947535 SUP HCPCS C1713 86947535 - SCREW BONE 7.5MM 35MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86947540 SUP HCPCS C1713 86947540 - SCREW BONE 7.5MM 40MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86947545 SUP HCPCS C1713 86947545 - SCREW BONE 7.5MM 45MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86947550 SUP HCPCS C1713 86947550 - SCREW BONE 7.5MM 50MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86947555 SUP HCPCS C1713 86947555 - SCREW BONE 7.5MM 55MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86947560 SUP HCPCS C1713 86947560 - SCREW BONE 7.5MM 60MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86947565 SUP HCPCS C1713 86947565 - SCREW BONE 7.5MM 65MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86947570 SUP HCPCS C1713 86947570 - SCREW BONE 7.5MM 70MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86947575 SUP HCPCS C1713 86947575 - SCREW BONE 7.5MM 75MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86948520 SUP HCPCS C1713 86948520 - SCREW BONE 8.5MM 20MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86948525 SUP HCPCS C1713 86948525 - SCREW BONE 8.5MM 25MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86948530 SUP HCPCS C1713 86948530 - SCREW BONE 8.5MM 30MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86948535 SUP HCPCS C1713 86948535 - SCREW BONE 8.5MM 35MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86948540 SUP HCPCS C1713 86948540 - SCREW BONE 8.5MM 40MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86948545 SUP HCPCS C1713 86948545 - SCREW BONE 8.5MM 45MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86948550 SUP HCPCS C1713 86948550 - SCREW BONE 8.5MM 50MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86948555 SUP HCPCS C1713 86948555 - SCREW BONE 8.5MM 55MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86948560 SUP HCPCS C1713 86948560 - SCREW BONE 8.5MM 60MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86948565 SUP HCPCS C1713 86948565 - SCREW BONE 8.5MM 65MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86948570 SUP HCPCS C1713 86948570 - SCREW BONE 8.5MM 70MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86948575 SUP HCPCS C1713 86948575 - SCREW BONE 8.5MM 75MM MULTIAX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992320 SUP HCPCS C1713 86992320 - SCREW BONE 5MM 20MM MULTIAX REDX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992325 SUP HCPCS C1713 86992325 - SCREW BONE 5MM 25MM MULTIAX REDX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992330 SUP HCPCS C1713 86992330 - SCREW BONE 5MM 30MM MULTIAX REDX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992335 SUP HCPCS C1713 86992335 - SCREW BONE 5MM 35MM MULTIAX REDX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 86992340 SUP HCPCS C1713 86992340 - SCREW BONE 5MM 40MM MULTIAX REDX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 86992345 SUP HCPCS C1713 86992345 - SCREW BONE 5MM 45MM MULTIAX REDX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992350 SUP HCPCS C1713 86992350 - SCREW BONE 5MM 50MM MULTIAX REDX CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992420 SUP HCPCS C1713 86992420 - SCREW BONE 4.5MM 20MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992425 SUP HCPCS C1713 86992425 - SCREW BONE 4.5MM 25MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992430 SUP HCPCS C1713 86992430 - SCREW BONE 4.5MM 30MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992435 SUP HCPCS C1713 86992435 - SCREW BONE 4.5MM 35MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992440 SUP HCPCS C1713 86992440 - SCREW BONE 4.5MM 40MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992445 SUP HCPCS C1713 86992445 - SCREW BONE 4.5MM 45MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992450 SUP HCPCS C1713 86992450 - SCREW BONE 4.5MM 50MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992525 SUP HCPCS C1713 86992525 - SCREW BONE 5.5MM 25MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992530 SUP HCPCS C1713 86992530 - SCREW BONE 5.5MM 30MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992535 SUP HCPCS C1713 86992535 - SCREW BONE 5.5MM 35MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992540 SUP HCPCS C1713 86992540 - SCREW BONE 5.5MM 40MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992545 SUP HCPCS C1713 86992545 - SCREW BONE 5.5MM 45MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992550 SUP HCPCS C1713 86992550 - SCREW BONE 5.5MM 50MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992555 SUP HCPCS C1713 86992555 - SCREW BONE 5.5MM 55MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992625 SUP HCPCS C1713 86992625 - SCREW BONE 6.5MM 25MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992630 SUP HCPCS C1713 86992630 - SCREW BONE 6.5MM 30MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992635 SUP HCPCS C1713 86992635 - SCREW BONE 6.5MM 35MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992640 SUP HCPCS C1713 86992640 - SCREW BONE 6.5MM 40MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992645 SUP HCPCS C1713 86992645 - SCREW BONE 6.5MM 45MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992650 SUP HCPCS C1713 86992650 - SCREW BONE 6.5MM 50MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992655 SUP HCPCS C1713 86992655 - SCREW BONE 6.5MM 55MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992725 SUP HCPCS C1713 86992725 - SCREW BONE 7.5MM 25MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992730 SUP HCPCS C1713 86992730 - SCREW BONE 7.5MM 30MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992735 SUP HCPCS C1713 86992735 - SCREW BONE 7.5MM 35MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 86992740 SUP HCPCS C1713 86992740 - SCREW BONE 7.5MM 40MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 86992745 SUP HCPCS C1713 86992745 - SCREW BONE 7.5MM 45MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 86992750 SUP HCPCS C1713 86992750 - SCREW BONE 7.5MM 50MM MULTIAX REDX CD HORIZON M8 TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88900101 SUP HCPCS C1713 88900101 - HOOK SPINAL SMALL RIGHT OFFST TSRH SILO TITANIUM LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900102 SUP HCPCS C1713 88900102 - HOOK SPINAL SMALL RIGHT OFFST TSRH SILO TITANIUM LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900105 SUP HCPCS C1713 88900105 - HOOK SPINAL RIGHT OFFST TSRH SILO TITANIUM PEDICLE 5.5 MM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900107 SUP HCPCS C1713 88900107 - HOOK SPINAL LARGE RIGHT OFFST TSRH SILO TITANIUM LMNR 5.5MM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900108 SUP HCPCS C1713 88900108 - HOOK SPINAL LARGE NARROW BLADE TSRH SILO TITANIUM LMNR 5.5MM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900109 SUP HCPCS C1713 88900109 - HOOK SPINAL SMALL NARROW BLADE TSRH SILO TITANIUM LMNR 5.5MM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900110 SUP HCPCS C1713 88900110 - HOOK SPINAL SMALL ELEVATE TSRH SILO TITANIUM LMNR 5.5MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900111 SUP HCPCS C1713 88900111 - HOOK SPINAL SMALL RIGHT OFFST TSRH SILO TITANIUM LMNR 5.5MM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900113 SUP HCPCS C1713 88900113 - HOOK SPINAL LARGE RIGHT OFFST ELEVATED TSRH SILO TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900114 SUP HCPCS C1713 88900114 - HOOK SPINAL RIGHT OFFST TSRH SILO TITANIUM LMNR 5.5 MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900201 SUP HCPCS C1713 88900201 - HOOK SPNL TSRH SILO LT OFST TI LMR THOR 5.5 MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900202 SUP HCPCS C1713 88900202 - HOOK SPNL TSRH SILO LT OFST TI LMR THOR 5.5 MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900205 SUP HCPCS C1713 88900205 - HOOK SPINAL W/O SCREW TITANIUM PEDICLE LEFT 5.5 MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900207 SUP HCPCS C1713 88900207 - HOOK SPINAL LARGE LEFT OFFST TSRH SILO TITANIUM LMNR 5.5MM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900208 SUP HCPCS C1713 88900208 - HOOK SPINAL LARGE NARROW BLADE LEFT OFFST TSRH SILO TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900209 SUP HCPCS C1713 88900209 - HOOK SPINAL SMALL NARROW BLADE LEFT OFFST TSRH SILO TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900210 SUP HCPCS C1713 88900210 - HOOK SPINAL SMALL LEFT OFFST ELEVATED TSRH SILO TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900211 SUP HCPCS C1713 88900211 - HOOK SPINAL SMALL LEFT OFFST TSRH SILO TITANIUM LMNR 5.5MM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900213 SUP HCPCS C1713 88900213 - HOOK SPINAL LARGE LEFT OFFST ELEVATED TSRH SILO TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88900214 SUP HCPCS C1713 88900214 - HOOK SPINAL LEFT OFFST TSRH SILO TITANIUM LATERAL 5.5 MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 88901000 SUP HCPCS C1713 88901000 - SCREW BONE .25IN T25 6.3MM 32MM LOCK SILO TSRH TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 88905512 SUP Custom 27803010 88905512 - CONNECTOR ROD 5.5MM 12MM OFFST TSRH SILO TITANIUM SPN BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 88905522 SUP Custom 27803010 88905522 - CONNECTOR ROD 5.5MM 22MM OFFST TSRH SILO TITANIUM SPN BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 88905532 SUP Custom 27803010 88905532 - CONNECTOR ROD 5.5MM 32MM OFFST TSRH SILO TITANIUM SPN BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 88924520 SUP HCPCS C1713 88924520 - SCREW BN 4.5MM 20MM TSRH SILO FA TI SPNE 5.5MM ROD BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" $762.60 "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88924525 SUP HCPCS C1713 88924525 - SCREW BN 4.5MM 25MM TSRH SILO FA TI SPNE 5.5MM ROD BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" $762.60 "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88924530 SUP HCPCS C1713 88924530 - SCREW BN 4.5MM 30MM TSRH SILO FA TI SPNE 5.5MM ROD BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" $762.60 "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88924535 SUP HCPCS C1713 88924535 - SCREW BONE 4.5MM 35MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" $762.60 "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88924540 SUP HCPCS C1713 88924540 - SCREW BONE 4.5MM 40MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" $762.60 "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88924545 SUP HCPCS C1713 88924545 - SCREW BONE 4.5MM 45MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" $762.60 "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88924550 SUP HCPCS C1713 88924550 - SCREW BONE 4.5MM 50MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88925025 SUP HCPCS C1713 88925025 - SCREW BONE 5MM 25MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88925030 SUP HCPCS C1713 88925030 - SCREW BONE 5MM 30MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88925035 SUP HCPCS C1713 88925035 - SCREW BONE 5MM 35MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88925040 SUP HCPCS C1713 88925040 - SCREW BONE 5MM 40MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88925045 SUP HCPCS C1713 88925045 - SCREW BONE 5MM 45MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88925050 SUP HCPCS C1713 88925050 - SCREW BONE 5MM 50MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88925055 SUP HCPCS C1713 88925055 - SCREW BONE 5MM 55MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88925525 SUP HCPCS C1713 88925525 - SCREW BONE 5.5MM 25MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88925530 SUP HCPCS C1713 88925530 - SCREW BONE 5.5MM 30MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88925535 SUP HCPCS C1713 88925535 - SCREW BONE 5.5MM 35MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88925540 SUP HCPCS C1713 88925540 - SCREW BONE 5.5MM 40MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88925545 SUP HCPCS C1713 88925545 - SCREW BONE 5.5MM 45MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88925550 SUP HCPCS C1713 88925550 - SCREW BONE 5.5MM 50MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88925555 SUP HCPCS C1713 88925555 - SCREW BONE 5.5MM 55MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88926525 SUP HCPCS C1713 88926525 - SCREW BONE 6.5MM 25MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88926530 SUP HCPCS C1713 88926530 - SCREW BONE 6.5MM 30MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,143.90" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88926535 SUP HCPCS C1713 88926535 - SCREW BONE 6.5MM 35MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,143.90" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88926540 SUP HCPCS C1713 88926540 - SCREW BONE 6.5MM 40MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,143.90" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88926545 SUP HCPCS C1713 88926545 - SCREW BONE 6.5MM 45MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88926550 SUP HCPCS C1713 88926550 - SCREW BONE 6.5MM 50MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" $762.60 "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88926555 SUP HCPCS C1713 88926555 - SCREW BONE 6.5MM 55MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88926560 SUP HCPCS C1713 88926560 - SCREW BONE 6.5MM 60MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88927530 SUP HCPCS C1713 88927530 - SCREW BONE 7.5MM 30MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" $762.60 "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88927535 SUP HCPCS C1713 88927535 - SCREW BONE 7.5MM 35MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" $762.60 "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,906.50" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88927540 SUP HCPCS C1713 88927540 - SCREW BONE 7.5MM 40MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" $762.60 "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,143.90" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88927545 SUP HCPCS C1713 88927545 - SCREW BONE 7.5MM 45MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,143.90" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88927550 SUP HCPCS C1713 88927550 - SCREW BONE 7.5MM 50MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" "$1,906.50" "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,143.90" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88927555 SUP HCPCS C1713 88927555 - SCREW BONE 7.5MM 55MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" $762.60 "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,143.90" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88927560 SUP HCPCS C1713 88927560 - SCREW BONE 7.5MM 60MM FIX ANGLE SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$1,906.50" "$1,411.00" $378.39 "$1,906.50" $857.93 $857.93 $857.93 $857.93 "$1,906.50" "$1,906.50" "$1,906.50" $397.36 "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" $397.34 "$1,906.50" $762.60 "$1,127.69" "$1,906.50" "$1,906.50" "$1,906.50" "$1,906.50" "$1,429.88" "$1,906.50" "$1,906.50" "$1,906.50" $953.25 $953.25 "$1,509.95" "$1,906.50" "$1,525.20" $857.93 $378.39 N/A "$1,105.77" "$1,906.50" "$1,143.90" "$1,906.50" $397.31 "$1,906.50" N/A N/A 88934520 SUP Custom 27803010 88934520 - SCREW BONE 4.5MM 20MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 88934525 SUP Custom 27803010 88934525 - SCREW BONE 4.5MM 25MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 88934530 SUP HCPCS C1713 88934530 - SCREW BONE 4.5MM 30MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88934535 SUP Custom 27803010 88934535 - SCREW BONE 4.5MM 35MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 88935525 SUP HCPCS C1713 88935525 - SCREW BONE 5.5MM 25MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88935530 SUP HCPCS C1713 88935530 - SCREW BONE 5.5MM 30MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88935535 SUP HCPCS C1713 88935535 - SCREW BONE 5.5MM 35MM MULTIAX SILO TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88935540 SUP HCPCS C1713 88935540 - SCREW BONE 5.5MM 40MM MULTIAX SILO TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88935545 SUP HCPCS C1713 88935545 - SCREW BONE 5.5MM 45MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88935550 SUP HCPCS C1713 88935550 - SCREW BONE 5.5MM 50MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88935555 SUP HCPCS C1713 88935555 - SCREW BONE 5.5MM 55MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88936525 SUP HCPCS C1713 88936525 - SCREW BONE 6.5MM 25MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88936530 SUP HCPCS C1713 88936530 - SCREW BONE 6.5MM 30MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88936535 SUP HCPCS C1713 88936535 - SCREW BONE 6.5MM 35MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88936540 SUP HCPCS C1713 88936540 - SCREW BONE 6.5MM 40MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88936545 SUP HCPCS C1713 88936545 - SCREW BONE 6.5MM 45MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88936550 SUP HCPCS C1713 88936550 - SCREW BONE 6.5MM 50MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88936555 SUP HCPCS C1713 88936555 - SCREW BONE 6.5MM 55MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88936560 SUP HCPCS C1713 88936560 - SCREW BONE 6.5MM 60MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88937525 SUP HCPCS C1713 88937525 - SCREW BONE 7.5MM 25MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88937530 SUP HCPCS C1713 88937530 - SCREW BONE 7.5MM 30MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88937535 SUP HCPCS C1713 88937535 - SCREW BONE 7.5MM 35MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88937540 SUP HCPCS C1713 88937540 - SCREW BONE 7.5MM 40MM MULTIAX SILO TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88937545 SUP HCPCS C1713 88937545 - SCREW BONE 7.5MM 45MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88937550 SUP HCPCS C1713 88937550 - SCREW BONE 7.5MM 50MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88937555 SUP HCPCS C1713 88937555 - SCREW BONE 7.5MM 55MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88937560 SUP HCPCS C1713 88937560 - SCREW BONE 7.5MM 60MM MULTIAX SILO TSRH TITANIUM SPN 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 88944520 SUP HCPCS C1713 88944520 - SCREW BONE 4.5MM 20MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88944525 SUP HCPCS C1713 88944525 - SCREW BONE 4.5MM 25MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88944530 SUP HCPCS C1713 88944530 - SCREW BONE 25D 4.5MM 30MM SAGITTAL ADJUST SILO TSRH TITANIUM BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88944535 SUP HCPCS C1713 88944535 - SCREW BONE 25D 4.5MM 35MM SAGITTAL ADJUST SILO TSRH TITANIUM BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88944540 SUP HCPCS C1713 88944540 - SCREW BONE 4.5MM 40MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88944545 SUP HCPCS C1713 88944545 - SCREW BONE 4.5MM 45MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88944550 SUP HCPCS C1713 88944550 - SCREW BONE 4.5MM 50MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88945025 SUP HCPCS C1713 88945025 - SCREW BONE 5MM 25MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88945030 SUP HCPCS C1713 88945030 - SCREW BONE 5MM 30MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88945035 SUP HCPCS C1713 88945035 - SCREW BONE 5MM 35MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88945040 SUP HCPCS C1713 88945040 - SCREW BONE 25D 5MM 40MM SAGITTAL ADJUST SILO TSRH TITANIUM BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88945045 SUP HCPCS C1713 88945045 - SCREW BONE 5MM 45MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88945050 SUP HCPCS C1713 88945050 - SCREW BONE 5MM 50MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88945055 SUP HCPCS C1713 88945055 - SCREW BONE 5MM 55MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88945525 SUP HCPCS C1713 88945525 - SCREW BONE 5.5MM 25MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88945530 SUP HCPCS C1713 88945530 - SCREW BONE 5.5MM 30MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88945535 SUP HCPCS C1713 88945535 - SCREW BONE 5.5MM 35MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88945540 SUP HCPCS C1713 88945540 - SCREW BONE 5.5MM 40MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88945545 SUP HCPCS C1713 88945545 - SCREW BONE 5.5MM 45MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88945550 SUP HCPCS C1713 88945550 - SCREW BONE 5.5MM 50MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88945555 SUP HCPCS C1713 88945555 - SCREW BONE 5.5MM 55MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88946525 SUP HCPCS C1713 88946525 - SCREW BONE 6.5MM 25MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88946530 SUP HCPCS C1713 88946530 - SCREW BONE 6.5MM 30MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88946535 SUP HCPCS C1713 88946535 - SCREW BONE 6.5MM 35MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88946540 SUP HCPCS C1713 88946540 - SCREW BONE 25D 6.5MM 40MM SAGITTAL ADJUST SILO TSRH TITANIUM BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88946545 SUP HCPCS C1713 88946545 - SCREW BONE 6.5MM 45MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88946550 SUP HCPCS C1713 88946550 - SCREW BONE 6.5MM 50MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88946555 SUP HCPCS C1713 88946555 - SCREW BONE 6.5MM 55MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88946560 SUP HCPCS C1713 88946560 - SCREW BONE 6.5MM 60MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88947525 SUP HCPCS C1713 88947525 - SCREW BONE 7.5MM 25MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88947530 SUP HCPCS C1713 88947530 - SCREW BONE 7.5MM 30MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88947535 SUP HCPCS C1713 88947535 - SCREW BONE 7.5MM 35MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88947540 SUP HCPCS C1713 88947540 - SCREW BONE 25D 7.5MM 40MM SAGITTAL ADJUST SILO TSRH TITANIUM BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88947545 SUP HCPCS C1713 88947545 - SCREW BONE 7.5MM 45MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88947550 SUP HCPCS C1713 88947550 - SCREW BONE 7.5MM 50MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88947555 SUP HCPCS C1713 88947555 - SCREW BONE 7.5MM 55MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$2,658.00" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88947560 SUP HCPCS C1713 88947560 - SCREW BONE 7.5MM 60MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$1,594.80" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88947565 SUP HCPCS C1713 88947565 - SCREW BONE 7.5MM 65MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 88947570 SUP HCPCS C1713 88947570 - SCREW BONE 7.5MM 70MM SAGITTAL ANGLE SILO TSRH TITANIUM SPN BOTH IP/OP "$2,658.00" "$1,967.00" $527.55 "$2,658.00" "$1,196.10" "$1,196.10" "$1,196.10" "$1,196.10" "$2,658.00" "$2,658.00" "$2,658.00" $553.99 "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" $553.96 "$2,658.00" "$1,063.20" "$1,310.39" "$2,658.00" "$2,658.00" "$2,658.00" "$2,658.00" "$1,993.50" "$2,658.00" "$2,658.00" "$2,658.00" "$1,329.00" "$1,329.00" "$2,105.14" "$2,658.00" "$2,126.40" "$1,196.10" $527.55 N/A "$1,541.64" "$2,658.00" "$2,658.00" "$2,658.00" $553.93 "$2,658.00" N/A N/A 98716200 SUP HCPCS C1713 98716200 - SCREW BONE 6.5MM 20MM VAR ANG TITANIUM SPN ANTERIOR BOTH IP/OP $880.50 $652.00 $174.76 $880.50 $396.23 $396.23 $396.23 $396.23 $880.50 $880.50 $880.50 $183.52 $880.50 $880.50 $880.50 $880.50 $880.50 $183.51 $880.50 $880.50 $520.82 $880.50 $880.50 $880.50 $880.50 $660.38 $880.50 $880.50 $880.50 $440.25 $440.25 $697.36 $880.50 $704.40 $396.23 $174.76 N/A $510.69 $880.50 $880.50 $880.50 $183.50 $880.50 N/A N/A 98716250 SUP HCPCS C1713 98716250 - SCREW BN 6.5MM 25MM PRMD VA TI SPNE ANT BOTH IP/OP $880.50 $652.00 $174.76 $880.50 $396.23 $396.23 $396.23 $396.23 $880.50 $880.50 $880.50 $183.52 $880.50 $880.50 $880.50 $880.50 $880.50 $183.51 $880.50 $880.50 $520.82 $880.50 $880.50 $880.50 $880.50 $660.38 $880.50 $880.50 $880.50 $440.25 $440.25 $697.36 $880.50 $704.40 $396.23 $174.76 N/A $510.69 $880.50 $528.30 $880.50 $183.50 $880.50 N/A N/A 98716300 SUP HCPCS C1713 98716300 - SCREW BN 6.5MM 30MM PRMD VA TI SPNE ANT BOTH IP/OP $880.50 $652.00 $174.76 $880.50 $396.23 $396.23 $396.23 $396.23 $880.50 $880.50 $880.50 $183.52 $880.50 $880.50 $880.50 $880.50 $880.50 $183.51 $880.50 $352.20 $520.82 $880.50 $880.50 $880.50 $880.50 $660.38 $880.50 $880.50 $880.50 $440.25 $440.25 $697.36 $880.50 $704.40 $396.23 $174.76 N/A $510.69 $880.50 $880.50 $880.50 $183.50 $880.50 N/A N/A 98716350 SUP HCPCS C1713 98716350 - SCREW BN 6.5MM 35MM PRMD VA TI SPNE ANT BOTH IP/OP $880.50 $652.00 $174.76 $880.50 $396.23 $396.23 $396.23 $396.23 $880.50 $880.50 $880.50 $183.52 $880.50 $880.50 $880.50 $880.50 $880.50 $183.51 $880.50 $352.20 $520.82 $880.50 $880.50 $880.50 $880.50 $660.38 $880.50 $880.50 $880.50 $440.25 $440.25 $697.36 $880.50 $704.40 $396.23 $174.76 N/A $510.69 $880.50 $880.50 $880.50 $183.50 $880.50 N/A N/A 99415530 SUP HCPCS C1713 99415530 - BOLT SPINAL SHORT POST 5.5MM 30MM TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $386.40 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $579.60 $966.00 $201.31 $966.00 N/A N/A 99415535 SUP HCPCS C1713 99415535 - BOLT SPINAL SHORT POST 5.5MM 35MM CD HORIZON ENGAGE TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $386.40 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $579.60 $966.00 $201.31 $966.00 N/A N/A 99415540 SUP HCPCS C1713 99415540 - BOLT SPINAL SHORT POST 5.5MM 40MM CD HORIZON ENGAGE TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $386.40 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $966.00 $966.00 $201.31 $966.00 N/A N/A 99415545 SUP HCPCS C1713 99415545 - BOLT SPINAL SHORT POST 5.5MM 45MM CD HORIZON ENGAGE TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $386.40 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $579.60 $966.00 $201.31 $966.00 N/A N/A 99415550 SUP HCPCS C1713 99415550 - BOLT SPINAL SHORT POST 5.5MM 50MM TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $386.40 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $579.60 $966.00 $201.31 $966.00 N/A N/A 99415555 SUP HCPCS C1713 99415555 - BOLT SPINAL SHORT POST 5.5MM 55MM TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $386.40 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $579.60 $966.00 $201.31 $966.00 N/A N/A 99416530 SUP HCPCS C1713 99416530 - BOLT SPINAL SHORT POST 6.5MM 30MM TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $386.40 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $966.00 $966.00 $201.31 $966.00 N/A N/A 99416535 SUP HCPCS C1713 99416535 - BOLT SPINAL SHORT POST 6.5MM 35MM CD HORIZON ENGAGE TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $386.40 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $579.60 $966.00 $201.31 $966.00 N/A N/A 99416540 SUP HCPCS C1713 99416540 - BOLT SPINAL SHORT POST 6.5MM 40MM CD HORIZON ENGAGE TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $386.40 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $579.60 $966.00 $201.31 $966.00 N/A N/A 99416545 SUP HCPCS C1713 99416545 - BOLT SPINAL SHORT POST 6.5MM 45MM CD HORIZON ENGAGE TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $386.40 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $966.00 $966.00 $201.31 $966.00 N/A N/A 99416550 SUP HCPCS C1713 99416550 - BOLT SPINAL SHORT POST 6.5MM 50MM CD HORIZON ENGAGE TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $966.00 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $966.00 $966.00 $201.31 $966.00 N/A N/A 99417535 SUP HCPCS C1713 99417535 - BOLT SPINAL SHORT POST 7.5MM 35MM CD HORIZON ENGAGE TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $386.40 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $579.60 $966.00 $201.31 $966.00 N/A N/A 99417540 SUP HCPCS C1713 99417540 - BOLT SPINAL SHORT POST 7.5MM 40MM CD HORIZON ENGAGE TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $386.40 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $579.60 $966.00 $201.31 $966.00 N/A N/A 99417545 SUP HCPCS C1713 99417545 - BOLT SPINAL SHORT POST 7.5MM 45MM CD HORIZON ENGAGE TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $966.00 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $579.60 $966.00 $201.31 $966.00 N/A N/A 99417550 SUP HCPCS C1713 99417550 - BOLT SPINAL SHORT POST 7.5MM 50MM CD HORIZON ENGAGE TITANIUM BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $966.00 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $579.60 $966.00 $201.31 $966.00 N/A N/A 99435530 SUP Custom 27803010 99435530 - BOLT SPINAL SHORT POST 5.5MM 30MM MULTIAX ASMBLY TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99435535 SUP Custom 27803010 99435535 - BOLT SPINAL SHORT POST 5.5MM 35MM MULTIAX ASMBLY TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99435540 SUP Custom 27803010 99435540 - BOLT SPINAL SHORT POST 5.5MM 40MM MULTIAX ASMBLY TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99435545 SUP Custom 27803010 99435545 - BOLT SPINAL SHORT POST 5.5MM 45MM MULTIAX ASMBLY TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99435550 SUP Custom 27803010 99435550 - BOLT SPINAL SHORT POST 5.5MM 50MM MULTIAX ASMBLY TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99435555 SUP Custom 27803010 99435555 - BOLT SPINAL SHORT POST 5.5MM 55MM MULTIAX TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99436530 SUP Custom 27803010 99436530 - BOLT SPINAL SHORT POST 6.5MM 30MM MULTIAX ASMBLY TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99436535 SUP Custom 27803010 99436535 - BOLT SPINAL SHORT POST 6.5MM 35MM MULTIAX ASMBLY TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99436540 SUP Custom 27803010 99436540 - BOLT SPINAL SHORT POST 6.5MM 40MM MULTIAX TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99436545 SUP Custom 27803010 99436545 - BOLT SPINAL SHORT POST 6.5MM 45MM MULTIAX ASMBLY TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99436550 SUP Custom 27803010 99436550 - BOLT SPINAL SHORT POST 6.5MM 50MM MULTIAX ASMBLY TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99436555 SUP Custom 27803010 99436555 - BOLT SPINAL SHORT POST 6.5MM 55MM MULTIAX TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99436560 SUP Custom 27803010 99436560 - BOLT SPINAL SHORT POST 6.5MM 60MM MULTIAX TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99437535 SUP Custom 27803010 99437535 - BOLT SPINAL SHORT POST 7.5MM 35MM MULTIAX ASMBLY TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99437540 SUP HCPCS C1713 99437540 - BOLT SPINAL SHORT POST 7.5MM 40MM MULTIAX ASMBLY TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $326.89 "$1,647.00" $741.15 $741.15 $741.15 $741.15 "$1,647.00" "$1,647.00" "$1,647.00" $343.28 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 $974.20 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 $326.89 N/A $955.26 "$1,647.00" $988.20 "$1,647.00" $343.23 "$1,647.00" N/A N/A 99437545 SUP HCPCS C1713 99437545 - BOLT SPINAL SHORT POST 7.5MM 45MM MULTIAX ASMBLY TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $326.89 "$1,647.00" $741.15 $741.15 $741.15 $741.15 "$1,647.00" "$1,647.00" "$1,647.00" $343.28 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 $974.20 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 $326.89 N/A $955.26 "$1,647.00" $988.20 "$1,647.00" $343.23 "$1,647.00" N/A N/A 99437550 SUP Custom 27803010 99437550 - BOLT SPINAL SHORT POST 7.5MM 50MM MULTIAX ASMBLY TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99437555 SUP Custom 27803010 99437555 - BOLT SPINAL SHORT POST 7.5MM 55MM MULTIAX TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99437560 SUP Custom 27803010 99437560 - BOLT SPINAL SHORT POST 7.5MM 60MM MULTIAX TITANIUM BOTH IP/OP "$1,647.00" "$1,219.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $293.17 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" $343.25 "$1,647.00" $658.80 "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,647.00" "$1,235.25" "$1,647.00" "$1,647.00" "$1,647.00" $823.50 $823.50 "$1,304.42" "$1,647.00" "$1,317.60" $741.15 "$1,647.00" N/A $955.26 "$1,647.00" $988.20 "$1,647.00" "$1,647.00" "$1,647.00" N/A N/A 99453105 SUP HCPCS C1713 99453105 - NUT LOCK MULTIAX TITANIUM SPN PEDICLE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 99453110 SUP HCPCS C1713 99453110 - WASHER SPINAL MULTIAX CD HORIZON ENGAGE TITANIUM BOTH IP/OP $201.00 $149.00 $39.89 $201.00 $90.45 $90.45 $90.45 $90.45 $201.00 $201.00 $201.00 $41.89 $201.00 $201.00 $201.00 $201.00 $201.00 $41.89 $201.00 $80.40 $118.89 $201.00 $201.00 $201.00 $201.00 $150.75 $201.00 $201.00 $201.00 $100.50 $100.50 $159.19 $201.00 $160.80 $90.45 $39.89 N/A $116.58 $201.00 $120.60 $201.00 $41.89 $201.00 N/A N/A 99453115 SUP HCPCS C1713 99453115 - SCREW SET BREAKOFF CLOSE CD HORIZON ENGAGE TITANIUM SPN T25 BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 99453200 SUP Custom 27803010 99453200 - CONNECTOR ROD XS 6.35MM LORDOTIC TITANIUM SPN PEDICLE BOTH IP/OP "$1,596.50" "$1,181.00" $284.16 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" $284.16 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" $332.71 "$1,596.43" $638.57 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,197.38" "$1,596.43" "$1,596.43" "$1,596.43" $798.22 $798.22 "$1,264.37" "$1,596.43" "$1,277.14" $718.39 "$1,596.43" N/A $925.97 "$1,596.43" $957.86 "$1,596.43" "$1,596.43" "$1,596.43" N/A N/A 99453201 SUP Custom 27803010 99453201 - CONNECTOR ROD SMALL 6.35MM SLOTTED TITANIUM SPN PEDICLE BOTH IP/OP "$1,596.50" "$1,181.00" $284.16 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" $284.16 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" $332.71 "$1,596.43" $638.57 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,197.38" "$1,596.43" "$1,596.43" "$1,596.43" $798.22 $798.22 "$1,264.37" "$1,596.43" "$1,277.14" $718.39 "$1,596.43" N/A $925.97 "$1,596.43" $957.86 "$1,596.43" "$1,596.43" "$1,596.43" N/A N/A 99453202 SUP Custom 27803010 99453202 - CONNECTOR ROD MEDIUM 6.35MM LORDOTIC TITANIUM SPN PEDICLE BOTH IP/OP "$1,596.50" "$1,181.00" $284.16 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" $284.16 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" $332.71 "$1,596.43" $638.57 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,197.38" "$1,596.43" "$1,596.43" "$1,596.43" $798.22 $798.22 "$1,264.37" "$1,596.43" "$1,277.14" $718.39 "$1,596.43" N/A $925.97 "$1,596.43" $957.86 "$1,596.43" "$1,596.43" "$1,596.43" N/A N/A 99453301 SUP HCPCS C1713 99453301 - CONNECTOR ROD MEDIUM 6.35MM TITANIUM SPN PEDICLE BOTH IP/OP "$1,596.50" "$1,181.00" $316.85 "$1,596.43" $718.39 $718.39 $718.39 $718.39 "$1,596.43" "$1,596.43" "$1,596.43" $332.74 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" $332.71 "$1,596.43" $638.57 $944.29 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,197.38" "$1,596.43" "$1,596.43" "$1,596.43" $798.22 $798.22 "$1,264.37" "$1,596.43" "$1,277.14" $718.39 $316.85 N/A $925.97 "$1,596.43" $957.86 "$1,596.43" $332.70 "$1,596.43" N/A N/A 99453302 SUP Custom 27803010 99453302 - CONNECTOR ROD MEDIUM 6.35MM LORDOTIC TITANIUM SPN BOTH IP/OP "$1,596.50" "$1,181.00" $284.16 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" $284.16 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" $332.71 "$1,596.43" $638.57 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,197.38" "$1,596.43" "$1,596.43" "$1,596.43" $798.22 $798.22 "$1,264.37" "$1,596.43" "$1,277.14" $718.39 "$1,596.43" N/A $925.97 "$1,596.43" $957.86 "$1,596.43" "$1,596.43" "$1,596.43" N/A N/A 99453305 SUP Custom 27803010 99453305 - CONNECTOR ROD MEDIUM 6.35MM SLOTT SAGITTAL SPINNER ENGAGE CD BOTH IP/OP "$1,596.50" "$1,181.00" $284.16 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" $284.16 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" $332.71 "$1,596.43" $638.57 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,197.38" "$1,596.43" "$1,596.43" "$1,596.43" $798.22 $798.22 "$1,264.37" "$1,596.43" "$1,277.14" $718.39 "$1,596.43" N/A $925.97 "$1,596.43" $957.86 "$1,596.43" "$1,596.43" "$1,596.43" N/A N/A 99453306 SUP Custom 27803010 99453306 - CONNECTOR ROD LARGE 6.35MM TITANIUM SPN BOTH IP/OP "$1,596.50" "$1,181.00" $284.16 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" $284.16 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" $332.71 "$1,596.43" $638.57 "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,596.43" "$1,197.38" "$1,596.43" "$1,596.43" "$1,596.43" $798.22 $798.22 "$1,264.37" "$1,596.43" "$1,277.14" $718.39 "$1,596.43" N/A $925.97 "$1,596.43" $957.86 "$1,596.43" "$1,596.43" "$1,596.43" N/A N/A 99453501 SUP Custom 27803010 99453501 - CONNECTOR ROD 6.35MM SLOT CLOSE ENGAGE CD HORIZON TITANIUM BOTH IP/OP "$1,183.50" $876.00 $210.66 "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" $210.66 "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" $246.65 "$1,183.50" $473.40 "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" $887.63 "$1,183.50" "$1,183.50" "$1,183.50" $591.75 $591.75 $937.33 "$1,183.50" $946.80 $532.58 "$1,183.50" N/A $686.43 "$1,183.50" $710.10 "$1,183.50" "$1,183.50" "$1,183.50" N/A N/A 99453502 SUP Custom 27803010 99453502 - CONNECTOR ROD 6.35MM SLOT OPEN CLOSE ENGAGE CD HORIZON BOTH IP/OP "$1,183.50" $876.00 $210.66 "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" $210.66 "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" $246.65 "$1,183.50" $473.40 "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" "$1,183.50" $887.63 "$1,183.50" "$1,183.50" "$1,183.50" $591.75 $591.75 $937.33 "$1,183.50" $946.80 $532.58 "$1,183.50" N/A $686.43 "$1,183.50" $710.10 "$1,183.50" "$1,183.50" "$1,183.50" N/A N/A 99460035 SUP HCPCS C1713 99460035 - PLATE BONE STR 35MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$2,253.00" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99460040 SUP HCPCS C1713 99460040 - PLATE BONE STR 40MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" "$2,253.00" "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99460045 SUP HCPCS C1713 99460045 - PLATE BONE STR 45MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" "$2,253.00" "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99460050 SUP HCPCS C1713 99460050 - PLATE BONE STR 50MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" "$2,253.00" "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99460055 SUP HCPCS C1713 99460055 - PLATE BONE STR 55MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" "$2,253.00" "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99460060 SUP HCPCS C1713 99460060 - PLATE BONE STR 60MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" "$2,253.00" "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99460065 SUP HCPCS C1713 99460065 - PLATE BONE STR 65MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" "$2,253.00" "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99460070 SUP HCPCS C1713 99460070 - PLATE BONE STR 70MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" "$2,253.00" "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99460075 SUP HCPCS C1713 99460075 - PLATE BONE STR 75MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" "$2,253.00" "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99460080 SUP HCPCS C1713 99460080 - PLATE BONE STR 80MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99461035 SUP HCPCS C1713 99461035 - PLATE BONE PREBENT 35MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99461040 SUP HCPCS C1713 99461040 - PLATE BONE PREBENT 40MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99461045 SUP HCPCS C1713 99461045 - PLATE BONE PREBENT 45MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99461050 SUP HCPCS C1713 99461050 - PLATE BONE PREBENT 50MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$2,253.00" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99461055 SUP HCPCS C1713 99461055 - PLATE BONE PREBENT 55MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$2,253.00" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99461060 SUP HCPCS C1713 99461060 - PLATE BONE PREBENT 60MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99461065 SUP HCPCS C1713 99461065 - PLATE BONE PREBENT 65MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99461070 SUP HCPCS C1713 99461070 - PLATE BONE PREBENT 70MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99461075 SUP HCPCS C1713 99461075 - PLATE BONE PREBENT 75MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99461080 SUP HCPCS C1713 99461080 - PLATE BONE PREBENT 80MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99462040 SUP HCPCS C1713 99462040 - PLATE BONE STR 40MM REVISION TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$2,253.00" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99462060 SUP HCPCS C1713 99462060 - PLATE BONE STR 60MM REVISION TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" "$2,253.00" "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99462080 SUP HCPCS C1713 99462080 - PLATE BONE STR 80MM REVISION TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" "$2,253.00" "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99464035 SUP HCPCS C1713 99464035 - PLATE BONE OFFST 3.5CM REVISION SHALLOW TITANIUM SPN BOTH IP/OP "$2,512.50" "$1,859.00" $498.67 "$2,512.50" "$1,130.63" "$1,130.63" "$1,130.63" "$1,130.63" "$2,512.50" "$2,512.50" "$2,512.50" $523.67 "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" $523.63 "$2,512.50" "$2,512.50" "$1,238.66" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$1,884.38" "$2,512.50" "$2,512.50" "$2,512.50" "$1,256.25" "$1,256.25" "$1,989.90" "$2,512.50" "$2,010.00" "$1,130.63" $498.67 N/A "$1,457.25" "$2,512.50" "$1,507.50" "$2,512.50" $523.61 "$2,512.50" N/A N/A 99464040 SUP HCPCS C1713 99464040 - PLATE BONE OFFST 4CM REVISION SHALLOW TITANIUM SPN BOTH IP/OP "$2,512.50" "$1,859.00" $498.67 "$2,512.50" "$1,130.63" "$1,130.63" "$1,130.63" "$1,130.63" "$2,512.50" "$2,512.50" "$2,512.50" $523.67 "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" $523.63 "$2,512.50" "$2,512.50" "$1,238.66" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$1,884.38" "$2,512.50" "$2,512.50" "$2,512.50" "$1,256.25" "$1,256.25" "$1,989.90" "$2,512.50" "$2,010.00" "$1,130.63" $498.67 N/A "$1,457.25" "$2,512.50" "$2,512.50" "$2,512.50" $523.61 "$2,512.50" N/A N/A 99464050 SUP HCPCS C1713 99464050 - PLATE BONE OFFST 5CM REVISION SHALLOW TITANIUM SPN BOTH IP/OP "$2,512.50" "$1,859.00" $498.67 "$2,512.50" "$1,130.63" "$1,130.63" "$1,130.63" "$1,130.63" "$2,512.50" "$2,512.50" "$2,512.50" $523.67 "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" $523.63 "$2,512.50" "$2,512.50" "$1,238.66" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$1,884.38" "$2,512.50" "$2,512.50" "$2,512.50" "$1,256.25" "$1,256.25" "$1,989.90" "$2,512.50" "$2,010.00" "$1,130.63" $498.67 N/A "$1,457.25" "$2,512.50" "$1,507.50" "$2,512.50" $523.61 "$2,512.50" N/A N/A 99464060 SUP HCPCS C1713 99464060 - PLATE BONE OFFST 6CM REVISION SHALLOW TITANIUM SPN BOTH IP/OP "$2,512.50" "$1,859.00" $498.67 "$2,512.50" "$1,130.63" "$1,130.63" "$1,130.63" "$1,130.63" "$2,512.50" "$2,512.50" "$2,512.50" $523.67 "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" $523.63 "$2,512.50" "$2,512.50" "$1,238.66" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$1,884.38" "$2,512.50" "$2,512.50" "$2,512.50" "$1,256.25" "$1,256.25" "$1,989.90" "$2,512.50" "$2,010.00" "$1,130.63" $498.67 N/A "$1,457.25" "$2,512.50" "$1,507.50" "$2,512.50" $523.61 "$2,512.50" N/A N/A 99464070 SUP HCPCS C1713 99464070 - PLATE BONE OFFST 7CM REVISION SHALLOW TITANIUM SPN BOTH IP/OP "$2,512.50" "$1,859.00" $498.67 "$2,512.50" "$1,130.63" "$1,130.63" "$1,130.63" "$1,130.63" "$2,512.50" "$2,512.50" "$2,512.50" $523.67 "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" $523.63 "$2,512.50" "$2,512.50" "$1,238.66" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$1,884.38" "$2,512.50" "$2,512.50" "$2,512.50" "$1,256.25" "$1,256.25" "$1,989.90" "$2,512.50" "$2,010.00" "$1,130.63" $498.67 N/A "$1,457.25" "$2,512.50" "$1,507.50" "$2,512.50" $523.61 "$2,512.50" N/A N/A 99465106 SUP HCPCS C1713 99465106 - PLATE BONE THREAD NUT TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 99465115 SUP Custom 27803010 99465115 - PLATE BONE SLIDER TITANIUM SPN BOTH IP/OP $192.00 $142.00 $34.18 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $34.18 $192.00 $192.00 $192.00 $192.00 $192.00 $192.00 $40.01 $192.00 $76.80 $192.00 $192.00 $192.00 $192.00 $192.00 $144.00 $192.00 $192.00 $192.00 $96.00 $96.00 $152.06 $192.00 $153.60 $86.40 $192.00 N/A $111.36 $192.00 $115.20 $192.00 $192.00 $192.00 N/A N/A 99465126 SUP HCPCS C1713 99465126 - PLATE BONE NUT REVISION TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 99465135 SUP HCPCS C1713 99465135 - WASHER SPINAL THREAD NUT CAP STERILE BOTH IP/OP $109.50 $81.00 $21.73 $109.50 $49.28 $49.28 $49.28 $49.28 $109.50 $109.50 $109.50 $22.82 $109.50 $109.50 $109.50 $109.50 $109.50 $22.82 $109.50 $43.80 $64.77 $109.50 $109.50 $109.50 $109.50 $82.13 $109.50 $109.50 $109.50 $54.75 $54.75 $86.72 $109.50 $87.60 $49.28 $21.73 N/A $63.51 $109.50 $65.70 $109.50 $22.82 $109.50 N/A N/A 99465140 SUP HCPCS C1713 99465140 - WASHER SPINAL FIXANG TITANIUM BOTH IP/OP $192.00 $142.00 $38.11 $192.00 $86.40 $86.40 $86.40 $86.40 $192.00 $192.00 $192.00 $40.02 $192.00 $192.00 $192.00 $192.00 $192.00 $40.01 $192.00 $76.80 $113.57 $192.00 $192.00 $192.00 $192.00 $144.00 $192.00 $192.00 $192.00 $96.00 $96.00 $152.06 $192.00 $153.60 $86.40 $38.11 N/A $111.36 $192.00 $115.20 $192.00 $40.01 $192.00 N/A N/A 99466035 SUP HCPCS C1713 99466035 - PLATE BONE OFFST 35MM REVISION TITANIUM SPN BOTH IP/OP "$2,512.50" "$1,859.00" $498.67 "$2,512.50" "$1,130.63" "$1,130.63" "$1,130.63" "$1,130.63" "$2,512.50" "$2,512.50" "$2,512.50" $523.67 "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" $523.63 "$2,512.50" "$1,005.00" "$1,238.66" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$1,884.38" "$2,512.50" "$2,512.50" "$2,512.50" "$1,256.25" "$1,256.25" "$1,989.90" "$2,512.50" "$2,010.00" "$1,130.63" $498.67 N/A "$1,457.25" "$2,512.50" "$1,507.50" "$2,512.50" $523.61 "$2,512.50" N/A N/A 99466040 SUP HCPCS C1713 99466040 - PLATE BONE OFFST 40MM REVISION TITANIUM SPN BOTH IP/OP "$2,512.50" "$1,859.00" $498.67 "$2,512.50" "$1,130.63" "$1,130.63" "$1,130.63" "$1,130.63" "$2,512.50" "$2,512.50" "$2,512.50" $523.67 "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" $523.63 "$2,512.50" "$1,005.00" "$1,238.66" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$1,884.38" "$2,512.50" "$2,512.50" "$2,512.50" "$1,256.25" "$1,256.25" "$1,989.90" "$2,512.50" "$2,010.00" "$1,130.63" $498.67 N/A "$1,457.25" "$2,512.50" "$2,512.50" "$2,512.50" $523.61 "$2,512.50" N/A N/A 99466050 SUP HCPCS C1713 99466050 - PLATE BONE OFFST 50MM REVISION TITANIUM SPN BOTH IP/OP "$2,512.50" "$1,859.00" $498.67 "$2,512.50" "$1,130.63" "$1,130.63" "$1,130.63" "$1,130.63" "$2,512.50" "$2,512.50" "$2,512.50" $523.67 "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" $523.63 "$2,512.50" "$1,005.00" "$1,238.66" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$1,884.38" "$2,512.50" "$2,512.50" "$2,512.50" "$1,256.25" "$1,256.25" "$1,989.90" "$2,512.50" "$2,010.00" "$1,130.63" $498.67 N/A "$1,457.25" "$2,512.50" "$2,512.50" "$2,512.50" $523.61 "$2,512.50" N/A N/A 99466060 SUP HCPCS C1713 99466060 - PLATE BONE OFFST 60MM REVISION TITANIUM SPN BOTH IP/OP "$2,512.50" "$1,859.00" $498.67 "$2,512.50" "$1,130.63" "$1,130.63" "$1,130.63" "$1,130.63" "$2,512.50" "$2,512.50" "$2,512.50" $523.67 "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" $523.63 "$2,512.50" "$1,005.00" "$1,238.66" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$1,884.38" "$2,512.50" "$2,512.50" "$2,512.50" "$1,256.25" "$1,256.25" "$1,989.90" "$2,512.50" "$2,010.00" "$1,130.63" $498.67 N/A "$1,457.25" "$2,512.50" "$2,512.50" "$2,512.50" $523.61 "$2,512.50" N/A N/A 99466070 SUP HCPCS C1713 99466070 - PLATE BONE OFFST 70MM REVISION TITANIUM SPN BOTH IP/OP "$2,512.50" "$1,859.00" $498.67 "$2,512.50" "$1,130.63" "$1,130.63" "$1,130.63" "$1,130.63" "$2,512.50" "$2,512.50" "$2,512.50" $523.67 "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" $523.63 "$2,512.50" "$2,512.50" "$1,238.66" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$1,884.38" "$2,512.50" "$2,512.50" "$2,512.50" "$1,256.25" "$1,256.25" "$1,989.90" "$2,512.50" "$2,010.00" "$1,130.63" $498.67 N/A "$1,457.25" "$2,512.50" "$2,512.50" "$2,512.50" $523.61 "$2,512.50" N/A N/A 99467085 SUP HCPCS C1713 99467085 - PLATE BONE STR 85MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" "$2,253.00" "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$2,253.00" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99467090 SUP HCPCS C1713 99467090 - PLATE BONE STR 90MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" "$2,253.00" "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$2,253.00" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99467095 SUP HCPCS C1713 99467095 - PLATE BONE STR 95MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$2,253.00" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99467100 SUP HCPCS C1713 99467100 - PLATE BONE STR 100MM TITANIUM SPN BOTH IP/OP "$2,425.50" "$1,795.00" $481.40 "$2,425.50" "$1,091.48" "$1,091.48" "$1,091.48" "$1,091.48" "$2,425.50" "$2,425.50" "$2,425.50" $505.53 "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" $505.50 "$2,425.50" $970.20 "$1,434.68" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$1,819.13" "$2,425.50" "$2,425.50" "$2,425.50" "$1,212.75" "$1,212.75" "$1,921.00" "$2,425.50" "$1,940.40" "$1,091.48" $481.40 N/A "$1,406.79" "$2,425.50" "$2,425.50" "$2,425.50" $505.47 "$2,425.50" N/A N/A 99467105 SUP HCPCS C1713 99467105 - PLATE BONE STR 105MM TITANIUM SPN BOTH IP/OP "$2,425.50" "$1,795.00" $481.40 "$2,425.50" "$1,091.48" "$1,091.48" "$1,091.48" "$1,091.48" "$2,425.50" "$2,425.50" "$2,425.50" $505.53 "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" $505.50 "$2,425.50" $970.20 "$1,434.68" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$1,819.13" "$2,425.50" "$2,425.50" "$2,425.50" "$1,212.75" "$1,212.75" "$1,921.00" "$2,425.50" "$1,940.40" "$1,091.48" $481.40 N/A "$1,406.79" "$2,425.50" "$2,425.50" "$2,425.50" $505.47 "$2,425.50" N/A N/A 99467110 SUP HCPCS C1713 99467110 - PLATE BONE STR 110MM TITANIUM SPN BOTH IP/OP "$2,425.50" "$1,795.00" $481.40 "$2,425.50" "$1,091.48" "$1,091.48" "$1,091.48" "$1,091.48" "$2,425.50" "$2,425.50" "$2,425.50" $505.53 "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" $505.50 "$2,425.50" "$2,425.50" "$1,434.68" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$1,819.13" "$2,425.50" "$2,425.50" "$2,425.50" "$1,212.75" "$1,212.75" "$1,921.00" "$2,425.50" "$1,940.40" "$1,091.48" $481.40 N/A "$1,406.79" "$2,425.50" "$2,425.50" "$2,425.50" $505.47 "$2,425.50" N/A N/A 99467115 SUP HCPCS C1713 99467115 - PLATE BONE STR 115MM TITANIUM SPN BOTH IP/OP "$2,425.50" "$1,795.00" $481.40 "$2,425.50" "$1,091.48" "$1,091.48" "$1,091.48" "$1,091.48" "$2,425.50" "$2,425.50" "$2,425.50" $505.53 "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" $505.50 "$2,425.50" "$2,425.50" "$1,434.68" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$1,819.13" "$2,425.50" "$2,425.50" "$2,425.50" "$1,212.75" "$1,212.75" "$1,921.00" "$2,425.50" "$1,940.40" "$1,091.48" $481.40 N/A "$1,406.79" "$2,425.50" "$2,425.50" "$2,425.50" $505.47 "$2,425.50" N/A N/A 99467120 SUP HCPCS C1713 99467120 - PLATE BN STRG 120MM TI SPNE BOTH IP/OP "$2,425.50" "$1,795.00" $481.40 "$2,425.50" "$1,091.48" "$1,091.48" "$1,091.48" "$1,091.48" "$2,425.50" "$2,425.50" "$2,425.50" $505.53 "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" $505.50 "$2,425.50" $970.20 "$1,434.68" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$1,819.13" "$2,425.50" "$2,425.50" "$2,425.50" "$1,212.75" "$1,212.75" "$1,921.00" "$2,425.50" "$1,940.40" "$1,091.48" $481.40 N/A "$1,406.79" "$2,425.50" "$2,425.50" "$2,425.50" $505.47 "$2,425.50" N/A N/A 99467125 SUP HCPCS C1713 99467125 - PLATE BN STRG 125MM TI SPNE BOTH IP/OP "$2,425.50" "$1,795.00" $481.40 "$2,425.50" "$1,091.48" "$1,091.48" "$1,091.48" "$1,091.48" "$2,425.50" "$2,425.50" "$2,425.50" $505.53 "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" $505.50 "$2,425.50" $970.20 "$1,434.68" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$1,819.13" "$2,425.50" "$2,425.50" "$2,425.50" "$1,212.75" "$1,212.75" "$1,921.00" "$2,425.50" "$1,940.40" "$1,091.48" $481.40 N/A "$1,406.79" "$2,425.50" "$2,425.50" "$2,425.50" $505.47 "$2,425.50" N/A N/A 99467130 SUP HCPCS C1713 99467130 - PLATE BONE STR 130MM TITANIUM SPN BOTH IP/OP "$2,425.50" "$1,795.00" $481.40 "$2,425.50" "$1,091.48" "$1,091.48" "$1,091.48" "$1,091.48" "$2,425.50" "$2,425.50" "$2,425.50" $505.53 "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" $505.50 "$2,425.50" $970.20 "$1,434.68" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$1,819.13" "$2,425.50" "$2,425.50" "$2,425.50" "$1,212.75" "$1,212.75" "$1,921.00" "$2,425.50" "$1,940.40" "$1,091.48" $481.40 N/A "$1,406.79" "$2,425.50" "$2,425.50" "$2,425.50" $505.47 "$2,425.50" N/A N/A 99467135 SUP HCPCS C1713 99467135 - PLATE BONE STR 135MM TITANIUM SPN BOTH IP/OP "$2,425.50" "$1,795.00" $481.40 "$2,425.50" "$1,091.48" "$1,091.48" "$1,091.48" "$1,091.48" "$2,425.50" "$2,425.50" "$2,425.50" $505.53 "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" $505.50 "$2,425.50" $970.20 "$1,434.68" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$1,819.13" "$2,425.50" "$2,425.50" "$2,425.50" "$1,212.75" "$1,212.75" "$1,921.00" "$2,425.50" "$1,940.40" "$1,091.48" $481.40 N/A "$1,406.79" "$2,425.50" "$2,425.50" "$2,425.50" $505.47 "$2,425.50" N/A N/A 99467140 SUP HCPCS C1713 99467140 - PLATE BONE STR 140MM TITANIUM SPN BOTH IP/OP "$2,425.50" "$1,795.00" $481.40 "$2,425.50" "$1,091.48" "$1,091.48" "$1,091.48" "$1,091.48" "$2,425.50" "$2,425.50" "$2,425.50" $505.53 "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" $505.50 "$2,425.50" $970.20 "$1,434.68" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$1,819.13" "$2,425.50" "$2,425.50" "$2,425.50" "$1,212.75" "$1,212.75" "$1,921.00" "$2,425.50" "$1,940.40" "$1,091.48" $481.40 N/A "$1,406.79" "$2,425.50" "$2,425.50" "$2,425.50" $505.47 "$2,425.50" N/A N/A 99467145 SUP HCPCS C1713 99467145 - PLATE BN STRG 145MM TI SPNE BOTH IP/OP "$2,425.50" "$1,795.00" $481.40 "$2,425.50" "$1,091.48" "$1,091.48" "$1,091.48" "$1,091.48" "$2,425.50" "$2,425.50" "$2,425.50" $505.53 "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" $505.50 "$2,425.50" $970.20 "$1,434.68" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$1,819.13" "$2,425.50" "$2,425.50" "$2,425.50" "$1,212.75" "$1,212.75" "$1,921.00" "$2,425.50" "$1,940.40" "$1,091.48" $481.40 N/A "$1,406.79" "$2,425.50" "$2,425.50" "$2,425.50" $505.47 "$2,425.50" N/A N/A 99467150 SUP HCPCS C1713 99467150 - PLATE BN STRG 150MM TI SPNE BOTH IP/OP "$2,425.50" "$1,795.00" $481.40 "$2,425.50" "$1,091.48" "$1,091.48" "$1,091.48" "$1,091.48" "$2,425.50" "$2,425.50" "$2,425.50" $505.53 "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" $505.50 "$2,425.50" $970.20 "$1,434.68" "$2,425.50" "$2,425.50" "$2,425.50" "$2,425.50" "$1,819.13" "$2,425.50" "$2,425.50" "$2,425.50" "$1,212.75" "$1,212.75" "$1,921.00" "$2,425.50" "$1,940.40" "$1,091.48" $481.40 N/A "$1,406.79" "$2,425.50" "$2,425.50" "$2,425.50" $505.47 "$2,425.50" N/A N/A 99467170 SUP HCPCS C1713 99467170 - PLATE BONE STR 17CM SET CD HORIZON ENGAGE TITANIUM SPN BOTH IP/OP "$2,887.50" "$2,137.00" $573.10 "$2,887.50" "$1,299.38" "$1,299.38" "$1,299.38" "$1,299.38" "$2,887.50" "$2,887.50" "$2,887.50" $601.83 "$2,887.50" "$2,887.50" "$2,887.50" "$2,887.50" "$2,887.50" $601.79 "$2,887.50" "$1,155.00" "$1,423.54" "$2,887.50" "$2,887.50" "$2,887.50" "$2,887.50" "$2,165.63" "$2,887.50" "$2,887.50" "$2,887.50" "$1,443.75" "$1,443.75" "$2,286.90" "$2,887.50" "$2,310.00" "$1,299.38" $573.10 N/A "$1,674.75" "$2,887.50" "$2,887.50" "$2,887.50" $601.76 "$2,887.50" N/A N/A 99467180 SUP HCPCS C1713 99467180 - PLATE BONE STR 18CM SET CD HORIZON ENGAGE TITANIUM SPN BOTH IP/OP "$2,887.50" "$2,137.00" $573.10 "$2,887.50" "$1,299.38" "$1,299.38" "$1,299.38" "$1,299.38" "$2,887.50" "$2,887.50" "$2,887.50" $601.83 "$2,887.50" "$2,887.50" "$2,887.50" "$2,887.50" "$2,887.50" $601.79 "$2,887.50" "$1,155.00" "$1,423.54" "$2,887.50" "$2,887.50" "$2,887.50" "$2,887.50" "$2,165.63" "$2,887.50" "$2,887.50" "$2,887.50" "$1,443.75" "$1,443.75" "$2,286.90" "$2,887.50" "$2,310.00" "$1,299.38" $573.10 N/A "$1,674.75" "$2,887.50" "$2,887.50" "$2,887.50" $601.76 "$2,887.50" N/A N/A 99467190 SUP HCPCS C1713 99467190 - PLATE BONE STR 19CM SET CD HORIZON ENGAGE TITANIUM SPN BOTH IP/OP "$2,887.50" "$2,137.00" $573.10 "$2,887.50" "$1,299.38" "$1,299.38" "$1,299.38" "$1,299.38" "$2,887.50" "$2,887.50" "$2,887.50" $601.83 "$2,887.50" "$2,887.50" "$2,887.50" "$2,887.50" "$2,887.50" $601.79 "$2,887.50" "$1,155.00" "$1,423.54" "$2,887.50" "$2,887.50" "$2,887.50" "$2,887.50" "$2,165.63" "$2,887.50" "$2,887.50" "$2,887.50" "$1,443.75" "$1,443.75" "$2,286.90" "$2,887.50" "$2,310.00" "$1,299.38" $573.10 N/A "$1,674.75" "$2,887.50" "$2,887.50" "$2,887.50" $601.76 "$2,887.50" N/A N/A 99467200 SUP HCPCS C1713 99467200 - PLATE BONE STR 20CM SET CD HORIZON ENGAGE TITANIUM SPN BOTH IP/OP "$2,887.50" "$2,137.00" $573.10 "$2,887.50" "$1,299.38" "$1,299.38" "$1,299.38" "$1,299.38" "$2,887.50" "$2,887.50" "$2,887.50" $601.83 "$2,887.50" "$2,887.50" "$2,887.50" "$2,887.50" "$2,887.50" $601.79 "$2,887.50" "$1,155.00" "$1,423.54" "$2,887.50" "$2,887.50" "$2,887.50" "$2,887.50" "$2,165.63" "$2,887.50" "$2,887.50" "$2,887.50" "$1,443.75" "$1,443.75" "$2,286.90" "$2,887.50" "$2,310.00" "$1,299.38" $573.10 N/A "$1,674.75" "$2,887.50" "$2,887.50" "$2,887.50" $601.76 "$2,887.50" N/A N/A 99468085 SUP HCPCS C1713 99468085 - PLATE BONE PREBENT 85MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$2,253.00" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99468090 SUP HCPCS C1713 99468090 - PLATE BONE PREBENT 90MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$2,253.00" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99468095 SUP HCPCS C1713 99468095 - PLATE BONE PREBENT 95MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 99468100 SUP HCPCS C1713 99468100 - PLATE BONE PREBENT 100MM TITANIUM SPN BOTH IP/OP "$2,253.00" "$1,667.00" $447.16 "$2,253.00" "$1,013.85" "$1,013.85" "$1,013.85" "$1,013.85" "$2,253.00" "$2,253.00" "$2,253.00" $469.58 "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" $469.55 "$2,253.00" $901.20 "$1,332.65" "$2,253.00" "$2,253.00" "$2,253.00" "$2,253.00" "$1,689.75" "$2,253.00" "$2,253.00" "$2,253.00" "$1,126.50" "$1,126.50" "$1,784.38" "$2,253.00" "$1,802.40" "$1,013.85" $447.16 N/A "$1,306.74" "$2,253.00" "$1,351.80" "$2,253.00" $469.53 "$2,253.00" N/A N/A 100003331 SUP Custom 27203010 100003331 - KIT ELTRD NS LF ENSITE NAVX SRFC DISP BOTH IP/OP $450.00 $333.00 $80.10 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $80.10 $450.00 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $180.00 $450.00 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $450.00 N/A $261.00 $450.00 $270.00 $450.00 $450.00 $450.00 N/A N/A 136521000 SUP HCPCS C1776 136521000 - HEAD FEM +1MM 12/14 STD TPR 32MM STRL LF ART/EZE MTL HIP BOTH IP/OP "$2,985.00" "$2,209.00" $592.45 "$2,985.00" "$1,343.25" "$1,343.25" "$1,343.25" "$1,343.25" "$2,985.00" "$2,985.00" "$2,985.00" $622.15 "$2,985.00" "$2,985.00" "$2,985.00" "$2,985.00" "$2,985.00" $622.11 "$2,985.00" "$1,194.00" "$1,471.61" "$2,985.00" "$2,985.00" "$2,985.00" "$2,985.00" "$2,238.75" "$2,985.00" "$2,985.00" "$2,985.00" "$1,492.50" "$1,492.50" "$2,364.12" "$2,985.00" "$2,388.00" "$1,343.25" $592.45 N/A "$1,731.30" "$2,985.00" "$2,985.00" "$2,985.00" $622.07 "$2,985.00" N/A N/A 136522000 SUP HCPCS C1776 136522000 - HEAD FEM +5MM 12/14 STD TPR 32MM STRL LF ART/EZE MTL HIP BOTH IP/OP "$2,985.00" "$2,209.00" $592.45 "$2,985.00" "$1,343.25" "$1,343.25" "$1,343.25" "$1,343.25" "$2,985.00" "$2,985.00" "$2,985.00" $622.15 "$2,985.00" "$2,985.00" "$2,985.00" "$2,985.00" "$2,985.00" $622.11 "$2,985.00" "$1,194.00" "$1,471.61" "$2,985.00" "$2,985.00" "$2,985.00" "$2,985.00" "$2,238.75" "$2,985.00" "$2,985.00" "$2,985.00" "$1,492.50" "$1,492.50" "$2,364.12" "$2,985.00" "$2,388.00" "$1,343.25" $592.45 N/A "$1,731.30" "$2,985.00" "$2,985.00" "$2,985.00" $622.07 "$2,985.00" N/A N/A 136523000 SUP HCPCS C1776 136523000 - HEAD FEM +9MM 12/14 STD TPR 32MM STRL LF ART/EZE MTL HIP BOTH IP/OP "$3,045.00" "$2,253.00" $604.36 "$3,045.00" "$1,370.25" "$1,370.25" "$1,370.25" "$1,370.25" "$3,045.00" "$3,045.00" "$3,045.00" $634.65 "$3,045.00" "$3,045.00" "$3,045.00" "$3,045.00" "$3,045.00" $634.61 "$3,045.00" "$1,218.00" "$1,501.19" "$3,045.00" "$3,045.00" "$3,045.00" "$3,045.00" "$2,283.75" "$3,045.00" "$3,045.00" "$3,045.00" "$1,522.50" "$1,522.50" "$2,411.64" "$3,045.00" "$2,436.00" "$1,370.25" $604.36 N/A "$1,766.10" "$3,045.00" "$3,045.00" "$3,045.00" $634.58 "$3,045.00" N/A N/A 154106000 SUP HCPCS C1776 154106000 - STEM FEMORAL 1 HIGH OFFST 105MM CEMENTED HIP BOTH IP/OP "$14,182.50" "$10,495.00" "$2,814.87" "$14,182.50" "$6,382.13" "$6,382.13" "$6,382.13" "$6,382.13" "$14,182.50" "$14,182.50" "$14,182.50" "$2,955.99" "$14,182.50" "$14,182.50" "$14,182.50" "$14,182.50" "$14,182.50" "$2,955.79" "$14,182.50" "$14,182.50" "$6,991.97" "$14,182.50" "$14,182.50" "$14,182.50" "$14,182.50" "$10,636.88" "$14,182.50" "$14,182.50" "$14,182.50" "$7,091.25" "$7,091.25" "$11,232.54" "$14,182.50" "$11,346.00" "$6,382.13" "$2,814.87" N/A "$8,225.85" "$14,182.50" "$14,182.50" "$14,182.50" "$2,955.63" "$14,182.50" N/A N/A 154118000 SUP HCPCS C1776 154118000 - STEM FEMORAL 3 150MM CEMENTED EXTN PROSTALAC HIP RIGHT BOTH IP/OP "$14,820.00" "$10,967.00" "$2,941.40" "$14,820.00" "$6,669.00" "$6,669.00" "$6,669.00" "$6,669.00" "$14,820.00" "$14,820.00" "$14,820.00" "$3,088.86" "$14,820.00" "$14,820.00" "$14,820.00" "$14,820.00" "$14,820.00" "$3,088.65" "$14,820.00" "$5,928.00" "$7,306.26" "$14,820.00" "$14,820.00" "$14,820.00" "$14,820.00" "$11,115.00" "$14,820.00" "$14,820.00" "$14,820.00" "$7,410.00" "$7,410.00" "$11,737.44" "$14,820.00" "$11,856.00" "$6,669.00" "$2,941.40" N/A "$8,595.60" "$14,820.00" "$14,820.00" "$14,820.00" "$3,088.49" "$14,820.00" N/A N/A 177300130 SUP Custom 27803010 177300130 - CAGE SPNL 12MM STD PRLL 14X30MM NS LF BENGAL STKBL RDLCNT BOTH IP/OP "$8,790.00" "$6,505.00" "$1,564.62" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$1,564.62" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$1,831.93" "$8,790.00" "$3,516.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$6,592.50" "$8,790.00" "$8,790.00" "$8,790.00" "$4,395.00" "$4,395.00" "$6,961.68" "$8,790.00" "$7,032.00" "$3,955.50" "$8,790.00" N/A "$5,098.20" "$8,790.00" "$5,274.00" "$8,790.00" "$8,790.00" "$8,790.00" N/A N/A 177306122 SUP Custom 27803010 177306122 - CAGE SPNL 12MM STD LRDTC 14X22MM NS LF BENGAL STKBL RDLCNT BOTH IP/OP "$8,790.00" "$6,505.00" "$1,564.62" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$1,564.62" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$1,831.93" "$8,790.00" "$3,516.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$6,592.50" "$8,790.00" "$8,790.00" "$8,790.00" "$4,395.00" "$4,395.00" "$6,961.68" "$8,790.00" "$7,032.00" "$3,955.50" "$8,790.00" N/A "$5,098.20" "$8,790.00" "$5,274.00" "$8,790.00" "$8,790.00" "$8,790.00" N/A N/A 177306124 SUP Custom 27803010 177306124 - CAGE SPNL STD LRDTC 24X14X12MM NS LF BENGAL STKBL RDLCNT BOTH IP/OP "$8,790.00" "$6,505.00" "$1,564.62" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$1,564.62" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$1,831.93" "$8,790.00" "$3,516.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$6,592.50" "$8,790.00" "$8,790.00" "$8,790.00" "$4,395.00" "$4,395.00" "$6,961.68" "$8,790.00" "$7,032.00" "$3,955.50" "$8,790.00" N/A "$5,098.20" "$8,790.00" "$5,274.00" "$8,790.00" "$8,790.00" "$8,790.00" N/A N/A 177306126 SUP Custom 27803010 177306126 - CAGE SPNL 12MM STD LRDTC 14X26MM NS LF BENGAL STKBL RDLCNT BOTH IP/OP "$8,790.00" "$6,505.00" "$1,564.62" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$1,564.62" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$1,831.93" "$8,790.00" "$3,516.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$6,592.50" "$8,790.00" "$8,790.00" "$8,790.00" "$4,395.00" "$4,395.00" "$6,961.68" "$8,790.00" "$7,032.00" "$3,955.50" "$8,790.00" N/A "$5,098.20" "$8,790.00" "$5,274.00" "$8,790.00" "$8,790.00" "$8,790.00" N/A N/A 177306128 SUP Custom 27803010 177306128 - CAGE SPNL 12MM STD LRDTC 14X28MM NS LF BENGAL STKBL RDLCNT BOTH IP/OP "$8,790.00" "$6,505.00" "$1,564.62" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$1,564.62" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$1,831.93" "$8,790.00" "$3,516.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$6,592.50" "$8,790.00" "$8,790.00" "$8,790.00" "$4,395.00" "$4,395.00" "$6,961.68" "$8,790.00" "$7,032.00" "$3,955.50" "$8,790.00" N/A "$5,098.20" "$8,790.00" "$5,274.00" "$8,790.00" "$8,790.00" "$8,790.00" N/A N/A 177306130 SUP Custom 27803010 177306130 - CAGE SPNL 12MM STD LRDTC 14X30MM NS LF BENGAL STKBL RDLCNT BOTH IP/OP "$8,790.00" "$6,505.00" "$1,564.62" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$1,564.62" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$1,831.93" "$8,790.00" "$3,516.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$6,592.50" "$8,790.00" "$8,790.00" "$8,790.00" "$4,395.00" "$4,395.00" "$6,961.68" "$8,790.00" "$7,032.00" "$3,955.50" "$8,790.00" N/A "$5,098.20" "$8,790.00" "$5,274.00" "$8,790.00" "$8,790.00" "$8,790.00" N/A N/A 179702000 SUP HCPCS C1713 179702000 - SCREW SET 1 INNER MNOAX EXPEDIUM TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 179706070 SUP HCPCS C1713 179706070 - SCREW BONE 10MM 70MM T27 VIPER TITANIUM ILIUM BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 179706870 SUP HCPCS C1713 179706870 - SCREW BONE 8MM 70MM VIPER TITANIUM SPN ILIUM PEDICLE T27 BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 179706880 SUP HCPCS C1713 179706880 - SCREW BONE 8MM 80MM VIPER TITANIUM SPN ILIUM PEDICLE T27 BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 179706970 SUP HCPCS C1713 179706970 - SCREW BONE 9MM 70MM VIPER TITANIUM ILIUM T27 BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 179712035 SUP HCPCS C1713 179712035 - SCREW BN 7.5MM 35MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712040 SUP HCPCS C1713 179712040 - SCREW BN 7.5MM 40MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712045 SUP HCPCS C1713 179712045 - SCREW BN 7.5MM 45MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712050 SUP HCPCS C1713 179712050 - SCREW BN 7.5MM 50MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712055 SUP HCPCS C1713 179712055 - SCREW BN 7.5MM 55MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712080 SUP HCPCS C1713 179712080 - SCREW BONE 7.5MM 80MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712420 SUP HCPCS C1713 179712420 - SCREW BONE 4.35MM 20MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712425 SUP HCPCS C1713 179712425 - SCREW BONE 4.35MM 25MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712430 SUP HCPCS C1713 179712430 - SCREW BONE 4.35MM 30MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712435 SUP HCPCS C1713 179712435 - SCREW BONE 4.35MM 35MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712440 SUP HCPCS C1713 179712440 - SCREW BONE 4.35MM 40MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712445 SUP HCPCS C1713 179712445 - SCREW BN 4.5MM 45MM NS XPDM 1 INNIE PA TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712530 SUP HCPCS C1713 179712530 - SCREW BONE 5MM 30MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712535 SUP HCPCS C1713 179712535 - SCREW BONE 5MM 35MM 1 INNIE POLYAX EXPEDIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712540 SUP HCPCS C1713 179712540 - SCREW BONE 5MM 40MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712545 SUP HCPCS C1713 179712545 - SCREW BONE 5MM 45MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712550 SUP HCPCS C1713 179712550 - SCREW BONE 5MM 50MM 1 INNIE POLYAX EXPEDIUM TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712630 SUP HCPCS C1713 179712630 - SCREW BONE 6MM 30MM POLYAX 1 INNIE EXPEDIUM TITANIUM SPN 5.5 BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712635 SUP HCPCS C1713 179712635 - SCREW BONE 6MM 35MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712640 SUP HCPCS C1713 179712640 - SCREW BONE 6MM 40MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712645 SUP HCPCS C1713 179712645 - SCREW BONE 6MM 45MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712650 SUP HCPCS C1713 179712650 - SCREW BONE 6MM 50MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN 5.5 BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712735 SUP HCPCS C1713 179712735 - SCREW BONE 7MM 35MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712740 SUP HCPCS C1713 179712740 - SCREW BONE 7MM 40MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712745 SUP HCPCS C1713 179712745 - SCREW BONE 7MM 45MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712750 SUP HCPCS C1713 179712750 - SCREW BONE 7MM 50MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179712755 SUP HCPCS C1713 179712755 - SCREW BONE 7MM 55MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179715540 SUP HCPCS C1713 179715540 - SCREW BONE 5.5MM 40MM POLYAX EXPEDIUM TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179715545 SUP HCPCS C1713 179715545 - SCREW BONE 5.5MM 45MM POLYAX EXPEDIUM TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179715635 SUP HCPCS C1713 179715635 - SCREW BONE 6.5MM 35MM POLYAX EXPEDIUM TITANIUM SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179715645 SUP HCPCS C1713 179715645 - SCREW BONE 6.5MM 45MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 179722050 SUP HCPCS C1713 179722050 - SCREW SET UNITIZED POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 179722890 SUP HCPCS C1713 179722890 - SCREW BONE 8MM 90MM 2 INNIE POLYAX EXPEDIUM TITANIUM SPN 5.5 BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 179762120 SUP HCPCS C1713 179762120 - ROD SPINAL 5.5MM 120MM PRECUT HEXAGONAL END EXPEDIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 179762300 SUP HCPCS C1713 179762300 - ROD SPINAL 300MM NONSTRL BOTH IP/OP "$1,395.00" "$1,032.00" $276.87 "$1,395.00" $627.75 $627.75 $627.75 $627.75 "$1,395.00" "$1,395.00" "$1,395.00" $290.75 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $290.73 "$1,395.00" $558.00 $825.14 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $627.75 $276.87 N/A $809.10 "$1,395.00" $837.00 "$1,395.00" $290.72 "$1,395.00" N/A N/A 179762480 SUP HCPCS C1713 179762480 - ROD SPINAL 5.5MM 480MM PRECUT HEXAGONAL END EXPEDIUM BOTH IP/OP "$1,395.00" "$1,032.00" $276.87 "$1,395.00" $627.75 $627.75 $627.75 $627.75 "$1,395.00" "$1,395.00" "$1,395.00" $290.75 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" $290.73 "$1,395.00" "$1,395.00" $825.14 "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,046.25" "$1,395.00" "$1,395.00" "$1,395.00" $697.50 $697.50 "$1,104.84" "$1,395.00" "$1,116.00" $627.75 $276.87 N/A $809.10 "$1,395.00" $837.00 "$1,395.00" $290.72 "$1,395.00" N/A N/A 179771055 SUP HCPCS C1713 179771055 - ROD SPNL 5.5MM 55MM NS XPDM PREBNT LN TI BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 179771065 SUP HCPCS C1713 179771065 - ROD SPINAL 5.5MM 65MM PRELORDOSED LINE EXPEDIUM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 179771075 SUP HCPCS C1713 179771075 - ROD SPINAL 5.5MM 75MM PRELORDOSED LINE EXPEDIUM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 179771085 SUP HCPCS C1713 179771085 - ROD SPINAL 5.5MM 85MM PRELORDOSED LINE EXPEDIUM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 179771090 SUP HCPCS C1713 179771090 - ROD SPINAL 5.5MM 90MM PRELORDOSED LINE EXPEDIUM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 179771095 SUP HCPCS C1713 179771095 - ROD SPINAL 5.5MM 95MM PRELORDOSED LINE EXPEDIUM TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 179772045 SUP Custom 27803010 179772045 - ROD SPINAL 5.5MM 45MM PREBENT MOSS MIAMI SI TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 179772055 SUP Custom 27803010 179772055 - ROD SPINAL 5.5MM 55MM PREBENT MOSS MIAMI SI TITANIUM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 179793020 SUP HCPCS C1713 179793020 - CONNECTOR ROD 5.5MM 20MM OPEN FIX TITANIUM LATERAL BOTH IP/OP "$2,152.50" "$1,593.00" $427.22 "$2,152.50" $968.63 $968.63 $968.63 $968.63 "$2,152.50" "$2,152.50" "$2,152.50" $448.63 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" "$2,152.50" "$1,273.20" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 $427.22 N/A "$1,248.45" "$2,152.50" "$2,152.50" "$2,152.50" $448.58 "$2,152.50" N/A N/A 179797020 SUP HCPCS C1713 179797020 - CONNECTOR ROD 5.5MM 20MM OPEN EXPEDIUM TITANIUM ILIAC SPN BOTH IP/OP "$2,550.00" "$1,887.00" $506.11 "$2,550.00" "$1,147.50" "$1,147.50" "$1,147.50" "$1,147.50" "$2,550.00" "$2,550.00" "$2,550.00" $531.48 "$2,550.00" "$2,550.00" "$2,550.00" "$2,550.00" "$2,550.00" $531.45 "$2,550.00" "$1,020.00" "$1,257.15" "$2,550.00" "$2,550.00" "$2,550.00" "$2,550.00" "$1,912.50" "$2,550.00" "$2,550.00" "$2,550.00" "$1,275.00" "$1,275.00" "$2,019.60" "$2,550.00" "$2,040.00" "$1,147.50" $506.11 N/A "$1,479.00" "$2,550.00" "$1,530.00" "$2,550.00" $531.42 "$2,550.00" N/A N/A 179797025 SUP HCPCS C1713 179797025 - CONNECTOR ROD 5.5MM 20MM OPEN EXTENDED TAB EXPEDIUM TITANIUM BOTH IP/OP "$2,550.00" "$1,887.00" $506.11 "$2,550.00" "$1,147.50" "$1,147.50" "$1,147.50" "$1,147.50" "$2,550.00" "$2,550.00" "$2,550.00" $531.48 "$2,550.00" "$2,550.00" "$2,550.00" "$2,550.00" "$2,550.00" $531.45 "$2,550.00" "$1,020.00" "$1,257.15" "$2,550.00" "$2,550.00" "$2,550.00" "$2,550.00" "$1,912.50" "$2,550.00" "$2,550.00" "$2,550.00" "$1,275.00" "$1,275.00" "$2,019.60" "$2,550.00" "$2,040.00" "$1,147.50" $506.11 N/A "$1,479.00" "$2,550.00" "$1,530.00" "$2,550.00" $531.42 "$2,550.00" N/A N/A 179797040 SUP HCPCS C1713 179797040 - CONNECTOR ROD 5.5MM 40MM OPEN EXPEDIUM TITANIUM ILIAC SPN BOTH IP/OP "$2,550.00" "$1,887.00" $506.11 "$2,550.00" "$1,147.50" "$1,147.50" "$1,147.50" "$1,147.50" "$2,550.00" "$2,550.00" "$2,550.00" $531.48 "$2,550.00" "$2,550.00" "$2,550.00" "$2,550.00" "$2,550.00" $531.45 "$2,550.00" "$1,020.00" "$1,257.15" "$2,550.00" "$2,550.00" "$2,550.00" "$2,550.00" "$1,912.50" "$2,550.00" "$2,550.00" "$2,550.00" "$1,275.00" "$1,275.00" "$2,019.60" "$2,550.00" "$2,040.00" "$1,147.50" $506.11 N/A "$1,479.00" "$2,550.00" "$1,530.00" "$2,550.00" $531.42 "$2,550.00" N/A N/A 179798020 SUP HCPCS C1713 179798020 - CONNECTOR ROD 5.5MM 20MM XPDM CLS TI SPNE ILC BOTH IP/OP "$2,550.00" "$1,887.00" $506.11 "$2,550.00" "$1,147.50" "$1,147.50" "$1,147.50" "$1,147.50" "$2,550.00" "$2,550.00" "$2,550.00" $531.48 "$2,550.00" "$2,550.00" "$2,550.00" "$2,550.00" "$2,550.00" $531.45 "$2,550.00" "$1,020.00" "$1,257.15" "$2,550.00" "$2,550.00" "$2,550.00" "$2,550.00" "$1,912.50" "$2,550.00" "$2,550.00" "$2,550.00" "$1,275.00" "$1,275.00" "$2,019.60" "$2,550.00" "$2,040.00" "$1,147.50" $506.11 N/A "$1,479.00" "$2,550.00" "$1,530.00" "$2,550.00" $531.42 "$2,550.00" N/A N/A 183612032 SUP HCPCS C1713 183612032 - PLATE BONE 180MM RAD PRELORDOTIC 32MM LEVEL 2 RIGID EAGLE BOTH IP/OP "$2,329.00" "$1,723.00" $462.20 "$2,328.75" "$1,047.94" "$1,047.94" "$1,047.94" "$1,047.94" "$2,328.75" "$2,328.75" "$2,328.75" $485.37 "$2,328.75" "$2,328.75" "$2,328.75" "$2,328.75" "$2,328.75" $485.34 "$2,328.75" $931.50 "$1,377.46" "$2,328.75" "$2,328.75" "$2,328.75" "$2,328.75" "$1,746.75" "$2,328.75" "$2,328.75" "$2,328.75" "$1,164.38" "$1,164.38" "$1,844.37" "$2,328.75" "$1,863.00" "$1,047.94" $462.20 N/A "$1,350.82" "$2,328.75" "$1,397.25" "$2,328.75" $485.31 "$2,328.75" N/A N/A 183651016 SUP HCPCS C1713 183651016 - SCREW BONE 4.4MM 16MM OVERSIZE SLFTAP EAGLE PLUS SWIFT PLUS BOTH IP/OP $388.50 $287.00 $77.03 $388.13 $174.66 $174.66 $174.66 $174.66 $388.13 $388.13 $388.13 $80.90 $388.13 $388.13 $388.13 $388.13 $388.13 $80.89 $388.13 $155.25 $229.58 $388.13 $388.13 $388.13 $388.13 $291.38 $388.13 $388.13 $388.13 $194.07 $194.07 $307.40 $388.13 $310.50 $174.66 $77.03 N/A $225.33 $388.13 $388.13 $388.13 $80.89 $388.13 N/A N/A 183656016 SUP HCPCS C1713 183656016 - SCREW BONE 4.25MM 16MM PRIM SLFTAP EAGLE PLUS SWIFT PLUS BOTH IP/OP $388.50 $287.00 $77.03 $388.13 $174.66 $174.66 $174.66 $174.66 $388.13 $388.13 $388.13 $80.90 $388.13 $388.13 $388.13 $388.13 $388.13 $80.89 $388.13 $155.25 $229.58 $388.13 $388.13 $388.13 $388.13 $291.38 $388.13 $388.13 $388.13 $194.07 $194.07 $307.40 $388.13 $310.50 $174.66 $77.03 N/A $225.33 $388.13 $388.13 $388.13 $80.89 $388.13 N/A N/A 185200320 SUP HCPCS C1757 185200320 - TUBE NASOPHARYNGEAL 32FR 170MM ADJUSTABLE FLANGE ROUND TIP BOTH IP/OP $12.00 $9.00 $2.32 $11.68 $6.34 $6.34 $6.34 $6.34 $11.68 $11.68 $11.68 $2.43 $11.68 $8.67 $8.67 $9.00 $6.09 $2.43 $11.68 $11.68 $6.91 $11.68 $11.68 $11.68 $11.68 $9.00 $11.68 $11.68 $11.68 $5.84 $5.84 $9.25 $11.68 $9.34 $7.59 $2.32 N/A $6.96 $11.68 $11.68 $11.68 $2.43 $11.68 N/A N/A 186715000 SUP HCPCS C1713 186715000 - SET SCREW 1 INNER TITANIUM SPN MIS BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 186715080 SUP HCPCS C1713 186715080 - SCREW BONE 7.5MM 80MM POLYAX CANN VIPER 2 TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 186715530 SUP HCPCS C1713 186715530 - SCREW BONE 5MM 30MM POLYAX CANN VIPER TITANIUM SPN MINIMALLY BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 186715535 SUP HCPCS C1713 186715535 - SCREW BONE 5MM 35MM POLYAX CANN VIPER TITANIUM SPN MIS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 186715540 SUP HCPCS C1713 186715540 - SCREW BONE 5MM 40MM POLYAX CANN VIPER TITANIUM SPN MIS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 186715635 SUP HCPCS C1713 186715635 - SCREW BONE 6MM 35MM POLYAX CANN VIPER TITANIUM SPN MIS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 186715640 SUP HCPCS C1713 186715640 - SCREW BONE 6MM 40MM POLYAX CANN VIPER TITANIUM SPN MIS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 186715645 SUP HCPCS C1713 186715645 - SCREW BONE 6MM 45MM POLYAX CANN VIPER TITANIUM SPN MIS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 186715730 SUP HCPCS C1713 186715730 - SCREW BONE 7MM 30MM POLYAX CANN VIPER 2 TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 186715855 SUP HCPCS C1713 186715855 - SCREW BONE 8MM 55MM POLYAX VIPER TITANIUM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 186731530 SUP HCPCS C1713 186731530 - SCREW BONE 5MM 30MM POLYAX FIX TITANIUM SPN CORTICAL 5.5MM BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$4,215.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$4,215.00" "$4,215.00" $878.41 "$4,215.00" N/A N/A 186731535 SUP HCPCS C1713 186731535 - SCREW BONE 5MM 35MM POLYAX FIX TITANIUM SPN CORTICAL 5.5MM BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$4,215.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$2,529.00" "$4,215.00" $878.41 "$4,215.00" N/A N/A 186731540 SUP HCPCS C1713 186731540 - SCREW BONE 5MM 40MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$4,215.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$2,529.00" "$4,215.00" $878.41 "$4,215.00" N/A N/A 186731635 SUP HCPCS C1713 186731635 - SCREW BONE 6MM 35MM XPDM VPR TI SPN CORT FIX 5.5MM BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$1,686.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$2,529.00" "$4,215.00" $878.41 "$4,215.00" N/A N/A 186731640 SUP HCPCS C1713 186731640 - SCREW BONE 6MM 40MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$4,215.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$2,529.00" "$4,215.00" $878.41 "$4,215.00" N/A N/A 186731650 SUP HCPCS C1713 186731650 - SCREW BN 6MM 50MM VPR FX TI SPNE CORT 5.5MM ROD BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$1,686.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" N/A N/A 186750030 SUP HCPCS C1713 186750030 - SCREW BONE 5MM 30MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186750035 SUP HCPCS C1713 186750035 - SCREW BONE 5MM 35MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186750040 SUP HCPCS C1713 186750040 - SCREW BONE 5MM 40MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186750045 SUP HCPCS C1713 186750045 - SCREW BONE 5MM 45MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186750050 SUP HCPCS C1713 186750050 - SCREW BONE 5MM 50MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186750230 SUP HCPCS C1713 186750230 - SCREW BONE 5x30MM TI VIPER PRIME X-TAB BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186750235 SUP HCPCS C1713 186750235 - SCREW BONE 5x35MM TI VIPER PRIME X-TAB BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186750250 SUP HCPCS C1713 186750250 - SCREW BONE 5x50MM TI VIPER PRIME X-TAB BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186750255 SUP HCPCS C1713 186750255 - SCREW BONE 5x55MM TI VIPER PRIME X-TAB BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" N/A N/A 186750430 SUP HCPCS C1713 186750430 - SCREW BONE 5x30MM VIPER PRIME CFXFEN XTAB BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 186750435 SUP HCPCS C1713 186750435 - SCREW BONE 5x35MM VIPER PRIME CFXFEN XTAB BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 186750450 SUP HCPCS C1713 186750450 - SCREW BONE 5x50MM VIPER PRIME CFXFEN XTAB BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 186750455 SUP HCPCS C1713 186750455 - SCREW BONE 5x55MM VIPER PRIME CFXFEN XTAB BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 186760035 SUP HCPCS C1713 186760035 - SCREW BONE 6MM 35MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186760040 SUP HCPCS C1713 186760040 - SCREW BONE 6MM 40MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186760045 SUP HCPCS C1713 186760045 - SCREW BONE 6MM 45MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186760050 SUP HCPCS C1713 186760050 - SCREW BONE 6MM 50MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186760230 SUP HCPCS C1713 186760230 - SCREW BONE 6x30MM TI VIPER PRIME X-TAB BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" N/A N/A 186760255 SUP HCPCS C1713 186760255 - SCREW BONE 6x55MM TI VIPER PRIME X-TAB BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186760430 SUP HCPCS C1713 186760430 - SCREW BONE 6x30MM VIPER PRIME CFXFEN XTAB BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 186760455 SUP HCPCS C1713 186760455 - SCREW BONE 6x55MM VIPER PRIME CFXFEN XTAB BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A 186770035 SUP HCPCS C1713 186770035 - SCREW BONE 7MM 35MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186770040 SUP HCPCS C1713 186770040 - SCREW BONE 7MM 40MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" "$3,250.00" "$3,250.00" N/A N/A 186770045 SUP HCPCS C1713 186770045 - SCREW BONE 7MM 45MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" N/A N/A 186770050 SUP HCPCS C1713 186770050 - SCREW BONE 7MM 50MM CANN EXTENDED TAB VIPER 2 TITANIUM SPN BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186770230 SUP HCPCS C1713 186770230 - SCREW BONE 7x30MM TI VIPER PRIME X-TAB BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186770235 SUP HCPCS C1713 186770235 - SCREW BONE 7x35MM TI VIPER PRIME X-TAB BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186770430 SUP HCPCS C1713 186770430 - SCREW BONE 7x30MM VIPER PRIME CFXFEN XTAB BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 186770435 SUP HCPCS C1713 186770435 - SCREW BONE 7x35MM VIPER PRIME CFXFEN XTAB BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 186770460 SUP HCPCS C1713 186770460 - SCREW BONE 7x60MM VIPER PRIME CFXFEN XTAB BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 186775235 SUP HCPCS C1713 186775235 - SCREW BONE 7.5x35MM TI VIPER PRIME X-TAB BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186775240 SUP HCPCS C1713 186775240 - SCREW BONE 7.5x40MM TI VIPER PRIME X-TAB BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186775245 SUP HCPCS C1713 186775245 - SCREW BONE 7.5x45MM TI VIPER PRIME X-TAB BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186775250 SUP HCPCS C1713 186775250 - SCREW BONE 7.5x50MM TI VIPER PRIME X-TAB BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186775255 SUP HCPCS C1713 186775255 - SCREW BONE 7.5x55MM TI VIPER PRIME X-TAB BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$1,950.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 186787040 SUP Custom 27803010 186787040 - ROD SPINAL 40MM KYPHOSED VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186787080 SUP Custom 27803010 186787080 - ROD SPINAL 80MM KYPHOSED VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186787090 SUP Custom 27803010 186787090 - ROD SPINAL 90MM KYPHOSED VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186787100 SUP Custom 27803010 186787100 - ROD SPINAL 100MM KYPHOSED VIPER 2 TITANIUM MINIMALLY BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186787110 SUP Custom 27803010 186787110 - ROD SPINAL 110MM KYPHOSED VIPER 2 TITANIUM MINIMALLY BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186787200 SUP Custom 27803010 186787200 - ROD SPINAL 200MM KYPHOSED VIPER 2 TITANIUM MINIMALLY BOTH IP/OP "$1,710.00" "$1,265.00" $304.38 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" $304.38 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" $356.38 "$1,710.00" $684.00 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,282.50" "$1,710.00" "$1,710.00" "$1,710.00" $855.00 $855.00 "$1,354.32" "$1,710.00" "$1,368.00" $769.50 "$1,710.00" N/A $991.80 "$1,710.00" "$1,026.00" "$1,710.00" "$1,710.00" "$1,710.00" N/A N/A 186788035 SUP HCPCS C1713 186788035 - ROD SPINAL 35MM LORDOTIC VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 186788045 SUP Custom 27803010 186788045 - ROD SPINAL 45MM LORDOTIC VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186788065 SUP Custom 27803010 186788065 - ROD SPINAL PRELORDOTIC 65MM LORDOTIC VIPER 2 TITANIUM BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186788075 SUP Custom 27803010 186788075 - ROD SPINAL 75MM LORDOTIC VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186788080 SUP Custom 27803010 186788080 - ROD SPINAL 80MM LORDOTIC VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186788090 SUP Custom 27803010 186788090 - ROD SPINAL 90MM LORDOTIC VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186788100 SUP Custom 27803010 186788100 - ROD SPINAL 100MM LORDOTIC VIPER 2 TITANIUM MINIMALLY BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186788120 SUP HCPCS C1713 186788120 - ROD SPINAL 120MM LORDOTIC VIPER 2 TITANIUM MINIMALLY BOTH IP/OP "$1,537.50" "$1,138.00" $305.16 "$1,537.50" $691.88 $691.88 $691.88 $691.88 "$1,537.50" "$1,537.50" "$1,537.50" $320.45 "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" $320.43 "$1,537.50" $615.00 $909.43 "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,153.13" "$1,537.50" "$1,537.50" "$1,537.50" $768.75 $768.75 "$1,217.70" "$1,537.50" "$1,230.00" $691.88 $305.16 N/A $891.75 "$1,537.50" $922.50 "$1,537.50" $320.42 "$1,537.50" N/A N/A 186788150 SUP Custom 27803010 186788150 - ROD SPINAL 150MM LORDOTIC VIPER 2 TITANIUM MINIMALLY BOTH IP/OP "$1,537.50" "$1,138.00" $273.68 "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" $273.68 "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" $320.43 "$1,537.50" $615.00 "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,153.13" "$1,537.50" "$1,537.50" "$1,537.50" $768.75 $768.75 "$1,217.70" "$1,537.50" "$1,230.00" $691.88 "$1,537.50" N/A $891.75 "$1,537.50" $922.50 "$1,537.50" "$1,537.50" "$1,537.50" N/A N/A 186789040 SUP Custom 27803010 186789040 - ROD SPINAL 40MM STR VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186789050 SUP Custom 27803010 186789050 - ROD SPINAL 50MM STR VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186789070 SUP Custom 27803010 186789070 - ROD SPINAL 70MM STR VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186789080 SUP Custom 27803010 186789080 - ROD SPINAL STR 80MM VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186789100 SUP Custom 27803010 186789100 - ROD SPINAL 100MM STR VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 186789150 SUP HCPCS C1713 186789150 - ROD SPINAL 150MM STR VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP "$1,537.50" "$1,138.00" $305.16 "$1,537.50" $691.88 $691.88 $691.88 $691.88 "$1,537.50" "$1,537.50" "$1,537.50" $320.45 "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" $320.43 "$1,537.50" "$1,537.50" $909.43 "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,153.13" "$1,537.50" "$1,537.50" "$1,537.50" $768.75 $768.75 "$1,217.70" "$1,537.50" "$1,230.00" $691.88 $305.16 N/A $891.75 "$1,537.50" $922.50 "$1,537.50" $320.42 "$1,537.50" N/A N/A 186789200 SUP Custom 27803010 186789200 - ROD SPINAL 200MM STR VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP "$1,710.00" "$1,265.00" $304.38 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" $304.38 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" $356.38 "$1,710.00" $684.00 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,282.50" "$1,710.00" "$1,710.00" "$1,710.00" $855.00 $855.00 "$1,354.32" "$1,710.00" "$1,368.00" $769.50 "$1,710.00" N/A $991.80 "$1,710.00" "$1,026.00" "$1,710.00" "$1,710.00" "$1,710.00" N/A N/A 186789300 SUP Custom 27803010 186789300 - ROD SPINAL STR 300MM VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP "$1,882.50" "$1,393.00" $335.09 "$1,882.50" "$1,882.50" "$1,882.50" "$1,882.50" "$1,882.50" "$1,882.50" "$1,882.50" $335.09 "$1,882.50" "$1,882.50" "$1,882.50" "$1,882.50" "$1,882.50" "$1,882.50" $392.33 "$1,882.50" $753.00 "$1,882.50" "$1,882.50" "$1,882.50" "$1,882.50" "$1,882.50" "$1,411.88" "$1,882.50" "$1,882.50" "$1,882.50" $941.25 $941.25 "$1,490.94" "$1,882.50" "$1,506.00" $847.13 "$1,882.50" N/A "$1,091.85" "$1,882.50" "$1,129.50" "$1,882.50" "$1,882.50" "$1,882.50" N/A N/A 186789400 SUP HCPCS C1713 186789400 - ROD SPINAL 400MM STR VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP "$2,055.00" "$1,521.00" $407.87 "$2,055.00" $924.75 $924.75 $924.75 $924.75 "$2,055.00" "$2,055.00" "$2,055.00" $428.31 "$2,055.00" "$2,055.00" "$2,055.00" "$2,055.00" "$2,055.00" $428.28 "$2,055.00" $822.00 "$1,215.53" "$2,055.00" "$2,055.00" "$2,055.00" "$2,055.00" "$1,541.25" "$2,055.00" "$2,055.00" "$2,055.00" "$1,027.50" "$1,027.50" "$1,627.56" "$2,055.00" "$1,644.00" $924.75 $407.87 N/A "$1,191.90" "$2,055.00" "$2,055.00" "$2,055.00" $428.26 "$2,055.00" N/A N/A 186789480 SUP HCPCS C1713 186789480 - ROD SPINAL STR 480MM VIPER 2 TITANIUM MINIMALLY INVASIVE BOTH IP/OP "$2,055.00" "$1,521.00" $407.87 "$2,055.00" $924.75 $924.75 $924.75 $924.75 "$2,055.00" "$2,055.00" "$2,055.00" $428.31 "$2,055.00" "$2,055.00" "$2,055.00" "$2,055.00" "$2,055.00" $428.28 "$2,055.00" $822.00 "$1,215.53" "$2,055.00" "$2,055.00" "$2,055.00" "$2,055.00" "$1,541.25" "$2,055.00" "$2,055.00" "$2,055.00" "$1,027.50" "$1,027.50" "$1,627.56" "$2,055.00" "$1,644.00" $924.75 $407.87 N/A "$1,191.90" "$2,055.00" "$1,233.00" "$2,055.00" $428.26 "$2,055.00" N/A N/A 186801012 SUP HCPCS C1713 186801012 - PLATE BONE PRELORDOTIC 19.8X16X2.5MM 12MM LEVEL 1 MEDIAL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 186801014 SUP HCPCS C1713 186801014 - PLATE BONE PRELORDOTIC 21.8X16X2.5MM 14MM LEVEL 1 MEDIAL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 186801016 SUP HCPCS C1713 186801016 - PLATE BONE PRELORDOTIC 23.8X16X2.5MM 16MM LEVEL 1 MEDIAL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 186801024 SUP HCPCS C1713 186801024 - PLATE BN 14MM PREBNT 24X16X2.5MM NS SKYLINE 1 LVL TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 186801026 SUP HCPCS C1713 186801026 - PLATE BONE PRELORDOTIC 33.8X16X2.5MM 26MM LEVEL 1 MEDIAL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 186801028 SUP HCPCS C1713 186801028 - PLATE BONE PRELORDOTIC 35.8X16X2.5MM 28MM LEVEL 1 MEDIAL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 186801030 SUP HCPCS C1713 186801030 - PLATE BONE PRELORDOTIC 37.8X16X2.5MM 30MM LEVEL 1 MEDIAL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 186802028 SUP HCPCS C1713 186802028 - PLATE BONE PRELORDOTIC 35.8X16X2.5MM 28MM LEVEL 2 MEDIAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 186802030 SUP HCPCS C1713 186802030 - PLATE BONE PRELORDOTIC 37.8X16X2.5MM 30MM LEVEL 2 MEDIAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 186802032 SUP HCPCS C1713 186802032 - PLATE BONE PRELORDOTIC 39.8X16X2.5MM 32MM LEVEL 2 MEDIAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 186802036 SUP HCPCS C1713 186802036 - PLATE BONE PRELORDOTIC 43.8X16X2.5MM 36MM LEVEL 2 MEDIAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 186803039 SUP HCPCS C1713 186803039 - PLATE BN 39MM NS SKYLINE 3 LVL SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 186803042 SUP HCPCS C1713 186803042 - PLATE BONE PRELORDOTIC 49.8X16X2.5MM 42MM LEVEL 3 MEDIAL BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 186803045 SUP HCPCS C1713 186803045 - PLATE BONE PRELORDOTIC 52.8X16X2.5MM 45MM LEVEL 3 MEDIAL BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 186803051 SUP HCPCS C1713 186803051 - PLATE BONE PRELORDOTIC 58.8X16X2.5MM 51MM LEVEL 3 MEDIAL BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 186820012 SUP Custom 27203010 186820012 - 14MM DRILL BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $640.15 $640.15 $664.82 $449.36 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $560.63 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 186850012 SUP HCPCS C1713 186850012 - SCREW BONE 12MM VAR ANG SELF DRILL SKYLINE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 186850014 SUP HCPCS C1713 186850014 - SCREW BONE 0-20D 4MM 14MM VARIABLE SLFDRILL SKYLINE GOLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 186850016 SUP HCPCS C1713 186850016 - SCREW BONE 16MM VAR ANG SELF DRILL SKYLINE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 186850017 SUP HCPCS C1713 186850017 - SCREW BN 0-20D 4MM 17MM LGHT GRN SKYLINE VAR SLFDRL TI ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 186850018 SUP HCPCS C1713 186850018 - SCREW BONE 18MM VAR ANG SELF DRILL SKYLINE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 186852014 SUP HCPCS C1713 186852014 - SCREW BONE 14MM VAR ANG SELF TAP SKYLINE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 186852015 SUP HCPCS C1713 186852015 - SCREW BONE 15MM SLFTAP VAR ANG SKYLINE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 186852016 SUP HCPCS C1713 186852016 - SCREW BONE 16MM VAR ANG SELF TAP SKYLINE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 186852017 SUP HCPCS C1713 186852017 - SCREW BONE 17MM SLFTAP VAR ANG SKYLINE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 186852018 SUP HCPCS C1713 186852018 - SCREW BONE 18MM SLFTAP VAR ANG SKYLINE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 186854014 SUP HCPCS C1713 186854014 - SCREW BONE LARGE DIAMETER 14MM VAR ANG SELF TAP SKYLINE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 186854016 SUP HCPCS C1713 186854016 - SCREW BN OVSZ 4.5MM 16MM NS SKYLINE VAR SLF DRL TI SPNE CRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 186854018 SUP HCPCS C1713 186854018 - SCREW BONE LARGE DIAMETER 18MM VAR ANG SELF TAP SKYLINE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 186862014 SUP HCPCS C1713 186862014 - SCREW BONE 4MM 14MM SELF TAP CONSTRAIN SKYLINE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 186862016 SUP HCPCS C1713 186862016 - SCREW BONE 4MM 16MM SELF TAP CONSTRAIN SKYLINE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 186864014 SUP HCPCS C1713 186864014 - SCREW BONE 14MM SELF TAP CONSTRAIN SKYLINE TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 187301105 SUP Custom 27803010 187301105 - CAGE SPNL 7D STD 5MM NS LF BENGAL CFRP CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 187301106 SUP Custom 27803010 187301106 - CAGE SPNL 7D STD 6MM NS LF BENGAL CFRP CRV INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 187301107 SUP Custom 27803010 187301107 - CAGE SPNL 7D STD 7MM NS LF BENGAL CFRP CRV INTRBD FS BOTH IP/OP "$2,458.50" "$1,819.00" $437.55 "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" $437.55 "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" $512.30 "$2,458.13" $983.25 "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" "$1,843.88" "$2,458.13" "$2,458.13" "$2,458.13" "$1,229.07" "$1,229.07" "$1,946.84" "$2,458.13" "$1,966.50" "$1,106.16" "$2,458.13" N/A "$1,425.93" "$2,458.13" "$1,474.88" "$2,458.13" "$2,458.13" "$2,458.13" N/A N/A 187301108 SUP Custom 27803010 187301108 - CAGE SPNL 7D STD 8MM NS LF BENGAL CFRP CRV INTRBD FS BOTH IP/OP "$2,458.50" "$1,819.00" $437.55 "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" $437.55 "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" $512.30 "$2,458.13" $983.25 "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" "$2,458.13" "$1,843.88" "$2,458.13" "$2,458.13" "$2,458.13" "$1,229.07" "$1,229.07" "$1,946.84" "$2,458.13" "$1,966.50" "$1,106.16" "$2,458.13" N/A "$1,425.93" "$2,458.13" "$1,474.88" "$2,458.13" "$2,458.13" "$2,458.13" N/A N/A 187301207 SUP HCPCS C1713 187301207 - CAGE SPNL 7D LG LRDTC 7MM NS LF BENGAL CFBR LMBR INTRBD FS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 187823107 SUP HCPCS C1713 187823107 - CAGE SPNL PRLL BLT 23X9X7MM NS LF CNCRD BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A 187823108 SUP Custom 27803010 187823108 - CAGE SPNL PRLL BLT NOSE 23X9X8MM NS LF CNCRD RADOPQ CFRP BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 187823409 SUP Custom 27803010 187823409 - CAGE SPNL 5D LRDTC BLT NOSE 23X9X9MM NS LF CNCRD RADOPQ CFRP BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 187823410 SUP Custom 27803010 187823410 - CAGE SPNL 5D LRDTC BLT NOSE 23X9X10MM NS LF CNCRD RADOPQ BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 187827108 SUP Custom 27803010 187827108 - CAGE SPNL PRLL BLT NOSE 27X9X8MM NS LF CNCRD RADOPQ CFRP BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 187827212 SUP Custom 27803010 187827212 - CAGE SPNL PRLL BLT NOSE 27X11X12MM NS LF CNCRD RADOPQ CFRP BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 187827409 SUP Custom 27803010 187827409 - CAGE SPNL 5D LRDTC BLT NOSE 27X9X9MM NS LF CNCRD RADOPQ CFRP BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 188311002 SUP HCPCS C1713 188311002 - ROD SPINAL 3.5-5.5MM 420MM 2 OPENING MOUNTAINEER TITANIUM BOTH IP/OP "$2,145.00" "$1,587.00" $425.73 "$2,145.00" $965.25 $965.25 $965.25 $965.25 "$2,145.00" "$2,145.00" "$2,145.00" $447.07 "$2,145.00" "$2,145.00" "$2,145.00" "$2,145.00" "$2,145.00" $447.04 "$2,145.00" $858.00 "$1,268.77" "$2,145.00" "$2,145.00" "$2,145.00" "$2,145.00" "$1,608.75" "$2,145.00" "$2,145.00" "$2,145.00" "$1,072.50" "$1,072.50" "$1,698.84" "$2,145.00" "$1,716.00" $965.25 $425.73 N/A "$1,244.10" "$2,145.00" "$1,287.00" "$2,145.00" $447.02 "$2,145.00" N/A N/A 188311200 SUP Custom 27803010 188311200 - CONNECTOR ROD 3.5MM WEDDING BAND MOUNTAINEER SPN BOTH IP/OP "$1,740.00" "$1,288.00" $309.72 "$1,740.00" "$1,740.00" "$1,740.00" "$1,740.00" "$1,740.00" "$1,740.00" "$1,740.00" $309.72 "$1,740.00" "$1,740.00" "$1,740.00" "$1,740.00" "$1,740.00" "$1,740.00" $362.64 "$1,740.00" $696.00 "$1,740.00" "$1,740.00" "$1,740.00" "$1,740.00" "$1,740.00" "$1,305.00" "$1,740.00" "$1,740.00" "$1,740.00" $870.00 $870.00 "$1,378.08" "$1,740.00" "$1,392.00" $783.00 "$1,740.00" N/A "$1,009.20" "$1,740.00" "$1,044.00" "$1,740.00" "$1,740.00" "$1,740.00" N/A N/A 188312001 SUP Custom 27803010 188312001 - CONNECTOR ROD OFFST ASMBLY MOUNTAINEER BOTH IP/OP "$1,342.50" $993.00 $238.97 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $238.97 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" $537.00 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 "$1,342.50" N/A $778.65 "$1,342.50" $805.50 "$1,342.50" "$1,342.50" "$1,342.50" N/A N/A 188312003 SUP Custom 27803010 188312003 - CONNECTOR ROD J HOOK ASMBLY MOUNTAINEER BOTH IP/OP "$1,170.00" $866.00 $208.26 "$1,170.00" "$1,170.00" "$1,170.00" "$1,170.00" "$1,170.00" "$1,170.00" "$1,170.00" $208.26 "$1,170.00" "$1,170.00" "$1,170.00" "$1,170.00" "$1,170.00" "$1,170.00" $243.84 "$1,170.00" $468.00 "$1,170.00" "$1,170.00" "$1,170.00" "$1,170.00" "$1,170.00" $877.50 "$1,170.00" "$1,170.00" "$1,170.00" $585.00 $585.00 $926.64 "$1,170.00" $936.00 $526.50 "$1,170.00" N/A $678.60 "$1,170.00" $702.00 "$1,170.00" "$1,170.00" "$1,170.00" N/A N/A 188316030 SUP Custom 27803010 188316030 - ROD SPINAL 3.5MM 30MM MOUNTAINEER BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 188316035 SUP Custom 27803010 188316035 - ROD SPINAL 3.5MM 35MM MOUNTAINEER BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 188316040 SUP Custom 27803010 188316040 - ROD SPINAL 3.5MM 40MM MOUNTAINEER BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 188316045 SUP Custom 27803010 188316045 - ROD SPINAL 3.5MM 45MM MOUNTAINEER BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 188316050 SUP Custom 27803010 188316050 - ROD SPINAL 3.5MM 50MM MOUNTAINEER BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 188316055 SUP Custom 27803010 188316055 - ROD SPINAL 3.5MM 55MM MOUNTAINEER BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 188316060 SUP Custom 27803010 188316060 - ROD SPINAL 3.5MM 60MM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 188316065 SUP Custom 27803010 188316065 - ROD SPINAL 3.5MM 65MM MOUNTAINEER BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 188316070 SUP Custom 27803010 188316070 - ROD SPINAL 3.5MM 70MM MOUNTAINEER BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 188316075 SUP Custom 27803010 188316075 - ROD SPINAL 3.5MM 75MM MOUNTAINEER BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 188316085 SUP HCPCS C1713 188316085 - ROD SPINAL 3.5MM 85MM MOUNTAINEER BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 188316100 SUP Custom 27803010 188316100 - ROD SPINAL 3.5MM 100MM MOUNTAINEER BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 188316120 SUP Custom 27803010 188316120 - ROD SPINAL 3.5MM 120MM RIGID MOUNTAINEER TITANIUM STERILE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 188318310 SUP HCPCS C1713 188318310 - SCREW BONE 3.5MM 10MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188318312 SUP HCPCS C1713 188318312 - SCREW BONE 3.5MM 12MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188318314 SUP HCPCS C1713 188318314 - SCREW BONE 3.5MM 14MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188318316 SUP HCPCS C1713 188318316 - SCREW BONE 3.5MM 16MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188318318 SUP HCPCS C1713 188318318 - SCREW BONE 3.5MM 18MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188318320 SUP HCPCS C1713 188318320 - SCREW BONE 3.5MM 20MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188318324 SUP HCPCS C1713 188318324 - SCREW BONE 3.5MM 24MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188318412 SUP HCPCS C1713 188318412 - SCREW BONE 4MM 12MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188318414 SUP HCPCS C1713 188318414 - SCREW BONE 4MM 14MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188318418 SUP HCPCS C1713 188318418 - SCREW BONE 4MM 18MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188318420 SUP HCPCS C1713 188318420 - SCREW BONE 4MM 20MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188318426 SUP HCPCS C1713 188318426 - SCREW BONE 4MM 26MM FAVORED ANGLE MOUNTAINEER TITANIUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188319310 SUP HCPCS C1713 188319310 - SCREW BONE 3.5MM 10MM FAVOR ANGLE MINIPOLYAXIAL SELF FORM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188319312 SUP HCPCS C1713 188319312 - SCREW BONE 3.5MM 12MM FAVOR ANGLE MINIPOLYAXIAL SELF FORM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188319314 SUP HCPCS C1713 188319314 - SCREW BONE 3.5MM 14MM FAVOR ANGLE MINIPOLYAXIAL SELF FORM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188319316 SUP HCPCS C1713 188319316 - SCREW BONE 3.5MM 16MM FAVOR ANGLE MINIPOLYAXIAL SELF FORM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188319420 SUP HCPCS C1713 188319420 - SCREW BONE 4MM 20MM FAVOR ANGLE MINIPOLYAXIAL SELF FORM TIP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188319424 SUP HCPCS C1713 188319424 - SCREW BONE 4MM 24MM FAVOR ANGLE MINIPOLYAXIAL SELF FORM TIP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188319426 SUP HCPCS C1713 188319426 - SCREW BONE 4MM 26MM FAVOR ANGLE MINIPOLYAXIAL SELF FORM TIP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188319525 SUP HCPCS C1713 188319525 - SCREW BONE 4.35MM 25MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188319530 SUP HCPCS C1713 188319530 - SCREW BONE 4.35MM 30MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188319535 SUP HCPCS C1713 188319535 - SCREW BONE 4.35MM 35MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188341021 SUP HCPCS C1713 188341021 - PLATE BN 21MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188341028 SUP HCPCS C1713 188341028 - PLATE BN 28MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188341035 SUP HCPCS C1713 188341035 - PLATE BN 35MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188341042 SUP HCPCS C1713 188341042 - PLATE BN 42MM NS MTNR HD TO HD CX CNCT SPNE OCT 3.5MM SCR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 188341100 SUP Custom 27803010 188341100 - NUT OUTER HEAD TO HEAD CROSS CONECTION MOUNTAINEER TITANIUM BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 188341200 SUP HCPCS C1713 188341200 - SCREW BONE 3.5MM 200MM INNER CROSS CONCTR HEAD TO HEAD BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 188341300 SUP Custom 27803010 188341300 - CONNECTOR ROD CROSS HOOK HEAD TO HEAD MOUNTAINEER BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 188342200 SUP HCPCS C1713 188342200 - SCREW SET INNER MOUNTAINEER SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 188362006 SUP HCPCS C1713 188362006 - SCREW BONE 4.5MM 6MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $459.00 $765.00 $159.43 $765.00 N/A N/A 188362007 SUP HCPCS C1713 188362007 - SCREW BONE 4.5MM 7MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $459.00 $765.00 $159.43 $765.00 N/A N/A 188362008 SUP HCPCS C1713 188362008 - SCREW BONE 4.5MM 8MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $306.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $459.00 $765.00 $159.43 $765.00 N/A N/A 188362010 SUP HCPCS C1713 188362010 - SCREW BONE 4.5MM 10MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $765.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $459.00 $765.00 $159.43 $765.00 N/A N/A 188362012 SUP HCPCS C1713 188362012 - SCREW BONE 4.5MM 12MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP $765.00 $566.00 $151.83 $765.00 $344.25 $344.25 $344.25 $344.25 $765.00 $765.00 $765.00 $159.45 $765.00 $765.00 $765.00 $765.00 $765.00 $159.43 $765.00 $765.00 $452.50 $765.00 $765.00 $765.00 $765.00 $573.75 $765.00 $765.00 $765.00 $382.50 $382.50 $605.88 $765.00 $612.00 $344.25 $151.83 N/A $443.70 $765.00 $459.00 $765.00 $159.43 $765.00 N/A N/A 188362025 SUP HCPCS C1713 188362025 - SCREW BONE 4.5MM 25MM FIX ANGLE MOUNTAINEER TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 188362031 SUP HCPCS C1713 188362031 - PLATE BN 31MM NS MTNR SPNE OC 3.5MM SCR BOTH IP/OP "$8,130.00" "$6,016.00" "$1,613.60" "$8,130.00" "$3,658.50" "$3,658.50" "$3,658.50" "$3,658.50" "$8,130.00" "$8,130.00" "$8,130.00" "$1,694.50" "$8,130.00" "$8,130.00" "$8,130.00" "$8,130.00" "$8,130.00" "$1,694.38" "$8,130.00" "$8,130.00" "$4,008.09" "$8,130.00" "$8,130.00" "$8,130.00" "$8,130.00" "$6,097.50" "$8,130.00" "$8,130.00" "$8,130.00" "$4,065.00" "$4,065.00" "$6,438.96" "$8,130.00" "$6,504.00" "$3,658.50" "$1,613.60" N/A "$4,715.40" "$8,130.00" "$4,878.00" "$8,130.00" "$1,694.29" "$8,130.00" N/A N/A 188362106 SUP HCPCS C1713 188362106 - SCREW BONE 5.25MM 6MM MOUNTAINEER TITANIUM BOTH IP/OP $817.50 $605.00 $162.25 $817.50 $367.88 $367.88 $367.88 $367.88 $817.50 $817.50 $817.50 $170.39 $817.50 $817.50 $817.50 $817.50 $817.50 $170.38 $817.50 $327.00 $483.55 $817.50 $817.50 $817.50 $817.50 $613.13 $817.50 $817.50 $817.50 $408.75 $408.75 $647.46 $817.50 $654.00 $367.88 $162.25 N/A $474.15 $817.50 $490.50 $817.50 $170.37 $817.50 N/A N/A 188363200 SUP Custom 27803010 188363200 - ROD SPINAL 3.5MM 120MM PREBENT MOUNTAINEER TITANIUM STERILE BOTH IP/OP $877.50 $649.00 $156.20 $877.50 $877.50 $877.50 $877.50 $877.50 $877.50 $877.50 $156.20 $877.50 $877.50 $877.50 $877.50 $877.50 $877.50 $182.88 $877.50 $351.00 $877.50 $877.50 $877.50 $877.50 $877.50 $658.13 $877.50 $877.50 $877.50 $438.75 $438.75 $694.98 $877.50 $702.00 $394.88 $877.50 N/A $508.95 $877.50 $526.50 $877.50 $877.50 $877.50 N/A N/A 188901040 SUP Custom 27803010 188901040 - CAGE SPNL 0D MED 20MM 40-56MM NS LF X-MESH XPD FTPRNT TI BOTH IP/OP "$13,737.50" "$10,166.00" "$2,445.28" "$13,737.50" "$13,737.50" "$13,737.50" "$13,737.50" "$13,737.50" "$13,737.50" "$13,737.50" "$2,445.28" "$13,737.50" "$13,737.50" "$13,737.50" "$13,737.50" "$13,737.50" "$13,737.50" "$2,863.05" "$13,737.50" "$5,495.00" "$13,737.50" "$13,737.50" "$13,737.50" "$13,737.50" "$13,737.50" "$10,303.13" "$13,737.50" "$13,737.50" "$13,737.50" "$6,868.75" "$6,868.75" "$10,880.10" "$13,737.50" "$10,990.00" "$6,181.88" "$13,737.50" N/A "$7,967.75" "$13,737.50" "$8,242.50" "$13,737.50" "$13,737.50" "$13,737.50" N/A N/A 188920022 SUP Custom 27803010 188920022 - CAGE SPNL 0D SM 16MM 22-30MM NS LF X-MESH XPD FTPRNT TI POST BOTH IP/OP "$11,744.00" "$8,691.00" "$2,090.39" "$11,743.75" "$11,743.75" "$11,743.75" "$11,743.75" "$11,743.75" "$11,743.75" "$11,743.75" "$2,090.39" "$11,743.75" "$11,743.75" "$11,743.75" "$11,743.75" "$11,743.75" "$11,743.75" "$2,447.53" "$11,743.75" "$4,697.50" "$11,743.75" "$11,743.75" "$11,743.75" "$11,743.75" "$11,743.75" "$8,808.00" "$11,743.75" "$11,743.75" "$11,743.75" "$5,871.88" "$5,871.88" "$9,301.05" "$11,743.75" "$9,395.00" "$5,284.69" "$11,743.75" N/A "$6,811.52" "$11,743.75" "$7,046.25" "$11,743.75" "$11,743.75" "$11,743.75" N/A N/A 189401207 SUP Custom 27803010 189401207 - CONNECTOR ROD F7 5.5MM SFX TITANIUM SPN MEDIAL BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 189401208 SUP Custom 27803010 189401208 - CONNECTOR ROD F8 5.5MM CROSS MEDIAL OFFST EXPEDIUM SFX BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 189401209 SUP Custom 27803010 189401209 - CONNECTOR ROD F9 5.5MM SFX TITANIUM SPN MEDIAL BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 189401302 SUP HCPCS C1713 189401302 - CONNECTOR ROD A2 5.5MM EXPEDIUM SFX TITANIUM LATERAL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 189401404 SUP Custom 27803010 189401404 - CONNECTOR ROD A4 5.5MM EXPEDIUM SFX TITANIUM MEDIAL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 189401405 SUP Custom 27803010 189401405 - CONNECTOR ROD A5 MEDIUM 5.5MM CROSS SFX TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 189401406 SUP Custom 27803010 189401406 - CONNECTOR ROD MEDIUM A6 5.5MM CROSSLINK SFX TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 189403303 SUP Custom 27803010 189403303 - CONNECTOR ROD A3 6.35MM CROSSLINK SFX TITANIUM LATERAL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 189706012 SUP HCPCS C1713 189706012 - SCREW BONE 4.6MM 12MM SELF TAP UNIPLATE 2 TITANIUM SPN CERV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 189707012 SUP HCPCS C1713 189707012 - SCREW BONE 4.6MM 12MM SELF DRILL UNIPLATE 2 TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 189707014 SUP HCPCS C1713 189707014 - SCREW BONE 4.6MM 14MM SELF DRILL UNIPLATE 2 TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 189707015 SUP HCPCS C1713 189707015 - SCREW BONE 4.6MM 15MM SELF DRILL UNIPLATE 2 TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 196789120 SUP HCPCS C1713 196789120 - ROD SPINAL STR 120MM VIPER 2 COCR MIS BOTH IP/OP "$1,612.50" "$1,193.00" $320.04 "$1,612.50" $725.63 $725.63 $725.63 $725.63 "$1,612.50" "$1,612.50" "$1,612.50" $336.09 "$1,612.50" "$1,612.50" "$1,612.50" "$1,612.50" "$1,612.50" $336.06 "$1,612.50" $645.00 $953.79 "$1,612.50" "$1,612.50" "$1,612.50" "$1,612.50" "$1,209.38" "$1,612.50" "$1,612.50" "$1,612.50" $806.25 $806.25 "$1,277.10" "$1,612.50" "$1,290.00" $725.63 $320.04 N/A $935.25 "$1,612.50" $967.50 "$1,612.50" $336.05 "$1,612.50" N/A N/A 219501200 SUP Custom 27203010 00219501200 - CARRIER GRAFT 1.5 1 PLATEAU GROOVE 8X3IN RATCHET HANDLE BOTH IP/OP $81.50 $60.00 $14.45 $81.20 $81.20 $81.20 $81.20 $81.20 $81.20 $81.20 $14.45 $81.20 $81.20 $60.27 $60.27 $62.59 $42.31 $16.92 $81.20 $32.48 $81.20 $81.20 $81.20 $81.20 $81.20 $61.13 $81.20 $81.20 $81.20 $40.60 $40.60 $64.31 $81.20 $64.96 $52.78 $81.20 N/A $47.27 $81.20 $48.72 $81.20 $81.20 $81.20 N/A N/A 234020053 SUP HCPCS C1713 234020053 - PIN FIX 2.4MM 12IN TROCAR TIPPED EYE LOOP LATEX FREE FEMUR BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A 234800835 SUP HCPCS C1713 00234800835 - SCREW BONE 3.5MM 2.7MM 8MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $62.10 $62.10 $12.94 $62.10 N/A N/A 234802435 SUP HCPCS C1713 00234802435 - SCREW BONE 3.5MM 2.7MM 24MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $62.10 $62.10 $12.94 $62.10 N/A N/A 234802835 SUP HCPCS C1713 00234802835 - SCREW BONE 3.5MM 2.7MM 28MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234803035 SUP HCPCS C1713 00234803035 - SCREW BONE 3.5MM 2.7MM 30MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234803235 SUP HCPCS C1713 00234803235 - SCREW BONE 3.5MM 2.7MM 32MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $62.10 $62.10 $12.94 $62.10 N/A N/A 234803435 SUP HCPCS C1713 00234803435 - SCREW BONE 3.5MM 2.7MM 34MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $62.10 $62.10 $12.94 $62.10 N/A N/A 234803635 SUP HCPCS C1713 00234803635 - SCREW BONE 3.5MM 2.7MM 36MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $62.10 $62.10 $12.94 $62.10 N/A N/A 234803835 SUP HCPCS C1713 00234803835 - SCREW BONE 3.5MM 2.7MM 38MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $62.10 $62.10 $12.94 $62.10 N/A N/A 234804035 SUP HCPCS C1713 00234804035 - SCREW BONE 3.5MM 2.7MM 40MM SLFTAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $62.10 $62.10 $12.94 $62.10 N/A N/A 234804235 SUP HCPCS C1713 00234804235 - SCREW BONE 3.5MM 2.7MM 42MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234804435 SUP HCPCS C1713 00234804435 - SCREW BONE 3.5MM 2.7MM 44MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234804635 SUP HCPCS C1713 00234804635 - SCREW BONE 3.5MM 2.7MM 46MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234804835 SUP HCPCS C1713 00234804835 - SCREW BONE 3.5MM 2.7MM 48MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234805035 SUP HCPCS C1713 00234805035 - SCREW BONE 3.5MM 2.7MM 50MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $62.10 $62.10 $12.94 $62.10 N/A N/A 234805235 SUP HCPCS C1713 00234805235 - SCREW BONE 3.5MM 2.7MM 52MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $62.10 $62.10 $12.94 $62.10 N/A N/A 234805435 SUP HCPCS C1713 00234805435 - SCREW BONE 3.5MM 2.7MM 54MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234805635 SUP HCPCS C1713 00234805635 - SCREW BONE 2.5MM 3.5MM 2.7MM 56MM SELF TAP LOCK STAINLESS BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234805835 SUP HCPCS C1713 00234805835 - SCREW BONE 3.5MM 2.7MM 58MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234806035 SUP HCPCS C1713 00234806035 - SCREW BONE 3.5MM 2.7MM 60MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234806535 SUP HCPCS C1713 00234806535 - SCREW BONE 3.5MM 2.7MM 65MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $62.10 $62.10 $12.94 $62.10 N/A N/A 234807035 SUP HCPCS C1713 00234807035 - SCREW BONE 3.5MM 2.7MM 70MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $62.10 $62.10 $12.94 $62.10 N/A N/A 234807535 SUP HCPCS C1713 00234807535 - SCREW BONE 3.5MM 2.7MM 75MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $62.10 $62.10 $12.94 $62.10 N/A N/A 234808035 SUP HCPCS C1713 00234808035 - SCREW BONE 3.5MM 2.7MM 80MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234808535 SUP HCPCS C1713 00234808535 - SCREW BONE 3.5MM 2.7MM 85MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234809035 SUP HCPCS C1713 00234809035 - SCREW BONE 3.5MM 2.7MM 90MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234809535 SUP HCPCS C1713 00234809535 - SCREW BONE 3.5MM 2.7MM 95MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234810035 SUP HCPCS C1713 00234810035 - SCREW BONE 3.5MM 2.7MM 100MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234810535 SUP HCPCS C1713 00234810535 - SCREW BONE 3.5MM 2.7MM 105MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 234811035 SUP HCPCS C1713 00234811035 - SCREW BONE 3.5MM 2.7MM 110MM SELF TAP STAINLESS STEEL BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 235701710 SUP HCPCS C1713 00235701710 - PLATE BONE 158MM 10 HOLE LOCK STAINLESS STEEL FIBULA RIGHT BOTH IP/OP "$1,404.50" "$1,039.00" $278.69 "$1,404.15" $631.87 $631.87 $631.87 $631.87 "$1,404.15" "$1,404.15" "$1,404.15" $292.66 "$1,404.15" "$1,404.15" "$1,404.15" "$1,404.15" "$1,404.15" $292.64 "$1,404.15" $561.66 $830.55 "$1,404.15" "$1,404.15" "$1,404.15" "$1,404.15" "$1,053.38" "$1,404.15" "$1,404.15" "$1,404.15" $702.08 $702.08 "$1,112.09" "$1,404.15" "$1,123.32" $631.87 $278.69 N/A $814.61 "$1,404.15" "$1,404.15" "$1,404.15" $292.62 "$1,404.15" N/A N/A 235701808 SUP HCPCS C1713 00235701808 - PLATE BONE 132MM 8 HOLE LOCK STAINLESS STEEL FIBULA LEFT BOTH IP/OP "$1,319.50" $976.00 $261.80 "$1,319.05" $593.57 $593.57 $593.57 $593.57 "$1,319.05" "$1,319.05" "$1,319.05" $274.92 "$1,319.05" "$1,319.05" "$1,319.05" "$1,319.05" "$1,319.05" $274.90 "$1,319.05" $527.62 $780.22 "$1,319.05" "$1,319.05" "$1,319.05" "$1,319.05" $989.63 "$1,319.05" "$1,319.05" "$1,319.05" $659.53 $659.53 "$1,044.69" "$1,319.05" "$1,055.24" $593.57 $261.80 N/A $765.31 "$1,319.05" "$1,319.05" "$1,319.05" $274.89 "$1,319.05" N/A N/A 235701810 SUP HCPCS C1713 00235701810 - PLATE BONE 158MM 10 HOLE LOCK STAINLESS STEEL FIBULA LEFT BOTH IP/OP "$1,404.50" "$1,039.00" $278.69 "$1,404.15" $631.87 $631.87 $631.87 $631.87 "$1,404.15" "$1,404.15" "$1,404.15" $292.66 "$1,404.15" "$1,404.15" "$1,404.15" "$1,404.15" "$1,404.15" $292.64 "$1,404.15" $561.66 $830.55 "$1,404.15" "$1,404.15" "$1,404.15" "$1,404.15" "$1,053.38" "$1,404.15" "$1,404.15" "$1,404.15" $702.08 $702.08 "$1,112.09" "$1,404.15" "$1,123.32" $631.87 $278.69 N/A $814.61 "$1,404.15" "$1,404.15" "$1,404.15" $292.62 "$1,404.15" N/A N/A 248001040 SUP HCPCS C1713 00248001040 - SCREW BONE 4MM 10MM 5MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248001041 SUP HCPCS C1713 00248001041 - SCREW BONE FULTHD 4MM 10MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248001240 SUP HCPCS C1713 00248001240 - SCREW BONE 4MM 12MM 5MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $111.55 $111.55 $23.25 $111.55 N/A N/A 248001241 SUP HCPCS C1713 00248001241 - SCREW BONE FULTHD 4MM 12MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248001440 SUP HCPCS C1713 00248001440 - SCREW BONE 4MM 14MM 5MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248001441 SUP HCPCS C1713 00248001441 - SCREW BONE FULTHD 4MM 14MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248001640 SUP HCPCS C1713 00248001640 - SCREW BONE 4MM 16MM 6MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248001641 SUP HCPCS C1713 00248001641 - SCREW BONE FULTHD 4MM 16MM FORTE STAINLESS STEEL BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248001840 SUP HCPCS C1713 00248001840 - SCREW BONE 4MM 18MM 7MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248001841 SUP HCPCS C1713 00248001841 - SCREW BONE FULTHD 4MM 18MM FORTE STAINLESS STEEL BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $111.55 $111.55 $23.25 $111.55 N/A N/A 248002040 SUP HCPCS C1713 00248002040 - SCREW BONE 4MM 20MM 8MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $111.55 $111.55 $23.25 $111.55 N/A N/A 248002041 SUP HCPCS C1713 00248002041 - SCREW BONE FULTHD 4MM 20MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248002240 SUP HCPCS C1713 00248002240 - SCREW BONE 4MM 22MM 9MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248002241 SUP HCPCS C1713 00248002241 - SCREW BONE FULTHD 4MM 22MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $111.55 $111.55 $23.25 $111.55 N/A N/A 248002440 SUP HCPCS C1713 00248002440 - SCREW BONE 4MM 24MM 10MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $111.55 $111.55 $23.25 $111.55 N/A N/A 248002441 SUP HCPCS C1713 00248002441 - SCREW BONE FULTHD 4MM 24MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248002640 SUP HCPCS C1713 00248002640 - SCREW BONE 4MM 26MM 12MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248002641 SUP HCPCS C1713 00248002641 - SCREW BONE FULTHD 4MM 26MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $111.55 $111.55 $23.25 $111.55 N/A N/A 248002840 SUP HCPCS C1713 00248002840 - SCREW BONE 4MM 28MM 14MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248002841 SUP HCPCS C1713 00248002841 - SCREW BONE FULTHD 4MM 28MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248003040 SUP HCPCS C1713 00248003040 - SCREW BONE 4MM 30MM 14MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248003041 SUP HCPCS C1713 00248003041 - SCREW BONE FULTHD 4MM 30MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248003240 SUP HCPCS C1713 00248003240 - SCREW BONE 4MM 32MM 14MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $111.55 $111.55 $23.25 $111.55 N/A N/A 248003241 SUP HCPCS C1713 00248003241 - SCREW BONE FULTHD 4MM 32MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248003440 SUP HCPCS C1713 00248003440 - SCREW BONE 4MM 34MM 14MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248003441 SUP HCPCS C1713 00248003441 - SCREW BONE FULTHD 4MM 34MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248003640 SUP HCPCS C1713 00248003640 - SCREW BONE 4MM 36MM 14MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248003641 SUP HCPCS C1713 00248003641 - SCREW BONE FULTHD 4MM 36MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248003840 SUP HCPCS C1713 00248003840 - SCREW BONE 4MM 38MM 14MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248003841 SUP HCPCS C1713 00248003841 - SCREW BONE FULTHD 4MM 38MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248004040 SUP HCPCS C1713 00248004040 - SCREW BONE 4MM 40MM 14MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248004041 SUP HCPCS C1713 00248004041 - SCREW BONE FULTHD 4MM 40MM FORTE STAINLESS STEEL CANCELLOUS BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 248781032 SUP Custom 27203010 248781032 - STATION EYEWASH 17.5X15IN 4 SCREW HOLE SAFETY BOTTLE WALL BOTH IP/OP $142.00 $105.00 $25.22 $141.66 $141.66 $141.66 $141.66 $141.66 $141.66 $141.66 $25.22 $141.66 $141.66 $105.14 $105.14 $109.19 $73.80 $29.52 $141.66 $56.66 $141.66 $141.66 $141.66 $141.66 $141.66 $106.50 $141.66 $141.66 $141.66 $70.83 $70.83 $112.19 $141.66 $113.33 $92.08 $141.66 N/A $82.36 $141.66 $85.00 $141.66 $141.66 $141.66 N/A N/A 272350250 SUP HCPCS C1769 272350250 - GUIDEWIRE ORTHOPEDIC 1.57MM SHARP BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 279351100 SUP Custom 27203010 0279351100 - ELTRD ESURG 90MM 3.5MM SERFAS ENRG 90D PRB SCT ARTHRO LATEX BOTH IP/OP $508.00 $376.00 $90.40 $507.88 $507.88 $507.88 $507.88 $507.88 $507.88 $507.88 $90.40 $507.88 $507.88 $376.95 $376.95 $391.47 $264.61 $105.85 $507.88 $203.15 $507.88 $507.88 $507.88 $507.88 $507.88 $381.00 $507.88 $507.88 $507.88 $253.94 $253.94 $402.24 $507.88 $406.30 $330.12 $507.88 N/A $294.64 $507.88 $304.73 $507.88 $507.88 $507.88 N/A N/A 279351300 SUP Custom 27203010 0279351300 - PROBE SCT 90MM SERFAS ENRG 3.5MM LATEX FREE BOTH IP/OP $523.00 $387.00 $93.05 $522.75 $522.75 $522.75 $522.75 $522.75 $522.75 $522.75 $93.05 $522.75 $522.75 $387.99 $387.99 $402.94 $272.35 $108.95 $522.75 $209.10 $522.75 $522.75 $522.75 $522.75 $522.75 $392.25 $522.75 $522.75 $522.75 $261.38 $261.38 $414.02 $522.75 $418.20 $339.79 $522.75 N/A $303.34 $522.75 $313.65 $522.75 $522.75 $522.75 N/A N/A 283903611 SUP HCPCS C1894 283903611 - NEEDLE SPNL 11GA 6IN INTRO CNFD DMD TIP BOTH IP/OP $165.00 $122.00 $32.75 $165.00 $89.60 $89.60 $89.60 $89.60 $165.00 $165.00 $165.00 $34.39 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $165.00 $97.60 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $32.75 N/A $95.70 $165.00 $165.00 $165.00 $34.39 $165.00 N/A N/A 286565001 SUP Custom 27803010 286565001 - HOLDER IMPLANT PIN TEMPORARY FIX THREADED SWIFT BOTH IP/OP $337.50 $250.00 $60.08 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $60.08 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $337.50 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $337.50 N/A $195.75 $337.50 $202.50 $337.50 $337.50 $337.50 N/A N/A 286705200 SUP Custom 27203010 286705200 - GUIDEWIRE ORTHOPEDIC BLUNT 1.37MM THREADED BLUNT VIPER SPN BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A 286705220 SUP Custom 27203010 286705220 - GUIDEWIRE ORTHOPEDIC 1.45MM THREADED BLUNT VIPER 2 SPN BOTH IP/OP $575.00 $426.00 $102.35 $575.00 $575.00 $575.00 $575.00 $575.00 $575.00 $575.00 $102.35 $575.00 $575.00 $426.77 $426.77 $443.21 $299.58 $119.84 $575.00 $230.00 $575.00 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $373.75 $575.00 N/A $333.50 $575.00 $345.00 $575.00 $575.00 $575.00 N/A N/A 286820012 SUP Custom 27203010 286820012 - BIT DRL 2.2MM 12MM NS SKYLINE REUSE ANT CRV PLT SYS BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $640.15 $640.15 $664.82 $449.36 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $560.63 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 286820014 SUP Custom 27203010 286820014 - DRILL SURG 14MM BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $640.15 $640.15 $664.82 $449.36 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $560.63 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 286820016 SUP Custom 27203010 286820016 - BIT DRILL FLAT 16MM CHUCK SKYLINE DISPOSABLE BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $640.15 $640.15 $664.82 $449.36 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $560.63 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 286850100 SUP HCPCS C1713 286850100 - PIN FIX STR TEMPORARY SKYLINE SPN BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $337.50 $337.50 $70.34 $337.50 N/A N/A 286850200 SUP HCPCS C1713 286850200 - PIN FIX 200MM 50MM THREADED TEMPORARY SKYLINE SPN BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $337.50 $337.50 $70.34 $337.50 N/A N/A 288301114 SUP Custom 27203010 288301114 - GUIDE DRILL 14MM FIX BOTH IP/OP $612.50 $453.00 $109.03 $612.50 $612.50 $612.50 $612.50 $612.50 $612.50 $612.50 $109.03 $612.50 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $245.00 $612.50 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $612.50 N/A $355.25 $612.50 $367.50 $612.50 $612.50 $612.50 N/A N/A 288302030 SUP Custom 27203010 288302030 - TAP SURG 3MM BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 288302035 SUP Custom 27203010 288302035 - TAP SPINAL 3.5MM STAINLESS STEEL DISPOSABLE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 288302040 SUP Custom 27203010 288302040 - TAP SURG 4MM MOUNTAINEER DISPOSABLE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 288310035 SUP Custom 27100030 288310035 - BIT DRILL 3.5MM QUICK COUPLING BOTH IP/OP $612.50 $453.00 $109.03 $612.50 $612.50 $612.50 $612.50 $612.50 $612.50 $612.50 $109.03 $612.50 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $245.00 $612.50 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $612.50 N/A $355.25 $612.50 $367.50 $612.50 $612.50 $612.50 N/A N/A 292301001 SUP Custom 27011340 292301001 - HALTER TRACTION 19-26IN 3D HALO CROWN HEAD BOTH IP/OP "$1,560.00" "$1,154.00" $277.68 "$1,560.00" "$1,560.00" "$1,560.00" "$1,560.00" "$1,560.00" "$1,560.00" "$1,560.00" $277.68 "$1,560.00" "$1,560.00" "$1,157.83" "$1,157.83" "$1,202.45" $812.76 $325.12 "$1,560.00" $624.00 "$1,560.00" "$1,560.00" "$1,560.00" "$1,560.00" "$1,560.00" "$1,170.00" "$1,560.00" "$1,560.00" "$1,560.00" $780.00 $780.00 "$1,235.52" "$1,560.00" "$1,248.00" "$1,014.00" "$1,560.00" N/A $904.80 "$1,560.00" $936.00 "$1,560.00" "$1,560.00" "$1,560.00" N/A N/A 306573000 SUP HCPCS C1713 306573000 - KIT BN CMNT ACM BWL CMNT CRTDG FEM NOZ MED PRS 180GM BOTH IP/OP $234.50 $174.00 $46.50 $234.28 $105.43 $105.43 $105.43 $105.43 $234.28 $234.28 $234.28 $48.83 $234.28 $234.28 $234.28 $234.28 $234.28 $48.83 $234.28 $93.71 $138.58 $234.28 $234.28 $234.28 $234.28 $175.88 $234.28 $234.28 $234.28 $117.14 $117.14 $185.55 $234.28 $187.42 $105.43 $46.50 N/A $136.01 $234.28 $140.57 $234.28 $48.82 $234.28 N/A N/A 336612008 SUP Custom 27803010 336612008 - CAGE SPNL 12MM 8MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336612009 SUP Custom 27803010 336612009 - CAGE SPNL 12MM 9MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336612010 SUP Custom 27803010 336612010 - CAGE SPNL 12MM 10MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336612011 SUP Custom 27803010 336612011 - CAGE SPNL 12MM 11MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336612012 SUP Custom 27803010 336612012 - CAGE SPNL 12MM 12MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336612040 SUP Custom 27803010 336612040 - CAGE SPNL 12MM 40MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336612080 SUP Custom 27803010 336612080 - CAGE SPNL 12MM 80MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336614008 SUP Custom 27803010 336614008 - CAGE SPNL 14MM 8MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336614009 SUP Custom 27803010 336614009 - CAGE SPNL 14MM 9MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336614010 SUP Custom 27803010 336614010 - CAGE SPNL 14MM 10MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336614011 SUP Custom 27803010 336614011 - CAGE SPNL 14MM 11MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336614012 SUP Custom 27803010 336614012 - CAGE SPNL 14MM 12MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336614040 SUP Custom 27803010 336614040 - CAGE SPNL 14MM 40MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336614080 SUP Custom 27803010 336614080 - CAGE SPNL 14MM 80MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336616040 SUP Custom 27803010 336616040 - CAGE SPNL 16MM 40MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336616080 SUP Custom 27803010 336616080 - CAGE SPNL 16MM 80MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336620040 SUP Custom 27803010 336620040 - CAGE SPNL 20MM 40MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336620080 SUP Custom 27803010 336620080 - CAGE SPNL 20MM 80MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336620120 SUP Custom 27803010 336620120 - CAGE SPNL 20MM 120MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336625040 SUP Custom 27803010 336625040 - CAGE SPNL 25MM 40MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336625080 SUP Custom 27803010 336625080 - CAGE SPNL 25MM 80MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 336625120 SUP Custom 27803010 336625120 - CAGE SPNL 25MM 120MM VBOSS TI THORLMBR INTRBD FS BOTH IP/OP "$6,250.00" "$4,625.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,112.50" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$2,500.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$6,250.00" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$6,250.00" "$6,250.00" N/A N/A 380544150 SUP Custom 27203010 380544150 - CUTTER ENDSCP ANG AGRS+ FRML 4.5MM BOTH IP/OP $238.00 $176.00 $42.36 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $238.00 $42.36 $238.00 $238.00 $176.64 $176.64 $183.45 $124.00 $49.60 $238.00 $95.20 $238.00 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $154.70 $238.00 N/A $138.04 $238.00 $142.80 $238.00 $238.00 $238.00 N/A N/A 381003004 SUP HCPCS C1773 381003004 - KIT SNR 3.2FR 2-4MM 175CM 150CM ATRIEVE VASC SNR 3 LOOP SHRT BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $678.75 $678.75 $678.75 $678.75 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 381003008 SUP HCPCS C1773 381003008 - KIT SNR 15D 3.2FR 4-8MM 175CM 150CM ATRIEVE VASC SNR 3 SHRT BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $678.75 $678.75 $678.75 $678.75 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 382006010 SUP HCPCS C1773 382006010 - KIT SNR 6-10MM 6FR .062IN 120CM 100CM ATRIEVE VASC SNR 3 BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $373.31 $373.31 $373.31 $373.31 $687.50 $687.50 $687.50 $143.29 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 382006015 SUP HCPCS C1773 382006015 - KIT SNR 9-15MM 6FR .062IN 120CM 100CM ATRIEVE VASC SNR 3 BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $373.31 $373.31 $373.31 $373.31 $687.50 $687.50 $687.50 $143.29 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 382006020 SUP HCPCS C1757 382006020 - SNARE VASC STD 12-20MM 6FR 120CM 100CM ENSNR CATH BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $373.31 $373.31 $373.31 $373.31 $687.50 $687.50 $687.50 $143.29 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 382007030 SUP HCPCS C1773 382007030 - KIT SNR MN 18-30MM 7FR 120CM 100CM ATRIEVE VASC SNR DLV CATH BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $373.31 $373.31 $373.31 $373.31 $687.50 $687.50 $687.50 $143.29 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 382007045 SUP HCPCS C1773 382007045 - KIT SNR 27-45MM 7FR 120MM 100MM ATRIEVE VASC SNR DLV CATH BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $373.31 $373.31 $373.31 $373.31 $687.50 $687.50 $687.50 $143.29 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 382412000 SUP Custom 27203010 382412000 - KNEE IMMOBILIZER MEDIUM BOTH IP/OP $48.50 $36.00 $8.59 $48.24 $48.24 $48.24 $48.24 $48.24 $48.24 $48.24 $8.59 $48.24 $48.24 $35.80 $35.80 $37.18 $25.13 $10.05 $48.24 $19.30 $48.24 $48.24 $48.24 $48.24 $48.24 $36.38 $48.24 $48.24 $48.24 $24.12 $24.12 $38.21 $48.24 $38.59 $31.36 $48.24 N/A $28.13 $48.24 $28.94 $48.24 $48.24 $48.24 N/A N/A 408831100 SUP Custom 27203010 0408831100 - CLIP VESSOCLUBE SMALL BOTH IP/OP $27.50 $20.00 $4.85 $27.27 $27.27 $27.27 $27.27 $27.27 $27.27 $27.27 $4.85 $27.27 $27.27 $20.24 $20.24 $21.02 $14.21 $5.68 $27.27 $10.91 $27.27 $27.27 $27.27 $27.27 $27.27 $20.63 $27.27 $27.27 $27.27 $13.64 $13.64 $21.60 $27.27 $21.82 $17.73 $27.27 N/A $15.95 $27.27 $16.36 $27.27 $27.27 $27.27 N/A N/A 436020300 SUP HCPCS C1713 436020300 - ENDCAP 436020300 EXTNDED 20 X 30MM 0 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 436020305 SUP HCPCS C1713 436020305 - ENDCAP 436020305 EXTND 20 X 30MM 15 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 436020350 SUP HCPCS C1713 436020350 - ENDCAP 436020350 EXTNDED 20 X 35MM 0 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 436020355 SUP HCPCS C1713 436020355 - ENDCAP 436020355 EXTND 20 X 35MM 15 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436020400 SUP HCPCS C1713 436020400 - ENDCAP 436020400 EXTNDED 20 X 40MM 0 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436020405 SUP HCPCS C1713 436020405 - ENDCAP 436020405 EXTND 20 X 40MM 15 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436020450 SUP HCPCS C1713 436020450 - ENDCAP 436020450 EXTNDED 20 X 45MM 0 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436020455 SUP HCPCS C1713 436020455 - ENDCAP 436020455 EXTND 20 X 45MM 15 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436025300 SUP HCPCS C1713 436025300 - ENDCAP 436025300 EXTNDED 25 X 30MM 0 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436025305 SUP HCPCS C1713 436025305 - ENDCAP 436025305 EXTND 25 X 30MM 15 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436025350 SUP HCPCS C1713 436025350 - ENDCAP 436025350 EXTNDED 25 X 35MM 0 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436025355 SUP HCPCS C1713 436025355 - ENDCAP 436025355 EXTND 25 X 35MM 15 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436025400 SUP HCPCS C1713 436025400 - ENDCAP 436025400 EXTNDED 25 X 40MM 0 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 436025405 SUP HCPCS C1713 436025405 - ENDCAP 436025405 EXTND 25 X 40MM 15 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 436025450 SUP HCPCS C1713 436025450 - ENDCAP 436025450 EXTNDED 25 X 45MM 0 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436025455 SUP HCPCS C1713 436025455 - ENDCAP 436025455 EXTND 25 X 45MM 15 DEG BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436120300 SUP HCPCS C1713 436120300 - ENDCAP 436120300 EXTENDED 20 X 30MM STER BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436120305 SUP HCPCS C1713 436120305 - ENDCAP 436120305 EXTND 20X30MM 15 DEG ST BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 436120350 SUP HCPCS C1713 436120350 - ENDCAP 436120350 EXTENDED 20 X 35MM STER BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 436120355 SUP HCPCS C1713 436120355 - ENDCAP 436120355 EXTND 20X35MM 15 DEG ST BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436120400 SUP HCPCS C1713 436120400 - ENDCAP 436120400 EXTENDED 20 X 40MM STER BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436120405 SUP HCPCS C1713 436120405 - ENDCAP 436120405 EXTND 20X40MM 15 DEG ST BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A 436120450 SUP HCPCS C1713 436120450 - ENDCAP 436120450 EXTENDED 20 X 45MM STER BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 436120455 SUP HCPCS C1713 436120455 - ENDCAP 436120455 EXTND 20X45MM 15 DEG ST BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 436125300 SUP HCPCS C1713 436125300 - ENDCAP 436125300 EXTENDED 25 X 30MM STER BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 436125305 SUP HCPCS C1713 436125305 - ENDCAP 436125305 EXTND 25X30MM 15 DEG ST BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 436125350 SUP HCPCS C1713 436125350 - ENDCAP 436125350 EXTENDED 25 X 35MM STER BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 436125355 SUP HCPCS C1713 436125355 - ENDCAP 436125355 EXTND 25X35MM 15 DEG ST BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 436125400 SUP HCPCS C1713 436125400 - ENDCAP 436125400 EXTENDED 25 X 40MM STER BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 436125405 SUP HCPCS C1713 436125405 - ENDCAP 436125405 EXTND 25X40MM 15 DEG ST BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 436125450 SUP HCPCS C1713 436125450 - ENDCAP 436125450 EXTENDED 25 X 45MM STER BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 436125455 SUP HCPCS C1713 436125455 - ENDCAP 436125455 EXTND 25X45MM 15 DEG ST BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 480316022 SUP HCPCS C1713 480316022 - SCREW BONE LONG STANDARD 6MM 22MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316025 SUP HCPCS C1713 480316025 - SCREW BONE LONG STANDARD 6MM 25MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316028 SUP HCPCS C1713 480316028 - SCREW BONE LONG STANDARD 6MM 28MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316031 SUP HCPCS C1713 480316031 - SCREW BONE LONG STANDARD 6MM 31MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316034 SUP HCPCS C1713 480316034 - SCREW BONE LONG STANDARD 6MM 34MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $365.95 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316037 SUP HCPCS C1713 480316037 - SCREW BONE LONG STANDARD 6MM 37MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316040 SUP HCPCS C1713 480316040 - SCREW BONE LONG STANDARD 6MM 40MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $365.95 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316043 SUP HCPCS C1713 480316043 - SCREW BONE LONG STANDARD 6MM 43MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316046 SUP HCPCS C1713 480316046 - SCREW BONE LONG STANDARD 6MM 46MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $365.95 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 480316049 SUP HCPCS C1713 480316049 - SCREW BONE LONG STANDARD 6MM 49MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 480316052 SUP HCPCS C1713 480316052 - SCREW BONE LONG STANDARD 6MM 52MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $365.95 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 480316055 SUP HCPCS C1713 480316055 - SCREW BONE LONG STANDARD 6MM 55MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316058 SUP HCPCS C1713 480316058 - SCREW BONE LONG STANDARD 6MM 58MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $365.95 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316061 SUP HCPCS C1713 480316061 - SCREW BONE LONG STANDARD 6MM 61MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 480316064 SUP HCPCS C1713 480316064 - SCREW BONE LONG STANDARD 6MM 64MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $365.95 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 480316067 SUP HCPCS C1713 480316067 - SCREW BONE LONG STANDARD 6MM 67MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 480316522 SUP HCPCS C1713 480316522 - SCREW BONE STANDARD 6.5MM 22MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $365.95 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 480316525 SUP HCPCS C1713 480316525 - SCREW BONE STANDARD 6.5MM 25MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 480316528 SUP HCPCS C1713 480316528 - SCREW BONE STANDARD 6.5MM 28MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 480316531 SUP HCPCS C1713 480316531 - SCREW BONE STANDARD 6.5MM 31MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $365.95 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316534 SUP HCPCS C1713 480316534 - SCREW BONE STANDARD 6.5MM 34MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $365.95 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316537 SUP HCPCS C1713 480316537 - SCREW BONE STANDARD 6.5MM 37MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 480316540 SUP HCPCS C1713 480316540 - SCREW BONE LONG STANDARD 6.5MM 40MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 480316543 SUP HCPCS C1713 480316543 - SCREW BONE LONG STANDARD 6.5MM 43MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $365.95 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 480316546 SUP HCPCS C1713 480316546 - SCREW BONE LONG STANDARD 6.5MM 46MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316549 SUP HCPCS C1713 480316549 - SCREW BONE LONG STANDARD 6.5MM 49MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $365.95 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316552 SUP HCPCS C1713 480316552 - SCREW BONE LONG STANDARD 6.5MM 52MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316555 SUP HCPCS C1713 480316555 - SCREW BONE LONG STANDARD 6.5MM 55MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $365.95 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316558 SUP HCPCS C1713 480316558 - SCREW BONE LONG STANDARD 6.5MM 58MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $914.88 $914.88 $190.66 $914.88 N/A N/A 480316561 SUP HCPCS C1713 480316561 - SCREW BONE LONG STANDARD 6.5MM 61MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $365.95 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 480316564 SUP HCPCS C1713 480316564 - SCREW BONE LONG STANDARD 6.5MM 64MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $914.88 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 480316567 SUP HCPCS C1713 480316567 - SCREW BONE LONG STANDARD 6.5MM 67MM SPN THORACIC BOTH IP/OP $915.00 $677.00 $181.58 $914.88 $411.70 $411.70 $411.70 $411.70 $914.88 $914.88 $914.88 $190.68 $914.88 $914.88 $914.88 $914.88 $914.88 $190.67 $914.88 $365.95 $541.15 $914.88 $914.88 $914.88 $914.88 $686.25 $914.88 $914.88 $914.88 $457.44 $457.44 $724.58 $914.88 $731.90 $411.70 $181.58 N/A $530.70 $914.88 $548.93 $914.88 $190.66 $914.88 N/A N/A 481322040 SUP HCPCS C1713 481322040 - ROD SPNL 4.5MM 40MM NS LF XIA PREBNT PCUT VIT SPNE BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 481322050 SUP HCPCS C1713 481322050 - ROD SPNL 50MM 4.5MM XIA PREBNT VIT PCUT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A 481322070 SUP HCPCS C1713 481322070 - ROD SPNL PREBNT HEX 4.5MM 70MM PCUT VITALIUM BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A 482204020 SUP HCPCS C1713 482204020 - SCREW BONE 4MM 20MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 482204025 SUP HCPCS C1713 482204025 - SCREW BONE 4MM 25MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 482204030 SUP HCPCS C1713 482204030 - SCREW BONE 4MM 30MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 482204035 SUP HCPCS C1713 482204035 - SCREW BONE 4MM 35MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 482204040 SUP HCPCS C1713 482204040 - SCREW BONE 4MM 40MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 482205025 SUP HCPCS C1713 482205025 - SCREW BONE 5MM 25MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 482205030 SUP HCPCS C1713 482205030 - SCREW BONE 5MM 30MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 482205035 SUP HCPCS C1713 482205035 - SCREW BONE 5MM 35MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 482205040 SUP HCPCS C1713 482205040 - SCREW BONE 5MM 40MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 482205045 SUP HCPCS C1713 482205045 - SCREW BONE 5MM 45MM MNOAX XIA STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 482214020 SUP HCPCS C1713 482214020 - SCREW BONE 4MM 20MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,737.50" "$4,246.00" "$1,138.75" "$5,737.50" "$2,581.88" "$2,581.88" "$2,581.88" "$2,581.88" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.84" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$5,737.50" "$2,828.59" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$1,138.75" N/A "$3,327.75" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.70" "$5,737.50" N/A N/A 482214025 SUP HCPCS C1713 482214025 - SCREW BONE 4MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,737.50" "$4,246.00" "$1,138.75" "$5,737.50" "$2,581.88" "$2,581.88" "$2,581.88" "$2,581.88" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.84" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$5,737.50" "$2,828.59" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$1,138.75" N/A "$3,327.75" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.70" "$5,737.50" N/A N/A 482214030 SUP HCPCS C1713 482214030 - SCREW BONE 4MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,737.50" "$4,246.00" "$1,138.75" "$5,737.50" "$2,581.88" "$2,581.88" "$2,581.88" "$2,581.88" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.84" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$5,737.50" "$2,828.59" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$1,138.75" N/A "$3,327.75" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.70" "$5,737.50" N/A N/A 482214035 SUP HCPCS C1713 482214035 - SCREW BONE 4MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$5,875.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A 482214040 SUP HCPCS C1713 482214040 - SCREW BONE 4MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$5,875.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A 482215025 SUP HCPCS C1713 482215025 - SCREW BONE 5MM 25MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 482215030 SUP HCPCS C1713 482215030 - SCREW BONE 5MM 30MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 482215035 SUP HCPCS C1713 482215035 - SCREW BONE 5MM 35MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$5,287.50" "$3,913.00" "$1,049.44" "$5,287.50" "$2,379.38" "$2,379.38" "$2,379.38" "$2,379.38" "$5,287.50" "$5,287.50" "$5,287.50" "$1,102.05" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$5,287.50" "$2,606.74" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$1,049.44" N/A "$3,066.75" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.92" "$5,287.50" N/A N/A 482215040 SUP HCPCS C1713 482215040 - SCREW BONE 5MM 40MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$4,750.00" "$3,515.00" $942.76 "$4,750.00" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$4,750.00" "$4,750.00" "$4,750.00" $990.02 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$4,750.00" "$2,341.75" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" $942.76 N/A "$2,755.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.90 "$4,750.00" N/A N/A 482215045 SUP HCPCS C1713 482215045 - SCREW BONE 5MM 45MM POLYAX XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$4,750.00" "$3,515.00" $942.76 "$4,750.00" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$4,750.00" "$4,750.00" "$4,750.00" $990.02 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$4,750.00" "$2,341.75" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" $942.76 N/A "$2,755.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.90 "$4,750.00" N/A N/A 482301500 SUP HCPCS C1713 482301500 - SCREW BONE 1.5MM 100MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 482301540 SUP HCPCS C1713 482301540 - SCREW BONE 1.5MM 40MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 482301545 SUP HCPCS C1713 482301545 - SCREW BONE 1.5MM 45MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 482301550 SUP HCPCS C1713 482301550 - SCREW BONE 1.5MM 50MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 482301555 SUP HCPCS C1713 482301555 - SCREW BONE 1.5MM 55MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 482301560 SUP HCPCS C1713 482301560 - SCREW BONE 1.5MM 60MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 482301565 SUP HCPCS C1713 482301565 - SCREW BONE 1.5MM 65MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 482301570 SUP HCPCS C1713 482301570 - SCREW BONE 1.5MM 70MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 482301580 SUP HCPCS C1713 482301580 - SCREW BONE 1.5MM 80MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 482301590 SUP HCPCS C1713 482301590 - SCREW BONE 1.5MM 90MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 482304020 SUP HCPCS C1713 482304020 - SCREW BONE 4MM 20MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482304025 SUP HCPCS C1713 482304025 - SCREW BONE 4MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482304030 SUP HCPCS C1713 482304030 - SCREW BONE 4MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482304035 SUP HCPCS C1713 482304035 - SCREW BONE 4MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482304040 SUP HCPCS C1713 482304040 - SCREW BONE 4MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482304045 SUP HCPCS C1713 482304045 - SCREW BONE 4MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482304520 SUP HCPCS C1713 482304520 - SCREW BONE 4.5MM 20MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482304525 SUP HCPCS C1713 482304525 - SCREW BONE 4.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482304530 SUP HCPCS C1713 482304530 - SCREW BONE 4.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482304535 SUP HCPCS C1713 482304535 - SCREW BONE 4.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482304540 SUP HCPCS C1713 482304540 - SCREW BONE 4.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482304545 SUP HCPCS C1713 482304545 - SCREW BONE 4.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482305020 SUP HCPCS C1713 482305020 - SCREW BONE 5MM 20MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482305025 SUP HCPCS C1713 482305025 - SCREW BONE 5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482305030 SUP HCPCS C1713 482305030 - SCREW BONE 5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482305035 SUP HCPCS C1713 482305035 - SCREW BONE 5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482305040 SUP HCPCS C1713 482305040 - SCREW BONE 5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482305045 SUP HCPCS C1713 482305045 - SCREW BONE 5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482305050 SUP HCPCS C1713 482305050 - SCREW BONE 5MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482305525 SUP HCPCS C1713 482305525 - SCREW BONE 5.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482305530 SUP HCPCS C1713 482305530 - SCREW BONE 5.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482305535 SUP HCPCS C1713 482305535 - SCREW BONE 5.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482305540 SUP HCPCS C1713 482305540 - SCREW BONE 5.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482305545 SUP HCPCS C1713 482305545 - SCREW BONE 5.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482305550 SUP HCPCS C1713 482305550 - SCREW BONE 5.5MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482305555 SUP HCPCS C1713 482305555 - SCREW BONE 5.5MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482306025 SUP HCPCS C1713 482306025 - SCREW BONE 6MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482306030 SUP HCPCS C1713 482306030 - SCREW BONE 6MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482306035 SUP HCPCS C1713 482306035 - SCREW BONE 6MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482306040 SUP HCPCS C1713 482306040 - SCREW BONE 6MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482306045 SUP HCPCS C1713 482306045 - SCREW BONE 6MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482306050 SUP HCPCS C1713 482306050 - SCREW BONE 6MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482306055 SUP HCPCS C1713 482306055 - SCREW BONE 6MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482306060 SUP HCPCS C1713 482306060 - SCREW BONE 6MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482306065 SUP HCPCS C1713 482306065 - SCREW BONE 6MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482306070 SUP HCPCS C1713 482306070 - SCREW BONE 6MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482306080 SUP HCPCS C1713 482306080 - SCREW BONE 6MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482306090 SUP HCPCS C1713 482306090 - SCREW BONE 6MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482306525 SUP HCPCS C1713 482306525 - SCREW BONE 6.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482306530 SUP HCPCS C1713 482306530 - SCREW BONE 6.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482306535 SUP HCPCS C1713 482306535 - SCREW BONE 6.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482306540 SUP HCPCS C1713 482306540 - SCREW BONE 6.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482306545 SUP HCPCS C1713 482306545 - SCREW BONE 6.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482306550 SUP HCPCS C1713 482306550 - SCREW BONE 6.5MM 50MM MULTIAX XIA 3 TITANIUM SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482306555 SUP HCPCS C1713 482306555 - SCREW BONE 6.5MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482306560 SUP HCPCS C1713 482306560 - SCREW BONE 6.5MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482306565 SUP HCPCS C1713 482306565 - SCREW BONE 6.5MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482306570 SUP HCPCS C1713 482306570 - SCREW BONE 6.5MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482306580 SUP HCPCS C1713 482306580 - SCREW BONE 6.5MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482306590 SUP HCPCS C1713 482306590 - SCREW BONE 6.5MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482307025 SUP HCPCS C1713 482307025 - SCREW BONE 7MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482307030 SUP HCPCS C1713 482307030 - SCREW BONE 7MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482307035 SUP HCPCS C1713 482307035 - SCREW BONE 7MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482307040 SUP HCPCS C1713 482307040 - SCREW BONE 7MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482307045 SUP HCPCS C1713 482307045 - SCREW BONE 7MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482307050 SUP HCPCS C1713 482307050 - SCREW BONE 7MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482307055 SUP HCPCS C1713 482307055 - SCREW BONE 7MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482307060 SUP HCPCS C1713 482307060 - SCREW BONE 7MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482307065 SUP HCPCS C1713 482307065 - SCREW BONE 7MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482307070 SUP HCPCS C1713 482307070 - SCREW BONE 7MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482307080 SUP HCPCS C1713 482307080 - SCREW BONE 7MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482307090 SUP HCPCS C1713 482307090 - SCREW BONE 7MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A 482307525 SUP HCPCS C1713 482307525 - SCREW BONE 7.5MM 25MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A 482307530 SUP HCPCS C1713 482307530 - SCREW BONE 7.5MM 30MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A 482307535 SUP HCPCS C1713 482307535 - SCREW BONE 7.5MM 35MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482307540 SUP HCPCS C1713 482307540 - SCREW BONE 7.5MM 40MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482307545 SUP HCPCS C1713 482307545 - SCREW BONE 7.5MM 45MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482307550 SUP HCPCS C1713 482307550 - SCREW BONE 7.5MM 50MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A 482307555 SUP HCPCS C1713 482307555 - SCREW BONE 7.5MM 55MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482307560 SUP HCPCS C1713 482307560 - SCREW BONE 7.5MM 60MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482307565 SUP HCPCS C1713 482307565 - SCREW BONE 7.5MM 65MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482307570 SUP HCPCS C1713 482307570 - SCREW BONE 7.5MM 70MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A 482307580 SUP HCPCS C1713 482307580 - SCREW BONE 7.5MM 80MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A 482307590 SUP HCPCS C1713 482307590 - SCREW BONE 7.5MM 90MM MNOAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482308500 SUP HCPCS C1713 482308500 - SCREW BONE 8.5MM 100MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482308525 SUP HCPCS C1713 482308525 - SCREW BONE 8.5MM 25MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482308530 SUP HCPCS C1713 482308530 - SCREW BONE 8.5MM 30MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482308535 SUP HCPCS C1713 482308535 - SCREW BONE 8.5MM 35MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482308540 SUP HCPCS C1713 482308540 - SCREW BONE 8.5MM 40MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482308545 SUP HCPCS C1713 482308545 - SCREW BONE 8.5MM 45MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482308550 SUP HCPCS C1713 482308550 - SCREW BONE 8.5MM 50MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482308555 SUP HCPCS C1713 482308555 - SCREW BONE 8.5MM 55MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482308560 SUP HCPCS C1713 482308560 - SCREW BONE 8.5MM 60MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 482308565 SUP HCPCS C1713 482308565 - SCREW BONE 8.5MM 65MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482308570 SUP HCPCS C1713 482308570 - SCREW BONE 8.5MM 70MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482308580 SUP HCPCS C1713 482308580 - SCREW BONE 8.5MM 80MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482308590 SUP HCPCS C1713 482308590 - SCREW BONE 8.5MM 90MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482309500 SUP HCPCS C1713 482309500 - SCREW BONE 9.5MM 100MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482309540 SUP HCPCS C1713 482309540 - SCREW BONE 9.5MM 40MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482309545 SUP HCPCS C1713 482309545 - SCREW BONE 9.5MM 45MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482309550 SUP HCPCS C1713 482309550 - SCREW BONE 9.5MM 50MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482309555 SUP HCPCS C1713 482309555 - SCREW BONE 9.5MM 55MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482309560 SUP HCPCS C1713 482309560 - SCREW BONE 9.5MM 60MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482309565 SUP HCPCS C1713 482309565 - SCREW BONE 9.5MM 65MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482309570 SUP HCPCS C1713 482309570 - SCREW BONE 9.5MM 70MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482309580 SUP HCPCS C1713 482309580 - SCREW BONE 9.5MM 80MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482309590 SUP HCPCS C1713 482309590 - SCREW BONE 9.5MM 90MM REVISION MNOAX ILIOSACRAL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 482311500 SUP HCPCS C1713 482311500 - SCREW BONE 1.5MM 100MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482311540 SUP HCPCS C1713 482311540 - SCREW BONE 1.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482311545 SUP HCPCS C1713 482311545 - SCREW BONE 1.5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482311550 SUP HCPCS C1713 482311550 - SCREW BONE 1.5MM 50MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482311555 SUP HCPCS C1713 482311555 - SCREW BONE 1.5MM 55MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482311560 SUP HCPCS C1713 482311560 - SCREW BONE 1.5MM 60MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482311565 SUP HCPCS C1713 482311565 - SCREW BONE 1.5MM 65MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482311570 SUP HCPCS C1713 482311570 - SCREW BONE 1.5MM 70MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482311580 SUP HCPCS C1713 482311580 - SCREW BONE 1.5MM 80MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482311590 SUP HCPCS C1713 482311590 - SCREW BONE 1.5MM 90MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482314020 SUP HCPCS C1713 482314020 - SCREW BONE 4MM 20MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482314025 SUP HCPCS C1713 482314025 - SCREW BONE 4MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482314030 SUP HCPCS C1713 482314030 - SCREW BONE 4MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482314035 SUP HCPCS C1713 482314035 - SCREW BONE 4MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482314040 SUP HCPCS C1713 482314040 - SCREW BONE 4MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482314045 SUP HCPCS C1713 482314045 - SCREW BONE 4MM 45MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482314520 SUP HCPCS C1713 482314520 - SCREW BONE 4.5MM 20MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482314525 SUP HCPCS C1713 482314525 - SCREW BONE 4.5MM 25MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482314530 SUP HCPCS C1713 482314530 - SCREW BONE 4.5MM 30MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482314535 SUP HCPCS C1713 482314535 - SCREW BONE 4.5MM 35MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482314540 SUP HCPCS C1713 482314540 - SCREW BONE 4.5MM 40MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482314545 SUP HCPCS C1713 482314545 - SCREW BONE 4.5MM 45MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482315020 SUP HCPCS C1713 482315020 - SCREW BONE 5MM 20MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482315025 SUP HCPCS C1713 482315025 - SCREW BONE 5MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482315030 SUP HCPCS C1713 482315030 - SCREW BONE 5MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482315035 SUP HCPCS C1713 482315035 - SCREW BONE 5MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482315040 SUP HCPCS C1713 482315040 - SCREW BONE 5MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482315045 SUP HCPCS C1713 482315045 - SCREW BONE 5MM 45MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482315050 SUP HCPCS C1713 482315050 - SCREW BONE 5MM 50MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482315525 SUP HCPCS C1713 482315525 - SCREW BONE 5.5MM 25MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482315530 SUP HCPCS C1713 482315530 - SCREW BONE 5.5MM 30MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482315535 SUP HCPCS C1713 482315535 - SCREW BONE 5.5MM 35MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482315540 SUP HCPCS C1713 482315540 - SCREW BONE 5.5MM 40MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482315545 SUP HCPCS C1713 482315545 - SCREW BONE 5.5MM 45MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482315550 SUP HCPCS C1713 482315550 - SCREW BONE 5.5MM 50MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482315555 SUP HCPCS C1713 482315555 - SCREW BONE 5.5MM 55MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316025 SUP HCPCS C1713 482316025 - SCREW BONE 6MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316030 SUP HCPCS C1713 482316030 - SCREW BONE 6MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316035 SUP HCPCS C1713 482316035 - SCREW BONE 6MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316040 SUP HCPCS C1713 482316040 - SCREW BONE 6MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482316045 SUP HCPCS C1713 482316045 - SCREW BN 6MM 50MM XIA 3 PA TI SPNE THORLMBR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482316050 SUP HCPCS C1713 482316050 - SCREW BONE 6MM 50MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316055 SUP HCPCS C1713 482316055 - SCREW BONE 6MM 55MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316060 SUP HCPCS C1713 482316060 - SCREW BONE 6MM 60MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316065 SUP HCPCS C1713 482316065 - SCREW BN 6MM 70MM XIA 3 PA TI SPNE THORLMBR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316070 SUP HCPCS C1713 482316070 - SCREW BONE 6MM 70MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316080 SUP HCPCS C1713 482316080 - SCREW BONE 6MM 80MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316090 SUP HCPCS C1713 482316090 - SCREW BONE 6MM 90MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316525 SUP HCPCS C1713 482316525 - SCREW BONE 6.5MM 25MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316530 SUP HCPCS C1713 482316530 - SCREW BONE 6.5MM 30MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316535 SUP HCPCS C1713 482316535 - SCREW BONE 6.5MM 35MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316540 SUP HCPCS C1713 482316540 - SCREW BONE 6.5MM 40MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316545 SUP HCPCS C1713 482316545 - SCREW BONE 6.5MM 45MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316550 SUP HCPCS C1713 482316550 - SCREW BONE 6.5MM 50MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316555 SUP HCPCS C1713 482316555 - SCREW BONE 6.5MM 55MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316560 SUP HCPCS C1713 482316560 - SCREW BONE 6.5MM 60MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316565 SUP HCPCS C1713 482316565 - SCREW BONE 6.5MM 65MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482316570 SUP HCPCS C1713 482316570 - SCREW BONE 6.5MM 70MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482316580 SUP HCPCS C1713 482316580 - SCREW BONE 6.5MM 80MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482316590 SUP HCPCS C1713 482316590 - SCREW BONE 6.5MM 90MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317025 SUP HCPCS C1713 482317025 - SCREW BONE 7MM 25MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317030 SUP HCPCS C1713 482317030 - SCREW BONE 7MM 30MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317035 SUP HCPCS C1713 482317035 - SCREW BONE 7MM 35MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317040 SUP HCPCS C1713 482317040 - SCREW BONE 7MM 40MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317045 SUP HCPCS C1713 482317045 - SCREW BONE 7MM 45MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317050 SUP HCPCS C1713 482317050 - SCREW BONE 7MM 50MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317055 SUP HCPCS C1713 482317055 - SCREW BONE 7MM 55MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317060 SUP HCPCS C1713 482317060 - SCREW BONE 7MM 60MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317065 SUP HCPCS C1713 482317065 - SCREW BONE 7MM 65MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317070 SUP HCPCS C1713 482317070 - SCREW BONE 7MM 70MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317080 SUP HCPCS C1713 482317080 - SCREW BONE 7MM 80MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317090 SUP HCPCS C1713 482317090 - SCREW BONE 7MM 90MM POLYAX XIA 3 TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317525 SUP HCPCS C1713 482317525 - SCREW BONE 7.5MM 25MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317530 SUP HCPCS C1713 482317530 - SCREW BONE 7.5MM 30MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317535 SUP HCPCS C1713 482317535 - SCREW BONE 7.5MM 35MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317540 SUP HCPCS C1713 482317540 - SCREW BONE 7.5MM 40MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317545 SUP HCPCS C1713 482317545 - SCREW BONE 7.5MM 45MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317550 SUP HCPCS C1713 482317550 - SCREW BONE 7.5MM 55MM CANN XIA TITANIUM SPN THORACOLUMBAR BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317555 SUP HCPCS C1713 482317555 - SCREW BONE 7.5MM 55MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317560 SUP HCPCS C1713 482317560 - SCREW BONE 7.5MM 60MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317565 SUP HCPCS C1713 482317565 - SCREW BONE 7.5MM 65MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317570 SUP HCPCS C1713 482317570 - SCREW BONE 7.5MM 70MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317580 SUP HCPCS C1713 482317580 - SCREW BONE 7.5MM 80MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482317590 SUP HCPCS C1713 482317590 - SCREW BONE 7.5MM 90MM POLYAX XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482318500 SUP HCPCS C1713 482318500 - SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482318525 SUP HCPCS C1713 482318525 - SCREW BONE 8.5MM 25MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482318530 SUP HCPCS C1713 482318530 - SCREW BONE 8.5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482318535 SUP HCPCS C1713 482318535 - SCREW BONE 8.5MM 35MM XIA 3 TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482318540 SUP HCPCS C1713 482318540 - SCREW BONE 8.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482318545 SUP HCPCS C1713 482318545 - SCREW BONE 8.5MM 45MM POLYAX REVISION SPN ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482318550 SUP HCPCS C1713 482318550 - SCREW BONE 8.5MM 50MM POLYAX REVISION SPN ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482318555 SUP HCPCS C1713 482318555 - SCREW BONE 8.5MM 55MM POLYAX REVISION SPN ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482318560 SUP HCPCS C1713 482318560 - SCREW BONE 8.5MM 60MM REVISION POLYAX SPN PEDICLE BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482318565 SUP HCPCS C1713 482318565 - SCREW BONE 8.5MM 65MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482318570 SUP HCPCS C1713 482318570 - BOLT SPINAL 8.5MM 70MM POLYAX XIA ILIUM BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482318580 SUP HCPCS C1713 482318580 - SCREW BONE 80MM XIA TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482318590 SUP HCPCS C1713 482318590 - SCREW BN 9.5MM 100MM REV PA ILSCRL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482319500 SUP HCPCS C1713 482319500 - SCREW BONE 9.5MM 100MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482319540 SUP HCPCS C1713 482319540 - SCREW BONE 9.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482319545 SUP HCPCS C1713 482319545 - SCREW BONE 9.5MM 45MM POLYAX REVISION SPN ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482319550 SUP HCPCS C1713 482319550 - SCREW BONE 9.5MM 50MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482319555 SUP HCPCS C1713 482319555 - SCREW BONE 9.5MM 55MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482319560 SUP HCPCS C1713 482319560 - SCREW BONE 9.5MM 60MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482319565 SUP HCPCS C1713 482319565 - SCREW BONE 9.5MM 65MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482319570 SUP HCPCS C1713 482319570 - SCREW BONE 9.5MM 70MM POLYAX RED PROFILE REVISION XIA SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482319580 SUP HCPCS C1713 482319580 - SCREW BONE 9.5MM 80MM POLYAX RED PROFILE REVISION XIA SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482319590 SUP HCPCS C1713 482319590 - SCREW BONE 9.5MM 90MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482326500 SUP HCPCS C1713 482326500 - SCREW BONE 6.5MM 100MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482326530 SUP HCPCS C1713 482326530 - SCREW BONE 6.5MM 30MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482326535 SUP HCPCS C1713 482326535 - SCREW BONE 6.5MM 35MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482326540 SUP HCPCS C1713 482326540 - SCREW BONE 6.5MM 40MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482326545 SUP HCPCS C1713 482326545 - SCREW BONE 6.5MM 45MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482326550 SUP HCPCS C1713 482326550 - SCREW BONE 6.5MM 50MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482326555 SUP HCPCS C1713 482326555 - SCREW BONE 6.5MM 55MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482326560 SUP HCPCS C1713 482326560 - SCREW BONE 6.5MM 60MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482326565 SUP HCPCS C1713 482326565 - SCREW BONE 6.5MM 65MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482326570 SUP HCPCS C1713 482326570 - SCREW BONE 6.5MM 70MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482326580 SUP HCPCS C1713 482326580 - SCREW BONE 6.5MM 80MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482326590 SUP HCPCS C1713 482326590 - SCREW BONE 6.5MM 90MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482327500 SUP HCPCS C1713 482327500 - SCREW BONE 7.5MM 100MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482327530 SUP HCPCS C1713 482327530 - SCREW BONE 7.5MM 30MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482327535 SUP HCPCS C1713 482327535 - SCREW BONE 7.5MM 35MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482327540 SUP HCPCS C1713 482327540 - SCREW BONE 7.5MM 40MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482327545 SUP HCPCS C1713 482327545 - SCREW BONE 7.5MM 45MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482327550 SUP HCPCS C1713 482327550 - SCREW BONE 7.5MM 50MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482327555 SUP HCPCS C1713 482327555 - SCREW BONE 7.5MM 55MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482327560 SUP HCPCS C1713 482327560 - SCREW BONE 7.5MM 60MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482327565 SUP HCPCS C1713 482327565 - SCREW BONE 7.5MM 65MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482327570 SUP HCPCS C1713 482327570 - SCREW BONE 7.5MM 70MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482327580 SUP HCPCS C1713 482327580 - SCREW BONE 7.5MM 80MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482327590 SUP HCPCS C1713 482327590 - SCREW BONE 7.5MM 90MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482328500 SUP HCPCS C1713 482328500 - SCREW BONE 8.5MM 100MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482328530 SUP HCPCS C1713 482328530 - SCREW BONE 8.5MM 30MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482328535 SUP HCPCS C1713 482328535 - SCREW BONE 8.5MM 35MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482328540 SUP HCPCS C1713 482328540 - SCREW BONE 8.5MM 40MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482328545 SUP HCPCS C1713 482328545 - SCREW BONE 8.5MM 45MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482328550 SUP HCPCS C1713 482328550 - SCREW BONE 8.5MM 50MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482328555 SUP HCPCS C1713 482328555 - SCREW BONE 8.5MM 55MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482328560 SUP HCPCS C1713 482328560 - SCREW BONE 8.5MM 60MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482328565 SUP HCPCS C1713 482328565 - SCREW BONE 8.5MM 65MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482328570 SUP HCPCS C1713 482328570 - SCREW BONE 8.5MM 70MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482328580 SUP HCPCS C1713 482328580 - SCREW BONE 8.5MM 80MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482328590 SUP HCPCS C1713 482328590 - SCREW BONE 8.5MM 90MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482329500 SUP HCPCS C1713 482329500 - SCREW BONE 9.5MM 100MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482329530 SUP HCPCS C1713 482329530 - SCREW BONE 9.5MM 30MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482329535 SUP HCPCS C1713 482329535 - SCREW BONE 9.5MM 35MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482329540 SUP HCPCS C1713 482329540 - SCREW BONE 9.5MM 40MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482329545 SUP HCPCS C1713 482329545 - SCREW BONE 9.5MM 45MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482329550 SUP HCPCS C1713 482329550 - SCREW BONE 9.5MM 50MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482329555 SUP HCPCS C1713 482329555 - SCREW BONE 9.5MM 55MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482329560 SUP HCPCS C1713 482329560 - SCREW BONE 9.5MM 60MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482329565 SUP HCPCS C1713 482329565 - SCREW BONE 9.5MM 65MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482329570 SUP HCPCS C1713 482329570 - SCREW BONE 9.5MM 70MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482329580 SUP HCPCS C1713 482329580 - SCREW BONE 9.5MM 80MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482329590 SUP HCPCS C1713 482329590 - SCREW BONE 9.5MM 90MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482335020 SUP HCPCS C1713 482335020 - SCREW BONE 5MM 20MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482335025 SUP HCPCS C1713 482335025 - SCREW BONE 5MM 25MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482335030 SUP HCPCS C1713 482335030 - SCREW BONE 5MM 30MM UNIPLNR XIA SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482335035 SUP HCPCS C1713 482335035 - SCREW BONE 5MM 35MM UNIPLNR XIA SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482335040 SUP HCPCS C1713 482335040 - SCREW BONE 5MM 40MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482335045 SUP HCPCS C1713 482335045 - SCREW BONE 5MM 45MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482336025 SUP HCPCS C1713 482336025 - SCREW BONE 6MM 25MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482336030 SUP HCPCS C1713 482336030 - SCREW BONE 6MM 30MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482336035 SUP HCPCS C1713 482336035 - SCREW BONE 6MM 35MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482336040 SUP HCPCS C1713 482336040 - SCREW BONE 6MM 40MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482336045 SUP HCPCS C1713 482336045 - SCREW BONE 6MM 45MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482336050 SUP HCPCS C1713 482336050 - SCREW BONE 6MM 50MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482336055 SUP HCPCS C1713 482336055 - SCREW BONE 6MM 55MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482336060 SUP HCPCS C1713 482336060 - SCREW BONE 6MM 60MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482337030 SUP HCPCS C1713 482337030 - SCREW BONE 7MM 30MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482337035 SUP HCPCS C1713 482337035 - SCREW BONE 7MM 35MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482337040 SUP HCPCS C1713 482337040 - SCREW BONE 7MM 40MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482337045 SUP HCPCS C1713 482337045 - SCREW BONE 7MM 45MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482337050 SUP HCPCS C1713 482337050 - SCREW BONE 7MM 50MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482337055 SUP HCPCS C1713 482337055 - SCREW BONE 7MM 55MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482337060 SUP HCPCS C1713 482337060 - SCREW BONE 7MM 60MM UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482364520 SUP HCPCS C1713 482364520 - SCREW BONE 4.5MM 20MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482364525 SUP HCPCS C1713 482364525 - SCREW BONE 4.5MM 25MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482364530 SUP HCPCS C1713 482364530 - SCREW BONE 4.5MM 30MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482364535 SUP HCPCS C1713 482364535 - SCREW BONE 4.5MM 35MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482364540 SUP HCPCS C1713 482364540 - SCREW BONE 4.5MM 40MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482364545 SUP HCPCS C1713 482364545 - SCREW BONE 4.5MM 45MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482365020 SUP HCPCS C1713 482365020 - SCREW BONE 5MM 20MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482365025 SUP HCPCS C1713 482365025 - SCREW BONE 5MM 25MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482365030 SUP HCPCS C1713 482365030 - SCREW BONE 5MM 30MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482365035 SUP HCPCS C1713 482365035 - SCREW BONE 5MM 35MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482365040 SUP HCPCS C1713 482365040 - SCREW BONE 5MM 40MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482365045 SUP HCPCS C1713 482365045 - SCREW BONE 5MM 45MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482365520 SUP HCPCS C1713 482365520 - SCREW BONE 5.5MM 20MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482365525 SUP HCPCS C1713 482365525 - SCREW BONE 5.5MM 25MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482365530 SUP HCPCS C1713 482365530 - SCREW BONE 5.5MM 30MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482365535 SUP HCPCS C1713 482365535 - SCREW BONE 5.5MM 35MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482365540 SUP HCPCS C1713 482365540 - SCREW BONE 5.5MM 40MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482365545 SUP HCPCS C1713 482365545 - SCREW BONE 5.5MM 45MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482365550 SUP HCPCS C1713 482365550 - SCREW BONE 5.5MM 50MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482365555 SUP HCPCS C1713 482365555 - SCREW BONE 5.5MM 55MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482366025 SUP HCPCS C1713 482366025 - SCREW BONE 6MM 25MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482366030 SUP HCPCS C1713 482366030 - SCREW BONE 6MM 30MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482366035 SUP HCPCS C1713 482366035 - SCREW BONE 6MM 35MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482366040 SUP HCPCS C1713 482366040 - SCREW BONE 6MM 40MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482366045 SUP HCPCS C1713 482366045 - SCREW BONE 6MM 45MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482366050 SUP HCPCS C1713 482366050 - SCREW BONE 6MM 50MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482366055 SUP HCPCS C1713 482366055 - SCREW BONE 6MM 55MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482366060 SUP HCPCS C1713 482366060 - SCREW BONE 6MM 60MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482366525 SUP HCPCS C1713 482366525 - SCREW BONE 6.5MM 25MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482366530 SUP HCPCS C1713 482366530 - SCREW BONE 6.5MM 30MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482366535 SUP HCPCS C1713 482366535 - SCREW BONE 6.5MM 35MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482366540 SUP HCPCS C1713 482366540 - SCREW BONE 6.5MM 40MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482366545 SUP HCPCS C1713 482366545 - SCREW BONE 6.5MM 45MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482366550 SUP HCPCS C1713 482366550 - SCREW BONE 6.5MM 50MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482366555 SUP HCPCS C1713 482366555 - SCREW BONE 6.5MM 55MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482366560 SUP HCPCS C1713 482366560 - SCREW BONE 6.5MM 60MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482367030 SUP HCPCS C1713 482367030 - SCREW BONE 7MM 30MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482367035 SUP HCPCS C1713 482367035 - SCREW BONE 7MM 35MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482367040 SUP HCPCS C1713 482367040 - SCREW BONE 7MM 40MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482367045 SUP HCPCS C1713 482367045 - SCREW BONE 7MM 45MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482367050 SUP HCPCS C1713 482367050 - SCREW BONE 7MM 50MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482367055 SUP HCPCS C1713 482367055 - SCREW BONE 7MM 55MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482367060 SUP HCPCS C1713 482367060 - SCREW BONE 7MM 60MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482367530 SUP HCPCS C1713 482367530 - SCREW BONE 7.5MM 30MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482367535 SUP HCPCS C1713 482367535 - SCREW BONE 7.5MM 35MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482367540 SUP HCPCS C1713 482367540 - SCREW BONE 7.5MM 40MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482367545 SUP HCPCS C1713 482367545 - SCREW BONE 7.5MM 45MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482367550 SUP HCPCS C1713 482367550 - SCREW BONE 7.5MM 50MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482367555 SUP HCPCS C1713 482367555 - SCREW BONE 7.5MM 55MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482367560 SUP HCPCS C1713 482367560 - SCREW BONE 7.5MM 60MM REDX UNIPLNR XIA 3 SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482376500 SUP HCPCS C1713 482376500 - SCREW BONE 6.5MM 100MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482376530 SUP HCPCS C1713 482376530 - SCREW BONE 6.5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482376535 SUP HCPCS C1713 482376535 - SCREW BONE 6.5MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482376540 SUP HCPCS C1713 482376540 - SCREW BONE 6.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482376545 SUP HCPCS C1713 482376545 - SCREW BONE 6.5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482376550 SUP HCPCS C1713 482376550 - SCREW BONE 6.5MM 50MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482376555 SUP HCPCS C1713 482376555 - SCREW BONE 6.5MM 55MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482376560 SUP HCPCS C1713 482376560 - SCREW BONE 6.5MM 60MM REVISION POLYAX CLOSE HEAD ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482376565 SUP HCPCS C1713 482376565 - SCREW BONE 6.5MM 65MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482376570 SUP HCPCS C1713 482376570 - SCREW BONE 6.5MM 70MM REVISION POLYAX CLOSE HEAD ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482376580 SUP HCPCS C1713 482376580 - SCREW BONE 6.5MM 80MM REVISION POLYAX CLOSE HEAD ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482376590 SUP HCPCS C1713 482376590 - SCREW BONE 6.5MM 90MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482377500 SUP HCPCS C1713 482377500 - SCREW BONE 7.5MM 100MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482377530 SUP HCPCS C1713 482377530 - SCREW BONE 7.5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482377535 SUP HCPCS C1713 482377535 - SCREW BONE 7.5MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482377540 SUP HCPCS C1713 482377540 - SCREW BONE 7.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482377545 SUP HCPCS C1713 482377545 - SCREW BONE 7.5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482377550 SUP HCPCS C1713 482377550 - SCREW BONE 7.5MM 50MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482377555 SUP HCPCS C1713 482377555 - SCREW BONE 7.5MM 55MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482377560 SUP HCPCS C1713 482377560 - SCREW BONE 7.5MM 60MM REVISION POLYAX CLOSE HEAD ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482377565 SUP HCPCS C1713 482377565 - SCREW BONE 7.5MM 65MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482377570 SUP HCPCS C1713 482377570 - SCREW BONE 7.5MM 70MM REVISION POLYAX CLOSE HEAD ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482377580 SUP HCPCS C1713 482377580 - SCREW BONE 7.5MM 80MM REVISION POLYAX CLOSE HEAD ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482377590 SUP HCPCS C1713 482377590 - SCREW BONE 7.5MM 90MM REVISION POLYAX CLOSE HEAD ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482378500 SUP HCPCS C1713 482378500 - SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482378530 SUP HCPCS C1713 482378530 - SCREW BONE 8.5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482378535 SUP HCPCS C1713 482378535 - SCREW BONE 8.5MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482378540 SUP HCPCS C1713 482378540 - SCREW BONE 8.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482378545 SUP HCPCS C1713 482378545 - SCREW BONE 8.5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482378550 SUP HCPCS C1713 482378550 - SCREW BONE 8.5MM 50MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482378555 SUP HCPCS C1713 482378555 - SCREW BONE 8.5MM 55MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482378560 SUP HCPCS C1713 482378560 - SCREW BONE 8.5MM 60MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482378565 SUP HCPCS C1713 482378565 - SCREW BONE 8.5MM 65MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482378570 SUP HCPCS C1713 482378570 - SCREW BONE 8.5MM 70MM REVISION POLYAX CLOSE HEAD ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482378580 SUP HCPCS C1713 482378580 - SCREW BONE 8.5MM 80MM REVISION POLYAX CLOSE HEAD ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482378590 SUP HCPCS C1713 482378590 - SCREW BONE 8.5MM 90MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482379500 SUP HCPCS C1713 482379500 - SCREW BONE 9.5MM 100MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482379530 SUP HCPCS C1713 482379530 - SCREW BONE 9.5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482379535 SUP HCPCS C1713 482379535 - SCREW BONE 9.5MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482379540 SUP HCPCS C1713 482379540 - SCREW BONE 9.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482379545 SUP HCPCS C1713 482379545 - SCREW BONE 9.5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482379550 SUP HCPCS C1713 482379550 - SCREW BONE 9.5MM 50MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482379555 SUP HCPCS C1713 482379555 - SCREW BONE 9.5MM 55MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482379560 SUP HCPCS C1713 482379560 - SCREW BONE 9.5MM 60MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482379565 SUP HCPCS C1713 482379565 - SCREW BONE 9.5MM 65MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482379570 SUP HCPCS C1713 482379570 - SCREW BONE 9.5MM 70MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482379580 SUP HCPCS C1713 482379580 - SCREW BONE 9.5MM 80MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482379590 SUP HCPCS C1713 482379590 - SCREW BONE 9.5MM 90MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482384020 SUP HCPCS C1713 482384020 - SCREW BONE 4MM 20MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482384025 SUP HCPCS C1713 482384025 - SCREW BONE 4MM 25MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482384030 SUP HCPCS C1713 482384030 - SCREW BONE 4MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482384035 SUP HCPCS C1713 482384035 - SCREW BONE 4MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482384040 SUP HCPCS C1713 482384040 - SCREW BONE 4MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482384045 SUP HCPCS C1713 482384045 - SCREW BONE 4MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482384520 SUP HCPCS C1713 482384520 - SCREW BONE 4.5MM 20MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482384525 SUP HCPCS C1713 482384525 - SCREW BONE 4.5MM 25MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482384530 SUP HCPCS C1713 482384530 - SCREW BONE 4.5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482384535 SUP HCPCS C1713 482384535 - SCREW BONE 4.5MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482384540 SUP HCPCS C1713 482384540 - SCREW BONE 4.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482384545 SUP HCPCS C1713 482384545 - SCREW BONE 4.5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482385020 SUP Custom 27803010 482385020 - CONNECTOR ROD 5MM 20MM ROD TO ROD RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482385025 SUP HCPCS C1713 482385025 - SCREW BONE 5MM 25MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482385030 SUP HCPCS C1713 482385030 - SCREW BONE 5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482385035 SUP HCPCS C1713 482385035 - SCREW BONE 5MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482385040 SUP HCPCS C1713 482385040 - SCREW BONE 5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482385045 SUP HCPCS C1713 482385045 - SCREW BONE 5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482385050 SUP HCPCS C1713 482385050 - SCREW BONE 5MM 50MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482385525 SUP HCPCS C1713 482385525 - SCREW BONE 5.5MM 25MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482385530 SUP HCPCS C1713 482385530 - SCREW BONE 5.5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482385535 SUP HCPCS C1713 482385535 - SCREW BONE 5.5MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482385540 SUP HCPCS C1713 482385540 - SCREW BONE 5.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482385545 SUP HCPCS C1713 482385545 - SCREW BONE 5.5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482385550 SUP HCPCS C1713 482385550 - SCREW BONE 5.5MM 50MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482385555 SUP HCPCS C1713 482385555 - SCREW BONE 5.5MM 55MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482386525 SUP HCPCS C1713 482386525 - SCREW BONE 6.5MM 25MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482386530 SUP HCPCS C1713 482386530 - SCREW BONE 6.5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482386535 SUP HCPCS C1713 482386535 - SCREW BONE 6.5MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482386540 SUP HCPCS C1713 482386540 - SCREW BONE 6.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482386545 SUP HCPCS C1713 482386545 - SCREW BONE 6.5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A 482386550 SUP HCPCS C1713 482386550 - SCREW BONE 6.5MM 50MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482386555 SUP HCPCS C1713 482386555 - SCREW BONE 6.5MM 55MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482386560 SUP HCPCS C1713 482386560 - SCREW BONE 6.5MM 60MM REVISION POLYAX BIASED ANGLE BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482386565 SUP HCPCS C1713 482386565 - SCREW BONE 6.5MM 65MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482386570 SUP HCPCS C1713 482386570 - SCREW BONE 6.5MM 70MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482386580 SUP HCPCS C1713 482386580 - SCREW BONE 6.5MM 80MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482386590 SUP HCPCS C1713 482386590 - SCREW BONE 6.5MM 90MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482387525 SUP HCPCS C1713 482387525 - SCREW BONE 7.5MM 25MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482387530 SUP HCPCS C1713 482387530 - SCREW BONE 7.5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482387535 SUP HCPCS C1713 482387535 - SCREW BONE 7.5MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482387540 SUP HCPCS C1713 482387540 - SCREW BONE 7.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482387545 SUP HCPCS C1713 482387545 - SCREW BONE 7.5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482387550 SUP HCPCS C1713 482387550 - SCREW BONE 7.5MM 50MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482387555 SUP HCPCS C1713 482387555 - SCREW BONE 7.5MM 55MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482387560 SUP HCPCS C1713 482387560 - SCREW BONE 7.5MM 60MM REVISION POLYAX BIASED ANGLE BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482387565 SUP HCPCS C1713 482387565 - SCREW BONE 7.5MM 65MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482387570 SUP HCPCS C1713 482387570 - SCREW BONE 7.5MM 70MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482387580 SUP HCPCS C1713 482387580 - SCREW BONE 7.5MM 80MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482387590 SUP HCPCS C1713 482387590 - SCREW BONE 7.5MM 90MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482388500 SUP HCPCS C1713 482388500 - SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482388560 SUP HCPCS C1713 482388560 - SCREW BONE 8.5MM 60MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482388570 SUP HCPCS C1713 482388570 - SCREW BONE 8.5MM 70MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482388580 SUP HCPCS C1713 482388580 - SCREW BONE 8.5MM 80MM REVISION POLYAX BIASED ANGLE BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482388590 SUP HCPCS C1713 482388590 - SCREW BONE 8.5MM 90MM REVISION POLYAX BIASED ANGLE BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482389500 SUP HCPCS C1713 482389500 - SCREW BONE 9.5MM 100MM REVISION POLYAX BIASED ANGLE BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482389560 SUP HCPCS C1713 482389560 - SCREW BONE 9.5MM 60MM REVISION POLYAX BIASED ANGLE BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482389570 SUP HCPCS C1713 482389570 - SCREW BONE 9.5MM 70MM REVISION POLYAX BIASED ANGLE BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482389580 SUP HCPCS C1713 482389580 - SCREW BONE 9.5MM 80MM REVISION POLYAX BIASED ANGLE BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 482389590 SUP HCPCS C1713 482389590 - SCREW BONE 9.5MM 90MM REVISION POLYAX BIASED ANGLE BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 482396500 SUP HCPCS C1713 482396500 - SCREW BONE 6.5MM 100MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482396560 SUP HCPCS C1713 482396560 - SCREW BONE 6.5MM 60MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482396570 SUP HCPCS C1713 482396570 - SCREW BONE 6.5MM 70MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482396580 SUP HCPCS C1713 482396580 - SCREW BONE 6.5MM 80MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482396590 SUP HCPCS C1713 482396590 - SCREW BONE 6.5MM 90MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482397500 SUP HCPCS C1713 482397500 - SCREW BONE 7.5MM 100MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482397560 SUP HCPCS C1713 482397560 - SCREW BONE 7.5MM 60MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482397570 SUP HCPCS C1713 482397570 - SCREW BONE 15D 7.5MM 70MM REVISION MNOAX BIASED ANGLE BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482397580 SUP HCPCS C1713 482397580 - SCREW BONE 15D 7.5MM 80MM REVISION MNOAX BIASED ANGLE BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482397590 SUP HCPCS C1713 482397590 - SCREW BONE 7.5MM 90MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482398500 SUP HCPCS C1713 482398500 - SCREW BONE 8.5MM 100MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482398560 SUP HCPCS C1713 482398560 - SCREW BONE 8.5MM 60MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482398570 SUP HCPCS C1713 482398570 - SCREW BONE 8.5MM 70MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482398580 SUP HCPCS C1713 482398580 - SCREW BONE 8.5MM 80MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$3,654.83" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482398590 SUP HCPCS C1713 482398590 - SCREW BONE 8.5MM 90MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482399500 SUP HCPCS C1713 482399500 - SCREW BONE 9.5MM 100MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482399560 SUP HCPCS C1713 482399560 - SCREW BONE 9.5MM 60MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482399570 SUP HCPCS C1713 482399570 - SCREW BONE 9.5MM 70MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$3,654.83" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482399580 SUP HCPCS C1713 482399580 - SCREW BONE 9.5MM 80MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482399590 SUP HCPCS C1713 482399590 - SCREW BONE 9.5MM 90MM REVISION MNOAX ILIOSACRAL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,654.83" "$1,644.67" "$1,644.67" "$1,644.67" "$1,644.67" "$3,654.83" "$3,654.83" "$3,654.83" $761.76 "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" $761.71 "$3,654.83" "$1,461.93" "$1,801.83" "$3,654.83" "$3,654.83" "$3,654.83" "$3,654.83" "$2,741.25" "$3,654.83" "$3,654.83" "$3,654.83" "$1,827.42" "$1,827.42" "$2,894.63" "$3,654.83" "$2,923.86" "$1,644.67" $725.39 N/A "$2,119.90" "$3,654.83" "$2,192.90" "$3,654.83" $761.67 "$3,654.83" N/A N/A 482700601 SUP HCPCS C1713 00482700601 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 6MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482700701 SUP HCPCS C1713 00482700701 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 7MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $22.08 $36.80 $7.67 $36.80 N/A N/A 482700800 SUP HCPCS C1713 00482700800 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 8MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482700801 SUP HCPCS C1713 00482700801 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 8MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482700901 SUP HCPCS C1713 00482700901 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 9MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482701000 SUP HCPCS C1713 00482701000 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 10MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482701001 SUP HCPCS C1713 00482701001 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 10MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482701200 SUP HCPCS C1713 00482701200 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 12MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482701201 SUP HCPCS C1713 00482701201 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 12MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482701400 SUP HCPCS C1713 00482701400 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 14MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482701401 SUP HCPCS C1713 00482701401 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 14MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482701600 SUP HCPCS C1713 00482701600 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 16MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482701601 SUP HCPCS C1713 00482701601 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 16MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482701800 SUP HCPCS C1713 00482701800 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 18MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $12.88 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482701801 SUP HCPCS C1713 00482701801 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 18MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482702000 SUP HCPCS C1713 00482702000 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 20MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482702200 SUP HCPCS C1713 00482702200 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 22MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $12.88 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482702201 SUP HCPCS C1713 00482702201 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 22MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482702400 SUP HCPCS C1713 00482702400 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 24MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $12.88 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $19.32 $32.20 $6.71 $32.20 N/A N/A 482702401 SUP HCPCS C1713 00482702401 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 24MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $22.08 $36.80 $7.67 $36.80 N/A N/A 482702600 SUP HCPCS C1713 00482702600 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 26MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $12.88 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482702601 SUP HCPCS C1713 00482702601 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 26MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482702800 SUP HCPCS C1713 00482702800 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 28MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482702801 SUP HCPCS C1713 00482702801 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 28MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482703000 SUP HCPCS C1713 00482703000 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 30MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $12.88 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $19.32 $32.20 $6.71 $32.20 N/A N/A 482703001 SUP HCPCS C1713 00482703001 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 30MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482703200 SUP HCPCS C1713 00482703200 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 32MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $12.88 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $19.32 $32.20 $6.71 $32.20 N/A N/A 482703201 SUP HCPCS C1713 00482703201 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 32MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482703400 SUP HCPCS C1713 00482703400 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 34MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482703401 SUP HCPCS C1713 00482703401 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 34MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482703600 SUP HCPCS C1713 00482703600 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 36MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482703601 SUP HCPCS C1713 00482703601 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 36MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482703800 SUP HCPCS C1713 00482703800 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 38MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482703801 SUP HCPCS C1713 00482703801 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 38MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482704000 SUP HCPCS C1713 00482704000 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 40MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482704001 SUP HCPCS C1713 00482704001 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 40MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482704201 SUP HCPCS C1713 00482704201 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 42MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482704401 SUP HCPCS C1713 00482704401 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 44MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482704500 SUP HCPCS C1713 00482704500 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 45MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482704501 SUP HCPCS C1713 00482704501 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 45MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482704601 SUP HCPCS C1713 00482704601 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 46MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482704801 SUP HCPCS C1713 00482704801 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 48MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482705000 SUP HCPCS C1713 00482705000 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 50MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482705001 SUP HCPCS C1713 00482705001 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 50MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $22.08 $36.80 $7.67 $36.80 N/A N/A 482705201 SUP HCPCS C1713 00482705201 - SCREW BONE SMALL HEXAGON 2.7MM 52MM SELF TAP CORTICAL BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $22.08 $36.80 $7.67 $36.80 N/A N/A 482705401 SUP HCPCS C1713 00482705401 - SCREW BONE SMALL HEXAGON 2.7MM 54MM SELF TAP CORTICAL BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482705500 SUP HCPCS C1713 00482705500 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 55MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $19.32 $32.20 $6.71 $32.20 N/A N/A 482705501 SUP HCPCS C1713 00482705501 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 55MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482705601 SUP HCPCS C1713 00482705601 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 56MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482705801 SUP HCPCS C1713 00482705801 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 58MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482706000 SUP HCPCS C1713 00482706000 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 60MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $12.88 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $19.32 $32.20 $6.71 $32.20 N/A N/A 482706001 SUP HCPCS C1713 00482706001 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 60MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $22.08 $36.80 $7.67 $36.80 N/A N/A 482706500 SUP HCPCS C1713 00482706500 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 65MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $12.88 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482706501 SUP HCPCS C1713 00482706501 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 65MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $14.72 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482707000 SUP HCPCS C1713 00482707000 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 70MM STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.20 $14.49 $14.49 $14.49 $14.49 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $32.20 $32.20 $32.20 $6.71 $32.20 $32.20 $19.05 $32.20 $32.20 $32.20 $32.20 $24.38 $32.20 $32.20 $32.20 $16.10 $16.10 $25.50 $32.20 $25.76 $14.49 $6.39 N/A $18.85 $32.20 $32.20 $32.20 $6.71 $32.20 N/A N/A 482707001 SUP HCPCS C1713 00482707001 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 70MM SELF TAP STAINLESS BOTH IP/OP $37.00 $27.00 $7.30 $36.80 $16.56 $16.56 $16.56 $16.56 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $36.80 $36.80 $36.80 $7.67 $36.80 $36.80 $21.77 $36.80 $36.80 $36.80 $36.80 $27.75 $36.80 $36.80 $36.80 $18.40 $18.40 $29.15 $36.80 $29.44 $16.56 $7.30 N/A $21.46 $36.80 $36.80 $36.80 $7.67 $36.80 N/A N/A 482802540 SUP HCPCS C1713 482802540 - SCREW BONE 5.5MM 40MM 15MM ES2 LT XIA 3 SHRT BLADE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 482802640 SUP HCPCS C1713 482802640 - SCREW BONE 6.5MM 40MM 15MM ES2 LT XIA 3 SHRT BLADE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 482802645 SUP HCPCS C1713 482802645 - SCREW BONE 6.5MM 45MM 15MM ES2 LT XIA 3 SHRT BLADE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 482802650 SUP HCPCS C1713 482802650 - SCREW BN SHRT BLDE LOPRFL 6.5MM 50MM 15MM ES2 LT XIA 3 6 PNT BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 482802745 SUP HCPCS C1713 482802745 - SCREW BN SHRT BLDE LOPRFL 7.5MM 45MM 15MM ES2 LT XIA 3 6 PNT BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 482804545 SUP HCPCS C1713 482804545 - SCREW BN LNG BLDE LOPRFL 5.5MM 45MM 15MM ES2 LT XIA 3 6 PNT BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 482804645 SUP HCPCS C1713 482804645 - SCREW BN LNG BLDE LOPRFL 6.5MM 45MM 15MM ES2 LT XIA 3 6 PNT BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 482804650 SUP HCPCS C1713 482804650 - SCREW BN LNG BLDE LOPRFL 6.5MM 50MM 15MM ES2 LT XIA 3 6 PNT BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 482804750 SUP HCPCS C1713 482804750 - SCREW BN LNG BLDE LOPRFL 7.5MM 50MM 15MM ES2 LT XIA 3 6 PNT BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 482806050 SUP HCPCS C1713 482806050 - ROD SPNL HEX 5.5MM 50MM ES2 RDS TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 482806055 SUP HCPCS C1713 482806055 - ROD SPNL HEX 5.5MM 55MM ES2 RDS TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $437.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 482807060 SUP HCPCS C1713 "482807060 - TITANIUM STRAIGHT ROD, 5.5X60MM" BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A 482807090 SUP HCPCS C1713 482807090 - ROD SPNL 90MM 5.5MM ES2 STR HEX TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $437.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A 482911180 SUP HCPCS C1713 482911180 - ENDCAP SPNL 18MM 0D BOTH IP/OP $747.00 $553.00 $148.22 $746.78 $336.05 $336.05 $336.05 $336.05 $746.78 $746.78 $746.78 $155.65 $746.78 $746.78 $746.78 $746.78 $746.78 $155.64 $746.78 $746.78 $441.72 $746.78 $746.78 $746.78 $746.78 $560.25 $746.78 $746.78 $746.78 $373.39 $373.39 $591.45 $746.78 $597.42 $336.05 $148.22 N/A $433.26 $746.78 $448.07 $746.78 $155.63 $746.78 N/A N/A 483510098 SUP Custom 27803010 483510098 - SPACER SPNL 8D LRDTC WDG NOSE 20X11X9MM AVS UNILIF HLW BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483510108 SUP Custom 27803010 483510108 - SPACER SPNL 8D LRDTC WDG NOSE 20X11X10MM AVS UNILIF HLW BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483510118 SUP Custom 27803010 483510118 - SPACER SPNL 8D LRDTC WDG NOSE 20X11X11MM AVS UNILIF HLW BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483510128 SUP Custom 27803010 483510128 - SPACER SPNL 8D LRDTC WDG NOSE 20X11X12MM AVS UNILIF HLW BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483510138 SUP Custom 27803010 483510138 - SPACER SPNL 8D LRDTC WDG NOSE 20X11X13MM AVS UNILIF HLW BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483510140 SUP Custom 27803010 483510140 - SPACER SPNL 0D WDG NOSE 20X11X14MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483510144 SUP Custom 27803010 483510144 - SPACER SPNL 4D LRDTC WDG NOSE 20X11X14MM AVS UNILIF HLW BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483510148 SUP Custom 27803010 483510148 - SPACER SPNL 8D LRDTC WDG NOSE 20X11X14MM AVS UNILIF HLW BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483510150 SUP Custom 27803010 483510150 - SPACER SPNL 0D WDG NOSE 20X11X15MM AVS UNILIF HLW PEEK-OPTM BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483510154 SUP Custom 27803010 483510154 - SPACER SPNL 4D LRDTC WDG NOSE 20X11X15MM AVS UNILIF HLW BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483510158 SUP Custom 27803010 483510158 - SPACER SPNL 8D LRDTC WDG NOSE 20X11X15MM AVS UNILIF HLW BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483510168 SUP Custom 27803010 483510168 - SPACER SPNL 8D LRDTC WDG NOSE 20X11X16MM AVS UNILIF HLW BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483515098 SUP Custom 27803010 483515098 - SPACER SPNL 8D WDG 25X11X9MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483515108 SUP Custom 27803010 483515108 - SPACER SPNL 8D WDG 25X11X10MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483515118 SUP Custom 27803010 483515118 - SPACER SPNL 8D WDG 25X11X11MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483515128 SUP Custom 27803010 483515128 - SPACER SPNL 8D WDG 25X11X12MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483515138 SUP Custom 27803010 483515138 - SPACER SPNL 8D WDG 25X11X13MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483515140 SUP Custom 27803010 483515140 - SPACER SPNL 0D RECT 25X11X14MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483515144 SUP Custom 27803010 483515144 - SPACER SPNL 4D WDG 25X11X14MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483515148 SUP Custom 27803010 483515148 - SPACER SPNL 8D WDG 25X11X14MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483515150 SUP Custom 27803010 483515150 - SPACER SPNL 0D RECT 25X11X15MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483515154 SUP Custom 27803010 483515154 - SPACER SPNL 4D WDG 25X11X15MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483515158 SUP Custom 27803010 483515158 - SPACER SPNL 8D WDG 25X11X15MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 483515168 SUP Custom 27803010 483515168 - SPACER SPNL 8D WDG 25X11X16MM AVS PL HLW PEEK PLIF BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 486610000 SUP HCPCS C1713 486610000 - CAP LOCKING SPN BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $75.00 $125.00 $26.05 $125.00 N/A N/A 486610425 SUP HCPCS C1713 486610425 - SCREW BONE STANDARD 4.75MM 25MM RAD SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 486610430 SUP HCPCS C1713 486610430 - SCREW BONE STANDARD 4.75MM 30MM RAD SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 486610435 SUP HCPCS C1713 486610435 - SCREW BONE STANDARD 4.75MM 35MM RAD SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 486610440 SUP HCPCS C1713 486610440 - SCREW BONE STANDARD 4.75MM 40MM RAD SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 486610445 SUP HCPCS C1713 486610445 - SCREW BONE STANDARD 4.75MM 45MM RAD SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 486610450 SUP HCPCS C1713 486610450 - SCREW BONE STANDARD 4.75MM 50MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610455 SUP HCPCS C1713 486610455 - SCREW BONE STANDARD 4.75MM 55MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610525 SUP HCPCS C1713 486610525 - SCREW BONE STANDARD 5.75MM 25MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610530 SUP HCPCS C1713 486610530 - SCREW BONE STANDARD 5.75MM 30MM RAD SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 486610535 SUP HCPCS C1713 486610535 - SCREW BONE STANDARD 5.75MM 35MM RAD SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A 486610540 SUP HCPCS C1713 486610540 - SCREW BONE STANDARD 5.75MM 40MM RAD SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 486610545 SUP HCPCS C1713 486610545 - SCREW BONE STANDARD 5.75MM 45MM RAD SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 486610550 SUP HCPCS C1713 486610550 - SCREW BONE STANDARD 5.75MM 50MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610555 SUP HCPCS C1713 486610555 - SCREW BONE STANDARD 5.75MM 55MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610560 SUP HCPCS C1713 486610560 - SCREW BONE STANDARD 5.75MM 60MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610565 SUP HCPCS C1713 486610565 - SCREW BONE STANDARD 5.75MM 65MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610600 SUP HCPCS C1713 486610600 - SCREW BONE STANDARD 6.75MM 100MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610625 SUP HCPCS C1713 486610625 - SCREW BONE STANDARD 6.75MM 25MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610630 SUP HCPCS C1713 486610630 - SCREW BONE STANDARD 6.75MM 30MM RAD SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 486610635 SUP HCPCS C1713 486610635 - SCREW BONE STANDARD 6.75MM 35MM RAD SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 486610640 SUP HCPCS C1713 486610640 - SCREW BONE STANDARD 6.75MM 40MM RAD SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 486610645 SUP HCPCS C1713 486610645 - SCREW BONE STANDARD 6.75MM 45MM RAD SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 486610650 SUP HCPCS C1713 486610650 - SCREW BONE STANDARD 6.75MM 50MM RAD SPN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 486610655 SUP HCPCS C1713 486610655 - SCREW BONE STANDARD 6.75MM 55MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610660 SUP HCPCS C1713 486610660 - SCREW BONE STANDARD 6.75MM 60MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610665 SUP HCPCS C1713 486610665 - SCREW BONE STANDARD 6.75MM 65MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610670 SUP HCPCS C1713 486610670 - SCREW BONE STANDARD 6.75MM 70MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610680 SUP HCPCS C1713 486610680 - SCREW BONE STANDARD 6.75MM 80MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610690 SUP HCPCS C1713 486610690 - SCREW BONE STANDARD 6.75MM 90MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610700 SUP HCPCS C1713 486610700 - SCREW BONE STANDARD 7.75MM 100MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610725 SUP HCPCS C1713 486610725 - SCREW BONE STANDARD 7.75MM 25MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610730 SUP HCPCS C1713 486610730 - SCREW BONE STANDARD 7.75MM 30MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610735 SUP HCPCS C1713 486610735 - SCREW BONE STANDARD 7.75MM 35MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610740 SUP HCPCS C1713 486610740 - SCREW BONE STANDARD 7.75MM 40MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610745 SUP HCPCS C1713 486610745 - SCREW BONE STANDARD 7.75MM 45MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610750 SUP HCPCS C1713 486610750 - SCREW BONE STANDARD 7.75MM 50MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610755 SUP HCPCS C1713 486610755 - SCREW BONE STANDARD 7.75MM 55MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610760 SUP HCPCS C1713 486610760 - SCREW BONE STANDARD 7.75MM 60MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610765 SUP HCPCS C1713 486610765 - SCREW BONE STANDARD 7.75MM 65MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610770 SUP HCPCS C1713 486610770 - SCREW BONE STANDARD 7.75MM 70MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610780 SUP HCPCS C1713 486610780 - SCREW BONE STANDARD 7.75MM 80MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610790 SUP HCPCS C1713 486610790 - SCREW BONE STANDARD 7.75MM 90MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610800 SUP HCPCS C1713 486610800 - SCREW BONE STANDARD 8.75MM 100MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610830 SUP HCPCS C1713 486610830 - SCREW BONE STANDARD 8.75MM 30MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610835 SUP HCPCS C1713 486610835 - SCREW BONE STANDARD 8.75MM 35MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610840 SUP HCPCS C1713 486610840 - SCREW BONE STANDARD 8.75MM 40MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610845 SUP HCPCS C1713 486610845 - SCREW BONE STANDARD 8.75MM 45MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610850 SUP HCPCS C1713 486610850 - SCREW BONE STANDARD 8.75MM 50MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610855 SUP HCPCS C1713 486610855 - SCREW BONE STANDARD 8.75MM 55MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610860 SUP HCPCS C1713 486610860 - SCREW BONE STANDARD 8.75MM 60MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610865 SUP HCPCS C1713 486610865 - SCREW BONE STANDARD 8.75MM 65MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610870 SUP HCPCS C1713 486610870 - SCREW BONE STANDARD 8.75MM 70MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610880 SUP HCPCS C1713 486610880 - SCREW BONE STANDARD 8.75MM 80MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610890 SUP HCPCS C1713 486610890 - SCREW BONE STANDARD 8.75MM 90MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610900 SUP HCPCS C1713 486610900 - SCREW BONE STANDARD 9.75MM 100MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610960 SUP HCPCS C1713 486610960 - SCREW BONE STANDARD 9.75MM 60MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610970 SUP HCPCS C1713 486610970 - SCREW BONE STANDARD 9.75MM 70MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610980 SUP HCPCS C1713 486610980 - SCREW BONE STANDARD 9.75MM 80MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486610990 SUP HCPCS C1713 486610990 - SCREW BONE STANDARD 9.75MM 90MM RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486611425 SUP HCPCS C1713 486611425 - SCREW BONE 4.75MM 25MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611430 SUP HCPCS C1713 486611430 - SCREW BONE 4.75MM 30MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611435 SUP HCPCS C1713 486611435 - SCREW BONE 4.75MM 35MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611440 SUP HCPCS C1713 486611440 - SCREW BONE 4.75MM 40MM MULTIANG TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611445 SUP HCPCS C1713 486611445 - SCREW BONE 4.75MM 45MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611450 SUP HCPCS C1713 486611450 - SCREW BONE 4.75MM 50MM MULTIANG TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611455 SUP HCPCS C1713 486611455 - SCREW BONE 4.75MM 55MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611525 SUP HCPCS C1713 486611525 - SCREW BONE 5.75MM 25MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611530 SUP HCPCS C1713 486611530 - SCREW BONE 5.75MM 30MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611535 SUP HCPCS C1713 486611535 - SCREW BONE 5.75MM 35MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611540 SUP HCPCS C1713 486611540 - SCREW BONE 5MM 40MM MULTIANG TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611545 SUP HCPCS C1713 486611545 - SCREW BONE 5.75MM 45MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611550 SUP HCPCS C1713 486611550 - SCREW BONE 5.75MM 50MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611555 SUP HCPCS C1713 486611555 - SCREW BONE 5MM 55MM MULTIANG TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611560 SUP HCPCS C1713 486611560 - SCREW BONE 5.75MM 60MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611565 SUP HCPCS C1713 486611565 - SCREW BONE 5.75MM 65MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611600 SUP HCPCS C1713 486611600 - SCREW BONE 6.75MM 100MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611625 SUP HCPCS C1713 486611625 - SCREW BONE 6.75MM 25MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611630 SUP HCPCS C1713 486611630 - SCREW BONE 6.75MM 30MM MULTIANG TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611635 SUP HCPCS C1713 486611635 - SCREW BONE 6.75MM 35MM MULTIANG TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611640 SUP HCPCS C1713 486611640 - SCREW BONE 6.75MM 40MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611645 SUP HCPCS C1713 486611645 - SCREW BONE 6.75MM 45MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611650 SUP HCPCS C1713 486611650 - SCREW BONE 6.75MM 50MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611655 SUP HCPCS C1713 486611655 - SCREW BONE 6.75MM 55MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611660 SUP HCPCS C1713 486611660 - SCREW BONE 6.75MM 60MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611665 SUP HCPCS C1713 486611665 - SCREW BONE 6.75MM 65MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611670 SUP HCPCS C1713 486611670 - SCREW BONE 6.75MM 70MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611680 SUP HCPCS C1713 486611680 - SCREW BONE 6.75MM 80MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611690 SUP HCPCS C1713 486611690 - SCREW BONE 6.75MM 90MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611700 SUP HCPCS C1713 486611700 - SCREW BONE 7.75MM 100MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611725 SUP HCPCS C1713 486611725 - SCREW BONE 7.75MM 25MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611730 SUP HCPCS C1713 486611730 - SCREW BONE 7.75MM 30MM MULTIANG TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611735 SUP HCPCS C1713 486611735 - SCREW BONE 7.75MM 35MM MULTIANG TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611740 SUP HCPCS C1713 486611740 - SCREW BONE 7.75MM 40MM MULTIANG TITANIUM SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611745 SUP HCPCS C1713 486611745 - SCREW BONE 7.75MM 45MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611750 SUP HCPCS C1713 486611750 - SCREW BONE 7.75MM 50MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611755 SUP HCPCS C1713 486611755 - SCREW BONE 7.75MM 55MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611760 SUP HCPCS C1713 486611760 - SCREW BONE 7.75MM 60MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611765 SUP HCPCS C1713 486611765 - SCREW BONE 7.75MM 65MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611770 SUP HCPCS C1713 486611770 - SCREW BONE 7.75MM 70MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611780 SUP HCPCS C1713 486611780 - SCREW BONE 7.75MM 80MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611790 SUP HCPCS C1713 486611790 - SCREW BONE 7.75MM 90MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611800 SUP HCPCS C1713 486611800 - SCREW BONE 8.75MM 100MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611830 SUP HCPCS C1713 486611830 - SCREW BONE 8.75MM 30MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611835 SUP HCPCS C1713 486611835 - SCREW BONE 8.75MM 35MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611840 SUP HCPCS C1713 486611840 - SCREW BONE 8.75MM 40MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611845 SUP HCPCS C1713 486611845 - SCREW BONE 8.75MM 45MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611850 SUP HCPCS C1713 486611850 - SCREW BONE 8.75MM 50MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611855 SUP HCPCS C1713 486611855 - SCREW BONE 8.75MM 55MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611860 SUP HCPCS C1713 486611860 - SCREW BONE 8.75MM 60MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611865 SUP HCPCS C1713 486611865 - SCREW BONE 8.75MM 65MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611870 SUP HCPCS C1713 486611870 - SCREW BONE 8.75MM 70MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611880 SUP HCPCS C1713 486611880 - SCREW BONE 8.75MM 80MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611890 SUP HCPCS C1713 486611890 - SCREW BONE 8.75MM 90MM MULTIANG RAD SPN BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 486611900 SUP HCPCS C1713 486611900 - SCREW BONE 9.75MM 100MM MULTIANG RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486611960 SUP HCPCS C1713 486611960 - SCREW BONE 9.75MM 60MM MULTIANG RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486611970 SUP HCPCS C1713 486611970 - SCREW BONE 9.75MM 70MM MULTIANG RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486611980 SUP HCPCS C1713 486611980 - SCREW BONE 9.75MM 80MM MULTIANG RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486611990 SUP HCPCS C1713 486611990 - SCREW BONE 9.75MM 90MM MULTIANG RAD SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 486612535 SUP HCPCS C1713 486612535 - SCREW BONE 5.75MM 35MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486612540 SUP HCPCS C1713 486612540 - SCREW BONE 5.75MM 40MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486612545 SUP HCPCS C1713 486612545 - SCREW BONE 5.75MM 45MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486612550 SUP HCPCS C1713 486612550 - SCREW BONE 5.75MM 50MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486612630 SUP HCPCS C1713 486612630 - SCREW BONE 6.75MM 30MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486612635 SUP Custom 27203010 486612635 - SCREW BONE 6.75MM 35MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A 486612640 SUP HCPCS C1713 486612640 - SCREW BONE 6.75MM 40MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486612645 SUP HCPCS C1713 486612645 - SCREW BONE 6.75MM 45MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486612650 SUP HCPCS C1713 486612650 - SCREW BONE 6.75MM 50MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486612655 SUP HCPCS C1713 486612655 - SCREW BONE 6.75MM 55MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486612730 SUP HCPCS C1713 486612730 - SCREW BONE 7.75MM 30MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486612735 SUP HCPCS C1713 486612735 - SCREW BONE 7.75MM 35MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486612740 SUP HCPCS C1713 486612740 - SCREW BONE 7.75MM 40MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486612745 SUP HCPCS C1713 486612745 - SCREW BONE 7.75MM 45MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486612750 SUP HCPCS C1713 486612750 - SCREW BONE 7.75MM 50MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486612755 SUP HCPCS C1713 486612755 - SCREW BONE 7.75MM 55MM MULTIANG CANN RAD SPN BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 486613000 SUP Custom 27803010 486613000 - ROD SPINAL 5.5MM 100MM NONHEXAGONAL TITANIUM RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613003 SUP Custom 27803010 486613003 - ROD SPINAL 5.5MM 30MM W/O HEXAGONAL RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613004 SUP Custom 27803010 486613004 - ROD SPINAL 40MM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613005 SUP Custom 27803010 486613005 - ROD SPINAL 5.5MM 50MM NONHEXAGONAL RAD TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613006 SUP Custom 27803010 486613006 - ROD SPINAL 5.5MM 60MM W/O HEXAGONAL RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613007 SUP Custom 27803010 486613007 - ROD SPNL 5.5MM 70MM RDS NONHEXAGONAL BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613008 SUP Custom 27803010 486613008 - ROD SPINAL 5.5MM 80MM W/O HEXAGONAL RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613009 SUP Custom 27803010 486613009 - ROD SPINAL 5.5MM 90MM NONHEXAGONAL RAD TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613010 SUP Custom 27803010 486613010 - ROD SPINAL 5.5MM 110MM W/O HEXAGONAL RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613020 SUP Custom 27803010 486613020 - ROD SPINAL 5.5MM 120MM RAD W/O HEXAGONAL BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613050 SUP Custom 27803010 486613050 - ROD SPINAL 5.5MM 50MM HEXAGON RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613053 SUP Custom 27803010 486613053 - ROD SPINAL 5.5MM 35MM RAD NONHEXAGONAL BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613054 SUP Custom 27803010 486613054 - ROD SPINAL 5.5MM 45MM NONHEXAGONAL RAD TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613060 SUP Custom 27803010 486613060 - ROD SPINAL 5.5MM 60MM HEXAGON RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613070 SUP Custom 27803010 486613070 - ROD SPINAL 5.5MM 70MM HEXAGON RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613080 SUP Custom 27803010 486613080 - ROD SPINAL 5.5MM 80MM HEXAGON RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613090 SUP Custom 27803010 486613090 - ROD SPINAL 5.5MM 90MM HEXAGON RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613100 SUP Custom 27803010 486613100 - ROD SPINAL 5.5MM 100MM HEXAGON RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613110 SUP Custom 27803010 486613110 - ROD SPINAL 5.5MM 110MM HEXAGON RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613120 SUP Custom 27803010 486613120 - ROD SPINAL 5.5MM 120MM HEXAGONAL RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613140 SUP Custom 27803010 486613140 - ROD SPINAL 5.5MM 140MM HEXAGON RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613160 SUP Custom 27803010 486613160 - ROD SPINAL 5.5MM 160MM HEXAGON RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613180 SUP Custom 27803010 486613180 - ROD SPINAL 5.5MM 180MM HEXAGONAL RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613200 SUP Custom 27803010 486613200 - ROD SPINAL 5.5MM 200MM HEXAGON RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486613220 SUP Custom 27803010 486613220 - ROD SPINAL 5.5MM 220MM RAD HEXAGONAL BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 486613240 SUP Custom 27803010 486613240 - ROD SPINAL 5.5MM 240MM HEXAGON RAD BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 486613260 SUP Custom 27803010 486613260 - ROD SPINAL 5.5MM 260MM HEXAGON RAD BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 486613280 SUP Custom 27803010 486613280 - ROD SPINAL 5.5MM 280MM HEXAGON RAD BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 486613300 SUP Custom 27803010 486613300 - ROD SPINAL 5.5MM 300MM HEXAGONAL RAD BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 486613320 SUP Custom 27803010 486613320 - ROD SPINAL 5.5MM 320MM HEXAGON RAD BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 486613340 SUP Custom 27803010 486613340 - ROD SPINAL 5.5MM 340MM HEXAGON RAD BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 486613360 SUP Custom 27803010 486613360 - ROD SPINAL 5.5MM 360MM HEXAGON RAD BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 486613380 SUP Custom 27803010 486613380 - ROD SPINAL 5.5MM 380MM HEXAGON RAD BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 486613400 SUP Custom 27803010 486613400 - ROD SPINAL 5.5MM 400MM RAD HEXAGONAL BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 486613600 SUP Custom 27803010 486613600 - ROD SPINAL 5.5MM 600MM HEXAGONAL RAD BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 486613601 SUP Custom 27803010 486613601 - ROD SPINAL 6.5MM 600MM RAD VITALLIUM PEDICLE BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 486613602 SUP Custom 27803010 486613602 - ROD SPINAL 5.5MM HEXAGON VITALLIUM BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A 486614022 SUP Custom 27803010 486614022 - CONNECTOR ROD 22MM CROSS RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614024 SUP Custom 27803010 486614024 - CONNECTOR ROD 24MM CROSS RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614026 SUP Custom 27803010 486614026 - CONNECTOR ROD 26MM CROSS RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614028 SUP Custom 27803010 486614028 - CONNECTOR ROD 28MM CROSS RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614030 SUP Custom 27803010 486614030 - CONNECTOR ROD 30MM CROSS RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614032 SUP Custom 27803010 486614032 - CONNECTOR ROD 32MM CROSS RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614034 SUP Custom 27803010 486614034 - CONNECTOR ROD 34MM CROSS RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614036 SUP Custom 27803010 486614036 - CONNECTOR ROD 36MM CROSS RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614100 SUP Custom 27803010 486614100 - CONNECTOR ROD SHORT CROSS VARIABLE RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614110 SUP Custom 27803010 486614110 - CONNECTOR ROD MEDIUM CROSS RAD VARIABLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614120 SUP Custom 27803010 486614120 - CONNECTOR ROD LONG CROSS VARIABLE RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614130 SUP Custom 27803010 486614130 - CONNECTOR ROD MEDIUM CROSS CVD RAD VARIABLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614140 SUP Custom 27803010 486614140 - CONNECTOR ROD LONG VARIABLE CROSS CVD RAD MA BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614170 SUP Custom 27803010 486614170 - CONNECTOR ROD MEDIUM CROSS MULTIANGLED RAD VARIABLE BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614180 SUP Custom 27803010 486614180 - CONNECTOR ROD LONG POLYAX CROSS VAR ANG RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614215 SUP Custom 27803010 486614215 - CONNECTOR ROD 15MM CROSS RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614216 SUP Custom 27803010 486614216 - CONNECTOR ROD 16MM CROSS RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614217 SUP Custom 27803010 486614217 - CONNECTOR ROD 18MM CROSS RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614218 SUP Custom 27803010 486614218 - CONNECTOR ROD 18MM CROSS RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614219 SUP Custom 27803010 486614219 - CONNECTOR ROD 19MM CROSS RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614220 SUP Custom 27803010 486614220 - CONNECTOR ROD 20MM CROSS RAD SPN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 486614300 SUP Custom 27803010 486614300 - CONNECTOR ROD 0D SMALL ROD TO ROD RAD SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 486614305 SUP Custom 27803010 486614305 - CONNECTOR ROD 105D OFFST RAD BEN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 486614310 SUP Custom 27803010 486614310 - CONNECTOR ROD NEUTRAL OFFST RAD BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 486614320 SUP Custom 27803010 486614320 - CONNECTOR ROD NEUTRAL LONG OFFST RAD SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 486614330 SUP Custom 27803010 486614330 - CONNECTOR ROD 30D SMALL ROD TO ROD RAD SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 486614375 SUP Custom 27803010 486614375 - CONNECTOR ROD 75D SMALL ROD TO ROD RAD SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 486614400 SUP Custom 27803010 486614400 - CONNECTOR ROD 10D LARGE ROD TO ROD RAD SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 486614430 SUP Custom 27803010 486614430 - CONNECTOR ROD 10D LARGE ROD TO ROD RAD SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 486614530 SUP Custom 27803010 486614530 - CONNECTOR ROD 5MM ROD TO ROD RAD SPN BOTH IP/OP "$2,077.00" "$1,537.00" $369.67 "$2,076.80" "$2,076.80" "$2,076.80" "$2,076.80" "$2,076.80" "$2,076.80" "$2,076.80" $369.67 "$2,076.80" "$2,076.80" "$2,076.80" "$2,076.80" "$2,076.80" "$2,076.80" $432.83 "$2,076.80" $830.72 "$2,076.80" "$2,076.80" "$2,076.80" "$2,076.80" "$2,076.80" "$1,557.75" "$2,076.80" "$2,076.80" "$2,076.80" "$1,038.40" "$1,038.40" "$1,644.83" "$2,076.80" "$1,661.44" $934.56 "$2,076.80" N/A "$1,204.66" "$2,076.80" "$1,246.08" "$2,076.80" "$2,076.80" "$2,076.80" N/A N/A 486614550 SUP Custom 27803010 486614550 - CONNECTOR ROD 5MM ROD TO ROD RAD SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 486614555 SUP Custom 27803010 486614555 - CONNECTOR ROD ROD TO ROD POLYAX RAD SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 486614560 SUP Custom 27803010 486614560 - CONNECTOR ROD 5MM ROD TO ROD RAD SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 486614565 SUP Custom 27803010 486614565 - CONNECTOR ROD OFFST RAD SPN BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 486615000 SUP Custom 27803010 486615000 - ROD SPINAL 5.5MM 100MM RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615010 SUP Custom 27803010 486615010 - ROD SPINAL 5.5MM 110MM RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615020 SUP Custom 27803010 486615020 - ROD SPINAL 5.5MM 120MM RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615030 SUP Custom 27803010 486615030 - ROD SPINAL 5.5MM 30MM RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615035 SUP Custom 27803010 486615035 - ROD SPNL 35MM BN BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615040 SUP Custom 27803010 486615040 - ROD SPINAL 5.5MM 40MM TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615045 SUP Custom 27803010 486615045 - ROD SPINAL 5.5MM 45MM TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615050 SUP Custom 27803010 486615050 - ROD SPINAL 50X5.5MM RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615060 SUP Custom 27803010 486615060 - ROD SPINAL 60X5.5MM RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615070 SUP Custom 27803010 486615070 - ROD SPINAL 70X5.5MM RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615080 SUP Custom 27803010 486615080 - ROD SPNL 5.5MM 80MM SPRL RDS BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615090 SUP Custom 27803010 486615090 - ROD SPINAL 5.5MM 90MM TITANIUM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615500 SUP Custom 27803010 486615500 - ROD SPINAL 5.5MM 100MM RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615510 SUP Custom 27803010 486615510 - ROD SPINAL 5.5MM 110MM MAX RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615520 SUP Custom 27803010 486615520 - ROD SPINAL 5.5MM 120MM RAD MAX BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615550 SUP Custom 27803010 486615550 - ROD SPINAL 5.5MM 50MM RAD MAX BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615560 SUP Custom 27803010 486615560 - ROD SPNL 60MM ISOBAR BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615570 SUP Custom 27803010 486615570 - ROD SPNL 5.5MM 70MM MAX BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615580 SUP Custom 27803010 486615580 - ROD SPINAL 5.5MM 80MM MAX RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486615590 SUP Custom 27803010 486615590 - ROD SPINAL 5.5MM 90MM MAX RAD BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A 486616000 SUP Custom 27803010 486616000 - HOOK SPINAL SMALL STR BLADE RAD LMNR BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616001 SUP Custom 27803010 486616001 - HOOK SPINAL SMALL NARROW BLADE RAD LMNR BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616002 SUP Custom 27803010 486616002 - HOOK SPINAL LARGE STR BLADE RAD LMNR BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616003 SUP Custom 27803010 486616003 - HOOK SPINAL LARGE NARROW BLADE RAD LMNR BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616004 SUP Custom 27803010 486616004 - HOOK SPINAL EXTENDED BLADE RAD LMNR BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616005 SUP Custom 27803010 486616005 - HOOK SPINAL LARGE RIGHT OFFST RAD LMNR BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616006 SUP Custom 27803010 486616006 - HOOK SPINAL LARGE LEFT OFFST RAD LMNR BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616007 SUP Custom 27803010 486616007 - HOOK SPINAL ANGLED BLADE RAD LMNR BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616008 SUP Custom 27803010 486616008 - HOOK SPINAL STANDARD BLADE RAD LMNR THORACIC BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616009 SUP Custom 27803010 486616009 - HOOK SPINAL NARROW BLADE RAD LMNR THORACIC BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616010 SUP Custom 27803010 486616010 - HOOK SPINAL SMALL OFFST RAD RIGHT LMNR THORACIC BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616011 SUP Custom 27803010 486616011 - HOOK SPINAL SMALL OFFST RAD LEFT LMNR THORACIC BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616012 SUP Custom 27803010 486616012 - HOOK SPINAL LARGE OFFST RAD RIGHT LMNR THORACIC BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616013 SUP Custom 27803010 486616013 - HOOK SPINAL LARGE OFFST RAD LEFT LMNR THORACIC BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616014 SUP Custom 27803010 486616014 - HOOK SPINAL SMALL RAD PEDICLE BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616015 SUP Custom 27803010 486616015 - HOOK SPINAL LARGE RAD PEDICLE BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616016 SUP Custom 27803010 486616016 - HOOK SPINAL TRNSVRS PROCESS RAD RIGHT BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616017 SUP Custom 27803010 486616017 - HOOK SPINAL TRNSVRS PROCESS RAD LEFT BOTH IP/OP "$2,393.00" "$1,771.00" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $425.92 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" $498.69 "$2,392.80" $957.12 "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$2,392.80" "$1,794.75" "$2,392.80" "$2,392.80" "$2,392.80" "$1,196.40" "$1,196.40" "$1,895.10" "$2,392.80" "$1,914.24" "$1,076.76" "$2,392.80" N/A "$1,387.94" "$2,392.80" "$1,435.68" "$2,392.80" "$2,392.80" "$2,392.80" N/A N/A 486616018 SUP Custom 27803010 486616018 - HOOK SPINAL NARROW BLADE RAD LMNR BOTH IP/OP "$2,686.50" "$1,988.00" $478.16 "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" $478.16 "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" $559.85 "$2,686.30" "$1,074.52" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,014.88" "$2,686.30" "$2,686.30" "$2,686.30" "$1,343.15" "$1,343.15" "$2,127.55" "$2,686.30" "$2,149.04" "$1,208.84" "$2,686.30" N/A "$1,558.17" "$2,686.30" "$1,611.78" "$2,686.30" "$2,686.30" "$2,686.30" N/A N/A 486616019 SUP Custom 27803010 486616019 - HOOK SPINAL STANDARD BLADE RAD LMNR BOTH IP/OP "$2,686.50" "$1,988.00" $478.16 "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" $478.16 "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" $559.85 "$2,686.30" "$1,074.52" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,014.88" "$2,686.30" "$2,686.30" "$2,686.30" "$1,343.15" "$1,343.15" "$2,127.55" "$2,686.30" "$2,149.04" "$1,208.84" "$2,686.30" N/A "$1,558.17" "$2,686.30" "$1,611.78" "$2,686.30" "$2,686.30" "$2,686.30" N/A N/A 486616020 SUP Custom 27803010 486616020 - HOOK SPINAL ANGLED BLADE RAD LMNR BOTH IP/OP "$2,686.50" "$1,988.00" $478.16 "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" $478.16 "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" $559.85 "$2,686.30" "$1,074.52" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,014.88" "$2,686.30" "$2,686.30" "$2,686.30" "$1,343.15" "$1,343.15" "$2,127.55" "$2,686.30" "$2,149.04" "$1,208.84" "$2,686.30" N/A "$1,558.17" "$2,686.30" "$1,611.78" "$2,686.30" "$2,686.30" "$2,686.30" N/A N/A 486616021 SUP Custom 27803010 486616021 - HOOK SPINAL NARROW BLADE RAD LMNR THORACIC RBH BOTH IP/OP "$2,686.50" "$1,988.00" $478.16 "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" $478.16 "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" $559.85 "$2,686.30" "$1,074.52" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,014.88" "$2,686.30" "$2,686.30" "$2,686.30" "$1,343.15" "$1,343.15" "$2,127.55" "$2,686.30" "$2,149.04" "$1,208.84" "$2,686.30" N/A "$1,558.17" "$2,686.30" "$1,611.78" "$2,686.30" "$2,686.30" "$2,686.30" N/A N/A 486616022 SUP Custom 27803010 486616022 - HOOK SPINAL RAD PEDICLE BOTH IP/OP "$2,686.50" "$1,988.00" $478.16 "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" $478.16 "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" $559.85 "$2,686.30" "$1,074.52" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,686.30" "$2,014.88" "$2,686.30" "$2,686.30" "$2,686.30" "$1,343.15" "$1,343.15" "$2,127.55" "$2,686.30" "$2,149.04" "$1,208.84" "$2,686.30" N/A "$1,558.17" "$2,686.30" "$1,611.78" "$2,686.30" "$2,686.30" "$2,686.30" N/A N/A 486617005 SUP HCPCS C1713 486617005 - STAPLE BONE XS 2 RAD SPN ROSTRAL BOTH IP/OP "$2,494.00" "$1,846.00" $494.97 "$2,493.88" "$1,122.25" "$1,122.25" "$1,122.25" "$1,122.25" "$2,493.88" "$2,493.88" "$2,493.88" $519.79 "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" $519.75 "$2,493.88" $997.55 "$1,475.13" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$1,870.50" "$2,493.88" "$2,493.88" "$2,493.88" "$1,246.94" "$1,246.94" "$1,975.15" "$2,493.88" "$1,995.10" "$1,122.25" $494.97 N/A "$1,446.52" "$2,493.88" "$2,493.88" "$2,493.88" $519.72 "$2,493.88" N/A N/A 486617006 SUP HCPCS C1713 486617006 - STAPLE BONE XS 2 RAD SPN CAUDAL BOTH IP/OP "$2,494.00" "$1,846.00" $494.97 "$2,493.88" "$1,122.25" "$1,122.25" "$1,122.25" "$1,122.25" "$2,493.88" "$2,493.88" "$2,493.88" $519.79 "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" $519.75 "$2,493.88" "$2,493.88" "$1,475.13" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$1,870.50" "$2,493.88" "$2,493.88" "$2,493.88" "$1,246.94" "$1,246.94" "$1,975.15" "$2,493.88" "$1,995.10" "$1,122.25" $494.97 N/A "$1,446.52" "$2,493.88" "$2,493.88" "$2,493.88" $519.72 "$2,493.88" N/A N/A 486617010 SUP HCPCS C1713 486617010 - STAPLE BONE SMALL 2 RAD SPN CAUDAL BOTH IP/OP "$2,494.00" "$1,846.00" $494.97 "$2,493.88" "$1,122.25" "$1,122.25" "$1,122.25" "$1,122.25" "$2,493.88" "$2,493.88" "$2,493.88" $519.79 "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" $519.75 "$2,493.88" "$2,493.88" "$1,475.13" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$1,870.50" "$2,493.88" "$2,493.88" "$2,493.88" "$1,246.94" "$1,246.94" "$1,975.15" "$2,493.88" "$1,995.10" "$1,122.25" $494.97 N/A "$1,446.52" "$2,493.88" "$2,493.88" "$2,493.88" $519.72 "$2,493.88" N/A N/A 486617015 SUP HCPCS C1713 486617015 - STAPLE BONE SMALL 2 RAD SPN ROSTRAL BOTH IP/OP "$2,494.00" "$1,846.00" $494.97 "$2,493.88" "$1,122.25" "$1,122.25" "$1,122.25" "$1,122.25" "$2,493.88" "$2,493.88" "$2,493.88" $519.79 "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" $519.75 "$2,493.88" "$2,493.88" "$1,475.13" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$1,870.50" "$2,493.88" "$2,493.88" "$2,493.88" "$1,246.94" "$1,246.94" "$1,975.15" "$2,493.88" "$1,995.10" "$1,122.25" $494.97 N/A "$1,446.52" "$2,493.88" "$2,493.88" "$2,493.88" $519.72 "$2,493.88" N/A N/A 486617020 SUP HCPCS C1713 486617020 - STAPLE BONE MEDIUM 2 RAD SPN CAUDAL BOTH IP/OP "$2,494.00" "$1,846.00" $494.97 "$2,493.88" "$1,122.25" "$1,122.25" "$1,122.25" "$1,122.25" "$2,493.88" "$2,493.88" "$2,493.88" $519.79 "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" $519.75 "$2,493.88" "$2,493.88" "$1,475.13" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$1,870.50" "$2,493.88" "$2,493.88" "$2,493.88" "$1,246.94" "$1,246.94" "$1,975.15" "$2,493.88" "$1,995.10" "$1,122.25" $494.97 N/A "$1,446.52" "$2,493.88" "$2,493.88" "$2,493.88" $519.72 "$2,493.88" N/A N/A 486617025 SUP HCPCS C1713 486617025 - STAPLE BONE MEDIUM 2 RAD SPN ROSTRAL BOTH IP/OP "$2,494.00" "$1,846.00" $494.97 "$2,493.88" "$1,122.25" "$1,122.25" "$1,122.25" "$1,122.25" "$2,493.88" "$2,493.88" "$2,493.88" $519.79 "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" $519.75 "$2,493.88" "$2,493.88" "$1,475.13" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$1,870.50" "$2,493.88" "$2,493.88" "$2,493.88" "$1,246.94" "$1,246.94" "$1,975.15" "$2,493.88" "$1,995.10" "$1,122.25" $494.97 N/A "$1,446.52" "$2,493.88" "$2,493.88" "$2,493.88" $519.72 "$2,493.88" N/A N/A 486617030 SUP HCPCS C1713 486617030 - STAPLE BONE LARGE 2 RAD SPN CAUDAL BOTH IP/OP "$2,494.00" "$1,846.00" $494.97 "$2,493.88" "$1,122.25" "$1,122.25" "$1,122.25" "$1,122.25" "$2,493.88" "$2,493.88" "$2,493.88" $519.79 "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" $519.75 "$2,493.88" $997.55 "$1,475.13" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$1,870.50" "$2,493.88" "$2,493.88" "$2,493.88" "$1,246.94" "$1,246.94" "$1,975.15" "$2,493.88" "$1,995.10" "$1,122.25" $494.97 N/A "$1,446.52" "$2,493.88" "$2,493.88" "$2,493.88" $519.72 "$2,493.88" N/A N/A 486617035 SUP HCPCS C1713 486617035 - STAPLE BONE LARGE 2 RAD SPN ROSTRAL BOTH IP/OP "$2,494.00" "$1,846.00" $494.97 "$2,493.88" "$1,122.25" "$1,122.25" "$1,122.25" "$1,122.25" "$2,493.88" "$2,493.88" "$2,493.88" $519.79 "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" $519.75 "$2,493.88" $997.55 "$1,475.13" "$2,493.88" "$2,493.88" "$2,493.88" "$2,493.88" "$1,870.50" "$2,493.88" "$2,493.88" "$2,493.88" "$1,246.94" "$1,246.94" "$1,975.15" "$2,493.88" "$1,995.10" "$1,122.25" $494.97 N/A "$1,446.52" "$2,493.88" "$2,493.88" "$2,493.88" $519.72 "$2,493.88" N/A N/A 486617040 SUP HCPCS C1713 486617040 - STAPLE BONE RAD TITANIUM SPN BOTH IP/OP "$1,032.00" $764.00 $204.82 "$1,031.95" $464.38 $464.38 $464.38 $464.38 "$1,031.95" "$1,031.95" "$1,031.95" $215.08 "$1,031.95" "$1,031.95" "$1,031.95" "$1,031.95" "$1,031.95" $215.07 "$1,031.95" $412.78 $610.40 "$1,031.95" "$1,031.95" "$1,031.95" "$1,031.95" $774.00 "$1,031.95" "$1,031.95" "$1,031.95" $515.98 $515.98 $817.30 "$1,031.95" $825.56 $464.38 $204.82 N/A $598.56 "$1,031.95" "$1,031.95" "$1,031.95" $215.06 "$1,031.95" N/A N/A 486617045 SUP HCPCS C1713 486617045 - WASHER ORTHOPEDIC RAD SPN BOTH IP/OP $780.50 $578.00 $154.90 $780.43 $351.19 $351.19 $351.19 $351.19 $780.43 $780.43 $780.43 $162.66 $780.43 $780.43 $780.43 $780.43 $780.43 $162.65 $780.43 $780.43 $461.62 $780.43 $780.43 $780.43 $780.43 $585.38 $780.43 $780.43 $780.43 $390.22 $390.22 $618.10 $780.43 $624.34 $351.19 $154.90 N/A $452.69 $780.43 $780.43 $780.43 $162.64 $780.43 N/A N/A 486617050 SUP HCPCS C1713 486617050 - WASHER ORTHOPEDIC TALL 4.75MM RAD SPN BOTH IP/OP $795.50 $589.00 $157.88 $795.48 $357.97 $357.97 $357.97 $357.97 $795.48 $795.48 $795.48 $165.80 $795.48 $795.48 $795.48 $795.48 $795.48 $165.79 $795.48 $795.48 $470.53 $795.48 $795.48 $795.48 $795.48 $596.63 $795.48 $795.48 $795.48 $397.74 $397.74 $630.02 $795.48 $636.38 $357.97 $157.88 N/A $461.39 $795.48 $795.48 $795.48 $165.78 $795.48 N/A N/A 486617051 SUP HCPCS C1713 486617051 - WASHER ORTHOPEDIC TALL 5.75MM RAD SPN BOTH IP/OP $795.50 $589.00 $157.88 $795.48 $357.97 $357.97 $357.97 $357.97 $795.48 $795.48 $795.48 $165.80 $795.48 $795.48 $795.48 $795.48 $795.48 $165.79 $795.48 $795.48 $470.53 $795.48 $795.48 $795.48 $795.48 $596.63 $795.48 $795.48 $795.48 $397.74 $397.74 $630.02 $795.48 $636.38 $357.97 $157.88 N/A $461.39 $795.48 $795.48 $795.48 $165.78 $795.48 N/A N/A 486617052 SUP HCPCS C1713 486617052 - WASHER ORTHOPEDIC TALL 6.75MM RAD SPN BOTH IP/OP $795.50 $589.00 $157.88 $795.48 $357.97 $357.97 $357.97 $357.97 $795.48 $795.48 $795.48 $165.80 $795.48 $795.48 $795.48 $795.48 $795.48 $165.79 $795.48 $795.48 $470.53 $795.48 $795.48 $795.48 $795.48 $596.63 $795.48 $795.48 $795.48 $397.74 $397.74 $630.02 $795.48 $636.38 $357.97 $157.88 N/A $461.39 $795.48 $477.29 $795.48 $165.78 $795.48 N/A N/A 486617053 SUP HCPCS C1713 486617053 - WASHER ORTHOPEDIC TALL 7.75MM RAD SPN BOTH IP/OP $795.50 $589.00 $157.88 $795.48 $357.97 $357.97 $357.97 $357.97 $795.48 $795.48 $795.48 $165.80 $795.48 $795.48 $795.48 $795.48 $795.48 $165.79 $795.48 $795.48 $470.53 $795.48 $795.48 $795.48 $795.48 $596.63 $795.48 $795.48 $795.48 $397.74 $397.74 $630.02 $795.48 $636.38 $357.97 $157.88 N/A $461.39 $795.48 $477.29 $795.48 $165.78 $795.48 N/A N/A 486617054 SUP HCPCS C1713 486617054 - WASHER ORTHOPEDIC TALL 8.75MM RAD SPN BOTH IP/OP $795.50 $589.00 $157.88 $795.48 $357.97 $357.97 $357.97 $357.97 $795.48 $795.48 $795.48 $165.80 $795.48 $795.48 $795.48 $795.48 $795.48 $165.79 $795.48 $318.19 $470.53 $795.48 $795.48 $795.48 $795.48 $596.63 $795.48 $795.48 $795.48 $397.74 $397.74 $630.02 $795.48 $636.38 $357.97 $157.88 N/A $461.39 $795.48 $477.29 $795.48 $165.78 $795.48 N/A N/A 488514535 SUP HCPCS C1713 488514535 - SCREW BN 4.5MM 35MM STRL XIA PA SPNE LMBR CORT BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 488515035 SUP HCPCS C1713 488515035 - SCREW BN 5MM 35MM XIA CT PA SPNE CORT BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 488515540 SUP HCPCS C1713 488515540 - SCREW BN 5.5MM 40MM STRL XIA PA SPNE LMBR CORT BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A 540133500 SUP Custom 27803010 540133500 - SYSTEM BONE CEMENT CARTRIDGE SELF CLEAN MIXING PADDLES SNAP BOTH IP/OP $920.50 $681.00 $163.83 $920.42 $920.42 $920.42 $920.42 $920.42 $920.42 $920.42 $163.83 $920.42 $920.42 $920.42 $920.42 $920.42 $920.42 $191.83 $920.42 $368.17 $920.42 $920.42 $920.42 $920.42 $920.42 $690.38 $920.42 $920.42 $920.42 $460.21 $460.21 $728.97 $920.42 $736.34 $414.19 $920.42 N/A $533.89 $920.42 $552.25 $920.42 $920.42 $920.42 N/A N/A 582010140 SUP Custom 27203010 582010140 - BURR SURG ROUND 4MM ROUND SOFT TOUCH LATEX FREE ELITE BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 606004102 SUP HCPCS Q4130 606004102 - MATRIX TISS THK1MM RECT 20X10CM STRL SURGIMEND PRS BOTH IP/OP "$9,000.00" "$6,660.00" "$1,875.70" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$1,875.70" "$9,000.00" "$3,600.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$9,000.00" "$6,750.00" "$9,000.00" "$9,000.00" "$9,000.00" "$4,500.00" "$4,500.00" "$7,128.00" "$9,000.00" "$7,200.00" "$4,050.00" "$9,000.00" N/A "$5,220.00" "$9,000.00" "$5,400.00" "$9,000.00" "$9,000.00" "$9,000.00" N/A N/A 606200006 SUP HCPCS C1713 606200006 - SCREW BONE 2.7MM 16MM SPN SNPOF BOTH IP/OP "$5,625.00" "$4,163.00" "$1,116.42" "$5,625.00" "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.39" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$2,250.00" "$2,773.13" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$1,116.42" N/A "$3,262.50" "$5,625.00" "$3,375.00" "$5,625.00" "$1,172.25" "$5,625.00" N/A N/A 630505036 SUP HCPCS C1776 630505036 - LINER ACETAB STANDARD NEUTRAL 50/52/54MM 36MM 6.8MM PRIM BOTH IP/OP "$2,979.00" "$2,204.00" $591.21 "$2,978.75" "$1,340.44" "$1,340.44" "$1,340.44" "$1,340.44" "$2,978.75" "$2,978.75" "$2,978.75" $620.85 "$2,978.75" "$2,978.75" "$2,978.75" "$2,978.75" "$2,978.75" $620.80 "$2,978.75" "$1,191.50" "$1,468.52" "$2,978.75" "$2,978.75" "$2,978.75" "$2,978.75" "$2,234.25" "$2,978.75" "$2,978.75" "$2,978.75" "$1,489.38" "$1,489.38" "$2,359.17" "$2,978.75" "$2,383.00" "$1,340.44" $591.21 N/A "$1,727.82" "$2,978.75" "$2,978.75" "$2,978.75" $620.77 "$2,978.75" N/A N/A 630505636 SUP HCPCS C1776 630505636 - LINER ACETAB STANDARD NEUTRAL 56MM 36MM 7.9MM PRIM MODULAR BOTH IP/OP "$4,007.50" "$2,966.00" $795.39 "$4,007.50" "$1,803.38" "$1,803.38" "$1,803.38" "$1,803.38" "$4,007.50" "$4,007.50" "$4,007.50" $835.26 "$4,007.50" "$4,007.50" "$4,007.50" "$4,007.50" "$4,007.50" $835.21 "$4,007.50" "$4,007.50" "$1,975.70" "$4,007.50" "$4,007.50" "$4,007.50" "$4,007.50" "$3,005.63" "$4,007.50" "$4,007.50" "$4,007.50" "$2,003.75" "$2,003.75" "$3,173.94" "$4,007.50" "$3,206.00" "$1,803.38" $795.39 N/A "$2,324.35" "$4,007.50" "$4,007.50" "$4,007.50" $835.16 "$4,007.50" N/A N/A 641003030 SUP HCPCS C1713 641003030 - ROD SPNL 30MM 4.75MM CD HZN COCRMO CAP BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 641003035 SUP HCPCS C1713 641003035 - ROD SPNL 35MM 4.75MM CD HZN COCRMO CAP BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 641003040 SUP HCPCS C1713 641003040 - ROD SPNL 40MM 4.75MM CD HZN COCRMO CAP BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 641003045 SUP HCPCS C1713 641003045 - ROD SPNL 45MM 4.75MM CD HZN COCRMO CAP BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 641003050 SUP HCPCS C1713 641003050 - ROD SPNL 50MM 4.75MM CD HZN COCRMO CAP BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 641003055 SUP HCPCS C1713 641003055 - ROD SPNL 55MM 4.75MM CD HZN COCRMO CAP BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 641003060 SUP HCPCS C1713 641003060 - ROD SPNL 60MM 4.75MM CD HZN COCRMO CAP BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 641003065 SUP HCPCS C1713 641003065 - ROD SPNL 65MM 4.75MM CD HZN COCRMO CAP BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 641003070 SUP HCPCS C1713 641003070 - ROD SPNL 70MM 4.75MM CD HZN COCRMO CAP BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 641003075 SUP HCPCS C1713 641003075 - ROD SPNL 75MM 4.75MM CD HZN CAP BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 641003080 SUP HCPCS C1713 641003080 - ROD SPNL 80MM 4.75MM CD HZN COCRMO CAP BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 641003085 SUP HCPCS C1713 641003085 - ROD SPNL 85MM 4.75MM CD HZN COCRMO CAP STRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 641003090 SUP HCPCS C1713 641003090 - ROD SPNL 90MM 4.75MM CD HZN COCRMO CAP STRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 641003095 SUP HCPCS C1713 641003095 - ROD SPNL 95MM 4.75MM CD HZN COCRMO CAP STRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 651506000 SUP HCPCS C1894 651506000 - SYSTEM INTRO .018IN 80CM SKTR GW SS BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $109.96 $109.96 $109.96 $109.96 $202.50 $202.50 $202.50 $42.21 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A 654000100 SUP HCPCS C1713 654000100 - ROD SPNL 5.5MM 100MM NS CD HZN SOLERA TI PERC BOTH IP/OP "$3,425.00" "$2,535.00" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$1,370.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 N/A "$1,986.50" "$3,425.00" "$3,425.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 755308040 SUP HCPCS C1729 755308040 - CATHETER DRN 8FR 40CM STRL LF SKTR LCK PGTL RADOPQ BAND PU BOTH IP/OP $227.50 $168.00 $45.15 $227.50 $123.53 $123.53 $123.53 $123.53 $227.50 $227.50 $227.50 $47.42 $227.50 $168.85 $168.85 $175.36 $118.53 $47.41 $227.50 $227.50 $134.57 $227.50 $227.50 $227.50 $227.50 $170.63 $227.50 $227.50 $227.50 $113.75 $113.75 $180.18 $227.50 $182.00 $147.88 $45.15 N/A $131.95 $227.50 $227.50 $227.50 $47.41 $227.50 N/A N/A 755608035 SUP HCPCS C1729 755608035 - CATHETER NPHSTM PGTL CRV LOPRFL 8FR 35CM SKTR LCK KINK RST BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $128.96 $128.96 $128.96 $128.96 $237.50 $237.50 $237.50 $49.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 755610035 SUP HCPCS C1729 755610035 - CATHETER NPHSTM .038IN PGTL CRV 10FR 35CM SKTR LCK GW PU BIL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 756506020 SUP HCPCS C1729 756506020 - CATHETER DRN 6FR 20CM SKTR CHC LCK AP LOPRFL TROC STY BOTH IP/OP $240.00 $178.00 $47.63 $240.00 $130.32 $130.32 $130.32 $130.32 $240.00 $240.00 $240.00 $50.02 $240.00 $178.13 $178.13 $184.99 $125.04 $50.02 $240.00 $240.00 $141.96 $240.00 $240.00 $240.00 $240.00 $180.00 $240.00 $240.00 $240.00 $120.00 $120.00 $190.08 $240.00 $192.00 $156.00 $47.63 N/A $139.20 $240.00 $240.00 $240.00 $50.02 $240.00 N/A N/A 756510025 SUP HCPCS C1729 756510025 - CATHETER DRN PGTL CRV 10FR 25CM SKTR CHC LCK LCK TROC STY LG BOTH IP/OP $235.00 $174.00 $46.63 $234.95 $127.58 $127.58 $127.58 $127.58 $234.95 $234.95 $234.95 $48.97 $234.95 $174.38 $174.38 $181.10 $122.41 $48.97 $234.95 $234.95 $138.97 $234.95 $234.95 $234.95 $234.95 $176.25 $234.95 $234.95 $234.95 $117.48 $117.48 $186.08 $234.95 $187.96 $152.72 $46.63 N/A $136.30 $234.95 $234.95 $234.95 $48.96 $234.95 N/A N/A 756512025 SUP HCPCS C1729 756512025 - CATHETER DRN PGTL CRV 12FR 25CM SKTR CHC LCK LCK TROC STY LG BOTH IP/OP "$1,175.00" $870.00 $233.15 "$1,174.73" $637.88 $637.88 $637.88 $637.88 "$1,174.73" "$1,174.73" "$1,174.73" $244.84 "$1,174.73" $871.88 $871.88 $905.48 $612.03 $244.83 "$1,174.73" "$1,174.73" $694.85 "$1,174.73" "$1,174.73" "$1,174.73" "$1,174.73" $881.25 "$1,174.73" "$1,174.73" "$1,174.73" $587.37 $587.37 $930.39 "$1,174.73" $939.78 $763.57 $233.15 N/A $681.50 "$1,174.73" "$1,174.73" "$1,174.73" $244.81 "$1,174.73" N/A N/A 756514025 SUP HCPCS C1729 756514025 - CATHETER DRN PGTL CRV 14FR 25CM SKTR CHC LCK LCK TROC STY LG BOTH IP/OP "$1,135.00" $840.00 $225.27 "$1,135.00" $616.31 $616.31 $616.31 $616.31 "$1,135.00" "$1,135.00" "$1,135.00" $236.56 "$1,135.00" $842.40 $842.40 $874.86 $591.34 $236.55 "$1,135.00" "$1,135.00" $671.35 "$1,135.00" "$1,135.00" "$1,135.00" "$1,135.00" $851.25 "$1,135.00" "$1,135.00" "$1,135.00" $567.50 $567.50 $898.92 "$1,135.00" $908.00 $737.75 $225.27 N/A $658.30 "$1,135.00" "$1,135.00" "$1,135.00" $236.53 "$1,135.00" N/A N/A 771600010 SUP Custom 27203010 00771600010 - CARRIER GRAFT 16X4IN BOARD LATEX FREE MESHGRAFT BOTH IP/OP $127.00 $94.00 $22.58 $126.88 $126.88 $126.88 $126.88 $126.88 $126.88 $126.88 $22.58 $126.88 $126.88 $94.17 $94.17 $97.80 $66.10 $26.44 $126.88 $50.75 $126.88 $126.88 $126.88 $126.88 $126.88 $95.25 $126.88 $126.88 $126.88 $63.44 $63.44 $100.49 $126.88 $101.50 $82.47 $126.88 N/A $73.66 $126.88 $76.13 $126.88 $126.88 $126.88 N/A N/A 778114545 SUP Custom 27803010 778114545 - CONNECTOR ROD CL4.5 OP4.5 CURVE AXIAL DOMINO TITANIUM SPN BOTH IP/OP "$2,346.50" "$1,736.00" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $938.44 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" "$2,346.10" N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 778114555 SUP Custom 27803010 778114555 - CONNECTOR ROD CL4.5 OP5.5 CURVE AXIAL DOMINO TITANIUM SPN BOTH IP/OP "$2,118.50" "$1,568.00" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $441.51 "$2,118.45" $847.38 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$1,588.88" "$2,118.45" "$2,118.45" "$2,118.45" "$1,059.23" "$1,059.23" "$1,677.81" "$2,118.45" "$1,694.76" $953.30 "$2,118.45" N/A "$1,228.73" "$2,118.45" "$1,271.07" "$2,118.45" "$2,118.45" "$2,118.45" N/A N/A 778114565 SUP Custom 27803010 778114565 - CONNECTOR ROD CL4.5 OP6.35 CURVE AXIAL DOMINO TITANIUM SPN BOTH IP/OP "$2,118.50" "$1,568.00" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $441.51 "$2,118.45" $847.38 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$1,588.88" "$2,118.45" "$2,118.45" "$2,118.45" "$1,059.23" "$1,059.23" "$1,677.81" "$2,118.45" "$1,694.76" $953.30 "$2,118.45" N/A "$1,228.73" "$2,118.45" "$1,271.07" "$2,118.45" "$2,118.45" "$2,118.45" N/A N/A 778115545 SUP Custom 27803010 778115545 - CONNECTOR ROD CL5.5 OP4.5 CURVE AXIAL DOMINO TITANIUM SPN BOTH IP/OP "$2,346.50" "$1,736.00" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $938.44 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" "$2,346.10" N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 778115555 SUP Custom 27803010 778115555 - CONNECTOR ROD 5.5MM AXIAL CLOSE TO OPEN TITANIUM SPN BOTH IP/OP "$2,346.50" "$1,736.00" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $938.44 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" "$2,346.10" N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 778115565 SUP Custom 27803010 778115565 - CONNECTOR ROD CL5.5 OP6.35 CURVE AXIAL DOMINO TITANIUM SPN BOTH IP/OP "$2,118.50" "$1,568.00" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $441.51 "$2,118.45" $847.38 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$1,588.88" "$2,118.45" "$2,118.45" "$2,118.45" "$1,059.23" "$1,059.23" "$1,677.81" "$2,118.45" "$1,694.76" $953.30 "$2,118.45" N/A "$1,228.73" "$2,118.45" "$1,271.07" "$2,118.45" "$2,118.45" "$2,118.45" N/A N/A 778116545 SUP Custom 27803010 778116545 - CONNECTOR ROD CL6.35 OP4.5 CURVE AXIAL DOMINO TITANIUM SPN BOTH IP/OP "$2,346.50" "$1,736.00" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $938.44 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" "$2,346.10" N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 778116555 SUP Custom 27803010 778116555 - CONNECTOR ROD CL6.35 OP5.5 CURVE AXIAL DOMINO TITANIUM SPN BOTH IP/OP "$2,346.50" "$1,736.00" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $938.44 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" "$2,346.10" N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 778116565 SUP Custom 27803010 778116565 - CONNECTOR ROD CL6.35 OP6.35 CURVE AXIAL DOMINO TITANIUM SPN BOTH IP/OP "$2,346.50" "$1,736.00" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $938.44 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" "$2,346.10" N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 778124545 SUP Custom 27803010 778124545 - CONNECTOR ROD CL4.5 CURVE DOMINO TITANIUM SPN BOTH IP/OP "$2,574.00" "$1,905.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $536.45 "$2,574.00" "$1,029.60" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,158.30" "$2,574.00" N/A "$1,492.92" "$2,574.00" "$1,544.40" "$2,574.00" "$2,574.00" "$2,574.00" N/A N/A 778124555 SUP Custom 27803010 778124555 - CONNECTOR ROD CL4.5 CL5.5 CURVE DOMINO TITANIUM SPN BOTH IP/OP "$2,574.00" "$1,905.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $536.45 "$2,574.00" "$1,029.60" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,158.30" "$2,574.00" N/A "$1,492.92" "$2,574.00" "$1,544.40" "$2,574.00" "$2,574.00" "$2,574.00" N/A N/A 778124565 SUP Custom 27803010 778124565 - CONNECTOR ROD CL4.5 CL6.35 CURVE DOMINO TITANIUM BOTH IP/OP "$2,053.00" "$1,519.00" $365.39 "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" $365.39 "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" $427.82 "$2,052.75" $821.10 "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$1,539.75" "$2,052.75" "$2,052.75" "$2,052.75" "$1,026.38" "$1,026.38" "$1,625.78" "$2,052.75" "$1,642.20" $923.74 "$2,052.75" N/A "$1,190.74" "$2,052.75" "$1,231.65" "$2,052.75" "$2,052.75" "$2,052.75" N/A N/A 778125555 SUP Custom 27803010 778125555 - CONNECTOR ROD CL5.5 CURVE DOMINO TITANIUM BOTH IP/OP "$2,574.00" "$1,905.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $536.45 "$2,574.00" "$1,029.60" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,158.30" "$2,574.00" N/A "$1,492.92" "$2,574.00" "$1,544.40" "$2,574.00" "$2,574.00" "$2,574.00" N/A N/A 778125565 SUP Custom 27803010 778125565 - CONNECTOR ROD CL5.5 CL6.35 CURVE DOMINO TITANIUM SPN BOTH IP/OP "$2,574.00" "$1,905.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $536.45 "$2,574.00" "$1,029.60" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,158.30" "$2,574.00" N/A "$1,492.92" "$2,574.00" "$1,544.40" "$2,574.00" "$2,574.00" "$2,574.00" N/A N/A 778126565 SUP Custom 27803010 778126565 - CONNECTOR ROD CL6.35 CURVE CLOSE DOMINO TITANIUM SPN BOTH IP/OP "$2,574.00" "$1,905.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $536.45 "$2,574.00" "$1,029.60" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,158.30" "$2,574.00" N/A "$1,492.92" "$2,574.00" "$1,544.40" "$2,574.00" "$2,574.00" "$2,574.00" N/A N/A 778144545 SUP Custom 27803010 778144545 - CONNECTOR ROD SD4.5 CURVE CL4.5 CURVE SOLID DOMINO TITANIUM BOTH IP/OP "$2,176.00" "$1,610.00" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $453.49 "$2,175.95" $870.38 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$1,632.00" "$2,175.95" "$2,175.95" "$2,175.95" "$1,087.98" "$1,087.98" "$1,723.35" "$2,175.95" "$1,740.76" $979.18 "$2,175.95" N/A "$1,262.08" "$2,175.95" "$1,305.57" "$2,175.95" "$2,175.95" "$2,175.95" N/A N/A 778144565 SUP Custom 27803010 778144565 - CONNECTOR ROD SD4.5 CL6.35 CURVE SOLID LENGTHENED TITANIUM BOTH IP/OP "$1,982.00" "$1,467.00" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $413.04 "$1,981.85" $792.74 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,486.50" "$1,981.85" "$1,981.85" "$1,981.85" $990.93 $990.93 "$1,569.63" "$1,981.85" "$1,585.48" $891.83 "$1,981.85" N/A "$1,149.56" "$1,981.85" "$1,189.11" "$1,981.85" "$1,981.85" "$1,981.85" N/A N/A 778145545 SUP Custom 27803010 778145545 - CONNECTOR ROD SD5.5 CURVE CL4.5 CURVE SOLID DOMINO TITANIUM BOTH IP/OP "$2,176.00" "$1,610.00" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $453.49 "$2,175.95" $870.38 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$1,632.00" "$2,175.95" "$2,175.95" "$2,175.95" "$1,087.98" "$1,087.98" "$1,723.35" "$2,175.95" "$1,740.76" $979.18 "$2,175.95" N/A "$1,262.08" "$2,175.95" "$1,305.57" "$2,175.95" "$2,175.95" "$2,175.95" N/A N/A 778145555 SUP Custom 27803010 778145555 - CONNECTOR ROD 5.5MM SIDE LOADING DOMINO BOTH IP/OP "$2,176.00" "$1,610.00" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $453.49 "$2,175.95" $870.38 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$1,632.00" "$2,175.95" "$2,175.95" "$2,175.95" "$1,087.98" "$1,087.98" "$1,723.35" "$2,175.95" "$1,740.76" $979.18 "$2,175.95" N/A "$1,262.08" "$2,175.95" "$1,305.57" "$2,175.95" "$2,175.95" "$2,175.95" N/A N/A 778145565 SUP Custom 27803010 778145565 - CONNECTOR ROD SD5.5 CL6.35 CURVE SOLID LENGTHENED TITANIUM BOTH IP/OP "$1,982.00" "$1,467.00" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $413.04 "$1,981.85" $792.74 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,486.50" "$1,981.85" "$1,981.85" "$1,981.85" $990.93 $990.93 "$1,569.63" "$1,981.85" "$1,585.48" $891.83 "$1,981.85" N/A "$1,149.56" "$1,981.85" "$1,189.11" "$1,981.85" "$1,981.85" "$1,981.85" N/A N/A 778146545 SUP Custom 27803010 778146545 - CONNECTOR ROD SD6.35 CL5.5 CURVE SOLID LENGTHENED TITANIUM BOTH IP/OP "$2,574.00" "$1,905.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $536.45 "$2,574.00" "$1,029.60" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,158.30" "$2,574.00" N/A "$1,492.92" "$2,574.00" "$1,544.40" "$2,574.00" "$2,574.00" "$2,574.00" N/A N/A 778146555 SUP Custom 27803010 778146555 - CONNECTOR ROD CL5.5 CURVE SD6.35 CURVE LENGTHENED SOLID BOTH IP/OP "$2,574.00" "$1,905.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $536.45 "$2,574.00" "$1,029.60" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,158.30" "$2,574.00" N/A "$1,492.92" "$2,574.00" "$1,544.40" "$2,574.00" "$2,574.00" "$2,574.00" N/A N/A 778146565 SUP Custom 27803010 778146565 - CONNECTOR ROD 6.5MM DOMINO TITANIUM SPN LATERAL BOTH IP/OP "$2,176.00" "$1,610.00" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $453.49 "$2,175.95" $870.38 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$1,632.00" "$2,175.95" "$2,175.95" "$2,175.95" "$1,087.98" "$1,087.98" "$1,723.35" "$2,175.95" "$1,740.76" $979.18 "$2,175.95" N/A "$1,262.08" "$2,175.95" "$1,305.57" "$2,175.95" "$2,175.95" "$2,175.95" N/A N/A 778161045 SUP HCPCS C1713 778161045 - ROD SPINAL 4.5MM 100MM SAGITTAL TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 778161065 SUP HCPCS C1713 778161065 - ROD SPINAL 6.35MM 100MM SAGITTAL TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 778162045 SUP HCPCS C1713 778162045 - ROD SPINAL 4.5MM 200MM SAGITTAL TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 778162055 SUP HCPCS C1713 778162055 - ROD SPINAL 5.5MM 200MM SAGITTAL TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 778162065 SUP HCPCS C1713 778162065 - ROD SPINAL 6.35MM 200MM SAGITTAL TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 778164045 SUP HCPCS C1713 778164045 - ROD SPINAL 4.5MM 40MM SAGITTAL TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 778164065 SUP HCPCS C1713 778164065 - ROD SPINAL 6.35MM 40MM SAGITTAL TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 778167045 SUP HCPCS C1713 778167045 - ROD SPINAL 4.5MM 70MM SAGITTAL TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 778167055 SUP HCPCS C1713 778167055 - ROD SPINAL 5.5MM 70MM SAGITTAL TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 778167065 SUP HCPCS C1713 778167065 - ROD SPINAL 6.35MM 70MM SAGITTAL TITANIUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 778170001 SUP HCPCS C1713 778170001 - SCREW SET STANDARD 32 THREAD .25IN TITANIUM SPN T30 BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 778214545 SUP Custom 27803010 778214545 - CONNECTOR ROD CL4.5 CURVE OP4.5 CURVE AXIAL DOMINO STAINLESS BOTH IP/OP "$2,118.50" "$1,568.00" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $441.51 "$2,118.45" $847.38 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$1,588.88" "$2,118.45" "$2,118.45" "$2,118.45" "$1,059.23" "$1,059.23" "$1,677.81" "$2,118.45" "$1,694.76" $953.30 "$2,118.45" N/A "$1,228.73" "$2,118.45" "$1,271.07" "$2,118.45" "$2,118.45" "$2,118.45" N/A N/A 778214555 SUP Custom 27803010 778214555 - CONNECTOR ROD CL4.5 OP5.5 CURVE AXIAL STAINLESS STEEL BOTH IP/OP "$2,346.50" "$1,736.00" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $938.44 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" "$2,346.10" N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 778214565 SUP Custom 27803010 778214565 - CONNECTOR ROD CL4.5 OP6.35 CURVE AXIAL STAINLESS STEEL BOTH IP/OP "$2,346.50" "$1,736.00" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $938.44 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" "$2,346.10" N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 778215545 SUP Custom 27803010 778215545 - CONNECTOR ROD CL5.5 CURVE OP4.5 CURVE AXIAL DOMINO STAINLESS BOTH IP/OP "$2,118.50" "$1,568.00" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $441.51 "$2,118.45" $847.38 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$1,588.88" "$2,118.45" "$2,118.45" "$2,118.45" "$1,059.23" "$1,059.23" "$1,677.81" "$2,118.45" "$1,694.76" $953.30 "$2,118.45" N/A "$1,228.73" "$2,118.45" "$1,271.07" "$2,118.45" "$2,118.45" "$2,118.45" N/A N/A 778215555 SUP Custom 27803010 778215555 - CONNECTOR ROD CL5.5 CURVE OP5.5 CURVE AXIAL STAINLESS STEEL BOTH IP/OP "$2,118.50" "$1,568.00" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $441.51 "$2,118.45" $847.38 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$1,588.88" "$2,118.45" "$2,118.45" "$2,118.45" "$1,059.23" "$1,059.23" "$1,677.81" "$2,118.45" "$1,694.76" $953.30 "$2,118.45" N/A "$1,228.73" "$2,118.45" "$1,271.07" "$2,118.45" "$2,118.45" "$2,118.45" N/A N/A 778215565 SUP Custom 27803010 778215565 - CONNECTOR ROD CL5.5 OP6.35 CURVE AXIAL STAINLESS STEEL BOTH IP/OP "$2,346.50" "$1,736.00" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $938.44 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" "$2,346.10" N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 778216545 SUP Custom 27803010 778216545 - CONNECTOR ROD CL6.35 OP4.5 CURVE AXIAL STAINLESS STEEL BOTH IP/OP "$2,118.50" "$1,568.00" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $441.51 "$2,118.45" $847.38 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$1,588.88" "$2,118.45" "$2,118.45" "$2,118.45" "$1,059.23" "$1,059.23" "$1,677.81" "$2,118.45" "$1,694.76" $953.30 "$2,118.45" N/A "$1,228.73" "$2,118.45" "$1,271.07" "$2,118.45" "$2,118.45" "$2,118.45" N/A N/A 778216555 SUP Custom 27803010 778216555 - CONNECTOR ROD CL6.35 CURVE OP5.5 CURVE AXIAL DOMINO BOTH IP/OP "$2,118.50" "$1,568.00" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $441.51 "$2,118.45" $847.38 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$1,588.88" "$2,118.45" "$2,118.45" "$2,118.45" "$1,059.23" "$1,059.23" "$1,677.81" "$2,118.45" "$1,694.76" $953.30 "$2,118.45" N/A "$1,228.73" "$2,118.45" "$1,271.07" "$2,118.45" "$2,118.45" "$2,118.45" N/A N/A 778216565 SUP Custom 27803010 778216565 - CONNECTOR ROD CL6.35 CURVE OP6.35 CURVE AXIAL DOMINO BOTH IP/OP "$2,118.50" "$1,568.00" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $441.51 "$2,118.45" $847.38 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$1,588.88" "$2,118.45" "$2,118.45" "$2,118.45" "$1,059.23" "$1,059.23" "$1,677.81" "$2,118.45" "$1,694.76" $953.30 "$2,118.45" N/A "$1,228.73" "$2,118.45" "$1,271.07" "$2,118.45" "$2,118.45" "$2,118.45" N/A N/A 778224545 SUP Custom 27803010 778224545 - CONNECTOR ROD CL4.5 CURVE DOMINO STAINLESS STEEL SPN BOTH IP/OP "$1,969.50" "$1,457.00" $350.57 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" $350.57 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" $410.47 "$1,969.50" $787.80 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,477.13" "$1,969.50" "$1,969.50" "$1,969.50" $984.75 $984.75 "$1,559.84" "$1,969.50" "$1,575.60" $886.28 "$1,969.50" N/A "$1,142.31" "$1,969.50" "$1,181.70" "$1,969.50" "$1,969.50" "$1,969.50" N/A N/A 778224555 SUP Custom 27803010 778224555 - CONNECTOR ROD CL4.5 CURVE OP5.5 CURVE SOLID DOMINO STAINLESS BOTH IP/OP "$1,969.50" "$1,457.00" $350.57 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" $350.57 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" $410.47 "$1,969.50" $787.80 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,477.13" "$1,969.50" "$1,969.50" "$1,969.50" $984.75 $984.75 "$1,559.84" "$1,969.50" "$1,575.60" $886.28 "$1,969.50" N/A "$1,142.31" "$1,969.50" "$1,181.70" "$1,969.50" "$1,969.50" "$1,969.50" N/A N/A 778224565 SUP Custom 27803010 778224565 - CONNECTOR ROD CL4.5 CL6.35 CURVE DOMINO STAINLESS STEEL BOTH IP/OP "$2,252.00" "$1,666.00" $400.80 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" $400.80 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" $469.28 "$2,251.70" $900.68 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$1,689.00" "$2,251.70" "$2,251.70" "$2,251.70" "$1,125.85" "$1,125.85" "$1,783.35" "$2,251.70" "$1,801.36" "$1,013.27" "$2,251.70" N/A "$1,306.16" "$2,251.70" "$1,351.02" "$2,251.70" "$2,251.70" "$2,251.70" N/A N/A 778225555 SUP Custom 27803010 778225555 - CONNECTOR ROD CL5.5 CURVE 5.5/5.5MM CLOSE DOMINO STAINLESS BOTH IP/OP "$1,969.50" "$1,457.00" $350.57 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" $350.57 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" $410.47 "$1,969.50" $787.80 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,477.13" "$1,969.50" "$1,969.50" "$1,969.50" $984.75 $984.75 "$1,559.84" "$1,969.50" "$1,575.60" $886.28 "$1,969.50" N/A "$1,142.31" "$1,969.50" "$1,181.70" "$1,969.50" "$1,969.50" "$1,969.50" N/A N/A 778225565 SUP Custom 27803010 778225565 - CONNECTOR ROD CL5.5 CL6.35 CURVE CLOSE DOMINO STAINLESS BOTH IP/OP "$1,969.50" "$1,457.00" $350.57 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" $350.57 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" $410.47 "$1,969.50" $787.80 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,477.13" "$1,969.50" "$1,969.50" "$1,969.50" $984.75 $984.75 "$1,559.84" "$1,969.50" "$1,575.60" $886.28 "$1,969.50" N/A "$1,142.31" "$1,969.50" "$1,181.70" "$1,969.50" "$1,969.50" "$1,969.50" N/A N/A 778226565 SUP Custom 27803010 778226565 - CONNECTOR ROD CL6.35 CURVE DOMINO STAINLESS STEEL SPN BOTH IP/OP "$1,969.50" "$1,457.00" $350.57 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" $350.57 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" $410.47 "$1,969.50" $787.80 "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,969.50" "$1,477.13" "$1,969.50" "$1,969.50" "$1,969.50" $984.75 $984.75 "$1,559.84" "$1,969.50" "$1,575.60" $886.28 "$1,969.50" N/A "$1,142.31" "$1,969.50" "$1,181.70" "$1,969.50" "$1,969.50" "$1,969.50" N/A N/A 778244545 SUP Custom 27803010 778244545 - CONNECTOR ROD SD4.5 CURVE CL4.5 CURVE SOLID DOMINO STAINLESS BOTH IP/OP "$1,982.00" "$1,467.00" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $413.04 "$1,981.85" $792.74 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,486.50" "$1,981.85" "$1,981.85" "$1,981.85" $990.93 $990.93 "$1,569.63" "$1,981.85" "$1,585.48" $891.83 "$1,981.85" N/A "$1,149.56" "$1,981.85" "$1,189.11" "$1,981.85" "$1,981.85" "$1,981.85" N/A N/A 778244555 SUP Custom 27803010 778244555 - CONNECTOR ROD SD4.5 CL5.5 CURVE SOLID LENGTHENED STAINLESS BOTH IP/OP "$2,176.00" "$1,610.00" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $453.49 "$2,175.95" $870.38 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$1,632.00" "$2,175.95" "$2,175.95" "$2,175.95" "$1,087.98" "$1,087.98" "$1,723.35" "$2,175.95" "$1,740.76" $979.18 "$2,175.95" N/A "$1,262.08" "$2,175.95" "$1,305.57" "$2,175.95" "$2,175.95" "$2,175.95" N/A N/A 778244565 SUP Custom 27803010 778244565 - CONNECTOR ROD SD4.5 CL6.35 CURVE SOLID LENGTHENED STAINLESS BOTH IP/OP "$2,176.00" "$1,610.00" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $453.49 "$2,175.95" $870.38 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$1,632.00" "$2,175.95" "$2,175.95" "$2,175.95" "$1,087.98" "$1,087.98" "$1,723.35" "$2,175.95" "$1,740.76" $979.18 "$2,175.95" N/A "$1,262.08" "$2,175.95" "$1,305.57" "$2,175.95" "$2,175.95" "$2,175.95" N/A N/A 778245545 SUP Custom 27803010 778245545 - CONNECTOR ROD SD5.5 CURVE CL4.5 CURVE SOLID DOMINO STAINLESS BOTH IP/OP "$1,982.00" "$1,467.00" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $413.04 "$1,981.85" $792.74 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,486.50" "$1,981.85" "$1,981.85" "$1,981.85" $990.93 $990.93 "$1,569.63" "$1,981.85" "$1,585.48" $891.83 "$1,981.85" N/A "$1,149.56" "$1,981.85" "$1,189.11" "$1,981.85" "$1,981.85" "$1,981.85" N/A N/A 778245555 SUP Custom 27803010 778245555 - CONNECTOR ROD SD5.5 CURVE CL5.5 CURVE SOLID STAINLESS STEEL BOTH IP/OP "$1,982.00" "$1,467.00" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $413.04 "$1,981.85" $792.74 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,486.50" "$1,981.85" "$1,981.85" "$1,981.85" $990.93 $990.93 "$1,569.63" "$1,981.85" "$1,585.48" $891.83 "$1,981.85" N/A "$1,149.56" "$1,981.85" "$1,189.11" "$1,981.85" "$1,981.85" "$1,981.85" N/A N/A 778245565 SUP Custom 27803010 778245565 - CONNECTOR ROD SD5.5 CURVE SOLID LENGTHENED STAINLESS STEEL BOTH IP/OP "$2,176.00" "$1,610.00" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $387.32 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" $453.49 "$2,175.95" $870.38 "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$2,175.95" "$1,632.00" "$2,175.95" "$2,175.95" "$2,175.95" "$1,087.98" "$1,087.98" "$1,723.35" "$2,175.95" "$1,740.76" $979.18 "$2,175.95" N/A "$1,262.08" "$2,175.95" "$1,305.57" "$2,175.95" "$2,175.95" "$2,175.95" N/A N/A 778246545 SUP Custom 27803010 778246545 - CONNECTOR ROD SD6.35 CURVE SOLID LENGTHENED STAINLESS STEEL BOTH IP/OP "$2,053.00" "$1,519.00" $365.39 "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" $365.39 "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" $427.82 "$2,052.75" $821.10 "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$1,539.75" "$2,052.75" "$2,052.75" "$2,052.75" "$1,026.38" "$1,026.38" "$1,625.78" "$2,052.75" "$1,642.20" $923.74 "$2,052.75" N/A "$1,190.74" "$2,052.75" "$1,231.65" "$2,052.75" "$2,052.75" "$2,052.75" N/A N/A 778246555 SUP Custom 27803010 778246555 - CONNECTOR ROD CL5.5 CURVE SD6.35 CURVE SOLID OPEN STAINLESS BOTH IP/OP "$2,053.00" "$1,519.00" $365.39 "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" $365.39 "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" $427.82 "$2,052.75" $821.10 "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$1,539.75" "$2,052.75" "$2,052.75" "$2,052.75" "$1,026.38" "$1,026.38" "$1,625.78" "$2,052.75" "$1,642.20" $923.74 "$2,052.75" N/A "$1,190.74" "$2,052.75" "$1,231.65" "$2,052.75" "$2,052.75" "$2,052.75" N/A N/A 778246565 SUP Custom 27803010 778246565 - CONNECTOR ROD SD6.35 CURVE CL6.35 CURVE CLOSE DOMINO BOTH IP/OP "$1,982.00" "$1,467.00" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $352.77 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" $413.04 "$1,981.85" $792.74 "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,981.85" "$1,486.50" "$1,981.85" "$1,981.85" "$1,981.85" $990.93 $990.93 "$1,569.63" "$1,981.85" "$1,585.48" $891.83 "$1,981.85" N/A "$1,149.56" "$1,981.85" "$1,189.11" "$1,981.85" "$1,981.85" "$1,981.85" N/A N/A 778261045 SUP HCPCS C1713 778261045 - ROD SPINAL 45.5MM 100MM SAGITTAL STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 778261055 SUP HCPCS C1713 778261055 - ROD SPINAL 5.5MM 100MM SAGITTAL STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 778261065 SUP HCPCS C1713 778261065 - ROD SPINAL 6.35MM 100MM SAGITTAL STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 778262045 SUP HCPCS C1713 778262045 - ROD SPINAL 4.5MM 200MM SAGITTAL STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 778262055 SUP HCPCS C1713 778262055 - ROD SPINAL 5.5MM 200MM SAGITTAL STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 778262065 SUP HCPCS C1713 778262065 - ROD SPINAL 6.35MM 200MM SAGITTAL STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 778264045 SUP HCPCS C1713 778264045 - ROD SPINAL 4.5MM 40MM SAGITTAL STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 778264055 SUP HCPCS C1713 778264055 - ROD SPINAL 5.5MM 40MM SAGITTAL STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 778264065 SUP HCPCS C1713 778264065 - ROD SPINAL 6.35MM 40MM SAGITTAL STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 778267045 SUP HCPCS C1713 778267045 - ROD SPINAL 4.5MM 70MM SAGITTAL STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 778267055 SUP HCPCS C1713 778267055 - ROD SPINAL 5.5MM 70MM SAGITTAL STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $750.00 $750.00 N/A N/A 778267065 SUP HCPCS C1713 778267065 - ROD SPINAL 6.35MM 70MM SAGITTAL STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 778270001 SUP HCPCS C1713 778270001 - SCREW SET 32 THREAD STANDARD .25IN BREAK OFF STAINLESS STEEL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 779115545 SUP Custom 27803010 779115545 - CONNECTOR ROD OP4.5 CL5.5 CURVE AXIAL LATEX FREE DOMINO BOTH IP/OP "$2,346.50" "$1,736.00" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $938.44 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" "$2,346.10" N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 779115555 SUP Custom 27803010 779115555 - CONNECTOR ROD CL5.5 OP5.5 CURVE AXIAL DOMINO TITANIUM SPN BOTH IP/OP "$2,346.50" "$1,736.00" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $938.44 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" "$2,346.10" N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 779115565 SUP Custom 27803010 779115565 - CONNECTOR ROD CL5.5 OP6.35 CURVE AXIAL CD HORIZON TITANIUM BOTH IP/OP "$2,574.00" "$1,905.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $458.17 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $536.45 "$2,574.00" "$1,029.60" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,158.30" "$2,574.00" N/A "$1,492.92" "$2,574.00" "$1,544.40" "$2,574.00" "$2,574.00" "$2,574.00" N/A N/A 779124555 SUP Custom 27803010 779124555 - CONNECTOR ROD CL4.5 CURVE CL5.5 CURVE DOMINO TITANIUM SPN BOTH IP/OP "$2,252.00" "$1,666.00" $400.80 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" $400.80 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" $469.28 "$2,251.70" $900.68 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$1,689.00" "$2,251.70" "$2,251.70" "$2,251.70" "$1,125.85" "$1,125.85" "$1,783.35" "$2,251.70" "$1,801.36" "$1,013.27" "$2,251.70" N/A "$1,306.16" "$2,251.70" "$1,351.02" "$2,251.70" "$2,251.70" "$2,251.70" N/A N/A 779125555 SUP Custom 27803010 779125555 - CONNECTOR ROD CL5.5 CURVE CLOSE DOMINO TITANIUM SPN BOTH IP/OP "$2,252.00" "$1,666.00" $400.80 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" $400.80 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" $469.28 "$2,251.70" $900.68 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$1,689.00" "$2,251.70" "$2,251.70" "$2,251.70" "$1,125.85" "$1,125.85" "$1,783.35" "$2,251.70" "$1,801.36" "$1,013.27" "$2,251.70" N/A "$1,306.16" "$2,251.70" "$1,351.02" "$2,251.70" "$2,251.70" "$2,251.70" N/A N/A 779125565 SUP Custom 27803010 779125565 - CONNECTOR ROD CL5.5 CURVE CL6.35 CURVE DOMINO TITANIUM SPN BOTH IP/OP "$2,252.00" "$1,666.00" $400.80 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" $400.80 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" $469.28 "$2,251.70" $900.68 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$1,689.00" "$2,251.70" "$2,251.70" "$2,251.70" "$1,125.85" "$1,125.85" "$1,783.35" "$2,251.70" "$1,801.36" "$1,013.27" "$2,251.70" N/A "$1,306.16" "$2,251.70" "$1,351.02" "$2,251.70" "$2,251.70" "$2,251.70" N/A N/A 779144555 SUP Custom 27803010 779144555 - CONNECTOR ROD CL5.5 SD4.5 CURVE OPEN CLOSE SOLID DOMINO BOTH IP/OP "$2,252.00" "$1,666.00" $400.80 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" $400.80 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" $469.28 "$2,251.70" $900.68 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$1,689.00" "$2,251.70" "$2,251.70" "$2,251.70" "$1,125.85" "$1,125.85" "$1,783.35" "$2,251.70" "$1,801.36" "$1,013.27" "$2,251.70" N/A "$1,306.16" "$2,251.70" "$1,351.02" "$2,251.70" "$2,251.70" "$2,251.70" N/A N/A 779145555 SUP Custom 27803010 779145555 - CONNECTOR ROD SD5.5 CURVE SOLID DOMINO TITANIUM SPN BOTH IP/OP "$2,252.00" "$1,666.00" $400.80 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" $400.80 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" $469.28 "$2,251.70" $900.68 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$1,689.00" "$2,251.70" "$2,251.70" "$2,251.70" "$1,125.85" "$1,125.85" "$1,783.35" "$2,251.70" "$1,801.36" "$1,013.27" "$2,251.70" N/A "$1,306.16" "$2,251.70" "$1,351.02" "$2,251.70" "$2,251.70" "$2,251.70" N/A N/A 779146555 SUP Custom 27803010 779146555 - CONNECTOR ROD CL5.5 SD6.35 CURVE OPEN CLOSE SOLID DOMINO BOTH IP/OP "$2,252.00" "$1,666.00" $400.80 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" $400.80 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" $469.28 "$2,251.70" $900.68 "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$2,251.70" "$1,689.00" "$2,251.70" "$2,251.70" "$2,251.70" "$1,125.85" "$1,125.85" "$1,783.35" "$2,251.70" "$1,801.36" "$1,013.27" "$2,251.70" N/A "$1,306.16" "$2,251.70" "$1,351.02" "$2,251.70" "$2,251.70" "$2,251.70" N/A N/A 779170005 SUP HCPCS C1713 779170005 - SCREW SET STANDARD 32 THREAD .25IN CAP SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 880000010 SUP Custom 27203010 00880000010 - BLADE DERMATOME 1.25-4.25IN STERILE BOTH IP/OP $134.00 $99.00 $23.80 $140.38 $133.69 $133.69 $133.69 $133.69 $133.69 $133.69 $23.80 $133.69 $133.69 $99.22 $99.22 $103.05 $69.65 $27.86 $133.69 $56.15 $133.69 $133.69 $140.38 $133.69 $133.69 $100.50 $133.69 $133.69 $133.69 $66.85 $66.85 $105.88 $133.69 $106.95 $86.90 $133.69 N/A $77.72 $133.69 $80.21 $133.69 $133.69 $133.69 N/A N/A 998604014 SUP HCPCS C1776 998604014 - SET TOT JOINT 11MM 8IN TREPHINE MRI NONSTRL BOTH IP/OP "$2,037.50" "$1,508.00" $404.39 "$2,037.50" $916.88 $916.88 $916.88 $916.88 "$2,037.50" "$2,037.50" "$2,037.50" $424.67 "$2,037.50" "$2,037.50" "$2,037.50" "$2,037.50" "$2,037.50" $424.64 "$2,037.50" $815.00 "$1,205.18" "$2,037.50" "$2,037.50" "$2,037.50" "$2,037.50" "$1,528.13" "$2,037.50" "$2,037.50" "$2,037.50" "$1,018.75" "$1,018.75" "$1,613.70" "$2,037.50" "$1,630.00" $916.88 $404.39 N/A "$1,181.75" "$2,037.50" "$2,037.50" "$2,037.50" $424.62 "$2,037.50" N/A N/A 1474000500 SUP HCPCS C1713 1474000500 - ROD SPINAL STR 4.75MM 500MM TITANIUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475000500 SUP HCPCS C1713 1475000500 - ROD SPINAL STR 4.75MM 500MM SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475001030 SUP HCPCS C1713 1475001030 - ROD SPINAL CURVE PREBENT 4.75MM 30MM SOLERA CD HORIZON COCR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475001035 SUP HCPCS C1713 1475001035 - ROD SPINAL CURVE 4.75MM 35MM PREBENT SOLERA CHROME NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475001040 SUP HCPCS C1713 1475001040 - ROD SPINAL CURVE PREBENT 4.75MM 40MM SOLERA CD HORIZON COCR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475001045 SUP HCPCS C1713 1475001045 - ROD SPINAL 4.75MM 45MM CVD SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475001050 SUP HCPCS C1713 1475001050 - ROD SPINAL CURVE PREBENT 4.75MM 50MM SOLERA CD HORIZON COCR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1475001055 SUP HCPCS C1713 1475001055 - ROD SPINAL 4.75MM 55MM CVD SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475001060 SUP HCPCS C1713 1475001060 - ROD SPINAL CURVE PREBENT 4.75MM 60MM SOLERA CD HORIZON COCR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1475001065 SUP HCPCS C1713 1475001065 - ROD SPINAL 4.75MM 65MM CVD SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1475001070 SUP HCPCS C1713 1475001070 - ROD SPINAL CURVE PREBENT 4.75MM 70MM SOLERA CD HORIZON COCR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1475001075 SUP HCPCS C1713 1475001075 - ROD SPINAL CURVE PREBENT 4.75MM 75MM SOLERA CD HORIZON COCR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475001080 SUP HCPCS C1713 1475001080 - ROD SPINAL CURVE PREBENT 4.75MM 80MM SOLERA CD HORIZON COCR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475001085 SUP HCPCS C1713 1475001085 - ROD SPINAL CURVE PREBENT 4.75MM 85MM SOLERA CD HORIZON COCR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475001090 SUP HCPCS C1713 1475001090 - ROD SPINAL CURVE PREBENT 4.75MM 90MM SOLERA CD HORIZON COCR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1475001100 SUP HCPCS C1713 1475001100 - ROD SPINAL CURVE PREBENT 4.75MM 100MM SOLERA CD HORIZON COCR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475001110 SUP HCPCS C1713 1475001110 - ROD SPNL CRV PREBNT 4.75MM 110MM NS SOLERA CD HZN CCM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475001120 SUP HCPCS C1713 1475001120 - ROD SPNL CRV 4.75MM 120MM NS SOLERA CD HZN COCR MLBDN BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475005040 SUP HCPCS C1713 1475005040 - ROD SPNL CRV 4.75MM 40MM NS SXTNT COCR MLBDN BOTH IP/OP "$2,820.00" "$2,087.00" $559.70 "$2,820.00" "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" "$2,820.00" "$2,820.00" "$2,820.00" $587.76 "$2,820.00" "$2,820.00" "$2,820.00" "$2,820.00" "$2,820.00" $587.72 "$2,820.00" "$1,128.00" "$1,390.26" "$2,820.00" "$2,820.00" "$2,820.00" "$2,820.00" "$2,115.00" "$2,820.00" "$2,820.00" "$2,820.00" "$1,410.00" "$1,410.00" "$2,233.44" "$2,820.00" "$2,256.00" "$1,269.00" $559.70 N/A "$1,635.60" "$2,820.00" "$1,692.00" "$2,820.00" $587.69 "$2,820.00" N/A N/A 1475005050 SUP HCPCS C1713 1475005050 - ROD SPINAL CURVE 4.75MM 50MM SEXTANT COCR BOTH IP/OP "$2,820.00" "$2,087.00" $559.70 "$2,820.00" "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" "$2,820.00" "$2,820.00" "$2,820.00" $587.76 "$2,820.00" "$2,820.00" "$2,820.00" "$2,820.00" "$2,820.00" $587.72 "$2,820.00" "$1,128.00" "$1,390.26" "$2,820.00" "$2,820.00" "$2,820.00" "$2,820.00" "$2,115.00" "$2,820.00" "$2,820.00" "$2,820.00" "$1,410.00" "$1,410.00" "$2,233.44" "$2,820.00" "$2,256.00" "$1,269.00" $559.70 N/A "$1,635.60" "$2,820.00" "$1,692.00" "$2,820.00" $587.69 "$2,820.00" N/A N/A 1475200500 SUP HCPCS C1713 1475200500 - ROD SPINAL STR 4.75MM 500MM LINE COCR MOLYBDENUM BOTH IP/OP "$2,125.50" "$1,573.00" $421.86 "$2,125.50" $956.48 $956.48 $956.48 $956.48 "$2,125.50" "$2,125.50" "$2,125.50" $443.01 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$1,257.23" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 $421.86 N/A "$1,232.79" "$2,125.50" "$2,125.50" "$2,125.50" $442.95 "$2,125.50" N/A N/A 1475501030 SUP HCPCS C1713 1475501030 - ROD SPINAL CURVE 4.75MM 30MM SOLERA MOLYBDENUM COCR NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1475501035 SUP HCPCS C1713 1475501035 - ROD SPINAL CURVE 4.75MM 35MM SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475501040 SUP HCPCS C1713 1475501040 - ROD SPINAL STR 4.75MM 40MM SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475501045 SUP HCPCS C1713 1475501045 - ROD SPINAL 4.75MM 45MM CVD SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1475501050 SUP HCPCS C1713 1475501050 - ROD SPINAL CURVE 4.75MM 50MM SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475501055 SUP HCPCS C1713 1475501055 - ROD SPINAL CURVE 4.75MM 55MM SOLERA CD HORIZON COCRMO BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475501060 SUP HCPCS C1713 1475501060 - ROD SPINAL CURVE 4.75MM 60MM SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475501065 SUP HCPCS C1713 1475501065 - ROD SPINAL CURVE 4.75MM 65MM SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475501070 SUP HCPCS C1713 1475501070 - ROD SPINAL 4.75MM 70MM CVD SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475501075 SUP HCPCS C1713 1475501075 - ROD SPINAL CURVE 4.75MM 75MM SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475501080 SUP HCPCS C1713 1475501080 - ROD SPINAL 4.75MM 80MM CVD SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $750.00 $750.00 N/A N/A 1475501085 SUP HCPCS C1713 1475501085 - ROD SPINAL CURVE 4.75MM 85MM SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1475501090 SUP HCPCS C1713 1475501090 - ROD SPINAL CURVE 4.75MM 90MM SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475501095 SUP HCPCS C1713 1475501095 - ROD SPINAL 4.75MM 95MM CVD SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1475501100 SUP HCPCS C1713 1475501100 - ROD SPINAL CURVE 4.75MM 100MM SOLERA CD HORIZON COCRMO BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $750.00 $750.00 N/A N/A 1475501105 SUP HCPCS C1713 1475501105 - ROD SPINAL 4.75MM 105MM CVD SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $750.00 $750.00 N/A N/A 1475501110 SUP HCPCS C1713 1475501110 - ROD SPINAL CURVE 4.75MM 110MM SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475501115 SUP HCPCS C1713 1475501115 - ROD SPINAL 4.75MM 115MM CVD SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1475501120 SUP HCPCS C1713 1475501120 - ROD SPINAL CURVE 4.75MM 120MM SOLERA COCR MOLYBDENUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1476000500 SUP HCPCS C1713 1476000500 - ROD SPINAL STR 4.75MM 500MM CD HORIZON COCRMO POSTERIOR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1476006040 SUP HCPCS C1713 1476006040 - ROD SPNL 40MM 4.75MM LNGT II STR CCM PLUS PERC BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1476006070 SUP HCPCS C1713 1476006070 - ROD SPINAL STR 4.75MM 70MM CCM PLUS PERCUTANEOUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1476006080 SUP HCPCS C1713 1476006080 - ROD SPINAL STR 4.75MM 80MM CCM PLUS PERCUTANEOUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1476006090 SUP HCPCS C1713 1476006090 - ROD SPINAL STR 4.75MM 90MM CCM PLUS PERCUTANEOUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1476006100 SUP HCPCS C1713 1476006100 - ROD SPINAL STR 4.75MM 100MM CCM PLUS PERCUTANEOUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1476006110 SUP HCPCS C1713 1476006110 - ROD SPINAL STR 4.75MM 110MM COCR PERCUTANEOUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1476006120 SUP HCPCS C1713 1476006120 - ROD SPINAL STR 4.75MM 120MM CCM PLUS PERCUTANEOUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1476006130 SUP HCPCS C1713 1476006130 - ROD SPINAL STR 4.75MM 130MM CCM PLUS PERCUTANEOUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1476006140 SUP HCPCS C1713 1476006140 - ROD SPINAL STR 4.75MM 140MM CCM PLUS PERCUTANEOUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1476006150 SUP HCPCS C1713 1476006150 - ROD SPINAL STR 4.75MM 150MM CCM PLUS PERCUTANEOUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1476006160 SUP HCPCS C1713 1476006160 - ROD SPINAL STR 4.75MM 160MM CCM PLUS PERCUTANEOUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1476006170 SUP HCPCS C1713 1476006170 - ROD SPINAL STR 4.75MM 170MM SOLERA COCR MOLYBDENUM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1476006180 SUP HCPCS C1713 1476006180 - ROD SPINAL STR 4.75MM 180MM CCM PLUS PERCUTANEOUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1476006200 SUP HCPCS C1713 1476006200 - ROD SPINAL STR 4.75MM 200MM CCM PLUS PERCUTANEOUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1476006220 SUP HCPCS C1713 1476006220 - ROD SPNL STRG 4.75MM 220MM CCM + PERC BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1476200500 SUP HCPCS C1713 1476200500 - ROD SPINAL CURVE 5.5MM 500MM LINE CD HORIZON COBALT STERILE BOTH IP/OP "$2,125.50" "$1,573.00" $421.86 "$2,125.50" $956.48 $956.48 $956.48 $956.48 "$2,125.50" "$2,125.50" "$2,125.50" $443.01 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$1,257.23" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 $421.86 N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" $442.95 "$2,125.50" N/A N/A 1553200500 SUP HCPCS C1713 1553200500 - ROD SPINAL STR 5.5MM 500MM LINE TITANIUM NONSTRL CP4 BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1553201030 SUP HCPCS C1713 1553201030 - ROD SPINAL CURVE 5.5MM 30MM LINE TITANIUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1553201035 SUP HCPCS C1713 1553201035 - ROD SPINAL PREBENT CURVE 5.5MM 35MM TITANIUM NONSTRL CP4 BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1553201040 SUP HCPCS C1713 1553201040 - ROD SPINAL CURVE 5.5MM 40MM CD HORIZON TITANIUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1553201045 SUP HCPCS C1713 1553201045 - ROD SPINAL CURVE 5.5MM 45MM CD HORIZON TITANIUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1553201050 SUP HCPCS C1713 1553201050 - ROD SPINAL CURVE 5.5MM 50MM TITANIUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $750.00 $750.00 N/A N/A 1553201055 SUP HCPCS C1713 1553201055 - ROD SPINAL CURVE 5.5MM 55MM TITANIUM NONSTRL CP4 BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1553201060 SUP HCPCS C1713 1553201060 - ROD SPINAL CURVE 5.5MM 60MM TITANIUM NONSTRL CP4 BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1553201070 SUP HCPCS C1713 1553201070 - ROD SPINAL CURVE 5.5MM 70MM SOLERA TITANIUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1553201080 SUP HCPCS C1713 1553201080 - ROD SPINAL CURVE 5.5MM 80MM SOLERA TITANIUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1553201090 SUP HCPCS C1713 1553201090 - ROD SPINAL CURVE 5.5MM 90MM TITANIUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1553201100 SUP HCPCS C1713 1553201100 - ROD SPINAL CURVE 5.5MM 100MM TITANIUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1553201110 SUP HCPCS C1713 1553201110 - ROD SPINAL CURVE 5.5MM 110MM TITANIUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1553201120 SUP HCPCS C1713 1553201120 - ROD SPINAL CURVE 5.5MM 120MM TITANIUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1554200500 SUP HCPCS C1713 1554200500 - ROD SPINAL STR 5.5MM 500MM LINE CD HORIZON TITANIUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1555000500 SUP HCPCS C1713 1555000500 - ROD SPNL STRG 5.5MM 500MM NS CD HZN COCRMO BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1555006100 SUP HCPCS C1713 1555006100 - ROD SPINAL STR 5.5MM 100MM PRECUT CD HORIZON COCR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1555006110 SUP HCPCS C1713 1555006110 - ROD SPNL STRG 5.5MM 110MM CCM PERC BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1555006120 SUP HCPCS C1713 1555006120 - ROD SPINAL STR 5.5MM 120MM CCM PERCUTANEOUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1555006170 SUP HCPCS C1713 1555006170 - ROD SPINAL STR 5.5MM 170MM PRECUT CD HORIZON COCR BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1555501030 SUP HCPCS C1713 1555501030 - ROD SPINAL CURVE 5.5MM 30MM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1555501035 SUP HCPCS C1713 1555501035 - ROD SPINAL CURVE 5.5MM 35MM CD HORIZON COCRMO NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1555501040 SUP HCPCS C1713 1555501040 - ROD SPINAL CURVE 5.5MM 40MM CD HORIZON COCRMO NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1555501045 SUP HCPCS C1713 1555501045 - ROD SPINAL CURVE 5.5MM 45MM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1555501050 SUP HCPCS C1713 1555501050 - ROD SPINAL CURVE 5.5MM 50MM CD HORIZON CCM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1555501055 SUP HCPCS C1713 1555501055 - ROD SPINAL CURVE 5.5MM 55MM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1555501060 SUP HCPCS C1713 1555501060 - ROD SPINAL CURVE 5.5MM 60MM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1555501070 SUP HCPCS C1713 1555501070 - ROD SPINAL CURVE 5.5MM 70MM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1555501080 SUP HCPCS C1713 1555501080 - ROD SPINAL CURVE 5.5MM 80MM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1555501090 SUP HCPCS C1713 1555501090 - ROD SPINAL CURVE 5.5MM 90MM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1555501100 SUP HCPCS C1713 1555501100 - ROD SPINAL CURVE 5.5MM 100MM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1555501110 SUP HCPCS C1713 1555501110 - ROD SPINAL CURVE 5.5MM 110MM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1555501120 SUP HCPCS C1713 1555501120 - ROD SPINAL CURVE 5.5MM 120MM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1556000500 SUP HCPCS C1713 1556000500 - ROD SPINAL STR 5.5MM 500MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1556000600 SUP HCPCS C1713 1556000600 - ROD SPINAL STR 5.5MM 600MM COCR POSTERIOR LUMBAR NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1556001030 SUP HCPCS C1713 1556001030 - ROD SPINAL CURVE 5.5MM 30MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1556001035 SUP HCPCS C1713 1556001035 - ROD SPINAL CURVE 5.5MM 35MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1556001040 SUP HCPCS C1713 1556001040 - ROD SPINAL CURVE 5.5MM 40MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1556001045 SUP HCPCS C1713 1556001045 - ROD SPINAL CURVE 5.5MM 45MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1556001050 SUP HCPCS C1713 1556001050 - ROD SPINAL 5.5MM 50MM CVD CHROMALOY PLUS CHROMALLOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1556001055 SUP HCPCS C1713 1556001055 - ROD SPINAL CURVE 5.5MM 55MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1556001060 SUP HCPCS C1713 1556001060 - ROD SPINAL CURVE 5.5MM 60MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1556001065 SUP HCPCS C1713 1556001065 - ROD SPINAL CURVE 5.5MM 65MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1556001070 SUP HCPCS C1713 1556001070 - ROD SPINAL CURVE 5.5MM 70MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1556001075 SUP HCPCS C1713 1556001075 - ROD SPINAL CURVE 5.5MM 75MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1556001080 SUP HCPCS C1713 1556001080 - ROD SPINAL CURVE 5.5MM 80MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1556001085 SUP HCPCS C1713 1556001085 - ROD SPINAL CURVE 5.5MM 85MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1556001090 SUP HCPCS C1713 1556001090 - ROD SPINAL CURVE 5.5MM 90MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1556001095 SUP HCPCS C1713 1556001095 - ROD SPINAL CURVE 5.5MM 95MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 1556001100 SUP HCPCS C1713 1556001100 - ROD SPINAL CURVE 5.5MM 100MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1556001105 SUP HCPCS C1713 1556001105 - ROD SPINAL CURVE 5.5MM 105MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1556001110 SUP HCPCS C1713 1556001110 - ROD SPINAL CURVE 5.5MM 110MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1556001115 SUP HCPCS C1713 1556001115 - ROD SPINAL CURVE 5.5MM 115MM CHROMALOY PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1603200500 SUP HCPCS C1713 1603200500 - ROD SPINAL STR 6MM 500MM LINE CD HORIZON TITANIUM NONSTRL CP BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1604200500 SUP HCPCS C1713 1604200500 - ROD SPINAL STR 6MM 500MM LINE CD HORIZON TITANIUM NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1605000500 SUP HCPCS C1713 1605000500 - ROD SPINAL STR 6MM 500MM CD HORIZON COCR NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1606000500 SUP HCPCS C1713 1606000500 - ROD SPINAL STR 6MM 500MM PLUS CD HORIZON COCRMO NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1606000600 SUP HCPCS C1713 1606000600 - ROD SPINAL STR 6MM 600MM COCR POSTERIOR LUMBAR NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1606000700 SUP HCPCS C1713 1606000700 - ROD SPINAL STR 6MM 700MM COCR POSTERIOR LUMBAR NONSTRL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 1606200500 SUP HCPCS C1713 1606200500 - ROD SPINAL STR 6MM 500MM LINE RED CCM PLUS BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 1607002003 SUP Custom 27203010 1607002003 - BURR SURG BARREL EGG 6MM STERILE BOTH IP/OP $146.00 $108.00 $25.94 $145.75 $145.75 $145.75 $145.75 $145.75 $145.75 $145.75 $25.94 $145.75 $145.75 $108.18 $108.18 $112.34 $75.94 $30.38 $145.75 $58.30 $145.75 $145.75 $145.75 $145.75 $145.75 $109.50 $145.75 $145.75 $145.75 $72.88 $72.88 $115.43 $145.75 $116.60 $94.74 $145.75 N/A $84.68 $145.75 $87.45 $145.75 $145.75 $145.75 N/A N/A 1608002005 SUP Custom 27203010 1608002005 - BURR SURG 6.1MM 54MM 9.5MM PEAR HEAD STAINLESS STEEL STERILE BOTH IP/OP $146.00 $108.00 $25.94 $145.75 $145.75 $145.75 $145.75 $145.75 $145.75 $145.75 $25.94 $145.75 $145.75 $108.18 $108.18 $112.34 $75.94 $30.38 $145.75 $58.30 $145.75 $145.75 $145.75 $145.75 $145.75 $109.50 $145.75 $145.75 $145.75 $72.88 $72.88 $115.43 $145.75 $116.60 $94.74 $145.75 N/A $84.68 $145.75 $87.45 $145.75 $145.75 $145.75 N/A N/A 1705015006 SUP Custom 27203010 1705015006 - PATCH CV THK.6MM 15X5CM STRL GRTX BOTH IP/OP "$1,555.00" "$1,151.00" $276.79 "$1,555.00" "$1,555.00" "$1,555.00" "$1,555.00" "$1,555.00" "$1,555.00" "$1,555.00" $276.79 "$1,555.00" "$1,555.00" "$1,154.12" "$1,154.12" "$1,198.59" $810.16 $324.08 "$1,555.00" $622.00 "$1,555.00" "$1,555.00" "$1,555.00" "$1,555.00" "$1,555.00" "$1,166.25" "$1,555.00" "$1,555.00" "$1,555.00" $777.50 $777.50 "$1,231.56" "$1,555.00" "$1,244.00" "$1,010.75" "$1,555.00" N/A $901.90 "$1,555.00" $933.00 "$1,555.00" "$1,555.00" "$1,555.00" N/A N/A 2108107005 SUP Custom 27203010 2108107005 - BLADE SW 84X29X1.24MM SGTL HVDTY BOTH IP/OP $77.50 $57.00 $44.95 $58.13 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $58.13 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $44.95 N/A N/A N/A N/A N/A N/A N/A 3571129240 SUP HCPCS C1713 3571129240 - SCREW BN 4.5MM 40MM ST HEX HD HIP BOTH IP/OP $51.00 $38.00 $10.10 $50.88 $22.90 $22.90 $22.90 $22.90 $50.88 $50.88 $50.88 $10.60 $50.88 $50.88 $50.88 $50.88 $50.88 $10.60 $50.88 $20.35 $30.10 $50.88 $50.88 $50.88 $50.88 $38.25 $50.88 $50.88 $50.88 $25.44 $25.44 $40.30 $50.88 $40.70 $22.90 $10.10 N/A $29.58 $50.88 $50.88 $50.88 $10.60 $50.88 N/A N/A 3571140003 SUP HCPCS C1713 3571140003 - PLATE BN 45MM 3 HL RECON PLVC 4.5MM SCR BOTH IP/OP $798.00 $591.00 $158.38 $798.00 $359.10 $359.10 $359.10 $359.10 $798.00 $798.00 $798.00 $166.32 $798.00 $798.00 $798.00 $798.00 $798.00 $166.31 $798.00 $798.00 $472.02 $798.00 $798.00 $798.00 $798.00 $598.50 $798.00 $798.00 $798.00 $399.00 $399.00 $632.02 $798.00 $638.40 $359.10 $158.38 N/A $462.84 $798.00 $478.80 $798.00 $798.00 $798.00 N/A N/A 3571140004 SUP HCPCS C1713 3571140004 - PLATE BN 61MM 4 HL RECON PLVC 4.5MM SCR BOTH IP/OP $846.50 $626.00 $167.97 $846.30 $380.84 $380.84 $380.84 $380.84 $846.30 $846.30 $846.30 $176.39 $846.30 $846.30 $846.30 $846.30 $846.30 $176.38 $846.30 $846.30 $500.59 $846.30 $846.30 $846.30 $846.30 $634.88 $846.30 $846.30 $846.30 $423.15 $423.15 $670.27 $846.30 $677.04 $380.84 $167.97 N/A $490.97 $846.30 $507.78 $846.30 $846.30 $846.30 N/A N/A 3571140005 SUP HCPCS C1713 3571140005 - PLATE BN 77MM STRL 5 HL RECON PLVC 4.5MM SCR BOTH IP/OP $910.50 $674.00 $180.68 $910.35 $409.66 $409.66 $409.66 $409.66 $910.35 $910.35 $910.35 $189.74 $910.35 $910.35 $910.35 $910.35 $910.35 $189.73 $910.35 $364.14 $538.47 $910.35 $910.35 $910.35 $910.35 $682.88 $910.35 $910.35 $910.35 $455.18 $455.18 $721.00 $910.35 $728.28 $409.66 $180.68 N/A $528.09 $910.35 $546.21 $910.35 $189.72 $910.35 N/A N/A 3571140006 SUP HCPCS C1713 3571140006 - PLATE BN 93MM STRL 6 HL RECON PLVC 4.5MM SCR BOTH IP/OP $972.50 $720.00 $192.98 $972.30 $437.54 $437.54 $437.54 $437.54 $972.30 $972.30 $972.30 $202.65 $972.30 $972.30 $972.30 $972.30 $972.30 $202.64 $972.30 $388.92 $575.12 $972.30 $972.30 $972.30 $972.30 $729.38 $972.30 $972.30 $972.30 $486.15 $486.15 $770.06 $972.30 $777.84 $437.54 $192.98 N/A $564.05 $972.30 $583.38 $972.30 $972.30 $972.30 N/A N/A 3571140007 SUP HCPCS C1713 3571140007 - PLATE BN 109MM STRL 7 HL RECON PLVC 4.5MM SCR BOTH IP/OP "$1,026.00" $759.00 $203.61 "$1,025.85" $461.63 $461.63 $461.63 $461.63 "$1,025.85" "$1,025.85" "$1,025.85" $213.81 "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" $213.80 "$1,025.85" $410.34 $606.79 "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" $769.50 "$1,025.85" "$1,025.85" "$1,025.85" $512.93 $512.93 $812.47 "$1,025.85" $820.68 $461.63 $203.61 N/A $595.08 "$1,025.85" $615.51 "$1,025.85" $213.79 "$1,025.85" N/A N/A 3571140008 SUP HCPCS C1713 3571140008 - PLATE BN 125MM STRL 8 HL RECON PLVC 4.5MM SCR BOTH IP/OP "$1,302.00" $963.00 $258.41 "$1,302.00" $585.90 $585.90 $585.90 $585.90 "$1,302.00" "$1,302.00" "$1,302.00" $271.37 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $271.35 "$1,302.00" $520.80 $770.13 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $976.50 "$1,302.00" "$1,302.00" "$1,302.00" $651.00 $651.00 "$1,031.18" "$1,302.00" "$1,041.60" $585.90 $258.41 N/A $755.16 "$1,302.00" $781.20 "$1,302.00" $271.34 "$1,302.00" N/A N/A 3571140009 SUP HCPCS C1713 3571140009 - PLATE BN 141MM STRL 9 HL RECON PLVC 4.5MM SCR BOTH IP/OP "$1,391.50" "$1,030.00" $276.13 "$1,391.25" $626.06 $626.06 $626.06 $626.06 "$1,391.25" "$1,391.25" "$1,391.25" $289.97 "$1,391.25" "$1,391.25" "$1,391.25" "$1,391.25" "$1,391.25" $289.95 "$1,391.25" $556.50 $822.92 "$1,391.25" "$1,391.25" "$1,391.25" "$1,391.25" "$1,043.63" "$1,391.25" "$1,391.25" "$1,391.25" $695.63 $695.63 "$1,101.87" "$1,391.25" "$1,113.00" $626.06 $276.13 N/A $807.07 "$1,391.25" $834.75 "$1,391.25" $289.94 "$1,391.25" N/A N/A 3571140010 SUP HCPCS C1713 3571140010 - PLATE BN 157MM STRL 10 HL RECON PLVC 4.5MM SCR BOTH IP/OP "$1,465.00" "$1,084.00" $290.72 "$1,464.75" $659.14 $659.14 $659.14 $659.14 "$1,464.75" "$1,464.75" "$1,464.75" $305.29 "$1,464.75" "$1,464.75" "$1,464.75" "$1,464.75" "$1,464.75" $305.27 "$1,464.75" $585.90 $866.40 "$1,464.75" "$1,464.75" "$1,464.75" "$1,464.75" "$1,098.75" "$1,464.75" "$1,464.75" "$1,464.75" $732.38 $732.38 "$1,160.08" "$1,464.75" "$1,171.80" $659.14 $290.72 N/A $849.70 "$1,464.75" $878.85 "$1,464.75" $305.25 "$1,464.75" N/A N/A 3571140011 SUP HCPCS C1713 3571140011 - PLATE BN 173MM STRL 11 HL RECON PLVC 4.5MM SCR BOTH IP/OP "$1,507.00" "$1,115.00" $299.05 "$1,506.75" $678.04 $678.04 $678.04 $678.04 "$1,506.75" "$1,506.75" "$1,506.75" $314.04 "$1,506.75" "$1,506.75" "$1,506.75" "$1,506.75" "$1,506.75" $314.02 "$1,506.75" "$1,506.75" $891.24 "$1,506.75" "$1,506.75" "$1,506.75" "$1,506.75" "$1,130.25" "$1,506.75" "$1,506.75" "$1,506.75" $753.38 $753.38 "$1,193.35" "$1,506.75" "$1,205.40" $678.04 $299.05 N/A $874.06 "$1,506.75" $904.05 "$1,506.75" $314.01 "$1,506.75" N/A N/A 3571140012 SUP HCPCS C1713 3571140012 - PLATE BN 189MM STRL 12 HL RECON PLVC 4.5MM SCR BOTH IP/OP "$1,302.00" $963.00 $258.41 "$1,302.00" $585.90 $585.90 $585.90 $585.90 "$1,302.00" "$1,302.00" "$1,302.00" $271.37 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $271.35 "$1,302.00" $520.80 $770.13 "$1,302.00" "$1,302.00" "$1,302.00" "$1,302.00" $976.50 "$1,302.00" "$1,302.00" "$1,302.00" $651.00 $651.00 "$1,031.18" "$1,302.00" "$1,041.60" $585.90 $258.41 N/A $755.16 "$1,302.00" $781.20 "$1,302.00" $271.34 "$1,302.00" N/A N/A 3571140013 SUP HCPCS C1713 3571140013 - PLATE BN 205MM STRL 13 HL RECON PLVC 4.5MM SCR BOTH IP/OP "$1,701.00" "$1,259.00" $337.61 "$1,701.00" $765.45 $765.45 $765.45 $765.45 "$1,701.00" "$1,701.00" "$1,701.00" $354.53 "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" $354.51 "$1,701.00" $680.40 "$1,006.14" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,275.75" "$1,701.00" "$1,701.00" "$1,701.00" $850.50 $850.50 "$1,347.19" "$1,701.00" "$1,360.80" $765.45 $337.61 N/A $986.58 "$1,701.00" "$1,020.60" "$1,701.00" $354.49 "$1,701.00" N/A N/A 3571140014 SUP HCPCS C1713 3571140014 - PLATE BN 221MM 14 HL RECON PLVC 4.5MM SCR BOTH IP/OP "$1,423.00" "$1,053.00" $282.38 "$1,422.75" $640.24 $640.24 $640.24 $640.24 "$1,422.75" "$1,422.75" "$1,422.75" $296.54 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" $296.52 "$1,422.75" $569.10 $841.56 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,067.25" "$1,422.75" "$1,422.75" "$1,422.75" $711.38 $711.38 "$1,126.82" "$1,422.75" "$1,138.20" $640.24 $282.38 N/A $825.34 "$1,422.75" "$1,422.75" "$1,422.75" $296.50 "$1,422.75" N/A N/A 3571140015 SUP HCPCS C1713 3571140015 - PLATE BN 237MM STRL 15 HL RECON PLVC 4.5MM SCR BOTH IP/OP "$1,806.00" "$1,336.00" $358.45 "$1,806.00" $812.70 $812.70 $812.70 $812.70 "$1,806.00" "$1,806.00" "$1,806.00" $376.42 "$1,806.00" "$1,806.00" "$1,806.00" "$1,806.00" "$1,806.00" $376.39 "$1,806.00" "$1,806.00" "$1,068.25" "$1,806.00" "$1,806.00" "$1,806.00" "$1,806.00" "$1,354.50" "$1,806.00" "$1,806.00" "$1,806.00" $903.00 $903.00 "$1,430.35" "$1,806.00" "$1,444.80" $812.70 $358.45 N/A "$1,047.48" "$1,806.00" "$1,083.60" "$1,806.00" $376.37 "$1,806.00" N/A N/A 3571140016 SUP HCPCS C1713 3571140016 - PLATE BN 253MM STRL 16 HL RECON PLVC 4.5MM SCR BOTH IP/OP "$1,869.00" "$1,383.00" $370.95 "$1,869.00" $841.05 $841.05 $841.05 $841.05 "$1,869.00" "$1,869.00" "$1,869.00" $389.55 "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" $389.52 "$1,869.00" "$1,869.00" "$1,105.51" "$1,869.00" "$1,869.00" "$1,869.00" "$1,869.00" "$1,401.75" "$1,869.00" "$1,869.00" "$1,869.00" $934.50 $934.50 "$1,480.25" "$1,869.00" "$1,495.20" $841.05 $370.95 N/A "$1,084.02" "$1,869.00" "$1,121.40" "$1,869.00" $389.50 "$1,869.00" N/A N/A 3571140104 SUP HCPCS C1713 3571140104 - PLATE BN 46MM STRL 4 HL RECON PLVC 3.5MM SCR BOTH IP/OP $876.00 $648.00 $173.80 $875.70 $394.07 $394.07 $394.07 $394.07 $875.70 $875.70 $875.70 $182.52 $875.70 $875.70 $875.70 $875.70 $875.70 $182.51 $875.70 $875.70 $517.98 $875.70 $875.70 $875.70 $875.70 $657.00 $875.70 $875.70 $875.70 $437.85 $437.85 $693.55 $875.70 $700.56 $394.07 $173.80 N/A $508.08 $875.70 $875.70 $875.70 $182.50 $875.70 N/A N/A 3571140105 SUP HCPCS C1713 3571140105 - PLATE BN 58MM 5 HL RECON PLVC 3.5MM SCR BOTH IP/OP $813.00 $602.00 $161.30 $812.70 $365.72 $365.72 $365.72 $365.72 $812.70 $812.70 $812.70 $169.39 $812.70 $812.70 $812.70 $812.70 $812.70 $169.38 $812.70 $325.08 $480.71 $812.70 $812.70 $812.70 $812.70 $609.75 $812.70 $812.70 $812.70 $406.35 $406.35 $643.66 $812.70 $650.16 $365.72 $161.30 N/A $471.54 $812.70 $812.70 $812.70 $169.37 $812.70 N/A N/A 3571140106 SUP HCPCS C1713 3571140106 - PLATE BN 70MM 6 HL RECON PLVC 3.5MM SCR BOTH IP/OP "$1,023.00" $757.00 $202.98 "$1,022.70" $460.22 $460.22 $460.22 $460.22 "$1,022.70" "$1,022.70" "$1,022.70" $213.16 "$1,022.70" "$1,022.70" "$1,022.70" "$1,022.70" "$1,022.70" $213.14 "$1,022.70" $409.08 $604.93 "$1,022.70" "$1,022.70" "$1,022.70" "$1,022.70" $767.25 "$1,022.70" "$1,022.70" "$1,022.70" $511.35 $511.35 $809.98 "$1,022.70" $818.16 $460.22 $202.98 N/A $593.34 "$1,022.70" $613.62 "$1,022.70" $213.13 "$1,022.70" N/A N/A 3571140107 SUP HCPCS C1713 3571140107 - PLATE BN 82MM 7 HL RECON PLVC 3.5MM SCR BOTH IP/OP $974.50 $721.00 $193.39 $974.40 $438.48 $438.48 $438.48 $438.48 $974.40 $974.40 $974.40 $203.09 $974.40 $974.40 $974.40 $974.40 $974.40 $203.08 $974.40 $389.76 $576.36 $974.40 $974.40 $974.40 $974.40 $730.88 $974.40 $974.40 $974.40 $487.20 $487.20 $771.72 $974.40 $779.52 $438.48 $193.39 N/A $565.21 $974.40 $584.64 $974.40 $203.06 $974.40 N/A N/A 3571140108 SUP HCPCS C1713 3571140108 - PLATE BN 94MM 8 HL RECON PLVC 3.5MM SCR BOTH IP/OP "$1,118.50" $828.00 $221.94 "$1,118.25" $503.21 $503.21 $503.21 $503.21 "$1,118.25" "$1,118.25" "$1,118.25" $233.07 "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" $233.06 "$1,118.25" "$1,118.25" $661.44 "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" $838.88 "$1,118.25" "$1,118.25" "$1,118.25" $559.13 $559.13 $885.65 "$1,118.25" $894.60 $503.21 $221.94 N/A $648.73 "$1,118.25" "$1,118.25" "$1,118.25" $233.04 "$1,118.25" N/A N/A 3571140109 SUP HCPCS C1713 3571140109 - PLATE BN 106MM 9 HL RECON PLVC 3.5MM SCR BOTH IP/OP "$1,050.00" $777.00 $208.40 "$1,050.00" $472.50 $472.50 $472.50 $472.50 "$1,050.00" "$1,050.00" "$1,050.00" $218.85 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $218.83 "$1,050.00" "$1,050.00" $621.08 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $787.50 "$1,050.00" "$1,050.00" "$1,050.00" $525.00 $525.00 $831.60 "$1,050.00" $840.00 $472.50 $208.40 N/A $609.00 "$1,050.00" $630.00 "$1,050.00" $218.82 "$1,050.00" N/A N/A 3571140110 SUP HCPCS C1713 3571140110 - PLATE BN 118MM 10 HL RECON PLVC 3.5MM SCR BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" $459.90 $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" $689.85 "$1,149.75" $239.61 "$1,149.75" N/A N/A 3571140111 SUP HCPCS C1713 3571140111 - PLATE BN 130MM STRL 11 HL RECON PLVC 3.5MM SCR BOTH IP/OP "$1,118.50" $828.00 $221.94 "$1,118.25" $503.21 $503.21 $503.21 $503.21 "$1,118.25" "$1,118.25" "$1,118.25" $233.07 "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" $233.06 "$1,118.25" $447.30 $661.44 "$1,118.25" "$1,118.25" "$1,118.25" "$1,118.25" $838.88 "$1,118.25" "$1,118.25" "$1,118.25" $559.13 $559.13 $885.65 "$1,118.25" $894.60 $503.21 $221.94 N/A $648.73 "$1,118.25" $670.95 "$1,118.25" $233.04 "$1,118.25" N/A N/A 3571140112 SUP HCPCS C1713 3571140112 - PLATE BN 142MM 12 HL RECON PLVC 3.5MM SCR BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" $504.00 $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" $756.00 "$1,260.00" $262.58 "$1,260.00" N/A N/A 3571140113 SUP HCPCS C1713 3571140113 - PLATE BN 154MM STRL 13 HL RECON PLVC 3.5MM SCR BOTH IP/OP "$1,496.50" "$1,107.00" $296.97 "$1,496.25" $673.31 $673.31 $673.31 $673.31 "$1,496.25" "$1,496.25" "$1,496.25" $311.86 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" $311.83 "$1,496.25" $598.50 $885.03 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,122.38" "$1,496.25" "$1,496.25" "$1,496.25" $748.13 $748.13 "$1,185.03" "$1,496.25" "$1,197.00" $673.31 $296.97 N/A $867.97 "$1,496.25" $897.75 "$1,496.25" $311.82 "$1,496.25" N/A N/A 3571140114 SUP HCPCS C1713 3571140114 - PLATE BN 166MM 14 HL RECON PLVC 3.5MM SCR BOTH IP/OP "$1,381.00" "$1,022.00" $274.04 "$1,380.75" $621.34 $621.34 $621.34 $621.34 "$1,380.75" "$1,380.75" "$1,380.75" $287.78 "$1,380.75" "$1,380.75" "$1,380.75" "$1,380.75" "$1,380.75" $287.76 "$1,380.75" $552.30 $816.71 "$1,380.75" "$1,380.75" "$1,380.75" "$1,380.75" "$1,035.75" "$1,380.75" "$1,380.75" "$1,380.75" $690.38 $690.38 "$1,093.55" "$1,380.75" "$1,104.60" $621.34 $274.04 N/A $800.98 "$1,380.75" $828.45 "$1,380.75" $287.75 "$1,380.75" N/A N/A 3571140115 SUP HCPCS C1713 3571140115 - PLATE BN 178MM STRL 15 HL RECON PLVC 3.5MM SCR BOTH IP/OP "$1,648.50" "$1,220.00" $327.19 "$1,648.50" $741.83 $741.83 $741.83 $741.83 "$1,648.50" "$1,648.50" "$1,648.50" $343.59 "$1,648.50" "$1,648.50" "$1,648.50" "$1,648.50" "$1,648.50" $343.57 "$1,648.50" $659.40 $975.09 "$1,648.50" "$1,648.50" "$1,648.50" "$1,648.50" "$1,236.38" "$1,648.50" "$1,648.50" "$1,648.50" $824.25 $824.25 "$1,305.61" "$1,648.50" "$1,318.80" $741.83 $327.19 N/A $956.13 "$1,648.50" "$1,648.50" "$1,648.50" $343.55 "$1,648.50" N/A N/A 3571140116 SUP HCPCS C1713 3571140116 - PLATE BN 190MM 16 HL RECON PLVC 3.5MM SCR BOTH IP/OP "$1,407.00" "$1,041.00" $279.25 "$1,407.00" $633.15 $633.15 $633.15 $633.15 "$1,407.00" "$1,407.00" "$1,407.00" $293.25 "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" $293.23 "$1,407.00" "$1,407.00" $832.24 "$1,407.00" "$1,407.00" "$1,407.00" "$1,407.00" "$1,055.25" "$1,407.00" "$1,407.00" "$1,407.00" $703.50 $703.50 "$1,114.34" "$1,407.00" "$1,125.60" $633.15 $279.25 N/A $816.06 "$1,407.00" $844.20 "$1,407.00" $293.22 "$1,407.00" N/A N/A 3571140118 SUP HCPCS C1713 3571140118 - PLATE BN 214MM 18 HL RECON PLVC 3.5MM SCR BOTH IP/OP "$1,480.50" "$1,096.00" $293.84 "$1,480.50" $666.23 $666.23 $666.23 $666.23 "$1,480.50" "$1,480.50" "$1,480.50" $308.57 "$1,480.50" "$1,480.50" "$1,480.50" "$1,480.50" "$1,480.50" $308.55 "$1,480.50" $592.20 $875.72 "$1,480.50" "$1,480.50" "$1,480.50" "$1,480.50" "$1,110.38" "$1,480.50" "$1,480.50" "$1,480.50" $740.25 $740.25 "$1,172.56" "$1,480.50" "$1,184.40" $666.23 $293.84 N/A $858.69 "$1,480.50" $888.30 "$1,480.50" $308.54 "$1,480.50" N/A N/A 3571140120 SUP HCPCS C1713 3571140120 - PLATE BN 238MM STRL 20 HL RECON PLVC 3.5MM SCR BOTH IP/OP "$1,801.00" "$1,333.00" $357.40 "$1,800.75" $810.34 $810.34 $810.34 $810.34 "$1,800.75" "$1,800.75" "$1,800.75" $375.32 "$1,800.75" "$1,800.75" "$1,800.75" "$1,800.75" "$1,800.75" $375.30 "$1,800.75" $720.30 "$1,065.14" "$1,800.75" "$1,800.75" "$1,800.75" "$1,800.75" "$1,350.75" "$1,800.75" "$1,800.75" "$1,800.75" $900.38 $900.38 "$1,426.19" "$1,800.75" "$1,440.60" $810.34 $357.40 N/A "$1,044.58" "$1,800.75" "$1,080.45" "$1,800.75" $375.28 "$1,800.75" N/A N/A 3571140122 SUP HCPCS C1713 3571140122 - PLATE BN 263MM STRL 22 HL RECON PLVC 3.5MM SCR BOTH IP/OP "$2,284.00" "$1,690.00" $453.27 "$2,283.75" "$1,027.69" "$1,027.69" "$1,027.69" "$1,027.69" "$2,283.75" "$2,283.75" "$2,283.75" $475.99 "$2,283.75" "$2,283.75" "$2,283.75" "$2,283.75" "$2,283.75" $475.96 "$2,283.75" $913.50 "$1,350.84" "$2,283.75" "$2,283.75" "$2,283.75" "$2,283.75" "$1,713.00" "$2,283.75" "$2,283.75" "$2,283.75" "$1,141.88" "$1,141.88" "$1,808.73" "$2,283.75" "$1,827.00" "$1,027.69" $453.27 N/A "$1,324.72" "$2,283.75" "$1,370.25" "$2,283.75" $475.93 "$2,283.75" N/A N/A 3571140202 SUP HCPCS C1713 3571140202 - PLATE BN 25MM STRL 2 HL 3.5MM SCR SM FRAG BOTH IP/OP $296.50 $219.00 $58.77 $296.10 $133.25 $133.25 $133.25 $133.25 $296.10 $296.10 $296.10 $61.71 $296.10 $296.10 $296.10 $296.10 $296.10 $61.71 $296.10 $118.44 $175.14 $296.10 $296.10 $296.10 $296.10 $222.38 $296.10 $296.10 $296.10 $148.05 $148.05 $234.51 $296.10 $236.88 $133.25 $58.77 N/A $171.97 $296.10 $177.66 $296.10 $61.71 $296.10 N/A N/A 3571140203 SUP HCPCS C1713 3571140203 - PLATE BN 37MM STRL 3 HL 3.5MM SCR SM FRAG BOTH IP/OP $310.00 $229.00 $61.48 $309.75 $139.39 $139.39 $139.39 $139.39 $309.75 $309.75 $309.75 $64.56 $309.75 $309.75 $309.75 $309.75 $309.75 $64.56 $309.75 $309.75 $183.22 $309.75 $309.75 $309.75 $309.75 $232.50 $309.75 $309.75 $309.75 $154.88 $154.88 $245.32 $309.75 $247.80 $139.39 $61.48 N/A $179.80 $309.75 $309.75 $309.75 $64.55 $309.75 N/A N/A 3571140204 SUP HCPCS C1713 3571140204 - PLATE BN 49MM STRL 4 HL 3.5MM SCR SM FRAG BOTH IP/OP $316.50 $234.00 $62.73 $316.05 $142.22 $142.22 $142.22 $142.22 $316.05 $316.05 $316.05 $65.87 $316.05 $316.05 $316.05 $316.05 $316.05 $65.87 $316.05 $126.42 $186.94 $316.05 $316.05 $316.05 $316.05 $237.38 $316.05 $316.05 $316.05 $158.03 $158.03 $250.31 $316.05 $252.84 $142.22 $62.73 N/A $183.57 $316.05 $189.63 $316.05 $65.86 $316.05 N/A N/A 3571140205 SUP HCPCS C1713 3571140205 - PLATE BN 61MM STRL 5 HL 3.5MM SCR SM FRAG BOTH IP/OP $345.50 $256.00 $68.56 $345.45 $155.45 $155.45 $155.45 $155.45 $345.45 $345.45 $345.45 $72.00 $345.45 $345.45 $345.45 $345.45 $345.45 $72.00 $345.45 $345.45 $204.33 $345.45 $345.45 $345.45 $345.45 $259.13 $345.45 $345.45 $345.45 $172.73 $172.73 $273.60 $345.45 $276.36 $155.45 $68.56 N/A $200.39 $345.45 $207.27 $345.45 $71.99 $345.45 N/A N/A 3571140206 SUP HCPCS C1713 3571140206 - PLATE BN 73MM STRL 6 HL 3.5MM SCR SM FRAG BOTH IP/OP $361.50 $268.00 $71.69 $361.20 $162.54 $162.54 $162.54 $162.54 $361.20 $361.20 $361.20 $75.28 $361.20 $361.20 $361.20 $361.20 $361.20 $75.28 $361.20 $361.20 $213.65 $361.20 $361.20 $361.20 $361.20 $271.13 $361.20 $361.20 $361.20 $180.60 $180.60 $286.07 $361.20 $288.96 $162.54 $71.69 N/A $209.67 $361.20 $361.20 $361.20 $75.27 $361.20 N/A N/A 3571140207 SUP HCPCS C1713 3571140207 - PLATE BN 85MM STRL 7 HL 3.5MM SCR SM FRAG BOTH IP/OP $378.00 $280.00 $75.02 $378.00 $170.10 $170.10 $170.10 $170.10 $378.00 $378.00 $378.00 $78.78 $378.00 $378.00 $378.00 $378.00 $378.00 $78.78 $378.00 $151.20 $223.59 $378.00 $378.00 $378.00 $378.00 $283.50 $378.00 $378.00 $378.00 $189.00 $189.00 $299.38 $378.00 $302.40 $170.10 $75.02 N/A $219.24 $378.00 $378.00 $378.00 $78.78 $378.00 N/A N/A 3571140208 SUP HCPCS C1713 3571140208 - PLATE BN 97MM STRL 8 HL 3.5MM SCR SM FRAG BOTH IP/OP $405.50 $300.00 $80.44 $405.30 $182.39 $182.39 $182.39 $182.39 $405.30 $405.30 $405.30 $84.47 $405.30 $405.30 $405.30 $405.30 $405.30 $84.47 $405.30 $405.30 $239.73 $405.30 $405.30 $405.30 $405.30 $304.13 $405.30 $405.30 $405.30 $202.65 $202.65 $321.00 $405.30 $324.24 $182.39 $80.44 N/A $235.19 $405.30 $243.18 $405.30 $84.46 $405.30 N/A N/A 3571140209 SUP HCPCS C1713 3571140209 - PLATE BN 109MM STRL 9 HL 3.5MM SCR SM FRAG BOTH IP/OP $415.00 $307.00 $82.32 $414.75 $186.64 $186.64 $186.64 $186.64 $414.75 $414.75 $414.75 $86.44 $414.75 $414.75 $414.75 $414.75 $414.75 $86.44 $414.75 $414.75 $245.32 $414.75 $414.75 $414.75 $414.75 $311.25 $414.75 $414.75 $414.75 $207.38 $207.38 $328.48 $414.75 $331.80 $186.64 $82.32 N/A $240.70 $414.75 $248.85 $414.75 $86.43 $414.75 N/A N/A 3571140210 SUP HCPCS C1713 3571140210 - PLATE BN 121MM STRL 10 HL 3.5MM SCR SM FRAG BOTH IP/OP $426.50 $316.00 $84.61 $426.30 $191.84 $191.84 $191.84 $191.84 $426.30 $426.30 $426.30 $88.85 $426.30 $426.30 $426.30 $426.30 $426.30 $88.85 $426.30 $170.52 $252.16 $426.30 $426.30 $426.30 $426.30 $319.88 $426.30 $426.30 $426.30 $213.15 $213.15 $337.63 $426.30 $341.04 $191.84 $84.61 N/A $247.37 $426.30 $255.78 $426.30 $88.84 $426.30 N/A N/A 3571140212 SUP HCPCS C1713 3571140212 - PLATE BN 145MM STRL 12 HL 3.5MM SCR SM FRAG BOTH IP/OP $474.00 $351.00 $93.99 $473.55 $213.10 $213.10 $213.10 $213.10 $473.55 $473.55 $473.55 $98.70 $473.55 $473.55 $473.55 $473.55 $473.55 $98.69 $473.55 $473.55 $280.10 $473.55 $473.55 $473.55 $473.55 $355.50 $473.55 $473.55 $473.55 $236.78 $236.78 $375.05 $473.55 $378.84 $213.10 $93.99 N/A $274.92 $473.55 $284.13 $473.55 $98.69 $473.55 N/A N/A 3571140214 SUP HCPCS C1713 3571140214 - PLATE BN 169MM STRL 14 HL 3.5MM SCR SM FRAG BOTH IP/OP $889.50 $658.00 $176.51 $889.35 $400.21 $400.21 $400.21 $400.21 $889.35 $889.35 $889.35 $185.36 $889.35 $889.35 $889.35 $889.35 $889.35 $185.35 $889.35 $889.35 $526.05 $889.35 $889.35 $889.35 $889.35 $667.13 $889.35 $889.35 $889.35 $444.68 $444.68 $704.37 $889.35 $711.48 $400.21 $176.51 N/A $515.91 $889.35 $533.61 $889.35 $185.34 $889.35 N/A N/A 3571140216 SUP HCPCS C1713 3571140216 - PLATE BN 194MM STRL 16 HL 3.5MM SCR SM FRAG BOTH IP/OP "$1,026.00" $759.00 $203.61 "$1,025.85" $461.63 $461.63 $461.63 $461.63 "$1,025.85" "$1,025.85" "$1,025.85" $213.81 "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" $213.80 "$1,025.85" "$1,025.85" $606.79 "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" $769.50 "$1,025.85" "$1,025.85" "$1,025.85" $512.93 $512.93 $812.47 "$1,025.85" $820.68 $461.63 $203.61 N/A $595.08 "$1,025.85" $615.51 "$1,025.85" $213.79 "$1,025.85" N/A N/A 3571140218 SUP HCPCS C1713 3571140218 - PLATE BN 217MM STRL 18 HL 3.5MM SCR SM FRAG BOTH IP/OP "$1,381.00" "$1,022.00" $274.04 "$1,380.75" $621.34 $621.34 $621.34 $621.34 "$1,380.75" "$1,380.75" "$1,380.75" $287.78 "$1,380.75" "$1,380.75" "$1,380.75" "$1,380.75" "$1,380.75" $287.76 "$1,380.75" "$1,380.75" $816.71 "$1,380.75" "$1,380.75" "$1,380.75" "$1,380.75" "$1,035.75" "$1,380.75" "$1,380.75" "$1,380.75" $690.38 $690.38 "$1,093.55" "$1,380.75" "$1,104.60" $621.34 $274.04 N/A $800.98 "$1,380.75" $828.45 "$1,380.75" $287.75 "$1,380.75" N/A N/A 3571140220 SUP HCPCS C1713 3571140220 - PLATE BN 242MM STRL 20 HL 3.5MM SCR SM FRAG BOTH IP/OP "$1,270.50" $940.00 $252.16 "$1,270.50" $571.73 $571.73 $571.73 $571.73 "$1,270.50" "$1,270.50" "$1,270.50" $264.80 "$1,270.50" "$1,270.50" "$1,270.50" "$1,270.50" "$1,270.50" $264.79 "$1,270.50" "$1,270.50" $751.50 "$1,270.50" "$1,270.50" "$1,270.50" "$1,270.50" $952.88 "$1,270.50" "$1,270.50" "$1,270.50" $635.25 $635.25 "$1,006.24" "$1,270.50" "$1,016.40" $571.73 $252.16 N/A $736.89 "$1,270.50" $762.30 "$1,270.50" $264.77 "$1,270.50" N/A N/A 3571140222 SUP HCPCS C1713 3571140222 - PLATE BN 265MM STRL 22 HL 3.5MM SCR SM FRAG BOTH IP/OP "$1,701.00" "$1,259.00" $337.61 "$1,701.00" $765.45 $765.45 $765.45 $765.45 "$1,701.00" "$1,701.00" "$1,701.00" $354.53 "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" $354.51 "$1,701.00" "$1,701.00" "$1,006.14" "$1,701.00" "$1,701.00" "$1,701.00" "$1,701.00" "$1,275.75" "$1,701.00" "$1,701.00" "$1,701.00" $850.50 $850.50 "$1,347.19" "$1,701.00" "$1,360.80" $765.45 $337.61 N/A $986.58 "$1,701.00" "$1,020.60" "$1,701.00" "$1,701.00" "$1,701.00" N/A N/A 3571140302 SUP HCPCS C1713 3571140302 - PLATE BN 25MM STRL 1/3 TBLR 2 HL COLR BOTH IP/OP $169.50 $125.00 $33.55 $169.05 $76.07 $76.07 $76.07 $76.07 $169.05 $169.05 $169.05 $35.23 $169.05 $169.05 $169.05 $169.05 $169.05 $35.23 $169.05 $169.05 $99.99 $169.05 $169.05 $169.05 $169.05 $127.13 $169.05 $169.05 $169.05 $84.53 $84.53 $133.89 $169.05 $135.24 $76.07 $33.55 N/A $98.31 $169.05 $101.43 $169.05 $169.05 $169.05 N/A N/A 3571140303 SUP HCPCS C1713 3571140303 - PLATE BN 37MM STRL 1/3 TBLR 3 HL COLR BOTH IP/OP $144.00 $107.00 $28.55 $143.85 $64.73 $64.73 $64.73 $64.73 $143.85 $143.85 $143.85 $29.98 $143.85 $143.85 $143.85 $143.85 $143.85 $29.98 $143.85 $143.85 $85.09 $143.85 $143.85 $143.85 $143.85 $108.00 $143.85 $143.85 $143.85 $71.93 $71.93 $113.93 $143.85 $115.08 $64.73 $28.55 N/A $83.52 $143.85 $143.85 $143.85 $143.85 $143.85 N/A N/A 3571140304 SUP HCPCS C1713 3571140304 - PLATE BN 49MM STRL 1/3 TBLR 4 HL COLR BOTH IP/OP $169.50 $125.00 $33.55 $169.05 $76.07 $76.07 $76.07 $76.07 $169.05 $169.05 $169.05 $35.23 $169.05 $169.05 $169.05 $169.05 $169.05 $35.23 $169.05 $169.05 $99.99 $169.05 $169.05 $169.05 $169.05 $127.13 $169.05 $169.05 $169.05 $84.53 $84.53 $133.89 $169.05 $135.24 $76.07 $33.55 N/A $98.31 $169.05 $101.43 $169.05 $35.23 $169.05 N/A N/A 3571140305 SUP HCPCS C1713 3571140305 - PLATE BN 61MM STRL 1/3 TBLR 5 HL COLR BOTH IP/OP $211.50 $157.00 $41.89 $211.05 $94.97 $94.97 $94.97 $94.97 $211.05 $211.05 $211.05 $43.99 $211.05 $211.05 $211.05 $211.05 $211.05 $43.99 $211.05 $211.05 $124.84 $211.05 $211.05 $211.05 $211.05 $158.63 $211.05 $211.05 $211.05 $105.53 $105.53 $167.15 $211.05 $168.84 $94.97 $41.89 N/A $122.67 $211.05 $126.63 $211.05 $211.05 $211.05 N/A N/A 3571140306 SUP HCPCS C1713 3571140306 - PLATE BN 73MM STRL 1/3 TBLR 6 HL COLR DIST FIB BOTH IP/OP $175.50 $130.00 $34.80 $175.35 $78.91 $78.91 $78.91 $78.91 $175.35 $175.35 $175.35 $36.55 $175.35 $175.35 $175.35 $175.35 $175.35 $36.54 $175.35 $175.35 $103.72 $175.35 $175.35 $175.35 $175.35 $131.63 $175.35 $175.35 $175.35 $87.68 $87.68 $138.88 $175.35 $140.28 $78.91 $34.80 N/A $101.79 $175.35 $105.21 $175.35 $36.54 $175.35 N/A N/A 3571140307 SUP HCPCS C1713 3571140307 - PLATE BN 85MM STRL 1/3 TBLR 7 HL COLR DIST FIB BOTH IP/OP $175.50 $130.00 $34.80 $175.35 $78.91 $78.91 $78.91 $78.91 $175.35 $175.35 $175.35 $36.55 $175.35 $175.35 $175.35 $175.35 $175.35 $36.54 $175.35 $175.35 $103.72 $175.35 $175.35 $175.35 $175.35 $131.63 $175.35 $175.35 $175.35 $87.68 $87.68 $138.88 $175.35 $140.28 $78.91 $34.80 N/A $101.79 $175.35 $175.35 $175.35 $36.54 $175.35 N/A N/A 3571140308 SUP HCPCS C1713 3571140308 - PLATE BN 97MM STRL 1/3 TBLR 8 HL COLR DIST FIB BOTH IP/OP $177.50 $131.00 $35.22 $177.45 $79.85 $79.85 $79.85 $79.85 $177.45 $177.45 $177.45 $36.99 $177.45 $177.45 $177.45 $177.45 $177.45 $36.98 $177.45 $177.45 $104.96 $177.45 $177.45 $177.45 $177.45 $133.13 $177.45 $177.45 $177.45 $88.73 $88.73 $140.54 $177.45 $141.96 $79.85 $35.22 N/A $102.95 $177.45 $106.47 $177.45 $36.98 $177.45 N/A N/A 3571140309 SUP HCPCS C1713 3571140309 - PLATE BN 109MM STRL 1/3 TBLR 9 HL COLR DIST FIB BOTH IP/OP $177.50 $131.00 $35.22 $177.45 $79.85 $79.85 $79.85 $79.85 $177.45 $177.45 $177.45 $36.99 $177.45 $177.45 $177.45 $177.45 $177.45 $36.98 $177.45 $177.45 $104.96 $177.45 $177.45 $177.45 $177.45 $133.13 $177.45 $177.45 $177.45 $88.73 $88.73 $140.54 $177.45 $141.96 $79.85 $35.22 N/A $102.95 $177.45 $106.47 $177.45 $177.45 $177.45 N/A N/A 3571140310 SUP HCPCS C1713 3571140310 - PLATE BN 121MM STRL 1/3 TBLR 10 HL COLR DIST FIB BOTH IP/OP $177.50 $131.00 $35.22 $177.45 $79.85 $79.85 $79.85 $79.85 $177.45 $177.45 $177.45 $36.99 $177.45 $177.45 $177.45 $177.45 $177.45 $36.98 $177.45 $177.45 $104.96 $177.45 $177.45 $177.45 $177.45 $133.13 $177.45 $177.45 $177.45 $88.73 $88.73 $140.54 $177.45 $141.96 $79.85 $35.22 N/A $102.95 $177.45 $106.47 $177.45 $177.45 $177.45 N/A N/A 3571140312 SUP HCPCS C1713 3571140312 - PLATE BN 145MM STRL 1/3 TBLR 12 HL COLR DIST FIB BOTH IP/OP $182.00 $135.00 $36.05 $181.65 $81.74 $81.74 $81.74 $81.74 $181.65 $181.65 $181.65 $37.86 $181.65 $181.65 $181.65 $181.65 $181.65 $37.86 $181.65 $181.65 $107.45 $181.65 $181.65 $181.65 $181.65 $136.50 $181.65 $181.65 $181.65 $90.83 $90.83 $143.87 $181.65 $145.32 $81.74 $36.05 N/A $105.56 $181.65 $108.99 $181.65 $181.65 $181.65 N/A N/A 3571140403 SUP HCPCS C1713 3571140403 - PLATE BN T RT ANG 50MM STRL 3X3 HL BOTH IP/OP $314.00 $232.00 $62.31 $313.95 $141.28 $141.28 $141.28 $141.28 $313.95 $313.95 $313.95 $65.44 $313.95 $313.95 $313.95 $313.95 $313.95 $65.43 $313.95 $313.95 $185.70 $313.95 $313.95 $313.95 $313.95 $235.50 $313.95 $313.95 $313.95 $156.98 $156.98 $248.65 $313.95 $251.16 $141.28 $62.31 N/A $182.12 $313.95 $313.95 $313.95 $65.43 $313.95 N/A N/A 3571140404 SUP HCPCS C1713 3571140404 - PLATE BN T RT ANG 56MM STRL 4X4 HL BOTH IP/OP $320.50 $237.00 $63.56 $320.25 $144.11 $144.11 $144.11 $144.11 $320.25 $320.25 $320.25 $66.75 $320.25 $320.25 $320.25 $320.25 $320.25 $66.74 $320.25 $320.25 $189.43 $320.25 $320.25 $320.25 $320.25 $240.38 $320.25 $320.25 $320.25 $160.13 $160.13 $253.64 $320.25 $256.20 $144.11 $63.56 N/A $185.89 $320.25 $192.15 $320.25 $66.74 $320.25 N/A N/A 3571140405 SUP HCPCS C1713 3571140405 - PLATE BN T RT ANG 67MM STRL 3X5 HL BOTH IP/OP $360.50 $267.00 $71.48 $360.15 $162.07 $162.07 $162.07 $162.07 $360.15 $360.15 $360.15 $75.06 $360.15 $360.15 $360.15 $360.15 $360.15 $75.06 $360.15 $360.15 $213.03 $360.15 $360.15 $360.15 $360.15 $270.38 $360.15 $360.15 $360.15 $180.08 $180.08 $285.24 $360.15 $288.12 $162.07 $71.48 N/A $209.09 $360.15 $216.09 $360.15 $75.06 $360.15 N/A N/A 3571140406 SUP HCPCS C1713 3571140406 - PLATE BN T RT ANG 78MM STRL 4X6 HL BOTH IP/OP $415.00 $307.00 $82.32 $414.75 $186.64 $186.64 $186.64 $186.64 $414.75 $414.75 $414.75 $86.44 $414.75 $414.75 $414.75 $414.75 $414.75 $86.44 $414.75 $414.75 $245.32 $414.75 $414.75 $414.75 $414.75 $311.25 $414.75 $414.75 $414.75 $207.38 $207.38 $328.48 $414.75 $331.80 $186.64 $82.32 N/A $240.70 $414.75 $248.85 $414.75 $86.43 $414.75 N/A N/A 3571140503 SUP HCPCS C1713 3571140503 - PLATE BN T 53MM STRL 3X3 HL OBLQ BOTH IP/OP $564.00 $417.00 $111.91 $563.85 $253.73 $253.73 $253.73 $253.73 $563.85 $563.85 $563.85 $117.52 $563.85 $563.85 $563.85 $563.85 $563.85 $117.51 $563.85 $563.85 $333.52 $563.85 $563.85 $563.85 $563.85 $423.00 $563.85 $563.85 $563.85 $281.93 $281.93 $446.57 $563.85 $451.08 $253.73 $111.91 N/A $327.12 $563.85 $338.31 $563.85 $117.51 $563.85 N/A N/A 3571140504 SUP HCPCS C1713 3571140504 - PLATE BN T 63MM STRL 3X4 HL OBLQ BOTH IP/OP $588.00 $435.00 $116.70 $588.00 $264.60 $264.60 $264.60 $264.60 $588.00 $588.00 $588.00 $122.55 $588.00 $588.00 $588.00 $588.00 $588.00 $122.55 $588.00 $588.00 $347.80 $588.00 $588.00 $588.00 $588.00 $441.00 $588.00 $588.00 $588.00 $294.00 $294.00 $465.70 $588.00 $470.40 $264.60 $116.70 N/A $341.04 $588.00 $588.00 $588.00 $122.54 $588.00 N/A N/A 3571140505 SUP HCPCS C1713 3571140505 - PLATE BN T 73MM STRL 5X4 HL OBLQ BOTH IP/OP $609.00 $451.00 $120.87 $609.00 $274.05 $274.05 $274.05 $274.05 $609.00 $609.00 $609.00 $126.93 $609.00 $609.00 $609.00 $609.00 $609.00 $126.92 $609.00 $609.00 $360.22 $609.00 $609.00 $609.00 $609.00 $456.75 $609.00 $609.00 $609.00 $304.50 $304.50 $482.33 $609.00 $487.20 $274.05 $120.87 N/A $353.22 $609.00 $609.00 $609.00 $126.92 $609.00 N/A N/A 3571140603 SUP HCPCS C1713 3571140603 - PLATE BN CLVRLF 88MM STRL 3 HL BOTH IP/OP $744.50 $551.00 $147.75 $744.45 $335.00 $335.00 $335.00 $335.00 $744.45 $744.45 $744.45 $155.16 $744.45 $744.45 $744.45 $744.45 $744.45 $155.15 $744.45 $744.45 $440.34 $744.45 $744.45 $744.45 $744.45 $558.38 $744.45 $744.45 $744.45 $372.23 $372.23 $589.60 $744.45 $595.56 $335.00 $147.75 N/A $431.81 $744.45 $446.67 $744.45 $155.14 $744.45 N/A N/A 3571140604 SUP HCPCS C1713 3571140604 - PLATE BN CLVRLF 104MM STRL 4 HL BOTH IP/OP $798.00 $591.00 $158.38 $798.00 $359.10 $359.10 $359.10 $359.10 $798.00 $798.00 $798.00 $166.32 $798.00 $798.00 $798.00 $798.00 $798.00 $166.31 $798.00 $319.20 $472.02 $798.00 $798.00 $798.00 $798.00 $598.50 $798.00 $798.00 $798.00 $399.00 $399.00 $632.02 $798.00 $638.40 $359.10 $158.38 N/A $462.84 $798.00 $478.80 $798.00 $166.30 $798.00 N/A N/A 3571140606 SUP HCPCS C1713 3571140606 - PLATE BN CRV 70MM 6 HL RECON SS 3.5MM SCR BOTH IP/OP "$1,039.50" $769.00 $206.31 "$1,039.50" $467.78 $467.78 $467.78 $467.78 "$1,039.50" "$1,039.50" "$1,039.50" $216.66 "$1,039.50" "$1,039.50" "$1,039.50" "$1,039.50" "$1,039.50" $216.64 "$1,039.50" $415.80 $614.86 "$1,039.50" "$1,039.50" "$1,039.50" "$1,039.50" $779.63 "$1,039.50" "$1,039.50" "$1,039.50" $519.75 $519.75 $823.28 "$1,039.50" $831.60 $467.78 $206.31 N/A $602.91 "$1,039.50" $623.70 "$1,039.50" $216.63 "$1,039.50" N/A N/A 3571140608 SUP HCPCS C1713 3571140608 - PLATE BN CRV 94MM 8 HL RECON SS 3.5MM SCR BOTH IP/OP "$1,134.00" $839.00 $225.07 "$1,134.00" $510.30 $510.30 $510.30 $510.30 "$1,134.00" "$1,134.00" "$1,134.00" $236.35 "$1,134.00" "$1,134.00" "$1,134.00" "$1,134.00" "$1,134.00" $236.34 "$1,134.00" $453.60 $670.76 "$1,134.00" "$1,134.00" "$1,134.00" "$1,134.00" $850.50 "$1,134.00" "$1,134.00" "$1,134.00" $567.00 $567.00 $898.13 "$1,134.00" $907.20 $510.30 $225.07 N/A $657.72 "$1,134.00" $680.40 "$1,134.00" $236.33 "$1,134.00" N/A N/A 3571140610 SUP HCPCS C1713 3571140610 - PLATE BN CRV 118MM 10 HL RECON SS 3.5MM SCR BOTH IP/OP "$1,186.50" $878.00 $235.49 "$1,186.50" $533.93 $533.93 $533.93 $533.93 "$1,186.50" "$1,186.50" "$1,186.50" $247.30 "$1,186.50" "$1,186.50" "$1,186.50" "$1,186.50" "$1,186.50" $247.28 "$1,186.50" "$1,186.50" $701.81 "$1,186.50" "$1,186.50" "$1,186.50" "$1,186.50" $889.88 "$1,186.50" "$1,186.50" "$1,186.50" $593.25 $593.25 $939.71 "$1,186.50" $949.20 $533.93 $235.49 N/A $688.17 "$1,186.50" $711.90 "$1,186.50" $247.27 "$1,186.50" N/A N/A 3571140612 SUP HCPCS C1713 3571140612 - PLATE BN CRV 142MM 12 HL RECON SS 3.5MM SCR BOTH IP/OP "$1,244.50" $921.00 $246.95 "$1,244.25" $559.91 $559.91 $559.91 $559.91 "$1,244.25" "$1,244.25" "$1,244.25" $259.33 "$1,244.25" "$1,244.25" "$1,244.25" "$1,244.25" "$1,244.25" $259.32 "$1,244.25" "$1,244.25" $735.97 "$1,244.25" "$1,244.25" "$1,244.25" "$1,244.25" $933.38 "$1,244.25" "$1,244.25" "$1,244.25" $622.13 $622.13 $985.45 "$1,244.25" $995.40 $559.91 $246.95 N/A $721.81 "$1,244.25" $746.55 "$1,244.25" $259.30 "$1,244.25" N/A N/A 3571140614 SUP HCPCS C1713 3571140614 - PLATE BN CRV 166MM 14 HL RECON SS 3.5MM SCR BOTH IP/OP "$1,402.00" "$1,037.00" $278.21 "$1,401.75" $630.79 $630.79 $630.79 $630.79 "$1,401.75" "$1,401.75" "$1,401.75" $292.16 "$1,401.75" "$1,401.75" "$1,401.75" "$1,401.75" "$1,401.75" $292.14 "$1,401.75" "$1,401.75" $829.14 "$1,401.75" "$1,401.75" "$1,401.75" "$1,401.75" "$1,051.50" "$1,401.75" "$1,401.75" "$1,401.75" $700.88 $700.88 "$1,110.19" "$1,401.75" "$1,121.40" $630.79 $278.21 N/A $813.16 "$1,401.75" $841.05 "$1,401.75" $292.12 "$1,401.75" N/A N/A 3571140616 SUP HCPCS C1713 3571140616 - PLATE BN CRV 190MM 16 HL RECON SS 3.5MM SCR BOTH IP/OP "$1,486.00" "$1,100.00" $294.88 "$1,485.75" $668.59 $668.59 $668.59 $668.59 "$1,485.75" "$1,485.75" "$1,485.75" $309.67 "$1,485.75" "$1,485.75" "$1,485.75" "$1,485.75" "$1,485.75" $309.65 "$1,485.75" "$1,485.75" $878.82 "$1,485.75" "$1,485.75" "$1,485.75" "$1,485.75" "$1,114.50" "$1,485.75" "$1,485.75" "$1,485.75" $742.88 $742.88 "$1,176.71" "$1,485.75" "$1,188.60" $668.59 $294.88 N/A $861.88 "$1,485.75" $891.45 "$1,485.75" $309.63 "$1,485.75" N/A N/A 3571140618 SUP HCPCS C1713 3571140618 - PLATE BN CRV 214MM STRL 18 HL RECON SS 3.5MM SCR BOTH IP/OP "$1,601.50" "$1,185.00" $317.81 "$1,601.25" $720.56 $720.56 $720.56 $720.56 "$1,601.25" "$1,601.25" "$1,601.25" $333.74 "$1,601.25" "$1,601.25" "$1,601.25" "$1,601.25" "$1,601.25" $333.72 "$1,601.25" $640.50 $947.14 "$1,601.25" "$1,601.25" "$1,601.25" "$1,601.25" "$1,201.13" "$1,601.25" "$1,601.25" "$1,601.25" $800.63 $800.63 "$1,268.19" "$1,601.25" "$1,281.00" $720.56 $317.81 N/A $928.87 "$1,601.25" $960.75 "$1,601.25" $333.70 "$1,601.25" N/A N/A 3571140704 SUP HCPCS C1713 3571140704 - PLATE BN 80MM STRL 4 HL TBTRS BOTH IP/OP $926.50 $686.00 $183.81 $926.10 $416.75 $416.75 $416.75 $416.75 $926.10 $926.10 $926.10 $193.02 $926.10 $926.10 $926.10 $926.10 $926.10 $193.01 $926.10 $926.10 $547.79 $926.10 $926.10 $926.10 $926.10 $694.88 $926.10 $926.10 $926.10 $463.05 $463.05 $733.47 $926.10 $740.88 $416.75 $183.81 N/A $537.37 $926.10 $926.10 $926.10 $926.10 $926.10 N/A N/A 3571140705 SUP HCPCS C1713 3571140705 - PLATE BN 96MM STRL 5 HL TBTRS BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" $459.90 $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" $689.85 "$1,149.75" $239.61 "$1,149.75" N/A N/A 3571140706 SUP HCPCS C1713 3571140706 - PLATE BN 112MM STRL 6 HL TBTRS BOTH IP/OP "$1,249.50" $925.00 $247.99 "$1,249.50" $562.28 $562.28 $562.28 $562.28 "$1,249.50" "$1,249.50" "$1,249.50" $260.43 "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" $260.41 "$1,249.50" $499.80 $739.08 "$1,249.50" "$1,249.50" "$1,249.50" "$1,249.50" $937.13 "$1,249.50" "$1,249.50" "$1,249.50" $624.75 $624.75 $989.60 "$1,249.50" $999.60 $562.28 $247.99 N/A $724.71 "$1,249.50" $749.70 "$1,249.50" $260.40 "$1,249.50" N/A N/A 3571140804 SUP HCPCS C1713 3571140804 - PLATE BN 86MM STRL 4 HL L BTRS TIB LT BOTH IP/OP $828.50 $613.00 $164.43 $828.45 $372.80 $372.80 $372.80 $372.80 $828.45 $828.45 $828.45 $172.67 $828.45 $828.45 $828.45 $828.45 $828.45 $172.66 $828.45 $331.38 $490.03 $828.45 $828.45 $828.45 $828.45 $621.38 $828.45 $828.45 $828.45 $414.23 $414.23 $656.13 $828.45 $662.76 $372.80 $164.43 N/A $480.53 $828.45 $828.45 $828.45 $172.65 $828.45 N/A N/A 3571140904 SUP HCPCS C1713 3571140904 - PLATE BN 86MM STRL 4 HL L BTRS TIB RT BOTH IP/OP $828.50 $613.00 $164.43 $828.45 $372.80 $372.80 $372.80 $372.80 $828.45 $828.45 $828.45 $172.67 $828.45 $828.45 $828.45 $828.45 $828.45 $172.66 $828.45 $828.45 $490.03 $828.45 $828.45 $828.45 $828.45 $621.38 $828.45 $828.45 $828.45 $414.23 $414.23 $656.13 $828.45 $662.76 $372.80 $164.43 N/A $480.53 $828.45 $497.07 $828.45 $172.65 $828.45 N/A N/A 3571141003 SUP HCPCS C1713 3571141003 - PLATE BN STRL 3 HL BTRS TIBHD RL BOTH IP/OP "$1,423.00" "$1,053.00" $282.38 "$1,422.75" $640.24 $640.24 $640.24 $640.24 "$1,422.75" "$1,422.75" "$1,422.75" $296.54 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" $296.52 "$1,422.75" $569.10 $841.56 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,067.25" "$1,422.75" "$1,422.75" "$1,422.75" $711.38 $711.38 "$1,126.82" "$1,422.75" "$1,138.20" $640.24 $282.38 N/A $825.34 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" N/A N/A 3571141005 SUP HCPCS C1713 3571141005 - PLATE BN 118MM STRL 5 HL BTRS TIBHD RL BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" $667.80 $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,001.70" "$1,669.50" $347.92 "$1,669.50" N/A N/A 3571141007 SUP HCPCS C1713 3571141007 - PLATE BN 149MM STRL 7 HL BTRS TIBHD RL BOTH IP/OP "$1,785.00" "$1,321.00" $354.28 "$1,785.00" $803.25 $803.25 $803.25 $803.25 "$1,785.00" "$1,785.00" "$1,785.00" $372.04 "$1,785.00" "$1,785.00" "$1,785.00" "$1,785.00" "$1,785.00" $372.01 "$1,785.00" $714.00 "$1,055.83" "$1,785.00" "$1,785.00" "$1,785.00" "$1,785.00" "$1,338.75" "$1,785.00" "$1,785.00" "$1,785.00" $892.50 $892.50 "$1,413.72" "$1,785.00" "$1,428.00" $803.25 $354.28 N/A "$1,035.30" "$1,785.00" "$1,071.00" "$1,785.00" "$1,785.00" "$1,785.00" N/A N/A 3571141009 SUP HCPCS C1713 3571141009 - PLATE BN 181MM STRL 9 HL BTRS TIBHD RL BOTH IP/OP "$1,906.00" "$1,410.00" $378.24 "$1,905.75" $857.59 $857.59 $857.59 $857.59 "$1,905.75" "$1,905.75" "$1,905.75" $397.21 "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" $397.18 "$1,905.75" "$1,905.75" "$1,127.25" "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" "$1,429.50" "$1,905.75" "$1,905.75" "$1,905.75" $952.88 $952.88 "$1,509.35" "$1,905.75" "$1,524.60" $857.59 $378.24 N/A "$1,105.48" "$1,905.75" "$1,143.45" "$1,905.75" "$1,905.75" "$1,905.75" N/A N/A 3571141011 SUP HCPCS C1713 3571141011 - PLATE BN 214MM STRL 11 HL BTRS TIBHD RL BOTH IP/OP "$2,499.00" "$1,849.00" $495.99 "$2,499.00" "$1,124.55" "$1,124.55" "$1,124.55" "$1,124.55" "$2,499.00" "$2,499.00" "$2,499.00" $520.85 "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" $520.82 "$2,499.00" "$2,499.00" "$1,478.16" "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" "$1,874.25" "$2,499.00" "$2,499.00" "$2,499.00" "$1,249.50" "$1,249.50" "$1,979.21" "$2,499.00" "$1,999.20" "$1,124.55" $495.99 N/A "$1,449.42" "$2,499.00" "$2,499.00" "$2,499.00" $520.79 "$2,499.00" N/A N/A 3571141013 SUP HCPCS C1713 3571141013 - PLATE BN 246MM STRL 13 HL BTRS TIBHD RL BOTH IP/OP "$2,593.50" "$1,919.00" $514.74 "$2,593.50" "$1,167.08" "$1,167.08" "$1,167.08" "$1,167.08" "$2,593.50" "$2,593.50" "$2,593.50" $540.55 "$2,593.50" "$2,593.50" "$2,593.50" "$2,593.50" "$2,593.50" $540.51 "$2,593.50" "$2,593.50" "$1,278.60" "$2,593.50" "$2,593.50" "$2,593.50" "$2,593.50" "$1,945.13" "$2,593.50" "$2,593.50" "$2,593.50" "$1,296.75" "$1,296.75" "$2,054.05" "$2,593.50" "$2,074.80" "$1,167.08" $514.74 N/A "$1,504.23" "$2,593.50" "$2,593.50" "$2,593.50" $540.49 "$2,593.50" N/A N/A 3571141103 SUP HCPCS C1713 3571141103 - PLATE BN STRL 3 HL BTRS TIBHD L/L BOTH IP/OP "$1,423.00" "$1,053.00" $282.38 "$1,422.75" $640.24 $640.24 $640.24 $640.24 "$1,422.75" "$1,422.75" "$1,422.75" $296.54 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" $296.52 "$1,422.75" "$1,422.75" $841.56 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,067.25" "$1,422.75" "$1,422.75" "$1,422.75" $711.38 $711.38 "$1,126.82" "$1,422.75" "$1,138.20" $640.24 $282.38 N/A $825.34 "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" "$1,422.75" N/A N/A 3571141105 SUP HCPCS C1713 3571141105 - PLATE BN 118MM STRL 5 HL BTRS TIBHD L/L BOTH IP/OP "$1,669.50" "$1,235.00" $331.35 "$1,669.50" $751.28 $751.28 $751.28 $751.28 "$1,669.50" "$1,669.50" "$1,669.50" $347.97 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" $347.94 "$1,669.50" "$1,669.50" $987.51 "$1,669.50" "$1,669.50" "$1,669.50" "$1,669.50" "$1,252.13" "$1,669.50" "$1,669.50" "$1,669.50" $834.75 $834.75 "$1,322.24" "$1,669.50" "$1,335.60" $751.28 $331.35 N/A $968.31 "$1,669.50" "$1,001.70" "$1,669.50" $347.92 "$1,669.50" N/A N/A 3571141107 SUP HCPCS C1713 3571141107 - PLATE BN 149MM STRL 7 HL BTRS TIBHD L/L BOTH IP/OP "$1,785.00" "$1,321.00" $354.28 "$1,785.00" $803.25 $803.25 $803.25 $803.25 "$1,785.00" "$1,785.00" "$1,785.00" $372.04 "$1,785.00" "$1,785.00" "$1,785.00" "$1,785.00" "$1,785.00" $372.01 "$1,785.00" "$1,785.00" "$1,055.83" "$1,785.00" "$1,785.00" "$1,785.00" "$1,785.00" "$1,338.75" "$1,785.00" "$1,785.00" "$1,785.00" $892.50 $892.50 "$1,413.72" "$1,785.00" "$1,428.00" $803.25 $354.28 N/A "$1,035.30" "$1,785.00" "$1,071.00" "$1,785.00" "$1,785.00" "$1,785.00" N/A N/A 3571141109 SUP HCPCS C1713 3571141109 - PLATE BN 181MM STRL 9 HL BTRS TIBHD L/L BOTH IP/OP "$1,906.00" "$1,410.00" $378.24 "$1,905.75" $857.59 $857.59 $857.59 $857.59 "$1,905.75" "$1,905.75" "$1,905.75" $397.21 "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" $397.18 "$1,905.75" $762.30 "$1,127.25" "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" "$1,429.50" "$1,905.75" "$1,905.75" "$1,905.75" $952.88 $952.88 "$1,509.35" "$1,905.75" "$1,524.60" $857.59 $378.24 N/A "$1,105.48" "$1,905.75" "$1,905.75" "$1,905.75" $397.16 "$1,905.75" N/A N/A 3571141111 SUP HCPCS C1713 3571141111 - PLATE BN 214MM STRL 11 HL BTRS TIBHD L/L BOTH IP/OP "$2,499.00" "$1,849.00" $495.99 "$2,499.00" "$1,124.55" "$1,124.55" "$1,124.55" "$1,124.55" "$2,499.00" "$2,499.00" "$2,499.00" $520.85 "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" $520.82 "$2,499.00" $999.60 "$1,478.16" "$2,499.00" "$2,499.00" "$2,499.00" "$2,499.00" "$1,874.25" "$2,499.00" "$2,499.00" "$2,499.00" "$1,249.50" "$1,249.50" "$1,979.21" "$2,499.00" "$1,999.20" "$1,124.55" $495.99 N/A "$1,449.42" "$2,499.00" "$1,499.40" "$2,499.00" $520.79 "$2,499.00" N/A N/A 3571141113 SUP HCPCS C1713 3571141113 - PLATE BN 246MM STRL 13 HL BTRS TIBHD L/L BOTH IP/OP "$2,593.50" "$1,919.00" $514.74 "$2,593.50" "$1,167.08" "$1,167.08" "$1,167.08" "$1,167.08" "$2,593.50" "$2,593.50" "$2,593.50" $540.55 "$2,593.50" "$2,593.50" "$2,593.50" "$2,593.50" "$2,593.50" $540.51 "$2,593.50" "$1,037.40" "$1,278.60" "$2,593.50" "$2,593.50" "$2,593.50" "$2,593.50" "$1,945.13" "$2,593.50" "$2,593.50" "$2,593.50" "$1,296.75" "$1,296.75" "$2,054.05" "$2,593.50" "$2,074.80" "$1,167.08" $514.74 N/A "$1,504.23" "$2,593.50" "$2,593.50" "$2,593.50" $540.49 "$2,593.50" N/A N/A 3571141206 SUP HCPCS C1713 3571141206 - PLATE BN BRD 103MM STRL 6 HL 4.5MM SCR BOTH IP/OP $546.00 $404.00 $108.37 $546.00 $245.70 $245.70 $245.70 $245.70 $546.00 $546.00 $546.00 $113.80 $546.00 $546.00 $546.00 $546.00 $546.00 $113.79 $546.00 $546.00 $322.96 $546.00 $546.00 $546.00 $546.00 $409.50 $546.00 $546.00 $546.00 $273.00 $273.00 $432.43 $546.00 $436.80 $245.70 $108.37 N/A $316.68 $546.00 $327.60 $546.00 $113.79 $546.00 N/A N/A 3571141207 SUP HCPCS C1713 3571141207 - PLATE BN BRD 119MM STRL 7 HL 4.5MM SCR BOTH IP/OP $546.00 $404.00 $108.37 $546.00 $245.70 $245.70 $245.70 $245.70 $546.00 $546.00 $546.00 $113.80 $546.00 $546.00 $546.00 $546.00 $546.00 $113.79 $546.00 $546.00 $322.96 $546.00 $546.00 $546.00 $546.00 $409.50 $546.00 $546.00 $546.00 $273.00 $273.00 $432.43 $546.00 $436.80 $245.70 $108.37 N/A $316.68 $546.00 $546.00 $546.00 $113.79 $546.00 N/A N/A 3571141208 SUP HCPCS C1713 3571141208 - PLATE BN BRD 135MM STRL 8 HL 4.5MM SCR BOTH IP/OP $680.50 $504.00 $135.04 $680.40 $306.18 $306.18 $306.18 $306.18 $680.40 $680.40 $680.40 $141.81 $680.40 $680.40 $680.40 $680.40 $680.40 $141.80 $680.40 $680.40 $402.46 $680.40 $680.40 $680.40 $680.40 $510.38 $680.40 $680.40 $680.40 $340.20 $340.20 $538.88 $680.40 $544.32 $306.18 $135.04 N/A $394.69 $680.40 $680.40 $680.40 $141.80 $680.40 N/A N/A 3571141209 SUP HCPCS C1713 3571141209 - PLATE BN BRD 151MM STRL 9 HL 4.5MM SCR BOTH IP/OP $680.50 $504.00 $135.04 $680.40 $306.18 $306.18 $306.18 $306.18 $680.40 $680.40 $680.40 $141.81 $680.40 $680.40 $680.40 $680.40 $680.40 $141.80 $680.40 $272.16 $402.46 $680.40 $680.40 $680.40 $680.40 $510.38 $680.40 $680.40 $680.40 $340.20 $340.20 $538.88 $680.40 $544.32 $306.18 $135.04 N/A $394.69 $680.40 $680.40 $680.40 $141.80 $680.40 N/A N/A 3571141210 SUP HCPCS C1713 3571141210 - PLATE BN BRD 167MM STRL 10 HL 4.5MM SCR BOTH IP/OP $680.50 $504.00 $135.04 $680.40 $306.18 $306.18 $306.18 $306.18 $680.40 $680.40 $680.40 $141.81 $680.40 $680.40 $680.40 $680.40 $680.40 $141.80 $680.40 $272.16 $402.46 $680.40 $680.40 $680.40 $680.40 $510.38 $680.40 $680.40 $680.40 $340.20 $340.20 $538.88 $680.40 $544.32 $306.18 $135.04 N/A $394.69 $680.40 $680.40 $680.40 $141.80 $680.40 N/A N/A 3571141212 SUP HCPCS C1713 3571141212 - PLATE BN BRD 199MM STRL 12 HL 4.5MM SCR BOTH IP/OP $732.00 $542.00 $145.25 $731.85 $329.33 $329.33 $329.33 $329.33 $731.85 $731.85 $731.85 $152.54 $731.85 $731.85 $731.85 $731.85 $731.85 $152.53 $731.85 $292.74 $432.89 $731.85 $731.85 $731.85 $731.85 $549.00 $731.85 $731.85 $731.85 $365.93 $365.93 $579.63 $731.85 $585.48 $329.33 $145.25 N/A $424.56 $731.85 $731.85 $731.85 $152.52 $731.85 N/A N/A 3571141214 SUP HCPCS C1713 3571141214 - PLATE BN BRD 231MM STRL 14 HL 4.5MM SCR BOTH IP/OP $732.00 $542.00 $145.25 $731.85 $329.33 $329.33 $329.33 $329.33 $731.85 $731.85 $731.85 $152.54 $731.85 $731.85 $731.85 $731.85 $731.85 $152.53 $731.85 $292.74 $432.89 $731.85 $731.85 $731.85 $731.85 $549.00 $731.85 $731.85 $731.85 $365.93 $365.93 $579.63 $731.85 $585.48 $329.33 $145.25 N/A $424.56 $731.85 $731.85 $731.85 $152.52 $731.85 N/A N/A 3571141216 SUP HCPCS C1713 3571141216 - PLATE BN BRD 263MM STRL 16 HL 4.5MM SCR BOTH IP/OP $926.50 $686.00 $183.81 $926.10 $416.75 $416.75 $416.75 $416.75 $926.10 $926.10 $926.10 $193.02 $926.10 $926.10 $926.10 $926.10 $926.10 $193.01 $926.10 $926.10 $547.79 $926.10 $926.10 $926.10 $926.10 $694.88 $926.10 $926.10 $926.10 $463.05 $463.05 $733.47 $926.10 $740.88 $416.75 $183.81 N/A $537.37 $926.10 $555.66 $926.10 $193.00 $926.10 N/A N/A 3571141218 SUP HCPCS C1713 3571141218 - PLATE BN BRD 295MM STRL 18 HL 4.5MM SCR BOTH IP/OP "$1,023.00" $757.00 $202.98 "$1,022.70" $460.22 $460.22 $460.22 $460.22 "$1,022.70" "$1,022.70" "$1,022.70" $213.16 "$1,022.70" "$1,022.70" "$1,022.70" "$1,022.70" "$1,022.70" $213.14 "$1,022.70" $409.08 $604.93 "$1,022.70" "$1,022.70" "$1,022.70" "$1,022.70" $767.25 "$1,022.70" "$1,022.70" "$1,022.70" $511.35 $511.35 $809.98 "$1,022.70" $818.16 $460.22 $202.98 N/A $593.34 "$1,022.70" $613.62 "$1,022.70" $213.13 "$1,022.70" N/A N/A 3571141220 SUP HCPCS C1713 3571141220 - PLATE BN BRD 326MM STRL 20 HL 4.5MM SCR BOTH IP/OP "$1,459.50" "$1,080.00" $289.67 "$1,459.50" $656.78 $656.78 $656.78 $656.78 "$1,459.50" "$1,459.50" "$1,459.50" $304.20 "$1,459.50" "$1,459.50" "$1,459.50" "$1,459.50" "$1,459.50" $304.18 "$1,459.50" $583.80 $863.29 "$1,459.50" "$1,459.50" "$1,459.50" "$1,459.50" "$1,094.63" "$1,459.50" "$1,459.50" "$1,459.50" $729.75 $729.75 "$1,155.92" "$1,459.50" "$1,167.60" $656.78 $289.67 N/A $846.51 "$1,459.50" $875.70 "$1,459.50" $304.16 "$1,459.50" N/A N/A 3571141222 SUP HCPCS C1713 3571141222 - PLATE BN BRD 358MM STRL 22 HL 4.5MM SCR BOTH IP/OP "$1,543.50" "$1,142.00" $306.35 "$1,543.50" $694.58 $694.58 $694.58 $694.58 "$1,543.50" "$1,543.50" "$1,543.50" $321.70 "$1,543.50" "$1,543.50" "$1,543.50" "$1,543.50" "$1,543.50" $321.68 "$1,543.50" $617.40 $912.98 "$1,543.50" "$1,543.50" "$1,543.50" "$1,543.50" "$1,157.63" "$1,543.50" "$1,543.50" "$1,543.50" $771.75 $771.75 "$1,222.45" "$1,543.50" "$1,234.80" $694.58 $306.35 N/A $895.23 "$1,543.50" "$1,543.50" "$1,543.50" "$1,543.50" "$1,543.50" N/A N/A 3571141224 SUP HCPCS C1713 3571141224 - PLATE BN BRD 390MM STRL 24 HL 4.5MM SCR BOTH IP/OP "$1,711.50" "$1,267.00" $339.69 "$1,711.50" $770.18 $770.18 $770.18 $770.18 "$1,711.50" "$1,711.50" "$1,711.50" $356.72 "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" $356.70 "$1,711.50" $684.60 "$1,012.35" "$1,711.50" "$1,711.50" "$1,711.50" "$1,711.50" "$1,283.63" "$1,711.50" "$1,711.50" "$1,711.50" $855.75 $855.75 "$1,355.51" "$1,711.50" "$1,369.20" $770.18 $339.69 N/A $992.67 "$1,711.50" "$1,026.90" "$1,711.50" $356.68 "$1,711.50" N/A N/A 3571141302 SUP HCPCS C1713 3571141302 - PLATE BN 39MM STRL 2 HL SMTB BOTH IP/OP $143.00 $106.00 $28.34 $142.80 $64.26 $64.26 $64.26 $64.26 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $84.47 $142.80 $142.80 $142.80 $142.80 $107.25 $142.80 $142.80 $142.80 $71.40 $71.40 $113.10 $142.80 $114.24 $64.26 $28.34 N/A $82.94 $142.80 $85.68 $142.80 $29.76 $142.80 N/A N/A 3571141303 SUP HCPCS C1713 3571141303 - PLATE BN 55MM STRL 3 HL SMTB BOTH IP/OP $147.00 $109.00 $29.18 $147.00 $66.15 $66.15 $66.15 $66.15 $147.00 $147.00 $147.00 $30.64 $147.00 $147.00 $147.00 $147.00 $147.00 $30.64 $147.00 $147.00 $86.95 $147.00 $147.00 $147.00 $147.00 $110.25 $147.00 $147.00 $147.00 $73.50 $73.50 $116.42 $147.00 $117.60 $66.15 $29.18 N/A $85.26 $147.00 $147.00 $147.00 $147.00 $147.00 N/A N/A 3571141304 SUP HCPCS C1713 3571141304 - PLATE BN 71MM STRL 4 HL SMTB BOTH IP/OP $160.00 $118.00 $31.68 $159.60 $71.82 $71.82 $71.82 $71.82 $159.60 $159.60 $159.60 $33.26 $159.60 $159.60 $159.60 $159.60 $159.60 $33.26 $159.60 $159.60 $94.40 $159.60 $159.60 $159.60 $159.60 $120.00 $159.60 $159.60 $159.60 $79.80 $79.80 $126.40 $159.60 $127.68 $71.82 $31.68 N/A $92.80 $159.60 $95.76 $159.60 $33.26 $159.60 N/A N/A 3571141305 SUP HCPCS C1713 3571141305 - PLATE BN 87MM STRL 5 HL SMTB BOTH IP/OP $167.00 $124.00 $33.14 $166.95 $75.13 $75.13 $75.13 $75.13 $166.95 $166.95 $166.95 $34.80 $166.95 $166.95 $166.95 $166.95 $166.95 $34.79 $166.95 $166.95 $98.75 $166.95 $166.95 $166.95 $166.95 $125.25 $166.95 $166.95 $166.95 $83.48 $83.48 $132.22 $166.95 $133.56 $75.13 $33.14 N/A $96.86 $166.95 $100.17 $166.95 $34.79 $166.95 N/A N/A 3571141306 SUP HCPCS C1713 3571141306 - PLATE BN 103MM STRL 6 HL SMTB BOTH IP/OP $177.50 $131.00 $35.22 $177.45 $79.85 $79.85 $79.85 $79.85 $177.45 $177.45 $177.45 $36.99 $177.45 $177.45 $177.45 $177.45 $177.45 $36.98 $177.45 $177.45 $104.96 $177.45 $177.45 $177.45 $177.45 $133.13 $177.45 $177.45 $177.45 $88.73 $88.73 $140.54 $177.45 $141.96 $79.85 $35.22 N/A $102.95 $177.45 $106.47 $177.45 $36.98 $177.45 N/A N/A 3571141307 SUP HCPCS C1713 3571141307 - PLATE BN 119MM STRL 7 HL SMTB BOTH IP/OP $192.50 $142.00 $38.14 $192.15 $86.47 $86.47 $86.47 $86.47 $192.15 $192.15 $192.15 $40.05 $192.15 $192.15 $192.15 $192.15 $192.15 $40.05 $192.15 $76.86 $113.66 $192.15 $192.15 $192.15 $192.15 $144.38 $192.15 $192.15 $192.15 $96.08 $96.08 $152.18 $192.15 $153.72 $86.47 $38.14 N/A $111.65 $192.15 $192.15 $192.15 $40.04 $192.15 N/A N/A 3571141308 SUP HCPCS C1713 3571141308 - PLATE BN 135MM STRL 8 HL SMTB BOTH IP/OP $247.00 $183.00 $48.97 $246.75 $111.04 $111.04 $111.04 $111.04 $246.75 $246.75 $246.75 $51.43 $246.75 $246.75 $246.75 $246.75 $246.75 $51.43 $246.75 $98.70 $145.95 $246.75 $246.75 $246.75 $246.75 $185.25 $246.75 $246.75 $246.75 $123.38 $123.38 $195.43 $246.75 $197.40 $111.04 $48.97 N/A $143.26 $246.75 $148.05 $246.75 $51.42 $246.75 N/A N/A 3571141309 SUP HCPCS C1713 3571141309 - PLATE BN 151MM STRL 9 HL SMTB BOTH IP/OP $218.50 $162.00 $43.35 $218.40 $98.28 $98.28 $98.28 $98.28 $218.40 $218.40 $218.40 $45.52 $218.40 $218.40 $218.40 $218.40 $218.40 $45.52 $218.40 $87.36 $129.18 $218.40 $218.40 $218.40 $218.40 $163.88 $218.40 $218.40 $218.40 $109.20 $109.20 $172.97 $218.40 $174.72 $98.28 $43.35 N/A $126.73 $218.40 $131.04 $218.40 $45.51 $218.40 N/A N/A 3571141310 SUP HCPCS C1713 3571141310 - PLATE BN 167MM STRL 10 HL SMTB BOTH IP/OP $271.00 $201.00 $53.77 $270.90 $121.91 $121.91 $121.91 $121.91 $270.90 $270.90 $270.90 $56.46 $270.90 $270.90 $270.90 $270.90 $270.90 $56.46 $270.90 $270.90 $160.24 $270.90 $270.90 $270.90 $270.90 $203.25 $270.90 $270.90 $270.90 $135.45 $135.45 $214.55 $270.90 $216.72 $121.91 $53.77 N/A $157.18 $270.90 $162.54 $270.90 $270.90 $270.90 N/A N/A 3571141311 SUP HCPCS C1713 3571141311 - PLATE BN 183MM STRL 11 HL SMTB BOTH IP/OP $282.50 $209.00 $56.06 $282.45 $127.10 $127.10 $127.10 $127.10 $282.45 $282.45 $282.45 $58.87 $282.45 $282.45 $282.45 $282.45 $282.45 $58.87 $282.45 $282.45 $167.07 $282.45 $282.45 $282.45 $282.45 $211.88 $282.45 $282.45 $282.45 $141.23 $141.23 $223.70 $282.45 $225.96 $127.10 $56.06 N/A $163.85 $282.45 $169.47 $282.45 $282.45 $282.45 N/A N/A 3571141312 SUP HCPCS C1713 3571141312 - PLATE BN 199MM STRL 12 HL SMTB BOTH IP/OP $289.00 $214.00 $57.31 $288.75 $129.94 $129.94 $129.94 $129.94 $288.75 $288.75 $288.75 $60.18 $288.75 $288.75 $288.75 $288.75 $288.75 $60.18 $288.75 $288.75 $170.80 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $129.94 $57.31 N/A $167.62 $288.75 $288.75 $288.75 $288.75 $288.75 N/A N/A 3571141402 SUP HCPCS C1713 3571141402 - PLATE BN NAR 39MM 2 HL SS 4.5MM SCR BOTH IP/OP $336.00 $249.00 $66.69 $336.00 $151.20 $151.20 $151.20 $151.20 $336.00 $336.00 $336.00 $70.03 $336.00 $336.00 $336.00 $336.00 $336.00 $70.03 $336.00 $336.00 $198.74 $336.00 $336.00 $336.00 $336.00 $252.00 $336.00 $336.00 $336.00 $168.00 $168.00 $266.11 $336.00 $268.80 $151.20 $66.69 N/A $194.88 $336.00 $336.00 $336.00 $70.02 $336.00 N/A N/A 3571141403 SUP HCPCS C1713 3571141403 - PLATE BN NAR 55MM 3 HL SS 4.5MM SCR BOTH IP/OP $353.00 $261.00 $70.02 $352.80 $158.76 $158.76 $158.76 $158.76 $352.80 $352.80 $352.80 $73.53 $352.80 $352.80 $352.80 $352.80 $352.80 $73.53 $352.80 $141.12 $208.68 $352.80 $352.80 $352.80 $352.80 $264.75 $352.80 $352.80 $352.80 $176.40 $176.40 $279.42 $352.80 $282.24 $158.76 $70.02 N/A $204.74 $352.80 $211.68 $352.80 $73.52 $352.80 N/A N/A 3571141404 SUP HCPCS C1713 3571141404 - PLATE BN NAR 71MM STRL 4 HL 4.5MM SCR BOTH IP/OP $369.00 $273.00 $73.15 $368.55 $165.85 $165.85 $165.85 $165.85 $368.55 $368.55 $368.55 $76.82 $368.55 $368.55 $368.55 $368.55 $368.55 $76.81 $368.55 $147.42 $218.00 $368.55 $368.55 $368.55 $368.55 $276.75 $368.55 $368.55 $368.55 $184.28 $184.28 $291.89 $368.55 $294.84 $165.85 $73.15 N/A $214.02 $368.55 $368.55 $368.55 $76.81 $368.55 N/A N/A 3571141405 SUP HCPCS C1713 3571141405 - PLATE BN NAR 87MM STRL 5 HL 4.5MM SCR BOTH IP/OP $369.00 $273.00 $73.15 $368.55 $165.85 $165.85 $165.85 $165.85 $368.55 $368.55 $368.55 $76.82 $368.55 $368.55 $368.55 $368.55 $368.55 $76.81 $368.55 $147.42 $218.00 $368.55 $368.55 $368.55 $368.55 $276.75 $368.55 $368.55 $368.55 $184.28 $184.28 $291.89 $368.55 $294.84 $165.85 $73.15 N/A $214.02 $368.55 $221.13 $368.55 $76.81 $368.55 N/A N/A 3571141406 SUP HCPCS C1713 3571141406 - PLATE BN NAR 103MM STRL 6 HL 4.5MM SCR BOTH IP/OP $411.00 $304.00 $81.48 $410.55 $184.75 $184.75 $184.75 $184.75 $410.55 $410.55 $410.55 $85.57 $410.55 $410.55 $410.55 $410.55 $410.55 $85.56 $410.55 $410.55 $242.84 $410.55 $410.55 $410.55 $410.55 $308.25 $410.55 $410.55 $410.55 $205.28 $205.28 $325.16 $410.55 $328.44 $184.75 $81.48 N/A $238.38 $410.55 $246.33 $410.55 $85.56 $410.55 N/A N/A 3571141407 SUP HCPCS C1713 3571141407 - PLATE BN NAR 119MM STRL 7 HL 4.5MM SCR BOTH IP/OP $411.00 $304.00 $81.48 $410.55 $184.75 $184.75 $184.75 $184.75 $410.55 $410.55 $410.55 $85.57 $410.55 $410.55 $410.55 $410.55 $410.55 $85.56 $410.55 $410.55 $242.84 $410.55 $410.55 $410.55 $410.55 $308.25 $410.55 $410.55 $410.55 $205.28 $205.28 $325.16 $410.55 $328.44 $184.75 $81.48 N/A $238.38 $410.55 $246.33 $410.55 $410.55 $410.55 N/A N/A 3571141408 SUP HCPCS C1713 3571141408 - PLATE BN NAR 135MM STRL 8 HL 4.5MM SCR BOTH IP/OP $411.00 $304.00 $81.48 $410.55 $184.75 $184.75 $184.75 $184.75 $410.55 $410.55 $410.55 $85.57 $410.55 $410.55 $410.55 $410.55 $410.55 $85.56 $410.55 $410.55 $242.84 $410.55 $410.55 $410.55 $410.55 $308.25 $410.55 $410.55 $410.55 $205.28 $205.28 $325.16 $410.55 $328.44 $184.75 $81.48 N/A $238.38 $410.55 $410.55 $410.55 $410.55 $410.55 N/A N/A 3571141409 SUP HCPCS C1713 3571141409 - PLATE BN NAR 151MM STRL 9 HL 4.5MM SCR BOTH IP/OP $411.00 $304.00 $81.48 $410.55 $184.75 $184.75 $184.75 $184.75 $410.55 $410.55 $410.55 $85.57 $410.55 $410.55 $410.55 $410.55 $410.55 $85.56 $410.55 $410.55 $242.84 $410.55 $410.55 $410.55 $410.55 $308.25 $410.55 $410.55 $410.55 $205.28 $205.28 $325.16 $410.55 $328.44 $184.75 $81.48 N/A $238.38 $410.55 $246.33 $410.55 $410.55 $410.55 N/A N/A 3571141410 SUP HCPCS C1713 3571141410 - PLATE BN NAR 167MM STRL 10 HL 4.5MM SCR BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $535.50 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $321.30 $535.50 $111.60 $535.50 N/A N/A 3571141411 SUP HCPCS C1713 3571141411 - PLATE BN NAR 183MM STRL 11 HL 4.5MM SCR BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $535.50 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $321.30 $535.50 $111.60 $535.50 N/A N/A 3571141412 SUP HCPCS C1713 3571141412 - PLATE BN NAR 199MM STRL 12 HL 4.5MM SCR BOTH IP/OP $535.50 $396.00 $106.28 $535.50 $240.98 $240.98 $240.98 $240.98 $535.50 $535.50 $535.50 $111.61 $535.50 $535.50 $535.50 $535.50 $535.50 $111.60 $535.50 $535.50 $316.75 $535.50 $535.50 $535.50 $535.50 $401.63 $535.50 $535.50 $535.50 $267.75 $267.75 $424.12 $535.50 $428.40 $240.98 $106.28 N/A $310.59 $535.50 $535.50 $535.50 $111.60 $535.50 N/A N/A 3571141413 SUP HCPCS C1713 3571141413 - PLATE BN NAR 215MM STRL 13 HL 4.5MM SCR BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $630.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $131.29 $630.00 N/A N/A 3571141414 SUP HCPCS C1713 3571141414 - PLATE BN NAR 231MM STRL 14 HL 4.5MM SCR BOTH IP/OP $763.50 $565.00 $151.51 $763.35 $343.51 $343.51 $343.51 $343.51 $763.35 $763.35 $763.35 $159.10 $763.35 $763.35 $763.35 $763.35 $763.35 $159.09 $763.35 $763.35 $451.52 $763.35 $763.35 $763.35 $763.35 $572.63 $763.35 $763.35 $763.35 $381.68 $381.68 $604.57 $763.35 $610.68 $343.51 $151.51 N/A $442.83 $763.35 $763.35 $763.35 $159.08 $763.35 N/A N/A 3571141415 SUP HCPCS C1713 3571141415 - PLATE BN NAR 247MM STRL 15 HL 4.5MM SCR BOTH IP/OP $805.50 $596.00 $159.84 $805.35 $362.41 $362.41 $362.41 $362.41 $805.35 $805.35 $805.35 $167.86 $805.35 $805.35 $805.35 $805.35 $805.35 $167.84 $805.35 $805.35 $476.36 $805.35 $805.35 $805.35 $805.35 $604.13 $805.35 $805.35 $805.35 $402.68 $402.68 $637.84 $805.35 $644.28 $362.41 $159.84 N/A $467.19 $805.35 $483.21 $805.35 $167.83 $805.35 N/A N/A 3571141416 SUP HCPCS C1713 3571141416 - PLATE BN NAR 263MM STRL 16 HL 4.5MM SCR BOTH IP/OP $805.50 $596.00 $159.84 $805.35 $362.41 $362.41 $362.41 $362.41 $805.35 $805.35 $805.35 $167.86 $805.35 $805.35 $805.35 $805.35 $805.35 $167.84 $805.35 $805.35 $476.36 $805.35 $805.35 $805.35 $805.35 $604.13 $805.35 $805.35 $805.35 $402.68 $402.68 $637.84 $805.35 $644.28 $362.41 $159.84 N/A $467.19 $805.35 $805.35 $805.35 $167.83 $805.35 N/A N/A 3571141418 SUP HCPCS C1713 3571141418 - PLATE BN NAR 295MM STRL 18 HL 4.5MM SCR BOTH IP/OP "$1,150.00" $851.00 $228.20 "$1,149.75" $517.39 $517.39 $517.39 $517.39 "$1,149.75" "$1,149.75" "$1,149.75" $239.64 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $239.62 "$1,149.75" "$1,149.75" $680.08 "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" $862.50 "$1,149.75" "$1,149.75" "$1,149.75" $574.88 $574.88 $910.60 "$1,149.75" $919.80 $517.39 $228.20 N/A $667.00 "$1,149.75" "$1,149.75" "$1,149.75" $239.61 "$1,149.75" N/A N/A 3571141420 SUP HCPCS C1713 3571141420 - PLATE BN NAR 326MM STRL 20 HL 4.5MM SCR BOTH IP/OP "$1,038.50" $768.00 $206.11 "$1,038.45" $467.30 $467.30 $467.30 $467.30 "$1,038.45" "$1,038.45" "$1,038.45" $216.44 "$1,038.45" "$1,038.45" "$1,038.45" "$1,038.45" "$1,038.45" $216.42 "$1,038.45" "$1,038.45" $614.24 "$1,038.45" "$1,038.45" "$1,038.45" "$1,038.45" $778.88 "$1,038.45" "$1,038.45" "$1,038.45" $519.23 $519.23 $822.45 "$1,038.45" $830.76 $467.30 $206.11 N/A $602.33 "$1,038.45" $623.07 "$1,038.45" $216.41 "$1,038.45" N/A N/A 3571141422 SUP HCPCS C1713 3571141422 - PLATE BN NAR 358MM STRL 22 HL 4.5MM SCR BOTH IP/OP "$1,402.00" "$1,037.00" $278.21 "$1,401.75" $630.79 $630.79 $630.79 $630.79 "$1,401.75" "$1,401.75" "$1,401.75" $292.16 "$1,401.75" "$1,401.75" "$1,401.75" "$1,401.75" "$1,401.75" $292.14 "$1,401.75" "$1,401.75" $829.14 "$1,401.75" "$1,401.75" "$1,401.75" "$1,401.75" "$1,051.50" "$1,401.75" "$1,401.75" "$1,401.75" $700.88 $700.88 "$1,110.19" "$1,401.75" "$1,121.40" $630.79 $278.21 N/A $813.16 "$1,401.75" $841.05 "$1,401.75" $292.12 "$1,401.75" N/A N/A 3571141424 SUP HCPCS C1713 3571141424 - PLATE BN NAR 390MM STRL 24 HL 4.5MM SCR BOTH IP/OP "$1,517.50" "$1,123.00" $301.14 "$1,517.25" $682.76 $682.76 $682.76 $682.76 "$1,517.25" "$1,517.25" "$1,517.25" $316.23 "$1,517.25" "$1,517.25" "$1,517.25" "$1,517.25" "$1,517.25" $316.21 "$1,517.25" "$1,517.25" $897.45 "$1,517.25" "$1,517.25" "$1,517.25" "$1,517.25" "$1,138.13" "$1,517.25" "$1,517.25" "$1,517.25" $758.63 $758.63 "$1,201.66" "$1,517.25" "$1,213.80" $682.76 $301.14 N/A $880.15 "$1,517.25" $910.35 "$1,517.25" $316.19 "$1,517.25" N/A N/A 3571141603 SUP HCPCS C1713 3571141603 - PLATE BN T 68MM STRL 3 HL BOTH IP/OP $568.50 $421.00 $112.74 $568.05 $255.62 $255.62 $255.62 $255.62 $568.05 $568.05 $568.05 $118.40 $568.05 $568.05 $568.05 $568.05 $568.05 $118.39 $568.05 $568.05 $336.00 $568.05 $568.05 $568.05 $568.05 $426.38 $568.05 $568.05 $568.05 $284.03 $284.03 $449.90 $568.05 $454.44 $255.62 $112.74 N/A $329.73 $568.05 $340.83 $568.05 $118.38 $568.05 N/A N/A 3571141604 SUP HCPCS C1713 3571141604 - PLATE BN T 84MM STRL 4 HL BOTH IP/OP $631.50 $467.00 $125.25 $631.05 $283.97 $283.97 $283.97 $283.97 $631.05 $631.05 $631.05 $131.53 $631.05 $631.05 $631.05 $631.05 $631.05 $131.52 $631.05 $631.05 $373.27 $631.05 $631.05 $631.05 $631.05 $473.63 $631.05 $631.05 $631.05 $315.53 $315.53 $499.79 $631.05 $504.84 $283.97 $125.25 N/A $366.27 $631.05 $378.63 $631.05 $131.51 $631.05 N/A N/A 3571141605 SUP HCPCS C1713 3571141605 - PLATE BN T 100MM STRL 5 HL BOTH IP/OP $671.00 $497.00 $133.17 $670.95 $301.93 $301.93 $301.93 $301.93 $670.95 $670.95 $670.95 $139.84 $670.95 $670.95 $670.95 $670.95 $670.95 $139.83 $670.95 $670.95 $396.87 $670.95 $670.95 $670.95 $670.95 $503.25 $670.95 $670.95 $670.95 $335.48 $335.48 $531.39 $670.95 $536.76 $301.93 $133.17 N/A $389.18 $670.95 $402.57 $670.95 $139.83 $670.95 N/A N/A 3571141606 SUP HCPCS C1713 3571141606 - PLATE BN T 116MM STRL 6 HL BOTH IP/OP $742.50 $549.00 $147.34 $742.35 $334.06 $334.06 $334.06 $334.06 $742.35 $742.35 $742.35 $154.72 $742.35 $742.35 $742.35 $742.35 $742.35 $154.71 $742.35 $742.35 $439.10 $742.35 $742.35 $742.35 $742.35 $556.88 $742.35 $742.35 $742.35 $371.18 $371.18 $587.94 $742.35 $593.88 $334.06 $147.34 N/A $430.65 $742.35 $445.41 $742.35 $742.35 $742.35 N/A N/A 3571141608 SUP HCPCS C1713 3571141608 - PLATE BN T 148MM STRL 8 HL BOTH IP/OP "$1,026.00" $759.00 $203.61 "$1,025.85" $461.63 $461.63 $461.63 $461.63 "$1,025.85" "$1,025.85" "$1,025.85" $213.81 "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" $213.80 "$1,025.85" "$1,025.85" $606.79 "$1,025.85" "$1,025.85" "$1,025.85" "$1,025.85" $769.50 "$1,025.85" "$1,025.85" "$1,025.85" $512.93 $512.93 $812.47 "$1,025.85" $820.68 $461.63 $203.61 N/A $595.08 "$1,025.85" $615.51 "$1,025.85" "$1,025.85" "$1,025.85" N/A N/A 3571142007 SUP HCPCS C1713 3571142007 - PLATE BN 158MM STRL 7 HL BTRS CNDYL BOTH IP/OP "$1,953.00" "$1,445.00" $387.62 "$1,953.00" $878.85 $878.85 $878.85 $878.85 "$1,953.00" "$1,953.00" "$1,953.00" $407.05 "$1,953.00" "$1,953.00" "$1,953.00" "$1,953.00" "$1,953.00" $407.03 "$1,953.00" "$1,953.00" "$1,155.20" "$1,953.00" "$1,953.00" "$1,953.00" "$1,953.00" "$1,464.75" "$1,953.00" "$1,953.00" "$1,953.00" $976.50 $976.50 "$1,546.78" "$1,953.00" "$1,562.40" $878.85 $387.62 N/A "$1,132.74" "$1,953.00" "$1,171.80" "$1,953.00" $407.01 "$1,953.00" N/A N/A 3571142009 SUP HCPCS C1713 3571142009 - PLATE BN 190MM STRL 9 HL BTRS CNDYL BOTH IP/OP "$2,026.50" "$1,500.00" $402.21 "$2,026.50" $911.93 $911.93 $911.93 $911.93 "$2,026.50" "$2,026.50" "$2,026.50" $422.37 "$2,026.50" "$2,026.50" "$2,026.50" "$2,026.50" "$2,026.50" $422.34 "$2,026.50" "$2,026.50" "$1,198.67" "$2,026.50" "$2,026.50" "$2,026.50" "$2,026.50" "$1,519.88" "$2,026.50" "$2,026.50" "$2,026.50" "$1,013.25" "$1,013.25" "$1,604.99" "$2,026.50" "$1,621.20" $911.93 $402.21 N/A "$1,175.37" "$2,026.50" "$1,215.90" "$2,026.50" $422.32 "$2,026.50" N/A N/A 3571142011 SUP HCPCS C1713 3571142011 - PLATE BN 221MM STRL 11 HL BTRS CNDYL BOTH IP/OP "$2,541.00" "$1,880.00" $504.32 "$2,541.00" "$1,143.45" "$1,143.45" "$1,143.45" "$1,143.45" "$2,541.00" "$2,541.00" "$2,541.00" $529.61 "$2,541.00" "$2,541.00" "$2,541.00" "$2,541.00" "$2,541.00" $529.57 "$2,541.00" "$2,541.00" "$1,252.71" "$2,541.00" "$2,541.00" "$2,541.00" "$2,541.00" "$1,905.75" "$2,541.00" "$2,541.00" "$2,541.00" "$1,270.50" "$1,270.50" "$2,012.47" "$2,541.00" "$2,032.80" "$1,143.45" $504.32 N/A "$1,473.78" "$2,541.00" "$1,524.60" "$2,541.00" $529.54 "$2,541.00" N/A N/A 3571142013 SUP HCPCS C1713 3571142013 - PLATE BN 253MM STRL 13 HL BTRS CNDYL BOTH IP/OP "$2,137.00" "$1,581.00" $424.09 "$2,136.75" $961.54 $961.54 $961.54 $961.54 "$2,136.75" "$2,136.75" "$2,136.75" $445.35 "$2,136.75" "$2,136.75" "$2,136.75" "$2,136.75" "$2,136.75" $445.32 "$2,136.75" "$2,136.75" "$1,263.89" "$2,136.75" "$2,136.75" "$2,136.75" "$2,136.75" "$1,602.75" "$2,136.75" "$2,136.75" "$2,136.75" "$1,068.38" "$1,068.38" "$1,692.31" "$2,136.75" "$1,709.40" $961.54 $424.09 N/A "$1,239.46" "$2,136.75" "$1,282.05" "$2,136.75" $445.30 "$2,136.75" N/A N/A 3571142015 SUP HCPCS C1713 3571142015 - PLATE BN 285MM STRL 15 HL BTRS CNDYL BOTH IP/OP "$2,683.00" "$1,985.00" $532.46 "$2,682.75" "$1,207.24" "$1,207.24" "$1,207.24" "$1,207.24" "$2,682.75" "$2,682.75" "$2,682.75" $559.15 "$2,682.75" "$2,682.75" "$2,682.75" "$2,682.75" "$2,682.75" $559.11 "$2,682.75" "$2,682.75" "$1,322.60" "$2,682.75" "$2,682.75" "$2,682.75" "$2,682.75" "$2,012.25" "$2,682.75" "$2,682.75" "$2,682.75" "$1,341.38" "$1,341.38" "$2,124.74" "$2,682.75" "$2,146.20" "$1,207.24" $532.46 N/A "$1,556.14" "$2,682.75" "$1,609.65" "$2,682.75" "$2,682.75" "$2,682.75" N/A N/A 3571142107 SUP HCPCS C1713 3571142107 - PLATE BN 158MM STRL 7 HL BTRS CNDYL BOTH IP/OP "$2,368.00" "$1,752.00" $469.94 "$2,367.75" "$1,065.49" "$1,065.49" "$1,065.49" "$1,065.49" "$2,367.75" "$2,367.75" "$2,367.75" $493.50 "$2,367.75" "$2,367.75" "$2,367.75" "$2,367.75" "$2,367.75" $493.47 "$2,367.75" "$2,367.75" "$1,400.52" "$2,367.75" "$2,367.75" "$2,367.75" "$2,367.75" "$1,776.00" "$2,367.75" "$2,367.75" "$2,367.75" "$1,183.88" "$1,183.88" "$1,875.26" "$2,367.75" "$1,894.20" "$1,065.49" $469.94 N/A "$1,373.44" "$2,367.75" "$1,420.65" "$2,367.75" "$2,367.75" "$2,367.75" N/A N/A 3571142109 SUP HCPCS C1713 3571142109 - PLATE BN 190MM STRL 9 HL BTRS CNDYL BOTH IP/OP "$2,026.50" "$1,500.00" $402.21 "$2,026.50" $911.93 $911.93 $911.93 $911.93 "$2,026.50" "$2,026.50" "$2,026.50" $422.37 "$2,026.50" "$2,026.50" "$2,026.50" "$2,026.50" "$2,026.50" $422.34 "$2,026.50" $810.60 "$1,198.67" "$2,026.50" "$2,026.50" "$2,026.50" "$2,026.50" "$1,519.88" "$2,026.50" "$2,026.50" "$2,026.50" "$1,013.25" "$1,013.25" "$1,604.99" "$2,026.50" "$1,621.20" $911.93 $402.21 N/A "$1,175.37" "$2,026.50" "$2,026.50" "$2,026.50" $422.32 "$2,026.50" N/A N/A 3571142111 SUP HCPCS C1713 3571142111 - PLATE BN 221MM STRL 11 HL BTRS CNDYL BOTH IP/OP "$2,541.00" "$1,880.00" $504.32 "$2,541.00" "$1,143.45" "$1,143.45" "$1,143.45" "$1,143.45" "$2,541.00" "$2,541.00" "$2,541.00" $529.61 "$2,541.00" "$2,541.00" "$2,541.00" "$2,541.00" "$2,541.00" $529.57 "$2,541.00" "$1,016.40" "$1,252.71" "$2,541.00" "$2,541.00" "$2,541.00" "$2,541.00" "$1,905.75" "$2,541.00" "$2,541.00" "$2,541.00" "$1,270.50" "$1,270.50" "$2,012.47" "$2,541.00" "$2,032.80" "$1,143.45" $504.32 N/A "$1,473.78" "$2,541.00" "$1,524.60" "$2,541.00" "$2,541.00" "$2,541.00" N/A N/A 3571142113 SUP HCPCS C1713 3571142113 - PLATE BN 253MM STRL 13 HL BTRS CNDYL BOTH IP/OP "$2,604.00" "$1,927.00" $516.83 "$2,604.00" "$1,171.80" "$1,171.80" "$1,171.80" "$1,171.80" "$2,604.00" "$2,604.00" "$2,604.00" $542.74 "$2,604.00" "$2,604.00" "$2,604.00" "$2,604.00" "$2,604.00" $542.70 "$2,604.00" "$1,041.60" "$1,283.77" "$2,604.00" "$2,604.00" "$2,604.00" "$2,604.00" "$1,953.00" "$2,604.00" "$2,604.00" "$2,604.00" "$1,302.00" "$1,302.00" "$2,062.37" "$2,604.00" "$2,083.20" "$1,171.80" $516.83 N/A "$1,510.32" "$2,604.00" "$1,562.40" "$2,604.00" "$2,604.00" "$2,604.00" N/A N/A 3571142115 SUP HCPCS C1713 3571142115 - PLATE BN 285MM STRL 15 HL BTRS CNDYL BOTH IP/OP "$2,683.00" "$1,985.00" $532.46 "$2,682.75" "$1,207.24" "$1,207.24" "$1,207.24" "$1,207.24" "$2,682.75" "$2,682.75" "$2,682.75" $559.15 "$2,682.75" "$2,682.75" "$2,682.75" "$2,682.75" "$2,682.75" $559.11 "$2,682.75" "$1,073.10" "$1,322.60" "$2,682.75" "$2,682.75" "$2,682.75" "$2,682.75" "$2,012.25" "$2,682.75" "$2,682.75" "$2,682.75" "$1,341.38" "$1,341.38" "$2,124.74" "$2,682.75" "$2,146.20" "$1,207.24" $532.46 N/A "$1,556.14" "$2,682.75" "$2,682.75" "$2,682.75" $559.09 "$2,682.75" N/A N/A 3571143113 SUP HCPCS C1713 3571143113 - WASHER BN 13MM SS BOTH IP/OP $85.50 $63.00 $16.91 $85.20 $38.34 $38.34 $38.34 $38.34 $85.20 $85.20 $85.20 $17.76 $85.20 $85.20 $85.20 $85.20 $85.20 $17.76 $85.20 $34.08 $50.40 $85.20 $85.20 $85.20 $85.20 $64.13 $85.20 $85.20 $85.20 $42.60 $42.60 $67.48 $85.20 $68.16 $38.34 $16.91 N/A $49.59 $85.20 $51.12 $85.20 $85.20 $85.20 N/A N/A 3571145020 SUP HCPCS C1713 3571145020 - PLATE BN STRG STRL 20 HL SS CNDYL 1.5MM SCR BOTH IP/OP $570.50 $422.00 $113.16 $570.15 $256.57 $256.57 $256.57 $256.57 $570.15 $570.15 $570.15 $118.83 $570.15 $570.15 $570.15 $570.15 $570.15 $118.83 $570.15 $570.15 $337.24 $570.15 $570.15 $570.15 $570.15 $427.88 $570.15 $570.15 $570.15 $285.08 $285.08 $451.56 $570.15 $456.12 $256.57 $113.16 N/A $330.89 $570.15 $342.09 $570.15 $118.82 $570.15 N/A N/A 3571145022 SUP HCPCS C1713 3571145022 - PLATE BN T 3X9 HL SS CNDYL 1.5MM SCR BOTH IP/OP $504.00 $373.00 $100.03 $504.00 $226.80 $226.80 $226.80 $226.80 $504.00 $504.00 $504.00 $105.05 $504.00 $504.00 $504.00 $504.00 $504.00 $105.04 $504.00 $504.00 $298.12 $504.00 $504.00 $504.00 $504.00 $378.00 $504.00 $504.00 $504.00 $252.00 $252.00 $399.17 $504.00 $403.20 $226.80 $100.03 N/A $292.32 $504.00 $302.40 $504.00 $105.03 $504.00 N/A N/A 3571145024 SUP HCPCS C1713 3571145024 - PLATE BN T 4X9 HL SS CNDYL 1.5MM SCR BOTH IP/OP $534.50 $396.00 $106.07 $534.45 $240.50 $240.50 $240.50 $240.50 $534.45 $534.45 $534.45 $111.39 $534.45 $534.45 $534.45 $534.45 $534.45 $111.39 $534.45 $534.45 $316.13 $534.45 $534.45 $534.45 $534.45 $400.88 $534.45 $534.45 $534.45 $267.23 $267.23 $423.28 $534.45 $427.56 $240.50 $106.07 N/A $310.01 $534.45 $534.45 $534.45 $111.38 $534.45 N/A N/A 3571145026 SUP HCPCS C1713 3571145026 - PLATE BN 6 HL SS CNDYL LT 1.5 MM SCR BOTH IP/OP $709.00 $525.00 $140.67 $708.75 $318.94 $318.94 $318.94 $318.94 $708.75 $708.75 $708.75 $147.72 $708.75 $708.75 $708.75 $708.75 $708.75 $147.71 $708.75 $283.50 $419.23 $708.75 $708.75 $708.75 $708.75 $531.75 $708.75 $708.75 $708.75 $354.38 $354.38 $561.33 $708.75 $567.00 $318.94 $140.67 N/A $411.22 $708.75 $425.25 $708.75 $147.70 $708.75 N/A N/A 3571145028 SUP HCPCS C1713 3571145028 - PLATE BN 6 HL SS CNDYL RT 1.5 MM SCR BOTH IP/OP $709.00 $525.00 $140.67 $708.75 $318.94 $318.94 $318.94 $318.94 $708.75 $708.75 $708.75 $147.72 $708.75 $708.75 $708.75 $708.75 $708.75 $147.71 $708.75 $283.50 $419.23 $708.75 $708.75 $708.75 $708.75 $531.75 $708.75 $708.75 $708.75 $354.38 $354.38 $561.33 $708.75 $567.00 $318.94 $140.67 N/A $411.22 $708.75 $425.25 $708.75 $708.75 $708.75 N/A N/A 3571145030 SUP HCPCS C1713 3571145030 - PLATE BN H STRL 4 HL CNDYL 1.5MM SCR BOTH IP/OP $406.50 $301.00 $80.65 $406.35 $182.86 $182.86 $182.86 $182.86 $406.35 $406.35 $406.35 $84.69 $406.35 $406.35 $406.35 $406.35 $406.35 $84.69 $406.35 $162.54 $240.36 $406.35 $406.35 $406.35 $406.35 $304.88 $406.35 $406.35 $406.35 $203.18 $203.18 $321.83 $406.35 $325.08 $182.86 $80.65 N/A $235.77 $406.35 $243.81 $406.35 $406.35 $406.35 N/A N/A 3571146020 SUP HCPCS C1713 3571146020 - PLATE BN STRG 3 HL SS CNDYL 2MM SCR BOTH IP/OP $134.50 $100.00 $26.68 $134.40 $60.48 $60.48 $60.48 $60.48 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $79.50 $134.40 $134.40 $134.40 $134.40 $100.88 $134.40 $134.40 $134.40 $67.20 $67.20 $106.44 $134.40 $107.52 $60.48 $26.68 N/A $78.01 $134.40 $80.64 $134.40 $28.01 $134.40 N/A N/A 3571146022 SUP HCPCS C1713 3571146022 - PLATE BN STRG 4 HL SS CNDYL 2MM SCR BOTH IP/OP $148.50 $110.00 $29.38 $148.05 $66.62 $66.62 $66.62 $66.62 $148.05 $148.05 $148.05 $30.86 $148.05 $148.05 $148.05 $148.05 $148.05 $30.86 $148.05 $148.05 $87.57 $148.05 $148.05 $148.05 $148.05 $111.38 $148.05 $148.05 $148.05 $74.03 $74.03 $117.26 $148.05 $118.44 $66.62 $29.38 N/A $86.13 $148.05 $88.83 $148.05 $30.85 $148.05 N/A N/A 3571146024 SUP HCPCS C1713 3571146024 - PLATE BN STRG 5 HL SS CNDYL 2MM SCR BOTH IP/OP $160.00 $118.00 $31.68 $159.60 $71.82 $71.82 $71.82 $71.82 $159.60 $159.60 $159.60 $33.26 $159.60 $159.60 $159.60 $159.60 $159.60 $33.26 $159.60 $159.60 $94.40 $159.60 $159.60 $159.60 $159.60 $120.00 $159.60 $159.60 $159.60 $79.80 $79.80 $126.40 $159.60 $127.68 $71.82 $31.68 N/A $92.80 $159.60 $95.76 $159.60 $33.26 $159.60 N/A N/A 3571146026 SUP HCPCS C1713 3571146026 - PLATE BN STRG STRL 6 HL CNDYL 2MM SCR BOTH IP/OP $177.50 $131.00 $35.22 $177.45 $79.85 $79.85 $79.85 $79.85 $177.45 $177.45 $177.45 $36.99 $177.45 $177.45 $177.45 $177.45 $177.45 $36.98 $177.45 $177.45 $104.96 $177.45 $177.45 $177.45 $177.45 $133.13 $177.45 $177.45 $177.45 $88.73 $88.73 $140.54 $177.45 $141.96 $79.85 $35.22 N/A $102.95 $177.45 $106.47 $177.45 $36.98 $177.45 N/A N/A 3571146028 SUP HCPCS C1713 3571146028 - PLATE BN STRG 20 HL SS CNDYL 2MM SCR BOTH IP/OP $568.50 $421.00 $112.74 $568.05 $255.62 $255.62 $255.62 $255.62 $568.05 $568.05 $568.05 $118.40 $568.05 $568.05 $568.05 $568.05 $568.05 $118.39 $568.05 $568.05 $336.00 $568.05 $568.05 $568.05 $568.05 $426.38 $568.05 $568.05 $568.05 $284.03 $284.03 $449.90 $568.05 $454.44 $255.62 $112.74 N/A $329.73 $568.05 $340.83 $568.05 $118.38 $568.05 N/A N/A 3571146030 SUP HCPCS C1713 3571146030 - PLATE BN T 3X9 HL SS CNDYL 2MM SCR BOTH IP/OP $504.00 $373.00 $100.03 $504.00 $226.80 $226.80 $226.80 $226.80 $504.00 $504.00 $504.00 $105.05 $504.00 $504.00 $504.00 $504.00 $504.00 $105.04 $504.00 $504.00 $298.12 $504.00 $504.00 $504.00 $504.00 $378.00 $504.00 $504.00 $504.00 $252.00 $252.00 $399.17 $504.00 $403.20 $226.80 $100.03 N/A $292.32 $504.00 $302.40 $504.00 $105.03 $504.00 N/A N/A 3571146032 SUP HCPCS C1713 3571146032 - PLATE BN T 4X9 HL SS CNDYL 2MM SCR BOTH IP/OP $534.50 $396.00 $106.07 $534.45 $240.50 $240.50 $240.50 $240.50 $534.45 $534.45 $534.45 $111.39 $534.45 $534.45 $534.45 $534.45 $534.45 $111.39 $534.45 $534.45 $316.13 $534.45 $534.45 $534.45 $534.45 $400.88 $534.45 $534.45 $534.45 $267.23 $267.23 $423.28 $534.45 $427.56 $240.50 $106.07 N/A $310.01 $534.45 $320.67 $534.45 $534.45 $534.45 N/A N/A 3571146034 SUP HCPCS C1713 3571146034 - PLATE BN T 2X2 HL SS CNDYL 2MM SCR BOTH IP/OP $134.50 $100.00 $26.68 $134.40 $60.48 $60.48 $60.48 $60.48 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $79.50 $134.40 $134.40 $134.40 $134.40 $100.88 $134.40 $134.40 $134.40 $67.20 $67.20 $106.44 $134.40 $107.52 $60.48 $26.68 N/A $78.01 $134.40 $80.64 $134.40 $134.40 $134.40 N/A N/A 3571146036 SUP HCPCS C1713 3571146036 - PLATE BN L 3 HL OBLQ SS CNDYL RT 2MM SCR BOTH IP/OP $134.50 $100.00 $26.68 $134.40 $60.48 $60.48 $60.48 $60.48 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $79.50 $134.40 $134.40 $134.40 $134.40 $100.88 $134.40 $134.40 $134.40 $67.20 $67.20 $106.44 $134.40 $107.52 $60.48 $26.68 N/A $78.01 $134.40 $80.64 $134.40 $28.01 $134.40 N/A N/A 3571146038 SUP HCPCS C1713 3571146038 - PLATE BN L 3 HL OBLQ SS CNDYL LT 2MM SCR BOTH IP/OP $134.50 $100.00 $26.68 $134.40 $60.48 $60.48 $60.48 $60.48 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $134.40 $134.40 $134.40 $28.01 $134.40 $134.40 $79.50 $134.40 $134.40 $134.40 $134.40 $100.88 $134.40 $134.40 $134.40 $67.20 $67.20 $106.44 $134.40 $107.52 $60.48 $26.68 N/A $78.01 $134.40 $134.40 $134.40 $28.01 $134.40 N/A N/A 3571146040 SUP HCPCS C1713 3571146040 - PLATE BN 6 HL OBLQ SS CNDYL LT 2 MM SCR BOTH IP/OP $678.50 $502.00 $134.63 $678.30 $305.24 $305.24 $305.24 $305.24 $678.30 $678.30 $678.30 $141.37 $678.30 $678.30 $678.30 $678.30 $678.30 $141.37 $678.30 $678.30 $401.21 $678.30 $678.30 $678.30 $678.30 $508.88 $678.30 $678.30 $678.30 $339.15 $339.15 $537.21 $678.30 $542.64 $305.24 $134.63 N/A $393.53 $678.30 $406.98 $678.30 $141.36 $678.30 N/A N/A 3571146042 SUP HCPCS C1713 3571146042 - PLATE BN 6 HL OBLQ SS CNDYL RT 2 MM SCR BOTH IP/OP $678.50 $502.00 $134.63 $678.30 $305.24 $305.24 $305.24 $305.24 $678.30 $678.30 $678.30 $141.37 $678.30 $678.30 $678.30 $678.30 $678.30 $141.37 $678.30 $678.30 $401.21 $678.30 $678.30 $678.30 $678.30 $508.88 $678.30 $678.30 $678.30 $339.15 $339.15 $537.21 $678.30 $542.64 $305.24 $134.63 N/A $393.53 $678.30 $406.98 $678.30 $678.30 $678.30 N/A N/A 3571146048 SUP HCPCS C1713 3571146048 - PLATE BN H STRL 4 HL CNDYL 2MM SCR BOTH IP/OP $406.50 $301.00 $80.65 $406.35 $182.86 $182.86 $182.86 $182.86 $406.35 $406.35 $406.35 $84.69 $406.35 $406.35 $406.35 $406.35 $406.35 $84.69 $406.35 $406.35 $240.36 $406.35 $406.35 $406.35 $406.35 $304.88 $406.35 $406.35 $406.35 $203.18 $203.18 $321.83 $406.35 $325.08 $182.86 $80.65 N/A $235.77 $406.35 $243.81 $406.35 $406.35 $406.35 N/A N/A 3571147001 SUP HCPCS C1713 3571147001 - PLATE BN L STRL CNDYL RT 2.7MM SCR BOTH IP/OP $143.00 $106.00 $28.34 $142.80 $64.26 $64.26 $64.26 $64.26 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $84.47 $142.80 $142.80 $142.80 $142.80 $107.25 $142.80 $142.80 $142.80 $71.40 $71.40 $113.10 $142.80 $114.24 $64.26 $28.34 N/A $82.94 $142.80 $85.68 $142.80 $142.80 $142.80 N/A N/A 3571147002 SUP HCPCS C1713 3571147002 - PLATE BN L 3 HL OBLQ SS CNDYL LT 2.7MM SCR BOTH IP/OP $143.00 $106.00 $28.34 $142.80 $64.26 $64.26 $64.26 $64.26 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $84.47 $142.80 $142.80 $142.80 $142.80 $107.25 $142.80 $142.80 $142.80 $71.40 $71.40 $113.10 $142.80 $114.24 $64.26 $28.34 N/A $82.94 $142.80 $85.68 $142.80 $29.76 $142.80 N/A N/A 3571147003 SUP HCPCS C1713 3571147003 - PLATE BN L STRL CNDYL LT 2.7MM SCR BOTH IP/OP $143.00 $106.00 $28.34 $142.80 $64.26 $64.26 $64.26 $64.26 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $84.47 $142.80 $142.80 $142.80 $142.80 $107.25 $142.80 $142.80 $142.80 $71.40 $71.40 $113.10 $142.80 $114.24 $64.26 $28.34 N/A $82.94 $142.80 $85.68 $142.80 $142.80 $142.80 N/A N/A 3571147004 SUP HCPCS C1713 3571147004 - PLATE BN L 3 HL OBLQ SS CNDYL RT 2.7MM SCR BOTH IP/OP $143.00 $106.00 $28.34 $142.80 $64.26 $64.26 $64.26 $64.26 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $84.47 $142.80 $142.80 $142.80 $142.80 $107.25 $142.80 $142.80 $142.80 $71.40 $71.40 $113.10 $142.80 $114.24 $64.26 $28.34 N/A $82.94 $142.80 $85.68 $142.80 $142.80 $142.80 N/A N/A 3571147006 SUP HCPCS C1713 3571147006 - PLATE BN T 3 HL SS CNDYL 2.7MM SCR BOTH IP/OP $143.00 $106.00 $28.34 $142.80 $64.26 $64.26 $64.26 $64.26 $142.80 $142.80 $142.80 $29.76 $142.80 $142.80 $142.80 $142.80 $142.80 $29.76 $142.80 $57.12 $84.47 $142.80 $142.80 $142.80 $142.80 $107.25 $142.80 $142.80 $142.80 $71.40 $71.40 $113.10 $142.80 $114.24 $64.26 $28.34 N/A $82.94 $142.80 $85.68 $142.80 $142.80 $142.80 N/A N/A 3571147008 SUP HCPCS C1713 3571147008 - PLATE BN 6 HL SS CNDYL LT 2.7 MM SCR BOTH IP/OP $720.50 $533.00 $142.96 $720.30 $324.14 $324.14 $324.14 $324.14 $720.30 $720.30 $720.30 $150.13 $720.30 $720.30 $720.30 $720.30 $720.30 $150.12 $720.30 $288.12 $426.06 $720.30 $720.30 $720.30 $720.30 $540.38 $720.30 $720.30 $720.30 $360.15 $360.15 $570.48 $720.30 $576.24 $324.14 $142.96 N/A $417.89 $720.30 $720.30 $720.30 $150.11 $720.30 N/A N/A 3571147010 SUP HCPCS C1713 3571147010 - PLATE BN 6 HL SS CNDYL RT 2.7 MM SCR BOTH IP/OP $720.50 $533.00 $142.96 $720.30 $324.14 $324.14 $324.14 $324.14 $720.30 $720.30 $720.30 $150.13 $720.30 $720.30 $720.30 $720.30 $720.30 $150.12 $720.30 $288.12 $426.06 $720.30 $720.30 $720.30 $720.30 $540.38 $720.30 $720.30 $720.30 $360.15 $360.15 $570.48 $720.30 $576.24 $324.14 $142.96 N/A $417.89 $720.30 $432.18 $720.30 $720.30 $720.30 N/A N/A 3571147012 SUP HCPCS C1713 3571147012 - PLATE BN STRL 7 HL MLT FRAG CNDYL 2.7 MM SCR BOTH IP/OP $169.50 $125.00 $33.55 $169.05 $76.07 $76.07 $76.07 $76.07 $169.05 $169.05 $169.05 $35.23 $169.05 $169.05 $169.05 $169.05 $169.05 $35.23 $169.05 $67.62 $99.99 $169.05 $169.05 $169.05 $169.05 $127.13 $169.05 $169.05 $169.05 $84.53 $84.53 $133.89 $169.05 $135.24 $76.07 $33.55 N/A $98.31 $169.05 $101.43 $169.05 $169.05 $169.05 N/A N/A 3571148003 SUP HCPCS C1713 3571148003 - PLATE BN STRL 3 HL QT TBLR SS CNDYL BOTH IP/OP $160.00 $118.00 $31.68 $159.60 $71.82 $71.82 $71.82 $71.82 $159.60 $159.60 $159.60 $33.26 $159.60 $159.60 $159.60 $159.60 $159.60 $33.26 $159.60 $63.84 $94.40 $159.60 $159.60 $159.60 $159.60 $120.00 $159.60 $159.60 $159.60 $79.80 $79.80 $126.40 $159.60 $127.68 $71.82 $31.68 N/A $92.80 $159.60 $159.60 $159.60 $33.26 $159.60 N/A N/A 3571148004 SUP HCPCS C1713 3571148004 - PLATE BN 4 HL QT TBLR SS CNDYL BOTH IP/OP $175.50 $130.00 $34.80 $175.35 $78.91 $78.91 $78.91 $78.91 $175.35 $175.35 $175.35 $36.55 $175.35 $175.35 $175.35 $175.35 $175.35 $36.54 $175.35 $70.14 $103.72 $175.35 $175.35 $175.35 $175.35 $131.63 $175.35 $175.35 $175.35 $87.68 $87.68 $138.88 $175.35 $140.28 $78.91 $34.80 N/A $101.79 $175.35 $105.21 $175.35 $36.54 $175.35 N/A N/A 3571148005 SUP HCPCS C1713 3571148005 - PLATE BN 5 HL QT TBLR SS CNDYL BOTH IP/OP $186.00 $138.00 $36.89 $185.85 $83.63 $83.63 $83.63 $83.63 $185.85 $185.85 $185.85 $38.74 $185.85 $185.85 $185.85 $185.85 $185.85 $38.73 $185.85 $185.85 $109.93 $185.85 $185.85 $185.85 $185.85 $139.50 $185.85 $185.85 $185.85 $92.93 $92.93 $147.19 $185.85 $148.68 $83.63 $36.89 N/A $107.88 $185.85 $111.51 $185.85 $38.73 $185.85 N/A N/A 3571148006 SUP HCPCS C1713 3571148006 - PLATE BN 6 HL QT TBLR SS CNDYL BOTH IP/OP $206.00 $152.00 $40.85 $205.80 $92.61 $92.61 $92.61 $92.61 $205.80 $205.80 $205.80 $42.89 $205.80 $205.80 $205.80 $205.80 $205.80 $42.89 $205.80 $205.80 $121.73 $205.80 $205.80 $205.80 $205.80 $154.50 $205.80 $205.80 $205.80 $102.90 $102.90 $162.99 $205.80 $164.64 $92.61 $40.85 N/A $119.48 $205.80 $123.48 $205.80 $205.80 $205.80 N/A N/A 3571148007 SUP HCPCS C1713 3571148007 - PLATE BN STRL 7 HL QT TBLR CNDYL BOTH IP/OP $214.50 $159.00 $42.51 $214.20 $96.39 $96.39 $96.39 $96.39 $214.20 $214.20 $214.20 $44.64 $214.20 $214.20 $214.20 $214.20 $214.20 $44.64 $214.20 $214.20 $126.70 $214.20 $214.20 $214.20 $214.20 $160.88 $214.20 $214.20 $214.20 $107.10 $107.10 $169.65 $214.20 $171.36 $96.39 $42.51 N/A $124.41 $214.20 $128.52 $214.20 $214.20 $214.20 N/A N/A 3571148008 SUP HCPCS C1713 3571148008 - PLATE BN STRL 8 HL QT TBLR CNDYL BOTH IP/OP $228.00 $169.00 $45.22 $227.85 $102.53 $102.53 $102.53 $102.53 $227.85 $227.85 $227.85 $47.49 $227.85 $227.85 $227.85 $227.85 $227.85 $47.49 $227.85 $227.85 $134.77 $227.85 $227.85 $227.85 $227.85 $171.00 $227.85 $227.85 $227.85 $113.93 $113.93 $180.46 $227.85 $182.28 $102.53 $45.22 N/A $132.24 $227.85 $136.71 $227.85 $227.85 $227.85 N/A N/A 3571149106 SUP HCPCS C1713 3571149106 - SCREW BN 1.5MM 6MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $77.55 $77.55 N/A N/A 3571149107 SUP HCPCS C1713 3571149107 - SCREW BN 1.5MM 7MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 3571149108 SUP HCPCS C1713 3571149108 - SCREW BN 1.5MM 8MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $31.02 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $77.55 $77.55 N/A N/A 3571149109 SUP HCPCS C1713 3571149109 - SCREW BN 1.5MM 9MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $77.55 $77.55 N/A N/A 3571149110 SUP HCPCS C1713 3571149110 - SCREW BN 1.5MM 10MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 3571149111 SUP HCPCS C1713 3571149111 - SCREW BN 1.5MM 11MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 3571149112 SUP HCPCS C1713 3571149112 - SCREW BN 1.5MM 12MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 3571149114 SUP HCPCS C1713 3571149114 - SCREW BN 1.5MM 14MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 3571149116 SUP HCPCS C1713 3571149116 - SCREW BN 1.5MM 16MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 3571149118 SUP HCPCS C1713 3571149118 - SCREW BN 1.5MM 18MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $16.16 $77.55 N/A N/A 3571149120 SUP HCPCS C1713 3571149120 - SCREW BN 1.5MM 20MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $16.16 $77.55 N/A N/A 3571149122 SUP HCPCS C1713 3571149122 - SCREW BN 1.5MM 22MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $46.53 $77.55 $77.55 $77.55 N/A N/A 3571149124 SUP HCPCS C1713 3571149124 - SCREW BN 1.5MM 24MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $78.00 $58.00 $15.39 $77.55 $34.90 $34.90 $34.90 $34.90 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $77.55 $77.55 $77.55 $16.16 $77.55 $77.55 $45.87 $77.55 $77.55 $77.55 $77.55 $58.50 $77.55 $77.55 $77.55 $38.78 $38.78 $61.42 $77.55 $62.04 $34.90 $15.39 N/A $45.24 $77.55 $77.55 $77.55 $77.55 $77.55 N/A N/A 3571149306 SUP HCPCS C1713 3571149306 - SCREW BN 2MM 6MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $79.43 $79.43 N/A N/A 3571149308 SUP HCPCS C1713 3571149308 - SCREW BN 2MM 8MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $16.55 $79.43 N/A N/A 3571149310 SUP HCPCS C1713 3571149310 - SCREW BN 2MM 10MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $79.43 $79.43 N/A N/A 3571149312 SUP HCPCS C1713 3571149312 - SCREW BN 2MM 12MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $79.43 $79.43 N/A N/A 3571149314 SUP HCPCS C1713 3571149314 - SCREW BN 2MM 14MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $16.55 $79.43 N/A N/A 3571149316 SUP HCPCS C1713 3571149316 - SCREW BN 2MM 16MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $79.43 $79.43 N/A N/A 3571149318 SUP HCPCS C1713 3571149318 - SCREW BN 2MM 18MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $79.43 $79.43 N/A N/A 3571149320 SUP HCPCS C1713 3571149320 - SCREW BN 2MM 20MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $79.43 $79.43 N/A N/A 3571149322 SUP HCPCS C1713 3571149322 - SCREW BN 2MM 22MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $79.43 $79.43 $16.55 $79.43 N/A N/A 3571149324 SUP HCPCS C1713 3571149324 - SCREW BN 2MM 24MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $79.43 $79.43 $79.43 $79.43 N/A N/A 3571149326 SUP HCPCS C1713 3571149326 - SCREW BN 2MM 26MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $79.43 $79.43 N/A N/A 3571149328 SUP HCPCS C1713 3571149328 - SCREW BN 2MM 28MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $31.77 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $16.55 $79.43 N/A N/A 3571149330 SUP HCPCS C1713 3571149330 - SCREW BN 2MM 30MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $79.50 $59.00 $15.76 $79.43 $35.74 $35.74 $35.74 $35.74 $79.43 $79.43 $79.43 $16.56 $79.43 $79.43 $79.43 $79.43 $79.43 $16.55 $79.43 $79.43 $46.98 $79.43 $79.43 $79.43 $79.43 $59.63 $79.43 $79.43 $79.43 $39.72 $39.72 $62.91 $79.43 $63.54 $35.74 $15.76 N/A $46.11 $79.43 $47.66 $79.43 $16.55 $79.43 N/A N/A 3571149406 SUP HCPCS C1713 3571149406 - SCREW BN 2.7MM 6MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $69.73 $69.73 N/A N/A 3571149408 SUP HCPCS C1713 3571149408 - SCREW BN 2.7MM 8MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $69.73 $69.73 N/A N/A 3571149410 SUP HCPCS C1713 3571149410 - SCREW BN 2.7MM 10MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 3571149412 SUP HCPCS C1713 3571149412 - SCREW BN 2.7MM 12MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 3571149414 SUP HCPCS C1713 3571149414 - SCREW BN 2.7MM 14MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 3571149416 SUP HCPCS C1713 3571149416 - SCREW BN 2.7MM 16MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $69.73 $69.73 N/A N/A 3571149418 SUP HCPCS C1713 3571149418 - SCREW BN 2.7MM 18MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $69.73 $69.73 N/A N/A 3571149420 SUP HCPCS C1713 3571149420 - SCREW BN 2.7MM 20MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 3571149422 SUP HCPCS C1713 3571149422 - SCREW BN 2.7MM 22MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 3571149424 SUP HCPCS C1713 3571149424 - SCREW BN 2.7MM 24MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $69.73 $69.73 N/A N/A 3571149426 SUP HCPCS C1713 3571149426 - SCREW BN 2.7MM 26MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $69.73 $69.73 N/A N/A 3571149428 SUP HCPCS C1713 3571149428 - SCREW BN 2.7MM 28MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 3571149430 SUP HCPCS C1713 3571149430 - SCREW BN 2.7MM 30MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 3571149432 SUP HCPCS C1713 3571149432 - SCREW BN 2.7MM 32MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $69.73 $69.73 N/A N/A 3571149434 SUP HCPCS C1713 3571149434 - SCREW BN 2.7MM 34MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 3571149436 SUP HCPCS C1713 3571149436 - SCREW BN 2.7MM 36MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 3571149440 SUP HCPCS C1713 3571149440 - SCREW BN 2.7MM 40MM STRL TC100 HEX HD ST SS CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 3571149445 SUP HCPCS C1713 3571149445 - SCREW BN 2.7MM 45MM STRL HEX HD ST CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $27.89 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $14.53 $69.73 N/A N/A 3571149450 SUP HCPCS C1713 3571149450 - SCREW BN 2.7MM 50MM STRL HEX HD ST CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $41.84 $69.73 $69.73 $69.73 N/A N/A 3571149455 SUP HCPCS C1713 3571149455 - SCREW BN 2.7MM 55MM STRL HEX HD ST CORT BOTH IP/OP $70.00 $52.00 $13.84 $69.73 $31.38 $31.38 $31.38 $31.38 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $69.73 $69.73 $69.73 $14.53 $69.73 $69.73 $41.25 $69.73 $69.73 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $31.38 $13.84 N/A $40.60 $69.73 $69.73 $69.73 $14.53 $69.73 N/A N/A 3571149510 SUP HCPCS C1713 3571149510 - SCREW BN 3.5MM 10MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 3571149512 SUP HCPCS C1713 3571149512 - SCREW BN 3.5MM 12MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149514 SUP HCPCS C1713 3571149514 - SCREW BN 3.5MM 14MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 3571149516 SUP HCPCS C1713 3571149516 - SCREW BN 3.5MM 16MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 3571149518 SUP HCPCS C1713 3571149518 - SCREW BN 3.5MM 18MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149520 SUP HCPCS C1713 3571149520 - SCREW BN 3.5MM 20MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 3571149522 SUP HCPCS C1713 3571149522 - SCREW BN 3.5MM 22MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 3571149524 SUP HCPCS C1713 3571149524 - SCREW BN 3.5MM 24MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 3571149526 SUP HCPCS C1713 3571149526 - SCREW BN 3.5MM 26MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149528 SUP HCPCS C1713 3571149528 - SCREW BN 3.5MM 28MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149530 SUP HCPCS C1713 3571149530 - SCREW BN 3.5MM 30MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149532 SUP HCPCS C1713 3571149532 - SCREW BN 3.5MM 32MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149534 SUP HCPCS C1713 3571149534 - SCREW BN 3.5MM 34MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 3571149536 SUP HCPCS C1713 3571149536 - SCREW BN 3.5MM 36MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 3571149538 SUP HCPCS C1713 3571149538 - SCREW BN 3.5MM 38MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 3571149540 SUP HCPCS C1713 3571149540 - SCREW BN 3.5MM 40MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149545 SUP HCPCS C1713 3571149545 - SCREW BN 3.5MM 45MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149550 SUP HCPCS C1713 3571149550 - SCREW BN 3.5MM 50MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149555 SUP HCPCS C1713 3571149555 - SCREW BN 3.5MM 55MM STRL HEX HD ST CORT BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $19.06 $91.45 N/A N/A 3571149560 SUP HCPCS C1713 3571149560 - SCREW BN 3.5MM 60MM STRL HEX HD ST CORT BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $19.06 $91.45 N/A N/A 3571149565 SUP HCPCS C1713 3571149565 - SCREW BN 3.5MM 65MM STRL HEX HD ST CORT BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $91.45 $91.45 $19.06 $91.45 N/A N/A 3571149570 SUP HCPCS C1713 3571149570 - SCREW BN 3.5MM 70MM STRL HEX HD ST CORT BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $19.06 $91.45 N/A N/A 3571149575 SUP HCPCS C1713 3571149575 - SCREW BN 3.5MM 75MM STRL HEX HD ST CORT BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $19.06 $91.45 N/A N/A 3571149580 SUP HCPCS C1713 3571149580 - SCREW BN 3.5MM 80MM STRL HEX HD ST CORT BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $19.06 $91.45 N/A N/A 3571149585 SUP HCPCS C1713 3571149585 - SCREW BN 3.5MM 85MM STRL HEX HD ST CORT BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $19.06 $91.45 N/A N/A 3571149590 SUP HCPCS C1713 3571149590 - SCREW BN 3.5MM 90MM STRL HEX HD ST CORT BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $19.06 $91.45 N/A N/A 3571149595 SUP HCPCS C1713 3571149595 - SCREW BN 3.5MM 95MM STRL HEX HD ST CORT BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $91.45 $91.45 N/A N/A 3571149600 SUP HCPCS C1713 3571149600 - SCREW BN 3.5MM 100MM STRL HEX HD ST CORT BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $91.45 $91.45 $91.45 $91.45 N/A N/A 3571149605 SUP HCPCS C1713 3571149605 - SCREW BN 3.5MM 105MM STRL HEX HD ST CORT BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $91.45 $91.45 N/A N/A 3571149610 SUP HCPCS C1713 3571149610 - SCREW BN 3.5MM 110MM STRL HEX HD ST CORT BOTH IP/OP $91.50 $68.00 $18.15 $91.45 $41.15 $41.15 $41.15 $41.15 $91.45 $91.45 $91.45 $19.06 $91.45 $91.45 $91.45 $91.45 $91.45 $19.06 $91.45 $36.58 $54.09 $91.45 $91.45 $91.45 $91.45 $68.63 $91.45 $91.45 $91.45 $45.73 $45.73 $72.43 $91.45 $73.16 $41.15 $18.15 N/A $53.07 $91.45 $54.87 $91.45 $19.06 $91.45 N/A N/A 3571149615 SUP HCPCS C1713 3571149615 - SCREW BN 3.5MM 115MM STRL HEX HD ST CORT BOTH IP/OP $93.50 $69.00 $18.53 $93.35 $42.01 $42.01 $42.01 $42.01 $93.35 $93.35 $93.35 $19.46 $93.35 $93.35 $93.35 $93.35 $93.35 $19.46 $93.35 $37.34 $55.22 $93.35 $93.35 $93.35 $93.35 $70.13 $93.35 $93.35 $93.35 $46.68 $46.68 $73.93 $93.35 $74.68 $42.01 $18.53 N/A $54.23 $93.35 $56.01 $93.35 $19.45 $93.35 N/A N/A 3571149620 SUP HCPCS C1713 3571149620 - SCREW BN 3.5MM 120MM STRL HEX HD ST CORT BOTH IP/OP $93.50 $69.00 $18.53 $93.35 $42.01 $42.01 $42.01 $42.01 $93.35 $93.35 $93.35 $19.46 $93.35 $93.35 $93.35 $93.35 $93.35 $19.46 $93.35 $37.34 $55.22 $93.35 $93.35 $93.35 $93.35 $70.13 $93.35 $93.35 $93.35 $46.68 $46.68 $73.93 $93.35 $74.68 $42.01 $18.53 N/A $54.23 $93.35 $56.01 $93.35 $19.45 $93.35 N/A N/A 3571149625 SUP HCPCS C1713 3571149625 - SCREW BN 3.5MM 125MM STRL HEX HD ST CORT BOTH IP/OP $93.50 $69.00 $18.53 $93.35 $42.01 $42.01 $42.01 $42.01 $93.35 $93.35 $93.35 $19.46 $93.35 $93.35 $93.35 $93.35 $93.35 $19.46 $93.35 $37.34 $55.22 $93.35 $93.35 $93.35 $93.35 $70.13 $93.35 $93.35 $93.35 $46.68 $46.68 $73.93 $93.35 $74.68 $42.01 $18.53 N/A $54.23 $93.35 $56.01 $93.35 $93.35 $93.35 N/A N/A 3571149630 SUP HCPCS C1713 3571149630 - SCREW BN 3.5MM 130MM STRL HEX HD ST CORT BOTH IP/OP $93.50 $69.00 $18.53 $93.35 $42.01 $42.01 $42.01 $42.01 $93.35 $93.35 $93.35 $19.46 $93.35 $93.35 $93.35 $93.35 $93.35 $19.46 $93.35 $37.34 $55.22 $93.35 $93.35 $93.35 $93.35 $70.13 $93.35 $93.35 $93.35 $46.68 $46.68 $73.93 $93.35 $74.68 $42.01 $18.53 N/A $54.23 $93.35 $56.01 $93.35 $93.35 $93.35 N/A N/A 3571149714 SUP HCPCS C1713 3571149714 - SCREW BN 4.5MM 14MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149716 SUP HCPCS C1713 3571149716 - SCREW BN 4.5MM 16MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149718 SUP HCPCS C1713 3571149718 - SCREW BN 4.5MM 18MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149720 SUP HCPCS C1713 3571149720 - SCREW BN 4.5MM 20MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149722 SUP HCPCS C1713 3571149722 - SCREW BN 4.5MM 22MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149724 SUP HCPCS C1713 3571149724 - SCREW BN 4.5MM 24MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149726 SUP HCPCS C1713 3571149726 - SCREW BN 4.5MM 26MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149728 SUP HCPCS C1713 3571149728 - SCREW BN 4.5MM 28MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149730 SUP HCPCS C1713 3571149730 - SCREW BN 4.5MM 30MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 3571149732 SUP HCPCS C1713 3571149732 - SCREW BN 4.5MM 32MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $75.70 $75.70 N/A N/A 3571149734 SUP HCPCS C1713 3571149734 - SCREW BN 4.5MM 34MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149736 SUP HCPCS C1713 3571149736 - SCREW BN 4.5MM 36MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149738 SUP HCPCS C1713 3571149738 - SCREW BN 4.5MM 38MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149740 SUP HCPCS C1713 3571149740 - SCREW BN 4.5MM 40MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149742 SUP HCPCS C1713 3571149742 - SCREW BN 4.5MM 42MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149744 SUP HCPCS C1713 3571149744 - SCREW BN 4.5MM 44MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149746 SUP HCPCS C1713 3571149746 - SCREW BN 4.5MM 46MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 3571149748 SUP HCPCS C1713 3571149748 - SCREW BN 4.5MM 48MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 3571149750 SUP HCPCS C1713 3571149750 - SCREW BN 4.5MM 50MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 3571149752 SUP HCPCS C1713 3571149752 - SCREW BN 4.5MM 52MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149754 SUP HCPCS C1713 3571149754 - SCREW BN 4.5MM 54MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149756 SUP HCPCS C1713 3571149756 - SCREW BN 4.5MM 56MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149758 SUP HCPCS C1713 3571149758 - SCREW BN 4.5MM 58MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149760 SUP HCPCS C1713 3571149760 - SCREW BN 4.5MM 60MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149762 SUP HCPCS C1713 3571149762 - SCREW BN 4.5MM 62MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149764 SUP HCPCS C1713 3571149764 - SCREW BN 4.5MM 64MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149766 SUP HCPCS C1713 3571149766 - SCREW BN 4.5MM 66MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $45.42 $75.70 $15.78 $75.70 N/A N/A 3571149768 SUP HCPCS C1713 3571149768 - SCREW BN 4.5MM 68MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $15.78 $75.70 N/A N/A 3571149770 SUP HCPCS C1713 3571149770 - SCREW BN 4.5MM 70MM STRL HEX HD ST CORT BOTH IP/OP $76.00 $56.00 $15.02 $75.70 $34.07 $34.07 $34.07 $34.07 $75.70 $75.70 $75.70 $15.78 $75.70 $75.70 $75.70 $75.70 $75.70 $15.78 $75.70 $30.28 $44.78 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $34.07 $15.02 N/A $44.08 $75.70 $75.70 $75.70 $75.70 $75.70 N/A N/A 3571149772 SUP HCPCS C1713 3571149772 - SCREW BN 4.5MM 72MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 3571149776 SUP HCPCS C1713 3571149776 - SCREW BN 4.5MM 76MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 3571149780 SUP HCPCS C1713 3571149780 - SCREW BN 4.5MM 80MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 3571149785 SUP HCPCS C1713 3571149785 - SCREW BN 4.5MM 85MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 3571149790 SUP HCPCS C1713 3571149790 - SCREW BN 4.5MM 90MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 3571149795 SUP HCPCS C1713 3571149795 - SCREW BN 4.5MM 95MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 3571149800 SUP HCPCS C1713 3571149800 - SCREW BN 4.5MM 100MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 3571149805 SUP HCPCS C1713 3571149805 - SCREW BN 4.5MM 105MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 3571149810 SUP HCPCS C1713 3571149810 - SCREW BN 4.5MM 110MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 3571149815 SUP HCPCS C1713 3571149815 - SCREW BN 4.5MM 115MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 3571149820 SUP HCPCS C1713 3571149820 - SCREW BN 4.5MM 120MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 3571149825 SUP HCPCS C1713 3571149825 - SCREW BN 4.5MM 125MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 3571149830 SUP HCPCS C1713 3571149830 - SCREW BN 4.5MM 130MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 3571149835 SUP HCPCS C1713 3571149835 - SCREW BN 4.5MM 135MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 3571149840 SUP HCPCS C1713 3571149840 - SCREW BN 4.5MM 140MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 3571149845 SUP HCPCS C1713 3571149845 - SCREW BN 4.5MM 145MM STRL HEX HD ST CORT BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 3571223010 SUP HCPCS C1713 3571223010 - SCREW BN FT 4MM 10MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $22.81 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223012 SUP HCPCS C1713 3571223012 - SCREW BN FT 4MM 12MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $22.81 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223014 SUP HCPCS C1713 3571223014 - SCREW BN FT 4MM 14MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $22.81 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223016 SUP HCPCS C1713 3571223016 - SCREW BN FT 4MM 16MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223018 SUP HCPCS C1713 3571223018 - SCREW BN FT 4MM 18MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223020 SUP HCPCS C1713 3571223020 - SCREW BN FT 4MM 20MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223022 SUP HCPCS C1713 3571223022 - SCREW BN FT 4MM 22MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223024 SUP HCPCS C1713 3571223024 - SCREW BN FT 4MM 24MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $22.81 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $57.03 $57.03 $11.89 $57.03 N/A N/A 3571223026 SUP HCPCS C1713 3571223026 - SCREW BN FT 4MM 26MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $22.81 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223028 SUP HCPCS C1713 3571223028 - SCREW BN FT 4MM 28MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $22.81 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223030 SUP HCPCS C1713 3571223030 - SCREW BN FT 4MM 30MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223035 SUP HCPCS C1713 3571223035 - SCREW BN FT 4MM 35MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223040 SUP HCPCS C1713 3571223040 - SCREW BN FT 4MM 40MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $22.81 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223045 SUP HCPCS C1713 3571223045 - SCREW BN FT 4MM 45MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $22.81 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223050 SUP HCPCS C1713 3571223050 - SCREW BN FT 4MM 50MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $22.81 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223055 SUP HCPCS C1713 3571223055 - SCREW BN FT 4MM 55MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223060 SUP HCPCS C1713 3571223060 - SCREW BN FT 4MM 60MM STRL CANC BOTH IP/OP $57.50 $43.00 $11.32 $57.03 $25.66 $25.66 $25.66 $25.66 $57.03 $57.03 $57.03 $11.89 $57.03 $57.03 $57.03 $57.03 $57.03 $11.89 $57.03 $22.81 $33.73 $57.03 $57.03 $57.03 $57.03 $43.13 $57.03 $57.03 $57.03 $28.52 $28.52 $45.17 $57.03 $45.62 $25.66 $11.32 N/A $33.35 $57.03 $34.22 $57.03 $11.89 $57.03 N/A N/A 3571223210 SUP HCPCS C1713 3571223210 - SCREW BN P/T 4MM 10MM STRL CANC BOTH IP/OP $55.50 $41.00 $10.93 $55.08 $24.79 $24.79 $24.79 $24.79 $55.08 $55.08 $55.08 $11.48 $55.08 $55.08 $55.08 $55.08 $55.08 $11.48 $55.08 $22.03 $32.58 $55.08 $55.08 $55.08 $55.08 $41.63 $55.08 $55.08 $55.08 $27.54 $27.54 $43.62 $55.08 $44.06 $24.79 $10.93 N/A $32.19 $55.08 $33.05 $55.08 $11.48 $55.08 N/A N/A 3571223212 SUP HCPCS C1713 3571223212 - SCREW BN P/T 4MM 12MM STRL CANC BOTH IP/OP $55.50 $41.00 $10.93 $55.08 $24.79 $24.79 $24.79 $24.79 $55.08 $55.08 $55.08 $11.48 $55.08 $55.08 $55.08 $55.08 $55.08 $11.48 $55.08 $22.03 $32.58 $55.08 $55.08 $55.08 $55.08 $41.63 $55.08 $55.08 $55.08 $27.54 $27.54 $43.62 $55.08 $44.06 $24.79 $10.93 N/A $32.19 $55.08 $33.05 $55.08 $11.48 $55.08 N/A N/A 3571223214 SUP HCPCS C1713 3571223214 - SCREW BN P/T 4MM 14MM STRL CANC BOTH IP/OP $37.00 $27.00 $7.29 $36.75 $16.54 $16.54 $16.54 $16.54 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $21.74 $36.75 $36.75 $36.75 $36.75 $27.75 $36.75 $36.75 $36.75 $18.38 $18.38 $29.11 $36.75 $29.40 $16.54 $7.29 N/A $21.46 $36.75 $22.05 $36.75 $7.66 $36.75 N/A N/A 3571223216 SUP HCPCS C1713 3571223216 - SCREW BN P/T 4MM 16MM STRL CANC BOTH IP/OP $37.00 $27.00 $7.29 $36.75 $16.54 $16.54 $16.54 $16.54 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $21.74 $36.75 $36.75 $36.75 $36.75 $27.75 $36.75 $36.75 $36.75 $18.38 $18.38 $29.11 $36.75 $29.40 $16.54 $7.29 N/A $21.46 $36.75 $22.05 $36.75 $7.66 $36.75 N/A N/A 3571223218 SUP HCPCS C1713 3571223218 - SCREW BN P/T 4MM 18MM STRL CANC BOTH IP/OP $37.00 $27.00 $7.29 $36.75 $16.54 $16.54 $16.54 $16.54 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $21.74 $36.75 $36.75 $36.75 $36.75 $27.75 $36.75 $36.75 $36.75 $18.38 $18.38 $29.11 $36.75 $29.40 $16.54 $7.29 N/A $21.46 $36.75 $22.05 $36.75 $7.66 $36.75 N/A N/A 3571223220 SUP HCPCS C1713 3571223220 - SCREW BN P/T 4MM 20MM STRL CANC BOTH IP/OP $37.00 $27.00 $7.29 $36.75 $16.54 $16.54 $16.54 $16.54 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $21.74 $36.75 $36.75 $36.75 $36.75 $27.75 $36.75 $36.75 $36.75 $18.38 $18.38 $29.11 $36.75 $29.40 $16.54 $7.29 N/A $21.46 $36.75 $22.05 $36.75 $7.66 $36.75 N/A N/A 3571223222 SUP HCPCS C1713 3571223222 - SCREW BN P/T 4MM 22MM STRL CANC BOTH IP/OP $37.00 $27.00 $7.29 $36.75 $16.54 $16.54 $16.54 $16.54 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $36.75 $36.75 $36.75 $7.66 $36.75 $14.70 $21.74 $36.75 $36.75 $36.75 $36.75 $27.75 $36.75 $36.75 $36.75 $18.38 $18.38 $29.11 $36.75 $29.40 $16.54 $7.29 N/A $21.46 $36.75 $22.05 $36.75 $7.66 $36.75 N/A N/A 3571223226 SUP HCPCS C1713 3571223226 - SCREW BN P/T 4MM 26MM STRL CANC BOTH IP/OP $37.00 $27.00 $7.29 $36.75 $16.54 $16.54 $16.54 $16.54 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $21.74 $36.75 $36.75 $36.75 $36.75 $27.75 $36.75 $36.75 $36.75 $18.38 $18.38 $29.11 $36.75 $29.40 $16.54 $7.29 N/A $21.46 $36.75 $22.05 $36.75 $7.66 $36.75 N/A N/A 3571223228 SUP HCPCS C1713 3571223228 - SCREW BN P/T 4MM 28MM STRL CANC BOTH IP/OP $37.00 $27.00 $7.29 $36.75 $16.54 $16.54 $16.54 $16.54 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $36.75 $36.75 $36.75 $7.66 $36.75 $14.70 $21.74 $36.75 $36.75 $36.75 $36.75 $27.75 $36.75 $36.75 $36.75 $18.38 $18.38 $29.11 $36.75 $29.40 $16.54 $7.29 N/A $21.46 $36.75 $22.05 $36.75 $7.66 $36.75 N/A N/A 3571223230 SUP HCPCS C1713 3571223230 - SCREW BN P/T 4MM 30MM STRL CANC BOTH IP/OP $37.00 $27.00 $7.29 $36.75 $16.54 $16.54 $16.54 $16.54 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $36.75 $36.75 $36.75 $7.66 $36.75 $14.70 $21.74 $36.75 $36.75 $36.75 $36.75 $27.75 $36.75 $36.75 $36.75 $18.38 $18.38 $29.11 $36.75 $29.40 $16.54 $7.29 N/A $21.46 $36.75 $22.05 $36.75 $36.75 $36.75 N/A N/A 3571223235 SUP HCPCS C1713 3571223235 - SCREW BN P/T 4MM 35MM STRL CANC BOTH IP/OP $37.00 $27.00 $7.29 $36.75 $16.54 $16.54 $16.54 $16.54 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $36.75 $36.75 $36.75 $7.66 $36.75 $14.70 $21.74 $36.75 $36.75 $36.75 $36.75 $27.75 $36.75 $36.75 $36.75 $18.38 $18.38 $29.11 $36.75 $29.40 $16.54 $7.29 N/A $21.46 $36.75 $36.75 $36.75 $36.75 $36.75 N/A N/A 3571223240 SUP HCPCS C1713 3571223240 - SCREW BN P/T 4MM 40MM STRL CANC BOTH IP/OP $37.00 $27.00 $7.29 $36.75 $16.54 $16.54 $16.54 $16.54 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $21.74 $36.75 $36.75 $36.75 $36.75 $27.75 $36.75 $36.75 $36.75 $18.38 $18.38 $29.11 $36.75 $29.40 $16.54 $7.29 N/A $21.46 $36.75 $22.05 $36.75 $36.75 $36.75 N/A N/A 3571223245 SUP HCPCS C1713 3571223245 - SCREW BN P/T 4MM 45MM STRL CANC BOTH IP/OP $37.00 $27.00 $7.29 $36.75 $16.54 $16.54 $16.54 $16.54 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $36.75 $36.75 $36.75 $7.66 $36.75 $14.70 $21.74 $36.75 $36.75 $36.75 $36.75 $27.75 $36.75 $36.75 $36.75 $18.38 $18.38 $29.11 $36.75 $29.40 $16.54 $7.29 N/A $21.46 $36.75 $22.05 $36.75 $36.75 $36.75 N/A N/A 3571223250 SUP HCPCS C1713 3571223250 - SCREW BN P/T 4MM 50MM STRL CANC BOTH IP/OP $37.00 $27.00 $7.29 $36.75 $16.54 $16.54 $16.54 $16.54 $36.75 $36.75 $36.75 $7.66 $36.75 $36.75 $36.75 $36.75 $36.75 $7.66 $36.75 $14.70 $21.74 $36.75 $36.75 $36.75 $36.75 $27.75 $36.75 $36.75 $36.75 $18.38 $18.38 $29.11 $36.75 $29.40 $16.54 $7.29 N/A $21.46 $36.75 $22.05 $36.75 $36.75 $36.75 N/A N/A 3571226030 SUP HCPCS C1713 3571226030 - SCREW BN 6.5MM 30MM STRL 16MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $45.36 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $113.40 $113.40 N/A N/A 3571226035 SUP HCPCS C1713 3571226035 - SCREW BN 6.5MM 35MM STRL 16MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $113.40 $113.40 N/A N/A 3571226040 SUP HCPCS C1713 3571226040 - SCREW BN 6.5MM 40MM STRL 16MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $113.40 $113.40 $113.40 $113.40 N/A N/A 3571226045 SUP HCPCS C1713 3571226045 - SCREW BN 6.5MM 45MM STRL 16MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $45.36 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571226050 SUP HCPCS C1713 3571226050 - SCREW BN 6.5MM 50MM STRL 16MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $45.36 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571226055 SUP HCPCS C1713 3571226055 - SCREW BN 6.5MM 55MM STRL 16MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $45.36 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571226060 SUP HCPCS C1713 3571226060 - SCREW BN 6.5MM 60MM STRL 16MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $45.36 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571226065 SUP HCPCS C1713 3571226065 - SCREW BN 6.5MM 65MM STRL 16MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $45.36 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571226070 SUP HCPCS C1713 3571226070 - SCREW BN 6.5MM 70MM STRL 16MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $45.36 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $113.40 $113.40 $113.40 $113.40 N/A N/A 3571226075 SUP HCPCS C1713 3571226075 - SCREW BN 6.5MM 75MM STRL 16MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $113.40 $113.40 N/A N/A 3571226080 SUP HCPCS C1713 3571226080 - SCREW BN 6.5MM 80MM STRL 16MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $113.40 $113.40 N/A N/A 3571226085 SUP HCPCS C1713 3571226085 - SCREW BN 6.5MM 85MM STRL 16MM THRD CANC BOTH IP/OP $125.00 $93.00 $24.80 $124.95 $56.23 $56.23 $56.23 $56.23 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $124.95 $124.95 $124.95 $26.04 $124.95 $49.98 $73.91 $124.95 $124.95 $124.95 $124.95 $93.75 $124.95 $124.95 $124.95 $62.48 $62.48 $98.96 $124.95 $99.96 $56.23 $24.80 N/A $72.50 $124.95 $74.97 $124.95 $124.95 $124.95 N/A N/A 3571226090 SUP HCPCS C1713 3571226090 - SCREW BN 6.5MM 90MM STRL 16MM THRD CANC BOTH IP/OP $125.00 $93.00 $24.80 $124.95 $56.23 $56.23 $56.23 $56.23 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $124.95 $124.95 $124.95 $26.04 $124.95 $49.98 $73.91 $124.95 $124.95 $124.95 $124.95 $93.75 $124.95 $124.95 $124.95 $62.48 $62.48 $98.96 $124.95 $99.96 $56.23 $24.80 N/A $72.50 $124.95 $74.97 $124.95 $124.95 $124.95 N/A N/A 3571226095 SUP HCPCS C1713 3571226095 - SCREW BN 6.5MM 95MM STRL 16MM THRD CANC BOTH IP/OP $125.00 $93.00 $24.80 $124.95 $56.23 $56.23 $56.23 $56.23 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $124.95 $124.95 $124.95 $26.04 $124.95 $49.98 $73.91 $124.95 $124.95 $124.95 $124.95 $93.75 $124.95 $124.95 $124.95 $62.48 $62.48 $98.96 $124.95 $99.96 $56.23 $24.80 N/A $72.50 $124.95 $74.97 $124.95 $124.95 $124.95 N/A N/A 3571226100 SUP HCPCS C1713 3571226100 - SCREW BN 6.5MM 100MM STRL 16MM THRD CANC BOTH IP/OP $125.00 $93.00 $24.80 $124.95 $56.23 $56.23 $56.23 $56.23 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $73.91 $124.95 $124.95 $124.95 $124.95 $93.75 $124.95 $124.95 $124.95 $62.48 $62.48 $98.96 $124.95 $99.96 $56.23 $24.80 N/A $72.50 $124.95 $74.97 $124.95 $124.95 $124.95 N/A N/A 3571226105 SUP HCPCS C1713 3571226105 - SCREW BN 6.5MM 105MM STRL 16MM THRD CANC BOTH IP/OP $125.00 $93.00 $24.80 $124.95 $56.23 $56.23 $56.23 $56.23 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $73.91 $124.95 $124.95 $124.95 $124.95 $93.75 $124.95 $124.95 $124.95 $62.48 $62.48 $98.96 $124.95 $99.96 $56.23 $24.80 N/A $72.50 $124.95 $74.97 $124.95 $124.95 $124.95 N/A N/A 3571226110 SUP HCPCS C1713 3571226110 - SCREW BN 6.5MM 110MM STRL 16MM THRD CANC BOTH IP/OP $125.00 $93.00 $24.80 $124.95 $56.23 $56.23 $56.23 $56.23 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $73.91 $124.95 $124.95 $124.95 $124.95 $93.75 $124.95 $124.95 $124.95 $62.48 $62.48 $98.96 $124.95 $99.96 $56.23 $24.80 N/A $72.50 $124.95 $74.97 $124.95 $26.04 $124.95 N/A N/A 3571228045 SUP HCPCS C1713 3571228045 - SCREW BN 6.5MM 45MM STRL 32MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571228050 SUP HCPCS C1713 3571228050 - SCREW BN 6.5MM 50MM STRL 32MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571228055 SUP HCPCS C1713 3571228055 - SCREW BN 6.5MM 55MM STRL 32MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $113.40 $113.40 $23.63 $113.40 N/A N/A 3571228060 SUP HCPCS C1713 3571228060 - SCREW BN 6.5MM 60MM STRL 32MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571228065 SUP HCPCS C1713 3571228065 - SCREW BN 6.5MM 65MM STRL 32MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571228070 SUP HCPCS C1713 3571228070 - SCREW BN 6.5MM 70MM STRL 32MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $113.40 $113.40 $23.63 $113.40 N/A N/A 3571228075 SUP HCPCS C1713 3571228075 - SCREW BN 6.5MM 75MM STRL 32MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571228080 SUP HCPCS C1713 3571228080 - SCREW BN 6.5MM 80MM STRL 32MM THRD CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571228085 SUP HCPCS C1713 3571228085 - SCREW BN 6.5MM 85MM STRL 32MM THRD CANC BOTH IP/OP $125.00 $93.00 $24.80 $124.95 $56.23 $56.23 $56.23 $56.23 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $73.91 $124.95 $124.95 $124.95 $124.95 $93.75 $124.95 $124.95 $124.95 $62.48 $62.48 $98.96 $124.95 $99.96 $56.23 $24.80 N/A $72.50 $124.95 $74.97 $124.95 $124.95 $124.95 N/A N/A 3571228090 SUP HCPCS C1713 3571228090 - SCREW BN 6.5MM 90MM STRL 32MM THRD CANC BOTH IP/OP $125.00 $93.00 $24.80 $124.95 $56.23 $56.23 $56.23 $56.23 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $73.91 $124.95 $124.95 $124.95 $124.95 $93.75 $124.95 $124.95 $124.95 $62.48 $62.48 $98.96 $124.95 $99.96 $56.23 $24.80 N/A $72.50 $124.95 $124.95 $124.95 $124.95 $124.95 N/A N/A 3571228095 SUP HCPCS C1713 3571228095 - SCREW BN 6.5MM 95MM STRL 32MM THRD CANC BOTH IP/OP $125.00 $93.00 $24.80 $124.95 $56.23 $56.23 $56.23 $56.23 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $73.91 $124.95 $124.95 $124.95 $124.95 $93.75 $124.95 $124.95 $124.95 $62.48 $62.48 $98.96 $124.95 $99.96 $56.23 $24.80 N/A $72.50 $124.95 $74.97 $124.95 $26.04 $124.95 N/A N/A 3571228100 SUP HCPCS C1713 3571228100 - SCREW BN 6.5MM 100MM STRL 32MM THRD CANC BOTH IP/OP $125.00 $93.00 $24.80 $124.95 $56.23 $56.23 $56.23 $56.23 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $124.95 $124.95 $124.95 $26.04 $124.95 $49.98 $73.91 $124.95 $124.95 $124.95 $124.95 $93.75 $124.95 $124.95 $124.95 $62.48 $62.48 $98.96 $124.95 $99.96 $56.23 $24.80 N/A $72.50 $124.95 $74.97 $124.95 $26.04 $124.95 N/A N/A 3571228105 SUP HCPCS C1713 3571228105 - SCREW BN 6.5MM 105MM STRL 32MM THRD CANC BOTH IP/OP $125.00 $93.00 $24.80 $124.95 $56.23 $56.23 $56.23 $56.23 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $73.91 $124.95 $124.95 $124.95 $124.95 $93.75 $124.95 $124.95 $124.95 $62.48 $62.48 $98.96 $124.95 $99.96 $56.23 $24.80 N/A $72.50 $124.95 $124.95 $124.95 $26.04 $124.95 N/A N/A 3571228110 SUP HCPCS C1713 3571228110 - SCREW BN 6.5MM 110MM STRL 32MM THRD CANC BOTH IP/OP $125.00 $93.00 $24.80 $124.95 $56.23 $56.23 $56.23 $56.23 $124.95 $124.95 $124.95 $26.04 $124.95 $124.95 $124.95 $124.95 $124.95 $26.04 $124.95 $49.98 $73.91 $124.95 $124.95 $124.95 $124.95 $93.75 $124.95 $124.95 $124.95 $62.48 $62.48 $98.96 $124.95 $99.96 $56.23 $24.80 N/A $72.50 $124.95 $74.97 $124.95 $26.04 $124.95 N/A N/A 3571229025 SUP HCPCS C1713 3571229025 - SCREW BN FT 6.5MM 25MM STRL CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571229030 SUP HCPCS C1713 3571229030 - SCREW BN FT 6.5MM 30MM STRL CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $45.36 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $113.40 $113.40 $23.63 $113.40 N/A N/A 3571229035 SUP HCPCS C1713 3571229035 - SCREW BN FT 6.5MM 35MM STRL CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $45.36 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571229040 SUP HCPCS C1713 3571229040 - SCREW BN FT 6.5MM 40MM STRL CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $45.36 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571229045 SUP HCPCS C1713 3571229045 - SCREW BN FT 6.5MM 45MM STRL CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $45.36 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 3571229050 SUP HCPCS C1713 3571229050 - SCREW BN FT 6.5MM 50MM STRL CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $113.40 $113.40 N/A N/A 3571229055 SUP HCPCS C1713 3571229055 - SCREW BN FT 6.5MM 55MM STRL CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $113.40 $113.40 N/A N/A 3571229060 SUP HCPCS C1713 3571229060 - SCREW BN FT 6.5MM 60MM STRL CANC BOTH IP/OP $113.50 $84.00 $22.51 $113.40 $51.03 $51.03 $51.03 $51.03 $113.40 $113.40 $113.40 $23.64 $113.40 $113.40 $113.40 $113.40 $113.40 $23.63 $113.40 $113.40 $67.08 $113.40 $113.40 $113.40 $113.40 $85.13 $113.40 $113.40 $113.40 $56.70 $56.70 $89.81 $113.40 $90.72 $51.03 $22.51 N/A $65.83 $113.40 $68.04 $113.40 $23.63 $113.40 N/A N/A 4823714020 SUP HCPCS C1713 4823714020 - SCREW BONE 4MM 20MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823714025 SUP HCPCS C1713 4823714025 - SCREW BONE 4MM 25MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823714030 SUP HCPCS C1713 4823714030 - SCREW BONE 4MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823714035 SUP HCPCS C1713 4823714035 - SCREW BONE 4MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823714040 SUP HCPCS C1713 4823714040 - SCREW BONE 4MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823714045 SUP HCPCS C1713 4823714045 - SCREW BONE 4MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823714520 SUP HCPCS C1713 4823714520 - SCREW BONE 4.5MM 20MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823714525 SUP HCPCS C1713 4823714525 - SCREW BONE 4.5MM 25MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823714530 SUP HCPCS C1713 4823714530 - SCREW BONE 4.5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823714535 SUP HCPCS C1713 4823714535 - SCREW BONE 4.5MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823714540 SUP HCPCS C1713 4823714540 - SCREW BONE 4.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823714545 SUP HCPCS C1713 4823714545 - SCREW BONE 4.5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823715020 SUP HCPCS C1713 4823715020 - SCREW BONE 5MM 20MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823715025 SUP HCPCS C1713 4823715025 - SCREW BONE 5MM 25MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823715030 SUP HCPCS C1713 4823715030 - SCREW BONE 5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823715035 SUP HCPCS C1713 4823715035 - SCREW BONE 5MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823715040 SUP HCPCS C1713 4823715040 - SCREW BONE 5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823715045 SUP HCPCS C1713 4823715045 - SCREW BONE 5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823715050 SUP HCPCS C1713 4823715050 - SCREW BONE 5MM 50MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823715525 SUP HCPCS C1713 4823715525 - SCREW BONE 5.5MM 25MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823715530 SUP HCPCS C1713 4823715530 - SCREW BONE 5.5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823715535 SUP HCPCS C1713 4823715535 - SCREW BONE 5.5MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823715540 SUP HCPCS C1713 4823715540 - SCREW BONE 5.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823715545 SUP HCPCS C1713 4823715545 - SCREW BONE 5.5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823715550 SUP HCPCS C1713 4823715550 - SCREW BONE 5.5MM 50MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823715555 SUP HCPCS C1713 4823715555 - SCREW BONE 5.5MM 55MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823716525 SUP HCPCS C1713 4823716525 - SCREW BONE 6.5MM 25MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823716530 SUP HCPCS C1713 4823716530 - SCREW BONE 6.5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823716535 SUP HCPCS C1713 4823716535 - SCREW BONE 6.5MM 35MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823716540 SUP HCPCS C1713 4823716540 - SCREW BONE 6.5MM 40MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823716545 SUP HCPCS C1713 4823716545 - SCREW BONE 6.5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823716550 SUP HCPCS C1713 4823716550 - SCREW BONE 6.5MM 50MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823716555 SUP HCPCS C1713 4823716555 - SCREW BONE 6.5MM 55MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823716560 SUP HCPCS C1713 4823716560 - SCREW BONE 6.5MM 60MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823716565 SUP HCPCS C1713 4823716565 - SCREW BONE 6.5MM 65MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823716570 SUP HCPCS C1713 4823716570 - SCREW BONE 6.5MM 70MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823716580 SUP HCPCS C1713 4823716580 - SCREW BONE 6.5MM 80MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823716590 SUP HCPCS C1713 4823716590 - SCREW BONE 6.5MM 90MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823717525 SUP HCPCS C1713 4823717525 - SCREW BONE 7.5MM 25MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823717530 SUP HCPCS C1713 4823717530 - SCREW BONE 7.5MM 30MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823717535 SUP HCPCS C1713 4823717535 - SCREW BONE 7.5MM 35MM REVISION POLYAX MEDIAL BIASED BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823717540 SUP HCPCS C1713 4823717540 - SCREW BONE 7.5MM 40MM REVISION POLYAX MEDIAL BIASED BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823717545 SUP HCPCS C1713 4823717545 - SCREW BONE 7.5MM 45MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823717550 SUP HCPCS C1713 4823717550 - SCREW BONE 7.5MM 50MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823717555 SUP HCPCS C1713 4823717555 - SCREW BONE 7.5MM 55MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823717560 SUP HCPCS C1713 4823717560 - SCREW BONE 7.5MM 60MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823717565 SUP HCPCS C1713 4823717565 - SCREW BONE 7.5MM 65MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823717570 SUP HCPCS C1713 4823717570 - SCREW BONE 7.5MM 70MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823717580 SUP HCPCS C1713 4823717580 - SCREW BONE 7.5MM 80MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823717590 SUP HCPCS C1713 4823717590 - SCREW BONE 7.5MM 90MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823718500 SUP HCPCS C1713 4823718500 - SCREW BONE 8.5MM 100MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823718560 SUP HCPCS C1713 4823718560 - SCREW BONE 8.5MM 60MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823718570 SUP HCPCS C1713 4823718570 - SCREW BONE 8.5MM 70MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823718580 SUP HCPCS C1713 4823718580 - SCREW BONE 8.5MM 80MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823718590 SUP HCPCS C1713 4823718590 - SCREW BONE 8.5MM 90MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823719500 SUP HCPCS C1713 4823719500 - SCREW BONE 9.5MM 100MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823719560 SUP HCPCS C1713 4823719560 - SCREW BONE 9.5MM 60MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823719570 SUP HCPCS C1713 4823719570 - SCREW BONE 9.5MM 70MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823719580 SUP HCPCS C1713 4823719580 - SCREW BONE 9.5MM 80MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 4823719590 SUP HCPCS C1713 4823719590 - SCREW BONE 9.5MM 90MM REVISION POLYAX ILIOSACRAL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 5100060001 SUP Custom 27203010 5100060001 - BIT DRILL LARGE 14MM PERFORATOR HUDSON END SHARP CRANIAL BOTH IP/OP $474.50 $351.00 $84.44 $474.38 $474.38 $474.38 $474.38 $474.38 $474.38 $474.38 $84.44 $474.38 $474.38 $352.08 $352.08 $365.65 $247.15 $98.87 $474.38 $189.75 $474.38 $474.38 $474.38 $474.38 $474.38 $355.88 $474.38 $474.38 $474.38 $237.19 $237.19 $375.71 $474.38 $379.50 $308.35 $474.38 N/A $275.21 $474.38 $284.63 $474.38 $474.38 $474.38 N/A N/A 5130020060 SUP Custom 27203010 5130020060 - BURR SURG LONG 6MM 7.9MM DRUM FLUTED BOTH IP/OP $244.50 $181.00 $43.50 $244.38 $244.38 $244.38 $244.38 $244.38 $244.38 $244.38 $43.50 $244.38 $244.38 $181.38 $181.38 $188.37 $127.32 $50.93 $244.38 $97.75 $244.38 $244.38 $244.38 $244.38 $244.38 $183.38 $244.38 $244.38 $244.38 $122.19 $122.19 $193.55 $244.38 $195.50 $158.85 $244.38 N/A $141.81 $244.38 $146.63 $244.38 $244.38 $244.38 N/A N/A 5130130250 SUP Custom 27203010 5130130250 - BURR SURG LONG .8MM 25.4MM DISK DIAMOND STERILE BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 5220030575 SUP Custom 27203010 5220030575 - BURR SURG MEDIUM 7.5MM PRECISION ACORN BOTH IP/OP $489.00 $362.00 $87.00 $488.75 $488.75 $488.75 $488.75 $488.75 $488.75 $488.75 $87.00 $488.75 $488.75 $362.75 $362.75 $376.73 $254.64 $101.86 $488.75 $195.50 $488.75 $488.75 $488.75 $488.75 $488.75 $366.75 $488.75 $488.75 $488.75 $244.38 $244.38 $387.09 $488.75 $391.00 $317.69 $488.75 N/A $283.62 $488.75 $293.25 $488.75 $488.75 $488.75 N/A N/A 5450800303 SUP Custom 27203010 5450800303 - TIP ASPIRAT 25KHZ SUPERLONG SPETZLER MICRO CLAW BONE BOTH IP/OP "$10,675.00" "$7,900.00" "$1,900.15" "$10,675.00" "$10,675.00" "$10,675.00" "$10,675.00" "$10,675.00" "$10,675.00" "$10,675.00" "$1,900.15" "$10,675.00" "$10,675.00" "$4,181.12" "$4,181.12" "$8,228.29" "$2,060.15" "$2,224.79" "$10,675.00" "$4,270.00" "$10,675.00" "$10,675.00" "$10,675.00" "$10,675.00" "$10,675.00" "$8,006.25" "$10,675.00" "$10,675.00" "$10,675.00" "$5,337.50" "$5,337.50" "$8,454.60" "$10,675.00" "$8,540.00" "$6,938.75" "$10,675.00" N/A "$6,191.50" "$10,675.00" "$6,405.00" "$10,675.00" "$10,675.00" "$10,675.00" N/A N/A 5450800306 SUP Custom 27203010 5450800306 - TIP ASPIRAT 25KHZ UNIVERSAL ULTRASONIC LARGE DIAMETER SOFT BOTH IP/OP "$8,455.50" "$6,257.00" "$1,505.04" "$8,455.28" "$8,455.28" "$8,455.28" "$8,455.28" "$8,455.28" "$8,455.28" "$8,455.28" "$1,505.04" "$8,455.28" "$8,455.28" "$4,181.12" "$4,181.12" "$6,517.33" "$2,060.15" "$1,762.17" "$8,455.28" "$3,382.11" "$8,455.28" "$8,455.28" "$8,455.28" "$8,455.28" "$8,455.28" "$6,341.63" "$8,455.28" "$8,455.28" "$8,455.28" "$4,227.64" "$4,227.64" "$6,696.58" "$8,455.28" "$6,764.22" "$5,495.93" "$8,455.28" N/A "$4,904.19" "$8,455.28" "$5,073.17" "$8,455.28" "$8,455.28" "$8,455.28" N/A N/A 5450800307 SUP Custom 27203010 5450800307 - TIP ASPIRAT 25KHZ UNIVERSAL STR SONOPET DISPOSABLE BOTH IP/OP "$7,750.00" "$5,735.00" "$1,379.50" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$1,379.50" "$7,750.00" "$7,750.00" "$4,181.12" "$4,181.12" "$5,973.70" "$2,060.15" "$1,615.19" "$7,750.00" "$3,100.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$5,812.50" "$7,750.00" "$7,750.00" "$7,750.00" "$3,875.00" "$3,875.00" "$6,138.00" "$7,750.00" "$6,200.00" "$5,037.50" "$7,750.00" N/A "$4,495.00" "$7,750.00" "$4,650.00" "$7,750.00" "$7,750.00" "$7,750.00" N/A N/A 5450800308 SUP Custom 27203010 5450800308 - TIP ASP LG DIA STRG 4.6IN STRL LF SONOPET SFT TIS DISP BOTH IP/OP "$1,650.00" "$1,221.00" $293.70 "$1,649.99" "$1,649.99" "$1,649.99" "$1,649.99" "$1,649.99" "$1,649.99" "$1,649.99" $293.70 "$1,649.99" "$1,649.99" "$1,224.62" "$1,224.62" "$1,271.81" $859.64 $343.88 "$1,649.99" $660.00 "$1,649.99" "$1,649.99" "$1,649.99" "$1,649.99" "$1,649.99" "$1,237.50" "$1,649.99" "$1,649.99" "$1,649.99" $825.00 $825.00 "$1,306.79" "$1,649.99" "$1,319.99" "$1,072.49" "$1,649.99" N/A $957.00 "$1,649.99" $989.99 "$1,649.99" "$1,649.99" "$1,649.99" N/A N/A 5820009060 SUP Custom 27203010 5820009060 - BURR SURG ROUND 6MM PRECISION BOTH IP/OP $506.00 $374.00 $90.05 $505.88 $505.88 $505.88 $505.88 $505.88 $505.88 $505.88 $90.05 $505.88 $505.88 $375.46 $375.46 $389.93 $263.56 $105.43 $505.88 $202.35 $505.88 $505.88 $505.88 $505.88 $505.88 $379.50 $505.88 $505.88 $505.88 $252.94 $252.94 $400.66 $505.88 $404.70 $328.82 $505.88 N/A $293.48 $505.88 $303.53 $505.88 $505.88 $505.88 N/A N/A 5820009075 SUP Custom 27203010 5820009075 - BURR SURG ROUND 7.5MM RIM GLIDE PRECISION BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A 5820010010 SUP Custom 27203010 5820010010 - BURR SURG ROUND FLUTE 1MM TPS ELITE BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 5820010125 SUP Custom 27203010 5820010125 - BURR SURG 2.5MM ROUND SOFT TOUCH FLUTED ELITE STERILE BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 5820010150 SUP Custom 27203010 5820010150 - BURR SURG ROUND FLUTE 5MM 5 NOTCH SOFT TOUCH SMOOTH CUT GOOD BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 5820010160 SUP Custom 27203010 5820010160 - BURR SURG ROUND FLUTE 6MM SOFT TOUCH ROUND FLUTED AGGRESSIVE BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 5820010170 SUP Custom 27203010 5820010170 - BURR SURG 7MM ROUND SOFT TOUCH ELITE STERILE BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 5820012010 SUP Custom 27203010 5820012010 - BURR SURG ROUND 1MM ROUND HEAD CUTTING TPS ELITE DIAMOND BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 5820012020 SUP Custom 27203010 5820012020 - BURR SRG RND 2MM TPS ELT DMD BOTH IP/OP $289.00 $214.00 $51.40 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $51.40 $288.75 $288.75 $214.31 $214.31 $222.57 $150.44 $60.18 $288.75 $115.50 $288.75 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $187.69 $288.75 N/A $167.62 $288.75 $173.25 $288.75 $288.75 $288.75 N/A N/A 5820012025 SUP Custom 27203010 5820012025 - BURR SURG ROUND 2.5MM TPS ELITE DIAMOND BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 5820012050 SUP Custom 27203010 5820012050 - BURR SURG DIAMOND 5MM 5 STEP NOTCH NUMBER SAFETY MARK CUT BOTH IP/OP $289.00 $214.00 $51.40 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $51.40 $288.75 $288.75 $214.31 $214.31 $222.57 $150.44 $60.18 $288.75 $115.50 $288.75 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $187.69 $288.75 N/A $167.62 $288.75 $173.25 $288.75 $288.75 $288.75 N/A N/A 5820012060 SUP Custom 27203010 5820012060 - BURR SURG ROUND 6MM LATEX FREE ELITE DIAMOND STERILE BOTH IP/OP $289.00 $214.00 $51.40 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $51.40 $288.75 $288.75 $214.31 $214.31 $222.57 $150.44 $60.18 $288.75 $115.50 $288.75 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $187.69 $288.75 N/A $167.62 $288.75 $173.25 $288.75 $288.75 $288.75 N/A N/A 5820013060 SUP Custom 27203010 5820013060 - BURR SRG RND CRS DMD 6MM STRL LF TPS ELT DISP BOTH IP/OP $777.50 $575.00 $124.20 $777.50 $777.50 $777.50 $777.50 $777.50 $777.50 $777.50 $138.40 $777.50 $777.50 $577.06 $577.06 $599.30 $405.08 $162.04 $777.50 $124.20 $777.50 $777.50 $777.50 $777.50 $777.50 $583.13 $777.50 $777.50 $777.50 $388.75 $388.75 $615.78 $777.50 $622.00 $505.38 $777.50 N/A $450.95 $777.50 $466.50 $777.50 $777.50 $777.50 N/A N/A 5820070011 SUP Custom 27203010 5820070011 - BURR SURG STR 1.1MM 6MM ROUTER STR BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 5820107020 SUP Custom 27203010 5820107020 - BURR SRG 2MM 3.1MM STRL LF MTCH HD SFTCH DISP NEURO BOTH IP/OP $289.00 $214.00 $51.40 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $51.40 $288.75 $288.75 $214.31 $214.31 $222.57 $150.44 $60.18 $288.75 $115.50 $288.75 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $187.69 $288.75 N/A $167.62 $288.75 $173.25 $288.75 $288.75 $288.75 N/A N/A 5820107120 SUP Custom 27203010 5820107120 - BURR SURG 2MM 3.1MM DIAMOND NEURO ELITE STERILE BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 5820107125 SUP Custom 27203010 5820107125 - BIT DRILL 2.5MM 3.4MM NEURO ELITE STERILE BOTH IP/OP $289.00 $214.00 $51.40 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $51.40 $288.75 $288.75 $214.31 $214.31 $222.57 $150.44 $60.18 $288.75 $115.50 $288.75 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $187.69 $288.75 N/A $167.62 $288.75 $173.25 $288.75 $288.75 $288.75 N/A N/A 5820107130 SUP Custom 27203010 5820107130 - BURR SURG 3MM 3.8MM DIAMOND NEURO ELITE STERILE BOTH IP/OP $289.00 $214.00 $51.40 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $51.40 $288.75 $288.75 $214.31 $214.31 $222.57 $150.44 $60.18 $288.75 $115.50 $288.75 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $187.69 $288.75 N/A $167.62 $288.75 $173.25 $288.75 $288.75 $288.75 N/A N/A 6279409577 SUP Custom 27203010 6279409577 - DRESSING BURN ADH SIL NYL 15X10IN BBRN BOTH IP/OP $248.50 $184.00 $44.15 $248.05 $248.05 $248.05 $248.05 $248.05 $248.05 $248.05 $44.15 $248.05 $248.05 $184.10 $184.10 $191.20 $129.23 $51.70 $248.05 $99.22 $248.05 $248.05 $248.05 $248.05 $248.05 $186.38 $248.05 $248.05 $248.05 $124.03 $124.03 $196.46 $248.05 $198.44 $161.23 $248.05 N/A $144.13 $248.05 $148.83 $248.05 $248.05 $248.05 N/A N/A 6770200005 SUP Custom 27203010 6770200005 - FORCEPS BP .5MM 8IN SPTZLR MLS 2 IRR DISP BOTH IP/OP "$1,210.00" $895.00 $215.38 "$1,209.99" "$1,209.99" "$1,209.99" "$1,209.99" "$1,209.99" "$1,209.99" "$1,209.99" $215.38 "$1,209.99" "$1,209.99" $898.05 $898.05 $932.66 $630.40 $252.18 "$1,209.99" $484.00 "$1,209.99" "$1,209.99" "$1,209.99" "$1,209.99" "$1,209.99" $907.50 "$1,209.99" "$1,209.99" "$1,209.99" $605.00 $605.00 $958.31 "$1,209.99" $967.99 $786.49 "$1,209.99" N/A $701.80 "$1,209.99" $725.99 "$1,209.99" "$1,209.99" "$1,209.99" N/A N/A 6770200010 SUP Custom 27203010 6770200010 - FORCEPS BP 1MM 8IN SPTZLR MLS 2 IRR DISP BOTH IP/OP "$1,135.50" $840.00 $202.12 "$1,135.50" "$1,135.50" "$1,135.50" "$1,135.50" "$1,135.50" "$1,135.50" "$1,135.50" $202.12 "$1,135.50" "$1,135.50" $842.77 $842.77 $875.24 $591.60 $236.65 "$1,135.50" $454.20 "$1,135.50" "$1,135.50" "$1,135.50" "$1,135.50" "$1,135.50" $851.63 "$1,135.50" "$1,135.50" "$1,135.50" $567.75 $567.75 $899.32 "$1,135.50" $908.40 $738.08 "$1,135.50" N/A $658.59 "$1,135.50" $681.30 "$1,135.50" "$1,135.50" "$1,135.50" N/A N/A 8065149527 SUP Custom 27203010 8065149527 - CANNULA OPHTHALMIC SHORT 23GA SOFT TIP STERILE DISPOSABLE BOTH IP/OP $450.00 $333.00 $80.10 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $80.10 $450.00 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $180.00 $450.00 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $450.00 N/A $261.00 $450.00 $270.00 $450.00 $450.00 $450.00 N/A N/A 8065149530 SUP Custom 27203010 8065149530 - CANNULA OPTH SHRT 25GA .8MM STRL GRSHBR SFTP DISP BOTH IP/OP $45.00 $33.00 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 N/A $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 8065740632 SUP Custom 27203010 8065740632 - PACK PHACO 30D RND .9MM STRL LF ABS LGC MXV DISP BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A 8065741080 SUP Custom 27203010 8065741080 - PACK PHACO US BSC BOTH IP/OP $114.00 $84.00 $20.21 $113.55 $113.55 $113.55 $113.55 $113.55 $113.55 $113.55 $20.21 $113.55 $113.55 $84.28 $84.28 $87.52 $59.16 $23.67 $113.55 $45.42 $113.55 $113.55 $113.55 $113.55 $113.55 $85.50 $113.55 $113.55 $113.55 $56.78 $56.78 $89.93 $113.55 $90.84 $73.81 $113.55 N/A $66.12 $113.55 $68.13 $113.55 $113.55 $113.55 N/A N/A 8065741089 SUP Custom 27203010 8065741089 - PACK PHACO 30D 1.1MM STRL INFNT RND US ABS TIP FLD MGMT SYS BOTH IP/OP $342.50 $253.00 $60.97 $342.50 $342.50 $342.50 $342.50 $342.50 $342.50 $342.50 $60.97 $342.50 $342.50 $254.20 $254.20 $264.00 $178.44 $71.38 $342.50 $137.00 $342.50 $342.50 $342.50 $342.50 $342.50 $256.88 $342.50 $342.50 $342.50 $171.25 $171.25 $271.26 $342.50 $274.00 $222.63 $342.50 N/A $198.65 $342.50 $205.50 $342.50 $342.50 $342.50 N/A N/A 8065750157 SUP Custom 27203010 8065750157 - PACK VITRECTOMY INFINITI ANTERIOR STERILE DISPOSABLE BOTH IP/OP $434.00 $321.00 $77.25 $434.00 $434.00 $434.00 $434.00 $434.00 $434.00 $434.00 $77.25 $434.00 $434.00 $322.11 $322.11 $334.53 $226.11 $90.45 $434.00 $173.60 $434.00 $434.00 $434.00 $434.00 $434.00 $325.50 $434.00 $434.00 $434.00 $217.00 $217.00 $343.73 $434.00 $347.20 $282.10 $434.00 N/A $251.72 $434.00 $260.40 $434.00 $434.00 $434.00 N/A N/A 8065750159 SUP Custom 27203010 8065750159 - KIT PHACOEMULSIFICATION .9MM SMALL PART MICROSMOOTH STERILE BOTH IP/OP $52.50 $39.00 $9.35 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $9.35 $52.50 $52.50 $38.97 $38.97 $40.47 $27.35 $10.94 $52.50 $21.00 $52.50 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $34.13 $52.50 N/A $30.45 $52.50 $31.50 $52.50 $52.50 $52.50 N/A N/A 8065751176 SUP Custom 27203010 8065751176 - TIP 30 DEG OZIL 12 PHACO BOTH IP/OP $144.50 $107.00 $25.70 $144.38 $144.38 $144.38 $144.38 $144.38 $144.38 $144.38 $25.70 $144.38 $144.38 $107.16 $107.16 $111.29 $75.22 $30.09 $144.38 $57.75 $144.38 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $93.85 $144.38 N/A $83.81 $144.38 $86.63 $144.38 $144.38 $144.38 N/A N/A 8065751177 SUP Custom 27203010 8065751177 - TIP PHACOEMULSIFICATION 45D .9MM 12MM MINIFLARE OZIL BOTH IP/OP $144.50 $107.00 $25.70 $144.38 $144.38 $144.38 $144.38 $144.38 $144.38 $144.38 $25.70 $144.38 $144.38 $107.16 $107.16 $111.29 $75.22 $30.09 $144.38 $57.75 $144.38 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $93.85 $144.38 N/A $83.81 $144.38 $86.63 $144.38 $144.38 $144.38 N/A N/A 8065751184 SUP Custom 27203010 8065751184 - ILLUMINATOR OPTH 23GA STRL CNSTL SPHR WA DISP BOTH IP/OP $309.50 $229.00 $55.07 $309.38 $309.38 $309.38 $309.38 $309.38 $309.38 $309.38 $55.07 $309.38 $309.38 $229.62 $229.62 $238.47 $161.19 $64.48 $309.38 $123.75 $309.38 $309.38 $309.38 $309.38 $309.38 $232.13 $309.38 $309.38 $309.38 $154.69 $154.69 $245.03 $309.38 $247.50 $201.10 $309.38 N/A $179.51 $309.38 $185.63 $309.38 $309.38 $309.38 N/A N/A 8065751576 SUP Custom 27203010 8065751576 - PROBE LASER 23GA ILLUMINATED PIK RFID BOTH IP/OP "$3,571.00" "$2,643.00" $635.62 "$3,570.90" "$3,570.90" "$3,570.90" "$3,570.90" "$3,570.90" "$3,570.90" "$3,570.90" $635.62 "$3,570.90" "$3,570.90" "$2,650.32" "$2,650.32" "$2,752.45" "$1,860.44" $744.21 "$3,570.90" "$1,428.36" "$3,570.90" "$3,570.90" "$3,570.90" "$3,570.90" "$3,570.90" "$2,678.25" "$3,570.90" "$3,570.90" "$3,570.90" "$1,785.45" "$1,785.45" "$2,828.15" "$3,570.90" "$2,856.72" "$2,321.09" "$3,570.90" N/A "$2,071.18" "$3,570.90" "$2,142.54" "$3,570.90" "$3,570.90" "$3,570.90" N/A N/A 8065751577 SUP Custom 27203010 8065751577 - ILLUMINATOR OPHTHALMIC 25GA RADIO FREQUENCY IDENTIFICATION BOTH IP/OP "$3,731.50" "$2,761.00" $664.14 "$3,731.10" "$3,731.10" "$3,731.10" "$3,731.10" "$3,731.10" "$3,731.10" "$3,731.10" $664.14 "$3,731.10" "$3,731.10" "$2,769.22" "$2,769.22" "$2,875.93" "$1,943.90" $777.60 "$3,731.10" "$1,492.44" "$3,731.10" "$3,731.10" "$3,731.10" "$3,731.10" "$3,731.10" "$2,798.63" "$3,731.10" "$3,731.10" "$3,731.10" "$1,865.55" "$1,865.55" "$2,955.03" "$3,731.10" "$2,984.88" "$2,425.22" "$3,731.10" N/A "$2,164.27" "$3,731.10" "$2,238.66" "$3,731.10" "$3,731.10" "$3,731.10" N/A N/A 8065751592 SUP Custom 27203010 8065751592 - PROBE LASER 78D 23GA 2IN ILLUMINATION CURVE TIP LARGE BOTH IP/OP "$2,760.00" "$2,042.00" $491.28 "$2,760.00" "$2,760.00" "$2,760.00" "$2,760.00" "$2,760.00" "$2,760.00" "$2,760.00" $491.28 "$2,760.00" "$2,760.00" "$2,048.47" "$2,048.47" "$2,127.41" "$1,437.96" $575.21 "$2,760.00" "$1,104.00" "$2,760.00" "$2,760.00" "$2,760.00" "$2,760.00" "$2,760.00" "$2,070.00" "$2,760.00" "$2,760.00" "$2,760.00" "$1,380.00" "$1,380.00" "$2,185.92" "$2,760.00" "$2,208.00" "$1,794.00" "$2,760.00" N/A "$1,600.80" "$2,760.00" "$1,656.00" "$2,760.00" "$2,760.00" "$2,760.00" N/A N/A 8065751593 SUP Custom 27203010 8065751593 - PROBE LASER 78D 25GA 2IN ILLUMINATION CURVE TIP LARGE BOTH IP/OP $541.00 $400.00 $96.25 $540.75 $540.75 $540.75 $540.75 $540.75 $540.75 $540.75 $96.25 $540.75 $540.75 $401.34 $401.34 $416.81 $281.73 $112.70 $540.75 $216.30 $540.75 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $351.49 $540.75 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 8065751922 SUP Custom 27203010 8065751922 - SET OPHTHALMIC INTREPID IRRIGATION ASPIRATION BIMANUAL HANDP BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $200.39 $200.39 $208.12 $140.67 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $175.50 $270.00 N/A $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A 8065752134 SUP Custom 27203010 8065752134 - PROBE VITRTM 23GA STRL LF ALCON CNTRN ULTRAVIT ANT DISP BOTH IP/OP $475.00 $352.00 $84.55 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $84.55 $475.00 $475.00 $352.55 $352.55 $366.13 $247.48 $99.00 $475.00 $190.00 $475.00 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $308.75 $475.00 N/A $275.50 $475.00 $285.00 $475.00 $475.00 $475.00 N/A N/A 8065752201 SUP Custom 27203010 8065752201 - PACK PHACO 45D .9MM STRL ABS TIP FLD MGMT SYS ULT SLV DISP BOTH IP/OP "$1,664.00" "$1,231.00" $296.13 "$1,663.65" "$1,663.65" "$1,663.65" "$1,663.65" "$1,663.65" "$1,663.65" "$1,663.65" $296.13 "$1,663.65" "$1,663.65" "$1,234.76" "$1,234.76" "$1,282.34" $866.76 $346.72 "$1,663.65" $665.46 "$1,663.65" "$1,663.65" "$1,663.65" "$1,663.65" "$1,663.65" "$1,248.00" "$1,663.65" "$1,663.65" "$1,663.65" $831.83 $831.83 "$1,317.61" "$1,663.65" "$1,330.92" "$1,081.37" "$1,663.65" N/A $965.12 "$1,663.65" $998.19 "$1,663.65" "$1,663.65" "$1,663.65" N/A N/A 8065754003 SUP HCPCS L8610 8065754003 - SHUNT GLCM STRL LF CYPASS BOTH IP/OP "$3,962.50" "$2,932.00" $786.46 "$3,962.50" "$1,783.13" "$1,783.13" "$1,783.13" "$1,783.13" "$3,962.50" "$3,962.50" "$3,962.50" $825.88 "$3,962.50" "$3,962.50" "$3,962.50" "$3,962.50" "$3,962.50" $825.83 "$3,962.50" "$3,962.50" "$1,953.51" "$3,962.50" "$3,962.50" "$3,962.50" "$3,962.50" "$2,971.88" "$3,962.50" "$3,962.50" "$3,962.50" "$1,981.25" "$1,981.25" "$3,138.30" "$3,962.50" "$3,170.00" "$1,783.13" $786.46 N/A "$2,298.25" "$3,962.50" "$3,962.50" "$3,962.50" $825.79 "$3,962.50" N/A N/A 8065817001 SUP Custom 27203010 8065817001 - TIP SUCTION/IRRIGATION STR .3MM 1 PIECE ULTRAFLOW BOTH IP/OP "$1,650.00" "$1,221.00" $293.70 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" $293.70 "$1,650.00" "$1,650.00" "$1,224.63" "$1,224.63" "$1,271.82" $859.65 $343.88 "$1,650.00" $660.00 "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,650.00" "$1,237.50" "$1,650.00" "$1,650.00" "$1,650.00" $825.00 $825.00 "$1,306.80" "$1,650.00" "$1,320.00" "$1,072.50" "$1,650.00" N/A $957.00 "$1,650.00" $990.00 "$1,650.00" "$1,650.00" "$1,650.00" N/A N/A 8065900163 SUP Custom 27203010 8065900163 - KIT ACCESSORY PROCEDURAL LIQUID PERFLUORON BOTH IP/OP "$3,050.00" "$2,257.00" $542.88 "$3,049.88" "$3,049.88" "$3,049.88" "$3,049.88" "$3,049.88" "$3,049.88" "$3,049.88" $542.88 "$3,049.88" "$3,049.88" "$2,263.62" "$2,263.62" "$2,350.85" "$1,588.99" $635.63 "$3,049.88" "$1,219.95" "$3,049.88" "$3,049.88" "$3,049.88" "$3,049.88" "$3,049.88" "$2,287.50" "$3,049.88" "$3,049.88" "$3,049.88" "$1,524.94" "$1,524.94" "$2,415.50" "$3,049.88" "$2,439.90" "$1,982.42" "$3,049.88" N/A "$1,769.00" "$3,049.88" "$1,829.93" "$3,049.88" "$3,049.88" "$3,049.88" N/A N/A 8065977758 SUP Custom 27203010 8065977758 - HOLDER LEN STRL LF MNRCH II B CRTDG IOL DLV SYS HNDPC DISP BOTH IP/OP $50.00 $37.00 $2.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $8.90 $50.00 $50.00 $37.11 $37.11 $38.54 $26.05 $10.42 $50.00 $2.00 $50.00 $50.00 $5.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $32.50 $50.00 N/A $29.00 $50.00 $30.00 $50.00 $50.00 $50.00 N/A N/A 8065992747 SUP Custom 27203010 8065992747 - KNIFE OPHTHALMIC ANGLE 2 BEVEL 2.75MM SLIT SATIN FINISH FULL BOTH IP/OP $46.50 $34.00 $8.21 $46.13 $46.13 $46.13 $46.13 $46.13 $46.13 $46.13 $8.21 $46.13 $46.13 $34.24 $34.24 $35.56 $24.03 $9.61 $46.13 $18.45 $46.13 $46.13 $46.13 $46.13 $46.13 $34.88 $46.13 $46.13 $46.13 $23.07 $23.07 $36.53 $46.13 $36.90 $29.98 $46.13 N/A $26.97 $46.13 $27.68 $46.13 $46.13 $46.13 N/A N/A 8065997001 SUP HCPCS C1713 8065997001 - SCREW BN 2.3MM STRL IKNF II STNCRSNT TIP STRG DISP BOTH IP/OP $42.00 $31.00 $8.25 $41.58 $18.71 $18.71 $18.71 $18.71 $41.58 $41.58 $41.58 $8.67 $41.58 $41.58 $41.58 $41.58 $41.58 $8.67 $41.58 $16.63 $24.59 $41.58 $41.58 $41.58 $41.58 $31.50 $41.58 $41.58 $41.58 $20.79 $20.79 $32.93 $41.58 $33.26 $18.71 $8.25 N/A $24.36 $41.58 $24.95 $41.58 $8.67 $41.58 N/A N/A 8450107030 SUP Custom 27203010 8450107030 - BURR SURG 3MM MATCH HEAD LATEX FREE BOTH IP/OP $466.50 $345.00 $83.01 $466.35 $466.35 $466.35 $466.35 $466.35 $466.35 $466.35 $83.01 $466.35 $466.35 $346.12 $346.12 $359.46 $242.97 $97.19 $466.35 $186.54 $466.35 $466.35 $466.35 $466.35 $466.35 $349.88 $466.35 $466.35 $466.35 $233.18 $233.18 $369.35 $466.35 $373.08 $303.13 $466.35 N/A $270.57 $466.35 $279.81 $466.35 $466.35 $466.35 N/A N/A 8884720825 SUP Custom 27203010 8884720825 - TUBE NG 8FR 36IN LF ENTFLX FD STY Y ST BOTH IP/OP $26.50 $20.00 $4.65 $26.13 $26.13 $26.13 $26.13 $26.13 $26.13 $26.13 $4.65 $26.13 $26.13 $19.39 $19.39 $20.14 $13.61 $5.45 $26.13 $10.45 $26.13 $26.13 $26.13 $26.13 $26.13 $19.88 $26.13 $26.13 $26.13 $13.07 $13.07 $20.69 $26.13 $20.90 $16.98 $26.13 N/A $15.37 $26.13 $15.68 $26.13 $26.13 $26.13 N/A N/A 8886808300 SUP Custom 27803010 8886808300 - RING ANSTM 2MM 25MM STRL VALTRAC RADOPQ BFRG MECH LCK CNCT BOTH IP/OP $829.50 $614.00 $147.64 $829.45 $829.45 $829.45 $829.45 $829.45 $829.45 $829.45 $147.64 $829.45 $829.45 $829.45 $829.45 $829.45 $829.45 $172.87 $829.45 $331.78 $829.45 $829.45 $829.45 $829.45 $829.45 $622.13 $829.45 $829.45 $829.45 $414.73 $414.73 $656.92 $829.45 $663.56 $373.25 $829.45 N/A $481.11 $829.45 $497.67 $829.45 $829.45 $829.45 N/A N/A 8886808800 SUP Custom 27803010 8886808800 - RING ANSTM 2MM 28MM STRL VALTRAC RADOPQ BFRG MECH LCK CNCT BOTH IP/OP $777.50 $575.00 $138.33 $777.13 $777.13 $777.13 $777.13 $777.13 $777.13 $777.13 $138.33 $777.13 $777.13 $777.13 $777.13 $777.13 $777.13 $161.96 $777.13 $310.85 $777.13 $777.13 $777.13 $777.13 $777.13 $583.13 $777.13 $777.13 $777.13 $388.57 $388.57 $615.49 $777.13 $621.70 $349.71 $777.13 N/A $450.95 $777.13 $466.28 $777.13 $777.13 $777.13 N/A N/A 8887654104 SUP HCPCS C1729 CATHETER URTH DOV 10FR FOLEY 2W SIL-EL 3ML LTX PED BOTH IP/OP $10.50 $8.00 $2.05 $10.33 $5.61 $5.61 $5.61 $5.61 $10.33 $10.33 $10.33 $2.15 $10.33 $7.67 $7.67 $7.96 $5.38 $2.15 $10.33 $10.33 $6.11 $10.33 $10.33 $10.33 $10.33 $7.88 $10.33 $10.33 $10.33 $5.17 $5.17 $8.18 $10.33 $8.26 $6.71 $2.05 N/A $6.09 $10.33 $10.33 $10.33 $2.15 $10.33 N/A N/A 8888119362 SUP HCPCS C1750 8888119362 - CATHETER HMDIAL 14.5FR 19CM MH MXD SPORTPACK 2 LUM KINK RST BOTH IP/OP $211.00 $156.00 $41.81 $210.68 $94.81 $94.81 $94.81 $94.81 $210.68 $210.68 $210.68 $43.91 $210.68 $210.68 $210.68 $210.68 $210.68 $43.91 $210.68 $210.68 $124.62 $210.68 $210.68 $210.68 $210.68 $158.25 $210.68 $210.68 $210.68 $105.34 $105.34 $166.86 $210.68 $168.54 $94.81 $41.81 N/A $122.38 $210.68 $210.68 $210.68 $43.91 $210.68 N/A N/A 8888123435 SUP HCPCS C1750 8888123435 - CATHETER HMDIAL 14.5FR 23CM MH MXD SPORTPACK 2 LUM KINK RST BOTH IP/OP $45.00 $33.00 $8.93 $45.00 $20.25 $20.25 $20.25 $20.25 $45.00 $45.00 $45.00 $9.38 $45.00 $45.00 $45.00 $45.00 $45.00 $9.38 $45.00 $45.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $20.25 $8.93 N/A $26.10 $45.00 $45.00 $45.00 $9.38 $45.00 N/A N/A 8888128485 SUP HCPCS C1750 8888128485 - PACK CATHETER 14.5FR 28/45CM 2 LUMEN SIDEHOLE MAHURKAR MAXID BOTH IP/OP $376.00 $278.00 $74.60 $375.88 $169.15 $169.15 $169.15 $169.15 $375.88 $375.88 $375.88 $78.34 $375.88 $375.88 $375.88 $375.88 $375.88 $78.34 $375.88 $375.88 $222.33 $375.88 $375.88 $375.88 $375.88 $282.00 $375.88 $375.88 $375.88 $187.94 $187.94 $297.70 $375.88 $300.70 $169.15 $74.60 N/A $218.08 $375.88 $375.88 $375.88 $78.33 $375.88 N/A N/A 8888133535 SUP HCPCS C1750 8888133535 - PACK CATHETER 14.5FR 33/50CM 2 LUMEN SIDEHOLE MAHURKAR MAXID BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 8888160333 SUP Custom 27203010 8888160333 - CATHETER UMB 3.5FR 15IN .15ML CLR STRL LF ARG 1 LUM LL HUB BOTH IP/OP $34.00 $25.00 $6.02 $35.34 $33.84 $33.84 $33.84 $33.84 $33.84 $33.84 $6.02 $33.84 $33.84 $25.12 $25.12 $26.08 $17.63 $7.05 $33.84 $15.55 $33.84 $33.84 $35.34 $33.84 $33.84 $25.50 $33.84 $33.84 $33.84 $16.92 $16.92 $26.80 $33.84 $27.07 $22.00 $33.84 N/A $19.72 $33.84 $20.30 $33.84 $33.84 $33.84 N/A N/A 8888160341 SUP Custom 27203010 8888160341 - CAP TUBE 13MM BLU EZTPR DBL FLNG SL THB TAB PE BOTH IP/OP $34.50 $26.00 $6.10 $34.28 $34.28 $34.28 $34.28 $34.28 $34.28 $34.28 $6.10 $34.28 $34.28 $25.44 $25.44 $26.42 $17.86 $7.14 $34.28 $14.67 $34.28 $34.28 $33.35 $34.28 $34.28 $25.88 $34.28 $34.28 $34.28 $17.14 $17.14 $27.15 $34.28 $27.42 $22.28 $34.28 N/A $20.01 $34.28 $20.57 $34.28 $34.28 $34.28 N/A N/A 8888160408 SUP Custom 27203010 8888160408 - TRAY CATH LF A NEOS 2 TIER DSGN FN TIP FCP INS DEPH FR MGLN BOTH IP/OP $127.00 $94.00 $22.59 $126.90 $126.90 $126.90 $126.90 $126.90 $126.90 $126.90 $22.59 $126.90 $126.90 $94.19 $94.19 $97.81 $66.11 $26.45 $126.90 $54.91 $126.90 $126.90 $124.80 $126.90 $126.90 $95.25 $126.90 $126.90 $126.90 $63.45 $63.45 $100.50 $126.90 $101.52 $82.49 $126.90 N/A $73.66 $126.90 $76.14 $126.90 $126.90 $126.90 N/A N/A 8888211120 SUP HCPCS C1752 8888211120 - MAHURKAR ELITE SE CATHETER ONLY 20CM BOTH IP/OP $138.50 $102.00 $28.81 $138.23 $138.23 $138.23 $138.23 $138.23 $138.23 $138.23 $138.23 $138.23 $138.23 $102.59 $102.59 $106.55 $72.02 $28.81 $138.23 $55.29 $138.23 $138.23 $138.23 $138.23 $138.23 $103.88 $138.23 $138.23 $138.23 $69.12 $69.12 $109.48 $138.23 $110.58 $89.85 $138.23 N/A $80.33 $138.23 $82.94 $138.23 $138.23 $138.23 N/A N/A 8888211124 SUP HCPCS C1752 8888211124 - MAHURKAR ELITE SE CATHETER ONLY 24CM BOTH IP/OP $115.00 $85.00 $23.97 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $23.97 $115.00 $46.00 $115.00 $115.00 $115.00 $115.00 $115.00 $86.25 $115.00 $115.00 $115.00 $57.50 $57.50 $91.08 $115.00 $92.00 $51.75 $115.00 N/A $66.70 $115.00 $69.00 $115.00 $115.00 $115.00 N/A N/A 8888211216 SUP HCPCS C1752 8888211216 - KIT CATH 13.5FR 16CM MHRKR ELT STRG XTN BOTH IP/OP $115.00 $85.00 $23.97 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $115.00 $85.35 $85.35 $88.64 $59.92 $23.97 $115.00 $46.00 $115.00 $115.00 $115.00 $115.00 $115.00 $86.25 $115.00 $115.00 $115.00 $57.50 $57.50 $91.08 $115.00 $92.00 $74.75 $115.00 N/A $66.70 $115.00 $69.00 $115.00 $115.00 $115.00 N/A N/A 8888265108 SUP Custom 27203010 8888265108 - TUBE NG 10FR 36IN STRL S SMP SNTNL LN 2 LUM RADOPQ 5IN 1 BOTH IP/OP $28.50 $21.00 $5.07 $32.70 $28.47 $28.47 $28.47 $28.47 $28.47 $28.47 $5.07 $28.47 $28.47 $21.13 $21.13 $21.94 $14.83 $5.93 $28.47 $13.08 $28.47 $28.47 $32.70 $28.47 $28.47 $21.38 $28.47 $28.47 $28.47 $14.24 $14.24 $22.55 $28.47 $22.78 $18.51 $28.47 N/A $16.53 $28.47 $17.08 $28.47 $28.47 $28.47 N/A N/A 8888265108 SUP Custom 27203010 TUBE NG 36IN 10FR SNTNL LN A SLM SM SIL BOTH IP/OP $29.00 $21.00 $5.07 $32.70 $28.47 $28.47 $28.47 $28.47 $28.47 $28.47 $5.07 $28.47 $28.47 $21.13 $21.13 $21.94 $14.83 $5.93 $28.47 $13.08 $28.47 $28.47 $32.70 $28.47 $28.47 $21.75 $28.47 $28.47 $28.47 $14.24 $14.24 $22.55 $28.47 $22.78 $18.51 $28.47 N/A $16.82 $28.47 $17.08 $28.47 $28.47 $28.47 N/A N/A 8888492120 SUP HCPCS C1758 8888492120 - CATH URTH DV RBNL 20FR 16IN PVC STRL LATEX FREE BOTH IP/OP $1.50 $1.00 $0.27 $1.38 $0.75 $0.75 $0.75 $0.75 $1.38 $1.38 $1.38 $0.29 $1.38 $1.02 $1.02 $1.06 $0.72 $0.29 $1.38 $1.38 $0.82 $1.38 $1.38 $1.38 $1.38 $1.13 $1.38 $1.38 $1.38 $0.69 $0.69 $1.09 $1.38 $1.10 $0.90 $0.27 N/A $0.87 $1.38 $1.38 $1.38 $0.29 $1.38 N/A N/A 8888560805 SUP HCPCS C1729 8888560805 - CATHETER DRAIN 8FR 9IN SHARP TROCAR TIP RADIOPQ DEPTH MARK BOTH IP/OP $34.50 $26.00 $6.78 $34.18 $18.56 $18.56 $18.56 $18.56 $34.18 $34.18 $34.18 $7.12 $34.18 $25.37 $25.37 $26.35 $17.81 $7.12 $34.18 $34.18 $20.22 $34.18 $34.18 $34.18 $34.18 $25.88 $34.18 $34.18 $34.18 $17.09 $17.09 $27.07 $34.18 $27.34 $22.22 $6.78 N/A $20.01 $34.18 $34.18 $34.18 $7.12 $34.18 N/A N/A 8888561019 SUP HCPCS C1729 8888561019 - CATHETER DRN 10FR 3.3MM 9IN TROC STRG SFT PVC THOR BOTH IP/OP $34.50 $26.00 $6.78 $34.18 $18.56 $18.56 $18.56 $18.56 $34.18 $34.18 $34.18 $7.12 $34.18 $25.37 $25.37 $26.35 $17.81 $7.12 $34.18 $34.18 $20.22 $34.18 $34.18 $34.18 $34.18 $25.88 $34.18 $34.18 $34.18 $17.09 $17.09 $27.07 $34.18 $27.34 $22.22 $6.78 N/A $20.01 $34.18 $34.18 $34.18 $7.12 $34.18 N/A N/A 8888561027 SUP HCPCS C1729 8888561027 - CATHETER DRAIN 12FR 9IN SHARP TROCAR TIP RADIOPQ DEPTH MARK BOTH IP/OP $34.50 $26.00 $6.78 $34.18 $18.56 $18.56 $18.56 $18.56 $34.18 $34.18 $34.18 $7.12 $34.18 $25.37 $25.37 $26.35 $17.81 $7.12 $34.18 $34.18 $20.22 $34.18 $34.18 $34.18 $34.18 $25.88 $34.18 $34.18 $34.18 $17.09 $17.09 $27.07 $34.18 $27.34 $22.22 $6.78 N/A $20.01 $34.18 $34.18 $34.18 $7.12 $34.18 N/A N/A 8888570515 SUP HCPCS C1725 CATHETER DRAIN 16FR 5.3MM 20IN 4 SD EYE STRG THOR THRMSNS BOTH IP/OP $13.00 $10.00 $2.51 $12.63 $6.86 $6.86 $6.86 $6.86 $12.63 $12.63 $12.63 $2.63 $12.63 $9.37 $9.37 $9.74 $6.58 $2.63 $12.63 $12.63 $7.47 $12.63 $12.63 $12.63 $12.63 $9.75 $12.63 $12.63 $12.63 $6.32 $6.32 $10.00 $12.63 $10.10 $8.21 $2.51 N/A $7.54 $12.63 $12.63 $12.63 $2.63 $12.63 N/A N/A 8888570523 SUP HCPCS C1725 CATHETER DRAIN 20FR 6.7MM 20IN EYLT RT ANG THRMSNS DEPTH BOTH IP/OP $13.00 $10.00 $2.51 $12.63 $6.86 $6.86 $6.86 $6.86 $12.63 $12.63 $12.63 $2.63 $12.63 $9.37 $9.37 $9.74 $6.58 $2.63 $12.63 $12.63 $7.47 $12.63 $12.63 $12.63 $12.63 $9.75 $12.63 $12.63 $12.63 $6.32 $6.32 $10.00 $12.63 $10.10 $8.21 $2.51 N/A $7.54 $12.63 $12.63 $12.63 $2.63 $12.63 N/A N/A 8888570572 SUP HCPCS C1729 8888570572 - CATHETER DRN STRG BVL 40FR 20IN CLR STRL LF ARG SNTNL LN SNT BOTH IP/OP $13.00 $10.00 $2.55 $12.83 $6.97 $6.97 $6.97 $6.97 $12.83 $12.83 $12.83 $2.67 $12.83 $9.52 $9.52 $9.89 $6.68 $2.67 $12.83 $12.83 $7.59 $12.83 $12.83 $12.83 $12.83 $9.75 $12.83 $12.83 $12.83 $6.42 $6.42 $10.16 $12.83 $10.26 $8.34 $2.55 N/A $7.54 $12.83 $12.83 $12.83 $2.67 $12.83 N/A N/A 8888571042 SUP HCPCS C1729 8888571042 - CATHETER DRAIN RIGHT ANG 28FR 20IN 6 SIDE EYE RADIOPQ TUBE BOTH IP/OP $185.50 $137.00 $36.72 $185.03 $100.47 $100.47 $100.47 $100.47 $185.03 $185.03 $185.03 $38.56 $185.03 $137.33 $137.33 $142.62 $96.40 $38.56 $185.03 $185.03 $109.45 $185.03 $185.03 $185.03 $185.03 $139.13 $185.03 $185.03 $185.03 $92.52 $92.52 $146.54 $185.03 $148.02 $120.27 $36.72 N/A $107.59 $185.03 $185.03 $185.03 $38.56 $185.03 N/A N/A 8888577700 SUP Custom 27803010 8888577700 - SHUNT CV 8FR 11IN CLR STRL LF ARG 4 TUBE KT PLSH TPR END BOTH IP/OP $87.00 $64.00 $15.40 $86.51 $86.51 $86.51 $86.51 $86.51 $86.51 $86.51 $15.40 $86.51 $86.51 $86.51 $86.51 $86.51 $86.51 $18.03 $86.51 $34.60 $86.51 $86.51 $86.51 $86.51 $86.51 $65.25 $86.51 $86.51 $86.51 $43.26 $43.26 $68.52 $86.51 $69.21 $38.93 $86.51 N/A $50.46 $86.51 $51.91 $86.51 $86.51 $86.51 N/A N/A 8888577775 SUP Custom 27803010 8888577775 - KIT SHNT STRG 8-14FR 6IN STRL ARG RADOPQ LN PVC CRTD DISP BOTH IP/OP $137.50 $102.00 $24.42 $137.21 $137.21 $137.21 $137.21 $137.21 $137.21 $137.21 $24.42 $137.21 $137.21 $137.21 $137.21 $137.21 $137.21 $28.60 $137.21 $60.92 $137.21 $137.21 $129.08 $137.21 $137.21 $103.13 $137.21 $137.21 $137.21 $68.61 $68.61 $108.67 $137.21 $109.77 $61.74 $137.21 N/A $79.75 $137.21 $82.33 $137.21 $137.21 $137.21 N/A N/A 8888590018 SUP HCPCS C1729 8888590018 - CATHETER DRAIN 18FR 4.7MM 20IN 14 CHANNEL 4 EYELET VENT BOTH IP/OP $124.00 $92.00 $24.53 $157.76 $67.12 $67.12 $67.12 $67.12 $123.61 $123.61 $123.61 $25.76 $123.61 $91.74 $91.74 $95.28 $64.40 $25.76 $123.61 $157.76 $73.12 $123.61 $145.33 $123.61 $123.61 $93.00 $123.61 $123.61 $123.61 $61.81 $61.81 $97.90 $123.61 $98.89 $80.35 $24.53 N/A $71.92 $123.61 $123.61 $123.61 $25.76 $123.61 N/A N/A 54410004020 SUP HCPCS C1713 54410004020 - SCREW BONE SMALL PROFILE 4MM 20MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410004025 SUP HCPCS C1713 54410004025 - SCREW BONE SMALL PROFILE 4MM 25MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410004030 SUP HCPCS C1713 54410004030 - SCREW BONE SMALL PROFILE 4MM 30MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410004035 SUP HCPCS C1713 54410004035 - SCREW BONE SMALL PROFILE 4MM 35MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410004040 SUP HCPCS C1713 54410004040 - SCREW BONE SMALL PROFILE 4MM 40MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410004045 SUP HCPCS C1713 54410004045 - SCREW BONE SMALL PROFILE 4MM 45MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410004520 SUP HCPCS C1713 54410004520 - SCREW BONE SMALL PROFILE 4.5MM 20MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410004525 SUP HCPCS C1713 54410004525 - SCREW BONE T25 SMALL PROFILE 4.5MM 25MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410004530 SUP HCPCS C1713 54410004530 - SCREW BONE T25 SMALL PROFILE 4.5MM 30MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410004535 SUP HCPCS C1713 54410004535 - SCREW BONE T25 SMALL PROFILE 4.5MM 35MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410004540 SUP HCPCS C1713 54410004540 - SCREW BONE T25 SMALL PROFILE 4.5MM 40MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410004545 SUP HCPCS C1713 54410004545 - SCREW BONE T25 SMALL PROFILE 4.5MM 45MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005020 SUP HCPCS C1713 54410005020 - SCREW BONE SMALL PROFILE 5MM 20MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005025 SUP HCPCS C1713 54410005025 - SCREW BONE T25 SMALL PROFILE 5MM 25MM 2 LEAD FIX ANGLE COLOR BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005030 SUP HCPCS C1713 54410005030 - SCREW BONE T25 SMALL PROFILE 5MM 30MM 2 LEAD FIX ANGLE COLOR BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005035 SUP HCPCS C1713 54410005035 - SCREW BONE T25 SMALL PROFILE 5MM 35MM 2 LEAD FIX ANGLE COLOR BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005040 SUP HCPCS C1713 54410005040 - SCREW BONE T25 SMALL PROFILE 5MM 40MM 2 LEAD FIX ANGLE COLOR BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005045 SUP HCPCS C1713 54410005045 - SCREW BONE T25 SMALL PROFILE 5MM 45MM 2 LEAD FIX ANGLE COLOR BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005050 SUP HCPCS C1713 54410005050 - SCREW BONE SMALL PROFILE 5MM 50MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005520 SUP HCPCS C1713 54410005520 - SCREW BONE T25 SMALL PROFILE 5.5MM 20MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005525 SUP HCPCS C1713 54410005525 - SCREW BONE SMALL PROFILE 5.5MM 25MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005530 SUP HCPCS C1713 54410005530 - SCREW BONE T25 SMALL PROFILE 5.5MM 30MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005535 SUP HCPCS C1713 54410005535 - SCREW BONE T25 SMALL PROFILE 5.5MM 35MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005540 SUP HCPCS C1713 54410005540 - SCREW BONE T25 SMALL PROFILE 5.5MM 40MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005545 SUP HCPCS C1713 54410005545 - SCREW BONE T25 SMALL PROFILE 5.5MM 45MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005550 SUP HCPCS C1713 54410005550 - SCREW BONE SMALL PROFILE 5.5MM 50MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410005555 SUP HCPCS C1713 54410005555 - SCREW BONE SMALL PROFILE 5.5MM 55MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006025 SUP HCPCS C1713 54410006025 - SCREW BONE SMALL PROFILE 6MM 25MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006030 SUP HCPCS C1713 54410006030 - SCREW BONE SMALL PROFILE 6MM 30MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006035 SUP HCPCS C1713 54410006035 - SCREW BONE SMALL PROFILE 6MM 35MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006040 SUP HCPCS C1713 54410006040 - SCREW BONE SMALL PROFILE 6MM 40MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006045 SUP HCPCS C1713 54410006045 - SCREW BONE SMALL PROFILE 6MM 45MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006050 SUP HCPCS C1713 54410006050 - SCREW BONE SMALL PROFILE 6MM 50MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006055 SUP HCPCS C1713 54410006055 - SCREW BONE SMALL PROFILE 6MM 55MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006520 SUP HCPCS C1713 54410006520 - SCREW BONE SMALL PROFILE 6.5MM 20MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006525 SUP HCPCS C1713 54410006525 - SCREW BONE SMALL PROFILE 6.5MM 25MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006530 SUP HCPCS C1713 54410006530 - SCREW BONE T25 SMALL PROFILE 6.5MM 30MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006535 SUP HCPCS C1713 54410006535 - SCREW BONE T25 SMALL PROFILE 6.5MM 35MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006540 SUP HCPCS C1713 54410006540 - SCREW BONE T25 SMALL PROFILE 6.5MM 40MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006545 SUP HCPCS C1713 54410006545 - SCREW BONE T25 SMALL PROFILE 6.5MM 45MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006550 SUP HCPCS C1713 54410006550 - SCREW BONE T25 SMALL PROFILE 6.5MM 50MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006555 SUP HCPCS C1713 54410006555 - SCREW BONE T25 SMALL PROFILE 6.5MM 55MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410006560 SUP HCPCS C1713 54410006560 - SCREW BONE SMALL PROFILE 6.5MM 60MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410007530 SUP HCPCS C1713 54410007530 - SCREW BONE SMALL PROFILE 7.5MM 30MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410007535 SUP HCPCS C1713 54410007535 - SCREW BONE T25 SMALL PROFILE 7.5MM 35MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410007540 SUP HCPCS C1713 54410007540 - SCREW BONE T25 SMALL PROFILE 7.5MM 40MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410007545 SUP HCPCS C1713 54410007545 - SCREW BONE T25 SMALL PROFILE 7.5MM 45MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410007550 SUP HCPCS C1713 54410007550 - SCREW BONE T25 SMALL PROFILE 7.5MM 50MM 2 LEAD FIX ANGLE BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410007555 SUP HCPCS C1713 54410007555 - SCREW BONE SMALL PROFILE 7.5MM 55MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54410007560 SUP HCPCS C1713 54410007560 - SCREW BONE SMALL PROFILE 7.5MM 60MM 2 LEAD THREAD FORM FIX BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 54740044520 SUP HCPCS C1713 54740044520 - SCREW BONE 4.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740044525 SUP HCPCS C1713 54740044525 - SCREW BONE 4.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740044530 SUP HCPCS C1713 54740044530 - SCREW BONE 4.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740044535 SUP HCPCS C1713 54740044535 - SCREW BONE 4.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740044540 SUP HCPCS C1713 54740044540 - SCREW BONE 4.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740044545 SUP HCPCS C1713 54740044545 - SCREW BONE 4.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740044550 SUP HCPCS C1713 54740044550 - SCREW BONE 4.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740044555 SUP HCPCS C1713 54740044555 - SCREW BONE 4.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740044560 SUP HCPCS C1713 54740044560 - SCREW BONE 4.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740045520 SUP HCPCS C1713 54740045520 - SCREW BONE 5.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740045525 SUP HCPCS C1713 54740045525 - SCREW BONE 5.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740045530 SUP HCPCS C1713 54740045530 - SCREW BONE 5.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740045535 SUP HCPCS C1713 54740045535 - SCREW BONE 5.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740045540 SUP HCPCS C1713 54740045540 - SCREW BONE 5.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740045545 SUP HCPCS C1713 54740045545 - SCREW BONE 5.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740045550 SUP HCPCS C1713 54740045550 - SCREW BONE 5.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740045555 SUP HCPCS C1713 54740045555 - SCREW BONE 5.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740045560 SUP HCPCS C1713 54740045560 - SCREW BONE 5.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740046520 SUP HCPCS C1713 54740046520 - SCREW BONE 6.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740046525 SUP HCPCS C1713 54740046525 - SCREW BONE 6.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740046530 SUP HCPCS C1713 54740046530 - SCREW BONE 6.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740046535 SUP HCPCS C1713 54740046535 - SCREW BONE 6.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740046540 SUP HCPCS C1713 54740046540 - SCREW BONE 6.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740046545 SUP HCPCS C1713 54740046545 - SCREW BONE 6.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740046550 SUP HCPCS C1713 54740046550 - SCREW BONE 6.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740046555 SUP HCPCS C1713 54740046555 - SCREW BONE 6.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740046560 SUP HCPCS C1713 54740046560 - SCREW BONE 6.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740047520 SUP HCPCS C1713 54740047520 - SCREW BONE 7.5MM 20MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740047525 SUP HCPCS C1713 54740047525 - SCREW BONE 7.5MM 25MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740047530 SUP HCPCS C1713 54740047530 - SCREW BONE 7.5MM 30MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740047535 SUP HCPCS C1713 54740047535 - SCREW BONE 7.5MM 35MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740047540 SUP HCPCS C1713 54740047540 - SCREW BONE 7.5MM 40MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740047545 SUP HCPCS C1713 54740047545 - SCREW BONE 7.5MM 45MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740047550 SUP HCPCS C1713 54740047550 - SCREW BONE 7.5MM 50MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740047555 SUP HCPCS C1713 54740047555 - SCREW BONE 7.5MM 55MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740047560 SUP HCPCS C1713 54740047560 - SCREW BONE 7.5MM 60MM ATS SPN MULTIAX 4.75MM ROD ST BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54740105515 SUP HCPCS C1713 54740105515 - SCREW BONE 5.5MM 15MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740105520 SUP HCPCS C1713 54740105520 - SCREW BONE 5.5MM 20MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740105525 SUP HCPCS C1713 54740105525 - SCREW BONE 5.5MM 25MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54740105530 SUP HCPCS C1713 54740105530 - SCREW BONE 5.5MM 30MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54740105535 SUP HCPCS C1713 54740105535 - SCREW BN 5.5MM 35MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740105540 SUP HCPCS C1713 54740105540 - SCREW BN 5.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54740105545 SUP HCPCS C1713 54740105545 - SCREW BN 5.5MM 45MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740105550 SUP HCPCS C1713 54740105550 - SCREW BN 5.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740105555 SUP HCPCS C1713 54740105555 - SCREW BONE 5.5MM 55MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54740105560 SUP HCPCS C1713 54740105560 - SCREW BONE 5.5MM 60MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54740105565 SUP HCPCS C1713 54740105565 - SCREW BONE 5.5MM 65MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740105570 SUP HCPCS C1713 54740105570 - SCREW BONE 5.5MM 70MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54740105575 SUP HCPCS C1713 54740105575 - SCREW BONE 5.5MM 75MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740105580 SUP HCPCS C1713 54740105580 - SCREW BONE 5.5MM 80MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106015 SUP HCPCS C1713 54740106015 - SCREW BONE 6MM 15MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54740106020 SUP HCPCS C1713 54740106020 - SCREW BONE 6MM 20MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54740106025 SUP HCPCS C1713 54740106025 - SCREW BONE 6MM 25MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106030 SUP HCPCS C1713 54740106030 - SCREW BONE 6MM 30MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54740106035 SUP HCPCS C1713 54740106035 - SCREW BONE 6MM 35MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106040 SUP HCPCS C1713 54740106040 - SCREW BONE 6MM 40MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106045 SUP HCPCS C1713 54740106045 - SCREW BONE 6MM 45MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106050 SUP HCPCS C1713 54740106050 - SCREW BONE 6MM 50MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106055 SUP HCPCS C1713 54740106055 - SCREW BONE 6MM 55MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106060 SUP HCPCS C1713 54740106060 - SCREW BONE 6MM 60MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106065 SUP HCPCS C1713 54740106065 - SCREW BONE 6MM 65MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106070 SUP HCPCS C1713 54740106070 - SCREW BONE 6MM 70MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106075 SUP HCPCS C1713 54740106075 - SCREW BONE 6MM 75MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106080 SUP HCPCS C1713 54740106080 - SCREW BONE 6MM 80MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106515 SUP HCPCS C1713 54740106515 - SCREW BONE 6.5MM 15MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106520 SUP HCPCS C1713 54740106520 - SCREW BONE 6.5MM 20MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106525 SUP HCPCS C1713 54740106525 - SCREW BONE 6.5MM 25MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106530 SUP HCPCS C1713 54740106530 - SCREW BN 6.5MM 30MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106535 SUP HCPCS C1713 54740106535 - SCREW BN 6.5MM 35MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106540 SUP HCPCS C1713 54740106540 - SCREW BN 6.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106545 SUP HCPCS C1713 54740106545 - SCREW BN 6.5MM 45MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106550 SUP HCPCS C1713 54740106550 - SCREW BN 6.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106555 SUP HCPCS C1713 54740106555 - SCREW BN 6.5MM 55MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106560 SUP HCPCS C1713 54740106560 - SCREW BONE 6.5MM 60MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106565 SUP HCPCS C1713 54740106565 - SCREW BONE 6.5MM 65MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106570 SUP HCPCS C1713 54740106570 - SCREW BONE 6.5MM 70MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106575 SUP HCPCS C1713 54740106575 - SCREW BONE 6.5MM 75MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740106580 SUP HCPCS C1713 54740106580 - SCREW BONE 6.5MM 80MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107020 SUP HCPCS C1713 54740107020 - SCREW BONE 7MM 20MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107025 SUP HCPCS C1713 54740107025 - SCREW BONE 7MM 25MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107030 SUP HCPCS C1713 54740107030 - SCREW BONE 7MM 30MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107035 SUP HCPCS C1713 54740107035 - SCREW BONE 7MM 35MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107040 SUP HCPCS C1713 54740107040 - SCREW BONE 7MM 40MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107045 SUP HCPCS C1713 54740107045 - SCREW BONE 7MM 45MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107050 SUP HCPCS C1713 54740107050 - SCREW BONE 7MM 50MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107055 SUP HCPCS C1713 54740107055 - SCREW BONE 7MM 55MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107060 SUP HCPCS C1713 54740107060 - SCREW BONE 7MM 60MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107065 SUP HCPCS C1713 54740107065 - SCREW BONE 7MM 65MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107070 SUP HCPCS C1713 54740107070 - SCREW BONE 7MM 70MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107075 SUP HCPCS C1713 54740107075 - SCREW BONE 7MM 75MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107080 SUP HCPCS C1713 54740107080 - SCREW BONE 7MM 80MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107500 SUP HCPCS C1713 54740107500 - SCREW BONE 7.5MM 100MM MULTIAX CANN SOLERA COCR HA SPN 4.75 BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107511 SUP HCPCS C1713 54740107511 - SCREW BONE 7.5MM 110MM MULTIAX CANN SOLERA COCR HA SPN 4.75 BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107520 SUP HCPCS C1713 54740107520 - SCREW BONE 7.5MM 20MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107525 SUP HCPCS C1713 54740107525 - SCREW BONE 7.5MM 25MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107530 SUP HCPCS C1713 54740107530 - SCREW BONE 7.5MM 30MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107535 SUP HCPCS C1713 54740107535 - SCREW BONE 7.5MM 35MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107540 SUP HCPCS C1713 54740107540 - SCREW BN 7.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107545 SUP HCPCS C1713 54740107545 - SCREW BN 7.5MM 45MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107550 SUP HCPCS C1713 54740107550 - SCREW BN 7.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107555 SUP HCPCS C1713 54740107555 - SCREW BN 7.5MM 55MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107560 SUP HCPCS C1713 54740107560 - SCREW BONE 7.5MM 60MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107565 SUP HCPCS C1713 54740107565 - SCREW BONE 7.5MM 65MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107570 SUP HCPCS C1713 54740107570 - SCREW BONE 7.5MM 70MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107575 SUP HCPCS C1713 54740107575 - SCREW BONE 7.5MM 75MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107580 SUP HCPCS C1713 54740107580 - SCREW BONE 7.5MM 80MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107585 SUP HCPCS C1713 54740107585 - SCREW BONE 7.5MM 85MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107590 SUP HCPCS C1713 54740107590 - SCREW BONE 7.5MM 90MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740107595 SUP HCPCS C1713 54740107595 - SCREW BONE 7.5MM 95MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108000 SUP HCPCS C1713 54740108000 - SCREW BONE 8MM 100MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108011 SUP HCPCS C1713 54740108011 - SCREW BONE 8MM 110MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108020 SUP HCPCS C1713 54740108020 - SCREW BONE 8MM 20MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108025 SUP HCPCS C1713 54740108025 - SCREW BONE 8MM 25MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108030 SUP HCPCS C1713 54740108030 - SCREW BONE 8MM 30MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108035 SUP HCPCS C1713 54740108035 - SCREW BONE 8MM 35MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108040 SUP HCPCS C1713 54740108040 - SCREW BONE 8MM 40MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108045 SUP HCPCS C1713 54740108045 - SCREW BONE 8MM 45MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108050 SUP HCPCS C1713 54740108050 - SCREW BONE 8MM 50MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108055 SUP HCPCS C1713 54740108055 - SCREW BONE 8MM 55MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108060 SUP HCPCS C1713 54740108060 - SCREW BONE 8MM 60MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108065 SUP HCPCS C1713 54740108065 - SCREW BONE 8MM 65MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108070 SUP HCPCS C1713 54740108070 - SCREW BONE 8MM 70MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108075 SUP HCPCS C1713 54740108075 - SCREW BONE 8MM 75MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108080 SUP HCPCS C1713 54740108080 - SCREW BONE 8MM 80MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108085 SUP HCPCS C1713 54740108085 - SCREW BONE 8MM 85MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108090 SUP HCPCS C1713 54740108090 - SCREW BONE 8MM 90MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108095 SUP HCPCS C1713 54740108095 - SCREW BONE 8MM 95MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108500 SUP HCPCS C1713 54740108500 - SCREW BONE 8.5MM 100MM MULTIAX CANN SOLERA COCR HA SPN 4.75 BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108511 SUP HCPCS C1713 54740108511 - SCREW BONE 8.5MM 110MM MULTIAX CANN SOLERA COCR HA SPN 4.75 BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108520 SUP HCPCS C1713 54740108520 - SCREW BONE 8.5MM 20MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108525 SUP HCPCS C1713 54740108525 - SCREW BONE 8.5MM 25MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108530 SUP HCPCS C1713 54740108530 - SCREW BONE 8.5MM 30MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108535 SUP HCPCS C1713 54740108535 - SCREW BONE 8.5MM 35MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108540 SUP HCPCS C1713 54740108540 - SCREW BN 8.5MM 40MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108545 SUP HCPCS C1713 54740108545 - SCREW BONE 8.5MM 45MM MULTIAX CD HORIZON HA SPINAL PEDICLE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108550 SUP HCPCS C1713 54740108550 - SCREW BN 8.5MM 50MM CD HZN SOLERA MA CNN COCR HA SPNE PDCL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108555 SUP HCPCS C1713 54740108555 - SCREW BONE 8.5MM 55MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108560 SUP HCPCS C1713 54740108560 - SCREW BONE 8.5MM 60MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108565 SUP HCPCS C1713 54740108565 - SCREW BONE 8.5MM 65MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108570 SUP HCPCS C1713 54740108570 - SCREW BONE 8.5MM 70MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108575 SUP HCPCS C1713 54740108575 - SCREW BONE 8.5MM 75MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108580 SUP HCPCS C1713 54740108580 - SCREW BONE 8.5MM 80MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108585 SUP HCPCS C1713 54740108585 - SCREW BONE 8.5MM 85MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108590 SUP HCPCS C1713 54740108590 - SCREW BONE 8.5MM 90MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740108595 SUP HCPCS C1713 54740108595 - SCREW BONE 8.5MM 95MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109500 SUP HCPCS C1713 54740109500 - SCREW BONE 9.5MM 100MM MULTIAX CANN SOLERA COCR HA SPN 4.75 BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109511 SUP HCPCS C1713 54740109511 - SCREW BONE 9.5MM 110MM MULTIAX CANN SOLERA COCR HA SPN 4.75 BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109520 SUP HCPCS C1713 54740109520 - SCREW BONE 9.5MM 20MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109525 SUP HCPCS C1713 54740109525 - SCREW BONE 9.5MM 25MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109530 SUP HCPCS C1713 54740109530 - SCREW BONE 9.5MM 30MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109535 SUP HCPCS C1713 54740109535 - SCREW BONE 9.5MM 35MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109540 SUP HCPCS C1713 54740109540 - SCREW BONE 9.5MM 40MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109545 SUP HCPCS C1713 54740109545 - SCREW BONE 9.5MM 45MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109550 SUP HCPCS C1713 54740109550 - SCREW BONE 9.5MM 50MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109555 SUP HCPCS C1713 54740109555 - SCREW BONE 9.5MM 55MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109560 SUP HCPCS C1713 54740109560 - SCREW BONE 9.5MM 60MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109565 SUP HCPCS C1713 54740109565 - SCREW BONE 9.5MM 65MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109570 SUP HCPCS C1713 54740109570 - SCREW BONE 9.5MM 70MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109575 SUP HCPCS C1713 54740109575 - SCREW BONE 9.5MM 75MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109580 SUP HCPCS C1713 54740109580 - SCREW BONE 9.5MM 80MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109585 SUP HCPCS C1713 54740109585 - SCREW BONE 9.5MM 85MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109590 SUP HCPCS C1713 54740109590 - SCREW BONE 9.5MM 90MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54740109595 SUP HCPCS C1713 54740109595 - SCREW BONE 9.5MM 95MM MULTIAX CANN SOLERA COCR HA SPN 4.75MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54750014525 SUP HCPCS C1713 54750014525 - SCREW BONE 4.5MM 25MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750014530 SUP HCPCS C1713 54750014530 - SCREW BONE 4.5MM 30MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750014535 SUP HCPCS C1713 54750014535 - SCREW BONE 4.5MM 35MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750014540 SUP HCPCS C1713 54750014540 - SCREW BONE 4.5MM 40MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750014545 SUP HCPCS C1713 54750014545 - SCREW BONE 4.5MM 45MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750014550 SUP HCPCS C1713 54750014550 - SCREW BONE 4.5MM 50MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750014555 SUP HCPCS C1713 54750014555 - SCREW BONE 4.5MM 55MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750015525 SUP HCPCS C1713 54750015525 - SCREW BONE 5.5MM 25MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750015530 SUP HCPCS C1713 54750015530 - SCREW BONE 5.5MM 30MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750015535 SUP HCPCS C1713 54750015535 - SCREW BONE 5.5MM 35MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750015540 SUP HCPCS C1713 54750015540 - SCREW BONE 5.5MM 40MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750015545 SUP HCPCS C1713 54750015545 - SCREW BONE 5.5MM 45MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750015550 SUP HCPCS C1713 54750015550 - SCREW BONE 5.5MM 50MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750015555 SUP HCPCS C1713 54750015555 - SCREW BONE 5.5MM 55MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750015560 SUP HCPCS C1713 54750015560 - SCREW BONE 5.5MM 60MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750015565 SUP HCPCS C1713 54750015565 - SCREW BONE 5.5MM 65MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750016530 SUP HCPCS C1713 54750016530 - SCREW BONE 6.5MM 30MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750016535 SUP HCPCS C1713 54750016535 - SCREW BONE 6.5MM 35MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750016540 SUP HCPCS C1713 54750016540 - SCREW BONE 6.5MM 40MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750016545 SUP HCPCS C1713 54750016545 - SCREW BONE 6.5MM 45MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750016550 SUP HCPCS C1713 54750016550 - SCREW BONE 6.5MM 50MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750016555 SUP HCPCS C1713 54750016555 - SCREW BONE 6.5MM 55MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750016560 SUP HCPCS C1713 54750016560 - SCREW BONE 6.5MM 60MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750016565 SUP HCPCS C1713 54750016565 - SCREW BONE 6.5MM 65MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750017530 SUP HCPCS C1713 54750017530 - SCREW BONE 7.5MM 30MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750017535 SUP HCPCS C1713 54750017535 - SCREW BONE 7.5MM 35MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750017540 SUP HCPCS C1713 54750017540 - SCREW BONE 7.5MM 40MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750017545 SUP HCPCS C1713 54750017545 - SCREW BONE 7.5MM 45MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750017550 SUP HCPCS C1713 54750017550 - SCREW BONE 7.5MM 50MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750017555 SUP HCPCS C1713 54750017555 - SCREW BONE 7.5MM 55MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750017560 SUP HCPCS C1713 54750017560 - SCREW BONE 7.5MM 60MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750017565 SUP HCPCS C1713 54750017565 - SCREW BONE 7.5MM 65MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750017570 SUP HCPCS C1713 54750017570 - SCREW BONE 7.5MM 70MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750018530 SUP HCPCS C1713 54750018530 - SCREW BONE 8.5MM 30MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750018535 SUP HCPCS C1713 54750018535 - SCREW BONE 8.5MM 35MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750018540 SUP HCPCS C1713 54750018540 - SCREW BONE 8.5MM 40MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750018545 SUP HCPCS C1713 54750018545 - SCREW BONE 8.5MM 45MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750018550 SUP HCPCS C1713 54750018550 - SCREW BONE 8.5MM 50MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750018555 SUP HCPCS C1713 54750018555 - SCREW BONE 8.5MM 55MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750018560 SUP HCPCS C1713 54750018560 - SCREW BONE 8.5MM 60MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750018565 SUP HCPCS C1713 54750018565 - SCREW BONE 8.5MM 65MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54750018570 SUP HCPCS C1713 54750018570 - SCREW BONE 8.5MM 70MM CD HZN SPN MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840004020 SUP HCPCS C1713 54840004020 - SCREW BONE LP 4MM 20MM 2 LEAD MULTIAX COLOR CODED SOLERA CD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004025 SUP HCPCS C1713 54840004025 - SCREW BONE LP 4MM 25MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004030 SUP HCPCS C1713 54840004030 - SCREW BN 4MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004035 SUP HCPCS C1713 54840004035 - SCREW BN 4MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004040 SUP HCPCS C1713 54840004040 - SCREW BN 4MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004045 SUP HCPCS C1713 54840004045 - SCREW BONE LP 4MM 45MM 2 LEAD MULTIAX COLOR CODED SOLERA CD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004050 SUP HCPCS C1713 54840004050 - SCREW BONE LP 4MM 50MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004055 SUP HCPCS C1713 54840004055 - SCREW BONE LP 4MM 55MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004520 SUP HCPCS C1713 54840004520 - SCREW BN 4.5MM 20MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004525 SUP HCPCS C1713 54840004525 - SCREW BN 4.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004530 SUP HCPCS C1713 54840004530 - SCREW BN 4.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004535 SUP HCPCS C1713 54840004535 - SCREW BN 4.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004540 SUP HCPCS C1713 54840004540 - SCREW BN 4.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004545 SUP HCPCS C1713 54840004545 - SCREW BN 4.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004550 SUP HCPCS C1713 54840004550 - SCREW BN 4.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840004555 SUP HCPCS C1713 54840004555 - SCREW BONE LP 4.5MM 55MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005020 SUP HCPCS C1713 54840005020 - SCREW BONE LP 5MM 20MM 2 LEAD MULTIAX COLOR CODED SOLERA CD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005025 SUP HCPCS C1713 54840005025 - SCREW BN 5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005030 SUP HCPCS C1713 54840005030 - SCREW BN 5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005035 SUP HCPCS C1713 54840005035 - SCREW BN 5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005040 SUP HCPCS C1713 54840005040 - SCREW BN 5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005045 SUP HCPCS C1713 54840005045 - SCREW BN 5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005050 SUP HCPCS C1713 54840005050 - SCREW BN 5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005055 SUP HCPCS C1713 54840005055 - SCREW BN 5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005520 SUP HCPCS C1713 54840005520 - SCREW BN 5.5MM 20MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005525 SUP HCPCS C1713 54840005525 - SCREW BN 5.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005530 SUP HCPCS C1713 54840005530 - SCREW BN 5.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005535 SUP HCPCS C1713 54840005535 - SCREW BN 5.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005540 SUP HCPCS C1713 54840005540 - SCREW BN 5.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005545 SUP HCPCS C1713 54840005545 - SCREW BN 5.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005550 SUP HCPCS C1713 54840005550 - SCREW BN 5.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005555 SUP HCPCS C1713 54840005555 - SCREW BN 5.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840005560 SUP HCPCS C1713 54840005560 - SCREW BONE LP 5.5MM 60MM 2 LEAD MULTIAX COLOR CODED SOLERA BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006020 SUP HCPCS C1713 54840006020 - SCREW BONE LP 6MM 20MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006025 SUP HCPCS C1713 54840006025 - SCREW BN 6MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006030 SUP HCPCS C1713 54840006030 - SCREW BONE LP 6MM 30MM 2 LEAD MULTIAX COLOR CODED SOLERA CD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006035 SUP HCPCS C1713 54840006035 - SCREW BN 6MM 35MM NS CD HZN MA COCR SPNL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006040 SUP HCPCS C1713 54840006040 - SCREW BONE LP 6MM 40MM 2 LEAD MULTIAX COLOR CODED SOLERA CD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006045 SUP HCPCS C1713 54840006045 - SCREW BONE LP 6MM 45MM 2 LEAD MULTIAX COLOR CODED SOLERA CD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006050 SUP HCPCS C1713 54840006050 - SCREW BONE LP 6MM 50MM 2 LEAD MULTIAX COLOR CODED SOLERA CD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006055 SUP HCPCS C1713 54840006055 - SCREW BONE LP 6MM 55MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006060 SUP HCPCS C1713 54840006060 - SCREW BONE LP 6MM 60MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006520 SUP HCPCS C1713 54840006520 - SCREW BONE LP 6.5MM 20MM 2 LEAD MULTIAX COLOR CODED SOLERA BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006525 SUP HCPCS C1713 54840006525 - SCREW BN 6.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006530 SUP HCPCS C1713 54840006530 - SCREW BN 6.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006535 SUP HCPCS C1713 54840006535 - SCREW BN 6.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840006540 SUP HCPCS C1713 54840006540 - SCREW BN 6.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840006545 SUP HCPCS C1713 54840006545 - SCREW BN 6.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006550 SUP HCPCS C1713 54840006550 - SCREW BN 6.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840006555 SUP HCPCS C1713 54840006555 - SCREW BN 6.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840006560 SUP HCPCS C1713 54840006560 - SCREW BN 6.5MM 60MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840006565 SUP HCPCS C1713 54840006565 - SCREW BONE LP 6.5MM 65MM 2 LEAD MULTIAX COLOR CODED SOLERA BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840006570 SUP HCPCS C1713 54840006570 - SCREW BN 6.5MM 70MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840006580 SUP HCPCS C1713 54840006580 - SCREW BONE LP 6.5MM 80MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840007500 SUP HCPCS C1713 54840007500 - SCREW BONE LP 7.5MM 100MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840007520 SUP HCPCS C1713 54840007520 - SCREW BONE LP 7.5MM 20MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840007525 SUP HCPCS C1713 54840007525 - SCREW BN 7.5MM 25MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840007530 SUP HCPCS C1713 54840007530 - SCREW BN 7.5MM 30MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840007535 SUP HCPCS C1713 54840007535 - SCREW BN 7.5MM 35MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840007540 SUP HCPCS C1713 54840007540 - SCREW BN 7.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840007545 SUP HCPCS C1713 54840007545 - SCREW BN 7.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840007550 SUP HCPCS C1713 54840007550 - SCREW BN 7.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840007555 SUP HCPCS C1713 54840007555 - SCREW BN 7.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840007560 SUP HCPCS C1713 54840007560 - SCREW BN 7.5MM 60MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840007565 SUP HCPCS C1713 54840007565 - SCREW BONE LP 7.5MM 65MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840007570 SUP HCPCS C1713 54840007570 - SCREW BONE LP 7.5MM 70MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840007580 SUP HCPCS C1713 54840007580 - SCREW BONE LP 7.5MM 80MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840007590 SUP HCPCS C1713 54840007590 - SCREW BONE LP 7.5MM 90MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840008500 SUP HCPCS C1713 54840008500 - SCREW BONE LP 8.5MM 100MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840008525 SUP HCPCS C1713 54840008525 - SCREW BONE LP 8.5MM 25MM 2 LEAD MULTIAX COLOR CODED SOLERA BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840008530 SUP HCPCS C1713 54840008530 - SCREW BONE LP 8.5MM 30MM 2 LEAD MULTIAX COLOR CODED SOLERA BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840008535 SUP HCPCS C1713 54840008535 - SCREW BONE LP 8.5MM 35MM 2 LEAD MULTIAX COLOR CODED SOLERA BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840008540 SUP HCPCS C1713 54840008540 - SCREW BONE LP 8.5MM 40MM 2 LEAD MULTIAX COLOR CODED SOLERA BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840008545 SUP HCPCS C1713 54840008545 - SCREW BONE LP 8.5MM 45MM 2 LEAD MULTIAX COLOR CODED SOLERA BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840008550 SUP HCPCS C1713 54840008550 - SCREW BONE LP 8.5MM 50MM 2 LEAD MULTIAX COLOR CODED SOLERA BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840008555 SUP HCPCS C1713 54840008555 - SCREW BN 8.5MM 55MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840008560 SUP HCPCS C1713 54840008560 - SCREW BONE LP 8.5MM 60MM 2 LEAD MULTIAX COLOR CODED SOLERA BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840008565 SUP HCPCS C1713 54840008565 - SCREW BONE LP 8.5MM 65MM 2 LEAD MULTIAX COLOR CODED SOLERA BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840008570 SUP HCPCS C1713 54840008570 - SCREW BONE LP 8.5MM 70MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840008580 SUP HCPCS C1713 54840008580 - SCREW BONE LP 8.5MM 80MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840008590 SUP HCPCS C1713 54840008590 - SCREW BONE LP 8.5MM 90MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840009500 SUP HCPCS C1713 54840009500 - SCREW BONE LP 9.5MM 100MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840009525 SUP HCPCS C1713 54840009525 - SCREW BONE LP 9.5MM 25MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840009530 SUP HCPCS C1713 54840009530 - SCREW BONE LP 9.5MM 30MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840009535 SUP HCPCS C1713 54840009535 - SCREW BONE LP 9.5MM 35MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840009540 SUP HCPCS C1713 54840009540 - SCREW BONE LP 9.5MM 40MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840009545 SUP HCPCS C1713 54840009545 - SCREW BONE LP 9.5MM 45MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840009550 SUP HCPCS C1713 54840009550 - SCREW BONE LP 9.5MM 50MM 2 LEAD MULTIAX COLOR CODED SOLERA BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840009555 SUP HCPCS C1713 54840009555 - SCREW BONE LP 9.5MM 55MM 2 LEAD MULTIAX COLOR CODED SOLERA BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840009560 SUP HCPCS C1713 54840009560 - SCREW BONE LP 9.5MM 60MM 2 LEAD MULTIAX COLOR CODED SOLERA BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 54840009565 SUP HCPCS C1713 54840009565 - SCREW BONE LP 9.5MM 65MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840009570 SUP HCPCS C1713 54840009570 - SCREW BONE LP 9.5MM 70MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840009580 SUP HCPCS C1713 54840009580 - SCREW BONE LP 9.5MM 80MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840009590 SUP HCPCS C1713 54840009590 - SCREW BONE LP 9.5MM 90MM 2 LEAD THREAD FORM MULTIAX COLOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54840014530 SUP HCPCS C1713 54840014530 - SCREW BONE 4.5MM 30MM MULTIAX CANN SOLERA CD HORIZON COCR BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840014535 SUP HCPCS C1713 54840014535 - SCREW BONE 4.5MM 35MM MULTIAX CANN SOLERA CD HORIZON COCR BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840014540 SUP HCPCS C1713 54840014540 - SCREW BONE 4.5MM 40MM MULTIAX CANN SOLERA CD HORIZON COCR BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840014545 SUP HCPCS C1713 54840014545 - SCREW BONE 4.5MM 45MM MULTIAX CANN SOLERA CD HORIZON COCR BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840015535 SUP HCPCS C1713 54840015535 - SCREW BONE 5.5MM 35MM MULTIAX CANN COCR SPN BOTH IP/OP "$6,492.50" "$4,804.00" "$1,288.60" "$6,492.50" "$2,921.63" "$2,921.63" "$2,921.63" "$2,921.63" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.20" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.11" "$6,492.50" "$6,492.50" "$3,200.80" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$4,869.38" "$6,492.50" "$6,492.50" "$6,492.50" "$3,246.25" "$3,246.25" "$5,142.06" "$6,492.50" "$5,194.00" "$2,921.63" "$1,288.60" N/A "$3,765.65" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.04" "$6,492.50" N/A N/A 54840015540 SUP HCPCS C1713 54840015540 - SCREW BONE 5.5MM 40MM MULTIAX CANN SOLERA CD HORIZON COCR BOTH IP/OP "$6,492.50" "$4,804.00" "$1,288.60" "$6,492.50" "$2,921.63" "$2,921.63" "$2,921.63" "$2,921.63" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.20" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.11" "$6,492.50" "$2,597.00" "$3,200.80" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$4,869.38" "$6,492.50" "$6,492.50" "$6,492.50" "$3,246.25" "$3,246.25" "$5,142.06" "$6,492.50" "$5,194.00" "$2,921.63" "$1,288.60" N/A "$3,765.65" "$6,492.50" "$3,895.50" "$6,492.50" "$1,353.04" "$6,492.50" N/A N/A 54840015545 SUP HCPCS C1713 54840015545 - SCREW BONE 5.5MM 45MM MULTIAX CANN SOLERA CD HORIZON BOTH IP/OP "$6,492.50" "$4,804.00" "$1,288.60" "$6,492.50" "$2,921.63" "$2,921.63" "$2,921.63" "$2,921.63" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.20" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.11" "$6,492.50" "$2,597.00" "$3,200.80" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$4,869.38" "$6,492.50" "$6,492.50" "$6,492.50" "$3,246.25" "$3,246.25" "$5,142.06" "$6,492.50" "$5,194.00" "$2,921.63" "$1,288.60" N/A "$3,765.65" "$6,492.50" "$3,895.50" "$6,492.50" "$1,353.04" "$6,492.50" N/A N/A 54840015550 SUP HCPCS C1713 54840015550 - SCREW BONE 5.5MM 50MM MULTIAX CANN SOLERA CD HORIZON BOTH IP/OP "$6,492.50" "$4,804.00" "$1,288.60" "$6,492.50" "$2,921.63" "$2,921.63" "$2,921.63" "$2,921.63" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.20" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.11" "$6,492.50" "$2,597.00" "$3,200.80" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$4,869.38" "$6,492.50" "$6,492.50" "$6,492.50" "$3,246.25" "$3,246.25" "$5,142.06" "$6,492.50" "$5,194.00" "$2,921.63" "$1,288.60" N/A "$3,765.65" "$6,492.50" "$3,895.50" "$6,492.50" "$1,353.04" "$6,492.50" N/A N/A 54840016535 SUP HCPCS C1713 54840016535 - SCREW BONE LP 6.5MM 35MM 2 LEAD MULTIAX CANN COLOR CODED BOTH IP/OP "$6,492.50" "$4,804.00" "$1,288.60" "$6,492.50" "$2,921.63" "$2,921.63" "$2,921.63" "$2,921.63" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.20" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.11" "$6,492.50" "$6,492.50" "$3,200.80" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$4,869.38" "$6,492.50" "$6,492.50" "$6,492.50" "$3,246.25" "$3,246.25" "$5,142.06" "$6,492.50" "$5,194.00" "$2,921.63" "$1,288.60" N/A "$3,765.65" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.04" "$6,492.50" N/A N/A 54840016540 SUP HCPCS C1713 54840016540 - SCREW BN 6.5MM 40MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$6,492.50" "$4,804.00" "$1,288.60" "$6,492.50" "$2,921.63" "$2,921.63" "$2,921.63" "$2,921.63" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.20" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.11" "$6,492.50" "$2,597.00" "$3,200.80" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$4,869.38" "$6,492.50" "$6,492.50" "$6,492.50" "$3,246.25" "$3,246.25" "$5,142.06" "$6,492.50" "$5,194.00" "$2,921.63" "$1,288.60" N/A "$3,765.65" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.04" "$6,492.50" N/A N/A 54840016545 SUP HCPCS C1713 54840016545 - SCREW BN 6.5MM 45MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$6,492.50" "$4,804.00" "$1,288.60" "$6,492.50" "$2,921.63" "$2,921.63" "$2,921.63" "$2,921.63" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.20" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.11" "$6,492.50" "$2,597.00" "$3,200.80" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$4,869.38" "$6,492.50" "$6,492.50" "$6,492.50" "$3,246.25" "$3,246.25" "$5,142.06" "$6,492.50" "$5,194.00" "$2,921.63" "$1,288.60" N/A "$3,765.65" "$6,492.50" "$3,895.50" "$6,492.50" "$1,353.04" "$6,492.50" N/A N/A 54840016550 SUP HCPCS C1713 54840016550 - SCREW BN 6.5MM 50MM NS SOLERA CD HZN OSTEOGRIP 2 LD THRD FRM BOTH IP/OP "$6,492.50" "$4,804.00" "$1,288.60" "$6,492.50" "$2,921.63" "$2,921.63" "$2,921.63" "$2,921.63" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.20" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.11" "$6,492.50" "$2,597.00" "$3,200.80" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$4,869.38" "$6,492.50" "$6,492.50" "$6,492.50" "$3,246.25" "$3,246.25" "$5,142.06" "$6,492.50" "$5,194.00" "$2,921.63" "$1,288.60" N/A "$3,765.65" "$6,492.50" "$3,895.50" "$6,492.50" "$1,353.04" "$6,492.50" N/A N/A 54840016555 SUP HCPCS C1713 54840016555 - SCREW BONE 6.5MM 55MM SOLERA CD HZN OSTEOGRIP TI BOTH IP/OP "$6,492.50" "$4,804.00" "$1,288.60" "$6,492.50" "$2,921.63" "$2,921.63" "$2,921.63" "$2,921.63" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.20" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.11" "$6,492.50" "$2,597.00" "$3,200.80" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$4,869.38" "$6,492.50" "$6,492.50" "$6,492.50" "$3,246.25" "$3,246.25" "$5,142.06" "$6,492.50" "$5,194.00" "$2,921.63" "$1,288.60" N/A "$3,765.65" "$6,492.50" "$3,895.50" "$6,492.50" "$1,353.04" "$6,492.50" N/A N/A 54840017540 SUP HCPCS C1713 54840017540 - SCREW BONE 7.5MM 40MM MULTIAX CANN COCR SPN BOTH IP/OP "$6,492.50" "$4,804.00" "$1,288.60" "$6,492.50" "$2,921.63" "$2,921.63" "$2,921.63" "$2,921.63" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.20" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.11" "$6,492.50" "$2,597.00" "$3,200.80" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$4,869.38" "$6,492.50" "$6,492.50" "$6,492.50" "$3,246.25" "$3,246.25" "$5,142.06" "$6,492.50" "$5,194.00" "$2,921.63" "$1,288.60" N/A "$3,765.65" "$6,492.50" "$3,895.50" "$6,492.50" "$1,353.04" "$6,492.50" N/A N/A 54840017545 SUP HCPCS C1713 54840017545 - SCREW BONE 7.5MM 45MM MULTIAX CANN SOLERA CD HORIZON COCR BOTH IP/OP "$6,492.50" "$4,804.00" "$1,288.60" "$6,492.50" "$2,921.63" "$2,921.63" "$2,921.63" "$2,921.63" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.20" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.11" "$6,492.50" "$2,597.00" "$3,200.80" "$6,492.50" "$6,492.50" "$6,492.50" "$6,492.50" "$4,869.38" "$6,492.50" "$6,492.50" "$6,492.50" "$3,246.25" "$3,246.25" "$5,142.06" "$6,492.50" "$5,194.00" "$2,921.63" "$1,288.60" N/A "$3,765.65" "$6,492.50" "$6,492.50" "$6,492.50" "$1,353.04" "$6,492.50" N/A N/A 54840044520 SUP HCPCS C1713 54840044520 - SCREW BONE 4.5MM 20MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840044525 SUP HCPCS C1713 54840044525 - SCREW BONE 4.5MM 25MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840044530 SUP HCPCS C1713 54840044530 - SCREW BONE 4.5MM 30MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840044535 SUP HCPCS C1713 54840044535 - SCREW BONE 4.5MM 35MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840044540 SUP HCPCS C1713 54840044540 - SCREW BONE 4.5MM 40MM MULTIAX ATS SPN 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840044545 SUP HCPCS C1713 54840044545 - SCREW BONE 4.5MM 45MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840044550 SUP HCPCS C1713 54840044550 - SCREW BONE 4.5MM 50MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840044555 SUP HCPCS C1713 54840044555 - SCREW BONE 4.5MM 55MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840044560 SUP HCPCS C1713 54840044560 - SCREW BONE 4.5MM 60MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840045520 SUP HCPCS C1713 54840045520 - SCREW BONE 5.5MM 20MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840045525 SUP HCPCS C1713 54840045525 - SCREW BONE 5.5MM 25MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840045530 SUP HCPCS C1713 54840045530 - SCREW BONE 5.5MM 30MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840045535 SUP HCPCS C1713 54840045535 - SCREW BONE 5.5MM 35MM MULTIAX ATS SPN 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840045540 SUP HCPCS C1713 54840045540 - SCREW BONE 5.5MM 40MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840045545 SUP HCPCS C1713 54840045545 - SCREW BONE 5.5MM 45MM MULTIAX ATS SPN 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840045550 SUP HCPCS C1713 54840045550 - SCREW BONE 5.5MM 50MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840045555 SUP HCPCS C1713 54840045555 - SCREW BONE 5.5MM 55MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840045560 SUP HCPCS C1713 54840045560 - SCREW BONE 5.5MM 60MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840046520 SUP HCPCS C1713 54840046520 - SCREW BONE 6.5MM 20MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840046525 SUP HCPCS C1713 54840046525 - SCREW BONE 6.5MM 25MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840046530 SUP HCPCS C1713 54840046530 - SCREW BONE 6.5MM 30MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840046535 SUP HCPCS C1713 54840046535 - SCREW BONE 6.5MM 35MM MULTIAX ATS SPN 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840046540 SUP HCPCS C1713 54840046540 - SCREW BONE 6.5MM 40MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840046545 SUP HCPCS C1713 54840046545 - SCREW BONE 6.5MM 45MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840046550 SUP HCPCS C1713 54840046550 - SCREW BONE 6.5MM 50MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840046555 SUP HCPCS C1713 54840046555 - SCREW BONE 6.5MM 55MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840046560 SUP HCPCS C1713 54840046560 - SCREW BONE 6.5MM 60MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840047520 SUP HCPCS C1713 54840047520 - SCREW BONE 7.5MM 20MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840047525 SUP HCPCS C1713 54840047525 - SCREW BONE 7.5MM 25MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840047530 SUP HCPCS C1713 54840047530 - SCREW BONE 7.5MM 30MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840047535 SUP HCPCS C1713 54840047535 - SCREW BONE 7.5MM 35MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840047540 SUP HCPCS C1713 54840047540 - SCREW BONE 7.5MM 40MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840047545 SUP HCPCS C1713 54840047545 - SCREW BONE 7.5MM 45MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840047550 SUP HCPCS C1713 54840047550 - SCREW BONE 7.5MM 50MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840047555 SUP HCPCS C1713 54840047555 - SCREW BONE 7.5MM 55MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54840047560 SUP HCPCS C1713 54840047560 - SCREW BONE 7.5MM 60MM ATS SPN MULTIAX 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850014530 SUP HCPCS C1713 54850014530 - SCREW BONE 4.5MM 30MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850014535 SUP HCPCS C1713 54850014535 - SCREW BN 4.5MM 35MM MAS CNN XTN TAB SPNE 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850014540 SUP HCPCS C1713 54850014540 - SCREW BN 4.5MM 40MM MAS CNN XTN TAB SPNE 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850014545 SUP HCPCS C1713 54850014545 - 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SCREW BONE 4.5MM 75MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850015530 SUP HCPCS C1713 54850015530 - SCREW BONE 5.5MM 30MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850015535 SUP HCPCS C1713 54850015535 - 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SCREW BN 5.5MM 45MM NS SOLERA CD HZN MA CNN XTD TAB SPNE BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850015550 SUP HCPCS C1713 54850015550 - SCREW BN 5.5MM 50MM NS SOLERA CD HZN MA CNN XTD TAB SPNE BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850015555 SUP HCPCS C1713 54850015555 - SCREW BONE 5.5MM 55MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850015560 SUP HCPCS C1713 54850015560 - SCREW BONE 5.5MM 60MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850015565 SUP HCPCS C1713 54850015565 - SCREW BONE 5.5MM 65MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850015570 SUP HCPCS C1713 54850015570 - SCREW BONE 5.5MM 70MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850015575 SUP HCPCS C1713 54850015575 - SCREW BONE 5.5MM 75MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850016530 SUP HCPCS C1713 54850016530 - SCREW BONE 6.5MM 30MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850016535 SUP HCPCS C1713 54850016535 - SCREW BN 6.5MM 35MM NS SOLERA CD HZN MA CNN XTD TAB SPNE BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850016540 SUP HCPCS C1713 54850016540 - SCREW BN 6.5MM 40MM NS SOLERA CD HZN MA CNN XTD TAB SPNE BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850016545 SUP HCPCS C1713 54850016545 - SCREW BN 6.5MM 45MM NS SOLERA CD HZN MA CNN XTD TAB SPNE BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850016550 SUP HCPCS C1713 54850016550 - SCREW BN 6.5MM 50MM NS SOLERA CD HZN MA CNN XTD TAB SPNE BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850016555 SUP HCPCS C1713 54850016555 - SCREW BN 6.5MM 55MM NS SOLERA CD HZN MA CNN XTD TAB SPNE BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850016560 SUP HCPCS C1713 54850016560 - SCREW BONE 6.5MM 60MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850016565 SUP HCPCS C1713 54850016565 - SCREW BONE 6.5MM 65MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850017530 SUP HCPCS C1713 54850017530 - SCREW BONE 7.5MM 30MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850017535 SUP HCPCS C1713 54850017535 - SCREW BONE 7.5MM 35MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850017540 SUP HCPCS C1713 54850017540 - SCREW BN 7.5MM 40MM MAS CNN XTN TAB SPNE 4.75MM ROD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850017545 SUP HCPCS C1713 54850017545 - SCREW BN 7.5MM 45MM NS SOLERA CD HZN MA CNN XTD TAB SPNE BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850017550 SUP HCPCS C1713 54850017550 - SCREW BN 7.5MM 50MM NS SOLERA CD HZN MA CNN XTD TAB SPNE BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850017555 SUP HCPCS C1713 54850017555 - SCREW BN 7.5MM 55MM NS SOLERA CD HZN MA CNN XTD TAB SPNE BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850017560 SUP HCPCS C1713 54850017560 - SCREW BN 7.5MM 60MM NS SOLERA CD HZN MA CNN XTD TAB SPNE BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850017565 SUP HCPCS C1713 54850017565 - SCREW BONE 7.5MM 65MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$1,558.20" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850018530 SUP HCPCS C1713 54850018530 - SCREW BONE 8.5MM 30MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850018535 SUP HCPCS C1713 54850018535 - SCREW BONE 8.5MM 35MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$3,895.50" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850018540 SUP HCPCS C1713 54850018540 - SCREW BONE 8.5MM 40MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850018545 SUP HCPCS C1713 54850018545 - SCREW BONE 8.5MM 45MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850018550 SUP HCPCS C1713 54850018550 - SCREW BONE 8.5MM 50MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850018555 SUP HCPCS C1713 54850018555 - SCREW BONE 8.5MM 55MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850018560 SUP HCPCS C1713 54850018560 - SCREW BONE 8.5MM 60MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850018565 SUP HCPCS C1713 54850018565 - SCREW BONE 8.5MM 65MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850018570 SUP HCPCS C1713 54850018570 - SCREW BONE 8.5MM 70MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850018575 SUP HCPCS C1713 54850018575 - SCREW BONE 8.5MM 75MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54850018580 SUP HCPCS C1713 54850018580 - SCREW BONE 8.5MM 80MM CD HZN SPNL MULTIAX CANN XTD BOTH IP/OP "$3,895.50" "$2,883.00" $773.16 "$3,895.50" "$1,752.98" "$1,752.98" "$1,752.98" "$1,752.98" "$3,895.50" "$3,895.50" "$3,895.50" $811.92 "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" $811.87 "$3,895.50" "$3,895.50" "$1,920.48" "$3,895.50" "$3,895.50" "$3,895.50" "$3,895.50" "$2,921.63" "$3,895.50" "$3,895.50" "$3,895.50" "$1,947.75" "$1,947.75" "$3,085.24" "$3,895.50" "$3,116.40" "$1,752.98" $773.16 N/A "$2,259.39" "$3,895.50" "$2,337.30" "$3,895.50" $811.82 "$3,895.50" N/A N/A 54890004525 SUP HCPCS C1713 54890004525 - SCREW BONE 4.5MM 25MM MULTIAX REDX SOLERA CD HORIZON COCR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890004530 SUP HCPCS C1713 54890004530 - SCREW BONE 4.5MM 30MM MULTIAX REDX SOLERA CD HORIZON COCR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890004535 SUP HCPCS C1713 54890004535 - SCREW BONE 4.5MM 35MM MULTIAX REDX SOLERA CD HORIZON COCR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890004540 SUP HCPCS C1713 54890004540 - SCREW BONE 4.5MM 40MM MULTIAX REDX SOLERA CD HORIZON COCR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890005525 SUP HCPCS C1713 54890005525 - SCREW BONE 5.5MM 25MM MULTIAX REDX SOLERA CD HORIZON COCR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890005530 SUP HCPCS C1713 54890005530 - SCREW BONE 5.5MM 30MM MULTIAX REDX SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890005535 SUP HCPCS C1713 54890005535 - SCREW BONE 5.5MM 35MM REDX MULTIAX COCR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890005540 SUP HCPCS C1713 54890005540 - SCREW BONE 5.5MM 40MM REDX MULTIAX COCR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890005545 SUP HCPCS C1713 54890005545 - SCREW BONE 5.5MM 45MM MULTIAX REDX SOLERA CD HORIZON COCR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890005550 SUP HCPCS C1713 54890005550 - SCREW BONE 5.5MM 50MM MULTIAX REDX SOLERA CD HORIZON COCR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890006530 SUP HCPCS C1713 54890006530 - SCREW BONE 6.5MM 30MM MULTIAX REDX SOLERA CD HORIZON COCR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890006535 SUP HCPCS C1713 54890006535 - SCREW BONE 6.5MM 35MM REDX MULTIAX COCR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890006540 SUP HCPCS C1713 54890006540 - SCREW BONE 6.5MM 40MM REDX MULTIAX COCR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890006545 SUP HCPCS C1713 54890006545 - SCREW BONE 6.5MM 45MM MULTIAX REDX SOLERA CD HORIZON COCR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890006550 SUP HCPCS C1713 54890006550 - SCREW BN 6.5MM 50MM NS SOLERA CD HZN MA RDC COCR SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890006555 SUP HCPCS C1713 54890006555 - SCREW BONE 6.5MM 55MM MULTIAX REDX SOLERA CD HORIZON COCR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890007535 SUP HCPCS C1713 54890007535 - SCREW BONE 7.5MM 35MM MULTIAX REDX SOLERA CD HORIZON COCR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890007540 SUP HCPCS C1713 54890007540 - SCREW BONE 7.5MM 40MM REDX MULTIAX COCR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890007545 SUP HCPCS C1713 54890007545 - SCREW BN 7.5MM 45MM NS SOLERA CD HZN MA RDC COCR SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890007550 SUP HCPCS C1713 54890007550 - SCREW BONE 7.5MM 50MM MULTIAX REDX SOLERA CD HORIZON COCR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 54890007555 SUP HCPCS C1713 54890007555 - SCREW BONE 7.5MM 55MM REDX SOLERA COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55410004020 SUP HCPCS C1713 55410004020 - SCREW BONE 4MM 20MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410004025 SUP HCPCS C1713 55410004025 - SCREW BONE 4MM 25MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410004030 SUP HCPCS C1713 55410004030 - SCREW BONE 4MM 30MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410004035 SUP HCPCS C1713 55410004035 - SCREW BONE 4MM 35MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410004040 SUP HCPCS C1713 55410004040 - SCREW BONE 4MM 40MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410004045 SUP HCPCS C1713 55410004045 - SCREW BONE 4MM 45MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410004520 SUP HCPCS C1713 55410004520 - SCREW BONE 4.5MM 20MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410004525 SUP HCPCS C1713 55410004525 - SCREW BONE 4.5MM 25MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410004530 SUP HCPCS C1713 55410004530 - SCREW BONE 4.5MM 30MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" "$1,990.50" "$1,990.50" N/A N/A 55410004535 SUP HCPCS C1713 55410004535 - SCREW BONE 4.5MM 35MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" "$1,990.50" "$1,990.50" N/A N/A 55410004540 SUP HCPCS C1713 55410004540 - SCREW BONE 4.5MM 40MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410004545 SUP HCPCS C1713 55410004545 - SCREW BONE 4.5MM 45MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410005020 SUP HCPCS C1713 55410005020 - SCREW BONE 5MM 20MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410005025 SUP HCPCS C1713 55410005025 - SCREW BONE 5MM 25MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410005030 SUP HCPCS C1713 55410005030 - SCREW BONE 5MM 30MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410005035 SUP HCPCS C1713 55410005035 - SCREW BONE 5MM 35MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410005040 SUP HCPCS C1713 55410005040 - SCREW BONE 5MM 40MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410005045 SUP HCPCS C1713 55410005045 - SCREW BONE 5MM 45MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" "$1,990.50" "$1,990.50" N/A N/A 55410005520 SUP HCPCS C1713 55410005520 - SCREW BONE 5.5MM 20MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410005525 SUP HCPCS C1713 55410005525 - SCREW BONE 5.5MM 25MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410005530 SUP HCPCS C1713 55410005530 - SCREW BONE 5.5MM 30MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410005535 SUP HCPCS C1713 55410005535 - SCREW BONE 5.5MM 35MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410005540 SUP HCPCS C1713 55410005540 - SCREW BONE 5.5MM 40MM FIXANG MULTIAX SOLERA CD HORIZON BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" "$1,990.50" "$1,990.50" N/A N/A 55410005545 SUP HCPCS C1713 55410005545 - SCREW BONE 5.5MM 45MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" N/A N/A 55410005550 SUP HCPCS C1713 55410005550 - SCREW BONE 5.5MM 50MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410006025 SUP HCPCS C1713 55410006025 - SCREW BONE 6MM 25MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" "$1,990.50" "$1,990.50" N/A N/A 55410006030 SUP HCPCS C1713 55410006030 - SCREW BONE 6MM 30MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410006035 SUP HCPCS C1713 55410006035 - SCREW BONE 6MM 35MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410006040 SUP HCPCS C1713 55410006040 - SCREW BONE 6MM 40MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" "$1,990.50" "$1,990.50" N/A N/A 55410006045 SUP HCPCS C1713 55410006045 - SCREW BONE 6MM 45MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" "$1,990.50" "$1,990.50" N/A N/A 55410006050 SUP HCPCS C1713 55410006050 - SCREW BONE 6MM 50MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410006055 SUP HCPCS C1713 55410006055 - SCREW BONE 6MM 55MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410006520 SUP HCPCS C1713 55410006520 - SCREW BONE 6.5MM 20MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410006525 SUP HCPCS C1713 55410006525 - SCREW BONE 6.5MM 25MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410006530 SUP HCPCS C1713 55410006530 - SCREW BONE 6.5MM 30MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410006535 SUP HCPCS C1713 55410006535 - SCREW BONE 6.5MM 35MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410006540 SUP HCPCS C1713 55410006540 - SCREW BONE 6.5MM 40MM FIXANG MULTIAX SOLERA CD HORIZON BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410006545 SUP HCPCS C1713 55410006545 - SCREW BONE 6.5MM 45MM FIXANG TITANIUM SPN 5.5MM ROD BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" $796.20 "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410006550 SUP HCPCS C1713 55410006550 - SCREW BONE 6.5MM 50MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410006555 SUP HCPCS C1713 55410006555 - SCREW BONE 6.5MM 55MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410007535 SUP HCPCS C1713 55410007535 - SCREW BONE 7.5MM 35MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410007540 SUP HCPCS C1713 55410007540 - SCREW BONE 7.5MM 40MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,990.50" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410007545 SUP HCPCS C1713 55410007545 - SCREW BONE 7.5MM 45MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410007550 SUP HCPCS C1713 55410007550 - SCREW BONE 7.5MM 50MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" $414.82 "$1,990.50" N/A N/A 55410007555 SUP HCPCS C1713 55410007555 - SCREW BONE 7.5MM 55MM FIXANG MULTIAX TITANIUM COCR SPN 5.5MM BOTH IP/OP "$1,990.50" "$1,473.00" $395.06 "$1,990.50" $895.73 $895.73 $895.73 $895.73 "$1,990.50" "$1,990.50" "$1,990.50" $414.87 "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" $414.84 "$1,990.50" "$1,990.50" "$1,177.38" "$1,990.50" "$1,990.50" "$1,990.50" "$1,990.50" "$1,492.88" "$1,990.50" "$1,990.50" "$1,990.50" $995.25 $995.25 "$1,576.48" "$1,990.50" "$1,592.40" $895.73 $395.06 N/A "$1,154.49" "$1,990.50" "$1,194.30" "$1,990.50" "$1,990.50" "$1,990.50" N/A N/A 55740105535 SUP HCPCS C1713 55740105535 - SCREW BN 5.5MM 35MM SOLERA CD HZN MA HA SPNE 5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55740105540 SUP HCPCS C1713 55740105540 - SCREW BN 5.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55740105545 SUP HCPCS C1713 55740105545 - SCREW BN 5.5MM 45MM SOLERA CD HZN MA HA SPNE 5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55740105550 SUP HCPCS C1713 55740105550 - SCREW BN 5.5MM 50MM SOLERA CD HZN MA HA SPNE 5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55740106540 SUP HCPCS C1713 55740106540 - SCREW BN 6.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55740106545 SUP HCPCS C1713 55740106545 - SCREW BN 6.5MM 45MM SOLERA CD HZN MA HA SPNE 5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55740106550 SUP HCPCS C1713 55740106550 - SCREW BN 6.5MM 50MM SOLERA CD HZN MA HA SPNE 5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55740106555 SUP HCPCS C1713 55740106555 - SCREW BN 6.5MM 55MM SOLERA CD HZN MA HA SPNE 5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55740107540 SUP HCPCS C1713 55740107540 - SCREW BN 7.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55740107545 SUP HCPCS C1713 55740107545 - SCREW BN 7.5MM 45MM SOLERA CD HZN MA HA SPNE 5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55740107550 SUP HCPCS C1713 55740107550 - SCREW BN 7.5MM 50MM SOLERA CD HZN MA HA SPNE 5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55740107555 SUP HCPCS C1713 55740107555 - SCREW BN 7.5MM 55MM SOLERA CD HZN MA HA SPNE 5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55740108535 SUP HCPCS C1713 55740108535 - SCREW BONE 8.5MM 35MM MULTIAX SOLERA HA SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55740108540 SUP HCPCS C1713 55740108540 - SCREW BN 8.5MM 40MM SOLERA CD HZN MA HA SPNE 5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55740108545 SUP HCPCS C1713 55740108545 - SCREW BONE 8.5MM 45MM MULTIAX SOLERA HA SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55740108550 SUP HCPCS C1713 55740108550 - SCREW BONE 8.5MM 50MM MULTIAX SOLERA HA SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811004025 SUP HCPCS C1713 55811004025 - SCREW BONE 4MM 25MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811004030 SUP HCPCS C1713 55811004030 - SCREW BONE 4MM 30MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811004035 SUP HCPCS C1713 55811004035 - SCREW BONE 4MM 35MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811004040 SUP HCPCS C1713 55811004040 - SCREW BONE 4MM 40MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811004045 SUP HCPCS C1713 55811004045 - SCREW BONE 4MM 45MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811004520 SUP HCPCS C1713 55811004520 - SCREW BONE 4.5MM 20MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811004525 SUP HCPCS C1713 55811004525 - SCREW BONE 4.5MM 25MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811004530 SUP HCPCS C1713 55811004530 - SCREW BN 4.5MM 30MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811004535 SUP HCPCS C1713 55811004535 - SCREW BN 4.5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811004540 SUP HCPCS C1713 55811004540 - SCREW BN 4.5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811004545 SUP HCPCS C1713 55811004545 - SCREW BN 4.5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005020 SUP HCPCS C1713 55811005020 - SCREW BONE 5MM 20MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005025 SUP HCPCS C1713 55811005025 - SCREW BONE 5MM 25MM SAGITTAL ADJUSTING COLOR CODED SOLERA CD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005030 SUP HCPCS C1713 55811005030 - SCREW BN 5MM 30MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005035 SUP HCPCS C1713 55811005035 - SCREW BN 5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005040 SUP HCPCS C1713 55811005040 - SCREW BN 5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005045 SUP HCPCS C1713 55811005045 - SCREW BN 5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005050 SUP HCPCS C1713 55811005050 - SCREW BONE 5MM 50MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005520 SUP HCPCS C1713 55811005520 - SCREW BONE 5.5MM 20MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005525 SUP HCPCS C1713 55811005525 - SCREW BONE 5.5MM 25MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005530 SUP HCPCS C1713 55811005530 - SCREW BN 5.5MM 30MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005535 SUP HCPCS C1713 55811005535 - SCREW BN 5.5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005540 SUP HCPCS C1713 55811005540 - SCREW BN 5.5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005545 SUP HCPCS C1713 55811005545 - SCREW BN 5.5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005550 SUP HCPCS C1713 55811005550 - SCREW BONE 5.5MM 50MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811005555 SUP HCPCS C1713 55811005555 - SCREW BONE 5.5MM 55MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811006030 SUP HCPCS C1713 55811006030 - SCREW BONE 6MM 30MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55811006035 SUP HCPCS C1713 55811006035 - SCREW BONE 6MM 35MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55811006040 SUP HCPCS C1713 55811006040 - SCREW BONE 6MM 40MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811006045 SUP HCPCS C1713 55811006045 - SCREW BONE 6MM 45MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811006050 SUP HCPCS C1713 55811006050 - SCREW BONE 6MM 50MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811006525 SUP HCPCS C1713 55811006525 - SCREW BONE 6.5MM 25MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811006530 SUP HCPCS C1713 55811006530 - SCREW BONE 6.5MM 30MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811006535 SUP HCPCS C1713 55811006535 - SCREW BN 6.5MM 35MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811006540 SUP HCPCS C1713 55811006540 - SCREW BN 6.5MM 40MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811006545 SUP HCPCS C1713 55811006545 - SCREW BN 6.5MM 45MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811006550 SUP HCPCS C1713 55811006550 - SCREW BN 6.5MM 50MM SOLERA CD HZN SGTL ADJ COCR SPNE 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811006555 SUP HCPCS C1713 55811006555 - SCREW BONE 6.5MM 55MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811006560 SUP HCPCS C1713 55811006560 - SCREW BONE 6.5MM 60MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811007535 SUP HCPCS C1713 55811007535 - SCREW BONE 7.5MM 35MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811007540 SUP HCPCS C1713 55811007540 - SCREW BONE 7.5MM 40MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811007545 SUP HCPCS C1713 55811007545 - SCREW BONE 7.5MM 45MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55811007550 SUP HCPCS C1713 55811007550 - SCREW BONE 7.5MM 50MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55811007555 SUP HCPCS C1713 55811007555 - SCREW BONE 7.5MM 55MM SAGITTAL ADJUSTING COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811008540 SUP HCPCS C1713 55811008540 - SCREW BONE 8.5MM 40MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811008545 SUP HCPCS C1713 55811008545 - SCREW BONE 8.5MM 45MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55811008550 SUP HCPCS C1713 55811008550 - SCREW BONE 8.5MM 50MM SAGITTAL ADJUSTING SOLERA CD HORIZON BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840001540 SUP HCPCS C1713 55840001540 - SCREW BONE 10.5MM 40MM MULTIAX COCR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840001545 SUP HCPCS C1713 55840001545 - SCREW BONE 10.5MM 45MM MULTIAX SOLERA COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840001550 SUP HCPCS C1713 55840001550 - SCREW BONE 10.5MM 50MM MULTIAX SOLERA CD HORIZON COCR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840001555 SUP HCPCS C1713 55840001555 - SCREW BONE 10.5MM 55MM MULTIAX SOLERA CD HORIZON COCR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840004020 SUP HCPCS C1713 55840004020 - SCREW BONE 4MM 20MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840004025 SUP HCPCS C1713 55840004025 - SCREW BONE 4MM 25MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840004030 SUP HCPCS C1713 55840004030 - SCREW BN 4MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840004035 SUP HCPCS C1713 55840004035 - SCREW BONE 4MM 35MM MULTIAX SOLERA COCR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840004040 SUP HCPCS C1713 55840004040 - SCREW BN 4MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840004045 SUP HCPCS C1713 55840004045 - SCREW BN 4MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840004050 SUP HCPCS C1713 55840004050 - SCREW BONE 4MM 50MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840004055 SUP HCPCS C1713 55840004055 - SCREW BONE 4MM 55MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840004520 SUP HCPCS C1713 55840004520 - SCREW BONE 4.5MM 20MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840004525 SUP HCPCS C1713 55840004525 - SCREW BN 4.5MM 25MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840004530 SUP HCPCS C1713 55840004530 - SCREW BN 4.5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840004535 SUP HCPCS C1713 55840004535 - SCREW BN 4.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840004540 SUP HCPCS C1713 55840004540 - SCREW BN 4.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840004545 SUP HCPCS C1713 55840004545 - SCREW BONE 4.5MM 45MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840004550 SUP HCPCS C1713 55840004550 - SCREW BONE 4.5MM 50MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840004555 SUP HCPCS C1713 55840004555 - SCREW BONE 4.5MM 55MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840005020 SUP HCPCS C1713 55840005020 - SCREW BONE 5MM 20MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840005025 SUP HCPCS C1713 55840005025 - SCREW BN 5MM 25MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840005030 SUP HCPCS C1713 55840005030 - SCREW BN 5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840005035 SUP HCPCS C1713 55840005035 - SCREW BN 5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840005040 SUP HCPCS C1713 55840005040 - SCREW BN 5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840005045 SUP HCPCS C1713 55840005045 - SCREW BN 5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840005050 SUP HCPCS C1713 55840005050 - SCREW BONE 5MM 50MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840005055 SUP HCPCS C1713 55840005055 - SCREW BONE 5MM 55MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840005520 SUP HCPCS C1713 55840005520 - SCREW BONE 5.5MM 20MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840005525 SUP HCPCS C1713 55840005525 - SCREW BN 5.5MM 25MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840005530 SUP HCPCS C1713 55840005530 - SCREW BN 5.5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840005535 SUP HCPCS C1713 55840005535 - SCREW BN 5.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840005540 SUP HCPCS C1713 55840005540 - SCREW BN 5.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840005545 SUP HCPCS C1713 55840005545 - SCREW BN 5.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840005550 SUP HCPCS C1713 55840005550 - SCREW BN 5.5MM 50MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840005555 SUP HCPCS C1713 55840005555 - SCREW BONE 5.5MM 55MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840005560 SUP HCPCS C1713 55840005560 - SCREW BONE 5.5MM 60MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840006020 SUP HCPCS C1713 55840006020 - SCREW BONE 6MM 60MM MULTIAX SOLERA CD HORIZON COCR SPN 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006025 SUP HCPCS C1713 55840006025 - SCREW BONE 6MM 25MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006030 SUP HCPCS C1713 55840006030 - SCREW BONE 6MM 30MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006035 SUP HCPCS C1713 55840006035 - SCREW BONE 6MM 35MM MULTIAX SOLERA CD HORIZON COCR SPN 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840006040 SUP HCPCS C1713 55840006040 - SCREW BONE 6MM 40MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840006045 SUP HCPCS C1713 55840006045 - SCREW BONE 6MM 45MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006050 SUP HCPCS C1713 55840006050 - SCREW BONE 6MM 50MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006055 SUP HCPCS C1713 55840006055 - SCREW BONE 6MM 55MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006060 SUP HCPCS C1713 55840006060 - SCREW BONE 6MM 60MM MULTIAX SOLERA CD HORIZON COCR SPN 5.5MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006500 SUP HCPCS C1713 55840006500 - SCREW BONE 6.5MM 100MM MULTIAX SOLERA CD HORIZON COCR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006520 SUP HCPCS C1713 55840006520 - SCREW BONE 6.5MM 20MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006525 SUP HCPCS C1713 55840006525 - SCREW BONE 6.5MM 25MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006530 SUP HCPCS C1713 55840006530 - SCREW BN 6.5MM 30MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006535 SUP HCPCS C1713 55840006535 - SCREW BN 6.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006540 SUP HCPCS C1713 55840006540 - SCREW BN 6.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006545 SUP HCPCS C1713 55840006545 - SCREW BN 6.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006550 SUP HCPCS C1713 55840006550 - SCREW BN 6.5MM 50MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006555 SUP HCPCS C1713 55840006555 - SCREW BN 6.5MM 55MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006560 SUP HCPCS C1713 55840006560 - SCREW BN 6.5MM 60MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840006565 SUP HCPCS C1713 55840006565 - SCREW BONE 6.5MM 65MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840006570 SUP HCPCS C1713 55840006570 - SCREW BN 6.5MM 70MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840006580 SUP HCPCS C1713 55840006580 - SCREW BONE 6.5MM 80MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840006590 SUP HCPCS C1713 55840006590 - SCREW BONE 6.5MM 90MM MULTIAX SOLERA CD HORIZON COCR SPN 5.5 BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840007500 SUP HCPCS C1713 55840007500 - SCREW BONE 7.5MM 100MM MULTIAX SOLERA CD HORIZON COCR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840007525 SUP HCPCS C1713 55840007525 - SCREW BONE 7.5MM 25MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840007530 SUP HCPCS C1713 55840007530 - SCREW BONE 7.5MM 30MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840007535 SUP HCPCS C1713 55840007535 - SCREW BN 7.5MM 35MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840007540 SUP HCPCS C1713 55840007540 - SCREW BN 7.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 55840007545 SUP HCPCS C1713 55840007545 - SCREW BN 7.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840007550 SUP HCPCS C1713 55840007550 - SCREW BN 7.5MM 50MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840007555 SUP HCPCS C1713 55840007555 - SCREW BN 7.5MM 55MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840007560 SUP HCPCS C1713 55840007560 - SCREW BN 7.5MM 60MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840007565 SUP HCPCS C1713 55840007565 - SCREW BONE 7.5MM 65MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840007570 SUP HCPCS C1713 55840007570 - SCREW BONE 7.5MM 70MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840007580 SUP HCPCS C1713 55840007580 - SCREW BONE 7.5MM 80MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840007590 SUP HCPCS C1713 55840007590 - SCREW BONE 7.5MM 90MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840008500 SUP HCPCS C1713 55840008500 - SCREW BONE 8.5MM 100MM MULTIAX SOLERA CD HORIZON COCR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840008525 SUP HCPCS C1713 55840008525 - SCREW BONE 8.5MM 25MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840008530 SUP HCPCS C1713 55840008530 - SCREW BONE 8.5MM 30MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840008535 SUP HCPCS C1713 55840008535 - SCREW BONE 8.5MM 35MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840008540 SUP HCPCS C1713 55840008540 - SCREW BN 8.5MM 40MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840008545 SUP HCPCS C1713 55840008545 - SCREW BN 8.5MM 45MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840008550 SUP HCPCS C1713 55840008550 - SCREW BONE 8.5MM 50MM MULTIAX SOLERA COCR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840008555 SUP HCPCS C1713 55840008555 - SCREW BN 8.5MM 55MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840008560 SUP HCPCS C1713 55840008560 - SCREW BN 8.5MM 60MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840008565 SUP HCPCS C1713 55840008565 - SCREW BONE 8.5MM 65MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840008570 SUP HCPCS C1713 55840008570 - SCREW BONE 8.5MM 70MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840008580 SUP HCPCS C1713 55840008580 - SCREW BONE 8.5MM 80MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840008590 SUP HCPCS C1713 55840008590 - SCREW BONE 8.5MM 90MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840009500 SUP HCPCS C1713 55840009500 - SCREW BONE 9.5MM 100MM MULTIAX SOLERA CD HORIZON COCR SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840009525 SUP HCPCS C1713 55840009525 - SCREW BONE 9.5MM 25MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840009530 SUP HCPCS C1713 55840009530 - SCREW BONE 9.5MM 30MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840009535 SUP HCPCS C1713 55840009535 - SCREW BONE 9.5MM 35MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840009540 SUP HCPCS C1713 55840009540 - SCREW BONE 9.5MM 40MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840009545 SUP HCPCS C1713 55840009545 - SCREW BONE 9.5MM 45MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840009550 SUP HCPCS C1713 55840009550 - SCREW BONE 9.5MM 50MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55840009555 SUP HCPCS C1713 55840009555 - SCREW BONE 9.5MM 55MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840009560 SUP HCPCS C1713 55840009560 - SCREW BONE 9.5MM 60MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840009565 SUP HCPCS C1713 55840009565 - SCREW BONE 9.5MM 65MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840009570 SUP HCPCS C1713 55840009570 - SCREW BONE 9.5MM 70MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840009580 SUP HCPCS C1713 55840009580 - SCREW BONE 9.5MM 80MM MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840009590 SUP HCPCS C1713 55840009590 - SCREW BN 9.5MM 90MM NS SOLERA CD HZN MA COCR SPNE 5.5MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55840015545 SUP HCPCS C1713 55840015545 - SCREW BONE 5.5MM 45MM MULTIAX CANN SOLERA COCR SPN 5.5/6MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 55840015550 SUP HCPCS C1713 55840015550 - SCREW BONE 5.5MM 50MM CANN MULTIAX COCR SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 55840016550 SUP HCPCS C1713 55840016550 - SCREW BONE 6.5MM 50MM MULTIAX CANN SOLERA COCR SPN 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 55840016555 SUP HCPCS C1713 55840016555 - SCREW BONE 6.5MM 55MM MULTIAX CANN COCR SPN 5.5 ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 55890004015 SUP HCPCS C1713 55890004015 - SCREW BONE 4MM 15MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004020 SUP HCPCS C1713 55890004020 - SCREW BONE 4MM 20MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004025 SUP HCPCS C1713 55890004025 - SCREW BONE 4MM 25MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004030 SUP HCPCS C1713 55890004030 - SCREW BONE 4MM 30MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004035 SUP HCPCS C1713 55890004035 - SCREW BONE 4MM 35MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004040 SUP HCPCS C1713 55890004040 - SCREW BONE 4MM 40MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004045 SUP HCPCS C1713 55890004045 - SCREW BONE 4MM 45MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004050 SUP HCPCS C1713 55890004050 - SCREW BONE 4MM 50MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004055 SUP HCPCS C1713 55890004055 - SCREW BONE 4MM 55MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004060 SUP HCPCS C1713 55890004060 - SCREW BONE 4MM 60MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004065 SUP HCPCS C1713 55890004065 - SCREW BONE 4MM 65MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004070 SUP HCPCS C1713 55890004070 - SCREW BONE 4MM 70MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004075 SUP HCPCS C1713 55890004075 - SCREW BONE 4MM 75MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004080 SUP HCPCS C1713 55890004080 - SCREW BONE 4MM 80MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004515 SUP HCPCS C1713 55890004515 - SCREW BONE 4.5MM 15MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004520 SUP HCPCS C1713 55890004520 - SCREW BONE 4.5MM 20MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004525 SUP HCPCS C1713 55890004525 - SCREW BONE 4.5MM 25MM REDX MULTIAX CD HORIZON SOLERA SPINAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004530 SUP HCPCS C1713 55890004530 - SCREW BONE 4.5MM 30MM REDX MULTIAX CD HORIZON SOLERA SPINAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004535 SUP HCPCS C1713 55890004535 - SCREW BONE 4.5MM 35MM REDX MULTIAX CD HORIZON SOLERA SPINAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890004540 SUP HCPCS C1713 55890004540 - SCREW BONE 4.5MM 40MM REDX MULTIAX CD HORIZON SOLERA SPINAL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890004545 SUP HCPCS C1713 55890004545 - SCREW BONE 4.5MM 45MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890004550 SUP HCPCS C1713 55890004550 - SCREW BONE 4.5MM 50MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004555 SUP HCPCS C1713 55890004555 - SCREW BONE 4.5MM 55MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890004560 SUP HCPCS C1713 55890004560 - SCREW BONE 4.5MM 60MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890004565 SUP HCPCS C1713 55890004565 - SCREW BONE 4.5MM 65MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004570 SUP HCPCS C1713 55890004570 - SCREW BONE 4.5MM 70MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004575 SUP HCPCS C1713 55890004575 - SCREW BONE 4.5MM 75MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890004580 SUP HCPCS C1713 55890004580 - SCREW BONE 4.5MM 80MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005015 SUP HCPCS C1713 55890005015 - SCREW BONE 5MM 15MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005020 SUP HCPCS C1713 55890005020 - SCREW BONE 5MM 20MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890005025 SUP HCPCS C1713 55890005025 - SCREW BONE 5MM 25MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890005030 SUP HCPCS C1713 55890005030 - SCREW BONE 5MM 30MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005035 SUP HCPCS C1713 55890005035 - SCREW BONE 5MM 35MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890005040 SUP HCPCS C1713 55890005040 - SCREW BONE 5MM 40MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005045 SUP HCPCS C1713 55890005045 - SCREW BONE 5MM 45MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005050 SUP HCPCS C1713 55890005050 - SCREW BONE 5MM 50MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005055 SUP HCPCS C1713 55890005055 - SCREW BONE 5MM 55MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005060 SUP HCPCS C1713 55890005060 - SCREW BONE 5MM 60MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005065 SUP HCPCS C1713 55890005065 - SCREW BONE 5MM 65MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005070 SUP HCPCS C1713 55890005070 - SCREW BONE 5MM 70MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005075 SUP HCPCS C1713 55890005075 - SCREW BONE 5MM 75MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005080 SUP HCPCS C1713 55890005080 - SCREW BONE 5MM 80MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005085 SUP HCPCS C1713 55890005085 - SCREW BONE 5MM 85MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890005090 SUP HCPCS C1713 55890005090 - SCREW BONE 5MM 90MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005515 SUP HCPCS C1713 55890005515 - SCREW BONE 5.5MM 15MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005520 SUP HCPCS C1713 55890005520 - SCREW BONE 5.5MM 20MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005525 SUP HCPCS C1713 55890005525 - SCREW BONE 5.5MM 25MM MULTIAX REDX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890005530 SUP HCPCS C1713 55890005530 - SCREW BN 5.5MM 30MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890005535 SUP HCPCS C1713 55890005535 - SCREW BN 5.5MM 35MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005540 SUP HCPCS C1713 55890005540 - SCREW BN 5.5MM 40MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005545 SUP HCPCS C1713 55890005545 - SCREW BN 5.5MM 45MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005550 SUP HCPCS C1713 55890005550 - SCREW BONE 5.5MM 50MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005555 SUP HCPCS C1713 55890005555 - SCREW BONE 5.5MM 55MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005560 SUP HCPCS C1713 55890005560 - SCREW BONE 5.5MM 60MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005565 SUP HCPCS C1713 55890005565 - SCREW BONE 5.5MM 65MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005570 SUP HCPCS C1713 55890005570 - SCREW BONE 5.5MM 70MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005575 SUP HCPCS C1713 55890005575 - SCREW BONE 5.5MM 75MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890005580 SUP HCPCS C1713 55890005580 - SCREW BONE 5.5MM 80MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890006015 SUP HCPCS C1713 55890006015 - SCREW BONE 6MM 15MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890006020 SUP HCPCS C1713 55890006020 - SCREW BONE 6MM 20MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006025 SUP HCPCS C1713 55890006025 - SCREW BONE 6MM 25MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006030 SUP HCPCS C1713 55890006030 - SCREW BONE 6MM 30MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006035 SUP HCPCS C1713 55890006035 - SCREW BONE 6MM 35MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006040 SUP HCPCS C1713 55890006040 - SCREW BONE 6MM 40MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006045 SUP HCPCS C1713 55890006045 - SCREW BONE 6MM 45MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006050 SUP HCPCS C1713 55890006050 - SCREW BONE 6MM 50MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890006055 SUP HCPCS C1713 55890006055 - SCREW BONE 6MM 55MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890006060 SUP HCPCS C1713 55890006060 - SCREW BONE 6MM 60MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006065 SUP HCPCS C1713 55890006065 - SCREW BONE 6MM 65MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006070 SUP HCPCS C1713 55890006070 - SCREW BONE 6MM 70MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890006075 SUP HCPCS C1713 55890006075 - SCREW BONE 6MM 75MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006080 SUP HCPCS C1713 55890006080 - SCREW BONE 6MM 80MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890006515 SUP HCPCS C1713 55890006515 - SCREW BONE 6.5MM 15MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890006520 SUP HCPCS C1713 55890006520 - SCREW BONE 6.5MM 20MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890006525 SUP HCPCS C1713 55890006525 - SCREW BONE 6.5MM 25MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006530 SUP HCPCS C1713 55890006530 - SCREW BONE 6.5MM 30MM MULTIAX REDX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890006535 SUP HCPCS C1713 55890006535 - SCREW BONE 6.5MM 35MM MULTIAX REDX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890006540 SUP HCPCS C1713 55890006540 - SCREW BN 6.5MM 40MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006545 SUP HCPCS C1713 55890006545 - SCREW BN 6.5MM 45MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006550 SUP HCPCS C1713 55890006550 - SCREW BN 6.5MM 50MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006555 SUP HCPCS C1713 55890006555 - SCREW BN 6.5MM 55MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006560 SUP HCPCS C1713 55890006560 - SCREW BONE 6.5MM 60MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006565 SUP HCPCS C1713 55890006565 - SCREW BONE 6.5MM 65MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006570 SUP HCPCS C1713 55890006570 - SCREW BONE 6.5MM 70MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890006575 SUP HCPCS C1713 55890006575 - SCREW BONE 6.5MM 75MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890006580 SUP HCPCS C1713 55890006580 - SCREW BONE 6.5MM 80MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890007015 SUP HCPCS C1713 55890007015 - SCREW BONE 7MM 15MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890007020 SUP HCPCS C1713 55890007020 - SCREW BONE 7MM 20MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007025 SUP HCPCS C1713 55890007025 - SCREW BONE 7MM 25MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007030 SUP HCPCS C1713 55890007030 - SCREW BONE 7MM 30MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007035 SUP HCPCS C1713 55890007035 - SCREW BONE 7MM 35MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007040 SUP HCPCS C1713 55890007040 - SCREW BONE 7MM 40MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007045 SUP HCPCS C1713 55890007045 - SCREW BONE 7MM 45MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007050 SUP HCPCS C1713 55890007050 - SCREW BONE 7MM 50MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007055 SUP HCPCS C1713 55890007055 - SCREW BONE 7MM 55MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007060 SUP HCPCS C1713 55890007060 - SCREW BONE 7MM 60MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007065 SUP HCPCS C1713 55890007065 - SCREW BONE 7MM 65MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007070 SUP HCPCS C1713 55890007070 - SCREW BONE 7MM 70MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007075 SUP HCPCS C1713 55890007075 - SCREW BONE 7MM 75MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007080 SUP HCPCS C1713 55890007080 - SCREW BONE 7MM 80MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007500 SUP HCPCS C1713 55890007500 - SCREW BONE 7.5MM 100MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007511 SUP HCPCS C1713 55890007511 - SCREW BONE 7.5MM 110MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890007515 SUP HCPCS C1713 55890007515 - SCREW BONE 7.5MM 15MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890007520 SUP HCPCS C1713 55890007520 - SCREW BONE 7.5MM 20MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890007525 SUP HCPCS C1713 55890007525 - SCREW BONE 7.5MM 25MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007530 SUP HCPCS C1713 55890007530 - SCREW BONE 7.5MM 30MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890007535 SUP HCPCS C1713 55890007535 - SCREW BN 7.5MM 35MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890007540 SUP HCPCS C1713 55890007540 - SCREW BN 7.5MM 40MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890007545 SUP HCPCS C1713 55890007545 - SCREW BN 7.5MM 45MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007550 SUP HCPCS C1713 55890007550 - SCREW BN 7.5MM 50MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890007555 SUP HCPCS C1713 55890007555 - SCREW BN 7.5MM 55MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890007560 SUP HCPCS C1713 55890007560 - SCREW BN 7.5MM 60MM SOLERA CD HZN RDC MA COCR SPNE 5.5/6MM BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890007565 SUP HCPCS C1713 55890007565 - SCREW BONE 7.5MM 65MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007570 SUP HCPCS C1713 55890007570 - SCREW BONE 7.5MM 70MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890007575 SUP HCPCS C1713 55890007575 - SCREW BONE 7.5MM 75MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890007580 SUP HCPCS C1713 55890007580 - SCREW BONE 7.5MM 80MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007585 SUP HCPCS C1713 55890007585 - SCREW BONE 7.5MM 85MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007590 SUP HCPCS C1713 55890007590 - SCREW BONE 7.5MM 90MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890007595 SUP HCPCS C1713 55890007595 - SCREW BONE 7.5MM 95MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008000 SUP HCPCS C1713 55890008000 - SCREW BONE 8MM 100MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008011 SUP HCPCS C1713 55890008011 - SCREW BONE 8MM 110MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008015 SUP HCPCS C1713 55890008015 - SCREW BONE 8MM 15MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008020 SUP HCPCS C1713 55890008020 - SCREW BONE 8MM 20MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008025 SUP HCPCS C1713 55890008025 - SCREW BONE 8MM 25MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008030 SUP HCPCS C1713 55890008030 - SCREW BONE 8MM 30MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008035 SUP HCPCS C1713 55890008035 - SCREW BONE 8MM 35MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008040 SUP HCPCS C1713 55890008040 - SCREW BONE 8MM 40MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008045 SUP HCPCS C1713 55890008045 - SCREW BONE 8MM 45MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008050 SUP HCPCS C1713 55890008050 - SCREW BONE 8MM 50MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008055 SUP HCPCS C1713 55890008055 - SCREW BONE 8MM 55MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008060 SUP HCPCS C1713 55890008060 - SCREW BONE 8MM 60MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008065 SUP HCPCS C1713 55890008065 - SCREW BONE 8MM 65MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008070 SUP HCPCS C1713 55890008070 - SCREW BONE 8MM 70MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008075 SUP HCPCS C1713 55890008075 - SCREW BONE 8MM 75MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008080 SUP HCPCS C1713 55890008080 - SCREW BONE 8MM 80MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008085 SUP HCPCS C1713 55890008085 - SCREW BONE 8MM 85MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008090 SUP HCPCS C1713 55890008090 - SCREW BONE 8MM 90MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008095 SUP HCPCS C1713 55890008095 - SCREW BONE 8MM 95MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008500 SUP HCPCS C1713 55890008500 - SCREW BONE 8.5MM 100MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008511 SUP HCPCS C1713 55890008511 - SCREW BONE 8.5MM 110MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008515 SUP HCPCS C1713 55890008515 - SCREW BONE 8.5MM 15MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008520 SUP HCPCS C1713 55890008520 - SCREW BONE 8.5MM 20MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008525 SUP HCPCS C1713 55890008525 - SCREW BONE 8.5MM 25MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008530 SUP HCPCS C1713 55890008530 - SCREW BONE 8.5MM 30MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008535 SUP HCPCS C1713 55890008535 - SCREW BONE 8.5MM 35MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008540 SUP HCPCS C1713 55890008540 - SCREW BONE 8.5MM 40MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008545 SUP HCPCS C1713 55890008545 - SCREW BONE 8.5MM 45MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008550 SUP HCPCS C1713 55890008550 - SCREW BONE 8.5MM 50MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008555 SUP HCPCS C1713 55890008555 - SCREW BONE 8.5MM 55MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008560 SUP HCPCS C1713 55890008560 - SCREW BONE 8.5MM 60MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008565 SUP HCPCS C1713 55890008565 - SCREW BONE 8.5MM 65MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008570 SUP HCPCS C1713 55890008570 - SCREW BONE 8.5MM 70MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890008575 SUP HCPCS C1713 55890008575 - SCREW BONE 8.5MM 75MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890008580 SUP HCPCS C1713 55890008580 - SCREW BONE 8.5MM 80MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008585 SUP HCPCS C1713 55890008585 - SCREW BONE 8.5MM 85MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008590 SUP HCPCS C1713 55890008590 - SCREW BONE 8.5MM 90MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890008595 SUP HCPCS C1713 55890008595 - SCREW BONE 8.5MM 95MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009000 SUP HCPCS C1713 55890009000 - SCREW BONE 9MM 100MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009011 SUP HCPCS C1713 55890009011 - SCREW BONE 9MM 110MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009015 SUP HCPCS C1713 55890009015 - SCREW BONE 9MM 15MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009020 SUP HCPCS C1713 55890009020 - SCREW BONE 9MM 20MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009025 SUP HCPCS C1713 55890009025 - SCREW BONE 9MM 25MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009030 SUP HCPCS C1713 55890009030 - SCREW BONE 9MM 30MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009035 SUP HCPCS C1713 55890009035 - SCREW BONE 9MM 35MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009040 SUP HCPCS C1713 55890009040 - SCREW BONE 9MM 40MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009045 SUP HCPCS C1713 55890009045 - SCREW BONE 9MM 45MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009050 SUP HCPCS C1713 55890009050 - SCREW BONE 9MM 50MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009055 SUP HCPCS C1713 55890009055 - SCREW BONE 9MM 55MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009060 SUP HCPCS C1713 55890009060 - SCREW BONE 9MM 60MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009065 SUP HCPCS C1713 55890009065 - SCREW BONE 9MM 65MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009070 SUP HCPCS C1713 55890009070 - SCREW BONE 9MM 70MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009075 SUP HCPCS C1713 55890009075 - SCREW BONE 9MM 75MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009080 SUP HCPCS C1713 55890009080 - SCREW BONE 9MM 80MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009085 SUP HCPCS C1713 55890009085 - SCREW BONE 9MM 85MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009090 SUP HCPCS C1713 55890009090 - SCREW BONE 9MM 90MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009095 SUP HCPCS C1713 55890009095 - SCREW BONE 9MM 95MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009500 SUP HCPCS C1713 55890009500 - SCREW BONE 9.5MM 100MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009511 SUP HCPCS C1713 55890009511 - SCREW BONE 9.5MM 110MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009515 SUP HCPCS C1713 55890009515 - SCREW BONE 9.5MM 15MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009520 SUP HCPCS C1713 55890009520 - SCREW BONE 9.5MM 20MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890009525 SUP HCPCS C1713 55890009525 - SCREW BONE 9.5MM 25MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009530 SUP HCPCS C1713 55890009530 - SCREW BONE 9.5MM 30MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009535 SUP HCPCS C1713 55890009535 - SCREW BONE 9.5MM 35MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890009540 SUP HCPCS C1713 55890009540 - SCREW BONE 9.5MM 40MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009545 SUP HCPCS C1713 55890009545 - SCREW BONE 9.5MM 45MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890009550 SUP HCPCS C1713 55890009550 - SCREW BONE 9.5MM 50MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890009555 SUP HCPCS C1713 55890009555 - SCREW BONE 9.5MM 55MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890009560 SUP HCPCS C1713 55890009560 - SCREW BONE 9.5MM 60MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009565 SUP HCPCS C1713 55890009565 - SCREW BONE 9.5MM 65MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009570 SUP HCPCS C1713 55890009570 - SCREW BONE 9.5MM 70MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009575 SUP HCPCS C1713 55890009575 - SCREW BONE 9.5MM 75MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009580 SUP HCPCS C1713 55890009580 - SCREW BONE 9.5MM 80MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 55890009585 SUP HCPCS C1713 55890009585 - SCREW BONE 9.5MM 85MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890009590 SUP HCPCS C1713 55890009590 - SCREW BONE 9.5MM 90MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 55890009595 SUP HCPCS C1713 55890009595 - SCREW BONE 9.5MM 95MM REDX MULTIAX COCR SPN 5.5/6MM ROD BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 60707010400 SUP Custom 27203010 60707010400 - CUFF TRNQT 24X4IN 2 PORT 1 BLDR W/O SLV ATS STRL LATEX FREE BOTH IP/OP $73.50 $54.00 $13.06 $73.39 $73.39 $73.39 $73.39 $73.39 $73.39 $73.39 $13.06 $73.39 $73.39 $54.47 $54.47 $56.57 $38.24 $15.30 $73.39 $29.36 $73.39 $73.39 $73.39 $73.39 $73.39 $55.13 $73.39 $73.39 $73.39 $36.70 $36.70 $58.12 $73.39 $58.71 $47.70 $73.39 N/A $42.63 $73.39 $44.03 $73.39 $73.39 $73.39 N/A N/A 60707010500 SUP Custom 27203010 60707010500 - CUFF TRNQT 30X4IN 2 PORT 1 BLDR W/O SLV ATS STRL LATEX FREE BOTH IP/OP $78.50 $58.00 $13.89 $78.02 $78.02 $78.02 $78.02 $78.02 $78.02 $78.02 $13.89 $78.02 $78.02 $57.91 $57.91 $60.14 $40.65 $16.26 $78.02 $31.21 $78.02 $78.02 $78.02 $78.02 $78.02 $58.88 $78.02 $78.02 $78.02 $39.01 $39.01 $61.79 $78.02 $62.42 $50.71 $78.02 N/A $45.53 $78.02 $46.81 $78.02 $78.02 $78.02 N/A N/A 60707010600 SUP Custom 27203010 60707010600 - CUFF TRNQT 34X4IN 2 PORT 1 BLDR W/O SLV ATS STRL LATEX FREE BOTH IP/OP $84.50 $63.00 $15.03 $84.46 $84.46 $84.46 $84.46 $84.46 $84.46 $84.46 $15.03 $84.46 $84.46 $62.69 $62.69 $65.10 $44.00 $17.60 $84.46 $33.78 $84.46 $84.46 $84.46 $84.46 $84.46 $63.38 $84.46 $84.46 $84.46 $42.23 $42.23 $66.89 $84.46 $67.57 $54.90 $84.46 N/A $49.01 $84.46 $50.68 $84.46 $84.46 $84.46 N/A N/A 60707010700 SUP Custom 27203010 60707010700 - CUFF TRNQT CYL 42X4IN RUBY STRL LF ATS 3K 2 PORT BLDR POS BOTH IP/OP $217.50 $161.00 $38.72 $217.50 $217.50 $217.50 $217.50 $217.50 $217.50 $217.50 $38.72 $217.50 $217.50 $161.43 $161.43 $167.65 $113.32 $45.33 $217.50 $87.00 $217.50 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $141.38 $217.50 N/A $126.15 $217.50 $130.50 $217.50 $217.50 $217.50 N/A N/A 9.89803E+11 SUP Custom 27203010 989803104341 - TUBING MONITR SMALL STATURE 10FT NIBP LATEX FREE REUSABLE BOTH IP/OP $121.00 $90.00 $21.49 $252.17 $120.75 $120.75 $120.75 $120.75 $120.75 $120.75 $21.49 $120.75 $120.75 $89.62 $89.62 $93.07 $62.91 $25.17 $120.75 $49.04 $120.75 $120.75 $252.17 $120.75 $120.75 $90.75 $120.75 $120.75 $120.75 $60.38 $60.38 $95.63 $120.75 $96.60 $78.49 $120.75 N/A $70.18 $120.75 $72.45 $120.75 $120.75 $120.75 N/A N/A 9.89803E+11 SUP Custom 27203010 989803125401 - PAD DEFIBRILLATOR 25-34CM 48IN RADIOTRANSPARENT REDUCE SKIN BOTH IP/OP $70.00 $52.00 $12.41 $69.73 $69.73 $69.73 $69.73 $69.73 $69.73 $69.73 $12.41 $69.73 $69.73 $51.75 $51.75 $53.75 $36.33 $14.53 $69.73 $26.88 $69.73 $69.73 $67.20 $69.73 $69.73 $52.50 $69.73 $69.73 $69.73 $34.87 $34.87 $55.23 $69.73 $55.78 $45.32 $69.73 N/A $40.60 $69.73 $41.84 $69.73 $69.73 $69.73 N/A N/A 0.8P8 SUP Custom 27803010 0.8P8 - PATCH VASCULAR THK.45MM TAPER 8X.8CM BIOLOGIC XENOSURE BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $180.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A 00-0114-006-00 SUP Custom 27203010 00-0114-006-00 - HOLDER PIN 3/16IN 21X11CM LF BHLR-STNM THB SCR SS SKL TRX BOTH IP/OP $442.00 $327.00 $78.68 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $442.00 $78.68 $442.00 $442.00 $328.05 $328.05 $340.69 $230.28 $92.12 $442.00 $176.80 $442.00 $442.00 $442.00 $442.00 $442.00 $331.50 $442.00 $442.00 $442.00 $221.00 $221.00 $350.06 $442.00 $353.60 $287.30 $442.00 N/A $256.36 $442.00 $265.20 $442.00 $442.00 $442.00 N/A N/A 000-2090 SUP HCPCS C1781 000-2090 - SCREWDRIVER SURG CARELINK PACEMAKER BOTH IP/OP "$1,277.50" $945.00 $253.48 "$1,277.13" $574.71 $574.71 $574.71 $574.71 "$1,277.13" "$1,277.13" "$1,277.13" $266.19 "$1,277.13" "$1,277.13" "$1,277.13" "$1,277.13" "$1,277.13" $266.17 "$1,277.13" "$1,277.13" $755.42 "$1,277.13" "$1,277.13" "$1,277.13" "$1,277.13" $958.13 "$1,277.13" "$1,277.13" "$1,277.13" $638.57 $638.57 "$1,011.49" "$1,277.13" "$1,021.70" $574.71 $253.48 N/A $740.95 "$1,277.13" "$1,277.13" "$1,277.13" $266.15 "$1,277.13" N/A N/A 0003H SUP Custom 27203010 0003H - NEEDLE OPTH 25GA 1.5IN ATKNSN ORNG HUB RTRBLBR DISP BOTH IP/OP $465.00 $344.00 $82.77 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $465.00 $82.77 $465.00 $465.00 $345.12 $345.12 $358.42 $242.27 $96.91 $465.00 $186.00 $465.00 $465.00 $465.00 $465.00 $465.00 $348.75 $465.00 $465.00 $465.00 $232.50 $232.50 $368.28 $465.00 $372.00 $302.25 $465.00 N/A $269.70 $465.00 $279.00 $465.00 $465.00 $465.00 N/A N/A 00085-4602-02 SUP HCPCS C2626 00085-4602-02 - SCREW SYSTEM INSPIREASE DRUG DELIVERY EA BOTH IP/OP $112.00 $83.00 $23.33 $111.93 $111.93 $111.93 $111.93 $111.93 $111.93 $111.93 $111.93 $111.93 $111.93 $111.93 $111.93 $111.93 $111.93 $23.33 $111.93 $44.77 $111.93 $111.93 $111.93 $111.93 $111.93 $84.00 $111.93 $111.93 $111.93 $55.97 $55.97 $88.65 $111.93 $89.54 $50.37 $111.93 N/A $64.96 $111.93 $67.16 $111.93 $111.93 $111.93 N/A N/A 00208-00 SUP Custom 27203010 ASSEMBLY ANTICOAGULATION/ASPIRATION TUBING FOR CELL SAVER PA BOTH IP/OP $63.50 $47.00 $11.28 $63.38 $63.38 $63.38 $63.38 $63.38 $63.38 $63.38 $11.28 $63.38 $63.38 $47.04 $47.04 $48.85 $33.02 $13.21 $63.38 $25.35 $63.38 $63.38 $63.38 $63.38 $63.38 $47.63 $63.38 $63.38 $63.38 $31.69 $31.69 $50.20 $63.38 $50.70 $41.20 $63.38 N/A $36.83 $63.38 $38.03 $63.38 $63.38 $63.38 N/A N/A 00-2348-010-35 SUP HCPCS C1713 00-2348-010-35 - SCREW BONE 3.5MM 2.7MM 10MM SELF TAP STAINLESS STEEL BOTH IP/OP $75.00 $56.00 $14.84 $74.75 $33.64 $33.64 $33.64 $33.64 $74.75 $74.75 $74.75 $15.58 $74.75 $74.75 $74.75 $74.75 $74.75 $15.58 $74.75 $29.90 $44.21 $74.75 $74.75 $74.75 $74.75 $56.25 $74.75 $74.75 $74.75 $37.38 $37.38 $59.20 $74.75 $59.80 $33.64 $14.84 N/A $43.50 $74.75 $44.85 $74.75 $15.58 $74.75 N/A N/A 00-2348-012-35 SUP HCPCS C1713 00-2348-012-35 - SCREW BONE 3.5MM 2.7MM 12MM SELF TAP STAINLESS STEEL BOTH IP/OP $75.00 $56.00 $14.84 $74.75 $33.64 $33.64 $33.64 $33.64 $74.75 $74.75 $74.75 $15.58 $74.75 $74.75 $74.75 $74.75 $74.75 $15.58 $74.75 $74.75 $44.21 $74.75 $74.75 $74.75 $74.75 $56.25 $74.75 $74.75 $74.75 $37.38 $37.38 $59.20 $74.75 $59.80 $33.64 $14.84 N/A $43.50 $74.75 $74.75 $74.75 $15.58 $74.75 N/A N/A 00-2348-014-35 SUP HCPCS C1713 00-2348-014-35 - SCREW BONE 3.5MM 2.7MM 14MM SELF TAP STAINLESS STEEL BOTH IP/OP $75.00 $56.00 $14.84 $74.75 $33.64 $33.64 $33.64 $33.64 $74.75 $74.75 $74.75 $15.58 $74.75 $74.75 $74.75 $74.75 $74.75 $15.58 $74.75 $74.75 $44.21 $74.75 $74.75 $74.75 $74.75 $56.25 $74.75 $74.75 $74.75 $37.38 $37.38 $59.20 $74.75 $59.80 $33.64 $14.84 N/A $43.50 $74.75 $44.85 $74.75 $15.58 $74.75 N/A N/A 00-2348-016-35 SUP HCPCS C1713 00-2348-016-35 - SCREW BONE 3.5MM 2.7MM 16MM SELF TAP STAINLESS STEEL BOTH IP/OP $75.00 $56.00 $14.84 $74.75 $33.64 $33.64 $33.64 $33.64 $74.75 $74.75 $74.75 $15.58 $74.75 $74.75 $74.75 $74.75 $74.75 $15.58 $74.75 $74.75 $44.21 $74.75 $74.75 $74.75 $74.75 $56.25 $74.75 $74.75 $74.75 $37.38 $37.38 $59.20 $74.75 $59.80 $33.64 $14.84 N/A $43.50 $74.75 $44.85 $74.75 $74.75 $74.75 N/A N/A 00-2348-020-35 SUP HCPCS C1713 00-2348-020-35 - SCREW BONE 3.5MM 2.7MM 20MM SELF TAP STAINLESS STEEL BOTH IP/OP $75.00 $56.00 $14.84 $74.75 $33.64 $33.64 $33.64 $33.64 $74.75 $74.75 $74.75 $15.58 $74.75 $74.75 $74.75 $74.75 $74.75 $15.58 $74.75 $29.90 $44.21 $74.75 $74.75 $74.75 $74.75 $56.25 $74.75 $74.75 $74.75 $37.38 $37.38 $59.20 $74.75 $59.80 $33.64 $14.84 N/A $43.50 $74.75 $44.85 $74.75 $74.75 $74.75 N/A N/A 00-2348-022-35 SUP HCPCS C1713 00-2348-022-35 - SCREW BONE 3.5MM 2.7MM 22MM SELF TAP STAINLESS STEEL BOTH IP/OP $75.00 $56.00 $14.84 $74.75 $33.64 $33.64 $33.64 $33.64 $74.75 $74.75 $74.75 $15.58 $74.75 $74.75 $74.75 $74.75 $74.75 $15.58 $74.75 $29.90 $44.21 $74.75 $74.75 $74.75 $74.75 $56.25 $74.75 $74.75 $74.75 $37.38 $37.38 $59.20 $74.75 $59.80 $33.64 $14.84 N/A $43.50 $74.75 $44.85 $74.75 $15.58 $74.75 N/A N/A 00-2348-026-35 SUP HCPCS C1713 00-2348-026-35 - SCREW BONE 3.5MM 2.7MM 26MM SELF TAP STAINLESS STEEL BOTH IP/OP $75.00 $56.00 $14.84 $74.75 $33.64 $33.64 $33.64 $33.64 $74.75 $74.75 $74.75 $15.58 $74.75 $74.75 $74.75 $74.75 $74.75 $15.58 $74.75 $29.90 $44.21 $74.75 $74.75 $74.75 $74.75 $56.25 $74.75 $74.75 $74.75 $37.38 $37.38 $59.20 $74.75 $59.80 $33.64 $14.84 N/A $43.50 $74.75 $44.85 $74.75 $15.58 $74.75 N/A N/A 00-2357-017-04 SUP HCPCS C1713 00-2357-017-04 - PLATE BONE 80MM 4 HOLE LOCK STAINLESS STEEL FIBULA RIGHT BOTH IP/OP "$1,378.00" "$1,020.00" $273.50 "$1,378.00" $620.10 $620.10 $620.10 $620.10 "$1,378.00" "$1,378.00" "$1,378.00" $287.21 "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" $287.19 "$1,378.00" "$1,378.00" $815.09 "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" "$1,033.50" "$1,378.00" "$1,378.00" "$1,378.00" $689.00 $689.00 "$1,091.38" "$1,378.00" "$1,102.40" $620.10 $273.50 N/A $799.24 "$1,378.00" $826.80 "$1,378.00" $287.18 "$1,378.00" N/A N/A 00-2357-017-06 SUP HCPCS C1713 00-2357-017-06 - PLATE BONE 106MM 6 HOLE LOCK STAINLESS STEEL FIBULA RIGHT BOTH IP/OP "$1,479.00" "$1,094.00" $293.49 "$1,478.75" $665.44 $665.44 $665.44 $665.44 "$1,478.75" "$1,478.75" "$1,478.75" $308.21 "$1,478.75" "$1,478.75" "$1,478.75" "$1,478.75" "$1,478.75" $308.19 "$1,478.75" $591.50 $874.68 "$1,478.75" "$1,478.75" "$1,478.75" "$1,478.75" "$1,109.25" "$1,478.75" "$1,478.75" "$1,478.75" $739.38 $739.38 "$1,171.17" "$1,478.75" "$1,183.00" $665.44 $293.49 N/A $857.82 "$1,478.75" $887.25 "$1,478.75" $308.17 "$1,478.75" N/A N/A 00-2357-017-08 SUP HCPCS C1713 00-2357-017-08 - PLATE BONE 132MM 8 HOLE LOCK FIBULA RIGHT DISTAL LATERAL BOTH IP/OP "$1,579.50" "$1,169.00" $313.49 "$1,579.50" $710.78 $710.78 $710.78 $710.78 "$1,579.50" "$1,579.50" "$1,579.50" $329.21 "$1,579.50" "$1,579.50" "$1,579.50" "$1,579.50" "$1,579.50" $329.19 "$1,579.50" $631.80 $934.27 "$1,579.50" "$1,579.50" "$1,579.50" "$1,579.50" "$1,184.63" "$1,579.50" "$1,579.50" "$1,579.50" $789.75 $789.75 "$1,250.96" "$1,579.50" "$1,263.60" $710.78 $313.49 N/A $916.11 "$1,579.50" $947.70 "$1,579.50" $329.17 "$1,579.50" N/A N/A 00-2357-018-04 SUP HCPCS C1713 00-2357-018-04 - PLATE BONE 80MM 4 HOLE LOCK STAINLESS STEEL FIBULA LEFT BOTH IP/OP "$1,378.00" "$1,020.00" $273.50 "$1,378.00" $620.10 $620.10 $620.10 $620.10 "$1,378.00" "$1,378.00" "$1,378.00" $287.21 "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" $287.19 "$1,378.00" "$1,378.00" $815.09 "$1,378.00" "$1,378.00" "$1,378.00" "$1,378.00" "$1,033.50" "$1,378.00" "$1,378.00" "$1,378.00" $689.00 $689.00 "$1,091.38" "$1,378.00" "$1,102.40" $620.10 $273.50 N/A $799.24 "$1,378.00" $826.80 "$1,378.00" $287.18 "$1,378.00" N/A N/A 00-2357-018-06 SUP HCPCS C1713 00-2357-018-06 - PLATE BONE 106MM 6 HOLE LOCK STAINLESS STEEL FIBULA LEFT BOTH IP/OP "$1,479.00" "$1,094.00" $293.49 "$1,478.75" $665.44 $665.44 $665.44 $665.44 "$1,478.75" "$1,478.75" "$1,478.75" $308.21 "$1,478.75" "$1,478.75" "$1,478.75" "$1,478.75" "$1,478.75" $308.19 "$1,478.75" "$1,478.75" $874.68 "$1,478.75" "$1,478.75" "$1,478.75" "$1,478.75" "$1,109.25" "$1,478.75" "$1,478.75" "$1,478.75" $739.38 $739.38 "$1,171.17" "$1,478.75" "$1,183.00" $665.44 $293.49 N/A $857.82 "$1,478.75" $887.25 "$1,478.75" $308.17 "$1,478.75" N/A N/A 00-2359-012-38 SUP HCPCS C1713 00-2359-012-38 - SCREW BONE 3.5MM 2.7MM 12MM LOCK STAINLESS STEEL ELBOW BOTH IP/OP $201.50 $149.00 $39.99 $201.50 $90.68 $90.68 $90.68 $90.68 $201.50 $201.50 $201.50 $42.00 $201.50 $201.50 $201.50 $201.50 $201.50 $41.99 $201.50 $201.50 $119.19 $201.50 $201.50 $201.50 $201.50 $151.13 $201.50 $201.50 $201.50 $100.75 $100.75 $159.59 $201.50 $161.20 $90.68 $39.99 N/A $116.87 $201.50 $120.90 $201.50 $41.99 $201.50 N/A N/A 00-2359-014-38 SUP HCPCS C1713 00-2359-014-38 - SCREW BONE 3.5MM 2.7MM 14MM LOCK STAINLESS STEEL ELBOW BOTH IP/OP $201.50 $149.00 $39.99 $201.50 $90.68 $90.68 $90.68 $90.68 $201.50 $201.50 $201.50 $42.00 $201.50 $201.50 $201.50 $201.50 $201.50 $41.99 $201.50 $80.60 $119.19 $201.50 $201.50 $201.50 $201.50 $151.13 $201.50 $201.50 $201.50 $100.75 $100.75 $159.59 $201.50 $161.20 $90.68 $39.99 N/A $116.87 $201.50 $120.90 $201.50 $41.99 $201.50 N/A N/A 00-2359-016-26 SUP HCPCS C1713 00-2359-016-26 - SCREW BONE CONE 2.6MM 16MM LOCK HEAD STAINLESS STEEL ELBOW BOTH IP/OP $114.00 $84.00 $22.58 $113.75 $51.19 $51.19 $51.19 $51.19 $113.75 $113.75 $113.75 $23.71 $113.75 $113.75 $113.75 $113.75 $113.75 $23.71 $113.75 $45.50 $67.28 $113.75 $113.75 $113.75 $113.75 $85.50 $113.75 $113.75 $113.75 $56.88 $56.88 $90.09 $113.75 $91.00 $51.19 $22.58 N/A $66.12 $113.75 $68.25 $113.75 $23.71 $113.75 N/A N/A 00-2359-016-38 SUP HCPCS C1713 00-2359-016-38 - SCREW BONE 3.5MM 2.7MM 16MM LOCK STAINLESS STEEL ELBOW BOTH IP/OP $201.50 $149.00 $39.99 $201.50 $90.68 $90.68 $90.68 $90.68 $201.50 $201.50 $201.50 $42.00 $201.50 $201.50 $201.50 $201.50 $201.50 $41.99 $201.50 $201.50 $119.19 $201.50 $201.50 $201.50 $201.50 $151.13 $201.50 $201.50 $201.50 $100.75 $100.75 $159.59 $201.50 $161.20 $90.68 $39.99 N/A $116.87 $201.50 $120.90 $201.50 $201.50 $201.50 N/A N/A 00-2359-018-35 SUP HCPCS C1713 00-2359-018-35 - SCREW BONE 3.5MM 18MM LOCK STAINLESS STEEL HUMERUS TIBIA BOTH IP/OP $218.00 $161.00 $43.22 $217.75 $97.99 $97.99 $97.99 $97.99 $217.75 $217.75 $217.75 $45.38 $217.75 $217.75 $217.75 $217.75 $217.75 $45.38 $217.75 $217.75 $128.80 $217.75 $217.75 $217.75 $217.75 $163.50 $217.75 $217.75 $217.75 $108.88 $108.88 $172.46 $217.75 $174.20 $97.99 $43.22 N/A $126.44 $217.75 $217.75 $217.75 $45.38 $217.75 N/A N/A 00-2359-018-38 SUP HCPCS C1713 00-2359-018-38 - SCREW BONE 3.5MM 2.7MM 18MM LOCK STAINLESS STEEL ELBOW BOTH IP/OP $201.50 $149.00 $39.99 $201.50 $90.68 $90.68 $90.68 $90.68 $201.50 $201.50 $201.50 $42.00 $201.50 $201.50 $201.50 $201.50 $201.50 $41.99 $201.50 $201.50 $119.19 $201.50 $201.50 $201.50 $201.50 $151.13 $201.50 $201.50 $201.50 $100.75 $100.75 $159.59 $201.50 $161.20 $90.68 $39.99 N/A $116.87 $201.50 $201.50 $201.50 $201.50 $201.50 N/A N/A 00-2359-040-35 SUP HCPCS C1713 00-2359-040-35 - SCREW BONE 3.5MM 40MM LOCK STAINLESS STEEL HUMERUS TIBIA BOTH IP/OP $218.00 $161.00 $43.22 $217.75 $97.99 $97.99 $97.99 $97.99 $217.75 $217.75 $217.75 $45.38 $217.75 $217.75 $217.75 $217.75 $217.75 $45.38 $217.75 $217.75 $128.80 $217.75 $217.75 $217.75 $217.75 $163.50 $217.75 $217.75 $217.75 $108.88 $108.88 $172.46 $217.75 $174.20 $97.99 $43.22 N/A $126.44 $217.75 $217.75 $217.75 $45.38 $217.75 N/A N/A 00-2359-044-35 SUP HCPCS C1713 00-2359-044-35 - SCREW BONE 3.5MM 44MM LOCK STAINLESS STEEL HUMERUS TIBIA BOTH IP/OP $218.00 $161.00 $43.22 $217.75 $97.99 $97.99 $97.99 $97.99 $217.75 $217.75 $217.75 $45.38 $217.75 $217.75 $217.75 $217.75 $217.75 $45.38 $217.75 $217.75 $128.80 $217.75 $217.75 $217.75 $217.75 $163.50 $217.75 $217.75 $217.75 $108.88 $108.88 $172.46 $217.75 $174.20 $97.99 $43.22 N/A $126.44 $217.75 $217.75 $217.75 $45.38 $217.75 N/A N/A 00-2359-046-35 SUP HCPCS C1713 00-2359-046-35 - SCREW BONE 3.5MM 46MM LOCK STAINLESS STEEL HUMERUS TIBIA BOTH IP/OP $218.00 $161.00 $43.22 $217.75 $97.99 $97.99 $97.99 $97.99 $217.75 $217.75 $217.75 $45.38 $217.75 $217.75 $217.75 $217.75 $217.75 $45.38 $217.75 $217.75 $128.80 $217.75 $217.75 $217.75 $217.75 $163.50 $217.75 $217.75 $217.75 $108.88 $108.88 $172.46 $217.75 $174.20 $97.99 $43.22 N/A $126.44 $217.75 $217.75 $217.75 $45.38 $217.75 N/A N/A 00-2359-048-35 SUP HCPCS C1713 00-2359-048-35 - SCREW BONE 3.5MM 48MM LOCK STAINLESS STEEL HUMERUS TIBIA BOTH IP/OP $218.00 $161.00 $43.22 $217.75 $97.99 $97.99 $97.99 $97.99 $217.75 $217.75 $217.75 $45.38 $217.75 $217.75 $217.75 $217.75 $217.75 $45.38 $217.75 $87.10 $128.80 $217.75 $217.75 $217.75 $217.75 $163.50 $217.75 $217.75 $217.75 $108.88 $108.88 $172.46 $217.75 $174.20 $97.99 $43.22 N/A $126.44 $217.75 $217.75 $217.75 $45.38 $217.75 N/A N/A 00-2359-050-37 SUP HCPCS C1713 00-2359-050-37 - SCREW BONE CONE 3.5MM 50MM CANN LOCK HEAD STAINLESS STEEL BOTH IP/OP $192.00 $142.00 $38.06 $191.75 $86.29 $86.29 $86.29 $86.29 $191.75 $191.75 $191.75 $39.97 $191.75 $191.75 $191.75 $191.75 $191.75 $39.96 $191.75 $76.70 $113.42 $191.75 $191.75 $191.75 $191.75 $144.00 $191.75 $191.75 $191.75 $95.88 $95.88 $151.87 $191.75 $153.40 $86.29 $38.06 N/A $111.36 $191.75 $115.05 $191.75 $39.96 $191.75 N/A N/A 00-2410-029-00 SUP Custom 27203010 00-2410-029-00 - BIT DRL 2.5MM 220MM QCK CNCT BOTH IP/OP $175.00 $130.00 $31.15 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $31.15 $175.00 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $70.00 $175.00 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $175.00 N/A $101.50 $175.00 $105.00 $175.00 $175.00 $175.00 N/A N/A 00-2490-012-30 SUP HCPCS C1713 00-2490-012-30 - PIN FIX ANTEGRADE THREAD 3MM 30.5CM NATURAL NAIL FEMUR BOTH IP/OP $211.50 $157.00 $41.93 $211.25 $95.06 $95.06 $95.06 $95.06 $211.25 $211.25 $211.25 $44.03 $211.25 $211.25 $211.25 $211.25 $211.25 $44.03 $211.25 $84.50 $124.95 $211.25 $211.25 $211.25 $211.25 $158.63 $211.25 $211.25 $211.25 $105.63 $105.63 $167.31 $211.25 $169.00 $95.06 $41.93 N/A $122.67 $211.25 $211.25 $211.25 $44.02 $211.25 N/A N/A 00-2490-034-49 SUP Custom 27203010 00-2490-034-49 - DRILL SRG 4.9MM RTRGD CLBRT FEM BOTH IP/OP $955.50 $707.00 $170.08 $955.50 $955.50 $955.50 $955.50 $955.50 $955.50 $955.50 $170.08 $955.50 $955.50 $709.17 $709.17 $736.50 $497.82 $199.14 $955.50 $382.20 $955.50 $955.50 $955.50 $955.50 $955.50 $716.63 $955.50 $955.50 $955.50 $477.75 $477.75 $756.76 $955.50 $764.40 $621.08 $955.50 N/A $554.19 $955.50 $573.30 $955.50 $955.50 $955.50 N/A N/A 00-2490-046-30 SUP HCPCS C1713 00-2490-046-30 - PIN FIX SMALL THREAD 3MM NATURAL NAIL TIBIA BOTH IP/OP $227.50 $168.00 $45.15 $227.50 $102.38 $102.38 $102.38 $102.38 $227.50 $227.50 $227.50 $47.42 $227.50 $227.50 $227.50 $227.50 $227.50 $47.41 $227.50 $91.00 $134.57 $227.50 $227.50 $227.50 $227.50 $170.63 $227.50 $227.50 $227.50 $113.75 $113.75 $180.18 $227.50 $182.00 $102.38 $45.15 N/A $131.95 $227.50 $136.50 $227.50 $47.41 $227.50 N/A N/A 00-2490-047-30 SUP HCPCS C1713 00-2490-047-30 - PIN FIX 3MM 35.5CM NATURAL NAIL BOTH IP/OP $253.50 $188.00 $50.31 $253.50 $114.08 $114.08 $114.08 $114.08 $253.50 $253.50 $253.50 $52.84 $253.50 $253.50 $253.50 $253.50 $253.50 $52.83 $253.50 $253.50 $149.95 $253.50 $253.50 $253.50 $253.50 $190.13 $253.50 $253.50 $253.50 $126.75 $126.75 $200.77 $253.50 $202.80 $114.08 $50.31 N/A $147.03 $253.50 $253.50 $253.50 $52.83 $253.50 N/A N/A 00-4806-100-20 SUP Custom 27203010 00-4806-100-20 - BIT DRL 2MM 100MM QCK CNCT BOTH IP/OP $140.00 $104.00 $24.88 $139.75 $139.75 $139.75 $139.75 $139.75 $139.75 $139.75 $24.88 $139.75 $139.75 $103.72 $103.72 $107.72 $72.81 $29.13 $139.75 $55.90 $139.75 $139.75 $139.75 $139.75 $139.75 $105.00 $139.75 $139.75 $139.75 $69.88 $69.88 $110.68 $139.75 $111.80 $90.84 $139.75 N/A $81.20 $139.75 $83.85 $139.75 $139.75 $139.75 N/A N/A 00-4806-110-25 SUP Custom 27203010 00-4806-110-25 - BIT DRL 2.5MM 110MM QCK CNCT BOTH IP/OP $140.00 $104.00 $24.88 $139.75 $139.75 $139.75 $139.75 $139.75 $139.75 $139.75 $24.88 $139.75 $139.75 $103.72 $103.72 $107.72 $72.81 $29.13 $139.75 $55.90 $139.75 $139.75 $139.75 $139.75 $139.75 $105.00 $139.75 $139.75 $139.75 $69.88 $69.88 $110.68 $139.75 $111.80 $90.84 $139.75 N/A $81.20 $139.75 $83.85 $139.75 $139.75 $139.75 N/A N/A 00-4806-110-35 SUP Custom 27203010 00-4806-110-35 - BIT DRL 3.5MM BOTH IP/OP $140.00 $104.00 $24.88 $139.75 $139.75 $139.75 $139.75 $139.75 $139.75 $139.75 $24.88 $139.75 $139.75 $103.72 $103.72 $107.72 $72.81 $29.13 $139.75 $55.90 $139.75 $139.75 $139.75 $139.75 $139.75 $105.00 $139.75 $139.75 $139.75 $69.88 $69.88 $110.68 $139.75 $111.80 $90.84 $139.75 N/A $81.20 $139.75 $83.85 $139.75 $139.75 $139.75 N/A N/A 00-4827-020-01 SUP HCPCS C1713 00-4827-020-01 - SCREW BONE SMALL HEXAGON 2.7MM 2.5MM 20MM SELF TAP STAINLESS BOTH IP/OP $45.50 $34.00 $9.03 $45.50 $20.48 $20.48 $20.48 $20.48 $45.50 $45.50 $45.50 $9.48 $45.50 $45.50 $45.50 $45.50 $45.50 $9.48 $45.50 $18.20 $26.91 $45.50 $45.50 $45.50 $45.50 $34.13 $45.50 $45.50 $45.50 $22.75 $22.75 $36.04 $45.50 $36.40 $20.48 $9.03 N/A $26.39 $45.50 $45.50 $45.50 $9.48 $45.50 N/A N/A 00-4828-012-02 SUP HCPCS C1713 00-4828-012-02 - SCREW BONE 2.7MM 12MM STAINLESS STEEL ELBOW PERIARTICULAR BOTH IP/OP $218.00 $161.00 $43.22 $217.75 $97.99 $97.99 $97.99 $97.99 $217.75 $217.75 $217.75 $45.38 $217.75 $217.75 $217.75 $217.75 $217.75 $45.38 $217.75 $87.10 $128.80 $217.75 $217.75 $217.75 $217.75 $163.50 $217.75 $217.75 $217.75 $108.88 $108.88 $172.46 $217.75 $174.20 $97.99 $43.22 N/A $126.44 $217.75 $217.75 $217.75 $45.38 $217.75 N/A N/A 00-4828-014-02 SUP HCPCS C1713 00-4828-014-02 - SCREW BONE 2.7MM 14MM STAINLESS STEEL ELBOW PERIARTICULAR BOTH IP/OP $218.00 $161.00 $43.22 $217.75 $97.99 $97.99 $97.99 $97.99 $217.75 $217.75 $217.75 $45.38 $217.75 $217.75 $217.75 $217.75 $217.75 $45.38 $217.75 $87.10 $128.80 $217.75 $217.75 $217.75 $217.75 $163.50 $217.75 $217.75 $217.75 $108.88 $108.88 $172.46 $217.75 $174.20 $97.99 $43.22 N/A $126.44 $217.75 $130.65 $217.75 $45.38 $217.75 N/A N/A 00-4828-016-02 SUP HCPCS C1713 00-4828-016-02 - SCREW BONE 2.7MM 16MM STAINLESS STEEL ELBOW PERIARTICULAR BOTH IP/OP $218.00 $161.00 $43.22 $217.75 $97.99 $97.99 $97.99 $97.99 $217.75 $217.75 $217.75 $45.38 $217.75 $217.75 $217.75 $217.75 $217.75 $45.38 $217.75 $87.10 $128.80 $217.75 $217.75 $217.75 $217.75 $163.50 $217.75 $217.75 $217.75 $108.88 $108.88 $172.46 $217.75 $174.20 $97.99 $43.22 N/A $126.44 $217.75 $130.65 $217.75 $45.38 $217.75 N/A N/A 00-4828-018-02 SUP HCPCS C1713 00-4828-018-02 - SCREW BONE 2.7MM 18MM STAINLESS STEEL ELBOW PERIARTICULAR BOTH IP/OP $218.00 $161.00 $43.22 $217.75 $97.99 $97.99 $97.99 $97.99 $217.75 $217.75 $217.75 $45.38 $217.75 $217.75 $217.75 $217.75 $217.75 $45.38 $217.75 $87.10 $128.80 $217.75 $217.75 $217.75 $217.75 $163.50 $217.75 $217.75 $217.75 $108.88 $108.88 $172.46 $217.75 $174.20 $97.99 $43.22 N/A $126.44 $217.75 $217.75 $217.75 $45.38 $217.75 N/A N/A 00-4828-020-02 SUP HCPCS C1713 00-4828-020-02 - SCREW BONE 2.7MM 20MM STAINLESS STEEL ELBOW PERIARTICULAR BOTH IP/OP $218.00 $161.00 $43.22 $217.75 $97.99 $97.99 $97.99 $97.99 $217.75 $217.75 $217.75 $45.38 $217.75 $217.75 $217.75 $217.75 $217.75 $45.38 $217.75 $87.10 $128.80 $217.75 $217.75 $217.75 $217.75 $163.50 $217.75 $217.75 $217.75 $108.88 $108.88 $172.46 $217.75 $174.20 $97.99 $43.22 N/A $126.44 $217.75 $130.65 $217.75 $217.75 $217.75 N/A N/A 00-4835-016-01 SUP HCPCS C1713 00-4835-016-01 - SCREW BONE SMALL HEXAGON 3.5MM 2.5MM 16MM SELF TAP STAINLESS BOTH IP/OP $52.00 $38.00 $10.32 $52.00 $23.40 $23.40 $23.40 $23.40 $52.00 $52.00 $52.00 $10.84 $52.00 $52.00 $52.00 $52.00 $52.00 $10.84 $52.00 $20.80 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $10.32 N/A $30.16 $52.00 $31.20 $52.00 $10.84 $52.00 N/A N/A 00-4835-018-01 SUP HCPCS C1713 00-4835-018-01 - SCREW BONE SMALL HEXAGON 3.5MM 2.5MM 18MM SELF TAP STAINLESS BOTH IP/OP $52.00 $38.00 $10.32 $52.00 $23.40 $23.40 $23.40 $23.40 $52.00 $52.00 $52.00 $10.84 $52.00 $52.00 $52.00 $52.00 $52.00 $10.84 $52.00 $52.00 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $10.32 N/A $30.16 $52.00 $31.20 $52.00 $10.84 $52.00 N/A N/A 00-4835-026-01 SUP HCPCS C1713 00-4835-026-01 - SCREW BONE SMALL HEXAGON 3.5MM 2.5MM 26MM SELF TAP STAINLESS BOTH IP/OP $52.00 $38.00 $10.32 $52.00 $23.40 $23.40 $23.40 $23.40 $52.00 $52.00 $52.00 $10.84 $52.00 $52.00 $52.00 $52.00 $52.00 $10.84 $52.00 $20.80 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $10.32 N/A $30.16 $52.00 $31.20 $52.00 $10.84 $52.00 N/A N/A 00-4835-040-01 SUP HCPCS C1713 00-4835-040-01 - SCREW BONE SMALL HEXAGON 3.5MM 2.5MM 40MM SELF TAP STAINLESS BOTH IP/OP $52.00 $38.00 $10.32 $52.00 $23.40 $23.40 $23.40 $23.40 $52.00 $52.00 $52.00 $10.84 $52.00 $52.00 $52.00 $52.00 $52.00 $10.84 $52.00 $20.80 $30.76 $52.00 $52.00 $52.00 $52.00 $39.00 $52.00 $52.00 $52.00 $26.00 $26.00 $41.18 $52.00 $41.60 $23.40 $10.32 N/A $30.16 $52.00 $31.20 $52.00 $10.84 $52.00 N/A N/A 00-4840-040-00 SUP HCPCS C1713 00-4840-040-00 - SCREW BONE SMALL FULTHD HEXAGON 4MM 2.5MM 40MM STAINLESS BOTH IP/OP $42.50 $31.00 $8.39 $42.25 $19.01 $19.01 $19.01 $19.01 $42.25 $42.25 $42.25 $8.81 $42.25 $42.25 $42.25 $42.25 $42.25 $8.81 $42.25 $42.25 $24.99 $42.25 $42.25 $42.25 $42.25 $31.88 $42.25 $42.25 $42.25 $21.13 $21.13 $33.46 $42.25 $33.80 $19.01 $8.39 N/A $24.65 $42.25 $25.35 $42.25 $8.80 $42.25 N/A N/A 00-4840-050-00 SUP HCPCS C1713 00-4840-050-00 - SCREW BONE SMALL FULTHD HEXAGON 4MM 2.5MM 50MM STAINLESS BOTH IP/OP $42.50 $31.00 $8.39 $42.25 $19.01 $19.01 $19.01 $19.01 $42.25 $42.25 $42.25 $8.81 $42.25 $42.25 $42.25 $42.25 $42.25 $8.81 $42.25 $16.90 $24.99 $42.25 $42.25 $42.25 $42.25 $31.88 $42.25 $42.25 $42.25 $21.13 $21.13 $33.46 $42.25 $33.80 $19.01 $8.39 N/A $24.65 $42.25 $25.35 $42.25 $8.80 $42.25 N/A N/A 00-4840-050-01 SUP HCPCS C1713 00-4840-050-01 - SCREW BONE SMALL HEXAGON 4MM 2.5MM 50MM 15MM STAINLESS STEEL BOTH IP/OP $42.50 $31.00 $8.39 $42.25 $19.01 $19.01 $19.01 $19.01 $42.25 $42.25 $42.25 $8.81 $42.25 $42.25 $42.25 $42.25 $42.25 $8.81 $42.25 $42.25 $24.99 $42.25 $42.25 $42.25 $42.25 $31.88 $42.25 $42.25 $42.25 $21.13 $21.13 $33.46 $42.25 $33.80 $19.01 $8.39 N/A $24.65 $42.25 $25.35 $42.25 $42.25 $42.25 N/A N/A 00-4901-016-15 SUP Custom 27203010 00-4901-016-15 - WIRE FIX 1.6MM 15CM 1 END TROCAR POINT KWIRE STAINLESS STEEL BOTH IP/OP $17.00 $13.00 $2.95 $16.58 $16.58 $16.58 $16.58 $16.58 $16.58 $16.58 $2.95 $16.58 $16.58 $12.31 $12.31 $12.78 $8.64 $3.46 $16.58 $6.63 $16.58 $16.58 $16.58 $16.58 $16.58 $12.75 $16.58 $16.58 $16.58 $8.29 $8.29 $13.13 $16.58 $13.26 $10.78 $16.58 N/A $9.86 $16.58 $9.95 $16.58 $16.58 $16.58 N/A N/A 005280-901 SUP Custom 27203010 005280-901 - LGTR 8MM FRNG FLLPN TUBE BAND STRL DISP ENDSCP LATEX FREE BOTH IP/OP $36.50 $27.00 $6.42 $36.09 $36.09 $36.09 $36.09 $36.09 $36.09 $36.09 $6.42 $36.09 $36.09 $26.79 $26.79 $27.82 $18.80 $7.52 $36.09 $14.44 $36.09 $36.09 $36.09 $36.09 $36.09 $27.38 $36.09 $36.09 $36.09 $18.05 $18.05 $28.58 $36.09 $28.87 $23.46 $36.09 N/A $21.17 $36.09 $21.65 $36.09 $36.09 $36.09 N/A N/A 00-6202-066-20 SUP HCPCS C1776 00-6202-066-20 - SHELL ACETAB 66MM PRIM MODULAR MULTIHOLE TRABECULAR METAL BOTH IP/OP "$7,315.00" "$5,413.00" "$1,451.84" "$7,315.00" "$3,291.75" "$3,291.75" "$3,291.75" "$3,291.75" "$7,315.00" "$7,315.00" "$7,315.00" "$1,524.63" "$7,315.00" "$7,315.00" "$7,315.00" "$7,315.00" "$7,315.00" "$1,524.53" "$7,315.00" "$7,315.00" "$3,606.30" "$7,315.00" "$7,315.00" "$7,315.00" "$7,315.00" "$5,486.25" "$7,315.00" "$7,315.00" "$7,315.00" "$3,657.50" "$3,657.50" "$5,793.48" "$7,315.00" "$5,852.00" "$3,291.75" "$1,451.84" N/A "$4,242.70" "$7,315.00" "$7,315.00" "$7,315.00" "$1,524.45" "$7,315.00" N/A N/A 00-6250-65-20 SUP HCPCS C1713 00-6250-65-20 - SCREW BN 6.5MM 20MM TRLG ST BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $475.00 $475.00 N/A N/A 00-6250-65-35 SUP HCPCS C1713 00-6250-65-35 - SCREW BN 6.5MM 35MM TRLG ST BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $475.00 $475.00 N/A N/A 00-6334-050-28 SUP HCPCS C1776 00-6334-050-28 - LINER ACETAB TRLG 8.3MM 50/52/54MM 28MM LNGVT HIP BOTH IP/OP "$14,925.00" "$11,045.00" "$2,962.24" "$14,925.00" "$6,716.25" "$6,716.25" "$6,716.25" "$6,716.25" "$14,925.00" "$14,925.00" "$14,925.00" "$3,110.74" "$14,925.00" "$14,925.00" "$14,925.00" "$14,925.00" "$14,925.00" "$3,110.53" "$14,925.00" "$5,970.00" "$7,358.03" "$14,925.00" "$14,925.00" "$14,925.00" "$14,925.00" "$11,193.75" "$14,925.00" "$14,925.00" "$14,925.00" "$7,462.50" "$7,462.50" "$11,820.60" "$14,925.00" "$11,940.00" "$6,716.25" "$2,962.24" N/A "$8,656.50" "$14,925.00" "$14,925.00" "$14,925.00" "$3,110.37" "$14,925.00" N/A N/A 00-7708-000-10 SUP Custom 27203010 00-7708-000-10 - CARRIER GRAFT 8X4IN BOARD LATEX FREE MESHGRAFT DERMACARRIERS BOTH IP/OP $68.00 $50.00 $12.07 $67.79 $67.79 $67.79 $67.79 $67.79 $67.79 $67.79 $12.07 $67.79 $67.79 $50.31 $50.31 $52.25 $35.32 $14.13 $67.79 $27.12 $67.79 $67.79 $67.79 $67.79 $67.79 $51.00 $67.79 $67.79 $67.79 $33.90 $33.90 $53.69 $67.79 $54.23 $44.06 $67.79 N/A $39.44 $67.79 $40.67 $67.79 $67.79 $67.79 N/A N/A 008556P SUP HCPCS C1733 008556P - CATHETER EP 5FR 110CM BP TEMP PCNG BLN FLW AST BOTH IP/OP $462.50 $342.00 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 N/A $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 01-0001-S SUP Custom 27803010 01-0001-S - CBL SLV ORTH 850MM 2MM HIP COCR SET STRL BOTH IP/OP "$1,047.50" $775.00 $186.46 "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" $186.46 "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" $218.31 "$1,047.50" $419.00 "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" $785.63 "$1,047.50" "$1,047.50" "$1,047.50" $523.75 $523.75 $829.62 "$1,047.50" $838.00 $471.38 "$1,047.50" N/A $607.55 "$1,047.50" $628.50 "$1,047.50" "$1,047.50" "$1,047.50" N/A N/A 01-0002-S SUP Custom 27203010 01-0002-S - SLEEVE CABLE 850MM 1.6MM ORTH COCR STRL BOTH IP/OP "$1,047.50" $775.00 $186.46 "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" $186.46 "$1,047.50" "$1,047.50" $777.45 $777.45 $807.41 $545.75 $218.31 "$1,047.50" $419.00 "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" $785.63 "$1,047.50" "$1,047.50" "$1,047.50" $523.75 $523.75 $829.62 "$1,047.50" $838.00 $680.88 "$1,047.50" N/A $607.55 "$1,047.50" $628.50 "$1,047.50" "$1,047.50" "$1,047.50" N/A N/A 01-0011-S SUP Custom 27803010 01-0011-S - CABLE ORTH COCR 2MM 850MM BOTH IP/OP $715.00 $529.00 $127.27 $715.00 $715.00 $715.00 $715.00 $715.00 $715.00 $715.00 $127.27 $715.00 $715.00 $715.00 $715.00 $715.00 $715.00 $149.01 $715.00 $286.00 $715.00 $715.00 $715.00 $715.00 $715.00 $536.25 $715.00 $715.00 $715.00 $357.50 $357.50 $566.28 $715.00 $572.00 $321.75 $715.00 N/A $414.70 $715.00 $429.00 $715.00 $715.00 $715.00 N/A N/A 01-0012-S SUP Custom 27803010 01-0012-S - CABLE ORTH COCR 1.6MM 850MM STRL BOTH IP/OP $715.00 $529.00 $127.27 $715.00 $715.00 $715.00 $715.00 $715.00 $715.00 $715.00 $127.27 $715.00 $715.00 $715.00 $715.00 $715.00 $715.00 $149.01 $715.00 $286.00 $715.00 $715.00 $715.00 $715.00 $715.00 $536.25 $715.00 $715.00 $715.00 $357.50 $357.50 $566.28 $715.00 $572.00 $321.75 $715.00 N/A $414.70 $715.00 $429.00 $715.00 $715.00 $715.00 N/A N/A 01-0013-S SUP Custom 27203010 01-0013-S - SLEEVE CABLE 2MM COCR STRL BOTH IP/OP $335.00 $248.00 $59.63 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $59.63 $335.00 $335.00 $248.64 $248.64 $258.22 $174.54 $69.82 $335.00 $134.00 $335.00 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $217.75 $335.00 N/A $194.30 $335.00 $201.00 $335.00 $335.00 $335.00 N/A N/A 01-0014-S SUP Custom 27203010 01-0014-S - SLEEVE CABLE 1.6MM COCR STRL BOTH IP/OP $335.00 $248.00 $59.63 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $59.63 $335.00 $335.00 $248.64 $248.64 $258.22 $174.54 $69.82 $335.00 $134.00 $335.00 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $217.75 $335.00 N/A $194.30 $335.00 $201.00 $335.00 $335.00 $335.00 N/A N/A 01-0020-S SUP Custom 27203010 01-0020-S - SLEEVE CABLE 850MM 2MM SS STRL BOTH IP/OP "$1,047.50" $775.00 $186.46 "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" $186.46 "$1,047.50" "$1,047.50" $777.45 $777.45 $807.41 $545.75 $218.31 "$1,047.50" $419.00 "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" "$1,047.50" $785.63 "$1,047.50" "$1,047.50" "$1,047.50" $523.75 $523.75 $829.62 "$1,047.50" $838.00 $680.88 "$1,047.50" N/A $607.55 "$1,047.50" $628.50 "$1,047.50" "$1,047.50" "$1,047.50" N/A N/A 01-0022-S SUP Custom 27203010 01-0022-S - SLEEVE CMPR SS 2MM BOTH IP/OP $335.00 $248.00 $59.63 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $335.00 $59.63 $335.00 $335.00 $248.64 $248.64 $258.22 $174.54 $69.82 $335.00 $134.00 $335.00 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $217.75 $335.00 N/A $194.30 $335.00 $201.00 $335.00 $335.00 $335.00 N/A N/A 010-0604 SUP Custom 27203010 010-0604 - BIT DRILL .6MM 4MM BOTH IP/OP $225.50 $167.00 $40.09 $225.25 $225.25 $225.25 $225.25 $225.25 $225.25 $225.25 $40.09 $225.25 $225.25 $167.18 $167.18 $173.62 $117.36 $46.94 $225.25 $90.10 $225.25 $225.25 $225.25 $225.25 $225.25 $169.13 $225.25 $225.25 $225.25 $112.63 $112.63 $178.40 $225.25 $180.20 $146.41 $225.25 N/A $130.79 $225.25 $135.15 $225.25 $225.25 $225.25 N/A N/A 010-0806 SUP Custom 27203010 010-0806 - BIT DRILL .8MM 6MM .6MM STOP BOTH IP/OP $272.00 $201.00 $48.42 $272.00 $272.00 $272.00 $272.00 $272.00 $272.00 $272.00 $48.42 $272.00 $272.00 $201.88 $201.88 $209.66 $141.71 $56.69 $272.00 $108.80 $272.00 $272.00 $272.00 $272.00 $272.00 $204.00 $272.00 $272.00 $272.00 $136.00 $136.00 $215.42 $272.00 $217.60 $176.80 $272.00 N/A $157.76 $272.00 $163.20 $272.00 $272.00 $272.00 N/A N/A 010-103L SUP HCPCS C1713 010-103L - PLATE BONE L ANGLE LEFT 4MM 3X5 HOLE SPN BOTH IP/OP $408.00 $302.00 $80.98 $408.00 $183.60 $183.60 $183.60 $183.60 $408.00 $408.00 $408.00 $85.04 $408.00 $408.00 $408.00 $408.00 $408.00 $85.03 $408.00 $163.20 $241.33 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $183.60 $80.98 N/A $236.64 $408.00 $408.00 $408.00 $408.00 $408.00 N/A N/A 010-103R SUP HCPCS C1713 010-103R - PLATE BONE L RIGHT ANG STANDARD 4MM 3X5 HOLE TIMESH CRANIAL BOTH IP/OP $408.00 $302.00 $80.98 $408.00 $183.60 $183.60 $183.60 $183.60 $408.00 $408.00 $408.00 $85.04 $408.00 $408.00 $408.00 $408.00 $408.00 $85.03 $408.00 $163.20 $241.33 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $183.60 $80.98 N/A $236.64 $408.00 $408.00 $408.00 $85.03 $408.00 N/A N/A 010-2001-5 SUP HCPCS C1781 010-2001-5 - PLATE BONE 110X75X5MM GRIDMESH TITANIUM CRANIAL BOTH IP/OP "$1,606.50" "$1,189.00" $318.85 "$1,606.50" $722.93 $722.93 $722.93 $722.93 "$1,606.50" "$1,606.50" "$1,606.50" $334.83 "$1,606.50" "$1,606.50" "$1,606.50" "$1,606.50" "$1,606.50" $334.81 "$1,606.50" "$1,606.50" $950.24 "$1,606.50" "$1,606.50" "$1,606.50" "$1,606.50" "$1,204.88" "$1,606.50" "$1,606.50" "$1,606.50" $803.25 $803.25 "$1,272.35" "$1,606.50" "$1,285.20" $722.93 $318.85 N/A $931.77 "$1,606.50" "$1,606.50" "$1,606.50" $334.79 "$1,606.50" N/A N/A 010-2010 SUP HCPCS C1781 010-2010 - PLATE BONE 55X45X.6MM SQUARE RECTANGLE GRID TIMESH TITANIUM BOTH IP/OP "$1,116.00" $826.00 $221.42 "$1,115.63" $502.03 $502.03 $502.03 $502.03 "$1,115.63" "$1,115.63" "$1,115.63" $232.53 "$1,115.63" "$1,115.63" "$1,115.63" "$1,115.63" "$1,115.63" $232.51 "$1,115.63" "$1,115.63" $659.90 "$1,115.63" "$1,115.63" "$1,115.63" "$1,115.63" $837.00 "$1,115.63" "$1,115.63" "$1,115.63" $557.82 $557.82 $883.58 "$1,115.63" $892.50 $502.03 $221.42 N/A $647.28 "$1,115.63" "$1,115.63" "$1,115.63" $232.50 "$1,115.63" N/A N/A 010-234 SUP HCPCS C1713 010-234 - PLATE BONE 7MM STANDARD Y 3X3 HOLE TIMESH TITANIUM CRANIUM BOTH IP/OP $408.00 $302.00 $80.98 $408.00 $183.60 $183.60 $183.60 $183.60 $408.00 $408.00 $408.00 $85.04 $408.00 $408.00 $408.00 $408.00 $408.00 $85.03 $408.00 $163.20 $241.33 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $183.60 $80.98 N/A $236.64 $408.00 $244.80 $408.00 $85.03 $408.00 N/A N/A 01-02950 SUP Custom 27803010 01-02950 - BAR ARCH 5IN ERICH SS FACE FX BOTH IP/OP $32.50 $24.00 $5.79 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $5.79 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $6.77 $32.50 $13.00 $32.50 $32.50 $32.50 $32.50 $32.50 $24.38 $32.50 $32.50 $32.50 $16.25 $16.25 $25.74 $32.50 $26.00 $14.63 $32.50 N/A $18.85 $32.50 $19.50 $32.50 $32.50 $32.50 N/A N/A 01-0298 SUP HCPCS C1713 01-0298 - BAR ARCH PREFORM OMNIMAX MMF SYSTEM BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A 01-0299 SUP Custom 27203010 01-0299 - BAR ARCH 1MR ROLL WIRE INSTR ERICH BOTH IP/OP $175.00 $130.00 $31.15 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $31.15 $175.00 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $70.00 $175.00 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $175.00 N/A $101.50 $175.00 $105.00 $175.00 $175.00 $175.00 N/A N/A 0102L12 SUP HCPCS C1729 0102L12 - CATHETER URETHRAL 12FR 2 WAY 1 DRAIN EYE FOLEY MEDIUM OLIVE BOTH IP/OP $25.50 $19.00 $4.99 $48.70 $13.65 $13.65 $13.65 $13.65 $25.13 $25.13 $25.13 $5.24 $25.13 $18.65 $18.65 $19.37 $13.09 $5.24 $25.13 $48.70 $14.86 $25.13 $48.70 $25.13 $25.13 $19.13 $25.13 $25.13 $25.13 $12.57 $12.57 $19.90 $25.13 $20.10 $16.33 $4.99 N/A $14.79 $25.13 $25.13 $25.13 $5.24 $25.13 N/A N/A 0102L14 SUP HCPCS A4344 0102L14 - CATHETER URETHRAL 14FR FOLEY 2 WAY MEDIUM OLIVE COUDE TIP 1 BOTH IP/OP $25.50 $19.00 $4.99 $48.70 $13.65 $13.65 $13.65 $13.65 $25.13 $25.13 $25.13 $5.24 $25.13 $18.65 $18.65 $19.37 $13.09 $5.24 $25.13 $48.70 $14.86 $25.13 $48.70 $25.13 $25.13 $19.13 $25.13 $25.13 $25.13 $12.57 $12.57 $19.90 $25.13 $20.10 $16.33 $4.99 N/A $14.79 $25.13 $25.13 $25.13 $5.24 $25.13 N/A N/A 0102L18 SUP HCPCS A4344 0102L18 - CATHETER URETHRAL 18FR FOLEY 2 WAY MEDIUM OLIVE COUDE TIP 1 BOTH IP/OP $25.50 $19.00 $4.99 $48.70 $13.65 $13.65 $13.65 $13.65 $25.13 $25.13 $25.13 $5.24 $25.13 $18.65 $18.65 $19.37 $13.09 $5.24 $25.13 $48.70 $14.86 $25.13 $48.70 $25.13 $25.13 $19.13 $25.13 $25.13 $25.13 $12.57 $12.57 $19.90 $25.13 $20.10 $16.33 $4.99 N/A $14.79 $25.13 $25.13 $25.13 $5.24 $25.13 N/A N/A 0102L20 SUP HCPCS A4344 0102L20 - CATHETER URETHRAL 20FR 2 WAY 1 DRAIN EYE FOLEY MEDIUM OLIVE BOTH IP/OP $25.50 $19.00 $4.99 $48.70 $13.65 $13.65 $13.65 $13.65 $25.13 $25.13 $25.13 $5.24 $25.13 $18.65 $18.65 $19.37 $13.09 $5.24 $25.13 $48.70 $14.86 $25.13 $48.70 $25.13 $25.13 $19.13 $25.13 $25.13 $25.13 $12.57 $12.57 $19.90 $25.13 $20.10 $16.33 $4.99 N/A $14.79 $25.13 $25.13 $25.13 $5.24 $25.13 N/A N/A 0102L22 SUP Custom 27203010 0102L22 - CATHETER URETHRAL 22FR 2 WAY 1 DRAIN EYE FOLEY MEDIUM OLIVE BOTH IP/OP $25.50 $19.00 $4.47 $25.75 $25.13 $25.13 $25.13 $25.13 $25.13 $25.13 $4.47 $25.13 $25.13 $18.65 $18.65 $19.37 $13.09 $5.24 $25.13 $10.30 $25.13 $25.13 $25.75 $25.13 $25.13 $19.13 $25.13 $25.13 $25.13 $12.57 $12.57 $19.90 $25.13 $20.10 $16.33 $25.13 N/A $14.79 $25.13 $15.08 $25.13 $25.13 $25.13 N/A N/A 0102L24 SUP Custom 27203010 0102L24 - CATHETER URETHRAL 24FR 2 WAY 1 DRAIN EYE FOLEY MEDIUM OLIVE BOTH IP/OP $25.50 $19.00 $4.47 $25.75 $25.13 $25.13 $25.13 $25.13 $25.13 $25.13 $4.47 $25.13 $25.13 $18.65 $18.65 $19.37 $13.09 $5.24 $25.13 $10.30 $25.13 $25.13 $25.75 $25.13 $25.13 $19.13 $25.13 $25.13 $25.13 $12.57 $12.57 $19.90 $25.13 $20.10 $16.33 $25.13 N/A $14.79 $25.13 $15.08 $25.13 $25.13 $25.13 N/A N/A 0102SI16 SUP Custom 27203010 0102SI16 - CATHETER URTH 16FR 5CC RD STRL LTX BDX IC 2W FL MED OLV CDE BOTH IP/OP $35.50 $26.00 $6.25 $36.00 $35.13 $35.13 $35.13 $35.13 $35.13 $35.13 $6.25 $35.13 $35.13 $26.07 $26.07 $27.08 $18.30 $7.32 $35.13 $14.40 $35.13 $35.13 $36.00 $35.13 $35.13 $26.63 $35.13 $35.13 $35.13 $17.57 $17.57 $27.82 $35.13 $28.10 $22.83 $35.13 N/A $20.59 $35.13 $21.08 $35.13 $35.13 $35.13 N/A N/A 0102SI18 SUP Custom 27203010 0102SI18 - CATHETER URTH 18FR 5CC RD STRL LTX BDX IC 2W FL MED OLV CDE BOTH IP/OP $35.50 $26.00 $6.25 $36.00 $35.13 $35.13 $35.13 $35.13 $35.13 $35.13 $6.25 $35.13 $35.13 $26.07 $26.07 $27.08 $18.30 $7.32 $35.13 $14.40 $35.13 $35.13 $36.00 $35.13 $35.13 $26.63 $35.13 $35.13 $35.13 $17.57 $17.57 $27.82 $35.13 $28.10 $22.83 $35.13 N/A $20.59 $35.13 $21.08 $35.13 $35.13 $35.13 N/A N/A 0102SI20 SUP Custom 27203010 0102SI20 - CATHETER URTH 20FR 5CC RD STRL LTX BDX IC 2W FL INFCT CNTRL BOTH IP/OP $35.50 $26.00 $6.25 $35.13 $35.13 $35.13 $35.13 $35.13 $35.13 $35.13 $6.25 $35.13 $35.13 $26.07 $26.07 $27.08 $18.30 $7.32 $35.13 $14.05 $35.13 $35.13 $35.13 $35.13 $35.13 $26.63 $35.13 $35.13 $35.13 $17.57 $17.57 $27.82 $35.13 $28.10 $22.83 $35.13 N/A $20.59 $35.13 $21.08 $35.13 $35.13 $35.13 N/A N/A 0102SI22 SUP Custom 27203010 0102SI22 - CATHETER URTH 22FR 5CC RD STRL LTX BDX IC 2W FL MED OLV CDE BOTH IP/OP $35.50 $26.00 $6.25 $36.00 $35.13 $35.13 $35.13 $35.13 $35.13 $35.13 $6.25 $35.13 $35.13 $26.07 $26.07 $27.08 $18.30 $7.32 $35.13 $14.40 $35.13 $35.13 $36.00 $35.13 $35.13 $26.63 $35.13 $35.13 $35.13 $17.57 $17.57 $27.82 $35.13 $28.10 $22.83 $35.13 N/A $20.59 $35.13 $21.08 $35.13 $35.13 $35.13 N/A N/A 0102SI24 SUP Custom 27203010 0102SI24 - CATHETER URTH 24FR 5CC RD STRL LTX BDX IC 2W FL INFCT CNTRL BOTH IP/OP $35.50 $26.00 $6.25 $36.00 $35.13 $35.13 $35.13 $35.13 $35.13 $35.13 $6.25 $35.13 $35.13 $26.07 $26.07 $27.08 $18.30 $7.32 $35.13 $14.40 $35.13 $35.13 $36.00 $35.13 $35.13 $26.63 $35.13 $35.13 $35.13 $17.57 $17.57 $27.82 $35.13 $28.10 $22.83 $35.13 N/A $20.59 $35.13 $21.08 $35.13 $35.13 $35.13 N/A N/A 01-0301 SUP Custom 27203010 01-0301 - BAND RUBBER SMALL 4MM ARCH BAR BOTH IP/OP $45.00 $33.00 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 N/A $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 01-03490 SUP Custom 27203010 01-03490 - WIRE FX .5MM 160MM LGT BLNT BOTH IP/OP $30.00 $22.00 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $30.00 N/A $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A 01-03492 SUP Custom 27203010 01-03492 - WIRE FX .64MM 160MM LGT BLNT BOTH IP/OP $62.50 $46.00 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A 0112-18 SUP Custom 27203010 0112-18 - TUBE GSTRM Y 18FR ORNG LF MGNPRT BLN RND SKN DISK DEHP-FR BOTH IP/OP $66.00 $49.00 $11.68 "$1,000.88" $65.63 $65.63 $65.63 $65.63 $65.63 $65.63 $11.68 $65.63 $65.63 $48.71 $48.71 $50.59 $34.19 $13.68 $65.63 $400.35 $65.63 $65.63 "$1,000.88" $65.63 $65.63 $49.50 $65.63 $65.63 $65.63 $32.82 $32.82 $51.98 $65.63 $52.50 $42.66 $65.63 N/A $38.28 $65.63 $39.38 $65.63 $65.63 $65.63 N/A N/A 0112-20 SUP HCPCS B4087 0112-20 - TUBE GSTRM UNV 20FR 7-10ML STRL ASMB VAL G SIL ENTRL BOTH IP/OP $45.50 $34.00 $9.44 $45.31 $45.31 $45.31 $45.31 $45.31 $45.31 $45.31 $20.89 $45.31 $45.31 $33.63 $33.63 $34.92 $23.61 $9.44 $45.31 $18.12 $45.31 $45.31 $45.31 $45.31 $45.31 $34.13 $45.31 $45.31 $45.31 $22.66 $22.66 $35.89 $45.31 $36.25 $29.45 $45.31 N/A $26.39 $45.31 $27.19 $45.31 $45.31 $45.31 N/A N/A 0112-22 SUP HCPCS B4087 0112-22 - TUBE GSTRM 22FR 14IN BLU LF MGNPRT YPRT BLN CNCT SIL DISP BOTH IP/OP $45.50 $34.00 $9.44 $45.31 $45.31 $45.31 $45.31 $45.31 $45.31 $45.31 $20.89 $45.31 $45.31 $33.63 $33.63 $34.92 $23.61 $9.44 $45.31 $18.12 $45.31 $45.31 $45.31 $45.31 $45.31 $34.13 $45.31 $45.31 $45.31 $22.66 $22.66 $35.89 $45.31 $36.25 $29.45 $45.31 N/A $26.39 $45.31 $27.19 $45.31 $45.31 $45.31 N/A N/A 0112-24 SUP HCPCS B4087 0112-24 - TUBE GSTRM 24FR 14IN PEACH LF MGNPRT SDPRT BLN REPL SIL BOTH IP/OP $45.50 $34.00 $9.44 $45.31 $45.31 $45.31 $45.31 $45.31 $45.31 $45.31 $20.89 $45.31 $45.31 $33.63 $33.63 $34.92 $23.61 $9.44 $45.31 $18.12 $45.31 $45.31 $45.31 $45.31 $45.31 $34.13 $45.31 $45.31 $45.31 $22.66 $22.66 $35.89 $45.31 $36.25 $29.45 $45.31 N/A $26.39 $45.31 $27.19 $45.31 $45.31 $45.31 N/A N/A 0119L18 SUP HCPCS A4346 0119L18 - CATHETER URETHRAL STANDARD 18FR 3 WAY 2 OPPOSING DRAIN EYE BOTH IP/OP $21.50 $16.00 $4.47 $21.47 $21.47 $21.47 $21.47 $21.47 $21.47 $21.47 $14.10 $21.47 $21.47 $15.94 $15.94 $16.55 $11.19 $4.47 $21.47 $8.59 $21.47 $21.47 $21.47 $21.47 $21.47 $16.13 $21.47 $21.47 $21.47 $10.74 $10.74 $17.00 $21.47 $17.18 $13.96 $21.47 N/A $12.47 $21.47 $12.88 $21.47 $21.47 $21.47 N/A N/A 0119L22 SUP Custom 27203010 0119L22 - CATHETER URETHRAL STANDARD 22FR 3 WAY 2 OPPOSING DRAIN EYE BOTH IP/OP $21.50 $16.00 $3.75 $21.58 $21.05 $21.05 $21.05 $21.05 $21.05 $21.05 $3.75 $21.05 $21.05 $15.62 $15.62 $16.23 $10.97 $4.39 $21.05 $8.63 $21.05 $21.05 $21.58 $21.05 $21.05 $16.13 $21.05 $21.05 $21.05 $10.53 $10.53 $16.67 $21.05 $16.84 $13.68 $21.05 N/A $12.47 $21.05 $12.63 $21.05 $21.05 $21.05 N/A N/A 0119SI18 SUP Custom 27203010 0119SI18 - CATHETER URTH 18FR 5CC AMBR STRL LTX BDX IC 3W FL BLN INFCT BOTH IP/OP $1.00 $1.00 $0.18 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.18 $1.00 $1.00 $0.74 $0.74 $0.77 $0.52 $0.21 $1.00 $0.40 $1.00 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.65 $1.00 N/A $0.58 $1.00 $0.60 $1.00 $1.00 $1.00 N/A N/A 0120-14-1.7 SUP Custom 27203010 0120-14-1.7 - KIT GASTROSTOMY LP TAPER 14FR 1.7CM 12IN ENTERAL FEED TUBE BOTH IP/OP $260.00 $192.00 $46.27 $259.94 $259.94 $259.94 $259.94 $259.94 $259.94 $259.94 $46.27 $259.94 $259.94 $192.93 $192.93 $200.36 $135.43 $54.17 $259.94 $103.98 $259.94 $259.94 $259.94 $259.94 $259.94 $195.00 $259.94 $259.94 $259.94 $129.97 $129.97 $205.87 $259.94 $207.95 $168.96 $259.94 N/A $150.80 $259.94 $155.96 $259.94 $259.94 $259.94 N/A N/A 0120-18-2.3 SUP HCPCS C1713 0120-18-2.3 - KIT GASTROSTOMY 18FR 2.3CM INTERNAL RETENTION BALLOON BOTH IP/OP $260.50 $193.00 $51.62 $260.08 $117.04 $117.04 $117.04 $117.04 $260.08 $260.08 $260.08 $54.21 $260.08 $260.08 $260.08 $260.08 $260.08 $54.20 $260.08 $260.08 $153.84 $260.08 $260.08 $260.08 $260.08 $195.38 $260.08 $260.08 $260.08 $130.04 $130.04 $205.98 $260.08 $208.06 $117.04 $51.62 N/A $151.09 $260.08 $260.08 $260.08 $54.20 $260.08 N/A N/A 0120-18-2.5 SUP Custom 27203010 0120-18-2.5 - KIT GASTROSTOMY LP TAPER 18FR 2.5CM ENTERAL FEED TUBE DEHP BOTH IP/OP $260.00 $192.00 $46.27 $494.62 $259.94 $259.94 $259.94 $259.94 $259.94 $259.94 $46.27 $259.94 $259.94 $192.93 $192.93 $200.36 $135.43 $54.17 $259.94 $199.91 $259.94 $259.94 $494.62 $259.94 $259.94 $195.00 $259.94 $259.94 $259.94 $129.97 $129.97 $205.87 $259.94 $207.95 $168.96 $259.94 N/A $150.80 $259.94 $155.96 $259.94 $259.94 $259.94 N/A N/A 0120-18-4.5 SUP HCPCS C1713 0120-18-4.5 - KIT GASTROSTOMY LP TAPER 18FR 4.5CM ENTERAL FEED TUBE DEHP BOTH IP/OP $260.50 $193.00 $51.62 $260.08 $117.04 $117.04 $117.04 $117.04 $260.08 $260.08 $260.08 $54.21 $260.08 $260.08 $260.08 $260.08 $260.08 $54.20 $260.08 $104.03 $153.84 $260.08 $260.08 $260.08 $260.08 $195.38 $260.08 $260.08 $260.08 $130.04 $130.04 $205.98 $260.08 $208.06 $117.04 $51.62 N/A $151.09 $260.08 $260.08 $260.08 $54.20 $260.08 N/A N/A 012DTC SUP Custom 27203010 012DTC - BAG DRAWTAPE 38 X38 CLEAR BOTH IP/OP $175.00 $130.00 $31.15 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $31.15 $175.00 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $70.00 $175.00 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $175.00 N/A $101.50 $175.00 $105.00 $175.00 $175.00 $175.00 N/A N/A 015-016 SUP HCPCS C1713 015-016 - PLATE BONE STR 20 HOLE TIMESH TITANIUM CRANIAL 1.5MM SCREW BOTH IP/OP $453.00 $335.00 $89.84 $452.63 $203.68 $203.68 $203.68 $203.68 $452.63 $452.63 $452.63 $94.34 $452.63 $452.63 $452.63 $452.63 $452.63 $94.33 $452.63 $452.63 $267.73 $452.63 $452.63 $452.63 $452.63 $339.75 $452.63 $452.63 $452.63 $226.32 $226.32 $358.48 $452.63 $362.10 $203.68 $89.84 N/A $262.74 $452.63 $452.63 $452.63 $94.33 $452.63 N/A N/A 015-016-C SUP HCPCS C1713 015-016-C - PLATE BONE STR 20 HOLE RIGID TITANIUM SPN BOTH IP/OP $489.00 $362.00 $97.00 $488.75 $219.94 $219.94 $219.94 $219.94 $488.75 $488.75 $488.75 $101.87 $488.75 $488.75 $488.75 $488.75 $488.75 $101.86 $488.75 $488.75 $289.10 $488.75 $488.75 $488.75 $488.75 $366.75 $488.75 $488.75 $488.75 $244.38 $244.38 $387.09 $488.75 $391.00 $219.94 $97.00 N/A $283.62 $488.75 $293.25 $488.75 $101.86 $488.75 N/A N/A 015-017 SUP HCPCS C1713 015-017 - PLATE BONE STANDARD STR 4MM 20 HOLE CRANIUM BOTH IP/OP $436.00 $323.00 $86.46 $435.63 $196.03 $196.03 $196.03 $196.03 $435.63 $435.63 $435.63 $90.80 $435.63 $435.63 $435.63 $435.63 $435.63 $90.79 $435.63 $435.63 $257.68 $435.63 $435.63 $435.63 $435.63 $327.00 $435.63 $435.63 $435.63 $217.82 $217.82 $345.02 $435.63 $348.50 $196.03 $86.46 N/A $252.88 $435.63 $261.38 $435.63 $90.79 $435.63 N/A N/A 015-017-C SUP HCPCS C1713 015-017-C - PLATE BONE STR 4MM 14 HOLE RIGID TIMESH TITANIUM CRANIAL BOTH IP/OP $463.50 $343.00 $91.94 $463.25 $208.46 $208.46 $208.46 $208.46 $463.25 $463.25 $463.25 $96.55 $463.25 $463.25 $463.25 $463.25 $463.25 $96.55 $463.25 $463.25 $274.01 $463.25 $463.25 $463.25 $463.25 $347.63 $463.25 $463.25 $463.25 $231.63 $231.63 $366.89 $463.25 $370.60 $208.46 $91.94 N/A $268.83 $463.25 $277.95 $463.25 $96.54 $463.25 N/A N/A 015-018 SUP HCPCS C1713 015-018 - PLATE BONE STR STANDARD 5MM 20 HOLE TIMESH TITANIUM CRANIAL BOTH IP/OP $461.50 $342.00 $91.52 $461.13 $207.51 $207.51 $207.51 $207.51 $461.13 $461.13 $461.13 $96.11 $461.13 $461.13 $461.13 $461.13 $461.13 $96.10 $461.13 $461.13 $272.76 $461.13 $461.13 $461.13 $461.13 $346.13 $461.13 $461.13 $461.13 $230.57 $230.57 $365.21 $461.13 $368.90 $207.51 $91.52 N/A $267.67 $461.13 $276.68 $461.13 $96.10 $461.13 N/A N/A 015-018-C SUP HCPCS C1713 015-018-C - PLATE BONE 5MM 20 HOLE STR RIGID TIMESH TITANIUM CRANIAL BOTH IP/OP $463.50 $343.00 $91.94 $463.25 $208.46 $208.46 $208.46 $208.46 $463.25 $463.25 $463.25 $96.55 $463.25 $463.25 $463.25 $463.25 $463.25 $96.55 $463.25 $463.25 $274.01 $463.25 $463.25 $463.25 $463.25 $347.63 $463.25 $463.25 $463.25 $231.63 $231.63 $366.89 $463.25 $370.60 $208.46 $91.94 N/A $268.83 $463.25 $463.25 $463.25 $96.54 $463.25 N/A N/A 015-032 SUP HCPCS C1713 015-032 - PLATE BONE TIMESH TITANIUM CRANIUM BOTH IP/OP $654.50 $484.00 $129.90 $654.50 $294.53 $294.53 $294.53 $294.53 $654.50 $654.50 $654.50 $136.41 $654.50 $654.50 $654.50 $654.50 $654.50 $136.40 $654.50 $261.80 $387.14 $654.50 $654.50 $654.50 $654.50 $490.88 $654.50 $654.50 $654.50 $327.25 $327.25 $518.36 $654.50 $523.60 $294.53 $129.90 N/A $379.61 $654.50 $392.70 $654.50 $136.40 $654.50 N/A N/A 015-040 SUP HCPCS C1713 015-040 - PLATE BN STD STRG 4MM TIMESH 2 HL TI CRNL 1.5MM SCR BOTH IP/OP $93.50 $69.00 $18.56 $93.50 $42.08 $42.08 $42.08 $42.08 $93.50 $93.50 $93.50 $19.49 $93.50 $93.50 $93.50 $93.50 $93.50 $19.49 $93.50 $37.40 $55.31 $93.50 $93.50 $93.50 $93.50 $70.13 $93.50 $93.50 $93.50 $46.75 $46.75 $74.05 $93.50 $74.80 $42.08 $18.56 N/A $54.23 $93.50 $56.10 $93.50 $19.49 $93.50 N/A N/A 015-040-C SUP HCPCS C1713 015-040-C - PLATE BONE 5MM 1X1 HOLE STR RIGID TIMESH TITANIUM CRANIAL BOTH IP/OP $96.00 $71.00 $18.98 $95.63 $43.03 $43.03 $43.03 $43.03 $95.63 $95.63 $95.63 $19.93 $95.63 $95.63 $95.63 $95.63 $95.63 $19.93 $95.63 $38.25 $56.57 $95.63 $95.63 $95.63 $95.63 $72.00 $95.63 $95.63 $95.63 $47.82 $47.82 $75.74 $95.63 $76.50 $43.03 $18.98 N/A $55.68 $95.63 $57.38 $95.63 $19.93 $95.63 N/A N/A 015-042 SUP HCPCS C1713 015-042 - PLATE BN STD STRG 8MM TIMESH 2 HL TI CRNL 1.5MM SCR BOTH IP/OP $96.00 $71.00 $18.98 $95.63 $43.03 $43.03 $43.03 $43.03 $95.63 $95.63 $95.63 $19.93 $95.63 $95.63 $95.63 $95.63 $95.63 $19.93 $95.63 $38.25 $56.57 $95.63 $95.63 $95.63 $95.63 $72.00 $95.63 $95.63 $95.63 $47.82 $47.82 $75.74 $95.63 $76.50 $43.03 $18.98 N/A $55.68 $95.63 $57.38 $95.63 $19.93 $95.63 N/A N/A 015-042-C SUP HCPCS C1713 015-042-C - PLATE BONE STR 8MM 1 HOLE HEAD 1 HOLE SHAFT RIGID TIMESH BOTH IP/OP $96.00 $71.00 $18.98 $95.63 $43.03 $43.03 $43.03 $43.03 $95.63 $95.63 $95.63 $19.93 $95.63 $95.63 $95.63 $95.63 $95.63 $19.93 $95.63 $95.63 $56.57 $95.63 $95.63 $95.63 $95.63 $72.00 $95.63 $95.63 $95.63 $47.82 $47.82 $75.74 $95.63 $76.50 $43.03 $18.98 N/A $55.68 $95.63 $95.63 $95.63 $19.93 $95.63 N/A N/A 015-044 SUP HCPCS C1713 015-044 - PLATE BONE STANDARD STR 12MM 2 HOLE TIMESH TITANIUM CRANIUM BOTH IP/OP $93.50 $69.00 $18.56 $93.50 $42.08 $42.08 $42.08 $42.08 $93.50 $93.50 $93.50 $19.49 $93.50 $93.50 $93.50 $93.50 $93.50 $19.49 $93.50 $93.50 $55.31 $93.50 $93.50 $93.50 $93.50 $70.13 $93.50 $93.50 $93.50 $46.75 $46.75 $74.05 $93.50 $74.80 $42.08 $18.56 N/A $54.23 $93.50 $56.10 $93.50 $19.49 $93.50 N/A N/A 015-044-C SUP HCPCS C1713 015-044-C - PLATE BONE STR 4MM 1X1 HOLE RIGID TIMESH TITANIUM CRANIAL BOTH IP/OP $102.00 $75.00 $20.24 $102.00 $45.90 $45.90 $45.90 $45.90 $102.00 $102.00 $102.00 $21.26 $102.00 $102.00 $102.00 $102.00 $102.00 $21.26 $102.00 $40.80 $60.33 $102.00 $102.00 $102.00 $102.00 $76.50 $102.00 $102.00 $102.00 $51.00 $51.00 $80.78 $102.00 $81.60 $45.90 $20.24 N/A $59.16 $102.00 $61.20 $102.00 $21.26 $102.00 N/A N/A 015-090 SUP HCPCS C1713 015-090 - PLATE BN STD CRV TIMESH 12 HL TI CRNL BOTH IP/OP $487.00 $360.00 $96.58 $486.63 $218.98 $218.98 $218.98 $218.98 $486.63 $486.63 $486.63 $101.43 $486.63 $486.63 $486.63 $486.63 $486.63 $101.42 $486.63 $486.63 $287.84 $486.63 $486.63 $486.63 $486.63 $365.25 $486.63 $486.63 $486.63 $243.32 $243.32 $385.41 $486.63 $389.30 $218.98 $96.58 N/A $282.46 $486.63 $486.63 $486.63 $101.41 $486.63 N/A N/A 015-090-C SUP HCPCS C1713 015-090-C - SCREW BONE CVD STANDARD 1.5MM 9MM 12 HOLE CROSS DRIVE RIGID BOTH IP/OP $487.00 $360.00 $96.58 $486.63 $218.98 $218.98 $218.98 $218.98 $486.63 $486.63 $486.63 $101.43 $486.63 $486.63 $486.63 $486.63 $486.63 $101.42 $486.63 $486.63 $287.84 $486.63 $486.63 $486.63 $486.63 $365.25 $486.63 $486.63 $486.63 $243.32 $243.32 $385.41 $486.63 $389.30 $218.98 $96.58 N/A $282.46 $486.63 $486.63 $486.63 $101.41 $486.63 N/A N/A 015-1006 SUP Custom 27203010 015-1006 - BIT DRILL 1MM 6MM BOTH IP/OP $266.00 $197.00 $47.28 $265.63 $265.63 $265.63 $265.63 $265.63 $265.63 $265.63 $47.28 $265.63 $265.63 $197.15 $197.15 $204.75 $138.39 $55.36 $265.63 $106.25 $265.63 $265.63 $265.63 $265.63 $265.63 $199.50 $265.63 $265.63 $265.63 $132.82 $132.82 $210.38 $265.63 $212.50 $172.66 $265.63 N/A $154.28 $265.63 $159.38 $265.63 $265.63 $265.63 N/A N/A 015-102L SUP HCPCS C1713 015-102L - PLATE BONE L STANDARD LEFT ANGLE 2X5 HOLE TIMESH TITANIUM BOTH IP/OP $408.00 $302.00 $80.98 $408.00 $183.60 $183.60 $183.60 $183.60 $408.00 $408.00 $408.00 $85.04 $408.00 $408.00 $408.00 $408.00 $408.00 $85.03 $408.00 $163.20 $241.33 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $183.60 $80.98 N/A $236.64 $408.00 $244.80 $408.00 $85.03 $408.00 N/A N/A 015-102R SUP HCPCS C1713 015-102R - PLATE BONE L STANDARD RIGHT ANG 2X5 HOLE TIMESH TITANIUM BOTH IP/OP $408.00 $302.00 $80.98 $408.00 $183.60 $183.60 $183.60 $183.60 $408.00 $408.00 $408.00 $85.04 $408.00 $408.00 $408.00 $408.00 $408.00 $85.03 $408.00 $163.20 $241.33 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $183.60 $80.98 N/A $236.64 $408.00 $244.80 $408.00 $85.03 $408.00 N/A N/A 015-104L SUP HCPCS C1713 015-104L - PLATE BONE 2.5MM 2X2 HOLE L LEFT ANGLE TIMESH TITANIUM BOTH IP/OP $408.00 $302.00 $80.98 $408.00 $183.60 $183.60 $183.60 $183.60 $408.00 $408.00 $408.00 $85.04 $408.00 $408.00 $408.00 $408.00 $408.00 $85.03 $408.00 $163.20 $241.33 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $183.60 $80.98 N/A $236.64 $408.00 $244.80 $408.00 $408.00 $408.00 N/A N/A 015-104R SUP HCPCS C1713 015-104R - PLATE BONE L STANDARD RIGHT ANG 2.5MM 2X2 HOLE TIMESH BOTH IP/OP $408.00 $302.00 $80.98 $408.00 $183.60 $183.60 $183.60 $183.60 $408.00 $408.00 $408.00 $85.04 $408.00 $408.00 $408.00 $408.00 $408.00 $85.03 $408.00 $163.20 $241.33 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $183.60 $80.98 N/A $236.64 $408.00 $408.00 $408.00 $408.00 $408.00 N/A N/A 015-105L SUP HCPCS C1713 015-105L - PLATE BONE 5MM 2X2 HOLE L LEFT ANGLE TIMESH TITANIUM CRANIAL BOTH IP/OP $404.00 $299.00 $80.13 $403.75 $181.69 $181.69 $181.69 $181.69 $403.75 $403.75 $403.75 $84.15 $403.75 $403.75 $403.75 $403.75 $403.75 $84.15 $403.75 $403.75 $238.82 $403.75 $403.75 $403.75 $403.75 $303.00 $403.75 $403.75 $403.75 $201.88 $201.88 $319.77 $403.75 $323.00 $181.69 $80.13 N/A $234.32 $403.75 $242.25 $403.75 $403.75 $403.75 N/A N/A 015-105R SUP HCPCS C1713 015-105R - PLATE BONE 5MM 2X2 HOLE L RIGHT ANG TIMESH TITANIUM CRANIAL BOTH IP/OP $404.00 $299.00 $80.13 $403.75 $181.69 $181.69 $181.69 $181.69 $403.75 $403.75 $403.75 $84.15 $403.75 $403.75 $403.75 $403.75 $403.75 $84.15 $403.75 $161.50 $238.82 $403.75 $403.75 $403.75 $403.75 $303.00 $403.75 $403.75 $403.75 $201.88 $201.88 $319.77 $403.75 $323.00 $181.69 $80.13 N/A $234.32 $403.75 $242.25 $403.75 $84.14 $403.75 N/A N/A 015-106L SUP HCPCS C1713 015-106L - PLATE BONE L STANDARD LEFT ANGLE 7MM 2X2 HOLE TIMESH BOTH IP/OP $408.00 $302.00 $80.98 $408.00 $183.60 $183.60 $183.60 $183.60 $408.00 $408.00 $408.00 $85.04 $408.00 $408.00 $408.00 $408.00 $408.00 $85.03 $408.00 $408.00 $241.33 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $183.60 $80.98 N/A $236.64 $408.00 $244.80 $408.00 $85.03 $408.00 N/A N/A 015-106R SUP HCPCS C1713 015-106R - PLATE BONE L STANDARD RIGHT ANG 7MM 2X2 HOLE TIMESH TITANIUM BOTH IP/OP $408.00 $302.00 $80.98 $408.00 $183.60 $183.60 $183.60 $183.60 $408.00 $408.00 $408.00 $85.04 $408.00 $408.00 $408.00 $408.00 $408.00 $85.03 $408.00 $408.00 $241.33 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $183.60 $80.98 N/A $236.64 $408.00 $244.80 $408.00 $408.00 $408.00 N/A N/A 015-107R SUP HCPCS C1713 015-107R - PLATE BONE L STANDARD RIGHT ANG 2.5MM 3X4 HOLE TIMESH BOTH IP/OP $408.00 $302.00 $80.98 $408.00 $183.60 $183.60 $183.60 $183.60 $408.00 $408.00 $408.00 $85.04 $408.00 $408.00 $408.00 $408.00 $408.00 $85.03 $408.00 $408.00 $241.33 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $183.60 $80.98 N/A $236.64 $408.00 $244.80 $408.00 $408.00 $408.00 N/A N/A 015-1206 SUP Custom 27203010 015-1206 - BIT DRILL 1.2MM 6MM TIMESH BOTH IP/OP $268.00 $198.00 $47.66 $267.75 $267.75 $267.75 $267.75 $267.75 $267.75 $267.75 $47.66 $267.75 $267.75 $198.72 $198.72 $206.38 $139.50 $55.80 $267.75 $107.10 $267.75 $267.75 $267.75 $267.75 $267.75 $201.00 $267.75 $267.75 $267.75 $133.88 $133.88 $212.06 $267.75 $214.20 $174.04 $267.75 N/A $155.44 $267.75 $160.65 $267.75 $267.75 $267.75 N/A N/A 015-1208 SUP Custom 27203010 015-1208 - BIT DRILL 1.2MM 8MM TIMESH BOTH IP/OP $268.00 $198.00 $47.66 $267.75 $267.75 $267.75 $267.75 $267.75 $267.75 $267.75 $47.66 $267.75 $267.75 $198.72 $198.72 $206.38 $139.50 $55.80 $267.75 $107.10 $267.75 $267.75 $267.75 $267.75 $267.75 $201.00 $267.75 $267.75 $267.75 $133.88 $133.88 $212.06 $267.75 $214.20 $174.04 $267.75 N/A $155.44 $267.75 $160.65 $267.75 $267.75 $267.75 N/A N/A 015-130 SUP HCPCS C1713 015-130 - PLATE BONE STANDARD T 2.5MM 3X3 HOLE TIMESH TITANIUM CRANIUM BOTH IP/OP $404.00 $299.00 $80.13 $403.75 $181.69 $181.69 $181.69 $181.69 $403.75 $403.75 $403.75 $84.15 $403.75 $403.75 $403.75 $403.75 $403.75 $84.15 $403.75 $161.50 $238.82 $403.75 $403.75 $403.75 $403.75 $303.00 $403.75 $403.75 $403.75 $201.88 $201.88 $319.77 $403.75 $323.00 $181.69 $80.13 N/A $234.32 $403.75 $403.75 $403.75 $84.14 $403.75 N/A N/A 015-1304 SUP Custom 27203010 015-1304 - BIT DRILL 1.3MM 4MM HALL BOTH IP/OP $253.00 $187.00 $45.01 $252.88 $252.88 $252.88 $252.88 $252.88 $252.88 $252.88 $45.01 $252.88 $252.88 $187.69 $187.69 $194.92 $131.75 $52.70 $252.88 $101.15 $252.88 $252.88 $252.88 $252.88 $252.88 $189.75 $252.88 $252.88 $252.88 $126.44 $126.44 $200.28 $252.88 $202.30 $164.37 $252.88 N/A $146.74 $252.88 $151.73 $252.88 $252.88 $252.88 N/A N/A 015-1306 SUP Custom 27203010 015-1306 - BIT DRILL 1.3MM 6MM TIMESH BOTH IP/OP $253.00 $187.00 $45.01 $252.88 $252.88 $252.88 $252.88 $252.88 $252.88 $252.88 $45.01 $252.88 $252.88 $187.69 $187.69 $194.92 $131.75 $52.70 $252.88 $101.15 $252.88 $252.88 $252.88 $252.88 $252.88 $189.75 $252.88 $252.88 $252.88 $126.44 $126.44 $200.28 $252.88 $202.30 $164.37 $252.88 N/A $146.74 $252.88 $151.73 $252.88 $252.88 $252.88 N/A N/A 015-1308 SUP Custom 27203010 015-1308 - BIT DRILL 1.3MM 8MM TIMESH BOTH IP/OP $268.00 $198.00 $47.66 $267.75 $267.75 $267.75 $267.75 $267.75 $267.75 $267.75 $47.66 $267.75 $267.75 $198.72 $198.72 $206.38 $139.50 $55.80 $267.75 $107.10 $267.75 $267.75 $267.75 $267.75 $267.75 $201.00 $267.75 $267.75 $267.75 $133.88 $133.88 $212.06 $267.75 $214.20 $174.04 $267.75 N/A $155.44 $267.75 $160.65 $267.75 $267.75 $267.75 N/A N/A 015-1312 SUP Custom 27203010 015-1312 - BIT DRILL 1.3MM 12MM TIMESH BOTH IP/OP $225.50 $167.00 $40.09 $225.25 $225.25 $225.25 $225.25 $225.25 $225.25 $225.25 $40.09 $225.25 $225.25 $167.18 $167.18 $173.62 $117.36 $46.94 $225.25 $90.10 $225.25 $225.25 $225.25 $225.25 $225.25 $169.13 $225.25 $225.25 $225.25 $112.63 $112.63 $178.40 $225.25 $180.20 $146.41 $225.25 N/A $130.79 $225.25 $135.15 $225.25 $225.25 $225.25 N/A N/A 015-132 SUP HCPCS C1713 015-132 - PLATE BONE T STANDARD 2.5MM 3X5 HOLE TIMESH TITANIUM CRANIAL BOTH IP/OP $404.00 $299.00 $80.13 $403.75 $181.69 $181.69 $181.69 $181.69 $403.75 $403.75 $403.75 $84.15 $403.75 $403.75 $403.75 $403.75 $403.75 $84.15 $403.75 $403.75 $238.82 $403.75 $403.75 $403.75 $403.75 $303.00 $403.75 $403.75 $403.75 $201.88 $201.88 $319.77 $403.75 $323.00 $181.69 $80.13 N/A $234.32 $403.75 $242.25 $403.75 $84.14 $403.75 N/A N/A 015-160 SUP HCPCS C1713 015-160 - PLATE BONE H STANDARD 3X1X 3 HOLE TIMESH TITANIUM CRANIUM BOTH IP/OP $404.00 $299.00 $80.13 $403.75 $181.69 $181.69 $181.69 $181.69 $403.75 $403.75 $403.75 $84.15 $403.75 $403.75 $403.75 $403.75 $403.75 $84.15 $403.75 $403.75 $238.82 $403.75 $403.75 $403.75 $403.75 $303.00 $403.75 $403.75 $403.75 $201.88 $201.88 $319.77 $403.75 $323.00 $181.69 $80.13 N/A $234.32 $403.75 $242.25 $403.75 $84.14 $403.75 N/A N/A 015-161 SUP HCPCS C1713 015-161 - PLATE BONE H STANDARD 3X3 HOLE TIMESH TITANIUM CRANIAL BOTH IP/OP $404.00 $299.00 $80.13 $403.75 $181.69 $181.69 $181.69 $181.69 $403.75 $403.75 $403.75 $84.15 $403.75 $403.75 $403.75 $403.75 $403.75 $84.15 $403.75 $403.75 $238.82 $403.75 $403.75 $403.75 $403.75 $303.00 $403.75 $403.75 $403.75 $201.88 $201.88 $319.77 $403.75 $323.00 $181.69 $80.13 N/A $234.32 $403.75 $242.25 $403.75 $84.14 $403.75 N/A N/A 015-2001-4 SUP HCPCS C1781 015-2001-4 - PLATE BONE 11CMX7.5CMX4MM GRIDMESH TITANIUM CRANIUM BOTH IP/OP "$1,519.50" "$1,124.00" $301.56 "$1,519.38" $683.72 $683.72 $683.72 $683.72 "$1,519.38" "$1,519.38" "$1,519.38" $316.68 "$1,519.38" "$1,519.38" "$1,519.38" "$1,519.38" "$1,519.38" $316.66 "$1,519.38" "$1,519.38" $898.71 "$1,519.38" "$1,519.38" "$1,519.38" "$1,519.38" "$1,139.63" "$1,519.38" "$1,519.38" "$1,519.38" $759.69 $759.69 "$1,203.35" "$1,519.38" "$1,215.50" $683.72 $301.56 N/A $881.31 "$1,519.38" "$1,519.38" "$1,519.38" $316.64 "$1,519.38" N/A N/A 015-2001-4-C SUP HCPCS C1713 015-2001-4-C - PLATE BONE 11CMX7.5CMX4MM RIGID GRIDMESH TITANIUM CRANIAL BOTH IP/OP "$1,468.50" "$1,087.00" $291.44 "$1,468.38" $660.77 $660.77 $660.77 $660.77 "$1,468.38" "$1,468.38" "$1,468.38" $306.05 "$1,468.38" "$1,468.38" "$1,468.38" "$1,468.38" "$1,468.38" $306.03 "$1,468.38" "$1,468.38" $868.55 "$1,468.38" "$1,468.38" "$1,468.38" "$1,468.38" "$1,101.38" "$1,468.38" "$1,468.38" "$1,468.38" $734.19 $734.19 "$1,162.96" "$1,468.38" "$1,174.70" $660.77 $291.44 N/A $851.73 "$1,468.38" $881.03 "$1,468.38" "$1,468.38" "$1,468.38" N/A N/A 015-2001-5 SUP HCPCS C1713 015-2001-5 - PLATE BN 11CMX7.5CMX5MM GRIDMESH TI CRNM HERNIATED CRV DISK BOTH IP/OP "$1,490.00" "$1,103.00" $295.65 "$1,489.63" $670.33 $670.33 $670.33 $670.33 "$1,489.63" "$1,489.63" "$1,489.63" $310.48 "$1,489.63" "$1,489.63" "$1,489.63" "$1,489.63" "$1,489.63" $310.46 "$1,489.63" "$1,489.63" $881.12 "$1,489.63" "$1,489.63" "$1,489.63" "$1,489.63" "$1,117.50" "$1,489.63" "$1,489.63" "$1,489.63" $744.82 $744.82 "$1,179.79" "$1,489.63" "$1,191.70" $670.33 $295.65 N/A $864.20 "$1,489.63" $893.78 "$1,489.63" $310.44 "$1,489.63" N/A N/A 015-2001-5-C SUP HCPCS C1713 015-2001-5-C - PLATE BONE 11CMX7.5CMX5MM RIGID GRIDMESH TITANIUM CRANIAL BOTH IP/OP "$1,538.50" "$1,138.00" $305.35 "$1,538.50" $692.33 $692.33 $692.33 $692.33 "$1,538.50" "$1,538.50" "$1,538.50" $320.66 "$1,538.50" "$1,538.50" "$1,538.50" "$1,538.50" "$1,538.50" $320.64 "$1,538.50" "$1,538.50" $910.02 "$1,538.50" "$1,538.50" "$1,538.50" "$1,538.50" "$1,153.88" "$1,538.50" "$1,538.50" "$1,538.50" $769.25 $769.25 "$1,218.49" "$1,538.50" "$1,230.80" $692.33 $305.35 N/A $892.33 "$1,538.50" $923.10 "$1,538.50" "$1,538.50" "$1,538.50" N/A N/A 015-2010 SUP HCPCS C1713 015-2010 - PLATE BN SQ RECT 8MM TIMESH MESH TI CRNM 1.5MM SCR BOTH IP/OP "$1,230.50" $911.00 $244.20 "$1,230.38" $553.67 $553.67 $553.67 $553.67 "$1,230.38" "$1,230.38" "$1,230.38" $256.44 "$1,230.38" "$1,230.38" "$1,230.38" "$1,230.38" "$1,230.38" $256.42 "$1,230.38" $492.15 $727.77 "$1,230.38" "$1,230.38" "$1,230.38" "$1,230.38" $922.88 "$1,230.38" "$1,230.38" "$1,230.38" $615.19 $615.19 $974.46 "$1,230.38" $984.30 $553.67 $244.20 N/A $713.69 "$1,230.38" "$1,230.38" "$1,230.38" $256.41 "$1,230.38" N/A N/A 0152-0218S SUP Custom 27803010 0152-0218S - WIRE FX 1.8MM 310MM STRL KRSH CNDYL SCR BOTH IP/OP $192.50 $142.00 $34.19 $207.63 $192.10 $192.10 $192.10 $192.10 $192.10 $192.10 $34.19 $192.10 $192.10 $192.10 $192.10 $192.10 $192.10 $40.04 $192.10 $83.05 $192.10 $192.10 $207.63 $192.10 $192.10 $144.38 $192.10 $192.10 $192.10 $96.05 $96.05 $152.14 $192.10 $153.68 $86.45 $192.10 N/A $111.65 $192.10 $115.26 $192.10 $192.10 $192.10 N/A N/A 015-2050 SUP Custom 27203010 015-2050 - PLATE BONE MESH ISOGRID TITANIUM SPN BOTH IP/OP "$1,241.00" $918.00 $220.90 "$1,241.00" "$1,241.00" "$1,241.00" "$1,241.00" "$1,241.00" "$1,241.00" "$1,241.00" $220.90 "$1,241.00" "$1,241.00" $921.07 $921.07 $956.56 $646.56 $258.64 "$1,241.00" $496.40 "$1,241.00" "$1,241.00" "$1,241.00" "$1,241.00" "$1,241.00" $930.75 "$1,241.00" "$1,241.00" "$1,241.00" $620.50 $620.50 $982.87 "$1,241.00" $992.80 $806.65 "$1,241.00" N/A $719.78 "$1,241.00" $744.60 "$1,241.00" "$1,241.00" "$1,241.00" N/A N/A 015-230 SUP HCPCS C1713 015-230 - PLATE BONE 2.5MM 1X1 HOLE Y TIMESH TITANIUM CRANIAL BOTH IP/OP $385.00 $285.00 $76.34 $384.63 $173.08 $173.08 $173.08 $173.08 $384.63 $384.63 $384.63 $80.17 $384.63 $384.63 $384.63 $384.63 $384.63 $80.16 $384.63 $153.85 $227.51 $384.63 $384.63 $384.63 $384.63 $288.75 $384.63 $384.63 $384.63 $192.32 $192.32 $304.63 $384.63 $307.70 $173.08 $76.34 N/A $223.30 $384.63 $230.78 $384.63 $80.16 $384.63 N/A N/A 015-233 SUP HCPCS C1713 015-233 - PLATE BONE Y 2.5MM 3X3 HOLE TIMESH TITANIUM CRANIUM BOTH IP/OP $385.00 $285.00 $76.34 $384.63 $173.08 $173.08 $173.08 $173.08 $384.63 $384.63 $384.63 $80.17 $384.63 $384.63 $384.63 $384.63 $384.63 $80.16 $384.63 $153.85 $227.51 $384.63 $384.63 $384.63 $384.63 $288.75 $384.63 $384.63 $384.63 $192.32 $192.32 $304.63 $384.63 $307.70 $173.08 $76.34 N/A $223.30 $384.63 $230.78 $384.63 $80.16 $384.63 N/A N/A 015-234 SUP HCPCS C1713 015-234 - PLATE BONE Y STANDARD 5MM 3X3 HOLE TIMESH TITANIUM CRANIAL BOTH IP/OP $385.00 $285.00 $76.34 $384.63 $173.08 $173.08 $173.08 $173.08 $384.63 $384.63 $384.63 $80.17 $384.63 $384.63 $384.63 $384.63 $384.63 $80.16 $384.63 $153.85 $227.51 $384.63 $384.63 $384.63 $384.63 $288.75 $384.63 $384.63 $384.63 $192.32 $192.32 $304.63 $384.63 $307.70 $173.08 $76.34 N/A $223.30 $384.63 $230.78 $384.63 $80.16 $384.63 N/A N/A 015-236 SUP HCPCS C1713 015-236 - PLATE BONE 2Y 2.5MM 3 HOLE HEAD 3 HOLE SHAFT TIMESH TITANIUM BOTH IP/OP $363.50 $269.00 $72.12 $363.38 $163.52 $163.52 $163.52 $163.52 $363.38 $363.38 $363.38 $75.74 $363.38 $363.38 $363.38 $363.38 $363.38 $75.73 $363.38 $363.38 $214.94 $363.38 $363.38 $363.38 $363.38 $272.63 $363.38 $363.38 $363.38 $181.69 $181.69 $287.80 $363.38 $290.70 $163.52 $72.12 N/A $210.83 $363.38 $218.03 $363.38 $75.73 $363.38 N/A N/A 015-237 SUP HCPCS C1713 015-237 - PLATE BN 2Y 5MM TIMESH 3X3 HL TI CRNL 1.5MM SCR BOTH IP/OP $376.50 $279.00 $74.65 $376.13 $169.26 $169.26 $169.26 $169.26 $376.13 $376.13 $376.13 $78.39 $376.13 $376.13 $376.13 $376.13 $376.13 $78.39 $376.13 $150.45 $222.48 $376.13 $376.13 $376.13 $376.13 $282.38 $376.13 $376.13 $376.13 $188.07 $188.07 $297.89 $376.13 $300.90 $169.26 $74.65 N/A $218.37 $376.13 $225.68 $376.13 $78.39 $376.13 N/A N/A 015-246 SUP HCPCS C1713 015-246 - PLATE BONE 2.5MM STR TIMESH TITANIUM CRANIUM BOTH IP/OP $234.00 $173.00 $46.39 $233.75 $105.19 $105.19 $105.19 $105.19 $233.75 $233.75 $233.75 $48.72 $233.75 $233.75 $233.75 $233.75 $233.75 $48.72 $233.75 $233.75 $138.26 $233.75 $233.75 $233.75 $233.75 $175.50 $233.75 $233.75 $233.75 $116.88 $116.88 $185.13 $233.75 $187.00 $105.19 $46.39 N/A $135.72 $233.75 $140.25 $233.75 $48.71 $233.75 N/A N/A 015-247 SUP HCPCS C1713 015-247 - PLATE BN STRG 5MM TIMESH 2X2 HL TI CRNMXF 1.5MM SCR BOTH IP/OP $234.00 $173.00 $46.39 $233.75 $105.19 $105.19 $105.19 $105.19 $233.75 $233.75 $233.75 $48.72 $233.75 $233.75 $233.75 $233.75 $233.75 $48.72 $233.75 $233.75 $138.26 $233.75 $233.75 $233.75 $233.75 $175.50 $233.75 $233.75 $233.75 $116.88 $116.88 $185.13 $233.75 $187.00 $105.19 $46.39 N/A $135.72 $233.75 $140.25 $233.75 $48.71 $233.75 N/A N/A 015-255 SUP HCPCS C1713 015-255 - PLATE BN X TIMESH TI CRNM 1.5MM SCR BOTH IP/OP $385.00 $285.00 $76.34 $384.63 $173.08 $173.08 $173.08 $173.08 $384.63 $384.63 $384.63 $80.17 $384.63 $384.63 $384.63 $384.63 $384.63 $80.16 $384.63 $384.63 $227.51 $384.63 $384.63 $384.63 $384.63 $288.75 $384.63 $384.63 $384.63 $192.32 $192.32 $304.63 $384.63 $307.70 $173.08 $76.34 N/A $223.30 $384.63 $384.63 $384.63 $80.16 $384.63 N/A N/A 015-257 SUP HCPCS C1713 015-257 - PLATE BN STD SM SQ TIMESH 4 HL TI CRNL 1.5MM SCR BOTH IP/OP $393.50 $291.00 $78.03 $393.13 $176.91 $176.91 $176.91 $176.91 $393.13 $393.13 $393.13 $81.94 $393.13 $393.13 $393.13 $393.13 $393.13 $81.93 $393.13 $393.13 $232.54 $393.13 $393.13 $393.13 $393.13 $295.13 $393.13 $393.13 $393.13 $196.57 $196.57 $311.36 $393.13 $314.50 $176.91 $78.03 N/A $228.23 $393.13 $393.13 $393.13 $81.93 $393.13 N/A N/A 015-257-C SUP HCPCS C1713 015-257-C - PLATE BONE SMALL SQUARE 4 HOLE RIGID TIMESH TITANIUM CRANIAL BOTH IP/OP $414.50 $307.00 $82.24 $414.38 $186.47 $186.47 $186.47 $186.47 $414.38 $414.38 $414.38 $86.37 $414.38 $414.38 $414.38 $414.38 $414.38 $86.36 $414.38 $414.38 $245.11 $414.38 $414.38 $414.38 $414.38 $310.88 $414.38 $414.38 $414.38 $207.19 $207.19 $328.19 $414.38 $331.50 $186.47 $82.24 N/A $240.41 $414.38 $414.38 $414.38 $86.36 $414.38 N/A N/A 015-258 SUP HCPCS C1713 015-258 - PLATE BONE SMALL RECTANGLE 4 HOLE TIMESH TITANIUM CRANIUM BOTH IP/OP $402.00 $297.00 $79.71 $401.63 $180.73 $180.73 $180.73 $180.73 $401.63 $401.63 $401.63 $83.71 $401.63 $401.63 $401.63 $401.63 $401.63 $83.70 $401.63 $401.63 $237.56 $401.63 $401.63 $401.63 $401.63 $301.50 $401.63 $401.63 $401.63 $200.82 $200.82 $318.09 $401.63 $321.30 $180.73 $79.71 N/A $233.16 $401.63 $401.63 $401.63 $83.70 $401.63 N/A N/A 015-260-11 SUP HCPCS C1781 015-260-11 - COVER BURR HOLE 11MM TIMESH TITANIUM CRANIAL BOTH IP/OP $431.50 $319.00 $85.62 $431.38 $194.12 $194.12 $194.12 $194.12 $431.38 $431.38 $431.38 $89.91 $431.38 $431.38 $431.38 $431.38 $431.38 $89.90 $431.38 $431.38 $255.16 $431.38 $431.38 $431.38 $431.38 $323.63 $431.38 $431.38 $431.38 $215.69 $215.69 $341.65 $431.38 $345.10 $194.12 $85.62 N/A $250.27 $431.38 $431.38 $431.38 $89.90 $431.38 N/A N/A 015-260-14 SUP HCPCS C1781 015-260-14 - COVER BURR HOLE 14MM TIMESH TITANIUM CRANIAL BOTH IP/OP $431.50 $319.00 $85.62 $431.38 $194.12 $194.12 $194.12 $194.12 $431.38 $431.38 $431.38 $89.91 $431.38 $431.38 $431.38 $431.38 $431.38 $89.90 $431.38 $431.38 $255.16 $431.38 $431.38 $431.38 $431.38 $323.63 $431.38 $431.38 $431.38 $215.69 $215.69 $341.65 $431.38 $345.10 $194.12 $85.62 N/A $250.27 $431.38 $431.38 $431.38 $89.90 $431.38 N/A N/A 015-260-18 SUP HCPCS C1781 015-260-18 - COVER BURR HOLE 18MM MESH TITANIUM SPN BOTH IP/OP $465.50 $344.00 $92.37 $465.38 $209.42 $209.42 $209.42 $209.42 $465.38 $465.38 $465.38 $97.00 $465.38 $465.38 $465.38 $465.38 $465.38 $96.99 $465.38 $465.38 $275.27 $465.38 $465.38 $465.38 $465.38 $349.13 $465.38 $465.38 $465.38 $232.69 $232.69 $368.58 $465.38 $372.30 $209.42 $92.37 N/A $269.99 $465.38 $465.38 $465.38 $96.99 $465.38 N/A N/A 015-260-25 SUP Custom 27803010 015-260-25 - COVER BURR HOLE 25MM TIMESH TITANIUM CRANIAL BOTH IP/OP $559.00 $414.00 $99.48 $558.88 $558.88 $558.88 $558.88 $558.88 $558.88 $558.88 $99.48 $558.88 $558.88 $558.88 $558.88 $558.88 $558.88 $116.48 $558.88 $223.55 $558.88 $558.88 $558.88 $558.88 $558.88 $419.25 $558.88 $558.88 $558.88 $279.44 $279.44 $442.63 $558.88 $447.10 $251.50 $558.88 N/A $324.22 $558.88 $335.33 $558.88 $558.88 $558.88 N/A N/A 015-262-14 SUP Custom 27803010 015-262-14 - COVER BUR HL 14MM TIMESH FAN BLDE TI CRNL BOTH IP/OP $431.50 $319.00 $76.79 $431.38 $431.38 $431.38 $431.38 $431.38 $431.38 $431.38 $76.79 $431.38 $431.38 $431.38 $431.38 $431.38 $431.38 $89.90 $431.38 $172.55 $431.38 $431.38 $431.38 $431.38 $431.38 $323.63 $431.38 $431.38 $431.38 $215.69 $215.69 $341.65 $431.38 $345.10 $194.12 $431.38 N/A $250.27 $431.38 $258.83 $431.38 $431.38 $431.38 N/A N/A 015-262-16 SUP Custom 27803010 015-262-16 - LG BURR HOLE CVR. BOTH IP/OP $321.00 $238.00 $57.07 $320.63 $320.63 $320.63 $320.63 $320.63 $320.63 $320.63 $57.07 $320.63 $320.63 $320.63 $320.63 $320.63 $320.63 $66.82 $320.63 $128.25 $320.63 $320.63 $320.63 $320.63 $320.63 $240.75 $320.63 $320.63 $320.63 $160.32 $160.32 $253.94 $320.63 $256.50 $144.28 $320.63 N/A $186.18 $320.63 $192.38 $320.63 $320.63 $320.63 N/A N/A 015-262-18 SUP Custom 27803010 015-262-18 - COVER BUR HL 18MM TIMESH FAN BLDE TI CRNMXF 1.5MM SCR BOTH IP/OP $440.00 $326.00 $78.30 $439.88 $439.88 $439.88 $439.88 $439.88 $439.88 $439.88 $78.30 $439.88 $439.88 $439.88 $439.88 $439.88 $439.88 $91.68 $439.88 $175.95 $439.88 $439.88 $439.88 $439.88 $439.88 $330.00 $439.88 $439.88 $439.88 $219.94 $219.94 $348.38 $439.88 $351.90 $197.95 $439.88 N/A $255.20 $439.88 $263.93 $439.88 $439.88 $439.88 N/A N/A 015-273 SUP HCPCS C1713 015-273 - PLATE 18MM TI BONE SPNL BOTH IP/OP $618.50 $458.00 $122.73 $618.38 $278.27 $278.27 $278.27 $278.27 $618.38 $618.38 $618.38 $128.89 $618.38 $618.38 $618.38 $618.38 $618.38 $128.88 $618.38 $247.35 $365.77 $618.38 $618.38 $618.38 $618.38 $463.88 $618.38 $618.38 $618.38 $309.19 $309.19 $489.76 $618.38 $494.70 $278.27 $122.73 N/A $358.73 $618.38 $371.03 $618.38 $128.87 $618.38 N/A N/A 015-275 SUP HCPCS C1713 015-275 - COVER BURR HOLE QUARDSTAR STANDARD 8.4MM TIMESH TITANIUM BOTH IP/OP $433.50 $321.00 $86.04 $433.50 $195.08 $195.08 $195.08 $195.08 $433.50 $433.50 $433.50 $90.35 $433.50 $433.50 $433.50 $433.50 $433.50 $90.35 $433.50 $433.50 $256.42 $433.50 $433.50 $433.50 $433.50 $325.13 $433.50 $433.50 $433.50 $216.75 $216.75 $343.33 $433.50 $346.80 $195.08 $86.04 N/A $251.43 $433.50 $260.10 $433.50 $90.34 $433.50 N/A N/A 015-276 SUP HCPCS C1713 015-276 - COVER BURR HOLE QUARDSTAR STANDARD 10MM TIMESH TITANIUM BOTH IP/OP $455.00 $337.00 $90.26 $454.75 $204.64 $204.64 $204.64 $204.64 $454.75 $454.75 $454.75 $94.78 $454.75 $454.75 $454.75 $454.75 $454.75 $94.77 $454.75 $454.75 $268.98 $454.75 $454.75 $454.75 $454.75 $341.25 $454.75 $454.75 $454.75 $227.38 $227.38 $360.16 $454.75 $363.80 $204.64 $90.26 N/A $263.90 $454.75 $272.85 $454.75 $94.77 $454.75 N/A N/A 016-100 SUP Custom 27803010 016-100 - IMPLANT CRANIAL 100X100MM PRESHAPED MESH UNFORMED PANEL BOTH IP/OP "$1,436.50" "$1,063.00" $255.70 "$1,436.50" "$1,436.50" "$1,436.50" "$1,436.50" "$1,436.50" "$1,436.50" "$1,436.50" $255.70 "$1,436.50" "$1,436.50" "$1,436.50" "$1,436.50" "$1,436.50" "$1,436.50" $299.38 "$1,436.50" $574.60 "$1,436.50" "$1,436.50" "$1,436.50" "$1,436.50" "$1,436.50" "$1,077.38" "$1,436.50" "$1,436.50" "$1,436.50" $718.25 $718.25 "$1,137.71" "$1,436.50" "$1,149.20" $646.43 "$1,436.50" N/A $833.17 "$1,436.50" $861.90 "$1,436.50" "$1,436.50" "$1,436.50" N/A N/A 016-120 SUP Custom 27803010 016-120 - IMPLANT CRANIAL 120X120MM PRESHAPED MESH UNFORMED PANEL BOTH IP/OP "$1,968.00" "$1,456.00" $350.26 "$1,967.75" "$1,967.75" "$1,967.75" "$1,967.75" "$1,967.75" "$1,967.75" "$1,967.75" $350.26 "$1,967.75" "$1,967.75" "$1,967.75" "$1,967.75" "$1,967.75" "$1,967.75" $410.10 "$1,967.75" $787.10 "$1,967.75" "$1,967.75" "$1,967.75" "$1,967.75" "$1,967.75" "$1,476.00" "$1,967.75" "$1,967.75" "$1,967.75" $983.88 $983.88 "$1,558.46" "$1,967.75" "$1,574.20" $885.49 "$1,967.75" N/A "$1,141.44" "$1,967.75" "$1,180.65" "$1,967.75" "$1,967.75" "$1,967.75" N/A N/A 016-128 SUP Custom 27803010 016-128 - IMPLANT CRANIAL 128X79MM PRESHAPED MESH UNFORMED PANEL BOTH IP/OP "$1,647.00" "$1,219.00" $293.14 "$1,646.88" "$1,646.88" "$1,646.88" "$1,646.88" "$1,646.88" "$1,646.88" "$1,646.88" $293.14 "$1,646.88" "$1,646.88" "$1,646.88" "$1,646.88" "$1,646.88" "$1,646.88" $343.23 "$1,646.88" $658.75 "$1,646.88" "$1,646.88" "$1,646.88" "$1,646.88" "$1,646.88" "$1,235.25" "$1,646.88" "$1,646.88" "$1,646.88" $823.44 $823.44 "$1,304.33" "$1,646.88" "$1,317.50" $741.10 "$1,646.88" N/A $955.26 "$1,646.88" $988.13 "$1,646.88" "$1,646.88" "$1,646.88" N/A N/A 016-152 SUP Custom 27803010 016-152 - IMPLANT CRANIAL 152X152MM PRESHAPED MESH UNFORMED PANEL BOTH IP/OP "$2,172.00" "$1,607.00" $386.57 "$2,171.75" "$2,171.75" "$2,171.75" "$2,171.75" "$2,171.75" "$2,171.75" "$2,171.75" $386.57 "$2,171.75" "$2,171.75" "$2,171.75" "$2,171.75" "$2,171.75" "$2,171.75" $452.62 "$2,171.75" $868.70 "$2,171.75" "$2,171.75" "$2,171.75" "$2,171.75" "$2,171.75" "$1,629.00" "$2,171.75" "$2,171.75" "$2,171.75" "$1,085.88" "$1,085.88" "$1,720.03" "$2,171.75" "$1,737.40" $977.29 "$2,171.75" N/A "$1,259.76" "$2,171.75" "$1,303.05" "$2,171.75" "$2,171.75" "$2,171.75" N/A N/A 016-200 SUP Custom 27803010 016-200 - IMPLANT CRANIAL 200X200MM PRESHAPED MESH UNFORMED PANEL BOTH IP/OP "$4,069.50" "$3,011.00" $724.35 "$4,069.38" "$4,069.38" "$4,069.38" "$4,069.38" "$4,069.38" "$4,069.38" "$4,069.38" $724.35 "$4,069.38" "$4,069.38" "$4,069.38" "$4,069.38" "$4,069.38" "$4,069.38" $848.10 "$4,069.38" "$1,627.75" "$4,069.38" "$4,069.38" "$4,069.38" "$4,069.38" "$4,069.38" "$3,052.13" "$4,069.38" "$4,069.38" "$4,069.38" "$2,034.69" "$2,034.69" "$3,222.95" "$4,069.38" "$3,255.50" "$1,831.22" "$4,069.38" N/A "$2,360.31" "$4,069.38" "$2,441.63" "$4,069.38" "$4,069.38" "$4,069.38" N/A N/A 0166L28 SUP HCPCS A4344 0166L28 - CATHETER URETHRAL 28FR 2 WAY 2 STAGGER EYE FOLEY ROUND TIP BOTH IP/OP $14.50 $11.00 $2.81 $14.53 $7.68 $7.68 $7.68 $7.68 $14.15 $14.15 $14.15 $2.95 $14.15 $10.50 $10.50 $10.91 $7.37 $2.95 $14.15 $14.53 $8.37 $14.15 $14.15 $14.15 $14.15 $10.88 $14.15 $14.15 $14.15 $7.08 $7.08 $11.21 $14.15 $11.32 $9.20 $2.81 N/A $8.41 $14.15 $14.15 $14.15 $2.95 $14.15 N/A N/A 0166L30 SUP HCPCS C1729 CATHETER URINARY BARDEX LUBRICATH FOLEY 30FR 30ML 2 WAY 2 ST BOTH IP/OP $10.00 $7.00 $1.90 $9.58 $5.20 $5.20 $5.20 $5.20 $9.58 $9.58 $9.58 $2.00 $9.58 $7.11 $7.11 $7.38 $4.99 $2.00 $9.58 $9.58 $5.67 $9.58 $9.58 $9.58 $9.58 $7.50 $9.58 $9.58 $9.58 $4.79 $4.79 $7.59 $9.58 $7.66 $6.23 $1.90 N/A $5.80 $9.58 $9.58 $9.58 $2.00 $9.58 N/A N/A 0166SI20 SUP Custom 27203010 0166SI20 - CATHETER URTH 20FR 30CC STRL LTX BDX IC 2W FL BLN ATRM INS BOTH IP/OP $1.00 $1.00 $0.18 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.18 $1.00 $1.00 $0.74 $0.74 $0.77 $0.52 $0.21 $1.00 $0.40 $1.00 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.65 $1.00 N/A $0.58 $1.00 $0.60 $1.00 $1.00 $1.00 N/A N/A 0166SI28 SUP Custom 27203010 0166SI28 - CATHETER URTH 28FR 30CC STRL LTX BDX IC 2W FL BLN ATRM INS BOTH IP/OP $1.00 $1.00 $0.18 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.18 $1.00 $1.00 $0.74 $0.74 $0.77 $0.52 $0.21 $1.00 $0.40 $1.00 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.65 $1.00 N/A $0.58 $1.00 $0.60 $1.00 $1.00 $1.00 N/A N/A 0167L18 SUP Custom 27203010 0167L18 - CATHETER URETHRAL 18FR FOLEY 3 WAY ROUND TIP 2 STAGGERED EYE BOTH IP/OP $21.50 $16.00 $3.77 $21.73 $21.20 $21.20 $21.20 $21.20 $21.20 $21.20 $3.77 $21.20 $21.20 $15.73 $15.73 $16.34 $11.05 $4.42 $21.20 $8.69 $21.20 $21.20 $21.73 $21.20 $21.20 $16.13 $21.20 $21.20 $21.20 $10.60 $10.60 $16.79 $21.20 $16.96 $13.78 $21.20 N/A $12.47 $21.20 $12.72 $21.20 $21.20 $21.20 N/A N/A 0167L20 SUP Custom 27203010 0167L20 - CATHETER URETHRAL STANDARD 20FR 3 WAY 2 STAGGER DRAIN EYE BOTH IP/OP $21.50 $16.00 $3.77 $21.73 $21.20 $21.20 $21.20 $21.20 $21.20 $21.20 $3.77 $21.20 $21.20 $15.73 $15.73 $16.34 $11.05 $4.42 $21.20 $8.69 $21.20 $21.20 $21.73 $21.20 $21.20 $16.13 $21.20 $21.20 $21.20 $10.60 $10.60 $16.79 $21.20 $16.96 $13.78 $21.20 N/A $12.47 $21.20 $12.72 $21.20 $21.20 $21.20 N/A N/A 0167L22 SUP Custom 27203010 0167L22 - CATHETER URETHRAL STANDARD 22FR 3 WAY 2 STAGGER DRAIN EYE BOTH IP/OP $21.50 $16.00 $3.77 $21.73 $21.20 $21.20 $21.20 $21.20 $21.20 $21.20 $3.77 $21.20 $21.20 $15.73 $15.73 $16.34 $11.05 $4.42 $21.20 $8.69 $21.20 $21.20 $21.73 $21.20 $21.20 $16.13 $21.20 $21.20 $21.20 $10.60 $10.60 $16.79 $21.20 $16.96 $13.78 $21.20 N/A $12.47 $21.20 $12.72 $21.20 $21.20 $21.20 N/A N/A 0167L24 SUP HCPCS C1729 0167L24 - CATHETER URETHRAL STANDARD 24FR 3 WAY 2 STAGGER DRAIN EYE BOTH IP/OP $21.50 $16.00 $4.21 $21.20 $11.51 $11.51 $11.51 $11.51 $21.20 $21.20 $21.20 $4.42 $21.20 $15.73 $15.73 $16.34 $11.05 $4.42 $21.20 $21.20 $12.54 $21.20 $21.20 $21.20 $21.20 $16.13 $21.20 $21.20 $21.20 $10.60 $10.60 $16.79 $21.20 $16.96 $13.78 $4.21 N/A $12.47 $21.20 $21.20 $21.20 $4.42 $21.20 N/A N/A 0196L16 SUP HCPCS C1729 0196L16 - CATHETER URTH 16FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN BOTH IP/OP $29.50 $22.00 $5.52 $31.03 $31.03 $31.03 $31.03 $31.03 $31.03 $31.03 $5.52 $31.03 $31.03 $23.03 $23.03 $23.92 $16.17 $6.47 $31.03 $12.41 $31.03 $31.03 $31.03 $31.03 $31.03 $22.13 $31.03 $31.03 $31.03 $15.52 $15.52 $24.58 $31.03 $24.82 $20.17 $31.03 N/A $17.11 $31.03 $18.62 $31.03 $31.03 $31.03 N/A N/A 0196L16 SUP Custom 27203010 0196L16 - CATHETER URTH 16FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN BOTH IP/OP $31.50 $23.00 $5.52 $31.03 $31.03 $31.03 $31.03 $31.03 $31.03 $31.03 $5.52 $31.03 $31.03 $23.03 $23.03 $23.92 $16.17 $6.47 $31.03 $12.41 $31.03 $31.03 $31.03 $31.03 $31.03 $23.63 $31.03 $31.03 $31.03 $15.52 $15.52 $24.58 $31.03 $24.82 $20.17 $31.03 N/A $18.27 $31.03 $18.62 $31.03 $31.03 $31.03 N/A N/A 0196L18 SUP Custom 27203010 0196L18 - CATHETER URTH 18FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN BOTH IP/OP $29.50 $22.00 $5.23 $30.13 $29.40 $29.40 $29.40 $29.40 $29.40 $29.40 $5.23 $29.40 $29.40 $21.82 $21.82 $22.66 $15.32 $6.13 $29.40 $12.05 $29.40 $29.40 $30.13 $29.40 $29.40 $22.13 $29.40 $29.40 $29.40 $14.70 $14.70 $23.28 $29.40 $23.52 $19.11 $29.40 N/A $17.11 $29.40 $17.64 $29.40 $29.40 $29.40 N/A N/A 0196L20 SUP Custom 27203010 0196L20 - CATHETER URTH 20FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN BOTH IP/OP $30.00 $22.00 $5.26 $29.55 $29.55 $29.55 $29.55 $29.55 $29.55 $29.55 $5.26 $29.55 $29.55 $21.93 $21.93 $22.78 $15.40 $6.16 $29.55 $11.82 $29.55 $29.55 $29.55 $29.55 $29.55 $22.50 $29.55 $29.55 $29.55 $14.78 $14.78 $23.40 $29.55 $23.64 $19.21 $29.55 N/A $17.40 $29.55 $17.73 $29.55 $29.55 $29.55 N/A N/A 0196L20 SUP HCPCS C1729 0196L20 - CATHETER URTH 20FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN BOTH IP/OP $353.00 $261.00 $5.26 $264.75 $29.55 $29.55 $29.55 $29.55 $29.55 $29.55 $5.26 $29.55 $29.55 $21.93 $21.93 $22.78 $15.40 $6.16 $29.55 $11.82 $29.55 $29.55 $29.55 $29.55 $29.55 $264.75 $29.55 $29.55 $29.55 $14.78 $14.78 $23.40 $29.55 $23.64 $19.21 $29.55 N/A $204.74 $29.55 $17.73 $29.55 $29.55 $29.55 N/A N/A 0196L22 SUP Custom 27203010 0196L22 - CATHETER URTH 22FR 5CC RD STRL LTX BDX LBR 2W FL 2 OPPS DRN BOTH IP/OP $29.50 $22.00 $5.23 $30.13 $29.40 $29.40 $29.40 $29.40 $29.40 $29.40 $5.23 $29.40 $29.40 $21.82 $21.82 $22.66 $15.32 $6.13 $29.40 $12.05 $29.40 $29.40 $30.13 $29.40 $29.40 $22.13 $29.40 $29.40 $29.40 $14.70 $14.70 $23.28 $29.40 $23.52 $19.11 $29.40 N/A $17.11 $29.40 $17.64 $29.40 $29.40 $29.40 N/A N/A 02.00024.001 SUP Custom 27203010 02.00024.001 - BIT DRILL STANDARD 4.3MM 145MM QUICK COUPLING NCB STAINLESS BOTH IP/OP $231.00 $171.00 $41.07 $230.75 $230.75 $230.75 $230.75 $230.75 $230.75 $230.75 $41.07 $230.75 $230.75 $171.26 $171.26 $177.86 $120.22 $48.09 $230.75 $92.30 $230.75 $230.75 $230.75 $230.75 $230.75 $173.25 $230.75 $230.75 $230.75 $115.38 $115.38 $182.75 $230.75 $184.60 $149.99 $230.75 N/A $133.98 $230.75 $138.45 $230.75 $230.75 $230.75 N/A N/A 02.001.300 SUP HCPCS C1713 02.001.300 - PLATE BONE CURVE 242X17.5X5.2MM 10 HOLE LP PRECONTOUR BOTH IP/OP "$3,080.00" "$2,279.00" $611.28 "$3,132.23" "$1,385.95" "$1,385.95" "$1,385.95" "$1,385.95" "$3,079.88" "$3,079.88" "$3,079.88" $641.92 "$3,079.88" "$3,079.88" "$3,079.88" "$3,079.88" "$3,079.88" $641.88 "$3,079.88" "$3,132.23" "$1,518.38" "$3,079.88" "$3,132.23" "$3,079.88" "$3,079.88" "$2,310.00" "$3,079.88" "$3,079.88" "$3,079.88" "$1,539.94" "$1,539.94" "$2,439.26" "$3,079.88" "$2,463.90" "$1,385.95" $611.28 N/A "$1,786.40" "$3,079.88" "$3,079.88" "$3,079.88" $641.85 "$3,079.88" N/A N/A 02.001.300S SUP HCPCS C1713 02.001.300S - PLATE BONE 242MM 10 HOLE CVD LCP STAINLESS STEEL CONDYLE BOTH IP/OP "$3,171.50" "$2,347.00" $629.41 "$3,225.15" "$1,427.06" "$1,427.06" "$1,427.06" "$1,427.06" "$3,171.25" "$3,171.25" "$3,171.25" $660.97 "$3,171.25" "$3,171.25" "$3,171.25" "$3,171.25" "$3,171.25" $660.92 "$3,171.25" "$1,290.06" "$1,563.43" "$3,171.25" "$3,225.15" "$3,171.25" "$3,171.25" "$2,378.63" "$3,171.25" "$3,171.25" "$3,171.25" "$1,585.63" "$1,585.63" "$2,511.63" "$3,171.25" "$2,537.00" "$1,427.06" $629.41 N/A "$1,839.47" "$3,171.25" "$3,171.25" "$3,171.25" $660.89 "$3,171.25" N/A N/A 02.001.302 SUP HCPCS C1713 02.001.302 - PLATE BN CRV 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL BOTH IP/OP "$3,145.00" "$2,327.00" $624.11 "$3,197.98" "$1,415.04" "$1,415.04" "$1,415.04" "$1,415.04" "$3,144.53" "$3,144.53" "$3,144.53" $655.40 "$3,144.53" "$3,144.53" "$3,144.53" "$3,144.53" "$3,144.53" $655.35 "$3,144.53" "$3,197.98" "$1,550.25" "$3,144.53" "$3,197.98" "$3,144.53" "$3,144.53" "$2,358.75" "$3,144.53" "$3,144.53" "$3,144.53" "$1,572.27" "$1,572.27" "$2,490.47" "$3,144.53" "$2,515.62" "$1,415.04" $624.11 N/A "$1,824.10" "$3,144.53" "$1,886.72" "$3,144.53" $655.32 "$3,144.53" N/A N/A 02.001.302S SUP HCPCS C1713 02.001.302S - PLATE BN CRV 278X17.5X5.2MM STRL LCP 12 HL LOPRFL PRECONTOUR BOTH IP/OP "$3,236.00" "$2,395.00" $642.25 "$3,290.90" "$1,456.16" "$1,456.16" "$1,456.16" "$1,456.16" "$3,235.90" "$3,235.90" "$3,235.90" $674.44 "$3,235.90" "$3,235.90" "$3,235.90" "$3,235.90" "$3,235.90" $674.40 "$3,235.90" "$3,290.90" "$1,595.30" "$3,235.90" "$3,290.90" "$3,235.90" "$3,235.90" "$2,427.00" "$3,235.90" "$3,235.90" "$3,235.90" "$1,617.95" "$1,617.95" "$2,562.83" "$3,235.90" "$2,588.72" "$1,456.16" $642.25 N/A "$1,876.88" "$3,235.90" "$3,235.90" "$3,235.90" $674.36 "$3,235.90" N/A N/A 02.001.304 SUP HCPCS C1713 02.001.304 - PLATE BN CRV 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL BOTH IP/OP "$3,211.00" "$2,376.00" $637.22 "$3,265.18" "$1,444.77" "$1,444.77" "$1,444.77" "$1,444.77" "$3,210.60" "$3,210.60" "$3,210.60" $669.17 "$3,210.60" "$3,210.60" "$3,210.60" "$3,210.60" "$3,210.60" $669.12 "$3,210.60" "$3,265.18" "$1,582.83" "$3,210.60" "$3,265.18" "$3,210.60" "$3,210.60" "$2,408.25" "$3,210.60" "$3,210.60" "$3,210.60" "$1,605.30" "$1,605.30" "$2,542.80" "$3,210.60" "$2,568.48" "$1,444.77" $637.22 N/A "$1,862.38" "$3,210.60" "$1,926.36" "$3,210.60" $669.09 "$3,210.60" N/A N/A 02.001.304S SUP HCPCS C1713 02.001.304S - PLATE BN CRV 314X17.5X5.2MM STRL LCP 14 HL LOPRFL PRECONTOUR BOTH IP/OP "$3,302.00" "$2,443.00" $655.36 "$3,358.10" "$1,485.89" "$1,485.89" "$1,485.89" "$1,485.89" "$3,301.98" "$3,301.98" "$3,301.98" $688.22 "$3,301.98" "$3,301.98" "$3,301.98" "$3,301.98" "$3,301.98" $688.17 "$3,301.98" "$1,343.24" "$1,627.88" "$3,301.98" "$3,358.10" "$3,301.98" "$3,301.98" "$2,476.50" "$3,301.98" "$3,301.98" "$3,301.98" "$1,650.99" "$1,650.99" "$2,615.17" "$3,301.98" "$2,641.58" "$1,485.89" $655.36 N/A "$1,915.16" "$3,301.98" "$3,301.98" "$3,301.98" $688.13 "$3,301.98" N/A N/A 02.001.306 SUP HCPCS C1713 02.001.306 - PLATE BN CRV 350X17.5X5.2MM NS LCP CMBN 16 HL LOPRFL BOTH IP/OP "$3,272.50" "$2,422.00" $649.50 "$3,328.08" "$1,472.60" "$1,472.60" "$1,472.60" "$1,472.60" "$3,272.45" "$3,272.45" "$3,272.45" $682.06 "$3,272.45" "$3,272.45" "$3,272.45" "$3,272.45" "$3,272.45" $682.01 "$3,272.45" "$1,331.23" "$1,613.32" "$3,272.45" "$3,328.08" "$3,272.45" "$3,272.45" "$2,454.38" "$3,272.45" "$3,272.45" "$3,272.45" "$1,636.23" "$1,636.23" "$2,591.78" "$3,272.45" "$2,617.96" "$1,472.60" $649.50 N/A "$1,898.05" "$3,272.45" "$1,963.47" "$3,272.45" $681.98 "$3,272.45" N/A N/A 02.001.306S SUP HCPCS C1713 02.001.306S - PLATE BN CRV 350X17.5X5.2MM STRL LCP 16 HL LOPRFL PRECONTOUR BOTH IP/OP "$3,364.00" "$2,489.00" $667.64 "$3,421.00" "$1,513.72" "$1,513.72" "$1,513.72" "$1,513.72" "$3,363.83" "$3,363.83" "$3,363.83" $701.11 "$3,363.83" "$3,363.83" "$3,363.83" "$3,363.83" "$3,363.83" $701.06 "$3,363.83" "$1,368.40" "$1,658.37" "$3,363.83" "$3,421.00" "$3,363.83" "$3,363.83" "$2,523.00" "$3,363.83" "$3,363.83" "$3,363.83" "$1,681.92" "$1,681.92" "$2,664.15" "$3,363.83" "$2,691.06" "$1,513.72" $667.64 N/A "$1,951.12" "$3,363.83" "$3,363.83" "$3,363.83" $701.02 "$3,363.83" N/A N/A 02.001.308 SUP HCPCS C1713 02.001.308 - PLATE BN CRV 386X17.5X5.2MM NS LCP CMBN 18 HL LOPRFL BOTH IP/OP "$3,454.00" "$2,556.00" $685.49 "$3,512.50" "$1,554.20" "$1,554.20" "$1,554.20" "$1,554.20" "$3,453.78" "$3,453.78" "$3,453.78" $719.85 "$3,453.78" "$3,453.78" "$3,453.78" "$3,453.78" "$3,453.78" $719.81 "$3,453.78" "$1,405.00" "$1,702.71" "$3,453.78" "$3,512.50" "$3,453.78" "$3,453.78" "$2,590.50" "$3,453.78" "$3,453.78" "$3,453.78" "$1,726.89" "$1,726.89" "$2,735.39" "$3,453.78" "$2,763.02" "$1,554.20" $685.49 N/A "$2,003.32" "$3,453.78" "$2,072.27" "$3,453.78" $719.77 "$3,453.78" N/A N/A 02.001.308S SUP HCPCS C1713 02.001.308S - PLATE BN CRV 386X17.5X5.2MM STRL LCP 18 HL LOPRFL PRECONTOUR BOTH IP/OP "$3,545.50" "$2,624.00" $703.62 "$3,605.43" "$1,595.32" "$1,595.32" "$1,595.32" "$1,595.32" "$3,545.15" "$3,545.15" "$3,545.15" $738.90 "$3,545.15" "$3,545.15" "$3,545.15" "$3,545.15" "$3,545.15" $738.85 "$3,545.15" "$1,442.17" "$1,747.76" "$3,545.15" "$3,605.43" "$3,545.15" "$3,545.15" "$2,659.13" "$3,545.15" "$3,545.15" "$3,545.15" "$1,772.58" "$1,772.58" "$2,807.76" "$3,545.15" "$2,836.12" "$1,595.32" $703.62 N/A "$2,056.39" "$3,545.15" "$3,545.15" "$3,545.15" $738.81 "$3,545.15" N/A N/A 02.001.320 SUP HCPCS C1713 02.001.320 - PLATE BN CRV 242X17.5X5.2MM NS LCP CMBN 10 HL LOPRFL BOTH IP/OP "$3,080.00" "$2,279.00" $611.28 "$3,132.23" "$1,385.95" "$1,385.95" "$1,385.95" "$1,385.95" "$3,079.88" "$3,079.88" "$3,079.88" $641.92 "$3,079.88" "$3,079.88" "$3,079.88" "$3,079.88" "$3,079.88" $641.88 "$3,079.88" "$1,252.89" "$1,518.38" "$3,079.88" "$3,132.23" "$3,079.88" "$3,079.88" "$2,310.00" "$3,079.88" "$3,079.88" "$3,079.88" "$1,539.94" "$1,539.94" "$2,439.26" "$3,079.88" "$2,463.90" "$1,385.95" $611.28 N/A "$1,786.40" "$3,079.88" "$3,079.88" "$3,079.88" $641.85 "$3,079.88" N/A N/A 02.001.320S SUP HCPCS C1713 02.001.320S - PLATE BN CRV 242X17.5X5.2MM STRL LCP 10 HL LOPRFL PRECONTOUR BOTH IP/OP "$3,171.50" "$2,347.00" $629.41 "$3,225.15" "$1,427.06" "$1,427.06" "$1,427.06" "$1,427.06" "$3,171.25" "$3,171.25" "$3,171.25" $660.97 "$3,171.25" "$3,171.25" "$3,171.25" "$3,171.25" "$3,171.25" $660.92 "$3,171.25" "$1,290.06" "$1,563.43" "$3,171.25" "$3,225.15" "$3,171.25" "$3,171.25" "$2,378.63" "$3,171.25" "$3,171.25" "$3,171.25" "$1,585.63" "$1,585.63" "$2,511.63" "$3,171.25" "$2,537.00" "$1,427.06" $629.41 N/A "$1,839.47" "$3,171.25" "$3,171.25" "$3,171.25" $660.89 "$3,171.25" N/A N/A 02.001.322 SUP HCPCS C1713 02.001.322 - PLATE BN CRV 278X17.5X5.2MM NS LCP CMBN 12 HL LOPRFL BOTH IP/OP "$3,145.00" "$2,327.00" $624.11 "$3,197.98" "$1,415.04" "$1,415.04" "$1,415.04" "$1,415.04" "$3,144.53" "$3,144.53" "$3,144.53" $655.40 "$3,144.53" "$3,144.53" "$3,144.53" "$3,144.53" "$3,144.53" $655.35 "$3,144.53" "$3,197.98" "$1,550.25" "$3,144.53" "$3,197.98" "$3,144.53" "$3,144.53" "$2,358.75" "$3,144.53" "$3,144.53" "$3,144.53" "$1,572.27" "$1,572.27" "$2,490.47" "$3,144.53" "$2,515.62" "$1,415.04" $624.11 N/A "$1,824.10" "$3,144.53" "$1,886.72" "$3,144.53" $655.32 "$3,144.53" N/A N/A 02.001.322S SUP HCPCS C1713 02.001.322S - PLATE BN CRV 278X17.5X5.2MM STRL LCP 12 HL LOPRFL PRECONTOUR BOTH IP/OP "$3,236.00" "$2,395.00" $642.25 "$3,290.90" "$1,456.16" "$1,456.16" "$1,456.16" "$1,456.16" "$3,235.90" "$3,235.90" "$3,235.90" $674.44 "$3,235.90" "$3,235.90" "$3,235.90" "$3,235.90" "$3,235.90" $674.40 "$3,235.90" "$1,316.36" "$1,595.30" "$3,235.90" "$3,290.90" "$3,235.90" "$3,235.90" "$2,427.00" "$3,235.90" "$3,235.90" "$3,235.90" "$1,617.95" "$1,617.95" "$2,562.83" "$3,235.90" "$2,588.72" "$1,456.16" $642.25 N/A "$1,876.88" "$3,235.90" "$3,235.90" "$3,235.90" $674.36 "$3,235.90" N/A N/A 02.001.324 SUP HCPCS C1713 02.001.324 - PLATE BN CRV 314X17.5X5.2MM NS LCP CMBN 14 HL LOPRFL BOTH IP/OP "$3,211.00" "$2,376.00" $637.22 "$3,265.18" "$1,444.77" "$1,444.77" "$1,444.77" "$1,444.77" "$3,210.60" "$3,210.60" "$3,210.60" $669.17 "$3,210.60" "$3,210.60" "$3,210.60" "$3,210.60" "$3,210.60" $669.12 "$3,210.60" "$1,306.07" "$1,582.83" "$3,210.60" "$3,265.18" "$3,210.60" "$3,210.60" "$2,408.25" "$3,210.60" "$3,210.60" "$3,210.60" "$1,605.30" "$1,605.30" "$2,542.80" "$3,210.60" "$2,568.48" "$1,444.77" $637.22 N/A "$1,862.38" "$3,210.60" "$1,926.36" "$3,210.60" $669.09 "$3,210.60" N/A N/A 02.001.324S SUP HCPCS C1713 02.001.324S - PLATE BN CRV 314X17.5X5.2MM STRL LCP 14 HL LOPRFL PRECONTOUR BOTH IP/OP "$3,302.00" "$2,443.00" $655.36 "$3,358.10" "$1,485.89" "$1,485.89" "$1,485.89" "$1,485.89" "$3,301.98" "$3,301.98" "$3,301.98" $688.22 "$3,301.98" "$3,301.98" "$3,301.98" "$3,301.98" "$3,301.98" $688.17 "$3,301.98" "$3,358.10" "$1,627.88" "$3,301.98" "$3,358.10" "$3,301.98" "$3,301.98" "$2,476.50" "$3,301.98" "$3,301.98" "$3,301.98" "$1,650.99" "$1,650.99" "$2,615.17" "$3,301.98" "$2,641.58" "$1,485.89" $655.36 N/A "$1,915.16" "$3,301.98" "$3,301.98" "$3,301.98" $688.13 "$3,301.98" N/A N/A 02.001.326 SUP HCPCS C1713 02.001.326 - PLATE BN CRV 350X17.5X5.2MM NS LCP CMBN 16 HL LOPRFL BOTH IP/OP "$3,272.50" "$2,422.00" $649.50 "$3,328.08" "$1,472.60" "$1,472.60" "$1,472.60" "$1,472.60" "$3,272.45" "$3,272.45" "$3,272.45" $682.06 "$3,272.45" "$3,272.45" "$3,272.45" "$3,272.45" "$3,272.45" $682.01 "$3,272.45" "$3,328.08" "$1,613.32" "$3,272.45" "$3,328.08" "$3,272.45" "$3,272.45" "$2,454.38" "$3,272.45" "$3,272.45" "$3,272.45" "$1,636.23" "$1,636.23" "$2,591.78" "$3,272.45" "$2,617.96" "$1,472.60" $649.50 N/A "$1,898.05" "$3,272.45" "$3,272.45" "$3,272.45" $681.98 "$3,272.45" N/A N/A 02.001.326S SUP HCPCS C1713 02.001.326S - PLATE BN CRV 350X17.5X5.2MM STRL LCP 16 HL LOPRFL PRECONTOUR BOTH IP/OP "$3,364.00" "$2,489.00" $667.64 "$3,421.00" "$1,513.72" "$1,513.72" "$1,513.72" "$1,513.72" "$3,363.83" "$3,363.83" "$3,363.83" $701.11 "$3,363.83" "$3,363.83" "$3,363.83" "$3,363.83" "$3,363.83" $701.06 "$3,363.83" "$1,368.40" "$1,658.37" "$3,363.83" "$3,421.00" "$3,363.83" "$3,363.83" "$2,523.00" "$3,363.83" "$3,363.83" "$3,363.83" "$1,681.92" "$1,681.92" "$2,664.15" "$3,363.83" "$2,691.06" "$1,513.72" $667.64 N/A "$1,951.12" "$3,363.83" "$3,363.83" "$3,363.83" $701.02 "$3,363.83" N/A N/A 02.001.328 SUP HCPCS C1713 02.001.328 - PLATE BN CRV 386X17.5X5.2MM NS LCP CMBN 18 HL LOPRFL BOTH IP/OP "$3,454.00" "$2,556.00" $685.49 "$3,512.50" "$1,554.20" "$1,554.20" "$1,554.20" "$1,554.20" "$3,453.78" "$3,453.78" "$3,453.78" $719.85 "$3,453.78" "$3,453.78" "$3,453.78" "$3,453.78" "$3,453.78" $719.81 "$3,453.78" "$1,405.00" "$1,702.71" "$3,453.78" "$3,512.50" "$3,453.78" "$3,453.78" "$2,590.50" "$3,453.78" "$3,453.78" "$3,453.78" "$1,726.89" "$1,726.89" "$2,735.39" "$3,453.78" "$2,763.02" "$1,554.20" $685.49 N/A "$2,003.32" "$3,453.78" "$2,072.27" "$3,453.78" $719.77 "$3,453.78" N/A N/A 02.001.328S SUP HCPCS C1713 02.001.328S - PLATE BN CRV 386X17.5X5.2MM STRL LCP 18 HL LOPRFL PRECONTOUR BOTH IP/OP "$3,545.50" "$2,624.00" $703.62 "$3,605.43" "$1,595.32" "$1,595.32" "$1,595.32" "$1,595.32" "$3,545.15" "$3,545.15" "$3,545.15" $738.90 "$3,545.15" "$3,545.15" "$3,545.15" "$3,545.15" "$3,545.15" $738.85 "$3,545.15" "$1,442.17" "$1,747.76" "$3,545.15" "$3,605.43" "$3,545.15" "$3,545.15" "$2,659.13" "$3,545.15" "$3,545.15" "$3,545.15" "$1,772.58" "$1,772.58" "$2,807.76" "$3,545.15" "$2,836.12" "$1,595.32" $703.62 N/A "$2,056.39" "$3,545.15" "$3,545.15" "$3,545.15" $738.81 "$3,545.15" N/A N/A 02.001.330S SUP HCPCS C1713 02.001.330S - PLATE BN CRV 422X17.5X5.2MM STRL LCP CMBN 20 HL LOPRFL BOTH IP/OP "$3,597.50" "$2,662.00" $713.95 "$3,658.33" "$1,618.73" "$1,618.73" "$1,618.73" "$1,618.73" "$3,597.18" "$3,597.18" "$3,597.18" $749.74 "$3,597.18" "$3,597.18" "$3,597.18" "$3,597.18" "$3,597.18" $749.69 "$3,597.18" "$3,658.33" "$1,773.41" "$3,597.18" "$3,658.33" "$3,597.18" "$3,597.18" "$2,698.13" "$3,597.18" "$3,597.18" "$3,597.18" "$1,798.59" "$1,798.59" "$2,848.97" "$3,597.18" "$2,877.74" "$1,618.73" $713.95 N/A "$2,086.55" "$3,597.18" "$2,158.31" "$3,597.18" $749.65 "$3,597.18" N/A N/A 02.001.332S SUP HCPCS C1713 02.001.332S - PLATE BN CRV 458X17.5X5.2MM STRL LCP CMBN 22 HL LOPRFL BOTH IP/OP "$3,655.00" "$2,705.00" $725.39 "$3,716.93" "$1,644.66" "$1,644.66" "$1,644.66" "$1,644.66" "$3,654.80" "$3,654.80" "$3,654.80" $761.75 "$3,654.80" "$3,654.80" "$3,654.80" "$3,654.80" "$3,654.80" $761.70 "$3,654.80" "$3,716.93" "$1,801.82" "$3,654.80" "$3,716.93" "$3,654.80" "$3,654.80" "$2,741.25" "$3,654.80" "$3,654.80" "$3,654.80" "$1,827.40" "$1,827.40" "$2,894.60" "$3,654.80" "$2,923.84" "$1,644.66" $725.39 N/A "$2,119.90" "$3,654.80" "$2,192.88" "$3,654.80" $761.66 "$3,654.80" N/A N/A 02.007.000S SUP Custom 27203010 02.007.000S - NAIL INTRAMEDULLARY END CAP STAINLESS STEEL OLECRANON BOTH IP/OP "$1,210.50" $896.00 $215.43 "$1,230.88" "$1,210.30" "$1,210.30" "$1,210.30" "$1,210.30" "$1,210.30" "$1,210.30" $215.43 "$1,210.30" "$1,210.30" $898.28 $898.28 $932.90 $630.57 $252.24 "$1,210.30" $492.35 "$1,210.30" "$1,210.30" "$1,230.88" "$1,210.30" "$1,210.30" $907.88 "$1,210.30" "$1,210.30" "$1,210.30" $605.15 $605.15 $958.56 "$1,210.30" $968.24 $786.70 "$1,210.30" N/A $702.09 "$1,210.30" $726.18 "$1,210.30" "$1,210.30" "$1,210.30" N/A N/A 02.007.001 SUP HCPCS C1713 02.007.001 - NAIL INTRAMEDULLARY OSTMY IMPLANT STAINLESS STEEL OLECRANON BOTH IP/OP $685.00 $507.00 $135.91 $684.75 $308.14 $308.14 $308.14 $308.14 $684.75 $684.75 $684.75 $142.72 $684.75 $684.75 $684.75 $684.75 $684.75 $142.71 $684.75 $273.90 $405.03 $684.75 $684.75 $684.75 $684.75 $513.75 $684.75 $684.75 $684.75 $342.38 $342.38 $542.32 $684.75 $547.80 $308.14 $135.91 N/A $397.30 $684.75 $410.85 $684.75 $142.70 $684.75 N/A N/A 02.03150.044 SUP HCPCS C1713 02.03150.044 - SCREW BONE HEXAGON 5MM 3.5MM 44MM SELF TAP NCB PROTASUL-64 BOTH IP/OP $344.50 $255.00 $68.37 $344.50 $155.03 $155.03 $155.03 $155.03 $344.50 $344.50 $344.50 $71.80 $344.50 $344.50 $344.50 $344.50 $344.50 $71.80 $344.50 $344.50 $203.77 $344.50 $344.50 $344.50 $344.50 $258.38 $344.50 $344.50 $344.50 $172.25 $172.25 $272.84 $344.50 $275.60 $155.03 $68.37 N/A $199.81 $344.50 $206.70 $344.50 $71.79 $344.50 N/A N/A 02.03150.048 SUP HCPCS C1713 02.03150.048 - SCREW BONE HEXAGON 5MM 3.5MM 48MM SELF TAP NCB PROTASUL-64 BOTH IP/OP $344.50 $255.00 $68.37 $344.50 $155.03 $155.03 $155.03 $155.03 $344.50 $344.50 $344.50 $71.80 $344.50 $344.50 $344.50 $344.50 $344.50 $71.80 $344.50 $344.50 $203.77 $344.50 $344.50 $344.50 $344.50 $258.38 $344.50 $344.50 $344.50 $172.25 $172.25 $272.84 $344.50 $275.60 $155.03 $68.37 N/A $199.81 $344.50 $206.70 $344.50 $71.79 $344.50 N/A N/A 02.03150.055 SUP HCPCS C1713 02.03150.055 - SCREW BONE HEXAGON 5MM 3.5MM 55MM SELF TAP NCB PROTASUL-64 BOTH IP/OP $344.50 $255.00 $68.37 $344.50 $155.03 $155.03 $155.03 $155.03 $344.50 $344.50 $344.50 $71.80 $344.50 $344.50 $344.50 $344.50 $344.50 $71.80 $344.50 $344.50 $203.77 $344.50 $344.50 $344.50 $344.50 $258.38 $344.50 $344.50 $344.50 $172.25 $172.25 $272.84 $344.50 $275.60 $155.03 $68.37 N/A $199.81 $344.50 $206.70 $344.50 $344.50 $344.50 N/A N/A 02.03150.300 SUP HCPCS C1713 02.03150.300 - CAP END LOCK NCB FEMUR STERILE LARGE FRAGMENT SYSTEM BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $143.33 $143.33 $143.33 $143.33 $318.50 $318.50 $318.50 $66.38 $318.50 $318.50 $318.50 $318.50 $318.50 $66.38 $318.50 $318.50 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $143.33 $63.21 N/A $184.73 $318.50 $191.10 $318.50 $66.38 $318.50 N/A N/A 02.03152.055 SUP HCPCS C1713 02.03152.055 - SCREW BONE HEXAGON 5MM 3.5MM 55MM 32MM SELF TAP NCB BOTH IP/OP $296.00 $219.00 $58.70 $295.75 $133.09 $133.09 $133.09 $133.09 $295.75 $295.75 $295.75 $61.64 $295.75 $295.75 $295.75 $295.75 $295.75 $61.64 $295.75 $295.75 $174.94 $295.75 $295.75 $295.75 $295.75 $222.00 $295.75 $295.75 $295.75 $147.88 $147.88 $234.23 $295.75 $236.60 $133.09 $58.70 N/A $171.68 $295.75 $177.45 $295.75 $61.63 $295.75 N/A N/A 02.03152.065 SUP HCPCS C1713 02.03152.065 - SCREW BONE HEXAGON 5MM 3.5MM 65MM 32MM SELF TAP NCB BOTH IP/OP $296.00 $219.00 $58.70 $295.75 $133.09 $133.09 $133.09 $133.09 $295.75 $295.75 $295.75 $61.64 $295.75 $295.75 $295.75 $295.75 $295.75 $61.64 $295.75 $295.75 $174.94 $295.75 $295.75 $295.75 $295.75 $222.00 $295.75 $295.75 $295.75 $147.88 $147.88 $234.23 $295.75 $236.60 $133.09 $58.70 N/A $171.68 $295.75 $177.45 $295.75 $61.63 $295.75 N/A N/A 02.03152.080 SUP HCPCS C1713 02.03152.080 - SCREW BONE HEXAGON 5MM 3.5MM 80MM 32MM SELF TAP NCB BOTH IP/OP $296.00 $219.00 $58.70 $295.75 $133.09 $133.09 $133.09 $133.09 $295.75 $295.75 $295.75 $61.64 $295.75 $295.75 $295.75 $295.75 $295.75 $61.64 $295.75 $295.75 $174.94 $295.75 $295.75 $295.75 $295.75 $222.00 $295.75 $295.75 $295.75 $147.88 $147.88 $234.23 $295.75 $236.60 $133.09 $58.70 N/A $171.68 $295.75 $295.75 $295.75 $61.63 $295.75 N/A N/A 02.03152.085 SUP HCPCS C1713 02.03152.085 - SCREW BONE HEXAGON 5MM 3.5MM 85MM 32MM SELF TAP NCB BOTH IP/OP $296.00 $219.00 $58.70 $295.75 $133.09 $133.09 $133.09 $133.09 $295.75 $295.75 $295.75 $61.64 $295.75 $295.75 $295.75 $295.75 $295.75 $61.64 $295.75 $295.75 $174.94 $295.75 $295.75 $295.75 $295.75 $222.00 $295.75 $295.75 $295.75 $147.88 $147.88 $234.23 $295.75 $236.60 $133.09 $58.70 N/A $171.68 $295.75 $177.45 $295.75 $61.63 $295.75 N/A N/A 02.03260.109 SUP HCPCS C1713 02.03260.109 - PLATE BONE 246MM 9 HOLE NCB PROTASUL-64 FEMUR LEFT DISTAL BOTH IP/OP "$2,957.50" "$2,189.00" $586.99 "$2,957.50" "$1,330.88" "$1,330.88" "$1,330.88" "$1,330.88" "$2,957.50" "$2,957.50" "$2,957.50" $616.42 "$2,957.50" "$2,957.50" "$2,957.50" "$2,957.50" "$2,957.50" $616.38 "$2,957.50" "$2,957.50" "$1,458.05" "$2,957.50" "$2,957.50" "$2,957.50" "$2,957.50" "$2,218.13" "$2,957.50" "$2,957.50" "$2,957.50" "$1,478.75" "$1,478.75" "$2,342.34" "$2,957.50" "$2,366.00" "$1,330.88" $586.99 N/A "$1,715.35" "$2,957.50" "$1,774.50" "$2,957.50" "$2,957.50" "$2,957.50" N/A N/A 02.100.004 SUP HCPCS C1713 02.100.004 - PLATE BN 57X10X3.4MM NS CMBN 4 HL LCK LOPRFL COAX SS PUBIC BOTH IP/OP "$1,479.00" "$1,094.00" $293.50 "$1,503.95" $665.46 $665.46 $665.46 $665.46 "$1,478.80" "$1,478.80" "$1,478.80" $308.22 "$1,478.80" "$1,478.80" "$1,478.80" "$1,478.80" "$1,478.80" $308.20 "$1,478.80" "$1,503.95" $874.71 "$1,478.80" "$1,503.95" "$1,478.80" "$1,478.80" "$1,109.25" "$1,478.80" "$1,478.80" "$1,478.80" $739.40 $739.40 "$1,171.21" "$1,478.80" "$1,183.04" $665.46 $293.50 N/A $857.82 "$1,478.80" $887.28 "$1,478.80" $308.18 "$1,478.80" N/A N/A 02.100.006 SUP HCPCS C1713 02.100.006 - PLATE BN 78X10X3.4MM NS CMBN 6 HL LCK LOPRFL COAX SS PUBIC BOTH IP/OP "$1,621.00" "$1,200.00" $321.68 "$1,648.33" $729.35 $729.35 $729.35 $729.35 "$1,620.78" "$1,620.78" "$1,620.78" $337.81 "$1,620.78" "$1,620.78" "$1,620.78" "$1,620.78" "$1,620.78" $337.79 "$1,620.78" "$1,648.33" $958.69 "$1,620.78" "$1,648.33" "$1,620.78" "$1,620.78" "$1,215.75" "$1,620.78" "$1,620.78" "$1,620.78" $810.39 $810.39 "$1,283.66" "$1,620.78" "$1,296.62" $729.35 $321.68 N/A $940.18 "$1,620.78" $972.47 "$1,620.78" $337.77 "$1,620.78" N/A N/A 02.100.014 SUP HCPCS C1713 02.100.014 - PLATE BONE 57MM 4 HOLE LP STAINLESS STEEL PUBIC SYMPHYSIS BOTH IP/OP "$1,624.00" "$1,202.00" $322.24 "$1,651.18" $730.61 $730.61 $730.61 $730.61 "$1,623.58" "$1,623.58" "$1,623.58" $338.39 "$1,623.58" "$1,623.58" "$1,623.58" "$1,623.58" "$1,623.58" $338.37 "$1,623.58" "$1,651.18" $960.35 "$1,623.58" "$1,651.18" "$1,623.58" "$1,623.58" "$1,218.00" "$1,623.58" "$1,623.58" "$1,623.58" $811.79 $811.79 "$1,285.88" "$1,623.58" "$1,298.86" $730.61 $322.24 N/A $941.92 "$1,623.58" $974.15 "$1,623.58" $338.35 "$1,623.58" N/A N/A 02.100.016 SUP HCPCS C1713 02.100.016 - PLATE BONE 78MM 6 HOLE LP STAINLESS STEEL PUBIC SYMPHYSIS BOTH IP/OP "$1,781.00" "$1,318.00" $353.48 "$1,811.28" $801.45 $801.45 $801.45 $801.45 "$1,781.00" "$1,781.00" "$1,781.00" $371.20 "$1,781.00" "$1,781.00" "$1,781.00" "$1,781.00" "$1,781.00" $371.18 "$1,781.00" "$1,811.28" "$1,053.46" "$1,781.00" "$1,811.28" "$1,781.00" "$1,781.00" "$1,335.75" "$1,781.00" "$1,781.00" "$1,781.00" $890.50 $890.50 "$1,410.55" "$1,781.00" "$1,424.80" $801.45 $353.48 N/A "$1,032.98" "$1,781.00" "$1,068.60" "$1,781.00" $371.16 "$1,781.00" N/A N/A 02.100.020 SUP HCPCS C1713 02.100.020 - PLATE BONE LOCK LCP STAINLESS STEEL NAVICULAR NONSTRL BOTH IP/OP "$1,465.00" "$1,084.00" $290.71 "$1,489.63" $659.13 $659.13 $659.13 $659.13 "$1,464.73" "$1,464.73" "$1,464.73" $305.29 "$1,464.73" "$1,464.73" "$1,464.73" "$1,464.73" "$1,464.73" $305.27 "$1,464.73" "$1,489.63" $866.39 "$1,464.73" "$1,489.63" "$1,464.73" "$1,464.73" "$1,098.75" "$1,464.73" "$1,464.73" "$1,464.73" $732.37 $732.37 "$1,160.07" "$1,464.73" "$1,171.78" $659.13 $290.71 N/A $849.70 "$1,464.73" "$1,464.73" "$1,464.73" $305.25 "$1,464.73" N/A N/A 02.100.021 SUP HCPCS C1713 02.100.021 - PLATE BONE LOCK STAINLESS STEEL LEFT CUBOID NONSTRL 2.4/2.7 BOTH IP/OP "$1,425.50" "$1,055.00" $282.90 "$1,449.60" $641.42 $641.42 $641.42 $641.42 "$1,425.38" "$1,425.38" "$1,425.38" $297.08 "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" $297.06 "$1,425.38" "$1,449.60" $843.11 "$1,425.38" "$1,449.60" "$1,425.38" "$1,425.38" "$1,069.13" "$1,425.38" "$1,425.38" "$1,425.38" $712.69 $712.69 "$1,128.90" "$1,425.38" "$1,140.30" $641.42 $282.90 N/A $826.79 "$1,425.38" "$1,425.38" "$1,425.38" $297.05 "$1,425.38" N/A N/A 02.100.022 SUP HCPCS C1713 02.100.022 - PLATE BONE LOCK STAINLESS STEEL RIGHT CUBOID NONSTRL 2.4/2.7 BOTH IP/OP "$1,425.50" "$1,055.00" $282.90 "$1,449.60" $641.42 $641.42 $641.42 $641.42 "$1,425.38" "$1,425.38" "$1,425.38" $297.08 "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" $297.06 "$1,425.38" "$1,449.60" $843.11 "$1,425.38" "$1,449.60" "$1,425.38" "$1,425.38" "$1,069.13" "$1,425.38" "$1,425.38" "$1,425.38" $712.69 $712.69 "$1,128.90" "$1,425.38" "$1,140.30" $641.42 $282.90 N/A $826.79 "$1,425.38" "$1,425.38" "$1,425.38" $297.05 "$1,425.38" N/A N/A 02.100.023 SUP HCPCS C1713 02.100.023 - PLATE BONE LOCK STAINLESS STEEL TALAR NONSTRL 2.4/2.7 MM BOTH IP/OP "$1,408.50" "$1,042.00" $279.55 "$1,432.45" $633.83 $633.83 $633.83 $633.83 "$1,408.50" "$1,408.50" "$1,408.50" $293.57 "$1,408.50" "$1,408.50" "$1,408.50" "$1,408.50" "$1,408.50" $293.55 "$1,408.50" "$1,432.45" $833.13 "$1,408.50" "$1,432.45" "$1,408.50" "$1,408.50" "$1,056.38" "$1,408.50" "$1,408.50" "$1,408.50" $704.25 $704.25 "$1,115.53" "$1,408.50" "$1,126.80" $633.83 $279.55 N/A $816.93 "$1,408.50" "$1,408.50" "$1,408.50" $293.53 "$1,408.50" N/A N/A 02.100.032S SUP HCPCS C1713 02.100.032S - PLATE BN 100MM STRL LCP CMBN 6 HL SS ANKL ANT 4.5MM CORT BOTH IP/OP "$2,016.00" "$1,492.00" $400.12 "$2,050.25" $907.19 $907.19 $907.19 $907.19 "$2,015.98" "$2,015.98" "$2,015.98" $420.18 "$2,015.98" "$2,015.98" "$2,015.98" "$2,015.98" "$2,015.98" $420.15 "$2,015.98" "$2,050.25" "$1,192.45" "$2,015.98" "$2,050.25" "$2,015.98" "$2,015.98" "$1,512.00" "$2,015.98" "$2,015.98" "$2,015.98" "$1,007.99" "$1,007.99" "$1,596.66" "$2,015.98" "$1,612.78" $907.19 $400.12 N/A "$1,169.28" "$2,015.98" "$1,209.59" "$2,015.98" $420.13 "$2,015.98" N/A N/A 02.100.033S SUP HCPCS C1713 02.100.033S - PLATE BONE 116MM 7 HOLE LCP STAINLESS STEEL ANTERIOR ANKLE BOTH IP/OP "$2,070.00" "$1,532.00" $410.83 "$2,105.15" $931.48 $931.48 $931.48 $931.48 "$2,069.95" "$2,069.95" "$2,069.95" $431.43 "$2,069.95" "$2,069.95" "$2,069.95" "$2,069.95" "$2,069.95" $431.40 "$2,069.95" $842.06 "$1,224.38" "$2,069.95" "$2,105.15" "$2,069.95" "$2,069.95" "$1,552.50" "$2,069.95" "$2,069.95" "$2,069.95" "$1,034.98" "$1,034.98" "$1,639.40" "$2,069.95" "$1,655.96" $931.48 $410.83 N/A "$1,200.60" "$2,069.95" "$2,069.95" "$2,069.95" $431.38 "$2,069.95" N/A N/A 02.100.103 SUP HCPCS C1713 02.100.103 - PLATE BN STRG 39X10.1X3.7MM NS CMBN 3 HL LCK LOPRFL RECON SS BOTH IP/OP $984.00 $728.00 $195.30 "$1,000.70" $442.79 $442.79 $442.79 $442.79 $983.98 $983.98 $983.98 $205.09 $983.98 $983.98 $983.98 $983.98 $983.98 $205.07 $983.98 "$1,000.70" $582.02 $983.98 "$1,000.70" $983.98 $983.98 $738.00 $983.98 $983.98 $983.98 $491.99 $491.99 $779.31 $983.98 $787.18 $442.79 $195.30 N/A $570.72 $983.98 $590.39 $983.98 $205.06 $983.98 N/A N/A 02.100.104 SUP HCPCS C1713 02.100.104 - PLATE BN STRG 52X10.1X3.7MM NS CMBN 4 HL LCK LOPRFL RECON SS BOTH IP/OP "$1,033.50" $765.00 $205.06 "$1,050.75" $464.93 $464.93 $464.93 $464.93 "$1,033.18" "$1,033.18" "$1,033.18" $215.34 "$1,033.18" "$1,033.18" "$1,033.18" "$1,033.18" "$1,033.18" $215.33 "$1,033.18" "$1,050.75" $611.13 "$1,033.18" "$1,050.75" "$1,033.18" "$1,033.18" $775.13 "$1,033.18" "$1,033.18" "$1,033.18" $516.59 $516.59 $818.28 "$1,033.18" $826.54 $464.93 $205.06 N/A $599.43 "$1,033.18" $619.91 "$1,033.18" $215.31 "$1,033.18" N/A N/A 02.100.105 SUP HCPCS C1713 02.100.105 - PLATE BN STRG 65X10.1X3.7MM NS CMBN 5 HL LCK LOPRFL RECON SS BOTH IP/OP "$1,080.00" $799.00 $214.27 "$1,097.93" $485.81 $485.81 $485.81 $485.81 "$1,079.58" "$1,079.58" "$1,079.58" $225.01 "$1,079.58" "$1,079.58" "$1,079.58" "$1,079.58" "$1,079.58" $225.00 "$1,079.58" $439.17 $638.57 "$1,079.58" "$1,097.93" "$1,079.58" "$1,079.58" $810.00 "$1,079.58" "$1,079.58" "$1,079.58" $539.79 $539.79 $855.03 "$1,079.58" $863.66 $485.81 $214.27 N/A $626.40 "$1,079.58" $647.75 "$1,079.58" $224.98 "$1,079.58" N/A N/A 02.100.106 SUP HCPCS C1713 02.100.106 - PLATE BN STRG 78X10.1X3.7MM NS CMBN 6 HL LCK LOPRFL RECON SS BOTH IP/OP "$1,125.00" $833.00 $223.20 "$1,143.68" $506.05 $506.05 $506.05 $506.05 "$1,124.55" "$1,124.55" "$1,124.55" $234.38 "$1,124.55" "$1,124.55" "$1,124.55" "$1,124.55" "$1,124.55" $234.37 "$1,124.55" "$1,143.68" $665.17 "$1,124.55" "$1,143.68" "$1,124.55" "$1,124.55" $843.75 "$1,124.55" "$1,124.55" "$1,124.55" $562.28 $562.28 $890.64 "$1,124.55" $899.64 $506.05 $223.20 N/A $652.50 "$1,124.55" $674.73 "$1,124.55" $234.36 "$1,124.55" N/A N/A 02.100.107 SUP HCPCS C1713 02.100.107 - PLATE BN STRG 91X10.1X3.7MM NS CMBN 7 HL LCK LOPRFL RECON SS BOTH IP/OP "$1,168.50" $865.00 $231.84 "$1,187.98" $525.66 $525.66 $525.66 $525.66 "$1,168.13" "$1,168.13" "$1,168.13" $243.47 "$1,168.13" "$1,168.13" "$1,168.13" "$1,168.13" "$1,168.13" $243.45 "$1,168.13" $475.19 $690.95 "$1,168.13" "$1,187.98" "$1,168.13" "$1,168.13" $876.38 "$1,168.13" "$1,168.13" "$1,168.13" $584.07 $584.07 $925.16 "$1,168.13" $934.50 $525.66 $231.84 N/A $677.73 "$1,168.13" "$1,168.13" "$1,168.13" $243.44 "$1,168.13" N/A N/A 02.100.108 SUP HCPCS C1713 02.100.108 - PLATE BN STRG 104X10.1X3.7MM NS CMBN 8 HL LCK LOPRFL RECON BOTH IP/OP "$1,213.50" $898.00 $240.78 "$1,233.75" $545.91 $545.91 $545.91 $545.91 "$1,213.13" "$1,213.13" "$1,213.13" $252.85 "$1,213.13" "$1,213.13" "$1,213.13" "$1,213.13" "$1,213.13" $252.83 "$1,213.13" "$1,233.75" $717.57 "$1,213.13" "$1,233.75" "$1,213.13" "$1,213.13" $910.13 "$1,213.13" "$1,213.13" "$1,213.13" $606.57 $606.57 $960.80 "$1,213.13" $970.50 $545.91 $240.78 N/A $703.83 "$1,213.13" "$1,213.13" "$1,213.13" $252.82 "$1,213.13" N/A N/A 02.100.109 SUP HCPCS C1713 02.100.109 - PLATE BN STRG 117X10.1X3.7MM NS CMBN 9 HL LCK LOPRFL RECON BOTH IP/OP "$1,258.50" $931.00 $249.70 "$1,279.50" $566.15 $566.15 $566.15 $566.15 "$1,258.10" "$1,258.10" "$1,258.10" $262.22 "$1,258.10" "$1,258.10" "$1,258.10" "$1,258.10" "$1,258.10" $262.20 "$1,258.10" "$1,279.50" $744.17 "$1,258.10" "$1,279.50" "$1,258.10" "$1,258.10" $943.88 "$1,258.10" "$1,258.10" "$1,258.10" $629.05 $629.05 $996.42 "$1,258.10" "$1,006.48" $566.15 $249.70 N/A $729.93 "$1,258.10" "$1,258.10" "$1,258.10" $262.19 "$1,258.10" N/A N/A 02.100.110 SUP HCPCS C1713 02.100.110 - PLATE BN STRG 130X10.1X3.7MM NS CMBN 10 HL LCK LOPRFL RECON BOTH IP/OP "$1,304.50" $965.00 $258.91 "$1,326.65" $587.02 $587.02 $587.02 $587.02 "$1,304.48" "$1,304.48" "$1,304.48" $271.89 "$1,304.48" "$1,304.48" "$1,304.48" "$1,304.48" "$1,304.48" $271.87 "$1,304.48" "$1,326.65" $771.60 "$1,304.48" "$1,326.65" "$1,304.48" "$1,304.48" $978.38 "$1,304.48" "$1,304.48" "$1,304.48" $652.24 $652.24 "$1,033.15" "$1,304.48" "$1,043.58" $587.02 $258.91 N/A $756.61 "$1,304.48" "$1,304.48" "$1,304.48" $271.85 "$1,304.48" N/A N/A 02.100.111 SUP HCPCS C1713 02.100.111 - PLATE BN STRG 143X10.1X3.7MM NS CMBN 11 HL LCK LOPRFL RECON BOTH IP/OP "$1,349.50" $999.00 $267.84 "$1,372.43" $607.27 $607.27 $607.27 $607.27 "$1,349.48" "$1,349.48" "$1,349.48" $281.27 "$1,349.48" "$1,349.48" "$1,349.48" "$1,349.48" "$1,349.48" $281.25 "$1,349.48" $548.97 $798.22 "$1,349.48" "$1,372.43" "$1,349.48" "$1,349.48" "$1,012.13" "$1,349.48" "$1,349.48" "$1,349.48" $674.74 $674.74 "$1,068.79" "$1,349.48" "$1,079.58" $607.27 $267.84 N/A $782.71 "$1,349.48" "$1,349.48" "$1,349.48" $281.23 "$1,349.48" N/A N/A 02.100.112 SUP HCPCS C1713 02.100.112 - PLATE BN STRG 156X10.1X3.7MM NS CMBN 12 HL LCK LOPRFL RECON BOTH IP/OP "$1,393.50" "$1,031.00" $276.49 "$1,416.73" $626.87 $626.87 $626.87 $626.87 "$1,393.05" "$1,393.05" "$1,393.05" $290.35 "$1,393.05" "$1,393.05" "$1,393.05" "$1,393.05" "$1,393.05" $290.33 "$1,393.05" "$1,416.73" $823.99 "$1,393.05" "$1,416.73" "$1,393.05" "$1,393.05" "$1,045.13" "$1,393.05" "$1,393.05" "$1,393.05" $696.53 $696.53 "$1,103.30" "$1,393.05" "$1,114.44" $626.87 $276.49 N/A $808.23 "$1,393.05" $835.83 "$1,393.05" $290.31 "$1,393.05" N/A N/A 02.100.113 SUP HCPCS C1713 02.100.113 - PLATE BN STRG 169X10.1X3.7MM NS CMBN 13 HL LCK LOPRFL RECON BOTH IP/OP "$1,439.50" "$1,065.00" $285.69 "$1,463.90" $647.74 $647.74 $647.74 $647.74 "$1,439.43" "$1,439.43" "$1,439.43" $300.01 "$1,439.43" "$1,439.43" "$1,439.43" "$1,439.43" "$1,439.43" $299.99 "$1,439.43" "$1,463.90" $851.42 "$1,439.43" "$1,463.90" "$1,439.43" "$1,439.43" "$1,079.63" "$1,439.43" "$1,439.43" "$1,439.43" $719.72 $719.72 "$1,140.03" "$1,439.43" "$1,151.54" $647.74 $285.69 N/A $834.91 "$1,439.43" $863.66 "$1,439.43" $299.98 "$1,439.43" N/A N/A 02.100.114 SUP HCPCS C1713 02.100.114 - PLATE BN STRG 182X10.1X3.7MM NS CMBN 14 HL LCK LOPRFL RECON BOTH IP/OP "$1,487.50" "$1,101.00" $295.18 "$1,512.50" $669.25 $669.25 $669.25 $669.25 "$1,487.23" "$1,487.23" "$1,487.23" $309.98 "$1,487.23" "$1,487.23" "$1,487.23" "$1,487.23" "$1,487.23" $309.96 "$1,487.23" "$1,512.50" $879.70 "$1,487.23" "$1,512.50" "$1,487.23" "$1,487.23" "$1,115.63" "$1,487.23" "$1,487.23" "$1,487.23" $743.62 $743.62 "$1,177.89" "$1,487.23" "$1,189.78" $669.25 $295.18 N/A $862.75 "$1,487.23" $892.34 "$1,487.23" $309.94 "$1,487.23" N/A N/A 02.100.115 SUP HCPCS C1713 02.100.115 - PLATE BN STRG 195X10.1X3.7MM NS CMBN 15 HL LCK LOPRFL RECON BOTH IP/OP "$1,532.50" "$1,134.00" $304.10 "$1,558.25" $689.49 $689.49 $689.49 $689.49 "$1,532.20" "$1,532.20" "$1,532.20" $319.35 "$1,532.20" "$1,532.20" "$1,532.20" "$1,532.20" "$1,532.20" $319.33 "$1,532.20" "$1,558.25" $906.30 "$1,532.20" "$1,558.25" "$1,532.20" "$1,532.20" "$1,149.38" "$1,532.20" "$1,532.20" "$1,532.20" $766.10 $766.10 "$1,213.50" "$1,532.20" "$1,225.76" $689.49 $304.10 N/A $888.85 "$1,532.20" $919.32 "$1,532.20" "$1,532.20" "$1,532.20" N/A N/A 02.100.116 SUP HCPCS C1713 02.100.116 - PLATE BN STRG 208X10.1X3.7MM NS CMBN 16 HL LCK LOPRFL RECON BOTH IP/OP "$1,577.50" "$1,167.00" $313.03 "$1,603.98" $709.73 $709.73 $709.73 $709.73 "$1,577.18" "$1,577.18" "$1,577.18" $328.72 "$1,577.18" "$1,577.18" "$1,577.18" "$1,577.18" "$1,577.18" $328.70 "$1,577.18" "$1,603.98" $932.90 "$1,577.18" "$1,603.98" "$1,577.18" "$1,577.18" "$1,183.13" "$1,577.18" "$1,577.18" "$1,577.18" $788.59 $788.59 "$1,249.13" "$1,577.18" "$1,261.74" $709.73 $313.03 N/A $914.95 "$1,577.18" "$1,577.18" "$1,577.18" "$1,577.18" "$1,577.18" N/A N/A 02.100.118 SUP HCPCS C1713 02.100.118 - PLATE BN STRG 234X10.1X3.7MM NS CMBN 18 HL LCK LOPRFL RECON BOTH IP/OP "$1,622.50" "$1,201.00" $321.96 "$1,649.75" $729.98 $729.98 $729.98 $729.98 "$1,622.18" "$1,622.18" "$1,622.18" $338.10 "$1,622.18" "$1,622.18" "$1,622.18" "$1,622.18" "$1,622.18" $338.08 "$1,622.18" "$1,649.75" $959.52 "$1,622.18" "$1,649.75" "$1,622.18" "$1,622.18" "$1,216.88" "$1,622.18" "$1,622.18" "$1,622.18" $811.09 $811.09 "$1,284.77" "$1,622.18" "$1,297.74" $729.98 $321.96 N/A $941.05 "$1,622.18" "$1,622.18" "$1,622.18" $338.06 "$1,622.18" N/A N/A 02.100.120 SUP HCPCS C1713 02.100.120 - PLATE BN STRG 260X10.1X3.7MM NS CMBN 20 HL LCK LOPRFL RECON BOTH IP/OP "$1,670.00" "$1,236.00" $331.45 "$1,698.38" $751.49 $751.49 $751.49 $751.49 "$1,669.98" "$1,669.98" "$1,669.98" $348.07 "$1,669.98" "$1,669.98" "$1,669.98" "$1,669.98" "$1,669.98" $348.04 "$1,669.98" $679.35 $987.79 "$1,669.98" "$1,698.38" "$1,669.98" "$1,669.98" "$1,252.50" "$1,669.98" "$1,669.98" "$1,669.98" $834.99 $834.99 "$1,322.62" "$1,669.98" "$1,335.98" $751.49 $331.45 N/A $968.60 "$1,669.98" "$1,669.98" "$1,669.98" $348.02 "$1,669.98" N/A N/A 02.100.203 SUP HCPCS C1713 02.100.203 - PLATE BONE WIDE ANGLE LP 39MM 3 HOLE RECONSTRUCTION BOTH IP/OP $607.50 $450.00 $120.52 $617.58 $273.26 $273.26 $273.26 $273.26 $607.25 $607.25 $607.25 $126.57 $607.25 $607.25 $607.25 $607.25 $607.25 $126.56 $607.25 $247.03 $359.19 $607.25 $617.58 $607.25 $607.25 $455.63 $607.25 $607.25 $607.25 $303.63 $303.63 $480.94 $607.25 $485.80 $273.26 $120.52 N/A $352.35 $607.25 $364.35 $607.25 $607.25 $607.25 N/A N/A 02.100.204 SUP HCPCS C1713 02.100.204 - PLATE BONE WIDE ANGLE LP 52MM 4 HOLE RECONSTRUCTION BOTH IP/OP $635.50 $470.00 $126.11 $646.18 $285.92 $285.92 $285.92 $285.92 $635.38 $635.38 $635.38 $132.43 $635.38 $635.38 $635.38 $635.38 $635.38 $132.42 $635.38 $258.47 $375.83 $635.38 $646.18 $635.38 $635.38 $476.63 $635.38 $635.38 $635.38 $317.69 $317.69 $503.22 $635.38 $508.30 $285.92 $126.11 N/A $368.59 $635.38 $381.23 $635.38 $132.41 $635.38 N/A N/A 02.100.205 SUP HCPCS C1713 02.100.205 - PLATE BONE WIDE ANGLE LP 65MM 5 HOLE RECONSTRUCTION BOTH IP/OP $662.50 $490.00 $131.41 $673.33 $297.94 $297.94 $297.94 $297.94 $662.08 $662.08 $662.08 $137.99 $662.08 $662.08 $662.08 $662.08 $662.08 $137.98 $662.08 $269.33 $391.62 $662.08 $673.33 $662.08 $662.08 $496.88 $662.08 $662.08 $662.08 $331.04 $331.04 $524.37 $662.08 $529.66 $297.94 $131.41 N/A $384.25 $662.08 $397.25 $662.08 $137.98 $662.08 N/A N/A 02.100.206 SUP HCPCS C1713 02.100.206 - PLATE BONE WIDE ANGLE LP 78MM 6 HOLE RECONSTRUCTION BOTH IP/OP $693.00 $513.00 $137.54 $704.78 $311.85 $311.85 $311.85 $311.85 $693.00 $693.00 $693.00 $144.44 $693.00 $693.00 $693.00 $693.00 $693.00 $144.43 $693.00 $281.91 $409.91 $693.00 $704.78 $693.00 $693.00 $519.75 $693.00 $693.00 $693.00 $346.50 $346.50 $548.86 $693.00 $554.40 $311.85 $137.54 N/A $401.94 $693.00 $415.80 $693.00 $693.00 $693.00 N/A N/A 02.100.207 SUP HCPCS C1713 02.100.207 - PLATE BONE WIDE ANGLE LP 91MM 7 HOLE RECONSTRUCTION BOTH IP/OP $721.50 $534.00 $143.13 $733.38 $324.51 $324.51 $324.51 $324.51 $721.13 $721.13 $721.13 $150.30 $721.13 $721.13 $721.13 $721.13 $721.13 $150.29 $721.13 $293.35 $426.55 $721.13 $733.38 $721.13 $721.13 $541.13 $721.13 $721.13 $721.13 $360.57 $360.57 $571.13 $721.13 $576.90 $324.51 $143.13 N/A $418.47 $721.13 $721.13 $721.13 $150.28 $721.13 N/A N/A 02.100.208 SUP HCPCS C1713 02.100.208 - PLATE BONE WIDE ANGLE 104MM 8 HOLE LP STAINLESS STEEL PELVIS BOTH IP/OP $748.00 $554.00 $148.43 $760.55 $336.52 $336.52 $336.52 $336.52 $747.83 $747.83 $747.83 $155.87 $747.83 $747.83 $747.83 $747.83 $747.83 $155.86 $747.83 $760.55 $442.34 $747.83 $760.55 $747.83 $747.83 $561.00 $747.83 $747.83 $747.83 $373.92 $373.92 $592.28 $747.83 $598.26 $336.52 $148.43 N/A $433.84 $747.83 $747.83 $747.83 $747.83 $747.83 N/A N/A 02.100.209 SUP HCPCS C1713 02.100.209 - PLATE BONE WIDE ANGLE LP 117MM 9 HOLE RECONSTRUCTION BOTH IP/OP $779.00 $576.00 $154.56 $792.00 $350.44 $350.44 $350.44 $350.44 $778.75 $778.75 $778.75 $162.31 $778.75 $778.75 $778.75 $778.75 $778.75 $162.30 $778.75 $316.80 $460.63 $778.75 $792.00 $778.75 $778.75 $584.25 $778.75 $778.75 $778.75 $389.38 $389.38 $616.77 $778.75 $623.00 $350.44 $154.56 N/A $451.82 $778.75 $778.75 $778.75 $778.75 $778.75 N/A N/A 02.100.210 SUP HCPCS C1713 02.100.210 - PLATE BONE WIDE ANGLE LP 130MM 10 HOLE RECONSTRUCTION BOTH IP/OP $808.50 $598.00 $160.42 $822.03 $363.73 $363.73 $363.73 $363.73 $808.28 $808.28 $808.28 $168.47 $808.28 $808.28 $808.28 $808.28 $808.28 $168.45 $808.28 $822.03 $478.10 $808.28 $822.03 $808.28 $808.28 $606.38 $808.28 $808.28 $808.28 $404.14 $404.14 $640.16 $808.28 $646.62 $363.73 $160.42 N/A $468.93 $808.28 $808.28 $808.28 $168.45 $808.28 N/A N/A 02.100.211 SUP HCPCS C1713 02.100.211 - PLATE BONE WIDE ANGLE LP 143MM 11 HOLE RECONSTRUCTION BOTH IP/OP $850.50 $629.00 $168.79 $864.90 $382.70 $382.70 $382.70 $382.70 $850.45 $850.45 $850.45 $177.26 $850.45 $850.45 $850.45 $850.45 $850.45 $177.24 $850.45 $864.90 $503.04 $850.45 $864.90 $850.45 $850.45 $637.88 $850.45 $850.45 $850.45 $425.23 $425.23 $673.56 $850.45 $680.36 $382.70 $168.79 N/A $493.29 $850.45 $510.27 $850.45 $177.23 $850.45 N/A N/A 02.100.212 SUP HCPCS C1713 02.100.212 - PLATE BN WA 156X10.1X3.85MM NS CMBN 12 HL RECON LOPRFL SS BOTH IP/OP $898.50 $665.00 $178.28 $913.53 $404.21 $404.21 $404.21 $404.21 $898.25 $898.25 $898.25 $187.22 $898.25 $898.25 $898.25 $898.25 $898.25 $187.21 $898.25 $913.53 $531.31 $898.25 $913.53 $898.25 $898.25 $673.88 $898.25 $898.25 $898.25 $449.13 $449.13 $711.41 $898.25 $718.60 $404.21 $178.28 N/A $521.13 $898.25 $538.95 $898.25 $187.20 $898.25 N/A N/A 02.100.213 SUP HCPCS C1713 02.100.213 - PLATE BONE WIDE ANGLE LP 169MM 13 HOLE RECONSTRUCTION BOTH IP/OP $945.00 $699.00 $187.49 $960.68 $425.08 $425.08 $425.08 $425.08 $944.63 $944.63 $944.63 $196.88 $944.63 $944.63 $944.63 $944.63 $944.63 $196.87 $944.63 $960.68 $558.75 $944.63 $960.68 $944.63 $944.63 $708.75 $944.63 $944.63 $944.63 $472.32 $472.32 $748.15 $944.63 $755.70 $425.08 $187.49 N/A $548.10 $944.63 $566.78 $944.63 $196.86 $944.63 N/A N/A 02.100.214 SUP HCPCS C1713 02.100.214 - PLATE BONE WIDE ANGLE LP 182MM 14 HOLE RECONSTRUCTION BOTH IP/OP $985.50 $729.00 $195.58 "$1,002.15" $443.43 $443.43 $443.43 $443.43 $985.40 $985.40 $985.40 $205.38 $985.40 $985.40 $985.40 $985.40 $985.40 $205.37 $985.40 "$1,002.15" $582.86 $985.40 "$1,002.15" $985.40 $985.40 $739.13 $985.40 $985.40 $985.40 $492.70 $492.70 $780.44 $985.40 $788.32 $443.43 $195.58 N/A $571.59 $985.40 $591.24 $985.40 $205.36 $985.40 N/A N/A 02.100.215 SUP HCPCS C1713 02.100.215 - PLATE BONE WIDE ANGLE LP 195MM 15 HOLE RECONSTRUCTION BOTH IP/OP "$1,035.00" $766.00 $205.34 "$1,052.20" $465.57 $465.57 $465.57 $465.57 "$1,034.60" "$1,034.60" "$1,034.60" $215.64 "$1,034.60" "$1,034.60" "$1,034.60" "$1,034.60" "$1,034.60" $215.62 "$1,034.60" "$1,052.20" $611.97 "$1,034.60" "$1,052.20" "$1,034.60" "$1,034.60" $776.25 "$1,034.60" "$1,034.60" "$1,034.60" $517.30 $517.30 $819.40 "$1,034.60" $827.68 $465.57 $205.34 N/A $600.30 "$1,034.60" $620.76 "$1,034.60" $215.61 "$1,034.60" N/A N/A 02.100.216 SUP HCPCS C1713 02.100.216 - PLATE BONE WIDE ANGLE LP 208MM 16 HOLE RECONSTRUCTION BOTH IP/OP "$1,081.00" $800.00 $214.55 "$1,099.35" $486.44 $486.44 $486.44 $486.44 "$1,080.98" "$1,080.98" "$1,080.98" $225.30 "$1,080.98" "$1,080.98" "$1,080.98" "$1,080.98" "$1,080.98" $225.29 "$1,080.98" "$1,099.35" $639.40 "$1,080.98" "$1,099.35" "$1,080.98" "$1,080.98" $810.75 "$1,080.98" "$1,080.98" "$1,080.98" $540.49 $540.49 $856.14 "$1,080.98" $864.78 $486.44 $214.55 N/A $626.98 "$1,080.98" "$1,080.98" "$1,080.98" $225.28 "$1,080.98" N/A N/A 02.100.218 SUP HCPCS C1713 02.100.218 - PLATE BONE WIDE ANGLE LP 234MM 18 HOLE RECONSTRUCTION BOTH IP/OP "$1,127.50" $834.00 $223.76 "$1,146.55" $507.32 $507.32 $507.32 $507.32 "$1,127.38" "$1,127.38" "$1,127.38" $234.97 "$1,127.38" "$1,127.38" "$1,127.38" "$1,127.38" "$1,127.38" $234.96 "$1,127.38" "$1,146.55" $666.85 "$1,127.38" "$1,146.55" "$1,127.38" "$1,127.38" $845.63 "$1,127.38" "$1,127.38" "$1,127.38" $563.69 $563.69 $892.88 "$1,127.38" $901.90 $507.32 $223.76 N/A $653.95 "$1,127.38" $676.43 "$1,127.38" $234.95 "$1,127.38" N/A N/A 02.100.220 SUP HCPCS C1713 02.100.220 - PLATE BONE WIDE ANGLE LP 260MM 20 HOLE RECONSTRUCTION BOTH IP/OP "$1,170.00" $866.00 $232.12 "$1,189.40" $526.29 $526.29 $526.29 $526.29 "$1,169.53" "$1,169.53" "$1,169.53" $243.76 "$1,169.53" "$1,169.53" "$1,169.53" "$1,169.53" "$1,169.53" $243.74 "$1,169.53" "$1,189.40" $691.78 "$1,169.53" "$1,189.40" "$1,169.53" "$1,169.53" $877.50 "$1,169.53" "$1,169.53" "$1,169.53" $584.77 $584.77 $926.27 "$1,169.53" $935.62 $526.29 $232.12 N/A $678.60 "$1,169.53" "$1,169.53" "$1,169.53" $243.73 "$1,169.53" N/A N/A 02.100.301 SUP HCPCS C1713 02.100.301 - PLATE BONE 1 HOLE SPRING LCP STAINLESS STEEL PELVIC NONSTRL BOTH IP/OP $425.00 $315.00 $84.26 $431.75 $191.04 $191.04 $191.04 $191.04 $424.53 $424.53 $424.53 $88.48 $424.53 $424.53 $424.53 $424.53 $424.53 $88.48 $424.53 $431.75 $251.11 $424.53 $431.75 $424.53 $424.53 $318.75 $424.53 $424.53 $424.53 $212.27 $212.27 $336.23 $424.53 $339.62 $191.04 $84.26 N/A $246.50 $424.53 $424.53 $424.53 $88.47 $424.53 N/A N/A 02.100.302 SUP HCPCS C1713 02.100.302 - PLATE BONE 2 HOLE SPRING LCP STAINLESS STEEL PELVIC NONSTRL BOTH IP/OP $461.50 $342.00 $91.51 $468.93 $207.49 $207.49 $207.49 $207.49 $461.08 $461.08 $461.08 $96.10 $461.08 $461.08 $461.08 $461.08 $461.08 $96.09 $461.08 $468.93 $272.73 $461.08 $468.93 $461.08 $461.08 $346.13 $461.08 $461.08 $461.08 $230.54 $230.54 $365.18 $461.08 $368.86 $207.49 $91.51 N/A $267.67 $461.08 $461.08 $461.08 $96.09 $461.08 N/A N/A 02.100.302S SUP HCPCS C1713 02.100.302S - PLATE BN STRL 2 HL LOPRFL SPRG SS PLVC 3.5 MM SCR BOTH IP/OP $562.00 $416.00 $111.51 $561.83 $252.82 $252.82 $252.82 $252.82 $561.83 $561.83 $561.83 $117.10 $561.83 $561.83 $561.83 $561.83 $561.83 $117.09 $561.83 $561.83 $332.32 $561.83 $561.83 $561.83 $561.83 $421.50 $561.83 $561.83 $561.83 $280.92 $280.92 $444.97 $561.83 $449.46 $252.82 $111.51 N/A $325.96 $561.83 $561.83 $561.83 $117.09 $561.83 N/A N/A 02.100.303 SUP HCPCS C1713 02.100.303 - PLATE BONE 3 HOLE SPRING LCP STAINLESS STEEL PELVIC NONSTRL BOTH IP/OP $506.50 $375.00 $100.44 $514.65 $227.72 $227.72 $227.72 $227.72 $506.05 $506.05 $506.05 $105.47 $506.05 $506.05 $506.05 $506.05 $506.05 $105.47 $506.05 $514.65 $299.33 $506.05 $514.65 $506.05 $506.05 $379.88 $506.05 $506.05 $506.05 $253.03 $253.03 $400.79 $506.05 $404.84 $227.72 $100.44 N/A $293.77 $506.05 $303.63 $506.05 $105.46 $506.05 N/A N/A 02.100.325S SUP HCPCS C1713 02.100.325S - PLATE BONE STANDARD QUADRILATERAL SURFACE STAINLESS STEEL BOTH IP/OP $737.00 $545.00 $146.19 $749.10 $331.46 $331.46 $331.46 $331.46 $736.58 $736.58 $736.58 $153.52 $736.58 $736.58 $736.58 $736.58 $736.58 $153.51 $736.58 $299.64 $435.69 $736.58 $749.10 $736.58 $736.58 $552.75 $736.58 $736.58 $736.58 $368.29 $368.29 $583.37 $736.58 $589.26 $331.46 $146.19 N/A $427.46 $736.58 $441.95 $736.58 $153.50 $736.58 N/A N/A 02.100.326S SUP HCPCS C1713 02.100.326S - PLATE BONE LONG QUADRILATERAL SURFACE STAINLESS STEEL PELVIS BOTH IP/OP $811.50 $601.00 $160.98 $824.88 $364.99 $364.99 $364.99 $364.99 $811.08 $811.08 $811.08 $169.05 $811.08 $811.08 $811.08 $811.08 $811.08 $169.04 $811.08 $824.88 $479.75 $811.08 $824.88 $811.08 $811.08 $608.63 $811.08 $811.08 $811.08 $405.54 $405.54 $642.38 $811.08 $648.86 $364.99 $160.98 N/A $470.67 $811.08 $486.65 $811.08 $169.03 $811.08 N/A N/A 02.100.327S SUP HCPCS C1713 02.100.327S - PLATE BONE SHORT LP QUADRILATERAL SURFACE STAINLESS STEEL BOTH IP/OP $669.50 $495.00 $132.80 $680.48 $301.10 $301.10 $301.10 $301.10 $669.10 $669.10 $669.10 $139.46 $669.10 $669.10 $669.10 $669.10 $669.10 $139.45 $669.10 $272.19 $395.77 $669.10 $680.48 $669.10 $669.10 $502.13 $669.10 $669.10 $669.10 $334.55 $334.55 $529.93 $669.10 $535.28 $301.10 $132.80 N/A $388.31 $669.10 $401.46 $669.10 $139.44 $669.10 N/A N/A 02.100.360 SUP HCPCS C1713 02.100.360 - PLATE BONE J CVD 130X10.1X3.7MM 10 HOLE LOCKING COAXIAL BOTH IP/OP "$1,356.50" "$1,004.00" $269.23 "$1,379.55" $610.43 $610.43 $610.43 $610.43 "$1,356.50" "$1,356.50" "$1,356.50" $282.73 "$1,356.50" "$1,356.50" "$1,356.50" "$1,356.50" "$1,356.50" $282.71 "$1,356.50" "$1,379.55" $802.37 "$1,356.50" "$1,379.55" "$1,356.50" "$1,356.50" "$1,017.38" "$1,356.50" "$1,356.50" "$1,356.50" $678.25 $678.25 "$1,074.35" "$1,356.50" "$1,085.20" $610.43 $269.23 N/A $786.77 "$1,356.50" $813.90 "$1,356.50" $282.69 "$1,356.50" N/A N/A 02.100.361 SUP HCPCS C1713 02.100.361 - PLATE BN 88MM RDS J 130X10.1X3.7MM NS CMBN 10 HL LCK LOPRFL BOTH IP/OP "$1,356.50" "$1,004.00" $269.23 "$1,379.55" $610.43 $610.43 $610.43 $610.43 "$1,356.50" "$1,356.50" "$1,356.50" $282.73 "$1,356.50" "$1,356.50" "$1,356.50" "$1,356.50" "$1,356.50" $282.71 "$1,356.50" "$1,379.55" $802.37 "$1,356.50" "$1,379.55" "$1,356.50" "$1,356.50" "$1,017.38" "$1,356.50" "$1,356.50" "$1,356.50" $678.25 $678.25 "$1,074.35" "$1,356.50" "$1,085.20" $610.43 $269.23 N/A $786.77 "$1,356.50" $813.90 "$1,356.50" $282.69 "$1,356.50" N/A N/A 02.100.362 SUP HCPCS C1713 02.100.362 - PLATE BONE 156MM 12 HOLE J LOCKING LP RECONSTRUCTION LCP BOTH IP/OP "$1,432.50" "$1,060.00" $284.30 "$1,456.75" $644.58 $644.58 $644.58 $644.58 "$1,432.40" "$1,432.40" "$1,432.40" $298.55 "$1,432.40" "$1,432.40" "$1,432.40" "$1,432.40" "$1,432.40" $298.53 "$1,432.40" "$1,456.75" $847.26 "$1,432.40" "$1,456.75" "$1,432.40" "$1,432.40" "$1,074.38" "$1,432.40" "$1,432.40" "$1,432.40" $716.20 $716.20 "$1,134.46" "$1,432.40" "$1,145.92" $644.58 $284.30 N/A $830.85 "$1,432.40" $859.44 "$1,432.40" "$1,432.40" "$1,432.40" N/A N/A 02.100.363 SUP HCPCS C1713 02.100.363 - PLATE BONE J CVD 156X10.1X3.7MM 12 HOLE LOCKING COAXIAL BOTH IP/OP "$1,432.50" "$1,060.00" $284.30 "$1,456.75" $644.58 $644.58 $644.58 $644.58 "$1,432.40" "$1,432.40" "$1,432.40" $298.55 "$1,432.40" "$1,432.40" "$1,432.40" "$1,432.40" "$1,432.40" $298.53 "$1,432.40" "$1,456.75" $847.26 "$1,432.40" "$1,456.75" "$1,432.40" "$1,432.40" "$1,074.38" "$1,432.40" "$1,432.40" "$1,432.40" $716.20 $716.20 "$1,134.46" "$1,432.40" "$1,145.92" $644.58 $284.30 N/A $830.85 "$1,432.40" "$1,432.40" "$1,432.40" "$1,432.40" "$1,432.40" N/A N/A 02.100.364 SUP HCPCS C1713 02.100.364 - PLATE BONE J CVD 182X10.1X3.7MM 14 HOLE LOCKING COAXIAL BOTH IP/OP "$1,510.00" "$1,117.00" $299.64 "$1,535.40" $679.38 $679.38 $679.38 $679.38 "$1,509.73" "$1,509.73" "$1,509.73" $314.67 "$1,509.73" "$1,509.73" "$1,509.73" "$1,509.73" "$1,509.73" $314.64 "$1,509.73" "$1,535.40" $893.01 "$1,509.73" "$1,535.40" "$1,509.73" "$1,509.73" "$1,132.50" "$1,509.73" "$1,509.73" "$1,509.73" $754.87 $754.87 "$1,195.71" "$1,509.73" "$1,207.78" $679.38 $299.64 N/A $875.80 "$1,509.73" $905.84 "$1,509.73" $314.63 "$1,509.73" N/A N/A 02.100.365 SUP HCPCS C1713 02.100.365 - PLATE BONE 182MM 14 HOLE J LOCKING LP RECONSTRUCTION LCP BOTH IP/OP "$1,510.00" "$1,117.00" $299.64 "$1,535.40" $679.38 $679.38 $679.38 $679.38 "$1,509.73" "$1,509.73" "$1,509.73" $314.67 "$1,509.73" "$1,509.73" "$1,509.73" "$1,509.73" "$1,509.73" $314.64 "$1,509.73" "$1,535.40" $893.01 "$1,509.73" "$1,535.40" "$1,509.73" "$1,509.73" "$1,132.50" "$1,509.73" "$1,509.73" "$1,509.73" $754.87 $754.87 "$1,195.71" "$1,509.73" "$1,207.78" $679.38 $299.64 N/A $875.80 "$1,509.73" $905.84 "$1,509.73" $314.63 "$1,509.73" N/A N/A 02.100.366 SUP HCPCS C1713 02.100.366 - PLATE BN 88MM RDS J 208X10.1X3.7MM NS CMBN 16 HL LCK LOPRFL BOTH IP/OP "$1,597.00" "$1,182.00" $316.94 "$1,624.03" $718.60 $718.60 $718.60 $718.60 "$1,596.88" "$1,596.88" "$1,596.88" $332.83 "$1,596.88" "$1,596.88" "$1,596.88" "$1,596.88" "$1,596.88" $332.81 "$1,596.88" "$1,624.03" $944.55 "$1,596.88" "$1,624.03" "$1,596.88" "$1,596.88" "$1,197.75" "$1,596.88" "$1,596.88" "$1,596.88" $798.44 $798.44 "$1,264.73" "$1,596.88" "$1,277.50" $718.60 $316.94 N/A $926.26 "$1,596.88" $958.13 "$1,596.88" $332.79 "$1,596.88" N/A N/A 02.100.367 SUP HCPCS C1713 02.100.367 - PLATE BN 88MM RDS J 208X10.1X3.7MM NS CMBN 16 HL LCK LOPRFL BOTH IP/OP "$1,597.00" "$1,182.00" $316.94 "$1,624.03" $718.60 $718.60 $718.60 $718.60 "$1,596.88" "$1,596.88" "$1,596.88" $332.83 "$1,596.88" "$1,596.88" "$1,596.88" "$1,596.88" "$1,596.88" $332.81 "$1,596.88" "$1,624.03" $944.55 "$1,596.88" "$1,624.03" "$1,596.88" "$1,596.88" "$1,197.75" "$1,596.88" "$1,596.88" "$1,596.88" $798.44 $798.44 "$1,264.73" "$1,596.88" "$1,277.50" $718.60 $316.94 N/A $926.26 "$1,596.88" "$1,596.88" "$1,596.88" $332.79 "$1,596.88" N/A N/A 02.102.001 SUP HCPCS C1713 02.102.001 - PLATE BONE UNIVERSAL 131MM LOCKING STABILIZATION LCP BOTH IP/OP "$1,234.50" $914.00 $244.96 "$1,255.18" $555.39 $555.39 $555.39 $555.39 "$1,234.20" "$1,234.20" "$1,234.20" $257.24 "$1,234.20" "$1,234.20" "$1,234.20" "$1,234.20" "$1,234.20" $257.22 "$1,234.20" "$1,255.18" $730.03 "$1,234.20" "$1,255.18" "$1,234.20" "$1,234.20" $925.88 "$1,234.20" "$1,234.20" "$1,234.20" $617.10 $617.10 $977.49 "$1,234.20" $987.36 $555.39 $244.96 N/A $716.01 "$1,234.20" $740.52 "$1,234.20" $257.21 "$1,234.20" N/A N/A 02.104.004 SUP HCPCS C1713 02.104.004 - PLATE BN 122MM NS LCP CMBN 4 HL PRECONTOUR LMT CNTCT TPR HD BOTH IP/OP "$2,293.00" "$1,697.00" $455.04 "$2,331.65" "$1,031.71" "$1,031.71" "$1,031.71" "$1,031.71" "$2,292.68" "$2,292.68" "$2,292.68" $477.85 "$2,292.68" "$2,292.68" "$2,292.68" "$2,292.68" "$2,292.68" $477.82 "$2,292.68" "$2,331.65" "$1,356.12" "$2,292.68" "$2,331.65" "$2,292.68" "$2,292.68" "$1,719.75" "$2,292.68" "$2,292.68" "$2,292.68" "$1,146.34" "$1,146.34" "$1,815.80" "$2,292.68" "$1,834.14" "$1,031.71" $455.04 N/A "$1,329.94" "$2,292.68" "$1,375.61" "$2,292.68" $477.79 "$2,292.68" N/A N/A 02.104.006 SUP HCPCS C1713 02.104.006 - PLATE BONE 158MM 6 HOLE LCP STAINLESS STEEL RIGHT DISTAL BOTH IP/OP "$2,623.50" "$1,941.00" $520.61 "$2,667.63" "$1,180.36" "$1,180.36" "$1,180.36" "$1,180.36" "$2,623.03" "$2,623.03" "$2,623.03" $546.71 "$2,623.03" "$2,623.03" "$2,623.03" "$2,623.03" "$2,623.03" $546.67 "$2,623.03" "$2,667.63" "$1,293.15" "$2,623.03" "$2,667.63" "$2,623.03" "$2,623.03" "$1,967.63" "$2,623.03" "$2,623.03" "$2,623.03" "$1,311.52" "$1,311.52" "$2,077.44" "$2,623.03" "$2,098.42" "$1,180.36" $520.61 N/A "$1,521.63" "$2,623.03" "$2,623.03" "$2,623.03" $546.64 "$2,623.03" N/A N/A 02.104.006S SUP HCPCS C1713 02.104.006S - PLATE BN 158MM STRL LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR BOTH IP/OP "$2,714.50" "$2,009.00" $538.74 "$2,760.55" "$1,221.48" "$1,221.48" "$1,221.48" "$1,221.48" "$2,714.40" "$2,714.40" "$2,714.40" $565.75 "$2,714.40" "$2,714.40" "$2,714.40" "$2,714.40" "$2,714.40" $565.71 "$2,714.40" "$1,104.22" "$1,338.20" "$2,714.40" "$2,760.55" "$2,714.40" "$2,714.40" "$2,035.88" "$2,714.40" "$2,714.40" "$2,714.40" "$1,357.20" "$1,357.20" "$2,149.80" "$2,714.40" "$2,171.52" "$1,221.48" $538.74 N/A "$1,574.41" "$2,714.40" "$2,714.40" "$2,714.40" $565.68 "$2,714.40" N/A N/A 02.104.008 SUP HCPCS C1713 02.104.008 - PLATE BONE 194MM 8 HOLE LOCKING TAPER HEAD LIMIT CONTACT BOTH IP/OP "$2,783.50" "$2,060.00" $552.41 "$2,830.60" "$1,252.48" "$1,252.48" "$1,252.48" "$1,252.48" "$2,783.28" "$2,783.28" "$2,783.28" $580.11 "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" $580.07 "$2,783.28" "$1,132.24" "$1,372.16" "$2,783.28" "$2,830.60" "$2,783.28" "$2,783.28" "$2,087.63" "$2,783.28" "$2,783.28" "$2,783.28" "$1,391.64" "$1,391.64" "$2,204.36" "$2,783.28" "$2,226.62" "$1,252.48" $552.41 N/A "$1,614.43" "$2,783.28" "$1,669.97" "$2,783.28" $580.04 "$2,783.28" N/A N/A 02.104.008S SUP HCPCS C1713 02.104.008S - PLATE BN 194MM STRL LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR BOTH IP/OP "$2,875.00" "$2,128.00" $570.55 "$2,923.53" "$1,293.59" "$1,293.59" "$1,293.59" "$1,293.59" "$2,874.65" "$2,874.65" "$2,874.65" $599.15 "$2,874.65" "$2,874.65" "$2,874.65" "$2,874.65" "$2,874.65" $599.11 "$2,874.65" "$2,923.53" "$1,417.20" "$2,874.65" "$2,923.53" "$2,874.65" "$2,874.65" "$2,156.25" "$2,874.65" "$2,874.65" "$2,874.65" "$1,437.33" "$1,437.33" "$2,276.72" "$2,874.65" "$2,299.72" "$1,293.59" $570.55 N/A "$1,667.50" "$2,874.65" "$2,874.65" "$2,874.65" $599.08 "$2,874.65" N/A N/A 02.104.010 SUP HCPCS C1713 02.104.010 - PLATE BONE 230MM 10 HOLE LCP STAINLESS STEEL EXTART RIGHT BOTH IP/OP "$2,946.50" "$2,180.00" $584.77 "$2,996.43" "$1,325.85" "$1,325.85" "$1,325.85" "$1,325.85" "$2,946.33" "$2,946.33" "$2,946.33" $614.09 "$2,946.33" "$2,946.33" "$2,946.33" "$2,946.33" "$2,946.33" $614.05 "$2,946.33" "$2,996.43" "$1,452.54" "$2,946.33" "$2,996.43" "$2,946.33" "$2,946.33" "$2,209.88" "$2,946.33" "$2,946.33" "$2,946.33" "$1,473.17" "$1,473.17" "$2,333.49" "$2,946.33" "$2,357.06" "$1,325.85" $584.77 N/A "$1,708.97" "$2,946.33" "$2,946.33" "$2,946.33" $614.02 "$2,946.33" N/A N/A 02.104.010S SUP HCPCS C1713 02.104.010S - PLATE BN 230MM STRL LCP CMBN 10 HL PRECONTOUR LMT CNTCT TPR BOTH IP/OP "$3,038.00" "$2,248.00" $602.91 "$3,089.35" "$1,366.97" "$1,366.97" "$1,366.97" "$1,366.97" "$3,037.70" "$3,037.70" "$3,037.70" $633.13 "$3,037.70" "$3,037.70" "$3,037.70" "$3,037.70" "$3,037.70" $633.09 "$3,037.70" "$1,235.74" "$1,497.59" "$3,037.70" "$3,089.35" "$3,037.70" "$3,037.70" "$2,278.50" "$3,037.70" "$3,037.70" "$3,037.70" "$1,518.85" "$1,518.85" "$2,405.86" "$3,037.70" "$2,430.16" "$1,366.97" $602.91 N/A "$1,762.04" "$3,037.70" "$3,037.70" "$3,037.70" $633.06 "$3,037.70" N/A N/A 02.104.012 SUP HCPCS C1713 02.104.012 - PLATE BN 266MM NS LCP CMBN 12 HL PRECONTOUR LMT CNTCT TPR HD BOTH IP/OP "$3,367.00" "$2,492.00" $668.19 "$3,423.85" "$1,514.98" "$1,514.98" "$1,514.98" "$1,514.98" "$3,366.63" "$3,366.63" "$3,366.63" $701.69 "$3,366.63" "$3,366.63" "$3,366.63" "$3,366.63" "$3,366.63" $701.64 "$3,366.63" "$3,423.85" "$1,659.75" "$3,366.63" "$3,423.85" "$3,366.63" "$3,366.63" "$2,525.25" "$3,366.63" "$3,366.63" "$3,366.63" "$1,683.32" "$1,683.32" "$2,666.37" "$3,366.63" "$2,693.30" "$1,514.98" $668.19 N/A "$1,952.86" "$3,366.63" "$3,366.63" "$3,366.63" $701.61 "$3,366.63" N/A N/A 02.104.014 SUP HCPCS C1713 02.104.014 - PLATE BN 302MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT TPR HD BOTH IP/OP "$3,705.50" "$2,742.00" $735.43 "$3,768.40" "$1,667.43" "$1,667.43" "$1,667.43" "$1,667.43" "$3,705.40" "$3,705.40" "$3,705.40" $772.30 "$3,705.40" "$3,705.40" "$3,705.40" "$3,705.40" "$3,705.40" $772.25 "$3,705.40" "$3,768.40" "$1,826.76" "$3,705.40" "$3,768.40" "$3,705.40" "$3,705.40" "$2,779.13" "$3,705.40" "$3,705.40" "$3,705.40" "$1,852.70" "$1,852.70" "$2,934.68" "$3,705.40" "$2,964.32" "$1,667.43" $735.43 N/A "$2,149.19" "$3,705.40" "$3,705.40" "$3,705.40" $772.21 "$3,705.40" N/A N/A 02.104.024 SUP HCPCS C1713 02.104.024 - PLATE BN 122MM NS LCP CMBN 4 HL PRECONTOUR LMT CNTCT TPR HD BOTH IP/OP "$2,293.00" "$1,697.00" $455.04 "$2,331.65" "$1,031.71" "$1,031.71" "$1,031.71" "$1,031.71" "$2,292.68" "$2,292.68" "$2,292.68" $477.85 "$2,292.68" "$2,292.68" "$2,292.68" "$2,292.68" "$2,292.68" $477.82 "$2,292.68" "$2,331.65" "$1,356.12" "$2,292.68" "$2,331.65" "$2,292.68" "$2,292.68" "$1,719.75" "$2,292.68" "$2,292.68" "$2,292.68" "$1,146.34" "$1,146.34" "$1,815.80" "$2,292.68" "$1,834.14" "$1,031.71" $455.04 N/A "$1,329.94" "$2,292.68" "$1,375.61" "$2,292.68" $477.79 "$2,292.68" N/A N/A 02.104.026 SUP HCPCS C1713 02.104.026 - PLATE BONE 158MM 6 HOLE LCP STAINLESS STEEL LEFT DISTAL BOTH IP/OP "$2,623.50" "$1,941.00" $520.61 "$2,667.63" "$1,180.36" "$1,180.36" "$1,180.36" "$1,180.36" "$2,623.03" "$2,623.03" "$2,623.03" $546.71 "$2,623.03" "$2,623.03" "$2,623.03" "$2,623.03" "$2,623.03" $546.67 "$2,623.03" "$2,667.63" "$1,293.15" "$2,623.03" "$2,667.63" "$2,623.03" "$2,623.03" "$1,967.63" "$2,623.03" "$2,623.03" "$2,623.03" "$1,311.52" "$1,311.52" "$2,077.44" "$2,623.03" "$2,098.42" "$1,180.36" $520.61 N/A "$1,521.63" "$2,623.03" "$2,623.03" "$2,623.03" $546.64 "$2,623.03" N/A N/A 02.104.026S SUP HCPCS C1713 02.104.026S - PLATE BN 158MM STRL LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR BOTH IP/OP "$2,714.50" "$2,009.00" $538.74 "$2,760.55" "$1,221.48" "$1,221.48" "$1,221.48" "$1,221.48" "$2,714.40" "$2,714.40" "$2,714.40" $565.75 "$2,714.40" "$2,714.40" "$2,714.40" "$2,714.40" "$2,714.40" $565.71 "$2,714.40" "$1,104.22" "$1,338.20" "$2,714.40" "$2,760.55" "$2,714.40" "$2,714.40" "$2,035.88" "$2,714.40" "$2,714.40" "$2,714.40" "$1,357.20" "$1,357.20" "$2,149.80" "$2,714.40" "$2,171.52" "$1,221.48" $538.74 N/A "$1,574.41" "$2,714.40" "$2,714.40" "$2,714.40" $565.68 "$2,714.40" N/A N/A 02.104.028 SUP HCPCS C1713 02.104.028 - PLATE BONE 194MM 8 HOLE LCP STAINLESS STEEL LEFT DISTAL BOTH IP/OP "$2,783.50" "$2,060.00" $552.41 "$2,830.60" "$1,252.48" "$1,252.48" "$1,252.48" "$1,252.48" "$2,783.28" "$2,783.28" "$2,783.28" $580.11 "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" "$2,783.28" $580.07 "$2,783.28" "$2,830.60" "$1,372.16" "$2,783.28" "$2,830.60" "$2,783.28" "$2,783.28" "$2,087.63" "$2,783.28" "$2,783.28" "$2,783.28" "$1,391.64" "$1,391.64" "$2,204.36" "$2,783.28" "$2,226.62" "$1,252.48" $552.41 N/A "$1,614.43" "$2,783.28" "$2,783.28" "$2,783.28" $580.04 "$2,783.28" N/A N/A 02.104.028S SUP HCPCS C1713 02.104.028S - PLATE BN 194MM STRL LCP CMBN 8 HL LMT CNTCT PRECONTOUR SS BOTH IP/OP "$2,875.00" "$2,128.00" $570.55 "$2,923.53" "$1,293.59" "$1,293.59" "$1,293.59" "$1,293.59" "$2,874.65" "$2,874.65" "$2,874.65" $599.15 "$2,874.65" "$2,874.65" "$2,874.65" "$2,874.65" "$2,874.65" $599.11 "$2,874.65" "$1,169.41" "$1,417.20" "$2,874.65" "$2,923.53" "$2,874.65" "$2,874.65" "$2,156.25" "$2,874.65" "$2,874.65" "$2,874.65" "$1,437.33" "$1,437.33" "$2,276.72" "$2,874.65" "$2,299.72" "$1,293.59" $570.55 N/A "$1,667.50" "$2,874.65" "$2,874.65" "$2,874.65" $599.08 "$2,874.65" N/A N/A 02.104.030 SUP HCPCS C1713 02.104.030 - PLATE BONE 230MM 10 HOLE LCP STAINLESS STEEL LEFT DISTAL BOTH IP/OP "$2,946.50" "$2,180.00" $584.77 "$2,996.43" "$1,325.85" "$1,325.85" "$1,325.85" "$1,325.85" "$2,946.33" "$2,946.33" "$2,946.33" $614.09 "$2,946.33" "$2,946.33" "$2,946.33" "$2,946.33" "$2,946.33" $614.05 "$2,946.33" "$2,996.43" "$1,452.54" "$2,946.33" "$2,996.43" "$2,946.33" "$2,946.33" "$2,209.88" "$2,946.33" "$2,946.33" "$2,946.33" "$1,473.17" "$1,473.17" "$2,333.49" "$2,946.33" "$2,357.06" "$1,325.85" $584.77 N/A "$1,708.97" "$2,946.33" "$1,767.80" "$2,946.33" $614.02 "$2,946.33" N/A N/A 02.104.030S SUP HCPCS C1713 02.104.030S - PLATE BN 230MM STRL LCP CMBN 10 HL LMT CNTCT PRECONTOUR SS BOTH IP/OP "$3,038.00" "$2,248.00" $602.91 "$3,089.35" "$1,366.97" "$1,366.97" "$1,366.97" "$1,366.97" "$3,037.70" "$3,037.70" "$3,037.70" $633.13 "$3,037.70" "$3,037.70" "$3,037.70" "$3,037.70" "$3,037.70" $633.09 "$3,037.70" "$1,235.74" "$1,497.59" "$3,037.70" "$3,089.35" "$3,037.70" "$3,037.70" "$2,278.50" "$3,037.70" "$3,037.70" "$3,037.70" "$1,518.85" "$1,518.85" "$2,405.86" "$3,037.70" "$2,430.16" "$1,366.97" $602.91 N/A "$1,762.04" "$3,037.70" "$3,037.70" "$3,037.70" $633.06 "$3,037.70" N/A N/A 02.104.032 SUP HCPCS C1713 02.104.032 - PLATE BN 266MM NS LCP CMBN 12 HL PRECONTOUR LMT CNTCT TPR HD BOTH IP/OP "$3,367.00" "$2,492.00" $668.19 "$3,423.85" "$1,514.98" "$1,514.98" "$1,514.98" "$1,514.98" "$3,366.63" "$3,366.63" "$3,366.63" $701.69 "$3,366.63" "$3,366.63" "$3,366.63" "$3,366.63" "$3,366.63" $701.64 "$3,366.63" "$3,423.85" "$1,659.75" "$3,366.63" "$3,423.85" "$3,366.63" "$3,366.63" "$2,525.25" "$3,366.63" "$3,366.63" "$3,366.63" "$1,683.32" "$1,683.32" "$2,666.37" "$3,366.63" "$2,693.30" "$1,514.98" $668.19 N/A "$1,952.86" "$3,366.63" "$3,366.63" "$3,366.63" "$3,366.63" "$3,366.63" N/A N/A 02.104.034 SUP HCPCS C1713 02.104.034 - PLATE BN 302MM NS LCP CMBN 14 HL PRECONTOUR LMT CNTCT TPR HD BOTH IP/OP "$3,705.50" "$2,742.00" $735.43 "$3,768.40" "$1,667.43" "$1,667.43" "$1,667.43" "$1,667.43" "$3,705.40" "$3,705.40" "$3,705.40" $772.30 "$3,705.40" "$3,705.40" "$3,705.40" "$3,705.40" "$3,705.40" $772.25 "$3,705.40" "$3,768.40" "$1,826.76" "$3,705.40" "$3,768.40" "$3,705.40" "$3,705.40" "$2,779.13" "$3,705.40" "$3,705.40" "$3,705.40" "$1,852.70" "$1,852.70" "$2,934.68" "$3,705.40" "$2,964.32" "$1,667.43" $735.43 N/A "$2,149.19" "$3,705.40" "$3,705.40" "$3,705.40" "$3,705.40" "$3,705.40" N/A N/A 02.107.002 SUP HCPCS C1713 02.107.002 - PLATE BN 73MM NS LCP CMBN 2 HL VA TPR TIP RND PRFL SS OLCRN BOTH IP/OP "$1,730.50" "$1,281.00" $343.44 "$1,759.83" $778.68 $778.68 $778.68 $778.68 "$1,730.40" "$1,730.40" "$1,730.40" $360.66 "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" $360.63 "$1,730.40" "$1,759.83" "$1,023.53" "$1,730.40" "$1,759.83" "$1,730.40" "$1,730.40" "$1,297.88" "$1,730.40" "$1,730.40" "$1,730.40" $865.20 $865.20 "$1,370.48" "$1,730.40" "$1,384.32" $778.68 $343.44 N/A "$1,003.69" "$1,730.40" "$1,730.40" "$1,730.40" $360.62 "$1,730.40" N/A N/A 02.107.002S SUP HCPCS C1713 02.107.002S - PLATE BONE 73MM 2 HOLE VAR ANG LCP STAINLESS STEEL RIGHT BOTH IP/OP "$1,822.00" "$1,348.00" $361.58 "$1,852.75" $819.80 $819.80 $819.80 $819.80 "$1,821.78" "$1,821.78" "$1,821.78" $379.70 "$1,821.78" "$1,821.78" "$1,821.78" "$1,821.78" "$1,821.78" $379.68 "$1,821.78" $741.10 "$1,077.58" "$1,821.78" "$1,852.75" "$1,821.78" "$1,821.78" "$1,366.50" "$1,821.78" "$1,821.78" "$1,821.78" $910.89 $910.89 "$1,442.85" "$1,821.78" "$1,457.42" $819.80 $361.58 N/A "$1,056.76" "$1,821.78" "$1,093.07" "$1,821.78" $379.66 "$1,821.78" N/A N/A 02.107.102 SUP HCPCS C1713 02.107.102 - PLATE BONE 73MM 2 HOLE VAR ANG LCP STAINLESS STEEL ELBOW BOTH IP/OP "$1,730.50" "$1,281.00" $343.44 "$1,759.83" $778.68 $778.68 $778.68 $778.68 "$1,730.40" "$1,730.40" "$1,730.40" $360.66 "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" $360.63 "$1,730.40" "$1,759.83" "$1,023.53" "$1,730.40" "$1,759.83" "$1,730.40" "$1,730.40" "$1,297.88" "$1,730.40" "$1,730.40" "$1,730.40" $865.20 $865.20 "$1,370.48" "$1,730.40" "$1,384.32" $778.68 $343.44 N/A "$1,003.69" "$1,730.40" "$1,038.24" "$1,730.40" $360.62 "$1,730.40" N/A N/A 02.107.102S SUP HCPCS C1713 02.107.102S - PLATE BN 73MM STRL LCP CMBN 2 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$1,822.00" "$1,348.00" $361.58 "$1,852.75" $819.80 $819.80 $819.80 $819.80 "$1,821.78" "$1,821.78" "$1,821.78" $379.70 "$1,821.78" "$1,821.78" "$1,821.78" "$1,821.78" "$1,821.78" $379.68 "$1,821.78" $741.10 "$1,077.58" "$1,821.78" "$1,852.75" "$1,821.78" "$1,821.78" "$1,366.50" "$1,821.78" "$1,821.78" "$1,821.78" $910.89 $910.89 "$1,442.85" "$1,821.78" "$1,457.42" $819.80 $361.58 N/A "$1,056.76" "$1,821.78" "$1,093.07" "$1,821.78" $379.66 "$1,821.78" N/A N/A 02.107.202S SUP HCPCS C1713 02.107.202S - PLATE BONE 90MM 2 HOLE VAR ANG LCP STAINLESS STEEL RIGHT BOTH IP/OP "$2,037.00" "$1,507.00" $404.26 "$2,071.48" $916.58 $916.58 $916.58 $916.58 "$2,036.85" "$2,036.85" "$2,036.85" $424.53 "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" $424.50 "$2,036.85" $828.59 "$1,204.80" "$2,036.85" "$2,071.48" "$2,036.85" "$2,036.85" "$1,527.75" "$2,036.85" "$2,036.85" "$2,036.85" "$1,018.43" "$1,018.43" "$1,613.19" "$2,036.85" "$1,629.48" $916.58 $404.26 N/A "$1,181.46" "$2,036.85" "$2,036.85" "$2,036.85" $424.48 "$2,036.85" N/A N/A 02.107.204 SUP HCPCS C1713 02.107.204 - PLATE BN 116MM NS LCP CMBN 4 HL VA TPR TIP RND PRFL SS OLCRN BOTH IP/OP "$1,945.50" "$1,440.00" $386.13 "$1,978.55" $875.47 $875.47 $875.47 $875.47 "$1,945.48" "$1,945.48" "$1,945.48" $405.49 "$1,945.48" "$1,945.48" "$1,945.48" "$1,945.48" "$1,945.48" $405.46 "$1,945.48" $791.42 "$1,150.75" "$1,945.48" "$1,978.55" "$1,945.48" "$1,945.48" "$1,459.13" "$1,945.48" "$1,945.48" "$1,945.48" $972.74 $972.74 "$1,540.82" "$1,945.48" "$1,556.38" $875.47 $386.13 N/A "$1,128.39" "$1,945.48" "$1,945.48" "$1,945.48" $405.44 "$1,945.48" N/A N/A 02.107.204S SUP HCPCS C1713 02.107.204S - PLATE BONE 116MM 4 HOLE VAR ANG LCP STAINLESS STEEL RIGHT BOTH IP/OP "$2,037.00" "$1,507.00" $404.26 "$2,071.48" $916.58 $916.58 $916.58 $916.58 "$2,036.85" "$2,036.85" "$2,036.85" $424.53 "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" $424.50 "$2,036.85" $828.59 "$1,204.80" "$2,036.85" "$2,071.48" "$2,036.85" "$2,036.85" "$1,527.75" "$2,036.85" "$2,036.85" "$2,036.85" "$1,018.43" "$1,018.43" "$1,613.19" "$2,036.85" "$1,629.48" $916.58 $404.26 N/A "$1,181.46" "$2,036.85" "$2,036.85" "$2,036.85" $424.48 "$2,036.85" N/A N/A 02.107.206S SUP HCPCS C1713 02.107.206S - PLATE BONE 142MM 2 HOLE VAR ANG RECONSTRUCTION SEGMENT BOTH IP/OP "$2,037.00" "$1,507.00" $404.26 "$2,071.48" $916.58 $916.58 $916.58 $916.58 "$2,036.85" "$2,036.85" "$2,036.85" $424.53 "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" $424.50 "$2,036.85" "$2,071.48" "$1,204.80" "$2,036.85" "$2,071.48" "$2,036.85" "$2,036.85" "$1,527.75" "$2,036.85" "$2,036.85" "$2,036.85" "$1,018.43" "$1,018.43" "$1,613.19" "$2,036.85" "$1,629.48" $916.58 $404.26 N/A "$1,181.46" "$2,036.85" "$2,036.85" "$2,036.85" $424.48 "$2,036.85" N/A N/A 02.107.208S SUP HCPCS C1713 02.107.208S - PLATE BN 169MM STRL LCP CMBN 8 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,037.00" "$1,507.00" $404.26 "$2,071.48" $916.58 $916.58 $916.58 $916.58 "$2,036.85" "$2,036.85" "$2,036.85" $424.53 "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" $424.50 "$2,036.85" "$2,071.48" "$1,204.80" "$2,036.85" "$2,071.48" "$2,036.85" "$2,036.85" "$1,527.75" "$2,036.85" "$2,036.85" "$2,036.85" "$1,018.43" "$1,018.43" "$1,613.19" "$2,036.85" "$1,629.48" $916.58 $404.26 N/A "$1,181.46" "$2,036.85" "$2,036.85" "$2,036.85" $424.48 "$2,036.85" N/A N/A 02.107.302S SUP HCPCS C1713 02.107.302S - PLATE BONE 90MM 2 HOLE VAR ANG LCP STAINLESS STEEL LEFT BOTH IP/OP "$2,037.00" "$1,507.00" $404.26 "$2,071.48" $916.58 $916.58 $916.58 $916.58 "$2,036.85" "$2,036.85" "$2,036.85" $424.53 "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" $424.50 "$2,036.85" $828.59 "$1,204.80" "$2,036.85" "$2,071.48" "$2,036.85" "$2,036.85" "$1,527.75" "$2,036.85" "$2,036.85" "$2,036.85" "$1,018.43" "$1,018.43" "$1,613.19" "$2,036.85" "$1,629.48" $916.58 $404.26 N/A "$1,181.46" "$2,036.85" "$2,036.85" "$2,036.85" $424.48 "$2,036.85" N/A N/A 02.107.304 SUP HCPCS C1713 02.107.304 - PLATE BN 116MM NS LCP CMBN 4 HL VA TPR TIP RND PRFL SS OLCRN BOTH IP/OP "$1,945.50" "$1,440.00" $386.13 "$1,978.55" $875.47 $875.47 $875.47 $875.47 "$1,945.48" "$1,945.48" "$1,945.48" $405.49 "$1,945.48" "$1,945.48" "$1,945.48" "$1,945.48" "$1,945.48" $405.46 "$1,945.48" $791.42 "$1,150.75" "$1,945.48" "$1,978.55" "$1,945.48" "$1,945.48" "$1,459.13" "$1,945.48" "$1,945.48" "$1,945.48" $972.74 $972.74 "$1,540.82" "$1,945.48" "$1,556.38" $875.47 $386.13 N/A "$1,128.39" "$1,945.48" "$1,945.48" "$1,945.48" $405.44 "$1,945.48" N/A N/A 02.107.304S SUP HCPCS C1713 02.107.304S - PLATE BONE 116MM 4 HOLE VAR ANG RECONSTRUCTION SEGMENT BOTH IP/OP "$2,037.00" "$1,507.00" $404.26 "$2,071.48" $916.58 $916.58 $916.58 $916.58 "$2,036.85" "$2,036.85" "$2,036.85" $424.53 "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" $424.50 "$2,036.85" $828.59 "$1,204.80" "$2,036.85" "$2,071.48" "$2,036.85" "$2,036.85" "$1,527.75" "$2,036.85" "$2,036.85" "$2,036.85" "$1,018.43" "$1,018.43" "$1,613.19" "$2,036.85" "$1,629.48" $916.58 $404.26 N/A "$1,181.46" "$2,036.85" "$1,222.11" "$2,036.85" $424.48 "$2,036.85" N/A N/A 02.107.306S SUP HCPCS C1713 02.107.306S - PLATE BONE 142MM 6 HOLE VAR ANG STAINLESS STEEL LEFT BOTH IP/OP "$2,037.00" "$1,507.00" $404.26 "$2,071.48" $916.58 $916.58 $916.58 $916.58 "$2,036.85" "$2,036.85" "$2,036.85" $424.53 "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" $424.50 "$2,036.85" $828.59 "$1,204.80" "$2,036.85" "$2,071.48" "$2,036.85" "$2,036.85" "$1,527.75" "$2,036.85" "$2,036.85" "$2,036.85" "$1,018.43" "$1,018.43" "$1,613.19" "$2,036.85" "$1,629.48" $916.58 $404.26 N/A "$1,181.46" "$2,036.85" "$1,222.11" "$2,036.85" $424.48 "$2,036.85" N/A N/A 02.107.308S SUP HCPCS C1713 02.107.308S - PLATE BN 169MM STRL LCP CMBN 8 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,037.00" "$1,507.00" $404.26 "$2,071.48" $916.58 $916.58 $916.58 $916.58 "$2,036.85" "$2,036.85" "$2,036.85" $424.53 "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" "$2,036.85" $424.50 "$2,036.85" "$2,071.48" "$1,204.80" "$2,036.85" "$2,071.48" "$2,036.85" "$2,036.85" "$1,527.75" "$2,036.85" "$2,036.85" "$2,036.85" "$1,018.43" "$1,018.43" "$1,613.19" "$2,036.85" "$1,629.48" $916.58 $404.26 N/A "$1,181.46" "$2,036.85" "$1,222.11" "$2,036.85" $424.48 "$2,036.85" N/A N/A 02.107.408S SUP HCPCS C1713 02.107.408S - PLATE BONE 157MM 8 HOLE VAR ANG RECONSTRUCTION SEGMENT BOTH IP/OP "$2,329.50" "$1,724.00" $462.29 "$2,368.83" "$1,048.15" "$1,048.15" "$1,048.15" "$1,048.15" "$2,329.23" "$2,329.23" "$2,329.23" $485.47 "$2,329.23" "$2,329.23" "$2,329.23" "$2,329.23" "$2,329.23" $485.44 "$2,329.23" $947.53 "$1,377.74" "$2,329.23" "$2,368.83" "$2,329.23" "$2,329.23" "$1,747.13" "$2,329.23" "$2,329.23" "$2,329.23" "$1,164.62" "$1,164.62" "$1,844.75" "$2,329.23" "$1,863.38" "$1,048.15" $462.29 N/A "$1,351.11" "$2,329.23" "$1,397.54" "$2,329.23" $485.41 "$2,329.23" N/A N/A 02.107.506S SUP HCPCS C1713 02.107.506S - PLATE BN 131MM STRL LCP CMBN 6 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,329.50" "$1,724.00" $462.29 "$2,368.83" "$1,048.15" "$1,048.15" "$1,048.15" "$1,048.15" "$2,329.23" "$2,329.23" "$2,329.23" $485.47 "$2,329.23" "$2,329.23" "$2,329.23" "$2,329.23" "$2,329.23" $485.44 "$2,329.23" "$2,368.83" "$1,377.74" "$2,329.23" "$2,329.23" "$2,329.23" "$2,329.23" "$1,747.13" "$2,329.23" "$2,329.23" "$2,329.23" "$1,164.62" "$1,164.62" "$1,844.75" "$2,329.23" "$1,863.38" "$1,048.15" $462.29 N/A "$1,351.11" "$2,329.23" "$1,397.54" "$2,329.23" "$2,329.23" "$2,329.23" N/A N/A 02.107.508 SUP HCPCS C1713 02.107.508 - PLATE BN 157MM NS LCP CMBN 8 HL VA TPR TIP RND PRFL SS ULNA BOTH IP/OP "$2,238.00" "$1,656.00" $444.16 "$2,275.90" "$1,007.03" "$1,007.03" "$1,007.03" "$1,007.03" "$2,237.85" "$2,237.85" "$2,237.85" $466.42 "$2,237.85" "$2,237.85" "$2,237.85" "$2,237.85" "$2,237.85" $466.39 "$2,237.85" "$2,275.90" "$1,323.69" "$2,237.85" "$2,275.90" "$2,237.85" "$2,237.85" "$1,678.50" "$2,237.85" "$2,237.85" "$2,237.85" "$1,118.93" "$1,118.93" "$1,772.38" "$2,237.85" "$1,790.28" "$1,007.03" $444.16 N/A "$1,298.04" "$2,237.85" "$2,237.85" "$2,237.85" $466.37 "$2,237.85" N/A N/A 02.107.508S SUP HCPCS C1713 02.107.508S - PLATE BONE 157MM 8 HOLE VAR ANG RECONSTRUCTION SEGMENT BOTH IP/OP "$2,329.50" "$1,724.00" $462.29 "$2,368.83" "$1,048.15" "$1,048.15" "$1,048.15" "$1,048.15" "$2,329.23" "$2,329.23" "$2,329.23" $485.47 "$2,329.23" "$2,329.23" "$2,329.23" "$2,329.23" "$2,329.23" $485.44 "$2,329.23" $947.53 "$1,377.74" "$2,329.23" "$2,368.83" "$2,329.23" "$2,329.23" "$1,747.13" "$2,329.23" "$2,329.23" "$2,329.23" "$1,164.62" "$1,164.62" "$1,844.75" "$2,329.23" "$1,863.38" "$1,048.15" $462.29 N/A "$1,351.11" "$2,329.23" "$1,397.54" "$2,329.23" $485.41 "$2,329.23" N/A N/A 02.107.512S SUP HCPCS C1713 02.107.512S - PLATE BONE 211MM 12 HOLE VAR ANG RECONSTRUCTION SEGMENT BOTH IP/OP "$2,329.50" "$1,724.00" $462.29 "$2,368.83" "$1,048.15" "$1,048.15" "$1,048.15" "$1,048.15" "$2,329.23" "$2,329.23" "$2,329.23" $485.47 "$2,329.23" "$2,329.23" "$2,329.23" "$2,329.23" "$2,329.23" $485.44 "$2,329.23" $947.53 "$1,377.74" "$2,329.23" "$2,368.83" "$2,329.23" "$2,329.23" "$1,747.13" "$2,329.23" "$2,329.23" "$2,329.23" "$1,164.62" "$1,164.62" "$1,844.75" "$2,329.23" "$1,863.38" "$1,048.15" $462.29 N/A "$1,351.11" "$2,329.23" "$1,397.54" "$2,329.23" $485.41 "$2,329.23" N/A N/A 02.108.200 SUP Custom 27203010 02.108.200 - GUIDEWIRE ORTHOPEDIC THREAD 3MM 230MM DRILL TIP NONSTRL BOTH IP/OP $36.50 $27.00 $6.43 $36.74 $36.13 $36.13 $36.13 $36.13 $36.13 $36.13 $6.43 $36.13 $36.13 $26.82 $26.82 $27.85 $18.82 $7.53 $36.13 $14.70 $36.13 $36.13 $36.74 $36.13 $36.13 $27.38 $36.13 $36.13 $36.13 $18.07 $18.07 $28.61 $36.13 $28.90 $23.48 $36.13 N/A $21.17 $36.13 $21.68 $36.13 $36.13 $36.13 N/A N/A 02.108.310 SUP HCPCS C1713 02.108.310 - PLATE BONE 100D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP BOTH IP/OP "$1,005.50" $744.00 $199.48 "$1,022.15" $452.29 $452.29 $452.29 $452.29 "$1,005.08" "$1,005.08" "$1,005.08" $209.48 "$1,005.08" "$1,005.08" "$1,005.08" "$1,005.08" "$1,005.08" $209.47 "$1,005.08" "$1,022.15" $594.50 "$1,005.08" "$1,022.15" "$1,005.08" "$1,005.08" $754.13 "$1,005.08" "$1,005.08" "$1,005.08" $502.54 $502.54 $796.02 "$1,005.08" $804.06 $452.29 $199.48 N/A $583.19 "$1,005.08" "$1,005.08" "$1,005.08" $209.46 "$1,005.08" N/A N/A 02.108.311 SUP HCPCS C1713 02.108.311 - PLATE BONE 110D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP BOTH IP/OP "$1,005.50" $744.00 $199.48 "$1,022.15" $452.29 $452.29 $452.29 $452.29 "$1,005.08" "$1,005.08" "$1,005.08" $209.48 "$1,005.08" "$1,005.08" "$1,005.08" "$1,005.08" "$1,005.08" $209.47 "$1,005.08" $408.86 $594.50 "$1,005.08" "$1,022.15" "$1,005.08" "$1,005.08" $754.13 "$1,005.08" "$1,005.08" "$1,005.08" $502.54 $502.54 $796.02 "$1,005.08" $804.06 $452.29 $199.48 N/A $583.19 "$1,005.08" "$1,005.08" "$1,005.08" $209.46 "$1,005.08" N/A N/A 02.108.313 SUP HCPCS C1713 02.108.313 - PLATE BN 120D 75X19-12MM NS LCP 4 HL SHFT SS PED HIP 3.5MM BOTH IP/OP "$1,005.50" $744.00 $199.48 "$1,022.15" $452.29 $452.29 $452.29 $452.29 "$1,005.08" "$1,005.08" "$1,005.08" $209.48 "$1,005.08" "$1,005.08" "$1,005.08" "$1,005.08" "$1,005.08" $209.47 "$1,005.08" "$1,022.15" $594.50 "$1,005.08" "$1,022.15" "$1,005.08" "$1,005.08" $754.13 "$1,005.08" "$1,005.08" "$1,005.08" $502.54 $502.54 $796.02 "$1,005.08" $804.06 $452.29 $199.48 N/A $583.19 "$1,005.08" "$1,005.08" "$1,005.08" $209.46 "$1,005.08" N/A N/A 02.108.315 SUP HCPCS C1713 02.108.315 - PLATE BONE 150D 60X18.5MM 3 HOLE LCP STAINLESS STEEL BOTH IP/OP "$1,005.50" $744.00 $199.48 "$1,022.15" $452.29 $452.29 $452.29 $452.29 "$1,005.08" "$1,005.08" "$1,005.08" $209.48 "$1,005.08" "$1,005.08" "$1,005.08" "$1,005.08" "$1,005.08" $209.47 "$1,005.08" $408.86 $594.50 "$1,005.08" "$1,022.15" "$1,005.08" "$1,005.08" $754.13 "$1,005.08" "$1,005.08" "$1,005.08" $502.54 $502.54 $796.02 "$1,005.08" $804.06 $452.29 $199.48 N/A $583.19 "$1,005.08" "$1,005.08" "$1,005.08" $209.46 "$1,005.08" N/A N/A 02.108.320 SUP HCPCS C1713 02.108.320 - PLATE BONE 100D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP BOTH IP/OP "$1,044.50" $773.00 $207.29 "$1,062.18" $469.99 $469.99 $469.99 $469.99 "$1,044.43" "$1,044.43" "$1,044.43" $217.69 "$1,044.43" "$1,044.43" "$1,044.43" "$1,044.43" "$1,044.43" $217.67 "$1,044.43" "$1,062.18" $617.78 "$1,044.43" "$1,062.18" "$1,044.43" "$1,044.43" $783.38 "$1,044.43" "$1,044.43" "$1,044.43" $522.22 $522.22 $827.19 "$1,044.43" $835.54 $469.99 $207.29 N/A $605.81 "$1,044.43" "$1,044.43" "$1,044.43" $217.66 "$1,044.43" N/A N/A 02.108.321 SUP HCPCS C1713 02.108.321 - PLATE BONE 110D 5 HOLE LCP STAINLESS STEEL PEDIATRIC HIP BOTH IP/OP "$1,044.50" $773.00 $207.29 "$1,062.18" $469.99 $469.99 $469.99 $469.99 "$1,044.43" "$1,044.43" "$1,044.43" $217.69 "$1,044.43" "$1,044.43" "$1,044.43" "$1,044.43" "$1,044.43" $217.67 "$1,044.43" $424.87 $617.78 "$1,044.43" "$1,062.18" "$1,044.43" "$1,044.43" $783.38 "$1,044.43" "$1,044.43" "$1,044.43" $522.22 $522.22 $827.19 "$1,044.43" $835.54 $469.99 $207.29 N/A $605.81 "$1,044.43" "$1,044.43" "$1,044.43" "$1,044.43" "$1,044.43" N/A N/A 02.108.323 SUP HCPCS C1713 02.108.323 - PLATE BN 120D 95X23-15MM NS LCP 4 HL SHFT SS PED HIP 5MM SCR BOTH IP/OP "$1,044.50" $773.00 $207.29 "$1,062.18" $469.99 $469.99 $469.99 $469.99 "$1,044.43" "$1,044.43" "$1,044.43" $217.69 "$1,044.43" "$1,044.43" "$1,044.43" "$1,044.43" "$1,044.43" $217.67 "$1,044.43" "$1,062.18" $617.78 "$1,044.43" "$1,062.18" "$1,044.43" "$1,044.43" $783.38 "$1,044.43" "$1,044.43" "$1,044.43" $522.22 $522.22 $827.19 "$1,044.43" $835.54 $469.99 $207.29 N/A $605.81 "$1,044.43" $626.66 "$1,044.43" $217.66 "$1,044.43" N/A N/A 02.108.325 SUP HCPCS C1713 02.108.325 - PLATE BONE 150D 3 HOLE LCP STAINLESS STEEL PEDIATRIC HIP BOTH IP/OP "$1,044.50" $773.00 $207.29 "$1,062.18" $469.99 $469.99 $469.99 $469.99 "$1,044.43" "$1,044.43" "$1,044.43" $217.69 "$1,044.43" "$1,044.43" "$1,044.43" "$1,044.43" "$1,044.43" $217.67 "$1,044.43" "$1,062.18" $617.78 "$1,044.43" "$1,062.18" "$1,044.43" "$1,044.43" $783.38 "$1,044.43" "$1,044.43" "$1,044.43" $522.22 $522.22 $827.19 "$1,044.43" $835.54 $469.99 $207.29 N/A $605.81 "$1,044.43" $626.66 "$1,044.43" $217.66 "$1,044.43" N/A N/A 02.110.005 SUP HCPCS C1713 02.110.005 - PLATE BN NS LCP 5 HL SHFT SS RDS RT VOLR DIST BOTH IP/OP "$2,921.50" "$2,162.00" $579.75 "$2,970.68" "$1,314.46" "$1,314.46" "$1,314.46" "$1,314.46" "$2,921.03" "$2,921.03" "$2,921.03" $608.82 "$2,921.03" "$2,921.03" "$2,921.03" "$2,921.03" "$2,921.03" $608.77 "$2,921.03" "$1,188.27" "$1,440.07" "$2,921.03" "$2,970.68" "$2,921.03" "$2,921.03" "$2,191.13" "$2,921.03" "$2,921.03" "$2,921.03" "$1,460.52" "$1,460.52" "$2,313.46" "$2,921.03" "$2,336.82" "$1,314.46" $579.75 N/A "$1,694.47" "$2,921.03" "$2,921.03" "$2,921.03" $608.74 "$2,921.03" N/A N/A 02.110.005S SUP HCPCS C1713 02.110.005S - PLATE BN STRL LCP 5 HL SHFT SS RDS RT DIST VOLR BOTH IP/OP "$3,012.50" "$2,229.00" $597.89 "$3,063.60" "$1,355.58" "$1,355.58" "$1,355.58" "$1,355.58" "$3,012.40" "$3,012.40" "$3,012.40" $627.86 "$3,012.40" "$3,012.40" "$3,012.40" "$3,012.40" "$3,012.40" $627.82 "$3,012.40" "$1,225.44" "$1,485.11" "$3,012.40" "$3,063.60" "$3,012.40" "$3,012.40" "$2,259.38" "$3,012.40" "$3,012.40" "$3,012.40" "$1,506.20" "$1,506.20" "$2,385.82" "$3,012.40" "$2,409.92" "$1,355.58" $597.89 N/A "$1,747.25" "$3,012.40" "$3,012.40" "$3,012.40" $627.78 "$3,012.40" N/A N/A 02.110.007 SUP HCPCS C1713 02.110.007 - PLATE BN NS LCP 7 HL SHFT SS RDS RT VOLR DIST BOTH IP/OP "$2,993.00" "$2,215.00" $593.98 "$3,043.60" "$1,346.73" "$1,346.73" "$1,346.73" "$1,346.73" "$2,992.73" "$2,992.73" "$2,992.73" $623.76 "$2,992.73" "$2,992.73" "$2,992.73" "$2,992.73" "$2,992.73" $623.72 "$2,992.73" "$1,217.44" "$1,475.42" "$2,992.73" "$3,043.60" "$2,992.73" "$2,992.73" "$2,244.75" "$2,992.73" "$2,992.73" "$2,992.73" "$1,496.37" "$1,496.37" "$2,370.24" "$2,992.73" "$2,394.18" "$1,346.73" $593.98 N/A "$1,735.94" "$2,992.73" "$2,992.73" "$2,992.73" $623.68 "$2,992.73" N/A N/A 02.110.007S SUP HCPCS C1713 02.110.007S - PLATE BN STRL LCP 7 HL SHFT SS RDS RT VOLR DIST BOTH IP/OP "$3,084.50" "$2,283.00" $612.12 "$3,136.53" "$1,387.85" "$1,387.85" "$1,387.85" "$1,387.85" "$3,084.10" "$3,084.10" "$3,084.10" $642.80 "$3,084.10" "$3,084.10" "$3,084.10" "$3,084.10" "$3,084.10" $642.76 "$3,084.10" "$3,136.53" "$1,520.46" "$3,084.10" "$3,136.53" "$3,084.10" "$3,084.10" "$2,313.38" "$3,084.10" "$3,084.10" "$3,084.10" "$1,542.05" "$1,542.05" "$2,442.61" "$3,084.10" "$2,467.28" "$1,387.85" $612.12 N/A "$1,789.01" "$3,084.10" "$3,084.10" "$3,084.10" $642.73 "$3,084.10" N/A N/A 02.110.009 SUP HCPCS C1713 02.110.009 - PLATE BN NS LCP 9 HL SHFT SS RDS RT VOLR DIST BOTH IP/OP "$3,063.00" "$2,267.00" $607.93 "$3,115.08" "$1,378.35" "$1,378.35" "$1,378.35" "$1,378.35" "$3,063.00" "$3,063.00" "$3,063.00" $638.41 "$3,063.00" "$3,063.00" "$3,063.00" "$3,063.00" "$3,063.00" $638.36 "$3,063.00" "$3,115.08" "$1,510.06" "$3,063.00" "$3,115.08" "$3,063.00" "$3,063.00" "$2,297.25" "$3,063.00" "$3,063.00" "$3,063.00" "$1,531.50" "$1,531.50" "$2,425.90" "$3,063.00" "$2,450.40" "$1,378.35" $607.93 N/A "$1,776.54" "$3,063.00" "$3,063.00" "$3,063.00" $638.33 "$3,063.00" N/A N/A 02.110.009S SUP HCPCS C1713 02.110.009S - PLATE BN STRL LCP 9 HL SHFT SS RDS RT VOLR DIST BOTH IP/OP "$3,154.50" "$2,334.00" $626.07 "$3,208.00" "$1,419.47" "$1,419.47" "$1,419.47" "$1,419.47" "$3,154.38" "$3,154.38" "$3,154.38" $657.45 "$3,154.38" "$3,154.38" "$3,154.38" "$3,154.38" "$3,154.38" $657.41 "$3,154.38" "$1,283.20" "$1,555.11" "$3,154.38" "$3,208.00" "$3,154.38" "$3,154.38" "$2,365.88" "$3,154.38" "$3,154.38" "$3,154.38" "$1,577.19" "$1,577.19" "$2,498.27" "$3,154.38" "$2,523.50" "$1,419.47" $626.07 N/A "$1,829.61" "$3,154.38" "$3,154.38" "$3,154.38" $657.37 "$3,154.38" N/A N/A 02.110.011 SUP HCPCS C1713 02.110.011 - PLATE BN NS LCP 11 HL SHFT SS RDS RT VOLR DIST BOTH IP/OP "$3,251.50" "$2,406.00" $645.32 "$3,306.65" "$1,463.12" "$1,463.12" "$1,463.12" "$1,463.12" "$3,251.38" "$3,251.38" "$3,251.38" $677.67 "$3,251.38" "$3,251.38" "$3,251.38" "$3,251.38" "$3,251.38" $677.62 "$3,251.38" "$3,306.65" "$1,602.93" "$3,251.38" "$3,306.65" "$3,251.38" "$3,251.38" "$2,438.63" "$3,251.38" "$3,251.38" "$3,251.38" "$1,625.69" "$1,625.69" "$2,575.09" "$3,251.38" "$2,601.10" "$1,463.12" $645.32 N/A "$1,885.87" "$3,251.38" "$3,251.38" "$3,251.38" $677.59 "$3,251.38" N/A N/A 02.110.013S SUP HCPCS C1713 02.110.013S - PLATE BONE 13 HOLE LCP STAINLESS STEEL RIGHT DIAPHYSIS BOTH IP/OP "$3,433.00" "$2,540.00" $681.31 "$3,491.05" "$1,544.72" "$1,544.72" "$1,544.72" "$1,544.72" "$3,432.70" "$3,432.70" "$3,432.70" $715.46 "$3,432.70" "$3,432.70" "$3,432.70" "$3,432.70" "$3,432.70" $715.41 "$3,432.70" "$3,491.05" "$1,692.32" "$3,432.70" "$3,491.05" "$3,432.70" "$3,432.70" "$2,574.75" "$3,432.70" "$3,432.70" "$3,432.70" "$1,716.35" "$1,716.35" "$2,718.70" "$3,432.70" "$2,746.16" "$1,544.72" $681.31 N/A "$1,991.14" "$3,432.70" "$3,432.70" "$3,432.70" $715.37 "$3,432.70" N/A N/A 02.110.015S SUP HCPCS C1713 02.110.015S - PLATE BONE 15 HOLE LCP STAINLESS STEEL RIGHT DIAPHYSIS BOTH IP/OP "$3,611.50" "$2,673.00" $716.74 "$3,672.63" "$1,625.05" "$1,625.05" "$1,625.05" "$1,625.05" "$3,611.23" "$3,611.23" "$3,611.23" $752.67 "$3,611.23" "$3,611.23" "$3,611.23" "$3,611.23" "$3,611.23" $752.62 "$3,611.23" "$3,672.63" "$1,780.34" "$3,611.23" "$3,672.63" "$3,611.23" "$3,611.23" "$2,708.63" "$3,611.23" "$3,611.23" "$3,611.23" "$1,805.62" "$1,805.62" "$2,860.09" "$3,611.23" "$2,888.98" "$1,625.05" $716.74 N/A "$2,094.67" "$3,611.23" "$3,611.23" "$3,611.23" "$3,611.23" "$3,611.23" N/A N/A 02.110.105 SUP HCPCS C1713 02.110.105 - PLATE BN NS LCP 5 HL SHFT SS RDS LT VOLR DIST BOTH IP/OP "$2,921.50" "$2,162.00" $579.75 "$2,970.68" "$1,314.46" "$1,314.46" "$1,314.46" "$1,314.46" "$2,921.03" "$2,921.03" "$2,921.03" $608.82 "$2,921.03" "$2,921.03" "$2,921.03" "$2,921.03" "$2,921.03" $608.77 "$2,921.03" "$1,188.27" "$1,440.07" "$2,921.03" "$2,970.68" "$2,921.03" "$2,921.03" "$2,191.13" "$2,921.03" "$2,921.03" "$2,921.03" "$1,460.52" "$1,460.52" "$2,313.46" "$2,921.03" "$2,336.82" "$1,314.46" $579.75 N/A "$1,694.47" "$2,921.03" "$2,921.03" "$2,921.03" $608.74 "$2,921.03" N/A N/A 02.110.105S SUP HCPCS C1713 02.110.105S - PLATE BN STRL LCP 5 HL SHFT SS RDS LT DIST VOLR BOTH IP/OP "$3,012.50" "$2,229.00" $597.89 "$3,063.60" "$1,355.58" "$1,355.58" "$1,355.58" "$1,355.58" "$3,012.40" "$3,012.40" "$3,012.40" $627.86 "$3,012.40" "$3,012.40" "$3,012.40" "$3,012.40" "$3,012.40" $627.82 "$3,012.40" "$1,225.44" "$1,485.11" "$3,012.40" "$3,063.60" "$3,012.40" "$3,012.40" "$2,259.38" "$3,012.40" "$3,012.40" "$3,012.40" "$1,506.20" "$1,506.20" "$2,385.82" "$3,012.40" "$2,409.92" "$1,355.58" $597.89 N/A "$1,747.25" "$3,012.40" "$3,012.40" "$3,012.40" $627.78 "$3,012.40" N/A N/A 02.110.107 SUP HCPCS C1713 02.110.107 - PLATE BN NS LCP 7 HL SHFT SS RDS LT VOLR DIST BOTH IP/OP "$2,993.00" "$2,215.00" $593.98 "$3,043.60" "$1,346.73" "$1,346.73" "$1,346.73" "$1,346.73" "$2,992.73" "$2,992.73" "$2,992.73" $623.76 "$2,992.73" "$2,992.73" "$2,992.73" "$2,992.73" "$2,992.73" $623.72 "$2,992.73" "$1,217.44" "$1,475.42" "$2,992.73" "$3,043.60" "$2,992.73" "$2,992.73" "$2,244.75" "$2,992.73" "$2,992.73" "$2,992.73" "$1,496.37" "$1,496.37" "$2,370.24" "$2,992.73" "$2,394.18" "$1,346.73" $593.98 N/A "$1,735.94" "$2,992.73" "$2,992.73" "$2,992.73" $623.68 "$2,992.73" N/A N/A 02.110.107S SUP HCPCS C1713 02.110.107S - PLATE BN STRL LCP 7 HL SHFT SS RDS LT VOLR DIST BOTH IP/OP "$3,084.50" "$2,283.00" $612.12 "$3,136.53" "$1,387.85" "$1,387.85" "$1,387.85" "$1,387.85" "$3,084.10" "$3,084.10" "$3,084.10" $642.80 "$3,084.10" "$3,084.10" "$3,084.10" "$3,084.10" "$3,084.10" $642.76 "$3,084.10" "$1,254.61" "$1,520.46" "$3,084.10" "$3,136.53" "$3,084.10" "$3,084.10" "$2,313.38" "$3,084.10" "$3,084.10" "$3,084.10" "$1,542.05" "$1,542.05" "$2,442.61" "$3,084.10" "$2,467.28" "$1,387.85" $612.12 N/A "$1,789.01" "$3,084.10" "$3,084.10" "$3,084.10" $642.73 "$3,084.10" N/A N/A 02.110.109 SUP HCPCS C1713 02.110.109 - PLATE BN NS LCP 9 HL SHFT SS RDS LT VOLR DIST BOTH IP/OP "$3,063.00" "$2,267.00" $607.93 "$3,115.08" "$1,378.35" "$1,378.35" "$1,378.35" "$1,378.35" "$3,063.00" "$3,063.00" "$3,063.00" $638.41 "$3,063.00" "$3,063.00" "$3,063.00" "$3,063.00" "$3,063.00" $638.36 "$3,063.00" "$1,246.03" "$1,510.06" "$3,063.00" "$3,115.08" "$3,063.00" "$3,063.00" "$2,297.25" "$3,063.00" "$3,063.00" "$3,063.00" "$1,531.50" "$1,531.50" "$2,425.90" "$3,063.00" "$2,450.40" "$1,378.35" $607.93 N/A "$1,776.54" "$3,063.00" "$3,063.00" "$3,063.00" $638.33 "$3,063.00" N/A N/A 02.110.109S SUP HCPCS C1713 02.110.109S - PLATE BN STRL LCP 9 HL SHFT SS RDS LT VOLR DIST BOTH IP/OP "$3,154.50" "$2,334.00" $626.07 "$3,208.00" "$1,419.47" "$1,419.47" "$1,419.47" "$1,419.47" "$3,154.38" "$3,154.38" "$3,154.38" $657.45 "$3,154.38" "$3,154.38" "$3,154.38" "$3,154.38" "$3,154.38" $657.41 "$3,154.38" "$1,283.20" "$1,555.11" "$3,154.38" "$3,208.00" "$3,154.38" "$3,154.38" "$2,365.88" "$3,154.38" "$3,154.38" "$3,154.38" "$1,577.19" "$1,577.19" "$2,498.27" "$3,154.38" "$2,523.50" "$1,419.47" $626.07 N/A "$1,829.61" "$3,154.38" "$3,154.38" "$3,154.38" $657.37 "$3,154.38" N/A N/A 02.110.111 SUP HCPCS C1713 02.110.111 - PLATE BN NS LCP 11 HL SHFT SS RDS LT VOLR DIST BOTH IP/OP "$3,133.50" "$2,319.00" $621.88 "$3,186.58" "$1,409.99" "$1,409.99" "$1,409.99" "$1,409.99" "$3,133.30" "$3,133.30" "$3,133.30" $653.06 "$3,133.30" "$3,133.30" "$3,133.30" "$3,133.30" "$3,133.30" $653.01 "$3,133.30" "$3,186.58" "$1,544.72" "$3,133.30" "$3,186.58" "$3,133.30" "$3,133.30" "$2,350.13" "$3,133.30" "$3,133.30" "$3,133.30" "$1,566.65" "$1,566.65" "$2,481.57" "$3,133.30" "$2,506.64" "$1,409.99" $621.88 N/A "$1,817.43" "$3,133.30" "$3,133.30" "$3,133.30" "$3,133.30" "$3,133.30" N/A N/A 02.110.111S SUP HCPCS C1713 02.110.111S - PLATE BN STRL LCP 11 HL SHFT SS RDS LT DIST VOLR BOTH IP/OP "$3,225.00" "$2,387.00" $640.01 "$3,279.48" "$1,451.09" "$1,451.09" "$1,451.09" "$1,451.09" "$3,224.65" "$3,224.65" "$3,224.65" $672.10 "$3,224.65" "$3,224.65" "$3,224.65" "$3,224.65" "$3,224.65" $672.05 "$3,224.65" "$3,279.48" "$1,589.75" "$3,224.65" "$3,279.48" "$3,224.65" "$3,224.65" "$2,418.75" "$3,224.65" "$3,224.65" "$3,224.65" "$1,612.33" "$1,612.33" "$2,553.92" "$3,224.65" "$2,579.72" "$1,451.09" $640.01 N/A "$1,870.50" "$3,224.65" "$3,224.65" "$3,224.65" $672.02 "$3,224.65" N/A N/A 02.110.113S SUP HCPCS C1713 02.110.113S - PLATE BONE 13 HOLE LCP STAINLESS STEEL LEFT DISTAL VOLAR BOTH IP/OP "$3,497.50" "$2,588.00" $694.14 "$3,556.83" "$1,573.82" "$1,573.82" "$1,573.82" "$1,573.82" "$3,497.38" "$3,497.38" "$3,497.38" $728.94 "$3,497.38" "$3,497.38" "$3,497.38" "$3,497.38" "$3,497.38" $728.89 "$3,497.38" "$1,422.73" "$1,724.21" "$3,497.38" "$3,556.83" "$3,497.38" "$3,497.38" "$2,623.13" "$3,497.38" "$3,497.38" "$3,497.38" "$1,748.69" "$1,748.69" "$2,769.92" "$3,497.38" "$2,797.90" "$1,573.82" $694.14 N/A "$2,028.55" "$3,497.38" "$3,497.38" "$3,497.38" $728.85 "$3,497.38" N/A N/A 02.110.115S SUP HCPCS C1713 02.110.115S - PLATE BONE 15 HOLE LCP STAINLESS STEEL LEFT DISTAL VOLAR BOTH IP/OP "$3,611.50" "$2,673.00" $716.74 "$3,672.63" "$1,625.05" "$1,625.05" "$1,625.05" "$1,625.05" "$3,611.23" "$3,611.23" "$3,611.23" $752.67 "$3,611.23" "$3,611.23" "$3,611.23" "$3,611.23" "$3,611.23" $752.62 "$3,611.23" "$1,469.05" "$1,780.34" "$3,611.23" "$3,672.63" "$3,611.23" "$3,611.23" "$2,708.63" "$3,611.23" "$3,611.23" "$3,611.23" "$1,805.62" "$1,805.62" "$2,860.09" "$3,611.23" "$2,888.98" "$1,625.05" $716.74 N/A "$2,094.67" "$3,611.23" "$3,611.23" "$3,611.23" "$3,611.23" "$3,611.23" N/A N/A 02.110.150 SUP HCPCS C1713 02.110.150 - PLATE BN STD BND 118MM NS LCP FSN SS WRST BOTH IP/OP "$3,146.00" "$2,328.00" $624.39 "$3,199.43" "$1,415.68" "$1,415.68" "$1,415.68" "$1,415.68" "$3,145.95" "$3,145.95" "$3,145.95" $655.69 "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" $655.65 "$3,145.95" "$1,279.77" "$1,550.95" "$3,145.95" "$3,199.43" "$3,145.95" "$3,145.95" "$2,359.50" "$3,145.95" "$3,145.95" "$3,145.95" "$1,572.98" "$1,572.98" "$2,491.59" "$3,145.95" "$2,516.76" "$1,415.68" $624.39 N/A "$1,824.68" "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" N/A N/A 02.110.151 SUP HCPCS C1713 02.110.151 - PLATE BN SHRT BND 118MM NS LCP FSN SS WRST BOTH IP/OP "$3,146.00" "$2,328.00" $624.39 "$3,199.43" "$1,415.68" "$1,415.68" "$1,415.68" "$1,415.68" "$3,145.95" "$3,145.95" "$3,145.95" $655.69 "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" $655.65 "$3,145.95" "$3,199.43" "$1,550.95" "$3,145.95" "$3,199.43" "$3,145.95" "$3,145.95" "$2,359.50" "$3,145.95" "$3,145.95" "$3,145.95" "$1,572.98" "$1,572.98" "$2,491.59" "$3,145.95" "$2,516.76" "$1,415.68" $624.39 N/A "$1,824.68" "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" N/A N/A 02.110.152 SUP HCPCS C1713 02.110.152 - PLATE BONE STR 112MM FUSION LCP STAINLESS STEEL WRIST BOTH IP/OP "$3,146.00" "$2,328.00" $624.39 "$3,199.43" "$1,415.68" "$1,415.68" "$1,415.68" "$1,415.68" "$3,145.95" "$3,145.95" "$3,145.95" $655.69 "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" $655.65 "$3,145.95" "$1,279.77" "$1,550.95" "$3,145.95" "$3,199.43" "$3,145.95" "$3,145.95" "$2,359.50" "$3,145.95" "$3,145.95" "$3,145.95" "$1,572.98" "$1,572.98" "$2,491.59" "$3,145.95" "$2,516.76" "$1,415.68" $624.39 N/A "$1,824.68" "$3,145.95" "$3,145.95" "$3,145.95" $655.62 "$3,145.95" N/A N/A 02.110.201 SUP HCPCS C1713 02.110.201 - PLATE BN 48MM NS LCP CMBN 5 HLE/HD 3 HL SHFT VA SS RDS RT BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 02.110.202 SUP HCPCS C1713 02.110.202 - PLATE BN 66MM NS LCP CMBN 5 HLE/HD 5 HL SHFT VA SS RDS RT BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" $420.09 "$2,015.78" N/A N/A 02.110.203 SUP HCPCS C1713 02.110.203 - PLATE BN 48MM NS LCP CMBN 5 HLE/HD 3 HL SHFT VA SS RDS LT BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 02.110.204 SUP HCPCS C1713 02.110.204 - PLATE BN 66MM NS LCP CMBN 5 HLE/HD 5 HL SHFT VA SS RDS LT BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" $420.09 "$2,015.78" N/A N/A 02.110.205 SUP HCPCS C1713 02.110.205 - PLATE BN 45MM NS LCP CMBN 4 HLE/HD 3 HL SHFT VA SS RDS RT BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 02.110.206 SUP HCPCS C1713 02.110.206 - PLATE BN 65MM NS LCP CMBN 4 HLE/HD 5 HL SHFT VA SS RDS RT BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" $420.09 "$2,015.78" N/A N/A 02.110.207 SUP HCPCS C1713 02.110.207 - PLATE BN 45MM NS LCP CMBN 4 HLE/HD 3 HL SHFT VA SS RDS LT BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 02.110.208 SUP HCPCS C1713 02.110.208 - PLATE BN 65MM NS LCP CMBN 4 HLE/HD 5 HL SHFT VA SS RDS LT BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" $420.09 "$2,015.78" N/A N/A 02.110.300 SUP Custom 27203010 02.110.300 - WIRE FIX 1.8MM 150MM TROCAR POINT KWIRE STAINLESS STEEL BOTH IP/OP $15.50 $11.00 $2.70 $15.44 $15.18 $15.18 $15.18 $15.18 $15.18 $15.18 $2.70 $15.18 $15.18 $11.27 $11.27 $11.70 $7.91 $3.16 $15.18 $6.18 $15.18 $15.18 $15.44 $15.18 $15.18 $11.63 $15.18 $15.18 $15.18 $7.59 $7.59 $12.02 $15.18 $12.14 $9.87 $15.18 N/A $8.99 $15.18 $9.11 $15.18 $15.18 $15.18 N/A N/A 02.110.330 SUP HCPCS C1713 02.110.330 - PLATE BN CNTR 50.5MM NS LCP CMBN 9 HLE/HD 3 HL SHFT CLMN RND BOTH IP/OP "$1,570.50" "$1,162.00" $311.64 "$1,596.85" $706.57 $706.57 $706.57 $706.57 "$1,570.15" "$1,570.15" "$1,570.15" $327.26 "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" $327.24 "$1,570.15" $638.74 $928.74 "$1,570.15" "$1,596.85" "$1,570.15" "$1,570.15" "$1,177.88" "$1,570.15" "$1,570.15" "$1,570.15" $785.08 $785.08 "$1,243.56" "$1,570.15" "$1,256.12" $706.57 $311.64 N/A $910.89 "$1,570.15" "$1,570.15" "$1,570.15" $327.22 "$1,570.15" N/A N/A 02.110.331 SUP HCPCS C1713 02.110.331 - PLATE BN CNTR 50.5MM NS LCP CMBN 9 HLE/HD 3 HL SHFT CLMN RND BOTH IP/OP "$1,570.50" "$1,162.00" $311.64 "$1,596.85" $706.57 $706.57 $706.57 $706.57 "$1,570.15" "$1,570.15" "$1,570.15" $327.26 "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" $327.24 "$1,570.15" "$1,596.85" $928.74 "$1,570.15" "$1,596.85" "$1,570.15" "$1,570.15" "$1,177.88" "$1,570.15" "$1,570.15" "$1,570.15" $785.08 $785.08 "$1,243.56" "$1,570.15" "$1,256.12" $706.57 $311.64 N/A $910.89 "$1,570.15" "$1,570.15" "$1,570.15" $327.22 "$1,570.15" N/A N/A 02.110.340 SUP HCPCS C1713 02.110.340 - PLATE BN CNTR 59.5MM NS LCP CMBN 9 HLE/HD 4 HL SHFT CLMN RND BOTH IP/OP "$1,619.50" "$1,198.00" $321.40 "$1,646.88" $728.71 $728.71 $728.71 $728.71 "$1,619.35" "$1,619.35" "$1,619.35" $337.51 "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" $337.49 "$1,619.35" $658.75 $957.85 "$1,619.35" "$1,646.88" "$1,619.35" "$1,619.35" "$1,214.63" "$1,619.35" "$1,619.35" "$1,619.35" $809.68 $809.68 "$1,282.53" "$1,619.35" "$1,295.48" $728.71 $321.40 N/A $939.31 "$1,619.35" "$1,619.35" "$1,619.35" $337.47 "$1,619.35" N/A N/A 02.110.341 SUP HCPCS C1713 02.110.341 - PLATE BN CNTR 59.5MM NS LCP CMBN 9 HLE/HD 4 HL SHFT CLMN RND BOTH IP/OP "$1,619.50" "$1,198.00" $321.40 "$1,646.88" $728.71 $728.71 $728.71 $728.71 "$1,619.35" "$1,619.35" "$1,619.35" $337.51 "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" $337.49 "$1,619.35" $658.75 $957.85 "$1,619.35" "$1,646.88" "$1,619.35" "$1,619.35" "$1,214.63" "$1,619.35" "$1,619.35" "$1,619.35" $809.68 $809.68 "$1,282.53" "$1,619.35" "$1,295.48" $728.71 $321.40 N/A $939.31 "$1,619.35" $971.61 "$1,619.35" $337.47 "$1,619.35" N/A N/A 02.110.350 SUP HCPCS C1713 02.110.350 - PLATE BN CNTR 68.5MM NS LCP CMBN 9 HLE/HD 5 HL SHFT CLMN RND BOTH IP/OP "$1,667.50" "$1,234.00" $330.89 "$1,695.50" $750.22 $750.22 $750.22 $750.22 "$1,667.15" "$1,667.15" "$1,667.15" $347.48 "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" $347.45 "$1,667.15" "$1,695.50" $986.12 "$1,667.15" "$1,695.50" "$1,667.15" "$1,667.15" "$1,250.63" "$1,667.15" "$1,667.15" "$1,667.15" $833.58 $833.58 "$1,320.38" "$1,667.15" "$1,333.72" $750.22 $330.89 N/A $967.15 "$1,667.15" "$1,000.29" "$1,667.15" $347.43 "$1,667.15" N/A N/A 02.110.351 SUP HCPCS C1713 02.110.351 - PLATE BN CNTR 68.5MM NS LCP CMBN 9 HLE/HD 5 HL SHFT CLMN RND BOTH IP/OP "$1,667.50" "$1,234.00" $330.89 "$1,695.50" $750.22 $750.22 $750.22 $750.22 "$1,667.15" "$1,667.15" "$1,667.15" $347.48 "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" $347.45 "$1,667.15" $678.20 $986.12 "$1,667.15" "$1,695.50" "$1,667.15" "$1,667.15" "$1,250.63" "$1,667.15" "$1,667.15" "$1,667.15" $833.58 $833.58 "$1,320.38" "$1,667.15" "$1,333.72" $750.22 $330.89 N/A $967.15 "$1,667.15" "$1,000.29" "$1,667.15" $347.43 "$1,667.15" N/A N/A 02.110.430 SUP HCPCS C1713 02.110.430 - PLATE BN CNTR 50.5MM NS LCP CMBN 8 HLE/HD 3 HL SHFT CLMN RND BOTH IP/OP "$1,570.50" "$1,162.00" $311.64 "$1,596.85" $706.57 $706.57 $706.57 $706.57 "$1,570.15" "$1,570.15" "$1,570.15" $327.26 "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" $327.24 "$1,570.15" "$1,596.85" $928.74 "$1,570.15" "$1,596.85" "$1,570.15" "$1,570.15" "$1,177.88" "$1,570.15" "$1,570.15" "$1,570.15" $785.08 $785.08 "$1,243.56" "$1,570.15" "$1,256.12" $706.57 $311.64 N/A $910.89 "$1,570.15" "$1,570.15" "$1,570.15" $327.22 "$1,570.15" N/A N/A 02.110.431 SUP HCPCS C1713 02.110.431 - PLATE BN CNTR 50.5MM NS LCP CMBN 8 HLE/HD 3 HL SHFT CLMN RND BOTH IP/OP "$1,570.50" "$1,162.00" $311.64 "$1,596.85" $706.57 $706.57 $706.57 $706.57 "$1,570.15" "$1,570.15" "$1,570.15" $327.26 "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" $327.24 "$1,570.15" $638.74 $928.74 "$1,570.15" "$1,596.85" "$1,570.15" "$1,570.15" "$1,177.88" "$1,570.15" "$1,570.15" "$1,570.15" $785.08 $785.08 "$1,243.56" "$1,570.15" "$1,256.12" $706.57 $311.64 N/A $910.89 "$1,570.15" $942.09 "$1,570.15" $327.22 "$1,570.15" N/A N/A 02.110.440 SUP HCPCS C1713 02.110.440 - PLATE BN CNTR 59.5MM NS LCP CMBN 8 HLE/HD 4 HL SHFT CLMN RND BOTH IP/OP "$1,619.50" "$1,198.00" $321.40 "$1,646.88" $728.71 $728.71 $728.71 $728.71 "$1,619.35" "$1,619.35" "$1,619.35" $337.51 "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" $337.49 "$1,619.35" "$1,646.88" $957.85 "$1,619.35" "$1,646.88" "$1,619.35" "$1,619.35" "$1,214.63" "$1,619.35" "$1,619.35" "$1,619.35" $809.68 $809.68 "$1,282.53" "$1,619.35" "$1,295.48" $728.71 $321.40 N/A $939.31 "$1,619.35" $971.61 "$1,619.35" $337.47 "$1,619.35" N/A N/A 02.110.441 SUP HCPCS C1713 02.110.441 - PLATE BN CNTR 59.5MM NS LCP CMBN 8 HLE/HD 4 HL SHFT CLMN RND BOTH IP/OP "$1,619.50" "$1,198.00" $321.40 "$1,646.88" $728.71 $728.71 $728.71 $728.71 "$1,619.35" "$1,619.35" "$1,619.35" $337.51 "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" $337.49 "$1,619.35" $658.75 $957.85 "$1,619.35" "$1,646.88" "$1,619.35" "$1,619.35" "$1,214.63" "$1,619.35" "$1,619.35" "$1,619.35" $809.68 $809.68 "$1,282.53" "$1,619.35" "$1,295.48" $728.71 $321.40 N/A $939.31 "$1,619.35" $971.61 "$1,619.35" $337.47 "$1,619.35" N/A N/A 02.110.450 SUP HCPCS C1713 02.110.450 - PLATE BN CNTR 68.5MM NS LCP CMBN 8 HLE/HD 5 HL SHFT CLMN RND BOTH IP/OP "$1,667.50" "$1,234.00" $330.89 "$1,695.50" $750.22 $750.22 $750.22 $750.22 "$1,667.15" "$1,667.15" "$1,667.15" $347.48 "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" $347.45 "$1,667.15" "$1,695.50" $986.12 "$1,667.15" "$1,695.50" "$1,667.15" "$1,667.15" "$1,250.63" "$1,667.15" "$1,667.15" "$1,667.15" $833.58 $833.58 "$1,320.38" "$1,667.15" "$1,333.72" $750.22 $330.89 N/A $967.15 "$1,667.15" "$1,000.29" "$1,667.15" $347.43 "$1,667.15" N/A N/A 02.110.451 SUP HCPCS C1713 02.110.451 - PLATE BN CNTR 68.5MM NS LCP CMBN 8 HLE/HD 5 HL SHFT CLMN RND BOTH IP/OP "$1,667.50" "$1,234.00" $330.89 "$1,695.50" $750.22 $750.22 $750.22 $750.22 "$1,667.15" "$1,667.15" "$1,667.15" $347.48 "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" $347.45 "$1,667.15" $678.20 $986.12 "$1,667.15" "$1,695.50" "$1,667.15" "$1,667.15" "$1,250.63" "$1,667.15" "$1,667.15" "$1,667.15" $833.58 $833.58 "$1,320.38" "$1,667.15" "$1,333.72" $750.22 $330.89 N/A $967.15 "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" N/A N/A 02.110.730 SUP HCPCS C1713 02.110.730 - PLATE BN CNTR 45MM NS LCP CMBN 6 HLE/HD 3 HL SHFT CLMN RND BOTH IP/OP "$1,570.50" "$1,162.00" $311.64 "$1,596.85" $706.57 $706.57 $706.57 $706.57 "$1,570.15" "$1,570.15" "$1,570.15" $327.26 "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" $327.24 "$1,570.15" $638.74 $928.74 "$1,570.15" "$1,596.85" "$1,570.15" "$1,570.15" "$1,177.88" "$1,570.15" "$1,570.15" "$1,570.15" $785.08 $785.08 "$1,243.56" "$1,570.15" "$1,256.12" $706.57 $311.64 N/A $910.89 "$1,570.15" "$1,570.15" "$1,570.15" $327.22 "$1,570.15" N/A N/A 02.110.731 SUP HCPCS C1713 02.110.731 - PLATE BN CNTR 45MM NS LCP CMBN 6 HLE/HD 3 HL SHFT CLMN RND BOTH IP/OP "$1,570.50" "$1,162.00" $311.64 "$1,596.85" $706.57 $706.57 $706.57 $706.57 "$1,570.15" "$1,570.15" "$1,570.15" $327.26 "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" $327.24 "$1,570.15" $638.74 $928.74 "$1,570.15" "$1,596.85" "$1,570.15" "$1,570.15" "$1,177.88" "$1,570.15" "$1,570.15" "$1,570.15" $785.08 $785.08 "$1,243.56" "$1,570.15" "$1,256.12" $706.57 $311.64 N/A $910.89 "$1,570.15" $942.09 "$1,570.15" "$1,570.15" "$1,570.15" N/A N/A 02.110.740 SUP HCPCS C1713 02.110.740 - PLATE BN CNTR 54MM NS LCP CMBN 6 HLE/HD 4 HL SHFT CLMN RND BOTH IP/OP "$1,619.50" "$1,198.00" $321.40 "$1,646.88" $728.71 $728.71 $728.71 $728.71 "$1,619.35" "$1,619.35" "$1,619.35" $337.51 "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" $337.49 "$1,619.35" $658.75 $957.85 "$1,619.35" "$1,646.88" "$1,619.35" "$1,619.35" "$1,214.63" "$1,619.35" "$1,619.35" "$1,619.35" $809.68 $809.68 "$1,282.53" "$1,619.35" "$1,295.48" $728.71 $321.40 N/A $939.31 "$1,619.35" $971.61 "$1,619.35" "$1,619.35" "$1,619.35" N/A N/A 02.110.741 SUP HCPCS C1713 02.110.741 - PLATE BN CNTR 54MM NS LCP CMBN 6 HLE/HD 4 HL SHFT CLMN RND BOTH IP/OP "$1,619.50" "$1,198.00" $321.40 "$1,646.88" $728.71 $728.71 $728.71 $728.71 "$1,619.35" "$1,619.35" "$1,619.35" $337.51 "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" $337.49 "$1,619.35" $658.75 $957.85 "$1,619.35" "$1,646.88" "$1,619.35" "$1,619.35" "$1,214.63" "$1,619.35" "$1,619.35" "$1,619.35" $809.68 $809.68 "$1,282.53" "$1,619.35" "$1,295.48" $728.71 $321.40 N/A $939.31 "$1,619.35" "$1,619.35" "$1,619.35" $337.47 "$1,619.35" N/A N/A 02.110.750 SUP HCPCS C1713 02.110.750 - PLATE BN CNTR 63MM NS LCP CMBN 6 HLE/HD 5 HL SHFT CLMN RND BOTH IP/OP "$1,667.50" "$1,234.00" $330.89 "$1,695.50" $750.22 $750.22 $750.22 $750.22 "$1,667.15" "$1,667.15" "$1,667.15" $347.48 "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" $347.45 "$1,667.15" $678.20 $986.12 "$1,667.15" "$1,695.50" "$1,667.15" "$1,667.15" "$1,250.63" "$1,667.15" "$1,667.15" "$1,667.15" $833.58 $833.58 "$1,320.38" "$1,667.15" "$1,333.72" $750.22 $330.89 N/A $967.15 "$1,667.15" "$1,667.15" "$1,667.15" $347.43 "$1,667.15" N/A N/A 02.110.751 SUP HCPCS C1713 02.110.751 - PLATE BN CNTR 63MM NS LCP CMBN 6 HLE/HD 5 HL SHFT CLMN RND BOTH IP/OP "$1,667.50" "$1,234.00" $330.89 "$1,695.50" $750.22 $750.22 $750.22 $750.22 "$1,667.15" "$1,667.15" "$1,667.15" $347.48 "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" $347.45 "$1,667.15" $678.20 $986.12 "$1,667.15" "$1,695.50" "$1,667.15" "$1,667.15" "$1,250.63" "$1,667.15" "$1,667.15" "$1,667.15" $833.58 $833.58 "$1,320.38" "$1,667.15" "$1,333.72" $750.22 $330.89 N/A $967.15 "$1,667.15" "$1,667.15" "$1,667.15" $347.43 "$1,667.15" N/A N/A 02.110.830 SUP HCPCS C1713 02.110.830 - PLATE BN CNTR 45MM NS LCP CMBN 7 HLE/HD 3 HL SHFT CLMN RND BOTH IP/OP "$1,570.50" "$1,162.00" $311.64 "$1,596.85" $706.57 $706.57 $706.57 $706.57 "$1,570.15" "$1,570.15" "$1,570.15" $327.26 "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" $327.24 "$1,570.15" $638.74 $928.74 "$1,570.15" "$1,596.85" "$1,570.15" "$1,570.15" "$1,177.88" "$1,570.15" "$1,570.15" "$1,570.15" $785.08 $785.08 "$1,243.56" "$1,570.15" "$1,256.12" $706.57 $311.64 N/A $910.89 "$1,570.15" $942.09 "$1,570.15" "$1,570.15" "$1,570.15" N/A N/A 02.110.831 SUP HCPCS C1713 02.110.831 - PLATE BN CNTR 45MM NS LCP CMBN 7 HLE/HD 3 HL SHFT CLMN RND BOTH IP/OP "$1,570.50" "$1,162.00" $311.64 "$1,596.85" $706.57 $706.57 $706.57 $706.57 "$1,570.15" "$1,570.15" "$1,570.15" $327.26 "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" "$1,570.15" $327.24 "$1,570.15" $638.74 $928.74 "$1,570.15" "$1,596.85" "$1,570.15" "$1,570.15" "$1,177.88" "$1,570.15" "$1,570.15" "$1,570.15" $785.08 $785.08 "$1,243.56" "$1,570.15" "$1,256.12" $706.57 $311.64 N/A $910.89 "$1,570.15" "$1,570.15" "$1,570.15" $327.22 "$1,570.15" N/A N/A 02.110.840 SUP HCPCS C1713 02.110.840 - PLATE BN CNTR 54MM NS LCP CMBN 7 HLE/HD 4 HL SHFT CLMN RND BOTH IP/OP "$1,619.50" "$1,198.00" $321.40 "$1,646.88" $728.71 $728.71 $728.71 $728.71 "$1,619.35" "$1,619.35" "$1,619.35" $337.51 "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" $337.49 "$1,619.35" "$1,646.88" $957.85 "$1,619.35" "$1,646.88" "$1,619.35" "$1,619.35" "$1,214.63" "$1,619.35" "$1,619.35" "$1,619.35" $809.68 $809.68 "$1,282.53" "$1,619.35" "$1,295.48" $728.71 $321.40 N/A $939.31 "$1,619.35" $971.61 "$1,619.35" "$1,619.35" "$1,619.35" N/A N/A 02.110.841 SUP HCPCS C1713 02.110.841 - PLATE BN CNTR 54MM NS LCP CMBN 7 HLE/HD 4 HL SHFT CLMN RND BOTH IP/OP "$1,619.50" "$1,198.00" $321.40 "$1,646.88" $728.71 $728.71 $728.71 $728.71 "$1,619.35" "$1,619.35" "$1,619.35" $337.51 "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" $337.49 "$1,619.35" $658.75 $957.85 "$1,619.35" "$1,646.88" "$1,619.35" "$1,619.35" "$1,214.63" "$1,619.35" "$1,619.35" "$1,619.35" $809.68 $809.68 "$1,282.53" "$1,619.35" "$1,295.48" $728.71 $321.40 N/A $939.31 "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" "$1,619.35" N/A N/A 02.110.850 SUP HCPCS C1713 02.110.850 - PLATE BN CNTR 63MM NS LCP CMBN 7 HLE/HD 5 HL SHFT CLMN RND BOTH IP/OP "$1,667.50" "$1,234.00" $330.89 "$1,695.50" $750.22 $750.22 $750.22 $750.22 "$1,667.15" "$1,667.15" "$1,667.15" $347.48 "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" $347.45 "$1,667.15" $678.20 $986.12 "$1,667.15" "$1,695.50" "$1,667.15" "$1,667.15" "$1,250.63" "$1,667.15" "$1,667.15" "$1,667.15" $833.58 $833.58 "$1,320.38" "$1,667.15" "$1,333.72" $750.22 $330.89 N/A $967.15 "$1,667.15" "$1,667.15" "$1,667.15" $347.43 "$1,667.15" N/A N/A 02.110.851 SUP HCPCS C1713 02.110.851 - PLATE BN CNTR 63MM NS LCP CMBN 7 HLE/HD 5 HL SHFT CLMN RND BOTH IP/OP "$1,667.50" "$1,234.00" $330.89 "$1,695.50" $750.22 $750.22 $750.22 $750.22 "$1,667.15" "$1,667.15" "$1,667.15" $347.48 "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" "$1,667.15" $347.45 "$1,667.15" $678.20 $986.12 "$1,667.15" "$1,695.50" "$1,667.15" "$1,667.15" "$1,250.63" "$1,667.15" "$1,667.15" "$1,667.15" $833.58 $833.58 "$1,320.38" "$1,667.15" "$1,333.72" $750.22 $330.89 N/A $967.15 "$1,667.15" "$1,667.15" "$1,667.15" $347.43 "$1,667.15" N/A N/A 02.111.500.01S SUP HCPCS C1713 02.111.500.01S - PLATE BONE 1.25MM 150MM REDX SMALL STOP WIRE THREADED BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 02.111.500.10 SUP HCPCS C1713 02.111.500.10 - WIRE REDX SMALL 1.25MM 150MM THREAD STOP STAINLESS STEEL BOTH IP/OP $32.50 $24.00 $6.39 $32.74 $14.49 $14.49 $14.49 $14.49 $32.19 $32.19 $32.19 $6.71 $32.19 $32.19 $32.19 $32.19 $32.19 $6.71 $32.19 $13.10 $19.04 $32.19 $32.74 $32.19 $32.19 $24.38 $32.19 $32.19 $32.19 $16.10 $16.10 $25.49 $32.19 $25.75 $14.49 $6.39 N/A $18.85 $32.19 $32.19 $32.19 $6.71 $32.19 N/A N/A 02.111.501.01S SUP HCPCS C1713 02.111.501.01S - PLATE BONE 1.25MM REDX WIRE LARGE STOP THREADED TIP LCP BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 02.111.501.10 SUP HCPCS C1713 02.111.501.10 - WIRE REDX 1.25MM 150MM THREAD TIP LARGE STOP STAINLESS STEEL BOTH IP/OP $31.50 $23.00 $6.20 $32.74 $14.06 $14.06 $14.06 $14.06 $31.25 $31.25 $31.25 $6.51 $31.25 $31.25 $31.25 $31.25 $31.25 $6.51 $31.25 $13.10 $18.48 $31.25 $32.74 $31.25 $31.25 $23.63 $31.25 $31.25 $31.25 $15.63 $15.63 $24.75 $31.25 $25.00 $14.06 $6.20 N/A $18.27 $31.25 $31.25 $31.25 $6.51 $31.25 N/A N/A 02.111.520 SUP HCPCS C1713 02.111.520 - PLATE BONE 42MM 6X2 HOLE 2 COLUMN VAR ANG LCP STAINLESS BOTH IP/OP "$1,802.50" "$1,334.00" $357.67 "$1,832.73" $810.95 $810.95 $810.95 $810.95 "$1,802.10" "$1,802.10" "$1,802.10" $375.60 "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" $375.58 "$1,802.10" "$1,832.73" "$1,065.94" "$1,802.10" "$1,832.73" "$1,802.10" "$1,802.10" "$1,351.88" "$1,802.10" "$1,802.10" "$1,802.10" $901.05 $901.05 "$1,427.26" "$1,802.10" "$1,441.68" $810.95 $357.67 N/A "$1,045.45" "$1,802.10" "$1,802.10" "$1,802.10" $375.56 "$1,802.10" N/A N/A 02.111.521 SUP HCPCS C1713 02.111.521 - PLATE BN NAR 42MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA BOTH IP/OP "$1,802.50" "$1,334.00" $357.67 "$1,832.73" $810.95 $810.95 $810.95 $810.95 "$1,802.10" "$1,802.10" "$1,802.10" $375.60 "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" $375.58 "$1,802.10" "$1,832.73" "$1,065.94" "$1,802.10" "$1,832.73" "$1,802.10" "$1,802.10" "$1,351.88" "$1,802.10" "$1,802.10" "$1,802.10" $901.05 $901.05 "$1,427.26" "$1,802.10" "$1,441.68" $810.95 $357.67 N/A "$1,045.45" "$1,802.10" "$1,802.10" "$1,802.10" $375.56 "$1,802.10" N/A N/A 02.111.530 SUP HCPCS C1713 02.111.530 - PLATE BN NAR 51MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 02.111.530S SUP HCPCS C1713 02.111.530S - PLATE BN NAR 51MM STRL LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA BOTH IP/OP "$1,965.50" "$1,454.00" $390.03 "$1,998.55" $884.32 $884.32 $884.32 $884.32 "$1,965.15" "$1,965.15" "$1,965.15" $409.59 "$1,965.15" "$1,965.15" "$1,965.15" "$1,965.15" "$1,965.15" $409.56 "$1,965.15" $799.42 "$1,162.39" "$1,965.15" "$1,998.55" "$1,965.15" "$1,965.15" "$1,474.13" "$1,965.15" "$1,965.15" "$1,965.15" $982.58 $982.58 "$1,556.40" "$1,965.15" "$1,572.12" $884.32 $390.03 N/A "$1,139.99" "$1,965.15" "$1,965.15" "$1,965.15" $409.54 "$1,965.15" N/A N/A 02.111.531 SUP HCPCS C1713 02.111.531 - PLATE BONE NARROW 51MM 6X3 HOLE 2 COLUMN VAR ANG LCP BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 02.111.540 SUP HCPCS C1713 02.111.540 - PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG SET LCP BOTH IP/OP "$1,944.50" "$1,439.00" $385.85 "$1,977.13" $874.84 $874.84 $874.84 $874.84 "$1,944.08" "$1,944.08" "$1,944.08" $405.19 "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" $405.17 "$1,944.08" "$1,977.13" "$1,149.92" "$1,944.08" "$1,977.13" "$1,944.08" "$1,944.08" "$1,458.38" "$1,944.08" "$1,944.08" "$1,944.08" $972.04 $972.04 "$1,539.71" "$1,944.08" "$1,555.26" $874.84 $385.85 N/A "$1,127.81" "$1,944.08" "$1,944.08" "$1,944.08" $405.15 "$1,944.08" N/A N/A 02.111.541 SUP HCPCS C1713 02.111.541 - PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG LCP BOTH IP/OP "$1,944.50" "$1,439.00" $385.85 "$1,977.13" $874.84 $874.84 $874.84 $874.84 "$1,944.08" "$1,944.08" "$1,944.08" $405.19 "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" $405.17 "$1,944.08" "$1,977.13" "$1,149.92" "$1,944.08" "$1,977.13" "$1,944.08" "$1,944.08" "$1,458.38" "$1,944.08" "$1,944.08" "$1,944.08" $972.04 $972.04 "$1,539.71" "$1,944.08" "$1,555.26" $874.84 $385.85 N/A "$1,127.81" "$1,944.08" "$1,944.08" "$1,944.08" $405.15 "$1,944.08" N/A N/A 02.111.541S SUP HCPCS C1713 02.111.541S - PLATE BN NAR 63MM STRL LCP CMBN 6 HLE/HD 4 HL SHFT 2 CLMN VA BOTH IP/OP "$2,035.50" "$1,506.00" $403.99 "$2,070.05" $915.95 $915.95 $915.95 $915.95 "$2,035.45" "$2,035.45" "$2,035.45" $424.24 "$2,035.45" "$2,035.45" "$2,035.45" "$2,035.45" "$2,035.45" $424.21 "$2,035.45" $828.02 "$1,203.97" "$2,035.45" "$2,070.05" "$2,035.45" "$2,035.45" "$1,526.63" "$2,035.45" "$2,035.45" "$2,035.45" "$1,017.73" "$1,017.73" "$1,612.08" "$2,035.45" "$1,628.36" $915.95 $403.99 N/A "$1,180.59" "$2,035.45" "$2,035.45" "$2,035.45" $424.19 "$2,035.45" N/A N/A 02.111.550 SUP HCPCS C1713 02.111.550 - PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG LCP BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" $420.09 "$2,015.78" N/A N/A 02.111.551 SUP HCPCS C1713 02.111.551 - PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG SET LCP BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" $420.09 "$2,015.78" N/A N/A 02.111.620 SUP HCPCS C1713 02.111.620 - PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA BOTH IP/OP "$1,802.50" "$1,334.00" $357.67 "$1,832.73" $810.95 $810.95 $810.95 $810.95 "$1,802.10" "$1,802.10" "$1,802.10" $375.60 "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" $375.58 "$1,802.10" "$1,832.73" "$1,065.94" "$1,802.10" "$1,832.73" "$1,802.10" "$1,802.10" "$1,351.88" "$1,802.10" "$1,802.10" "$1,802.10" $901.05 $901.05 "$1,427.26" "$1,802.10" "$1,441.68" $810.95 $357.67 N/A "$1,045.45" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" N/A N/A 02.111.620S SUP HCPCS C1713 02.111.620S - PLATE BN 45MM STRL LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA SS BOTH IP/OP "$1,893.50" "$1,401.00" $375.81 "$1,925.68" $852.07 $852.07 $852.07 $852.07 "$1,893.48" "$1,893.48" "$1,893.48" $394.65 "$1,893.48" "$1,893.48" "$1,893.48" "$1,893.48" "$1,893.48" $394.62 "$1,893.48" $770.27 "$1,119.99" "$1,893.48" "$1,925.68" "$1,893.48" "$1,893.48" "$1,420.13" "$1,893.48" "$1,893.48" "$1,893.48" $946.74 $946.74 "$1,499.64" "$1,893.48" "$1,514.78" $852.07 $375.81 N/A "$1,098.23" "$1,893.48" "$1,893.48" "$1,893.48" $394.60 "$1,893.48" N/A N/A 02.111.621 SUP HCPCS C1713 02.111.621 - PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA BOTH IP/OP "$1,802.50" "$1,334.00" $357.67 "$1,832.73" $810.95 $810.95 $810.95 $810.95 "$1,802.10" "$1,802.10" "$1,802.10" $375.60 "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" $375.58 "$1,802.10" "$1,832.73" "$1,065.94" "$1,802.10" "$1,832.73" "$1,802.10" "$1,802.10" "$1,351.88" "$1,802.10" "$1,802.10" "$1,802.10" $901.05 $901.05 "$1,427.26" "$1,802.10" "$1,441.68" $810.95 $357.67 N/A "$1,045.45" "$1,802.10" "$1,802.10" "$1,802.10" $375.56 "$1,802.10" N/A N/A 02.111.621S SUP HCPCS C1713 02.111.621S - PLATE BN 45MM STRL LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA SS BOTH IP/OP "$1,893.50" "$1,401.00" $375.81 "$1,925.68" $852.07 $852.07 $852.07 $852.07 "$1,893.48" "$1,893.48" "$1,893.48" $394.65 "$1,893.48" "$1,893.48" "$1,893.48" "$1,893.48" "$1,893.48" $394.62 "$1,893.48" "$1,925.68" "$1,119.99" "$1,893.48" "$1,925.68" "$1,893.48" "$1,893.48" "$1,420.13" "$1,893.48" "$1,893.48" "$1,893.48" $946.74 $946.74 "$1,499.64" "$1,893.48" "$1,514.78" $852.07 $375.81 N/A "$1,098.23" "$1,893.48" "$1,893.48" "$1,893.48" $394.60 "$1,893.48" N/A N/A 02.111.630 SUP HCPCS C1713 02.111.630 - PLATE BN STD 54MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 02.111.630S SUP HCPCS C1713 02.111.630S - PLATE BONE 58MM 6X3 HOLE 2 COLUMN VAR ANG LCP STAINLESS BOTH IP/OP "$1,965.50" "$1,454.00" $390.03 "$1,998.55" $884.32 $884.32 $884.32 $884.32 "$1,965.15" "$1,965.15" "$1,965.15" $409.59 "$1,965.15" "$1,965.15" "$1,965.15" "$1,965.15" "$1,965.15" $409.56 "$1,965.15" $799.42 "$1,162.39" "$1,965.15" "$1,998.55" "$1,965.15" "$1,965.15" "$1,474.13" "$1,965.15" "$1,965.15" "$1,965.15" $982.58 $982.58 "$1,556.40" "$1,965.15" "$1,572.12" $884.32 $390.03 N/A "$1,139.99" "$1,965.15" "$1,965.15" "$1,965.15" $409.54 "$1,965.15" N/A N/A 02.111.631 SUP HCPCS C1713 02.111.631 - PLATE BN STD 54MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" $762.26 "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 02.111.631S SUP HCPCS C1713 02.111.631S - PLATE BONE 54MM 6X3 HOLE 2 COLUMN VAR ANG LCP STAINLESS BOTH IP/OP "$1,965.50" "$1,454.00" $390.03 "$1,998.55" $884.32 $884.32 $884.32 $884.32 "$1,965.15" "$1,965.15" "$1,965.15" $409.59 "$1,965.15" "$1,965.15" "$1,965.15" "$1,965.15" "$1,965.15" $409.56 "$1,965.15" "$1,998.55" "$1,162.39" "$1,965.15" "$1,998.55" "$1,965.15" "$1,965.15" "$1,474.13" "$1,965.15" "$1,965.15" "$1,965.15" $982.58 $982.58 "$1,556.40" "$1,965.15" "$1,572.12" $884.32 $390.03 N/A "$1,139.99" "$1,965.15" "$1,965.15" "$1,965.15" "$1,965.15" "$1,965.15" N/A N/A 02.111.640 SUP HCPCS C1713 02.111.640 - PLATE BN STD 66MM NS LCP CMBN 6 HLE/HD 4 HL SHFT 2 CLMN VA BOTH IP/OP "$1,944.50" "$1,439.00" $385.85 "$1,977.13" $874.84 $874.84 $874.84 $874.84 "$1,944.08" "$1,944.08" "$1,944.08" $405.19 "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" $405.17 "$1,944.08" "$1,977.13" "$1,149.92" "$1,944.08" "$1,977.13" "$1,944.08" "$1,944.08" "$1,458.38" "$1,944.08" "$1,944.08" "$1,944.08" $972.04 $972.04 "$1,539.71" "$1,944.08" "$1,555.26" $874.84 $385.85 N/A "$1,127.81" "$1,944.08" "$1,944.08" "$1,944.08" $405.15 "$1,944.08" N/A N/A 02.111.640S SUP HCPCS C1713 02.111.640S - PLATE BN 66MM STRL LCP CMBN 6 HLE/HD 4 HL SHFT 2 CLMN VA SS BOTH IP/OP "$2,035.50" "$1,506.00" $403.99 "$2,070.05" $915.95 $915.95 $915.95 $915.95 "$2,035.45" "$2,035.45" "$2,035.45" $424.24 "$2,035.45" "$2,035.45" "$2,035.45" "$2,035.45" "$2,035.45" $424.21 "$2,035.45" "$2,070.05" "$1,203.97" "$2,035.45" "$2,070.05" "$2,035.45" "$2,035.45" "$1,526.63" "$2,035.45" "$2,035.45" "$2,035.45" "$1,017.73" "$1,017.73" "$1,612.08" "$2,035.45" "$1,628.36" $915.95 $403.99 N/A "$1,180.59" "$2,035.45" "$2,035.45" "$2,035.45" $424.19 "$2,035.45" N/A N/A 02.111.641 SUP HCPCS C1713 02.111.641 - PLATE BN STD 66MM NS LCP CMBN 6 HLE/HD 4 HL SHFT 2 CLMN VA BOTH IP/OP "$1,944.50" "$1,439.00" $385.85 "$1,977.13" $874.84 $874.84 $874.84 $874.84 "$1,944.08" "$1,944.08" "$1,944.08" $405.19 "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" $405.17 "$1,944.08" $790.85 "$1,149.92" "$1,944.08" "$1,977.13" "$1,944.08" "$1,944.08" "$1,458.38" "$1,944.08" "$1,944.08" "$1,944.08" $972.04 $972.04 "$1,539.71" "$1,944.08" "$1,555.26" $874.84 $385.85 N/A "$1,127.81" "$1,944.08" "$1,944.08" "$1,944.08" $405.15 "$1,944.08" N/A N/A 02.111.641S SUP HCPCS C1713 02.111.641S - PLATE BN 66MM STRL LCP CMBN 6 HLE/HD 4 HL SHFT 2 CLMN VA SS BOTH IP/OP "$2,035.50" "$1,506.00" $403.99 "$2,070.05" $915.95 $915.95 $915.95 $915.95 "$2,035.45" "$2,035.45" "$2,035.45" $424.24 "$2,035.45" "$2,035.45" "$2,035.45" "$2,035.45" "$2,035.45" $424.21 "$2,035.45" $828.02 "$1,203.97" "$2,035.45" "$2,070.05" "$2,035.45" "$2,035.45" "$1,526.63" "$2,035.45" "$2,035.45" "$2,035.45" "$1,017.73" "$1,017.73" "$1,612.08" "$2,035.45" "$1,628.36" $915.95 $403.99 N/A "$1,180.59" "$2,035.45" "$2,035.45" "$2,035.45" $424.19 "$2,035.45" N/A N/A 02.111.650 SUP HCPCS C1713 02.111.650 - PLATE BN STD 75MM NS LCP CMBN 6 HLE/HD 5 HL SHFT 2 CLMN VA BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" $420.09 "$2,015.78" N/A N/A 02.111.651 SUP HCPCS C1713 02.111.651 - PLATE BN STD 75MM NS LCP CMBN 6 HLE/HD 5 HL SHFT 2 CLMN VA BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" $820.02 "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$1,209.47" "$2,015.78" $420.09 "$2,015.78" N/A N/A 02.111.720 SUP HCPCS C1713 02.111.720 - PLATE BN STD 47MM NS LCP CMBN 7 HLE/HD 2 HL SHFT 2 CLMN VA BOTH IP/OP "$1,802.50" "$1,334.00" $357.67 "$1,832.73" $810.95 $810.95 $810.95 $810.95 "$1,802.10" "$1,802.10" "$1,802.10" $375.60 "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" $375.58 "$1,802.10" "$1,832.73" "$1,065.94" "$1,802.10" "$1,832.73" "$1,802.10" "$1,802.10" "$1,351.88" "$1,802.10" "$1,802.10" "$1,802.10" $901.05 $901.05 "$1,427.26" "$1,802.10" "$1,441.68" $810.95 $357.67 N/A "$1,045.45" "$1,802.10" "$1,081.26" "$1,802.10" $375.56 "$1,802.10" N/A N/A 02.111.720S SUP HCPCS C1713 02.111.720S - PLATE BN 47MM STRL LCP CMBN 7 HLE/HD 2 HL SHFT 2 CLMN VA SS BOTH IP/OP "$1,893.50" "$1,401.00" $375.81 "$1,925.68" $852.07 $852.07 $852.07 $852.07 "$1,893.48" "$1,893.48" "$1,893.48" $394.65 "$1,893.48" "$1,893.48" "$1,893.48" "$1,893.48" "$1,893.48" $394.62 "$1,893.48" "$1,925.68" "$1,119.99" "$1,893.48" "$1,925.68" "$1,893.48" "$1,893.48" "$1,420.13" "$1,893.48" "$1,893.48" "$1,893.48" $946.74 $946.74 "$1,499.64" "$1,893.48" "$1,514.78" $852.07 $375.81 N/A "$1,098.23" "$1,893.48" "$1,893.48" "$1,893.48" $394.60 "$1,893.48" N/A N/A 02.111.721 SUP HCPCS C1713 02.111.721 - PLATE BN STD 47MM NS LCP CMBN 7 HLE/HD 2 HL SHFT 2 CLMN VA BOTH IP/OP "$1,802.50" "$1,334.00" $357.67 "$1,832.73" $810.95 $810.95 $810.95 $810.95 "$1,802.10" "$1,802.10" "$1,802.10" $375.60 "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" $375.58 "$1,802.10" "$1,832.73" "$1,065.94" "$1,802.10" "$1,832.73" "$1,802.10" "$1,802.10" "$1,351.88" "$1,802.10" "$1,802.10" "$1,802.10" $901.05 $901.05 "$1,427.26" "$1,802.10" "$1,441.68" $810.95 $357.67 N/A "$1,045.45" "$1,802.10" "$1,081.26" "$1,802.10" $375.56 "$1,802.10" N/A N/A 02.111.730 SUP HCPCS C1713 02.111.730 - PLATE BN STD 55MM NS LCP CMBN 7 HLE/HD 3 HL SHFT 2 CLMN VA BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,124.28" "$1,873.80" "$1,873.80" "$1,873.80" N/A N/A 02.111.730S SUP HCPCS C1713 02.111.730S - PLATE BN 55MM STRL LCP CMBN 7 HLE/HD 3 HL SHFT 2 CLMN VA SS BOTH IP/OP "$1,965.50" "$1,454.00" $390.03 "$1,998.55" $884.32 $884.32 $884.32 $884.32 "$1,965.15" "$1,965.15" "$1,965.15" $409.59 "$1,965.15" "$1,965.15" "$1,965.15" "$1,965.15" "$1,965.15" $409.56 "$1,965.15" "$1,998.55" "$1,162.39" "$1,965.15" "$1,998.55" "$1,965.15" "$1,965.15" "$1,474.13" "$1,965.15" "$1,965.15" "$1,965.15" $982.58 $982.58 "$1,556.40" "$1,965.15" "$1,572.12" $884.32 $390.03 N/A "$1,139.99" "$1,965.15" "$1,965.15" "$1,965.15" $409.54 "$1,965.15" N/A N/A 02.111.731 SUP HCPCS C1713 02.111.731 - PLATE BN STD 55MM NS LCP CMBN 7 HLE/HD 3 HL SHFT 2 CLMN VA BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" $762.26 "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 02.111.731S SUP HCPCS C1713 02.111.731S - PLATE BN 55MM STRL LCP CMBN 7 HLE/HD 3 HL SHFT 2 CLMN VA SS BOTH IP/OP "$1,965.50" "$1,454.00" $390.03 "$1,998.55" $884.32 $884.32 $884.32 $884.32 "$1,965.15" "$1,965.15" "$1,965.15" $409.59 "$1,965.15" "$1,965.15" "$1,965.15" "$1,965.15" "$1,965.15" $409.56 "$1,965.15" "$1,998.55" "$1,162.39" "$1,965.15" "$1,998.55" "$1,965.15" "$1,965.15" "$1,474.13" "$1,965.15" "$1,965.15" "$1,965.15" $982.58 $982.58 "$1,556.40" "$1,965.15" "$1,572.12" $884.32 $390.03 N/A "$1,139.99" "$1,965.15" "$1,965.15" "$1,965.15" $409.54 "$1,965.15" N/A N/A 02.111.740 SUP HCPCS C1713 02.111.740 - PLATE BN STD 68MM NS LCP CMBN 7 HLE/HD 4 HL SHFT 2 CLMN VA BOTH IP/OP "$1,944.50" "$1,439.00" $385.85 "$1,977.13" $874.84 $874.84 $874.84 $874.84 "$1,944.08" "$1,944.08" "$1,944.08" $405.19 "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" $405.17 "$1,944.08" "$1,977.13" "$1,149.92" "$1,944.08" "$1,977.13" "$1,944.08" "$1,944.08" "$1,458.38" "$1,944.08" "$1,944.08" "$1,944.08" $972.04 $972.04 "$1,539.71" "$1,944.08" "$1,555.26" $874.84 $385.85 N/A "$1,127.81" "$1,944.08" "$1,166.45" "$1,944.08" $405.15 "$1,944.08" N/A N/A 02.111.741 SUP HCPCS C1713 02.111.741 - PLATE BN STD 68MM NS LCP CMBN 7 HLE/HD 4 HL SHFT 2 CLMN VA BOTH IP/OP "$1,944.50" "$1,439.00" $385.85 "$1,977.13" $874.84 $874.84 $874.84 $874.84 "$1,944.08" "$1,944.08" "$1,944.08" $405.19 "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" $405.17 "$1,944.08" "$1,977.13" "$1,149.92" "$1,944.08" "$1,977.13" "$1,944.08" "$1,944.08" "$1,458.38" "$1,944.08" "$1,944.08" "$1,944.08" $972.04 $972.04 "$1,539.71" "$1,944.08" "$1,555.26" $874.84 $385.85 N/A "$1,127.81" "$1,944.08" "$1,166.45" "$1,944.08" "$1,944.08" "$1,944.08" N/A N/A 02.111.741S SUP HCPCS C1713 02.111.741S - PLATE BN 68MM STRL LCP CMBN 7 HLE/HD 4 HL SHFT 2 CLMN VA SS BOTH IP/OP "$2,035.50" "$1,506.00" $403.99 "$2,070.05" $915.95 $915.95 $915.95 $915.95 "$2,035.45" "$2,035.45" "$2,035.45" $424.24 "$2,035.45" "$2,035.45" "$2,035.45" "$2,035.45" "$2,035.45" $424.21 "$2,035.45" $828.02 "$1,203.97" "$2,035.45" "$2,070.05" "$2,035.45" "$2,035.45" "$1,526.63" "$2,035.45" "$2,035.45" "$2,035.45" "$1,017.73" "$1,017.73" "$1,612.08" "$2,035.45" "$1,628.36" $915.95 $403.99 N/A "$1,180.59" "$2,035.45" "$2,035.45" "$2,035.45" $424.19 "$2,035.45" N/A N/A 02.111.750 SUP HCPCS C1713 02.111.750 - PLATE BN STD 77MM NS LCP CMBN 7 HLE/HD 5 HL SHFT 2 CLMN VA BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$1,209.47" "$2,015.78" $420.09 "$2,015.78" N/A N/A 02.111.750S SUP HCPCS C1713 02.111.750S - PLATE BN 77MM STRL LCP CMBN 7 HLE/HD 5 HL SHFT 2 CLMN VA SS BOTH IP/OP "$2,107.50" "$1,560.00" $418.21 "$2,142.95" $948.21 $948.21 $948.21 $948.21 "$2,107.13" "$2,107.13" "$2,107.13" $439.18 "$2,107.13" "$2,107.13" "$2,107.13" "$2,107.13" "$2,107.13" $439.15 "$2,107.13" $857.18 "$1,246.37" "$2,107.13" "$2,142.95" "$2,107.13" "$2,107.13" "$1,580.63" "$2,107.13" "$2,107.13" "$2,107.13" "$1,053.57" "$1,053.57" "$1,668.85" "$2,107.13" "$1,685.70" $948.21 $418.21 N/A "$1,222.35" "$2,107.13" "$2,107.13" "$2,107.13" $439.13 "$2,107.13" N/A N/A 02.111.751 SUP HCPCS C1713 02.111.751 - PLATE BN STD 77MM NS LCP CMBN 7 HLE/HD 5 HL SHFT 2 CLMN VA BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$1,209.47" "$2,015.78" $420.09 "$2,015.78" N/A N/A 02.111.751S SUP HCPCS C1713 02.111.751S - PLATE BN 77MM STRL LCP CMBN 7 HLE/HD 5 HL SHFT 2 CLMN VA SS BOTH IP/OP "$2,107.50" "$1,560.00" $418.21 "$2,142.95" $948.21 $948.21 $948.21 $948.21 "$2,107.13" "$2,107.13" "$2,107.13" $439.18 "$2,107.13" "$2,107.13" "$2,107.13" "$2,107.13" "$2,107.13" $439.15 "$2,107.13" "$2,142.95" "$1,246.37" "$2,107.13" "$2,142.95" "$2,107.13" "$2,107.13" "$1,580.63" "$2,107.13" "$2,107.13" "$2,107.13" "$1,053.57" "$1,053.57" "$1,668.85" "$2,107.13" "$1,685.70" $948.21 $418.21 N/A "$1,222.35" "$2,107.13" "$2,107.13" "$2,107.13" $439.13 "$2,107.13" N/A N/A 02.112.006 SUP HCPCS C1713 02.112.006 - PLATE BN 69MM NS LCP CMBN 3 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,624.00" "$1,202.00" $322.24 "$1,651.18" $730.61 $730.61 $730.61 $730.61 "$1,623.58" "$1,623.58" "$1,623.58" $338.39 "$1,623.58" "$1,623.58" "$1,623.58" "$1,623.58" "$1,623.58" $338.37 "$1,623.58" "$1,651.18" $960.35 "$1,623.58" "$1,651.18" "$1,623.58" "$1,623.58" "$1,218.00" "$1,623.58" "$1,623.58" "$1,623.58" $811.79 $811.79 "$1,285.88" "$1,623.58" "$1,298.86" $730.61 $322.24 N/A $941.92 "$1,623.58" $974.15 "$1,623.58" "$1,623.58" "$1,623.58" N/A N/A 02.112.007 SUP HCPCS C1713 02.112.007 - PLATE BN 69MM NS LCP CMBN 3 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,624.00" "$1,202.00" $322.24 "$1,651.18" $730.61 $730.61 $730.61 $730.61 "$1,623.58" "$1,623.58" "$1,623.58" $338.39 "$1,623.58" "$1,623.58" "$1,623.58" "$1,623.58" "$1,623.58" $338.37 "$1,623.58" "$1,651.18" $960.35 "$1,623.58" "$1,651.18" "$1,623.58" "$1,623.58" "$1,218.00" "$1,623.58" "$1,623.58" "$1,623.58" $811.79 $811.79 "$1,285.88" "$1,623.58" "$1,298.86" $730.61 $322.24 N/A $941.92 "$1,623.58" "$1,623.58" "$1,623.58" $338.35 "$1,623.58" N/A N/A 02.112.008 SUP HCPCS C1713 02.112.008 - PLATE BN 108MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" "$1,724.10" "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" N/A N/A 02.112.009 SUP HCPCS C1713 02.112.009 - PLATE BN 108MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" "$1,724.10" "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" N/A N/A 02.112.010 SUP HCPCS C1713 02.112.010 - PLATE BN 81MM NS LCP CMBN 4 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,649.00" "$1,220.00" $327.26 "$1,676.90" $742.00 $742.00 $742.00 $742.00 "$1,648.88" "$1,648.88" "$1,648.88" $343.67 "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" $343.64 "$1,648.88" "$1,676.90" $975.31 "$1,648.88" "$1,676.90" "$1,648.88" "$1,648.88" "$1,236.75" "$1,648.88" "$1,648.88" "$1,648.88" $824.44 $824.44 "$1,305.91" "$1,648.88" "$1,319.10" $742.00 $327.26 N/A $956.42 "$1,648.88" "$1,648.88" "$1,648.88" $343.63 "$1,648.88" N/A N/A 02.112.011 SUP HCPCS C1713 02.112.011 - PLATE BN 81MM NS LCP CMBN 4 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,649.00" "$1,220.00" $327.26 "$1,676.90" $742.00 $742.00 $742.00 $742.00 "$1,648.88" "$1,648.88" "$1,648.88" $343.67 "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" $343.64 "$1,648.88" "$1,676.90" $975.31 "$1,648.88" "$1,676.90" "$1,648.88" "$1,648.88" "$1,236.75" "$1,648.88" "$1,648.88" "$1,648.88" $824.44 $824.44 "$1,305.91" "$1,648.88" "$1,319.10" $742.00 $327.26 N/A $956.42 "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" N/A N/A 02.112.012 SUP HCPCS C1713 02.112.012 - PLATE BN 94MM NS LCP CMBN 5 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,677.00" "$1,241.00" $332.84 "$1,705.50" $754.65 $754.65 $754.65 $754.65 "$1,677.00" "$1,677.00" "$1,677.00" $349.53 "$1,677.00" "$1,677.00" "$1,677.00" "$1,677.00" "$1,677.00" $349.51 "$1,677.00" "$1,705.50" $991.95 "$1,677.00" "$1,705.50" "$1,677.00" "$1,677.00" "$1,257.75" "$1,677.00" "$1,677.00" "$1,677.00" $838.50 $838.50 "$1,328.18" "$1,677.00" "$1,341.60" $754.65 $332.84 N/A $972.66 "$1,677.00" "$1,677.00" "$1,677.00" "$1,677.00" "$1,677.00" N/A N/A 02.112.013 SUP HCPCS C1713 02.112.013 - PLATE BN 94MM NS LCP CMBN 5 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,677.00" "$1,241.00" $332.84 "$1,705.50" $754.65 $754.65 $754.65 $754.65 "$1,677.00" "$1,677.00" "$1,677.00" $349.53 "$1,677.00" "$1,677.00" "$1,677.00" "$1,677.00" "$1,677.00" $349.51 "$1,677.00" "$1,705.50" $991.95 "$1,677.00" "$1,705.50" "$1,677.00" "$1,677.00" "$1,257.75" "$1,677.00" "$1,677.00" "$1,677.00" $838.50 $838.50 "$1,328.18" "$1,677.00" "$1,341.60" $754.65 $332.84 N/A $972.66 "$1,677.00" "$1,677.00" "$1,677.00" $349.49 "$1,677.00" N/A N/A 02.112.018 SUP HCPCS C1713 02.112.018 - PLATE BN 123MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" "$1,769.83" "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,740.25" "$1,740.25" $362.67 "$1,740.25" N/A N/A 02.112.019 SUP HCPCS C1713 02.112.019 - PLATE BN 123MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" $707.93 "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,740.25" "$1,740.25" $362.67 "$1,740.25" N/A N/A 02.112.020 SUP HCPCS C1713 02.112.020 - PLATE BN 135MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" N/A N/A 02.112.021 SUP HCPCS C1713 02.112.021 - PLATE BN 135MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.026 SUP HCPCS C1713 02.112.026 - PLATE BN 94MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" $689.64 "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,695.28" "$1,695.28" $353.30 "$1,695.28" N/A N/A 02.112.027 SUP HCPCS C1713 02.112.027 - PLATE BN 94MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" "$1,724.10" "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,695.28" "$1,695.28" $353.30 "$1,695.28" N/A N/A 02.112.028 SUP HCPCS C1713 02.112.028 - PLATE BN 110MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" "$1,769.83" "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,740.25" "$1,740.25" $362.67 "$1,740.25" N/A N/A 02.112.029 SUP HCPCS C1713 02.112.029 - PLATE BN 110MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" "$1,769.83" "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" N/A N/A 02.112.030 SUP HCPCS C1713 02.112.030 - PLATE BN 120MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.031 SUP HCPCS C1713 02.112.031 - PLATE BN 120MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.040 SUP HCPCS C1713 02.112.040 - PLATE BONE 79MM 6 HOLE LCP STAINLESS STEEL ANTERIOR MEDIAL BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,071.14" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.041 SUP HCPCS C1713 02.112.041 - PLATE BONE 91MM 7 HOLE LCP STAINLESS STEEL MEDIAL ANTERIOR BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,071.14" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.042 SUP HCPCS C1713 02.112.042 - PLATE BONE 8 HOLE LCP STAINLESS STEEL MEDIAL ANTERIOR BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,071.14" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.045 SUP HCPCS C1713 02.112.045 - PLATE BONE 77MM 7 HOLE VAR ANG LCP STAINLESS STEEL LATERAL BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.046 SUP HCPCS C1713 02.112.046 - PLATE BONE 89MM 9 HOLE VAR ANG LCP STAINLESS STEEL LATERAL BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" $726.23 "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.047 SUP HCPCS C1713 02.112.047 - PLATE BONE 101MM 10 HOLE VAR ANG LCP STAINLESS STEEL LATERAL BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.048 SUP HCPCS C1713 02.112.048 - PLATE BONE 113MM 11 HOLE VAR ANG LCP STAINLESS STEEL LATERAL BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,071.14" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.049 SUP HCPCS C1713 02.112.049 - PLATE BONE 12 HOLE LCP STAINLESS STEEL LATERAL VOLAR BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,071.14" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.080 SUP HCPCS C1713 02.112.080 - PLATE BN 85MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" "$1,724.10" "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,017.17" "$1,695.28" $353.30 "$1,695.28" N/A N/A 02.112.081 SUP HCPCS C1713 02.112.081 - PLATE BN 85MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" "$1,724.10" "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,695.28" "$1,695.28" $353.30 "$1,695.28" N/A N/A 02.112.082 SUP HCPCS C1713 02.112.082 - PLATE BN 100MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" "$1,769.83" "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,044.15" "$1,740.25" $362.67 "$1,740.25" N/A N/A 02.112.083 SUP HCPCS C1713 02.112.083 - PLATE BN 100MM NS LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR TIP BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" "$1,769.83" "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,044.15" "$1,740.25" $362.67 "$1,740.25" N/A N/A 02.112.083S SUP HCPCS C1713 02.112.083S - PLATE BN 100MM STRL LCP CMBN 7 HL PRECONTOUR LMT CNTCT TPR BOTH IP/OP "$1,832.00" "$1,356.00" $363.53 "$1,862.78" $824.23 $824.23 $824.23 $824.23 "$1,831.63" "$1,831.63" "$1,831.63" $381.76 "$1,831.63" "$1,831.63" "$1,831.63" "$1,831.63" "$1,831.63" $381.73 "$1,831.63" $745.11 "$1,083.41" "$1,831.63" "$1,862.78" "$1,831.63" "$1,831.63" "$1,374.00" "$1,831.63" "$1,831.63" "$1,831.63" $915.82 $915.82 "$1,450.65" "$1,831.63" "$1,465.30" $824.23 $363.53 N/A "$1,062.56" "$1,831.63" "$1,831.63" "$1,831.63" $381.71 "$1,831.63" N/A N/A 02.112.084 SUP HCPCS C1713 02.112.084 - PLATE BN 115MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,071.14" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.085 SUP HCPCS C1713 02.112.085 - PLATE BN 115MM NS LCP CMBN 8 HL PRECONTOUR LMT CNTCT TPR TIP BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,071.14" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.090 SUP HCPCS C1713 02.112.090 - PLATE BN 105MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" "$1,724.10" "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,017.17" "$1,695.28" "$1,695.28" "$1,695.28" N/A N/A 02.112.091 SUP HCPCS C1713 02.112.091 - PLATE BN 105MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" "$1,724.10" "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,017.17" "$1,695.28" $353.30 "$1,695.28" N/A N/A 02.112.092 SUP HCPCS C1713 02.112.092 - PLATE BN 120MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" $707.93 "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,044.15" "$1,740.25" $362.67 "$1,740.25" N/A N/A 02.112.093 SUP HCPCS C1713 02.112.093 - PLATE BN 120MM NS LCP CMBN 7 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" $707.93 "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,044.15" "$1,740.25" $362.67 "$1,740.25" N/A N/A 02.112.094 SUP HCPCS C1713 02.112.094 - PLATE BN 130MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" $726.23 "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.095 SUP HCPCS C1713 02.112.095 - PLATE BN 130MM NS LCP CMBN 8 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" $372.04 "$1,785.23" N/A N/A 02.112.106 SUP HCPCS C1713 02.112.106 - PLATE BONE 77MM 3 HOLE LCP STAINLESS STEEL RIGHT DISTAL BOTH IP/OP "$1,186.50" $878.00 $235.47 "$1,206.58" $533.88 $533.88 $533.88 $533.88 "$1,186.40" "$1,186.40" "$1,186.40" $247.28 "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" $247.26 "$1,186.40" "$1,206.58" $701.76 "$1,186.40" "$1,206.58" "$1,186.40" "$1,186.40" $889.88 "$1,186.40" "$1,186.40" "$1,186.40" $593.20 $593.20 $939.63 "$1,186.40" $949.12 $533.88 $235.47 N/A $688.17 "$1,186.40" $711.84 "$1,186.40" $247.25 "$1,186.40" N/A N/A 02.112.107 SUP HCPCS C1713 02.112.107 - PLATE BONE 77MM 3 HOLE LCP STAINLESS STEEL LEFT DISTAL BOTH IP/OP "$1,186.50" $878.00 $235.47 "$1,206.58" $533.88 $533.88 $533.88 $533.88 "$1,186.40" "$1,186.40" "$1,186.40" $247.28 "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" $247.26 "$1,186.40" $482.63 $701.76 "$1,186.40" "$1,206.58" "$1,186.40" "$1,186.40" $889.88 "$1,186.40" "$1,186.40" "$1,186.40" $593.20 $593.20 $939.63 "$1,186.40" $949.12 $533.88 $235.47 N/A $688.17 "$1,186.40" $711.84 "$1,186.40" $247.25 "$1,186.40" N/A N/A 02.112.108 SUP HCPCS C1713 02.112.108 - PLATE BONE 9CM 4 HOLE LCP STAINLESS STEEL RIGHT POSTLAT BOTH IP/OP "$1,206.50" $893.00 $239.38 "$1,226.58" $542.74 $542.74 $542.74 $542.74 "$1,206.08" "$1,206.08" "$1,206.08" $251.38 "$1,206.08" "$1,206.08" "$1,206.08" "$1,206.08" "$1,206.08" $251.36 "$1,206.08" "$1,226.58" $713.40 "$1,206.08" "$1,226.58" "$1,206.08" "$1,206.08" $904.88 "$1,206.08" "$1,206.08" "$1,206.08" $603.04 $603.04 $955.22 "$1,206.08" $964.86 $542.74 $239.38 N/A $699.77 "$1,206.08" "$1,206.08" "$1,206.08" $251.35 "$1,206.08" N/A N/A 02.112.109 SUP HCPCS C1713 02.112.109 - PLATE BONE 9CM 4 HOLE LCP STAINLESS STEEL LEFT POSTLAT BOTH IP/OP "$1,206.50" $893.00 $239.38 "$1,226.58" $542.74 $542.74 $542.74 $542.74 "$1,206.08" "$1,206.08" "$1,206.08" $251.38 "$1,206.08" "$1,206.08" "$1,206.08" "$1,206.08" "$1,206.08" $251.36 "$1,206.08" $490.63 $713.40 "$1,206.08" "$1,226.58" "$1,206.08" "$1,206.08" $904.88 "$1,206.08" "$1,206.08" "$1,206.08" $603.04 $603.04 $955.22 "$1,206.08" $964.86 $542.74 $239.38 N/A $699.77 "$1,206.08" "$1,206.08" "$1,206.08" $251.35 "$1,206.08" N/A N/A 02.112.110 SUP HCPCS C1713 02.112.110 - PLATE BONE 103MM 5 HOLE LCP STAINLESS STEEL RIGHT DISTAL BOTH IP/OP "$1,222.00" $904.00 $242.45 "$1,242.33" $549.70 $549.70 $549.70 $549.70 "$1,221.55" "$1,221.55" "$1,221.55" $254.60 "$1,221.55" "$1,221.55" "$1,221.55" "$1,221.55" "$1,221.55" $254.58 "$1,221.55" "$1,242.33" $722.55 "$1,221.55" "$1,242.33" "$1,221.55" "$1,221.55" $916.50 "$1,221.55" "$1,221.55" "$1,221.55" $610.78 $610.78 $967.47 "$1,221.55" $977.24 $549.70 $242.45 N/A $708.76 "$1,221.55" $732.93 "$1,221.55" $254.57 "$1,221.55" N/A N/A 02.112.111 SUP HCPCS C1713 02.112.111 - PLATE BONE 103MM 5 HOLE LCP STAINLESS STEEL LEFT POSTLAT BOTH IP/OP "$1,222.00" $904.00 $242.45 "$1,242.33" $549.70 $549.70 $549.70 $549.70 "$1,221.55" "$1,221.55" "$1,221.55" $254.60 "$1,221.55" "$1,221.55" "$1,221.55" "$1,221.55" "$1,221.55" $254.58 "$1,221.55" $496.93 $722.55 "$1,221.55" "$1,242.33" "$1,221.55" "$1,221.55" $916.50 "$1,221.55" "$1,221.55" "$1,221.55" $610.78 $610.78 $967.47 "$1,221.55" $977.24 $549.70 $242.45 N/A $708.76 "$1,221.55" $732.93 "$1,221.55" $254.57 "$1,221.55" N/A N/A 02.112.112 SUP HCPCS C1713 02.112.112 - PLATE BONE 112MM 6 HOLE LCP STAINLESS STEEL RIGHT POSTLAT BOTH IP/OP "$1,241.50" $919.00 $246.35 "$1,262.33" $558.55 $558.55 $558.55 $558.55 "$1,241.23" "$1,241.23" "$1,241.23" $258.70 "$1,241.23" "$1,241.23" "$1,241.23" "$1,241.23" "$1,241.23" $258.69 "$1,241.23" $504.93 $734.19 "$1,241.23" "$1,262.33" "$1,241.23" "$1,241.23" $931.13 "$1,241.23" "$1,241.23" "$1,241.23" $620.62 $620.62 $983.05 "$1,241.23" $992.98 $558.55 $246.35 N/A $720.07 "$1,241.23" $744.74 "$1,241.23" $258.67 "$1,241.23" N/A N/A 02.112.113 SUP HCPCS C1713 02.112.113 - PLATE BONE 112MM 6 HOLE LCP STAINLESS STEEL LEFT POSTLAT BOTH IP/OP "$1,241.50" $919.00 $246.35 "$1,262.33" $558.55 $558.55 $558.55 $558.55 "$1,241.23" "$1,241.23" "$1,241.23" $258.70 "$1,241.23" "$1,241.23" "$1,241.23" "$1,241.23" "$1,241.23" $258.69 "$1,241.23" $504.93 $734.19 "$1,241.23" "$1,262.33" "$1,241.23" "$1,241.23" $931.13 "$1,241.23" "$1,241.23" "$1,241.23" $620.62 $620.62 $983.05 "$1,241.23" $992.98 $558.55 $246.35 N/A $720.07 "$1,241.23" $744.74 "$1,241.23" $258.67 "$1,241.23" N/A N/A 02.112.114 SUP HCPCS C1713 02.112.114 - PLATE BONE 12.9CM 7 HOLE LCP STAINLESS STEEL RIGHT POSTLAT BOTH IP/OP "$1,258.50" $931.00 $249.70 "$1,279.50" $566.15 $566.15 $566.15 $566.15 "$1,258.10" "$1,258.10" "$1,258.10" $262.22 "$1,258.10" "$1,258.10" "$1,258.10" "$1,258.10" "$1,258.10" $262.20 "$1,258.10" $511.80 $744.17 "$1,258.10" "$1,279.50" "$1,258.10" "$1,258.10" $943.88 "$1,258.10" "$1,258.10" "$1,258.10" $629.05 $629.05 $996.42 "$1,258.10" "$1,006.48" $566.15 $249.70 N/A $729.93 "$1,258.10" $754.86 "$1,258.10" $262.19 "$1,258.10" N/A N/A 02.112.115 SUP HCPCS C1713 02.112.115 - PLATE BONE 12.9CM 7 HOLE LCP STAINLESS STEEL LEFT POSTLAT BOTH IP/OP "$1,258.50" $931.00 $249.70 "$1,279.50" $566.15 $566.15 $566.15 $566.15 "$1,258.10" "$1,258.10" "$1,258.10" $262.22 "$1,258.10" "$1,258.10" "$1,258.10" "$1,258.10" "$1,258.10" $262.20 "$1,258.10" "$1,279.50" $744.17 "$1,258.10" "$1,279.50" "$1,258.10" "$1,258.10" $943.88 "$1,258.10" "$1,258.10" "$1,258.10" $629.05 $629.05 $996.42 "$1,258.10" "$1,006.48" $566.15 $249.70 N/A $729.93 "$1,258.10" $754.86 "$1,258.10" $262.19 "$1,258.10" N/A N/A 02.112.118 SUP HCPCS C1713 02.112.118 - PLATE BONE 151MM 9 HOLE LCP STAINLESS STEEL RIGHT POSTLAT BOTH IP/OP "$1,276.50" $945.00 $253.33 "$1,298.08" $574.37 $574.37 $574.37 $574.37 "$1,276.38" "$1,276.38" "$1,276.38" $266.03 "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" $266.01 "$1,276.38" $519.23 $754.98 "$1,276.38" "$1,298.08" "$1,276.38" "$1,276.38" $957.38 "$1,276.38" "$1,276.38" "$1,276.38" $638.19 $638.19 "$1,010.89" "$1,276.38" "$1,021.10" $574.37 $253.33 N/A $740.37 "$1,276.38" "$1,276.38" "$1,276.38" $266.00 "$1,276.38" N/A N/A 02.112.119 SUP HCPCS C1713 02.112.119 - PLATE BONE 151MM 9 HOLE LCP STAINLESS STEEL LEFT POSTLAT BOTH IP/OP "$1,276.50" $945.00 $253.33 "$1,298.08" $574.37 $574.37 $574.37 $574.37 "$1,276.38" "$1,276.38" "$1,276.38" $266.03 "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" $266.01 "$1,276.38" $519.23 $754.98 "$1,276.38" "$1,298.08" "$1,276.38" "$1,276.38" $957.38 "$1,276.38" "$1,276.38" "$1,276.38" $638.19 $638.19 "$1,010.89" "$1,276.38" "$1,021.10" $574.37 $253.33 N/A $740.37 "$1,276.38" "$1,276.38" "$1,276.38" $266.00 "$1,276.38" N/A N/A 02.112.122 SUP HCPCS C1713 02.112.122 - PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL RIGHT POSTLAT BOTH IP/OP "$1,296.50" $959.00 $257.23 "$1,318.08" $583.22 $583.22 $583.22 $583.22 "$1,296.05" "$1,296.05" "$1,296.05" $270.13 "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" $270.11 "$1,296.05" "$1,318.08" $766.61 "$1,296.05" "$1,318.08" "$1,296.05" "$1,296.05" $972.38 "$1,296.05" "$1,296.05" "$1,296.05" $648.03 $648.03 "$1,026.47" "$1,296.05" "$1,036.84" $583.22 $257.23 N/A $751.97 "$1,296.05" "$1,296.05" "$1,296.05" $270.10 "$1,296.05" N/A N/A 02.112.123 SUP HCPCS C1713 02.112.123 - PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL LEFT POSTLAT BOTH IP/OP "$1,296.50" $959.00 $257.23 "$1,318.08" $583.22 $583.22 $583.22 $583.22 "$1,296.05" "$1,296.05" "$1,296.05" $270.13 "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" $270.11 "$1,296.05" "$1,318.08" $766.61 "$1,296.05" "$1,318.08" "$1,296.05" "$1,296.05" $972.38 "$1,296.05" "$1,296.05" "$1,296.05" $648.03 $648.03 "$1,026.47" "$1,296.05" "$1,036.84" $583.22 $257.23 N/A $751.97 "$1,296.05" "$1,296.05" "$1,296.05" $270.10 "$1,296.05" N/A N/A 02.112.126 SUP HCPCS C1713 02.112.126 - PLATE BONE 126MM 13 HOLE LCP STAINLESS STEEL RIGHT POSTLAT BOTH IP/OP "$1,313.00" $972.00 $260.58 "$1,335.25" $590.82 $590.82 $590.82 $590.82 "$1,312.93" "$1,312.93" "$1,312.93" $273.65 "$1,312.93" "$1,312.93" "$1,312.93" "$1,312.93" "$1,312.93" $273.63 "$1,312.93" $534.10 $776.60 "$1,312.93" "$1,335.25" "$1,312.93" "$1,312.93" $984.75 "$1,312.93" "$1,312.93" "$1,312.93" $656.47 $656.47 "$1,039.84" "$1,312.93" "$1,050.34" $590.82 $260.58 N/A $761.54 "$1,312.93" $787.76 "$1,312.93" $273.61 "$1,312.93" N/A N/A 02.112.127 SUP HCPCS C1713 02.112.127 - PLATE BONE 127MM 13 HOLE LCP STAINLESS STEEL LEFT POSTLAT BOTH IP/OP "$1,313.00" $972.00 $260.58 "$1,335.25" $590.82 $590.82 $590.82 $590.82 "$1,312.93" "$1,312.93" "$1,312.93" $273.65 "$1,312.93" "$1,312.93" "$1,312.93" "$1,312.93" "$1,312.93" $273.63 "$1,312.93" $534.10 $776.60 "$1,312.93" "$1,335.25" "$1,312.93" "$1,312.93" $984.75 "$1,312.93" "$1,312.93" "$1,312.93" $656.47 $656.47 "$1,039.84" "$1,312.93" "$1,050.34" $590.82 $260.58 N/A $761.54 "$1,312.93" $787.76 "$1,312.93" $273.61 "$1,312.93" N/A N/A 02.112.130 SUP HCPCS C1713 02.112.130 - PLATE BONE 233MM 15 HOLE LCP STAINLESS STEEL RIGHT DISTAL BOTH IP/OP "$1,330.00" $984.00 $263.93 "$1,352.38" $598.40 $598.40 $598.40 $598.40 "$1,329.78" "$1,329.78" "$1,329.78" $277.16 "$1,329.78" "$1,329.78" "$1,329.78" "$1,329.78" "$1,329.78" $277.14 "$1,329.78" $540.95 $786.56 "$1,329.78" "$1,352.38" "$1,329.78" "$1,329.78" $997.50 "$1,329.78" "$1,329.78" "$1,329.78" $664.89 $664.89 "$1,053.19" "$1,329.78" "$1,063.82" $598.40 $263.93 N/A $771.40 "$1,329.78" $797.87 "$1,329.78" $277.13 "$1,329.78" N/A N/A 02.112.131 SUP HCPCS C1713 02.112.131 - PLATE BONE 233MM 15 HOLE LCP STAINLESS STEEL LEFT POSTLAT BOTH IP/OP "$1,330.00" $984.00 $263.93 "$1,352.38" $598.40 $598.40 $598.40 $598.40 "$1,329.78" "$1,329.78" "$1,329.78" $277.16 "$1,329.78" "$1,329.78" "$1,329.78" "$1,329.78" "$1,329.78" $277.14 "$1,329.78" $540.95 $786.56 "$1,329.78" "$1,352.38" "$1,329.78" "$1,329.78" $997.50 "$1,329.78" "$1,329.78" "$1,329.78" $664.89 $664.89 "$1,053.19" "$1,329.78" "$1,063.82" $598.40 $263.93 N/A $771.40 "$1,329.78" $797.87 "$1,329.78" $277.13 "$1,329.78" N/A N/A 02.112.136 SUP HCPCS C1713 02.112.136 - PLATE BN CNTR 73MM NS LCP CMBN 3 HL SS FIB RT DIST LAT BOTH IP/OP "$1,147.50" $849.00 $227.66 "$1,166.55" $516.17 $516.17 $516.17 $516.17 "$1,147.05" "$1,147.05" "$1,147.05" $239.07 "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" $239.06 "$1,147.05" "$1,166.55" $678.48 "$1,147.05" "$1,166.55" "$1,147.05" "$1,147.05" $860.63 "$1,147.05" "$1,147.05" "$1,147.05" $573.53 $573.53 $908.46 "$1,147.05" $917.64 $516.17 $227.66 N/A $665.55 "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" N/A N/A 02.112.136S SUP HCPCS C1713 02.112.136S - PLATE BN CNTR 73MM STRL LCP CMBN 3 HL SS FIB RT DIST LAT BOTH IP/OP "$1,238.50" $916.00 $245.80 "$1,259.48" $557.29 $557.29 $557.29 $557.29 "$1,238.43" "$1,238.43" "$1,238.43" $258.12 "$1,238.43" "$1,238.43" "$1,238.43" "$1,238.43" "$1,238.43" $258.10 "$1,238.43" $503.79 $732.53 "$1,238.43" "$1,259.48" "$1,238.43" "$1,238.43" $928.88 "$1,238.43" "$1,238.43" "$1,238.43" $619.22 $619.22 $980.84 "$1,238.43" $990.74 $557.29 $245.80 N/A $718.33 "$1,238.43" "$1,238.43" "$1,238.43" $258.09 "$1,238.43" N/A N/A 02.112.137 SUP HCPCS C1713 02.112.137 - PLATE BN CNTR 73MM NS LCP CMBN 3 HL SS FIB LT DIST LAT BOTH IP/OP "$1,147.50" $849.00 $227.66 "$1,166.55" $516.17 $516.17 $516.17 $516.17 "$1,147.05" "$1,147.05" "$1,147.05" $239.07 "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" $239.06 "$1,147.05" $466.62 $678.48 "$1,147.05" "$1,166.55" "$1,147.05" "$1,147.05" $860.63 "$1,147.05" "$1,147.05" "$1,147.05" $573.53 $573.53 $908.46 "$1,147.05" $917.64 $516.17 $227.66 N/A $665.55 "$1,147.05" "$1,147.05" "$1,147.05" $239.05 "$1,147.05" N/A N/A 02.112.138 SUP HCPCS C1713 02.112.138 - PLATE BN CNTR 86MM NS LCP CMBN 4 HL SS FIB RT DIST LAT BOTH IP/OP "$1,167.00" $864.00 $231.57 "$1,186.55" $525.03 $525.03 $525.03 $525.03 "$1,166.73" "$1,166.73" "$1,166.73" $243.18 "$1,166.73" "$1,166.73" "$1,166.73" "$1,166.73" "$1,166.73" $243.16 "$1,166.73" $474.62 $690.12 "$1,166.73" "$1,186.55" "$1,166.73" "$1,166.73" $875.25 "$1,166.73" "$1,166.73" "$1,166.73" $583.37 $583.37 $924.05 "$1,166.73" $933.38 $525.03 $231.57 N/A $676.86 "$1,166.73" "$1,166.73" "$1,166.73" $243.15 "$1,166.73" N/A N/A 02.112.138S SUP HCPCS C1713 02.112.138S - PLATE BONE 86MM 4 HOLE LOCKING COMPRESSION LCP STAINLESS BOTH IP/OP "$1,258.50" $931.00 $249.70 "$1,279.50" $566.15 $566.15 $566.15 $566.15 "$1,258.10" "$1,258.10" "$1,258.10" $262.22 "$1,258.10" "$1,258.10" "$1,258.10" "$1,258.10" "$1,258.10" $262.20 "$1,258.10" $511.80 $744.17 "$1,258.10" "$1,279.50" "$1,258.10" "$1,258.10" $943.88 "$1,258.10" "$1,258.10" "$1,258.10" $629.05 $629.05 $996.42 "$1,258.10" "$1,006.48" $566.15 $249.70 N/A $729.93 "$1,258.10" "$1,258.10" "$1,258.10" $262.19 "$1,258.10" N/A N/A 02.112.139 SUP HCPCS C1713 02.112.139 - PLATE BN CNTR 86MM NS LCP CMBN 4 HL SS FIB LT DIST LAT BOTH IP/OP "$1,167.00" $864.00 $231.57 "$1,186.55" $525.03 $525.03 $525.03 $525.03 "$1,166.73" "$1,166.73" "$1,166.73" $243.18 "$1,166.73" "$1,166.73" "$1,166.73" "$1,166.73" "$1,166.73" $243.16 "$1,166.73" $474.62 $690.12 "$1,166.73" "$1,186.55" "$1,166.73" "$1,166.73" $875.25 "$1,166.73" "$1,166.73" "$1,166.73" $583.37 $583.37 $924.05 "$1,166.73" $933.38 $525.03 $231.57 N/A $676.86 "$1,166.73" "$1,166.73" "$1,166.73" $243.15 "$1,166.73" N/A N/A 02.112.139S SUP HCPCS C1713 02.112.139S - PLATE BN CNTR 86MM STRL LCP CMBN 4 HL SS FIB LT DIST LAT BOTH IP/OP "$1,258.50" $931.00 $249.70 "$1,279.50" $566.15 $566.15 $566.15 $566.15 "$1,258.10" "$1,258.10" "$1,258.10" $262.22 "$1,258.10" "$1,258.10" "$1,258.10" "$1,258.10" "$1,258.10" $262.20 "$1,258.10" $511.80 $744.17 "$1,258.10" "$1,279.50" "$1,258.10" "$1,258.10" $943.88 "$1,258.10" "$1,258.10" "$1,258.10" $629.05 $629.05 $996.42 "$1,258.10" "$1,006.48" $566.15 $249.70 N/A $729.93 "$1,258.10" "$1,258.10" "$1,258.10" $262.19 "$1,258.10" N/A N/A 02.112.140 SUP HCPCS C1713 02.112.140 - PLATE BN CNTR 99MM NS LCP CMBN 5 HL SS FIB RT DIST LAT BOTH IP/OP "$1,182.50" $875.00 $234.63 "$1,202.28" $531.98 $531.98 $531.98 $531.98 "$1,182.18" "$1,182.18" "$1,182.18" $246.40 "$1,182.18" "$1,182.18" "$1,182.18" "$1,182.18" "$1,182.18" $246.38 "$1,182.18" $480.91 $699.26 "$1,182.18" "$1,202.28" "$1,182.18" "$1,182.18" $886.88 "$1,182.18" "$1,182.18" "$1,182.18" $591.09 $591.09 $936.29 "$1,182.18" $945.74 $531.98 $234.63 N/A $685.85 "$1,182.18" "$1,182.18" "$1,182.18" $246.37 "$1,182.18" N/A N/A 02.112.140S SUP HCPCS C1713 02.112.140S - PLATE BN CNTR 99MM STRL LCP CMBN 5 HL SS FIB RT DIST LAT BOTH IP/OP "$1,274.00" $943.00 $252.77 "$1,295.20" $573.10 $573.10 $573.10 $573.10 "$1,273.55" "$1,273.55" "$1,273.55" $265.44 "$1,273.55" "$1,273.55" "$1,273.55" "$1,273.55" "$1,273.55" $265.42 "$1,273.55" $518.08 $753.30 "$1,273.55" "$1,295.20" "$1,273.55" "$1,273.55" $955.50 "$1,273.55" "$1,273.55" "$1,273.55" $636.78 $636.78 "$1,008.65" "$1,273.55" "$1,018.84" $573.10 $252.77 N/A $738.92 "$1,273.55" "$1,273.55" "$1,273.55" $265.41 "$1,273.55" N/A N/A 02.112.141 SUP HCPCS C1713 02.112.141 - PLATE BN CNTR 99MM NS LCP CMBN 5 HL SS FIB LT DIST LAT BOTH IP/OP "$1,182.50" $875.00 $234.63 "$1,202.28" $531.98 $531.98 $531.98 $531.98 "$1,182.18" "$1,182.18" "$1,182.18" $246.40 "$1,182.18" "$1,182.18" "$1,182.18" "$1,182.18" "$1,182.18" $246.38 "$1,182.18" "$1,202.28" $699.26 "$1,182.18" "$1,202.28" "$1,182.18" "$1,182.18" $886.88 "$1,182.18" "$1,182.18" "$1,182.18" $591.09 $591.09 $936.29 "$1,182.18" $945.74 $531.98 $234.63 N/A $685.85 "$1,182.18" "$1,182.18" "$1,182.18" $246.37 "$1,182.18" N/A N/A 02.112.141S SUP HCPCS C1713 02.112.141S - PLATE BN CNTR 99MM STRL LCP CMBN 5 HL SS FIB LT DIST LAT BOTH IP/OP "$1,274.00" $943.00 $252.77 "$1,295.20" $573.10 $573.10 $573.10 $573.10 "$1,273.55" "$1,273.55" "$1,273.55" $265.44 "$1,273.55" "$1,273.55" "$1,273.55" "$1,273.55" "$1,273.55" $265.42 "$1,273.55" $518.08 $753.30 "$1,273.55" "$1,295.20" "$1,273.55" "$1,273.55" $955.50 "$1,273.55" "$1,273.55" "$1,273.55" $636.78 $636.78 "$1,008.65" "$1,273.55" "$1,018.84" $573.10 $252.77 N/A $738.92 "$1,273.55" "$1,273.55" "$1,273.55" $265.41 "$1,273.55" N/A N/A 02.112.142 SUP HCPCS C1713 02.112.142 - PLATE BN CNTR 112MM NS LCP CMBN 6 HL SS FIB RT DIST LAT BOTH IP/OP "$1,200.50" $888.00 $238.26 "$1,220.85" $540.20 $540.20 $540.20 $540.20 "$1,200.45" "$1,200.45" "$1,200.45" $250.20 "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" $250.19 "$1,200.45" "$1,220.85" $710.07 "$1,200.45" "$1,220.85" "$1,200.45" "$1,200.45" $900.38 "$1,200.45" "$1,200.45" "$1,200.45" $600.23 $600.23 $950.76 "$1,200.45" $960.36 $540.20 $238.26 N/A $696.29 "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" N/A N/A 02.112.142S SUP HCPCS C1713 02.112.142S - PLATE BN CNTR 112MM STRL LCP CMBN 6 HL SS FIB RT DIST LAT BOTH IP/OP "$1,292.00" $956.00 $256.40 "$1,313.78" $581.32 $581.32 $581.32 $581.32 "$1,291.83" "$1,291.83" "$1,291.83" $269.25 "$1,291.83" "$1,291.83" "$1,291.83" "$1,291.83" "$1,291.83" $269.23 "$1,291.83" $525.51 $764.12 "$1,291.83" "$1,313.78" "$1,291.83" "$1,291.83" $969.00 "$1,291.83" "$1,291.83" "$1,291.83" $645.92 $645.92 "$1,023.13" "$1,291.83" "$1,033.46" $581.32 $256.40 N/A $749.36 "$1,291.83" "$1,291.83" "$1,291.83" $269.22 "$1,291.83" N/A N/A 02.112.143 SUP HCPCS C1713 02.112.143 - PLATE BN CNTR 112MM NS LCP CMBN 6 HL SS FIB LT DIST LAT BOTH IP/OP "$1,200.50" $888.00 $238.26 "$1,220.85" $540.20 $540.20 $540.20 $540.20 "$1,200.45" "$1,200.45" "$1,200.45" $250.20 "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" $250.19 "$1,200.45" $488.34 $710.07 "$1,200.45" "$1,220.85" "$1,200.45" "$1,200.45" $900.38 "$1,200.45" "$1,200.45" "$1,200.45" $600.23 $600.23 $950.76 "$1,200.45" $960.36 $540.20 $238.26 N/A $696.29 "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" N/A N/A 02.112.144 SUP HCPCS C1713 02.112.144 - PLATE BONE 125MM 7 HOLE LCP STAINLESS STEEL RIGHT DISTAL BOTH IP/OP "$1,217.50" $901.00 $241.61 "$1,238.03" $547.80 $547.80 $547.80 $547.80 "$1,217.33" "$1,217.33" "$1,217.33" $253.72 "$1,217.33" "$1,217.33" "$1,217.33" "$1,217.33" "$1,217.33" $253.70 "$1,217.33" "$1,238.03" $720.05 "$1,217.33" "$1,238.03" "$1,217.33" "$1,217.33" $913.13 "$1,217.33" "$1,217.33" "$1,217.33" $608.67 $608.67 $964.13 "$1,217.33" $973.86 $547.80 $241.61 N/A $706.15 "$1,217.33" "$1,217.33" "$1,217.33" $253.69 "$1,217.33" N/A N/A 02.112.144S SUP HCPCS C1713 02.112.144S - PLATE BN CNTR 125MM STRL LCP CMBN 7 HL SS FIB RT DIST LAT BOTH IP/OP "$1,309.00" $969.00 $259.74 "$1,330.95" $588.92 $588.92 $588.92 $588.92 "$1,308.70" "$1,308.70" "$1,308.70" $272.77 "$1,308.70" "$1,308.70" "$1,308.70" "$1,308.70" "$1,308.70" $272.75 "$1,308.70" "$1,330.95" $774.10 "$1,308.70" "$1,330.95" "$1,308.70" "$1,308.70" $981.75 "$1,308.70" "$1,308.70" "$1,308.70" $654.35 $654.35 "$1,036.49" "$1,308.70" "$1,046.96" $588.92 $259.74 N/A $759.22 "$1,308.70" "$1,308.70" "$1,308.70" $272.73 "$1,308.70" N/A N/A 02.112.145 SUP HCPCS C1713 02.112.145 - PLATE BN CNTR 125MM NS LCP CMBN 7 HL SS FIB LT DIST LAT BOTH IP/OP "$1,217.50" $901.00 $241.61 "$1,238.03" $547.80 $547.80 $547.80 $547.80 "$1,217.33" "$1,217.33" "$1,217.33" $253.72 "$1,217.33" "$1,217.33" "$1,217.33" "$1,217.33" "$1,217.33" $253.70 "$1,217.33" "$1,238.03" $720.05 "$1,217.33" "$1,238.03" "$1,217.33" "$1,217.33" $913.13 "$1,217.33" "$1,217.33" "$1,217.33" $608.67 $608.67 $964.13 "$1,217.33" $973.86 $547.80 $241.61 N/A $706.15 "$1,217.33" "$1,217.33" "$1,217.33" $253.69 "$1,217.33" N/A N/A 02.112.148 SUP HCPCS C1713 02.112.148 - PLATE BONE 151MM 9 HOLE ANATOMICALLY CNTOUR LCP STAINLESS BOTH IP/OP "$1,276.50" $945.00 $253.33 "$1,298.08" $574.37 $574.37 $574.37 $574.37 "$1,276.38" "$1,276.38" "$1,276.38" $266.03 "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" $266.01 "$1,276.38" "$1,298.08" $754.98 "$1,276.38" "$1,298.08" "$1,276.38" "$1,276.38" $957.38 "$1,276.38" "$1,276.38" "$1,276.38" $638.19 $638.19 "$1,010.89" "$1,276.38" "$1,021.10" $574.37 $253.33 N/A $740.37 "$1,276.38" "$1,276.38" "$1,276.38" $266.00 "$1,276.38" N/A N/A 02.112.149 SUP HCPCS C1713 02.112.149 - PLATE BONE 151MM 9 HOLE LCP STAINLESS STEEL LEFT DISTAL BOTH IP/OP "$1,276.50" $945.00 $253.33 "$1,298.08" $574.37 $574.37 $574.37 $574.37 "$1,276.38" "$1,276.38" "$1,276.38" $266.03 "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" $266.01 "$1,276.38" "$1,298.08" $754.98 "$1,276.38" "$1,298.08" "$1,276.38" "$1,276.38" $957.38 "$1,276.38" "$1,276.38" "$1,276.38" $638.19 $638.19 "$1,010.89" "$1,276.38" "$1,021.10" $574.37 $253.33 N/A $740.37 "$1,276.38" "$1,276.38" "$1,276.38" $266.00 "$1,276.38" N/A N/A 02.112.149S SUP HCPCS C1713 02.112.149S - PLATE BN CNTR 151MM STRL LCP CMBN 9 HL SS FIB LT DIST LAT BOTH IP/OP "$1,368.00" "$1,012.00" $271.46 "$1,391.00" $615.49 $615.49 $615.49 $615.49 "$1,367.75" "$1,367.75" "$1,367.75" $285.07 "$1,367.75" "$1,367.75" "$1,367.75" "$1,367.75" "$1,367.75" $285.05 "$1,367.75" "$1,391.00" $809.02 "$1,367.75" "$1,391.00" "$1,367.75" "$1,367.75" "$1,026.00" "$1,367.75" "$1,367.75" "$1,367.75" $683.88 $683.88 "$1,083.26" "$1,367.75" "$1,094.20" $615.49 $271.46 N/A $793.44 "$1,367.75" "$1,367.75" "$1,367.75" $285.04 "$1,367.75" N/A N/A 02.112.152 SUP HCPCS C1713 02.112.152 - PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL RIGHT LATERAL BOTH IP/OP "$1,296.50" $959.00 $257.23 "$1,318.08" $583.22 $583.22 $583.22 $583.22 "$1,296.05" "$1,296.05" "$1,296.05" $270.13 "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" $270.11 "$1,296.05" "$1,318.08" $766.61 "$1,296.05" "$1,318.08" "$1,296.05" "$1,296.05" $972.38 "$1,296.05" "$1,296.05" "$1,296.05" $648.03 $648.03 "$1,026.47" "$1,296.05" "$1,036.84" $583.22 $257.23 N/A $751.97 "$1,296.05" "$1,296.05" "$1,296.05" $270.10 "$1,296.05" N/A N/A 02.112.153 SUP HCPCS C1713 02.112.153 - PLATE BONE 177MM 11 HOLE LCP STAINLESS STEEL LEFT LATERAL BOTH IP/OP "$1,296.50" $959.00 $257.23 "$1,318.08" $583.22 $583.22 $583.22 $583.22 "$1,296.05" "$1,296.05" "$1,296.05" $270.13 "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" $270.11 "$1,296.05" $527.23 $766.61 "$1,296.05" "$1,318.08" "$1,296.05" "$1,296.05" $972.38 "$1,296.05" "$1,296.05" "$1,296.05" $648.03 $648.03 "$1,026.47" "$1,296.05" "$1,036.84" $583.22 $257.23 N/A $751.97 "$1,296.05" "$1,296.05" "$1,296.05" $270.10 "$1,296.05" N/A N/A 02.112.156 SUP HCPCS C1713 02.112.156 - PLATE BONE 203MM 13 HOLE LCP STAINLESS STEEL RIGHT LATERAL BOTH IP/OP "$1,351.00" "$1,000.00" $268.12 "$1,373.85" $607.90 $607.90 $607.90 $607.90 "$1,350.88" "$1,350.88" "$1,350.88" $281.56 "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" $281.54 "$1,350.88" $549.54 $799.05 "$1,350.88" "$1,373.85" "$1,350.88" "$1,350.88" "$1,013.25" "$1,350.88" "$1,350.88" "$1,350.88" $675.44 $675.44 "$1,069.90" "$1,350.88" "$1,080.70" $607.90 $268.12 N/A $783.58 "$1,350.88" "$1,350.88" "$1,350.88" $281.52 "$1,350.88" N/A N/A 02.112.157 SUP HCPCS C1713 02.112.157 - PLATE BONE 203MM 13 HOLE LCP STAINLESS STEEL LEFT LATERAL BOTH IP/OP "$1,351.00" "$1,000.00" $268.12 "$1,373.85" $607.90 $607.90 $607.90 $607.90 "$1,350.88" "$1,350.88" "$1,350.88" $281.56 "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" $281.54 "$1,350.88" $549.54 $799.05 "$1,350.88" "$1,373.85" "$1,350.88" "$1,350.88" "$1,013.25" "$1,350.88" "$1,350.88" "$1,350.88" $675.44 $675.44 "$1,069.90" "$1,350.88" "$1,080.70" $607.90 $268.12 N/A $783.58 "$1,350.88" $810.53 "$1,350.88" $281.52 "$1,350.88" N/A N/A 02.112.160 SUP HCPCS C1713 02.112.160 - PLATE BONE 299MM 15 HOLE LCP STAINLESS STEEL RIGHT LATERAL BOTH IP/OP "$1,371.00" "$1,015.00" $272.02 "$1,393.85" $616.75 $616.75 $616.75 $616.75 "$1,370.55" "$1,370.55" "$1,370.55" $285.66 "$1,370.55" "$1,370.55" "$1,370.55" "$1,370.55" "$1,370.55" $285.64 "$1,370.55" $557.54 $810.68 "$1,370.55" "$1,393.85" "$1,370.55" "$1,370.55" "$1,028.25" "$1,370.55" "$1,370.55" "$1,370.55" $685.28 $685.28 "$1,085.48" "$1,370.55" "$1,096.44" $616.75 $272.02 N/A $795.18 "$1,370.55" $822.33 "$1,370.55" $285.62 "$1,370.55" N/A N/A 02.112.161 SUP HCPCS C1713 02.112.161 - PLATE BONE 229MM 15 HOLE LCP STAINLESS STEEL LEFT LATERAL BOTH IP/OP "$1,371.00" "$1,015.00" $272.02 "$1,393.85" $616.75 $616.75 $616.75 $616.75 "$1,370.55" "$1,370.55" "$1,370.55" $285.66 "$1,370.55" "$1,370.55" "$1,370.55" "$1,370.55" "$1,370.55" $285.64 "$1,370.55" $557.54 $810.68 "$1,370.55" "$1,393.85" "$1,370.55" "$1,370.55" "$1,028.25" "$1,370.55" "$1,370.55" "$1,370.55" $685.28 $685.28 "$1,085.48" "$1,370.55" "$1,096.44" $616.75 $272.02 N/A $795.18 "$1,370.55" $822.33 "$1,370.55" $285.62 "$1,370.55" N/A N/A 02.112.203 SUP HCPCS C1713 02.112.203 - PLATE BONE T 64MM 3 HOLE LCP STAINLESS STEEL DISTAL TIBIA BOTH IP/OP "$1,385.00" "$1,025.00" $274.81 "$1,408.15" $623.07 $623.07 $623.07 $623.07 "$1,384.60" "$1,384.60" "$1,384.60" $288.59 "$1,384.60" "$1,384.60" "$1,384.60" "$1,384.60" "$1,384.60" $288.57 "$1,384.60" $563.26 $818.99 "$1,384.60" "$1,408.15" "$1,384.60" "$1,384.60" "$1,038.75" "$1,384.60" "$1,384.60" "$1,384.60" $692.30 $692.30 "$1,096.60" "$1,384.60" "$1,107.68" $623.07 $274.81 N/A $803.30 "$1,384.60" "$1,384.60" "$1,384.60" $288.55 "$1,384.60" N/A N/A 02.112.205S SUP HCPCS C1713 02.112.205S - PLATE BONE T 90X4.5X1.5MM 5 HOLE 4 LOCKING ANGULAR STABILITY BOTH IP/OP "$1,531.00" "$1,133.00" $303.83 "$1,556.83" $688.86 $688.86 $688.86 $688.86 "$1,530.80" "$1,530.80" "$1,530.80" $319.06 "$1,530.80" "$1,530.80" "$1,530.80" "$1,530.80" "$1,530.80" $319.04 "$1,530.80" "$1,556.83" $905.47 "$1,530.80" "$1,556.83" "$1,530.80" "$1,530.80" "$1,148.25" "$1,530.80" "$1,530.80" "$1,530.80" $765.40 $765.40 "$1,212.39" "$1,530.80" "$1,224.64" $688.86 $303.83 N/A $887.98 "$1,530.80" "$1,530.80" "$1,530.80" "$1,530.80" "$1,530.80" N/A N/A 02.112.208 SUP HCPCS C1713 02.112.208 - PLATE BONE T 13.2CM 8 HOLE LCP STAINLESS STEEL POSTERIOR BOTH IP/OP "$2,397.00" "$1,774.00" $475.69 "$2,437.45" "$1,078.52" "$1,078.52" "$1,078.52" "$1,078.52" "$2,396.70" "$2,396.70" "$2,396.70" $499.53 "$2,396.70" "$2,396.70" "$2,396.70" "$2,396.70" "$2,396.70" $499.50 "$2,396.70" $974.98 "$1,417.65" "$2,396.70" "$2,437.45" "$2,396.70" "$2,396.70" "$1,797.75" "$2,396.70" "$2,396.70" "$2,396.70" "$1,198.35" "$1,198.35" "$1,898.19" "$2,396.70" "$1,917.36" "$1,078.52" $475.69 N/A "$1,390.26" "$2,396.70" "$2,396.70" "$2,396.70" $499.47 "$2,396.70" N/A N/A 02.112.208S SUP HCPCS C1713 02.112.208S - PLATE BN T 132MM STRL LCP CMBN 8 HL 4 LCK SS TIB DP 3.5MM BOTH IP/OP "$2,488.50" "$1,841.00" $493.82 "$2,530.38" "$1,119.64" "$1,119.64" "$1,119.64" "$1,119.64" "$2,488.08" "$2,488.08" "$2,488.08" $518.58 "$2,488.08" "$2,488.08" "$2,488.08" "$2,488.08" "$2,488.08" $518.54 "$2,488.08" "$2,530.38" "$1,471.70" "$2,488.08" "$2,530.38" "$2,488.08" "$2,488.08" "$1,866.38" "$2,488.08" "$2,488.08" "$2,488.08" "$1,244.04" "$1,244.04" "$1,970.56" "$2,488.08" "$1,990.46" "$1,119.64" $493.82 N/A "$1,443.33" "$2,488.08" "$2,488.08" "$2,488.08" $518.52 "$2,488.08" N/A N/A 02.112.212 SUP HCPCS C1713 02.112.212 - PLATE BONE T 184MM 4 LOCKING 12 HOLE SHAFT PROFILE ANGULAR BOTH IP/OP "$2,558.50" "$1,893.00" $507.77 "$2,601.85" "$1,151.26" "$1,151.26" "$1,151.26" "$1,151.26" "$2,558.35" "$2,558.35" "$2,558.35" $533.22 "$2,558.35" "$2,558.35" "$2,558.35" "$2,558.35" "$2,558.35" $533.19 "$2,558.35" "$2,601.85" "$1,261.27" "$2,558.35" "$2,601.85" "$2,558.35" "$2,558.35" "$1,918.88" "$2,558.35" "$2,558.35" "$2,558.35" "$1,279.18" "$1,279.18" "$2,026.21" "$2,558.35" "$2,046.68" "$1,151.26" $507.77 N/A "$1,483.93" "$2,558.35" "$2,558.35" "$2,558.35" "$2,558.35" "$2,558.35" N/A N/A 02.112.216 SUP HCPCS C1713 02.112.216 - PLATE BONE T 236MM 4 LOCKING 16 HOLE SHAFT PROFILE ANGULAR BOTH IP/OP "$2,653.00" "$1,963.00" $526.46 "$2,697.65" "$1,193.65" "$1,193.65" "$1,193.65" "$1,193.65" "$2,652.55" "$2,652.55" "$2,652.55" $552.86 "$2,652.55" "$2,652.55" "$2,652.55" "$2,652.55" "$2,652.55" $552.82 "$2,652.55" "$1,079.06" "$1,307.71" "$2,652.55" "$2,697.65" "$2,652.55" "$2,652.55" "$1,989.75" "$2,652.55" "$2,652.55" "$2,652.55" "$1,326.28" "$1,326.28" "$2,100.82" "$2,652.55" "$2,122.04" "$1,193.65" $526.46 N/A "$1,538.74" "$2,652.55" "$2,652.55" "$2,652.55" $552.79 "$2,652.55" N/A N/A 02.112.510 SUP HCPCS C1713 02.112.510 - PLATE BN LO BND 109MM NS LCP CMBN 4 HL LOPRFL RND EDG SS TIB BOTH IP/OP "$2,598.00" "$1,923.00" $515.58 "$2,641.88" "$1,168.98" "$1,168.98" "$1,168.98" "$1,168.98" "$2,597.73" "$2,597.73" "$2,597.73" $541.43 "$2,597.73" "$2,597.73" "$2,597.73" "$2,597.73" "$2,597.73" $541.40 "$2,597.73" "$2,641.88" "$1,280.68" "$2,597.73" "$2,641.88" "$2,597.73" "$2,597.73" "$1,948.50" "$2,597.73" "$2,597.73" "$2,597.73" "$1,298.87" "$1,298.87" "$2,057.40" "$2,597.73" "$2,078.18" "$1,168.98" $515.58 N/A "$1,506.84" "$2,597.73" "$2,597.73" "$2,597.73" $541.37 "$2,597.73" N/A N/A 02.112.511 SUP HCPCS C1713 02.112.511 - PLATE BN LO BND 109MM NS LCP CMBN 4 HL LOPRFL RND EDG SS TIB BOTH IP/OP "$2,598.00" "$1,923.00" $515.58 "$2,641.88" "$1,168.98" "$1,168.98" "$1,168.98" "$1,168.98" "$2,597.73" "$2,597.73" "$2,597.73" $541.43 "$2,597.73" "$2,597.73" "$2,597.73" "$2,597.73" "$2,597.73" $541.40 "$2,597.73" "$1,056.75" "$1,280.68" "$2,597.73" "$2,641.88" "$2,597.73" "$2,597.73" "$1,948.50" "$2,597.73" "$2,597.73" "$2,597.73" "$1,298.87" "$1,298.87" "$2,057.40" "$2,597.73" "$2,078.18" "$1,168.98" $515.58 N/A "$1,506.84" "$2,597.73" "$1,558.64" "$2,597.73" $541.37 "$2,597.73" N/A N/A 02.112.514 SUP HCPCS C1713 02.112.514 - PLATE BN LO BND 135MM NS LCP CMBN 6 HL LOPRFL RND EDG SS TIB BOTH IP/OP "$2,627.50" "$1,944.00" $521.44 "$2,671.93" "$1,182.26" "$1,182.26" "$1,182.26" "$1,182.26" "$2,627.25" "$2,627.25" "$2,627.25" $547.58 "$2,627.25" "$2,627.25" "$2,627.25" "$2,627.25" "$2,627.25" $547.55 "$2,627.25" "$1,068.77" "$1,295.23" "$2,627.25" "$2,671.93" "$2,627.25" "$2,627.25" "$1,970.63" "$2,627.25" "$2,627.25" "$2,627.25" "$1,313.63" "$1,313.63" "$2,080.78" "$2,627.25" "$2,101.80" "$1,182.26" $521.44 N/A "$1,523.95" "$2,627.25" "$1,576.35" "$2,627.25" $547.52 "$2,627.25" N/A N/A 02.112.514S SUP HCPCS C1713 02.112.514S - PLATE BN 135MM STRL LCP CMBN 6 HL LO BND LOPRFL RND EDG SS BOTH IP/OP "$2,719.00" "$2,012.00" $539.57 "$2,764.83" "$1,223.37" "$1,223.37" "$1,223.37" "$1,223.37" "$2,718.60" "$2,718.60" "$2,718.60" $566.62 "$2,718.60" "$2,718.60" "$2,718.60" "$2,718.60" "$2,718.60" $566.59 "$2,718.60" "$2,764.83" "$1,340.27" "$2,718.60" "$2,764.83" "$2,718.60" "$2,718.60" "$2,039.25" "$2,718.60" "$2,718.60" "$2,718.60" "$1,359.30" "$1,359.30" "$2,153.13" "$2,718.60" "$2,174.88" "$1,223.37" $539.57 N/A "$1,577.02" "$2,718.60" "$1,631.16" "$2,718.60" $566.56 "$2,718.60" N/A N/A 02.112.515 SUP HCPCS C1713 02.112.515 - PLATE BONE 135MM 6 HOLE LOW BEND LP HEAD ROUNDED EDGE LCP BOTH IP/OP "$2,627.50" "$1,944.00" $521.44 "$2,671.93" "$1,182.26" "$1,182.26" "$1,182.26" "$1,182.26" "$2,627.25" "$2,627.25" "$2,627.25" $547.58 "$2,627.25" "$2,627.25" "$2,627.25" "$2,627.25" "$2,627.25" $547.55 "$2,627.25" "$2,671.93" "$1,295.23" "$2,627.25" "$2,671.93" "$2,627.25" "$2,627.25" "$1,970.63" "$2,627.25" "$2,627.25" "$2,627.25" "$1,313.63" "$1,313.63" "$2,080.78" "$2,627.25" "$2,101.80" "$1,182.26" $521.44 N/A "$1,523.95" "$2,627.25" "$1,576.35" "$2,627.25" $547.52 "$2,627.25" N/A N/A 02.112.518 SUP HCPCS C1713 02.112.518 - PLATE BN 161MM NS LCP CMBN 8 HL LO BND LOPRFL RND EDG SS TIB BOTH IP/OP "$2,653.00" "$1,963.00" $526.46 "$2,697.65" "$1,193.65" "$1,193.65" "$1,193.65" "$1,193.65" "$2,652.55" "$2,652.55" "$2,652.55" $552.86 "$2,652.55" "$2,652.55" "$2,652.55" "$2,652.55" "$2,652.55" $552.82 "$2,652.55" "$1,079.06" "$1,307.71" "$2,652.55" "$2,697.65" "$2,652.55" "$2,652.55" "$1,989.75" "$2,652.55" "$2,652.55" "$2,652.55" "$1,326.28" "$1,326.28" "$2,100.82" "$2,652.55" "$2,122.04" "$1,193.65" $526.46 N/A "$1,538.74" "$2,652.55" "$1,591.53" "$2,652.55" $552.79 "$2,652.55" N/A N/A 02.112.519 SUP HCPCS C1713 02.112.519 - PLATE BONE 161MM 8 HOLE LOW BEND ROUNDED EDGE LP LCP BOTH IP/OP "$2,653.00" "$1,963.00" $526.46 "$2,697.65" "$1,193.65" "$1,193.65" "$1,193.65" "$1,193.65" "$2,652.55" "$2,652.55" "$2,652.55" $552.86 "$2,652.55" "$2,652.55" "$2,652.55" "$2,652.55" "$2,652.55" $552.82 "$2,652.55" "$1,079.06" "$1,307.71" "$2,652.55" "$2,697.65" "$2,652.55" "$2,652.55" "$1,989.75" "$2,652.55" "$2,652.55" "$2,652.55" "$1,326.28" "$1,326.28" "$2,100.82" "$2,652.55" "$2,122.04" "$1,193.65" $526.46 N/A "$1,538.74" "$2,652.55" "$1,591.53" "$2,652.55" $552.79 "$2,652.55" N/A N/A 02.112.522 SUP HCPCS C1713 02.112.522 - PLATE BONE 187MM 10 HOLE LOW BEND ROUNDED EDGE LP LCP BOTH IP/OP "$2,681.00" "$1,984.00" $532.04 "$2,726.23" "$1,206.29" "$1,206.29" "$1,206.29" "$1,206.29" "$2,680.65" "$2,680.65" "$2,680.65" $558.71 "$2,680.65" "$2,680.65" "$2,680.65" "$2,680.65" "$2,680.65" $558.68 "$2,680.65" "$2,726.23" "$1,321.56" "$2,680.65" "$2,726.23" "$2,680.65" "$2,680.65" "$2,010.75" "$2,680.65" "$2,680.65" "$2,680.65" "$1,340.33" "$1,340.33" "$2,123.07" "$2,680.65" "$2,144.52" "$1,206.29" $532.04 N/A "$1,554.98" "$2,680.65" "$1,608.39" "$2,680.65" $558.65 "$2,680.65" N/A N/A 02.112.523 SUP HCPCS C1713 02.112.523 - PLATE BONE 187MM 10 HOLE LOW BEND ROUNDED EDGE LP LCP BOTH IP/OP "$2,681.00" "$1,984.00" $532.04 "$2,726.23" "$1,206.29" "$1,206.29" "$1,206.29" "$1,206.29" "$2,680.65" "$2,680.65" "$2,680.65" $558.71 "$2,680.65" "$2,680.65" "$2,680.65" "$2,680.65" "$2,680.65" $558.68 "$2,680.65" "$1,090.49" "$1,321.56" "$2,680.65" "$2,726.23" "$2,680.65" "$2,680.65" "$2,010.75" "$2,680.65" "$2,680.65" "$2,680.65" "$1,340.33" "$1,340.33" "$2,123.07" "$2,680.65" "$2,144.52" "$1,206.29" $532.04 N/A "$1,554.98" "$2,680.65" "$1,608.39" "$2,680.65" $558.65 "$2,680.65" N/A N/A 02.112.523S SUP HCPCS C1713 02.112.523S - PLATE BN 187MM STRL LCP CMBN 10 HL LO BND LOPRFL RND EDG SS BOTH IP/OP "$2,772.50" "$2,052.00" $550.18 "$2,819.15" "$1,247.41" "$1,247.41" "$1,247.41" "$1,247.41" "$2,772.03" "$2,772.03" "$2,772.03" $577.76 "$2,772.03" "$2,772.03" "$2,772.03" "$2,772.03" "$2,772.03" $577.72 "$2,772.03" "$2,819.15" "$1,366.61" "$2,772.03" "$2,819.15" "$2,772.03" "$2,772.03" "$2,079.38" "$2,772.03" "$2,772.03" "$2,772.03" "$1,386.02" "$1,386.02" "$2,195.45" "$2,772.03" "$2,217.62" "$1,247.41" $550.18 N/A "$1,608.05" "$2,772.03" "$2,772.03" "$2,772.03" $577.69 "$2,772.03" N/A N/A 02.112.526 SUP HCPCS C1713 02.112.526 - PLATE BONE 213MM 12 HOLE LOW BEND LCP STAINLESS STEEL TIBIA BOTH IP/OP "$2,710.50" "$2,006.00" $537.90 "$2,756.25" "$1,219.58" "$1,219.58" "$1,219.58" "$1,219.58" "$2,710.18" "$2,710.18" "$2,710.18" $564.87 "$2,710.18" "$2,710.18" "$2,710.18" "$2,710.18" "$2,710.18" $564.83 "$2,710.18" "$1,102.50" "$1,336.12" "$2,710.18" "$2,756.25" "$2,710.18" "$2,710.18" "$2,032.88" "$2,710.18" "$2,710.18" "$2,710.18" "$1,355.09" "$1,355.09" "$2,146.46" "$2,710.18" "$2,168.14" "$1,219.58" $537.90 N/A "$1,572.09" "$2,710.18" "$2,710.18" "$2,710.18" $564.80 "$2,710.18" N/A N/A 02.112.526S SUP HCPCS C1713 02.112.526S - PLATE BN LO BND 213MM STRL LCP CMBN 12 HL LOPRFL RND EDG SS BOTH IP/OP "$2,802.00" "$2,073.00" $556.04 "$2,849.18" "$1,260.70" "$1,260.70" "$1,260.70" "$1,260.70" "$2,801.55" "$2,801.55" "$2,801.55" $583.91 "$2,801.55" "$2,801.55" "$2,801.55" "$2,801.55" "$2,801.55" $583.87 "$2,801.55" "$1,139.67" "$1,381.16" "$2,801.55" "$2,849.18" "$2,801.55" "$2,801.55" "$2,101.50" "$2,801.55" "$2,801.55" "$2,801.55" "$1,400.78" "$1,400.78" "$2,218.83" "$2,801.55" "$2,241.24" "$1,260.70" $556.04 N/A "$1,625.16" "$2,801.55" "$2,801.55" "$2,801.55" $583.84 "$2,801.55" N/A N/A 02.112.527 SUP HCPCS C1713 02.112.527 - PLATE BONE 213MM 12 HOLE LOW BEND LCP STAINLESS STEEL TIBIA BOTH IP/OP "$2,710.50" "$2,006.00" $537.90 "$2,756.25" "$1,219.58" "$1,219.58" "$1,219.58" "$1,219.58" "$2,710.18" "$2,710.18" "$2,710.18" $564.87 "$2,710.18" "$2,710.18" "$2,710.18" "$2,710.18" "$2,710.18" $564.83 "$2,710.18" "$1,102.50" "$1,336.12" "$2,710.18" "$2,756.25" "$2,710.18" "$2,710.18" "$2,032.88" "$2,710.18" "$2,710.18" "$2,710.18" "$1,355.09" "$1,355.09" "$2,146.46" "$2,710.18" "$2,168.14" "$1,219.58" $537.90 N/A "$1,572.09" "$2,710.18" "$2,710.18" "$2,710.18" $564.80 "$2,710.18" N/A N/A 02.112.527S SUP HCPCS C1713 02.112.527S - PLATE BN LO BND 213MM STRL LCP CMBN 12 HL LOPRFL RND EDG SS BOTH IP/OP "$2,802.00" "$2,073.00" $556.04 "$2,849.18" "$1,260.70" "$1,260.70" "$1,260.70" "$1,260.70" "$2,801.55" "$2,801.55" "$2,801.55" $583.91 "$2,801.55" "$2,801.55" "$2,801.55" "$2,801.55" "$2,801.55" $583.87 "$2,801.55" "$1,139.67" "$1,381.16" "$2,801.55" "$2,849.18" "$2,801.55" "$2,801.55" "$2,101.50" "$2,801.55" "$2,801.55" "$2,801.55" "$1,400.78" "$1,400.78" "$2,218.83" "$2,801.55" "$2,241.24" "$1,260.70" $556.04 N/A "$1,625.16" "$2,801.55" "$2,801.55" "$2,801.55" $583.84 "$2,801.55" N/A N/A 02.112.530 SUP HCPCS C1713 02.112.530 - PLATE BONE 239MM 14 HOLE LOW BEND LCP STAINLESS STEEL RIGHT BOTH IP/OP "$2,745.50" "$2,032.00" $544.88 "$2,792.00" "$1,235.40" "$1,235.40" "$1,235.40" "$1,235.40" "$2,745.33" "$2,745.33" "$2,745.33" $572.20 "$2,745.33" "$2,745.33" "$2,745.33" "$2,745.33" "$2,745.33" $572.16 "$2,745.33" "$1,116.80" "$1,353.45" "$2,745.33" "$2,792.00" "$2,745.33" "$2,745.33" "$2,059.13" "$2,745.33" "$2,745.33" "$2,745.33" "$1,372.67" "$1,372.67" "$2,174.30" "$2,745.33" "$2,196.26" "$1,235.40" $544.88 N/A "$1,592.39" "$2,745.33" "$1,647.20" "$2,745.33" $572.13 "$2,745.33" N/A N/A 02.112.531 SUP HCPCS C1713 02.112.531 - PLATE BONE 239MM 14 HOLE LOW BEND LCP STAINLESS STEEL TIBIA BOTH IP/OP "$2,745.50" "$2,032.00" $544.88 "$2,792.00" "$1,235.40" "$1,235.40" "$1,235.40" "$1,235.40" "$2,745.33" "$2,745.33" "$2,745.33" $572.20 "$2,745.33" "$2,745.33" "$2,745.33" "$2,745.33" "$2,745.33" $572.16 "$2,745.33" "$1,116.80" "$1,353.45" "$2,745.33" "$2,792.00" "$2,745.33" "$2,745.33" "$2,059.13" "$2,745.33" "$2,745.33" "$2,745.33" "$1,372.67" "$1,372.67" "$2,174.30" "$2,745.33" "$2,196.26" "$1,235.40" $544.88 N/A "$1,592.39" "$2,745.33" "$1,647.20" "$2,745.33" $572.13 "$2,745.33" N/A N/A 02.113.001 SUP Custom 27203010 02.113.001 - GUIDEWIRE ORTHOPEDIC 1.6MM 200MM DRILL TIP LCP STAINLESS BOTH IP/OP $70.00 $52.00 $12.39 $70.75 $69.58 $69.58 $69.58 $69.58 $69.58 $69.58 $12.39 $69.58 $69.58 $51.64 $51.64 $53.63 $36.25 $14.50 $69.58 $28.30 $69.58 $69.58 $70.75 $69.58 $69.58 $52.50 $69.58 $69.58 $69.58 $34.79 $34.79 $55.11 $69.58 $55.66 $45.23 $69.58 N/A $40.60 $69.58 $41.75 $69.58 $69.58 $69.58 N/A N/A 02.113.103 SUP HCPCS C1713 02.113.103 - PLATE BONE 62MM 3 HOLE SHARP HOOK LP PRECONTOUR SCALLOPED BOTH IP/OP "$1,019.50" $754.00 $202.27 "$1,036.45" $458.61 $458.61 $458.61 $458.61 "$1,019.13" "$1,019.13" "$1,019.13" $212.41 "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" $212.40 "$1,019.13" "$1,036.45" $602.82 "$1,019.13" "$1,036.45" "$1,019.13" "$1,019.13" $764.63 "$1,019.13" "$1,019.13" "$1,019.13" $509.57 $509.57 $807.15 "$1,019.13" $815.30 $458.61 $202.27 N/A $591.31 "$1,019.13" "$1,019.13" "$1,019.13" $212.39 "$1,019.13" N/A N/A 02.113.103S SUP HCPCS C1713 02.113.103S - PLATE BN 62MM STRL LCP CMBN 3 HL SHRP HK LOPRFL PRECONTOUR BOTH IP/OP "$1,110.50" $822.00 $220.41 "$1,129.38" $499.73 $499.73 $499.73 $499.73 "$1,110.50" "$1,110.50" "$1,110.50" $231.46 "$1,110.50" "$1,110.50" "$1,110.50" "$1,110.50" "$1,110.50" $231.44 "$1,110.50" $451.75 $656.86 "$1,110.50" "$1,129.38" "$1,110.50" "$1,110.50" $832.88 "$1,110.50" "$1,110.50" "$1,110.50" $555.25 $555.25 $879.52 "$1,110.50" $888.40 $499.73 $220.41 N/A $644.09 "$1,110.50" "$1,110.50" "$1,110.50" $231.43 "$1,110.50" N/A N/A 02.114.002 SUP HCPCS C1713 02.114.002 - PLATE BONE 23MM 4 HOLE LCP STAINLESS STEEL NONSTRL 1.5MM BOTH IP/OP $410.50 $304.00 $81.46 $417.43 $184.70 $184.70 $184.70 $184.70 $410.45 $410.45 $410.45 $85.55 $410.45 $410.45 $410.45 $410.45 $410.45 $85.54 $410.45 $166.97 $242.78 $410.45 $417.43 $410.45 $410.45 $307.88 $410.45 $410.45 $410.45 $205.23 $205.23 $325.08 $410.45 $328.36 $184.70 $81.46 N/A $238.09 $410.45 $246.27 $410.45 $85.54 $410.45 N/A N/A 02.114.003 SUP HCPCS C1713 02.114.003 - PLATE BONE 29MM 6 HOLE ADAPTION LCP STAINLESS STEEL HAND BOTH IP/OP $752.50 $557.00 $149.26 $764.83 $338.42 $338.42 $338.42 $338.42 $752.05 $752.05 $752.05 $156.75 $752.05 $752.05 $752.05 $752.05 $752.05 $156.74 $752.05 $305.93 $444.84 $752.05 $764.83 $752.05 $752.05 $564.38 $752.05 $752.05 $752.05 $376.03 $376.03 $595.62 $752.05 $601.64 $338.42 $149.26 N/A $436.45 $752.05 $752.05 $752.05 $156.73 $752.05 N/A N/A 02.114.004 SUP HCPCS C1713 02.114.004 - PLATE BONE 36MM 6 HOLE LCP STAINLESS STEEL NONSTRL 1.5MM BOTH IP/OP $410.50 $304.00 $81.46 $417.43 $184.70 $184.70 $184.70 $184.70 $410.45 $410.45 $410.45 $85.55 $410.45 $410.45 $410.45 $410.45 $410.45 $85.54 $410.45 $417.43 $242.78 $410.45 $417.43 $410.45 $410.45 $307.88 $410.45 $410.45 $410.45 $205.23 $205.23 $325.08 $410.45 $328.36 $184.70 $81.46 N/A $238.09 $410.45 $246.27 $410.45 $85.54 $410.45 N/A N/A 02.114.005 SUP HCPCS C1713 02.114.005 - PLATE BONE 59MM 12 HOLE ADAPTION LCP STAINLESS STEEL NONSTRL BOTH IP/OP $752.50 $557.00 $149.26 $764.83 $338.42 $338.42 $338.42 $338.42 $752.05 $752.05 $752.05 $156.75 $752.05 $752.05 $752.05 $752.05 $752.05 $156.74 $752.05 $305.93 $444.84 $752.05 $764.83 $752.05 $752.05 $564.38 $752.05 $752.05 $752.05 $376.03 $376.03 $595.62 $752.05 $601.64 $338.42 $149.26 N/A $436.45 $752.05 $451.23 $752.05 $156.73 $752.05 N/A N/A 02.114.006 SUP HCPCS C1713 02.114.006 - PLATE BONE 3X8 HOLE T LCP STAINLESS STEEL NONSTRL 1.5 MM BOTH IP/OP $790.00 $585.00 $156.80 $803.43 $355.50 $355.50 $355.50 $355.50 $790.00 $790.00 $790.00 $164.66 $790.00 $790.00 $790.00 $790.00 $790.00 $164.64 $790.00 $321.37 $467.29 $790.00 $803.43 $790.00 $790.00 $592.50 $790.00 $790.00 $790.00 $395.00 $395.00 $625.68 $790.00 $632.00 $355.50 $156.80 N/A $458.20 $790.00 $474.00 $790.00 $164.64 $790.00 N/A N/A 02.114.007 SUP HCPCS C1713 02.114.007 - PLATE BONE 4X8 HOLE T LCP STAINLESS STEEL NONSTRL 1.5 MM BOTH IP/OP $790.00 $585.00 $156.80 $803.43 $355.50 $355.50 $355.50 $355.50 $790.00 $790.00 $790.00 $164.66 $790.00 $790.00 $790.00 $790.00 $790.00 $164.64 $790.00 $321.37 $467.29 $790.00 $803.43 $790.00 $790.00 $592.50 $790.00 $790.00 $790.00 $395.00 $395.00 $625.68 $790.00 $632.00 $355.50 $156.80 N/A $458.20 $790.00 $790.00 $790.00 $164.64 $790.00 N/A N/A 02.114.009 SUP HCPCS C1713 02.114.009 - PLATE BONE H EXTENDED LCP STAINLESS STEEL LEFT NONSTRL 1.5 BOTH IP/OP $760.50 $563.00 $150.94 $773.40 $342.22 $342.22 $342.22 $342.22 $760.48 $760.48 $760.48 $158.50 $760.48 $760.48 $760.48 $760.48 $760.48 $158.49 $760.48 $309.36 $449.82 $760.48 $773.40 $760.48 $760.48 $570.38 $760.48 $760.48 $760.48 $380.24 $380.24 $602.30 $760.48 $608.38 $342.22 $150.94 N/A $441.09 $760.48 $760.48 $760.48 $158.48 $760.48 N/A N/A 02.114.010 SUP HCPCS C1713 02.114.010 - PLATE BONE H EXTENDED LCP STAINLESS STEEL RIGHT NONSTRL 1.5 BOTH IP/OP $760.50 $563.00 $150.94 $773.40 $342.22 $342.22 $342.22 $342.22 $760.48 $760.48 $760.48 $158.50 $760.48 $760.48 $760.48 $760.48 $760.48 $158.49 $760.48 $309.36 $449.82 $760.48 $773.40 $760.48 $760.48 $570.38 $760.48 $760.48 $760.48 $380.24 $380.24 $602.30 $760.48 $608.38 $342.22 $150.94 N/A $441.09 $760.48 $456.29 $760.48 $158.48 $760.48 N/A N/A 02.114.013 SUP HCPCS C1713 02.114.013 - PLATE BONE 3X8 HOLE Y LCP STAINLESS STEEL NONSTRL 1.5 MM BOTH IP/OP $760.50 $563.00 $150.94 $773.40 $342.22 $342.22 $342.22 $342.22 $760.48 $760.48 $760.48 $158.50 $760.48 $760.48 $760.48 $760.48 $760.48 $158.49 $760.48 $773.40 $449.82 $760.48 $773.40 $760.48 $760.48 $570.38 $760.48 $760.48 $760.48 $380.24 $380.24 $602.30 $760.48 $608.38 $342.22 $150.94 N/A $441.09 $760.48 $456.29 $760.48 $158.48 $760.48 N/A N/A 02.114.014 SUP HCPCS C1713 02.114.014 - PLATE BONE 6 HOLE LCP STAINLESS STEEL CONDYLE NONSTRL 1.5 MM BOTH IP/OP $945.00 $699.00 $187.49 $960.68 $425.08 $425.08 $425.08 $425.08 $944.63 $944.63 $944.63 $196.88 $944.63 $944.63 $944.63 $944.63 $944.63 $196.87 $944.63 $960.68 $558.75 $944.63 $960.68 $944.63 $944.63 $708.75 $944.63 $944.63 $944.63 $472.32 $472.32 $748.15 $944.63 $755.70 $425.08 $187.49 N/A $548.10 $944.63 $566.78 $944.63 $196.86 $944.63 N/A N/A 02.114.502 SUP HCPCS C1713 02.114.502 - PLATE BONE 2.3CM 4 HOLE SHORT THREADED DRILL GUIDE LP CUT TO BOTH IP/OP $491.00 $363.00 $97.37 $498.93 $220.76 $220.76 $220.76 $220.76 $490.58 $490.58 $490.58 $102.25 $490.58 $490.58 $490.58 $490.58 $490.58 $102.24 $490.58 $199.57 $290.18 $490.58 $498.93 $490.58 $490.58 $368.25 $490.58 $490.58 $490.58 $245.29 $245.29 $388.54 $490.58 $392.46 $220.76 $97.37 N/A $284.78 $490.58 $294.35 $490.58 $102.24 $490.58 N/A N/A 02.114.503 SUP HCPCS C1713 02.114.503 - PLATE BONE 2.9CM 6 HOLE SHORT THREADED DRILL GUIDE ADAPTION BOTH IP/OP $836.50 $619.00 $166.00 $850.60 $376.37 $376.37 $376.37 $376.37 $836.38 $836.38 $836.38 $174.32 $836.38 $836.38 $836.38 $836.38 $836.38 $174.31 $836.38 $340.24 $494.72 $836.38 $850.60 $836.38 $836.38 $627.38 $836.38 $836.38 $836.38 $418.19 $418.19 $662.41 $836.38 $669.10 $376.37 $166.00 N/A $485.17 $836.38 $501.83 $836.38 $174.30 $836.38 N/A N/A 02.114.504 SUP HCPCS C1713 02.114.504 - PLATE BONE 3.6CM 6 HOLE SHORT THREADED DRILL GUIDE LP CUT TO BOTH IP/OP $491.00 $363.00 $97.37 $498.93 $220.76 $220.76 $220.76 $220.76 $490.58 $490.58 $490.58 $102.25 $490.58 $490.58 $490.58 $490.58 $490.58 $102.24 $490.58 $199.57 $290.18 $490.58 $498.93 $490.58 $490.58 $368.25 $490.58 $490.58 $490.58 $245.29 $245.29 $388.54 $490.58 $392.46 $220.76 $97.37 N/A $284.78 $490.58 $294.35 $490.58 $102.24 $490.58 N/A N/A 02.114.505 SUP HCPCS C1713 02.114.505 - PLATE BONE 5.9CM 12 HOLE SHORT THREADED DRILL GUIDE ADAPTION BOTH IP/OP $836.50 $619.00 $166.00 $850.60 $376.37 $376.37 $376.37 $376.37 $836.38 $836.38 $836.38 $174.32 $836.38 $836.38 $836.38 $836.38 $836.38 $174.31 $836.38 $850.60 $494.72 $836.38 $850.60 $836.38 $836.38 $627.38 $836.38 $836.38 $836.38 $418.19 $418.19 $662.41 $836.38 $669.10 $376.37 $166.00 N/A $485.17 $836.38 $501.83 $836.38 $174.30 $836.38 N/A N/A 02.114.506 SUP HCPCS C1713 02.114.506 - PLATE BONE T 3X8 HOLE SHORT THREADED DRILL GUIDE LP CUT TO BOTH IP/OP $886.00 $656.00 $175.77 $900.63 $398.51 $398.51 $398.51 $398.51 $885.58 $885.58 $885.58 $184.58 $885.58 $885.58 $885.58 $885.58 $885.58 $184.56 $885.58 $360.25 $523.82 $885.58 $900.63 $885.58 $885.58 $664.50 $885.58 $885.58 $885.58 $442.79 $442.79 $701.38 $885.58 $708.46 $398.51 $175.77 N/A $513.88 $885.58 $531.35 $885.58 $184.55 $885.58 N/A N/A 02.114.507 SUP HCPCS C1713 02.114.507 - PLATE BONE T 4 HOLE HEAD 8 HOLE SHAFT LP CUT TO LENGTH LCP BOTH IP/OP $886.00 $656.00 $175.77 $900.63 $398.51 $398.51 $398.51 $398.51 $885.58 $885.58 $885.58 $184.58 $885.58 $885.58 $885.58 $885.58 $885.58 $184.56 $885.58 $360.25 $523.82 $885.58 $900.63 $885.58 $885.58 $664.50 $885.58 $885.58 $885.58 $442.79 $442.79 $701.38 $885.58 $708.46 $398.51 $175.77 N/A $513.88 $885.58 $531.35 $885.58 $184.55 $885.58 N/A N/A 02.114.509 SUP HCPCS C1713 02.114.509 - PLATE BONE H EXTENDED PRELOADED DRILL GUIDE LP CUT TO LENGTH BOTH IP/OP $846.50 $626.00 $167.96 $860.60 $380.80 $380.80 $380.80 $380.80 $846.23 $846.23 $846.23 $176.38 $846.23 $846.23 $846.23 $846.23 $846.23 $176.36 $846.23 $344.24 $500.55 $846.23 $860.60 $846.23 $846.23 $634.88 $846.23 $846.23 $846.23 $423.12 $423.12 $670.21 $846.23 $676.98 $380.80 $167.96 N/A $490.97 $846.23 $507.74 $846.23 $176.35 $846.23 N/A N/A 02.114.510 SUP HCPCS C1713 02.114.510 - PLATE BONE H EXTENDED PRELOADED DRILL GUIDE LP CUT TO LENGTH BOTH IP/OP $846.50 $626.00 $167.96 $860.60 $380.80 $380.80 $380.80 $380.80 $846.23 $846.23 $846.23 $176.38 $846.23 $846.23 $846.23 $846.23 $846.23 $176.36 $846.23 $860.60 $500.55 $846.23 $860.60 $846.23 $846.23 $634.88 $846.23 $846.23 $846.23 $423.12 $423.12 $670.21 $846.23 $676.98 $380.80 $167.96 N/A $490.97 $846.23 $846.23 $846.23 $176.35 $846.23 N/A N/A 02.114.513 SUP HCPCS C1713 02.114.513 - PLATE BONE Y 3X8 HOLE LP SHORT THREADED DRILL GUIDE CUT TO BOTH IP/OP $846.50 $626.00 $167.96 $860.60 $380.80 $380.80 $380.80 $380.80 $846.23 $846.23 $846.23 $176.38 $846.23 $846.23 $846.23 $846.23 $846.23 $176.36 $846.23 $860.60 $500.55 $846.23 $860.60 $846.23 $846.23 $634.88 $846.23 $846.23 $846.23 $423.12 $423.12 $670.21 $846.23 $676.98 $380.80 $167.96 N/A $490.97 $846.23 $507.74 $846.23 $176.35 $846.23 N/A N/A 02.114.514 SUP HCPCS C1713 02.114.514 - PLATE BONE 6 HOLE LP SHORT THREADED DRILL GUIDE CUT TO BOTH IP/OP "$1,030.50" $763.00 $204.50 "$1,047.90" $463.67 $463.67 $463.67 $463.67 "$1,030.38" "$1,030.38" "$1,030.38" $214.76 "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" $214.74 "$1,030.38" "$1,047.90" $609.47 "$1,030.38" "$1,047.90" "$1,030.38" "$1,030.38" $772.88 "$1,030.38" "$1,030.38" "$1,030.38" $515.19 $515.19 $816.06 "$1,030.38" $824.30 $463.67 $204.50 N/A $597.69 "$1,030.38" $618.23 "$1,030.38" $214.73 "$1,030.38" N/A N/A 02.115.130 SUP HCPCS C1713 02.115.130 - PLATE BONE 90D L 37MM 2X3 HOLE VAR ANG LCP STAINLESS STEEL BOTH IP/OP "$1,026.50" $760.00 $203.67 "$1,043.60" $461.77 $461.77 $461.77 $461.77 "$1,026.15" "$1,026.15" "$1,026.15" $213.88 "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" $213.86 "$1,026.15" "$1,043.60" $606.97 "$1,026.15" "$1,043.60" "$1,026.15" "$1,026.15" $769.88 "$1,026.15" "$1,026.15" "$1,026.15" $513.08 $513.08 $812.71 "$1,026.15" $820.92 $461.77 $203.67 N/A $595.37 "$1,026.15" $615.69 "$1,026.15" $213.85 "$1,026.15" N/A N/A 02.115.131 SUP HCPCS C1713 02.115.131 - PLATE BONE -90D L 37MM 2X3 HOLE VAR ANG LCP STAINLESS STEEL BOTH IP/OP "$1,026.50" $760.00 $203.67 "$1,043.60" $461.77 $461.77 $461.77 $461.77 "$1,026.15" "$1,026.15" "$1,026.15" $213.88 "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" $213.86 "$1,026.15" "$1,043.60" $606.97 "$1,026.15" "$1,043.60" "$1,026.15" "$1,026.15" $769.88 "$1,026.15" "$1,026.15" "$1,026.15" $513.08 $513.08 $812.71 "$1,026.15" $820.92 $461.77 $203.67 N/A $595.37 "$1,026.15" $615.69 "$1,026.15" $213.85 "$1,026.15" N/A N/A 02.115.150 SUP HCPCS C1713 02.115.150 - PLATE BONE 90+ D L 51MM 2 HOLE HEAD 5 HOLE SHAFT VAR ANG LCP BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" "$1,096.50" $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" $646.91 "$1,078.18" $224.69 "$1,078.18" N/A N/A 02.115.151 SUP HCPCS C1713 02.115.151 - PLATE BONE -90D 51MM 2X5 HOLE L VAR ANG LCP STAINLESS STEEL BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" "$1,096.50" $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" $646.91 "$1,078.18" $224.69 "$1,078.18" N/A N/A 02.115.230 SUP HCPCS C1713 02.115.230 - PLATE BONE +90D L 37MM 3X3 HOLE VAR ANG LCP STAINLESS STEEL BOTH IP/OP "$1,026.50" $760.00 $203.67 "$1,043.60" $461.77 $461.77 $461.77 $461.77 "$1,026.15" "$1,026.15" "$1,026.15" $213.88 "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" $213.86 "$1,026.15" "$1,043.60" $606.97 "$1,026.15" "$1,043.60" "$1,026.15" "$1,026.15" $769.88 "$1,026.15" "$1,026.15" "$1,026.15" $513.08 $513.08 $812.71 "$1,026.15" $820.92 $461.77 $203.67 N/A $595.37 "$1,026.15" "$1,026.15" "$1,026.15" $213.85 "$1,026.15" N/A N/A 02.115.231 SUP HCPCS C1713 02.115.231 - PLATE BONE -90D 37MM 3X3 HOLE L VAR ANG LCP STAINLESS STEEL BOTH IP/OP "$1,026.50" $760.00 $203.67 "$1,043.60" $461.77 $461.77 $461.77 $461.77 "$1,026.15" "$1,026.15" "$1,026.15" $213.88 "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" $213.86 "$1,026.15" "$1,043.60" $606.97 "$1,026.15" "$1,043.60" "$1,026.15" "$1,026.15" $769.88 "$1,026.15" "$1,026.15" "$1,026.15" $513.08 $513.08 $812.71 "$1,026.15" $820.92 $461.77 $203.67 N/A $595.37 "$1,026.15" "$1,026.15" "$1,026.15" $213.85 "$1,026.15" N/A N/A 02.115.250 SUP HCPCS C1713 02.115.250 - PLATE BONE +90D 51MM 3X5 HOLE L VAR ANG LCP STAINLESS STEEL BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" "$1,096.50" $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" $646.91 "$1,078.18" $224.69 "$1,078.18" N/A N/A 02.115.251 SUP HCPCS C1713 02.115.251 - PLATE BONE -90D 51MM 3X5 HOLE L VAR ANG LCP STAINLESS STEEL BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" "$1,096.50" $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" $646.91 "$1,078.18" $224.69 "$1,078.18" N/A N/A 02.115.330 SUP HCPCS C1713 02.115.330 - PLATE BONE 37MM 3X3 HOLE T VAR ANG LCP STAINLESS STEEL BOTH IP/OP "$1,060.00" $784.00 $210.36 "$1,077.93" $476.96 $476.96 $476.96 $476.96 "$1,059.90" "$1,059.90" "$1,059.90" $220.91 "$1,059.90" "$1,059.90" "$1,059.90" "$1,059.90" "$1,059.90" $220.89 "$1,059.90" "$1,077.93" $626.93 "$1,059.90" "$1,077.93" "$1,059.90" "$1,059.90" $795.00 "$1,059.90" "$1,059.90" "$1,059.90" $529.95 $529.95 $839.44 "$1,059.90" $847.92 $476.96 $210.36 N/A $614.80 "$1,059.90" $635.94 "$1,059.90" $220.88 "$1,059.90" N/A N/A 02.115.350 SUP HCPCS C1713 02.115.350 - PLATE BONE 51MM 3X5 HOLE T VAR ANG LCP STAINLESS STEEL BOTH IP/OP "$1,106.50" $819.00 $219.57 "$1,125.08" $497.83 $497.83 $497.83 $497.83 "$1,106.28" "$1,106.28" "$1,106.28" $230.58 "$1,106.28" "$1,106.28" "$1,106.28" "$1,106.28" "$1,106.28" $230.56 "$1,106.28" "$1,125.08" $654.36 "$1,106.28" "$1,125.08" "$1,106.28" "$1,106.28" $829.88 "$1,106.28" "$1,106.28" "$1,106.28" $553.14 $553.14 $876.17 "$1,106.28" $885.02 $497.83 $219.57 N/A $641.77 "$1,106.28" "$1,106.28" "$1,106.28" $230.55 "$1,106.28" N/A N/A 02.115.430 SUP HCPCS C1713 02.115.430 - PLATE BONE 20D 41MM 3X3 HOLE L VAR ANG OBLIQUE LCP STAINLESS BOTH IP/OP "$1,026.50" $760.00 $203.67 "$1,043.60" $461.77 $461.77 $461.77 $461.77 "$1,026.15" "$1,026.15" "$1,026.15" $213.88 "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" $213.86 "$1,026.15" "$1,043.60" $606.97 "$1,026.15" "$1,043.60" "$1,026.15" "$1,026.15" $769.88 "$1,026.15" "$1,026.15" "$1,026.15" $513.08 $513.08 $812.71 "$1,026.15" $820.92 $461.77 $203.67 N/A $595.37 "$1,026.15" "$1,026.15" "$1,026.15" $213.85 "$1,026.15" N/A N/A 02.115.430S SUP HCPCS C1713 02.115.430S - PLATE BN +20D OBLQ L 41MM STRL LCP CMBN 3 HLE/HD 3 HL SHFT BOTH IP/OP "$1,118.00" $827.00 $221.80 "$1,136.53" $502.89 $502.89 $502.89 $502.89 "$1,117.53" "$1,117.53" "$1,117.53" $232.92 "$1,117.53" "$1,117.53" "$1,117.53" "$1,117.53" "$1,117.53" $232.91 "$1,117.53" "$1,136.53" $661.02 "$1,117.53" "$1,117.53" "$1,117.53" "$1,117.53" $838.50 "$1,117.53" "$1,117.53" "$1,117.53" $558.77 $558.77 $885.08 "$1,117.53" $894.02 $502.89 $221.80 N/A $648.44 "$1,117.53" "$1,117.53" "$1,117.53" $232.89 "$1,117.53" N/A N/A 02.115.431 SUP HCPCS C1713 02.115.431 - PLATE BONE -20D L 41MM 3X3 HOLE VAR ANG OBLIQUE LCP BOTH IP/OP "$1,026.50" $760.00 $203.67 "$1,043.60" $461.77 $461.77 $461.77 $461.77 "$1,026.15" "$1,026.15" "$1,026.15" $213.88 "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" $213.86 "$1,026.15" "$1,043.60" $606.97 "$1,026.15" "$1,043.60" "$1,026.15" "$1,026.15" $769.88 "$1,026.15" "$1,026.15" "$1,026.15" $513.08 $513.08 $812.71 "$1,026.15" $820.92 $461.77 $203.67 N/A $595.37 "$1,026.15" "$1,026.15" "$1,026.15" $213.85 "$1,026.15" N/A N/A 02.115.431S SUP HCPCS C1713 02.115.431S - PLATE BN -20D OBLQ L 41MM STRL LCP CMBN 3 HLE/HD 3 HL SHFT BOTH IP/OP "$1,118.00" $827.00 $221.80 "$1,136.53" $502.89 $502.89 $502.89 $502.89 "$1,117.53" "$1,117.53" "$1,117.53" $232.92 "$1,117.53" "$1,117.53" "$1,117.53" "$1,117.53" "$1,117.53" $232.91 "$1,117.53" "$1,136.53" $661.02 "$1,117.53" "$1,136.53" "$1,117.53" "$1,117.53" $838.50 "$1,117.53" "$1,117.53" "$1,117.53" $558.77 $558.77 $885.08 "$1,117.53" $894.02 $502.89 $221.80 N/A $648.44 "$1,117.53" "$1,117.53" "$1,117.53" $232.89 "$1,117.53" N/A N/A 02.115.450 SUP HCPCS C1713 02.115.450 - PLATE BONE +20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LCP BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" "$1,096.50" $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" "$1,078.18" "$1,078.18" $224.69 "$1,078.18" N/A N/A 02.115.451 SUP HCPCS C1713 02.115.451 - PLATE BONE -20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LCP BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" "$1,096.50" $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" "$1,078.18" "$1,078.18" $224.69 "$1,078.18" N/A N/A 02.115.530 SUP HCPCS C1713 02.115.530 - PLATE BONE 46MM 5 HOLE VAR ANG COLUMN LCP STAINLESS STEEL BOTH IP/OP "$1,006.50" $745.00 $199.76 "$1,023.58" $452.92 $452.92 $452.92 $452.92 "$1,006.48" "$1,006.48" "$1,006.48" $209.78 "$1,006.48" "$1,006.48" "$1,006.48" "$1,006.48" "$1,006.48" $209.76 "$1,006.48" $409.43 $595.33 "$1,006.48" "$1,023.58" "$1,006.48" "$1,006.48" $754.88 "$1,006.48" "$1,006.48" "$1,006.48" $503.24 $503.24 $797.13 "$1,006.48" $805.18 $452.92 $199.76 N/A $583.77 "$1,006.48" "$1,006.48" "$1,006.48" $209.75 "$1,006.48" N/A N/A 02.115.540 SUP HCPCS C1713 02.115.540 - PLATE BONE 57MM 6 HOLE VAR ANG COLUMN LCP STAINLESS STEEL BOTH IP/OP "$1,060.00" $784.00 $210.36 "$1,077.93" $476.96 $476.96 $476.96 $476.96 "$1,059.90" "$1,059.90" "$1,059.90" $220.91 "$1,059.90" "$1,059.90" "$1,059.90" "$1,059.90" "$1,059.90" $220.89 "$1,059.90" "$1,077.93" $626.93 "$1,059.90" "$1,077.93" "$1,059.90" "$1,059.90" $795.00 "$1,059.90" "$1,059.90" "$1,059.90" $529.95 $529.95 $839.44 "$1,059.90" $847.92 $476.96 $210.36 N/A $614.80 "$1,059.90" "$1,059.90" "$1,059.90" $220.88 "$1,059.90" N/A N/A 02.115.630 SUP HCPCS C1713 02.115.630 - PLATE BONE 90D 41MM 3 HOLE VAR ANG INTERMEDIATE COLUMN LCP BOTH IP/OP "$1,106.50" $819.00 $219.57 "$1,125.08" $497.83 $497.83 $497.83 $497.83 "$1,106.28" "$1,106.28" "$1,106.28" $230.58 "$1,106.28" "$1,106.28" "$1,106.28" "$1,106.28" "$1,106.28" $230.56 "$1,106.28" $450.03 $654.36 "$1,106.28" "$1,125.08" "$1,106.28" "$1,106.28" $829.88 "$1,106.28" "$1,106.28" "$1,106.28" $553.14 $553.14 $876.17 "$1,106.28" $885.02 $497.83 $219.57 N/A $641.77 "$1,106.28" "$1,106.28" "$1,106.28" $230.55 "$1,106.28" N/A N/A 02.115.631 SUP HCPCS C1713 02.115.631 - PLATE BONE -90D 41MM 3 HOLE VAR ANG INTERMEDIATE COLUMN LCP BOTH IP/OP "$1,106.50" $819.00 $219.57 "$1,125.08" $497.83 $497.83 $497.83 $497.83 "$1,106.28" "$1,106.28" "$1,106.28" $230.58 "$1,106.28" "$1,106.28" "$1,106.28" "$1,106.28" "$1,106.28" $230.56 "$1,106.28" $450.03 $654.36 "$1,106.28" "$1,125.08" "$1,106.28" "$1,106.28" $829.88 "$1,106.28" "$1,106.28" "$1,106.28" $553.14 $553.14 $876.17 "$1,106.28" $885.02 $497.83 $219.57 N/A $641.77 "$1,106.28" "$1,106.28" "$1,106.28" $230.55 "$1,106.28" N/A N/A 02.115.640 SUP HCPCS C1713 02.115.640 - PLATE BONE +90D 49MM 4 HOLE VAR ANG INTERMEDIATE COLUMN LCP BOTH IP/OP "$1,147.50" $849.00 $227.66 "$1,166.55" $516.17 $516.17 $516.17 $516.17 "$1,147.05" "$1,147.05" "$1,147.05" $239.07 "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" $239.06 "$1,147.05" "$1,166.55" $678.48 "$1,147.05" "$1,166.55" "$1,147.05" "$1,147.05" $860.63 "$1,147.05" "$1,147.05" "$1,147.05" $573.53 $573.53 $908.46 "$1,147.05" $917.64 $516.17 $227.66 N/A $665.55 "$1,147.05" "$1,147.05" "$1,147.05" $239.05 "$1,147.05" N/A N/A 02.115.641 SUP HCPCS C1713 02.115.641 - PLATE BONE -90D 49MM 4 HOLE VAR ANG INTERMEDIATE COLUMN LCP BOTH IP/OP "$1,147.50" $849.00 $227.66 "$1,166.55" $516.17 $516.17 $516.17 $516.17 "$1,147.05" "$1,147.05" "$1,147.05" $239.07 "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" $239.06 "$1,147.05" "$1,166.55" $678.48 "$1,147.05" "$1,166.55" "$1,147.05" "$1,147.05" $860.63 "$1,147.05" "$1,147.05" "$1,147.05" $573.53 $573.53 $908.46 "$1,147.05" $917.64 $516.17 $227.66 N/A $665.55 "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" N/A N/A 02.115.751S SUP HCPCS C1713 02.115.751S - PLATE BN 57MM STRL LCP CMBN 6 HLE/HD 5 HL SHFT VA SS RDS LT BOTH IP/OP "$1,889.50" "$1,398.00" $374.97 "$1,921.38" $850.16 $850.16 $850.16 $850.16 "$1,889.25" "$1,889.25" "$1,889.25" $393.77 "$1,889.25" "$1,889.25" "$1,889.25" "$1,889.25" "$1,889.25" $393.74 "$1,889.25" "$1,921.38" "$1,117.49" "$1,889.25" "$1,889.25" "$1,889.25" "$1,889.25" "$1,417.13" "$1,889.25" "$1,889.25" "$1,889.25" $944.63 $944.63 "$1,496.29" "$1,889.25" "$1,511.40" $850.16 $374.97 N/A "$1,095.91" "$1,889.25" "$1,133.55" "$1,889.25" $393.72 "$1,889.25" N/A N/A 02.117.003S SUP HCPCS C1713 02.117.003S - PLATE BN SHRT 75MM STRL LCP CMBN 3 HL VA TPR TIP LAT SPRT SS BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" $933.81 "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$1,377.30" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.004S SUP HCPCS C1713 02.117.004S - PLATE BONE MEDIUM 88MM 4 HOLE VAR ANG LATERAL SUPPORT BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" $933.81 "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$1,377.30" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.007S SUP HCPCS C1713 02.117.007S - PLATE BONE LONG 127MM 7 HOLE VAR ANG TAPER TIP LATERAL BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" $933.81 "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$1,377.30" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.009S SUP HCPCS C1713 02.117.009S - PLATE BONE XLONG 153MM 9 HOLE VAR ANG LATERAL SUPPORT BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" $933.81 "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$1,377.30" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.013S SUP HCPCS C1713 02.117.013S - PLATE BN 205MM STRL LCP CMBN 13 HL VA TPR TIP LAT SPRT SS BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" "$2,334.53" "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$2,295.50" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.103S SUP HCPCS C1713 02.117.103S - PLATE BONE SHORT 75MM 3 HOLE VAR ANG LATERAL SUPPORT LCP BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" $933.81 "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$1,377.30" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.104 SUP HCPCS C1713 02.117.104 - PLATE BN MED 88MM NS LCP CMBN 4 HL VA TPR TIP LAT SPRT SS BOTH IP/OP "$2,204.50" "$1,631.00" $437.46 "$2,241.60" $991.86 $991.86 $991.86 $991.86 "$2,204.13" "$2,204.13" "$2,204.13" $459.40 "$2,204.13" "$2,204.13" "$2,204.13" "$2,204.13" "$2,204.13" $459.36 "$2,204.13" "$2,241.60" "$1,303.74" "$2,204.13" "$2,241.60" "$2,204.13" "$2,204.13" "$1,653.38" "$2,204.13" "$2,204.13" "$2,204.13" "$1,102.07" "$1,102.07" "$1,745.67" "$2,204.13" "$1,763.30" $991.86 $437.46 N/A "$1,278.61" "$2,204.13" "$2,204.13" "$2,204.13" $459.34 "$2,204.13" N/A N/A 02.117.104S SUP HCPCS C1713 02.117.104S - PLATE BONE MEDIUM 88MM 4 HOLE VAR ANG LATERAL SUPPORT BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" $933.81 "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$1,377.30" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.107S SUP HCPCS C1713 02.117.107S - PLATE BONE LONG 127MM 7 HOLE VAR ANG LATERAL SUPPORT TAPERED BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" $933.81 "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$1,377.30" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.111S SUP HCPCS C1713 02.117.111S - PLATE BN 179MM STRL LCP CMBN 11 HL VA TPR TIP LAT SPRT SS BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" "$2,334.53" "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$2,295.50" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.203S SUP HCPCS C1713 02.117.203S - PLATE SHRT 75MM SS 2.7/3.5MM SCR 3 HOLE VAR ANG BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" "$2,267.33" "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.204S SUP HCPCS C1713 02.117.204S - PLATE BN MED 88MM STRL LCP CMBN 4 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.207S SUP HCPCS C1713 02.117.207S - PLATE BN LNG 127MM STRL LCP CMBN 7 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.211S SUP HCPCS C1713 02.117.211S - PLATE BN 179MM STRL LCP CMBN 11 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$2,229.43" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.213S SUP HCPCS C1713 02.117.213S - PLATE BN 205MM STRL LCP CMBN 13 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" "$2,267.33" "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$2,229.43" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.303S SUP HCPCS C1713 02.117.303S - PLATE BONE SHORT 75MM 3 HOLE VAR ANG ROUND PROFILE TAPERED BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.304S SUP HCPCS C1713 02.117.304S - PLATE BONE MEDIUM 88MM 4 HOLE VAR ANG ROUND PROFILE TAPERED BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.307S SUP HCPCS C1713 02.117.307S - PLATE BN LNG 127MM STRL LCP CMBN 7 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" "$2,267.33" "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.309S SUP HCPCS C1713 02.117.309S - PLATE BONE XLONG 153MM 9 HOLE VAR ANG ROUND PROFILE TAPERED BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$2,229.43" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.311S SUP HCPCS C1713 02.117.311S - PLATE BN 179MM STRL LCP CMBN 11 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$2,229.43" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.313S SUP HCPCS C1713 02.117.313S - PLATE BN 205MM STRL LCP CMBN 13 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$2,229.43" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.401S SUP HCPCS C1713 02.117.401S - PLATE BONE SHORT 69MM 1 HOLE VAR ANG ROUND PROFILE TAPERED BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" "$2,267.33" "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$2,229.43" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.402S SUP HCPCS C1713 02.117.402S - PLATE BN MED 82MM STRL LCP CMBN 2 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" "$2,267.33" "$1,318.71" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" "$2,229.43" "$2,229.43" N/A N/A 02.117.404S SUP HCPCS C1713 02.117.404S - PLATE BONE LONG 108MM 4 HOLE VAR ANG TAPER TIP ROUND PROFILE BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" "$2,267.33" "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$2,229.43" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.406S SUP HCPCS C1713 02.117.406S - PLATE BONE XLONG 134MM 6 HOLE VAR ANG TAPER TIP ROUND BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" "$2,267.33" "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.410S SUP HCPCS C1713 02.117.410S - PLATE BN 186MM STRL LCP CMBN 10 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$2,229.43" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.501S SUP HCPCS C1713 02.117.501S - PLATE BONE SHORT 69MM 1 HOLE VAR ANG ROUND PROFILE TAPERED BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" "$2,267.33" "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$2,229.43" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.502 SUP HCPCS C1713 02.117.502 - PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG LCP STAINLESS STEEL BOTH IP/OP "$2,138.50" "$1,582.00" $424.35 "$2,174.40" $962.12 $962.12 $962.12 $962.12 "$2,138.05" "$2,138.05" "$2,138.05" $445.62 "$2,138.05" "$2,138.05" "$2,138.05" "$2,138.05" "$2,138.05" $445.59 "$2,138.05" "$2,174.40" "$1,264.66" "$2,138.05" "$2,174.40" "$2,138.05" "$2,138.05" "$1,603.88" "$2,138.05" "$2,138.05" "$2,138.05" "$1,069.03" "$1,069.03" "$1,693.34" "$2,138.05" "$1,710.44" $962.12 $424.35 N/A "$1,240.33" "$2,138.05" "$1,282.83" "$2,138.05" $445.57 "$2,138.05" N/A N/A 02.117.502S SUP HCPCS C1713 02.117.502S - PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG ROUND PROFILE TAPERED BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" "$2,267.33" "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.504 SUP HCPCS C1713 02.117.504 - PLATE BN LNG 108MM NS LCP CMBN 4 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,138.50" "$1,582.00" $424.35 "$2,174.40" $962.12 $962.12 $962.12 $962.12 "$2,138.05" "$2,138.05" "$2,138.05" $445.62 "$2,138.05" "$2,138.05" "$2,138.05" "$2,138.05" "$2,138.05" $445.59 "$2,138.05" $869.76 "$1,264.66" "$2,138.05" "$2,174.40" "$2,138.05" "$2,138.05" "$1,603.88" "$2,138.05" "$2,138.05" "$2,138.05" "$1,069.03" "$1,069.03" "$1,693.34" "$2,138.05" "$1,710.44" $962.12 $424.35 N/A "$1,240.33" "$2,138.05" "$2,138.05" "$2,138.05" $445.57 "$2,138.05" N/A N/A 02.117.504S SUP HCPCS C1713 02.117.504S - PLATE BONE LONG 108MM 4 HOLE VAR ANG ROUND PROFILE TAPERED BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" "$2,267.33" "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.506 SUP HCPCS C1713 02.117.506 - PLATE BN XLNG 134MM NS LCP CMBN 6 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,138.50" "$1,582.00" $424.35 "$2,174.40" $962.12 $962.12 $962.12 $962.12 "$2,138.05" "$2,138.05" "$2,138.05" $445.62 "$2,138.05" "$2,138.05" "$2,138.05" "$2,138.05" "$2,138.05" $445.59 "$2,138.05" $869.76 "$1,264.66" "$2,138.05" "$2,174.40" "$2,138.05" "$2,138.05" "$1,603.88" "$2,138.05" "$2,138.05" "$2,138.05" "$1,069.03" "$1,069.03" "$1,693.34" "$2,138.05" "$1,710.44" $962.12 $424.35 N/A "$1,240.33" "$2,138.05" "$2,138.05" "$2,138.05" $445.57 "$2,138.05" N/A N/A 02.117.506S SUP HCPCS C1713 02.117.506S - PLATE BN XLNG 134MM STRL LCP CMBN 6 HL VA TPR TIP RND PRFL BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.508S SUP HCPCS C1713 02.117.508S - PLATE BN 160MM STRL LCP CMBN 8 HL VA TPR TIP RND PRFL SS HUM BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$2,229.43" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.510S SUP HCPCS C1713 02.117.510S - PLATE BN 186MM STRL LCP CMBN 10 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$2,229.43" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.601S SUP HCPCS C1713 02.117.601S - PLATE BONE LCP COMBI STAINLESS STEEL SHORT L72 MM HUMERUS RI BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" "$2,334.53" "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$1,377.30" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.602 SUP HCPCS C1713 02.117.602 - PLATE BONE MEDIUM 85MM 2 HOLE EXTENDED VAR ANG LCP STAINLESS BOTH IP/OP "$2,204.50" "$1,631.00" $437.46 "$2,241.60" $991.86 $991.86 $991.86 $991.86 "$2,204.13" "$2,204.13" "$2,204.13" $459.40 "$2,204.13" "$2,204.13" "$2,204.13" "$2,204.13" "$2,204.13" $459.36 "$2,204.13" "$2,241.60" "$1,303.74" "$2,204.13" "$2,241.60" "$2,204.13" "$2,204.13" "$1,653.38" "$2,204.13" "$2,204.13" "$2,204.13" "$1,102.07" "$1,102.07" "$1,745.67" "$2,204.13" "$1,763.30" $991.86 $437.46 N/A "$1,278.61" "$2,204.13" "$1,322.48" "$2,204.13" $459.34 "$2,204.13" N/A N/A 02.117.602S SUP HCPCS C1713 02.117.602S - PLATE BONE LCP COMBI STAINLESS STEEL MEDIUM L85 MM HUMERUS R BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" $933.81 "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$1,377.30" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.604 SUP HCPCS C1713 02.117.604 - PLATE BN LNG 111MM NS LCP CMBN 4 HL VA TPR TIP XTD SS HUM RT BOTH IP/OP "$2,204.50" "$1,631.00" $437.46 "$2,241.60" $991.86 $991.86 $991.86 $991.86 "$2,204.13" "$2,204.13" "$2,204.13" $459.40 "$2,204.13" "$2,204.13" "$2,204.13" "$2,204.13" "$2,204.13" $459.36 "$2,204.13" "$2,241.60" "$1,303.74" "$2,204.13" "$2,241.60" "$2,204.13" "$2,204.13" "$1,653.38" "$2,204.13" "$2,204.13" "$2,204.13" "$1,102.07" "$1,102.07" "$1,745.67" "$2,204.13" "$1,763.30" $991.86 $437.46 N/A "$1,278.61" "$2,204.13" "$2,204.13" "$2,204.13" $459.34 "$2,204.13" N/A N/A 02.117.604S SUP HCPCS C1713 02.117.604S - PLATE BONE LONG 111MM 4 HOLE EXTENDED VAR ANG ROUND PROFILE BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" "$2,334.53" "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$2,295.50" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.606S SUP HCPCS C1713 02.117.606S - PLATE BN XLNG 137MM STRL LCP CMBN 6 HL VA TPR TIP XTD SS HUM BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" "$2,334.53" "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$1,377.30" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.608S SUP HCPCS C1713 02.117.608S - PLATE BN 163MM STRL LCP CMBN 8 HL VA TPR TIP XTD SS HUM RT BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" "$2,334.53" "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$2,295.50" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.610S SUP HCPCS C1713 02.117.610S - PLATE BN 189MM STRL LCP CMBN 10 HL VA TPR TIP XTD SS HUM RT BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" "$2,334.53" "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$2,295.50" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.701S SUP HCPCS C1713 02.117.701S - PLATE BONE SHORT 72MM 1 HOLE VAR ANG EXTENDED LCP STAINLESS BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" "$2,334.53" "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$1,377.30" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.702S SUP HCPCS C1713 02.117.702S - PLATE BONE MEDIUM 85MM 2 HOLE EXTENDED VAR ANG ROUND PROFILE BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" "$2,334.53" "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$2,295.50" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.704 SUP HCPCS C1713 02.117.704 - PLATE BN LNG 111MM NS LCP CMBN 4 HL VA TPR TIP XTD SS HUM LT BOTH IP/OP "$2,204.50" "$1,631.00" $437.46 "$2,241.60" $991.86 $991.86 $991.86 $991.86 "$2,204.13" "$2,204.13" "$2,204.13" $459.40 "$2,204.13" "$2,204.13" "$2,204.13" "$2,204.13" "$2,204.13" $459.36 "$2,204.13" "$2,241.60" "$1,303.74" "$2,204.13" "$2,241.60" "$2,204.13" "$2,204.13" "$1,653.38" "$2,204.13" "$2,204.13" "$2,204.13" "$1,102.07" "$1,102.07" "$1,745.67" "$2,204.13" "$1,763.30" $991.86 $437.46 N/A "$1,278.61" "$2,204.13" "$2,204.13" "$2,204.13" $459.34 "$2,204.13" N/A N/A 02.117.704S SUP HCPCS C1713 02.117.704S - PLATE BN LNG 111MM STRL LCP CMBN 4 HL VA TPR TIP XTD SS HUM BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" $933.81 "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$2,295.50" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.706 SUP HCPCS C1713 02.117.706 - PLATE BN XLNG 137MM NS LCP CMBN 6 HL VA TPR TIP XTD SS HUM BOTH IP/OP "$2,204.50" "$1,631.00" $437.46 "$2,241.60" $991.86 $991.86 $991.86 $991.86 "$2,204.13" "$2,204.13" "$2,204.13" $459.40 "$2,204.13" "$2,204.13" "$2,204.13" "$2,204.13" "$2,204.13" $459.36 "$2,204.13" "$2,241.60" "$1,303.74" "$2,204.13" "$2,241.60" "$2,204.13" "$2,204.13" "$1,653.38" "$2,204.13" "$2,204.13" "$2,204.13" "$1,102.07" "$1,102.07" "$1,745.67" "$2,204.13" "$1,763.30" $991.86 $437.46 N/A "$1,278.61" "$2,204.13" "$2,204.13" "$2,204.13" $459.34 "$2,204.13" N/A N/A 02.117.706S SUP HCPCS C1713 02.117.706S - PLATE BONE XLONG 137MM 6 HOLE VAR ANG TAPER TIP EXTEND LCP BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" "$2,334.53" "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$1,377.30" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.708S SUP HCPCS C1713 02.117.708S - PLATE BN 163MM STRL LCP CMBN 8 HL VA TPR TIP XTD SS HUM LT BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" "$2,334.53" "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$2,295.50" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.710S SUP HCPCS C1713 02.117.710S - PLATE BN 189MM STRL LCP CMBN 10 HL VA TPR TIP XTD SS HUM LT BOTH IP/OP "$2,295.50" "$1,699.00" $455.60 "$2,334.53" "$1,032.98" "$1,032.98" "$1,032.98" "$1,032.98" "$2,295.50" "$2,295.50" "$2,295.50" $478.44 "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" "$2,295.50" $478.41 "$2,295.50" "$2,334.53" "$1,357.79" "$2,295.50" "$2,334.53" "$2,295.50" "$2,295.50" "$1,721.63" "$2,295.50" "$2,295.50" "$2,295.50" "$1,147.75" "$1,147.75" "$1,818.04" "$2,295.50" "$1,836.40" "$1,032.98" $455.60 N/A "$1,331.39" "$2,295.50" "$2,295.50" "$2,295.50" $478.38 "$2,295.50" N/A N/A 02.117.802 SUP HCPCS C1713 02.117.802 - PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG LCP STAINLESS STEEL BOTH IP/OP "$2,138.50" "$1,582.00" $424.35 "$2,174.40" $962.12 $962.12 $962.12 $962.12 "$2,138.05" "$2,138.05" "$2,138.05" $445.62 "$2,138.05" "$2,138.05" "$2,138.05" "$2,138.05" "$2,138.05" $445.59 "$2,138.05" "$2,174.40" "$1,264.66" "$2,138.05" "$2,174.40" "$2,138.05" "$2,138.05" "$1,603.88" "$2,138.05" "$2,138.05" "$2,138.05" "$1,069.03" "$1,069.03" "$1,693.34" "$2,138.05" "$1,710.44" $962.12 $424.35 N/A "$1,240.33" "$2,138.05" "$1,282.83" "$2,138.05" $445.57 "$2,138.05" N/A N/A 02.117.802S SUP HCPCS C1713 02.117.802S - PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG ROUND PROFILE TAPERED BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.805S SUP HCPCS C1713 02.117.805S - PLATE BONE LONG 121MM 5 HOLE VAR ANG ROUND PROFILE TAPERED BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.807S SUP HCPCS C1713 02.117.807S - PLATE BONE LCP COMBI STAINLESS STEEL XLONG L147 MM HUMERUS R BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" $906.93 "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.902 SUP HCPCS C1713 02.117.902 - PLATE BN MED 82MM NS LCP CMBN 2 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,138.50" "$1,582.00" $424.35 "$2,174.40" $962.12 $962.12 $962.12 $962.12 "$2,138.05" "$2,138.05" "$2,138.05" $445.62 "$2,138.05" "$2,138.05" "$2,138.05" "$2,138.05" "$2,138.05" $445.59 "$2,138.05" $869.76 "$1,264.66" "$2,138.05" "$2,174.40" "$2,138.05" "$2,138.05" "$1,603.88" "$2,138.05" "$2,138.05" "$2,138.05" "$1,069.03" "$1,069.03" "$1,693.34" "$2,138.05" "$1,710.44" $962.12 $424.35 N/A "$1,240.33" "$2,138.05" "$2,138.05" "$2,138.05" $445.57 "$2,138.05" N/A N/A 02.117.902S SUP HCPCS C1713 02.117.902S - PLATE BONE MEDIUM 82MM 2 HOLE VAR ANG EXTENDED LCP STAINLESS BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" "$2,267.33" "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$1,337.66" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.117.905 SUP HCPCS C1713 02.117.905 - PLATE BN LNG 121MM NS LCP CMBN 5 HL VA TPR TIP RND PRFL SS BOTH IP/OP "$2,138.50" "$1,582.00" $424.35 "$2,174.40" $962.12 $962.12 $962.12 $962.12 "$2,138.05" "$2,138.05" "$2,138.05" $445.62 "$2,138.05" "$2,138.05" "$2,138.05" "$2,138.05" "$2,138.05" $445.59 "$2,138.05" "$2,174.40" "$1,264.66" "$2,138.05" "$2,174.40" "$2,138.05" "$2,138.05" "$1,603.88" "$2,138.05" "$2,138.05" "$2,138.05" "$1,069.03" "$1,069.03" "$1,693.34" "$2,138.05" "$1,710.44" $962.12 $424.35 N/A "$1,240.33" "$2,138.05" "$2,138.05" "$2,138.05" $445.57 "$2,138.05" N/A N/A 02.117.905S SUP HCPCS C1713 02.117.905S - PLATE BONE LONG 121MM 5 HOLE VAR ANG ROUND PROFILE TAPERED BOTH IP/OP "$2,229.50" "$1,650.00" $442.49 "$2,267.33" "$1,003.24" "$1,003.24" "$1,003.24" "$1,003.24" "$2,229.43" "$2,229.43" "$2,229.43" $464.67 "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" "$2,229.43" $464.64 "$2,229.43" "$2,267.33" "$1,318.71" "$2,229.43" "$2,267.33" "$2,229.43" "$2,229.43" "$1,672.13" "$2,229.43" "$2,229.43" "$2,229.43" "$1,114.72" "$1,114.72" "$1,765.71" "$2,229.43" "$1,783.54" "$1,003.24" $442.49 N/A "$1,293.11" "$2,229.43" "$2,229.43" "$2,229.43" $464.61 "$2,229.43" N/A N/A 02.118.002S SUP HCPCS C1713 02.118.002S - PLATE BN 112MM STRL LCP CMBN 4 HL VA LOPRFL SS TIB RT DIST BOTH IP/OP "$2,858.00" "$2,115.00" $567.20 "$2,906.35" "$1,286.00" "$1,286.00" "$1,286.00" "$1,286.00" "$2,857.78" "$2,857.78" "$2,857.78" $595.63 "$2,857.78" "$2,857.78" "$2,857.78" "$2,857.78" "$2,857.78" $595.59 "$2,857.78" "$2,906.35" "$1,408.89" "$2,857.78" "$2,906.35" "$2,857.78" "$2,857.78" "$2,143.50" "$2,857.78" "$2,857.78" "$2,857.78" "$1,428.89" "$1,428.89" "$2,263.36" "$2,857.78" "$2,286.22" "$1,286.00" $567.20 N/A "$1,657.64" "$2,857.78" "$2,857.78" "$2,857.78" $595.56 "$2,857.78" N/A N/A 02.118.003S SUP HCPCS C1713 02.118.003S - PLATE BN 112MM STRL LCP CMBN 4 HL VA LOPRFL SS TIB LT DIST BOTH IP/OP "$2,858.00" "$2,115.00" $567.20 "$2,906.35" "$1,286.00" "$1,286.00" "$1,286.00" "$1,286.00" "$2,857.78" "$2,857.78" "$2,857.78" $595.63 "$2,857.78" "$2,857.78" "$2,857.78" "$2,857.78" "$2,857.78" $595.59 "$2,857.78" "$1,162.54" "$1,408.89" "$2,857.78" "$2,906.35" "$2,857.78" "$2,857.78" "$2,143.50" "$2,857.78" "$2,857.78" "$2,857.78" "$1,428.89" "$1,428.89" "$2,263.36" "$2,857.78" "$2,286.22" "$1,286.00" $567.20 N/A "$1,657.64" "$2,857.78" "$2,857.78" "$2,857.78" $595.56 "$2,857.78" N/A N/A 02.118.004S SUP HCPCS C1713 02.118.004S - PLATE BN 142MM STRL LCP CMBN 6 HL VA LOPRFL SS TIB RT DIST BOTH IP/OP "$2,889.00" "$2,138.00" $573.33 "$2,937.80" "$1,299.92" "$1,299.92" "$1,299.92" "$1,299.92" "$2,888.70" "$2,888.70" "$2,888.70" $602.08 "$2,888.70" "$2,888.70" "$2,888.70" "$2,888.70" "$2,888.70" $602.04 "$2,888.70" "$2,937.80" "$1,424.13" "$2,888.70" "$2,937.80" "$2,888.70" "$2,888.70" "$2,166.75" "$2,888.70" "$2,888.70" "$2,888.70" "$1,444.35" "$1,444.35" "$2,287.85" "$2,888.70" "$2,310.96" "$1,299.92" $573.33 N/A "$1,675.62" "$2,888.70" "$2,888.70" "$2,888.70" $602.01 "$2,888.70" N/A N/A 02.118.005S SUP HCPCS C1713 02.118.005S - PLATE BN 142MM STRL LCP CMBN 6 HL VA LOPRFL SS TIB LT DIST BOTH IP/OP "$2,889.00" "$2,138.00" $573.33 "$2,937.80" "$1,299.92" "$1,299.92" "$1,299.92" "$1,299.92" "$2,888.70" "$2,888.70" "$2,888.70" $602.08 "$2,888.70" "$2,888.70" "$2,888.70" "$2,888.70" "$2,888.70" $602.04 "$2,888.70" "$2,937.80" "$1,424.13" "$2,888.70" "$2,937.80" "$2,888.70" "$2,888.70" "$2,166.75" "$2,888.70" "$2,888.70" "$2,888.70" "$1,444.35" "$1,444.35" "$2,287.85" "$2,888.70" "$2,310.96" "$1,299.92" $573.33 N/A "$1,675.62" "$2,888.70" "$2,888.70" "$2,888.70" $602.01 "$2,888.70" N/A N/A 02.118.006S SUP HCPCS C1713 02.118.006S - PLATE BN 172MM STRL LCP CMBN 8 HL VA LOPRFL SS TIB RT DIST BOTH IP/OP "$2,917.00" "$2,159.00" $578.91 "$2,966.38" "$1,312.56" "$1,312.56" "$1,312.56" "$1,312.56" "$2,916.80" "$2,916.80" "$2,916.80" $607.93 "$2,916.80" "$2,916.80" "$2,916.80" "$2,916.80" "$2,916.80" $607.89 "$2,916.80" "$2,966.38" "$1,437.98" "$2,916.80" "$2,966.38" "$2,916.80" "$2,916.80" "$2,187.75" "$2,916.80" "$2,916.80" "$2,916.80" "$1,458.40" "$1,458.40" "$2,310.11" "$2,916.80" "$2,333.44" "$1,312.56" $578.91 N/A "$1,691.86" "$2,916.80" "$2,916.80" "$2,916.80" $607.86 "$2,916.80" N/A N/A 02.118.007S SUP HCPCS C1713 02.118.007S - PLATE BN 172MM STRL LCP CMBN 8 HL VA LOPRFL SS TIB LT DIST BOTH IP/OP "$2,917.00" "$2,159.00" $578.91 "$2,966.38" "$1,312.56" "$1,312.56" "$1,312.56" "$1,312.56" "$2,916.80" "$2,916.80" "$2,916.80" $607.93 "$2,916.80" "$2,916.80" "$2,916.80" "$2,916.80" "$2,916.80" $607.89 "$2,916.80" "$2,966.38" "$1,437.98" "$2,916.80" "$2,966.38" "$2,916.80" "$2,916.80" "$2,187.75" "$2,916.80" "$2,916.80" "$2,916.80" "$1,458.40" "$1,458.40" "$2,310.11" "$2,916.80" "$2,333.44" "$1,312.56" $578.91 N/A "$1,691.86" "$2,916.80" "$2,916.80" "$2,916.80" $607.86 "$2,916.80" N/A N/A 02.118.008S SUP HCPCS C1713 02.118.008S - PLATE BN 202MM STRL LCP CMBN 10 HL VA LOPRFL SS TIB RT DIST BOTH IP/OP "$2,946.50" "$2,180.00" $584.77 "$2,996.43" "$1,325.85" "$1,325.85" "$1,325.85" "$1,325.85" "$2,946.33" "$2,946.33" "$2,946.33" $614.09 "$2,946.33" "$2,946.33" "$2,946.33" "$2,946.33" "$2,946.33" $614.05 "$2,946.33" "$2,996.43" "$1,452.54" "$2,946.33" "$2,996.43" "$2,946.33" "$2,946.33" "$2,209.88" "$2,946.33" "$2,946.33" "$2,946.33" "$1,473.17" "$1,473.17" "$2,333.49" "$2,946.33" "$2,357.06" "$1,325.85" $584.77 N/A "$1,708.97" "$2,946.33" "$2,946.33" "$2,946.33" $614.02 "$2,946.33" N/A N/A 02.118.009S SUP HCPCS C1713 02.118.009S - PLATE BN 202MM STRL LCP CMBN 10 HL VA LOPRFL SS TIB LT DIST BOTH IP/OP "$2,946.50" "$2,180.00" $584.77 "$2,996.43" "$1,325.85" "$1,325.85" "$1,325.85" "$1,325.85" "$2,946.33" "$2,946.33" "$2,946.33" $614.09 "$2,946.33" "$2,946.33" "$2,946.33" "$2,946.33" "$2,946.33" $614.05 "$2,946.33" "$2,996.43" "$1,452.54" "$2,946.33" "$2,996.43" "$2,946.33" "$2,946.33" "$2,209.88" "$2,946.33" "$2,946.33" "$2,946.33" "$1,473.17" "$1,473.17" "$2,333.49" "$2,946.33" "$2,357.06" "$1,325.85" $584.77 N/A "$1,708.97" "$2,946.33" "$2,946.33" "$2,946.33" $614.02 "$2,946.33" N/A N/A 02.118.010S SUP HCPCS C1713 02.118.010S - PLATE BN 232MM STRL LCP CMBN 12 HL VA LOPRFL SS TIB RT DIST BOTH IP/OP "$3,423.00" "$2,533.00" $679.35 "$3,481.05" "$1,540.28" "$1,540.28" "$1,540.28" "$1,540.28" "$3,422.85" "$3,422.85" "$3,422.85" $713.41 "$3,422.85" "$3,422.85" "$3,422.85" "$3,422.85" "$3,422.85" $713.36 "$3,422.85" "$1,392.42" "$1,687.47" "$3,422.85" "$3,481.05" "$3,422.85" "$3,422.85" "$2,567.25" "$3,422.85" "$3,422.85" "$3,422.85" "$1,711.43" "$1,711.43" "$2,710.90" "$3,422.85" "$2,738.28" "$1,540.28" $679.35 N/A "$1,985.34" "$3,422.85" "$3,422.85" "$3,422.85" $713.32 "$3,422.85" N/A N/A 02.118.011S SUP HCPCS C1713 02.118.011S - PLATE BN 232MM STRL LCP CMBN 12 HL VA LOPRFL SS TIB LT DIST BOTH IP/OP "$3,423.00" "$2,533.00" $679.35 "$3,481.05" "$1,540.28" "$1,540.28" "$1,540.28" "$1,540.28" "$3,422.85" "$3,422.85" "$3,422.85" $713.41 "$3,422.85" "$3,422.85" "$3,422.85" "$3,422.85" "$3,422.85" $713.36 "$3,422.85" "$1,392.42" "$1,687.47" "$3,422.85" "$3,481.05" "$3,422.85" "$3,422.85" "$2,567.25" "$3,422.85" "$3,422.85" "$3,422.85" "$1,711.43" "$1,711.43" "$2,710.90" "$3,422.85" "$2,738.28" "$1,540.28" $679.35 N/A "$1,985.34" "$3,422.85" "$3,422.85" "$3,422.85" $713.32 "$3,422.85" N/A N/A 02.118.012S SUP HCPCS C1713 02.118.012S - PLATE BN 262MM STRL LCP CMBN 14 HL VA LOPRFL SS TIB RT DIST BOTH IP/OP "$3,807.00" "$2,817.00" $755.52 "$3,871.35" "$1,712.98" "$1,712.98" "$1,712.98" "$1,712.98" "$3,806.63" "$3,806.63" "$3,806.63" $793.40 "$3,806.63" "$3,806.63" "$3,806.63" "$3,806.63" "$3,806.63" $793.34 "$3,806.63" "$1,548.54" "$1,876.67" "$3,806.63" "$3,871.35" "$3,806.63" "$3,806.63" "$2,855.25" "$3,806.63" "$3,806.63" "$3,806.63" "$1,903.32" "$1,903.32" "$3,014.85" "$3,806.63" "$3,045.30" "$1,712.98" $755.52 N/A "$2,208.06" "$3,806.63" "$3,806.63" "$3,806.63" $793.30 "$3,806.63" N/A N/A 02.118.013S SUP HCPCS C1713 02.118.013S - PLATE BN 262MM STRL LCP CMBN 14 HL VA LOPRFL SS TIB LT DIST BOTH IP/OP "$3,807.00" "$2,817.00" $755.52 "$3,871.35" "$1,712.98" "$1,712.98" "$1,712.98" "$1,712.98" "$3,806.63" "$3,806.63" "$3,806.63" $793.40 "$3,806.63" "$3,806.63" "$3,806.63" "$3,806.63" "$3,806.63" $793.34 "$3,806.63" "$1,548.54" "$1,876.67" "$3,806.63" "$3,871.35" "$3,806.63" "$3,806.63" "$2,855.25" "$3,806.63" "$3,806.63" "$3,806.63" "$1,903.32" "$1,903.32" "$3,014.85" "$3,806.63" "$3,045.30" "$1,712.98" $755.52 N/A "$2,208.06" "$3,806.63" "$3,806.63" "$3,806.63" $793.30 "$3,806.63" N/A N/A 02.118.014S SUP HCPCS C1713 02.118.014S - PLATE BN 292MM STRL LCP CMBN 16 HL VA LOPRFL SS TIB RT DIST BOTH IP/OP "$3,898.00" "$2,885.00" $773.65 "$3,964.25" "$1,754.09" "$1,754.09" "$1,754.09" "$1,754.09" "$3,897.98" "$3,897.98" "$3,897.98" $812.44 "$3,897.98" "$3,897.98" "$3,897.98" "$3,897.98" "$3,897.98" $812.38 "$3,897.98" "$3,964.25" "$1,921.70" "$3,897.98" "$3,964.25" "$3,897.98" "$3,897.98" "$2,923.50" "$3,897.98" "$3,897.98" "$3,897.98" "$1,948.99" "$1,948.99" "$3,087.20" "$3,897.98" "$3,118.38" "$1,754.09" $773.65 N/A "$2,260.84" "$3,897.98" "$3,897.98" "$3,897.98" $812.34 "$3,897.98" N/A N/A 02.118.015S SUP HCPCS C1713 02.118.015S - PLATE BN 292MM STRL LCP CMBN 16 HL VA LOPRFL SS TIB LT DIST BOTH IP/OP "$3,898.00" "$2,885.00" $773.65 "$3,964.25" "$1,754.09" "$1,754.09" "$1,754.09" "$1,754.09" "$3,897.98" "$3,897.98" "$3,897.98" $812.44 "$3,897.98" "$3,897.98" "$3,897.98" "$3,897.98" "$3,897.98" $812.38 "$3,897.98" "$1,585.70" "$1,921.70" "$3,897.98" "$3,964.25" "$3,897.98" "$3,897.98" "$2,923.50" "$3,897.98" "$3,897.98" "$3,897.98" "$1,948.99" "$1,948.99" "$3,087.20" "$3,897.98" "$3,118.38" "$1,754.09" $773.65 N/A "$2,260.84" "$3,897.98" "$3,897.98" "$3,897.98" $812.34 "$3,897.98" N/A N/A 02.118.510 SUP HCPCS C1713 02.118.510 - SCREW BN T8 2.7MM 10MM NS LCP ST STRDR LOPRFL SS ELB MTPHSL BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.512 SUP HCPCS C1713 02.118.512 - SCREW BONE T8 LP 2.7MM 12MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $85.75 $85.75 $17.87 $85.75 N/A N/A 02.118.514 SUP HCPCS C1713 02.118.514 - SCREW BONE T8 LP 2.7MM 14MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $87.20 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $85.75 $85.75 $17.87 $85.75 N/A N/A 02.118.516 SUP HCPCS C1713 02.118.516 - SCREW BONE T8 LP 2.7MM 16MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.518 SUP HCPCS C1713 02.118.518 - SCREW BONE T8 LP 2.7MM 18MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $87.20 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.520 SUP HCPCS C1713 02.118.520 - SCREW BONE T8 LP 2.7MM 20MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.522 SUP HCPCS C1713 02.118.522 - SCREW BONE T8 LP 2.7MM 22MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $85.75 $85.75 $17.87 $85.75 N/A N/A 02.118.524 SUP HCPCS C1713 02.118.524 - SCREW BONE T8 2.7MM 24MM SELF TAP STARDRIVE LP LCP STAINLESS BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.526 SUP HCPCS C1713 02.118.526 - SCREW BONE 2.7MM 26MM VAR ANG SELF TAP T8 STARDRIVE LP HEAD BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.528 SUP HCPCS C1713 02.118.528 - SCREW BONE T8 LP 2.7MM 28MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.530 SUP HCPCS C1713 02.118.530 - SCREW BONE T8 LP 2.7MM 30MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.532 SUP HCPCS C1713 02.118.532 - SCREW BONE T8 LP 2.7MM 32MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.534 SUP HCPCS C1713 02.118.534 - SCREW BONE T8 LP 2.7MM 34MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.536 SUP HCPCS C1713 02.118.536 - SCREW BN T8 2.7MM 36MM NS ST STRDR LOPRFL HD SS MTPHSL BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.538 SUP HCPCS C1713 02.118.538 - SCREW BONE T8 LP 2.7MM 38MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $85.75 $85.75 $17.87 $85.75 N/A N/A 02.118.540 SUP HCPCS C1713 02.118.540 - SCREW BN T8 2.7MM 40MM NS LCP ST STRDR LOPRFL SS ELB MTPHSL BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $85.75 $85.75 N/A N/A 02.118.542 SUP HCPCS C1713 02.118.542 - SCREW BONE T8 2.7MM 42MM SELF TAP STARDRIVE LP LCP STAINLESS BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.544 SUP HCPCS C1713 02.118.544 - SCREW BONE 2.7MM 44MM VAR ANG SELF TAP T8 STARDRIVE LP HEAD BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $85.75 $85.75 $17.87 $85.75 N/A N/A 02.118.546 SUP HCPCS C1713 02.118.546 - SCREW BONE T8 LP 2.7MM 46MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $85.75 $85.75 $17.87 $85.75 N/A N/A 02.118.548 SUP HCPCS C1713 02.118.548 - SCREW BONE T8 LP 2.7MM 48MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $85.75 $85.75 $17.87 $85.75 N/A N/A 02.118.550 SUP HCPCS C1713 02.118.550 - SCREW BONE T8 LP 2.7MM 50MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.552 SUP HCPCS C1713 02.118.552 - SCREW BONE 2.7MM 52MM VAR ANG SELF TAP T8 STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $87.20 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.554 SUP HCPCS C1713 02.118.554 - SCREW BONE T8 LP 2.7MM 54MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $85.75 $85.75 $17.87 $85.75 N/A N/A 02.118.556 SUP HCPCS C1713 02.118.556 - SCREW BONE T8 LP 2.7MM 56MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.558 SUP HCPCS C1713 02.118.558 - SCREW BONE T8 LP 2.7MM 58MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $34.88 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.560 SUP HCPCS C1713 02.118.560 - SCREW BONE T8 LP 2.7MM 60MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $87.20 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $85.75 $85.75 $17.87 $85.75 N/A N/A 02.118.562 SUP HCPCS C1713 02.118.562 - SCREW BONE T8 LP 2.7MM 62MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $87.20 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.564 SUP HCPCS C1713 02.118.564 - SCREW BONE T8 LP 2.7MM 64MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $87.20 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.566 SUP HCPCS C1713 02.118.566 - SCREW BONE T8 LP 2.7MM 66MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $87.20 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.568 SUP HCPCS C1713 02.118.568 - SCREW BONE T8 LP 2.7MM 68MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $87.20 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $51.45 $85.75 $17.87 $85.75 N/A N/A 02.118.570 SUP HCPCS C1713 02.118.570 - SCREW BONE T8 LP 2.7MM 70MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $86.00 $64.00 $17.02 $87.20 $38.59 $38.59 $38.59 $38.59 $85.75 $85.75 $85.75 $17.87 $85.75 $85.75 $85.75 $85.75 $85.75 $17.87 $85.75 $87.20 $50.72 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $38.59 $17.02 N/A $49.88 $85.75 $85.75 $85.75 $17.87 $85.75 N/A N/A 02.118.575S SUP HCPCS C1713 02.118.575S - SCREW BN 2.7MM 75MM STRL LCP T8 STRDR RCS ST LOPRFL SS BOTH IP/OP $177.50 $131.00 $35.16 $180.13 $79.71 $79.71 $79.71 $79.71 $177.13 $177.13 $177.13 $36.92 $177.13 $177.13 $177.13 $177.13 $177.13 $36.92 $177.13 $180.13 $104.77 $177.13 $180.13 $177.13 $177.13 $133.13 $177.13 $177.13 $177.13 $88.57 $88.57 $140.29 $177.13 $141.70 $79.71 $35.16 N/A $102.95 $177.13 $177.13 $177.13 $36.91 $177.13 N/A N/A 02.118.580S SUP HCPCS C1713 02.118.580S - SCREW BN 2.7MM 80MM STRL LCP T8 STRDR RCS ST LOPRFL SS BOTH IP/OP $177.50 $131.00 $35.16 $180.13 $79.71 $79.71 $79.71 $79.71 $177.13 $177.13 $177.13 $36.92 $177.13 $177.13 $177.13 $177.13 $177.13 $36.92 $177.13 $72.05 $104.77 $177.13 $180.13 $177.13 $177.13 $133.13 $177.13 $177.13 $177.13 $88.57 $88.57 $140.29 $177.13 $141.70 $79.71 $35.16 N/A $102.95 $177.13 $177.13 $177.13 $36.91 $177.13 N/A N/A 02.120.601 SUP HCPCS C1713 02.120.601 - PLATE BONE 4 HOLE LOCKING LCP STAINLESS STEEL FEMUR PROXIMAL BOTH IP/OP $940.50 $696.00 $186.65 $956.38 $423.18 $423.18 $423.18 $423.18 $940.40 $940.40 $940.40 $196.00 $940.40 $940.40 $940.40 $940.40 $940.40 $195.99 $940.40 $382.55 $556.25 $940.40 $956.38 $940.40 $940.40 $705.38 $940.40 $940.40 $940.40 $470.20 $470.20 $744.80 $940.40 $752.32 $423.18 $186.65 N/A $545.49 $940.40 $940.40 $940.40 $195.98 $940.40 N/A N/A 02.120.602 SUP HCPCS C1713 02.120.602 - PLATE BONE 8 HOLE ATTCH LOCKING LCP STAINLESS STEEL FEMUR BOTH IP/OP "$1,030.50" $763.00 $204.50 "$1,047.90" $463.67 $463.67 $463.67 $463.67 "$1,030.38" "$1,030.38" "$1,030.38" $214.76 "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" $214.74 "$1,030.38" $419.16 $609.47 "$1,030.38" "$1,047.90" "$1,030.38" "$1,030.38" $772.88 "$1,030.38" "$1,030.38" "$1,030.38" $515.19 $515.19 $816.06 "$1,030.38" $824.30 $463.67 $204.50 N/A $597.69 "$1,030.38" "$1,030.38" "$1,030.38" $214.73 "$1,030.38" N/A N/A 02.120.603 SUP HCPCS C1713 02.120.603 - PLATE BONE 4.5MM 4 HOLE ATTCH LOCKING LCP STAINLESS STEEL BOTH IP/OP $940.50 $696.00 $186.65 $956.38 $423.18 $423.18 $423.18 $423.18 $940.40 $940.40 $940.40 $196.00 $940.40 $940.40 $940.40 $940.40 $940.40 $195.99 $940.40 $382.55 $556.25 $940.40 $956.38 $940.40 $940.40 $705.38 $940.40 $940.40 $940.40 $470.20 $470.20 $744.80 $940.40 $752.32 $423.18 $186.65 N/A $545.49 $940.40 $940.40 $940.40 $195.98 $940.40 N/A N/A 02.120.604 SUP HCPCS C1713 02.120.604 - PLATE BONE 4.5MM 8 HOLE ATTCH LOCKING LCP STAINLESS STEEL BOTH IP/OP "$1,030.50" $763.00 $204.50 "$1,047.90" $463.67 $463.67 $463.67 $463.67 "$1,030.38" "$1,030.38" "$1,030.38" $214.76 "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" $214.74 "$1,030.38" "$1,047.90" $609.47 "$1,030.38" "$1,047.90" "$1,030.38" "$1,030.38" $772.88 "$1,030.38" "$1,030.38" "$1,030.38" $515.19 $515.19 $816.06 "$1,030.38" $824.30 $463.67 $204.50 N/A $597.69 "$1,030.38" "$1,030.38" "$1,030.38" $214.73 "$1,030.38" N/A N/A 02.120.606 SUP HCPCS C1713 02.120.606 - SCREW BONE 2 PART CONNECT STARDRIVE LCP STAINLESS STEEL BOTH IP/OP $304.00 $225.00 $60.26 $308.78 $136.63 $136.63 $136.63 $136.63 $303.63 $303.63 $303.63 $63.28 $303.63 $303.63 $303.63 $303.63 $303.63 $63.28 $303.63 $123.51 $179.60 $303.63 $308.78 $303.63 $303.63 $228.00 $303.63 $303.63 $303.63 $151.82 $151.82 $240.47 $303.63 $242.90 $136.63 $60.26 N/A $176.32 $303.63 $303.63 $303.63 $63.28 $303.63 N/A N/A 02.120.701 SUP HCPCS C1713 02.120.701 - PLATE BONE 69MM 1 HOLE SET W/O CASE LCP STAINLESS STEEL BOTH IP/OP "$1,750.50" "$1,295.00" $347.35 "$1,779.83" $787.54 $787.54 $787.54 $787.54 "$1,750.08" "$1,750.08" "$1,750.08" $364.76 "$1,750.08" "$1,750.08" "$1,750.08" "$1,750.08" "$1,750.08" $364.74 "$1,750.08" $711.93 "$1,035.17" "$1,750.08" "$1,779.83" "$1,750.08" "$1,750.08" "$1,312.88" "$1,750.08" "$1,750.08" "$1,750.08" $875.04 $875.04 "$1,386.06" "$1,750.08" "$1,400.06" $787.54 $347.35 N/A "$1,015.29" "$1,750.08" "$1,750.08" "$1,750.08" $364.72 "$1,750.08" N/A N/A 02.120.701S SUP HCPCS C1713 02.120.701S - PLATE BN 69MM STRL LCP CMBN 1 HL LOPRFL LMT CNTCT SS TIB BOTH IP/OP "$1,841.50" "$1,363.00" $365.48 "$1,872.75" $828.65 $828.65 $828.65 $828.65 "$1,841.45" "$1,841.45" "$1,841.45" $383.80 "$1,841.45" "$1,841.45" "$1,841.45" "$1,841.45" "$1,841.45" $383.78 "$1,841.45" "$1,872.75" "$1,089.22" "$1,841.45" "$1,872.75" "$1,841.45" "$1,841.45" "$1,381.13" "$1,841.45" "$1,841.45" "$1,841.45" $920.73 $920.73 "$1,458.43" "$1,841.45" "$1,473.16" $828.65 $365.48 N/A "$1,068.07" "$1,841.45" "$1,841.45" "$1,841.45" $383.76 "$1,841.45" N/A N/A 02.120.702 SUP HCPCS C1713 02.120.702 - PLATE BONE 79MM 2 HOLE SET W/O CASE LCP STAINLESS STEEL BOTH IP/OP "$1,770.00" "$1,310.00" $351.26 "$1,799.85" $796.40 $796.40 $796.40 $796.40 "$1,769.78" "$1,769.78" "$1,769.78" $368.87 "$1,769.78" "$1,769.78" "$1,769.78" "$1,769.78" "$1,769.78" $368.84 "$1,769.78" "$1,799.85" "$1,046.82" "$1,769.78" "$1,799.85" "$1,769.78" "$1,769.78" "$1,327.50" "$1,769.78" "$1,769.78" "$1,769.78" $884.89 $884.89 "$1,401.67" "$1,769.78" "$1,415.82" $796.40 $351.26 N/A "$1,026.60" "$1,769.78" "$1,769.78" "$1,769.78" $368.82 "$1,769.78" N/A N/A 02.120.702S SUP HCPCS C1713 02.120.702S - PLATE BN 79MM STRL LCP CMBN 2 HL LOPRFL LMT CNTCT SS TIB BOTH IP/OP "$1,861.50" "$1,378.00" $369.39 "$1,892.78" $837.51 $837.51 $837.51 $837.51 "$1,861.13" "$1,861.13" "$1,861.13" $387.91 "$1,861.13" "$1,861.13" "$1,861.13" "$1,861.13" "$1,861.13" $387.88 "$1,861.13" "$1,892.78" "$1,100.86" "$1,861.13" "$1,892.78" "$1,861.13" "$1,861.13" "$1,396.13" "$1,861.13" "$1,861.13" "$1,861.13" $930.57 $930.57 "$1,474.01" "$1,861.13" "$1,488.90" $837.51 $369.39 N/A "$1,079.67" "$1,861.13" "$1,861.13" "$1,861.13" $387.86 "$1,861.13" N/A N/A 02.120.704 SUP HCPCS C1713 02.120.704 - PLATE BONE 105MM 4 HOLE LCP STAINLESS STEEL TIBIA BOTH IP/OP "$1,788.50" "$1,323.00" $354.88 "$1,818.45" $804.62 $804.62 $804.62 $804.62 "$1,788.05" "$1,788.05" "$1,788.05" $372.67 "$1,788.05" "$1,788.05" "$1,788.05" "$1,788.05" "$1,788.05" $372.65 "$1,788.05" $727.38 "$1,057.63" "$1,788.05" "$1,818.45" "$1,788.05" "$1,788.05" "$1,341.38" "$1,788.05" "$1,788.05" "$1,788.05" $894.03 $894.03 "$1,416.14" "$1,788.05" "$1,430.44" $804.62 $354.88 N/A "$1,037.33" "$1,788.05" "$1,788.05" "$1,788.05" $372.63 "$1,788.05" N/A N/A 02.120.704S SUP HCPCS C1713 02.120.704S - PLATE BN 105MM STRL LCP CMBN 4 HL LOPRFL LMT CNTCT SS TIB BOTH IP/OP "$1,879.50" "$1,391.00" $373.01 "$1,911.35" $845.73 $845.73 $845.73 $845.73 "$1,879.40" "$1,879.40" "$1,879.40" $391.71 "$1,879.40" "$1,879.40" "$1,879.40" "$1,879.40" "$1,879.40" $391.69 "$1,879.40" "$1,911.35" "$1,111.67" "$1,879.40" "$1,911.35" "$1,879.40" "$1,879.40" "$1,409.63" "$1,879.40" "$1,879.40" "$1,879.40" $939.70 $939.70 "$1,488.48" "$1,879.40" "$1,503.52" $845.73 $373.01 N/A "$1,090.11" "$1,879.40" "$1,879.40" "$1,879.40" $391.67 "$1,879.40" N/A N/A 02.120.706 SUP HCPCS C1713 02.120.706 - PLATE BONE 131MM 6 HOLE LCP STAINLESS STEEL TIBIA BOTH IP/OP "$1,805.00" "$1,336.00" $358.23 "$1,835.58" $812.21 $812.21 $812.21 $812.21 "$1,804.90" "$1,804.90" "$1,804.90" $376.19 "$1,804.90" "$1,804.90" "$1,804.90" "$1,804.90" "$1,804.90" $376.16 "$1,804.90" $734.23 "$1,067.60" "$1,804.90" "$1,835.58" "$1,804.90" "$1,804.90" "$1,353.75" "$1,804.90" "$1,804.90" "$1,804.90" $902.45 $902.45 "$1,429.48" "$1,804.90" "$1,443.92" $812.21 $358.23 N/A "$1,046.90" "$1,804.90" "$1,804.90" "$1,804.90" $376.14 "$1,804.90" N/A N/A 02.120.706S SUP HCPCS C1713 02.120.706S - PLATE BN 131MM STRL LCP CMBN 6 HL LOPRFL LMT CNTCT SS TIB BOTH IP/OP "$1,896.50" "$1,403.00" $376.36 "$1,928.50" $853.33 $853.33 $853.33 $853.33 "$1,896.28" "$1,896.28" "$1,896.28" $395.23 "$1,896.28" "$1,896.28" "$1,896.28" "$1,896.28" "$1,896.28" $395.21 "$1,896.28" "$1,928.50" "$1,121.65" "$1,896.28" "$1,928.50" "$1,896.28" "$1,896.28" "$1,422.38" "$1,896.28" "$1,896.28" "$1,896.28" $948.14 $948.14 "$1,501.85" "$1,896.28" "$1,517.02" $853.33 $376.36 N/A "$1,099.97" "$1,896.28" "$1,896.28" "$1,896.28" $395.18 "$1,896.28" N/A N/A 02.120.708 SUP HCPCS C1713 02.120.708 - PLATE BONE 157MM 8 HOLE SET W/O CASE LCP STAINLESS STEEL BOTH IP/OP "$1,877.00" "$1,389.00" $372.46 "$1,908.50" $844.47 $844.47 $844.47 $844.47 "$1,876.60" "$1,876.60" "$1,876.60" $391.13 "$1,876.60" "$1,876.60" "$1,876.60" "$1,876.60" "$1,876.60" $391.10 "$1,876.60" $763.40 "$1,110.01" "$1,876.60" "$1,908.50" "$1,876.60" "$1,876.60" "$1,407.75" "$1,876.60" "$1,876.60" "$1,876.60" $938.30 $938.30 "$1,486.27" "$1,876.60" "$1,501.28" $844.47 $372.46 N/A "$1,088.66" "$1,876.60" "$1,876.60" "$1,876.60" $391.08 "$1,876.60" N/A N/A 02.120.710 SUP HCPCS C1713 02.120.710 - PLATE BONE 183MM 10 HOLE SET W/O CASE LCP STAINLESS STEEL BOTH IP/OP "$1,896.50" "$1,403.00" $376.36 "$1,928.50" $853.33 $853.33 $853.33 $853.33 "$1,896.28" "$1,896.28" "$1,896.28" $395.23 "$1,896.28" "$1,896.28" "$1,896.28" "$1,896.28" "$1,896.28" $395.21 "$1,896.28" "$1,928.50" "$1,121.65" "$1,896.28" "$1,928.50" "$1,896.28" "$1,896.28" "$1,422.38" "$1,896.28" "$1,896.28" "$1,896.28" $948.14 $948.14 "$1,501.85" "$1,896.28" "$1,517.02" $853.33 $376.36 N/A "$1,099.97" "$1,896.28" "$1,896.28" "$1,896.28" $395.18 "$1,896.28" N/A N/A 02.123.020 SUP HCPCS C1713 02.123.020 - PLATE BN CNTR 91MM NS LCP CMBN 2 HL LMT CNTCT TPR TIP SS HUM BOTH IP/OP "$2,858.00" "$2,115.00" $567.20 "$2,906.35" "$1,286.00" "$1,286.00" "$1,286.00" "$1,286.00" "$2,857.78" "$2,857.78" "$2,857.78" $595.63 "$2,857.78" "$2,857.78" "$2,857.78" "$2,857.78" "$2,857.78" $595.59 "$2,857.78" "$2,906.35" "$1,408.89" "$2,857.78" "$2,906.35" "$2,857.78" "$2,857.78" "$2,143.50" "$2,857.78" "$2,857.78" "$2,857.78" "$1,428.89" "$1,428.89" "$2,263.36" "$2,857.78" "$2,286.22" "$1,286.00" $567.20 N/A "$1,657.64" "$2,857.78" "$2,857.78" "$2,857.78" $595.56 "$2,857.78" N/A N/A 02.123.021 SUP HCPCS C1713 02.123.021 - PLATE BN CNTR 91MM NS LCP CMBN 2 HL LMT CNTCT TPR TIP SS HUM BOTH IP/OP "$2,858.00" "$2,115.00" $567.20 "$2,906.35" "$1,286.00" "$1,286.00" "$1,286.00" "$1,286.00" "$2,857.78" "$2,857.78" "$2,857.78" $595.63 "$2,857.78" "$2,857.78" "$2,857.78" "$2,857.78" "$2,857.78" $595.59 "$2,857.78" "$2,906.35" "$1,408.89" "$2,857.78" "$2,906.35" "$2,857.78" "$2,857.78" "$2,143.50" "$2,857.78" "$2,857.78" "$2,857.78" "$1,428.89" "$1,428.89" "$2,263.36" "$2,857.78" "$2,286.22" "$1,286.00" $567.20 N/A "$1,657.64" "$2,857.78" "$2,857.78" "$2,857.78" $595.56 "$2,857.78" N/A N/A 02.123.022 SUP HCPCS C1713 02.123.022 - PLATE BONE 91MM 4 HOLE LCP STAINLESS STEEL PERIARTICULAR BOTH IP/OP "$2,944.00" "$2,179.00" $584.22 "$2,993.58" "$1,324.59" "$1,324.59" "$1,324.59" "$1,324.59" "$2,943.53" "$2,943.53" "$2,943.53" $613.51 "$2,943.53" "$2,943.53" "$2,943.53" "$2,943.53" "$2,943.53" $613.46 "$2,943.53" "$2,993.58" "$1,451.16" "$2,943.53" "$2,993.58" "$2,943.53" "$2,943.53" "$2,208.00" "$2,943.53" "$2,943.53" "$2,943.53" "$1,471.77" "$1,471.77" "$2,331.28" "$2,943.53" "$2,354.82" "$1,324.59" $584.22 N/A "$1,707.52" "$2,943.53" "$2,943.53" "$2,943.53" $613.43 "$2,943.53" N/A N/A 02.123.023 SUP HCPCS C1713 02.123.023 - PLATE BN CNTR 127MM NS LCP CMBN 4 HL LMT CNTCT TPR TIP SS BOTH IP/OP "$2,944.00" "$2,179.00" $584.22 "$2,993.58" "$1,324.59" "$1,324.59" "$1,324.59" "$1,324.59" "$2,943.53" "$2,943.53" "$2,943.53" $613.51 "$2,943.53" "$2,943.53" "$2,943.53" "$2,943.53" "$2,943.53" $613.46 "$2,943.53" "$2,993.58" "$1,451.16" "$2,943.53" "$2,993.58" "$2,943.53" "$2,943.53" "$2,208.00" "$2,943.53" "$2,943.53" "$2,943.53" "$1,471.77" "$1,471.77" "$2,331.28" "$2,943.53" "$2,354.82" "$1,324.59" $584.22 N/A "$1,707.52" "$2,943.53" "$2,943.53" "$2,943.53" $613.43 "$2,943.53" N/A N/A 02.123.024 SUP HCPCS C1713 02.123.024 - PLATE BONE 163MM 6 HOLE LCP STAINLESS STEEL PERIARTICULAR BOTH IP/OP "$3,101.00" "$2,295.00" $615.46 "$3,153.68" "$1,395.43" "$1,395.43" "$1,395.43" "$1,395.43" "$3,100.95" "$3,100.95" "$3,100.95" $646.32 "$3,100.95" "$3,100.95" "$3,100.95" "$3,100.95" "$3,100.95" $646.27 "$3,100.95" "$3,153.68" "$1,528.77" "$3,100.95" "$3,153.68" "$3,100.95" "$3,100.95" "$2,325.75" "$3,100.95" "$3,100.95" "$3,100.95" "$1,550.48" "$1,550.48" "$2,455.95" "$3,100.95" "$2,480.76" "$1,395.43" $615.46 N/A "$1,798.58" "$3,100.95" "$1,860.57" "$3,100.95" $646.24 "$3,100.95" N/A N/A 02.123.024S SUP HCPCS C1713 02.123.024S - PLATE BN CNTR 163MM STRL LCP CMBN 6 HL LMT CNTCT TPR TIP SS BOTH IP/OP "$3,192.50" "$2,362.00" $633.60 "$3,246.60" "$1,436.55" "$1,436.55" "$1,436.55" "$1,436.55" "$3,192.33" "$3,192.33" "$3,192.33" $665.36 "$3,192.33" "$3,192.33" "$3,192.33" "$3,192.33" "$3,192.33" $665.32 "$3,192.33" "$3,246.60" "$1,573.82" "$3,192.33" "$3,246.60" "$3,192.33" "$3,192.33" "$2,394.38" "$3,192.33" "$3,192.33" "$3,192.33" "$1,596.17" "$1,596.17" "$2,528.33" "$3,192.33" "$2,553.86" "$1,436.55" $633.60 N/A "$1,851.65" "$3,192.33" "$3,192.33" "$3,192.33" $665.28 "$3,192.33" N/A N/A 02.123.025 SUP HCPCS C1713 02.123.025 - PLATE BONE 163MM 6 HOLE LCP STAINLESS STEEL LEFT PROXIMAL BOTH IP/OP "$3,101.00" "$2,295.00" $615.46 "$3,153.68" "$1,395.43" "$1,395.43" "$1,395.43" "$1,395.43" "$3,100.95" "$3,100.95" "$3,100.95" $646.32 "$3,100.95" "$3,100.95" "$3,100.95" "$3,100.95" "$3,100.95" $646.27 "$3,100.95" "$3,153.68" "$1,528.77" "$3,100.95" "$3,153.68" "$3,100.95" "$3,100.95" "$2,325.75" "$3,100.95" "$3,100.95" "$3,100.95" "$1,550.48" "$1,550.48" "$2,455.95" "$3,100.95" "$2,480.76" "$1,395.43" $615.46 N/A "$1,798.58" "$3,100.95" "$3,100.95" "$3,100.95" $646.24 "$3,100.95" N/A N/A 02.123.026 SUP HCPCS C1713 02.123.026 - PLATE BN CNTR 199MM NS LCP CMBN 8 HL LMT CNTCT TPR TIP SS BOTH IP/OP "$3,220.50" "$2,383.00" $639.18 "$3,275.20" "$1,449.20" "$1,449.20" "$1,449.20" "$1,449.20" "$3,220.45" "$3,220.45" "$3,220.45" $671.22 "$3,220.45" "$3,220.45" "$3,220.45" "$3,220.45" "$3,220.45" $671.18 "$3,220.45" "$1,310.08" "$1,587.68" "$3,220.45" "$3,275.20" "$3,220.45" "$3,220.45" "$2,415.38" "$3,220.45" "$3,220.45" "$3,220.45" "$1,610.23" "$1,610.23" "$2,550.60" "$3,220.45" "$2,576.36" "$1,449.20" $639.18 N/A "$1,867.89" "$3,220.45" "$3,220.45" "$3,220.45" $671.14 "$3,220.45" N/A N/A 02.123.027 SUP HCPCS C1713 02.123.027 - PLATE BN CNTR 199MM NS LCP CMBN 8 HL LMT CNTCT TPR TIP SS BOTH IP/OP "$3,220.50" "$2,383.00" $639.18 "$3,275.20" "$1,449.20" "$1,449.20" "$1,449.20" "$1,449.20" "$3,220.45" "$3,220.45" "$3,220.45" $671.22 "$3,220.45" "$3,220.45" "$3,220.45" "$3,220.45" "$3,220.45" $671.18 "$3,220.45" "$1,310.08" "$1,587.68" "$3,220.45" "$3,275.20" "$3,220.45" "$3,220.45" "$2,415.38" "$3,220.45" "$3,220.45" "$3,220.45" "$1,610.23" "$1,610.23" "$2,550.60" "$3,220.45" "$2,576.36" "$1,449.20" $639.18 N/A "$1,867.89" "$3,220.45" "$3,220.45" "$3,220.45" $671.14 "$3,220.45" N/A N/A 02.123.028 SUP HCPCS C1713 02.123.028 - PLATE BN CNTR 235MM NS LCP CMBN 10 HL LMT CNTCT TPR TIP SS BOTH IP/OP "$3,341.50" "$2,473.00" $663.17 "$3,398.13" "$1,503.60" "$1,503.60" "$1,503.60" "$1,503.60" "$3,341.33" "$3,341.33" "$3,341.33" $696.42 "$3,341.33" "$3,341.33" "$3,341.33" "$3,341.33" "$3,341.33" $696.37 "$3,341.33" "$1,359.25" "$1,647.28" "$3,341.33" "$3,398.13" "$3,341.33" "$3,341.33" "$2,506.13" "$3,341.33" "$3,341.33" "$3,341.33" "$1,670.67" "$1,670.67" "$2,646.33" "$3,341.33" "$2,673.06" "$1,503.60" $663.17 N/A "$1,938.07" "$3,341.33" "$3,341.33" "$3,341.33" "$3,341.33" "$3,341.33" N/A N/A 02.123.029 SUP HCPCS C1713 02.123.029 - PLATE BONE 235MM 10 HOLE LCP STAINLESS STEEL LEFT PROXIMAL BOTH IP/OP "$3,341.50" "$2,473.00" $663.17 "$3,398.13" "$1,503.60" "$1,503.60" "$1,503.60" "$1,503.60" "$3,341.33" "$3,341.33" "$3,341.33" $696.42 "$3,341.33" "$3,341.33" "$3,341.33" "$3,341.33" "$3,341.33" $696.37 "$3,341.33" "$3,398.13" "$1,647.28" "$3,341.33" "$3,398.13" "$3,341.33" "$3,341.33" "$2,506.13" "$3,341.33" "$3,341.33" "$3,341.33" "$1,670.67" "$1,670.67" "$2,646.33" "$3,341.33" "$2,673.06" "$1,503.60" $663.17 N/A "$1,938.07" "$3,341.33" "$2,004.80" "$3,341.33" "$3,341.33" "$3,341.33" N/A N/A 02.123.029S SUP HCPCS C1713 02.123.029S - PLATE BN CNTR 235MM STRL LCP CMBN 10 HL LMT CNTCT TPR TIP SS BOTH IP/OP "$3,433.00" "$2,540.00" $681.31 "$3,491.05" "$1,544.72" "$1,544.72" "$1,544.72" "$1,544.72" "$3,432.70" "$3,432.70" "$3,432.70" $715.46 "$3,432.70" "$3,432.70" "$3,432.70" "$3,432.70" "$3,432.70" $715.41 "$3,432.70" "$3,491.05" "$1,692.32" "$3,432.70" "$3,491.05" "$3,432.70" "$3,432.70" "$2,574.75" "$3,432.70" "$3,432.70" "$3,432.70" "$1,716.35" "$1,716.35" "$2,718.70" "$3,432.70" "$2,746.16" "$1,544.72" $681.31 N/A "$1,991.14" "$3,432.70" "$3,432.70" "$3,432.70" $715.37 "$3,432.70" N/A N/A 02.123.030 SUP HCPCS C1713 02.123.030 - PLATE BN CNTR 271MM NS LCP CMBN 12 HL LMT CNTCT TPR TIP SS BOTH IP/OP "$3,448.50" "$2,552.00" $684.38 "$3,506.80" "$1,551.68" "$1,551.68" "$1,551.68" "$1,551.68" "$3,448.18" "$3,448.18" "$3,448.18" $718.69 "$3,448.18" "$3,448.18" "$3,448.18" "$3,448.18" "$3,448.18" $718.64 "$3,448.18" "$3,506.80" "$1,699.95" "$3,448.18" "$3,506.80" "$3,448.18" "$3,448.18" "$2,586.38" "$3,448.18" "$3,448.18" "$3,448.18" "$1,724.09" "$1,724.09" "$2,730.96" "$3,448.18" "$2,758.54" "$1,551.68" $684.38 N/A "$2,000.13" "$3,448.18" "$2,068.91" "$3,448.18" $718.60 "$3,448.18" N/A N/A 02.123.031 SUP HCPCS C1713 02.123.031 - PLATE BONE 271MM 12 HOLE LCP STAINLESS STEEL PERIARTICULAR BOTH IP/OP "$3,448.50" "$2,552.00" $684.38 "$3,506.80" "$1,551.68" "$1,551.68" "$1,551.68" "$1,551.68" "$3,448.18" "$3,448.18" "$3,448.18" $718.69 "$3,448.18" "$3,448.18" "$3,448.18" "$3,448.18" "$3,448.18" $718.64 "$3,448.18" "$3,506.80" "$1,699.95" "$3,448.18" "$3,506.80" "$3,448.18" "$3,448.18" "$2,586.38" "$3,448.18" "$3,448.18" "$3,448.18" "$1,724.09" "$1,724.09" "$2,730.96" "$3,448.18" "$2,758.54" "$1,551.68" $684.38 N/A "$2,000.13" "$3,448.18" "$2,068.91" "$3,448.18" $718.60 "$3,448.18" N/A N/A 02.123.032S SUP HCPCS C1713 02.123.032S - PLATE BONE 307MM 14 HOLE LCP STAINLESS STEEL PERIARTICULAR BOTH IP/OP "$3,767.50" "$2,788.00" $747.70 "$3,831.30" "$1,695.26" "$1,695.26" "$1,695.26" "$1,695.26" "$3,767.25" "$3,767.25" "$3,767.25" $785.19 "$3,767.25" "$3,767.25" "$3,767.25" "$3,767.25" "$3,767.25" $785.14 "$3,767.25" "$1,532.52" "$1,857.25" "$3,767.25" "$3,831.30" "$3,767.25" "$3,767.25" "$2,825.63" "$3,767.25" "$3,767.25" "$3,767.25" "$1,883.63" "$1,883.63" "$2,983.66" "$3,767.25" "$3,013.80" "$1,695.26" $747.70 N/A "$2,185.15" "$3,767.25" "$3,767.25" "$3,767.25" $785.09 "$3,767.25" N/A N/A 02.123.033S SUP HCPCS C1713 02.123.033S - PLATE BONE 307MM 14 HOLE LCP STAINLESS STEEL PERIARTICULAR BOTH IP/OP "$3,767.50" "$2,788.00" $747.70 "$3,831.30" "$1,695.26" "$1,695.26" "$1,695.26" "$1,695.26" "$3,767.25" "$3,767.25" "$3,767.25" $785.19 "$3,767.25" "$3,767.25" "$3,767.25" "$3,767.25" "$3,767.25" $785.14 "$3,767.25" "$1,532.52" "$1,857.25" "$3,767.25" "$3,831.30" "$3,767.25" "$3,767.25" "$2,825.63" "$3,767.25" "$3,767.25" "$3,767.25" "$1,883.63" "$1,883.63" "$2,983.66" "$3,767.25" "$3,013.80" "$1,695.26" $747.70 N/A "$2,185.15" "$3,767.25" "$3,767.25" "$3,767.25" $785.09 "$3,767.25" N/A N/A 02.123.040 SUP HCPCS C1713 02.123.040 - PLATE BONE 109MM 3 HOLE LCP STAINLESS STEEL RIGHT PROXIMAL BOTH IP/OP "$2,899.00" "$2,145.00" $575.29 "$2,947.83" "$1,304.35" "$1,304.35" "$1,304.35" "$1,304.35" "$2,898.55" "$2,898.55" "$2,898.55" $604.13 "$2,898.55" "$2,898.55" "$2,898.55" "$2,898.55" "$2,898.55" $604.09 "$2,898.55" "$1,179.13" "$1,428.99" "$2,898.55" "$2,947.83" "$2,898.55" "$2,898.55" "$2,174.25" "$2,898.55" "$2,898.55" "$2,898.55" "$1,449.28" "$1,449.28" "$2,295.65" "$2,898.55" "$2,318.84" "$1,304.35" $575.29 N/A "$1,681.42" "$2,898.55" "$2,898.55" "$2,898.55" $604.06 "$2,898.55" N/A N/A 02.123.041 SUP HCPCS C1713 02.123.041 - PLATE BN CNTR 109MM NS LCP CMBN 3 HL LMT CNTCT TPR TIP SS BOTH IP/OP "$2,899.00" "$2,145.00" $575.29 "$2,947.83" "$1,304.35" "$1,304.35" "$1,304.35" "$1,304.35" "$2,898.55" "$2,898.55" "$2,898.55" $604.13 "$2,898.55" "$2,898.55" "$2,898.55" "$2,898.55" "$2,898.55" $604.09 "$2,898.55" "$2,947.83" "$1,428.99" "$2,898.55" "$2,947.83" "$2,898.55" "$2,898.55" "$2,174.25" "$2,898.55" "$2,898.55" "$2,898.55" "$1,449.28" "$1,449.28" "$2,295.65" "$2,898.55" "$2,318.84" "$1,304.35" $575.29 N/A "$1,681.42" "$2,898.55" "$2,898.55" "$2,898.55" $604.06 "$2,898.55" N/A N/A 02.123.042 SUP HCPCS C1713 02.123.042 - PLATE BN CNTR 145MM NS LCP CMBN 5 HL LMT CNTCT TPR TIP SS BOTH IP/OP "$3,017.00" "$2,233.00" $598.73 "$3,067.90" "$1,357.48" "$1,357.48" "$1,357.48" "$1,357.48" "$3,016.63" "$3,016.63" "$3,016.63" $628.74 "$3,016.63" "$3,016.63" "$3,016.63" "$3,016.63" "$3,016.63" $628.70 "$3,016.63" "$3,067.90" "$1,487.20" "$3,016.63" "$3,067.90" "$3,016.63" "$3,016.63" "$2,262.75" "$3,016.63" "$3,016.63" "$3,016.63" "$1,508.32" "$1,508.32" "$2,389.17" "$3,016.63" "$2,413.30" "$1,357.48" $598.73 N/A "$1,749.86" "$3,016.63" "$1,809.98" "$3,016.63" $628.67 "$3,016.63" N/A N/A 02.123.043 SUP HCPCS C1713 02.123.043 - PLATE BONE 14.5CM 5 HOLE SET LCP STAINLESS STEEL LEFT BOTH IP/OP "$3,017.00" "$2,233.00" $598.73 "$3,067.90" "$1,357.48" "$1,357.48" "$1,357.48" "$1,357.48" "$3,016.63" "$3,016.63" "$3,016.63" $628.74 "$3,016.63" "$3,016.63" "$3,016.63" "$3,016.63" "$3,016.63" $628.70 "$3,016.63" "$3,067.90" "$1,487.20" "$3,016.63" "$3,067.90" "$3,016.63" "$3,016.63" "$2,262.75" "$3,016.63" "$3,016.63" "$3,016.63" "$1,508.32" "$1,508.32" "$2,389.17" "$3,016.63" "$2,413.30" "$1,357.48" $598.73 N/A "$1,749.86" "$3,016.63" "$1,809.98" "$3,016.63" $628.67 "$3,016.63" N/A N/A 02.124.030S SUP HCPCS C1713 02.124.030S - PLATE BONE 356MM 15 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR BOTH IP/OP "$3,319.00" "$2,456.00" $658.71 "$3,375.28" "$1,493.48" "$1,493.48" "$1,493.48" "$1,493.48" "$3,318.85" "$3,318.85" "$3,318.85" $691.73 "$3,318.85" "$3,318.85" "$3,318.85" "$3,318.85" "$3,318.85" $691.68 "$3,318.85" "$1,350.11" "$1,636.19" "$3,318.85" "$3,375.28" "$3,318.85" "$3,318.85" "$2,489.25" "$3,318.85" "$3,318.85" "$3,318.85" "$1,659.43" "$1,659.43" "$2,628.53" "$3,318.85" "$2,655.08" "$1,493.48" $658.71 N/A "$1,925.02" "$3,318.85" "$1,991.31" "$3,318.85" $691.65 "$3,318.85" N/A N/A 02.124.031S SUP HCPCS C1713 02.124.031S - PLATE BONE 356MM 15 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR BOTH IP/OP "$3,319.00" "$2,456.00" $658.71 "$3,375.28" "$1,493.48" "$1,493.48" "$1,493.48" "$1,493.48" "$3,318.85" "$3,318.85" "$3,318.85" $691.73 "$3,318.85" "$3,318.85" "$3,318.85" "$3,318.85" "$3,318.85" $691.68 "$3,318.85" "$1,350.11" "$1,636.19" "$3,318.85" "$3,375.28" "$3,318.85" "$3,318.85" "$2,489.25" "$3,318.85" "$3,318.85" "$3,318.85" "$1,659.43" "$1,659.43" "$2,628.53" "$3,318.85" "$2,655.08" "$1,493.48" $658.71 N/A "$1,925.02" "$3,318.85" "$1,991.31" "$3,318.85" $691.65 "$3,318.85" N/A N/A 02.124.034S SUP HCPCS C1713 02.124.034S - PLATE BN 396MM STRL LCP CMBN 17 HL PSHP RND TIP LOPRFL SS BOTH IP/OP "$3,379.50" "$2,501.00" $670.70 "$3,436.73" "$1,520.68" "$1,520.68" "$1,520.68" "$1,520.68" "$3,379.28" "$3,379.28" "$3,379.28" $704.33 "$3,379.28" "$3,379.28" "$3,379.28" "$3,379.28" "$3,379.28" $704.28 "$3,379.28" "$1,374.69" "$1,665.99" "$3,379.28" "$3,436.73" "$3,379.28" "$3,379.28" "$2,534.63" "$3,379.28" "$3,379.28" "$3,379.28" "$1,689.64" "$1,689.64" "$2,676.39" "$3,379.28" "$2,703.42" "$1,520.68" $670.70 N/A "$1,960.11" "$3,379.28" "$2,027.57" "$3,379.28" $704.24 "$3,379.28" N/A N/A 02.124.035S SUP HCPCS C1713 02.124.035S - PLATE BONE 396MM 17 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR BOTH IP/OP "$3,379.50" "$2,501.00" $670.70 "$3,436.73" "$1,520.68" "$1,520.68" "$1,520.68" "$1,520.68" "$3,379.28" "$3,379.28" "$3,379.28" $704.33 "$3,379.28" "$3,379.28" "$3,379.28" "$3,379.28" "$3,379.28" $704.28 "$3,379.28" "$1,374.69" "$1,665.99" "$3,379.28" "$3,436.73" "$3,379.28" "$3,379.28" "$2,534.63" "$3,379.28" "$3,379.28" "$3,379.28" "$1,689.64" "$1,689.64" "$2,676.39" "$3,379.28" "$2,703.42" "$1,520.68" $670.70 N/A "$1,960.11" "$3,379.28" "$2,027.57" "$3,379.28" $704.24 "$3,379.28" N/A N/A 02.124.038S SUP HCPCS C1713 02.124.038S - PLATE BONE 436MM 19 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR BOTH IP/OP "$3,441.50" "$2,547.00" $682.98 "$3,499.63" "$1,548.51" "$1,548.51" "$1,548.51" "$1,548.51" "$3,441.13" "$3,441.13" "$3,441.13" $717.22 "$3,441.13" "$3,441.13" "$3,441.13" "$3,441.13" "$3,441.13" $717.17 "$3,441.13" "$1,399.85" "$1,696.48" "$3,441.13" "$3,499.63" "$3,441.13" "$3,441.13" "$2,581.13" "$3,441.13" "$3,441.13" "$3,441.13" "$1,720.57" "$1,720.57" "$2,725.37" "$3,441.13" "$2,752.90" "$1,548.51" $682.98 N/A "$1,996.07" "$3,441.13" "$3,441.13" "$3,441.13" $717.13 "$3,441.13" N/A N/A 02.124.039S SUP HCPCS C1713 02.124.039S - PLATE BONE 436MM 19 HOLE ANATOMIC LCP STAINLESS STEEL FEMUR BOTH IP/OP "$3,441.50" "$2,547.00" $682.98 "$3,499.63" "$1,548.51" "$1,548.51" "$1,548.51" "$1,548.51" "$3,441.13" "$3,441.13" "$3,441.13" $717.22 "$3,441.13" "$3,441.13" "$3,441.13" "$3,441.13" "$3,441.13" $717.17 "$3,441.13" "$3,499.63" "$1,696.48" "$3,441.13" "$3,499.63" "$3,441.13" "$3,441.13" "$2,581.13" "$3,441.13" "$3,441.13" "$3,441.13" "$1,720.57" "$1,720.57" "$2,725.37" "$3,441.13" "$2,752.90" "$1,548.51" $682.98 N/A "$1,996.07" "$3,441.13" "$3,441.13" "$3,441.13" $717.13 "$3,441.13" N/A N/A 02.124.200 SUP HCPCS C1713 02.124.200 - PLATE BN CNTR LO BND 76MM NS LCP CMBN 4 HL LMT CNTCT SS TIB BOTH IP/OP "$2,664.00" "$1,971.00" $528.69 "$2,709.05" "$1,198.70" "$1,198.70" "$1,198.70" "$1,198.70" "$2,663.78" "$2,663.78" "$2,663.78" $555.20 "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" $555.16 "$2,663.78" "$1,083.62" "$1,313.24" "$2,663.78" "$2,709.05" "$2,663.78" "$2,663.78" "$1,998.00" "$2,663.78" "$2,663.78" "$2,663.78" "$1,331.89" "$1,331.89" "$2,109.71" "$2,663.78" "$2,131.02" "$1,198.70" $528.69 N/A "$1,545.12" "$2,663.78" "$1,598.27" "$2,663.78" $555.13 "$2,663.78" N/A N/A 02.124.200S SUP HCPCS C1713 02.124.200S - PLATE BN 76MM STRL LCP CMBN 4 HL LO BND LMT CNTCT SS TIB RT BOTH IP/OP "$2,755.50" "$2,039.00" $546.83 "$2,802.00" "$1,239.82" "$1,239.82" "$1,239.82" "$1,239.82" "$2,755.15" "$2,755.15" "$2,755.15" $574.24 "$2,755.15" "$2,755.15" "$2,755.15" "$2,755.15" "$2,755.15" $574.20 "$2,755.15" "$1,120.80" "$1,358.29" "$2,755.15" "$2,802.00" "$2,755.15" "$2,755.15" "$2,066.63" "$2,755.15" "$2,755.15" "$2,755.15" "$1,377.58" "$1,377.58" "$2,182.08" "$2,755.15" "$2,204.12" "$1,239.82" $546.83 N/A "$1,598.19" "$2,755.15" "$1,653.09" "$2,755.15" $574.17 "$2,755.15" N/A N/A 02.124.201 SUP HCPCS C1713 02.124.201 - PLATE BN CNTR LO BND 76MM NS LCP CMBN 4 HL LMT CNTCT SS TIB BOTH IP/OP "$2,664.00" "$1,971.00" $528.69 "$2,709.05" "$1,198.70" "$1,198.70" "$1,198.70" "$1,198.70" "$2,663.78" "$2,663.78" "$2,663.78" $555.20 "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" $555.16 "$2,663.78" "$1,083.62" "$1,313.24" "$2,663.78" "$2,709.05" "$2,663.78" "$2,663.78" "$1,998.00" "$2,663.78" "$2,663.78" "$2,663.78" "$1,331.89" "$1,331.89" "$2,109.71" "$2,663.78" "$2,131.02" "$1,198.70" $528.69 N/A "$1,545.12" "$2,663.78" "$1,598.27" "$2,663.78" $555.13 "$2,663.78" N/A N/A 02.124.201S SUP HCPCS C1713 02.124.201S - PLATE BN 76MM STRL LCP CMBN 4 HL LO BND LMT CNTCT SS TIB LT BOTH IP/OP "$2,755.50" "$2,039.00" $546.83 "$2,802.00" "$1,239.82" "$1,239.82" "$1,239.82" "$1,239.82" "$2,755.15" "$2,755.15" "$2,755.15" $574.24 "$2,755.15" "$2,755.15" "$2,755.15" "$2,755.15" "$2,755.15" $574.20 "$2,755.15" "$1,120.80" "$1,358.29" "$2,755.15" "$2,802.00" "$2,755.15" "$2,755.15" "$2,066.63" "$2,755.15" "$2,755.15" "$2,755.15" "$1,377.58" "$1,377.58" "$2,182.08" "$2,755.15" "$2,204.12" "$1,239.82" $546.83 N/A "$1,598.19" "$2,755.15" "$1,653.09" "$2,755.15" $574.17 "$2,755.15" N/A N/A 02.124.204 SUP HCPCS C1713 02.124.204 - PLATE BN CNTR LO BND 102MM NS LCP CMBN 6 HL LMT CNTCT SS TIB BOTH IP/OP "$2,696.50" "$1,995.00" $535.11 "$2,741.95" "$1,213.26" "$1,213.26" "$1,213.26" "$1,213.26" "$2,696.13" "$2,696.13" "$2,696.13" $561.94 "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" $561.90 "$2,696.13" "$2,741.95" "$1,329.19" "$2,696.13" "$2,741.95" "$2,696.13" "$2,696.13" "$2,022.38" "$2,696.13" "$2,696.13" "$2,696.13" "$1,348.07" "$1,348.07" "$2,135.33" "$2,696.13" "$2,156.90" "$1,213.26" $535.11 N/A "$1,563.97" "$2,696.13" "$1,617.68" "$2,696.13" $561.87 "$2,696.13" N/A N/A 02.124.204S SUP HCPCS C1713 02.124.204S - PLATE BN 102MM STRL LCP CMBN 6 HL LO BND LMT CNTCT SS TIB RT BOTH IP/OP "$2,787.50" "$2,063.00" $553.25 "$2,834.90" "$1,254.38" "$1,254.38" "$1,254.38" "$1,254.38" "$2,787.50" "$2,787.50" "$2,787.50" $580.98 "$2,787.50" "$2,787.50" "$2,787.50" "$2,787.50" "$2,787.50" $580.95 "$2,787.50" "$2,834.90" "$1,374.24" "$2,787.50" "$2,834.90" "$2,787.50" "$2,787.50" "$2,090.63" "$2,787.50" "$2,787.50" "$2,787.50" "$1,393.75" "$1,393.75" "$2,207.70" "$2,787.50" "$2,230.00" "$1,254.38" $553.25 N/A "$1,616.75" "$2,787.50" "$2,787.50" "$2,787.50" $580.92 "$2,787.50" N/A N/A 02.124.205 SUP HCPCS C1713 02.124.205 - PLATE BN CNTR LO BND 102MM NS LCP CMBN 6 HL LMT CNTCT SS TIB BOTH IP/OP "$2,696.50" "$1,995.00" $535.11 "$2,741.95" "$1,213.26" "$1,213.26" "$1,213.26" "$1,213.26" "$2,696.13" "$2,696.13" "$2,696.13" $561.94 "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" $561.90 "$2,696.13" "$1,096.78" "$1,329.19" "$2,696.13" "$2,741.95" "$2,696.13" "$2,696.13" "$2,022.38" "$2,696.13" "$2,696.13" "$2,696.13" "$1,348.07" "$1,348.07" "$2,135.33" "$2,696.13" "$2,156.90" "$1,213.26" $535.11 N/A "$1,563.97" "$2,696.13" "$1,617.68" "$2,696.13" $561.87 "$2,696.13" N/A N/A 02.124.205S SUP HCPCS C1713 02.124.205S - PLATE BN 102MM STRL LCP CMBN 6 HL LO BND LMT CNTCT SS TIB LT BOTH IP/OP "$2,787.50" "$2,063.00" $553.25 "$2,834.90" "$1,254.38" "$1,254.38" "$1,254.38" "$1,254.38" "$2,787.50" "$2,787.50" "$2,787.50" $580.98 "$2,787.50" "$2,787.50" "$2,787.50" "$2,787.50" "$2,787.50" $580.95 "$2,787.50" "$1,133.96" "$1,374.24" "$2,787.50" "$2,834.90" "$2,787.50" "$2,787.50" "$2,090.63" "$2,787.50" "$2,787.50" "$2,787.50" "$1,393.75" "$1,393.75" "$2,207.70" "$2,787.50" "$2,230.00" "$1,254.38" $553.25 N/A "$1,616.75" "$2,787.50" "$2,787.50" "$2,787.50" $580.92 "$2,787.50" N/A N/A 02.124.208 SUP HCPCS C1713 02.124.208 - PLATE BN CNTR LO BND 128MM NS LCP CMBN 8 HL LMT CNTCT SS TIB BOTH IP/OP "$2,727.50" "$2,018.00" $541.25 "$2,773.40" "$1,227.17" "$1,227.17" "$1,227.17" "$1,227.17" "$2,727.05" "$2,727.05" "$2,727.05" $568.39 "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" $568.35 "$2,727.05" "$2,773.40" "$1,344.44" "$2,727.05" "$2,773.40" "$2,727.05" "$2,727.05" "$2,045.63" "$2,727.05" "$2,727.05" "$2,727.05" "$1,363.53" "$1,363.53" "$2,159.82" "$2,727.05" "$2,181.64" "$1,227.17" $541.25 N/A "$1,581.95" "$2,727.05" "$1,636.23" "$2,727.05" $568.32 "$2,727.05" N/A N/A 02.124.208S SUP HCPCS C1713 02.124.208S - PLATE BN 128MM STRL LCP CMBN 8 HL LO BND LMT CNTCT SS TIB RT BOTH IP/OP "$2,818.50" "$2,086.00" $559.39 "$2,866.35" "$1,268.29" "$1,268.29" "$1,268.29" "$1,268.29" "$2,818.43" "$2,818.43" "$2,818.43" $587.43 "$2,818.43" "$2,818.43" "$2,818.43" "$2,818.43" "$2,818.43" $587.39 "$2,818.43" "$2,866.35" "$1,389.49" "$2,818.43" "$2,866.35" "$2,818.43" "$2,818.43" "$2,113.88" "$2,818.43" "$2,818.43" "$2,818.43" "$1,409.22" "$1,409.22" "$2,232.20" "$2,818.43" "$2,254.74" "$1,268.29" $559.39 N/A "$1,634.73" "$2,818.43" "$2,818.43" "$2,818.43" $587.36 "$2,818.43" N/A N/A 02.124.209 SUP HCPCS C1713 02.124.209 - PLATE BN CNTR LO BND 128MM NS LCP CMBN 8 HL LMT CNTCT SS TIB BOTH IP/OP "$2,727.50" "$2,018.00" $541.25 "$2,773.40" "$1,227.17" "$1,227.17" "$1,227.17" "$1,227.17" "$2,727.05" "$2,727.05" "$2,727.05" $568.39 "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" $568.35 "$2,727.05" "$2,773.40" "$1,344.44" "$2,727.05" "$2,773.40" "$2,727.05" "$2,727.05" "$2,045.63" "$2,727.05" "$2,727.05" "$2,727.05" "$1,363.53" "$1,363.53" "$2,159.82" "$2,727.05" "$2,181.64" "$1,227.17" $541.25 N/A "$1,581.95" "$2,727.05" "$1,636.23" "$2,727.05" $568.32 "$2,727.05" N/A N/A 02.124.209S SUP HCPCS C1713 02.124.209S - PLATE BN 128MM STRL LCP CMBN 8 HL LO BND LMT CNTCT SS TIB LT BOTH IP/OP "$2,818.50" "$2,086.00" $559.39 "$2,866.35" "$1,268.29" "$1,268.29" "$1,268.29" "$1,268.29" "$2,818.43" "$2,818.43" "$2,818.43" $587.43 "$2,818.43" "$2,818.43" "$2,818.43" "$2,818.43" "$2,818.43" $587.39 "$2,818.43" "$2,866.35" "$1,389.49" "$2,818.43" "$2,866.35" "$2,818.43" "$2,818.43" "$2,113.88" "$2,818.43" "$2,818.43" "$2,818.43" "$1,409.22" "$1,409.22" "$2,232.20" "$2,818.43" "$2,254.74" "$1,268.29" $559.39 N/A "$1,634.73" "$2,818.43" "$2,818.43" "$2,818.43" $587.36 "$2,818.43" N/A N/A 02.124.212 SUP HCPCS C1713 02.124.212 - PLATE BN CNTR LO BND 154MM NS LCP CMBN 10 HL LMT CNTCT SS BOTH IP/OP "$2,757.00" "$2,040.00" $547.11 "$2,803.43" "$1,240.46" "$1,240.46" "$1,240.46" "$1,240.46" "$2,756.58" "$2,756.58" "$2,756.58" $574.54 "$2,756.58" "$2,756.58" "$2,756.58" "$2,756.58" "$2,756.58" $574.50 "$2,756.58" "$1,121.37" "$1,358.99" "$2,756.58" "$2,803.43" "$2,756.58" "$2,756.58" "$2,067.75" "$2,756.58" "$2,756.58" "$2,756.58" "$1,378.29" "$1,378.29" "$2,183.21" "$2,756.58" "$2,205.26" "$1,240.46" $547.11 N/A "$1,599.06" "$2,756.58" "$1,653.95" "$2,756.58" $574.47 "$2,756.58" N/A N/A 02.124.212S SUP HCPCS C1713 02.124.212S - PLATE BN 154MM STRL LCP CMBN 10 HL LO BND LMT CNTCT SS TIB BOTH IP/OP "$2,848.00" "$2,108.00" $565.24 "$2,896.35" "$1,281.57" "$1,281.57" "$1,281.57" "$1,281.57" "$2,847.93" "$2,847.93" "$2,847.93" $593.58 "$2,847.93" "$2,847.93" "$2,847.93" "$2,847.93" "$2,847.93" $593.54 "$2,847.93" "$2,896.35" "$1,404.03" "$2,847.93" "$2,896.35" "$2,847.93" "$2,847.93" "$2,136.00" "$2,847.93" "$2,847.93" "$2,847.93" "$1,423.97" "$1,423.97" "$2,255.56" "$2,847.93" "$2,278.34" "$1,281.57" $565.24 N/A "$1,651.84" "$2,847.93" "$2,847.93" "$2,847.93" $593.51 "$2,847.93" N/A N/A 02.124.213 SUP HCPCS C1713 02.124.213 - PLATE BN CNTR LO BND 154MM NS LCP CMBN 10 HL LMT CNTCT SS BOTH IP/OP "$2,757.00" "$2,040.00" $547.11 "$2,803.43" "$1,240.46" "$1,240.46" "$1,240.46" "$1,240.46" "$2,756.58" "$2,756.58" "$2,756.58" $574.54 "$2,756.58" "$2,756.58" "$2,756.58" "$2,756.58" "$2,756.58" $574.50 "$2,756.58" "$2,803.43" "$1,358.99" "$2,756.58" "$2,803.43" "$2,756.58" "$2,756.58" "$2,067.75" "$2,756.58" "$2,756.58" "$2,756.58" "$1,378.29" "$1,378.29" "$2,183.21" "$2,756.58" "$2,205.26" "$1,240.46" $547.11 N/A "$1,599.06" "$2,756.58" "$1,653.95" "$2,756.58" $574.47 "$2,756.58" N/A N/A 02.124.213S SUP HCPCS C1713 02.124.213S - PLATE BN 154MM STRL LCP CMBN 10 HL LO BND LMT CNTCT SS TIB BOTH IP/OP "$2,848.00" "$2,108.00" $565.24 "$2,896.35" "$1,281.57" "$1,281.57" "$1,281.57" "$1,281.57" "$2,847.93" "$2,847.93" "$2,847.93" $593.58 "$2,847.93" "$2,847.93" "$2,847.93" "$2,847.93" "$2,847.93" $593.54 "$2,847.93" "$1,158.54" "$1,404.03" "$2,847.93" "$2,896.35" "$2,847.93" "$2,847.93" "$2,136.00" "$2,847.93" "$2,847.93" "$2,847.93" "$1,423.97" "$1,423.97" "$2,255.56" "$2,847.93" "$2,278.34" "$1,281.57" $565.24 N/A "$1,651.84" "$2,847.93" "$2,847.93" "$2,847.93" $593.51 "$2,847.93" N/A N/A 02.124.216 SUP HCPCS C1713 02.124.216 - PLATE BN CNTR LO BND 180MM NS LCP CMBN 12 HL LMT CNTCT SS BOTH IP/OP "$2,887.50" "$2,137.00" $573.06 "$2,936.38" "$1,299.29" "$1,299.29" "$1,299.29" "$1,299.29" "$2,887.30" "$2,887.30" "$2,887.30" $601.79 "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" $601.75 "$2,887.30" "$2,936.38" "$1,423.44" "$2,887.30" "$2,936.38" "$2,887.30" "$2,887.30" "$2,165.63" "$2,887.30" "$2,887.30" "$2,887.30" "$1,443.65" "$1,443.65" "$2,286.74" "$2,887.30" "$2,309.84" "$1,299.29" $573.06 N/A "$1,674.75" "$2,887.30" "$1,732.38" "$2,887.30" $601.71 "$2,887.30" N/A N/A 02.124.217 SUP HCPCS C1713 02.124.217 - PLATE BN CNTR LO BND 180MM NS LCP CMBN 12 HL LMT CNTCT SS BOTH IP/OP "$2,887.50" "$2,137.00" $573.06 "$2,936.38" "$1,299.29" "$1,299.29" "$1,299.29" "$1,299.29" "$2,887.30" "$2,887.30" "$2,887.30" $601.79 "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" $601.75 "$2,887.30" "$1,174.55" "$1,423.44" "$2,887.30" "$2,936.38" "$2,887.30" "$2,887.30" "$2,165.63" "$2,887.30" "$2,887.30" "$2,887.30" "$1,443.65" "$1,443.65" "$2,286.74" "$2,887.30" "$2,309.84" "$1,299.29" $573.06 N/A "$1,674.75" "$2,887.30" "$1,732.38" "$2,887.30" $601.71 "$2,887.30" N/A N/A 02.124.217S SUP HCPCS C1713 02.124.217S - PLATE BN 180MM STRL LCP CMBN 12 HL LO BND LMT CNTCT SS TIB BOTH IP/OP "$2,979.00" "$2,204.00" $591.19 "$3,029.28" "$1,340.39" "$1,340.39" "$1,340.39" "$1,340.39" "$2,978.65" "$2,978.65" "$2,978.65" $620.83 "$2,978.65" "$2,978.65" "$2,978.65" "$2,978.65" "$2,978.65" $620.78 "$2,978.65" "$3,029.28" "$1,468.47" "$2,978.65" "$3,029.28" "$2,978.65" "$2,978.65" "$2,234.25" "$2,978.65" "$2,978.65" "$2,978.65" "$1,489.33" "$1,489.33" "$2,359.09" "$2,978.65" "$2,382.92" "$1,340.39" $591.19 N/A "$1,727.82" "$2,978.65" "$2,978.65" "$2,978.65" $620.75 "$2,978.65" N/A N/A 02.124.220 SUP HCPCS C1713 02.124.220 - PLATE BN CNTR LO BND 206MM NS LCP CMBN 14 HL LMT CNTCT SS BOTH IP/OP "$2,918.50" "$2,160.00" $579.20 "$2,967.83" "$1,313.20" "$1,313.20" "$1,313.20" "$1,313.20" "$2,918.23" "$2,918.23" "$2,918.23" $608.23 "$2,918.23" "$2,918.23" "$2,918.23" "$2,918.23" "$2,918.23" $608.19 "$2,918.23" "$1,187.13" "$1,438.69" "$2,918.23" "$2,967.83" "$2,918.23" "$2,918.23" "$2,188.88" "$2,918.23" "$2,918.23" "$2,918.23" "$1,459.12" "$1,459.12" "$2,311.24" "$2,918.23" "$2,334.58" "$1,313.20" $579.20 N/A "$1,692.73" "$2,918.23" "$1,750.94" "$2,918.23" $608.16 "$2,918.23" N/A N/A 02.124.220S SUP HCPCS C1713 02.124.220S - PLATE BN 206MM STRL LCP CMBN 14 HL LO BND LMT CNTCT SS TIB BOTH IP/OP "$3,010.00" "$2,227.00" $597.33 "$3,060.78" "$1,354.32" "$1,354.32" "$1,354.32" "$1,354.32" "$3,009.60" "$3,009.60" "$3,009.60" $627.28 "$3,009.60" "$3,009.60" "$3,009.60" "$3,009.60" "$3,009.60" $627.23 "$3,009.60" "$1,224.31" "$1,483.73" "$3,009.60" "$3,060.78" "$3,009.60" "$3,009.60" "$2,257.50" "$3,009.60" "$3,009.60" "$3,009.60" "$1,504.80" "$1,504.80" "$2,383.60" "$3,009.60" "$2,407.68" "$1,354.32" $597.33 N/A "$1,745.80" "$3,009.60" "$1,805.76" "$3,009.60" $627.20 "$3,009.60" N/A N/A 02.124.221 SUP HCPCS C1713 02.124.221 - PLATE BN CNTR LO BND 206MM NS LCP CMBN 14 HL LMT CNTCT SS BOTH IP/OP "$2,918.50" "$2,160.00" $579.20 "$2,967.83" "$1,313.20" "$1,313.20" "$1,313.20" "$1,313.20" "$2,918.23" "$2,918.23" "$2,918.23" $608.23 "$2,918.23" "$2,918.23" "$2,918.23" "$2,918.23" "$2,918.23" $608.19 "$2,918.23" "$1,187.13" "$1,438.69" "$2,918.23" "$2,967.83" "$2,918.23" "$2,918.23" "$2,188.88" "$2,918.23" "$2,918.23" "$2,918.23" "$1,459.12" "$1,459.12" "$2,311.24" "$2,918.23" "$2,334.58" "$1,313.20" $579.20 N/A "$1,692.73" "$2,918.23" "$1,750.94" "$2,918.23" $608.16 "$2,918.23" N/A N/A 02.124.224 SUP HCPCS C1713 02.124.224 - PLATE BN CNTR LO BND 232MM NS LCP CMBN 16 HL LMT CNTCT SS BOTH IP/OP "$3,021.00" "$2,236.00" $599.56 "$3,072.18" "$1,359.37" "$1,359.37" "$1,359.37" "$1,359.37" "$3,020.83" "$3,020.83" "$3,020.83" $629.62 "$3,020.83" "$3,020.83" "$3,020.83" "$3,020.83" "$3,020.83" $629.57 "$3,020.83" "$1,228.87" "$1,489.27" "$3,020.83" "$3,072.18" "$3,020.83" "$3,020.83" "$2,265.75" "$3,020.83" "$3,020.83" "$3,020.83" "$1,510.42" "$1,510.42" "$2,392.50" "$3,020.83" "$2,416.66" "$1,359.37" $599.56 N/A "$1,752.18" "$3,020.83" "$1,812.50" "$3,020.83" $629.54 "$3,020.83" N/A N/A 02.124.225 SUP HCPCS C1713 02.124.225 - PLATE BN CNTR LO BND 232MM NS LCP CMBN 16 HL LMT CNTCT SS BOTH IP/OP "$3,021.00" "$2,236.00" $599.56 "$3,072.18" "$1,359.37" "$1,359.37" "$1,359.37" "$1,359.37" "$3,020.83" "$3,020.83" "$3,020.83" $629.62 "$3,020.83" "$3,020.83" "$3,020.83" "$3,020.83" "$3,020.83" $629.57 "$3,020.83" "$1,228.87" "$1,489.27" "$3,020.83" "$3,072.18" "$3,020.83" "$3,020.83" "$2,265.75" "$3,020.83" "$3,020.83" "$3,020.83" "$1,510.42" "$1,510.42" "$2,392.50" "$3,020.83" "$2,416.66" "$1,359.37" $599.56 N/A "$1,752.18" "$3,020.83" "$1,812.50" "$3,020.83" $629.54 "$3,020.83" N/A N/A 02.124.406S SUP HCPCS C1713 02.124.406S - PLATE BN CRV 159MM STRL LCP CMBN 6 HL 4 CLMN THRD VA SS BOTH IP/OP "$3,222.00" "$2,384.00" $639.46 "$3,276.63" "$1,449.83" "$1,449.83" "$1,449.83" "$1,449.83" "$3,221.85" "$3,221.85" "$3,221.85" $671.51 "$3,221.85" "$3,221.85" "$3,221.85" "$3,221.85" "$3,221.85" $671.47 "$3,221.85" "$3,276.63" "$1,588.37" "$3,221.85" "$3,276.63" "$3,221.85" "$3,221.85" "$2,416.50" "$3,221.85" "$3,221.85" "$3,221.85" "$1,610.93" "$1,610.93" "$2,551.71" "$3,221.85" "$2,577.48" "$1,449.83" $639.46 N/A "$1,868.76" "$3,221.85" "$3,221.85" "$3,221.85" $671.43 "$3,221.85" N/A N/A 02.124.408S SUP HCPCS C1713 02.124.408S - PLATE CURVE 195MM SS 4.5MM SCR 8 HOLE 4 CLMN THRD BOTH IP/OP "$3,282.50" "$2,429.00" $651.45 "$3,338.10" "$1,477.04" "$1,477.04" "$1,477.04" "$1,477.04" "$3,282.30" "$3,282.30" "$3,282.30" $684.11 "$3,282.30" "$3,282.30" "$3,282.30" "$3,282.30" "$3,282.30" $684.07 "$3,282.30" "$1,335.24" "$1,618.17" "$3,282.30" "$3,338.10" "$3,282.30" "$3,282.30" "$2,461.88" "$3,282.30" "$3,282.30" "$3,282.30" "$1,641.15" "$1,641.15" "$2,599.58" "$3,282.30" "$2,625.84" "$1,477.04" $651.45 N/A "$1,903.85" "$3,282.30" "$1,969.38" "$3,282.30" $684.03 "$3,282.30" N/A N/A 02.124.410S SUP HCPCS C1713 02.124.410S - PLATE BONE CURVE 230MM 10 HOLE VAR ANG LCP COMBI STAINLESS BOTH IP/OP "$3,431.50" "$2,539.00" $681.03 "$3,489.63" "$1,544.09" "$1,544.09" "$1,544.09" "$1,544.09" "$3,431.30" "$3,431.30" "$3,431.30" $715.17 "$3,431.30" "$3,431.30" "$3,431.30" "$3,431.30" "$3,431.30" $715.12 "$3,431.30" "$3,489.63" "$1,691.63" "$3,431.30" "$3,489.63" "$3,431.30" "$3,431.30" "$2,573.63" "$3,431.30" "$3,431.30" "$3,431.30" "$1,715.65" "$1,715.65" "$2,717.59" "$3,431.30" "$2,745.04" "$1,544.09" $681.03 N/A "$1,990.27" "$3,431.30" "$3,431.30" "$3,431.30" $715.08 "$3,431.30" N/A N/A 02.124.411 SUP HCPCS C1713 02.124.411 - PLATE BONE CURVE 23CM 10 HOLE VAR ANG LCP STAINLESS STEEL BOTH IP/OP "$3,340.00" "$2,472.00" $662.89 "$3,396.70" "$1,502.97" "$1,502.97" "$1,502.97" "$1,502.97" "$3,339.93" "$3,339.93" "$3,339.93" $696.12 "$3,339.93" "$3,339.93" "$3,339.93" "$3,339.93" "$3,339.93" $696.08 "$3,339.93" "$1,358.68" "$1,646.59" "$3,339.93" "$3,396.70" "$3,339.93" "$3,339.93" "$2,505.00" "$3,339.93" "$3,339.93" "$3,339.93" "$1,669.97" "$1,669.97" "$2,645.22" "$3,339.93" "$2,671.94" "$1,502.97" $662.89 N/A "$1,937.20" "$3,339.93" "$2,003.96" "$3,339.93" $696.04 "$3,339.93" N/A N/A 02.124.412 SUP HCPCS C1713 02.124.412 - PLATE BONE 267MM 12 HOLE VAR ANG CVD LCP STAINLESS STEEL BOTH IP/OP "$3,410.50" "$2,524.00" $676.84 "$3,468.18" "$1,534.59" "$1,534.59" "$1,534.59" "$1,534.59" "$3,410.20" "$3,410.20" "$3,410.20" $710.77 "$3,410.20" "$3,410.20" "$3,410.20" "$3,410.20" "$3,410.20" $710.72 "$3,410.20" "$1,387.27" "$1,681.23" "$3,410.20" "$3,468.18" "$3,410.20" "$3,410.20" "$2,557.88" "$3,410.20" "$3,410.20" "$3,410.20" "$1,705.10" "$1,705.10" "$2,700.88" "$3,410.20" "$2,728.16" "$1,534.59" $676.84 N/A "$1,978.09" "$3,410.20" "$2,046.12" "$3,410.20" $710.69 "$3,410.20" N/A N/A 02.124.412S SUP HCPCS C1713 02.124.412s - PLATE BN CRV 266MM STRL LCP CMBN 12 HL 4 CLMN THRD VA SS BOTH IP/OP "$3,301.00" "$2,443.00" $655.08 "$3,300.58" "$1,485.26" "$1,485.26" "$1,485.26" "$1,485.26" "$3,300.58" "$3,300.58" "$3,300.58" $687.92 "$3,300.58" "$3,300.58" "$3,300.58" "$3,300.58" "$3,300.58" $687.88 "$3,300.58" "$1,320.23" "$1,627.19" "$3,300.58" "$3,300.58" "$3,300.58" "$3,300.58" "$2,475.75" "$3,300.58" "$3,300.58" "$3,300.58" "$1,650.29" "$1,650.29" "$2,614.06" "$3,300.58" "$2,640.46" "$1,485.26" $655.08 N/A "$1,914.58" "$3,300.58" "$3,300.58" "$3,300.58" $687.84 "$3,300.58" N/A N/A 02.124.413 SUP HCPCS C1713 02.124.413 - PLATE BN CRV 266MM NS LCP CMBN 12 HL 4 CLMN THRD VA SS CNDRL BOTH IP/OP "$3,410.50" "$2,524.00" $676.84 "$3,468.18" "$1,534.59" "$1,534.59" "$1,534.59" "$1,534.59" "$3,410.20" "$3,410.20" "$3,410.20" $710.77 "$3,410.20" "$3,410.20" "$3,410.20" "$3,410.20" "$3,410.20" $710.72 "$3,410.20" N/A "$1,681.23" "$3,410.20" "$3,468.18" "$3,410.20" "$3,410.20" "$2,557.88" "$3,410.20" "$3,410.20" "$3,410.20" "$1,705.10" "$1,705.10" "$2,700.88" "$3,410.20" "$2,728.16" "$1,534.59" $676.84 N/A "$1,978.09" "$3,410.20" "$2,046.12" "$3,410.20" $710.69 "$3,410.20" N/A N/A 02.124.413S SUP HCPCS C1713 02.124.413S - PLATE BN CRV 266MM STRL LCP CMBN 12 HL 4 CLMN THRD VA SS BOTH IP/OP "$3,502.00" "$2,591.00" $694.98 "$3,561.10" "$1,575.71" "$1,575.71" "$1,575.71" "$1,575.71" "$3,501.58" "$3,501.58" "$3,501.58" $729.82 "$3,501.58" "$3,501.58" "$3,501.58" "$3,501.58" "$3,501.58" $729.77 "$3,501.58" "$1,424.44" "$1,726.28" "$3,501.58" "$3,561.10" "$3,501.58" "$3,501.58" "$2,626.50" "$3,501.58" "$3,501.58" "$3,501.58" "$1,750.79" "$1,750.79" "$2,773.25" "$3,501.58" "$2,801.26" "$1,575.71" $694.98 N/A "$2,031.16" "$3,501.58" "$3,501.58" "$3,501.58" $729.73 "$3,501.58" N/A N/A 02.124.414S SUP HCPCS C1713 02.124.414S - PLATE BN CRV 301MM STRL LCP CMBN 14 HL 4 CLMN THRD VA SS BOTH IP/OP "$3,731.00" "$2,761.00" $740.45 "$3,794.13" "$1,678.82" "$1,678.82" "$1,678.82" "$1,678.82" "$3,730.70" "$3,730.70" "$3,730.70" $777.57 "$3,730.70" "$3,730.70" "$3,730.70" "$3,730.70" "$3,730.70" $777.52 "$3,730.70" "$3,794.13" "$1,839.24" "$3,730.70" "$3,794.13" "$3,730.70" "$3,730.70" "$2,798.25" "$3,730.70" "$3,730.70" "$3,730.70" "$1,865.35" "$1,865.35" "$2,954.71" "$3,730.70" "$2,984.56" "$1,678.82" $740.45 N/A "$2,163.98" "$3,730.70" "$3,730.70" "$3,730.70" $777.48 "$3,730.70" N/A N/A 02.124.415 SUP HCPCS C1713 02.124.415 - PLATE BN CRV 301MM NS LCP CMBN 14 HL 4 CLMN THRD VA SS CNDRL BOTH IP/OP "$3,639.50" "$2,693.00" $722.32 "$3,701.23" "$1,637.71" "$1,637.71" "$1,637.71" "$1,637.71" "$3,639.35" "$3,639.35" "$3,639.35" $758.53 "$3,639.35" "$3,639.35" "$3,639.35" "$3,639.35" "$3,639.35" $758.48 "$3,639.35" "$3,701.23" "$1,794.20" "$3,639.35" "$3,701.23" "$3,639.35" "$3,639.35" "$2,729.63" "$3,639.35" "$3,639.35" "$3,639.35" "$1,819.68" "$1,819.68" "$2,882.37" "$3,639.35" "$2,911.48" "$1,637.71" $722.32 N/A "$2,110.91" "$3,639.35" "$2,183.61" "$3,639.35" $758.44 "$3,639.35" N/A N/A 02.124.415S SUP HCPCS C1713 02.124.415S - PLATE BN CRV 301MM STRL LCP CMBN 14 HL 4 CLMN THRD VA SS BOTH IP/OP "$3,731.00" "$2,761.00" $740.45 "$3,794.13" "$1,678.82" "$1,678.82" "$1,678.82" "$1,678.82" "$3,730.70" "$3,730.70" "$3,730.70" $777.57 "$3,730.70" "$3,730.70" "$3,730.70" "$3,730.70" "$3,730.70" $777.52 "$3,730.70" "$3,794.13" "$1,839.24" "$3,730.70" "$3,794.13" "$3,730.70" "$3,730.70" "$2,798.25" "$3,730.70" "$3,730.70" "$3,730.70" "$1,865.35" "$1,865.35" "$2,954.71" "$3,730.70" "$2,984.56" "$1,678.82" $740.45 N/A "$2,163.98" "$3,730.70" "$3,730.70" "$3,730.70" $777.48 "$3,730.70" N/A N/A 02.124.416 SUP HCPCS C1713 02.124.416 - PLATE BONE CURVE 336MM 16 HOLE LCP STAINLESS STEEL RIGHT BOTH IP/OP "$3,710.00" "$2,745.00" $736.27 "$3,772.70" "$1,669.33" "$1,669.33" "$1,669.33" "$1,669.33" "$3,709.63" "$3,709.63" "$3,709.63" $773.18 "$3,709.63" "$3,709.63" "$3,709.63" "$3,709.63" "$3,709.63" $773.13 "$3,709.63" "$1,509.08" "$1,828.85" "$3,709.63" "$3,772.70" "$3,709.63" "$3,709.63" "$2,782.50" "$3,709.63" "$3,709.63" "$3,709.63" "$1,854.82" "$1,854.82" "$2,938.03" "$3,709.63" "$2,967.70" "$1,669.33" $736.27 N/A "$2,151.80" "$3,709.63" "$2,225.78" "$3,709.63" $773.09 "$3,709.63" N/A N/A 02.124.416S SUP HCPCS C1713 02.124.416S - PLATE CURVE 336MM SS 4.5MM SCR 16 HOLE 4 CLMN THRD BOTH IP/OP "$3,801.00" "$2,813.00" $754.40 "$3,865.63" "$1,710.45" "$1,710.45" "$1,710.45" "$1,710.45" "$3,801.00" "$3,801.00" "$3,801.00" $792.22 "$3,801.00" "$3,801.00" "$3,801.00" "$3,801.00" "$3,801.00" $792.17 "$3,801.00" "$1,546.25" "$1,873.89" "$3,801.00" "$3,865.63" "$3,801.00" "$3,801.00" "$2,850.75" "$3,801.00" "$3,801.00" "$3,801.00" "$1,900.50" "$1,900.50" "$3,010.39" "$3,801.00" "$3,040.80" "$1,710.45" $754.40 N/A "$2,204.58" "$3,801.00" "$2,280.60" "$3,801.00" $792.13 "$3,801.00" N/A N/A 02.124.417S SUP HCPCS C1713 02.124.417S - PLATE BONE CURVE 336MM 16 HOLE VAR ANG LCP STAINLESS STEEL BOTH IP/OP "$3,801.00" "$2,813.00" $754.40 "$3,865.63" "$1,710.45" "$1,710.45" "$1,710.45" "$1,710.45" "$3,801.00" "$3,801.00" "$3,801.00" $792.22 "$3,801.00" "$3,801.00" "$3,801.00" "$3,801.00" "$3,801.00" $792.17 "$3,801.00" "$3,865.63" "$1,873.89" "$3,801.00" "$3,865.63" "$3,801.00" "$3,801.00" "$2,850.75" "$3,801.00" "$3,801.00" "$3,801.00" "$1,900.50" "$1,900.50" "$3,010.39" "$3,801.00" "$3,040.80" "$1,710.45" $754.40 N/A "$2,204.58" "$3,801.00" "$3,801.00" "$3,801.00" $792.13 "$3,801.00" N/A N/A 02.124.418S SUP HCPCS C1713 02.124.418S - PLATE BN CRV 370MM STRL LCP CMBN 18 HL 4 CLMN THRD VA SS BOTH IP/OP "$4,043.00" "$2,992.00" $802.39 "$4,111.50" "$1,819.25" "$1,819.25" "$1,819.25" "$1,819.25" "$4,042.78" "$4,042.78" "$4,042.78" $842.62 "$4,042.78" "$4,042.78" "$4,042.78" "$4,042.78" "$4,042.78" $842.56 "$4,042.78" "$4,111.50" "$1,993.09" "$4,042.78" "$4,111.50" "$4,042.78" "$4,042.78" "$3,032.25" "$4,042.78" "$4,042.78" "$4,042.78" "$2,021.39" "$2,021.39" "$3,201.88" "$4,042.78" "$3,234.22" "$1,819.25" $802.39 N/A "$2,344.94" "$4,042.78" "$4,042.78" "$4,042.78" $842.52 "$4,042.78" N/A N/A 02.124.419 SUP HCPCS C1713 02.124.419 - PLATE BONE 375MM 18 HOLE VAR ANG CVD LCP STAINLESS STEEL BOTH IP/OP "$3,951.50" "$2,924.00" $784.25 "$4,018.58" "$1,778.13" "$1,778.13" "$1,778.13" "$1,778.13" "$3,951.40" "$3,951.40" "$3,951.40" $823.57 "$3,951.40" "$3,951.40" "$3,951.40" "$3,951.40" "$3,951.40" $823.52 "$3,951.40" "$1,607.43" "$1,948.04" "$3,951.40" "$4,018.58" "$3,951.40" "$3,951.40" "$2,963.63" "$3,951.40" "$3,951.40" "$3,951.40" "$1,975.70" "$1,975.70" "$3,129.51" "$3,951.40" "$3,161.12" "$1,778.13" $784.25 N/A "$2,291.87" "$3,951.40" "$2,370.84" "$3,951.40" $823.47 "$3,951.40" N/A N/A 02.124.419S SUP HCPCS C1713 02.124.419S - PLATE BN CRV 370MM STRL LCP CMBN 18 HL 4 CLMN THRD VA SS BOTH IP/OP "$4,043.00" "$2,992.00" $802.39 "$4,111.50" "$1,819.25" "$1,819.25" "$1,819.25" "$1,819.25" "$4,042.78" "$4,042.78" "$4,042.78" $842.62 "$4,042.78" "$4,042.78" "$4,042.78" "$4,042.78" "$4,042.78" $842.56 "$4,042.78" "$4,111.50" "$1,993.09" "$4,042.78" "$4,111.50" "$4,042.78" "$4,042.78" "$3,032.25" "$4,042.78" "$4,042.78" "$4,042.78" "$2,021.39" "$2,021.39" "$3,201.88" "$4,042.78" "$3,234.22" "$1,819.25" $802.39 N/A "$2,344.94" "$4,042.78" "$4,042.78" "$4,042.78" $842.52 "$4,042.78" N/A N/A 02.130.004 SUP HCPCS C1713 02.130.004 - SCREW BN T4 1.3MM 4MM SLFRET ST TIP STRDR SS CORT BOTH IP/OP $82.00 $61.00 $16.18 $82.90 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $33.16 $48.22 $81.53 $82.90 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $81.53 $81.53 $16.99 $81.53 N/A N/A 02.130.005 SUP HCPCS C1713 02.130.005 - SCREW BN T4 1.3MM 5MM SLFRET ST TIP STRDR SS CORT BOTH IP/OP $82.00 $61.00 $16.18 $82.90 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $82.90 $48.22 $81.53 $82.90 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $81.53 $81.53 $16.99 $81.53 N/A N/A 02.130.006 SUP HCPCS C1713 02.130.006 - SCREW BN T4 1.3MM 6MM SLFRET ST TIP STRDR SS CORT BOTH IP/OP $82.00 $61.00 $16.18 $82.90 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $33.16 $48.22 $81.53 $82.90 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $81.53 $81.53 $16.99 $81.53 N/A N/A 02.130.007 SUP HCPCS C1713 02.130.007 - SCREW BN T4 1.3MM 7MM SLFRET ST TIP STRDR SS CORT BOTH IP/OP $82.00 $61.00 $16.18 $82.90 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $82.90 $48.22 $81.53 $82.90 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $81.53 $81.53 $16.99 $81.53 N/A N/A 02.130.008 SUP HCPCS C1713 02.130.008 - SCREW BN T4 1.3MM 8MM SLFRET ST TIP STRDR SS CORT BOTH IP/OP $82.00 $61.00 $16.18 $82.90 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $82.90 $48.22 $81.53 $82.90 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $81.53 $81.53 $16.99 $81.53 N/A N/A 02.130.009 SUP HCPCS C1713 02.130.009 - SCREW BN T4 1.3MM 9MM SLFRET ST TIP STRDR SS CORT BOTH IP/OP $82.00 $61.00 $16.18 $82.90 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $82.90 $48.22 $81.53 $82.90 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $81.53 $81.53 $16.99 $81.53 N/A N/A 02.130.010 SUP HCPCS C1713 02.130.010 - SCREW BN T4 1.3MM 10MM SLFRET ST TIP STRDR SS CORT BOTH IP/OP $82.00 $61.00 $16.18 $82.90 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $82.90 $48.22 $81.53 $82.90 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $81.53 $81.53 $16.99 $81.53 N/A N/A 02.130.011 SUP HCPCS C1713 02.130.011 - SCREW BN T4 1.3MM 11MM NS SLFRET ST TIP STRDR SS CORT BOTH IP/OP $82.00 $61.00 $16.18 $82.90 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $82.90 $48.22 $81.53 $82.90 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $81.53 $81.53 $16.99 $81.53 N/A N/A 02.130.012 SUP HCPCS C1713 02.130.012 - SCREW BN T4 1.3MM 12MM NS SLFRET ST TIP STRDR SS CORT BOTH IP/OP $82.00 $61.00 $16.18 $82.90 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $82.90 $48.22 $81.53 $82.90 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $81.53 $81.53 $16.99 $81.53 N/A N/A 02.130.013 SUP HCPCS C1713 02.130.013 - SCREW BN T4 1.3MM 13MM SLFRET ST TIP STRDR SS CORT BOTH IP/OP $82.00 $61.00 $16.18 $82.90 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $82.90 $48.22 $81.53 $82.90 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $48.92 $81.53 $16.99 $81.53 N/A N/A 02.130.014 SUP HCPCS C1713 02.130.014 - SCREW BN T4 1.3MM 14MM SLFRET ST TIP STRDR SS CORT BOTH IP/OP $82.00 $61.00 $16.18 $82.90 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $82.90 $48.22 $81.53 $82.90 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $48.92 $81.53 $16.99 $81.53 N/A N/A 02.130.015 SUP HCPCS C1713 02.130.015 - SCREW BN T4 1.3MM 15MM SLFRET ST STRDR SS CORT BOTH IP/OP $82.00 $61.00 $16.18 $82.90 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $82.90 $48.22 $81.53 $82.90 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $48.92 $81.53 $16.99 $81.53 N/A N/A 02.130.016 SUP HCPCS C1713 02.130.016 - SCREW BN T4 1.3MM 16MM ST TIP SLFRET STRDR SS CORT BOTH IP/OP $82.00 $61.00 $16.18 $82.90 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $82.90 $48.22 $81.53 $82.90 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $81.53 $81.53 $16.99 $81.53 N/A N/A 02.130.018 SUP HCPCS C1713 02.130.018 - SCREW BN T4 1.3MM 18MM ST TIP SLFRET LCK STRDR SS CORT BOTH IP/OP $82.00 $61.00 $16.18 $82.90 $36.69 $36.69 $36.69 $36.69 $81.53 $81.53 $81.53 $16.99 $81.53 $81.53 $81.53 $81.53 $81.53 $16.99 $81.53 $82.90 $48.22 $81.53 $82.90 $81.53 $81.53 $61.50 $81.53 $81.53 $81.53 $40.77 $40.77 $64.57 $81.53 $65.22 $36.69 $16.18 N/A $47.56 $81.53 $81.53 $81.53 $16.99 $81.53 N/A N/A 02.130.104 SUP HCPCS C1713 02.130.104 - SCREW BN T4 1.3MM 4MM ST TIP SLFRET LCK STRDR SS HND BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 02.130.105 SUP HCPCS C1713 02.130.105 - SCREW BN T4 1.3MM 5MM ST TIP SLFRET LCK STRDR SS HND BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 02.130.106 SUP HCPCS C1713 02.130.106 - SCREW BN T4 1.3MM 6MM ST TIP SLFRET LCK STRDR SS HND BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 02.130.107 SUP HCPCS C1713 02.130.107 - SCREW BN T4 1.3MM 7MM ST TIP SLFRET LCK STRDR SS HND BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 02.130.108 SUP HCPCS C1713 02.130.108 - SCREW BN T4 1.3MM 8MM ST TIP SLFRET LCK STRDR SS HND BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $87.49 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 02.130.109 SUP HCPCS C1713 02.130.109 - SCREW BN T4 1.3MM 9MM ST TIP SLFRET LCK STRDR SS HND BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 02.130.110 SUP HCPCS C1713 02.130.110 - SCREW BN T4 1.3MM 10MM ST TIP SLFRET LCK STRDR SS HND BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $87.49 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 02.130.111 SUP HCPCS C1713 02.130.111 - SCREW BN T4 1.3MM 11MM ST TIP SLFRET LCK STRDR SS HND BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 02.130.112 SUP HCPCS C1713 02.130.112 - SCREW BN T4 1.3MM 12MM ST TIP SLFRET LCK STRDR SS HND BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $87.49 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 02.130.113 SUP HCPCS C1713 02.130.113 - SCREW BN T4 1.3MM 13MM ST TIP SLFRET LCK STRDR SS HND BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $129.05 $215.08 $44.82 $215.08 N/A N/A 02.130.114 SUP HCPCS C1713 02.130.114 - SCREW BN T4 1.3MM 14MM SLFRET ST TIP LCK STRDR SS HND BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $87.49 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 02.130.115 SUP HCPCS C1713 02.130.115 - SCREW BN T4 1.3MM 15MM ST TIP SLFRET LCK STRDR SS HND BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 02.130.116 SUP HCPCS C1713 02.130.116 - SCREW BN T4 1.3MM 16MM ST TIP SLFRET LCK STRDR SS HND BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 02.130.118 SUP HCPCS C1713 02.130.118 - SCREW BN T4 1.3MM 18MM ST SLF RTN LCK STRDR SS BOTH IP/OP $215.50 $159.00 $42.69 $218.73 $96.79 $96.79 $96.79 $96.79 $215.08 $215.08 $215.08 $44.83 $215.08 $215.08 $215.08 $215.08 $215.08 $44.83 $215.08 $218.73 $127.22 $215.08 $218.73 $215.08 $215.08 $161.63 $215.08 $215.08 $215.08 $107.54 $107.54 $170.34 $215.08 $172.06 $96.79 $42.69 N/A $124.99 $215.08 $215.08 $215.08 $44.82 $215.08 N/A N/A 02.130.150 SUP HCPCS C1713 02.130.150 - PLATE BN STRG .75MM LCK 6 HL LOPRFL PRECONTOUR SS HND 1.3MM BOTH IP/OP $724.00 $536.00 $143.68 $736.23 $325.77 $325.77 $325.77 $325.77 $723.93 $723.93 $723.93 $150.89 $723.93 $723.93 $723.93 $723.93 $723.93 $150.87 $723.93 $294.49 $428.20 $723.93 $736.23 $723.93 $723.93 $543.00 $723.93 $723.93 $723.93 $361.97 $361.97 $573.35 $723.93 $579.14 $325.77 $143.68 N/A $419.92 $723.93 $723.93 $723.93 $150.87 $723.93 N/A N/A 02.130.151 SUP HCPCS C1713 02.130.151 - PLATE BN STRG .75MM LCK 12 HL LOPRFL PRECONTOUR SS HND 1.3MM BOTH IP/OP $794.50 $588.00 $157.63 $807.73 $357.40 $357.40 $357.40 $357.40 $794.23 $794.23 $794.23 $165.54 $794.23 $794.23 $794.23 $794.23 $794.23 $165.53 $794.23 $807.73 $469.79 $794.23 $807.73 $794.23 $794.23 $595.88 $794.23 $794.23 $794.23 $397.12 $397.12 $629.03 $794.23 $635.38 $357.40 $157.63 N/A $460.81 $794.23 $794.23 $794.23 $165.52 $794.23 N/A N/A 02.130.152 SUP HCPCS C1713 02.130.152 - PLATE BN T .75MM LCK 3 HLE/HD 5 HL SHFT LOPRFL SS HND 1.3MM BOTH IP/OP $794.50 $588.00 $157.63 $807.73 $357.40 $357.40 $357.40 $357.40 $794.23 $794.23 $794.23 $165.54 $794.23 $794.23 $794.23 $794.23 $794.23 $165.53 $794.23 $323.09 $469.79 $794.23 $807.73 $794.23 $794.23 $595.88 $794.23 $794.23 $794.23 $397.12 $397.12 $629.03 $794.23 $635.38 $357.40 $157.63 N/A $460.81 $794.23 $794.23 $794.23 $165.52 $794.23 N/A N/A 02.130.153 SUP HCPCS C1713 02.130.153 - PLATE BN Y .75MM LCK 3 HLE/HD 5 HL SHFT LOPRFL SS HND 1.3MM BOTH IP/OP $794.50 $588.00 $157.63 $807.73 $357.40 $357.40 $357.40 $357.40 $794.23 $794.23 $794.23 $165.54 $794.23 $794.23 $794.23 $794.23 $794.23 $165.53 $794.23 $807.73 $469.79 $794.23 $807.73 $794.23 $794.23 $595.88 $794.23 $794.23 $794.23 $397.12 $397.12 $629.03 $794.23 $635.38 $357.40 $157.63 N/A $460.81 $794.23 $794.23 $794.23 $165.52 $794.23 N/A N/A 02.130.154 SUP HCPCS C1713 02.130.154 - PLATE BN .75MM LCK 2 HLE/HD 5 HL SHFT LOPRFL SS PHLNG BS 1.3 BOTH IP/OP $905.50 $670.00 $179.68 $920.68 $407.38 $407.38 $407.38 $407.38 $905.28 $905.28 $905.28 $188.68 $905.28 $905.28 $905.28 $905.28 $905.28 $188.67 $905.28 $368.27 $535.47 $905.28 $920.68 $905.28 $905.28 $679.13 $905.28 $905.28 $905.28 $452.64 $452.64 $716.98 $905.28 $724.22 $407.38 $179.68 N/A $525.19 $905.28 $905.28 $905.28 $188.66 $905.28 N/A N/A 02.130.156 SUP HCPCS C1713 02.130.156 - PLATE BN CRV .75MM LCK LOPRFL PRECONTOUR SS PHLNG HD RT 1.3 BOTH IP/OP $905.50 $670.00 $179.68 $920.68 $407.38 $407.38 $407.38 $407.38 $905.28 $905.28 $905.28 $188.68 $905.28 $905.28 $905.28 $905.28 $905.28 $188.67 $905.28 $920.68 $535.47 $905.28 $920.68 $905.28 $905.28 $679.13 $905.28 $905.28 $905.28 $452.64 $452.64 $716.98 $905.28 $724.22 $407.38 $179.68 N/A $525.19 $905.28 $543.17 $905.28 $188.66 $905.28 N/A N/A 02.130.157 SUP HCPCS C1713 02.130.157 - PLATE BN CRV .75MM LCK LOPRFL PRECONTOUR SS PHLNG HD LT 1.3 BOTH IP/OP $905.50 $670.00 $179.68 $920.68 $407.38 $407.38 $407.38 $407.38 $905.28 $905.28 $905.28 $188.68 $905.28 $905.28 $905.28 $905.28 $905.28 $188.67 $905.28 $368.27 $535.47 $905.28 $920.68 $905.28 $905.28 $679.13 $905.28 $905.28 $905.28 $452.64 $452.64 $716.98 $905.28 $724.22 $407.38 $179.68 N/A $525.19 $905.28 $543.17 $905.28 $905.28 $905.28 N/A N/A 02.130.158 SUP HCPCS C1713 02.130.158 - PLATE BN STRUT OBLQ .75MM 8 HL LCK LOPRFL PRECONTOUR SS HND BOTH IP/OP $794.50 $588.00 $157.63 $807.73 $357.40 $357.40 $357.40 $357.40 $794.23 $794.23 $794.23 $165.54 $794.23 $794.23 $794.23 $794.23 $794.23 $165.53 $794.23 $807.73 $469.79 $794.23 $807.73 $794.23 $794.23 $595.88 $794.23 $794.23 $794.23 $397.12 $397.12 $629.03 $794.23 $635.38 $357.40 $157.63 N/A $460.81 $794.23 $476.54 $794.23 $794.23 $794.23 N/A N/A 02.130.159 SUP HCPCS C1713 02.130.159 - PLATE BN STRUT OBLQ .75MM 8 HL LCK LOPRFL PRECONTOUR SS HND BOTH IP/OP $794.50 $588.00 $157.63 $807.73 $357.40 $357.40 $357.40 $357.40 $794.23 $794.23 $794.23 $165.54 $794.23 $794.23 $794.23 $794.23 $794.23 $165.53 $794.23 $807.73 $469.79 $794.23 $807.73 $794.23 $794.23 $595.88 $794.23 $794.23 $794.23 $397.12 $397.12 $629.03 $794.23 $635.38 $357.40 $157.63 N/A $460.81 $794.23 $476.54 $794.23 $165.52 $794.23 N/A N/A 02.130.161 SUP HCPCS C1713 02.130.161 - PLATE BN WEB .75MM 14 HL LCK LOPRFL PRECONTOUR SS HND 1.3MM BOTH IP/OP $836.50 $619.00 $166.00 $850.60 $376.37 $376.37 $376.37 $376.37 $836.38 $836.38 $836.38 $174.32 $836.38 $836.38 $836.38 $836.38 $836.38 $174.31 $836.38 $850.60 $494.72 $836.38 $850.60 $836.38 $836.38 $627.38 $836.38 $836.38 $836.38 $418.19 $418.19 $662.41 $836.38 $669.10 $376.37 $166.00 N/A $485.17 $836.38 $836.38 $836.38 $174.30 $836.38 N/A N/A 02.130.204 SUP HCPCS C1713 02.130.204 - SCREW BN T4 1.5MM 4MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.205 SUP HCPCS C1713 02.130.205 - SCREW BN T4 1.5MM 5MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.206 SUP HCPCS C1713 02.130.206 - SCREW BN T4 1.5MM 6MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.207 SUP HCPCS C1713 02.130.207 - SCREW BN T4 1.5MM 7MM PUR ST VA LCK STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.208 SUP HCPCS C1713 02.130.208 - SCREW BN T4 1.5MM 8MM ST LCK VA STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.209 SUP HCPCS C1713 02.130.209 - SCREW BN T4 1.5MM 9MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.210 SUP HCPCS C1713 02.130.210 - SCREW BN T4 1.5MM 10MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.211 SUP HCPCS C1713 02.130.211 - SCREW BN T4 1.5MM 11MM ST LCK VA STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.212 SUP HCPCS C1713 02.130.212 - SCREW BN T4 1.5MM 12MM ST LCK VA STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.213 SUP HCPCS C1713 02.130.213 - SCREW BN T4 1.5MM 13MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.214 SUP HCPCS C1713 02.130.214 - SCREW BN T4 1.5MM 14MM PUR ST TIP LCK VA STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $143.39 $238.98 $238.98 $238.98 N/A N/A 02.130.215 SUP HCPCS C1713 02.130.215 - SCREW BN T4 1.5MM 15MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.216 SUP HCPCS C1713 02.130.216 - SCREW BN T4 1.5MM 16MM PUR ST TIP LCK VA STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.218 SUP HCPCS C1713 02.130.218 - SCREW BN T4 1.5MM 18MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.220 SUP HCPCS C1713 02.130.220 - SCREW BN T4 1.5MM 20MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.222 SUP HCPCS C1713 02.130.222 - SCREW BN T4 1.5MM 22MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.224 SUP HCPCS C1713 02.130.224 - SCREW BN T4 1.5MM 24MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $239.00 $177.00 $47.43 $243.05 $107.54 $107.54 $107.54 $107.54 $238.98 $238.98 $238.98 $49.81 $238.98 $238.98 $238.98 $238.98 $238.98 $49.81 $238.98 $243.05 $141.36 $238.98 $243.05 $238.98 $238.98 $179.25 $238.98 $238.98 $238.98 $119.49 $119.49 $189.27 $238.98 $191.18 $107.54 $47.43 N/A $138.62 $238.98 $238.98 $238.98 $49.80 $238.98 N/A N/A 02.130.250 SUP HCPCS C1713 02.130.250 - PLATE BN STRG 1MM 6 HL VA LCK LOPRFL SS 1.5MM SCR BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $331.09 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $813.90 $813.90 $169.62 $813.90 N/A N/A 02.130.251 SUP HCPCS C1713 02.130.251 - PLATE BN STRG 1MM NS 12 HL VA LCK LOPRFL SS 1.5MM SCR BOTH IP/OP $884.50 $655.00 $175.49 $899.20 $397.88 $397.88 $397.88 $397.88 $884.18 $884.18 $884.18 $184.29 $884.18 $884.18 $884.18 $884.18 $884.18 $184.27 $884.18 $899.20 $522.99 $884.18 $899.20 $884.18 $884.18 $663.38 $884.18 $884.18 $884.18 $442.09 $442.09 $700.27 $884.18 $707.34 $397.88 $175.49 N/A $513.01 $884.18 $884.18 $884.18 $884.18 $884.18 N/A N/A 02.130.252 SUP HCPCS C1713 02.130.252 - PLATE BN T 1MM 3 HLE/HD 7 HL SHFT VA LCK SS 1.5MM SCR BOTH IP/OP $884.50 $655.00 $175.49 $899.20 $397.88 $397.88 $397.88 $397.88 $884.18 $884.18 $884.18 $184.29 $884.18 $884.18 $884.18 $884.18 $884.18 $184.27 $884.18 $359.68 $522.99 $884.18 $899.20 $884.18 $884.18 $663.38 $884.18 $884.18 $884.18 $442.09 $442.09 $700.27 $884.18 $707.34 $397.88 $175.49 N/A $513.01 $884.18 $884.18 $884.18 $884.18 $884.18 N/A N/A 02.130.253 SUP HCPCS C1713 02.130.253 - PLATE BN Y 1MM 3 HLE/HD 7 HL SHFT VA LCK SS 1.5MM SCR BOTH IP/OP $884.50 $655.00 $175.49 $899.20 $397.88 $397.88 $397.88 $397.88 $884.18 $884.18 $884.18 $184.29 $884.18 $884.18 $884.18 $884.18 $884.18 $184.27 $884.18 $899.20 $522.99 $884.18 $899.20 $884.18 $884.18 $663.38 $884.18 $884.18 $884.18 $442.09 $442.09 $700.27 $884.18 $707.34 $397.88 $175.49 N/A $513.01 $884.18 $884.18 $884.18 $184.26 $884.18 N/A N/A 02.130.254 SUP HCPCS C1713 02.130.254 - PLATE BN 1MM 2 HLE/HD 6 HL SHFT VA LCK PHLNG BS 1.5MM SCR BOTH IP/OP $970.00 $718.00 $192.51 $986.43 $436.47 $436.47 $436.47 $436.47 $969.93 $969.93 $969.93 $202.16 $969.93 $969.93 $969.93 $969.93 $969.93 $202.14 $969.93 $394.57 $573.71 $969.93 $986.43 $969.93 $969.93 $727.50 $969.93 $969.93 $969.93 $484.97 $484.97 $768.18 $969.93 $775.94 $436.47 $192.51 N/A $562.60 $969.93 $969.93 $969.93 $969.93 $969.93 N/A N/A 02.130.255 SUP HCPCS C1713 02.130.255 - PLATE BN STRG 1MM 2 HLE/HD 6 HL SHFT VA LCK SS CNDRL 1.5MM BOTH IP/OP $928.00 $687.00 $184.14 $943.53 $417.49 $417.49 $417.49 $417.49 $927.75 $927.75 $927.75 $193.37 $927.75 $927.75 $927.75 $927.75 $927.75 $193.35 $927.75 $943.53 $548.76 $927.75 $943.53 $927.75 $927.75 $696.00 $927.75 $927.75 $927.75 $463.88 $463.88 $734.78 $927.75 $742.20 $417.49 $184.14 N/A $538.24 $927.75 $927.75 $927.75 $927.75 $927.75 N/A N/A 02.130.256 SUP HCPCS C1713 02.130.256 - PLATE BN CRV 1MM VA LCK LOPRFL PRECONTOUR SS PHLNG HD RT 1.5 BOTH IP/OP $970.00 $718.00 $192.51 $986.43 $436.47 $436.47 $436.47 $436.47 $969.93 $969.93 $969.93 $202.16 $969.93 $969.93 $969.93 $969.93 $969.93 $202.14 $969.93 $394.57 $573.71 $969.93 $986.43 $969.93 $969.93 $727.50 $969.93 $969.93 $969.93 $484.97 $484.97 $768.18 $969.93 $775.94 $436.47 $192.51 N/A $562.60 $969.93 $969.93 $969.93 $202.13 $969.93 N/A N/A 02.130.257 SUP HCPCS C1713 02.130.257 - PLATE BN CRV 1MM VA LCK LOPRFL PRECONTOUR SS PHLNG HD LT 1.5 BOTH IP/OP $970.00 $718.00 $192.51 $986.43 $436.47 $436.47 $436.47 $436.47 $969.93 $969.93 $969.93 $202.16 $969.93 $969.93 $969.93 $969.93 $969.93 $202.14 $969.93 $986.43 $573.71 $969.93 $986.43 $969.93 $969.93 $727.50 $969.93 $969.93 $969.93 $484.97 $484.97 $768.18 $969.93 $775.94 $436.47 $192.51 N/A $562.60 $969.93 $969.93 $969.93 $202.13 $969.93 N/A N/A 02.130.258 SUP HCPCS C1713 02.130.258 - PLATE BN STRUT OBLQ 1MM VA LCK 8 HL LOPRFL SS HND RT 1.5MM BOTH IP/OP $884.50 $655.00 $175.49 $899.20 $397.88 $397.88 $397.88 $397.88 $884.18 $884.18 $884.18 $184.29 $884.18 $884.18 $884.18 $884.18 $884.18 $184.27 $884.18 $899.20 $522.99 $884.18 $899.20 $884.18 $884.18 $663.38 $884.18 $884.18 $884.18 $442.09 $442.09 $700.27 $884.18 $707.34 $397.88 $175.49 N/A $513.01 $884.18 $530.51 $884.18 $184.26 $884.18 N/A N/A 02.130.259 SUP HCPCS C1713 02.130.259 - PLATE BN STRUT OBLQ 1MM VA LCK 8 HL LOPRFL SS HND LT 1.5MM BOTH IP/OP $884.50 $655.00 $175.49 $899.20 $397.88 $397.88 $397.88 $397.88 $884.18 $884.18 $884.18 $184.29 $884.18 $884.18 $884.18 $884.18 $884.18 $184.27 $884.18 $359.68 $522.99 $884.18 $899.20 $884.18 $884.18 $663.38 $884.18 $884.18 $884.18 $442.09 $442.09 $700.27 $884.18 $707.34 $397.88 $175.49 N/A $513.01 $884.18 $530.51 $884.18 $184.26 $884.18 N/A N/A 02.130.260 SUP HCPCS C1713 02.130.260 - PLATE BN STRUT 1MM VA LCK 12 HL LOPRFL SS HND 1.5MM SCR BOTH IP/OP $970.00 $718.00 $192.51 $986.43 $436.47 $436.47 $436.47 $436.47 $969.93 $969.93 $969.93 $202.16 $969.93 $969.93 $969.93 $969.93 $969.93 $202.14 $969.93 $394.57 $573.71 $969.93 $986.43 $969.93 $969.93 $727.50 $969.93 $969.93 $969.93 $484.97 $484.97 $768.18 $969.93 $775.94 $436.47 $192.51 N/A $562.60 $969.93 $581.96 $969.93 $202.13 $969.93 N/A N/A 02.130.261 SUP HCPCS C1713 02.130.261 - PLATE BN WEB 1MM VA LCK 14 HL LOPRFL SS HND 1.5MM SCR BOTH IP/OP $884.50 $655.00 $175.49 $899.20 $397.88 $397.88 $397.88 $397.88 $884.18 $884.18 $884.18 $184.29 $884.18 $884.18 $884.18 $884.18 $884.18 $184.27 $884.18 $359.68 $522.99 $884.18 $899.20 $884.18 $884.18 $663.38 $884.18 $884.18 $884.18 $442.09 $442.09 $700.27 $884.18 $707.34 $397.88 $175.49 N/A $513.01 $884.18 $884.18 $884.18 $184.26 $884.18 N/A N/A 02.130.263 SUP HCPCS C1713 02.130.263 - PLATE BN CNTR 1MM VA LCK LOPRFL SS 1ST MTCRPL DRSL 1.5MM SCR BOTH IP/OP $942.00 $697.00 $186.93 $957.83 $423.82 $423.82 $423.82 $423.82 $941.83 $941.83 $941.83 $196.30 $941.83 $941.83 $941.83 $941.83 $941.83 $196.29 $941.83 $957.83 $557.09 $941.83 $957.83 $941.83 $941.83 $706.50 $941.83 $941.83 $941.83 $470.92 $470.92 $745.93 $941.83 $753.46 $423.82 $186.93 N/A $546.36 $941.83 $941.83 $941.83 $196.28 $941.83 N/A N/A 02.130.264 SUP HCPCS C1713 02.130.264 - PLATE BN Y 1MM VA LCK ELONGATE HL SS 1ST MTCRPL RL 1.5MM SCR BOTH IP/OP "$1,237.00" $915.00 $245.51 "$1,258.03" $556.65 $556.65 $556.65 $556.65 "$1,237.00" "$1,237.00" "$1,237.00" $257.82 "$1,237.00" "$1,237.00" "$1,237.00" "$1,237.00" "$1,237.00" $257.80 "$1,237.00" $503.21 $731.69 "$1,237.00" "$1,258.03" "$1,237.00" "$1,237.00" $927.75 "$1,237.00" "$1,237.00" "$1,237.00" $618.50 $618.50 $979.70 "$1,237.00" $989.60 $556.65 $245.51 N/A $717.46 "$1,237.00" $742.20 "$1,237.00" $257.79 "$1,237.00" N/A N/A 02.130.265 SUP HCPCS C1713 02.130.265 - PLATE BN Y 1MM VA LCK ELONGATE HL SS 1ST MATECARPAL L/L 1.5 BOTH IP/OP "$1,237.00" $915.00 $245.51 "$1,258.03" $556.65 $556.65 $556.65 $556.65 "$1,237.00" "$1,237.00" "$1,237.00" $257.82 "$1,237.00" "$1,237.00" "$1,237.00" "$1,237.00" "$1,237.00" $257.80 "$1,237.00" "$1,258.03" $731.69 "$1,237.00" "$1,258.03" "$1,237.00" "$1,237.00" $927.75 "$1,237.00" "$1,237.00" "$1,237.00" $618.50 $618.50 $979.70 "$1,237.00" $989.60 $556.65 $245.51 N/A $717.46 "$1,237.00" $742.20 "$1,237.00" $257.79 "$1,237.00" N/A N/A 02.130.266 SUP HCPCS C1713 02.130.266 - PLATE BN 1MM VA LCK 6 HL ROT CRRT SS MTCRPL PHALANGE 1.5MM BOTH IP/OP "$1,237.00" $915.00 $245.51 "$1,258.03" $556.65 $556.65 $556.65 $556.65 "$1,237.00" "$1,237.00" "$1,237.00" $257.82 "$1,237.00" "$1,237.00" "$1,237.00" "$1,237.00" "$1,237.00" $257.80 "$1,237.00" "$1,258.03" $731.69 "$1,237.00" "$1,258.03" "$1,237.00" "$1,237.00" $927.75 "$1,237.00" "$1,237.00" "$1,237.00" $618.50 $618.50 $979.70 "$1,237.00" $989.60 $556.65 $245.51 N/A $717.46 "$1,237.00" $742.20 "$1,237.00" $257.79 "$1,237.00" N/A N/A 02.130.268 SUP HCPCS C1713 02.130.268 - PLATE BN 1MM VA LCK KWR HL SS MTCRPL NK 1.5MM SCR BOTH IP/OP "$1,237.00" $915.00 $245.51 "$1,258.03" $556.65 $556.65 $556.65 $556.65 "$1,237.00" "$1,237.00" "$1,237.00" $257.82 "$1,237.00" "$1,237.00" "$1,237.00" "$1,237.00" "$1,237.00" $257.80 "$1,237.00" "$1,258.03" $731.69 "$1,237.00" "$1,258.03" "$1,237.00" "$1,237.00" $927.75 "$1,237.00" "$1,237.00" "$1,237.00" $618.50 $618.50 $979.70 "$1,237.00" $989.60 $556.65 $245.51 N/A $717.46 "$1,237.00" $742.20 "$1,237.00" $257.79 "$1,237.00" N/A N/A 02.130.306 SUP HCPCS C1713 02.130.306 - SCREW BN T6 2MM 6MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $251.60 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $247.40 $247.40 $247.40 $247.40 N/A N/A 02.130.307 SUP HCPCS C1713 02.130.307 - SCREW BN T6 2MM 7MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $251.60 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $247.40 $247.40 $51.56 $247.40 N/A N/A 02.130.308 SUP HCPCS C1713 02.130.308 - SCREW BN T6 2MM 8MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $251.60 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $148.44 $247.40 $247.40 $247.40 N/A N/A 02.130.309 SUP HCPCS C1713 02.130.309 - SCREW BN T6 2MM 9MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $251.60 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $247.40 $247.40 $51.56 $247.40 N/A N/A 02.130.310 SUP HCPCS C1713 02.130.310 - SCREW BN T6 2MM 10MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $251.60 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $247.40 $247.40 $51.56 $247.40 N/A N/A 02.130.311 SUP HCPCS C1713 02.130.311 - SCREW BN T6 2MM 11MM PUR VA LCK ST TIP STRDR SS HND BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $251.60 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $247.40 $247.40 $51.56 $247.40 N/A N/A 02.130.312 SUP HCPCS C1713 02.130.312 - SCREW BN T6 2MM 12MM PUR STRDR VA ST LCK SS HND BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $251.60 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $148.44 $247.40 $51.56 $247.40 N/A N/A 02.130.313 SUP HCPCS C1713 02.130.313 - SCREW BN T6 2MM 13MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $100.64 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $247.40 $247.40 $51.56 $247.40 N/A N/A 02.130.314 SUP HCPCS C1713 02.130.314 - SCREW BN T6 2MM 14MM PUR NS STRDR ST LCK VA SS BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $100.64 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $247.40 $247.40 $247.40 $247.40 N/A N/A 02.130.315 SUP HCPCS C1713 02.130.315 - SCREW BN T6 2MM 15MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $100.64 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $247.40 $247.40 $51.56 $247.40 N/A N/A 02.130.316 SUP HCPCS C1713 02.130.316 - SCREW BN T6 2MM 16MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $100.64 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $247.40 $247.40 $247.40 $247.40 N/A N/A 02.130.318 SUP HCPCS C1713 02.130.318 - SCREW BN T6 2MM 18MM PUR STRDR VA ST LCK SS HND BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $100.64 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $247.40 $247.40 $247.40 $247.40 N/A N/A 02.130.320 SUP HCPCS C1713 02.130.320 - SCREW BN T6 2MM 20MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $251.60 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $247.40 $247.40 $51.56 $247.40 N/A N/A 02.130.322 SUP HCPCS C1713 02.130.322 - SCREW BN T6 2MM 22MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $251.60 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $247.40 $247.40 $247.40 $247.40 N/A N/A 02.130.324 SUP HCPCS C1713 02.130.324 - SCREW BN T6 2MM 24MM PUR ST TIP VA LCK STRDR SS HND BOTH IP/OP $247.50 $183.00 $49.10 $251.60 $111.33 $111.33 $111.33 $111.33 $247.40 $247.40 $247.40 $51.56 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $251.60 $146.34 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $49.10 N/A $143.55 $247.40 $247.40 $247.40 $247.40 $247.40 N/A N/A 02.130.350 SUP HCPCS C1713 02.130.350 - PLATE BN STRG 1.3MM 6 HL LCK VA LOPRFL HND 2MM SCR BOTH IP/OP $949.00 $702.00 $188.32 $964.98 $426.98 $426.98 $426.98 $426.98 $948.85 $948.85 $948.85 $197.76 $948.85 $948.85 $948.85 $948.85 $948.85 $197.75 $948.85 $385.99 $561.24 $948.85 $964.98 $948.85 $948.85 $711.75 $948.85 $948.85 $948.85 $474.43 $474.43 $751.49 $948.85 $759.08 $426.98 $188.32 N/A $550.42 $948.85 $569.31 $948.85 $197.74 $948.85 N/A N/A 02.130.351 SUP HCPCS C1713 02.130.351 - PLATE BN FT STRG 1.3MM 12 HL VA LCK COAX SS HND 2MM SCR BOTH IP/OP "$1,019.50" $754.00 $202.27 "$1,036.45" $458.61 $458.61 $458.61 $458.61 "$1,019.13" "$1,019.13" "$1,019.13" $212.41 "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" $212.40 "$1,019.13" $414.58 $602.82 "$1,019.13" "$1,036.45" "$1,019.13" "$1,019.13" $764.63 "$1,019.13" "$1,019.13" "$1,019.13" $509.57 $509.57 $807.15 "$1,019.13" $815.30 $458.61 $202.27 N/A $591.31 "$1,019.13" $611.48 "$1,019.13" $212.39 "$1,019.13" N/A N/A 02.130.352 SUP HCPCS C1713 02.130.352 - PLATE BN FT T 1.3MM 3 HLE/HD 7 HL SHFT VA LCK SS HND 2MM SCR BOTH IP/OP "$1,019.50" $754.00 $202.27 "$1,036.45" $458.61 $458.61 $458.61 $458.61 "$1,019.13" "$1,019.13" "$1,019.13" $212.41 "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" $212.40 "$1,019.13" $414.58 $602.82 "$1,019.13" "$1,036.45" "$1,019.13" "$1,019.13" $764.63 "$1,019.13" "$1,019.13" "$1,019.13" $509.57 $509.57 $807.15 "$1,019.13" $815.30 $458.61 $202.27 N/A $591.31 "$1,019.13" "$1,019.13" "$1,019.13" $212.39 "$1,019.13" N/A N/A 02.130.353 SUP HCPCS C1713 02.130.353 - PLATE BN Y 1.3MM 3 HLE/HD 7 HL SHFT LCK VA SS HND 2MM SCR BOTH IP/OP "$1,019.50" $754.00 $202.27 "$1,036.45" $458.61 $458.61 $458.61 $458.61 "$1,019.13" "$1,019.13" "$1,019.13" $212.41 "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" $212.40 "$1,019.13" $414.58 $602.82 "$1,019.13" "$1,036.45" "$1,019.13" "$1,019.13" $764.63 "$1,019.13" "$1,019.13" "$1,019.13" $509.57 $509.57 $807.15 "$1,019.13" $815.30 $458.61 $202.27 N/A $591.31 "$1,019.13" "$1,019.13" "$1,019.13" $212.39 "$1,019.13" N/A N/A 02.130.354 SUP HCPCS C1713 02.130.354 - PLATE BN CNTR 1.3MM 2 HLE/HD 6 HL SHFT LCK ELONGATE HL SS BOTH IP/OP "$1,118.00" $827.00 $221.80 "$1,136.53" $502.89 $502.89 $502.89 $502.89 "$1,117.53" "$1,117.53" "$1,117.53" $232.92 "$1,117.53" "$1,117.53" "$1,117.53" "$1,117.53" "$1,117.53" $232.91 "$1,117.53" $454.61 $661.02 "$1,117.53" "$1,136.53" "$1,117.53" "$1,117.53" $838.50 "$1,117.53" "$1,117.53" "$1,117.53" $558.77 $558.77 $885.08 "$1,117.53" $894.02 $502.89 $221.80 N/A $648.44 "$1,117.53" "$1,117.53" "$1,117.53" $232.89 "$1,117.53" N/A N/A 02.130.355 SUP HCPCS C1713 02.130.355 - PLATE BN 1.3MM 2 HLE/HD 6 HL SHFT LCK VA SS CNDRL 2MM SCR BOTH IP/OP "$1,089.50" $806.00 $216.22 "$1,107.93" $490.23 $490.23 $490.23 $490.23 "$1,089.40" "$1,089.40" "$1,089.40" $227.06 "$1,089.40" "$1,089.40" "$1,089.40" "$1,089.40" "$1,089.40" $227.04 "$1,089.40" "$1,107.93" $644.38 "$1,089.40" "$1,107.93" "$1,089.40" "$1,089.40" $817.13 "$1,089.40" "$1,089.40" "$1,089.40" $544.70 $544.70 $862.80 "$1,089.40" $871.52 $490.23 $216.22 N/A $631.91 "$1,089.40" "$1,089.40" "$1,089.40" $227.03 "$1,089.40" N/A N/A 02.130.360 SUP HCPCS C1713 02.130.360 - PLATE BN STRUT 1.3MM 12 HL LCK VA LOPRFL SS HND 2MM SCR BOTH IP/OP "$1,118.00" $827.00 $221.80 "$1,136.53" $502.89 $502.89 $502.89 $502.89 "$1,117.53" "$1,117.53" "$1,117.53" $232.92 "$1,117.53" "$1,117.53" "$1,117.53" "$1,117.53" "$1,117.53" $232.91 "$1,117.53" "$1,136.53" $661.02 "$1,117.53" "$1,136.53" "$1,117.53" "$1,117.53" $838.50 "$1,117.53" "$1,117.53" "$1,117.53" $558.77 $558.77 $885.08 "$1,117.53" $894.02 $502.89 $221.80 N/A $648.44 "$1,117.53" "$1,117.53" "$1,117.53" $232.89 "$1,117.53" N/A N/A 02.130.363 SUP HCPCS C1713 02.130.363 - PLATE BN 1.3MM LCK VA LOPRFL ANTM CNTR SS 1ST MTCRPL DRSL 2 BOTH IP/OP "$1,399.00" "$1,035.00" $277.60 "$1,422.45" $629.41 $629.41 $629.41 $629.41 "$1,398.68" "$1,398.68" "$1,398.68" $291.52 "$1,398.68" "$1,398.68" "$1,398.68" "$1,398.68" "$1,398.68" $291.50 "$1,398.68" $568.98 $827.32 "$1,398.68" "$1,422.45" "$1,398.68" "$1,398.68" "$1,049.25" "$1,398.68" "$1,398.68" "$1,398.68" $699.34 $699.34 "$1,107.75" "$1,398.68" "$1,118.94" $629.41 $277.60 N/A $811.42 "$1,398.68" "$1,398.68" "$1,398.68" $291.48 "$1,398.68" N/A N/A 02.130.366 SUP HCPCS C1713 02.130.366 - PLATE BN 1.3MM 6 HL LCK VA ROT CRRT SS HND 2MM SCR BOTH IP/OP "$1,399.00" "$1,035.00" $277.60 "$1,422.45" $629.41 $629.41 $629.41 $629.41 "$1,398.68" "$1,398.68" "$1,398.68" $291.52 "$1,398.68" "$1,398.68" "$1,398.68" "$1,398.68" "$1,398.68" $291.50 "$1,398.68" "$1,422.45" $827.32 "$1,398.68" "$1,422.45" "$1,398.68" "$1,398.68" "$1,049.25" "$1,398.68" "$1,398.68" "$1,398.68" $699.34 $699.34 "$1,107.75" "$1,398.68" "$1,118.94" $629.41 $277.60 N/A $811.42 "$1,398.68" "$1,398.68" "$1,398.68" $291.48 "$1,398.68" N/A N/A 02.161.210 SUP HCPCS C1713 02.161.210 - PLATE BONE NARROW 10 HOLE CVD LCP STAINLESS STEEL NONSTRL BOTH IP/OP $704.50 $521.00 $139.78 $716.23 $316.91 $316.91 $316.91 $316.91 $704.25 $704.25 $704.25 $146.78 $704.25 $704.25 $704.25 $704.25 $704.25 $146.77 $704.25 $286.49 $416.56 $704.25 $716.23 $704.25 $704.25 $528.38 $704.25 $704.25 $704.25 $352.13 $352.13 $557.77 $704.25 $563.40 $316.91 $139.78 N/A $408.61 $704.25 $422.55 $704.25 $146.77 $704.25 N/A N/A 02.161.212 SUP HCPCS C1713 02.161.212 - PLATE BONE NARROW CVD 12 HOLE LCP STAINLESS STEEL HUMERUS BOTH IP/OP "$1,073.00" $794.00 $212.87 "$1,090.78" $482.65 $482.65 $482.65 $482.65 "$1,072.55" "$1,072.55" "$1,072.55" $223.55 "$1,072.55" "$1,072.55" "$1,072.55" "$1,072.55" "$1,072.55" $223.53 "$1,072.55" $436.31 $634.41 "$1,072.55" "$1,090.78" "$1,072.55" "$1,072.55" $804.75 "$1,072.55" "$1,072.55" "$1,072.55" $536.28 $536.28 $849.46 "$1,072.55" $858.04 $482.65 $212.87 N/A $622.34 "$1,072.55" $643.53 "$1,072.55" "$1,072.55" "$1,072.55" N/A N/A 02.161.214 SUP HCPCS C1713 02.161.214 - PLATE BONE NARROW 14 HOLE CVD LCP STAINLESS STEEL NONSTRL BOTH IP/OP "$1,241.50" $919.00 $246.35 "$1,262.33" $558.55 $558.55 $558.55 $558.55 "$1,241.23" "$1,241.23" "$1,241.23" $258.70 "$1,241.23" "$1,241.23" "$1,241.23" "$1,241.23" "$1,241.23" $258.69 "$1,241.23" $504.93 $734.19 "$1,241.23" "$1,262.33" "$1,241.23" "$1,241.23" $931.13 "$1,241.23" "$1,241.23" "$1,241.23" $620.62 $620.62 $983.05 "$1,241.23" $992.98 $558.55 $246.35 N/A $720.07 "$1,241.23" $744.74 "$1,241.23" "$1,241.23" "$1,241.23" N/A N/A 02.161.216 SUP HCPCS C1713 02.161.216 - PLATE BONE NARROW 16 HOLE CVD LCP STAINLESS STEEL NONSTRL BOTH IP/OP "$1,341.50" $993.00 $266.16 "$1,363.83" $603.46 $603.46 $603.46 $603.46 "$1,341.03" "$1,341.03" "$1,341.03" $279.50 "$1,341.03" "$1,341.03" "$1,341.03" "$1,341.03" "$1,341.03" $279.49 "$1,341.03" $545.53 $793.22 "$1,341.03" "$1,363.83" "$1,341.03" "$1,341.03" "$1,006.13" "$1,341.03" "$1,341.03" "$1,341.03" $670.52 $670.52 "$1,062.10" "$1,341.03" "$1,072.82" $603.46 $266.16 N/A $778.07 "$1,341.03" $804.62 "$1,341.03" $279.47 "$1,341.03" N/A N/A 02.161.218 SUP HCPCS C1713 02.161.218 - PLATE BONE NARROW 18 HOLE CVD LCP STAINLESS STEEL NONSTRL BOTH IP/OP "$1,510.00" "$1,117.00" $299.64 "$1,535.40" $679.38 $679.38 $679.38 $679.38 "$1,509.73" "$1,509.73" "$1,509.73" $314.67 "$1,509.73" "$1,509.73" "$1,509.73" "$1,509.73" "$1,509.73" $314.64 "$1,509.73" $614.16 $893.01 "$1,509.73" "$1,535.40" "$1,509.73" "$1,509.73" "$1,132.50" "$1,509.73" "$1,509.73" "$1,509.73" $754.87 $754.87 "$1,195.71" "$1,509.73" "$1,207.78" $679.38 $299.64 N/A $875.80 "$1,509.73" $905.84 "$1,509.73" $314.63 "$1,509.73" N/A N/A 02.161.220 SUP HCPCS C1713 02.161.220 - PLATE BONE NARROW 20 HOLE CVD LCP STAINLESS STEEL NONSTRL BOTH IP/OP "$1,676.00" "$1,240.00" $332.56 "$1,704.05" $754.01 $754.01 $754.01 $754.01 "$1,675.58" "$1,675.58" "$1,675.58" $349.23 "$1,675.58" "$1,675.58" "$1,675.58" "$1,675.58" "$1,675.58" $349.21 "$1,675.58" $681.62 $991.11 "$1,675.58" "$1,704.05" "$1,675.58" "$1,675.58" "$1,257.00" "$1,675.58" "$1,675.58" "$1,675.58" $837.79 $837.79 "$1,327.06" "$1,675.58" "$1,340.46" $754.01 $332.56 N/A $972.08 "$1,675.58" "$1,005.35" "$1,675.58" $349.19 "$1,675.58" N/A N/A 02.161.222 SUP HCPCS C1713 02.161.222 - PLATE BONE NARROW 22 HOLE CVD LCP STAINLESS STEEL NONSTRL BOTH IP/OP "$1,676.00" "$1,240.00" $332.56 "$1,704.05" $754.01 $754.01 $754.01 $754.01 "$1,675.58" "$1,675.58" "$1,675.58" $349.23 "$1,675.58" "$1,675.58" "$1,675.58" "$1,675.58" "$1,675.58" $349.21 "$1,675.58" $681.62 $991.11 "$1,675.58" "$1,704.05" "$1,675.58" "$1,675.58" "$1,257.00" "$1,675.58" "$1,675.58" "$1,675.58" $837.79 $837.79 "$1,327.06" "$1,675.58" "$1,340.46" $754.01 $332.56 N/A $972.08 "$1,675.58" "$1,005.35" "$1,675.58" $349.19 "$1,675.58" N/A N/A 02.161.240 SUP HCPCS C1713 02.161.240 - PLATE BONE NARROW 10 HOLE CVD LCP STAINLESS STEEL NONSTRL BOTH IP/OP "$1,165.50" $862.00 $231.29 "$1,185.13" $524.40 $524.40 $524.40 $524.40 "$1,165.33" "$1,165.33" "$1,165.33" $242.88 "$1,165.33" "$1,165.33" "$1,165.33" "$1,165.33" "$1,165.33" $242.87 "$1,165.33" $474.05 $689.29 "$1,165.33" "$1,185.13" "$1,165.33" "$1,165.33" $874.13 "$1,165.33" "$1,165.33" "$1,165.33" $582.67 $582.67 $922.94 "$1,165.33" $932.26 $524.40 $231.29 N/A $675.99 "$1,165.33" "$1,165.33" "$1,165.33" $242.85 "$1,165.33" N/A N/A 02.161.242 SUP HCPCS C1713 02.161.242 - PLATE BONE NARROW 12 HOLE CVD LCP STAINLESS STEEL NONSTRL BOTH IP/OP "$1,345.50" $996.00 $267.00 "$1,368.13" $605.36 $605.36 $605.36 $605.36 "$1,345.25" "$1,345.25" "$1,345.25" $280.38 "$1,345.25" "$1,345.25" "$1,345.25" "$1,345.25" "$1,345.25" $280.36 "$1,345.25" $547.25 $795.72 "$1,345.25" "$1,368.13" "$1,345.25" "$1,345.25" "$1,009.13" "$1,345.25" "$1,345.25" "$1,345.25" $672.63 $672.63 "$1,065.44" "$1,345.25" "$1,076.20" $605.36 $267.00 N/A $780.39 "$1,345.25" $807.15 "$1,345.25" $280.35 "$1,345.25" N/A N/A 02.161.244 SUP HCPCS C1713 02.161.244 - PLATE BONE NARROW 14 HOLE CVD LCP STAINLESS STEEL NONSTRL BOTH IP/OP "$1,435.50" "$1,062.00" $284.85 "$1,459.60" $645.84 $645.84 $645.84 $645.84 "$1,435.20" "$1,435.20" "$1,435.20" $299.13 "$1,435.20" "$1,435.20" "$1,435.20" "$1,435.20" "$1,435.20" $299.11 "$1,435.20" $583.84 $848.92 "$1,435.20" "$1,459.60" "$1,435.20" "$1,435.20" "$1,076.63" "$1,435.20" "$1,435.20" "$1,435.20" $717.60 $717.60 "$1,136.68" "$1,435.20" "$1,148.16" $645.84 $284.85 N/A $832.59 "$1,435.20" $861.12 "$1,435.20" $299.10 "$1,435.20" N/A N/A 02.161.246 SUP HCPCS C1713 02.161.246 - PLATE BONE NARROW 16 HOLE CVD LCP STAINLESS STEEL NONSTRL BOTH IP/OP "$1,614.00" "$1,194.00" $320.29 "$1,641.15" $726.18 $726.18 $726.18 $726.18 "$1,613.73" "$1,613.73" "$1,613.73" $336.34 "$1,613.73" "$1,613.73" "$1,613.73" "$1,613.73" "$1,613.73" $336.32 "$1,613.73" $656.46 $954.52 "$1,613.73" "$1,641.15" "$1,613.73" "$1,613.73" "$1,210.50" "$1,613.73" "$1,613.73" "$1,613.73" $806.87 $806.87 "$1,278.07" "$1,613.73" "$1,290.98" $726.18 $320.29 N/A $936.12 "$1,613.73" $968.24 "$1,613.73" $336.30 "$1,613.73" N/A N/A 02.161.248 SUP HCPCS C1713 02.161.248 - PLATE BONE NARROW 18 HOLE CVD LCP STAINLESS STEEL NONSTRL BOTH IP/OP "$1,969.50" "$1,457.00" $390.87 "$2,002.85" $886.22 $886.22 $886.22 $886.22 "$1,969.38" "$1,969.38" "$1,969.38" $410.47 "$1,969.38" "$1,969.38" "$1,969.38" "$1,969.38" "$1,969.38" $410.44 "$1,969.38" "$2,002.85" "$1,164.89" "$1,969.38" "$2,002.85" "$1,969.38" "$1,969.38" "$1,477.13" "$1,969.38" "$1,969.38" "$1,969.38" $984.69 $984.69 "$1,559.75" "$1,969.38" "$1,575.50" $886.22 $390.87 N/A "$1,142.31" "$1,969.38" "$1,969.38" "$1,969.38" $410.42 "$1,969.38" N/A N/A 02.161.250 SUP HCPCS C1713 02.161.250 - PLATE BONE NARROW 20 HOLE CVD LCP STAINLESS STEEL NONSTRL BOTH IP/OP "$2,329.50" "$1,724.00" $462.29 "$2,368.83" "$1,048.15" "$1,048.15" "$1,048.15" "$1,048.15" "$2,329.23" "$2,329.23" "$2,329.23" $485.47 "$2,329.23" "$2,329.23" "$2,329.23" "$2,329.23" "$2,329.23" $485.44 "$2,329.23" "$2,368.83" "$1,377.74" "$2,329.23" "$2,368.83" "$2,329.23" "$2,329.23" "$1,747.13" "$2,329.23" "$2,329.23" "$2,329.23" "$1,164.62" "$1,164.62" "$1,844.75" "$2,329.23" "$1,863.38" "$1,048.15" $462.29 N/A "$1,351.11" "$2,329.23" "$1,397.54" "$2,329.23" $485.41 "$2,329.23" N/A N/A 02.161.252 SUP HCPCS C1713 02.161.252 - PLATE BONE NARROW 22 HOLE CVD LCP STAINLESS STEEL NONSTRL BOTH IP/OP "$2,598.00" "$1,923.00" $515.58 "$2,641.88" "$1,168.98" "$1,168.98" "$1,168.98" "$1,168.98" "$2,597.73" "$2,597.73" "$2,597.73" $541.43 "$2,597.73" "$2,597.73" "$2,597.73" "$2,597.73" "$2,597.73" $541.40 "$2,597.73" "$1,056.75" "$1,280.68" "$2,597.73" "$2,641.88" "$2,597.73" "$2,597.73" "$1,948.50" "$2,597.73" "$2,597.73" "$2,597.73" "$1,298.87" "$1,298.87" "$2,057.40" "$2,597.73" "$2,078.18" "$1,168.98" $515.58 N/A "$1,506.84" "$2,597.73" "$1,558.64" "$2,597.73" $541.37 "$2,597.73" N/A N/A 02.161.270 SUP HCPCS C1713 02.161.270 - PLATE BONE BROAD 10 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5 BOTH IP/OP $890.00 $659.00 $176.60 $904.93 $400.41 $400.41 $400.41 $400.41 $889.80 $889.80 $889.80 $185.46 $889.80 $889.80 $889.80 $889.80 $889.80 $185.44 $889.80 $361.97 $526.32 $889.80 $904.93 $889.80 $889.80 $667.50 $889.80 $889.80 $889.80 $444.90 $444.90 $704.72 $889.80 $711.84 $400.41 $176.60 N/A $516.20 $889.80 $889.80 $889.80 $185.43 $889.80 N/A N/A 02.161.272 SUP HCPCS C1713 02.161.272 - PLATE BONE BROAD CVD 12 HOLE LCP STAINLESS STEEL TIBIA BOTH IP/OP "$1,157.00" $856.00 $229.61 "$1,176.55" $520.60 $520.60 $520.60 $520.60 "$1,156.88" "$1,156.88" "$1,156.88" $241.12 "$1,156.88" "$1,156.88" "$1,156.88" "$1,156.88" "$1,156.88" $241.11 "$1,156.88" $470.62 $684.29 "$1,156.88" "$1,176.55" "$1,156.88" "$1,156.88" $867.75 "$1,156.88" "$1,156.88" "$1,156.88" $578.44 $578.44 $916.25 "$1,156.88" $925.50 $520.60 $229.61 N/A $671.06 "$1,156.88" $694.13 "$1,156.88" $241.09 "$1,156.88" N/A N/A 02.161.274 SUP HCPCS C1713 02.161.274 - PLATE BONE BROAD 14 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5 BOTH IP/OP "$1,241.50" $919.00 $246.35 "$1,262.33" $558.55 $558.55 $558.55 $558.55 "$1,241.23" "$1,241.23" "$1,241.23" $258.70 "$1,241.23" "$1,241.23" "$1,241.23" "$1,241.23" "$1,241.23" $258.69 "$1,241.23" "$1,262.33" $734.19 "$1,241.23" "$1,262.33" "$1,241.23" "$1,241.23" $931.13 "$1,241.23" "$1,241.23" "$1,241.23" $620.62 $620.62 $983.05 "$1,241.23" $992.98 $558.55 $246.35 N/A $720.07 "$1,241.23" $744.74 "$1,241.23" $258.67 "$1,241.23" N/A N/A 02.161.276 SUP HCPCS C1713 02.161.276 - PLATE BN BRD CRV NS LCP CMBN 16 HL LMT CNTCT TPR END SS BOTH IP/OP "$1,341.50" $993.00 $266.16 "$1,363.83" $603.46 $603.46 $603.46 $603.46 "$1,341.03" "$1,341.03" "$1,341.03" $279.50 "$1,341.03" "$1,341.03" "$1,341.03" "$1,341.03" "$1,341.03" $279.49 "$1,341.03" $545.53 $793.22 "$1,341.03" "$1,363.83" "$1,341.03" "$1,341.03" "$1,006.13" "$1,341.03" "$1,341.03" "$1,341.03" $670.52 $670.52 "$1,062.10" "$1,341.03" "$1,072.82" $603.46 $266.16 N/A $778.07 "$1,341.03" $804.62 "$1,341.03" $279.47 "$1,341.03" N/A N/A 02.161.278 SUP HCPCS C1713 02.161.278 - PLATE BONE BROAD 18 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5 BOTH IP/OP "$1,510.00" "$1,117.00" $299.64 "$1,535.40" $679.38 $679.38 $679.38 $679.38 "$1,509.73" "$1,509.73" "$1,509.73" $314.67 "$1,509.73" "$1,509.73" "$1,509.73" "$1,509.73" "$1,509.73" $314.64 "$1,509.73" $614.16 $893.01 "$1,509.73" "$1,535.40" "$1,509.73" "$1,509.73" "$1,132.50" "$1,509.73" "$1,509.73" "$1,509.73" $754.87 $754.87 "$1,195.71" "$1,509.73" "$1,207.78" $679.38 $299.64 N/A $875.80 "$1,509.73" "$1,509.73" "$1,509.73" $314.63 "$1,509.73" N/A N/A 02.161.280 SUP HCPCS C1713 02.161.280 - PLATE BONE BROAD 20 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5 BOTH IP/OP "$1,608.50" "$1,190.00" $319.17 "$1,635.45" $723.65 $723.65 $723.65 $723.65 "$1,608.10" "$1,608.10" "$1,608.10" $335.17 "$1,608.10" "$1,608.10" "$1,608.10" "$1,608.10" "$1,608.10" $335.15 "$1,608.10" "$1,635.45" $951.19 "$1,608.10" "$1,635.45" "$1,608.10" "$1,608.10" "$1,206.38" "$1,608.10" "$1,608.10" "$1,608.10" $804.05 $804.05 "$1,273.62" "$1,608.10" "$1,286.48" $723.65 $319.17 N/A $932.93 "$1,608.10" "$1,608.10" "$1,608.10" $335.13 "$1,608.10" N/A N/A 02.161.282 SUP HCPCS C1713 02.161.282 - PLATE BONE BROAD 22 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5 BOTH IP/OP "$1,692.50" "$1,252.00" $335.91 "$1,721.23" $761.60 $761.60 $761.60 $761.60 "$1,692.45" "$1,692.45" "$1,692.45" $352.75 "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" $352.73 "$1,692.45" "$1,721.23" "$1,001.08" "$1,692.45" "$1,721.23" "$1,692.45" "$1,692.45" "$1,269.38" "$1,692.45" "$1,692.45" "$1,692.45" $846.23 $846.23 "$1,340.42" "$1,692.45" "$1,353.96" $761.60 $335.91 N/A $981.65 "$1,692.45" "$1,692.45" "$1,692.45" $352.71 "$1,692.45" N/A N/A 02.161.284 SUP HCPCS C1713 02.161.284 - PLATE BONE BROAD 24 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5 BOTH IP/OP "$1,692.50" "$1,252.00" $335.91 "$1,721.23" $761.60 $761.60 $761.60 $761.60 "$1,692.45" "$1,692.45" "$1,692.45" $352.75 "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" $352.73 "$1,692.45" $688.49 "$1,001.08" "$1,692.45" "$1,721.23" "$1,692.45" "$1,692.45" "$1,269.38" "$1,692.45" "$1,692.45" "$1,692.45" $846.23 $846.23 "$1,340.42" "$1,692.45" "$1,353.96" $761.60 $335.91 N/A $981.65 "$1,692.45" "$1,015.47" "$1,692.45" $352.71 "$1,692.45" N/A N/A 02.161.286 SUP HCPCS C1713 02.161.286 - PLATE BONE BROAD 26 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5 BOTH IP/OP "$1,795.50" "$1,329.00" $356.28 "$1,825.60" $807.79 $807.79 $807.79 $807.79 "$1,795.08" "$1,795.08" "$1,795.08" $374.14 "$1,795.08" "$1,795.08" "$1,795.08" "$1,795.08" "$1,795.08" $374.11 "$1,795.08" $730.24 "$1,061.79" "$1,795.08" "$1,825.60" "$1,795.08" "$1,795.08" "$1,346.63" "$1,795.08" "$1,795.08" "$1,795.08" $897.54 $897.54 "$1,421.70" "$1,795.08" "$1,436.06" $807.79 $356.28 N/A "$1,041.39" "$1,795.08" "$1,077.05" "$1,795.08" "$1,795.08" "$1,795.08" N/A N/A 02.161.288 SUP HCPCS C1713 02.161.288 - PLATE BONE BROAD 28 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5 BOTH IP/OP "$1,974.00" "$1,461.00" $391.71 "$2,007.15" $888.12 $888.12 $888.12 $888.12 "$1,973.60" "$1,973.60" "$1,973.60" $411.35 "$1,973.60" "$1,973.60" "$1,973.60" "$1,973.60" "$1,973.60" $411.32 "$1,973.60" "$2,007.15" "$1,167.38" "$1,973.60" "$2,007.15" "$1,973.60" "$1,973.60" "$1,480.50" "$1,973.60" "$1,973.60" "$1,973.60" $986.80 $986.80 "$1,563.09" "$1,973.60" "$1,578.88" $888.12 $391.71 N/A "$1,144.92" "$1,973.60" "$1,184.16" "$1,973.60" "$1,973.60" "$1,973.60" N/A N/A 02.161.290 SUP HCPCS C1713 02.161.290 - PLATE BONE BROAD 30 HOLE CVD LCP STAINLESS STEEL NONSTRL 3.5 BOTH IP/OP "$2,154.00" "$1,594.00" $427.42 "$2,190.13" $969.09 $969.09 $969.09 $969.09 "$2,153.53" "$2,153.53" "$2,153.53" $448.85 "$2,153.53" "$2,153.53" "$2,153.53" "$2,153.53" "$2,153.53" $448.82 "$2,153.53" "$2,190.13" "$1,273.81" "$2,153.53" "$2,190.13" "$2,153.53" "$2,153.53" "$1,615.50" "$2,153.53" "$2,153.53" "$2,153.53" "$1,076.77" "$1,076.77" "$1,705.60" "$2,153.53" "$1,722.82" $969.09 $427.42 N/A "$1,249.32" "$2,153.53" "$1,292.12" "$2,153.53" $448.80 "$2,153.53" N/A N/A 02.200.003 SUP HCPCS C1713 02.200.003 - PLUG PLT 3.5MM NS LCP THRD STRDR RCS SS LOPRFL PLVC SYS BOTH IP/OP $204.00 $151.00 $40.46 $207.30 $91.72 $91.72 $91.72 $91.72 $203.83 $203.83 $203.83 $42.48 $203.83 $203.83 $203.83 $203.83 $203.83 $42.48 $203.83 $82.92 $120.57 $203.83 $207.30 $203.83 $203.83 $153.00 $203.83 $203.83 $203.83 $101.92 $101.92 $161.43 $203.83 $163.06 $91.72 $40.46 N/A $118.32 $203.83 $203.83 $203.83 $203.83 $203.83 N/A N/A 02.200.010 SUP HCPCS C1713 02.200.010 - SCREW BONE T15 LP 3.5MM 6MM 10MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 02.200.012 SUP HCPCS C1713 02.200.012 - SCREW BONE FULTHD 3.5MM 6MM 12MM T15 STARDRIVE SELF TAP LP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 02.200.014 SUP HCPCS C1713 02.200.014 - SCREW BONE T15 LP 3.5MM 6MM 14MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $9.88 $47.43 N/A N/A 02.200.016 SUP HCPCS C1713 02.200.016 - SCREW BONE T15 LP 3.5MM 6MM 16MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $9.88 $47.43 N/A N/A 02.200.018 SUP HCPCS C1713 02.200.018 - SCREW BONE T15 LP 3.5MM 6MM 18MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $9.88 $47.43 N/A N/A 02.200.020 SUP HCPCS C1713 02.200.020 - SCREW BONE FULTHD 3.5MM 20MM T15 STARDRIVE RECESS SLFTAP LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $9.88 $47.43 N/A N/A 02.200.022 SUP HCPCS C1713 02.200.022 - SCREW BONE T15 LP 3.5MM 6MM 22MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $9.88 $47.43 N/A N/A 02.200.024 SUP HCPCS C1713 02.200.024 - SCREW BONE T15 LP 3.5MM 6MM 24MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 02.200.026 SUP HCPCS C1713 02.200.026 - SCREW BONE T15 LP 3.5MM 6MM 26MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $47.43 $47.43 N/A N/A 02.200.028 SUP HCPCS C1713 02.200.028 - SCREW BONE T15 LP 3.5MM 6MM 28MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $47.43 $47.43 N/A N/A 02.200.030 SUP HCPCS C1713 02.200.030 - SCREW BONE FULTHD 3.5MM 6MM 30MM T15 STARDRIVE RECESS SLFTAP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 02.200.032 SUP HCPCS C1713 02.200.032 - SCREW BONE T15 LP 3.5MM 6MM 32MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $47.43 $47.43 N/A N/A 02.200.034 SUP HCPCS C1713 02.200.034 - SCREW BONE T15 LP 3.5MM 6MM 34MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $47.43 $47.43 N/A N/A 02.200.036 SUP HCPCS C1713 02.200.036 - SCREW BONE T15 LP 3.5MM 6MM 36MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $9.88 $47.43 N/A N/A 02.200.038 SUP HCPCS C1713 02.200.038 - SCREW BONE FULTHD LP 3.5MM 6MM 38MM SELF TAP T15 STARDRIVE BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 02.200.040 SUP HCPCS C1713 02.200.040 - SCREW BONE T15 LP 3.5MM 6MM 40MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 02.200.042 SUP HCPCS C1713 02.200.042 - SCREW BONE T15 LP 3.5MM 6MM 42MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 02.200.044 SUP HCPCS C1713 02.200.044 - SCREW BONE T15 LP 3.5MM 6MM 44MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 02.200.045 SUP HCPCS C1713 02.200.045 - SCREW BONE 3.5MM 45MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $47.43 $47.43 N/A N/A 02.200.046 SUP HCPCS C1713 02.200.046 - SCREW BONE T15 LP 3.5MM 6MM 46MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $9.88 $47.43 N/A N/A 02.200.048 SUP HCPCS C1713 02.200.048 - SCREW BONE 3.5MM 48MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $9.88 $47.43 N/A N/A 02.200.050 SUP HCPCS C1713 02.200.050 - SCREW BONE T15 LP 3.5MM 6MM 50MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $47.43 $47.43 N/A N/A 02.200.055 SUP HCPCS C1713 02.200.055 - SCREW BONE T15 LP 3.5MM 6MM 55MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $9.88 $47.43 N/A N/A 02.200.060 SUP HCPCS C1713 02.200.060 - SCREW BONE 3.5MM 60MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $9.88 $47.43 N/A N/A 02.200.065 SUP HCPCS C1713 02.200.065 - SCREW BONE 3.5MM 65MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 02.200.070 SUP HCPCS C1713 02.200.070 - SCREW BONE 3.5MM 70MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 02.200.075 SUP HCPCS C1713 02.200.075 - SCREW BONE 3.5MM 75MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $47.43 $47.43 N/A N/A 02.200.080 SUP HCPCS C1713 02.200.080 - SCREW BONE 3.5MM 80MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $9.88 $47.43 N/A N/A 02.200.085 SUP HCPCS C1713 02.200.085 - SCREW BONE T15 LP 3.5MM 6MM 85MM SELF TAP STARDRIVE LCP BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $28.46 $47.43 $47.43 $47.43 N/A N/A 02.200.090 SUP HCPCS C1713 02.200.090 - SCREW BONE 3.5MM 90MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 02.200.095 SUP HCPCS C1713 02.200.095 - SCREW BONE 3.5MM 95MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 02.200.100 SUP HCPCS C1713 02.200.100 - SCREW BONE 3.5MM 100MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $59.50 $44.00 $11.72 $60.05 $26.57 $26.57 $26.57 $26.57 $59.05 $59.05 $59.05 $12.31 $59.05 $59.05 $59.05 $59.05 $59.05 $12.31 $59.05 $24.02 $34.93 $59.05 $60.05 $59.05 $59.05 $44.63 $59.05 $59.05 $59.05 $29.53 $29.53 $46.77 $59.05 $47.24 $26.57 $11.72 N/A $34.51 $59.05 $59.05 $59.05 $59.05 $59.05 N/A N/A 02.200.105 SUP HCPCS C1713 02.200.105 - SCREW BONE 3.5MM 105MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $59.50 $44.00 $11.72 $60.05 $26.57 $26.57 $26.57 $26.57 $59.05 $59.05 $59.05 $12.31 $59.05 $59.05 $59.05 $59.05 $59.05 $12.31 $59.05 $24.02 $34.93 $59.05 $60.05 $59.05 $59.05 $44.63 $59.05 $59.05 $59.05 $29.53 $29.53 $46.77 $59.05 $47.24 $26.57 $11.72 N/A $34.51 $59.05 $35.43 $59.05 $59.05 $59.05 N/A N/A 02.200.110 SUP HCPCS C1713 02.200.110 - SCREW BONE 3.5MM 110MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $59.50 $44.00 $11.72 $60.05 $26.57 $26.57 $26.57 $26.57 $59.05 $59.05 $59.05 $12.31 $59.05 $59.05 $59.05 $59.05 $59.05 $12.31 $59.05 $24.02 $34.93 $59.05 $60.05 $59.05 $59.05 $44.63 $59.05 $59.05 $59.05 $29.53 $29.53 $46.77 $59.05 $47.24 $26.57 $11.72 N/A $34.51 $59.05 $35.43 $59.05 $12.31 $59.05 N/A N/A 02.200.115 SUP HCPCS C1713 02.200.115 - SCREW BONE 3.5MM 115MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $59.50 $44.00 $11.72 $60.05 $26.57 $26.57 $26.57 $26.57 $59.05 $59.05 $59.05 $12.31 $59.05 $59.05 $59.05 $59.05 $59.05 $12.31 $59.05 $60.05 $34.93 $59.05 $60.05 $59.05 $59.05 $44.63 $59.05 $59.05 $59.05 $29.53 $29.53 $46.77 $59.05 $47.24 $26.57 $11.72 N/A $34.51 $59.05 $35.43 $59.05 $12.31 $59.05 N/A N/A 02.200.120 SUP HCPCS C1713 02.200.120 - SCREW BONE 3.5MM 120MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $59.50 $44.00 $11.72 $60.05 $26.57 $26.57 $26.57 $26.57 $59.05 $59.05 $59.05 $12.31 $59.05 $59.05 $59.05 $59.05 $59.05 $12.31 $59.05 $60.05 $34.93 $59.05 $60.05 $59.05 $59.05 $44.63 $59.05 $59.05 $59.05 $29.53 $29.53 $46.77 $59.05 $47.24 $26.57 $11.72 N/A $34.51 $59.05 $35.43 $59.05 $12.31 $59.05 N/A N/A 02.200.125 SUP HCPCS C1713 02.200.125 - SCREW BONE 3.5MM 125MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $59.50 $44.00 $11.72 $60.05 $26.57 $26.57 $26.57 $26.57 $59.05 $59.05 $59.05 $12.31 $59.05 $59.05 $59.05 $59.05 $59.05 $12.31 $59.05 $24.02 $34.93 $59.05 $60.05 $59.05 $59.05 $44.63 $59.05 $59.05 $59.05 $29.53 $29.53 $46.77 $59.05 $47.24 $26.57 $11.72 N/A $34.51 $59.05 $35.43 $59.05 $12.31 $59.05 N/A N/A 02.200.130 SUP HCPCS C1713 02.200.130 - SCREW BONE 3.5MM 130MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $191.50 $142.00 $37.94 $194.43 $86.03 $86.03 $86.03 $86.03 $191.18 $191.18 $191.18 $39.85 $191.18 $191.18 $191.18 $191.18 $191.18 $39.84 $191.18 $77.77 $113.08 $191.18 $194.43 $191.18 $191.18 $143.63 $191.18 $191.18 $191.18 $95.59 $95.59 $151.41 $191.18 $152.94 $86.03 $37.94 N/A $111.07 $191.18 $114.71 $191.18 $39.84 $191.18 N/A N/A 02.200.135 SUP HCPCS C1713 02.200.135 - SCREW BONE 3.5MM 135MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $191.50 $142.00 $37.94 $194.43 $86.03 $86.03 $86.03 $86.03 $191.18 $191.18 $191.18 $39.85 $191.18 $191.18 $191.18 $191.18 $191.18 $39.84 $191.18 $194.43 $113.08 $191.18 $194.43 $191.18 $191.18 $143.63 $191.18 $191.18 $191.18 $95.59 $95.59 $151.41 $191.18 $152.94 $86.03 $37.94 N/A $111.07 $191.18 $114.71 $191.18 $39.84 $191.18 N/A N/A 02.200.140 SUP HCPCS C1713 02.200.140 - SCREW BONE 3.5MM 140MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $191.50 $142.00 $37.94 $194.43 $86.03 $86.03 $86.03 $86.03 $191.18 $191.18 $191.18 $39.85 $191.18 $191.18 $191.18 $191.18 $191.18 $39.84 $191.18 $194.43 $113.08 $191.18 $194.43 $191.18 $191.18 $143.63 $191.18 $191.18 $191.18 $95.59 $95.59 $151.41 $191.18 $152.94 $86.03 $37.94 N/A $111.07 $191.18 $191.18 $191.18 $39.84 $191.18 N/A N/A 02.200.145 SUP HCPCS C1713 02.200.145 - SCREW BONE 3.5MM 145MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $191.50 $142.00 $37.94 $194.43 $86.03 $86.03 $86.03 $86.03 $191.18 $191.18 $191.18 $39.85 $191.18 $191.18 $191.18 $191.18 $191.18 $39.84 $191.18 $77.77 $113.08 $191.18 $194.43 $191.18 $191.18 $143.63 $191.18 $191.18 $191.18 $95.59 $95.59 $151.41 $191.18 $152.94 $86.03 $37.94 N/A $111.07 $191.18 $114.71 $191.18 $191.18 $191.18 N/A N/A 02.200.150 SUP HCPCS C1713 02.200.150 - SCREW BONE 3.5MM 150MM SLFTAP LP STARDRIVE RECESS STAINLESS BOTH IP/OP $191.50 $142.00 $37.94 $194.43 $86.03 $86.03 $86.03 $86.03 $191.18 $191.18 $191.18 $39.85 $191.18 $191.18 $191.18 $191.18 $191.18 $39.84 $191.18 $77.77 $113.08 $191.18 $194.43 $191.18 $191.18 $143.63 $191.18 $191.18 $191.18 $95.59 $95.59 $151.41 $191.18 $152.94 $86.03 $37.94 N/A $111.07 $191.18 $114.71 $191.18 $39.84 $191.18 N/A N/A 02.204.014 SUP HCPCS C1713 02.204.014 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 14MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $109.80 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.016 SUP HCPCS C1713 02.204.016 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 16MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $274.50 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.018 SUP HCPCS C1713 02.204.018 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 18MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $274.50 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $161.94 $269.90 $56.25 $269.90 N/A N/A 02.204.020 SUP HCPCS C1713 02.204.020 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 20MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $109.80 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.022 SUP HCPCS C1713 02.204.022 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 22MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $274.50 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.024 SUP HCPCS C1713 02.204.024 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 24MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $274.50 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.026 SUP HCPCS C1713 02.204.026 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 26MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $274.50 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $161.94 $269.90 $56.25 $269.90 N/A N/A 02.204.028 SUP HCPCS C1713 02.204.028 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 28MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $109.80 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.030 SUP HCPCS C1713 02.204.030 - SCREW BONE FULTHD 4MM 30MM T25 STARDRIVE RECESS SLFTAP TIP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $109.80 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.032 SUP HCPCS C1713 02.204.032 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 32MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $109.80 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.034 SUP HCPCS C1713 02.204.034 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 34MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $109.80 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.036 SUP HCPCS C1713 02.204.036 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 36MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $274.50 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.038 SUP HCPCS C1713 02.204.038 - SCREW BONE FULTHD 4MM 38MM T25 STARDRIVE SELF TAP TIP LOCK BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $274.50 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.040 SUP HCPCS C1713 02.204.040 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 40MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $274.50 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.042 SUP HCPCS C1713 02.204.042 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 42MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $109.80 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.044 SUP HCPCS C1713 02.204.044 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 44MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $109.80 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.046 SUP HCPCS C1713 02.204.046 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 46MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $274.50 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $161.94 $269.90 $56.25 $269.90 N/A N/A 02.204.048 SUP HCPCS C1713 02.204.048 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 48MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $109.80 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $161.94 $269.90 $56.25 $269.90 N/A N/A 02.204.050 SUP HCPCS C1713 02.204.050 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 50MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $274.50 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $161.94 $269.90 $56.25 $269.90 N/A N/A 02.204.052 SUP HCPCS C1713 02.204.052 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 52MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $274.50 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.054 SUP HCPCS C1713 02.204.054 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 54MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $109.80 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.056 SUP HCPCS C1713 02.204.056 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 56MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $274.50 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $161.94 $269.90 $56.25 $269.90 N/A N/A 02.204.058 SUP HCPCS C1713 02.204.058 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 58MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $109.80 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.060 SUP HCPCS C1713 02.204.060 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 60MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $274.50 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $269.90 $269.90 $56.25 $269.90 N/A N/A 02.204.062 SUP HCPCS C1713 02.204.062 - SCREW BONE T25 FULTHD CONE 4MM 3.4MM 62MM FIX ANGLE SELF TAP BOTH IP/OP $270.00 $200.00 $53.57 $274.50 $121.46 $121.46 $121.46 $121.46 $269.90 $269.90 $269.90 $56.25 $269.90 $269.90 $269.90 $269.90 $269.90 $56.25 $269.90 $274.50 $159.65 $269.90 $274.50 $269.90 $269.90 $202.50 $269.90 $269.90 $269.90 $134.95 $134.95 $213.76 $269.90 $215.92 $121.46 $53.57 N/A $156.60 $269.90 $161.94 $269.90 $56.25 $269.90 N/A N/A 02.204.420 SUP HCPCS C1713 02.204.420 - SCREW BONE 4MM 20MM LOCK STAINLESS STEEL PERIARTICULAR BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $152.64 $254.40 $53.02 $254.40 N/A N/A 02.204.424 SUP HCPCS C1713 02.204.424 - SCREW BONE 4MM 24MM LOCK STAINLESS STEEL PERIARTICULAR BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 02.204.428 SUP HCPCS C1713 02.204.428 - SCREW BONE 4MM 3.4MM 28MM LOCKING SLFTAP TIP THREADED BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $101.76 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 02.204.432 SUP HCPCS C1713 02.204.432 - SCREW BONE 4MM 32MM LOCKING SLFTAP TIP THREADED CONICAL HEAD BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $152.64 $254.40 $53.02 $254.40 N/A N/A 02.204.436 SUP HCPCS C1713 02.204.436 - SCREW BONE 4MM 36MM LOCKING SLFTAP TIP THREADED CONICAL HEAD BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $152.64 $254.40 $53.02 $254.40 N/A N/A 02.204.440 SUP HCPCS C1713 02.204.440 - SCREW BONE 4MM 40MM LOCKING SLFTAP TIP THREADED CONICAL HEAD BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 02.204.444 SUP HCPCS C1713 02.204.444 - SCREW BONE 4MM 44MM LOCKING SLFTAP TIP THREADED CONICAL HEAD BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $152.64 $254.40 $53.02 $254.40 N/A N/A 02.204.448 SUP HCPCS C1713 02.204.448 - SCREW BONE 4MM 48MM LOCKING HEX RECESS STAINLESS STEEL BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 02.204.452 SUP HCPCS C1713 02.204.452 - SCREW BONE 4MM 52MM LOCKING HEX RECESS STAINLESS STEEL BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $152.64 $254.40 $53.02 $254.40 N/A N/A 02.204.456 SUP HCPCS C1713 02.204.456 - SCREW BONE 4MM 56MM LOCKING HEX RECESS STAINLESS STEEL BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $101.76 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $152.64 $254.40 $53.02 $254.40 N/A N/A 02.204.460 SUP HCPCS C1713 02.204.460 - SCREW BONE 4MM 60MM LOCKING HEX RECESS STAINLESS STEEL BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $152.64 $254.40 $53.02 $254.40 N/A N/A 02.205.025 SUP HCPCS C1713 02.205.025 - SCREW BONE 4MM FULTHD 5MM 4.4MM 25MM SELF DRILL SELF TAP BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 02.205.030 SUP HCPCS C1713 02.205.030 - SCREW BONE 4MM FULTHD 5MM 4.4MM 30MM SELF DRILL SELF TAP BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 02.205.035 SUP HCPCS C1713 02.205.035 - SCREW BONE 4MM FULTHD 5MM 4.4MM 35MM SELF DRILL SELF TAP BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 02.205.040 SUP HCPCS C1713 02.205.040 - SCREW BONE 4MM FULTHD 5MM 4.4MM 40MM CANN LOCKING SLFDRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 02.205.045 SUP HCPCS C1713 02.205.045 - SCREW BONE 4MM FULTHD 5MM 4.4MM 45MM SELF DRILL SELF TAP BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 02.205.050 SUP HCPCS C1713 02.205.050 - SCREW BONE 4MM FULTHD 5MM 4.4MM 50MM SELF DRILL SELF TAP BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 02.205.055 SUP HCPCS C1713 02.205.055 - SCREW BONE 4MM FULTHD 5MM 4.4MM 55MM CANN LOCK DRILL SELF BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 02.205.060 SUP HCPCS C1713 02.205.060 - SCREW BONE 4MM FULTHD 5MM 4.4MM 60MM SELF DRILL SELF TAP BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 02.205.065 SUP HCPCS C1713 02.205.065 - SCREW BONE 4MM FULTHD 5MM 4.4MM 65MM CANN LOCK DRILL SELF BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 02.205.070 SUP HCPCS C1713 02.205.070 - SCREW BONE 4MM FULTHD 5MM 4.4MM 70MM SELF DRILL SELF TAP BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $220.98 $368.30 $76.75 $368.30 N/A N/A 02.205.075 SUP HCPCS C1713 02.205.075 - SCREW BONE 4MM FULTHD 5MM 4.4MM 75MM SELF DRILL SELF TAP BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 02.205.080 SUP HCPCS C1713 02.205.080 - SCREW BONE 4MM FULTHD 5MM 4.4MM 80MM SELF DRILL SELF TAP BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 02.205.085 SUP HCPCS C1713 02.205.085 - SCREW BONE 4MM FULTHD 5MM 4.4MM 85MM CANN LOCKING SLFDRILL BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 02.205.090 SUP HCPCS C1713 02.205.090 - SCREW BONE 4MM FULTHD 5MM 4.4MM 90MM SELF DRILL SELF TAP BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 02.205.095 SUP HCPCS C1713 02.205.095 - SCREW BONE 4MM FULTHD 5MM 4.4MM 95MM CANN LOCK DRILL SELF BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 02.205.100 SUP HCPCS C1713 02.205.100 - SCREW BONE FULTHD 5MM 100MM SELF TAP SELF DRILL CANN LOCK BOTH IP/OP $380.00 $281.00 $75.33 $385.98 $170.79 $170.79 $170.79 $170.79 $379.53 $379.53 $379.53 $79.10 $379.53 $379.53 $379.53 $379.53 $379.53 $79.10 $379.53 $385.98 $224.49 $379.53 $385.98 $379.53 $379.53 $285.00 $379.53 $379.53 $379.53 $189.77 $189.77 $300.59 $379.53 $303.62 $170.79 $75.33 N/A $220.40 $379.53 $227.72 $379.53 $79.09 $379.53 N/A N/A 02.205.105 SUP HCPCS C1713 02.205.105 - SCREW BONE FULTHD 5MM 105MM SELF TAP SELF DRILL CANN LOCK BOTH IP/OP $380.00 $281.00 $75.33 $385.98 $170.79 $170.79 $170.79 $170.79 $379.53 $379.53 $379.53 $79.10 $379.53 $379.53 $379.53 $379.53 $379.53 $79.10 $379.53 $385.98 $224.49 $379.53 $385.98 $379.53 $379.53 $285.00 $379.53 $379.53 $379.53 $189.77 $189.77 $300.59 $379.53 $303.62 $170.79 $75.33 N/A $220.40 $379.53 $227.72 $379.53 $79.09 $379.53 N/A N/A 02.205.110 SUP HCPCS C1713 02.205.110 - SCREW BONE 4MM FULTHD 5MM 4.4MM 110MM SELF DRILL SELF TAP BOTH IP/OP $380.00 $281.00 $75.33 $385.98 $170.79 $170.79 $170.79 $170.79 $379.53 $379.53 $379.53 $79.10 $379.53 $379.53 $379.53 $379.53 $379.53 $79.10 $379.53 $385.98 $224.49 $379.53 $385.98 $379.53 $379.53 $285.00 $379.53 $379.53 $379.53 $189.77 $189.77 $300.59 $379.53 $303.62 $170.79 $75.33 N/A $220.40 $379.53 $227.72 $379.53 $79.09 $379.53 N/A N/A 02.205.115 SUP HCPCS C1713 02.205.115 - SCREW BONE FULTHD 5MM 115MM SELF TAP TIP SELF DRILL CANN BOTH IP/OP $380.00 $281.00 $75.33 $385.98 $170.79 $170.79 $170.79 $170.79 $379.53 $379.53 $379.53 $79.10 $379.53 $379.53 $379.53 $379.53 $379.53 $79.10 $379.53 $385.98 $224.49 $379.53 $385.98 $379.53 $379.53 $285.00 $379.53 $379.53 $379.53 $189.77 $189.77 $300.59 $379.53 $303.62 $170.79 $75.33 N/A $220.40 $379.53 $227.72 $379.53 $79.09 $379.53 N/A N/A 02.205.120 SUP HCPCS C1713 02.205.120 - SCREW BONE FULTHD 5MM 120MM SELF TAP SELF DRILL CANN LOCK BOTH IP/OP $380.00 $281.00 $75.33 $385.98 $170.79 $170.79 $170.79 $170.79 $379.53 $379.53 $379.53 $79.10 $379.53 $379.53 $379.53 $379.53 $379.53 $79.10 $379.53 $385.98 $224.49 $379.53 $385.98 $379.53 $379.53 $285.00 $379.53 $379.53 $379.53 $189.77 $189.77 $300.59 $379.53 $303.62 $170.79 $75.33 N/A $220.40 $379.53 $227.72 $379.53 $79.09 $379.53 N/A N/A 02.205.125 SUP HCPCS C1713 02.205.125 - SCREW BONE FULTHD 5MM 125MM SELF TAP SELF DRILL CANN LOCK BOTH IP/OP $380.00 $281.00 $75.33 $385.98 $170.79 $170.79 $170.79 $170.79 $379.53 $379.53 $379.53 $79.10 $379.53 $379.53 $379.53 $379.53 $379.53 $79.10 $379.53 $385.98 $224.49 $379.53 $385.98 $379.53 $379.53 $285.00 $379.53 $379.53 $379.53 $189.77 $189.77 $300.59 $379.53 $303.62 $170.79 $75.33 N/A $220.40 $379.53 $227.72 $379.53 $79.09 $379.53 N/A N/A 02.205.130 SUP HCPCS C1713 02.205.130 - SCREW BONE FULTHD 5MM 130MM SELF TAP SELF DRILL CANN LOCK BOTH IP/OP $380.00 $281.00 $75.33 $385.98 $170.79 $170.79 $170.79 $170.79 $379.53 $379.53 $379.53 $79.10 $379.53 $379.53 $379.53 $379.53 $379.53 $79.10 $379.53 $385.98 $224.49 $379.53 $385.98 $379.53 $379.53 $285.00 $379.53 $379.53 $379.53 $189.77 $189.77 $300.59 $379.53 $303.62 $170.79 $75.33 N/A $220.40 $379.53 $227.72 $379.53 $79.09 $379.53 N/A N/A 02.205.135 SUP HCPCS C1713 02.205.135 - SCREW BONE FULTHD 5MM 135MM SELF TAP SELF DRILL CANN LOCK BOTH IP/OP $380.00 $281.00 $75.33 $385.98 $170.79 $170.79 $170.79 $170.79 $379.53 $379.53 $379.53 $79.10 $379.53 $379.53 $379.53 $379.53 $379.53 $79.10 $379.53 $385.98 $224.49 $379.53 $385.98 $379.53 $379.53 $285.00 $379.53 $379.53 $379.53 $189.77 $189.77 $300.59 $379.53 $303.62 $170.79 $75.33 N/A $220.40 $379.53 $227.72 $379.53 $79.09 $379.53 N/A N/A 02.205.140 SUP HCPCS C1713 02.205.140 - SCREW BONE FULTHD 5MM 140MM SELF TAP SELF DRILL CANN LOCK BOTH IP/OP $380.00 $281.00 $75.33 $385.98 $170.79 $170.79 $170.79 $170.79 $379.53 $379.53 $379.53 $79.10 $379.53 $379.53 $379.53 $379.53 $379.53 $79.10 $379.53 $385.98 $224.49 $379.53 $385.98 $379.53 $379.53 $285.00 $379.53 $379.53 $379.53 $189.77 $189.77 $300.59 $379.53 $303.62 $170.79 $75.33 N/A $220.40 $379.53 $227.72 $379.53 $79.09 $379.53 N/A N/A 02.205.145 SUP HCPCS C1713 02.205.145 - SCREW BONE 4MM FULTHD 5MM 4.4MM 145MM SELF DRILL SELF TAP BOTH IP/OP $380.00 $281.00 $75.33 $385.98 $170.79 $170.79 $170.79 $170.79 $379.53 $379.53 $379.53 $79.10 $379.53 $379.53 $379.53 $379.53 $379.53 $79.10 $379.53 $385.98 $224.49 $379.53 $385.98 $379.53 $379.53 $285.00 $379.53 $379.53 $379.53 $189.77 $189.77 $300.59 $379.53 $303.62 $170.79 $75.33 N/A $220.40 $379.53 $227.72 $379.53 $79.09 $379.53 N/A N/A 02.205.240 SUP HCPCS C1713 02.205.240 - SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 40MM SELF DRILL BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 02.205.245 SUP HCPCS C1713 02.205.245 - SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 45MM SELF DRILL BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 02.205.250 SUP HCPCS C1713 02.205.250 - SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 50MM SELF DRILL BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $132.67 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $195.68 $326.13 $67.97 $326.13 N/A N/A 02.205.255 SUP HCPCS C1713 02.205.255 - SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 55MM SELF DRILL BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $195.68 $326.13 $67.97 $326.13 N/A N/A 02.205.260 SUP HCPCS C1713 02.205.260 - SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 60MM SELF DRILL BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $132.67 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 02.205.265 SUP HCPCS C1713 02.205.265 - SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 65MM SELF DRILL BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $132.67 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 02.205.270 SUP HCPCS C1713 02.205.270 - SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 70MM SELF DRILL BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $195.68 $326.13 $67.97 $326.13 N/A N/A 02.205.275 SUP HCPCS C1713 02.205.275 - SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 75MM SELF DRILL BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $195.68 $326.13 $67.97 $326.13 N/A N/A 02.205.280 SUP HCPCS C1713 02.205.280 - SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 80MM SELF DRILL BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $132.67 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 02.205.285 SUP HCPCS C1713 02.205.285 - SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 85MM SELF DRILL BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 02.205.290 SUP HCPCS C1713 02.205.290 - SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 90MM SELF DRILL BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $195.68 $326.13 $67.97 $326.13 N/A N/A 02.205.295 SUP HCPCS C1713 02.205.295 - SCREW BONE 4MM PTHRD CONE HEXAGON 5MM 4.4MM 95MM SELF DRILL BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $195.68 $326.13 $67.97 $326.13 N/A N/A 02.206.214 SUP HCPCS C1713 02.206.214 - SCREW BONE T15 3.5MM 14MM LP HEAD STARDRIVE SELF TAP TIP BOTH IP/OP $67.50 $50.00 $13.39 $68.63 $30.37 $30.37 $30.37 $30.37 $67.48 $67.48 $67.48 $14.06 $67.48 $67.48 $67.48 $67.48 $67.48 $14.06 $67.48 $27.45 $39.91 $67.48 $68.63 $67.48 $67.48 $50.63 $67.48 $67.48 $67.48 $33.74 $33.74 $53.44 $67.48 $53.98 $30.37 $13.39 N/A $39.15 $67.48 $40.49 $67.48 $14.06 $67.48 N/A N/A 02.206.216 SUP HCPCS C1713 02.206.216 - SCREW BONE T15 3.5MM 16MM SELF TAP LP STARDRIVE STAINLESS BOTH IP/OP $67.50 $50.00 $13.39 $68.63 $30.37 $30.37 $30.37 $30.37 $67.48 $67.48 $67.48 $14.06 $67.48 $67.48 $67.48 $67.48 $67.48 $14.06 $67.48 $27.45 $39.91 $67.48 $68.63 $67.48 $67.48 $50.63 $67.48 $67.48 $67.48 $33.74 $33.74 $53.44 $67.48 $53.98 $30.37 $13.39 N/A $39.15 $67.48 $67.48 $67.48 $14.06 $67.48 N/A N/A 02.206.218 SUP HCPCS C1713 02.206.218 - SCREW BONE T15 LP 3.5MM 18MM SELF TAP STAINLESS STEEL BOTH IP/OP $67.50 $50.00 $13.39 $68.63 $30.37 $30.37 $30.37 $30.37 $67.48 $67.48 $67.48 $14.06 $67.48 $67.48 $67.48 $67.48 $67.48 $14.06 $67.48 $27.45 $39.91 $67.48 $68.63 $67.48 $67.48 $50.63 $67.48 $67.48 $67.48 $33.74 $33.74 $53.44 $67.48 $53.98 $30.37 $13.39 N/A $39.15 $67.48 $67.48 $67.48 $14.06 $67.48 N/A N/A 02.206.228 SUP HCPCS C1713 02.206.228 - SCREW BONE T15 3.5MM 28MM LP HEAD STARDRIVE SELF TAP TIP BOTH IP/OP $67.50 $50.00 $13.39 $68.63 $30.37 $30.37 $30.37 $30.37 $67.48 $67.48 $67.48 $14.06 $67.48 $67.48 $67.48 $67.48 $67.48 $14.06 $67.48 $27.45 $39.91 $67.48 $68.63 $67.48 $67.48 $50.63 $67.48 $67.48 $67.48 $33.74 $33.74 $53.44 $67.48 $53.98 $30.37 $13.39 N/A $39.15 $67.48 $67.48 $67.48 $14.06 $67.48 N/A N/A 02.206.230 SUP Custom 27203010 02.206.230 - SCREW BONE 3.5MM 30MM LCP SS MIDFT HINDFOOT TIB BOTH IP/OP $67.50 $50.00 $12.01 $68.63 $67.48 $67.48 $67.48 $67.48 $67.48 $67.48 $12.01 $67.48 $67.48 $50.08 $50.08 $52.01 $35.16 $14.06 $67.48 $27.45 $67.48 $67.48 $68.63 $67.48 $67.48 $50.63 $67.48 $67.48 $67.48 $33.74 $33.74 $53.44 $67.48 $53.98 $43.86 $67.48 N/A $39.15 $67.48 $40.49 $67.48 $67.48 $67.48 N/A N/A 02.206.232 SUP HCPCS C1713 02.206.232 - SCREW BONE 3.5MM 32MM SS T15 LP CLVCL FEM HUM TIB BOTH IP/OP $67.50 $50.00 $13.39 $68.63 $30.37 $30.37 $30.37 $30.37 $67.48 $67.48 $67.48 $14.06 $67.48 $67.48 $67.48 $67.48 $67.48 $14.06 $67.48 $68.63 $39.91 $67.48 $68.63 $67.48 $67.48 $50.63 $67.48 $67.48 $67.48 $33.74 $33.74 $53.44 $67.48 $53.98 $30.37 $13.39 N/A $39.15 $67.48 $67.48 $67.48 $14.06 $67.48 N/A N/A 02.206.238 SUP HCPCS C1713 02.206.238 - SCREW BONE T15 3.5MM 38MM LP HEAD STARDRIVE SELF TAP TIP BOTH IP/OP $67.50 $50.00 $13.39 $68.63 $30.37 $30.37 $30.37 $30.37 $67.48 $67.48 $67.48 $14.06 $67.48 $67.48 $67.48 $67.48 $67.48 $14.06 $67.48 $27.45 $39.91 $67.48 $68.63 $67.48 $67.48 $50.63 $67.48 $67.48 $67.48 $33.74 $33.74 $53.44 $67.48 $53.98 $30.37 $13.39 N/A $39.15 $67.48 $40.49 $67.48 $14.06 $67.48 N/A N/A 02.206.240 SUP HCPCS C1713 02.206.240 - SCREW BONE 3.5MM 40MM SELF TAP LP HEAD TI5 STARDRIVE LCP BOTH IP/OP $67.50 $50.00 $13.39 $68.63 $30.37 $30.37 $30.37 $30.37 $67.48 $67.48 $67.48 $14.06 $67.48 $67.48 $67.48 $67.48 $67.48 $14.06 $67.48 $68.63 $39.91 $67.48 $68.63 $67.48 $67.48 $50.63 $67.48 $67.48 $67.48 $33.74 $33.74 $53.44 $67.48 $53.98 $30.37 $13.39 N/A $39.15 $67.48 $40.49 $67.48 $14.06 $67.48 N/A N/A 02.206.265S SUP HCPCS C1713 02.206.265S - SCREW BN 3.5MM 65MM STRL LCP T15 STRDR RCS ST LOPRFL HD SS BOTH IP/OP $159.00 $118.00 $31.53 $161.55 $71.48 $71.48 $71.48 $71.48 $158.85 $158.85 $158.85 $33.11 $158.85 $158.85 $158.85 $158.85 $158.85 $33.11 $158.85 $64.62 $93.96 $158.85 $161.55 $158.85 $158.85 $119.25 $158.85 $158.85 $158.85 $79.43 $79.43 $125.81 $158.85 $127.08 $71.48 $31.53 N/A $92.22 $158.85 $158.85 $158.85 $33.10 $158.85 N/A N/A 02.206.270S SUP HCPCS C1713 02.206.270S - SCREW BN 3.5MM 70MM STRL LCP T15 STRDR RCS ST LOPRFL HD SS BOTH IP/OP $159.00 $118.00 $31.53 $161.55 $71.48 $71.48 $71.48 $71.48 $158.85 $158.85 $158.85 $33.11 $158.85 $158.85 $158.85 $158.85 $158.85 $33.11 $158.85 $64.62 $93.96 $158.85 $161.55 $158.85 $158.85 $119.25 $158.85 $158.85 $158.85 $79.43 $79.43 $125.81 $158.85 $127.08 $71.48 $31.53 N/A $92.22 $158.85 $158.85 $158.85 $33.10 $158.85 N/A N/A 02.206.280S SUP HCPCS C1713 02.206.280S - SCREW BN 3.5MM 80MM STRL LCP T15 STRDR RCS ST LOPRFL HD SS BOTH IP/OP $159.00 $118.00 $31.53 $161.55 $71.48 $71.48 $71.48 $71.48 $158.85 $158.85 $158.85 $33.11 $158.85 $158.85 $158.85 $158.85 $158.85 $33.11 $158.85 $64.62 $93.96 $158.85 $161.55 $158.85 $158.85 $119.25 $158.85 $158.85 $158.85 $79.43 $79.43 $125.81 $158.85 $127.08 $71.48 $31.53 N/A $92.22 $158.85 $158.85 $158.85 $33.10 $158.85 N/A N/A 02.206.285S SUP HCPCS C1713 02.206.285S - SCREW BN 3.5MM 85MM STRL LCP T15 STRDR RCS ST LOPRFL HD SS BOTH IP/OP $159.00 $118.00 $31.53 $161.55 $71.48 $71.48 $71.48 $71.48 $158.85 $158.85 $158.85 $33.11 $158.85 $158.85 $158.85 $158.85 $158.85 $33.11 $158.85 $64.62 $93.96 $158.85 $161.55 $158.85 $158.85 $119.25 $158.85 $158.85 $158.85 $79.43 $79.43 $125.81 $158.85 $127.08 $71.48 $31.53 N/A $92.22 $158.85 $158.85 $158.85 $33.10 $158.85 N/A N/A 02.206.290S SUP HCPCS C1713 02.206.290S - SCREW BN 3.5MM 90MM STRL LCP T15 STRDR RCS ST LOPRFL HD SS BOTH IP/OP $159.00 $118.00 $31.53 $161.55 $71.48 $71.48 $71.48 $71.48 $158.85 $158.85 $158.85 $33.11 $158.85 $158.85 $158.85 $158.85 $158.85 $33.11 $158.85 $161.55 $93.96 $158.85 $161.55 $158.85 $158.85 $119.25 $158.85 $158.85 $158.85 $79.43 $79.43 $125.81 $158.85 $127.08 $71.48 $31.53 N/A $92.22 $158.85 $158.85 $158.85 $33.10 $158.85 N/A N/A 02.207.001 SUP HCPCS C1769 02.207.001 - GUIDEWIRE ORTHOPEDIC FLUTE 2.8MM 450MM NONSTRL BOTH IP/OP $167.50 $124.00 $33.20 $170.13 $90.83 $90.83 $90.83 $90.83 $167.28 $167.28 $167.28 $34.87 $167.28 $124.16 $124.16 $128.94 $87.15 $34.86 $167.28 $68.05 $98.95 $167.28 $170.13 $167.28 $167.28 $125.63 $167.28 $167.28 $167.28 $83.64 $83.64 $132.49 $167.28 $133.82 $108.73 $33.20 N/A $97.15 $167.28 $167.28 $167.28 $34.86 $167.28 N/A N/A 02.207.020 SUP HCPCS C1713 02.207.020 - SCREW BONE 4MM FULTHD 7.3MM 5MM 20MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $222.45 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $328.10 $546.83 $113.96 $546.83 N/A N/A 02.207.025 SUP HCPCS C1713 02.207.025 - SCREW BONE 4MM FULTHD 7.3MM 5MM 25MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $222.45 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $328.10 $546.83 $113.96 $546.83 N/A N/A 02.207.030 SUP HCPCS C1713 02.207.030 - SCREW BONE 4MM FULTHD 7.3MM 5MM 30MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $222.45 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $328.10 $546.83 $113.96 $546.83 N/A N/A 02.207.035 SUP HCPCS C1713 02.207.035 - SCREW BONE 4MM FULTHD 7.3MM 5MM 35MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $222.45 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $328.10 $546.83 $113.96 $546.83 N/A N/A 02.207.040 SUP HCPCS C1713 02.207.040 - SCREW BONE 4MM FULTHD 7.3MM 5MM 40MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $556.13 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $328.10 $546.83 $113.96 $546.83 N/A N/A 02.207.045 SUP HCPCS C1713 02.207.045 - SCREW BONE 4MM FULTHD 7.3MM 5MM 45MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $222.45 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $328.10 $546.83 $113.96 $546.83 N/A N/A 02.207.050 SUP HCPCS C1713 02.207.050 - SCREW BONE 4MM FULTHD 7.3MM 5MM 50MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $222.45 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $328.10 $546.83 $113.96 $546.83 N/A N/A 02.207.055 SUP HCPCS C1713 02.207.055 - SCREW BONE 4MM FULTHD 7.3MM 5MM 55MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $222.45 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $328.10 $546.83 $113.96 $546.83 N/A N/A 02.207.060 SUP HCPCS C1713 02.207.060 - SCREW BONE 4MM FULTHD 7.3MM 5MM 60MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $222.45 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $546.83 $546.83 $113.96 $546.83 N/A N/A 02.207.065 SUP HCPCS C1713 02.207.065 - SCREW BONE 4MM FULTHD 7.3MM 5MM 65MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $556.13 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $546.83 $546.83 $113.96 $546.83 N/A N/A 02.207.070 SUP HCPCS C1713 02.207.070 - SCREW BONE 4MM FULTHD 7.3MM 5MM 70MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $556.13 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $546.83 $546.83 $113.96 $546.83 N/A N/A 02.207.075 SUP HCPCS C1713 02.207.075 - SCREW BONE 4MM FULTHD 7.3MM 5MM 75MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $556.13 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $546.83 $546.83 $113.96 $546.83 N/A N/A 02.207.080 SUP HCPCS C1713 02.207.080 - SCREW BONE 4MM FULTHD 7.3MM 5MM 80MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $222.45 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $546.83 $546.83 $113.96 $546.83 N/A N/A 02.207.085 SUP HCPCS C1713 02.207.085 - SCREW BONE 4MM FULTHD 7.3MM 5MM 85MM SLFTAP TIP SLFDRILL BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $222.45 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $546.83 $546.83 $113.96 $546.83 N/A N/A 02.207.090 SUP HCPCS C1713 02.207.090 - SCREW BONE 4MM FULTHD 7.3MM 5MM 90MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $222.45 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $546.83 $546.83 $113.96 $546.83 N/A N/A 02.207.095 SUP HCPCS C1713 02.207.095 - SCREW BONE 4MM FULTHD 7.3MM 5MM 95MM SELF DRILL SELF TAP BOTH IP/OP $547.00 $405.00 $108.53 $556.13 $246.07 $246.07 $246.07 $246.07 $546.83 $546.83 $546.83 $113.97 $546.83 $546.83 $546.83 $546.83 $546.83 $113.97 $546.83 $222.45 $323.45 $546.83 $556.13 $546.83 $546.83 $410.25 $546.83 $546.83 $546.83 $273.42 $273.42 $433.09 $546.83 $437.46 $246.07 $108.53 N/A $317.26 $546.83 $546.83 $546.83 $113.96 $546.83 N/A N/A 02.207.100 SUP HCPCS C1713 02.207.100 - SCREW BONE 4MM FULTHD 7.3MM 5MM 100MM SELF DRILL SELF TAP BOTH IP/OP $559.50 $414.00 $111.04 $568.98 $251.77 $251.77 $251.77 $251.77 $559.48 $559.48 $559.48 $116.61 $559.48 $559.48 $559.48 $559.48 $559.48 $116.60 $559.48 $227.59 $330.93 $559.48 $568.98 $559.48 $559.48 $419.63 $559.48 $559.48 $559.48 $279.74 $279.74 $443.11 $559.48 $447.58 $251.77 $111.04 N/A $324.51 $559.48 $335.69 $559.48 $116.60 $559.48 N/A N/A 02.207.105 SUP HCPCS C1713 02.207.105 - SCREW BONE 4MM FULTHD 7.3MM 5MM 105MM SELF DRILL SELF TAP BOTH IP/OP $559.50 $414.00 $111.04 $568.98 $251.77 $251.77 $251.77 $251.77 $559.48 $559.48 $559.48 $116.61 $559.48 $559.48 $559.48 $559.48 $559.48 $116.60 $559.48 $227.59 $330.93 $559.48 $568.98 $559.48 $559.48 $419.63 $559.48 $559.48 $559.48 $279.74 $279.74 $443.11 $559.48 $447.58 $251.77 $111.04 N/A $324.51 $559.48 $335.69 $559.48 $116.60 $559.48 N/A N/A 02.207.110 SUP HCPCS C1713 02.207.110 - SCREW BONE 4MM FULTHD 7.3MM 5MM 110MM SELF DRILL SELF TAP BOTH IP/OP $559.50 $414.00 $111.04 $568.98 $251.77 $251.77 $251.77 $251.77 $559.48 $559.48 $559.48 $116.61 $559.48 $559.48 $559.48 $559.48 $559.48 $116.60 $559.48 $568.98 $330.93 $559.48 $568.98 $559.48 $559.48 $419.63 $559.48 $559.48 $559.48 $279.74 $279.74 $443.11 $559.48 $447.58 $251.77 $111.04 N/A $324.51 $559.48 $335.69 $559.48 $116.60 $559.48 N/A N/A 02.207.115 SUP HCPCS C1713 02.207.115 - SCREW BONE 4MM FULTHD 7.3MM 5MM 115MM SELF DRILL SELF TAP BOTH IP/OP $559.50 $414.00 $111.04 $568.98 $251.77 $251.77 $251.77 $251.77 $559.48 $559.48 $559.48 $116.61 $559.48 $559.48 $559.48 $559.48 $559.48 $116.60 $559.48 $227.59 $330.93 $559.48 $568.98 $559.48 $559.48 $419.63 $559.48 $559.48 $559.48 $279.74 $279.74 $443.11 $559.48 $447.58 $251.77 $111.04 N/A $324.51 $559.48 $335.69 $559.48 $116.60 $559.48 N/A N/A 02.207.120 SUP HCPCS C1713 02.207.120 - SCREW BONE 4MM FULTHD 7.3MM 5MM 120MM SELF DRILL SELF TAP BOTH IP/OP $559.50 $414.00 $111.04 $568.98 $251.77 $251.77 $251.77 $251.77 $559.48 $559.48 $559.48 $116.61 $559.48 $559.48 $559.48 $559.48 $559.48 $116.60 $559.48 $227.59 $330.93 $559.48 $568.98 $559.48 $559.48 $419.63 $559.48 $559.48 $559.48 $279.74 $279.74 $443.11 $559.48 $447.58 $251.77 $111.04 N/A $324.51 $559.48 $335.69 $559.48 $116.60 $559.48 N/A N/A 02.207.125 SUP HCPCS C1713 02.207.125 - SCREW BONE 4MM FULTHD 7.3MM 5MM 125MM SELF DRILL SELF TAP BOTH IP/OP $559.50 $414.00 $111.04 $568.98 $251.77 $251.77 $251.77 $251.77 $559.48 $559.48 $559.48 $116.61 $559.48 $559.48 $559.48 $559.48 $559.48 $116.60 $559.48 $568.98 $330.93 $559.48 $568.98 $559.48 $559.48 $419.63 $559.48 $559.48 $559.48 $279.74 $279.74 $443.11 $559.48 $447.58 $251.77 $111.04 N/A $324.51 $559.48 $335.69 $559.48 $116.60 $559.48 N/A N/A 02.207.130 SUP HCPCS C1713 02.207.130 - SCREW BONE 4MM FULTHD 7.3MM 5MM 130MM SELF DRILL SELF TAP BOTH IP/OP $559.50 $414.00 $111.04 $568.98 $251.77 $251.77 $251.77 $251.77 $559.48 $559.48 $559.48 $116.61 $559.48 $559.48 $559.48 $559.48 $559.48 $116.60 $559.48 $227.59 $330.93 $559.48 $568.98 $559.48 $559.48 $419.63 $559.48 $559.48 $559.48 $279.74 $279.74 $443.11 $559.48 $447.58 $251.77 $111.04 N/A $324.51 $559.48 $335.69 $559.48 $116.60 $559.48 N/A N/A 02.207.135 SUP HCPCS C1713 02.207.135 - SCREW BONE 4MM FULTHD 7.3MM 5MM 135MM SELF DRILL SELF TAP BOTH IP/OP $559.50 $414.00 $111.04 $568.98 $251.77 $251.77 $251.77 $251.77 $559.48 $559.48 $559.48 $116.61 $559.48 $559.48 $559.48 $559.48 $559.48 $116.60 $559.48 $227.59 $330.93 $559.48 $568.98 $559.48 $559.48 $419.63 $559.48 $559.48 $559.48 $279.74 $279.74 $443.11 $559.48 $447.58 $251.77 $111.04 N/A $324.51 $559.48 $335.69 $559.48 $116.60 $559.48 N/A N/A 02.207.140 SUP HCPCS C1713 02.207.140 - SCREW BONE 4MM FULTHD 7.3MM 5MM 140MM SELF DRILL SELF TAP BOTH IP/OP $559.50 $414.00 $111.04 $568.98 $251.77 $251.77 $251.77 $251.77 $559.48 $559.48 $559.48 $116.61 $559.48 $559.48 $559.48 $559.48 $559.48 $116.60 $559.48 $227.59 $330.93 $559.48 $568.98 $559.48 $559.48 $419.63 $559.48 $559.48 $559.48 $279.74 $279.74 $443.11 $559.48 $447.58 $251.77 $111.04 N/A $324.51 $559.48 $559.48 $559.48 $116.60 $559.48 N/A N/A 02.207.145 SUP HCPCS C1713 02.207.145 - SCREW BONE 4MM FULTHD 7.3MM 5MM 145MM SELF DRILL SELF TAP BOTH IP/OP $559.50 $414.00 $111.04 $568.98 $251.77 $251.77 $251.77 $251.77 $559.48 $559.48 $559.48 $116.61 $559.48 $559.48 $559.48 $559.48 $559.48 $116.60 $559.48 $227.59 $330.93 $559.48 $568.98 $559.48 $559.48 $419.63 $559.48 $559.48 $559.48 $279.74 $279.74 $443.11 $559.48 $447.58 $251.77 $111.04 N/A $324.51 $559.48 $335.69 $559.48 $116.60 $559.48 N/A N/A 02.207.250 SUP HCPCS C1713 02.207.250 - SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 50MM SELF DRILL BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $198.43 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $292.67 $487.78 $101.65 $487.78 N/A N/A 02.207.255 SUP HCPCS C1713 02.207.255 - SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 55MM SELF DRILL BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $198.43 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $292.67 $487.78 $101.65 $487.78 N/A N/A 02.207.260 SUP HCPCS C1713 02.207.260 - SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 60MM SELF DRILL BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $198.43 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $292.67 $487.78 $101.65 $487.78 N/A N/A 02.207.265 SUP HCPCS C1713 02.207.265 - SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 65MM SELF DRILL BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $198.43 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $292.67 $487.78 $101.65 $487.78 N/A N/A 02.207.270 SUP HCPCS C1713 02.207.270 - SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 70MM SELF DRILL BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $198.43 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $487.78 $487.78 $101.65 $487.78 N/A N/A 02.207.275 SUP HCPCS C1713 02.207.275 - SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 75MM SELF DRILL BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $198.43 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $292.67 $487.78 $101.65 $487.78 N/A N/A 02.207.280 SUP HCPCS C1713 02.207.280 - SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 80MM SELF DRILL BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $198.43 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $292.67 $487.78 $101.65 $487.78 N/A N/A 02.207.285 SUP HCPCS C1713 02.207.285 - SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 85MM SELF DRILL BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $496.08 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $292.67 $487.78 $101.65 $487.78 N/A N/A 02.207.290 SUP HCPCS C1713 02.207.290 - SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 90MM SELF DRILL BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $198.43 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $487.78 $487.78 $101.65 $487.78 N/A N/A 02.207.295 SUP HCPCS C1713 02.207.295 - SCREW BONE 4MM FULTHD CONE HEXAGON 7.3MM 5MM 95MM SELF DRILL BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $198.43 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $292.67 $487.78 $101.65 $487.78 N/A N/A 02.207.450 SUP HCPCS C1713 02.207.450 - SCREW BONE CONICAL PTHRD 7.3MM 5MM 50MM SELF TAP SELF DRILL BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $496.08 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $292.67 $487.78 $101.65 $487.78 N/A N/A 02.207.455 SUP HCPCS C1713 02.207.455 - SCREW BONE 95D PTHRD CONE 7.3MM 5MM 55MM SELF DRILL SELF TAP BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $198.43 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $487.78 $487.78 $101.65 $487.78 N/A N/A 02.207.460 SUP HCPCS C1713 02.207.460 - SCREW BONE 95D PTHRD CONE 7.3MM 5MM 60MM SELF DRILL SELF TAP BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $198.43 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $292.67 $487.78 $101.65 $487.78 N/A N/A 02.207.465 SUP HCPCS C1713 02.207.465 - SCREW BONE 95D PTHRD CONE 7.3MM 5MM 65MM SELF DRILL SELF TAP BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $198.43 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $292.67 $487.78 $101.65 $487.78 N/A N/A 02.207.470 SUP HCPCS C1713 02.207.470 - SCREW BONE 95D PTHRD CONE 7.3MM 5MM 70MM SELF DRILL SELF TAP BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $198.43 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $487.78 $487.78 $487.78 $487.78 N/A N/A 02.207.475 SUP HCPCS C1713 02.207.475 - SCREW BONE 95D PTHRD CONE 7.3MM 5MM 75MM SELF DRILL SELF TAP BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $198.43 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $487.78 $487.78 $101.65 $487.78 N/A N/A 02.207.480 SUP HCPCS C1713 02.207.480 - SCREW BONE 95D PTHRD CONE 7.3MM 5MM 80MM SELF DRILL SELF TAP BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $496.08 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $292.67 $487.78 $101.65 $487.78 N/A N/A 02.207.485 SUP HCPCS C1713 02.207.485 - SCREW BONE 95D PTHRD CONE 7.3MM 5MM 85MM SELF DRILL SELF TAP BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $496.08 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $292.67 $487.78 $101.65 $487.78 N/A N/A 02.207.490 SUP HCPCS C1713 02.207.490 - SCREW BONE 95D PTHRD CONE 7.3MM 5MM 90MM SELF DRILL SELF TAP BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $496.08 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $292.67 $487.78 $101.65 $487.78 N/A N/A 02.207.495 SUP HCPCS C1713 02.207.495 - SCREW BONE 95D PTHRD CONE 7.3MM 5MM 95MM SELF DRILL SELF TAP BOTH IP/OP $488.00 $361.00 $96.81 $496.08 $219.50 $219.50 $219.50 $219.50 $487.78 $487.78 $487.78 $101.67 $487.78 $487.78 $487.78 $487.78 $487.78 $101.66 $487.78 $496.08 $288.52 $487.78 $496.08 $487.78 $487.78 $366.00 $487.78 $487.78 $487.78 $243.89 $243.89 $386.32 $487.78 $390.22 $219.50 $96.81 N/A $283.04 $487.78 $487.78 $487.78 $101.65 $487.78 N/A N/A 02.207.500 SUP HCPCS C1713 02.207.500 - SCREW BONE PTHRD 7.3MM 100MM CANN SMOOTH CONICAL HEAD BOTH IP/OP $519.00 $384.00 $102.95 $527.53 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $527.53 $306.81 $518.70 $527.53 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 02.207.505 SUP HCPCS C1713 02.207.505 - SCREW BONE PTHRD 7.3MM 105MM CANN SMOOTH CONICAL HEAD BOTH IP/OP $519.00 $384.00 $102.95 $527.53 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $211.01 $306.81 $518.70 $527.53 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $518.70 $518.70 $108.10 $518.70 N/A N/A 02.207.510 SUP HCPCS C1713 02.207.510 - SCREW BONE PTHRD 7.3MM 110MM CANN SMOOTH CONICAL HEAD BOTH IP/OP $519.00 $384.00 $102.95 $527.53 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $211.01 $306.81 $518.70 $527.53 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 02.207.515 SUP HCPCS C1713 02.207.515 - SCREW BONE PTHRD 7.3MM 115MM CANN SMOOTH CONICAL HEAD BOTH IP/OP $519.00 $384.00 $102.95 $527.53 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $211.01 $306.81 $518.70 $527.53 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 02.207.520 SUP HCPCS C1713 02.207.520 - SCREW BONE PTHRD 7.3MM 120MM CANN SMOOTH CONICAL HEAD BOTH IP/OP $519.00 $384.00 $102.95 $527.53 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $211.01 $306.81 $518.70 $527.53 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 02.207.525 SUP HCPCS C1713 02.207.525 - SCREW BONE PTHRD 7.3MM 125MM CANN SMOOTH CONICAL HEAD BOTH IP/OP $519.00 $384.00 $102.95 $527.53 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $211.01 $306.81 $518.70 $527.53 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 02.207.530 SUP HCPCS C1713 02.207.530 - SCREW BONE PTHRD 7.3MM 130MM CANN SMOOTH CONICAL HEAD BOTH IP/OP $519.00 $384.00 $102.95 $527.53 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $527.53 $306.81 $518.70 $527.53 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 02.207.535 SUP HCPCS C1713 02.207.535 - SCREW BONE PTHRD 7.3MM 135MM CANN SMOOTH CONICAL HEAD BOTH IP/OP $519.00 $384.00 $102.95 $527.53 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $527.53 $306.81 $518.70 $527.53 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $518.70 $518.70 $108.10 $518.70 N/A N/A 02.207.540 SUP HCPCS C1713 02.207.540 - SCREW BONE PTHRD 7.3MM 140MM CANN SMOOTH CONICAL HEAD BOTH IP/OP $519.00 $384.00 $102.95 $527.53 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $211.01 $306.81 $518.70 $527.53 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 02.207.545 SUP HCPCS C1713 02.207.545 - SCREW BONE PTHRD 7.3MM 145MM CANN SMOOTH CONICAL HEAD BOTH IP/OP $519.00 $384.00 $102.95 $527.53 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $211.01 $306.81 $518.70 $527.53 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 02.207.600 SUP HCPCS C1713 02.207.600 - SCREW BONE 7.3MM 45MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $570.40 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $560.88 $560.88 $116.89 $560.88 N/A N/A 02.207.601 SUP HCPCS C1713 02.207.601 - SCREW BONE 7.3MM 50MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $570.40 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $560.88 $560.88 $116.89 $560.88 N/A N/A 02.207.602 SUP HCPCS C1713 02.207.602 - SCREW BONE 7.3MM 55MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $570.40 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $560.88 $560.88 $116.89 $560.88 N/A N/A 02.207.603 SUP HCPCS C1713 02.207.603 - SCREW BONE 7.3MM 60MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $570.40 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.604 SUP HCPCS C1713 02.207.604 - SCREW BONE 7.3MM 65MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $570.40 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.605 SUP HCPCS C1713 02.207.605 - SCREW BONE 7.3MM 70MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $570.40 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.606 SUP HCPCS C1713 02.207.606 - SCREW BONE 7.3MM 75MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $560.88 $560.88 $116.89 $560.88 N/A N/A 02.207.607 SUP HCPCS C1713 02.207.607 - SCREW BONE 7.3MM 80MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $560.88 $560.88 $116.89 $560.88 N/A N/A 02.207.608 SUP HCPCS C1713 02.207.608 - SCREW BONE 7.3MM 85MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $570.40 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.609 SUP HCPCS C1713 02.207.609 - SCREW BONE 7.3MM 90MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $570.40 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.610 SUP HCPCS C1713 02.207.610 - SCREW BONE 7.3MM 95MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.611 SUP HCPCS C1713 02.207.611 - SCREW BONE 7.3MM 100MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $560.88 $560.88 $116.89 $560.88 N/A N/A 02.207.612 SUP HCPCS C1713 02.207.612 - SCREW BONE 7.3MM 105MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $560.88 $560.88 $116.89 $560.88 N/A N/A 02.207.613 SUP HCPCS C1713 02.207.613 - SCREW BONE 7.3MM 110MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.614 SUP HCPCS C1713 02.207.614 - SCREW BONE 7.3MM 115MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.615 SUP HCPCS C1713 02.207.615 - SCREW BONE 7.3MM 120MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.616 SUP HCPCS C1713 02.207.616 - SCREW BONE 7.3MM 125MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.617 SUP HCPCS C1713 02.207.617 - SCREW BONE 7.3MM 103MM 10MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.618 SUP HCPCS C1713 02.207.618 - SCREW BONE 7.3MM 45MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.619 SUP HCPCS C1713 02.207.619 - SCREW BONE 7.3MM 50MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $570.40 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.620 SUP HCPCS C1713 02.207.620 - SCREW BONE 7.3MM 55MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.621 SUP HCPCS C1713 02.207.621 - SCREW BONE 7.3MM 60MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.622 SUP HCPCS C1713 02.207.622 - SCREW BONE 7.3MM 65MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.623 SUP HCPCS C1713 02.207.623 - SCREW BONE 7.3MM 70MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.624 SUP HCPCS C1713 02.207.624 - SCREW BONE 7.3MM 75MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.625 SUP HCPCS C1713 02.207.625 - SCREW BONE 7.3MM 80MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $570.40 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.626 SUP HCPCS C1713 02.207.626 - SCREW BONE 7.3MM 85MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $570.40 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.627 SUP HCPCS C1713 02.207.627 - SCREW BONE 7.3MM 90MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $560.88 $560.88 $116.89 $560.88 N/A N/A 02.207.628 SUP HCPCS C1713 02.207.628 - SCREW BONE 7.3MM 95MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $570.40 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $560.88 $560.88 $116.89 $560.88 N/A N/A 02.207.629 SUP HCPCS C1713 02.207.629 - SCREW BONE 7.3MM 100MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $570.40 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.630 SUP HCPCS C1713 02.207.630 - SCREW BONE 7.3MM 105MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.631 SUP HCPCS C1713 02.207.631 - SCREW BONE 7.3MM 110MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.632 SUP HCPCS C1713 02.207.632 - SCREW BONE 7.3MM 115MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.633 SUP HCPCS C1713 02.207.633 - SCREW BONE 7.3MM 120MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.207.634 SUP HCPCS C1713 02.207.634 - SCREW BONE 7.3MM 125MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $560.88 $560.88 $116.89 $560.88 N/A N/A 02.207.635 SUP HCPCS C1713 02.207.635 - SCREW BONE 7.3MM 130MM 20MM CANN THREADED SCFE STAINLESS BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $570.40 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $560.88 $560.88 $116.89 $560.88 N/A N/A 02.207.636 SUP Custom 27803010 02.207.636 - WASHER ORTHOPEDIC OVAL 1MM STAINLESS STEEL FEMUR NONSTRL BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $72.74 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 02.207.637 SUP Custom 27803010 02.207.637 - WASHER ORTHOPEDIC OVAL 2MM STAINLESS STEEL FEMUR NONSTRL BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $72.74 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 02.210.078 SUP HCPCS C1713 02.210.078 - PIN FIX 1.8MM 8MM T8 STARDRIVE RECESS VAR ANG LOCKING BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.080 SUP HCPCS C1713 02.210.080 - PIN FIX 1.8MM 10MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $254.43 $254.43 $53.02 $254.43 N/A N/A 02.210.082 SUP HCPCS C1713 02.210.082 - PIN FIX 1.8MM 12MM T8 STARDRIVE RECESS BUTTRESS VAR ANG BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.084 SUP HCPCS C1713 02.210.084 - PIN FIX 1.8MM 14MM T8 STARDRIVE RECESS BUTTRESS VAR ANG BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.086 SUP Custom 27203010 02.210.086 - PIN FIX 1.8MM 16MM T8 STARDRIVE RECESS BUTTRESS VAR ANG BOTH IP/OP $254.50 $188.00 $45.29 $258.75 $254.43 $254.43 $254.43 $254.43 $254.43 $254.43 $45.29 $254.43 $254.43 $188.84 $188.84 $196.11 $132.56 $53.03 $254.43 $103.50 $254.43 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $165.38 $254.43 N/A $147.61 $254.43 $152.66 $254.43 $254.43 $254.43 N/A N/A 02.210.088 SUP Custom 27203010 02.210.088 - PIN FIX 1.8MM 18MM T8 STARDRIVE RECESS BUTTRESS VAR ANG BOTH IP/OP $254.50 $188.00 $45.29 $258.75 $254.43 $254.43 $254.43 $254.43 $254.43 $254.43 $45.29 $254.43 $254.43 $188.84 $188.84 $196.11 $132.56 $53.03 $254.43 $103.50 $254.43 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $165.38 $254.43 N/A $147.61 $254.43 $152.66 $254.43 $254.43 $254.43 N/A N/A 02.210.090 SUP HCPCS C1713 02.210.090 - PIN FIX 1.8MM 20MM T8 STARDRIVE RECESS BUTTRESS VAR ANG BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.092 SUP Custom 27203010 02.210.092 - PIN FIX 1.8MM 22MM T8 STARDRIVE RECESS BUTTRESS VAR ANG BOTH IP/OP $254.50 $188.00 $45.29 $258.75 $254.43 $254.43 $254.43 $254.43 $254.43 $254.43 $45.29 $254.43 $254.43 $188.84 $188.84 $196.11 $132.56 $53.03 $254.43 $103.50 $254.43 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $165.38 $254.43 N/A $147.61 $254.43 $152.66 $254.43 $254.43 $254.43 N/A N/A 02.210.094 SUP HCPCS C1713 02.210.094 - PIN FIX 1.8MM 24MM T8 STARDRIVE RECESS BUTTRESS VAR ANG BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.096 SUP HCPCS C1713 02.210.096 - PIN FIX 1.8MM 26MM T8 STARDRIVE RECESS BUTTRESS VAR ANG BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $254.43 $254.43 $53.02 $254.43 N/A N/A 02.210.098 SUP HCPCS C1713 02.210.098 - PIN FIX 1.8MM 28MM T8 STARDRIVE RECESS BUTTRESS VAR ANG BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.100 SUP HCPCS C1713 02.210.100 - PIN FIX 1.8MM 30MM T8 STARDRIVE RECESS VAR ANG LOCKING BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.107 SUP HCPCS C1713 02.210.107 - SCREW BONE 2.4MM 7MM STARDRIVE VAR ANG SLFTAP LOCKING LCP BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.108 SUP HCPCS C1713 02.210.108 - SCREW BONE T8 2.4MM 8MM VAR ANG SELF TAP THREAD STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $254.43 $254.43 N/A N/A 02.210.109 SUP HCPCS C1713 02.210.109 - SCREW BONE 2.4MM 9MM STARDRIVE VAR ANG SLFTAP LOCKING LCP BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.110 SUP HCPCS C1713 02.210.110 - SCREW BONE T8 2.4MM 10MM VAR ANG SELF TAP THREAD STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $254.43 $254.43 N/A N/A 02.210.111 SUP HCPCS C1713 02.210.111 - SCREW BONE 2.4MM 11MM STARDRIVE VAR ANG SLFTAP LOCKING LCP BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.112 SUP HCPCS C1713 02.210.112 - SCREW BONE T8 2.4MM 12MM VAR ANG SELF TAP THREAD STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $254.43 $254.43 $53.02 $254.43 N/A N/A 02.210.113 SUP HCPCS C1713 02.210.113 - SCREW BONE 2.4MM 13MM STARDRIVE VAR ANG SLFTAP LOCKING LCP BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $254.43 $254.43 $53.02 $254.43 N/A N/A 02.210.114 SUP HCPCS C1713 02.210.114 - SCREW BONE T8 2.4MM 14MM VAR ANG SELF TAP THREAD STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $254.43 $254.43 $53.02 $254.43 N/A N/A 02.210.116 SUP HCPCS C1713 02.210.116 - SCREW BONE T8 2.4MM 16MM VAR ANG SELF TAP THREAD STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $254.43 $254.43 $53.02 $254.43 N/A N/A 02.210.118 SUP HCPCS C1713 02.210.118 - SCREW BONE T8 2.4MM 18MM VAR ANG SELF TAP THREAD STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $254.43 $254.43 $53.02 $254.43 N/A N/A 02.210.120 SUP HCPCS C1713 02.210.120 - SCREW BONE 2.4MM 20MM T8 STARDRIVE RECESS LOCKING VAR ANG BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $254.43 $254.43 $53.02 $254.43 N/A N/A 02.210.122 SUP HCPCS C1713 02.210.122 - SCREW BONE 2.4MM 22MM VAR ANG SELF TAP THREAD T8 STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $254.43 $254.43 $53.02 $254.43 N/A N/A 02.210.124 SUP HCPCS C1713 02.210.124 - SCREW BONE T8 2.4MM 24MM VAR ANG SELF TAP THREAD STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $254.43 $254.43 $254.43 $254.43 N/A N/A 02.210.126 SUP HCPCS C1713 02.210.126 - SCREW BONE T8 2.4MM 26MM VAR ANG SELF TAP THREAD STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $254.43 $254.43 N/A N/A 02.210.128 SUP HCPCS C1713 02.210.128 - SCREW BONE T8 2.4MM 28MM VAR ANG SELF TAP THREAD STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $254.43 $254.43 $254.43 $254.43 N/A N/A 02.210.130 SUP HCPCS C1713 02.210.130 - SCREW BONE T8 2.4MM 30MM VAR ANG SELF TAP THREAD STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.132 SUP HCPCS C1713 02.210.132 - SCREW BONE 2.4MM 32MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $254.43 $254.43 $53.02 $254.43 N/A N/A 02.210.134 SUP HCPCS C1713 02.210.134 - SCREW BONE 2.4MM 34MM SLFTAP LOCKING VAR ANG T8 STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.136 SUP HCPCS C1713 02.210.136 - SCREW BONE 2.4MM 36MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.138 SUP HCPCS C1713 02.210.138 - SCREW BONE 2.4MM 38MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.140 SUP HCPCS C1713 02.210.140 - SCREW BONE 2.4MM 40MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.142 SUP HCPCS C1713 02.210.142 - SCREW BONE 2.4MM 42MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.144 SUP HCPCS C1713 02.210.144 - SCREW BONE 2.4MM 44MM SLFTAP LOCKING VAR ANG T8 STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.146 SUP HCPCS C1713 02.210.146 - SCREW BONE 2.4MM 46MM SLFTAP LOCKING VAR ANG T8 STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.148 SUP HCPCS C1713 02.210.148 - SCREW BONE 2.4MM 48MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.150 SUP HCPCS C1713 02.210.150 - SCREW BONE 2.4MM 50MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.152 SUP HCPCS C1713 02.210.152 - SCREW BONE 2.4MM 52MM SLFTAP LOCKING VAR ANG T8 STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.154 SUP HCPCS C1713 02.210.154 - SCREW BONE 2.4MM 54MM SLFTAP LOCKING VAR ANG T8 STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $254.43 $254.43 $53.02 $254.43 N/A N/A 02.210.156 SUP HCPCS C1713 02.210.156 - SCREW BONE 2.4MM 56MM SLFTAP LOCKING VAR ANG T8 STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $103.50 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.158 SUP HCPCS C1713 02.210.158 - SCREW BONE 2.4MM 58MM STARDRIVE SLFTAP LOCKING VAR ANG BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.160 SUP HCPCS C1713 02.210.160 - SCREW BONE 2.4MM 60MM STARDRIVE SLFTAP LOCKING VAR ANG BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 02.210.942 SUP HCPCS C1713 02.210.942 - SCREW BONE T8 2.4MM 42MM SLFTAP STARDRIVE RECESS STAINLESS BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $62.82 $104.70 $21.82 $104.70 N/A N/A 02.210.944 SUP HCPCS C1713 02.210.944 - SCREW BONE 2.4MM 44MM T8 STARDRIVE RECESS SLFTAP LCP BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $62.82 $104.70 $21.82 $104.70 N/A N/A 02.210.946 SUP HCPCS C1713 02.210.946 - SCREW BONE 2.4MM 46MM T8 STARDRIVE RECESS SLFTAP LCP BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $62.82 $104.70 $21.82 $104.70 N/A N/A 02.210.948 SUP HCPCS C1713 02.210.948 - SCREW BONE 2.4MM 48MM T8 STARDRIVE RECESS SLFTAP LCP BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $62.82 $104.70 $21.82 $104.70 N/A N/A 02.210.950 SUP HCPCS C1713 02.210.950 - SCREW BONE 2.4MM 50MM T8 STARDRIVE RECESS SLFTAP LCP BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 02.210.952 SUP HCPCS C1713 02.210.952 - SCREW BONE T8 2.4MM 52MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $62.82 $104.70 $21.82 $104.70 N/A N/A 02.210.954 SUP HCPCS C1713 02.210.954 - SCREW BONE 2.4MM 54MM T8 STARDRIVE RECESS SLFTAP LCP BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $62.82 $104.70 $21.82 $104.70 N/A N/A 02.210.956 SUP HCPCS C1713 02.210.956 - SCREW BONE T8 2.4MM 56MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 02.210.958 SUP HCPCS C1713 02.210.958 - SCREW BONE 2.4MM 58MM T8 STARDRIVE SLFTAP STAINLESS STEEL BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $62.82 $104.70 $21.82 $104.70 N/A N/A 02.210.960 SUP HCPCS C1713 02.210.960 - SCREW BONE 2.4MM 60MM T8 STARDRIVE SLFTAP STAINLESS STEEL BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $106.48 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $62.82 $104.70 $21.82 $104.70 N/A N/A 02.211.008 SUP HCPCS C1713 02.211.008 - SCREW BONE 2.7MM 8MM T8 STARDRIVE RECESS VAR ANG SLFTAP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $271.63 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $160.25 $267.08 $55.66 $267.08 N/A N/A 02.211.009 SUP HCPCS C1713 02.211.009 - SCREW BONE 2.7MM 9MM T8 STARDRIVE RECESS VAR ANG SLFTAP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $271.63 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $160.25 $267.08 $55.66 $267.08 N/A N/A 02.211.010 SUP HCPCS C1713 02.211.010 - SCREW BONE T8 2.7MM 10MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $271.63 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.011 SUP HCPCS C1713 02.211.011 - SCREW BONE 2.7MM 11MM T8 STARDRIVE RECESS VAR ANG SLFTAP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $271.63 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.012 SUP HCPCS C1713 02.211.012 - SCREW BONE T8 2.7MM 12MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.013 SUP HCPCS C1713 02.211.013 - SCREW BONE 2.7MM 13MM T8 STARDRIVE RECESS VAR ANG SLFTAP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.014 SUP HCPCS C1713 02.211.014 - SCREW BONE T8 2.7MM 14MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.016 SUP HCPCS C1713 02.211.016 - SCREW BONE T8 2.7MM 16MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $271.63 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.018 SUP HCPCS C1713 02.211.018 - SCREW BONE T8 2.7MM 18MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.020 SUP HCPCS C1713 02.211.020 - SCREW BONE T8 2.7MM 20MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.022 SUP HCPCS C1713 02.211.022 - SCREW BONE T8 2.7MM 22MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.024 SUP HCPCS C1713 02.211.024 - SCREW BONE T8 2.7MM 24MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.026 SUP HCPCS C1713 02.211.026 - SCREW BONE T8 2.7MM 26MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.028 SUP HCPCS C1713 02.211.028 - SCREW BONE T8 2.7MM 28MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.030 SUP HCPCS C1713 02.211.030 - SCREW BONE 2.7MM 30MM LOCK VAR ANG SELF TAP T8 STARDRIVE BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.032 SUP HCPCS C1713 02.211.032 - SCREW BONE T8 2.7MM 32MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.034 SUP HCPCS C1713 02.211.034 - SCREW BONE T8 2.7MM 34MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.036 SUP HCPCS C1713 02.211.036 - SCREW BONE 2.7MM 36MM LOCK VAR ANG SELF TAP T8 STARDRIVE BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.038 SUP HCPCS C1713 02.211.038 - SCREW BONE T8 2.7MM 38MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.040 SUP HCPCS C1713 02.211.040 - SCREW BONE T8 2.7MM 40MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.042 SUP HCPCS C1713 02.211.042 - SCREW BONE 2.7MM 42MM VAR ANG SELF TAP T8 STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.044 SUP HCPCS C1713 02.211.044 - SCREW BONE T8 2.7MM 44MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.046 SUP HCPCS C1713 02.211.046 - SCREW BONE T8 2.7MM 46MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.048 SUP HCPCS C1713 02.211.048 - SCREW BONE T8 2.7MM 48MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.050 SUP HCPCS C1713 02.211.050 - SCREW BONE T8 2.7MM 50MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.052 SUP HCPCS C1713 02.211.052 - SCREW BONE T8 2.7MM 52MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.054 SUP HCPCS C1713 02.211.054 - SCREW BONE T8 2.7MM 54MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.056 SUP HCPCS C1713 02.211.056 - SCREW BONE T8 2.7MM 56MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.058 SUP HCPCS C1713 02.211.058 - SCREW BONE T8 2.7MM 58MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.060 SUP HCPCS C1713 02.211.060 - SCREW BONE T8 2.7MM 60MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $267.50 $198.00 $53.01 $271.63 $120.19 $120.19 $120.19 $120.19 $267.08 $267.08 $267.08 $55.67 $267.08 $267.08 $267.08 $267.08 $267.08 $55.66 $267.08 $108.65 $157.98 $267.08 $271.63 $267.08 $267.08 $200.63 $267.08 $267.08 $267.08 $133.54 $133.54 $211.53 $267.08 $213.66 $120.19 $53.01 N/A $155.15 $267.08 $267.08 $267.08 $55.66 $267.08 N/A N/A 02.211.201 SUP HCPCS C1713 02.211.201 - PLATE BN XS X 24MM NS LCP VA LCK LOPRFL CMPR WRE HL SS BOTH IP/OP "$1,773.00" "$1,312.00" $351.81 "$1,802.70" $797.66 $797.66 $797.66 $797.66 "$1,772.58" "$1,772.58" "$1,772.58" $369.45 "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" $369.43 "$1,772.58" $721.08 "$1,048.48" "$1,772.58" "$1,802.70" "$1,772.58" "$1,772.58" "$1,329.75" "$1,772.58" "$1,772.58" "$1,772.58" $886.29 $886.29 "$1,403.88" "$1,772.58" "$1,418.06" $797.66 $351.81 N/A "$1,028.34" "$1,772.58" "$1,063.55" "$1,772.58" $369.41 "$1,772.58" N/A N/A 02.211.202 SUP HCPCS C1713 02.211.202 - PLATE BN SM X 27MM NS LCP VA LCK LOPRFL CMPR WRE HL SS BOTH IP/OP "$1,773.00" "$1,312.00" $351.81 "$1,802.70" $797.66 $797.66 $797.66 $797.66 "$1,772.58" "$1,772.58" "$1,772.58" $369.45 "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" $369.43 "$1,772.58" $721.08 "$1,048.48" "$1,772.58" "$1,802.70" "$1,772.58" "$1,772.58" "$1,329.75" "$1,772.58" "$1,772.58" "$1,772.58" $886.29 $886.29 "$1,403.88" "$1,772.58" "$1,418.06" $797.66 $351.81 N/A "$1,028.34" "$1,772.58" "$1,772.58" "$1,772.58" $369.41 "$1,772.58" N/A N/A 02.211.203 SUP HCPCS C1713 02.211.203 - PLATE BN MED X 32MM NS LCP VA LCK LOPRFL CMPR WRE HL SS BOTH IP/OP "$1,773.00" "$1,312.00" $351.81 "$1,802.70" $797.66 $797.66 $797.66 $797.66 "$1,772.58" "$1,772.58" "$1,772.58" $369.45 "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" "$1,772.58" $369.43 "$1,772.58" $721.08 "$1,048.48" "$1,772.58" "$1,802.70" "$1,772.58" "$1,772.58" "$1,329.75" "$1,772.58" "$1,772.58" "$1,772.58" $886.29 $886.29 "$1,403.88" "$1,772.58" "$1,418.06" $797.66 $351.81 N/A "$1,028.34" "$1,772.58" "$1,063.55" "$1,772.58" $369.41 "$1,772.58" N/A N/A 02.211.204 SUP HCPCS C1713 02.211.204 - PLATE BN LG X 36MM NS LCP VA LCK LOPRFL CMPR WRE HL SS BOTH IP/OP "$1,822.00" "$1,348.00" $361.58 "$1,852.75" $819.80 $819.80 $819.80 $819.80 "$1,821.78" "$1,821.78" "$1,821.78" $379.70 "$1,821.78" "$1,821.78" "$1,821.78" "$1,821.78" "$1,821.78" $379.68 "$1,821.78" $741.10 "$1,077.58" "$1,821.78" "$1,852.75" "$1,821.78" "$1,821.78" "$1,366.50" "$1,821.78" "$1,821.78" "$1,821.78" $910.89 $910.89 "$1,442.85" "$1,821.78" "$1,457.42" $819.80 $361.58 N/A "$1,056.76" "$1,821.78" "$1,093.07" "$1,821.78" $379.66 "$1,821.78" N/A N/A 02.211.210 SUP HCPCS C1713 02.211.210 - PLATE BONE LP OPENING WEDGE LOCKING VAR ANG ANATOMIC LCP BOTH IP/OP "$1,778.50" "$1,316.00" $352.93 "$1,808.43" $800.19 $800.19 $800.19 $800.19 "$1,778.20" "$1,778.20" "$1,778.20" $370.62 "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" $370.60 "$1,778.20" $723.37 "$1,051.81" "$1,778.20" "$1,808.43" "$1,778.20" "$1,778.20" "$1,333.88" "$1,778.20" "$1,778.20" "$1,778.20" $889.10 $889.10 "$1,408.33" "$1,778.20" "$1,422.56" $800.19 $352.93 N/A "$1,031.53" "$1,778.20" "$1,066.92" "$1,778.20" $370.58 "$1,778.20" N/A N/A 02.211.211 SUP HCPCS C1713 02.211.211 - PLATE BONE 3MM SPACER OPENING WEDGE LOCKING VAR ANG LCP BOTH IP/OP "$1,730.50" "$1,281.00" $343.44 "$1,759.83" $778.68 $778.68 $778.68 $778.68 "$1,730.40" "$1,730.40" "$1,730.40" $360.66 "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" $360.63 "$1,730.40" $703.93 "$1,023.53" "$1,730.40" "$1,759.83" "$1,730.40" "$1,730.40" "$1,297.88" "$1,730.40" "$1,730.40" "$1,730.40" $865.20 $865.20 "$1,370.48" "$1,730.40" "$1,384.32" $778.68 $343.44 N/A "$1,003.69" "$1,730.40" "$1,038.24" "$1,730.40" $360.62 "$1,730.40" N/A N/A 02.211.212 SUP HCPCS C1713 02.211.212 - PLATE BONE 4MM SPACER OPENING WEDGE LOCKING VAR ANG LCP BOTH IP/OP "$1,730.50" "$1,281.00" $343.44 "$1,759.83" $778.68 $778.68 $778.68 $778.68 "$1,730.40" "$1,730.40" "$1,730.40" $360.66 "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" $360.63 "$1,730.40" $703.93 "$1,023.53" "$1,730.40" "$1,759.83" "$1,730.40" "$1,730.40" "$1,297.88" "$1,730.40" "$1,730.40" "$1,730.40" $865.20 $865.20 "$1,370.48" "$1,730.40" "$1,384.32" $778.68 $343.44 N/A "$1,003.69" "$1,730.40" "$1,730.40" "$1,730.40" $360.62 "$1,730.40" N/A N/A 02.211.213 SUP HCPCS C1713 02.211.213 - PLATE BONE 5MM SPACER OPENING WEDGE LOCKING VAR ANG LCP BOTH IP/OP "$1,730.50" "$1,281.00" $343.44 "$1,759.83" $778.68 $778.68 $778.68 $778.68 "$1,730.40" "$1,730.40" "$1,730.40" $360.66 "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" $360.63 "$1,730.40" $703.93 "$1,023.53" "$1,730.40" "$1,759.83" "$1,730.40" "$1,730.40" "$1,297.88" "$1,730.40" "$1,730.40" "$1,730.40" $865.20 $865.20 "$1,370.48" "$1,730.40" "$1,384.32" $778.68 $343.44 N/A "$1,003.69" "$1,730.40" "$1,730.40" "$1,730.40" $360.62 "$1,730.40" N/A N/A 02.211.214 SUP HCPCS C1713 02.211.214 - PLATE BONE 6MM SPACER OPENING WEDGE VAR ANG LOCKING LCP BOTH IP/OP "$1,778.50" "$1,316.00" $352.93 "$1,808.43" $800.19 $800.19 $800.19 $800.19 "$1,778.20" "$1,778.20" "$1,778.20" $370.62 "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" $370.60 "$1,778.20" $723.37 "$1,051.81" "$1,778.20" "$1,808.43" "$1,778.20" "$1,778.20" "$1,333.88" "$1,778.20" "$1,778.20" "$1,778.20" $889.10 $889.10 "$1,408.33" "$1,778.20" "$1,422.56" $800.19 $352.93 N/A "$1,031.53" "$1,778.20" "$1,066.92" "$1,778.20" $370.58 "$1,778.20" N/A N/A 02.211.215 SUP HCPCS C1713 02.211.215 - PLATE BONE 7MM SPACER OPENING WEDGE VAR ANG LOCKING LCP BOTH IP/OP "$1,778.50" "$1,316.00" $352.93 "$1,808.43" $800.19 $800.19 $800.19 $800.19 "$1,778.20" "$1,778.20" "$1,778.20" $370.62 "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" $370.60 "$1,778.20" $723.37 "$1,051.81" "$1,778.20" "$1,808.43" "$1,778.20" "$1,778.20" "$1,333.88" "$1,778.20" "$1,778.20" "$1,778.20" $889.10 $889.10 "$1,408.33" "$1,778.20" "$1,422.56" $800.19 $352.93 N/A "$1,031.53" "$1,778.20" "$1,066.92" "$1,778.20" $370.58 "$1,778.20" N/A N/A 02.211.220 SUP HCPCS C1713 02.211.220 - PLATE BN CNTR NS LCP VA LCK LOPRFL SS NAVICULAR 2.4/2.7MM BOTH IP/OP "$2,110.00" "$1,561.00" $418.77 "$2,145.83" $949.48 $949.48 $949.48 $949.48 "$2,109.95" "$2,109.95" "$2,109.95" $439.77 "$2,109.95" "$2,109.95" "$2,109.95" "$2,109.95" "$2,109.95" $439.74 "$2,109.95" "$2,145.83" "$1,248.04" "$2,109.95" "$2,145.83" "$2,109.95" "$2,109.95" "$1,582.50" "$2,109.95" "$2,109.95" "$2,109.95" "$1,054.98" "$1,054.98" "$1,671.08" "$2,109.95" "$1,687.96" $949.48 $418.77 N/A "$1,223.80" "$2,109.95" "$1,265.97" "$2,109.95" $439.71 "$2,109.95" N/A N/A 02.211.221 SUP HCPCS C1713 02.211.221 - PLATE BN CNTR NS LCP VA LCK LOPRFL SS CUBOID LT 2.4/2.7MM BOTH IP/OP "$2,110.00" "$1,561.00" $418.77 "$2,145.83" $949.48 $949.48 $949.48 $949.48 "$2,109.95" "$2,109.95" "$2,109.95" $439.77 "$2,109.95" "$2,109.95" "$2,109.95" "$2,109.95" "$2,109.95" $439.74 "$2,109.95" $858.33 "$1,248.04" "$2,109.95" "$2,145.83" "$2,109.95" "$2,109.95" "$1,582.50" "$2,109.95" "$2,109.95" "$2,109.95" "$1,054.98" "$1,054.98" "$1,671.08" "$2,109.95" "$1,687.96" $949.48 $418.77 N/A "$1,223.80" "$2,109.95" "$1,265.97" "$2,109.95" $439.71 "$2,109.95" N/A N/A 02.211.222 SUP HCPCS C1713 02.211.222 - PLATE BN CNTR NS LCP VA LCK LOPRFL SS CUBOID RT 2.4/2.7MM BOTH IP/OP "$2,110.00" "$1,561.00" $418.77 "$2,145.83" $949.48 $949.48 $949.48 $949.48 "$2,109.95" "$2,109.95" "$2,109.95" $439.77 "$2,109.95" "$2,109.95" "$2,109.95" "$2,109.95" "$2,109.95" $439.74 "$2,109.95" $858.33 "$1,248.04" "$2,109.95" "$2,145.83" "$2,109.95" "$2,109.95" "$1,582.50" "$2,109.95" "$2,109.95" "$2,109.95" "$1,054.98" "$1,054.98" "$1,671.08" "$2,109.95" "$1,687.96" $949.48 $418.77 N/A "$1,223.80" "$2,109.95" "$1,265.97" "$2,109.95" $439.71 "$2,109.95" N/A N/A 02.211.224 SUP HCPCS C1713 02.211.224 - PLATE BONE 5X12 HOLE VAR ANG LOCK MESH LCP STAINLESS STEEL BOTH IP/OP "$2,972.00" "$2,199.00" $589.79 "$3,022.15" "$1,337.23" "$1,337.23" "$1,337.23" "$1,337.23" "$2,971.63" "$2,971.63" "$2,971.63" $619.36 "$2,971.63" "$2,971.63" "$2,971.63" "$2,971.63" "$2,971.63" $619.32 "$2,971.63" "$3,022.15" "$1,465.01" "$2,971.63" "$3,022.15" "$2,971.63" "$2,971.63" "$2,229.00" "$2,971.63" "$2,971.63" "$2,971.63" "$1,485.82" "$1,485.82" "$2,353.53" "$2,971.63" "$2,377.30" "$1,337.23" $589.79 N/A "$1,723.76" "$2,971.63" "$1,782.98" "$2,971.63" $619.29 "$2,971.63" N/A N/A 02.211.230 SUP HCPCS C1713 02.211.230 - PLATE BN 0D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,113.32" "$1,855.53" $386.69 "$1,855.53" N/A N/A 02.211.231 SUP HCPCS C1713 02.211.231 - PLATE BN 0D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,113.32" "$1,855.53" $386.69 "$1,855.53" N/A N/A 02.211.232 SUP HCPCS C1713 02.211.232 - PLATE BN 5D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" "$1,887.08" "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,113.32" "$1,855.53" $386.69 "$1,855.53" N/A N/A 02.211.233 SUP HCPCS C1713 02.211.233 - PLATE BN 5D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" "$1,887.08" "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,113.32" "$1,855.53" $386.69 "$1,855.53" N/A N/A 02.211.234 SUP HCPCS C1713 02.211.234 - PLATE BN 10D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,113.32" "$1,855.53" $386.69 "$1,855.53" N/A N/A 02.211.235 SUP HCPCS C1713 02.211.235 - PLATE BN 10D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,113.32" "$1,855.53" $386.69 "$1,855.53" N/A N/A 02.211.236 SUP HCPCS C1713 02.211.236 - PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,113.32" "$1,855.53" $386.69 "$1,855.53" N/A N/A 02.211.237 SUP HCPCS C1713 02.211.237 - PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,113.32" "$1,855.53" $386.69 "$1,855.53" N/A N/A 02.211.238 SUP HCPCS C1713 02.211.238 - PLATE BN 5D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,113.32" "$1,855.53" $386.69 "$1,855.53" N/A N/A 02.211.239 SUP HCPCS C1713 02.211.239 - PLATE BN 5D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,113.32" "$1,855.53" $386.69 "$1,855.53" N/A N/A 02.211.240 SUP HCPCS C1713 02.211.240 - PLATE BN 10D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1 BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,855.53" "$1,855.53" $386.69 "$1,855.53" N/A N/A 02.211.241 SUP HCPCS C1713 02.211.241 - PLATE BN 10D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1 BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,113.32" "$1,855.53" $386.69 "$1,855.53" N/A N/A 02.211.242 SUP HCPCS C1713 02.211.242 - PLATE BN 5D LG 57MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST BOTH IP/OP "$2,110.00" "$1,561.00" $418.77 "$2,145.83" $949.48 $949.48 $949.48 $949.48 "$2,109.95" "$2,109.95" "$2,109.95" $439.77 "$2,109.95" "$2,109.95" "$2,109.95" "$2,109.95" "$2,109.95" $439.74 "$2,109.95" $858.33 "$1,248.04" "$2,109.95" "$2,145.83" "$2,109.95" "$2,109.95" "$1,582.50" "$2,109.95" "$2,109.95" "$2,109.95" "$1,054.98" "$1,054.98" "$1,671.08" "$2,109.95" "$1,687.96" $949.48 $418.77 N/A "$1,223.80" "$2,109.95" "$1,265.97" "$2,109.95" $439.71 "$2,109.95" N/A N/A 02.211.243 SUP HCPCS C1713 02.211.243 - PLATE BN 5D LG 57MM NS LCP VA FSN LOPRFL CMPR WRE HL SS 1ST BOTH IP/OP "$2,110.00" "$1,561.00" $418.77 "$2,145.83" $949.48 $949.48 $949.48 $949.48 "$2,109.95" "$2,109.95" "$2,109.95" $439.77 "$2,109.95" "$2,109.95" "$2,109.95" "$2,109.95" "$2,109.95" $439.74 "$2,109.95" $858.33 "$1,248.04" "$2,109.95" "$2,145.83" "$2,109.95" "$2,109.95" "$1,582.50" "$2,109.95" "$2,109.95" "$2,109.95" "$1,054.98" "$1,054.98" "$1,671.08" "$2,109.95" "$1,687.96" $949.48 $418.77 N/A "$1,223.80" "$2,109.95" "$1,265.97" "$2,109.95" $439.71 "$2,109.95" N/A N/A 02.211.244 SUP HCPCS C1713 02.211.244 - PLATE BONE 0D 53MM VAR ANG FUSION REVISION DORSIFLEXION LCP BOTH IP/OP "$2,342.00" "$1,733.00" $464.80 "$2,381.68" "$1,053.85" "$1,053.85" "$1,053.85" "$1,053.85" "$2,341.88" "$2,341.88" "$2,341.88" $488.11 "$2,341.88" "$2,341.88" "$2,341.88" "$2,341.88" "$2,341.88" $488.07 "$2,341.88" $952.67 "$1,385.22" "$2,341.88" "$2,381.68" "$2,341.88" "$2,341.88" "$1,756.50" "$2,341.88" "$2,341.88" "$2,341.88" "$1,170.94" "$1,170.94" "$1,854.77" "$2,341.88" "$1,873.50" "$1,053.85" $464.80 N/A "$1,358.36" "$2,341.88" "$1,405.13" "$2,341.88" $488.05 "$2,341.88" N/A N/A 02.211.245 SUP HCPCS C1713 02.211.245 - PLATE BONE 0D 53MM VAR ANG FUSION REVISION DORSIFLEXION LCP BOTH IP/OP "$2,342.00" "$1,733.00" $464.80 "$2,381.68" "$1,053.85" "$1,053.85" "$1,053.85" "$1,053.85" "$2,341.88" "$2,341.88" "$2,341.88" $488.11 "$2,341.88" "$2,341.88" "$2,341.88" "$2,341.88" "$2,341.88" $488.07 "$2,341.88" $952.67 "$1,385.22" "$2,341.88" "$2,381.68" "$2,341.88" "$2,341.88" "$1,756.50" "$2,341.88" "$2,341.88" "$2,341.88" "$1,170.94" "$1,170.94" "$1,854.77" "$2,341.88" "$1,873.50" "$1,053.85" $464.80 N/A "$1,358.36" "$2,341.88" "$1,405.13" "$2,341.88" $488.05 "$2,341.88" N/A N/A 02.211.246 SUP HCPCS C1713 02.211.246 - PLATE BN STD 39MM NS LCP VA FSN LOPRFL PRECONTOUR SS 1ST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,113.32" "$1,855.53" $386.69 "$1,855.53" N/A N/A 02.211.247 SUP HCPCS C1713 02.211.247 - PLATE BN LNG 48MM NS LCP VA FSN LOPRFL PRECONTOUR SS 1ST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,855.53" "$1,855.53" $386.69 "$1,855.53" N/A N/A 02.211.250 SUP HCPCS C1713 02.211.250 - PLATE BN SHRT CLVRLF 38MM NS LCP VA FSN LOPRFL CMPR WRE HL BOTH IP/OP "$1,604.00" "$1,187.00" $318.33 "$1,631.18" $721.76 $721.76 $721.76 $721.76 "$1,603.90" "$1,603.90" "$1,603.90" $334.29 "$1,603.90" "$1,603.90" "$1,603.90" "$1,603.90" "$1,603.90" $334.27 "$1,603.90" "$1,631.18" $948.71 "$1,603.90" "$1,631.18" "$1,603.90" "$1,603.90" "$1,203.00" "$1,603.90" "$1,603.90" "$1,603.90" $801.95 $801.95 "$1,270.29" "$1,603.90" "$1,283.12" $721.76 $318.33 N/A $930.32 "$1,603.90" $962.34 "$1,603.90" $334.25 "$1,603.90" N/A N/A 02.211.251 SUP HCPCS C1713 02.211.251 - PLATE BN STD CLVRLF 45MM NS LCP VA FSN LOPRFL CMPR WRE HL SS BOTH IP/OP "$1,646.50" "$1,218.00" $326.71 "$1,674.05" $740.74 $740.74 $740.74 $740.74 "$1,646.08" "$1,646.08" "$1,646.08" $343.08 "$1,646.08" "$1,646.08" "$1,646.08" "$1,646.08" "$1,646.08" $343.06 "$1,646.08" "$1,674.05" $973.66 "$1,646.08" "$1,674.05" "$1,646.08" "$1,646.08" "$1,234.88" "$1,646.08" "$1,646.08" "$1,646.08" $823.04 $823.04 "$1,303.70" "$1,646.08" "$1,316.86" $740.74 $326.71 N/A $954.97 "$1,646.08" $987.65 "$1,646.08" $343.04 "$1,646.08" N/A N/A 02.211.252 SUP HCPCS C1713 02.211.252 - PLATE BN LNG CLVRLF 64MM NS LCP VA FSN LOPRFL CMPR WRE HL SS BOTH IP/OP "$1,687.00" "$1,248.00" $334.79 "$1,715.50" $759.07 $759.07 $759.07 $759.07 "$1,686.83" "$1,686.83" "$1,686.83" $351.58 "$1,686.83" "$1,686.83" "$1,686.83" "$1,686.83" "$1,686.83" $351.55 "$1,686.83" "$1,715.50" $997.76 "$1,686.83" "$1,715.50" "$1,686.83" "$1,686.83" "$1,265.25" "$1,686.83" "$1,686.83" "$1,686.83" $843.42 $843.42 "$1,335.97" "$1,686.83" "$1,349.46" $759.07 $334.79 N/A $978.46 "$1,686.83" "$1,012.10" "$1,686.83" $351.54 "$1,686.83" N/A N/A 02.211.253 SUP HCPCS C1713 02.211.253 - PLATE BONE T SHORT 35MM 2 HOLE FUSION VAR ANG LCP STAINLESS BOTH IP/OP "$1,604.00" "$1,187.00" $318.33 "$1,631.18" $721.76 $721.76 $721.76 $721.76 "$1,603.90" "$1,603.90" "$1,603.90" $334.29 "$1,603.90" "$1,603.90" "$1,603.90" "$1,603.90" "$1,603.90" $334.27 "$1,603.90" $652.47 $948.71 "$1,603.90" "$1,631.18" "$1,603.90" "$1,603.90" "$1,203.00" "$1,603.90" "$1,603.90" "$1,603.90" $801.95 $801.95 "$1,270.29" "$1,603.90" "$1,283.12" $721.76 $318.33 N/A $930.32 "$1,603.90" "$1,603.90" "$1,603.90" $334.25 "$1,603.90" N/A N/A 02.211.254 SUP HCPCS C1713 02.211.254 - PLATE BONE STANDARD 42MM 2 HOLE T FUSION VAR ANG LCP BOTH IP/OP "$1,646.50" "$1,218.00" $326.71 "$1,674.05" $740.74 $740.74 $740.74 $740.74 "$1,646.08" "$1,646.08" "$1,646.08" $343.08 "$1,646.08" "$1,646.08" "$1,646.08" "$1,646.08" "$1,646.08" $343.06 "$1,646.08" $669.62 $973.66 "$1,646.08" "$1,674.05" "$1,646.08" "$1,646.08" "$1,234.88" "$1,646.08" "$1,646.08" "$1,646.08" $823.04 $823.04 "$1,303.70" "$1,646.08" "$1,316.86" $740.74 $326.71 N/A $954.97 "$1,646.08" "$1,646.08" "$1,646.08" $343.04 "$1,646.08" N/A N/A 02.211.255 SUP HCPCS C1713 02.211.255 - PLATE BONE T LONG 6.1CM 2 HOLE VAR ANG LCP STAINLESS STEEL BOTH IP/OP "$1,687.00" "$1,248.00" $334.79 "$1,715.50" $759.07 $759.07 $759.07 $759.07 "$1,686.83" "$1,686.83" "$1,686.83" $351.58 "$1,686.83" "$1,686.83" "$1,686.83" "$1,686.83" "$1,686.83" $351.55 "$1,686.83" $686.20 $997.76 "$1,686.83" "$1,715.50" "$1,686.83" "$1,686.83" "$1,265.25" "$1,686.83" "$1,686.83" "$1,686.83" $843.42 $843.42 "$1,335.97" "$1,686.83" "$1,349.46" $759.07 $334.79 N/A $978.46 "$1,686.83" "$1,012.10" "$1,686.83" $351.54 "$1,686.83" N/A N/A 02.211.256 SUP HCPCS C1713 02.211.256 - PLATE BN SHRT L 37MM NS LCP VA FSN LOPRFL CMPR WRE HL SS BOTH IP/OP "$1,649.00" "$1,220.00" $327.26 "$1,676.90" $742.00 $742.00 $742.00 $742.00 "$1,648.88" "$1,648.88" "$1,648.88" $343.67 "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" $343.64 "$1,648.88" $670.76 $975.31 "$1,648.88" "$1,676.90" "$1,648.88" "$1,648.88" "$1,236.75" "$1,648.88" "$1,648.88" "$1,648.88" $824.44 $824.44 "$1,305.91" "$1,648.88" "$1,319.10" $742.00 $327.26 N/A $956.42 "$1,648.88" $989.33 "$1,648.88" $343.63 "$1,648.88" N/A N/A 02.211.257 SUP HCPCS C1713 02.211.257 - PLATE BN SHRT L 37MM NS LCP VA FSN LOPRFL CMPR WRE HL SS BOTH IP/OP "$1,604.00" "$1,187.00" $318.33 "$1,631.18" $721.76 $721.76 $721.76 $721.76 "$1,603.90" "$1,603.90" "$1,603.90" $334.29 "$1,603.90" "$1,603.90" "$1,603.90" "$1,603.90" "$1,603.90" $334.27 "$1,603.90" $652.47 $948.71 "$1,603.90" "$1,631.18" "$1,603.90" "$1,603.90" "$1,203.00" "$1,603.90" "$1,603.90" "$1,603.90" $801.95 $801.95 "$1,270.29" "$1,603.90" "$1,283.12" $721.76 $318.33 N/A $930.32 "$1,603.90" $962.34 "$1,603.90" $334.25 "$1,603.90" N/A N/A 02.211.258 SUP HCPCS C1713 02.211.258 - PLATE BN STD L 44MM NS LCP VA FSN LOPRFL CMPR WRE HL SS BOTH IP/OP "$1,692.50" "$1,252.00" $335.91 "$1,721.23" $761.60 $761.60 $761.60 $761.60 "$1,692.45" "$1,692.45" "$1,692.45" $352.75 "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" $352.73 "$1,692.45" $688.49 "$1,001.08" "$1,692.45" "$1,721.23" "$1,692.45" "$1,692.45" "$1,269.38" "$1,692.45" "$1,692.45" "$1,692.45" $846.23 $846.23 "$1,340.42" "$1,692.45" "$1,353.96" $761.60 $335.91 N/A $981.65 "$1,692.45" "$1,015.47" "$1,692.45" $352.71 "$1,692.45" N/A N/A 02.211.259 SUP HCPCS C1713 02.211.259 - PLATE BN STD L 44MM NS LCP VA FSN LOPRFL CMPR WRE HL SS BOTH IP/OP "$1,692.50" "$1,252.00" $335.91 "$1,721.23" $761.60 $761.60 $761.60 $761.60 "$1,692.45" "$1,692.45" "$1,692.45" $352.75 "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" $352.73 "$1,692.45" $688.49 "$1,001.08" "$1,692.45" "$1,721.23" "$1,692.45" "$1,692.45" "$1,269.38" "$1,692.45" "$1,692.45" "$1,692.45" $846.23 $846.23 "$1,340.42" "$1,692.45" "$1,353.96" $761.60 $335.91 N/A $981.65 "$1,692.45" "$1,015.47" "$1,692.45" $352.71 "$1,692.45" N/A N/A 02.211.260 SUP HCPCS C1713 02.211.260 - PLATE BN LNG L 62MM NS LCP VA FSN LOPRFL CMPR WRE HL SS BOTH IP/OP "$1,735.00" "$1,284.00" $344.28 "$1,764.13" $780.58 $780.58 $780.58 $780.58 "$1,734.63" "$1,734.63" "$1,734.63" $361.54 "$1,734.63" "$1,734.63" "$1,734.63" "$1,734.63" "$1,734.63" $361.52 "$1,734.63" $705.65 "$1,026.03" "$1,734.63" "$1,764.13" "$1,734.63" "$1,734.63" "$1,301.25" "$1,734.63" "$1,734.63" "$1,734.63" $867.32 $867.32 "$1,373.83" "$1,734.63" "$1,387.70" $780.58 $344.28 N/A "$1,006.30" "$1,734.63" "$1,040.78" "$1,734.63" $361.50 "$1,734.63" N/A N/A 02.211.261 SUP HCPCS C1713 02.211.261 - PLATE BN LNG L 62MM NS LCP VA FSN LOPRFL CMPR WRE HL SS BOTH IP/OP "$1,735.00" "$1,284.00" $344.28 "$1,764.13" $780.58 $780.58 $780.58 $780.58 "$1,734.63" "$1,734.63" "$1,734.63" $361.54 "$1,734.63" "$1,734.63" "$1,734.63" "$1,734.63" "$1,734.63" $361.52 "$1,734.63" $705.65 "$1,026.03" "$1,734.63" "$1,764.13" "$1,734.63" "$1,734.63" "$1,301.25" "$1,734.63" "$1,734.63" "$1,734.63" $867.32 $867.32 "$1,373.83" "$1,734.63" "$1,387.70" $780.58 $344.28 N/A "$1,006.30" "$1,734.63" "$1,734.63" "$1,734.63" $361.50 "$1,734.63" N/A N/A 02.211.262 SUP HCPCS C1713 02.211.262 - PLATE BONE 27MM 2 HOLE STR FUSION VAR ANG LOCKING LCP BOTH IP/OP "$1,435.50" "$1,062.00" $284.85 "$1,459.60" $645.84 $645.84 $645.84 $645.84 "$1,435.20" "$1,435.20" "$1,435.20" $299.13 "$1,435.20" "$1,435.20" "$1,435.20" "$1,435.20" "$1,435.20" $299.11 "$1,435.20" "$1,459.60" $848.92 "$1,435.20" "$1,459.60" "$1,435.20" "$1,435.20" "$1,076.63" "$1,435.20" "$1,435.20" "$1,435.20" $717.60 $717.60 "$1,136.68" "$1,435.20" "$1,148.16" $645.84 $284.85 N/A $832.59 "$1,435.20" "$1,435.20" "$1,435.20" $299.10 "$1,435.20" N/A N/A 02.211.263 SUP HCPCS C1713 02.211.263 - PLATE BONE 43MM 4 HOLE STR FUSION VAR ANG LOCKING LCP BOTH IP/OP "$1,518.50" "$1,124.00" $301.31 "$1,543.95" $683.17 $683.17 $683.17 $683.17 "$1,518.15" "$1,518.15" "$1,518.15" $316.42 "$1,518.15" "$1,518.15" "$1,518.15" "$1,518.15" "$1,518.15" $316.40 "$1,518.15" $617.58 $897.99 "$1,518.15" "$1,543.95" "$1,518.15" "$1,518.15" "$1,138.88" "$1,518.15" "$1,518.15" "$1,518.15" $759.08 $759.08 "$1,202.37" "$1,518.15" "$1,214.52" $683.17 $301.31 N/A $880.73 "$1,518.15" $910.89 "$1,518.15" $316.38 "$1,518.15" N/A N/A 02.211.265 SUP HCPCS C1713 02.211.265 - PLATE BONE XLONG 92MM 3 HOLE T FUSION VAR ANG LCP STAINLESS BOTH IP/OP "$2,110.00" "$1,561.00" $418.77 "$2,145.83" $949.48 $949.48 $949.48 $949.48 "$2,109.95" "$2,109.95" "$2,109.95" $439.77 "$2,109.95" "$2,109.95" "$2,109.95" "$2,109.95" "$2,109.95" $439.74 "$2,109.95" $858.33 "$1,248.04" "$2,109.95" "$2,145.83" "$2,109.95" "$2,109.95" "$1,582.50" "$2,109.95" "$2,109.95" "$2,109.95" "$1,054.98" "$1,054.98" "$1,671.08" "$2,109.95" "$1,687.96" $949.48 $418.77 N/A "$1,223.80" "$2,109.95" "$1,265.97" "$2,109.95" $439.71 "$2,109.95" N/A N/A 02.211.266 SUP HCPCS C1713 02.211.266 - PLATE BN 43MM NS LCP VA FSN LOPRFL PRECONTOUR SS BOTH IP/OP "$1,687.00" "$1,248.00" $334.79 "$1,715.50" $759.07 $759.07 $759.07 $759.07 "$1,686.83" "$1,686.83" "$1,686.83" $351.58 "$1,686.83" "$1,686.83" "$1,686.83" "$1,686.83" "$1,686.83" $351.55 "$1,686.83" "$1,715.50" $997.76 "$1,686.83" "$1,715.50" "$1,686.83" "$1,686.83" "$1,265.25" "$1,686.83" "$1,686.83" "$1,686.83" $843.42 $843.42 "$1,335.97" "$1,686.83" "$1,349.46" $759.07 $334.79 N/A $978.46 "$1,686.83" "$1,012.10" "$1,686.83" $351.54 "$1,686.83" N/A N/A 02.211.400S SUP HCPCS C1713 02.211.400S - PLATE BN SM 58MM STRL LCP VA LCK LOPRFL PRECONTOUR SS CALC BOTH IP/OP "$2,114.50" "$1,565.00" $419.61 "$2,150.10" $951.37 $951.37 $951.37 $951.37 "$2,114.15" "$2,114.15" "$2,114.15" $440.64 "$2,114.15" "$2,114.15" "$2,114.15" "$2,114.15" "$2,114.15" $440.61 "$2,114.15" $860.04 "$1,250.52" "$2,114.15" "$2,150.10" "$2,114.15" "$2,114.15" "$1,585.88" "$2,114.15" "$2,114.15" "$2,114.15" "$1,057.08" "$1,057.08" "$1,674.41" "$2,114.15" "$1,691.32" $951.37 $419.61 N/A "$1,226.41" "$2,114.15" "$2,114.15" "$2,114.15" $440.59 "$2,114.15" N/A N/A 02.211.402S SUP HCPCS C1713 02.211.402S - PLATE BN MED 64MM STRL LCP VA LCK LOPRFL PRECONTOUR SS CALC BOTH IP/OP "$2,130.00" "$1,576.00" $422.68 "$2,165.83" $958.33 $958.33 $958.33 $958.33 "$2,129.63" "$2,129.63" "$2,129.63" $443.87 "$2,129.63" "$2,129.63" "$2,129.63" "$2,129.63" "$2,129.63" $443.84 "$2,129.63" "$2,165.83" "$1,259.68" "$2,129.63" "$2,165.83" "$2,129.63" "$2,129.63" "$1,597.50" "$2,129.63" "$2,129.63" "$2,129.63" "$1,064.82" "$1,064.82" "$1,686.67" "$2,129.63" "$1,703.70" $958.33 $422.68 N/A "$1,235.40" "$2,129.63" "$2,129.63" "$2,129.63" $443.81 "$2,129.63" N/A N/A 02.211.404S SUP HCPCS C1713 02.211.404S - PLATE BN LG 70MM STRL LCP VA LCK LOPRFL PRECONTOUR SS CALC BOTH IP/OP "$2,144.00" "$1,587.00" $425.47 "$2,180.13" $964.66 $964.66 $964.66 $964.66 "$2,143.68" "$2,143.68" "$2,143.68" $446.80 "$2,143.68" "$2,143.68" "$2,143.68" "$2,143.68" "$2,143.68" $446.77 "$2,143.68" $872.05 "$1,267.99" "$2,143.68" "$2,180.13" "$2,143.68" "$2,143.68" "$1,608.00" "$2,143.68" "$2,143.68" "$2,143.68" "$1,071.84" "$1,071.84" "$1,697.79" "$2,143.68" "$1,714.94" $964.66 $425.47 N/A "$1,243.52" "$2,143.68" "$2,143.68" "$2,143.68" $446.74 "$2,143.68" N/A N/A 02.211.410S SUP HCPCS C1713 02.211.410S - PLATE BN SHRT 40MM STRL LCP VA LCK LOPRFL PRECONTOUR SS CALC BOTH IP/OP "$1,969.50" "$1,457.00" $390.87 "$2,002.85" $886.22 $886.22 $886.22 $886.22 "$1,969.38" "$1,969.38" "$1,969.38" $410.47 "$1,969.38" "$1,969.38" "$1,969.38" "$1,969.38" "$1,969.38" $410.44 "$1,969.38" $801.14 "$1,164.89" "$1,969.38" "$2,002.85" "$1,969.38" "$1,969.38" "$1,477.13" "$1,969.38" "$1,969.38" "$1,969.38" $984.69 $984.69 "$1,559.75" "$1,969.38" "$1,575.50" $886.22 $390.87 N/A "$1,142.31" "$1,969.38" "$1,969.38" "$1,969.38" $410.42 "$1,969.38" N/A N/A 02.211.412S SUP HCPCS C1713 02.211.412S - PLATE BN LNG 56MM STRL LCP VA LCK LOPRFL PRECONTOUR SS CALC BOTH IP/OP "$2,042.50" "$1,511.00" $405.38 "$2,077.20" $919.12 $919.12 $919.12 $919.12 "$2,042.48" "$2,042.48" "$2,042.48" $425.70 "$2,042.48" "$2,042.48" "$2,042.48" "$2,042.48" "$2,042.48" $425.68 "$2,042.48" $830.88 "$1,208.13" "$2,042.48" "$2,077.20" "$2,042.48" "$2,042.48" "$1,531.88" "$2,042.48" "$2,042.48" "$2,042.48" "$1,021.24" "$1,021.24" "$1,617.64" "$2,042.48" "$1,633.98" $919.12 $405.38 N/A "$1,184.65" "$2,042.48" "$2,042.48" "$2,042.48" $425.65 "$2,042.48" N/A N/A 02.212.054 SUP HCPCS C1713 02.212.054 - SCREW BONE T15 3.5MM 54MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 02.212.056 SUP HCPCS C1713 02.212.056 - SCREW BONE T15 3.5MM 56MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 02.212.058 SUP HCPCS C1713 02.212.058 - SCREW BONE T15 3.5MM 58MM SELF TAP STARDRIVE LCP STAINLESS BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $48.92 $234.75 N/A N/A 02.214.006 SUP HCPCS C1713 02.214.006 - SCREW BONE 1.5MM 6MM T4 STARDRIVE RECESS LOCKING SLFTAP BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 02.214.007 SUP HCPCS C1713 02.214.007 - SCREW BONE T4 LP 1.5MM 7MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 02.214.008 SUP HCPCS C1713 02.214.008 - SCREW BONE T4 LP 1.5MM 8MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $84.63 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 02.214.009 SUP HCPCS C1713 02.214.009 - SCREW BONE T4 LP 1.5MM 9MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $208.05 $208.05 $43.36 $208.05 N/A N/A 02.214.010 SUP HCPCS C1713 02.214.010 - SCREW BONE T4 1.5MM 10MM SELF TAP SELF RETAINING LP BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $84.63 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 02.214.011 SUP HCPCS C1713 02.214.011 - SCREW BONE T4 LP 1.5MM 11MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $84.63 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 02.214.012 SUP HCPCS C1713 02.214.012 - SCREW BONE T4 LP 1.5MM 12MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $84.63 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $208.05 $208.05 $43.36 $208.05 N/A N/A 02.214.013 SUP HCPCS C1713 02.214.013 - SCREW BONE T4 LP 1.5MM 13MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $84.63 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 02.214.014 SUP HCPCS C1713 02.214.014 - SCREW BONE 1.5MM 14MM LOCK SELF TAP MODULAR T4 STARDRIVE LCP BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $84.63 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 02.214.015 SUP HCPCS C1713 02.214.015 - SCREW BONE T4 LP 1.5MM 15MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $84.63 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 02.214.016 SUP HCPCS C1713 02.214.016 - SCREW BONE T4 LP 1.5MM 16MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $84.63 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 02.214.018 SUP HCPCS C1713 02.214.018 - SCREW BONE T4 LP 1.5MM 18MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $84.63 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 02.214.020 SUP HCPCS C1713 02.214.020 - SCREW BONE T4 LP 1.5MM 20MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 02.214.022 SUP HCPCS C1713 02.214.022 - SCREW BONE T4 LP 1.5MM 22MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 02.214.024 SUP HCPCS C1713 02.214.024 - SCREW BONE T4 LP 1.5MM 24MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 02.214.104 SUP HCPCS C1713 02.214.104 - SCREW BN T4 1.5MM 4MM ST TIP VA LCK STRDR SS CORT BOTH IP/OP $87.50 $65.00 $17.30 $88.63 $39.22 $39.22 $39.22 $39.22 $87.15 $87.15 $87.15 $18.16 $87.15 $87.15 $87.15 $87.15 $87.15 $18.16 $87.15 $35.45 $51.55 $87.15 $88.63 $87.15 $87.15 $65.63 $87.15 $87.15 $87.15 $43.58 $43.58 $69.02 $87.15 $69.72 $39.22 $17.30 N/A $50.75 $87.15 $87.15 $87.15 $18.16 $87.15 N/A N/A 02.214.105 SUP HCPCS C1713 02.214.105 - SCREW BN T4 1.5MM 5MM SLFRET ST STRDR SS HND CORT VA LCK SYS BOTH IP/OP $87.50 $65.00 $17.30 $88.63 $39.22 $39.22 $39.22 $39.22 $87.15 $87.15 $87.15 $18.16 $87.15 $87.15 $87.15 $87.15 $87.15 $18.16 $87.15 $35.45 $51.55 $87.15 $88.63 $87.15 $87.15 $65.63 $87.15 $87.15 $87.15 $43.58 $43.58 $69.02 $87.15 $69.72 $39.22 $17.30 N/A $50.75 $87.15 $87.15 $87.15 $18.16 $87.15 N/A N/A 02.214.106 SUP HCPCS C1713 02.214.106 - SCREW BONE T4 LP 1.5MM 6MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $84.35 $84.35 N/A N/A 02.214.107 SUP HCPCS C1713 02.214.107 - SCREW BONE T4 LP 1.5MM 7MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 02.214.108 SUP HCPCS C1713 02.214.108 - SCREW BONE T4 LP 1.5MM 8MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $34.31 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 02.214.109 SUP HCPCS C1713 02.214.109 - SCREW BONE T4 LP 1.5MM 9MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $34.31 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 02.214.110 SUP HCPCS C1713 02.214.110 - SCREW BONE T4 LP 1.5MM 10MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $34.31 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 02.214.111 SUP HCPCS C1713 02.214.111 - SCREW BONE T4 LP 1.5MM 11MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $34.31 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 02.214.112 SUP HCPCS C1713 02.214.112 - SCREW BONE T4 LP 1.5MM 12MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $34.31 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $84.35 $84.35 $84.35 $84.35 N/A N/A 02.214.113 SUP HCPCS C1713 02.214.113 - SCREW BONE T4 LP 1.5MM 13MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $34.31 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $84.35 $84.35 N/A N/A 02.214.114 SUP HCPCS C1713 02.214.114 - SCREW BONE T4 LP 1.5MM 14MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $34.31 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 02.214.115 SUP HCPCS C1713 02.214.115 - SCREW BONE T4 LP 1.5MM 15MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 02.214.116 SUP HCPCS C1713 02.214.116 - SCREW BONE T4 LP 1.5MM 16MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $84.35 $84.35 $17.58 $84.35 N/A N/A 02.214.118 SUP HCPCS C1713 02.214.118 - SCREW BONE T4 LP 1.5MM 18MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $34.31 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 02.214.120 SUP HCPCS C1713 02.214.120 - SCREW BONE T4 LP 1.5MM 20MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 02.214.122 SUP HCPCS C1713 02.214.122 - SCREW BONE T4 LP 1.5MM 22MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $34.31 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 02.214.124 SUP HCPCS C1713 02.214.124 - SCREW BONE T4 LP 1.5MM 24MM SELF TAP SELF RETAINING THREAD BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $34.31 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $84.35 $84.35 N/A N/A 02.221.002S SUP Custom 27803010 02.221.002S - BUTTON CERCLAGE 2.5MM T15 STARDRIVE STAINLESS STEEL STERILE BOTH IP/OP $343.00 $254.00 $61.05 $348.83 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $61.05 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $71.48 $343.00 $139.53 $343.00 $343.00 $348.83 $343.00 $343.00 $257.25 $343.00 $343.00 $343.00 $171.50 $171.50 $271.66 $343.00 $274.40 $154.35 $343.00 N/A $198.94 $343.00 $205.80 $343.00 $343.00 $343.00 N/A N/A 02.221.003S SUP Custom 27803010 02.221.003S - BUTTON FIX 3.5MM 3.5MM T25 STARDRIVE/HEXAGONAL RECESS BOTH IP/OP $343.00 $254.00 $61.05 $348.83 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $61.05 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $71.48 $343.00 $139.53 $343.00 $343.00 $348.83 $343.00 $343.00 $257.25 $343.00 $343.00 $343.00 $171.50 $171.50 $271.66 $343.00 $274.40 $154.35 $343.00 N/A $198.94 $343.00 $205.80 $343.00 $343.00 $343.00 N/A N/A 02.221.004S SUP Custom 27803010 02.221.004S - BUTTON FIX 4MM CERCLAGE HEXAGONAL CANN STAINLESS STEEL BOTH IP/OP $343.00 $254.00 $61.05 $348.83 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $61.05 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $71.48 $343.00 $139.53 $343.00 $343.00 $348.83 $343.00 $343.00 $257.25 $343.00 $343.00 $343.00 $171.50 $171.50 $271.66 $343.00 $274.40 $154.35 $343.00 N/A $198.94 $343.00 $205.80 $343.00 $343.00 $343.00 N/A N/A 02.221.005S SUP Custom 27803010 02.221.005S - PIN POSITIONING 5MM CRIMP STAINLESS STEEL STERILE BOTH IP/OP $516.00 $382.00 $91.83 $524.68 $515.90 $515.90 $515.90 $515.90 $515.90 $515.90 $91.83 $515.90 $515.90 $515.90 $515.90 $515.90 $515.90 $107.52 $515.90 $209.87 $515.90 $515.90 $524.68 $515.90 $515.90 $387.00 $515.90 $515.90 $515.90 $257.95 $257.95 $408.59 $515.90 $412.72 $232.16 $515.90 N/A $299.28 $515.90 $309.54 $515.90 $515.90 $515.90 N/A N/A 02.221.006S SUP HCPCS C1713 02.221.006S - PIN POSITIONING 7.3MM CRIMP STAINLESS STEEL STERILE BOTH IP/OP $516.00 $382.00 $102.39 $524.68 $232.16 $232.16 $232.16 $232.16 $515.90 $515.90 $515.90 $107.53 $515.90 $515.90 $515.90 $515.90 $515.90 $107.52 $515.90 $209.87 $305.15 $515.90 $524.68 $515.90 $515.90 $387.00 $515.90 $515.90 $515.90 $257.95 $257.95 $408.59 $515.90 $412.72 $232.16 $102.39 N/A $299.28 $515.90 $309.54 $515.90 $107.51 $515.90 N/A N/A 02.221.458 SUP HCPCS C1713 02.221.458 - SCREW BONE 5MM 8MM SLFTAP LOCKING LCP STAINLESS STEEL DISTAL BOTH IP/OP $398.00 $295.00 $78.95 $404.58 $179.01 $179.01 $179.01 $179.01 $397.80 $397.80 $397.80 $82.91 $397.80 $397.80 $397.80 $397.80 $397.80 $82.91 $397.80 $161.83 $235.30 $397.80 $404.58 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $179.01 $78.95 N/A $230.84 $397.80 $238.68 $397.80 $397.80 $397.80 N/A N/A 02.221.460 SUP HCPCS C1713 02.221.460 - SCREW BONE 5MM 10MM SLFTAP LOCKING LCP STAINLESS STEEL BOTH IP/OP $398.00 $295.00 $78.95 $404.58 $179.01 $179.01 $179.01 $179.01 $397.80 $397.80 $397.80 $82.91 $397.80 $397.80 $397.80 $397.80 $397.80 $82.91 $397.80 $161.83 $235.30 $397.80 $404.58 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $179.01 $78.95 N/A $230.84 $397.80 $238.68 $397.80 $397.80 $397.80 N/A N/A 02.221.462 SUP HCPCS C1713 02.221.462 - SCREW BONE 5MM 12MM SLFTAP LOCKING LCP STAINLESS STEEL BOTH IP/OP $398.00 $295.00 $78.95 $404.58 $179.01 $179.01 $179.01 $179.01 $397.80 $397.80 $397.80 $82.91 $397.80 $397.80 $397.80 $397.80 $397.80 $82.91 $397.80 $161.83 $235.30 $397.80 $404.58 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $179.01 $78.95 N/A $230.84 $397.80 $238.68 $397.80 $82.90 $397.80 N/A N/A 02.221.508 SUP HCPCS C1713 02.221.508 - SCREW BONE T25 BLUNT CONE 5MM 4.4MM 8MM SELF TAP THREAD HEAD BOTH IP/OP $398.00 $295.00 $78.95 $404.58 $179.01 $179.01 $179.01 $179.01 $397.80 $397.80 $397.80 $82.91 $397.80 $397.80 $397.80 $397.80 $397.80 $82.91 $397.80 $404.58 $235.30 $397.80 $404.58 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $179.01 $78.95 N/A $230.84 $397.80 $238.68 $397.80 $82.90 $397.80 N/A N/A 02.221.508S SUP HCPCS C1713 02.221.508S - SCREW BN T25 BLNT CONE 5MM 4.4MM 8MM STRL LCP ST THRD HD BOTH IP/OP $489.50 $362.00 $97.09 $497.50 $220.13 $220.13 $220.13 $220.13 $489.18 $489.18 $489.18 $101.96 $489.18 $489.18 $489.18 $489.18 $489.18 $101.95 $489.18 $199.00 $289.35 $489.18 $497.50 $489.18 $489.18 $367.13 $489.18 $489.18 $489.18 $244.59 $244.59 $387.43 $489.18 $391.34 $220.13 $97.09 N/A $283.91 $489.18 $489.18 $489.18 $101.95 $489.18 N/A N/A 02.221.510 SUP HCPCS C1713 02.221.510 - SCREW BONE FULTHD 5MM 4.4MM 10MM T25 STARDRIVE RECESS BOTH IP/OP $398.00 $295.00 $78.95 $404.58 $179.01 $179.01 $179.01 $179.01 $397.80 $397.80 $397.80 $82.91 $397.80 $397.80 $397.80 $397.80 $397.80 $82.91 $397.80 $404.58 $235.30 $397.80 $404.58 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $179.01 $78.95 N/A $230.84 $397.80 $238.68 $397.80 $82.90 $397.80 N/A N/A 02.221.510S SUP HCPCS C1713 02.221.510S - SCREW BN 5MM 10MM STRL LCP ST T25 STRDR RCS LCK SS DIST FEM BOTH IP/OP $489.50 $362.00 $97.09 $497.50 $220.13 $220.13 $220.13 $220.13 $489.18 $489.18 $489.18 $101.96 $489.18 $489.18 $489.18 $489.18 $489.18 $101.95 $489.18 $199.00 $289.35 $489.18 $497.50 $489.18 $489.18 $367.13 $489.18 $489.18 $489.18 $244.59 $244.59 $387.43 $489.18 $391.34 $220.13 $97.09 N/A $283.91 $489.18 $293.51 $489.18 $101.95 $489.18 N/A N/A 02.221.512 SUP HCPCS C1713 02.221.512 - SCREW BONE T25 BLUNT CONE 5MM 4.4MM 12MM SELF TAP THREAD BOTH IP/OP $398.00 $295.00 $78.95 $404.58 $179.01 $179.01 $179.01 $179.01 $397.80 $397.80 $397.80 $82.91 $397.80 $397.80 $397.80 $397.80 $397.80 $82.91 $397.80 $404.58 $235.30 $397.80 $404.58 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $179.01 $78.95 N/A $230.84 $397.80 $238.68 $397.80 $82.90 $397.80 N/A N/A 02.221.514 SUP HCPCS C1713 02.221.514 - SCREW BONE 5MM 14MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $398.00 $295.00 $78.95 $404.58 $179.01 $179.01 $179.01 $179.01 $397.80 $397.80 $397.80 $82.91 $397.80 $397.80 $397.80 $397.80 $397.80 $82.91 $397.80 $404.58 $235.30 $397.80 $404.58 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $179.01 $78.95 N/A $230.84 $397.80 $238.68 $397.80 $82.90 $397.80 N/A N/A 02.221.518 SUP HCPCS C1713 02.221.518 - SCREW BONE 5MM 18MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $398.00 $295.00 $78.95 $404.58 $179.01 $179.01 $179.01 $179.01 $397.80 $397.80 $397.80 $82.91 $397.80 $397.80 $397.80 $397.80 $397.80 $82.91 $397.80 $404.58 $235.30 $397.80 $404.58 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $179.01 $78.95 N/A $230.84 $397.80 $238.68 $397.80 $82.90 $397.80 N/A N/A 02.224.030S SUP HCPCS C1713 02.224.030S - SCREW BONE HELIX 30MM LCP DHHS STAINLESS STEEL HIP STERILE BOTH IP/OP $174.00 $129.00 $34.46 $176.55 $78.12 $78.12 $78.12 $78.12 $173.60 $173.60 $173.60 $36.18 $173.60 $173.60 $173.60 $173.60 $173.60 $36.18 $173.60 $176.55 $102.68 $173.60 $176.55 $173.60 $173.60 $130.50 $173.60 $173.60 $173.60 $86.80 $86.80 $137.49 $173.60 $138.88 $78.12 $34.46 N/A $100.92 $173.60 $104.16 $173.60 $36.18 $173.60 N/A N/A 02.226.000 SUP HCPCS C1713 02.226.000 - GUIDEWIRE ORTHOPEDIC 1.6MM 220MM TROCAR POINT THREADED BOTH IP/OP $71.00 $53.00 $14.09 $72.18 $31.94 $31.94 $31.94 $31.94 $70.98 $70.98 $70.98 $14.79 $70.98 $70.98 $70.98 $70.98 $70.98 $14.79 $70.98 $72.18 $41.98 $70.98 $72.18 $70.98 $70.98 $53.25 $70.98 $70.98 $70.98 $35.49 $35.49 $56.22 $70.98 $56.78 $31.94 $14.09 N/A $41.18 $70.98 $70.98 $70.98 $14.79 $70.98 N/A N/A 02.226.001 SUP HCPCS C1713 02.226.001 - GUIDEWIRE ORTHOPEDIC 1.6MM 220MM TROCAR POINT NONTHREADED BOTH IP/OP $70.50 $52.00 $13.95 $71.48 $31.63 $31.63 $31.63 $31.63 $70.28 $70.28 $70.28 $14.65 $70.28 $70.28 $70.28 $70.28 $70.28 $14.65 $70.28 $28.59 $41.57 $70.28 $71.48 $70.28 $70.28 $52.88 $70.28 $70.28 $70.28 $35.14 $35.14 $55.66 $70.28 $56.22 $31.63 $13.95 N/A $40.89 $70.28 $42.17 $70.28 $14.65 $70.28 N/A N/A 02.226.010 SUP HCPCS C1713 02.226.010 - SCREW BONE T8 3MM 2MM 1.1MM 10MM 4MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.011 SUP HCPCS C1713 02.226.011 - SCREW BONE T8 3MM 2MM 1.1MM 11MM 4MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.012 SUP HCPCS C1713 02.226.012 - SCREW BONE T8 3MM 2MM 1.1MM 12MM 4MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.013 SUP HCPCS C1713 02.226.013 - SCREW BONE T8 3MM 2MM 1.1MM 13MM 4MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 02.226.014 SUP HCPCS C1713 02.226.014 - SCREW BONE T8 3MM 2MM 1.1MM 14MM 4MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.015 SUP HCPCS C1713 02.226.015 - SCREW BONE T8 3MM 2MM 1.1MM 15MM 4MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.016 SUP HCPCS C1713 02.226.016 - SCREW BONE T8 3MM 2MM 1.1MM 16MM 4MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 02.226.017 SUP HCPCS C1713 02.226.017 - SCREW BONE T8 3MM 2MM 1.1MM 17MM 4MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.018 SUP HCPCS C1713 02.226.018 - SCREW BONE 1.1MM SHORT THREAD 3MM 2MM 18MM 4MM T8 STARDRIVE BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.019 SUP HCPCS C1713 02.226.019 - SCREW BONE T8 3MM 2MM 1.1MM 19MM 4MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.020 SUP HCPCS C1713 02.226.020 - SCREW BONE T8 3MM 2MM 1.1MM 20MM 4MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.021 SUP HCPCS C1713 02.226.021 - SCREW BONE T8 3MM 2MM 1.1MM 21MM 4MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.022 SUP HCPCS C1713 02.226.022 - SCREW BONE T8 3MM 2MM 1.1MM 22MM 4MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.023 SUP HCPCS C1713 02.226.023 - SCREW BONE T8 3MM 2MM 1.1MM 23MM 4MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.024 SUP HCPCS C1713 02.226.024 - SCREW BONE T8 3MM 2MM 1.1MM 24MM 5MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.025 SUP HCPCS C1713 02.226.025 - SCREW BONE T8 3MM 2MM 1.1MM 25MM 5MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.026 SUP HCPCS C1713 02.226.026 - SCREW BONE T8 3MM 2MM 1.1MM 26MM 5MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.027 SUP HCPCS C1713 02.226.027 - SCREW BONE T8 3MM 2MM 1.1MM 27MM 6MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.028 SUP HCPCS C1713 02.226.028 - SCREW BONE T8 3MM 2MM 1.1MM 28MM 6MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.029 SUP HCPCS C1713 02.226.029 - SCREW BONE T8 3MM 2MM 1.1MM 29MM 6MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.030 SUP HCPCS C1713 02.226.030 - SCREW BONE T8 3MM 2MM 1.1MM 30MM 7MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.032 SUP HCPCS C1713 02.226.032 - SCREW BONE T8 3MM 2MM 1.1MM 32MM 7MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.034 SUP HCPCS C1713 02.226.034 - SCREW BONE T8 3MM 2MM 1.1MM 34MM 8MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.036 SUP HCPCS C1713 02.226.036 - SCREW BONE 1.1MM SHORT THREAD 3MM 2MM 36MM 9MM T8 STARDRIVE BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.038 SUP HCPCS C1713 02.226.038 - SCREW BONE T8 3MM 2MM 1.1MM 38MM 9MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.040 SUP HCPCS C1713 02.226.040 - SCREW BONE T8 3MM 2MM 1.1MM 40MM 10MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.116 SUP HCPCS C1713 02.226.116 - SCREW BONE LNGTHRD 3MM 2MM 16MM 5MM SELF TAP DRILL BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.117 SUP HCPCS C1713 02.226.117 - SCREW BONE LNGTHRD 3MM 2MM 17MM 6MM T8 STARDRIVE CANN SELF BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.118 SUP HCPCS C1713 02.226.118 - SCREW BONE LNGTHRD 3MM 2MM 1.1MM 18MM 6MM T8 STARDRIVE CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.119 SUP HCPCS C1713 02.226.119 - SCREW BONE LNGTHRD 3MM 2MM 1.1MM 19MM 7MM T8 STARDRIVE CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.120 SUP HCPCS C1713 02.226.120 - SCREW BONE LNGTHRD 3MM 2MM 20MM 7MM T8 STARDRIVE CANN SELF BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.121 SUP HCPCS C1713 02.226.121 - SCREW BONE LNGTHRD 3MM 2MM 1.1MM 21MM 8MM T8 STARDRIVE CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.122 SUP HCPCS C1713 02.226.122 - SCREW BONE T8 3MM 2MM 1.1MM 22MM 8MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.123 SUP HCPCS C1713 02.226.123 - SCREW BONE LNGTHRD 3MM 2MM 1.1MM 23MM 8MM T8 STARDRIVE CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.124 SUP HCPCS C1713 02.226.124 - SCREW BONE LNGTHRD 3MM 2MM 1.1MM 24MM 8MM T8 STARDRIVE CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.125 SUP HCPCS C1713 02.226.125 - SCREW BONE T8 3MM 2MM 1.1MM 25MM 8MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.126 SUP HCPCS C1713 02.226.126 - SCREW BONE 1.1MM LNGTHRD 3MM 2MM 26MM 10MM T8 STARDRIVE BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 02.226.127 SUP HCPCS C1713 02.226.127 - SCREW BONE T8 3MM 2MM 1.1MM 27MM 10MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.128 SUP HCPCS C1713 02.226.128 - SCREW BONE T8 3MM 2MM 1.1MM 28MM 10MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.129 SUP HCPCS C1713 02.226.129 - SCREW BONE LNGTHRD 3MM 2MM 1.1MM 29MM 10MM T8 STARDRIVE CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.130 SUP HCPCS C1713 02.226.130 - SCREW BONE T8 3MM 2MM 1.1MM 30MM 12MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.132 SUP HCPCS C1713 02.226.132 - SCREW BONE 1.1MM LNGTHRD 3MM 2MM 32MM 12MM COMPRESSION CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.134 SUP HCPCS C1713 02.226.134 - SCREW BONE T8 3MM 2MM 1.1MM 34MM 14MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.136 SUP HCPCS C1713 02.226.136 - SCREW BONE LNGTHRD 3MM 2MM 36MM 14MM COMPRESSION CANN T8 BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.138 SUP HCPCS C1713 02.226.138 - SCREW BN T8 L/T FLUT 3MM 2MM 38MM NS 16MM CMPR CNN ST HDLS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.140 SUP HCPCS C1713 02.226.140 - SCREW BONE T8 3MM 2MM 1.1MM 40MM 16MM SELF DRILL SELF TAP BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.209 SUP HCPCS C1713 02.226.209 - SCREW BONE SHORT THREAD 2.4MM 9MM 4MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.210 SUP HCPCS C1713 02.226.210 - SCREW BONE T8 2.4MM 10MM 4MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.211 SUP HCPCS C1713 02.226.211 - SCREW BONE T8 2.4MM 11MM 4MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.212 SUP HCPCS C1713 02.226.212 - SCREW BONE T8 2.4MM 12MM 4MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.213 SUP HCPCS C1713 02.226.213 - SCREW BONE T8 2.4MM 13MM 4MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.214 SUP HCPCS C1713 02.226.214 - SCREW BONE T8 2.4MM 14MM 4MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.215 SUP HCPCS C1713 02.226.215 - SCREW BONE T8 2.4MM 15MM 4MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.216 SUP HCPCS C1713 02.226.216 - SCREW BONE T8 2.4MM 16MM 4MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.217 SUP HCPCS C1713 02.226.217 - SCREW BONE T8 2.4MM 17MM 4MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.218 SUP HCPCS C1713 02.226.218 - SCREW BONE T8 2.4MM 18MM 4MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.219 SUP HCPCS C1713 02.226.219 - SCREW BONE T8 2.4MM 19MM 4MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.220 SUP HCPCS C1713 02.226.220 - SCREW BONE T8 2.4MM 20MM 4MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 02.226.221 SUP HCPCS C1713 02.226.221 - SCREW BONE T8 2.4MM 21MM 4MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.222 SUP HCPCS C1713 02.226.222 - SCREW BONE T8 2.4MM 22MM 4MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.223 SUP HCPCS C1713 02.226.223 - SCREW BONE T8 2.4MM 23MM 4MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.224 SUP HCPCS C1713 02.226.224 - SCREW BONE T8 2.4MM 24MM 5MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 02.226.225 SUP HCPCS C1713 02.226.225 - SCREW BONE T8 2.4MM 25MM 5MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.226 SUP HCPCS C1713 02.226.226 - SCREW BONE T8 2.4MM 26MM 5MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.227 SUP HCPCS C1713 02.226.227 - SCREW BONE T8 2.4MM 27MM 6MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.228 SUP HCPCS C1713 02.226.228 - SCREW BONE T8 2.4MM 28MM 6MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 02.226.229 SUP HCPCS C1713 02.226.229 - SCREW BONE T8 2.4MM 29MM 6MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.230 SUP HCPCS C1713 02.226.230 - SCREW BONE T8 2.4MM 30MM 7MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.232 SUP HCPCS C1713 02.226.232 - SCREW BONE T8 2.4MM 32MM 7MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.234 SUP HCPCS C1713 02.226.234 - SCREW BONE T8 2.4MM 34MM 8MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 02.226.236 SUP HCPCS C1713 02.226.236 - SCREW BONE T8 2.4MM 36MM 9MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 02.226.238 SUP HCPCS C1713 02.226.238 - SCREW BONE T8 2.4MM 38MM 9MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.240 SUP HCPCS C1713 02.226.240 - SCREW BONE T8 2.4MM 40MM 10MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.317 SUP HCPCS C1713 02.226.317 - SCREW BONE T8 2.4MM 17MM 6MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.318 SUP HCPCS C1713 02.226.318 - SCREW BONE T8 2.4MM 18MM 6MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 02.226.319 SUP HCPCS C1713 02.226.319 - SCREW BONE T8 2.4MM 19MM 7MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.320 SUP HCPCS C1713 02.226.320 - SCREW BONE T8 2.4MM 20MM 7MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 02.226.321 SUP HCPCS C1713 02.226.321 - SCREW BONE T8 2.4MM 21MM 8MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.322 SUP HCPCS C1713 02.226.322 - SCREW BONE T8 2.4MM 22MM 8MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.323 SUP HCPCS C1713 02.226.323 - SCREW BONE T8 2.4MM 23MM 8MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.324 SUP HCPCS C1713 02.226.324 - SCREW BONE T8 2.4MM 24MM 8MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.325 SUP HCPCS C1713 02.226.325 - SCREW BONE T8 2.4MM 25MM 8MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.326 SUP HCPCS C1713 02.226.326 - SCREW BONE T8 2.4MM 26MM 10MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 02.226.327 SUP HCPCS C1713 02.226.327 - SCREW BONE T8 2.4MM 27MM 10MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.328 SUP HCPCS C1713 02.226.328 - SCREW BONE T8 2.4MM 28MM 10MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.329 SUP HCPCS C1713 02.226.329 - SCREW BONE T8 2.4MM 29MM 10MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $133.58 $641.00 N/A N/A 02.226.330 SUP HCPCS C1713 02.226.330 - SCREW BONE T8 2.4MM 30MM 12MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.332 SUP HCPCS C1713 02.226.332 - SCREW BONE T8 2.4MM 32MM 12MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 02.226.334 SUP HCPCS C1713 02.226.334 - SCREW BONE T8 2.4MM 34MM 14MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.336 SUP HCPCS C1713 02.226.336 - SCREW BONE T8 2.4MM 36MM 14MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.338 SUP HCPCS C1713 02.226.338 - SCREW BONE T8 2.4MM 38MM 16MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.340 SUP HCPCS C1713 02.226.340 - SCREW BONE T8 2.4MM 40MM 16MM SELF DRILL SELF TAP CANN BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 02.226.620 SUP HCPCS C1713 02.226.620 - SCREW BONE T15 4.5MM 20MM 7MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.622 SUP HCPCS C1713 02.226.622 - SCREW BONE T15 4.5MM 22MM 7MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.624 SUP HCPCS C1713 02.226.624 - SCREW BONE T15 4.5MM 24MM 7MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.226.626 SUP HCPCS C1713 02.226.626 - SCREW BONE T15 4.5MM 26MM 7MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.628 SUP HCPCS C1713 02.226.628 - SCREW BONE T15 4.5MM 28MM 7MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.630 SUP HCPCS C1713 02.226.630 - SCREW BONE SHORT THREAD 4.5MM 30MM 7MM COMPRESSION HEADLESS BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.632 SUP HCPCS C1713 02.226.632 - SCREW BONE T15 4.5MM 32MM 7MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.634 SUP HCPCS C1713 02.226.634 - SCREW BONE T15 4.5MM 34MM 7MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.636 SUP HCPCS C1713 02.226.636 - SCREW BONE T15 4.5MM 36MM 7MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.226.638 SUP HCPCS C1713 02.226.638 - SCREW BONE T15 4.5MM 38MM 7MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.226.640 SUP HCPCS C1713 02.226.640 - SCREW BONE T15 4.5MM 40MM 8MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.226.642 SUP HCPCS C1713 02.226.642 - SCREW BONE T15 4.5MM 42MM 8MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.226.644 SUP HCPCS C1713 02.226.644 - SCREW BONE T15 4.5MM 44MM 9MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.226.646 SUP HCPCS C1713 02.226.646 - SCREW BONE T15 4.5MM 46MM 9MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.648 SUP HCPCS C1713 02.226.648 - SCREW BONE T15 4.5MM 48MM 9MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.650 SUP HCPCS C1713 02.226.650 - SCREW BONE T15 4.5MM 50MM 10MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.652 SUP HCPCS C1713 02.226.652 - SCREW BONE T15 4.5MM 52MM 10MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.654 SUP HCPCS C1713 02.226.654 - SCREW BONE T15 4.5MM 54MM 11MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.226.656 SUP HCPCS C1713 02.226.656 - SCREW BONE T15 4.5MM 56MM 11MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 02.226.658 SUP HCPCS C1713 02.226.658 - SCREW BONE T15 4.5MM 58MM 11MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.660 SUP HCPCS C1713 02.226.660 - SCREW BONE T15 4.5MM 60MM 12MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.665 SUP HCPCS C1713 02.226.665 - SCREW BONE T15 4.5MM 65MM 13MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.670 SUP HCPCS C1713 02.226.670 - SCREW BONE T15 4.5MM 70MM 14MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.226.675 SUP HCPCS C1713 02.226.675 - SCREW BONE T15 4.5MM 75MM 15MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.226.680 SUP HCPCS C1713 02.226.680 - SCREW BONE T15 4.5MM 80MM 16MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.226.685 SUP HCPCS C1713 02.226.685 - SCREW BONE T15 4.5MM 85MM 17MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.690 SUP HCPCS C1713 02.226.690 - SCREW BONE T15 4.5MM 90MM 18MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.695 SUP HCPCS C1713 02.226.695 - SCREW BONE T15 4.5MM 95MM 19MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.226.700 SUP HCPCS C1713 02.226.700 - SCREW BONE T15 4.5MM 100MM 20MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.226.730 SUP HCPCS C1713 02.226.730 - SCREW BONE T15 4.5MM 30MM 12MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.732 SUP HCPCS C1713 02.226.732 - SCREW BONE T15 4.5MM 32MM 12MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.226.734 SUP HCPCS C1713 02.226.734 - SCREW BONE T15 4.5MM 34MM 12MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 02.226.736 SUP HCPCS C1713 02.226.736 - SCREW BONE T15 4.5MM 36MM 14MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.738 SUP HCPCS C1713 02.226.738 - SCREW BONE T15 4.5MM 38MM 14MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.740 SUP HCPCS C1713 02.226.740 - SCREW BONE T15 4.5MM 40MM 16MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.742 SUP HCPCS C1713 02.226.742 - SCREW BONE T15 4.5MM 42MM 16MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.744 SUP HCPCS C1713 02.226.744 - SCREW BONE T15 4.5MM 44MM 18MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.746 SUP HCPCS C1713 02.226.746 - SCREW BONE T15 4.5MM 46MM 18MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.226.748 SUP HCPCS C1713 02.226.748 - SCREW BONE T15 4.5MM 48MM 18MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.750 SUP HCPCS C1713 02.226.750 - SCREW BONE T15 4.5MM 50MM 20MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.752 SUP HCPCS C1713 02.226.752 - SCREW BONE T15 4.5MM 52MM 20MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.754 SUP HCPCS C1713 02.226.754 - SCREW BONE T15 4.5MM 54MM 22MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.756 SUP HCPCS C1713 02.226.756 - SCREW BONE LNGTHRD 4.5MM 56MM 22MM SLFDRILL SLFTAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.758 SUP HCPCS C1713 02.226.758 - SCREW BONE T15 4.5MM 58MM 22MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.760 SUP HCPCS C1713 02.226.760 - SCREW BONE T15 4.5MM 60MM 24MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.765 SUP HCPCS C1713 02.226.765 - SCREW BONE T15 4.5MM 65MM 26MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.770 SUP HCPCS C1713 02.226.770 - SCREW BONE T15 4.5MM 70MM 28MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.226.775 SUP HCPCS C1713 02.226.775 - SCREW BONE T15 4.5MM 75MM 30MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.226.780 SUP HCPCS C1713 02.226.780 - SCREW BONE T15 4.5MM 80MM 32MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.226.785 SUP HCPCS C1713 02.226.785 - SCREW BONE T15 4.5MM 85MM 34MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.226.790 SUP HCPCS C1713 02.226.790 - SCREW BONE T15 4.5MM 90MM 36MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.226.795 SUP HCPCS C1713 02.226.795 - SCREW BONE T15 4.5MM 95MM 38MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.226.800 SUP HCPCS C1713 02.226.800 - SCREW BONE T15 4.5MM 100MM 40MM SELF DRILL SELF TAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.001 SUP HCPCS C1713 02.227.001 - GUIDEWIRE ORTHOPEDIC 2.8MM 300MM NONTHREADED TROCAR POINT BOTH IP/OP $79.50 $59.00 $15.76 $80.75 $35.73 $35.73 $35.73 $35.73 $79.40 $79.40 $79.40 $16.55 $79.40 $79.40 $79.40 $79.40 $79.40 $16.55 $79.40 $32.30 $46.97 $79.40 $80.75 $79.40 $79.40 $59.63 $79.40 $79.40 $79.40 $39.70 $39.70 $62.88 $79.40 $63.52 $35.73 $15.76 N/A $46.11 $79.40 $47.64 $79.40 $16.55 $79.40 N/A N/A 02.227.030 SUP HCPCS C1713 02.227.030 - SCREW BONE 6.5MM 30MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.035 SUP HCPCS C1713 02.227.035 - SCREW BONE 6.5MM 35MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.040 SUP HCPCS C1713 02.227.040 - SCREW BONE 6.5MM 40MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.227.045 SUP HCPCS C1713 02.227.045 - SCREW BONE 6.5MM 45MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.227.050 SUP HCPCS C1713 02.227.050 - SCREW BONE 6.5MM 50MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.055 SUP HCPCS C1713 02.227.055 - SCREW BONE 6.5MM 55MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.060 SUP HCPCS C1713 02.227.060 - SCREW BONE 6.5MM 60MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.065 SUP HCPCS C1713 02.227.065 - SCREW BONE 6.5MM 65MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.227.070 SUP HCPCS C1713 02.227.070 - SCREW BONE 6.5MM 70MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 02.227.075 SUP HCPCS C1713 02.227.075 - SCREW BONE 6.5MM 75MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 02.227.080 SUP HCPCS C1713 02.227.080 - SCREW BONE 6.5MM 80MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.085 SUP HCPCS C1713 02.227.085 - SCREW BONE 6.5MM 85MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.090 SUP HCPCS C1713 02.227.090 - SCREW BONE 6.5MM 90MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.095 SUP HCPCS C1713 02.227.095 - SCREW BONE 6.5MM 95MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 02.227.100 SUP HCPCS C1713 02.227.100 - SCREW BONE 6.5MM 100MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 02.227.105 SUP HCPCS C1713 02.227.105 - SCREW BONE 6.5MM 105MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.110 SUP HCPCS C1713 02.227.110 - SCREW BONE 6.5MM 110MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 02.227.115 SUP HCPCS C1713 02.227.115 - SCREW BONE 6.5MM 115MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 02.227.120 SUP HCPCS C1713 02.227.120 - SCREW BONE 6.5MM 120MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.125 SUP HCPCS C1713 02.227.125 - SCREW BONE 6.5MM 125MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.227.130 SUP HCPCS C1713 02.227.130 - SCREW BONE 6.5MM 130MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.227.135 SUP HCPCS C1713 02.227.135 - SCREW BONE 6.5MM 135MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.140 SUP HCPCS C1713 02.227.140 - SCREW BONE 6.5MM 140MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.145 SUP HCPCS C1713 02.227.145 - SCREW BONE 6.5MM 145MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.227.150 SUP HCPCS C1713 02.227.150 - SCREW BONE 6.5MM 150MM 16MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.227.245 SUP HCPCS C1713 02.227.245 - SCREW BONE 6.5MM 45MM 32MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.250 SUP HCPCS C1713 02.227.250 - SCREW BONE 6.5MM 50MM 32MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 02.227.255 SUP HCPCS C1713 02.227.255 - SCREW BONE 6.5MM 55MM 32MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.260 SUP HCPCS C1713 02.227.260 - SCREW BONE 6.5MM 60MM 32MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.265 SUP HCPCS C1713 02.227.265 - SCREW BONE 6.5MM 65MM 32MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.270 SUP HCPCS C1713 02.227.270 - SCREW BONE 6.5MM 70MM 32MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.275 SUP HCPCS C1713 02.227.275 - SCREW BONE 6.5MM 75MM 32MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.280 SUP HCPCS C1713 02.227.280 - SCREW BONE 6.5MM 80MM 32MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.285 SUP HCPCS C1713 02.227.285 - SCREW BONE 6.5MM 7.5MM 85MM 32MM 2 LEAD COMPRESSION SLFTAP BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.290 SUP HCPCS C1713 02.227.290 - SCREW BN 6.5MM 7.5MM 90MM NS 32MM CMPR ST SLF DRL HDLS SS BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.295 SUP HCPCS C1713 02.227.295 - SCREW BONE 6.5MM 95MM 32MM COMPRESSION HEADLESS STAINLESS BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.300 SUP HCPCS C1713 02.227.300 - SCREW BONE 6.5MM 100MM 32MM COMPRESSION HEADLESS STAINLESS BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.305 SUP HCPCS C1713 02.227.305 - SCREW BONE FLUTE 6.5MM 7.5MM 105MM 32MM 2 LEAD SELF TAP SELF BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.310 SUP HCPCS C1713 02.227.310 - SCREW BONE FLUTE 6.5MM 7.5MM 110MM 32MM 2 LEAD SELF TAP SELF BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.315 SUP HCPCS C1713 02.227.315 - SCREW BONE FLUTE 6.5MM 7.5MM 115MM 32MM 2 LEAD SELF TAP SELF BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.320 SUP HCPCS C1713 02.227.320 - SCREW BN 4MM FLUT 6.5MM 7.5MM 120MM NS 32MM 2 LD ST SLF DRL BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.325 SUP HCPCS C1713 02.227.325 - SCREW BN 4MM FLUT 6.5MM 7.5MM 125MM NS 32MM 2 LD ST SLF DRL BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.330 SUP HCPCS C1713 02.227.330 - SCREW BONE FLUTE 6.5MM 7.5MM 130MM 32MM 2 LEAD SELF TAP SELF BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 02.227.335 SUP HCPCS C1713 02.227.335 - SCREW BONE 6.5MM 135MM 32MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.340 SUP HCPCS C1713 02.227.340 - SCREW BONE 6.5MM 140MM 32MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.345 SUP HCPCS C1713 02.227.345 - SCREW BONE 6.5MM 145MM 32MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.227.350 SUP HCPCS C1713 02.227.350 - SCREW BONE 6.5MM 150MM 32MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 02.230.109 SUP HCPCS C1713 02.230.109 - SCREW BONE T4 1.5MM 9MM 4MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $486.38 $486.38 N/A N/A 02.230.110 SUP HCPCS C1713 02.230.110 - SCREW BONE T4 1.5MM 10MM 4MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 02.230.111 SUP HCPCS C1713 02.230.111 - SCREW BONE T4 1.5MM 11MM 4MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 02.230.112 SUP HCPCS C1713 02.230.112 - SCREW BONE T4 1.5MM 12MM 4MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 02.230.113 SUP HCPCS C1713 02.230.113 - SCREW BONE T4 1.5MM 13MM 4MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 02.230.114 SUP HCPCS C1713 02.230.114 - SCREW BONE 1.5MM 1MM 14MM 4MM COMPRESSION THREAD HEADLESS T4 BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $486.38 $486.38 N/A N/A 02.230.115 SUP HCPCS C1713 02.230.115 - SCREW BONE T4 1.5MM 15MM 4MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 02.230.116 SUP HCPCS C1713 02.230.116 - SCREW BONE T4 1.5MM 16MM 5MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $486.38 $486.38 N/A N/A 02.230.117 SUP HCPCS C1713 02.230.117 - SCREW BONE T4 1.5MM 17MM 5MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 02.230.118 SUP HCPCS C1713 02.230.118 - SCREW BONE T4 1.5MM 18MM 5MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 02.230.119 SUP HCPCS C1713 02.230.119 - SCREW BONE T4 1.5MM 19MM 5MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 02.230.120 SUP HCPCS C1713 02.230.120 - SCREW BONE T4 1.5MM 20MM 6MM SELF DRILL SELF TAP COMPRESSION BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $197.86 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $486.38 $486.38 N/A N/A 02.231.010S SUP HCPCS C1713 02.231.010S - SCREW BN 5MM 10MM STRL LCK VA ST RND HD SS CNDYL PERIART BOTH IP/OP $571.00 $423.00 $113.27 $580.40 $256.82 $256.82 $256.82 $256.82 $570.70 $570.70 $570.70 $118.95 $570.70 $570.70 $570.70 $570.70 $570.70 $118.94 $570.70 $580.40 $337.57 $570.70 $580.40 $570.70 $570.70 $428.25 $570.70 $570.70 $570.70 $285.35 $285.35 $451.99 $570.70 $456.56 $256.82 $113.27 N/A $331.18 $570.70 $570.70 $570.70 $118.93 $570.70 N/A N/A 02.231.012 SUP HCPCS C1713 02.231.012 - SCREW BONE T25 5MM 12MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $479.50 $355.00 $95.14 $487.50 $215.71 $215.71 $215.71 $215.71 $479.35 $479.35 $479.35 $99.91 $479.35 $479.35 $479.35 $479.35 $479.35 $99.90 $479.35 $195.00 $283.54 $479.35 $487.50 $479.35 $479.35 $359.63 $479.35 $479.35 $479.35 $239.68 $239.68 $379.65 $479.35 $383.48 $215.71 $95.14 N/A $278.11 $479.35 $287.61 $479.35 $99.90 $479.35 N/A N/A 02.231.012S SUP HCPCS C1713 02.231.012S - SCREW BN T25 5MM 12MM STRL LCP VA ST STRDR SS CNDYL BOTH IP/OP $571.00 $423.00 $113.27 $580.40 $256.82 $256.82 $256.82 $256.82 $570.70 $570.70 $570.70 $118.95 $570.70 $570.70 $570.70 $570.70 $570.70 $118.94 $570.70 $232.16 $337.57 $570.70 $580.40 $570.70 $570.70 $428.25 $570.70 $570.70 $570.70 $285.35 $285.35 $451.99 $570.70 $456.56 $256.82 $113.27 N/A $331.18 $570.70 $570.70 $570.70 $118.93 $570.70 N/A N/A 02.231.016 SUP HCPCS C1713 02.231.016 - SCREW BONE T25 5MM 16MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $479.50 $355.00 $95.14 $487.50 $215.71 $215.71 $215.71 $215.71 $479.35 $479.35 $479.35 $99.91 $479.35 $479.35 $479.35 $479.35 $479.35 $99.90 $479.35 $487.50 $283.54 $479.35 $487.50 $479.35 $479.35 $359.63 $479.35 $479.35 $479.35 $239.68 $239.68 $379.65 $479.35 $383.48 $215.71 $95.14 N/A $278.11 $479.35 $287.61 $479.35 $99.90 $479.35 N/A N/A 02.231.018S SUP HCPCS C1713 02.231.018S - SCREW BN T25 5MM 18MM STRL ST LCK VA THRD RND HD SS CNDRL BOTH IP/OP $571.00 $423.00 $113.27 $580.40 $256.82 $256.82 $256.82 $256.82 $570.70 $570.70 $570.70 $118.95 $570.70 $570.70 $570.70 $570.70 $570.70 $118.94 $570.70 $580.40 $337.57 $570.70 $580.40 $570.70 $570.70 $428.25 $570.70 $570.70 $570.70 $285.35 $285.35 $451.99 $570.70 $456.56 $256.82 $113.27 N/A $331.18 $570.70 $342.42 $570.70 $118.93 $570.70 N/A N/A 02.231.220 SUP HCPCS C1713 02.231.220 - SCREW BONE T25 5MM 20MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $138.95 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $204.95 $341.58 $71.19 $341.58 N/A N/A 02.231.222 SUP HCPCS C1713 02.231.222 - SCREW BONE T25 5MM 22MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $347.38 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $204.95 $341.58 $71.19 $341.58 N/A N/A 02.231.224 SUP HCPCS C1713 02.231.224 - SCREW BONE T25 5MM 24MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $347.38 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $204.95 $341.58 $71.19 $341.58 N/A N/A 02.231.226 SUP HCPCS C1713 02.231.226 - SCREW BONE T25 5MM 26MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $347.38 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $341.58 $341.58 $71.19 $341.58 N/A N/A 02.231.228 SUP HCPCS C1713 02.231.228 - SCREW BONE T25 5MM 28MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $138.95 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $341.58 $341.58 $71.19 $341.58 N/A N/A 02.231.230 SUP HCPCS C1713 02.231.230 - SCREW BONE T25 5MM 30MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $138.95 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $204.95 $341.58 $71.19 $341.58 N/A N/A 02.231.234 SUP HCPCS C1713 02.231.234 - SCREW BONE T25 5MM 34MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $347.38 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $204.95 $341.58 $71.19 $341.58 N/A N/A 02.231.236 SUP HCPCS C1713 02.231.236 - SCREW BONE T25 5MM 36MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $347.38 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $204.95 $341.58 $71.19 $341.58 N/A N/A 02.231.238 SUP HCPCS C1713 02.231.238 - SCREW BONE T25 5MM 38MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $347.38 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $204.95 $341.58 $71.19 $341.58 N/A N/A 02.231.240 SUP HCPCS C1713 02.231.240 - SCREW BONE T25 5MM 40MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $347.38 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $204.95 $341.58 $71.19 $341.58 N/A N/A 02.231.242 SUP HCPCS C1713 02.231.242 - SCREW BONE T25 5MM 42MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $347.38 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $341.58 $341.58 $71.19 $341.58 N/A N/A 02.231.270 SUP HCPCS C1713 02.231.270 - SCREW BONE T25 5MM 70MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $347.38 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $341.58 $341.58 $71.19 $341.58 N/A N/A 02.231.275 SUP HCPCS C1713 02.231.275 - SCREW BONE T25 5MM 75MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $347.38 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $341.58 $341.58 $71.19 $341.58 N/A N/A 02.231.280 SUP HCPCS C1713 02.231.280 - SCREW BONE T25 5MM 80MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $347.38 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $204.95 $341.58 $71.19 $341.58 N/A N/A 02.231.285 SUP HCPCS C1713 02.231.285 - SCREW BONE T25 5MM 85MM VAR ANG SELF TAP STARDRIVE LCP BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $347.38 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $204.95 $341.58 $71.19 $341.58 N/A N/A 02.231.295S SUP HCPCS C1713 02.231.295S - SCREW BN 5MM 95MM STRL LCP T25 STRDR RCS LCK VA ST SS CNDYL BOTH IP/OP $436.00 $323.00 $86.49 $443.18 $196.10 $196.10 $196.10 $196.10 $435.78 $435.78 $435.78 $90.83 $435.78 $435.78 $435.78 $435.78 $435.78 $90.82 $435.78 $177.27 $257.76 $435.78 $443.18 $435.78 $435.78 $327.00 $435.78 $435.78 $435.78 $217.89 $217.89 $345.14 $435.78 $348.62 $196.10 $86.49 N/A $252.88 $435.78 $261.47 $435.78 $90.82 $435.78 N/A N/A 02.231.300S SUP HCPCS C1713 02.231.300S - SCREW BN 5MM 100MM STRL LCP T25 STRDR RCS LCK VA ST SS CNDYL BOTH IP/OP $436.00 $323.00 $86.49 $443.18 $196.10 $196.10 $196.10 $196.10 $435.78 $435.78 $435.78 $90.83 $435.78 $435.78 $435.78 $435.78 $435.78 $90.82 $435.78 $177.27 $257.76 $435.78 $443.18 $435.78 $435.78 $327.00 $435.78 $435.78 $435.78 $217.89 $217.89 $345.14 $435.78 $348.62 $196.10 $86.49 N/A $252.88 $435.78 $261.47 $435.78 $90.82 $435.78 N/A N/A 02.231.640 SUP HCPCS C1713 02.231.640 - SCREW BONE 3.5MM HEXAGON FLUTE 5MM 40MM VAR ANG SELF DRILL BOTH IP/OP $464.00 $343.00 $92.07 $471.75 $208.75 $208.75 $208.75 $208.75 $463.88 $463.88 $463.88 $96.68 $463.88 $463.88 $463.88 $463.88 $463.88 $96.68 $463.88 $188.70 $274.39 $463.88 $471.75 $463.88 $463.88 $348.00 $463.88 $463.88 $463.88 $231.94 $231.94 $367.39 $463.88 $371.10 $208.75 $92.07 N/A $269.12 $463.88 $278.33 $463.88 $96.67 $463.88 N/A N/A 02.231.675 SUP HCPCS C1713 02.231.675 - SCREW BONE 3.5MM HEXAGON FLUTE 5MM 75MM VAR ANG SELF DRILL BOTH IP/OP $464.00 $343.00 $92.07 $471.75 $208.75 $208.75 $208.75 $208.75 $463.88 $463.88 $463.88 $96.68 $463.88 $463.88 $463.88 $463.88 $463.88 $96.68 $463.88 $471.75 $274.39 $463.88 $471.75 $463.88 $463.88 $348.00 $463.88 $463.88 $463.88 $231.94 $231.94 $367.39 $463.88 $371.10 $208.75 $92.07 N/A $269.12 $463.88 $278.33 $463.88 $96.67 $463.88 N/A N/A 02.231.680 SUP HCPCS C1713 02.231.680 - SCREW BONE 3.5MM HEXAGON FLUTE 5MM 80MM VAR ANG SELF DRILL BOTH IP/OP $464.00 $343.00 $92.07 $471.75 $208.75 $208.75 $208.75 $208.75 $463.88 $463.88 $463.88 $96.68 $463.88 $463.88 $463.88 $463.88 $463.88 $96.68 $463.88 $188.70 $274.39 $463.88 $471.75 $463.88 $463.88 $348.00 $463.88 $463.88 $463.88 $231.94 $231.94 $367.39 $463.88 $371.10 $208.75 $92.07 N/A $269.12 $463.88 $278.33 $463.88 $96.67 $463.88 N/A N/A 02.231.685 SUP HCPCS C1713 02.231.685 - SCREW BONE 3.5MM HEXAGON FLUTE 5MM 85MM VAR ANG SELF DRILL BOTH IP/OP $464.00 $343.00 $92.07 $471.75 $208.75 $208.75 $208.75 $208.75 $463.88 $463.88 $463.88 $96.68 $463.88 $463.88 $463.88 $463.88 $463.88 $96.68 $463.88 $188.70 $274.39 $463.88 $471.75 $463.88 $463.88 $348.00 $463.88 $463.88 $463.88 $231.94 $231.94 $367.39 $463.88 $371.10 $208.75 $92.07 N/A $269.12 $463.88 $463.88 $463.88 $96.67 $463.88 N/A N/A 02.231.690 SUP HCPCS C1713 02.231.690 - SCREW BONE 3.5MM HEXAGON FLUTE 5MM 90MM VAR ANG SELF DRILL BOTH IP/OP $464.00 $343.00 $92.07 $471.75 $208.75 $208.75 $208.75 $208.75 $463.88 $463.88 $463.88 $96.68 $463.88 $463.88 $463.88 $463.88 $463.88 $96.68 $463.88 $471.75 $274.39 $463.88 $471.75 $463.88 $463.88 $348.00 $463.88 $463.88 $463.88 $231.94 $231.94 $367.39 $463.88 $371.10 $208.75 $92.07 N/A $269.12 $463.88 $278.33 $463.88 $96.67 $463.88 N/A N/A 02.231.695S SUP HCPCS C1713 02.231.695S - SCREW BN 5MM 3.5MM 95MM STRL VA ST TIP LCK CNN SS CNDRL BOTH IP/OP $561.00 $415.00 $111.32 $570.40 $252.40 $252.40 $252.40 $252.40 $560.88 $560.88 $560.88 $116.90 $560.88 $560.88 $560.88 $560.88 $560.88 $116.89 $560.88 $228.16 $331.76 $560.88 $570.40 $560.88 $560.88 $420.75 $560.88 $560.88 $560.88 $280.44 $280.44 $444.22 $560.88 $448.70 $252.40 $111.32 N/A $325.38 $560.88 $336.53 $560.88 $116.89 $560.88 N/A N/A 02.240.010 SUP HCPCS C1713 02.240.010 - SCREW BONE T15 FULTHD 3.7MM 10MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.012 SUP HCPCS C1713 02.240.012 - SCREW BONE T15 FULTHD 3.7MM 12MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.014 SUP HCPCS C1713 02.240.014 - SCREW BONE T15 FULTHD 3.7MM 14MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.016 SUP HCPCS C1713 02.240.016 - SCREW BONE T15 FULTHD 3.7MM 16MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.018 SUP HCPCS C1713 02.240.018 - SCREW BONE T15 FULTHD 3.7MM 18MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.020 SUP HCPCS C1713 02.240.020 - SCREW BONE T15 FULTHD 3.7MM 20MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.022 SUP HCPCS C1713 02.240.022 - SCREW BONE T15 FULTHD 3.7MM 22MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.024 SUP HCPCS C1713 02.240.024 - SCREW BONE T15 FULTHD 3.7MM 24MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.026 SUP HCPCS C1713 02.240.026 - SCREW BONE T15 FULTHD 3.7MM 26MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $215.07 $358.45 $358.45 $358.45 N/A N/A 02.240.028 SUP HCPCS C1713 02.240.028 - SCREW BONE T15 FULTHD 3.7MM 28MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $215.07 $358.45 $74.70 $358.45 N/A N/A 02.240.030 SUP HCPCS C1713 02.240.030 - SCREW BONE T15 FULTHD 3.7MM 30MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $215.07 $358.45 $358.45 $358.45 N/A N/A 02.240.032 SUP HCPCS C1713 02.240.032 - SCREW BONE T15 FULTHD 3.7MM 32MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $215.07 $358.45 $358.45 $358.45 N/A N/A 02.240.034 SUP HCPCS C1713 02.240.034 - SCREW BONE T15 FULTHD 3.7MM 34MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $215.07 $358.45 $74.70 $358.45 N/A N/A 02.240.036 SUP HCPCS C1713 02.240.036 - SCREW BONE T15 FULTHD 3.7MM 36MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $215.07 $358.45 $74.70 $358.45 N/A N/A 02.240.038 SUP HCPCS C1713 02.240.038 - SCREW BONE T15 FULTHD 3.7MM 38MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.040 SUP HCPCS C1713 02.240.040 - SCREW BONE T15 FULTHD 3.7MM 40MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.042 SUP HCPCS C1713 02.240.042 - SCREW BONE T15 FULTHD 3.7MM 42MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $215.07 $358.45 $74.70 $358.45 N/A N/A 02.240.044 SUP HCPCS C1713 02.240.044 - SCREW BONE T15 FULTHD 3.7MM 44MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.046 SUP HCPCS C1713 02.240.046 - SCREW BONE T15 FULTHD 3.7MM 46MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.048 SUP HCPCS C1713 02.240.048 - SCREW BONE T15 FULTHD 3.7MM 48MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.050 SUP HCPCS C1713 02.240.050 - SCREW BONE T15 FULTHD 3.7MM 50MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.052 SUP HCPCS C1713 02.240.052 - SCREW BONE T15 FULTHD 3.7MM 52MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.054 SUP HCPCS C1713 02.240.054 - SCREW BONE T15 FULTHD 3.7MM 54MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.056 SUP HCPCS C1713 02.240.056 - SCREW BONE T15 FULTHD 3.7MM 56MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.058 SUP HCPCS C1713 02.240.058 - SCREW BONE T15 FULTHD 3.7MM 58MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.060 SUP HCPCS C1713 02.240.060 - SCREW BONE T15 FULTHD 3.7MM 60MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.065 SUP HCPCS C1713 02.240.065 - SCREW BONE T15 FULTHD 3.7MM 65MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.070 SUP HCPCS C1713 02.240.070 - SCREW BONE T15 FULTHD 3.7MM 70MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.075 SUP HCPCS C1713 02.240.075 - SCREW BONE T15 FULTHD 3.7MM 75MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.080 SUP HCPCS C1713 02.240.080 - SCREW BONE T15 FULTHD 3.7MM 80MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $215.07 $358.45 $74.70 $358.45 N/A N/A 02.240.085 SUP HCPCS C1713 02.240.085 - SCREW BONE T15 FULTHD 3.7MM 85MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $215.07 $358.45 $74.70 $358.45 N/A N/A 02.240.090 SUP HCPCS C1713 02.240.090 - SCREW BONE T15 FULTHD 3.7MM 90MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $364.55 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.095 SUP HCPCS C1713 02.240.095 - SCREW BONE T15 FULTHD 3.7MM 95MM SELF DRILL SELF TAP LOCK BOTH IP/OP $358.50 $265.00 $71.14 $364.55 $161.30 $161.30 $161.30 $161.30 $358.45 $358.45 $358.45 $74.71 $358.45 $358.45 $358.45 $358.45 $358.45 $74.70 $358.45 $145.82 $212.02 $358.45 $364.55 $358.45 $358.45 $268.88 $358.45 $358.45 $358.45 $179.23 $179.23 $283.89 $358.45 $286.76 $161.30 $71.14 N/A $207.93 $358.45 $358.45 $358.45 $74.70 $358.45 N/A N/A 02.240.210 SUP HCPCS C1713 02.240.210 - SCREW BONE CONE 3.7MM 10MM 6MM SELF DRILL SELF TAP LOCK CANN BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $65.33 $313.48 N/A N/A 02.240.212 SUP HCPCS C1713 02.240.212 - SCREW BONE CONE 3.7MM 12MM 8MM SELF DRILL SELF TAP LOCK CANN BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $313.48 $313.48 N/A N/A 02.240.214 SUP HCPCS C1713 02.240.214 - SCREW BONE CONE 3.7MM 14MM 8MM SELF DRILL SELF TAP LOCK CANN BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $313.48 $313.48 N/A N/A 02.240.216 SUP HCPCS C1713 02.240.216 - SCREW BONE CONE 3.7MM 16MM 8MM SELF DRILL SELF TAP LOCK CANN BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $65.33 $313.48 N/A N/A 02.240.218 SUP HCPCS C1713 02.240.218 - SCREW BONE CONE 3.7MM 18MM 8MM SELF DRILL SELF TAP LOCK CANN BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $65.33 $313.48 N/A N/A 02.240.220 SUP HCPCS C1713 02.240.220 - SCREW BONE CONE 3.7MM 20MM 15MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $65.33 $313.48 N/A N/A 02.240.222 SUP HCPCS C1713 02.240.222 - SCREW BONE CONE 3.7MM 22MM 15MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $65.33 $313.48 N/A N/A 02.240.224 SUP HCPCS C1713 02.240.224 - SCREW BONE CONE 3.7MM 24MM 15MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $65.33 $313.48 N/A N/A 02.240.226 SUP HCPCS C1713 02.240.226 - SCREW BONE CONE 3.7MM 26MM 15MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $313.48 $313.48 N/A N/A 02.240.228 SUP HCPCS C1713 02.240.228 - SCREW BONE CONE 3.7MM 28MM 15MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $65.33 $313.48 N/A N/A 02.240.230 SUP HCPCS C1713 02.240.230 - SCREW BONE CONE 3.7MM 30MM 15MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $65.33 $313.48 N/A N/A 02.240.232 SUP HCPCS C1713 02.240.232 - SCREW BONE CONE 3.7MM 32MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $65.33 $313.48 N/A N/A 02.240.234 SUP HCPCS C1713 02.240.234 - SCREW BONE CONE 3.7MM 34MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $65.33 $313.48 N/A N/A 02.240.236 SUP HCPCS C1713 02.240.236 - SCREW BONE CONE 3.7MM 36MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $313.48 $313.48 N/A N/A 02.240.238 SUP HCPCS C1713 02.240.238 - SCREW BONE CONE 3.7MM 38MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $65.33 $313.48 N/A N/A 02.240.240 SUP HCPCS C1713 02.240.240 - SCREW BONE CONE 3.7MM 40MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $65.33 $313.48 N/A N/A 02.240.242 SUP HCPCS C1713 02.240.242 - SCREW BONE CONE 3.7MM 42MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $313.48 $313.48 N/A N/A 02.240.244 SUP HCPCS C1713 02.240.244 - SCREW BONE CONE 3.7MM 44MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $65.33 $313.48 N/A N/A 02.240.246 SUP HCPCS C1713 02.240.246 - SCREW BONE CONE 3.7MM 46MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $65.33 $313.48 N/A N/A 02.240.248 SUP HCPCS C1713 02.240.248 - SCREW BONE CONE 3.7MM 48MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $313.48 $313.48 N/A N/A 02.240.250 SUP HCPCS C1713 02.240.250 - SCREW BONE CONE 3.7MM 50MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $65.33 $313.48 N/A N/A 02.240.252 SUP HCPCS C1713 02.240.252 - SCREW BONE CONE 3.7MM 52MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $65.33 $313.48 N/A N/A 02.240.254 SUP HCPCS C1713 02.240.254 - SCREW BONE CONE 3.7MM 54MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $313.48 $313.48 N/A N/A 02.240.256 SUP HCPCS C1713 02.240.256 - SCREW BONE CONE 3.7MM 56MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $313.48 $313.48 N/A N/A 02.240.258 SUP HCPCS C1713 02.240.258 - SCREW BONE CONE 3.7MM 58MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $65.33 $313.48 N/A N/A 02.240.260 SUP HCPCS C1713 02.240.260 - SCREW BONE CONE 3.7MM 60MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $65.33 $313.48 N/A N/A 02.240.265 SUP HCPCS C1713 02.240.265 - SCREW BONE CONE 3.7MM 65MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $188.09 $313.48 $313.48 $313.48 N/A N/A 02.240.270 SUP HCPCS C1713 02.240.270 - SCREW BONE CONE 3.7MM 70MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $65.33 $313.48 N/A N/A 02.240.275 SUP HCPCS C1713 02.240.275 - SCREW BONE CONE 3.7MM 75MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $318.80 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $65.33 $313.48 N/A N/A 02.240.280 SUP HCPCS C1713 02.240.280 - SCREW BONE CONE 3.7MM 80MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $65.33 $313.48 N/A N/A 02.240.285 SUP HCPCS C1713 02.240.285 - SCREW BONE CONE 3.7MM 85MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $65.33 $313.48 N/A N/A 02.240.290 SUP HCPCS C1713 02.240.290 - SCREW BONE CONE 3.7MM 90MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $65.33 $313.48 N/A N/A 02.240.295 SUP HCPCS C1713 02.240.295 - SCREW BONE CONE 3.7MM 95MM 25MM SELF DRILL SELF TAP LOCK BOTH IP/OP $313.50 $232.00 $62.22 $318.80 $141.07 $141.07 $141.07 $141.07 $313.48 $313.48 $313.48 $65.34 $313.48 $313.48 $313.48 $313.48 $313.48 $65.33 $313.48 $127.52 $185.42 $313.48 $318.80 $313.48 $313.48 $235.13 $313.48 $313.48 $313.48 $156.74 $156.74 $248.28 $313.48 $250.78 $141.07 $62.22 N/A $181.83 $313.48 $313.48 $313.48 $313.48 $313.48 N/A N/A 02.306.006 SUP HCPCS C1713 02.306.006 - NAIL INTRAMEDULLARY SHORT CANN ORTHOPEDIC NONSTRL PELVIC BOTH IP/OP $967.50 $716.00 $191.95 $983.58 $435.21 $435.21 $435.21 $435.21 $967.13 $967.13 $967.13 $201.57 $967.13 $967.13 $967.13 $967.13 $967.13 $201.56 $967.13 $393.43 $572.06 $967.13 $983.58 $967.13 $967.13 $725.63 $967.13 $967.13 $967.13 $483.57 $483.57 $765.97 $967.13 $773.70 $435.21 $191.95 N/A $561.15 $967.13 $580.28 $967.13 $201.55 $967.13 N/A N/A 02.306.007 SUP HCPCS C1713 02.306.007 - NAIL INTRAMEDULLARY LONG CANN ORTHOPEDIC NONSTRL PELVIC BOTH IP/OP $967.50 $716.00 $191.95 $983.58 $435.21 $435.21 $435.21 $435.21 $967.13 $967.13 $967.13 $201.57 $967.13 $967.13 $967.13 $967.13 $967.13 $201.56 $967.13 $393.43 $572.06 $967.13 $983.58 $967.13 $967.13 $725.63 $967.13 $967.13 $967.13 $483.57 $483.57 $765.97 $967.13 $773.70 $435.21 $191.95 N/A $561.15 $967.13 $580.28 $967.13 $967.13 $967.13 N/A N/A 02.600.020 SUP Custom 27203010 02.600.020 - WIRE FX 1.6MM 400MM NS KRSH TROC PNT SS BOTH IP/OP $122.50 $91.00 $21.81 $122.50 $122.50 $122.50 $122.50 $122.50 $122.50 $122.50 $21.81 $122.50 $122.50 $90.92 $90.92 $94.42 $63.82 $25.53 $122.50 $49.00 $122.50 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $79.63 $122.50 N/A $71.05 $122.50 $73.50 $122.50 $122.50 $122.50 N/A N/A 02.600.022.02S SUP HCPCS C1713 02.600.022.02S - PIN DISTRACTION 12MM STERILE BOTH IP/OP $205.00 $152.00 $40.64 $204.75 $92.14 $92.14 $92.14 $92.14 $204.75 $204.75 $204.75 $42.68 $204.75 $204.75 $204.75 $204.75 $204.75 $42.67 $204.75 $204.75 $121.11 $204.75 $204.75 $204.75 $204.75 $153.75 $204.75 $204.75 $204.75 $102.38 $102.38 $162.16 $204.75 $163.80 $92.14 $40.64 N/A $118.90 $204.75 $122.85 $204.75 $42.67 $204.75 N/A N/A 0200-12LV SUP Custom 27203010 0200-12LV - TUBE JJNSTM 12FR 2-3ML STRL LF MC SLK MED PORT RADOPQ STRP BOTH IP/OP $337.50 $250.00 $60.05 $337.35 $337.35 $337.35 $337.35 $337.35 $337.35 $337.35 $60.05 $337.35 $337.35 $250.38 $250.38 $260.03 $175.76 $70.31 $337.35 $134.94 $337.35 $337.35 $337.35 $337.35 $337.35 $253.13 $337.35 $337.35 $337.35 $168.68 $168.68 $267.18 $337.35 $269.88 $219.28 $337.35 N/A $195.75 $337.35 $202.41 $337.35 $337.35 $337.35 N/A N/A 0200-18 SUP Custom 27203010 0200-18 - TUBE JEJUNOSTOMY STANDARD J 18FR TRIMMABLE DISTAL TIP BOTH IP/OP $337.50 $250.00 $60.05 $506.03 $337.35 $337.35 $337.35 $337.35 $337.35 $337.35 $60.05 $337.35 $337.35 $250.38 $250.38 $260.03 $175.76 $70.31 $337.35 $208.49 $337.35 $337.35 $506.03 $337.35 $337.35 $253.13 $337.35 $337.35 $337.35 $168.68 $168.68 $267.18 $337.35 $269.88 $219.28 $337.35 N/A $195.75 $337.35 $202.41 $337.35 $337.35 $337.35 N/A N/A 0206-710-000 SUP HCPCS C1713 0206-710-000 - KIT BN CMNT STRL BIOPREP PREP PLG INSRTR BRSH CURT SCT FEM BOTH IP/OP $256.50 $190.00 $50.87 $256.29 $115.33 $115.33 $115.33 $115.33 $256.29 $256.29 $256.29 $53.42 $256.29 $256.29 $256.29 $256.29 $256.29 $53.41 $256.29 $96.77 $151.60 $256.29 $241.92 $256.29 $256.29 $192.38 $256.29 $256.29 $256.29 $128.15 $128.15 $202.98 $256.29 $205.03 $115.33 $50.87 N/A $148.77 $256.29 $153.77 $256.29 $53.41 $256.29 N/A N/A 022-001 SUP Custom 27203010 022-001 - WIRE PACING 2-0 TAPER LOOP 1/8IN 61CM 89MM 1 ARM SNAP OFF BOTH IP/OP $49.50 $37.00 $8.78 $49.32 $49.32 $49.32 $49.32 $49.32 $49.32 $49.32 $8.78 $49.32 $49.32 $36.61 $36.61 $38.02 $25.70 $10.28 $49.32 $19.73 $49.32 $49.32 $49.32 $49.32 $49.32 $37.13 $49.32 $49.32 $49.32 $24.66 $24.66 $39.06 $49.32 $39.46 $32.06 $49.32 N/A $28.71 $49.32 $29.59 $49.32 $49.32 $49.32 N/A N/A 02-2005-S SUP HCPCS C1713 02-2005-S - PLATE SS 5 HOLE CMPR BONE 6MM STRL BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" "$1,342.50" $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" "$1,342.50" "$1,342.50" $279.78 "$1,342.50" N/A N/A 02-2007-S SUP HCPCS C1713 02-2007-S - PLATE 203.2MM SS 7 HOLE 8 GRV CMPR BONE ORTH STRL BOTH IP/OP "$1,342.50" $993.00 $266.45 "$1,342.50" $604.13 $604.13 $604.13 $604.13 "$1,342.50" "$1,342.50" "$1,342.50" $279.81 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" $279.79 "$1,342.50" "$1,342.50" $794.09 "$1,342.50" "$1,342.50" "$1,342.50" "$1,342.50" "$1,006.88" "$1,342.50" "$1,342.50" "$1,342.50" $671.25 $671.25 "$1,063.26" "$1,342.50" "$1,074.00" $604.13 $266.45 N/A $778.65 "$1,342.50" $805.50 "$1,342.50" $279.78 "$1,342.50" N/A N/A 02-2009-S SUP HCPCS C1713 02-2009-S - PLATE 6 SS 9 HOLE CMPR BONE 10MM STRL BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" "$1,440.00" $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" $864.00 "$1,440.00" $300.10 "$1,440.00" N/A N/A 02-2011-S SUP HCPCS C1713 02-2011-S - PLATE 6 12IN SS 11 HOLE 12 GRV CMPR BONE 12MM STRL BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" "$1,440.00" $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 02-205-085 SUP HCPCS C1713 02-205-085 - SCREW BONE 5MM 85MM LCP SS PROX FEM CANN LCK NONSTRL BOTH IP/OP $415.50 $307.00 $82.45 $415.40 $186.93 $186.93 $186.93 $186.93 $415.40 $415.40 $415.40 $86.58 $415.40 $415.40 $415.40 $415.40 $415.40 $86.57 $415.40 $166.16 $245.71 $415.40 $415.40 $415.40 $415.40 $311.63 $415.40 $415.40 $415.40 $207.70 $207.70 $329.00 $415.40 $332.32 $186.93 $82.45 N/A $240.99 $415.40 $415.40 $415.40 $86.57 $415.40 N/A N/A 02-205-280 SUP HCPCS C1713 02-205-280 - SCREW BONE 5MM 80MM LCP SS PERIART FEM/TIB CANN CONICAL BOTH IP/OP $355.00 $263.00 $70.41 $354.75 $159.64 $159.64 $159.64 $159.64 $354.75 $354.75 $354.75 $73.94 $354.75 $354.75 $354.75 $354.75 $354.75 $73.93 $354.75 $141.90 $209.83 $354.75 $354.75 $354.75 $354.75 $266.25 $354.75 $354.75 $354.75 $177.38 $177.38 $280.96 $354.75 $283.80 $159.64 $70.41 N/A $205.90 $354.75 $354.75 $354.75 $73.93 $354.75 N/A N/A 02-210-122 SUP HCPCS C1713 02-210-122 - SCREW BONE 2.4MM 22MM LCP SS DISTAL RADL LCK VAR ANG BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 0250-18 SUP HCPCS B4088 0250-18 - TUBE JJNSTM 18FR 45CM 7-10ML STRL LF MC SLK RADOPQ STRP RTNT BOTH IP/OP $565.00 $418.00 $23.24 $564.68 $564.68 $564.68 $564.68 $564.68 $564.68 $564.68 $23.24 $564.68 $564.68 $564.68 $564.68 $564.68 $564.68 $117.69 $564.68 $225.87 $564.68 $564.68 $564.68 $564.68 $564.68 $423.75 $564.68 $564.68 $564.68 $282.34 $282.34 $447.23 $564.68 $451.74 $254.11 $564.68 N/A $327.70 $564.68 $338.81 $564.68 $564.68 $564.68 N/A N/A 0250-22 SUP HCPCS B4088 0250-22 - TUBE JJNSTM 22FR 45CM 7-10ML STRL LF MC SLK RADOPQ STRP RTNT BOTH IP/OP $565.00 $418.00 $23.24 $564.68 $564.68 $564.68 $564.68 $564.68 $564.68 $564.68 $23.24 $564.68 $564.68 $564.68 $564.68 $564.68 $564.68 $117.69 $564.68 $225.87 $564.68 $564.68 $564.68 $564.68 $564.68 $423.75 $564.68 $564.68 $564.68 $282.34 $282.34 $447.23 $564.68 $451.74 $254.11 $564.68 N/A $327.70 $564.68 $338.81 $564.68 $564.68 $564.68 N/A N/A 025-200 SUP Custom 27203010 025-200 - WIRE PACING 2-0 26MM .5 CIR CURVE TAPER 61CM 89MM M25 STYLE BOTH IP/OP $32.50 $24.00 $5.75 $36.77 $32.29 $32.29 $32.29 $32.29 $32.29 $32.29 $5.75 $32.29 $32.29 $23.97 $23.97 $24.89 $16.82 $6.73 $32.29 $14.71 $32.29 $32.29 $36.77 $32.29 $32.29 $24.38 $32.29 $32.29 $32.29 $16.15 $16.15 $25.57 $32.29 $25.83 $20.99 $32.29 N/A $18.85 $32.29 $19.37 $32.29 $32.29 $32.29 N/A N/A 0277082085S5 SUP Custom 27203010 0277082085S5 - BIT DRILL 7/64IN 128MM BOTH IP/OP $722.50 $535.00 $128.61 $722.50 $722.50 $722.50 $722.50 $722.50 $722.50 $722.50 $128.61 $722.50 $722.50 $536.24 $536.24 $556.90 $376.42 $150.58 $722.50 $289.00 $722.50 $722.50 $722.50 $722.50 $722.50 $541.88 $722.50 $722.50 $722.50 $361.25 $361.25 $572.22 $722.50 $578.00 $469.63 $722.50 N/A $419.05 $722.50 $433.50 $722.50 $722.50 $722.50 N/A N/A 028506-CE SUP HCPCS C1729 028506-CE - CATH URTH 6FR 25CM 2W FOLEY CLOSE END RND SIL 1.5ML BOTH IP/OP $50.00 $37.00 $9.87 $49.75 $27.01 $27.01 $27.01 $27.01 $49.75 $49.75 $49.75 $10.37 $49.75 $36.92 $36.92 $38.35 $25.92 $10.37 $49.75 $49.75 $29.43 $49.75 $49.75 $49.75 $49.75 $37.50 $49.75 $49.75 $49.75 $24.88 $24.88 $39.40 $49.75 $39.80 $32.34 $9.87 N/A $29.00 $49.75 $49.75 $49.75 $10.37 $49.75 N/A N/A 0298-097-100 SUP Custom 27203010 0298-097-100 - BLADE SAW THK.031IN 32MM CUT EDGE HEAVY DUTY STERNUM BOTH IP/OP $57.50 $43.00 $10.17 $57.13 $57.13 $57.13 $57.13 $57.13 $57.13 $57.13 $10.17 $57.13 $57.13 $42.40 $42.40 $44.04 $29.76 $11.91 $57.13 $22.85 $57.13 $57.13 $57.13 $57.13 $57.13 $43.13 $57.13 $57.13 $57.13 $28.57 $28.57 $45.25 $57.13 $45.70 $37.13 $57.13 N/A $33.35 $57.13 $34.28 $57.13 $57.13 $57.13 N/A N/A 02B002 SUP HCPCS C1776 02B002 - GRAFT SFT TIS STRUT AT BOTH IP/OP "$4,592.50" "$3,398.00" $911.50 "$5,260.00" "$2,066.63" "$2,066.63" "$2,066.63" "$2,066.63" "$4,592.50" "$4,592.50" "$4,592.50" $957.19 "$4,592.50" "$4,592.50" "$4,592.50" "$4,592.50" "$4,592.50" $957.13 "$4,592.50" "$2,104.00" "$2,264.10" "$4,592.50" "$5,260.00" "$4,592.50" "$4,592.50" "$3,444.38" "$4,592.50" "$4,592.50" "$4,592.50" "$2,296.25" "$2,296.25" "$3,637.26" "$4,592.50" "$3,674.00" "$2,066.63" $911.50 N/A "$2,663.65" "$4,592.50" "$4,592.50" "$4,592.50" $957.08 "$4,592.50" N/A N/A 02B003 SUP Custom 27804086 02B003 - FILLER BN VOID BLCK .5-1MM 4.5X5X10MM .3ML STRL PO 200R RSRB BOTH IP/OP "$6,170.00" "$4,566.00" "$1,098.26" "$7,067.50" "$6,170.00" "$6,170.00" "$6,170.00" "$6,170.00" "$6,170.00" "$6,170.00" "$1,098.26" "$6,170.00" "$6,170.00" "$6,170.00" "$6,170.00" "$6,170.00" "$6,170.00" "$1,285.90" "$6,170.00" "$2,827.00" "$6,170.00" "$6,170.00" "$7,067.50" "$6,170.00" "$6,170.00" "$4,627.50" "$6,170.00" "$6,170.00" "$6,170.00" "$3,085.00" "$3,085.00" "$4,886.64" "$6,170.00" "$4,936.00" "$2,776.50" "$6,170.00" N/A "$3,578.60" "$6,170.00" "$3,702.00" "$6,170.00" "$6,170.00" "$6,170.00" N/A N/A 03.000.409.98S SUP Custom 27203010 03.000.409.98S - CUTTER SRG THK.6MM 24.6X12.85X2.6MM STRL DMD PIEZOELECTRIC BOTH IP/OP $623.50 $461.00 $110.94 $623.25 $623.25 $623.25 $623.25 $623.25 $623.25 $623.25 $110.94 $623.25 $623.25 $462.58 $462.58 $480.40 $324.71 $129.89 $623.25 $249.30 $623.25 $623.25 $623.25 $623.25 $623.25 $467.63 $623.25 $623.25 $623.25 $311.63 $311.63 $493.61 $623.25 $498.60 $405.11 $623.25 N/A $361.63 $623.25 $373.95 $623.25 $623.25 $623.25 N/A N/A 03.000.410.98S SUP Custom 27203010 03.000.410.98S - CUTTER SRG THK.6MM RND 21.9X12.4X1.8MM STRL DMD BOTH IP/OP $623.50 $461.00 $110.94 $623.25 $623.25 $623.25 $623.25 $623.25 $623.25 $623.25 $110.94 $623.25 $623.25 $462.58 $462.58 $480.40 $324.71 $129.89 $623.25 $249.30 $623.25 $623.25 $623.25 $623.25 $623.25 $467.63 $623.25 $623.25 $623.25 $311.63 $311.63 $493.61 $623.25 $498.60 $405.11 $623.25 N/A $361.63 $623.25 $373.95 $623.25 $623.25 $623.25 N/A N/A 03.000.411.98S SUP Custom 27803010 03.000.411.98S - HANDPIECE SURG .4MM 22.9X10.1X5MM SINUS LIFT STERILE BOTH IP/OP $623.50 $461.00 $110.94 $623.25 $623.25 $623.25 $623.25 $623.25 $623.25 $623.25 $110.94 $623.25 $623.25 $623.25 $623.25 $623.25 $623.25 $129.89 $623.25 $249.30 $623.25 $623.25 $623.25 $623.25 $623.25 $467.63 $623.25 $623.25 $623.25 $311.63 $311.63 $493.61 $623.25 $498.60 $280.46 $623.25 N/A $361.63 $623.25 $373.95 $623.25 $623.25 $623.25 N/A N/A 03.007.020 SUP HCPCS C1769 03.007.020 - GUIDEWIRE ORTHOPEDIC 2.8MM 180MM 10MM TROCAR NONSTRL BOTH IP/OP $117.50 $87.00 $23.29 $119.35 $63.72 $63.72 $63.72 $63.72 $117.35 $117.35 $117.35 $24.46 $117.35 $87.10 $87.10 $90.45 $61.14 $24.46 $117.35 $119.35 $69.41 $117.35 $119.35 $117.35 $117.35 $88.13 $117.35 $117.35 $117.35 $58.68 $58.68 $92.94 $117.35 $93.88 $76.28 $23.29 N/A $68.15 $117.35 $117.35 $117.35 $24.46 $117.35 N/A N/A 03.010.015 SUP Custom 27203010 03.010.015 - SET TRAUMA FIX CANN COMPRESSION DEVICE TITANIUM TIBIA BOTH IP/OP $875.50 $648.00 $155.79 $890.13 $875.25 $875.25 $875.25 $875.25 $875.25 $875.25 $155.79 $875.25 $875.25 $649.61 $649.61 $674.64 $456.01 $182.41 $875.25 $356.05 $875.25 $875.25 $890.13 $875.25 $875.25 $656.63 $875.25 $875.25 $875.25 $437.63 $437.63 $693.20 $875.25 $700.20 $568.91 $875.25 N/A $507.79 $875.25 $525.15 $875.25 $875.25 $875.25 N/A N/A 03.010.025 SUP HCPCS C1713 03.010.025 - WIRE FIX 2MM 240MM TROCAR POINT KWIRE NONSTRL EXPERT CANN BOTH IP/OP $66.00 $49.00 $13.10 $67.13 $29.70 $29.70 $29.70 $29.70 $66.00 $66.00 $66.00 $13.76 $66.00 $66.00 $66.00 $66.00 $66.00 $13.76 $66.00 $67.13 $39.04 $66.00 $67.13 $66.00 $66.00 $49.50 $66.00 $66.00 $66.00 $33.00 $33.00 $52.27 $66.00 $52.80 $29.70 $13.10 N/A $38.28 $66.00 $66.00 $66.00 $13.75 $66.00 N/A N/A 03.010.028 SUP Custom 27203010 03.010.028 - BIT DRL 15MM 280MM NS CNN LG QC BOTH IP/OP $972.00 $719.00 $172.93 $988.05 $971.53 $971.53 $971.53 $971.53 $971.53 $971.53 $172.93 $971.53 $971.53 $721.07 $721.07 $748.86 $506.17 $202.48 $971.53 $395.22 $971.53 $971.53 $988.05 $971.53 $971.53 $729.00 $971.53 $971.53 $971.53 $485.77 $485.77 $769.45 $971.53 $777.22 $631.49 $971.53 N/A $563.76 $971.53 $582.92 $971.53 $971.53 $971.53 N/A N/A 03.010.029 SUP Custom 27203010 03.010.029 - BIT DRILL LARGE 17MM 280MM QUICK COUPLING CANN NONSTRL BOTH IP/OP "$1,215.50" $899.00 $216.29 "$1,235.78" "$1,215.13" "$1,215.13" "$1,215.13" "$1,215.13" "$1,215.13" "$1,215.13" $216.29 "$1,215.13" "$1,215.13" $901.87 $901.87 $936.62 $633.08 $253.25 "$1,215.13" $494.31 "$1,215.13" "$1,215.13" "$1,235.78" "$1,215.13" "$1,215.13" $911.63 "$1,215.13" "$1,215.13" "$1,215.13" $607.57 $607.57 $962.38 "$1,215.13" $972.10 $789.83 "$1,215.13" N/A $704.99 "$1,215.13" $729.08 "$1,215.13" "$1,215.13" "$1,215.13" N/A N/A 03.010.034 SUP Custom 27203010 03.010.034 - BIT DRL 13MM 465MM NS CNN LG QC FLXB BOTH IP/OP "$1,365.50" "$1,010.00" $243.04 "$1,388.58" "$1,365.38" "$1,365.38" "$1,365.38" "$1,365.38" "$1,365.38" "$1,365.38" $243.04 "$1,365.38" "$1,365.38" "$1,013.39" "$1,013.39" "$1,052.43" $711.36 $284.56 "$1,365.38" $555.43 "$1,365.38" "$1,365.38" "$1,388.58" "$1,365.38" "$1,365.38" "$1,024.13" "$1,365.38" "$1,365.38" "$1,365.38" $682.69 $682.69 "$1,081.38" "$1,365.38" "$1,092.30" $887.50 "$1,365.38" N/A $791.99 "$1,365.38" $819.23 "$1,365.38" "$1,365.38" "$1,365.38" N/A N/A 03.010.036 SUP Custom 27203010 03.010.036 - BIT DRILL LARGE 12MM 190MM CANN LARGE QUICK COUPLING EXPERT BOTH IP/OP "$1,025.50" $759.00 $182.54 "$1,042.93" "$1,025.50" "$1,025.50" "$1,025.50" "$1,025.50" "$1,025.50" "$1,025.50" $182.54 "$1,025.50" "$1,025.50" $761.13 $761.13 $790.46 $534.29 $213.73 "$1,025.50" $417.17 "$1,025.50" "$1,025.50" "$1,042.93" "$1,025.50" "$1,025.50" $769.13 "$1,025.50" "$1,025.50" "$1,025.50" $512.75 $512.75 $812.20 "$1,025.50" $820.40 $666.58 "$1,025.50" N/A $594.79 "$1,025.50" $615.30 "$1,025.50" "$1,025.50" "$1,025.50" N/A N/A 03.010.036S SUP Custom 27203010 03.010.036S - BIT DRL LG 12MM 190MM STRL NLEX QC CNN BOTH IP/OP "$1,120.50" $829.00 $199.41 "$1,139.35" "$1,120.30" "$1,120.30" "$1,120.30" "$1,120.30" "$1,120.30" "$1,120.30" $199.41 "$1,120.30" "$1,120.30" $831.49 $831.49 $863.53 $583.68 $233.48 "$1,120.30" $455.74 "$1,120.30" "$1,120.30" "$1,139.35" "$1,120.30" "$1,120.30" $840.38 "$1,120.30" "$1,120.30" "$1,120.30" $560.15 $560.15 $887.28 "$1,120.30" $896.24 $728.20 "$1,120.30" N/A $649.89 "$1,120.30" $672.18 "$1,120.30" "$1,120.30" "$1,120.30" N/A N/A 03.010.044 SUP HCPCS C1713 03.010.044 - SCREW INSERTION HANDLE CANN CONNCTNG EXPERT NONSTRL TIBIAL BOTH IP/OP $598.50 $443.00 $118.70 $608.25 $269.14 $269.14 $269.14 $269.14 $598.08 $598.08 $598.08 $124.65 $598.08 $598.08 $598.08 $598.08 $598.08 $124.65 $598.08 $608.25 $353.76 $598.08 $608.25 $598.08 $598.08 $448.88 $598.08 $598.08 $598.08 $299.04 $299.04 $473.68 $598.08 $478.46 $269.14 $118.70 N/A $347.13 $598.08 $598.08 $598.08 $124.64 $598.08 N/A N/A 03.010.060 SUP Custom 27203010 03.010.060 - BIT DRL 100MM 3 FLUT 3.2MM 330MM NS CLBRT QC BOTH IP/OP $462.50 $342.00 $82.31 $470.28 $462.43 $462.43 $462.43 $462.43 $462.43 $462.43 $82.31 $462.43 $462.43 $343.22 $343.22 $356.44 $240.93 $96.38 $462.43 $188.11 $462.43 $462.43 $470.28 $462.43 $462.43 $346.88 $462.43 $462.43 $462.43 $231.22 $231.22 $366.24 $462.43 $369.94 $300.58 $462.43 N/A $268.25 $462.43 $277.46 $462.43 $462.43 $462.43 N/A N/A 03.010.060S SUP Custom 27203010 3.2MM THREE-FLUTED DRILL BIT QC/330MM/100MM CALIB-STERILE BOTH IP/OP $517.50 $383.00 $92.08 $517.33 $517.33 $517.33 $517.33 $517.33 $517.33 $517.33 $92.08 $517.33 $517.33 $383.96 $383.96 $398.76 $269.53 $107.82 $517.33 $206.93 $517.33 $517.33 $517.33 $517.33 $517.33 $388.13 $517.33 $517.33 $517.33 $258.67 $258.67 $409.73 $517.33 $413.86 $336.26 $517.33 $517.33 $300.15 $517.33 $310.40 $517.33 $517.33 $517.33 N/A N/A 03.010.060S SUP Custom 27203010 03.010.060S - BIT DRL 3 FLUT 3.2MM 330MM BLU AU STRL 100MM XPRT QC CLBRT BOTH IP/OP $557.50 $413.00 $92.08 $517.33 $517.33 $517.33 $517.33 $517.33 $517.33 $517.33 $92.08 $517.33 $517.33 $383.96 $383.96 $398.76 $269.53 $107.82 $517.33 $206.93 $517.33 $517.33 $517.33 $517.33 $517.33 $418.13 $517.33 $517.33 $517.33 $258.67 $258.67 $409.73 $517.33 $413.86 $336.26 $517.33 $517.33 $323.35 $517.33 $310.40 $517.33 $517.33 $517.33 N/A N/A 03.010.061 SUP Custom 27203010 03.010.061 - BIT DRL 100MM 3 FLUT 4.2MM 330MM NS CLBRT QC BOTH IP/OP $462.50 $342.00 $82.31 $470.28 $462.43 $462.43 $462.43 $462.43 $462.43 $462.43 $82.31 $462.43 $462.43 $343.22 $343.22 $356.44 $240.93 $96.38 $462.43 $188.11 $462.43 $462.43 $470.28 $462.43 $462.43 $346.88 $462.43 $462.43 $462.43 $231.22 $231.22 $366.24 $462.43 $369.94 $300.58 $462.43 N/A $268.25 $462.43 $277.46 $462.43 $462.43 $462.43 N/A N/A 03.010.061S SUP Custom 27203010 03.010.061S - BIT DRL 3 FLUT 4.2MM 330MM GRN STRL 100MM QC CLBRT TIB BOTH IP/OP $557.50 $413.00 $99.19 $566.73 $557.25 $557.25 $557.25 $557.25 $557.25 $557.25 $99.19 $557.25 $557.25 $413.59 $413.59 $429.53 $290.33 $116.14 $557.25 $226.69 $557.25 $557.25 $566.73 $557.25 $557.25 $418.13 $557.25 $557.25 $557.25 $278.63 $278.63 $441.34 $557.25 $445.80 $362.21 $557.25 N/A $323.35 $557.25 $334.35 $557.25 $557.25 $557.25 N/A N/A 03.010.062 SUP Custom 27203010 03.010.062 - BIT DRL 100MM 3 FLUT 5MM 330MM NS CLBRT QC BOTH IP/OP $462.50 $342.00 $82.31 $470.28 $462.43 $462.43 $462.43 $462.43 $462.43 $462.43 $82.31 $462.43 $462.43 $343.22 $343.22 $356.44 $240.93 $96.38 $462.43 $188.11 $462.43 $462.43 $470.28 $462.43 $462.43 $346.88 $462.43 $462.43 $462.43 $231.22 $231.22 $366.24 $462.43 $369.94 $300.58 $462.43 N/A $268.25 $462.43 $277.46 $462.43 $462.43 $462.43 N/A N/A 03.010.062S SUP Custom 27203010 5.0MM THREE-FLUTED DRILL BIT QC/330MM/100MM CALIB-STERILE BOTH IP/OP $517.50 $383.00 $92.08 $517.33 $517.33 $517.33 $517.33 $517.33 $517.33 $517.33 $92.08 $517.33 $517.33 $383.96 $383.96 $398.76 $269.53 $107.82 $517.33 $206.93 $517.33 $517.33 $517.33 $517.33 $517.33 $388.13 $517.33 $517.33 $517.33 $258.67 $258.67 $409.73 $517.33 $413.86 $336.26 $517.33 $517.33 $300.15 $517.33 $310.40 $517.33 $517.33 $517.33 N/A N/A 03.010.062S SUP Custom 27203010 03.010.062S - BIT DRL 5MM 330MM STRL 3 FLT QC BOTH IP/OP $557.50 $413.00 $92.08 $517.33 $517.33 $517.33 $517.33 $517.33 $517.33 $517.33 $92.08 $517.33 $517.33 $383.96 $383.96 $398.76 $269.53 $107.82 $517.33 $206.93 $517.33 $517.33 $517.33 $517.33 $517.33 $418.13 $517.33 $517.33 $517.33 $258.67 $258.67 $409.73 $517.33 $413.86 $336.26 $517.33 $517.33 $323.35 $517.33 $310.40 $517.33 $517.33 $517.33 N/A N/A 03.010.078 SUP Custom 27203010 03.010.078 - BIT DRL 4.5-6.5MM 485MM NS LG QC STP BOTH IP/OP $980.50 $726.00 $174.49 $996.95 $980.28 $980.28 $980.28 $980.28 $980.28 $980.28 $174.49 $980.28 $980.28 $727.56 $727.56 $755.60 $510.73 $204.30 $980.28 $398.78 $980.28 $980.28 $996.95 $980.28 $980.28 $735.38 $980.28 $980.28 $980.28 $490.14 $490.14 $776.38 $980.28 $784.22 $637.18 $980.28 N/A $568.69 $980.28 $588.17 $980.28 $980.28 $980.28 N/A N/A 03.010.079 SUP Custom 27203010 03.010.079 - BIT DRL NS STP 4.5 MM 6.5 MM BOTH IP/OP $457.00 $338.00 $81.27 $464.33 $456.58 $456.58 $456.58 $456.58 $456.58 $456.58 $81.27 $456.58 $456.58 $338.87 $338.87 $351.93 $237.88 $95.16 $456.58 $185.73 $456.58 $456.58 $464.33 $456.58 $456.58 $342.75 $456.58 $456.58 $456.58 $228.29 $228.29 $361.61 $456.58 $365.26 $296.78 $456.58 N/A $265.06 $456.58 $273.95 $456.58 $456.58 $456.58 N/A N/A 03.010.089 SUP Custom 27203010 03.010.089 - BIT DRL 135MM 4.5MM 165MM NS CNN JCHK STP BOTH IP/OP $693.00 $513.00 $123.34 $704.68 $692.90 $692.90 $692.90 $692.90 $692.90 $692.90 $123.34 $692.90 $692.90 $514.27 $514.27 $534.09 $361.00 $144.41 $692.90 $281.87 $692.90 $692.90 $704.68 $692.90 $692.90 $519.75 $692.90 $692.90 $692.90 $346.45 $346.45 $548.78 $692.90 $554.32 $450.39 $692.90 N/A $401.94 $692.90 $415.74 $692.90 $692.90 $692.90 N/A N/A 03.010.089S SUP Custom 27203010 03.010.089s - BIT DRILL 4.5MM 165MM 135MM CANN JACOBS CHUCK STOP STERILE BOTH IP/OP $849.50 $629.00 $151.21 $849.48 $849.48 $849.48 $849.48 $849.48 $849.48 $849.48 $151.21 $849.48 $849.48 $630.48 $630.48 $654.78 $442.58 $177.04 $849.48 $339.79 $849.48 $849.48 $849.48 $849.48 $849.48 $637.13 $849.48 $849.48 $849.48 $424.74 $424.74 $672.79 $849.48 $679.58 $552.16 $849.48 N/A $492.71 $849.48 $509.69 $849.48 $849.48 $849.48 N/A N/A 03.010.100 SUP Custom 27203010 03.010.100 - BIT DRILL 3.2MM 145MM 3 FLUTED QUICK COUPLING NEEDLE POINT BOTH IP/OP $459.50 $340.00 $81.79 $467.30 $459.50 $459.50 $459.50 $459.50 $459.50 $459.50 $81.79 $459.50 $459.50 $341.04 $341.04 $354.18 $239.40 $95.76 $459.50 $186.92 $459.50 $459.50 $467.30 $459.50 $459.50 $344.63 $459.50 $459.50 $459.50 $229.75 $229.75 $363.92 $459.50 $367.60 $298.68 $459.50 N/A $266.51 $459.50 $275.70 $459.50 $459.50 $459.50 N/A N/A 03.010.101 SUP Custom 27203010 03.010.101 - BIT DRILL 4.2MM 145MM 3 FLUTED QUICK COUPLING NEEDLE POINT BOTH IP/OP $459.50 $340.00 $81.79 $467.30 $459.50 $459.50 $459.50 $459.50 $459.50 $459.50 $81.79 $459.50 $459.50 $341.04 $341.04 $354.18 $239.40 $95.76 $459.50 $186.92 $459.50 $459.50 $467.30 $459.50 $459.50 $344.63 $459.50 $459.50 $459.50 $229.75 $229.75 $363.92 $459.50 $367.60 $298.68 $459.50 N/A $266.51 $459.50 $275.70 $459.50 $459.50 $459.50 N/A N/A 03.010.102 SUP Custom 27203010 03.010.102 - BIT DRILL 5MM 145MM QUICK COUPLING 3 FLUTED NONSTRL BOTH IP/OP $459.50 $340.00 $81.79 $467.30 $459.50 $459.50 $459.50 $459.50 $459.50 $459.50 $81.79 $459.50 $459.50 $341.04 $341.04 $354.18 $239.40 $95.76 $459.50 $186.92 $459.50 $459.50 $467.30 $459.50 $459.50 $344.63 $459.50 $459.50 $459.50 $229.75 $229.75 $363.92 $459.50 $367.60 $298.68 $459.50 N/A $266.51 $459.50 $275.70 $459.50 $459.50 $459.50 N/A N/A 03.010.103 SUP Custom 27203010 03.010.103 - BIT DRL 3 FLUT 3.2MM 145MM NS QC BOTH IP/OP $330.00 $244.00 $58.68 $335.28 $329.68 $329.68 $329.68 $329.68 $329.68 $329.68 $58.68 $329.68 $329.68 $244.69 $244.69 $254.12 $171.76 $68.71 $329.68 $134.11 $329.68 $329.68 $335.28 $329.68 $329.68 $247.50 $329.68 $329.68 $329.68 $164.84 $164.84 $261.11 $329.68 $263.74 $214.29 $329.68 N/A $191.40 $329.68 $197.81 $329.68 $329.68 $329.68 N/A N/A 03.010.103S SUP Custom 27203010 03.010.103S - BIT DRL 3 FLUT 3.2MM 145MM STRL XPRT QC BOTH IP/OP $424.50 $314.00 $75.56 $431.73 $424.50 $424.50 $424.50 $424.50 $424.50 $424.50 $75.56 $424.50 $424.50 $315.06 $315.06 $327.20 $221.16 $88.47 $424.50 $172.69 $424.50 $424.50 $431.73 $424.50 $424.50 $318.38 $424.50 $424.50 $424.50 $212.25 $212.25 $336.20 $424.50 $339.60 $275.93 $424.50 N/A $246.21 $424.50 $254.70 $424.50 $424.50 $424.50 N/A N/A 03.010.104 SUP Custom 27203010 03.010.104 - BIT DRL 3 FLUT 4.2MM 145MM NS QC NDL PNT BOTH IP/OP $330.00 $244.00 $58.68 $335.28 $329.68 $329.68 $329.68 $329.68 $329.68 $329.68 $58.68 $329.68 $329.68 $244.69 $244.69 $254.12 $171.76 $68.71 $329.68 $134.11 $329.68 $329.68 $335.28 $329.68 $329.68 $247.50 $329.68 $329.68 $329.68 $164.84 $164.84 $261.11 $329.68 $263.74 $214.29 $329.68 N/A $191.40 $329.68 $197.81 $329.68 $329.68 $329.68 N/A N/A 03.010.104S SUP Custom 27203010 03.010.104S - BIT DRL 3 FLUT 4.2MM 145MM STRL QC NDL PNT BOTH IP/OP $424.50 $314.00 $75.56 $431.73 $424.50 $424.50 $424.50 $424.50 $424.50 $424.50 $75.56 $424.50 $424.50 $315.06 $315.06 $327.20 $221.16 $88.47 $424.50 $172.69 $424.50 $424.50 $431.73 $424.50 $424.50 $318.38 $424.50 $424.50 $424.50 $212.25 $212.25 $336.20 $424.50 $339.60 $275.93 $424.50 N/A $246.21 $424.50 $254.70 $424.50 $424.50 $424.50 N/A N/A 03.010.105 SUP Custom 27203010 03.010.105 - BIT DRILL SHORT 5MM 145MM 3 FLUTED QUICK COUPLING NEEDLE BOTH IP/OP $330.00 $244.00 $58.68 $335.28 $329.68 $329.68 $329.68 $329.68 $329.68 $329.68 $58.68 $329.68 $329.68 $244.69 $244.69 $254.12 $171.76 $68.71 $329.68 $134.11 $329.68 $329.68 $335.28 $329.68 $329.68 $247.50 $329.68 $329.68 $329.68 $164.84 $164.84 $261.11 $329.68 $263.74 $214.29 $329.68 N/A $191.40 $329.68 $197.81 $329.68 $329.68 $329.68 N/A N/A 03.010.105S SUP Custom 27203010 5.0MM THREE-FLUTED DRILL BIT QC/NEEDLE POINT/145MM-STERILE BOTH IP/OP $389.00 $288.00 $69.16 $388.53 $388.53 $388.53 $388.53 $388.53 $388.53 $388.53 $69.16 $388.53 $388.53 $288.37 $288.37 $299.48 $202.42 $80.97 $388.53 $155.41 $388.53 $388.53 $388.53 $388.53 $388.53 $291.75 $388.53 $388.53 $388.53 $194.27 $194.27 $307.72 $388.53 $310.82 $252.54 $388.53 $388.53 $225.62 $388.53 $233.12 $388.53 $388.53 $388.53 N/A N/A 03.010.105S SUP Custom 27203010 03.010.105S - BIT DRL 5MM 145MM STRL 3 FLT QC BOTH IP/OP $424.50 $314.00 $69.16 $388.53 $388.53 $388.53 $388.53 $388.53 $388.53 $388.53 $69.16 $388.53 $388.53 $288.37 $288.37 $299.48 $202.42 $80.97 $388.53 $155.41 $388.53 $388.53 $388.53 $388.53 $388.53 $318.38 $388.53 $388.53 $388.53 $194.27 $194.27 $307.72 $388.53 $310.82 $252.54 $388.53 $388.53 $246.21 $388.53 $233.12 $388.53 $388.53 $388.53 N/A N/A 03.010.115 SUP HCPCS C1769 03.010.115 - GUIDEWIRE ORTHOPEDIC 3.2MM 290MM THREAD NONSTRL TITANIUM BOTH IP/OP $184.00 $136.00 $36.48 $186.93 $99.80 $99.80 $99.80 $99.80 $183.80 $183.80 $183.80 $38.31 $183.80 $136.42 $136.42 $141.67 $95.76 $38.31 $183.80 $186.93 $108.72 $183.80 $186.93 $183.80 $183.80 $138.00 $183.80 $183.80 $183.80 $91.90 $91.90 $145.57 $183.80 $147.04 $119.47 $36.48 N/A $106.72 $183.80 $183.80 $183.80 $38.30 $183.80 N/A N/A 03.010.165 SUP Custom 27203010 03.010.165 - BIT DRILL LARGE 15MM 310MM LARGE QUICK COUPLING CANN BOTH IP/OP "$1,336.50" $989.00 $237.84 "$1,358.93" "$1,336.20" "$1,336.20" "$1,336.20" "$1,336.20" "$1,336.20" "$1,336.20" $237.84 "$1,336.20" "$1,336.20" $991.73 $991.73 "$1,029.94" $696.16 $278.48 "$1,336.20" $543.57 "$1,336.20" "$1,336.20" "$1,358.93" "$1,336.20" "$1,336.20" "$1,002.38" "$1,336.20" "$1,336.20" "$1,336.20" $668.10 $668.10 "$1,058.27" "$1,336.20" "$1,068.96" $868.53 "$1,336.20" N/A $775.17 "$1,336.20" $801.72 "$1,336.20" "$1,336.20" "$1,336.20" N/A N/A 03.010.167 SUP Custom 27203010 03.010.167 - BIT DRILL LARGE 17MM 310MM LARGE QUICK COUPLING CANN BOTH IP/OP "$1,430.00" "$1,058.00" $254.47 "$1,453.88" "$1,429.58" "$1,429.58" "$1,429.58" "$1,429.58" "$1,429.58" "$1,429.58" $254.47 "$1,429.58" "$1,429.58" "$1,061.03" "$1,061.03" "$1,101.92" $744.81 $297.94 "$1,429.58" $581.55 "$1,429.58" "$1,429.58" "$1,453.88" "$1,429.58" "$1,429.58" "$1,072.50" "$1,429.58" "$1,429.58" "$1,429.58" $714.79 $714.79 "$1,132.23" "$1,429.58" "$1,143.66" $929.23 "$1,429.58" N/A $829.40 "$1,429.58" $857.75 "$1,429.58" "$1,429.58" "$1,429.58" N/A N/A 03.010.228 SUP Custom 27203010 03.010.228 - BIT DRILL LARGE 3.2MM 474MM 3 FLUTE CALIBRATED NONSTRL 5MM BOTH IP/OP $828.00 $613.00 $147.38 $842.03 $827.95 $827.95 $827.95 $827.95 $827.95 $827.95 $147.38 $827.95 $827.95 $614.50 $614.50 $638.18 $431.36 $172.55 $827.95 $336.81 $827.95 $827.95 $842.03 $827.95 $827.95 $621.00 $827.95 $827.95 $827.95 $413.98 $413.98 $655.74 $827.95 $662.36 $538.17 $827.95 N/A $480.24 $827.95 $496.77 $827.95 $827.95 $827.95 N/A N/A 03.010.437S SUP Custom 27203010 03.010.437S - SLEEVE PROTECTION 12MM STERILE SUPRAPATELLAR BOTH IP/OP $195.50 $145.00 $34.80 $198.80 $195.48 $195.48 $195.48 $195.48 $195.48 $195.48 $34.80 $195.48 $195.48 $145.09 $145.09 $150.68 $101.85 $40.74 $195.48 $79.52 $195.48 $195.48 $198.80 $195.48 $195.48 $146.63 $195.48 $195.48 $195.48 $97.74 $97.74 $154.82 $195.48 $156.38 $127.06 $195.48 N/A $113.39 $195.48 $117.29 $195.48 $195.48 $195.48 N/A N/A 03.010.439 SUP Custom 27203010 03.010.439 - BIT DRILL LARGE 12MM 270MM QUICK COUPLING CANN NAIL-EX BOTH IP/OP $935.50 $692.00 $166.44 $950.95 $935.05 $935.05 $935.05 $935.05 $935.05 $935.05 $166.44 $935.05 $935.05 $693.99 $693.99 $720.74 $487.16 $194.87 $935.05 $380.38 $935.05 $935.05 $950.95 $935.05 $935.05 $701.63 $935.05 $935.05 $935.05 $467.53 $467.53 $740.56 $935.05 $748.04 $607.78 $935.05 N/A $542.59 $935.05 $561.03 $935.05 $935.05 $935.05 N/A N/A 03.010.439S SUP Custom 27203010 03.010.439S - BIT DRL LNG 12MM STRL CNN LG QC BOTH IP/OP "$1,030.00" $762.00 $183.32 "$1,047.38" "$1,029.88" "$1,029.88" "$1,029.88" "$1,029.88" "$1,029.88" "$1,029.88" $183.32 "$1,029.88" "$1,029.88" $764.38 $764.38 $793.83 $536.57 $214.64 "$1,029.88" $418.95 "$1,029.88" "$1,029.88" "$1,047.38" "$1,029.88" "$1,029.88" $772.50 "$1,029.88" "$1,029.88" "$1,029.88" $514.94 $514.94 $815.66 "$1,029.88" $823.90 $669.42 "$1,029.88" N/A $597.40 "$1,029.88" $617.93 "$1,029.88" "$1,029.88" "$1,029.88" N/A N/A 03.019.003 SUP Custom 27203010 03.019.003 - BIT DRILL 10MM HOLLOW NONSTRL OPEN MEDULLARY CANAL MULTILOC BOTH IP/OP $551.50 $408.00 $98.15 $560.78 $551.40 $551.40 $551.40 $551.40 $551.40 $551.40 $98.15 $551.40 $551.40 $409.25 $409.25 $425.02 $287.28 $114.92 $551.40 $224.31 $551.40 $551.40 $560.78 $551.40 $551.40 $413.63 $551.40 $551.40 $551.40 $275.70 $275.70 $436.71 $551.40 $441.12 $358.41 $551.40 N/A $319.87 $551.40 $330.84 $551.40 $551.40 $551.40 N/A N/A 03.019.003S SUP Custom 27203010 03.019.003S - BIT DRL 10MM STRL HLW MULTILOC HUM NL SYS BOTH IP/OP $646.50 $478.00 $115.03 $657.20 $646.23 $646.23 $646.23 $646.23 $646.23 $646.23 $115.03 $646.23 $646.23 $479.63 $479.63 $498.11 $336.69 $134.68 $646.23 $262.88 $646.23 $646.23 $657.20 $646.23 $646.23 $484.88 $646.23 $646.23 $646.23 $323.12 $323.12 $511.81 $646.23 $516.98 $420.05 $646.23 N/A $374.97 $646.23 $387.74 $646.23 $646.23 $646.23 N/A N/A 03.019.016 SUP Custom 27203010 03.019.016 - BIT DRL 3 FLUT 3.8MM 270MM NS QC CLBRT BOTH IP/OP $408.50 $302.00 $72.70 $415.40 $408.45 $408.45 $408.45 $408.45 $408.45 $408.45 $72.70 $408.45 $408.45 $303.15 $303.15 $314.83 $212.80 $85.13 $408.45 $166.16 $408.45 $408.45 $415.40 $408.45 $408.45 $306.38 $408.45 $408.45 $408.45 $204.23 $204.23 $323.49 $408.45 $326.76 $265.49 $408.45 N/A $236.93 $408.45 $245.07 $408.45 $408.45 $408.45 N/A N/A 03.019.016S SUP Custom 27203010 03.019.016S - BIT DRL 3.8MM 270MM STRL 3 FLT CLBRT QC BOTH IP/OP $503.50 $373.00 $89.58 $511.83 $503.28 $503.28 $503.28 $503.28 $503.28 $503.28 $89.58 $503.28 $503.28 $373.53 $373.53 $387.93 $262.21 $104.89 $503.28 $204.73 $503.28 $503.28 $511.83 $503.28 $503.28 $377.63 $503.28 $503.28 $503.28 $251.64 $251.64 $398.60 $503.28 $402.62 $327.13 $503.28 N/A $292.03 $503.28 $301.97 $503.28 $503.28 $503.28 N/A N/A 03.019.026 SUP HCPCS C1713 03.019.026 - GUIDE ROD ORTH 2.5MM 230MM NS MULTILOC STP TROC TIP SS HLW BOTH IP/OP $39.50 $29.00 $7.82 $40.05 $17.72 $17.72 $17.72 $17.72 $39.38 $39.38 $39.38 $8.21 $39.38 $39.38 $39.38 $39.38 $39.38 $8.21 $39.38 $16.02 $23.29 $39.38 $40.05 $39.38 $39.38 $29.63 $39.38 $39.38 $39.38 $19.69 $19.69 $31.19 $39.38 $31.50 $17.72 $7.82 N/A $22.91 $39.38 $39.38 $39.38 $8.21 $39.38 N/A N/A 03.019.026S SUP HCPCS C1713 03.019.026S - GUIDE ROD ORTH 2.5MM 230MM STRL STP TROC TIP SS HLW DRL BOTH IP/OP $134.50 $100.00 $26.64 $136.48 $60.39 $60.39 $60.39 $60.39 $134.20 $134.20 $134.20 $27.97 $134.20 $134.20 $134.20 $134.20 $134.20 $27.97 $134.20 $136.48 $79.38 $134.20 $136.48 $134.20 $134.20 $100.88 $134.20 $134.20 $134.20 $67.10 $67.10 $106.29 $134.20 $107.36 $60.39 $26.64 N/A $78.01 $134.20 $134.20 $134.20 $27.97 $134.20 N/A N/A 03.033.004 SUP Custom 27203010 03.033.004 - BIT DRL 14MM NS CNN LG QC FLXB FEM/RECON NL SYS BOTH IP/OP "$1,976.50" "$1,463.00" $351.80 "$2,010.00" "$1,976.40" "$1,976.40" "$1,976.40" "$1,976.40" "$1,976.40" "$1,976.40" $351.80 "$1,976.40" "$1,976.40" "$1,466.88" "$1,466.88" "$1,523.41" "$1,029.70" $411.90 "$1,976.40" $804.00 "$1,976.40" "$1,976.40" "$2,010.00" "$1,976.40" "$1,976.40" "$1,482.38" "$1,976.40" "$1,976.40" "$1,976.40" $988.20 $988.20 "$1,565.31" "$1,976.40" "$1,581.12" "$1,284.66" "$1,976.40" N/A "$1,146.37" "$1,976.40" "$1,185.84" "$1,976.40" "$1,976.40" "$1,976.40" N/A N/A 03.033.005 SUP Custom 27203010 03.033.005 - BIT DRL 14MM NS CNN LG QC FEM/RECON NL SYS BOTH IP/OP "$1,216.00" $900.00 $216.44 "$1,236.60" "$1,215.93" "$1,215.93" "$1,215.93" "$1,215.93" "$1,215.93" "$1,215.93" $216.44 "$1,215.93" "$1,215.93" $902.46 $902.46 $937.24 $633.50 $253.41 "$1,215.93" $494.64 "$1,215.93" "$1,215.93" "$1,236.60" "$1,215.93" "$1,215.93" $912.00 "$1,215.93" "$1,215.93" "$1,215.93" $607.97 $607.97 $963.02 "$1,215.93" $972.74 $790.35 "$1,215.93" N/A $705.28 "$1,215.93" $729.56 "$1,215.93" "$1,215.93" "$1,215.93" N/A N/A 03.100.034 SUP HCPCS C1713 03.100.034 - TEMPLATE SIZING 20 HOLE PELVIS 3.5 MM LP RECONSTRUCTION BOTH IP/OP $186.00 $138.00 $36.83 $188.70 $83.50 $83.50 $83.50 $83.50 $185.55 $185.55 $185.55 $38.67 $185.55 $185.55 $185.55 $185.55 $185.55 $38.67 $185.55 $188.70 $109.75 $185.55 $188.70 $185.55 $185.55 $139.50 $185.55 $185.55 $185.55 $92.78 $92.78 $146.96 $185.55 $148.44 $83.50 $36.83 N/A $107.88 $185.55 $111.33 $185.55 $38.67 $185.55 N/A N/A 03.100.036 SUP HCPCS C1713 03.100.036 - TEMPLATE BENDING 88MM 16 HOLE PELVIS 3.5MM LP CVD BOTH IP/OP $211.00 $156.00 $41.85 $214.43 $94.88 $94.88 $94.88 $94.88 $210.85 $210.85 $210.85 $43.95 $210.85 $210.85 $210.85 $210.85 $210.85 $43.94 $210.85 $214.43 $124.72 $210.85 $214.43 $210.85 $210.85 $158.25 $210.85 $210.85 $210.85 $105.43 $105.43 $166.99 $210.85 $168.68 $94.88 $41.85 N/A $122.38 $210.85 $126.51 $210.85 $43.94 $210.85 N/A N/A 03.100.037 SUP HCPCS C1713 03.100.037 - TEMPLATE BENDING 108MM RAD 16 HOLE PELVIS NONSTRL 3.5MM LP BOTH IP/OP $211.00 $156.00 $41.85 $214.43 $94.88 $94.88 $94.88 $94.88 $210.85 $210.85 $210.85 $43.95 $210.85 $210.85 $210.85 $210.85 $210.85 $43.94 $210.85 $85.77 $124.72 $210.85 $214.43 $210.85 $210.85 $158.25 $210.85 $210.85 $210.85 $105.43 $105.43 $166.99 $210.85 $168.68 $94.88 $41.85 N/A $122.38 $210.85 $126.51 $210.85 $43.94 $210.85 N/A N/A 03.111.002 SUP Custom 27203010 03.111.002 - BIT DRILL 5MM 300MM 200MM 3 FLUTED CANN CALIBRATION NONSTRL BOTH IP/OP $735.50 $544.00 $130.86 $747.68 $735.18 $735.18 $735.18 $735.18 $735.18 $735.18 $130.86 $735.18 $735.18 $545.65 $545.65 $566.68 $383.03 $153.22 $735.18 $299.07 $735.18 $735.18 $747.68 $735.18 $735.18 $551.63 $735.18 $735.18 $735.18 $367.59 $367.59 $582.26 $735.18 $588.14 $477.87 $735.18 N/A $426.59 $735.18 $441.11 $735.18 $735.18 $735.18 N/A N/A 03.112.003 SUP Custom 27203010 03.112.003 - BIT DRILL SHORT 2.8MM CALIBRATED STOP NONSTRL BOTH IP/OP $233.50 $173.00 $41.54 $237.33 $233.35 $233.35 $233.35 $233.35 $233.35 $233.35 $41.54 $233.35 $233.35 $173.19 $173.19 $179.87 $121.58 $48.63 $233.35 $94.93 $233.35 $233.35 $237.33 $233.35 $233.35 $175.13 $233.35 $233.35 $233.35 $116.68 $116.68 $184.81 $233.35 $186.68 $151.68 $233.35 N/A $135.43 $233.35 $140.01 $233.35 $233.35 $233.35 N/A N/A 03.114.007 SUP Custom 27203010 03.114.007 - BIT DRL 2 FLUT 1.1MM 75MM NS 61MM MNQK CPLNG 1.5MM CORT SCR BOTH IP/OP $169.00 $125.00 $30.03 $171.55 $168.68 $168.68 $168.68 $168.68 $168.68 $168.68 $30.03 $168.68 $168.68 $125.19 $125.19 $130.02 $87.88 $35.15 $168.68 $68.62 $168.68 $168.68 $171.55 $168.68 $168.68 $126.75 $168.68 $168.68 $168.68 $84.34 $84.34 $133.59 $168.68 $134.94 $109.64 $168.68 N/A $98.02 $168.68 $101.21 $168.68 $168.68 $168.68 N/A N/A 03.120.023 SUP Custom 27203010 03.120.023 - DEVICE XTRNFX PUL RDC 4.3 MM PERC DRL GD BOTH IP/OP $980.00 $725.00 $174.40 $996.43 $979.78 $979.78 $979.78 $979.78 $979.78 $979.78 $174.40 $979.78 $979.78 $727.19 $727.19 $755.21 $510.47 $204.20 $979.78 $398.57 $979.78 $979.78 $996.43 $979.78 $979.78 $735.00 $979.78 $979.78 $979.78 $489.89 $489.89 $775.99 $979.78 $783.82 $636.86 $979.78 N/A $568.40 $979.78 $587.87 $979.78 $979.78 $979.78 N/A N/A 03.120.026 SUP Custom 27203010 03.120.026 - GUIDEWIRE ORTHOPEDIC 2.5MM 300MM DRILL TIP NONSTRL BOTH IP/OP $128.00 $95.00 $22.77 $130.10 $127.93 $127.93 $127.93 $127.93 $127.93 $127.93 $22.77 $127.93 $127.93 $94.95 $94.95 $98.61 $66.65 $26.66 $127.93 $52.04 $127.93 $127.93 $130.10 $127.93 $127.93 $96.00 $127.93 $127.93 $127.93 $63.97 $63.97 $101.32 $127.93 $102.34 $83.15 $127.93 N/A $74.24 $127.93 $76.76 $127.93 $127.93 $127.93 N/A N/A 03.122.002 SUP Custom 27203010 03.122.002 - BIT DRL 95MM 2.8MM 248MM NS QC CLBRT BOTH IP/OP $297.00 $220.00 $52.79 $301.65 $296.60 $296.60 $296.60 $296.60 $296.60 $296.60 $52.79 $296.60 $296.60 $220.14 $220.14 $228.62 $154.53 $61.81 $296.60 $120.66 $296.60 $296.60 $301.65 $296.60 $296.60 $222.75 $296.60 $296.60 $296.60 $148.30 $148.30 $234.91 $296.60 $237.28 $192.79 $296.60 N/A $172.26 $296.60 $177.96 $296.60 $296.60 $296.60 N/A N/A 03.122.056 SUP Custom 27203010 03.122.056 - DEVICE MEASURING AIMING NOSE PHILOS NONSTRL BOTH IP/OP "$2,745.50" "$2,032.00" $488.67 "$2,792.00" "$2,745.33" "$2,745.33" "$2,745.33" "$2,745.33" "$2,745.33" "$2,745.33" $488.67 "$2,745.33" "$2,745.33" "$2,037.58" "$2,037.58" "$2,116.10" "$1,430.32" $572.16 "$2,745.33" "$1,116.80" "$2,745.33" "$2,745.33" "$2,792.00" "$2,745.33" "$2,745.33" "$2,059.13" "$2,745.33" "$2,745.33" "$2,745.33" "$1,372.67" "$1,372.67" "$2,174.30" "$2,745.33" "$2,196.26" "$1,784.46" "$2,745.33" N/A "$1,592.39" "$2,745.33" "$1,647.20" "$2,745.33" "$2,745.33" "$2,745.33" N/A N/A 03.130.100 SUP Custom 27203010 03.130.100 - BIT DRL 1MM 75MM KRSH THRD HL WRE HND 1.3MM SCR BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $119.98 $119.98 $124.60 $84.22 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $105.07 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 03.130.102 SUP Custom 27203010 03.130.102 - BIT DRL 1MM 61MM MNQK CPLNG THRD HL BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $119.98 $119.98 $124.60 $84.22 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $105.07 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 03.130.110 SUP Custom 27203010 03.130.110 - BIT DRL 1.3MM 60MM KRSH THRD HL WRE GLD HND BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $119.98 $119.98 $124.60 $84.22 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $105.07 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 03.130.112 SUP Custom 27203010 03.130.112 - BIT DRL 1.3MM 46MM MNQK CPLNG GLD HL BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $119.98 $119.98 $124.60 $84.22 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $105.07 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 03.130.120 SUP Custom 27203010 03.130.120 - GUIDE DRL 1MM THRD 1.3MM LCK PLT BOTH IP/OP $499.50 $370.00 $88.83 $507.50 $499.03 $499.03 $499.03 $499.03 $499.03 $499.03 $88.83 $499.03 $499.03 $370.38 $370.38 $384.65 $259.99 $104.00 $499.03 $203.00 $499.03 $499.03 $507.50 $499.03 $499.03 $374.63 $499.03 $499.03 $499.03 $249.52 $249.52 $395.23 $499.03 $399.22 $324.37 $499.03 N/A $289.71 $499.03 $299.42 $499.03 $499.03 $499.03 N/A N/A 03.130.125 SUP Custom 27203010 03.130.125 - SLEEVE DRL 1.3MM 1MM YLW 2 1.3MM CORT SCR BOTH IP/OP $618.50 $458.00 $110.09 $629.03 $618.50 $618.50 $618.50 $618.50 $618.50 $618.50 $110.09 $618.50 $618.50 $459.05 $459.05 $476.74 $322.24 $128.90 $618.50 $251.61 $618.50 $618.50 $629.03 $618.50 $618.50 $463.88 $618.50 $618.50 $618.50 $309.25 $309.25 $489.85 $618.50 $494.80 $402.03 $618.50 N/A $358.73 $618.50 $371.10 $618.50 $618.50 $618.50 N/A N/A 03.130.130 SUP HCPCS C1713 03.130.130 - HOLDER PLT 1.3-2 MM BOTH IP/OP $530.00 $392.00 $105.18 $538.95 $238.48 $238.48 $238.48 $238.48 $529.95 $529.95 $529.95 $110.45 $529.95 $529.95 $529.95 $529.95 $529.95 $110.45 $529.95 $215.58 $313.47 $529.95 $538.95 $529.95 $529.95 $397.50 $529.95 $529.95 $529.95 $264.98 $264.98 $419.72 $529.95 $423.96 $238.48 $105.18 N/A $307.40 $529.95 $317.97 $529.95 $110.44 $529.95 N/A N/A 03.130.140 SUP HCPCS C1713 03.130.140 - PIN BNDRG 1.3MM LCK PLT BOTH IP/OP $499.50 $370.00 $99.04 $507.50 $224.56 $224.56 $224.56 $224.56 $499.03 $499.03 $499.03 $104.01 $499.03 $499.03 $499.03 $499.03 $499.03 $104.00 $499.03 $203.00 $295.18 $499.03 $507.50 $499.03 $499.03 $374.63 $499.03 $499.03 $499.03 $249.52 $249.52 $395.23 $499.03 $399.22 $224.56 $99.04 N/A $289.71 $499.03 $499.03 $499.03 $104.00 $499.03 N/A N/A 03.130.200 SUP Custom 27203010 03.130.200 - BIT DRL 1.1MM 70MM KWR 1.5MM SCR THRD HL BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $119.98 $119.98 $124.60 $84.22 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $105.07 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 03.130.202 SUP Custom 27203010 03.130.202 - BIT DRL 1.1MM 56MM MNQK CPLNG THRD HL BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $119.98 $119.98 $124.60 $84.22 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $105.07 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 03.130.210 SUP Custom 27203010 03.130.210 - BIT DRL 1.5MM 62MM BLU KWR ATCH 2MM SCR GLD HL BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $119.98 $119.98 $124.60 $84.22 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $105.07 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 03.130.212 SUP Custom 27203010 03.130.212 - BIT DRL 1.5MM 48MM MNQK CPLNG GLD HL BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $119.98 $119.98 $124.60 $84.22 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $105.07 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 03.130.215 SUP Custom 27203010 03.130.215 - COUNTERSINK DRL 1.3 MM 1.5 MM 2 MM SCR BOTH IP/OP $415.00 $307.00 $73.81 $421.73 $414.68 $414.68 $414.68 $414.68 $414.68 $414.68 $73.81 $414.68 $414.68 $307.78 $307.78 $319.64 $216.05 $86.42 $414.68 $168.69 $414.68 $414.68 $421.73 $414.68 $414.68 $311.25 $414.68 $414.68 $414.68 $207.34 $207.34 $328.43 $414.68 $331.74 $269.54 $414.68 N/A $240.70 $414.68 $248.81 $414.68 $414.68 $414.68 N/A N/A 03.130.221 SUP Custom 27203010 03.130.221 - GUIDE DRL 1.1MM 2 VA FRHD 1.5MM LCK PLT BOTH IP/OP "$1,234.50" $914.00 $219.69 "$1,255.18" "$1,234.20" "$1,234.20" "$1,234.20" "$1,234.20" "$1,234.20" "$1,234.20" $219.69 "$1,234.20" "$1,234.20" $916.02 $916.02 $951.32 $643.02 $257.22 "$1,234.20" $502.07 "$1,234.20" "$1,234.20" "$1,255.18" "$1,234.20" "$1,234.20" $925.88 "$1,234.20" "$1,234.20" "$1,234.20" $617.10 $617.10 $977.49 "$1,234.20" $987.36 $802.23 "$1,234.20" N/A $716.01 "$1,234.20" $740.52 "$1,234.20" "$1,234.20" "$1,234.20" N/A N/A 03.130.225 SUP Custom 27203010 03.130.225 - SLEEVE DRL 1.5MM 1.1MM RD 2 1.5MM CORT SCR BOTH IP/OP $618.50 $458.00 $110.09 $629.03 $618.50 $618.50 $618.50 $618.50 $618.50 $618.50 $110.09 $618.50 $618.50 $459.05 $459.05 $476.74 $322.24 $128.90 $618.50 $251.61 $618.50 $618.50 $629.03 $618.50 $618.50 $463.88 $618.50 $618.50 $618.50 $309.25 $309.25 $489.85 $618.50 $494.80 $402.03 $618.50 N/A $358.73 $618.50 $371.10 $618.50 $618.50 $618.50 N/A N/A 03.130.250 SUP Custom 27203010 03.130.250 - GAUGE D 1.3/1.5/2 MM SCR BOTH IP/OP "$2,242.50" "$1,659.00" $399.09 "$2,280.20" "$2,242.08" "$2,242.08" "$2,242.08" "$2,242.08" "$2,242.08" "$2,242.08" $399.09 "$2,242.08" "$2,242.08" "$1,664.07" "$1,664.07" "$1,728.20" "$1,168.12" $467.27 "$2,242.08" $912.08 "$2,242.08" "$2,242.08" "$2,280.20" "$2,242.08" "$2,242.08" "$1,681.88" "$2,242.08" "$2,242.08" "$2,242.08" "$1,121.04" "$1,121.04" "$1,775.73" "$2,242.08" "$1,793.66" "$1,457.35" "$2,242.08" N/A "$1,300.65" "$2,242.08" "$1,345.25" "$2,242.08" "$2,242.08" "$2,242.08" N/A N/A 03.130.260 SUP HCPCS C1713 03.130.260 - PLIERS PLT BNDRG RT 1.3 MM LCK 1.5/2 MM VA PLT BOTH IP/OP $834.00 $617.00 $165.44 $847.75 $375.11 $375.11 $375.11 $375.11 $833.58 $833.58 $833.58 $173.74 $833.58 $833.58 $833.58 $833.58 $833.58 $173.73 $833.58 $339.10 $493.06 $833.58 $847.75 $833.58 $833.58 $625.50 $833.58 $833.58 $833.58 $416.79 $416.79 $660.20 $833.58 $666.86 $375.11 $165.44 N/A $483.72 $833.58 $500.15 $833.58 $173.72 $833.58 N/A N/A 03.130.261 SUP HCPCS C1713 03.130.261 - PLIERS PLT BNDRG LT 1.3 MM LCK 1.5/2 MM VA PLT BOTH IP/OP $834.00 $617.00 $165.44 $847.75 $375.11 $375.11 $375.11 $375.11 $833.58 $833.58 $833.58 $173.74 $833.58 $833.58 $833.58 $833.58 $833.58 $173.73 $833.58 $339.10 $493.06 $833.58 $847.75 $833.58 $833.58 $625.50 $833.58 $833.58 $833.58 $416.79 $416.79 $660.20 $833.58 $666.86 $375.11 $165.44 N/A $483.72 $833.58 $833.58 $833.58 $173.72 $833.58 N/A N/A 03.130.292 SUP Custom 27203010 03.130.292 - GUIDE DRL YLW INS 1MM BIT BOTH IP/OP $218.00 $161.00 $38.78 $221.58 $217.88 $217.88 $217.88 $217.88 $217.88 $217.88 $38.78 $217.88 $217.88 $161.71 $161.71 $167.94 $113.52 $45.41 $217.88 $88.63 $217.88 $217.88 $221.58 $217.88 $217.88 $163.50 $217.88 $217.88 $217.88 $108.94 $108.94 $172.56 $217.88 $174.30 $141.62 $217.88 N/A $126.44 $217.88 $130.73 $217.88 $217.88 $217.88 N/A N/A 03.130.293 SUP Custom 27203010 03.130.293 - GUIDE DRL RD INS 1.1MM BIT BOTH IP/OP $218.00 $161.00 $38.78 $221.58 $217.88 $217.88 $217.88 $217.88 $217.88 $217.88 $38.78 $217.88 $217.88 $161.71 $161.71 $167.94 $113.52 $45.41 $217.88 $88.63 $217.88 $217.88 $221.58 $217.88 $217.88 $163.50 $217.88 $217.88 $217.88 $108.94 $108.94 $172.56 $217.88 $174.30 $141.62 $217.88 N/A $126.44 $217.88 $130.73 $217.88 $217.88 $217.88 N/A N/A 03.130.294 SUP Custom 27203010 03.130.294 - GUIDE DRL YLW INS 1.3MM BIT BOTH IP/OP $218.00 $161.00 $38.78 $221.58 $217.88 $217.88 $217.88 $217.88 $217.88 $217.88 $38.78 $217.88 $217.88 $161.71 $161.71 $167.94 $113.52 $45.41 $217.88 $88.63 $217.88 $217.88 $221.58 $217.88 $217.88 $163.50 $217.88 $217.88 $217.88 $108.94 $108.94 $172.56 $217.88 $174.30 $141.62 $217.88 N/A $126.44 $217.88 $130.73 $217.88 $217.88 $217.88 N/A N/A 03.130.295 SUP Custom 27203010 03.130.295 - GUIDE DRL RD INS 1.5MM BIT BOTH IP/OP $218.00 $161.00 $38.78 $221.58 $217.88 $217.88 $217.88 $217.88 $217.88 $217.88 $38.78 $217.88 $217.88 $161.71 $161.71 $167.94 $113.52 $45.41 $217.88 $88.63 $217.88 $217.88 $221.58 $217.88 $217.88 $163.50 $217.88 $217.88 $217.88 $108.94 $108.94 $172.56 $217.88 $174.30 $141.62 $217.88 N/A $126.44 $217.88 $130.73 $217.88 $217.88 $217.88 N/A N/A 03.130.296 SUP Custom 27203010 03.130.296 - GUIDE DRL BLU INS 1.5MM BIT BOTH IP/OP $218.00 $161.00 $38.78 $221.58 $217.88 $217.88 $217.88 $217.88 $217.88 $217.88 $38.78 $217.88 $217.88 $161.71 $161.71 $167.94 $113.52 $45.41 $217.88 $88.63 $217.88 $217.88 $221.58 $217.88 $217.88 $163.50 $217.88 $217.88 $217.88 $108.94 $108.94 $172.56 $217.88 $174.30 $141.62 $217.88 N/A $126.44 $217.88 $130.73 $217.88 $217.88 $217.88 N/A N/A 03.130.297 SUP Custom 27203010 03.130.297 - GUIDE DRL BLU INS 2MM BIT BOTH IP/OP $218.00 $161.00 $38.78 $221.58 $217.88 $217.88 $217.88 $217.88 $217.88 $217.88 $38.78 $217.88 $217.88 $161.71 $161.71 $167.94 $113.52 $45.41 $217.88 $88.63 $217.88 $217.88 $221.58 $217.88 $217.88 $163.50 $217.88 $217.88 $217.88 $108.94 $108.94 $172.56 $217.88 $174.30 $141.62 $217.88 N/A $126.44 $217.88 $130.73 $217.88 $217.88 $217.88 N/A N/A 03.130.300 SUP Custom 27203010 03.130.300 - BIT DRL 1.5MM 88MM BLU KRSH WRE ATCH 2MM SCR BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $119.98 $119.98 $124.60 $84.22 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $105.07 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 03.130.301 SUP Custom 27203010 03.130.301 - BIT DRL 1.5MM 83MM 57MM CLR CD PILT HL JLTCH CPLNG BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $119.98 $119.98 $124.60 $84.22 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $105.07 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 03.130.302 SUP Custom 27203010 03.130.302 - BIT DRL 1.5MM 74MM 57MM CLR CD PILT HL MNQK CPLNG BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $119.98 $119.98 $124.60 $84.22 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $105.07 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 03.130.310 SUP Custom 27203010 03.130.310 - BIT DRL 2MM 71MM 41MM CLR CD GLD HL JCHK BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $119.98 $119.98 $124.60 $84.22 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $105.07 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 03.130.311 SUP Custom 27203010 03.130.311 - BIT DRL 2MM 66MM JLTCH GLD HL BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $119.98 $119.98 $124.60 $84.22 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $105.07 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 03.130.312 SUP Custom 27203010 03.130.312 - BIT DRL 2MM 57MM MNQK CPLNG GLD HL BOTH IP/OP $162.00 $120.00 $28.77 $164.40 $161.65 $161.65 $161.65 $161.65 $161.65 $161.65 $28.77 $161.65 $161.65 $119.98 $119.98 $124.60 $84.22 $33.69 $161.65 $65.76 $161.65 $161.65 $164.40 $161.65 $161.65 $121.50 $161.65 $161.65 $161.65 $80.83 $80.83 $128.03 $161.65 $129.32 $105.07 $161.65 N/A $93.96 $161.65 $96.99 $161.65 $161.65 $161.65 N/A N/A 03.130.321 SUP Custom 27203010 03.130.321 - GUIDE DRL 1.5MM 2 VA LCK FR HND 2MM PLT BOTH IP/OP "$1,234.50" $914.00 $219.69 "$1,255.18" "$1,234.20" "$1,234.20" "$1,234.20" "$1,234.20" "$1,234.20" "$1,234.20" $219.69 "$1,234.20" "$1,234.20" $916.02 $916.02 $951.32 $643.02 $257.22 "$1,234.20" $502.07 "$1,234.20" "$1,234.20" "$1,255.18" "$1,234.20" "$1,234.20" $925.88 "$1,234.20" "$1,234.20" "$1,234.20" $617.10 $617.10 $977.49 "$1,234.20" $987.36 $802.23 "$1,234.20" N/A $716.01 "$1,234.20" $740.52 "$1,234.20" "$1,234.20" "$1,234.20" N/A N/A 03.130.325 SUP Custom 27203010 03.130.325 - SLEEVE DRL 1.5MM BLU 2 2MM CORT SCR BOTH IP/OP $618.50 $458.00 $110.09 $629.03 $618.50 $618.50 $618.50 $618.50 $618.50 $618.50 $110.09 $618.50 $618.50 $459.05 $459.05 $476.74 $322.24 $128.90 $618.50 $251.61 $618.50 $618.50 $629.03 $618.50 $618.50 $463.88 $618.50 $618.50 $618.50 $309.25 $309.25 $489.85 $618.50 $494.80 $402.03 $618.50 N/A $358.73 $618.50 $371.10 $618.50 $618.50 $618.50 N/A N/A 03.161.024 SUP Custom 27203010 03.161.024 - BIT DRL 3.2MM NS OCPTL CRV FSN SYS BOTH IP/OP "$1,060.00" $784.00 $188.68 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $188.68 "$1,060.00" "$1,060.00" $786.73 $786.73 $817.05 $552.26 $220.92 "$1,060.00" $424.00 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $795.00 "$1,060.00" "$1,060.00" "$1,060.00" $530.00 $530.00 $839.52 "$1,060.00" $848.00 $689.00 "$1,060.00" N/A $614.80 "$1,060.00" $636.00 "$1,060.00" "$1,060.00" "$1,060.00" N/A N/A 03.161.026 SUP HCPCS C1713 03.161.026 - TAP SURG NONSTRL 4.5 MM OCCPTL SCREW BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" $510.00 $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" "$1,275.00" "$1,275.00" $265.71 "$1,275.00" N/A N/A 03.161.027 SUP Custom 27203010 03.161.027 - SCREWDRIVER SURG UNIVERSAL JOINT 4 MM OCCPTL SCREW BOTH IP/OP "$3,267.50" "$2,418.00" $581.62 "$3,267.50" "$3,267.50" "$3,267.50" "$3,267.50" "$3,267.50" "$3,267.50" "$3,267.50" $581.62 "$3,267.50" "$3,267.50" "$2,425.14" "$2,425.14" "$2,518.59" "$1,702.37" $680.98 "$3,267.50" "$1,307.00" "$3,267.50" "$3,267.50" "$3,267.50" "$3,267.50" "$3,267.50" "$2,450.63" "$3,267.50" "$3,267.50" "$3,267.50" "$1,633.75" "$1,633.75" "$2,587.86" "$3,267.50" "$2,614.00" "$2,123.88" "$3,267.50" N/A "$1,895.15" "$3,267.50" "$1,960.50" "$3,267.50" "$3,267.50" "$3,267.50" N/A N/A 03.211.410 SUP Custom 27203010 03.211.410 - WIRE FX 1.6MM 150MM NS 10MM LCP CMPR THRD BOTH IP/OP $86.00 $64.00 $15.26 $87.20 $85.75 $85.75 $85.75 $85.75 $85.75 $85.75 $15.26 $85.75 $85.75 $63.64 $63.64 $66.10 $44.68 $17.87 $85.75 $34.88 $85.75 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $55.74 $85.75 N/A $49.88 $85.75 $51.45 $85.75 $85.75 $85.75 N/A N/A 03.211.415 SUP Custom 27203010 03.211.415 - WIRE FX 1.6MM 150MM NS 15MM LCP CMPR THRD BOTH IP/OP $86.00 $64.00 $15.26 $87.20 $85.75 $85.75 $85.75 $85.75 $85.75 $85.75 $15.26 $85.75 $85.75 $63.64 $63.64 $66.10 $44.68 $17.87 $85.75 $34.88 $85.75 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $55.74 $85.75 N/A $49.88 $85.75 $51.45 $85.75 $85.75 $85.75 N/A N/A 03.211.420 SUP Custom 27203010 03.211.420 - WIRE FX 1.6MM 150MM NS 20MM LCP CMPR THRD BOTH IP/OP $86.00 $64.00 $15.26 $87.20 $85.75 $85.75 $85.75 $85.75 $85.75 $85.75 $15.26 $85.75 $85.75 $63.64 $63.64 $66.10 $44.68 $17.87 $85.75 $34.88 $85.75 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $55.74 $85.75 N/A $49.88 $85.75 $51.45 $85.75 $85.75 $85.75 N/A N/A 03.211.425 SUP Custom 27203010 03.211.425 - WIRE FX 1.6MM 150MM NS 25MM LCP CMPR THRD BOTH IP/OP $86.00 $64.00 $15.26 $87.20 $85.75 $85.75 $85.75 $85.75 $85.75 $85.75 $15.26 $85.75 $85.75 $63.64 $63.64 $66.10 $44.68 $17.87 $85.75 $34.88 $85.75 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $55.74 $85.75 N/A $49.88 $85.75 $51.45 $85.75 $85.75 $85.75 N/A N/A 03.211.430 SUP Custom 27203010 03.211.430 - WIRE FX 1.6MM 150MM NS 30MM LCP CMPR THRD BOTH IP/OP $86.00 $64.00 $15.26 $87.20 $85.75 $85.75 $85.75 $85.75 $85.75 $85.75 $15.26 $85.75 $85.75 $63.64 $63.64 $66.10 $44.68 $17.87 $85.75 $34.88 $85.75 $85.75 $87.20 $85.75 $85.75 $64.50 $85.75 $85.75 $85.75 $42.88 $42.88 $67.91 $85.75 $68.60 $55.74 $85.75 N/A $49.88 $85.75 $51.45 $85.75 $85.75 $85.75 N/A N/A 03.211.435 SUP Custom 27203010 03.211.435 - WIRE FX 1.6MM 150MM NS 35MM LCP CMPR THRD BOTH IP/OP $89.00 $66.00 $15.76 $90.05 $88.55 $88.55 $88.55 $88.55 $88.55 $88.55 $15.76 $88.55 $88.55 $65.72 $65.72 $68.25 $46.13 $18.45 $88.55 $36.02 $88.55 $88.55 $90.05 $88.55 $88.55 $66.75 $88.55 $88.55 $88.55 $44.28 $44.28 $70.13 $88.55 $70.84 $57.56 $88.55 N/A $51.62 $88.55 $53.13 $88.55 $88.55 $88.55 N/A N/A 03.211.440 SUP Custom 27203010 03.211.440 - WIRE FX 1.6MM 150MM NS 40MM LCP CMPR THRD BOTH IP/OP $89.00 $66.00 $15.76 $90.05 $88.55 $88.55 $88.55 $88.55 $88.55 $88.55 $15.76 $88.55 $88.55 $65.72 $65.72 $68.25 $46.13 $18.45 $88.55 $36.02 $88.55 $88.55 $90.05 $88.55 $88.55 $66.75 $88.55 $88.55 $88.55 $44.28 $44.28 $70.13 $88.55 $70.84 $57.56 $88.55 N/A $51.62 $88.55 $53.13 $88.55 $88.55 $88.55 N/A N/A 03.226.039 SUP Custom 27203010 03.226.039 - BIT DRILL 3.2MM CANN NONSTRL 4.5MM SCREW BOTH IP/OP $753.50 $558.00 $134.11 $766.25 $753.45 $753.45 $753.45 $753.45 $753.45 $753.45 $134.11 $753.45 $753.45 $559.21 $559.21 $580.76 $392.55 $157.03 $753.45 $306.50 $753.45 $753.45 $766.25 $753.45 $753.45 $565.13 $753.45 $753.45 $753.45 $376.73 $376.73 $596.73 $753.45 $602.76 $489.74 $753.45 N/A $437.03 $753.45 $452.07 $753.45 $753.45 $753.45 N/A N/A 03.226.042 SUP Custom 27203010 03.226.042 - BIT DRILL 4MM DEVICE CANN BOTH IP/OP $811.50 $601.00 $144.37 $824.88 $811.08 $811.08 $811.08 $811.08 $811.08 $811.08 $144.37 $811.08 $811.08 $601.98 $601.98 $625.18 $422.57 $169.04 $811.08 $329.95 $811.08 $811.08 $824.88 $811.08 $811.08 $608.63 $811.08 $811.08 $811.08 $405.54 $405.54 $642.38 $811.08 $648.86 $527.20 $811.08 N/A $470.67 $811.08 $486.65 $811.08 $811.08 $811.08 N/A N/A 03.227.042 SUP Custom 27203010 03.227.042 - BIT DRILL 6MM CANN NONSTRL 6.5MM HEADLESS COMPRESSION SCREW BOTH IP/OP $773.50 $572.00 $137.62 $786.28 $773.13 $773.13 $773.13 $773.13 $773.13 $773.13 $137.62 $773.13 $773.13 $573.82 $573.82 $595.93 $402.80 $161.13 $773.13 $314.51 $773.13 $773.13 $786.28 $773.13 $773.13 $580.13 $773.13 $773.13 $773.13 $386.57 $386.57 $612.32 $773.13 $618.50 $502.53 $773.13 N/A $448.63 $773.13 $463.88 $773.13 $773.13 $773.13 N/A N/A 03.301.010S SUP Custom 27203010 03.301.010S - SET EXFIX LARGE FRAME ANKLE STERILE BOTH IP/OP "$5,761.50" "$4,264.00" "$1,025.52" "$5,859.28" "$5,761.33" "$5,761.33" "$5,761.33" "$5,761.33" "$5,761.33" "$5,761.33" "$1,025.52" "$5,761.33" "$5,761.33" "$4,181.12" "$4,181.12" "$4,440.83" "$2,060.15" "$1,200.72" "$5,761.33" "$2,343.71" "$5,761.33" "$5,761.33" "$5,859.28" "$5,761.33" "$5,761.33" "$4,321.13" "$5,761.33" "$5,761.33" "$5,761.33" "$2,880.67" "$2,880.67" "$4,562.97" "$5,761.33" "$4,609.06" "$3,744.86" "$5,761.33" N/A "$3,341.67" "$5,761.33" "$3,456.80" "$5,761.33" "$5,761.33" "$5,761.33" N/A N/A 03.301.011S SUP Custom 27203010 03.301.011S - KIT TRAUMA LARGE EXFIX STERILE BOTH IP/OP "$6,038.00" "$4,468.00" "$1,074.69" "$6,140.23" "$6,037.58" "$6,037.58" "$6,037.58" "$6,037.58" "$6,037.58" "$6,037.58" "$1,074.69" "$6,037.58" "$6,037.58" "$4,181.12" "$4,181.12" "$4,653.77" "$2,060.15" "$1,258.30" "$6,037.58" "$2,456.09" "$6,037.58" "$6,037.58" "$6,140.23" "$6,037.58" "$6,037.58" "$4,528.50" "$6,037.58" "$6,037.58" "$6,037.58" "$3,018.79" "$3,018.79" "$4,781.76" "$6,037.58" "$4,830.06" "$3,924.43" "$6,037.58" N/A "$3,502.04" "$6,037.58" "$3,622.55" "$6,037.58" "$6,037.58" "$6,037.58" N/A N/A 03.301.012S SUP Custom 27203010 03.301.012S - KIT FRAME LARGE EXFIX PELVIC STERILE BOTH IP/OP "$8,095.50" "$5,991.00" "$1,440.92" "$8,232.68" "$8,095.05" "$8,095.05" "$8,095.05" "$8,095.05" "$8,095.05" "$8,095.05" "$1,440.92" "$8,095.05" "$8,095.05" "$4,181.12" "$4,181.12" "$6,239.66" "$2,060.15" "$1,687.10" "$8,095.05" "$3,293.07" "$8,095.05" "$8,095.05" "$8,232.68" "$8,095.05" "$8,095.05" "$6,071.63" "$8,095.05" "$8,095.05" "$8,095.05" "$4,047.53" "$4,047.53" "$6,411.28" "$8,095.05" "$6,476.04" "$5,261.78" "$8,095.05" N/A "$4,695.39" "$8,095.05" "$4,857.03" "$8,095.05" "$8,095.05" "$8,095.05" N/A N/A 03.304.220S SUP HCPCS C1713 03.304.220S - FIXATOR XTRNFX 2.5MM 4MM 200MM STRL LF SCHNZ LOPRFL ROD CFBR BOTH IP/OP "$1,660.00" "$1,228.00" $329.42 "$1,688.00" $746.90 $746.90 $746.90 $746.90 "$1,659.78" "$1,659.78" "$1,659.78" $345.94 "$1,659.78" "$1,659.78" "$1,659.78" "$1,659.78" "$1,659.78" $345.92 "$1,659.78" "$1,688.00" $981.76 "$1,659.78" "$1,688.00" "$1,659.78" "$1,659.78" "$1,245.00" "$1,659.78" "$1,659.78" "$1,659.78" $829.89 $829.89 "$1,314.55" "$1,659.78" "$1,327.82" $746.90 $329.42 N/A $962.80 "$1,659.78" $995.87 "$1,659.78" $345.90 "$1,659.78" N/A N/A 03.304.222S SUP HCPCS C1713 03.304.222S - FIXATOR XTRNFX 2.5-4MM 220MM STRL LOPRFL ROD CFBR WRST BOTH IP/OP "$1,660.00" "$1,228.00" $329.42 "$1,688.00" $746.90 $746.90 $746.90 $746.90 "$1,659.78" "$1,659.78" "$1,659.78" $345.94 "$1,659.78" "$1,659.78" "$1,659.78" "$1,659.78" "$1,659.78" $345.92 "$1,659.78" "$1,688.00" $981.76 "$1,659.78" "$1,688.00" "$1,659.78" "$1,659.78" "$1,245.00" "$1,659.78" "$1,659.78" "$1,659.78" $829.89 $829.89 "$1,314.55" "$1,659.78" "$1,327.82" $746.90 $329.42 N/A $962.80 "$1,659.78" $995.87 "$1,659.78" $345.90 "$1,659.78" N/A N/A 03.304.320S SUP Custom 27203010 03.304.320S - FIXATOR XTRNFX 3MM 4MM 200MM STRL LF SCHNZ ROD LOPRFL SLF BOTH IP/OP "$2,106.50" "$1,559.00" $374.95 "$2,142.28" "$2,106.48" "$2,106.48" "$2,106.48" "$2,106.48" "$2,106.48" "$2,106.48" $374.95 "$2,106.48" "$2,106.48" "$1,563.43" "$1,563.43" "$1,623.67" "$1,097.48" $439.01 "$2,106.48" $856.91 "$2,106.48" "$2,106.48" "$2,142.28" "$2,106.48" "$2,106.48" "$1,579.88" "$2,106.48" "$2,106.48" "$2,106.48" "$1,053.24" "$1,053.24" "$1,668.33" "$2,106.48" "$1,685.18" "$1,369.21" "$2,106.48" N/A "$1,221.77" "$2,106.48" "$1,263.89" "$2,106.48" "$2,106.48" "$2,106.48" N/A N/A 03.304.322S SUP Custom 27203010 03.304.322S - ROD EXFIX 220MM MRI SAFE LOW-PROFILE WRIST FIXATOR BOTH IP/OP "$2,106.50" "$1,559.00" $374.95 "$2,142.28" "$2,106.48" "$2,106.48" "$2,106.48" "$2,106.48" "$2,106.48" "$2,106.48" $374.95 "$2,106.48" "$2,106.48" "$1,563.43" "$1,563.43" "$1,623.67" "$1,097.48" $439.01 "$2,106.48" $856.91 "$2,106.48" "$2,106.48" "$2,142.28" "$2,106.48" "$2,106.48" "$1,579.88" "$2,106.48" "$2,106.48" "$2,106.48" "$1,053.24" "$1,053.24" "$1,668.33" "$2,106.48" "$1,685.18" "$1,369.21" "$2,106.48" N/A "$1,221.77" "$2,106.48" "$1,263.89" "$2,106.48" "$2,106.48" "$2,106.48" N/A N/A 03.305.004 SUP Custom 27203010 03.305.004 - BIT DRL 24MM 1.8/4MM NS MATRIXRIB JLTCH CPLNG STP STRYK BOTH IP/OP $630.00 $466.00 $112.14 $630.00 $630.00 $630.00 $630.00 $630.00 $630.00 $630.00 $112.14 $630.00 $630.00 $467.59 $467.59 $485.60 $328.23 $131.30 $630.00 $252.00 $630.00 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $409.50 $630.00 N/A $365.40 $630.00 $378.00 $630.00 $630.00 $630.00 N/A N/A 03.305.006 SUP Custom 27203010 03.305.006 - CLAMP XTRNFX NS ADJ MNDB XTRNFXTR II BOTH IP/OP "$1,392.50" "$1,030.00" $247.87 "$1,392.50" "$1,392.50" "$1,392.50" "$1,392.50" "$1,392.50" "$1,392.50" "$1,392.50" $247.87 "$1,392.50" "$1,392.50" "$1,033.51" "$1,033.51" "$1,073.34" $725.49 $290.21 "$1,392.50" $557.00 "$1,392.50" "$1,392.50" "$1,392.50" "$1,392.50" "$1,392.50" "$1,044.38" "$1,392.50" "$1,392.50" "$1,392.50" $696.25 $696.25 "$1,102.86" "$1,392.50" "$1,114.00" $905.13 "$1,392.50" N/A $807.65 "$1,392.50" $835.50 "$1,392.50" "$1,392.50" "$1,392.50" N/A N/A 03.305.009 SUP Custom 27203010 03.305.009 - TEMPLATE SIZING 4MM ROD BOTH IP/OP $917.50 $679.00 $163.32 $917.50 $917.50 $917.50 $917.50 $917.50 $917.50 $917.50 $163.32 $917.50 $917.50 $680.97 $680.97 $707.21 $478.02 $191.22 $917.50 $367.00 $917.50 $917.50 $917.50 $917.50 $917.50 $688.13 $917.50 $917.50 $917.50 $458.75 $458.75 $726.66 $917.50 $734.00 $596.38 $917.50 N/A $532.15 $917.50 $550.50 $917.50 $917.50 $917.50 N/A N/A 03.305.500 SUP Custom 27203010 03.305.500 - ROD EXFIX 500MM NONSTRL MANDIB FIXATOR BOTH IP/OP "$4,300.00" "$3,182.00" $765.40 "$4,300.00" "$4,300.00" "$4,300.00" "$4,300.00" "$4,300.00" "$4,300.00" "$4,300.00" $765.40 "$4,300.00" "$4,300.00" "$3,191.46" "$3,191.46" "$3,314.44" "$2,060.15" $896.17 "$4,300.00" "$1,720.00" "$4,300.00" "$4,300.00" "$4,300.00" "$4,300.00" "$4,300.00" "$3,225.00" "$4,300.00" "$4,300.00" "$4,300.00" "$2,150.00" "$2,150.00" "$3,405.60" "$4,300.00" "$3,440.00" "$2,795.00" "$4,300.00" N/A "$2,494.00" "$4,300.00" "$2,580.00" "$4,300.00" "$4,300.00" "$4,300.00" N/A N/A 03.306.010 SUP Custom 27203010 03.306.010 - SET ORTHOPEDIC C CLMP II PELVIC BOTH IP/OP "$13,379.50" "$9,901.00" "$2,060.15" "$13,606.83" "$13,379.38" "$13,379.38" "$13,379.38" "$13,379.38" "$13,379.38" "$13,379.38" "$2,381.53" "$13,379.38" "$13,379.38" "$4,181.12" "$4,181.12" "$10,312.83" "$2,060.15" "$2,788.41" "$13,379.38" "$5,442.73" "$13,379.38" "$13,379.38" "$13,606.83" "$13,379.38" "$13,379.38" "$10,034.63" "$13,379.38" "$13,379.38" "$13,379.38" "$6,689.69" "$6,689.69" "$10,596.47" "$13,379.38" "$10,703.50" "$8,696.60" "$13,379.38" N/A "$7,760.11" "$13,379.38" "$8,027.63" "$13,379.38" "$13,379.38" "$13,379.38" N/A N/A 03.307.001 SUP Custom 27203010 03.307.001 - CLAMP EXFIX WIRE FIX EXTERNAL MIDFAC DISTRCT BOTH IP/OP $632.50 $468.00 $112.59 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $112.59 $632.50 $632.50 $469.44 $469.44 $487.53 $329.53 $131.82 $632.50 $253.00 $632.50 $632.50 $632.50 $632.50 $632.50 $474.38 $632.50 $632.50 $632.50 $316.25 $316.25 $500.94 $632.50 $506.00 $411.13 $632.50 N/A $366.85 $632.50 $379.50 $632.50 $632.50 $632.50 N/A N/A 03.307.010 SUP Custom 27203010 03.307.010 - ROD EXFIX 100MM CARFBR NONSTRL MIDFAC DISTRCT BOTH IP/OP $515.00 $381.00 $91.67 $515.00 $515.00 $515.00 $515.00 $515.00 $515.00 $515.00 $91.67 $515.00 $515.00 $382.23 $382.23 $396.96 $268.32 $107.33 $515.00 $206.00 $515.00 $515.00 $515.00 $515.00 $515.00 $386.25 $515.00 $515.00 $515.00 $257.50 $257.50 $407.88 $515.00 $412.00 $334.75 $515.00 N/A $298.70 $515.00 $309.00 $515.00 $515.00 $515.00 N/A N/A 03.307.105 SUP Custom 27203010 03.307.105 - BAR EXFIX 50MM CONNCTNG EXTERNAL MIDFAC DISTRCT BOTH IP/OP $390.00 $289.00 $69.42 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $69.42 $390.00 $390.00 $289.46 $289.46 $300.61 $203.19 $81.28 $390.00 $156.00 $390.00 $390.00 $390.00 $390.00 $390.00 $292.50 $390.00 $390.00 $390.00 $195.00 $195.00 $308.88 $390.00 $312.00 $253.50 $390.00 N/A $226.20 $390.00 $234.00 $390.00 $390.00 $390.00 N/A N/A 03.307.112 SUP Custom 27203010 03.307.112 - BAR EXFIX 120MM CONNCTNG EXTERNAL MIDFAC DISTRCT BOTH IP/OP $390.00 $289.00 $69.42 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $390.00 $69.42 $390.00 $390.00 $289.46 $289.46 $300.61 $203.19 $81.28 $390.00 $156.00 $390.00 $390.00 $390.00 $390.00 $390.00 $292.50 $390.00 $390.00 $390.00 $195.00 $195.00 $308.88 $390.00 $312.00 $253.50 $390.00 N/A $226.20 $390.00 $234.00 $390.00 $390.00 $390.00 N/A N/A 03.311.010 SUP HCPCS C1713 03.311.010 - BOLT XTRNFX SCHNZ SCR BOTH IP/OP $341.00 $252.00 $67.66 $346.68 $153.40 $153.40 $153.40 $153.40 $340.88 $340.88 $340.88 $71.05 $340.88 $340.88 $340.88 $340.88 $340.88 $71.04 $340.88 $138.67 $201.63 $340.88 $346.68 $340.88 $340.88 $255.75 $340.88 $340.88 $340.88 $170.44 $170.44 $269.98 $340.88 $272.70 $153.40 $67.66 N/A $197.78 $340.88 $340.88 $340.88 $71.04 $340.88 N/A N/A 03.311.011 SUP Custom 27203010 03.311.011 - CLAMP EXFIX SCREW MR SAFE PIVOT SCHANZ NONSTRL BOTH IP/OP $681.00 $504.00 $121.15 $692.20 $680.63 $680.63 $680.63 $680.63 $680.63 $680.63 $121.15 $680.63 $680.63 $505.16 $505.16 $524.63 $354.61 $141.85 $680.63 $276.88 $680.63 $680.63 $692.20 $680.63 $680.63 $510.75 $680.63 $680.63 $680.63 $340.32 $340.32 $539.06 $680.63 $544.50 $442.41 $680.63 N/A $394.98 $680.63 $408.38 $680.63 $680.63 $680.63 N/A N/A 03.311.012 SUP Custom 27803010 03.311.012 - HINGE XTRNFX NS LCK MRI SAFE BOTH IP/OP $341.00 $252.00 $60.68 $346.68 $340.88 $340.88 $340.88 $340.88 $340.88 $340.88 $60.68 $340.88 $340.88 $340.88 $340.88 $340.88 $340.88 $71.04 $340.88 $138.67 $340.88 $340.88 $346.68 $340.88 $340.88 $255.75 $340.88 $340.88 $340.88 $170.44 $170.44 $269.98 $340.88 $272.70 $153.40 $340.88 N/A $197.78 $340.88 $204.53 $340.88 $340.88 $340.88 N/A N/A 03.311.022 SUP HCPCS C1713 03.311.022 - PLATE EXFIX 90D 2 HOLE OFFST CONNCTNG NONSTRL BOTH IP/OP $157.50 $117.00 $31.18 $159.75 $70.69 $70.69 $70.69 $70.69 $157.08 $157.08 $157.08 $32.74 $157.08 $157.08 $157.08 $157.08 $157.08 $32.74 $157.08 $159.75 $92.91 $157.08 $159.75 $157.08 $157.08 $118.13 $157.08 $157.08 $157.08 $78.54 $78.54 $124.41 $157.08 $125.66 $70.69 $31.18 N/A $91.35 $157.08 $94.25 $157.08 $32.74 $157.08 N/A N/A 03.311.023 SUP HCPCS C1713 03.311.023 - PLATE EXFIX 90D 3 HOLE OFFST CONNCTNG NONSTRL BOTH IP/OP $168.50 $125.00 $33.38 $171.05 $75.69 $75.69 $75.69 $75.69 $168.20 $168.20 $168.20 $35.06 $168.20 $168.20 $168.20 $168.20 $168.20 $35.05 $168.20 $68.42 $99.49 $168.20 $171.05 $168.20 $168.20 $126.38 $168.20 $168.20 $168.20 $84.10 $84.10 $133.21 $168.20 $134.56 $75.69 $33.38 N/A $97.73 $168.20 $100.92 $168.20 $35.05 $168.20 N/A N/A 03.311.024 SUP HCPCS C1713 03.311.024 - PLATE EXFIX 90D 4 HOLE OFFST CONNCTNG NONSTRL BOTH IP/OP $180.50 $134.00 $35.81 $183.53 $81.20 $81.20 $81.20 $81.20 $180.45 $180.45 $180.45 $37.61 $180.45 $180.45 $180.45 $180.45 $180.45 $37.61 $180.45 $73.41 $106.74 $180.45 $183.53 $180.45 $180.45 $135.38 $180.45 $180.45 $180.45 $90.23 $90.23 $142.92 $180.45 $144.36 $81.20 $35.81 N/A $104.69 $180.45 $108.27 $180.45 $37.61 $180.45 N/A N/A 03.311.025 SUP HCPCS C1713 03.311.025 - PLATE EXFIX 90D 5 HOLE OFFST CONNCTNG NONSTRL BOTH IP/OP $193.00 $143.00 $38.25 $195.98 $86.72 $86.72 $86.72 $86.72 $192.70 $192.70 $192.70 $40.16 $192.70 $192.70 $192.70 $192.70 $192.70 $40.16 $192.70 $78.39 $113.98 $192.70 $195.98 $192.70 $192.70 $144.75 $192.70 $192.70 $192.70 $96.35 $96.35 $152.62 $192.70 $154.16 $86.72 $38.25 N/A $111.94 $192.70 $192.70 $192.70 $40.16 $192.70 N/A N/A 03.311.031 SUP Custom 27203010 03.311.031 - EXTRACTOR SRG 1.5MM 400MM NS SMTH MR SF DSTRCT OSTEOGENESIS BOTH IP/OP $119.50 $88.00 $21.22 $121.23 $119.20 $119.20 $119.20 $119.20 $119.20 $119.20 $21.22 $119.20 $119.20 $88.47 $88.47 $91.88 $62.10 $24.84 $119.20 $48.49 $119.20 $119.20 $121.23 $119.20 $119.20 $89.63 $119.20 $119.20 $119.20 $59.60 $59.60 $94.41 $119.20 $95.36 $77.48 $119.20 N/A $69.31 $119.20 $71.52 $119.20 $119.20 $119.20 N/A N/A 03.311.032 SUP Custom 27203010 03.311.032 - WIRE FIX 1.8MM 400MM SMOOTH MRI SAFE NONSTRL BOTH IP/OP $119.50 $88.00 $21.22 $121.23 $119.20 $119.20 $119.20 $119.20 $119.20 $119.20 $21.22 $119.20 $119.20 $88.47 $88.47 $91.88 $62.10 $24.84 $119.20 $48.49 $119.20 $119.20 $121.23 $119.20 $119.20 $89.63 $119.20 $119.20 $119.20 $59.60 $59.60 $94.41 $119.20 $95.36 $77.48 $119.20 N/A $69.31 $119.20 $71.52 $119.20 $119.20 $119.20 N/A N/A 03.311.033 SUP Custom 27203010 03.311.033 - WIRE FX 2MM 400MM NS SMTH MRI SAFE BOTH IP/OP $119.50 $88.00 $21.22 $121.23 $119.20 $119.20 $119.20 $119.20 $119.20 $119.20 $21.22 $119.20 $119.20 $88.47 $88.47 $91.88 $62.10 $24.84 $119.20 $48.49 $119.20 $119.20 $121.23 $119.20 $119.20 $89.63 $119.20 $119.20 $119.20 $59.60 $59.60 $94.41 $119.20 $95.36 $77.48 $119.20 N/A $69.31 $119.20 $71.52 $119.20 $119.20 $119.20 N/A N/A 03.311.036 SUP Custom 27203010 03.311.036 - WIRE XTRNFX 1.5MM SMTH HLF PNT TIP MRI SAFE BOTH IP/OP $119.50 $88.00 $21.22 $121.23 $119.20 $119.20 $119.20 $119.20 $119.20 $119.20 $21.22 $119.20 $119.20 $88.47 $88.47 $91.88 $62.10 $24.84 $119.20 $48.49 $119.20 $119.20 $121.23 $119.20 $119.20 $89.63 $119.20 $119.20 $119.20 $59.60 $59.60 $94.41 $119.20 $95.36 $77.48 $119.20 N/A $69.31 $119.20 $71.52 $119.20 $119.20 $119.20 N/A N/A 03.311.037 SUP Custom 27203010 03.311.037 - WIRE XTRNFX 1.8MM SMTH HLF PNT TIP MRI SAFE BOTH IP/OP $119.50 $88.00 $21.22 $121.23 $119.20 $119.20 $119.20 $119.20 $119.20 $119.20 $21.22 $119.20 $119.20 $88.47 $88.47 $91.88 $62.10 $24.84 $119.20 $48.49 $119.20 $119.20 $121.23 $119.20 $119.20 $89.63 $119.20 $119.20 $119.20 $59.60 $59.60 $94.41 $119.20 $95.36 $77.48 $119.20 N/A $69.31 $119.20 $71.52 $119.20 $119.20 $119.20 N/A N/A 03.311.038 SUP Custom 27203010 03.311.038 - WIRE XTRNFX 2MM SMTH HLF PNT TIP MRI SAFE BOTH IP/OP $119.50 $88.00 $21.22 $121.23 $119.20 $119.20 $119.20 $119.20 $119.20 $119.20 $21.22 $119.20 $119.20 $88.47 $88.47 $91.88 $62.10 $24.84 $119.20 $48.49 $119.20 $119.20 $121.23 $119.20 $119.20 $89.63 $119.20 $119.20 $119.20 $59.60 $59.60 $94.41 $119.20 $95.36 $77.48 $119.20 N/A $69.31 $119.20 $71.52 $119.20 $119.20 $119.20 N/A N/A 03.311.041 SUP Custom 27203010 03.311.041 - WIRE XTRNFX 1.5MM 400MM RDC MRI SAFE BOTH IP/OP $371.00 $275.00 $66.03 $377.25 $370.95 $370.95 $370.95 $370.95 $370.95 $370.95 $66.03 $370.95 $370.95 $275.32 $275.32 $285.93 $193.26 $77.31 $370.95 $150.90 $370.95 $370.95 $377.25 $370.95 $370.95 $278.25 $370.95 $370.95 $370.95 $185.48 $185.48 $293.79 $370.95 $296.76 $241.12 $370.95 N/A $215.18 $370.95 $222.57 $370.95 $370.95 $370.95 N/A N/A 03.311.042 SUP Custom 27203010 03.311.042 - WIRE XTRNFX 1.8MM 400MM RDC MRI SAFE BOTH IP/OP $371.00 $275.00 $66.03 $377.25 $370.95 $370.95 $370.95 $370.95 $370.95 $370.95 $66.03 $370.95 $370.95 $275.32 $275.32 $285.93 $193.26 $77.31 $370.95 $150.90 $370.95 $370.95 $377.25 $370.95 $370.95 $278.25 $370.95 $370.95 $370.95 $185.48 $185.48 $293.79 $370.95 $296.76 $241.12 $370.95 N/A $215.18 $370.95 $222.57 $370.95 $370.95 $370.95 N/A N/A 03.311.043 SUP Custom 27203010 03.311.043 - WIRE FX 2MM 400MM NS SMTH MRI SAFE BOTH IP/OP $371.00 $275.00 $66.03 $377.25 $370.95 $370.95 $370.95 $370.95 $370.95 $370.95 $66.03 $370.95 $370.95 $275.32 $275.32 $285.93 $193.26 $77.31 $370.95 $150.90 $370.95 $370.95 $377.25 $370.95 $370.95 $278.25 $370.95 $370.95 $370.95 $185.48 $185.48 $293.79 $370.95 $296.76 $241.12 $370.95 N/A $215.18 $370.95 $222.57 $370.95 $370.95 $370.95 N/A N/A 03.311.046 SUP Custom 27203010 03.311.046 - WIRE XTRNFX 1.5MM RDC HLF PNT TIP MRI SAFE BOTH IP/OP $371.00 $275.00 $66.03 $377.25 $370.95 $370.95 $370.95 $370.95 $370.95 $370.95 $66.03 $370.95 $370.95 $275.32 $275.32 $285.93 $193.26 $77.31 $370.95 $150.90 $370.95 $370.95 $377.25 $370.95 $370.95 $278.25 $370.95 $370.95 $370.95 $185.48 $185.48 $293.79 $370.95 $296.76 $241.12 $370.95 N/A $215.18 $370.95 $222.57 $370.95 $370.95 $370.95 N/A N/A 03.311.047 SUP Custom 27203010 03.311.047 - WIRE XTRNFX 1.8MM RDC HLF PNT TIP MRI SAFE BOTH IP/OP $371.00 $275.00 $66.03 $377.25 $370.95 $370.95 $370.95 $370.95 $370.95 $370.95 $66.03 $370.95 $370.95 $275.32 $275.32 $285.93 $193.26 $77.31 $370.95 $150.90 $370.95 $370.95 $377.25 $370.95 $370.95 $278.25 $370.95 $370.95 $370.95 $185.48 $185.48 $293.79 $370.95 $296.76 $241.12 $370.95 N/A $215.18 $370.95 $222.57 $370.95 $370.95 $370.95 N/A N/A 03.311.048 SUP Custom 27203010 03.311.048 - WIRE XTRNFX 2MM RDC HLF PNT TIP MRI SAFE BOTH IP/OP $371.00 $275.00 $66.03 $377.25 $370.95 $370.95 $370.95 $370.95 $370.95 $370.95 $66.03 $370.95 $370.95 $275.32 $275.32 $285.93 $193.26 $77.31 $370.95 $150.90 $370.95 $370.95 $377.25 $370.95 $370.95 $278.25 $370.95 $370.95 $370.95 $185.48 $185.48 $293.79 $370.95 $296.76 $241.12 $370.95 N/A $215.18 $370.95 $222.57 $370.95 $370.95 $370.95 N/A N/A 03.311.051 SUP HCPCS C1713 03.311.051 - BOLT XTRNFX WRE OFST BOTH IP/OP $70.00 $52.00 $13.82 $70.80 $31.33 $31.33 $31.33 $31.33 $69.63 $69.63 $69.63 $14.51 $69.63 $69.63 $69.63 $69.63 $69.63 $14.51 $69.63 $28.32 $41.19 $69.63 $70.80 $69.63 $69.63 $52.50 $69.63 $69.63 $69.63 $34.82 $34.82 $55.15 $69.63 $55.70 $31.33 $13.82 N/A $40.60 $69.63 $69.63 $69.63 $14.51 $69.63 N/A N/A 03.311.060 SUP Custom 27203010 03.311.060 - NUT XTRNFX SQ MRI SAFE BOTH IP/OP $127.00 $94.00 $22.61 $129.15 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $22.61 $127.00 $127.00 $94.26 $94.26 $97.89 $66.17 $26.47 $127.00 $51.66 $127.00 $127.00 $129.15 $127.00 $127.00 $95.25 $127.00 $127.00 $127.00 $63.50 $63.50 $100.58 $127.00 $101.60 $82.55 $127.00 N/A $73.66 $127.00 $76.20 $127.00 $127.00 $127.00 N/A N/A 03.311.061.10 SUP Custom 27203010 03.311.061.10 - NUT XTRNFX NS LF DISP BOTH IP/OP $6.50 $5.00 $1.08 $6.57 $6.09 $6.09 $6.09 $6.09 $6.09 $6.09 $1.08 $6.09 $6.09 $4.52 $4.52 $4.69 $3.17 $1.27 $6.09 $2.63 $6.09 $6.09 $6.57 $6.09 $6.09 $4.88 $6.09 $6.09 $6.09 $3.05 $3.05 $4.82 $6.09 $4.87 $3.96 $6.09 N/A $3.77 $6.09 $3.65 $6.09 $6.09 $6.09 N/A N/A 03.311.062 SUP Custom 27803010 03.311.062 - NUT ORTHOPEDIC MRI SAFE NONSTRL BOTH IP/OP $246.50 $182.00 $43.82 $250.35 $246.18 $246.18 $246.18 $246.18 $246.18 $246.18 $43.82 $246.18 $246.18 $246.18 $246.18 $246.18 $246.18 $51.31 $246.18 $100.14 $246.18 $246.18 $250.35 $246.18 $246.18 $184.88 $246.18 $246.18 $246.18 $123.09 $123.09 $194.97 $246.18 $196.94 $110.78 $246.18 N/A $142.97 $246.18 $147.71 $246.18 $246.18 $246.18 N/A N/A 03.311.070 SUP Custom 27203010 03.311.070 - POST EXFIX SHORT WIRE MRI SAFE NONSTRL BOTH IP/OP $305.50 $226.00 $54.33 $310.43 $305.23 $305.23 $305.23 $305.23 $305.23 $305.23 $54.33 $305.23 $305.23 $226.54 $226.54 $235.27 $159.02 $63.61 $305.23 $124.17 $305.23 $305.23 $310.43 $305.23 $305.23 $229.13 $305.23 $305.23 $305.23 $152.62 $152.62 $241.74 $305.23 $244.18 $198.40 $305.23 N/A $177.19 $305.23 $183.14 $305.23 $305.23 $305.23 N/A N/A 03.311.071 SUP Custom 27203010 03.311.071 - POST XTRNFX TLL NS WRE MRI SAFE BOTH IP/OP $346.50 $256.00 $61.66 $352.33 $346.43 $346.43 $346.43 $346.43 $346.43 $346.43 $61.66 $346.43 $346.43 $257.12 $257.12 $267.03 $180.49 $72.20 $346.43 $140.93 $346.43 $346.43 $352.33 $346.43 $346.43 $259.88 $346.43 $346.43 $346.43 $173.22 $173.22 $274.37 $346.43 $277.14 $225.18 $346.43 N/A $200.97 $346.43 $207.86 $346.43 $346.43 $346.43 N/A N/A 03.311.090 SUP Custom 27803010 03.311.090 - WASHER XTRNFX SPHRCL CPLNG MRI SAFE BOTH IP/OP $54.50 $40.00 $9.62 $54.95 $54.03 $54.03 $54.03 $54.03 $54.03 $54.03 $9.62 $54.03 $54.03 $54.03 $54.03 $54.03 $54.03 $11.26 $54.03 $21.98 $54.03 $54.03 $54.95 $54.03 $54.03 $40.88 $54.03 $54.03 $54.03 $27.02 $27.02 $42.79 $54.03 $43.22 $24.31 $54.03 N/A $31.61 $54.03 $32.42 $54.03 $54.03 $54.03 N/A N/A 03.311.091 SUP Custom 27203010 03.311.091 - SUPPORT XTRNFX OBLQ NS BOTH IP/OP $860.00 $636.00 $153.08 $874.60 $859.98 $859.98 $859.98 $859.98 $859.98 $859.98 $153.08 $859.98 $859.98 $638.28 $638.28 $662.87 $448.05 $179.23 $859.98 $349.84 $859.98 $859.98 $874.60 $859.98 $859.98 $645.00 $859.98 $859.98 $859.98 $429.99 $429.99 $681.10 $859.98 $687.98 $558.99 $859.98 N/A $498.80 $859.98 $515.99 $859.98 $859.98 $859.98 N/A N/A 03.311.106 SUP HCPCS C1713 03.311.106 - ROD EXFIX 60MM THREAD SLOT MR SAFE NONSTRL DISTRACTION BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 03.311.108 SUP HCPCS C1713 03.311.108 - ROD EXFIX 80MM THREAD SLOT MR SAFE NONSTRL DISTRACTION BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 03.311.110 SUP Custom 27203010 03.311.110 - ROD EXFIX 100MM THREAD SLOT MR SAFE NONSTRL DISTRACTION BOTH IP/OP $105.00 $78.00 $18.64 $106.48 $104.70 $104.70 $104.70 $104.70 $104.70 $104.70 $18.64 $104.70 $104.70 $77.71 $77.71 $80.70 $54.55 $21.82 $104.70 $42.59 $104.70 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $68.06 $104.70 N/A $60.90 $104.70 $62.82 $104.70 $104.70 $104.70 N/A N/A 03.311.112 SUP HCPCS C1713 03.311.112 - ROD EXFIX 120MM THREAD MR SAFE NONSTRL DISTRACTION BOTH IP/OP $105.00 $78.00 $20.78 $106.48 $47.12 $47.12 $47.12 $47.12 $104.70 $104.70 $104.70 $21.82 $104.70 $104.70 $104.70 $104.70 $104.70 $21.82 $104.70 $42.59 $61.93 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $47.12 $20.78 N/A $60.90 $104.70 $104.70 $104.70 $21.82 $104.70 N/A N/A 03.311.115 SUP Custom 27203010 03.311.115 - ROD EXFIX 150MM THREAD MR SAFE NONSTRL DISTRACTION BOTH IP/OP $105.00 $78.00 $18.64 $106.48 $104.70 $104.70 $104.70 $104.70 $104.70 $104.70 $18.64 $104.70 $104.70 $77.71 $77.71 $80.70 $54.55 $21.82 $104.70 $42.59 $104.70 $104.70 $106.48 $104.70 $104.70 $78.75 $104.70 $104.70 $104.70 $52.35 $52.35 $82.92 $104.70 $83.76 $68.06 $104.70 N/A $60.90 $104.70 $62.82 $104.70 $104.70 $104.70 N/A N/A 03.311.120 SUP Custom 27203010 03.311.120 - ROD EXFIX 200MM THREAD MR SAFE NONSTRL DISTRACTION BOTH IP/OP $114.00 $84.00 $20.23 $115.55 $113.63 $113.63 $113.63 $113.63 $113.63 $113.63 $20.23 $113.63 $113.63 $84.34 $84.34 $87.59 $59.20 $23.68 $113.63 $46.22 $113.63 $113.63 $115.55 $113.63 $113.63 $85.50 $113.63 $113.63 $113.63 $56.82 $56.82 $89.99 $113.63 $90.90 $73.86 $113.63 N/A $66.12 $113.63 $68.18 $113.63 $113.63 $113.63 N/A N/A 03.311.125 SUP Custom 27203010 03.311.125 - ROD EXFIX 250MM THREAD MR SAFE NONSTRL DISTRACTION BOTH IP/OP $114.00 $84.00 $20.23 $115.55 $113.63 $113.63 $113.63 $113.63 $113.63 $113.63 $20.23 $113.63 $113.63 $84.34 $84.34 $87.59 $59.20 $23.68 $113.63 $46.22 $113.63 $113.63 $115.55 $113.63 $113.63 $85.50 $113.63 $113.63 $113.63 $56.82 $56.82 $89.99 $113.63 $90.90 $73.86 $113.63 N/A $66.12 $113.63 $68.18 $113.63 $113.63 $113.63 N/A N/A 03.311.130 SUP Custom 27203010 03.311.130 - ROD EXFIX 300MM THREAD MR SAFE NONSTRL DISTRACTION BOTH IP/OP $131.50 $97.00 $23.40 $133.68 $131.45 $131.45 $131.45 $131.45 $131.45 $131.45 $23.40 $131.45 $131.45 $97.56 $97.56 $101.32 $68.49 $27.40 $131.45 $53.47 $131.45 $131.45 $133.68 $131.45 $131.45 $98.63 $131.45 $131.45 $131.45 $65.73 $65.73 $104.11 $131.45 $105.16 $85.44 $131.45 N/A $76.27 $131.45 $78.87 $131.45 $131.45 $131.45 N/A N/A 03.311.135 SUP Custom 27203010 03.311.135 - ROD EXFIX 350MM THREAD MR SAFE NONSTRL DISTRACTION BOTH IP/OP $131.50 $97.00 $23.40 $133.68 $131.45 $131.45 $131.45 $131.45 $131.45 $131.45 $23.40 $131.45 $131.45 $97.56 $97.56 $101.32 $68.49 $27.40 $131.45 $53.47 $131.45 $131.45 $133.68 $131.45 $131.45 $98.63 $131.45 $131.45 $131.45 $65.73 $65.73 $104.11 $131.45 $105.16 $85.44 $131.45 N/A $76.27 $131.45 $78.87 $131.45 $131.45 $131.45 N/A N/A 03.311.140 SUP Custom 27203010 03.311.140 - ROD EXFIX 400MM THREAD MR SAFE NONSTRL DISTRACTION BOTH IP/OP $173.00 $128.00 $30.73 $175.58 $172.65 $172.65 $172.65 $172.65 $172.65 $172.65 $30.73 $172.65 $172.65 $128.14 $128.14 $133.08 $89.95 $35.98 $172.65 $70.23 $172.65 $172.65 $175.58 $172.65 $172.65 $129.75 $172.65 $172.65 $172.65 $86.33 $86.33 $136.74 $172.65 $138.12 $112.22 $172.65 N/A $100.34 $172.65 $103.59 $172.65 $172.65 $172.65 N/A N/A 03.311.171 SUP Custom 27100030 03.311.171 - POST XTRNFX NS 1 HL WRE FEM BOTH IP/OP $333.50 $247.00 $59.29 $338.73 $333.08 $333.08 $333.08 $333.08 $333.08 $333.08 $59.29 $333.08 $333.08 $247.21 $247.21 $256.74 $173.53 $69.42 $333.08 $135.49 $333.08 $333.08 $338.73 $333.08 $333.08 $250.13 $333.08 $333.08 $333.08 $166.54 $166.54 $263.80 $333.08 $266.46 $216.50 $333.08 N/A $193.43 $333.08 $199.85 $333.08 $333.08 $333.08 N/A N/A 03.311.172 SUP Custom 27203010 03.311.172 - POST XTRNFX NS 2 HL WRE FEM BOTH IP/OP $346.50 $256.00 $61.66 $352.33 $346.43 $346.43 $346.43 $346.43 $346.43 $346.43 $61.66 $346.43 $346.43 $257.12 $257.12 $267.03 $180.49 $72.20 $346.43 $140.93 $346.43 $346.43 $352.33 $346.43 $346.43 $259.88 $346.43 $346.43 $346.43 $173.22 $173.22 $274.37 $346.43 $277.14 $225.18 $346.43 N/A $200.97 $346.43 $207.86 $346.43 $346.43 $346.43 N/A N/A 03.311.173 SUP Custom 27203010 03.311.173 - POST XTRNFX NS 3 HL WRE FEM BOTH IP/OP $359.00 $266.00 $63.85 $364.80 $358.70 $358.70 $358.70 $358.70 $358.70 $358.70 $63.85 $358.70 $358.70 $266.23 $266.23 $276.49 $186.88 $74.76 $358.70 $145.92 $358.70 $358.70 $364.80 $358.70 $358.70 $269.25 $358.70 $358.70 $358.70 $179.35 $179.35 $284.09 $358.70 $286.96 $233.16 $358.70 N/A $208.22 $358.70 $215.22 $358.70 $358.70 $358.70 N/A N/A 03.311.174 SUP Custom 27203010 03.311.174 - POST XTRNFX NS 4 HL WRE FEM BOTH IP/OP $373.50 $276.00 $66.43 $379.53 $373.18 $373.18 $373.18 $373.18 $373.18 $373.18 $66.43 $373.18 $373.18 $276.97 $276.97 $287.65 $194.43 $77.77 $373.18 $151.81 $373.18 $373.18 $379.53 $373.18 $373.18 $280.13 $373.18 $373.18 $373.18 $186.59 $186.59 $295.56 $373.18 $298.54 $242.57 $373.18 N/A $216.63 $373.18 $223.91 $373.18 $373.18 $373.18 N/A N/A 03.311.175 SUP Custom 27203010 03.311.175 - POST XTRNFX NS 5 HL WRE FEM BOTH IP/OP $385.50 $285.00 $68.61 $391.98 $385.43 $385.43 $385.43 $385.43 $385.43 $385.43 $68.61 $385.43 $385.43 $286.07 $286.07 $297.09 $200.81 $80.33 $385.43 $156.79 $385.43 $385.43 $391.98 $385.43 $385.43 $289.13 $385.43 $385.43 $385.43 $192.72 $192.72 $305.26 $385.43 $308.34 $250.53 $385.43 N/A $223.59 $385.43 $231.26 $385.43 $385.43 $385.43 N/A N/A 03.311.200 SUP HCPCS C1713 03.311.200 - PLATE XTRNFX FLT NS 1 HL CNCT MRI SAFE FEM CFBR RING BOTH IP/OP $118.50 $88.00 $23.44 $120.08 $53.14 $53.14 $53.14 $53.14 $118.08 $118.08 $118.08 $24.61 $118.08 $118.08 $118.08 $118.08 $118.08 $24.61 $118.08 $48.03 $69.84 $118.08 $120.08 $118.08 $118.08 $88.88 $118.08 $118.08 $118.08 $59.04 $59.04 $93.52 $118.08 $94.46 $53.14 $23.44 N/A $68.73 $118.08 $118.08 $118.08 $118.08 $118.08 N/A N/A 03.311.201 SUP HCPCS C1713 03.311.201 - PLATE XTRNFX NS 1 HL CNCT MRI SAFE FEM CFBR RING BOTH IP/OP $118.50 $88.00 $23.44 $120.08 $53.14 $53.14 $53.14 $53.14 $118.08 $118.08 $118.08 $24.61 $118.08 $118.08 $118.08 $118.08 $118.08 $24.61 $118.08 $120.08 $69.84 $118.08 $120.08 $118.08 $118.08 $88.88 $118.08 $118.08 $118.08 $59.04 $59.04 $93.52 $118.08 $94.46 $53.14 $23.44 N/A $68.73 $118.08 $118.08 $118.08 $118.08 $118.08 N/A N/A 03.311.202 SUP HCPCS C1713 03.311.202 - PLATE XTRNFX NS 2 HL CNCT MRI SAFE FEM CFBR RING BOTH IP/OP $127.00 $94.00 $25.21 $129.15 $57.15 $57.15 $57.15 $57.15 $127.00 $127.00 $127.00 $26.47 $127.00 $127.00 $127.00 $127.00 $127.00 $26.47 $127.00 $129.15 $75.12 $127.00 $129.15 $127.00 $127.00 $95.25 $127.00 $127.00 $127.00 $63.50 $63.50 $100.58 $127.00 $101.60 $57.15 $25.21 N/A $73.66 $127.00 $127.00 $127.00 $26.47 $127.00 N/A N/A 03.311.203 SUP HCPCS C1713 03.311.203 - PLATE XTRNFX NS 3 HL CNCT MRI SAFE FEM CFBR RING BOTH IP/OP $131.50 $97.00 $26.09 $133.68 $59.15 $59.15 $59.15 $59.15 $131.45 $131.45 $131.45 $27.40 $131.45 $131.45 $131.45 $131.45 $131.45 $27.40 $131.45 $53.47 $77.75 $131.45 $133.68 $131.45 $131.45 $98.63 $131.45 $131.45 $131.45 $65.73 $65.73 $104.11 $131.45 $105.16 $59.15 $26.09 N/A $76.27 $131.45 $131.45 $131.45 $131.45 $131.45 N/A N/A 03.311.204 SUP HCPCS C1713 03.311.204 - PLATE XTRNFX NS 4 HL CNCT MRI SAFE FEM CFBR RING BOTH IP/OP $149.50 $111.00 $29.63 $151.83 $67.18 $67.18 $67.18 $67.18 $149.28 $149.28 $149.28 $31.11 $149.28 $149.28 $149.28 $149.28 $149.28 $31.11 $149.28 $151.83 $88.30 $149.28 $151.83 $149.28 $149.28 $112.13 $149.28 $149.28 $149.28 $74.64 $74.64 $118.23 $149.28 $119.42 $67.18 $29.63 N/A $86.71 $149.28 $149.28 $149.28 $149.28 $149.28 N/A N/A 03.311.205 SUP HCPCS C1713 03.311.205 - PLATE XTRNFX NS 5 HL CNCT MRI SAFE FEM CFBR RING BOTH IP/OP $173.00 $128.00 $34.27 $175.58 $77.69 $77.69 $77.69 $77.69 $172.65 $172.65 $172.65 $35.98 $172.65 $172.65 $172.65 $172.65 $172.65 $35.98 $172.65 $70.23 $102.12 $172.65 $175.58 $172.65 $172.65 $129.75 $172.65 $172.65 $172.65 $86.33 $86.33 $136.74 $172.65 $138.12 $77.69 $34.27 N/A $100.34 $172.65 $172.65 $172.65 $35.98 $172.65 N/A N/A 03.311.212 SUP HCPCS C1713 03.311.212 - PLATE XTRNFX NS 2 HL CNCT BOTH IP/OP $126.00 $93.00 $24.98 $128.03 $56.65 $56.65 $56.65 $56.65 $125.88 $125.88 $125.88 $26.24 $125.88 $125.88 $125.88 $125.88 $125.88 $26.23 $125.88 $51.21 $74.46 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $56.65 $24.98 N/A $73.08 $125.88 $75.53 $125.88 $26.23 $125.88 N/A N/A 03.311.213 SUP HCPCS C1713 03.311.213 - PLATE XTRNFX NS 3 HL CNCT BOTH IP/OP $139.50 $103.00 $27.64 $141.63 $62.66 $62.66 $62.66 $62.66 $139.25 $139.25 $139.25 $29.02 $139.25 $139.25 $139.25 $139.25 $139.25 $29.02 $139.25 $56.65 $82.37 $139.25 $141.63 $139.25 $139.25 $104.63 $139.25 $139.25 $139.25 $69.63 $69.63 $110.29 $139.25 $111.40 $62.66 $27.64 N/A $80.91 $139.25 $83.55 $139.25 $29.02 $139.25 N/A N/A 03.311.214 SUP HCPCS C1713 03.311.214 - PLATE XTRNFX NS 4 HL CNCT BOTH IP/OP $150.50 $111.00 $29.85 $152.93 $67.67 $67.67 $67.67 $67.67 $150.38 $150.38 $150.38 $31.34 $150.38 $150.38 $150.38 $150.38 $150.38 $31.34 $150.38 $61.17 $88.95 $150.38 $152.93 $150.38 $150.38 $112.88 $150.38 $150.38 $150.38 $75.19 $75.19 $119.10 $150.38 $120.30 $67.67 $29.85 N/A $87.29 $150.38 $90.23 $150.38 $31.34 $150.38 N/A N/A 03.311.215 SUP HCPCS C1713 03.311.215 - PLATE XTRNFX NS 5 HL CNCT BOTH IP/OP $163.00 $121.00 $32.28 $165.40 $73.18 $73.18 $73.18 $73.18 $162.63 $162.63 $162.63 $33.90 $162.63 $162.63 $162.63 $162.63 $162.63 $33.89 $162.63 $66.16 $96.20 $162.63 $165.40 $162.63 $162.63 $122.25 $162.63 $162.63 $162.63 $81.32 $81.32 $128.80 $162.63 $130.10 $73.18 $32.28 N/A $94.54 $162.63 $97.58 $162.63 $33.89 $162.63 N/A N/A 03.311.220 SUP Custom 27203010 03.311.220 - SPACER XTRNFX 20MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS BOTH IP/OP $73.00 $54.00 $12.99 $74.23 $72.98 $72.98 $72.98 $72.98 $72.98 $72.98 $12.99 $72.98 $72.98 $54.17 $54.17 $56.25 $38.02 $15.21 $72.98 $29.69 $72.98 $72.98 $74.23 $72.98 $72.98 $54.75 $72.98 $72.98 $72.98 $36.49 $36.49 $57.80 $72.98 $58.38 $47.44 $72.98 N/A $42.34 $72.98 $43.79 $72.98 $72.98 $72.98 N/A N/A 03.311.230 SUP Custom 27803010 03.311.230 - SPACER XTRNFX 30MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS BOTH IP/OP $79.50 $59.00 $14.08 $80.45 $79.10 $79.10 $79.10 $79.10 $79.10 $79.10 $14.08 $79.10 $79.10 $79.10 $79.10 $79.10 $79.10 $16.49 $79.10 $32.18 $79.10 $79.10 $80.45 $79.10 $79.10 $59.63 $79.10 $79.10 $79.10 $39.55 $39.55 $62.65 $79.10 $63.28 $35.60 $79.10 N/A $46.11 $79.10 $47.46 $79.10 $79.10 $79.10 N/A N/A 03.311.240 SUP Custom 27203010 03.311.240 - SPACER XTRNFX 40MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS BOTH IP/OP $87.50 $65.00 $15.57 $88.93 $87.45 $87.45 $87.45 $87.45 $87.45 $87.45 $15.57 $87.45 $87.45 $64.91 $64.91 $67.41 $45.56 $18.23 $87.45 $35.57 $87.45 $87.45 $88.93 $87.45 $87.45 $65.63 $87.45 $87.45 $87.45 $43.73 $43.73 $69.26 $87.45 $69.96 $56.84 $87.45 N/A $50.75 $87.45 $52.47 $87.45 $87.45 $87.45 N/A N/A 03.311.250 SUP Custom 27203010 03.311.250 - SPACER XTRNFX 50MM NS STNDOF MRI SAFE DSTRCT OSTEOGENESIS BOTH IP/OP $118.50 $88.00 $21.02 $120.08 $118.08 $118.08 $118.08 $118.08 $118.08 $118.08 $21.02 $118.08 $118.08 $87.64 $87.64 $91.02 $61.52 $24.61 $118.08 $48.03 $118.08 $118.08 $120.08 $118.08 $118.08 $88.88 $118.08 $118.08 $118.08 $59.04 $59.04 $93.52 $118.08 $94.46 $76.75 $118.08 N/A $68.73 $118.08 $70.85 $118.08 $118.08 $118.08 N/A N/A 03.311.308 SUP Custom 27203010 03.311.308 - RING EXFIX HALF 80MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP $578.50 $428.00 $102.91 $587.95 $578.13 $578.13 $578.13 $578.13 $578.13 $578.13 $102.91 $578.13 $578.13 $429.09 $429.09 $445.62 $301.21 $120.49 $578.13 $235.18 $578.13 $578.13 $587.95 $578.13 $578.13 $433.88 $578.13 $578.13 $578.13 $289.07 $289.07 $457.88 $578.13 $462.50 $375.78 $578.13 N/A $335.53 $578.13 $346.88 $578.13 $578.13 $578.13 N/A N/A 03.311.310 SUP Custom 27203010 03.311.310 - RING EXFIX HALF 100MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP $624.00 $462.00 $111.04 $634.40 $623.80 $623.80 $623.80 $623.80 $623.80 $623.80 $111.04 $623.80 $623.80 $462.98 $462.98 $480.83 $325.00 $130.01 $623.80 $253.76 $623.80 $623.80 $634.40 $623.80 $623.80 $468.00 $623.80 $623.80 $623.80 $311.90 $311.90 $494.05 $623.80 $499.04 $405.47 $623.80 N/A $361.92 $623.80 $374.28 $623.80 $623.80 $623.80 N/A N/A 03.311.311 SUP Custom 27203010 03.311.311 - RING EXFIX HALF 110MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP $639.50 $473.00 $113.81 $650.28 $639.40 $639.40 $639.40 $639.40 $639.40 $639.40 $113.81 $639.40 $639.40 $474.56 $474.56 $492.85 $333.13 $133.26 $639.40 $260.11 $639.40 $639.40 $650.28 $639.40 $639.40 $479.63 $639.40 $639.40 $639.40 $319.70 $319.70 $506.40 $639.40 $511.52 $415.61 $639.40 N/A $370.91 $639.40 $383.64 $639.40 $639.40 $639.40 N/A N/A 03.311.312 SUP Custom 27203010 03.311.312 - RING EXFIX HALF 120MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP $666.50 $493.00 $118.57 $677.48 $666.15 $666.15 $666.15 $666.15 $666.15 $666.15 $118.57 $666.15 $666.15 $494.42 $494.42 $513.47 $347.06 $138.83 $666.15 $270.99 $666.15 $666.15 $677.48 $666.15 $666.15 $499.88 $666.15 $666.15 $666.15 $333.08 $333.08 $527.59 $666.15 $532.92 $433.00 $666.15 N/A $386.57 $666.15 $399.69 $666.15 $666.15 $666.15 N/A N/A 03.311.313 SUP Custom 27203010 03.311.313 - RING EXFIX HALF 130MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP $683.00 $505.00 $121.55 $694.45 $682.85 $682.85 $682.85 $682.85 $682.85 $682.85 $121.55 $682.85 $682.85 $506.81 $506.81 $526.34 $355.76 $142.31 $682.85 $277.78 $682.85 $682.85 $694.45 $682.85 $682.85 $512.25 $682.85 $682.85 $682.85 $341.43 $341.43 $540.82 $682.85 $546.28 $443.85 $682.85 N/A $396.14 $682.85 $409.71 $682.85 $682.85 $682.85 N/A N/A 03.311.314 SUP Custom 27203010 03.311.314 - RING EXFIX HALF 140MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP $710.00 $525.00 $126.31 $721.65 $709.58 $709.58 $709.58 $709.58 $709.58 $709.58 $126.31 $709.58 $709.58 $526.65 $526.65 $546.94 $369.69 $147.88 $709.58 $288.66 $709.58 $709.58 $721.65 $709.58 $709.58 $532.50 $709.58 $709.58 $709.58 $354.79 $354.79 $561.99 $709.58 $567.66 $461.23 $709.58 N/A $411.80 $709.58 $425.75 $709.58 $709.58 $709.58 N/A N/A 03.311.315 SUP Custom 27203010 03.311.315 - RING EXFIX HALF 150MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP $755.50 $559.00 $134.43 $768.10 $755.25 $755.25 $755.25 $755.25 $755.25 $755.25 $134.43 $755.25 $755.25 $560.55 $560.55 $582.15 $393.49 $157.40 $755.25 $307.24 $755.25 $755.25 $768.10 $755.25 $755.25 $566.63 $755.25 $755.25 $755.25 $377.63 $377.63 $598.16 $755.25 $604.20 $490.91 $755.25 N/A $438.19 $755.25 $453.15 $755.25 $755.25 $755.25 N/A N/A 03.311.316 SUP Custom 27203010 03.311.316 - RING EXFIX HALF 160MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP $823.50 $609.00 $146.53 $837.20 $823.20 $823.20 $823.20 $823.20 $823.20 $823.20 $146.53 $823.20 $823.20 $610.98 $610.98 $634.52 $428.89 $171.56 $823.20 $334.88 $823.20 $823.20 $837.20 $823.20 $823.20 $617.63 $823.20 $823.20 $823.20 $411.60 $411.60 $651.97 $823.20 $658.56 $535.08 $823.20 N/A $477.63 $823.20 $493.92 $823.20 $823.20 $823.20 N/A N/A 03.311.318 SUP Custom 27203010 03.311.318 - RING EXFIX HALF 180MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP $884.50 $655.00 $157.44 $899.50 $884.48 $884.48 $884.48 $884.48 $884.48 $884.48 $157.44 $884.48 $884.48 $656.46 $656.46 $681.76 $460.81 $184.34 $884.48 $359.80 $884.48 $884.48 $899.50 $884.48 $884.48 $663.38 $884.48 $884.48 $884.48 $442.24 $442.24 $700.51 $884.48 $707.58 $574.91 $884.48 N/A $513.01 $884.48 $530.69 $884.48 $884.48 $884.48 N/A N/A 03.311.320 SUP Custom 27203010 03.311.320 - RING EXFIX HALF 200MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP $958.00 $709.00 $170.52 $974.28 $958.00 $958.00 $958.00 $958.00 $958.00 $958.00 $170.52 $958.00 $958.00 $711.03 $711.03 $738.43 $499.12 $199.66 $958.00 $389.71 $958.00 $958.00 $974.28 $958.00 $958.00 $718.50 $958.00 $958.00 $958.00 $479.00 $479.00 $758.74 $958.00 $766.40 $622.70 $958.00 N/A $555.64 $958.00 $574.80 $958.00 $958.00 $958.00 N/A N/A 03.311.322 SUP Custom 27203010 03.311.322 - RING EXFIX HALF 220MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP "$1,019.50" $754.00 $181.43 "$1,036.58" "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" $181.43 "$1,019.25" "$1,019.25" $756.49 $756.49 $785.64 $531.03 $212.42 "$1,019.25" $414.63 "$1,019.25" "$1,019.25" "$1,036.58" "$1,019.25" "$1,019.25" $764.63 "$1,019.25" "$1,019.25" "$1,019.25" $509.63 $509.63 $807.25 "$1,019.25" $815.40 $662.51 "$1,019.25" N/A $591.31 "$1,019.25" $611.55 "$1,019.25" "$1,019.25" "$1,019.25" N/A N/A 03.311.324 SUP Custom 27203010 03.311.324 - RING EXFIX HALF 240MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP "$1,064.00" $787.00 $189.36 "$1,081.90" "$1,063.83" "$1,063.83" "$1,063.83" "$1,063.83" "$1,063.83" "$1,063.83" $189.36 "$1,063.83" "$1,063.83" $789.57 $789.57 $820.00 $554.26 $221.71 "$1,063.83" $432.76 "$1,063.83" "$1,063.83" "$1,081.90" "$1,063.83" "$1,063.83" $798.00 "$1,063.83" "$1,063.83" "$1,063.83" $531.92 $531.92 $842.55 "$1,063.83" $851.06 $691.49 "$1,063.83" N/A $617.12 "$1,063.83" $638.30 "$1,063.83" "$1,063.83" "$1,063.83" N/A N/A 03.311.344 SUP Custom 27203010 03.311.344 - RING EXFIX FULL 140MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP "$1,415.00" "$1,047.00" $251.82 "$1,438.75" "$1,414.70" "$1,414.70" "$1,414.70" "$1,414.70" "$1,414.70" "$1,414.70" $251.82 "$1,414.70" "$1,414.70" "$1,049.99" "$1,049.99" "$1,090.45" $737.06 $294.84 "$1,414.70" $575.50 "$1,414.70" "$1,414.70" "$1,438.75" "$1,414.70" "$1,414.70" "$1,061.25" "$1,414.70" "$1,414.70" "$1,414.70" $707.35 $707.35 "$1,120.44" "$1,414.70" "$1,131.76" $919.56 "$1,414.70" N/A $820.70 "$1,414.70" $848.82 "$1,414.70" "$1,414.70" "$1,414.70" N/A N/A 03.311.346 SUP Custom 27203010 03.311.346 - RING EXFIX FULL 160MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP "$1,645.50" "$1,218.00" $292.86 "$1,673.28" "$1,645.30" "$1,645.30" "$1,645.30" "$1,645.30" "$1,645.30" "$1,645.30" $292.86 "$1,645.30" "$1,645.30" "$1,221.14" "$1,221.14" "$1,268.20" $857.20 $342.90 "$1,645.30" $669.31 "$1,645.30" "$1,645.30" "$1,673.28" "$1,645.30" "$1,645.30" "$1,234.13" "$1,645.30" "$1,645.30" "$1,645.30" $822.65 $822.65 "$1,303.08" "$1,645.30" "$1,316.24" "$1,069.45" "$1,645.30" N/A $954.39 "$1,645.30" $987.18 "$1,645.30" "$1,645.30" "$1,645.30" N/A N/A 03.311.348 SUP Custom 27203010 03.311.348 - RING EXFIX FULL 180MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP "$1,769.00" "$1,309.00" $314.87 "$1,799.03" "$1,768.95" "$1,768.95" "$1,768.95" "$1,768.95" "$1,768.95" "$1,768.95" $314.87 "$1,768.95" "$1,768.95" "$1,312.91" "$1,312.91" "$1,363.51" $921.62 $368.67 "$1,768.95" $719.61 "$1,768.95" "$1,768.95" "$1,799.03" "$1,768.95" "$1,768.95" "$1,326.75" "$1,768.95" "$1,768.95" "$1,768.95" $884.48 $884.48 "$1,401.01" "$1,768.95" "$1,415.16" "$1,149.82" "$1,768.95" N/A "$1,026.02" "$1,768.95" "$1,061.37" "$1,768.95" "$1,768.95" "$1,768.95" N/A N/A 03.311.350 SUP Custom 27203010 03.311.350 - RING EXFIX FULL 200MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP "$1,920.50" "$1,421.00" $341.84 "$1,953.10" "$1,920.45" "$1,920.45" "$1,920.45" "$1,920.45" "$1,920.45" "$1,920.45" $341.84 "$1,920.45" "$1,920.45" "$1,425.36" "$1,425.36" "$1,480.28" "$1,000.55" $400.24 "$1,920.45" $781.24 "$1,920.45" "$1,920.45" "$1,953.10" "$1,920.45" "$1,920.45" "$1,440.38" "$1,920.45" "$1,920.45" "$1,920.45" $960.23 $960.23 "$1,521.00" "$1,920.45" "$1,536.36" "$1,248.29" "$1,920.45" N/A "$1,113.89" "$1,920.45" "$1,152.27" "$1,920.45" "$1,920.45" "$1,920.45" N/A N/A 03.311.373 SUP Custom 27203010 03.311.373 - RING EXFIX 5/8 130MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP $930.50 $689.00 $165.57 $945.98 $930.15 $930.15 $930.15 $930.15 $930.15 $930.15 $165.57 $930.15 $930.15 $690.36 $690.36 $716.96 $484.61 $193.85 $930.15 $378.39 $930.15 $930.15 $945.98 $930.15 $930.15 $697.88 $930.15 $930.15 $930.15 $465.08 $465.08 $736.68 $930.15 $744.12 $604.60 $930.15 N/A $539.69 $930.15 $558.09 $930.15 $930.15 $930.15 N/A N/A 03.311.375 SUP Custom 27203010 03.311.375 - RING EXFIX 5/8 150MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP "$1,019.50" $754.00 $181.43 "$1,036.58" "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" $181.43 "$1,019.25" "$1,019.25" $756.49 $756.49 $785.64 $531.03 $212.42 "$1,019.25" $414.63 "$1,019.25" "$1,019.25" "$1,036.58" "$1,019.25" "$1,019.25" $764.63 "$1,019.25" "$1,019.25" "$1,019.25" $509.63 $509.63 $807.25 "$1,019.25" $815.40 $662.51 "$1,019.25" N/A $591.31 "$1,019.25" $611.55 "$1,019.25" "$1,019.25" "$1,019.25" N/A N/A 03.311.376 SUP Custom 27203010 03.311.376 - RING EXFIX 5/8 160MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP "$1,106.50" $819.00 $196.89 "$1,124.95" "$1,106.15" "$1,106.15" "$1,106.15" "$1,106.15" "$1,106.15" "$1,106.15" $196.89 "$1,106.15" "$1,106.15" $820.98 $820.98 $852.62 $576.30 $230.53 "$1,106.15" $449.98 "$1,106.15" "$1,106.15" "$1,124.95" "$1,106.15" "$1,106.15" $829.88 "$1,106.15" "$1,106.15" "$1,106.15" $553.08 $553.08 $876.07 "$1,106.15" $884.92 $719.00 "$1,106.15" N/A $641.77 "$1,106.15" $663.69 "$1,106.15" "$1,106.15" "$1,106.15" N/A N/A 03.311.378 SUP Custom 27203010 03.311.378 - RING EXFIX 5/8 180MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP "$1,284.50" $951.00 $228.62 "$1,306.20" "$1,284.38" "$1,284.38" "$1,284.38" "$1,284.38" "$1,284.38" "$1,284.38" $228.62 "$1,284.38" "$1,284.38" $953.27 $953.27 $990.00 $669.16 $267.68 "$1,284.38" $522.48 "$1,284.38" "$1,284.38" "$1,306.20" "$1,284.38" "$1,284.38" $963.38 "$1,284.38" "$1,284.38" "$1,284.38" $642.19 $642.19 "$1,017.23" "$1,284.38" "$1,027.50" $834.85 "$1,284.38" N/A $745.01 "$1,284.38" $770.63 "$1,284.38" "$1,284.38" "$1,284.38" N/A N/A 03.311.380 SUP Custom 27203010 03.311.380 - RING EXFIX 5/8 200MM TITANIUM NONSTRL DISTRACTION BOTH IP/OP "$1,328.00" $983.00 $236.35 "$1,350.40" "$1,327.83" "$1,327.83" "$1,327.83" "$1,327.83" "$1,327.83" "$1,327.83" $236.35 "$1,327.83" "$1,327.83" $985.52 $985.52 "$1,023.49" $691.80 $276.73 "$1,327.83" $540.16 "$1,327.83" "$1,327.83" "$1,350.40" "$1,327.83" "$1,327.83" $996.00 "$1,327.83" "$1,327.83" "$1,327.83" $663.92 $663.92 "$1,051.64" "$1,327.83" "$1,062.26" $863.09 "$1,327.83" N/A $770.24 "$1,327.83" $796.70 "$1,327.83" "$1,327.83" "$1,327.83" N/A N/A 03.311.391 SUP HCPCS C1713 03.311.391 - PLATE XTRNFX 90D ARCH 180MM NS TI FEM DSTRCT OSTEOGENESIS BOTH IP/OP "$1,593.00" "$1,179.00" $316.16 "$1,620.03" $716.83 $716.83 $716.83 $716.83 "$1,592.95" "$1,592.95" "$1,592.95" $332.01 "$1,592.95" "$1,592.95" "$1,592.95" "$1,592.95" "$1,592.95" $331.99 "$1,592.95" $648.01 $942.23 "$1,592.95" "$1,620.03" "$1,592.95" "$1,592.95" "$1,194.75" "$1,592.95" "$1,592.95" "$1,592.95" $796.48 $796.48 "$1,261.62" "$1,592.95" "$1,274.36" $716.83 $316.16 N/A $923.94 "$1,592.95" "$1,592.95" "$1,592.95" $331.97 "$1,592.95" N/A N/A 03.311.392 SUP HCPCS C1713 03.311.392 - PLATE XTRNFX 120D ARCH 180MM NS TI FEM DSTRCT OSTEOGENESIS BOTH IP/OP "$1,636.50" "$1,211.00" $324.78 "$1,664.20" $736.37 $736.37 $736.37 $736.37 "$1,636.38" "$1,636.38" "$1,636.38" $341.06 "$1,636.38" "$1,636.38" "$1,636.38" "$1,636.38" "$1,636.38" $341.04 "$1,636.38" $665.68 $967.92 "$1,636.38" "$1,664.20" "$1,636.38" "$1,636.38" "$1,227.38" "$1,636.38" "$1,636.38" "$1,636.38" $818.19 $818.19 "$1,296.01" "$1,636.38" "$1,309.10" $736.37 $324.78 N/A $949.17 "$1,636.38" "$1,636.38" "$1,636.38" "$1,636.38" "$1,636.38" N/A N/A 03.311.396 SUP HCPCS C1713 03.311.396 - PLATE XTRNFX 90D ARCH 240MM NS TI FEM DSTRCT OSTEOGENESIS BOTH IP/OP "$1,728.00" "$1,279.00" $342.91 "$1,757.10" $777.48 $777.48 $777.48 $777.48 "$1,727.73" "$1,727.73" "$1,727.73" $360.10 "$1,727.73" "$1,727.73" "$1,727.73" "$1,727.73" "$1,727.73" $360.08 "$1,727.73" $702.84 "$1,021.95" "$1,727.73" "$1,757.10" "$1,727.73" "$1,727.73" "$1,296.00" "$1,727.73" "$1,727.73" "$1,727.73" $863.87 $863.87 "$1,368.36" "$1,727.73" "$1,382.18" $777.48 $342.91 N/A "$1,002.24" "$1,727.73" "$1,727.73" "$1,727.73" "$1,727.73" "$1,727.73" N/A N/A 03.311.397 SUP HCPCS C1713 03.311.397 - PLATE XTRNFX 120D ARCH 240MM NS TI FEM DSTRCT OSTEOGENESIS BOTH IP/OP "$1,769.00" "$1,309.00" $351.09 "$1,799.03" $796.03 $796.03 $796.03 $796.03 "$1,768.95" "$1,768.95" "$1,768.95" $368.69 "$1,768.95" "$1,768.95" "$1,768.95" "$1,768.95" "$1,768.95" $368.67 "$1,768.95" $719.61 "$1,046.33" "$1,768.95" "$1,799.03" "$1,768.95" "$1,768.95" "$1,326.75" "$1,768.95" "$1,768.95" "$1,768.95" $884.48 $884.48 "$1,401.01" "$1,768.95" "$1,415.16" $796.03 $351.09 N/A "$1,026.02" "$1,768.95" "$1,768.95" "$1,768.95" $368.65 "$1,768.95" N/A N/A 03.311.406 SUP Custom 27803010 03.311.406 - DISTRACTOR SURG 60MM 25MM LINEAR NONSTRL BOTH IP/OP "$1,019.50" $754.00 $181.43 "$1,036.58" "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" $181.43 "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" $212.42 "$1,019.25" $414.63 "$1,019.25" "$1,019.25" "$1,036.58" "$1,019.25" "$1,019.25" $764.63 "$1,019.25" "$1,019.25" "$1,019.25" $509.63 $509.63 $807.25 "$1,019.25" $815.40 $458.66 "$1,019.25" N/A $591.31 "$1,019.25" $611.55 "$1,019.25" "$1,019.25" "$1,019.25" N/A N/A 03.311.412 SUP Custom 27803010 03.311.412 - DISTRACTOR SURG 85MM TRAVEL 120MM LINEAR MRI SAFE NONSTRL BOTH IP/OP "$1,106.50" $819.00 $196.89 "$1,124.95" "$1,106.15" "$1,106.15" "$1,106.15" "$1,106.15" "$1,106.15" "$1,106.15" $196.89 "$1,106.15" "$1,106.15" "$1,106.15" "$1,106.15" "$1,106.15" "$1,106.15" $230.53 "$1,106.15" $449.98 "$1,106.15" "$1,106.15" "$1,124.95" "$1,106.15" "$1,106.15" $829.88 "$1,106.15" "$1,106.15" "$1,106.15" $553.08 $553.08 $876.07 "$1,106.15" $884.92 $497.77 "$1,106.15" N/A $641.77 "$1,106.15" $663.69 "$1,106.15" "$1,106.15" "$1,106.15" N/A N/A 03.311.418 SUP Custom 27803010 03.311.418 - DISTRACTOR SURG 180MM LINEAR MRI SAFE NONSTRL BOTH IP/OP "$1,240.00" $918.00 $220.69 "$1,260.90" "$1,239.83" "$1,239.83" "$1,239.83" "$1,239.83" "$1,239.83" "$1,239.83" $220.69 "$1,239.83" "$1,239.83" "$1,239.83" "$1,239.83" "$1,239.83" "$1,239.83" $258.39 "$1,239.83" $504.36 "$1,239.83" "$1,239.83" "$1,260.90" "$1,239.83" "$1,239.83" $930.00 "$1,239.83" "$1,239.83" "$1,239.83" $619.92 $619.92 $981.95 "$1,239.83" $991.86 $557.92 "$1,239.83" N/A $719.20 "$1,239.83" $743.90 "$1,239.83" "$1,239.83" "$1,239.83" N/A N/A 03.311.425 SUP Custom 27803010 03.311.425 - DISTRACTOR SURG 215MM TRAVEL 250MM LINEAR MRI SAFE NONSTRL BOTH IP/OP "$1,505.00" "$1,114.00" $267.88 "$1,530.53" "$1,504.95" "$1,504.95" "$1,504.95" "$1,504.95" "$1,504.95" "$1,504.95" $267.88 "$1,504.95" "$1,504.95" "$1,504.95" "$1,504.95" "$1,504.95" "$1,504.95" $313.65 "$1,504.95" $612.21 "$1,504.95" "$1,504.95" "$1,530.53" "$1,504.95" "$1,504.95" "$1,128.75" "$1,504.95" "$1,504.95" "$1,504.95" $752.48 $752.48 "$1,191.92" "$1,504.95" "$1,203.96" $677.23 "$1,504.95" N/A $872.90 "$1,504.95" $902.97 "$1,504.95" "$1,504.95" "$1,504.95" N/A N/A 03.311.450 SUP Custom 27803010 03.311.450 - DISTRACTOR SURG ANGLE NONSTRL BOTH IP/OP $990.50 $733.00 $176.27 "$1,007.13" $990.30 $990.30 $990.30 $990.30 $990.30 $990.30 $176.27 $990.30 $990.30 $990.30 $990.30 $990.30 $990.30 $206.39 $990.30 $402.85 $990.30 $990.30 "$1,007.13" $990.30 $990.30 $742.88 $990.30 $990.30 $990.30 $495.15 $495.15 $784.32 $990.30 $792.24 $445.64 $990.30 N/A $574.49 $990.30 $594.18 $990.30 $990.30 $990.30 N/A N/A 03.311.451 SUP Custom 27803010 03.311.451 - DISTRACTOR SURG ANGLE PIVOT NONSTRL BOTH IP/OP $432.50 $320.00 $76.93 $439.55 $432.20 $432.20 $432.20 $432.20 $432.20 $432.20 $76.93 $432.20 $432.20 $432.20 $432.20 $432.20 $432.20 $90.08 $432.20 $175.82 $432.20 $432.20 $439.55 $432.20 $432.20 $324.38 $432.20 $432.20 $432.20 $216.10 $216.10 $342.30 $432.20 $345.76 $194.49 $432.20 N/A $250.85 $432.20 $259.32 $432.20 $432.20 $432.20 N/A N/A 03.311.810 SUP Custom 27203010 03.311.810 - RING EXFIX .5 100MM MRI SAFE CARFBR NONSTRL BOTH IP/OP $710.00 $525.00 $126.31 $721.65 $709.58 $709.58 $709.58 $709.58 $709.58 $709.58 $126.31 $709.58 $709.58 $526.65 $526.65 $546.94 $369.69 $147.88 $709.58 $288.66 $709.58 $709.58 $721.65 $709.58 $709.58 $532.50 $709.58 $709.58 $709.58 $354.79 $354.79 $561.99 $709.58 $567.66 $461.23 $709.58 N/A $411.80 $709.58 $425.75 $709.58 $709.58 $709.58 N/A N/A 03.311.812 SUP Custom 27203010 03.311.812 - RING EXFIX .5 120MM MRI SAFE CARFBR NONSTRL BOTH IP/OP $755.50 $559.00 $134.43 $768.10 $755.25 $755.25 $755.25 $755.25 $755.25 $755.25 $134.43 $755.25 $755.25 $560.55 $560.55 $582.15 $393.49 $157.40 $755.25 $307.24 $755.25 $755.25 $768.10 $755.25 $755.25 $566.63 $755.25 $755.25 $755.25 $377.63 $377.63 $598.16 $755.25 $604.20 $490.91 $755.25 N/A $438.19 $755.25 $453.15 $755.25 $755.25 $755.25 N/A N/A 03.311.814 SUP Custom 27203010 03.311.814 - RING EXFIX .5 140MM MRI SAFE CARFBR NONSTRL BOTH IP/OP $799.00 $591.00 $142.17 $812.28 $798.70 $798.70 $798.70 $798.70 $798.70 $798.70 $142.17 $798.70 $798.70 $592.80 $592.80 $615.64 $416.12 $166.46 $798.70 $324.91 $798.70 $798.70 $812.28 $798.70 $798.70 $599.25 $798.70 $798.70 $798.70 $399.35 $399.35 $632.57 $798.70 $638.96 $519.16 $798.70 N/A $463.42 $798.70 $479.22 $798.70 $798.70 $798.70 N/A N/A 03.311.816 SUP Custom 27203010 03.311.816 - RING EXFIX .5 160MM MRI SAFE CARFBR NONSTRL BOTH IP/OP $884.50 $655.00 $157.44 $899.50 $884.48 $884.48 $884.48 $884.48 $884.48 $884.48 $157.44 $884.48 $884.48 $656.46 $656.46 $681.76 $460.81 $184.34 $884.48 $359.80 $884.48 $884.48 $899.50 $884.48 $884.48 $663.38 $884.48 $884.48 $884.48 $442.24 $442.24 $700.51 $884.48 $707.58 $574.91 $884.48 N/A $513.01 $884.48 $530.69 $884.48 $884.48 $884.48 N/A N/A 03.311.818 SUP Custom 27203010 03.311.818 - RING EXFIX .5 180MM MRI SAFE CARFBR NONSTRL BOTH IP/OP $930.50 $689.00 $165.57 $945.98 $930.15 $930.15 $930.15 $930.15 $930.15 $930.15 $165.57 $930.15 $930.15 $690.36 $690.36 $716.96 $484.61 $193.85 $930.15 $378.39 $930.15 $930.15 $945.98 $930.15 $930.15 $697.88 $930.15 $930.15 $930.15 $465.08 $465.08 $736.68 $930.15 $744.12 $604.60 $930.15 N/A $539.69 $930.15 $558.09 $930.15 $930.15 $930.15 N/A N/A 03.311.820 SUP Custom 27203010 03.311.820 - RING EXFIX .5 200MM MRI SAFE CARFBR NONSTRL BOTH IP/OP $975.00 $722.00 $173.50 $991.28 $974.70 $974.70 $974.70 $974.70 $974.70 $974.70 $173.50 $974.70 $974.70 $723.42 $723.42 $751.30 $507.82 $203.14 $974.70 $396.51 $974.70 $974.70 $991.28 $974.70 $974.70 $731.25 $974.70 $974.70 $974.70 $487.35 $487.35 $771.96 $974.70 $779.76 $633.56 $974.70 N/A $565.50 $974.70 $584.82 $974.70 $974.70 $974.70 N/A N/A 03.311.844 SUP Custom 27203010 03.311.844 - RING EXFIX 140MM FULL RING MRI SAFE CARFBR BOTH IP/OP "$1,593.00" "$1,179.00" $283.55 "$1,620.03" "$1,592.95" "$1,592.95" "$1,592.95" "$1,592.95" "$1,592.95" "$1,592.95" $283.55 "$1,592.95" "$1,592.95" "$1,182.29" "$1,182.29" "$1,227.85" $829.93 $331.99 "$1,592.95" $648.01 "$1,592.95" "$1,592.95" "$1,620.03" "$1,592.95" "$1,592.95" "$1,194.75" "$1,592.95" "$1,592.95" "$1,592.95" $796.48 $796.48 "$1,261.62" "$1,592.95" "$1,274.36" "$1,035.42" "$1,592.95" N/A $923.94 "$1,592.95" $955.77 "$1,592.95" "$1,592.95" "$1,592.95" N/A N/A 03.311.846 SUP Custom 27203010 03.311.846 - RING EXFIX FULL 160MM FULL RING MRI SAFE CARFBR NONSTRL BOTH IP/OP "$1,769.00" "$1,309.00" $314.87 "$1,799.03" "$1,768.95" "$1,768.95" "$1,768.95" "$1,768.95" "$1,768.95" "$1,768.95" $314.87 "$1,768.95" "$1,768.95" "$1,312.91" "$1,312.91" "$1,363.51" $921.62 $368.67 "$1,768.95" $719.61 "$1,768.95" "$1,768.95" "$1,799.03" "$1,768.95" "$1,768.95" "$1,326.75" "$1,768.95" "$1,768.95" "$1,768.95" $884.48 $884.48 "$1,401.01" "$1,768.95" "$1,415.16" "$1,149.82" "$1,768.95" N/A "$1,026.02" "$1,768.95" "$1,061.37" "$1,768.95" "$1,768.95" "$1,768.95" N/A N/A 03.311.848 SUP Custom 27203010 03.311.848 - RING EXFIX 180MM FULL RING MRI SAFE CARFBR BOTH IP/OP "$1,947.50" "$1,441.00" $346.60 "$1,980.28" "$1,947.18" "$1,947.18" "$1,947.18" "$1,947.18" "$1,947.18" "$1,947.18" $346.60 "$1,947.18" "$1,947.18" "$1,445.20" "$1,445.20" "$1,500.89" "$1,014.48" $405.81 "$1,947.18" $792.11 "$1,947.18" "$1,947.18" "$1,980.28" "$1,947.18" "$1,947.18" "$1,460.63" "$1,947.18" "$1,947.18" "$1,947.18" $973.59 $973.59 "$1,542.17" "$1,947.18" "$1,557.74" "$1,265.67" "$1,947.18" N/A "$1,129.55" "$1,947.18" "$1,168.31" "$1,947.18" "$1,947.18" "$1,947.18" N/A N/A 03.311.850 SUP Custom 27203010 03.311.850 - RING EXFIX 200MM FULL RING MRI SAFE CARFBR BOTH IP/OP "$2,122.50" "$1,571.00" $377.73 "$2,158.15" "$2,122.08" "$2,122.08" "$2,122.08" "$2,122.08" "$2,122.08" "$2,122.08" $377.73 "$2,122.08" "$2,122.08" "$1,575.01" "$1,575.01" "$1,635.70" "$1,105.60" $442.26 "$2,122.08" $863.26 "$2,122.08" "$2,122.08" "$2,158.15" "$2,122.08" "$2,122.08" "$1,591.88" "$2,122.08" "$2,122.08" "$2,122.08" "$1,061.04" "$1,061.04" "$1,680.69" "$2,122.08" "$1,697.66" "$1,379.35" "$2,122.08" N/A "$1,231.05" "$2,122.08" "$1,273.25" "$2,122.08" "$2,122.08" "$2,122.08" N/A N/A 03.311.874 SUP Custom 27203010 03.311.874 - RING EXFIX 5/8 140MM MRI SAFE CARFBR NONSTRL BOTH IP/OP $930.50 $689.00 $165.57 $945.98 $930.15 $930.15 $930.15 $930.15 $930.15 $930.15 $165.57 $930.15 $930.15 $690.36 $690.36 $716.96 $484.61 $193.85 $930.15 $378.39 $930.15 $930.15 $945.98 $930.15 $930.15 $697.88 $930.15 $930.15 $930.15 $465.08 $465.08 $736.68 $930.15 $744.12 $604.60 $930.15 N/A $539.69 $930.15 $558.09 $930.15 $930.15 $930.15 N/A N/A 03.311.876 SUP Custom 27203010 03.311.876 - RING EXFIX 5/8 160MM MRI SAFE CARFBR NONSTRL BOTH IP/OP $975.00 $722.00 $173.50 $991.28 $974.70 $974.70 $974.70 $974.70 $974.70 $974.70 $173.50 $974.70 $974.70 $723.42 $723.42 $751.30 $507.82 $203.14 $974.70 $396.51 $974.70 $974.70 $991.28 $974.70 $974.70 $731.25 $974.70 $974.70 $974.70 $487.35 $487.35 $771.96 $974.70 $779.76 $633.56 $974.70 N/A $565.50 $974.70 $584.82 $974.70 $974.70 $974.70 N/A N/A 03.311.878 SUP Custom 27203010 03.311.878 - RING EXFIX 5/8 180MM MRI SAFE CARFBR NONSTRL BOTH IP/OP "$1,019.50" $754.00 $181.43 "$1,036.58" "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" "$1,019.25" $181.43 "$1,019.25" "$1,019.25" $756.49 $756.49 $785.64 $531.03 $212.42 "$1,019.25" $414.63 "$1,019.25" "$1,019.25" "$1,036.58" "$1,019.25" "$1,019.25" $764.63 "$1,019.25" "$1,019.25" "$1,019.25" $509.63 $509.63 $807.25 "$1,019.25" $815.40 $662.51 "$1,019.25" N/A $591.31 "$1,019.25" $611.55 "$1,019.25" "$1,019.25" "$1,019.25" N/A N/A 03.311.880 SUP Custom 27203010 03.311.880 - RING EXFIX 5/8 200MM MRI SAFE CARFBR NONSTRL BOTH IP/OP "$1,064.00" $787.00 $189.36 "$1,081.90" "$1,063.83" "$1,063.83" "$1,063.83" "$1,063.83" "$1,063.83" "$1,063.83" $189.36 "$1,063.83" "$1,063.83" $789.57 $789.57 $820.00 $554.26 $221.71 "$1,063.83" $432.76 "$1,063.83" "$1,063.83" "$1,081.90" "$1,063.83" "$1,063.83" $798.00 "$1,063.83" "$1,063.83" "$1,063.83" $531.92 $531.92 $842.55 "$1,063.83" $851.06 $691.49 "$1,063.83" N/A $617.12 "$1,063.83" $638.30 "$1,063.83" "$1,063.83" "$1,063.83" N/A N/A 03.311.891 SUP HCPCS C1713 03.311.891 - PLATE XTRNFX 90D ARCH 180MM NS MRI SAFE CFBR FEM BOTH IP/OP "$1,463.00" "$1,083.00" $290.29 "$1,487.48" $658.17 $658.17 $658.17 $658.17 "$1,462.60" "$1,462.60" "$1,462.60" $304.84 "$1,462.60" "$1,462.60" "$1,462.60" "$1,462.60" "$1,462.60" $304.82 "$1,462.60" $594.99 $865.13 "$1,462.60" "$1,487.48" "$1,462.60" "$1,462.60" "$1,097.25" "$1,462.60" "$1,462.60" "$1,462.60" $731.30 $731.30 "$1,158.38" "$1,462.60" "$1,170.08" $658.17 $290.29 N/A $848.54 "$1,462.60" "$1,462.60" "$1,462.60" $304.81 "$1,462.60" N/A N/A 03.311.892 SUP HCPCS C1713 03.311.892 - PLATE XTRNFX 120D ARCH 180MM NS MRI SAFE CFBR FEM BOTH IP/OP "$1,512.00" "$1,119.00" $300.02 "$1,537.33" $680.23 $680.23 $680.23 $680.23 "$1,511.63" "$1,511.63" "$1,511.63" $315.06 "$1,511.63" "$1,511.63" "$1,511.63" "$1,511.63" "$1,511.63" $315.04 "$1,511.63" $614.93 $894.13 "$1,511.63" "$1,537.33" "$1,511.63" "$1,511.63" "$1,134.00" "$1,511.63" "$1,511.63" "$1,511.63" $755.82 $755.82 "$1,197.21" "$1,511.63" "$1,209.30" $680.23 $300.02 N/A $876.96 "$1,511.63" "$1,511.63" "$1,511.63" $315.02 "$1,511.63" N/A N/A 03.311.896 SUP HCPCS C1713 03.311.896 - PLATE XTRNFX 90D ARCH 240MM NS MRI SAFE CFBR FEM BOTH IP/OP "$1,556.50" "$1,152.00" $308.86 "$1,582.63" $700.28 $700.28 $700.28 $700.28 "$1,556.18" "$1,556.18" "$1,556.18" $324.35 "$1,556.18" "$1,556.18" "$1,556.18" "$1,556.18" "$1,556.18" $324.33 "$1,556.18" $633.05 $920.48 "$1,556.18" "$1,582.63" "$1,556.18" "$1,556.18" "$1,167.38" "$1,556.18" "$1,556.18" "$1,556.18" $778.09 $778.09 "$1,232.49" "$1,556.18" "$1,244.94" $700.28 $308.86 N/A $902.77 "$1,556.18" "$1,556.18" "$1,556.18" $324.31 "$1,556.18" N/A N/A 03.311.897 SUP HCPCS C1713 03.311.897 - PLATE XTRNFX 120D ARCH 240MM NS MRI SAFE CFBR FEM BOTH IP/OP "$1,646.50" "$1,218.00" $326.77 "$1,674.40" $740.88 $740.88 $740.88 $740.88 "$1,646.40" "$1,646.40" "$1,646.40" $343.15 "$1,646.40" "$1,646.40" "$1,646.40" "$1,646.40" "$1,646.40" $343.13 "$1,646.40" $669.76 $973.85 "$1,646.40" "$1,674.40" "$1,646.40" "$1,646.40" "$1,234.88" "$1,646.40" "$1,646.40" "$1,646.40" $823.20 $823.20 "$1,303.95" "$1,646.40" "$1,317.12" $740.88 $326.77 N/A $954.97 "$1,646.40" "$1,646.40" "$1,646.40" $343.11 "$1,646.40" N/A N/A 03.311.910 SUP Custom 27203010 03.311.910 - RING EXFIX SHORT 100MM MRI SAFE CARFBR FT BOTH IP/OP "$1,144.50" $847.00 $203.64 "$1,163.48" "$1,144.03" "$1,144.03" "$1,144.03" "$1,144.03" "$1,144.03" "$1,144.03" $203.64 "$1,144.03" "$1,144.03" $849.10 $849.10 $881.82 $596.04 $238.43 "$1,144.03" $465.39 "$1,144.03" "$1,144.03" "$1,163.48" "$1,144.03" "$1,144.03" $858.38 "$1,144.03" "$1,144.03" "$1,144.03" $572.02 $572.02 $906.07 "$1,144.03" $915.22 $743.62 "$1,144.03" N/A $663.81 "$1,144.03" $686.42 "$1,144.03" "$1,144.03" "$1,144.03" N/A N/A 03.311.914 SUP Custom 27203010 03.311.914 - RING EXFIX SHORT 140MM MRI SAFE CARFBR FT BOTH IP/OP "$1,190.00" $881.00 $211.77 "$1,209.93" "$1,189.70" "$1,189.70" "$1,189.70" "$1,189.70" "$1,189.70" "$1,189.70" $211.77 "$1,189.70" "$1,189.70" $883.00 $883.00 $917.02 $619.83 $247.95 "$1,189.70" $483.97 "$1,189.70" "$1,189.70" "$1,209.93" "$1,189.70" "$1,189.70" $892.50 "$1,189.70" "$1,189.70" "$1,189.70" $594.85 $594.85 $942.24 "$1,189.70" $951.76 $773.31 "$1,189.70" N/A $690.20 "$1,189.70" $713.82 "$1,189.70" "$1,189.70" "$1,189.70" N/A N/A 03.311.916 SUP Custom 27203010 03.311.916 - RING EXFIX SHORT 160MM FT RING MRI SAFE CARFBR BOTH IP/OP "$1,236.50" $915.00 $220.09 "$1,257.50" "$1,236.48" "$1,236.48" "$1,236.48" "$1,236.48" "$1,236.48" "$1,236.48" $220.09 "$1,236.48" "$1,236.48" $917.72 $917.72 $953.08 $644.21 $257.70 "$1,236.48" $503.00 "$1,236.48" "$1,236.48" "$1,257.50" "$1,236.48" "$1,236.48" $927.38 "$1,236.48" "$1,236.48" "$1,236.48" $618.24 $618.24 $979.29 "$1,236.48" $989.18 $803.71 "$1,236.48" N/A $717.17 "$1,236.48" $741.89 "$1,236.48" "$1,236.48" "$1,236.48" N/A N/A 03.311.918 SUP Custom 27203010 03.311.918 - RING EXFIX SHORT 180MM MRI SAFE CARFBR FT BOTH IP/OP "$1,282.50" $949.00 $228.22 "$1,303.95" "$1,282.15" "$1,282.15" "$1,282.15" "$1,282.15" "$1,282.15" "$1,282.15" $228.22 "$1,282.15" "$1,282.15" $951.61 $951.61 $988.28 $668.00 $267.21 "$1,282.15" $521.58 "$1,282.15" "$1,282.15" "$1,303.95" "$1,282.15" "$1,282.15" $961.88 "$1,282.15" "$1,282.15" "$1,282.15" $641.08 $641.08 "$1,015.46" "$1,282.15" "$1,025.72" $833.40 "$1,282.15" N/A $743.85 "$1,282.15" $769.29 "$1,282.15" "$1,282.15" "$1,282.15" N/A N/A 03.311.940 SUP Custom 27203010 03.311.940 - RING EXFIX LONG 100MM MRI SAFE CARFBR FT BOTH IP/OP "$1,144.50" $847.00 $203.64 "$1,163.48" "$1,144.03" "$1,144.03" "$1,144.03" "$1,144.03" "$1,144.03" "$1,144.03" $203.64 "$1,144.03" "$1,144.03" $849.10 $849.10 $881.82 $596.04 $238.43 "$1,144.03" $465.39 "$1,144.03" "$1,144.03" "$1,163.48" "$1,144.03" "$1,144.03" $858.38 "$1,144.03" "$1,144.03" "$1,144.03" $572.02 $572.02 $906.07 "$1,144.03" $915.22 $743.62 "$1,144.03" N/A $663.81 "$1,144.03" $686.42 "$1,144.03" "$1,144.03" "$1,144.03" N/A N/A 03.311.944 SUP Custom 27203010 03.311.944 - RING EXFIX LONG 140MM MRI SAFE CARFBR FT BOTH IP/OP "$1,190.00" $881.00 $211.77 "$1,209.93" "$1,189.70" "$1,189.70" "$1,189.70" "$1,189.70" "$1,189.70" "$1,189.70" $211.77 "$1,189.70" "$1,189.70" $883.00 $883.00 $917.02 $619.83 $247.95 "$1,189.70" $483.97 "$1,189.70" "$1,189.70" "$1,209.93" "$1,189.70" "$1,189.70" $892.50 "$1,189.70" "$1,189.70" "$1,189.70" $594.85 $594.85 $942.24 "$1,189.70" $951.76 $773.31 "$1,189.70" N/A $690.20 "$1,189.70" $713.82 "$1,189.70" "$1,189.70" "$1,189.70" N/A N/A 03.311.946 SUP Custom 27203010 03.311.946 - RING EXFIX 160MM MRI SAFE CARFBR FT BOTH IP/OP "$1,236.50" $915.00 $220.09 "$1,257.50" "$1,236.48" "$1,236.48" "$1,236.48" "$1,236.48" "$1,236.48" "$1,236.48" $220.09 "$1,236.48" "$1,236.48" $917.72 $917.72 $953.08 $644.21 $257.70 "$1,236.48" $503.00 "$1,236.48" "$1,236.48" "$1,257.50" "$1,236.48" "$1,236.48" $927.38 "$1,236.48" "$1,236.48" "$1,236.48" $618.24 $618.24 $979.29 "$1,236.48" $989.18 $803.71 "$1,236.48" N/A $717.17 "$1,236.48" $741.89 "$1,236.48" "$1,236.48" "$1,236.48" N/A N/A 03.311.948 SUP Custom 27203010 03.311.948 - RING EXFIX LONG 180MM MRI SAFE CARFBR FT BOTH IP/OP "$1,282.50" $949.00 $228.22 "$1,303.95" "$1,282.15" "$1,282.15" "$1,282.15" "$1,282.15" "$1,282.15" "$1,282.15" $228.22 "$1,282.15" "$1,282.15" $951.61 $951.61 $988.28 $668.00 $267.21 "$1,282.15" $521.58 "$1,282.15" "$1,282.15" "$1,303.95" "$1,282.15" "$1,282.15" $961.88 "$1,282.15" "$1,282.15" "$1,282.15" $641.08 $641.08 "$1,015.46" "$1,282.15" "$1,025.72" $833.40 "$1,282.15" N/A $743.85 "$1,282.15" $769.29 "$1,282.15" "$1,282.15" "$1,282.15" N/A N/A 03.311.960 SUP Custom 27203010 03.311.960 - RING EXFIX SHORT 100MM MRI SAFE TITANIUM FT NONSTRL BOTH IP/OP "$1,505.00" "$1,114.00" $267.88 "$1,530.53" "$1,504.95" "$1,504.95" "$1,504.95" "$1,504.95" "$1,504.95" "$1,504.95" $267.88 "$1,504.95" "$1,504.95" "$1,116.97" "$1,116.97" "$1,160.02" $784.08 $313.65 "$1,504.95" $612.21 "$1,504.95" "$1,504.95" "$1,530.53" "$1,504.95" "$1,504.95" "$1,128.75" "$1,504.95" "$1,504.95" "$1,504.95" $752.48 $752.48 "$1,191.92" "$1,504.95" "$1,203.96" $978.22 "$1,504.95" N/A $872.90 "$1,504.95" $902.97 "$1,504.95" "$1,504.95" "$1,504.95" N/A N/A 03.311.964 SUP Custom 27203010 03.311.964 - RING EXFIX SHORT 140MM MRI SAFE TITANIUM FT NONSTRL BOTH IP/OP "$1,566.50" "$1,159.00" $278.78 "$1,592.83" "$1,566.20" "$1,566.20" "$1,566.20" "$1,566.20" "$1,566.20" "$1,566.20" $278.78 "$1,566.20" "$1,566.20" "$1,162.43" "$1,162.43" "$1,207.23" $815.99 $326.41 "$1,566.20" $637.13 "$1,566.20" "$1,566.20" "$1,592.83" "$1,566.20" "$1,566.20" "$1,174.88" "$1,566.20" "$1,566.20" "$1,566.20" $783.10 $783.10 "$1,240.43" "$1,566.20" "$1,252.96" "$1,018.03" "$1,566.20" N/A $908.57 "$1,566.20" $939.72 "$1,566.20" "$1,566.20" "$1,566.20" N/A N/A 03.311.966 SUP Custom 27203010 03.311.966 - RING EXFIX SHORT 160MM MRI SAFE TITANIUM FT NONSTRL BOTH IP/OP "$1,629.00" "$1,205.00" $289.89 "$1,656.28" "$1,628.60" "$1,628.60" "$1,628.60" "$1,628.60" "$1,628.60" "$1,628.60" $289.89 "$1,628.60" "$1,628.60" "$1,208.75" "$1,208.75" "$1,255.32" $848.50 $339.42 "$1,628.60" $662.51 "$1,628.60" "$1,628.60" "$1,656.28" "$1,628.60" "$1,628.60" "$1,221.75" "$1,628.60" "$1,628.60" "$1,628.60" $814.30 $814.30 "$1,289.85" "$1,628.60" "$1,302.88" "$1,058.59" "$1,628.60" N/A $944.82 "$1,628.60" $977.16 "$1,628.60" "$1,628.60" "$1,628.60" N/A N/A 03.311.968 SUP Custom 27203010 03.311.968 - RING EXFIX SHORT 180MM MRI SAFE TITANIUM FT NONSTRL BOTH IP/OP "$1,690.00" "$1,251.00" $300.79 "$1,718.58" "$1,689.85" "$1,689.85" "$1,689.85" "$1,689.85" "$1,689.85" "$1,689.85" $300.79 "$1,689.85" "$1,689.85" "$1,254.21" "$1,254.21" "$1,302.54" $880.41 $352.18 "$1,689.85" $687.43 "$1,689.85" "$1,689.85" "$1,718.58" "$1,689.85" "$1,689.85" "$1,267.50" "$1,689.85" "$1,689.85" "$1,689.85" $844.93 $844.93 "$1,338.36" "$1,689.85" "$1,351.88" "$1,098.40" "$1,689.85" N/A $980.20 "$1,689.85" "$1,013.91" "$1,689.85" "$1,689.85" "$1,689.85" N/A N/A 03.311.970 SUP Custom 27203010 03.311.970 - RING EXFIX SHORT 200MM MRI SAFE TITANIUM FT NONSTRL BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,779.75" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" $711.90 "$1,750.00" "$1,750.00" "$1,779.75" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 03.311.980 SUP Custom 27203010 03.311.980 - RING EXFIX LONG 100MM MRI SAFE TITANIUM FT NONSTRL BOTH IP/OP "$1,505.00" "$1,114.00" $267.88 "$1,530.53" "$1,504.95" "$1,504.95" "$1,504.95" "$1,504.95" "$1,504.95" "$1,504.95" $267.88 "$1,504.95" "$1,504.95" "$1,116.97" "$1,116.97" "$1,160.02" $784.08 $313.65 "$1,504.95" $612.21 "$1,504.95" "$1,504.95" "$1,530.53" "$1,504.95" "$1,504.95" "$1,128.75" "$1,504.95" "$1,504.95" "$1,504.95" $752.48 $752.48 "$1,191.92" "$1,504.95" "$1,203.96" $978.22 "$1,504.95" N/A $872.90 "$1,504.95" $902.97 "$1,504.95" "$1,504.95" "$1,504.95" N/A N/A 03.311.984 SUP Custom 27203010 03.311.984 - RING EXFIX LONG 140MM MRI SAFE TITANIUM FT NONSTRL BOTH IP/OP "$1,566.50" "$1,159.00" $278.78 "$1,592.83" "$1,566.20" "$1,566.20" "$1,566.20" "$1,566.20" "$1,566.20" "$1,566.20" $278.78 "$1,566.20" "$1,566.20" "$1,162.43" "$1,162.43" "$1,207.23" $815.99 $326.41 "$1,566.20" $637.13 "$1,566.20" "$1,566.20" "$1,592.83" "$1,566.20" "$1,566.20" "$1,174.88" "$1,566.20" "$1,566.20" "$1,566.20" $783.10 $783.10 "$1,240.43" "$1,566.20" "$1,252.96" "$1,018.03" "$1,566.20" N/A $908.57 "$1,566.20" $939.72 "$1,566.20" "$1,566.20" "$1,566.20" N/A N/A 03.311.986 SUP Custom 27203010 03.311.986 - RING EXFIX LONG 160MM MRI SAFE TITANIUM FT NONSTRL BOTH IP/OP "$1,629.00" "$1,205.00" $289.89 "$1,656.28" "$1,628.60" "$1,628.60" "$1,628.60" "$1,628.60" "$1,628.60" "$1,628.60" $289.89 "$1,628.60" "$1,628.60" "$1,208.75" "$1,208.75" "$1,255.32" $848.50 $339.42 "$1,628.60" $662.51 "$1,628.60" "$1,628.60" "$1,656.28" "$1,628.60" "$1,628.60" "$1,221.75" "$1,628.60" "$1,628.60" "$1,628.60" $814.30 $814.30 "$1,289.85" "$1,628.60" "$1,302.88" "$1,058.59" "$1,628.60" N/A $944.82 "$1,628.60" $977.16 "$1,628.60" "$1,628.60" "$1,628.60" N/A N/A 03.311.988 SUP Custom 27203010 03.311.988 - RING EXFIX LONG 180+ MM MRI SAFE TITANIUM FT NONSTRL BOTH IP/OP "$1,690.00" "$1,251.00" $300.79 "$1,718.58" "$1,689.85" "$1,689.85" "$1,689.85" "$1,689.85" "$1,689.85" "$1,689.85" $300.79 "$1,689.85" "$1,689.85" "$1,254.21" "$1,254.21" "$1,302.54" $880.41 $352.18 "$1,689.85" $687.43 "$1,689.85" "$1,689.85" "$1,718.58" "$1,689.85" "$1,689.85" "$1,267.50" "$1,689.85" "$1,689.85" "$1,689.85" $844.93 $844.93 "$1,338.36" "$1,689.85" "$1,351.88" "$1,098.40" "$1,689.85" N/A $980.20 "$1,689.85" "$1,013.91" "$1,689.85" "$1,689.85" "$1,689.85" N/A N/A 03.311.990 SUP Custom 27203010 03.311.990 - RING EXFIX LONG 200+ MM MRI SAFE TITANIUM FT NONSTRL BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,779.75" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" $711.90 "$1,750.00" "$1,750.00" "$1,779.75" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 03.312.150 SUP Custom 27203010 03.312.150 - RING XTRNFX FULL 150MM MAXFRAME AL MA CRRT SYS BOTH IP/OP "$3,249.00" "$2,404.00" $578.24 "$3,303.78" "$3,248.55" "$3,248.55" "$3,248.55" "$3,248.55" "$3,248.55" "$3,248.55" $578.24 "$3,248.55" "$3,248.55" "$2,411.07" "$2,411.07" "$2,503.98" "$1,692.49" $677.03 "$3,248.55" "$1,321.51" "$3,248.55" "$3,248.55" "$3,303.78" "$3,248.55" "$3,248.55" "$2,436.75" "$3,248.55" "$3,248.55" "$3,248.55" "$1,624.28" "$1,624.28" "$2,572.85" "$3,248.55" "$2,598.84" "$2,111.56" "$3,248.55" N/A "$1,884.42" "$3,248.55" "$1,949.13" "$3,248.55" "$3,248.55" "$3,248.55" N/A N/A 03.312.180 SUP Custom 27203010 03.312.180 - RING XTRNFX FULL 180MM MAXFRAME AL MA CRRT SYS BOTH IP/OP "$3,249.00" "$2,404.00" $578.24 "$3,303.78" "$3,248.55" "$3,248.55" "$3,248.55" "$3,248.55" "$3,248.55" "$3,248.55" $578.24 "$3,248.55" "$3,248.55" "$2,411.07" "$2,411.07" "$2,503.98" "$1,692.49" $677.03 "$3,248.55" "$1,321.51" "$3,248.55" "$3,248.55" "$3,303.78" "$3,248.55" "$3,248.55" "$2,436.75" "$3,248.55" "$3,248.55" "$3,248.55" "$1,624.28" "$1,624.28" "$2,572.85" "$3,248.55" "$2,598.84" "$2,111.56" "$3,248.55" N/A "$1,884.42" "$3,248.55" "$1,949.13" "$3,248.55" "$3,248.55" "$3,248.55" N/A N/A 03.312.811 SUP Custom 27203010 03.312.811 - STRUT XTRNFX SHRT MAXFRAME ADJ BOTH IP/OP "$3,119.50" "$2,308.00" $555.22 "$3,172.25" "$3,119.23" "$3,119.23" "$3,119.23" "$3,119.23" "$3,119.23" "$3,119.23" $555.22 "$3,119.23" "$3,119.23" "$2,315.09" "$2,315.09" "$2,404.30" "$1,625.12" $650.08 "$3,119.23" "$1,268.90" "$3,119.23" "$3,119.23" "$3,172.25" "$3,119.23" "$3,119.23" "$2,339.63" "$3,119.23" "$3,119.23" "$3,119.23" "$1,559.62" "$1,559.62" "$2,470.43" "$3,119.23" "$2,495.38" "$2,027.50" "$3,119.23" N/A "$1,809.31" "$3,119.23" "$1,871.54" "$3,119.23" "$3,119.23" "$3,119.23" N/A N/A 03.312.812 SUP Custom 27203010 03.312.812 - STRUT XTRNFX MED MAXFRAME ADJ BOTH IP/OP "$3,119.50" "$2,308.00" $555.22 "$3,172.25" "$3,119.23" "$3,119.23" "$3,119.23" "$3,119.23" "$3,119.23" "$3,119.23" $555.22 "$3,119.23" "$3,119.23" "$2,315.09" "$2,315.09" "$2,404.30" "$1,625.12" $650.08 "$3,119.23" "$1,268.90" "$3,119.23" "$3,119.23" "$3,172.25" "$3,119.23" "$3,119.23" "$2,339.63" "$3,119.23" "$3,119.23" "$3,119.23" "$1,559.62" "$1,559.62" "$2,470.43" "$3,119.23" "$2,495.38" "$2,027.50" "$3,119.23" N/A "$1,809.31" "$3,119.23" "$1,871.54" "$3,119.23" "$3,119.23" "$3,119.23" N/A N/A 03.312.820 SUP Custom 27203010 03.312.820 - BAND ID MAXFRAME STRUT SET BOTH IP/OP "$1,054.50" $780.00 $187.66 "$1,072.20" "$1,054.28" "$1,054.28" "$1,054.28" "$1,054.28" "$1,054.28" "$1,054.28" $187.66 "$1,054.28" "$1,054.28" $782.49 $782.49 $812.64 $549.28 $219.72 "$1,054.28" $428.88 "$1,054.28" "$1,054.28" "$1,072.20" "$1,054.28" "$1,054.28" $790.88 "$1,054.28" "$1,054.28" "$1,054.28" $527.14 $527.14 $834.99 "$1,054.28" $843.42 $685.28 "$1,054.28" N/A $611.61 "$1,054.28" $632.57 "$1,054.28" "$1,054.28" "$1,054.28" N/A N/A 03.312.821 SUP Custom 27203010 03.312.821 - SET SRG MAXFRAME STRUT ID PLG BOTH IP/OP "$1,054.50" $780.00 $187.66 "$1,072.20" "$1,054.28" "$1,054.28" "$1,054.28" "$1,054.28" "$1,054.28" "$1,054.28" $187.66 "$1,054.28" "$1,054.28" $782.49 $782.49 $812.64 $549.28 $219.72 "$1,054.28" $428.88 "$1,054.28" "$1,054.28" "$1,072.20" "$1,054.28" "$1,054.28" $790.88 "$1,054.28" "$1,054.28" "$1,054.28" $527.14 $527.14 $834.99 "$1,054.28" $843.42 $685.28 "$1,054.28" N/A $611.61 "$1,054.28" $632.57 "$1,054.28" "$1,054.28" "$1,054.28" N/A N/A 03.312.830 SUP Custom 27203010 03.312.830 - BOLT XTRNFX MAXFRAME SHLDR 8 MM RING BOTH IP/OP $211.00 $156.00 $37.53 $214.43 $210.85 $210.85 $210.85 $210.85 $210.85 $210.85 $37.53 $210.85 $210.85 $156.49 $156.49 $162.52 $109.85 $43.94 $210.85 $85.77 $210.85 $210.85 $214.43 $210.85 $210.85 $158.25 $210.85 $210.85 $210.85 $105.43 $105.43 $166.99 $210.85 $168.68 $137.05 $210.85 N/A $122.38 $210.85 $126.51 $210.85 $210.85 $210.85 N/A N/A 03.390.052S SUP HCPCS C1713 03.390.052S - FIXATOR XTRNFX 200MM STRL SCHNZ PREASSEMBLE FRM SLF DRL CFBR BOTH IP/OP "$4,162.00" "$3,080.00" $825.99 "$4,232.45" "$1,872.77" "$1,872.77" "$1,872.77" "$1,872.77" "$4,161.70" "$4,161.70" "$4,161.70" $867.40 "$4,161.70" "$4,161.70" "$4,161.70" "$4,161.70" "$4,161.70" $867.34 "$4,161.70" "$1,692.98" "$2,051.72" "$4,161.70" "$4,232.45" "$4,161.70" "$4,161.70" "$3,121.50" "$4,161.70" "$4,161.70" "$4,161.70" "$2,080.85" "$2,080.85" "$3,296.07" "$4,161.70" "$3,329.36" "$1,872.77" $825.99 N/A "$2,413.96" "$4,161.70" "$2,497.02" "$4,161.70" $867.30 "$4,161.70" N/A N/A 03.390.053S SUP Custom 27203010 03.390.053S - SET EXFIX 220MM SCREW ROD MRI SAFE DISTAL RAD NONSTRL BOTH IP/OP "$4,162.00" "$3,080.00" $740.78 "$4,232.45" "$4,161.70" "$4,161.70" "$4,161.70" "$4,161.70" "$4,161.70" "$4,161.70" $740.78 "$4,161.70" "$4,161.70" "$3,088.81" "$3,088.81" "$3,207.84" "$2,060.15" $867.34 "$4,161.70" "$1,692.98" "$4,161.70" "$4,161.70" "$4,232.45" "$4,161.70" "$4,161.70" "$3,121.50" "$4,161.70" "$4,161.70" "$4,161.70" "$2,080.85" "$2,080.85" "$3,296.07" "$4,161.70" "$3,329.36" "$2,705.11" "$4,161.70" N/A "$2,413.96" "$4,161.70" "$2,497.02" "$4,161.70" "$4,161.70" "$4,161.70" N/A N/A 03.390.054S SUP HCPCS C1713 03.390.054S - FIXATOR XTRNFX 240MM STRL SCHNZ PREASSEMBLE FRM SLF DRL CFBR BOTH IP/OP "$4,162.00" "$3,080.00" $825.99 "$4,232.45" "$1,872.77" "$1,872.77" "$1,872.77" "$1,872.77" "$4,161.70" "$4,161.70" "$4,161.70" $867.40 "$4,161.70" "$4,161.70" "$4,161.70" "$4,161.70" "$4,161.70" $867.34 "$4,161.70" "$1,692.98" "$2,051.72" "$4,161.70" "$4,232.45" "$4,161.70" "$4,161.70" "$3,121.50" "$4,161.70" "$4,161.70" "$4,161.70" "$2,080.85" "$2,080.85" "$3,296.07" "$4,161.70" "$3,329.36" "$1,872.77" $825.99 N/A "$2,413.96" "$4,161.70" "$4,161.70" "$4,161.70" "$4,161.70" "$4,161.70" N/A N/A 03.390.055S SUP HCPCS C1713 03.390.055S - FIXATOR EXFIX 200MM SLFDRILL SCHANZ SCREW ROD MRI SAFE BOTH IP/OP "$4,447.00" "$3,291.00" $882.59 "$4,522.48" "$2,001.10" "$2,001.10" "$2,001.10" "$2,001.10" "$4,446.88" "$4,446.88" "$4,446.88" $926.84 "$4,446.88" "$4,446.88" "$4,446.88" "$4,446.88" "$4,446.88" $926.78 "$4,446.88" "$4,522.48" "$2,192.31" "$4,446.88" "$4,522.48" "$4,446.88" "$4,446.88" "$3,335.25" "$4,446.88" "$4,446.88" "$4,446.88" "$2,223.44" "$2,223.44" "$3,521.93" "$4,446.88" "$3,557.50" "$2,001.10" $882.59 N/A "$2,579.26" "$4,446.88" "$4,446.88" "$4,446.88" "$4,446.88" "$4,446.88" N/A N/A 03.390.056S SUP HCPCS C1713 03.390.056S - FIXATOR EXFIX 220MM SLFDRILL SCHANZ SCREW ROD MRI SAFE BOTH IP/OP "$4,447.00" "$3,291.00" $882.59 "$4,522.48" "$2,001.10" "$2,001.10" "$2,001.10" "$2,001.10" "$4,446.88" "$4,446.88" "$4,446.88" $926.84 "$4,446.88" "$4,446.88" "$4,446.88" "$4,446.88" "$4,446.88" $926.78 "$4,446.88" "$4,522.48" "$2,192.31" "$4,446.88" "$4,522.48" "$4,446.88" "$4,446.88" "$3,335.25" "$4,446.88" "$4,446.88" "$4,446.88" "$2,223.44" "$2,223.44" "$3,521.93" "$4,446.88" "$3,557.50" "$2,001.10" $882.59 N/A "$2,579.26" "$4,446.88" "$4,446.88" "$4,446.88" $926.73 "$4,446.88" N/A N/A 03.390.057S SUP Custom 27203010 03.390.057S - SET EXFIX SLFDRILL SCHANZ SCREW CARFBR ROD MR SAFE TITANIUM BOTH IP/OP "$4,447.00" "$3,291.00" $791.54 "$4,522.48" "$4,446.88" "$4,446.88" "$4,446.88" "$4,446.88" "$4,446.88" "$4,446.88" $791.54 "$4,446.88" "$4,446.88" "$3,300.47" "$3,300.47" "$3,427.66" "$2,060.15" $926.78 "$4,446.88" "$1,808.99" "$4,446.88" "$4,446.88" "$4,522.48" "$4,446.88" "$4,446.88" "$3,335.25" "$4,446.88" "$4,446.88" "$4,446.88" "$2,223.44" "$2,223.44" "$3,521.93" "$4,446.88" "$3,557.50" "$2,890.47" "$4,446.88" N/A "$2,579.26" "$4,446.88" "$2,668.13" "$4,446.88" "$4,446.88" "$4,446.88" N/A N/A 03.500.004 SUP Custom 27203010 03.500.004 - BIT DRILL 1.25MM 44.5MM 4MM J LATCH STOP TITANIUM BOTH IP/OP $355.50 $263.00 $63.28 $355.50 $355.50 $355.50 $355.50 $355.50 $355.50 $355.50 $63.28 $355.50 $355.50 $263.85 $263.85 $274.02 $185.22 $74.09 $355.50 $142.20 $355.50 $355.50 $355.50 $355.50 $355.50 $266.63 $355.50 $355.50 $355.50 $177.75 $177.75 $281.56 $355.50 $284.40 $231.08 $355.50 N/A $206.19 $355.50 $213.30 $355.50 $355.50 $355.50 N/A N/A 03.500.006 SUP Custom 27203010 03.500.006 - BIT DRILL 1.25MM 44.5MM 6MM J LATCH STOP TITANIUM BOTH IP/OP $355.50 $263.00 $63.28 $355.50 $355.50 $355.50 $355.50 $355.50 $355.50 $355.50 $63.28 $355.50 $355.50 $263.85 $263.85 $274.02 $185.22 $74.09 $355.50 $142.20 $355.50 $355.50 $355.50 $355.50 $355.50 $266.63 $355.50 $355.50 $355.50 $177.75 $177.75 $281.56 $355.50 $284.40 $231.08 $355.50 N/A $206.19 $355.50 $213.30 $355.50 $355.50 $355.50 N/A N/A 03.500.008 SUP Custom 27203010 03.500.008 - BIT DRILL 1.25MM 44.5MM 8MM J LATCH STOP NONSTRL BOTH IP/OP $355.50 $263.00 $63.28 $355.50 $355.50 $355.50 $355.50 $355.50 $355.50 $355.50 $63.28 $355.50 $355.50 $263.85 $263.85 $274.02 $185.22 $74.09 $355.50 $142.20 $355.50 $355.50 $355.50 $355.50 $355.50 $266.63 $355.50 $355.50 $355.50 $177.75 $177.75 $281.56 $355.50 $284.40 $231.08 $355.50 N/A $206.19 $355.50 $213.30 $355.50 $355.50 $355.50 N/A N/A 03.500.010 SUP Custom 27203010 03.500.010 - BIT DRILL 1.25MM 44.5MM 10MM J LATCH STOP NONSTRL BOTH IP/OP $355.50 $263.00 $63.28 $355.50 $355.50 $355.50 $355.50 $355.50 $355.50 $355.50 $63.28 $355.50 $355.50 $263.85 $263.85 $274.02 $185.22 $74.09 $355.50 $142.20 $355.50 $355.50 $355.50 $355.50 $355.50 $266.63 $355.50 $355.50 $355.50 $177.75 $177.75 $281.56 $355.50 $284.40 $231.08 $355.50 N/A $206.19 $355.50 $213.30 $355.50 $355.50 $355.50 N/A N/A 03.500.018 SUP Custom 27203010 03.500.018 - TEMPLATE BENDING STR NONSTRL CURVILINEAR DISTRCT BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 03.500.030 SUP Custom 27203010 03.500.030 - TEMPLATE BENDING 30MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 03.500.031 SUP Custom 27203010 03.500.031 - TEMPLATE BENDING 30MM RAD LEFT NONSTRL CURVILINEAR DISTRCT BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 03.500.040 SUP Custom 27203010 03.500.040 - TEMPLATE BENDING 40MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 03.500.041 SUP Custom 27203010 03.500.041 - TEMPLATE BENDING 40MM RAD LEFT NONSTRL CURVILINEAR DISTRCT BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 03.500.050 SUP Custom 27203010 03.500.050 - TEMPLATE BENDING 50MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 03.500.051 SUP Custom 27203010 03.500.051 - TEMPLATE BENDING 50MM RAD LEFT NONSTRL CURVILINEAR DISTRCT BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 03.500.070 SUP Custom 27203010 03.500.070 - TEMPLATE BENDING 70MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 03.500.071 SUP Custom 27203010 03.500.071 - TEMPLATE BENDING 70MM RAD LEFT NONSTRL CURVILINEAR DISTRCT BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 03.500.100 SUP Custom 27203010 03.500.100 - TEMPLATE BENDING 100MM RAD RIGHT NONSTRL CURVILINEAR DISTRCT BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 03.500.101 SUP Custom 27203010 03.500.101 - TEMPLATE BENDING 100MM RAD LEFT NONSTRL CURVILINEAR DISTRCT BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 03.501.008 SUP Custom 27203010 03.501.008 - BIT DRILL 8MM STOP 1.5MM 82MM J LATCH COUPLING 2 FLUTED BOTH IP/OP $502.50 $372.00 $89.45 $502.50 $502.50 $502.50 $502.50 $502.50 $502.50 $502.50 $89.45 $502.50 $502.50 $372.96 $372.96 $387.33 $261.80 $104.73 $502.50 $201.00 $502.50 $502.50 $502.50 $502.50 $502.50 $376.88 $502.50 $502.50 $502.50 $251.25 $251.25 $397.98 $502.50 $402.00 $326.63 $502.50 N/A $291.45 $502.50 $301.50 $502.50 $502.50 $502.50 N/A N/A 03.501.010 SUP Custom 27203010 03.501.010 - BIT DRILL 10MM STOP 82MM J LATCH TITANIUM NONSTRL BOTH IP/OP $502.50 $372.00 $89.45 $502.50 $502.50 $502.50 $502.50 $502.50 $502.50 $502.50 $89.45 $502.50 $502.50 $372.96 $372.96 $387.33 $261.80 $104.73 $502.50 $201.00 $502.50 $502.50 $502.50 $502.50 $502.50 $376.88 $502.50 $502.50 $502.50 $251.25 $251.25 $397.98 $502.50 $402.00 $326.63 $502.50 N/A $291.45 $502.50 $301.50 $502.50 $502.50 $502.50 N/A N/A 03.501.012 SUP Custom 27203010 03.501.012 - BIT DRILL 12MM STOP 1.5MM 82MM J LATCH COUPLING 2 FLUTED BOTH IP/OP $502.50 $372.00 $89.45 $502.50 $502.50 $502.50 $502.50 $502.50 $502.50 $502.50 $89.45 $502.50 $502.50 $372.96 $372.96 $387.33 $261.80 $104.73 $502.50 $201.00 $502.50 $502.50 $502.50 $502.50 $502.50 $376.88 $502.50 $502.50 $502.50 $251.25 $251.25 $397.98 $502.50 $402.00 $326.63 $502.50 N/A $291.45 $502.50 $301.50 $502.50 $502.50 $502.50 N/A N/A 03.501.014 SUP Custom 27203010 03.501.014 - BIT DRILL 1.5MM 82MM 14MM J LATCH COUPLING SELF STOP BOTH IP/OP $572.50 $424.00 $101.91 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $101.91 $572.50 $572.50 $424.91 $424.91 $441.28 $298.27 $119.32 $572.50 $229.00 $572.50 $572.50 $572.50 $572.50 $572.50 $429.38 $572.50 $572.50 $572.50 $286.25 $286.25 $453.42 $572.50 $458.00 $372.13 $572.50 N/A $332.05 $572.50 $343.50 $572.50 $572.50 $572.50 N/A N/A 03.501.016 SUP Custom 27203010 03.501.016 - BIT DRILL 16MM STOP 1.5MM 82MM J LATCH STERNUM NONSTRL BOTH IP/OP $572.50 $424.00 $101.91 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $101.91 $572.50 $572.50 $424.91 $424.91 $441.28 $298.27 $119.32 $572.50 $229.00 $572.50 $572.50 $572.50 $572.50 $572.50 $429.38 $572.50 $572.50 $572.50 $286.25 $286.25 $453.42 $572.50 $458.00 $372.13 $572.50 N/A $332.05 $572.50 $343.50 $572.50 $572.50 $572.50 N/A N/A 03.501.018 SUP Custom 27203010 03.501.018 - BIT DRILL 18MM STOP 1.5MM 82MM J LATCH STERNUM NONSTRL BOTH IP/OP $502.50 $372.00 $89.45 $502.50 $502.50 $502.50 $502.50 $502.50 $502.50 $502.50 $89.45 $502.50 $502.50 $372.96 $372.96 $387.33 $261.80 $104.73 $502.50 $201.00 $502.50 $502.50 $502.50 $502.50 $502.50 $376.88 $502.50 $502.50 $502.50 $251.25 $251.25 $397.98 $502.50 $402.00 $326.63 $502.50 N/A $291.45 $502.50 $301.50 $502.50 $502.50 $502.50 N/A N/A 03.501.020 SUP Custom 27203010 03.501.020 - BIT DRILL 20MM STOP 1.5MM 88MM J LATCH BOTH IP/OP $502.50 $372.00 $89.45 $502.50 $502.50 $502.50 $502.50 $502.50 $502.50 $502.50 $89.45 $502.50 $502.50 $372.96 $372.96 $387.33 $261.80 $104.73 $502.50 $201.00 $502.50 $502.50 $502.50 $502.50 $502.50 $376.88 $502.50 $502.50 $502.50 $251.25 $251.25 $397.98 $502.50 $402.00 $326.63 $502.50 N/A $291.45 $502.50 $301.50 $502.50 $502.50 $502.50 N/A N/A 03.501.022 SUP Custom 27203010 03.501.022 - BIT DRILL 1.5MM 88MM 22MM J LATCH COUPLING SELF STOP BOTH IP/OP $502.50 $372.00 $89.45 $502.50 $502.50 $502.50 $502.50 $502.50 $502.50 $502.50 $89.45 $502.50 $502.50 $372.96 $372.96 $387.33 $261.80 $104.73 $502.50 $201.00 $502.50 $502.50 $502.50 $502.50 $502.50 $376.88 $502.50 $502.50 $502.50 $251.25 $251.25 $397.98 $502.50 $402.00 $326.63 $502.50 N/A $291.45 $502.50 $301.50 $502.50 $502.50 $502.50 N/A N/A 03.501.024 SUP Custom 27203010 03.501.024 - BIT DRILL 1.5MM 88MM 24MM J LATCH COUPLING SELF STOP BOTH IP/OP $378.00 $280.00 $67.28 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $67.28 $378.00 $378.00 $280.55 $280.55 $291.36 $196.94 $78.78 $378.00 $151.20 $378.00 $378.00 $378.00 $378.00 $378.00 $283.50 $378.00 $378.00 $378.00 $189.00 $189.00 $299.38 $378.00 $302.40 $245.70 $378.00 N/A $219.24 $378.00 $226.80 $378.00 $378.00 $378.00 N/A N/A 03.501.036 SUP Custom 27203010 03.501.036 - BIT DRILL 2.2MM 135MM 6MM J LATCH STOP MATRIXRIB NONSTRL BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.038 SUP Custom 27203010 03.501.038 - BIT DRL 8MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.040 SUP Custom 27203010 03.501.040 - BIT DRILL 2.2MM 135MM 10MM J LATCH STOP MATRIXRIB NONSTRL BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.042 SUP Custom 27203010 03.501.042 - BIT DRL 12MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.044 SUP Custom 27203010 03.501.044 - BIT DRILL 2.2MM 135MM 14MM J LATCH STOP MATRIXRIB NONSTRL BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.046 SUP Custom 27203010 03.501.046 - BIT DRL 16MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.048 SUP Custom 27203010 03.501.048 - BIT DRL 18MM 2.2MM 135MM NS MATRIXRIB JLTCH CPLNG STP STRYK BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.072 SUP HCPCS C1713 03.501.072 - TEMPLATE BENDING CNTOUR NONSTRL MATRIXRIB LOCK PLATE BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $217.50 $217.50 $45.33 $217.50 N/A N/A 03.501.210 SUP Custom 27203010 03.501.210 - BIT DRILL 1.8MM 82MM 10MM J LATCH COUPLING SELF STOP BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.212 SUP Custom 27203010 03.501.212 - BIT DRILL 1.8MM 82MM 12MM J LATCH COUPLING SELF STOP BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.214 SUP Custom 27203010 03.501.214 - BIT DRILL 14MM STOP 1.8MM 82MM J LATCH STERNUM STRYKER BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.216 SUP Custom 27203010 03.501.216 - BIT DRILL 16MM STOP 1.8MM 82MM J LATCH STERNUM STRYKER BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.218 SUP Custom 27203010 03.501.218 - BIT DRILL 1.8MM 82MM 18MM J LATCH COUPLING SELF STOP BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.220 SUP Custom 27203010 03.501.220 - BIT DRILL 1.8MM 88MM 20MM J LATCH COUPLING SELF STOP BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.222 SUP Custom 27203010 03.501.222 - BIT DRILL 1.8MM 88MM 22MM J LATCH COUPLING SELF STOP BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.224 SUP Custom 27203010 03.501.224 - BIT DRILL 1.8MM 88MM 24MM J LATCH COUPLING SELF STOP BOTH IP/OP $398.50 $295.00 $70.89 $398.25 $398.25 $398.25 $398.25 $398.25 $398.25 $398.25 $70.89 $398.25 $398.25 $295.58 $295.58 $306.97 $207.49 $83.00 $398.25 $159.30 $398.25 $398.25 $398.25 $398.25 $398.25 $298.88 $398.25 $398.25 $398.25 $199.13 $199.13 $315.41 $398.25 $318.60 $258.86 $398.25 N/A $231.13 $398.25 $238.95 $398.25 $398.25 $398.25 N/A N/A 03.501.410 SUP Custom 27203010 03.501.410 - BIT DRILL 10MM STOP 1.5MM 82MM HEX COUPLING NONSTRL BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.412 SUP Custom 27203010 03.501.412 - BIT DRILL 12MM STOP 1.5MM 82MM HEX COUPLING NONSTRL BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.414 SUP Custom 27203010 03.501.414 - BIT DRILL 1.5MM 82MM 14MM HEXAGONAL COUPLING SELF STOP BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.416 SUP Custom 27203010 03.501.416 - BIT DRILL 1.5MM 82MM 16MM HEXAGONAL COUPLING SELF STOP BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.418 SUP Custom 27203010 03.501.418 - BIT DRILL 18MM STOP 1.5MM 82MM HEX COUPLING NONSTRL BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.420 SUP Custom 27203010 03.501.420 - BIT DRILL 20MM STOP 1.5MM 88MM HEX COUPLING NONSTRL BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.422 SUP Custom 27203010 03.501.422 - BIT DRILL 1.5MM 88MM 22MM HEXAGONAL COUPLING SELF STOP BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.424 SUP Custom 27203010 03.501.424 - BIT DRILL 1.5MM 88MM 24MM HEXAGONAL COUPLING SELF STOP BOTH IP/OP $398.50 $295.00 $70.89 $398.25 $398.25 $398.25 $398.25 $398.25 $398.25 $398.25 $70.89 $398.25 $398.25 $295.58 $295.58 $306.97 $207.49 $83.00 $398.25 $159.30 $398.25 $398.25 $398.25 $398.25 $398.25 $298.88 $398.25 $398.25 $398.25 $199.13 $199.13 $315.41 $398.25 $318.60 $258.86 $398.25 N/A $231.13 $398.25 $238.95 $398.25 $398.25 $398.25 N/A N/A 03.501.510 SUP Custom 27203010 03.501.510 - BIT DRILL 1.8MM 82MM 10MM HEXAGONAL COUPLING SELF STOP BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.512 SUP Custom 27203010 03.501.512 - BIT DRILL 12MM STOP 1.8MM 82MM HEX COUPLING NONSTRL BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.514 SUP Custom 27203010 03.501.514 - BIT DRILL 1.8MM 82MM 14MM HEXAGONAL COUPLING SELF STOP BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.516 SUP Custom 27203010 03.501.516 - BIT DRILL 1.8MM 82MM 16MM HEXAGONAL COUPLING SELF STOP BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.518 SUP Custom 27203010 03.501.518 - BIT DRILL 1.8MM 82MM 18MM HEXAGONAL COUPLING SELF STOP BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.520 SUP Custom 27203010 03.501.520 - BIT DRILL 1.8MM 88MM 20MM HEXAGONAL COUPLING SELF STOP BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.522 SUP Custom 27203010 03.501.522 - BIT DRILL 1.8MM 88MM 22MM HEXAGONAL COUPLING SELF STOP BOTH IP/OP $416.50 $308.00 $74.09 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $416.25 $74.09 $416.25 $416.25 $308.94 $308.94 $320.85 $216.87 $86.75 $416.25 $166.50 $416.25 $416.25 $416.25 $416.25 $416.25 $312.38 $416.25 $416.25 $416.25 $208.13 $208.13 $329.67 $416.25 $333.00 $270.56 $416.25 N/A $241.57 $416.25 $249.75 $416.25 $416.25 $416.25 N/A N/A 03.501.524 SUP Custom 27203010 03.501.524 - BIT DRILL 1.8MM 88MM 24MM HEXAGONAL COUPLING SELF STOP BOTH IP/OP $398.50 $295.00 $70.89 $398.25 $398.25 $398.25 $398.25 $398.25 $398.25 $398.25 $70.89 $398.25 $398.25 $295.58 $295.58 $306.97 $207.49 $83.00 $398.25 $159.30 $398.25 $398.25 $398.25 $398.25 $398.25 $298.88 $398.25 $398.25 $398.25 $199.13 $199.13 $315.41 $398.25 $318.60 $258.86 $398.25 N/A $231.13 $398.25 $238.95 $398.25 $398.25 $398.25 N/A N/A 03.501.612 SUP Custom 27203010 03.501.612 - BIT DRL 2.2MM 135MM NS 12MM MATRIXRIB AO QC STP STRNM BOTH IP/OP $487.00 $360.00 $86.62 $486.63 $486.63 $486.63 $486.63 $486.63 $486.63 $486.63 $86.62 $486.63 $486.63 $361.18 $361.18 $375.09 $253.53 $101.42 $486.63 $194.65 $486.63 $486.63 $486.63 $486.63 $486.63 $365.25 $486.63 $486.63 $486.63 $243.32 $243.32 $385.41 $486.63 $389.30 $316.31 $486.63 N/A $282.46 $486.63 $291.98 $486.63 $486.63 $486.63 N/A N/A 03.501.614 SUP Custom 27203010 03.501.614 - BIT DRL 2.2MM 135MM NS 14MM MATRIXRIB AO QC STP STRNM BOTH IP/OP $398.50 $295.00 $70.89 $398.25 $398.25 $398.25 $398.25 $398.25 $398.25 $398.25 $70.89 $398.25 $398.25 $295.58 $295.58 $306.97 $207.49 $83.00 $398.25 $159.30 $398.25 $398.25 $398.25 $398.25 $398.25 $298.88 $398.25 $398.25 $398.25 $199.13 $199.13 $315.41 $398.25 $318.60 $258.86 $398.25 N/A $231.13 $398.25 $238.95 $398.25 $398.25 $398.25 N/A N/A 03.501.764 SUP Custom 27203010 03.501.764 - BIT DRL 2 FLUT 2.2MM 14MM NS MATRIXRIB STP 90D SCRDRVR BOTH IP/OP $398.50 $295.00 $70.89 $398.25 $398.25 $398.25 $398.25 $398.25 $398.25 $398.25 $70.89 $398.25 $398.25 $295.58 $295.58 $306.97 $207.49 $83.00 $398.25 $159.30 $398.25 $398.25 $398.25 $398.25 $398.25 $298.88 $398.25 $398.25 $398.25 $199.13 $199.13 $315.41 $398.25 $318.60 $258.86 $398.25 N/A $231.13 $398.25 $238.95 $398.25 $398.25 $398.25 N/A N/A 03.503.103 SUP Custom 27203010 03.503.103 - BIT DRILL 1.25MM 44.5MM 3MM J LATCH COUPLING STOP BLOCKING BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.104 SUP HCPCS C1713 03.503.104 - BIT DRILL 1.25MM 44.5MM 4MM J LATCH COUPLING STOP BLOCKING BOTH IP/OP $425.50 $315.00 $84.40 $425.25 $191.36 $191.36 $191.36 $191.36 $425.25 $425.25 $425.25 $88.63 $425.25 $425.25 $425.25 $425.25 $425.25 $88.63 $425.25 $170.10 $251.54 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $191.36 $84.40 N/A $246.79 $425.25 $255.15 $425.25 $88.62 $425.25 N/A N/A 03.503.106 SUP Custom 27203010 03.503.106 - BIT DRILL 1.25MM 44.5MM 6MM J LATCH COUPLING STOP BLOCKING BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.108 SUP Custom 27203010 03.503.108 - BIT DRILL 1.25MM 44.5MM 8MM J LATCH COUPLING STOP BLOCKING BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.110 SUP Custom 27203010 03.503.110 - BIT DRILL 10MM STOP 1.25MM 44.5MM 10MM 2 FLUTE J LATCH BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.112 SUP Custom 27203010 03.503.112 - BIT DRILL 1.25MM 44.5MM 12MM 2 FLUTE J LATCH COUPLING STOP BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.118 SUP Custom 27203010 03.503.118 - BIT DRILL 1.25MM 44.5MM 18MM J LATCH STOP MTRXMDFACE BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.120 SUP Custom 27203010 03.503.120 - BIT DRL 1.25MM 80MM NS MATRIXMIDFACE JLTCH CPLNG WO STP BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.121 SUP Custom 27203010 03.503.121 - BIT DRILL 1.25MM 125MM 2 FLUTE J LATCH COUPLING MTRXMDFACE BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.122 SUP Custom 27203010 03.503.122 - BIT DRILL 1.25MM 125MM 8MM J LATCH STOP MTRXMDFACE NONSTRL BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.123 SUP Custom 27203010 03.503.123 - BIT DRILL 1.25MM 125MM 18MM J LATCH STOP MTRXMDFACE NONSTRL BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.133 SUP Custom 27203010 03.503.133 - BIT DRILL 1.25MM 44.5MM 3MM MINI QUICK COUPLING STOP BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.136 SUP Custom 27203010 03.503.136 - BIT DRILL MINI 1.25MM 44.5MM 6MM 2 FLUTE MINI QUICK COUPLING BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.140 SUP Custom 27203010 03.503.140 - BIT DRILL MINI 1.25MM 44.5MM 10MM 2 FLUTE MINI QUICK BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.142 SUP Custom 27203010 03.503.142 - BIT DRILL MINI 1.25MM 44.5MM 12MM 2 FLUTE MINI QUICK BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.148 SUP Custom 27203010 03.503.148 - BIT DRILL MINI 1.25MM 44.5MM 18MM MINI QUICK COUPLING STOP BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.150 SUP Custom 27203010 03.503.150 - BIT DRILL 1.25MM 80MM 2 FLUTE MINI QUICK COUPLING MTRXMDFACE BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.151 SUP Custom 27203010 03.503.151 - BIT DRILL 1.25MM 125MM 2 FLUTE MINI QUICK COUPLING BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.152 SUP Custom 27203010 03.503.152 - BIT DRILL MINI 1.25MM 125MM 8MM 2 FLUTE MINI QUICK COUPLING BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.153 SUP Custom 27203010 03.503.153 - BIT DRILL MINI 1.25MM 125MM 18MM 2 FLUTE MINI QUICK COUPLING BOTH IP/OP $425.50 $315.00 $75.69 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $425.25 $75.69 $425.25 $425.25 $315.62 $315.62 $327.78 $221.56 $88.63 $425.25 $170.10 $425.25 $425.25 $425.25 $425.25 $425.25 $319.13 $425.25 $425.25 $425.25 $212.63 $212.63 $336.80 $425.25 $340.20 $276.41 $425.25 N/A $246.79 $425.25 $255.15 $425.25 $425.25 $425.25 N/A N/A 03.503.160 SUP Custom 27203010 03.503.160 - TEMPLATE BENDING MTRXMAND NONSTRL NARROW TENSION BAND PLATE BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.161 SUP Custom 27203010 03.503.161 - TEMPLATE BENDING MTRXMAND NONSTRL 1 MM BROAD TENSION BAND BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.162 SUP Custom 27203010 03.503.162 - TEMPLATE BENDING MTRXMAND NONSTRL 1 MM ADAPTION PLATE BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.163 SUP Custom 27203010 03.503.163 - TEMPLATE BENDING MTRXMAND NONSTRL 1.25 MM STR PLATE BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.164 SUP Custom 27203010 03.503.164 - TEMPLATE BENDING 2X2 HOLE MTRXMAND NONSTRL 1.25 MM CRESCENT BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.165 SUP Custom 27203010 03.503.165 - TEMPLATE BENDING 3X3 HOLE MTRXMAND NONSTRL 1.25 MM CRESCENT BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.166 SUP Custom 27203010 03.503.166 - TEMPLATE BENDING MTRXMAND NONSTRL 1.25 MM ANGLE PLATE BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.167 SUP Custom 27203010 03.503.167 - TEMPLATE BENDING MTRXMAND NONSTRL 1.25 MM ADAPTION PLATE BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.168 SUP Custom 27203010 03.503.168 - TEMPLATE BENDING MTRXMAND NONSTRL 1.5 MM STR PLATE BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.169 SUP Custom 27203010 03.503.169 - TEMPLATE BENDING 3X3 HOLE MTRXMAND NONSTRL 1.5 MM STR PLATE BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.170 SUP Custom 27203010 03.503.170 - TEMPLATE BENDING THK1.5MM 3X3 HOLE MTRXMAND NONSTRL 1.5MM BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.171 SUP Custom 27203010 03.503.171 - TEMPLATE BENDING THK1.5MM 6 HOLE MTRXMAND NONSTRL 1.5MM BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.172 SUP Custom 27203010 03.503.172 - TEMPLATE BENDING THK1.5MM 2X2/3X3 HOLE MTRXMAND NONSTRL 1.5 BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.173 SUP Custom 27203010 03.503.173 - TEMPLATE BENDING 2MM BROAD CRESCENT PLATE MTRXMAND NONSTRL 2 BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.174 SUP Custom 27203010 03.503.174 - TEMPLATE BENDING MTRXMAND NONSTRL 2 MM STR PLATE BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.175 SUP Custom 27203010 03.503.175 - TEMPLATE BENDING 2MM 3X3 HOLE MTRXMAND NONSTRL 2MM BROAD BOTH IP/OP $171.00 $127.00 $30.44 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $171.00 $30.44 $171.00 $171.00 $126.92 $126.92 $131.81 $89.09 $35.64 $171.00 $68.40 $171.00 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $111.15 $171.00 N/A $99.18 $171.00 $102.60 $171.00 $171.00 $171.00 N/A N/A 03.503.176 SUP HCPCS C1713 03.503.176 - TEMPLATE BNDRG NS MATRIXMANDIBLE 2 MM ANG RECON PLT BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $81.00 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $121.50 $202.50 $42.20 $202.50 N/A N/A 03.503.177 SUP Custom 27203010 03.503.177 - TEMPLATE BENDING SMALL MTRXMAND NONSTRL 2MM 2 ANGLE BOTH IP/OP $202.50 $150.00 $36.05 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $36.05 $202.50 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $81.00 $202.50 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $202.50 N/A $117.45 $202.50 $121.50 $202.50 $202.50 $202.50 N/A N/A 03.503.178 SUP Custom 27203010 03.503.178 - TEMPLATE BENDING MEDIUM MTRXMAND NONSTRL 2MM 2 ANGLE BOTH IP/OP $202.50 $150.00 $36.05 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $36.05 $202.50 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $81.00 $202.50 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $202.50 N/A $117.45 $202.50 $121.50 $202.50 $202.50 $202.50 N/A N/A 03.503.179 SUP Custom 27203010 03.503.179 - TEMPLATE BENDING LARGE MTRXMAND NONSTRL 2MM 2 ANGLE BOTH IP/OP $202.50 $150.00 $36.05 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $36.05 $202.50 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $81.00 $202.50 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $202.50 N/A $117.45 $202.50 $121.50 $202.50 $202.50 $202.50 N/A N/A 03.503.180 SUP Custom 27203010 03.503.180 - TEMPLATE BENDING MTRXMAND NONSTRL 2.5/2.8 MM STR BOTH IP/OP $202.50 $150.00 $36.05 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $36.05 $202.50 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $81.00 $202.50 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $202.50 N/A $117.45 $202.50 $121.50 $202.50 $202.50 $202.50 N/A N/A 03.503.181 SUP Custom 27203010 03.503.181 - TEMPLATE BENDING 2.5-2.8MM RECONSTRUCTION MTRXMAND NONSTRL BOTH IP/OP $202.50 $150.00 $36.05 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $36.05 $202.50 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $81.00 $202.50 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $202.50 N/A $117.45 $202.50 $121.50 $202.50 $202.50 $202.50 N/A N/A 03.503.182 SUP Custom 27203010 03.503.182 - TEMPLATE BENDING SMALL MTRXMAND NONSTRL 2.5MM 2 ANGLE BOTH IP/OP $202.50 $150.00 $36.05 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $36.05 $202.50 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $81.00 $202.50 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $202.50 N/A $117.45 $202.50 $121.50 $202.50 $202.50 $202.50 N/A N/A 03.503.183 SUP Custom 27203010 03.503.183 - TEMPLATE BENDING MEDIUM MTRXMAND NONSTRL 2.5MM 2 ANGLE BOTH IP/OP $202.50 $150.00 $36.05 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $36.05 $202.50 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $81.00 $202.50 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $202.50 N/A $117.45 $202.50 $121.50 $202.50 $202.50 $202.50 N/A N/A 03.503.184 SUP Custom 27203010 03.503.184 - TEMPLATE BENDING LARGE MTRXMAND NONSTRL 2.5MM 2 ANGLE BOTH IP/OP $202.50 $150.00 $36.05 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $36.05 $202.50 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $81.00 $202.50 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $202.50 N/A $117.45 $202.50 $121.50 $202.50 $202.50 $202.50 N/A N/A 03.503.201 SUP Custom 27203010 03.503.201 - BLADE SCREWDRIVER SHORT 52MM SELF HOLDING HEXAGONAL COUPLING BOTH IP/OP "$1,586.50" "$1,174.00" $282.35 "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" $282.35 "$1,586.25" "$1,586.25" "$1,177.31" "$1,177.31" "$1,222.68" $826.44 $330.59 "$1,586.25" $634.50 "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,189.88" "$1,586.25" "$1,586.25" "$1,586.25" $793.13 $793.13 "$1,256.31" "$1,586.25" "$1,269.00" "$1,031.06" "$1,586.25" N/A $920.17 "$1,586.25" $951.75 "$1,586.25" "$1,586.25" "$1,586.25" N/A N/A 03.503.202 SUP Custom 27203010 03.503.202 - BLADE SCREWDRIVER MEDIUM 76MM SELF HOLDING HEXAGONAL BOTH IP/OP "$1,586.50" "$1,174.00" $282.35 "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" $282.35 "$1,586.25" "$1,586.25" "$1,177.31" "$1,177.31" "$1,222.68" $826.44 $330.59 "$1,586.25" $634.50 "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,189.88" "$1,586.25" "$1,586.25" "$1,586.25" $793.13 $793.13 "$1,256.31" "$1,586.25" "$1,269.00" "$1,031.06" "$1,586.25" N/A $920.17 "$1,586.25" $951.75 "$1,586.25" "$1,586.25" "$1,586.25" N/A N/A 03.503.203 SUP Custom 27203010 03.503.203 - BLADE SCREWDRIVER LONG 96MM SELF HOLDING HEXAGONAL COUPLING BOTH IP/OP "$1,586.50" "$1,174.00" $282.35 "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" $282.35 "$1,586.25" "$1,586.25" "$1,177.31" "$1,177.31" "$1,222.68" $826.44 $330.59 "$1,586.25" $634.50 "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$1,189.88" "$1,586.25" "$1,586.25" "$1,586.25" $793.13 $793.13 "$1,256.31" "$1,586.25" "$1,269.00" "$1,031.06" "$1,586.25" N/A $920.17 "$1,586.25" $951.75 "$1,586.25" "$1,586.25" "$1,586.25" N/A N/A 03.503.244 SUP Custom 27203010 03.503.244 - BIT DRILL 1.1MM 44.5/4MM 4MM STOP J LATCH COUPLING BOTH IP/OP $378.00 $280.00 $67.28 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $67.28 $378.00 $378.00 $280.55 $280.55 $291.36 $196.94 $78.78 $378.00 $151.20 $378.00 $378.00 $378.00 $378.00 $378.00 $283.50 $378.00 $378.00 $378.00 $189.00 $189.00 $299.38 $378.00 $302.40 $245.70 $378.00 N/A $219.24 $378.00 $226.80 $378.00 $378.00 $378.00 N/A N/A 03.503.246 SUP Custom 27203010 03.503.246 - BIT DRL 6MM 1.1MM 44.5MM NS MTRX JLTCH CPLNG STP STRYK BOTH IP/OP $378.00 $280.00 $67.28 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $67.28 $378.00 $378.00 $280.55 $280.55 $291.36 $196.94 $78.78 $378.00 $151.20 $378.00 $378.00 $378.00 $378.00 $378.00 $283.50 $378.00 $378.00 $378.00 $189.00 $189.00 $299.38 $378.00 $302.40 $245.70 $378.00 N/A $219.24 $378.00 $226.80 $378.00 $378.00 $378.00 N/A N/A 03.503.248 SUP Custom 27203010 03.503.248 - BIT DRL 8MM 1.1MM 44.5MM NS MTRX JLTCH CPLNG STP STRYK BOTH IP/OP $378.00 $280.00 $67.28 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $67.28 $378.00 $378.00 $280.55 $280.55 $291.36 $196.94 $78.78 $378.00 $151.20 $378.00 $378.00 $378.00 $378.00 $378.00 $283.50 $378.00 $378.00 $378.00 $189.00 $189.00 $299.38 $378.00 $302.40 $245.70 $378.00 N/A $219.24 $378.00 $226.80 $378.00 $378.00 $378.00 N/A N/A 03.503.264 SUP Custom 27203010 03.503.264 - BIT DRILL HEXAGON 1.1MM 52MM 4MM HEX COUPLING STOP BOTH IP/OP $378.00 $280.00 $67.28 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $378.00 $67.28 $378.00 $378.00 $280.55 $280.55 $291.36 $196.94 $78.78 $378.00 $151.20 $378.00 $378.00 $378.00 $378.00 $378.00 $283.50 $378.00 $378.00 $378.00 $189.00 $189.00 $299.38 $378.00 $302.40 $245.70 $378.00 N/A $219.24 $378.00 $226.80 $378.00 $378.00 $378.00 N/A N/A 03.503.360 SUP Custom 27203010 03.503.360 - TEMPLATE BENDING THK.5MM SMALL ANATOMIC TITANIUM NONSTRL BOTH IP/OP $515.50 $381.00 $91.71 $515.25 $515.25 $515.25 $515.25 $515.25 $515.25 $515.25 $91.71 $515.25 $515.25 $382.42 $382.42 $397.15 $268.45 $107.38 $515.25 $206.10 $515.25 $515.25 $515.25 $515.25 $515.25 $386.63 $515.25 $515.25 $515.25 $257.63 $257.63 $408.08 $515.25 $412.20 $334.91 $515.25 N/A $298.99 $515.25 $309.15 $515.25 $515.25 $515.25 N/A N/A 03.503.361 SUP Custom 27203010 03.503.361 - TEMPLATE BENDING THK.5MM MEDIUM ANATOMIC NONSTRL MTRXMDFACE BOTH IP/OP $515.50 $381.00 $91.71 $515.25 $515.25 $515.25 $515.25 $515.25 $515.25 $515.25 $91.71 $515.25 $515.25 $382.42 $382.42 $397.15 $268.45 $107.38 $515.25 $206.10 $515.25 $515.25 $515.25 $515.25 $515.25 $386.63 $515.25 $515.25 $515.25 $257.63 $257.63 $408.08 $515.25 $412.20 $334.91 $515.25 N/A $298.99 $515.25 $309.15 $515.25 $515.25 $515.25 N/A N/A 03.503.362 SUP Custom 27203010 03.503.362 - TEMPLATE BENDING THK.5MM LARGE ANATOMIC NONSTRL MTRXMDFACE BOTH IP/OP $515.50 $381.00 $91.71 $515.25 $515.25 $515.25 $515.25 $515.25 $515.25 $515.25 $91.71 $515.25 $515.25 $382.42 $382.42 $397.15 $268.45 $107.38 $515.25 $206.10 $515.25 $515.25 $515.25 $515.25 $515.25 $386.63 $515.25 $515.25 $515.25 $257.63 $257.63 $408.08 $515.25 $412.20 $334.91 $515.25 N/A $298.99 $515.25 $309.15 $515.25 $515.25 $515.25 N/A N/A 03.503.363 SUP Custom 27203010 03.503.363 - TEMPLATE BENDING THK.5MM NONSTRL MTRXMDFACE UNIVERSAL ORBTL BOTH IP/OP $515.50 $381.00 $91.71 $515.25 $515.25 $515.25 $515.25 $515.25 $515.25 $515.25 $91.71 $515.25 $515.25 $382.42 $382.42 $397.15 $268.45 $107.38 $515.25 $206.10 $515.25 $515.25 $515.25 $515.25 $515.25 $386.63 $515.25 $515.25 $515.25 $257.63 $257.63 $408.08 $515.25 $412.20 $334.91 $515.25 N/A $298.99 $515.25 $309.15 $515.25 $515.25 $515.25 N/A N/A 03.503.364 SUP Custom 27203010 03.503.364 - TEMPLATE BENDING THK.5MM NONSTRL MTRXMDFACE MEDIAL WALL BOTH IP/OP $515.50 $381.00 $91.71 $515.25 $515.25 $515.25 $515.25 $515.25 $515.25 $515.25 $91.71 $515.25 $515.25 $382.42 $382.42 $397.15 $268.45 $107.38 $515.25 $206.10 $515.25 $515.25 $515.25 $515.25 $515.25 $386.63 $515.25 $515.25 $515.25 $257.63 $257.63 $408.08 $515.25 $412.20 $334.91 $515.25 N/A $298.99 $515.25 $309.15 $515.25 $515.25 $515.25 N/A N/A 03.503.365 SUP Custom 27203010 03.503.365 - TEMPLATE BENDING THK.5MM NONSTRL MTRXMDFACE ORBTL FLOOR MESH BOTH IP/OP $515.50 $381.00 $91.71 $515.25 $515.25 $515.25 $515.25 $515.25 $515.25 $515.25 $91.71 $515.25 $515.25 $382.42 $382.42 $397.15 $268.45 $107.38 $515.25 $206.10 $515.25 $515.25 $515.25 $515.25 $515.25 $386.63 $515.25 $515.25 $515.25 $257.63 $257.63 $408.08 $515.25 $412.20 $334.91 $515.25 N/A $298.99 $515.25 $309.15 $515.25 $515.25 $515.25 N/A N/A 03.503.366 SUP Custom 27203010 03.503.366 - TEMPLATE BENDING THK.5MM 20 HOLE NONSTRL MTRXMDFACE ADAPTION BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.367 SUP Custom 27203010 03.503.367 - TEMPLATE BENDING THK.5MM 12 HOLE NONSTRL MTRXMDFACE RIM BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.368 SUP Custom 27203010 03.503.368 - TEMPLATE BENDING THK.5MM 2X3 HOLE NONSTRL MTRXMDFACE OBLIQUE BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.369 SUP Custom 27203010 03.503.369 - TEMPLATE BENDING THK.5MM 3X4 HOLE NONSTRL MTRXMDFACE OBLIQUE BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.370 SUP Custom 27203010 03.503.370 - TEMPLATE BENDING THK.5MM 4X6 HOLE NONSTRL MTRXMDFACE OBLIQUE BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.371 SUP Custom 27203010 03.503.371 - TEMPLATE BENDING THK.5MM 1X3 HOLE NONSTRL MTRXMDFACE BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.372 SUP Custom 27203010 03.503.372 - TEMPLATE BENDING THK.5MM 4 HOLE NONSTRL MTRXMDFACE TITANIUM BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.373 SUP Custom 27203010 03.503.373 - TEMPLATE BENDING THK.5MM 11 HOLE NONSTRL MTRXMDFACE TITANIUM BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.374 SUP Custom 27203010 03.503.374 - TEMPLATE BENDING THK.5MM 3X4 HOLE NONSTRL MTRXMDFACE BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.375 SUP Custom 27203010 03.503.375 - TEMPLATE BENDING THK.5MM 10X5MM 4 HOLE NONSTRL MTRXMDFACE BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.376 SUP Custom 27203010 03.503.376 - TEMPLATE BENDING THK.5MM 10X10MM 4 HOLE NONSTRL MTRXMDFACE BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.377 SUP Custom 27203010 03.503.377 - TEMPLATE BENDING THK.5MM 18 HOLE NONSTRL MTRXMDFACE TITANIUM BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.378 SUP Custom 27203010 03.503.378 - TEMPLATE BENDING THK.4MM 6 HOLE NONSTRL MTRXMDFACE SILVER BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.379 SUP Custom 27203010 03.503.379 - TEMPLATE BENDING THK.5MM 6 HOLE NONSTRL MTRXMDFACE BLUE BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.380 SUP Custom 27203010 03.503.380 - TEMPLATE BENDING THK.7MM 6 HOLE NONSTRL MTRXMDFACE PINK BOTH IP/OP $125.00 $93.00 $22.23 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $124.88 $22.23 $124.88 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $49.95 $124.88 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $124.88 N/A $72.50 $124.88 $74.93 $124.88 $124.88 $124.88 N/A N/A 03.503.404 SUP Custom 27203010 03.503.404 - BIT DRL 4MM 1.5MM 50MM NS MATRIXMANDIBLE JLTCH CPLNG STP BOTH IP/OP $380.50 $282.00 $67.68 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $67.68 $380.25 $380.25 $282.22 $282.22 $293.10 $198.11 $79.25 $380.25 $152.10 $380.25 $380.25 $380.25 $380.25 $380.25 $285.38 $380.25 $380.25 $380.25 $190.13 $190.13 $301.16 $380.25 $304.20 $247.16 $380.25 N/A $220.69 $380.25 $228.15 $380.25 $380.25 $380.25 N/A N/A 03.503.406 SUP Custom 27203010 03.503.406 - BIT DRILL 1.5MM 50MM 6MM J LATCH COUPLING STOP MTRXMAND BOTH IP/OP $380.50 $282.00 $67.68 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $67.68 $380.25 $380.25 $282.22 $282.22 $293.10 $198.11 $79.25 $380.25 $152.10 $380.25 $380.25 $380.25 $380.25 $380.25 $285.38 $380.25 $380.25 $380.25 $190.13 $190.13 $301.16 $380.25 $304.20 $247.16 $380.25 N/A $220.69 $380.25 $228.15 $380.25 $380.25 $380.25 N/A N/A 03.503.408 SUP Custom 27203010 03.503.408 - BIT DRL 8MM 1.5MM 50MM NS MATRIXMANDIBLE JLTCH CPLNG STP BOTH IP/OP $380.50 $282.00 $67.68 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $67.68 $380.25 $380.25 $282.22 $282.22 $293.10 $198.11 $79.25 $380.25 $152.10 $380.25 $380.25 $380.25 $380.25 $380.25 $285.38 $380.25 $380.25 $380.25 $190.13 $190.13 $301.16 $380.25 $304.20 $247.16 $380.25 N/A $220.69 $380.25 $228.15 $380.25 $380.25 $380.25 N/A N/A 03.503.412 SUP Custom 27203010 03.503.412 - BIT DRILL 1.5MM 50MM 12MM J LATCH COUPLING STOP MTRXMAND BOTH IP/OP $380.50 $282.00 $67.68 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $67.68 $380.25 $380.25 $282.22 $282.22 $293.10 $198.11 $79.25 $380.25 $152.10 $380.25 $380.25 $380.25 $380.25 $380.25 $285.38 $380.25 $380.25 $380.25 $190.13 $190.13 $301.16 $380.25 $304.20 $247.16 $380.25 N/A $220.69 $380.25 $228.15 $380.25 $380.25 $380.25 N/A N/A 03.503.451 SUP Custom 27203010 03.503.451 - BIT DRL 1.5MM 90MM NS MATRIXMANDIBLE JLTCH CPLNG STRYK BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.503.452 SUP Custom 27203010 03.503.452 - BIT DRILL 1.5MM 145MM 2 FLUTE J LATCH COUPLING MTRXMAND BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.503.461 SUP Custom 27203010 03.503.461 - BIT DRILL 90MM 1.8MM JLTCH NSTRL BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.503.462 SUP Custom 27203010 03.503.462 - BIT DRILL 1.8MM 145MM 2 FLUTE J LATCH COUPLING MTRXMAND BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.503.471 SUP Custom 27203010 03.503.471 - BIT DRL 2.4MM 90MM NS MATRIXMANDIBLE JLTCH CPLNG STRYK BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.503.472 SUP Custom 27203010 03.503.472 - BIT DRILL 2.4MM 145MM 2 FLUTE J LATCH COUPLING MTRXMAND BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.503.476 SUP Custom 27203010 03.503.476 - BIT DRL 1.5MM 125MM NS MATRIXMANDIBLE JLTCH CPLNG CLBRT BOTH IP/OP $468.00 $346.00 $83.30 $468.00 $468.00 $468.00 $468.00 $468.00 $468.00 $468.00 $83.30 $468.00 $468.00 $347.35 $347.35 $360.73 $243.83 $97.54 $468.00 $187.20 $468.00 $468.00 $468.00 $468.00 $468.00 $351.00 $468.00 $468.00 $468.00 $234.00 $234.00 $370.66 $468.00 $374.40 $304.20 $468.00 N/A $271.44 $468.00 $280.80 $468.00 $468.00 $468.00 N/A N/A 03.503.477 SUP Custom 27203010 03.503.477 - BIT DRL 1.8MM 125MM NS MATRIXMANDIBLE JLTCH CPLNG CLBRT BOTH IP/OP $468.00 $346.00 $83.30 $468.00 $468.00 $468.00 $468.00 $468.00 $468.00 $468.00 $83.30 $468.00 $468.00 $347.35 $347.35 $360.73 $243.83 $97.54 $468.00 $187.20 $468.00 $468.00 $468.00 $468.00 $468.00 $351.00 $468.00 $468.00 $468.00 $234.00 $234.00 $370.66 $468.00 $374.40 $304.20 $468.00 N/A $271.44 $468.00 $280.80 $468.00 $468.00 $468.00 N/A N/A 03.503.478 SUP Custom 27203010 03.503.478 - BIT DRL 2.4MM 125MM NS MATRIXMANDIBLE JLTCH CPLNG CLBRT BOTH IP/OP $468.00 $346.00 $83.30 $468.00 $468.00 $468.00 $468.00 $468.00 $468.00 $468.00 $83.30 $468.00 $468.00 $347.35 $347.35 $360.73 $243.83 $97.54 $468.00 $187.20 $468.00 $468.00 $468.00 $468.00 $468.00 $351.00 $468.00 $468.00 $468.00 $234.00 $234.00 $370.66 $468.00 $374.40 $304.20 $468.00 N/A $271.44 $468.00 $280.80 $468.00 $468.00 $468.00 N/A N/A 03.503.479 SUP Custom 27203010 03.503.479 - BIT DRILL MINI 1.5MM 125MM COUPLING QUICK COUPLING BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.503.480 SUP Custom 27203010 03.503.480 - BIT DRILL 1.8MM 125MM 2 FLUTE MINI QUICK COUPLING CALIBRATED BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.503.481 SUP Custom 27203010 03.503.481 - BIT DRILL MINI 2.4MM 125MM 2 FLUTE MINI QUICK COUPLING BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.503.504 SUP Custom 27203010 03.503.504 - BIT DRILL 1.5MM 50MM 4MM 2 FLUTE STOP MINI QUICK COUPLING BOTH IP/OP $380.50 $282.00 $67.68 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $67.68 $380.25 $380.25 $282.22 $282.22 $293.10 $198.11 $79.25 $380.25 $152.10 $380.25 $380.25 $380.25 $380.25 $380.25 $285.38 $380.25 $380.25 $380.25 $190.13 $190.13 $301.16 $380.25 $304.20 $247.16 $380.25 N/A $220.69 $380.25 $228.15 $380.25 $380.25 $380.25 N/A N/A 03.503.506 SUP Custom 27203010 03.503.506 - BIT DRILL 1.5MM 50MM 6MM 2 FLUTE STOP MINI QUICK COUPLING BOTH IP/OP $380.50 $282.00 $67.68 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $67.68 $380.25 $380.25 $282.22 $282.22 $293.10 $198.11 $79.25 $380.25 $152.10 $380.25 $380.25 $380.25 $380.25 $380.25 $285.38 $380.25 $380.25 $380.25 $190.13 $190.13 $301.16 $380.25 $304.20 $247.16 $380.25 N/A $220.69 $380.25 $228.15 $380.25 $380.25 $380.25 N/A N/A 03.503.508 SUP Custom 27203010 03.503.508 - BIT DRILL 1.5MM 50MM 8MM 2 FLUTE STOP MINI QUICK COUPLING BOTH IP/OP $380.50 $282.00 $67.68 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $67.68 $380.25 $380.25 $282.22 $282.22 $293.10 $198.11 $79.25 $380.25 $152.10 $380.25 $380.25 $380.25 $380.25 $380.25 $285.38 $380.25 $380.25 $380.25 $190.13 $190.13 $301.16 $380.25 $304.20 $247.16 $380.25 N/A $220.69 $380.25 $228.15 $380.25 $380.25 $380.25 N/A N/A 03.503.512 SUP Custom 27203010 03.503.512 - BIT DRILL 1.5MM 50MM 12MM 2 FLUTE STOP MINI QUICK COUPLING BOTH IP/OP $380.50 $282.00 $67.68 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $380.25 $67.68 $380.25 $380.25 $282.22 $282.22 $293.10 $198.11 $79.25 $380.25 $152.10 $380.25 $380.25 $380.25 $380.25 $380.25 $285.38 $380.25 $380.25 $380.25 $190.13 $190.13 $301.16 $380.25 $304.20 $247.16 $380.25 N/A $220.69 $380.25 $228.15 $380.25 $380.25 $380.25 N/A N/A 03.503.551 SUP Custom 27203010 03.503.551 - BIT DRILL MINI 1.5MM 90MM 2 FLUTE MINI QUICK COUPLING BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.503.552 SUP Custom 27203010 03.503.552 - BIT DRILL MINI 1.5MM 145MM 2 FLUTE MINI QUICK COUPLING BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.503.561 SUP Custom 27203010 03.503.561 - BIT DRILL 1.8MM 90MM 2 FLUTE MINI QUICK COUPLING MTRXMAND BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.503.562 SUP Custom 27203010 03.503.562 - BIT DRILL MINI 1.8MM 145MM MINI QUICK COUPLING MTRXMAND BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.503.571 SUP Custom 27203010 03.503.571 - BIT DRILL 2.4MM 90MM 2 FLUTE MINI QUICK COUPLING MTRXMAND BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.503.572 SUP Custom 27203010 03.503.572 - BIT DRILL MINI 2.4MM 145MM MINI QUICK COUPLING MTRXMAND BOTH IP/OP $405.00 $300.00 $72.09 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $405.00 $72.09 $405.00 $405.00 $300.59 $300.59 $312.17 $211.01 $84.41 $405.00 $162.00 $405.00 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $263.25 $405.00 N/A $234.90 $405.00 $243.00 $405.00 $405.00 $405.00 N/A N/A 03.507.002S SUP Custom 27203010 03.507.002S - TOOL REDX HEXGAON 2.4MM 78MM THREADED SLFDRILL COUPLING BOTH IP/OP $385.00 $285.00 $68.49 $384.75 $384.75 $384.75 $384.75 $384.75 $384.75 $384.75 $68.49 $384.75 $384.75 $285.56 $285.56 $296.57 $200.45 $80.19 $384.75 $153.90 $384.75 $384.75 $384.75 $384.75 $384.75 $288.75 $384.75 $384.75 $384.75 $192.38 $192.38 $304.72 $384.75 $307.80 $250.09 $384.75 N/A $223.30 $384.75 $230.85 $384.75 $384.75 $384.75 N/A N/A 03.507.003 SUP Custom 27203010 03.507.003 - TOOL REDX 3.5MM 78MM SLFTAP THREADED HEXAGONAL COUPLING BOTH IP/OP $614.50 $455.00 $109.34 $614.25 $614.25 $614.25 $614.25 $614.25 $614.25 $614.25 $109.34 $614.25 $614.25 $455.90 $455.90 $473.46 $320.02 $128.02 $614.25 $245.70 $614.25 $614.25 $614.25 $614.25 $614.25 $460.88 $614.25 $614.25 $614.25 $307.13 $307.13 $486.49 $614.25 $491.40 $399.26 $614.25 N/A $356.41 $614.25 $368.55 $614.25 $614.25 $614.25 N/A N/A 03.614.015 SUP HCPCS C1713 03.614.015 - TAP SURG 4.5MM 205MM 50MM CALIBRATED CANCELLOUS BOTH IP/OP $545.00 $403.00 $108.17 $545.00 $245.25 $245.25 $245.25 $245.25 $545.00 $545.00 $545.00 $113.59 $545.00 $545.00 $545.00 $545.00 $545.00 $113.58 $545.00 $218.00 $322.37 $545.00 $545.00 $545.00 $545.00 $408.75 $545.00 $545.00 $545.00 $272.50 $272.50 $431.64 $545.00 $436.00 $245.25 $108.17 N/A $316.10 $545.00 $545.00 $545.00 $113.58 $545.00 N/A N/A 03.620.104 SUP HCPCS C1713 03.620.104 - TAP SURG 6MM HEXAGONAL COUPLING NONSTRL 4MM DUAL CORE SCREWS BOTH IP/OP $628.50 $465.00 $124.69 $628.25 $282.71 $282.71 $282.71 $282.71 $628.25 $628.25 $628.25 $130.94 $628.25 $628.25 $628.25 $628.25 $628.25 $130.93 $628.25 $628.25 $371.61 $628.25 $628.25 $628.25 $628.25 $471.38 $628.25 $628.25 $628.25 $314.13 $314.13 $497.57 $628.25 $502.60 $282.71 $124.69 N/A $364.53 $628.25 $628.25 $628.25 $130.93 $628.25 N/A N/A 03.620.105 SUP HCPCS C1713 03.620.105 - TAP SPINAL 6MM 5MM HEXAGONAL COUPLING NONSTRL 2 CORE SCREW BOTH IP/OP $628.50 $465.00 $124.69 $628.25 $282.71 $282.71 $282.71 $282.71 $628.25 $628.25 $628.25 $130.94 $628.25 $628.25 $628.25 $628.25 $628.25 $130.93 $628.25 $628.25 $371.61 $628.25 $628.25 $628.25 $628.25 $471.38 $628.25 $628.25 $628.25 $314.13 $314.13 $497.57 $628.25 $502.60 $282.71 $124.69 N/A $364.53 $628.25 $628.25 $628.25 $130.93 $628.25 N/A N/A 03.620.106 SUP HCPCS C1713 03.620.106 - TAP SURG 6MM HEXAGONAL COUPLING NONSTRL BOTH IP/OP $628.50 $465.00 $124.69 $628.25 $282.71 $282.71 $282.71 $282.71 $628.25 $628.25 $628.25 $130.94 $628.25 $628.25 $628.25 $628.25 $628.25 $130.93 $628.25 $251.30 $371.61 $628.25 $628.25 $628.25 $628.25 $471.38 $628.25 $628.25 $628.25 $314.13 $314.13 $497.57 $628.25 $502.60 $282.71 $124.69 N/A $364.53 $628.25 $376.95 $628.25 $130.93 $628.25 N/A N/A 0301-14 SUP Custom 27203010 0301-14 - TUBE JJNSTM 14FR 9FR STRL LF MIC LL RADOPQ STRP TRM DIST TIP BOTH IP/OP $479.50 $355.00 $85.33 $479.38 $479.38 $479.38 $479.38 $479.38 $479.38 $479.38 $85.33 $479.38 $479.38 $355.80 $355.80 $369.51 $249.76 $99.91 $479.38 $191.75 $479.38 $479.38 $479.38 $479.38 $479.38 $359.63 $479.38 $479.38 $479.38 $239.69 $239.69 $379.67 $479.38 $383.50 $311.60 $479.38 N/A $278.11 $479.38 $287.63 $479.38 $479.38 $479.38 N/A N/A 0306-573-000 SUP HCPCS C1713 0306-573-000 - KIT BN CMNT ACM BWL CMNT CRTDG FEM NOZ MED PRS 180GM BOTH IP/OP "$1,440.50" "$1,066.00" $285.81 "$1,440.03" $648.01 $648.01 $648.01 $648.01 "$1,440.03" "$1,440.03" "$1,440.03" $300.14 "$1,440.03" "$1,440.03" "$1,440.03" "$1,440.03" "$1,440.03" $300.12 "$1,440.03" $576.01 $851.78 "$1,440.03" "$1,440.03" "$1,440.03" "$1,440.03" "$1,080.38" "$1,440.03" "$1,440.03" "$1,440.03" $720.02 $720.02 "$1,140.50" "$1,440.03" "$1,152.02" $648.01 $285.81 N/A $835.49 "$1,440.03" "$1,440.03" "$1,440.03" $300.10 "$1,440.03" N/A N/A 03-10-0110 SUP HCPCS C1713 03-10-0110 - PLATE BONE 10MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 03-10-0112 SUP HCPCS C1713 03-10-0112 - PLATE BONE 12MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 03-10-0114 SUP HCPCS C1713 03-10-0114 - PLATE BONE 14MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 03-10-0116 SUP HCPCS C1713 03-10-0116 - PLATE BONE 16MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 03-10-0118 SUP HCPCS C1713 03-10-0118 - PLATE BONE 18MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 03-10-0120 SUP HCPCS C1713 03-10-0120 - PLATE BONE 20MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 03-10-0122 SUP HCPCS C1713 03-10-0122 - PLATE BONE 22MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 03-10-0124 SUP HCPCS C1713 03-10-0124 - PLATE BONE 24MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 03-10-0126 SUP HCPCS C1713 03-10-0126 - PLATE BONE 26MM LEVEL 1 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 03-10-0229 SUP HCPCS C1713 03-10-0229 - PLATE BONE 29MM LEVEL 2 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 03-10-0232 SUP HCPCS C1713 03-10-0232 - PLATE BONE 32MM LEVEL 2 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 03-10-0235 SUP HCPCS C1713 03-10-0235 - PLATE BONE 35MM LEVEL 2 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 03-10-0238 SUP HCPCS C1713 03-10-0238 - PLATE BONE 38MM LEVEL 2 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 03-10-0241 SUP HCPCS C1713 03-10-0241 - PLATE BONE 41MM LEVEL 2 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 03-10-0244 SUP HCPCS C1713 03-10-0244 - PLATE BONE 44MM LEVEL 2 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 03-10-0343 SUP HCPCS C1713 03-10-0343 - PLATE BONE 43MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 03-10-0346 SUP HCPCS C1713 03-10-0346 - PLATE BONE 46MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 03-10-0349 SUP HCPCS C1713 03-10-0349 - PLATE BONE 49MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 03-10-0352 SUP HCPCS C1713 03-10-0352 - PLATE BONE 52MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 03-10-0355 SUP HCPCS C1713 03-10-0355 - PLATE BONE 55MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 03-10-0358 SUP HCPCS C1713 03-10-0358 - PLATE BONE 58MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 03-10-0362 SUP HCPCS C1713 03-10-0362 - PLATE BONE 62MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 03-10-0366 SUP HCPCS C1713 03-10-0366 - PLATE BONE 66MM LEVEL 3 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A 03-10-0460 SUP HCPCS C1713 03-10-0460 - PLATE BONE 60MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 03-10-0464 SUP HCPCS C1713 03-10-0464 - PLATE BONE 64MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 03-10-0468 SUP HCPCS C1713 03-10-0468 - PLATE BONE 68MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 03-10-0472 SUP HCPCS C1713 03-10-0472 - PLATE BONE 72MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 03-10-0476 SUP HCPCS C1713 03-10-0476 - PLATE BONE 76MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 03-10-0480 SUP HCPCS C1713 03-10-0480 - PLATE BONE 80MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A 03-10-0484 SUP HCPCS C1713 03-10-0484 - PLATE BONE 84MM LEVEL 4 TETHER TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 03-503-246 SUP Custom 27203010 03-503-246 - BIT DRILL 44.5MM 1.1MM MTRX 6MM STOP JLTCH CPLNG NONSTRL BOTH IP/OP $286.00 $212.00 $50.86 $285.75 $285.75 $285.75 $285.75 $285.75 $285.75 $285.75 $50.86 $285.75 $285.75 $212.08 $212.08 $220.26 $148.88 $59.55 $285.75 $114.30 $285.75 $285.75 $285.75 $285.75 $285.75 $214.50 $285.75 $285.75 $285.75 $142.88 $142.88 $226.31 $285.75 $228.60 $185.74 $285.75 N/A $165.88 $285.75 $171.45 $285.75 $285.75 $285.75 N/A N/A 0382-1425 SUP HCPCS C1713 0382-1425 - SCREW BONE 4.5MM 25MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 0382-1430 SUP HCPCS C1713 0382-1430 - SCREW BONE 4.5MM 30MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 0382-1445 SUP HCPCS C1713 0382-1445 - SCREW BN 4.5MM 45MM X2 PA TI SPNE THORLMBR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 0382-1525 SUP HCPCS C1713 0382-1525 - SCREW BONE 5.5MM 25MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 0382-1535 SUP HCPCS C1713 0382-1535 - SCREW BONE 5.5MM 35MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 0382-1650 SUP HCPCS C1713 0382-1650 - SCREW BONE 6.5MM 50MM POLYAX XIA II TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 04.001.000 SUP HCPCS C1713 04.001.000 - CAP END 0MM HUM XTD STARDRIVE RECESS CANN IM NAIL TI NONSTRL BOTH IP/OP $330.50 $245.00 $65.55 $330.25 $148.61 $148.61 $148.61 $148.61 $330.25 $330.25 $330.25 $68.83 $330.25 $330.25 $330.25 $330.25 $330.25 $68.83 $330.25 $132.10 $195.34 $330.25 $330.25 $330.25 $330.25 $247.88 $330.25 $330.25 $330.25 $165.13 $165.13 $261.56 $330.25 $264.20 $148.61 $65.55 N/A $191.69 $330.25 $330.25 $330.25 $68.82 $330.25 N/A N/A 04.001.000S SUP Custom 27803010 04.001.000S - CAP END 0MM EXTENDED SPIRAL BLADE SELF HOLDING T25 STARDRIVE BOTH IP/OP $389.50 $288.00 $69.33 $396.10 $389.48 $389.48 $389.48 $389.48 $389.48 $389.48 $69.33 $389.48 $389.48 $389.48 $389.48 $389.48 $389.48 $81.17 $389.48 $158.44 $389.48 $389.48 $396.10 $389.48 $389.48 $292.13 $389.48 $389.48 $389.48 $194.74 $194.74 $308.47 $389.48 $311.58 $175.27 $389.48 N/A $225.91 $389.48 $233.69 $389.48 $389.48 $389.48 N/A N/A 04.001.001S SUP Custom 27803010 04.001.001S - CAP END 5MM EXTENDED SPIRAL BLADE SELF HOLDING T25 STARDRIVE BOTH IP/OP $389.50 $288.00 $69.33 $396.10 $389.48 $389.48 $389.48 $389.48 $389.48 $389.48 $69.33 $389.48 $389.48 $389.48 $389.48 $389.48 $389.48 $81.17 $389.48 $158.44 $389.48 $389.48 $396.10 $389.48 $389.48 $292.13 $389.48 $389.48 $389.48 $194.74 $194.74 $308.47 $389.48 $311.58 $175.27 $389.48 N/A $225.91 $389.48 $233.69 $389.48 $389.48 $389.48 N/A N/A 04.001.002S SUP Custom 27803010 04.001.002S - CAP END 10MM EXTENDED STARDRIVE RECESS NAIL-EX TITANIUM BOTH IP/OP $389.50 $288.00 $69.33 $396.10 $389.48 $389.48 $389.48 $389.48 $389.48 $389.48 $69.33 $389.48 $389.48 $389.48 $389.48 $389.48 $389.48 $81.17 $389.48 $158.44 $389.48 $389.48 $396.10 $389.48 $389.48 $292.13 $389.48 $389.48 $389.48 $194.74 $194.74 $308.47 $389.48 $311.58 $175.27 $389.48 N/A $225.91 $389.48 $233.69 $389.48 $389.48 $389.48 N/A N/A 04.001.003S SUP Custom 27803010 04.001.003S - CAP END 15MM 15MM EXTENDED SPIRAL BLADE SELF HOLDING T25 BOTH IP/OP $389.50 $288.00 $69.33 $396.10 $389.48 $389.48 $389.48 $389.48 $389.48 $389.48 $69.33 $389.48 $389.48 $389.48 $389.48 $389.48 $389.48 $81.17 $389.48 $158.44 $389.48 $389.48 $396.10 $389.48 $389.48 $292.13 $389.48 $389.48 $389.48 $194.74 $194.74 $308.47 $389.48 $311.58 $175.27 $389.48 N/A $225.91 $389.48 $233.69 $389.48 $389.48 $389.48 N/A N/A 04.001.210S SUP HCPCS C1713 04.001.210S - NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 15CM CANN BOTH IP/OP "$3,590.00" "$2,657.00" $712.52 "$3,650.98" "$1,615.48" "$1,615.48" "$1,615.48" "$1,615.48" "$3,589.95" "$3,589.95" "$3,589.95" $748.24 "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" $748.19 "$3,589.95" "$3,650.98" "$1,769.85" "$3,589.95" "$3,650.98" "$3,589.95" "$3,589.95" "$2,692.50" "$3,589.95" "$3,589.95" "$3,589.95" "$1,794.98" "$1,794.98" "$2,843.24" "$3,589.95" "$2,871.96" "$1,615.48" $712.52 N/A "$2,082.20" "$3,589.95" "$2,153.97" "$3,589.95" $748.15 "$3,589.95" N/A N/A 04.001.218S SUP HCPCS C1713 04.001.218S - NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 19CM CANN BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$3,760.78" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$2,218.74" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.220S SUP HCPCS C1713 04.001.220S - NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 20CM CANN BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$1,504.31" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$3,697.90" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.222S SUP HCPCS C1713 04.001.222S - NAIL INTRAMEDULLARY UNIVERSAL 7MM 210MM SOLID CANN EXPERT BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$3,760.78" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$2,218.74" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.224S SUP HCPCS C1713 04.001.224S - NAIL INTRAMEDULLARY UNIVERSAL 7MM 220MM CANN ROUND BARREL BOTH IP/OP "$3,590.00" "$2,657.00" $712.52 "$3,650.98" "$1,615.48" "$1,615.48" "$1,615.48" "$1,615.48" "$3,589.95" "$3,589.95" "$3,589.95" $748.24 "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" $748.19 "$3,589.95" "$1,460.39" "$1,769.85" "$3,589.95" "$3,650.98" "$3,589.95" "$3,589.95" "$2,692.50" "$3,589.95" "$3,589.95" "$3,589.95" "$1,794.98" "$1,794.98" "$2,843.24" "$3,589.95" "$2,871.96" "$1,615.48" $712.52 N/A "$2,082.20" "$3,589.95" "$2,153.97" "$3,589.95" $748.15 "$3,589.95" N/A N/A 04.001.226S SUP HCPCS C1713 04.001.226S - NAIL INTRAMEDULLARY 7MM 230MM CANN NAIL-EX BLUE TITANIUM BOTH IP/OP "$3,590.00" "$2,657.00" $712.52 "$3,650.98" "$1,615.48" "$1,615.48" "$1,615.48" "$1,615.48" "$3,589.95" "$3,589.95" "$3,589.95" $748.24 "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" $748.19 "$3,589.95" "$1,460.39" "$1,769.85" "$3,589.95" "$3,650.98" "$3,589.95" "$3,589.95" "$2,692.50" "$3,589.95" "$3,589.95" "$3,589.95" "$1,794.98" "$1,794.98" "$2,843.24" "$3,589.95" "$2,871.96" "$1,615.48" $712.52 N/A "$2,082.20" "$3,589.95" "$2,153.97" "$3,589.95" $748.15 "$3,589.95" N/A N/A 04.001.228S SUP HCPCS C1713 04.001.228S - NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 24CM CANN BOTH IP/OP "$3,590.00" "$2,657.00" $712.52 "$3,650.98" "$1,615.48" "$1,615.48" "$1,615.48" "$1,615.48" "$3,589.95" "$3,589.95" "$3,589.95" $748.24 "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" $748.19 "$3,589.95" "$1,460.39" "$1,769.85" "$3,589.95" "$3,650.98" "$3,589.95" "$3,589.95" "$2,692.50" "$3,589.95" "$3,589.95" "$3,589.95" "$1,794.98" "$1,794.98" "$2,843.24" "$3,589.95" "$2,871.96" "$1,615.48" $712.52 N/A "$2,082.20" "$3,589.95" "$2,153.97" "$3,589.95" $748.15 "$3,589.95" N/A N/A 04.001.230S SUP HCPCS C1713 04.001.230S - NAIL INTRAMEDULLARY UNIVERSAL 7MM 250MM SOLID CANN EXPERT BOTH IP/OP "$3,590.00" "$2,657.00" $712.52 "$3,650.98" "$1,615.48" "$1,615.48" "$1,615.48" "$1,615.48" "$3,589.95" "$3,589.95" "$3,589.95" $748.24 "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" $748.19 "$3,589.95" "$3,650.98" "$1,769.85" "$3,589.95" "$3,650.98" "$3,589.95" "$3,589.95" "$2,692.50" "$3,589.95" "$3,589.95" "$3,589.95" "$1,794.98" "$1,794.98" "$2,843.24" "$3,589.95" "$2,871.96" "$1,615.48" $712.52 N/A "$2,082.20" "$3,589.95" "$2,153.97" "$3,589.95" $748.15 "$3,589.95" N/A N/A 04.001.232S SUP HCPCS C1713 04.001.232S - NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 26CM CANN BOTH IP/OP "$3,590.00" "$2,657.00" $712.52 "$3,650.98" "$1,615.48" "$1,615.48" "$1,615.48" "$1,615.48" "$3,589.95" "$3,589.95" "$3,589.95" $748.24 "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" $748.19 "$3,589.95" "$1,460.39" "$1,769.85" "$3,589.95" "$3,650.98" "$3,589.95" "$3,589.95" "$2,692.50" "$3,589.95" "$3,589.95" "$3,589.95" "$1,794.98" "$1,794.98" "$2,843.24" "$3,589.95" "$2,871.96" "$1,615.48" $712.52 N/A "$2,082.20" "$3,589.95" "$3,589.95" "$3,589.95" $748.15 "$3,589.95" N/A N/A 04.001.234S SUP HCPCS C1713 04.001.234S - NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 27CM CANN BOTH IP/OP "$3,590.00" "$2,657.00" $712.52 "$3,650.98" "$1,615.48" "$1,615.48" "$1,615.48" "$1,615.48" "$3,589.95" "$3,589.95" "$3,589.95" $748.24 "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" $748.19 "$3,589.95" "$1,460.39" "$1,769.85" "$3,589.95" "$3,650.98" "$3,589.95" "$3,589.95" "$2,692.50" "$3,589.95" "$3,589.95" "$3,589.95" "$1,794.98" "$1,794.98" "$2,843.24" "$3,589.95" "$2,871.96" "$1,615.48" $712.52 N/A "$2,082.20" "$3,589.95" "$2,153.97" "$3,589.95" $748.15 "$3,589.95" N/A N/A 04.001.236S SUP HCPCS C1713 04.001.236S - NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 28CM CANN BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$1,504.31" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$2,218.74" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.238S SUP HCPCS C1713 04.001.238S - NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 7MM 29CM CANN BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$3,760.78" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$2,218.74" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.240S SUP HCPCS C1713 04.001.240S - NAIL INTRAMEDULLARY 7MM 300MM SOLID CANN EXPERT BLUE BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$3,760.78" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$2,218.74" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.242S SUP HCPCS C1713 04.001.242S - NAIL INTRAMEDULLARY 7MM 310MM CANN NAIL-EX BLUE TITANIUM BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$3,760.78" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$2,218.74" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.244S SUP HCPCS C1713 04.001.244S - NAIL INTRAMEDULLARY 7MM 320MM SOLID CANN EXPERT BLUE BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$3,760.78" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$2,218.74" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.410S SUP HCPCS C1713 04.001.410S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 150MM CANN ROUND BARREL BOTH IP/OP "$3,590.00" "$2,657.00" $712.52 "$3,650.98" "$1,615.48" "$1,615.48" "$1,615.48" "$1,615.48" "$3,589.95" "$3,589.95" "$3,589.95" $748.24 "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" $748.19 "$3,589.95" "$3,650.98" "$1,769.85" "$3,589.95" "$3,650.98" "$3,589.95" "$3,589.95" "$2,692.50" "$3,589.95" "$3,589.95" "$3,589.95" "$1,794.98" "$1,794.98" "$2,843.24" "$3,589.95" "$2,871.96" "$1,615.48" $712.52 N/A "$2,082.20" "$3,589.95" "$2,153.97" "$3,589.95" $748.15 "$3,589.95" N/A N/A 04.001.418S SUP HCPCS C1713 04.001.418S - NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 19CM CANN BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$1,504.31" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$3,697.90" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.420S SUP HCPCS C1713 04.001.420S - NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 20CM CANN BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$1,504.31" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$2,218.74" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.422S SUP HCPCS C1713 04.001.422S - NAIL INTRAMEDULLARY 9MM 210MM SOLID CANN EXPERT BLUE BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$1,504.31" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$2,218.74" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.424S SUP HCPCS C1713 04.001.424S - NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 220MM CANN BOTH IP/OP "$3,590.00" "$2,657.00" $712.52 "$3,650.98" "$1,615.48" "$1,615.48" "$1,615.48" "$1,615.48" "$3,589.95" "$3,589.95" "$3,589.95" $748.24 "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" $748.19 "$3,589.95" "$1,460.39" "$1,769.85" "$3,589.95" "$3,650.98" "$3,589.95" "$3,589.95" "$2,692.50" "$3,589.95" "$3,589.95" "$3,589.95" "$1,794.98" "$1,794.98" "$2,843.24" "$3,589.95" "$2,871.96" "$1,615.48" $712.52 N/A "$2,082.20" "$3,589.95" "$2,153.97" "$3,589.95" $748.15 "$3,589.95" N/A N/A 04.001.426S SUP HCPCS C1713 04.001.426S - NAIL INTRAMEDULLARY 9MM 230MM CANN IMPLANT NAIL-EX TITANIUM BOTH IP/OP "$3,590.00" "$2,657.00" $712.52 "$3,650.98" "$1,615.48" "$1,615.48" "$1,615.48" "$1,615.48" "$3,589.95" "$3,589.95" "$3,589.95" $748.24 "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" $748.19 "$3,589.95" "$3,650.98" "$1,769.85" "$3,589.95" "$3,650.98" "$3,589.95" "$3,589.95" "$2,692.50" "$3,589.95" "$3,589.95" "$3,589.95" "$1,794.98" "$1,794.98" "$2,843.24" "$3,589.95" "$2,871.96" "$1,615.48" $712.52 N/A "$2,082.20" "$3,589.95" "$2,153.97" "$3,589.95" $748.15 "$3,589.95" N/A N/A 04.001.428S SUP HCPCS C1713 04.001.428S - NAIL INTRAMEDULLARY ROUND BARREL UNIVERSAL 9MM 24CM CANN BOTH IP/OP "$3,590.00" "$2,657.00" $712.52 "$3,650.98" "$1,615.48" "$1,615.48" "$1,615.48" "$1,615.48" "$3,589.95" "$3,589.95" "$3,589.95" $748.24 "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" $748.19 "$3,589.95" "$3,650.98" "$1,769.85" "$3,589.95" "$3,650.98" "$3,589.95" "$3,589.95" "$2,692.50" "$3,589.95" "$3,589.95" "$3,589.95" "$1,794.98" "$1,794.98" "$2,843.24" "$3,589.95" "$2,871.96" "$1,615.48" $712.52 N/A "$2,082.20" "$3,589.95" "$3,589.95" "$3,589.95" $748.15 "$3,589.95" N/A N/A 04.001.430S SUP HCPCS C1713 04.001.430S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 250MM SOLID CANN EXPERT BOTH IP/OP "$3,590.00" "$2,657.00" $712.52 "$3,650.98" "$1,615.48" "$1,615.48" "$1,615.48" "$1,615.48" "$3,589.95" "$3,589.95" "$3,589.95" $748.24 "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" $748.19 "$3,589.95" "$1,460.39" "$1,769.85" "$3,589.95" "$3,650.98" "$3,589.95" "$3,589.95" "$2,692.50" "$3,589.95" "$3,589.95" "$3,589.95" "$1,794.98" "$1,794.98" "$2,843.24" "$3,589.95" "$2,871.96" "$1,615.48" $712.52 N/A "$2,082.20" "$3,589.95" "$3,589.95" "$3,589.95" $748.15 "$3,589.95" N/A N/A 04.001.432S SUP HCPCS C1713 04.001.432S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 260MM SOLID CANN EXPERT BOTH IP/OP "$3,590.00" "$2,657.00" $712.52 "$3,650.98" "$1,615.48" "$1,615.48" "$1,615.48" "$1,615.48" "$3,589.95" "$3,589.95" "$3,589.95" $748.24 "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" $748.19 "$3,589.95" "$3,650.98" "$1,769.85" "$3,589.95" "$3,650.98" "$3,589.95" "$3,589.95" "$2,692.50" "$3,589.95" "$3,589.95" "$3,589.95" "$1,794.98" "$1,794.98" "$2,843.24" "$3,589.95" "$2,871.96" "$1,615.48" $712.52 N/A "$2,082.20" "$3,589.95" "$3,589.95" "$3,589.95" $748.15 "$3,589.95" N/A N/A 04.001.434S SUP HCPCS C1713 04.001.434S - NAIL INTRAMEDULLARY 9MM 270MM SOLID CANN EXPERT BLUE BOTH IP/OP "$3,590.00" "$2,657.00" $712.52 "$3,650.98" "$1,615.48" "$1,615.48" "$1,615.48" "$1,615.48" "$3,589.95" "$3,589.95" "$3,589.95" $748.24 "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" "$3,589.95" $748.19 "$3,589.95" "$3,650.98" "$1,769.85" "$3,589.95" "$3,650.98" "$3,589.95" "$3,589.95" "$2,692.50" "$3,589.95" "$3,589.95" "$3,589.95" "$1,794.98" "$1,794.98" "$2,843.24" "$3,589.95" "$2,871.96" "$1,615.48" $712.52 N/A "$2,082.20" "$3,589.95" "$2,153.97" "$3,589.95" $748.15 "$3,589.95" N/A N/A 04.001.436S SUP HCPCS C1713 04.001.436S - NAIL INTRAMEDULLARY 9MM 280MM SOLID CANN EXPERT BLUE BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$3,760.78" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$2,218.74" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.438S SUP HCPCS C1713 04.001.438S - NAIL INTRAMEDULLARY 9MM 290MM CANN NAIL-EX BLUE TITANIUM BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$1,504.31" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$2,218.74" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.440S SUP HCPCS C1713 04.001.440S - NAIL INTRAMEDULLARY 9MM 300MM SOLID CANN EXPERT BLUE BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$3,760.78" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$2,218.74" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.442S SUP HCPCS C1713 04.001.442S - NAIL INTRAMEDULLARY 9MM 310MM CANN NAIL-EX BLUE TITANIUM BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$1,504.31" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$3,697.90" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.444S SUP HCPCS C1713 04.001.444S - NAIL INTRAMEDULLARY 9MM 320MM SOLID CANN EXPERT BLUE BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$3,760.78" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$3,697.90" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.610S SUP HCPCS C1713 04.001.610S - NAIL INTRAMEDULLARY 11MM 150MM CANN EXPERT BLUE TITANIUM BOTH IP/OP "$3,698.00" "$2,737.00" $733.94 "$3,760.78" "$1,664.06" "$1,664.06" "$1,664.06" "$1,664.06" "$3,697.90" "$3,697.90" "$3,697.90" $770.73 "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" "$3,697.90" $770.68 "$3,697.90" "$1,504.31" "$1,823.06" "$3,697.90" "$3,760.78" "$3,697.90" "$3,697.90" "$2,773.50" "$3,697.90" "$3,697.90" "$3,697.90" "$1,848.95" "$1,848.95" "$2,928.74" "$3,697.90" "$2,958.32" "$1,664.06" $733.94 N/A "$2,144.84" "$3,697.90" "$3,697.90" "$3,697.90" $770.64 "$3,697.90" N/A N/A 04.001.618S SUP HCPCS C1713 04.001.618S - NAIL INTRAMEDULLARY 11MM 19CM CANN NAIL-EX TITANIUM HUMERUS BOTH IP/OP "$3,823.50" "$2,829.00" $758.84 "$3,888.35" "$1,720.51" "$1,720.51" "$1,720.51" "$1,720.51" "$3,823.35" "$3,823.35" "$3,823.35" $796.88 "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" $796.83 "$3,823.35" "$3,888.35" "$1,884.91" "$3,823.35" "$3,888.35" "$3,823.35" "$3,823.35" "$2,867.63" "$3,823.35" "$3,823.35" "$3,823.35" "$1,911.68" "$1,911.68" "$3,028.09" "$3,823.35" "$3,058.68" "$1,720.51" $758.84 N/A "$2,217.63" "$3,823.35" "$3,823.35" "$3,823.35" $796.79 "$3,823.35" N/A N/A 04.001.620S SUP HCPCS C1713 04.001.620S - NAIL INTRAMEDULLARY 11MM 20CM CANN NAIL-EX TITANIUM HUMERUS BOTH IP/OP "$3,823.50" "$2,829.00" $758.84 "$3,888.35" "$1,720.51" "$1,720.51" "$1,720.51" "$1,720.51" "$3,823.35" "$3,823.35" "$3,823.35" $796.88 "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" $796.83 "$3,823.35" "$1,555.34" "$1,884.91" "$3,823.35" "$3,888.35" "$3,823.35" "$3,823.35" "$2,867.63" "$3,823.35" "$3,823.35" "$3,823.35" "$1,911.68" "$1,911.68" "$3,028.09" "$3,823.35" "$3,058.68" "$1,720.51" $758.84 N/A "$2,217.63" "$3,823.35" "$2,294.01" "$3,823.35" $796.79 "$3,823.35" N/A N/A 04.001.622S SUP HCPCS C1713 04.001.622S - NAIL INTRAMEDULLARY 11MM 21CM CANN NAIL-EX TITANIUM HUMERUS BOTH IP/OP "$3,823.50" "$2,829.00" $758.84 "$3,888.35" "$1,720.51" "$1,720.51" "$1,720.51" "$1,720.51" "$3,823.35" "$3,823.35" "$3,823.35" $796.88 "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" $796.83 "$3,823.35" "$3,888.35" "$1,884.91" "$3,823.35" "$3,888.35" "$3,823.35" "$3,823.35" "$2,867.63" "$3,823.35" "$3,823.35" "$3,823.35" "$1,911.68" "$1,911.68" "$3,028.09" "$3,823.35" "$3,058.68" "$1,720.51" $758.84 N/A "$2,217.63" "$3,823.35" "$3,823.35" "$3,823.35" $796.79 "$3,823.35" N/A N/A 04.001.624S SUP HCPCS C1713 04.001.624S - NAIL INTRAMEDULLARY 11MM 22CM CANN NAIL-EX TITANIUM HUMERUS BOTH IP/OP "$3,823.50" "$2,829.00" $758.84 "$3,888.35" "$1,720.51" "$1,720.51" "$1,720.51" "$1,720.51" "$3,823.35" "$3,823.35" "$3,823.35" $796.88 "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" $796.83 "$3,823.35" "$1,555.34" "$1,884.91" "$3,823.35" "$3,888.35" "$3,823.35" "$3,823.35" "$2,867.63" "$3,823.35" "$3,823.35" "$3,823.35" "$1,911.68" "$1,911.68" "$3,028.09" "$3,823.35" "$3,058.68" "$1,720.51" $758.84 N/A "$2,217.63" "$3,823.35" "$3,823.35" "$3,823.35" $796.79 "$3,823.35" N/A N/A 04.001.626S SUP HCPCS C1713 04.001.626S - NAIL INTRAMEDULLARY 11MM 23CM CANN NAIL-EX TITANIUM HUMERUS BOTH IP/OP "$3,823.50" "$2,829.00" $758.84 "$3,888.35" "$1,720.51" "$1,720.51" "$1,720.51" "$1,720.51" "$3,823.35" "$3,823.35" "$3,823.35" $796.88 "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" $796.83 "$3,823.35" "$3,888.35" "$1,884.91" "$3,823.35" "$3,888.35" "$3,823.35" "$3,823.35" "$2,867.63" "$3,823.35" "$3,823.35" "$3,823.35" "$1,911.68" "$1,911.68" "$3,028.09" "$3,823.35" "$3,058.68" "$1,720.51" $758.84 N/A "$2,217.63" "$3,823.35" "$3,823.35" "$3,823.35" $796.79 "$3,823.35" N/A N/A 04.001.628S SUP HCPCS C1713 04.001.628S - NAIL INTRAMEDULLARY 11MM 24CM CANN NAIL-EX TITANIUM HUMERUS BOTH IP/OP "$3,823.50" "$2,829.00" $758.84 "$3,888.35" "$1,720.51" "$1,720.51" "$1,720.51" "$1,720.51" "$3,823.35" "$3,823.35" "$3,823.35" $796.88 "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" $796.83 "$3,823.35" "$1,555.34" "$1,884.91" "$3,823.35" "$3,888.35" "$3,823.35" "$3,823.35" "$2,867.63" "$3,823.35" "$3,823.35" "$3,823.35" "$1,911.68" "$1,911.68" "$3,028.09" "$3,823.35" "$3,058.68" "$1,720.51" $758.84 N/A "$2,217.63" "$3,823.35" "$3,823.35" "$3,823.35" $796.79 "$3,823.35" N/A N/A 04.001.630S SUP HCPCS C1713 04.001.630S - NAIL INTRAMEDULLARY 11MM 25CM CANN NAIL-EX TITANIUM HUMERUS BOTH IP/OP "$3,823.50" "$2,829.00" $758.84 "$3,888.35" "$1,720.51" "$1,720.51" "$1,720.51" "$1,720.51" "$3,823.35" "$3,823.35" "$3,823.35" $796.88 "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" $796.83 "$3,823.35" "$3,888.35" "$1,884.91" "$3,823.35" "$3,888.35" "$3,823.35" "$3,823.35" "$2,867.63" "$3,823.35" "$3,823.35" "$3,823.35" "$1,911.68" "$1,911.68" "$3,028.09" "$3,823.35" "$3,058.68" "$1,720.51" $758.84 N/A "$2,217.63" "$3,823.35" "$3,823.35" "$3,823.35" $796.79 "$3,823.35" N/A N/A 04.001.632S SUP HCPCS C1713 04.001.632S - NAIL INTRAMEDULLARY 11MM 26CM CANN NAIL-EX TITANIUM HUMERUS BOTH IP/OP "$3,823.50" "$2,829.00" $758.84 "$3,888.35" "$1,720.51" "$1,720.51" "$1,720.51" "$1,720.51" "$3,823.35" "$3,823.35" "$3,823.35" $796.88 "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" $796.83 "$3,823.35" "$1,555.34" "$1,884.91" "$3,823.35" "$3,888.35" "$3,823.35" "$3,823.35" "$2,867.63" "$3,823.35" "$3,823.35" "$3,823.35" "$1,911.68" "$1,911.68" "$3,028.09" "$3,823.35" "$3,058.68" "$1,720.51" $758.84 N/A "$2,217.63" "$3,823.35" "$3,823.35" "$3,823.35" $796.79 "$3,823.35" N/A N/A 04.001.634S SUP HCPCS C1713 04.001.634S - NAIL INTRAMEDULLARY 11MM 270MM CANN NAIL-EX TITANIUM HUMERUS BOTH IP/OP "$3,823.50" "$2,829.00" $758.84 "$3,888.35" "$1,720.51" "$1,720.51" "$1,720.51" "$1,720.51" "$3,823.35" "$3,823.35" "$3,823.35" $796.88 "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" $796.83 "$3,823.35" "$3,888.35" "$1,884.91" "$3,823.35" "$3,888.35" "$3,823.35" "$3,823.35" "$2,867.63" "$3,823.35" "$3,823.35" "$3,823.35" "$1,911.68" "$1,911.68" "$3,028.09" "$3,823.35" "$3,058.68" "$1,720.51" $758.84 N/A "$2,217.63" "$3,823.35" "$3,823.35" "$3,823.35" $796.79 "$3,823.35" N/A N/A 04.001.636S SUP HCPCS C1713 04.001.636S - NAIL INTRAMEDULLARY 11MM 28CM CANN NAIL-EX TITANIUM HUMERUS BOTH IP/OP "$3,823.50" "$2,829.00" $758.84 "$3,888.35" "$1,720.51" "$1,720.51" "$1,720.51" "$1,720.51" "$3,823.35" "$3,823.35" "$3,823.35" $796.88 "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" $796.83 "$3,823.35" "$3,888.35" "$1,884.91" "$3,823.35" "$3,888.35" "$3,823.35" "$3,823.35" "$2,867.63" "$3,823.35" "$3,823.35" "$3,823.35" "$1,911.68" "$1,911.68" "$3,028.09" "$3,823.35" "$3,058.68" "$1,720.51" $758.84 N/A "$2,217.63" "$3,823.35" "$3,823.35" "$3,823.35" $796.79 "$3,823.35" N/A N/A 04.001.638S SUP HCPCS C1713 04.001.638S - NAIL INTRAMEDULLARY 11MM 29CM CANN NAIL-EX TITANIUM HUMERUS BOTH IP/OP "$3,823.50" "$2,829.00" $758.84 "$3,888.35" "$1,720.51" "$1,720.51" "$1,720.51" "$1,720.51" "$3,823.35" "$3,823.35" "$3,823.35" $796.88 "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" $796.83 "$3,823.35" "$3,888.35" "$1,884.91" "$3,823.35" "$3,888.35" "$3,823.35" "$3,823.35" "$2,867.63" "$3,823.35" "$3,823.35" "$3,823.35" "$1,911.68" "$1,911.68" "$3,028.09" "$3,823.35" "$3,058.68" "$1,720.51" $758.84 N/A "$2,217.63" "$3,823.35" "$3,823.35" "$3,823.35" $796.79 "$3,823.35" N/A N/A 04.001.640S SUP HCPCS C1713 04.001.640S - NAIL INTRAMEDULLARY 11MM 30CM CANN NAIL-EX TITANIUM HUMERUS BOTH IP/OP "$3,823.50" "$2,829.00" $758.84 "$3,888.35" "$1,720.51" "$1,720.51" "$1,720.51" "$1,720.51" "$3,823.35" "$3,823.35" "$3,823.35" $796.88 "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" $796.83 "$3,823.35" "$1,555.34" "$1,884.91" "$3,823.35" "$3,888.35" "$3,823.35" "$3,823.35" "$2,867.63" "$3,823.35" "$3,823.35" "$3,823.35" "$1,911.68" "$1,911.68" "$3,028.09" "$3,823.35" "$3,058.68" "$1,720.51" $758.84 N/A "$2,217.63" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" N/A N/A 04.001.642S SUP HCPCS C1713 04.001.642S - NAIL INTRAMEDULLARY 11MM 31CM CANN NAIL-EX TITANIUM HUMERUS BOTH IP/OP "$3,823.50" "$2,829.00" $758.84 "$3,888.35" "$1,720.51" "$1,720.51" "$1,720.51" "$1,720.51" "$3,823.35" "$3,823.35" "$3,823.35" $796.88 "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" $796.83 "$3,823.35" "$1,555.34" "$1,884.91" "$3,823.35" "$3,888.35" "$3,823.35" "$3,823.35" "$2,867.63" "$3,823.35" "$3,823.35" "$3,823.35" "$1,911.68" "$1,911.68" "$3,028.09" "$3,823.35" "$3,058.68" "$1,720.51" $758.84 N/A "$2,217.63" "$3,823.35" "$3,823.35" "$3,823.35" $796.79 "$3,823.35" N/A N/A 04.001.644S SUP HCPCS C1713 04.001.644S - NAIL INTRAMEDULLARY 11MM 32CM CANN NAIL-EX TITANIUM HUMERUS BOTH IP/OP "$3,823.50" "$2,829.00" $758.84 "$3,888.35" "$1,720.51" "$1,720.51" "$1,720.51" "$1,720.51" "$3,823.35" "$3,823.35" "$3,823.35" $796.88 "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" "$3,823.35" $796.83 "$3,823.35" "$1,555.34" "$1,884.91" "$3,823.35" "$3,888.35" "$3,823.35" "$3,823.35" "$2,867.63" "$3,823.35" "$3,823.35" "$3,823.35" "$1,911.68" "$1,911.68" "$3,028.09" "$3,823.35" "$3,058.68" "$1,720.51" $758.84 N/A "$2,217.63" "$3,823.35" "$3,823.35" "$3,823.35" $796.79 "$3,823.35" N/A N/A 04.003.000S SUP Custom 27803010 04.003.000S - CAP END 0MM T40 STARDRIVE RECESS CANN FLUSH SELF RETAINING BOTH IP/OP $414.50 $307.00 $73.74 $421.33 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $73.74 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $86.34 $414.28 $168.53 $414.28 $414.28 $421.33 $414.28 $414.28 $310.88 $414.28 $414.28 $414.28 $207.14 $207.14 $328.11 $414.28 $331.42 $186.43 $414.28 N/A $240.41 $414.28 $248.57 $414.28 $414.28 $414.28 N/A N/A 04.003.001S SUP Custom 27803010 04.003.001S - CAP END 5MM T40 STARDRIVE RECESS CANN SELF RETAINING LATERAL BOTH IP/OP $414.50 $307.00 $73.74 $421.33 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $73.74 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $86.34 $414.28 $168.53 $414.28 $414.28 $421.33 $414.28 $414.28 $310.88 $414.28 $414.28 $414.28 $207.14 $207.14 $328.11 $414.28 $331.42 $186.43 $414.28 N/A $240.41 $414.28 $248.57 $414.28 $414.28 $414.28 N/A N/A 04.003.002S SUP Custom 27803010 04.003.002S - CAP END 10MM T40 STARDRIVE RECESS CANN SELF RETAINING BOTH IP/OP $414.50 $307.00 $73.74 $421.33 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $73.74 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $86.34 $414.28 $168.53 $414.28 $414.28 $421.33 $414.28 $414.28 $310.88 $414.28 $414.28 $414.28 $207.14 $207.14 $328.11 $414.28 $331.42 $186.43 $414.28 N/A $240.41 $414.28 $248.57 $414.28 $414.28 $414.28 N/A N/A 04.003.003S SUP Custom 27803010 04.003.003S - CAP END 15MM 12MM T40 STARDRIVE RECESS CANN SELF RETAINING BOTH IP/OP $414.50 $307.00 $73.74 $421.33 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $73.74 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $86.34 $414.28 $168.53 $414.28 $414.28 $421.33 $414.28 $414.28 $310.88 $414.28 $414.28 $414.28 $207.14 $207.14 $328.11 $414.28 $331.42 $186.43 $414.28 N/A $240.41 $414.28 $248.57 $414.28 $414.28 $414.28 N/A N/A 04.003.004S SUP Custom 27803010 04.003.004S - CAP END 20MM T40 STARDRIVE RECESS CANN SELF RETAINING BOTH IP/OP $414.50 $307.00 $73.74 $421.33 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $73.74 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $86.34 $414.28 $168.53 $414.28 $414.28 $421.33 $414.28 $414.28 $310.88 $414.28 $414.28 $414.28 $207.14 $207.14 $328.11 $414.28 $331.42 $186.43 $414.28 N/A $240.41 $414.28 $248.57 $414.28 $414.28 $414.28 N/A N/A 04.003.006S SUP Custom 27803010 04.003.006S - CAP END 5MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING BOTH IP/OP $414.50 $307.00 $73.74 $421.33 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $73.74 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $86.34 $414.28 $168.53 $414.28 $414.28 $421.33 $414.28 $414.28 $310.88 $414.28 $414.28 $414.28 $207.14 $207.14 $328.11 $414.28 $331.42 $186.43 $414.28 N/A $240.41 $414.28 $248.57 $414.28 $414.28 $414.28 N/A N/A 04.003.007S SUP Custom 27803010 04.003.007S - CAP END 10MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING BOTH IP/OP $414.50 $307.00 $73.74 $421.33 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $73.74 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $86.34 $414.28 $168.53 $414.28 $414.28 $421.33 $414.28 $414.28 $310.88 $414.28 $414.28 $414.28 $207.14 $207.14 $328.11 $414.28 $331.42 $186.43 $414.28 N/A $240.41 $414.28 $248.57 $414.28 $414.28 $414.28 N/A N/A 04.003.008S SUP Custom 27803010 04.003.008S - CAP END 15MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING BOTH IP/OP $414.50 $307.00 $73.74 $421.33 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $73.74 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $86.34 $414.28 $168.53 $414.28 $414.28 $421.33 $414.28 $414.28 $310.88 $414.28 $414.28 $414.28 $207.14 $207.14 $328.11 $414.28 $331.42 $186.43 $414.28 N/A $240.41 $414.28 $248.57 $414.28 $414.28 $414.28 N/A N/A 04.003.009S SUP Custom 27803010 04.003.009S - CAP END 20MM 16MM T40 STARDRIVE RECESS CANN SELF RETAINING BOTH IP/OP $414.50 $307.00 $73.74 $421.33 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $73.74 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $86.34 $414.28 $168.53 $414.28 $414.28 $421.33 $414.28 $414.28 $310.88 $414.28 $414.28 $414.28 $207.14 $207.14 $328.11 $414.28 $331.42 $186.43 $414.28 N/A $240.41 $414.28 $248.57 $414.28 $414.28 $414.28 N/A N/A 04.003.022 SUP HCPCS C1713 04.003.022 - SCREW BONE 6.5MM 60MM TI FEM SLFTAP TIP RECON T25 STARDRIVE BOTH IP/OP $400.50 $296.00 $79.47 $400.38 $180.17 $180.17 $180.17 $180.17 $400.38 $400.38 $400.38 $83.45 $400.38 $400.38 $400.38 $400.38 $400.38 $83.44 $400.38 $160.15 $236.82 $400.38 $400.38 $400.38 $400.38 $300.38 $400.38 $400.38 $400.38 $200.19 $200.19 $317.10 $400.38 $320.30 $180.17 $79.47 N/A $232.29 $400.38 $240.23 $400.38 $400.38 $400.38 N/A N/A 04.003.022S SUP HCPCS C1713 04.003.022S - SCREW BN T25 6.5MM 60MM AU STRL ST BLNT TIP STRDR TI FEM LAT BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $458.43 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $270.45 $450.75 $93.94 $450.75 N/A N/A 04.003.023 SUP HCPCS C1713 04.003.023 - SCREW BONE 6.5MM 65MM TI FEM SLFTAP TIP RECON T25 STARDRIVE BOTH IP/OP $400.50 $296.00 $79.47 $400.38 $180.17 $180.17 $180.17 $180.17 $400.38 $400.38 $400.38 $83.45 $400.38 $400.38 $400.38 $400.38 $400.38 $83.44 $400.38 $400.38 $236.82 $400.38 $400.38 $400.38 $400.38 $300.38 $400.38 $400.38 $400.38 $200.19 $200.19 $317.10 $400.38 $320.30 $180.17 $79.47 N/A $232.29 $400.38 $240.23 $400.38 $83.44 $400.38 N/A N/A 04.003.023S SUP HCPCS C1713 04.003.023S - SCREW BN T25 6.5MM 65MM AU STRL ST BLNT TIP STRDR TI FEM LAT BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $183.37 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $270.45 $450.75 $93.94 $450.75 N/A N/A 04.003.024 SUP HCPCS C1713 04.003.024 - SCREW BONE 6.5MM 70MM TI FEM T25 STARDRIVE RECESS SLFTAP BOTH IP/OP $400.50 $296.00 $79.47 $400.38 $180.17 $180.17 $180.17 $180.17 $400.38 $400.38 $400.38 $83.45 $400.38 $400.38 $400.38 $400.38 $400.38 $83.44 $400.38 $160.15 $236.82 $400.38 $400.38 $400.38 $400.38 $300.38 $400.38 $400.38 $400.38 $200.19 $200.19 $317.10 $400.38 $320.30 $180.17 $79.47 N/A $232.29 $400.38 $240.23 $400.38 $83.44 $400.38 N/A N/A 04.003.024S SUP HCPCS C1713 04.003.024S - SCREW BN T25 6.5MM 70MM AU STRL ST BLNT TIP STRDR TI FEM LAT BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $458.43 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $270.45 $450.75 $93.94 $450.75 N/A N/A 04.003.025 SUP HCPCS C1713 04.003.025 - SCREW BONE 6.5MM 75MM TI FEM SLFTAP TIP RECON T25 STARDRIVE BOTH IP/OP $400.50 $296.00 $79.47 $400.38 $180.17 $180.17 $180.17 $180.17 $400.38 $400.38 $400.38 $83.45 $400.38 $400.38 $400.38 $400.38 $400.38 $83.44 $400.38 $400.38 $236.82 $400.38 $400.38 $400.38 $400.38 $300.38 $400.38 $400.38 $400.38 $200.19 $200.19 $317.10 $400.38 $320.30 $180.17 $79.47 N/A $232.29 $400.38 $240.23 $400.38 $83.44 $400.38 N/A N/A 04.003.025S SUP HCPCS C1713 04.003.025S - SCREW BN T25 6.5MM 75MM AU STRL ST BLNT TIP STRDR TI FEM LAT BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $458.43 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $270.45 $450.75 $93.94 $450.75 N/A N/A 04.003.026 SUP HCPCS C1713 04.003.026 - SCREW BONE 6.5MM 80MM TI FEM SLFTAP RECON STARDRIVE RECESS BOTH IP/OP $400.50 $296.00 $79.47 $400.38 $180.17 $180.17 $180.17 $180.17 $400.38 $400.38 $400.38 $83.45 $400.38 $400.38 $400.38 $400.38 $400.38 $83.44 $400.38 $160.15 $236.82 $400.38 $400.38 $400.38 $400.38 $300.38 $400.38 $400.38 $400.38 $200.19 $200.19 $317.10 $400.38 $320.30 $180.17 $79.47 N/A $232.29 $400.38 $240.23 $400.38 $400.38 $400.38 N/A N/A 04.003.026S SUP HCPCS C1713 04.003.026S - SCREW BN T25 6.5MM 80MM AU STRL ST BLNT TIP STRDR TI FEM LAT BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $183.37 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $270.45 $450.75 $93.94 $450.75 N/A N/A 04.003.027 SUP HCPCS C1713 04.003.027 - SCREW BONE 6.5MM 85MM TI FEM SLFTAP TIP RECON T25 STARDRIVE BOTH IP/OP $400.50 $296.00 $79.47 $400.38 $180.17 $180.17 $180.17 $180.17 $400.38 $400.38 $400.38 $83.45 $400.38 $400.38 $400.38 $400.38 $400.38 $83.44 $400.38 $160.15 $236.82 $400.38 $400.38 $400.38 $400.38 $300.38 $400.38 $400.38 $400.38 $200.19 $200.19 $317.10 $400.38 $320.30 $180.17 $79.47 N/A $232.29 $400.38 $240.23 $400.38 $83.44 $400.38 N/A N/A 04.003.027S SUP HCPCS C1713 04.003.027S - SCREW BN T25 6.5MM 85MM AU STRL ST BLNT TIP STRDR TI FEM LAT BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $183.37 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $270.45 $450.75 $93.94 $450.75 N/A N/A 04.003.028 SUP HCPCS C1713 04.003.028 - SCREW BONE 6.5MM 90MM TI FEM SLFTAP TIP RECON T25 STARDRIVE BOTH IP/OP $425.00 $315.00 $84.30 $424.75 $191.14 $191.14 $191.14 $191.14 $424.75 $424.75 $424.75 $88.53 $424.75 $424.75 $424.75 $424.75 $424.75 $88.52 $424.75 $169.90 $251.24 $424.75 $424.75 $424.75 $424.75 $318.75 $424.75 $424.75 $424.75 $212.38 $212.38 $336.40 $424.75 $339.80 $191.14 $84.30 N/A $246.50 $424.75 $254.85 $424.75 $88.52 $424.75 N/A N/A 04.003.028S SUP HCPCS C1713 04.003.028S - SCREW BN T25 6.5MM 90MM AU STRL ST BLNT TIP STRDR TI FEM LAT BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $183.37 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $270.45 $450.75 $93.94 $450.75 N/A N/A 04.003.029 SUP HCPCS C1713 04.003.029 - SCREW BONE 6.5MM 95MM TI FEM SLFTAP TIP RECON T25 STARDRIVE BOTH IP/OP $425.00 $315.00 $84.30 $424.75 $191.14 $191.14 $191.14 $191.14 $424.75 $424.75 $424.75 $88.53 $424.75 $424.75 $424.75 $424.75 $424.75 $88.52 $424.75 $169.90 $251.24 $424.75 $424.75 $424.75 $424.75 $318.75 $424.75 $424.75 $424.75 $212.38 $212.38 $336.40 $424.75 $339.80 $191.14 $84.30 N/A $246.50 $424.75 $424.75 $424.75 $88.52 $424.75 N/A N/A 04.003.029S SUP HCPCS C1713 04.003.029S - SCREW BN T25 6.5MM 95MM AU STRL ST BLNT TIP STRDR TI FEM LAT BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $458.43 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $270.45 $450.75 $93.94 $450.75 N/A N/A 04.003.030 SUP HCPCS C1713 04.003.030 - SCREW BONE NONSTRL 6.5MM 100MM TI FEM T25 STARDRIVE RECESS BOTH IP/OP $400.50 $296.00 $79.47 $400.38 $180.17 $180.17 $180.17 $180.17 $400.38 $400.38 $400.38 $83.45 $400.38 $400.38 $400.38 $400.38 $400.38 $83.44 $400.38 $400.38 $236.82 $400.38 $400.38 $400.38 $400.38 $300.38 $400.38 $400.38 $400.38 $200.19 $200.19 $317.10 $400.38 $320.30 $180.17 $79.47 N/A $232.29 $400.38 $240.23 $400.38 $400.38 $400.38 N/A N/A 04.003.030S SUP HCPCS C1713 04.003.030S - SCREW BN T25 6.5MM 100MM AU STRL ST BLNT TIP STRDR TI FEM BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $458.43 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $270.45 $450.75 $93.94 $450.75 N/A N/A 04.003.031 SUP HCPCS C1713 04.003.031 - SCREW BONE 6.5MM 105MM TI FEM T25 STARDRIVE RECESS RECON BOTH IP/OP $425.00 $315.00 $84.30 $424.75 $191.14 $191.14 $191.14 $191.14 $424.75 $424.75 $424.75 $88.53 $424.75 $424.75 $424.75 $424.75 $424.75 $88.52 $424.75 $424.75 $251.24 $424.75 $424.75 $424.75 $424.75 $318.75 $424.75 $424.75 $424.75 $212.38 $212.38 $336.40 $424.75 $339.80 $191.14 $84.30 N/A $246.50 $424.75 $424.75 $424.75 $88.52 $424.75 N/A N/A 04.003.031S SUP HCPCS C1713 04.003.031S - SCREW BN T25 6.5MM 105MM AU STRL ST BLNT TIP STRDR TI FEM BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $458.43 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $270.45 $450.75 $93.94 $450.75 N/A N/A 04.003.032 SUP HCPCS C1713 04.003.032 - SCREW BONE 6.5MM 110MM TI FEM T25 STARDRIVE RECESS SLFTAP BOTH IP/OP $400.50 $296.00 $79.47 $400.38 $180.17 $180.17 $180.17 $180.17 $400.38 $400.38 $400.38 $83.45 $400.38 $400.38 $400.38 $400.38 $400.38 $83.44 $400.38 $160.15 $236.82 $400.38 $400.38 $400.38 $400.38 $300.38 $400.38 $400.38 $400.38 $200.19 $200.19 $317.10 $400.38 $320.30 $180.17 $79.47 N/A $232.29 $400.38 $240.23 $400.38 $83.44 $400.38 N/A N/A 04.003.032S SUP HCPCS C1713 04.003.032S - SCREW BN T25 6.5MM 110MM AU STRL ST BLNT TIP STRDR TI FEM BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $183.37 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $270.45 $450.75 $93.94 $450.75 N/A N/A 04.003.033 SUP HCPCS C1713 04.003.033 - SCREW BONE 6.5MM 115MM TI FEM T25 STARDRIVE RECESS SLFTAP BOTH IP/OP $400.50 $296.00 $79.47 $400.38 $180.17 $180.17 $180.17 $180.17 $400.38 $400.38 $400.38 $83.45 $400.38 $400.38 $400.38 $400.38 $400.38 $83.44 $400.38 $160.15 $236.82 $400.38 $400.38 $400.38 $400.38 $300.38 $400.38 $400.38 $400.38 $200.19 $200.19 $317.10 $400.38 $320.30 $180.17 $79.47 N/A $232.29 $400.38 $400.38 $400.38 $83.44 $400.38 N/A N/A 04.003.033S SUP HCPCS C1713 04.003.033S - SCREW BN T25 6.5MM 115MM AU STRL ST BLNT TIP STRDR TI FEM BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $458.43 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $450.75 $450.75 $93.94 $450.75 N/A N/A 04.003.034 SUP HCPCS C1713 04.003.034 - SCREW BONE 6.5MM 120MM TI FEM T25 STARDRIVE RECESS SLFTAP BOTH IP/OP $400.50 $296.00 $79.47 $400.38 $180.17 $180.17 $180.17 $180.17 $400.38 $400.38 $400.38 $83.45 $400.38 $400.38 $400.38 $400.38 $400.38 $83.44 $400.38 $160.15 $236.82 $400.38 $400.38 $400.38 $400.38 $300.38 $400.38 $400.38 $400.38 $200.19 $200.19 $317.10 $400.38 $320.30 $180.17 $79.47 N/A $232.29 $400.38 $240.23 $400.38 $83.44 $400.38 N/A N/A 04.003.034S SUP HCPCS C1713 04.003.034S - SCREW BN T25 6.5MM 120MM AU STRL ST BLNT TIP STRDR TI FEM BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $183.37 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $270.45 $450.75 $93.94 $450.75 N/A N/A 04.003.035 SUP HCPCS C1713 04.003.035 - SCREW BONE 6.5MM 125MM TI FEM T25 STARDRIVE RECESS SLFTAP BOTH IP/OP $400.50 $296.00 $79.47 $400.38 $180.17 $180.17 $180.17 $180.17 $400.38 $400.38 $400.38 $83.45 $400.38 $400.38 $400.38 $400.38 $400.38 $83.44 $400.38 $160.15 $236.82 $400.38 $400.38 $400.38 $400.38 $300.38 $400.38 $400.38 $400.38 $200.19 $200.19 $317.10 $400.38 $320.30 $180.17 $79.47 N/A $232.29 $400.38 $240.23 $400.38 $83.44 $400.38 N/A N/A 04.003.035S SUP HCPCS C1713 04.003.035S - SCREW BN T25 6.5MM 125MM AU STRL ST BLNT TIP STRDR TI FEM BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $183.37 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $270.45 $450.75 $93.94 $450.75 N/A N/A 04.003.036 SUP HCPCS C1713 04.003.036 - SCREW BONE 6.5MM 130MM TI FEM T25 STARDRIVE RECESS SLFTAP BOTH IP/OP $400.50 $296.00 $79.47 $400.38 $180.17 $180.17 $180.17 $180.17 $400.38 $400.38 $400.38 $83.45 $400.38 $400.38 $400.38 $400.38 $400.38 $83.44 $400.38 $160.15 $236.82 $400.38 $400.38 $400.38 $400.38 $300.38 $400.38 $400.38 $400.38 $200.19 $200.19 $317.10 $400.38 $320.30 $180.17 $79.47 N/A $232.29 $400.38 $400.38 $400.38 $83.44 $400.38 N/A N/A 04.003.036S SUP HCPCS C1713 04.003.036S - SCREW BN T25 6.5MM 130MM AU STRL ST BLNT TIP STRDR TI FEM BOTH IP/OP $451.00 $334.00 $89.46 $458.43 $202.84 $202.84 $202.84 $202.84 $450.75 $450.75 $450.75 $93.95 $450.75 $450.75 $450.75 $450.75 $450.75 $93.94 $450.75 $183.37 $266.62 $450.75 $458.43 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $202.84 $89.46 N/A $261.58 $450.75 $450.75 $450.75 $93.94 $450.75 N/A N/A 04.003.240S SUP HCPCS C1713 04.003.240S - NAIL INTRAMEDULLARY 9MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.241S SUP HCPCS C1713 04.003.241S - NAIL INTRAMEDULLARY 9MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.244S SUP HCPCS C1713 04.003.244S - NAIL INTRAMEDULLARY 9MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.245S SUP HCPCS C1713 04.003.245S - NAIL INTRAMEDULLARY 9MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.248S SUP HCPCS C1713 04.003.248S - NAIL INTRAMEDULLARY 9MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.249S SUP HCPCS C1713 04.003.249S - NAIL INTRAMEDULLARY 9MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.252S SUP HCPCS C1713 04.003.252S - NAIL INTRAMEDULLARY 9MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.253S SUP HCPCS C1713 04.003.253S - NAIL INTRAMEDULLARY 9MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.256S SUP HCPCS C1713 04.003.256S - NAIL INTRAMEDULLARY 9MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.257S SUP HCPCS C1713 04.003.257S - NAIL INTRAMEDULLARY 9MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.260S SUP HCPCS C1713 04.003.260S - NAIL INTRAMEDULLARY 9MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.261S SUP HCPCS C1713 04.003.261S - NAIL INTRAMEDULLARY 9MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.264S SUP HCPCS C1713 04.003.264S - NAIL INTRAMEDULLARY 9MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.265S SUP HCPCS C1713 04.003.265S - NAIL INTRAMEDULLARY 9MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.268S SUP HCPCS C1713 04.003.268S - NAIL INTRAMEDULLARY 9MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.269S SUP HCPCS C1713 04.003.269S - NAIL INTRAMEDULLARY 9MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.272S SUP HCPCS C1713 04.003.272S - NAIL INTRAMEDULLARY 9MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.273S SUP HCPCS C1713 04.003.273S - NAIL INTRAMEDULLARY 9MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.276S SUP HCPCS C1713 04.003.276S - NAIL INTRAMEDULLARY 9MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.277S SUP HCPCS C1713 04.003.277S - NAIL INTRAMEDULLARY 9MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.340S SUP HCPCS C1713 04.003.340S - NAIL INTRAMEDULLARY 10MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.341S SUP HCPCS C1713 04.003.341S - NAIL INTRAMEDULLARY 10MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.344S SUP HCPCS C1713 04.003.344S - NAIL INTRAMEDULLARY 10MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.345S SUP HCPCS C1713 04.003.345S - NAIL INTRAMEDULLARY 10MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.348S SUP HCPCS C1713 04.003.348S - NAIL INTRAMEDULLARY 10MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.349S SUP HCPCS C1713 04.003.349S - NAIL INTRAMEDULLARY 10MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.352S SUP HCPCS C1713 04.003.352S - NAIL INTRAMEDULLARY 10MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.353S SUP HCPCS C1713 04.003.353S - NAIL INTRAMEDULLARY 10MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.356S SUP HCPCS C1713 04.003.356S - NAIL INTRAMEDULLARY 10MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.357S SUP HCPCS C1713 04.003.357S - NAIL INTRAMEDULLARY 10MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.360S SUP HCPCS C1713 04.003.360S - NAIL INTRAMEDULLARY 10MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.361S SUP HCPCS C1713 04.003.361S - NAIL INTRAMEDULLARY 10MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.364S SUP HCPCS C1713 04.003.364S - NAIL INTRAMEDULLARY 10MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.365S SUP HCPCS C1713 04.003.365S - NAIL INTRAMEDULLARY 10MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.368S SUP HCPCS C1713 04.003.368S - NAIL INTRAMEDULLARY 10MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.369S SUP HCPCS C1713 04.003.369S - NAIL INTRAMEDULLARY 10MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.372S SUP HCPCS C1713 04.003.372S - NAIL INTRAMEDULLARY 10MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.373S SUP HCPCS C1713 04.003.373S - NAIL INTRAMEDULLARY 10MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.376S SUP HCPCS C1713 04.003.376S - NAIL INTRAMEDULLARY 10MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.377S SUP HCPCS C1713 04.003.377S - NAIL INTRAMEDULLARY 10MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.440S SUP HCPCS C1713 04.003.440S - NAIL INTRAMEDULLARY 11MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.441S SUP HCPCS C1713 04.003.441S - NAIL INTRAMEDULLARY 11MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.444S SUP HCPCS C1713 04.003.444S - NAIL INTRAMEDULLARY 11MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.445S SUP HCPCS C1713 04.003.445S - NAIL INTRAMEDULLARY 11MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.448S SUP HCPCS C1713 04.003.448S - NAIL INTRAMEDULLARY 11MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.449S SUP HCPCS C1713 04.003.449S - NAIL INTRAMEDULLARY 11MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.452S SUP HCPCS C1713 04.003.452S - NAIL INTRAMEDULLARY 11MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.453S SUP HCPCS C1713 04.003.453S - NAIL INTRAMEDULLARY 11MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.456S SUP HCPCS C1713 04.003.456S - NAIL INTRAMEDULLARY 11MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.457S SUP HCPCS C1713 04.003.457S - NAIL INTRAMEDULLARY 11MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.460S SUP HCPCS C1713 04.003.460S - NAIL INTRAMEDULLARY 11MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.461S SUP HCPCS C1713 04.003.461S - NAIL INTRAMEDULLARY 11MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.464S SUP HCPCS C1713 04.003.464S - NAIL INTRAMEDULLARY 11MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.465S SUP HCPCS C1713 04.003.465S - NAIL INTRAMEDULLARY 11MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.468S SUP HCPCS C1713 04.003.468S - NAIL INTRAMEDULLARY 11MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.469S SUP HCPCS C1713 04.003.469S - NAIL INTRAMEDULLARY 11MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.472S SUP HCPCS C1713 04.003.472S - NAIL INTRAMEDULLARY 11MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.473S SUP HCPCS C1713 04.003.473S - NAIL INTRAMEDULLARY 11MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.476S SUP HCPCS C1713 04.003.476S - NAIL INTRAMEDULLARY 11MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.477S SUP HCPCS C1713 04.003.477S - NAIL INTRAMEDULLARY 11MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.540S SUP HCPCS C1713 04.003.540S - NAIL INTRAMEDULLARY 12MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.541S SUP HCPCS C1713 04.003.541S - NAIL INTRAMEDULLARY 12MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.544S SUP HCPCS C1713 04.003.544S - NAIL INTRAMEDULLARY 12MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.545S SUP HCPCS C1713 04.003.545S - NAIL INTRAMEDULLARY 12MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.548S SUP HCPCS C1713 04.003.548S - NAIL INTRAMEDULLARY 12MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.549S SUP HCPCS C1713 04.003.549S - NAIL INTRAMEDULLARY 12MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.552S SUP HCPCS C1713 04.003.552S - NAIL INTRAMEDULLARY 12MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.553S SUP HCPCS C1713 04.003.553S - NAIL INTRAMEDULLARY 12MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.556S SUP HCPCS C1713 04.003.556S - NAIL INTRAMEDULLARY 12MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.557S SUP HCPCS C1713 04.003.557S - NAIL INTRAMEDULLARY 12MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.560S SUP HCPCS C1713 04.003.560S - NAIL INTRAMEDULLARY 12MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.561S SUP HCPCS C1713 04.003.561S - NAIL INTRAMEDULLARY 12MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.564S SUP HCPCS C1713 04.003.564S - NAIL INTRAMEDULLARY 12MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.565S SUP HCPCS C1713 04.003.565S - NAIL INTRAMEDULLARY 12MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.568S SUP HCPCS C1713 04.003.568S - NAIL INTRAMEDULLARY 12MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.569S SUP HCPCS C1713 04.003.569S - NAIL INTRAMEDULLARY 12MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.572S SUP HCPCS C1713 04.003.572S - NAIL INTRAMEDULLARY 12MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.573S SUP HCPCS C1713 04.003.573S - NAIL INTRAMEDULLARY 12MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.576S SUP HCPCS C1713 04.003.576S - NAIL INTRAMEDULLARY 12MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.577S SUP HCPCS C1713 04.003.577S - NAIL INTRAMEDULLARY 12MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.640S SUP HCPCS C1713 04.003.640S - NAIL INTRAMEDULLARY 13MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.641S SUP HCPCS C1713 04.003.641S - NAIL INTRAMEDULLARY 13MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.644S SUP HCPCS C1713 04.003.644S - NAIL INTRAMEDULLARY 13MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.645S SUP HCPCS C1713 04.003.645S - NAIL INTRAMEDULLARY 13MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$3,136.28" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.648S SUP HCPCS C1713 04.003.648S - NAIL INTRAMEDULLARY 13MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.649S SUP HCPCS C1713 04.003.649S - NAIL INTRAMEDULLARY 13MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.652S SUP HCPCS C1713 04.003.652S - NAIL INTRAMEDULLARY 13MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.653S SUP HCPCS C1713 04.003.653S - NAIL INTRAMEDULLARY 13MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.656S SUP HCPCS C1713 04.003.656S - NAIL INTRAMEDULLARY 13MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.657S SUP HCPCS C1713 04.003.657S - NAIL INTRAMEDULLARY 13MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.660S SUP HCPCS C1713 04.003.660S - NAIL INTRAMEDULLARY 13MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.661S SUP HCPCS C1713 04.003.661S - NAIL INTRAMEDULLARY 13MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.664S SUP HCPCS C1713 04.003.664S - NAIL INTRAMEDULLARY 13MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.665S SUP HCPCS C1713 04.003.665S - NAIL INTRAMEDULLARY 13MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.668S SUP HCPCS C1713 04.003.668S - NAIL INTRAMEDULLARY 13MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" "$3,136.28" "$3,136.28" N/A N/A 04.003.669S SUP HCPCS C1713 04.003.669S - NAIL INTRAMEDULLARY 13MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$1,275.84" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.672S SUP HCPCS C1713 04.003.672S - NAIL INTRAMEDULLARY 13MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.673S SUP HCPCS C1713 04.003.673S - NAIL INTRAMEDULLARY 13MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.676S SUP HCPCS C1713 04.003.676S - NAIL INTRAMEDULLARY 13MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,136.50" "$2,321.00" $622.47 "$3,189.60" "$1,411.33" "$1,411.33" "$1,411.33" "$1,411.33" "$3,136.28" "$3,136.28" "$3,136.28" $653.68 "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" "$3,136.28" $653.64 "$3,136.28" "$3,189.60" "$1,546.19" "$3,136.28" "$3,189.60" "$3,136.28" "$3,136.28" "$2,352.38" "$3,136.28" "$3,136.28" "$3,136.28" "$1,568.14" "$1,568.14" "$2,483.93" "$3,136.28" "$2,509.02" "$1,411.33" $622.47 N/A "$1,819.17" "$3,136.28" "$1,881.77" "$3,136.28" $653.60 "$3,136.28" N/A N/A 04.003.677S SUP HCPCS C1713 04.003.677S - NAIL INTRAMEDULLARY 13MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,243.00" "$2,400.00" $643.61 "$3,297.90" "$1,459.25" "$1,459.25" "$1,459.25" "$1,459.25" "$3,242.78" "$3,242.78" "$3,242.78" $675.88 "$3,242.78" "$3,242.78" "$3,242.78" "$3,242.78" "$3,242.78" $675.83 "$3,242.78" "$3,297.90" "$1,598.69" "$3,242.78" "$3,297.90" "$3,242.78" "$3,242.78" "$2,432.25" "$3,242.78" "$3,242.78" "$3,242.78" "$1,621.39" "$1,621.39" "$2,568.28" "$3,242.78" "$2,594.22" "$1,459.25" $643.61 N/A "$1,880.94" "$3,242.78" "$1,945.67" "$3,242.78" $675.80 "$3,242.78" N/A N/A 04.003.740S SUP HCPCS C1713 04.003.740S - NAIL INTRAMEDULLARY 14MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.741S SUP HCPCS C1713 04.003.741S - NAIL INTRAMEDULLARY 14MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.744S SUP HCPCS C1713 04.003.744S - NAIL INTRAMEDULLARY 14MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.745S SUP HCPCS C1713 04.003.745S - NAIL INTRAMEDULLARY 14MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.748S SUP HCPCS C1713 04.003.748S - NAIL INTRAMEDULLARY 14MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.749S SUP HCPCS C1713 04.003.749S - NAIL INTRAMEDULLARY 14MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.752S SUP HCPCS C1713 04.003.752S - NAIL INTRAMEDULLARY 14MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.753S SUP HCPCS C1713 04.003.753S - NAIL INTRAMEDULLARY 14MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.756S SUP HCPCS C1713 04.003.756S - NAIL INTRAMEDULLARY 14MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.757S SUP HCPCS C1713 04.003.757S - NAIL INTRAMEDULLARY 14MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.760S SUP HCPCS C1713 04.003.760S - NAIL INTRAMEDULLARY 14MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.761S SUP HCPCS C1713 04.003.761S - NAIL INTRAMEDULLARY 14MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.764S SUP HCPCS C1713 04.003.764S - NAIL INTRAMEDULLARY 14MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.765S SUP HCPCS C1713 04.003.765S - NAIL INTRAMEDULLARY 14MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.768S SUP HCPCS C1713 04.003.768S - NAIL INTRAMEDULLARY 14MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.769S SUP HCPCS C1713 04.003.769S - NAIL INTRAMEDULLARY 14MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$3,340.50" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.772S SUP HCPCS C1713 04.003.772S - NAIL INTRAMEDULLARY 14MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.773S SUP HCPCS C1713 04.003.773S - NAIL INTRAMEDULLARY 14MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.776S SUP HCPCS C1713 04.003.776S - NAIL INTRAMEDULLARY 14MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.777S SUP HCPCS C1713 04.003.777S - NAIL INTRAMEDULLARY 14MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.840S SUP HCPCS C1713 04.003.840S - NAIL INTRAMEDULLARY 15MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.841S SUP HCPCS C1713 04.003.841S - NAIL INTRAMEDULLARY 15MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.844S SUP HCPCS C1713 04.003.844S - NAIL INTRAMEDULLARY 15MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.845S SUP HCPCS C1713 04.003.845S - NAIL INTRAMEDULLARY 15MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.848S SUP HCPCS C1713 04.003.848S - NAIL INTRAMEDULLARY 15MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.849S SUP HCPCS C1713 04.003.849S - NAIL INTRAMEDULLARY 15MM 340MM RECONSTRUCTION ANATOMIC CANN BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.852S SUP HCPCS C1713 04.003.852S - NAIL INTRAMEDULLARY 15MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.853S SUP HCPCS C1713 04.003.853S - NAIL INTRAMEDULLARY 15MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.856S SUP HCPCS C1713 04.003.856S - NAIL INTRAMEDULLARY 15MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.857S SUP HCPCS C1713 04.003.857S - NAIL INTRAMEDULLARY 15MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.860S SUP HCPCS C1713 04.003.860S - NAIL INTRAMEDULLARY 15MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.861S SUP HCPCS C1713 04.003.861S - NAIL INTRAMEDULLARY 15MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.864S SUP HCPCS C1713 04.003.864S - NAIL INTRAMEDULLARY 15MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.865S SUP HCPCS C1713 04.003.865S - NAIL INTRAMEDULLARY 15MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.868S SUP HCPCS C1713 04.003.868S - NAIL INTRAMEDULLARY 15MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.869S SUP HCPCS C1713 04.003.869S - NAIL INTRAMEDULLARY 15MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.872S SUP HCPCS C1713 04.003.872S - NAIL INTRAMEDULLARY 15MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.873S SUP HCPCS C1713 04.003.873S - NAIL INTRAMEDULLARY 15MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.876S SUP HCPCS C1713 04.003.876S - NAIL INTRAMEDULLARY 15MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.877S SUP HCPCS C1713 04.003.877S - NAIL INTRAMEDULLARY 15MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.940S SUP HCPCS C1713 04.003.940S - NAIL INTRAMEDULLARY 16MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" "$3,340.50" "$3,340.50" N/A N/A 04.003.941S SUP HCPCS C1713 04.003.941S - NAIL INTRAMEDULLARY 16MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.944S SUP HCPCS C1713 04.003.944S - NAIL INTRAMEDULLARY 16MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.945S SUP HCPCS C1713 04.003.945S - NAIL INTRAMEDULLARY 16MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.948S SUP HCPCS C1713 04.003.948S - NAIL INTRAMEDULLARY 16MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.949S SUP HCPCS C1713 04.003.949S - NAIL INTRAMEDULLARY 16MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$3,340.50" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.952S SUP HCPCS C1713 04.003.952S - NAIL INTRAMEDULLARY 16MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.953S SUP HCPCS C1713 04.003.953S - NAIL INTRAMEDULLARY 16MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.956S SUP HCPCS C1713 04.003.956S - NAIL INTRAMEDULLARY 16MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.957S SUP HCPCS C1713 04.003.957S - NAIL INTRAMEDULLARY 16MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$3,340.50" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.960S SUP HCPCS C1713 04.003.960S - NAIL INTRAMEDULLARY 16MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.961S SUP HCPCS C1713 04.003.961S - NAIL INTRAMEDULLARY 16MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.964S SUP HCPCS C1713 04.003.964S - NAIL INTRAMEDULLARY 16MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.965S SUP HCPCS C1713 04.003.965S - NAIL INTRAMEDULLARY 16MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.968S SUP HCPCS C1713 04.003.968S - NAIL INTRAMEDULLARY 16MM 440MM CANN LATERAL ENTRY BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.969S SUP HCPCS C1713 04.003.969S - NAIL INTRAMEDULLARY 16MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.972S SUP HCPCS C1713 04.003.972S - NAIL INTRAMEDULLARY 16MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.973S SUP HCPCS C1713 04.003.973S - NAIL INTRAMEDULLARY 16MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$3,397.30" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.976S SUP HCPCS C1713 04.003.976S - NAIL INTRAMEDULLARY 16MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.003.977S SUP HCPCS C1713 04.003.977S - NAIL INTRAMEDULLARY 16MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,340.50" "$2,472.00" $663.01 "$3,397.30" "$1,503.23" "$1,503.23" "$1,503.23" "$1,503.23" "$3,340.50" "$3,340.50" "$3,340.50" $696.24 "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" "$3,340.50" $696.20 "$3,340.50" "$1,358.92" "$1,646.87" "$3,340.50" "$3,397.30" "$3,340.50" "$3,340.50" "$2,505.38" "$3,340.50" "$3,340.50" "$3,340.50" "$1,670.25" "$1,670.25" "$2,645.68" "$3,340.50" "$2,672.40" "$1,503.23" $663.01 N/A "$1,937.49" "$3,340.50" "$2,004.30" "$3,340.50" $696.16 "$3,340.50" N/A N/A 04.004.000S SUP Custom 27803010 04.004.000S - CAP END 5MM T40 STARDRIVE RECESS EXTENDED NAIL-EX GOLD BOTH IP/OP $414.50 $307.00 $73.74 $421.33 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $73.74 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $86.34 $414.28 $168.53 $414.28 $414.28 $421.33 $414.28 $414.28 $310.88 $414.28 $414.28 $414.28 $207.14 $207.14 $328.11 $414.28 $331.42 $186.43 $414.28 N/A $240.41 $414.28 $248.57 $414.28 $414.28 $414.28 N/A N/A 04.004.001S SUP Custom 27803010 04.004.001S - CAP END 5MM STARDRIVE T40 RECESS EXTENDED EXPERT GOLD BOTH IP/OP $505.00 $374.00 $89.84 $513.30 $504.73 $504.73 $504.73 $504.73 $504.73 $504.73 $89.84 $504.73 $504.73 $504.73 $504.73 $504.73 $504.73 $105.19 $504.73 $205.32 $504.73 $504.73 $513.30 $504.73 $504.73 $378.75 $504.73 $504.73 $504.73 $252.37 $252.37 $399.75 $504.73 $403.78 $227.13 $504.73 N/A $292.90 $504.73 $302.84 $504.73 $504.73 $504.73 N/A N/A 04.004.002S SUP Custom 27803010 04.004.002S - CAP END 10MM EXTN T40 STARDRIVE RECESS EXPERT GOLD TITANIUM BOTH IP/OP $505.00 $374.00 $89.84 $513.30 $504.73 $504.73 $504.73 $504.73 $504.73 $504.73 $89.84 $504.73 $504.73 $504.73 $504.73 $504.73 $504.73 $105.19 $504.73 $205.32 $504.73 $504.73 $513.30 $504.73 $504.73 $378.75 $504.73 $504.73 $504.73 $252.37 $252.37 $399.75 $504.73 $403.78 $227.13 $504.73 N/A $292.90 $504.73 $302.84 $504.73 $504.73 $504.73 N/A N/A 04.004.003S SUP Custom 27803010 04.004.003S - CAP END 15MM EXTN T40 STARDRIVE RECESS EXPERT GOLD TITANIUM BOTH IP/OP $505.00 $374.00 $89.84 $513.30 $504.73 $504.73 $504.73 $504.73 $504.73 $504.73 $89.84 $504.73 $504.73 $504.73 $504.73 $504.73 $504.73 $105.19 $504.73 $205.32 $504.73 $504.73 $513.30 $504.73 $504.73 $378.75 $504.73 $504.73 $504.73 $252.37 $252.37 $399.75 $504.73 $403.78 $227.13 $504.73 N/A $292.90 $504.73 $302.84 $504.73 $504.73 $504.73 N/A N/A 04.004.008S SUP Custom 27803010 04.004.008S - CAP END 0MM T40 STARDRIVE RECESS EXTENDED NAIL-EX GRAY BOTH IP/OP $414.50 $307.00 $73.74 $421.33 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $73.74 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $86.34 $414.28 $168.53 $414.28 $414.28 $421.33 $414.28 $414.28 $310.88 $414.28 $414.28 $414.28 $207.14 $207.14 $328.11 $414.28 $331.42 $186.43 $414.28 N/A $240.41 $414.28 $248.57 $414.28 $414.28 $414.28 N/A N/A 04.004.009S SUP Custom 27803010 04.004.009S - CAP END 5MM EXTENDED T40 STARDRIVE RECESS LOCKING HOLE BOTH IP/OP $505.00 $374.00 $89.84 $513.30 $504.73 $504.73 $504.73 $504.73 $504.73 $504.73 $89.84 $504.73 $504.73 $504.73 $504.73 $504.73 $504.73 $105.19 $504.73 $205.32 $504.73 $504.73 $513.30 $504.73 $504.73 $378.75 $504.73 $504.73 $504.73 $252.37 $252.37 $399.75 $504.73 $403.78 $227.13 $504.73 N/A $292.90 $504.73 $302.84 $504.73 $504.73 $504.73 N/A N/A 04.004.010S SUP Custom 27803010 04.004.010S - CAP END 10MM EXTENDED T40 STARDRIVE RECESS LOCKING HOLE BOTH IP/OP $505.00 $374.00 $89.84 $513.30 $504.73 $504.73 $504.73 $504.73 $504.73 $504.73 $89.84 $504.73 $504.73 $504.73 $504.73 $504.73 $504.73 $105.19 $504.73 $205.32 $504.73 $504.73 $513.30 $504.73 $504.73 $378.75 $504.73 $504.73 $504.73 $252.37 $252.37 $399.75 $504.73 $403.78 $227.13 $504.73 N/A $292.90 $504.73 $302.84 $504.73 $504.73 $504.73 N/A N/A 04.004.011S SUP Custom 27803010 04.004.011S - CAP END 15MM EXTN T40 STARDRIVE RECESS EXPERT GRAY TITANIUM BOTH IP/OP $505.00 $374.00 $89.84 $513.30 $504.73 $504.73 $504.73 $504.73 $504.73 $504.73 $89.84 $504.73 $504.73 $504.73 $504.73 $504.73 $504.73 $105.19 $504.73 $205.32 $504.73 $504.73 $513.30 $504.73 $504.73 $378.75 $504.73 $504.73 $504.73 $252.37 $252.37 $399.75 $504.73 $403.78 $227.13 $504.73 N/A $292.90 $504.73 $302.84 $504.73 $504.73 $504.73 N/A N/A 04.004.231S SUP HCPCS C1713 04.004.231S - NAIL INTRAMEDULLARY 8MM 25.5CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$1,227.18" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.004.234S SUP HCPCS C1713 04.004.234S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 270MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.237S SUP HCPCS C1713 04.004.237S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 285MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.240S SUP HCPCS C1713 04.004.240S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 300MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.243S SUP HCPCS C1713 04.004.243S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 315MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.246S SUP HCPCS C1713 04.004.246S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 330MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.249S SUP HCPCS C1713 04.004.249S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 345MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.252S SUP HCPCS C1713 04.004.252S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 360MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.255S SUP HCPCS C1713 04.004.255S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 375MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.258S SUP HCPCS C1713 04.004.258S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 390MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.261S SUP HCPCS C1713 04.004.261S - NAIL INTRAMEDULLARY 8MM 40.5CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$2,917.50" "$2,159.00" $579.05 "$2,967.08" "$1,312.87" "$1,312.87" "$1,312.87" "$1,312.87" "$2,917.48" "$2,917.48" "$2,917.48" $608.08 "$2,917.48" "$2,917.48" "$2,917.48" "$2,917.48" "$2,917.48" $608.03 "$2,917.48" "$1,186.83" "$1,438.32" "$2,917.48" "$2,967.08" "$2,917.48" "$2,917.48" "$2,188.13" "$2,917.48" "$2,917.48" "$2,917.48" "$1,458.74" "$1,458.74" "$2,310.64" "$2,917.48" "$2,333.98" "$1,312.87" $579.05 N/A "$1,692.15" "$2,917.48" "$1,750.49" "$2,917.48" "$2,917.48" "$2,917.48" N/A N/A 04.004.264S SUP HCPCS C1713 04.004.264S - NAIL INTRAMEDULLARY 8MM 42CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$2,917.50" "$2,159.00" $579.05 "$2,967.08" "$1,312.87" "$1,312.87" "$1,312.87" "$1,312.87" "$2,917.48" "$2,917.48" "$2,917.48" $608.08 "$2,917.48" "$2,917.48" "$2,917.48" "$2,917.48" "$2,917.48" $608.03 "$2,917.48" "$2,967.08" "$1,438.32" "$2,917.48" "$2,967.08" "$2,917.48" "$2,917.48" "$2,188.13" "$2,917.48" "$2,917.48" "$2,917.48" "$1,458.74" "$1,458.74" "$2,310.64" "$2,917.48" "$2,333.98" "$1,312.87" $579.05 N/A "$1,692.15" "$2,917.48" "$1,750.49" "$2,917.48" "$2,917.48" "$2,917.48" N/A N/A 04.004.267S SUP HCPCS C1713 04.004.267S - NAIL INTRAMEDULLARY 8MM 43.5CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.004.331S SUP HCPCS C1713 04.004.331S - NAIL INTRAMEDULLARY 9MM 25.5CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$2,928.00" "$2,167.00" $581.07 "$2,977.45" "$1,317.46" "$1,317.46" "$1,317.46" "$1,317.46" "$2,927.68" "$2,927.68" "$2,927.68" $610.20 "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" $610.16 "$2,927.68" "$1,190.98" "$1,443.35" "$2,927.68" "$2,977.45" "$2,927.68" "$2,927.68" "$2,196.00" "$2,927.68" "$2,927.68" "$2,927.68" "$1,463.84" "$1,463.84" "$2,318.72" "$2,927.68" "$2,342.14" "$1,317.46" $581.07 N/A "$1,698.24" "$2,927.68" "$1,756.61" "$2,927.68" $610.13 "$2,927.68" N/A N/A 04.004.334S SUP HCPCS C1713 04.004.334S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 270MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.337S SUP HCPCS C1713 04.004.337S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 285MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.340S SUP HCPCS C1713 04.004.340S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 300MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.343S SUP HCPCS C1713 04.004.343S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 315MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.346S SUP HCPCS C1713 04.004.346S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 330MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.349S SUP HCPCS C1713 04.004.349S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 345MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.352S SUP HCPCS C1713 04.004.352S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 360MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.355S SUP HCPCS C1713 04.004.355S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 375MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.358S SUP HCPCS C1713 04.004.358S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 390MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" "$2,831.40" "$2,831.40" N/A N/A 04.004.361S SUP HCPCS C1713 04.004.361S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 405MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.364S SUP HCPCS C1713 04.004.364S - NAIL INTRAMEDULLARY 9MM 42CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" "$2,831.40" "$2,831.40" N/A N/A 04.004.367S SUP HCPCS C1713 04.004.367S - NAIL INTRAMEDULLARY 9MM 43.5CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.004.431S SUP HCPCS C1713 04.004.431S - NAIL INTRAMEDULLARY 10MM 25.5CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$2,917.50" "$2,159.00" $579.05 "$2,967.08" "$1,312.87" "$1,312.87" "$1,312.87" "$1,312.87" "$2,917.48" "$2,917.48" "$2,917.48" $608.08 "$2,917.48" "$2,917.48" "$2,917.48" "$2,917.48" "$2,917.48" $608.03 "$2,917.48" "$2,967.08" "$1,438.32" "$2,917.48" "$2,967.08" "$2,917.48" "$2,917.48" "$2,188.13" "$2,917.48" "$2,917.48" "$2,917.48" "$1,458.74" "$1,458.74" "$2,310.64" "$2,917.48" "$2,333.98" "$1,312.87" $579.05 N/A "$1,692.15" "$2,917.48" "$1,750.49" "$2,917.48" $608.00 "$2,917.48" N/A N/A 04.004.434S SUP HCPCS C1713 04.004.434S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 270MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.437S SUP HCPCS C1713 04.004.437S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 285MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.440S SUP HCPCS C1713 04.004.440S - NAIL INTRAMEDULLARY UNIVERSAL ROUND BARREL 10MM 300MM CANN BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.443S SUP HCPCS C1713 04.004.443S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 315MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.446S SUP HCPCS C1713 04.004.446S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 33CM CANN EXPERT LIGHT BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.449S SUP HCPCS C1713 04.004.449S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 34.5CM CANN EXPERT LIGHT BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.452S SUP HCPCS C1713 04.004.452S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 360MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.455S SUP HCPCS C1713 04.004.455S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 375MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.458S SUP HCPCS C1713 04.004.458S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 390MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.461S SUP HCPCS C1713 04.004.461S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 405MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.464S SUP HCPCS C1713 04.004.464S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM CANN ROUND BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.467S SUP HCPCS C1713 04.004.467S - NAIL INTRAMEDULLARY 10MM 43.5CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$2,928.00" "$2,167.00" $581.07 "$2,977.45" "$1,317.46" "$1,317.46" "$1,317.46" "$1,317.46" "$2,927.68" "$2,927.68" "$2,927.68" $610.20 "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" $610.16 "$2,927.68" "$2,977.45" "$1,443.35" "$2,927.68" "$2,977.45" "$2,927.68" "$2,927.68" "$2,196.00" "$2,927.68" "$2,927.68" "$2,927.68" "$1,463.84" "$1,463.84" "$2,318.72" "$2,927.68" "$2,342.14" "$1,317.46" $581.07 N/A "$1,698.24" "$2,927.68" "$1,756.61" "$2,927.68" $610.13 "$2,927.68" N/A N/A 04.004.531S SUP HCPCS C1713 04.004.531S - NAIL INTRAMEDULLARY 11MM 25.5CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$1,227.18" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.004.534S SUP HCPCS C1713 04.004.534S - NAIL INTRAMEDULLARY 11MM 27CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.537S SUP HCPCS C1713 04.004.537S - NAIL INTRAMEDULLARY 11MM 28.5CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.540S SUP HCPCS C1713 04.004.540S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.543S SUP HCPCS C1713 04.004.543S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 315MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.546S SUP HCPCS C1713 04.004.546S - NAIL INTRAMEDULLARY 11MM 330MM CANN NAIL-EX LIGHT GREEN BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.549S SUP HCPCS C1713 04.004.549S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 345MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.552S SUP HCPCS C1713 04.004.552S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.555S SUP HCPCS C1713 04.004.555S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 375MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.558S SUP HCPCS C1713 04.004.558S - NAIL INTRAMEDULLARY UNIVERSAL FLUTE BARREL 11MM 390MM CANN BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.561S SUP HCPCS C1713 04.004.561S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 405MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.564S SUP HCPCS C1713 04.004.564S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 420MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.567S SUP HCPCS C1713 04.004.567S - NAIL INTRAMEDULLARY 11MM 43.5CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$1,227.18" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.004.631S SUP HCPCS C1713 04.004.631S - NAIL INTRAMEDULLARY 12MM 25.5CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$1,227.18" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.004.634S SUP HCPCS C1713 04.004.634S - NAIL INTRAMEDULLARY 12MM 27CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.637S SUP HCPCS C1713 04.004.637S - NAIL INTRAMEDULLARY 12MM 28.5CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.640S SUP HCPCS C1713 04.004.640S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.643S SUP HCPCS C1713 04.004.643S - NAIL INTRAMEDULLARY UNIVERSAL FLUTE 12MM 315MM CANN EXPERT BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.646S SUP HCPCS C1713 04.004.646S - NAIL INTRAMEDULLARY UNIVERSAL FLUTE BARREL 12MM 330MM CANN BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.649S SUP HCPCS C1713 04.004.649S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 345MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.652S SUP HCPCS C1713 04.004.652S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.655S SUP HCPCS C1713 04.004.655S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 375MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.658S SUP HCPCS C1713 04.004.658S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 390MM CANN EXPERT LIGHT BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.661S SUP HCPCS C1713 04.004.661S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 405MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$2,831.40" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.664S SUP HCPCS C1713 04.004.664S - NAIL INTRAMEDULLARY 12MM 42CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.667S SUP HCPCS C1713 04.004.667S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 435MM CANN FLUTED BARREL BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.004.731S SUP HCPCS C1713 04.004.731S - NAIL INTRAMEDULLARY 13MM 25.5CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" "$3,016.68" "$3,016.68" N/A N/A 04.004.734S SUP HCPCS C1713 04.004.734S - NAIL INTRAMEDULLARY 13MM 27CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" "$3,016.68" "$3,016.68" N/A N/A 04.004.737S SUP HCPCS C1713 04.004.737S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 285MM CANN FLUTED BARREL BOTH IP/OP "$2,928.00" "$2,167.00" $581.07 "$2,977.45" "$1,317.46" "$1,317.46" "$1,317.46" "$1,317.46" "$2,927.68" "$2,927.68" "$2,927.68" $610.20 "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" $610.16 "$2,927.68" "$2,977.45" "$1,443.35" "$2,927.68" "$2,977.45" "$2,927.68" "$2,927.68" "$2,196.00" "$2,927.68" "$2,927.68" "$2,927.68" "$1,463.84" "$1,463.84" "$2,318.72" "$2,927.68" "$2,342.14" "$1,317.46" $581.07 N/A "$1,698.24" "$2,927.68" "$1,756.61" "$2,927.68" $610.13 "$2,927.68" N/A N/A 04.004.740S SUP HCPCS C1713 04.004.740S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM CANN FLUTED BARREL BOTH IP/OP "$2,928.00" "$2,167.00" $581.07 "$2,977.45" "$1,317.46" "$1,317.46" "$1,317.46" "$1,317.46" "$2,927.68" "$2,927.68" "$2,927.68" $610.20 "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" $610.16 "$2,927.68" "$2,977.45" "$1,443.35" "$2,927.68" "$2,977.45" "$2,927.68" "$2,927.68" "$2,196.00" "$2,927.68" "$2,927.68" "$2,927.68" "$1,463.84" "$1,463.84" "$2,318.72" "$2,927.68" "$2,342.14" "$1,317.46" $581.07 N/A "$1,698.24" "$2,927.68" "$1,756.61" "$2,927.68" $610.13 "$2,927.68" N/A N/A 04.004.743S SUP HCPCS C1713 04.004.743S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 315MM CANN FLUTED BARREL BOTH IP/OP "$2,928.00" "$2,167.00" $581.07 "$2,977.45" "$1,317.46" "$1,317.46" "$1,317.46" "$1,317.46" "$2,927.68" "$2,927.68" "$2,927.68" $610.20 "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" $610.16 "$2,927.68" "$2,977.45" "$1,443.35" "$2,927.68" "$2,977.45" "$2,927.68" "$2,927.68" "$2,196.00" "$2,927.68" "$2,927.68" "$2,927.68" "$1,463.84" "$1,463.84" "$2,318.72" "$2,927.68" "$2,342.14" "$1,317.46" $581.07 N/A "$1,698.24" "$2,927.68" "$1,756.61" "$2,927.68" $610.13 "$2,927.68" N/A N/A 04.004.746S SUP HCPCS C1713 04.004.746S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 330MM CANN FLUTED BARREL BOTH IP/OP "$2,928.00" "$2,167.00" $581.07 "$2,977.45" "$1,317.46" "$1,317.46" "$1,317.46" "$1,317.46" "$2,927.68" "$2,927.68" "$2,927.68" $610.20 "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" $610.16 "$2,927.68" "$2,977.45" "$1,443.35" "$2,927.68" "$2,977.45" "$2,927.68" "$2,927.68" "$2,196.00" "$2,927.68" "$2,927.68" "$2,927.68" "$1,463.84" "$1,463.84" "$2,318.72" "$2,927.68" "$2,342.14" "$1,317.46" $581.07 N/A "$1,698.24" "$2,927.68" "$1,756.61" "$2,927.68" $610.13 "$2,927.68" N/A N/A 04.004.749S SUP HCPCS C1713 04.004.749S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 345MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.752S SUP HCPCS C1713 04.004.752S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.755S SUP HCPCS C1713 04.004.755S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 375MM CANN FLUTED BARREL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.004.758S SUP HCPCS C1713 04.004.758S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 390MM CANN FLUTED BARREL BOTH IP/OP "$2,928.00" "$2,167.00" $581.07 "$2,977.45" "$1,317.46" "$1,317.46" "$1,317.46" "$1,317.46" "$2,927.68" "$2,927.68" "$2,927.68" $610.20 "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" $610.16 "$2,927.68" "$2,977.45" "$1,443.35" "$2,927.68" "$2,977.45" "$2,927.68" "$2,927.68" "$2,196.00" "$2,927.68" "$2,927.68" "$2,927.68" "$1,463.84" "$1,463.84" "$2,318.72" "$2,927.68" "$2,342.14" "$1,317.46" $581.07 N/A "$1,698.24" "$2,927.68" "$1,756.61" "$2,927.68" $610.13 "$2,927.68" N/A N/A 04.004.761S SUP HCPCS C1713 04.004.761S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 405MM CANN FLUTED BARREL BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$1,227.18" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.004.764S SUP HCPCS C1713 04.004.764S - NAIL INTRAMEDULLARY 13MM 42CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$1,227.18" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.004.767S SUP HCPCS C1713 04.004.767S - NAIL INTRAMEDULLARY 13MM 43.5CM CANN NAIL-EX TITANIUM TIBIA BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$1,227.18" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.005.408 SUP HCPCS C1713 04.005.408 - SCREW BONE NONSTRL 4MM 18MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.408S SUP HCPCS C1713 04.005.408S - SCREW BN T25 FT 4MM 3.3MM 18MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.410 SUP HCPCS C1713 04.005.410 - SCREW BONE NONSTRL 4MM 20MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.410S SUP HCPCS C1713 04.005.410S - SCREW BN T25 FT 4MM 3.3MM 20MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.412 SUP HCPCS C1713 04.005.412 - SCREW BONE NONSTRL 4MM 22MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.412S SUP HCPCS C1713 04.005.412S - SCREW BN T25 FT 4MM 3.3MM 22MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.414 SUP HCPCS C1713 04.005.414 - SCREW BONE NONSTRL 4MM 24MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 04.005.414S SUP HCPCS C1713 04.005.414S - SCREW BN T25 FT 4MM 3.3MM 24MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $436.18 $436.18 N/A N/A 04.005.416 SUP HCPCS C1713 04.005.416 - SCREW BONE NONSTRL 4MM 26MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $307.65 $307.65 $64.11 $307.65 N/A N/A 04.005.416S SUP HCPCS C1713 04.005.416S - SCREW BN T25 FT 4MM 3.3MM 26MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.418 SUP HCPCS C1713 04.005.418 - SCREW BONE 4MM 28MM NLEX TI HUM TIB LCK STARDRIVE RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.418S SUP HCPCS C1713 04.005.418S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 28MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.420 SUP HCPCS C1713 04.005.420 - SCREW BONE 4MM 30MM NLEX TI HUM TIB LCK STARDRIVE RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.420S SUP HCPCS C1713 04.005.420S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 30MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.422 SUP HCPCS C1713 04.005.422 - SCREW BONE 4MM 32MM NLEX TI HUM TIB LCK STARDRIVE RECESS BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 04.005.422S SUP HCPCS C1713 04.005.422S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 32MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.424 SUP HCPCS C1713 04.005.424 - SCREW BONE NONSTRL 4MM 34MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 04.005.424S SUP HCPCS C1713 04.005.424S - SCREW BN T25 FT 4MM 3.3MM 34MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $436.18 $436.18 N/A N/A 04.005.426 SUP HCPCS C1713 04.005.426 - SCREW BONE NONSTRL 4MM 36MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.426S SUP HCPCS C1713 04.005.426S - SCREW BN T25 FT 4MM 3.3MM 36MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.428 SUP HCPCS C1713 04.005.428 - SCREW BONE NONSTRL 4MM 38MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.428S SUP HCPCS C1713 04.005.428S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 38MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.430 SUP HCPCS C1713 04.005.430 - SCREW BONE NONSTRL 4MM 40MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 04.005.430S SUP HCPCS C1713 04.005.430S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 40MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.432 SUP HCPCS C1713 04.005.432 - SCREW BONE NONSTRL 4MM 42MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $290.00 $290.00 $60.44 $290.00 N/A N/A 04.005.432S SUP HCPCS C1713 04.005.432S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 42MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.434 SUP HCPCS C1713 04.005.434 - SCREW BONE 4MM 44MM NLEX TI FULTHD HUM TIB SLFTAP LCK BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $290.00 $290.00 $60.44 $290.00 N/A N/A 04.005.434S SUP HCPCS C1713 04.005.434S - SCREW BN T25 FT 4MM 3.3MM 44MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.436 SUP HCPCS C1713 04.005.436 - SCREW BONE NONSTRL 4MM 46MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.436S SUP HCPCS C1713 04.005.436S - SCREW BN T25 FT 4MM 3.3MM 46MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.438 SUP HCPCS C1713 04.005.438 - SCREW BONE NONSTRL 4MM 48MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.438S SUP HCPCS C1713 04.005.438S - SCREW BN T25 FT 4MM 3.3MM 48MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.440 SUP HCPCS C1713 04.005.440 - SCREW BONE NONSTRL 4MM 50MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $290.00 $290.00 $60.44 $290.00 N/A N/A 04.005.440S SUP HCPCS C1713 04.005.440S - SCREW BN T25 FT 4MM 3.3MM 50MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.442 SUP HCPCS C1713 04.005.442 - SCREW BONE NONSTRL 4MM 52MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $290.00 $290.00 $60.44 $290.00 N/A N/A 04.005.442S SUP HCPCS C1713 04.005.442S - SCREW BN T25 FT 4MM 3.3MM 52MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.444 SUP HCPCS C1713 04.005.444 - SCREW BONE NONSTRL 4MM 54MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 04.005.444S SUP HCPCS C1713 04.005.444S - SCREW BN T25 FT 4MM 3.3MM 54MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $436.18 $436.18 N/A N/A 04.005.446 SUP HCPCS C1713 04.005.446 - SCREW BONE NONSTRL 4MM 56MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.446S SUP HCPCS C1713 04.005.446S - SCREW BN T25 FT 4MM 3.3MM 56MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.448 SUP HCPCS C1713 04.005.448 - SCREW BONE NONSTRL 4MM 58MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.448S SUP HCPCS C1713 04.005.448S - SCREW BN T25 FT 4MM 3.3MM 58MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $436.18 $436.18 N/A N/A 04.005.450 SUP HCPCS C1713 04.005.450 - SCREW BONE NONSTRL 4MM 60MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 04.005.450S SUP HCPCS C1713 04.005.450S - SCREW BN T25 FT 4MM 3.3MM 60MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.452 SUP HCPCS C1713 04.005.452 - SCREW BONE NONSTRL 4MM 62MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.452S SUP HCPCS C1713 04.005.452S - SCREW BN T25 FT 4MM 3.3MM 62MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.454 SUP HCPCS C1713 04.005.454 - SCREW BONE NONSTRL 4MM 64MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.454S SUP HCPCS C1713 04.005.454S - SCREW BN T25 FT 4MM 3.3MM 64MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.456 SUP HCPCS C1713 04.005.456 - SCREW BONE NONSTRL 4MM 66MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.456S SUP HCPCS C1713 04.005.456S - SCREW BN T25 FT 4MM 3.3MM 66MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.458 SUP HCPCS C1713 04.005.458 - SCREW BONE NONSTRL 4MM 68MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.458S SUP HCPCS C1713 04.005.458S - SCREW BN T25 FT 4MM 3.3MM 68MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.460 SUP HCPCS C1713 04.005.460 - SCREW BONE NONSTRL 4MM 70MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.460S SUP HCPCS C1713 04.005.460S - SCREW BN T25 FT 4MM 3.3MM 70MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $436.18 $436.18 N/A N/A 04.005.462 SUP HCPCS C1713 04.005.462 - SCREW BONE NONSTRL 4MM 72MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 04.005.462S SUP HCPCS C1713 04.005.462S - SCREW BN T25 FT 4MM 3.3MM 72MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.464 SUP HCPCS C1713 04.005.464 - SCREW BONE NONSTRL 4MM 74MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.464S SUP HCPCS C1713 04.005.464S - SCREW BN T25 FT 4MM 3.3MM 74MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $436.18 $436.18 N/A N/A 04.005.466 SUP HCPCS C1713 04.005.466 - SCREW BONE NONSTRL 4MM 76MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 04.005.466S SUP HCPCS C1713 04.005.466S - SCREW BN T25 FT 4MM 3.3MM 76MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $436.18 $436.18 N/A N/A 04.005.468 SUP HCPCS C1713 04.005.468 - SCREW BONE NONSTRL 4MM 78MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.468S SUP HCPCS C1713 04.005.468S - SCREW BN T25 FT 4MM 3.3MM 78MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.470 SUP HCPCS C1713 04.005.470 - SCREW BONE NONSTRL 4MM 80MM NLEX TI FULTHD HUM TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.470S SUP HCPCS C1713 04.005.470S - SCREW BN T25 FT 4MM 3.3MM 80MM BLU STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.516 SUP HCPCS C1713 04.005.516 - SCREW BONE 5MM 26MM NLEX TI FEM/TIB LCK STARDRIVE RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 04.005.516S SUP HCPCS C1713 04.005.516S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 26MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.518 SUP HCPCS C1713 04.005.518 - SCREW BONE 5MM 4.3MM 28MM NLEX TI FULTHD FEM/TIB T25 BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 04.005.518S SUP HCPCS C1713 04.005.518S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 28MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.520 SUP HCPCS C1713 04.005.520 - SCREW BONE 5MM 30MM NLEX TI FULTHD FEM/TIB SLFTAP LCK BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 04.005.520S SUP HCPCS C1713 04.005.520S - SCREW BONE FULTHD 5MM 4.3MM 30MM T25 STARDRIVE RECESS BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.522 SUP HCPCS C1713 04.005.522 - SCREW BONE NONSTRL 5MM 32MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 04.005.522S SUP HCPCS C1713 04.005.522S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 32MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.524 SUP HCPCS C1713 04.005.524 - SCREW BONE NONSTRL 5MM 34MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 04.005.524S SUP HCPCS C1713 04.005.524S - SCREW BONE FULTHD 5MM 4.3MM 34MM T25 STARDRIVE RECESS BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.526 SUP HCPCS C1713 04.005.526 - SCREW BONE NONSTRL 5MM 36MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.526S SUP HCPCS C1713 04.005.526S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 36MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.528 SUP HCPCS C1713 04.005.528 - SCREW BONE NONSTRL 5MM 38MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.528S SUP HCPCS C1713 04.005.528S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 38MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.530 SUP HCPCS C1713 04.005.530 - SCREW BONE NONSTRL 5MM 40MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 04.005.530S SUP HCPCS C1713 04.005.530S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 40MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.532 SUP HCPCS C1713 04.005.532 - SCREW BONE NONSTRL 5MM 42MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $123.06 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $307.65 $307.65 $64.11 $307.65 N/A N/A 04.005.532S SUP HCPCS C1713 04.005.532S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 42MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.534 SUP HCPCS C1713 04.005.534 - SCREW BONE NONSTRL 5MM 44MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 04.005.534S SUP HCPCS C1713 04.005.534S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 44MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.536 SUP HCPCS C1713 04.005.536 - SCREW BONE NONSTRL 5MM 46MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.536S SUP HCPCS C1713 04.005.536S - SCREW BN T25 FT 5MM 4.3MM 46MM LGHT GRN STRL LCK ST BLNT TIP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $436.18 $436.18 N/A N/A 04.005.538 SUP HCPCS C1713 04.005.538 - SCREW BONE NONSTRL 5MM 48MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.538S SUP HCPCS C1713 04.005.538S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 48MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.540 SUP HCPCS C1713 04.005.540 - SCREW BONE NONSTRL 5MM 50MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 04.005.540S SUP HCPCS C1713 04.005.540S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 50MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.542 SUP HCPCS C1713 04.005.542 - SCREW BONE NONSTRL 5MM 52MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $290.00 $290.00 $60.44 $290.00 N/A N/A 04.005.542S SUP HCPCS C1713 04.005.542S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 52MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.544 SUP HCPCS C1713 04.005.544 - SCREW BONE NONSTRL 5MM 54MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.544S SUP HCPCS C1713 04.005.544S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 54MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.546 SUP HCPCS C1713 04.005.546 - SCREW BONE NONSTRL 5MM 56MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.546S SUP HCPCS C1713 04.005.546S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 56MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.548 SUP HCPCS C1713 04.005.548 - SCREW BONE NONSTRL 5MM 58MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 04.005.548S SUP HCPCS C1713 04.005.548S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 58MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.550 SUP HCPCS C1713 04.005.550 - SCREW BONE NONSTRL 5MM 60MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 04.005.550S SUP HCPCS C1713 04.005.550S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 60MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.552 SUP HCPCS C1713 04.005.552 - SCREW BONE 5MM 62MM NLEX TI FEM/TIB LCK STARDRIVE RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.552S SUP HCPCS C1713 04.005.552S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 62MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.554 SUP HCPCS C1713 04.005.554 - SCREW BONE 5MM 64MM NLEX TI FEM/TIB LCK STARDRIVE RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.554S SUP HCPCS C1713 04.005.554S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 64MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.556 SUP HCPCS C1713 04.005.556 - SCREW BONE 5MM 66MM NLEX TI FEM/TIB LCK STARDRIVE RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.556S SUP HCPCS C1713 04.005.556S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 66MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.558 SUP HCPCS C1713 04.005.558 - SCREW BONE 5MM 68MM NLEX TI FEM/TIB LCK STARDRIVE RECESS BOTH IP/OP $308.00 $228.00 $61.06 $307.65 $138.44 $138.44 $138.44 $138.44 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $307.65 $181.97 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $61.06 N/A $178.64 $307.65 $184.59 $307.65 $64.11 $307.65 N/A N/A 04.005.558S SUP HCPCS C1713 04.005.558S - SCREW BONE FULTHD 5MM 8MM 68MM T25 STARDRIVE RECESS LOCKING BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.560 SUP HCPCS C1713 04.005.560 - SCREW BONE 5MM 70MM NLEX TI FEM/TIB LCK STARDRIVE RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.560S SUP HCPCS C1713 04.005.560S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 70MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.562 SUP HCPCS C1713 04.005.562 - SCREW BONE 5MM 72MM NLEX TI FEM/TIB LCK STARDRIVE RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.562S SUP HCPCS C1713 04.005.562S - SCREW BN T25 FT 5MM 4.3MM 72MM LGHT GRN STRL LCK ST BLNT TIP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.564 SUP HCPCS C1713 04.005.564 - SCREW BONE 5MM 74MM NLEX TI FEM/TIB LCK STARDRIVE RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.564S SUP HCPCS C1713 04.005.564S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 74MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.566 SUP HCPCS C1713 04.005.566 - SCREW BONE 5MM 76MM NLEX TI FEM/TIB LCK STARDRIVE RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.566S SUP HCPCS C1713 04.005.566S - SCREW BONE FULTHD 5MM 8MM 76MM T25 STARDRIVE RECESS LOCKING BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.568 SUP HCPCS C1713 04.005.568 - SCREW BONE 5MM 78MM NLEX TI FEM/TIB LCK STARDRIVE RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.568S SUP HCPCS C1713 04.005.568S - SCREW BONE FULTHD 5MM 8MM 78MM LOCK CANN SELF TAP BLUNT TIP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.570 SUP HCPCS C1713 04.005.570 - SCREW BONE 5MM 80MM NLEX TI FEM/TIB LCK STARDRIVE RECESS BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $290.00 $290.00 $60.44 $290.00 N/A N/A 04.005.570S SUP HCPCS C1713 04.005.570S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 80MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.575 SUP HCPCS C1713 04.005.575 - SCREW BONE NONSTRL 5MM 85MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $60.44 $290.00 N/A N/A 04.005.575S SUP HCPCS C1713 04.005.575S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 85MM 2 LEAD SELF TAP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.580 SUP HCPCS C1713 04.005.580 - SCREW BONE NONSTRL 5MM 90MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $116.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 04.005.580S SUP HCPCS C1713 04.005.580S - SCREW BONE FULTHD 5MM 8MM 90MM T25 STARDRIVE RECESS LOCKING BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.585 SUP HCPCS C1713 04.005.585 - SCREW BONE NONSTRL 5MM 95MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $290.00 $290.00 $290.00 $290.00 N/A N/A 04.005.585S SUP HCPCS C1713 04.005.585S - SCREW BN T25 FT 5MM 4.3MM 95MM LGHT GRN STRL LCK ST BLNT TIP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $436.18 $436.18 N/A N/A 04.005.590 SUP HCPCS C1713 04.005.590 - SCREW BONE NONSTRL 5MM 100MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 04.005.590S SUP HCPCS C1713 04.005.590S - SCREW BONE FULTHD 5MM 8MM 100MM T25 STARDRIVE RECESS LOCKING BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.616 SUP HCPCS C1713 04.005.616 - SCREW BONE NONSTRL 6MM 26MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $413.95 $413.95 $413.95 $413.95 N/A N/A 04.005.616S SUP HCPCS C1713 04.005.616S - SCREW BN FT 6MM 8MM 26MM AQ STRL NLEX T25 STRDR RCS LCK CNN BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.618 SUP HCPCS C1713 04.005.618 - SCREW BONE NONSTRL 6MM 28MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.618S SUP HCPCS C1713 04.005.618S - SCREW BN FT 6MM 8MM 28MM AQ STRL NLEX T25 STRDR RCS LCK CNN BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.620 SUP HCPCS C1713 04.005.620 - SCREW BONE NONSTRL 6MM 30MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $413.95 $413.95 N/A N/A 04.005.620S SUP HCPCS C1713 04.005.620S - SCREW BN FT 6MM 8MM 30MM AQ STRL NLEX T25 STRDR RCS LCK CNN BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $436.18 $436.18 N/A N/A 04.005.622 SUP HCPCS C1713 04.005.622 - SCREW BONE NONSTRL 6MM 32MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.622S SUP HCPCS C1713 04.005.622S - SCREW BN T25 FT BLNT 6MM 8MM 32MM AQ STRL XPRT 2 LD ST LCK BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.624 SUP HCPCS C1713 04.005.624 - SCREW BONE NONSTRL 6MM 34MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.624S SUP HCPCS C1713 04.005.624S - SCREW BN FT 6MM 8MM 34MM AQ STRL NLEX T25 STRDR RCS LCK CNN BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.626 SUP HCPCS C1713 04.005.626 - SCREW BONE NONSTRL 6MM 36MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $413.95 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.626S SUP HCPCS C1713 04.005.626S - SCREW BN T25 FT BLNT 6MM 8MM 36MM AQ STRL XPRT 2 LD ST LCK BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.628 SUP HCPCS C1713 04.005.628 - SCREW BONE NONSTRL 6MM 38MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $413.95 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.628S SUP HCPCS C1713 04.005.628S - SCREW BN T25 FT 6MM 4.8MM 38MM AQ STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.630 SUP HCPCS C1713 04.005.630 - SCREW BONE NONSTRL 6MM 40MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $413.95 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.630S SUP HCPCS C1713 04.005.630S - SCREW BN FT 6MM 8MM 40MM AQ STRL NLEX T25 STRDR RCS LCK CNN BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.632 SUP HCPCS C1713 04.005.632 - SCREW BONE NONSTRL 6MM 42MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $413.95 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.632S SUP HCPCS C1713 04.005.632S - SCREW BN FT 6MM 8MM 42MM AQ STRL NLEX T25 STRDR RCS LCK CNN BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.634 SUP HCPCS C1713 04.005.634 - SCREW BONE NONSTRL 6MM 44MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $413.95 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.634S SUP HCPCS C1713 04.005.634S - SCREW BN T25 FT 6MM 4.8MM 44MM AQ STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.636 SUP HCPCS C1713 04.005.636 - SCREW BONE NONSTRL 6MM 46MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $413.95 $413.95 N/A N/A 04.005.636S SUP HCPCS C1713 04.005.636S - SCREW BN FT 6MM 8MM 46MM AQ STRL NLEX T25 STRDR RCS LCK CNN BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.638 SUP HCPCS C1713 04.005.638 - SCREW BONE NONSTRL 6MM 48MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.638S SUP HCPCS C1713 04.005.638S - SCREW BN FT 6MM 8MM 48MM AQ STRL NLEX T25 STRDR RCS LCK CNN BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.640 SUP HCPCS C1713 04.005.640 - SCREW BONE NONSTRL 6MM 50MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $413.95 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.640S SUP HCPCS C1713 04.005.640S - SCREW BN FT 6MM 8MM 50MM AQ STRL NLEX T25 STRDR RCS LCK CNN BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.642 SUP HCPCS C1713 04.005.642 - SCREW BONE NONSTRL 6MM 52MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $413.95 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.642S SUP HCPCS C1713 04.005.642S - SCREW BN T25 FT BLNT 6MM 8MM 52MM AQ STRL XPRT 2 LD ST LCK BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.644 SUP HCPCS C1713 04.005.644 - SCREW BONE NONSTRL 6MM 54MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.644S SUP HCPCS C1713 04.005.644S - SCREW BN T25 FT 6MM 8MM 54MM AQ STRL ST LCK BLNT TIP STRDR BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.646 SUP HCPCS C1713 04.005.646 - SCREW BONE NONSTRL 6MM 56MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.646S SUP HCPCS C1713 04.005.646S - SCREW BN T25 FT 6MM 8MM 56MM AQ STRL ST LCK 2 LD STRDR TI BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.648 SUP HCPCS C1713 04.005.648 - SCREW BONE NONSTRL 6MM 58MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.648S SUP HCPCS C1713 04.005.648S - SCREW BN T25 FT 6MM 4.8MM 58MM AQ STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.650 SUP HCPCS C1713 04.005.650 - SCREW BONE NONSTRL 6MM 60MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.650S SUP HCPCS C1713 04.005.650S - SCREW BN T25 FT 6MM 4.8MM 60MM AQ STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.654 SUP HCPCS C1713 04.005.654 - SCREW BONE NONSTRL 6MM 64MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.654S SUP HCPCS C1713 04.005.654S - SCREW BN T25 FT 6MM 4.8MM 64MM AQ STRL LCK CNN ST BLNT TIP BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.658 SUP HCPCS C1713 04.005.658 - SCREW BONE 6MM 68MM NLEX TI FEM LCK STARDRIVE RECESS NONSTRL BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.658S SUP HCPCS C1713 04.005.658S - SCREW BN T25 FT 6MM 4.8MM 68MM AQ STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.662 SUP HCPCS C1713 04.005.662 - SCREW BONE NONSTRL 6MM 72MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.662S SUP HCPCS C1713 04.005.662S - SCREW BN T25 FT 6MM 4.8MM 72MM AQ STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $436.18 $436.18 $90.90 $436.18 N/A N/A 04.005.666 SUP HCPCS C1713 04.005.666 - SCREW BONE NONSTRL 6MM 76MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.666S SUP HCPCS C1713 04.005.666S - SCREW BN T25 FT BLNT 6MM 8MM 76MM AQ STRL XPRT 2 LD ST LCK BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.670 SUP HCPCS C1713 04.005.670 - SCREW BONE 6MM 80MM NLEX TI FEM LCK STARDRIVE RECESS NONSTRL BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.670S SUP HCPCS C1713 04.005.670S - SCREW BN FT 6MM 8MM 80MM AQ STRL NLEX T25 STRDR RCS LCK CNN BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.675 SUP HCPCS C1713 04.005.675 - SCREW BONE NONSTRL 6MM 85MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $86.27 $413.95 N/A N/A 04.005.675S SUP HCPCS C1713 04.005.675S - SCREW BN T25 FT 6MM 4.8MM 85MM AQ STRL LCK ST BLNT TIP 2 LD BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.680 SUP HCPCS C1713 04.005.680 - SCREW BONE NONSTRL 6MM 90MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $413.95 $413.95 N/A N/A 04.005.680S SUP HCPCS C1713 04.005.680S - SCREW BN FT 6MM 8MM 90MM AQ STRL NLEX T25 STRDR RCS LCK CNN BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $436.18 $436.18 N/A N/A 04.005.685 SUP HCPCS C1713 04.005.685 - SCREW BONE NONSTRL 6MM 95MM NLEX TI FULTHD FEM/TIB SLFTAP BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $413.95 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $413.95 $413.95 N/A N/A 04.005.685S SUP HCPCS C1713 04.005.685S - SCREW BN FT 6MM 8MM 95MM AQ STRL NLEX T25 STRDR RCS LCK CNN BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $177.44 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $90.90 $436.18 N/A N/A 04.005.690 SUP HCPCS C1713 04.005.690 - SCREW BONE 6MM 100MM NLEX TI FULTHD FEM/TIB SLFTAP CANN LCK BOTH IP/OP $414.00 $306.00 $82.16 $413.95 $186.28 $186.28 $186.28 $186.28 $413.95 $413.95 $413.95 $86.28 $413.95 $413.95 $413.95 $413.95 $413.95 $86.27 $413.95 $165.58 $244.85 $413.95 $413.95 $413.95 $413.95 $310.50 $413.95 $413.95 $413.95 $206.98 $206.98 $327.85 $413.95 $331.16 $186.28 $82.16 N/A $240.12 $413.95 $248.37 $413.95 $413.95 $413.95 N/A N/A 04.005.690S SUP HCPCS C1713 04.005.690S - SCREW BN FT 6MM 8MM 100MM AQ STRL NLEX T25 STRDR RCS LCK CNN BOTH IP/OP $436.50 $323.00 $86.57 $443.60 $196.28 $196.28 $196.28 $196.28 $436.18 $436.18 $436.18 $90.91 $436.18 $436.18 $436.18 $436.18 $436.18 $90.90 $436.18 $443.60 $258.00 $436.18 $443.60 $436.18 $436.18 $327.38 $436.18 $436.18 $436.18 $218.09 $218.09 $345.45 $436.18 $348.94 $196.28 $86.57 N/A $253.17 $436.18 $261.71 $436.18 $436.18 $436.18 N/A N/A 04.005.691 SUP HCPCS C1713 04.005.691 - SCREW BONE FULTHD 6MM 105MM SLFTAP CANN LOCKING STARDRIVE BOTH IP/OP $341.50 $253.00 $67.75 $347.15 $153.61 $153.61 $153.61 $153.61 $341.35 $341.35 $341.35 $71.15 $341.35 $341.35 $341.35 $341.35 $341.35 $71.14 $341.35 $347.15 $201.91 $341.35 $347.15 $341.35 $341.35 $256.13 $341.35 $341.35 $341.35 $170.68 $170.68 $270.35 $341.35 $273.08 $153.61 $67.75 N/A $198.07 $341.35 $204.81 $341.35 $71.14 $341.35 N/A N/A 04.005.692 SUP HCPCS C1713 04.005.692 - SCREW BONE FULTHD 6MM 110MM SLFTAP CANN LOCKING STARDRIVE BOTH IP/OP $341.50 $253.00 $67.75 $347.15 $153.61 $153.61 $153.61 $153.61 $341.35 $341.35 $341.35 $71.15 $341.35 $341.35 $341.35 $341.35 $341.35 $71.14 $341.35 $347.15 $201.91 $341.35 $347.15 $341.35 $341.35 $256.13 $341.35 $341.35 $341.35 $170.68 $170.68 $270.35 $341.35 $273.08 $153.61 $67.75 N/A $198.07 $341.35 $204.81 $341.35 $71.14 $341.35 N/A N/A 04.005.693 SUP HCPCS C1713 04.005.693 - SCREW BONE FULTHD 6MM 115MM SLFTAP CANN LOCKING STARDRIVE BOTH IP/OP $341.50 $253.00 $67.75 $347.15 $153.61 $153.61 $153.61 $153.61 $341.35 $341.35 $341.35 $71.15 $341.35 $341.35 $341.35 $341.35 $341.35 $71.14 $341.35 $347.15 $201.91 $341.35 $347.15 $341.35 $341.35 $256.13 $341.35 $341.35 $341.35 $170.68 $170.68 $270.35 $341.35 $273.08 $153.61 $67.75 N/A $198.07 $341.35 $204.81 $341.35 $71.14 $341.35 N/A N/A 04.005.694 SUP HCPCS C1713 04.005.694 - SCREW BONE FULTHD 6MM 120MM SLFTAP CANN LOCKING STARDRIVE BOTH IP/OP $341.50 $253.00 $67.75 $347.15 $153.61 $153.61 $153.61 $153.61 $341.35 $341.35 $341.35 $71.15 $341.35 $341.35 $341.35 $341.35 $341.35 $71.14 $341.35 $347.15 $201.91 $341.35 $347.15 $341.35 $341.35 $256.13 $341.35 $341.35 $341.35 $170.68 $170.68 $270.35 $341.35 $273.08 $153.61 $67.75 N/A $198.07 $341.35 $204.81 $341.35 $71.14 $341.35 N/A N/A 04.005.695 SUP HCPCS C1713 04.005.695 - SCREW BONE FULTHD 6MM 125MM SLFTAP CANN LOCKING STARDRIVE BOTH IP/OP $341.50 $253.00 $67.75 $347.15 $153.61 $153.61 $153.61 $153.61 $341.35 $341.35 $341.35 $71.15 $341.35 $341.35 $341.35 $341.35 $341.35 $71.14 $341.35 $347.15 $201.91 $341.35 $347.15 $341.35 $341.35 $256.13 $341.35 $341.35 $341.35 $170.68 $170.68 $270.35 $341.35 $273.08 $153.61 $67.75 N/A $198.07 $341.35 $204.81 $341.35 $71.14 $341.35 N/A N/A 04.008.000S SUP Custom 27803010 04.008.000S - CAP END T25 STARDRIVE RECESS NAIL-EX GOLD TITANIUM HINDFOOT BOTH IP/OP $429.00 $317.00 $76.34 $436.18 $428.88 $428.88 $428.88 $428.88 $428.88 $428.88 $76.34 $428.88 $428.88 $428.88 $428.88 $428.88 $428.88 $89.38 $428.88 $174.47 $428.88 $428.88 $436.18 $428.88 $428.88 $321.75 $428.88 $428.88 $428.88 $214.44 $214.44 $339.67 $428.88 $343.10 $193.00 $428.88 N/A $248.82 $428.88 $257.33 $428.88 $428.88 $428.88 N/A N/A 04.008.001S SUP Custom 27803010 04.008.001S - CAP END 0MM EXTENDED STARDRIVE RECESS NAIL-EX AQUA TITANIUM BOTH IP/OP $429.00 $317.00 $76.34 $436.18 $428.88 $428.88 $428.88 $428.88 $428.88 $428.88 $76.34 $428.88 $428.88 $428.88 $428.88 $428.88 $428.88 $89.38 $428.88 $174.47 $428.88 $428.88 $436.18 $428.88 $428.88 $321.75 $428.88 $428.88 $428.88 $214.44 $214.44 $339.67 $428.88 $343.10 $193.00 $428.88 N/A $248.82 $428.88 $257.33 $428.88 $428.88 $428.88 N/A N/A 04.008.010S SUP HCPCS C1713 04.008.010S - NAIL INTRAMEDULLARY 10MM 150CM CANN EXPERT GREEN TITANIUM BOTH IP/OP "$3,006.50" "$2,225.00" $596.71 "$3,057.55" "$1,352.90" "$1,352.90" "$1,352.90" "$1,352.90" "$3,006.45" "$3,006.45" "$3,006.45" $626.62 "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" $626.58 "$3,006.45" "$3,057.55" "$1,482.18" "$3,006.45" "$3,057.55" "$3,006.45" "$3,006.45" "$2,254.88" "$3,006.45" "$3,006.45" "$3,006.45" "$1,503.23" "$1,503.23" "$2,381.11" "$3,006.45" "$2,405.16" "$1,352.90" $596.71 N/A "$1,743.77" "$3,006.45" "$1,803.87" "$3,006.45" "$3,006.45" "$3,006.45" N/A N/A 04.008.016S SUP HCPCS C1713 04.008.016S - NAIL INTRAMEDULLARY 12D 10MM 180MM CANN BALL TIPPED REAMING BOTH IP/OP "$3,006.50" "$2,225.00" $596.71 "$3,057.55" "$1,352.90" "$1,352.90" "$1,352.90" "$1,352.90" "$3,006.45" "$3,006.45" "$3,006.45" $626.62 "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" $626.58 "$3,006.45" "$3,057.55" "$1,482.18" "$3,006.45" "$3,057.55" "$3,006.45" "$3,006.45" "$2,254.88" "$3,006.45" "$3,006.45" "$3,006.45" "$1,503.23" "$1,503.23" "$2,381.11" "$3,006.45" "$2,405.16" "$1,352.90" $596.71 N/A "$1,743.77" "$3,006.45" "$1,803.87" "$3,006.45" $626.54 "$3,006.45" N/A N/A 04.008.028S SUP HCPCS C1713 04.008.028S - NAIL INTRAMEDULLARY 12D 10MM 240MM CANN BALL TIPPED REAMING BOTH IP/OP "$3,006.50" "$2,225.00" $596.71 "$3,057.55" "$1,352.90" "$1,352.90" "$1,352.90" "$1,352.90" "$3,006.45" "$3,006.45" "$3,006.45" $626.62 "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" $626.58 "$3,006.45" "$1,223.02" "$1,482.18" "$3,006.45" "$3,057.55" "$3,006.45" "$3,006.45" "$2,254.88" "$3,006.45" "$3,006.45" "$3,006.45" "$1,503.23" "$1,503.23" "$2,381.11" "$3,006.45" "$2,405.16" "$1,352.90" $596.71 N/A "$1,743.77" "$3,006.45" "$1,803.87" "$3,006.45" $626.54 "$3,006.45" N/A N/A 04.008.060S SUP HCPCS C1713 04.008.060S - NAIL INTRAMEDULLARY 10MM 15CM CANN NAIL-EX GREEN TITANIUM BOTH IP/OP "$3,006.50" "$2,225.00" $596.71 "$3,057.55" "$1,352.90" "$1,352.90" "$1,352.90" "$1,352.90" "$3,006.45" "$3,006.45" "$3,006.45" $626.62 "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" $626.58 "$3,006.45" "$1,223.02" "$1,482.18" "$3,006.45" "$3,057.55" "$3,006.45" "$3,006.45" "$2,254.88" "$3,006.45" "$3,006.45" "$3,006.45" "$1,503.23" "$1,503.23" "$2,381.11" "$3,006.45" "$2,405.16" "$1,352.90" $596.71 N/A "$1,743.77" "$3,006.45" "$1,803.87" "$3,006.45" "$3,006.45" "$3,006.45" N/A N/A 04.008.066S SUP HCPCS C1713 04.008.066S - NAIL INTRAMEDULLARY 10MM 180MM CANN NAIL-EX GREEN TITANIUM BOTH IP/OP "$3,006.50" "$2,225.00" $596.71 "$3,057.55" "$1,352.90" "$1,352.90" "$1,352.90" "$1,352.90" "$3,006.45" "$3,006.45" "$3,006.45" $626.62 "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" $626.58 "$3,006.45" "$1,223.02" "$1,482.18" "$3,006.45" "$3,057.55" "$3,006.45" "$3,006.45" "$2,254.88" "$3,006.45" "$3,006.45" "$3,006.45" "$1,503.23" "$1,503.23" "$2,381.11" "$3,006.45" "$2,405.16" "$1,352.90" $596.71 N/A "$1,743.77" "$3,006.45" "$1,803.87" "$3,006.45" "$3,006.45" "$3,006.45" N/A N/A 04.008.078S SUP HCPCS C1713 04.008.078S - NAIL INTRAMEDULLARY 10MM 24CM CANN NAIL-EX TITANIUM LEFT BOTH IP/OP "$3,006.50" "$2,225.00" $596.71 "$3,057.55" "$1,352.90" "$1,352.90" "$1,352.90" "$1,352.90" "$3,006.45" "$3,006.45" "$3,006.45" $626.62 "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" $626.58 "$3,006.45" "$1,223.02" "$1,482.18" "$3,006.45" "$3,057.55" "$3,006.45" "$3,006.45" "$2,254.88" "$3,006.45" "$3,006.45" "$3,006.45" "$1,503.23" "$1,503.23" "$2,381.11" "$3,006.45" "$2,405.16" "$1,352.90" $596.71 N/A "$1,743.77" "$3,006.45" "$1,803.87" "$3,006.45" $626.54 "$3,006.45" N/A N/A 04.008.210S SUP HCPCS C1713 04.008.210S - NAIL INTRAMEDULLARY 12MM 15CM CANN NAIL-EX TITANIUM RIGHT BOTH IP/OP "$3,097.00" "$2,292.00" $614.66 "$3,149.55" "$1,393.61" "$1,393.61" "$1,393.61" "$1,393.61" "$3,096.90" "$3,096.90" "$3,096.90" $645.47 "$3,096.90" "$3,096.90" "$3,096.90" "$3,096.90" "$3,096.90" $645.43 "$3,096.90" "$1,259.82" "$1,526.77" "$3,096.90" "$3,149.55" "$3,096.90" "$3,096.90" "$2,322.75" "$3,096.90" "$3,096.90" "$3,096.90" "$1,548.45" "$1,548.45" "$2,452.74" "$3,096.90" "$2,477.52" "$1,393.61" $614.66 N/A "$1,796.26" "$3,096.90" "$1,858.14" "$3,096.90" $645.39 "$3,096.90" N/A N/A 04.008.216S SUP HCPCS C1713 04.008.216S - NAIL INTRAMEDULLARY 12MM 180MM CANN NAIL-EX TITANIUM RIGHT BOTH IP/OP "$3,006.50" "$2,225.00" $596.71 "$3,057.55" "$1,352.90" "$1,352.90" "$1,352.90" "$1,352.90" "$3,006.45" "$3,006.45" "$3,006.45" $626.62 "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" $626.58 "$3,006.45" "$3,057.55" "$1,482.18" "$3,006.45" "$3,057.55" "$3,006.45" "$3,006.45" "$2,254.88" "$3,006.45" "$3,006.45" "$3,006.45" "$1,503.23" "$1,503.23" "$2,381.11" "$3,006.45" "$2,405.16" "$1,352.90" $596.71 N/A "$1,743.77" "$3,006.45" "$1,803.87" "$3,006.45" $626.54 "$3,006.45" N/A N/A 04.008.228S SUP HCPCS C1713 04.008.228S - NAIL INTRAMEDULLARY 12MM 24CM CANN NAIL-EX TITANIUM RIGHT BOTH IP/OP "$3,006.50" "$2,225.00" $596.71 "$3,057.55" "$1,352.90" "$1,352.90" "$1,352.90" "$1,352.90" "$3,006.45" "$3,006.45" "$3,006.45" $626.62 "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" $626.58 "$3,006.45" "$1,223.02" "$1,482.18" "$3,006.45" "$3,057.55" "$3,006.45" "$3,006.45" "$2,254.88" "$3,006.45" "$3,006.45" "$3,006.45" "$1,503.23" "$1,503.23" "$2,381.11" "$3,006.45" "$2,405.16" "$1,352.90" $596.71 N/A "$1,743.77" "$3,006.45" "$1,803.87" "$3,006.45" $626.54 "$3,006.45" N/A N/A 04.008.260S SUP HCPCS C1713 04.008.260S - NAIL INTRAMEDULLARY 12MM 15CM CANN NAIL-EX TITANIUM LEFT BOTH IP/OP "$3,097.00" "$2,292.00" $614.66 "$3,149.55" "$1,393.61" "$1,393.61" "$1,393.61" "$1,393.61" "$3,096.90" "$3,096.90" "$3,096.90" $645.47 "$3,096.90" "$3,096.90" "$3,096.90" "$3,096.90" "$3,096.90" $645.43 "$3,096.90" "$1,259.82" "$1,526.77" "$3,096.90" "$3,149.55" "$3,096.90" "$3,096.90" "$2,322.75" "$3,096.90" "$3,096.90" "$3,096.90" "$1,548.45" "$1,548.45" "$2,452.74" "$3,096.90" "$2,477.52" "$1,393.61" $614.66 N/A "$1,796.26" "$3,096.90" "$1,858.14" "$3,096.90" "$3,096.90" "$3,096.90" N/A N/A 04.008.266S SUP HCPCS C1713 04.008.266S - NAIL INTRAMEDULLARY 12MM 18CM CANN NAIL-EX TITANIUM LEFT BOTH IP/OP "$3,006.50" "$2,225.00" $596.71 "$3,057.55" "$1,352.90" "$1,352.90" "$1,352.90" "$1,352.90" "$3,006.45" "$3,006.45" "$3,006.45" $626.62 "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" $626.58 "$3,006.45" "$3,057.55" "$1,482.18" "$3,006.45" "$3,057.55" "$3,006.45" "$3,006.45" "$2,254.88" "$3,006.45" "$3,006.45" "$3,006.45" "$1,503.23" "$1,503.23" "$2,381.11" "$3,006.45" "$2,405.16" "$1,352.90" $596.71 N/A "$1,743.77" "$3,006.45" "$1,803.87" "$3,006.45" "$3,006.45" "$3,006.45" N/A N/A 04.008.278S SUP HCPCS C1713 04.008.278S - NAIL INTRAMEDULLARY 12MM 24CM CANN NAIL-EX TITANIUM LEFT BOTH IP/OP "$3,006.50" "$2,225.00" $596.71 "$3,057.55" "$1,352.90" "$1,352.90" "$1,352.90" "$1,352.90" "$3,006.45" "$3,006.45" "$3,006.45" $626.62 "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" $626.58 "$3,006.45" "$1,223.02" "$1,482.18" "$3,006.45" "$3,057.55" "$3,006.45" "$3,006.45" "$2,254.88" "$3,006.45" "$3,006.45" "$3,006.45" "$1,503.23" "$1,503.23" "$2,381.11" "$3,006.45" "$2,405.16" "$1,352.90" $596.71 N/A "$1,743.77" "$3,006.45" "$1,803.87" "$3,006.45" "$3,006.45" "$3,006.45" N/A N/A 04.008.310S SUP HCPCS C1713 04.008.310S - NAIL INTRAMEDULLARY 13MM 15CM CANN NAIL-EX TITANIUM RIGHT BOTH IP/OP "$3,097.00" "$2,292.00" $614.66 "$3,149.55" "$1,393.61" "$1,393.61" "$1,393.61" "$1,393.61" "$3,096.90" "$3,096.90" "$3,096.90" $645.47 "$3,096.90" "$3,096.90" "$3,096.90" "$3,096.90" "$3,096.90" $645.43 "$3,096.90" "$1,259.82" "$1,526.77" "$3,096.90" "$3,149.55" "$3,096.90" "$3,096.90" "$2,322.75" "$3,096.90" "$3,096.90" "$3,096.90" "$1,548.45" "$1,548.45" "$2,452.74" "$3,096.90" "$2,477.52" "$1,393.61" $614.66 N/A "$1,796.26" "$3,096.90" "$1,858.14" "$3,096.90" $645.39 "$3,096.90" N/A N/A 04.008.316S SUP HCPCS C1713 04.008.316S - NAIL INTRAMEDULLARY 13MM 18CM CANN NAIL-EX TITANIUM RIGHT BOTH IP/OP "$3,097.00" "$2,292.00" $614.66 "$3,149.55" "$1,393.61" "$1,393.61" "$1,393.61" "$1,393.61" "$3,096.90" "$3,096.90" "$3,096.90" $645.47 "$3,096.90" "$3,096.90" "$3,096.90" "$3,096.90" "$3,096.90" $645.43 "$3,096.90" "$1,259.82" "$1,526.77" "$3,096.90" "$3,149.55" "$3,096.90" "$3,096.90" "$2,322.75" "$3,096.90" "$3,096.90" "$3,096.90" "$1,548.45" "$1,548.45" "$2,452.74" "$3,096.90" "$2,477.52" "$1,393.61" $614.66 N/A "$1,796.26" "$3,096.90" "$1,858.14" "$3,096.90" "$3,096.90" "$3,096.90" N/A N/A 04.008.328S SUP HCPCS C1713 04.008.328S - NAIL INTRAMEDULLARY 13MM 240MM FLUTED EXPERT LIGHT GREEN BOTH IP/OP "$3,006.50" "$2,225.00" $596.71 "$3,057.55" "$1,352.90" "$1,352.90" "$1,352.90" "$1,352.90" "$3,006.45" "$3,006.45" "$3,006.45" $626.62 "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" $626.58 "$3,006.45" "$1,223.02" "$1,482.18" "$3,006.45" "$3,057.55" "$3,006.45" "$3,006.45" "$2,254.88" "$3,006.45" "$3,006.45" "$3,006.45" "$1,503.23" "$1,503.23" "$2,381.11" "$3,006.45" "$2,405.16" "$1,352.90" $596.71 N/A "$1,743.77" "$3,006.45" "$1,803.87" "$3,006.45" "$3,006.45" "$3,006.45" N/A N/A 04.008.360S SUP HCPCS C1713 04.008.360S - NAIL INTRAMEDULLARY 13MM 15CM CANN NAIL-EX TITANIUM LEFT BOTH IP/OP "$3,097.00" "$2,292.00" $614.66 "$3,149.55" "$1,393.61" "$1,393.61" "$1,393.61" "$1,393.61" "$3,096.90" "$3,096.90" "$3,096.90" $645.47 "$3,096.90" "$3,096.90" "$3,096.90" "$3,096.90" "$3,096.90" $645.43 "$3,096.90" "$1,259.82" "$1,526.77" "$3,096.90" "$3,149.55" "$3,096.90" "$3,096.90" "$2,322.75" "$3,096.90" "$3,096.90" "$3,096.90" "$1,548.45" "$1,548.45" "$2,452.74" "$3,096.90" "$2,477.52" "$1,393.61" $614.66 N/A "$1,796.26" "$3,096.90" "$1,858.14" "$3,096.90" $645.39 "$3,096.90" N/A N/A 04.008.366S SUP HCPCS C1713 04.008.366S - NAIL INTRAMEDULLARY 13MM 18CM CANN NAIL-EX TITANIUM LEFT BOTH IP/OP "$3,097.00" "$2,292.00" $614.66 "$3,149.55" "$1,393.61" "$1,393.61" "$1,393.61" "$1,393.61" "$3,096.90" "$3,096.90" "$3,096.90" $645.47 "$3,096.90" "$3,096.90" "$3,096.90" "$3,096.90" "$3,096.90" $645.43 "$3,096.90" "$3,149.55" "$1,526.77" "$3,096.90" "$3,149.55" "$3,096.90" "$3,096.90" "$2,322.75" "$3,096.90" "$3,096.90" "$3,096.90" "$1,548.45" "$1,548.45" "$2,452.74" "$3,096.90" "$2,477.52" "$1,393.61" $614.66 N/A "$1,796.26" "$3,096.90" "$1,858.14" "$3,096.90" $645.39 "$3,096.90" N/A N/A 04.008.378S SUP HCPCS C1713 04.008.378S - NAIL INTRAMEDULLARY 13MM 24CM CANN NAIL-EX TITANIUM LEFT BOTH IP/OP "$3,006.50" "$2,225.00" $596.71 "$3,057.55" "$1,352.90" "$1,352.90" "$1,352.90" "$1,352.90" "$3,006.45" "$3,006.45" "$3,006.45" $626.62 "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" "$3,006.45" $626.58 "$3,006.45" "$3,057.55" "$1,482.18" "$3,006.45" "$3,057.55" "$3,006.45" "$3,006.45" "$2,254.88" "$3,006.45" "$3,006.45" "$3,006.45" "$1,503.23" "$1,503.23" "$2,381.11" "$3,006.45" "$2,405.16" "$1,352.90" $596.71 N/A "$1,743.77" "$3,006.45" "$3,006.45" "$3,006.45" $626.54 "$3,006.45" N/A N/A 04.013.000 SUP HCPCS C1713 04.013.000 - CAP END 0MM FEM XTD STARDRIVE RECESS CANN IM NAIL TI NONSTRL BOTH IP/OP $357.50 $265.00 $70.93 $357.38 $160.82 $160.82 $160.82 $160.82 $357.38 $357.38 $357.38 $74.49 $357.38 $357.38 $357.38 $357.38 $357.38 $74.48 $357.38 $357.38 $211.39 $357.38 $357.38 $357.38 $357.38 $268.13 $357.38 $357.38 $357.38 $178.69 $178.69 $283.04 $357.38 $285.90 $160.82 $70.93 N/A $207.35 $357.38 $214.43 $357.38 $74.48 $357.38 N/A N/A 04.013.000S SUP Custom 27803010 04.013.000S - CAP END 0MM T40 STARDRIVE NAIL-EX GOLD TITANIUM FEMUR BOTH IP/OP $414.50 $307.00 $73.74 $421.33 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $73.74 $414.28 $414.28 $414.28 $414.28 $414.28 $414.28 $86.34 $414.28 $168.53 $414.28 $414.28 $421.33 $414.28 $414.28 $310.88 $414.28 $414.28 $414.28 $207.14 $207.14 $328.11 $414.28 $331.42 $186.43 $414.28 N/A $240.41 $414.28 $248.57 $414.28 $414.28 $414.28 N/A N/A 04.013.041S SUP Custom 27803010 04.013.041S - BLADE INTRAMEDULLARY NAIL 45MM CANN SPIRAL RTRGRD NAIL-EX BOTH IP/OP "$1,161.50" $860.00 $206.68 "$1,180.90" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $206.68 "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $242.00 "$1,161.15" $472.36 "$1,161.15" "$1,161.15" "$1,180.90" "$1,161.15" "$1,161.15" $871.13 "$1,161.15" "$1,161.15" "$1,161.15" $580.58 $580.58 $919.63 "$1,161.15" $928.92 $522.52 "$1,161.15" N/A $673.67 "$1,161.15" $696.69 "$1,161.15" "$1,161.15" "$1,161.15" N/A N/A 04.013.042S SUP Custom 27803010 04.013.042S - BLADE INTRAMEDULLARY NAIL 50MM CANN SPIRAL RTRGRD NAIL-EX BOTH IP/OP "$1,161.50" $860.00 $206.68 "$1,180.90" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $206.68 "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $242.00 "$1,161.15" $472.36 "$1,161.15" "$1,161.15" "$1,180.90" "$1,161.15" "$1,161.15" $871.13 "$1,161.15" "$1,161.15" "$1,161.15" $580.58 $580.58 $919.63 "$1,161.15" $928.92 $522.52 "$1,161.15" N/A $673.67 "$1,161.15" $696.69 "$1,161.15" "$1,161.15" "$1,161.15" N/A N/A 04.013.043S SUP Custom 27803010 04.013.043S - BLADE INTRAMEDULLARY NAIL 55MM CANN SPIRAL RTRGRD NAIL-EX BOTH IP/OP "$1,161.50" $860.00 $206.68 "$1,180.90" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $206.68 "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $242.00 "$1,161.15" $472.36 "$1,161.15" "$1,161.15" "$1,180.90" "$1,161.15" "$1,161.15" $871.13 "$1,161.15" "$1,161.15" "$1,161.15" $580.58 $580.58 $919.63 "$1,161.15" $928.92 $522.52 "$1,161.15" N/A $673.67 "$1,161.15" $696.69 "$1,161.15" "$1,161.15" "$1,161.15" N/A N/A 04.013.044S SUP Custom 27803010 04.013.044S - BLADE INTRAMEDULLARY NAIL 60MM CANN SPIRAL RTRGRD NAIL-EX BOTH IP/OP "$1,161.50" $860.00 $206.68 "$1,180.90" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $206.68 "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $242.00 "$1,161.15" $472.36 "$1,161.15" "$1,161.15" "$1,180.90" "$1,161.15" "$1,161.15" $871.13 "$1,161.15" "$1,161.15" "$1,161.15" $580.58 $580.58 $919.63 "$1,161.15" $928.92 $522.52 "$1,161.15" N/A $673.67 "$1,161.15" $696.69 "$1,161.15" "$1,161.15" "$1,161.15" N/A N/A 04.013.045S SUP Custom 27803010 04.013.045S - BLADE INTRAMEDULLARY FIX SPIRAL 65MM RTRGRD EXPERT GOLD BOTH IP/OP "$1,161.50" $860.00 $206.68 "$1,180.90" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $206.68 "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $242.00 "$1,161.15" $472.36 "$1,161.15" "$1,161.15" "$1,180.90" "$1,161.15" "$1,161.15" $871.13 "$1,161.15" "$1,161.15" "$1,161.15" $580.58 $580.58 $919.63 "$1,161.15" $928.92 $522.52 "$1,161.15" N/A $673.67 "$1,161.15" $696.69 "$1,161.15" "$1,161.15" "$1,161.15" N/A N/A 04.013.046 SUP HCPCS C1713 04.013.046 - BLADE IM NAIL 70MM NLEX FEM TI CANN SPRL RTRGRD NONSTRL BOTH IP/OP "$1,215.00" $899.00 $241.08 "$1,214.65" $546.59 $546.59 $546.59 $546.59 "$1,214.65" "$1,214.65" "$1,214.65" $253.16 "$1,214.65" "$1,214.65" "$1,214.65" "$1,214.65" "$1,214.65" $253.15 "$1,214.65" "$1,214.65" $718.47 "$1,214.65" "$1,214.65" "$1,214.65" "$1,214.65" $911.25 "$1,214.65" "$1,214.65" "$1,214.65" $607.33 $607.33 $962.00 "$1,214.65" $971.72 $546.59 $241.08 N/A $704.70 "$1,214.65" $728.79 "$1,214.65" $253.13 "$1,214.65" N/A N/A 04.013.046S SUP Custom 27803010 04.013.046S - BLADE INTRAMEDULLARY NAIL 70MM SPIRAL RTRGRD NAIL-EX GOLD BOTH IP/OP "$1,161.50" $860.00 $206.68 "$1,180.90" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $206.68 "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $242.00 "$1,161.15" $472.36 "$1,161.15" "$1,161.15" "$1,180.90" "$1,161.15" "$1,161.15" $871.13 "$1,161.15" "$1,161.15" "$1,161.15" $580.58 $580.58 $919.63 "$1,161.15" $928.92 $522.52 "$1,161.15" N/A $673.67 "$1,161.15" $696.69 "$1,161.15" "$1,161.15" "$1,161.15" N/A N/A 04.013.047S SUP Custom 27803010 04.013.047S - BLADE INTRAMEDULLARY FIX 12.5MM 75MM SPIRAL CANN NAIL-EX BOTH IP/OP "$1,161.50" $860.00 $206.68 "$1,180.90" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $206.68 "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $242.00 "$1,161.15" $472.36 "$1,161.15" "$1,161.15" "$1,180.90" "$1,161.15" "$1,161.15" $871.13 "$1,161.15" "$1,161.15" "$1,161.15" $580.58 $580.58 $919.63 "$1,161.15" $928.92 $522.52 "$1,161.15" N/A $673.67 "$1,161.15" $696.69 "$1,161.15" "$1,161.15" "$1,161.15" N/A N/A 04.013.048S SUP Custom 27803010 04.013.048S - BLADE INTRAMEDULLARY FIX 80MM SPIRAL NAIL-EX TITANIUM FEMUR BOTH IP/OP "$1,161.50" $860.00 $206.68 "$1,180.90" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $206.68 "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $242.00 "$1,161.15" $472.36 "$1,161.15" "$1,161.15" "$1,180.90" "$1,161.15" "$1,161.15" $871.13 "$1,161.15" "$1,161.15" "$1,161.15" $580.58 $580.58 $919.63 "$1,161.15" $928.92 $522.52 "$1,161.15" N/A $673.67 "$1,161.15" $696.69 "$1,161.15" "$1,161.15" "$1,161.15" N/A N/A 04.013.049S SUP Custom 27803010 04.013.049S - BLADE INTRAMEDULLARY NAIL SPIRAL 12.5MM 85MM RTRGRD CANN BOTH IP/OP "$1,161.50" $860.00 $206.68 "$1,180.90" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $206.68 "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $242.00 "$1,161.15" $472.36 "$1,161.15" "$1,161.15" "$1,180.90" "$1,161.15" "$1,161.15" $871.13 "$1,161.15" "$1,161.15" "$1,161.15" $580.58 $580.58 $919.63 "$1,161.15" $928.92 $522.52 "$1,161.15" N/A $673.67 "$1,161.15" $696.69 "$1,161.15" "$1,161.15" "$1,161.15" N/A N/A 04.013.050S SUP Custom 27803010 04.013.050S - BLADE INTRAMEDULLARY FIX SPIRAL 90MM CANN RTRGRD EXPERT GOLD BOTH IP/OP "$1,161.50" $860.00 $206.68 "$1,180.90" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $206.68 "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $242.00 "$1,161.15" $472.36 "$1,161.15" "$1,161.15" "$1,180.90" "$1,161.15" "$1,161.15" $871.13 "$1,161.15" "$1,161.15" "$1,161.15" $580.58 $580.58 $919.63 "$1,161.15" $928.92 $522.52 "$1,161.15" N/A $673.67 "$1,161.15" $696.69 "$1,161.15" "$1,161.15" "$1,161.15" N/A N/A 04.013.051S SUP Custom 27803010 04.013.051S - BLADE INTRAMEDULLARY NAIL 95MM CANN SPIRAL RTRGRD NAIL-EX BOTH IP/OP "$1,161.50" $860.00 $206.68 "$1,180.90" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $206.68 "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $242.00 "$1,161.15" $472.36 "$1,161.15" "$1,161.15" "$1,180.90" "$1,161.15" "$1,161.15" $871.13 "$1,161.15" "$1,161.15" "$1,161.15" $580.58 $580.58 $919.63 "$1,161.15" $928.92 $522.52 "$1,161.15" N/A $673.67 "$1,161.15" $696.69 "$1,161.15" "$1,161.15" "$1,161.15" N/A N/A 04.013.052S SUP Custom 27803010 04.013.052S - BLADE INTRAMEDULLARY NAIL 100MM CANN SPIRAL RTRGRD NAIL-EX BOTH IP/OP "$1,161.50" $860.00 $206.68 "$1,180.90" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $206.68 "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" "$1,161.15" $242.00 "$1,161.15" $472.36 "$1,161.15" "$1,161.15" "$1,180.90" "$1,161.15" "$1,161.15" $871.13 "$1,161.15" "$1,161.15" "$1,161.15" $580.58 $580.58 $919.63 "$1,161.15" $928.92 $522.52 "$1,161.15" N/A $673.67 "$1,161.15" $696.69 "$1,161.15" "$1,161.15" "$1,161.15" N/A N/A 04.013.312S SUP HCPCS C1713 04.013.312S - NAIL INTRAMEDULLARY 9MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$3,502.63" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.316S SUP HCPCS C1713 04.013.316S - NAIL INTRAMEDULLARY 9MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$3,502.63" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.320S SUP HCPCS C1713 04.013.320S - NAIL INTRAMEDULLARY 9MM 20CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$1,401.05" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.324S SUP HCPCS C1713 04.013.324S - NAIL INTRAMEDULLARY 9MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$1,401.05" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.328S SUP HCPCS C1713 04.013.328S - NAIL INTRAMEDULLARY 9MM 24CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$3,502.63" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.332S SUP HCPCS C1713 04.013.332S - NAIL INTRAMEDULLARY 9MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$1,401.05" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.336S SUP HCPCS C1713 04.013.336S - NAIL INTRAMEDULLARY 9MM 28CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,342.00" "$2,473.00" $663.30 "$3,398.80" "$1,503.89" "$1,503.89" "$1,503.89" "$1,503.89" "$3,341.98" "$3,341.98" "$3,341.98" $696.55 "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" $696.51 "$3,341.98" "$1,359.52" "$1,647.60" "$3,341.98" "$3,398.80" "$3,341.98" "$3,341.98" "$2,506.50" "$3,341.98" "$3,341.98" "$3,341.98" "$1,670.99" "$1,670.99" "$2,646.85" "$3,341.98" "$2,673.58" "$1,503.89" $663.30 N/A "$1,938.36" "$3,341.98" "$2,005.19" "$3,341.98" $696.47 "$3,341.98" N/A N/A 04.013.340S SUP HCPCS C1713 04.013.340S - NAIL INTRAMEDULLARY 9MM 30CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.344S SUP HCPCS C1713 04.013.344S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 320MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.348S SUP HCPCS C1713 04.013.348S - NAIL INTRAMEDULLARY 9MM 34CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.352S SUP HCPCS C1713 04.013.352S - NAIL INTRAMEDULLARY 9MM 36CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.356S SUP HCPCS C1713 04.013.356S - NAIL INTRAMEDULLARY 9MM 38CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.360S SUP HCPCS C1713 04.013.360S - NAIL INTRAMEDULLARY 9MM 40CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.364S SUP HCPCS C1713 04.013.364S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 420MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.368S SUP HCPCS C1713 04.013.368S - NAIL INTRAMEDULLARY 9MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.372S SUP HCPCS C1713 04.013.372S - NAIL INTRAMEDULLARY 9MM 46CM CANN ANTEGRADE/RTRGRD NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$1,401.05" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.376S SUP HCPCS C1713 04.013.376S - NAIL INTRAMEDULLARY 9MM 48CM CANN ANTEGRADE/RTRGRD NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$1,401.05" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.412S SUP HCPCS C1713 04.013.412S - NAIL INTRAMEDULLARY 10MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.416S SUP HCPCS C1713 04.013.416S - NAIL INTRAMEDULLARY 10MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.420S SUP HCPCS C1713 04.013.420S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 200MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.424S SUP HCPCS C1713 04.013.424S - NAIL INTRAMEDULLARY 10MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.428S SUP HCPCS C1713 04.013.428S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 240MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.432S SUP HCPCS C1713 04.013.432S - NAIL INTRAMEDULLARY 10MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.436S SUP HCPCS C1713 04.013.436S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 280MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.440S SUP HCPCS C1713 04.013.440S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.444S SUP HCPCS C1713 04.013.444S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.448S SUP HCPCS C1713 04.013.448S - NAIL INTRAMEDULLARY 10MM 34CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.452S SUP HCPCS C1713 04.013.452S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 360MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.456S SUP HCPCS C1713 04.013.456S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.460S SUP HCPCS C1713 04.013.460S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.464S SUP HCPCS C1713 04.013.464S - NAIL INTRAMEDULLARY UNIVERSAL ROUND 10MM 420MM CANN RTRGRD BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.468S SUP HCPCS C1713 04.013.468S - NAIL INTRAMEDULLARY 10MM 440MM CANN NAIL-EX GREEN TITANIUM BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.472S SUP HCPCS C1713 04.013.472S - NAIL INTRAMEDULLARY 10MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.476S SUP HCPCS C1713 04.013.476S - NAIL INTRAMEDULLARY 10MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,342.00" "$2,473.00" $663.30 "$3,398.80" "$1,503.89" "$1,503.89" "$1,503.89" "$1,503.89" "$3,341.98" "$3,341.98" "$3,341.98" $696.55 "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" $696.51 "$3,341.98" "$3,398.80" "$1,647.60" "$3,341.98" "$3,398.80" "$3,341.98" "$3,341.98" "$2,506.50" "$3,341.98" "$3,341.98" "$3,341.98" "$1,670.99" "$1,670.99" "$2,646.85" "$3,341.98" "$2,673.58" "$1,503.89" $663.30 N/A "$1,938.36" "$3,341.98" "$2,005.19" "$3,341.98" $696.47 "$3,341.98" N/A N/A 04.013.512S SUP HCPCS C1713 04.013.512S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 160MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.516S SUP HCPCS C1713 04.013.516S - NAIL INTRAMEDULLARY 11MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.520S SUP HCPCS C1713 04.013.520S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 200MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.524S SUP HCPCS C1713 04.013.524S - NAIL INTRAMEDULLARY 11MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.528S SUP HCPCS C1713 04.013.528S - NAIL INTRAMEDULLARY 11MM 24CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.532S SUP HCPCS C1713 04.013.532S - NAIL INTRAMEDULLARY 11MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.536S SUP HCPCS C1713 04.013.536S - NAIL INTRAMEDULLARY 11MM 28CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.540S SUP HCPCS C1713 04.013.540S - NAIL INTRAMEDULLARY 11MM 30CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.544S SUP HCPCS C1713 04.013.544S - NAIL INTRAMEDULLARY UNIVERSAL FLUTED BARREL 11MM 320MM CANN BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.548S SUP HCPCS C1713 04.013.548S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 340MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.552S SUP HCPCS C1713 04.013.552S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.556S SUP HCPCS C1713 04.013.556S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 380MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.560S SUP HCPCS C1713 04.013.560S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 400MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.564S SUP HCPCS C1713 04.013.564S - NAIL INTRAMEDULLARY 11MM 42CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.568S SUP HCPCS C1713 04.013.568S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 440MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.572S SUP HCPCS C1713 04.013.572S - NAIL INTRAMEDULLARY 11MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.576S SUP HCPCS C1713 04.013.576S - NAIL INTRAMEDULLARY 11MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,342.00" "$2,473.00" $663.30 "$3,398.80" "$1,503.89" "$1,503.89" "$1,503.89" "$1,503.89" "$3,341.98" "$3,341.98" "$3,341.98" $696.55 "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" $696.51 "$3,341.98" "$1,359.52" "$1,647.60" "$3,341.98" "$3,398.80" "$3,341.98" "$3,341.98" "$2,506.50" "$3,341.98" "$3,341.98" "$3,341.98" "$1,670.99" "$1,670.99" "$2,646.85" "$3,341.98" "$2,673.58" "$1,503.89" $663.30 N/A "$1,938.36" "$3,341.98" "$2,005.19" "$3,341.98" $696.47 "$3,341.98" N/A N/A 04.013.612S SUP HCPCS C1713 04.013.612S - NAIL INTRAMEDULLARY 12MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.616S SUP HCPCS C1713 04.013.616S - NAIL INTRAMEDULLARY 12MM 18CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.620S SUP HCPCS C1713 04.013.620S - NAIL INTRAMEDULLARY 12MM 20CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.624S SUP HCPCS C1713 04.013.624S - NAIL INTRAMEDULLARY 12MM 22CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.628S SUP HCPCS C1713 04.013.628S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 240MM CANN FLUTED BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.632S SUP HCPCS C1713 04.013.632S - NAIL INTRAMEDULLARY 12MM 26CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.636S SUP HCPCS C1713 04.013.636S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 280MM CANN FLUTED BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.640S SUP HCPCS C1713 04.013.640S - NAIL INTRAMEDULLARY UNIVERSAL FLUTED 12MM 300MM CANN RTRGRD BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.644S SUP HCPCS C1713 04.013.644S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 320MM CANN FLUTED BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.648S SUP HCPCS C1713 04.013.648S - NAIL INTRAMEDULLARY 12MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.652S SUP HCPCS C1713 04.013.652S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 36CM CANN RTRGRD BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.656S SUP HCPCS C1713 04.013.656S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.660S SUP HCPCS C1713 04.013.660S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 400MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.664S SUP HCPCS C1713 04.013.664S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM CANN ROUND BARREL BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.668S SUP HCPCS C1713 04.013.668S - NAIL INTRAMEDULLARY 12MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.672S SUP HCPCS C1713 04.013.672S - NAIL INTRAMEDULLARY 12MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,332.00" "$2,466.00" $661.27 "$3,388.40" "$1,499.29" "$1,499.29" "$1,499.29" "$1,499.29" "$3,331.75" "$3,331.75" "$3,331.75" $694.42 "$3,331.75" "$3,331.75" "$3,331.75" "$3,331.75" "$3,331.75" $694.37 "$3,331.75" "$1,355.36" "$1,642.55" "$3,331.75" "$3,388.40" "$3,331.75" "$3,331.75" "$2,499.00" "$3,331.75" "$3,331.75" "$3,331.75" "$1,665.88" "$1,665.88" "$2,638.75" "$3,331.75" "$2,665.40" "$1,499.29" $661.27 N/A "$1,932.56" "$3,331.75" "$1,999.05" "$3,331.75" $694.34 "$3,331.75" N/A N/A 04.013.676S SUP HCPCS C1713 04.013.676S - NAIL INTRAMEDULLARY 12MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$1,401.05" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$3,444.08" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.712S SUP HCPCS C1713 04.013.712S - NAIL INTRAMEDULLARY 13MM 16CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,332.00" "$2,466.00" $661.27 "$3,388.40" "$1,499.29" "$1,499.29" "$1,499.29" "$1,499.29" "$3,331.75" "$3,331.75" "$3,331.75" $694.42 "$3,331.75" "$3,331.75" "$3,331.75" "$3,331.75" "$3,331.75" $694.37 "$3,331.75" "$1,355.36" "$1,642.55" "$3,331.75" "$3,388.40" "$3,331.75" "$3,331.75" "$2,499.00" "$3,331.75" "$3,331.75" "$3,331.75" "$1,665.88" "$1,665.88" "$2,638.75" "$3,331.75" "$2,665.40" "$1,499.29" $661.27 N/A "$1,932.56" "$3,331.75" "$1,999.05" "$3,331.75" $694.34 "$3,331.75" N/A N/A 04.013.716S SUP HCPCS C1713 04.013.716S - NAIL INTRAMEDULLARY 13MM 18CM CANN RTRGRD NAIL-EX TITANIUM BOTH IP/OP "$3,332.00" "$2,466.00" $661.27 "$3,388.40" "$1,499.29" "$1,499.29" "$1,499.29" "$1,499.29" "$3,331.75" "$3,331.75" "$3,331.75" $694.42 "$3,331.75" "$3,331.75" "$3,331.75" "$3,331.75" "$3,331.75" $694.37 "$3,331.75" "$1,355.36" "$1,642.55" "$3,331.75" "$3,388.40" "$3,331.75" "$3,331.75" "$2,499.00" "$3,331.75" "$3,331.75" "$3,331.75" "$1,665.88" "$1,665.88" "$2,638.75" "$3,331.75" "$2,665.40" "$1,499.29" $661.27 N/A "$1,932.56" "$3,331.75" "$1,999.05" "$3,331.75" "$3,331.75" "$3,331.75" N/A N/A 04.013.720S SUP HCPCS C1713 04.013.720S - NAIL INTRAMEDULLARY 13MM 200CM CANN RTRGRD ANTEGRADE EXPERT BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.724S SUP HCPCS C1713 04.013.724S - NAIL INTRAMEDULLARY 13MM 22CM CANN RTRGRD NAIL-EX TITANIUM BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.728S SUP HCPCS C1713 04.013.728S - NAIL INTRAMEDULLARY 13MM 24CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.732S SUP HCPCS C1713 04.013.732S - NAIL INTRAMEDULLARY 13MM 26CM CANN RTRGRD NAIL-EX TITANIUM BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.736S SUP HCPCS C1713 04.013.736S - NAIL INTRAMEDULLARY 13MM 28CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.740S SUP HCPCS C1713 04.013.740S - NAIL INTRAMEDULLARY 13MM 30CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.744S SUP HCPCS C1713 04.013.744S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM CANN RTRGRD NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.748S SUP HCPCS C1713 04.013.748S - NAIL INTRAMEDULLARY 13MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.752S SUP HCPCS C1713 04.013.752S - NAIL INTRAMEDULLARY 13MM 360CM CANN RTRGRD ANTEGRADE EXPERT BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.756S SUP HCPCS C1713 04.013.756S - NAIL INTRAMEDULLARY 13MM 380MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.760S SUP HCPCS C1713 04.013.760S - NAIL INTRAMEDULLARY 13MM 400CM CANN RTRGRD ANTEGRADE EXPERT BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.764S SUP HCPCS C1713 04.013.764S - NAIL INTRAMEDULLARY 13MM 420MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.768S SUP HCPCS C1713 04.013.768S - NAIL INTRAMEDULLARY 13MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.772S SUP HCPCS C1713 04.013.772S - NAIL INTRAMEDULLARY 13MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,332.00" "$2,466.00" $661.27 "$3,388.40" "$1,499.29" "$1,499.29" "$1,499.29" "$1,499.29" "$3,331.75" "$3,331.75" "$3,331.75" $694.42 "$3,331.75" "$3,331.75" "$3,331.75" "$3,331.75" "$3,331.75" $694.37 "$3,331.75" "$3,388.40" "$1,642.55" "$3,331.75" "$3,388.40" "$3,331.75" "$3,331.75" "$2,499.00" "$3,331.75" "$3,331.75" "$3,331.75" "$1,665.88" "$1,665.88" "$2,638.75" "$3,331.75" "$2,665.40" "$1,499.29" $661.27 N/A "$1,932.56" "$3,331.75" "$1,999.05" "$3,331.75" $694.34 "$3,331.75" N/A N/A 04.013.776S SUP HCPCS C1713 04.013.776S - NAIL INTRAMEDULLARY 13MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$1,401.05" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" "$3,444.08" "$3,444.08" N/A N/A 04.013.812S SUP HCPCS C1713 04.013.812S - NAIL INTRAMEDULLARY 14MM 16CM CANN RTRGRD ANTEGRADE TITANIUM BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$3,502.63" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" "$3,444.08" "$3,444.08" N/A N/A 04.013.816S SUP HCPCS C1713 04.013.816S - NAIL INTRAMEDULLARY 14MM 18CM CANN RTRGRD NAIL-EX TITANIUM BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$3,502.63" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.820S SUP HCPCS C1713 04.013.820S - NAIL INTRAMEDULLARY 14MM 20CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$1,401.05" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$3,444.08" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.824S SUP HCPCS C1713 04.013.824S - NAIL INTRAMEDULLARY 14MM 22CM CANN RTRGRD NAIL-EX TITANIUM BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$1,401.05" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$3,444.08" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.828S SUP HCPCS C1713 04.013.828S - NAIL INTRAMEDULLARY 14MM 240MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$3,502.63" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.832S SUP HCPCS C1713 04.013.832S - NAIL INTRAMEDULLARY 14MM 26CM CANN RTRGRD NAIL-EX TITANIUM BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$3,502.63" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.836S SUP HCPCS C1713 04.013.836S - NAIL INTRAMEDULLARY 14MM 280MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$3,502.63" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.840S SUP HCPCS C1713 04.013.840S - NAIL INTRAMEDULLARY 14MM 300MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.844S SUP HCPCS C1713 04.013.844S - NAIL INTRAMEDULLARY 14MM 320MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.848S SUP HCPCS C1713 04.013.848S - NAIL INTRAMEDULLARY 14MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.852S SUP HCPCS C1713 04.013.852S - NAIL INTRAMEDULLARY 14MM 360MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.856S SUP HCPCS C1713 04.013.856S - NAIL INTRAMEDULLARY 14MM 38CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.860S SUP HCPCS C1713 04.013.860S - NAIL INTRAMEDULLARY 14MM 40CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.864S SUP HCPCS C1713 04.013.864S - NAIL INTRAMEDULLARY 14MM 42CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.868S SUP HCPCS C1713 04.013.868S - NAIL INTRAMEDULLARY 14MM 44CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.872S SUP HCPCS C1713 04.013.872S - NAIL INTRAMEDULLARY 14MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.876S SUP HCPCS C1713 04.013.876S - NAIL INTRAMEDULLARY 14MM 480MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$1,401.05" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$3,444.08" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.912S SUP HCPCS C1713 04.013.912S - NAIL INTRAMEDULLARY 15MM 160MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$1,401.05" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.916S SUP HCPCS C1713 04.013.916S - NAIL INTRAMEDULLARY 15MM 18CM CANN RTRGRD NAIL-EX TITANIUM BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$1,401.05" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$2,066.45" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.013.920S SUP HCPCS C1713 04.013.920S - NAIL INTRAMEDULLARY 15MM 200MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,342.00" "$2,473.00" $663.30 "$3,398.80" "$1,503.89" "$1,503.89" "$1,503.89" "$1,503.89" "$3,341.98" "$3,341.98" "$3,341.98" $696.55 "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" $696.51 "$3,341.98" "$1,359.52" "$1,647.60" "$3,341.98" "$3,398.80" "$3,341.98" "$3,341.98" "$2,506.50" "$3,341.98" "$3,341.98" "$3,341.98" "$1,670.99" "$1,670.99" "$2,646.85" "$3,341.98" "$2,673.58" "$1,503.89" $663.30 N/A "$1,938.36" "$3,341.98" "$2,005.19" "$3,341.98" $696.47 "$3,341.98" N/A N/A 04.013.924S SUP HCPCS C1713 04.013.924S - NAIL INTRAMEDULLARY 15MM 22CM CANN RTRGRD NAIL-EX TITANIUM BOTH IP/OP "$3,342.00" "$2,473.00" $663.30 "$3,398.80" "$1,503.89" "$1,503.89" "$1,503.89" "$1,503.89" "$3,341.98" "$3,341.98" "$3,341.98" $696.55 "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" $696.51 "$3,341.98" "$1,359.52" "$1,647.60" "$3,341.98" "$3,398.80" "$3,341.98" "$3,341.98" "$2,506.50" "$3,341.98" "$3,341.98" "$3,341.98" "$1,670.99" "$1,670.99" "$2,646.85" "$3,341.98" "$2,673.58" "$1,503.89" $663.30 N/A "$1,938.36" "$3,341.98" "$2,005.19" "$3,341.98" "$3,341.98" "$3,341.98" N/A N/A 04.013.928S SUP HCPCS C1713 04.013.928S - NAIL INTRAMEDULLARY 15MM 24CM CANN RTRGRD NAIL-EX TITANIUM BOTH IP/OP "$3,342.00" "$2,473.00" $663.30 "$3,398.80" "$1,503.89" "$1,503.89" "$1,503.89" "$1,503.89" "$3,341.98" "$3,341.98" "$3,341.98" $696.55 "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" $696.51 "$3,341.98" "$3,398.80" "$1,647.60" "$3,341.98" "$3,398.80" "$3,341.98" "$3,341.98" "$2,506.50" "$3,341.98" "$3,341.98" "$3,341.98" "$1,670.99" "$1,670.99" "$2,646.85" "$3,341.98" "$2,673.58" "$1,503.89" $663.30 N/A "$1,938.36" "$3,341.98" "$2,005.19" "$3,341.98" "$3,341.98" "$3,341.98" N/A N/A 04.013.932S SUP HCPCS C1713 04.013.932S - NAIL INTRAMEDULLARY 15MM 26CM CANN RTRGRD NAIL-EX TITANIUM BOTH IP/OP "$3,342.00" "$2,473.00" $663.30 "$3,398.80" "$1,503.89" "$1,503.89" "$1,503.89" "$1,503.89" "$3,341.98" "$3,341.98" "$3,341.98" $696.55 "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" $696.51 "$3,341.98" "$1,359.52" "$1,647.60" "$3,341.98" "$3,398.80" "$3,341.98" "$3,341.98" "$2,506.50" "$3,341.98" "$3,341.98" "$3,341.98" "$1,670.99" "$1,670.99" "$2,646.85" "$3,341.98" "$2,673.58" "$1,503.89" $663.30 N/A "$1,938.36" "$3,341.98" "$2,005.19" "$3,341.98" "$3,341.98" "$3,341.98" N/A N/A 04.013.936S SUP HCPCS C1713 04.013.936S - NAIL INTRAMEDULLARY 15MM 280MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,342.00" "$2,473.00" $663.30 "$3,398.80" "$1,503.89" "$1,503.89" "$1,503.89" "$1,503.89" "$3,341.98" "$3,341.98" "$3,341.98" $696.55 "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" $696.51 "$3,341.98" "$1,359.52" "$1,647.60" "$3,341.98" "$3,398.80" "$3,341.98" "$3,341.98" "$2,506.50" "$3,341.98" "$3,341.98" "$3,341.98" "$1,670.99" "$1,670.99" "$2,646.85" "$3,341.98" "$2,673.58" "$1,503.89" $663.30 N/A "$1,938.36" "$3,341.98" "$2,005.19" "$3,341.98" "$3,341.98" "$3,341.98" N/A N/A 04.013.940S SUP HCPCS C1713 04.013.940S - NAIL INTRAMEDULLARY 15MM 300MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.944S SUP HCPCS C1713 04.013.944S - NAIL INTRAMEDULLARY 15MM 320MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.948S SUP HCPCS C1713 04.013.948S - NAIL INTRAMEDULLARY 15MM 340MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.952S SUP HCPCS C1713 04.013.952S - NAIL INTRAMEDULLARY 15MM 360MM CANN RTRGRD ANTEGRADE FLUTED BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.956S SUP HCPCS C1713 04.013.956S - NAIL INTRAMEDULLARY 15MM 380MM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.960S SUP HCPCS C1713 04.013.960S - NAIL INTRAMEDULLARY 15MM 40CM CANN RTRGRD/ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" "$3,232.55" "$3,232.55" N/A N/A 04.013.964S SUP HCPCS C1713 04.013.964S - NAIL INTRAMEDULLARY 15MM 42CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$1,315.00" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.968S SUP HCPCS C1713 04.013.968S - NAIL INTRAMEDULLARY 15MM 44CM CANN RTRGRD/ANTEGRADE NAIL-EX BOTH IP/OP "$3,233.00" "$2,392.00" $641.58 "$3,287.50" "$1,454.65" "$1,454.65" "$1,454.65" "$1,454.65" "$3,232.55" "$3,232.55" "$3,232.55" $673.74 "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" "$3,232.55" $673.70 "$3,232.55" "$3,287.50" "$1,593.65" "$3,232.55" "$3,287.50" "$3,232.55" "$3,232.55" "$2,424.75" "$3,232.55" "$3,232.55" "$3,232.55" "$1,616.28" "$1,616.28" "$2,560.18" "$3,232.55" "$2,586.04" "$1,454.65" $641.58 N/A "$1,875.14" "$3,232.55" "$1,939.53" "$3,232.55" $673.66 "$3,232.55" N/A N/A 04.013.972S SUP HCPCS C1713 04.013.972S - NAIL INTRAMEDULLARY 15MM 46CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,342.00" "$2,473.00" $663.30 "$3,398.80" "$1,503.89" "$1,503.89" "$1,503.89" "$1,503.89" "$3,341.98" "$3,341.98" "$3,341.98" $696.55 "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" "$3,341.98" $696.51 "$3,341.98" "$3,398.80" "$1,647.60" "$3,341.98" "$3,398.80" "$3,341.98" "$3,341.98" "$2,506.50" "$3,341.98" "$3,341.98" "$3,341.98" "$1,670.99" "$1,670.99" "$2,646.85" "$3,341.98" "$2,673.58" "$1,503.89" $663.30 N/A "$1,938.36" "$3,341.98" "$2,005.19" "$3,341.98" $696.47 "$3,341.98" N/A N/A 04.013.976S SUP HCPCS C1713 04.013.976S - NAIL INTRAMEDULLARY 15MM 48CM CANN RTRGRD ANTEGRADE NAIL-EX BOTH IP/OP "$3,444.50" "$2,549.00" $683.56 "$3,502.63" "$1,549.84" "$1,549.84" "$1,549.84" "$1,549.84" "$3,444.08" "$3,444.08" "$3,444.08" $717.83 "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" "$3,444.08" $717.78 "$3,444.08" "$1,401.05" "$1,697.93" "$3,444.08" "$3,502.63" "$3,444.08" "$3,444.08" "$2,583.38" "$3,444.08" "$3,444.08" "$3,444.08" "$1,722.04" "$1,722.04" "$2,727.71" "$3,444.08" "$2,755.26" "$1,549.84" $683.56 N/A "$1,997.81" "$3,444.08" "$3,444.08" "$3,444.08" $717.75 "$3,444.08" N/A N/A 04.015.518S SUP HCPCS C1713 04.015.518S - SCREW BONE FULTHD 5MM 28MM 2 CORE LOCK GOLD TITANIUM KNEE BOTH IP/OP $477.00 $353.00 $94.67 $485.10 $214.65 $214.65 $214.65 $214.65 $477.00 $477.00 $477.00 $99.42 $477.00 $477.00 $477.00 $477.00 $477.00 $99.41 $477.00 $485.10 $282.15 $477.00 $485.10 $477.00 $477.00 $357.75 $477.00 $477.00 $477.00 $238.50 $238.50 $377.78 $477.00 $381.60 $214.65 $94.67 N/A $276.66 $477.00 $286.20 $477.00 $99.41 $477.00 N/A N/A 04.015.520 SUP HCPCS C1713 04.015.520 - SCREW BONE T25 BLUNT 5MM 8MM 30MM 2 CORE SELF TAP LOCK BOTH IP/OP $388.50 $287.00 $77.01 $394.63 $174.61 $174.61 $174.61 $174.61 $388.03 $388.03 $388.03 $80.88 $388.03 $388.03 $388.03 $388.03 $388.03 $80.87 $388.03 $157.85 $229.52 $388.03 $394.63 $388.03 $388.03 $291.38 $388.03 $388.03 $388.03 $194.02 $194.02 $307.32 $388.03 $310.42 $174.61 $77.01 N/A $225.33 $388.03 $388.03 $388.03 $80.87 $388.03 N/A N/A 04.015.522S SUP HCPCS C1713 04.015.522S - SCREW BONE FULTHD 5MM 32MM 2 CORE LOCK T25 STARDRIVE RECESS BOTH IP/OP $483.00 $357.00 $95.83 $491.05 $217.28 $217.28 $217.28 $217.28 $482.85 $482.85 $482.85 $100.64 $482.85 $482.85 $482.85 $482.85 $482.85 $100.63 $482.85 $196.42 $285.61 $482.85 $491.05 $482.85 $482.85 $362.25 $482.85 $482.85 $482.85 $241.43 $241.43 $382.42 $482.85 $386.28 $217.28 $95.83 N/A $280.14 $482.85 $482.85 $482.85 $100.63 $482.85 N/A N/A 04.015.525 SUP HCPCS C1713 04.015.525 - SCREW BONE T25 BLUNT 5MM 8MM 35MM 2 CORE SELF TAP LOCK BOTH IP/OP $388.50 $287.00 $77.01 $394.63 $174.61 $174.61 $174.61 $174.61 $388.03 $388.03 $388.03 $80.88 $388.03 $388.03 $388.03 $388.03 $388.03 $80.87 $388.03 $157.85 $229.52 $388.03 $394.63 $388.03 $388.03 $291.38 $388.03 $388.03 $388.03 $194.02 $194.02 $307.32 $388.03 $310.42 $174.61 $77.01 N/A $225.33 $388.03 $388.03 $388.03 $80.87 $388.03 N/A N/A 04.015.527S SUP HCPCS C1713 04.015.527S - SCREW BONE FULTHD 5MM 37MM 2 CORE LOCK T25 STARDRIVE RECESS BOTH IP/OP $483.00 $357.00 $95.83 $491.05 $217.28 $217.28 $217.28 $217.28 $482.85 $482.85 $482.85 $100.64 $482.85 $482.85 $482.85 $482.85 $482.85 $100.63 $482.85 $196.42 $285.61 $482.85 $491.05 $482.85 $482.85 $362.25 $482.85 $482.85 $482.85 $241.43 $241.43 $382.42 $482.85 $386.28 $217.28 $95.83 N/A $280.14 $482.85 $289.71 $482.85 $100.63 $482.85 N/A N/A 04.015.530 SUP HCPCS C1713 04.015.530 - SCREW BONE T25 BLUNT 5MM 8MM 40MM 2 CORE SELF TAP LOCK BOTH IP/OP $388.50 $287.00 $77.01 $394.63 $174.61 $174.61 $174.61 $174.61 $388.03 $388.03 $388.03 $80.88 $388.03 $388.03 $388.03 $388.03 $388.03 $80.87 $388.03 $157.85 $229.52 $388.03 $394.63 $388.03 $388.03 $291.38 $388.03 $388.03 $388.03 $194.02 $194.02 $307.32 $388.03 $310.42 $174.61 $77.01 N/A $225.33 $388.03 $232.82 $388.03 $388.03 $388.03 N/A N/A 04.015.532S SUP HCPCS C1713 04.015.532S - SCREW BONE FULTHD 5MM 42MM 2 CORE LOCK T25 STARDRIVE RECESS BOTH IP/OP $483.00 $357.00 $95.83 $491.05 $217.28 $217.28 $217.28 $217.28 $482.85 $482.85 $482.85 $100.64 $482.85 $482.85 $482.85 $482.85 $482.85 $100.63 $482.85 $196.42 $285.61 $482.85 $491.05 $482.85 $482.85 $362.25 $482.85 $482.85 $482.85 $241.43 $241.43 $382.42 $482.85 $386.28 $217.28 $95.83 N/A $280.14 $482.85 $289.71 $482.85 $100.63 $482.85 N/A N/A 04.015.535 SUP HCPCS C1713 04.015.535 - SCREW BONE T25 BLUNT 5MM 8MM 45MM 2 CORE SELF TAP LOCK BOTH IP/OP $388.50 $287.00 $77.01 $394.63 $174.61 $174.61 $174.61 $174.61 $388.03 $388.03 $388.03 $80.88 $388.03 $388.03 $388.03 $388.03 $388.03 $80.87 $388.03 $157.85 $229.52 $388.03 $394.63 $388.03 $388.03 $291.38 $388.03 $388.03 $388.03 $194.02 $194.02 $307.32 $388.03 $310.42 $174.61 $77.01 N/A $225.33 $388.03 $232.82 $388.03 $388.03 $388.03 N/A N/A 04.015.537S SUP HCPCS C1713 04.015.537S - SCREW BONE FULTHD 5MM 47MM 2 CORE LOCK T25 STARDRIVE RECESS BOTH IP/OP $483.00 $357.00 $95.83 $491.05 $217.28 $217.28 $217.28 $217.28 $482.85 $482.85 $482.85 $100.64 $482.85 $482.85 $482.85 $482.85 $482.85 $100.63 $482.85 $491.05 $285.61 $482.85 $491.05 $482.85 $482.85 $362.25 $482.85 $482.85 $482.85 $241.43 $241.43 $382.42 $482.85 $386.28 $217.28 $95.83 N/A $280.14 $482.85 $289.71 $482.85 $100.63 $482.85 N/A N/A 04.015.540 SUP HCPCS C1713 04.015.540 - SCREW BONE T25 BLUNT 5MM 8MM 50MM 2 CORE SELF TAP LOCK BOTH IP/OP $388.50 $287.00 $77.01 $394.63 $174.61 $174.61 $174.61 $174.61 $388.03 $388.03 $388.03 $80.88 $388.03 $388.03 $388.03 $388.03 $388.03 $80.87 $388.03 $157.85 $229.52 $388.03 $394.63 $388.03 $388.03 $291.38 $388.03 $388.03 $388.03 $194.02 $194.02 $307.32 $388.03 $310.42 $174.61 $77.01 N/A $225.33 $388.03 $232.82 $388.03 $80.87 $388.03 N/A N/A 04.015.542S SUP HCPCS C1713 04.015.542S - SCREW BONE FULTHD 5MM 52MM 2 CORE LOCK T25 STARDRIVE RECESS BOTH IP/OP $483.00 $357.00 $95.83 $491.05 $217.28 $217.28 $217.28 $217.28 $482.85 $482.85 $482.85 $100.64 $482.85 $482.85 $482.85 $482.85 $482.85 $100.63 $482.85 $491.05 $285.61 $482.85 $491.05 $482.85 $482.85 $362.25 $482.85 $482.85 $482.85 $241.43 $241.43 $382.42 $482.85 $386.28 $217.28 $95.83 N/A $280.14 $482.85 $289.71 $482.85 $482.85 $482.85 N/A N/A 04.015.545 SUP HCPCS C1713 04.015.545 - SCREW BONE T25 FULTHD 5MM 55MM 2 CORE LOCK STARDRIVE RECESS BOTH IP/OP $388.50 $287.00 $77.01 $394.63 $174.61 $174.61 $174.61 $174.61 $388.03 $388.03 $388.03 $80.88 $388.03 $388.03 $388.03 $388.03 $388.03 $80.87 $388.03 $157.85 $229.52 $388.03 $394.63 $388.03 $388.03 $291.38 $388.03 $388.03 $388.03 $194.02 $194.02 $307.32 $388.03 $310.42 $174.61 $77.01 N/A $225.33 $388.03 $388.03 $388.03 $80.87 $388.03 N/A N/A 04.015.547S SUP HCPCS C1713 04.015.547S - SCREW BONE FULTHD 5MM 57MM 2 CORE LOCK T25 STARDRIVE RECESS BOTH IP/OP $483.00 $357.00 $95.83 $491.05 $217.28 $217.28 $217.28 $217.28 $482.85 $482.85 $482.85 $100.64 $482.85 $482.85 $482.85 $482.85 $482.85 $100.63 $482.85 $196.42 $285.61 $482.85 $491.05 $482.85 $482.85 $362.25 $482.85 $482.85 $482.85 $241.43 $241.43 $382.42 $482.85 $386.28 $217.28 $95.83 N/A $280.14 $482.85 $482.85 $482.85 $100.63 $482.85 N/A N/A 04.015.550 SUP HCPCS C1713 04.015.550 - SCREW BONE T25 BLUNT 5MM 8MM 60MM 2 CORE SELF TAP LOCK BOTH IP/OP $388.50 $287.00 $77.01 $394.63 $174.61 $174.61 $174.61 $174.61 $388.03 $388.03 $388.03 $80.88 $388.03 $388.03 $388.03 $388.03 $388.03 $80.87 $388.03 $157.85 $229.52 $388.03 $394.63 $388.03 $388.03 $291.38 $388.03 $388.03 $388.03 $194.02 $194.02 $307.32 $388.03 $310.42 $174.61 $77.01 N/A $225.33 $388.03 $388.03 $388.03 $80.87 $388.03 N/A N/A 04.015.552S SUP HCPCS C1713 04.015.552S - SCREW BONE FULTHD 5MM 62MM 2 CORE LOCK SELF TAP T25 BOTH IP/OP $483.00 $357.00 $95.83 $491.05 $217.28 $217.28 $217.28 $217.28 $482.85 $482.85 $482.85 $100.64 $482.85 $482.85 $482.85 $482.85 $482.85 $100.63 $482.85 $196.42 $285.61 $482.85 $491.05 $482.85 $482.85 $362.25 $482.85 $482.85 $482.85 $241.43 $241.43 $382.42 $482.85 $386.28 $217.28 $95.83 N/A $280.14 $482.85 $289.71 $482.85 $100.63 $482.85 N/A N/A 04.015.555 SUP HCPCS C1713 04.015.555 - SCREW BONE T25 BLUNT 5MM 8MM 65MM 2 CORE SELF TAP LOCK BOTH IP/OP $388.50 $287.00 $77.01 $394.63 $174.61 $174.61 $174.61 $174.61 $388.03 $388.03 $388.03 $80.88 $388.03 $388.03 $388.03 $388.03 $388.03 $80.87 $388.03 $157.85 $229.52 $388.03 $394.63 $388.03 $388.03 $291.38 $388.03 $388.03 $388.03 $194.02 $194.02 $307.32 $388.03 $310.42 $174.61 $77.01 N/A $225.33 $388.03 $232.82 $388.03 $388.03 $388.03 N/A N/A 04.015.555S SUP HCPCS C1713 04.015.555S - SCREW BN T25 FT 5MM 8MM 65MM AU STRL 2 COR ST LCK STRDR TI BOTH IP/OP $483.00 $357.00 $95.83 $491.05 $217.28 $217.28 $217.28 $217.28 $482.85 $482.85 $482.85 $100.64 $482.85 $482.85 $482.85 $482.85 $482.85 $100.63 $482.85 $491.05 $285.61 $482.85 $491.05 $482.85 $482.85 $362.25 $482.85 $482.85 $482.85 $241.43 $241.43 $382.42 $482.85 $386.28 $217.28 $95.83 N/A $280.14 $482.85 $482.85 $482.85 $100.63 $482.85 N/A N/A 04.015.557S SUP HCPCS C1713 04.015.557S - SCREW BONE FULTHD 5MM 67MM 2 CORE LOCK T25 STARDRIVE RECESS BOTH IP/OP $483.00 $357.00 $95.83 $491.05 $217.28 $217.28 $217.28 $217.28 $482.85 $482.85 $482.85 $100.64 $482.85 $482.85 $482.85 $482.85 $482.85 $100.63 $482.85 $491.05 $285.61 $482.85 $491.05 $482.85 $482.85 $362.25 $482.85 $482.85 $482.85 $241.43 $241.43 $382.42 $482.85 $386.28 $217.28 $95.83 N/A $280.14 $482.85 $289.71 $482.85 $100.63 $482.85 N/A N/A 04.015.560 SUP HCPCS C1713 04.015.560 - SCREW BONE T25 BLUNT 5MM 8MM 70MM 2 CORE SELF TAP LOCK BOTH IP/OP $388.50 $287.00 $77.01 $394.63 $174.61 $174.61 $174.61 $174.61 $388.03 $388.03 $388.03 $80.88 $388.03 $388.03 $388.03 $388.03 $388.03 $80.87 $388.03 $157.85 $229.52 $388.03 $394.63 $388.03 $388.03 $291.38 $388.03 $388.03 $388.03 $194.02 $194.02 $307.32 $388.03 $310.42 $174.61 $77.01 N/A $225.33 $388.03 $232.82 $388.03 $388.03 $388.03 N/A N/A 04.015.562S SUP HCPCS C1713 04.015.562S - SCREW BONE FULTHD 5MM 72MM 2 CORE LOCK T25 STARDRIVE RECESS BOTH IP/OP $483.00 $357.00 $95.83 $491.05 $217.28 $217.28 $217.28 $217.28 $482.85 $482.85 $482.85 $100.64 $482.85 $482.85 $482.85 $482.85 $482.85 $100.63 $482.85 $491.05 $285.61 $482.85 $491.05 $482.85 $482.85 $362.25 $482.85 $482.85 $482.85 $241.43 $241.43 $382.42 $482.85 $386.28 $217.28 $95.83 N/A $280.14 $482.85 $289.71 $482.85 $100.63 $482.85 N/A N/A 04.015.565 SUP HCPCS C1713 04.015.565 - SCREW BONE T25 BLUNT 5MM 8MM 75MM 2 CORE SELF TAP LOCK BOTH IP/OP $388.50 $287.00 $77.01 $394.63 $174.61 $174.61 $174.61 $174.61 $388.03 $388.03 $388.03 $80.88 $388.03 $388.03 $388.03 $388.03 $388.03 $80.87 $388.03 $157.85 $229.52 $388.03 $394.63 $388.03 $388.03 $291.38 $388.03 $388.03 $388.03 $194.02 $194.02 $307.32 $388.03 $310.42 $174.61 $77.01 N/A $225.33 $388.03 $232.82 $388.03 $388.03 $388.03 N/A N/A 04.015.567S SUP HCPCS C1713 04.015.567S - SCREW BONE FULTHD 5MM 77MM 2 CORE LOCK T25 STARDRIVE RECESS BOTH IP/OP $483.00 $357.00 $95.83 $491.05 $217.28 $217.28 $217.28 $217.28 $482.85 $482.85 $482.85 $100.64 $482.85 $482.85 $482.85 $482.85 $482.85 $100.63 $482.85 $196.42 $285.61 $482.85 $491.05 $482.85 $482.85 $362.25 $482.85 $482.85 $482.85 $241.43 $241.43 $382.42 $482.85 $386.28 $217.28 $95.83 N/A $280.14 $482.85 $482.85 $482.85 $100.63 $482.85 N/A N/A 04.015.570 SUP HCPCS C1713 04.015.570 - SCREW BONE T25 BLUNT 5MM 8MM 80MM 2 CORE SELF TAP LOCK BOTH IP/OP $388.50 $287.00 $77.01 $394.63 $174.61 $174.61 $174.61 $174.61 $388.03 $388.03 $388.03 $80.88 $388.03 $388.03 $388.03 $388.03 $388.03 $80.87 $388.03 $157.85 $229.52 $388.03 $394.63 $388.03 $388.03 $291.38 $388.03 $388.03 $388.03 $194.02 $194.02 $307.32 $388.03 $310.42 $174.61 $77.01 N/A $225.33 $388.03 $388.03 $388.03 $80.87 $388.03 N/A N/A 04.015.572S SUP HCPCS C1713 04.015.572S - SCREW BONE FULTHD 5MM 82MM 2 CORE LOCK T25 STARDRIVE RECESS BOTH IP/OP $483.00 $357.00 $95.83 $491.05 $217.28 $217.28 $217.28 $217.28 $482.85 $482.85 $482.85 $100.64 $482.85 $482.85 $482.85 $482.85 $482.85 $100.63 $482.85 $196.42 $285.61 $482.85 $491.05 $482.85 $482.85 $362.25 $482.85 $482.85 $482.85 $241.43 $241.43 $382.42 $482.85 $386.28 $217.28 $95.83 N/A $280.14 $482.85 $289.71 $482.85 $100.63 $482.85 N/A N/A 04.015.575 SUP HCPCS C1713 04.015.575 - SCREW BONE T25 BLUNT 5MM 8MM 85MM 2 CORE SELF TAP LOCK BOTH IP/OP $388.50 $287.00 $77.01 $394.63 $174.61 $174.61 $174.61 $174.61 $388.03 $388.03 $388.03 $80.88 $388.03 $388.03 $388.03 $388.03 $388.03 $80.87 $388.03 $394.63 $229.52 $388.03 $394.63 $388.03 $388.03 $291.38 $388.03 $388.03 $388.03 $194.02 $194.02 $307.32 $388.03 $310.42 $174.61 $77.01 N/A $225.33 $388.03 $232.82 $388.03 $80.87 $388.03 N/A N/A 04.015.577S SUP HCPCS C1713 04.015.577S - SCREW BONE FULTHD 5MM 87MM 2 CORE LOCK T25 STARDRIVE RECESS BOTH IP/OP $483.00 $357.00 $95.83 $491.05 $217.28 $217.28 $217.28 $217.28 $482.85 $482.85 $482.85 $100.64 $482.85 $482.85 $482.85 $482.85 $482.85 $100.63 $482.85 $196.42 $285.61 $482.85 $491.05 $482.85 $482.85 $362.25 $482.85 $482.85 $482.85 $241.43 $241.43 $382.42 $482.85 $386.28 $217.28 $95.83 N/A $280.14 $482.85 $289.71 $482.85 $100.63 $482.85 N/A N/A 04.015.580 SUP HCPCS C1713 04.015.580 - SCREW BONE T25 BLUNT 5MM 8MM 90MM 2 CORE SELF TAP LOCK BOTH IP/OP $388.50 $287.00 $77.01 $394.63 $174.61 $174.61 $174.61 $174.61 $388.03 $388.03 $388.03 $80.88 $388.03 $388.03 $388.03 $388.03 $388.03 $80.87 $388.03 $394.63 $229.52 $388.03 $394.63 $388.03 $388.03 $291.38 $388.03 $388.03 $388.03 $194.02 $194.02 $307.32 $388.03 $310.42 $174.61 $77.01 N/A $225.33 $388.03 $232.82 $388.03 $80.87 $388.03 N/A N/A 04.016.034S SUP HCPCS C1713 04.016.034S - NAIL INTRAMEDULLARY SHORT STR 8MM 9.5MM 160MM CANN MULTILOC BOTH IP/OP "$3,667.50" "$2,714.00" $727.86 "$3,729.63" "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" "$3,667.28" "$3,667.28" "$3,667.28" $764.35 "$3,667.28" "$3,667.28" "$3,667.28" "$3,667.28" "$3,667.28" $764.30 "$3,667.28" "$1,491.85" "$1,807.97" "$3,667.28" "$3,729.63" "$3,667.28" "$3,667.28" "$2,750.63" "$3,667.28" "$3,667.28" "$3,667.28" "$1,833.64" "$1,833.64" "$2,904.49" "$3,667.28" "$2,933.82" "$1,650.28" $727.86 N/A "$2,127.15" "$3,667.28" "$2,200.37" "$3,667.28" $764.26 "$3,667.28" N/A N/A 04.016.035S SUP HCPCS C1713 04.016.035S - NAIL IM SHRT STRG 8MM 9.5MM 160MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,667.50" "$2,714.00" $727.86 "$3,729.63" "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" "$3,667.28" "$3,667.28" "$3,667.28" $764.35 "$3,667.28" "$3,667.28" "$3,667.28" "$3,667.28" "$3,667.28" $764.30 "$3,667.28" "$1,491.85" "$1,807.97" "$3,667.28" "$3,729.63" "$3,667.28" "$3,667.28" "$2,750.63" "$3,667.28" "$3,667.28" "$3,667.28" "$1,833.64" "$1,833.64" "$2,904.49" "$3,667.28" "$2,933.82" "$1,650.28" $727.86 N/A "$2,127.15" "$3,667.28" "$3,667.28" "$3,667.28" $764.26 "$3,667.28" N/A N/A 04.016.039S SUP HCPCS C1713 04.016.039S - NAIL IM SHRT STRG 9.5MM 11MM 160MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,667.50" "$2,714.00" $727.86 "$3,729.63" "$1,650.28" "$1,650.28" "$1,650.28" "$1,650.28" "$3,667.28" "$3,667.28" "$3,667.28" $764.35 "$3,667.28" "$3,667.28" "$3,667.28" "$3,667.28" "$3,667.28" $764.30 "$3,667.28" "$1,491.85" "$1,807.97" "$3,667.28" "$3,729.63" "$3,667.28" "$3,667.28" "$2,750.63" "$3,667.28" "$3,667.28" "$3,667.28" "$1,833.64" "$1,833.64" "$2,904.49" "$3,667.28" "$2,933.82" "$1,650.28" $727.86 N/A "$2,127.15" "$3,667.28" "$3,667.28" "$3,667.28" $764.26 "$3,667.28" N/A N/A 04.016.180S SUP HCPCS C1713 04.016.180S - NAIL IM LNG STRG 7MM 9.5MM 180MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.016.195S SUP HCPCS C1713 04.016.195S - NAIL IM LNG STRG 7MM 9.5MM 195MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$3,886.88" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.016.210S SUP HCPCS C1713 04.016.210S - NAIL IM LNG STRG 7MM 9.5MM 210MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.016.225S SUP HCPCS C1713 04.016.225S - NAIL IM LNG STRG 7MM 9.5MM 225MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.016.240S SUP HCPCS C1713 04.016.240S - NAIL IM LNG STRG 7MM 9.5MM 240MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.016.255S SUP HCPCS C1713 04.016.255S - NAIL INTRAMEDULLARY LONG STR 7MM 255MM CANN ROUND BARREL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$2,293.14" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.016.270S SUP HCPCS C1713 04.016.270S - NAIL IM LNG STRG 7MM 9.5MM 270MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$3,886.88" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.016.285S SUP HCPCS C1713 04.016.285S - NAIL IM LNG STRG 7MM 9.5MM 285MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.016.300S SUP HCPCS C1713 04.016.300S - NAIL IM LNG STRG 7MM 9.5MM 300MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.016.315S SUP HCPCS C1713 04.016.315S - NAIL IM LNG STRG 7MM 9.5MM 315MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.017.180S SUP HCPCS C1713 04.017.180S - NAIL IM LNG STRG 7MM 9.5MM 180MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.017.195S SUP HCPCS C1713 04.017.195S - NAIL IM LNG STRG 7MM 9.5MM 195MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.017.210S SUP HCPCS C1713 04.017.210S - NAIL IM LNG STRG 7MM 9.5MM 210MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$3,886.88" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.017.225S SUP HCPCS C1713 04.017.225S - NAIL IM LNG STRG 7MM 9.5MM 225MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$3,886.88" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.017.240S SUP HCPCS C1713 04.017.240S - NAIL INTRAMEDULLARY LONG STR 7MM 240MM CANN ROUND BARREL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$3,886.88" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$2,293.14" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.017.255S SUP HCPCS C1713 04.017.255S - NAIL IM LNG STRG 7MM 9.5MM 255MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.017.270S SUP HCPCS C1713 04.017.270S - NAIL IM LNG STRG 7MM 9.5MM 270MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.017.285S SUP HCPCS C1713 04.017.285S - NAIL IM LNG STRG 7MM 9.5MM 285MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.017.300S SUP HCPCS C1713 04.017.300S - NAIL IM LNG STRG 7MM 9.5MM 300MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.017.315S SUP HCPCS C1713 04.017.315S - NAIL IM LNG STRG 7MM 9.5MM 315MM BLU STRL MULTILOC CNN TI AL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.018.180S SUP HCPCS C1713 04.018.180S - NAIL IM LNG STRG 8.5MM 9.5MM 180MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$3,886.88" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.018.195S SUP HCPCS C1713 04.018.195S - NAIL IM LNG STRG 8.5MM 9.5MM 195MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.018.210S SUP HCPCS C1713 04.018.210S - NAIL IM LNG STRG 8.5MM 9.5MM 210MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.018.225S SUP HCPCS C1713 04.018.225S - NAIL IM LNG STRG 8.5MM 9.5MM 225MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$3,886.88" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$2,293.14" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.018.240S SUP HCPCS C1713 04.018.240S - NAIL IM LNG STRG 8.5MM 9.5MM 240MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.018.255S SUP HCPCS C1713 04.018.255S - NAIL IM LNG STRG 8.5MM 9.5MM 255MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$3,886.88" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.018.270S SUP HCPCS C1713 04.018.270S - NAIL INTRAMEDULLARY LONG STR 8.5MM 270MM CANN ROUND BARREL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$2,293.14" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.018.285S SUP HCPCS C1713 04.018.285S - NAIL IM LNG STRG 8.5MM 9.5MM 285MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.018.300S SUP HCPCS C1713 04.018.300S - NAIL IM LNG STRG 8.5MM 9.5MM 300MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$3,886.88" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.018.315S SUP HCPCS C1713 04.018.315S - NAIL IM LNG STRG 8.5MM 9.5MM 315MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.019.028S SUP HCPCS C1713 04.019.028S - SCREW BN FT 4.5MM 3.9MM 28MM AU STRL MULTILOC BLNT TIP SLF BOTH IP/OP $579.50 $429.00 $114.94 $588.98 $260.61 $260.61 $260.61 $260.61 $579.13 $579.13 $579.13 $120.71 $579.13 $579.13 $579.13 $579.13 $579.13 $120.70 $579.13 $235.59 $342.56 $579.13 $588.98 $579.13 $579.13 $434.63 $579.13 $579.13 $579.13 $289.57 $289.57 $458.67 $579.13 $463.30 $260.61 $114.94 N/A $336.11 $579.13 $579.13 $579.13 $120.69 $579.13 N/A N/A 04.019.030S SUP HCPCS C1713 04.019.030S - SCREW BONE FULTHD 4.5MM 30MM BLUNT TIP SELF CUTTING BOTH IP/OP $579.50 $429.00 $114.94 $588.98 $260.61 $260.61 $260.61 $260.61 $579.13 $579.13 $579.13 $120.71 $579.13 $579.13 $579.13 $579.13 $579.13 $120.70 $579.13 $235.59 $342.56 $579.13 $588.98 $579.13 $579.13 $434.63 $579.13 $579.13 $579.13 $289.57 $289.57 $458.67 $579.13 $463.30 $260.61 $114.94 N/A $336.11 $579.13 $579.13 $579.13 $120.69 $579.13 N/A N/A 04.019.034S SUP HCPCS C1713 04.019.034S - SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 34MM SELF CUT BOTH IP/OP $579.50 $429.00 $114.94 $588.98 $260.61 $260.61 $260.61 $260.61 $579.13 $579.13 $579.13 $120.71 $579.13 $579.13 $579.13 $579.13 $579.13 $120.70 $579.13 $235.59 $342.56 $579.13 $588.98 $579.13 $579.13 $434.63 $579.13 $579.13 $579.13 $289.57 $289.57 $458.67 $579.13 $463.30 $260.61 $114.94 N/A $336.11 $579.13 $579.13 $579.13 $120.69 $579.13 N/A N/A 04.019.036S SUP HCPCS C1713 04.019.036S - SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 36MM SELF CUT BOTH IP/OP $579.50 $429.00 $114.94 $588.98 $260.61 $260.61 $260.61 $260.61 $579.13 $579.13 $579.13 $120.71 $579.13 $579.13 $579.13 $579.13 $579.13 $120.70 $579.13 $588.98 $342.56 $579.13 $588.98 $579.13 $579.13 $434.63 $579.13 $579.13 $579.13 $289.57 $289.57 $458.67 $579.13 $463.30 $260.61 $114.94 N/A $336.11 $579.13 $347.48 $579.13 $120.69 $579.13 N/A N/A 04.019.038S SUP HCPCS C1713 04.019.038S - SCREW BONE FULTHD 4.5MM 38MM BLUNT TIP SELF CUTTING BOTH IP/OP $579.50 $429.00 $114.94 $588.98 $260.61 $260.61 $260.61 $260.61 $579.13 $579.13 $579.13 $120.71 $579.13 $579.13 $579.13 $579.13 $579.13 $120.70 $579.13 $588.98 $342.56 $579.13 $588.98 $579.13 $579.13 $434.63 $579.13 $579.13 $579.13 $289.57 $289.57 $458.67 $579.13 $463.30 $260.61 $114.94 N/A $336.11 $579.13 $347.48 $579.13 $120.69 $579.13 N/A N/A 04.019.040S SUP HCPCS C1713 04.019.040S - SCREW BONE FULTHD 4.5MM 3.9MM 40MM BLUNT TIP SELF CUTTING BOTH IP/OP $579.50 $429.00 $114.94 $588.98 $260.61 $260.61 $260.61 $260.61 $579.13 $579.13 $579.13 $120.71 $579.13 $579.13 $579.13 $579.13 $579.13 $120.70 $579.13 $588.98 $342.56 $579.13 $588.98 $579.13 $579.13 $434.63 $579.13 $579.13 $579.13 $289.57 $289.57 $458.67 $579.13 $463.30 $260.61 $114.94 N/A $336.11 $579.13 $347.48 $579.13 $120.69 $579.13 N/A N/A 04.019.042S SUP HCPCS C1713 04.019.042S - SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 42MM SELF CUT BOTH IP/OP $579.50 $429.00 $114.94 $588.98 $260.61 $260.61 $260.61 $260.61 $579.13 $579.13 $579.13 $120.71 $579.13 $579.13 $579.13 $579.13 $579.13 $120.70 $579.13 $235.59 $342.56 $579.13 $588.98 $579.13 $579.13 $434.63 $579.13 $579.13 $579.13 $289.57 $289.57 $458.67 $579.13 $463.30 $260.61 $114.94 N/A $336.11 $579.13 $347.48 $579.13 $120.69 $579.13 N/A N/A 04.019.044S SUP HCPCS C1713 04.019.044S - SCREW BONE 3.8MM FULTHD BLUNT 4.5MM 3.9MM 44MM SELF CUT BOTH IP/OP $579.50 $429.00 $114.94 $588.98 $260.61 $260.61 $260.61 $260.61 $579.13 $579.13 $579.13 $120.71 $579.13 $579.13 $579.13 $579.13 $579.13 $120.70 $579.13 $235.59 $342.56 $579.13 $588.98 $579.13 $579.13 $434.63 $579.13 $579.13 $579.13 $289.57 $289.57 $458.67 $579.13 $463.30 $260.61 $114.94 N/A $336.11 $579.13 $347.48 $579.13 $120.69 $579.13 N/A N/A 04.019.046S SUP HCPCS C1713 04.019.046S - SCREW BONE FULTHD 4.5MM 46MM BLUNT TIP SELF CUTTING BOTH IP/OP $579.50 $429.00 $114.94 $588.98 $260.61 $260.61 $260.61 $260.61 $579.13 $579.13 $579.13 $120.71 $579.13 $579.13 $579.13 $579.13 $579.13 $120.70 $579.13 $235.59 $342.56 $579.13 $588.98 $579.13 $579.13 $434.63 $579.13 $579.13 $579.13 $289.57 $289.57 $458.67 $579.13 $463.30 $260.61 $114.94 N/A $336.11 $579.13 $347.48 $579.13 $120.69 $579.13 N/A N/A 04.019.050S SUP HCPCS C1713 04.019.050S - SCREW BN FT 4.5MM 3.9MM 50MM AU STRL MULTILOC BLNT TIP SLF BOTH IP/OP $579.50 $429.00 $114.94 $588.98 $260.61 $260.61 $260.61 $260.61 $579.13 $579.13 $579.13 $120.71 $579.13 $579.13 $579.13 $579.13 $579.13 $120.70 $579.13 $588.98 $342.56 $579.13 $588.98 $579.13 $579.13 $434.63 $579.13 $579.13 $579.13 $289.57 $289.57 $458.67 $579.13 $463.30 $260.61 $114.94 N/A $336.11 $579.13 $579.13 $579.13 $120.69 $579.13 N/A N/A 04.019.180S SUP HCPCS C1713 04.019.180S - NAIL IM LNG STRG 8.5MM 9.5MM 180MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$3,886.88" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.019.195S SUP HCPCS C1713 04.019.195S - NAIL IM LNG STRG 8.5MM 9.5MM 195MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.019.210S SUP HCPCS C1713 04.019.210S - NAIL IM LNG STRG 8.5MM 9.5MM 210MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$3,886.88" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.019.225S SUP HCPCS C1713 04.019.225S - NAIL IM LNG STRG 8.5MM 9.5MM 225MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$3,886.88" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$2,293.14" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.019.240S SUP HCPCS C1713 04.019.240S - NAIL INTRAMEDULLARY LONG STR 8.5MM 240MM CANN ROUND BARREL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.019.255S SUP HCPCS C1713 04.019.255S - NAIL INTRAMEDULLARY MULTILOC TITANIUM ALUMINUM NIOBIUM LONG BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$3,886.88" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$2,293.14" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.019.270S SUP HCPCS C1713 04.019.270S - NAIL INTRAMEDULLARY LONG STR 8.5MM 270MM CANN ROUND BARREL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$2,293.14" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.019.285S SUP HCPCS C1713 04.019.285S - NAIL INTRAMEDULLARY LONG STR 8.5MM 285MM CANN ROUND BARREL BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$2,293.14" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.019.300S SUP HCPCS C1713 04.019.300S - NAIL IM LNG STRG 8.5MM 9.5MM 300MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$3,886.88" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.019.315S SUP HCPCS C1713 04.019.315S - NAIL IM LNG STRG 8.5MM 9.5MM 315MM BLU STRL MULTILOC CNN TI BOTH IP/OP "$3,822.00" "$2,828.00" $758.55 "$3,886.88" "$1,719.86" "$1,719.86" "$1,719.86" "$1,719.86" "$3,821.90" "$3,821.90" "$3,821.90" $796.58 "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" "$3,821.90" $796.53 "$3,821.90" "$1,554.75" "$1,884.20" "$3,821.90" "$3,886.88" "$3,821.90" "$3,821.90" "$2,866.50" "$3,821.90" "$3,821.90" "$3,821.90" "$1,910.95" "$1,910.95" "$3,026.94" "$3,821.90" "$3,057.52" "$1,719.86" $758.55 N/A "$2,216.76" "$3,821.90" "$3,821.90" "$3,821.90" $796.48 "$3,821.90" N/A N/A 04.025.416S SUP HCPCS C1713 04.025.416S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 26MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.418S SUP HCPCS C1713 04.025.418S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 28MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $418.65 $418.65 N/A N/A 04.025.420S SUP HCPCS C1713 04.025.420S - SCREW BONE FULTHD 4MM 30MM T25 STARDRIVE RECESS LOCKING BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $87.25 $418.65 N/A N/A 04.025.422S SUP HCPCS C1713 04.025.422S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 32MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $418.65 $418.65 N/A N/A 04.025.424S SUP HCPCS C1713 04.025.424S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 34MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $418.65 $418.65 N/A N/A 04.025.426S SUP HCPCS C1713 04.025.426S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 36MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.428S SUP HCPCS C1713 04.025.428S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 38MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $87.25 $418.65 N/A N/A 04.025.430S SUP HCPCS C1713 04.025.430S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 40MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $418.65 $418.65 N/A N/A 04.025.432S SUP HCPCS C1713 04.025.432S - SCREW BONE 4MM 42MM T25 STARDRIVE RECESS ANGULAR STABLE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $418.65 $418.65 N/A N/A 04.025.434S SUP HCPCS C1713 04.025.434S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 44MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.436S SUP HCPCS C1713 04.025.436S - SCREW BONE T25 FULTHD BLUNT 4MM 8MM 46MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $87.25 $418.65 N/A N/A 04.025.438S SUP HCPCS C1713 04.025.438S - SCREW BONE FULTHD 4MM 48MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $87.25 $418.65 N/A N/A 04.025.440S SUP HCPCS C1713 04.025.440S - SCREW BONE FULTHD 4MM 50MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $87.25 $418.65 N/A N/A 04.025.442S SUP HCPCS C1713 04.025.442S - SCREW BONE FULTHD 4MM 52MM T25 STARDRIVE RECESS LOCKING BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $87.25 $418.65 N/A N/A 04.025.444S SUP HCPCS C1713 04.025.444S - SCREW BONE FULTHD 4MM 54MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.446S SUP HCPCS C1713 04.025.446S - SCREW BONE FULTHD 4MM 56MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.448S SUP HCPCS C1713 04.025.448S - SCREW BONE FULTHD 4MM 58MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.450S SUP HCPCS C1713 04.025.450S - SCREW BONE FULTHD 4MM 60MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.452S SUP HCPCS C1713 04.025.452S - SCREW BONE FULTHD 4MM 62MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $87.25 $418.65 N/A N/A 04.025.454S SUP HCPCS C1713 04.025.454S - SCREW BONE FULTHD 4MM 64MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.456S SUP HCPCS C1713 04.025.456S - SCREW BONE FULTHD 4MM 66MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.458S SUP HCPCS C1713 04.025.458S - SCREW BONE FULTHD 4MM 68MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.460S SUP HCPCS C1713 04.025.460S - SCREW BONE FULTHD 4MM 70MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.462S SUP HCPCS C1713 04.025.462S - SCREW BONE FULTHD 4MM 72MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.464S SUP HCPCS C1713 04.025.464S - SCREW BONE FULTHD 4MM 74MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.466S SUP HCPCS C1713 04.025.466S - SCREW BONE FULTHD 4MM 76MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.468S SUP HCPCS C1713 04.025.468S - SCREW BONE FULTHD 4MM 78MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.470S SUP HCPCS C1713 04.025.470S - SCREW BONE FULTHD 4MM 80MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.520S SUP HCPCS C1713 04.025.520S - SCREW BONE FULTHD 5MM 8MM 30MM T25 STARDRIVE RECESS SLFTAP BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.522S SUP HCPCS C1713 04.025.522S - SCREW BONE FULTHD 5MM 32MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.524S SUP HCPCS C1713 04.025.524S - SCREW BONE FULTHD 5MM 34MM T25 STARDRIVE RECESS LOCKING ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.526S SUP HCPCS C1713 04.025.526S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 36MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.528S SUP HCPCS C1713 04.025.528S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 38MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.530S SUP HCPCS C1713 04.025.530S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 40MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.532S SUP HCPCS C1713 04.025.532S - SCREW BONE FULTHD 5MM 8MM 42MM T25 STARDRIVE RECESS SLFTAP BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.534S SUP HCPCS C1713 04.025.534S - SCREW BONE FULTHD 5MM 30MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.536S SUP HCPCS C1713 04.025.536S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 46MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.538S SUP HCPCS C1713 04.025.538S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 48MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.540S SUP HCPCS C1713 04.025.540S - SCREW BONE FULTHD 5MM 50MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.542S SUP HCPCS C1713 04.025.542S - SCREW BONE FULTHD 5MM 52MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.544S SUP HCPCS C1713 04.025.544S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 54MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.546S SUP HCPCS C1713 04.025.546S - SCREW BONE FULTHD 5MM 56MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $418.65 $418.65 N/A N/A 04.025.548S SUP HCPCS C1713 04.025.548S - SCREW BONE FULTHD 5MM 58MM T25 STARDRIVE RECESS LOCKING ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $418.65 $418.65 N/A N/A 04.025.550S SUP HCPCS C1713 04.025.550S - SCREW BONE FULTHD 5MM 8MM 60MM T25 STARDRIVE RECESS SLFTAP BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $418.65 $418.65 N/A N/A 04.025.552S SUP HCPCS C1713 04.025.552S - SCREW BONE FULTHD 5MM 8MM 62MM SLFTAP BLUNT TIP T25 BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.554S SUP HCPCS C1713 04.025.554S - SCREW BONE FULTHD 5MM 64MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.556S SUP HCPCS C1713 04.025.556S - SCREW BONE FULTHD 5MM 66MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.558S SUP HCPCS C1713 04.025.558S - SCREW BONE FULTHD 5MM 68MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $87.25 $418.65 N/A N/A 04.025.560S SUP HCPCS C1713 04.025.560S - SCREW BONE FULTHD 5MM 70MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.562S SUP HCPCS C1713 04.025.562S - SCREW BONE FULTHD 5MM 72MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $87.25 $418.65 N/A N/A 04.025.564S SUP HCPCS C1713 04.025.564S - SCREW BONE FULTHD 5MM 8MM 74MM SLFTAP BLUNT TIP T25 BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $425.78 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $87.25 $418.65 N/A N/A 04.025.566S SUP HCPCS C1713 04.025.566S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 76MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $418.65 $418.65 $87.25 $418.65 N/A N/A 04.025.568S SUP HCPCS C1713 04.025.568S - SCREW BONE FULTHD 5MM 78MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $87.25 $418.65 N/A N/A 04.025.570S SUP HCPCS C1713 04.025.570S - SCREW BONE FULTHD 5MM 80MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $418.65 $418.65 N/A N/A 04.025.575S SUP HCPCS C1713 04.025.575S - SCREW BONE T25 FULTHD BLUNT 5MM 8MM 85MM SELF TAP STARDRIVE BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $87.25 $418.65 N/A N/A 04.025.580S SUP HCPCS C1713 04.025.580S - SCREW BONE FULTHD 5MM 90MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $418.65 $418.65 N/A N/A 04.025.585S SUP HCPCS C1713 04.025.585S - SCREW BONE FULTHD 5MM 95MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $418.65 $418.65 N/A N/A 04.025.590S SUP HCPCS C1713 04.025.590S - SCREW BONE FULTHD 5MM 100MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $419.00 $310.00 $83.09 $425.78 $188.39 $188.39 $188.39 $188.39 $418.65 $418.65 $418.65 $87.26 $418.65 $418.65 $418.65 $418.65 $418.65 $87.25 $418.65 $170.31 $247.63 $418.65 $425.78 $418.65 $418.65 $314.25 $418.65 $418.65 $418.65 $209.33 $209.33 $331.57 $418.65 $334.92 $188.39 $83.09 N/A $243.02 $418.65 $251.19 $418.65 $87.25 $418.65 N/A N/A 04.025.622S SUP HCPCS C1713 04.025.622S - SCREW BONE FULTHD 6MM 32MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.624S SUP HCPCS C1713 04.025.624S - SCREW BONE FULTHD 6MM 34MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.626S SUP HCPCS C1713 04.025.626S - SCREW BONE FULTHD 6MM 36MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $406.48 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.628S SUP HCPCS C1713 04.025.628S - SCREW BONE FULTHD 6MM 38MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $406.48 $406.48 $406.48 $406.48 N/A N/A 04.025.630S SUP HCPCS C1713 04.025.630S - SCREW BONE FULTHD 6MM 40MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $406.48 $406.48 N/A N/A 04.025.632S SUP HCPCS C1713 04.025.632S - SCREW BONE FULTHD 6MM 42MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.634S SUP HCPCS C1713 04.025.634S - SCREW BONE FULTHD 6MM 44MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $406.48 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.636S SUP HCPCS C1713 04.025.636S - SCREW BONE FULTHD 6MM 46MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.638S SUP HCPCS C1713 04.025.638S - SCREW BONE FULTHD 6MM 48MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.640S SUP HCPCS C1713 04.025.640S - SCREW BONE FULTHD 6MM 50MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.642S SUP HCPCS C1713 04.025.642S - SCREW BONE FULTHD 6MM 52MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $406.48 $406.48 $84.71 $406.48 N/A N/A 04.025.644S SUP HCPCS C1713 04.025.644S - SCREW BONE FULTHD 6MM 54MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.646S SUP HCPCS C1713 04.025.646S - SCREW BONE FULTHD 6MM 56MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.648S SUP HCPCS C1713 04.025.648S - SCREW BONE FULTHD 6MM 58MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $406.48 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.650S SUP HCPCS C1713 04.025.650S - SCREW BONE FULTHD 6MM 60MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $406.48 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.652S SUP HCPCS C1713 04.025.652S - SCREW BONE FULTHD 6MM 62MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $406.48 $406.48 $406.48 $406.48 N/A N/A 04.025.654S SUP HCPCS C1713 04.025.654S - SCREW BONE FULTHD 6MM 64MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $406.48 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $406.48 $406.48 N/A N/A 04.025.656S SUP HCPCS C1713 04.025.656S - SCREW BONE FULTHD 6MM 66MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $406.48 $406.48 N/A N/A 04.025.658S SUP HCPCS C1713 04.025.658S - SCREW BONE FULTHD 6MM 68MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.660S SUP HCPCS C1713 04.025.660S - SCREW BONE FULTHD 6MM 70MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $406.48 $406.48 N/A N/A 04.025.662S SUP HCPCS C1713 04.025.662S - SCREW BONE FULTHD 6MM 72MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.664S SUP HCPCS C1713 04.025.664S - SCREW BONE FULTHD 6MM 74MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.666S SUP HCPCS C1713 04.025.666S - SCREW BONE FULTHD 6MM 78MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $406.48 $406.48 N/A N/A 04.025.668S SUP HCPCS C1713 04.025.668S - SCREW BONE FULTHD 6MM 78MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $406.48 $406.48 $84.71 $406.48 N/A N/A 04.025.670S SUP HCPCS C1713 04.025.670S - SCREW BONE FULTHD 6MM 80MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.675S SUP HCPCS C1713 04.025.675S - SCREW BONE FULTHD 6MM 85MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.680S SUP HCPCS C1713 04.025.680S - SCREW BONE FULTHD 6MM 90MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $406.48 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $406.48 $406.48 $84.71 $406.48 N/A N/A 04.025.685S SUP HCPCS C1713 04.025.685S - SCREW BONE FULTHD 6MM 95MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $406.48 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.690S SUP HCPCS C1713 04.025.690S - SCREW BONE FULTHD 6MM 100MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $406.48 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.695S SUP HCPCS C1713 04.025.695S - SCREW BONE FULTHD 6MM 105MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.700S SUP HCPCS C1713 04.025.700S - SCREW BONE FULTHD 6MM 110MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $406.48 $406.48 $84.71 $406.48 N/A N/A 04.025.705S SUP HCPCS C1713 04.025.705S - SCREW BONE FULTHD 6MM 115MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $162.59 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $406.48 $406.48 $84.71 $406.48 N/A N/A 04.025.710S SUP HCPCS C1713 04.025.710S - SCREW BONE FULTHD 6MM 120MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $406.48 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $84.71 $406.48 N/A N/A 04.025.715S SUP HCPCS C1713 04.025.715S - SCREW BONE FULTHD 6MM 125MM LOCKING STARDRIVE RECESS ASLS BOTH IP/OP $406.50 $301.00 $80.68 $406.48 $182.92 $182.92 $182.92 $182.92 $406.48 $406.48 $406.48 $84.72 $406.48 $406.48 $406.48 $406.48 $406.48 $84.71 $406.48 $406.48 $240.43 $406.48 $406.48 $406.48 $406.48 $304.88 $406.48 $406.48 $406.48 $203.24 $203.24 $321.93 $406.48 $325.18 $182.92 $80.68 N/A $235.77 $406.48 $243.89 $406.48 $406.48 $406.48 N/A N/A 04.030.030S SUP HCPCS C1713 04.030.030S - NAIL INTRAMEDULLARY 10MM 30CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.031S SUP HCPCS C1713 04.030.031S - NAIL INTRAMEDULLARY 10MM 300MM ANATOMIC CANN ROUND BARREL BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.032S SUP HCPCS C1713 04.030.032S - NAIL INTRAMEDULLARY 10MM 32CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.033S SUP HCPCS C1713 04.030.033S - NAIL INTRAMEDULLARY 10MM 320MM ANATOMIC CANN ROUND BARREL BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.034S SUP HCPCS C1713 04.030.034S - NAIL INTRAMEDULLARY 10MM 34CM CANN NAIL-EX TITANIUM FEMUR BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.035S SUP HCPCS C1713 04.030.035S - NAIL INTRAMEDULLARY 10MM 340MM ANATOMIC CANN ROUND BARREL BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.036S SUP HCPCS C1713 04.030.036S - NAIL INTRAMEDULLARY 10MM 36CM CANN NAIL-EX TITANIUM RIGHT BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.037S SUP HCPCS C1713 04.030.037S - NAIL INTRAMEDULLARY 10MM 360MM ANATOMIC CANN ROUND BARREL BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.038S SUP HCPCS C1713 04.030.038S - NAIL INTRAMEDULLARY 10MM 38CM CANN NAIL-EX TITANIUM FEMUR BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.039S SUP HCPCS C1713 04.030.039S - NAIL INTRAMEDULLARY 10MM 380MM ANATOMIC CANN ROUND BARREL BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.040S SUP HCPCS C1713 04.030.040S - NAIL INTRAMEDULLARY 10MM 40CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.041S SUP HCPCS C1713 04.030.041S - NAIL INTRAMEDULLARY 10MM 400MM ANATOMIC CANN ROUND BARREL BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.042S SUP HCPCS C1713 04.030.042S - NAIL INTRAMEDULLARY 10MM 42CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.043S SUP HCPCS C1713 04.030.043S - NAIL INTRAMEDULLARY 10MM 420MM ANATOMIC CANN ROUND BARREL BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.044S SUP HCPCS C1713 04.030.044S - NAIL INTRAMEDULLARY 10MM 44CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.045S SUP HCPCS C1713 04.030.045S - NAIL INTRAMEDULLARY 10MM 440MM ANATOMIC CANN ROUND BARREL BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.046S SUP HCPCS C1713 04.030.046S - NAIL INTRAMEDULLARY 10MM 46CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.047S SUP HCPCS C1713 04.030.047S - NAIL INTRAMEDULLARY 10MM 460MM ANATOMIC CANN ROUND BARREL BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.048S SUP HCPCS C1713 04.030.048S - NAIL INTRAMEDULLARY 10MM 48CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.049S SUP HCPCS C1713 04.030.049S - NAIL INTRAMEDULLARY 10MM 480MM ANATOMIC CANN ROUND BARREL BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.130S SUP HCPCS C1713 04.030.130S - NAIL INTRAMEDULLARY 11MM 30CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.131S SUP HCPCS C1713 04.030.131S - NAIL INTRAMEDULLARY 11MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.132S SUP HCPCS C1713 04.030.132S - NAIL INTRAMEDULLARY 11MM 32CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.133S SUP HCPCS C1713 04.030.133S - NAIL INTRAMEDULLARY 11MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.134S SUP HCPCS C1713 04.030.134S - NAIL IM 11MM 340MM LGHT GRN STRL NLEX CNN LAT ENTRY TI AL BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.135S SUP HCPCS C1713 04.030.135S - NAIL INTRAMEDULLARY 11MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.136S SUP HCPCS C1713 04.030.136S - NAIL INTRAMEDULLARY 11MM 36CM CANN NAIL-EX TITANIUM FEMUR BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.137S SUP HCPCS C1713 04.030.137S - NAIL INTRAMEDULLARY 11MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.138S SUP HCPCS C1713 04.030.138S - NAIL INTRAMEDULLARY 11MM 380MM CANN LATERAL ENTRY EXPERT BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.139S SUP HCPCS C1713 04.030.139S - NAIL INTRAMEDULLARY 11MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.140S SUP HCPCS C1713 04.030.140S - NAIL INTRAMEDULLARY 11MM 40CM CANN NAIL-EX TITANIUM FEMUR BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.141S SUP HCPCS C1713 04.030.141S - NAIL INTRAMEDULLARY 11MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.142S SUP HCPCS C1713 04.030.142S - NAIL INTRAMEDULLARY 11MM 42CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.143S SUP HCPCS C1713 04.030.143S - NAIL INTRAMEDULLARY 11MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.144S SUP HCPCS C1713 04.030.144S - NAIL INTRAMEDULLARY 11MM 44CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.145S SUP HCPCS C1713 04.030.145S - NAIL INTRAMEDULLARY 11MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.146S SUP HCPCS C1713 04.030.146S - NAIL INTRAMEDULLARY 11MM 46CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.147S SUP HCPCS C1713 04.030.147S - NAIL INTRAMEDULLARY 11MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.148S SUP HCPCS C1713 04.030.148S - NAIL INTRAMEDULLARY 11MM 48CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.149S SUP HCPCS C1713 04.030.149S - NAIL INTRAMEDULLARY 11MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.230S SUP HCPCS C1713 04.030.230S - NAIL INTRAMEDULLARY 12MM 30CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.231S SUP HCPCS C1713 04.030.231S - NAIL INTRAMEDULLARY 12MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.232S SUP HCPCS C1713 04.030.232S - NAIL INTRAMEDULLARY 12MM 32CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.233S SUP HCPCS C1713 04.030.233S - NAIL INTRAMEDULLARY 12MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.234S SUP HCPCS C1713 04.030.234S - NAIL INTRAMEDULLARY 12MM 34CM CANN NAIL-EX TITANIUM FEMUR BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.235S SUP HCPCS C1713 04.030.235S - NAIL INTRAMEDULLARY 12MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.236S SUP HCPCS C1713 04.030.236S - NAIL INTRAMEDULLARY 12MM 36CM CANN NAIL-EX TITANIUM FEMUR BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.237S SUP HCPCS C1713 04.030.237S - NAIL INTRAMEDULLARY 12MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.238S SUP HCPCS C1713 04.030.238S - NAIL INTRAMEDULLARY 12MM 38CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.239S SUP HCPCS C1713 04.030.239S - NAIL INTRAMEDULLARY 12MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.240S SUP HCPCS C1713 04.030.240S - NAIL INTRAMEDULLARY 12MM 40CM CANN NAIL-EX TITANIUM FEMUR BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.241S SUP HCPCS C1713 04.030.241S - NAIL INTRAMEDULLARY 12MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.242S SUP HCPCS C1713 04.030.242S - NAIL INTRAMEDULLARY 12MM 42CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.243S SUP HCPCS C1713 04.030.243S - NAIL INTRAMEDULLARY 12MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.244S SUP HCPCS C1713 04.030.244S - NAIL INTRAMEDULLARY 12MM 44CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.245S SUP HCPCS C1713 04.030.245S - NAIL INTRAMEDULLARY 12MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.246S SUP HCPCS C1713 04.030.246S - NAIL INTRAMEDULLARY 12MM 46CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.247S SUP HCPCS C1713 04.030.247S - NAIL INTRAMEDULLARY 12MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.248S SUP HCPCS C1713 04.030.248S - NAIL INTRAMEDULLARY 12MM 48CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.249S SUP HCPCS C1713 04.030.249S - NAIL INTRAMEDULLARY 12MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.330S SUP HCPCS C1713 04.030.330S - NAIL INTRAMEDULLARY 13MM 30CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.331S SUP HCPCS C1713 04.030.331S - NAIL INTRAMEDULLARY 13MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.332S SUP HCPCS C1713 04.030.332S - NAIL INTRAMEDULLARY 13MM 32CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.333S SUP HCPCS C1713 04.030.333S - NAIL INTRAMEDULLARY 13MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.334S SUP HCPCS C1713 04.030.334S - NAIL INTRAMEDULLARY 13MM 34CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.335S SUP HCPCS C1713 04.030.335S - NAIL INTRAMEDULLARY 13MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.336S SUP HCPCS C1713 04.030.336S - NAIL INTRAMEDULLARY 13MM 36CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.337S SUP HCPCS C1713 04.030.337S - NAIL INTRAMEDULLARY 13MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.338S SUP HCPCS C1713 04.030.338S - NAIL INTRAMEDULLARY 13MM 38CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.339S SUP HCPCS C1713 04.030.339S - NAIL INTRAMEDULLARY 13MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.340S SUP HCPCS C1713 04.030.340S - NAIL INTRAMEDULLARY 13MM 40CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.341S SUP HCPCS C1713 04.030.341S - NAIL INTRAMEDULLARY 13MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.342S SUP HCPCS C1713 04.030.342S - NAIL INTRAMEDULLARY 13MM 42CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.343S SUP HCPCS C1713 04.030.343S - NAIL INTRAMEDULLARY 13MM 42CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.344S SUP HCPCS C1713 04.030.344S - NAIL INTRAMEDULLARY 13MM 44CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.345S SUP HCPCS C1713 04.030.345S - NAIL INTRAMEDULLARY 13MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.346S SUP HCPCS C1713 04.030.346S - NAIL INTRAMEDULLARY 13MM 46CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.347S SUP HCPCS C1713 04.030.347S - NAIL INTRAMEDULLARY 13MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.348S SUP HCPCS C1713 04.030.348S - NAIL INTRAMEDULLARY 13MM 48CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.349S SUP HCPCS C1713 04.030.349S - NAIL INTRAMEDULLARY 13MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.430S SUP HCPCS C1713 04.030.430S - NAIL INTRAMEDULLARY 14MM 30CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.431S SUP HCPCS C1713 04.030.431S - NAIL INTRAMEDULLARY 14MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.432S SUP HCPCS C1713 04.030.432S - NAIL INTRAMEDULLARY 14MM 32CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.433S SUP HCPCS C1713 04.030.433S - NAIL INTRAMEDULLARY 14MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.434S SUP HCPCS C1713 04.030.434S - NAIL INTRAMEDULLARY 14MM 34CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.435S SUP HCPCS C1713 04.030.435S - NAIL INTRAMEDULLARY 14MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.436S SUP HCPCS C1713 04.030.436S - NAIL INTRAMEDULLARY 14MM 36CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.437S SUP HCPCS C1713 04.030.437S - NAIL INTRAMEDULLARY 14MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.438S SUP HCPCS C1713 04.030.438S - NAIL INTRAMEDULLARY 14MM 38CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.439S SUP HCPCS C1713 04.030.439S - NAIL INTRAMEDULLARY 14MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.440S SUP HCPCS C1713 04.030.440S - NAIL INTRAMEDULLARY 14MM 40CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.441S SUP HCPCS C1713 04.030.441S - NAIL INTRAMEDULLARY 14MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.442S SUP HCPCS C1713 04.030.442S - NAIL INTRAMEDULLARY 14MM 42CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.443S SUP HCPCS C1713 04.030.443S - NAIL INTRAMEDULLARY 14MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.444S SUP HCPCS C1713 04.030.444S - NAIL INTRAMEDULLARY 14MM 44CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.445S SUP HCPCS C1713 04.030.445S - NAIL INTRAMEDULLARY 14MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.446S SUP HCPCS C1713 04.030.446S - NAIL INTRAMEDULLARY 14MM 46CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.447S SUP HCPCS C1713 04.030.447S - NAIL INTRAMEDULLARY 14MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.448S SUP HCPCS C1713 04.030.448S - NAIL INTRAMEDULLARY 14MM 48CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.449S SUP HCPCS C1713 04.030.449S - NAIL INTRAMEDULLARY 14MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.530S SUP HCPCS C1713 04.030.530S - NAIL INTRAMEDULLARY 15MM 30CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.531S SUP HCPCS C1713 04.030.531S - NAIL INTRAMEDULLARY 15MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.532S SUP HCPCS C1713 04.030.532S - NAIL INTRAMEDULLARY 15MM 32CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.533S SUP HCPCS C1713 04.030.533S - NAIL INTRAMEDULLARY 15MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.534S SUP HCPCS C1713 04.030.534S - NAIL INTRAMEDULLARY 15MM 34CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.535S SUP HCPCS C1713 04.030.535S - NAIL INTRAMEDULLARY 15MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.536S SUP HCPCS C1713 04.030.536S - NAIL INTRAMEDULLARY 15MM 36CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.537S SUP HCPCS C1713 04.030.537S - NAIL INTRAMEDULLARY 15MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.538S SUP HCPCS C1713 04.030.538S - NAIL INTRAMEDULLARY 15MM 38CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.539S SUP HCPCS C1713 04.030.539S - NAIL INTRAMEDULLARY 15MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.540S SUP HCPCS C1713 04.030.540S - NAIL INTRAMEDULLARY 15MM 40CM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.541S SUP HCPCS C1713 04.030.541S - NAIL INTRAMEDULLARY 15MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.542S SUP HCPCS C1713 04.030.542S - NAIL INTRAMEDULLARY 15MM 42CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.543S SUP HCPCS C1713 04.030.543S - NAIL INTRAMEDULLARY 15MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.544S SUP HCPCS C1713 04.030.544S - NAIL INTRAMEDULLARY 15MM 44CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.545S SUP HCPCS C1713 04.030.545S - NAIL INTRAMEDULLARY 15MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.546S SUP HCPCS C1713 04.030.546S - NAIL INTRAMEDULLARY 15MM 46CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.547S SUP HCPCS C1713 04.030.547S - NAIL INTRAMEDULLARY 15MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.548S SUP HCPCS C1713 04.030.548S - NAIL INTRAMEDULLARY 15MM 48CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.549S SUP HCPCS C1713 04.030.549S - NAIL INTRAMEDULLARY 15MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.630S SUP HCPCS C1713 04.030.630S - NAIL INTRAMEDULLARY 16MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.631S SUP HCPCS C1713 04.030.631S - NAIL INTRAMEDULLARY 16MM 300MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.632S SUP HCPCS C1713 04.030.632S - NAIL INTRAMEDULLARY 16MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.633S SUP HCPCS C1713 04.030.633S - NAIL INTRAMEDULLARY 16MM 320MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.634S SUP HCPCS C1713 04.030.634S - NAIL INTRAMEDULLARY 16MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.635S SUP HCPCS C1713 04.030.635S - NAIL INTRAMEDULLARY 16MM 340MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.636S SUP HCPCS C1713 04.030.636S - NAIL INTRAMEDULLARY 16MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.637S SUP HCPCS C1713 04.030.637S - NAIL INTRAMEDULLARY 16MM 360MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.638S SUP HCPCS C1713 04.030.638S - NAIL INTRAMEDULLARY 16MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.639S SUP HCPCS C1713 04.030.639S - NAIL INTRAMEDULLARY 16MM 380MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.640S SUP HCPCS C1713 04.030.640S - NAIL INTRAMEDULLARY 16MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.641S SUP HCPCS C1713 04.030.641S - NAIL INTRAMEDULLARY 16MM 400MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.642S SUP HCPCS C1713 04.030.642S - NAIL INTRAMEDULLARY 16MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.643S SUP HCPCS C1713 04.030.643S - NAIL INTRAMEDULLARY 16MM 420MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.644S SUP HCPCS C1713 04.030.644S - NAIL INTRAMEDULLARY 16MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.645S SUP HCPCS C1713 04.030.645S - NAIL INTRAMEDULLARY 16MM 440MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.646S SUP HCPCS C1713 04.030.646S - NAIL INTRAMEDULLARY 16MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.647S SUP HCPCS C1713 04.030.647S - NAIL INTRAMEDULLARY 16MM 460MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.648S SUP HCPCS C1713 04.030.648S - NAIL INTRAMEDULLARY 16MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.649S SUP HCPCS C1713 04.030.649S - NAIL INTRAMEDULLARY 16MM 480MM ANATOMIC CANN HELICAL FLUTED BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.930S SUP HCPCS C1713 04.030.930S - NAIL INTRAMEDULLARY 9MM 30CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.931S SUP HCPCS C1713 04.030.931S - NAIL INTRAMEDULLARY 9MM 30CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.932S SUP HCPCS C1713 04.030.932S - NAIL INTRAMEDULLARY 9MM 320MM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.933S SUP HCPCS C1713 04.030.933S - NAIL INTRAMEDULLARY 9MM 320MM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.934S SUP HCPCS C1713 04.030.934S - NAIL INTRAMEDULLARY 9MM 340MM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.935S SUP HCPCS C1713 04.030.935S - NAIL INTRAMEDULLARY 9MM 340MM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.936S SUP HCPCS C1713 04.030.936S - NAIL INTRAMEDULLARY 9MM 360MM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.937S SUP HCPCS C1713 04.030.937S - NAIL INTRAMEDULLARY 9MM 36CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.938S SUP HCPCS C1713 04.030.938S - NAIL INTRAMEDULLARY 9MM 380MM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.939S SUP HCPCS C1713 04.030.939S - NAIL INTRAMEDULLARY 9MM 380MM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.940S SUP HCPCS C1713 04.030.940S - NAIL INTRAMEDULLARY 9MM 400MM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.941S SUP HCPCS C1713 04.030.941S - NAIL INTRAMEDULLARY 9MM 400MM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$3,685.58" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.942S SUP HCPCS C1713 04.030.942S - NAIL INTRAMEDULLARY 9MM 420MM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.943S SUP HCPCS C1713 04.030.943S - NAIL INTRAMEDULLARY 9MM 420MM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.944S SUP HCPCS C1713 04.030.944S - NAIL INTRAMEDULLARY 9MM 44CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" "$3,685.58" "$3,685.58" N/A N/A 04.030.945S SUP HCPCS C1713 04.030.945S - NAIL INTRAMEDULLARY 9MM 44CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.946S SUP HCPCS C1713 04.030.946S - NAIL INTRAMEDULLARY 9MM 46CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.947S SUP HCPCS C1713 04.030.947S - NAIL INTRAMEDULLARY 9MM 46CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.948S SUP HCPCS C1713 04.030.948S - NAIL INTRAMEDULLARY 9MM 48CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$3,685.58" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.030.949S SUP HCPCS C1713 04.030.949S - NAIL INTRAMEDULLARY 9MM 48CM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$3,686.00" "$2,728.00" $731.50 "$3,685.58" "$1,658.51" "$1,658.51" "$1,658.51" "$1,658.51" "$3,685.58" "$3,685.58" "$3,685.58" $768.17 "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" $768.12 "$3,685.58" "$1,474.23" "$1,816.99" "$3,685.58" "$3,685.58" "$3,685.58" "$3,685.58" "$2,764.50" "$3,685.58" "$3,685.58" "$3,685.58" "$1,842.79" "$1,842.79" "$2,918.98" "$3,685.58" "$2,948.46" "$1,658.51" $731.50 N/A "$2,137.88" "$3,685.58" "$2,211.35" "$3,685.58" $768.07 "$3,685.58" N/A N/A 04.031.000S SUP HCPCS C1713 04.031.000S - CAP END 0MM T40 STARDRIVE RECESS CANN LATERAL ENTRY NAIL-EX BOTH IP/OP $389.50 $288.00 $77.28 $396.00 $175.22 $175.22 $175.22 $175.22 $389.38 $389.38 $389.38 $81.16 $389.38 $389.38 $389.38 $389.38 $389.38 $81.15 $389.38 $158.40 $230.32 $389.38 $396.00 $389.38 $389.38 $292.13 $389.38 $389.38 $389.38 $194.69 $194.69 $308.39 $389.38 $311.50 $175.22 $77.28 N/A $225.91 $389.38 $233.63 $389.38 $81.15 $389.38 N/A N/A 04.031.001S SUP HCPCS C1713 04.031.001S - CAP END 5MM T40 LATERAL ENTRY EXTN STARDRIVE RECESS NAIL-EX BOTH IP/OP $389.50 $288.00 $77.28 $396.00 $175.22 $175.22 $175.22 $175.22 $389.38 $389.38 $389.38 $81.16 $389.38 $389.38 $389.38 $389.38 $389.38 $81.15 $389.38 $396.00 $230.32 $389.38 $396.00 $389.38 $389.38 $292.13 $389.38 $389.38 $389.38 $194.69 $194.69 $308.39 $389.38 $311.50 $175.22 $77.28 N/A $225.91 $389.38 $233.63 $389.38 $81.15 $389.38 N/A N/A 04.031.002S SUP HCPCS C1713 04.031.002S - CAP END 10MM T40 EXTENDED STARDRIVE RECESS NAIL-EX TITANIUM BOTH IP/OP $389.50 $288.00 $77.28 $396.00 $175.22 $175.22 $175.22 $175.22 $389.38 $389.38 $389.38 $81.16 $389.38 $389.38 $389.38 $389.38 $389.38 $81.15 $389.38 $396.00 $230.32 $389.38 $396.00 $389.38 $389.38 $292.13 $389.38 $389.38 $389.38 $194.69 $194.69 $308.39 $389.38 $311.50 $175.22 $77.28 N/A $225.91 $389.38 $233.63 $389.38 $81.15 $389.38 N/A N/A 04.031.003S SUP HCPCS C1713 04.031.003S - CAP END 15MM T40 LATERAL ENTRY EXTN STARDRIVE RECESS NAIL-EX BOTH IP/OP $389.50 $288.00 $77.28 $396.00 $175.22 $175.22 $175.22 $175.22 $389.38 $389.38 $389.38 $81.16 $389.38 $389.38 $389.38 $389.38 $389.38 $81.15 $389.38 $396.00 $230.32 $389.38 $396.00 $389.38 $389.38 $292.13 $389.38 $389.38 $389.38 $194.69 $194.69 $308.39 $389.38 $311.50 $175.22 $77.28 N/A $225.91 $389.38 $233.63 $389.38 $81.15 $389.38 N/A N/A 04.031.021 SUP HCPCS C1713 04.031.021 - SCREW BONE PTHRD 5MM 55MM T25 STARDRIVE RECESS SLFTAP BLUNT BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $327.38 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $193.14 $321.90 $67.08 $321.90 N/A N/A 04.031.022 SUP HCPCS C1713 04.031.022 - SCREW BONE PTHRD 5MM 60MM T25 STARDRIVE RECESS SLFTAP BLUNT BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $130.95 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $321.90 $321.90 $67.08 $321.90 N/A N/A 04.031.023 SUP HCPCS C1713 04.031.023 - SCREW BONE STANDARD PTHRD BLUNT 5MM 8.2MM 65MM SELF TAP SELF BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $327.38 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $321.90 $321.90 $67.08 $321.90 N/A N/A 04.031.024 SUP HCPCS C1713 04.031.024 - SCREW BONE STANDARD PTHRD BLUNT 5MM 8.2MM 70MM SELF TAP SELF BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $130.95 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $321.90 $321.90 $67.08 $321.90 N/A N/A 04.031.025 SUP HCPCS C1713 04.031.025 - SCREW BONE PTHRD 5MM 75MM RECONSTRUCTION STARDRIVE RECESS BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $327.38 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $193.14 $321.90 $67.08 $321.90 N/A N/A 04.031.026 SUP HCPCS C1713 04.031.026 - SCREW BONE PTHRD 5MM 80MM RECONSTRUCTION STARDRIVE RECESS BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $130.95 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $193.14 $321.90 $67.08 $321.90 N/A N/A 04.031.027 SUP HCPCS C1713 04.031.027 - SCREW BONE PTHRD 5MM 85MM RECONSTRUCTION STARDRIVE RECESS BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $327.38 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $193.14 $321.90 $67.08 $321.90 N/A N/A 04.031.028 SUP HCPCS C1713 04.031.028 - SCREW BONE PTHRD 5MM 90MM RECONSTRUCTION STARDRIVE RECESS BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $130.95 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $193.14 $321.90 $67.08 $321.90 N/A N/A 04.031.029 SUP HCPCS C1713 04.031.029 - SCREW BONE PTHRD 5MM 3.2MM 95MM T25 STARDRIVE RECESS BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $130.95 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $193.14 $321.90 $321.90 $321.90 N/A N/A 04.031.030 SUP HCPCS C1713 04.031.030 - SCREW BONE PTHRD 5MM 100MM RECONSTRUCTION STARDRIVE RECESS BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $130.95 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $193.14 $321.90 $321.90 $321.90 N/A N/A 04.031.031 SUP HCPCS C1713 04.031.031 - SCREW BONE PTHRD 5MM 105MM RECONSTRUCTION STARDRIVE RECESS BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $130.95 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $193.14 $321.90 $67.08 $321.90 N/A N/A 04.031.032 SUP HCPCS C1713 04.031.032 - SCREW BONE PTHRD 5MM 110MM RECONSTRUCTION STARDRIVE RECESS BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $130.95 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $321.90 $321.90 $67.08 $321.90 N/A N/A 04.031.033 SUP HCPCS C1713 04.031.033 - SCREW BONE PTHRD 5MM 115MM RECONSTRUCTION STARDRIVE RECESS BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $130.95 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $193.14 $321.90 $67.08 $321.90 N/A N/A 04.031.034 SUP HCPCS C1713 04.031.034 - SCREW BONE PTHRD 5MM 120MM RECONSTRUCTION STARDRIVE RECESS BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $130.95 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $193.14 $321.90 $67.08 $321.90 N/A N/A 04.031.035 SUP HCPCS C1713 04.031.035 - SCREW BONE PTHRD 5MM 125MM RECONSTRUCTION STARDRIVE RECESS BOTH IP/OP $322.00 $238.00 $63.89 $327.38 $144.86 $144.86 $144.86 $144.86 $321.90 $321.90 $321.90 $67.09 $321.90 $321.90 $321.90 $321.90 $321.90 $67.09 $321.90 $327.38 $190.40 $321.90 $327.38 $321.90 $321.90 $241.50 $321.90 $321.90 $321.90 $160.95 $160.95 $254.94 $321.90 $257.52 $144.86 $63.89 N/A $186.76 $321.90 $193.14 $321.90 $67.08 $321.90 N/A N/A 04.031.924S SUP HCPCS C1713 04.031.924S - NAIL INTRAMEDULLARY 8.2MM 240MM LATERAL ENTRY EXPERT BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.925S SUP HCPCS C1713 04.031.925S - NAIL INTRAMEDULLARY 8.2MM 240MM LATERAL ENTRY EXPERT BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.926S SUP HCPCS C1713 04.031.926S - NAIL INTRAMEDULLARY 8.2MM 260MM LATERAL ENTRY EXPERT BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.927S SUP HCPCS C1713 04.031.927S - NAIL INTRAMEDULLARY 8.2MM 260MM LATERAL ENTRY EXPERT BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.928S SUP HCPCS C1713 04.031.928S - NAIL INTRAMEDULLARY 8.2MM 280MM LATERAL ENTRY EXPERT BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.929S SUP HCPCS C1713 04.031.929S - NAIL INTRAMEDULLARY 8.2MM 280MM LATERAL ENTRY EXPERT BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" "$2,807.18" "$2,807.18" N/A N/A 04.031.930S SUP HCPCS C1713 04.031.930S - NAIL INTRAMEDULLARY 8.2MM 300MM LATERAL ENTRY EXPERT BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" "$2,807.18" "$2,807.18" N/A N/A 04.031.931S SUP HCPCS C1713 04.031.931S - NAIL INTRAMEDULLARY 8.2MM 300MM LATERAL ENTRY EXPERT BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" "$2,807.18" "$2,807.18" N/A N/A 04.031.932S SUP HCPCS C1713 04.031.932S - NAIL INTRAMEDULLARY 8.2MM 320MM LATERAL ENTRY TITANIUM BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.933S SUP HCPCS C1713 04.031.933S - NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.934S SUP HCPCS C1713 04.031.934S - NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.935S SUP HCPCS C1713 04.031.935S - NAIL INTRAMEDULLARY 8.2MM 340MM LATERAL ENTRY NAIL-EX BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.936S SUP HCPCS C1713 04.031.936S - NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.937S SUP HCPCS C1713 04.031.937S - NAIL INTRAMEDULLARY 8.2MM LATERAL ENTRY TITANIUM PEDIATRIC BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.938S SUP HCPCS C1713 04.031.938S - NAIL INTRAMEDULLARY 380MM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.939S SUP HCPCS C1713 04.031.939S - NAIL INTRAMEDULLARY 380MM CANN LATERAL ENTRY NAIL-EX BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.940S SUP HCPCS C1713 04.031.940S - NAIL INTRAMEDULLARY 8.2MM 400MM LATERAL ENTRY EXPERT BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.941S SUP HCPCS C1713 04.031.941S - NAIL INTRAMEDULLARY 8.2MM 400MM LATERAL ENTRY EXPERT BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.944S SUP HCPCS C1713 04.031.944S - NAIL INTRAMEDULLARY 9MM 240MM LATERAL ENTRY CANN EXPERT DARK BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" "$2,807.18" "$2,807.18" N/A N/A 04.031.945S SUP HCPCS C1713 04.031.945S - NAIL INTRAMEDULLARY 9MM 240MM LATERAL ENTRY CANN EXPERT DARK BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" "$2,807.18" "$2,807.18" N/A N/A 04.031.946S SUP HCPCS C1713 04.031.946S - NAIL INTRAMEDULLARY 9MM 260MM LATERAL ENTRY CANN EXPERT DARK BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$2,807.18" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.947S SUP HCPCS C1713 04.031.947S - NAIL INTRAMEDULLARY 9MM 260MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.948S SUP HCPCS C1713 04.031.948S - NAIL INTRAMEDULLARY 9MM 280MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.949S SUP HCPCS C1713 04.031.949S - NAIL INTRAMEDULLARY 9MM 280MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.950S SUP HCPCS C1713 04.031.950S - NAIL INTRAMEDULLARY 9MM 300MM LATERAL ENTRY CANN HELICAL BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.951S SUP HCPCS C1713 04.031.951S - NAIL INTRAMEDULLARY 9MM 300MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.952S SUP HCPCS C1713 04.031.952S - NAIL INTRAMEDULLARY 9MM 320MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$2,807.18" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.953S SUP HCPCS C1713 04.031.953S - NAIL INTRAMEDULLARY 9MM 320MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.954S SUP HCPCS C1713 04.031.954S - NAIL INTRAMEDULLARY 9MM 340MM LATERAL ENTRY TITANIUM BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.955S SUP HCPCS C1713 04.031.955S - NAIL INTRAMEDULLARY 9MM 340MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.956S SUP HCPCS C1713 04.031.956S - NAIL INTRAMEDULLARY 9MM 360MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" N/A N/A 04.031.957S SUP HCPCS C1713 04.031.957S - NAIL INTRAMEDULLARY 9MM 360MM LATERAL ENTRY NAIL-EX TITANIUM BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.958S SUP HCPCS C1713 04.031.958S - NAIL INTRAMEDULLARY 9MM 380MM LATERAL ENTRY NAIL-EX TITANIUM BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.959S SUP HCPCS C1713 04.031.959S - NAIL INTRAMEDULLARY 9MM 380MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" "$2,807.18" "$2,807.18" N/A N/A 04.031.960S SUP HCPCS C1713 04.031.960S - NAIL INTRAMEDULLARY 9MM 400MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$2,854.90" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" $585.02 "$2,807.18" N/A N/A 04.031.961S SUP HCPCS C1713 04.031.961S - NAIL INTRAMEDULLARY 9MM 400MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,807.50" "$2,078.00" $557.16 "$2,854.90" "$1,263.23" "$1,263.23" "$1,263.23" "$1,263.23" "$2,807.18" "$2,807.18" "$2,807.18" $585.09 "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" "$2,807.18" $585.05 "$2,807.18" "$1,141.96" "$1,383.94" "$2,807.18" "$2,854.90" "$2,807.18" "$2,807.18" "$2,105.63" "$2,807.18" "$2,807.18" "$2,807.18" "$1,403.59" "$1,403.59" "$2,223.29" "$2,807.18" "$2,245.74" "$1,263.23" $557.16 N/A "$1,628.35" "$2,807.18" "$1,684.31" "$2,807.18" "$2,807.18" "$2,807.18" N/A N/A 04.031.964S SUP HCPCS C1713 04.031.964S - NAIL INTRAMEDULLARY 10MM 240MM LATERAL ENTRY CANN EXPERT BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$1,176.84" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$1,735.76" "$2,892.93" "$2,892.93" "$2,892.93" N/A N/A 04.031.965S SUP HCPCS C1713 04.031.965S - NAIL INTRAMEDULLARY 10MM 240MM LATERAL ENTRY CANN EXPERT BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$1,176.84" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$1,735.76" "$2,892.93" $602.89 "$2,892.93" N/A N/A 04.031.966S SUP HCPCS C1713 04.031.966S - NAIL INTRAMEDULLARY 10MM 260MM LATERAL ENTRY CANN EXPERT BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$1,176.84" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$1,735.76" "$2,892.93" "$2,892.93" "$2,892.93" N/A N/A 04.031.967S SUP HCPCS C1713 04.031.967S - NAIL INTRAMEDULLARY 10MM 260MM LATERAL ENTRY CANN EXPERT BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$1,176.84" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$1,735.76" "$2,892.93" $602.89 "$2,892.93" N/A N/A 04.031.968S SUP HCPCS C1713 04.031.968S - NAIL INTRAMEDULLARY 10MM 280MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$1,176.84" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$1,735.76" "$2,892.93" $602.89 "$2,892.93" N/A N/A 04.031.969S SUP HCPCS C1713 04.031.969S - NAIL INTRAMEDULLARY 10MM 280MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$1,176.84" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$1,735.76" "$2,892.93" "$2,892.93" "$2,892.93" N/A N/A 04.031.970S SUP HCPCS C1713 04.031.970S - NAIL INTRAMEDULLARY 10MM 300MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$1,176.84" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$1,735.76" "$2,892.93" $602.89 "$2,892.93" N/A N/A 04.031.971S SUP HCPCS C1713 04.031.971S - NAIL INTRAMEDULLARY 10MM 300MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$1,176.84" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" N/A N/A 04.031.972S SUP HCPCS C1713 04.031.972S - NAIL INTRAMEDULLARY 10MM 320MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$2,942.10" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$1,735.76" "$2,892.93" $602.89 "$2,892.93" N/A N/A 04.031.973S SUP HCPCS C1713 04.031.973S - NAIL INTRAMEDULLARY 10MM 320MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$2,942.10" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$1,735.76" "$2,892.93" $602.89 "$2,892.93" N/A N/A 04.031.974S SUP HCPCS C1713 04.031.974S - NAIL INTRAMEDULLARY 10MM 340MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$2,942.10" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$1,735.76" "$2,892.93" $602.89 "$2,892.93" N/A N/A 04.031.975S SUP HCPCS C1713 04.031.975S - NAIL INTRAMEDULLARY 10MM 340MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$2,942.10" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$1,735.76" "$2,892.93" $602.89 "$2,892.93" N/A N/A 04.031.976S SUP HCPCS C1713 04.031.976S - NAIL INTRAMEDULLARY 10MM 360MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$2,942.10" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$1,735.76" "$2,892.93" $602.89 "$2,892.93" N/A N/A 04.031.977S SUP HCPCS C1713 04.031.977S - NAIL INTRAMEDULLARY 10MM 360MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$1,176.84" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$2,892.93" "$2,892.93" $602.89 "$2,892.93" N/A N/A 04.031.978S SUP HCPCS C1713 04.031.978S - NAIL INTRAMEDULLARY 10MM 380MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$1,176.84" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$2,892.93" "$2,892.93" $602.89 "$2,892.93" N/A N/A 04.031.979S SUP HCPCS C1713 04.031.979S - NAIL INTRAMEDULLARY 10MM 380MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$1,176.84" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$2,892.93" "$2,892.93" $602.89 "$2,892.93" N/A N/A 04.031.980S SUP HCPCS C1713 04.031.980S - NAIL INTRAMEDULLARY 10MM 400MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$2,942.10" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$1,735.76" "$2,892.93" $602.89 "$2,892.93" N/A N/A 04.031.981S SUP HCPCS C1713 04.031.981S - NAIL INTRAMEDULLARY 10MM 400MM LATERAL ENTRY IMPLANT NAIL-EX BOTH IP/OP "$2,893.00" "$2,141.00" $574.17 "$2,942.10" "$1,301.82" "$1,301.82" "$1,301.82" "$1,301.82" "$2,892.93" "$2,892.93" "$2,892.93" $602.96 "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" "$2,892.93" $602.92 "$2,892.93" "$2,942.10" "$1,426.21" "$2,892.93" "$2,942.10" "$2,892.93" "$2,892.93" "$2,169.75" "$2,892.93" "$2,892.93" "$2,892.93" "$1,446.47" "$1,446.47" "$2,291.20" "$2,892.93" "$2,314.34" "$1,301.82" $574.17 N/A "$1,677.94" "$2,892.93" "$1,735.76" "$2,892.93" $602.89 "$2,892.93" N/A N/A 04.032.001S SUP HCPCS C1713 04.032.001S - SCREW SET 130D TITANIUM INTRAMEDULLARY STERILE TROC NAIL BOTH IP/OP $322.50 $239.00 $63.98 $327.85 $145.07 $145.07 $145.07 $145.07 $322.38 $322.38 $322.38 $67.19 $322.38 $322.38 $322.38 $322.38 $322.38 $67.19 $322.38 $131.14 $190.69 $322.38 $327.85 $322.38 $322.38 $241.88 $322.38 $322.38 $322.38 $161.19 $161.19 $255.32 $322.38 $257.90 $145.07 $63.98 N/A $187.05 $322.38 $193.43 $322.38 $67.18 $322.38 N/A N/A 04.032.070S SUP HCPCS C1713 04.032.070S - SCREW BONE THREAD 11MM 70X130MM FIX SELFTAPPING INVERSE BOTH IP/OP "$1,103.00" $816.00 $218.88 "$1,121.55" $496.26 $496.26 $496.26 $496.26 "$1,102.80" "$1,102.80" "$1,102.80" $229.85 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" $229.84 "$1,102.80" "$1,121.55" $652.31 "$1,102.80" "$1,121.55" "$1,102.80" "$1,102.80" $827.25 "$1,102.80" "$1,102.80" "$1,102.80" $551.40 $551.40 $873.42 "$1,102.80" $882.24 $496.26 $218.88 N/A $639.74 "$1,102.80" "$1,102.80" "$1,102.80" $229.82 "$1,102.80" N/A N/A 04.032.075S SUP HCPCS C1713 04.032.075S - SCREW BONE 11MM 75MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL BOTH IP/OP "$1,103.00" $816.00 $218.88 "$1,121.55" $496.26 $496.26 $496.26 $496.26 "$1,102.80" "$1,102.80" "$1,102.80" $229.85 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" $229.84 "$1,102.80" $448.62 $652.31 "$1,102.80" "$1,121.55" "$1,102.80" "$1,102.80" $827.25 "$1,102.80" "$1,102.80" "$1,102.80" $551.40 $551.40 $873.42 "$1,102.80" $882.24 $496.26 $218.88 N/A $639.74 "$1,102.80" "$1,102.80" "$1,102.80" $229.82 "$1,102.80" N/A N/A 04.032.080S SUP HCPCS C1713 04.032.080S - SCREW BONE 11MM 80MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL BOTH IP/OP "$1,103.00" $816.00 $218.88 "$1,121.55" $496.26 $496.26 $496.26 $496.26 "$1,102.80" "$1,102.80" "$1,102.80" $229.85 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" $229.84 "$1,102.80" $448.62 $652.31 "$1,102.80" "$1,121.55" "$1,102.80" "$1,102.80" $827.25 "$1,102.80" "$1,102.80" "$1,102.80" $551.40 $551.40 $873.42 "$1,102.80" $882.24 $496.26 $218.88 N/A $639.74 "$1,102.80" $661.68 "$1,102.80" $229.82 "$1,102.80" N/A N/A 04.032.085S SUP HCPCS C1713 04.032.085S - SCREW BONE 11MM 85MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL BOTH IP/OP "$1,103.00" $816.00 $218.88 "$1,121.55" $496.26 $496.26 $496.26 $496.26 "$1,102.80" "$1,102.80" "$1,102.80" $229.85 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" $229.84 "$1,102.80" "$1,121.55" $652.31 "$1,102.80" "$1,121.55" "$1,102.80" "$1,102.80" $827.25 "$1,102.80" "$1,102.80" "$1,102.80" $551.40 $551.40 $873.42 "$1,102.80" $882.24 $496.26 $218.88 N/A $639.74 "$1,102.80" $661.68 "$1,102.80" $229.82 "$1,102.80" N/A N/A 04.032.090S SUP HCPCS C1713 04.032.090S - SCREW BONE 11MM 90MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL BOTH IP/OP "$1,103.00" $816.00 $218.88 "$1,121.55" $496.26 $496.26 $496.26 $496.26 "$1,102.80" "$1,102.80" "$1,102.80" $229.85 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" $229.84 "$1,102.80" "$1,121.55" $652.31 "$1,102.80" "$1,121.55" "$1,102.80" "$1,102.80" $827.25 "$1,102.80" "$1,102.80" "$1,102.80" $551.40 $551.40 $873.42 "$1,102.80" $882.24 $496.26 $218.88 N/A $639.74 "$1,102.80" "$1,102.80" "$1,102.80" $229.82 "$1,102.80" N/A N/A 04.032.095S SUP HCPCS C1713 04.032.095S - SCREW BONE 11MM 95MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL BOTH IP/OP "$1,103.00" $816.00 $218.88 "$1,121.55" $496.26 $496.26 $496.26 $496.26 "$1,102.80" "$1,102.80" "$1,102.80" $229.85 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" $229.84 "$1,102.80" $448.62 $652.31 "$1,102.80" "$1,121.55" "$1,102.80" "$1,102.80" $827.25 "$1,102.80" "$1,102.80" "$1,102.80" $551.40 $551.40 $873.42 "$1,102.80" $882.24 $496.26 $218.88 N/A $639.74 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" N/A N/A 04.032.100S SUP HCPCS C1713 04.032.100S - SCREW BONE 11MM 100MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL BOTH IP/OP "$1,103.00" $816.00 $218.88 "$1,121.55" $496.26 $496.26 $496.26 $496.26 "$1,102.80" "$1,102.80" "$1,102.80" $229.85 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" $229.84 "$1,102.80" $448.62 $652.31 "$1,102.80" "$1,121.55" "$1,102.80" "$1,102.80" $827.25 "$1,102.80" "$1,102.80" "$1,102.80" $551.40 $551.40 $873.42 "$1,102.80" $882.24 $496.26 $218.88 N/A $639.74 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" N/A N/A 04.032.105S SUP HCPCS C1713 04.032.105S - SCREW BONE 11MM 105MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL BOTH IP/OP "$1,103.00" $816.00 $218.88 "$1,121.55" $496.26 $496.26 $496.26 $496.26 "$1,102.80" "$1,102.80" "$1,102.80" $229.85 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" $229.84 "$1,102.80" $448.62 $652.31 "$1,102.80" "$1,121.55" "$1,102.80" "$1,102.80" $827.25 "$1,102.80" "$1,102.80" "$1,102.80" $551.40 $551.40 $873.42 "$1,102.80" $882.24 $496.26 $218.88 N/A $639.74 "$1,102.80" $661.68 "$1,102.80" $229.82 "$1,102.80" N/A N/A 04.032.110S SUP HCPCS C1713 04.032.110S - SCREW BONE 11MM 110MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL BOTH IP/OP "$1,103.00" $816.00 $218.88 "$1,121.55" $496.26 $496.26 $496.26 $496.26 "$1,102.80" "$1,102.80" "$1,102.80" $229.85 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" $229.84 "$1,102.80" "$1,121.55" $652.31 "$1,102.80" "$1,121.55" "$1,102.80" "$1,102.80" $827.25 "$1,102.80" "$1,102.80" "$1,102.80" $551.40 $551.40 $873.42 "$1,102.80" $882.24 $496.26 $218.88 N/A $639.74 "$1,102.80" $661.68 "$1,102.80" $229.82 "$1,102.80" N/A N/A 04.032.115S SUP HCPCS C1713 04.032.115S - SCREW BONE 11MM 115MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL BOTH IP/OP "$1,103.00" $816.00 $218.88 "$1,121.55" $496.26 $496.26 $496.26 $496.26 "$1,102.80" "$1,102.80" "$1,102.80" $229.85 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" $229.84 "$1,102.80" "$1,121.55" $652.31 "$1,102.80" "$1,121.55" "$1,102.80" "$1,102.80" $827.25 "$1,102.80" "$1,102.80" "$1,102.80" $551.40 $551.40 $873.42 "$1,102.80" $882.24 $496.26 $218.88 N/A $639.74 "$1,102.80" "$1,102.80" "$1,102.80" $229.82 "$1,102.80" N/A N/A 04.032.120S SUP HCPCS C1713 04.032.120S - SCREW BONE 11MM 120MM FIX TITANIUM FEMUR TROCHANTER PROXIMAL BOTH IP/OP "$1,103.00" $816.00 $218.88 "$1,121.55" $496.26 $496.26 $496.26 $496.26 "$1,102.80" "$1,102.80" "$1,102.80" $229.85 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" $229.84 "$1,102.80" $448.62 $652.31 "$1,102.80" "$1,121.55" "$1,102.80" "$1,102.80" $827.25 "$1,102.80" "$1,102.80" "$1,102.80" $551.40 $551.40 $873.42 "$1,102.80" $882.24 $496.26 $218.88 N/A $639.74 "$1,102.80" "$1,102.80" "$1,102.80" $229.82 "$1,102.80" N/A N/A 04.032.125S SUP HCPCS C1713 04.032.125S - SCREW BONE 11MM 125MM TITANIUM FEMUR TROCHANTER PROXIMAL BOTH IP/OP "$1,103.00" $816.00 $218.88 "$1,121.55" $496.26 $496.26 $496.26 $496.26 "$1,102.80" "$1,102.80" "$1,102.80" $229.85 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" $229.84 "$1,102.80" $448.62 $652.31 "$1,102.80" "$1,121.55" "$1,102.80" "$1,102.80" $827.25 "$1,102.80" "$1,102.80" "$1,102.80" $551.40 $551.40 $873.42 "$1,102.80" $882.24 $496.26 $218.88 N/A $639.74 "$1,102.80" $661.68 "$1,102.80" $229.82 "$1,102.80" N/A N/A 04.032.130S SUP HCPCS C1713 04.032.130S - SCREW BN 11MM 130MM AU STRL CNN SELP TAP INVERSE ANG THRD TI BOTH IP/OP "$1,103.00" $816.00 $218.88 "$1,121.55" $496.26 $496.26 $496.26 $496.26 "$1,102.80" "$1,102.80" "$1,102.80" $229.85 "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" "$1,102.80" $229.84 "$1,102.80" $448.62 $652.31 "$1,102.80" "$1,121.55" "$1,102.80" "$1,102.80" $827.25 "$1,102.80" "$1,102.80" "$1,102.80" $551.40 $551.40 $873.42 "$1,102.80" $882.24 $496.26 $218.88 N/A $639.74 "$1,102.80" "$1,102.80" "$1,102.80" $229.82 "$1,102.80" N/A N/A 04.033.272S SUP HCPCS C1713 04.033.272S - NAIL IM 140D 12MM 420MM LGHT GRN 8 HL CNN RECON TI NIOBIUM BOTH IP/OP "$4,751.50" "$3,516.00" $943.00 "$4,832.03" "$2,138.06" "$2,138.06" "$2,138.06" "$2,138.06" "$4,751.25" "$4,751.25" "$4,751.25" $990.28 "$4,751.25" "$4,751.25" "$4,751.25" "$4,751.25" "$4,751.25" $990.21 "$4,751.25" "$4,832.03" "$2,342.37" "$4,751.25" "$4,832.03" "$4,751.25" "$4,751.25" "$3,563.63" "$4,751.25" "$4,751.25" "$4,751.25" "$2,375.63" "$2,375.63" "$3,762.99" "$4,751.25" "$3,801.00" "$2,138.06" $943.00 N/A "$2,755.87" "$4,751.25" "$4,751.25" "$4,751.25" $990.16 "$4,751.25" N/A N/A 04.034.231S SUP HCPCS C1713 04.034.231S - NAIL INTRAMEDULLARY 8MM 255MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,928.00" "$2,167.00" $581.07 "$2,977.45" "$1,317.46" "$1,317.46" "$1,317.46" "$1,317.46" "$2,927.68" "$2,927.68" "$2,927.68" $610.20 "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" $610.16 "$2,927.68" "$1,190.98" "$1,443.35" "$2,927.68" "$2,977.45" "$2,927.68" "$2,927.68" "$2,196.00" "$2,927.68" "$2,927.68" "$2,927.68" "$1,463.84" "$1,463.84" "$2,318.72" "$2,927.68" "$2,342.14" "$1,317.46" $581.07 N/A "$1,698.24" "$2,927.68" "$1,756.61" "$2,927.68" $610.13 "$2,927.68" N/A N/A 04.034.234S SUP HCPCS C1713 04.034.234S - NAIL INTRAMEDULLARY 8MM 27CM CANN PROXIMAL BEND NAIL-EX DARK BOTH IP/OP "$2,928.00" "$2,167.00" $581.07 "$2,977.45" "$1,317.46" "$1,317.46" "$1,317.46" "$1,317.46" "$2,927.68" "$2,927.68" "$2,927.68" $610.20 "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" $610.16 "$2,927.68" "$1,190.98" "$1,443.35" "$2,927.68" "$2,977.45" "$2,927.68" "$2,927.68" "$2,196.00" "$2,927.68" "$2,927.68" "$2,927.68" "$1,463.84" "$1,463.84" "$2,318.72" "$2,927.68" "$2,342.14" "$1,317.46" $581.07 N/A "$1,698.24" "$2,927.68" "$1,756.61" "$2,927.68" $610.13 "$2,927.68" N/A N/A 04.034.237S SUP HCPCS C1713 04.034.237S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 285MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.240S SUP HCPCS C1713 04.034.240S - NAIL INTRAMEDULLARY 8MM 30CM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.243S SUP HCPCS C1713 04.034.243S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 315MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.246S SUP HCPCS C1713 04.034.246S - NAIL INTRAMEDULLARY 8MM 33CM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" "$2,831.40" "$2,831.40" N/A N/A 04.034.249S SUP HCPCS C1713 04.034.249S - NAIL INTRAMEDULLARY 8MM 34.5CM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" "$2,831.40" "$2,831.40" N/A N/A 04.034.252S SUP HCPCS C1713 04.034.252S - NAIL INTRAMEDULLARY UNIVERSAL ROUND BARREL 8MM 36CM CANN BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.255S SUP HCPCS C1713 04.034.255S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 375MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" "$2,831.40" "$2,831.40" N/A N/A 04.034.258S SUP HCPCS C1713 04.034.258S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 390MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.261S SUP HCPCS C1713 04.034.261S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 405MM CANN PROXIMAL BEND BOTH IP/OP "$2,917.50" "$2,159.00" $579.05 "$2,967.08" "$1,312.87" "$1,312.87" "$1,312.87" "$1,312.87" "$2,917.48" "$2,917.48" "$2,917.48" $608.08 "$2,917.48" "$2,917.48" "$2,917.48" "$2,917.48" "$2,917.48" $608.03 "$2,917.48" "$1,186.83" "$1,438.32" "$2,917.48" "$2,967.08" "$2,917.48" "$2,917.48" "$2,188.13" "$2,917.48" "$2,917.48" "$2,917.48" "$1,458.74" "$1,458.74" "$2,310.64" "$2,917.48" "$2,333.98" "$1,312.87" $579.05 N/A "$1,692.15" "$2,917.48" "$1,750.49" "$2,917.48" "$2,917.48" "$2,917.48" N/A N/A 04.034.264S SUP HCPCS C1713 04.034.264S - NAIL INTRAMEDULLARY UNIVERSAL 8MM 420MM CANN PROXIMAL BEND BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$1,227.18" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$3,016.68" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.034.267S SUP HCPCS C1713 04.034.267S - NAIL INTRAMEDULLARY 8MM 43.5CM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$1,227.18" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.034.331S SUP HCPCS C1713 04.034.331S - NAIL INTRAMEDULLARY 9MM 25.5CM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.034.334S SUP HCPCS C1713 04.034.334S - NAIL INTRAMEDULLARY 9MM 27CM CANN PROXIMAL BEND NAIL-EX DARK BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" "$2,831.40" "$2,831.40" N/A N/A 04.034.337S SUP HCPCS C1713 04.034.337S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 285MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" "$2,831.40" "$2,831.40" N/A N/A 04.034.340S SUP HCPCS C1713 04.034.340S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 300MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.343S SUP HCPCS C1713 04.034.343S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 315MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.346S SUP HCPCS C1713 04.034.346S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 330MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.349S SUP HCPCS C1713 04.034.349S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 345MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" N/A N/A 04.034.352S SUP HCPCS C1713 04.034.352S - NAIL INTRAMEDULLARY UNIVERSAL ROUND 9MM 36CM CANN PROXIMAL BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" "$2,831.40" "$2,831.40" N/A N/A 04.034.355S SUP HCPCS C1713 04.034.355S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 375MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.358S SUP HCPCS C1713 04.034.358S - NAIL INTRAMEDULLARY 9MM 39CM PROXIMAL BEND CANN EXPERT BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.361S SUP HCPCS C1713 04.034.361S - NAIL INTRAMEDULLARY 9MM 40.5CM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$2,831.40" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.364S SUP HCPCS C1713 04.034.364S - NAIL INTRAMEDULLARY 9MM 420MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" "$3,016.68" "$3,016.68" N/A N/A 04.034.367S SUP HCPCS C1713 04.034.367S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 435MM CANN PROXIMAL BEND BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" "$3,016.68" "$3,016.68" N/A N/A 04.034.431S SUP HCPCS C1713 04.034.431S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 255MM CANN PROXIMAL BEND BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$1,227.18" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.034.434S SUP HCPCS C1713 04.034.434S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 270MM CANN PROXIMAL BEND BOTH IP/OP "$2,928.00" "$2,167.00" $581.07 "$2,977.45" "$1,317.46" "$1,317.46" "$1,317.46" "$1,317.46" "$2,927.68" "$2,927.68" "$2,927.68" $610.20 "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" $610.16 "$2,927.68" "$1,190.98" "$1,443.35" "$2,927.68" "$2,977.45" "$2,927.68" "$2,927.68" "$2,196.00" "$2,927.68" "$2,927.68" "$2,927.68" "$1,463.84" "$1,463.84" "$2,318.72" "$2,927.68" "$2,342.14" "$1,317.46" $581.07 N/A "$1,698.24" "$2,927.68" "$1,756.61" "$2,927.68" $610.13 "$2,927.68" N/A N/A 04.034.437S SUP HCPCS C1713 04.034.437S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 285MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.440S SUP HCPCS C1713 04.034.440S - NAIL INTRAMEDULLARY 10MM 30CM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.443S SUP HCPCS C1713 04.034.443S - NAIL INTRAMEDULLARY 10MM 315MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" "$2,831.40" "$2,831.40" N/A N/A 04.034.446S SUP HCPCS C1713 04.034.446S - NAIL INTRAMEDULLARY 10MM 33CM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" "$2,831.40" "$2,831.40" N/A N/A 04.034.449S SUP HCPCS C1713 04.034.449S - NAIL INTRAMEDULLARY 10MM 34.5CM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$2,831.40" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.452S SUP HCPCS C1713 04.034.452S - NAIL INTRAMEDULLARY 10MM 360MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.455S SUP HCPCS C1713 04.034.455S - NAIL INTRAMEDULLARY 10MM 375MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.458S SUP HCPCS C1713 04.034.458S - NAIL INTRAMEDULLARY 10MM 390MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$2,831.40" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.461S SUP HCPCS C1713 04.034.461S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 405MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.464S SUP HCPCS C1713 04.034.464S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM CANN PROXIMAL BEND BOTH IP/OP "$2,928.00" "$2,167.00" $581.07 "$2,977.45" "$1,317.46" "$1,317.46" "$1,317.46" "$1,317.46" "$2,927.68" "$2,927.68" "$2,927.68" $610.20 "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" $610.16 "$2,927.68" "$2,977.45" "$1,443.35" "$2,927.68" "$2,977.45" "$2,927.68" "$2,927.68" "$2,196.00" "$2,927.68" "$2,927.68" "$2,927.68" "$1,463.84" "$1,463.84" "$2,318.72" "$2,927.68" "$2,342.14" "$1,317.46" $581.07 N/A "$1,698.24" "$2,927.68" "$1,756.61" "$2,927.68" $610.13 "$2,927.68" N/A N/A 04.034.467S SUP HCPCS C1713 04.034.467S - NAIL INTRAMEDULLARY 10MM 435MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.034.531S SUP HCPCS C1713 04.034.531S - NAIL INTRAMEDULLARY 11MM 255MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.034.534S SUP HCPCS C1713 04.034.534S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 270MM CANN PROXIMAL BEND BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.034.537S SUP HCPCS C1713 04.034.537S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 285MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.540S SUP HCPCS C1713 04.034.540S - NAIL INTRAMEDULLARY UNIVERSAL FLUTE BARREL 11MM 300MM CANN BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.543S SUP HCPCS C1713 04.034.543S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 315MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.546S SUP HCPCS C1713 04.034.546S - NAIL INTRAMEDULLARY 11MM 330MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.549S SUP HCPCS C1713 04.034.549S - NAIL INTRAMEDULLARY 11MM 345MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.552S SUP HCPCS C1713 04.034.552S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.555S SUP HCPCS C1713 04.034.555S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 375MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.558S SUP HCPCS C1713 04.034.558S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 390MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$2,831.40" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.561S SUP HCPCS C1713 04.034.561S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 405MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.564S SUP HCPCS C1713 04.034.564S - NAIL INTRAMEDULLARY 11MM 420MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.567S SUP HCPCS C1713 04.034.567S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 235MM CANN PROXIMAL BEND BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.034.631S SUP HCPCS C1713 04.034.631S - NAIL INTRAMEDULLARY 12MM 255MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$3,016.68" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.034.634S SUP HCPCS C1713 04.034.634S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 270MM CANN PROXIMAL BEND BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.034.637S SUP HCPCS C1713 04.034.637S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 285MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.640S SUP HCPCS C1713 04.034.640S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.643S SUP HCPCS C1713 04.034.643S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 315MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.646S SUP HCPCS C1713 04.034.646S - NAIL INTRAMEDULLARY 12MM 33CM CANN PROXIMAL BEND EXPERT BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$2,831.40" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.649S SUP HCPCS C1713 04.034.649S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 345MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.652S SUP HCPCS C1713 04.034.652S - NAIL INTRAMEDULLARY 12MM 360MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.655S SUP HCPCS C1713 04.034.655S - NAIL INTRAMEDULLARY 12MM 375MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$2,831.40" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.658S SUP HCPCS C1713 04.034.658S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 390MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.661S SUP HCPCS C1713 04.034.661S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 405MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.664S SUP HCPCS C1713 04.034.664S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM CANN PROXIMAL BEND BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.034.667S SUP HCPCS C1713 04.034.667S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 435MM CANN PROXIMAL BEND BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$1,227.18" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$3,016.68" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.034.731S SUP HCPCS C1713 04.034.731S - NAIL INTRAMEDULLARY 13MM 255MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.034.734S SUP HCPCS C1713 04.034.734S - NAIL INTRAMEDULLARY 13MM 270MM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.034.737S SUP HCPCS C1713 04.034.737S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 285MM CANN PROXIMAL BEND BOTH IP/OP "$2,917.50" "$2,159.00" $579.05 "$2,967.08" "$1,312.87" "$1,312.87" "$1,312.87" "$1,312.87" "$2,917.48" "$2,917.48" "$2,917.48" $608.08 "$2,917.48" "$2,917.48" "$2,917.48" "$2,917.48" "$2,917.48" $608.03 "$2,917.48" "$2,967.08" "$1,438.32" "$2,917.48" "$2,967.08" "$2,917.48" "$2,917.48" "$2,188.13" "$2,917.48" "$2,917.48" "$2,917.48" "$1,458.74" "$1,458.74" "$2,310.64" "$2,917.48" "$2,333.98" "$1,312.87" $579.05 N/A "$1,692.15" "$2,917.48" "$1,750.49" "$2,917.48" $608.00 "$2,917.48" N/A N/A 04.034.740S SUP HCPCS C1713 04.034.740S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$2,831.40" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.743S SUP HCPCS C1713 04.034.743S - NAIL INTRAMEDULLARY 13MM 31.5CM CANN PROXIMAL BEND TITANIUM BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.746S SUP HCPCS C1713 04.034.746S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 330MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.749S SUP HCPCS C1713 04.034.749S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 345MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.752S SUP HCPCS C1713 04.034.752S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.755S SUP HCPCS C1713 04.034.755S - NAIL INTRAMEDULLARY UNIVERSAL ROUND BARREL 13MM 37.5CM CANN BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$2,879.53" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" $590.06 "$2,831.40" N/A N/A 04.034.758S SUP HCPCS C1713 04.034.758S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 390MM CANN PROXIMAL BEND BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" N/A N/A 04.034.761S SUP HCPCS C1713 04.034.761S - NAIL INTRAMEDULLARY 13MM 40.5CM CANN PROXIMAL BEND NAIL-EX BOTH IP/OP "$2,831.50" "$2,095.00" $561.96 "$2,879.53" "$1,274.13" "$1,274.13" "$1,274.13" "$1,274.13" "$2,831.40" "$2,831.40" "$2,831.40" $590.13 "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" "$2,831.40" $590.09 "$2,831.40" "$1,151.81" "$1,395.88" "$2,831.40" "$2,879.53" "$2,831.40" "$2,831.40" "$2,123.63" "$2,831.40" "$2,831.40" "$2,831.40" "$1,415.70" "$1,415.70" "$2,242.47" "$2,831.40" "$2,265.12" "$1,274.13" $561.96 N/A "$1,642.27" "$2,831.40" "$1,698.84" "$2,831.40" "$2,831.40" "$2,831.40" N/A N/A 04.034.764S SUP HCPCS C1713 04.034.764S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 420MM CANN PROXIMAL BEND BOTH IP/OP "$2,928.00" "$2,167.00" $581.07 "$2,977.45" "$1,317.46" "$1,317.46" "$1,317.46" "$1,317.46" "$2,927.68" "$2,927.68" "$2,927.68" $610.20 "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" "$2,927.68" $610.16 "$2,927.68" "$2,977.45" "$1,443.35" "$2,927.68" "$2,977.45" "$2,927.68" "$2,927.68" "$2,196.00" "$2,927.68" "$2,927.68" "$2,927.68" "$1,463.84" "$1,463.84" "$2,318.72" "$2,927.68" "$2,342.14" "$1,317.46" $581.07 N/A "$1,698.24" "$2,927.68" "$1,756.61" "$2,927.68" "$2,927.68" "$2,927.68" N/A N/A 04.034.767S SUP HCPCS C1713 04.034.767S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 435MM CANN PROXIMAL BEND BOTH IP/OP "$3,017.00" "$2,233.00" $598.74 "$3,067.95" "$1,357.51" "$1,357.51" "$1,357.51" "$1,357.51" "$3,016.68" "$3,016.68" "$3,016.68" $628.75 "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" "$3,016.68" $628.71 "$3,016.68" "$3,067.95" "$1,487.22" "$3,016.68" "$3,067.95" "$3,016.68" "$3,016.68" "$2,262.75" "$3,016.68" "$3,016.68" "$3,016.68" "$1,508.34" "$1,508.34" "$2,389.21" "$3,016.68" "$2,413.34" "$1,357.51" $598.74 N/A "$1,749.86" "$3,016.68" "$1,810.01" "$3,016.68" $628.68 "$3,016.68" N/A N/A 04.037.052S SUP HCPCS C1713 04.037.052S - NAIL IM 130D LNG 10MM 320MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.053S SUP HCPCS C1713 04.037.053S - NAIL IM 130D LNG 10MM 320MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.054S SUP HCPCS C1713 04.037.054S - NAIL IM 130D LNG 10MM 340MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.055S SUP HCPCS C1713 04.037.055S - NAIL IM 130D LNG 10MM 340MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.056S SUP HCPCS C1713 04.037.056S - NAIL IM 130D LNG 10MM 360MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.057S SUP HCPCS C1713 04.037.057S - NAIL IM 130D LNG 10MM 360MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.058S SUP HCPCS C1713 04.037.058S - NAIL IM 130D LNG 10MM 380MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.059S SUP HCPCS C1713 04.037.059S - NAIL IM 130D LNG 10MM 380MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.060S SUP HCPCS C1713 04.037.060S - NAIL IM 130D LNG 10MM 400MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.061S SUP HCPCS C1713 04.037.061S - NAIL IM 130D LNG 10MM 400MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.062S SUP HCPCS C1713 04.037.062S - NAIL IM 130D LNG 10MM 420MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.063S SUP HCPCS C1713 04.037.063S - NAIL IM 130D LNG 10MM 420MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.064S SUP HCPCS C1713 04.037.064S - NAIL IM 130D LNG 10MM 440MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.065S SUP HCPCS C1713 04.037.065S - NAIL IM 130D LNG 10MM 440MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.066S SUP HCPCS C1713 04.037.066S - NAIL IM 130D LNG 10MM 460MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.067S SUP HCPCS C1713 04.037.067S - NAIL IM 130D LNG 10MM 460MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.068S SUP HCPCS C1713 04.037.068S - NAIL IM 130D LNG 10MM 480MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.069S SUP HCPCS C1713 04.037.069S - NAIL IM 130D LNG 10MM 480MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.142S SUP HCPCS C1713 04.037.142S - NAIL IM 130D SHRT 11MM 170MM GRN STRL TFN-ADV CNN BOTH IP/OP "$3,133.50" "$2,319.00" $621.88 "$3,186.58" "$1,409.99" "$1,409.99" "$1,409.99" "$1,409.99" "$3,133.30" "$3,133.30" "$3,133.30" $653.06 "$3,133.30" "$3,133.30" "$3,133.30" "$3,133.30" "$3,133.30" $653.01 "$3,133.30" "$1,274.63" "$1,544.72" "$3,133.30" "$3,186.58" "$3,133.30" "$3,133.30" "$2,350.13" "$3,133.30" "$3,133.30" "$3,133.30" "$1,566.65" "$1,566.65" "$2,481.57" "$3,133.30" "$2,506.64" "$1,409.99" $621.88 N/A "$1,817.43" "$3,133.30" "$3,133.30" "$3,133.30" $652.98 "$3,133.30" N/A N/A 04.037.152S SUP HCPCS C1713 04.037.152S - NAIL IM 130D LNG 11MM 320MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.153S SUP HCPCS C1713 04.037.153S - NAIL IM 130D LNG 11MM 320MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.154S SUP HCPCS C1713 04.037.154S - NAIL IM 130D LNG 11MM 340MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.155S SUP HCPCS C1713 04.037.155S - NAIL IM 130D LNG 11MM 340MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.156S SUP HCPCS C1713 04.037.156S - NAIL IM 130D LNG 11MM 360MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.157S SUP HCPCS C1713 04.037.157S - NAIL IM 130D LNG 11MM 360MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.158S SUP HCPCS C1713 04.037.158S - NAIL IM 130D LNG 11MM 380MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.159S SUP HCPCS C1713 04.037.159S - NAIL IM 130D LNG 11MM 380MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.160S SUP HCPCS C1713 04.037.160S - NAIL IM 130D LNG 11MM 400MM GRN STRL TFN-ADV CNN TI COCR FEM BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.161S SUP HCPCS C1713 04.037.161S - NAIL IM 130D LNG 11MM 400MM STRL LF TFN-ADV TI FEM LT DIST BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.162S SUP HCPCS C1713 04.037.162S - NAIL IM 130D LNG 11MM 420MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.163S SUP HCPCS C1713 04.037.163S - NAIL IM 130D LNG 11MM 420MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.164S SUP HCPCS C1713 04.037.164S - NAIL IM 130D LNG 11MM 440MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.165S SUP HCPCS C1713 04.037.165S - NAIL IM 130D LNG 11MM 440MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.166S SUP HCPCS C1713 04.037.166S - NAIL IM 130D LNG 11MM 460MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.167S SUP HCPCS C1713 04.037.167S - NAIL IM 130D LNG 11MM 460MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.168S SUP HCPCS C1713 04.037.168S - NAIL IM 130D LNG 11MM 480MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.169S SUP HCPCS C1713 04.037.169S - NAIL IM 130D LNG 11MM 480MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.242S SUP HCPCS C1713 04.037.242S - NAIL IM 130D SHRT 12MM 170MM GRN STRL TFN-ADV CNN BOTH IP/OP "$3,133.50" "$2,319.00" $621.88 "$3,186.58" "$1,409.99" "$1,409.99" "$1,409.99" "$1,409.99" "$3,133.30" "$3,133.30" "$3,133.30" $653.06 "$3,133.30" "$3,133.30" "$3,133.30" "$3,133.30" "$3,133.30" $653.01 "$3,133.30" "$1,274.63" "$1,544.72" "$3,133.30" "$3,186.58" "$3,133.30" "$3,133.30" "$2,350.13" "$3,133.30" "$3,133.30" "$3,133.30" "$1,566.65" "$1,566.65" "$2,481.57" "$3,133.30" "$2,506.64" "$1,409.99" $621.88 N/A "$1,817.43" "$3,133.30" "$3,133.30" "$3,133.30" $652.98 "$3,133.30" N/A N/A 04.037.252S SUP HCPCS C1713 04.037.252S - NAIL IM 130D LNG 12MM 320MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.253S SUP HCPCS C1713 04.037.253S - NAIL IM 130D LNG 12MM 320MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.254S SUP HCPCS C1713 04.037.254S - NAIL IM 130D LNG 12MM 340MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.255S SUP HCPCS C1713 04.037.255S - NAIL IM 130D LNG 12MM 340MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.256S SUP HCPCS C1713 04.037.256S - NAIL IM 130D LNG 12MM 360MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.257S SUP HCPCS C1713 04.037.257S - NAIL IM 130D LNG 12MM 360MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.258S SUP HCPCS C1713 04.037.258S - NAIL IM 130D LNG 12MM 380MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.259S SUP HCPCS C1713 04.037.259S - NAIL IM 130D LNG 12MM 380MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.260S SUP HCPCS C1713 04.037.260S - NAIL IM 130D LNG 12MM 400MM GRN STRL TFN-ADV CNN PREASSEMBLE BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.261S SUP HCPCS C1713 04.037.261S - NAIL IM 130D LNG 12MM 400MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.262S SUP HCPCS C1713 04.037.262S - NAIL IM 130D LNG 12MM 420MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.263S SUP HCPCS C1713 04.037.263S - NAIL IM 130D LNG 12MM 420MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.264S SUP HCPCS C1713 04.037.264S - NAIL IM 130D LNG 12MM 440MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.265S SUP HCPCS C1713 04.037.265S - NAIL IM 130D LNG 12MM 440MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.266S SUP HCPCS C1713 04.037.266S - NAIL IM 130D LNG 12MM 460MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.267S SUP HCPCS C1713 04.037.267S - NAIL IM 130D LNG 12MM 460MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.268S SUP HCPCS C1713 04.037.268S - NAIL IM 130D LNG 12MM 480MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.269S SUP HCPCS C1713 04.037.269S - NAIL IM 130D LNG 12MM 480MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.456S SUP HCPCS C1713 04.037.456S - NAIL IM 130D LNG 14MM 360MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.458S SUP HCPCS C1713 04.037.458S - NAIL IM 130D LNG 14MM 380MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.459S SUP HCPCS C1713 04.037.459S - NAIL IM 130D LNG 14MM 380MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.460S SUP HCPCS C1713 04.037.460S - NAIL IM 130D LNG 14MM 400MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.461S SUP HCPCS C1713 04.037.461S - NAIL IM 130D LNG 14MM 400MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$1,786.41" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.462S SUP HCPCS C1713 04.037.462S - NAIL IM 130D LNG 14MM 420MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.037.464S SUP HCPCS C1713 04.037.464S - NAIL IM 130D LNG 14MM 440MM GRN STRL TFN-ADV LAT RLF CUT CNN BOTH IP/OP "$4,391.50" "$3,250.00" $871.58 "$4,466.03" "$1,976.12" "$1,976.12" "$1,976.12" "$1,976.12" "$4,391.38" "$4,391.38" "$4,391.38" $915.27 "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" "$4,391.38" $915.21 "$4,391.38" "$4,466.03" "$2,164.95" "$4,391.38" "$4,466.03" "$4,391.38" "$4,391.38" "$3,293.63" "$4,391.38" "$4,391.38" "$4,391.38" "$2,195.69" "$2,195.69" "$3,477.97" "$4,391.38" "$3,513.10" "$1,976.12" $871.58 N/A "$2,547.07" "$4,391.38" "$4,391.38" "$4,391.38" $915.16 "$4,391.38" N/A N/A 04.038.105S SUP HCPCS C1713 04.038.105S - SCREW BN 10.35MM 105MM AU STRL LF TFN-ADV CNN TI BOTH IP/OP "$1,427.00" "$1,056.00" $283.18 "$1,451.03" $642.05 $642.05 $642.05 $642.05 "$1,426.78" "$1,426.78" "$1,426.78" $297.38 "$1,426.78" "$1,426.78" "$1,426.78" "$1,426.78" "$1,426.78" $297.36 "$1,426.78" "$1,451.03" $843.94 "$1,426.78" "$1,451.03" "$1,426.78" "$1,426.78" "$1,070.25" "$1,426.78" "$1,426.78" "$1,426.78" $713.39 $713.39 "$1,130.01" "$1,426.78" "$1,141.42" $642.05 $283.18 N/A $827.66 "$1,426.78" "$1,426.78" "$1,426.78" $297.34 "$1,426.78" N/A N/A 04.038.285S SUP Custom 27203010 04.038.285S - BLADE IM NL HLCL 10.35MM 85MM AU STRL TFN-ADV CNN TI-6AL-7NB BOTH IP/OP "$1,497.50" "$1,108.00" $266.48 "$1,522.53" "$1,497.08" "$1,497.08" "$1,497.08" "$1,497.08" "$1,497.08" "$1,497.08" $266.48 "$1,497.08" "$1,497.08" "$1,111.13" "$1,111.13" "$1,153.95" $779.98 $312.01 "$1,497.08" $609.01 "$1,497.08" "$1,497.08" "$1,522.53" "$1,497.08" "$1,497.08" "$1,123.13" "$1,497.08" "$1,497.08" "$1,497.08" $748.54 $748.54 "$1,185.69" "$1,497.08" "$1,197.66" $973.10 "$1,497.08" N/A $868.55 "$1,497.08" $898.25 "$1,497.08" "$1,497.08" "$1,497.08" N/A N/A 04.038.290S SUP Custom 27203010 04.038.290S - BLADE IM NL HLCL 90MM STRL TFN-ADV CNN TI FEM PROX BOTH IP/OP "$1,497.50" "$1,108.00" $266.48 "$1,522.53" "$1,497.08" "$1,497.08" "$1,497.08" "$1,497.08" "$1,497.08" "$1,497.08" $266.48 "$1,497.08" "$1,497.08" "$1,111.13" "$1,111.13" "$1,153.95" $779.98 $312.01 "$1,497.08" $609.01 "$1,497.08" "$1,497.08" "$1,522.53" "$1,497.08" "$1,497.08" "$1,123.13" "$1,497.08" "$1,497.08" "$1,497.08" $748.54 $748.54 "$1,185.69" "$1,497.08" "$1,197.66" $973.10 "$1,497.08" N/A $868.55 "$1,497.08" $898.25 "$1,497.08" "$1,497.08" "$1,497.08" N/A N/A 04.038.295S SUP Custom 27203010 04.038.295S - BLADE IM NL HLCL 10.35MM 95MM AU STRL TFN-ADV CNN TI-6AL-7NB BOTH IP/OP "$1,497.50" "$1,108.00" $266.48 "$1,522.53" "$1,497.08" "$1,497.08" "$1,497.08" "$1,497.08" "$1,497.08" "$1,497.08" $266.48 "$1,497.08" "$1,497.08" "$1,111.13" "$1,111.13" "$1,153.95" $779.98 $312.01 "$1,497.08" $609.01 "$1,497.08" "$1,497.08" "$1,522.53" "$1,497.08" "$1,497.08" "$1,123.13" "$1,497.08" "$1,497.08" "$1,497.08" $748.54 $748.54 "$1,185.69" "$1,497.08" "$1,197.66" $973.10 "$1,497.08" N/A $868.55 "$1,497.08" $898.25 "$1,497.08" "$1,497.08" "$1,497.08" N/A N/A 04.038.305S SUP Custom 27203010 04.038.305S - BLADE IM NL HLCL 10.35MM 105MM AU STRL TFN-ADV CNN TI-6AL-7 BOTH IP/OP "$1,497.50" "$1,108.00" $266.48 "$1,522.53" "$1,497.08" "$1,497.08" "$1,497.08" "$1,497.08" "$1,497.08" "$1,497.08" $266.48 "$1,497.08" "$1,497.08" "$1,111.13" "$1,111.13" "$1,153.95" $779.98 $312.01 "$1,497.08" $609.01 "$1,497.08" "$1,497.08" "$1,522.53" "$1,497.08" "$1,497.08" "$1,123.13" "$1,497.08" "$1,497.08" "$1,497.08" $748.54 $748.54 "$1,185.69" "$1,497.08" "$1,197.66" $973.10 "$1,497.08" N/A $868.55 "$1,497.08" $898.25 "$1,497.08" "$1,497.08" "$1,497.08" N/A N/A 04.100.020 SUP HCPCS C1713 04.100.020 - PLATE BONE LOCK TITANIUM FT NONSTRL 2.4-2.7 MM SCREWS BOTH IP/OP "$1,465.00" "$1,084.00" $290.71 "$1,489.63" $659.13 $659.13 $659.13 $659.13 "$1,464.73" "$1,464.73" "$1,464.73" $305.29 "$1,464.73" "$1,464.73" "$1,464.73" "$1,464.73" "$1,464.73" $305.27 "$1,464.73" "$1,489.63" $866.39 "$1,464.73" "$1,489.63" "$1,464.73" "$1,464.73" "$1,098.75" "$1,464.73" "$1,464.73" "$1,464.73" $732.37 $732.37 "$1,160.07" "$1,464.73" "$1,171.78" $659.13 $290.71 N/A $849.70 "$1,464.73" "$1,464.73" "$1,464.73" $305.25 "$1,464.73" N/A N/A 04.100.021 SUP HCPCS C1713 04.100.021 - PLATE BONE LOCK TITANIUM LEFT CUBOID FT NONSTRL 2.4-2.7 MM BOTH IP/OP "$1,425.50" "$1,055.00" $282.90 "$1,449.60" $641.42 $641.42 $641.42 $641.42 "$1,425.38" "$1,425.38" "$1,425.38" $297.08 "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" $297.06 "$1,425.38" "$1,449.60" $843.11 "$1,425.38" "$1,449.60" "$1,425.38" "$1,425.38" "$1,069.13" "$1,425.38" "$1,425.38" "$1,425.38" $712.69 $712.69 "$1,128.90" "$1,425.38" "$1,140.30" $641.42 $282.90 N/A $826.79 "$1,425.38" "$1,425.38" "$1,425.38" $297.05 "$1,425.38" N/A N/A 04.100.022 SUP HCPCS C1713 04.100.022 - PLATE BONE LOCK TITANIUM RIGHT CUBOID FT NONSTRL 2.4-2.7 MM BOTH IP/OP "$1,425.50" "$1,055.00" $282.90 "$1,449.60" $641.42 $641.42 $641.42 $641.42 "$1,425.38" "$1,425.38" "$1,425.38" $297.08 "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" $297.06 "$1,425.38" $579.84 $843.11 "$1,425.38" "$1,449.60" "$1,425.38" "$1,425.38" "$1,069.13" "$1,425.38" "$1,425.38" "$1,425.38" $712.69 $712.69 "$1,128.90" "$1,425.38" "$1,140.30" $641.42 $282.90 N/A $826.79 "$1,425.38" "$1,425.38" "$1,425.38" $297.05 "$1,425.38" N/A N/A 04.100.023 SUP HCPCS C1713 04.100.023 - PLATE BONE LOCK TITANIUM TALUS FT NONSTRL 2.4-2.7 MM SCREW BOTH IP/OP "$1,408.50" "$1,042.00" $279.55 "$1,432.45" $633.83 $633.83 $633.83 $633.83 "$1,408.50" "$1,408.50" "$1,408.50" $293.57 "$1,408.50" "$1,408.50" "$1,408.50" "$1,408.50" "$1,408.50" $293.55 "$1,408.50" "$1,432.45" $833.13 "$1,408.50" "$1,432.45" "$1,408.50" "$1,408.50" "$1,056.38" "$1,408.50" "$1,408.50" "$1,408.50" $704.25 $704.25 "$1,115.53" "$1,408.50" "$1,126.80" $633.83 $279.55 N/A $816.93 "$1,408.50" "$1,408.50" "$1,408.50" $293.53 "$1,408.50" N/A N/A 04.100.032S SUP HCPCS C1713 04.100.032S - PLATE BONE 100MM 6 HOLE LCP TITANIUM ANTERIOR ANKLE FT BOTH IP/OP "$2,316.00" "$1,714.00" $459.59 "$2,315.60" "$1,042.02" "$1,042.02" "$1,042.02" "$1,042.02" "$2,315.60" "$2,315.60" "$2,315.60" $482.63 "$2,315.60" "$2,315.60" "$2,315.60" "$2,315.60" "$2,315.60" $482.60 "$2,315.60" "$2,315.60" "$1,369.68" "$2,315.60" "$2,315.60" "$2,315.60" "$2,315.60" "$1,737.00" "$2,315.60" "$2,315.60" "$2,315.60" "$1,157.80" "$1,157.80" "$1,833.96" "$2,315.60" "$1,852.48" "$1,042.02" $459.59 N/A "$1,343.28" "$2,315.60" "$2,315.60" "$2,315.60" $482.57 "$2,315.60" N/A N/A 04.100.033S SUP HCPCS C1713 04.100.033S - PLATE BONE 116MM 7 HOLE LCP TITANIUM ANTERIOR ANKLE FT BOTH IP/OP "$2,380.50" "$1,762.00" $472.46 "$2,380.43" "$1,071.19" "$1,071.19" "$1,071.19" "$1,071.19" "$2,380.43" "$2,380.43" "$2,380.43" $496.14 "$2,380.43" "$2,380.43" "$2,380.43" "$2,380.43" "$2,380.43" $496.11 "$2,380.43" "$2,380.43" "$1,408.02" "$2,380.43" "$2,380.43" "$2,380.43" "$2,380.43" "$1,785.38" "$2,380.43" "$2,380.43" "$2,380.43" "$1,190.22" "$1,190.22" "$1,885.30" "$2,380.43" "$1,904.34" "$1,071.19" $472.46 N/A "$1,380.69" "$2,380.43" "$2,380.43" "$2,380.43" $496.08 "$2,380.43" N/A N/A 04.104.004S SUP HCPCS C1713 04.104.004S - PLATE BONE 122MM 4 HOLE LCP TITANIUM EXTART RIGHT HUMERUS BOTH IP/OP "$2,384.50" "$1,765.00" $473.17 "$2,424.58" "$1,072.82" "$1,072.82" "$1,072.82" "$1,072.82" "$2,384.05" "$2,384.05" "$2,384.05" $496.90 "$2,384.05" "$2,384.05" "$2,384.05" "$2,384.05" "$2,384.05" $496.86 "$2,384.05" $969.83 "$1,410.17" "$2,384.05" "$2,424.58" "$2,384.05" "$2,384.05" "$1,788.38" "$2,384.05" "$2,384.05" "$2,384.05" "$1,192.03" "$1,192.03" "$1,888.17" "$2,384.05" "$1,907.24" "$1,072.82" $473.17 N/A "$1,383.01" "$2,384.05" "$2,384.05" "$2,384.05" $496.84 "$2,384.05" N/A N/A 04.104.006S SUP HCPCS C1713 04.104.006S - PLATE BONE 158MM 6 HOLE LCP TITANIUM EXTART RIGHT HUMERUS BOTH IP/OP "$2,714.50" "$2,009.00" $538.74 "$2,760.55" "$1,221.48" "$1,221.48" "$1,221.48" "$1,221.48" "$2,714.40" "$2,714.40" "$2,714.40" $565.75 "$2,714.40" "$2,714.40" "$2,714.40" "$2,714.40" "$2,714.40" $565.71 "$2,714.40" "$2,760.55" "$1,338.20" "$2,714.40" "$2,760.55" "$2,714.40" "$2,714.40" "$2,035.88" "$2,714.40" "$2,714.40" "$2,714.40" "$1,357.20" "$1,357.20" "$2,149.80" "$2,714.40" "$2,171.52" "$1,221.48" $538.74 N/A "$1,574.41" "$2,714.40" "$2,714.40" "$2,714.40" $565.68 "$2,714.40" N/A N/A 04.104.008S SUP HCPCS C1713 04.104.008S - PLATE BN 194MM STRL LCP CMBN 8 HL PRECONTOUR LMT CNTCT TI BOTH IP/OP "$2,875.00" "$2,128.00" $570.55 "$2,923.53" "$1,293.59" "$1,293.59" "$1,293.59" "$1,293.59" "$2,874.65" "$2,874.65" "$2,874.65" $599.15 "$2,874.65" "$2,874.65" "$2,874.65" "$2,874.65" "$2,874.65" $599.11 "$2,874.65" "$1,169.41" "$1,417.20" "$2,874.65" "$2,923.53" "$2,874.65" "$2,874.65" "$2,156.25" "$2,874.65" "$2,874.65" "$2,874.65" "$1,437.33" "$1,437.33" "$2,276.72" "$2,874.65" "$2,299.72" "$1,293.59" $570.55 N/A "$1,667.50" "$2,874.65" "$2,874.65" "$2,874.65" $599.08 "$2,874.65" N/A N/A 04.104.010S SUP HCPCS C1713 04.104.010S - PLATE BONE 230MM 10 HOLE LCP TITANIUM EXTART RIGHT HUMERUS BOTH IP/OP "$3,038.00" "$2,248.00" $602.91 "$3,089.35" "$1,366.97" "$1,366.97" "$1,366.97" "$1,366.97" "$3,037.70" "$3,037.70" "$3,037.70" $633.13 "$3,037.70" "$3,037.70" "$3,037.70" "$3,037.70" "$3,037.70" $633.09 "$3,037.70" "$3,089.35" "$1,497.59" "$3,037.70" "$3,089.35" "$3,037.70" "$3,037.70" "$2,278.50" "$3,037.70" "$3,037.70" "$3,037.70" "$1,518.85" "$1,518.85" "$2,405.86" "$3,037.70" "$2,430.16" "$1,366.97" $602.91 N/A "$1,762.04" "$3,037.70" "$3,037.70" "$3,037.70" "$3,037.70" "$3,037.70" N/A N/A 04.104.012S SUP HCPCS C1713 04.104.012S - PLATE BONE 266MM 12 HOLE LCP TITANIUM EXTART RIGHT HUMERUS BOTH IP/OP "$3,458.00" "$2,559.00" $686.33 "$3,516.78" "$1,556.10" "$1,556.10" "$1,556.10" "$1,556.10" "$3,458.00" "$3,458.00" "$3,458.00" $720.73 "$3,458.00" "$3,458.00" "$3,458.00" "$3,458.00" "$3,458.00" $720.69 "$3,458.00" "$1,406.71" "$1,704.79" "$3,458.00" "$3,516.78" "$3,458.00" "$3,458.00" "$2,593.50" "$3,458.00" "$3,458.00" "$3,458.00" "$1,729.00" "$1,729.00" "$2,738.74" "$3,458.00" "$2,766.40" "$1,556.10" $686.33 N/A "$2,005.64" "$3,458.00" "$3,458.00" "$3,458.00" "$3,458.00" "$3,458.00" N/A N/A 04.104.014S SUP HCPCS C1713 04.104.014S - PLATE BONE 302MM 14 HOLE LCP TITANIUM EXTART RIGHT HUMERUS BOTH IP/OP "$3,797.00" "$2,810.00" $753.57 "$3,861.33" "$1,708.55" "$1,708.55" "$1,708.55" "$1,708.55" "$3,796.78" "$3,796.78" "$3,796.78" $791.34 "$3,796.78" "$3,796.78" "$3,796.78" "$3,796.78" "$3,796.78" $791.29 "$3,796.78" "$3,861.33" "$1,871.81" "$3,796.78" "$3,861.33" "$3,796.78" "$3,796.78" "$2,847.75" "$3,796.78" "$3,796.78" "$3,796.78" "$1,898.39" "$1,898.39" "$3,007.05" "$3,796.78" "$3,037.42" "$1,708.55" $753.57 N/A "$2,202.26" "$3,796.78" "$3,796.78" "$3,796.78" "$3,796.78" "$3,796.78" N/A N/A 04.104.024S SUP HCPCS C1713 04.104.024S - PLATE BONE 122MM 4 HOLE LCP TITANIUM LEFT DISTAL EXTART BOTH IP/OP "$2,384.50" "$1,765.00" $473.17 "$2,424.58" "$1,072.82" "$1,072.82" "$1,072.82" "$1,072.82" "$2,384.05" "$2,384.05" "$2,384.05" $496.90 "$2,384.05" "$2,384.05" "$2,384.05" "$2,384.05" "$2,384.05" $496.86 "$2,384.05" $969.83 "$1,410.17" "$2,384.05" "$2,424.58" "$2,384.05" "$2,384.05" "$1,788.38" "$2,384.05" "$2,384.05" "$2,384.05" "$1,192.03" "$1,192.03" "$1,888.17" "$2,384.05" "$1,907.24" "$1,072.82" $473.17 N/A "$1,383.01" "$2,384.05" "$2,384.05" "$2,384.05" $496.84 "$2,384.05" N/A N/A 04.104.026S SUP HCPCS C1713 04.104.026S - PLATE BONE 158MM 6 HOLE LCP TITANIUM LEFT DISTAL EXTART BOTH IP/OP "$2,714.50" "$2,009.00" $538.74 "$2,760.55" "$1,221.48" "$1,221.48" "$1,221.48" "$1,221.48" "$2,714.40" "$2,714.40" "$2,714.40" $565.75 "$2,714.40" "$2,714.40" "$2,714.40" "$2,714.40" "$2,714.40" $565.71 "$2,714.40" "$1,104.22" "$1,338.20" "$2,714.40" "$2,760.55" "$2,714.40" "$2,714.40" "$2,035.88" "$2,714.40" "$2,714.40" "$2,714.40" "$1,357.20" "$1,357.20" "$2,149.80" "$2,714.40" "$2,171.52" "$1,221.48" $538.74 N/A "$1,574.41" "$2,714.40" "$2,714.40" "$2,714.40" $565.68 "$2,714.40" N/A N/A 04.104.028S SUP HCPCS C1713 04.104.028S - PLATE BONE 194MM 8 HOLE LCP TITANIUM LEFT DISTAL EXTART BOTH IP/OP "$2,875.00" "$2,128.00" $570.55 "$2,923.53" "$1,293.59" "$1,293.59" "$1,293.59" "$1,293.59" "$2,874.65" "$2,874.65" "$2,874.65" $599.15 "$2,874.65" "$2,874.65" "$2,874.65" "$2,874.65" "$2,874.65" $599.11 "$2,874.65" "$2,923.53" "$1,417.20" "$2,874.65" "$2,923.53" "$2,874.65" "$2,874.65" "$2,156.25" "$2,874.65" "$2,874.65" "$2,874.65" "$1,437.33" "$1,437.33" "$2,276.72" "$2,874.65" "$2,299.72" "$1,293.59" $570.55 N/A "$1,667.50" "$2,874.65" "$2,874.65" "$2,874.65" $599.08 "$2,874.65" N/A N/A 04.104.030S SUP HCPCS C1713 04.104.030S - PLATE BONE 230MM 10 HOLE LCP TITANIUM LEFT DISTAL EXTART BOTH IP/OP "$3,038.00" "$2,248.00" $602.91 "$3,089.35" "$1,366.97" "$1,366.97" "$1,366.97" "$1,366.97" "$3,037.70" "$3,037.70" "$3,037.70" $633.13 "$3,037.70" "$3,037.70" "$3,037.70" "$3,037.70" "$3,037.70" $633.09 "$3,037.70" "$1,235.74" "$1,497.59" "$3,037.70" "$3,089.35" "$3,037.70" "$3,037.70" "$2,278.50" "$3,037.70" "$3,037.70" "$3,037.70" "$1,518.85" "$1,518.85" "$2,405.86" "$3,037.70" "$2,430.16" "$1,366.97" $602.91 N/A "$1,762.04" "$3,037.70" "$3,037.70" "$3,037.70" $633.06 "$3,037.70" N/A N/A 04.104.032S SUP HCPCS C1713 04.104.032S - PLATE BONE 266MM 12 HOLE LCP TITANIUM LEFT DISTAL EXTART BOTH IP/OP "$3,458.00" "$2,559.00" $686.33 "$3,516.78" "$1,556.10" "$1,556.10" "$1,556.10" "$1,556.10" "$3,458.00" "$3,458.00" "$3,458.00" $720.73 "$3,458.00" "$3,458.00" "$3,458.00" "$3,458.00" "$3,458.00" $720.69 "$3,458.00" "$3,516.78" "$1,704.79" "$3,458.00" "$3,516.78" "$3,458.00" "$3,458.00" "$2,593.50" "$3,458.00" "$3,458.00" "$3,458.00" "$1,729.00" "$1,729.00" "$2,738.74" "$3,458.00" "$2,766.40" "$1,556.10" $686.33 N/A "$2,005.64" "$3,458.00" "$3,458.00" "$3,458.00" $720.65 "$3,458.00" N/A N/A 04.104.034S SUP HCPCS C1713 04.104.034S - PLATE BONE 302MM 14 HOLE LCP TITANIUM LEFT DISTAL EXTART BOTH IP/OP "$3,797.00" "$2,810.00" $753.57 "$3,861.33" "$1,708.55" "$1,708.55" "$1,708.55" "$1,708.55" "$3,796.78" "$3,796.78" "$3,796.78" $791.34 "$3,796.78" "$3,796.78" "$3,796.78" "$3,796.78" "$3,796.78" $791.29 "$3,796.78" "$3,861.33" "$1,871.81" "$3,796.78" "$3,861.33" "$3,796.78" "$3,796.78" "$2,847.75" "$3,796.78" "$3,796.78" "$3,796.78" "$1,898.39" "$1,898.39" "$3,007.05" "$3,796.78" "$3,037.42" "$1,708.55" $753.57 N/A "$2,202.26" "$3,796.78" "$3,796.78" "$3,796.78" $791.25 "$3,796.78" N/A N/A 04.110.005 SUP HCPCS C1713 04.110.005 - PLATE BONE 5 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL BOTH IP/OP "$2,921.50" "$2,162.00" $579.75 "$2,970.68" "$1,314.46" "$1,314.46" "$1,314.46" "$1,314.46" "$2,921.03" "$2,921.03" "$2,921.03" $608.82 "$2,921.03" "$2,921.03" "$2,921.03" "$2,921.03" "$2,921.03" $608.77 "$2,921.03" "$2,970.68" "$1,440.07" "$2,921.03" "$2,970.68" "$2,921.03" "$2,921.03" "$2,191.13" "$2,921.03" "$2,921.03" "$2,921.03" "$1,460.52" "$1,460.52" "$2,313.46" "$2,921.03" "$2,336.82" "$1,314.46" $579.75 N/A "$1,694.47" "$2,921.03" "$2,921.03" "$2,921.03" $608.74 "$2,921.03" N/A N/A 04.110.007 SUP HCPCS C1713 04.110.007 - PLATE BONE 7 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL BOTH IP/OP "$2,993.00" "$2,215.00" $593.98 "$3,043.60" "$1,346.73" "$1,346.73" "$1,346.73" "$1,346.73" "$2,992.73" "$2,992.73" "$2,992.73" $623.76 "$2,992.73" "$2,992.73" "$2,992.73" "$2,992.73" "$2,992.73" $623.72 "$2,992.73" "$3,043.60" "$1,475.42" "$2,992.73" "$3,043.60" "$2,992.73" "$2,992.73" "$2,244.75" "$2,992.73" "$2,992.73" "$2,992.73" "$1,496.37" "$1,496.37" "$2,370.24" "$2,992.73" "$2,394.18" "$1,346.73" $593.98 N/A "$1,735.94" "$2,992.73" "$2,992.73" "$2,992.73" $623.68 "$2,992.73" N/A N/A 04.110.009 SUP HCPCS C1713 04.110.009 - PLATE BONE 9 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL BOTH IP/OP "$3,063.00" "$2,267.00" $607.93 "$3,115.08" "$1,378.35" "$1,378.35" "$1,378.35" "$1,378.35" "$3,063.00" "$3,063.00" "$3,063.00" $638.41 "$3,063.00" "$3,063.00" "$3,063.00" "$3,063.00" "$3,063.00" $638.36 "$3,063.00" "$3,115.08" "$1,510.06" "$3,063.00" "$3,115.08" "$3,063.00" "$3,063.00" "$2,297.25" "$3,063.00" "$3,063.00" "$3,063.00" "$1,531.50" "$1,531.50" "$2,425.90" "$3,063.00" "$2,450.40" "$1,378.35" $607.93 N/A "$1,776.54" "$3,063.00" "$3,063.00" "$3,063.00" $638.33 "$3,063.00" N/A N/A 04.110.011 SUP HCPCS C1713 04.110.011 - PLATE BONE 11 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL BOTH IP/OP "$3,251.50" "$2,406.00" $645.32 "$3,306.65" "$1,463.12" "$1,463.12" "$1,463.12" "$1,463.12" "$3,251.38" "$3,251.38" "$3,251.38" $677.67 "$3,251.38" "$3,251.38" "$3,251.38" "$3,251.38" "$3,251.38" $677.62 "$3,251.38" "$3,306.65" "$1,602.93" "$3,251.38" "$3,306.65" "$3,251.38" "$3,251.38" "$2,438.63" "$3,251.38" "$3,251.38" "$3,251.38" "$1,625.69" "$1,625.69" "$2,575.09" "$3,251.38" "$2,601.10" "$1,463.12" $645.32 N/A "$1,885.87" "$3,251.38" "$3,251.38" "$3,251.38" $677.59 "$3,251.38" N/A N/A 04.110.013S SUP HCPCS C1713 04.110.013S - PLATE BONE 13 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL BOTH IP/OP "$3,497.50" "$2,588.00" $694.14 "$3,556.83" "$1,573.82" "$1,573.82" "$1,573.82" "$1,573.82" "$3,497.38" "$3,497.38" "$3,497.38" $728.94 "$3,497.38" "$3,497.38" "$3,497.38" "$3,497.38" "$3,497.38" $728.89 "$3,497.38" "$3,556.83" "$1,724.21" "$3,497.38" "$3,556.83" "$3,497.38" "$3,497.38" "$2,623.13" "$3,497.38" "$3,497.38" "$3,497.38" "$1,748.69" "$1,748.69" "$2,769.92" "$3,497.38" "$2,797.90" "$1,573.82" $694.14 N/A "$2,028.55" "$3,497.38" "$3,497.38" "$3,497.38" $728.85 "$3,497.38" N/A N/A 04.110.015S SUP HCPCS C1713 04.110.015S - PLATE BONE 15 HOLE LCP TITANIUM RIGHT DISTAL DIAPHYSEAL BOTH IP/OP "$3,611.50" "$2,673.00" $716.74 "$3,672.63" "$1,625.05" "$1,625.05" "$1,625.05" "$1,625.05" "$3,611.23" "$3,611.23" "$3,611.23" $752.67 "$3,611.23" "$3,611.23" "$3,611.23" "$3,611.23" "$3,611.23" $752.62 "$3,611.23" "$3,672.63" "$1,780.34" "$3,611.23" "$3,672.63" "$3,611.23" "$3,611.23" "$2,708.63" "$3,611.23" "$3,611.23" "$3,611.23" "$1,805.62" "$1,805.62" "$2,860.09" "$3,611.23" "$2,888.98" "$1,625.05" $716.74 N/A "$2,094.67" "$3,611.23" "$3,611.23" "$3,611.23" $752.58 "$3,611.23" N/A N/A 04.110.105 SUP HCPCS C1713 04.110.105 - PLATE BONE 5 HOLE LCP TITANIUM LEFT DISTAL RADIAL NONSTRL BOTH IP/OP "$2,921.50" "$2,162.00" $579.75 "$2,970.68" "$1,314.46" "$1,314.46" "$1,314.46" "$1,314.46" "$2,921.03" "$2,921.03" "$2,921.03" $608.82 "$2,921.03" "$2,921.03" "$2,921.03" "$2,921.03" "$2,921.03" $608.77 "$2,921.03" "$2,970.68" "$1,440.07" "$2,921.03" "$2,970.68" "$2,921.03" "$2,921.03" "$2,191.13" "$2,921.03" "$2,921.03" "$2,921.03" "$1,460.52" "$1,460.52" "$2,313.46" "$2,921.03" "$2,336.82" "$1,314.46" $579.75 N/A "$1,694.47" "$2,921.03" "$2,921.03" "$2,921.03" $608.74 "$2,921.03" N/A N/A 04.110.107 SUP HCPCS C1713 04.110.107 - PLATE BONE 7 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL BOTH IP/OP "$2,993.00" "$2,215.00" $593.98 "$3,043.60" "$1,346.73" "$1,346.73" "$1,346.73" "$1,346.73" "$2,992.73" "$2,992.73" "$2,992.73" $623.76 "$2,992.73" "$2,992.73" "$2,992.73" "$2,992.73" "$2,992.73" $623.72 "$2,992.73" "$3,043.60" "$1,475.42" "$2,992.73" "$3,043.60" "$2,992.73" "$2,992.73" "$2,244.75" "$2,992.73" "$2,992.73" "$2,992.73" "$1,496.37" "$1,496.37" "$2,370.24" "$2,992.73" "$2,394.18" "$1,346.73" $593.98 N/A "$1,735.94" "$2,992.73" "$2,992.73" "$2,992.73" $623.68 "$2,992.73" N/A N/A 04.110.109 SUP HCPCS C1713 04.110.109 - PLATE BONE 9 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL BOTH IP/OP "$3,063.00" "$2,267.00" $607.93 "$3,115.08" "$1,378.35" "$1,378.35" "$1,378.35" "$1,378.35" "$3,063.00" "$3,063.00" "$3,063.00" $638.41 "$3,063.00" "$3,063.00" "$3,063.00" "$3,063.00" "$3,063.00" $638.36 "$3,063.00" "$3,115.08" "$1,510.06" "$3,063.00" "$3,115.08" "$3,063.00" "$3,063.00" "$2,297.25" "$3,063.00" "$3,063.00" "$3,063.00" "$1,531.50" "$1,531.50" "$2,425.90" "$3,063.00" "$2,450.40" "$1,378.35" $607.93 N/A "$1,776.54" "$3,063.00" "$3,063.00" "$3,063.00" $638.33 "$3,063.00" N/A N/A 04.110.111 SUP HCPCS C1713 04.110.111 - PLATE BONE 11 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL BOTH IP/OP "$3,251.50" "$2,406.00" $645.32 "$3,306.65" "$1,463.12" "$1,463.12" "$1,463.12" "$1,463.12" "$3,251.38" "$3,251.38" "$3,251.38" $677.67 "$3,251.38" "$3,251.38" "$3,251.38" "$3,251.38" "$3,251.38" $677.62 "$3,251.38" "$3,306.65" "$1,602.93" "$3,251.38" "$3,306.65" "$3,251.38" "$3,251.38" "$2,438.63" "$3,251.38" "$3,251.38" "$3,251.38" "$1,625.69" "$1,625.69" "$2,575.09" "$3,251.38" "$2,601.10" "$1,463.12" $645.32 N/A "$1,885.87" "$3,251.38" "$3,251.38" "$3,251.38" $677.59 "$3,251.38" N/A N/A 04.110.113S SUP HCPCS C1713 04.110.113S - PLATE BONE 13 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL BOTH IP/OP "$3,497.50" "$2,588.00" $694.14 "$3,556.83" "$1,573.82" "$1,573.82" "$1,573.82" "$1,573.82" "$3,497.38" "$3,497.38" "$3,497.38" $728.94 "$3,497.38" "$3,497.38" "$3,497.38" "$3,497.38" "$3,497.38" $728.89 "$3,497.38" "$3,556.83" "$1,724.21" "$3,497.38" "$3,556.83" "$3,497.38" "$3,497.38" "$2,623.13" "$3,497.38" "$3,497.38" "$3,497.38" "$1,748.69" "$1,748.69" "$2,769.92" "$3,497.38" "$2,797.90" "$1,573.82" $694.14 N/A "$2,028.55" "$3,497.38" "$3,497.38" "$3,497.38" $728.85 "$3,497.38" N/A N/A 04.110.115S SUP HCPCS C1713 04.110.115S - PLATE BONE 15 HOLE LCP TITANIUM LEFT DISTAL DIAPHYSEAL BOTH IP/OP "$3,611.50" "$2,673.00" $716.74 "$3,672.63" "$1,625.05" "$1,625.05" "$1,625.05" "$1,625.05" "$3,611.23" "$3,611.23" "$3,611.23" $752.67 "$3,611.23" "$3,611.23" "$3,611.23" "$3,611.23" "$3,611.23" $752.62 "$3,611.23" "$3,672.63" "$1,780.34" "$3,611.23" "$3,672.63" "$3,611.23" "$3,611.23" "$2,708.63" "$3,611.23" "$3,611.23" "$3,611.23" "$1,805.62" "$1,805.62" "$2,860.09" "$3,611.23" "$2,888.98" "$1,625.05" $716.74 N/A "$2,094.67" "$3,611.23" "$3,611.23" "$3,611.23" $752.58 "$3,611.23" N/A N/A 04.110.150 SUP HCPCS C1713 04.110.150 - PLATE BONE STANDARD BEND 118MM FUSION LCP TITANIUM WRIST BOTH IP/OP "$3,146.00" "$2,328.00" $624.39 "$3,199.43" "$1,415.68" "$1,415.68" "$1,415.68" "$1,415.68" "$3,145.95" "$3,145.95" "$3,145.95" $655.69 "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" $655.65 "$3,145.95" "$3,199.43" "$1,550.95" "$3,145.95" "$3,199.43" "$3,145.95" "$3,145.95" "$2,359.50" "$3,145.95" "$3,145.95" "$3,145.95" "$1,572.98" "$1,572.98" "$2,491.59" "$3,145.95" "$2,516.76" "$1,415.68" $624.39 N/A "$1,824.68" "$3,145.95" "$3,145.95" "$3,145.95" $655.62 "$3,145.95" N/A N/A 04.110.151 SUP HCPCS C1713 04.110.151 - PLATE BN SHRT BND 118MM NS LCP FSN TI WRST BOTH IP/OP "$3,146.00" "$2,328.00" $624.39 "$3,199.43" "$1,415.68" "$1,415.68" "$1,415.68" "$1,415.68" "$3,145.95" "$3,145.95" "$3,145.95" $655.69 "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" $655.65 "$3,145.95" "$3,199.43" "$1,550.95" "$3,145.95" "$3,199.43" "$3,145.95" "$3,145.95" "$2,359.50" "$3,145.95" "$3,145.95" "$3,145.95" "$1,572.98" "$1,572.98" "$2,491.59" "$3,145.95" "$2,516.76" "$1,415.68" $624.39 N/A "$1,824.68" "$3,145.95" "$3,145.95" "$3,145.95" $655.62 "$3,145.95" N/A N/A 04.110.152 SUP HCPCS C1713 04.110.152 - PLATE BONE 112MM STR FUSION LCP TITANIUM WRIST NONSTRL BOTH IP/OP "$3,146.00" "$2,328.00" $624.39 "$3,199.43" "$1,415.68" "$1,415.68" "$1,415.68" "$1,415.68" "$3,145.95" "$3,145.95" "$3,145.95" $655.69 "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" "$3,145.95" $655.65 "$3,145.95" "$3,199.43" "$1,550.95" "$3,145.95" "$3,199.43" "$3,145.95" "$3,145.95" "$2,359.50" "$3,145.95" "$3,145.95" "$3,145.95" "$1,572.98" "$1,572.98" "$2,491.59" "$3,145.95" "$2,516.76" "$1,415.68" $624.39 N/A "$1,824.68" "$3,145.95" "$3,145.95" "$3,145.95" $655.62 "$3,145.95" N/A N/A 04.110.201 SUP HCPCS C1713 04.110.201 - PLATE BONE 5X3 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 04.110.202 SUP HCPCS C1713 04.110.202 - PLATE BONE 5X5 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" $420.09 "$2,015.78" N/A N/A 04.110.203 SUP HCPCS C1713 04.110.203 - PLATE BONE 4X3 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 04.110.204 SUP HCPCS C1713 04.110.204 - PLATE BONE 5X5 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" $420.09 "$2,015.78" N/A N/A 04.110.205 SUP HCPCS C1713 04.110.205 - PLATE BONE 4X3 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 04.110.206 SUP HCPCS C1713 04.110.206 - PLATE BONE 4X5 HOLE VAR ANG LCP TITANIUM RIGHT VOLAR DISTAL BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" $420.09 "$2,015.78" N/A N/A 04.110.207 SUP HCPCS C1713 04.110.207 - PLATE BONE 4X3 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 04.110.208 SUP HCPCS C1713 04.110.208 - PLATE BONE 4X5 HOLE VAR ANG LCP TITANIUM LEFT VOLAR DISTAL BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$1,209.47" "$2,015.78" $420.09 "$2,015.78" N/A N/A 04.110.300 SUP Custom 27203010 04.110.300 - WIRE FIX 1.8MM 150MM TROCAR POINT DEPTH MARKING KWIRE BOTH IP/OP $20.50 $15.00 $3.58 $20.45 $20.10 $20.10 $20.10 $20.10 $20.10 $20.10 $3.58 $20.10 $20.10 $14.92 $14.92 $15.49 $10.47 $4.19 $20.10 $8.18 $20.10 $20.10 $20.45 $20.10 $20.10 $15.38 $20.10 $20.10 $20.10 $10.05 $10.05 $15.92 $20.10 $16.08 $13.07 $20.10 N/A $11.89 $20.10 $12.06 $20.10 $20.10 $20.10 N/A N/A 04.110.330 SUP HCPCS C1713 04.110.330 - PLATE BONE 50.5MM 9X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL BOTH IP/OP "$1,524.50" "$1,128.00" $302.56 "$1,524.43" $685.99 $685.99 $685.99 $685.99 "$1,524.43" "$1,524.43" "$1,524.43" $317.73 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" $317.71 "$1,524.43" "$1,524.43" $901.70 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,143.38" "$1,524.43" "$1,524.43" "$1,524.43" $762.22 $762.22 "$1,207.35" "$1,524.43" "$1,219.54" $685.99 $302.56 N/A $884.21 "$1,524.43" "$1,524.43" "$1,524.43" $317.69 "$1,524.43" N/A N/A 04.110.331 SUP HCPCS C1713 04.110.331 - PLATE BONE 50.5MM 9X3 HOLE COLUMN LCP TITANIUM LEFT DISTAL BOTH IP/OP "$1,524.50" "$1,128.00" $302.56 "$1,524.43" $685.99 $685.99 $685.99 $685.99 "$1,524.43" "$1,524.43" "$1,524.43" $317.73 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" $317.71 "$1,524.43" "$1,524.43" $901.70 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,143.38" "$1,524.43" "$1,524.43" "$1,524.43" $762.22 $762.22 "$1,207.35" "$1,524.43" "$1,219.54" $685.99 $302.56 N/A $884.21 "$1,524.43" "$1,524.43" "$1,524.43" $317.69 "$1,524.43" N/A N/A 04.110.340 SUP HCPCS C1713 04.110.340 - PLATE BONE 59.5MM 9X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL BOTH IP/OP "$1,572.50" "$1,164.00" $312.04 "$1,572.20" $707.49 $707.49 $707.49 $707.49 "$1,572.20" "$1,572.20" "$1,572.20" $327.69 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" $327.66 "$1,572.20" "$1,572.20" $929.96 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,179.38" "$1,572.20" "$1,572.20" "$1,572.20" $786.10 $786.10 "$1,245.18" "$1,572.20" "$1,257.76" $707.49 $312.04 N/A $912.05 "$1,572.20" "$1,572.20" "$1,572.20" $327.65 "$1,572.20" N/A N/A 04.110.341 SUP HCPCS C1713 04.110.341 - PLATE BONE 59.5MM 9X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL BOTH IP/OP "$1,572.50" "$1,164.00" $312.04 "$1,572.20" $707.49 $707.49 $707.49 $707.49 "$1,572.20" "$1,572.20" "$1,572.20" $327.69 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" $327.66 "$1,572.20" "$1,572.20" $929.96 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,179.38" "$1,572.20" "$1,572.20" "$1,572.20" $786.10 $786.10 "$1,245.18" "$1,572.20" "$1,257.76" $707.49 $312.04 N/A $912.05 "$1,572.20" "$1,572.20" "$1,572.20" $327.65 "$1,572.20" N/A N/A 04.110.350 SUP HCPCS C1713 04.110.350 - PLATE BONE 68.5MM 9X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL BOTH IP/OP "$1,619.00" "$1,198.00" $321.25 "$1,618.60" $728.37 $728.37 $728.37 $728.37 "$1,618.60" "$1,618.60" "$1,618.60" $337.36 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" $337.33 "$1,618.60" "$1,618.60" $957.40 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,214.25" "$1,618.60" "$1,618.60" "$1,618.60" $809.30 $809.30 "$1,281.93" "$1,618.60" "$1,294.88" $728.37 $321.25 N/A $939.02 "$1,618.60" "$1,618.60" "$1,618.60" $337.32 "$1,618.60" N/A N/A 04.110.351 SUP HCPCS C1713 04.110.351 - PLATE BONE 68.5MM 9X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL BOTH IP/OP "$1,619.00" "$1,198.00" $321.25 "$1,618.60" $728.37 $728.37 $728.37 $728.37 "$1,618.60" "$1,618.60" "$1,618.60" $337.36 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" $337.33 "$1,618.60" "$1,618.60" $957.40 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,214.25" "$1,618.60" "$1,618.60" "$1,618.60" $809.30 $809.30 "$1,281.93" "$1,618.60" "$1,294.88" $728.37 $321.25 N/A $939.02 "$1,618.60" "$1,618.60" "$1,618.60" $337.32 "$1,618.60" N/A N/A 04.110.430 SUP HCPCS C1713 04.110.430 - PLATE BONE 50.5MM 8X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL BOTH IP/OP "$1,524.50" "$1,128.00" $302.56 "$1,524.43" $685.99 $685.99 $685.99 $685.99 "$1,524.43" "$1,524.43" "$1,524.43" $317.73 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" $317.71 "$1,524.43" "$1,524.43" $901.70 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,143.38" "$1,524.43" "$1,524.43" "$1,524.43" $762.22 $762.22 "$1,207.35" "$1,524.43" "$1,219.54" $685.99 $302.56 N/A $884.21 "$1,524.43" "$1,524.43" "$1,524.43" $317.69 "$1,524.43" N/A N/A 04.110.431 SUP HCPCS C1713 04.110.431 - PLATE BN 50.5MM NS LCP CMBN 8 HLE/HD 3 HL SHFT CLMN RND EDG BOTH IP/OP "$1,524.50" "$1,128.00" $302.56 "$1,524.43" $685.99 $685.99 $685.99 $685.99 "$1,524.43" "$1,524.43" "$1,524.43" $317.73 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" $317.71 "$1,524.43" "$1,524.43" $901.70 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,143.38" "$1,524.43" "$1,524.43" "$1,524.43" $762.22 $762.22 "$1,207.35" "$1,524.43" "$1,219.54" $685.99 $302.56 N/A $884.21 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" N/A N/A 04.110.440 SUP HCPCS C1713 04.110.440 - PLATE BONE 59.5MM 8X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL BOTH IP/OP "$1,572.50" "$1,164.00" $312.04 "$1,572.20" $707.49 $707.49 $707.49 $707.49 "$1,572.20" "$1,572.20" "$1,572.20" $327.69 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" $327.66 "$1,572.20" $628.88 $929.96 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,179.38" "$1,572.20" "$1,572.20" "$1,572.20" $786.10 $786.10 "$1,245.18" "$1,572.20" "$1,257.76" $707.49 $312.04 N/A $912.05 "$1,572.20" $943.32 "$1,572.20" "$1,572.20" "$1,572.20" N/A N/A 04.110.441 SUP HCPCS C1713 04.110.441 - PLATE BONE 59.5MM 8X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL BOTH IP/OP "$1,572.50" "$1,164.00" $312.04 "$1,572.20" $707.49 $707.49 $707.49 $707.49 "$1,572.20" "$1,572.20" "$1,572.20" $327.69 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" $327.66 "$1,572.20" $628.88 $929.96 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,179.38" "$1,572.20" "$1,572.20" "$1,572.20" $786.10 $786.10 "$1,245.18" "$1,572.20" "$1,257.76" $707.49 $312.04 N/A $912.05 "$1,572.20" $943.32 "$1,572.20" $327.65 "$1,572.20" N/A N/A 04.110.450 SUP HCPCS C1713 04.110.450 - PLATE BONE 68.5MM 8X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL BOTH IP/OP "$1,619.00" "$1,198.00" $321.25 "$1,618.60" $728.37 $728.37 $728.37 $728.37 "$1,618.60" "$1,618.60" "$1,618.60" $337.36 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" $337.33 "$1,618.60" $647.44 $957.40 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,214.25" "$1,618.60" "$1,618.60" "$1,618.60" $809.30 $809.30 "$1,281.93" "$1,618.60" "$1,294.88" $728.37 $321.25 N/A $939.02 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" N/A N/A 04.110.451 SUP HCPCS C1713 04.110.451 - PLATE BONE 68.5MM 8X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL BOTH IP/OP "$1,619.00" "$1,198.00" $321.25 "$1,618.60" $728.37 $728.37 $728.37 $728.37 "$1,618.60" "$1,618.60" "$1,618.60" $337.36 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" $337.33 "$1,618.60" $647.44 $957.40 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,214.25" "$1,618.60" "$1,618.60" "$1,618.60" $809.30 $809.30 "$1,281.93" "$1,618.60" "$1,294.88" $728.37 $321.25 N/A $939.02 "$1,618.60" $971.16 "$1,618.60" "$1,618.60" "$1,618.60" N/A N/A 04.110.730 SUP HCPCS C1713 04.110.730 - PLATE BONE 45MM 6X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL BOTH IP/OP "$1,524.50" "$1,128.00" $302.56 "$1,524.43" $685.99 $685.99 $685.99 $685.99 "$1,524.43" "$1,524.43" "$1,524.43" $317.73 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" $317.71 "$1,524.43" $609.77 $901.70 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,143.38" "$1,524.43" "$1,524.43" "$1,524.43" $762.22 $762.22 "$1,207.35" "$1,524.43" "$1,219.54" $685.99 $302.56 N/A $884.21 "$1,524.43" "$1,524.43" "$1,524.43" $317.69 "$1,524.43" N/A N/A 04.110.731 SUP HCPCS C1713 04.110.731 - PLATE BONE 45MM 6X3 HOLE COLUMN LCP TITANIUM LEFT DISTAL BOTH IP/OP "$1,524.50" "$1,128.00" $302.56 "$1,524.43" $685.99 $685.99 $685.99 $685.99 "$1,524.43" "$1,524.43" "$1,524.43" $317.73 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" $317.71 "$1,524.43" $609.77 $901.70 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,143.38" "$1,524.43" "$1,524.43" "$1,524.43" $762.22 $762.22 "$1,207.35" "$1,524.43" "$1,219.54" $685.99 $302.56 N/A $884.21 "$1,524.43" $914.66 "$1,524.43" $317.69 "$1,524.43" N/A N/A 04.110.740 SUP HCPCS C1713 04.110.740 - PLATE BONE 54MM 6X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL BOTH IP/OP "$1,572.50" "$1,164.00" $312.04 "$1,572.20" $707.49 $707.49 $707.49 $707.49 "$1,572.20" "$1,572.20" "$1,572.20" $327.69 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" $327.66 "$1,572.20" $628.88 $929.96 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,179.38" "$1,572.20" "$1,572.20" "$1,572.20" $786.10 $786.10 "$1,245.18" "$1,572.20" "$1,257.76" $707.49 $312.04 N/A $912.05 "$1,572.20" $943.32 "$1,572.20" $327.65 "$1,572.20" N/A N/A 04.110.741 SUP HCPCS C1713 04.110.741 - PLATE BONE 54MM 6X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL BOTH IP/OP "$1,572.50" "$1,164.00" $312.04 "$1,572.20" $707.49 $707.49 $707.49 $707.49 "$1,572.20" "$1,572.20" "$1,572.20" $327.69 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" $327.66 "$1,572.20" $628.88 $929.96 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,179.38" "$1,572.20" "$1,572.20" "$1,572.20" $786.10 $786.10 "$1,245.18" "$1,572.20" "$1,257.76" $707.49 $312.04 N/A $912.05 "$1,572.20" $943.32 "$1,572.20" $327.65 "$1,572.20" N/A N/A 04.110.750 SUP HCPCS C1713 04.110.750 - PLATE BONE 63MM 6X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL BOTH IP/OP "$1,619.00" "$1,198.00" $321.25 "$1,618.60" $728.37 $728.37 $728.37 $728.37 "$1,618.60" "$1,618.60" "$1,618.60" $337.36 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" $337.33 "$1,618.60" $647.44 $957.40 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,214.25" "$1,618.60" "$1,618.60" "$1,618.60" $809.30 $809.30 "$1,281.93" "$1,618.60" "$1,294.88" $728.37 $321.25 N/A $939.02 "$1,618.60" "$1,618.60" "$1,618.60" $337.32 "$1,618.60" N/A N/A 04.110.751 SUP HCPCS C1713 04.110.751 - PLATE BONE 63MM 6X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL BOTH IP/OP "$1,619.00" "$1,198.00" $321.25 "$1,618.60" $728.37 $728.37 $728.37 $728.37 "$1,618.60" "$1,618.60" "$1,618.60" $337.36 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" $337.33 "$1,618.60" $647.44 $957.40 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,214.25" "$1,618.60" "$1,618.60" "$1,618.60" $809.30 $809.30 "$1,281.93" "$1,618.60" "$1,294.88" $728.37 $321.25 N/A $939.02 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" N/A N/A 04.110.830 SUP HCPCS C1713 04.110.830 - PLATE BONE 45MM 7X3 HOLE COLUMN LCP TITANIUM RIGHT DISTAL BOTH IP/OP "$1,524.50" "$1,128.00" $302.56 "$1,524.43" $685.99 $685.99 $685.99 $685.99 "$1,524.43" "$1,524.43" "$1,524.43" $317.73 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" $317.71 "$1,524.43" "$1,524.43" $901.70 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,143.38" "$1,524.43" "$1,524.43" "$1,524.43" $762.22 $762.22 "$1,207.35" "$1,524.43" "$1,219.54" $685.99 $302.56 N/A $884.21 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" N/A N/A 04.110.831 SUP HCPCS C1713 04.110.831 - PLATE BONE 45MM 7X3 HOLE COLUMN LCP TITANIUM LEFT VOLAR BOTH IP/OP "$1,524.50" "$1,128.00" $302.56 "$1,524.43" $685.99 $685.99 $685.99 $685.99 "$1,524.43" "$1,524.43" "$1,524.43" $317.73 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" $317.71 "$1,524.43" $609.77 $901.70 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,143.38" "$1,524.43" "$1,524.43" "$1,524.43" $762.22 $762.22 "$1,207.35" "$1,524.43" "$1,219.54" $685.99 $302.56 N/A $884.21 "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" "$1,524.43" N/A N/A 04.110.840 SUP HCPCS C1713 04.110.840 - PLATE BONE 54MM 7X4 HOLE COLUMN LCP TITANIUM RIGHT DISTAL BOTH IP/OP "$1,572.50" "$1,164.00" $312.04 "$1,572.20" $707.49 $707.49 $707.49 $707.49 "$1,572.20" "$1,572.20" "$1,572.20" $327.69 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" $327.66 "$1,572.20" $628.88 $929.96 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,179.38" "$1,572.20" "$1,572.20" "$1,572.20" $786.10 $786.10 "$1,245.18" "$1,572.20" "$1,257.76" $707.49 $312.04 N/A $912.05 "$1,572.20" $943.32 "$1,572.20" $327.65 "$1,572.20" N/A N/A 04.110.841 SUP HCPCS C1713 04.110.841 - PLATE BONE 54MM 7X4 HOLE COLUMN LCP TITANIUM LEFT DISTAL BOTH IP/OP "$1,572.50" "$1,164.00" $312.04 "$1,572.20" $707.49 $707.49 $707.49 $707.49 "$1,572.20" "$1,572.20" "$1,572.20" $327.69 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" $327.66 "$1,572.20" $628.88 $929.96 "$1,572.20" "$1,572.20" "$1,572.20" "$1,572.20" "$1,179.38" "$1,572.20" "$1,572.20" "$1,572.20" $786.10 $786.10 "$1,245.18" "$1,572.20" "$1,257.76" $707.49 $312.04 N/A $912.05 "$1,572.20" "$1,572.20" "$1,572.20" $327.65 "$1,572.20" N/A N/A 04.110.850 SUP HCPCS C1713 04.110.850 - PLATE BONE 63MM 7X5 HOLE COLUMN LCP TITANIUM RIGHT DISTAL BOTH IP/OP "$1,619.00" "$1,198.00" $321.25 "$1,618.60" $728.37 $728.37 $728.37 $728.37 "$1,618.60" "$1,618.60" "$1,618.60" $337.36 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" $337.33 "$1,618.60" "$1,618.60" $957.40 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,214.25" "$1,618.60" "$1,618.60" "$1,618.60" $809.30 $809.30 "$1,281.93" "$1,618.60" "$1,294.88" $728.37 $321.25 N/A $939.02 "$1,618.60" "$1,618.60" "$1,618.60" $337.32 "$1,618.60" N/A N/A 04.110.851 SUP HCPCS C1713 04.110.851 - PLATE BONE 63MM 7X5 HOLE COLUMN LCP TITANIUM LEFT DISTAL BOTH IP/OP "$1,619.00" "$1,198.00" $321.25 "$1,618.60" $728.37 $728.37 $728.37 $728.37 "$1,618.60" "$1,618.60" "$1,618.60" $337.36 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" $337.33 "$1,618.60" $647.44 $957.40 "$1,618.60" "$1,618.60" "$1,618.60" "$1,618.60" "$1,214.25" "$1,618.60" "$1,618.60" "$1,618.60" $809.30 $809.30 "$1,281.93" "$1,618.60" "$1,294.88" $728.37 $321.25 N/A $939.02 "$1,618.60" "$1,618.60" "$1,618.60" $337.32 "$1,618.60" N/A N/A 04.111.520 SUP HCPCS C1713 04.111.520 - PLATE BONE NARROW 42MM 6X2 HOLE 2 COLUMN VAR ANG LCP BOTH IP/OP "$1,802.50" "$1,334.00" $357.67 "$1,832.73" $810.95 $810.95 $810.95 $810.95 "$1,802.10" "$1,802.10" "$1,802.10" $375.60 "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" $375.58 "$1,802.10" $733.09 "$1,065.94" "$1,802.10" "$1,832.73" "$1,802.10" "$1,802.10" "$1,351.88" "$1,802.10" "$1,802.10" "$1,802.10" $901.05 $901.05 "$1,427.26" "$1,802.10" "$1,441.68" $810.95 $357.67 N/A "$1,045.45" "$1,802.10" "$1,802.10" "$1,802.10" $375.56 "$1,802.10" N/A N/A 04.111.521 SUP HCPCS C1713 04.111.521 - PLATE BONE NARROW 42MM 6X2 HOLE 2 COLUMN VAR ANG LCP BOTH IP/OP "$1,802.50" "$1,334.00" $357.67 "$1,832.73" $810.95 $810.95 $810.95 $810.95 "$1,802.10" "$1,802.10" "$1,802.10" $375.60 "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" $375.58 "$1,802.10" $733.09 "$1,065.94" "$1,802.10" "$1,832.73" "$1,802.10" "$1,802.10" "$1,351.88" "$1,802.10" "$1,802.10" "$1,802.10" $901.05 $901.05 "$1,427.26" "$1,802.10" "$1,441.68" $810.95 $357.67 N/A "$1,045.45" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" N/A N/A 04.111.530 SUP HCPCS C1713 04.111.530 - PLATE BONE NARROW 51MM 6X3 HOLE 2 COLUMN VAR ANG LCP BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" $762.26 "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" N/A N/A 04.111.531 SUP HCPCS C1713 04.111.531 - PLATE BONE NARROW 51MM 6X3 HOLE 2 COLUMN VAR ANG LCP BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" $762.26 "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 04.111.540 SUP HCPCS C1713 04.111.540 - PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG LCP BOTH IP/OP "$1,944.50" "$1,439.00" $385.85 "$1,977.13" $874.84 $874.84 $874.84 $874.84 "$1,944.08" "$1,944.08" "$1,944.08" $405.19 "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" $405.17 "$1,944.08" $790.85 "$1,149.92" "$1,944.08" "$1,977.13" "$1,944.08" "$1,944.08" "$1,458.38" "$1,944.08" "$1,944.08" "$1,944.08" $972.04 $972.04 "$1,539.71" "$1,944.08" "$1,555.26" $874.84 $385.85 N/A "$1,127.81" "$1,944.08" "$1,944.08" "$1,944.08" $405.15 "$1,944.08" N/A N/A 04.111.541 SUP HCPCS C1713 04.111.541 - PLATE BONE NARROW 63MM 6X4 HOLE 2 COLUMN VAR ANG LCP BOTH IP/OP "$1,944.50" "$1,439.00" $385.85 "$1,977.13" $874.84 $874.84 $874.84 $874.84 "$1,944.08" "$1,944.08" "$1,944.08" $405.19 "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" $405.17 "$1,944.08" $790.85 "$1,149.92" "$1,944.08" "$1,977.13" "$1,944.08" "$1,944.08" "$1,458.38" "$1,944.08" "$1,944.08" "$1,944.08" $972.04 $972.04 "$1,539.71" "$1,944.08" "$1,555.26" $874.84 $385.85 N/A "$1,127.81" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" N/A N/A 04.111.550 SUP HCPCS C1713 04.111.550 - PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG LCP BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" $820.02 "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" $420.09 "$2,015.78" N/A N/A 04.111.551 SUP HCPCS C1713 04.111.551 - PLATE BONE NARROW 72MM 6X5 HOLE 2 COLUMN VAR ANG LCP BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" $820.02 "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" N/A N/A 04.111.620 SUP HCPCS C1713 04.111.620 - PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA BOTH IP/OP "$1,802.50" "$1,334.00" $357.67 "$1,832.73" $810.95 $810.95 $810.95 $810.95 "$1,802.10" "$1,802.10" "$1,802.10" $375.60 "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" $375.58 "$1,802.10" $733.09 "$1,065.94" "$1,802.10" "$1,832.73" "$1,802.10" "$1,802.10" "$1,351.88" "$1,802.10" "$1,802.10" "$1,802.10" $901.05 $901.05 "$1,427.26" "$1,802.10" "$1,441.68" $810.95 $357.67 N/A "$1,045.45" "$1,802.10" "$1,081.26" "$1,802.10" $375.56 "$1,802.10" N/A N/A 04.111.621 SUP HCPCS C1713 04.111.621 - PLATE BN STD 45MM NS LCP CMBN 6 HLE/HD 2 HL SHFT 2 CLMN VA BOTH IP/OP "$1,802.50" "$1,334.00" $357.67 "$1,832.73" $810.95 $810.95 $810.95 $810.95 "$1,802.10" "$1,802.10" "$1,802.10" $375.60 "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" $375.58 "$1,802.10" $733.09 "$1,065.94" "$1,802.10" "$1,832.73" "$1,802.10" "$1,802.10" "$1,351.88" "$1,802.10" "$1,802.10" "$1,802.10" $901.05 $901.05 "$1,427.26" "$1,802.10" "$1,441.68" $810.95 $357.67 N/A "$1,045.45" "$1,802.10" "$1,081.26" "$1,802.10" "$1,802.10" "$1,802.10" N/A N/A 04.111.630 SUP HCPCS C1713 04.111.630 - PLATE BN STD 54MM NS LCP CMBN 6 HLE/HD 3 HL SHFT 2 CLMN VA BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 04.111.631 SUP HCPCS C1713 04.111.631 - PLATE BONE 54MM 6X3 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" $762.26 "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 04.111.640 SUP HCPCS C1713 04.111.640 - PLATE BONE 70MM 6X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM LEFT BOTH IP/OP "$1,944.50" "$1,439.00" $385.85 "$1,977.13" $874.84 $874.84 $874.84 $874.84 "$1,944.08" "$1,944.08" "$1,944.08" $405.19 "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" $405.17 "$1,944.08" "$1,977.13" "$1,149.92" "$1,944.08" "$1,977.13" "$1,944.08" "$1,944.08" "$1,458.38" "$1,944.08" "$1,944.08" "$1,944.08" $972.04 $972.04 "$1,539.71" "$1,944.08" "$1,555.26" $874.84 $385.85 N/A "$1,127.81" "$1,944.08" "$1,944.08" "$1,944.08" $405.15 "$1,944.08" N/A N/A 04.111.641 SUP HCPCS C1713 04.111.641 - PLATE BONE 70MM 6X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM RIGHT BOTH IP/OP "$1,944.50" "$1,439.00" $385.85 "$1,977.13" $874.84 $874.84 $874.84 $874.84 "$1,944.08" "$1,944.08" "$1,944.08" $405.19 "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" $405.17 "$1,944.08" $790.85 "$1,149.92" "$1,944.08" "$1,977.13" "$1,944.08" "$1,944.08" "$1,458.38" "$1,944.08" "$1,944.08" "$1,944.08" $972.04 $972.04 "$1,539.71" "$1,944.08" "$1,555.26" $874.84 $385.85 N/A "$1,127.81" "$1,944.08" "$1,166.45" "$1,944.08" "$1,944.08" "$1,944.08" N/A N/A 04.111.650 SUP HCPCS C1713 04.111.650 - PLATE BONE 75MM 6X5 HOLE 2 COLUMN VAR ANG LCP TITANIUM RIGHT BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" N/A N/A 04.111.651 SUP HCPCS C1713 04.111.651 - PLATE BONE 75MM 6X5 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" N/A N/A 04.111.720 SUP HCPCS C1713 04.111.720 - PLATE BN STD 47MM NS LCP CMBN 7 HLE/HD 2 HL SHFT 2 CLMN VA BOTH IP/OP "$1,802.50" "$1,334.00" $357.67 "$1,832.73" $810.95 $810.95 $810.95 $810.95 "$1,802.10" "$1,802.10" "$1,802.10" $375.60 "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" $375.58 "$1,802.10" "$1,832.73" "$1,065.94" "$1,802.10" "$1,832.73" "$1,802.10" "$1,802.10" "$1,351.88" "$1,802.10" "$1,802.10" "$1,802.10" $901.05 $901.05 "$1,427.26" "$1,802.10" "$1,441.68" $810.95 $357.67 N/A "$1,045.45" "$1,802.10" "$1,081.26" "$1,802.10" "$1,802.10" "$1,802.10" N/A N/A 04.111.721 SUP HCPCS C1713 04.111.721 - PLATE BONE 49MM 7X2 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT BOTH IP/OP "$1,802.50" "$1,334.00" $357.67 "$1,832.73" $810.95 $810.95 $810.95 $810.95 "$1,802.10" "$1,802.10" "$1,802.10" $375.60 "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" "$1,802.10" $375.58 "$1,802.10" $733.09 "$1,065.94" "$1,802.10" "$1,832.73" "$1,802.10" "$1,802.10" "$1,351.88" "$1,802.10" "$1,802.10" "$1,802.10" $901.05 $901.05 "$1,427.26" "$1,802.10" "$1,441.68" $810.95 $357.67 N/A "$1,045.45" "$1,802.10" "$1,081.26" "$1,802.10" $375.56 "$1,802.10" N/A N/A 04.111.730 SUP HCPCS C1713 04.111.730 - PLATE BONE 55MM 7X3 HOLE 2 COLUMN VAR ANG LCP TITANIUM RIGHT BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 04.111.731 SUP HCPCS C1713 04.111.731 - PLATE BONE 55MM 7X3 HOLE 2 COLUMN VAR ANG LCP TITANIUM LEFT BOTH IP/OP "$1,874.00" "$1,387.00" $371.90 "$1,905.65" $843.21 $843.21 $843.21 $843.21 "$1,873.80" "$1,873.80" "$1,873.80" $390.55 "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" "$1,873.80" $390.52 "$1,873.80" "$1,905.65" "$1,108.35" "$1,873.80" "$1,905.65" "$1,873.80" "$1,873.80" "$1,405.50" "$1,873.80" "$1,873.80" "$1,873.80" $936.90 $936.90 "$1,484.05" "$1,873.80" "$1,499.04" $843.21 $371.90 N/A "$1,086.92" "$1,873.80" "$1,873.80" "$1,873.80" $390.50 "$1,873.80" N/A N/A 04.111.740 SUP HCPCS C1713 04.111.740 - PLATE BONE 70MM 7X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM RIGHT BOTH IP/OP "$1,944.50" "$1,439.00" $385.85 "$1,977.13" $874.84 $874.84 $874.84 $874.84 "$1,944.08" "$1,944.08" "$1,944.08" $405.19 "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" $405.17 "$1,944.08" "$1,977.13" "$1,149.92" "$1,944.08" "$1,977.13" "$1,944.08" "$1,944.08" "$1,458.38" "$1,944.08" "$1,944.08" "$1,944.08" $972.04 $972.04 "$1,539.71" "$1,944.08" "$1,555.26" $874.84 $385.85 N/A "$1,127.81" "$1,944.08" "$1,944.08" "$1,944.08" $405.15 "$1,944.08" N/A N/A 04.111.741 SUP HCPCS C1713 04.111.741 - PLATE BONE 70MM 7X4 HOLE VAR ANG 2 COLUMN LCP TITANIUM LEFT BOTH IP/OP "$1,944.50" "$1,439.00" $385.85 "$1,977.13" $874.84 $874.84 $874.84 $874.84 "$1,944.08" "$1,944.08" "$1,944.08" $405.19 "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" $405.17 "$1,944.08" "$1,977.13" "$1,149.92" "$1,944.08" "$1,977.13" "$1,944.08" "$1,944.08" "$1,458.38" "$1,944.08" "$1,944.08" "$1,944.08" $972.04 $972.04 "$1,539.71" "$1,944.08" "$1,555.26" $874.84 $385.85 N/A "$1,127.81" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" "$1,944.08" N/A N/A 04.111.750 SUP HCPCS C1713 04.111.750 - PLATE BONE 77MM 7X5 HOLE 2 COLUMN VAR ANG LCP TITANIUM RIGHT BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" $420.09 "$2,015.78" N/A N/A 04.111.751 SUP HCPCS C1713 04.111.751 - PLATE BONE 77MM 7X5 HOLE 2 COLUMN VARIABLE LCP TITANIUM LEFT BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" "$2,050.05" "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" $420.09 "$2,015.78" N/A N/A 04.112.006 SUP HCPCS C1713 04.112.006 - PLATE BONE 69MM 3 HOLE LATERAL EXTN LCP TITANIUM LEFT BOTH IP/OP "$1,624.00" "$1,202.00" $322.24 "$1,651.18" $730.61 $730.61 $730.61 $730.61 "$1,623.58" "$1,623.58" "$1,623.58" $338.39 "$1,623.58" "$1,623.58" "$1,623.58" "$1,623.58" "$1,623.58" $338.37 "$1,623.58" "$1,651.18" $960.35 "$1,623.58" "$1,651.18" "$1,623.58" "$1,623.58" "$1,218.00" "$1,623.58" "$1,623.58" "$1,623.58" $811.79 $811.79 "$1,285.88" "$1,623.58" "$1,298.86" $730.61 $322.24 N/A $941.92 "$1,623.58" "$1,623.58" "$1,623.58" $338.35 "$1,623.58" N/A N/A 04.112.007 SUP HCPCS C1713 04.112.007 - PLATE BONE 69MM 3 HOLE LATERAL EXTN LCP TITANIUM LEFT BOTH IP/OP "$1,624.00" "$1,202.00" $322.24 "$1,651.18" $730.61 $730.61 $730.61 $730.61 "$1,623.58" "$1,623.58" "$1,623.58" $338.39 "$1,623.58" "$1,623.58" "$1,623.58" "$1,623.58" "$1,623.58" $338.37 "$1,623.58" "$1,651.18" $960.35 "$1,623.58" "$1,651.18" "$1,623.58" "$1,623.58" "$1,218.00" "$1,623.58" "$1,623.58" "$1,623.58" $811.79 $811.79 "$1,285.88" "$1,623.58" "$1,298.86" $730.61 $322.24 N/A $941.92 "$1,623.58" "$1,623.58" "$1,623.58" $338.35 "$1,623.58" N/A N/A 04.112.008 SUP HCPCS C1713 04.112.008 - PLATE BONE 108MM 6 HOLE LATERAL EXTN LCP TITANIUM LEFT BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" "$1,724.10" "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" N/A N/A 04.112.009 SUP HCPCS C1713 04.112.009 - PLATE BONE 108MM 6 HOLE LATERAL EXTN LCP TITANIUM LEFT BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" "$1,724.10" "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,017.17" "$1,695.28" "$1,695.28" "$1,695.28" N/A N/A 04.112.010 SUP HCPCS C1713 04.112.010 - PLATE BONE 81MM 4 HOLE LATERAL EXTN LCP TITANIUM LEFT BOTH IP/OP "$1,649.00" "$1,220.00" $327.26 "$1,676.90" $742.00 $742.00 $742.00 $742.00 "$1,648.88" "$1,648.88" "$1,648.88" $343.67 "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" $343.64 "$1,648.88" "$1,676.90" $975.31 "$1,648.88" "$1,676.90" "$1,648.88" "$1,648.88" "$1,236.75" "$1,648.88" "$1,648.88" "$1,648.88" $824.44 $824.44 "$1,305.91" "$1,648.88" "$1,319.10" $742.00 $327.26 N/A $956.42 "$1,648.88" $989.33 "$1,648.88" $343.63 "$1,648.88" N/A N/A 04.112.011 SUP HCPCS C1713 04.112.011 - PLATE BONE 81MM 4 HOLE LATERAL EXTN LCP TITANIUM LEFT BOTH IP/OP "$1,649.00" "$1,220.00" $327.26 "$1,676.90" $742.00 $742.00 $742.00 $742.00 "$1,648.88" "$1,648.88" "$1,648.88" $343.67 "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" $343.64 "$1,648.88" "$1,676.90" $975.31 "$1,648.88" "$1,676.90" "$1,648.88" "$1,648.88" "$1,236.75" "$1,648.88" "$1,648.88" "$1,648.88" $824.44 $824.44 "$1,305.91" "$1,648.88" "$1,319.10" $742.00 $327.26 N/A $956.42 "$1,648.88" $989.33 "$1,648.88" $343.63 "$1,648.88" N/A N/A 04.112.012 SUP HCPCS C1713 04.112.012 - PLATE BONE 94MM 5 HOLE LATERAL EXTN LCP TITANIUM LEFT BOTH IP/OP "$1,677.00" "$1,241.00" $332.84 "$1,705.50" $754.65 $754.65 $754.65 $754.65 "$1,677.00" "$1,677.00" "$1,677.00" $349.53 "$1,677.00" "$1,677.00" "$1,677.00" "$1,677.00" "$1,677.00" $349.51 "$1,677.00" "$1,705.50" $991.95 "$1,677.00" "$1,705.50" "$1,677.00" "$1,677.00" "$1,257.75" "$1,677.00" "$1,677.00" "$1,677.00" $838.50 $838.50 "$1,328.18" "$1,677.00" "$1,341.60" $754.65 $332.84 N/A $972.66 "$1,677.00" "$1,677.00" "$1,677.00" $349.49 "$1,677.00" N/A N/A 04.112.013 SUP HCPCS C1713 04.112.013 - PLATE BONE 94MM 5 HOLE LATERAL EXTN LCP TITANIUM LEFT BOTH IP/OP "$1,677.00" "$1,241.00" $332.84 "$1,705.50" $754.65 $754.65 $754.65 $754.65 "$1,677.00" "$1,677.00" "$1,677.00" $349.53 "$1,677.00" "$1,677.00" "$1,677.00" "$1,677.00" "$1,677.00" $349.51 "$1,677.00" "$1,705.50" $991.95 "$1,677.00" "$1,705.50" "$1,677.00" "$1,677.00" "$1,257.75" "$1,677.00" "$1,677.00" "$1,677.00" $838.50 $838.50 "$1,328.18" "$1,677.00" "$1,341.60" $754.65 $332.84 N/A $972.66 "$1,677.00" "$1,677.00" "$1,677.00" $349.49 "$1,677.00" N/A N/A 04.112.018 SUP HCPCS C1713 04.112.018 - PLATE BONE 123MM 7 HOLE LATERAL EXTN LCP TITANIUM LEFT BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" "$1,769.83" "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" N/A N/A 04.112.019 SUP HCPCS C1713 04.112.019 - PLATE BONE 123MM 7 HOLE LATERAL EXTN LCP TITANIUM LEFT BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" "$1,769.83" "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" N/A N/A 04.112.020 SUP HCPCS C1713 04.112.020 - PLATE BONE 135MM 8 HOLE LATERAL EXTN LCP TITANIUM RIGHT BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" $372.04 "$1,785.23" N/A N/A 04.112.021 SUP HCPCS C1713 04.112.021 - PLATE BONE 135MM 8 HOLE LATERAL EXTN LCP TITANIUM LEFT BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" N/A N/A 04.112.026 SUP HCPCS C1713 04.112.026 - PLATE BN 94MM NS LCP CMBN 6 HL PRECONTOUR LMT CNTCT TPR TIP BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" "$1,724.10" "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" N/A N/A 04.112.027 SUP HCPCS C1713 04.112.027 - PLATE BONE 94MM 6 HOLE LCP TITANIUM LEFT SUPERIOR ANTERIOR BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" "$1,724.10" "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" N/A N/A 04.112.028 SUP HCPCS C1713 04.112.028 - PLATE BONE 110MM 7 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" "$1,769.83" "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,740.25" "$1,740.25" $362.67 "$1,740.25" N/A N/A 04.112.029 SUP HCPCS C1713 04.112.029 - PLATE BONE 110MM 7 HOLE LCP TITANIUM LEFT SUPERIOR ANTERIOR BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" "$1,769.83" "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,740.25" "$1,740.25" $362.67 "$1,740.25" N/A N/A 04.112.030 SUP HCPCS C1713 04.112.030 - PLATE BONE 120MM 8 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" $372.04 "$1,785.23" N/A N/A 04.112.031 SUP HCPCS C1713 04.112.031 - PLATE BONE 120MM 8 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" $372.04 "$1,785.23" N/A N/A 04.112.040S SUP HCPCS C1713 04.112.040S - PLATE BONE 79MM 6 HOLE LCP TITANIUM MEDIAL ANTERIOR CLAVICLE BOTH IP/OP "$1,877.00" "$1,389.00" $372.46 "$1,908.50" $844.47 $844.47 $844.47 $844.47 "$1,876.60" "$1,876.60" "$1,876.60" $391.13 "$1,876.60" "$1,876.60" "$1,876.60" "$1,876.60" "$1,876.60" $391.10 "$1,876.60" "$1,908.50" "$1,110.01" "$1,876.60" "$1,908.50" "$1,876.60" "$1,876.60" "$1,407.75" "$1,876.60" "$1,876.60" "$1,876.60" $938.30 $938.30 "$1,486.27" "$1,876.60" "$1,501.28" $844.47 $372.46 N/A "$1,088.66" "$1,876.60" "$1,876.60" "$1,876.60" $391.08 "$1,876.60" N/A N/A 04.112.041 SUP HCPCS C1713 04.112.041 - PLATE BONE 91MM 7 HOLE LCP TITANIUM MEDIAL ANTERIOR CLAVICLE BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" $372.04 "$1,785.23" N/A N/A 04.112.042 SUP HCPCS C1713 04.112.042 - PLATE BONE 102MM 8 HOLE LCP TITANIUM MEDIAL ANTERIOR BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" $372.04 "$1,785.23" N/A N/A 04.112.045 SUP HCPCS C1713 04.112.045 - PLATE BONE 77MM 7 HOLE VAR ANG LCP TITANIUM LATERAL ANTERIOR BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" $726.23 "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,071.14" "$1,785.23" $372.04 "$1,785.23" N/A N/A 04.112.046 SUP HCPCS C1713 04.112.046 - PLATE BONE 89MM 9 HOLE VAR ANG LCP TITANIUM LATERAL ANTERIOR BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,071.14" "$1,785.23" $372.04 "$1,785.23" N/A N/A 04.112.047 SUP HCPCS C1713 04.112.047 - PLATE BONE 101MM 10 HOLE VAR ANG LCP TITANIUM LATERAL BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,071.14" "$1,785.23" $372.04 "$1,785.23" N/A N/A 04.112.048S SUP HCPCS C1713 04.112.048S - PLATE BONE 113MM 11 HOLE VAR ANG LCP TITANIUM LATERAL BOTH IP/OP "$1,877.00" "$1,389.00" $372.46 "$1,908.50" $844.47 $844.47 $844.47 $844.47 "$1,876.60" "$1,876.60" "$1,876.60" $391.13 "$1,876.60" "$1,876.60" "$1,876.60" "$1,876.60" "$1,876.60" $391.10 "$1,876.60" $763.40 "$1,110.01" "$1,876.60" "$1,908.50" "$1,876.60" "$1,876.60" "$1,407.75" "$1,876.60" "$1,876.60" "$1,876.60" $938.30 $938.30 "$1,486.27" "$1,876.60" "$1,501.28" $844.47 $372.46 N/A "$1,088.66" "$1,876.60" "$1,876.60" "$1,876.60" $391.08 "$1,876.60" N/A N/A 04.112.049S SUP HCPCS C1713 04.112.049S - PLATE BONE 124MM 12 HOLE VAR ANG LCP TITANIUM LATERAL BOTH IP/OP "$1,877.00" "$1,389.00" $372.46 "$1,908.50" $844.47 $844.47 $844.47 $844.47 "$1,876.60" "$1,876.60" "$1,876.60" $391.13 "$1,876.60" "$1,876.60" "$1,876.60" "$1,876.60" "$1,876.60" $391.10 "$1,876.60" $763.40 "$1,110.01" "$1,876.60" "$1,908.50" "$1,876.60" "$1,876.60" "$1,407.75" "$1,876.60" "$1,876.60" "$1,876.60" $938.30 $938.30 "$1,486.27" "$1,876.60" "$1,501.28" $844.47 $372.46 N/A "$1,088.66" "$1,876.60" "$1,125.96" "$1,876.60" "$1,876.60" "$1,876.60" N/A N/A 04.112.080 SUP HCPCS C1713 04.112.080 - PLATE BONE 85MM 6 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" $689.64 "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,017.17" "$1,695.28" $353.30 "$1,695.28" N/A N/A 04.112.081 SUP HCPCS C1713 04.112.081 - PLATE BONE 85MM 6 HOLE LCP TITANIUM LEFT SUPERIOR ANTERIOR BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" "$1,724.10" "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,017.17" "$1,695.28" $353.30 "$1,695.28" N/A N/A 04.112.082 SUP HCPCS C1713 04.112.082 - PLATE BONE 100MM 7 HOLE LCP TITANIUM RIGHT SUPERIOR ANTERIOR BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" "$1,769.83" "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,740.25" "$1,740.25" $362.67 "$1,740.25" N/A N/A 04.112.083 SUP HCPCS C1713 04.112.083 - PLATE BONE 100MM 7 HOLE LCP TITANIUM LEFT SUPERIOR CLAVICLE BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" "$1,769.83" "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" N/A N/A 04.112.084 SUP HCPCS C1713 04.112.084 - PLATE BONE 115MM 8 HOLE LCP TITANIUM RIGHT SUPERIOR CLAVICLE BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" N/A N/A 04.112.085 SUP HCPCS C1713 04.112.085 - PLATE BONE 115MM 8 HOLE LCP TITANIUM LEFT SUPERIOR CLAVICLE BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,785.23" "$1,785.23" $372.04 "$1,785.23" N/A N/A 04.112.090 SUP HCPCS C1713 04.112.090 - PLATE BONE 105MM 6 HOLE LATERAL EXTN LCP TITANIUM RIGHT BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" $689.64 "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" N/A N/A 04.112.091 SUP HCPCS C1713 04.112.091 - PLATE BN 105MM NS LCP CMBN 6 HL LAT XTN PRECONTOUR LMT CNTCT BOTH IP/OP "$1,695.50" "$1,255.00" $336.47 "$1,724.10" $762.88 $762.88 $762.88 $762.88 "$1,695.28" "$1,695.28" "$1,695.28" $353.34 "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" "$1,695.28" $353.32 "$1,695.28" $689.64 "$1,002.76" "$1,695.28" "$1,724.10" "$1,695.28" "$1,695.28" "$1,271.63" "$1,695.28" "$1,695.28" "$1,695.28" $847.64 $847.64 "$1,342.66" "$1,695.28" "$1,356.22" $762.88 $336.47 N/A $983.39 "$1,695.28" "$1,017.17" "$1,695.28" $353.30 "$1,695.28" N/A N/A 04.112.092 SUP HCPCS C1713 04.112.092 - PLATE BONE 120MM 7 HOLE LATERAL EXTN LCP TITANIUM RIGHT BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" "$1,769.83" "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,044.15" "$1,740.25" $362.67 "$1,740.25" N/A N/A 04.112.093 SUP HCPCS C1713 04.112.093 - PLATE BONE 120MM 7 HOLE LATERAL EXTN LCP TITANIUM LEFT BOTH IP/OP "$1,740.50" "$1,288.00" $345.40 "$1,769.83" $783.11 $783.11 $783.11 $783.11 "$1,740.25" "$1,740.25" "$1,740.25" $362.71 "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" "$1,740.25" $362.69 "$1,740.25" "$1,769.83" "$1,029.36" "$1,740.25" "$1,769.83" "$1,740.25" "$1,740.25" "$1,305.38" "$1,740.25" "$1,740.25" "$1,740.25" $870.13 $870.13 "$1,378.28" "$1,740.25" "$1,392.20" $783.11 $345.40 N/A "$1,009.49" "$1,740.25" "$1,044.15" "$1,740.25" "$1,740.25" "$1,740.25" N/A N/A 04.112.094 SUP HCPCS C1713 04.112.094 - PLATE BONE 130MM 8 HOLE LATERAL EXTN LCP TITANIUM RIGHT BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,071.14" "$1,785.23" $372.04 "$1,785.23" N/A N/A 04.112.095 SUP HCPCS C1713 04.112.095 - PLATE BONE 130MM 8 HOLE LATERAL EXTN LCP TITANIUM LEFT BOTH IP/OP "$1,785.50" "$1,321.00" $354.32 "$1,815.58" $803.35 $803.35 $803.35 $803.35 "$1,785.23" "$1,785.23" "$1,785.23" $372.09 "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" "$1,785.23" $372.06 "$1,785.23" "$1,815.58" "$1,055.96" "$1,785.23" "$1,815.58" "$1,785.23" "$1,785.23" "$1,339.13" "$1,785.23" "$1,785.23" "$1,785.23" $892.62 $892.62 "$1,413.90" "$1,785.23" "$1,428.18" $803.35 $354.32 N/A "$1,035.59" "$1,785.23" "$1,071.14" "$1,785.23" $372.04 "$1,785.23" N/A N/A 04.112.106 SUP HCPCS C1713 04.112.106 - PLATE BONE 73MM 3 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT BOTH IP/OP "$1,186.50" $878.00 $235.47 "$1,206.58" $533.88 $533.88 $533.88 $533.88 "$1,186.40" "$1,186.40" "$1,186.40" $247.28 "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" $247.26 "$1,186.40" "$1,206.58" $701.76 "$1,186.40" "$1,206.58" "$1,186.40" "$1,186.40" $889.88 "$1,186.40" "$1,186.40" "$1,186.40" $593.20 $593.20 $939.63 "$1,186.40" $949.12 $533.88 $235.47 N/A $688.17 "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" N/A N/A 04.112.107 SUP HCPCS C1713 04.112.107 - PLATE BONE 73MM 3 HOLE LCP TITANIUM LEFT DISTAL POSTLAT BOTH IP/OP "$1,186.50" $878.00 $235.47 "$1,206.58" $533.88 $533.88 $533.88 $533.88 "$1,186.40" "$1,186.40" "$1,186.40" $247.28 "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" $247.26 "$1,186.40" "$1,206.58" $701.76 "$1,186.40" "$1,206.58" "$1,186.40" "$1,186.40" $889.88 "$1,186.40" "$1,186.40" "$1,186.40" $593.20 $593.20 $939.63 "$1,186.40" $949.12 $533.88 $235.47 N/A $688.17 "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" "$1,186.40" N/A N/A 04.112.108 SUP HCPCS C1713 04.112.108 - PLATE BONE 86MM 4 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT BOTH IP/OP "$1,206.50" $893.00 $239.38 "$1,226.58" $542.74 $542.74 $542.74 $542.74 "$1,206.08" "$1,206.08" "$1,206.08" $251.38 "$1,206.08" "$1,206.08" "$1,206.08" "$1,206.08" "$1,206.08" $251.36 "$1,206.08" "$1,226.58" $713.40 "$1,206.08" "$1,226.58" "$1,206.08" "$1,206.08" $904.88 "$1,206.08" "$1,206.08" "$1,206.08" $603.04 $603.04 $955.22 "$1,206.08" $964.86 $542.74 $239.38 N/A $699.77 "$1,206.08" "$1,206.08" "$1,206.08" $251.35 "$1,206.08" N/A N/A 04.112.109 SUP HCPCS C1713 04.112.109 - PLATE BONE 86MM 4 HOLE LCP TITANIUM LEFT DISTAL POSTLAT BOTH IP/OP "$1,206.50" $893.00 $239.38 "$1,226.58" $542.74 $542.74 $542.74 $542.74 "$1,206.08" "$1,206.08" "$1,206.08" $251.38 "$1,206.08" "$1,206.08" "$1,206.08" "$1,206.08" "$1,206.08" $251.36 "$1,206.08" $490.63 $713.40 "$1,206.08" "$1,226.58" "$1,206.08" "$1,206.08" $904.88 "$1,206.08" "$1,206.08" "$1,206.08" $603.04 $603.04 $955.22 "$1,206.08" $964.86 $542.74 $239.38 N/A $699.77 "$1,206.08" "$1,206.08" "$1,206.08" $251.35 "$1,206.08" N/A N/A 04.112.110 SUP HCPCS C1713 04.112.110 - PLATE BONE 99MM 5 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT BOTH IP/OP "$1,222.00" $904.00 $242.45 "$1,242.33" $549.70 $549.70 $549.70 $549.70 "$1,221.55" "$1,221.55" "$1,221.55" $254.60 "$1,221.55" "$1,221.55" "$1,221.55" "$1,221.55" "$1,221.55" $254.58 "$1,221.55" "$1,242.33" $722.55 "$1,221.55" "$1,242.33" "$1,221.55" "$1,221.55" $916.50 "$1,221.55" "$1,221.55" "$1,221.55" $610.78 $610.78 $967.47 "$1,221.55" $977.24 $549.70 $242.45 N/A $708.76 "$1,221.55" $732.93 "$1,221.55" "$1,221.55" "$1,221.55" N/A N/A 04.112.111 SUP HCPCS C1713 04.112.111 - PLATE BONE 99MM 5 HOLE LCP TITANIUM LEFT DISTAL POSTLAT BOTH IP/OP "$1,222.00" $904.00 $242.45 "$1,242.33" $549.70 $549.70 $549.70 $549.70 "$1,221.55" "$1,221.55" "$1,221.55" $254.60 "$1,221.55" "$1,221.55" "$1,221.55" "$1,221.55" "$1,221.55" $254.58 "$1,221.55" "$1,242.33" $722.55 "$1,221.55" "$1,242.33" "$1,221.55" "$1,221.55" $916.50 "$1,221.55" "$1,221.55" "$1,221.55" $610.78 $610.78 $967.47 "$1,221.55" $977.24 $549.70 $242.45 N/A $708.76 "$1,221.55" $732.93 "$1,221.55" $254.57 "$1,221.55" N/A N/A 04.112.112 SUP HCPCS C1713 04.112.112 - PLATE BONE 112MM 6 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT BOTH IP/OP "$1,241.50" $919.00 $246.35 "$1,262.33" $558.55 $558.55 $558.55 $558.55 "$1,241.23" "$1,241.23" "$1,241.23" $258.70 "$1,241.23" "$1,241.23" "$1,241.23" "$1,241.23" "$1,241.23" $258.69 "$1,241.23" "$1,262.33" $734.19 "$1,241.23" "$1,262.33" "$1,241.23" "$1,241.23" $931.13 "$1,241.23" "$1,241.23" "$1,241.23" $620.62 $620.62 $983.05 "$1,241.23" $992.98 $558.55 $246.35 N/A $720.07 "$1,241.23" "$1,241.23" "$1,241.23" $258.67 "$1,241.23" N/A N/A 04.112.113 SUP HCPCS C1713 04.112.113 - PLATE BONE 112MM 6 HOLE LCP TITANIUM LEFT DISTAL POSTLAT BOTH IP/OP "$1,241.50" $919.00 $246.35 "$1,262.33" $558.55 $558.55 $558.55 $558.55 "$1,241.23" "$1,241.23" "$1,241.23" $258.70 "$1,241.23" "$1,241.23" "$1,241.23" "$1,241.23" "$1,241.23" $258.69 "$1,241.23" "$1,262.33" $734.19 "$1,241.23" "$1,262.33" "$1,241.23" "$1,241.23" $931.13 "$1,241.23" "$1,241.23" "$1,241.23" $620.62 $620.62 $983.05 "$1,241.23" $992.98 $558.55 $246.35 N/A $720.07 "$1,241.23" "$1,241.23" "$1,241.23" $258.67 "$1,241.23" N/A N/A 04.112.114 SUP HCPCS C1713 04.112.114 - PLATE BONE 125MM 7 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT BOTH IP/OP "$1,258.50" $931.00 $249.70 "$1,279.50" $566.15 $566.15 $566.15 $566.15 "$1,258.10" "$1,258.10" "$1,258.10" $262.22 "$1,258.10" "$1,258.10" "$1,258.10" "$1,258.10" "$1,258.10" $262.20 "$1,258.10" "$1,279.50" $744.17 "$1,258.10" "$1,279.50" "$1,258.10" "$1,258.10" $943.88 "$1,258.10" "$1,258.10" "$1,258.10" $629.05 $629.05 $996.42 "$1,258.10" "$1,006.48" $566.15 $249.70 N/A $729.93 "$1,258.10" $754.86 "$1,258.10" $262.19 "$1,258.10" N/A N/A 04.112.115 SUP HCPCS C1713 04.112.115 - PLATE BONE 125MM 7 HOLE LCP TITANIUM LEFT DISTAL POSTLAT BOTH IP/OP "$1,258.50" $931.00 $249.70 "$1,279.50" $566.15 $566.15 $566.15 $566.15 "$1,258.10" "$1,258.10" "$1,258.10" $262.22 "$1,258.10" "$1,258.10" "$1,258.10" "$1,258.10" "$1,258.10" $262.20 "$1,258.10" "$1,279.50" $744.17 "$1,258.10" "$1,279.50" "$1,258.10" "$1,258.10" $943.88 "$1,258.10" "$1,258.10" "$1,258.10" $629.05 $629.05 $996.42 "$1,258.10" "$1,006.48" $566.15 $249.70 N/A $729.93 "$1,258.10" $754.86 "$1,258.10" $262.19 "$1,258.10" N/A N/A 04.112.118 SUP HCPCS C1713 04.112.118 - PLATE BONE 151MM 9 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT BOTH IP/OP "$1,276.50" $945.00 $253.33 "$1,298.08" $574.37 $574.37 $574.37 $574.37 "$1,276.38" "$1,276.38" "$1,276.38" $266.03 "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" $266.01 "$1,276.38" "$1,298.08" $754.98 "$1,276.38" "$1,298.08" "$1,276.38" "$1,276.38" $957.38 "$1,276.38" "$1,276.38" "$1,276.38" $638.19 $638.19 "$1,010.89" "$1,276.38" "$1,021.10" $574.37 $253.33 N/A $740.37 "$1,276.38" $765.83 "$1,276.38" $266.00 "$1,276.38" N/A N/A 04.112.119 SUP HCPCS C1713 04.112.119 - PLATE BONE 151MM 9 HOLE LCP TITANIUM LEFT DISTAL POSTLAT BOTH IP/OP "$1,276.50" $945.00 $253.33 "$1,298.08" $574.37 $574.37 $574.37 $574.37 "$1,276.38" "$1,276.38" "$1,276.38" $266.03 "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" $266.01 "$1,276.38" "$1,298.08" $754.98 "$1,276.38" "$1,298.08" "$1,276.38" "$1,276.38" $957.38 "$1,276.38" "$1,276.38" "$1,276.38" $638.19 $638.19 "$1,010.89" "$1,276.38" "$1,021.10" $574.37 $253.33 N/A $740.37 "$1,276.38" "$1,276.38" "$1,276.38" $266.00 "$1,276.38" N/A N/A 04.112.122 SUP HCPCS C1713 04.112.122 - PLATE BONE 177MM 11 HOLE LCP TITANIUM RIGHT DISTAL POSTLAT BOTH IP/OP "$1,296.50" $959.00 $257.23 "$1,318.08" $583.22 $583.22 $583.22 $583.22 "$1,296.05" "$1,296.05" "$1,296.05" $270.13 "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" $270.11 "$1,296.05" "$1,318.08" $766.61 "$1,296.05" "$1,318.08" "$1,296.05" "$1,296.05" $972.38 "$1,296.05" "$1,296.05" "$1,296.05" $648.03 $648.03 "$1,026.47" "$1,296.05" "$1,036.84" $583.22 $257.23 N/A $751.97 "$1,296.05" "$1,296.05" "$1,296.05" $270.10 "$1,296.05" N/A N/A 04.112.123 SUP HCPCS C1713 04.112.123 - PLATE BONE 177MM 11 HOLE LCP TITANIUM LEFT DISTAL POSTLAT BOTH IP/OP "$1,296.50" $959.00 $257.23 "$1,318.08" $583.22 $583.22 $583.22 $583.22 "$1,296.05" "$1,296.05" "$1,296.05" $270.13 "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" $270.11 "$1,296.05" "$1,318.08" $766.61 "$1,296.05" "$1,318.08" "$1,296.05" "$1,296.05" $972.38 "$1,296.05" "$1,296.05" "$1,296.05" $648.03 $648.03 "$1,026.47" "$1,296.05" "$1,036.84" $583.22 $257.23 N/A $751.97 "$1,296.05" "$1,296.05" "$1,296.05" $270.10 "$1,296.05" N/A N/A 04.112.126 SUP HCPCS C1713 04.112.126 - PLATE BONE 207MM 13 HOLE LCP TITANIUM RIGHT POSTLAT DISTAL BOTH IP/OP "$1,313.00" $972.00 $260.58 "$1,335.25" $590.82 $590.82 $590.82 $590.82 "$1,312.93" "$1,312.93" "$1,312.93" $273.65 "$1,312.93" "$1,312.93" "$1,312.93" "$1,312.93" "$1,312.93" $273.63 "$1,312.93" "$1,335.25" $776.60 "$1,312.93" "$1,335.25" "$1,312.93" "$1,312.93" $984.75 "$1,312.93" "$1,312.93" "$1,312.93" $656.47 $656.47 "$1,039.84" "$1,312.93" "$1,050.34" $590.82 $260.58 N/A $761.54 "$1,312.93" "$1,312.93" "$1,312.93" $273.61 "$1,312.93" N/A N/A 04.112.127 SUP HCPCS C1713 04.112.127 - PLATE BONE 207MM 13 HOLE LCP TITANIUM LEFT POSTLAT DISTAL BOTH IP/OP "$1,313.00" $972.00 $260.58 "$1,335.25" $590.82 $590.82 $590.82 $590.82 "$1,312.93" "$1,312.93" "$1,312.93" $273.65 "$1,312.93" "$1,312.93" "$1,312.93" "$1,312.93" "$1,312.93" $273.63 "$1,312.93" "$1,335.25" $776.60 "$1,312.93" "$1,335.25" "$1,312.93" "$1,312.93" $984.75 "$1,312.93" "$1,312.93" "$1,312.93" $656.47 $656.47 "$1,039.84" "$1,312.93" "$1,050.34" $590.82 $260.58 N/A $761.54 "$1,312.93" "$1,312.93" "$1,312.93" $273.61 "$1,312.93" N/A N/A 04.112.130 SUP HCPCS C1713 04.112.130 - PLATE BONE 233MM 15 HOLE LCP RIGHT POSTLAT DISTAL FIBULAR BOTH IP/OP "$1,330.00" $984.00 $263.93 "$1,352.38" $598.40 $598.40 $598.40 $598.40 "$1,329.78" "$1,329.78" "$1,329.78" $277.16 "$1,329.78" "$1,329.78" "$1,329.78" "$1,329.78" "$1,329.78" $277.14 "$1,329.78" "$1,352.38" $786.56 "$1,329.78" "$1,352.38" "$1,329.78" "$1,329.78" $997.50 "$1,329.78" "$1,329.78" "$1,329.78" $664.89 $664.89 "$1,053.19" "$1,329.78" "$1,063.82" $598.40 $263.93 N/A $771.40 "$1,329.78" "$1,329.78" "$1,329.78" "$1,329.78" "$1,329.78" N/A N/A 04.112.131 SUP HCPCS C1713 04.112.131 - PLATE BONE 233MM 15 HOLE LCP LEFT POSTLAT DISTAL FIBULAR BOTH IP/OP "$1,330.00" $984.00 $263.93 "$1,352.38" $598.40 $598.40 $598.40 $598.40 "$1,329.78" "$1,329.78" "$1,329.78" $277.16 "$1,329.78" "$1,329.78" "$1,329.78" "$1,329.78" "$1,329.78" $277.14 "$1,329.78" "$1,352.38" $786.56 "$1,329.78" "$1,352.38" "$1,329.78" "$1,329.78" $997.50 "$1,329.78" "$1,329.78" "$1,329.78" $664.89 $664.89 "$1,053.19" "$1,329.78" "$1,063.82" $598.40 $263.93 N/A $771.40 "$1,329.78" "$1,329.78" "$1,329.78" "$1,329.78" "$1,329.78" N/A N/A 04.112.136 SUP HCPCS C1713 04.112.136 - PLATE BONE 73MM 3 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR BOTH IP/OP "$1,147.50" $849.00 $227.66 "$1,166.55" $516.17 $516.17 $516.17 $516.17 "$1,147.05" "$1,147.05" "$1,147.05" $239.07 "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" $239.06 "$1,147.05" $466.62 $678.48 "$1,147.05" "$1,166.55" "$1,147.05" "$1,147.05" $860.63 "$1,147.05" "$1,147.05" "$1,147.05" $573.53 $573.53 $908.46 "$1,147.05" $917.64 $516.17 $227.66 N/A $665.55 "$1,147.05" "$1,147.05" "$1,147.05" $239.05 "$1,147.05" N/A N/A 04.112.137 SUP HCPCS C1713 04.112.137 - PLATE BONE 73MM 3 HOLE LCP TITANIUM LEFT DISTAL FIBULA BOTH IP/OP "$1,147.50" $849.00 $227.66 "$1,166.55" $516.17 $516.17 $516.17 $516.17 "$1,147.05" "$1,147.05" "$1,147.05" $239.07 "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" $239.06 "$1,147.05" "$1,166.55" $678.48 "$1,147.05" "$1,166.55" "$1,147.05" "$1,147.05" $860.63 "$1,147.05" "$1,147.05" "$1,147.05" $573.53 $573.53 $908.46 "$1,147.05" $917.64 $516.17 $227.66 N/A $665.55 "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" N/A N/A 04.112.138 SUP HCPCS C1713 04.112.138 - PLATE BONE 86MM LCP TITANIUM RIGHT LEFT DISTAL LATERAL BOTH IP/OP "$1,167.00" $864.00 $231.57 "$1,186.55" $525.03 $525.03 $525.03 $525.03 "$1,166.73" "$1,166.73" "$1,166.73" $243.18 "$1,166.73" "$1,166.73" "$1,166.73" "$1,166.73" "$1,166.73" $243.16 "$1,166.73" "$1,186.55" $690.12 "$1,166.73" "$1,186.55" "$1,166.73" "$1,166.73" $875.25 "$1,166.73" "$1,166.73" "$1,166.73" $583.37 $583.37 $924.05 "$1,166.73" $933.38 $525.03 $231.57 N/A $676.86 "$1,166.73" "$1,166.73" "$1,166.73" $243.15 "$1,166.73" N/A N/A 04.112.139 SUP HCPCS C1713 04.112.139 - PLATE BONE 86MM 4 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR BOTH IP/OP "$1,167.00" $864.00 $231.57 "$1,186.55" $525.03 $525.03 $525.03 $525.03 "$1,166.73" "$1,166.73" "$1,166.73" $243.18 "$1,166.73" "$1,166.73" "$1,166.73" "$1,166.73" "$1,166.73" $243.16 "$1,166.73" "$1,186.55" $690.12 "$1,166.73" "$1,186.55" "$1,166.73" "$1,166.73" $875.25 "$1,166.73" "$1,166.73" "$1,166.73" $583.37 $583.37 $924.05 "$1,166.73" $933.38 $525.03 $231.57 N/A $676.86 "$1,166.73" "$1,166.73" "$1,166.73" $243.15 "$1,166.73" N/A N/A 04.112.140 SUP HCPCS C1713 04.112.140 - PLATE BONE 99MM 5 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR BOTH IP/OP "$1,182.50" $875.00 $234.63 "$1,202.28" $531.98 $531.98 $531.98 $531.98 "$1,182.18" "$1,182.18" "$1,182.18" $246.40 "$1,182.18" "$1,182.18" "$1,182.18" "$1,182.18" "$1,182.18" $246.38 "$1,182.18" $480.91 $699.26 "$1,182.18" "$1,202.28" "$1,182.18" "$1,182.18" $886.88 "$1,182.18" "$1,182.18" "$1,182.18" $591.09 $591.09 $936.29 "$1,182.18" $945.74 $531.98 $234.63 N/A $685.85 "$1,182.18" "$1,182.18" "$1,182.18" "$1,182.18" "$1,182.18" N/A N/A 04.112.141 SUP HCPCS C1713 04.112.141 - PLATE BONE 99MM 5 HOLE LCP TITANIUM LEFT DISTAL FIBULAR BOTH IP/OP "$1,182.50" $875.00 $234.63 "$1,202.28" $531.98 $531.98 $531.98 $531.98 "$1,182.18" "$1,182.18" "$1,182.18" $246.40 "$1,182.18" "$1,182.18" "$1,182.18" "$1,182.18" "$1,182.18" $246.38 "$1,182.18" "$1,202.28" $699.26 "$1,182.18" "$1,202.28" "$1,182.18" "$1,182.18" $886.88 "$1,182.18" "$1,182.18" "$1,182.18" $591.09 $591.09 $936.29 "$1,182.18" $945.74 $531.98 $234.63 N/A $685.85 "$1,182.18" "$1,182.18" "$1,182.18" $246.37 "$1,182.18" N/A N/A 04.112.142 SUP HCPCS C1713 04.112.142 - PLATE BONE 112MM 6 HOLE LCP TITANIUM RIGHT DISTAL FIBULAR BOTH IP/OP "$1,200.50" $888.00 $238.26 "$1,220.85" $540.20 $540.20 $540.20 $540.20 "$1,200.45" "$1,200.45" "$1,200.45" $250.20 "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" $250.19 "$1,200.45" "$1,220.85" $710.07 "$1,200.45" "$1,220.85" "$1,200.45" "$1,200.45" $900.38 "$1,200.45" "$1,200.45" "$1,200.45" $600.23 $600.23 $950.76 "$1,200.45" $960.36 $540.20 $238.26 N/A $696.29 "$1,200.45" $720.27 "$1,200.45" "$1,200.45" "$1,200.45" N/A N/A 04.112.143 SUP HCPCS C1713 04.112.143 - PLATE BONE 112MM 6 HOLE LCP TITANIUM LEFT LATERAL DISTAL BOTH IP/OP "$1,200.50" $888.00 $238.26 "$1,220.85" $540.20 $540.20 $540.20 $540.20 "$1,200.45" "$1,200.45" "$1,200.45" $250.20 "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" "$1,200.45" $250.19 "$1,200.45" "$1,220.85" $710.07 "$1,200.45" "$1,220.85" "$1,200.45" "$1,200.45" $900.38 "$1,200.45" "$1,200.45" "$1,200.45" $600.23 $600.23 $950.76 "$1,200.45" $960.36 $540.20 $238.26 N/A $696.29 "$1,200.45" $720.27 "$1,200.45" $250.17 "$1,200.45" N/A N/A 04.112.144 SUP HCPCS C1713 04.112.144 - PLATE BONE 125MM 7 HOLE LCP TITANIUM RIGHT LATERAL DISTAL BOTH IP/OP "$1,217.50" $901.00 $241.61 "$1,238.03" $547.80 $547.80 $547.80 $547.80 "$1,217.33" "$1,217.33" "$1,217.33" $253.72 "$1,217.33" "$1,217.33" "$1,217.33" "$1,217.33" "$1,217.33" $253.70 "$1,217.33" $495.21 $720.05 "$1,217.33" "$1,238.03" "$1,217.33" "$1,217.33" $913.13 "$1,217.33" "$1,217.33" "$1,217.33" $608.67 $608.67 $964.13 "$1,217.33" $973.86 $547.80 $241.61 N/A $706.15 "$1,217.33" $730.40 "$1,217.33" $253.69 "$1,217.33" N/A N/A 04.112.145 SUP HCPCS C1713 04.112.145 - PLATE BONE 125MM 7 HOLE LCP TITANIUM LEFT LATERAL DISTAL BOTH IP/OP "$1,217.50" $901.00 $241.61 "$1,238.03" $547.80 $547.80 $547.80 $547.80 "$1,217.33" "$1,217.33" "$1,217.33" $253.72 "$1,217.33" "$1,217.33" "$1,217.33" "$1,217.33" "$1,217.33" $253.70 "$1,217.33" $495.21 $720.05 "$1,217.33" "$1,238.03" "$1,217.33" "$1,217.33" $913.13 "$1,217.33" "$1,217.33" "$1,217.33" $608.67 $608.67 $964.13 "$1,217.33" $973.86 $547.80 $241.61 N/A $706.15 "$1,217.33" "$1,217.33" "$1,217.33" $253.69 "$1,217.33" N/A N/A 04.112.148 SUP HCPCS C1713 04.112.148 - PLATE BONE 177MM 11 HOLE LCP TITANIUM RIGHT LATERAL DISTAL BOTH IP/OP "$1,276.50" $945.00 $253.33 "$1,298.08" $574.37 $574.37 $574.37 $574.37 "$1,276.38" "$1,276.38" "$1,276.38" $266.03 "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" $266.01 "$1,276.38" "$1,298.08" $754.98 "$1,276.38" "$1,298.08" "$1,276.38" "$1,276.38" $957.38 "$1,276.38" "$1,276.38" "$1,276.38" $638.19 $638.19 "$1,010.89" "$1,276.38" "$1,021.10" $574.37 $253.33 N/A $740.37 "$1,276.38" "$1,276.38" "$1,276.38" $266.00 "$1,276.38" N/A N/A 04.112.149 SUP HCPCS C1713 04.112.149 - PLATE BONE 151MM 9 HOLE LCP TITANIUM LEFT LATERAL DISTAL BOTH IP/OP "$1,276.50" $945.00 $253.33 "$1,298.08" $574.37 $574.37 $574.37 $574.37 "$1,276.38" "$1,276.38" "$1,276.38" $266.03 "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" "$1,276.38" $266.01 "$1,276.38" "$1,298.08" $754.98 "$1,276.38" "$1,298.08" "$1,276.38" "$1,276.38" $957.38 "$1,276.38" "$1,276.38" "$1,276.38" $638.19 $638.19 "$1,010.89" "$1,276.38" "$1,021.10" $574.37 $253.33 N/A $740.37 "$1,276.38" $765.83 "$1,276.38" $266.00 "$1,276.38" N/A N/A 04.112.152 SUP HCPCS C1713 04.112.152 - PLATE BONE 177MM 11 HOLE LCP TITANIUM RIGHT LATERAL DISTAL BOTH IP/OP "$1,296.50" $959.00 $257.23 "$1,318.08" $583.22 $583.22 $583.22 $583.22 "$1,296.05" "$1,296.05" "$1,296.05" $270.13 "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" $270.11 "$1,296.05" "$1,318.08" $766.61 "$1,296.05" "$1,318.08" "$1,296.05" "$1,296.05" $972.38 "$1,296.05" "$1,296.05" "$1,296.05" $648.03 $648.03 "$1,026.47" "$1,296.05" "$1,036.84" $583.22 $257.23 N/A $751.97 "$1,296.05" $777.63 "$1,296.05" $270.10 "$1,296.05" N/A N/A 04.112.153 SUP HCPCS C1713 04.112.153 - PLATE BONE 177MM 11 HOLE LCP TITANIUM LEFT LATERAL DISTAL BOTH IP/OP "$1,296.50" $959.00 $257.23 "$1,318.08" $583.22 $583.22 $583.22 $583.22 "$1,296.05" "$1,296.05" "$1,296.05" $270.13 "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" "$1,296.05" $270.11 "$1,296.05" "$1,318.08" $766.61 "$1,296.05" "$1,318.08" "$1,296.05" "$1,296.05" $972.38 "$1,296.05" "$1,296.05" "$1,296.05" $648.03 $648.03 "$1,026.47" "$1,296.05" "$1,036.84" $583.22 $257.23 N/A $751.97 "$1,296.05" "$1,296.05" "$1,296.05" $270.10 "$1,296.05" N/A N/A 04.112.156 SUP HCPCS C1713 04.112.156 - PLATE BONE 203MM 13 HOLE LCP RIGHT LATERAL DISTAL FIBULAR BOTH IP/OP "$1,351.00" "$1,000.00" $268.12 "$1,373.85" $607.90 $607.90 $607.90 $607.90 "$1,350.88" "$1,350.88" "$1,350.88" $281.56 "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" $281.54 "$1,350.88" "$1,373.85" $799.05 "$1,350.88" "$1,373.85" "$1,350.88" "$1,350.88" "$1,013.25" "$1,350.88" "$1,350.88" "$1,350.88" $675.44 $675.44 "$1,069.90" "$1,350.88" "$1,080.70" $607.90 $268.12 N/A $783.58 "$1,350.88" "$1,350.88" "$1,350.88" $281.52 "$1,350.88" N/A N/A 04.112.157 SUP HCPCS C1713 04.112.157 - PLATE BONE 203MM 13 HOLE LCP LEFT LATERAL DISTAL FIBULAR BOTH IP/OP "$1,351.00" "$1,000.00" $268.12 "$1,373.85" $607.90 $607.90 $607.90 $607.90 "$1,350.88" "$1,350.88" "$1,350.88" $281.56 "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" "$1,350.88" $281.54 "$1,350.88" $549.54 $799.05 "$1,350.88" "$1,373.85" "$1,350.88" "$1,350.88" "$1,013.25" "$1,350.88" "$1,350.88" "$1,350.88" $675.44 $675.44 "$1,069.90" "$1,350.88" "$1,080.70" $607.90 $268.12 N/A $783.58 "$1,350.88" $810.53 "$1,350.88" $281.52 "$1,350.88" N/A N/A 04.112.160 SUP HCPCS C1713 04.112.160 - PLATE BONE 229MM LCP LATERAL DISTAL FIBULAR NONSTRL 2.7/3.5 BOTH IP/OP "$1,371.00" "$1,015.00" $272.02 "$1,393.85" $616.75 $616.75 $616.75 $616.75 "$1,370.55" "$1,370.55" "$1,370.55" $285.66 "$1,370.55" "$1,370.55" "$1,370.55" "$1,370.55" "$1,370.55" $285.64 "$1,370.55" "$1,393.85" $810.68 "$1,370.55" "$1,393.85" "$1,370.55" "$1,370.55" "$1,028.25" "$1,370.55" "$1,370.55" "$1,370.55" $685.28 $685.28 "$1,085.48" "$1,370.55" "$1,096.44" $616.75 $272.02 N/A $795.18 "$1,370.55" $822.33 "$1,370.55" $285.62 "$1,370.55" N/A N/A 04.112.161 SUP HCPCS C1713 04.112.161 - PLATE BONE 229MM 15 HOLE LCP LATERAL DISTAL FIBULAR NONSTRL BOTH IP/OP "$1,371.00" "$1,015.00" $272.02 "$1,393.85" $616.75 $616.75 $616.75 $616.75 "$1,370.55" "$1,370.55" "$1,370.55" $285.66 "$1,370.55" "$1,370.55" "$1,370.55" "$1,370.55" "$1,370.55" $285.64 "$1,370.55" "$1,393.85" $810.68 "$1,370.55" "$1,393.85" "$1,370.55" "$1,370.55" "$1,028.25" "$1,370.55" "$1,370.55" "$1,370.55" $685.28 $685.28 "$1,085.48" "$1,370.55" "$1,096.44" $616.75 $272.02 N/A $795.18 "$1,370.55" $822.33 "$1,370.55" $285.62 "$1,370.55" N/A N/A 04.112.510 SUP HCPCS C1713 04.112.510 - PLATE BONE 109MM 4 HOLE LOW BEND LCP TITANIUM RIGHT MEDIAL BOTH IP/OP "$2,685.00" "$1,987.00" $532.88 "$2,730.53" "$1,208.20" "$1,208.20" "$1,208.20" "$1,208.20" "$2,684.88" "$2,684.88" "$2,684.88" $559.60 "$2,684.88" "$2,684.88" "$2,684.88" "$2,684.88" "$2,684.88" $559.56 "$2,684.88" "$1,092.21" "$1,323.65" "$2,684.88" "$2,730.53" "$2,684.88" "$2,684.88" "$2,013.75" "$2,684.88" "$2,684.88" "$2,684.88" "$1,342.44" "$1,342.44" "$2,126.42" "$2,684.88" "$2,147.90" "$1,208.20" $532.88 N/A "$1,557.30" "$2,684.88" "$1,610.93" "$2,684.88" $559.53 "$2,684.88" N/A N/A 04.112.511 SUP HCPCS C1713 04.112.511 - PLATE BONE 109MM 4 HOLE LOW BEND LCP TITANIUM TIBIA LEFT BOTH IP/OP "$2,685.00" "$1,987.00" $532.88 "$2,730.53" "$1,208.20" "$1,208.20" "$1,208.20" "$1,208.20" "$2,684.88" "$2,684.88" "$2,684.88" $559.60 "$2,684.88" "$2,684.88" "$2,684.88" "$2,684.88" "$2,684.88" $559.56 "$2,684.88" "$2,730.53" "$1,323.65" "$2,684.88" "$2,730.53" "$2,684.88" "$2,684.88" "$2,013.75" "$2,684.88" "$2,684.88" "$2,684.88" "$1,342.44" "$1,342.44" "$2,126.42" "$2,684.88" "$2,147.90" "$1,208.20" $532.88 N/A "$1,557.30" "$2,684.88" "$2,684.88" "$2,684.88" $559.53 "$2,684.88" N/A N/A 04.112.514 SUP HCPCS C1713 04.112.514 - PLATE BONE 135MM 6 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$2,627.50" "$1,944.00" $521.44 "$2,671.93" "$1,182.26" "$1,182.26" "$1,182.26" "$1,182.26" "$2,627.25" "$2,627.25" "$2,627.25" $547.58 "$2,627.25" "$2,627.25" "$2,627.25" "$2,627.25" "$2,627.25" $547.55 "$2,627.25" "$1,068.77" "$1,295.23" "$2,627.25" "$2,671.93" "$2,627.25" "$2,627.25" "$1,970.63" "$2,627.25" "$2,627.25" "$2,627.25" "$1,313.63" "$1,313.63" "$2,080.78" "$2,627.25" "$2,101.80" "$1,182.26" $521.44 N/A "$1,523.95" "$2,627.25" "$1,576.35" "$2,627.25" $547.52 "$2,627.25" N/A N/A 04.112.515 SUP HCPCS C1713 04.112.515 - PLATE BONE 135MM 6 HOLE LOW BEND LCP TITANIUM LEFT MEDIAL BOTH IP/OP "$2,627.50" "$1,944.00" $521.44 "$2,671.93" "$1,182.26" "$1,182.26" "$1,182.26" "$1,182.26" "$2,627.25" "$2,627.25" "$2,627.25" $547.58 "$2,627.25" "$2,627.25" "$2,627.25" "$2,627.25" "$2,627.25" $547.55 "$2,627.25" "$1,068.77" "$1,295.23" "$2,627.25" "$2,671.93" "$2,627.25" "$2,627.25" "$1,970.63" "$2,627.25" "$2,627.25" "$2,627.25" "$1,313.63" "$1,313.63" "$2,080.78" "$2,627.25" "$2,101.80" "$1,182.26" $521.44 N/A "$1,523.95" "$2,627.25" "$2,627.25" "$2,627.25" $547.52 "$2,627.25" N/A N/A 04.112.518 SUP HCPCS C1713 04.112.518 - PLATE BONE 161MM 8 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$2,653.00" "$1,963.00" $526.46 "$2,697.65" "$1,193.65" "$1,193.65" "$1,193.65" "$1,193.65" "$2,652.55" "$2,652.55" "$2,652.55" $552.86 "$2,652.55" "$2,652.55" "$2,652.55" "$2,652.55" "$2,652.55" $552.82 "$2,652.55" "$1,079.06" "$1,307.71" "$2,652.55" "$2,697.65" "$2,652.55" "$2,652.55" "$1,989.75" "$2,652.55" "$2,652.55" "$2,652.55" "$1,326.28" "$1,326.28" "$2,100.82" "$2,652.55" "$2,122.04" "$1,193.65" $526.46 N/A "$1,538.74" "$2,652.55" "$1,591.53" "$2,652.55" $552.79 "$2,652.55" N/A N/A 04.112.519 SUP HCPCS C1713 04.112.519 - PLATE BONE 161MM 8 HOLE LOW BEND LCP TITANIUM TIBIA LEFT BOTH IP/OP "$2,653.00" "$1,963.00" $526.46 "$2,697.65" "$1,193.65" "$1,193.65" "$1,193.65" "$1,193.65" "$2,652.55" "$2,652.55" "$2,652.55" $552.86 "$2,652.55" "$2,652.55" "$2,652.55" "$2,652.55" "$2,652.55" $552.82 "$2,652.55" "$1,079.06" "$1,307.71" "$2,652.55" "$2,697.65" "$2,652.55" "$2,652.55" "$1,989.75" "$2,652.55" "$2,652.55" "$2,652.55" "$1,326.28" "$1,326.28" "$2,100.82" "$2,652.55" "$2,122.04" "$1,193.65" $526.46 N/A "$1,538.74" "$2,652.55" "$1,591.53" "$2,652.55" "$2,652.55" "$2,652.55" N/A N/A 04.112.522 SUP HCPCS C1713 04.112.522 - PLATE BONE 187MM 10 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$2,681.00" "$1,984.00" $532.04 "$2,726.23" "$1,206.29" "$1,206.29" "$1,206.29" "$1,206.29" "$2,680.65" "$2,680.65" "$2,680.65" $558.71 "$2,680.65" "$2,680.65" "$2,680.65" "$2,680.65" "$2,680.65" $558.68 "$2,680.65" "$1,090.49" "$1,321.56" "$2,680.65" "$2,726.23" "$2,680.65" "$2,680.65" "$2,010.75" "$2,680.65" "$2,680.65" "$2,680.65" "$1,340.33" "$1,340.33" "$2,123.07" "$2,680.65" "$2,144.52" "$1,206.29" $532.04 N/A "$1,554.98" "$2,680.65" "$1,608.39" "$2,680.65" "$2,680.65" "$2,680.65" N/A N/A 04.112.523 SUP HCPCS C1713 04.112.523 - PLATE BONE 187MM 10 HOLE LOW BEND LCP TITANIUM TIBIA LEFT BOTH IP/OP "$2,681.00" "$1,984.00" $532.04 "$2,726.23" "$1,206.29" "$1,206.29" "$1,206.29" "$1,206.29" "$2,680.65" "$2,680.65" "$2,680.65" $558.71 "$2,680.65" "$2,680.65" "$2,680.65" "$2,680.65" "$2,680.65" $558.68 "$2,680.65" "$1,090.49" "$1,321.56" "$2,680.65" "$2,726.23" "$2,680.65" "$2,680.65" "$2,010.75" "$2,680.65" "$2,680.65" "$2,680.65" "$1,340.33" "$1,340.33" "$2,123.07" "$2,680.65" "$2,144.52" "$1,206.29" $532.04 N/A "$1,554.98" "$2,680.65" "$1,608.39" "$2,680.65" $558.65 "$2,680.65" N/A N/A 04.112.526 SUP HCPCS C1713 04.112.526 - PLATE BONE 213MM 12 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$2,710.50" "$2,006.00" $537.90 "$2,756.25" "$1,219.58" "$1,219.58" "$1,219.58" "$1,219.58" "$2,710.18" "$2,710.18" "$2,710.18" $564.87 "$2,710.18" "$2,710.18" "$2,710.18" "$2,710.18" "$2,710.18" $564.83 "$2,710.18" "$1,102.50" "$1,336.12" "$2,710.18" "$2,756.25" "$2,710.18" "$2,710.18" "$2,032.88" "$2,710.18" "$2,710.18" "$2,710.18" "$1,355.09" "$1,355.09" "$2,146.46" "$2,710.18" "$2,168.14" "$1,219.58" $537.90 N/A "$1,572.09" "$2,710.18" "$2,710.18" "$2,710.18" $564.80 "$2,710.18" N/A N/A 04.112.527 SUP HCPCS C1713 04.112.527 - PLATE BONE 213MM 12 HOLE LOW BEND LCP TITANIUM TIBIA LEFT BOTH IP/OP "$2,710.50" "$2,006.00" $537.90 "$2,756.25" "$1,219.58" "$1,219.58" "$1,219.58" "$1,219.58" "$2,710.18" "$2,710.18" "$2,710.18" $564.87 "$2,710.18" "$2,710.18" "$2,710.18" "$2,710.18" "$2,710.18" $564.83 "$2,710.18" "$1,102.50" "$1,336.12" "$2,710.18" "$2,756.25" "$2,710.18" "$2,710.18" "$2,032.88" "$2,710.18" "$2,710.18" "$2,710.18" "$1,355.09" "$1,355.09" "$2,146.46" "$2,710.18" "$2,168.14" "$1,219.58" $537.90 N/A "$1,572.09" "$2,710.18" "$2,710.18" "$2,710.18" $564.80 "$2,710.18" N/A N/A 04.112.530 SUP HCPCS C1713 04.112.530 - PLATE BONE 239MM 14 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$2,838.50" "$2,100.00" $563.29 "$2,886.35" "$1,277.15" "$1,277.15" "$1,277.15" "$1,277.15" "$2,838.10" "$2,838.10" "$2,838.10" $591.53 "$2,838.10" "$2,838.10" "$2,838.10" "$2,838.10" "$2,838.10" $591.49 "$2,838.10" "$1,154.54" "$1,399.18" "$2,838.10" "$2,886.35" "$2,838.10" "$2,838.10" "$2,128.88" "$2,838.10" "$2,838.10" "$2,838.10" "$1,419.05" "$1,419.05" "$2,247.78" "$2,838.10" "$2,270.48" "$1,277.15" $563.29 N/A "$1,646.33" "$2,838.10" "$2,838.10" "$2,838.10" $591.46 "$2,838.10" N/A N/A 04.112.531 SUP HCPCS C1713 04.112.531 - PLATE BONE 239MM 14 HOLE LOW BEND LCP TITANIUM TIBIA LEFT BOTH IP/OP "$2,838.50" "$2,100.00" $563.29 "$2,886.35" "$1,277.15" "$1,277.15" "$1,277.15" "$1,277.15" "$2,838.10" "$2,838.10" "$2,838.10" $591.53 "$2,838.10" "$2,838.10" "$2,838.10" "$2,838.10" "$2,838.10" $591.49 "$2,838.10" "$2,886.35" "$1,399.18" "$2,838.10" "$2,886.35" "$2,838.10" "$2,838.10" "$2,128.88" "$2,838.10" "$2,838.10" "$2,838.10" "$1,419.05" "$1,419.05" "$2,247.78" "$2,838.10" "$2,270.48" "$1,277.15" $563.29 N/A "$1,646.33" "$2,838.10" "$2,838.10" "$2,838.10" $591.46 "$2,838.10" N/A N/A 04.113.103 SUP HCPCS C1713 04.113.103 - PLATE BONE 62MM 3 HOLE HOOK LCP TITANIUM NONSTRL 3.5MM BOTH IP/OP "$1,019.50" $754.00 $202.27 "$1,036.45" $458.61 $458.61 $458.61 $458.61 "$1,019.13" "$1,019.13" "$1,019.13" $212.41 "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" $212.40 "$1,019.13" "$1,036.45" $602.82 "$1,019.13" "$1,036.45" "$1,019.13" "$1,019.13" $764.63 "$1,019.13" "$1,019.13" "$1,019.13" $509.57 $509.57 $807.15 "$1,019.13" $815.30 $458.61 $202.27 N/A $591.31 "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" "$1,019.13" N/A N/A 04.114.002 SUP HCPCS C1713 04.114.002 - PLATE BONE 23MM 4 HOLE PURE STR LCP TITANIUM HAND WRIST BOTH IP/OP $410.50 $304.00 $81.46 $417.43 $184.70 $184.70 $184.70 $184.70 $410.45 $410.45 $410.45 $85.55 $410.45 $410.45 $410.45 $410.45 $410.45 $85.54 $410.45 $417.43 $242.78 $410.45 $417.43 $410.45 $410.45 $307.88 $410.45 $410.45 $410.45 $205.23 $205.23 $325.08 $410.45 $328.36 $184.70 $81.46 N/A $238.09 $410.45 $246.27 $410.45 $410.45 $410.45 N/A N/A 04.114.003 SUP HCPCS C1713 04.114.003 - PLATE BONE 29MM 6 HOLE PURE STR LOCKING LCP TITANIUM HAND BOTH IP/OP $752.50 $557.00 $149.26 $764.83 $338.42 $338.42 $338.42 $338.42 $752.05 $752.05 $752.05 $156.75 $752.05 $752.05 $752.05 $752.05 $752.05 $156.74 $752.05 $764.83 $444.84 $752.05 $764.83 $752.05 $752.05 $564.38 $752.05 $752.05 $752.05 $376.03 $376.03 $595.62 $752.05 $601.64 $338.42 $149.26 N/A $436.45 $752.05 $451.23 $752.05 $156.73 $752.05 N/A N/A 04.114.004 SUP HCPCS C1713 04.114.004 - PLATE BONE 36MM 6 HOLE PURE STR LCP TITANIUM HAND WRIST BOTH IP/OP $410.50 $304.00 $81.46 $417.43 $184.70 $184.70 $184.70 $184.70 $410.45 $410.45 $410.45 $85.55 $410.45 $410.45 $410.45 $410.45 $410.45 $85.54 $410.45 $417.43 $242.78 $410.45 $417.43 $410.45 $410.45 $307.88 $410.45 $410.45 $410.45 $205.23 $205.23 $325.08 $410.45 $328.36 $184.70 $81.46 N/A $238.09 $410.45 $246.27 $410.45 $85.54 $410.45 N/A N/A 04.114.005 SUP HCPCS C1713 04.114.005 - PLATE BONE 59MM 12 HOLE PURE STR LOCKING ADAPTION LCP BOTH IP/OP $752.50 $557.00 $149.26 $764.83 $338.42 $338.42 $338.42 $338.42 $752.05 $752.05 $752.05 $156.75 $752.05 $752.05 $752.05 $752.05 $752.05 $156.74 $752.05 $305.93 $444.84 $752.05 $764.83 $752.05 $752.05 $564.38 $752.05 $752.05 $752.05 $376.03 $376.03 $595.62 $752.05 $601.64 $338.42 $149.26 N/A $436.45 $752.05 $451.23 $752.05 $156.73 $752.05 N/A N/A 04.114.006 SUP HCPCS C1713 04.114.006 - PLATE BONE T 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW BOTH IP/OP $790.00 $585.00 $156.80 $803.43 $355.50 $355.50 $355.50 $355.50 $790.00 $790.00 $790.00 $164.66 $790.00 $790.00 $790.00 $790.00 $790.00 $164.64 $790.00 $321.37 $467.29 $790.00 $803.43 $790.00 $790.00 $592.50 $790.00 $790.00 $790.00 $395.00 $395.00 $625.68 $790.00 $632.00 $355.50 $156.80 N/A $458.20 $790.00 $474.00 $790.00 $164.64 $790.00 N/A N/A 04.114.007 SUP HCPCS C1713 04.114.007 - PLATE BONE T 4X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW BOTH IP/OP $790.00 $585.00 $156.80 $803.43 $355.50 $355.50 $355.50 $355.50 $790.00 $790.00 $790.00 $164.66 $790.00 $790.00 $790.00 $790.00 $790.00 $164.64 $790.00 $321.37 $467.29 $790.00 $803.43 $790.00 $790.00 $592.50 $790.00 $790.00 $790.00 $395.00 $395.00 $625.68 $790.00 $632.00 $355.50 $156.80 N/A $458.20 $790.00 $474.00 $790.00 $164.64 $790.00 N/A N/A 04.114.009 SUP HCPCS C1713 04.114.009 - PLATE BONE H LEFT EXTEND LCP TITANIUM SPN NONSTRL 1.5MM BOTH IP/OP $760.50 $563.00 $150.94 $773.40 $342.22 $342.22 $342.22 $342.22 $760.48 $760.48 $760.48 $158.50 $760.48 $760.48 $760.48 $760.48 $760.48 $158.49 $760.48 $309.36 $449.82 $760.48 $773.40 $760.48 $760.48 $570.38 $760.48 $760.48 $760.48 $380.24 $380.24 $602.30 $760.48 $608.38 $342.22 $150.94 N/A $441.09 $760.48 $456.29 $760.48 $158.48 $760.48 N/A N/A 04.114.010 SUP HCPCS C1713 04.114.010 - PLATE BONE H RIGHT EXTEND LCP TITANIUM SPN NONSTRL 1.5MM BOTH IP/OP $760.50 $563.00 $150.94 $773.40 $342.22 $342.22 $342.22 $342.22 $760.48 $760.48 $760.48 $158.50 $760.48 $760.48 $760.48 $760.48 $760.48 $158.49 $760.48 $309.36 $449.82 $760.48 $773.40 $760.48 $760.48 $570.38 $760.48 $760.48 $760.48 $380.24 $380.24 $602.30 $760.48 $608.38 $342.22 $150.94 N/A $441.09 $760.48 $760.48 $760.48 $158.48 $760.48 N/A N/A 04.114.013 SUP HCPCS C1713 04.114.013 - PLATE BONE Y 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW BOTH IP/OP $760.50 $563.00 $150.94 $773.40 $342.22 $342.22 $342.22 $342.22 $760.48 $760.48 $760.48 $158.50 $760.48 $760.48 $760.48 $760.48 $760.48 $158.49 $760.48 $309.36 $449.82 $760.48 $773.40 $760.48 $760.48 $570.38 $760.48 $760.48 $760.48 $380.24 $380.24 $602.30 $760.48 $608.38 $342.22 $150.94 N/A $441.09 $760.48 $456.29 $760.48 $158.48 $760.48 N/A N/A 04.114.014 SUP HCPCS C1713 04.114.014 - PLATE BONE Y 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW BOTH IP/OP $884.50 $655.00 $175.49 $899.20 $397.88 $397.88 $397.88 $397.88 $884.18 $884.18 $884.18 $184.29 $884.18 $884.18 $884.18 $884.18 $884.18 $184.27 $884.18 $899.20 $522.99 $884.18 $899.20 $884.18 $884.18 $663.38 $884.18 $884.18 $884.18 $442.09 $442.09 $700.27 $884.18 $707.34 $397.88 $175.49 N/A $513.01 $884.18 $530.51 $884.18 $184.26 $884.18 N/A N/A 04.114.502 SUP HCPCS C1713 04.114.502 - PLATE BONE SHORT THREAD 23MM 4 HOLE ASSEMBLE DRILL GUIDE LCP BOTH IP/OP $491.00 $363.00 $97.37 $498.93 $220.76 $220.76 $220.76 $220.76 $490.58 $490.58 $490.58 $102.25 $490.58 $490.58 $490.58 $490.58 $490.58 $102.24 $490.58 $498.93 $290.18 $490.58 $498.93 $490.58 $490.58 $368.25 $490.58 $490.58 $490.58 $245.29 $245.29 $388.54 $490.58 $392.46 $220.76 $97.37 N/A $284.78 $490.58 $294.35 $490.58 $102.24 $490.58 N/A N/A 04.114.503 SUP HCPCS C1713 04.114.503 - PLATE BONE SHORT THREAD 29MM 6 HOLE ADAPTION LCP TITANIUM BOTH IP/OP $836.50 $619.00 $166.00 $850.60 $376.37 $376.37 $376.37 $376.37 $836.38 $836.38 $836.38 $174.32 $836.38 $836.38 $836.38 $836.38 $836.38 $174.31 $836.38 $850.60 $494.72 $836.38 $850.60 $836.38 $836.38 $627.38 $836.38 $836.38 $836.38 $418.19 $418.19 $662.41 $836.38 $669.10 $376.37 $166.00 N/A $485.17 $836.38 $836.38 $836.38 $174.30 $836.38 N/A N/A 04.114.504 SUP HCPCS C1713 04.114.504 - PLATE BONE 36MM 6 HOLE PURE STR PREASSEMBLED DRILL SLEEVE BOTH IP/OP $491.00 $363.00 $97.37 $498.93 $220.76 $220.76 $220.76 $220.76 $490.58 $490.58 $490.58 $102.25 $490.58 $490.58 $490.58 $490.58 $490.58 $102.24 $490.58 $498.93 $290.18 $490.58 $498.93 $490.58 $490.58 $368.25 $490.58 $490.58 $490.58 $245.29 $245.29 $388.54 $490.58 $392.46 $220.76 $97.37 N/A $284.78 $490.58 $490.58 $490.58 $102.24 $490.58 N/A N/A 04.114.505 SUP HCPCS C1713 04.114.505 - PLATE BONE 59MM 12 HOLE PURE STR PREASSEMBLED DRILL SLEEVE BOTH IP/OP $836.50 $619.00 $166.00 $850.60 $376.37 $376.37 $376.37 $376.37 $836.38 $836.38 $836.38 $174.32 $836.38 $836.38 $836.38 $836.38 $836.38 $174.31 $836.38 $850.60 $494.72 $836.38 $850.60 $836.38 $836.38 $627.38 $836.38 $836.38 $836.38 $418.19 $418.19 $662.41 $836.38 $669.10 $376.37 $166.00 N/A $485.17 $836.38 $836.38 $836.38 $174.30 $836.38 N/A N/A 04.114.506 SUP HCPCS C1713 04.114.506 - PLATE BONE 3X8 HOLE T PREASSEMBLED DRILL SLEEVE LOCKING LCP BOTH IP/OP $886.00 $656.00 $175.77 $900.63 $398.51 $398.51 $398.51 $398.51 $885.58 $885.58 $885.58 $184.58 $885.58 $885.58 $885.58 $885.58 $885.58 $184.56 $885.58 $360.25 $523.82 $885.58 $900.63 $885.58 $885.58 $664.50 $885.58 $885.58 $885.58 $442.79 $442.79 $701.38 $885.58 $708.46 $398.51 $175.77 N/A $513.88 $885.58 $885.58 $885.58 $184.55 $885.58 N/A N/A 04.114.507 SUP HCPCS C1713 04.114.507 - PLATE BONE 4X8 HOLE T PREASSEMBLED DRILL SLEEVE LOCKING LCP BOTH IP/OP $886.00 $656.00 $175.77 $900.63 $398.51 $398.51 $398.51 $398.51 $885.58 $885.58 $885.58 $184.58 $885.58 $885.58 $885.58 $885.58 $885.58 $184.56 $885.58 $360.25 $523.82 $885.58 $900.63 $885.58 $885.58 $664.50 $885.58 $885.58 $885.58 $442.79 $442.79 $701.38 $885.58 $708.46 $398.51 $175.77 N/A $513.88 $885.58 $531.35 $885.58 $184.55 $885.58 N/A N/A 04.114.509 SUP HCPCS C1713 04.114.509 - PLATE BONE 8 HOLE STRUT PREASSEMBLED DRILL SLEEVE LOCKING BOTH IP/OP $846.50 $626.00 $167.96 $860.60 $380.80 $380.80 $380.80 $380.80 $846.23 $846.23 $846.23 $176.38 $846.23 $846.23 $846.23 $846.23 $846.23 $176.36 $846.23 $344.24 $500.55 $846.23 $860.60 $846.23 $846.23 $634.88 $846.23 $846.23 $846.23 $423.12 $423.12 $670.21 $846.23 $676.98 $380.80 $167.96 N/A $490.97 $846.23 $507.74 $846.23 $176.35 $846.23 N/A N/A 04.114.510 SUP HCPCS C1713 04.114.510 - PLATE BONE H RIGHT EXTEND LCP TITANIUM SPN NONSTRL 1.5MM BOTH IP/OP $846.50 $626.00 $167.96 $860.60 $380.80 $380.80 $380.80 $380.80 $846.23 $846.23 $846.23 $176.38 $846.23 $846.23 $846.23 $846.23 $846.23 $176.36 $846.23 $860.60 $500.55 $846.23 $860.60 $846.23 $846.23 $634.88 $846.23 $846.23 $846.23 $423.12 $423.12 $670.21 $846.23 $676.98 $380.80 $167.96 N/A $490.97 $846.23 $507.74 $846.23 $176.35 $846.23 N/A N/A 04.114.513 SUP HCPCS C1713 04.114.513 - PLATE BONE Y 3X8 HOLE LCP TITANIUM SPN NONSTRL 1.5MM SCREW BOTH IP/OP $846.50 $626.00 $167.96 $860.60 $380.80 $380.80 $380.80 $380.80 $846.23 $846.23 $846.23 $176.38 $846.23 $846.23 $846.23 $846.23 $846.23 $176.36 $846.23 $860.60 $500.55 $846.23 $860.60 $846.23 $846.23 $634.88 $846.23 $846.23 $846.23 $423.12 $423.12 $670.21 $846.23 $676.98 $380.80 $167.96 N/A $490.97 $846.23 $846.23 $846.23 $176.35 $846.23 N/A N/A 04.114.514 SUP HCPCS C1713 04.114.514 - PLATE BONE 6 HOLE LCP TITANIUM CONDYLE NONSTRL 1.5 MM SCREWS BOTH IP/OP $969.00 $717.00 $192.23 $985.00 $435.84 $435.84 $435.84 $435.84 $968.53 $968.53 $968.53 $201.87 $968.53 $968.53 $968.53 $968.53 $968.53 $201.85 $968.53 $985.00 $572.89 $968.53 $985.00 $968.53 $968.53 $726.75 $968.53 $968.53 $968.53 $484.27 $484.27 $767.08 $968.53 $774.82 $435.84 $192.23 N/A $562.02 $968.53 $968.53 $968.53 $201.84 $968.53 N/A N/A 04.115.130 SUP HCPCS C1713 04.115.130 - PLATE BONE +90D 37MM 2X3 HOLE L VAR ANG LOCKING LCP TITANIUM BOTH IP/OP "$1,026.50" $760.00 $203.67 "$1,043.60" $461.77 $461.77 $461.77 $461.77 "$1,026.15" "$1,026.15" "$1,026.15" $213.88 "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" $213.86 "$1,026.15" $417.44 $606.97 "$1,026.15" "$1,043.60" "$1,026.15" "$1,026.15" $769.88 "$1,026.15" "$1,026.15" "$1,026.15" $513.08 $513.08 $812.71 "$1,026.15" $820.92 $461.77 $203.67 N/A $595.37 "$1,026.15" $615.69 "$1,026.15" $213.85 "$1,026.15" N/A N/A 04.115.131 SUP HCPCS C1713 04.115.131 - PLATE BONE -90D 37MM 2X3 HOLE L VAR ANG LOCKING LCP TITANIUM BOTH IP/OP "$1,026.50" $760.00 $203.67 "$1,043.60" $461.77 $461.77 $461.77 $461.77 "$1,026.15" "$1,026.15" "$1,026.15" $213.88 "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" $213.86 "$1,026.15" $417.44 $606.97 "$1,026.15" "$1,043.60" "$1,026.15" "$1,026.15" $769.88 "$1,026.15" "$1,026.15" "$1,026.15" $513.08 $513.08 $812.71 "$1,026.15" $820.92 $461.77 $203.67 N/A $595.37 "$1,026.15" $615.69 "$1,026.15" $213.85 "$1,026.15" N/A N/A 04.115.150 SUP HCPCS C1713 04.115.150 - PLATE BONE +90D 51MM 2X5 HOLE L VAR ANG LOCKING LCP TITANIUM BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" $438.60 $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" $646.91 "$1,078.18" "$1,078.18" "$1,078.18" N/A N/A 04.115.151 SUP HCPCS C1713 04.115.151 - PLATE BONE -90D 51MM 2X5 HOLE L VAR ANG LOCKING LCP TITANIUM BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" "$1,096.50" $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" $646.91 "$1,078.18" "$1,078.18" "$1,078.18" N/A N/A 04.115.230 SUP HCPCS C1713 04.115.230 - PLATE BONE +90D 37MM 3X3 HOLE L VAR ANG LOCKING LCP TITANIUM BOTH IP/OP "$1,026.50" $760.00 $203.67 "$1,043.60" $461.77 $461.77 $461.77 $461.77 "$1,026.15" "$1,026.15" "$1,026.15" $213.88 "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" $213.86 "$1,026.15" "$1,043.60" $606.97 "$1,026.15" "$1,043.60" "$1,026.15" "$1,026.15" $769.88 "$1,026.15" "$1,026.15" "$1,026.15" $513.08 $513.08 $812.71 "$1,026.15" $820.92 $461.77 $203.67 N/A $595.37 "$1,026.15" $615.69 "$1,026.15" "$1,026.15" "$1,026.15" N/A N/A 04.115.231 SUP HCPCS C1713 04.115.231 - PLATE BONE -90D 37MM 3X3 HOLE L VAR ANG LOCKING LCP TITANIUM BOTH IP/OP "$1,026.50" $760.00 $203.67 "$1,043.60" $461.77 $461.77 $461.77 $461.77 "$1,026.15" "$1,026.15" "$1,026.15" $213.88 "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" $213.86 "$1,026.15" "$1,043.60" $606.97 "$1,026.15" "$1,043.60" "$1,026.15" "$1,026.15" $769.88 "$1,026.15" "$1,026.15" "$1,026.15" $513.08 $513.08 $812.71 "$1,026.15" $820.92 $461.77 $203.67 N/A $595.37 "$1,026.15" $615.69 "$1,026.15" $213.85 "$1,026.15" N/A N/A 04.115.250 SUP HCPCS C1713 04.115.250 - PLATE BONE +90D 51MM 3X5 HOLE L VAR ANG LOCKING LCP TITANIUM BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" $438.60 $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" "$1,078.18" "$1,078.18" $224.69 "$1,078.18" N/A N/A 04.115.251 SUP HCPCS C1713 04.115.251 - PLATE BONE -90D 51MM 3X5 HOLE L VAR ANG LOCKING LCP TITANIUM BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" $438.60 $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" N/A N/A 04.115.330 SUP HCPCS C1713 04.115.330 - PLATE BONE 37MM 3X3 HOLE T VAR ANG LOCKING LCP TITANIUM BOTH IP/OP "$1,060.00" $784.00 $210.36 "$1,077.93" $476.96 $476.96 $476.96 $476.96 "$1,059.90" "$1,059.90" "$1,059.90" $220.91 "$1,059.90" "$1,059.90" "$1,059.90" "$1,059.90" "$1,059.90" $220.89 "$1,059.90" $431.17 $626.93 "$1,059.90" "$1,077.93" "$1,059.90" "$1,059.90" $795.00 "$1,059.90" "$1,059.90" "$1,059.90" $529.95 $529.95 $839.44 "$1,059.90" $847.92 $476.96 $210.36 N/A $614.80 "$1,059.90" "$1,059.90" "$1,059.90" $220.88 "$1,059.90" N/A N/A 04.115.350 SUP HCPCS C1713 04.115.350 - PLATE BONE 51MM 3X5 HOLE T VAR ANG LOCKING LCP TITANIUM BOTH IP/OP "$1,106.50" $819.00 $219.57 "$1,125.08" $497.83 $497.83 $497.83 $497.83 "$1,106.28" "$1,106.28" "$1,106.28" $230.58 "$1,106.28" "$1,106.28" "$1,106.28" "$1,106.28" "$1,106.28" $230.56 "$1,106.28" $450.03 $654.36 "$1,106.28" "$1,125.08" "$1,106.28" "$1,106.28" $829.88 "$1,106.28" "$1,106.28" "$1,106.28" $553.14 $553.14 $876.17 "$1,106.28" $885.02 $497.83 $219.57 N/A $641.77 "$1,106.28" "$1,106.28" "$1,106.28" $230.55 "$1,106.28" N/A N/A 04.115.430 SUP HCPCS C1713 04.115.430 - PLATE BONE +20D 41MM 3X3 HOLE L VAR ANG OPLIQUE LOCKING LCP BOTH IP/OP "$1,026.50" $760.00 $203.67 "$1,043.60" $461.77 $461.77 $461.77 $461.77 "$1,026.15" "$1,026.15" "$1,026.15" $213.88 "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" $213.86 "$1,026.15" $417.44 $606.97 "$1,026.15" "$1,043.60" "$1,026.15" "$1,026.15" $769.88 "$1,026.15" "$1,026.15" "$1,026.15" $513.08 $513.08 $812.71 "$1,026.15" $820.92 $461.77 $203.67 N/A $595.37 "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" N/A N/A 04.115.431 SUP HCPCS C1713 04.115.431 - PLATE BONE -20D 41MM 3X3 HOLE L VAR ANG OBLIQUE LOCKING LCP BOTH IP/OP "$1,026.50" $760.00 $203.67 "$1,043.60" $461.77 $461.77 $461.77 $461.77 "$1,026.15" "$1,026.15" "$1,026.15" $213.88 "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" "$1,026.15" $213.86 "$1,026.15" $417.44 $606.97 "$1,026.15" "$1,043.60" "$1,026.15" "$1,026.15" $769.88 "$1,026.15" "$1,026.15" "$1,026.15" $513.08 $513.08 $812.71 "$1,026.15" $820.92 $461.77 $203.67 N/A $595.37 "$1,026.15" $615.69 "$1,026.15" $213.85 "$1,026.15" N/A N/A 04.115.450 SUP HCPCS C1713 04.115.450 - PLATE BONE +20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LOCKING LCP BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" $438.60 $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" $646.91 "$1,078.18" "$1,078.18" "$1,078.18" N/A N/A 04.115.451 SUP HCPCS C1713 04.115.451 - PLATE BONE -20D 55MM 3X5 HOLE L VAR ANG OBLIQUE LOCKING LCP BOTH IP/OP "$1,078.50" $798.00 $213.99 "$1,096.50" $485.18 $485.18 $485.18 $485.18 "$1,078.18" "$1,078.18" "$1,078.18" $224.72 "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" "$1,078.18" $224.70 "$1,078.18" $438.60 $637.74 "$1,078.18" "$1,096.50" "$1,078.18" "$1,078.18" $808.88 "$1,078.18" "$1,078.18" "$1,078.18" $539.09 $539.09 $853.92 "$1,078.18" $862.54 $485.18 $213.99 N/A $625.53 "$1,078.18" $646.91 "$1,078.18" $224.69 "$1,078.18" N/A N/A 04.115.530 SUP HCPCS C1713 04.115.530 - PLATE BONE 46MM 3X5 HOLE VAR ANG COLUMN LOCKING LCP TITANIUM BOTH IP/OP "$1,060.00" $784.00 $210.36 "$1,077.93" $476.96 $476.96 $476.96 $476.96 "$1,059.90" "$1,059.90" "$1,059.90" $220.91 "$1,059.90" "$1,059.90" "$1,059.90" "$1,059.90" "$1,059.90" $220.89 "$1,059.90" $431.17 $626.93 "$1,059.90" "$1,077.93" "$1,059.90" "$1,059.90" $795.00 "$1,059.90" "$1,059.90" "$1,059.90" $529.95 $529.95 $839.44 "$1,059.90" $847.92 $476.96 $210.36 N/A $614.80 "$1,059.90" $635.94 "$1,059.90" $220.88 "$1,059.90" N/A N/A 04.115.540 SUP HCPCS C1713 04.115.540 - PLATE BONE 57MM 6 HOLE L VAR ANG COLUMN LCP TITANIUM DISTAL BOTH IP/OP "$1,106.50" $819.00 $219.57 "$1,125.08" $497.83 $497.83 $497.83 $497.83 "$1,106.28" "$1,106.28" "$1,106.28" $230.58 "$1,106.28" "$1,106.28" "$1,106.28" "$1,106.28" "$1,106.28" $230.56 "$1,106.28" "$1,125.08" $654.36 "$1,106.28" "$1,125.08" "$1,106.28" "$1,106.28" $829.88 "$1,106.28" "$1,106.28" "$1,106.28" $553.14 $553.14 $876.17 "$1,106.28" $885.02 $497.83 $219.57 N/A $641.77 "$1,106.28" "$1,106.28" "$1,106.28" $230.55 "$1,106.28" N/A N/A 04.115.630 SUP HCPCS C1713 04.115.630 - PLATE BONE +90D 41MM 2X3 HOLE VARIABLE INTERMEDIATE COLUMN BOTH IP/OP "$1,106.50" $819.00 $219.57 "$1,125.08" $497.83 $497.83 $497.83 $497.83 "$1,106.28" "$1,106.28" "$1,106.28" $230.58 "$1,106.28" "$1,106.28" "$1,106.28" "$1,106.28" "$1,106.28" $230.56 "$1,106.28" $450.03 $654.36 "$1,106.28" "$1,125.08" "$1,106.28" "$1,106.28" $829.88 "$1,106.28" "$1,106.28" "$1,106.28" $553.14 $553.14 $876.17 "$1,106.28" $885.02 $497.83 $219.57 N/A $641.77 "$1,106.28" "$1,106.28" "$1,106.28" $230.55 "$1,106.28" N/A N/A 04.115.631 SUP HCPCS C1713 04.115.631 - PLATE BONE -90D 41MM 2X3 HOLE VARIABLE INTERMEDIATE COLUMN BOTH IP/OP "$1,106.50" $819.00 $219.57 "$1,125.08" $497.83 $497.83 $497.83 $497.83 "$1,106.28" "$1,106.28" "$1,106.28" $230.58 "$1,106.28" "$1,106.28" "$1,106.28" "$1,106.28" "$1,106.28" $230.56 "$1,106.28" $450.03 $654.36 "$1,106.28" "$1,125.08" "$1,106.28" "$1,106.28" $829.88 "$1,106.28" "$1,106.28" "$1,106.28" $553.14 $553.14 $876.17 "$1,106.28" $885.02 $497.83 $219.57 N/A $641.77 "$1,106.28" "$1,106.28" "$1,106.28" $230.55 "$1,106.28" N/A N/A 04.115.640 SUP HCPCS C1713 04.115.640 - PLATE BONE +90D 49MM 2X4 HOLE VARIABLE INTERMEDIATE COLUMN BOTH IP/OP "$1,147.50" $849.00 $227.66 "$1,166.55" $516.17 $516.17 $516.17 $516.17 "$1,147.05" "$1,147.05" "$1,147.05" $239.07 "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" $239.06 "$1,147.05" $466.62 $678.48 "$1,147.05" "$1,166.55" "$1,147.05" "$1,147.05" $860.63 "$1,147.05" "$1,147.05" "$1,147.05" $573.53 $573.53 $908.46 "$1,147.05" $917.64 $516.17 $227.66 N/A $665.55 "$1,147.05" "$1,147.05" "$1,147.05" $239.05 "$1,147.05" N/A N/A 04.115.641 SUP HCPCS C1713 04.115.641 - PLATE BONE -90D 49MM 2X4 HOLE VARIABLE INTERMEDIATE COLUMN BOTH IP/OP "$1,147.50" $849.00 $227.66 "$1,166.55" $516.17 $516.17 $516.17 $516.17 "$1,147.05" "$1,147.05" "$1,147.05" $239.07 "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" "$1,147.05" $239.06 "$1,147.05" $466.62 $678.48 "$1,147.05" "$1,166.55" "$1,147.05" "$1,147.05" $860.63 "$1,147.05" "$1,147.05" "$1,147.05" $573.53 $573.53 $908.46 "$1,147.05" $917.64 $516.17 $227.66 N/A $665.55 "$1,147.05" "$1,147.05" "$1,147.05" $239.05 "$1,147.05" N/A N/A 04.120.601 SUP HCPCS C1713 04.120.601 - PLATE BONE 4.5MM 4 HOLE LOCKING ATTCH LCP TITANIUM FEMUR BOTH IP/OP $940.50 $696.00 $186.65 $956.38 $423.18 $423.18 $423.18 $423.18 $940.40 $940.40 $940.40 $196.00 $940.40 $940.40 $940.40 $940.40 $940.40 $195.99 $940.40 $382.55 $556.25 $940.40 $956.38 $940.40 $940.40 $705.38 $940.40 $940.40 $940.40 $470.20 $470.20 $744.80 $940.40 $752.32 $423.18 $186.65 N/A $545.49 $940.40 $940.40 $940.40 $195.98 $940.40 N/A N/A 04.120.602 SUP HCPCS C1713 04.120.602 - PLATE BONE 4.5MM 8 HOLE LOCKING ATTCH LCP TITANIUM FEMUR BOTH IP/OP "$1,030.50" $763.00 $204.50 "$1,047.90" $463.67 $463.67 $463.67 $463.67 "$1,030.38" "$1,030.38" "$1,030.38" $214.76 "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" "$1,030.38" $214.74 "$1,030.38" $419.16 $609.47 "$1,030.38" "$1,047.90" "$1,030.38" "$1,030.38" $772.88 "$1,030.38" "$1,030.38" "$1,030.38" $515.19 $515.19 $816.06 "$1,030.38" $824.30 $463.67 $204.50 N/A $597.69 "$1,030.38" "$1,030.38" "$1,030.38" $214.73 "$1,030.38" N/A N/A 04.120.606 SUP HCPCS C1713 04.120.606 - SCREW BONE 6MM CONNCTNG STARDRIVE RECESS TITANIUM NONSTRL BOTH IP/OP $304.00 $225.00 $60.26 $308.78 $136.63 $136.63 $136.63 $136.63 $303.63 $303.63 $303.63 $63.28 $303.63 $303.63 $303.63 $303.63 $303.63 $63.28 $303.63 $123.51 $179.60 $303.63 $308.78 $303.63 $303.63 $228.00 $303.63 $303.63 $303.63 $151.82 $151.82 $240.47 $303.63 $242.90 $136.63 $60.26 N/A $176.32 $303.63 $303.63 $303.63 $63.28 $303.63 N/A N/A 04.120.701 SUP HCPCS C1713 04.120.701 - PLATE BONE 69MM 1 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL BOTH IP/OP "$1,750.50" "$1,295.00" $347.35 "$1,779.83" $787.54 $787.54 $787.54 $787.54 "$1,750.08" "$1,750.08" "$1,750.08" $364.76 "$1,750.08" "$1,750.08" "$1,750.08" "$1,750.08" "$1,750.08" $364.74 "$1,750.08" $711.93 "$1,035.17" "$1,750.08" "$1,779.83" "$1,750.08" "$1,750.08" "$1,312.88" "$1,750.08" "$1,750.08" "$1,750.08" $875.04 $875.04 "$1,386.06" "$1,750.08" "$1,400.06" $787.54 $347.35 N/A "$1,015.29" "$1,750.08" "$1,750.08" "$1,750.08" "$1,750.08" "$1,750.08" N/A N/A 04.120.702 SUP HCPCS C1713 04.120.702 - PLATE BONE 79MM 2 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL BOTH IP/OP "$1,770.00" "$1,310.00" $351.26 "$1,799.85" $796.40 $796.40 $796.40 $796.40 "$1,769.78" "$1,769.78" "$1,769.78" $368.87 "$1,769.78" "$1,769.78" "$1,769.78" "$1,769.78" "$1,769.78" $368.84 "$1,769.78" $719.94 "$1,046.82" "$1,769.78" "$1,799.85" "$1,769.78" "$1,769.78" "$1,327.50" "$1,769.78" "$1,769.78" "$1,769.78" $884.89 $884.89 "$1,401.67" "$1,769.78" "$1,415.82" $796.40 $351.26 N/A "$1,026.60" "$1,769.78" "$1,769.78" "$1,769.78" "$1,769.78" "$1,769.78" N/A N/A 04.120.704 SUP HCPCS C1713 04.120.704 - PLATE BONE 105MM 4 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL BOTH IP/OP "$1,788.50" "$1,323.00" $354.88 "$1,818.45" $804.62 $804.62 $804.62 $804.62 "$1,788.05" "$1,788.05" "$1,788.05" $372.67 "$1,788.05" "$1,788.05" "$1,788.05" "$1,788.05" "$1,788.05" $372.65 "$1,788.05" "$1,818.45" "$1,057.63" "$1,788.05" "$1,818.45" "$1,788.05" "$1,788.05" "$1,341.38" "$1,788.05" "$1,788.05" "$1,788.05" $894.03 $894.03 "$1,416.14" "$1,788.05" "$1,430.44" $804.62 $354.88 N/A "$1,037.33" "$1,788.05" "$1,788.05" "$1,788.05" $372.63 "$1,788.05" N/A N/A 04.120.706 SUP HCPCS C1713 04.120.706 - PLATE BONE 131MM 6 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL BOTH IP/OP "$1,805.00" "$1,336.00" $358.23 "$1,835.58" $812.21 $812.21 $812.21 $812.21 "$1,804.90" "$1,804.90" "$1,804.90" $376.19 "$1,804.90" "$1,804.90" "$1,804.90" "$1,804.90" "$1,804.90" $376.16 "$1,804.90" "$1,835.58" "$1,067.60" "$1,804.90" "$1,835.58" "$1,804.90" "$1,804.90" "$1,353.75" "$1,804.90" "$1,804.90" "$1,804.90" $902.45 $902.45 "$1,429.48" "$1,804.90" "$1,443.92" $812.21 $358.23 N/A "$1,046.90" "$1,804.90" "$1,804.90" "$1,804.90" $376.14 "$1,804.90" N/A N/A 04.120.708 SUP HCPCS C1713 04.120.708 - PLATE BONE 157MM 8 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL BOTH IP/OP "$1,825.00" "$1,351.00" $362.14 "$1,855.63" $821.07 $821.07 $821.07 $821.07 "$1,824.60" "$1,824.60" "$1,824.60" $380.29 "$1,824.60" "$1,824.60" "$1,824.60" "$1,824.60" "$1,824.60" $380.27 "$1,824.60" "$1,855.63" "$1,079.25" "$1,824.60" "$1,855.63" "$1,824.60" "$1,824.60" "$1,368.75" "$1,824.60" "$1,824.60" "$1,824.60" $912.30 $912.30 "$1,445.08" "$1,824.60" "$1,459.68" $821.07 $362.14 N/A "$1,058.50" "$1,824.60" "$1,824.60" "$1,824.60" $380.25 "$1,824.60" N/A N/A 04.120.710 SUP HCPCS C1713 04.120.710 - PLATE BONE 183MM 10 HOLE LCP TITANIUM TIBIA POSTEROMEDIAL BOTH IP/OP "$1,844.50" "$1,365.00" $366.04 "$1,875.63" $829.93 $829.93 $829.93 $829.93 "$1,844.28" "$1,844.28" "$1,844.28" $384.39 "$1,844.28" "$1,844.28" "$1,844.28" "$1,844.28" "$1,844.28" $384.37 "$1,844.28" $750.25 "$1,090.89" "$1,844.28" "$1,875.63" "$1,844.28" "$1,844.28" "$1,383.38" "$1,844.28" "$1,844.28" "$1,844.28" $922.14 $922.14 "$1,460.67" "$1,844.28" "$1,475.42" $829.93 $366.04 N/A "$1,069.81" "$1,844.28" "$1,844.28" "$1,844.28" $384.35 "$1,844.28" N/A N/A 04.124.030S SUP HCPCS C1713 04.124.030S - PLATE BONE 356MM 15 HOLE LCP TITANIUM FEMUR RIGHT DISTAL BOTH IP/OP "$3,319.00" "$2,456.00" $658.71 "$3,375.28" "$1,493.48" "$1,493.48" "$1,493.48" "$1,493.48" "$3,318.85" "$3,318.85" "$3,318.85" $691.73 "$3,318.85" "$3,318.85" "$3,318.85" "$3,318.85" "$3,318.85" $691.68 "$3,318.85" "$1,350.11" "$1,636.19" "$3,318.85" "$3,375.28" "$3,318.85" "$3,318.85" "$2,489.25" "$3,318.85" "$3,318.85" "$3,318.85" "$1,659.43" "$1,659.43" "$2,628.53" "$3,318.85" "$2,655.08" "$1,493.48" $658.71 N/A "$1,925.02" "$3,318.85" "$3,318.85" "$3,318.85" $691.65 "$3,318.85" N/A N/A 04.124.031S SUP HCPCS C1713 04.124.031S - PLATE BONE 356MM 15 HOLE LCP TITANIUM FEMUR LEFT DISTAL BOTH IP/OP "$3,319.00" "$2,456.00" $658.71 "$3,375.28" "$1,493.48" "$1,493.48" "$1,493.48" "$1,493.48" "$3,318.85" "$3,318.85" "$3,318.85" $691.73 "$3,318.85" "$3,318.85" "$3,318.85" "$3,318.85" "$3,318.85" $691.68 "$3,318.85" "$1,350.11" "$1,636.19" "$3,318.85" "$3,375.28" "$3,318.85" "$3,318.85" "$2,489.25" "$3,318.85" "$3,318.85" "$3,318.85" "$1,659.43" "$1,659.43" "$2,628.53" "$3,318.85" "$2,655.08" "$1,493.48" $658.71 N/A "$1,925.02" "$3,318.85" "$3,318.85" "$3,318.85" $691.65 "$3,318.85" N/A N/A 04.124.034S SUP HCPCS C1713 04.124.034S - PLATE BONE 396MM 17 HOLE LCP TITANIUM FEMUR RIGHT DISTAL BOTH IP/OP "$3,379.50" "$2,501.00" $670.70 "$3,436.73" "$1,520.68" "$1,520.68" "$1,520.68" "$1,520.68" "$3,379.28" "$3,379.28" "$3,379.28" $704.33 "$3,379.28" "$3,379.28" "$3,379.28" "$3,379.28" "$3,379.28" $704.28 "$3,379.28" "$3,436.73" "$1,665.99" "$3,379.28" "$3,436.73" "$3,379.28" "$3,379.28" "$2,534.63" "$3,379.28" "$3,379.28" "$3,379.28" "$1,689.64" "$1,689.64" "$2,676.39" "$3,379.28" "$2,703.42" "$1,520.68" $670.70 N/A "$1,960.11" "$3,379.28" "$3,379.28" "$3,379.28" $704.24 "$3,379.28" N/A N/A 04.124.035S SUP HCPCS C1713 04.124.035S - PLATE BONE 396MM 17 HOLE LCP TITANIUM FEMUR LEFT DISTAL BOTH IP/OP "$3,379.50" "$2,501.00" $670.70 "$3,436.73" "$1,520.68" "$1,520.68" "$1,520.68" "$1,520.68" "$3,379.28" "$3,379.28" "$3,379.28" $704.33 "$3,379.28" "$3,379.28" "$3,379.28" "$3,379.28" "$3,379.28" $704.28 "$3,379.28" "$1,374.69" "$1,665.99" "$3,379.28" "$3,436.73" "$3,379.28" "$3,379.28" "$2,534.63" "$3,379.28" "$3,379.28" "$3,379.28" "$1,689.64" "$1,689.64" "$2,676.39" "$3,379.28" "$2,703.42" "$1,520.68" $670.70 N/A "$1,960.11" "$3,379.28" "$3,379.28" "$3,379.28" $704.24 "$3,379.28" N/A N/A 04.124.038S SUP HCPCS C1713 04.124.038S - PLATE BONE 436MM 19 HOLE LCP TITANIUM FEMUR RIGHT DISTAL BOTH IP/OP "$3,441.50" "$2,547.00" $682.98 "$3,499.63" "$1,548.51" "$1,548.51" "$1,548.51" "$1,548.51" "$3,441.13" "$3,441.13" "$3,441.13" $717.22 "$3,441.13" "$3,441.13" "$3,441.13" "$3,441.13" "$3,441.13" $717.17 "$3,441.13" "$1,399.85" "$1,696.48" "$3,441.13" "$3,499.63" "$3,441.13" "$3,441.13" "$2,581.13" "$3,441.13" "$3,441.13" "$3,441.13" "$1,720.57" "$1,720.57" "$2,725.37" "$3,441.13" "$2,752.90" "$1,548.51" $682.98 N/A "$1,996.07" "$3,441.13" "$3,441.13" "$3,441.13" $717.13 "$3,441.13" N/A N/A 04.124.039S SUP HCPCS C1713 04.124.039S - PLATE BONE 436MM 19 HOLE LCP TITANIUM FEMUR LEFT DISTAL BOTH IP/OP "$3,441.50" "$2,547.00" $682.98 "$3,499.63" "$1,548.51" "$1,548.51" "$1,548.51" "$1,548.51" "$3,441.13" "$3,441.13" "$3,441.13" $717.22 "$3,441.13" "$3,441.13" "$3,441.13" "$3,441.13" "$3,441.13" $717.17 "$3,441.13" "$1,399.85" "$1,696.48" "$3,441.13" "$3,499.63" "$3,441.13" "$3,441.13" "$2,581.13" "$3,441.13" "$3,441.13" "$3,441.13" "$1,720.57" "$1,720.57" "$2,725.37" "$3,441.13" "$2,752.90" "$1,548.51" $682.98 N/A "$1,996.07" "$3,441.13" "$2,064.68" "$3,441.13" $717.13 "$3,441.13" N/A N/A 04.124.200 SUP HCPCS C1713 04.124.200 - PLATE BONE 76MM 4 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$2,664.00" "$1,971.00" $528.69 "$2,709.05" "$1,198.70" "$1,198.70" "$1,198.70" "$1,198.70" "$2,663.78" "$2,663.78" "$2,663.78" $555.20 "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" $555.16 "$2,663.78" "$1,083.62" "$1,313.24" "$2,663.78" "$2,709.05" "$2,663.78" "$2,663.78" "$1,998.00" "$2,663.78" "$2,663.78" "$2,663.78" "$1,331.89" "$1,331.89" "$2,109.71" "$2,663.78" "$2,131.02" "$1,198.70" $528.69 N/A "$1,545.12" "$2,663.78" "$1,598.27" "$2,663.78" $555.13 "$2,663.78" N/A N/A 04.124.201 SUP HCPCS C1713 04.124.201 - PLATE BONE 76MM 6 HOLE LOW BEND LCP TITANIUM TIBIA LEFT BOTH IP/OP "$2,664.00" "$1,971.00" $528.69 "$2,709.05" "$1,198.70" "$1,198.70" "$1,198.70" "$1,198.70" "$2,663.78" "$2,663.78" "$2,663.78" $555.20 "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" "$2,663.78" $555.16 "$2,663.78" "$1,083.62" "$1,313.24" "$2,663.78" "$2,709.05" "$2,663.78" "$2,663.78" "$1,998.00" "$2,663.78" "$2,663.78" "$2,663.78" "$1,331.89" "$1,331.89" "$2,109.71" "$2,663.78" "$2,131.02" "$1,198.70" $528.69 N/A "$1,545.12" "$2,663.78" "$1,598.27" "$2,663.78" "$2,663.78" "$2,663.78" N/A N/A 04.124.204 SUP HCPCS C1713 04.124.204 - PLATE BONE 102MM 6 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$2,696.50" "$1,995.00" $535.11 "$2,741.95" "$1,213.26" "$1,213.26" "$1,213.26" "$1,213.26" "$2,696.13" "$2,696.13" "$2,696.13" $561.94 "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" $561.90 "$2,696.13" "$2,741.95" "$1,329.19" "$2,696.13" "$2,741.95" "$2,696.13" "$2,696.13" "$2,022.38" "$2,696.13" "$2,696.13" "$2,696.13" "$1,348.07" "$1,348.07" "$2,135.33" "$2,696.13" "$2,156.90" "$1,213.26" $535.11 N/A "$1,563.97" "$2,696.13" "$1,617.68" "$2,696.13" "$2,696.13" "$2,696.13" N/A N/A 04.124.205 SUP HCPCS C1713 04.124.205 - PLATE BONE 102MM 6 HOLE LOW BEND LCP TITANIUM TIBIA LEFT BOTH IP/OP "$2,696.50" "$1,995.00" $535.11 "$2,741.95" "$1,213.26" "$1,213.26" "$1,213.26" "$1,213.26" "$2,696.13" "$2,696.13" "$2,696.13" $561.94 "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" $561.90 "$2,696.13" "$2,741.95" "$1,329.19" "$2,696.13" "$2,741.95" "$2,696.13" "$2,696.13" "$2,022.38" "$2,696.13" "$2,696.13" "$2,696.13" "$1,348.07" "$1,348.07" "$2,135.33" "$2,696.13" "$2,156.90" "$1,213.26" $535.11 N/A "$1,563.97" "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" "$2,696.13" N/A N/A 04.124.208 SUP HCPCS C1713 04.124.208 - PLATE BONE 128MM 8 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$2,727.50" "$2,018.00" $541.25 "$2,773.40" "$1,227.17" "$1,227.17" "$1,227.17" "$1,227.17" "$2,727.05" "$2,727.05" "$2,727.05" $568.39 "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" $568.35 "$2,727.05" "$1,109.36" "$1,344.44" "$2,727.05" "$2,773.40" "$2,727.05" "$2,727.05" "$2,045.63" "$2,727.05" "$2,727.05" "$2,727.05" "$1,363.53" "$1,363.53" "$2,159.82" "$2,727.05" "$2,181.64" "$1,227.17" $541.25 N/A "$1,581.95" "$2,727.05" "$1,636.23" "$2,727.05" $568.32 "$2,727.05" N/A N/A 04.124.209 SUP HCPCS C1713 04.124.209 - PLATE BONE 128MM 8 HOLE LOW BEND LCP TITANIUM TIBIA LEFT BOTH IP/OP "$2,727.50" "$2,018.00" $541.25 "$2,773.40" "$1,227.17" "$1,227.17" "$1,227.17" "$1,227.17" "$2,727.05" "$2,727.05" "$2,727.05" $568.39 "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" "$2,727.05" $568.35 "$2,727.05" "$1,109.36" "$1,344.44" "$2,727.05" "$2,773.40" "$2,727.05" "$2,727.05" "$2,045.63" "$2,727.05" "$2,727.05" "$2,727.05" "$1,363.53" "$1,363.53" "$2,159.82" "$2,727.05" "$2,181.64" "$1,227.17" $541.25 N/A "$1,581.95" "$2,727.05" "$1,636.23" "$2,727.05" $568.32 "$2,727.05" N/A N/A 04.124.212 SUP HCPCS C1713 04.124.212 - PLATE BONE 154MM 10 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$2,757.00" "$2,040.00" $547.11 "$2,803.43" "$1,240.46" "$1,240.46" "$1,240.46" "$1,240.46" "$2,756.58" "$2,756.58" "$2,756.58" $574.54 "$2,756.58" "$2,756.58" "$2,756.58" "$2,756.58" "$2,756.58" $574.50 "$2,756.58" "$1,121.37" "$1,358.99" "$2,756.58" "$2,803.43" "$2,756.58" "$2,756.58" "$2,067.75" "$2,756.58" "$2,756.58" "$2,756.58" "$1,378.29" "$1,378.29" "$2,183.21" "$2,756.58" "$2,205.26" "$1,240.46" $547.11 N/A "$1,599.06" "$2,756.58" "$1,653.95" "$2,756.58" $574.47 "$2,756.58" N/A N/A 04.124.213 SUP HCPCS C1713 04.124.213 - PLATE BONE 154MM 10 HOLE LOW BEND LCP TITANIUM TIBIA LEFT BOTH IP/OP "$2,757.00" "$2,040.00" $547.11 "$2,803.43" "$1,240.46" "$1,240.46" "$1,240.46" "$1,240.46" "$2,756.58" "$2,756.58" "$2,756.58" $574.54 "$2,756.58" "$2,756.58" "$2,756.58" "$2,756.58" "$2,756.58" $574.50 "$2,756.58" "$1,121.37" "$1,358.99" "$2,756.58" "$2,803.43" "$2,756.58" "$2,756.58" "$2,067.75" "$2,756.58" "$2,756.58" "$2,756.58" "$1,378.29" "$1,378.29" "$2,183.21" "$2,756.58" "$2,205.26" "$1,240.46" $547.11 N/A "$1,599.06" "$2,756.58" "$1,653.95" "$2,756.58" $574.47 "$2,756.58" N/A N/A 04.124.216 SUP HCPCS C1713 04.124.216 - PLATE BONE 180MM 12 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$2,887.50" "$2,137.00" $573.06 "$2,936.38" "$1,299.29" "$1,299.29" "$1,299.29" "$1,299.29" "$2,887.30" "$2,887.30" "$2,887.30" $601.79 "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" $601.75 "$2,887.30" "$1,174.55" "$1,423.44" "$2,887.30" "$2,936.38" "$2,887.30" "$2,887.30" "$2,165.63" "$2,887.30" "$2,887.30" "$2,887.30" "$1,443.65" "$1,443.65" "$2,286.74" "$2,887.30" "$2,309.84" "$1,299.29" $573.06 N/A "$1,674.75" "$2,887.30" "$1,732.38" "$2,887.30" $601.71 "$2,887.30" N/A N/A 04.124.217 SUP HCPCS C1713 04.124.217 - PLATE BONE 180MM 12 HOLE LOW BEND LCP TITANIUM TIBIA LEFT BOTH IP/OP "$2,887.50" "$2,137.00" $573.06 "$2,936.38" "$1,299.29" "$1,299.29" "$1,299.29" "$1,299.29" "$2,887.30" "$2,887.30" "$2,887.30" $601.79 "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" $601.75 "$2,887.30" "$1,174.55" "$1,423.44" "$2,887.30" "$2,936.38" "$2,887.30" "$2,887.30" "$2,165.63" "$2,887.30" "$2,887.30" "$2,887.30" "$1,443.65" "$1,443.65" "$2,286.74" "$2,887.30" "$2,309.84" "$1,299.29" $573.06 N/A "$1,674.75" "$2,887.30" "$1,732.38" "$2,887.30" $601.71 "$2,887.30" N/A N/A 04.124.220 SUP HCPCS C1713 04.124.220 - PLATE BONE 206MM 14 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$2,918.50" "$2,160.00" $579.20 "$2,967.83" "$1,313.20" "$1,313.20" "$1,313.20" "$1,313.20" "$2,918.23" "$2,918.23" "$2,918.23" $608.23 "$2,918.23" "$2,918.23" "$2,918.23" "$2,918.23" "$2,918.23" $608.19 "$2,918.23" "$2,967.83" "$1,438.69" "$2,918.23" "$2,967.83" "$2,918.23" "$2,918.23" "$2,188.88" "$2,918.23" "$2,918.23" "$2,918.23" "$1,459.12" "$1,459.12" "$2,311.24" "$2,918.23" "$2,334.58" "$1,313.20" $579.20 N/A "$1,692.73" "$2,918.23" "$1,750.94" "$2,918.23" $608.16 "$2,918.23" N/A N/A 04.124.221 SUP HCPCS C1713 04.124.221 - PLATE BONE 206MM 14 HOLE LOW BEND LCP TITANIUM TIBIA LEFT BOTH IP/OP "$2,918.50" "$2,160.00" $579.20 "$2,967.83" "$1,313.20" "$1,313.20" "$1,313.20" "$1,313.20" "$2,918.23" "$2,918.23" "$2,918.23" $608.23 "$2,918.23" "$2,918.23" "$2,918.23" "$2,918.23" "$2,918.23" $608.19 "$2,918.23" "$2,967.83" "$1,438.69" "$2,918.23" "$2,967.83" "$2,918.23" "$2,918.23" "$2,188.88" "$2,918.23" "$2,918.23" "$2,918.23" "$1,459.12" "$1,459.12" "$2,311.24" "$2,918.23" "$2,334.58" "$1,313.20" $579.20 N/A "$1,692.73" "$2,918.23" "$1,750.94" "$2,918.23" "$2,918.23" "$2,918.23" N/A N/A 04.124.224 SUP HCPCS C1713 04.124.224 - PLATE BONE 232MM 16 HOLE LOW BEND LCP TITANIUM TIBIA RIGHT BOTH IP/OP "$3,021.00" "$2,236.00" $599.56 "$3,072.18" "$1,359.37" "$1,359.37" "$1,359.37" "$1,359.37" "$3,020.83" "$3,020.83" "$3,020.83" $629.62 "$3,020.83" "$3,020.83" "$3,020.83" "$3,020.83" "$3,020.83" $629.57 "$3,020.83" "$1,228.87" "$1,489.27" "$3,020.83" "$3,072.18" "$3,020.83" "$3,020.83" "$2,265.75" "$3,020.83" "$3,020.83" "$3,020.83" "$1,510.42" "$1,510.42" "$2,392.50" "$3,020.83" "$2,416.66" "$1,359.37" $599.56 N/A "$1,752.18" "$3,020.83" "$1,812.50" "$3,020.83" "$3,020.83" "$3,020.83" N/A N/A 04.124.225 SUP HCPCS C1713 04.124.225 - PLATE BONE 232MM 16 HOLE LOW BEND LCP TITANIUM TIBIA LEFT BOTH IP/OP "$3,021.00" "$2,236.00" $599.56 "$3,072.18" "$1,359.37" "$1,359.37" "$1,359.37" "$1,359.37" "$3,020.83" "$3,020.83" "$3,020.83" $629.62 "$3,020.83" "$3,020.83" "$3,020.83" "$3,020.83" "$3,020.83" $629.57 "$3,020.83" "$1,228.87" "$1,489.27" "$3,020.83" "$3,072.18" "$3,020.83" "$3,020.83" "$2,265.75" "$3,020.83" "$3,020.83" "$3,020.83" "$1,510.42" "$1,510.42" "$2,392.50" "$3,020.83" "$2,416.66" "$1,359.37" $599.56 N/A "$1,752.18" "$3,020.83" "$1,812.50" "$3,020.83" $629.54 "$3,020.83" N/A N/A 04.161.001 SUP HCPCS C1713 04.161.001 - PLATE BONE 50MM GREEN TITANIUM SPN OCCIPITOCERVICAL MEDIAL BOTH IP/OP "$8,232.00" "$6,092.00" "$1,633.85" "$8,232.00" "$3,704.40" "$3,704.40" "$3,704.40" "$3,704.40" "$8,232.00" "$8,232.00" "$8,232.00" "$1,715.75" "$8,232.00" "$8,232.00" "$8,232.00" "$8,232.00" "$8,232.00" "$1,715.64" "$8,232.00" "$8,232.00" "$4,058.38" "$8,232.00" "$8,232.00" "$8,232.00" "$8,232.00" "$6,174.00" "$8,232.00" "$8,232.00" "$8,232.00" "$4,116.00" "$4,116.00" "$6,519.74" "$8,232.00" "$6,585.60" "$3,704.40" "$1,633.85" N/A "$4,774.56" "$8,232.00" "$4,939.20" "$8,232.00" "$1,715.55" "$8,232.00" N/A N/A 04.161.032 SUP HCPCS C1713 04.161.032 - ROD SPINAL 3.5MM 240MM PREBENT GOLD TITANIUM BOTH IP/OP $892.50 $660.00 $177.14 $892.50 $401.63 $401.63 $401.63 $401.63 $892.50 $892.50 $892.50 $186.02 $892.50 $892.50 $892.50 $892.50 $892.50 $186.01 $892.50 $892.50 $527.91 $892.50 $892.50 $892.50 $892.50 $669.38 $892.50 $892.50 $892.50 $446.25 $446.25 $706.86 $892.50 $714.00 $401.63 $177.14 N/A $517.65 $892.50 $535.50 $892.50 $186.00 $892.50 N/A N/A 04.161.210S SUP HCPCS C1713 04.161.210S - PLATE BONE NARROW 10 HOLE CVD LCP TITANIUM STERILE 3.5MM BOTH IP/OP $796.00 $589.00 $157.91 $809.15 $358.03 $358.03 $358.03 $358.03 $795.63 $795.63 $795.63 $165.83 $795.63 $795.63 $795.63 $795.63 $795.63 $165.82 $795.63 $323.66 $470.62 $795.63 $809.15 $795.63 $795.63 $597.00 $795.63 $795.63 $795.63 $397.82 $397.82 $630.14 $795.63 $636.50 $358.03 $157.91 N/A $461.68 $795.63 $477.38 $795.63 $795.63 $795.63 N/A N/A 04.161.212S SUP HCPCS C1713 04.161.212S - PLATE BONE NARROW 12 HOLE CVD LCP TITANIUM PEDIATRIC STERILE BOTH IP/OP "$1,164.00" $861.00 $231.01 "$1,183.70" $523.77 $523.77 $523.77 $523.77 "$1,163.93" "$1,163.93" "$1,163.93" $242.59 "$1,163.93" "$1,163.93" "$1,163.93" "$1,163.93" "$1,163.93" $242.58 "$1,163.93" "$1,183.70" $688.46 "$1,163.93" "$1,183.70" "$1,163.93" "$1,163.93" $873.00 "$1,163.93" "$1,163.93" "$1,163.93" $581.97 $581.97 $921.83 "$1,163.93" $931.14 $523.77 $231.01 N/A $675.12 "$1,163.93" "$1,163.93" "$1,163.93" $242.56 "$1,163.93" N/A N/A 04.161.214S SUP HCPCS C1713 04.161.214S - PLATE BONE CURVE NARROW 14 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,333.00" $986.00 $264.49 "$1,355.25" $599.67 $599.67 $599.67 $599.67 "$1,332.60" "$1,332.60" "$1,332.60" $277.75 "$1,332.60" "$1,332.60" "$1,332.60" "$1,332.60" "$1,332.60" $277.73 "$1,332.60" "$1,355.25" $788.23 "$1,332.60" "$1,355.25" "$1,332.60" "$1,332.60" $999.75 "$1,332.60" "$1,332.60" "$1,332.60" $666.30 $666.30 "$1,055.42" "$1,332.60" "$1,066.08" $599.67 $264.49 N/A $773.14 "$1,332.60" "$1,332.60" "$1,332.60" $277.71 "$1,332.60" N/A N/A 04.161.216S SUP HCPCS C1713 04.161.216S - PLATE BONE CURVE NARROW 16 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,432.50" "$1,060.00" $284.30 "$1,456.75" $644.58 $644.58 $644.58 $644.58 "$1,432.40" "$1,432.40" "$1,432.40" $298.55 "$1,432.40" "$1,432.40" "$1,432.40" "$1,432.40" "$1,432.40" $298.53 "$1,432.40" "$1,456.75" $847.26 "$1,432.40" "$1,456.75" "$1,432.40" "$1,432.40" "$1,074.38" "$1,432.40" "$1,432.40" "$1,432.40" $716.20 $716.20 "$1,134.46" "$1,432.40" "$1,145.92" $644.58 $284.30 N/A $830.85 "$1,432.40" "$1,432.40" "$1,432.40" $298.51 "$1,432.40" N/A N/A 04.161.218S SUP HCPCS C1713 04.161.218S - PLATE BONE CURVE NARROW 18 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,601.50" "$1,185.00" $317.77 "$1,628.30" $720.49 $720.49 $720.49 $720.49 "$1,601.08" "$1,601.08" "$1,601.08" $333.71 "$1,601.08" "$1,601.08" "$1,601.08" "$1,601.08" "$1,601.08" $333.68 "$1,601.08" $651.32 $947.04 "$1,601.08" "$1,628.30" "$1,601.08" "$1,601.08" "$1,201.13" "$1,601.08" "$1,601.08" "$1,601.08" $800.54 $800.54 "$1,268.06" "$1,601.08" "$1,280.86" $720.49 $317.77 N/A $928.87 "$1,601.08" "$1,601.08" "$1,601.08" $333.67 "$1,601.08" N/A N/A 04.161.220S SUP HCPCS C1713 04.161.220S - PLATE BONE CURVE NARROW 20 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,767.00" "$1,308.00" $350.70 "$1,797.00" $795.13 $795.13 $795.13 $795.13 "$1,766.95" "$1,766.95" "$1,766.95" $368.28 "$1,766.95" "$1,766.95" "$1,766.95" "$1,766.95" "$1,766.95" $368.25 "$1,766.95" "$1,797.00" "$1,045.15" "$1,766.95" "$1,797.00" "$1,766.95" "$1,766.95" "$1,325.25" "$1,766.95" "$1,766.95" "$1,766.95" $883.48 $883.48 "$1,399.42" "$1,766.95" "$1,413.56" $795.13 $350.70 N/A "$1,024.86" "$1,766.95" "$1,766.95" "$1,766.95" "$1,766.95" "$1,766.95" N/A N/A 04.161.222S SUP HCPCS C1713 04.161.222S - PLATE BONE CURVE NARROW 22 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,767.00" "$1,308.00" $350.70 "$1,797.00" $795.13 $795.13 $795.13 $795.13 "$1,766.95" "$1,766.95" "$1,766.95" $368.28 "$1,766.95" "$1,766.95" "$1,766.95" "$1,766.95" "$1,766.95" $368.25 "$1,766.95" "$1,797.00" "$1,045.15" "$1,766.95" "$1,797.00" "$1,766.95" "$1,766.95" "$1,325.25" "$1,766.95" "$1,766.95" "$1,766.95" $883.48 $883.48 "$1,399.42" "$1,766.95" "$1,413.56" $795.13 $350.70 N/A "$1,024.86" "$1,766.95" "$1,766.95" "$1,766.95" "$1,766.95" "$1,766.95" N/A N/A 04.161.240S SUP HCPCS C1713 04.161.240S - PLATE BONE CURVE NARROW 10 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,257.00" $930.00 $249.42 "$1,278.08" $565.52 $565.52 $565.52 $565.52 "$1,256.70" "$1,256.70" "$1,256.70" $261.93 "$1,256.70" "$1,256.70" "$1,256.70" "$1,256.70" "$1,256.70" $261.91 "$1,256.70" "$1,278.08" $743.34 "$1,256.70" "$1,278.08" "$1,256.70" "$1,256.70" $942.75 "$1,256.70" "$1,256.70" "$1,256.70" $628.35 $628.35 $995.31 "$1,256.70" "$1,005.36" $565.52 $249.42 N/A $729.06 "$1,256.70" "$1,256.70" "$1,256.70" $261.90 "$1,256.70" N/A N/A 04.161.242S SUP HCPCS C1713 04.161.242S - PLATE BONE CURVE NARROW 12 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,437.00" "$1,063.00" $285.14 "$1,461.05" $646.48 $646.48 $646.48 $646.48 "$1,436.63" "$1,436.63" "$1,436.63" $299.43 "$1,436.63" "$1,436.63" "$1,436.63" "$1,436.63" "$1,436.63" $299.41 "$1,436.63" "$1,461.05" $849.77 "$1,436.63" "$1,461.05" "$1,436.63" "$1,436.63" "$1,077.75" "$1,436.63" "$1,436.63" "$1,436.63" $718.32 $718.32 "$1,137.81" "$1,436.63" "$1,149.30" $646.48 $285.14 N/A $833.46 "$1,436.63" "$1,436.63" "$1,436.63" "$1,436.63" "$1,436.63" N/A N/A 04.161.244S SUP HCPCS C1713 04.161.244S - PLATE BONE CURVE NARROW 14 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,527.00" "$1,130.00" $302.99 "$1,552.53" $686.96 $686.96 $686.96 $686.96 "$1,526.58" "$1,526.58" "$1,526.58" $318.18 "$1,526.58" "$1,526.58" "$1,526.58" "$1,526.58" "$1,526.58" $318.16 "$1,526.58" $621.01 $902.97 "$1,526.58" "$1,552.53" "$1,526.58" "$1,526.58" "$1,145.25" "$1,526.58" "$1,526.58" "$1,526.58" $763.29 $763.29 "$1,209.05" "$1,526.58" "$1,221.26" $686.96 $302.99 N/A $885.66 "$1,526.58" "$1,526.58" "$1,526.58" "$1,526.58" "$1,526.58" N/A N/A 04.161.246S SUP HCPCS C1713 04.161.246S - PLATE BONE CURVE NARROW 16 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,705.50" "$1,262.00" $338.42 "$1,734.08" $767.30 $767.30 $767.30 $767.30 "$1,705.10" "$1,705.10" "$1,705.10" $355.39 "$1,705.10" "$1,705.10" "$1,705.10" "$1,705.10" "$1,705.10" $355.36 "$1,705.10" $693.63 "$1,008.57" "$1,705.10" "$1,734.08" "$1,705.10" "$1,705.10" "$1,279.13" "$1,705.10" "$1,705.10" "$1,705.10" $852.55 $852.55 "$1,350.44" "$1,705.10" "$1,364.08" $767.30 $338.42 N/A $989.19 "$1,705.10" "$1,705.10" "$1,705.10" $355.34 "$1,705.10" N/A N/A 04.161.248S SUP HCPCS C1713 04.161.248S - PLATE BONE CURVE NARROW 18 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$2,061.00" "$1,525.00" $409.01 "$2,095.78" $927.34 $927.34 $927.34 $927.34 "$2,060.75" "$2,060.75" "$2,060.75" $429.51 "$2,060.75" "$2,060.75" "$2,060.75" "$2,060.75" "$2,060.75" $429.48 "$2,060.75" $838.31 "$1,218.93" "$2,060.75" "$2,095.78" "$2,060.75" "$2,060.75" "$1,545.75" "$2,060.75" "$2,060.75" "$2,060.75" "$1,030.38" "$1,030.38" "$1,632.11" "$2,060.75" "$1,648.60" $927.34 $409.01 N/A "$1,195.38" "$2,060.75" "$2,060.75" "$2,060.75" $429.46 "$2,060.75" N/A N/A 04.161.250S SUP HCPCS C1713 04.161.250S - PLATE BONE CURVE NARROW 20 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$2,421.00" "$1,792.00" $480.43 "$2,461.75" "$1,089.27" "$1,089.27" "$1,089.27" "$1,089.27" "$2,420.60" "$2,420.60" "$2,420.60" $504.51 "$2,420.60" "$2,420.60" "$2,420.60" "$2,420.60" "$2,420.60" $504.48 "$2,420.60" "$2,461.75" "$1,431.78" "$2,420.60" "$2,461.75" "$2,420.60" "$2,420.60" "$1,815.75" "$2,420.60" "$2,420.60" "$2,420.60" "$1,210.30" "$1,210.30" "$1,917.12" "$2,420.60" "$1,936.48" "$1,089.27" $480.43 N/A "$1,404.18" "$2,420.60" "$2,420.60" "$2,420.60" $504.45 "$2,420.60" N/A N/A 04.161.252S SUP HCPCS C1713 04.161.252S - PLATE BONE CURVE NARROW 22 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$2,689.50" "$1,990.00" $533.72 "$2,734.83" "$1,210.10" "$1,210.10" "$1,210.10" "$1,210.10" "$2,689.10" "$2,689.10" "$2,689.10" $560.48 "$2,689.10" "$2,689.10" "$2,689.10" "$2,689.10" "$2,689.10" $560.44 "$2,689.10" "$2,734.83" "$1,325.73" "$2,689.10" "$2,734.83" "$2,689.10" "$2,689.10" "$2,017.13" "$2,689.10" "$2,689.10" "$2,689.10" "$1,344.55" "$1,344.55" "$2,129.77" "$2,689.10" "$2,151.28" "$1,210.10" $533.72 N/A "$1,559.91" "$2,689.10" "$2,689.10" "$2,689.10" $560.41 "$2,689.10" N/A N/A 04.161.270S SUP HCPCS C1713 04.161.270S - PLATE BONE CURVE BROAD 10 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP $981.50 $726.00 $194.74 $997.85 $441.53 $441.53 $441.53 $441.53 $981.18 $981.18 $981.18 $204.50 $981.18 $981.18 $981.18 $981.18 $981.18 $204.49 $981.18 $997.85 $580.37 $981.18 $997.85 $981.18 $981.18 $736.13 $981.18 $981.18 $981.18 $490.59 $490.59 $777.09 $981.18 $784.94 $441.53 $194.74 N/A $569.27 $981.18 $981.18 $981.18 $981.18 $981.18 N/A N/A 04.161.272S SUP HCPCS C1713 04.161.272S - PLATE BONE CURVE BROAD 12 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,248.50" $924.00 $247.75 "$1,269.48" $561.71 $561.71 $561.71 $561.71 "$1,248.25" "$1,248.25" "$1,248.25" $260.17 "$1,248.25" "$1,248.25" "$1,248.25" "$1,248.25" "$1,248.25" $260.15 "$1,248.25" $507.79 $738.34 "$1,248.25" "$1,269.48" "$1,248.25" "$1,248.25" $936.38 "$1,248.25" "$1,248.25" "$1,248.25" $624.13 $624.13 $988.61 "$1,248.25" $998.60 $561.71 $247.75 N/A $724.13 "$1,248.25" "$1,248.25" "$1,248.25" "$1,248.25" "$1,248.25" N/A N/A 04.161.274S SUP HCPCS C1713 04.161.274S - PLATE BONE CURVE BROAD 14 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,333.00" $986.00 $264.49 "$1,355.25" $599.67 $599.67 $599.67 $599.67 "$1,332.60" "$1,332.60" "$1,332.60" $277.75 "$1,332.60" "$1,332.60" "$1,332.60" "$1,332.60" "$1,332.60" $277.73 "$1,332.60" "$1,355.25" $788.23 "$1,332.60" "$1,355.25" "$1,332.60" "$1,332.60" $999.75 "$1,332.60" "$1,332.60" "$1,332.60" $666.30 $666.30 "$1,055.42" "$1,332.60" "$1,066.08" $599.67 $264.49 N/A $773.14 "$1,332.60" "$1,332.60" "$1,332.60" "$1,332.60" "$1,332.60" N/A N/A 04.161.276S SUP HCPCS C1713 04.161.276S - PLATE BONE CURVE BROAD 16 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,432.50" "$1,060.00" $284.30 "$1,456.75" $644.58 $644.58 $644.58 $644.58 "$1,432.40" "$1,432.40" "$1,432.40" $298.55 "$1,432.40" "$1,432.40" "$1,432.40" "$1,432.40" "$1,432.40" $298.53 "$1,432.40" "$1,456.75" $847.26 "$1,432.40" "$1,456.75" "$1,432.40" "$1,432.40" "$1,074.38" "$1,432.40" "$1,432.40" "$1,432.40" $716.20 $716.20 "$1,134.46" "$1,432.40" "$1,145.92" $644.58 $284.30 N/A $830.85 "$1,432.40" "$1,432.40" "$1,432.40" $298.51 "$1,432.40" N/A N/A 04.161.278S SUP HCPCS C1713 04.161.278S - PLATE BONE CURVE BROAD 18 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,601.50" "$1,185.00" $317.77 "$1,628.30" $720.49 $720.49 $720.49 $720.49 "$1,601.08" "$1,601.08" "$1,601.08" $333.71 "$1,601.08" "$1,601.08" "$1,601.08" "$1,601.08" "$1,601.08" $333.68 "$1,601.08" $651.32 $947.04 "$1,601.08" "$1,628.30" "$1,601.08" "$1,601.08" "$1,201.13" "$1,601.08" "$1,601.08" "$1,601.08" $800.54 $800.54 "$1,268.06" "$1,601.08" "$1,280.86" $720.49 $317.77 N/A $928.87 "$1,601.08" "$1,601.08" "$1,601.08" "$1,601.08" "$1,601.08" N/A N/A 04.161.280S SUP HCPCS C1713 04.161.280S - PLATE BONE CURVE BROAD 20 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,699.50" "$1,258.00" $337.30 "$1,728.38" $764.77 $764.77 $764.77 $764.77 "$1,699.48" "$1,699.48" "$1,699.48" $354.21 "$1,699.48" "$1,699.48" "$1,699.48" "$1,699.48" "$1,699.48" $354.19 "$1,699.48" $691.35 "$1,005.24" "$1,699.48" "$1,728.38" "$1,699.48" "$1,699.48" "$1,274.63" "$1,699.48" "$1,699.48" "$1,699.48" $849.74 $849.74 "$1,345.99" "$1,699.48" "$1,359.58" $764.77 $337.30 N/A $985.71 "$1,699.48" "$1,699.48" "$1,699.48" "$1,699.48" "$1,699.48" N/A N/A 04.161.282S SUP HCPCS C1713 04.161.282S - PLATE BONE CURVE BROAD 22 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,784.00" "$1,320.00" $354.05 "$1,814.15" $802.72 $802.72 $802.72 $802.72 "$1,783.83" "$1,783.83" "$1,783.83" $371.79 "$1,783.83" "$1,783.83" "$1,783.83" "$1,783.83" "$1,783.83" $371.77 "$1,783.83" $725.66 "$1,055.14" "$1,783.83" "$1,814.15" "$1,783.83" "$1,783.83" "$1,338.00" "$1,783.83" "$1,783.83" "$1,783.83" $891.92 $891.92 "$1,412.79" "$1,783.83" "$1,427.06" $802.72 $354.05 N/A "$1,034.72" "$1,783.83" "$1,783.83" "$1,783.83" $371.75 "$1,783.83" N/A N/A 04.161.284S SUP HCPCS C1713 04.161.284S - PLATE BONE CURVE BROAD 24 HOLE LCP TITANIUM PEDIATRIC SPN BOTH IP/OP "$1,784.00" "$1,320.00" $354.05 "$1,814.15" $802.72 $802.72 $802.72 $802.72 "$1,783.83" "$1,783.83" "$1,783.83" $371.79 "$1,783.83" "$1,783.83" "$1,783.83" "$1,783.83" "$1,783.83" $371.77 "$1,783.83" $725.66 "$1,055.14" "$1,783.83" "$1,814.15" "$1,783.83" "$1,783.83" "$1,338.00" "$1,783.83" "$1,783.83" "$1,783.83" $891.92 $891.92 "$1,412.79" "$1,783.83" "$1,427.06" $802.72 $354.05 N/A "$1,034.72" "$1,783.83" "$1,070.30" "$1,783.83" $371.75 "$1,783.83" N/A N/A 04.161.286S SUP HCPCS C1713 04.161.286S - PLATE BONE 26 HOLE CVD LCP TITANIUM PEDIATRIC STERILE 3.5 MM BOTH IP/OP "$1,886.50" "$1,396.00" $374.41 "$1,918.53" $848.90 $848.90 $848.90 $848.90 "$1,886.45" "$1,886.45" "$1,886.45" $393.18 "$1,886.45" "$1,886.45" "$1,886.45" "$1,886.45" "$1,886.45" $393.16 "$1,886.45" $767.41 "$1,115.84" "$1,886.45" "$1,918.53" "$1,886.45" "$1,886.45" "$1,414.88" "$1,886.45" "$1,886.45" "$1,886.45" $943.23 $943.23 "$1,494.07" "$1,886.45" "$1,509.16" $848.90 $374.41 N/A "$1,094.17" "$1,886.45" "$1,886.45" "$1,886.45" "$1,886.45" "$1,886.45" N/A N/A 04.161.288S SUP HCPCS C1713 04.161.288S - PLATE BONE 28 HOLE CVD LCP TITANIUM PEDIATRIC STERILE 3.5 MM BOTH IP/OP "$2,065.00" "$1,528.00" $409.84 "$2,100.05" $929.23 $929.23 $929.23 $929.23 "$2,064.95" "$2,064.95" "$2,064.95" $430.39 "$2,064.95" "$2,064.95" "$2,064.95" "$2,064.95" "$2,064.95" $430.36 "$2,064.95" "$2,100.05" "$1,221.42" "$2,064.95" "$2,100.05" "$2,064.95" "$2,064.95" "$1,548.75" "$2,064.95" "$2,064.95" "$2,064.95" "$1,032.48" "$1,032.48" "$1,635.44" "$2,064.95" "$1,651.96" $929.23 $409.84 N/A "$1,197.70" "$2,064.95" "$1,238.97" "$2,064.95" $430.34 "$2,064.95" N/A N/A 04.161.290S SUP HCPCS C1713 04.161.290S - PLATE BONE 30 HOLE CVD LCP TITANIUM PEDIATRIC STERILE 3.5 MM BOTH IP/OP "$2,245.00" "$1,661.00" $445.56 "$2,283.08" "$1,010.21" "$1,010.21" "$1,010.21" "$1,010.21" "$2,244.90" "$2,244.90" "$2,244.90" $467.89 "$2,244.90" "$2,244.90" "$2,244.90" "$2,244.90" "$2,244.90" $467.86 "$2,244.90" "$2,283.08" "$1,327.86" "$2,244.90" "$2,283.08" "$2,244.90" "$2,244.90" "$1,683.75" "$2,244.90" "$2,244.90" "$2,244.90" "$1,122.45" "$1,122.45" "$1,777.96" "$2,244.90" "$1,795.92" "$1,010.21" $445.56 N/A "$1,302.10" "$2,244.90" "$1,346.94" "$2,244.90" $467.84 "$2,244.90" N/A N/A 04.200.010 SUP HCPCS C1713 04.200.010 - SCREW BONE FULTHD 3.5MM 10MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 04.200.012 SUP HCPCS C1713 04.200.012 - SCREW BONE FULTHD 3.5MM 12MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 04.200.014 SUP HCPCS C1713 04.200.014 - SCREW BONE FULTHD 3.5MM 14MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 04.200.016 SUP HCPCS C1713 04.200.016 - SCREW BONE FULTHD 3.5MM 16MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 04.200.018 SUP HCPCS C1713 04.200.018 - SCREW BONE FULTHD 3.5MM 18MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 04.200.020 SUP HCPCS C1713 04.200.020 - SCREW BONE FULTHD 3.5MM 20MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 04.200.022 SUP HCPCS C1713 04.200.022 - SCREW BONE FULTHD 3.5MM 22MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 04.200.024 SUP HCPCS C1713 04.200.024 - SCREW BONE FULTHD 3.5MM 25MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 04.200.026 SUP HCPCS C1713 04.200.026 - SCREW BONE FULTHD 3.5MM 26MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 04.200.028 SUP HCPCS C1713 04.200.028 - SCREW BONE FULTHD 3.5MM 28MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 04.200.030 SUP HCPCS C1713 04.200.030 - SCREW BONE FULTHD 3.5MM 30MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 04.200.032 SUP HCPCS C1713 04.200.032 - SCREW BONE FULTHD 3.5MM 32MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 04.200.034 SUP HCPCS C1713 04.200.034 - SCREW BONE FULTHD 3.5MM 34MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 04.200.036 SUP HCPCS C1713 04.200.036 - SCREW BONE FULTHD 3.5MM 36MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 04.200.038 SUP HCPCS C1713 04.200.038 - SCREW BONE FULTHD 3.5MM 38MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 04.200.040 SUP HCPCS C1713 04.200.040 - SCREW BONE FULTHD 3.5MM 40MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 04.200.042 SUP HCPCS C1713 04.200.042 - SCREW BONE FULTHD 3.5MM 42MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $47.43 $47.43 N/A N/A 04.200.044 SUP HCPCS C1713 04.200.044 - SCREW BONE FULTHD 3.5MM 44MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 04.200.045 SUP HCPCS C1713 04.200.045 - SCREW BONE FULTHD 3.5MM 45MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 04.200.046 SUP HCPCS C1713 04.200.046 - SCREW BONE FULTHD 3.5MM 46MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 04.200.048 SUP HCPCS C1713 04.200.048 - SCREW BONE FULTHD 3.5MM 48MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 04.200.050 SUP HCPCS C1713 04.200.050 - SCREW BONE FULTHD 3.5MM 50MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $19.29 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 04.200.055 SUP HCPCS C1713 04.200.055 - SCREW BONE FULTHD 3.5MM 55MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 04.200.060 SUP HCPCS C1713 04.200.060 - SCREW BONE FULTHD 3.5MM 60MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $47.50 $35.00 $9.41 $48.23 $21.34 $21.34 $21.34 $21.34 $47.43 $47.43 $47.43 $9.89 $47.43 $47.43 $47.43 $47.43 $47.43 $9.88 $47.43 $48.23 $28.05 $47.43 $48.23 $47.43 $47.43 $35.63 $47.43 $47.43 $47.43 $23.72 $23.72 $37.56 $47.43 $37.94 $21.34 $9.41 N/A $27.55 $47.43 $47.43 $47.43 $9.88 $47.43 N/A N/A 04.204.014 SUP HCPCS C1713 04.204.014 - SCREW BONE 4MM 14MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 04.204.016 SUP HCPCS C1713 04.204.016 - SCREW BONE 4MM 16MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 04.204.018 SUP HCPCS C1713 04.204.018 - SCREW BONE 4MM 18MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 04.204.020 SUP HCPCS C1713 04.204.020 - SCREW BONE 4MM 20MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $254.40 $254.40 N/A N/A 04.204.022 SUP HCPCS C1713 04.204.022 - SCREW BONE 4MM 22MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $254.40 $254.40 N/A N/A 04.204.024 SUP HCPCS C1713 04.204.024 - SCREW BONE 4MM 24MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $254.40 $254.40 N/A N/A 04.204.026 SUP HCPCS C1713 04.204.026 - SCREW BONE 4MM 26MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 04.204.028 SUP HCPCS C1713 04.204.028 - SCREW BONE 4MM 28MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $254.40 $254.40 N/A N/A 04.204.030 SUP HCPCS C1713 04.204.030 - SCREW BONE 4MM 30MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $254.40 $254.40 N/A N/A 04.204.032 SUP HCPCS C1713 04.204.032 - SCREW BONE 4MM 32MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 04.204.034 SUP HCPCS C1713 04.204.034 - SCREW BONE 4MM 34MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 04.204.036 SUP HCPCS C1713 04.204.036 - SCREW BONE 4MM 36MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 04.204.038 SUP HCPCS C1713 04.204.038 - SCREW BONE 4MM 38MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $101.76 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 04.204.040 SUP HCPCS C1713 04.204.040 - SCREW BONE 4MM 40MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $101.76 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 04.204.042 SUP HCPCS C1713 04.204.042 - SCREW BONE 4MM 42MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $101.76 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $254.40 $254.40 N/A N/A 04.204.044 SUP HCPCS C1713 04.204.044 - SCREW BONE 4MM 44MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $101.76 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $254.40 $254.40 N/A N/A 04.204.046 SUP HCPCS C1713 04.204.046 - SCREW BONE 4MM 46MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $101.76 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $254.40 $254.40 N/A N/A 04.204.048 SUP HCPCS C1713 04.204.048 - SCREW BONE 4MM 48MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $101.76 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $254.40 $254.40 N/A N/A 04.204.050 SUP HCPCS C1713 04.204.050 - SCREW BONE 4MM 50MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $101.76 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 04.204.052 SUP HCPCS C1713 04.204.052 - SCREW BONE 4MM 52MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $101.76 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $254.40 $254.40 N/A N/A 04.204.054 SUP HCPCS C1713 04.204.054 - SCREW BONE 4MM 54MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $254.40 $254.40 N/A N/A 04.204.056 SUP HCPCS C1713 04.204.056 - SCREW BONE 4MM 56MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 04.204.058 SUP HCPCS C1713 04.204.058 - SCREW BONE 4MM 58MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $101.76 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $53.02 $254.40 N/A N/A 04.204.060 SUP HCPCS C1713 04.204.060 - SCREW BONE 4MM 60MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $101.76 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $254.40 $254.40 N/A N/A 04.204.062 SUP HCPCS C1713 04.204.062 - SCREW BONE 4MM 62MM SLFTAP LOCKING STARDRIVE RECESS LCP BOTH IP/OP $254.50 $188.00 $50.49 $254.40 $114.48 $114.48 $114.48 $114.48 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $254.40 $254.40 $254.40 $53.02 $254.40 $254.40 $150.48 $254.40 $254.40 $254.40 $254.40 $190.88 $254.40 $254.40 $254.40 $127.20 $127.20 $201.48 $254.40 $203.52 $114.48 $50.49 N/A $147.61 $254.40 $254.40 $254.40 $254.40 $254.40 N/A N/A 04.205.025 SUP HCPCS C1713 04.205.025 - SCREW BONE 5MM 25MM LOCK CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 04.205.030 SUP HCPCS C1713 04.205.030 - SCREW BONE 5MM 30MM LOCK CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $368.30 $368.30 N/A N/A 04.205.035 SUP HCPCS C1713 04.205.035 - SCREW BONE 5MM 35MM LOCK CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $149.82 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $368.30 $368.30 N/A N/A 04.205.040 SUP HCPCS C1713 04.205.040 - SCREW BONE 5MM 40MM LOCK CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 04.205.045 SUP HCPCS C1713 04.205.045 - SCREW BONE 5MM 45MM LOCK CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 04.205.050 SUP HCPCS C1713 04.205.050 - SCREW BONE 5MM 50MM LOCK CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 04.205.055 SUP HCPCS C1713 04.205.055 - SCREW BONE 5MM 55MM LOCK CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 04.205.060 SUP HCPCS C1713 04.205.060 - SCREW BONE 5MM 60MM LOCK CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 04.205.065 SUP HCPCS C1713 04.205.065 - SCREW BONE 5MM 65MM CANN SELF DRILL LOCK THREAD CONICAL HEAD BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 04.205.070 SUP HCPCS C1713 04.205.070 - SCREW BONE 5MM 70MM LOCK CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 04.205.075 SUP HCPCS C1713 04.205.075 - SCREW BONE 5MM 75MM CANN SELF DRILL LOCK THREAD CONICAL HEAD BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 04.205.080 SUP HCPCS C1713 04.205.080 - SCREW BONE 5MM 80MM CANN SELF DRILL LOCK THREAD CONICAL HEAD BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 04.205.085 SUP HCPCS C1713 04.205.085 - SCREW BONE 5MM 85MM LOCK CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 04.205.090 SUP HCPCS C1713 04.205.090 - SCREW BONE 5MM 90MM LOCK CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 04.205.095 SUP HCPCS C1713 04.205.095 - SCREW BONE 5MM 95MM LOCK CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $368.50 $273.00 $73.10 $374.55 $165.74 $165.74 $165.74 $165.74 $368.30 $368.30 $368.30 $76.76 $368.30 $368.30 $368.30 $368.30 $368.30 $76.76 $368.30 $374.55 $217.85 $368.30 $374.55 $368.30 $368.30 $276.38 $368.30 $368.30 $368.30 $184.15 $184.15 $291.69 $368.30 $294.64 $165.74 $73.10 N/A $213.73 $368.30 $368.30 $368.30 $76.75 $368.30 N/A N/A 04.205.240 SUP HCPCS C1713 04.205.240 - SCREW BONE CONE 5MM 40MM CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 04.205.245 SUP HCPCS C1713 04.205.245 - SCREW BONE CONE 5MM 45MM CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 04.205.250 SUP HCPCS C1713 04.205.250 - SCREW BONE CONE 5MM 50MM CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 04.205.255 SUP HCPCS C1713 04.205.255 - SCREW BONE CONE 5MM 55MM CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 04.205.260 SUP HCPCS C1713 04.205.260 - SCREW BONE CONE 5MM 60MM CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $326.13 $326.13 N/A N/A 04.205.265 SUP HCPCS C1713 04.205.265 - SCREW BONE CONE 5MM 65MM CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $326.13 $326.13 N/A N/A 04.205.270 SUP HCPCS C1713 04.205.270 - SCREW BONE CONE 5MM 70MM CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 04.205.275 SUP HCPCS C1713 04.205.275 - SCREW BONE CONE 5MM 75MM CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 04.205.280 SUP HCPCS C1713 04.205.280 - SCREW BONE CONE 5MM 80MM CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 04.205.285 SUP HCPCS C1713 04.205.285 - SCREW BONE CONE 5MM 85MM CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 04.205.290 SUP HCPCS C1713 04.205.290 - SCREW BONE CONE 5MM 90MM CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $326.13 $326.13 N/A N/A 04.205.295 SUP HCPCS C1713 04.205.295 - SCREW BONE CONE 5MM 95MM CANN LCP TITANIUM PERIARTICULAR BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $326.13 $326.13 N/A N/A 04.210.078 SUP HCPCS C1713 04.210.078 - PIN FIX 1.8MM 8MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE BOTH IP/OP $254.50 $188.00 $50.50 $258.75 $114.49 $114.49 $114.49 $114.49 $254.43 $254.43 $254.43 $53.03 $254.43 $254.43 $254.43 $254.43 $254.43 $53.03 $254.43 $258.75 $150.50 $254.43 $258.75 $254.43 $254.43 $190.88 $254.43 $254.43 $254.43 $127.22 $127.22 $201.51 $254.43 $203.54 $114.49 $50.50 N/A $147.61 $254.43 $152.66 $254.43 $53.02 $254.43 N/A N/A 04.210.080 SUP HCPCS C1713 04.210.080 - PIN FIX 1.8MM 10MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.082 SUP HCPCS C1713 04.210.082 - PIN FIX 1.8MM 12MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.084 SUP HCPCS C1713 04.210.084 - PIN FIX 1.8MM 14MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $52.15 $250.23 N/A N/A 04.210.086 SUP HCPCS C1713 04.210.086 - PIN FIX 1.8MM 16MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $250.23 $250.23 N/A N/A 04.210.088 SUP HCPCS C1713 04.210.088 - PIN FIX 1.8MM 18MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $250.23 $250.23 N/A N/A 04.210.090 SUP HCPCS C1713 04.210.090 - PIN FIX 1.8MM 20MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.092 SUP HCPCS C1713 04.210.092 - PIN FIX 1.8MM 22MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.094 SUP HCPCS C1713 04.210.094 - PIN FIX 1.8MM 24MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.096 SUP HCPCS C1713 04.210.096 - PIN FIX 1.8MM 26MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.098 SUP HCPCS C1713 04.210.098 - PIN FIX 1.8MM 28MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $250.23 $250.23 N/A N/A 04.210.100 SUP HCPCS C1713 04.210.100 - PIN FIX 1.8MM 30MM BUTTRESS VAR ANG LOCKING T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $250.23 $250.23 N/A N/A 04.210.107 SUP HCPCS C1713 04.210.107 - SCREW BONE 2.4MM 7MM STARDRIVE LOCKING VAR ANG SLFTAP LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $52.15 $250.23 N/A N/A 04.210.108 SUP HCPCS C1713 04.210.108 - SCREW BONE 2.4MM 8MM T8 STARDRIVE RECESS LOCKING VAR ANG LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.109 SUP HCPCS C1713 04.210.109 - SCREW BONE 2.4MM 9MM STARDRIVE LOCKING VAR ANG SLFTAP LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $52.15 $250.23 N/A N/A 04.210.110 SUP HCPCS C1713 04.210.110 - SCREW BONE 2.4MM 10MM LOCKING VAR ANG STARDRIVE RECESS LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.111 SUP HCPCS C1713 04.210.111 - SCREW BONE 2.4MM 11MM STARDRIVE LOCKING VAR ANG SLFTAP LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.112 SUP HCPCS C1713 04.210.112 - SCREW BONE 2.4MM 12MM LOCKING VAR ANG STARDRIVE RECESS LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $250.23 $250.23 N/A N/A 04.210.113 SUP HCPCS C1713 04.210.113 - SCREW BONE 2.4MM 13MM STARDRIVE LOCKING VAR ANG SLFTAP LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.114 SUP HCPCS C1713 04.210.114 - SCREW BONE T8 2.4MM 14MM VAR ANG LOCK STARDRIVE LCP TITANIUM BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $250.23 $250.23 N/A N/A 04.210.116 SUP HCPCS C1713 04.210.116 - SCREW BONE T8 2.4MM 16MM VAR ANG LOCK STARDRIVE LCP TITANIUM BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.118 SUP HCPCS C1713 04.210.118 - SCREW BONE T8 2.4MM 18MM VAR ANG LOCK STARDRIVE LCP TITANIUM BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.120 SUP HCPCS C1713 04.210.120 - SCREW BONE T8 2.4MM 20MM VAR ANG LOCK STARDRIVE LCP TITANIUM BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.122 SUP HCPCS C1713 04.210.122 - SCREW BONE T8 2.4MM 22MM VAR ANG LOCK STARDRIVE LCP TITANIUM BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.124 SUP HCPCS C1713 04.210.124 - SCREW BONE T8 2.4MM 24MM VAR ANG LOCK STARDRIVE LCP TITANIUM BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $250.23 $250.23 N/A N/A 04.210.126 SUP HCPCS C1713 04.210.126 - SCREW BONE 2.4MM 26MM LOCKING VAR ANG STARDRIVE RECESS LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.128 SUP HCPCS C1713 04.210.128 - SCREW BONE 2.4MM 28MM LOCKING STARDRIVE RECESS VAR ANG LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.130 SUP HCPCS C1713 04.210.130 - SCREW BONE 2.4MM 30MM LOCKING STARDRIVE RECESS VAR ANG LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $250.23 $250.23 N/A N/A 04.210.132 SUP HCPCS C1713 04.210.132 - SCREW BONE 2.4MM 32MM LOCKING VAR ANG STARDRIVE RECESS LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $250.23 $250.23 N/A N/A 04.210.134 SUP HCPCS C1713 04.210.134 - SCREW BONE 2.4MM 34MM STARDRIVE LOCKING VAR ANG SLFTAP LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $250.23 $250.23 N/A N/A 04.210.136 SUP HCPCS C1713 04.210.136 - SCREW BONE 2.4MM 36MM STARDRIVE LOCKING VAR ANG SLFTAP LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $52.15 $250.23 N/A N/A 04.210.138 SUP HCPCS C1713 04.210.138 - SCREW BONE 2.4MM 38MM STARDRIVE LOCKING VAR ANG SLFTAP LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $52.15 $250.23 N/A N/A 04.210.140 SUP HCPCS C1713 04.210.140 - SCREW BONE 2.4MM 40MM STARDRIVE LOCKING VAR ANG SLFTAP LCP BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $101.79 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $52.15 $250.23 N/A N/A 04.210.142 SUP HCPCS C1713 04.210.142 - SCREW BONE 2.4MM 42MM LOCKING VAR ANG SLFTAP T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $52.15 $250.23 N/A N/A 04.210.144 SUP HCPCS C1713 04.210.144 - SCREW BONE 2.4MM 44MM LOCKING VAR ANG SLFTAP T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $52.15 $250.23 N/A N/A 04.210.146 SUP HCPCS C1713 04.210.146 - SCREW BONE 2.4MM 46MM LOCKING VAR ANG SLFTAP T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $250.23 $250.23 N/A N/A 04.210.148 SUP HCPCS C1713 04.210.148 - SCREW BONE 2.4MM 48MM LOCKING VAR ANG SLFTAP T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $52.15 $250.23 N/A N/A 04.210.150 SUP HCPCS C1713 04.210.150 - SCREW BONE 2.4MM 50MM LOCKING VAR ANG SLFTAP T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.152 SUP HCPCS C1713 04.210.152 - SCREW BONE 2.4MM 52MM LOCKING VAR ANG SLFTAP T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $52.15 $250.23 N/A N/A 04.210.154 SUP HCPCS C1713 04.210.154 - SCREW BONE 2.4MM 54MM LOCKING VAR ANG SLFTAP T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $52.15 $250.23 N/A N/A 04.210.156 SUP HCPCS C1713 04.210.156 - SCREW BONE 2.4MM 56MM LOCKING VAR ANG SLFTAP T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $250.23 $250.23 $52.15 $250.23 N/A N/A 04.210.158 SUP HCPCS C1713 04.210.158 - SCREW BONE 2.4MM 58MM LOCKING VAR ANG SLFTAP T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $52.15 $250.23 N/A N/A 04.210.160 SUP HCPCS C1713 04.210.160 - SCREW BONE 2.4MM 60MM LOCKING VAR ANG SLFTAP T8 STARDRIVE BOTH IP/OP $250.50 $185.00 $49.66 $254.48 $112.60 $112.60 $112.60 $112.60 $250.23 $250.23 $250.23 $52.15 $250.23 $250.23 $250.23 $250.23 $250.23 $52.15 $250.23 $254.48 $148.01 $250.23 $254.48 $250.23 $250.23 $187.88 $250.23 $250.23 $250.23 $125.12 $125.12 $198.18 $250.23 $200.18 $112.60 $49.66 N/A $145.29 $250.23 $150.14 $250.23 $52.15 $250.23 N/A N/A 04.210.942 SUP HCPCS C1713 04.210.942 - SCREW BONE 2.4MM 42MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP BOTH IP/OP $93.50 $69.00 $18.55 $95.08 $42.07 $42.07 $42.07 $42.07 $93.48 $93.48 $93.48 $19.48 $93.48 $93.48 $93.48 $93.48 $93.48 $19.48 $93.48 $38.03 $55.29 $93.48 $95.08 $93.48 $93.48 $70.13 $93.48 $93.48 $93.48 $46.74 $46.74 $74.04 $93.48 $74.78 $42.07 $18.55 N/A $54.23 $93.48 $56.09 $93.48 $19.48 $93.48 N/A N/A 04.210.944 SUP HCPCS C1713 04.210.944 - SCREW BONE 2.4MM 44MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP BOTH IP/OP $93.50 $69.00 $18.55 $95.08 $42.07 $42.07 $42.07 $42.07 $93.48 $93.48 $93.48 $19.48 $93.48 $93.48 $93.48 $93.48 $93.48 $19.48 $93.48 $38.03 $55.29 $93.48 $95.08 $93.48 $93.48 $70.13 $93.48 $93.48 $93.48 $46.74 $46.74 $74.04 $93.48 $74.78 $42.07 $18.55 N/A $54.23 $93.48 $93.48 $93.48 $19.48 $93.48 N/A N/A 04.210.946 SUP HCPCS C1713 04.210.946 - SCREW BONE 2.4MM 46MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP BOTH IP/OP $93.50 $69.00 $18.55 $95.08 $42.07 $42.07 $42.07 $42.07 $93.48 $93.48 $93.48 $19.48 $93.48 $93.48 $93.48 $93.48 $93.48 $19.48 $93.48 $38.03 $55.29 $93.48 $95.08 $93.48 $93.48 $70.13 $93.48 $93.48 $93.48 $46.74 $46.74 $74.04 $93.48 $74.78 $42.07 $18.55 N/A $54.23 $93.48 $56.09 $93.48 $93.48 $93.48 N/A N/A 04.210.948 SUP HCPCS C1713 04.210.948 - SCREW BONE 2.4MM 48MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP BOTH IP/OP $93.50 $69.00 $18.55 $95.08 $42.07 $42.07 $42.07 $42.07 $93.48 $93.48 $93.48 $19.48 $93.48 $93.48 $93.48 $93.48 $93.48 $19.48 $93.48 $95.08 $55.29 $93.48 $95.08 $93.48 $93.48 $70.13 $93.48 $93.48 $93.48 $46.74 $46.74 $74.04 $93.48 $74.78 $42.07 $18.55 N/A $54.23 $93.48 $56.09 $93.48 $93.48 $93.48 N/A N/A 04.210.950 SUP HCPCS C1713 04.210.950 - SCREW BONE 2.4MM 50MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP BOTH IP/OP $93.50 $69.00 $18.55 $95.08 $42.07 $42.07 $42.07 $42.07 $93.48 $93.48 $93.48 $19.48 $93.48 $93.48 $93.48 $93.48 $93.48 $19.48 $93.48 $95.08 $55.29 $93.48 $95.08 $93.48 $93.48 $70.13 $93.48 $93.48 $93.48 $46.74 $46.74 $74.04 $93.48 $74.78 $42.07 $18.55 N/A $54.23 $93.48 $56.09 $93.48 $19.48 $93.48 N/A N/A 04.210.952 SUP HCPCS C1713 04.210.952 - SCREW BONE 2.4MM 52MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP BOTH IP/OP $93.50 $69.00 $18.55 $95.08 $42.07 $42.07 $42.07 $42.07 $93.48 $93.48 $93.48 $19.48 $93.48 $93.48 $93.48 $93.48 $93.48 $19.48 $93.48 $38.03 $55.29 $93.48 $95.08 $93.48 $93.48 $70.13 $93.48 $93.48 $93.48 $46.74 $46.74 $74.04 $93.48 $74.78 $42.07 $18.55 N/A $54.23 $93.48 $93.48 $93.48 $19.48 $93.48 N/A N/A 04.210.954 SUP HCPCS C1713 04.210.954 - SCREW BONE 2.4MM 54MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP BOTH IP/OP $93.50 $69.00 $18.55 $95.08 $42.07 $42.07 $42.07 $42.07 $93.48 $93.48 $93.48 $19.48 $93.48 $93.48 $93.48 $93.48 $93.48 $19.48 $93.48 $38.03 $55.29 $93.48 $95.08 $93.48 $93.48 $70.13 $93.48 $93.48 $93.48 $46.74 $46.74 $74.04 $93.48 $74.78 $42.07 $18.55 N/A $54.23 $93.48 $56.09 $93.48 $19.48 $93.48 N/A N/A 04.210.956 SUP HCPCS C1713 04.210.956 - SCREW BONE 2.4MM 56MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP BOTH IP/OP $93.50 $69.00 $18.55 $95.08 $42.07 $42.07 $42.07 $42.07 $93.48 $93.48 $93.48 $19.48 $93.48 $93.48 $93.48 $93.48 $93.48 $19.48 $93.48 $95.08 $55.29 $93.48 $95.08 $93.48 $93.48 $70.13 $93.48 $93.48 $93.48 $46.74 $46.74 $74.04 $93.48 $74.78 $42.07 $18.55 N/A $54.23 $93.48 $56.09 $93.48 $19.48 $93.48 N/A N/A 04.210.958 SUP HCPCS C1713 04.210.958 - SCREW BONE 2.4MM 58MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP BOTH IP/OP $93.50 $69.00 $18.55 $95.08 $42.07 $42.07 $42.07 $42.07 $93.48 $93.48 $93.48 $19.48 $93.48 $93.48 $93.48 $93.48 $93.48 $19.48 $93.48 $95.08 $55.29 $93.48 $95.08 $93.48 $93.48 $70.13 $93.48 $93.48 $93.48 $46.74 $46.74 $74.04 $93.48 $74.78 $42.07 $18.55 N/A $54.23 $93.48 $56.09 $93.48 $19.48 $93.48 N/A N/A 04.210.960 SUP HCPCS C1713 04.210.960 - SCREW BONE 2.4MM 60MM T8 STARDRIVE RECESS VAR ANG SLFTAP LCP BOTH IP/OP $93.50 $69.00 $18.55 $95.08 $42.07 $42.07 $42.07 $42.07 $93.48 $93.48 $93.48 $19.48 $93.48 $93.48 $93.48 $93.48 $93.48 $19.48 $93.48 $95.08 $55.29 $93.48 $95.08 $93.48 $93.48 $70.13 $93.48 $93.48 $93.48 $46.74 $46.74 $74.04 $93.48 $74.78 $42.07 $18.55 N/A $54.23 $93.48 $56.09 $93.48 $19.48 $93.48 N/A N/A 04.211.008 SUP HCPCS C1713 04.211.008 - SCREW BONE 2.7MM 8MM T8 STARDRIVE RECESS VAR ANG SLFTAP BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $257.33 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.009 SUP HCPCS C1713 04.211.009 - SCREW BONE 2.7MM 9MM T8 STARDRIVE RECESS VAR ANG SLFTAP BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $253.03 $253.03 N/A N/A 04.211.010 SUP HCPCS C1713 04.211.010 - SCREW BONE 2.7MM 10MM LOCKING VAR ANG SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.011 SUP HCPCS C1713 04.211.011 - SCREW BONE 2.7MM 11MM T8 STARDRIVE RECESS VAR ANG SLFTAP BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $257.33 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $151.82 $253.03 $52.73 $253.03 N/A N/A 04.211.012 SUP HCPCS C1713 04.211.012 - SCREW BONE 2.7MM 12MM LOCKING VAR ANG SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $257.33 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $151.82 $253.03 $52.73 $253.03 N/A N/A 04.211.013 SUP HCPCS C1713 04.211.013 - SCREW BONE 2.7MM 13MM T8 STARDRIVE RECESS VAR ANG SLFTAP BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $257.33 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $151.82 $253.03 $52.73 $253.03 N/A N/A 04.211.014 SUP HCPCS C1713 04.211.014 - SCREW BONE 2.7MM 14MM T8 STARDRIVE RECESS SLFTAP LOCKING VAR BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $257.33 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $151.82 $253.03 $52.73 $253.03 N/A N/A 04.211.016 SUP HCPCS C1713 04.211.016 - SCREW BONE 2.7MM 16MM LOCKING VAR ANG SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $151.82 $253.03 $52.73 $253.03 N/A N/A 04.211.018 SUP HCPCS C1713 04.211.018 - SCREW BONE T8 2.7MM 18MM VAR ANG SELF TAP LOCK STARDRIVE LCP BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.020 SUP HCPCS C1713 04.211.020 - SCREW BONE T8 2.7MM 20MM VAR ANG SELF TAP LOCK STARDRIVE LCP BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.022 SUP HCPCS C1713 04.211.022 - SCREW BONE T8 2.7MM 22MM VAR ANG SELF TAP LOCK STARDRIVE LCP BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $257.33 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.024 SUP HCPCS C1713 04.211.024 - SCREW BONE T8 2.7MM 24MM VAR ANG SELF TAP LOCK STARDRIVE LCP BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $257.33 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.026 SUP HCPCS C1713 04.211.026 - SCREW BONE T8 2.7MM 26MM VAR ANG SELF TAP LOCK STARDRIVE LCP BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.028 SUP HCPCS C1713 04.211.028 - SCREW BONE T8 2.7MM 28MM VAR ANG SELF TAP LOCK STARDRIVE LCP BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.030 SUP HCPCS C1713 04.211.030 - SCREW BONE 2.7MM 30MM VAR ANG LOCKING SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.032 SUP HCPCS C1713 04.211.032 - SCREW BONE 2.7MM 32MM VAR ANG LOCKING SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $257.33 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.034 SUP HCPCS C1713 04.211.034 - SCREW BONE 2.7MM 34MM VAR ANG LOCKING SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $257.33 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.036 SUP HCPCS C1713 04.211.036 - SCREW BONE 2.7MM 36MM VAR ANG LOCKING SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.038 SUP HCPCS C1713 04.211.038 - SCREW BONE 2.7MM 38MM VAR ANG LOCKING SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $257.33 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.040 SUP HCPCS C1713 04.211.040 - SCREW BONE 2.7MM 40MM VAR ANG LOCKING SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $253.03 $253.03 N/A N/A 04.211.042 SUP HCPCS C1713 04.211.042 - SCREW BONE 2.7MM 42MM VAR ANG LOCKING SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $257.33 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $151.82 $253.03 $253.03 $253.03 N/A N/A 04.211.044 SUP HCPCS C1713 04.211.044 - SCREW BONE 2.7MM 44MM VAR ANG LOCKING SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $151.82 $253.03 $52.73 $253.03 N/A N/A 04.211.046 SUP HCPCS C1713 04.211.046 - SCREW BONE 2.7MM 46MM VAR ANG LOCKING SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $151.82 $253.03 $52.73 $253.03 N/A N/A 04.211.048 SUP HCPCS C1713 04.211.048 - SCREW BONE 2.7MM 48MM VAR ANG LOCKING SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $151.82 $253.03 $52.73 $253.03 N/A N/A 04.211.050 SUP HCPCS C1713 04.211.050 - SCREW BONE 2.7MM 50MM VAR ANG LOCKING SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.052 SUP HCPCS C1713 04.211.052 - SCREW BONE 2.7MM 52MM VAR ANG LOCKING SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.054 SUP HCPCS C1713 04.211.054 - SCREW BONE 2.7MM 54MM VAR ANG LOCKING SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $257.33 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $151.82 $253.03 $52.73 $253.03 N/A N/A 04.211.056 SUP HCPCS C1713 04.211.056 - SCREW BONE 2.7MM 56MM VAR ANG LOCKING SLFTAP T8 STARDRIVE BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $257.33 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.058 SUP HCPCS C1713 04.211.058 - SCREW BONE 2.4MM 58MM LOCKING T8 STARDRIVE RECESS VAR ANG BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $257.33 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.060 SUP HCPCS C1713 04.211.060 - SCREW BONE 2.4MM 60MM LOCKING T8 STARDRIVE RECESS VAR ANG BOTH IP/OP $253.50 $188.00 $50.22 $257.33 $113.86 $113.86 $113.86 $113.86 $253.03 $253.03 $253.03 $52.74 $253.03 $253.03 $253.03 $253.03 $253.03 $52.73 $253.03 $102.93 $149.67 $253.03 $257.33 $253.03 $253.03 $190.13 $253.03 $253.03 $253.03 $126.52 $126.52 $200.40 $253.03 $202.42 $113.86 $50.22 N/A $147.03 $253.03 $253.03 $253.03 $52.73 $253.03 N/A N/A 04.211.201 SUP HCPCS C1713 04.211.201 - PLATE BONE XS 24MM VAR ANG LOCKING X LCP TITANIUM FRFT MIDFT BOTH IP/OP "$1,822.00" "$1,348.00" $361.58 "$1,852.75" $819.80 $819.80 $819.80 $819.80 "$1,821.78" "$1,821.78" "$1,821.78" $379.70 "$1,821.78" "$1,821.78" "$1,821.78" "$1,821.78" "$1,821.78" $379.68 "$1,821.78" $741.10 "$1,077.58" "$1,821.78" "$1,852.75" "$1,821.78" "$1,821.78" "$1,366.50" "$1,821.78" "$1,821.78" "$1,821.78" $910.89 $910.89 "$1,442.85" "$1,821.78" "$1,457.42" $819.80 $361.58 N/A "$1,056.76" "$1,821.78" "$1,821.78" "$1,821.78" $379.66 "$1,821.78" N/A N/A 04.211.202 SUP HCPCS C1713 04.211.202 - PLATE BONE SMALL 27MM VAR ANG LOCKING X LCP TITANIUM FRFT BOTH IP/OP "$1,822.00" "$1,348.00" $361.58 "$1,852.75" $819.80 $819.80 $819.80 $819.80 "$1,821.78" "$1,821.78" "$1,821.78" $379.70 "$1,821.78" "$1,821.78" "$1,821.78" "$1,821.78" "$1,821.78" $379.68 "$1,821.78" $741.10 "$1,077.58" "$1,821.78" "$1,852.75" "$1,821.78" "$1,821.78" "$1,366.50" "$1,821.78" "$1,821.78" "$1,821.78" $910.89 $910.89 "$1,442.85" "$1,821.78" "$1,457.42" $819.80 $361.58 N/A "$1,056.76" "$1,821.78" "$1,821.78" "$1,821.78" $379.66 "$1,821.78" N/A N/A 04.211.203 SUP HCPCS C1713 04.211.203 - PLATE BONE MEDIUM 32MM VAR ANG LOCKING X LCP TITANIUM FRFT BOTH IP/OP "$1,822.00" "$1,348.00" $361.58 "$1,852.75" $819.80 $819.80 $819.80 $819.80 "$1,821.78" "$1,821.78" "$1,821.78" $379.70 "$1,821.78" "$1,821.78" "$1,821.78" "$1,821.78" "$1,821.78" $379.68 "$1,821.78" "$1,852.75" "$1,077.58" "$1,821.78" "$1,852.75" "$1,821.78" "$1,821.78" "$1,366.50" "$1,821.78" "$1,821.78" "$1,821.78" $910.89 $910.89 "$1,442.85" "$1,821.78" "$1,457.42" $819.80 $361.58 N/A "$1,056.76" "$1,821.78" "$1,821.78" "$1,821.78" $379.66 "$1,821.78" N/A N/A 04.211.204 SUP HCPCS C1713 04.211.204 - PLATE BN LG X 36MM NS LCP VA LCK LOPRFL CMPR WRE HL TI BOTH IP/OP "$1,822.00" "$1,348.00" $361.58 "$1,852.75" $819.80 $819.80 $819.80 $819.80 "$1,821.78" "$1,821.78" "$1,821.78" $379.70 "$1,821.78" "$1,821.78" "$1,821.78" "$1,821.78" "$1,821.78" $379.68 "$1,821.78" $741.10 "$1,077.58" "$1,821.78" "$1,852.75" "$1,821.78" "$1,821.78" "$1,366.50" "$1,821.78" "$1,821.78" "$1,821.78" $910.89 $910.89 "$1,442.85" "$1,821.78" "$1,457.42" $819.80 $361.58 N/A "$1,056.76" "$1,821.78" "$1,821.78" "$1,821.78" $379.66 "$1,821.78" N/A N/A 04.211.210 SUP HCPCS C1713 04.211.210 - PLATE BONE 0MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT BOTH IP/OP "$1,778.50" "$1,316.00" $352.93 "$1,808.43" $800.19 $800.19 $800.19 $800.19 "$1,778.20" "$1,778.20" "$1,778.20" $370.62 "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" $370.60 "$1,778.20" $723.37 "$1,051.81" "$1,778.20" "$1,808.43" "$1,778.20" "$1,778.20" "$1,333.88" "$1,778.20" "$1,778.20" "$1,778.20" $889.10 $889.10 "$1,408.33" "$1,778.20" "$1,422.56" $800.19 $352.93 N/A "$1,031.53" "$1,778.20" "$1,778.20" "$1,778.20" $370.58 "$1,778.20" N/A N/A 04.211.211 SUP HCPCS C1713 04.211.211 - PLATE BONE 3MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT BOTH IP/OP "$1,778.50" "$1,316.00" $352.93 "$1,808.43" $800.19 $800.19 $800.19 $800.19 "$1,778.20" "$1,778.20" "$1,778.20" $370.62 "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" $370.60 "$1,778.20" $723.37 "$1,051.81" "$1,778.20" "$1,808.43" "$1,778.20" "$1,778.20" "$1,333.88" "$1,778.20" "$1,778.20" "$1,778.20" $889.10 $889.10 "$1,408.33" "$1,778.20" "$1,422.56" $800.19 $352.93 N/A "$1,031.53" "$1,778.20" "$1,778.20" "$1,778.20" $370.58 "$1,778.20" N/A N/A 04.211.212 SUP HCPCS C1713 04.211.212 - PLATE BONE 4MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT BOTH IP/OP "$1,778.50" "$1,316.00" $352.93 "$1,808.43" $800.19 $800.19 $800.19 $800.19 "$1,778.20" "$1,778.20" "$1,778.20" $370.62 "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" $370.60 "$1,778.20" $723.37 "$1,051.81" "$1,778.20" "$1,808.43" "$1,778.20" "$1,778.20" "$1,333.88" "$1,778.20" "$1,778.20" "$1,778.20" $889.10 $889.10 "$1,408.33" "$1,778.20" "$1,422.56" $800.19 $352.93 N/A "$1,031.53" "$1,778.20" "$1,778.20" "$1,778.20" $370.58 "$1,778.20" N/A N/A 04.211.213 SUP HCPCS C1713 04.211.213 - PLATE BONE 5MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT BOTH IP/OP "$1,730.50" "$1,281.00" $343.44 "$1,759.83" $778.68 $778.68 $778.68 $778.68 "$1,730.40" "$1,730.40" "$1,730.40" $360.66 "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" "$1,730.40" $360.63 "$1,730.40" $703.93 "$1,023.53" "$1,730.40" "$1,759.83" "$1,730.40" "$1,730.40" "$1,297.88" "$1,730.40" "$1,730.40" "$1,730.40" $865.20 $865.20 "$1,370.48" "$1,730.40" "$1,384.32" $778.68 $343.44 N/A "$1,003.69" "$1,730.40" "$1,730.40" "$1,730.40" $360.62 "$1,730.40" N/A N/A 04.211.214 SUP HCPCS C1713 04.211.214 - PLATE BONE 6MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT BOTH IP/OP "$1,778.50" "$1,316.00" $352.93 "$1,808.43" $800.19 $800.19 $800.19 $800.19 "$1,778.20" "$1,778.20" "$1,778.20" $370.62 "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" $370.60 "$1,778.20" $723.37 "$1,051.81" "$1,778.20" "$1,808.43" "$1,778.20" "$1,778.20" "$1,333.88" "$1,778.20" "$1,778.20" "$1,778.20" $889.10 $889.10 "$1,408.33" "$1,778.20" "$1,422.56" $800.19 $352.93 N/A "$1,031.53" "$1,778.20" "$1,778.20" "$1,778.20" $370.58 "$1,778.20" N/A N/A 04.211.215 SUP HCPCS C1713 04.211.215 - PLATE BONE 7MM SPACER VAR ANG LOCKING LCP TITANIUM FRFT BOTH IP/OP "$1,778.50" "$1,316.00" $352.93 "$1,808.43" $800.19 $800.19 $800.19 $800.19 "$1,778.20" "$1,778.20" "$1,778.20" $370.62 "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" "$1,778.20" $370.60 "$1,778.20" $723.37 "$1,051.81" "$1,778.20" "$1,808.43" "$1,778.20" "$1,778.20" "$1,333.88" "$1,778.20" "$1,778.20" "$1,778.20" $889.10 $889.10 "$1,408.33" "$1,778.20" "$1,422.56" $800.19 $352.93 N/A "$1,031.53" "$1,778.20" "$1,778.20" "$1,778.20" $370.58 "$1,778.20" N/A N/A 04.211.220 SUP HCPCS C1713 04.211.220 - PLATE BONE VAR ANG LOCKING LCP TITANIUM NAVICULAR TARSAL BOTH IP/OP "$2,169.00" "$1,605.00" $430.49 "$2,205.85" $976.04 $976.04 $976.04 $976.04 "$2,168.98" "$2,168.98" "$2,168.98" $452.07 "$2,168.98" "$2,168.98" "$2,168.98" "$2,168.98" "$2,168.98" $452.04 "$2,168.98" "$2,205.85" "$1,282.95" "$2,168.98" "$2,205.85" "$2,168.98" "$2,168.98" "$1,626.75" "$2,168.98" "$2,168.98" "$2,168.98" "$1,084.49" "$1,084.49" "$1,717.83" "$2,168.98" "$1,735.18" $976.04 $430.49 N/A "$1,258.02" "$2,168.98" "$2,168.98" "$2,168.98" $452.02 "$2,168.98" N/A N/A 04.211.221 SUP HCPCS C1713 04.211.221 - PLATE BONE VAR ANG LOCKING LCP TITANIUM LEFT CUBOID TARSAL BOTH IP/OP "$2,169.00" "$1,605.00" $430.49 "$2,205.85" $976.04 $976.04 $976.04 $976.04 "$2,168.98" "$2,168.98" "$2,168.98" $452.07 "$2,168.98" "$2,168.98" "$2,168.98" "$2,168.98" "$2,168.98" $452.04 "$2,168.98" $882.34 "$1,282.95" "$2,168.98" "$2,205.85" "$2,168.98" "$2,168.98" "$1,626.75" "$2,168.98" "$2,168.98" "$2,168.98" "$1,084.49" "$1,084.49" "$1,717.83" "$2,168.98" "$1,735.18" $976.04 $430.49 N/A "$1,258.02" "$2,168.98" "$2,168.98" "$2,168.98" $452.02 "$2,168.98" N/A N/A 04.211.222 SUP HCPCS C1713 04.211.222 - PLATE BONE VAR ANG LOCKING LCP TITANIUM RIGHT CUBOID TARSAL BOTH IP/OP "$2,169.00" "$1,605.00" $430.49 "$2,205.85" $976.04 $976.04 $976.04 $976.04 "$2,168.98" "$2,168.98" "$2,168.98" $452.07 "$2,168.98" "$2,168.98" "$2,168.98" "$2,168.98" "$2,168.98" $452.04 "$2,168.98" $882.34 "$1,282.95" "$2,168.98" "$2,205.85" "$2,168.98" "$2,168.98" "$1,626.75" "$2,168.98" "$2,168.98" "$2,168.98" "$1,084.49" "$1,084.49" "$1,717.83" "$2,168.98" "$1,735.18" $976.04 $430.49 N/A "$1,258.02" "$2,168.98" "$2,168.98" "$2,168.98" $452.02 "$2,168.98" N/A N/A 04.211.224 SUP HCPCS C1713 04.211.224 - PLATE BONE 5X12 HOLE MESH VAR ANG LOCKING LCP TITANIUM BOTH IP/OP "$3,055.00" "$2,261.00" $606.26 "$3,106.50" "$1,374.56" "$1,374.56" "$1,374.56" "$1,374.56" "$3,054.58" "$3,054.58" "$3,054.58" $636.65 "$3,054.58" "$3,054.58" "$3,054.58" "$3,054.58" "$3,054.58" $636.61 "$3,054.58" "$1,242.60" "$1,505.91" "$3,054.58" "$3,106.50" "$3,054.58" "$3,054.58" "$2,291.25" "$3,054.58" "$3,054.58" "$3,054.58" "$1,527.29" "$1,527.29" "$2,419.23" "$3,054.58" "$2,443.66" "$1,374.56" $606.26 N/A "$1,771.90" "$3,054.58" "$3,054.58" "$3,054.58" $636.57 "$3,054.58" N/A N/A 04.211.230 SUP HCPCS C1713 04.211.230 - PLATE BN 0D SM 42MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" "$1,887.08" "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,855.53" "$1,855.53" $386.69 "$1,855.53" N/A N/A 04.211.231 SUP HCPCS C1713 04.211.231 - PLATE BONE 0D SMALL 42MM FUSION VAR ANG LCP TITANIUM LEFT BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,855.53" "$1,855.53" $386.69 "$1,855.53" N/A N/A 04.211.232 SUP HCPCS C1713 04.211.232 - PLATE BONE 5D SMALL 42MM FUSION VAR ANG LCP TITANIUM RIGHT BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,855.53" "$1,855.53" $386.69 "$1,855.53" N/A N/A 04.211.233 SUP HCPCS C1713 04.211.233 - PLATE BONE 5D SMALL 42MM FUSION VAR ANG LCP TITANIUM LEFT BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" $754.83 "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,855.53" "$1,855.53" $386.69 "$1,855.53" N/A N/A 04.211.234 SUP HCPCS C1713 04.211.234 - PLATE BONE 10D SMALL 42MM FUSION VAR ANG LCP TITANIUM RIGHT BOTH IP/OP "$1,908.00" "$1,412.00" $378.60 "$1,939.95" $858.39 $858.39 $858.39 $858.39 "$1,907.53" "$1,907.53" "$1,907.53" $397.58 "$1,907.53" "$1,907.53" "$1,907.53" "$1,907.53" "$1,907.53" $397.55 "$1,907.53" "$1,939.95" "$1,128.30" "$1,907.53" "$1,939.95" "$1,907.53" "$1,907.53" "$1,431.00" "$1,907.53" "$1,907.53" "$1,907.53" $953.77 $953.77 "$1,510.76" "$1,907.53" "$1,526.02" $858.39 $378.60 N/A "$1,106.64" "$1,907.53" "$1,907.53" "$1,907.53" $397.53 "$1,907.53" N/A N/A 04.211.235 SUP HCPCS C1713 04.211.235 - PLATE BONE 10D SMALL 42MM FUSION VAR ANG LCP TITANIUM LEFT BOTH IP/OP "$1,908.00" "$1,412.00" $378.60 "$1,939.95" $858.39 $858.39 $858.39 $858.39 "$1,907.53" "$1,907.53" "$1,907.53" $397.58 "$1,907.53" "$1,907.53" "$1,907.53" "$1,907.53" "$1,907.53" $397.55 "$1,907.53" "$1,939.95" "$1,128.30" "$1,907.53" "$1,939.95" "$1,907.53" "$1,907.53" "$1,431.00" "$1,907.53" "$1,907.53" "$1,907.53" $953.77 $953.77 "$1,510.76" "$1,907.53" "$1,526.02" $858.39 $378.60 N/A "$1,106.64" "$1,907.53" "$1,907.53" "$1,907.53" $397.53 "$1,907.53" N/A N/A 04.211.236 SUP HCPCS C1713 04.211.236 - PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" "$1,887.08" "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,855.53" "$1,855.53" $386.69 "$1,855.53" N/A N/A 04.211.237 SUP HCPCS C1713 04.211.237 - PLATE BN 0D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST BOTH IP/OP "$1,908.00" "$1,412.00" $378.60 "$1,939.95" $858.39 $858.39 $858.39 $858.39 "$1,907.53" "$1,907.53" "$1,907.53" $397.58 "$1,907.53" "$1,907.53" "$1,907.53" "$1,907.53" "$1,907.53" $397.55 "$1,907.53" "$1,939.95" "$1,128.30" "$1,907.53" "$1,939.95" "$1,907.53" "$1,907.53" "$1,431.00" "$1,907.53" "$1,907.53" "$1,907.53" $953.77 $953.77 "$1,510.76" "$1,907.53" "$1,526.02" $858.39 $378.60 N/A "$1,106.64" "$1,907.53" "$1,907.53" "$1,907.53" $397.53 "$1,907.53" N/A N/A 04.211.238 SUP HCPCS C1713 04.211.238 - PLATE BONE 5D MEDIUM 52MM FUSION VAR ANG LCP TITANIUM RIGHT BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" "$1,887.08" "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,855.53" "$1,855.53" $386.69 "$1,855.53" N/A N/A 04.211.239 SUP HCPCS C1713 04.211.239 - PLATE BN 5D MED 52MM NS LCP VA FSN LOPRFL CMPR WRE HL TI 1ST BOTH IP/OP "$1,908.00" "$1,412.00" $378.60 "$1,939.95" $858.39 $858.39 $858.39 $858.39 "$1,907.53" "$1,907.53" "$1,907.53" $397.58 "$1,907.53" "$1,907.53" "$1,907.53" "$1,907.53" "$1,907.53" $397.55 "$1,907.53" "$1,939.95" "$1,128.30" "$1,907.53" "$1,939.95" "$1,907.53" "$1,907.53" "$1,431.00" "$1,907.53" "$1,907.53" "$1,907.53" $953.77 $953.77 "$1,510.76" "$1,907.53" "$1,526.02" $858.39 $378.60 N/A "$1,106.64" "$1,907.53" "$1,907.53" "$1,907.53" $397.53 "$1,907.53" N/A N/A 04.211.240 SUP HCPCS C1713 04.211.240 - PLATE BONE 10D MEDIUM 52MM FUSION VAR ANG LCP TITANIUM RIGHT BOTH IP/OP "$1,908.00" "$1,412.00" $378.60 "$1,939.95" $858.39 $858.39 $858.39 $858.39 "$1,907.53" "$1,907.53" "$1,907.53" $397.58 "$1,907.53" "$1,907.53" "$1,907.53" "$1,907.53" "$1,907.53" $397.55 "$1,907.53" "$1,939.95" "$1,128.30" "$1,907.53" "$1,939.95" "$1,907.53" "$1,907.53" "$1,431.00" "$1,907.53" "$1,907.53" "$1,907.53" $953.77 $953.77 "$1,510.76" "$1,907.53" "$1,526.02" $858.39 $378.60 N/A "$1,106.64" "$1,907.53" "$1,907.53" "$1,907.53" $397.53 "$1,907.53" N/A N/A 04.211.241 SUP HCPCS C1713 04.211.241 - PLATE BONE 10D MEDIUM 52MM FUSION VAR ANG LCP TITANIUM LEFT BOTH IP/OP "$1,908.00" "$1,412.00" $378.60 "$1,939.95" $858.39 $858.39 $858.39 $858.39 "$1,907.53" "$1,907.53" "$1,907.53" $397.58 "$1,907.53" "$1,907.53" "$1,907.53" "$1,907.53" "$1,907.53" $397.55 "$1,907.53" $775.98 "$1,128.30" "$1,907.53" "$1,939.95" "$1,907.53" "$1,907.53" "$1,431.00" "$1,907.53" "$1,907.53" "$1,907.53" $953.77 $953.77 "$1,510.76" "$1,907.53" "$1,526.02" $858.39 $378.60 N/A "$1,106.64" "$1,907.53" "$1,907.53" "$1,907.53" $397.53 "$1,907.53" N/A N/A 04.211.242 SUP HCPCS C1713 04.211.242 - PLATE BONE 5D LARGE 57MM FUSION VAR ANG LCP TITANIUM RIGHT BOTH IP/OP "$2,169.00" "$1,605.00" $430.49 "$2,205.85" $976.04 $976.04 $976.04 $976.04 "$2,168.98" "$2,168.98" "$2,168.98" $452.07 "$2,168.98" "$2,168.98" "$2,168.98" "$2,168.98" "$2,168.98" $452.04 "$2,168.98" "$2,205.85" "$1,282.95" "$2,168.98" "$2,205.85" "$2,168.98" "$2,168.98" "$1,626.75" "$2,168.98" "$2,168.98" "$2,168.98" "$1,084.49" "$1,084.49" "$1,717.83" "$2,168.98" "$1,735.18" $976.04 $430.49 N/A "$1,258.02" "$2,168.98" "$1,301.39" "$2,168.98" $452.02 "$2,168.98" N/A N/A 04.211.243 SUP HCPCS C1713 04.211.243 - PLATE BONE 5D LARGE 57MM FUSION VAR ANG LCP TITANIUM LEFT BOTH IP/OP "$2,169.00" "$1,605.00" $430.49 "$2,205.85" $976.04 $976.04 $976.04 $976.04 "$2,168.98" "$2,168.98" "$2,168.98" $452.07 "$2,168.98" "$2,168.98" "$2,168.98" "$2,168.98" "$2,168.98" $452.04 "$2,168.98" $882.34 "$1,282.95" "$2,168.98" "$2,205.85" "$2,168.98" "$2,168.98" "$1,626.75" "$2,168.98" "$2,168.98" "$2,168.98" "$1,084.49" "$1,084.49" "$1,717.83" "$2,168.98" "$1,735.18" $976.04 $430.49 N/A "$1,258.02" "$2,168.98" "$1,301.39" "$2,168.98" $452.02 "$2,168.98" N/A N/A 04.211.244 SUP HCPCS C1713 04.211.244 - PLATE BONE 0D 53MM REVISION FUSION VAR ANG LCP TITANIUM BOTH IP/OP "$2,342.00" "$1,733.00" $464.80 "$2,381.68" "$1,053.85" "$1,053.85" "$1,053.85" "$1,053.85" "$2,341.88" "$2,341.88" "$2,341.88" $488.11 "$2,341.88" "$2,341.88" "$2,341.88" "$2,341.88" "$2,341.88" $488.07 "$2,341.88" "$2,381.68" "$1,385.22" "$2,341.88" "$2,381.68" "$2,341.88" "$2,341.88" "$1,756.50" "$2,341.88" "$2,341.88" "$2,341.88" "$1,170.94" "$1,170.94" "$1,854.77" "$2,341.88" "$1,873.50" "$1,053.85" $464.80 N/A "$1,358.36" "$2,341.88" "$1,405.13" "$2,341.88" $488.05 "$2,341.88" N/A N/A 04.211.245 SUP HCPCS C1713 04.211.245 - PLATE BONE 0D 53MM REVISION FUSION VAR ANG LCP TITANIUM LEFT BOTH IP/OP "$2,342.00" "$1,733.00" $464.80 "$2,381.68" "$1,053.85" "$1,053.85" "$1,053.85" "$1,053.85" "$2,341.88" "$2,341.88" "$2,341.88" $488.11 "$2,341.88" "$2,341.88" "$2,341.88" "$2,341.88" "$2,341.88" $488.07 "$2,341.88" $952.67 "$1,385.22" "$2,341.88" "$2,381.68" "$2,341.88" "$2,341.88" "$1,756.50" "$2,341.88" "$2,341.88" "$2,341.88" "$1,170.94" "$1,170.94" "$1,854.77" "$2,341.88" "$1,873.50" "$1,053.85" $464.80 N/A "$1,358.36" "$2,341.88" "$2,341.88" "$2,341.88" $488.05 "$2,341.88" N/A N/A 04.211.246 SUP HCPCS C1713 04.211.246 - PLATE BONE LONG 39MM FUSION VAR ANG LCP TITANIUM FIRST BOTH IP/OP "$1,856.00" "$1,373.00" $368.28 "$1,887.08" $834.99 $834.99 $834.99 $834.99 "$1,855.53" "$1,855.53" "$1,855.53" $386.74 "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" $386.71 "$1,855.53" "$1,887.08" "$1,097.55" "$1,855.53" "$1,887.08" "$1,855.53" "$1,855.53" "$1,392.00" "$1,855.53" "$1,855.53" "$1,855.53" $927.77 $927.77 "$1,469.58" "$1,855.53" "$1,484.42" $834.99 $368.28 N/A "$1,076.48" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" "$1,855.53" N/A N/A 04.211.247 SUP HCPCS C1713 04.211.247 - PLATE BONE LONG 48MM FUSION VAR ANG LCP TITANIUM FIRST BOTH IP/OP "$1,908.00" "$1,412.00" $378.60 "$1,939.95" $858.39 $858.39 $858.39 $858.39 "$1,907.53" "$1,907.53" "$1,907.53" $397.58 "$1,907.53" "$1,907.53" "$1,907.53" "$1,907.53" "$1,907.53" $397.55 "$1,907.53" $775.98 "$1,128.30" "$1,907.53" "$1,939.95" "$1,907.53" "$1,907.53" "$1,431.00" "$1,907.53" "$1,907.53" "$1,907.53" $953.77 $953.77 "$1,510.76" "$1,907.53" "$1,526.02" $858.39 $378.60 N/A "$1,106.64" "$1,907.53" "$1,144.52" "$1,907.53" "$1,907.53" "$1,907.53" N/A N/A 04.211.250 SUP HCPCS C1713 04.211.250 - PLATE BONE SHORT 38MM CLOVERLEAF FUSION VAR ANG LCP TITANIUM BOTH IP/OP "$1,692.50" "$1,252.00" $335.91 "$1,721.23" $761.60 $761.60 $761.60 $761.60 "$1,692.45" "$1,692.45" "$1,692.45" $352.75 "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" $352.73 "$1,692.45" "$1,721.23" "$1,001.08" "$1,692.45" "$1,721.23" "$1,692.45" "$1,692.45" "$1,269.38" "$1,692.45" "$1,692.45" "$1,692.45" $846.23 $846.23 "$1,340.42" "$1,692.45" "$1,353.96" $761.60 $335.91 N/A $981.65 "$1,692.45" "$1,015.47" "$1,692.45" "$1,692.45" "$1,692.45" N/A N/A 04.211.251 SUP HCPCS C1713 04.211.251 - PLATE BONE STANDARD 45MM CLOVERLEAF FUSION VAR ANG LCP BOTH IP/OP "$1,692.50" "$1,252.00" $335.91 "$1,721.23" $761.60 $761.60 $761.60 $761.60 "$1,692.45" "$1,692.45" "$1,692.45" $352.75 "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" $352.73 "$1,692.45" "$1,721.23" "$1,001.08" "$1,692.45" "$1,721.23" "$1,692.45" "$1,692.45" "$1,269.38" "$1,692.45" "$1,692.45" "$1,692.45" $846.23 $846.23 "$1,340.42" "$1,692.45" "$1,353.96" $761.60 $335.91 N/A $981.65 "$1,692.45" "$1,692.45" "$1,692.45" $352.71 "$1,692.45" N/A N/A 04.211.252 SUP HCPCS C1713 04.211.252 - PLATE BONE LONG 64MM CLOVERLEAF FUSION VAR ANG LCP TITANIUM BOTH IP/OP "$1,735.00" "$1,284.00" $344.28 "$1,764.13" $780.58 $780.58 $780.58 $780.58 "$1,734.63" "$1,734.63" "$1,734.63" $361.54 "$1,734.63" "$1,734.63" "$1,734.63" "$1,734.63" "$1,734.63" $361.52 "$1,734.63" $705.65 "$1,026.03" "$1,734.63" "$1,764.13" "$1,734.63" "$1,734.63" "$1,301.25" "$1,734.63" "$1,734.63" "$1,734.63" $867.32 $867.32 "$1,373.83" "$1,734.63" "$1,387.70" $780.58 $344.28 N/A "$1,006.30" "$1,734.63" "$1,734.63" "$1,734.63" "$1,734.63" "$1,734.63" N/A N/A 04.211.253 SUP HCPCS C1713 04.211.253 - PLATE BONE SHORT 35MM T FUSION VAR ANG LCP TITANIUM FRFT BOTH IP/OP "$1,604.00" "$1,187.00" $318.33 "$1,631.18" $721.76 $721.76 $721.76 $721.76 "$1,603.90" "$1,603.90" "$1,603.90" $334.29 "$1,603.90" "$1,603.90" "$1,603.90" "$1,603.90" "$1,603.90" $334.27 "$1,603.90" "$1,631.18" $948.71 "$1,603.90" "$1,631.18" "$1,603.90" "$1,603.90" "$1,203.00" "$1,603.90" "$1,603.90" "$1,603.90" $801.95 $801.95 "$1,270.29" "$1,603.90" "$1,283.12" $721.76 $318.33 N/A $930.32 "$1,603.90" $962.34 "$1,603.90" $334.25 "$1,603.90" N/A N/A 04.211.254 SUP HCPCS C1713 04.211.254 - PLATE BONE STANDARD 42MM T FUSION VAR ANG LCP TITANIUM FRFT BOTH IP/OP "$1,692.50" "$1,252.00" $335.91 "$1,721.23" $761.60 $761.60 $761.60 $761.60 "$1,692.45" "$1,692.45" "$1,692.45" $352.75 "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" $352.73 "$1,692.45" $688.49 "$1,001.08" "$1,692.45" "$1,721.23" "$1,692.45" "$1,692.45" "$1,269.38" "$1,692.45" "$1,692.45" "$1,692.45" $846.23 $846.23 "$1,340.42" "$1,692.45" "$1,353.96" $761.60 $335.91 N/A $981.65 "$1,692.45" "$1,015.47" "$1,692.45" $352.71 "$1,692.45" N/A N/A 04.211.255 SUP HCPCS C1713 04.211.255 - PLATE BONE LONG 61MM T FUSION VAR ANG LCP TITANIUM FRFT BOTH IP/OP "$1,735.00" "$1,284.00" $344.28 "$1,764.13" $780.58 $780.58 $780.58 $780.58 "$1,734.63" "$1,734.63" "$1,734.63" $361.54 "$1,734.63" "$1,734.63" "$1,734.63" "$1,734.63" "$1,734.63" $361.52 "$1,734.63" "$1,764.13" "$1,026.03" "$1,734.63" "$1,764.13" "$1,734.63" "$1,734.63" "$1,301.25" "$1,734.63" "$1,734.63" "$1,734.63" $867.32 $867.32 "$1,373.83" "$1,734.63" "$1,387.70" $780.58 $344.28 N/A "$1,006.30" "$1,734.63" "$1,040.78" "$1,734.63" $361.50 "$1,734.63" N/A N/A 04.211.256 SUP HCPCS C1713 04.211.256 - PLATE BONE SHORT 37MM L FUSION VAR ANG LCP TITANIUM RIGHT BOTH IP/OP "$1,649.00" "$1,220.00" $327.26 "$1,676.90" $742.00 $742.00 $742.00 $742.00 "$1,648.88" "$1,648.88" "$1,648.88" $343.67 "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" $343.64 "$1,648.88" $670.76 $975.31 "$1,648.88" "$1,676.90" "$1,648.88" "$1,648.88" "$1,236.75" "$1,648.88" "$1,648.88" "$1,648.88" $824.44 $824.44 "$1,305.91" "$1,648.88" "$1,319.10" $742.00 $327.26 N/A $956.42 "$1,648.88" "$1,648.88" "$1,648.88" $343.63 "$1,648.88" N/A N/A 04.211.257 SUP HCPCS C1713 04.211.257 - PLATE BONE SHORT 37MM L FUSION VAR ANG LCP TITANIUM LEFT BOTH IP/OP "$1,649.00" "$1,220.00" $327.26 "$1,676.90" $742.00 $742.00 $742.00 $742.00 "$1,648.88" "$1,648.88" "$1,648.88" $343.67 "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" "$1,648.88" $343.64 "$1,648.88" "$1,676.90" $975.31 "$1,648.88" "$1,676.90" "$1,648.88" "$1,648.88" "$1,236.75" "$1,648.88" "$1,648.88" "$1,648.88" $824.44 $824.44 "$1,305.91" "$1,648.88" "$1,319.10" $742.00 $327.26 N/A $956.42 "$1,648.88" "$1,648.88" "$1,648.88" $343.63 "$1,648.88" N/A N/A 04.211.258 SUP HCPCS C1713 04.211.258 - PLATE BONE STANDARD 37MM L FUSION VAR ANG LCP TITANIUM RIGHT BOTH IP/OP "$1,692.50" "$1,252.00" $335.91 "$1,721.23" $761.60 $761.60 $761.60 $761.60 "$1,692.45" "$1,692.45" "$1,692.45" $352.75 "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" $352.73 "$1,692.45" $688.49 "$1,001.08" "$1,692.45" "$1,721.23" "$1,692.45" "$1,692.45" "$1,269.38" "$1,692.45" "$1,692.45" "$1,692.45" $846.23 $846.23 "$1,340.42" "$1,692.45" "$1,353.96" $761.60 $335.91 N/A $981.65 "$1,692.45" "$1,015.47" "$1,692.45" $352.71 "$1,692.45" N/A N/A 04.211.259 SUP HCPCS C1713 04.211.259 - PLATE BONE STANDARD 44MM L FUSION VAR ANG LCP TITANIUM LEFT BOTH IP/OP "$1,692.50" "$1,252.00" $335.91 "$1,721.23" $761.60 $761.60 $761.60 $761.60 "$1,692.45" "$1,692.45" "$1,692.45" $352.75 "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" $352.73 "$1,692.45" "$1,721.23" "$1,001.08" "$1,692.45" "$1,721.23" "$1,692.45" "$1,692.45" "$1,269.38" "$1,692.45" "$1,692.45" "$1,692.45" $846.23 $846.23 "$1,340.42" "$1,692.45" "$1,353.96" $761.60 $335.91 N/A $981.65 "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" "$1,692.45" N/A N/A 04.211.260 SUP HCPCS C1713 04.211.260 - PLATE BONE LONG 62MM L FUSION VAR ANG LCP TITANIUM RIGHT BOTH IP/OP "$1,735.00" "$1,284.00" $344.28 "$1,764.13" $780.58 $780.58 $780.58 $780.58 "$1,734.63" "$1,734.63" "$1,734.63" $361.54 "$1,734.63" "$1,734.63" "$1,734.63" "$1,734.63" "$1,734.63" $361.52 "$1,734.63" "$1,764.13" "$1,026.03" "$1,734.63" "$1,764.13" "$1,734.63" "$1,734.63" "$1,301.25" "$1,734.63" "$1,734.63" "$1,734.63" $867.32 $867.32 "$1,373.83" "$1,734.63" "$1,387.70" $780.58 $344.28 N/A "$1,006.30" "$1,734.63" "$1,734.63" "$1,734.63" $361.50 "$1,734.63" N/A N/A 04.211.261 SUP HCPCS C1713 04.211.261 - PLATE BN LNG L 62MM NS LCP VA FSN LOPRFL CMPR WRE HL TI BOTH IP/OP "$1,735.00" "$1,284.00" $344.28 "$1,764.13" $780.58 $780.58 $780.58 $780.58 "$1,734.63" "$1,734.63" "$1,734.63" $361.54 "$1,734.63" "$1,734.63" "$1,734.63" "$1,734.63" "$1,734.63" $361.52 "$1,734.63" $705.65 "$1,026.03" "$1,734.63" "$1,764.13" "$1,734.63" "$1,734.63" "$1,301.25" "$1,734.63" "$1,734.63" "$1,734.63" $867.32 $867.32 "$1,373.83" "$1,734.63" "$1,387.70" $780.58 $344.28 N/A "$1,006.30" "$1,734.63" "$1,734.63" "$1,734.63" $361.50 "$1,734.63" N/A N/A 04.211.262 SUP HCPCS C1713 04.211.262 - PLATE BONE 27MM 2 HOLE STR FUSION LOCKING VAR ANG LCP BOTH IP/OP "$1,476.00" "$1,092.00" $292.95 "$1,501.08" $664.19 $664.19 $664.19 $664.19 "$1,475.98" "$1,475.98" "$1,475.98" $307.63 "$1,475.98" "$1,475.98" "$1,475.98" "$1,475.98" "$1,475.98" $307.61 "$1,475.98" "$1,501.08" $873.04 "$1,475.98" "$1,501.08" "$1,475.98" "$1,475.98" "$1,107.00" "$1,475.98" "$1,475.98" "$1,475.98" $737.99 $737.99 "$1,168.98" "$1,475.98" "$1,180.78" $664.19 $292.95 N/A $856.08 "$1,475.98" $885.59 "$1,475.98" $307.59 "$1,475.98" N/A N/A 04.211.263 SUP HCPCS C1713 04.211.263 - PLATE BONE 40MM 4 HOLE STR FUSION LOCKING VAR ANG LCP BOTH IP/OP "$1,560.50" "$1,155.00" $309.69 "$1,586.85" $702.15 $702.15 $702.15 $702.15 "$1,560.33" "$1,560.33" "$1,560.33" $325.21 "$1,560.33" "$1,560.33" "$1,560.33" "$1,560.33" "$1,560.33" $325.19 "$1,560.33" $634.74 $922.94 "$1,560.33" "$1,586.85" "$1,560.33" "$1,560.33" "$1,170.38" "$1,560.33" "$1,560.33" "$1,560.33" $780.17 $780.17 "$1,235.78" "$1,560.33" "$1,248.26" $702.15 $309.69 N/A $905.09 "$1,560.33" $936.20 "$1,560.33" $325.17 "$1,560.33" N/A N/A 04.211.265 SUP HCPCS C1713 04.211.265 - PLATE BONE XLONG 92MM 3 HOLE T FUSION VAR ANG LCP TITANIUM BOTH IP/OP "$2,169.00" "$1,605.00" $430.49 "$2,205.85" $976.04 $976.04 $976.04 $976.04 "$2,168.98" "$2,168.98" "$2,168.98" $452.07 "$2,168.98" "$2,168.98" "$2,168.98" "$2,168.98" "$2,168.98" $452.04 "$2,168.98" "$2,205.85" "$1,282.95" "$2,168.98" "$2,205.85" "$2,168.98" "$2,168.98" "$1,626.75" "$2,168.98" "$2,168.98" "$2,168.98" "$1,084.49" "$1,084.49" "$1,717.83" "$2,168.98" "$1,735.18" $976.04 $430.49 N/A "$1,258.02" "$2,168.98" "$1,301.39" "$2,168.98" $452.02 "$2,168.98" N/A N/A 04.211.266 SUP HCPCS C1713 04.211.266 - PLATE BONE 43MM TMT FUSION VAR ANG LCP TITANIUM FRFT MIDFT BOTH IP/OP "$1,687.00" "$1,248.00" $334.79 "$1,715.50" $759.07 $759.07 $759.07 $759.07 "$1,686.83" "$1,686.83" "$1,686.83" $351.58 "$1,686.83" "$1,686.83" "$1,686.83" "$1,686.83" "$1,686.83" $351.55 "$1,686.83" $686.20 $997.76 "$1,686.83" "$1,715.50" "$1,686.83" "$1,686.83" "$1,265.25" "$1,686.83" "$1,686.83" "$1,686.83" $843.42 $843.42 "$1,335.97" "$1,686.83" "$1,349.46" $759.07 $334.79 N/A $978.46 "$1,686.83" "$1,012.10" "$1,686.83" $351.54 "$1,686.83" N/A N/A 04.212.054 SUP HCPCS C1713 04.212.054 - SCREW BONE 3.5MM 54MM SELF TAP LOCK LCP TITANIUM FIBULA BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $238.75 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $234.75 $234.75 N/A N/A 04.212.056 SUP HCPCS C1713 04.212.056 - SCREW BONE 3.5MM 56MM SELF TAP LOCK LCP TITANIUM FIBULA BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $234.75 $234.75 $48.92 $234.75 N/A N/A 04.212.058 SUP HCPCS C1713 04.212.058 - SCREW BONE 3.5MM 58MM SELF TAP LOCK LCP TITANIUM FIBULA BOTH IP/OP $235.00 $174.00 $46.59 $238.75 $105.64 $105.64 $105.64 $105.64 $234.75 $234.75 $234.75 $48.93 $234.75 $234.75 $234.75 $234.75 $234.75 $48.92 $234.75 $95.50 $138.85 $234.75 $238.75 $234.75 $234.75 $176.25 $234.75 $234.75 $234.75 $117.38 $117.38 $185.92 $234.75 $187.80 $105.64 $46.59 N/A $136.30 $234.75 $140.85 $234.75 $234.75 $234.75 N/A N/A 04.214.006 SUP HCPCS C1713 04.214.006 - SCREW BONE 1.5MM 6MM LOCKING SLFTAP T4 STARDRIVE RECESS BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 04.214.007 SUP HCPCS C1713 04.214.007 - SCREW BONE 1.5MM 7MM LOCKING SLFTAP T4 STARDRIVE RECESS BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $84.63 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 04.214.008 SUP HCPCS C1713 04.214.008 - SCREW BONE 1.5MM 8MM LOCKING SLFTAP T4 STARDRIVE RECESS BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 04.214.009 SUP HCPCS C1713 04.214.009 - SCREW BONE 1.5MM 9MM LOCKING SLFTAP T4 STARDRIVE RECESS BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $84.63 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 04.214.010 SUP HCPCS C1713 04.214.010 - SCREW BONE 1.5MM 10MM LOCKING SLFTAP T4 STARDRIVE RECESS BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 04.214.011 SUP HCPCS C1713 04.214.011 - SCREW BONE 1.5MM 11MM LOCKING SLFTAP T4 STARDRIVE RECESS BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $84.63 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 04.214.012 SUP HCPCS C1713 04.214.012 - SCREW BONE 1.5MM 12MM LOCKING SLFTAP T4 STARDRIVE RECESS BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 04.214.013 SUP HCPCS C1713 04.214.013 - SCREW BONE 1.5MM 13MM SLFTAP STARDRIVE TITANIUM ALLOY BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $84.63 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 04.214.014 SUP HCPCS C1713 04.214.014 - SCREW BONE 1.5MM 14MM SLFTAP STARDRIVE TITANIUM ALLOY BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $208.05 $208.05 $43.36 $208.05 N/A N/A 04.214.015 SUP HCPCS C1713 04.214.015 - SCREW BONE 1.5MM 15MM SLFTAP STARDRIVE TITANIUM ALLOY BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $84.63 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 04.214.016 SUP HCPCS C1713 04.214.016 - SCREW BONE 1.5MM 16MM SLFTAP STARDRIVE TITANIUM ALLOY BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 04.214.018 SUP HCPCS C1713 04.214.018 - SCREW BONE 1.5MM 18MM SLFTAP STARDRIVE TITANIUM ALLOY BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $208.05 $208.05 $208.05 $208.05 N/A N/A 04.214.020 SUP HCPCS C1713 04.214.020 - SCREW BONE 1.5MM 20MM SLFTAP STARDRIVE TITANIUM ALLOY BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $208.05 $208.05 $208.05 $208.05 N/A N/A 04.214.022 SUP HCPCS C1713 04.214.022 - SCREW BONE 1.5MM 22MM LOCKING SLFTAP COMPACT STARDRIVE LCP BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $208.05 $208.05 $208.05 $208.05 N/A N/A 04.214.024 SUP HCPCS C1713 04.214.024 - SCREW BONE 1.5MM 24MM LOCKING SLFTAP COMPACT STARDRIVE LCP BOTH IP/OP $208.50 $154.00 $41.29 $211.58 $93.62 $93.62 $93.62 $93.62 $208.05 $208.05 $208.05 $43.36 $208.05 $208.05 $208.05 $208.05 $208.05 $43.36 $208.05 $211.58 $123.06 $208.05 $211.58 $208.05 $208.05 $156.38 $208.05 $208.05 $208.05 $104.03 $104.03 $164.78 $208.05 $166.44 $93.62 $41.29 N/A $120.93 $208.05 $124.83 $208.05 $43.36 $208.05 N/A N/A 04.214.106 SUP HCPCS C1713 04.214.106 - SCREW BONE 1.5MM 6MM SLFTAP COMPACT STARDRIVE LCP TITANIUM BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 04.214.107 SUP HCPCS C1713 04.214.107 - SCREW BONE 1.5MM 7MM SLFTAP COMPACT STARDRIVE LCP TITANIUM BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $84.35 $84.35 $17.58 $84.35 N/A N/A 04.214.108 SUP HCPCS C1713 04.214.108 - SCREW BONE 1.5MM 8MM SLFTAP COMPACT STARDRIVE LCP TITANIUM BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 04.214.109 SUP HCPCS C1713 04.214.109 - SCREW BONE 1.5MM 9MM SLFTAP COMPACT STARDRIVE LCP TITANIUM BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 04.214.110 SUP HCPCS C1713 04.214.110 - SCREW BONE 1.5MM 8MM SLFTAP COMPACT STARDRIVE LCP TITANIUM BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 04.214.111 SUP HCPCS C1713 04.214.111 - SCREW BONE 1.5MM 11MM SLFTAP COMPACT STARDRIVE LCP TITANIUM BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $84.35 $84.35 $17.58 $84.35 N/A N/A 04.214.112 SUP HCPCS C1713 04.214.112 - SCREW BONE 1.5MM 12MM SLFTAP COMPACT STARDRIVE LCP TITANIUM BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 04.214.113 SUP HCPCS C1713 04.214.113 - SCREW BONE 1.5MM 13MM SLFTAP COMPACT STARDRIVE LCP TITANIUM BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $84.35 $84.35 N/A N/A 04.214.114 SUP HCPCS C1713 04.214.114 - SCREW BONE 1.5MM 14MM SLFTAP LCP STARDRIVE TITANIUM ALLOY BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $84.35 $84.35 N/A N/A 04.214.115 SUP HCPCS C1713 04.214.115 - SCREW BONE 1.5MM 15MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 04.214.116 SUP HCPCS C1713 04.214.116 - SCREW BONE 1.5MM 16MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 04.214.118 SUP HCPCS C1713 04.214.118 - SCREW BONE 1.5MM 18MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 04.214.120 SUP HCPCS C1713 04.214.120 - SCREW BONE 1.5MM 20MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 04.214.122 SUP HCPCS C1713 04.214.122 - SCREW BONE 1.5MM 22MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $84.35 $84.35 $17.58 $84.35 N/A N/A 04.214.124 SUP HCPCS C1713 04.214.124 - SCREW BONE 1.5MM 24MM SLFTAP T4 STARDRIVE RECESS MODULAR LCP BOTH IP/OP $84.50 $63.00 $16.74 $85.78 $37.96 $37.96 $37.96 $37.96 $84.35 $84.35 $84.35 $17.58 $84.35 $84.35 $84.35 $84.35 $84.35 $17.58 $84.35 $85.78 $49.89 $84.35 $85.78 $84.35 $84.35 $63.38 $84.35 $84.35 $84.35 $42.18 $42.18 $66.81 $84.35 $67.48 $37.96 $16.74 N/A $49.01 $84.35 $50.61 $84.35 $17.58 $84.35 N/A N/A 04.221.002S SUP HCPCS C1713 04.221.002S - BUTTON FIX 2.5MM CERCLAGE HEXAGONAL STARDRIVE RECESS BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $138.95 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $341.58 $341.58 $341.58 $341.58 N/A N/A 04.221.003S SUP HCPCS C1713 04.221.003S - BUTTON FIX HEXAGON 3.5MM CERCLAGE T25 STARDRIVE TITANIUM BOTH IP/OP $342.00 $253.00 $67.80 $347.38 $153.71 $153.71 $153.71 $153.71 $341.58 $341.58 $341.58 $71.19 $341.58 $341.58 $341.58 $341.58 $341.58 $71.19 $341.58 $347.38 $202.04 $341.58 $347.38 $341.58 $341.58 $256.50 $341.58 $341.58 $341.58 $170.79 $170.79 $270.53 $341.58 $273.26 $153.71 $67.80 N/A $198.36 $341.58 $204.95 $341.58 $71.19 $341.58 N/A N/A 04.221.004S SUP HCPCS C1713 04.221.004S - NAIL INTRAMEDULLARY 4MM CANN HEXAGONAL TITANIUM ORTHOPEDIC BOTH IP/OP $343.00 $254.00 $68.08 $348.83 $154.35 $154.35 $154.35 $154.35 $343.00 $343.00 $343.00 $71.49 $343.00 $343.00 $343.00 $343.00 $343.00 $71.48 $343.00 $348.83 $202.88 $343.00 $348.83 $343.00 $343.00 $257.25 $343.00 $343.00 $343.00 $171.50 $171.50 $271.66 $343.00 $274.40 $154.35 $68.08 N/A $198.94 $343.00 $205.80 $343.00 $71.48 $343.00 N/A N/A 04.221.005S SUP Custom 27803010 04.221.005S - CABLE ORTHOPEDIC 5MM POSITIONING PIN CRIMP STAINLESS STEEL BOTH IP/OP $516.00 $382.00 $91.83 $524.68 $515.90 $515.90 $515.90 $515.90 $515.90 $515.90 $91.83 $515.90 $515.90 $515.90 $515.90 $515.90 $515.90 $107.52 $515.90 $209.87 $515.90 $515.90 $524.68 $515.90 $515.90 $387.00 $515.90 $515.90 $515.90 $257.95 $257.95 $408.59 $515.90 $412.72 $232.16 $515.90 N/A $299.28 $515.90 $309.54 $515.90 $515.90 $515.90 N/A N/A 04.221.508 SUP HCPCS C1713 04.221.508 - SCREW BONE 5MM 8MM SLFTAP LOCKING STARDRIVE PERIPROSTHETIC BOTH IP/OP $398.00 $295.00 $78.95 $404.58 $179.01 $179.01 $179.01 $179.01 $397.80 $397.80 $397.80 $82.91 $397.80 $397.80 $397.80 $397.80 $397.80 $82.91 $397.80 $161.83 $235.30 $397.80 $404.58 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $179.01 $78.95 N/A $230.84 $397.80 $238.68 $397.80 $397.80 $397.80 N/A N/A 04.221.510 SUP HCPCS C1713 04.221.510 - SCREW BONE 5MM 10MM SLFTAP LOCKING STARDRIVE RECESS BOTH IP/OP $398.00 $295.00 $78.95 $404.58 $179.01 $179.01 $179.01 $179.01 $397.80 $397.80 $397.80 $82.91 $397.80 $397.80 $397.80 $397.80 $397.80 $82.91 $397.80 $161.83 $235.30 $397.80 $404.58 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $179.01 $78.95 N/A $230.84 $397.80 $397.80 $397.80 $82.90 $397.80 N/A N/A 04.221.512 SUP HCPCS C1713 04.221.512 - SCREW BONE 5MM 12MM SLFTAP LOCKING STARDRIVE RECESS TITANIUM BOTH IP/OP $398.00 $295.00 $78.95 $404.58 $179.01 $179.01 $179.01 $179.01 $397.80 $397.80 $397.80 $82.91 $397.80 $397.80 $397.80 $397.80 $397.80 $82.91 $397.80 $161.83 $235.30 $397.80 $404.58 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $179.01 $78.95 N/A $230.84 $397.80 $238.68 $397.80 $397.80 $397.80 N/A N/A 04.221.514 SUP HCPCS C1713 04.221.514 - SCREW BONE 5MM 14MM SLFTAP LOCKING STARDRIVE RECESS TITANIUM BOTH IP/OP $398.00 $295.00 $78.95 $404.58 $179.01 $179.01 $179.01 $179.01 $397.80 $397.80 $397.80 $82.91 $397.80 $397.80 $397.80 $397.80 $397.80 $82.91 $397.80 $404.58 $235.30 $397.80 $404.58 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $179.01 $78.95 N/A $230.84 $397.80 $238.68 $397.80 $397.80 $397.80 N/A N/A 04.221.518 SUP HCPCS C1713 04.221.518 - SCREW BONE 5MM 18MM SLFTAP LOCKING STARDRIVE RECESS TITANIUM BOTH IP/OP $398.00 $295.00 $78.95 $404.58 $179.01 $179.01 $179.01 $179.01 $397.80 $397.80 $397.80 $82.91 $397.80 $397.80 $397.80 $397.80 $397.80 $82.91 $397.80 $404.58 $235.30 $397.80 $404.58 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $179.01 $78.95 N/A $230.84 $397.80 $238.68 $397.80 $82.90 $397.80 N/A N/A 04.226.010 SUP HCPCS C1713 04.226.010 - SCREW BONE SHORT THREAD 3MM 10MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $384.60 $641.00 $641.00 $641.00 N/A N/A 04.226.011 SUP HCPCS C1713 04.226.011 - SCREW BONE SHORT THREAD 3MM 11MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.012 SUP HCPCS C1713 04.226.012 - SCREW BONE SHORT THREAD 3MM 12MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.013 SUP HCPCS C1713 04.226.013 - SCREW BONE SHORT THREAD 3MM 13MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.014 SUP HCPCS C1713 04.226.014 - SCREW BONE SHORT THREAD 3MM 14MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.015 SUP HCPCS C1713 04.226.015 - SCREW BONE SHORT THREAD 3MM 15MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.016 SUP HCPCS C1713 04.226.016 - SCREW BONE SHORT THREAD 3MM 16MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.017 SUP HCPCS C1713 04.226.017 - SCREW BONE SHORT THREAD 3MM 17MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.018 SUP HCPCS C1713 04.226.018 - SCREW BONE SHORT THREAD 3MM 18MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.019 SUP HCPCS C1713 04.226.019 - SCREW BONE SHORT THREAD 3MM 19MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.020 SUP HCPCS C1713 04.226.020 - SCREW BONE SHORT THREAD 3MM 20MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.021 SUP HCPCS C1713 04.226.021 - SCREW BONE SHORT THREAD 3MM 21MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.022 SUP HCPCS C1713 04.226.022 - SCREW BONE SHORT THREAD 3MM 22MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.023 SUP HCPCS C1713 04.226.023 - SCREW BONE SHORT THREAD 3MM 23MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.024 SUP HCPCS C1713 04.226.024 - SCREW BONE SHORT THREAD 3MM 24MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.025 SUP HCPCS C1713 04.226.025 - SCREW BONE SHORT THREAD 3MM 25MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.026 SUP HCPCS C1713 04.226.026 - SCREW BONE SHORT THREAD 3MM 26MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.027 SUP HCPCS C1713 04.226.027 - SCREW BONE SHORT THREAD 3MM 27MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.028 SUP HCPCS C1713 04.226.028 - SCREW BONE SHORT THREAD 3MM 28MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.029 SUP HCPCS C1713 04.226.029 - SCREW BONE SHORT THREAD 3MM 29MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.030 SUP HCPCS C1713 04.226.030 - SCREW BONE SHORT THREAD 3MM 30MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.032 SUP HCPCS C1713 04.226.032 - SCREW BONE SHORT THREAD 3MM 32MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.034 SUP HCPCS C1713 04.226.034 - SCREW BONE SHORT THREAD 3MM 34MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.036 SUP HCPCS C1713 04.226.036 - SCREW BONE SHORT THREAD 3MM 36MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.038 SUP HCPCS C1713 04.226.038 - SCREW BONE SHORT THREAD 3MM 38MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.040 SUP HCPCS C1713 04.226.040 - SCREW BONE SHORT THREAD 3MM 40MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.116 SUP HCPCS C1713 04.226.116 - SCREW BONE LNGTHRD 3MM 16MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.117 SUP HCPCS C1713 04.226.117 - SCREW BONE 3MM 17MM 6MM COMPRESSION TITANIUM SMALL BONE BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.118 SUP HCPCS C1713 04.226.118 - SCREW BONE LNGTHRD 3MM 18MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.119 SUP HCPCS C1713 04.226.119 - SCREW BONE LNGTHRD 3MM 19MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.120 SUP HCPCS C1713 04.226.120 - SCREW BONE 3MM 20MM 7MM COMPRESSION TITANIUM SMALL BONE BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.121 SUP HCPCS C1713 04.226.121 - SCREW BONE LNGTHRD 3MM 21MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.122 SUP HCPCS C1713 04.226.122 - SCREW BONE LNGTHRD 3MM 22MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.123 SUP HCPCS C1713 04.226.123 - SCREW BONE LNGTHRD 3MM 23MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.124 SUP HCPCS C1713 04.226.124 - SCREW BONE LNGTHRD 3MM 24MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.125 SUP HCPCS C1713 04.226.125 - SCREW BONE LNGTHRD 3MM 25MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.126 SUP HCPCS C1713 04.226.126 - SCREW BONE LNGTHRD 3MM 26MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.127 SUP HCPCS C1713 04.226.127 - SCREW BONE LNGTHRD 3MM 27MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.128 SUP HCPCS C1713 04.226.128 - SCREW BONE LNGTHRD 3MM 28MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.129 SUP HCPCS C1713 04.226.129 - SCREW BONE LNGTHRD 3MM 29MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.130 SUP HCPCS C1713 04.226.130 - SCREW BONE LNGTHRD 3MM 30MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.132 SUP HCPCS C1713 04.226.132 - SCREW BONE LNGTHRD 3MM 32MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.134 SUP HCPCS C1713 04.226.134 - SCREW BONE LNGTHRD 3MM 34MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.136 SUP HCPCS C1713 04.226.136 - SCREW BONE LNGTHRD 3MM 36MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.138 SUP HCPCS C1713 04.226.138 - SCREW BONE LNGTHRD 3MM 38MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.140 SUP HCPCS C1713 04.226.140 - SCREW BONE LNGTHRD 3MM 40MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.209 SUP HCPCS C1713 04.226.209 - SCREW BONE SHORT THREAD 2.4MM 9MM 4MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.210 SUP HCPCS C1713 04.226.210 - SCREW BONE SHORT THREAD 2.4MM 10MM 4MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.211 SUP HCPCS C1713 04.226.211 - SCREW BONE SHORT THREAD 2.4MM 11MM 4MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.212 SUP HCPCS C1713 04.226.212 - SCREW BONE SHORT THREAD 2.4MM 12MM 4MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.213 SUP HCPCS C1713 04.226.213 - SCREW BONE SHORT THREAD 2.4MM 13MM 4MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.214 SUP HCPCS C1713 04.226.214 - SCREW BONE SHORT THREAD 2.4MM 14MM 4MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.215 SUP HCPCS C1713 04.226.215 - SCREW BONE SHORT THREAD 2.4MM 15MM 4MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.216 SUP HCPCS C1713 04.226.216 - SCREW BONE SHORT THREAD 2.4MM 16MM 4MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.217 SUP HCPCS C1713 04.226.217 - SCREW BONE SHORT THREAD 2.4MM 17MM 4MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.218 SUP HCPCS C1713 04.226.218 - SCREW BONE 2.4MM 18MM 4MM COMPRESSION TITANIUM SMALL BONE BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.219 SUP HCPCS C1713 04.226.219 - SCREW BONE SHORT THREAD 2.4MM 19MM 4MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.220 SUP HCPCS C1713 04.226.220 - SCREW BONE 2.4MM 20MM 4MM COMPRESSION TITANIUM SMALL BONE BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.221 SUP HCPCS C1713 04.226.221 - SCREW BONE SHORT THREAD 2.4MM 21MM 4MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.222 SUP HCPCS C1713 04.226.222 - SCREW BONE SHORT THREAD 2.4MM 22MM 4MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $260.76 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.223 SUP HCPCS C1713 04.226.223 - SCREW BONE SHORT THREAD 2.4MM 23MM 4MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.224 SUP HCPCS C1713 04.226.224 - SCREW BONE SHORT THREAD 2.4MM 24MM 5MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.225 SUP HCPCS C1713 04.226.225 - SCREW BONE SHORT THREAD 2.4MM 25MM 5MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.226 SUP HCPCS C1713 04.226.226 - SCREW BONE SHORT THREAD 2.4MM 26MM 5MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.227 SUP HCPCS C1713 04.226.227 - SCREW BONE SHORT THREAD 2.4MM 27MM 6MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.228 SUP HCPCS C1713 04.226.228 - SCREW BONE SHORT THREAD 2.4MM 28MM 6MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.229 SUP HCPCS C1713 04.226.229 - SCREW BONE SHORT THREAD 2.4MM 29MM 6MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.230 SUP HCPCS C1713 04.226.230 - SCREW BONE 2.4MM 30MM 7MM COMPRESSION TITANIUM SMALL BONE BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.232 SUP HCPCS C1713 04.226.232 - SCREW BONE SHORT THREAD 2.4MM 32MM 7MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.234 SUP HCPCS C1713 04.226.234 - SCREW BONE SHORT THREAD 2.4MM 34MM 8MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.236 SUP HCPCS C1713 04.226.236 - SCREW BONE SHORT THREAD 2.4MM 36MM 9MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.238 SUP HCPCS C1713 04.226.238 - SCREW BONE SHORT THREAD 2.4MM 38MM 9MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.240 SUP HCPCS C1713 04.226.240 - SCREW BONE 2.4MM 40MM 10MM COMPRESSION SHORT THREAD HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.317 SUP HCPCS C1713 04.226.317 - SCREW BONE LNGTHRD 2.4MM 17MM 6MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.318 SUP HCPCS C1713 04.226.318 - SCREW BONE LNGTHRD 2.4MM 18MM 6MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.319 SUP HCPCS C1713 04.226.319 - SCREW BONE LNGTHRD 2.4MM 19MM 7MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.320 SUP HCPCS C1713 04.226.320 - SCREW BONE LNGTHRD 2.4MM 20MM 7MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.321 SUP HCPCS C1713 04.226.321 - SCREW BONE LNGTHRD 2.4MM 21MM 8MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.322 SUP HCPCS C1713 04.226.322 - SCREW BONE LNGTHRD 2.4MM 22MM 8MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.323 SUP HCPCS C1713 04.226.323 - SCREW BONE LNGTHRD 2.4MM 23MM 8MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.324 SUP HCPCS C1713 04.226.324 - SCREW BONE LNGTHRD 2.4MM 24MM 8MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.325 SUP HCPCS C1713 04.226.325 - SCREW BONE LNGTHRD 2.4MM 25MM 8MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.326 SUP HCPCS C1713 04.226.326 - SCREW BONE LNGTHRD 2.4MM 26MM 10MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.327 SUP HCPCS C1713 04.226.327 - SCREW BONE LNGTHRD 2.4MM 27MM 10MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.328 SUP HCPCS C1713 04.226.328 - SCREW BONE LNGTHRD 2.4MM 28MM 10MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.329 SUP HCPCS C1713 04.226.329 - SCREW BONE LNGTHRD 2.4MM 29MM 10MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.330 SUP HCPCS C1713 04.226.330 - SCREW BONE LNGTHRD 2.4MM 30MM 12MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $641.00 $641.00 N/A N/A 04.226.332 SUP HCPCS C1713 04.226.332 - SCREW BONE LNGTHRD 2.4MM 32MM 12MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.334 SUP HCPCS C1713 04.226.334 - SCREW BONE LNGTHRD 2.4MM 34MM 14MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.336 SUP HCPCS C1713 04.226.336 - SCREW BONE LNGTHRD 2.4MM 36MM 14MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.338 SUP HCPCS C1713 04.226.338 - SCREW BONE LNGTHRD 2.4MM 38MM 16MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.340 SUP HCPCS C1713 04.226.340 - SCREW BONE LNGTHRD 2.4MM 40MM 16MM COMPRESSION HEADLESS BOTH IP/OP $641.00 $474.00 $127.22 $651.90 $288.45 $288.45 $288.45 $288.45 $641.00 $641.00 $641.00 $133.60 $641.00 $641.00 $641.00 $641.00 $641.00 $133.59 $641.00 $651.90 $379.15 $641.00 $651.90 $641.00 $641.00 $480.75 $641.00 $641.00 $641.00 $320.50 $320.50 $507.67 $641.00 $512.80 $288.45 $127.22 N/A $371.78 $641.00 $641.00 $641.00 $133.58 $641.00 N/A N/A 04.226.620 SUP HCPCS C1713 04.226.620 - SCREW BONE SHORT THREAD 4.5MM 20MM 7MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.226.622 SUP HCPCS C1713 04.226.622 - SCREW BONE SHORT THREAD 4.5MM 22MM 7MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.226.624 SUP HCPCS C1713 04.226.624 - SCREW BONE SHORT THREAD 4.5MM 24MM 7MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.226.626 SUP HCPCS C1713 04.226.626 - SCREW BONE SHORT THREAD 4.5MM 26MM 7MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.226.628 SUP HCPCS C1713 04.226.628 - SCREW BONE SHORT THREAD 4.5MM 28MM 7MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.226.630 SUP HCPCS C1713 04.226.630 - SCREW BONE SHORT THREAD 4.5MM 30MM 7MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.632 SUP HCPCS C1713 04.226.632 - SCREW BONE SHORT THREAD 4.5MM 32MM 7MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.226.634 SUP HCPCS C1713 04.226.634 - SCREW BONE SHORT THREAD 4.5MM 34MM 7MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.226.636 SUP HCPCS C1713 04.226.636 - SCREW BONE SHORT THREAD 4.5MM 36MM 7MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.226.638 SUP HCPCS C1713 04.226.638 - SCREW BONE SHORT THREAD 4.5MM 38MM 7MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.226.640 SUP HCPCS C1713 04.226.640 - SCREW BONE SHORT THREAD 4.5MM 40MM 8MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.642 SUP HCPCS C1713 04.226.642 - SCREW BONE SHORT THREAD 4.5MM 42MM 8MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.644 SUP HCPCS C1713 04.226.644 - SCREW BONE SHORT THREAD 4.5MM 44MM 9MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.646 SUP HCPCS C1713 04.226.646 - SCREW BONE SHORT THREAD 4.5MM 46MM 9MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.648 SUP HCPCS C1713 04.226.648 - SCREW BONE SHORT THREAD 4.5MM 48MM 9MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.226.650 SUP HCPCS C1713 04.226.650 - SCREW BONE SHORT THREAD 4.5MM 50MM 10MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.226.652 SUP HCPCS C1713 04.226.652 - SCREW BONE SHORT THREAD 4.5MM 52MM 10MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.654 SUP HCPCS C1713 04.226.654 - SCREW BONE SHORT THREAD 6.5MM 54MM 16MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.226.656 SUP HCPCS C1713 04.226.656 - SCREW BONE SHORT THREAD 4.5MM 56MM 11MM COMPRESSION HEADLESS BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.658 SUP HCPCS C1713 04.226.658 - SCREW BONE SHORT THREAD 4.5MM 58MM 11MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.660 SUP HCPCS C1713 04.226.660 - SCREW BONE SHORT THREAD 4.5MM 60MM 12MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.665 SUP HCPCS C1713 04.226.665 - SCREW BONE SHORT THREAD 4.5MM 65MM 13MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.226.670 SUP HCPCS C1713 04.226.670 - SCREW BONE SHORT THREAD 4.5MM 70MM 14MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.675 SUP HCPCS C1713 04.226.675 - SCREW BONE SHORT THREAD 4.5MM 75MM 15MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.226.680 SUP HCPCS C1713 04.226.680 - SCREW BONE SHORT THREAD 4.5MM 80MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 04.226.685 SUP HCPCS C1713 04.226.685 - SCREW BONE SHORT THREAD 4.5MM 85MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.226.690 SUP HCPCS C1713 04.226.690 - SCREW BONE SHORT THREAD 4.5MM 90MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.226.695 SUP HCPCS C1713 04.226.695 - SCREW BONE SHORT THREAD 4.5MM 95MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.700 SUP HCPCS C1713 04.226.700 - SCREW BONE SHORT THREAD 4.5MM 100MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.730 SUP HCPCS C1713 04.226.730 - SCREW BONE LNGTHRD 4.5MM 32MM 12MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.732 SUP HCPCS C1713 04.226.732 - SCREW BONE LNGTHRD 4.5MM 32MM 12MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.734 SUP HCPCS C1713 04.226.734 - SCREW BONE LNGTHRD 4.5MM 34MM 12MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.226.736 SUP HCPCS C1713 04.226.736 - SCREW BONE LNGTHRD 4.5MM 36MM 14MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 04.226.738 SUP HCPCS C1713 04.226.738 - SCREW BONE LNGTHRD 4.5MM 38MM 14MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.226.740 SUP HCPCS C1713 04.226.740 - SCREW BONE LNGTHRD 4.5MM 40MM 16MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.226.742 SUP HCPCS C1713 04.226.742 - SCREW BONE LNGTHRD 4.5MM 42MM 16MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.744 SUP HCPCS C1713 04.226.744 - SCREW BONE LNGTHRD 4.5MM 44MM 18MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.746 SUP HCPCS C1713 04.226.746 - SCREW BONE LNGTHRD 4.5MM 46MM 18MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.748 SUP HCPCS C1713 04.226.748 - SCREW BONE LNGTHRD 4.5MM 48MM 18MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.750 SUP HCPCS C1713 04.226.750 - SCREW BONE LNGTHRD 4.5MM 50MM 20MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.752 SUP HCPCS C1713 04.226.752 - SCREW BONE LNGTHRD 4.5MM 52MM 20MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.754 SUP HCPCS C1713 04.226.754 - SCREW BONE LNGTHRD 4.5MM 54MM 22MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.756 SUP HCPCS C1713 04.226.756 - SCREW BONE LNGTHRD 4.5MM 56MM 22MM COMPRESSION HEADLESS BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.758 SUP HCPCS C1713 04.226.758 - SCREW BONE LNGTHRD 4.5MM 58MM 22MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.760 SUP HCPCS C1713 04.226.760 - SCREW BONE LNGTHRD 4.5MM 60MM 24MM COMPRESSION HEADLESS BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.765 SUP HCPCS C1713 04.226.765 - SCREW BONE LNGTHRD 4.5MM 65MM 26MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.226.770 SUP HCPCS C1713 04.226.770 - SCREW BONE LNGTHRD 4.5MM 70MM 28MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.775 SUP HCPCS C1713 04.226.775 - SCREW BONE LNGTHRD 4.5MM 75MM 30MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.780 SUP HCPCS C1713 04.226.780 - SCREW BONE LNGTHRD 4.5MM 80MM 32MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.785 SUP HCPCS C1713 04.226.785 - SCREW BONE LNGTHRD 4.5MM 85MM 34MM COMPRESSION HEADLESS BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.226.790 SUP HCPCS C1713 04.226.790 - SCREW BONE LNGTHRD 4.5MM 90MM 36MM COMPRESSION HEADLESS BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.226.795 SUP HCPCS C1713 04.226.795 - SCREW BONE LNGTHRD 4.5MM 95MM 38MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.226.800 SUP HCPCS C1713 04.226.800 - SCREW BONE LNGTHRD 4.5MM 100MM 40MM HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.227.030 SUP HCPCS C1713 04.227.030 - SCREW BONE 6.5MM 30MM 16MM HEADLESS COMPRESSION THREADED BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.035 SUP HCPCS C1713 04.227.035 - SCREW BONE 6.5MM 35MM 16MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.040 SUP HCPCS C1713 04.227.040 - SCREW BONE 6.5MM 40MM 16MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.045 SUP HCPCS C1713 04.227.045 - SCREW BONE 6.5MM 45MM 16MM HEADLESS COMPRESSION THREADED BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.227.050 SUP HCPCS C1713 04.227.050 - SCREW BONE 6.5MM 50MM 16MM HEADLESS COMPRESSION THREADED BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.227.055 SUP HCPCS C1713 04.227.055 - SCREW BONE 6.5MM 55MM 16MM HEADLESS COMPRESSION THREADED BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.227.060 SUP HCPCS C1713 04.227.060 - SCREW BONE 6.5MM 60MM 16MM HEADLESS COMPRESSION THREADED SET BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.227.065 SUP HCPCS C1713 04.227.065 - SCREW BONE 6.5MM 65MM 16MM HEADLESS COMPRESSION THREADED SET BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.227.070 SUP HCPCS C1713 04.227.070 - SCREW BONE 6.5MM 70MM 16MM COMPRESSION THREAD TITANIUM FEMUR BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.075 SUP HCPCS C1713 04.227.075 - SCREW BONE 6.5MM 75MM 16MM HEADLESS COMPRESSION THREADED SET BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.080 SUP HCPCS C1713 04.227.080 - SCREW BONE 6.5MM 80MM 16MM HEADLESS COMPRESSION THREADED SET BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.227.085 SUP HCPCS C1713 04.227.085 - SCREW BONE 6.5MM 85MM 16MM COMPRESSION HEADLESS THREADED BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.090 SUP HCPCS C1713 04.227.090 - SCREW BONE 6.5MM 90MM 16MM HEADLESS COMPRESSION THREADED BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.095 SUP HCPCS C1713 04.227.095 - SCREW BONE 6.5MM 95MM 16MM HEADLESS COMPRESSION THREADED BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.227.100 SUP HCPCS C1713 04.227.100 - SCREW BONE 6.5MM 100MM 16MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.227.105 SUP HCPCS C1713 04.227.105 - SCREW BONE 6.5MM 105MM 16MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.110 SUP HCPCS C1713 04.227.110 - SCREW BONE 6.5MM 105MM 16MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.115 SUP HCPCS C1713 04.227.115 - SCREW BONE 6.5MM 115MM 16MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 04.227.120 SUP HCPCS C1713 04.227.120 - SCREW BONE 6.5MM 120MM 16MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.125 SUP HCPCS C1713 04.227.125 - SCREW BONE 6.5MM 125MM 16MM HEADLESS COMPRESSION THREADED BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 04.227.130 SUP HCPCS C1713 04.227.130 - SCREW BONE 6.5MM 130MM 16MM HEADLESS COMPRESSION THREADED BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.135 SUP HCPCS C1713 04.227.135 - SCREW BONE 6.5MM 135MM 16MM HEADLESS COMPRESSION THREADED BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.140 SUP HCPCS C1713 04.227.140 - SCREW BONE 6.5MM 140MM 16MM HEADLESS COMPRESSION THREADED BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.145 SUP HCPCS C1713 04.227.145 - SCREW BONE 6.5MM 145MM 16MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.150 SUP HCPCS C1713 04.227.150 - SCREW BONE 6.5MM 150MM 16MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.245 SUP HCPCS C1713 04.227.245 - SCREW BONE 6.5MM 45MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 04.227.250 SUP HCPCS C1713 04.227.250 - SCREW BONE 6.5MM 50MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.227.255 SUP HCPCS C1713 04.227.255 - SCREW BONE 6.5MM 55MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.260 SUP HCPCS C1713 04.227.260 - SCREW BONE 6.5MM 60MM 32MM COMPRESSION HEADLESS TITANIUM BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.265 SUP HCPCS C1713 04.227.265 - SCREW BONE 6.5MM 65MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 04.227.270 SUP HCPCS C1713 04.227.270 - SCREW BONE 6.5MM 70MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 04.227.275 SUP HCPCS C1713 04.227.275 - SCREW BONE 6.5MM 75MM 32MM COMPRESSION THREAD TITANIUM FEMUR BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.280 SUP HCPCS C1713 04.227.280 - SCREW BONE 6.5MM 80MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.285 SUP HCPCS C1713 04.227.285 - SCREW BONE 6.5MM 85MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.290 SUP HCPCS C1713 04.227.290 - SCREW BONE 6.5MM 90MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.295 SUP HCPCS C1713 04.227.295 - SCREW BONE 6.5MM 95MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.227.300 SUP HCPCS C1713 04.227.300 - SCREW BONE 6.5MM 100MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $135.34 $649.43 N/A N/A 04.227.305 SUP HCPCS C1713 04.227.305 - SCREW BONE 6.5MM 105MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.310 SUP HCPCS C1713 04.227.310 - SCREW BONE 6.5MM 110MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.315 SUP HCPCS C1713 04.227.315 - SCREW BONE 6.5MM 115MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.320 SUP HCPCS C1713 04.227.320 - SCREW BONE 6.5MM 120MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 04.227.325 SUP HCPCS C1713 04.227.325 - SCREW BONE 6.5MM 125MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 04.227.330 SUP HCPCS C1713 04.227.330 - SCREW BONE 6.5MM 130MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.335 SUP HCPCS C1713 04.227.335 - SCREW BONE 6.5MM 135MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.227.340 SUP HCPCS C1713 04.227.340 - SCREW BONE 6.5MM 140MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $649.43 $649.43 $649.43 $649.43 N/A N/A 04.227.345 SUP HCPCS C1713 04.227.345 - SCREW BONE 6.5MM 145MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $660.48 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $649.43 $649.43 N/A N/A 04.227.350 SUP HCPCS C1713 04.227.350 - SCREW BONE 6.5MM 150MM 32MM THREADED HEADLESS COMPRESSION BOTH IP/OP $649.50 $481.00 $128.90 $660.48 $292.24 $292.24 $292.24 $292.24 $649.43 $649.43 $649.43 $135.36 $649.43 $649.43 $649.43 $649.43 $649.43 $135.35 $649.43 $264.19 $384.14 $649.43 $660.48 $649.43 $649.43 $487.13 $649.43 $649.43 $649.43 $324.72 $324.72 $514.35 $649.43 $519.54 $292.24 $128.90 N/A $376.71 $649.43 $389.66 $649.43 $135.34 $649.43 N/A N/A 04.230.109 SUP HCPCS C1713 04.230.109 - SCREW BONE 1.5MM 9MM 4MM HEADLESS COMPRESSION THREAD BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 04.230.110 SUP HCPCS C1713 04.230.110 - SCREW BONE 1.5MM 10MM 4MM HEADLESS COMPRESSION THREAD BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 04.230.111 SUP HCPCS C1713 04.230.111 - SCREW BONE 1.5MM 11MM 4MM HEADLESS COMPRESSION THREAD BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 04.230.112 SUP HCPCS C1713 04.230.112 - SCREW BONE 1.5MM 12MM 4MM HEADLESS COMPRESSION THREAD BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 04.230.113 SUP HCPCS C1713 04.230.113 - SCREW BONE 1.5MM 13MM 4MM HEADLESS COMPRESSION THREAD BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 04.230.114 SUP HCPCS C1713 04.230.114 - SCREW BONE 1.5MM 14MM 4MM HEADLESS COMPRESSION THREAD BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $486.38 $486.38 N/A N/A 04.230.115 SUP HCPCS C1713 04.230.115 - SCREW BONE 1.5MM 15MM 4MM HEADLESS COMPRESSION THREAD BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $486.38 $486.38 N/A N/A 04.230.116 SUP HCPCS C1713 04.230.116 - SCREW BONE 1.5MM 16MM 5MM HEADLESS COMPRESSION THREAD BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 04.230.117 SUP HCPCS C1713 04.230.117 - SCREW BONE 1.5MM 17MM 5MM HEADLESS COMPRESSION THREAD BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 04.230.118 SUP HCPCS C1713 04.230.118 - SCREW BONE 1.5MM 18MM 5MM HEADLESS COMPRESSION THREAD BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 04.230.119 SUP HCPCS C1713 04.230.119 - SCREW BONE 1.5MM 19MM 5MM HEADLESS COMPRESSION THREAD BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $291.83 $486.38 $101.36 $486.38 N/A N/A 04.230.120 SUP HCPCS C1713 04.230.120 - SCREW BONE 1.5MM 20MM 6MM HEADLESS COMPRESSION THREAD BOTH IP/OP $486.50 $360.00 $96.53 $494.65 $218.87 $218.87 $218.87 $218.87 $486.38 $486.38 $486.38 $101.37 $486.38 $486.38 $486.38 $486.38 $486.38 $101.37 $486.38 $494.65 $287.69 $486.38 $494.65 $486.38 $486.38 $364.88 $486.38 $486.38 $486.38 $243.19 $243.19 $385.21 $486.38 $389.10 $218.87 $96.53 N/A $282.17 $486.38 $486.38 $486.38 $101.36 $486.38 N/A N/A 04.305.003 SUP HCPCS C1713 04.305.003 - SCREW BONE 2.5/4MM 50MM BLUNT TIP SCHANZ TITANIUM MANDIB BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $405.00 $405.00 $405.00 $405.00 $900.00 $900.00 $900.00 $187.58 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $900.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $178.63 N/A $522.00 $900.00 $900.00 $900.00 $187.56 $900.00 N/A N/A 04.305.004 SUP HCPCS C1713 04.305.004 - SCREW BONE 2.5/4MM 60MM BLUNT TIP SCHANZ TITANIUM MANDIB BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $405.00 $405.00 $405.00 $405.00 $900.00 $900.00 $900.00 $187.58 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $360.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $178.63 N/A $522.00 $900.00 $900.00 $900.00 $187.56 $900.00 N/A N/A 04.305.005 SUP HCPCS C1713 04.305.005 - SCREW BONE 2.5/4MM 70MM BLUNT TIP SCHANZ TITANIUM MANDIB BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $405.00 $405.00 $405.00 $405.00 $900.00 $900.00 $900.00 $187.58 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $360.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $178.63 N/A $522.00 $900.00 $900.00 $900.00 $187.56 $900.00 N/A N/A 04.305.010 SUP HCPCS C1713 04.305.010 - SCREW BONE 2.5/4MM 50MM SLFDRILL SCHANZ TITANIUM MANDIB BOTH IP/OP "$1,055.00" $781.00 $209.39 "$1,055.00" $474.75 $474.75 $474.75 $474.75 "$1,055.00" "$1,055.00" "$1,055.00" $219.89 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $219.87 "$1,055.00" $422.00 $624.03 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $791.25 "$1,055.00" "$1,055.00" "$1,055.00" $527.50 $527.50 $835.56 "$1,055.00" $844.00 $474.75 $209.39 N/A $611.90 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" N/A N/A 04.305.011 SUP HCPCS C1713 04.305.011 - SCREW BONE 2.5/4MM 60MM SLFDRILL SCHANZ TITANIUM MANDIB BOTH IP/OP "$1,055.00" $781.00 $209.39 "$1,055.00" $474.75 $474.75 $474.75 $474.75 "$1,055.00" "$1,055.00" "$1,055.00" $219.89 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $219.87 "$1,055.00" $422.00 $624.03 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $791.25 "$1,055.00" "$1,055.00" "$1,055.00" $527.50 $527.50 $835.56 "$1,055.00" $844.00 $474.75 $209.39 N/A $611.90 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" N/A N/A 04.305.012 SUP HCPCS C1713 04.305.012 - SCREW BONE 2.5/4MM 70MM SLFDRILL SCHANZ TITANIUM MANDIB BOTH IP/OP "$1,055.00" $781.00 $209.39 "$1,055.00" $474.75 $474.75 $474.75 $474.75 "$1,055.00" "$1,055.00" "$1,055.00" $219.89 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $219.87 "$1,055.00" $422.00 $624.03 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $791.25 "$1,055.00" "$1,055.00" "$1,055.00" $527.50 $527.50 $835.56 "$1,055.00" $844.00 $474.75 $209.39 N/A $611.90 "$1,055.00" "$1,055.00" "$1,055.00" $219.86 "$1,055.00" N/A N/A 04.305.100 SUP Custom 27203010 04.305.100 - ROD EXFIX 4MM FULL PREBENT RAMUS TITANIUM MANDIB NONSTRL BOTH IP/OP "$2,167.50" "$1,604.00" $385.82 "$2,167.50" "$2,167.50" "$2,167.50" "$2,167.50" "$2,167.50" "$2,167.50" "$2,167.50" $385.82 "$2,167.50" "$2,167.50" "$1,608.72" "$1,608.72" "$1,670.71" "$1,129.27" $451.73 "$2,167.50" $867.00 "$2,167.50" "$2,167.50" "$2,167.50" "$2,167.50" "$2,167.50" "$1,625.63" "$2,167.50" "$2,167.50" "$2,167.50" "$1,083.75" "$1,083.75" "$1,716.66" "$2,167.50" "$1,734.00" "$1,408.88" "$2,167.50" N/A "$1,257.15" "$2,167.50" "$1,300.50" "$2,167.50" "$2,167.50" "$2,167.50" N/A N/A 04.305.101 SUP Custom 27203010 04.305.101 - ROD EXFIX 4MM FULL PREBENT TITANIUM MANDIB NONSTRL MANDIB BOTH IP/OP "$1,852.50" "$1,371.00" $329.75 "$1,852.50" "$1,852.50" "$1,852.50" "$1,852.50" "$1,852.50" "$1,852.50" "$1,852.50" $329.75 "$1,852.50" "$1,852.50" "$1,374.93" "$1,374.93" "$1,427.91" $965.15 $386.08 "$1,852.50" $741.00 "$1,852.50" "$1,852.50" "$1,852.50" "$1,852.50" "$1,852.50" "$1,389.38" "$1,852.50" "$1,852.50" "$1,852.50" $926.25 $926.25 "$1,467.18" "$1,852.50" "$1,482.00" "$1,204.13" "$1,852.50" N/A "$1,074.45" "$1,852.50" "$1,111.50" "$1,852.50" "$1,852.50" "$1,852.50" N/A N/A 04.305.102 SUP Custom 27203010 04.305.102 - ROD EXFIX 4MM .75 PREBENT TITANIUM MANDIB NONSTRL MANDIB BOTH IP/OP "$1,702.50" "$1,260.00" $303.05 "$1,702.50" "$1,702.50" "$1,702.50" "$1,702.50" "$1,702.50" "$1,702.50" "$1,702.50" $303.05 "$1,702.50" "$1,702.50" "$1,263.60" "$1,263.60" "$1,312.29" $887.00 $354.82 "$1,702.50" $681.00 "$1,702.50" "$1,702.50" "$1,702.50" "$1,702.50" "$1,702.50" "$1,276.88" "$1,702.50" "$1,702.50" "$1,702.50" $851.25 $851.25 "$1,348.38" "$1,702.50" "$1,362.00" "$1,106.63" "$1,702.50" N/A $987.45 "$1,702.50" "$1,021.50" "$1,702.50" "$1,702.50" "$1,702.50" N/A N/A 04.305.103 SUP HCPCS C1713 04.305.103 - ROD FIX 4MM .5 PREBENT TITANIUM MANDIB NONSTRL EXFIX SYSTEM BOTH IP/OP "$1,552.50" "$1,149.00" $308.13 "$1,552.50" $698.63 $698.63 $698.63 $698.63 "$1,552.50" "$1,552.50" "$1,552.50" $323.58 "$1,552.50" "$1,552.50" "$1,552.50" "$1,552.50" "$1,552.50" $323.56 "$1,552.50" $621.00 $918.30 "$1,552.50" "$1,552.50" "$1,552.50" "$1,552.50" "$1,164.38" "$1,552.50" "$1,552.50" "$1,552.50" $776.25 $776.25 "$1,229.58" "$1,552.50" "$1,242.00" $698.63 $308.13 N/A $900.45 "$1,552.50" "$1,552.50" "$1,552.50" $323.54 "$1,552.50" N/A N/A 04.305.128 SUP HCPCS C1713 04.305.128 - SCREW BONE 2.5MM 4MM 8MM SELF DRILL SCHANZ TITANIUM MANDIB BOTH IP/OP "$1,100.00" $814.00 $218.32 "$1,100.00" $495.00 $495.00 $495.00 $495.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.27 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $229.25 "$1,100.00" "$1,100.00" $650.65 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $495.00 $218.32 N/A $638.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.24 "$1,100.00" N/A N/A 04.305.130 SUP HCPCS C1713 04.305.130 - SCREW XTRNFX 2.5MM 4MM 10MM SCHNZ SLF DRL TI MNDB RAMUS BOTH IP/OP "$1,100.00" $814.00 $218.32 "$1,100.00" $495.00 $495.00 $495.00 $495.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.27 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $229.25 "$1,100.00" "$1,100.00" $650.65 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $495.00 $218.32 N/A $638.00 "$1,100.00" $660.00 "$1,100.00" $229.24 "$1,100.00" N/A N/A 04.305.134 SUP HCPCS C1713 04.305.134 - SCREW XTRNFX 2.5MM 4MM 14MM SCHNZ SLF DRL TI MNDB XTRNFXTR BOTH IP/OP "$1,100.00" $814.00 $218.32 "$1,100.00" $495.00 $495.00 $495.00 $495.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.27 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $229.25 "$1,100.00" "$1,100.00" $650.65 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $495.00 $218.32 N/A $638.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.24 "$1,100.00" N/A N/A 04.305.138 SUP HCPCS C1713 04.305.138 - SCREW XTRNFX 2.5MM 4MM 18MM SCHNZ SLF DRL TI MNDB XTRNFXTR BOTH IP/OP "$1,100.00" $814.00 $218.32 "$1,100.00" $495.00 $495.00 $495.00 $495.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.27 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $229.25 "$1,100.00" "$1,100.00" $650.65 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $495.00 $218.32 N/A $638.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.24 "$1,100.00" N/A N/A 04.305.140 SUP HCPCS C1713 04.305.140 - SCREW BONE 2.5/4MM 20MM SLFDRILL SCHANZ TITANIUM RAMUS BOTH IP/OP "$1,100.00" $814.00 $218.32 "$1,100.00" $495.00 $495.00 $495.00 $495.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.27 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $229.25 "$1,100.00" "$1,100.00" $650.65 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $495.00 $218.32 N/A $638.00 "$1,100.00" $660.00 "$1,100.00" $229.24 "$1,100.00" N/A N/A 04.305.142 SUP HCPCS C1713 04.305.142 - SCREW BONE 2.5/4MM 22MM SLFDRILL SCHANZ TITANIUM MANDIB BOTH IP/OP "$1,100.00" $814.00 $218.32 "$1,100.00" $495.00 $495.00 $495.00 $495.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.27 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $229.25 "$1,100.00" "$1,100.00" $650.65 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $495.00 $218.32 N/A $638.00 "$1,100.00" $660.00 "$1,100.00" $229.24 "$1,100.00" N/A N/A 04.307.001 SUP Custom 27803010 04.307.001 - FOOTPLATE BONE 40MM TITANIUM MAXL NONSTRL BOTH IP/OP "$1,277.50" $945.00 $227.40 "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" $227.40 "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" $266.25 "$1,277.50" $511.00 "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" "$1,277.50" $958.13 "$1,277.50" "$1,277.50" "$1,277.50" $638.75 $638.75 "$1,011.78" "$1,277.50" "$1,022.00" $574.88 "$1,277.50" N/A $740.95 "$1,277.50" $766.50 "$1,277.50" "$1,277.50" "$1,277.50" N/A N/A 04.307.008 SUP HCPCS C1713 04.307.008 - ROD FIX 80MM TITANIUM MAXL NONSTRL BOTH IP/OP $767.50 $568.00 $152.33 $767.50 $345.38 $345.38 $345.38 $345.38 $767.50 $767.50 $767.50 $159.97 $767.50 $767.50 $767.50 $767.50 $767.50 $159.96 $767.50 $767.50 $453.98 $767.50 $767.50 $767.50 $767.50 $575.63 $767.50 $767.50 $767.50 $383.75 $383.75 $607.86 $767.50 $614.00 $345.38 $152.33 N/A $445.15 $767.50 $460.50 $767.50 $159.95 $767.50 N/A N/A 04.307.108 SUP HCPCS C1713 04.307.108 - ROD FIX 80MM TALL OFFST TITANIUM MAXL NONSTRL BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $506.25 $506.25 $506.25 $506.25 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 $223.28 N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 04.307.111 SUP HCPCS C1713 04.307.111 - ROD FIX 110MM TALL OFFST TITANIUM MAXL NONSTRL BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $506.25 $506.25 $506.25 $506.25 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 $223.28 N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 04.315.000 SUP HCPCS C1713 04.315.000 - SCREW MACHINE 2.7MM TITANIUM CMF DISTRCT BOTH IP/OP $647.50 $479.00 $128.51 $647.50 $291.38 $291.38 $291.38 $291.38 $647.50 $647.50 $647.50 $134.96 $647.50 $647.50 $647.50 $647.50 $647.50 $134.95 $647.50 $647.50 $383.00 $647.50 $647.50 $647.50 $647.50 $485.63 $647.50 $647.50 $647.50 $323.75 $323.75 $512.82 $647.50 $518.00 $291.38 $128.51 N/A $375.55 $647.50 $388.50 $647.50 $134.94 $647.50 N/A N/A 04.315.001 SUP Custom 27803010 04.315.001 - CAP END REMOVABLE CMF DISTRCT BOTH IP/OP "$1,070.00" $792.00 $190.46 "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" $190.46 "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" $223.00 "$1,070.00" $428.00 "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" $802.50 "$1,070.00" "$1,070.00" "$1,070.00" $535.00 $535.00 $847.44 "$1,070.00" $856.00 $481.50 "$1,070.00" N/A $620.60 "$1,070.00" $642.00 "$1,070.00" "$1,070.00" "$1,070.00" N/A N/A 04.315.003 SUP Custom 27803010 04.315.003 - BODY DISTRCT 15MM END ACTIVATED TITANIUM MANDIB NONSTRL AB BOTH IP/OP "$11,330.00" "$8,384.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,361.30" "$11,330.00" "$4,532.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$8,497.50" "$11,330.00" "$11,330.00" "$11,330.00" "$5,665.00" "$5,665.00" "$8,973.36" "$11,330.00" "$9,064.00" "$5,098.50" "$11,330.00" N/A "$6,571.40" "$11,330.00" "$6,798.00" "$11,330.00" "$11,330.00" "$11,330.00" N/A N/A 04.315.004 SUP Custom 27803010 04.315.004 - BODY DISTRCT 20MM END ACTIVATED TITANIUM MANDIB NONSTRL AB BOTH IP/OP "$11,330.00" "$8,384.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,361.30" "$11,330.00" "$4,532.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$8,497.50" "$11,330.00" "$11,330.00" "$11,330.00" "$5,665.00" "$5,665.00" "$8,973.36" "$11,330.00" "$9,064.00" "$5,098.50" "$11,330.00" N/A "$6,571.40" "$11,330.00" "$6,798.00" "$11,330.00" "$11,330.00" "$11,330.00" N/A N/A 04.315.005 SUP Custom 27803010 04.315.005 - DISTRACTOR SURG 25MM AB JOINT BODIES END ACTIVATED TITANIUM BOTH IP/OP "$11,330.00" "$8,384.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,361.30" "$11,330.00" "$4,532.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$8,497.50" "$11,330.00" "$11,330.00" "$11,330.00" "$5,665.00" "$5,665.00" "$8,973.36" "$11,330.00" "$9,064.00" "$5,098.50" "$11,330.00" N/A "$6,571.40" "$11,330.00" "$6,798.00" "$11,330.00" "$11,330.00" "$11,330.00" N/A N/A 04.315.006 SUP Custom 27803010 04.315.006 - BODY DISTRCT 30MM END ACTIVATED TITANIUM MANDIB NONSTRL AB BOTH IP/OP "$11,330.00" "$8,384.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,361.30" "$11,330.00" "$4,532.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$8,497.50" "$11,330.00" "$11,330.00" "$11,330.00" "$5,665.00" "$5,665.00" "$8,973.36" "$11,330.00" "$9,064.00" "$5,098.50" "$11,330.00" N/A "$6,571.40" "$11,330.00" "$6,798.00" "$11,330.00" "$11,330.00" "$11,330.00" N/A N/A 04.315.023 SUP Custom 27803010 04.315.023 - DISTRACTOR SURG 15MM BODIES END TRANSLATING NONSTRL BC BOTH IP/OP "$11,330.00" "$8,384.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,361.30" "$11,330.00" "$4,532.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$8,497.50" "$11,330.00" "$11,330.00" "$11,330.00" "$5,665.00" "$5,665.00" "$8,973.36" "$11,330.00" "$9,064.00" "$5,098.50" "$11,330.00" N/A "$6,571.40" "$11,330.00" "$6,798.00" "$11,330.00" "$11,330.00" "$11,330.00" N/A N/A 04.315.024 SUP Custom 27803010 04.315.024 - BODY DISTRCT 20MM END ACTIVATED TITANIUM MANDIB NONSTRL BC BOTH IP/OP "$11,330.00" "$8,384.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,361.30" "$11,330.00" "$4,532.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$8,497.50" "$11,330.00" "$11,330.00" "$11,330.00" "$5,665.00" "$5,665.00" "$8,973.36" "$11,330.00" "$9,064.00" "$5,098.50" "$11,330.00" N/A "$6,571.40" "$11,330.00" "$6,798.00" "$11,330.00" "$11,330.00" "$11,330.00" N/A N/A 04.315.025 SUP Custom 27803010 04.315.025 - DISTRACTOR SURG 25MM BODY BOTH IP/OP "$11,330.00" "$8,384.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,361.30" "$11,330.00" "$4,532.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$8,497.50" "$11,330.00" "$11,330.00" "$11,330.00" "$5,665.00" "$5,665.00" "$8,973.36" "$11,330.00" "$9,064.00" "$5,098.50" "$11,330.00" N/A "$6,571.40" "$11,330.00" "$6,798.00" "$11,330.00" "$11,330.00" "$11,330.00" N/A N/A 04.315.026 SUP Custom 27803010 04.315.026 - DISTRACTOR SURG 30MM BC JOINT BODIES END ACTIVATED TITANIUM BOTH IP/OP "$11,330.00" "$8,384.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,361.30" "$11,330.00" "$4,532.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$8,497.50" "$11,330.00" "$11,330.00" "$11,330.00" "$5,665.00" "$5,665.00" "$8,973.36" "$11,330.00" "$9,064.00" "$5,098.50" "$11,330.00" N/A "$6,571.40" "$11,330.00" "$6,798.00" "$11,330.00" "$11,330.00" "$11,330.00" N/A N/A 04.315.027 SUP Custom 27803010 04.315.027 - BODY DISTRCT 35MM BODY END ACTIVATED TITANIUM MANDIB NONSTRL BOTH IP/OP "$11,330.00" "$8,384.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,361.30" "$11,330.00" "$4,532.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$8,497.50" "$11,330.00" "$11,330.00" "$11,330.00" "$5,665.00" "$5,665.00" "$8,973.36" "$11,330.00" "$9,064.00" "$5,098.50" "$11,330.00" N/A "$6,571.40" "$11,330.00" "$6,798.00" "$11,330.00" "$11,330.00" "$11,330.00" N/A N/A 04.315.028 SUP Custom 27803010 04.315.028 - BODY DISTRCT 40MM BODY END ACTIVATED TITANIUM MANDIB NONSTRL BOTH IP/OP "$11,330.00" "$8,384.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,016.74" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$2,361.30" "$11,330.00" "$4,532.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$11,330.00" "$8,497.50" "$11,330.00" "$11,330.00" "$11,330.00" "$5,665.00" "$5,665.00" "$8,973.36" "$11,330.00" "$9,064.00" "$5,098.50" "$11,330.00" N/A "$6,571.40" "$11,330.00" "$6,798.00" "$11,330.00" "$11,330.00" "$11,330.00" N/A N/A 04.315.053 SUP Custom 27803010 04.315.053 - BODY DISTRCT 15MM U JOINT BODY END ACTIVATED TITANIUM MANDIB BOTH IP/OP "$11,952.50" "$8,845.00" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,491.03" "$11,952.50" "$4,781.00" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$8,964.38" "$11,952.50" "$11,952.50" "$11,952.50" "$5,976.25" "$5,976.25" "$9,466.38" "$11,952.50" "$9,562.00" "$5,378.63" "$11,952.50" N/A "$6,932.45" "$11,952.50" "$7,171.50" "$11,952.50" "$11,952.50" "$11,952.50" N/A N/A 04.315.054 SUP Custom 27803010 04.315.054 - DISTRACTOR SURG 20MM U JOINT BODIES END ACTIVATED TITANIUM BOTH IP/OP "$11,952.50" "$8,845.00" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,491.03" "$11,952.50" "$4,781.00" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$8,964.38" "$11,952.50" "$11,952.50" "$11,952.50" "$5,976.25" "$5,976.25" "$9,466.38" "$11,952.50" "$9,562.00" "$5,378.63" "$11,952.50" N/A "$6,932.45" "$11,952.50" "$7,171.50" "$11,952.50" "$11,952.50" "$11,952.50" N/A N/A 04.315.055 SUP Custom 27803010 04.315.055 - BODY DISTRCT 25MM U JOINT BODY END ACTIVATED TITANIUM MANDIB BOTH IP/OP "$11,952.50" "$8,845.00" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,491.03" "$11,952.50" "$4,781.00" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$8,964.38" "$11,952.50" "$11,952.50" "$11,952.50" "$5,976.25" "$5,976.25" "$9,466.38" "$11,952.50" "$9,562.00" "$5,378.63" "$11,952.50" N/A "$6,932.45" "$11,952.50" "$7,171.50" "$11,952.50" "$11,952.50" "$11,952.50" N/A N/A 04.315.056 SUP Custom 27803010 04.315.056 - BODY DISTRCT 30MM END ACTIVATED A AND B STYLE FOOTPLATE U BOTH IP/OP "$11,952.50" "$8,845.00" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,491.03" "$11,952.50" "$4,781.00" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$8,964.38" "$11,952.50" "$11,952.50" "$11,952.50" "$5,976.25" "$5,976.25" "$9,466.38" "$11,952.50" "$9,562.00" "$5,378.63" "$11,952.50" N/A "$6,932.45" "$11,952.50" "$7,171.50" "$11,952.50" "$11,952.50" "$11,952.50" N/A N/A 04.315.063 SUP Custom 27803010 04.315.063 - DISTRACTOR SURG 15MM BODIES END ACTIVATED U JOINT TITANIUM BOTH IP/OP "$11,952.50" "$8,845.00" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,491.03" "$11,952.50" "$4,781.00" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$8,964.38" "$11,952.50" "$11,952.50" "$11,952.50" "$5,976.25" "$5,976.25" "$9,466.38" "$11,952.50" "$9,562.00" "$5,378.63" "$11,952.50" N/A "$6,932.45" "$11,952.50" "$7,171.50" "$11,952.50" "$11,952.50" "$11,952.50" N/A N/A 04.315.064 SUP Custom 27803010 04.315.064 - DISTRACTOR SURG 20MM BODIES END ACTIVATED U JOINT TITANIUM BOTH IP/OP "$11,952.50" "$8,845.00" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,491.03" "$11,952.50" "$4,781.00" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$8,964.38" "$11,952.50" "$11,952.50" "$11,952.50" "$5,976.25" "$5,976.25" "$9,466.38" "$11,952.50" "$9,562.00" "$5,378.63" "$11,952.50" N/A "$6,932.45" "$11,952.50" "$7,171.50" "$11,952.50" "$11,952.50" "$11,952.50" N/A N/A 04.315.065 SUP Custom 27803010 04.315.065 - DISTRACTOR SURG 25MM U JOINT BODY BOTH IP/OP "$11,952.50" "$8,845.00" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,491.03" "$11,952.50" "$4,781.00" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$8,964.38" "$11,952.50" "$11,952.50" "$11,952.50" "$5,976.25" "$5,976.25" "$9,466.38" "$11,952.50" "$9,562.00" "$5,378.63" "$11,952.50" N/A "$6,932.45" "$11,952.50" "$7,171.50" "$11,952.50" "$11,952.50" "$11,952.50" N/A N/A 04.315.066 SUP Custom 27803010 04.315.066 - DISTRACTOR SURG 30MM NONSTRL BOTH IP/OP "$11,952.50" "$8,845.00" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,491.03" "$11,952.50" "$4,781.00" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$8,964.38" "$11,952.50" "$11,952.50" "$11,952.50" "$5,976.25" "$5,976.25" "$9,466.38" "$11,952.50" "$9,562.00" "$5,378.63" "$11,952.50" N/A "$6,932.45" "$11,952.50" "$7,171.50" "$11,952.50" "$11,952.50" "$11,952.50" N/A N/A 04.315.067 SUP Custom 27803010 04.315.067 - BODY DISTRCT 35MM END ACTIVATED B AND C STYLE FOOTPLATE U BOTH IP/OP "$11,952.50" "$8,845.00" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,491.03" "$11,952.50" "$4,781.00" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$8,964.38" "$11,952.50" "$11,952.50" "$11,952.50" "$5,976.25" "$5,976.25" "$9,466.38" "$11,952.50" "$9,562.00" "$5,378.63" "$11,952.50" N/A "$6,932.45" "$11,952.50" "$7,171.50" "$11,952.50" "$11,952.50" "$11,952.50" N/A N/A 04.315.068 SUP Custom 27803010 04.315.068 - BODY DISTRCT 40MM END ACTIVATED B AND C STYLE FOOTPLATE U BOTH IP/OP "$11,952.50" "$8,845.00" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,127.55" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$2,491.03" "$11,952.50" "$4,781.00" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$11,952.50" "$8,964.38" "$11,952.50" "$11,952.50" "$11,952.50" "$5,976.25" "$5,976.25" "$9,466.38" "$11,952.50" "$9,562.00" "$5,378.63" "$11,952.50" N/A "$6,932.45" "$11,952.50" "$7,171.50" "$11,952.50" "$11,952.50" "$11,952.50" N/A N/A 04.315.104 SUP Custom 27203010 04.315.104 - ARM DISTRCT 20MM EXTN RIGID BOTH IP/OP "$2,282.50" "$1,689.00" $406.29 "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" $406.29 "$2,282.50" "$2,282.50" "$1,694.07" "$1,694.07" "$1,759.35" "$1,189.18" $475.70 "$2,282.50" $913.00 "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$1,711.88" "$2,282.50" "$2,282.50" "$2,282.50" "$1,141.25" "$1,141.25" "$1,807.74" "$2,282.50" "$1,826.00" "$1,483.63" "$2,282.50" N/A "$1,323.85" "$2,282.50" "$1,369.50" "$2,282.50" "$2,282.50" "$2,282.50" N/A N/A 04.315.108 SUP Custom 27203010 04.315.108 - SET EXTN 40MM REMOVABLE RIGID ARM NONSTRL BOTH IP/OP "$2,282.50" "$1,689.00" $406.29 "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" $406.29 "$2,282.50" "$2,282.50" "$1,694.07" "$1,694.07" "$1,759.35" "$1,189.18" $475.70 "$2,282.50" $913.00 "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$1,711.88" "$2,282.50" "$2,282.50" "$2,282.50" "$1,141.25" "$1,141.25" "$1,807.74" "$2,282.50" "$1,826.00" "$1,483.63" "$2,282.50" N/A "$1,323.85" "$2,282.50" "$1,369.50" "$2,282.50" "$2,282.50" "$2,282.50" N/A N/A 04.315.112 SUP Custom 27803010 04.315.112 - ARM EXTN 60MM RIGID REMOVAL TITANIUM COCR SILICONE NONSTRL BOTH IP/OP "$2,282.50" "$1,689.00" $406.29 "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" $406.29 "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" $475.70 "$2,282.50" $913.00 "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$2,282.50" "$1,711.88" "$2,282.50" "$2,282.50" "$2,282.50" "$1,141.25" "$1,141.25" "$1,807.74" "$2,282.50" "$1,826.00" "$1,027.13" "$2,282.50" N/A "$1,323.85" "$2,282.50" "$1,369.50" "$2,282.50" "$2,282.50" "$2,282.50" N/A N/A 04.315.125 SUP Custom 27203010 04.315.125 - SET EXTN 30MM FLEXIBLE REMOVABLE ARM BOTH IP/OP "$2,700.00" "$1,998.00" $480.60 "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" $480.60 "$2,700.00" "$2,700.00" "$2,003.94" "$2,003.94" "$2,081.16" "$1,406.70" $562.71 "$2,700.00" "$1,080.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,025.00" "$2,700.00" "$2,700.00" "$2,700.00" "$1,350.00" "$1,350.00" "$2,138.40" "$2,700.00" "$2,160.00" "$1,755.00" "$2,700.00" N/A "$1,566.00" "$2,700.00" "$1,620.00" "$2,700.00" "$2,700.00" "$2,700.00" N/A N/A 04.315.127 SUP Custom 27203010 04.315.127 - SET EXTN 40MM FLEXIBLE REMOVABLE ARM BOTH IP/OP "$2,700.00" "$1,998.00" $480.60 "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" $480.60 "$2,700.00" "$2,700.00" "$2,003.94" "$2,003.94" "$2,081.16" "$1,406.70" $562.71 "$2,700.00" "$1,080.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,025.00" "$2,700.00" "$2,700.00" "$2,700.00" "$1,350.00" "$1,350.00" "$2,138.40" "$2,700.00" "$2,160.00" "$1,755.00" "$2,700.00" N/A "$1,566.00" "$2,700.00" "$1,620.00" "$2,700.00" "$2,700.00" "$2,700.00" N/A N/A 04.315.132 SUP Custom 27203010 04.315.132 - ARM DISTRCT 60MM EXTN FLEXIBLE REMOVABLE TITANIUM NONSTRL BOTH IP/OP "$2,700.00" "$1,998.00" $480.60 "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" $480.60 "$2,700.00" "$2,700.00" "$2,003.94" "$2,003.94" "$2,081.16" "$1,406.70" $562.71 "$2,700.00" "$1,080.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,025.00" "$2,700.00" "$2,700.00" "$2,700.00" "$1,350.00" "$1,350.00" "$2,138.40" "$2,700.00" "$2,160.00" "$1,755.00" "$2,700.00" N/A "$1,566.00" "$2,700.00" "$1,620.00" "$2,700.00" "$2,700.00" "$2,700.00" N/A N/A 04.315.201 SUP Custom 27803010 04.315.201 - COMPONENT DISTRCT 1MM A TYPE MESH FEET TITANIUM MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.202 SUP Custom 27803010 04.315.202 - COMPONENT DISTRCT 1MM MESH FT B TYPE INTERNAL MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.203 SUP Custom 27803010 04.315.203 - COMPONENT DISTRCT 1MM MESH FT C TYPE INTERNAL MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.211 SUP Custom 27803010 04.315.211 - FOOTPLATE BONE TYPE B CLOVERLEAF GREEN TITANIUM MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.212 SUP Custom 27803010 04.315.212 - FOOTPLATE BONE CLOVERLEAF B TYPE INTERNAL MANDIB 1 MM SCREW BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.213 SUP Custom 27803010 04.315.213 - FOOTPLATE BONE MESH C TYPE INTERNAL MANDIB 1 MM SCREW BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.301 SUP Custom 27803010 04.315.301 - FOOTPLATE BONE TYPE A MESH PINK TITANIUM MANDIB NONSTRL 1.5 BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.302 SUP HCPCS C1713 04.315.302 - FOOTPLATE BONE B TYPE MESH TITANIUM MANDIB NONSTRL CMF BOTH IP/OP "$2,130.00" "$1,576.00" $422.75 "$2,130.00" $958.50 $958.50 $958.50 $958.50 "$2,130.00" "$2,130.00" "$2,130.00" $443.95 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" "$2,130.00" "$1,259.90" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 $422.75 N/A "$1,235.40" "$2,130.00" "$2,130.00" "$2,130.00" $443.89 "$2,130.00" N/A N/A 04.315.303 SUP HCPCS C1713 04.315.303 - FOOTPLATE BONE C TYPE MESH TITANIUM MANDIB NONSTRL CMF BOTH IP/OP "$2,130.00" "$1,576.00" $422.75 "$2,130.00" $958.50 $958.50 $958.50 $958.50 "$2,130.00" "$2,130.00" "$2,130.00" $443.95 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" "$2,130.00" "$1,259.90" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 $422.75 N/A "$1,235.40" "$2,130.00" "$2,130.00" "$2,130.00" $443.89 "$2,130.00" N/A N/A 04.315.311 SUP Custom 27803010 04.315.311 - FOOTPLATE BONE TYPE A CLOVERLEAF PINK TITANIUM MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.312 SUP Custom 27803010 04.315.312 - FOOTPLATE BONE TYPE B CLOVERLEAF PINK TITANIUM MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.313 SUP Custom 27803010 04.315.313 - FOOTPLATE BONE TYPE C CLOVERLEAF PINK TITANIUM MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.321 SUP Custom 27803010 04.315.321 - FOOTPLATE BONE 5.5MM TYPE B ELEVATED MESH OFFST PINK BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.322 SUP Custom 27803010 04.315.322 - FOOTPLATE BONE 7.5MM TYPE B ELEVATED MESH OFFST PINK BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.323 SUP Custom 27803010 04.315.323 - FOOTPLATE BONE TYPE C ELEVATED MESH OFFST PINK TITANIUM BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.401 SUP Custom 27803010 04.315.401 - FOOTPLATE BONE TYPE A MESH BLUE TITANIUM MANDIB NONSTRL 2MM BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.402 SUP Custom 27803010 04.315.402 - FOOTPLATE BONE TYPE B MESH BLUE TITANIUM MANDIB NONSTRL 2MM BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.403 SUP Custom 27803010 04.315.403 - FOOTPLATE BONE TYPE C MESH BLUE TITANIUM MANDIB NONSTRL 2MM BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.411 SUP Custom 27803010 04.315.411 - FOOTPLATE BONE TYPE A CLOVERLEAF BLUE TITANIUM MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.412 SUP Custom 27803010 04.315.412 - FOOTPLATE BONE TYPE B CLOVERLEAF BLUE TITANIUM MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.413 SUP Custom 27803010 04.315.413 - FOOTPLATE BONE TYPE C CLOVERLEAF BLUE TITANIUM MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.421 SUP Custom 27803010 04.315.421 - FOOTPLATE BONE 5.5MM TYPE B MESH OFFST BLUE TITANIUM MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.422 SUP Custom 27803010 04.315.422 - FOOTPLATE BONE 7.5MM TYPE C MESH OFFST BLUE TITANIUM MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.423 SUP Custom 27803010 04.315.423 - FOOTPLATE BONE TYPE C MESH OFFST BLUE TITANIUM MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.501 SUP Custom 27803010 04.315.501 - FOOTPLATE BONE TYPE A MESH YELLOW TITANIUM MANDIB NONSTRL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.502 SUP Custom 27803010 04.315.502 - COMPONENT DISTRCT 1.3MM MESH FEET INTERNAL B TYPE MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.503 SUP Custom 27803010 04.315.503 - COMPONENT DISTRCT 1.3MM MESH FEET C TYPE INTERNAL MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.511 SUP Custom 27803010 04.315.511 - FOOTPLATE BONE TYPE A CLOVERLEAF YELLOW TITANIUM MANDIB BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 04.315.512 SUP HCPCS C1713 04.315.512 - PLATE BONE B MANDIB NONSTRL 1.3 MM SCREWS BOTH IP/OP "$2,130.00" "$1,576.00" $422.75 "$2,130.00" $958.50 $958.50 $958.50 $958.50 "$2,130.00" "$2,130.00" "$2,130.00" $443.95 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" "$2,130.00" "$1,259.90" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 $422.75 N/A "$1,235.40" "$2,130.00" "$2,130.00" "$2,130.00" $443.89 "$2,130.00" N/A N/A 04.315.513 SUP HCPCS C1713 04.315.513 - PLATE BONE C MANDIB NONSTRL 1.3 MM SCREWS BOTH IP/OP "$2,130.00" "$1,576.00" $422.75 "$2,130.00" $958.50 $958.50 $958.50 $958.50 "$2,130.00" "$2,130.00" "$2,130.00" $443.95 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" "$2,130.00" "$1,259.90" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 $422.75 N/A "$1,235.40" "$2,130.00" "$2,130.00" "$2,130.00" $443.89 "$2,130.00" N/A N/A 04.402.007S SUP HCPCS C1713 04.402.007S - STEM RADIAL STR 7MM 26MM TITANIUM STERILE BOTH IP/OP "$3,286.50" "$2,432.00" $652.25 "$3,286.33" "$1,478.85" "$1,478.85" "$1,478.85" "$1,478.85" "$3,286.33" "$3,286.33" "$3,286.33" $684.95 "$3,286.33" "$3,286.33" "$3,286.33" "$3,286.33" "$3,286.33" $684.91 "$3,286.33" "$1,314.53" "$1,620.16" "$3,286.33" "$3,286.33" "$3,286.33" "$3,286.33" "$2,464.88" "$3,286.33" "$3,286.33" "$3,286.33" "$1,643.17" "$1,643.17" "$2,602.77" "$3,286.33" "$2,629.06" "$1,478.85" $652.25 N/A "$1,906.17" "$3,286.33" "$3,286.33" "$3,286.33" $684.87 "$3,286.33" N/A N/A 04.449.000 SUP HCPCS C1713 04.449.000 - HEAD SCREW TITANIUM CONDYLE NONSTRL BOTH IP/OP "$6,745.50" "$4,992.00" "$1,338.81" "$6,745.50" "$3,035.48" "$3,035.48" "$3,035.48" "$3,035.48" "$6,745.50" "$6,745.50" "$6,745.50" "$1,405.93" "$6,745.50" "$6,745.50" "$6,745.50" "$6,745.50" "$6,745.50" "$1,405.84" "$6,745.50" "$6,745.50" "$3,325.53" "$6,745.50" "$6,745.50" "$6,745.50" "$6,745.50" "$5,059.13" "$6,745.50" "$6,745.50" "$6,745.50" "$3,372.75" "$3,372.75" "$5,342.44" "$6,745.50" "$5,396.40" "$3,035.48" "$1,338.81" N/A "$3,912.39" "$6,745.50" "$6,745.50" "$6,745.50" "$1,405.76" "$6,745.50" N/A N/A 04.449.010 SUP HCPCS C1713 04.449.010 - PLATE BONE 0MM LOCKING CNDYLR HEAD RECONSTRUCTION TITANIUM BOTH IP/OP $772.00 $571.00 $153.17 $771.75 $347.29 $347.29 $347.29 $347.29 $771.75 $771.75 $771.75 $160.85 $771.75 $771.75 $771.75 $771.75 $771.75 $160.84 $771.75 $771.75 $456.49 $771.75 $771.75 $771.75 $771.75 $579.00 $771.75 $771.75 $771.75 $385.88 $385.88 $611.23 $771.75 $617.40 $347.29 $153.17 N/A $447.76 $771.75 $771.75 $771.75 $160.83 $771.75 N/A N/A 04.449.020 SUP HCPCS C1713 04.449.020 - PLATE BONE 2MM LOCKING CNDYLR HEAD RECONSTRUCTION TITANIUM BOTH IP/OP $772.00 $571.00 $153.17 $771.75 $347.29 $347.29 $347.29 $347.29 $771.75 $771.75 $771.75 $160.85 $771.75 $771.75 $771.75 $771.75 $771.75 $160.84 $771.75 $771.75 $456.49 $771.75 $771.75 $771.75 $771.75 $579.00 $771.75 $771.75 $771.75 $385.88 $385.88 $611.23 $771.75 $617.40 $347.29 $153.17 N/A $447.76 $771.75 $771.75 $771.75 $160.83 $771.75 N/A N/A 04.449.030 SUP HCPCS C1713 04.449.030 - PLATE BONE 4MM LOCKING CNDYLR HEAD RECONSTRUCTION TITANIUM BOTH IP/OP $772.00 $571.00 $153.17 $771.75 $347.29 $347.29 $347.29 $347.29 $771.75 $771.75 $771.75 $160.85 $771.75 $771.75 $771.75 $771.75 $771.75 $160.84 $771.75 $771.75 $456.49 $771.75 $771.75 $771.75 $771.75 $579.00 $771.75 $771.75 $771.75 $385.88 $385.88 $611.23 $771.75 $617.40 $347.29 $153.17 N/A $447.76 $771.75 $771.75 $771.75 $160.83 $771.75 N/A N/A 04.449.040 SUP HCPCS C1713 04.449.040 - PLATE BONE 6MM LOCKING CNDYLR HEAD RECONSTRUCTION TITANIUM BOTH IP/OP $772.00 $571.00 $153.17 $771.75 $347.29 $347.29 $347.29 $347.29 $771.75 $771.75 $771.75 $160.85 $771.75 $771.75 $771.75 $771.75 $771.75 $160.84 $771.75 $771.75 $456.49 $771.75 $771.75 $771.75 $771.75 $579.00 $771.75 $771.75 $771.75 $385.88 $385.88 $611.23 $771.75 $617.40 $347.29 $153.17 N/A $447.76 $771.75 $771.75 $771.75 $160.83 $771.75 N/A N/A 04.497.000 SUP HCPCS C1713 04.497.000 - SCREW BONE HEAD TITANIUM CONDYLE NONSTRL BOTH IP/OP $328.50 $243.00 $65.20 $328.50 $147.83 $147.83 $147.83 $147.83 $328.50 $328.50 $328.50 $68.47 $328.50 $328.50 $328.50 $328.50 $328.50 $68.46 $328.50 $328.50 $194.31 $328.50 $328.50 $328.50 $328.50 $246.38 $328.50 $328.50 $328.50 $164.25 $164.25 $260.17 $328.50 $262.80 $147.83 $65.20 N/A $190.53 $328.50 $328.50 $328.50 $68.46 $328.50 N/A N/A 04.497.001 SUP HCPCS C1713 04.497.001 - SCREW BONE SLOTTED HEAD MTRXMAND TITANIUM CONDYLE NONSTRL BOTH IP/OP $385.00 $285.00 $76.36 $384.75 $173.14 $173.14 $173.14 $173.14 $384.75 $384.75 $384.75 $80.19 $384.75 $384.75 $384.75 $384.75 $384.75 $80.19 $384.75 $384.75 $227.58 $384.75 $384.75 $384.75 $384.75 $288.75 $384.75 $384.75 $384.75 $192.38 $192.38 $304.72 $384.75 $307.80 $173.14 $76.36 N/A $223.30 $384.75 $384.75 $384.75 $80.18 $384.75 N/A N/A 04.500.000 SUP HCPCS C1713 04.500.000 - ROD FIX 110MM TITANIUM MAXL NONSTRL BOTH IP/OP $767.50 $568.00 $152.33 $767.50 $345.38 $345.38 $345.38 $345.38 $767.50 $767.50 $767.50 $159.97 $767.50 $767.50 $767.50 $767.50 $767.50 $159.96 $767.50 $767.50 $453.98 $767.50 $767.50 $767.50 $767.50 $575.63 $767.50 $767.50 $767.50 $383.75 $383.75 $607.86 $767.50 $614.00 $345.38 $152.33 N/A $445.15 $767.50 $767.50 $767.50 $159.95 $767.50 N/A N/A 04.500.001 SUP HCPCS C1713 04.500.001 - SCREW SURG DISTRCT EXTERNAL TITANIUM MAXILLOMANDIBULAR BOTH IP/OP $290.00 $215.00 $57.56 $290.00 $130.50 $130.50 $130.50 $130.50 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $290.00 $290.00 $290.00 $60.44 $290.00 $290.00 $171.54 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $130.50 $57.56 N/A $168.20 $290.00 $290.00 $290.00 $60.44 $290.00 N/A N/A 04.500.002 SUP HCPCS C1713 04.500.002 - SCREW BONE 27MM SLFDRILL WIRE FIX TITANIUM MANDIB NONSTRL BOTH IP/OP $347.50 $257.00 $68.97 $347.50 $156.38 $156.38 $156.38 $156.38 $347.50 $347.50 $347.50 $72.43 $347.50 $347.50 $347.50 $347.50 $347.50 $72.42 $347.50 $347.50 $205.55 $347.50 $347.50 $347.50 $347.50 $260.63 $347.50 $347.50 $347.50 $173.75 $173.75 $275.22 $347.50 $278.00 $156.38 $68.97 N/A $201.55 $347.50 $347.50 $347.50 $72.42 $347.50 N/A N/A 04.500.006 SUP HCPCS C1713 04.500.006 - ANCHOR SCREW 6MM ANCHORAGE SLFDRILL TITANIUM ORTHODONTIC BOTH IP/OP $274.50 $203.00 $54.48 $274.50 $123.53 $123.53 $123.53 $123.53 $274.50 $274.50 $274.50 $57.21 $274.50 $274.50 $274.50 $274.50 $274.50 $57.21 $274.50 $274.50 $162.37 $274.50 $274.50 $274.50 $274.50 $205.88 $274.50 $274.50 $274.50 $137.25 $137.25 $217.40 $274.50 $219.60 $123.53 $54.48 N/A $159.21 $274.50 $274.50 $274.50 $57.21 $274.50 N/A N/A 04.500.008 SUP HCPCS C1713 04.500.008 - ANCHOR SCREW 8MM SLFDRILL TITANIUM ORTHODONTIC BONE NONSTRL BOTH IP/OP $274.50 $203.00 $54.48 $274.50 $123.53 $123.53 $123.53 $123.53 $274.50 $274.50 $274.50 $57.21 $274.50 $274.50 $274.50 $274.50 $274.50 $57.21 $274.50 $274.50 $162.37 $274.50 $274.50 $274.50 $274.50 $205.88 $274.50 $274.50 $274.50 $137.25 $137.25 $217.40 $274.50 $219.60 $123.53 $54.48 N/A $159.21 $274.50 $274.50 $274.50 $57.21 $274.50 N/A N/A 04.500.010 SUP HCPCS C1713 04.500.010 - SCREW ANCHOR 10MM ANCHOR SLFTAP TITANIUM OBA BOTH IP/OP $274.50 $203.00 $54.48 $274.50 $123.53 $123.53 $123.53 $123.53 $274.50 $274.50 $274.50 $57.21 $274.50 $274.50 $274.50 $274.50 $274.50 $57.21 $274.50 $274.50 $162.37 $274.50 $274.50 $274.50 $274.50 $205.88 $274.50 $274.50 $274.50 $137.25 $137.25 $217.40 $274.50 $219.60 $123.53 $54.48 N/A $159.21 $274.50 $274.50 $274.50 $57.21 $274.50 N/A N/A 04.500.012 SUP HCPCS C1713 04.500.012 - PLATE ANCHOR 4 HOLE BRACKET DESIGN TITANIUM MIDFAC NONSTRL BOTH IP/OP $484.00 $358.00 $96.01 $483.75 $217.69 $217.69 $217.69 $217.69 $483.75 $483.75 $483.75 $100.83 $483.75 $483.75 $483.75 $483.75 $483.75 $100.82 $483.75 $483.75 $286.14 $483.75 $483.75 $483.75 $483.75 $363.00 $483.75 $483.75 $483.75 $241.88 $241.88 $383.13 $483.75 $387.00 $217.69 $96.01 N/A $280.72 $483.75 $483.75 $483.75 $100.81 $483.75 N/A N/A 04.500.013 SUP HCPCS C1713 04.500.013 - PLATE ANCHOR 4 HOLE DOMED DESIGN TITANIUM BOTH IP/OP $484.00 $358.00 $96.01 $483.75 $217.69 $217.69 $217.69 $217.69 $483.75 $483.75 $483.75 $100.83 $483.75 $483.75 $483.75 $483.75 $483.75 $100.82 $483.75 $483.75 $286.14 $483.75 $483.75 $483.75 $483.75 $363.00 $483.75 $483.75 $483.75 $241.88 $241.88 $383.13 $483.75 $387.00 $217.69 $96.01 N/A $280.72 $483.75 $483.75 $483.75 $100.81 $483.75 N/A N/A 04.500.014 SUP HCPCS C1713 04.500.014 - PLATE BONE 4 HOLE ANCHOR MESH PAD DESIGN TITANIUM BOTH IP/OP $484.00 $358.00 $96.01 $483.75 $217.69 $217.69 $217.69 $217.69 $483.75 $483.75 $483.75 $100.83 $483.75 $483.75 $483.75 $483.75 $483.75 $100.82 $483.75 $483.75 $286.14 $483.75 $483.75 $483.75 $483.75 $363.00 $483.75 $483.75 $483.75 $241.88 $241.88 $383.13 $483.75 $387.00 $217.69 $96.01 N/A $280.72 $483.75 $483.75 $483.75 $100.81 $483.75 N/A N/A 04.500.015 SUP HCPCS C1713 04.500.015 - PLATE ANCHOR 5 HOLE BRACKET DESIGN TITANIUM MIDFAC NONSTRL BOTH IP/OP $484.00 $358.00 $96.01 $483.75 $217.69 $217.69 $217.69 $217.69 $483.75 $483.75 $483.75 $100.83 $483.75 $483.75 $483.75 $483.75 $483.75 $100.82 $483.75 $483.75 $286.14 $483.75 $483.75 $483.75 $483.75 $363.00 $483.75 $483.75 $483.75 $241.88 $241.88 $383.13 $483.75 $387.00 $217.69 $96.01 N/A $280.72 $483.75 $483.75 $483.75 $100.81 $483.75 N/A N/A 04.500.016 SUP HCPCS C1713 04.500.016 - PLATE ANCHOR 5 HOLE DOMED DESIGN TITANIUM BOTH IP/OP $484.00 $358.00 $96.01 $483.75 $217.69 $217.69 $217.69 $217.69 $483.75 $483.75 $483.75 $100.83 $483.75 $483.75 $483.75 $483.75 $483.75 $100.82 $483.75 $483.75 $286.14 $483.75 $483.75 $483.75 $483.75 $363.00 $483.75 $483.75 $483.75 $241.88 $241.88 $383.13 $483.75 $387.00 $217.69 $96.01 N/A $280.72 $483.75 $483.75 $483.75 $483.75 $483.75 N/A N/A 04.500.017 SUP HCPCS C1713 04.500.017 - PLATE BONE 5 HOLE ANCHOR MESH PAD DESIGN TITANIUM BOTH IP/OP $484.00 $358.00 $96.01 $483.75 $217.69 $217.69 $217.69 $217.69 $483.75 $483.75 $483.75 $100.83 $483.75 $483.75 $483.75 $483.75 $483.75 $100.82 $483.75 $483.75 $286.14 $483.75 $483.75 $483.75 $483.75 $363.00 $483.75 $483.75 $483.75 $241.88 $241.88 $383.13 $483.75 $387.00 $217.69 $96.01 N/A $280.72 $483.75 $290.25 $483.75 $100.81 $483.75 N/A N/A 04.500.018 SUP Custom 27803010 04.500.018 - BODY DISTRCT 100MM RAD STR CURVILINEAR TITANIUM MANDIB BOTH IP/OP "$16,962.50" "$12,552.00" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,535.17" "$16,962.50" "$6,785.00" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$12,721.88" "$16,962.50" "$16,962.50" "$16,962.50" "$8,481.25" "$8,481.25" "$13,434.30" "$16,962.50" "$13,570.00" "$7,633.13" "$16,962.50" N/A "$9,838.25" "$16,962.50" "$10,177.50" "$16,962.50" "$16,962.50" "$16,962.50" N/A N/A 04.500.024.01 SUP HCPCS C1713 04.500.024.01 - SCREW BONE 4MM SLFDRILL TITANIUM CRANIOMAXILLOFACIAL NONSTRL BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 04.500.026.01 SUP HCPCS C1713 04.500.026.01 - SCREW BONE 6MM SLFDRILL TITANIUM CRANIOMAXILLOFACIAL NONSTRL BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 04.500.028.01 SUP HCPCS C1713 04.500.028.01 - SCREW BONE 8MM SLFDRILL PLATE ANCHOR ORTHODONTIC TITANIUM BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 04.500.034.01 SUP HCPCS C1713 04.500.034.01 - SCREW BONE 4MM ORTHODONTIC EMERGENCY TITANIUM MAXFACL BOTH IP/OP $215.00 $159.00 $42.65 $214.88 $96.70 $96.70 $96.70 $96.70 $214.88 $214.88 $214.88 $44.79 $214.88 $214.88 $214.88 $214.88 $214.88 $44.78 $214.88 $214.88 $127.10 $214.88 $214.88 $214.88 $214.88 $161.25 $214.88 $214.88 $214.88 $107.44 $107.44 $170.18 $214.88 $171.90 $96.70 $42.65 N/A $124.70 $214.88 $128.93 $214.88 $44.78 $214.88 N/A N/A 04.500.036.01 SUP HCPCS C1713 04.500.036.01 - SCREW BONE 6MM ORTHODONTIC EMERGENCY TITANIUM BOTH IP/OP $215.00 $159.00 $42.65 $214.88 $96.70 $96.70 $96.70 $96.70 $214.88 $214.88 $214.88 $44.79 $214.88 $214.88 $214.88 $214.88 $214.88 $44.78 $214.88 $214.88 $127.10 $214.88 $214.88 $214.88 $214.88 $161.25 $214.88 $214.88 $214.88 $107.44 $107.44 $170.18 $214.88 $171.90 $96.70 $42.65 N/A $124.70 $214.88 $214.88 $214.88 $44.78 $214.88 N/A N/A 04.500.038.01 SUP HCPCS C1713 04.500.038.01 - SCREW BONE 8MM EMERGENCY TITANIUM MAXFACL BOTH IP/OP $215.00 $159.00 $42.65 $214.88 $96.70 $96.70 $96.70 $96.70 $214.88 $214.88 $214.88 $44.79 $214.88 $214.88 $214.88 $214.88 $214.88 $44.78 $214.88 $214.88 $127.10 $214.88 $214.88 $214.88 $214.88 $161.25 $214.88 $214.88 $214.88 $107.44 $107.44 $170.18 $214.88 $171.90 $96.70 $42.65 N/A $124.70 $214.88 $214.88 $214.88 $44.78 $214.88 N/A N/A 04.500.100 SUP Custom 27803010 04.500.100 - BODY DSTRCT 100MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK BOTH IP/OP "$16,962.50" "$12,552.00" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,535.17" "$16,962.50" "$6,785.00" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$12,721.88" "$16,962.50" "$16,962.50" "$16,962.50" "$8,481.25" "$8,481.25" "$13,434.30" "$16,962.50" "$13,570.00" "$7,633.13" "$16,962.50" N/A "$9,838.25" "$16,962.50" "$10,177.50" "$16,962.50" "$16,962.50" "$16,962.50" N/A N/A 04.500.101 SUP Custom 27803010 04.500.101 - BODY DSTRCT 100MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK BOTH IP/OP "$16,962.50" "$12,552.00" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,535.17" "$16,962.50" "$6,785.00" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$12,721.88" "$16,962.50" "$16,962.50" "$16,962.50" "$8,481.25" "$8,481.25" "$13,434.30" "$16,962.50" "$13,570.00" "$7,633.13" "$16,962.50" N/A "$9,838.25" "$16,962.50" "$10,177.50" "$16,962.50" "$16,962.50" "$16,962.50" N/A N/A 04.500.130 SUP Custom 27803010 04.500.130 - BODY DSTRCT 30MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK BOTH IP/OP "$16,962.50" "$12,552.00" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,535.17" "$16,962.50" "$6,785.00" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$12,721.88" "$16,962.50" "$16,962.50" "$16,962.50" "$8,481.25" "$8,481.25" "$13,434.30" "$16,962.50" "$13,570.00" "$7,633.13" "$16,962.50" N/A "$9,838.25" "$16,962.50" "$10,177.50" "$16,962.50" "$16,962.50" "$16,962.50" N/A N/A 04.500.131 SUP Custom 27803010 04.500.131 - BODY DSTRCT 30MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK BOTH IP/OP "$16,962.50" "$12,552.00" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,535.17" "$16,962.50" "$6,785.00" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$12,721.88" "$16,962.50" "$16,962.50" "$16,962.50" "$8,481.25" "$8,481.25" "$13,434.30" "$16,962.50" "$13,570.00" "$7,633.13" "$16,962.50" N/A "$9,838.25" "$16,962.50" "$10,177.50" "$16,962.50" "$16,962.50" "$16,962.50" N/A N/A 04.500.140 SUP Custom 27803010 04.500.140 - BODY DSTRCT 40MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK BOTH IP/OP "$16,962.50" "$12,552.00" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,535.17" "$16,962.50" "$6,785.00" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$12,721.88" "$16,962.50" "$16,962.50" "$16,962.50" "$8,481.25" "$8,481.25" "$13,434.30" "$16,962.50" "$13,570.00" "$7,633.13" "$16,962.50" N/A "$9,838.25" "$16,962.50" "$10,177.50" "$16,962.50" "$16,962.50" "$16,962.50" N/A N/A 04.500.141 SUP Custom 27803010 04.500.141 - BODY DSTRCT 40MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK BOTH IP/OP "$16,962.50" "$12,552.00" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,535.17" "$16,962.50" "$6,785.00" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$12,721.88" "$16,962.50" "$16,962.50" "$16,962.50" "$8,481.25" "$8,481.25" "$13,434.30" "$16,962.50" "$13,570.00" "$7,633.13" "$16,962.50" N/A "$9,838.25" "$16,962.50" "$10,177.50" "$16,962.50" "$16,962.50" "$16,962.50" N/A N/A 04.500.150 SUP Custom 27803010 04.500.150 - BODY DSTRCT 50MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK BOTH IP/OP "$16,962.50" "$12,552.00" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,535.17" "$16,962.50" "$6,785.00" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$12,721.88" "$16,962.50" "$16,962.50" "$16,962.50" "$8,481.25" "$8,481.25" "$13,434.30" "$16,962.50" "$13,570.00" "$7,633.13" "$16,962.50" N/A "$9,838.25" "$16,962.50" "$10,177.50" "$16,962.50" "$16,962.50" "$16,962.50" N/A N/A 04.500.151 SUP Custom 27803010 04.500.151 - BODY DSTRCT 50MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK BOTH IP/OP "$16,962.50" "$12,552.00" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,535.17" "$16,962.50" "$6,785.00" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$12,721.88" "$16,962.50" "$16,962.50" "$16,962.50" "$8,481.25" "$8,481.25" "$13,434.30" "$16,962.50" "$13,570.00" "$7,633.13" "$16,962.50" N/A "$9,838.25" "$16,962.50" "$10,177.50" "$16,962.50" "$16,962.50" "$16,962.50" N/A N/A 04.500.170 SUP Custom 27803010 04.500.170 - BODY DSTRCT 70MM RDS STRG NS CURVILINEAR TI MNDB RT 2MM LCK BOTH IP/OP "$16,962.50" "$12,552.00" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,535.17" "$16,962.50" "$6,785.00" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$12,721.88" "$16,962.50" "$16,962.50" "$16,962.50" "$8,481.25" "$8,481.25" "$13,434.30" "$16,962.50" "$13,570.00" "$7,633.13" "$16,962.50" N/A "$9,838.25" "$16,962.50" "$10,177.50" "$16,962.50" "$16,962.50" "$16,962.50" N/A N/A 04.500.171 SUP Custom 27803010 04.500.171 - BODY DSTRCT 70MM RDS STRG NS CURVILINEAR TI MNDB LT 2MM LCK BOTH IP/OP "$16,962.50" "$12,552.00" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,019.33" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$3,535.17" "$16,962.50" "$6,785.00" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$16,962.50" "$12,721.88" "$16,962.50" "$16,962.50" "$16,962.50" "$8,481.25" "$8,481.25" "$13,434.30" "$16,962.50" "$13,570.00" "$7,633.13" "$16,962.50" N/A "$9,838.25" "$16,962.50" "$10,177.50" "$16,962.50" "$16,962.50" "$16,962.50" N/A N/A 04.501.001 SUP HCPCS C1713 04.501.001 - PLATE BN 1.5MM NS MATRIXRIB 15 HL PRECONTOUR LCK LOPRFL TI 3 BOTH IP/OP "$4,307.50" "$3,188.00" $854.93 "$4,307.50" "$1,938.38" "$1,938.38" "$1,938.38" "$1,938.38" "$4,307.50" "$4,307.50" "$4,307.50" $897.79 "$4,307.50" "$4,307.50" "$4,307.50" "$4,307.50" "$4,307.50" $897.73 "$4,307.50" "$1,723.00" "$2,123.60" "$4,307.50" "$4,307.50" "$4,307.50" "$4,307.50" "$3,230.63" "$4,307.50" "$4,307.50" "$4,307.50" "$2,153.75" "$2,153.75" "$3,411.54" "$4,307.50" "$3,446.00" "$1,938.38" $854.93 N/A "$2,498.35" "$4,307.50" "$2,584.50" "$4,307.50" "$4,307.50" "$4,307.50" N/A N/A 04.501.002 SUP HCPCS C1713 04.501.002 - PLATE BN 1.5MM NS MATRIXRIB 15 HL PRECONTOUR LCK LOPRFL TI 3 BOTH IP/OP "$4,307.50" "$3,188.00" $854.93 "$4,307.50" "$1,938.38" "$1,938.38" "$1,938.38" "$1,938.38" "$4,307.50" "$4,307.50" "$4,307.50" $897.79 "$4,307.50" "$4,307.50" "$4,307.50" "$4,307.50" "$4,307.50" $897.73 "$4,307.50" "$1,723.00" "$2,123.60" "$4,307.50" "$4,307.50" "$4,307.50" "$4,307.50" "$3,230.63" "$4,307.50" "$4,307.50" "$4,307.50" "$2,153.75" "$2,153.75" "$3,411.54" "$4,307.50" "$3,446.00" "$1,938.38" $854.93 N/A "$2,498.35" "$4,307.50" "$2,584.50" "$4,307.50" $897.68 "$4,307.50" N/A N/A 04.501.003 SUP HCPCS C1713 04.501.003 - PLATE BN 1.5MM NS MATRIXRIB 16 HL PRECONTOUR LCK LOPRFL TI 4 BOTH IP/OP "$4,154.50" "$3,074.00" $824.54 "$4,154.38" "$1,869.47" "$1,869.47" "$1,869.47" "$1,869.47" "$4,154.38" "$4,154.38" "$4,154.38" $865.88 "$4,154.38" "$4,154.38" "$4,154.38" "$4,154.38" "$4,154.38" $865.82 "$4,154.38" "$4,154.38" "$2,048.11" "$4,154.38" "$4,154.38" "$4,154.38" "$4,154.38" "$3,115.88" "$4,154.38" "$4,154.38" "$4,154.38" "$2,077.19" "$2,077.19" "$3,290.27" "$4,154.38" "$3,323.50" "$1,869.47" $824.54 N/A "$2,409.61" "$4,154.38" "$4,154.38" "$4,154.38" "$4,154.38" "$4,154.38" N/A N/A 04.501.004 SUP HCPCS C1713 04.501.004 - PLATE BN 1.5MM NS MATRIXRIB 16 HL PRECONTOUR LCK LOPRFL TI 4 BOTH IP/OP "$4,154.50" "$3,074.00" $824.54 "$4,154.38" "$1,869.47" "$1,869.47" "$1,869.47" "$1,869.47" "$4,154.38" "$4,154.38" "$4,154.38" $865.88 "$4,154.38" "$4,154.38" "$4,154.38" "$4,154.38" "$4,154.38" $865.82 "$4,154.38" "$4,154.38" "$2,048.11" "$4,154.38" "$4,154.38" "$4,154.38" "$4,154.38" "$3,115.88" "$4,154.38" "$4,154.38" "$4,154.38" "$2,077.19" "$2,077.19" "$3,290.27" "$4,154.38" "$3,323.50" "$1,869.47" $824.54 N/A "$2,409.61" "$4,154.38" "$2,492.63" "$4,154.38" $865.77 "$4,154.38" N/A N/A 04.501.005 SUP HCPCS C1713 04.501.005 - PLATE BN 1.5MM NS MATRIXRIB 17 HL PRECONTOUR LCK LOPRFL TI 6 BOTH IP/OP "$4,154.50" "$3,074.00" $824.54 "$4,154.38" "$1,869.47" "$1,869.47" "$1,869.47" "$1,869.47" "$4,154.38" "$4,154.38" "$4,154.38" $865.88 "$4,154.38" "$4,154.38" "$4,154.38" "$4,154.38" "$4,154.38" $865.82 "$4,154.38" "$4,154.38" "$2,048.11" "$4,154.38" "$4,154.38" "$4,154.38" "$4,154.38" "$3,115.88" "$4,154.38" "$4,154.38" "$4,154.38" "$2,077.19" "$2,077.19" "$3,290.27" "$4,154.38" "$3,323.50" "$1,869.47" $824.54 N/A "$2,409.61" "$4,154.38" "$4,154.38" "$4,154.38" $865.77 "$4,154.38" N/A N/A 04.501.006 SUP HCPCS C1713 04.501.006 - PLATE BN 1.5MM NS MATRIXRIB 17 HL PRECONTOUR LCK LOPRFL TI 6 BOTH IP/OP "$4,154.50" "$3,074.00" $824.54 "$4,154.38" "$1,869.47" "$1,869.47" "$1,869.47" "$1,869.47" "$4,154.38" "$4,154.38" "$4,154.38" $865.88 "$4,154.38" "$4,154.38" "$4,154.38" "$4,154.38" "$4,154.38" $865.82 "$4,154.38" "$4,154.38" "$2,048.11" "$4,154.38" "$4,154.38" "$4,154.38" "$4,154.38" "$3,115.88" "$4,154.38" "$4,154.38" "$4,154.38" "$2,077.19" "$2,077.19" "$3,290.27" "$4,154.38" "$3,323.50" "$1,869.47" $824.54 N/A "$2,409.61" "$4,154.38" "$2,492.63" "$4,154.38" "$4,154.38" "$4,154.38" N/A N/A 04.501.007 SUP HCPCS C1713 04.501.007 - PLATE BN 1.5MM NS MATRIXRIB 18 HL PRECONTOUR LCK LOPRFL TI BOTH IP/OP "$4,307.50" "$3,188.00" $854.93 "$4,307.50" "$1,938.38" "$1,938.38" "$1,938.38" "$1,938.38" "$4,307.50" "$4,307.50" "$4,307.50" $897.79 "$4,307.50" "$4,307.50" "$4,307.50" "$4,307.50" "$4,307.50" $897.73 "$4,307.50" "$4,307.50" "$2,123.60" "$4,307.50" "$4,307.50" "$4,307.50" "$4,307.50" "$3,230.63" "$4,307.50" "$4,307.50" "$4,307.50" "$2,153.75" "$2,153.75" "$3,411.54" "$4,307.50" "$3,446.00" "$1,938.38" $854.93 N/A "$2,498.35" "$4,307.50" "$4,307.50" "$4,307.50" $897.68 "$4,307.50" N/A N/A 04.501.008 SUP HCPCS C1713 04.501.008 - PLATE BN 1.5MM NS MATRIXRIB 18 HL PRECONTOUR LCK LOPRFL TI BOTH IP/OP "$4,307.50" "$3,188.00" $854.93 "$4,307.50" "$1,938.38" "$1,938.38" "$1,938.38" "$1,938.38" "$4,307.50" "$4,307.50" "$4,307.50" $897.79 "$4,307.50" "$4,307.50" "$4,307.50" "$4,307.50" "$4,307.50" $897.73 "$4,307.50" "$4,307.50" "$2,123.60" "$4,307.50" "$4,307.50" "$4,307.50" "$4,307.50" "$3,230.63" "$4,307.50" "$4,307.50" "$4,307.50" "$2,153.75" "$2,153.75" "$3,411.54" "$4,307.50" "$3,446.00" "$1,938.38" $854.93 N/A "$2,498.35" "$4,307.50" "$2,584.50" "$4,307.50" $897.68 "$4,307.50" N/A N/A 04.501.009 SUP HCPCS C1713 04.501.009 - PLATE BONE UNIVERSAL 8 HOLE MATRIXRIB TITANIUM RIB NONSTRL BOTH IP/OP "$2,935.00" "$2,172.00" $582.52 "$2,935.00" "$1,320.75" "$1,320.75" "$1,320.75" "$1,320.75" "$2,935.00" "$2,935.00" "$2,935.00" $611.73 "$2,935.00" "$2,935.00" "$2,935.00" "$2,935.00" "$2,935.00" $611.69 "$2,935.00" "$2,935.00" "$1,446.96" "$2,935.00" "$2,935.00" "$2,935.00" "$2,935.00" "$2,201.25" "$2,935.00" "$2,935.00" "$2,935.00" "$1,467.50" "$1,467.50" "$2,324.52" "$2,935.00" "$2,348.00" "$1,320.75" $582.52 N/A "$1,702.30" "$2,935.00" "$2,935.00" "$2,935.00" $611.65 "$2,935.00" N/A N/A 04.501.010 SUP HCPCS C1713 04.501.010 - IMPLANT FIX SMALL 3MM SPLINT MATRIXRIB TITANIUM BOTH IP/OP "$1,557.50" "$1,153.00" $309.12 "$1,557.50" $700.88 $700.88 $700.88 $700.88 "$1,557.50" "$1,557.50" "$1,557.50" $324.62 "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" $324.60 "$1,557.50" "$1,557.50" $921.26 "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" "$1,168.13" "$1,557.50" "$1,557.50" "$1,557.50" $778.75 $778.75 "$1,233.54" "$1,557.50" "$1,246.00" $700.88 $309.12 N/A $903.35 "$1,557.50" "$1,557.50" "$1,557.50" $324.58 "$1,557.50" N/A N/A 04.501.011 SUP HCPCS C1713 04.501.011 - IMPLANT FIX MEDIUM 4MM SPLINT MATRIXRIB TITANIUM BOTH IP/OP "$1,557.50" "$1,153.00" $309.12 "$1,557.50" $700.88 $700.88 $700.88 $700.88 "$1,557.50" "$1,557.50" "$1,557.50" $324.62 "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" $324.60 "$1,557.50" "$1,557.50" $921.26 "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" "$1,168.13" "$1,557.50" "$1,557.50" "$1,557.50" $778.75 $778.75 "$1,233.54" "$1,557.50" "$1,246.00" $700.88 $309.12 N/A $903.35 "$1,557.50" "$1,557.50" "$1,557.50" $324.58 "$1,557.50" N/A N/A 04.501.012 SUP Custom 27803010 04.501.012 - IMPLANT FIX LARGE 5MM SPLINT MATRIXRIB TITANIUM BOTH IP/OP "$1,557.50" "$1,153.00" $277.24 "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" $277.24 "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" $324.60 "$1,557.50" $623.00 "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" "$1,557.50" "$1,168.13" "$1,557.50" "$1,557.50" "$1,557.50" $778.75 $778.75 "$1,233.54" "$1,557.50" "$1,246.00" $700.88 "$1,557.50" N/A $903.35 "$1,557.50" $934.50 "$1,557.50" "$1,557.50" "$1,557.50" N/A N/A 04.501.016.01 SUP HCPCS C1713 04.501.016.01 - SCREW BONE 2.9MM 6MM SELF TAP LOCK MATRIXRIB TITANIUM RIB BOTH IP/OP $542.50 $401.00 $107.67 $542.50 $244.13 $244.13 $244.13 $244.13 $542.50 $542.50 $542.50 $113.07 $542.50 $542.50 $542.50 $542.50 $542.50 $113.06 $542.50 $542.50 $320.89 $542.50 $542.50 $542.50 $542.50 $406.88 $542.50 $542.50 $542.50 $271.25 $271.25 $429.66 $542.50 $434.00 $244.13 $107.67 N/A $314.65 $542.50 $542.50 $542.50 $113.06 $542.50 N/A N/A 04.501.018.01 SUP HCPCS C1713 04.501.018.01 - SCREW BONE 2.9MM 8MM SELF TAP LOCK MATRIXRIB TITANIUM RIB BOTH IP/OP $542.50 $401.00 $107.67 $542.50 $244.13 $244.13 $244.13 $244.13 $542.50 $542.50 $542.50 $113.07 $542.50 $542.50 $542.50 $542.50 $542.50 $113.06 $542.50 $542.50 $320.89 $542.50 $542.50 $542.50 $542.50 $406.88 $542.50 $542.50 $542.50 $271.25 $271.25 $429.66 $542.50 $434.00 $244.13 $107.67 N/A $314.65 $542.50 $542.50 $542.50 $113.06 $542.50 N/A N/A 04.501.020.01 SUP HCPCS C1713 04.501.020.01 - SCREW BONE 2.9MM 10MM SELF TAP LOCK MATRIXRIB TITANIUM RIB BOTH IP/OP $542.50 $401.00 $107.67 $542.50 $244.13 $244.13 $244.13 $244.13 $542.50 $542.50 $542.50 $113.07 $542.50 $542.50 $542.50 $542.50 $542.50 $113.06 $542.50 $542.50 $320.89 $542.50 $542.50 $542.50 $542.50 $406.88 $542.50 $542.50 $542.50 $271.25 $271.25 $429.66 $542.50 $434.00 $244.13 $107.67 N/A $314.65 $542.50 $542.50 $542.50 $113.06 $542.50 N/A N/A 04.501.022.01 SUP HCPCS C1713 04.501.022.01 - SCREW BONE 2.9MM 12MM SELF TAP LOCK MATRIXRIB TITANIUM RIB BOTH IP/OP $525.00 $389.00 $104.18 $524.88 $236.20 $236.20 $236.20 $236.20 $524.88 $524.88 $524.88 $109.40 $524.88 $524.88 $524.88 $524.88 $524.88 $109.39 $524.88 $209.95 $310.47 $524.88 $524.88 $524.88 $524.88 $393.75 $524.88 $524.88 $524.88 $262.44 $262.44 $415.70 $524.88 $419.90 $236.20 $104.18 N/A $304.50 $524.88 $524.88 $524.88 $109.38 $524.88 N/A N/A 04.501.024.01 SUP HCPCS C1713 04.501.024.01 - IMPLANT FIX 14MM SYSTEM SET MATRIXRIB BOTH IP/OP $542.50 $401.00 $107.67 $542.50 $244.13 $244.13 $244.13 $244.13 $542.50 $542.50 $542.50 $113.07 $542.50 $542.50 $542.50 $542.50 $542.50 $113.06 $542.50 $542.50 $320.89 $542.50 $542.50 $542.50 $542.50 $406.88 $542.50 $542.50 $542.50 $271.25 $271.25 $429.66 $542.50 $434.00 $244.13 $107.67 N/A $314.65 $542.50 $325.50 $542.50 $113.06 $542.50 N/A N/A 04.501.026.01 SUP HCPCS C1713 04.501.026.01 - SCREW BONE 2.9MM 16MM ANGULAR STABLE SLFTAP LOCKING BOTH IP/OP $542.50 $401.00 $107.67 $542.50 $244.13 $244.13 $244.13 $244.13 $542.50 $542.50 $542.50 $113.07 $542.50 $542.50 $542.50 $542.50 $542.50 $113.06 $542.50 $542.50 $320.89 $542.50 $542.50 $542.50 $542.50 $406.88 $542.50 $542.50 $542.50 $271.25 $271.25 $429.66 $542.50 $434.00 $244.13 $107.67 N/A $314.65 $542.50 $325.50 $542.50 $113.06 $542.50 N/A N/A 04.501.028.01 SUP HCPCS C1713 04.501.028.01 - SCREW BONE 2.9MM 18MM ANGULAR STABLE SLFTAP LOCKING BOTH IP/OP $542.50 $401.00 $107.67 $542.50 $244.13 $244.13 $244.13 $244.13 $542.50 $542.50 $542.50 $113.07 $542.50 $542.50 $542.50 $542.50 $542.50 $113.06 $542.50 $542.50 $320.89 $542.50 $542.50 $542.50 $542.50 $406.88 $542.50 $542.50 $542.50 $271.25 $271.25 $429.66 $542.50 $434.00 $244.13 $107.67 N/A $314.65 $542.50 $542.50 $542.50 $113.06 $542.50 N/A N/A 04.501.036.05 SUP HCPCS C1713 04.501.036.05 - SCREW BONE 2.9MM 6MM SLFTAP NONLOCKING MATRIXRIB TITANIUM BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $132.75 $132.75 $132.75 $132.75 $295.00 $295.00 $295.00 $61.49 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $295.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $58.55 N/A $171.10 $295.00 $295.00 $295.00 $61.48 $295.00 N/A N/A 04.501.094 SUP HCPCS C1713 04.501.094 - PLATE BN I 2.8MM NS MATRIXRIB 9 HL TI RB BOTH IP/OP "$3,170.00" "$2,346.00" $629.17 "$3,170.00" "$1,426.50" "$1,426.50" "$1,426.50" "$1,426.50" "$3,170.00" "$3,170.00" "$3,170.00" $660.71 "$3,170.00" "$3,170.00" "$3,170.00" "$3,170.00" "$3,170.00" $660.66 "$3,170.00" "$3,170.00" "$1,562.81" "$3,170.00" "$3,170.00" "$3,170.00" "$3,170.00" "$2,377.50" "$3,170.00" "$3,170.00" "$3,170.00" "$1,585.00" "$1,585.00" "$2,510.64" "$3,170.00" "$2,536.00" "$1,426.50" $629.17 N/A "$1,838.60" "$3,170.00" "$1,902.00" "$3,170.00" $660.63 "$3,170.00" N/A N/A 04.501.110.01 SUP HCPCS C1713 04.501.110.01 - SCREW BONE 3MM 10MM LOCK SELF DRILL TITANIUM STERNAL NONSTRL BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $510.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $106.28 $510.00 N/A N/A 04.501.112.01 SUP HCPCS C1713 04.501.112.01 - SCREW BONE 3MM 12MM SELF DRILL UNILOCK TITANIUM STERNUM BOTH IP/OP $491.00 $363.00 $97.43 $490.88 $220.90 $220.90 $220.90 $220.90 $490.88 $490.88 $490.88 $102.31 $490.88 $490.88 $490.88 $490.88 $490.88 $102.30 $490.88 $490.88 $290.36 $490.88 $490.88 $490.88 $490.88 $368.25 $490.88 $490.88 $490.88 $245.44 $245.44 $388.78 $490.88 $392.70 $220.90 $97.43 N/A $284.78 $490.88 $294.53 $490.88 $490.88 $490.88 N/A N/A 04.501.114.01 SUP HCPCS C1713 04.501.114.01 - SCREW BONE 3MM 14MM SELF DRILL UNILOCK TITANIUM STERNUM BOTH IP/OP $577.50 $427.00 $114.62 $577.50 $259.88 $259.88 $259.88 $259.88 $577.50 $577.50 $577.50 $120.37 $577.50 $577.50 $577.50 $577.50 $577.50 $120.36 $577.50 $577.50 $341.59 $577.50 $577.50 $577.50 $577.50 $433.13 $577.50 $577.50 $577.50 $288.75 $288.75 $457.38 $577.50 $462.00 $259.88 $114.62 N/A $334.95 $577.50 $346.50 $577.50 $120.35 $577.50 N/A N/A 04.501.116.01 SUP HCPCS C1713 04.501.116.01 - SCREW BONE 3MM 16MM SELF DRILL UNILOCK TITANIUM STERNUM BOTH IP/OP $577.50 $427.00 $114.62 $577.50 $259.88 $259.88 $259.88 $259.88 $577.50 $577.50 $577.50 $120.37 $577.50 $577.50 $577.50 $577.50 $577.50 $120.36 $577.50 $577.50 $341.59 $577.50 $577.50 $577.50 $577.50 $433.13 $577.50 $577.50 $577.50 $288.75 $288.75 $457.38 $577.50 $462.00 $259.88 $114.62 N/A $334.95 $577.50 $346.50 $577.50 $120.35 $577.50 N/A N/A 04.501.118.01 SUP HCPCS C1713 04.501.118.01 - SCREW BONE 3MM 18MM SELF DRILL UNILOCK TITANIUM STERNUM BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $510.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $106.28 $510.00 N/A N/A 04.501.120.01 SUP HCPCS C1713 04.501.120.01 - SCREW BONE 3MM 20MM SLFDRILL TITANIUM STERNUM NONSTRL BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $510.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $106.28 $510.00 N/A N/A 04.503.021 SUP Custom 27803010 04.503.021 - COVER BURR HOLE THK.4MM 12MM MATRIXNEURO BLUE TITANIUM BOTH IP/OP $697.50 $516.00 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $279.00 $697.50 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $697.50 N/A $404.55 $697.50 $418.50 $697.50 $697.50 $697.50 N/A N/A 04.503.022 SUP Custom 27803010 04.503.022 - COVER BURR HOLE 15MM MATRIXNEURO BLUE TITANIUM NONSTRL BOTH IP/OP $697.50 $516.00 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $279.00 $697.50 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $697.50 N/A $404.55 $697.50 $418.50 $697.50 $697.50 $697.50 N/A N/A 04.503.023 SUP Custom 27803010 04.503.023 - COVER BURR HOLE 17MM .4MM MATRIXNEURO BLUE TITANIUM BOTH IP/OP $697.50 $516.00 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $279.00 $697.50 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $697.50 N/A $404.55 $697.50 $418.50 $697.50 $697.50 $697.50 N/A N/A 04.503.024 SUP Custom 27803010 04.503.024 - COVER BURR HOLE 24MM MATRIXNEURO BLUE TITANIUM CRANIAL BOTH IP/OP $697.50 $516.00 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $279.00 $697.50 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $697.50 N/A $404.55 $697.50 $418.50 $697.50 $697.50 $697.50 N/A N/A 04.503.026 SUP Custom 27803010 04.503.026 - COVER BURR HOLE 12MM SHUNT MATRIXNEURO BLUE TITANIUM BOTH IP/OP $697.50 $516.00 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $279.00 $697.50 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $697.50 N/A $404.55 $697.50 $418.50 $697.50 $697.50 $697.50 N/A N/A 04.503.027 SUP Custom 27803010 04.503.027 - COVER BURR HOLE 15MM SHUNT MATRIXNEURO BLUE TITANIUM BOTH IP/OP $697.50 $516.00 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $279.00 $697.50 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $697.50 N/A $404.55 $697.50 $418.50 $697.50 $697.50 $697.50 N/A N/A 04.503.028 SUP Custom 27803010 04.503.028 - COVER BURR HOLE 17MM SHUNT MATRIXNEURO BLUE TITANIUM NONSTRL BOTH IP/OP $697.50 $516.00 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $279.00 $697.50 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $697.50 N/A $404.55 $697.50 $418.50 $697.50 $697.50 $697.50 N/A N/A 04.503.029 SUP Custom 27803010 04.503.029 - COVER BURR HOLE 24MM MATRIXNEURO BLUE TITANIUM BOTH IP/OP $697.50 $516.00 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $279.00 $697.50 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $697.50 N/A $404.55 $697.50 $418.50 $697.50 $697.50 $697.50 N/A N/A 04.503.056 SUP HCPCS C1713 04.503.056 - PLATE BONE .4MM MESH STRUT MALBLE CONTUR MATRIXNEURO SILVER BOTH IP/OP "$1,665.00" "$1,232.00" $330.46 "$1,665.00" $749.25 $749.25 $749.25 $749.25 "$1,665.00" "$1,665.00" "$1,665.00" $347.03 "$1,665.00" "$1,665.00" "$1,665.00" "$1,665.00" "$1,665.00" $347.00 "$1,665.00" "$1,665.00" $984.85 "$1,665.00" "$1,665.00" "$1,665.00" "$1,665.00" "$1,248.75" "$1,665.00" "$1,665.00" "$1,665.00" $832.50 $832.50 "$1,318.68" "$1,665.00" "$1,332.00" $749.25 $330.46 N/A $965.70 "$1,665.00" $999.00 "$1,665.00" $346.99 "$1,665.00" N/A N/A 04.503.057 SUP HCPCS C1713 04.503.057 - PLATE BONE MESH MALBLE MATRIXNEURO TITANIUM TEMPORAL NONSTRL BOTH IP/OP "$2,203.00" "$1,630.00" $437.19 "$2,202.75" $991.24 $991.24 $991.24 $991.24 "$2,202.75" "$2,202.75" "$2,202.75" $459.11 "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" $459.08 "$2,202.75" "$2,202.75" "$1,302.93" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$1,652.25" "$2,202.75" "$2,202.75" "$2,202.75" "$1,101.38" "$1,101.38" "$1,744.58" "$2,202.75" "$1,762.20" $991.24 $437.19 N/A "$1,277.74" "$2,202.75" "$2,202.75" "$2,202.75" $459.05 "$2,202.75" N/A N/A 04.503.061 SUP HCPCS C1713 04.503.061 - PLATE BONE STR 9MM 2 HOLE CENTRE SPACE MATRIXNEURO BLUE BOTH IP/OP $177.00 $131.00 $35.06 $176.63 $79.48 $79.48 $79.48 $79.48 $176.63 $176.63 $176.63 $36.81 $176.63 $176.63 $176.63 $176.63 $176.63 $36.81 $176.63 $176.63 $104.48 $176.63 $176.63 $176.63 $176.63 $132.75 $176.63 $176.63 $176.63 $88.32 $88.32 $139.89 $176.63 $141.30 $79.48 $35.06 N/A $102.66 $176.63 $176.63 $176.63 $36.81 $176.63 N/A N/A 04.503.062 SUP HCPCS C1713 04.503.062 - PLATE BN STRG 12MMX.4MM NS MATRIXNEURO 2 HL TI CRNL BOTH IP/OP $183.50 $136.00 $36.40 $183.38 $82.52 $82.52 $82.52 $82.52 $183.38 $183.38 $183.38 $38.22 $183.38 $183.38 $183.38 $183.38 $183.38 $38.22 $183.38 $183.38 $108.47 $183.38 $183.38 $183.38 $183.38 $137.63 $183.38 $183.38 $183.38 $91.69 $91.69 $145.24 $183.38 $146.70 $82.52 $36.40 N/A $106.43 $183.38 $110.03 $183.38 $38.22 $183.38 N/A N/A 04.503.063 SUP HCPCS C1713 04.503.063 - PLATE BN STRG 24MMX.4MM NS MATRIXNEURO 4 HL TI CRNL BOTH IP/OP $209.50 $155.00 $41.53 $209.25 $94.16 $94.16 $94.16 $94.16 $209.25 $209.25 $209.25 $43.61 $209.25 $209.25 $209.25 $209.25 $209.25 $43.61 $209.25 $209.25 $123.77 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $94.16 $41.53 N/A $121.51 $209.25 $125.55 $209.25 $43.61 $209.25 N/A N/A 04.503.064 SUP HCPCS C1713 04.503.064 - PLATE BN X .4MM NS MATRIXNEURO 4 HL TI CRNL BOTH IP/OP $675.00 $500.00 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $270.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 N/A $391.50 $675.00 $675.00 $675.00 $140.67 $675.00 N/A N/A 04.503.065 SUP HCPCS C1713 04.503.065 - PLATE BN BX 14X14X.4MM NS MATRIXNEURO 4 HL TI CRNL BOTH IP/OP $675.00 $500.00 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $270.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 N/A $391.50 $675.00 $405.00 $675.00 $140.67 $675.00 N/A N/A 04.503.066 SUP HCPCS C1713 04.503.066 - PLATE BONE BOX 16X16X.4MM 4 HOLE MATRIXNEURO BLUE TITANIUM BOTH IP/OP $675.00 $500.00 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $270.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 N/A $391.50 $675.00 $405.00 $675.00 $140.67 $675.00 N/A N/A 04.503.067 SUP HCPCS C1713 04.503.067 - PLATE BN Y .4MM NS MATRIXNEURO 5 HL TI CRNL BOTH IP/OP $675.00 $500.00 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $270.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 N/A $391.50 $675.00 $405.00 $675.00 $140.67 $675.00 N/A N/A 04.503.068 SUP HCPCS C1713 04.503.068 - PLATE BN 2Y 18MMX.4MM NS MATRIXNEURO 6 HL TI CRNL BOTH IP/OP $675.00 $500.00 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $675.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 N/A $391.50 $675.00 $405.00 $675.00 $140.67 $675.00 N/A N/A 04.503.069 SUP HCPCS C1713 04.503.069 - PLATE BN 2Y 21MMX.4MM NS MATRIXNEURO 6 HL TI CRNL BOTH IP/OP $675.00 $500.00 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $675.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 N/A $391.50 $675.00 $405.00 $675.00 $140.67 $675.00 N/A N/A 04.503.070 SUP HCPCS C1713 04.503.070 - PLATE BN .4MM NS MATRIXNEURO 5 HL ADP TI CRNL BOTH IP/OP $605.50 $448.00 $120.13 $605.25 $272.36 $272.36 $272.36 $272.36 $605.25 $605.25 $605.25 $126.15 $605.25 $605.25 $605.25 $605.25 $605.25 $126.14 $605.25 $605.25 $358.01 $605.25 $605.25 $605.25 $605.25 $454.13 $605.25 $605.25 $605.25 $302.63 $302.63 $479.36 $605.25 $484.20 $272.36 $120.13 N/A $351.19 $605.25 $363.15 $605.25 $126.13 $605.25 N/A N/A 04.503.071 SUP HCPCS C1713 04.503.071 - PLATE BONE .4MM 7 HOLE ADAPTION MATRIXNEURO BLUE TITANIUM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $300.60 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $450.90 $751.50 $156.61 $751.50 N/A N/A 04.503.072 SUP HCPCS C1713 04.503.072 - PLATE BONE .4MM 20 HOLE ADAPTION MATRIXNEURO BLUE TITANIUM BOTH IP/OP "$1,498.50" "$1,109.00" $297.41 "$1,498.50" $674.33 $674.33 $674.33 $674.33 "$1,498.50" "$1,498.50" "$1,498.50" $312.32 "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" $312.30 "$1,498.50" $599.40 $886.36 "$1,498.50" "$1,498.50" "$1,498.50" "$1,498.50" "$1,123.88" "$1,498.50" "$1,498.50" "$1,498.50" $749.25 $749.25 "$1,186.81" "$1,498.50" "$1,198.80" $674.33 $297.41 N/A $869.13 "$1,498.50" $899.10 "$1,498.50" $312.29 "$1,498.50" N/A N/A 04.503.073 SUP HCPCS C1713 04.503.073 - PLATE BN BX 16X10X.4MM NS MATRIXNEURO 4 HL TI CRNL BOTH IP/OP $643.50 $476.00 $127.72 $643.50 $289.58 $289.58 $289.58 $289.58 $643.50 $643.50 $643.50 $134.12 $643.50 $643.50 $643.50 $643.50 $643.50 $134.11 $643.50 $257.40 $380.63 $643.50 $643.50 $643.50 $643.50 $482.63 $643.50 $643.50 $643.50 $321.75 $321.75 $509.65 $643.50 $514.80 $289.58 $127.72 N/A $373.23 $643.50 $643.50 $643.50 $134.11 $643.50 N/A N/A 04.503.074 SUP HCPCS C1713 04.503.074 - PLATE BONE STRUT 24X14X.4MM 2X3 HOLE MATRIXNEURO BLUE BOTH IP/OP "$1,170.00" $866.00 $232.22 "$1,170.00" $526.50 $526.50 $526.50 $526.50 "$1,170.00" "$1,170.00" "$1,170.00" $243.86 "$1,170.00" "$1,170.00" "$1,170.00" "$1,170.00" "$1,170.00" $243.84 "$1,170.00" $468.00 $692.06 "$1,170.00" "$1,170.00" "$1,170.00" "$1,170.00" $877.50 "$1,170.00" "$1,170.00" "$1,170.00" $585.00 $585.00 $926.64 "$1,170.00" $936.00 $526.50 $232.22 N/A $678.60 "$1,170.00" $702.00 "$1,170.00" $243.83 "$1,170.00" N/A N/A 04.503.075 SUP HCPCS C1713 04.503.075 - PLATE BONE 34X14X.4MM 2X4 HOLE STRUT MATRIXNEURO BLUE BOTH IP/OP "$1,665.00" "$1,232.00" $330.46 "$1,665.00" $749.25 $749.25 $749.25 $749.25 "$1,665.00" "$1,665.00" "$1,665.00" $347.03 "$1,665.00" "$1,665.00" "$1,665.00" "$1,665.00" "$1,665.00" $347.00 "$1,665.00" $666.00 $984.85 "$1,665.00" "$1,665.00" "$1,665.00" "$1,665.00" "$1,248.75" "$1,665.00" "$1,665.00" "$1,665.00" $832.50 $832.50 "$1,318.68" "$1,665.00" "$1,332.00" $749.25 $330.46 N/A $965.70 "$1,665.00" $999.00 "$1,665.00" "$1,665.00" "$1,665.00" N/A N/A 04.503.076 SUP HCPCS C1713 04.503.076 - PLATE BONE CURVE .4MM 2X3 HOLE STRUT MATRIXNEURO BLUE BOTH IP/OP "$1,091.50" $808.00 $216.59 "$1,091.25" $491.06 $491.06 $491.06 $491.06 "$1,091.25" "$1,091.25" "$1,091.25" $227.44 "$1,091.25" "$1,091.25" "$1,091.25" "$1,091.25" "$1,091.25" $227.43 "$1,091.25" "$1,091.25" $645.47 "$1,091.25" "$1,091.25" "$1,091.25" "$1,091.25" $818.63 "$1,091.25" "$1,091.25" "$1,091.25" $545.63 $545.63 $864.27 "$1,091.25" $873.00 $491.06 $216.59 N/A $633.07 "$1,091.25" $654.75 "$1,091.25" "$1,091.25" "$1,091.25" N/A N/A 04.503.077 SUP HCPCS C1713 04.503.077 - PLATE BONE CURVE .4MM 2X4 HOLE STRUT MATRIXNEURO BLUE BOTH IP/OP "$1,555.00" "$1,151.00" $308.58 "$1,554.75" $699.64 $699.64 $699.64 $699.64 "$1,554.75" "$1,554.75" "$1,554.75" $324.05 "$1,554.75" "$1,554.75" "$1,554.75" "$1,554.75" "$1,554.75" $324.03 "$1,554.75" $621.90 $919.63 "$1,554.75" "$1,554.75" "$1,554.75" "$1,554.75" "$1,166.25" "$1,554.75" "$1,554.75" "$1,554.75" $777.38 $777.38 "$1,231.36" "$1,554.75" "$1,243.80" $699.64 $308.58 N/A $901.90 "$1,554.75" "$1,554.75" "$1,554.75" "$1,554.75" "$1,554.75" N/A N/A 04.503.081 SUP HCPCS C1713 04.503.081 - PLATE BONE 45X38X.4MM CONTUR MESH MALBLE MATRIXNEURO BOTH IP/OP "$3,832.00" "$2,836.00" $760.51 "$3,831.75" "$1,724.29" "$1,724.29" "$1,724.29" "$1,724.29" "$3,831.75" "$3,831.75" "$3,831.75" $798.63 "$3,831.75" "$3,831.75" "$3,831.75" "$3,831.75" "$3,831.75" $798.58 "$3,831.75" "$1,532.70" "$1,889.05" "$3,831.75" "$3,831.75" "$3,831.75" "$3,831.75" "$2,874.00" "$3,831.75" "$3,831.75" "$3,831.75" "$1,915.88" "$1,915.88" "$3,034.75" "$3,831.75" "$3,065.40" "$1,724.29" $760.51 N/A "$2,222.56" "$3,831.75" "$2,299.05" "$3,831.75" $798.54 "$3,831.75" N/A N/A 04.503.082 SUP HCPCS C1713 04.503.082 - PLATE BONE 45X38X.4MM CONTUR MESH RIGID MATRIXNEURO TITANIUM BOTH IP/OP "$3,832.00" "$2,836.00" $760.51 "$3,831.75" "$1,724.29" "$1,724.29" "$1,724.29" "$1,724.29" "$3,831.75" "$3,831.75" "$3,831.75" $798.63 "$3,831.75" "$3,831.75" "$3,831.75" "$3,831.75" "$3,831.75" $798.58 "$3,831.75" "$1,532.70" "$1,889.05" "$3,831.75" "$3,831.75" "$3,831.75" "$3,831.75" "$2,874.00" "$3,831.75" "$3,831.75" "$3,831.75" "$1,915.88" "$1,915.88" "$3,034.75" "$3,831.75" "$3,065.40" "$1,724.29" $760.51 N/A "$2,222.56" "$3,831.75" "$2,299.05" "$3,831.75" $798.54 "$3,831.75" N/A N/A 04.503.083 SUP HCPCS C1713 04.503.083 - MESH CRNL CNTR 100X100X.4MM SLVR NS MATRIXNEURO RGD TI BOTH IP/OP "$5,965.00" "$4,414.00" "$1,183.85" "$5,964.75" "$2,684.14" "$2,684.14" "$2,684.14" "$2,684.14" "$5,964.75" "$5,964.75" "$5,964.75" "$1,243.20" "$5,964.75" "$5,964.75" "$5,964.75" "$5,964.75" "$5,964.75" "$1,243.12" "$5,964.75" "$2,385.90" "$2,940.62" "$5,964.75" "$5,964.75" "$5,964.75" "$5,964.75" "$4,473.75" "$5,964.75" "$5,964.75" "$5,964.75" "$2,982.38" "$2,982.38" "$4,724.08" "$5,964.75" "$4,771.80" "$2,684.14" "$1,183.85" N/A "$3,459.70" "$5,964.75" "$5,964.75" "$5,964.75" "$1,243.05" "$5,964.75" N/A N/A 04.503.084 SUP HCPCS C1713 04.503.084 - MESH CRNL CNTR 100X100X.4MM BLU NS MATRIXNEURO RGD TI BOTH IP/OP "$5,965.00" "$4,414.00" "$1,183.85" "$5,964.75" "$2,684.14" "$2,684.14" "$2,684.14" "$2,684.14" "$5,964.75" "$5,964.75" "$5,964.75" "$1,243.20" "$5,964.75" "$5,964.75" "$5,964.75" "$5,964.75" "$5,964.75" "$1,243.12" "$5,964.75" "$2,385.90" "$2,940.62" "$5,964.75" "$5,964.75" "$5,964.75" "$5,964.75" "$4,473.75" "$5,964.75" "$5,964.75" "$5,964.75" "$2,982.38" "$2,982.38" "$4,724.08" "$5,964.75" "$4,771.80" "$2,684.14" "$1,183.85" N/A "$3,459.70" "$5,964.75" "$5,964.75" "$5,964.75" "$1,243.05" "$5,964.75" N/A N/A 04.503.085 SUP HCPCS C1713 04.503.085 - PLATE BONE CONTUR MESH RIGID MATRIXNEURO TITANIUM BOTH IP/OP "$22,842.00" "$16,903.00" "$4,533.57" "$22,842.00" "$10,278.90" "$10,278.90" "$10,278.90" "$10,278.90" "$22,842.00" "$22,842.00" "$22,842.00" "$4,760.84" "$22,842.00" "$22,842.00" "$22,842.00" "$22,842.00" "$22,842.00" "$4,760.52" "$22,842.00" "$22,842.00" "$11,261.11" "$22,842.00" "$22,842.00" "$22,842.00" "$22,842.00" "$17,131.50" "$22,842.00" "$22,842.00" "$22,842.00" "$11,421.00" "$11,421.00" "$18,090.86" "$22,842.00" "$18,273.60" "$10,278.90" "$4,533.57" N/A "$13,248.36" "$22,842.00" "$22,842.00" "$22,842.00" "$4,760.27" "$22,842.00" N/A N/A 04.503.086 SUP HCPCS C1713 04.503.086 - PLATE BONE SMALL CONTUR MESH MALBLE ARC MATRIXNEURO TITANIUM BOTH IP/OP "$2,203.00" "$1,630.00" $437.19 "$2,202.75" $991.24 $991.24 $991.24 $991.24 "$2,202.75" "$2,202.75" "$2,202.75" $459.11 "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" $459.08 "$2,202.75" $881.10 "$1,302.93" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$1,652.25" "$2,202.75" "$2,202.75" "$2,202.75" "$1,101.38" "$1,101.38" "$1,744.58" "$2,202.75" "$1,762.20" $991.24 $437.19 N/A "$1,277.74" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" N/A N/A 04.503.087 SUP HCPCS C1713 04.503.087 - PLATE BONE LARGE CONTUR MESH MALBLE ARC MATRIXNEURO TITANIUM BOTH IP/OP "$3,433.50" "$2,541.00" $681.46 "$3,433.50" "$1,545.08" "$1,545.08" "$1,545.08" "$1,545.08" "$3,433.50" "$3,433.50" "$3,433.50" $715.63 "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" $715.58 "$3,433.50" "$3,433.50" "$1,692.72" "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" "$2,575.13" "$3,433.50" "$3,433.50" "$3,433.50" "$1,716.75" "$1,716.75" "$2,719.33" "$3,433.50" "$2,746.80" "$1,545.08" $681.46 N/A "$1,991.43" "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" N/A N/A 04.503.088 SUP HCPCS C1713 04.503.088 - PLATE BONE SMALL CONTUR MESH RIGID ARC MATRIXNEURO TITANIUM BOTH IP/OP "$2,203.00" "$1,630.00" $437.19 "$2,202.75" $991.24 $991.24 $991.24 $991.24 "$2,202.75" "$2,202.75" "$2,202.75" $459.11 "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" $459.08 "$2,202.75" $881.10 "$1,302.93" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$1,652.25" "$2,202.75" "$2,202.75" "$2,202.75" "$1,101.38" "$1,101.38" "$1,744.58" "$2,202.75" "$1,762.20" $991.24 $437.19 N/A "$1,277.74" "$2,202.75" "$1,321.65" "$2,202.75" $459.05 "$2,202.75" N/A N/A 04.503.089 SUP HCPCS C1713 04.503.089 - PLATE BONE LARGE RIGID ARC MATRIXNEURO BLUE TITANIUM MIDFAC BOTH IP/OP "$3,433.50" "$2,541.00" $681.46 "$3,433.50" "$1,545.08" "$1,545.08" "$1,545.08" "$1,545.08" "$3,433.50" "$3,433.50" "$3,433.50" $715.63 "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" $715.58 "$3,433.50" "$1,373.40" "$1,692.72" "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" "$2,575.13" "$3,433.50" "$3,433.50" "$3,433.50" "$1,716.75" "$1,716.75" "$2,719.33" "$3,433.50" "$2,746.80" "$1,545.08" $681.46 N/A "$1,991.43" "$3,433.50" "$2,060.10" "$3,433.50" $715.54 "$3,433.50" N/A N/A 04.503.090 SUP HCPCS C1713 04.503.090 - PLATE BONE 30MM CONTUR MESH MALBLE MATRIXNEURO TITANIUM BOTH IP/OP "$2,203.00" "$1,630.00" $437.19 "$2,202.75" $991.24 $991.24 $991.24 $991.24 "$2,202.75" "$2,202.75" "$2,202.75" $459.11 "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" $459.08 "$2,202.75" "$2,202.75" "$1,302.93" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$1,652.25" "$2,202.75" "$2,202.75" "$2,202.75" "$1,101.38" "$1,101.38" "$1,744.58" "$2,202.75" "$1,762.20" $991.24 $437.19 N/A "$1,277.74" "$2,202.75" "$1,321.65" "$2,202.75" $459.05 "$2,202.75" N/A N/A 04.503.091 SUP HCPCS C1713 04.503.091 - PLATE BONE 70MM CONTUR MESH MALBLE MATRIXNEURO TITANIUM BOTH IP/OP "$4,561.00" "$3,375.00" $905.19 "$4,560.75" "$2,052.34" "$2,052.34" "$2,052.34" "$2,052.34" "$4,560.75" "$4,560.75" "$4,560.75" $950.57 "$4,560.75" "$4,560.75" "$4,560.75" "$4,560.75" "$4,560.75" $950.51 "$4,560.75" "$1,824.30" "$2,248.45" "$4,560.75" "$4,560.75" "$4,560.75" "$4,560.75" "$3,420.75" "$4,560.75" "$4,560.75" "$4,560.75" "$2,280.38" "$2,280.38" "$3,612.11" "$4,560.75" "$3,648.60" "$2,052.34" $905.19 N/A "$2,645.38" "$4,560.75" "$2,736.45" "$4,560.75" "$4,560.75" "$4,560.75" N/A N/A 04.503.092 SUP HCPCS C1713 04.503.092 - MESH DYNAMIC CIR 100MM .4MM CONTUR MALBLE MATRIXNEURO SILVER BOTH IP/OP "$5,688.00" "$4,209.00" "$1,128.93" "$5,688.00" "$2,559.60" "$2,559.60" "$2,559.60" "$2,559.60" "$5,688.00" "$5,688.00" "$5,688.00" "$1,185.52" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$1,185.44" "$5,688.00" "$5,688.00" "$2,804.18" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$4,266.00" "$5,688.00" "$5,688.00" "$5,688.00" "$2,844.00" "$2,844.00" "$4,504.90" "$5,688.00" "$4,550.40" "$2,559.60" "$1,128.93" N/A "$3,299.04" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" N/A N/A 04.503.093 SUP HCPCS C1713 04.503.093 - PLATE BONE 30MM CONTUR MESH RIGID MATRIXNEURO TITANIUM BOTH IP/OP "$2,203.00" "$1,630.00" $437.19 "$2,202.75" $991.24 $991.24 $991.24 $991.24 "$2,202.75" "$2,202.75" "$2,202.75" $459.11 "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" $459.08 "$2,202.75" "$2,202.75" "$1,302.93" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$1,652.25" "$2,202.75" "$2,202.75" "$2,202.75" "$1,101.38" "$1,101.38" "$1,744.58" "$2,202.75" "$1,762.20" $991.24 $437.19 N/A "$1,277.74" "$2,202.75" "$2,202.75" "$2,202.75" $459.05 "$2,202.75" N/A N/A 04.503.094 SUP HCPCS C1713 04.503.094 - PLATE BONE 70MM CONTUR MESH RIGID MATRIXNEURO TITANIUM BOTH IP/OP "$4,561.00" "$3,375.00" $905.19 "$4,560.75" "$2,052.34" "$2,052.34" "$2,052.34" "$2,052.34" "$4,560.75" "$4,560.75" "$4,560.75" $950.57 "$4,560.75" "$4,560.75" "$4,560.75" "$4,560.75" "$4,560.75" $950.51 "$4,560.75" "$1,824.30" "$2,248.45" "$4,560.75" "$4,560.75" "$4,560.75" "$4,560.75" "$3,420.75" "$4,560.75" "$4,560.75" "$4,560.75" "$2,280.38" "$2,280.38" "$3,612.11" "$4,560.75" "$3,648.60" "$2,052.34" $905.19 N/A "$2,645.38" "$4,560.75" "$4,560.75" "$4,560.75" "$4,560.75" "$4,560.75" N/A N/A 04.503.095 SUP HCPCS C1713 04.503.095 - MESH DYNAMIC CIR 100MM .4MM CONTUR RIGID MATRIXNEURO BLUE BOTH IP/OP "$5,688.00" "$4,209.00" "$1,128.93" "$5,688.00" "$2,559.60" "$2,559.60" "$2,559.60" "$2,559.60" "$5,688.00" "$5,688.00" "$5,688.00" "$1,185.52" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$1,185.44" "$5,688.00" "$5,688.00" "$2,804.18" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$4,266.00" "$5,688.00" "$5,688.00" "$5,688.00" "$2,844.00" "$2,844.00" "$4,504.90" "$5,688.00" "$4,550.40" "$2,559.60" "$1,128.93" N/A "$3,299.04" "$5,688.00" "$3,412.80" "$5,688.00" "$5,688.00" "$5,688.00" N/A N/A 04.503.096 SUP HCPCS C1713 04.503.096 - PLATE BONE SMALL .4MM CONTUR MESH MALBLE MATRIXNEURO BOTH IP/OP "$2,135.50" "$1,580.00" $423.79 "$2,135.25" $960.86 $960.86 $960.86 $960.86 "$2,135.25" "$2,135.25" "$2,135.25" $445.04 "$2,135.25" "$2,135.25" "$2,135.25" "$2,135.25" "$2,135.25" $445.01 "$2,135.25" $854.10 "$1,263.00" "$2,135.25" "$2,135.25" "$2,135.25" "$2,135.25" "$1,601.63" "$2,135.25" "$2,135.25" "$2,135.25" "$1,067.63" "$1,067.63" "$1,691.12" "$2,135.25" "$1,708.20" $960.86 $423.79 N/A "$1,238.59" "$2,135.25" "$1,281.15" "$2,135.25" "$2,135.25" "$2,135.25" N/A N/A 04.503.097 SUP HCPCS C1713 04.503.097 - PLATE BONE MEDIUM .4MM CONTUR MESH MALBLE MATRIXNEURO BOTH IP/OP "$2,416.50" "$1,788.00" $479.61 "$2,416.50" "$1,087.43" "$1,087.43" "$1,087.43" "$1,087.43" "$2,416.50" "$2,416.50" "$2,416.50" $503.66 "$2,416.50" "$2,416.50" "$2,416.50" "$2,416.50" "$2,416.50" $503.63 "$2,416.50" $966.60 "$1,429.36" "$2,416.50" "$2,416.50" "$2,416.50" "$2,416.50" "$1,812.38" "$2,416.50" "$2,416.50" "$2,416.50" "$1,208.25" "$1,208.25" "$1,913.87" "$2,416.50" "$1,933.20" "$1,087.43" $479.61 N/A "$1,401.57" "$2,416.50" "$2,416.50" "$2,416.50" $503.60 "$2,416.50" N/A N/A 04.503.098 SUP HCPCS C1713 04.503.098 - PLATE BONE LARGE .4MM CONTUR MESH MALBLE MATRIXNEURO SILVER BOTH IP/OP "$2,664.00" "$1,971.00" $528.74 "$2,664.00" "$1,198.80" "$1,198.80" "$1,198.80" "$1,198.80" "$2,664.00" "$2,664.00" "$2,664.00" $555.24 "$2,664.00" "$2,664.00" "$2,664.00" "$2,664.00" "$2,664.00" $555.21 "$2,664.00" "$1,065.60" "$1,313.35" "$2,664.00" "$2,664.00" "$2,664.00" "$2,664.00" "$1,998.00" "$2,664.00" "$2,664.00" "$2,664.00" "$1,332.00" "$1,332.00" "$2,109.89" "$2,664.00" "$2,131.20" "$1,198.80" $528.74 N/A "$1,545.12" "$2,664.00" "$2,664.00" "$2,664.00" $555.18 "$2,664.00" N/A N/A 04.503.103.01 SUP HCPCS C1713 04.503.103.01 - SCREW BONE 3MM SELF DRILL MATRIXNEURO TITANIUM BOTH IP/OP $217.50 $161.00 $43.09 $217.13 $97.71 $97.71 $97.71 $97.71 $217.13 $217.13 $217.13 $45.26 $217.13 $217.13 $217.13 $217.13 $217.13 $45.25 $217.13 $86.85 $128.43 $217.13 $217.13 $217.13 $217.13 $163.13 $217.13 $217.13 $217.13 $108.57 $108.57 $171.97 $217.13 $173.70 $97.71 $43.09 N/A $126.15 $217.13 $130.28 $217.13 $217.13 $217.13 N/A N/A 04.503.104.01 SUP HCPCS C1713 04.503.104.01 - SCREW BN 4MM NS MATRIXNEURO SLF DRL TI CRNMXF BOTH IP/OP $217.50 $161.00 $43.09 $217.13 $97.71 $97.71 $97.71 $97.71 $217.13 $217.13 $217.13 $45.26 $217.13 $217.13 $217.13 $217.13 $217.13 $45.25 $217.13 $86.85 $128.43 $217.13 $217.13 $217.13 $217.13 $163.13 $217.13 $217.13 $217.13 $108.57 $108.57 $171.97 $217.13 $173.70 $97.71 $43.09 N/A $126.15 $217.13 $130.28 $217.13 $45.25 $217.13 N/A N/A 04.503.105.01 SUP HCPCS C1713 04.503.105.01 - SCREW BN 5MM NS MATRIXNEURO SLF DRL TI CRNMXF BOTH IP/OP $217.50 $161.00 $43.09 $217.13 $97.71 $97.71 $97.71 $97.71 $217.13 $217.13 $217.13 $45.26 $217.13 $217.13 $217.13 $217.13 $217.13 $45.25 $217.13 $86.85 $128.43 $217.13 $217.13 $217.13 $217.13 $163.13 $217.13 $217.13 $217.13 $108.57 $108.57 $171.97 $217.13 $173.70 $97.71 $43.09 N/A $126.15 $217.13 $130.28 $217.13 $217.13 $217.13 N/A N/A 04.503.113.01 SUP HCPCS C1713 04.503.113.01 - SCREW BONE 1.55MM 2.65MM 3MM EMERGENCY SELF TAP MATRIXNEURO BOTH IP/OP $217.50 $161.00 $43.09 $217.13 $97.71 $97.71 $97.71 $97.71 $217.13 $217.13 $217.13 $45.26 $217.13 $217.13 $217.13 $217.13 $217.13 $45.25 $217.13 $86.85 $128.43 $217.13 $217.13 $217.13 $217.13 $163.13 $217.13 $217.13 $217.13 $108.57 $108.57 $171.97 $217.13 $173.70 $97.71 $43.09 N/A $126.15 $217.13 $217.13 $217.13 $217.13 $217.13 N/A N/A 04.503.114.01 SUP HCPCS C1713 04.503.114.01 - SCREW BN 4MM NS MATRIXNEURO ER TI CRNMXF BOTH IP/OP $217.50 $161.00 $43.09 $217.13 $97.71 $97.71 $97.71 $97.71 $217.13 $217.13 $217.13 $45.26 $217.13 $217.13 $217.13 $217.13 $217.13 $45.25 $217.13 $86.85 $128.43 $217.13 $217.13 $217.13 $217.13 $163.13 $217.13 $217.13 $217.13 $108.57 $108.57 $171.97 $217.13 $173.70 $97.71 $43.09 N/A $126.15 $217.13 $217.13 $217.13 $45.25 $217.13 N/A N/A 04.503.115.01 SUP HCPCS C1713 04.503.115.01 - SCREW BONE 1.55MM 2.65MM 5MM EMERGENCY SELF TAP MATRIXNEURO BOTH IP/OP $217.50 $161.00 $43.09 $217.13 $97.71 $97.71 $97.71 $97.71 $217.13 $217.13 $217.13 $45.26 $217.13 $217.13 $217.13 $217.13 $217.13 $45.25 $217.13 $86.85 $128.43 $217.13 $217.13 $217.13 $217.13 $163.13 $217.13 $217.13 $217.13 $108.57 $108.57 $171.97 $217.13 $173.70 $97.71 $43.09 N/A $126.15 $217.13 $130.28 $217.13 $45.25 $217.13 N/A N/A 04.503.120 SUP HCPCS C1713 04.503.120 - PLATE BONE .6MM 45X38MM CONTUR MESH RIGID MATRIXNEURO BOTH IP/OP "$3,832.00" "$2,836.00" $760.51 "$3,831.75" "$1,724.29" "$1,724.29" "$1,724.29" "$1,724.29" "$3,831.75" "$3,831.75" "$3,831.75" $798.63 "$3,831.75" "$3,831.75" "$3,831.75" "$3,831.75" "$3,831.75" $798.58 "$3,831.75" "$1,532.70" "$1,889.05" "$3,831.75" "$3,831.75" "$3,831.75" "$3,831.75" "$2,874.00" "$3,831.75" "$3,831.75" "$3,831.75" "$1,915.88" "$1,915.88" "$3,034.75" "$3,831.75" "$3,065.40" "$1,724.29" $760.51 N/A "$2,222.56" "$3,831.75" "$2,299.05" "$3,831.75" $798.54 "$3,831.75" N/A N/A 04.503.121 SUP HCPCS C1713 04.503.121 - PLATE BONE 100X100X.6MM CONTUR MESH RIGID MATRIXNEURO BOTH IP/OP "$5,965.00" "$4,414.00" "$1,183.85" "$5,964.75" "$2,684.14" "$2,684.14" "$2,684.14" "$2,684.14" "$5,964.75" "$5,964.75" "$5,964.75" "$1,243.20" "$5,964.75" "$5,964.75" "$5,964.75" "$5,964.75" "$5,964.75" "$1,243.12" "$5,964.75" "$2,385.90" "$2,940.62" "$5,964.75" "$5,964.75" "$5,964.75" "$5,964.75" "$4,473.75" "$5,964.75" "$5,964.75" "$5,964.75" "$2,982.38" "$2,982.38" "$4,724.08" "$5,964.75" "$4,771.80" "$2,684.14" "$1,183.85" N/A "$3,459.70" "$5,964.75" "$3,578.85" "$5,964.75" "$1,243.05" "$5,964.75" N/A N/A 04.503.122 SUP Custom 27803010 04.503.122 - PLATE BONE 200X200X.6MM CONTUR MESH EXTRA RIGID MATRIXNEURO BOTH IP/OP "$22,842.00" "$16,903.00" "$4,065.88" "$22,842.00" "$22,842.00" "$22,842.00" "$22,842.00" "$22,842.00" "$22,842.00" "$22,842.00" "$4,065.88" "$22,842.00" "$22,842.00" "$22,842.00" "$22,842.00" "$22,842.00" "$22,842.00" "$4,760.52" "$22,842.00" "$9,136.80" "$22,842.00" "$22,842.00" "$22,842.00" "$22,842.00" "$22,842.00" "$17,131.50" "$22,842.00" "$22,842.00" "$22,842.00" "$11,421.00" "$11,421.00" "$18,090.86" "$22,842.00" "$18,273.60" "$10,278.90" "$22,842.00" N/A "$13,248.36" "$22,842.00" "$13,705.20" "$22,842.00" "$22,842.00" "$22,842.00" N/A N/A 04.503.123 SUP Custom 27803010 04.503.123 - PLATE BONE SMALL CRESCENT .6MM CONTUR MESH EXTRA RIGID BOTH IP/OP "$2,203.00" "$1,630.00" $392.09 "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" $392.09 "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" $459.08 "$2,202.75" $881.10 "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$1,652.25" "$2,202.75" "$2,202.75" "$2,202.75" "$1,101.38" "$1,101.38" "$1,744.58" "$2,202.75" "$1,762.20" $991.24 "$2,202.75" N/A "$1,277.74" "$2,202.75" "$1,321.65" "$2,202.75" "$2,202.75" "$2,202.75" N/A N/A 04.503.124 SUP Custom 27803010 04.503.124 - PLATE BONE LARGE CRESCENT .6MM CONTUR MESH EXTRA RIGID BOTH IP/OP "$3,433.50" "$2,541.00" $611.16 "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" $611.16 "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" $715.58 "$3,433.50" "$1,373.40" "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" "$2,575.13" "$3,433.50" "$3,433.50" "$3,433.50" "$1,716.75" "$1,716.75" "$2,719.33" "$3,433.50" "$2,746.80" "$1,545.08" "$3,433.50" N/A "$1,991.43" "$3,433.50" "$2,060.10" "$3,433.50" "$3,433.50" "$3,433.50" N/A N/A 04.503.125 SUP HCPCS C1713 04.503.125 - PLATE BONE 30MM .6MM CONTUR MESH RIGID CRANIAL SYSTEM BOTH IP/OP "$2,203.00" "$1,630.00" $437.19 "$2,202.75" $991.24 $991.24 $991.24 $991.24 "$2,202.75" "$2,202.75" "$2,202.75" $459.11 "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" $459.08 "$2,202.75" "$2,202.75" "$1,302.93" "$2,202.75" "$2,202.75" "$2,202.75" "$2,202.75" "$1,652.25" "$2,202.75" "$2,202.75" "$2,202.75" "$1,101.38" "$1,101.38" "$1,744.58" "$2,202.75" "$1,762.20" $991.24 $437.19 N/A "$1,277.74" "$2,202.75" "$2,202.75" "$2,202.75" $459.05 "$2,202.75" N/A N/A 04.503.126 SUP HCPCS C1713 04.503.126 - PLATE BONE 70MM .6MM CONTUR MESH RIGID CRANIAL SYSTEM BOTH IP/OP "$4,561.00" "$3,375.00" $905.19 "$4,560.75" "$2,052.34" "$2,052.34" "$2,052.34" "$2,052.34" "$4,560.75" "$4,560.75" "$4,560.75" $950.57 "$4,560.75" "$4,560.75" "$4,560.75" "$4,560.75" "$4,560.75" $950.51 "$4,560.75" "$4,560.75" "$2,248.45" "$4,560.75" "$4,560.75" "$4,560.75" "$4,560.75" "$3,420.75" "$4,560.75" "$4,560.75" "$4,560.75" "$2,280.38" "$2,280.38" "$3,612.11" "$4,560.75" "$3,648.60" "$2,052.34" $905.19 N/A "$2,645.38" "$4,560.75" "$4,560.75" "$4,560.75" $950.46 "$4,560.75" N/A N/A 04.503.127 SUP Custom 27803010 04.503.127 - MESH DYNAMIC CIR 100MM .6MM CONTUR EXTRA RIGID MATRIXNEURO BOTH IP/OP "$5,688.00" "$4,209.00" "$1,012.46" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$1,012.46" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$1,185.44" "$5,688.00" "$2,275.20" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$5,688.00" "$4,266.00" "$5,688.00" "$5,688.00" "$5,688.00" "$2,844.00" "$2,844.00" "$4,504.90" "$5,688.00" "$4,550.40" "$2,559.60" "$5,688.00" N/A "$3,299.04" "$5,688.00" "$3,412.80" "$5,688.00" "$5,688.00" "$5,688.00" N/A N/A 04.503.131S SUP Custom 27803010 04.503.131S - KIT SCREW 4MM STANDARD SLFDRILL MATRIXNEURO STERILE CRANIAL BOTH IP/OP "$1,843.00" "$1,364.00" $328.01 "$1,842.75" "$1,842.75" "$1,842.75" "$1,842.75" "$1,842.75" "$1,842.75" "$1,842.75" $328.01 "$1,842.75" "$1,842.75" "$1,842.75" "$1,842.75" "$1,842.75" "$1,842.75" $384.05 "$1,842.75" $737.10 "$1,842.75" "$1,842.75" "$1,842.75" "$1,842.75" "$1,842.75" "$1,382.25" "$1,842.75" "$1,842.75" "$1,842.75" $921.38 $921.38 "$1,459.46" "$1,842.75" "$1,474.20" $829.24 "$1,842.75" N/A "$1,068.94" "$1,842.75" "$1,105.65" "$1,842.75" "$1,842.75" "$1,842.75" N/A N/A 04.503.134S SUP Custom 27803010 04.503.134S - COVER BURR HOLE 2.9MM 17MM SLFTAP LOCKING MATRIXRIB TITANIUM BOTH IP/OP "$2,781.00" "$2,058.00" $495.02 "$2,781.00" "$2,781.00" "$2,781.00" "$2,781.00" "$2,781.00" "$2,781.00" "$2,781.00" $495.02 "$2,781.00" "$2,781.00" "$2,781.00" "$2,781.00" "$2,781.00" "$2,781.00" $579.59 "$2,781.00" "$1,112.40" "$2,781.00" "$2,781.00" "$2,781.00" "$2,781.00" "$2,781.00" "$2,085.75" "$2,781.00" "$2,781.00" "$2,781.00" "$1,390.50" "$1,390.50" "$2,202.55" "$2,781.00" "$2,224.80" "$1,251.45" "$2,781.00" N/A "$1,612.98" "$2,781.00" "$1,668.60" "$2,781.00" "$2,781.00" "$2,781.00" N/A N/A 04.503.203.01 SUP HCPCS C1713 04.503.203.01 - SCREW BONE 1.55MM 1.22MM 3MM SLFTAP MTRXMDFACE BRONZE BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $211.50 $211.50 N/A N/A 04.503.204.01 SUP HCPCS C1713 04.503.204.01 - SCREW BONE 1.55MM 1.22MM 4MM SLFTAP MTRXMDFACE BRONZE BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $44.08 $211.50 N/A N/A 04.503.205.01 SUP HCPCS C1713 04.503.205.01 - SCREW BONE 1.5MM 5MM SLFTAP MTRXMDFACE BRONZE TITANIUM BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $211.50 $211.50 $44.08 $211.50 N/A N/A 04.503.206.01 SUP HCPCS C1713 04.503.206.01 - SCREW BONE 1.55MM 1.22MM 6MM SLFTAP MTRXMDFACE BRONZE BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $211.50 $211.50 $44.08 $211.50 N/A N/A 04.503.208.01 SUP HCPCS C1713 04.503.208.01 - SCREW BONE 1.55MM 1.22MM 8MM SLFTAP MTRXMDFACE BRONZE BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $44.08 $211.50 N/A N/A 04.503.210.01 SUP HCPCS C1713 04.503.210.01 - SCREW BONE 1.55MM 2.65MM 10MM SELF TAP MTRXMDFACE BRONZE BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $211.50 $211.50 $44.08 $211.50 N/A N/A 04.503.212.01 SUP HCPCS C1713 04.503.212.01 - SCREW BONE 1.55MM 2.65MM 12MM SELF TAP MTRXMDFACE BRONZE BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $211.50 $211.50 $44.08 $211.50 N/A N/A 04.503.214.01 SUP HCPCS C1713 04.503.214.01 - SCREW BONE 1.55MM 2.65MM 14MM SELF TAP MTRXMDFACE BRONZE BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $44.08 $211.50 N/A N/A 04.503.216.01 SUP HCPCS C1713 04.503.216.01 - SCREW BONE 1.55MM 2.65MM 16MM SLFTAP MTRXMDFACE BRONZE BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $44.08 $211.50 N/A N/A 04.503.218.01 SUP HCPCS C1713 04.503.218.01 - SCREW BONE 1.55MM 2.65MM 18MM SLFTAP MTRXMDFACE BRONZE BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $44.08 $211.50 N/A N/A 04.503.223.01 SUP HCPCS C1713 04.503.223.01 - SCREW BONE 1.55MM 2.65MM 3MM SLFDRILL MTRXMDFACE SILVER BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 04.503.224 SUP HCPCS C1713 04.503.224 - SCREW TI 4MM CRNMXF ORBTL FLR SLFDRILL BONE MTRX MIDFAC BOTH IP/OP $164.50 $122.00 $32.60 $164.25 $73.91 $73.91 $73.91 $73.91 $164.25 $164.25 $164.25 $34.23 $164.25 $164.25 $164.25 $164.25 $164.25 $34.23 $164.25 $65.70 $97.15 $164.25 $164.25 $164.25 $164.25 $123.38 $164.25 $164.25 $164.25 $82.13 $82.13 $130.09 $164.25 $131.40 $73.91 $32.60 N/A $95.41 $164.25 $98.55 $164.25 $34.23 $164.25 N/A N/A 04.503.224.01 SUP HCPCS C1713 04.503.224.01 - SCREW BONE 1.5MM 4MM SLFDRILL MTRXMDFACE SILVER TITANIUM BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 04.503.225 SUP HCPCS C1713 04.503.225 - SCREW TI 5MM MIDFAC BONE MTRXMDFACE NONSTRL BOTH IP/OP $164.50 $122.00 $32.60 $164.25 $73.91 $73.91 $73.91 $73.91 $164.25 $164.25 $164.25 $34.23 $164.25 $164.25 $164.25 $164.25 $164.25 $34.23 $164.25 $65.70 $97.15 $164.25 $164.25 $164.25 $164.25 $123.38 $164.25 $164.25 $164.25 $82.13 $82.13 $130.09 $164.25 $131.40 $73.91 $32.60 N/A $95.41 $164.25 $98.55 $164.25 $34.23 $164.25 N/A N/A 04.503.225.01 SUP HCPCS C1713 04.503.225.01 - SCREW BONE 1.5MM 5MM SLFDRILL MTRXMDFACE SILVER TITANIUM BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $87.30 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 04.503.226 SUP HCPCS C1713 04.503.226 - SCREW TI 6MM CRNMXF ORBTL FLR SLFDRILL BONE MTRXMDFACE BOTH IP/OP $164.50 $122.00 $32.60 $164.25 $73.91 $73.91 $73.91 $73.91 $164.25 $164.25 $164.25 $34.23 $164.25 $164.25 $164.25 $164.25 $164.25 $34.23 $164.25 $65.70 $97.15 $164.25 $164.25 $164.25 $164.25 $123.38 $164.25 $164.25 $164.25 $82.13 $82.13 $130.09 $164.25 $131.40 $73.91 $32.60 N/A $95.41 $164.25 $164.25 $164.25 $34.23 $164.25 N/A N/A 04.503.226.01 SUP HCPCS C1713 04.503.226.01 - SCREW BONE 1.5MM 6MM SLFDRILL MTRXMDFACE SILVER TITANIUM BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $87.30 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $218.25 $218.25 $45.48 $218.25 N/A N/A 04.503.228.01 SUP HCPCS C1713 04.503.228.01 - SCREW BONE 1.5MM 8MM SLFDRILL MTRXMDFACE SILVER TITANIUM BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $87.30 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 04.503.233.01 SUP HCPCS C1713 04.503.233.01 - SCREW BONE 3MM EMERGENCY MTRXMDFACE LIGHT BLUE TITANIUM BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $87.30 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 04.503.234.01 SUP HCPCS C1713 04.503.234.01 - SCREW BONE 1.8MM 4MM SLFDRILL EMERGENCY MTRXMDFACE LIGHT BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $218.25 $218.25 N/A N/A 04.503.235.01 SUP HCPCS C1713 04.503.235.01 - SCREW BONE 1.8MM 5MM EMERGENCY MTRXMDFACE LIGHT BLUE BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 04.503.236.01 SUP HCPCS C1713 04.503.236.01 - SCREW BONE 1.55MM 2.65MM 6MM EMERGENCY MTRXMDFACE LIGHT BLUE BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $218.25 $218.25 $45.48 $218.25 N/A N/A 04.503.238.01 SUP HCPCS C1713 04.503.238.01 - SCREW BONE 1.55MM 2.65MM 8MM EMERGENCY MTRXMDFACE LIGHT BLUE BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 04.503.240.01 SUP HCPCS C1713 04.503.240.01 - SCREW BONE 1.55MM 2.65MM 10MM EMERGENCY MTRXMDFACE LIGHT BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $87.30 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 04.503.242.01 SUP HCPCS C1713 04.503.242.01 - SCREW BONE 1.55MM 2.65MM 12MM EMERGENCY MTRXMDFACE LIGHT BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $87.30 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $218.25 $218.25 $45.48 $218.25 N/A N/A 04.503.244.01 SUP HCPCS C1713 04.503.244.01 - SCREW BONE 1.55MM 2.65MM 14MM EMERGENCY MTRXMDFACE LIGHT BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $87.30 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $218.25 $218.25 $45.48 $218.25 N/A N/A 04.503.246.01 SUP HCPCS C1713 04.503.246.01 - SCREW BONE 1.55MM 2.65MM 16MM EMERGENCY MTRXMDFACE LIGHT BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $45.48 $218.25 N/A N/A 04.503.248.01 SUP HCPCS C1713 04.503.248.01 - SCREW BONE 1.55MM 2.65MM 18MM EMERGENCY MTRXMDFACE LIGHT BOTH IP/OP $218.50 $162.00 $43.32 $218.25 $98.21 $98.21 $98.21 $98.21 $218.25 $218.25 $218.25 $45.49 $218.25 $218.25 $218.25 $218.25 $218.25 $45.49 $218.25 $87.30 $129.09 $218.25 $218.25 $218.25 $218.25 $163.88 $218.25 $218.25 $218.25 $109.13 $109.13 $172.85 $218.25 $174.60 $98.21 $43.32 N/A $126.73 $218.25 $130.95 $218.25 $218.25 $218.25 N/A N/A 04.503.301 SUP HCPCS C1713 04.503.301 - PLATE BN SM .3MM NS MATRIXMIDFACE TI ORBT FLR BOTH IP/OP "$3,202.00" "$2,369.00" $635.47 "$3,201.75" "$1,440.79" "$1,440.79" "$1,440.79" "$1,440.79" "$3,201.75" "$3,201.75" "$3,201.75" $667.32 "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" $667.28 "$3,201.75" "$3,201.75" "$1,578.46" "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" "$2,401.50" "$3,201.75" "$3,201.75" "$3,201.75" "$1,600.88" "$1,600.88" "$2,535.79" "$3,201.75" "$2,561.40" "$1,440.79" $635.47 N/A "$1,857.16" "$3,201.75" "$3,201.75" "$3,201.75" $667.24 "$3,201.75" N/A N/A 04.503.302 SUP HCPCS C1713 04.503.302 - PLATE BN MED .3MM NS MATRIXMIDFACE TI ORBT FLR BOTH IP/OP "$3,202.00" "$2,369.00" $635.47 "$3,201.75" "$1,440.79" "$1,440.79" "$1,440.79" "$1,440.79" "$3,201.75" "$3,201.75" "$3,201.75" $667.32 "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" $667.28 "$3,201.75" "$3,201.75" "$1,578.46" "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" "$2,401.50" "$3,201.75" "$3,201.75" "$3,201.75" "$1,600.88" "$1,600.88" "$2,535.79" "$3,201.75" "$2,561.40" "$1,440.79" $635.47 N/A "$1,857.16" "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" N/A N/A 04.503.303 SUP HCPCS C1713 04.503.303 - PLATE BN LG .3MM NS MATRIXMIDFACE TI ORBT FLR BOTH IP/OP "$3,202.00" "$2,369.00" $635.47 "$3,201.75" "$1,440.79" "$1,440.79" "$1,440.79" "$1,440.79" "$3,201.75" "$3,201.75" "$3,201.75" $667.32 "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" $667.28 "$3,201.75" "$3,201.75" "$1,578.46" "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" "$2,401.50" "$3,201.75" "$3,201.75" "$3,201.75" "$1,600.88" "$1,600.88" "$2,535.79" "$3,201.75" "$2,561.40" "$1,440.79" $635.47 N/A "$1,857.16" "$3,201.75" "$3,201.75" "$3,201.75" $667.24 "$3,201.75" N/A N/A 04.503.304 SUP HCPCS C1713 04.503.304 - PLATE BN UNV .4MM NS MATRIXMIDFACE TI ORBT FLR BOTH IP/OP "$3,202.00" "$2,369.00" $635.47 "$3,201.75" "$1,440.79" "$1,440.79" "$1,440.79" "$1,440.79" "$3,201.75" "$3,201.75" "$3,201.75" $667.32 "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" $667.28 "$3,201.75" "$3,201.75" "$1,578.46" "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" "$2,401.50" "$3,201.75" "$3,201.75" "$3,201.75" "$1,600.88" "$1,600.88" "$2,535.79" "$3,201.75" "$2,561.40" "$1,440.79" $635.47 N/A "$1,857.16" "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" N/A N/A 04.503.305 SUP HCPCS C1713 04.503.305 - PLATE BN UNV .5MM NS MATRIXMIDFACE TI ORBT FLR MDL WL BOTH IP/OP "$3,202.00" "$2,369.00" $635.47 "$3,201.75" "$1,440.79" "$1,440.79" "$1,440.79" "$1,440.79" "$3,201.75" "$3,201.75" "$3,201.75" $667.32 "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" $667.28 "$3,201.75" "$3,201.75" "$1,578.46" "$3,201.75" "$3,201.75" "$3,201.75" "$3,201.75" "$2,401.50" "$3,201.75" "$3,201.75" "$3,201.75" "$1,600.88" "$1,600.88" "$2,535.79" "$3,201.75" "$2,561.40" "$1,440.79" $635.47 N/A "$1,857.16" "$3,201.75" "$3,201.75" "$3,201.75" $667.24 "$3,201.75" N/A N/A 04.503.306 SUP HCPCS C1713 04.503.306 - PLATE BN .2MM NS MATRIXMIDFACE MESH TI ORBT FLR BOTH IP/OP "$3,323.50" "$2,459.00" $659.58 "$3,323.25" "$1,495.46" "$1,495.46" "$1,495.46" "$1,495.46" "$3,323.25" "$3,323.25" "$3,323.25" $692.65 "$3,323.25" "$3,323.25" "$3,323.25" "$3,323.25" "$3,323.25" $692.60 "$3,323.25" "$3,323.25" "$1,638.36" "$3,323.25" "$3,323.25" "$3,323.25" "$3,323.25" "$2,492.63" "$3,323.25" "$3,323.25" "$3,323.25" "$1,661.63" "$1,661.63" "$2,632.01" "$3,323.25" "$2,658.60" "$1,495.46" $659.58 N/A "$1,927.63" "$3,323.25" "$3,323.25" "$3,323.25" "$3,323.25" "$3,323.25" N/A N/A 04.503.307 SUP HCPCS C1713 04.503.307 - PLATE BN .3MM NS MATRIXMIDFACE MESH TI ORBT FLR BOTH IP/OP "$3,323.50" "$2,459.00" $659.58 "$3,323.25" "$1,495.46" "$1,495.46" "$1,495.46" "$1,495.46" "$3,323.25" "$3,323.25" "$3,323.25" $692.65 "$3,323.25" "$3,323.25" "$3,323.25" "$3,323.25" "$3,323.25" $692.60 "$3,323.25" "$3,323.25" "$1,638.36" "$3,323.25" "$3,323.25" "$3,323.25" "$3,323.25" "$2,492.63" "$3,323.25" "$3,323.25" "$3,323.25" "$1,661.63" "$1,661.63" "$2,632.01" "$3,323.25" "$2,658.60" "$1,495.46" $659.58 N/A "$1,927.63" "$3,323.25" "$3,323.25" "$3,323.25" $692.57 "$3,323.25" N/A N/A 04.503.308 SUP HCPCS C1713 04.503.308 - PLATE BN .4MM NS MATRIXMIDFACE MESH TI ORBT FLR BOTH IP/OP "$3,323.50" "$2,459.00" $659.58 "$3,323.25" "$1,495.46" "$1,495.46" "$1,495.46" "$1,495.46" "$3,323.25" "$3,323.25" "$3,323.25" $692.65 "$3,323.25" "$3,323.25" "$3,323.25" "$3,323.25" "$3,323.25" $692.60 "$3,323.25" "$3,323.25" "$1,638.36" "$3,323.25" "$3,323.25" "$3,323.25" "$3,323.25" "$2,492.63" "$3,323.25" "$3,323.25" "$3,323.25" "$1,661.63" "$1,661.63" "$2,632.01" "$3,323.25" "$2,658.60" "$1,495.46" $659.58 N/A "$1,927.63" "$3,323.25" "$1,993.95" "$3,323.25" $692.57 "$3,323.25" N/A N/A 04.503.313 SUP HCPCS C1713 04.503.313 - PLATE BN STD MIC .4MM NS MATRIXMIDFACE 12 HL TI ORBT RIM BOTH IP/OP $927.00 $686.00 $183.99 $927.00 $417.15 $417.15 $417.15 $417.15 $927.00 $927.00 $927.00 $193.21 $927.00 $927.00 $927.00 $927.00 $927.00 $193.20 $927.00 $370.80 $548.32 $927.00 $927.00 $927.00 $927.00 $695.25 $927.00 $927.00 $927.00 $463.50 $463.50 $734.18 $927.00 $741.60 $417.15 $183.99 N/A $537.66 $927.00 $556.20 $927.00 $193.19 $927.00 N/A N/A 04.503.314 SUP HCPCS C1713 04.503.314 - PLATE BONE .4MM 6 HOLE ADAPTION MTRXMDFACE SILVER TITANIUM BOTH IP/OP $679.50 $503.00 $134.86 $679.50 $305.78 $305.78 $305.78 $305.78 $679.50 $679.50 $679.50 $141.62 $679.50 $679.50 $679.50 $679.50 $679.50 $141.62 $679.50 $271.80 $401.92 $679.50 $679.50 $679.50 $679.50 $509.63 $679.50 $679.50 $679.50 $339.75 $339.75 $538.16 $679.50 $543.60 $305.78 $134.86 N/A $394.11 $679.50 $407.70 $679.50 $141.61 $679.50 N/A N/A 04.503.315 SUP HCPCS C1713 04.503.315 - PLATE BN STD MIC .4MM SLVR NS MATRIXMIDFACE 8 HL ADP TI MDFC BOTH IP/OP $841.50 $623.00 $167.02 $841.50 $378.68 $378.68 $378.68 $378.68 $841.50 $841.50 $841.50 $175.39 $841.50 $841.50 $841.50 $841.50 $841.50 $175.38 $841.50 $336.60 $497.75 $841.50 $841.50 $841.50 $841.50 $631.13 $841.50 $841.50 $841.50 $420.75 $420.75 $666.47 $841.50 $673.20 $378.68 $167.02 N/A $488.07 $841.50 $504.90 $841.50 $841.50 $841.50 N/A N/A 04.503.316 SUP HCPCS C1713 04.503.316 - PLATE BN STD MIC .4MM NS MATRIXMIDFACE 20 HL ADP TI MDFC BOTH IP/OP "$1,681.00" "$1,244.00" $333.59 "$1,680.75" $756.34 $756.34 $756.34 $756.34 "$1,680.75" "$1,680.75" "$1,680.75" $350.31 "$1,680.75" "$1,680.75" "$1,680.75" "$1,680.75" "$1,680.75" $350.29 "$1,680.75" "$1,680.75" $994.16 "$1,680.75" "$1,680.75" "$1,680.75" "$1,680.75" "$1,260.75" "$1,680.75" "$1,680.75" "$1,680.75" $840.38 $840.38 "$1,331.15" "$1,680.75" "$1,344.60" $756.34 $333.59 N/A $974.98 "$1,680.75" "$1,680.75" "$1,680.75" "$1,680.75" "$1,680.75" N/A N/A 04.503.317 SUP HCPCS C1713 04.503.317 - PLATE BN STD MIC Y .4MM NS MATRIXMIDFACE 1X3 HL TI MDFC BOTH IP/OP $747.00 $553.00 $148.26 $747.00 $336.15 $336.15 $336.15 $336.15 $747.00 $747.00 $747.00 $155.69 $747.00 $747.00 $747.00 $747.00 $747.00 $155.68 $747.00 $298.80 $441.85 $747.00 $747.00 $747.00 $747.00 $560.25 $747.00 $747.00 $747.00 $373.50 $373.50 $591.62 $747.00 $597.60 $336.15 $148.26 N/A $433.26 $747.00 $448.20 $747.00 $155.67 $747.00 N/A N/A 04.503.318 SUP HCPCS C1713 04.503.318 - PLATE BN STD MIC 2Y .4MM NS MATRIXMIDFACE 6 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $758.25 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $454.95 $758.25 $158.02 $758.25 N/A N/A 04.503.322 SUP HCPCS C1713 04.503.322 - PLATE BN STD MN H .5MM NS MATRIXMIDFACE 11 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $758.25 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $758.25 $758.25 $158.02 $758.25 N/A N/A 04.503.323 SUP HCPCS C1713 04.503.323 - PLATE BN STD MN OB L L .5MM NS MATRIXMIDFACE 2X3 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $758.25 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $454.95 $758.25 $158.02 $758.25 N/A N/A 04.503.324 SUP HCPCS C1713 04.503.324 - PLATE BN STD MN OB R L .5MM NS MATRIXMIDFACE 2X3 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $758.25 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $454.95 $758.25 $158.02 $758.25 N/A N/A 04.503.325 SUP HCPCS C1713 04.503.325 - PLATE BN STD MN OB L L .5MM NS MATRIXMIDFACE 3X4 HL TI MDFC BOTH IP/OP $776.50 $575.00 $154.07 $776.25 $349.31 $349.31 $349.31 $349.31 $776.25 $776.25 $776.25 $161.79 $776.25 $776.25 $776.25 $776.25 $776.25 $161.78 $776.25 $310.50 $459.15 $776.25 $776.25 $776.25 $776.25 $582.38 $776.25 $776.25 $776.25 $388.13 $388.13 $614.79 $776.25 $621.00 $349.31 $154.07 N/A $450.37 $776.25 $465.75 $776.25 $161.77 $776.25 N/A N/A 04.503.326 SUP HCPCS C1713 04.503.326 - PLATE BN STD MN OB R L .5MM NS MATRIXMIDFACE 3X4 HL TI MDFC BOTH IP/OP $776.50 $575.00 $154.07 $776.25 $349.31 $349.31 $349.31 $349.31 $776.25 $776.25 $776.25 $161.79 $776.25 $776.25 $776.25 $776.25 $776.25 $161.78 $776.25 $310.50 $459.15 $776.25 $776.25 $776.25 $776.25 $582.38 $776.25 $776.25 $776.25 $388.13 $388.13 $614.79 $776.25 $621.00 $349.31 $154.07 N/A $450.37 $776.25 $465.75 $776.25 $161.77 $776.25 N/A N/A 04.503.327 SUP HCPCS C1713 04.503.327 - PLATE BN STD MN T .5MM NS MATRIXMIDFACE 3X4 HL TI MDFC BOTH IP/OP $675.00 $500.00 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $675.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 N/A $391.50 $675.00 $675.00 $675.00 $140.67 $675.00 N/A N/A 04.503.330 SUP HCPCS C1713 04.503.330 - PLATE BN STD MIC BX 10X5X.4MM NS MATRIXMIDFACE 4 HL TI MDFC BOTH IP/OP $747.00 $553.00 $148.26 $747.00 $336.15 $336.15 $336.15 $336.15 $747.00 $747.00 $747.00 $155.69 $747.00 $747.00 $747.00 $747.00 $747.00 $155.68 $747.00 $298.80 $441.85 $747.00 $747.00 $747.00 $747.00 $560.25 $747.00 $747.00 $747.00 $373.50 $373.50 $591.62 $747.00 $597.60 $336.15 $148.26 N/A $433.26 $747.00 $448.20 $747.00 $155.67 $747.00 N/A N/A 04.503.331 SUP HCPCS C1713 04.503.331 - PLATE BN STD MN BX 10X10X.4MM NS MATRIXMIDFACE 4 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $758.25 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $454.95 $758.25 $158.02 $758.25 N/A N/A 04.503.332 SUP HCPCS C1713 04.503.332 - PLATE BN STD MIC X .4MM NS MATRIXMIDFACE 4 HL TI MDFC BOTH IP/OP $747.00 $553.00 $148.26 $747.00 $336.15 $336.15 $336.15 $336.15 $747.00 $747.00 $747.00 $155.69 $747.00 $747.00 $747.00 $747.00 $747.00 $155.68 $747.00 $747.00 $441.85 $747.00 $747.00 $747.00 $747.00 $560.25 $747.00 $747.00 $747.00 $373.50 $373.50 $591.62 $747.00 $597.60 $336.15 $148.26 N/A $433.26 $747.00 $448.20 $747.00 $747.00 $747.00 N/A N/A 04.503.333 SUP HCPCS C1713 04.503.333 - PLATE BN STD MIC .4MM NS MATRIXMIDFACE 18 HL STRUT TI MDFC BOTH IP/OP "$1,600.00" "$1,184.00" $317.51 "$1,599.75" $719.89 $719.89 $719.89 $719.89 "$1,599.75" "$1,599.75" "$1,599.75" $333.43 "$1,599.75" "$1,599.75" "$1,599.75" "$1,599.75" "$1,599.75" $333.41 "$1,599.75" "$1,599.75" $946.25 "$1,599.75" "$1,599.75" "$1,599.75" "$1,599.75" "$1,200.00" "$1,599.75" "$1,599.75" "$1,599.75" $799.88 $799.88 "$1,267.00" "$1,599.75" "$1,279.80" $719.89 $317.51 N/A $928.00 "$1,599.75" $959.85 "$1,599.75" "$1,599.75" "$1,599.75" N/A N/A 04.503.334 SUP HCPCS C1713 04.503.334 - PLATE BN STD MN OB L L .5MM NS MATRIXMIDFACE 4X6 HL TI MDFC BOTH IP/OP $803.50 $595.00 $159.43 $803.25 $361.46 $361.46 $361.46 $361.46 $803.25 $803.25 $803.25 $167.42 $803.25 $803.25 $803.25 $803.25 $803.25 $167.41 $803.25 $803.25 $475.12 $803.25 $803.25 $803.25 $803.25 $602.63 $803.25 $803.25 $803.25 $401.63 $401.63 $636.17 $803.25 $642.60 $361.46 $159.43 N/A $466.03 $803.25 $481.95 $803.25 $167.40 $803.25 N/A N/A 04.503.335 SUP HCPCS C1713 04.503.335 - PLATE BN STD MN OB R L .5MM NS MATRIXMIDFACE 4X6 HL TI MDFC BOTH IP/OP $803.50 $595.00 $159.43 $803.25 $361.46 $361.46 $361.46 $361.46 $803.25 $803.25 $803.25 $167.42 $803.25 $803.25 $803.25 $803.25 $803.25 $167.41 $803.25 $803.25 $475.12 $803.25 $803.25 $803.25 $803.25 $602.63 $803.25 $803.25 $803.25 $401.63 $401.63 $636.17 $803.25 $642.60 $361.46 $159.43 N/A $466.03 $803.25 $481.95 $803.25 $167.40 $803.25 N/A N/A 04.503.343 SUP HCPCS C1713 04.503.343 - PLATE BN STD MN .5MM NS MATRIXMIDFACE 12 HL TI ORBT RIM BOTH IP/OP $927.00 $686.00 $183.99 $927.00 $417.15 $417.15 $417.15 $417.15 $927.00 $927.00 $927.00 $193.21 $927.00 $927.00 $927.00 $927.00 $927.00 $193.20 $927.00 $370.80 $548.32 $927.00 $927.00 $927.00 $927.00 $695.25 $927.00 $927.00 $927.00 $463.50 $463.50 $734.18 $927.00 $741.60 $417.15 $183.99 N/A $537.66 $927.00 $556.20 $927.00 $193.19 $927.00 N/A N/A 04.503.344 SUP HCPCS C1713 04.503.344 - PLATE BONE MINI STANDARD .5MM 6 HOLE MTRXMDFACE BLUE BOTH IP/OP $679.50 $503.00 $134.86 $679.50 $305.78 $305.78 $305.78 $305.78 $679.50 $679.50 $679.50 $141.62 $679.50 $679.50 $679.50 $679.50 $679.50 $141.62 $679.50 $271.80 $401.92 $679.50 $679.50 $679.50 $679.50 $509.63 $679.50 $679.50 $679.50 $339.75 $339.75 $538.16 $679.50 $543.60 $305.78 $134.86 N/A $394.11 $679.50 $407.70 $679.50 $679.50 $679.50 N/A N/A 04.503.345 SUP HCPCS C1713 04.503.345 - PLATE BN STD MN .5MM NS MATRIXMIDFACE 8 HL ADP TI MDFC BOTH IP/OP $841.50 $623.00 $167.02 $841.50 $378.68 $378.68 $378.68 $378.68 $841.50 $841.50 $841.50 $175.39 $841.50 $841.50 $841.50 $841.50 $841.50 $175.38 $841.50 $336.60 $497.75 $841.50 $841.50 $841.50 $841.50 $631.13 $841.50 $841.50 $841.50 $420.75 $420.75 $666.47 $841.50 $673.20 $378.68 $167.02 N/A $488.07 $841.50 $504.90 $841.50 $175.37 $841.50 N/A N/A 04.503.346 SUP HCPCS C1713 04.503.346 - PLATE BN STD MN .5MM NS MATRIXMIDFACE 20 HL ADP TI MDFC BOTH IP/OP "$1,681.00" "$1,244.00" $333.59 "$1,680.75" $756.34 $756.34 $756.34 $756.34 "$1,680.75" "$1,680.75" "$1,680.75" $350.31 "$1,680.75" "$1,680.75" "$1,680.75" "$1,680.75" "$1,680.75" $350.29 "$1,680.75" $672.30 $994.16 "$1,680.75" "$1,680.75" "$1,680.75" "$1,680.75" "$1,260.75" "$1,680.75" "$1,680.75" "$1,680.75" $840.38 $840.38 "$1,331.15" "$1,680.75" "$1,344.60" $756.34 $333.59 N/A $974.98 "$1,680.75" "$1,680.75" "$1,680.75" $350.27 "$1,680.75" N/A N/A 04.503.347 SUP HCPCS C1713 04.503.347 - PLATE BN STD MN Y .5MM NS MATRIXMIDFACE 1X3 HL TI MDFC BOTH IP/OP $747.00 $553.00 $148.26 $747.00 $336.15 $336.15 $336.15 $336.15 $747.00 $747.00 $747.00 $155.69 $747.00 $747.00 $747.00 $747.00 $747.00 $155.68 $747.00 $747.00 $441.85 $747.00 $747.00 $747.00 $747.00 $560.25 $747.00 $747.00 $747.00 $373.50 $373.50 $591.62 $747.00 $597.60 $336.15 $148.26 N/A $433.26 $747.00 $448.20 $747.00 $747.00 $747.00 N/A N/A 04.503.348 SUP HCPCS C1713 04.503.348 - PLATE BN STD MN 2Y .5MM NS MATRIXMIDFACE 6 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $758.25 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $454.95 $758.25 $758.25 $758.25 N/A N/A 04.503.352 SUP HCPCS C1713 04.503.352 - PLATE BN STD MED H .7MM NS MATRIXMIDFACE 11 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $758.25 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $758.25 $758.25 $158.02 $758.25 N/A N/A 04.503.353 SUP HCPCS C1713 04.503.353 - PLATE BN STD MED OB L L .7MM NS MATRIXMIDFACE 2X3 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $758.25 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $454.95 $758.25 $758.25 $758.25 N/A N/A 04.503.354 SUP HCPCS C1713 04.503.354 - PLATE BN STD MED OB R L .7MM NS MATRIXMIDFACE 2X3 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $758.25 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $758.25 $758.25 $758.25 $758.25 N/A N/A 04.503.355 SUP HCPCS C1713 04.503.355 - PLATE BN STD MN OB L L .7MM NS MATRIXMIDFACE 3X4 HL TI MDFC BOTH IP/OP $776.50 $575.00 $154.07 $776.25 $349.31 $349.31 $349.31 $349.31 $776.25 $776.25 $776.25 $161.79 $776.25 $776.25 $776.25 $776.25 $776.25 $161.78 $776.25 $776.25 $459.15 $776.25 $776.25 $776.25 $776.25 $582.38 $776.25 $776.25 $776.25 $388.13 $388.13 $614.79 $776.25 $621.00 $349.31 $154.07 N/A $450.37 $776.25 $465.75 $776.25 $776.25 $776.25 N/A N/A 04.503.356 SUP HCPCS C1713 04.503.356 - PLATE BN STD MN OB R L .7MM NS MATRIXMIDFACE 3X4 HL TI MDFC BOTH IP/OP $776.50 $575.00 $154.07 $776.25 $349.31 $349.31 $349.31 $349.31 $776.25 $776.25 $776.25 $161.79 $776.25 $776.25 $776.25 $776.25 $776.25 $161.78 $776.25 $776.25 $459.15 $776.25 $776.25 $776.25 $776.25 $582.38 $776.25 $776.25 $776.25 $388.13 $388.13 $614.79 $776.25 $621.00 $349.31 $154.07 N/A $450.37 $776.25 $465.75 $776.25 $161.77 $776.25 N/A N/A 04.503.357 SUP HCPCS C1713 04.503.357 - PLATE BN STD MED T .7MM NS MATRIXMIDFACE 3X4 HL TI MDFC BOTH IP/OP $675.00 $500.00 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $675.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 N/A $391.50 $675.00 $405.00 $675.00 $140.67 $675.00 N/A N/A 04.503.360 SUP HCPCS C1713 04.503.360 - PLATE BN STD MN BX 10X5X.5MM NS MATRIXMIDFACE 4 HL TI MDFC BOTH IP/OP $747.00 $553.00 $148.26 $747.00 $336.15 $336.15 $336.15 $336.15 $747.00 $747.00 $747.00 $155.69 $747.00 $747.00 $747.00 $747.00 $747.00 $155.68 $747.00 $747.00 $441.85 $747.00 $747.00 $747.00 $747.00 $560.25 $747.00 $747.00 $747.00 $373.50 $373.50 $591.62 $747.00 $597.60 $336.15 $148.26 N/A $433.26 $747.00 $747.00 $747.00 $155.67 $747.00 N/A N/A 04.503.361 SUP HCPCS C1713 04.503.361 - PLATE BN STD MN BX 10X10X.5MM NS MATRIXMIDFACE 4 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $758.25 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $454.95 $758.25 $158.02 $758.25 N/A N/A 04.503.362 SUP HCPCS C1713 04.503.362 - PLATE BN STD MN X .5MM NS MATRIXMIDFACE 4 HL TI MDFC BOTH IP/OP $747.00 $553.00 $148.26 $747.00 $336.15 $336.15 $336.15 $336.15 $747.00 $747.00 $747.00 $155.69 $747.00 $747.00 $747.00 $747.00 $747.00 $155.68 $747.00 $747.00 $441.85 $747.00 $747.00 $747.00 $747.00 $560.25 $747.00 $747.00 $747.00 $373.50 $373.50 $591.62 $747.00 $597.60 $336.15 $148.26 N/A $433.26 $747.00 $448.20 $747.00 $155.67 $747.00 N/A N/A 04.503.363 SUP HCPCS C1713 04.503.363 - PLATE BN STD MN .5MM NS MATRIXMIDFACE 18 HL STRUT TI MDFC BOTH IP/OP "$1,600.00" "$1,184.00" $317.51 "$1,599.75" $719.89 $719.89 $719.89 $719.89 "$1,599.75" "$1,599.75" "$1,599.75" $333.43 "$1,599.75" "$1,599.75" "$1,599.75" "$1,599.75" "$1,599.75" $333.41 "$1,599.75" "$1,599.75" $946.25 "$1,599.75" "$1,599.75" "$1,599.75" "$1,599.75" "$1,200.00" "$1,599.75" "$1,599.75" "$1,599.75" $799.88 $799.88 "$1,267.00" "$1,599.75" "$1,279.80" $719.89 $317.51 N/A $928.00 "$1,599.75" "$1,599.75" "$1,599.75" $333.39 "$1,599.75" N/A N/A 04.503.364 SUP HCPCS C1713 04.503.364 - PLATE BN STD MED OB L L .7MM NS MATRIXMIDFACE 4X6 HL TI MDFC BOTH IP/OP $803.50 $595.00 $159.43 $803.25 $361.46 $361.46 $361.46 $361.46 $803.25 $803.25 $803.25 $167.42 $803.25 $803.25 $803.25 $803.25 $803.25 $167.41 $803.25 $803.25 $475.12 $803.25 $803.25 $803.25 $803.25 $602.63 $803.25 $803.25 $803.25 $401.63 $401.63 $636.17 $803.25 $642.60 $361.46 $159.43 N/A $466.03 $803.25 $481.95 $803.25 $167.40 $803.25 N/A N/A 04.503.365 SUP HCPCS C1713 04.503.365 - PLATE BN STD MED OB R L .7MM NS MATRIXMIDFACE 4X6 HL TI MDFC BOTH IP/OP $803.50 $595.00 $159.43 $803.25 $361.46 $361.46 $361.46 $361.46 $803.25 $803.25 $803.25 $167.42 $803.25 $803.25 $803.25 $803.25 $803.25 $167.41 $803.25 $803.25 $475.12 $803.25 $803.25 $803.25 $803.25 $602.63 $803.25 $803.25 $803.25 $401.63 $401.63 $636.17 $803.25 $642.60 $361.46 $159.43 N/A $466.03 $803.25 $481.95 $803.25 $167.40 $803.25 N/A N/A 04.503.373 SUP HCPCS C1713 04.503.373 - PLATE BN STD MED .7MM NS MATRIXMIDFACE 12 HL TI ORBT RIM BOTH IP/OP $927.00 $686.00 $183.99 $927.00 $417.15 $417.15 $417.15 $417.15 $927.00 $927.00 $927.00 $193.21 $927.00 $927.00 $927.00 $927.00 $927.00 $193.20 $927.00 $370.80 $548.32 $927.00 $927.00 $927.00 $927.00 $695.25 $927.00 $927.00 $927.00 $463.50 $463.50 $734.18 $927.00 $741.60 $417.15 $183.99 N/A $537.66 $927.00 $556.20 $927.00 $193.19 $927.00 N/A N/A 04.503.374 SUP HCPCS C1713 04.503.374 - PLATE BONE MEDIUM STANDARD .7MM 6 HOLE EXTRA RIGID ADAPTION BOTH IP/OP $679.50 $503.00 $134.86 $679.50 $305.78 $305.78 $305.78 $305.78 $679.50 $679.50 $679.50 $141.62 $679.50 $679.50 $679.50 $679.50 $679.50 $141.62 $679.50 $271.80 $401.92 $679.50 $679.50 $679.50 $679.50 $509.63 $679.50 $679.50 $679.50 $339.75 $339.75 $538.16 $679.50 $543.60 $305.78 $134.86 N/A $394.11 $679.50 $407.70 $679.50 $141.61 $679.50 N/A N/A 04.503.375 SUP HCPCS C1713 04.503.375 - PLATE BN STD MED .7MM NS MATRIXMIDFACE 8 HL ADP TI MDFC BOTH IP/OP $841.50 $623.00 $167.02 $841.50 $378.68 $378.68 $378.68 $378.68 $841.50 $841.50 $841.50 $175.39 $841.50 $841.50 $841.50 $841.50 $841.50 $175.38 $841.50 $841.50 $497.75 $841.50 $841.50 $841.50 $841.50 $631.13 $841.50 $841.50 $841.50 $420.75 $420.75 $666.47 $841.50 $673.20 $378.68 $167.02 N/A $488.07 $841.50 $504.90 $841.50 $175.37 $841.50 N/A N/A 04.503.376 SUP HCPCS C1713 04.503.376 - PLATE BN STD MED .7MM NS MATRIXMIDFACE 20 HL ADP TI MDFC BOTH IP/OP "$1,681.00" "$1,244.00" $333.59 "$1,680.75" $756.34 $756.34 $756.34 $756.34 "$1,680.75" "$1,680.75" "$1,680.75" $350.31 "$1,680.75" "$1,680.75" "$1,680.75" "$1,680.75" "$1,680.75" $350.29 "$1,680.75" "$1,680.75" $994.16 "$1,680.75" "$1,680.75" "$1,680.75" "$1,680.75" "$1,260.75" "$1,680.75" "$1,680.75" "$1,680.75" $840.38 $840.38 "$1,331.15" "$1,680.75" "$1,344.60" $756.34 $333.59 N/A $974.98 "$1,680.75" "$1,008.45" "$1,680.75" $350.27 "$1,680.75" N/A N/A 04.503.377 SUP HCPCS C1713 04.503.377 - PLATE BN STD MED Y .7MM NS MATRIXMIDFACE 1X3 HL TI MDFC BOTH IP/OP $747.00 $553.00 $148.26 $747.00 $336.15 $336.15 $336.15 $336.15 $747.00 $747.00 $747.00 $155.69 $747.00 $747.00 $747.00 $747.00 $747.00 $155.68 $747.00 $747.00 $441.85 $747.00 $747.00 $747.00 $747.00 $560.25 $747.00 $747.00 $747.00 $373.50 $373.50 $591.62 $747.00 $597.60 $336.15 $148.26 N/A $433.26 $747.00 $747.00 $747.00 $155.67 $747.00 N/A N/A 04.503.378 SUP HCPCS C1713 04.503.378 - PLATE BN STD MED 2Y .7MM NS MATRIXMIDFACE 6 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $758.25 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $454.95 $758.25 $158.02 $758.25 N/A N/A 04.503.382 SUP HCPCS C1713 04.503.382 - PLATE BN STD LG H .8MM NS MATRIXMIDFACE 11 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $758.25 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $454.95 $758.25 $158.02 $758.25 N/A N/A 04.503.383 SUP HCPCS C1713 04.503.383 - PLATE BN STD LG OB L L .8MM NS MATRIXMIDFACE 2X3 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $303.30 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $454.95 $758.25 $158.02 $758.25 N/A N/A 04.503.384 SUP HCPCS C1713 04.503.384 - PLATE BN STD LG OB R L .8MM NS MATRIXMIDFACE 2X3 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $303.30 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $454.95 $758.25 $158.02 $758.25 N/A N/A 04.503.385 SUP HCPCS C1713 04.503.385 - PLATE BN STD LG OB L L .8MM NS MATRIXMIDFACE 3X4 HL TI MDFC BOTH IP/OP $776.50 $575.00 $154.07 $776.25 $349.31 $349.31 $349.31 $349.31 $776.25 $776.25 $776.25 $161.79 $776.25 $776.25 $776.25 $776.25 $776.25 $161.78 $776.25 $776.25 $459.15 $776.25 $776.25 $776.25 $776.25 $582.38 $776.25 $776.25 $776.25 $388.13 $388.13 $614.79 $776.25 $621.00 $349.31 $154.07 N/A $450.37 $776.25 $465.75 $776.25 $161.77 $776.25 N/A N/A 04.503.386 SUP HCPCS C1713 04.503.386 - PLATE BN STD LG OB R L .8MM NS MATRIXMIDFACE 3X4 HL TI MDFC BOTH IP/OP $776.50 $575.00 $154.07 $776.25 $349.31 $349.31 $349.31 $349.31 $776.25 $776.25 $776.25 $161.79 $776.25 $776.25 $776.25 $776.25 $776.25 $161.78 $776.25 $310.50 $459.15 $776.25 $776.25 $776.25 $776.25 $582.38 $776.25 $776.25 $776.25 $388.13 $388.13 $614.79 $776.25 $621.00 $349.31 $154.07 N/A $450.37 $776.25 $465.75 $776.25 $161.77 $776.25 N/A N/A 04.503.387 SUP HCPCS C1713 04.503.387 - PLATE BN STD LG T .8MM NS MATRIXMIDFACE 3X4 HL TI MDFC BOTH IP/OP $675.00 $500.00 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $675.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 N/A $391.50 $675.00 $405.00 $675.00 $675.00 $675.00 N/A N/A 04.503.390 SUP HCPCS C1713 04.503.390 - PLATE BN STD MED BX 10X5X.7MM NS MATRIXMIDFACE 4 HL TI MDFC BOTH IP/OP $747.00 $553.00 $148.26 $747.00 $336.15 $336.15 $336.15 $336.15 $747.00 $747.00 $747.00 $155.69 $747.00 $747.00 $747.00 $747.00 $747.00 $155.68 $747.00 $747.00 $441.85 $747.00 $747.00 $747.00 $747.00 $560.25 $747.00 $747.00 $747.00 $373.50 $373.50 $591.62 $747.00 $597.60 $336.15 $148.26 N/A $433.26 $747.00 $448.20 $747.00 $747.00 $747.00 N/A N/A 04.503.391 SUP HCPCS C1713 04.503.391 - PLATE BN STD MED BX 10X10X.7MM NS MATRIXMIDFACE 4 HL TI MDFC BOTH IP/OP $758.50 $561.00 $150.49 $758.25 $341.21 $341.21 $341.21 $341.21 $758.25 $758.25 $758.25 $158.04 $758.25 $758.25 $758.25 $758.25 $758.25 $158.03 $758.25 $758.25 $448.50 $758.25 $758.25 $758.25 $758.25 $568.88 $758.25 $758.25 $758.25 $379.13 $379.13 $600.53 $758.25 $606.60 $341.21 $150.49 N/A $439.93 $758.25 $454.95 $758.25 $158.02 $758.25 N/A N/A 04.503.392 SUP HCPCS C1713 04.503.392 - PLATE BN STD MED X .7MM NS MATRIXMIDFACE 4 HL TI MDFC BOTH IP/OP $747.00 $553.00 $148.26 $747.00 $336.15 $336.15 $336.15 $336.15 $747.00 $747.00 $747.00 $155.69 $747.00 $747.00 $747.00 $747.00 $747.00 $155.68 $747.00 $747.00 $441.85 $747.00 $747.00 $747.00 $747.00 $560.25 $747.00 $747.00 $747.00 $373.50 $373.50 $591.62 $747.00 $597.60 $336.15 $148.26 N/A $433.26 $747.00 $747.00 $747.00 $155.67 $747.00 N/A N/A 04.503.393 SUP HCPCS C1713 04.503.393 - PLATE BN STD MED .7MM NS MATRIXMIDFACE 18 HL STRUT TI MDFC BOTH IP/OP "$1,600.00" "$1,184.00" $317.51 "$1,599.75" $719.89 $719.89 $719.89 $719.89 "$1,599.75" "$1,599.75" "$1,599.75" $333.43 "$1,599.75" "$1,599.75" "$1,599.75" "$1,599.75" "$1,599.75" $333.41 "$1,599.75" "$1,599.75" $946.25 "$1,599.75" "$1,599.75" "$1,599.75" "$1,599.75" "$1,200.00" "$1,599.75" "$1,599.75" "$1,599.75" $799.88 $799.88 "$1,267.00" "$1,599.75" "$1,279.80" $719.89 $317.51 N/A $928.00 "$1,599.75" $959.85 "$1,599.75" $333.39 "$1,599.75" N/A N/A 04.503.394 SUP HCPCS C1713 04.503.394 - PLATE BN L OB L .8MM NS MATRIXMIDFACE 4X6 HL TI MDFC BOTH IP/OP $803.50 $595.00 $159.43 $803.25 $361.46 $361.46 $361.46 $361.46 $803.25 $803.25 $803.25 $167.42 $803.25 $803.25 $803.25 $803.25 $803.25 $167.41 $803.25 $321.30 $475.12 $803.25 $803.25 $803.25 $803.25 $602.63 $803.25 $803.25 $803.25 $401.63 $401.63 $636.17 $803.25 $642.60 $361.46 $159.43 N/A $466.03 $803.25 $481.95 $803.25 $167.40 $803.25 N/A N/A 04.503.395 SUP HCPCS C1713 04.503.395 - PLATE BN STD LG OB R L .8MM NS MATRIXMIDFACE 4X6 HL TI MDFC BOTH IP/OP $803.50 $595.00 $159.43 $803.25 $361.46 $361.46 $361.46 $361.46 $803.25 $803.25 $803.25 $167.42 $803.25 $803.25 $803.25 $803.25 $803.25 $167.41 $803.25 $803.25 $475.12 $803.25 $803.25 $803.25 $803.25 $602.63 $803.25 $803.25 $803.25 $401.63 $401.63 $636.17 $803.25 $642.60 $361.46 $159.43 N/A $466.03 $803.25 $481.95 $803.25 $167.40 $803.25 N/A N/A 04.503.396 SUP HCPCS C1713 04.503.396 - PLATE BN LG .8MM NS MATRIXMIDFACE 20 HL ADP TI MDFC BOTH IP/OP "$1,681.00" "$1,244.00" $333.59 "$1,680.75" $756.34 $756.34 $756.34 $756.34 "$1,680.75" "$1,680.75" "$1,680.75" $350.31 "$1,680.75" "$1,680.75" "$1,680.75" "$1,680.75" "$1,680.75" $350.29 "$1,680.75" "$1,680.75" $994.16 "$1,680.75" "$1,680.75" "$1,680.75" "$1,680.75" "$1,260.75" "$1,680.75" "$1,680.75" "$1,680.75" $840.38 $840.38 "$1,331.15" "$1,680.75" "$1,344.60" $756.34 $333.59 N/A $974.98 "$1,680.75" "$1,008.45" "$1,680.75" $350.27 "$1,680.75" N/A N/A 04.503.397 SUP HCPCS C1713 04.503.397 - PLATE BONE LARGE STANDARD .8MM 12 HOLE MTRXMDFACE GOLD BOTH IP/OP $927.00 $686.00 $183.99 $927.00 $417.15 $417.15 $417.15 $417.15 $927.00 $927.00 $927.00 $193.21 $927.00 $927.00 $927.00 $927.00 $927.00 $193.20 $927.00 $370.80 $548.32 $927.00 $927.00 $927.00 $927.00 $695.25 $927.00 $927.00 $927.00 $463.50 $463.50 $734.18 $927.00 $741.60 $417.15 $183.99 N/A $537.66 $927.00 $556.20 $927.00 $193.19 $927.00 N/A N/A 04.503.398 SUP HCPCS C1713 04.503.398 - PLATE BONE LARGE STANDARD .8MM 6 HOLE ADAPTION MTRXMDFACE BOTH IP/OP $679.50 $503.00 $134.86 $679.50 $305.78 $305.78 $305.78 $305.78 $679.50 $679.50 $679.50 $141.62 $679.50 $679.50 $679.50 $679.50 $679.50 $141.62 $679.50 $271.80 $401.92 $679.50 $679.50 $679.50 $679.50 $509.63 $679.50 $679.50 $679.50 $339.75 $339.75 $538.16 $679.50 $543.60 $305.78 $134.86 N/A $394.11 $679.50 $407.70 $679.50 $141.61 $679.50 N/A N/A 04.503.399 SUP HCPCS C1713 04.503.399 - PLATE BONE LARGE STANDARD .8MM 8 HOLE ADAPTION MTRXMDFACE BOTH IP/OP $841.50 $623.00 $167.02 $841.50 $378.68 $378.68 $378.68 $378.68 $841.50 $841.50 $841.50 $175.39 $841.50 $841.50 $841.50 $841.50 $841.50 $175.38 $841.50 $336.60 $497.75 $841.50 $841.50 $841.50 $841.50 $631.13 $841.50 $841.50 $841.50 $420.75 $420.75 $666.47 $841.50 $673.20 $378.68 $167.02 N/A $488.07 $841.50 $504.90 $841.50 $175.37 $841.50 N/A N/A 04.503.405.01 SUP HCPCS C1713 04.503.405.01 - SCREW BONE 2MM 5MM SLFTAP FINE PITCH MATRIX DRIVE RECESS BOTH IP/OP $169.00 $125.00 $33.49 $168.75 $75.94 $75.94 $75.94 $75.94 $168.75 $168.75 $168.75 $35.17 $168.75 $168.75 $168.75 $168.75 $168.75 $35.17 $168.75 $168.75 $99.82 $168.75 $168.75 $168.75 $168.75 $126.75 $168.75 $168.75 $168.75 $84.38 $84.38 $133.65 $168.75 $135.00 $75.94 $33.49 N/A $98.02 $168.75 $168.75 $168.75 $35.17 $168.75 N/A N/A 04.503.406 SUP HCPCS C1713 04.503.406 - SCREW TI 6MM 2MM MIDFAC SLFTAP BONE MTRXMDFACE NONSTRL BOTH IP/OP $135.00 $100.00 $26.79 $135.00 $60.75 $60.75 $60.75 $60.75 $135.00 $135.00 $135.00 $28.14 $135.00 $135.00 $135.00 $135.00 $135.00 $28.14 $135.00 $135.00 $79.85 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $60.75 $26.79 N/A $78.30 $135.00 $81.00 $135.00 $28.13 $135.00 N/A N/A 04.503.406.01 SUP HCPCS C1713 04.503.406.01 - SCREW BONE 2MM 6MM SELF TAP MTRXMAND TITANIUM MANDIB NONSTRL BOTH IP/OP $169.00 $125.00 $33.49 $168.75 $75.94 $75.94 $75.94 $75.94 $168.75 $168.75 $168.75 $35.17 $168.75 $168.75 $168.75 $168.75 $168.75 $35.17 $168.75 $168.75 $99.82 $168.75 $168.75 $168.75 $168.75 $126.75 $168.75 $168.75 $168.75 $84.38 $84.38 $133.65 $168.75 $135.00 $75.94 $33.49 N/A $98.02 $168.75 $101.25 $168.75 $35.17 $168.75 N/A N/A 04.503.408 SUP HCPCS C1713 04.503.408 - SCREW TI 8MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL BOTH IP/OP $135.00 $100.00 $26.79 $135.00 $60.75 $60.75 $60.75 $60.75 $135.00 $135.00 $135.00 $28.14 $135.00 $135.00 $135.00 $135.00 $135.00 $28.14 $135.00 $135.00 $79.85 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $60.75 $26.79 N/A $78.30 $135.00 $81.00 $135.00 $28.13 $135.00 N/A N/A 04.503.408.01 SUP HCPCS C1713 04.503.408.01 - SCREW BONE 2MM 8MM SLFTAP LOCKING MTRXMAND TITANIUM NONSTRL BOTH IP/OP $169.00 $125.00 $33.49 $168.75 $75.94 $75.94 $75.94 $75.94 $168.75 $168.75 $168.75 $35.17 $168.75 $168.75 $168.75 $168.75 $168.75 $35.17 $168.75 $67.50 $99.82 $168.75 $168.75 $168.75 $168.75 $126.75 $168.75 $168.75 $168.75 $84.38 $84.38 $133.65 $168.75 $135.00 $75.94 $33.49 N/A $98.02 $168.75 $168.75 $168.75 $35.17 $168.75 N/A N/A 04.503.408.01E SUP HCPCS C1713 04.503.408.01E - SCREW TI 8MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL BOTH IP/OP $135.00 $100.00 $26.79 $135.00 $60.75 $60.75 $60.75 $60.75 $135.00 $135.00 $135.00 $28.14 $135.00 $135.00 $135.00 $135.00 $135.00 $28.14 $135.00 $135.00 $79.85 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $60.75 $26.79 N/A $78.30 $135.00 $135.00 $135.00 $28.13 $135.00 N/A N/A 04.503.410.01 SUP HCPCS C1713 04.503.410.01 - SCREW BONE 2MM 10MM SLFTAP MTRXMAND TITANIUM BOTH IP/OP $169.00 $125.00 $33.49 $168.75 $75.94 $75.94 $75.94 $75.94 $168.75 $168.75 $168.75 $35.17 $168.75 $168.75 $168.75 $168.75 $168.75 $35.17 $168.75 $67.50 $99.82 $168.75 $168.75 $168.75 $168.75 $126.75 $168.75 $168.75 $168.75 $84.38 $84.38 $133.65 $168.75 $135.00 $75.94 $33.49 N/A $98.02 $168.75 $101.25 $168.75 $35.17 $168.75 N/A N/A 04.503.412 SUP HCPCS C1713 04.503.412 - SCREW TI 12MM 2MM CRNMXF SLFTAP BONE MTRXMAND NONSTRL BOTH IP/OP $135.00 $100.00 $26.79 $135.00 $60.75 $60.75 $60.75 $60.75 $135.00 $135.00 $135.00 $28.14 $135.00 $135.00 $135.00 $135.00 $135.00 $28.14 $135.00 $54.00 $79.85 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $60.75 $26.79 N/A $78.30 $135.00 $81.00 $135.00 $28.13 $135.00 N/A N/A 04.503.412.01 SUP HCPCS C1713 04.503.412.01 - SCREW BONE 2MM 12MM SLFTAP MTRXMAND TITANIUM MANDIB NONSTRL BOTH IP/OP $169.00 $125.00 $33.49 $168.75 $75.94 $75.94 $75.94 $75.94 $168.75 $168.75 $168.75 $35.17 $168.75 $168.75 $168.75 $168.75 $168.75 $35.17 $168.75 $67.50 $99.82 $168.75 $168.75 $168.75 $168.75 $126.75 $168.75 $168.75 $168.75 $84.38 $84.38 $133.65 $168.75 $135.00 $75.94 $33.49 N/A $98.02 $168.75 $101.25 $168.75 $35.17 $168.75 N/A N/A 04.503.414.01 SUP HCPCS C1713 04.503.414.01 - SCREW BONE 2MM 14MM SELF TAP MTRXMAND TITANIUM MANDIB BOTH IP/OP $169.00 $125.00 $33.49 $168.75 $75.94 $75.94 $75.94 $75.94 $168.75 $168.75 $168.75 $35.17 $168.75 $168.75 $168.75 $168.75 $168.75 $35.17 $168.75 $67.50 $99.82 $168.75 $168.75 $168.75 $168.75 $126.75 $168.75 $168.75 $168.75 $84.38 $84.38 $133.65 $168.75 $135.00 $75.94 $33.49 N/A $98.02 $168.75 $101.25 $168.75 $35.17 $168.75 N/A N/A 04.503.416.01 SUP HCPCS C1713 04.503.416.01 - SCREW BONE 2MM 16MM SLFTAP MTRXMAND TITANIUM BOTH IP/OP $169.00 $125.00 $33.49 $168.75 $75.94 $75.94 $75.94 $75.94 $168.75 $168.75 $168.75 $35.17 $168.75 $168.75 $168.75 $168.75 $168.75 $35.17 $168.75 $67.50 $99.82 $168.75 $168.75 $168.75 $168.75 $126.75 $168.75 $168.75 $168.75 $84.38 $84.38 $133.65 $168.75 $135.00 $75.94 $33.49 N/A $98.02 $168.75 $101.25 $168.75 $35.17 $168.75 N/A N/A 04.503.418.01 SUP HCPCS C1713 04.503.418.01 - SCREW BONE 2MM 18MM SLFTAP MTRXMAND TITANIUM BOTH IP/OP $169.00 $125.00 $33.49 $168.75 $75.94 $75.94 $75.94 $75.94 $168.75 $168.75 $168.75 $35.17 $168.75 $168.75 $168.75 $168.75 $168.75 $35.17 $168.75 $67.50 $99.82 $168.75 $168.75 $168.75 $168.75 $126.75 $168.75 $168.75 $168.75 $84.38 $84.38 $133.65 $168.75 $135.00 $75.94 $33.49 N/A $98.02 $168.75 $101.25 $168.75 $168.75 $168.75 N/A N/A 04.503.435.01 SUP HCPCS C1713 04.503.435.01 - SCREW BONE 2.4MM 5MM SELF TAP MTRXMAND TITANIUM MANDIB BOTH IP/OP $243.00 $180.00 $48.23 $243.00 $109.35 $109.35 $109.35 $109.35 $243.00 $243.00 $243.00 $50.65 $243.00 $243.00 $243.00 $243.00 $243.00 $50.64 $243.00 $97.20 $143.73 $243.00 $243.00 $243.00 $243.00 $182.25 $243.00 $243.00 $243.00 $121.50 $121.50 $192.46 $243.00 $194.40 $109.35 $48.23 N/A $140.94 $243.00 $145.80 $243.00 $50.64 $243.00 N/A N/A 04.503.436.01 SUP HCPCS C1713 04.503.436.01 - SCREW BONE 2.4MM 6MM SELF TAP MTRXMAND TITANIUM MANDIB BOTH IP/OP $243.00 $180.00 $48.23 $243.00 $109.35 $109.35 $109.35 $109.35 $243.00 $243.00 $243.00 $50.65 $243.00 $243.00 $243.00 $243.00 $243.00 $50.64 $243.00 $97.20 $143.73 $243.00 $243.00 $243.00 $243.00 $182.25 $243.00 $243.00 $243.00 $121.50 $121.50 $192.46 $243.00 $194.40 $109.35 $48.23 N/A $140.94 $243.00 $243.00 $243.00 $243.00 $243.00 N/A N/A 04.503.438.01 SUP HCPCS C1713 04.503.438.01 - SCREW BONE 2.4MM 8MM SLFTAP MTRXMAND TITANIUM MANDIB NONSTRL BOTH IP/OP $243.00 $180.00 $48.23 $243.00 $109.35 $109.35 $109.35 $109.35 $243.00 $243.00 $243.00 $50.65 $243.00 $243.00 $243.00 $243.00 $243.00 $50.64 $243.00 $97.20 $143.73 $243.00 $243.00 $243.00 $243.00 $182.25 $243.00 $243.00 $243.00 $121.50 $121.50 $192.46 $243.00 $194.40 $109.35 $48.23 N/A $140.94 $243.00 $243.00 $243.00 $50.64 $243.00 N/A N/A 04.503.440.01 SUP HCPCS C1713 04.503.440.01 - SCREW BONE 2.4MM 10MM SELF TAP MTRXMAND TITANIUM MANDIB BOTH IP/OP $243.00 $180.00 $48.23 $243.00 $109.35 $109.35 $109.35 $109.35 $243.00 $243.00 $243.00 $50.65 $243.00 $243.00 $243.00 $243.00 $243.00 $50.64 $243.00 $243.00 $143.73 $243.00 $243.00 $243.00 $243.00 $182.25 $243.00 $243.00 $243.00 $121.50 $121.50 $192.46 $243.00 $194.40 $109.35 $48.23 N/A $140.94 $243.00 $145.80 $243.00 $50.64 $243.00 N/A N/A 04.503.442.01 SUP HCPCS C1713 04.503.442.01 - SCREW BONE 2.4MM 12MM SLFTAP MTRXMAND TITANIUM MANDIB BOTH IP/OP $243.00 $180.00 $48.23 $243.00 $109.35 $109.35 $109.35 $109.35 $243.00 $243.00 $243.00 $50.65 $243.00 $243.00 $243.00 $243.00 $243.00 $50.64 $243.00 $97.20 $143.73 $243.00 $243.00 $243.00 $243.00 $182.25 $243.00 $243.00 $243.00 $121.50 $121.50 $192.46 $243.00 $194.40 $109.35 $48.23 N/A $140.94 $243.00 $145.80 $243.00 $50.64 $243.00 N/A N/A 04.503.444 SUP HCPCS C1713 04.503.444 - SCREW TI 14MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL BOTH IP/OP $193.50 $143.00 $38.40 $193.50 $87.08 $87.08 $87.08 $87.08 $193.50 $193.50 $193.50 $40.33 $193.50 $193.50 $193.50 $193.50 $193.50 $40.33 $193.50 $193.50 $114.46 $193.50 $193.50 $193.50 $193.50 $145.13 $193.50 $193.50 $193.50 $96.75 $96.75 $153.25 $193.50 $154.80 $87.08 $38.40 N/A $112.23 $193.50 $116.10 $193.50 $40.33 $193.50 N/A N/A 04.503.444.01 SUP HCPCS C1713 04.503.444.01 - SCREW BONE 2.4MM 14MM SLFTAP EMERGENCY MTRXMAND TITANIUM BOTH IP/OP $243.00 $180.00 $48.23 $243.00 $109.35 $109.35 $109.35 $109.35 $243.00 $243.00 $243.00 $50.65 $243.00 $243.00 $243.00 $243.00 $243.00 $50.64 $243.00 $97.20 $143.73 $243.00 $243.00 $243.00 $243.00 $182.25 $243.00 $243.00 $243.00 $121.50 $121.50 $192.46 $243.00 $194.40 $109.35 $48.23 N/A $140.94 $243.00 $145.80 $243.00 $243.00 $243.00 N/A N/A 04.503.446 SUP HCPCS C1713 04.503.446 - SCREW TI 16MM 2.4MM SLFTAP BONE MTRXMAND NONSTRL BOTH IP/OP $193.50 $143.00 $38.40 $193.50 $87.08 $87.08 $87.08 $87.08 $193.50 $193.50 $193.50 $40.33 $193.50 $193.50 $193.50 $193.50 $193.50 $40.33 $193.50 $77.40 $114.46 $193.50 $193.50 $193.50 $193.50 $145.13 $193.50 $193.50 $193.50 $96.75 $96.75 $153.25 $193.50 $154.80 $87.08 $38.40 N/A $112.23 $193.50 $116.10 $193.50 $40.33 $193.50 N/A N/A 04.503.446.01 SUP HCPCS C1713 04.503.446.01 - SCREW BONE 2.4MM 16MM SELF TAP MTRXMAND TITANIUM MANDIB BOTH IP/OP $243.00 $180.00 $48.23 $243.00 $109.35 $109.35 $109.35 $109.35 $243.00 $243.00 $243.00 $50.65 $243.00 $243.00 $243.00 $243.00 $243.00 $50.64 $243.00 $97.20 $143.73 $243.00 $243.00 $243.00 $243.00 $182.25 $243.00 $243.00 $243.00 $121.50 $121.50 $192.46 $243.00 $194.40 $109.35 $48.23 N/A $140.94 $243.00 $145.80 $243.00 $50.64 $243.00 N/A N/A 04.503.448.01 SUP HCPCS C1713 04.503.448.01 - SCREW BONE 2.4MM 18MM SELF TAP MTRXMAND TITANIUM MANDIB BOTH IP/OP $243.00 $180.00 $48.23 $243.00 $109.35 $109.35 $109.35 $109.35 $243.00 $243.00 $243.00 $50.65 $243.00 $243.00 $243.00 $243.00 $243.00 $50.64 $243.00 $97.20 $143.73 $243.00 $243.00 $243.00 $243.00 $182.25 $243.00 $243.00 $243.00 $121.50 $121.50 $192.46 $243.00 $194.40 $109.35 $48.23 N/A $140.94 $243.00 $145.80 $243.00 $50.64 $243.00 N/A N/A 04.503.465.01 SUP HCPCS C1713 04.503.465.01 - SCREW BONE 2.7MM 5MM EMERGENCY SELF TAP MTRXMAND TITANIUM BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $265.50 $265.50 $55.33 $265.50 N/A N/A 04.503.466.01 SUP HCPCS C1713 04.503.466.01 - SCREW BONE 2.7MM 6MM EMERGENCY SELF TAP MTRXMAND TITANIUM BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $265.50 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $265.50 $265.50 $55.33 $265.50 N/A N/A 04.503.468 SUP HCPCS C1713 04.503.468 - SCREW TI 8MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $211.50 $211.50 $44.08 $211.50 N/A N/A 04.503.468.01 SUP HCPCS C1713 04.503.468.01 - SCREW BONE 2.7MM 8MM EMERGENCY SELF TAP MTRXMAND TITANIUM BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $265.50 $265.50 $55.33 $265.50 N/A N/A 04.503.470 SUP HCPCS C1713 04.503.470 - SCREW TI 10MM 2.7MM SLFTAP ER BONE MTRXMAND NONSTRL BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $44.08 $211.50 N/A N/A 04.503.470.01 SUP HCPCS C1713 04.503.470.01 - SCREW BONE 2.7MM 10MM SLFTAP EMERGENCY MTRXMAND TITANIUM BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $159.30 $265.50 $55.33 $265.50 N/A N/A 04.503.472.01 SUP HCPCS C1713 04.503.472.01 - SCREW BONE 2.7MM 12MM EMERGENCY SELF TAP MTRXMAND TITANIUM BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $159.30 $265.50 $55.33 $265.50 N/A N/A 04.503.474.01 SUP HCPCS C1713 04.503.474.01 - SCREW BONE 2.7MM 14MM SLFTAP EMERGENCY MTRXMAND TITANIUM BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $159.30 $265.50 $55.33 $265.50 N/A N/A 04.503.476.01 SUP HCPCS C1713 04.503.476.01 - SCREW BONE 2.7MM 16MM SLFTAP EMERGENCY MTRXMAND TITANIUM BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $159.30 $265.50 $55.33 $265.50 N/A N/A 04.503.478.01 SUP HCPCS C1713 04.503.478.01 - SCREW BONE 2.7MM 18MM EMERGENCY SELF TAP MTRXMAND TITANIUM BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $159.30 $265.50 $55.33 $265.50 N/A N/A 04.503.506.01 SUP HCPCS C1713 04.503.506.01 - SCREW BONE 2MM 6MM SLFDRILL FINE PITCH MATRIX DRIVE RECESS BOTH IP/OP $188.00 $139.00 $37.29 $187.88 $84.55 $84.55 $84.55 $84.55 $187.88 $187.88 $187.88 $39.16 $187.88 $187.88 $187.88 $187.88 $187.88 $39.16 $187.88 $75.15 $111.13 $187.88 $187.88 $187.88 $187.88 $141.00 $187.88 $187.88 $187.88 $93.94 $93.94 $148.80 $187.88 $150.30 $84.55 $37.29 N/A $109.04 $187.88 $112.73 $187.88 $187.88 $187.88 N/A N/A 04.503.508.01 SUP HCPCS C1713 04.503.508.01 - SCREW BONE 2MM 8MM SLFDRILL FINE PITCH MATRIX DRIVE RECESS BOTH IP/OP $188.00 $139.00 $37.29 $187.88 $84.55 $84.55 $84.55 $84.55 $187.88 $187.88 $187.88 $39.16 $187.88 $187.88 $187.88 $187.88 $187.88 $39.16 $187.88 $75.15 $111.13 $187.88 $187.88 $187.88 $187.88 $141.00 $187.88 $187.88 $187.88 $93.94 $93.94 $148.80 $187.88 $150.30 $84.55 $37.29 N/A $109.04 $187.88 $112.73 $187.88 $187.88 $187.88 N/A N/A 04.503.546.01 SUP HCPCS C1713 04.503.546.01 - SCREW BONE 2MM 6MM LOCKING SLFDRILL MATRIX DRIVE RECESS BOTH IP/OP $324.00 $240.00 $64.31 $324.00 $145.80 $145.80 $145.80 $145.80 $324.00 $324.00 $324.00 $67.53 $324.00 $324.00 $324.00 $324.00 $324.00 $67.53 $324.00 $129.60 $191.65 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $145.80 $64.31 N/A $187.92 $324.00 $194.40 $324.00 $67.52 $324.00 N/A N/A 04.503.548.01 SUP HCPCS C1713 04.503.548.01 - SCREW BONE 2MM 8MM LOCKING SLFDRILL MATRIX DRIVE RECESS BOTH IP/OP $324.00 $240.00 $64.31 $324.00 $145.80 $145.80 $145.80 $145.80 $324.00 $324.00 $324.00 $67.53 $324.00 $324.00 $324.00 $324.00 $324.00 $67.53 $324.00 $129.60 $191.65 $324.00 $324.00 $324.00 $324.00 $243.00 $324.00 $324.00 $324.00 $162.00 $162.00 $256.61 $324.00 $259.20 $145.80 $64.31 N/A $187.92 $324.00 $194.40 $324.00 $324.00 $324.00 N/A N/A 04.503.605 SUP HCPCS C1713 04.503.605 - SCREW TI 5MM 2MM LCK SLFTAP BONE MTRXMAND NONSTRL BOTH IP/OP $252.00 $186.00 $50.02 $252.00 $113.40 $113.40 $113.40 $113.40 $252.00 $252.00 $252.00 $52.52 $252.00 $252.00 $252.00 $252.00 $252.00 $52.52 $252.00 $100.80 $149.06 $252.00 $252.00 $252.00 $252.00 $189.00 $252.00 $252.00 $252.00 $126.00 $126.00 $199.58 $252.00 $201.60 $113.40 $50.02 N/A $146.16 $252.00 $151.20 $252.00 $52.52 $252.00 N/A N/A 04.503.605.01 SUP HCPCS C1713 04.503.605.01 - SCREW BONE 2MM 5MM LOCKING SLFTAP MTRXMAND TITANIUM MANDIB BOTH IP/OP $317.50 $235.00 $62.97 $317.25 $142.76 $142.76 $142.76 $142.76 $317.25 $317.25 $317.25 $66.12 $317.25 $317.25 $317.25 $317.25 $317.25 $66.12 $317.25 $126.90 $187.65 $317.25 $317.25 $317.25 $317.25 $238.13 $317.25 $317.25 $317.25 $158.63 $158.63 $251.26 $317.25 $253.80 $142.76 $62.97 N/A $184.15 $317.25 $190.35 $317.25 $66.11 $317.25 N/A N/A 04.503.606.01 SUP HCPCS C1713 04.503.606.01 - SCREW BONE 2MM 6MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $317.50 $235.00 $62.97 $317.25 $142.76 $142.76 $142.76 $142.76 $317.25 $317.25 $317.25 $66.12 $317.25 $317.25 $317.25 $317.25 $317.25 $66.12 $317.25 $126.90 $187.65 $317.25 $317.25 $317.25 $317.25 $238.13 $317.25 $317.25 $317.25 $158.63 $158.63 $251.26 $317.25 $253.80 $142.76 $62.97 N/A $184.15 $317.25 $190.35 $317.25 $66.11 $317.25 N/A N/A 04.503.608 SUP HCPCS C1713 04.503.608 - SCREW TI 8MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL BOTH IP/OP $252.00 $186.00 $50.02 $252.00 $113.40 $113.40 $113.40 $113.40 $252.00 $252.00 $252.00 $52.52 $252.00 $252.00 $252.00 $252.00 $252.00 $52.52 $252.00 $100.80 $149.06 $252.00 $252.00 $252.00 $252.00 $189.00 $252.00 $252.00 $252.00 $126.00 $126.00 $199.58 $252.00 $201.60 $113.40 $50.02 N/A $146.16 $252.00 $151.20 $252.00 $52.52 $252.00 N/A N/A 04.503.608.01 SUP HCPCS C1713 04.503.608.01 - SCREW BONE 2MM 8MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $317.50 $235.00 $62.97 $317.25 $142.76 $142.76 $142.76 $142.76 $317.25 $317.25 $317.25 $66.12 $317.25 $317.25 $317.25 $317.25 $317.25 $66.12 $317.25 $317.25 $187.65 $317.25 $317.25 $317.25 $317.25 $238.13 $317.25 $317.25 $317.25 $158.63 $158.63 $251.26 $317.25 $253.80 $142.76 $62.97 N/A $184.15 $317.25 $317.25 $317.25 $66.11 $317.25 N/A N/A 04.503.608.01E SUP HCPCS C1713 04.503.608.01E - SCREW TI 8MM 2.4MM SLFTAP ER BONE MTRXMAND STRL BOTH IP/OP $252.00 $186.00 $50.02 $252.00 $113.40 $113.40 $113.40 $113.40 $252.00 $252.00 $252.00 $52.52 $252.00 $252.00 $252.00 $252.00 $252.00 $52.52 $252.00 $252.00 $149.06 $252.00 $252.00 $252.00 $252.00 $189.00 $252.00 $252.00 $252.00 $126.00 $126.00 $199.58 $252.00 $201.60 $113.40 $50.02 N/A $146.16 $252.00 $252.00 $252.00 $52.52 $252.00 N/A N/A 04.503.610 SUP HCPCS C1713 04.503.610 - SCREW TI 10MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL BOTH IP/OP $252.00 $186.00 $50.02 $252.00 $113.40 $113.40 $113.40 $113.40 $252.00 $252.00 $252.00 $52.52 $252.00 $252.00 $252.00 $252.00 $252.00 $52.52 $252.00 $252.00 $149.06 $252.00 $252.00 $252.00 $252.00 $189.00 $252.00 $252.00 $252.00 $126.00 $126.00 $199.58 $252.00 $201.60 $113.40 $50.02 N/A $146.16 $252.00 $151.20 $252.00 $52.52 $252.00 N/A N/A 04.503.610.01 SUP HCPCS C1713 04.503.610.01 - SCREW BONE 2MM 10MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $317.50 $235.00 $62.97 $317.25 $142.76 $142.76 $142.76 $142.76 $317.25 $317.25 $317.25 $66.12 $317.25 $317.25 $317.25 $317.25 $317.25 $66.12 $317.25 $126.90 $187.65 $317.25 $317.25 $317.25 $317.25 $238.13 $317.25 $317.25 $317.25 $158.63 $158.63 $251.26 $317.25 $253.80 $142.76 $62.97 N/A $184.15 $317.25 $190.35 $317.25 $317.25 $317.25 N/A N/A 04.503.612 SUP HCPCS C1713 04.503.612 - SCREW TI 12MM 2MM SLFTAP LCK BONE MTRXMAND NONSTRL BOTH IP/OP $252.00 $186.00 $50.02 $252.00 $113.40 $113.40 $113.40 $113.40 $252.00 $252.00 $252.00 $52.52 $252.00 $252.00 $252.00 $252.00 $252.00 $52.52 $252.00 $252.00 $149.06 $252.00 $252.00 $252.00 $252.00 $189.00 $252.00 $252.00 $252.00 $126.00 $126.00 $199.58 $252.00 $201.60 $113.40 $50.02 N/A $146.16 $252.00 $151.20 $252.00 $52.52 $252.00 N/A N/A 04.503.612.01 SUP HCPCS C1713 04.503.612.01 - SCREW BONE 2MM 12MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $317.50 $235.00 $62.97 $317.25 $142.76 $142.76 $142.76 $142.76 $317.25 $317.25 $317.25 $66.12 $317.25 $317.25 $317.25 $317.25 $317.25 $66.12 $317.25 $317.25 $187.65 $317.25 $317.25 $317.25 $317.25 $238.13 $317.25 $317.25 $317.25 $158.63 $158.63 $251.26 $317.25 $253.80 $142.76 $62.97 N/A $184.15 $317.25 $190.35 $317.25 $66.11 $317.25 N/A N/A 04.503.614 SUP HCPCS C1713 04.503.614 - SCREW TI 14MM 2MM LCK SLFTAP BONE MTRXMAND NONSTRL BOTH IP/OP $252.00 $186.00 $50.02 $252.00 $113.40 $113.40 $113.40 $113.40 $252.00 $252.00 $252.00 $52.52 $252.00 $252.00 $252.00 $252.00 $252.00 $52.52 $252.00 $100.80 $149.06 $252.00 $252.00 $252.00 $252.00 $189.00 $252.00 $252.00 $252.00 $126.00 $126.00 $199.58 $252.00 $201.60 $113.40 $50.02 N/A $146.16 $252.00 $151.20 $252.00 $52.52 $252.00 N/A N/A 04.503.614.01 SUP HCPCS C1713 04.503.614.01 - SCREW BONE 2MM 14MM SELF TAP LOCK MTRXMAND TITANIUM MAXFACL BOTH IP/OP $317.50 $235.00 $62.97 $317.25 $142.76 $142.76 $142.76 $142.76 $317.25 $317.25 $317.25 $66.12 $317.25 $317.25 $317.25 $317.25 $317.25 $66.12 $317.25 $126.90 $187.65 $317.25 $317.25 $317.25 $317.25 $238.13 $317.25 $317.25 $317.25 $158.63 $158.63 $251.26 $317.25 $253.80 $142.76 $62.97 N/A $184.15 $317.25 $317.25 $317.25 $66.11 $317.25 N/A N/A 04.503.616 SUP HCPCS C1713 04.503.616 - SCREW TI 16MM 2MM LCK SLFTAP BONE MTRXMAND NONSTRL BOTH IP/OP $252.00 $186.00 $50.02 $252.00 $113.40 $113.40 $113.40 $113.40 $252.00 $252.00 $252.00 $52.52 $252.00 $252.00 $252.00 $252.00 $252.00 $52.52 $252.00 $252.00 $149.06 $252.00 $252.00 $252.00 $252.00 $189.00 $252.00 $252.00 $252.00 $126.00 $126.00 $199.58 $252.00 $201.60 $113.40 $50.02 N/A $146.16 $252.00 $252.00 $252.00 $52.52 $252.00 N/A N/A 04.503.616.01 SUP HCPCS C1713 04.503.616.01 - SCREW BONE 2MM 16MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $317.50 $235.00 $62.97 $317.25 $142.76 $142.76 $142.76 $142.76 $317.25 $317.25 $317.25 $66.12 $317.25 $317.25 $317.25 $317.25 $317.25 $66.12 $317.25 $126.90 $187.65 $317.25 $317.25 $317.25 $317.25 $238.13 $317.25 $317.25 $317.25 $158.63 $158.63 $251.26 $317.25 $253.80 $142.76 $62.97 N/A $184.15 $317.25 $190.35 $317.25 $66.11 $317.25 N/A N/A 04.503.618.01 SUP HCPCS C1713 04.503.618.01 - SCREW BONE 2MM 18MM SLFTAP LOCKING MTRXMAND TITANIUM MANDIB BOTH IP/OP $317.50 $235.00 $62.97 $317.25 $142.76 $142.76 $142.76 $142.76 $317.25 $317.25 $317.25 $66.12 $317.25 $317.25 $317.25 $317.25 $317.25 $66.12 $317.25 $317.25 $187.65 $317.25 $317.25 $317.25 $317.25 $238.13 $317.25 $317.25 $317.25 $158.63 $158.63 $251.26 $317.25 $253.80 $142.76 $62.97 N/A $184.15 $317.25 $317.25 $317.25 $66.11 $317.25 N/A N/A 04.503.638.01 SUP HCPCS C1713 04.503.638.01 - SCREW BONE 2.4MM 8MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $389.50 $288.00 $77.26 $389.25 $175.16 $175.16 $175.16 $175.16 $389.25 $389.25 $389.25 $81.13 $389.25 $389.25 $389.25 $389.25 $389.25 $81.12 $389.25 $155.70 $230.24 $389.25 $389.25 $389.25 $389.25 $292.13 $389.25 $389.25 $389.25 $194.63 $194.63 $308.29 $389.25 $311.40 $175.16 $77.26 N/A $225.91 $389.25 $233.55 $389.25 $81.12 $389.25 N/A N/A 04.503.640 SUP HCPCS C1713 04.503.640 - SCREW TI 10MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL BOTH IP/OP $310.50 $230.00 $61.63 $310.50 $139.73 $139.73 $139.73 $139.73 $310.50 $310.50 $310.50 $64.72 $310.50 $310.50 $310.50 $310.50 $310.50 $64.71 $310.50 $310.50 $183.66 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $139.73 $61.63 N/A $180.09 $310.50 $186.30 $310.50 $64.71 $310.50 N/A N/A 04.503.640.01 SUP HCPCS C1713 04.503.640.01 - SCREW BONE 2.4MM 10MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $389.50 $288.00 $77.26 $389.25 $175.16 $175.16 $175.16 $175.16 $389.25 $389.25 $389.25 $81.13 $389.25 $389.25 $389.25 $389.25 $389.25 $81.12 $389.25 $155.70 $230.24 $389.25 $389.25 $389.25 $389.25 $292.13 $389.25 $389.25 $389.25 $194.63 $194.63 $308.29 $389.25 $311.40 $175.16 $77.26 N/A $225.91 $389.25 $389.25 $389.25 $81.12 $389.25 N/A N/A 04.503.642.01 SUP HCPCS C1713 04.503.642.01 - SCREW BONE 2.4MM 12MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $389.50 $288.00 $77.26 $389.25 $175.16 $175.16 $175.16 $175.16 $389.25 $389.25 $389.25 $81.13 $389.25 $389.25 $389.25 $389.25 $389.25 $81.12 $389.25 $155.70 $230.24 $389.25 $389.25 $389.25 $389.25 $292.13 $389.25 $389.25 $389.25 $194.63 $194.63 $308.29 $389.25 $311.40 $175.16 $77.26 N/A $225.91 $389.25 $389.25 $389.25 $81.12 $389.25 N/A N/A 04.503.644 SUP HCPCS C1713 04.503.644 - SCREW TI 14MM 2.4MM SLFTAP LCK BONE MTRXMAND NONSTRL BOTH IP/OP $310.50 $230.00 $61.63 $310.50 $139.73 $139.73 $139.73 $139.73 $310.50 $310.50 $310.50 $64.72 $310.50 $310.50 $310.50 $310.50 $310.50 $64.71 $310.50 $124.20 $183.66 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $139.73 $61.63 N/A $180.09 $310.50 $186.30 $310.50 $64.71 $310.50 N/A N/A 04.503.644.01 SUP HCPCS C1713 04.503.644.01 - SCREW BONE 2.4MM 14MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $389.50 $288.00 $77.26 $389.25 $175.16 $175.16 $175.16 $175.16 $389.25 $389.25 $389.25 $81.13 $389.25 $389.25 $389.25 $389.25 $389.25 $81.12 $389.25 $155.70 $230.24 $389.25 $389.25 $389.25 $389.25 $292.13 $389.25 $389.25 $389.25 $194.63 $194.63 $308.29 $389.25 $311.40 $175.16 $77.26 N/A $225.91 $389.25 $389.25 $389.25 $389.25 $389.25 N/A N/A 04.503.646 SUP HCPCS C1713 04.503.646 - SCREW TI 16MM 2.4MM LCK SLFTAP BONE MTRXMAND NONSTRL BOTH IP/OP $310.50 $230.00 $61.63 $310.50 $139.73 $139.73 $139.73 $139.73 $310.50 $310.50 $310.50 $64.72 $310.50 $310.50 $310.50 $310.50 $310.50 $64.71 $310.50 $124.20 $183.66 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $139.73 $61.63 N/A $180.09 $310.50 $186.30 $310.50 $64.71 $310.50 N/A N/A 04.503.646.01 SUP HCPCS C1713 04.503.646.01 - SCREW BONE 2.4MM 16MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $389.50 $288.00 $77.26 $389.25 $175.16 $175.16 $175.16 $175.16 $389.25 $389.25 $389.25 $81.13 $389.25 $389.25 $389.25 $389.25 $389.25 $81.12 $389.25 $155.70 $230.24 $389.25 $389.25 $389.25 $389.25 $292.13 $389.25 $389.25 $389.25 $194.63 $194.63 $308.29 $389.25 $311.40 $175.16 $77.26 N/A $225.91 $389.25 $389.25 $389.25 $81.12 $389.25 N/A N/A 04.503.648.01 SUP HCPCS C1713 04.503.648.01 - SCREW BONE 2.4MM 18MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $389.50 $288.00 $77.26 $389.25 $175.16 $175.16 $175.16 $175.16 $389.25 $389.25 $389.25 $81.13 $389.25 $389.25 $389.25 $389.25 $389.25 $81.12 $389.25 $155.70 $230.24 $389.25 $389.25 $389.25 $389.25 $292.13 $389.25 $389.25 $389.25 $194.63 $194.63 $308.29 $389.25 $311.40 $175.16 $77.26 N/A $225.91 $389.25 $233.55 $389.25 $389.25 $389.25 N/A N/A 04.503.668.01 SUP HCPCS C1713 04.503.668.01 - SCREW BONE 2.9MM 8MM LOCKING SLFTAP MTRXMAND TITANIUM MANDIB BOTH IP/OP $448.00 $332.00 $88.87 $447.75 $201.49 $201.49 $201.49 $201.49 $447.75 $447.75 $447.75 $93.32 $447.75 $447.75 $447.75 $447.75 $447.75 $93.32 $447.75 $179.10 $264.84 $447.75 $447.75 $447.75 $447.75 $336.00 $447.75 $447.75 $447.75 $223.88 $223.88 $354.62 $447.75 $358.20 $201.49 $88.87 N/A $259.84 $447.75 $268.65 $447.75 $447.75 $447.75 N/A N/A 04.503.670 SUP HCPCS C1713 04.503.670 - SCREW TI 10MM 2.9MM LCK SLFTAP BONE MTRXMAND NONSTRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $140.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A 04.503.670.01 SUP HCPCS C1713 04.503.670.01 - SCREW BONE 2.9MM 10MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $448.00 $332.00 $88.87 $447.75 $201.49 $201.49 $201.49 $201.49 $447.75 $447.75 $447.75 $93.32 $447.75 $447.75 $447.75 $447.75 $447.75 $93.32 $447.75 $179.10 $264.84 $447.75 $447.75 $447.75 $447.75 $336.00 $447.75 $447.75 $447.75 $223.88 $223.88 $354.62 $447.75 $358.20 $201.49 $88.87 N/A $259.84 $447.75 $447.75 $447.75 $447.75 $447.75 N/A N/A 04.503.672 SUP HCPCS C1713 04.503.672 - SCREW TI 12MM 2.9MM LCK SLFTAP BONE MTRXMAND NONSTRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $140.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A 04.503.672.01 SUP HCPCS C1713 04.503.672.01 - SCREW BONE 2.9MM 12MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $448.00 $332.00 $88.87 $447.75 $201.49 $201.49 $201.49 $201.49 $447.75 $447.75 $447.75 $93.32 $447.75 $447.75 $447.75 $447.75 $447.75 $93.32 $447.75 $179.10 $264.84 $447.75 $447.75 $447.75 $447.75 $336.00 $447.75 $447.75 $447.75 $223.88 $223.88 $354.62 $447.75 $358.20 $201.49 $88.87 N/A $259.84 $447.75 $447.75 $447.75 $93.31 $447.75 N/A N/A 04.503.674.01 SUP HCPCS C1713 04.503.674.01 - SCREW BONE 2.9MM 14MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $448.00 $332.00 $88.87 $447.75 $201.49 $201.49 $201.49 $201.49 $447.75 $447.75 $447.75 $93.32 $447.75 $447.75 $447.75 $447.75 $447.75 $93.32 $447.75 $179.10 $264.84 $447.75 $447.75 $447.75 $447.75 $336.00 $447.75 $447.75 $447.75 $223.88 $223.88 $354.62 $447.75 $358.20 $201.49 $88.87 N/A $259.84 $447.75 $447.75 $447.75 $93.31 $447.75 N/A N/A 04.503.676.01 SUP HCPCS C1713 04.503.676.01 - SCREW BONE 2.9MM 16MM LOCKING SLFTAP MTRXMAND TITANIUM BOTH IP/OP $448.00 $332.00 $88.87 $447.75 $201.49 $201.49 $201.49 $201.49 $447.75 $447.75 $447.75 $93.32 $447.75 $447.75 $447.75 $447.75 $447.75 $93.32 $447.75 $447.75 $264.84 $447.75 $447.75 $447.75 $447.75 $336.00 $447.75 $447.75 $447.75 $223.88 $223.88 $354.62 $447.75 $358.20 $201.49 $88.87 N/A $259.84 $447.75 $447.75 $447.75 $93.31 $447.75 N/A N/A 04.503.678.01 SUP HCPCS C1713 04.503.678.01 - SCREW BONE 2.9MM 18MM SELF TAP LOCK MTRXMAND TITANIUM MANDIB BOTH IP/OP $448.00 $332.00 $88.87 $447.75 $201.49 $201.49 $201.49 $201.49 $447.75 $447.75 $447.75 $93.32 $447.75 $447.75 $447.75 $447.75 $447.75 $93.32 $447.75 $447.75 $264.84 $447.75 $447.75 $447.75 $447.75 $336.00 $447.75 $447.75 $447.75 $223.88 $223.88 $354.62 $447.75 $358.20 $201.49 $88.87 N/A $259.84 $447.75 $447.75 $447.75 $93.31 $447.75 N/A N/A 04.503.701 SUP HCPCS C1713 04.503.701 - PLATE BN MN NAR 1MM NS MATRIXMANDIBLE 2X2 HL TNSNBND MLBL TI BOTH IP/OP $922.50 $683.00 $183.09 $922.50 $415.13 $415.13 $415.13 $415.13 $922.50 $922.50 $922.50 $192.27 $922.50 $922.50 $922.50 $922.50 $922.50 $192.26 $922.50 $369.00 $545.66 $922.50 $922.50 $922.50 $922.50 $691.88 $922.50 $922.50 $922.50 $461.25 $461.25 $730.62 $922.50 $738.00 $415.13 $183.09 N/A $535.05 $922.50 $922.50 $922.50 $192.25 $922.50 N/A N/A 04.503.702 SUP HCPCS C1713 04.503.702 - PLATE BONE MINI NARROW 1MM 2X2 HOLE TENSION BAND MTRXMAND BOTH IP/OP $922.50 $683.00 $183.09 $922.50 $415.13 $415.13 $415.13 $415.13 $922.50 $922.50 $922.50 $192.27 $922.50 $922.50 $922.50 $922.50 $922.50 $192.26 $922.50 $369.00 $545.66 $922.50 $922.50 $922.50 $922.50 $691.88 $922.50 $922.50 $922.50 $461.25 $461.25 $730.62 $922.50 $738.00 $415.13 $183.09 N/A $535.05 $922.50 $553.50 $922.50 $192.25 $922.50 N/A N/A 04.503.703 SUP HCPCS C1713 04.503.703 - PLATE BN MN NAR 1MM NS MATRIXMANDIBLE 3X3 HL TNSNBND MLBL TI BOTH IP/OP "$1,006.00" $744.00 $199.62 "$1,005.75" $452.59 $452.59 $452.59 $452.59 "$1,005.75" "$1,005.75" "$1,005.75" $209.62 "$1,005.75" "$1,005.75" "$1,005.75" "$1,005.75" "$1,005.75" $209.61 "$1,005.75" $402.30 $594.90 "$1,005.75" "$1,005.75" "$1,005.75" "$1,005.75" $754.50 "$1,005.75" "$1,005.75" "$1,005.75" $502.88 $502.88 $796.55 "$1,005.75" $804.60 $452.59 $199.62 N/A $583.48 "$1,005.75" "$1,005.75" "$1,005.75" $209.60 "$1,005.75" N/A N/A 04.503.704 SUP HCPCS C1713 04.503.704 - PLATE BONE MINI NARROW 1MM 3X3 HOLE TENSION BAND MTRXMAND BOTH IP/OP "$1,006.00" $744.00 $199.62 "$1,005.75" $452.59 $452.59 $452.59 $452.59 "$1,005.75" "$1,005.75" "$1,005.75" $209.62 "$1,005.75" "$1,005.75" "$1,005.75" "$1,005.75" "$1,005.75" $209.61 "$1,005.75" "$1,005.75" $594.90 "$1,005.75" "$1,005.75" "$1,005.75" "$1,005.75" $754.50 "$1,005.75" "$1,005.75" "$1,005.75" $502.88 $502.88 $796.55 "$1,005.75" $804.60 $452.59 $199.62 N/A $583.48 "$1,005.75" "$1,005.75" "$1,005.75" $209.60 "$1,005.75" N/A N/A 04.503.705 SUP HCPCS C1713 04.503.705 - PLATE BN 1MM NS MATRIXMANDIBLE 12 HL ADP TI MNDB BOTH IP/OP "$1,651.50" "$1,222.00" $327.78 "$1,651.50" $743.18 $743.18 $743.18 $743.18 "$1,651.50" "$1,651.50" "$1,651.50" $344.21 "$1,651.50" "$1,651.50" "$1,651.50" "$1,651.50" "$1,651.50" $344.19 "$1,651.50" "$1,651.50" $976.86 "$1,651.50" "$1,651.50" "$1,651.50" "$1,651.50" "$1,238.63" "$1,651.50" "$1,651.50" "$1,651.50" $825.75 $825.75 "$1,307.99" "$1,651.50" "$1,321.20" $743.18 $327.78 N/A $957.87 "$1,651.50" $990.90 "$1,651.50" $344.17 "$1,651.50" N/A N/A 04.503.706 SUP HCPCS C1713 04.503.706 - PLATE BN 1MM NS MATRIXMANDIBLE 20 HL ADP TI MNDB BOTH IP/OP "$1,809.00" "$1,339.00" $359.04 "$1,809.00" $814.05 $814.05 $814.05 $814.05 "$1,809.00" "$1,809.00" "$1,809.00" $377.04 "$1,809.00" "$1,809.00" "$1,809.00" "$1,809.00" "$1,809.00" $377.02 "$1,809.00" "$1,809.00" "$1,070.02" "$1,809.00" "$1,809.00" "$1,809.00" "$1,809.00" "$1,356.75" "$1,809.00" "$1,809.00" "$1,809.00" $904.50 $904.50 "$1,432.73" "$1,809.00" "$1,447.20" $814.05 $359.04 N/A "$1,049.22" "$1,809.00" "$1,809.00" "$1,809.00" $377.00 "$1,809.00" N/A N/A 04.503.707 SUP HCPCS C1713 04.503.707 - PLATE BN BX 1MM NS MATRIXMANDIBLE 4 HL MLBL TI MNDB BOTH IP/OP $722.50 $535.00 $143.35 $722.25 $325.01 $325.01 $325.01 $325.01 $722.25 $722.25 $722.25 $150.53 $722.25 $722.25 $722.25 $722.25 $722.25 $150.52 $722.25 $722.25 $427.21 $722.25 $722.25 $722.25 $722.25 $541.88 $722.25 $722.25 $722.25 $361.13 $361.13 $572.02 $722.25 $577.80 $325.01 $143.35 N/A $419.05 $722.25 $433.35 $722.25 $150.52 $722.25 N/A N/A 04.503.708 SUP HCPCS C1713 04.503.708 - PLATE BN 1MM NS MATRIXMANDIBLE 8 HL MLBL STRUT TI MNDB BOTH IP/OP "$1,420.00" "$1,051.00" $281.78 "$1,419.75" $638.89 $638.89 $638.89 $638.89 "$1,419.75" "$1,419.75" "$1,419.75" $295.91 "$1,419.75" "$1,419.75" "$1,419.75" "$1,419.75" "$1,419.75" $295.89 "$1,419.75" "$1,419.75" $839.78 "$1,419.75" "$1,419.75" "$1,419.75" "$1,419.75" "$1,065.00" "$1,419.75" "$1,419.75" "$1,419.75" $709.88 $709.88 "$1,124.44" "$1,419.75" "$1,135.80" $638.89 $281.78 N/A $823.60 "$1,419.75" $851.85 "$1,419.75" $295.88 "$1,419.75" N/A N/A 04.503.709 SUP HCPCS C1713 04.503.709 - PLATE BN MN CRV 1MM NS MATRIXMANDIBLE 8 HL MLBL STRUT TI BOTH IP/OP "$1,420.00" "$1,051.00" $281.78 "$1,419.75" $638.89 $638.89 $638.89 $638.89 "$1,419.75" "$1,419.75" "$1,419.75" $295.91 "$1,419.75" "$1,419.75" "$1,419.75" "$1,419.75" "$1,419.75" $295.89 "$1,419.75" "$1,419.75" $839.78 "$1,419.75" "$1,419.75" "$1,419.75" "$1,419.75" "$1,065.00" "$1,419.75" "$1,419.75" "$1,419.75" $709.88 $709.88 "$1,124.44" "$1,419.75" "$1,135.80" $638.89 $281.78 N/A $823.60 "$1,419.75" $851.85 "$1,419.75" "$1,419.75" "$1,419.75" N/A N/A 04.503.710 SUP HCPCS C1713 04.503.710 - PLATE BN STRG 1.25MM NS MATRIXMANDIBLE DCP 2X2 HL TI MNDB BOTH IP/OP $893.50 $661.00 $177.29 $893.25 $401.96 $401.96 $401.96 $401.96 $893.25 $893.25 $893.25 $186.18 $893.25 $893.25 $893.25 $893.25 $893.25 $186.16 $893.25 $893.25 $528.36 $893.25 $893.25 $893.25 $893.25 $670.13 $893.25 $893.25 $893.25 $446.63 $446.63 $707.45 $893.25 $714.60 $401.96 $177.29 N/A $518.23 $893.25 $535.95 $893.25 $186.15 $893.25 N/A N/A 04.503.711 SUP HCPCS C1713 04.503.711 - PLATE BN CRSNT 1.25MM NS MATRIXMANDIBLE 2X2 HL TI MNDB BOTH IP/OP "$1,188.00" $879.00 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 N/A $689.04 "$1,188.00" $712.80 "$1,188.00" $247.58 "$1,188.00" N/A N/A 04.503.712 SUP HCPCS C1713 04.503.712 - PLATE BN STRG 1.25MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB BOTH IP/OP "$1,051.00" $778.00 $208.55 "$1,050.75" $472.84 $472.84 $472.84 $472.84 "$1,050.75" "$1,050.75" "$1,050.75" $219.00 "$1,050.75" "$1,050.75" "$1,050.75" "$1,050.75" "$1,050.75" $218.99 "$1,050.75" "$1,050.75" $621.52 "$1,050.75" "$1,050.75" "$1,050.75" "$1,050.75" $788.25 "$1,050.75" "$1,050.75" "$1,050.75" $525.38 $525.38 $832.19 "$1,050.75" $840.60 $472.84 $208.55 N/A $609.58 "$1,050.75" $630.45 "$1,050.75" $218.98 "$1,050.75" N/A N/A 04.503.713 SUP HCPCS C1713 04.503.713 - PLATE BN CRSNT 1.25MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB BOTH IP/OP "$1,264.50" $936.00 $250.97 "$1,264.50" $569.03 $569.03 $569.03 $569.03 "$1,264.50" "$1,264.50" "$1,264.50" $263.55 "$1,264.50" "$1,264.50" "$1,264.50" "$1,264.50" "$1,264.50" $263.54 "$1,264.50" "$1,264.50" $747.95 "$1,264.50" "$1,264.50" "$1,264.50" "$1,264.50" $948.38 "$1,264.50" "$1,264.50" "$1,264.50" $632.25 $632.25 "$1,001.48" "$1,264.50" "$1,011.60" $569.03 $250.97 N/A $733.41 "$1,264.50" $758.70 "$1,264.50" $263.52 "$1,264.50" N/A N/A 04.503.714 SUP HCPCS C1713 04.503.714 - PLATE BN ANG 1.25MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB BOTH IP/OP "$1,323.00" $979.00 $262.58 "$1,323.00" $595.35 $595.35 $595.35 $595.35 "$1,323.00" "$1,323.00" "$1,323.00" $275.75 "$1,323.00" "$1,323.00" "$1,323.00" "$1,323.00" "$1,323.00" $275.73 "$1,323.00" "$1,323.00" $782.55 "$1,323.00" "$1,323.00" "$1,323.00" "$1,323.00" $992.25 "$1,323.00" "$1,323.00" "$1,323.00" $661.50 $661.50 "$1,047.82" "$1,323.00" "$1,058.40" $595.35 $262.58 N/A $767.34 "$1,323.00" $793.80 "$1,323.00" "$1,323.00" "$1,323.00" N/A N/A 04.503.715 SUP HCPCS C1713 04.503.715 - PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 6 HL TI MNDB BOTH IP/OP "$1,784.50" "$1,321.00" $354.13 "$1,784.25" $802.91 $802.91 $802.91 $802.91 "$1,784.25" "$1,784.25" "$1,784.25" $371.88 "$1,784.25" "$1,784.25" "$1,784.25" "$1,784.25" "$1,784.25" $371.86 "$1,784.25" "$1,784.25" "$1,055.38" "$1,784.25" "$1,784.25" "$1,784.25" "$1,784.25" "$1,338.38" "$1,784.25" "$1,784.25" "$1,784.25" $892.13 $892.13 "$1,413.13" "$1,784.25" "$1,427.40" $802.91 $354.13 N/A "$1,035.01" "$1,784.25" "$1,784.25" "$1,784.25" "$1,784.25" "$1,784.25" N/A N/A 04.503.716 SUP HCPCS C1713 04.503.716 - PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 3X3 HL TI MNDB BOTH IP/OP "$1,784.50" "$1,321.00" $354.13 "$1,784.25" $802.91 $802.91 $802.91 $802.91 "$1,784.25" "$1,784.25" "$1,784.25" $371.88 "$1,784.25" "$1,784.25" "$1,784.25" "$1,784.25" "$1,784.25" $371.86 "$1,784.25" "$1,784.25" "$1,055.38" "$1,784.25" "$1,784.25" "$1,784.25" "$1,784.25" "$1,338.38" "$1,784.25" "$1,784.25" "$1,784.25" $892.13 $892.13 "$1,413.13" "$1,784.25" "$1,427.40" $802.91 $354.13 N/A "$1,035.01" "$1,784.25" "$1,070.55" "$1,784.25" "$1,784.25" "$1,784.25" N/A N/A 04.503.717 SUP HCPCS C1713 04.503.717 - PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 12 HL TI MNDB BOTH IP/OP "$2,043.00" "$1,512.00" $405.48 "$2,043.00" $919.35 $919.35 $919.35 $919.35 "$2,043.00" "$2,043.00" "$2,043.00" $425.81 "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" $425.78 "$2,043.00" "$2,043.00" "$1,208.43" "$2,043.00" "$2,043.00" "$2,043.00" "$2,043.00" "$1,532.25" "$2,043.00" "$2,043.00" "$2,043.00" "$1,021.50" "$1,021.50" "$1,618.06" "$2,043.00" "$1,634.40" $919.35 $405.48 N/A "$1,184.94" "$2,043.00" "$2,043.00" "$2,043.00" $425.76 "$2,043.00" N/A N/A 04.503.718 SUP HCPCS C1713 04.503.718 - PLATE BN STRG 1.5MM NS MATRIXMANDIBLE 20 HL TI MNDB BOTH IP/OP "$2,819.50" "$2,086.00" $559.55 "$2,819.25" "$1,268.66" "$1,268.66" "$1,268.66" "$1,268.66" "$2,819.25" "$2,819.25" "$2,819.25" $587.60 "$2,819.25" "$2,819.25" "$2,819.25" "$2,819.25" "$2,819.25" $587.56 "$2,819.25" "$2,819.25" "$1,389.89" "$2,819.25" "$2,819.25" "$2,819.25" "$2,819.25" "$2,114.63" "$2,819.25" "$2,819.25" "$2,819.25" "$1,409.63" "$1,409.63" "$2,232.85" "$2,819.25" "$2,255.40" "$1,268.66" $559.55 N/A "$1,635.31" "$2,819.25" "$1,691.55" "$2,819.25" "$2,819.25" "$2,819.25" N/A N/A 04.503.721 SUP HCPCS C1713 04.503.721 - PLATE BN ANG 1.5MM NS MATRIXMANDIBLE 3X3 HL TI MNDB BOTH IP/OP "$2,457.00" "$1,818.00" $487.65 "$2,457.00" "$1,105.65" "$1,105.65" "$1,105.65" "$1,105.65" "$2,457.00" "$2,457.00" "$2,457.00" $512.10 "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" $512.07 "$2,457.00" "$2,457.00" "$1,453.32" "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" "$1,842.75" "$2,457.00" "$2,457.00" "$2,457.00" "$1,228.50" "$1,228.50" "$1,945.94" "$2,457.00" "$1,965.60" "$1,105.65" $487.65 N/A "$1,425.06" "$2,457.00" "$1,474.20" "$2,457.00" $512.04 "$2,457.00" N/A N/A 04.503.722 SUP HCPCS C1713 04.503.722 - PLATE BN CRSNT 1.5MM NS MATRIXMANDIBLE 3X3 HL TI MNDB BOTH IP/OP "$2,457.00" "$1,818.00" $487.65 "$2,457.00" "$1,105.65" "$1,105.65" "$1,105.65" "$1,105.65" "$2,457.00" "$2,457.00" "$2,457.00" $512.10 "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" $512.07 "$2,457.00" "$2,457.00" "$1,453.32" "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" "$1,842.75" "$2,457.00" "$2,457.00" "$2,457.00" "$1,228.50" "$1,228.50" "$1,945.94" "$2,457.00" "$1,965.60" "$1,105.65" $487.65 N/A "$1,425.06" "$2,457.00" "$1,474.20" "$2,457.00" $512.04 "$2,457.00" N/A N/A 04.503.723 SUP HCPCS C1713 04.503.723 - PLATE BN STRG 1.5MM NS MATRIXMANDIBLE DCP 2X2 HL TI MNDB BOTH IP/OP "$1,591.00" "$1,177.00" $315.72 "$1,590.75" $715.84 $715.84 $715.84 $715.84 "$1,590.75" "$1,590.75" "$1,590.75" $331.55 "$1,590.75" "$1,590.75" "$1,590.75" "$1,590.75" "$1,590.75" $331.53 "$1,590.75" $636.30 $940.93 "$1,590.75" "$1,590.75" "$1,590.75" "$1,590.75" "$1,193.25" "$1,590.75" "$1,590.75" "$1,590.75" $795.38 $795.38 "$1,259.87" "$1,590.75" "$1,272.60" $715.84 $315.72 N/A $922.78 "$1,590.75" $954.45 "$1,590.75" $331.51 "$1,590.75" N/A N/A 04.503.724 SUP HCPCS C1713 04.503.724 - PLATE BN STRG 1.5MM NS MATRIXMANDIBLE DCP 3X3 HL TI MNDB BOTH IP/OP "$1,683.00" "$1,245.00" $334.03 "$1,683.00" $757.35 $757.35 $757.35 $757.35 "$1,683.00" "$1,683.00" "$1,683.00" $350.78 "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" $350.76 "$1,683.00" "$1,683.00" $995.49 "$1,683.00" "$1,683.00" "$1,683.00" "$1,683.00" "$1,262.25" "$1,683.00" "$1,683.00" "$1,683.00" $841.50 $841.50 "$1,332.94" "$1,683.00" "$1,346.40" $757.35 $334.03 N/A $976.14 "$1,683.00" "$1,683.00" "$1,683.00" $350.74 "$1,683.00" N/A N/A 04.503.726 SUP HCPCS C1713 04.503.726 - PLATE BN BRD CRSNT 2MM NS MATRIXMANDIBLE 2X2 HL TI MNDB BOTH IP/OP "$1,732.50" "$1,282.00" $343.86 "$1,732.50" $779.63 $779.63 $779.63 $779.63 "$1,732.50" "$1,732.50" "$1,732.50" $361.10 "$1,732.50" "$1,732.50" "$1,732.50" "$1,732.50" "$1,732.50" $361.07 "$1,732.50" "$1,732.50" "$1,024.77" "$1,732.50" "$1,732.50" "$1,732.50" "$1,732.50" "$1,299.38" "$1,732.50" "$1,732.50" "$1,732.50" $866.25 $866.25 "$1,372.14" "$1,732.50" "$1,386.00" $779.63 $343.86 N/A "$1,004.85" "$1,732.50" "$1,039.50" "$1,732.50" $361.05 "$1,732.50" N/A N/A 04.503.727 SUP HCPCS C1713 04.503.727 - PLATE BN BRD CRSNT 2MM NS MATRIXMANDIBLE 3X3 HL TI MNDB BOTH IP/OP "$1,863.00" "$1,379.00" $369.76 "$1,863.00" $838.35 $838.35 $838.35 $838.35 "$1,863.00" "$1,863.00" "$1,863.00" $388.30 "$1,863.00" "$1,863.00" "$1,863.00" "$1,863.00" "$1,863.00" $388.27 "$1,863.00" $745.20 "$1,101.96" "$1,863.00" "$1,863.00" "$1,863.00" "$1,863.00" "$1,397.25" "$1,863.00" "$1,863.00" "$1,863.00" $931.50 $931.50 "$1,475.50" "$1,863.00" "$1,490.40" $838.35 $369.76 N/A "$1,080.54" "$1,863.00" "$1,117.80" "$1,863.00" $388.25 "$1,863.00" N/A N/A 04.503.728 SUP HCPCS C1713 04.503.728 - PLATE BN STRG 2MM NS MATRIXMANDIBLE 6 HL TI MNDB BOTH IP/OP "$1,732.50" "$1,282.00" $343.86 "$1,732.50" $779.63 $779.63 $779.63 $779.63 "$1,732.50" "$1,732.50" "$1,732.50" $361.10 "$1,732.50" "$1,732.50" "$1,732.50" "$1,732.50" "$1,732.50" $361.07 "$1,732.50" "$1,732.50" "$1,024.77" "$1,732.50" "$1,732.50" "$1,732.50" "$1,732.50" "$1,299.38" "$1,732.50" "$1,732.50" "$1,732.50" $866.25 $866.25 "$1,372.14" "$1,732.50" "$1,386.00" $779.63 $343.86 N/A "$1,004.85" "$1,732.50" "$1,039.50" "$1,732.50" "$1,732.50" "$1,732.50" N/A N/A 04.503.729 SUP HCPCS C1713 04.503.729 - PLATE BN STRG 2MM NS MATRIXMANDIBLE 12 HL TI MNDB BOTH IP/OP "$2,342.50" "$1,733.00" $464.88 "$2,342.25" "$1,054.01" "$1,054.01" "$1,054.01" "$1,054.01" "$2,342.25" "$2,342.25" "$2,342.25" $488.18 "$2,342.25" "$2,342.25" "$2,342.25" "$2,342.25" "$2,342.25" $488.15 "$2,342.25" "$2,342.25" "$1,385.44" "$2,342.25" "$2,342.25" "$2,342.25" "$2,342.25" "$1,756.88" "$2,342.25" "$2,342.25" "$2,342.25" "$1,171.13" "$1,171.13" "$1,855.06" "$2,342.25" "$1,873.80" "$1,054.01" $464.88 N/A "$1,358.65" "$2,342.25" "$1,405.35" "$2,342.25" $488.12 "$2,342.25" N/A N/A 04.503.730 SUP HCPCS C1713 04.503.730 - PLATE BN STRG 2MM NS MATRIXMANDIBLE 20 HL TI MNDB BOTH IP/OP "$2,954.50" "$2,186.00" $586.34 "$2,954.25" "$1,329.41" "$1,329.41" "$1,329.41" "$1,329.41" "$2,954.25" "$2,954.25" "$2,954.25" $615.74 "$2,954.25" "$2,954.25" "$2,954.25" "$2,954.25" "$2,954.25" $615.70 "$2,954.25" "$2,954.25" "$1,456.45" "$2,954.25" "$2,954.25" "$2,954.25" "$2,954.25" "$2,215.88" "$2,954.25" "$2,954.25" "$2,954.25" "$1,477.13" "$1,477.13" "$2,339.77" "$2,954.25" "$2,363.40" "$1,329.41" $586.34 N/A "$1,713.61" "$2,954.25" "$1,772.55" "$2,954.25" "$2,954.25" "$2,954.25" N/A N/A 04.503.731 SUP HCPCS C1713 04.503.731 - PLATE BN BRD ANG 2MM NS MATRIXMANDIBLE 3X3 HL TI MNDB BOTH IP/OP "$2,556.00" "$1,891.00" $507.30 "$2,556.00" "$1,150.20" "$1,150.20" "$1,150.20" "$1,150.20" "$2,556.00" "$2,556.00" "$2,556.00" $532.73 "$2,556.00" "$2,556.00" "$2,556.00" "$2,556.00" "$2,556.00" $532.70 "$2,556.00" "$2,556.00" "$1,260.11" "$2,556.00" "$2,556.00" "$2,556.00" "$2,556.00" "$1,917.00" "$2,556.00" "$2,556.00" "$2,556.00" "$1,278.00" "$1,278.00" "$2,024.35" "$2,556.00" "$2,044.80" "$1,150.20" $507.30 N/A "$1,482.48" "$2,556.00" "$2,556.00" "$2,556.00" "$2,556.00" "$2,556.00" N/A N/A 04.503.732 SUP HCPCS C1713 04.503.732 - PLATE BN LT ANG 2MM NS MATRIXMANDIBLE 7X23 HL RECON TI MNDB BOTH IP/OP "$4,887.00" "$3,616.00" $969.95 "$4,887.00" "$2,199.15" "$2,199.15" "$2,199.15" "$2,199.15" "$4,887.00" "$4,887.00" "$4,887.00" "$1,018.57" "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" "$1,018.50" "$4,887.00" "$4,887.00" "$2,409.29" "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" "$3,665.25" "$4,887.00" "$4,887.00" "$4,887.00" "$2,443.50" "$2,443.50" "$3,870.50" "$4,887.00" "$3,909.60" "$2,199.15" $969.95 N/A "$2,834.46" "$4,887.00" "$2,932.20" "$4,887.00" "$1,018.45" "$4,887.00" N/A N/A 04.503.733 SUP HCPCS C1713 04.503.733 - PLATE BN RT ANG 2MM NS MATRIXMANDIBLE 7X23 HL RECON TI MNDB BOTH IP/OP "$4,887.00" "$3,616.00" $969.95 "$4,887.00" "$2,199.15" "$2,199.15" "$2,199.15" "$2,199.15" "$4,887.00" "$4,887.00" "$4,887.00" "$1,018.57" "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" "$1,018.50" "$4,887.00" "$4,887.00" "$2,409.29" "$4,887.00" "$4,887.00" "$4,887.00" "$4,887.00" "$3,665.25" "$4,887.00" "$4,887.00" "$4,887.00" "$2,443.50" "$2,443.50" "$3,870.50" "$4,887.00" "$3,909.60" "$2,199.15" $969.95 N/A "$2,834.46" "$4,887.00" "$2,932.20" "$4,887.00" "$1,018.45" "$4,887.00" N/A N/A 04.503.734 SUP HCPCS C1713 04.503.734 - PLATE BN 2 ANG SM 2MM NS MATRIXMANDIBLE 4X20X4 HL RECON TI BOTH IP/OP "$5,656.50" "$4,186.00" "$1,122.67" "$5,656.50" "$2,545.43" "$2,545.43" "$2,545.43" "$2,545.43" "$5,656.50" "$5,656.50" "$5,656.50" "$1,178.96" "$5,656.50" "$5,656.50" "$5,656.50" "$5,656.50" "$5,656.50" "$1,178.88" "$5,656.50" "$5,656.50" "$2,788.65" "$5,656.50" "$5,656.50" "$5,656.50" "$5,656.50" "$4,242.38" "$5,656.50" "$5,656.50" "$5,656.50" "$2,828.25" "$2,828.25" "$4,479.95" "$5,656.50" "$4,525.20" "$2,545.43" "$1,122.67" N/A "$3,280.77" "$5,656.50" "$3,393.90" "$5,656.50" "$1,178.81" "$5,656.50" N/A N/A 04.503.735 SUP HCPCS C1713 04.503.735 - PLATE BN 2 ANG MED 2MM NS MATRIXMANDIBLE 5X22X5 HL RECON TI BOTH IP/OP "$5,974.00" "$4,421.00" "$1,185.64" "$5,973.75" "$2,688.19" "$2,688.19" "$2,688.19" "$2,688.19" "$5,973.75" "$5,973.75" "$5,973.75" "$1,245.08" "$5,973.75" "$5,973.75" "$5,973.75" "$5,973.75" "$5,973.75" "$1,245.00" "$5,973.75" "$5,973.75" "$2,945.06" "$5,973.75" "$5,973.75" "$5,973.75" "$5,973.75" "$4,480.50" "$5,973.75" "$5,973.75" "$5,973.75" "$2,986.88" "$2,986.88" "$4,731.21" "$5,973.75" "$4,779.00" "$2,688.19" "$1,185.64" N/A "$3,464.92" "$5,973.75" "$3,584.25" "$5,973.75" "$1,244.93" "$5,973.75" N/A N/A 04.503.736 SUP HCPCS C1713 04.503.736 - PLATE BN 2 ANG LG 2MM NS MATRIXMANDIBLE 6X24X6 HL RECON TI BOTH IP/OP "$6,293.50" "$4,657.00" "$1,249.05" "$6,293.25" "$2,831.96" "$2,831.96" "$2,831.96" "$2,831.96" "$6,293.25" "$6,293.25" "$6,293.25" "$1,311.67" "$6,293.25" "$6,293.25" "$6,293.25" "$6,293.25" "$6,293.25" "$1,311.58" "$6,293.25" "$6,293.25" "$3,102.57" "$6,293.25" "$6,293.25" "$6,293.25" "$6,293.25" "$4,720.13" "$6,293.25" "$6,293.25" "$6,293.25" "$3,146.63" "$3,146.63" "$4,984.25" "$6,293.25" "$5,034.60" "$2,831.96" "$1,249.05" N/A "$3,650.23" "$6,293.25" "$3,775.95" "$6,293.25" "$1,311.51" "$6,293.25" N/A N/A 04.503.737 SUP HCPCS C1713 04.503.737 - PLATE BN STRG 2.5MM NS MATRIXMANDIBLE 12 HL RECON TI MNDB BOTH IP/OP "$2,520.00" "$1,865.00" $500.16 "$2,520.00" "$1,134.00" "$1,134.00" "$1,134.00" "$1,134.00" "$2,520.00" "$2,520.00" "$2,520.00" $525.23 "$2,520.00" "$2,520.00" "$2,520.00" "$2,520.00" "$2,520.00" $525.20 "$2,520.00" "$2,520.00" "$1,242.36" "$2,520.00" "$2,520.00" "$2,520.00" "$2,520.00" "$1,890.00" "$2,520.00" "$2,520.00" "$2,520.00" "$1,260.00" "$1,260.00" "$1,995.84" "$2,520.00" "$2,016.00" "$1,134.00" $500.16 N/A "$1,461.60" "$2,520.00" "$1,512.00" "$2,520.00" $525.17 "$2,520.00" N/A N/A 04.503.738 SUP HCPCS C1713 04.503.738 - PLATE BN STRG 2.5MM NS MATRIXMANDIBLE 20 HL RECON TI MNDB BOTH IP/OP "$3,492.00" "$2,584.00" $693.07 "$3,492.00" "$1,571.40" "$1,571.40" "$1,571.40" "$1,571.40" "$3,492.00" "$3,492.00" "$3,492.00" $727.82 "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" $727.77 "$3,492.00" "$3,492.00" "$1,721.56" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$2,619.00" "$3,492.00" "$3,492.00" "$3,492.00" "$1,746.00" "$1,746.00" "$2,765.66" "$3,492.00" "$2,793.60" "$1,571.40" $693.07 N/A "$2,025.36" "$3,492.00" "$2,095.20" "$3,492.00" $727.73 "$3,492.00" N/A N/A 04.503.739 SUP HCPCS C1713 04.503.739 - PLATE BN LT ANG 2.5MM NS MATRIXMANDIBLE 7X23 HL RECON TI BOTH IP/OP "$5,260.50" "$3,893.00" "$1,044.08" "$5,260.50" "$2,367.23" "$2,367.23" "$2,367.23" "$2,367.23" "$5,260.50" "$5,260.50" "$5,260.50" "$1,096.42" "$5,260.50" "$5,260.50" "$5,260.50" "$5,260.50" "$5,260.50" "$1,096.35" "$5,260.50" "$2,104.20" "$2,593.43" "$5,260.50" "$5,260.50" "$5,260.50" "$5,260.50" "$3,945.38" "$5,260.50" "$5,260.50" "$5,260.50" "$2,630.25" "$2,630.25" "$4,166.32" "$5,260.50" "$4,208.40" "$2,367.23" "$1,044.08" N/A "$3,051.09" "$5,260.50" "$5,260.50" "$5,260.50" "$1,096.29" "$5,260.50" N/A N/A 04.503.740 SUP HCPCS C1713 04.503.740 - PLATE BN RT ANG 2.5MM NS MATRIXMANDIBLE 7X23 HL RECON TI BOTH IP/OP "$5,260.50" "$3,893.00" "$1,044.08" "$5,260.50" "$2,367.23" "$2,367.23" "$2,367.23" "$2,367.23" "$5,260.50" "$5,260.50" "$5,260.50" "$1,096.42" "$5,260.50" "$5,260.50" "$5,260.50" "$5,260.50" "$5,260.50" "$1,096.35" "$5,260.50" "$5,260.50" "$2,593.43" "$5,260.50" "$5,260.50" "$5,260.50" "$5,260.50" "$3,945.38" "$5,260.50" "$5,260.50" "$5,260.50" "$2,630.25" "$2,630.25" "$4,166.32" "$5,260.50" "$4,208.40" "$2,367.23" "$1,044.08" N/A "$3,051.09" "$5,260.50" "$3,156.30" "$5,260.50" "$1,096.29" "$5,260.50" N/A N/A 04.503.741 SUP HCPCS C1713 04.503.741 - PLATE BN 2 ANG SM 2.5MM NS MATRIXMANDIBLE 4X20X4 HL RECON TI BOTH IP/OP "$6,091.00" "$4,507.00" "$1,208.86" "$6,090.75" "$2,740.84" "$2,740.84" "$2,740.84" "$2,740.84" "$6,090.75" "$6,090.75" "$6,090.75" "$1,269.46" "$6,090.75" "$6,090.75" "$6,090.75" "$6,090.75" "$6,090.75" "$1,269.38" "$6,090.75" "$6,090.75" "$3,002.74" "$6,090.75" "$6,090.75" "$6,090.75" "$6,090.75" "$4,568.25" "$6,090.75" "$6,090.75" "$6,090.75" "$3,045.38" "$3,045.38" "$4,823.87" "$6,090.75" "$4,872.60" "$2,740.84" "$1,208.86" N/A "$3,532.78" "$6,090.75" "$6,090.75" "$6,090.75" "$1,269.31" "$6,090.75" N/A N/A 04.503.742 SUP HCPCS C1713 04.503.742 - PLATE BN 2 ANG MED 2.5MM NS MATRIXMANDIBLE 5X22X5 HL RECON BOTH IP/OP "$6,428.50" "$4,757.00" "$1,275.85" "$6,428.25" "$2,892.71" "$2,892.71" "$2,892.71" "$2,892.71" "$6,428.25" "$6,428.25" "$6,428.25" "$1,339.81" "$6,428.25" "$6,428.25" "$6,428.25" "$6,428.25" "$6,428.25" "$1,339.72" "$6,428.25" "$6,428.25" "$3,169.13" "$6,428.25" "$6,428.25" "$6,428.25" "$6,428.25" "$4,821.38" "$6,428.25" "$6,428.25" "$6,428.25" "$3,214.13" "$3,214.13" "$5,091.17" "$6,428.25" "$5,142.60" "$2,892.71" "$1,275.85" N/A "$3,728.53" "$6,428.25" "$6,428.25" "$6,428.25" "$1,339.65" "$6,428.25" N/A N/A 04.503.743 SUP HCPCS C1713 04.503.743 - PLATE BN 2 ANG LG 2.5MM NS MATRIXMANDIBLE 6X24X6 HL RECON TI BOTH IP/OP "$6,784.00" "$5,020.00" "$1,346.40" "$6,783.75" "$3,052.69" "$3,052.69" "$3,052.69" "$3,052.69" "$6,783.75" "$6,783.75" "$6,783.75" "$1,413.90" "$6,783.75" "$6,783.75" "$6,783.75" "$6,783.75" "$6,783.75" "$1,413.81" "$6,783.75" "$6,783.75" "$3,344.39" "$6,783.75" "$6,783.75" "$6,783.75" "$6,783.75" "$5,088.00" "$6,783.75" "$6,783.75" "$6,783.75" "$3,391.88" "$3,391.88" "$5,372.73" "$6,783.75" "$5,427.00" "$3,052.69" "$1,346.40" N/A "$3,934.72" "$6,783.75" "$4,070.25" "$6,783.75" "$1,413.73" "$6,783.75" N/A N/A 04.503.750 SUP HCPCS C1713 04.503.750 - PLATE BN BRD MN 1MM NS MATRIXMANDIBLE 2X2 HL MLBL TNSNBND TI BOTH IP/OP "$1,152.00" $852.00 $228.64 "$1,152.00" $518.40 $518.40 $518.40 $518.40 "$1,152.00" "$1,152.00" "$1,152.00" $240.11 "$1,152.00" "$1,152.00" "$1,152.00" "$1,152.00" "$1,152.00" $240.09 "$1,152.00" "$1,152.00" $681.41 "$1,152.00" "$1,152.00" "$1,152.00" "$1,152.00" $864.00 "$1,152.00" "$1,152.00" "$1,152.00" $576.00 $576.00 $912.38 "$1,152.00" $921.60 $518.40 $228.64 N/A $668.16 "$1,152.00" "$1,152.00" "$1,152.00" $240.08 "$1,152.00" N/A N/A 04.503.751 SUP HCPCS C1713 04.503.751 - PLATE BN BRD MN 1MM NS MATRIXMANDIBLE 2X3 HL MLBL TNSNBND TI BOTH IP/OP "$1,197.00" $886.00 $237.57 "$1,197.00" $538.65 $538.65 $538.65 $538.65 "$1,197.00" "$1,197.00" "$1,197.00" $249.48 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $249.47 "$1,197.00" "$1,197.00" $708.03 "$1,197.00" "$1,197.00" "$1,197.00" "$1,197.00" $897.75 "$1,197.00" "$1,197.00" "$1,197.00" $598.50 $598.50 $948.02 "$1,197.00" $957.60 $538.65 $237.57 N/A $694.26 "$1,197.00" $718.20 "$1,197.00" $249.45 "$1,197.00" N/A N/A 04.503.752 SUP HCPCS C1713 04.503.752 - PLATE BN BRD MN 1MM NS MATRIXMANDIBLE 3X3 HL MLBL TNSNBND TI BOTH IP/OP "$1,244.50" $921.00 $246.95 "$1,244.25" $559.91 $559.91 $559.91 $559.91 "$1,244.25" "$1,244.25" "$1,244.25" $259.33 "$1,244.25" "$1,244.25" "$1,244.25" "$1,244.25" "$1,244.25" $259.32 "$1,244.25" $497.70 $735.97 "$1,244.25" "$1,244.25" "$1,244.25" "$1,244.25" $933.38 "$1,244.25" "$1,244.25" "$1,244.25" $622.13 $622.13 $985.45 "$1,244.25" $995.40 $559.91 $246.95 N/A $721.81 "$1,244.25" "$1,244.25" "$1,244.25" $259.30 "$1,244.25" N/A N/A 04.503.756 SUP HCPCS C1713 04.503.756 - PLATE BN 1.25MM NS MATRIXMANDIBLE 12 HL ADP TI MNDB BOTH IP/OP "$1,773.00" "$1,312.00" $351.90 "$1,773.00" $797.85 $797.85 $797.85 $797.85 "$1,773.00" "$1,773.00" "$1,773.00" $369.54 "$1,773.00" "$1,773.00" "$1,773.00" "$1,773.00" "$1,773.00" $369.51 "$1,773.00" "$1,773.00" "$1,048.73" "$1,773.00" "$1,773.00" "$1,773.00" "$1,773.00" "$1,329.75" "$1,773.00" "$1,773.00" "$1,773.00" $886.50 $886.50 "$1,404.22" "$1,773.00" "$1,418.40" $797.85 $351.90 N/A "$1,028.34" "$1,773.00" "$1,063.80" "$1,773.00" $369.49 "$1,773.00" N/A N/A 04.503.761 SUP HCPCS C1713 04.503.761 - PLATE BONE STR 1.25MM 2X2 HOLE MTRXMAND DCP SILVER TITANIUM BOTH IP/OP "$1,188.00" $879.00 $235.79 "$1,188.00" $534.60 $534.60 $534.60 $534.60 "$1,188.00" "$1,188.00" "$1,188.00" $247.61 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $247.59 "$1,188.00" "$1,188.00" $702.70 "$1,188.00" "$1,188.00" "$1,188.00" "$1,188.00" $891.00 "$1,188.00" "$1,188.00" "$1,188.00" $594.00 $594.00 $940.90 "$1,188.00" $950.40 $534.60 $235.79 N/A $689.04 "$1,188.00" $712.80 "$1,188.00" $247.58 "$1,188.00" N/A N/A 04.503.770 SUP HCPCS C1713 04.503.770 - PLATE BN STRG 2.8MM NS MATRIXMANDIBLE 12 HL RECON TI MNDB BOTH IP/OP "$2,965.50" "$2,194.00" $588.58 "$2,965.50" "$1,334.48" "$1,334.48" "$1,334.48" "$1,334.48" "$2,965.50" "$2,965.50" "$2,965.50" $618.08 "$2,965.50" "$2,965.50" "$2,965.50" "$2,965.50" "$2,965.50" $618.04 "$2,965.50" "$1,186.20" "$1,461.99" "$2,965.50" "$2,965.50" "$2,965.50" "$2,965.50" "$2,224.13" "$2,965.50" "$2,965.50" "$2,965.50" "$1,482.75" "$1,482.75" "$2,348.68" "$2,965.50" "$2,372.40" "$1,334.48" $588.58 N/A "$1,719.99" "$2,965.50" "$2,965.50" "$2,965.50" $618.01 "$2,965.50" N/A N/A 04.503.771 SUP HCPCS C1713 04.503.771 - PLATE BN STRG 2.8MM NS MATRIXMANDIBLE 20 HL RECON TI MNDB BOTH IP/OP "$4,338.00" "$3,210.00" $860.98 "$4,338.00" "$1,952.10" "$1,952.10" "$1,952.10" "$1,952.10" "$4,338.00" "$4,338.00" "$4,338.00" $904.15 "$4,338.00" "$4,338.00" "$4,338.00" "$4,338.00" "$4,338.00" $904.09 "$4,338.00" "$1,735.20" "$2,138.63" "$4,338.00" "$4,338.00" "$4,338.00" "$4,338.00" "$3,253.50" "$4,338.00" "$4,338.00" "$4,338.00" "$2,169.00" "$2,169.00" "$3,435.70" "$4,338.00" "$3,470.40" "$1,952.10" $860.98 N/A "$2,516.04" "$4,338.00" "$4,338.00" "$4,338.00" $904.04 "$4,338.00" N/A N/A 04.503.772 SUP HCPCS C1713 04.503.772 - PLATE BN LT ANG 2.8MM NS MATRIXMANDIBLE 7X23 HL RECON TI BOTH IP/OP "$6,444.00" "$4,769.00" "$1,278.97" "$6,444.00" "$2,899.80" "$2,899.80" "$2,899.80" "$2,899.80" "$6,444.00" "$6,444.00" "$6,444.00" "$1,343.09" "$6,444.00" "$6,444.00" "$6,444.00" "$6,444.00" "$6,444.00" "$1,343.00" "$6,444.00" "$6,444.00" "$3,176.89" "$6,444.00" "$6,444.00" "$6,444.00" "$6,444.00" "$4,833.00" "$6,444.00" "$6,444.00" "$6,444.00" "$3,222.00" "$3,222.00" "$5,103.65" "$6,444.00" "$5,155.20" "$2,899.80" "$1,278.97" N/A "$3,737.52" "$6,444.00" "$3,866.40" "$6,444.00" "$1,342.93" "$6,444.00" N/A N/A 04.503.773 SUP HCPCS C1713 04.503.773 - PLATE BN RT ANG 2.8MM NS MATRIXMANDIBLE 7X23 HL RECON TI BOTH IP/OP "$6,444.00" "$4,769.00" "$1,278.97" "$6,444.00" "$2,899.80" "$2,899.80" "$2,899.80" "$2,899.80" "$6,444.00" "$6,444.00" "$6,444.00" "$1,343.09" "$6,444.00" "$6,444.00" "$6,444.00" "$6,444.00" "$6,444.00" "$1,343.00" "$6,444.00" "$6,444.00" "$3,176.89" "$6,444.00" "$6,444.00" "$6,444.00" "$6,444.00" "$4,833.00" "$6,444.00" "$6,444.00" "$6,444.00" "$3,222.00" "$3,222.00" "$5,103.65" "$6,444.00" "$5,155.20" "$2,899.80" "$1,278.97" N/A "$3,737.52" "$6,444.00" "$6,444.00" "$6,444.00" "$1,342.93" "$6,444.00" N/A N/A 04.503.780 SUP HCPCS C1713 04.503.780 - PLATE BONE MINI PREBENT 1MM 2X2 HOLE TENSION BAND MTRXMAND BOTH IP/OP $988.00 $731.00 $196.04 $987.75 $444.49 $444.49 $444.49 $444.49 $987.75 $987.75 $987.75 $205.87 $987.75 $987.75 $987.75 $987.75 $987.75 $205.86 $987.75 $395.10 $584.25 $987.75 $987.75 $987.75 $987.75 $741.00 $987.75 $987.75 $987.75 $493.88 $493.88 $782.30 $987.75 $790.20 $444.49 $196.04 N/A $573.04 $987.75 $987.75 $987.75 $205.85 $987.75 N/A N/A 04.503.781 SUP HCPCS C1713 04.503.781 - PLATE BONE MINI PREBENT 1MM 2X2 HOLE TENSION BAND MTRXMAND BOTH IP/OP $988.00 $731.00 $196.04 $987.75 $444.49 $444.49 $444.49 $444.49 $987.75 $987.75 $987.75 $205.87 $987.75 $987.75 $987.75 $987.75 $987.75 $205.86 $987.75 $395.10 $584.25 $987.75 $987.75 $987.75 $987.75 $741.00 $987.75 $987.75 $987.75 $493.88 $493.88 $782.30 $987.75 $790.20 $444.49 $196.04 N/A $573.04 $987.75 $987.75 $987.75 $205.85 $987.75 N/A N/A 04.503.783 SUP HCPCS C1713 04.503.783 - PLATE BONE 1MM 4 HOLE ADAPTION MTRXMAND SILVER TITANIUM BOTH IP/OP $927.00 $686.00 $183.99 $927.00 $417.15 $417.15 $417.15 $417.15 $927.00 $927.00 $927.00 $193.21 $927.00 $927.00 $927.00 $927.00 $927.00 $193.20 $927.00 $927.00 $548.32 $927.00 $927.00 $927.00 $927.00 $695.25 $927.00 $927.00 $927.00 $463.50 $463.50 $734.18 $927.00 $741.60 $417.15 $183.99 N/A $537.66 $927.00 $556.20 $927.00 $193.19 $927.00 N/A N/A 04.503.801 SUP HCPCS C1713 04.503.801 - PLATE BN 3D SM .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM BOTH IP/OP "$4,167.00" "$3,084.00" $827.05 "$4,167.00" "$1,875.15" "$1,875.15" "$1,875.15" "$1,875.15" "$4,167.00" "$4,167.00" "$4,167.00" $868.51 "$4,167.00" "$4,167.00" "$4,167.00" "$4,167.00" "$4,167.00" $868.45 "$4,167.00" "$1,666.80" "$2,054.33" "$4,167.00" "$4,167.00" "$4,167.00" "$4,167.00" "$3,125.25" "$4,167.00" "$4,167.00" "$4,167.00" "$2,083.50" "$2,083.50" "$3,300.26" "$4,167.00" "$3,333.60" "$1,875.15" $827.05 N/A "$2,416.86" "$4,167.00" "$2,500.20" "$4,167.00" $868.40 "$4,167.00" N/A N/A 04.503.802 SUP HCPCS C1713 04.503.802 - PLATE BN 3D LG .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM BOTH IP/OP "$4,311.00" "$3,190.00" $855.63 "$4,311.00" "$1,939.95" "$1,939.95" "$1,939.95" "$1,939.95" "$4,311.00" "$4,311.00" "$4,311.00" $898.52 "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" $898.46 "$4,311.00" "$1,724.40" "$2,125.32" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" "$3,233.25" "$4,311.00" "$4,311.00" "$4,311.00" "$2,155.50" "$2,155.50" "$3,414.31" "$4,311.00" "$3,448.80" "$1,939.95" $855.63 N/A "$2,500.38" "$4,311.00" "$2,586.60" "$4,311.00" $898.41 "$4,311.00" N/A N/A 04.503.811 SUP HCPCS C1713 04.503.811 - PLATE BN 3D SM .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM BOTH IP/OP "$4,167.00" "$3,084.00" $827.05 "$4,167.00" "$1,875.15" "$1,875.15" "$1,875.15" "$1,875.15" "$4,167.00" "$4,167.00" "$4,167.00" $868.51 "$4,167.00" "$4,167.00" "$4,167.00" "$4,167.00" "$4,167.00" $868.45 "$4,167.00" "$1,666.80" "$2,054.33" "$4,167.00" "$4,167.00" "$4,167.00" "$4,167.00" "$3,125.25" "$4,167.00" "$4,167.00" "$4,167.00" "$2,083.50" "$2,083.50" "$3,300.26" "$4,167.00" "$3,333.60" "$1,875.15" $827.05 N/A "$2,416.86" "$4,167.00" "$2,500.20" "$4,167.00" $868.40 "$4,167.00" N/A N/A 04.503.812 SUP HCPCS C1713 04.503.812 - PLATE BN 3D LG .4MM NS MATRIXMIDFACE MATRIXORBITAL PREFORM BOTH IP/OP "$4,311.00" "$3,190.00" $855.63 "$4,311.00" "$1,939.95" "$1,939.95" "$1,939.95" "$1,939.95" "$4,311.00" "$4,311.00" "$4,311.00" $898.52 "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" $898.46 "$4,311.00" "$1,724.40" "$2,125.32" "$4,311.00" "$4,311.00" "$4,311.00" "$4,311.00" "$3,233.25" "$4,311.00" "$4,311.00" "$4,311.00" "$2,155.50" "$2,155.50" "$3,414.31" "$4,311.00" "$3,448.80" "$1,939.95" $855.63 N/A "$2,500.38" "$4,311.00" "$2,586.60" "$4,311.00" $898.41 "$4,311.00" N/A N/A 04.503.820 SUP HCPCS C1713 04.503.820 - PLATE BN SHRT NS MATRIXWAVE 10 HL TI MXLMNDB BOTH IP/OP $776.50 $575.00 $154.07 $776.25 $349.31 $349.31 $349.31 $349.31 $776.25 $776.25 $776.25 $161.79 $776.25 $776.25 $776.25 $776.25 $776.25 $161.78 $776.25 $776.25 $459.15 $776.25 $776.25 $776.25 $776.25 $582.38 $776.25 $776.25 $776.25 $388.13 $388.13 $614.79 $776.25 $621.00 $349.31 $154.07 N/A $450.37 $776.25 $465.75 $776.25 $161.77 $776.25 N/A N/A 04.503.824.01 SUP HCPCS C1713 04.503.824.01 - MATRIXWAVE MMF TI 1.85MM SCREW SELF-DRILLING/6MM LENGTH BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A 04.503.825.01 SUP HCPCS C1713 04.503.825.01 - SCREW BONE 1.85MM 8MM SELF DRILL MATRIXWAVE TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $337.50 $337.50 $70.34 $337.50 N/A N/A 04.503.830 SUP HCPCS C1713 04.503.830 - PLATE BONE LAMBDA 1MM MALBLE MTRXMAND GRAY GREEN TITANIUM BOTH IP/OP "$2,099.50" "$1,554.00" $416.65 "$2,099.25" $944.66 $944.66 $944.66 $944.66 "$2,099.25" "$2,099.25" "$2,099.25" $437.54 "$2,099.25" "$2,099.25" "$2,099.25" "$2,099.25" "$2,099.25" $437.51 "$2,099.25" "$2,099.25" "$1,241.71" "$2,099.25" "$2,099.25" "$2,099.25" "$2,099.25" "$1,574.63" "$2,099.25" "$2,099.25" "$2,099.25" "$1,049.63" "$1,049.63" "$1,662.61" "$2,099.25" "$1,679.40" $944.66 $416.65 N/A "$1,217.71" "$2,099.25" "$2,099.25" "$2,099.25" $437.48 "$2,099.25" N/A N/A 04.503.831 SUP HCPCS C1713 04.503.831 - PLATE BONE LAMBDA 1MM MALBLE MTRXMAND GRAY GREEN TITANIUM BOTH IP/OP "$2,099.50" "$1,554.00" $416.65 "$2,099.25" $944.66 $944.66 $944.66 $944.66 "$2,099.25" "$2,099.25" "$2,099.25" $437.54 "$2,099.25" "$2,099.25" "$2,099.25" "$2,099.25" "$2,099.25" $437.51 "$2,099.25" $839.70 "$1,241.71" "$2,099.25" "$2,099.25" "$2,099.25" "$2,099.25" "$1,574.63" "$2,099.25" "$2,099.25" "$2,099.25" "$1,049.63" "$1,049.63" "$1,662.61" "$2,099.25" "$1,679.40" $944.66 $416.65 N/A "$1,217.71" "$2,099.25" "$1,259.55" "$2,099.25" "$2,099.25" "$2,099.25" N/A N/A 04.503.834 SUP HCPCS C1713 04.503.834 - PLATE BONE TRAPEZOID 1MM 7 HOLE MALBLE MTRXMAND GREEN BOTH IP/OP "$2,099.50" "$1,554.00" $416.65 "$2,099.25" $944.66 $944.66 $944.66 $944.66 "$2,099.25" "$2,099.25" "$2,099.25" $437.54 "$2,099.25" "$2,099.25" "$2,099.25" "$2,099.25" "$2,099.25" $437.51 "$2,099.25" $839.70 "$1,241.71" "$2,099.25" "$2,099.25" "$2,099.25" "$2,099.25" "$1,574.63" "$2,099.25" "$2,099.25" "$2,099.25" "$1,049.63" "$1,049.63" "$1,662.61" "$2,099.25" "$1,679.40" $944.66 $416.65 N/A "$1,217.71" "$2,099.25" "$2,099.25" "$2,099.25" "$2,099.25" "$2,099.25" N/A N/A 04.503.900 SUP HCPCS C1713 04.503.900 - PLATE BN SM 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB RT BOTH IP/OP "$7,144.00" "$5,287.00" "$1,417.86" "$7,143.75" "$3,214.69" "$3,214.69" "$3,214.69" "$3,214.69" "$7,143.75" "$7,143.75" "$7,143.75" "$1,488.94" "$7,143.75" "$7,143.75" "$7,143.75" "$7,143.75" "$7,143.75" "$1,488.84" "$7,143.75" "$7,143.75" "$3,521.87" "$7,143.75" "$7,143.75" "$7,143.75" "$7,143.75" "$5,358.00" "$7,143.75" "$7,143.75" "$7,143.75" "$3,571.88" "$3,571.88" "$5,657.85" "$7,143.75" "$5,715.00" "$3,214.69" "$1,417.86" N/A "$4,143.52" "$7,143.75" "$7,143.75" "$7,143.75" "$7,143.75" "$7,143.75" N/A N/A 04.503.901 SUP HCPCS C1713 04.503.901 - PLATE BN SM 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB LT BOTH IP/OP "$7,144.00" "$5,287.00" "$1,417.86" "$7,143.75" "$3,214.69" "$3,214.69" "$3,214.69" "$3,214.69" "$7,143.75" "$7,143.75" "$7,143.75" "$1,488.94" "$7,143.75" "$7,143.75" "$7,143.75" "$7,143.75" "$7,143.75" "$1,488.84" "$7,143.75" "$2,857.50" "$3,521.87" "$7,143.75" "$7,143.75" "$7,143.75" "$7,143.75" "$5,358.00" "$7,143.75" "$7,143.75" "$7,143.75" "$3,571.88" "$3,571.88" "$5,657.85" "$7,143.75" "$5,715.00" "$3,214.69" "$1,417.86" N/A "$4,143.52" "$7,143.75" "$7,143.75" "$7,143.75" "$1,488.76" "$7,143.75" N/A N/A 04.503.902 SUP HCPCS C1713 04.503.902 - PLATE BN MED 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB RT BOTH IP/OP "$7,411.50" "$5,485.00" "$1,471.00" "$7,411.50" "$3,335.18" "$3,335.18" "$3,335.18" "$3,335.18" "$7,411.50" "$7,411.50" "$7,411.50" "$1,544.74" "$7,411.50" "$7,411.50" "$7,411.50" "$7,411.50" "$7,411.50" "$1,544.64" "$7,411.50" "$2,964.60" "$3,653.87" "$7,411.50" "$7,411.50" "$7,411.50" "$7,411.50" "$5,558.63" "$7,411.50" "$7,411.50" "$7,411.50" "$3,705.75" "$3,705.75" "$5,869.91" "$7,411.50" "$5,929.20" "$3,335.18" "$1,471.00" N/A "$4,298.67" "$7,411.50" "$4,446.90" "$7,411.50" "$1,544.56" "$7,411.50" N/A N/A 04.503.903 SUP HCPCS C1713 04.503.903 - PLATE BN MED 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB LT BOTH IP/OP "$7,411.50" "$5,485.00" "$1,471.00" "$7,411.50" "$3,335.18" "$3,335.18" "$3,335.18" "$3,335.18" "$7,411.50" "$7,411.50" "$7,411.50" "$1,544.74" "$7,411.50" "$7,411.50" "$7,411.50" "$7,411.50" "$7,411.50" "$1,544.64" "$7,411.50" "$7,411.50" "$3,653.87" "$7,411.50" "$7,411.50" "$7,411.50" "$7,411.50" "$5,558.63" "$7,411.50" "$7,411.50" "$7,411.50" "$3,705.75" "$3,705.75" "$5,869.91" "$7,411.50" "$5,929.20" "$3,335.18" "$1,471.00" N/A "$4,298.67" "$7,411.50" "$4,446.90" "$7,411.50" "$1,544.56" "$7,411.50" N/A N/A 04.503.904 SUP HCPCS C1713 04.503.904 - PLATE BN LG 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB RT BOTH IP/OP "$7,679.50" "$5,683.00" "$1,524.14" "$7,679.25" "$3,455.66" "$3,455.66" "$3,455.66" "$3,455.66" "$7,679.25" "$7,679.25" "$7,679.25" "$1,600.55" "$7,679.25" "$7,679.25" "$7,679.25" "$7,679.25" "$7,679.25" "$1,600.44" "$7,679.25" "$3,071.70" "$3,785.87" "$7,679.25" "$7,679.25" "$7,679.25" "$7,679.25" "$5,759.63" "$7,679.25" "$7,679.25" "$7,679.25" "$3,839.63" "$3,839.63" "$6,081.97" "$7,679.25" "$6,143.40" "$3,455.66" "$1,524.14" N/A "$4,454.11" "$7,679.25" "$4,607.55" "$7,679.25" "$1,600.36" "$7,679.25" N/A N/A 04.503.905 SUP HCPCS C1713 04.503.905 - PLATE BN LG 2.5MM NS MATRIXMANDIBLE PRFRM RECON TI MNDB LT BOTH IP/OP "$7,679.50" "$5,683.00" "$1,524.14" "$7,679.25" "$3,455.66" "$3,455.66" "$3,455.66" "$3,455.66" "$7,679.25" "$7,679.25" "$7,679.25" "$1,600.55" "$7,679.25" "$7,679.25" "$7,679.25" "$7,679.25" "$7,679.25" "$1,600.44" "$7,679.25" "$3,071.70" "$3,785.87" "$7,679.25" "$7,679.25" "$7,679.25" "$7,679.25" "$5,759.63" "$7,679.25" "$7,679.25" "$7,679.25" "$3,839.63" "$3,839.63" "$6,081.97" "$7,679.25" "$6,143.40" "$3,455.66" "$1,524.14" N/A "$4,454.11" "$7,679.25" "$4,607.55" "$7,679.25" "$1,600.36" "$7,679.25" N/A N/A 04.511.204.01 SUP HCPCS C1713 04.511.204.01 - SCREW BONE 1.85MM 4MM SLFTAP MATRIX LIGHT BLUE TITANIUM BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $211.50 $211.50 N/A N/A 04.511.205.01 SUP HCPCS C1713 04.511.205.01 - SCREW BONE 1.85MM 5MM SLFTAP MATRIX LIGHT BLUE TITANIUM BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $211.50 $211.50 N/A N/A 04.511.206.01 SUP HCPCS C1713 04.511.206.01 - SCREW BONE 1.85MM 6MM SLFTAP MATRIX LIGHT BLUE TITANIUM BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $44.08 $211.50 N/A N/A 04.511.208.01 SUP HCPCS C1713 04.511.208.01 - SCREW BONE 1.85MM 8MM SLFTAP MATRIX LIGHT BLUE TITANIUM BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $44.08 $211.50 N/A N/A 04.511.210.01 SUP HCPCS C1713 04.511.210.01 - SCREW BONE 1.85MM 10MM SLFTAP COARSE PITCH MATRIX LIGHT BLUE BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $44.08 $211.50 N/A N/A 04.511.212.01 SUP HCPCS C1713 04.511.212.01 - SCREW BONE 1.85MM 3MM 12MM SLFTAP COARSE PITCH MATRIX LIGHT BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $44.08 $211.50 N/A N/A 04.511.214.01 SUP HCPCS C1713 04.511.214.01 - SCREW BONE 1.85MM 3MM 14MM SLFTAP COARSE PITCH MATRIX LIGHT BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $44.08 $211.50 N/A N/A 04.511.216.01 SUP HCPCS C1713 04.511.216.01 - SCREW BONE 1.85MM 3MM 16MM SLFTAP COARSE PITCH MATRIX LIGHT BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $126.90 $211.50 $44.08 $211.50 N/A N/A 04.511.218.01 SUP HCPCS C1713 04.511.218.01 - SCREW BONE 1.85MM 3MM 18MM SLFTAP COARSE PITCH MATRIX LIGHT BOTH IP/OP $211.50 $157.00 $41.98 $211.50 $95.18 $95.18 $95.18 $95.18 $211.50 $211.50 $211.50 $44.08 $211.50 $211.50 $211.50 $211.50 $211.50 $44.08 $211.50 $84.60 $125.10 $211.50 $211.50 $211.50 $211.50 $158.63 $211.50 $211.50 $211.50 $105.75 $105.75 $167.51 $211.50 $169.20 $95.18 $41.98 N/A $122.67 $211.50 $211.50 $211.50 $44.08 $211.50 N/A N/A 04.511.224.01 SUP HCPCS C1713 04.511.224.01 - SCREW BONE 1.85MM 2.65MM 4MM SELF DRILL MATRIXORTHOGNATHIC BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $89.10 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $133.65 $222.75 $46.42 $222.75 N/A N/A 04.511.225.01 SUP HCPCS C1713 04.511.225.01 - SCREW BONE 1.85MM 5MM SELF DRILL RECESS DESIGN COARSE PITCH BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $222.75 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $222.75 $222.75 $46.42 $222.75 N/A N/A 04.511.226.01 SUP HCPCS C1713 04.511.226.01 - SCREW BONE 1.85MM 6MM SLFTAP ORTHGNAT MATRIX LIGHT BLUE BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $222.75 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $222.75 $222.75 $46.42 $222.75 N/A N/A 04.511.228.01 SUP HCPCS C1713 04.511.228.01 - SCREW BONE 1.85MM 2.65MM 8MM SLFDRILL MATRIX PURPLE TITANIUM BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $89.10 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $222.75 $222.75 $46.42 $222.75 N/A N/A 04.511.234.01 SUP HCPCS C1713 04.511.234.01 - SCREW BONE 2.1MM 2.65MM 4MM EMERGENCY SELF TAP BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $89.10 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $222.75 $222.75 $46.42 $222.75 N/A N/A 04.511.235.01 SUP HCPCS C1713 04.511.235.01 - SCREW BONE 2.1MM 2.65MM 5MM EMERGENCY SELF TAP BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $89.10 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $222.75 $222.75 $46.42 $222.75 N/A N/A 04.511.236.01 SUP HCPCS C1713 04.511.236.01 - SCREW BONE 2.1MM 2.65MM 6MM SLFTAP EMERGENCY MATRIX PINK BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $89.10 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $133.65 $222.75 $46.42 $222.75 N/A N/A 04.511.238.01 SUP HCPCS C1713 04.511.238.01 - SCREW BONE 2.1MM 8MM SLFDRILL MATRIX PINK TITANIUM MANDIB BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $89.10 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $222.75 $222.75 $222.75 $222.75 N/A N/A 04.511.240.01 SUP HCPCS C1713 04.511.240.01 - SCREW BONE 2.1MM 3MM 8MM SLFTAP EMERGENCY COARSE PITCH BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $89.10 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $222.75 $222.75 $222.75 $222.75 N/A N/A 04.511.242.01 SUP HCPCS C1713 04.511.242.01 - SCREW BONE 2.1MM 3MM 12MM SLFTAP EMERGENCY COARSE PITCH BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $222.75 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $222.75 $222.75 $46.42 $222.75 N/A N/A 04.511.244.01 SUP HCPCS C1713 04.511.244.01 - SCREW BONE 2.1MM 3MM 14MM SLFTAP EMERGENCY COARSE PITCH BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $222.75 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $222.75 $222.75 $46.42 $222.75 N/A N/A 04.511.246.01 SUP HCPCS C1713 04.511.246.01 - SCREW BONE 2.1MM 16MM SLFTAP COARSE PITCH MATRIX PINK BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $89.10 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $222.75 $222.75 $46.42 $222.75 N/A N/A 04.511.248.01 SUP HCPCS C1713 04.511.248.01 - SCREW BONE 2.1MM 3MM 18MM SLFTAP EMERGENCY COARSE PITCH BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $89.10 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $133.65 $222.75 $46.42 $222.75 N/A N/A 04.511.301 SUP HCPCS C1713 04.511.301 - PLATE BN 90D L 2MMX.5MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS BOTH IP/OP $657.00 $486.00 $130.40 $657.00 $295.65 $295.65 $295.65 $295.65 $657.00 $657.00 $657.00 $136.94 $657.00 $657.00 $657.00 $657.00 $657.00 $136.93 $657.00 $262.80 $388.62 $657.00 $657.00 $657.00 $657.00 $492.75 $657.00 $657.00 $657.00 $328.50 $328.50 $520.34 $657.00 $525.60 $295.65 $130.40 N/A $381.06 $657.00 $394.20 $657.00 $136.92 $657.00 N/A N/A 04.511.302 SUP HCPCS C1713 04.511.302 - PLATE BN 90D L 6MMX.5MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS BOTH IP/OP $657.00 $486.00 $130.40 $657.00 $295.65 $295.65 $295.65 $295.65 $657.00 $657.00 $657.00 $136.94 $657.00 $657.00 $657.00 $657.00 $657.00 $136.93 $657.00 $657.00 $388.62 $657.00 $657.00 $657.00 $657.00 $492.75 $657.00 $657.00 $657.00 $328.50 $328.50 $520.34 $657.00 $525.60 $295.65 $130.40 N/A $381.06 $657.00 $394.20 $657.00 $136.92 $657.00 N/A N/A 04.511.303 SUP HCPCS C1713 04.511.303 - PLATE BN 90D L 11MMX.5MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS BOTH IP/OP $657.00 $486.00 $130.40 $657.00 $295.65 $295.65 $295.65 $295.65 $657.00 $657.00 $657.00 $136.94 $657.00 $657.00 $657.00 $657.00 $657.00 $136.93 $657.00 $657.00 $388.62 $657.00 $657.00 $657.00 $657.00 $492.75 $657.00 $657.00 $657.00 $328.50 $328.50 $520.34 $657.00 $525.60 $295.65 $130.40 N/A $381.06 $657.00 $657.00 $657.00 $136.92 $657.00 N/A N/A 04.511.304 SUP HCPCS C1713 04.511.304 - PLATE BN 90D L 2MMX.7MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS BOTH IP/OP $657.00 $486.00 $130.40 $657.00 $295.65 $295.65 $295.65 $295.65 $657.00 $657.00 $657.00 $136.94 $657.00 $657.00 $657.00 $657.00 $657.00 $136.93 $657.00 $262.80 $388.62 $657.00 $657.00 $657.00 $657.00 $492.75 $657.00 $657.00 $657.00 $328.50 $328.50 $520.34 $657.00 $525.60 $295.65 $130.40 N/A $381.06 $657.00 $657.00 $657.00 $136.92 $657.00 N/A N/A 04.511.305 SUP HCPCS C1713 04.511.305 - PLATE BN 90D L 6MMX.7MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS BOTH IP/OP $657.00 $486.00 $130.40 $657.00 $295.65 $295.65 $295.65 $295.65 $657.00 $657.00 $657.00 $136.94 $657.00 $657.00 $657.00 $657.00 $657.00 $136.93 $657.00 $262.80 $388.62 $657.00 $657.00 $657.00 $657.00 $492.75 $657.00 $657.00 $657.00 $328.50 $328.50 $520.34 $657.00 $525.60 $295.65 $130.40 N/A $381.06 $657.00 $657.00 $657.00 $136.92 $657.00 N/A N/A 04.511.306 SUP HCPCS C1713 04.511.306 - PLATE BN 90D L 11MMX.7MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS BOTH IP/OP $657.00 $486.00 $130.40 $657.00 $295.65 $295.65 $295.65 $295.65 $657.00 $657.00 $657.00 $136.94 $657.00 $657.00 $657.00 $657.00 $657.00 $136.93 $657.00 $262.80 $388.62 $657.00 $657.00 $657.00 $657.00 $492.75 $657.00 $657.00 $657.00 $328.50 $328.50 $520.34 $657.00 $525.60 $295.65 $130.40 N/A $381.06 $657.00 $657.00 $657.00 $136.92 $657.00 N/A N/A 04.511.307 SUP HCPCS C1713 04.511.307 - PLATE BONE 90D L SHORT 2MMX.8MM 2X2 HOLE REVERSIBLE LP BOTH IP/OP $657.00 $486.00 $130.40 $657.00 $295.65 $295.65 $295.65 $295.65 $657.00 $657.00 $657.00 $136.94 $657.00 $657.00 $657.00 $657.00 $657.00 $136.93 $657.00 $262.80 $388.62 $657.00 $657.00 $657.00 $657.00 $492.75 $657.00 $657.00 $657.00 $328.50 $328.50 $520.34 $657.00 $525.60 $295.65 $130.40 N/A $381.06 $657.00 $657.00 $657.00 $136.92 $657.00 N/A N/A 04.511.308 SUP HCPCS C1713 04.511.308 - PLATE BONE 90D L MEDIUM 6MMX.8MM 2X2 HOLE REVERSIBLE LP BOTH IP/OP $657.00 $486.00 $130.40 $657.00 $295.65 $295.65 $295.65 $295.65 $657.00 $657.00 $657.00 $136.94 $657.00 $657.00 $657.00 $657.00 $657.00 $136.93 $657.00 $262.80 $388.62 $657.00 $657.00 $657.00 $657.00 $492.75 $657.00 $657.00 $657.00 $328.50 $328.50 $520.34 $657.00 $525.60 $295.65 $130.40 N/A $381.06 $657.00 $657.00 $657.00 $136.92 $657.00 N/A N/A 04.511.309 SUP HCPCS C1713 04.511.309 - PLATE BN 90D L 11MMX.8MM NS MATRIXORTHOGNATHIC 2X2 HL RVRS BOTH IP/OP $657.00 $486.00 $130.40 $657.00 $295.65 $295.65 $295.65 $295.65 $657.00 $657.00 $657.00 $136.94 $657.00 $657.00 $657.00 $657.00 $657.00 $136.93 $657.00 $657.00 $388.62 $657.00 $657.00 $657.00 $657.00 $492.75 $657.00 $657.00 $657.00 $328.50 $328.50 $520.34 $657.00 $525.60 $295.65 $130.40 N/A $381.06 $657.00 $657.00 $657.00 $136.92 $657.00 N/A N/A 04.511.321 SUP HCPCS C1713 04.511.321 - PLATE BN L OBLQ 4MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS BOTH IP/OP $686.50 $508.00 $136.20 $686.25 $308.81 $308.81 $308.81 $308.81 $686.25 $686.25 $686.25 $143.03 $686.25 $686.25 $686.25 $686.25 $686.25 $143.02 $686.25 $686.25 $405.92 $686.25 $686.25 $686.25 $686.25 $514.88 $686.25 $686.25 $686.25 $343.13 $343.13 $543.51 $686.25 $549.00 $308.81 $136.20 N/A $398.17 $686.25 $686.25 $686.25 $143.01 $686.25 N/A N/A 04.511.322 SUP HCPCS C1713 04.511.322 - PLATE BN L OBLQ 8MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS BOTH IP/OP $686.50 $508.00 $136.20 $686.25 $308.81 $308.81 $308.81 $308.81 $686.25 $686.25 $686.25 $143.03 $686.25 $686.25 $686.25 $686.25 $686.25 $143.02 $686.25 $686.25 $405.92 $686.25 $686.25 $686.25 $686.25 $514.88 $686.25 $686.25 $686.25 $343.13 $343.13 $543.51 $686.25 $549.00 $308.81 $136.20 N/A $398.17 $686.25 $686.25 $686.25 $686.25 $686.25 N/A N/A 04.511.323 SUP HCPCS C1713 04.511.323 - PLATE BN L OBLQ 13MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS BOTH IP/OP $686.50 $508.00 $136.20 $686.25 $308.81 $308.81 $308.81 $308.81 $686.25 $686.25 $686.25 $143.03 $686.25 $686.25 $686.25 $686.25 $686.25 $143.02 $686.25 $686.25 $405.92 $686.25 $686.25 $686.25 $686.25 $514.88 $686.25 $686.25 $686.25 $343.13 $343.13 $543.51 $686.25 $549.00 $308.81 $136.20 N/A $398.17 $686.25 $686.25 $686.25 $686.25 $686.25 N/A N/A 04.511.324 SUP HCPCS C1713 04.511.324 - PLATE BN L OBLQ 4MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS BOTH IP/OP $686.50 $508.00 $136.20 $686.25 $308.81 $308.81 $308.81 $308.81 $686.25 $686.25 $686.25 $143.03 $686.25 $686.25 $686.25 $686.25 $686.25 $143.02 $686.25 $686.25 $405.92 $686.25 $686.25 $686.25 $686.25 $514.88 $686.25 $686.25 $686.25 $343.13 $343.13 $543.51 $686.25 $549.00 $308.81 $136.20 N/A $398.17 $686.25 $686.25 $686.25 $143.01 $686.25 N/A N/A 04.511.325 SUP HCPCS C1713 04.511.325 - PLATE BN L OBLQ 8MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS BOTH IP/OP $686.50 $508.00 $136.20 $686.25 $308.81 $308.81 $308.81 $308.81 $686.25 $686.25 $686.25 $143.03 $686.25 $686.25 $686.25 $686.25 $686.25 $143.02 $686.25 $274.50 $405.92 $686.25 $686.25 $686.25 $686.25 $514.88 $686.25 $686.25 $686.25 $343.13 $343.13 $543.51 $686.25 $549.00 $308.81 $136.20 N/A $398.17 $686.25 $686.25 $686.25 $143.01 $686.25 N/A N/A 04.511.326 SUP HCPCS C1713 04.511.326 - PLATE BN L OBLQ 13MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS BOTH IP/OP $686.50 $508.00 $136.20 $686.25 $308.81 $308.81 $308.81 $308.81 $686.25 $686.25 $686.25 $143.03 $686.25 $686.25 $686.25 $686.25 $686.25 $143.02 $686.25 $274.50 $405.92 $686.25 $686.25 $686.25 $686.25 $514.88 $686.25 $686.25 $686.25 $343.13 $343.13 $543.51 $686.25 $549.00 $308.81 $136.20 N/A $398.17 $686.25 $686.25 $686.25 $143.01 $686.25 N/A N/A 04.511.327 SUP HCPCS C1713 04.511.327 - PLATE BN L OBLQ 4MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS BOTH IP/OP $686.50 $508.00 $136.20 $686.25 $308.81 $308.81 $308.81 $308.81 $686.25 $686.25 $686.25 $143.03 $686.25 $686.25 $686.25 $686.25 $686.25 $143.02 $686.25 $274.50 $405.92 $686.25 $686.25 $686.25 $686.25 $514.88 $686.25 $686.25 $686.25 $343.13 $343.13 $543.51 $686.25 $549.00 $308.81 $136.20 N/A $398.17 $686.25 $686.25 $686.25 $143.01 $686.25 N/A N/A 04.511.328 SUP HCPCS C1713 04.511.328 - PLATE BN L OBLQ 8MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS BOTH IP/OP $686.50 $508.00 $136.20 $686.25 $308.81 $308.81 $308.81 $308.81 $686.25 $686.25 $686.25 $143.03 $686.25 $686.25 $686.25 $686.25 $686.25 $143.02 $686.25 $274.50 $405.92 $686.25 $686.25 $686.25 $686.25 $514.88 $686.25 $686.25 $686.25 $343.13 $343.13 $543.51 $686.25 $549.00 $308.81 $136.20 N/A $398.17 $686.25 $686.25 $686.25 $143.01 $686.25 N/A N/A 04.511.329 SUP HCPCS C1713 04.511.329 - PLATE BN L OBLQ 13MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL RVRS BOTH IP/OP $686.50 $508.00 $136.20 $686.25 $308.81 $308.81 $308.81 $308.81 $686.25 $686.25 $686.25 $143.03 $686.25 $686.25 $686.25 $686.25 $686.25 $143.02 $686.25 $274.50 $405.92 $686.25 $686.25 $686.25 $686.25 $514.88 $686.25 $686.25 $686.25 $343.13 $343.13 $543.51 $686.25 $549.00 $308.81 $136.20 N/A $398.17 $686.25 $686.25 $686.25 $143.01 $686.25 N/A N/A 04.511.341 SUP HCPCS C1713 04.511.341 - PLATE BN L 4MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS BOTH IP/OP $718.00 $531.00 $142.46 $717.75 $322.99 $322.99 $322.99 $322.99 $717.75 $717.75 $717.75 $149.60 $717.75 $717.75 $717.75 $717.75 $717.75 $149.59 $717.75 $287.10 $424.55 $717.75 $717.75 $717.75 $717.75 $538.50 $717.75 $717.75 $717.75 $358.88 $358.88 $568.46 $717.75 $574.20 $322.99 $142.46 N/A $416.44 $717.75 $717.75 $717.75 $149.58 $717.75 N/A N/A 04.511.342 SUP HCPCS C1713 04.511.342 - PLATE BN L 8MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS BOTH IP/OP $718.00 $531.00 $142.46 $717.75 $322.99 $322.99 $322.99 $322.99 $717.75 $717.75 $717.75 $149.60 $717.75 $717.75 $717.75 $717.75 $717.75 $149.59 $717.75 $287.10 $424.55 $717.75 $717.75 $717.75 $717.75 $538.50 $717.75 $717.75 $717.75 $358.88 $358.88 $568.46 $717.75 $574.20 $322.99 $142.46 N/A $416.44 $717.75 $717.75 $717.75 $149.58 $717.75 N/A N/A 04.511.343 SUP HCPCS C1713 04.511.343 - PLATE BN L 12MMX.5MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS BOTH IP/OP $718.00 $531.00 $142.46 $717.75 $322.99 $322.99 $322.99 $322.99 $717.75 $717.75 $717.75 $149.60 $717.75 $717.75 $717.75 $717.75 $717.75 $149.59 $717.75 $717.75 $424.55 $717.75 $717.75 $717.75 $717.75 $538.50 $717.75 $717.75 $717.75 $358.88 $358.88 $568.46 $717.75 $574.20 $322.99 $142.46 N/A $416.44 $717.75 $717.75 $717.75 $149.58 $717.75 N/A N/A 04.511.344 SUP HCPCS C1713 04.511.344 - PLATE BN L 4MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS BOTH IP/OP $718.00 $531.00 $142.46 $717.75 $322.99 $322.99 $322.99 $322.99 $717.75 $717.75 $717.75 $149.60 $717.75 $717.75 $717.75 $717.75 $717.75 $149.59 $717.75 $717.75 $424.55 $717.75 $717.75 $717.75 $717.75 $538.50 $717.75 $717.75 $717.75 $358.88 $358.88 $568.46 $717.75 $574.20 $322.99 $142.46 N/A $416.44 $717.75 $717.75 $717.75 $149.58 $717.75 N/A N/A 04.511.345 SUP HCPCS C1713 04.511.345 - PLATE BN L 8MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS BOTH IP/OP $718.00 $531.00 $142.46 $717.75 $322.99 $322.99 $322.99 $322.99 $717.75 $717.75 $717.75 $149.60 $717.75 $717.75 $717.75 $717.75 $717.75 $149.59 $717.75 $287.10 $424.55 $717.75 $717.75 $717.75 $717.75 $538.50 $717.75 $717.75 $717.75 $358.88 $358.88 $568.46 $717.75 $574.20 $322.99 $142.46 N/A $416.44 $717.75 $717.75 $717.75 $717.75 $717.75 N/A N/A 04.511.346 SUP HCPCS C1713 04.511.346 - PLATE BN L 12MMX.7MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS BOTH IP/OP $718.00 $531.00 $142.46 $717.75 $322.99 $322.99 $322.99 $322.99 $717.75 $717.75 $717.75 $149.60 $717.75 $717.75 $717.75 $717.75 $717.75 $149.59 $717.75 $287.10 $424.55 $717.75 $717.75 $717.75 $717.75 $538.50 $717.75 $717.75 $717.75 $358.88 $358.88 $568.46 $717.75 $574.20 $322.99 $142.46 N/A $416.44 $717.75 $717.75 $717.75 $717.75 $717.75 N/A N/A 04.511.347 SUP HCPCS C1713 04.511.347 - PLATE BN L 4MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS BOTH IP/OP $718.00 $531.00 $142.46 $717.75 $322.99 $322.99 $322.99 $322.99 $717.75 $717.75 $717.75 $149.60 $717.75 $717.75 $717.75 $717.75 $717.75 $149.59 $717.75 $717.75 $424.55 $717.75 $717.75 $717.75 $717.75 $538.50 $717.75 $717.75 $717.75 $358.88 $358.88 $568.46 $717.75 $574.20 $322.99 $142.46 N/A $416.44 $717.75 $717.75 $717.75 $149.58 $717.75 N/A N/A 04.511.348 SUP HCPCS C1713 04.511.348 - PLATE BN L 8MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS BOTH IP/OP $718.00 $531.00 $142.46 $717.75 $322.99 $322.99 $322.99 $322.99 $717.75 $717.75 $717.75 $149.60 $717.75 $717.75 $717.75 $717.75 $717.75 $149.59 $717.75 $287.10 $424.55 $717.75 $717.75 $717.75 $717.75 $538.50 $717.75 $717.75 $717.75 $358.88 $358.88 $568.46 $717.75 $574.20 $322.99 $142.46 N/A $416.44 $717.75 $717.75 $717.75 $149.58 $717.75 N/A N/A 04.511.349 SUP HCPCS C1713 04.511.349 - PLATE BN L 12MMX.8MM NS MATRIXORTHOGNATHIC 3X3 HL ANTM RVRS BOTH IP/OP $718.00 $531.00 $142.46 $717.75 $322.99 $322.99 $322.99 $322.99 $717.75 $717.75 $717.75 $149.60 $717.75 $717.75 $717.75 $717.75 $717.75 $149.59 $717.75 $287.10 $424.55 $717.75 $717.75 $717.75 $717.75 $538.50 $717.75 $717.75 $717.75 $358.88 $358.88 $568.46 $717.75 $574.20 $322.99 $142.46 N/A $416.44 $717.75 $717.75 $717.75 $149.58 $717.75 N/A N/A 04.511.381 SUP HCPCS C1713 04.511.381 - PLATE BN 2MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC BOTH IP/OP "$1,100.50" $814.00 $218.37 "$1,100.25" $495.11 $495.11 $495.11 $495.11 "$1,100.25" "$1,100.25" "$1,100.25" $229.32 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $229.30 "$1,100.25" $440.10 $650.80 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $825.38 "$1,100.25" "$1,100.25" "$1,100.25" $550.13 $550.13 $871.40 "$1,100.25" $880.20 $495.11 $218.37 N/A $638.29 "$1,100.25" "$1,100.25" "$1,100.25" $229.29 "$1,100.25" N/A N/A 04.511.382 SUP HCPCS C1713 04.511.382 - PLATE BN 2MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC BOTH IP/OP "$1,100.50" $814.00 $218.37 "$1,100.25" $495.11 $495.11 $495.11 $495.11 "$1,100.25" "$1,100.25" "$1,100.25" $229.32 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $229.30 "$1,100.25" "$1,100.25" $650.80 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $825.38 "$1,100.25" "$1,100.25" "$1,100.25" $550.13 $550.13 $871.40 "$1,100.25" $880.20 $495.11 $218.37 N/A $638.29 "$1,100.25" "$1,100.25" "$1,100.25" $229.29 "$1,100.25" N/A N/A 04.511.383 SUP HCPCS C1713 04.511.383 - PLATE BN 4MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC BOTH IP/OP "$1,100.50" $814.00 $218.37 "$1,100.25" $495.11 $495.11 $495.11 $495.11 "$1,100.25" "$1,100.25" "$1,100.25" $229.32 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $229.30 "$1,100.25" $440.10 $650.80 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $825.38 "$1,100.25" "$1,100.25" "$1,100.25" $550.13 $550.13 $871.40 "$1,100.25" $880.20 $495.11 $218.37 N/A $638.29 "$1,100.25" "$1,100.25" "$1,100.25" $229.29 "$1,100.25" N/A N/A 04.511.384 SUP HCPCS C1713 04.511.384 - PLATE BN 4MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC BOTH IP/OP "$1,100.50" $814.00 $218.37 "$1,100.25" $495.11 $495.11 $495.11 $495.11 "$1,100.25" "$1,100.25" "$1,100.25" $229.32 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $229.30 "$1,100.25" $440.10 $650.80 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $825.38 "$1,100.25" "$1,100.25" "$1,100.25" $550.13 $550.13 $871.40 "$1,100.25" $880.20 $495.11 $218.37 N/A $638.29 "$1,100.25" "$1,100.25" "$1,100.25" $229.29 "$1,100.25" N/A N/A 04.511.385 SUP HCPCS C1713 04.511.385 - PLATE BN 6MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC BOTH IP/OP "$1,100.50" $814.00 $218.37 "$1,100.25" $495.11 $495.11 $495.11 $495.11 "$1,100.25" "$1,100.25" "$1,100.25" $229.32 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $229.30 "$1,100.25" "$1,100.25" $650.80 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $825.38 "$1,100.25" "$1,100.25" "$1,100.25" $550.13 $550.13 $871.40 "$1,100.25" $880.20 $495.11 $218.37 N/A $638.29 "$1,100.25" "$1,100.25" "$1,100.25" $229.29 "$1,100.25" N/A N/A 04.511.386 SUP HCPCS C1713 04.511.386 - PLATE BN 6MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC BOTH IP/OP "$1,100.50" $814.00 $218.37 "$1,100.25" $495.11 $495.11 $495.11 $495.11 "$1,100.25" "$1,100.25" "$1,100.25" $229.32 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $229.30 "$1,100.25" $440.10 $650.80 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $825.38 "$1,100.25" "$1,100.25" "$1,100.25" $550.13 $550.13 $871.40 "$1,100.25" $880.20 $495.11 $218.37 N/A $638.29 "$1,100.25" "$1,100.25" "$1,100.25" $229.29 "$1,100.25" N/A N/A 04.511.387 SUP HCPCS C1713 04.511.387 - PLATE BN 8MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC BOTH IP/OP "$1,100.50" $814.00 $218.37 "$1,100.25" $495.11 $495.11 $495.11 $495.11 "$1,100.25" "$1,100.25" "$1,100.25" $229.32 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $229.30 "$1,100.25" $440.10 $650.80 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $825.38 "$1,100.25" "$1,100.25" "$1,100.25" $550.13 $550.13 $871.40 "$1,100.25" $880.20 $495.11 $218.37 N/A $638.29 "$1,100.25" "$1,100.25" "$1,100.25" $229.29 "$1,100.25" N/A N/A 04.511.388 SUP HCPCS C1713 04.511.388 - PLATE BN 8MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC BOTH IP/OP "$1,100.50" $814.00 $218.37 "$1,100.25" $495.11 $495.11 $495.11 $495.11 "$1,100.25" "$1,100.25" "$1,100.25" $229.32 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $229.30 "$1,100.25" $440.10 $650.80 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $825.38 "$1,100.25" "$1,100.25" "$1,100.25" $550.13 $550.13 $871.40 "$1,100.25" $880.20 $495.11 $218.37 N/A $638.29 "$1,100.25" "$1,100.25" "$1,100.25" $229.29 "$1,100.25" N/A N/A 04.511.389 SUP HCPCS C1713 04.511.389 - PLATE BN 10MM LT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC BOTH IP/OP "$1,100.50" $814.00 $218.37 "$1,100.25" $495.11 $495.11 $495.11 $495.11 "$1,100.25" "$1,100.25" "$1,100.25" $229.32 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $229.30 "$1,100.25" "$1,100.25" $650.80 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $825.38 "$1,100.25" "$1,100.25" "$1,100.25" $550.13 $550.13 $871.40 "$1,100.25" $880.20 $495.11 $218.37 N/A $638.29 "$1,100.25" "$1,100.25" "$1,100.25" $229.29 "$1,100.25" N/A N/A 04.511.390 SUP HCPCS C1713 04.511.390 - PLATE BN 10MM RT OFST PREBNT .8MM NS MATRIXORTHOGNATHIC BOTH IP/OP "$1,100.50" $814.00 $218.37 "$1,100.25" $495.11 $495.11 $495.11 $495.11 "$1,100.25" "$1,100.25" "$1,100.25" $229.32 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $229.30 "$1,100.25" $440.10 $650.80 "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" $825.38 "$1,100.25" "$1,100.25" "$1,100.25" $550.13 $550.13 $871.40 "$1,100.25" $880.20 $495.11 $218.37 N/A $638.29 "$1,100.25" "$1,100.25" "$1,100.25" $229.29 "$1,100.25" N/A N/A 04.511.401 SUP HCPCS C1713 04.511.401 - PLATE BN CRV 6MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL BOTH IP/OP $956.50 $708.00 $189.79 $956.25 $430.31 $430.31 $430.31 $430.31 $956.25 $956.25 $956.25 $199.31 $956.25 $956.25 $956.25 $956.25 $956.25 $199.29 $956.25 $382.50 $565.62 $956.25 $956.25 $956.25 $956.25 $717.38 $956.25 $956.25 $956.25 $478.13 $478.13 $757.35 $956.25 $765.00 $430.31 $189.79 N/A $554.77 $956.25 $573.75 $956.25 $199.28 $956.25 N/A N/A 04.511.402 SUP HCPCS C1713 04.511.402 - PLATE BN CRV 8MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL BOTH IP/OP $956.50 $708.00 $189.79 $956.25 $430.31 $430.31 $430.31 $430.31 $956.25 $956.25 $956.25 $199.31 $956.25 $956.25 $956.25 $956.25 $956.25 $199.29 $956.25 $956.25 $565.62 $956.25 $956.25 $956.25 $956.25 $717.38 $956.25 $956.25 $956.25 $478.13 $478.13 $757.35 $956.25 $765.00 $430.31 $189.79 N/A $554.77 $956.25 $956.25 $956.25 $199.28 $956.25 N/A N/A 04.511.403 SUP HCPCS C1713 04.511.403 - PLATE BN CRV 10MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL BOTH IP/OP $956.50 $708.00 $189.79 $956.25 $430.31 $430.31 $430.31 $430.31 $956.25 $956.25 $956.25 $199.31 $956.25 $956.25 $956.25 $956.25 $956.25 $199.29 $956.25 $382.50 $565.62 $956.25 $956.25 $956.25 $956.25 $717.38 $956.25 $956.25 $956.25 $478.13 $478.13 $757.35 $956.25 $765.00 $430.31 $189.79 N/A $554.77 $956.25 $956.25 $956.25 $199.28 $956.25 N/A N/A 04.511.404 SUP HCPCS C1713 04.511.404 - PLATE BN CRV 12MMX1MM NS MATRIXORTHOGNATHIC 6 HL LOPRFL SGTL BOTH IP/OP $956.50 $708.00 $189.79 $956.25 $430.31 $430.31 $430.31 $430.31 $956.25 $956.25 $956.25 $199.31 $956.25 $956.25 $956.25 $956.25 $956.25 $199.29 $956.25 $382.50 $565.62 $956.25 $956.25 $956.25 $956.25 $717.38 $956.25 $956.25 $956.25 $478.13 $478.13 $757.35 $956.25 $765.00 $430.31 $189.79 N/A $554.77 $956.25 $573.75 $956.25 $199.28 $956.25 N/A N/A 04.511.421 SUP HCPCS C1713 04.511.421 - PLATE BN STRG 6MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL SGTL BOTH IP/OP $940.50 $696.00 $186.67 $940.50 $423.23 $423.23 $423.23 $423.23 $940.50 $940.50 $940.50 $196.02 $940.50 $940.50 $940.50 $940.50 $940.50 $196.01 $940.50 $376.20 $556.31 $940.50 $940.50 $940.50 $940.50 $705.38 $940.50 $940.50 $940.50 $470.25 $470.25 $744.88 $940.50 $752.40 $423.23 $186.67 N/A $545.49 $940.50 $564.30 $940.50 $196.00 $940.50 N/A N/A 04.511.422 SUP HCPCS C1713 04.511.422 - PLATE BN STRG 8MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL SGTL BOTH IP/OP $940.50 $696.00 $186.67 $940.50 $423.23 $423.23 $423.23 $423.23 $940.50 $940.50 $940.50 $196.02 $940.50 $940.50 $940.50 $940.50 $940.50 $196.01 $940.50 $940.50 $556.31 $940.50 $940.50 $940.50 $940.50 $705.38 $940.50 $940.50 $940.50 $470.25 $470.25 $744.88 $940.50 $752.40 $423.23 $186.67 N/A $545.49 $940.50 $564.30 $940.50 $196.00 $940.50 N/A N/A 04.511.423 SUP HCPCS C1713 04.511.423 - PLATE BN STRG 10MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL BOTH IP/OP $940.50 $696.00 $186.67 $940.50 $423.23 $423.23 $423.23 $423.23 $940.50 $940.50 $940.50 $196.02 $940.50 $940.50 $940.50 $940.50 $940.50 $196.01 $940.50 $376.20 $556.31 $940.50 $940.50 $940.50 $940.50 $705.38 $940.50 $940.50 $940.50 $470.25 $470.25 $744.88 $940.50 $752.40 $423.23 $186.67 N/A $545.49 $940.50 $564.30 $940.50 $940.50 $940.50 N/A N/A 04.511.424 SUP HCPCS C1713 04.511.424 - PLATE BN STRG 12MMX1MM NS MATRIXORTHOGNATHIC 4 HL LOPRFL BOTH IP/OP $940.50 $696.00 $186.67 $940.50 $423.23 $423.23 $423.23 $423.23 $940.50 $940.50 $940.50 $196.02 $940.50 $940.50 $940.50 $940.50 $940.50 $196.01 $940.50 $376.20 $556.31 $940.50 $940.50 $940.50 $940.50 $705.38 $940.50 $940.50 $940.50 $470.25 $470.25 $744.88 $940.50 $752.40 $423.23 $186.67 N/A $545.49 $940.50 $940.50 $940.50 $196.00 $940.50 N/A N/A 04.511.444 SUP HCPCS C1713 04.511.444 - PLATE BN 33MMX.7MM NS MATRIXORTHOGNATHIC 4 HL SGTL SPLT ADJ BOTH IP/OP "$1,282.50" $949.00 $254.54 "$1,282.50" $577.13 $577.13 $577.13 $577.13 "$1,282.50" "$1,282.50" "$1,282.50" $267.31 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $267.29 "$1,282.50" $513.00 $758.60 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $961.88 "$1,282.50" "$1,282.50" "$1,282.50" $641.25 $641.25 "$1,015.74" "$1,282.50" "$1,026.00" $577.13 $254.54 N/A $743.85 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" N/A N/A 04.511.445 SUP Custom 27203010 04.511.445 - INSERTER SURG 40MMX.7MM LINER CONSTRAINED MATRIX TITANIUM BOTH IP/OP "$1,282.50" $949.00 $228.29 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $228.29 "$1,282.50" "$1,282.50" $951.87 $951.87 $988.55 $668.18 $267.29 "$1,282.50" $513.00 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $961.88 "$1,282.50" "$1,282.50" "$1,282.50" $641.25 $641.25 "$1,015.74" "$1,282.50" "$1,026.00" $833.63 "$1,282.50" N/A $743.85 "$1,282.50" $769.50 "$1,282.50" "$1,282.50" "$1,282.50" N/A N/A 04.511.461 SUP HCPCS C1713 04.511.461 - PLATE BN 4MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL BOTH IP/OP $898.00 $665.00 $178.18 $897.75 $403.99 $403.99 $403.99 $403.99 $897.75 $897.75 $897.75 $187.11 $897.75 $897.75 $897.75 $897.75 $897.75 $187.10 $897.75 $359.10 $531.02 $897.75 $897.75 $897.75 $897.75 $673.50 $897.75 $897.75 $897.75 $448.88 $448.88 $711.02 $897.75 $718.20 $403.99 $178.18 N/A $520.84 $897.75 $897.75 $897.75 $897.75 $897.75 N/A N/A 04.511.462 SUP HCPCS C1713 04.511.462 - PLATE BN 6MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL BOTH IP/OP $898.00 $665.00 $178.18 $897.75 $403.99 $403.99 $403.99 $403.99 $897.75 $897.75 $897.75 $187.11 $897.75 $897.75 $897.75 $897.75 $897.75 $187.10 $897.75 $359.10 $531.02 $897.75 $897.75 $897.75 $897.75 $673.50 $897.75 $897.75 $897.75 $448.88 $448.88 $711.02 $897.75 $718.20 $403.99 $178.18 N/A $520.84 $897.75 $897.75 $897.75 $187.09 $897.75 N/A N/A 04.511.463 SUP HCPCS C1713 04.511.463 - PLATE BN 8MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL BOTH IP/OP $898.00 $665.00 $178.18 $897.75 $403.99 $403.99 $403.99 $403.99 $897.75 $897.75 $897.75 $187.11 $897.75 $897.75 $897.75 $897.75 $897.75 $187.10 $897.75 $359.10 $531.02 $897.75 $897.75 $897.75 $897.75 $673.50 $897.75 $897.75 $897.75 $448.88 $448.88 $711.02 $897.75 $718.20 $403.99 $178.18 N/A $520.84 $897.75 $897.75 $897.75 $187.09 $897.75 N/A N/A 04.511.464 SUP HCPCS C1713 04.511.464 - PLATE BN 10MM OFST 2 CRV .7MM NS MATRIXORTHOGNATHIC 5 HL BOTH IP/OP $898.00 $665.00 $178.18 $897.75 $403.99 $403.99 $403.99 $403.99 $897.75 $897.75 $897.75 $187.11 $897.75 $897.75 $897.75 $897.75 $897.75 $187.10 $897.75 $359.10 $531.02 $897.75 $897.75 $897.75 $897.75 $673.50 $897.75 $897.75 $897.75 $448.88 $448.88 $711.02 $897.75 $718.20 $403.99 $178.18 N/A $520.84 $897.75 $897.75 $897.75 $187.09 $897.75 N/A N/A 04.600.022.02S SUP HCPCS C1713 04.600.022.02S - PIN DISTRACTION 12MM TITANIUM STERILE BOTH IP/OP $896.00 $663.00 $177.83 $896.00 $403.20 $403.20 $403.20 $403.20 $896.00 $896.00 $896.00 $186.75 $896.00 $896.00 $896.00 $896.00 $896.00 $186.74 $896.00 $358.40 $529.98 $896.00 $896.00 $896.00 $896.00 $672.00 $896.00 $896.00 $896.00 $448.00 $448.00 $709.63 $896.00 $716.80 $403.20 $177.83 N/A $519.68 $896.00 $537.60 $896.00 $186.73 $896.00 N/A N/A 04.600.023.02S SUP HCPCS C1713 04.600.023.02S - PIN DISTRACTION 14MM TITANIUM STERILE BOTH IP/OP $448.00 $332.00 $88.92 $448.00 $201.60 $201.60 $201.60 $201.60 $448.00 $448.00 $448.00 $93.37 $448.00 $448.00 $448.00 $448.00 $448.00 $93.37 $448.00 $448.00 $264.99 $448.00 $448.00 $448.00 $448.00 $336.00 $448.00 $448.00 $448.00 $224.00 $224.00 $354.82 $448.00 $358.40 $201.60 $88.92 N/A $259.84 $448.00 $268.80 $448.00 $93.36 $448.00 N/A N/A 04.600.029.02S SUP HCPCS C1713 04.600.029.02S - PIN DISTRACTION 16MM TITANIUM STERILE BOTH IP/OP $448.00 $332.00 $88.92 $448.00 $201.60 $201.60 $201.60 $201.60 $448.00 $448.00 $448.00 $93.37 $448.00 $448.00 $448.00 $448.00 $448.00 $93.37 $448.00 $179.20 $264.99 $448.00 $448.00 $448.00 $448.00 $336.00 $448.00 $448.00 $448.00 $224.00 $224.00 $354.82 $448.00 $358.40 $201.60 $88.92 N/A $259.84 $448.00 $448.00 $448.00 $448.00 $448.00 N/A N/A 04.601.108 SUP HCPCS C1713 04.601.108 - SCREW BN T15 4.5MM 3.2MM 8MM NS SLF RTN STRDR BLNT TIP TI BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 04.601.110 SUP HCPCS C1713 04.601.110 - SCREW BONE 4.5MM 10MM TITANIUM OCCIPITOCERVICAL SPN NONSTRL BOTH IP/OP $392.00 $290.00 $77.80 $392.00 $176.40 $176.40 $176.40 $176.40 $392.00 $392.00 $392.00 $81.70 $392.00 $392.00 $392.00 $392.00 $392.00 $81.70 $392.00 $156.80 $231.87 $392.00 $392.00 $392.00 $392.00 $294.00 $392.00 $392.00 $392.00 $196.00 $196.00 $310.46 $392.00 $313.60 $176.40 $77.80 N/A $227.36 $392.00 $392.00 $392.00 $81.69 $392.00 N/A N/A 04.601.112 SUP HCPCS C1713 04.601.112 - SCREW BONE 4.5MM 12MM TITANIUM OCCIPITOCERVICAL SPN NONSTRL BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $399.00 $399.00 $83.15 $399.00 N/A N/A 04.601.208 SUP HCPCS C1713 04.601.208 - SCREW BN T15 5MM 3.2MM 8MM NS SLFRET STRDR BLNT TIP 7% BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 04.601.210 SUP HCPCS C1713 04.601.210 - SCREW BN T15 5MM 3.2MM 10MM NS SLFRET STRDR BLNT TIP 7% BOTH IP/OP $399.00 $295.00 $79.19 $399.00 $179.55 $179.55 $179.55 $179.55 $399.00 $399.00 $399.00 $83.16 $399.00 $399.00 $399.00 $399.00 $399.00 $83.16 $399.00 $159.60 $236.01 $399.00 $399.00 $399.00 $399.00 $299.25 $399.00 $399.00 $399.00 $199.50 $199.50 $316.01 $399.00 $319.20 $179.55 $79.19 N/A $231.42 $399.00 $239.40 $399.00 $83.15 $399.00 N/A N/A 04.613.014 SUP HCPCS C1713 04.613.014 - PLATE BONE BENT GROOVE PRELORDOTIC 23X16.5X2.5MM 14MM LEVEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 04.613.016 SUP HCPCS C1713 04.613.016 - PLATE BONE BENT GROOVE PRELORDOTIC 25X16.5X2.5MM 16MM LEVEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 04.613.130 SUP HCPCS C1713 04.613.130 - PLATE BN BNT GRV PREBNT 39X16.5X2.5MM NS 30MM VCTR 2 LVL 1 BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 04.613.132 SUP HCPCS C1713 04.613.132 - PLATE BN BNT GRV PREBNT 41X16.5X2.5MM NS 32MM VCTR 2 LVL 1 BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 04.613.516 SUP HCPCS C1713 04.613.516 - SCREW BONE 4MM 16MM VAR ANG SELF DRILL SELF RETAINING VECTRA BOTH IP/OP $498.50 $369.00 $98.86 $498.10 $224.15 $224.15 $224.15 $224.15 $498.10 $498.10 $498.10 $103.82 $498.10 $498.10 $498.10 $498.10 $498.10 $103.81 $498.10 $498.10 $294.63 $498.10 $498.10 $498.10 $498.10 $373.88 $498.10 $498.10 $498.10 $249.05 $249.05 $394.50 $498.10 $398.48 $224.15 $98.86 N/A $289.13 $498.10 $498.10 $498.10 $103.80 $498.10 N/A N/A 04.613.616 SUP HCPCS C1713 04.613.616 - SCREW BONE 4MM 16MM VAR ANG SELF TAP SELF RETAINING VECTRA BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 04.613.618 SUP HCPCS C1713 04.613.618 - SCREW BONE 4MM 18MM VAR ANG SELF TAP SELF RETAINING VECTRA BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 04.613.666 SUP HCPCS C1713 04.613.666 - SCREW BONE 4.5MM 16MM VAR ANG SELF TAP SELF RETAINING VECTRA BOTH IP/OP $478.00 $354.00 $94.81 $477.70 $214.97 $214.97 $214.97 $214.97 $477.70 $477.70 $477.70 $99.56 $477.70 $477.70 $477.70 $477.70 $477.70 $99.56 $477.70 $191.08 $282.56 $477.70 $477.70 $477.70 $477.70 $358.50 $477.70 $477.70 $477.70 $238.85 $238.85 $378.34 $477.70 $382.16 $214.97 $94.81 N/A $277.24 $477.70 $477.70 $477.70 $99.55 $477.70 N/A N/A 04.614.010 SUP HCPCS C1713 04.614.010 - SCREW BONE 0-50D 3.5MM 2.4MM 10MM T15 STARDRIVE POLYAX BOTH IP/OP "$2,576.00" "$1,906.00" $511.27 "$2,576.00" "$1,159.20" "$1,159.20" "$1,159.20" "$1,159.20" "$2,576.00" "$2,576.00" "$2,576.00" $536.90 "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" $536.87 "$2,576.00" "$1,030.40" "$1,269.97" "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" "$1,932.00" "$2,576.00" "$2,576.00" "$2,576.00" "$1,288.00" "$1,288.00" "$2,040.19" "$2,576.00" "$2,060.80" "$1,159.20" $511.27 N/A "$1,494.08" "$2,576.00" "$2,576.00" "$2,576.00" $536.84 "$2,576.00" N/A N/A 04.614.012 SUP HCPCS C1713 04.614.012 - SCREW BONE 50- D T15 SQUARE 3.5MM 2.4MM 12MM POLYAX SELF TAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 04.614.014 SUP HCPCS C1713 04.614.014 - SCREW BONE 0-50D 3.5MM 2.4MM 14MM T15 STARDRIVE POLYAX BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 04.614.016 SUP HCPCS C1713 04.614.016 - SCREW BONE 0-50D 3.5MM 2.4MM 16MM T15 STARDRIVE POLYAX BOTH IP/OP "$2,576.00" "$1,906.00" $511.27 "$2,576.00" "$1,159.20" "$1,159.20" "$1,159.20" "$1,159.20" "$2,576.00" "$2,576.00" "$2,576.00" $536.90 "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" $536.87 "$2,576.00" "$2,576.00" "$1,269.97" "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" "$1,932.00" "$2,576.00" "$2,576.00" "$2,576.00" "$1,288.00" "$1,288.00" "$2,040.19" "$2,576.00" "$2,060.80" "$1,159.20" $511.27 N/A "$1,494.08" "$2,576.00" "$2,576.00" "$2,576.00" $536.84 "$2,576.00" N/A N/A 04.614.020 SUP HCPCS C1713 04.614.020 - SCREW BONE 0-50D 3.5MM 2.4MM 20MM T15 STARDRIVE POLYAX BOTH IP/OP "$2,576.00" "$1,906.00" $511.27 "$2,576.00" "$1,159.20" "$1,159.20" "$1,159.20" "$1,159.20" "$2,576.00" "$2,576.00" "$2,576.00" $536.90 "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" $536.87 "$2,576.00" "$1,030.40" "$1,269.97" "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" "$1,932.00" "$2,576.00" "$2,576.00" "$2,576.00" "$1,288.00" "$1,288.00" "$2,040.19" "$2,576.00" "$2,060.80" "$1,159.20" $511.27 N/A "$1,494.08" "$2,576.00" "$2,576.00" "$2,576.00" $536.84 "$2,576.00" N/A N/A 04.614.110 SUP HCPCS C1713 04.614.110 - SCREW BONE 0-50D 4MM 2.4MM 10MM T15 STARDRIVE POLYAX SLFTAP BOTH IP/OP "$2,576.00" "$1,906.00" $511.27 "$2,576.00" "$1,159.20" "$1,159.20" "$1,159.20" "$1,159.20" "$2,576.00" "$2,576.00" "$2,576.00" $536.90 "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" $536.87 "$2,576.00" "$1,030.40" "$1,269.97" "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" "$1,932.00" "$2,576.00" "$2,576.00" "$2,576.00" "$1,288.00" "$1,288.00" "$2,040.19" "$2,576.00" "$2,060.80" "$1,159.20" $511.27 N/A "$1,494.08" "$2,576.00" "$2,576.00" "$2,576.00" $536.84 "$2,576.00" N/A N/A 04.614.112 SUP HCPCS C1713 04.614.112 - SCREW BONE 0-50D 4MM 2.4MM 12MM T15 STARDRIVE POLYAX SLFTAP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 04.614.114 SUP HCPCS C1713 04.614.114 - SCREW BONE 4MM 2.4MM 14MM SYNAPSE TI 50- D T15 SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 04.614.118 SUP HCPCS C1713 04.614.118 - SCREW BN 50- D T15 4MM 2.4MM 18MM GRN GRY NS SYNAPSE PA ST BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 04.614.124 SUP HCPCS C1713 04.614.124 - SCREW BONE 0-50D 4MM 2.4MM 24MM T15 STARDRIVE POLYAX SLFTAP BOTH IP/OP "$2,576.00" "$1,906.00" $511.27 "$2,576.00" "$1,159.20" "$1,159.20" "$1,159.20" "$1,159.20" "$2,576.00" "$2,576.00" "$2,576.00" $536.90 "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" $536.87 "$2,576.00" "$2,576.00" "$1,269.97" "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" "$1,932.00" "$2,576.00" "$2,576.00" "$2,576.00" "$1,288.00" "$1,288.00" "$2,040.19" "$2,576.00" "$2,060.80" "$1,159.20" $511.27 N/A "$1,494.08" "$2,576.00" "$2,576.00" "$2,576.00" $536.84 "$2,576.00" N/A N/A 04.614.126 SUP HCPCS C1713 04.614.126 - SCREW BONE 0-50D 4MM 2.4MM 26MM T15 STARDRIVE POLYAX SLFTAP BOTH IP/OP "$2,576.00" "$1,906.00" $511.27 "$2,576.00" "$1,159.20" "$1,159.20" "$1,159.20" "$1,159.20" "$2,576.00" "$2,576.00" "$2,576.00" $536.90 "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" $536.87 "$2,576.00" "$2,576.00" "$1,269.97" "$2,576.00" "$2,576.00" "$2,576.00" "$2,576.00" "$1,932.00" "$2,576.00" "$2,576.00" "$2,576.00" "$1,288.00" "$1,288.00" "$2,040.19" "$2,576.00" "$2,060.80" "$1,159.20" $511.27 N/A "$1,494.08" "$2,576.00" "$2,576.00" "$2,576.00" $536.84 "$2,576.00" N/A N/A 04.614.226 SUP HCPCS C1713 04.614.226 - SCREW BONE 40D LARGE DIAMETER T15 SQUARE 4.5MM 3.2MM 26MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 04.614.508 SUP HCPCS C1713 04.614.508 - SCREW BONE 4.5MM 8MM LOCK SYNAPSE TITANIUM SPN NONSTRL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 04.614.510 SUP HCPCS C1713 04.614.510 - ROD SPINAL 3.5-5MM 120-175MM HARD SYNAPSE TITANIUM NONSTRL BOTH IP/OP "$1,748.50" "$1,294.00" $346.98 "$1,748.25" $786.71 $786.71 $786.71 $786.71 "$1,748.25" "$1,748.25" "$1,748.25" $364.38 "$1,748.25" "$1,748.25" "$1,748.25" "$1,748.25" "$1,748.25" $364.35 "$1,748.25" $699.30 "$1,034.09" "$1,748.25" "$1,748.25" "$1,748.25" "$1,748.25" "$1,311.38" "$1,748.25" "$1,748.25" "$1,748.25" $874.13 $874.13 "$1,384.61" "$1,748.25" "$1,398.60" $786.71 $346.98 N/A "$1,014.13" "$1,748.25" "$1,748.25" "$1,748.25" $364.34 "$1,748.25" N/A N/A 04.614.513 SUP Custom 27803010 04.614.513 - TRANSCONNECTOR ROD 3.5MM 60MM TRNSVRS SYNAPSE TITANIUM SPN BOTH IP/OP "$2,709.00" "$2,005.00" $482.20 "$2,709.00" "$2,709.00" "$2,709.00" "$2,709.00" "$2,709.00" "$2,709.00" "$2,709.00" $482.20 "$2,709.00" "$2,709.00" "$2,709.00" "$2,709.00" "$2,709.00" "$2,709.00" $564.59 "$2,709.00" "$1,083.60" "$2,709.00" "$2,709.00" "$2,709.00" "$2,709.00" "$2,709.00" "$2,031.75" "$2,709.00" "$2,709.00" "$2,709.00" "$1,354.50" "$1,354.50" "$2,145.53" "$2,709.00" "$2,167.20" "$1,219.05" "$2,709.00" N/A "$1,571.22" "$2,709.00" "$1,625.40" "$2,709.00" "$2,709.00" "$2,709.00" N/A N/A 04.614.516 SUP Custom 27803010 04.614.516 - TRANSCONNECTOR ROD MEDIUM TOP LOAD SYNAPSE TITANIUM SPN BOTH IP/OP "$3,150.00" "$2,331.00" $560.70 "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" $560.70 "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" $656.49 "$3,150.00" "$1,260.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$3,150.00" "$2,362.50" "$3,150.00" "$3,150.00" "$3,150.00" "$1,575.00" "$1,575.00" "$2,494.80" "$3,150.00" "$2,520.00" "$1,417.50" "$3,150.00" N/A "$1,827.00" "$3,150.00" "$1,890.00" "$3,150.00" "$3,150.00" "$3,150.00" N/A N/A 04.614.521 SUP HCPCS C1713 04.614.521 - NUT LOCK 7.5MM TRNCON SYNAPSE TITANIUM SPN NONSTRL 3.5/4MM BOTH IP/OP $219.00 $162.00 $43.42 $218.75 $98.44 $98.44 $98.44 $98.44 $218.75 $218.75 $218.75 $45.59 $218.75 $218.75 $218.75 $218.75 $218.75 $45.59 $218.75 $218.75 $129.39 $218.75 $218.75 $218.75 $218.75 $164.25 $218.75 $218.75 $218.75 $109.38 $109.38 $173.25 $218.75 $175.00 $98.44 $43.42 N/A $127.02 $218.75 $218.75 $218.75 $45.59 $218.75 N/A N/A 04.614.522 SUP HCPCS C1713 04.614.522 - SCREW BONE LOCK TRNCON SYNAPSE TITANIUM SPN NONSTRL 3.5/4 MM BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $393.75 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $393.75 $393.75 $82.06 $393.75 N/A N/A 04.614.745 SUP HCPCS C1713 04.614.745 - ROD SPNL 45MM 3.5MM CURVE TI NONSTRL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 04.617.129S SUP Custom 27803010 04.617.129S - SPACER SPNL STD LRDTC 9MM STRL ZERO-PPEEK-OPTM TI BOTH IP/OP "$10,500.00" "$7,770.00" "$1,869.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$1,869.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.32" "$10,500.00" "$4,200.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$7,875.00" "$10,500.00" "$10,500.00" "$10,500.00" "$5,250.00" "$5,250.00" "$8,316.00" "$10,500.00" "$8,400.00" "$4,725.00" "$10,500.00" N/A "$6,090.00" "$10,500.00" "$6,300.00" "$10,500.00" "$10,500.00" "$10,500.00" N/A N/A 04.617.814 SUP HCPCS C1713 04.617.814 - SCREW BONE 3MM 14MM SELF TAP SELF CENTER LOCK ZERO-P GOLD BOTH IP/OP $722.50 $535.00 $143.40 $722.50 $325.13 $325.13 $325.13 $325.13 $722.50 $722.50 $722.50 $150.59 $722.50 $722.50 $722.50 $722.50 $722.50 $150.58 $722.50 $289.00 $427.36 $722.50 $722.50 $722.50 $722.50 $541.88 $722.50 $722.50 $722.50 $361.25 $361.25 $572.22 $722.50 $578.00 $325.13 $143.40 N/A $419.05 $722.50 $722.50 $722.50 $150.57 $722.50 N/A N/A 04.620.000 SUP Custom 27803010 04.620.000 - CAP LOCKING ROD GRIPPING RIDGE SELF ALIGNING SADDLE VISUAL BOTH IP/OP $375.00 $278.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $375.00 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 04.620.170 SUP HCPCS C1713 04.620.170 - ROD SPINAL CURVE 6MM 70MM SOFT PANGEA TITANIUM PEDICLE BOTH IP/OP $483.00 $357.00 $95.86 $483.00 $217.35 $217.35 $217.35 $217.35 $483.00 $483.00 $483.00 $100.67 $483.00 $483.00 $483.00 $483.00 $483.00 $100.66 $483.00 $193.20 $285.69 $483.00 $483.00 $483.00 $483.00 $362.25 $483.00 $483.00 $483.00 $241.50 $241.50 $382.54 $483.00 $386.40 $217.35 $95.86 N/A $280.14 $483.00 $483.00 $483.00 $100.66 $483.00 N/A N/A 04.620.203 SUP Custom 27803010 04.620.203 - TRANSCONNECTOR ROD 33-36.5MM LP PANGEA TITANIUM SPN PEDICLE BOTH IP/OP "$2,432.50" "$1,800.00" $432.99 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" $432.99 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" $506.96 "$2,432.50" $973.00 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$1,824.38" "$2,432.50" "$2,432.50" "$2,432.50" "$1,216.25" "$1,216.25" "$1,926.54" "$2,432.50" "$1,946.00" "$1,094.63" "$2,432.50" N/A "$1,410.85" "$2,432.50" "$1,459.50" "$2,432.50" "$2,432.50" "$2,432.50" N/A N/A 04.620.204 SUP Custom 27803010 04.620.204 - TRANSCONNECTOR ROD 38.5-48MM LP PANGEA USS TITANIUM SPN BOTH IP/OP "$2,432.50" "$1,800.00" $432.99 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" $432.99 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" $506.96 "$2,432.50" $973.00 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$1,824.38" "$2,432.50" "$2,432.50" "$2,432.50" "$1,216.25" "$1,216.25" "$1,926.54" "$2,432.50" "$1,946.00" "$1,094.63" "$2,432.50" N/A "$1,410.85" "$2,432.50" "$1,459.50" "$2,432.50" "$2,432.50" "$2,432.50" N/A N/A 04.620.205 SUP Custom 27803010 04.620.205 - TRANSCONNECTOR ROD 6MM 49-69MM LP PANGEA USS TITANIUM SPN BOTH IP/OP "$2,432.50" "$1,800.00" $432.99 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" $432.99 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" $506.96 "$2,432.50" $973.00 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$1,824.38" "$2,432.50" "$2,432.50" "$2,432.50" "$1,216.25" "$1,216.25" "$1,926.54" "$2,432.50" "$1,946.00" "$1,094.63" "$2,432.50" N/A "$1,410.85" "$2,432.50" "$1,459.50" "$2,432.50" "$2,432.50" "$2,432.50" N/A N/A 04.620.425 SUP HCPCS C1713 04.620.425 - SCREW BONE BLUNT 4MM 25MM 2 CORE SELF TAP POLYAX T25 BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 04.620.430 SUP HCPCS C1713 04.620.430 - SCREW BONE BLUNT 4MM 30MM 2 CORE SELF TAP POLYAX T25 BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 04.620.530 SUP HCPCS C1713 04.620.530 - SCREW BONE 5MM 30MM 2 CORE T25 STARDRIVE RECESS POLYAX BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 04.620.535 SUP HCPCS C1713 04.620.535 - SCREW BONE BLUNT 5MM 35MM 2 CORE SELF TAP POLYAX T25 BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 04.620.540 SUP HCPCS C1713 04.620.540 - SCREW BONE BLUNT 5MM 40MM 2 CORE SELF TAP POLYAX T25 BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 04.620.630 SUP HCPCS C1713 04.620.630 - SCREW BONE 6MM 30MM 2 CORE T25 STARDRIVE RECESS POLYAX BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 04.620.635 SUP HCPCS C1713 04.620.635 - SCREW BONE T25 BLUNT 6MM 35MM 2 CORE POLYAX SELF TAP BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 04.620.640 SUP HCPCS C1713 04.620.640 - SCREW BONE BLUNT 6MM 40MM 2 CORE SELF TAP POLYAX T25 BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 04.620.645 SUP HCPCS C1713 04.620.645 - SCREW BONE T25 BLUNT 6MM 45MM 2 CORE POLYAX SELF TAP BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 04.620.650 SUP HCPCS C1713 04.620.650 - SCREW BONE BLUNT 6MM 50MM 2 CORE SELF TAP POLYAX T25 BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 04.620.740 SUP HCPCS C1713 04.620.740 - SCREW BONE BLUNT 7MM 40MM 2 CORE SELF TAP POLYAX T25 BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 04.620.745 SUP HCPCS C1713 04.620.745 - SCREW BONE BLUNT 7MM 45MM 2 CORE SELF TAP POLYAX T25 BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 04.620.750 SUP HCPCS C1713 04.620.750 - SCREW BONE BLUNT 7MM 50MM 2 CORE SELF TAP POLYAX T25 BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 04.808.003 SUP HCPCS C1713 04.808.003 - CAGE SPNL 29X21MM SYNEX 2 TI ALIF NONSTRL BOTH IP/OP "$10,017.00" "$7,413.00" "$1,988.12" "$10,017.00" "$4,507.65" "$4,507.65" "$4,507.65" "$4,507.65" "$10,017.00" "$10,017.00" "$10,017.00" "$2,087.79" "$10,017.00" "$10,017.00" "$10,017.00" "$10,017.00" "$10,017.00" "$2,087.65" "$10,017.00" "$4,006.80" "$4,938.38" "$10,017.00" "$10,017.00" "$10,017.00" "$10,017.00" "$7,512.75" "$10,017.00" "$10,017.00" "$10,017.00" "$5,008.50" "$5,008.50" "$7,933.46" "$10,017.00" "$8,013.60" "$4,507.65" "$1,988.12" N/A "$5,809.86" "$10,017.00" "$10,017.00" "$10,017.00" "$10,017.00" "$10,017.00" N/A N/A 04.808.004 SUP HCPCS C1713 04.808.004 - CAGE SPNL 25-33MM SYNEX 2 TI LMBR INTRBD FS CENTRL BODY BOTH IP/OP "$11,408.50" "$8,442.00" "$2,264.25" "$11,408.25" "$5,133.71" "$5,133.71" "$5,133.71" "$5,133.71" "$11,408.25" "$11,408.25" "$11,408.25" "$2,377.76" "$11,408.25" "$11,408.25" "$11,408.25" "$11,408.25" "$11,408.25" "$2,377.60" "$11,408.25" "$11,408.25" "$5,624.27" "$11,408.25" "$11,408.25" "$11,408.25" "$11,408.25" "$8,556.38" "$11,408.25" "$11,408.25" "$11,408.25" "$5,704.13" "$5,704.13" "$9,035.33" "$11,408.25" "$9,126.60" "$5,133.71" "$2,264.25" N/A "$6,616.93" "$11,408.25" "$6,844.95" "$11,408.25" "$11,408.25" "$11,408.25" N/A N/A 04.808.018 SUP HCPCS C1713 04.808.018 - EPLT SPNL GOLD 20X19MM SYNEX 2 SM 0 BOTH IP/OP "$2,040.50" "$1,510.00" $404.99 "$2,040.50" $918.23 $918.23 $918.23 $918.23 "$2,040.50" "$2,040.50" "$2,040.50" $425.29 "$2,040.50" "$2,040.50" "$2,040.50" "$2,040.50" "$2,040.50" $425.26 "$2,040.50" "$2,040.50" "$1,206.96" "$2,040.50" "$2,040.50" "$2,040.50" "$2,040.50" "$1,530.38" "$2,040.50" "$2,040.50" "$2,040.50" "$1,020.25" "$1,020.25" "$1,616.08" "$2,040.50" "$1,632.40" $918.23 $404.99 N/A "$1,183.49" "$2,040.50" "$2,040.50" "$2,040.50" $425.24 "$2,040.50" N/A N/A 04.808.027 SUP HCPCS C1713 04.808.027 - EPLT SPNL 25MM 22MM 0D TI NONSTRL BOTH IP/OP "$2,040.50" "$1,510.00" $404.99 "$2,040.50" $918.23 $918.23 $918.23 $918.23 "$2,040.50" "$2,040.50" "$2,040.50" $425.29 "$2,040.50" "$2,040.50" "$2,040.50" "$2,040.50" "$2,040.50" $425.26 "$2,040.50" "$2,040.50" "$1,206.96" "$2,040.50" "$2,040.50" "$2,040.50" "$2,040.50" "$1,530.38" "$2,040.50" "$2,040.50" "$2,040.50" "$1,020.25" "$1,020.25" "$1,616.08" "$2,040.50" "$1,632.40" $918.23 $404.99 N/A "$1,183.49" "$2,040.50" "$2,040.50" "$2,040.50" $425.24 "$2,040.50" N/A N/A 04-503-228 SUP HCPCS C1713 04-503-228 - SCREW TI 8MM SLFDRILL BONE MTRXMDFACE PLT SYS BOTH IP/OP $164.50 $122.00 $32.60 $164.25 $73.91 $73.91 $73.91 $73.91 $164.25 $164.25 $164.25 $34.23 $164.25 $164.25 $164.25 $164.25 $164.25 $34.23 $164.25 $164.25 $97.15 $164.25 $164.25 $164.25 $164.25 $123.38 $164.25 $164.25 $164.25 $82.13 $82.13 $130.09 $164.25 $131.40 $73.91 $32.60 N/A $95.41 $164.25 $164.25 $164.25 $34.23 $164.25 N/A N/A 046-237 SUP Custom 27803010 046-237 - WIRE SUTURE 6 CCS-1 14IN 2 MONOFILAMENT MYO/WIRE II BOTH IP/OP "$1,980.00" "$1,465.00" $352.44 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $352.44 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 "$1,980.00" N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" "$1,980.00" "$1,980.00" N/A N/A 050-508-000 SUP Custom 27203010 050-508-000 - GLOVE SRG 8.5 301X109MM STRW STRL LTX BGL PF BEAD CUF MIC BOTH IP/OP $20.00 $15.00 $3.54 $19.90 $19.90 $19.90 $19.90 $19.90 $19.90 $19.90 $3.54 $19.90 $19.90 $14.77 $14.77 $15.34 $10.37 $4.15 $19.90 $7.96 $19.90 $19.90 $19.90 $19.90 $19.90 $15.00 $19.90 $19.90 $19.90 $9.95 $9.95 $15.76 $19.90 $15.92 $12.94 $19.90 N/A $11.60 $19.90 $11.94 $19.90 $19.90 $19.90 N/A N/A 050-526-000 SUP Custom 27011340 050-526-000 - CONNECTOR PERFUSION 3/8INX3/8INX3/8IN 3/8INX3/8INX3/8IN Y BOTH IP/OP $1.00 $1.00 $0.09 $0.75 $0.53 $0.53 $0.53 $0.53 $0.53 $0.53 $0.09 $0.53 $0.53 $0.39 $0.39 $0.41 $0.28 $0.11 $0.53 $0.21 $0.53 $0.53 $0.53 $0.53 $0.53 $0.75 $0.53 $0.53 $0.53 $0.27 $0.27 $0.42 $0.53 $0.42 $0.34 $0.53 N/A $0.58 $0.53 $0.32 $0.53 $0.53 $0.53 N/A N/A 0523-48 SUP Custom 27203010 ADHESIVE LQ VL AMPULE MSTSL STRL 2/3ML SKN BOTH IP/OP $3.50 $3.00 $0.58 $3.25 $3.25 $3.25 $3.25 $3.25 $3.25 $3.25 $0.58 $3.25 $3.25 $2.41 $2.41 $2.51 $1.69 $0.68 $3.25 $1.30 $3.25 $3.25 $3.25 $3.25 $3.25 $2.63 $3.25 $3.25 $3.25 $1.63 $1.63 $2.57 $3.25 $2.60 $2.11 $3.25 N/A $2.03 $3.25 $1.95 $3.25 $3.25 $3.25 N/A N/A 0570-0375 SUP Custom 27203010 0570-0375 - BRONCHOSCOPE GLIDESCOPE SINGLE USE STERILE BOTH IP/OP $369.00 $273.00 $65.64 $368.75 $368.75 $368.75 $368.75 $368.75 $368.75 $368.75 $65.64 $368.75 $368.75 $273.69 $273.69 $284.23 $192.12 $76.85 $368.75 $132.75 $368.75 $368.75 $368.75 $368.75 $368.75 $276.75 $368.75 $368.75 $368.75 $184.38 $184.38 $292.05 $368.75 $295.00 $239.69 $368.75 N/A $214.02 $368.75 $221.25 $368.75 $368.75 $368.75 N/A N/A 0580-0-200 SUP HCPCS C1776 0580-0-200 - STEM FEMORAL 3 LONG 200MM OFFST EXETER BOTH IP/OP "$6,271.00" "$4,641.00" "$1,244.64" "$6,271.00" "$2,821.95" "$2,821.95" "$2,821.95" "$2,821.95" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$1,306.95" "$6,271.00" "$6,271.00" "$3,091.60" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$4,703.25" "$6,271.00" "$6,271.00" "$6,271.00" "$3,135.50" "$3,135.50" "$4,966.63" "$6,271.00" "$5,016.80" "$2,821.95" "$1,244.64" N/A "$3,637.18" "$6,271.00" "$3,762.60" "$6,271.00" "$1,306.88" "$6,271.00" N/A N/A 0580-0-220 SUP HCPCS C1776 0580-0-220 - STEM FEMORAL 3 OFFST LONG 220MM EXETER HIP BOTH IP/OP "$6,271.00" "$4,641.00" "$1,244.64" "$6,271.00" "$2,821.95" "$2,821.95" "$2,821.95" "$2,821.95" "$6,271.00" "$6,271.00" "$6,271.00" "$1,307.03" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$1,306.95" "$6,271.00" "$2,508.40" "$3,091.60" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$4,703.25" "$6,271.00" "$6,271.00" "$6,271.00" "$3,135.50" "$3,135.50" "$4,966.63" "$6,271.00" "$5,016.80" "$2,821.95" "$1,244.64" N/A "$3,637.18" "$6,271.00" "$6,271.00" "$6,271.00" "$1,306.88" "$6,271.00" N/A N/A 0580-0-240 SUP HCPCS C1776 0580-0-240 - STEM FEMORAL 3 LONG 240MM EXETER ORTHINOX HIP BOTH IP/OP "$6,271.00" "$4,641.00" "$1,244.64" "$6,271.00" "$2,821.95" "$2,821.95" "$2,821.95" "$2,821.95" "$6,271.00" "$6,271.00" "$6,271.00" "$1,307.03" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$1,306.95" "$6,271.00" "$6,271.00" "$3,091.60" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$4,703.25" "$6,271.00" "$6,271.00" "$6,271.00" "$3,135.50" "$3,135.50" "$4,966.63" "$6,271.00" "$5,016.80" "$2,821.95" "$1,244.64" N/A "$3,637.18" "$6,271.00" "$6,271.00" "$6,271.00" "$1,306.88" "$6,271.00" N/A N/A 0580-0-260 SUP HCPCS C1776 0580-0-260 - STEM FEMORAL 3 LONG 260MM EXETER ORTHINOX HIP BOTH IP/OP "$6,271.00" "$4,641.00" "$1,244.64" "$6,271.00" "$2,821.95" "$2,821.95" "$2,821.95" "$2,821.95" "$6,271.00" "$6,271.00" "$6,271.00" "$1,307.03" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$1,306.95" "$6,271.00" "$6,271.00" "$3,091.60" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$4,703.25" "$6,271.00" "$6,271.00" "$6,271.00" "$3,135.50" "$3,135.50" "$4,966.63" "$6,271.00" "$5,016.80" "$2,821.95" "$1,244.64" N/A "$3,637.18" "$6,271.00" "$6,271.00" "$6,271.00" "$1,306.88" "$6,271.00" N/A N/A 0580-0-330 SUP HCPCS C1776 0580-0-330 - STEM FEMORAL 2 120MM EXETER ORTHINOX HIP ANTERIOR POSTERIOR BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" $888.72 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$4,264.00" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$2,558.40" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-351 SUP HCPCS C1776 0580-0-351 - STEM FEMORAL 1 35.5MM OFFST SMALL EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" $888.72 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$4,264.00" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$2,558.40" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-352 SUP HCPCS C1776 0580-0-352 - STEM FEMORAL 0 37.5MM OFFST LARGE EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" $888.72 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$1,705.60" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$4,264.00" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-371 SUP HCPCS C1776 0580-0-371 - STEM FEMORAL 1 37.5MM OFFST EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" $888.72 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$4,264.00" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$4,264.00" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-372 SUP HCPCS C1776 0580-0-372 - STEM FEMORAL 2 37.5MM OFFST EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" $888.72 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$4,264.00" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$2,558.40" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-373 SUP HCPCS C1776 0580-0-373 - STEM FEMORAL 3 37.5MM OFFST EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" $888.72 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$4,264.00" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$2,558.40" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-374 SUP HCPCS C1776 0580-0-374 - STEM FEMORAL 4 37.5MM OFFST EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" $888.72 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$4,264.00" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$2,558.40" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-441 SUP HCPCS C1776 0580-0-441 - STEM FEMORAL 1 44MM OFFST EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" $888.72 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$4,264.00" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$4,264.00" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-442 SUP HCPCS C1776 0580-0-442 - STEM FEMORAL 2 44MM OFFST EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" $888.72 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$4,264.00" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$2,558.40" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-443 SUP HCPCS C1776 0580-0-443 - STEM FEMORAL 3 44MM OFFST EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" $888.72 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$4,264.00" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$2,558.40" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-444 SUP HCPCS C1776 0580-0-444 - STEM FEMORAL 4 44MM OFFST EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" $888.72 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$4,264.00" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$2,558.40" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-445 SUP HCPCS C1776 0580-0-445 - STEM FEMORAL 5 44MM OFFST EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$4,264.00" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$4,264.00" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-446 SUP HCPCS C1776 0580-0-446 - STEM FEMORAL 6 44MM OFFST EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$1,705.60" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$2,558.40" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-503 SUP HCPCS C1776 0580-0-503 - STEM FEMORAL 3 50MM OFFST EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" $888.72 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$4,264.00" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$2,558.40" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-504 SUP HCPCS C1776 0580-0-504 - STEM FEMORAL 4 50MM OFFST EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" $888.72 "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$1,705.60" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$2,558.40" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-505 SUP HCPCS C1776 0580-0-505 - STEM FEMORAL 5 50MM OFFST EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$4,264.00" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$4,264.00" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-0-506 SUP HCPCS C1776 0580-0-506 - STEM FEMORAL 6 50MM OFFST EXETER ORTHINOX HIP BOTH IP/OP "$4,264.00" "$3,155.00" $846.30 "$4,264.00" "$1,918.80" "$1,918.80" "$1,918.80" "$1,918.80" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" $888.66 "$4,264.00" "$4,264.00" "$2,102.15" "$4,264.00" "$4,264.00" "$4,264.00" "$4,264.00" "$3,198.00" "$4,264.00" "$4,264.00" "$4,264.00" "$2,132.00" "$2,132.00" "$3,377.09" "$4,264.00" "$3,411.20" "$1,918.80" $846.30 N/A "$2,473.12" "$4,264.00" "$4,264.00" "$4,264.00" $888.62 "$4,264.00" N/A N/A 0580-1-044 SUP HCPCS C1776 0580-1-044 - STEM FEMORAL 0 44MM OFFST LONG CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-200 SUP HCPCS C1776 0580-1-200 - STEM FEMORAL 3 44MM OFFST LONG 200MM CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-220 SUP HCPCS C1776 0580-1-220 - STEM FEMORAL 3 44MM OFFST LONG 220MM CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-240 SUP HCPCS C1776 0580-1-240 - STEM FEMORAL 3 44MM OFFST LONG 240MM CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-260 SUP HCPCS C1776 0580-1-260 - STEM FEMORAL 3 44MM OFFST LONG 260MM CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-300 SUP HCPCS C1776 0580-1-300 - STEM FEMORAL 30MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-330 SUP HCPCS C1776 0580-1-330 - STEM FEMORAL 33MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-351 SUP HCPCS C1776 0580-1-351 - STEM FEMORAL 35.5MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-352 SUP HCPCS C1776 0580-1-352 - STEM FEMORAL 0 35.5MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-371 SUP HCPCS C1776 0580-1-371 - STEM FEMORAL 1 37.5MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-372 SUP HCPCS C1776 0580-1-372 - STEM FEMORAL 2 37.5MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-373 SUP HCPCS C1776 0580-1-373 - STEM FEMORAL 3 37.5MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-374 SUP HCPCS C1776 0580-1-374 - STEM FEMORAL 4 37.5MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-440 SUP HCPCS C1776 0580-1-440 - STEM FEMORAL 0 44MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-441 SUP HCPCS C1776 0580-1-441 - STEM FEMORAL 1 44MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-442 SUP HCPCS C1776 0580-1-442 - STEM FEMORAL 2 44MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-443 SUP HCPCS C1776 0580-1-443 - STEM FEMORAL 3 44MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-444 SUP HCPCS C1776 0580-1-444 - STEM FEMORAL 4 44MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-445 SUP HCPCS C1776 0580-1-445 - STEM FEMORAL 5 45MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-446 SUP HCPCS C1776 0580-1-446 - STEM FEMORAL 6 45MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-501 SUP HCPCS C1776 0580-1-501 - STEM FEMORAL 1 50MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-502 SUP HCPCS C1776 0580-1-502 - STEM FEMORAL 2 50MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-503 SUP HCPCS C1776 0580-1-503 - STEM FEMORAL 3 50MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-504 SUP HCPCS C1776 0580-1-504 - STEM FEMORAL 4 50MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-1-505 SUP HCPCS C1776 0580-1-505 - STEM FEMORAL 5 50MM OFFST CEMENTED EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-2-442 SUP HCPCS C1776 0580-2-442 - STEM FEMORAL 2 44MM TAPER LONG 44MM 205MM EXETER V40 HIP BOTH IP/OP "$6,271.00" "$4,641.00" "$1,244.64" "$6,271.00" "$2,821.95" "$2,821.95" "$2,821.95" "$2,821.95" "$6,271.00" "$6,271.00" "$6,271.00" "$1,307.03" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$1,306.95" "$6,271.00" "$6,271.00" "$3,091.60" "$6,271.00" "$6,271.00" "$6,271.00" "$6,271.00" "$4,703.25" "$6,271.00" "$6,271.00" "$6,271.00" "$3,135.50" "$3,135.50" "$4,966.63" "$6,271.00" "$5,016.80" "$2,821.95" "$1,244.64" N/A "$3,637.18" "$6,271.00" "$3,762.60" "$6,271.00" "$1,306.88" "$6,271.00" N/A N/A 0580-3-371 SUP HCPCS C1776 0580-3-371 - STEM FEM 1 37.5MM OFST 125MM STRL EXTR V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-3-422 SUP HCPCS C1776 0580-3-422 - STEM FEMORAL 2 44MM TAPER 44MM 205MM EXETER V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-3-441 SUP HCPCS C1776 0580-3-441 - STEM FEM 1 44MM OFST 125MM STRL EXTR V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-3-501 SUP HCPCS C1776 0580-3-501 - STEM FEM 1 50MM OFST 125MM STRL EXTR V40 HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 0580-9-300 SUP Custom 27803010 0580-9-300 - STEM SURG 30MM AP1 TECHNIQUE OFFST RASP EXETER ORTHINOX BOTH IP/OP $721.00 $534.00 $128.34 $721.00 $721.00 $721.00 $721.00 $721.00 $721.00 $721.00 $128.34 $721.00 $721.00 $721.00 $721.00 $721.00 $721.00 $150.26 $721.00 $288.40 $721.00 $721.00 $721.00 $721.00 $721.00 $540.75 $721.00 $721.00 $721.00 $360.50 $360.50 $571.03 $721.00 $576.80 $324.45 $721.00 N/A $418.18 $721.00 $432.60 $721.00 $721.00 $721.00 N/A N/A 0586-0-022 SUP Custom 27803010 0586-0-022 - HEAD FEMORAL +0MM 22MM CEMENTED EXETER ORTHINOX HIP BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $519.75 "$1,155.00" N/A $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 0586-0-026 SUP Custom 27803010 0586-0-026 - HEAD FEMORAL +0MM 26MM CEMENTED EXETER ORTHINOX HIP BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $519.75 "$1,155.00" N/A $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 0586-0-028 SUP Custom 27803010 0586-0-028 - HEAD FEMORAL +0MM 28MM CEMENTED EXETER ORTHINOX HIP BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $519.75 "$1,155.00" N/A $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 0586-0-032 SUP Custom 27803010 0586-0-032 - HEAD FEMORAL +0MM 32MM CEMENTED EXETER ORTHINOX HIP BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $519.75 "$1,155.00" N/A $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 0586-0-326 SUP Custom 27803010 0586-0-326 - HEAD FEMORAL -3MM 26MM CEMENTED EXETER ORTHINOX HIP BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $519.75 "$1,155.00" N/A $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 0586-0-328 SUP Custom 27803010 0586-0-328 - HEAD FEMORAL -3MM 28MM NECK EXETER ORTHINOX HIP BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $519.75 "$1,155.00" N/A $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 0586-0-332 SUP Custom 27803010 0586-0-332 - HEAD FEMORAL -3MM 32MM NECK EXETER ORTHINOX HIP BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $519.75 "$1,155.00" N/A $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 0586-5-026 SUP Custom 27803010 0586-5-026 - HEAD FEMORAL +5MM 26MM NECK EXETER ORTHINOX HIP BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $519.75 "$1,155.00" N/A $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 0586-5-028 SUP Custom 27803010 0586-5-028 - HEAD FEMORAL +5MM 28MM NECK EXETER ORTHINOX HIP BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $519.75 "$1,155.00" N/A $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 0586-5-032 SUP Custom 27803010 0586-5-032 - HEAD FEMORAL 5MM 35MM NECK EXETER ORTHINOX HIP BOTH IP/OP "$1,155.00" $855.00 $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $205.59 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $240.71 "$1,155.00" $462.00 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $519.75 "$1,155.00" N/A $669.90 "$1,155.00" $693.00 "$1,155.00" "$1,155.00" "$1,155.00" N/A N/A 0650HYB0605A SUP HCPCS C1768 0650HYB0605A - GRAFT VASCULAR 6MM 6MM 50CM 5CM HYBRID REINFORCED COATED BOTH IP/OP "$6,125.00" "$4,533.00" "$1,215.66" "$6,125.00" "$2,756.25" "$2,756.25" "$2,756.25" "$2,756.25" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.60" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.52" "$6,125.00" "$6,125.00" "$3,019.63" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$4,593.75" "$6,125.00" "$6,125.00" "$6,125.00" "$3,062.50" "$3,062.50" "$4,851.00" "$6,125.00" "$4,900.00" "$2,756.25" "$1,215.66" N/A "$3,552.50" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.45" "$6,125.00" N/A N/A 0650HYB0610A SUP HCPCS C1768 0650HYB0610A - GRAFT VASCULAR 6MM 6MM 50CM 10CM HYBRID REINFORCED COATED BOTH IP/OP "$7,125.00" "$5,273.00" "$1,414.13" "$7,125.00" "$3,206.25" "$3,206.25" "$3,206.25" "$3,206.25" "$7,125.00" "$7,125.00" "$7,125.00" "$1,485.03" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$1,484.93" "$7,125.00" "$7,125.00" "$3,512.63" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$5,343.75" "$7,125.00" "$7,125.00" "$7,125.00" "$3,562.50" "$3,562.50" "$5,643.00" "$7,125.00" "$5,700.00" "$3,206.25" "$1,414.13" N/A "$4,132.50" "$7,125.00" "$7,125.00" "$7,125.00" "$1,484.85" "$7,125.00" N/A N/A 0650HYB0705A SUP HCPCS C1768 0650HYB0705A - GRAFT VASCULAR 6MM 7MM 50CM 5CM HYBRID REINFORCED COATED BOTH IP/OP "$6,125.00" "$4,533.00" "$1,215.66" "$6,125.00" "$2,756.25" "$2,756.25" "$2,756.25" "$2,756.25" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.60" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.52" "$6,125.00" "$6,125.00" "$3,019.63" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$4,593.75" "$6,125.00" "$6,125.00" "$6,125.00" "$3,062.50" "$3,062.50" "$4,851.00" "$6,125.00" "$4,900.00" "$2,756.25" "$1,215.66" N/A "$3,552.50" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.45" "$6,125.00" N/A N/A 0650HYB0805A SUP HCPCS C1768 0650HYB0805A - GRAFT VASCULAR 6MM 8MM 50CM 5CM HYBRID REINFORCED COATED BOTH IP/OP "$6,125.00" "$4,533.00" "$1,215.66" "$6,125.00" "$2,756.25" "$2,756.25" "$2,756.25" "$2,756.25" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.60" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.52" "$6,125.00" "$6,125.00" "$3,019.63" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$4,593.75" "$6,125.00" "$6,125.00" "$6,125.00" "$3,062.50" "$3,062.50" "$4,851.00" "$6,125.00" "$4,900.00" "$2,756.25" "$1,215.66" N/A "$3,552.50" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.45" "$6,125.00" N/A N/A 0684-00-0568-01 SUP Custom 27803010 0684-00-0568-01 - CATHETER IAB 7.5FR 6IN 40ML SNS + 2 STLK DEV FO INS KT INTRO BOTH IP/OP "$2,725.00" "$2,017.00" $485.05 "$2,725.00" "$2,725.00" "$2,725.00" "$2,725.00" "$2,725.00" "$2,725.00" "$2,725.00" $485.05 "$2,725.00" "$2,725.00" "$2,725.00" "$2,725.00" "$2,725.00" "$2,725.00" $567.92 "$2,725.00" "$1,090.00" "$2,725.00" "$2,725.00" "$2,725.00" "$2,725.00" "$2,725.00" "$2,043.75" "$2,725.00" "$2,725.00" "$2,725.00" "$1,362.50" "$1,362.50" "$2,158.20" "$2,725.00" "$2,180.00" "$1,226.25" "$2,725.00" N/A "$1,580.50" "$2,725.00" "$1,635.00" "$2,725.00" "$2,725.00" "$2,725.00" N/A N/A 0684-00-0576-01 SUP Custom 27803010 0684-00-0576-01 - CATHETER IAB .025IN 8FR 17.4MM .027IN 6IN 50CC 258MM SNS + BOTH IP/OP "$2,614.00" "$1,934.00" $465.23 "$2,613.63" "$2,613.63" "$2,613.63" "$2,613.63" "$2,613.63" "$2,613.63" "$2,613.63" $465.23 "$2,613.63" "$2,613.63" "$2,613.63" "$2,613.63" "$2,613.63" "$2,613.63" $544.71 "$2,613.63" "$1,045.45" "$2,613.63" "$2,613.63" "$2,613.63" "$2,613.63" "$2,613.63" "$1,960.50" "$2,613.63" "$2,613.63" "$2,613.63" "$1,306.82" "$1,306.82" "$2,069.99" "$2,613.63" "$2,090.90" "$1,176.13" "$2,613.63" N/A "$1,516.12" "$2,613.63" "$1,568.18" "$2,613.63" "$2,613.63" "$2,613.63" N/A N/A 07.704.010S SUP HCPCS C1713 07.704.010S - FILLER BONE VOID DRILLABLE INJECT REINFORCED BIORESORBABLE BOTH IP/OP "$7,229.00" "$5,349.00" "$1,434.72" "$7,351.60" "$3,252.92" "$3,252.92" "$3,252.92" "$3,252.92" "$7,228.70" "$7,228.70" "$7,228.70" "$1,506.64" "$7,228.70" "$7,228.70" "$7,228.70" "$7,228.70" "$7,228.70" "$1,506.54" "$7,228.70" "$2,940.64" "$3,563.75" "$7,228.70" "$7,351.60" "$7,228.70" "$7,228.70" "$5,421.75" "$7,228.70" "$7,228.70" "$7,228.70" "$3,614.35" "$3,614.35" "$5,725.13" "$7,228.70" "$5,782.96" "$3,252.92" "$1,434.72" N/A "$4,192.82" "$7,228.70" "$7,228.70" "$7,228.70" "$1,506.46" "$7,228.70" N/A N/A 07.704.105S SUP HCPCS C1713 07.704.105S - FILLER BONE VOID DRILLABLE FAST SET PUTTY NORIAN 5ML STERILE BOTH IP/OP "$3,678.00" "$2,722.00" $729.99 "$3,740.53" "$1,655.10" "$1,655.10" "$1,655.10" "$1,655.10" "$3,678.00" "$3,678.00" "$3,678.00" $766.59 "$3,678.00" "$3,678.00" "$3,678.00" "$3,678.00" "$3,678.00" $766.54 "$3,678.00" "$1,496.21" "$1,813.25" "$3,678.00" "$3,740.53" "$3,678.00" "$3,678.00" "$2,758.50" "$3,678.00" "$3,678.00" "$3,678.00" "$1,839.00" "$1,839.00" "$2,912.98" "$3,678.00" "$2,942.40" "$1,655.10" $729.99 N/A "$2,133.24" "$3,678.00" "$2,206.80" "$3,678.00" $766.50 "$3,678.00" N/A N/A 07.704.110S SUP HCPCS C1713 07.704.110S - FILLER BONE VOID DRILLABLE FAST SET PUTTY NORIAN 10ML BOTH IP/OP "$7,229.00" "$5,349.00" "$1,434.72" "$7,351.60" "$3,252.92" "$3,252.92" "$3,252.92" "$3,252.92" "$7,228.70" "$7,228.70" "$7,228.70" "$1,506.64" "$7,228.70" "$7,228.70" "$7,228.70" "$7,228.70" "$7,228.70" "$1,506.54" "$7,228.70" "$2,940.64" "$3,563.75" "$7,228.70" "$7,351.60" "$7,228.70" "$7,228.70" "$5,421.75" "$7,228.70" "$7,228.70" "$7,228.70" "$3,614.35" "$3,614.35" "$5,725.13" "$7,228.70" "$5,782.96" "$3,252.92" "$1,434.72" N/A "$4,192.82" "$7,228.70" "$4,337.22" "$7,228.70" "$1,506.46" "$7,228.70" N/A N/A 07.704-003S SUP HCPCS C1713 07.704-003S - FILLER BONE VOID DRILLABLE INJECT REINFORCED BIORESORBABLE BOTH IP/OP "$2,019.00" "$1,494.00" $400.64 "$2,018.60" $908.37 $908.37 $908.37 $908.37 "$2,018.60" "$2,018.60" "$2,018.60" $420.73 "$2,018.60" "$2,018.60" "$2,018.60" "$2,018.60" "$2,018.60" $420.70 "$2,018.60" "$2,018.60" "$1,194.00" "$2,018.60" "$2,018.60" "$2,018.60" "$2,018.60" "$1,514.25" "$2,018.60" "$2,018.60" "$2,018.60" "$1,009.30" "$1,009.30" "$1,598.73" "$2,018.60" "$1,614.88" $908.37 $400.64 N/A "$1,171.02" "$2,018.60" "$2,018.60" "$2,018.60" $420.68 "$2,018.60" N/A N/A 07.704-005S SUP HCPCS C1713 07.704-005S - FILLER BONE VOID DRILLABLE INJECT REINFORCED BIORESORBABLE BOTH IP/OP "$3,678.00" "$2,722.00" $729.99 "$3,740.53" "$1,655.10" "$1,655.10" "$1,655.10" "$1,655.10" "$3,678.00" "$3,678.00" "$3,678.00" $766.59 "$3,678.00" "$3,678.00" "$3,678.00" "$3,678.00" "$3,678.00" $766.54 "$3,678.00" "$3,740.53" "$1,813.25" "$3,678.00" "$3,740.53" "$3,678.00" "$3,678.00" "$2,758.50" "$3,678.00" "$3,678.00" "$3,678.00" "$1,839.00" "$1,839.00" "$2,912.98" "$3,678.00" "$2,942.40" "$1,655.10" $729.99 N/A "$2,133.24" "$3,678.00" "$3,678.00" "$3,678.00" $766.50 "$3,678.00" N/A N/A 0703-046-000 SUP Custom 27203010 "0703-046-000 - CTRY,PENCIL,PUSH BUTTON,SMOKE EVAC,70MM" BOTH IP/OP $76.00 $56.00 $13.47 $75.70 $75.70 $75.70 $75.70 $75.70 $75.70 $75.70 $13.47 $75.70 $75.70 $56.18 $56.18 $58.35 $39.44 $15.78 $75.70 $30.28 $75.70 $75.70 $75.70 $75.70 $75.70 $57.00 $75.70 $75.70 $75.70 $37.85 $37.85 $59.95 $75.70 $60.56 $49.21 $75.70 N/A $44.08 $75.70 $45.42 $75.70 $75.70 $75.70 N/A N/A 07-036P SUP HCPCS C1713 07-036P - 7 MM WASHER BOTH IP/OP $28.50 $21.00 $5.66 $28.50 $12.83 $12.83 $12.83 $12.83 $28.50 $28.50 $28.50 $5.94 $28.50 $28.50 $28.50 $28.50 $28.50 $5.94 $28.50 $11.40 $16.86 $28.50 $28.50 $28.50 $28.50 $21.38 $28.50 $28.50 $28.50 $14.25 $14.25 $22.57 $28.50 $22.80 $12.83 $5.66 N/A $16.53 $28.50 $28.50 $28.50 $5.94 $28.50 N/A N/A 07-150-10 SUP Custom 27203010 07-150-10 - PROBE DOPPLER 20MHZ 280MM BAYONETED STERILE BOTH IP/OP "$2,625.00" "$1,943.00" $467.25 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $467.25 "$2,625.00" "$2,625.00" "$1,948.28" "$1,948.28" "$2,023.35" "$1,367.63" $547.08 "$2,625.00" "$1,050.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,706.25" "$2,625.00" N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" "$2,625.00" "$2,625.00" N/A N/A 07-150-12 SUP Custom 27203010 07-150-12 - PROBE DOPPLER MINI NEURO DISPOSABLE BOTH IP/OP "$4,015.00" "$2,971.00" $714.67 "$4,015.00" "$4,015.00" "$4,015.00" "$4,015.00" "$4,015.00" "$4,015.00" "$4,015.00" $714.67 "$4,015.00" "$4,015.00" "$2,979.93" "$2,979.93" "$3,094.76" "$2,060.15" $836.77 "$4,015.00" "$1,606.00" "$4,015.00" "$4,015.00" "$4,015.00" "$4,015.00" "$4,015.00" "$3,011.25" "$4,015.00" "$4,015.00" "$4,015.00" "$2,007.50" "$2,007.50" "$3,179.88" "$4,015.00" "$3,212.00" "$2,609.75" "$4,015.00" N/A "$2,328.70" "$4,015.00" "$2,409.00" "$4,015.00" "$4,015.00" "$4,015.00" N/A N/A 07-40230 SUP Custom 27803010 07-40230 - DRILL DRL 2.4MM CNN D STP BOTH IP/OP $463.50 $343.00 $82.46 $463.25 $463.25 $463.25 $463.25 $463.25 $463.25 $463.25 $82.46 $463.25 $463.25 $463.25 $463.25 $463.25 $463.25 $96.55 $463.25 $185.30 $463.25 $463.25 $463.25 $463.25 $463.25 $347.63 $463.25 $463.25 $463.25 $231.63 $231.63 $366.89 $463.25 $370.60 $208.46 $463.25 N/A $268.83 $463.25 $277.95 $463.25 $463.25 $463.25 N/A N/A 07-40232 SUP Custom 27803010 07-40232 - TAP SURG CANN DEPTH STOP BOTH IP/OP $417.00 $309.00 $74.23 $417.00 $417.00 $417.00 $417.00 $417.00 $417.00 $417.00 $74.23 $417.00 $417.00 $417.00 $417.00 $417.00 $417.00 $86.91 $417.00 $166.80 $417.00 $417.00 $417.00 $417.00 $417.00 $312.75 $417.00 $417.00 $417.00 $208.50 $208.50 $330.26 $417.00 $333.60 $187.65 $417.00 N/A $241.86 $417.00 $250.20 $417.00 $417.00 $417.00 N/A N/A 07-40280 SUP HCPCS C1713 07-40280 - WIRE FIX 1MM 160MM KWIRE STAINLESS STEEL NONSTRL BOTH IP/OP $44.50 $33.00 $8.78 $44.25 $19.91 $19.91 $19.91 $19.91 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $44.25 $44.25 $44.25 $9.22 $44.25 $44.25 $26.17 $44.25 $44.25 $44.25 $44.25 $33.38 $44.25 $44.25 $44.25 $22.13 $22.13 $35.05 $44.25 $35.40 $19.91 $8.78 N/A $25.81 $44.25 $44.25 $44.25 $9.22 $44.25 N/A N/A 07-40281 SUP HCPCS C1713 07-40281 - WIRE FX 1.1MM 160MM NS KRSH LGTH MRK SS BOTH IP/OP $37.50 $28.00 $7.42 $37.40 $16.83 $16.83 $16.83 $16.83 $37.40 $37.40 $37.40 $7.80 $37.40 $37.40 $37.40 $37.40 $37.40 $7.79 $37.40 $37.40 $22.12 $37.40 $37.40 $37.40 $37.40 $28.13 $37.40 $37.40 $37.40 $18.70 $18.70 $29.62 $37.40 $29.92 $16.83 $7.42 N/A $21.75 $37.40 $37.40 $37.40 $7.79 $37.40 N/A N/A 08.510.543S SUP HCPCS C1713 08.510.543S - PLATE BONE 24MMX1.5MM SYNPOR POLYETHYLENE POROUS ORBTL FLOOR BOTH IP/OP "$1,447.50" "$1,071.00" $287.29 "$1,447.50" $651.38 $651.38 $651.38 $651.38 "$1,447.50" "$1,447.50" "$1,447.50" $301.70 "$1,447.50" "$1,447.50" "$1,447.50" "$1,447.50" "$1,447.50" $301.67 "$1,447.50" $579.00 $856.20 "$1,447.50" "$1,447.50" "$1,447.50" "$1,447.50" "$1,085.63" "$1,447.50" "$1,447.50" "$1,447.50" $723.75 $723.75 "$1,146.42" "$1,447.50" "$1,158.00" $651.38 $287.29 N/A $839.55 "$1,447.50" $868.50 "$1,447.50" $301.66 "$1,447.50" N/A N/A 08.520.221S SUP HCPCS C1713 08.520.221S - PLATE BN FAN .8MM STRL SYNPOR SMTH EXPOSE FX HL RADGR VSB TI BOTH IP/OP "$4,292.50" "$3,176.00" $851.95 "$4,292.50" "$1,931.63" "$1,931.63" "$1,931.63" "$1,931.63" "$4,292.50" "$4,292.50" "$4,292.50" $894.66 "$4,292.50" "$4,292.50" "$4,292.50" "$4,292.50" "$4,292.50" $894.60 "$4,292.50" "$1,717.00" "$2,116.20" "$4,292.50" "$4,292.50" "$4,292.50" "$4,292.50" "$3,219.38" "$4,292.50" "$4,292.50" "$4,292.50" "$2,146.25" "$2,146.25" "$3,399.66" "$4,292.50" "$3,434.00" "$1,931.63" $851.95 N/A "$2,489.65" "$4,292.50" "$2,575.50" "$4,292.50" $894.56 "$4,292.50" N/A N/A 08.803.209 SUP HCPCS C1713 08.803.209 - SPACER SPNL BLT NOSE 32X10X9MM NS OPAL REVOLVE RADOPQ SLF BOTH IP/OP "$13,782.50" "$10,199.00" "$2,735.48" "$13,782.50" "$6,202.13" "$6,202.13" "$6,202.13" "$6,202.13" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.62" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$2,872.42" "$13,782.50" "$13,782.50" "$6,794.77" "$13,782.50" "$13,782.50" "$13,782.50" "$13,782.50" "$10,336.88" "$13,782.50" "$13,782.50" "$13,782.50" "$6,891.25" "$6,891.25" "$10,915.74" "$13,782.50" "$11,026.00" "$6,202.13" "$2,735.48" N/A "$7,993.85" "$13,782.50" "$8,269.50" "$13,782.50" "$13,782.50" "$13,782.50" N/A N/A 08A020 SUP HCPCS C9359 08A020 - GRAFT BN 4-10MM 30ML FRZDR CANC BOTH IP/OP "$1,165.00" $862.00 $231.22 "$1,260.00" $524.25 $524.25 $524.25 $524.25 "$1,165.00" "$1,165.00" "$1,165.00" $242.82 "$1,165.00" "$1,165.00" "$1,165.00" "$1,165.00" "$1,165.00" $242.80 "$1,165.00" "$1,260.00" $689.10 "$1,165.00" "$1,260.00" "$1,165.00" "$1,165.00" $873.75 "$1,165.00" "$1,165.00" "$1,165.00" $582.50 $582.50 $922.68 "$1,165.00" $932.00 $524.25 $231.22 N/A $675.70 "$1,165.00" "$1,165.00" "$1,165.00" $242.79 "$1,165.00" N/A N/A 08A022 SUP Custom 27803010 08A022 - GRAFT BN 15ML CHP CANC BOTH IP/OP $740.00 $548.00 $131.72 $785.00 $740.00 $740.00 $740.00 $740.00 $740.00 $740.00 $131.72 $740.00 $740.00 $740.00 $740.00 $740.00 $740.00 $154.22 $740.00 $314.00 $740.00 $740.00 $785.00 $740.00 $740.00 $555.00 $740.00 $740.00 $740.00 $370.00 $370.00 $586.08 $740.00 $592.00 $333.00 $740.00 N/A $429.20 $740.00 $444.00 $740.00 $740.00 $740.00 N/A N/A 08A024 SUP Custom 27804086 08A024 - GRAFT BN 4-10MM 5ML CHP CANC TBA 013470059 09 BOTH IP/OP $462.50 $342.00 $82.33 $490.00 $462.50 $462.50 $462.50 $462.50 $462.50 $462.50 $82.33 $462.50 $462.50 $462.50 $462.50 $462.50 $462.50 $96.39 $462.50 $196.00 $462.50 $462.50 $490.00 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $208.13 $462.50 N/A $268.25 $462.50 $277.50 $462.50 $462.50 $462.50 N/A N/A 09.402.022S SUP HCPCS C1713 09.402.022S - HEAD RADIAL STANDARD 22MM 12MM COCR ELBOW STERILE BOTH IP/OP "$3,286.50" "$2,432.00" $652.25 "$3,286.33" "$1,478.85" "$1,478.85" "$1,478.85" "$1,478.85" "$3,286.33" "$3,286.33" "$3,286.33" $684.95 "$3,286.33" "$3,286.33" "$3,286.33" "$3,286.33" "$3,286.33" $684.91 "$3,286.33" "$1,314.53" "$1,620.16" "$3,286.33" "$3,286.33" "$3,286.33" "$3,286.33" "$2,464.88" "$3,286.33" "$3,286.33" "$3,286.33" "$1,643.17" "$1,643.17" "$2,602.77" "$3,286.33" "$2,629.06" "$1,478.85" $652.25 N/A "$1,906.17" "$3,286.33" "$3,286.33" "$3,286.33" $684.87 "$3,286.33" N/A N/A 0920-2-920 SUP Custom 27803010 0920-2-920 - CENTRALIZER STEM EXETER PMMA BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 0939-0-106 SUP HCPCS C1713 0939-0-106 - PLUG BONE CEMENT 6MM EXETER PMMA INTRAMEDULLARY BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 0939-0-108 SUP HCPCS C1713 0939-0-108 - PLUG BONE CEMENT 8MM EXETER PMMA INTRAMEDULLARY BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 0939-0-110 SUP HCPCS C1713 0939-0-110 - PLUG BONE CEMENT 10MM EXETER PMMA INTRAMEDULLARY BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 0939-0-112 SUP HCPCS C1713 0939-0-112 - PLUG BONE CEMENT 12MM EXETER PMMA INTRAMEDULLARY BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 0939-0-114 SUP HCPCS C1713 0939-0-114 - PLUG BONE CEMENT 14MM EXETER PMMA INTRAMEDULLARY BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 0939-0-116 SUP HCPCS C1713 0939-0-116 - PLUG BONE CEMENT 16MM EXETER PMMA INTRAMEDULLARY BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 0939-0-118 SUP HCPCS C1713 0939-0-118 - PLUG BONE CEMENT 18MM EXETER PMMA INTRAMEDULLARY BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 0939-0-120 SUP HCPCS C1713 0939-0-120 - PLUG BONE CEMENT 20MM EXETER PMMA INTRAMEDULLARY BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 0942-2-110 SUP HCPCS C1713 0942-2-110 - PLUG BONE CEMENT 10MM EXETER X-CHANGE BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $73.50 $122.50 $25.53 $122.50 N/A N/A 0942-2-112 SUP HCPCS C1713 0942-2-112 - PLUG BONE CEMENT 12MM EXETER X-CHANGE BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $73.50 $122.50 $25.53 $122.50 N/A N/A 0942-2-114 SUP HCPCS C1713 0942-2-114 - SPACER CEMENT 14MM 14MM BONE PLUGS ACCESSORIES EXETER BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $73.50 $122.50 $25.53 $122.50 N/A N/A 0942-2-116 SUP HCPCS C1713 0942-2-116 - PLUG BONE CEMENT 16MM EXETER X-CHANGE BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $73.50 $122.50 $25.53 $122.50 N/A N/A 0942-2-118 SUP HCPCS C1713 0942-2-118 - SPACER CEMENT 18MM BONE PLUGS ACCESSORIES EXETER X-CHANGE BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $73.50 $122.50 $25.53 $122.50 N/A N/A 0942-2-120 SUP HCPCS C1713 0942-2-120 - PLUG BONE CEMENT 20MM 20MM EXETER X-CHANGE HIP BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $73.50 $122.50 $25.53 $122.50 N/A N/A 0942-8-000 SUP HCPCS C1713 0942-8-000 - SCREW BONE 3.5MM 10MM SELF TAP SELF DRILL X-CHANGE HIP BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $73.50 $122.50 $25.53 $122.50 N/A N/A 0942-8-001 SUP HCPCS C1713 0942-8-001 - SCREW BONE 3.5MM 15MM SELF TAP SELF DRILL X-CHANGE HIP BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $73.50 $122.50 $25.53 $122.50 N/A N/A 0942-8-002 SUP HCPCS C1713 0942-8-002 - SCREW BONE 3.5MM 20MM SELF TAP SELF DRILL X-CHANGE HIP BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $122.50 $122.50 $25.53 $122.50 N/A N/A 0942-8-003 SUP HCPCS C1713 0942-8-003 - SCREW BONE 3.5MM 25MM SELF TAP SELF DRILL X-CHANGE HIP BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $73.50 $122.50 $25.53 $122.50 N/A N/A 0942-8-004 SUP HCPCS C1713 0942-8-004 - SCREW BONE 3.5MM 30MM SELF TAP SELF DRILL X-CHANGE HIP BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $73.50 $122.50 $25.53 $122.50 N/A N/A 0942-8-005 SUP HCPCS C1713 0942-8-005 - SCREW BONE 3.5MM 35MM SELF TAP SELF DRILL X-CHANGE HIP BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $122.50 $122.50 $25.53 $122.50 N/A N/A 0942-8-010 SUP HCPCS C1781 0942-8-010 - MESH ACETAB CURVE X-CHANGE RSTOR HIP BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 0942-8-020 SUP HCPCS C1781 0942-8-020 - MESH ACETAB LARGE X-CHANGE RSTOR HIP MEDIAL WALL BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 0942-8-025 SUP HCPCS C1781 0942-8-025 - MESH ACETAB SMALL X-CHANGE RSTOR HIP MEDIAL WALL BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 0942-8-030 SUP HCPCS C1781 0942-8-030 - MESH ACETAB FLAT X-CHANGE RSTOR HIP BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 0942-8-040 SUP HCPCS C1781 0942-8-040 - MESH ACETAB SMALL X-CHANGE RSTOR HIP RIM BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 0942-8-050 SUP HCPCS C1781 0942-8-050 - MESH ACETAB MEDIUM X-CHANGE RSTOR HIP RIM BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 0942-8-060 SUP HCPCS C1781 0942-8-060 - MESH ACETAB LARGE X-CHANGE RSTOR HIP RIM BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 0942-8-070 SUP HCPCS C1781 0942-8-070 - MESH ACETAB ANATOMIC X-CHANGE RSTOR HIP FEMURAL BOTH IP/OP "$1,285.00" $951.00 $255.04 "$1,285.00" $578.25 $578.25 $578.25 $578.25 "$1,285.00" "$1,285.00" "$1,285.00" $267.83 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $267.81 "$1,285.00" "$1,285.00" $760.08 "$1,285.00" "$1,285.00" "$1,285.00" "$1,285.00" $963.75 "$1,285.00" "$1,285.00" "$1,285.00" $642.50 $642.50 "$1,017.72" "$1,285.00" "$1,028.00" $578.25 $255.04 N/A $745.30 "$1,285.00" "$1,285.00" "$1,285.00" $267.79 "$1,285.00" N/A N/A 0994-001 SUP HCPCS C1887 0994-001 - CATHETER GD 6FR 140CM VNTR OTW RADOPQ STRBL ML LR COIL TRQ BOTH IP/OP "$1,625.00" "$1,203.00" $322.52 "$1,625.00" $882.38 $882.38 $882.38 $882.38 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" $322.52 N/A $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 1000-00-0614 SUP HCPCS C1713 1000-00-0614 - CAGE SPNL 7D LRDTC 14X12X6MM COHERE LOPRFL MATTE FNSH PEEK BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 1000-00-0616 SUP HCPCS C1713 1000-00-0616 - CAGE SPNL 7D LRDTC 16X14X6MM COHERE LOPRFL MATTE FNSH PEEK BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 1000-00-0714 SUP HCPCS C1713 1000-00-0714 - CAGE SPNL 7D LRDTC 14X12X7MM COHERE LOPRFL MATTE FNSH PEEK BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 1000-00-0716 SUP HCPCS C1713 1000-00-0716 - CAGE SPNL 7D LRDTC 16X14X7MM COHERE LOPRFL MATTE FNSH PEEK BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 1000-00-0814 SUP HCPCS C1713 1000-00-0814 - CAGE SPNL 7D LRDTC 14X12X8MM COHERE LOPRFL MATTE FNSH PEEK BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 1000-00-0816 SUP HCPCS C1713 1000-00-0816 - CAGE SPNL 7D LRDTC 16X14X8MM COHERE LOPRFL MATTE FNSH PEEK BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 1000-00-0914 SUP HCPCS C1713 1000-00-0914 - CAGE SPNL 7D LRDTC 14X12X9MM COHERE LOPRFL MATTE FNSH PEEK BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 1000-00-0916 SUP HCPCS C1713 1000-00-0916 - CAGE SPNL 7D LRDTC 16X14X9MM COHERE LOPRFL MATTE FNSH PEEK BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 1000-00-1014 SUP HCPCS C1713 1000-00-1014 - CAGE SPNL 7D LRDTC 14X12X10MM COHERE LOPRFL MATTE FNSH PEEK BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 1000-00-1016 SUP HCPCS C1713 1000-00-1016 - CAGE SPNL 7D LRDTC 16X14X10MM COHERE LOPRFL MATTE FNSH PEEK BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 100-06 SUP HCPCS C1713 100-06 - PLATE BONE STANDARD STR 6 HOLE UTILITY COMPRESSION TIMESH BOTH IP/OP $249.00 $184.00 $49.35 $248.63 $111.88 $111.88 $111.88 $111.88 $248.63 $248.63 $248.63 $51.82 $248.63 $248.63 $248.63 $248.63 $248.63 $51.82 $248.63 $99.45 $147.06 $248.63 $248.63 $248.63 $248.63 $186.75 $248.63 $248.63 $248.63 $124.32 $124.32 $196.91 $248.63 $198.90 $111.88 $49.35 N/A $144.42 $248.63 $248.63 $248.63 $51.81 $248.63 N/A N/A 1001-2200 SUP Custom 27803010 1001-2200 - HEAD FEMORAL +00MM MORSE TAPER 32MM OMNIFIT COCR HIP BOTH IP/OP "$1,297.50" $960.00 $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $270.41 "$1,297.50" $519.00 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $973.13 "$1,297.50" "$1,297.50" "$1,297.50" $648.75 $648.75 "$1,027.62" "$1,297.50" "$1,038.00" $583.88 "$1,297.50" N/A $752.55 "$1,297.50" $778.50 "$1,297.50" "$1,297.50" "$1,297.50" N/A N/A 1001-2205 SUP Custom 27803010 1001-2205 - HEAD FEMORAL +05MM MORSE TAPER 22MM OMNIFIT COCR HIP BOTH IP/OP "$1,297.50" $960.00 $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $270.41 "$1,297.50" $519.00 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $973.13 "$1,297.50" "$1,297.50" "$1,297.50" $648.75 $648.75 "$1,027.62" "$1,297.50" "$1,038.00" $583.88 "$1,297.50" N/A $752.55 "$1,297.50" $778.50 "$1,297.50" "$1,297.50" "$1,297.50" N/A N/A 1001-2600 SUP Custom 27803010 1001-2600 - HEAD FEMORAL +00MM MORSE TAPER 26MM OMNIFIT COCR HIP BOTH IP/OP "$1,297.50" $960.00 $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $270.41 "$1,297.50" $519.00 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $973.13 "$1,297.50" "$1,297.50" "$1,297.50" $648.75 $648.75 "$1,027.62" "$1,297.50" "$1,038.00" $583.88 "$1,297.50" N/A $752.55 "$1,297.50" $778.50 "$1,297.50" "$1,297.50" "$1,297.50" N/A N/A 1001-2605 SUP Custom 27803010 1001-2605 - HEAD FEMORAL +05MM MORSE TAPER 26MM OMNIFIT COCR HIP BOTH IP/OP "$1,297.50" $960.00 $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $270.41 "$1,297.50" $519.00 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $973.13 "$1,297.50" "$1,297.50" "$1,297.50" $648.75 $648.75 "$1,027.62" "$1,297.50" "$1,038.00" $583.88 "$1,297.50" N/A $752.55 "$1,297.50" $778.50 "$1,297.50" "$1,297.50" "$1,297.50" N/A N/A 1001-2610 SUP Custom 27803010 1001-2610 - HEAD FEMORAL +10MM MORSE TAPER 26MM OMNIFIT COCR HIP BOTH IP/OP "$1,297.50" $960.00 $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $270.41 "$1,297.50" $519.00 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $973.13 "$1,297.50" "$1,297.50" "$1,297.50" $648.75 $648.75 "$1,027.62" "$1,297.50" "$1,038.00" $583.88 "$1,297.50" N/A $752.55 "$1,297.50" $778.50 "$1,297.50" "$1,297.50" "$1,297.50" N/A N/A 1001-2800 SUP Custom 27803010 1001-2800 - HEAD FEMORAL +00MM MORSE TAPER 28MM OMNIFIT COCR HIP BOTH IP/OP "$1,297.50" $960.00 $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $270.41 "$1,297.50" $519.00 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $973.13 "$1,297.50" "$1,297.50" "$1,297.50" $648.75 $648.75 "$1,027.62" "$1,297.50" "$1,038.00" $583.88 "$1,297.50" N/A $752.55 "$1,297.50" $778.50 "$1,297.50" "$1,297.50" "$1,297.50" N/A N/A 1001-2805 SUP Custom 27803010 1001-2805 - HEAD FEMORAL +5MM 28MM MORSE TAPERED LFIT COCR HIP BOTH IP/OP "$1,297.50" $960.00 $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $270.41 "$1,297.50" $519.00 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $973.13 "$1,297.50" "$1,297.50" "$1,297.50" $648.75 $648.75 "$1,027.62" "$1,297.50" "$1,038.00" $583.88 "$1,297.50" N/A $752.55 "$1,297.50" $778.50 "$1,297.50" "$1,297.50" "$1,297.50" N/A N/A 1001-2810 SUP Custom 27803010 1001-2810 - HEAD FEM +10 28MM HIP MRS TPR COCR LFIT BOTH IP/OP $814.00 $602.00 $144.89 $814.00 $814.00 $814.00 $814.00 $814.00 $814.00 $814.00 $144.89 $814.00 $814.00 $814.00 $814.00 $814.00 $814.00 $169.65 $814.00 $325.60 $814.00 $814.00 $814.00 $814.00 $814.00 $610.50 $814.00 $814.00 $814.00 $407.00 $407.00 $644.69 $814.00 $651.20 $366.30 $814.00 N/A $472.12 $814.00 $488.40 $814.00 $814.00 $814.00 N/A N/A 1001-3200 SUP Custom 27803010 1001-3200 - HEAD FEMORAL +00MM MORSE TAPER 32MM OMNIFIT COCR HIP BOTH IP/OP "$1,297.50" $960.00 $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $270.41 "$1,297.50" $519.00 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $973.13 "$1,297.50" "$1,297.50" "$1,297.50" $648.75 $648.75 "$1,027.62" "$1,297.50" "$1,038.00" $583.88 "$1,297.50" N/A $752.55 "$1,297.50" $778.50 "$1,297.50" "$1,297.50" "$1,297.50" N/A N/A 1001-3205 SUP Custom 27803010 1001-3205 - HEAD FEMORAL +05MM MORSE TAPER 32MM OMNIFIT COCR HIP BOTH IP/OP "$1,297.50" $960.00 $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $270.41 "$1,297.50" $519.00 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $973.13 "$1,297.50" "$1,297.50" "$1,297.50" $648.75 $648.75 "$1,027.62" "$1,297.50" "$1,038.00" $583.88 "$1,297.50" N/A $752.55 "$1,297.50" $778.50 "$1,297.50" "$1,297.50" "$1,297.50" N/A N/A 1001-3210 SUP Custom 27803010 1001-3210 - HEAD FEMORAL +10MM MORSE TAPER 32MM OMNIFIT COCR HIP BOTH IP/OP "$1,297.50" $960.00 $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $270.41 "$1,297.50" $519.00 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $973.13 "$1,297.50" "$1,297.50" "$1,297.50" $648.75 $648.75 "$1,027.62" "$1,297.50" "$1,038.00" $583.88 "$1,297.50" N/A $752.55 "$1,297.50" $778.50 "$1,297.50" "$1,297.50" "$1,297.50" N/A N/A 1001-3299 SUP Custom 27803010 1001-3299 - HEAD FEMORAL +99MM MORSE TAPER 32MM OMNIFIT COCR HIP BOTH IP/OP "$1,297.50" $960.00 $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $230.96 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $270.41 "$1,297.50" $519.00 "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" "$1,297.50" $973.13 "$1,297.50" "$1,297.50" "$1,297.50" $648.75 $648.75 "$1,027.62" "$1,297.50" "$1,038.00" $583.88 "$1,297.50" N/A $752.55 "$1,297.50" $778.50 "$1,297.50" "$1,297.50" "$1,297.50" N/A N/A 1001-532 SUP Custom 27203010 1001-532 - CLAMP SURG 75-80GM CLAMPING PRESSURE MIDI STR BULLDOG BOTH IP/OP $209.50 $155.00 $37.29 $209.50 $209.50 $209.50 $209.50 $209.50 $209.50 $209.50 $37.29 $209.50 $209.50 $155.49 $155.49 $161.48 $109.15 $43.66 $209.50 $83.80 $209.50 $209.50 $209.50 $209.50 $209.50 $157.13 $209.50 $209.50 $209.50 $104.75 $104.75 $165.92 $209.50 $167.60 $136.18 $209.50 N/A $121.51 $209.50 $125.70 $209.50 $209.50 $209.50 N/A N/A 1003381-13 SUP HCPCS C1874 1003381-13 - STENT CORON .014IN LP 4.5MM 13MM RAPEX SMOOTH SURFACE MARKER BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1003381-18 SUP HCPCS C1874 1003381-18 - SYSTEM COR STNT 4.5MM 18MM MTLNK UL RX LOPRFL RADOPQ SMTH BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1003381-28 SUP HCPCS C1874 1003381-28 - STENT CORON .014IN LP 4.5MM 28MM RAPEX SMOOTH SURFACE MARKER BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 100-36-01 SUP Custom 27203010 100-36-01 - CHEST TUBE INSERTION DEVICE MINIMALLY INVASIVE BOTH IP/OP "$5,025.00" "$3,719.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" $894.45 "$5,025.00" "$5,025.00" "$3,729.56" "$3,729.56" "$3,873.27" "$2,060.15" "$1,047.27" "$5,025.00" "$2,010.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$3,768.75" "$5,025.00" "$5,025.00" "$5,025.00" "$2,512.50" "$2,512.50" "$3,979.80" "$5,025.00" "$4,020.00" "$3,266.25" "$5,025.00" N/A "$2,914.50" "$5,025.00" "$3,015.00" "$5,025.00" "$5,025.00" "$5,025.00" N/A N/A 1005359H SUP HCPCS C1760 1005359H - GUIDEWIRE VASCULAR STR .014IN 300CM 3CM HI-TORQUE WHISPER MS BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $79.88 $79.88 $79.88 $79.88 $177.50 $177.50 $177.50 $37.00 $177.50 $177.50 $177.50 $177.50 $177.50 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $79.88 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A 1005359H NEW ITEM # 80322174 SUP HCPCS C1760 1005359H NEW ITEM # 80322174 - GUIDEWIRE VASCULAR STR .014IN 300CM 3CM HI-TORQUE WHISPER MS BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 1007-00 SUP Custom 27203010 1007-00 - VALVULOTOME ANGIOSCOPIC 1.5MM 98CM EXPANDABLE OTW BOTH IP/OP "$4,197.50" "$3,106.00" $747.16 "$4,197.50" "$4,197.50" "$4,197.50" "$4,197.50" "$4,197.50" "$4,197.50" "$4,197.50" $747.16 "$4,197.50" "$4,197.50" "$3,115.38" "$3,115.38" "$3,235.43" "$2,060.15" $874.81 "$4,197.50" "$1,679.00" "$4,197.50" "$4,197.50" "$4,197.50" "$4,197.50" "$4,197.50" "$3,148.13" "$4,197.50" "$4,197.50" "$4,197.50" "$2,098.75" "$2,098.75" "$3,324.42" "$4,197.50" "$3,358.00" "$2,728.38" "$4,197.50" N/A "$2,434.55" "$4,197.50" "$2,518.50" "$4,197.50" "$4,197.50" "$4,197.50" N/A N/A 1007822-08 SUP HCPCS C1874 1007822-08 - STENT CORON 2.25MM 8MM 2 RADIOPQ MARKER BALLOON EXPANDABLE BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1007823-08 SUP HCPCS C1876 1007823-08 - SYSTEM COR STNT 2.5MM 8MM MTLNK MVSN RX RADOPQ BLN XPD COCR BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1007823-15 SUP HCPCS C1874 1007823-15 - STENT CORON LP 2.5MM 15MM 2 RADIOPQ MARKER BALLOON BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1007823-28 SUP HCPCS C1874 1007823-28 - STENT CORON LP 2.5MM 28MM 2 RADIOPQ MARKER BALLOON BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1007848-08 SUP HCPCS C1874 1007848-08 - SYSTEM CORON STENT 3MM 8MM RAPEX MULTI-LINK VISION BARE BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1007848-12 SUP HCPCS C1874 1007848-12 - SYSTEM CORON STENT 3MM 12MM RAPEX MULTI-LINK VISION BARE BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1007848-23 SUP HCPCS C1874 1007848-23 - STENT CORON LP 3MM 23MM 2 RADIOPQ MARKER BALLOON EXPANDABLE BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1007848-28 SUP HCPCS C1874 1007848-28 - SYSTEM CORON STENT 3MM 28MM RAPEX MULTI-LINK VISION BARE BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1007849-12 SUP HCPCS C1874 1007849-12 - SYSTEM COR STNT 3.5MM 12MM MTLNK VSN RX LOPRFL RADOPQ BLN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1007849-18 SUP HCPCS C1874 1007849-18 - STENT CORON LP 3.5MM 18MM 2 RADIOPQ MARKER BALLOON BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1007849-23 SUP HCPCS C1874 1007849-23 - STENT CORON LP 3.5MM 23MM 2 RADIOPQ MARKER BALLOON BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1007849-28 SUP HCPCS C1874 1007849-28 - SYSTEM COR STNT 3.5MM 28MM MTLNK VSN RX LOPRFL RADOPQ BLN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1007850-08 SUP HCPCS C1876 1007850-08 - SYSTEM COR STNT 4MM 8MM MTLNK VSN RX LOPRFL RADOPQ BLN XPD BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1007850-12 SUP HCPCS C1874 1007850-12 - STENT CORON LP 4MM 12MM 2 RADIOPQ MARKER BALLOON EXPANDABLE BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1007850-15 SUP HCPCS C1874 1007850-15 - STENT CORON LP 4MM 15MM 2 RADIOPQ MARKER BALLOON EXPANDABLE BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 1008193-20 SUP HCPCS C1725 1008193-20 - CATHETER BLNDIL 5MM 135CM 20MM VTRC14 + RX LOPRFL FLXB KINK BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 N/A $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A 1009-00 SUP Custom 27203010 1009-00 - VLVLTM ANGIOSCOPIC 1.5MM 98CM GRN/WHT STRL HDR LMTR IRR PORT BOTH IP/OP "$5,297.50" "$3,920.00" $942.96 "$5,297.50" "$5,297.50" "$5,297.50" "$5,297.50" "$5,297.50" "$5,297.50" "$5,297.50" $942.96 "$5,297.50" "$5,297.50" "$3,931.80" "$3,931.80" "$4,083.31" "$2,060.15" "$1,104.06" "$5,297.50" "$2,799.00" "$5,297.50" "$5,297.50" "$5,297.50" "$5,297.50" "$5,297.50" "$3,973.13" "$5,297.50" "$5,297.50" "$5,297.50" "$2,648.75" "$2,648.75" "$4,195.62" "$5,297.50" "$4,238.00" "$3,443.38" "$5,297.50" N/A "$3,072.55" "$5,297.50" "$3,178.50" "$5,297.50" "$5,297.50" "$5,297.50" N/A N/A 1009539-08 SUP HCPCS C1874 1009539-08 - STENT COR 2.5MM 8MM 143CM XIENCE V DLV SYS RX RADOPQ TPR BLN BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009539-12 SUP HCPCS C1874 1009539-12 - SYSTEM COR STNT 2.5MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009539-15 SUP HCPCS C1874 1009539-15 - SYSTEM COR STNT 2.5MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009539-18 SUP HCPCS C1874 1009539-18 - SYSTEM COR STNT 2.5MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009539-23 SUP HCPCS C1874 1009539-23 - SYSTEM COR STNT 2.5MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009539-28 SUP HCPCS C1874 1009539-28 - SYSTEM COR STNT 2.5MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009540-12 SUP HCPCS C1874 1009540-12 - SYSTEM COR STNT 2.75MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009540-15 SUP HCPCS C1874 1009540-15 - SYSTEM COR STNT 2.75MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009540-18 SUP HCPCS C1874 1009540-18 - SYSTEM COR STNT 2.75MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009540-23 SUP HCPCS C1874 1009540-23 - SYSTEM COR STNT 2.75MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009540-28 SUP HCPCS C1874 1009540-28 - SYSTEM COR STNT 2.75MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009541-12 SUP HCPCS C1874 1009541-12 - SYSTEM COR STNT 3MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009541-15 SUP HCPCS C1874 1009541-15 - SYSTEM COR STNT 3MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009541-18 SUP HCPCS C1874 1009541-18 - SYSTEM COR STNT 3MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009541-23 SUP HCPCS C1874 1009541-23 - SYSTEM COR STNT 3MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009541-28 SUP HCPCS C1874 1009541-28 - SYSTEM COR STNT 3MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009542-08 SUP HCPCS C1874 1009542-08 - SYSTEM COR STNT 3.5MM 8MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009542-12 SUP HCPCS C1874 1009542-12 - SYSTEM COR STNT 3.5MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009542-15 SUP HCPCS C1874 1009542-15 - SYSTEM COR STNT 3.5MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009542-18 SUP HCPCS C1874 1009542-18 - SYSTEM COR STNT 3.5MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009542-23 SUP HCPCS C1874 1009542-23 - SYSTEM COR STNT 3.5MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009542-28 SUP HCPCS C1874 1009542-28 - SYSTEM COR STNT 3.5MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009543-08 SUP HCPCS C1874 1009543-08 - SYSTEM COR STNT 4MM 8MM 143CM XIENCE V RX DLV SYS RADOPQ TPR BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009543-12 SUP HCPCS C1874 1009543-12 - SYSTEM COR STNT 4MM 12MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009543-15 SUP HCPCS C1874 1009543-15 - SYSTEM COR STNT 4MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009543-18 SUP HCPCS C1874 1009543-18 - SYSTEM COR STNT 4MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009543-23 SUP HCPCS C1874 1009543-23 - SYSTEM COR STNT 4MM 23MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009543-28 SUP HCPCS C1874 1009543-28 - SYSTEM COR STNT 4MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009544-08 SUP HCPCS C1874 1009544-08 - SYSTEM COR STNT 2.25MM 8MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009544-15 SUP HCPCS C1874 1009544-15 - SYSTEM COR STNT 2.25MM 15MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009544-18 SUP HCPCS C1874 1009544-18 - SYSTEM COR STNT 2.25MM 18MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1009544-28 SUP HCPCS C1874 1009544-28 - SYSTEM COR STNT 2.25MM 28MM 143CM XIENCE V RX DLV SYS RADOPQ BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 1010-10-PAD SUP HCPCS A4565 1010-10-PAD - SLING ORTHOPEDIC LARGE PAD LIGHT BLUE FELT ARM BOTH IP/OP $7.50 $6.00 $1.40 $7.07 $3.84 $3.84 $3.84 $3.84 $7.07 $7.07 $7.07 $1.47 $7.07 $5.25 $5.25 $5.45 $3.68 $1.47 $7.07 $7.07 $4.18 $7.07 $7.07 $7.07 $7.07 $5.63 $7.07 $7.07 $7.07 $3.54 $3.54 $5.60 $7.07 $5.66 $4.60 $1.40 N/A $4.35 $7.07 $7.07 $7.07 $1.47 $7.07 N/A N/A 1010-10-PAD-30 SUP HCPCS A4565 1010-10-PAD-30 - SLING ORTH MED BOTH IP/OP $7.50 $6.00 $1.40 $7.07 $3.84 $3.84 $3.84 $3.84 $7.07 $7.07 $7.07 $1.47 $7.07 $5.25 $5.25 $5.45 $3.68 $1.47 $7.07 $7.07 $4.18 $7.07 $7.07 $7.07 $7.07 $5.63 $7.07 $7.07 $7.07 $3.54 $3.54 $5.60 $7.07 $5.66 $4.60 $1.40 N/A $4.35 $7.07 $7.07 $7.07 $1.47 $7.07 N/A N/A 1010-10-PAD-40 SUP HCPCS A4565 1010-10-PAD-40 - SLING ORTH LG BOTH IP/OP $7.50 $6.00 $1.40 $7.07 $3.84 $3.84 $3.84 $3.84 $7.07 $7.07 $7.07 $1.47 $7.07 $5.25 $5.25 $5.45 $3.68 $1.47 $7.07 $7.07 $4.18 $7.07 $7.07 $7.07 $7.07 $5.63 $7.07 $7.07 $7.07 $3.54 $3.54 $5.60 $7.07 $5.66 $4.60 $1.40 N/A $4.35 $7.07 $7.07 $7.07 $1.47 $7.07 N/A N/A 10-1073 SUP Custom 27203010 10-1073 - SET BONE BIOP 15GA 18GA 16CM CANNU STYLET EJECTOR PIN DEPTH BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 1011337-40 SUP HCPCS C1876 1011337-40 - STENT VASCULAR STR LP 5MM 8FR 40MM 132CM SELF EXPANDABLE BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$4,125.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 N/A "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A 1011338-40 SUP HCPCS C1876 1011338-40 - STENT VASCULAR STR LP 6MM 8FR 40MM 132CM SELF EXPANDABLE BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$4,125.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 N/A "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A 1011339-40 SUP HCPCS C1876 1011339-40 - STENT VASCULAR STR LP 7MM 8FR 40MM 132CM SELF EXPANDABLE BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$4,125.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 N/A "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A 1011340-40 SUP HCPCS C1876 1011340-40 - STENT VASCULAR STR LP 8MM 8FR 40MM 132CM SELF EXPANDABLE BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$4,125.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 N/A "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A 1011341-40 SUP HCPCS C1876 1011341-40 - STENT VASCULAR STR LP 9MM 8FR 40MM 132CM SELF EXPANDABLE BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$4,125.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 N/A "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A 1011342-40 SUP HCPCS C1876 1011342-40 - STENT VASCULAR STR LP 10MM 8FR 40MM 132CM SELF EXPANDABLE BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$4,125.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 N/A "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A 1011343-30 SUP HCPCS C1876 1011343-30 - STENT VASCULAR LP TAPER 6-8MM 8FR 30MM 132CM SELF EXPANDABLE BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$4,125.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 N/A "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A 1011343-40 SUP HCPCS C1876 1011343-40 - STENT VASCULAR LP TAPER 6-8MM 8FR 40MM 132CM SELF EXPANDABLE BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$4,125.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 N/A "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A 1011344-40 SUP HCPCS C1876 1011344-40 - STENT VASCULAR LP TAPER 7-10MM 8FR 40MM 132CM SELF BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$4,125.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 N/A "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A 1011650-55 SUP HCPCS C1760 1011650-55 - SYSTEM EMBOLIC PROTECTION LP 4.5MM 6-8FR 300CM GWIRE BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 1012402-15A SUP HCPCS C1725 1012402-15A - CATHETER BLNDIL 1.5MM 145CM 15MM MN TREK II OTW 2 LUM ULT BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012404-06 SUP HCPCS C1725 1012404-06 - CATHETER BLNDIL 2.25MM 145CM 6MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012404-08 SUP HCPCS C1725 1012404-08 - CATHETER BLNDIL 2.25MM 145CM 8MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012404-12 SUP HCPCS C1725 1012404-12 - CATHETER BLNDIL 2.25MM 145CM 12MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012404-15 SUP HCPCS C1725 1012404-15 - CATHETER BLNDIL 2.25MM 145CM 15MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012404-20 SUP HCPCS C1725 1012404-20 - CATHETER BLNDIL 2.25MM 145CM 20MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012404-25 SUP HCPCS C1725 1012404-25 - CATHETER BLNDIL 2.25MM 145CM 25MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012404-30 SUP HCPCS C1725 1012404-30 - CATHETER BLNDIL 2.25MM 145CM 30MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012405-06 SUP HCPCS C1725 1012405-06 - CATHETER BLNDIL 2.5MM 145CM 6MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012405-08 SUP HCPCS C1725 1012405-08 - CATHETER BLNDIL 2.5MM 145CM 8MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012405-12 SUP HCPCS C1725 1012405-12 - CATHETER BLNDIL 2.5MM 145CM 12MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012405-15 SUP HCPCS C1725 1012405-15 - CATHETER BLNDIL 2.5MM 145CM 15MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012405-20 SUP HCPCS C1725 1012405-20 - CATHETER BLNDIL 2.5MM 145CM 20MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012405-25 SUP HCPCS C1725 1012405-25 - CATHETER BLNDIL 2.5MM 145CM 25MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012405-30 SUP HCPCS C1725 1012405-30 - CATHETER BLNDIL 2.5MM 145CM 30MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012406-06 SUP HCPCS C1725 1012406-06 - CATHETER BLNDIL 2.75MM 145CM 6MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012406-08 SUP HCPCS C1725 1012406-08 - CATHETER BLNDIL 2.75MM 145CM 8MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012406-12 SUP HCPCS C1725 1012406-12 - CATHETER BLNDIL 2.75MM 145CM 12MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012406-15 SUP HCPCS C1725 1012406-15 - CATHETER BLNDIL 2.75MM 145CM 15MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012406-20 SUP HCPCS C1725 1012406-20 - CATHETER BLNDIL 2.75MM 145CM 20MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012406-25 SUP HCPCS C1725 1012406-25 - CATHETER BLNDIL 2.75MM 145CM 25MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012406-30 SUP HCPCS C1725 1012406-30 - CATHETER BLNDIL 2.75MM 145CM 30MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012407-06 SUP HCPCS C1725 1012407-06 - CATHETER BLNDIL 3MM 145CM 6MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012407-08 SUP HCPCS C1725 1012407-08 - CATHETER BLNDIL 3MM 145CM 8MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012407-12 SUP HCPCS C1725 1012407-12 - CATHETER BLNDIL 3MM 145CM 12MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012407-15 SUP HCPCS C1725 1012407-15 - CATHETER BLNDIL 3MM 145CM 15MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012407-20 SUP HCPCS C1725 1012407-20 - CATHETER BLNDIL 3MM 145CM 20MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012407-25 SUP HCPCS C1725 1012407-25 - CATHETER BLNDIL 3MM 145CM 25MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012407-30 SUP HCPCS C1725 1012407-30 - CATHETER BLNDIL 3MM 145CM 30MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012408-06 SUP HCPCS C1725 1012408-06 - CATHETER BLNDIL 3.25MM 145CM 6MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012408-08 SUP HCPCS C1725 1012408-08 - CATHETER BLNDIL 3.25MM 145CM 8MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012408-12 SUP HCPCS C1725 1012408-12 - CATHETER BLNDIL 3.25MM 145CM 12MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012408-15 SUP HCPCS C1725 1012408-15 - CATHETER BLNDIL 3.25MM 145CM 15MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012408-20 SUP HCPCS C1725 1012408-20 - CATHETER BLNDIL 3.25MM 145CM 20MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012408-25 SUP HCPCS C1725 1012408-25 - CATHETER BLNDIL 3.25MM 145CM 25MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012408-30 SUP HCPCS C1725 1012408-30 - CATHETER BLNDIL 3.25MM 145CM 30MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012409-06 SUP HCPCS C1725 1012409-06 - CATHETER BLNDIL 3.5MM 145CM 6MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012409-08 SUP HCPCS C1725 1012409-08 - CATHETER BLNDIL 3.5MM 145CM 8MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012409-12 SUP HCPCS C1725 1012409-12 - CATHETER BLNDIL 3.5MM 145CM 12MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012409-15 SUP HCPCS C1725 1012409-15 - CATHETER BLNDIL 3.5MM 145CM 15MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012409-20 SUP HCPCS C1725 1012409-20 - CATHETER BLNDIL 3.5MM 145CM 20MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012409-25 SUP HCPCS C1725 1012409-25 - CATHETER BLNDIL 3.5MM 145CM 25MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012409-30 SUP HCPCS C1725 1012409-30 - CATHETER BLNDIL 3.5MM 145CM 30MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012410-06 SUP HCPCS C1725 1012410-06 - CATHETER BLNDIL 3.75MM 145CM 6MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012410-08 SUP HCPCS C1725 1012410-08 - CATHETER BLNDIL 3.75MM 145CM 8MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012410-12 SUP HCPCS C1725 1012410-12 - CATHETER BLNDIL 3.75MM 145CM 12MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012410-15 SUP HCPCS C1725 1012410-15 - CATHETER BLNDIL 3.75MM 145CM 15MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012410-20 SUP HCPCS C1725 1012410-20 - CATHETER BLNDIL 3.75MM 145CM 20MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012410-25 SUP HCPCS C1725 1012410-25 - CATHETER BLNDIL 3.75MM 145CM 25MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012410-30 SUP HCPCS C1725 1012410-30 - CATHETER BLNDIL 3.75MM 145CM 30MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012411-06 SUP HCPCS C1725 1012411-06 - CATHETER BLNDIL 4MM 145CM 6MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012411-08 SUP HCPCS C1725 1012411-08 - CATHETER BLNDIL 4MM 145CM 8MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012411-12 SUP HCPCS C1725 1012411-12 - CATHETER BLNDIL 4MM 145CM 12MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012411-15 SUP HCPCS C1725 1012411-15 - CATHETER BLNDIL 4MM 145CM 15MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012411-20 SUP HCPCS C1725 1012411-20 - CATHETER BLNDIL 4MM 145CM 20MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012411-25 SUP HCPCS C1725 1012411-25 - CATHETER BLNDIL 4MM 145CM 25MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012411-30 SUP HCPCS C1725 1012411-30 - CATHETER BLNDIL 4MM 145CM 30MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012412-12 SUP HCPCS C1725 1012412-12 - CATHETER BLNDIL 4.5MM 145CM 12MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012412-15 SUP HCPCS C1725 1012412-15 - CATHETER BLNDIL 4.5MM 145CM 15MM TREK OTW 2 LUM RADOPQ BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012413-12 SUP HCPCS C1725 1012413-12 - CATHETER BLNDIL 5MM 145CM 12MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012413-15 SUP HCPCS C1725 1012413-15 - CATHETER BLNDIL 5MM 145CM 15MM TREK OTW 2 LUM RADOPQ TRNSTLS BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012433-08 SUP HCPCS C1725 1012433-08 - CATHETER BLNDIL 2MM 143CM 8MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012433-15 SUP HCPCS C1725 1012433-15 - CATHETER BLNDIL 2MM 143CM 15MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012433-20 SUP HCPCS C1725 1012433-20 - CATHETER BLNDIL 2MM 143CM 20MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012434-08 SUP HCPCS C1725 1012434-08 - CATHETER BLNDIL 2.25MM 143CM 8MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012434-12 SUP HCPCS C1725 1012434-12 - CATHETER BLNDIL 2.25MM 143CM 12MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012434-15 SUP HCPCS C1725 1012434-15 - CATHETER BLNDIL 2.25MM 143CM 15MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012435-06 SUP HCPCS C1725 1012435-06 - CATHETER BLNDIL 2.5MM 143CM 6MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012435-08 SUP HCPCS C1725 1012435-08 - CATHETER BLNDIL 2.5MM 143CM 8MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012435-12 SUP HCPCS C1725 1012435-12 - CATHETER BLNDIL 2.5MM 143CM 12MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012436-15 SUP HCPCS C1725 1012436-15 - CATHETER BLNDIL 2.75MM 143CM 15MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012437-08 SUP HCPCS C1725 1012437-08 - CATHETER BLNDIL 3MM 143CM 8MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012438-06 SUP HCPCS C1725 1012438-06 - CATHETER BLNDIL 3.25MM 143CM 6MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012439-08 SUP HCPCS C1725 1012439-08 - CATHETER BLNDIL 3.5MM 143CM 8MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012440-08 SUP HCPCS C1725 1012440-08 - CATHETER BLNDIL 3.75MM 143CM 8MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012441-15 SUP HCPCS C1725 1012441-15 - CATHETER BLNDIL 4MM 143CM 15MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012441-20 SUP HCPCS C1725 1012441-20 - CATHETER BLNDIL 4MM 143CM 20MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012443-12 SUP HCPCS C1725 1012443-12 - CATHETER BLNDIL 5MM 143CM 12MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012443-15 SUP HCPCS C1725 1012443-15 - CATHETER BLNDIL 5MM 143CM 15MM NC TREK OTW SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012446-06 SUP HCPCS C1725 1012446-06 - CATHETER BLNDIL 2.25MM 6MM NC TREK RX RADOPQ SMTH RND TIP BOTH IP/OP $175.00 $130.00 $34.73 $212.50 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $212.50 $103.51 $175.00 $212.50 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A 1012534-100 SUP HCPCS C1876 1012534-100 - STENT BILIARY 6MM 100MM 135CM SELF EXPANDABLE RADIOPQ MARKER BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $937.50 $937.50 $195.38 $937.50 N/A N/A 1012535-100 SUP HCPCS C1876 1012535-100 - STENT BILIARY 7MM 100MM 135CM SELF EXPANDABLE RADIOPQ MARKER BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $937.50 $937.50 $195.38 $937.50 N/A N/A 1013317J SUP HCPCS C1769 1013317J - GUIDEWIRE VASC J CRV .014IN 190CM STRL LF 3CM HTORQ BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $96.38 $96.38 $96.38 $96.38 $177.50 $177.50 $177.50 $37.00 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A 1013319J SUP HCPCS C1769 1013319J - GUIDEWIRE VASC J CRV .014IN 190CM STRL LF 3CM HTORQ BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $96.38 $96.38 $96.38 $96.38 $177.50 $177.50 $177.50 $37.00 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A 1016-17 SUP HCPCS Q4116 1016-17 - GRAFT SKIN MEDIUM FROZEN CADAVER NONMESHED 232 SQ CM/ ¼ SQ F BOTH IP/OP "$1,120.00" $829.00 $222.29 "$1,120.00" $504.00 $504.00 $504.00 $504.00 "$1,120.00" "$1,120.00" "$1,120.00" $233.44 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $233.42 "$1,120.00" "$1,120.00" $662.48 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $840.00 "$1,120.00" "$1,120.00" "$1,120.00" $560.00 $560.00 $887.04 "$1,120.00" $896.00 $504.00 $222.29 N/A $649.60 "$1,120.00" "$1,120.00" "$1,120.00" $233.41 "$1,120.00" N/A N/A 1017-17 SUP HCPCS Q4116 1017-17 - GRAFT SKN 154SQ CM NONMESHED CRPRS BOTH IP/OP $645.00 $477.00 $128.02 $645.00 $290.25 $290.25 $290.25 $290.25 $645.00 $645.00 $645.00 $134.43 $645.00 $645.00 $645.00 $645.00 $645.00 $134.43 $645.00 $645.00 $381.52 $645.00 $645.00 $645.00 $645.00 $483.75 $645.00 $645.00 $645.00 $322.50 $322.50 $510.84 $645.00 $516.00 $290.25 $128.02 N/A $374.10 $645.00 $645.00 $645.00 $134.42 $645.00 N/A N/A 101-L05-C SUP HCPCS C1713 101-L05-C - PLATE BONE L 5MM 2X2 HOLE RIGID TIMESH TITANIUM CRANIAL LEFT BOTH IP/OP $408.00 $302.00 $80.98 $408.00 $183.60 $183.60 $183.60 $183.60 $408.00 $408.00 $408.00 $85.04 $408.00 $408.00 $408.00 $408.00 $408.00 $85.03 $408.00 $408.00 $241.33 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $183.60 $80.98 N/A $236.64 $408.00 $244.80 $408.00 $85.03 $408.00 N/A N/A 101-L25 SUP HCPCS C1713 101-L25 - PLATE BONE 2.5MM 2X2 HOLE L TIMESH TITANIUM LEFT CRANIAL BOTH IP/OP $404.00 $299.00 $80.13 $403.75 $181.69 $181.69 $181.69 $181.69 $403.75 $403.75 $403.75 $84.15 $403.75 $403.75 $403.75 $403.75 $403.75 $84.15 $403.75 $161.50 $238.82 $403.75 $403.75 $403.75 $403.75 $303.00 $403.75 $403.75 $403.75 $201.88 $201.88 $319.77 $403.75 $323.00 $181.69 $80.13 N/A $234.32 $403.75 $242.25 $403.75 $84.14 $403.75 N/A N/A 101-R25 SUP HCPCS C1713 101-R25 - PLATE BONE L RIGHT ANG 2.5MM 2X2 HOLE TIMESH TITANIUM BOTH IP/OP $408.00 $302.00 $80.98 $408.00 $183.60 $183.60 $183.60 $183.60 $408.00 $408.00 $408.00 $85.04 $408.00 $408.00 $408.00 $408.00 $408.00 $85.03 $408.00 $163.20 $241.33 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $183.60 $80.98 N/A $236.64 $408.00 $244.80 $408.00 $85.03 $408.00 N/A N/A 1022-0004 SUP Custom 27803010 1022-0004 - STEM FEMORAL 4 COLLAR SMOOTH OMNIFLEX HIP BOTH IP/OP $610.00 $451.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $127.13 $610.00 $244.00 $610.00 $610.00 $610.00 $610.00 $610.00 $457.50 $610.00 $610.00 $610.00 $305.00 $305.00 $483.12 $610.00 $488.00 $274.50 $610.00 N/A $353.80 $610.00 $366.00 $610.00 $610.00 $610.00 N/A N/A 1022-0005 SUP Custom 27803010 1022-0005 - STEM FEMORAL 5 COLLAR SMOOTH OMNIFLEX HIP BOTH IP/OP $610.00 $451.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $127.13 $610.00 $244.00 $610.00 $610.00 $610.00 $610.00 $610.00 $457.50 $610.00 $610.00 $610.00 $305.00 $305.00 $483.12 $610.00 $488.00 $274.50 $610.00 N/A $353.80 $610.00 $366.00 $610.00 $610.00 $610.00 N/A N/A 1022-0006 SUP Custom 27803010 1022-0006 - STEM FEMORAL 6 COLLAR SMOOTH OMNIFLEX HIP BOTH IP/OP $610.00 $451.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $127.13 $610.00 $244.00 $610.00 $610.00 $610.00 $610.00 $610.00 $457.50 $610.00 $610.00 $610.00 $305.00 $305.00 $483.12 $610.00 $488.00 $274.50 $610.00 N/A $353.80 $610.00 $366.00 $610.00 $610.00 $610.00 N/A N/A 1022-0007 SUP Custom 27803010 1022-0007 - STEM FEMORAL 7 COLLAR SMOOTH OMNIFLEX HIP BOTH IP/OP $610.00 $451.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $127.13 $610.00 $244.00 $610.00 $610.00 $610.00 $610.00 $610.00 $457.50 $610.00 $610.00 $610.00 $305.00 $305.00 $483.12 $610.00 $488.00 $274.50 $610.00 N/A $353.80 $610.00 $366.00 $610.00 $610.00 $610.00 N/A N/A 1022-0008 SUP Custom 27803010 1022-0008 - STEM FEMORAL 8 COLLAR SMOOTH OMNIFLEX HIP BOTH IP/OP $610.00 $451.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $127.13 $610.00 $244.00 $610.00 $610.00 $610.00 $610.00 $610.00 $457.50 $610.00 $610.00 $610.00 $305.00 $305.00 $483.12 $610.00 $488.00 $274.50 $610.00 N/A $353.80 $610.00 $366.00 $610.00 $610.00 $610.00 N/A N/A 1022-0009 SUP Custom 27803010 1022-0009 - STEM FEMORAL 9 COLLAR SMOOTH OMNIFLEX HIP BOTH IP/OP $610.00 $451.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $127.13 $610.00 $244.00 $610.00 $610.00 $610.00 $610.00 $610.00 $457.50 $610.00 $610.00 $610.00 $305.00 $305.00 $483.12 $610.00 $488.00 $274.50 $610.00 N/A $353.80 $610.00 $366.00 $610.00 $610.00 $610.00 N/A N/A 1022-0010 SUP Custom 27803010 1022-0010 - STEM FEMORAL 10 COLLAR SMOOTH OMNIFLEX HIP BOTH IP/OP $610.00 $451.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $127.13 $610.00 $244.00 $610.00 $610.00 $610.00 $610.00 $610.00 $457.50 $610.00 $610.00 $610.00 $305.00 $305.00 $483.12 $610.00 $488.00 $274.50 $610.00 N/A $353.80 $610.00 $366.00 $610.00 $610.00 $610.00 N/A N/A 1022-0011 SUP Custom 27803010 1022-0011 - STEM FEMORAL 11 COLLAR SMOOTH OMNIFLEX HIP BOTH IP/OP $610.00 $451.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $127.13 $610.00 $244.00 $610.00 $610.00 $610.00 $610.00 $610.00 $457.50 $610.00 $610.00 $610.00 $305.00 $305.00 $483.12 $610.00 $488.00 $274.50 $610.00 N/A $353.80 $610.00 $366.00 $610.00 $610.00 $610.00 N/A N/A 1022-0012 SUP Custom 27803010 1022-0012 - STEM FEMORAL 12 COLLAR SMOOTH OMNIFLEX HIP BOTH IP/OP $610.00 $451.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $127.13 $610.00 $244.00 $610.00 $610.00 $610.00 $610.00 $610.00 $457.50 $610.00 $610.00 $610.00 $305.00 $305.00 $483.12 $610.00 $488.00 $274.50 $610.00 N/A $353.80 $610.00 $366.00 $610.00 $610.00 $610.00 N/A N/A 1022-0013 SUP Custom 27803010 1022-0013 - STEM FEMORAL 13 COLLAR SMOOTH OMNIFLEX HIP BOTH IP/OP $610.00 $451.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $127.13 $610.00 $244.00 $610.00 $610.00 $610.00 $610.00 $610.00 $457.50 $610.00 $610.00 $610.00 $305.00 $305.00 $483.12 $610.00 $488.00 $274.50 $610.00 N/A $353.80 $610.00 $366.00 $610.00 $610.00 $610.00 N/A N/A 1022-0014 SUP Custom 27803010 1022-0014 - STEM FEMORAL 14 COLLAR SMOOTH OMNIFLEX HIP BOTH IP/OP $610.00 $451.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $127.13 $610.00 $244.00 $610.00 $610.00 $610.00 $610.00 $610.00 $457.50 $610.00 $610.00 $610.00 $305.00 $305.00 $483.12 $610.00 $488.00 $274.50 $610.00 N/A $353.80 $610.00 $366.00 $610.00 $610.00 $610.00 N/A N/A 103.25.180 SUP Custom 27203010 103.25.180 - BIT DRL 2 FLUT 2.5MM 180MM 154MM QC BOTH IP/OP $208.00 $154.00 $37.02 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $208.00 $37.02 $208.00 $208.00 $154.38 $154.38 $160.33 $108.37 $43.35 $208.00 $83.20 $208.00 $208.00 $208.00 $208.00 $208.00 $156.00 $208.00 $208.00 $208.00 $104.00 $104.00 $164.74 $208.00 $166.40 $135.20 $208.00 N/A $120.64 $208.00 $124.80 $208.00 $208.00 $208.00 N/A N/A 103-0304 SUP Custom 27803010 103-0304 - DEVICE INFL 1ML CADENCE PRCS SYR INJECTOR THRD PLNG BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A 103-0601-200 SUP HCPCS C1769 103-0601-200 - GUIDEWIRE VASC .01IN 200CM STRL 10CM SILVERSPEED SFT COIL BOTH IP/OP $575.00 $426.00 $114.12 $575.00 $312.23 $312.23 $312.23 $312.23 $575.00 $575.00 $575.00 $119.84 $575.00 $426.77 $426.77 $443.21 $299.58 $119.84 $575.00 $512.50 $340.11 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $373.75 $114.12 N/A $333.50 $575.00 $575.00 $575.00 $119.83 $575.00 N/A N/A 103-0602-300 SUP HCPCS C1769 103-0602-300 - GUIDEWIRE VASC .014IN 300CM STRL 20CM XCLRT EXCH RADOPQ DIST BOTH IP/OP $867.50 $642.00 $172.18 $867.50 $471.05 $471.05 $471.05 $471.05 $867.50 $867.50 $867.50 $180.81 $867.50 $643.86 $643.86 $668.67 $451.97 $180.80 $867.50 $867.50 $513.13 $867.50 $867.50 $867.50 $867.50 $650.63 $867.50 $867.50 $867.50 $433.75 $433.75 $687.06 $867.50 $694.00 $563.88 $172.18 N/A $503.15 $867.50 $867.50 $867.50 $180.79 $867.50 N/A N/A 103-0603-200 SUP HCPCS C1769 103-0603-200 - GUIDEWIRE VASC .016IN 200CM 20CM SILVERSPEED RADOPQ DIST BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $291.86 $291.86 $291.86 $291.86 $537.50 $537.50 $537.50 $112.03 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $512.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $106.68 N/A $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A 103-0605-200 SUP HCPCS C1769 103-0605-200 - GUIDEWIRE VASC .01IN .012IN 200CM 10CM XPDN SFTP RADOPQ DIST BOTH IP/OP $657.50 $487.00 $130.50 $657.50 $357.02 $357.02 $357.02 $357.02 $657.50 $657.50 $657.50 $137.04 $657.50 $488.00 $488.00 $506.80 $342.56 $137.03 $657.50 $625.00 $388.91 $657.50 $657.50 $657.50 $657.50 $493.13 $657.50 $657.50 $657.50 $328.75 $328.75 $520.74 $657.50 $526.00 $427.38 $130.50 N/A $381.35 $657.50 $657.50 $657.50 $137.02 $657.50 N/A N/A 103-0608 SUP HCPCS C1769 103-0608 - GUIDEWIRE VASC TPR .008IN 200CM 10CM MRG SFTP X SPRT RADOPQ BOTH IP/OP "$1,090.00" $807.00 $216.34 "$1,090.00" $591.87 $591.87 $591.87 $591.87 "$1,090.00" "$1,090.00" "$1,090.00" $227.18 "$1,090.00" $809.00 $809.00 $840.17 $567.89 $227.17 "$1,090.00" "$1,037.50" $644.74 "$1,090.00" "$1,090.00" "$1,090.00" "$1,090.00" $817.50 "$1,090.00" "$1,090.00" "$1,090.00" $545.00 $545.00 $863.28 "$1,090.00" $872.00 $708.50 $216.34 N/A $632.20 "$1,090.00" "$1,090.00" "$1,090.00" $227.16 "$1,090.00" N/A N/A 103-L05 SUP HCPCS C1713 103-L05 - PLATE BONE L LEFT ANGLE 5MM 3X4 HOLE TIMESH TITANIUM CRANIAL BOTH IP/OP $404.00 $299.00 $80.13 $403.75 $181.69 $181.69 $181.69 $181.69 $403.75 $403.75 $403.75 $84.15 $403.75 $403.75 $403.75 $403.75 $403.75 $84.15 $403.75 $161.50 $238.82 $403.75 $403.75 $403.75 $403.75 $303.00 $403.75 $403.75 $403.75 $201.88 $201.88 $319.77 $403.75 $323.00 $181.69 $80.13 N/A $234.32 $403.75 $403.75 $403.75 $84.14 $403.75 N/A N/A 103-R05 SUP HCPCS C1713 103-R05 - PLATE BONE L RIGHT ANG 5MM 3X4 HOLE TIMESH TITANIUM CRANIAL BOTH IP/OP $408.00 $302.00 $80.98 $408.00 $183.60 $183.60 $183.60 $183.60 $408.00 $408.00 $408.00 $85.04 $408.00 $408.00 $408.00 $408.00 $408.00 $85.03 $408.00 $408.00 $241.33 $408.00 $408.00 $408.00 $408.00 $306.00 $408.00 $408.00 $408.00 $204.00 $204.00 $323.14 $408.00 $326.40 $183.60 $80.98 N/A $236.64 $408.00 $408.00 $408.00 $85.03 $408.00 N/A N/A 10-403FC SUP Custom 27203010 10-403FC - DEVICE SPECIMEN RETRIEVAL TISSUE REMOVAL MYOSURE BOTH IP/OP "$3,890.00" "$2,879.00" $692.42 "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" $692.42 "$3,890.00" "$3,890.00" "$2,887.16" "$2,887.16" "$2,998.41" "$2,026.69" $810.72 "$3,890.00" $968.33 "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$3,890.00" "$2,917.50" "$3,890.00" "$3,890.00" "$3,890.00" "$1,945.00" "$1,945.00" "$3,080.88" "$3,890.00" "$3,112.00" "$2,528.50" "$3,890.00" N/A "$2,256.20" "$3,890.00" "$2,334.00" "$3,890.00" "$3,890.00" "$3,890.00" N/A N/A 104-4112 SUP HCPCS C2628 104-4112 - CATHETER BLNOCC .01IN 4MM 2.2-2.8FR 4MM 150CM 15MM BOTH IP/OP "$2,675.00" "$1,980.00" $530.92 "$2,675.00" "$1,452.53" "$1,452.53" "$1,452.53" "$1,452.53" "$2,675.00" "$2,675.00" "$2,675.00" $557.54 "$2,675.00" "$1,985.39" "$1,985.39" "$2,061.89" "$1,393.68" $557.50 "$2,675.00" "$2,562.50" "$1,582.26" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,738.75" $530.92 N/A "$1,551.50" "$2,675.00" "$2,675.00" "$2,675.00" $557.47 "$2,675.00" N/A N/A 104-4127 SUP HCPCS C2628 104-4127 - CATHETER BLNOCC .01IN 4MM 2.2-2.8FR 4MM 150CM 20MM BOTH IP/OP "$2,562.50" "$1,896.00" $508.59 "$2,562.50" "$1,391.44" "$1,391.44" "$1,391.44" "$1,391.44" "$2,562.50" "$2,562.50" "$2,562.50" $534.09 "$2,562.50" "$1,901.89" "$1,901.89" "$1,975.18" "$1,335.06" $534.05 "$2,562.50" "$2,562.50" "$1,515.72" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$1,921.88" "$2,562.50" "$2,562.50" "$2,562.50" "$1,281.25" "$1,281.25" "$2,029.50" "$2,562.50" "$2,050.00" "$1,665.63" $508.59 N/A "$1,486.25" "$2,562.50" "$2,562.50" "$2,562.50" $534.03 "$2,562.50" N/A N/A 104-4132 SUP HCPCS C2628 104-4132 - CATHETER BLNOCC .01IN 4MM 2.2-2.8FR 4MM 150CM 30MM BOTH IP/OP "$2,562.50" "$1,896.00" $508.59 "$2,562.50" "$1,391.44" "$1,391.44" "$1,391.44" "$1,391.44" "$2,562.50" "$2,562.50" "$2,562.50" $534.09 "$2,562.50" "$1,901.89" "$1,901.89" "$1,975.18" "$1,335.06" $534.05 "$2,562.50" "$2,562.50" "$1,515.72" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$1,921.88" "$2,562.50" "$2,562.50" "$2,562.50" "$1,281.25" "$1,281.25" "$2,029.50" "$2,562.50" "$2,050.00" "$1,665.63" $508.59 N/A "$1,486.25" "$2,562.50" "$2,562.50" "$2,562.50" $534.03 "$2,562.50" N/A N/A 104-4310 SUP HCPCS C1769 104-4310 - CATHETER BLNOCC 4MM 2.2-2.8FR 3MM 150CM 10MM HYPERGLIDE 1 BOTH IP/OP "$2,675.00" "$1,980.00" $530.92 "$2,675.00" "$1,452.53" "$1,452.53" "$1,452.53" "$1,452.53" "$2,675.00" "$2,675.00" "$2,675.00" $557.54 "$2,675.00" "$1,985.39" "$1,985.39" "$2,061.89" "$1,393.68" $557.50 "$2,675.00" "$2,562.50" "$1,582.26" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,738.75" $530.92 N/A "$1,551.50" "$2,675.00" "$2,675.00" "$2,675.00" $557.47 "$2,675.00" N/A N/A 104-4315 SUP HCPCS C2628 104-4315 - CATHETER BLNOCC .01IN 4MM 2.2-2.8FR 3MM 150CM 15MM BOTH IP/OP "$2,675.00" "$1,980.00" $530.92 "$2,675.00" "$1,452.53" "$1,452.53" "$1,452.53" "$1,452.53" "$2,675.00" "$2,675.00" "$2,675.00" $557.54 "$2,675.00" "$1,985.39" "$1,985.39" "$2,061.89" "$1,393.68" $557.50 "$2,675.00" "$2,562.50" "$1,582.26" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,738.75" $530.92 N/A "$1,551.50" "$2,675.00" "$2,675.00" "$2,675.00" $557.47 "$2,675.00" N/A N/A 104-4470 SUP HCPCS C2628 104-4470 - CATHETER BLNOCC .01IN 2MM 2.5-2.8FR 4MM 150CM 7MM HYPERFORM BOTH IP/OP "$3,312.50" "$2,451.00" $657.45 "$3,312.50" "$1,798.69" "$1,798.69" "$1,798.69" "$1,798.69" "$3,312.50" "$3,312.50" "$3,312.50" $690.41 "$3,312.50" "$2,458.54" "$2,458.54" "$2,553.28" "$1,725.81" $690.36 "$3,312.50" "$3,312.50" "$1,959.34" "$3,312.50" "$3,312.50" "$3,312.50" "$3,312.50" "$2,484.38" "$3,312.50" "$3,312.50" "$3,312.50" "$1,656.25" "$1,656.25" "$2,623.50" "$3,312.50" "$2,650.00" "$2,153.13" $657.45 N/A "$1,921.25" "$3,312.50" "$3,312.50" "$3,312.50" $690.33 "$3,312.50" N/A N/A 104-4515 SUP HCPCS C1757 104-4515 - CATHETER BLNOCC .01IN 4MM 2.8-2.2FR 5MM 150CM 15MM BOTH IP/OP "$2,675.00" "$1,980.00" $530.92 "$2,675.00" "$1,452.53" "$1,452.53" "$1,452.53" "$1,452.53" "$2,675.00" "$2,675.00" "$2,675.00" $557.54 "$2,675.00" "$1,985.39" "$1,985.39" "$2,061.89" "$1,393.68" $557.50 "$2,675.00" "$2,562.50" "$1,582.26" "$2,675.00" "$2,675.00" "$2,675.00" "$2,675.00" "$2,006.25" "$2,675.00" "$2,675.00" "$2,675.00" "$1,337.50" "$1,337.50" "$2,118.60" "$2,675.00" "$2,140.00" "$1,738.75" $530.92 N/A "$1,551.50" "$2,675.00" "$2,675.00" "$2,675.00" $557.47 "$2,675.00" N/A N/A 104-4520 SUP HCPCS C1757 104-4520 - CATHETER BLNOCC 4MM 2.8-2.2FR 5MM 150CM 20MM HYPERGLIDE 1 BOTH IP/OP "$2,562.50" "$1,896.00" $508.59 "$2,562.50" "$1,391.44" "$1,391.44" "$1,391.44" "$1,391.44" "$2,562.50" "$2,562.50" "$2,562.50" $534.09 "$2,562.50" "$1,901.89" "$1,901.89" "$1,975.18" "$1,335.06" $534.05 "$2,562.50" "$2,562.50" "$1,515.72" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$1,921.88" "$2,562.50" "$2,562.50" "$2,562.50" "$1,281.25" "$1,281.25" "$2,029.50" "$2,562.50" "$2,050.00" "$1,665.63" $508.59 N/A "$1,486.25" "$2,562.50" "$2,562.50" "$2,562.50" $534.03 "$2,562.50" N/A N/A 1044594J SUP HCPCS C1769 1044594J - GUIDEWIRE VASC J CRV .014IN 190CM STRL LF HTORQ POWERTURN BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $96.38 $96.38 $96.38 $96.38 $177.50 $177.50 $177.50 $37.00 $177.50 $131.74 $131.74 $136.82 $92.48 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $115.38 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A 1044595J SUP HCPCS C1769 1044595J - GUIDEWIRE VASC J CRV .014IN 300CM STRL LF HTORQ POWERTURN BOTH IP/OP $215.00 $159.00 $42.67 $215.00 $116.75 $116.75 $116.75 $116.75 $215.00 $215.00 $215.00 $44.81 $215.00 $159.57 $159.57 $165.72 $112.02 $44.81 $215.00 $215.00 $127.17 $215.00 $215.00 $215.00 $215.00 $161.25 $215.00 $215.00 $215.00 $107.50 $107.50 $170.28 $215.00 $172.00 $139.75 $42.67 N/A $124.70 $215.00 $215.00 $215.00 $44.81 $215.00 N/A N/A 104-4770 SUP HCPCS C2628 104-4770 - CATHETER BLNOCC .01IN 2MM 3-2.8FR 7MM 150CM 7MM HYPERFORM 1 BOTH IP/OP "$3,312.50" "$2,451.00" $657.45 "$3,312.50" "$1,798.69" "$1,798.69" "$1,798.69" "$1,798.69" "$3,312.50" "$3,312.50" "$3,312.50" $690.41 "$3,312.50" "$2,458.54" "$2,458.54" "$2,553.28" "$1,725.81" $690.36 "$3,312.50" "$3,312.50" "$1,959.34" "$3,312.50" "$3,312.50" "$3,312.50" "$3,312.50" "$2,484.38" "$3,312.50" "$3,312.50" "$3,312.50" "$1,656.25" "$1,656.25" "$2,623.50" "$3,312.50" "$2,650.00" "$2,153.13" $657.45 N/A "$1,921.25" "$3,312.50" "$3,312.50" "$3,312.50" $690.33 "$3,312.50" N/A N/A 104834-001 SUP Custom 27203010 104834-001 - CATHETER THROMBECTOMY Y SPIKE 6FR LATEX FREE ANGIOJET POWER BOTH IP/OP $425.00 $315.00 $75.65 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $75.65 $425.00 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $170.00 $425.00 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $425.00 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 104834-002 SUP HCPCS C1757 104834-002 - KIT THRMB 1.5MM 3-4FR 145CM LF 15MM ANGJT ULT ULT SYS OTW BOTH IP/OP $85.00 $63.00 $16.87 $85.00 $46.16 $46.16 $46.16 $46.16 $85.00 $85.00 $85.00 $17.72 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $85.00 $50.28 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $16.87 N/A $49.30 $85.00 $85.00 $85.00 $17.71 $85.00 N/A N/A 1050-02 SUP Custom 27203010 1050-02 - VLVLTM ANGIOSCOPIC ANTGRD 12.5CM LEMILLS BOTH IP/OP "$2,062.50" "$1,526.00" $367.13 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $367.13 "$2,062.50" "$2,062.50" "$1,530.79" "$1,530.79" "$1,589.78" "$1,074.56" $429.85 "$2,062.50" $825.00 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" "$1,340.63" "$2,062.50" N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" "$2,062.50" "$2,062.50" N/A N/A 1050-0523 SUP HCPCS C1776 1050-0523 - STEM FEMORAL 5 23MM HEAD NECK OMNIFIT COCR PLASMA HIP BOTH IP/OP "$5,486.00" "$4,060.00" "$1,088.83" "$5,486.00" "$2,468.70" "$2,468.70" "$2,468.70" "$2,468.70" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.42" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.34" "$5,486.00" "$2,194.40" "$2,704.60" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$4,114.50" "$5,486.00" "$5,486.00" "$5,486.00" "$2,743.00" "$2,743.00" "$4,344.91" "$5,486.00" "$4,388.80" "$2,468.70" "$1,088.83" N/A "$3,181.88" "$5,486.00" "$3,291.60" "$5,486.00" "$1,143.28" "$5,486.00" N/A N/A 1050-0531 SUP HCPCS C1776 1050-0531 - STEM FEMORAL 5 31MM HEAD NECK OMNIFIT COCR PLASMA HIP BOTH IP/OP "$5,486.00" "$4,060.00" "$1,088.83" "$5,486.00" "$2,468.70" "$2,468.70" "$2,468.70" "$2,468.70" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.42" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.34" "$5,486.00" "$2,194.40" "$2,704.60" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$4,114.50" "$5,486.00" "$5,486.00" "$5,486.00" "$2,743.00" "$2,743.00" "$4,344.91" "$5,486.00" "$4,388.80" "$2,468.70" "$1,088.83" N/A "$3,181.88" "$5,486.00" "$3,291.60" "$5,486.00" "$1,143.28" "$5,486.00" N/A N/A 1050-0727 SUP HCPCS C1776 1050-0727 - STEM FEMORAL 7 27MM HEAD NECK OMNIFIT COCR PLASMA HIP BOTH IP/OP "$5,486.00" "$4,060.00" "$1,088.83" "$5,486.00" "$2,468.70" "$2,468.70" "$2,468.70" "$2,468.70" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.42" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.34" "$5,486.00" "$5,486.00" "$2,704.60" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$4,114.50" "$5,486.00" "$5,486.00" "$5,486.00" "$2,743.00" "$2,743.00" "$4,344.91" "$5,486.00" "$4,388.80" "$2,468.70" "$1,088.83" N/A "$3,181.88" "$5,486.00" "$3,291.60" "$5,486.00" "$1,143.28" "$5,486.00" N/A N/A 1050-0737 SUP HCPCS C1776 1050-0737 - STEM FEMORAL 7 37MM HEAD NECK OMNIFIT COCR PLASMA HIP BOTH IP/OP "$5,486.00" "$4,060.00" "$1,088.83" "$5,486.00" "$2,468.70" "$2,468.70" "$2,468.70" "$2,468.70" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.42" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.34" "$5,486.00" "$5,486.00" "$2,704.60" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$4,114.50" "$5,486.00" "$5,486.00" "$5,486.00" "$2,743.00" "$2,743.00" "$4,344.91" "$5,486.00" "$4,388.80" "$2,468.70" "$1,088.83" N/A "$3,181.88" "$5,486.00" "$3,291.60" "$5,486.00" "$1,143.28" "$5,486.00" N/A N/A 1050-0747 SUP HCPCS C1776 1050-0747 - STEM FEMORAL 7 47MM HEAD NECK OMNIFIT COCR PLASMA HIP BOTH IP/OP "$5,486.00" "$4,060.00" "$1,088.83" "$5,486.00" "$2,468.70" "$2,468.70" "$2,468.70" "$2,468.70" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.42" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.34" "$5,486.00" "$5,486.00" "$2,704.60" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$4,114.50" "$5,486.00" "$5,486.00" "$5,486.00" "$2,743.00" "$2,743.00" "$4,344.91" "$5,486.00" "$4,388.80" "$2,468.70" "$1,088.83" N/A "$3,181.88" "$5,486.00" "$3,291.60" "$5,486.00" "$1,143.28" "$5,486.00" N/A N/A 1050-0932 SUP HCPCS C1776 1050-0932 - STEM FEMORAL 9 32MM HEAD NECK OMNIFIT COCR PLASMA HIP BOTH IP/OP "$5,486.00" "$4,060.00" "$1,088.83" "$5,486.00" "$2,468.70" "$2,468.70" "$2,468.70" "$2,468.70" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.42" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.34" "$5,486.00" "$5,486.00" "$2,704.60" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$4,114.50" "$5,486.00" "$5,486.00" "$5,486.00" "$2,743.00" "$2,743.00" "$4,344.91" "$5,486.00" "$4,388.80" "$2,468.70" "$1,088.83" N/A "$3,181.88" "$5,486.00" "$3,291.60" "$5,486.00" "$1,143.28" "$5,486.00" N/A N/A 1050-0943 SUP HCPCS C1776 1050-0943 - STEM FEMORAL 9 43MM HEAD NECK OMNIFIT COCR PLASMA HIP BOTH IP/OP "$5,486.00" "$4,060.00" "$1,088.83" "$5,486.00" "$2,468.70" "$2,468.70" "$2,468.70" "$2,468.70" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.42" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.34" "$5,486.00" "$5,486.00" "$2,704.60" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$4,114.50" "$5,486.00" "$5,486.00" "$5,486.00" "$2,743.00" "$2,743.00" "$4,344.91" "$5,486.00" "$4,388.80" "$2,468.70" "$1,088.83" N/A "$3,181.88" "$5,486.00" "$3,291.60" "$5,486.00" "$1,143.28" "$5,486.00" N/A N/A 1050-0955 SUP HCPCS C1776 1050-0955 - STEM FEMORAL 9 55MM HEAD NECK OMNIFIT COCR PLASMA HIP BOTH IP/OP "$5,486.00" "$4,060.00" "$1,088.83" "$5,486.00" "$2,468.70" "$2,468.70" "$2,468.70" "$2,468.70" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.42" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.34" "$5,486.00" "$2,194.40" "$2,704.60" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$4,114.50" "$5,486.00" "$5,486.00" "$5,486.00" "$2,743.00" "$2,743.00" "$4,344.91" "$5,486.00" "$4,388.80" "$2,468.70" "$1,088.83" N/A "$3,181.88" "$5,486.00" "$3,291.60" "$5,486.00" "$1,143.28" "$5,486.00" N/A N/A 1050-1136 SUP HCPCS C1776 1050-1136 - STEM FEMORAL 11 36MM HEAD NECK OMNIFIT COCR PLASMA HIP BOTH IP/OP "$5,486.00" "$4,060.00" "$1,088.83" "$5,486.00" "$2,468.70" "$2,468.70" "$2,468.70" "$2,468.70" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.42" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.34" "$5,486.00" "$2,194.40" "$2,704.60" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$4,114.50" "$5,486.00" "$5,486.00" "$5,486.00" "$2,743.00" "$2,743.00" "$4,344.91" "$5,486.00" "$4,388.80" "$2,468.70" "$1,088.83" N/A "$3,181.88" "$5,486.00" "$3,291.60" "$5,486.00" "$1,143.28" "$5,486.00" N/A N/A 1050-1149 SUP HCPCS C1776 1050-1149 - STEM FEMORAL 11 49MM HEAD NECK OMNIFIT COCR PLASMA HIP BOTH IP/OP "$5,486.00" "$4,060.00" "$1,088.83" "$5,486.00" "$2,468.70" "$2,468.70" "$2,468.70" "$2,468.70" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.42" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.34" "$5,486.00" "$2,194.40" "$2,704.60" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$4,114.50" "$5,486.00" "$5,486.00" "$5,486.00" "$2,743.00" "$2,743.00" "$4,344.91" "$5,486.00" "$4,388.80" "$2,468.70" "$1,088.83" N/A "$3,181.88" "$5,486.00" "$3,291.60" "$5,486.00" "$1,143.28" "$5,486.00" N/A N/A 1050-1163 SUP HCPCS C1776 1050-1163 - STEM FEMORAL 11 63MM HEAD NECK OMNIFIT COCR PLASMA HIP BOTH IP/OP "$5,486.00" "$4,060.00" "$1,088.83" "$5,486.00" "$2,468.70" "$2,468.70" "$2,468.70" "$2,468.70" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.42" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$1,143.34" "$5,486.00" "$5,486.00" "$2,704.60" "$5,486.00" "$5,486.00" "$5,486.00" "$5,486.00" "$4,114.50" "$5,486.00" "$5,486.00" "$5,486.00" "$2,743.00" "$2,743.00" "$4,344.91" "$5,486.00" "$4,388.80" "$2,468.70" "$1,088.83" N/A "$3,181.88" "$5,486.00" "$3,291.60" "$5,486.00" "$1,143.28" "$5,486.00" N/A N/A 105039-001 SUP HCPCS C1757 105039-001 - SET THROMBECTOMY 15MM TAPER 6FR 3MM 50CM OTW SHEATH CATHETER BOTH IP/OP "$1,850.00" "$1,369.00" $367.18 "$1,850.00" "$1,004.55" "$1,004.55" "$1,004.55" "$1,004.55" "$1,850.00" "$1,850.00" "$1,850.00" $385.59 "$1,850.00" "$1,373.07" "$1,373.07" "$1,425.98" $963.85 $385.56 "$1,850.00" "$1,850.00" "$1,094.28" "$1,850.00" "$1,850.00" "$1,850.00" "$1,850.00" "$1,387.50" "$1,850.00" "$1,850.00" "$1,850.00" $925.00 $925.00 "$1,465.20" "$1,850.00" "$1,480.00" "$1,202.50" $367.18 N/A "$1,073.00" "$1,850.00" "$1,850.00" "$1,850.00" $385.54 "$1,850.00" N/A N/A 105040-001 SUP HCPCS C1757 105040-001 - SET THRMB 6FR 3MM 120CM LF ANGJT ULT XPEEDIOR 1 LUM OTW CATH BOTH IP/OP "$3,287.50" "$2,433.00" $652.49 "$3,287.50" "$1,785.11" "$1,785.11" "$1,785.11" "$1,785.11" "$3,287.50" "$3,287.50" "$3,287.50" $685.20 "$3,287.50" "$2,439.98" "$2,439.98" "$2,534.01" "$1,712.79" $685.15 "$3,287.50" "$3,287.50" "$1,944.56" "$3,287.50" "$3,287.50" "$3,287.50" "$3,287.50" "$2,465.63" "$3,287.50" "$3,287.50" "$3,287.50" "$1,643.75" "$1,643.75" "$2,603.70" "$3,287.50" "$2,630.00" "$2,136.88" $652.49 N/A "$1,906.75" "$3,287.50" "$3,287.50" "$3,287.50" $685.12 "$3,287.50" N/A N/A 105042-001 SUP HCPCS C1757 105042-001 - SET THROMBECTOMY XVC BOTH IP/OP "$4,362.50" "$3,228.00" $865.85 "$4,362.50" "$2,368.84" "$2,368.84" "$2,368.84" "$2,368.84" "$4,362.50" "$4,362.50" "$4,362.50" $909.25 "$4,362.50" "$3,237.85" "$3,237.85" "$3,362.62" "$2,060.15" $909.19 "$4,362.50" "$4,362.50" "$2,580.42" "$4,362.50" "$4,362.50" "$4,362.50" "$4,362.50" "$3,271.88" "$4,362.50" "$4,362.50" "$4,362.50" "$2,181.25" "$2,181.25" "$3,455.10" "$4,362.50" "$3,490.00" "$2,835.63" $865.85 N/A "$2,530.25" "$4,362.50" "$4,362.50" "$4,362.50" $909.15 "$4,362.50" N/A N/A 105-5056 SUP HCPCS C1757 105-5056 - CATHETER INFS .010IN MIC 2.7-1.5FR .013IN 170CM 25CM MRTHN BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $855.23 $855.23 $855.23 $855.23 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,168.97" "$1,168.97" "$1,214.01" $820.58 $328.25 "$1,575.00" "$1,500.00" $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" "$1,023.75" $312.60 N/A $913.50 "$1,575.00" "$1,575.00" "$1,575.00" $328.23 "$1,575.00" N/A N/A 105-5091-150 SUP HCPCS C1887 105-5091-150 - CATHETER INFS MIC 2.1-1.7FR 5FR .017IN 155CM .34ML 150CM BOTH IP/OP "$1,587.50" "$1,175.00" $315.08 "$1,587.50" $862.01 $862.01 $862.01 $862.01 "$1,587.50" "$1,587.50" "$1,587.50" $330.87 "$1,587.50" "$1,178.24" "$1,178.24" "$1,223.65" $827.09 $330.85 "$1,587.50" "$1,587.50" $939.01 "$1,587.50" "$1,587.50" "$1,587.50" "$1,587.50" "$1,190.63" "$1,587.50" "$1,587.50" "$1,587.50" $793.75 $793.75 "$1,257.30" "$1,587.50" "$1,270.00" "$1,031.88" $315.08 N/A $920.75 "$1,587.50" "$1,587.50" "$1,587.50" $330.84 "$1,587.50" N/A N/A 105-5092-150 SUP HCPCS C1887 105-5092-150 - CATHETER INFS .014IN MIC 2.4-1.9FR .017IN 155CM 150CM ECHLN BOTH IP/OP "$1,587.50" "$1,175.00" $315.08 "$1,587.50" $862.01 $862.01 $862.01 $862.01 "$1,587.50" "$1,587.50" "$1,587.50" $330.87 "$1,587.50" "$1,178.24" "$1,178.24" "$1,223.65" $827.09 $330.85 "$1,587.50" "$1,587.50" $939.01 "$1,587.50" "$1,587.50" "$1,587.50" "$1,587.50" "$1,190.63" "$1,587.50" "$1,587.50" "$1,587.50" $793.75 $793.75 "$1,257.30" "$1,587.50" "$1,270.00" "$1,031.88" $315.08 N/A $920.75 "$1,587.50" "$1,587.50" "$1,587.50" $330.84 "$1,587.50" N/A N/A 105-5094-153 SUP HCPCS C1757 105-5094-153 - MICROCATHETER GD 2.8-2.2FR 155CM NAUTICA 14XL OTW REINF ACPT BOTH IP/OP "$1,310.00" $969.00 $260.00 "$1,310.00" $711.33 $711.33 $711.33 $711.33 "$1,310.00" "$1,310.00" "$1,310.00" $273.04 "$1,310.00" $972.28 $972.28 "$1,009.75" $682.51 $273.02 "$1,310.00" "$1,247.50" $774.87 "$1,310.00" "$1,310.00" "$1,310.00" "$1,310.00" $982.50 "$1,310.00" "$1,310.00" "$1,310.00" $655.00 $655.00 "$1,037.52" "$1,310.00" "$1,048.00" $851.50 $260.00 N/A $759.80 "$1,310.00" "$1,310.00" "$1,310.00" $273.00 "$1,310.00" N/A N/A 1057-0018 SUP HCPCS C1713 1057-0018 - SPACER CEMENT 18MM CEMENT KNEE BOTH IP/OP $75.00 $56.00 $14.89 $75.00 $33.75 $33.75 $33.75 $33.75 $75.00 $75.00 $75.00 $15.63 $75.00 $75.00 $75.00 $75.00 $75.00 $15.63 $75.00 $30.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $33.75 $14.89 N/A $43.50 $75.00 $45.00 $75.00 $15.63 $75.00 N/A N/A 1057-0019 SUP HCPCS C1713 1057-0019 - SPACER CEMENT 19MM CEMENT KNEE BOTH IP/OP $75.00 $56.00 $14.89 $75.00 $33.75 $33.75 $33.75 $33.75 $75.00 $75.00 $75.00 $15.63 $75.00 $75.00 $75.00 $75.00 $75.00 $15.63 $75.00 $30.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $33.75 $14.89 N/A $43.50 $75.00 $75.00 $75.00 $15.63 $75.00 N/A N/A 1057-0020 SUP HCPCS C1713 1057-0020 - SPACER CEMENT 20MM CEMENT KNEE BOTH IP/OP $75.00 $56.00 $14.89 $75.00 $33.75 $33.75 $33.75 $33.75 $75.00 $75.00 $75.00 $15.63 $75.00 $75.00 $75.00 $75.00 $75.00 $15.63 $75.00 $30.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $33.75 $14.89 N/A $43.50 $75.00 $45.00 $75.00 $15.63 $75.00 N/A N/A 1057-0021 SUP HCPCS C1713 1057-0021 - SPACER CEMENT 21MM CEMENT KNEE BOTH IP/OP $75.00 $56.00 $14.89 $75.00 $33.75 $33.75 $33.75 $33.75 $75.00 $75.00 $75.00 $15.63 $75.00 $75.00 $75.00 $75.00 $75.00 $15.63 $75.00 $30.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $33.75 $14.89 N/A $43.50 $75.00 $45.00 $75.00 $15.63 $75.00 N/A N/A 1057-0022 SUP HCPCS C1713 1057-0022 - SPACER CEMENT 22MM CEMENT KNEE BOTH IP/OP $75.00 $56.00 $14.89 $75.00 $33.75 $33.75 $33.75 $33.75 $75.00 $75.00 $75.00 $15.63 $75.00 $75.00 $75.00 $75.00 $75.00 $15.63 $75.00 $30.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $33.75 $14.89 N/A $43.50 $75.00 $45.00 $75.00 $15.63 $75.00 N/A N/A 105-7100-060 SUP Custom 27803010 105-7100-060 - SYSTEM EMBL 1.5ML 1ML ONX18 SYR DMTH SLFXD BOTH IP/OP "$5,625.00" "$4,163.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$2,500.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$5,625.00" N/A "$3,262.50" "$5,625.00" "$3,375.00" "$5,625.00" "$5,625.00" "$5,625.00" N/A N/A 105-7100-080 SUP Custom 27803010 105-7100-080 - SYSTEM EMBL 1.5ML 1ML ONX34 SYR VL LQ 8% ETHYL VNYL ALC DMTH BOTH IP/OP "$5,625.00" "$4,163.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$2,500.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$5,625.00" N/A "$3,262.50" "$5,625.00" "$3,375.00" "$5,625.00" "$5,625.00" "$5,625.00" N/A N/A 1058-0005 SUP Custom 27803010 1058-0005 - SPACER FEMORAL 5MM OMNIFIT BARIUM HIP PROXIMAL BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1058-0006 SUP Custom 27803010 1058-0006 - SPACER FEMORAL 6MM OMNIFIT BARIUM HIP PROXIMAL BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1058-0007 SUP Custom 27803010 1058-0007 - SPACER FEMORAL 7MM OMNIFIT BARIUM HIP PROXIMAL BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1058-0008 SUP Custom 27803010 1058-0008 - SPACER FEMORAL 8MM OMNIFIT BARIUM HIP PROXIMAL BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1058-0009 SUP Custom 27803010 1058-0009 - SPACER FEMORAL 9MM OMNIFIT BARIUM HIP PROXIMAL BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1058-0010 SUP Custom 27803010 1058-0010 - SPACER FEMORAL 10MM OMNIFIT BARIUM HIP PROXIMAL BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1058-0011 SUP Custom 27803010 1058-0011 - SPACER FEMORAL 11MM OMNIFIT BARIUM HIP PROXIMAL BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-2310 SUP Custom 27803010 1059-2310 - SPACER FEMORAL SMALL 10MM RING STYLE CEMENTED ACCOLADE C HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-2311 SUP Custom 27803010 1059-2311 - SPACER FEMORAL SMALL 11MM RING STYLE CEMENTED ACCOLADE C HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-2312 SUP Custom 27803010 1059-2312 - SPACER FEMORAL SMALL 12MM RING STYLE CEMENTED ACCOLADE C HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-2313 SUP Custom 27803010 1059-2313 - SPACER FEMORAL SMALL 13MM RING STYLE CEMENTED ACCOLADE C HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-2314 SUP Custom 27803010 1059-2314 - SPACER FEMORAL SMALL 14MM RING STYLE CEMENTED ACCOLADE C HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-2315 SUP Custom 27803010 1059-2315 - SPACER FEMORAL SMALL 15MM RING STYLE CEMENTED ACCOLADE C HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-4512 SUP Custom 27803010 1059-4512 - SPACER FEMORAL MEDIUM 12MM RING STYLE CEMENTED ACCOLADE C BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-4513 SUP Custom 27803010 1059-4513 - SPACER FEMORAL MEDIUM 13MM RING STYLE CEMENTED ACCOLADE C BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-4514 SUP Custom 27803010 1059-4514 - SPACER FEMORAL MEDIUM 14MM RING STYLE CEMENTED ACCOLADE C BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-4515 SUP Custom 27803010 1059-4515 - SPACER FEMORAL MEDIUM 15MM RING STYLE CEMENTED ACCOLADE C BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-4516 SUP Custom 27803010 1059-4516 - SPACER FEMORAL MEDIUM 16MM RING STYLE CEMENTED ACCOLADE C BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-4517 SUP Custom 27803010 1059-4517 - SPACER FEMORAL MEDIUM 17MM RING STYLE CEMENTED ACCOLADE C BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-6713 SUP Custom 27803010 1059-6713 - SPACER FEMORAL LARGE 13MM RING STYLE CEMENTED ACCOLADE C HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-6714 SUP Custom 27803010 1059-6714 - SPACER FEMORAL LARGE 14MM RING STYLE CEMENTED ACCOLADE C HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-6715 SUP Custom 27803010 1059-6715 - SPACER FEMORAL LARGE 15MM RING STYLE CEMENTED ACCOLADE C HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-6716 SUP Custom 27803010 1059-6716 - SPACER FEMORAL LARGE 16MM RING STYLE CEMENTED ACCOLADE C HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-6717 SUP Custom 27803010 1059-6717 - SPACER FEMORAL LARGE 17MM RING STYLE CEMENTED ACCOLADE C HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1059-6718 SUP Custom 27803010 1059-6718 - SPACER FEMORAL LARGE 18MM RING STYLE CEMENTED ACCOLADE C HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1064-0425 SUP HCPCS C1776 1064-0425 - STEM FEMORAL CEMENTED OMNIFIT EON HIP BOTH IP/OP "$5,062.00" "$3,746.00" "$1,004.68" "$5,062.00" "$2,277.90" "$2,277.90" "$2,277.90" "$2,277.90" "$5,062.00" "$5,062.00" "$5,062.00" "$1,055.05" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$1,054.98" "$5,062.00" "$2,024.80" "$2,495.57" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$3,796.50" "$5,062.00" "$5,062.00" "$5,062.00" "$2,531.00" "$2,531.00" "$4,009.10" "$5,062.00" "$4,049.60" "$2,277.90" "$1,004.68" N/A "$2,935.96" "$5,062.00" "$3,037.20" "$5,062.00" "$1,054.92" "$5,062.00" N/A N/A 1064-0525 SUP HCPCS C1776 1064-0525 - OMNIFIT CEMENTED STEM (MT) BOTH IP/OP "$5,062.00" "$3,746.00" "$1,004.68" "$5,062.00" "$2,277.90" "$2,277.90" "$2,277.90" "$2,277.90" "$5,062.00" "$5,062.00" "$5,062.00" "$1,055.05" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$1,054.98" "$5,062.00" "$2,024.80" "$2,495.57" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$3,796.50" "$5,062.00" "$5,062.00" "$5,062.00" "$2,531.00" "$2,531.00" "$4,009.10" "$5,062.00" "$4,049.60" "$2,277.90" "$1,004.68" N/A "$2,935.96" "$5,062.00" "$3,037.20" "$5,062.00" "$1,054.92" "$5,062.00" N/A N/A 1064-0625 SUP HCPCS C1776 1064-0625 - STEM FEMORAL CEMENTED OMNIFIT EON HIP BOTH IP/OP "$3,657.00" "$2,706.00" $725.82 "$3,657.00" "$1,645.65" "$1,645.65" "$1,645.65" "$1,645.65" "$3,657.00" "$3,657.00" "$3,657.00" $762.21 "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" $762.16 "$3,657.00" "$3,657.00" "$1,802.90" "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" "$2,742.75" "$3,657.00" "$3,657.00" "$3,657.00" "$1,828.50" "$1,828.50" "$2,896.34" "$3,657.00" "$2,925.60" "$1,645.65" $725.82 N/A "$2,121.06" "$3,657.00" "$3,657.00" "$3,657.00" $762.12 "$3,657.00" N/A N/A 1064-0730 SUP HCPCS C1776 1064-0730 - STEM FEMORAL CEMENTED OMNIFIT EON HIP BOTH IP/OP "$5,062.00" "$3,746.00" "$1,004.68" "$5,062.00" "$2,277.90" "$2,277.90" "$2,277.90" "$2,277.90" "$5,062.00" "$5,062.00" "$5,062.00" "$1,055.05" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$1,054.98" "$5,062.00" "$2,024.80" "$2,495.57" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$3,796.50" "$5,062.00" "$5,062.00" "$5,062.00" "$2,531.00" "$2,531.00" "$4,009.10" "$5,062.00" "$4,049.60" "$2,277.90" "$1,004.68" N/A "$2,935.96" "$5,062.00" "$3,037.20" "$5,062.00" "$1,054.92" "$5,062.00" N/A N/A 1064-0830 SUP HCPCS C1776 1064-0830 - STEM FEMORAL CEMENTED OMNIFIT EON HIP BOTH IP/OP "$5,062.00" "$3,746.00" "$1,004.68" "$5,062.00" "$2,277.90" "$2,277.90" "$2,277.90" "$2,277.90" "$5,062.00" "$5,062.00" "$5,062.00" "$1,055.05" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$1,054.98" "$5,062.00" "$2,024.80" "$2,495.57" "$5,062.00" "$5,062.00" "$5,062.00" "$5,062.00" "$3,796.50" "$5,062.00" "$5,062.00" "$5,062.00" "$2,531.00" "$2,531.00" "$4,009.10" "$5,062.00" "$4,049.60" "$2,277.90" "$1,004.68" N/A "$2,935.96" "$5,062.00" "$3,037.20" "$5,062.00" "$1,054.92" "$5,062.00" N/A N/A 106552-001 SUP HCPCS C1757 106552-001 - SET THROMBECTOMY 6FR 3MM 90CM OTW POWER PULSE DELIVERY BOTH IP/OP "$3,787.50" "$2,803.00" $751.72 "$3,787.50" "$2,056.61" "$2,056.61" "$2,056.61" "$2,056.61" "$3,787.50" "$3,787.50" "$3,787.50" $789.41 "$3,787.50" "$2,811.08" "$2,811.08" "$2,919.41" "$1,973.29" $789.36 "$3,787.50" "$3,787.50" "$2,240.31" "$3,787.50" "$3,787.50" "$3,787.50" "$3,787.50" "$2,840.63" "$3,787.50" "$3,787.50" "$3,787.50" "$1,893.75" "$1,893.75" "$2,999.70" "$3,787.50" "$3,030.00" "$2,461.88" $751.72 N/A "$2,196.75" "$3,787.50" "$3,787.50" "$3,787.50" $789.32 "$3,787.50" N/A N/A 106553-001 SUP HCPCS C1757 106553-001 - SET THROMBECTOMY LONG TAPER 4FR 2MM 135CM OTW RAPEX CATHETER BOTH IP/OP "$4,487.50" "$3,321.00" $890.66 "$4,487.50" "$2,436.71" "$2,436.71" "$2,436.71" "$2,436.71" "$4,487.50" "$4,487.50" "$4,487.50" $935.31 "$4,487.50" "$3,330.62" "$3,330.62" "$3,458.97" "$2,060.15" $935.24 "$4,487.50" "$4,487.50" "$2,654.36" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$3,365.63" "$4,487.50" "$4,487.50" "$4,487.50" "$2,243.75" "$2,243.75" "$3,554.10" "$4,487.50" "$3,590.00" "$2,916.88" $890.66 N/A "$2,602.75" "$4,487.50" "$4,487.50" "$4,487.50" $935.20 "$4,487.50" N/A N/A 106608-001 SUP HCPCS C1757 106608-001 - SET THROMBECTOMY 60ML/MIN LONG TAPER 5FR 3MM 135CM RAPEX BOTH IP/OP "$5,375.00" "$3,978.00" "$1,066.80" "$5,375.00" "$2,918.63" "$2,918.63" "$2,918.63" "$2,918.63" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.28" "$5,375.00" "$3,989.33" "$3,989.33" "$4,143.05" "$2,060.15" "$1,120.21" "$5,375.00" "$5,375.00" "$3,094.73" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$4,031.25" "$5,375.00" "$5,375.00" "$5,375.00" "$2,687.50" "$2,687.50" "$4,257.00" "$5,375.00" "$4,300.00" "$3,493.75" "$1,066.80" N/A "$3,117.50" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.15" "$5,375.00" N/A N/A 1067-0002 SUP HCPCS C1713 1067-0002 - SPACER FEMORAL UNIVERSAL HOLE PLUG CEMENTED OMNIFIT BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0008 SUP HCPCS C1713 1067-0008 - SPACER FEMORAL UNIVERSAL 8MM CEMENTED ACCOLADE HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0009 SUP HCPCS C1713 1067-0009 - SPACER FEMORAL UNIVERSAL 9MM CEMENTED ACCOLADE HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0010 SUP Custom 27803010 1067-0010 - SPACER CMNT UNV 10MM HIP DIST BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1067-0011 SUP HCPCS C1713 1067-0011 - SPACER FEMORAL UNIVERSAL 11MM CEMENTED ACCOLADE HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0012 SUP Custom 27803010 1067-0012 - SPACER FEMORAL UNIVERSAL 12MM CEMENTED ACCOLADE HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 1067-0013 SUP HCPCS C1713 1067-0013 - SPACER FEMORAL UNIVERSAL 13MM CEMENTED ACCOLADE HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0014 SUP HCPCS C1713 1067-0014 - SPACER CMNT UNV 14MM ACLD HIP DIST BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0015 SUP HCPCS C1713 1067-0015 - SPACER FEMORAL UNIVERSAL 15MM CEMENTED ACCOLADE HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0016 SUP HCPCS C1713 1067-0016 - SPACER CMNT UNV 16MM ACLD HIP DIST BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0017 SUP HCPCS C1713 1067-0017 - SPACER CMNT UNV 17MM ACLD HIP DIST BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0018 SUP HCPCS C1713 1067-0018 - SPACER FEMORAL UNIVERSAL 18MM CEMENTED ACCOLADE HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0019 SUP HCPCS C1713 1067-0019 - SPACER CMNT UNV 19MM ACLD HIP DIST BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0020 SUP HCPCS C1713 1067-0020 - SPACER FEMORAL UNIVERSAL 20MM PRIM C-STEM HIP DISTAL BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0021 SUP HCPCS C1713 1067-0021 - SPACER CMNT UNV 21MM ACLD HIP DIST BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0022 SUP HCPCS C1713 1067-0022 - SPACER CMNT UNV 22MM ACLD HIP DIST BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 1067-0023 SUP HCPCS C1713 1067-0023 - SPACER CMNT UNV 23MM ACLD HIP DIST BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0024 SUP HCPCS C1713 1067-0024 - SPACER CMNT UNV 24MM ACLD HIP DIST BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1067-0025 SUP HCPCS C1713 1067-0025 - SPACER FEM UNV 25MM ACLD POLYMETHYLMETHACRYLATE DIST HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 1074225-08 SUP HCPCS C1874 1074225-08 - STENT CORON .014IN TAPER 2.25MM 8MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074225-12 SUP HCPCS C1874 1074225-12 - STENT CORON .014IN TAPER 2.25MM 12MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074225-15 SUP HCPCS C1874 1074225-15 - STENT CORON .014IN TAPER 2.25MM 15MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074225-18 SUP HCPCS C1874 1074225-18 - STENT CORON .014IN TAPER 2.25MM 18MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074225-23 SUP HCPCS C1874 1074225-23 - STENT CORON .014IN TAPER 2.25MM 23MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074225-28 SUP HCPCS C1874 1074225-28 - STENT CORON .014IN TAPER 2.25MM 28MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074250-08 SUP HCPCS C1874 1074250-08 - STENT CORON .014IN TAPER 2.5MM 8MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074250-12 SUP HCPCS C1874 1074250-12 - STENT CORON .014IN TAPER 2.5MM 12MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074250-15 SUP HCPCS C1874 1074250-15 - STENT CORON .014IN TAPER 2.5MM 15MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074250-18 SUP HCPCS C1874 1074250-18 - STENT CORON .014IN TAPER 2.5MM 18MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074250-23 SUP HCPCS C1874 1074250-23 - STENT CORON .014IN TAPER 2.5MM 23MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074250-28 SUP HCPCS C1874 1074250-28 - STENT CORON .014IN TAPER 2.5MM 28MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074250-33 SUP HCPCS C1874 1074250-33 - STENT CORON .014IN TAPER 2.5MM 33MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074250-38 SUP HCPCS C1874 1074250-38 - STENT CORON .014IN TAPER 2.5MM 38MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074275-08 SUP HCPCS C1874 1074275-08 - STENT CORON .014IN TAPER 2.75MM 8MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074275-12 SUP HCPCS C1874 1074275-12 - STENT CORON .014IN TAPER 2.75MM 12MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074275-15 SUP HCPCS C1874 1074275-15 - STENT CORON .014IN TAPER 2.75MM 15MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074275-18 SUP HCPCS C1874 1074275-18 - STENT CORON .014IN TAPER 2.75MM 18MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074275-23 SUP HCPCS C1874 1074275-23 - STENT CORON .014IN TAPER 2.75MM 23MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074275-28 SUP HCPCS C1874 1074275-28 - STENT CORON .014IN TAPER 2.75MM 28MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074275-33 SUP HCPCS C1874 1074275-33 - STENT CORON .014IN TAPER 2.75MM 33MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074275-38 SUP HCPCS C1874 1074275-38 - STENT CORON .014IN TAPER 2.75MM 38MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074300-08 SUP HCPCS C1874 1074300-08 - STENT CORON .014IN TAPER 3MM 8MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074300-12 SUP HCPCS C1874 1074300-12 - STENT CORON .014IN TAPER 3MM 12MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074300-15 SUP HCPCS C1874 1074300-15 - STENT CORON .014IN TAPER 3MM 15MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074300-18 SUP HCPCS C1874 1074300-18 - STENT CORON .014IN TAPER 3MM 18MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074300-23 SUP HCPCS C1874 1074300-23 - STENT CORON .014IN TAPER 3MM 23MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074300-28 SUP HCPCS C1874 1074300-28 - STENT CORON .014IN TAPER 3MM 28MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074300-33 SUP HCPCS C1874 1074300-33 - STENT CORON .014IN TAPER 3MM 33MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074300-38 SUP HCPCS C1874 1074300-38 - STENT CORON .014IN TAPER 3MM 38MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074325-08 SUP HCPCS C1874 1074325-08 - STENT CORON .014IN TAPER 3.25MM .028IN 5FR 8MM 145CM 2 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074325-12 SUP HCPCS C1874 1074325-12 - STENT CORON .014IN TAPER 3.25MM .028IN 5FR 12MM 145CM 2 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074325-18 SUP HCPCS C1874 1074325-18 - STENT CORON .014IN TAPER 3.25MM 18MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074325-23 SUP HCPCS C1874 1074325-23 - STENT CORON .014IN TAPER 3.25MM 23MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074325-28 SUP HCPCS C1874 1074325-28 - STENT CORON .014IN TAPER 3.25MM 28MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074325-33 SUP HCPCS C1874 1074325-33 - STENT CORON .014IN TAPER 3.25MM 33MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074325-38 SUP HCPCS C1874 1074325-38 - STENT CORON .014IN TAPER 3.25MM 38MM 145CM 2 RADIOPQ MARKER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074350-08 SUP HCPCS C1874 1074350-08 - STENT CORON .014IN TAPER 3.5MM 8MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074350-12 SUP HCPCS C1874 1074350-12 - STENT CORON .014IN TAPER 3.5MM 12MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074350-15 SUP HCPCS C1874 1074350-15 - STENT CORON .014IN TAPER 3.5MM 15MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074350-18 SUP HCPCS C1874 1074350-18 - STENT CORON .014IN TAPER 3.5MM 18MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074350-23 SUP HCPCS C1874 1074350-23 - STENT CORON .014IN TAPER 3.5MM 23MM 145CM 2 RADIOPQ 1 ACCES BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074350-28 SUP HCPCS C1874 1074350-28 - STENT CORON .014IN TAPER 3.5MM 28MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074350-33 SUP HCPCS C1874 1074350-33 - STENT CORON .014IN TAPER 3.5MM 33MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074350-38 SUP HCPCS C1874 1074350-38 - STENT CORON .014IN TAPER 3.5MM 38MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074400-08 SUP HCPCS C1874 1074400-08 - STENT CORON .014IN TAPER 4MM 8MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074400-12 SUP HCPCS C1874 1074400-12 - STENT CORON .014IN TAPER 4MM 12MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074400-15 SUP HCPCS C1874 1074400-15 - STENT CORON .014IN TAPER 4MM 15MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074400-18 SUP HCPCS C1874 1074400-18 - STENT CORON .014IN TAPER 4MM 18MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074400-23 SUP HCPCS C1874 1074400-23 - STENT CORON .014IN TAPER 4MM 23MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074400-28 SUP HCPCS C1874 1074400-28 - STENT CORON .014IN TAPER 4MM 28MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074400-33 SUP HCPCS C1874 1074400-33 - STENT CORON .014IN TAPER 4MM 33MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1074400-38 SUP HCPCS C1874 1074400-38 - STENT CORON .014IN TAPER 4MM 38MM 145CM 2 RADIOPQ MARKER 1 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 1082-MED SUP HCPCS L3702 1082-MED - SUPPORT ORTHOPEDIC MEDIUM 10IN CORSET ELAST VELCRO CLOSURE BOTH IP/OP $45.00 $33.00 $9.33 $208.54 $20.14 $20.14 $20.14 $20.14 $44.75 $44.75 $170.29 $208.54 $44.75 $44.75 $44.75 $44.75 $44.75 $9.33 $44.75 $17.90 $26.47 $44.75 $44.75 $44.75 $44.75 $33.75 $44.75 $44.75 $44.75 $22.38 $22.38 $35.44 $44.75 $35.80 $20.14 $44.75 N/A $26.10 $44.75 $26.85 $44.75 $202.65 $44.75 N/A N/A 109681-001 SUP HCPCS C1757 109681-001 - SET THROMBECTOMY 6FR 3MM 120CM 15MM OTW CONTRAST INJEC PORT BOTH IP/OP "$4,225.00" "$3,127.00" $838.56 "$4,225.00" "$2,294.18" "$2,294.18" "$2,294.18" "$2,294.18" "$4,225.00" "$4,225.00" "$4,225.00" $880.60 "$4,225.00" "$3,135.80" "$3,135.80" "$3,256.63" "$2,060.15" $880.54 "$4,225.00" "$4,225.00" "$2,499.09" "$4,225.00" "$4,225.00" "$4,225.00" "$4,225.00" "$3,168.75" "$4,225.00" "$4,225.00" "$4,225.00" "$2,112.50" "$2,112.50" "$3,346.20" "$4,225.00" "$3,380.00" "$2,746.25" $838.56 N/A "$2,450.50" "$4,225.00" "$4,225.00" "$4,225.00" $880.49 "$4,225.00" N/A N/A 10A001 SUP Custom 27804086 10A001 - GRAFT BONE 1-4MM CANCELLOUS CORTICAL 30ML BOTH IP/OP "$1,042.50" $771.00 $185.57 "$1,105.00" "$1,042.50" "$1,042.50" "$1,042.50" "$1,042.50" "$1,042.50" "$1,042.50" $185.57 "$1,042.50" "$1,042.50" "$1,042.50" "$1,042.50" "$1,042.50" "$1,042.50" $217.27 "$1,042.50" $442.00 "$1,042.50" "$1,042.50" "$1,105.00" "$1,042.50" "$1,042.50" $781.88 "$1,042.50" "$1,042.50" "$1,042.50" $521.25 $521.25 $825.66 "$1,042.50" $834.00 $469.13 "$1,042.50" N/A $604.65 "$1,042.50" $625.50 "$1,042.50" "$1,042.50" "$1,042.50" N/A N/A 10A002 SUP Custom 27804086 10A002 - GRAFT BONE 1-4MM CANCELLOUS CORTICAL 15ML BOTH IP/OP $595.00 $440.00 $105.91 $630.00 $595.00 $595.00 $595.00 $595.00 $595.00 $595.00 $105.91 $595.00 $595.00 $595.00 $595.00 $595.00 $595.00 $124.00 $595.00 $252.00 $595.00 $595.00 $630.00 $595.00 $595.00 $446.25 $595.00 $595.00 $595.00 $297.50 $297.50 $471.24 $595.00 $476.00 $267.75 $595.00 N/A $345.10 $595.00 $357.00 $595.00 $595.00 $595.00 N/A N/A 10AC50 SUP Custom 27203010 10AC50 - TOOL DISSECTING 5MM 10CM ACORN MIDAS REX LEGEND STERILE BOTH IP/OP $314.50 $233.00 $55.98 $314.50 $314.50 $314.50 $314.50 $314.50 $314.50 $314.50 $55.98 $314.50 $314.50 $233.42 $233.42 $242.42 $163.85 $65.55 $314.50 $125.80 $314.50 $314.50 $314.50 $314.50 $314.50 $235.88 $314.50 $314.50 $314.50 $157.25 $157.25 $249.08 $314.50 $251.60 $204.43 $314.50 N/A $182.41 $314.50 $188.70 $314.50 $314.50 $314.50 N/A N/A 10AC60 SUP Custom 27203010 10AC60 - TOOL DISSECTING 6MM 10CM ACORN MIDAS REX LEGEND STERILE BOTH IP/OP $314.50 $233.00 $55.98 $314.50 $314.50 $314.50 $314.50 $314.50 $314.50 $314.50 $55.98 $314.50 $314.50 $233.42 $233.42 $242.42 $163.85 $65.55 $314.50 $125.80 $314.50 $314.50 $314.50 $314.50 $314.50 $235.88 $314.50 $314.50 $314.50 $157.25 $157.25 $249.08 $314.50 $251.60 $204.43 $314.50 N/A $182.41 $314.50 $188.70 $314.50 $314.50 $314.50 N/A N/A 10BA10 SUP Custom 27203010 10BA10 - TOOL DISSECTING 1MM 10CM BALL FLUTED MIDAS REX LEGEND BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 10BA10D SUP Custom 27203010 10BA10D - TOOL DISSECTING 1MM 10CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 10BA10D-MN SUP Custom 27203010 10BA10D-MN - TOOL DISSECTING 1MM 10CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 10BA10-MN SUP Custom 27203010 10BA10-MN - TOOL DISSECTING BALL FLUTE 1MM 10CM MIDAS REX LEGEND MEDNEXT BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 10BA20 SUP Custom 27203010 10BA20 - TOOL DISSECTING BALL 2MM 10CM LEGEND STERILE BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 10BA20D SUP Custom 27203010 10BA20D - TOOL DISSECTING BALL 2MM 10CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 10BA20D-MN SUP Custom 27203010 10BA20D-MN - TOOL DISSECTING 2MM 10CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 10BA20-MN SUP Custom 27203010 10BA20-MN - TOOL DISSECTING BALL 2MM 10CM FLUTED SMALL BORE MIDAS REX BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 10BA30 SUP Custom 27203010 10BA30 - TOOL DISSECTING BALL 3MM 10CM FLUTED MIDAS REX LEGEND BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 10BA30D SUP Custom 27203010 10BA30D - TOOL DISSECTING 3MM 100MM BALL DIAMOND LEGEND STERILE BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 10BA30DC SUP Custom 27203010 10BA30DC - TOOL DISSECTING 3MM 10CM BALL DIAMOND COARSE MIDAS REX BOTH IP/OP $329.50 $244.00 $58.63 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $58.63 $329.38 $329.38 $244.47 $244.47 $253.89 $171.61 $68.65 $329.38 $131.75 $329.38 $329.38 $329.38 $329.38 $329.38 $247.13 $329.38 $329.38 $329.38 $164.69 $164.69 $260.87 $329.38 $263.50 $214.10 $329.38 N/A $191.11 $329.38 $197.63 $329.38 $329.38 $329.38 N/A N/A 10BA30D-MN SUP Custom 27203010 10BA30D-MN - TOOL DISSECTING 3MM 10CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 10BA30-MN SUP Custom 27203010 10BA30-MN - TOOL DISSECTING 3MM 10CM BALL FLUTED MIDAS REX LEGEND BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 10BA40 SUP Custom 27203010 10BA40 - TOOL DISSECTING BALL COARSE 4MM 10CM BALL LEGEND STERILE BOTH IP/OP $334.00 $247.00 $59.39 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $59.39 $333.63 $333.63 $247.62 $247.62 $257.16 $173.82 $69.53 $333.63 $133.45 $333.63 $333.63 $333.63 $333.63 $333.63 $250.50 $333.63 $333.63 $333.63 $166.82 $166.82 $264.23 $333.63 $266.90 $216.86 $333.63 N/A $193.72 $333.63 $200.18 $333.63 $333.63 $333.63 N/A N/A 10BA40D SUP Custom 27203010 10BA40D - TOOL DISSECTING BALL 4MM 10CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $334.00 $247.00 $59.39 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $59.39 $333.63 $333.63 $247.62 $247.62 $257.16 $173.82 $69.53 $333.63 $133.45 $333.63 $333.63 $333.63 $333.63 $333.63 $250.50 $333.63 $333.63 $333.63 $166.82 $166.82 $264.23 $333.63 $266.90 $216.86 $333.63 N/A $193.72 $333.63 $200.18 $333.63 $333.63 $333.63 N/A N/A 10BA40DC SUP Custom 27203010 10BA40DC - TOOL DISSECTING BALL COARSE 4MM 10CM DIAMOND MIDAS REX BOTH IP/OP $336.00 $249.00 $59.76 $335.75 $335.75 $335.75 $335.75 $335.75 $335.75 $335.75 $59.76 $335.75 $335.75 $249.19 $249.19 $258.80 $174.93 $69.97 $335.75 $134.30 $335.75 $335.75 $335.75 $335.75 $335.75 $252.00 $335.75 $335.75 $335.75 $167.88 $167.88 $265.91 $335.75 $268.60 $218.24 $335.75 N/A $194.88 $335.75 $201.45 $335.75 $335.75 $335.75 N/A N/A 10BA40D-MN SUP Custom 27203010 10BA40D-MN - TOOL DISSECTING 4MM 10CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 10BA40DX SUP Custom 27203010 10BA40DX - TOOL DISSECTING 4MM 10CM BALL DIAMOND XCOARSE MIDAS REX BOTH IP/OP $346.50 $256.00 $61.66 $346.38 $346.38 $346.38 $346.38 $346.38 $346.38 $346.38 $61.66 $346.38 $346.38 $257.08 $257.08 $266.99 $180.46 $72.19 $346.38 $138.55 $346.38 $346.38 $346.38 $346.38 $346.38 $259.88 $346.38 $346.38 $346.38 $173.19 $173.19 $274.33 $346.38 $277.10 $225.15 $346.38 N/A $200.97 $346.38 $207.83 $346.38 $346.38 $346.38 N/A N/A 10BA40-MN SUP Custom 27203010 10BA40-MN - TOOL DISSECTING 4MM 10CM BALL FLUTED MIDAS REX LEGEND BOTH IP/OP $314.50 $233.00 $55.98 $314.50 $314.50 $314.50 $314.50 $314.50 $314.50 $314.50 $55.98 $314.50 $314.50 $233.42 $233.42 $242.42 $163.85 $65.55 $314.50 $125.80 $314.50 $314.50 $314.50 $314.50 $314.50 $235.88 $314.50 $314.50 $314.50 $157.25 $157.25 $249.08 $314.50 $251.60 $204.43 $314.50 N/A $182.41 $314.50 $188.70 $314.50 $314.50 $314.50 N/A N/A 10BA50 SUP Custom 27203010 10BA50 - TOOL DISSECTING 5MM 10CM BALL LEGEND STERILE BOTH IP/OP $321.00 $238.00 $57.12 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $57.12 $320.88 $320.88 $238.16 $238.16 $247.33 $167.18 $66.87 $320.88 $128.35 $320.88 $320.88 $320.88 $320.88 $320.88 $240.75 $320.88 $320.88 $320.88 $160.44 $160.44 $254.14 $320.88 $256.70 $208.57 $320.88 N/A $186.18 $320.88 $192.53 $320.88 $320.88 $320.88 N/A N/A 10BA50D SUP Custom 27203010 10BA50D - TOOL DISSECTING 5MM 10CM BALL DIAMOND LEGEND STERILE BOTH IP/OP $329.50 $244.00 $58.63 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $58.63 $329.38 $329.38 $244.47 $244.47 $253.89 $171.61 $68.65 $329.38 $131.75 $329.38 $329.38 $329.38 $329.38 $329.38 $247.13 $329.38 $329.38 $329.38 $164.69 $164.69 $260.87 $329.38 $263.50 $214.10 $329.38 N/A $191.11 $329.38 $197.63 $329.38 $329.38 $329.38 N/A N/A 10BA50DC SUP Custom 27203010 10BA50DC - TOOL DISSECTING 5MM 10CM BALL DIAMOND COARSE MIDAS REX BOTH IP/OP $329.50 $244.00 $58.63 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $58.63 $329.38 $329.38 $244.47 $244.47 $253.89 $171.61 $68.65 $329.38 $131.75 $329.38 $329.38 $329.38 $329.38 $329.38 $247.13 $329.38 $329.38 $329.38 $164.69 $164.69 $260.87 $329.38 $263.50 $214.10 $329.38 N/A $191.11 $329.38 $197.63 $329.38 $329.38 $329.38 N/A N/A 10BA50D-MN SUP Custom 27203010 10BA50D-MN - TOOL DISSECTING 5MM 10CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 10BA50DX SUP Custom 27203010 10BA50DX - TOOL DISSECTING 5MM 10CM BALL DIAMOND XCOARSE MIDAS REX BOTH IP/OP $336.00 $249.00 $59.76 $335.75 $335.75 $335.75 $335.75 $335.75 $335.75 $335.75 $59.76 $335.75 $335.75 $249.19 $249.19 $258.80 $174.93 $69.97 $335.75 $134.30 $335.75 $335.75 $335.75 $335.75 $335.75 $252.00 $335.75 $335.75 $335.75 $167.88 $167.88 $265.91 $335.75 $268.60 $218.24 $335.75 N/A $194.88 $335.75 $201.45 $335.75 $335.75 $335.75 N/A N/A 10BA50-MN SUP Custom 27203010 10BA50-MN - TOOL DISSECTING 5MM 10CM BALL FLUTED MIDAS REX LEGEND BOTH IP/OP $308.50 $228.00 $54.85 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $54.85 $308.13 $308.13 $228.69 $228.69 $237.51 $160.54 $64.22 $308.13 $123.25 $308.13 $308.13 $308.13 $308.13 $308.13 $231.38 $308.13 $308.13 $308.13 $154.07 $154.07 $244.04 $308.13 $246.50 $200.28 $308.13 N/A $178.93 $308.13 $184.88 $308.13 $308.13 $308.13 N/A N/A 10BA60 SUP Custom 27203010 10BA60 - TOOL DISSECTING BALL 6MM 10CM FLUTED MIDAS REX LEGEND BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 10BA60D SUP Custom 27203010 10BA60D - TOOL DISSECTING BALL 6MM 10CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 10BA60D-MN SUP Custom 27203010 10BA60D-MN - TOOL DISSECTING BALL 6MM 10CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 10BA60DX SUP Custom 27203010 10BA60DX - TOOL DISSECTING BALL XCOARSE 6MM 10CM DIAMOND MIDAS REX BOTH IP/OP $334.00 $247.00 $59.39 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $59.39 $333.63 $333.63 $247.62 $247.62 $257.16 $173.82 $69.53 $333.63 $133.45 $333.63 $333.63 $333.63 $333.63 $333.63 $250.50 $333.63 $333.63 $333.63 $166.82 $166.82 $264.23 $333.63 $266.90 $216.86 $333.63 N/A $193.72 $333.63 $200.18 $333.63 $333.63 $333.63 N/A N/A 10BA60-MN SUP Custom 27203010 10BA60-MN - TOOL DISSECTING BALL 6MM 10CM FLUTED MIDAS REX LEGEND BOTH IP/OP $308.50 $228.00 $54.85 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $54.85 $308.13 $308.13 $228.69 $228.69 $237.51 $160.54 $64.22 $308.13 $123.25 $308.13 $308.13 $308.13 $308.13 $308.13 $231.38 $308.13 $308.13 $308.13 $154.07 $154.07 $244.04 $308.13 $246.50 $200.28 $308.13 N/A $178.93 $308.13 $184.88 $308.13 $308.13 $308.13 N/A N/A 10CY40 SUP Custom 27203010 10CY40 - TOOL DISSECTING CYLINDER 4MM 10CM MIDAS REX LEGEND STERILE BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 10CY40BR SUP Custom 27203010 10CY40BR - TOOL DISSECTING BARREL CYLINDER 4MM 10CM MIDAS REX LEGEND BOTH IP/OP $355.00 $263.00 $63.17 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $63.17 $354.88 $354.88 $263.39 $263.39 $273.54 $184.89 $73.96 $354.88 $141.95 $354.88 $354.88 $354.88 $354.88 $354.88 $266.25 $354.88 $354.88 $354.88 $177.44 $177.44 $281.06 $354.88 $283.90 $230.67 $354.88 N/A $205.90 $354.88 $212.93 $354.88 $354.88 $354.88 N/A N/A 10CY50 SUP Custom 27203010 10CY50 - TOOL DISSECTING CYLINDER 5MM 10CM MIDAS REX LEGEND STERILE BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 10CY50BR SUP Custom 27203010 10CY50BR - TOOL DISSECTING BARREL CYLINDER 5MM 10CM MIDAS REX LEGEND BOTH IP/OP $355.00 $263.00 $63.17 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $63.17 $354.88 $354.88 $263.39 $263.39 $273.54 $184.89 $73.96 $354.88 $141.95 $354.88 $354.88 $354.88 $354.88 $354.88 $266.25 $354.88 $354.88 $354.88 $177.44 $177.44 $281.06 $354.88 $283.90 $230.67 $354.88 N/A $205.90 $354.88 $212.93 $354.88 $354.88 $354.88 N/A N/A 10CY50L SUP Custom 27203010 10CY50L - TOOL DISSECTING LONG CYLINDER 5MM 10CM MIDAS REX LEGEND BOTH IP/OP $312.50 $231.00 $55.60 $312.38 $312.38 $312.38 $312.38 $312.38 $312.38 $312.38 $55.60 $312.38 $312.38 $231.85 $231.85 $240.78 $162.75 $65.10 $312.38 $124.95 $312.38 $312.38 $312.38 $312.38 $312.38 $234.38 $312.38 $312.38 $312.38 $156.19 $156.19 $247.40 $312.38 $249.90 $203.05 $312.38 N/A $181.25 $312.38 $187.43 $312.38 $312.38 $312.38 N/A N/A 10CY60 SUP Custom 27203010 10CY60 - TOOL DISSECTING CYLINDER 6MM 10CM MIDAS REX LEGEND STERILE BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 10CY60BR SUP Custom 27203010 10CY60BR - TOOL DISSECTING BARREL CYLINDER 6MM 10CM MIDAS REX LEGEND BOTH IP/OP $355.00 $263.00 $63.17 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $63.17 $354.88 $354.88 $263.39 $263.39 $273.54 $184.89 $73.96 $354.88 $141.95 $354.88 $354.88 $354.88 $354.88 $354.88 $266.25 $354.88 $354.88 $354.88 $177.44 $177.44 $281.06 $354.88 $283.90 $230.67 $354.88 N/A $205.90 $354.88 $212.93 $354.88 $354.88 $354.88 N/A N/A 10CY65DX SUP Custom 27203010 10CY65DX - TOOL DISSECTING CYLINDER XCOARSE 6.5MM 10CM DIAMOND MIDAS BOTH IP/OP $340.00 $252.00 $60.52 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $60.52 $340.00 $340.00 $252.35 $252.35 $262.07 $177.14 $70.86 $340.00 $136.00 $340.00 $340.00 $340.00 $340.00 $340.00 $255.00 $340.00 $340.00 $340.00 $170.00 $170.00 $269.28 $340.00 $272.00 $221.00 $340.00 N/A $197.20 $340.00 $204.00 $340.00 $340.00 $340.00 N/A N/A 10DCT SUP Custom 27203010 10DCT - TUBE TRCH 10 13.8MM 8.9MM 79MM STRL LF SHLY CUF DISP INR CNN BOTH IP/OP $94.00 $70.00 $16.68 $210.83 $93.68 $93.68 $93.68 $93.68 $93.68 $93.68 $16.68 $93.68 $93.68 $69.53 $69.53 $72.21 $48.81 $19.52 $93.68 $84.33 $93.68 $93.68 $210.83 $93.68 $93.68 $70.50 $93.68 $93.68 $93.68 $46.84 $46.84 $74.19 $93.68 $74.94 $60.89 $93.68 N/A $54.52 $93.68 $56.21 $93.68 $93.68 $93.68 N/A N/A 10DFEN SUP Custom 27203010 10DFEN - TUBE TRACHEOSTOMY 10 13MM 8.9MM 79MM CUFF DISPOSABLE INNER BOTH IP/OP $91.50 $68.00 $16.26 $91.35 $91.35 $91.35 $91.35 $91.35 $91.35 $91.35 $16.26 $91.35 $91.35 $67.80 $67.80 $70.41 $47.59 $19.04 $91.35 $36.54 $91.35 $91.35 $91.35 $91.35 $91.35 $68.63 $91.35 $91.35 $91.35 $45.68 $45.68 $72.35 $91.35 $73.08 $59.38 $91.35 N/A $53.07 $91.35 $54.81 $91.35 $91.35 $91.35 N/A N/A 10LGT SUP Custom 27203010 10LGT - TUBE TRACHEOSTOMY 10 13.7MM 8.9MM 50MM SMOOTH INNER CANNU BOTH IP/OP $115.00 $85.00 $20.42 $114.73 $114.73 $114.73 $114.73 $114.73 $114.73 $114.73 $20.42 $114.73 $114.73 $85.15 $85.15 $88.43 $59.77 $23.91 $114.73 $45.89 $114.73 $114.73 $114.73 $114.73 $114.73 $86.25 $114.73 $114.73 $114.73 $57.37 $57.37 $90.87 $114.73 $91.78 $74.57 $114.73 N/A $66.70 $114.73 $68.84 $114.73 $114.73 $114.73 N/A N/A 10MH17 SUP Custom 27203010 10MH17 - TOOL DISSECTING 1.7MM 10CM MATCH HEAD LEGEND STERILE BOTH IP/OP $285.00 $211.00 $50.69 $284.75 $284.75 $284.75 $284.75 $284.75 $284.75 $284.75 $50.69 $284.75 $284.75 $211.34 $211.34 $219.49 $148.35 $59.35 $284.75 $113.90 $284.75 $284.75 $284.75 $284.75 $284.75 $213.75 $284.75 $284.75 $284.75 $142.38 $142.38 $225.52 $284.75 $227.80 $185.09 $284.75 N/A $165.30 $284.75 $170.85 $284.75 $284.75 $284.75 N/A N/A 10MH17D SUP Custom 27203010 10MH17D - TOOL DISSECTING MATCH HEAD 1.7MM 10CM DIAMOND MIDAS REX BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 10MH22 SUP Custom 27203010 10MH22 - TOOL DISSECTING MATCH HEAD 2.2MM 10CM MIDAS REX LEGEND BOTH IP/OP $278.50 $206.00 $49.55 $278.38 $278.38 $278.38 $278.38 $278.38 $278.38 $278.38 $49.55 $278.38 $278.38 $206.61 $206.61 $214.58 $145.04 $58.02 $278.38 $111.35 $278.38 $278.38 $278.38 $278.38 $278.38 $208.88 $278.38 $278.38 $278.38 $139.19 $139.19 $220.48 $278.38 $222.70 $180.95 $278.38 N/A $161.53 $278.38 $167.03 $278.38 $278.38 $278.38 N/A N/A 10MH22D SUP Custom 27203010 10MH22D - TOOL DISSECTING MATCH HEAD 2.2MM 10CM DIAMOND MIDAS REX BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 10MH30 SUP Custom 27203010 10MH30 - TOOL DISSECTING 3MM 10CM MATCH HEAD LEGEND STERILE MIDAS REX BOTH IP/OP $287.00 $212.00 $51.06 $286.88 $286.88 $286.88 $286.88 $286.88 $286.88 $286.88 $51.06 $286.88 $286.88 $212.92 $212.92 $221.13 $149.46 $59.79 $286.88 $114.75 $286.88 $286.88 $286.88 $286.88 $286.88 $215.25 $286.88 $286.88 $286.88 $143.44 $143.44 $227.21 $286.88 $229.50 $186.47 $286.88 N/A $166.46 $286.88 $172.13 $286.88 $286.88 $286.88 N/A N/A 10MH30DC SUP Custom 27203010 10MH30DC - TOOL DISSECTING MATCH HEAD COARSE 3MM 10CM DIAMOND MIDAS REX BOTH IP/OP $310.50 $230.00 $55.22 $310.25 $310.25 $310.25 $310.25 $310.25 $310.25 $310.25 $55.22 $310.25 $310.25 $230.27 $230.27 $239.14 $161.64 $64.66 $310.25 $124.10 $310.25 $310.25 $310.25 $310.25 $310.25 $232.88 $310.25 $310.25 $310.25 $155.13 $155.13 $245.72 $310.25 $248.20 $201.66 $310.25 N/A $180.09 $310.25 $186.15 $310.25 $310.25 $310.25 N/A N/A 10MH30D-MN SUP Custom 27203010 10MH30D-MN - TOOL DISSECTING 3MM 10CM DIAMOND MATCH HEAD LEGEND STERILE BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 10MH30L SUP Custom 27203010 10MH30L - TOOL DISSECTING LONG MATCH HEAD 3MM 10CM MIDAS REX LEGEND BOTH IP/OP $355.00 $263.00 $63.17 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $63.17 $354.88 $354.88 $263.39 $263.39 $273.54 $184.89 $73.96 $354.88 $141.95 $354.88 $354.88 $354.88 $354.88 $354.88 $266.25 $354.88 $354.88 $354.88 $177.44 $177.44 $281.06 $354.88 $283.90 $230.67 $354.88 N/A $205.90 $354.88 $212.93 $354.88 $354.88 $354.88 N/A N/A 10MH30-MN SUP Custom 27203010 10MH30-MN - TOOL DISSECTING 3MM 10CM MATCH HEAD LEGEND STERILE BOTH IP/OP $308.50 $228.00 $54.85 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $54.85 $308.13 $308.13 $228.69 $228.69 $237.51 $160.54 $64.22 $308.13 $123.25 $308.13 $308.13 $308.13 $308.13 $308.13 $231.38 $308.13 $308.13 $308.13 $154.07 $154.07 $244.04 $308.13 $246.50 $200.28 $308.13 N/A $178.93 $308.13 $184.88 $308.13 $308.13 $308.13 N/A N/A 10OV40 SUP Custom 27203010 10OV40 - TOOL DISSECTING OVAL 4MM 10CM MIDAS REX LEGEND STERILE BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 10OV40L SUP Custom 27203010 10OV40L - TOOL DISSECTING LONG OVAL 4MM 10CM MIDAS REX LEGEND STERILE BOTH IP/OP $342.50 $253.00 $60.90 $342.13 $342.13 $342.13 $342.13 $342.13 $342.13 $342.13 $60.90 $342.13 $342.13 $253.93 $253.93 $263.71 $178.25 $71.30 $342.13 $136.85 $342.13 $342.13 $342.13 $342.13 $342.13 $256.88 $342.13 $342.13 $342.13 $171.07 $171.07 $270.97 $342.13 $273.70 $222.38 $342.13 N/A $198.65 $342.13 $205.28 $342.13 $342.13 $342.13 N/A N/A 10SCT SUP Custom 27203010 10SCT - TUBE TRACHEOSTOMY 10 13.3MM 10MM 105MM CANNU CUFF LOW BOTH IP/OP $71.50 $53.00 $12.71 $71.38 $71.38 $71.38 $71.38 $71.38 $71.38 $71.38 $12.71 $71.38 $71.38 $52.98 $52.98 $55.02 $37.19 $14.88 $71.38 $71.03 $71.38 $71.38 $71.38 $71.38 $71.38 $53.63 $71.38 $71.38 $71.38 $35.69 $35.69 $56.53 $71.38 $57.10 $46.40 $71.38 N/A $41.47 $71.38 $42.83 $71.38 $71.38 $71.38 N/A N/A 10TA23 SUP Custom 27203010 10TA23 - TOOL DISSECTING TAPER 2.3MM 10CM MIDAS REX LEGEND STERILE BOTH IP/OP $295.50 $219.00 $52.58 $295.38 $295.38 $295.38 $295.38 $295.38 $295.38 $295.38 $52.58 $295.38 $295.38 $219.23 $219.23 $227.68 $153.89 $61.56 $295.38 $118.15 $295.38 $295.38 $295.38 $295.38 $295.38 $221.63 $295.38 $295.38 $295.38 $147.69 $147.69 $233.94 $295.38 $236.30 $192.00 $295.38 N/A $171.39 $295.38 $177.23 $295.38 $295.38 $295.38 N/A N/A 10X52 SUP Custom 27203010 10X52 - SUTURE NONABSORBABLE 2-0 V-5 30IN 2 ARM BRAID 10 STRAND BOTH IP/OP $138.00 $102.00 $24.53 $141.82 $137.82 $137.82 $137.82 $137.82 $137.82 $137.82 $24.53 $137.82 $137.82 $102.29 $102.29 $106.23 $71.80 $28.72 $137.82 $56.73 $137.82 $137.82 $141.82 $137.82 $137.82 $103.50 $137.82 $137.82 $137.82 $68.91 $68.91 $109.15 $137.82 $110.26 $89.58 $137.82 N/A $80.04 $137.82 $82.69 $137.82 $137.82 $137.82 N/A N/A 10X72 SUP Custom 27203010 10X72 - SUTURE NONABSORBABLE 2-0 V-7 30IN 2 ARM BRAID 10 STRAND BOTH IP/OP $138.00 $102.00 $24.55 $137.91 $137.91 $137.91 $137.91 $137.91 $137.91 $137.91 $24.55 $137.91 $137.91 $102.36 $102.36 $106.30 $71.85 $28.74 $137.91 $55.16 $137.91 $137.91 $137.91 $137.91 $137.91 $103.50 $137.91 $137.91 $137.91 $68.96 $68.96 $109.22 $137.91 $110.33 $89.64 $137.91 N/A $80.04 $137.91 $82.75 $137.91 $137.91 $137.91 N/A N/A 110-08 SUP HCPCS C1713 110-08 - PLATE BONE STR 8MM 2X2 HOLE TIMESH TITANIUM CRANIAL BOTH IP/OP $249.00 $184.00 $49.35 $248.63 $111.88 $111.88 $111.88 $111.88 $248.63 $248.63 $248.63 $51.82 $248.63 $248.63 $248.63 $248.63 $248.63 $51.82 $248.63 $99.45 $147.06 $248.63 $248.63 $248.63 $248.63 $186.75 $248.63 $248.63 $248.63 $124.32 $124.32 $196.91 $248.63 $198.90 $111.88 $49.35 N/A $144.42 $248.63 $248.63 $248.63 $51.81 $248.63 N/A N/A 11-0401-CA SUP Custom 27203010 11-0401-CA - KIT PRESSURE MONITR CRANIAL ACCES BOTH IP/OP "$3,600.00" "$2,664.00" $640.80 "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" $640.80 "$3,600.00" "$3,600.00" "$2,671.92" "$2,671.92" "$2,774.88" "$1,875.60" $750.28 "$3,600.00" "$1,440.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$3,600.00" "$2,700.00" "$3,600.00" "$3,600.00" "$3,600.00" "$1,800.00" "$1,800.00" "$2,851.20" "$3,600.00" "$2,880.00" "$2,340.00" "$3,600.00" N/A "$2,088.00" "$3,600.00" "$2,160.00" "$3,600.00" "$3,600.00" "$3,600.00" N/A N/A 11-0401-CAL SUP Custom 27203010 11-0401-CAL - KIT CRANIOTOMY SEPS SLIDOCAINE EPINEPHRINE STERILE BOTH IP/OP "$4,221.00" "$3,124.00" $751.34 "$4,221.00" "$4,221.00" "$4,221.00" "$4,221.00" "$4,221.00" "$4,221.00" "$4,221.00" $751.34 "$4,221.00" "$4,221.00" "$3,132.83" "$3,132.83" "$3,253.55" "$2,060.15" $879.70 "$4,221.00" "$1,688.40" "$4,221.00" "$4,221.00" "$4,221.00" "$4,221.00" "$4,221.00" "$3,165.75" "$4,221.00" "$4,221.00" "$4,221.00" "$2,110.50" "$2,110.50" "$3,343.03" "$4,221.00" "$3,376.80" "$2,743.65" "$4,221.00" N/A "$2,448.18" "$4,221.00" "$2,532.60" "$4,221.00" "$4,221.00" "$4,221.00" N/A N/A 11-0401-CE SUP Custom 27203010 11-0401-CE - SYSTEM EVACUATION KIT LATEX FREE SEPS OUS BOTH IP/OP "$3,712.50" "$2,747.00" $660.83 "$3,712.50" "$3,712.50" "$3,712.50" "$3,712.50" "$3,712.50" "$3,712.50" "$3,712.50" $660.83 "$3,712.50" "$3,712.50" "$2,755.42" "$2,755.42" "$2,861.60" "$1,934.21" $773.73 "$3,712.50" "$1,485.00" "$3,712.50" "$3,712.50" "$3,712.50" "$3,712.50" "$3,712.50" "$2,784.38" "$3,712.50" "$3,712.50" "$3,712.50" "$1,856.25" "$1,856.25" "$2,940.30" "$3,712.50" "$2,970.00" "$2,413.13" "$3,712.50" N/A "$2,153.25" "$3,712.50" "$2,227.50" "$3,712.50" "$3,712.50" "$3,712.50" N/A N/A 1104B SUP Custom 27803010 1104B - KIT PRESSURE MONITR TRANSDUCER TIPPED CATHETER DRILL BIT BOTH IP/OP "$2,402.50" "$1,778.00" $427.65 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $427.65 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" "$2,402.50" N/A "$1,393.45" "$2,402.50" "$1,441.50" "$2,402.50" "$2,402.50" "$2,402.50" N/A N/A 110-4HMC SUP Custom 27203010 110-4HMC - KIT PRSS MNTR MIC 4FR 12FR STRL CMN TRNDCR TIP CATH DRN STY BOTH IP/OP "$5,034.00" "$3,725.00" $896.05 "$5,034.00" "$5,034.00" "$5,034.00" "$5,034.00" "$5,034.00" "$5,034.00" "$5,034.00" $896.05 "$5,034.00" "$5,034.00" "$3,736.23" "$3,736.23" "$3,880.21" "$2,060.15" "$1,049.14" "$5,034.00" "$2,013.60" "$5,034.00" "$5,034.00" "$5,034.00" "$5,034.00" "$5,034.00" "$3,775.50" "$5,034.00" "$5,034.00" "$5,034.00" "$2,517.00" "$2,517.00" "$3,986.93" "$5,034.00" "$4,027.20" "$3,272.10" "$5,034.00" N/A "$2,919.72" "$5,034.00" "$3,020.40" "$5,034.00" "$5,034.00" "$5,034.00" N/A N/A 110-4L SUP Custom 27803010 110-4L - KIT PRESSURE MONITR 4FR TRANSDUCER TIPPED CATHETER BOLT BOTH IP/OP "$2,007.50" "$1,486.00" $357.34 "$2,007.50" "$2,007.50" "$2,007.50" "$2,007.50" "$2,007.50" "$2,007.50" "$2,007.50" $357.34 "$2,007.50" "$2,007.50" "$2,007.50" "$2,007.50" "$2,007.50" "$2,007.50" $418.39 "$2,007.50" $803.00 "$2,007.50" "$2,007.50" "$2,007.50" "$2,007.50" "$2,007.50" "$1,505.63" "$2,007.50" "$2,007.50" "$2,007.50" "$1,003.75" "$1,003.75" "$1,589.94" "$2,007.50" "$1,606.00" $903.38 "$2,007.50" N/A "$1,164.35" "$2,007.50" "$1,204.50" "$2,007.50" "$2,007.50" "$2,007.50" N/A N/A 1111-1-501 SUP HCPCS C1713 1111-1-501 - TRAY STERILIZATION MILLED NUT GROSSE-KEMPF LOCKING NAIL BOTH IP/OP $368.50 $273.00 $73.14 $368.50 $165.83 $165.83 $165.83 $165.83 $368.50 $368.50 $368.50 $76.80 $368.50 $368.50 $368.50 $368.50 $368.50 $76.80 $368.50 $147.40 $217.97 $368.50 $368.50 $368.50 $368.50 $276.38 $368.50 $368.50 $368.50 $184.25 $184.25 $291.85 $368.50 $294.80 $165.83 $73.14 N/A $213.73 $368.50 $221.10 $368.50 $368.50 $368.50 N/A N/A 111303-001 SUP Custom 27203010 111303-001 - SET THROMBECTOMY .014IN 3FR 1.5MM 145CM OTW DISTAL SHAFT BOTH IP/OP "$5,000.00" "$3,700.00" $890.00 "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" $890.00 "$5,000.00" "$5,000.00" "$3,711.00" "$3,711.00" "$3,854.00" "$2,060.15" "$1,042.06" "$5,000.00" "$2,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$3,250.00" "$5,000.00" N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$5,000.00" "$5,000.00" N/A N/A 1156T/75 SUP HCPCS C1900 1156T/75 - LEAD PCNG S LOPRFL 5-5.6FR 7FR 75CM 8MM QUICKFLEX IS-1 BP BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$4,000.00" "$1,972.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" $793.90 N/A "$2,320.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.60 "$4,000.00" N/A N/A 1156T/86 SUP HCPCS C1900 1156T/86 - LEAD PACING S CURVE 5-5.6FR 7FR 86CMX8MM IS-1 CONCTR BIPOL BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$4,000.00" "$1,972.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" $793.90 N/A "$2,320.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.60 "$4,000.00" N/A N/A 1158T/75 SUP HCPCS C1900 1158T/75 - LEAD PACING S CURVE 5-5.6FR 7FR 75CMX16MM IS-1 CONCTR BIPOL BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$4,000.00" "$1,972.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" $793.90 N/A "$2,320.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.60 "$4,000.00" N/A N/A 1158T/86 SUP HCPCS C1900 1158T/86 - LEAD PCNG 16MM S 7FR 86CM QUICKFLEX IS 1 BP CNCT STRBL TIP BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$4,000.00" "$1,972.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" $793.90 N/A "$2,320.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.60 "$4,000.00" N/A N/A 1174108D SUP HCPCS C1751 1174108D - CATHETER CV 4FR P PICC SHRLK 3CG LUM MAXIMAL BRR TPS STY PP BOTH IP/OP $516.50 $382.00 $102.47 $516.28 $280.34 $280.34 $280.34 $280.34 $516.28 $516.28 $516.28 $107.61 $516.28 $383.18 $383.18 $397.95 $268.98 $107.60 $516.28 $516.28 $305.38 $516.28 $516.28 $516.28 $516.28 $387.38 $516.28 $516.28 $516.28 $258.14 $258.14 $408.89 $516.28 $413.02 $335.58 $102.47 N/A $299.57 $516.28 $516.28 $516.28 $107.59 $516.28 N/A N/A 1200-01-1022 SUP HCPCS C1713 "1200-01-1022 - DynaNail, 10 mm x 22 cm" BOTH IP/OP "$11,000.00" "$8,140.00" "$2,183.23" "$11,000.00" "$4,950.00" "$4,950.00" "$4,950.00" "$4,950.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.68" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.52" "$11,000.00" "$11,000.00" "$5,423.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$8,250.00" "$11,000.00" "$11,000.00" "$11,000.00" "$5,500.00" "$5,500.00" "$8,712.00" "$11,000.00" "$8,800.00" "$4,950.00" "$2,183.23" N/A "$6,380.00" "$11,000.00" "$6,600.00" "$11,000.00" "$2,292.40" "$11,000.00" N/A N/A 1200-01-1222 SUP HCPCS C1713 "1200-01-1222 - DynaNail, 12 mm x 22 cm" BOTH IP/OP "$11,000.00" "$8,140.00" "$2,183.23" "$11,000.00" "$4,950.00" "$4,950.00" "$4,950.00" "$4,950.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.68" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.52" "$11,000.00" "$11,000.00" "$5,423.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$8,250.00" "$11,000.00" "$11,000.00" "$11,000.00" "$5,500.00" "$5,500.00" "$8,712.00" "$11,000.00" "$8,800.00" "$4,950.00" "$2,183.23" N/A "$6,380.00" "$11,000.00" "$6,600.00" "$11,000.00" "$2,292.40" "$11,000.00" N/A N/A 1200-02-5020 SUP HCPCS C1713 1200-02-5020 - SCREW BONE 5MM 20MM CORT BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A 1200-02-5025 SUP HCPCS C1713 "1200-02-5025 - Headed Cortical Screw, 5.0 mm x 25 mm" BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A 1200-02-5030 SUP HCPCS C1713 1200-02-5030 - SCREW BONE 5MM 30MM HEADED SECURE FIX DYNANAIL HINDFOOT BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A 1200-02-5035 SUP HCPCS C1713 "1200-02-5035 - Headed Cortical Screw, 5.0 mm x 35 mm" BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A 1200-02-5040 SUP HCPCS C1713 "1200-02-5040 - Headed Cortical Screw, 5.0 mm x 40 mm" BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A 1200-02-5045 SUP HCPCS C1713 "1200-02-5045 - Headed Cortical Screw, 5.0 mm x 45 mm" BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A 1200-02-5050 SUP HCPCS C1713 "1200-02-5050 - Headed Cortical Screw, 5.0 mm x 50 mm" BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A 1200-02-5055 SUP HCPCS C1713 "1200-02-5055 - Headed Cortical Screw, 5.0 mm x 55 mm" BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A 1200-02-5060 SUP HCPCS C1713 "1200-02-5060 - Headed Cortical Screw, 5.0 mm x 60 mm" BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A 1200-03-5065 SUP HCPCS C1713 1200-03-5065 - SCREW BONE 5MM 65MM CORT BOTH IP/OP $428.50 $317.00 $84.97 $428.13 $192.66 $192.66 $192.66 $192.66 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $253.24 $428.13 $428.13 $428.13 $428.13 $321.38 $428.13 $428.13 $428.13 $214.07 $214.07 $339.08 $428.13 $342.50 $192.66 $84.97 N/A $248.53 $428.13 $428.13 $428.13 $89.22 $428.13 N/A N/A 1200-03-5070 SUP HCPCS C1713 "1200-03-5070 - Headless PA Screw, 5.0 mm x 70 mm" BOTH IP/OP $428.50 $317.00 $84.97 $428.13 $192.66 $192.66 $192.66 $192.66 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $253.24 $428.13 $428.13 $428.13 $428.13 $321.38 $428.13 $428.13 $428.13 $214.07 $214.07 $339.08 $428.13 $342.50 $192.66 $84.97 N/A $248.53 $428.13 $428.13 $428.13 $89.22 $428.13 N/A N/A 1200-03-5075 SUP HCPCS C1713 "1200-03-5075 - Headless PA Screw, 5.0 mm x 75 mm" BOTH IP/OP $428.50 $317.00 $84.97 $428.13 $192.66 $192.66 $192.66 $192.66 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $253.24 $428.13 $428.13 $428.13 $428.13 $321.38 $428.13 $428.13 $428.13 $214.07 $214.07 $339.08 $428.13 $342.50 $192.66 $84.97 N/A $248.53 $428.13 $256.88 $428.13 $89.22 $428.13 N/A N/A 1200-03-5080 SUP HCPCS C1713 "1200-03-5080 - Headless PA Screw, 5.0 mm x 80 mm" BOTH IP/OP $428.50 $317.00 $84.97 $428.13 $192.66 $192.66 $192.66 $192.66 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $253.24 $428.13 $428.13 $428.13 $428.13 $321.38 $428.13 $428.13 $428.13 $214.07 $214.07 $339.08 $428.13 $342.50 $192.66 $84.97 N/A $248.53 $428.13 $256.88 $428.13 $89.22 $428.13 N/A N/A 1200-03-5085 SUP HCPCS C1713 "1200-03-5085 - Headless PA Screw, 5.0 mm x 85 mm" BOTH IP/OP $428.50 $317.00 $84.97 $428.13 $192.66 $192.66 $192.66 $192.66 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $253.24 $428.13 $428.13 $428.13 $428.13 $321.38 $428.13 $428.13 $428.13 $214.07 $214.07 $339.08 $428.13 $342.50 $192.66 $84.97 N/A $248.53 $428.13 $256.88 $428.13 $89.22 $428.13 N/A N/A 1200-03-5090 SUP HCPCS C1713 "1200-03-5090 - Headless PA Screw, 5.0 mm x 90 mm" BOTH IP/OP $428.50 $317.00 $84.97 $428.13 $192.66 $192.66 $192.66 $192.66 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $253.24 $428.13 $428.13 $428.13 $428.13 $321.38 $428.13 $428.13 $428.13 $214.07 $214.07 $339.08 $428.13 $342.50 $192.66 $84.97 N/A $248.53 $428.13 $428.13 $428.13 $89.22 $428.13 N/A N/A 1200-03-5095 SUP HCPCS C1713 "1200-03-5095 - Headless PA Screw, 5.0 mm x 95 mm" BOTH IP/OP $428.50 $317.00 $84.97 $428.13 $192.66 $192.66 $192.66 $192.66 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $253.24 $428.13 $428.13 $428.13 $428.13 $321.38 $428.13 $428.13 $428.13 $214.07 $214.07 $339.08 $428.13 $342.50 $192.66 $84.97 N/A $248.53 $428.13 $256.88 $428.13 $89.22 $428.13 N/A N/A 1200-03-5100 SUP HCPCS C1713 "1200-03-5100 - Headless PA Screw, 5.0 mm x 100 mm" BOTH IP/OP $428.50 $317.00 $84.97 $428.13 $192.66 $192.66 $192.66 $192.66 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $253.24 $428.13 $428.13 $428.13 $428.13 $321.38 $428.13 $428.13 $428.13 $214.07 $214.07 $339.08 $428.13 $342.50 $192.66 $84.97 N/A $248.53 $428.13 $256.88 $428.13 $89.22 $428.13 N/A N/A 1200-03-5105 SUP HCPCS C1713 "1200-03-5105 - Headless PA Screw, 5.0 mm x 105 mm" BOTH IP/OP $428.50 $317.00 $84.97 $428.13 $192.66 $192.66 $192.66 $192.66 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $253.24 $428.13 $428.13 $428.13 $428.13 $321.38 $428.13 $428.13 $428.13 $214.07 $214.07 $339.08 $428.13 $342.50 $192.66 $84.97 N/A $248.53 $428.13 $256.88 $428.13 $89.22 $428.13 N/A N/A 1200-03-5110 SUP HCPCS C1713 "1200-03-5110 - Headless PA Screw, 5.0 mm x 110 mm" BOTH IP/OP $428.50 $317.00 $84.97 $428.13 $192.66 $192.66 $192.66 $192.66 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $428.13 $428.13 $428.13 $89.23 $428.13 $428.13 $253.24 $428.13 $428.13 $428.13 $428.13 $321.38 $428.13 $428.13 $428.13 $214.07 $214.07 $339.08 $428.13 $342.50 $192.66 $84.97 N/A $248.53 $428.13 $428.13 $428.13 $89.22 $428.13 N/A N/A 120602FP SUP HCPCS C1757 120602FP - CATHETER EMBL RND 2FR 4MM 60CM STRL LTX FGRTY BLN REINF SMTH BOTH IP/OP $220.00 $163.00 $43.66 "$1,528.13" $119.46 $119.46 $119.46 $119.46 $220.00 $220.00 $220.00 $45.85 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 "$1,528.13" $130.13 $220.00 $242.55 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A 120803FSP SUP HCPCS C1757 120803FSP - CATHETER EMBL RND 3FR 5MM 80CM .1ML STRL LTX FGRTY BLN REINF BOTH IP/OP $125.00 $93.00 $24.81 $868.25 $67.88 $67.88 $67.88 $67.88 $125.00 $125.00 $125.00 $26.05 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $868.25 $73.94 $125.00 $137.83 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 120804FP SUP Custom 27203010 120804FP - CATHETER EMBL RND 4FR 9MM 80CM .5ML STRL LTX FGRTY BLN REINF BOTH IP/OP $125.00 $93.00 $22.25 $289.45 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $289.45 $125.00 $125.00 $137.83 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 120805FP SUP HCPCS C1757 120805FP - CATHETER EMBL RND 5FR 11MM 80CM STRL LTX FGRTY BLN REINF BOTH IP/OP $125.00 $93.00 $24.81 $144.73 $67.88 $67.88 $67.88 $67.88 $125.00 $125.00 $125.00 $26.05 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $144.73 $73.94 $125.00 $137.83 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 120806FP SUP HCPCS C1757 120806FP - CATHETER EMBL RND 6FR 13MM 80CM STRL LTX FGRTY BLN REINF BOTH IP/OP $125.00 $93.00 $24.81 $144.73 $67.88 $67.88 $67.88 $67.88 $125.00 $125.00 $125.00 $26.05 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $144.73 $73.94 $125.00 $137.83 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A 120807FP SUP HCPCS C1757 120807FP - CATHETER EMBL RND 7FR 14MM 80CM 2ML STRL LTX FGRTY BLN REINF BOTH IP/OP $130.00 $96.00 $25.79 $723.63 $70.56 $70.56 $70.56 $70.56 $129.95 $129.95 $129.95 $27.08 $129.95 $96.45 $96.45 $100.17 $67.70 $27.08 $129.95 $723.63 $76.87 $129.95 $137.83 $129.95 $129.95 $97.50 $129.95 $129.95 $129.95 $64.98 $64.98 $102.92 $129.95 $103.96 $84.47 $25.79 N/A $75.40 $129.95 $129.95 $129.95 $27.08 $129.95 N/A N/A 1210-3 SUP HCPCS C1713 1210-3 - TONGS TRC 3IN PIN PRES BOTH IP/OP "$1,362.50" "$1,008.00" $270.42 "$1,362.50" $613.13 $613.13 $613.13 $613.13 "$1,362.50" "$1,362.50" "$1,362.50" $283.98 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" "$1,362.50" $805.92 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 $270.42 N/A $790.25 "$1,362.50" "$1,362.50" "$1,362.50" $283.95 "$1,362.50" N/A N/A 1210-5-250 SUP HCPCS C1769 1210-5-250 - GUIDEWIRE ORTHOPEDIC KWIRE GAMA HIP BOTH IP/OP $495.00 $366.00 $98.25 $495.00 $268.79 $268.79 $268.79 $268.79 $495.00 $495.00 $495.00 $103.17 $495.00 $367.39 $367.39 $381.55 $257.90 $103.16 $495.00 $495.00 $292.79 $495.00 $495.00 $495.00 $495.00 $371.25 $495.00 $495.00 $495.00 $247.50 $247.50 $392.04 $495.00 $396.00 $321.75 $98.25 N/A $287.10 $495.00 $495.00 $495.00 $103.16 $495.00 N/A N/A 1210-6450 SUP HCPCS C1713 1210-6450 - WIRE FIX 3.2MM 450MM KWIRE SS ORTH GAMA BOTH IP/OP $128.00 $95.00 $25.38 $127.88 $57.55 $57.55 $57.55 $57.55 $127.88 $127.88 $127.88 $26.65 $127.88 $127.88 $127.88 $127.88 $127.88 $26.65 $127.88 $127.88 $75.64 $127.88 $127.88 $127.88 $127.88 $96.00 $127.88 $127.88 $127.88 $63.94 $63.94 $101.28 $127.88 $102.30 $57.55 $25.38 N/A $74.24 $127.88 $76.73 $127.88 $26.65 $127.88 N/A N/A 1210-6450S SUP Custom 27203010 1210-6450S - WIRE FX 3.2MM 450MM STRL KRSH BOTH IP/OP $192.50 $142.00 $34.27 $192.50 $192.50 $192.50 $192.50 $192.50 $192.50 $192.50 $34.27 $192.50 $192.50 $142.87 $142.87 $148.38 $100.29 $40.12 $192.50 $77.00 $192.50 $192.50 $192.50 $192.50 $192.50 $144.38 $192.50 $192.50 $192.50 $96.25 $96.25 $152.46 $192.50 $154.00 $125.13 $192.50 N/A $111.65 $192.50 $115.50 $192.50 $192.50 $192.50 N/A N/A 12-1113 SUP HCPCS C1713 12-1113 - SCREW BN STD .5IN 9MM 120MM 21MM AMBI CLS IMHS LG BOTH IP/OP "$1,134.00" $839.00 $225.07 "$1,134.00" $510.30 $510.30 $510.30 $510.30 "$1,134.00" "$1,134.00" "$1,134.00" $236.35 "$1,134.00" "$1,134.00" "$1,134.00" "$1,134.00" "$1,134.00" $236.34 "$1,134.00" $453.60 $670.76 "$1,134.00" "$1,134.00" "$1,134.00" "$1,134.00" $850.50 "$1,134.00" "$1,134.00" "$1,134.00" $567.00 $567.00 $898.13 "$1,134.00" $907.20 $510.30 $225.07 N/A $657.72 "$1,134.00" "$1,134.00" "$1,134.00" $236.33 "$1,134.00" N/A N/A 12-1114 SUP HCPCS C1713 12-1114 - SCREW BN STD .5IN 9MM 125MM 21MM AMBI CLS IMHS LG BOTH IP/OP "$1,134.00" $839.00 $225.07 "$1,134.00" $510.30 $510.30 $510.30 $510.30 "$1,134.00" "$1,134.00" "$1,134.00" $236.35 "$1,134.00" "$1,134.00" "$1,134.00" "$1,134.00" "$1,134.00" $236.34 "$1,134.00" $453.60 $670.76 "$1,134.00" "$1,134.00" "$1,134.00" "$1,134.00" $850.50 "$1,134.00" "$1,134.00" "$1,134.00" $567.00 $567.00 $898.13 "$1,134.00" $907.20 $510.30 $225.07 N/A $657.72 "$1,134.00" $680.40 "$1,134.00" $236.33 "$1,134.00" N/A N/A 1211-3055 SUP Custom 27203010 1211-3055 - DRILL SRG 5.5MM GMA NL DIST BOTH IP/OP $203.50 $151.00 $36.22 $203.50 $203.50 $203.50 $203.50 $203.50 $203.50 $203.50 $36.22 $203.50 $203.50 $151.04 $151.04 $156.86 $106.02 $42.41 $203.50 $81.40 $203.50 $203.50 $203.50 $203.50 $203.50 $152.63 $203.50 $203.50 $203.50 $101.75 $101.75 $161.17 $203.50 $162.80 $132.28 $203.50 N/A $118.03 $203.50 $122.10 $203.50 $203.50 $203.50 N/A N/A 12-1180 SUP HCPCS C1713 12-1180 - SCREW BN 9/16IN 9MM 55MM 21MM AMBI CLS SPLG BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" "$1,210.00" "$1,210.00" N/A N/A 12-1182 SUP HCPCS C1713 12-1182 - SCREW BN 9/16IN 9MM 65MM 21MM AMBI CLS SPLG BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" $252.16 "$1,210.00" N/A N/A 12-1183 SUP HCPCS C1713 12-1183 - SCREW BN 9/16IN 9MM 70MM 21MM AMBI CLS SPLG BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" $252.16 "$1,210.00" N/A N/A 12-1184 SUP HCPCS C1713 12-1184 - SCREW BN 9/16IN 9MM 75MM 21MM AMBI CLS SPLG BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" $252.16 "$1,210.00" N/A N/A 12-1185 SUP HCPCS C1713 12-1185 - SCREW BN 9/16IN 9MM 80MM 21MM AMBI CLS SPLG BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" "$1,210.00" "$1,210.00" N/A N/A 12-1186 SUP HCPCS C1713 12-1186 - SCREW BN 9/16IN 9MM 85MM 21MM AMBI CLS SPLG BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" $252.16 "$1,210.00" N/A N/A 12-1187 SUP HCPCS C1713 12-1187 - SCREW BN 9/16IN 9MM 90MM 21MM AMBI CLS SPLG BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" $252.16 "$1,210.00" N/A N/A 12-1188 SUP HCPCS C1713 12-1188 - SCREW BN 9/16IN 9MM 95MM 21MM AMBI CLS SPLG BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" "$1,210.00" "$1,210.00" N/A N/A 12-1189 SUP HCPCS C1713 12-1189 - SCREW BN 9/16IN 9MM 100MM 21MM AMBI CLS SPLG BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" "$1,210.00" "$1,210.00" N/A N/A 12-1190 SUP HCPCS C1713 12-1190 - SCREW BN 9/16IN 9MM 105MM 21MM AMBI CLS SPLG BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" $252.16 "$1,210.00" N/A N/A 1212-5160S SUP Custom 27203010 1212-5160S - DRILL SURG 160MM AO HIP GAMA 5.5MM STRL BOTH IP/OP $296.00 $219.00 $52.62 $295.63 $295.63 $295.63 $295.63 $295.63 $295.63 $295.63 $52.62 $295.63 $295.63 $219.42 $219.42 $227.87 $154.02 $61.61 $295.63 $118.25 $295.63 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $192.16 $295.63 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 1212-5300S SUP Custom 27203010 1212-5300S - DRILL SURG 5.5MM 300MM AO CALIBRATED GAMA HIP STERILE BOTH IP/OP $296.00 $219.00 $52.62 $295.63 $295.63 $295.63 $295.63 $295.63 $295.63 $295.63 $52.62 $295.63 $295.63 $219.42 $219.42 $227.87 $154.02 $61.61 $295.63 $118.25 $295.63 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $192.16 $295.63 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 1213-9091S SUP HCPCS C1713 1213-9091S - GUIDE PIN ORTHOPEDIC 4MM 400MM GAMMA3 HIP STERILE CANNULATE BOTH IP/OP $192.50 $142.00 $38.21 $192.50 $86.63 $86.63 $86.63 $86.63 $192.50 $192.50 $192.50 $40.12 $192.50 $192.50 $192.50 $192.50 $192.50 $40.12 $192.50 $77.00 $113.86 $192.50 $192.50 $192.50 $192.50 $144.38 $192.50 $192.50 $192.50 $96.25 $96.25 $152.46 $192.50 $154.00 $86.63 $38.21 N/A $111.65 $192.50 $115.50 $192.50 $40.12 $192.50 N/A N/A 1214-5055 SUP Custom 27203010 1214-5055 - BIT DRILL 5.5MM 300MM GAMA STAINLESS STEEL HIP STERILE BOTH IP/OP $213.50 $158.00 $37.94 $213.13 $213.13 $213.13 $213.13 $213.13 $213.13 $213.13 $37.94 $213.13 $213.13 $158.19 $158.19 $164.28 $111.04 $44.42 $213.13 $85.25 $213.13 $213.13 $213.13 $213.13 $213.13 $160.13 $213.13 $213.13 $213.13 $106.57 $106.57 $168.80 $213.13 $170.50 $138.53 $213.13 N/A $123.83 $213.13 $127.88 $213.13 $213.13 $213.13 N/A N/A 1214-5160S SUP Custom 27203010 1214-5160S - BIT DRILL 5.5MM 165MM GAMA STAINLESS STEEL HIP STERILE BOTH IP/OP $296.00 $219.00 $52.62 $295.63 $295.63 $295.63 $295.63 $295.63 $295.63 $295.63 $52.62 $295.63 $295.63 $219.42 $219.42 $227.87 $154.02 $61.61 $295.63 $118.25 $295.63 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $192.16 $295.63 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 1214-5-180 SUP Custom 27203010 1214-5-180 - BIT DRILL 5.5MM 220MM GAMA STAINLESS STEEL HIP STERILE BOTH IP/OP $203.50 $151.00 $36.22 $203.50 $203.50 $203.50 $203.50 $203.50 $203.50 $203.50 $36.22 $203.50 $203.50 $151.04 $151.04 $156.86 $106.02 $42.41 $203.50 $81.40 $203.50 $203.50 $203.50 $203.50 $203.50 $152.63 $203.50 $203.50 $203.50 $101.75 $101.75 $161.17 $203.50 $162.80 $132.28 $203.50 N/A $118.03 $203.50 $122.10 $203.50 $203.50 $203.50 N/A N/A 1214-5300S SUP Custom 27203010 1214-5300S - BIT DRILL 5.5MM 300MM CALIBRATE GAMA STAINLESS STEEL HIP BOTH IP/OP $296.00 $219.00 $52.62 $295.63 $295.63 $295.63 $295.63 $295.63 $295.63 $295.63 $52.62 $295.63 $295.63 $219.42 $219.42 $227.87 $154.02 $61.61 $295.63 $118.25 $295.63 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $192.16 $295.63 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 1235-2-461 SUP Custom 27803010 1235-2-461 - CUP ACETAB 46MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-462 SUP Custom 27803010 1235-2-462 - CUP ACETAB 46MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-481 SUP Custom 27803010 1235-2-481 - CUP ACETAB 48MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-482 SUP Custom 27803010 1235-2-482 - CUP ACTB 48MM RSTR ADM MBL BR HIP PERI SLF LCK X3 HA HIP LT BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-501 SUP Custom 27803010 1235-2-501 - CUP ACETAB 50MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-502 SUP Custom 27803010 1235-2-502 - CUP ACTB 50MM RSTR ADM MBL BR HIP PERI SLF LCK X3 HA HIP LT BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-521 SUP Custom 27803010 1235-2-521 - CUP ACETAB 52MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-522 SUP Custom 27803010 1235-2-522 - SHELL ACETAB 52MM ANATOMIC DUAL MOBILITY MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-541 SUP Custom 27803010 1235-2-541 - CUP ACETAB 54MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-542 SUP Custom 27803010 1235-2-542 - CUP ACETAB 54MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-561 SUP Custom 27803010 1235-2-561 - CUP ACETAB 56MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-562 SUP Custom 27803010 1235-2-562 - CUP ACETAB 56MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-581 SUP Custom 27803010 1235-2-581 - CUP ACETAB 58MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-582 SUP Custom 27803010 1235-2-582 - CUP ACETAB 58MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-601 SUP Custom 27803010 1235-2-601 - CUP ACETAB 60MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-602 SUP Custom 27803010 1235-2-602 - CUP ACETAB 60MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-621 SUP Custom 27803010 1235-2-621 - CUP ACETAB 62MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-622 SUP Custom 27803010 1235-2-622 - CUP ACETAB 62MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-641 SUP Custom 27803010 1235-2-641 - CUP ACETAB 64MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-642 SUP Custom 27803010 1235-2-642 - CUP ACETAB 64MM PERIPHERAL SELF LOCK ADM MOBILE BEARING HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 1235-2-848 SUP Custom 27803010 1235-2-848 - INSERT ACETAB 0D 48MM 28MM 6.9MM ADM MOBILE BEARING HIP BOTH IP/OP "$2,015.00" "$1,491.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 "$2,015.00" N/A "$1,168.70" "$2,015.00" "$1,209.00" "$2,015.00" "$2,015.00" "$2,015.00" N/A N/A 1235-2-850 SUP Custom 27803010 1235-2-850 - INSERT ACTB 0D 50MM 28MM 7.9MM ADM MBL BR HIP RSTR DRTN BOTH IP/OP "$2,015.00" "$1,491.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 "$2,015.00" N/A "$1,168.70" "$2,015.00" "$1,209.00" "$2,015.00" "$2,015.00" "$2,015.00" N/A N/A 1235-2-852 SUP Custom 27803010 1235-2-852 - INSERT ACETAB 0D 52MM 28MM 8.9MM ADM MOBILE BEARING HIP BOTH IP/OP "$2,015.00" "$1,491.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 "$2,015.00" N/A "$1,168.70" "$2,015.00" "$1,209.00" "$2,015.00" "$2,015.00" "$2,015.00" N/A N/A 1235-2-854 SUP Custom 27803010 1235-2-854 - INSERT ACETAB 0D 54MM 28MM 9.9MM ADM MOBILE BEARING HIP BOTH IP/OP "$2,015.00" "$1,491.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 "$2,015.00" N/A "$1,168.70" "$2,015.00" "$1,209.00" "$2,015.00" "$2,015.00" "$2,015.00" N/A N/A 1235-2-856 SUP Custom 27803010 1235-2-856 - INSERT ACETAB 0D 56MM 28MM 10.9MM ADM MOBILE BEARING HIP BOTH IP/OP "$2,015.00" "$1,491.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 "$2,015.00" N/A "$1,168.70" "$2,015.00" "$1,209.00" "$2,015.00" "$2,015.00" "$2,015.00" N/A N/A 1235-2-858 SUP Custom 27803010 1235-2-858 - INSERT ACETAB 0D 58MM 28MM 11.9MM ADM MOBILE BEARING HIP BOTH IP/OP "$2,015.00" "$1,491.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 "$2,015.00" N/A "$1,168.70" "$2,015.00" "$1,209.00" "$2,015.00" "$2,015.00" "$2,015.00" N/A N/A 1235-2-860 SUP Custom 27803010 1235-2-860 - INSERT ACETAB 0D 60MM 28MM 12.9MM ADM MOBILE BEARING HIP BOTH IP/OP "$2,015.00" "$1,491.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 "$2,015.00" N/A "$1,168.70" "$2,015.00" "$1,209.00" "$2,015.00" "$2,015.00" "$2,015.00" N/A N/A 1235-2-862 SUP Custom 27803010 1235-2-862 - INSERT ACETAB 0D 62MM 28MM 13.9MM ADM MOBILE BEARING HIP BOTH IP/OP "$2,015.00" "$1,491.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 "$2,015.00" N/A "$1,168.70" "$2,015.00" "$1,209.00" "$2,015.00" "$2,015.00" "$2,015.00" N/A N/A 1235-2-864 SUP Custom 27803010 1235-2-864 - INSERT ACETAB 0D 64MM 28MM 14.9MM ADM MOBILE BEARING HIP BOTH IP/OP "$2,015.00" "$1,491.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 "$2,015.00" N/A "$1,168.70" "$2,015.00" "$1,209.00" "$2,015.00" "$2,015.00" "$2,015.00" N/A N/A 1236-2-242 SUP HCPCS C1776 1236-2-242 - INSERT ACTB MBL BR HIP ANTM DL MBL MDLR X3 HIP 22.2 MM FEM BOTH IP/OP "$2,015.00" "$1,491.00" $399.93 "$2,015.00" $906.75 $906.75 $906.75 $906.75 "$2,015.00" "$2,015.00" "$2,015.00" $419.98 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" "$2,015.00" "$1,191.87" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 $399.93 N/A "$1,168.70" "$2,015.00" "$1,209.00" "$2,015.00" $419.93 "$2,015.00" N/A N/A 1236-2-244 SUP HCPCS C1776 1236-2-244 - INSERT ACTB 38MM ADM MDM MBL BR HIP RSTR X3 HIP 22.2MM FEM BOTH IP/OP "$2,015.00" "$1,491.00" $399.93 "$2,015.00" $906.75 $906.75 $906.75 $906.75 "$2,015.00" "$2,015.00" "$2,015.00" $419.98 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$1,191.87" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 $399.93 N/A "$1,168.70" "$2,015.00" "$1,209.00" "$2,015.00" $419.93 "$2,015.00" N/A N/A 1236-2-846 SUP HCPCS C1776 1236-2-846 - INSERT ACTB 0D 46MM 28MM 5.9MM ADM MBL BR HIP RSTR X3 BOTH IP/OP "$2,015.00" "$1,491.00" $399.93 "$2,015.00" $906.75 $906.75 $906.75 $906.75 "$2,015.00" "$2,015.00" "$2,015.00" $419.98 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" "$2,015.00" "$1,191.87" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 $399.93 N/A "$1,168.70" "$2,015.00" "$2,015.00" "$2,015.00" $419.93 "$2,015.00" N/A N/A 1236-2-848 SUP Custom 27803010 "1236-2-848 - INSERT, X3 FOR ADM/ MDM, RESTORATION" BOTH IP/OP "$2,015.00" "$1,491.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $358.67 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 "$2,015.00" N/A "$1,168.70" "$2,015.00" "$1,209.00" "$2,015.00" "$2,015.00" "$2,015.00" N/A N/A 1236-2-850 SUP HCPCS C1776 1236-2-850 - INSERT ACTB 0D 50MM 28MM 7.9MM ADM MBL BR HIP RSTR X3 BOTH IP/OP "$2,015.00" "$1,491.00" $399.93 "$2,015.00" $906.75 $906.75 $906.75 $906.75 "$2,015.00" "$2,015.00" "$2,015.00" $419.98 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$1,191.87" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 $399.93 N/A "$1,168.70" "$2,015.00" "$2,015.00" "$2,015.00" $419.93 "$2,015.00" N/A N/A 1236-2-856 SUP HCPCS C1776 1236-2-856 - INSERT ACTB 0D 56MM 28MM 10.9MM ADM MBL BR HIP RSTR X3 BOTH IP/OP "$2,015.00" "$1,491.00" $399.93 "$2,015.00" $906.75 $906.75 $906.75 $906.75 "$2,015.00" "$2,015.00" "$2,015.00" $419.98 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" "$2,015.00" "$1,191.87" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 $399.93 N/A "$1,168.70" "$2,015.00" "$2,015.00" "$2,015.00" $419.93 "$2,015.00" N/A N/A 1236-2-858 SUP HCPCS C1776 1236-2-858 - INSERT ACTB 58MM 14.9MM ADM MDM MBL BR HIP RSTR X3 HIP 28MM BOTH IP/OP "$2,015.00" "$1,491.00" $399.93 "$2,015.00" $906.75 $906.75 $906.75 $906.75 "$2,015.00" "$2,015.00" "$2,015.00" $419.98 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$1,191.87" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 $399.93 N/A "$1,168.70" "$2,015.00" "$2,015.00" "$2,015.00" $419.93 "$2,015.00" N/A N/A 1236-2-860 SUP HCPCS C1776 1236-2-860 - INSERT ACTB 0D 60MM 28MM 12.9MM DRTN ADM X3 BOTH IP/OP "$2,015.00" "$1,491.00" $399.93 "$2,015.00" $906.75 $906.75 $906.75 $906.75 "$2,015.00" "$2,015.00" "$2,015.00" $419.98 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" "$2,015.00" "$1,191.87" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 $399.93 N/A "$1,168.70" "$2,015.00" "$2,015.00" "$2,015.00" $419.93 "$2,015.00" N/A N/A 1236-2-862 SUP HCPCS C1776 1236-2-862 - INSERT ACTB 62MM 13.9MM ADM MDM MBL BR HIP RSTR X3 HIP 28MM BOTH IP/OP "$2,015.00" "$1,491.00" $399.93 "$2,015.00" $906.75 $906.75 $906.75 $906.75 "$2,015.00" "$2,015.00" "$2,015.00" $419.98 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$1,191.87" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 $399.93 N/A "$1,168.70" "$2,015.00" "$1,209.00" "$2,015.00" $419.93 "$2,015.00" N/A N/A 1236-2-864 SUP HCPCS C1776 1236-2-864 - INSERT ACTB 0D 64MM 28MM 14.9MM ADM MBL BR HIP RSTR X3 BOTH IP/OP "$2,015.00" "$1,491.00" $399.93 "$2,015.00" $906.75 $906.75 $906.75 $906.75 "$2,015.00" "$2,015.00" "$2,015.00" $419.98 "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" $419.95 "$2,015.00" $806.00 "$1,191.87" "$2,015.00" "$2,015.00" "$2,015.00" "$2,015.00" "$1,511.25" "$2,015.00" "$2,015.00" "$2,015.00" "$1,007.50" "$1,007.50" "$1,595.88" "$2,015.00" "$1,612.00" $906.75 $399.93 N/A "$1,168.70" "$2,015.00" "$1,209.00" "$2,015.00" $419.93 "$2,015.00" N/A N/A 125-150P SUP Custom 27203010 125-150P - GUIDEPIN1.25 MM BOTH IP/OP $75.00 $56.00 $13.35 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $13.35 $75.00 $75.00 $55.67 $55.67 $57.81 $39.08 $15.63 $75.00 $30.00 $75.00 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $48.75 $75.00 N/A $43.50 $75.00 $45.00 $75.00 $75.00 $75.00 N/A N/A 1258T/75 SUP HCPCS C1900 1258T/75 - LEAD PACING MICRO S CURVE 4.3FR 75CM BIPOL STEERABLE TIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 1258T/86 SUP HCPCS C1900 1258T/86 - LEAD PCNG MIC S 4.3FR 86CM QUICKFLEX BP STRBL TIP OPTIM INSL BOTH IP/OP "$4,275.00" "$3,164.00" $848.48 "$4,275.00" "$1,923.75" "$1,923.75" "$1,923.75" "$1,923.75" "$4,275.00" "$4,275.00" "$4,275.00" $891.02 "$4,275.00" "$4,275.00" "$4,275.00" "$4,275.00" "$4,275.00" $890.96 "$4,275.00" "$4,275.00" "$2,107.58" "$4,275.00" "$4,275.00" "$4,275.00" "$4,275.00" "$3,206.25" "$4,275.00" "$4,275.00" "$4,275.00" "$2,137.50" "$2,137.50" "$3,385.80" "$4,275.00" "$3,420.00" "$1,923.75" $848.48 N/A "$2,479.50" "$4,275.00" "$4,275.00" "$4,275.00" $890.91 "$4,275.00" N/A N/A 1258T/92 SUP HCPCS C1900 1258T/92 - LEAD PACING MICRO S CURVE 4.3FR 92CM BIPOL STEERABLE TIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 1259BOP16 SUP HCPCS L1830 1259BOP16 - IMMOBILIZER ORTHOPEDIC THK3/8IN 16IN E-Z WRAP FOAM KNEE BOTH IP/OP $56.50 $42.00 $11.70 $56.13 $56.13 $56.13 $56.13 $56.13 $56.13 $56.13 $48.84 $56.13 $56.13 $56.13 $56.13 $56.13 $56.13 $11.70 $56.13 $22.45 $56.13 $56.13 $56.13 $56.13 $56.13 $42.38 $56.13 $56.13 $56.13 $28.07 $28.07 $44.45 $56.13 $44.90 $25.26 $56.13 N/A $32.77 $56.13 $33.68 $56.13 $56.13 $56.13 N/A N/A 1259BOP18 SUP HCPCS L1830 1259BOP18 - IMMOBILIZER ORTHOPEDIC THK3/8IN 18IN E-Z WRAP FOAM KNEE BOTH IP/OP $64.00 $47.00 $13.25 $63.58 $63.58 $63.58 $63.58 $63.58 $63.58 $63.58 $48.84 $63.58 $63.58 $63.58 $63.58 $63.58 $63.58 $13.25 $63.58 $25.43 $63.58 $63.58 $63.58 $63.58 $63.58 $48.00 $63.58 $63.58 $63.58 $31.79 $31.79 $50.36 $63.58 $50.86 $28.61 $63.58 N/A $37.12 $63.58 $38.15 $63.58 $63.58 $63.58 N/A N/A 12673-03 SUP HCPCS C1760 12673-03 - DEVICE CLOSURE 6FR SUTURE MEDIATE KNOT PUSHER LATEX FREE BOTH IP/OP $65.00 $48.00 $12.90 $65.00 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $38.45 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 12744-16 SUP HCPCS C1875 12744-16 - STENT COR 3MM 16MM JSTNT GFTMSTR OTW BLN EXPANDABLE SS PTFE BOTH IP/OP "$5,987.50" "$4,431.00" "$1,247.86" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.86" "$5,987.50" "$2,395.00" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$4,490.63" "$5,987.50" "$5,987.50" "$5,987.50" "$2,993.75" "$2,993.75" "$4,742.10" "$5,987.50" "$4,790.00" "$2,694.38" "$5,987.50" N/A "$3,472.75" "$5,987.50" "$3,592.50" "$5,987.50" "$5,987.50" "$5,987.50" N/A N/A 12745-16 SUP HCPCS C1875 12745-16 - STENT COR 3.5MM 16MM JSTNT GFTMSTR OTW BLN EXPANDABLE SS BOTH IP/OP "$5,987.50" "$4,431.00" "$1,247.86" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.86" "$5,987.50" "$2,395.00" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$4,490.63" "$5,987.50" "$5,987.50" "$5,987.50" "$2,993.75" "$2,993.75" "$4,742.10" "$5,987.50" "$4,790.00" "$2,694.38" "$5,987.50" N/A "$3,472.75" "$5,987.50" "$3,592.50" "$5,987.50" "$5,987.50" "$5,987.50" N/A N/A 12746-19 SUP HCPCS C1874 12746-19 - STENT COR 4MM 19MM JSTNT GFTMSTR OTW BLN EXPANDABLE SS PTFE BOTH IP/OP "$5,987.50" "$4,431.00" "$1,188.37" "$5,987.50" "$2,694.38" "$2,694.38" "$2,694.38" "$2,694.38" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.94" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.86" "$5,987.50" "$5,987.50" "$2,951.84" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$4,490.63" "$5,987.50" "$5,987.50" "$5,987.50" "$2,993.75" "$2,993.75" "$4,742.10" "$5,987.50" "$4,790.00" "$2,694.38" "$1,188.37" N/A "$3,472.75" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.80" "$5,987.50" N/A N/A 1275108D SUP HCPCS C1751 1275108D - CATHETER CV 5FR LF P PICC SHRLK 3CG 2 LUM MAXIMAL BRR TRY BOTH IP/OP $533.50 $395.00 $105.81 $533.13 $289.49 $289.49 $289.49 $289.49 $533.13 $533.13 $533.13 $111.12 $533.13 $395.69 $395.69 $410.94 $277.76 $111.11 $533.13 $533.13 $315.35 $533.13 $533.13 $533.13 $533.13 $400.13 $533.13 $533.13 $533.13 $266.57 $266.57 $422.24 $533.13 $426.50 $346.53 $105.81 N/A $309.43 $533.13 $533.13 $533.13 $111.10 $533.13 N/A N/A 12BA30 SUP Custom 27203010 12BA30 - TOOL DISSECTING BALL 3MM 12CM FLUTED MIDAS REX LEGEND BOTH IP/OP $329.50 $244.00 $58.63 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $58.63 $329.38 $329.38 $244.47 $244.47 $253.89 $171.61 $68.65 $329.38 $131.75 $329.38 $329.38 $329.38 $329.38 $329.38 $247.13 $329.38 $329.38 $329.38 $164.69 $164.69 $260.87 $329.38 $263.50 $214.10 $329.38 N/A $191.11 $329.38 $197.63 $329.38 $329.38 $329.38 N/A N/A 12BA30D SUP Custom 27203010 12BA30D - TOOL DISSECTING BALL 3MM 12CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $348.50 $258.00 $62.03 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $62.03 $348.50 $348.50 $258.66 $258.66 $268.62 $181.57 $72.63 $348.50 $139.40 $348.50 $348.50 $348.50 $348.50 $348.50 $261.38 $348.50 $348.50 $348.50 $174.25 $174.25 $276.01 $348.50 $278.80 $226.53 $348.50 N/A $202.13 $348.50 $209.10 $348.50 $348.50 $348.50 N/A N/A 12BA40 SUP Custom 27203010 12BA40 - TOOL DISSECTING BALL 4MM 12CM FLUTED MIDAS REX LEGEND BOTH IP/OP $329.50 $244.00 $58.63 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $58.63 $329.38 $329.38 $244.47 $244.47 $253.89 $171.61 $68.65 $329.38 $131.75 $329.38 $329.38 $329.38 $329.38 $329.38 $247.13 $329.38 $329.38 $329.38 $164.69 $164.69 $260.87 $329.38 $263.50 $214.10 $329.38 N/A $191.11 $329.38 $197.63 $329.38 $329.38 $329.38 N/A N/A 12BA40D SUP Custom 27203010 12BA40D - TOOL DISSECTING BALL 4MM 12CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $348.50 $258.00 $62.03 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $62.03 $348.50 $348.50 $258.66 $258.66 $268.62 $181.57 $72.63 $348.50 $139.40 $348.50 $348.50 $348.50 $348.50 $348.50 $261.38 $348.50 $348.50 $348.50 $174.25 $174.25 $276.01 $348.50 $278.80 $226.53 $348.50 N/A $202.13 $348.50 $209.10 $348.50 $348.50 $348.50 N/A N/A 12BA40DX SUP Custom 27203010 12BA40DX - TOOL DISSECTING BALL XCOARSE 4MM 12CM DIAMOND MIDAS REX BOTH IP/OP $395.50 $293.00 $70.35 $395.25 $395.25 $395.25 $395.25 $395.25 $395.25 $395.25 $70.35 $395.25 $395.25 $293.35 $293.35 $304.66 $205.93 $82.37 $395.25 $158.10 $395.25 $395.25 $395.25 $395.25 $395.25 $296.63 $395.25 $395.25 $395.25 $197.63 $197.63 $313.04 $395.25 $316.20 $256.91 $395.25 N/A $229.39 $395.25 $237.15 $395.25 $395.25 $395.25 N/A N/A 12BA50 SUP Custom 27203010 12BA50 - TOOL DISSECTING BALL 5MM 12CM FLUTED MIDAS REX LEGEND BOTH IP/OP $329.50 $244.00 $58.63 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $58.63 $329.38 $329.38 $244.47 $244.47 $253.89 $171.61 $68.65 $329.38 $131.75 $329.38 $329.38 $329.38 $329.38 $329.38 $247.13 $329.38 $329.38 $329.38 $164.69 $164.69 $260.87 $329.38 $263.50 $214.10 $329.38 N/A $191.11 $329.38 $197.63 $329.38 $329.38 $329.38 N/A N/A 12BA50D SUP Custom 27203010 12BA50D - TOOL DISSECTING BALL 5MM 12CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $348.50 $258.00 $62.03 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $62.03 $348.50 $348.50 $258.66 $258.66 $268.62 $181.57 $72.63 $348.50 $139.40 $348.50 $348.50 $348.50 $348.50 $348.50 $261.38 $348.50 $348.50 $348.50 $174.25 $174.25 $276.01 $348.50 $278.80 $226.53 $348.50 N/A $202.13 $348.50 $209.10 $348.50 $348.50 $348.50 N/A N/A 12BA60 SUP Custom 27203010 12BA60 - TOOL DISSECTING BALL 6MM 12CM FLUTED MIDAS REX LEGEND BOTH IP/OP $329.50 $244.00 $58.63 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $58.63 $329.38 $329.38 $244.47 $244.47 $253.89 $171.61 $68.65 $329.38 $131.75 $329.38 $329.38 $329.38 $329.38 $329.38 $247.13 $329.38 $329.38 $329.38 $164.69 $164.69 $260.87 $329.38 $263.50 $214.10 $329.38 N/A $191.11 $329.38 $197.63 $329.38 $329.38 $329.38 N/A N/A 12BA60D SUP Custom 27203010 12BA60D - TOOL DISSECTING BALL 6MM 12CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $329.50 $244.00 $58.63 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $329.38 $58.63 $329.38 $329.38 $244.47 $244.47 $253.89 $171.61 $68.65 $329.38 $131.75 $329.38 $329.38 $329.38 $329.38 $329.38 $247.13 $329.38 $329.38 $329.38 $164.69 $164.69 $260.87 $329.38 $263.50 $214.10 $329.38 N/A $191.11 $329.38 $197.63 $329.38 $329.38 $329.38 N/A N/A 12BA60DX SUP Custom 27203010 12BA60DX - TOOL DISSECTING 6MM 12CM BALL DIAMOND XCOARSE MIDAS REX BOTH IP/OP $402.00 $297.00 $71.49 $401.63 $401.63 $401.63 $401.63 $401.63 $401.63 $401.63 $71.49 $401.63 $401.63 $298.09 $298.09 $309.58 $209.25 $83.70 $401.63 $160.65 $401.63 $401.63 $401.63 $401.63 $401.63 $301.50 $401.63 $401.63 $401.63 $200.82 $200.82 $318.09 $401.63 $321.30 $261.06 $401.63 N/A $233.16 $401.63 $240.98 $401.63 $401.63 $401.63 N/A N/A 12MH22 SUP Custom 27203010 12MH22 - TOOL DISSECTING 2.2MM 12CM MATCH HEAD MIDAS REX LEGEND BOTH IP/OP $295.50 $219.00 $52.58 $295.38 $295.38 $295.38 $295.38 $295.38 $295.38 $295.38 $52.58 $295.38 $295.38 $219.23 $219.23 $227.68 $153.89 $61.56 $295.38 $118.15 $295.38 $295.38 $295.38 $295.38 $295.38 $221.63 $295.38 $295.38 $295.38 $147.69 $147.69 $233.94 $295.38 $236.30 $192.00 $295.38 N/A $171.39 $295.38 $177.23 $295.38 $295.38 $295.38 N/A N/A 12MH30 SUP Custom 27203010 12MH30 - TOOL DISSECTING 3MM 12CM MATCH HEAD MIDAS REX LEGEND STERILE BOTH IP/OP $300.00 $222.00 $53.33 $299.63 $299.63 $299.63 $299.63 $299.63 $299.63 $299.63 $53.33 $299.63 $299.63 $222.39 $222.39 $230.95 $156.11 $62.45 $299.63 $119.85 $299.63 $299.63 $299.63 $299.63 $299.63 $225.00 $299.63 $299.63 $299.63 $149.82 $149.82 $237.31 $299.63 $239.70 $194.76 $299.63 N/A $174.00 $299.63 $179.78 $299.63 $299.63 $299.63 N/A N/A 12MH30D SUP Custom 27203010 12MH30D - TOOL DISSECTING 3MM 12CM MATCH HEAD DIAMOND MIDAS REX LEGEND BOTH IP/OP $340.00 $252.00 $60.52 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $340.00 $60.52 $340.00 $340.00 $252.35 $252.35 $262.07 $177.14 $70.86 $340.00 $136.00 $340.00 $340.00 $340.00 $340.00 $340.00 $255.00 $340.00 $340.00 $340.00 $170.00 $170.00 $269.28 $340.00 $272.00 $221.00 $340.00 N/A $197.20 $340.00 $204.00 $340.00 $340.00 $340.00 N/A N/A 12TLW805F35 SUP HCPCS C1757 12TLW805F35 - CATHETER EMBOLECTOMY 5.5FR 11MM 80CM OTW RADIOPACITY LATEX BOTH IP/OP $225.00 $167.00 $44.66 $306.63 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $306.63 $133.09 $225.00 $243.35 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 13016540P3 SUP HCPCS C1713 13016540P3 - SCREW BN 6.5MM 40MM NS RELINE PA SPNL 2S BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13016545P3 SUP HCPCS C1713 13016545P3 - SCREW BN 6.5MM 45MM NS RELINE PA SPNL 2S BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13016550P3 SUP HCPCS C1713 13016550P3 - SCREW BN 6.5MM 50MM NS RELINE PA SPNL 2S BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 13-066P SUP HCPCS C1713 13-066P - WASHERS 13MM BOTH IP/OP $28.50 $21.00 $5.66 $28.50 $12.83 $12.83 $12.83 $12.83 $28.50 $28.50 $28.50 $5.94 $28.50 $28.50 $28.50 $28.50 $28.50 $5.94 $28.50 $28.50 $16.86 $28.50 $28.50 $28.50 $28.50 $21.38 $28.50 $28.50 $28.50 $14.25 $14.25 $22.57 $28.50 $22.80 $12.83 $5.66 N/A $16.53 $28.50 $17.10 $28.50 $5.94 $28.50 N/A N/A 1314-3042 SUP Custom 27203010 1314-3042 - BIT DRL 4.2MM 300MM TRFLT BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A 131712-01 SUP HCPCS Q4136 131712-01 - DRESSING BIO 12X3IN EZ DERM MSH BOTH IP/OP $459.00 $340.00 $95.66 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $459.00 $95.66 $459.00 $183.60 $459.00 $459.00 $459.00 $459.00 $459.00 $344.25 $459.00 $459.00 $459.00 $229.50 $229.50 $363.53 $459.00 $367.20 $206.55 $459.00 N/A $266.22 $459.00 $275.40 $459.00 $459.00 $459.00 N/A N/A 1320-0125S SUP Custom 27203010 1320-0125S - CLIP SURG CLOSE TUBE GAMMA3 STERILE BOTH IP/OP $227.00 $168.00 $40.38 $226.88 $226.88 $226.88 $226.88 $226.88 $226.88 $226.88 $40.38 $226.88 $226.88 $168.39 $168.39 $174.88 $118.20 $47.28 $226.88 $90.75 $226.88 $226.88 $226.88 $226.88 $226.88 $170.25 $226.88 $226.88 $226.88 $113.44 $113.44 $179.69 $226.88 $181.50 $147.47 $226.88 N/A $131.66 $226.88 $136.13 $226.88 $226.88 $226.88 N/A N/A 1320-0190 SUP Custom 27203010 1320-0190 - BIT DRILL STEP GAMMA3 HIP BOTH IP/OP "$2,695.00" "$1,994.00" $479.71 "$2,695.00" "$2,695.00" "$2,695.00" "$2,695.00" "$2,695.00" "$2,695.00" "$2,695.00" $479.71 "$2,695.00" "$2,695.00" "$2,000.23" "$2,000.23" "$2,077.31" "$1,404.10" $561.67 "$2,695.00" "$1,078.00" "$2,695.00" "$2,695.00" "$2,695.00" "$2,695.00" "$2,695.00" "$2,021.25" "$2,695.00" "$2,695.00" "$2,695.00" "$1,347.50" "$1,347.50" "$2,134.44" "$2,695.00" "$2,156.00" "$1,751.75" "$2,695.00" N/A "$1,563.10" "$2,695.00" "$1,617.00" "$2,695.00" "$2,695.00" "$2,695.00" N/A N/A 1320-3030S SUP Custom 27203010 1320-3030S - BIT DRILL 3MM 300MM GAMA WHITE STAINLESS STEEL HIP STERILE BOTH IP/OP $275.00 $204.00 $48.95 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $48.95 $275.00 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $110.00 $275.00 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $275.00 N/A $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A 1320-3042S SUP Custom 27203010 1320-3042S - BIT DRL 4.2MM 300MM STRL QC DISP BOTH IP/OP $282.00 $209.00 $50.17 $281.88 $281.88 $281.88 $281.88 $281.88 $281.88 $281.88 $50.17 $281.88 $281.88 $209.21 $209.21 $217.27 $146.86 $58.75 $281.88 $112.75 $281.88 $281.88 $281.88 $281.88 $281.88 $211.50 $281.88 $281.88 $281.88 $140.94 $140.94 $223.25 $281.88 $225.50 $183.22 $281.88 N/A $163.56 $281.88 $169.13 $281.88 $281.88 $281.88 N/A N/A 132-40-53 SUP HCPCS C1776 132-40-53 - LINER ACETAB 40MM LIPPED NOVATION CROWN CUP CONNEXION GXL BOTH IP/OP "$4,118.50" "$3,048.00" $817.35 "$4,118.13" "$1,853.16" "$1,853.16" "$1,853.16" "$1,853.16" "$4,118.13" "$4,118.13" "$4,118.13" $858.32 "$4,118.13" "$4,118.13" "$4,118.13" "$4,118.13" "$4,118.13" $858.26 "$4,118.13" "$4,118.13" "$2,030.24" "$4,118.13" "$4,118.13" "$4,118.13" "$4,118.13" "$3,088.88" "$4,118.13" "$4,118.13" "$4,118.13" "$2,059.07" "$2,059.07" "$3,261.56" "$4,118.13" "$3,294.50" "$1,853.16" $817.35 N/A "$2,388.73" "$4,118.13" "$4,118.13" "$4,118.13" $858.22 "$4,118.13" N/A N/A 134046J SUP Custom 27203010 134046J - APPLIER IN CLP SM 9IN LF PRM SGCLP SUP INTLK 20 ATO CLIP LGT BOTH IP/OP $21.00 $16.00 $3.70 $20.79 $20.79 $20.79 $20.79 $20.79 $20.79 $20.79 $3.70 $20.79 $20.79 $15.43 $15.43 $16.02 $10.83 $4.33 $20.79 $8.32 $20.79 $20.79 $20.79 $20.79 $20.79 $15.75 $20.79 $20.79 $20.79 $10.40 $10.40 $16.47 $20.79 $16.63 $13.51 $20.79 N/A $12.18 $20.79 $12.47 $20.79 $20.79 $20.79 N/A N/A 1365-24-000 SUP HCPCS C1776 1365-24-000 - HEAD FEM +13MM 12/14 STD 32MM STRL LF ART/EZE SKRT COCR HIP BOTH IP/OP "$2,897.50" "$2,144.00" $575.08 "$2,897.50" "$1,303.88" "$1,303.88" "$1,303.88" "$1,303.88" "$2,897.50" "$2,897.50" "$2,897.50" $603.91 "$2,897.50" "$2,897.50" "$2,897.50" "$2,897.50" "$2,897.50" $603.87 "$2,897.50" "$1,159.00" "$1,428.47" "$2,897.50" "$2,897.50" "$2,897.50" "$2,897.50" "$2,173.13" "$2,897.50" "$2,897.50" "$2,897.50" "$1,448.75" "$1,448.75" "$2,294.82" "$2,897.50" "$2,318.00" "$1,303.88" $575.08 N/A "$1,680.55" "$2,897.50" "$2,897.50" "$2,897.50" $603.84 "$2,897.50" N/A N/A 138-36-53 SUP HCPCS C1776 138-36-53 - LINER ACETAB 10D 53MM 36MM FACE NOVATION CONNEXION GXL HIP BOTH IP/OP "$4,118.50" "$3,048.00" $817.35 "$4,118.13" "$1,853.16" "$1,853.16" "$1,853.16" "$1,853.16" "$4,118.13" "$4,118.13" "$4,118.13" $858.32 "$4,118.13" "$4,118.13" "$4,118.13" "$4,118.13" "$4,118.13" $858.26 "$4,118.13" "$4,118.13" "$2,030.24" "$4,118.13" "$4,118.13" "$4,118.13" "$4,118.13" "$3,088.88" "$4,118.13" "$4,118.13" "$4,118.13" "$2,059.07" "$2,059.07" "$3,261.56" "$4,118.13" "$3,294.50" "$1,853.16" $817.35 N/A "$2,388.73" "$4,118.13" "$4,118.13" "$4,118.13" $858.22 "$4,118.13" N/A N/A 1385108QD SUP HCPCS C1751 1385108QD - CATHETER CV 5FR LF P PICC SHRLK 3CG 3 LUM MAXIMAL BRR TRY BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $335.57 $335.57 $335.57 $335.57 $618.00 $618.00 $618.00 $128.81 $618.00 $458.68 $458.68 $476.35 $321.98 $128.80 $618.00 $618.00 $365.55 $618.00 $618.00 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $401.70 $122.66 N/A $358.44 $618.00 $618.00 $618.00 $128.79 $618.00 N/A N/A 14-521014 SUP Custom 27203010 14-521014 - BIT DRL 4MM 14MM MAXAN SPNE ANT CRV PLT SYS BOTH IP/OP $752.00 $556.00 $133.86 $752.00 $752.00 $752.00 $752.00 $752.00 $752.00 $752.00 $133.86 $752.00 $752.00 $558.13 $558.13 $579.64 $391.79 $156.73 $752.00 $300.80 $752.00 $752.00 $752.00 $752.00 $752.00 $564.00 $752.00 $752.00 $752.00 $376.00 $376.00 $595.58 $752.00 $601.60 $488.80 $752.00 N/A $436.16 $752.00 $451.20 $752.00 $752.00 $752.00 N/A N/A 14-521614 SUP HCPCS C1713 14-521614 - SCREW BN 4MM 14MM MAXAN VA SLF DRL SPNE BOTH IP/OP "$1,064.00" $787.00 $211.18 "$1,064.00" $478.80 $478.80 $478.80 $478.80 "$1,064.00" "$1,064.00" "$1,064.00" $221.76 "$1,064.00" "$1,064.00" "$1,064.00" "$1,064.00" "$1,064.00" $221.75 "$1,064.00" $425.60 $629.36 "$1,064.00" "$1,064.00" "$1,064.00" "$1,064.00" $798.00 "$1,064.00" "$1,064.00" "$1,064.00" $532.00 $532.00 $842.69 "$1,064.00" $851.20 $478.80 $211.18 N/A $617.12 "$1,064.00" $638.40 "$1,064.00" "$1,064.00" "$1,064.00" N/A N/A 14-521616 SUP HCPCS C1713 14-521616 - SCREW BONE 4MM 16MM MAXAN SPN VAR ANG BOTH IP/OP "$1,064.00" $787.00 $211.18 "$1,064.00" $478.80 $478.80 $478.80 $478.80 "$1,064.00" "$1,064.00" "$1,064.00" $221.76 "$1,064.00" "$1,064.00" "$1,064.00" "$1,064.00" "$1,064.00" $221.75 "$1,064.00" $425.60 $629.36 "$1,064.00" "$1,064.00" "$1,064.00" "$1,064.00" $798.00 "$1,064.00" "$1,064.00" "$1,064.00" $532.00 $532.00 $842.69 "$1,064.00" $851.20 $478.80 $211.18 N/A $617.12 "$1,064.00" $638.40 "$1,064.00" $221.74 "$1,064.00" N/A N/A 14-524004 SUP HCPCS C1713 14-524004 - ROD SPINAL 40MM PRECUT LINEUM UNIVERSAL BLUE TITANIUM 3.5MM BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $550.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A 14-524008 SUP HCPCS C1713 14-524008 - ROD SPNL UNV 3.5MM 80MM BLU NS LINEUM PCUT TI OCT BOTH IP/OP "$1,100.00" $814.00 $218.32 "$1,100.00" $495.00 $495.00 $495.00 $495.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.27 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $229.25 "$1,100.00" $440.00 $650.65 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $495.00 $218.32 N/A $638.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.24 "$1,100.00" N/A N/A 14-524018 SUP HCPCS C1713 14-524018 - ROD SPINAL UNIVERSAL 3.5MM 180MM PRECUT LINEUM BLUE TITANIUM BOTH IP/OP "$1,100.00" $814.00 $218.32 "$1,100.00" $495.00 $495.00 $495.00 $495.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.27 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $229.25 "$1,100.00" $440.00 $650.65 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $495.00 $218.32 N/A $638.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.24 "$1,100.00" N/A N/A 14-524024 SUP HCPCS C1713 14-524024 - ROD SPNL UNV 3.5MM 240MM BLU NS LINEUM PCUT TI OCT BOTH IP/OP "$1,050.00" $777.00 $208.40 "$1,050.00" $472.50 $472.50 $472.50 $472.50 "$1,050.00" "$1,050.00" "$1,050.00" $218.85 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $218.83 "$1,050.00" $420.00 $621.08 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $787.50 "$1,050.00" "$1,050.00" "$1,050.00" $525.00 $525.00 $831.60 "$1,050.00" $840.00 $472.50 $208.40 N/A $609.00 "$1,050.00" "$1,050.00" "$1,050.00" $218.82 "$1,050.00" N/A N/A 14-524038 SUP HCPCS C1713 14-524038 - SCREW SET PLUG LINEUM HELICAL FLANGE TITANIUM SPN CERV UPPER BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $193.50 $193.50 $193.50 $193.50 $430.00 $430.00 $430.00 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $193.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A 14-524212 SUP HCPCS C1713 14-524212 - SCREW BN 3.5MM 12MM AU NS LINEUM TRNSL HLCL FLNG ST TOP LD BOTH IP/OP "$4,694.00" "$3,474.00" $931.64 "$4,694.00" "$2,112.30" "$2,112.30" "$2,112.30" "$2,112.30" "$4,694.00" "$4,694.00" "$4,694.00" $978.35 "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" $978.28 "$4,694.00" "$1,877.60" "$2,314.14" "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" "$3,520.50" "$4,694.00" "$4,694.00" "$4,694.00" "$2,347.00" "$2,347.00" "$3,717.65" "$4,694.00" "$3,755.20" "$2,112.30" $931.64 N/A "$2,722.52" "$4,694.00" "$4,694.00" "$4,694.00" $978.23 "$4,694.00" N/A N/A 14-524214 SUP HCPCS C1713 14-524214 - SCREW BONE 14MM SELF TAP TOP LOAD FRICTION FIT SMOOTH SHANK BOTH IP/OP "$4,694.00" "$3,474.00" $931.64 "$4,694.00" "$2,112.30" "$2,112.30" "$2,112.30" "$2,112.30" "$4,694.00" "$4,694.00" "$4,694.00" $978.35 "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" $978.28 "$4,694.00" "$1,877.60" "$2,314.14" "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" "$3,520.50" "$4,694.00" "$4,694.00" "$4,694.00" "$2,347.00" "$2,347.00" "$3,717.65" "$4,694.00" "$3,755.20" "$2,112.30" $931.64 N/A "$2,722.52" "$4,694.00" "$4,694.00" "$4,694.00" $978.23 "$4,694.00" N/A N/A 14-524218 SUP HCPCS C1713 14-524218 - SCREW BONE STANDARD 3.5MM 18MM SLFTAP TOP LOADING FRICTION BOTH IP/OP "$4,694.00" "$3,474.00" $931.64 "$4,694.00" "$2,112.30" "$2,112.30" "$2,112.30" "$2,112.30" "$4,694.00" "$4,694.00" "$4,694.00" $978.35 "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" $978.28 "$4,694.00" "$1,877.60" "$2,314.14" "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" "$3,520.50" "$4,694.00" "$4,694.00" "$4,694.00" "$2,347.00" "$2,347.00" "$3,717.65" "$4,694.00" "$3,755.20" "$2,112.30" $931.64 N/A "$2,722.52" "$4,694.00" "$4,694.00" "$4,694.00" $978.23 "$4,694.00" N/A N/A 14-524378 SUP HCPCS C1713 14-524378 - SCREW BONE LINEUM TITANIUM L28 MM OD3.5 MM OCCIPITOCERVICOTH BOTH IP/OP "$4,694.00" "$3,474.00" $931.64 "$4,694.00" "$2,112.30" "$2,112.30" "$2,112.30" "$2,112.30" "$4,694.00" "$4,694.00" "$4,694.00" $978.35 "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" $978.28 "$4,694.00" "$4,694.00" "$2,314.14" "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" "$3,520.50" "$4,694.00" "$4,694.00" "$4,694.00" "$2,347.00" "$2,347.00" "$3,717.65" "$4,694.00" "$3,755.20" "$2,112.30" $931.64 N/A "$2,722.52" "$4,694.00" "$2,816.40" "$4,694.00" $978.23 "$4,694.00" N/A N/A 14-524380 SUP HCPCS C1713 14-524380 - SCREW BONE 3.5MM 30MM SMOOTH SHANK TRANSLATION TECHNOLOGY BOTH IP/OP "$4,694.00" "$3,474.00" $931.64 "$4,694.00" "$2,112.30" "$2,112.30" "$2,112.30" "$2,112.30" "$4,694.00" "$4,694.00" "$4,694.00" $978.35 "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" $978.28 "$4,694.00" "$4,694.00" "$2,314.14" "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" "$3,520.50" "$4,694.00" "$4,694.00" "$4,694.00" "$2,347.00" "$2,347.00" "$3,717.65" "$4,694.00" "$3,755.20" "$2,112.30" $931.64 N/A "$2,722.52" "$4,694.00" "$2,816.40" "$4,694.00" $978.23 "$4,694.00" N/A N/A 14-524512 SUP HCPCS C1713 14-524512 - SCREW BONE 12MM TRANSLATION TECHNOLOGY GREEN HEAD LINEUM BOTH IP/OP "$5,867.50" "$4,342.00" "$1,164.55" "$5,867.50" "$2,640.38" "$2,640.38" "$2,640.38" "$2,640.38" "$5,867.50" "$5,867.50" "$5,867.50" "$1,222.93" "$5,867.50" "$5,867.50" "$5,867.50" "$5,867.50" "$5,867.50" "$1,222.85" "$5,867.50" "$2,347.00" "$2,892.68" "$5,867.50" "$5,867.50" "$5,867.50" "$5,867.50" "$4,400.63" "$5,867.50" "$5,867.50" "$5,867.50" "$2,933.75" "$2,933.75" "$4,647.06" "$5,867.50" "$4,694.00" "$2,640.38" "$1,164.55" N/A "$3,403.15" "$5,867.50" "$5,867.50" "$5,867.50" "$1,222.79" "$5,867.50" N/A N/A 14-524514 SUP HCPCS C1713 14-524514 - SCREW BN 4MM 14MM LINEUM TRNSL TCH GRN HD TI OCT SPNE BOTH IP/OP "$5,867.50" "$4,342.00" "$1,164.55" "$5,867.50" "$2,640.38" "$2,640.38" "$2,640.38" "$2,640.38" "$5,867.50" "$5,867.50" "$5,867.50" "$1,222.93" "$5,867.50" "$5,867.50" "$5,867.50" "$5,867.50" "$5,867.50" "$1,222.85" "$5,867.50" "$5,867.50" "$2,892.68" "$5,867.50" "$5,867.50" "$5,867.50" "$5,867.50" "$4,400.63" "$5,867.50" "$5,867.50" "$5,867.50" "$2,933.75" "$2,933.75" "$4,647.06" "$5,867.50" "$4,694.00" "$2,640.38" "$1,164.55" N/A "$3,403.15" "$5,867.50" "$3,520.50" "$5,867.50" "$1,222.79" "$5,867.50" N/A N/A 14-524530 SUP HCPCS C1713 14-524530 - SCREW BONE 30MM TRANSLATION TECHNOLOGY GREEN HEAD LINEUM BOTH IP/OP "$4,694.00" "$3,474.00" $931.64 "$4,694.00" "$2,112.30" "$2,112.30" "$2,112.30" "$2,112.30" "$4,694.00" "$4,694.00" "$4,694.00" $978.35 "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" $978.28 "$4,694.00" "$4,694.00" "$2,314.14" "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" "$3,520.50" "$4,694.00" "$4,694.00" "$4,694.00" "$2,347.00" "$2,347.00" "$3,717.65" "$4,694.00" "$3,755.20" "$2,112.30" $931.64 N/A "$2,722.52" "$4,694.00" "$4,694.00" "$4,694.00" $978.23 "$4,694.00" N/A N/A 14-524728 SUP HCPCS C1713 14-524728 - SCREW BONE 4.35MM 28MM TRANSLATION TECHNOLOGY BLUE HEAD BOTH IP/OP "$4,694.00" "$3,474.00" $931.64 "$4,694.00" "$2,112.30" "$2,112.30" "$2,112.30" "$2,112.30" "$4,694.00" "$4,694.00" "$4,694.00" $978.35 "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" $978.28 "$4,694.00" "$4,694.00" "$2,314.14" "$4,694.00" "$4,694.00" "$4,694.00" "$4,694.00" "$3,520.50" "$4,694.00" "$4,694.00" "$4,694.00" "$2,347.00" "$2,347.00" "$3,717.65" "$4,694.00" "$3,755.20" "$2,112.30" $931.64 N/A "$2,722.52" "$4,694.00" "$2,816.40" "$4,694.00" $978.23 "$4,694.00" N/A N/A 14-525000 SUP HCPCS C1713 14-525000 - DRILL SURG SLEEVE LINEUM STANDARD GOLD TITANIUM 3.5MM BOTH IP/OP $892.50 $660.00 $177.14 $892.50 $401.63 $401.63 $401.63 $401.63 $892.50 $892.50 $892.50 $186.02 $892.50 $892.50 $892.50 $892.50 $892.50 $186.01 $892.50 $892.50 $527.91 $892.50 $892.50 $892.50 $892.50 $669.38 $892.50 $892.50 $892.50 $446.25 $446.25 $706.86 $892.50 $714.00 $401.63 $177.14 N/A $517.65 $892.50 $892.50 $892.50 $186.00 $892.50 N/A N/A 14-525055 SUP HCPCS C1713 14-525055 - TAP SURGICAL LINEUM STANDARD OD3 MM OCCIPITOCERVICOTHORACIC BOTH IP/OP "$1,050.00" $777.00 $208.40 "$1,050.00" $472.50 $472.50 $472.50 $472.50 "$1,050.00" "$1,050.00" "$1,050.00" $218.85 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $218.83 "$1,050.00" $420.00 $621.08 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $787.50 "$1,050.00" "$1,050.00" "$1,050.00" $525.00 $525.00 $831.60 "$1,050.00" $840.00 $472.50 $208.40 N/A $609.00 "$1,050.00" $630.00 "$1,050.00" $218.82 "$1,050.00" N/A N/A 145-351 SUP HCPCS C1768 145-351 - STENT URET 4.8FR 24CM W/O GWIRE PRCFLX HDR+ BOTH IP/OP $316.00 $234.00 $62.62 $315.53 $141.99 $141.99 $141.99 $141.99 $315.53 $315.53 $315.53 $65.76 $315.53 $315.53 $315.53 $315.53 $315.53 $65.76 $315.53 $315.53 $186.64 $315.53 $315.53 $315.53 $315.53 $237.00 $315.53 $315.53 $315.53 $157.77 $157.77 $249.90 $315.53 $252.42 $141.99 $62.62 N/A $183.28 $315.53 $315.53 $315.53 $65.76 $315.53 N/A N/A 145-5091-150 SUP HCPCS C1887 145-5091-150 - CATHETER INFS 45D .014IN MIC 2.1-1.7FR .017IN 155CM 150CM BOTH IP/OP "$1,687.50" "$1,249.00" $334.93 "$1,687.50" $916.31 $916.31 $916.31 $916.31 "$1,687.50" "$1,687.50" "$1,687.50" $351.72 "$1,687.50" "$1,252.46" "$1,252.46" "$1,300.73" $879.19 $351.69 "$1,687.50" "$1,687.50" $998.16 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" "$1,096.88" $334.93 N/A $978.75 "$1,687.50" "$1,687.50" "$1,687.50" $351.68 "$1,687.50" N/A N/A 145-5092-150 SUP HCPCS C1887 145-5092-150 - CATHETER INFS 45D .014IN MIC STRG 1.9-2.4FR .017IN 155CM 150 BOTH IP/OP "$1,772.50" "$1,312.00" $351.80 "$1,772.50" $962.47 $962.47 $962.47 $962.47 "$1,772.50" "$1,772.50" "$1,772.50" $369.43 "$1,772.50" "$1,315.55" "$1,315.55" "$1,366.24" $923.47 $369.41 "$1,772.50" "$1,687.50" "$1,048.43" "$1,772.50" "$1,772.50" "$1,772.50" "$1,772.50" "$1,329.38" "$1,772.50" "$1,772.50" "$1,772.50" $886.25 $886.25 "$1,403.82" "$1,772.50" "$1,418.00" "$1,152.13" $351.80 N/A "$1,028.05" "$1,772.50" "$1,772.50" "$1,772.50" $369.39 "$1,772.50" N/A N/A 14574-01 SUP HCPCS C2617 14574-01 - STENT BILIARY 5MM 30MM 120CM SELF EXPANDABLE OTW XPERT BOTH IP/OP "$4,312.50" "$3,191.00" $855.92 "$4,312.50" "$1,940.63" "$1,940.63" "$1,940.63" "$1,940.63" "$4,312.50" "$4,312.50" "$4,312.50" $898.83 "$4,312.50" "$4,312.50" "$4,312.50" "$4,312.50" "$4,312.50" $898.77 "$4,312.50" "$4,312.50" "$2,126.06" "$4,312.50" "$4,312.50" "$4,312.50" "$4,312.50" "$3,234.38" "$4,312.50" "$4,312.50" "$4,312.50" "$2,156.25" "$2,156.25" "$3,415.50" "$4,312.50" "$3,450.00" "$1,940.63" $855.92 N/A "$2,501.25" "$4,312.50" "$4,312.50" "$4,312.50" $898.73 "$4,312.50" N/A N/A 14575-01 SUP HCPCS C2617 14575-01 - STENT BILIARY 5MM 40MM 120CM SELF EXPANDABLE OTW XPERT BOTH IP/OP "$4,312.50" "$3,191.00" $855.92 "$4,312.50" "$1,940.63" "$1,940.63" "$1,940.63" "$1,940.63" "$4,312.50" "$4,312.50" "$4,312.50" $898.83 "$4,312.50" "$4,312.50" "$4,312.50" "$4,312.50" "$4,312.50" $898.77 "$4,312.50" "$4,312.50" "$2,126.06" "$4,312.50" "$4,312.50" "$4,312.50" "$4,312.50" "$3,234.38" "$4,312.50" "$4,312.50" "$4,312.50" "$2,156.25" "$2,156.25" "$3,415.50" "$4,312.50" "$3,450.00" "$1,940.63" $855.92 N/A "$2,501.25" "$4,312.50" "$4,312.50" "$4,312.50" $898.73 "$4,312.50" N/A N/A 14577-01 SUP HCPCS C2617 14577-01 - STENT BILIARY 6MM 30MM 120CM SELF EXPANDABLE OTW XPERT BOTH IP/OP "$4,312.50" "$3,191.00" $855.92 "$4,312.50" "$1,940.63" "$1,940.63" "$1,940.63" "$1,940.63" "$4,312.50" "$4,312.50" "$4,312.50" $898.83 "$4,312.50" "$4,312.50" "$4,312.50" "$4,312.50" "$4,312.50" $898.77 "$4,312.50" "$4,312.50" "$2,126.06" "$4,312.50" "$4,312.50" "$4,312.50" "$4,312.50" "$3,234.38" "$4,312.50" "$4,312.50" "$4,312.50" "$2,156.25" "$2,156.25" "$3,415.50" "$4,312.50" "$3,450.00" "$1,940.63" $855.92 N/A "$2,501.25" "$4,312.50" "$4,312.50" "$4,312.50" $898.73 "$4,312.50" N/A N/A 14578-01 SUP HCPCS C2617 14578-01 - STENT BILIARY 6MM 40MM 120CM SELF EXPANDABLE OTW XPERT BOTH IP/OP "$4,312.50" "$3,191.00" $855.92 "$4,312.50" "$1,940.63" "$1,940.63" "$1,940.63" "$1,940.63" "$4,312.50" "$4,312.50" "$4,312.50" $898.83 "$4,312.50" "$4,312.50" "$4,312.50" "$4,312.50" "$4,312.50" $898.77 "$4,312.50" "$4,312.50" "$2,126.06" "$4,312.50" "$4,312.50" "$4,312.50" "$4,312.50" "$3,234.38" "$4,312.50" "$4,312.50" "$4,312.50" "$2,156.25" "$2,156.25" "$3,415.50" "$4,312.50" "$3,450.00" "$1,940.63" $855.92 N/A "$2,501.25" "$4,312.50" "$4,312.50" "$4,312.50" $898.73 "$4,312.50" N/A N/A 145FS38 SUP HCPCS C1769 145FS38 - GWIRE ENDSCP .038IN 145CM STR TIP HDRGLD HYDPHI STRL DISP BOTH IP/OP $157.50 $117.00 $31.26 $157.50 $85.52 $85.52 $85.52 $85.52 $157.50 $157.50 $157.50 $32.83 $157.50 $116.90 $116.90 $121.40 $82.06 $32.82 $157.50 $157.50 $93.16 $157.50 $157.50 $157.50 $157.50 $118.13 $157.50 $157.50 $157.50 $78.75 $78.75 $124.74 $157.50 $126.00 $102.38 $31.26 N/A $91.35 $157.50 $157.50 $157.50 $32.82 $157.50 N/A N/A 14679-01 SUP HCPCS C1760 14679-01 - DEVICE CLSR 6FR STRL STRCLS SE CLIP NTNL VASC DISP BOTH IP/OP $625.00 $463.00 $156.30 $787.50 $354.38 $354.38 $354.38 $354.38 $787.50 $787.50 $787.50 $164.13 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $787.50 $465.81 $787.50 $787.50 $787.50 $787.50 $468.75 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $156.30 N/A $362.50 $787.50 $787.50 $787.50 $164.12 $787.50 N/A N/A 14679-01 SUP HCPCS C1760 14679-01 - DEVICE CLOSURE 6FR CLIP LATEX FREE STARCLOSE SE NITINOL BOTH IP/OP $787.50 $583.00 $156.30 $787.50 $354.38 $354.38 $354.38 $354.38 $787.50 $787.50 $787.50 $164.13 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $787.50 $465.81 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $156.30 N/A $456.75 $787.50 $787.50 $787.50 $164.12 $787.50 N/A N/A 14937-01 SUP HCPCS C1769 14937-01 - GUIDEWIRE VASC .014IN 300CM STRL 11CM ASAHI MRCLBRS 3 RADOPQ BOTH IP/OP $60.00 $44.00 $11.91 $60.00 $32.58 $32.58 $32.58 $32.58 $60.00 $60.00 $60.00 $12.51 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $60.00 $35.49 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $11.91 N/A $34.80 $60.00 $60.00 $60.00 $12.50 $60.00 N/A N/A 149R SUP Custom 27203010 149R - BRUSH CYTOLOGY RING HANDLE 3MM LATEX FREE PULMONARY STERILE BOTH IP/OP $24.50 $18.00 $4.33 $24.33 $24.33 $24.33 $24.33 $24.33 $24.33 $24.33 $4.33 $24.33 $24.33 $18.06 $18.06 $18.75 $12.68 $5.07 $24.33 $9.73 $24.33 $24.33 $24.33 $24.33 $24.33 $18.38 $24.33 $24.33 $24.33 $12.17 $12.17 $19.27 $24.33 $19.46 $15.81 $24.33 N/A $14.21 $24.33 $14.60 $24.33 $24.33 $24.33 N/A N/A 14AC50 SUP Custom 27203010 14AC50 - TOOL DISSECTING 5MM 14CM ACORN MIDAS REX LEGEND STERILE BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 14AC60 SUP Custom 27203010 14AC60 - TOOL DISSECTING FLUTE 6MM 14CM MIDAS REX LEGEND STERILE BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 14AC90 SUP Custom 27203010 14AC90 - TOOL DISSECTING 9MM 14CM ATTCH LATEX FREE LEGEND STERILE BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 14BA20 SUP Custom 27203010 14BA20 - TOOL DISSECTING 2MM 14CM BALL FLUTED MIDAS REX LEGEND BOTH IP/OP $348.50 $258.00 $62.03 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $62.03 $348.50 $348.50 $258.66 $258.66 $268.62 $181.57 $72.63 $348.50 $139.40 $348.50 $348.50 $348.50 $348.50 $348.50 $261.38 $348.50 $348.50 $348.50 $174.25 $174.25 $276.01 $348.50 $278.80 $226.53 $348.50 N/A $202.13 $348.50 $209.10 $348.50 $348.50 $348.50 N/A N/A 14BA25 SUP Custom 27203010 14BA25 - TOOL DISSECTING 2.5MM 14CM BALL FLUTED MIDAS REX LEGEND BOTH IP/OP $348.50 $258.00 $62.03 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $62.03 $348.50 $348.50 $258.66 $258.66 $268.62 $181.57 $72.63 $348.50 $139.40 $348.50 $348.50 $348.50 $348.50 $348.50 $261.38 $348.50 $348.50 $348.50 $174.25 $174.25 $276.01 $348.50 $278.80 $226.53 $348.50 N/A $202.13 $348.50 $209.10 $348.50 $348.50 $348.50 N/A N/A 14BA25D SUP Custom 27203010 14BA25D - TOOL DISSECTING 2.5MM 14CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $372.00 $275.00 $66.19 $371.88 $371.88 $371.88 $371.88 $371.88 $371.88 $371.88 $66.19 $371.88 $371.88 $276.01 $276.01 $286.65 $193.75 $77.50 $371.88 $148.75 $371.88 $371.88 $371.88 $371.88 $371.88 $279.00 $371.88 $371.88 $371.88 $185.94 $185.94 $294.53 $371.88 $297.50 $241.72 $371.88 N/A $215.76 $371.88 $223.13 $371.88 $371.88 $371.88 N/A N/A 14BA30 SUP Custom 27203010 14BA30 - TOOL DISSECTING BALL FLUTE 3MM 14CM LEGEND STERILE BOTH IP/OP $355.00 $263.00 $63.17 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $63.17 $354.88 $354.88 $263.39 $263.39 $273.54 $184.89 $73.96 $354.88 $141.95 $354.88 $354.88 $354.88 $354.88 $354.88 $266.25 $354.88 $354.88 $354.88 $177.44 $177.44 $281.06 $354.88 $283.90 $230.67 $354.88 N/A $205.90 $354.88 $212.93 $354.88 $354.88 $354.88 N/A N/A 14BA30D SUP Custom 27203010 14BA30D - TOOL DISSECTING 3MM 14CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $372.00 $275.00 $66.19 $371.88 $371.88 $371.88 $371.88 $371.88 $371.88 $371.88 $66.19 $371.88 $371.88 $276.01 $276.01 $286.65 $193.75 $77.50 $371.88 $148.75 $371.88 $371.88 $371.88 $371.88 $371.88 $279.00 $371.88 $371.88 $371.88 $185.94 $185.94 $294.53 $371.88 $297.50 $241.72 $371.88 N/A $215.76 $371.88 $223.13 $371.88 $371.88 $371.88 N/A N/A 14BA30DC SUP Custom 27203010 14BA30DC - TOOL DISSECTING 3MM 14CM BALL DIAMOND COARSE MIDAS REX BOTH IP/OP $376.50 $279.00 $66.95 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $66.95 $376.13 $376.13 $279.16 $279.16 $289.92 $195.96 $78.39 $376.13 $150.45 $376.13 $376.13 $376.13 $376.13 $376.13 $282.38 $376.13 $376.13 $376.13 $188.07 $188.07 $297.89 $376.13 $300.90 $244.48 $376.13 N/A $218.37 $376.13 $225.68 $376.13 $376.13 $376.13 N/A N/A 14BA40D SUP Custom 27203010 14BA40D - TOOL DISSECTING 4MM 14CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $378.50 $280.00 $67.33 $378.25 $378.25 $378.25 $378.25 $378.25 $378.25 $378.25 $67.33 $378.25 $378.25 $280.74 $280.74 $291.56 $197.07 $78.83 $378.25 $151.30 $378.25 $378.25 $378.25 $378.25 $378.25 $283.88 $378.25 $378.25 $378.25 $189.13 $189.13 $299.57 $378.25 $302.60 $245.86 $378.25 N/A $219.53 $378.25 $226.95 $378.25 $378.25 $378.25 N/A N/A 14BA40DC SUP Custom 27203010 14BA40DC - TOOL DISSECTING 4MM 14CM BALL DIAMOND COARSE MIDAS REX BOTH IP/OP $376.50 $279.00 $66.95 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $66.95 $376.13 $376.13 $279.16 $279.16 $289.92 $195.96 $78.39 $376.13 $150.45 $376.13 $376.13 $376.13 $376.13 $376.13 $282.38 $376.13 $376.13 $376.13 $188.07 $188.07 $297.89 $376.13 $300.90 $244.48 $376.13 N/A $218.37 $376.13 $225.68 $376.13 $376.13 $376.13 N/A N/A 14BA40DX SUP Custom 27203010 14BA40DX - TOOL DISSECTING 4MM 14CM BALL DIAMOND XCOARSE MIDAS REX BOTH IP/OP $382.50 $283.00 $68.09 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $68.09 $382.50 $382.50 $283.89 $283.89 $294.83 $199.28 $79.72 $382.50 $153.00 $382.50 $382.50 $382.50 $382.50 $382.50 $286.88 $382.50 $382.50 $382.50 $191.25 $191.25 $302.94 $382.50 $306.00 $248.63 $382.50 N/A $221.85 $382.50 $229.50 $382.50 $382.50 $382.50 N/A N/A 14BA50 SUP Custom 27203010 14BA50 - TOOL DISSECTING BALL FLUTE 5MM 14CM MIDAS REX LEGEND STERILE BOTH IP/OP $363.50 $269.00 $64.68 $363.38 $363.38 $363.38 $363.38 $363.38 $363.38 $363.38 $64.68 $363.38 $363.38 $269.70 $269.70 $280.09 $189.32 $75.73 $363.38 $145.35 $363.38 $363.38 $363.38 $363.38 $363.38 $272.63 $363.38 $363.38 $363.38 $181.69 $181.69 $287.80 $363.38 $290.70 $236.20 $363.38 N/A $210.83 $363.38 $218.03 $363.38 $363.38 $363.38 N/A N/A 14BA50D SUP Custom 27203010 14BA50D - TOOL DISSECTING 5MM 14CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $378.50 $280.00 $67.33 $378.25 $378.25 $378.25 $378.25 $378.25 $378.25 $378.25 $67.33 $378.25 $378.25 $280.74 $280.74 $291.56 $197.07 $78.83 $378.25 $151.30 $378.25 $378.25 $378.25 $378.25 $378.25 $283.88 $378.25 $378.25 $378.25 $189.13 $189.13 $299.57 $378.25 $302.60 $245.86 $378.25 N/A $219.53 $378.25 $226.95 $378.25 $378.25 $378.25 N/A N/A 14BA50DC SUP Custom 27203010 14BA50DC - TOOL DISSECTING 5MM 14CM BALL DIAMOND COARSE MIDAS REX BOTH IP/OP $378.50 $280.00 $67.33 $378.25 $378.25 $378.25 $378.25 $378.25 $378.25 $378.25 $67.33 $378.25 $378.25 $280.74 $280.74 $291.56 $197.07 $78.83 $378.25 $151.30 $378.25 $378.25 $378.25 $378.25 $378.25 $283.88 $378.25 $378.25 $378.25 $189.13 $189.13 $299.57 $378.25 $302.60 $245.86 $378.25 N/A $219.53 $378.25 $226.95 $378.25 $378.25 $378.25 N/A N/A 14BA50DX SUP Custom 27203010 14BA50DX - TOOL DISSECTING 5MM 14CM BALL DIAMOND XCOARSE MIDAS REX BOTH IP/OP $382.50 $283.00 $68.09 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $68.09 $382.50 $382.50 $283.89 $283.89 $294.83 $199.28 $79.72 $382.50 $153.00 $382.50 $382.50 $382.50 $382.50 $382.50 $286.88 $382.50 $382.50 $382.50 $191.25 $191.25 $302.94 $382.50 $306.00 $248.63 $382.50 N/A $221.85 $382.50 $229.50 $382.50 $382.50 $382.50 N/A N/A 14BA60 SUP Custom 27203010 14BA60 - TOOL DISSECTING 6MM 14CM BALL FLUTED LEGEND MIDAS STERILE BOTH IP/OP $355.00 $263.00 $63.17 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $63.17 $354.88 $354.88 $263.39 $263.39 $273.54 $184.89 $73.96 $354.88 $141.95 $354.88 $354.88 $354.88 $354.88 $354.88 $266.25 $354.88 $354.88 $354.88 $177.44 $177.44 $281.06 $354.88 $283.90 $230.67 $354.88 N/A $205.90 $354.88 $212.93 $354.88 $354.88 $354.88 N/A N/A 14BA60D SUP Custom 27203010 14BA60D - TOOL DISSECTING 6MM 14CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $372.00 $275.00 $66.19 $371.88 $371.88 $371.88 $371.88 $371.88 $371.88 $371.88 $66.19 $371.88 $371.88 $276.01 $276.01 $286.65 $193.75 $77.50 $371.88 $148.75 $371.88 $371.88 $371.88 $371.88 $371.88 $279.00 $371.88 $371.88 $371.88 $185.94 $185.94 $294.53 $371.88 $297.50 $241.72 $371.88 N/A $215.76 $371.88 $223.13 $371.88 $371.88 $371.88 N/A N/A 14BA60DC SUP Custom 27203010 14BA60DC - TOOL DISSECTING 6MM 14CM BALL DIAMOND COARSE MIDAS REX BOTH IP/OP $376.50 $279.00 $66.95 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $66.95 $376.13 $376.13 $279.16 $279.16 $289.92 $195.96 $78.39 $376.13 $150.45 $376.13 $376.13 $376.13 $376.13 $376.13 $282.38 $376.13 $376.13 $376.13 $188.07 $188.07 $297.89 $376.13 $300.90 $244.48 $376.13 N/A $218.37 $376.13 $225.68 $376.13 $376.13 $376.13 N/A N/A 14BA60DX SUP Custom 27203010 14BA60DX - TOOL DISSECTING 6MM 14CM BALL DIAMOND XCOARSE MIDAS REX BOTH IP/OP $382.50 $283.00 $68.09 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $68.09 $382.50 $382.50 $283.89 $283.89 $294.83 $199.28 $79.72 $382.50 $153.00 $382.50 $382.50 $382.50 $382.50 $382.50 $286.88 $382.50 $382.50 $382.50 $191.25 $191.25 $302.94 $382.50 $306.00 $248.63 $382.50 N/A $221.85 $382.50 $229.50 $382.50 $382.50 $382.50 N/A N/A 14BA70DX SUP Custom 27203010 14BA70DX - TOOL DISSECTING 7MM 14CM BALL DIAMOND LEGEND STERILE BOTH IP/OP $382.50 $283.00 $68.09 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $68.09 $382.50 $382.50 $283.89 $283.89 $294.83 $199.28 $79.72 $382.50 $153.00 $382.50 $382.50 $382.50 $382.50 $382.50 $286.88 $382.50 $382.50 $382.50 $191.25 $191.25 $302.94 $382.50 $306.00 $248.63 $382.50 N/A $221.85 $382.50 $229.50 $382.50 $382.50 $382.50 N/A N/A 14BA75 SUP Custom 27203010 14BA75 - TOOL DISSECTING 7.5MM 14CM BALL LEGEND STERILE BOTH IP/OP $355.00 $263.00 $63.17 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $63.17 $354.88 $354.88 $263.39 $263.39 $273.54 $184.89 $73.96 $354.88 $141.95 $354.88 $354.88 $354.88 $354.88 $354.88 $266.25 $354.88 $354.88 $354.88 $177.44 $177.44 $281.06 $354.88 $283.90 $230.67 $354.88 N/A $205.90 $354.88 $212.93 $354.88 $354.88 $354.88 N/A N/A 14BA75D SUP Custom 27203010 14BA75D - TOOL DISSECTING 7.5MM 14CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $372.00 $275.00 $66.19 $371.88 $371.88 $371.88 $371.88 $371.88 $371.88 $371.88 $66.19 $371.88 $371.88 $276.01 $276.01 $286.65 $193.75 $77.50 $371.88 $148.75 $371.88 $371.88 $371.88 $371.88 $371.88 $279.00 $371.88 $371.88 $371.88 $185.94 $185.94 $294.53 $371.88 $297.50 $241.72 $371.88 N/A $215.76 $371.88 $223.13 $371.88 $371.88 $371.88 N/A N/A 14BA80DX SUP Custom 27203010 14BA80DX - TOOL DISSECTING 8MM 14CM BALL DIAMOND XCOARSE MIDAS REX BOTH IP/OP $382.50 $283.00 $68.09 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $68.09 $382.50 $382.50 $283.89 $283.89 $294.83 $199.28 $79.72 $382.50 $153.00 $382.50 $382.50 $382.50 $382.50 $382.50 $286.88 $382.50 $382.50 $382.50 $191.25 $191.25 $302.94 $382.50 $306.00 $248.63 $382.50 N/A $221.85 $382.50 $229.50 $382.50 $382.50 $382.50 N/A N/A 14BA90 SUP Custom 27203010 14BA90 - TOOL DISSECTING 9MM 14CM BALL FLUTED LARGE BORE LEGEND BOTH IP/OP $355.00 $263.00 $63.17 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $63.17 $354.88 $354.88 $263.39 $263.39 $273.54 $184.89 $73.96 $354.88 $141.95 $354.88 $354.88 $354.88 $354.88 $354.88 $266.25 $354.88 $354.88 $354.88 $177.44 $177.44 $281.06 $354.88 $283.90 $230.67 $354.88 N/A $205.90 $354.88 $212.93 $354.88 $354.88 $354.88 N/A N/A 14CY50 SUP Custom 27203010 14CY50 - TOOL DISSECTING CYLND 5MM 140MM LATEX FREE MIDAS REX LEGEND BOTH IP/OP $334.00 $247.00 $59.39 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $59.39 $333.63 $333.63 $247.62 $247.62 $257.16 $173.82 $69.53 $333.63 $133.45 $333.63 $333.63 $333.63 $333.63 $333.63 $250.50 $333.63 $333.63 $333.63 $166.82 $166.82 $264.23 $333.63 $266.90 $216.86 $333.63 N/A $193.72 $333.63 $200.18 $333.63 $333.63 $333.63 N/A N/A 14CY50B SUP Custom 27203010 14CY50B - TOOL DISSECTING 5MM 14CM CYLINDER BLUNT MIDAS REX LEGEND BOTH IP/OP $334.00 $247.00 $59.39 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $59.39 $333.63 $333.63 $247.62 $247.62 $257.16 $173.82 $69.53 $333.63 $133.45 $333.63 $333.63 $333.63 $333.63 $333.63 $250.50 $333.63 $333.63 $333.63 $166.82 $166.82 $264.23 $333.63 $266.90 $216.86 $333.63 N/A $193.72 $333.63 $200.18 $333.63 $333.63 $333.63 N/A N/A 14CY50DCSH SUP Custom 27203010 14CY50DCSH - TOOL DISSECTING SHORT CYLINDER 5MM 14CM LATEX FREE LEGEND BOTH IP/OP $412.50 $305.00 $73.38 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $73.38 $412.25 $412.25 $305.97 $305.97 $317.76 $214.78 $85.92 $412.25 $164.90 $412.25 $412.25 $412.25 $412.25 $412.25 $309.38 $412.25 $412.25 $412.25 $206.13 $206.13 $326.50 $412.25 $329.80 $267.96 $412.25 N/A $239.25 $412.25 $247.35 $412.25 $412.25 $412.25 N/A N/A 14CY60DCSH SUP Custom 27203010 14CY60DCSH - TOOL DISSECTING SHORT CYLINDER 6MM 14CM LATEX FREE LEGEND BOTH IP/OP $412.50 $305.00 $73.38 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $73.38 $412.25 $412.25 $305.97 $305.97 $317.76 $214.78 $85.92 $412.25 $164.90 $412.25 $412.25 $412.25 $412.25 $412.25 $309.38 $412.25 $412.25 $412.25 $206.13 $206.13 $326.50 $412.25 $329.80 $267.96 $412.25 N/A $239.25 $412.25 $247.35 $412.25 $412.25 $412.25 N/A N/A 14CY65DX SUP Custom 27203010 14CY65DX - TOOL DISSECTING 6.5MM 14CM CYLINDER DIAMOND XCOARSE MIDAS BOTH IP/OP $378.50 $280.00 $67.33 $378.25 $378.25 $378.25 $378.25 $378.25 $378.25 $378.25 $67.33 $378.25 $378.25 $280.74 $280.74 $291.56 $197.07 $78.83 $378.25 $151.30 $378.25 $378.25 $378.25 $378.25 $378.25 $283.88 $378.25 $378.25 $378.25 $189.13 $189.13 $299.57 $378.25 $302.60 $245.86 $378.25 N/A $219.53 $378.25 $226.95 $378.25 $378.25 $378.25 N/A N/A 14CY70DCSH SUP Custom 27203010 14CY70DCSH - TOOL DISSECTING SHORT CYLINDER 7MM 14CM LATEX FREE LEGEND BOTH IP/OP $412.50 $305.00 $73.38 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $73.38 $412.25 $412.25 $305.97 $305.97 $317.76 $214.78 $85.92 $412.25 $164.90 $412.25 $412.25 $412.25 $412.25 $412.25 $309.38 $412.25 $412.25 $412.25 $206.13 $206.13 $326.50 $412.25 $329.80 $267.96 $412.25 N/A $239.25 $412.25 $247.35 $412.25 $412.25 $412.25 N/A N/A 14CY75 SUP Custom 27203010 14CY75 - TOOL DISSECTING 7.5MM 14CM CYLINDER FLUTED HEAD SHAFT MIDAS BOTH IP/OP $334.00 $247.00 $59.39 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $59.39 $333.63 $333.63 $247.62 $247.62 $257.16 $173.82 $69.53 $333.63 $133.45 $333.63 $333.63 $333.63 $333.63 $333.63 $250.50 $333.63 $333.63 $333.63 $166.82 $166.82 $264.23 $333.63 $266.90 $216.86 $333.63 N/A $193.72 $333.63 $200.18 $333.63 $333.63 $333.63 N/A N/A 14CY76L SUP Custom 27203010 14CY76L - TOOL DISSECTING LONG 7.6MM 14CM CYLINDER MIDAS REX LEGEND BOTH IP/OP $389.00 $288.00 $69.22 $388.88 $388.88 $388.88 $388.88 $388.88 $388.88 $388.88 $69.22 $388.88 $388.88 $288.63 $288.63 $299.75 $202.61 $81.05 $388.88 $155.55 $388.88 $388.88 $388.88 $388.88 $388.88 $291.75 $388.88 $388.88 $388.88 $194.44 $194.44 $307.99 $388.88 $311.10 $252.77 $388.88 N/A $225.62 $388.88 $233.33 $388.88 $388.88 $388.88 N/A N/A 14CY90 SUP Custom 27203010 14CY90 - TOOL DISSECTING 9MM 14CM CYLINDER MIDAS REX LEGEND STERILE BOTH IP/OP $334.00 $247.00 $59.39 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $59.39 $333.63 $333.63 $247.62 $247.62 $257.16 $173.82 $69.53 $333.63 $133.45 $333.63 $333.63 $333.63 $333.63 $333.63 $250.50 $333.63 $333.63 $333.63 $166.82 $166.82 $264.23 $333.63 $266.90 $216.86 $333.63 N/A $193.72 $333.63 $200.18 $333.63 $333.63 $333.63 N/A N/A 14HM126 SUP Custom 27203010 14HM126 - TOOL DISSECTING 12.6MM 14CM HOLE MAKER MIDAS REX LEGEND BOTH IP/OP $425.00 $315.00 $75.65 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $75.65 $425.00 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $170.00 $425.00 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $425.00 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 14HM95 SUP Custom 27203010 14HM95 - TOOL DISSECTING 9.5MM 14CM HOLE MAKER MIDAS REX LEGEND BOTH IP/OP $425.00 $315.00 $75.65 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $75.65 $425.00 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $170.00 $425.00 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $425.00 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 14MH30DC SUP Custom 27203010 14MH30DC - TOOL DISSECTING 3MM 14CM MATCH HEAD DIAMOND COARSE MIDAS REX BOTH IP/OP $376.50 $279.00 $66.95 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $66.95 $376.13 $376.13 $279.16 $279.16 $289.92 $195.96 $78.39 $376.13 $150.45 $376.13 $376.13 $376.13 $376.13 $376.13 $282.38 $376.13 $376.13 $376.13 $188.07 $188.07 $297.89 $376.13 $300.90 $244.48 $376.13 N/A $218.37 $376.13 $225.68 $376.13 $376.13 $376.13 N/A N/A 14OV55 SUP Custom 27203010 14OV55 - TOOL DISSECTING 5.5MM 14CM OVAL MIDAS REX LEGEND STERILE BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 14TA30 SUP Custom 27203010 14TA30 - TOOL DISSECTING TAPER 3MM 14CM 35.1MM LARGE BORE MIDAS REX BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A 14TA31 SUP Custom 27203010 14TA31 - TOOL DISSECTING TAPER 3.1MM 14CM MIDAS REX LEGEND STERILE BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A 151F7 SUP Custom 27203010 151F7 - CATHETER ART LN STD 7FR 110CM SG 4 LUM S TIP TD FEM VN BOTH IP/OP $145.00 $107.00 $25.81 $185.93 $145.00 $145.00 $145.00 $145.00 $145.00 $145.00 $25.81 $145.00 $145.00 $107.62 $107.62 $111.77 $75.55 $30.22 $145.00 $74.37 $145.00 $145.00 $185.93 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $94.25 $145.00 N/A $84.10 $145.00 $87.00 $145.00 $145.00 $145.00 N/A N/A 15-28126 SUP Custom 27203010 15-28126 - SPLINT NSL MED FOAM RBR LTWT AL LNNG WTR RS ADH XTRN SKNPRP BOTH IP/OP $20.50 $15.00 $3.65 $20.50 $20.50 $20.50 $20.50 $20.50 $20.50 $20.50 $3.65 $20.50 $20.50 $15.22 $15.22 $15.80 $10.68 $4.27 $20.50 $8.20 $20.50 $20.50 $20.50 $20.50 $20.50 $15.38 $20.50 $20.50 $20.50 $10.25 $10.25 $16.24 $20.50 $16.40 $13.33 $20.50 N/A $11.89 $20.50 $12.30 $20.50 $20.50 $20.50 N/A N/A 1541-01-000 SUP HCPCS C1776 1541-01-000 - STEM FEM 1 STD OFST 105MM LF PROSTALAC CMNT XTN HIP BOTH IP/OP "$13,132.50" "$9,718.00" "$2,606.47" "$13,132.50" "$5,909.63" "$5,909.63" "$5,909.63" "$5,909.63" "$13,132.50" "$13,132.50" "$13,132.50" "$2,737.14" "$13,132.50" "$13,132.50" "$13,132.50" "$13,132.50" "$13,132.50" "$2,736.96" "$13,132.50" "$5,253.00" "$6,474.32" "$13,132.50" "$13,132.50" "$13,132.50" "$13,132.50" "$9,849.38" "$13,132.50" "$13,132.50" "$13,132.50" "$6,566.25" "$6,566.25" "$10,400.94" "$13,132.50" "$10,506.00" "$5,909.63" "$2,606.47" N/A "$7,616.85" "$13,132.50" "$13,132.50" "$13,132.50" "$2,736.81" "$13,132.50" N/A N/A 1541-42-320 SUP HCPCS C1776 1541-42-320 - CUP ACETAB 42MM 32MM CEMENTED PROSTALAC ALL POLY HIP BOTH IP/OP "$2,615.00" "$1,935.00" $519.01 "$2,615.00" "$1,176.75" "$1,176.75" "$1,176.75" "$1,176.75" "$2,615.00" "$2,615.00" "$2,615.00" $545.03 "$2,615.00" "$2,615.00" "$2,615.00" "$2,615.00" "$2,615.00" $544.99 "$2,615.00" "$1,046.00" "$1,289.20" "$2,615.00" "$2,615.00" "$2,615.00" "$2,615.00" "$1,961.25" "$2,615.00" "$2,615.00" "$2,615.00" "$1,307.50" "$1,307.50" "$2,071.08" "$2,615.00" "$2,092.00" "$1,176.75" $519.01 N/A "$1,516.70" "$2,615.00" "$2,615.00" "$2,615.00" $544.97 "$2,615.00" N/A N/A 1584S SUP Custom 27203010 1584S - WRAP COMPRESSION 5YDX4IN ELAST SELF ADHERENT FULL STRETCH BOTH IP/OP $69.50 $51.00 $12.34 $252.13 $69.35 $69.35 $69.35 $69.35 $69.35 $69.35 $12.34 $69.35 $69.35 $51.47 $51.47 $53.45 $36.13 $14.45 $69.35 $109.74 $69.35 $69.35 $252.13 $69.35 $69.35 $52.13 $69.35 $69.35 $69.35 $34.68 $34.68 $54.93 $69.35 $55.48 $45.08 $69.35 N/A $40.31 $69.35 $41.61 $69.35 $69.35 $69.35 N/A N/A 15AC50 SUP Custom 27203010 15AC50 - TOOL DISSECTING ACORN 5MM 15CM MIDAS REX LEGEND STERILE BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 15AC60 SUP Custom 27203010 15AC60 - TOOL DISSECTING ACORN 6MM 15CM MIDAS REX LEGEND STERILE BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 15BA40D SUP Custom 27203010 15BA40D - TOOL DISSECTING BALL 4MM 15CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $382.50 $283.00 $68.09 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $68.09 $382.50 $382.50 $283.89 $283.89 $294.83 $199.28 $79.72 $382.50 $153.00 $382.50 $382.50 $382.50 $382.50 $382.50 $286.88 $382.50 $382.50 $382.50 $191.25 $191.25 $302.94 $382.50 $306.00 $248.63 $382.50 N/A $221.85 $382.50 $229.50 $382.50 $382.50 $382.50 N/A N/A 15BA40DX SUP Custom 27203010 15BA40DX - TOOL DISSECTING BALL XCOARSE 4MM 15CM DIAMOND MIDAS REX BOTH IP/OP $387.00 $286.00 $68.84 $386.75 $386.75 $386.75 $386.75 $386.75 $386.75 $386.75 $68.84 $386.75 $386.75 $287.05 $287.05 $298.11 $201.50 $80.60 $386.75 $154.70 $386.75 $386.75 $386.75 $386.75 $386.75 $290.25 $386.75 $386.75 $386.75 $193.38 $193.38 $306.31 $386.75 $309.40 $251.39 $386.75 N/A $224.46 $386.75 $232.05 $386.75 $386.75 $386.75 N/A N/A 15BA50 SUP Custom 27203010 15BA50 - TOOL DISSECTING 5MM 150MM BALL FLUTED MIDAS REX STERILE BOTH IP/OP $355.00 $263.00 $63.17 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $63.17 $354.88 $354.88 $263.39 $263.39 $273.54 $184.89 $73.96 $354.88 $141.95 $354.88 $354.88 $354.88 $354.88 $354.88 $266.25 $354.88 $354.88 $354.88 $177.44 $177.44 $281.06 $354.88 $283.90 $230.67 $354.88 N/A $205.90 $354.88 $212.93 $354.88 $354.88 $354.88 N/A N/A 15BA50D SUP Custom 27203010 15BA50D - TOOL DISSECTING BALL 5MM 15CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $382.50 $283.00 $68.09 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $68.09 $382.50 $382.50 $283.89 $283.89 $294.83 $199.28 $79.72 $382.50 $153.00 $382.50 $382.50 $382.50 $382.50 $382.50 $286.88 $382.50 $382.50 $382.50 $191.25 $191.25 $302.94 $382.50 $306.00 $248.63 $382.50 N/A $221.85 $382.50 $229.50 $382.50 $382.50 $382.50 N/A N/A 15BA60 SUP Custom 27203010 15BA60 - TOOL DISSECTING BALL 6MM 15CM FLUTED MIDAS REX LEGEND BOTH IP/OP $355.00 $263.00 $63.17 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $354.88 $63.17 $354.88 $354.88 $263.39 $263.39 $273.54 $184.89 $73.96 $354.88 $141.95 $354.88 $354.88 $354.88 $354.88 $354.88 $266.25 $354.88 $354.88 $354.88 $177.44 $177.44 $281.06 $354.88 $283.90 $230.67 $354.88 N/A $205.90 $354.88 $212.93 $354.88 $354.88 $354.88 N/A N/A 15BA60D SUP Custom 27203010 15BA60D - TOOL DISSECTING BALL 6MM 15CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $382.50 $283.00 $68.09 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $68.09 $382.50 $382.50 $283.89 $283.89 $294.83 $199.28 $79.72 $382.50 $153.00 $382.50 $382.50 $382.50 $382.50 $382.50 $286.88 $382.50 $382.50 $382.50 $191.25 $191.25 $302.94 $382.50 $306.00 $248.63 $382.50 N/A $221.85 $382.50 $229.50 $382.50 $382.50 $382.50 N/A N/A 15CY50 SUP Custom 27203010 15CY50 - TOOL DISSECTING CYLINDER 5MM 15CM MIDAS REX LEGEND STERILE BOTH IP/OP $325.50 $241.00 $57.87 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $57.87 $325.13 $325.13 $241.31 $241.31 $250.61 $169.39 $67.76 $325.13 $130.05 $325.13 $325.13 $325.13 $325.13 $325.13 $244.13 $325.13 $325.13 $325.13 $162.57 $162.57 $257.50 $325.13 $260.10 $211.33 $325.13 N/A $188.79 $325.13 $195.08 $325.13 $325.13 $325.13 N/A N/A 15CY50L SUP Custom 27203010 15CY50L - TOOL DISSECTING LONG CYLINDER 5MM 15CM MIDAS REX LEGEND BOTH IP/OP $334.00 $247.00 $59.39 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $59.39 $333.63 $333.63 $247.62 $247.62 $257.16 $173.82 $69.53 $333.63 $133.45 $333.63 $333.63 $333.63 $333.63 $333.63 $250.50 $333.63 $333.63 $333.63 $166.82 $166.82 $264.23 $333.63 $266.90 $216.86 $333.63 N/A $193.72 $333.63 $200.18 $333.63 $333.63 $333.63 N/A N/A 15CY60 SUP Custom 27203010 15CY60 - TOOL DISSECTING CYLINDER 6MM 15CM 7.9MM CYLINDER FLUTED BOTH IP/OP $325.50 $241.00 $57.87 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $57.87 $325.13 $325.13 $241.31 $241.31 $250.61 $169.39 $67.76 $325.13 $130.05 $325.13 $325.13 $325.13 $325.13 $325.13 $244.13 $325.13 $325.13 $325.13 $162.57 $162.57 $257.50 $325.13 $260.10 $211.33 $325.13 N/A $188.79 $325.13 $195.08 $325.13 $325.13 $325.13 N/A N/A 15CY65DX SUP Custom 27203010 15CY65DX - TOOL DISSECTING CYLINDER XCOARSE 6.5MM 15CM DIAMOND MIDAS BOTH IP/OP $376.50 $279.00 $66.95 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $66.95 $376.13 $376.13 $279.16 $279.16 $289.92 $195.96 $78.39 $376.13 $150.45 $376.13 $376.13 $376.13 $376.13 $376.13 $282.38 $376.13 $376.13 $376.13 $188.07 $188.07 $297.89 $376.13 $300.90 $244.48 $376.13 N/A $218.37 $376.13 $225.68 $376.13 $376.13 $376.13 N/A N/A 15MH17 SUP Custom 27203010 15MH17 - TOOL DISSECTING FLUTE MATCH HEAD 1.7MM 15CM SMALL BORE BOTH IP/OP $325.50 $241.00 $57.87 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $57.87 $325.13 $325.13 $241.31 $241.31 $250.61 $169.39 $67.76 $325.13 $130.05 $325.13 $325.13 $325.13 $325.13 $325.13 $244.13 $325.13 $325.13 $325.13 $162.57 $162.57 $257.50 $325.13 $260.10 $211.33 $325.13 N/A $188.79 $325.13 $195.08 $325.13 $325.13 $325.13 N/A N/A 15MH17D SUP Custom 27203010 15MH17D - TOOL DISSECTING MATCH HEAD 1.7MM 15CM DIAMOND MIDAS REX BOTH IP/OP $327.50 $242.00 $58.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $327.25 $58.25 $327.25 $327.25 $242.88 $242.88 $252.24 $170.50 $68.20 $327.25 $130.90 $327.25 $327.25 $327.25 $327.25 $327.25 $245.63 $327.25 $327.25 $327.25 $163.63 $163.63 $259.18 $327.25 $261.80 $212.71 $327.25 N/A $189.95 $327.25 $196.35 $327.25 $327.25 $327.25 N/A N/A 15MH22 SUP Custom 27203010 15MH22 - TOOL DISSECTING 2.2MM 15CM MATCH HEAD MIDAS REX LEGEND BOTH IP/OP $325.50 $241.00 $57.87 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $57.87 $325.13 $325.13 $241.31 $241.31 $250.61 $169.39 $67.76 $325.13 $130.05 $325.13 $325.13 $325.13 $325.13 $325.13 $244.13 $325.13 $325.13 $325.13 $162.57 $162.57 $257.50 $325.13 $260.10 $211.33 $325.13 N/A $188.79 $325.13 $195.08 $325.13 $325.13 $325.13 N/A N/A 15MH30D SUP Custom 27203010 15MH30D - TOOL DISSECTING MATCH HEAD 3MM 15CM MATCH HEAD DIAMOND BOTH IP/OP $363.50 $269.00 $64.68 $363.38 $363.38 $363.38 $363.38 $363.38 $363.38 $363.38 $64.68 $363.38 $363.38 $269.70 $269.70 $280.09 $189.32 $75.73 $363.38 $145.35 $363.38 $363.38 $363.38 $363.38 $363.38 $272.63 $363.38 $363.38 $363.38 $181.69 $181.69 $287.80 $363.38 $290.70 $236.20 $363.38 N/A $210.83 $363.38 $218.03 $363.38 $363.38 $363.38 N/A N/A 15TA23 SUP Custom 27203010 15TA23 - TOOL DISSECTING TAPER 2.3MM 15CM MIDAS REX LEGEND STERILE BOTH IP/OP $342.50 $253.00 $60.90 $342.13 $342.13 $342.13 $342.13 $342.13 $342.13 $342.13 $60.90 $342.13 $342.13 $253.93 $253.93 $263.71 $178.25 $71.30 $342.13 $136.85 $342.13 $342.13 $342.13 $342.13 $342.13 $256.88 $342.13 $342.13 $342.13 $171.07 $171.07 $270.97 $342.13 $273.70 $222.38 $342.13 N/A $198.65 $342.13 $205.28 $342.13 $342.13 $342.13 N/A N/A 15TA23L SUP Custom 27203010 15TA23L - TOOL DISSECTING LONG TAPER 2.3MM 15CM MIDAS REX LEGEND BOTH IP/OP $342.50 $253.00 $60.90 $342.13 $342.13 $342.13 $342.13 $342.13 $342.13 $342.13 $60.90 $342.13 $342.13 $253.93 $253.93 $263.71 $178.25 $71.30 $342.13 $136.85 $342.13 $342.13 $342.13 $342.13 $342.13 $256.88 $342.13 $342.13 $342.13 $171.07 $171.07 $270.97 $342.13 $273.70 $222.38 $342.13 N/A $198.65 $342.13 $205.28 $342.13 $342.13 $342.13 N/A N/A 1601-04132 SUP HCPCS C1776 1601-04132 - STEM FEM 132D 4 31.5MM OFST 5.1MM 110MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-05132 SUP HCPCS C1776 1601-05132 - STEM FEM 132D 5 32.5MM OFST 6MM 115MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-06127 SUP HCPCS C1776 1601-06127 - STEM FEM 127D 6 37.2MM OFST 6.9MM 120MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-06132 SUP HCPCS C1776 1601-06132 - STEM FEM 132D 6 33.6MM OFST 6.9MM 120MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-07127 SUP HCPCS C1776 1601-07127 - STEM FEM 127D 7 41.5MM OFST 7.4MM 130MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-07132 SUP HCPCS C1776 1601-07132 - STEM FEM 132D 7 37.5MM OFST 7.4MM 130MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-08127 SUP HCPCS C1776 1601-08127 - STEM FEM 127D 8 42.4MM OFST 8.1MM 136MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-08132 SUP HCPCS C1776 1601-08132 - STEM FEM 132D 8 38.4MM OFST 8.1MM 136MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-09127 SUP HCPCS C1776 1601-09127 - STEM FEM 127D 9 46.9MM OFST 8.9MM 142MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-09132 SUP HCPCS C1776 1601-09132 - STEM FEM 132D 9 42.6MM OFST 8.9MM 142MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-10127 SUP HCPCS C1776 1601-10127 - STEM FEM 127D 10 48.1MM OFST 9.7MM 148MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-10132 SUP HCPCS C1776 1601-10132 - STEM FEM 132D 10 43.8MM OFST 9.7MM 148MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-11127 SUP HCPCS C1776 1601-11127 - STEM FEM 127D 11 52.6MM OFST 9.7MM 155MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-11132 SUP HCPCS C1776 1601-11132 - STEM FEM 132D 11 47.9MM OFST 9.7MM 155MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-12127 SUP HCPCS C1776 1601-12127 - STEM FEM 127D 12 53.7MM OFST 10.7MM 160MM STRL SCRFT ADV BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 1601-12132 SUP HCPCS C1776 1601-12132 - STEM FEM 132D 12 49MM OFST 10.7MM 160MM STRL SCRFT ADV PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 16-3663 SUP HCPCS C1776 16-3663 - HEAD FEMORAL +3MM 28MM MODULAR TYPE 1 COCR HIP BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 1663H SUP Custom 27203010 1663H - SUTURE NABSB 3-0 PS1 18IN BLK ETH MTPS MFL BOTH IP/OP $29.50 $22.00 $5.22 $29.35 $29.35 $29.35 $29.35 $29.35 $29.35 $29.35 $5.22 $29.35 $29.35 $21.78 $21.78 $22.62 $15.29 $6.12 $29.35 $11.74 $29.35 $29.35 $29.35 $29.35 $29.35 $22.13 $29.35 $29.35 $29.35 $14.68 $14.68 $23.25 $29.35 $23.48 $19.08 $29.35 N/A $17.11 $29.35 $17.61 $29.35 $29.35 $29.35 N/A N/A 1698G SUP Custom 27203010 1698G - SUTURE NABSB 6-0 P-3 18IN BLK ETH MTPS MFL BOTH IP/OP $10.00 $7.00 $1.74 $10.06 $9.77 $9.77 $9.77 $9.77 $9.77 $9.77 $1.74 $9.77 $9.77 $7.25 $7.25 $7.53 $5.09 $2.04 $9.77 $4.02 $9.77 $9.77 $10.06 $9.77 $9.77 $7.50 $9.77 $9.77 $9.77 $4.89 $4.89 $7.74 $9.77 $7.82 $6.35 $9.77 N/A $5.80 $9.77 $5.86 $9.77 $9.77 $9.77 N/A N/A 1699T/40 SUP HCPCS C1898 1699T/40 - OptiSense BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 1699T/58 SUP HCPCS C1898 1699T/58 - OptiSense BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 1699TC/40 SUP HCPCS C1898 1699TC/40 - LEAD PCNG 6.2FR 40CM LF TNDRL FSR STRD ELUT ATR BOTH IP/OP "$1,250.00" $925.00 $260.51 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 1699TC/46 SUP HCPCS C1898 1699TC/46 - LEAD PACING 1.1MM SPACE 6.2FR 46CM 1 PASS VDD BIPOL ACTIVE BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 1699TC/52 SUP HCPCS C1898 1699TC/52 - LEAD PCNG 1.1MM SPC 6.2FR 52CM LF OPTISENSE 1 PASS VDD BP BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 16MH18 SUP Custom 27203010 16MH18 - TOOL DISSECTING MATCH HEAD 1.8MM 16CM MIDAS REX LEGEND BOTH IP/OP $270.00 $200.00 $48.04 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $48.04 $269.88 $269.88 $200.30 $200.30 $208.02 $140.61 $56.25 $269.88 $107.95 $269.88 $269.88 $269.88 $269.88 $269.88 $202.50 $269.88 $269.88 $269.88 $134.94 $134.94 $213.74 $269.88 $215.90 $175.42 $269.88 N/A $156.60 $269.88 $161.93 $269.88 $269.88 $269.88 N/A N/A 16MH18L SUP Custom 27203010 16MH18L - TOOL DISSECTING LONG MATCH HEAD 1.8MM 16CM MIDAS REX LEGEND BOTH IP/OP $270.00 $200.00 $48.04 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $48.04 $269.88 $269.88 $200.30 $200.30 $208.02 $140.61 $56.25 $269.88 $107.95 $269.88 $269.88 $269.88 $269.88 $269.88 $202.50 $269.88 $269.88 $269.88 $134.94 $134.94 $213.74 $269.88 $215.90 $175.42 $269.88 N/A $156.60 $269.88 $161.93 $269.88 $269.88 $269.88 N/A N/A 16MH22 SUP Custom 27203010 16MH22 - TOOL DISSECTING MATCH HEAD 2.2MM 16CM MIDAS REX LEGEND BOTH IP/OP $270.00 $200.00 $48.04 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $48.04 $269.88 $269.88 $200.30 $200.30 $208.02 $140.61 $56.25 $269.88 $107.95 $269.88 $269.88 $269.88 $269.88 $269.88 $202.50 $269.88 $269.88 $269.88 $134.94 $134.94 $213.74 $269.88 $215.90 $175.42 $269.88 N/A $156.60 $269.88 $161.93 $269.88 $269.88 $269.88 N/A N/A 16TA11 SUP Custom 27203010 16TA11 - TOOL DISSECTING TAPER 1.1MM 16CM MIDAS REX LEGEND STERILE BOTH IP/OP $270.00 $200.00 $48.04 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $48.04 $269.88 $269.88 $200.30 $200.30 $208.02 $140.61 $56.25 $269.88 $107.95 $269.88 $269.88 $269.88 $269.88 $269.88 $202.50 $269.88 $269.88 $269.88 $134.94 $134.94 $213.74 $269.88 $215.90 $175.42 $269.88 N/A $156.60 $269.88 $161.93 $269.88 $269.88 $269.88 N/A N/A 16TA13 SUP Custom 27203010 16TA13 - TOOL DISSECTING TAPER 1.3MM 16CM MIDAS REX LEGEND STERILE BOTH IP/OP $270.00 $200.00 $48.04 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $48.04 $269.88 $269.88 $200.30 $200.30 $208.02 $140.61 $56.25 $269.88 $107.95 $269.88 $269.88 $269.88 $269.88 $269.88 $202.50 $269.88 $269.88 $269.88 $134.94 $134.94 $213.74 $269.88 $215.90 $175.42 $269.88 N/A $156.60 $269.88 $161.93 $269.88 $269.88 $269.88 N/A N/A 16TA15 SUP Custom 27203010 16TA15 - TOOL DISSECTING TAPER 1.5MM 16CM MIDAS REX LEGEND STERILE BOTH IP/OP $270.00 $200.00 $48.04 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $48.04 $269.88 $269.88 $200.30 $200.30 $208.02 $140.61 $56.25 $269.88 $107.95 $269.88 $269.88 $269.88 $269.88 $269.88 $202.50 $269.88 $269.88 $269.88 $134.94 $134.94 $213.74 $269.88 $215.90 $175.42 $269.88 N/A $156.60 $269.88 $161.93 $269.88 $269.88 $269.88 N/A N/A 16TA17 SUP Custom 27203010 16TA17 - TOOL DISSECTING TAPER 1.7MM 16CM MIDAS REX LEGEND STERILE BOTH IP/OP $270.00 $200.00 $48.04 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $48.04 $269.88 $269.88 $200.30 $200.30 $208.02 $140.61 $56.25 $269.88 $107.95 $269.88 $269.88 $269.88 $269.88 $269.88 $202.50 $269.88 $269.88 $269.88 $134.94 $134.94 $213.74 $269.88 $215.90 $175.42 $269.88 N/A $156.60 $269.88 $161.93 $269.88 $269.88 $269.88 N/A N/A 16TA23 SUP Custom 27203010 16TA23 - TOOL DISSECTING TAPER 2.3MM 16CM MIDAS REX LEGEND STERILE BOTH IP/OP $270.00 $200.00 $48.04 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $48.04 $269.88 $269.88 $200.30 $200.30 $208.02 $140.61 $56.25 $269.88 $107.95 $269.88 $269.88 $269.88 $269.88 $269.88 $202.50 $269.88 $269.88 $269.88 $134.94 $134.94 $213.74 $269.88 $215.90 $175.42 $269.88 N/A $156.60 $269.88 $161.93 $269.88 $269.88 $269.88 N/A N/A 16TA24 SUP Custom 27203010 16TA24 - TOOL DISSECTING TAPER 2.4MM 16CM MIDAS REX LEGEND STERILE BOTH IP/OP $270.00 $200.00 $48.04 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $48.04 $269.88 $269.88 $200.30 $200.30 $208.02 $140.61 $56.25 $269.88 $107.95 $269.88 $269.88 $269.88 $269.88 $269.88 $202.50 $269.88 $269.88 $269.88 $134.94 $134.94 $213.74 $269.88 $215.90 $175.42 $269.88 N/A $156.60 $269.88 $161.93 $269.88 $269.88 $269.88 N/A N/A 17-0000E SUP Custom 27803010 17-0000E - SLEEVE ADAPTER V40 TITANIUM ALUM CERAMIC NONSTRL BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 17-001-01 SUP HCPCS C1713 17-001-01 - CLIP ANEURYSM 1 8.5MM OPENING STANDARD 7MM STR SUGITA BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,222.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $489.00 $720.15 "$1,217.50" "$1,222.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" $730.50 "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-02 SUP HCPCS C1713 17-001-02 - CLIP ANEURYSM 10.5MM STANDARD 10MM STR SUGITA TITANIUM 2 BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,222.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $489.00 $720.15 "$1,217.50" "$1,222.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" $730.50 "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-03 SUP HCPCS C1713 17-001-03 - CLIP ANEURYSM 11MM STANDARD 7MM BAYONET SUGITA TITANIUM 2 BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-001-04 SUP HCPCS C1713 17-001-04 - CLIP ANEURYSM 9.5MM STANDARD 8MM BENT SUGITA TITANIUM 2 BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-001-05 SUP HCPCS C1713 17-001-05 - CLIP ANRSM 8MM SGTA 11MM STD TI 2 SDWRD BNT BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-06 SUP HCPCS C1713 17-001-06 - CLIP ANEURYSM 6 10MM OPENING STANDARD 9MM SIDEWARD CVD BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-001-07 SUP HCPCS C1713 17-001-07 - CLIP ANEURYSM 12MM STANDARD 8.5MM SLIGHTLY CVD BAYONET BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-001-08 SUP HCPCS C1713 17-001-08 - CLIP ANRSM 9MM SGTA 9.5MM STD TI 2 CVD NONSTRL BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-09 SUP HCPCS C1713 17-001-09 - CLIP ANEURYSM 10MM STANDARD 9MM SLIGHTLY CVD SUGITA TITANIUM BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $375.00 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $937.50 $937.50 $195.38 $937.50 N/A N/A 17-001-10 SUP HCPCS C1713 17-001-10 - CLIP ANEURYSM 11.5MM STANDARD 12MM STR SUGITA TITANIUM 2 BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,217.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" "$1,217.50" $720.15 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" "$1,217.50" "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-11 SUP HCPCS C1713 17-001-11 - CLIP ANRSM 12MM SGTA 13.5MM STD TI 2 SDWRD BNT BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-13 SUP HCPCS C1713 17-001-13 - CLIP ANEURYSM 13MM STANDARD 10MM BAYONET SUGITA TITANIUM 2 BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-001-15 SUP HCPCS C1713 17-001-15 - CLIP ANRSM 15MM SGTA 13.5MM STD TI 2 STR NONSTRL BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-18 SUP HCPCS C1713 17-001-18 - CLIP ANRSM 18MM SGTA 15.5MM STD TI 2 STR BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-20 SUP HCPCS C1713 17-001-20 - CLIP ANEURYSM 8MM STANDARD 5MM L SUGITA TITANIUM 2 NONSTRL BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-23 SUP HCPCS C1713 17-001-23 - CLIP ANRSM 6MM SGTA 9MM STD TI 2 J BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-001-26 SUP HCPCS C1713 17-001-26 - CLIP ANEURYSM 26 11MM OPENING STANDARD STR FENST SUGITA BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,217.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $487.00 $720.15 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" "$1,217.50" "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-27 SUP HCPCS C1713 17-001-27 - CLIP ANRSM 9MM 3.5MM SGTA 13MM STD TI 2 STR FENST BOTH IP/OP $812.50 $601.00 $161.26 "$1,222.50" $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 "$1,222.50" $480.59 $812.50 "$1,222.50" $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-001-29 SUP HCPCS C1713 17-001-29 - CLIP ANEURYSM 29 12MM OPENING STANDARD 5MM 6MM STR FENST BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-30 SUP HCPCS C1713 17-001-30 - CLIP ANEURYSM 14MM STANDARD 5MM 9MM STR FENST SUGITA BOTH IP/OP "$1,182.50" $875.00 $234.70 "$1,182.50" $532.13 $532.13 $532.13 $532.13 "$1,182.50" "$1,182.50" "$1,182.50" $246.46 "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" $246.45 "$1,182.50" $473.00 $699.45 "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" $886.88 "$1,182.50" "$1,182.50" "$1,182.50" $591.25 $591.25 $936.54 "$1,182.50" $946.00 $532.13 $234.70 N/A $685.85 "$1,182.50" $709.50 "$1,182.50" $246.43 "$1,182.50" N/A N/A 17-001-31 SUP HCPCS C1713 17-001-31 - CLIP ANEURYSM 15.5MM STANDARD 5MM 12MM STR FENST SUGITA BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-35 SUP HCPCS C1713 17-001-35 - CLIP ANRSM 5MM 5MM SGTA 9.5MM STD TI 2 BNT FENST BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-001-36 SUP HCPCS C1713 17-001-36 - CLIP ANRSM 7.5MM 5MM SGTA 10MM STD TI 2 BNT FENST BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-37 SUP HCPCS C1713 17-001-37 - CLIP ANRSM 10MM 5MM SGTA 11MM STD TI 2 BNT FENST BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-38 SUP HCPCS C1713 17-001-38 - CLIP ANRSM 5MM 3.5MM SGTA 7.5MM STD TI 2 L FENST BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-41 SUP HCPCS C1713 17-001-41 - CLIP ANRSM 5MM 5MM SGTA 8.5MM STD TI 2 L FENST BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-48 SUP HCPCS C1713 17-001-48 - CLIP ANRSM 7.5MM SGTA 45D 11.5MM STD TI 2 ANG BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-50 SUP HCPCS C1713 17-001-50 - CLIP ANEURYSM 13MM STANDARD 14MM CVD SUGITA TITANIUM 2 BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-51 SUP HCPCS C1713 17-001-51 - CLIP ANEURYSM 9MM STANDARD 7MM STR TEMPORARY SUGITA TITANIUM BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,222.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $489.00 $720.15 "$1,217.50" "$1,222.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" $730.50 "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-52 SUP HCPCS C1713 17-001-52 - CLIP ANEURYSM 10.5MM STANDARD 10MM STR TEMPORARY SUGITA BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,217.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $487.00 $720.15 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" $730.50 "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-53 SUP HCPCS C1713 17-001-53 - CLIP ANEURYSM 11.5MM STANDARD 7MM BAYONET TEMPORARY SUGITA BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $562.50 $937.50 $195.38 $937.50 N/A N/A 17-001-54 SUP HCPCS C1713 17-001-54 - CLIP ANRSM 8MM SGTA 9.5MM STD TI 2 BNT TEMP BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-55 SUP HCPCS C1713 17-001-55 - CLIP ANRSM 11MM SGTA 11MM STD TI 2 SLT CVD TEMP BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-56 SUP HCPCS C1713 17-001-56 - CLIP ANEURYSM 56 7MM MINI STR 6MM TEMPORARY WIDE OPENING BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,222.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" "$1,222.50" $720.15 "$1,217.50" "$1,222.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" "$1,217.50" "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-57 SUP HCPCS C1713 17-001-57 - CLIP ANEURYSM 7MM MINI 5MM BENT TEMPORARY SUGITA TITANIUM 2 BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,217.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" "$1,217.50" $720.15 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" $730.50 "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-58 SUP HCPCS C1713 17-001-58 - CLIP ANEURYSM 7MM MINI 6MM STR TEMPORARY SLIM TIP SUGITA BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,222.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $489.00 $720.15 "$1,217.50" "$1,222.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" $730.50 "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-64 SUP HCPCS C1713 17-001-64 - CLIP ANRSM 8MM SGTA 10.5MM STD TI 2 SLT BNT BOTH IP/OP "$1,182.50" $875.00 $234.70 "$1,182.50" $532.13 $532.13 $532.13 $532.13 "$1,182.50" "$1,182.50" "$1,182.50" $246.46 "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" $246.45 "$1,182.50" "$1,182.50" $699.45 "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" $886.88 "$1,182.50" "$1,182.50" "$1,182.50" $591.25 $591.25 $936.54 "$1,182.50" $946.00 $532.13 $234.70 N/A $685.85 "$1,182.50" "$1,182.50" "$1,182.50" $246.43 "$1,182.50" N/A N/A 17-001-65 SUP HCPCS C1713 17-001-65 - CLIP ANEURYSM 11MM STANDARD 11MM SLIGHTLY CVD SUGITA BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $937.50 $937.50 $195.38 $937.50 N/A N/A 17-001-66 SUP HCPCS C1713 17-001-66 - CLIP ANRSM 11MM SGTA 11MM STD TI 2 CVD NONSTRL BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,260.00" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" "$1,260.00" $720.15 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" "$1,217.50" "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-68 SUP HCPCS C1713 17-001-68 - CLIP ANEURYSM 10MM STANDARD 9MM SLIGHTLY CVD SUGITA TITANIUM BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,217.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $487.00 $720.15 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" $730.50 "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-69 SUP HCPCS C1713 17-001-69 - CLIP ANRSM 9MM SGTA 69 9.5MM OPN STD TI 2 CVD BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,217.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" "$1,217.50" $720.15 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" "$1,217.50" "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-72 SUP HCPCS C1713 17-001-72 - TII 18.0 Straight 25mm BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-001-76 SUP HCPCS C1713 17-001-76 - CLIP ANRSM 10MM 5MM 8.5MM STD LEFT TI 2 L FENST BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-001-79 SUP HCPCS C1713 17-001-79 - CLIP ANRSM 10MM 5MM 8.5MM STD RIGHT TI 2 L FENST BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-001-80 SUP HCPCS C1713 17-001-80 - CLIP ANEURYSM 5.5MM MINI 4MM STR SUGITA TITANIUM 2 NONSTRL BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,217.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $487.00 $720.15 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" $730.50 "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-81 SUP HCPCS C1713 17-001-81 - CLIP ANEURYSM 7MM MINI 6MM STR SUGITA TITANIUM 2 NONSTRL BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,222.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $489.00 $720.15 "$1,217.50" "$1,222.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" $730.50 "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-83 SUP HCPCS C1713 17-001-83 - CLIP ANRSM 5MM SGTA 6.5MM MINI TI 2 CVD NONSTRL BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $937.50 $937.50 $195.38 $937.50 N/A N/A 17-001-84 SUP HCPCS C1713 17-001-84 - CLIP ANEURYSM 7MM MINI 5MM BENT SUGITA TITANIUM 2 NONSTRL BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-85 SUP HCPCS C1713 17-001-85 - CLIP ANRSM 4MM SGTA 5.5MM MINI TI 2 CVD NONSTRL BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $937.50 $937.50 $195.38 $937.50 N/A N/A 17-001-86 SUP HCPCS C1713 17-001-86 - CLIP ANRSM 7MM SGTA 7.5MM MINI TI 2 SDWRD CVD BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $937.50 $937.50 $195.38 $937.50 N/A N/A 17-001-88 SUP HCPCS C1713 17-001-88 - CLIP ANEURYSM 7.5MM MINI 7MM CVD SUGITA TITANIUM 2 NONSTRL BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-001-89 SUP HCPCS C1713 17-001-89 - CLIP ANRSM 5MM SGTA 89 8.5MM OPN MINI TI 2 BYNT BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-001-90 SUP HCPCS C1713 17-001-90 - T2 20.5 STRAIGHT 30MM BOTH IP/OP "$1,740.50" "$1,288.00" $345.36 "$1,740.05" $783.02 $783.02 $783.02 $783.02 "$1,740.05" "$1,740.05" "$1,740.05" $362.67 "$1,740.05" "$1,740.05" "$1,740.05" "$1,740.05" "$1,740.05" $362.65 "$1,740.05" "$1,740.05" "$1,029.24" "$1,740.05" "$1,740.05" "$1,740.05" "$1,740.05" "$1,305.38" "$1,740.05" "$1,740.05" "$1,740.05" $870.03 $870.03 "$1,378.12" "$1,740.05" "$1,392.04" $783.02 $345.36 N/A "$1,009.49" "$1,740.05" "$1,044.03" "$1,740.05" $362.63 "$1,740.05" N/A N/A 17-001-91 SUP HCPCS C1713 17-001-91 - T2 23.5 STRAIGHT 35MM BOTH IP/OP "$1,740.50" "$1,288.00" $345.36 "$1,740.05" $783.02 $783.02 $783.02 $783.02 "$1,740.05" "$1,740.05" "$1,740.05" $362.67 "$1,740.05" "$1,740.05" "$1,740.05" "$1,740.05" "$1,740.05" $362.65 "$1,740.05" "$1,740.05" "$1,029.24" "$1,740.05" "$1,740.05" "$1,740.05" "$1,740.05" "$1,305.38" "$1,740.05" "$1,740.05" "$1,740.05" $870.03 $870.03 "$1,378.12" "$1,740.05" "$1,392.04" $783.02 $345.36 N/A "$1,009.49" "$1,740.05" "$1,740.05" "$1,740.05" $362.63 "$1,740.05" N/A N/A 17-001-92 SUP HCPCS C1713 17-001-92 - CLIP ANRSM 92 26MM OPN LNG STRG 40MM TI 2 BOTH IP/OP "$1,740.50" "$1,288.00" $345.36 "$1,740.05" $783.02 $783.02 $783.02 $783.02 "$1,740.05" "$1,740.05" "$1,740.05" $362.67 "$1,740.05" "$1,740.05" "$1,740.05" "$1,740.05" "$1,740.05" $362.65 "$1,740.05" "$1,740.05" "$1,029.24" "$1,740.05" "$1,740.05" "$1,740.05" "$1,740.05" "$1,305.38" "$1,740.05" "$1,740.05" "$1,740.05" $870.03 $870.03 "$1,378.12" "$1,740.05" "$1,392.04" $783.02 $345.36 N/A "$1,009.49" "$1,740.05" "$1,044.03" "$1,740.05" $362.63 "$1,740.05" N/A N/A 17-001-95 SUP HCPCS C1713 17-001-95 - CLIP ANEURYSM 5.5MM MINI 4MM STR SLIM TIP SUGITA TITANIUM 2 BOTH IP/OP "$1,182.50" $875.00 $234.70 "$1,182.50" $532.13 $532.13 $532.13 $532.13 "$1,182.50" "$1,182.50" "$1,182.50" $246.46 "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" $246.45 "$1,182.50" $473.00 $699.45 "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" $886.88 "$1,182.50" "$1,182.50" "$1,182.50" $591.25 $591.25 $936.54 "$1,182.50" $946.00 $532.13 $234.70 N/A $685.85 "$1,182.50" $709.50 "$1,182.50" $246.43 "$1,182.50" N/A N/A 17-001-96 SUP HCPCS C1713 17-001-96 - CLIP ANEURYSM 7MM MINI 6MM STR SLIM TIP SUGITA TITANIUM 2 BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,217.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $487.00 $720.15 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" "$1,217.50" "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-001-97 SUP HCPCS C1713 17-001-97 - CLIP ANRSM 6.7MM SGTA 7MM MINI TI 2 CVD SLIM TIP BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $562.50 $937.50 $195.38 $937.50 N/A N/A 17-001-99 SUP HCPCS C1713 17-001-99 - CLIP ANRSM 5.2MM SGTA 6.5MM MINI TI 2 CVD SLIM TIP BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $937.50 $937.50 $195.38 $937.50 N/A N/A 17-002-03 SUP HCPCS C1713 17-002-03 - CLIP ANRSM 10 T2 STD TLL 4MM SGTA CRANK SHFT TI BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-002-05 SUP HCPCS C1713 17-002-05 - CLIP ANRSM 12MM 5MM HEAD STRNG 7.5MM STD TI 2 BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-002-15 SUP HCPCS C1713 17-002-15 - CLIP ANEURYSM 8MM MINI 8MM STR SUGITA TITANIUM 2 BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,217.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" $504.00 $720.15 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" $730.50 "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-002-16 SUP HCPCS C1713 17-002-16 - CLIP ANRSM 6.5MM SGTA 7MM MINI TI 2 CVD BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $562.50 $937.50 $195.38 $937.50 N/A N/A 17-002-17 SUP HCPCS C1713 17-002-17 - CLIP ANRSM 5.5MM SGTA 6.5MM MINI TI 2 SLT CVD BOTH IP/OP $812.50 $601.00 $161.26 "$1,222.50" $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 "$1,222.50" $480.59 $812.50 "$1,222.50" $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 17-002-19 SUP Custom 27011340 17-002-19 - CLIP ANRSM 6MM SGTA 8.5MM MINI TI 2 SDWRD BNT BOTH IP/OP "$1,182.50" $875.00 $210.49 "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" $210.49 "$1,182.50" "$1,182.50" $877.65 $877.65 $911.47 $616.08 $246.45 "$1,182.50" $473.00 "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" $886.88 "$1,182.50" "$1,182.50" "$1,182.50" $591.25 $591.25 $936.54 "$1,182.50" $946.00 $768.63 "$1,182.50" N/A $685.85 "$1,182.50" $709.50 "$1,182.50" "$1,182.50" "$1,182.50" N/A N/A 17-002-20 SUP HCPCS C1713 17-002-20 - CLIP ANRSM 7MM SGTA 10MM MINI TI 2 BYNT BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-002-21 SUP HCPCS C1713 17-002-21 - CLIP ANRSM 5.5MM SGTA 6.5MM MINI TI 2 CVD SLIM TIP BOTH IP/OP $937.50 $694.00 $186.07 "$1,222.50" $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $489.00 $554.53 $937.50 "$1,222.50" $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $937.50 $937.50 $195.38 $937.50 N/A N/A 170-03-25008 SUP HCPCS C1874 170-03-25008 - SYSTEM COR STNT 2.5MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-25012 SUP HCPCS C1874 170-03-25012 - SYSTEM COR STNT 2.5MM 12MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-25015 SUP HCPCS C1874 170-03-25015 - SYSTEM COR STNT 2.5MM 15MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-25018 SUP HCPCS C1874 170-03-25018 - SYSTEM COR STNT 2.5MM 18MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-25024 SUP HCPCS C1874 170-03-25024 - SYSTEM COR STNT 2.5MM 24MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-25030 SUP HCPCS C1874 170-03-25030 - SYSTEM COR STNT 2.5MM 30MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-27508 SUP HCPCS C1874 170-03-27508 - SYSTEM COR STNT 2.75MM 8MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-27512 SUP HCPCS C1874 170-03-27512 - SYSTEM COR STNT 2.75MM 12MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-27515 SUP HCPCS C1874 170-03-27515 - SYSTEM COR STNT 2.75MM 15MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-27518 SUP HCPCS C1874 170-03-27518 - SYSTEM COR STNT 2.75MM 18MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-27524 SUP HCPCS C1874 170-03-27524 - SYSTEM COR STNT 2.75MM 24MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-27530 SUP HCPCS C1874 170-03-27530 - SYSTEM COR STNT 2.75MM 30MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-30008 SUP HCPCS C1874 170-03-30008 - SYSTEM COR STNT 3MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-30012 SUP HCPCS C1874 170-03-30012 - SYSTEM COR STNT 3MM 12MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-30015 SUP HCPCS C1874 170-03-30015 - SYSTEM COR STNT 3MM 15MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-30018 SUP HCPCS C1874 170-03-30018 - SYSTEM COR STNT 3MM 18MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-30024 SUP HCPCS C1874 170-03-30024 - SYSTEM COR STNT 3MM 24MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-30030 SUP HCPCS C1874 170-03-30030 - SYSTEM COR STNT 3MM 30MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-35008 SUP HCPCS C1874 170-03-35008 - SYSTEM COR STNT 3.5MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-35012 SUP HCPCS C1874 170-03-35012 - SYSTEM COR STNT 3.5MM 12MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-35015 SUP HCPCS C1876 170-03-35015 - SYSTEM COR STNT 3.5MM 15MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-35018 SUP HCPCS C1876 170-03-35018 - SYSTEM COR STNT 3.5MM 18MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-35024 SUP HCPCS C1874 170-03-35024 - SYSTEM COR STNT 3.5MM 24MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-35030 SUP HCPCS C1874 170-03-35030 - SYSTEM COR STNT 3.5MM 30MM CBR PZF RX DLV SYS POLYZENE-F BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-40008 SUP HCPCS C1874 170-03-40008 - SYSTEM COR STNT 4MM 8MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-40012 SUP HCPCS C1874 170-03-40012 - SYSTEM COR STNT 4MM 12MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-40015 SUP HCPCS C1874 170-03-40015 - SYSTEM COR STNT 4MM 15MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-40018 SUP HCPCS C1874 170-03-40018 - SYSTEM COR STNT 4MM 18MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-40024 SUP HCPCS C1874 170-03-40024 - SYSTEM COR STNT 4MM 24MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 170-03-40030 SUP HCPCS C1874 170-03-40030 - SYSTEM COR STNT 4MM 30MM CBR PZF RX DLV SYS POLYZENE-F COCR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 17-006-03 SUP HCPCS C1713 17-006-03 - CLIP ANRSM 11 T2 STD L 5MM SGTA WDW TI BOTH IP/OP "$1,302.50" $964.00 $258.47 "$1,302.30" $586.04 $586.04 $586.04 $586.04 "$1,302.30" "$1,302.30" "$1,302.30" $271.43 "$1,302.30" "$1,302.30" "$1,302.30" "$1,302.30" "$1,302.30" $271.41 "$1,302.30" $520.92 $770.31 "$1,302.30" "$1,302.30" "$1,302.30" "$1,302.30" $976.88 "$1,302.30" "$1,302.30" "$1,302.30" $651.15 $651.15 "$1,031.42" "$1,302.30" "$1,041.84" $586.04 $258.47 N/A $755.45 "$1,302.30" "$1,302.30" "$1,302.30" $271.40 "$1,302.30" N/A N/A 17-006-36 SUP HCPCS C1713 17-006-36 - CLIP ANRSM 142 006-36 STD BNT 5MM 3MM FENESTRATE TI BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $504.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 17-006-39 SUP HCPCS C1713 17-006-39 - CLIP ANRSM STRG 3.5MM 4MM SGTA T2 FENESTRATE TI BOTH IP/OP "$1,217.50" $901.00 $241.64 "$1,217.50" $547.88 $547.88 $547.88 $547.88 "$1,217.50" "$1,217.50" "$1,217.50" $253.76 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $253.74 "$1,217.50" "$1,217.50" $720.15 "$1,217.50" "$1,217.50" "$1,217.50" "$1,217.50" $913.13 "$1,217.50" "$1,217.50" "$1,217.50" $608.75 $608.75 $964.26 "$1,217.50" $974.00 $547.88 $241.64 N/A $706.15 "$1,217.50" "$1,217.50" "$1,217.50" $253.73 "$1,217.50" N/A N/A 17-006-40 SUP HCPCS C1713 17-006-40 - CLIP ANRSM STRG 5MM 4MM SGTA T2 FENESTRATE TI BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 1714G SUP Custom 27203010 1714G - SUTURE NONABSORBABLE 8-0 TG100-8 12IN 2 ARM MONOFILAMENT BOTH IP/OP $33.50 $25.00 $5.96 $33.48 $33.48 $33.48 $33.48 $33.48 $33.48 $33.48 $5.96 $33.48 $33.48 $24.85 $24.85 $25.81 $17.44 $6.98 $33.48 $13.39 $33.48 $33.48 $33.48 $33.48 $33.48 $25.13 $33.48 $33.48 $33.48 $16.74 $16.74 $26.52 $33.48 $26.78 $21.76 $33.48 N/A $19.43 $33.48 $20.09 $33.48 $33.48 $33.48 N/A N/A 1716G SUP Custom 27203010 1716G - SUTURE NONABSORBABLE 8-0 TG175-8 12IN 2 ARM MONOFILAMENT BOTH IP/OP $34.00 $25.00 $5.98 $34.59 $33.61 $33.61 $33.61 $33.61 $33.61 $33.61 $5.98 $33.61 $33.61 $24.95 $24.95 $25.91 $17.51 $7.00 $33.61 $13.84 $33.61 $33.61 $34.59 $33.61 $33.61 $25.50 $33.61 $33.61 $33.61 $16.81 $16.81 $26.62 $33.61 $26.89 $21.85 $33.61 N/A $19.72 $33.61 $20.17 $33.61 $33.61 $33.61 N/A N/A 17200D600 SUP Custom 27203010 17200D600 - PUNCH SURG 6MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A 17200D650 SUP Custom 27203010 17200D650 - PUNCH SURG 6.5MM CORNEUM 2 PC VAC UL SHRP BLADE BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A 17200D700 SUP Custom 27203010 17200D700 - PUNCH SURG 7MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A 17200D725 SUP Custom 27203010 17200D725 - PUNCH SURG 7.25MM CORNEUM 2 PC VAC UL SHRP BLADE BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A 17200D750 SUP Custom 27203010 17200D750 - PUNCH SURG 7.5MM CORNEUM 2 PC VAC UL SHRP BLADE BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A 17200D775 SUP Custom 27203010 17200D775 - PUNCH SURG 7.75MM CORNEUM 2 PC VAC UL SHRP BLADE BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A 17200D800 SUP Custom 27203010 17200D800 - PUNCH SURG 8MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A 17200D825 SUP Custom 27203010 17200D825 - PUNCH SURG 8.25MM CORNEUM 2 PC VAC UL SHRP BLADE BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A 17200D850 SUP Custom 27203010 17200D850 - PUNCH SURG 8.5MM CORNEUM 2 PC VAC UL SHRP BLADE BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A 17200D875 SUP Custom 27203010 17200D875 - PUNCH SURG 8.75MM CORNEUM 2 PC VAC UL SHRP BLADE BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A 17200D900 SUP Custom 27203010 17200D900 - PUNCH SURG 9MM CORNEUM 2 PC VAC UL SHRP BLADE SPRG BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A 17200D950 SUP Custom 27203010 17200D950 - PUNCH SURG 9.5MM CORNEUM 2 PC VAC UL SHRP BLADE BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A 1722G SUP Custom 27203010 1722G - SUTURE NONABSORBABLE 6-0 S-14 18IN MONOFILAMENT PLIABILIZE BOTH IP/OP $34.00 $25.00 $5.98 $33.57 $33.57 $33.57 $33.57 $33.57 $33.57 $33.57 $5.98 $33.57 $33.57 $24.92 $24.92 $25.88 $17.49 $7.00 $33.57 $13.43 $33.57 $33.57 $33.57 $33.57 $33.57 $25.50 $33.57 $33.57 $33.57 $16.79 $16.79 $26.59 $33.57 $26.86 $21.82 $33.57 N/A $19.72 $33.57 $20.14 $33.57 $33.57 $33.57 N/A N/A 17-2800E SUP Custom 27803010 17-2800E - HEAD FEMORAL C TAPER ALUM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 17-2805E SUP Custom 27803010 17-2805E - HEAD FEMORAL +5MM 28MM C TAPER ALUM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 17-28-3E SUP Custom 27803010 17-28-3E - HEAD FEMORAL +3MM 28MM C TAPER ALUM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 173050G SUP Custom 27203010 173050G - POUCH SPECIMEN RETRIEVAL 10MM 34.5CM MINIMIZE SPILLAGE BOTH IP/OP $148.00 $110.00 $26.34 $147.95 $147.95 $147.95 $147.95 $147.95 $147.95 $147.95 $26.34 $147.95 $147.95 $109.81 $109.81 $114.04 $77.08 $30.83 $147.95 $40.00 $147.95 $147.95 $100.00 $147.95 $147.95 $111.00 $147.95 $147.95 $147.95 $73.98 $73.98 $117.18 $147.95 $118.36 $96.17 $147.95 N/A $85.84 $147.95 $88.77 $147.95 $147.95 $147.95 N/A N/A 17-3200E SUP Custom 27803010 17-3200E - HEAD FEM +0MM OFST CTPR 32MM STRL AL CERM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 17-3205E SUP Custom 27803010 17-3205E - HEAD FEMORAL +5MM 32MM C TAPER ALUM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 17-32-3E SUP Custom 27803010 17-32-3E - HEAD FEM -2.5MM CTPR 32MM STRL AL CERM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 1735G SUP Custom 27203010 1735G - SUTURE ABSORBABLE 6-0 TG140-8 18IN 2 ARM MONOFILAMENT BOTH IP/OP $56.00 $41.00 $9.92 $57.34 $55.72 $55.72 $55.72 $55.72 $55.72 $55.72 $9.92 $55.72 $55.72 $41.36 $41.36 $42.95 $29.03 $11.61 $55.72 $22.94 $55.72 $55.72 $57.34 $55.72 $55.72 $42.00 $55.72 $55.72 $55.72 $27.86 $27.86 $44.13 $55.72 $44.58 $36.22 $55.72 N/A $32.48 $55.72 $33.43 $55.72 $55.72 $55.72 N/A N/A 17-3600E SUP Custom 27803010 17-3600E - HEAD FEM +0MM OFST CTPR 36MM STRL AL CERM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 17-3605E SUP Custom 27803010 17-3605E - HEAD FEMORAL +5MM 36MM C TAPER ALUM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 17-36-5E SUP HCPCS C1713 17-36-5E - HEAD FEMORAL -5MM C-TAPER 36MM OFFST ALUM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" "$1,725.00" "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 174105-2 SUP Custom 27203010 174105-2 - MAGNET PACEMAKER RING 90 GAUSS DEVICE STATUS BLUE FERROUS BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 175031EN SUP Custom 27203010 175031EN - SYSTEM IRRIGATION ENT LATEX FREE IFU MR7 BOTH IP/OP $24.00 $18.00 $4.27 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $4.27 $24.00 $24.00 $17.81 $17.81 $18.50 $12.50 $5.00 $24.00 $9.60 $24.00 $24.00 $24.00 $24.00 $24.00 $18.00 $24.00 $24.00 $24.00 $12.00 $12.00 $19.01 $24.00 $19.20 $15.60 $24.00 N/A $13.92 $24.00 $14.40 $24.00 $24.00 $24.00 N/A N/A 1754G SUP Custom 27203010 1754G - SUTURE NONABSORBABLE 9-0 TG140-8 6IN 2 ARM MONOFILAMENT BOTH IP/OP $42.50 $31.00 $7.48 $42.02 $42.02 $42.02 $42.02 $42.02 $42.02 $42.02 $7.48 $42.02 $42.02 $31.19 $31.19 $32.39 $21.89 $8.76 $42.02 $16.81 $42.02 $42.02 $42.02 $42.02 $42.02 $31.88 $42.02 $42.02 $42.02 $21.01 $21.01 $33.28 $42.02 $33.62 $27.31 $42.02 N/A $24.65 $42.02 $25.21 $42.02 $42.02 $42.02 N/A N/A 1758SI16 SUP Custom 27203010 1758SI16 - CATHETER URTH 16FR 5CC STRL LF BARD LBRSL IC 2W FL BLN BOTH IP/OP $1.00 $1.00 $0.18 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.18 $1.00 $1.00 $0.74 $0.74 $0.77 $0.52 $0.21 $1.00 $0.40 $1.00 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.65 $1.00 N/A $0.58 $1.00 $0.60 $1.00 $1.00 $1.00 N/A N/A 1762G SUP Custom 27203010 1762G - SUTURE NONABSORBABLE 4-0 S-24 18IN MONOFILAMENT PLIABILIZE BOTH IP/OP $37.50 $28.00 $6.63 $38.35 $37.27 $37.27 $37.27 $37.27 $37.27 $37.27 $6.63 $37.27 $37.27 $27.66 $27.66 $28.73 $19.42 $7.77 $37.27 $15.34 $37.27 $37.27 $38.35 $37.27 $37.27 $28.13 $37.27 $37.27 $37.27 $18.64 $18.64 $29.52 $37.27 $29.82 $24.23 $37.27 N/A $21.75 $37.27 $22.36 $37.27 $37.27 $37.27 N/A N/A 1764G SUP Custom 27203010 1764G - SUTURE NABSB 5-0 S-24 18IN WHT MERS SABRELOC 2 ARM BRD BOTH IP/OP $37.00 $27.00 $6.57 $37.97 $36.90 $36.90 $36.90 $36.90 $36.90 $36.90 $6.57 $36.90 $36.90 $27.39 $27.39 $28.44 $19.22 $7.69 $36.90 $15.19 $36.90 $36.90 $37.97 $36.90 $36.90 $27.75 $36.90 $36.90 $36.90 $18.45 $18.45 $29.22 $36.90 $29.52 $23.99 $36.90 N/A $21.46 $36.90 $22.14 $36.90 $36.90 $36.90 N/A N/A 1773.00.126 SUP HCPCS C1713 1773.00.126 - CAGE SPNL 12MM STD PRLL 14X26MM NS LF BENGAL STKBL RDLCNT BOTH IP/OP "$8,790.00" "$6,505.00" "$1,744.60" "$8,790.00" "$3,955.50" "$3,955.50" "$3,955.50" "$3,955.50" "$8,790.00" "$8,790.00" "$8,790.00" "$1,832.06" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$1,831.93" "$8,790.00" "$3,516.00" "$4,333.47" "$8,790.00" "$8,790.00" "$8,790.00" "$8,790.00" "$6,592.50" "$8,790.00" "$8,790.00" "$8,790.00" "$4,395.00" "$4,395.00" "$6,961.68" "$8,790.00" "$7,032.00" "$3,955.50" "$1,744.60" N/A "$5,098.20" "$8,790.00" "$5,274.00" "$8,790.00" "$1,831.84" "$8,790.00" N/A N/A 1779G SUP Custom 27203010 1779G - SUTURE NONABSORBABLE 4-0 S-2 18IN MONOFILAMENT PLIABILIZE BOTH IP/OP $34.00 $25.00 $6.04 $33.94 $33.94 $33.94 $33.94 $33.94 $33.94 $33.94 $6.04 $33.94 $33.94 $25.19 $25.19 $26.16 $17.68 $7.07 $33.94 $13.58 $33.94 $33.94 $33.94 $33.94 $33.94 $25.50 $33.94 $33.94 $33.94 $16.97 $16.97 $26.88 $33.94 $27.15 $22.06 $33.94 N/A $19.72 $33.94 $20.36 $33.94 $33.94 $33.94 N/A N/A 179078P SUP Custom 27203010 179078P - TROCAR LAPSCOP PYRAMID 10-15MM 100MM 5MM SAFETY SHIELD SELF BOTH IP/OP $120.50 $89.00 $21.39 $120.15 $120.15 $120.15 $120.15 $120.15 $120.15 $120.15 $21.39 $120.15 $120.15 $89.18 $89.18 $92.61 $62.60 $25.04 $120.15 $48.06 $120.15 $120.15 $120.15 $120.15 $120.15 $90.38 $120.15 $120.15 $120.15 $60.08 $60.08 $95.16 $120.15 $96.12 $78.10 $120.15 N/A $69.89 $120.15 $72.09 $120.15 $120.15 $120.15 N/A N/A 179094F SUP Custom 27203010 179094F - TROCAR LAPSCP 5MM LVN VPRT+ V2 VERSASEAL + FX CNN CNVTRLS BOTH IP/OP $74.00 $55.00 $13.16 $73.95 $73.95 $73.95 $73.95 $73.95 $73.95 $73.95 $13.16 $73.95 $73.95 $54.89 $54.89 $57.00 $38.53 $15.41 $73.95 $29.58 $73.95 $73.95 $73.95 $73.95 $73.95 $55.50 $73.95 $73.95 $73.95 $36.98 $36.98 $58.57 $73.95 $59.16 $48.07 $73.95 N/A $42.92 $73.95 $44.37 $73.95 $73.95 $73.95 N/A N/A 179096PF SUP Custom 27203010 179096PF - TROCAR LAPSCP 5-12MM 110MM BLK STRL LF VPRT+ V2 VERSASEAL + BOTH IP/OP $86.50 $64.00 $15.36 $86.28 $86.28 $86.28 $86.28 $86.28 $86.28 $86.28 $15.36 $86.28 $86.28 $64.04 $64.04 $66.50 $44.95 $17.98 $86.28 $34.51 $86.28 $86.28 $86.28 $86.28 $86.28 $64.88 $86.28 $86.28 $86.28 $43.14 $43.14 $68.33 $86.28 $69.02 $56.08 $86.28 N/A $50.17 $86.28 $51.77 $86.28 $86.28 $86.28 N/A N/A 1797.12.765 SUP HCPCS C1713 1797.12.765 - SCREW BONE 7MM 65MM 1 INNIE POLYAX EXPEDIUM TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 1797.71.150 SUP HCPCS C1713 1797.71.150 - ROD SPNL PREBNT 5.5MM 150MM NS XPDM LN TI BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $562.50 $937.50 $195.38 $937.50 N/A N/A 1797.71.555 SUP HCPCS C1713 1797.71.555 - CONNECTOR ROD 5.5MM TOP NOTCH OUTER TO OUTER SIDE SPN BOTH IP/OP "$2,752.50" "$2,037.00" $546.30 "$2,752.50" "$1,238.63" "$1,238.63" "$1,238.63" "$1,238.63" "$2,752.50" "$2,752.50" "$2,752.50" $573.69 "$2,752.50" "$2,752.50" "$2,752.50" "$2,752.50" "$2,752.50" $573.65 "$2,752.50" "$2,752.50" "$1,356.98" "$2,752.50" "$2,752.50" "$2,752.50" "$2,752.50" "$2,064.38" "$2,752.50" "$2,752.50" "$2,752.50" "$1,376.25" "$1,376.25" "$2,179.98" "$2,752.50" "$2,202.00" "$1,238.63" $546.30 N/A "$1,596.45" "$2,752.50" "$1,651.50" "$2,752.50" $573.62 "$2,752.50" N/A N/A 1797G SUP Custom 27203010 1797G - SUTURE ABSORBABLE 7-0 TG140-8 18IN 2 ARM MONOFILAMENT BOTH IP/OP $67.50 $50.00 $11.93 $68.97 $67.02 $67.02 $67.02 $67.02 $67.02 $67.02 $11.93 $67.02 $67.02 $49.74 $49.74 $51.66 $34.92 $13.97 $67.02 $27.59 $67.02 $67.02 $68.97 $67.02 $67.02 $50.63 $67.02 $67.02 $67.02 $33.51 $33.51 $53.08 $67.02 $53.62 $43.56 $67.02 N/A $39.15 $67.02 $40.21 $67.02 $67.02 $67.02 N/A N/A 180320-1 SUP HCPCS C1776 180320-1 - COMPONENT PTLR RND 26MM RSRFC KN MCK SYS BOTH IP/OP "$2,192.50" "$1,622.00" $435.16 "$2,192.50" $986.63 $986.63 $986.63 $986.63 "$2,192.50" "$2,192.50" "$2,192.50" $456.97 "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" $456.94 "$2,192.50" "$2,192.50" "$1,296.86" "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" "$1,644.38" "$2,192.50" "$2,192.50" "$2,192.50" "$1,096.25" "$1,096.25" "$1,736.46" "$2,192.50" "$1,754.00" $986.63 $435.16 N/A "$1,271.65" "$2,192.50" "$2,192.50" "$2,192.50" $456.92 "$2,192.50" N/A N/A 180320-2 SUP HCPCS C1776 180320-2 - COMPONENT PTLR RND 29MM RSRFC KN MCK SYS BOTH IP/OP "$2,192.50" "$1,622.00" $435.16 "$2,192.50" $986.63 $986.63 $986.63 $986.63 "$2,192.50" "$2,192.50" "$2,192.50" $456.97 "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" $456.94 "$2,192.50" $877.00 "$1,296.86" "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" "$1,644.38" "$2,192.50" "$2,192.50" "$2,192.50" "$1,096.25" "$1,096.25" "$1,736.46" "$2,192.50" "$1,754.00" $986.63 $435.16 N/A "$1,271.65" "$2,192.50" "$2,192.50" "$2,192.50" $456.92 "$2,192.50" N/A N/A 180320-3 SUP HCPCS C1776 180320-3 - COMPONENT PTLR RND 32MM RSRFC KN MCK SYS BOTH IP/OP "$2,192.50" "$1,622.00" $435.16 "$2,192.50" $986.63 $986.63 $986.63 $986.63 "$2,192.50" "$2,192.50" "$2,192.50" $456.97 "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" $456.94 "$2,192.50" "$2,192.50" "$1,296.86" "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" "$1,644.38" "$2,192.50" "$2,192.50" "$2,192.50" "$1,096.25" "$1,096.25" "$1,736.46" "$2,192.50" "$1,754.00" $986.63 $435.16 N/A "$1,271.65" "$2,192.50" "$2,192.50" "$2,192.50" $456.92 "$2,192.50" N/A N/A 180320-4 SUP HCPCS C1776 180320-4 - DOME PTLR RND 35MM RSRFC KN MCK SYS BOTH IP/OP "$2,192.50" "$1,622.00" $435.16 "$2,192.50" $986.63 $986.63 $986.63 $986.63 "$2,192.50" "$2,192.50" "$2,192.50" $456.97 "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" $456.94 "$2,192.50" $877.00 "$1,296.86" "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" "$1,644.38" "$2,192.50" "$2,192.50" "$2,192.50" "$1,096.25" "$1,096.25" "$1,736.46" "$2,192.50" "$1,754.00" $986.63 $435.16 N/A "$1,271.65" "$2,192.50" "$2,192.50" "$2,192.50" $456.92 "$2,192.50" N/A N/A 180320-6 SUP HCPCS C1776 180320-6 - DOME PTLR RND 41MM RSRFC KN MCK SYS BOTH IP/OP "$2,192.50" "$1,622.00" $435.16 "$2,192.50" $986.63 $986.63 $986.63 $986.63 "$2,192.50" "$2,192.50" "$2,192.50" $456.97 "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" $456.94 "$2,192.50" $877.00 "$1,296.86" "$2,192.50" "$2,192.50" "$2,192.50" "$2,192.50" "$1,644.38" "$2,192.50" "$2,192.50" "$2,192.50" "$1,096.25" "$1,096.25" "$1,736.46" "$2,192.50" "$1,754.00" $986.63 $435.16 N/A "$1,271.65" "$2,192.50" "$2,192.50" "$2,192.50" $456.92 "$2,192.50" N/A N/A 1806-0004 SUP HCPCS C1713 1806-0004 - SCREW BONE LOCKING INSERT T2 BOTH IP/OP $461.00 $341.00 $91.42 $460.63 $207.28 $207.28 $207.28 $207.28 $460.63 $460.63 $460.63 $96.01 $460.63 $460.63 $460.63 $460.63 $460.63 $96.00 $460.63 $184.25 $272.46 $460.63 $460.63 $460.63 $460.63 $345.75 $460.63 $460.63 $460.63 $230.32 $230.32 $364.82 $460.63 $368.50 $207.28 $91.42 N/A $267.38 $460.63 $460.63 $460.63 $96.00 $460.63 N/A N/A 1806-0007 SUP HCPCS C1713 1806-0007 - SCREW BONE INSERT T2 CONDYLE BOTH IP/OP $426.50 $316.00 $84.60 $426.25 $191.81 $191.81 $191.81 $191.81 $426.25 $426.25 $426.25 $88.84 $426.25 $426.25 $426.25 $426.25 $426.25 $88.84 $426.25 $426.25 $252.13 $426.25 $426.25 $426.25 $426.25 $319.88 $426.25 $426.25 $426.25 $213.13 $213.13 $337.59 $426.25 $341.00 $191.81 $84.60 N/A $247.37 $426.25 $426.25 $426.25 $88.83 $426.25 N/A N/A 1806-0009 SUP HCPCS C1713 1806-0009 - SCREW BONE INSERT COMPRESSION T2 FEMUR TIBIA BOTH IP/OP $527.00 $390.00 $104.52 $526.63 $236.98 $236.98 $236.98 $236.98 $526.63 $526.63 $526.63 $109.76 $526.63 $526.63 $526.63 $526.63 $526.63 $109.76 $526.63 $526.63 $311.50 $526.63 $526.63 $526.63 $526.63 $395.25 $526.63 $526.63 $526.63 $263.32 $263.32 $417.09 $526.63 $421.30 $236.98 $104.52 N/A $305.66 $526.63 $526.63 $526.63 $109.75 $526.63 N/A N/A 1806-0050S SUP HCPCS C1713 1806-0050S - WIRE FX 3MM 285MM STRL KRSH T2 SS BOTH IP/OP $195.50 $145.00 $38.80 $195.50 $87.98 $87.98 $87.98 $87.98 $195.50 $195.50 $195.50 $40.75 $195.50 $195.50 $195.50 $195.50 $195.50 $40.74 $195.50 $195.50 $115.64 $195.50 $195.50 $195.50 $195.50 $146.63 $195.50 $195.50 $195.50 $97.75 $97.75 $154.84 $195.50 $156.40 $87.98 $38.80 N/A $113.39 $195.50 $195.50 $195.50 $40.74 $195.50 N/A N/A 1806-0073S SUP Custom 27203010 1806-0073S - TUBE ORTH TFLN T2 HUM NL SYS BOTH IP/OP $388.00 $287.00 $69.02 $387.75 $387.75 $387.75 $387.75 $387.75 $387.75 $387.75 $69.02 $387.75 $387.75 $287.79 $287.79 $298.88 $202.02 $80.81 $387.75 $155.10 $387.75 $387.75 $387.75 $387.75 $387.75 $291.00 $387.75 $387.75 $387.75 $193.88 $193.88 $307.10 $387.75 $310.20 $252.04 $387.75 N/A $225.04 $387.75 $232.65 $387.75 $387.75 $387.75 N/A N/A 1806-0080S SUP HCPCS C1769 1806-0080S - GUIDEWIRE ORTHOPEDIC 3MM 800MM BALL TIP T2 TITANIUM STERILE BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $160.53 $160.53 $160.53 $160.53 $295.63 $295.63 $295.63 $61.62 $295.63 $219.42 $219.42 $227.87 $154.02 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $192.16 $58.68 N/A $171.68 $295.63 $295.63 $295.63 $61.61 $295.63 N/A N/A 1806-0083S SUP HCPCS C1769 1806-0083S - GUIDEWIRE ORTHOPEDIC 2.5MM 800MM BALL TIP T2 TITANIUM BOTH IP/OP $291.00 $215.00 $57.70 $290.70 $157.85 $157.85 $157.85 $157.85 $290.70 $290.70 $290.70 $60.59 $290.70 $215.76 $215.76 $224.07 $151.45 $60.59 $290.70 $290.70 $171.95 $290.70 $290.70 $290.70 $290.70 $218.25 $290.70 $290.70 $290.70 $145.35 $145.35 $230.23 $290.70 $232.56 $188.96 $57.70 N/A $168.78 $290.70 $290.70 $290.70 $60.58 $290.70 N/A N/A 1806-0085S SUP HCPCS C1769 1806-0085S - GUIDEWIRE ORTHOPEDIC 3MM 1000MM BALL TIP T2 TITANIUM FEMUR BOTH IP/OP $313.00 $232.00 $62.08 $312.80 $169.85 $169.85 $169.85 $169.85 $312.80 $312.80 $312.80 $65.20 $312.80 $232.16 $232.16 $241.11 $162.97 $65.19 $312.80 $312.80 $185.02 $312.80 $312.80 $312.80 $312.80 $234.75 $312.80 $312.80 $312.80 $156.40 $156.40 $247.74 $312.80 $250.24 $203.32 $62.08 N/A $181.54 $312.80 $312.80 $312.80 $65.19 $312.80 N/A N/A 1806-0090S SUP HCPCS C1769 1806-0090S - GUIDEWIRE ORTHOPEDIC 3MM 800MM SMOOTH TIP T2 TITANIUM TIBIA BOTH IP/OP $294.50 $218.00 $58.37 $294.10 $159.70 $159.70 $159.70 $159.70 $294.10 $294.10 $294.10 $61.30 $294.10 $218.28 $218.28 $226.69 $153.23 $61.29 $294.10 $294.10 $173.96 $294.10 $294.10 $294.10 $294.10 $220.88 $294.10 $294.10 $294.10 $147.05 $147.05 $232.93 $294.10 $235.28 $191.17 $58.37 N/A $170.81 $294.10 $294.10 $294.10 $61.29 $294.10 N/A N/A 1806-0093S SUP HCPCS C1769 1806-0093S - GUIDEWIRE ORTHOPEDIC 2.2MM 800MM SMOOTH TIP T2 TITANIUM BOTH IP/OP $283.50 $210.00 $56.18 $283.05 $153.70 $153.70 $153.70 $153.70 $283.05 $283.05 $283.05 $58.99 $283.05 $210.08 $210.08 $218.17 $147.47 $58.99 $283.05 $283.05 $167.42 $283.05 $283.05 $283.05 $283.05 $212.63 $283.05 $283.05 $283.05 $141.53 $141.53 $224.18 $283.05 $226.44 $183.98 $56.18 N/A $164.43 $283.05 $283.05 $283.05 $58.99 $283.05 N/A N/A 1806-0225 SUP Custom 27203010 1806-0225 - BIT DRILL LONG 3.5MM DRIVER AO T2 BOTH IP/OP $716.50 $530.00 $127.52 $716.38 $716.38 $716.38 $716.38 $716.38 $716.38 $716.38 $127.52 $716.38 $716.38 $531.70 $531.70 $552.19 $373.23 $149.30 $716.38 $286.55 $716.38 $716.38 $716.38 $716.38 $716.38 $537.38 $716.38 $716.38 $716.38 $358.19 $358.19 $567.37 $716.38 $573.10 $465.65 $716.38 N/A $415.57 $716.38 $429.83 $716.38 $716.38 $716.38 N/A N/A 1806-1005 SUP Custom 27203010 1806-1005 - SET ORTHOPEDIC TARGET DEVICE FEMUR BOTH IP/OP "$6,640.00" "$4,914.00" "$1,181.90" "$6,639.88" "$6,639.88" "$6,639.88" "$6,639.88" "$6,639.88" "$6,639.88" "$6,639.88" "$1,181.90" "$6,639.88" "$6,639.88" "$4,181.12" "$4,181.12" "$5,118.02" "$2,060.15" "$1,383.82" "$6,639.88" "$2,655.95" "$6,639.88" "$6,639.88" "$6,639.88" "$6,639.88" "$6,639.88" "$4,980.00" "$6,639.88" "$6,639.88" "$6,639.88" "$3,319.94" "$3,319.94" "$5,258.78" "$6,639.88" "$5,311.90" "$4,315.92" "$6,639.88" N/A "$3,851.20" "$6,639.88" "$3,983.93" "$6,639.88" "$6,639.88" "$6,639.88" N/A N/A 1806-1250S SUP HCPCS C1769 1806-1250S - GUIDEWIRE ORTHOPEDIC 3MM 1250MM BALL TIP T2 STERILE BOTH IP/OP $295.00 $218.00 $58.54 $294.95 $160.16 $160.16 $160.16 $160.16 $294.95 $294.95 $294.95 $61.47 $294.95 $218.91 $218.91 $227.35 $153.67 $61.47 $294.95 $294.95 $174.46 $294.95 $294.95 $294.95 $294.95 $221.25 $294.95 $294.95 $294.95 $147.48 $147.48 $233.60 $294.95 $235.96 $191.72 $58.54 N/A $171.10 $294.95 $294.95 $294.95 $61.47 $294.95 N/A N/A 1806-2020 SUP Custom 27203010 1806-2020 - DRILL SURG CROWN T2 NONSTRL BOTH IP/OP $598.50 $443.00 $106.47 $598.13 $598.13 $598.13 $598.13 $598.13 $598.13 $598.13 $106.47 $598.13 $598.13 $443.93 $443.93 $461.04 $311.63 $124.66 $598.13 $239.25 $598.13 $598.13 $598.13 $598.13 $598.13 $448.88 $598.13 $598.13 $598.13 $299.07 $299.07 $473.72 $598.13 $478.50 $388.78 $598.13 N/A $347.13 $598.13 $358.88 $598.13 $598.13 $598.13 N/A N/A 1806-3025 SUP Custom 27203010 1806-3025 - BIT DRILL CANN STEP T2 BOTH IP/OP "$2,152.00" "$1,592.00" $383.03 "$2,151.88" "$2,151.88" "$2,151.88" "$2,151.88" "$2,151.88" "$2,151.88" "$2,151.88" $383.03 "$2,151.88" "$2,151.88" "$1,597.13" "$1,597.13" "$1,658.67" "$1,121.13" $448.48 "$2,151.88" $860.75 "$2,151.88" "$2,151.88" "$2,151.88" "$2,151.88" "$2,151.88" "$1,614.00" "$2,151.88" "$2,151.88" "$2,151.88" "$1,075.94" "$1,075.94" "$1,704.29" "$2,151.88" "$1,721.50" "$1,398.72" "$2,151.88" N/A "$1,248.16" "$2,151.88" "$1,291.13" "$2,151.88" "$2,151.88" "$2,151.88" N/A N/A 1806-3030 SUP HCPCS C1713 1806-3030 - WIRE FX 3.2MM 400MM NS KRSH T2 RECON SS NL SYS BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $282.20 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $169.32 $282.20 $58.81 $282.20 N/A N/A 1806-3030S SUP HCPCS C1713 1806-3030S - WIRE FIX 3.2MM 400MM RECONSTRUCTION KWIRE T2 STAINLESS STEEL BOTH IP/OP $373.50 $276.00 $74.06 $373.15 $167.92 $167.92 $167.92 $167.92 $373.15 $373.15 $373.15 $77.77 $373.15 $373.15 $373.15 $373.15 $373.15 $77.77 $373.15 $373.15 $220.72 $373.15 $373.15 $373.15 $373.15 $280.13 $373.15 $373.15 $373.15 $186.58 $186.58 $295.53 $373.15 $298.52 $167.92 $74.06 N/A $216.63 $373.15 $373.15 $373.15 $77.76 $373.15 N/A N/A 1806-3031S SUP HCPCS C1713 1806-3031S - WIRE FX 3.2MM 400MM STRL KRSH T2 RECON COCR NL SYS BOTH IP/OP $237.50 $176.00 $47.07 $237.15 $106.72 $106.72 $106.72 $106.72 $237.15 $237.15 $237.15 $49.43 $237.15 $237.15 $237.15 $237.15 $237.15 $49.42 $237.15 $237.15 $140.27 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $106.72 $47.07 N/A $137.75 $237.15 $237.15 $237.15 $49.42 $237.15 N/A N/A 1806-3500S SUP Custom 27203010 1806-3500S - BIT DRILL 3.5MM 130MM AO T2 STERILE BOTH IP/OP $296.00 $219.00 $52.62 $295.63 $295.63 $295.63 $295.63 $295.63 $295.63 $295.63 $52.62 $295.63 $295.63 $219.42 $219.42 $227.87 $154.02 $61.61 $295.63 $118.25 $295.63 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $192.16 $295.63 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 1806-3505 SUP Custom 27203010 1806-3505 - BIT DRILL 3.5MM 130MM TRIFLAT T2 BOTH IP/OP $227.00 $168.00 $40.38 $226.88 $226.88 $226.88 $226.88 $226.88 $226.88 $226.88 $40.38 $226.88 $226.88 $168.39 $168.39 $174.88 $118.20 $47.28 $226.88 $90.75 $226.88 $226.88 $226.88 $226.88 $226.88 $170.25 $226.88 $226.88 $226.88 $113.44 $113.44 $179.69 $226.88 $181.50 $147.47 $226.88 N/A $131.66 $226.88 $136.13 $226.88 $226.88 $226.88 N/A N/A 1806-3510S SUP Custom 27203010 1806-3510S - BIT DRILL 3.5MM 230MM AO T2 STERILE BOTH IP/OP $208.00 $154.00 $36.96 $207.63 $207.63 $207.63 $207.63 $207.63 $207.63 $207.63 $36.96 $207.63 $207.63 $154.10 $154.10 $160.04 $108.18 $43.27 $207.63 $83.05 $207.63 $207.63 $207.63 $207.63 $207.63 $156.00 $207.63 $207.63 $207.63 $103.82 $103.82 $164.44 $207.63 $166.10 $134.96 $207.63 N/A $120.64 $207.63 $124.58 $207.63 $207.63 $207.63 N/A N/A 1806-3515 SUP Custom 27203010 1806-3515 - BIT DRILL 3.5MM 230MM TRIFLAT T2 BOTH IP/OP $259.50 $192.00 $46.19 $259.50 $259.50 $259.50 $259.50 $259.50 $259.50 $259.50 $46.19 $259.50 $259.50 $192.60 $192.60 $200.02 $135.20 $54.08 $259.50 $103.80 $259.50 $259.50 $259.50 $259.50 $259.50 $194.63 $259.50 $259.50 $259.50 $129.75 $129.75 $205.52 $259.50 $207.60 $168.68 $259.50 N/A $150.51 $259.50 $155.70 $259.50 $259.50 $259.50 N/A N/A 1806-3520S SUP Custom 27203010 1806-3520S - BIT DRILL 3.5MM 130MM AO T2 STERILE BOTH IP/OP $296.00 $219.00 $52.62 $295.63 $295.63 $295.63 $295.63 $295.63 $295.63 $295.63 $52.62 $295.63 $295.63 $219.42 $219.42 $227.87 $154.02 $61.61 $295.63 $118.25 $295.63 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $192.16 $295.63 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 1806-3525S SUP Custom 27203010 1806-3525S - BIT DRILL 3.5MM 130MM TRIFLAT T2 STERILE BOTH IP/OP $294.50 $218.00 $52.38 $294.25 $294.25 $294.25 $294.25 $294.25 $294.25 $294.25 $52.38 $294.25 $294.25 $218.39 $218.39 $226.81 $153.30 $61.32 $294.25 $117.70 $294.25 $294.25 $294.25 $294.25 $294.25 $220.88 $294.25 $294.25 $294.25 $147.13 $147.13 $233.05 $294.25 $235.40 $191.26 $294.25 N/A $170.81 $294.25 $176.55 $294.25 $294.25 $294.25 N/A N/A 1806-3540S SUP Custom 27203010 1806-3540S - BIT DRILL 230MM 3.5MM T2 AO STRL BOTH IP/OP $294.50 $218.00 $52.35 $294.10 $294.10 $294.10 $294.10 $294.10 $294.10 $294.10 $52.35 $294.10 $294.10 $218.28 $218.28 $226.69 $153.23 $61.29 $294.10 $117.64 $294.10 $294.10 $294.10 $294.10 $294.10 $220.88 $294.10 $294.10 $294.10 $147.05 $147.05 $232.93 $294.10 $235.28 $191.17 $294.10 N/A $170.81 $294.10 $176.46 $294.10 $294.10 $294.10 N/A N/A 1806-3545S SUP Custom 27203010 1806-3545S - BIT DRILL 3.5MM 230MM TRIFLAT T2 STERILE BOTH IP/OP $259.50 $192.00 $46.19 $259.50 $259.50 $259.50 $259.50 $259.50 $259.50 $259.50 $46.19 $259.50 $259.50 $192.60 $192.60 $200.02 $135.20 $54.08 $259.50 $103.80 $259.50 $259.50 $259.50 $259.50 $259.50 $194.63 $259.50 $259.50 $259.50 $129.75 $129.75 $205.52 $259.50 $207.60 $168.68 $259.50 N/A $150.51 $259.50 $155.70 $259.50 $259.50 $259.50 N/A N/A 1806-3550S SUP Custom 27203010 1806-3550S - BIT DRL 3.5MM 130MM STRL AO CPLNG BOTH IP/OP $294.50 $218.00 $52.35 $294.10 $294.10 $294.10 $294.10 $294.10 $294.10 $294.10 $52.35 $294.10 $294.10 $218.28 $218.28 $226.69 $153.23 $61.29 $294.10 $117.64 $294.10 $294.10 $294.10 $294.10 $294.10 $220.88 $294.10 $294.10 $294.10 $147.05 $147.05 $232.93 $294.10 $235.28 $191.17 $294.10 N/A $170.81 $294.10 $176.46 $294.10 $294.10 $294.10 N/A N/A 1806-3555S SUP Custom 27203010 1806-3555S - BIT DRILL 3.5MM 130MM AO T2 STERILE BOTH IP/OP $259.50 $192.00 $46.19 $259.50 $259.50 $259.50 $259.50 $259.50 $259.50 $259.50 $46.19 $259.50 $259.50 $192.60 $192.60 $200.02 $135.20 $54.08 $259.50 $103.80 $259.50 $259.50 $259.50 $259.50 $259.50 $194.63 $259.50 $259.50 $259.50 $129.75 $129.75 $205.52 $259.50 $207.60 $168.68 $259.50 N/A $150.51 $259.50 $155.70 $259.50 $259.50 $259.50 N/A N/A 1806-4000S SUP Custom 27203010 1806-4000S - BIT DRL 4MM 180MM STRL AO CPLNG BOTH IP/OP $294.50 $218.00 $52.35 $294.10 $294.10 $294.10 $294.10 $294.10 $294.10 $294.10 $52.35 $294.10 $294.10 $218.28 $218.28 $226.69 $153.23 $61.29 $294.10 $117.64 $294.10 $294.10 $294.10 $294.10 $294.10 $220.88 $294.10 $294.10 $294.10 $147.05 $147.05 $232.93 $294.10 $235.28 $191.17 $294.10 N/A $170.81 $294.10 $176.46 $294.10 $294.10 $294.10 N/A N/A 1806-4005S SUP Custom 27203010 1806-4005S - BIT DRILL 4MM 180MM TRIFLAT T2 STERILE HUMERAL NAILING BOTH IP/OP $294.50 $218.00 $52.35 $294.10 $294.10 $294.10 $294.10 $294.10 $294.10 $294.10 $52.35 $294.10 $294.10 $218.28 $218.28 $226.69 $153.23 $61.29 $294.10 $117.64 $294.10 $294.10 $294.10 $294.10 $294.10 $220.88 $294.10 $294.10 $294.10 $147.05 $147.05 $232.93 $294.10 $235.28 $191.17 $294.10 N/A $170.81 $294.10 $176.46 $294.10 $294.10 $294.10 N/A N/A 1806-4200S SUP Custom 27203010 1806-4200S - BIT DRILL 4.2MM 260MM AO T2 STERILE BOTH IP/OP $201.00 $149.00 $35.73 $200.75 $200.75 $200.75 $200.75 $200.75 $200.75 $200.75 $35.73 $200.75 $200.75 $149.00 $149.00 $154.74 $104.59 $41.84 $200.75 $80.30 $200.75 $200.75 $200.75 $200.75 $200.75 $150.75 $200.75 $200.75 $200.75 $100.38 $100.38 $158.99 $200.75 $160.60 $130.49 $200.75 N/A $116.58 $200.75 $120.45 $200.75 $200.75 $200.75 N/A N/A 1806-4205 SUP Custom 27203010 1806-4205 - BIT DRILL 4.2MM 260MM TRIFLAT T2 BOTH IP/OP $191.50 $142.00 $34.02 $191.13 $191.13 $191.13 $191.13 $191.13 $191.13 $191.13 $34.02 $191.13 $191.13 $141.86 $141.86 $147.32 $99.58 $39.83 $191.13 $76.45 $191.13 $191.13 $191.13 $191.13 $191.13 $143.63 $191.13 $191.13 $191.13 $95.57 $95.57 $151.37 $191.13 $152.90 $124.23 $191.13 N/A $111.07 $191.13 $114.68 $191.13 $191.13 $191.13 N/A N/A 1806-4210 SUP Custom 27203010 1806-4210 - BIT DRILL 4.2MM 340MM AO T2 BOTH IP/OP $210.50 $156.00 $37.45 $210.38 $210.38 $210.38 $210.38 $210.38 $210.38 $210.38 $37.45 $210.38 $210.38 $156.14 $156.14 $162.16 $109.61 $43.85 $210.38 $84.15 $210.38 $210.38 $210.38 $210.38 $210.38 $157.88 $210.38 $210.38 $210.38 $105.19 $105.19 $166.62 $210.38 $168.30 $136.75 $210.38 N/A $122.09 $210.38 $126.23 $210.38 $210.38 $210.38 N/A N/A 1806-4220 SUP Custom 27203010 1806-4220 - BIT DRILL 4.2MM 180MM AO T2 BOTH IP/OP $210.50 $156.00 $37.45 $210.38 $210.38 $210.38 $210.38 $210.38 $210.38 $210.38 $37.45 $210.38 $210.38 $156.14 $156.14 $162.16 $109.61 $43.85 $210.38 $84.15 $210.38 $210.38 $210.38 $210.38 $210.38 $157.88 $210.38 $210.38 $210.38 $105.19 $105.19 $166.62 $210.38 $168.30 $136.75 $210.38 N/A $122.09 $210.38 $126.23 $210.38 $210.38 $210.38 N/A N/A 1806-4230S SUP Custom 27203010 1806-4230S - BIT DRILL 4.2MM 130MM AO T2 STERILE BOTH IP/OP $201.00 $149.00 $35.73 $200.75 $200.75 $200.75 $200.75 $200.75 $200.75 $200.75 $35.73 $200.75 $200.75 $149.00 $149.00 $154.74 $104.59 $41.84 $200.75 $80.30 $200.75 $200.75 $200.75 $200.75 $200.75 $150.75 $200.75 $200.75 $200.75 $100.38 $100.38 $158.99 $200.75 $160.60 $130.49 $200.75 N/A $116.58 $200.75 $120.45 $200.75 $200.75 $200.75 N/A N/A 1806-4235 SUP Custom 27203010 1806-4235 - BIT DRILL 4.2MM 130MM TRIFLAT T2 BOTH IP/OP $191.50 $142.00 $34.02 $191.13 $191.13 $191.13 $191.13 $191.13 $191.13 $191.13 $34.02 $191.13 $191.13 $141.86 $141.86 $147.32 $99.58 $39.83 $191.13 $76.45 $191.13 $191.13 $191.13 $191.13 $191.13 $143.63 $191.13 $191.13 $191.13 $95.57 $95.57 $151.37 $191.13 $152.90 $124.23 $191.13 N/A $111.07 $191.13 $114.68 $191.13 $191.13 $191.13 N/A N/A 1806-4240 SUP Custom 27203010 1806-4240 - BIT DRILL 4.2MM 30MM AO T2 BOTH IP/OP $210.50 $156.00 $37.45 $210.38 $210.38 $210.38 $210.38 $210.38 $210.38 $210.38 $37.45 $210.38 $210.38 $156.14 $156.14 $162.16 $109.61 $43.85 $210.38 $84.15 $210.38 $210.38 $210.38 $210.38 $210.38 $157.88 $210.38 $210.38 $210.38 $105.19 $105.19 $166.62 $210.38 $168.30 $136.75 $210.38 N/A $122.09 $210.38 $126.23 $210.38 $210.38 $210.38 N/A N/A 1806-4245 SUP Custom 27203010 1806-4245 - BIT DRILL 4.2MM 230MM TRIFLAT T2 BOTH IP/OP $191.50 $142.00 $34.02 $191.13 $191.13 $191.13 $191.13 $191.13 $191.13 $191.13 $34.02 $191.13 $191.13 $141.86 $141.86 $147.32 $99.58 $39.83 $191.13 $76.45 $191.13 $191.13 $191.13 $191.13 $191.13 $143.63 $191.13 $191.13 $191.13 $95.57 $95.57 $151.37 $191.13 $152.90 $124.23 $191.13 N/A $111.07 $191.13 $114.68 $191.13 $191.13 $191.13 N/A N/A 1806-4250S SUP Custom 27203010 1806-4250S - BIT DRL 4.2MM 260MM STRL AO BOTH IP/OP $284.00 $210.00 $50.53 $283.90 $283.90 $283.90 $283.90 $283.90 $283.90 $283.90 $50.53 $283.90 $283.90 $210.71 $210.71 $218.83 $147.91 $59.17 $283.90 $113.56 $283.90 $283.90 $283.90 $283.90 $283.90 $213.00 $283.90 $283.90 $283.90 $141.95 $141.95 $224.85 $283.90 $227.12 $184.54 $283.90 N/A $164.72 $283.90 $170.34 $283.90 $283.90 $283.90 N/A N/A 1806-4255S SUP Custom 27203010 1806-4255S - BIT DRILL 4.2MM 260MM TRIFLAT T2 STERILE BOTH IP/OP $295.00 $218.00 $52.50 $294.95 $294.95 $294.95 $294.95 $294.95 $294.95 $294.95 $52.50 $294.95 $294.95 $218.91 $218.91 $227.35 $153.67 $61.47 $294.95 $117.98 $294.95 $294.95 $294.95 $294.95 $294.95 $221.25 $294.95 $294.95 $294.95 $147.48 $147.48 $233.60 $294.95 $235.96 $191.72 $294.95 N/A $171.10 $294.95 $176.97 $294.95 $294.95 $294.95 N/A N/A 1806-4260S SUP Custom 27203010 1806-4260S - BIT DRL 4.2MM 340MM STRL AO CPLNG BOTH IP/OP $284.00 $210.00 $50.53 $302.50 $283.90 $283.90 $283.90 $283.90 $283.90 $283.90 $50.53 $283.90 $283.90 $210.71 $210.71 $218.83 $147.91 $59.17 $283.90 $121.00 $283.90 $283.90 $302.50 $283.90 $283.90 $213.00 $283.90 $283.90 $283.90 $141.95 $141.95 $224.85 $283.90 $227.12 $184.54 $283.90 N/A $164.72 $283.90 $170.34 $283.90 $283.90 $283.90 N/A N/A 1806-4265S SUP Custom 27203010 1806-4265S - BIT DRILL 4.2MM 340MM TRIFLAT T2 STERILE BOTH IP/OP $187.00 $138.00 $33.29 $187.00 $187.00 $187.00 $187.00 $187.00 $187.00 $187.00 $33.29 $187.00 $187.00 $138.79 $138.79 $144.14 $97.43 $38.97 $187.00 $74.80 $187.00 $187.00 $187.00 $187.00 $187.00 $140.25 $187.00 $187.00 $187.00 $93.50 $93.50 $148.10 $187.00 $149.60 $121.55 $187.00 N/A $108.46 $187.00 $112.20 $187.00 $187.00 $187.00 N/A N/A 1806-4270S SUP Custom 27203010 1806-4270S - DRILL SRG 4.2MM 180MM STRL AO CPLNG BOTH IP/OP $304.50 $225.00 $54.17 $323.13 $304.30 $304.30 $304.30 $304.30 $304.30 $304.30 $54.17 $304.30 $304.30 $225.85 $225.85 $234.55 $158.54 $63.42 $304.30 $129.25 $304.30 $304.30 $323.13 $304.30 $304.30 $228.38 $304.30 $304.30 $304.30 $152.15 $152.15 $241.01 $304.30 $243.44 $197.80 $304.30 N/A $176.61 $304.30 $182.58 $304.30 $304.30 $304.30 N/A N/A 1806-4275S SUP Custom 27203010 1806-4275S - BIT DRILL 4.2MM 180MM TRIFLAT T2 STERILE BOTH IP/OP $205.00 $152.00 $36.46 $204.85 $204.85 $204.85 $204.85 $204.85 $204.85 $204.85 $36.46 $204.85 $204.85 $152.04 $152.04 $157.90 $106.73 $42.69 $204.85 $81.94 $204.85 $204.85 $204.85 $204.85 $204.85 $153.75 $204.85 $204.85 $204.85 $102.43 $102.43 $162.24 $204.85 $163.88 $133.15 $204.85 N/A $118.90 $204.85 $122.91 $204.85 $204.85 $204.85 N/A N/A 1806-4280S SUP Custom 27203010 1806-4280S - BIT DRL 4.2MM 130MM STRL AO CPLNG BOTH IP/OP $284.00 $210.00 $50.53 $283.90 $283.90 $283.90 $283.90 $283.90 $283.90 $283.90 $50.53 $283.90 $283.90 $210.71 $210.71 $218.83 $147.91 $59.17 $283.90 $113.56 $283.90 $283.90 $283.90 $283.90 $283.90 $213.00 $283.90 $283.90 $283.90 $141.95 $141.95 $224.85 $283.90 $227.12 $184.54 $283.90 N/A $164.72 $283.90 $170.34 $283.90 $283.90 $283.90 N/A N/A 1806-4285S SUP Custom 27203010 1806-4285S - BIT DRILL 4.2MM 130MM TRIFLAT T2 STERILE BOTH IP/OP $288.50 $213.00 $51.29 $288.15 $288.15 $288.15 $288.15 $288.15 $288.15 $288.15 $51.29 $288.15 $288.15 $213.86 $213.86 $222.11 $150.13 $60.05 $288.15 $115.26 $288.15 $288.15 $288.15 $288.15 $288.15 $216.38 $288.15 $288.15 $288.15 $144.08 $144.08 $228.21 $288.15 $230.52 $187.30 $288.15 N/A $167.33 $288.15 $172.89 $288.15 $288.15 $288.15 N/A N/A 1806-4290S SUP Custom 27203010 1806-4290S - BIT DRILL 4.2MM 230MM AO S2 STERILE BOTH IP/OP $305.50 $226.00 $54.32 $305.15 $305.15 $305.15 $305.15 $305.15 $305.15 $305.15 $54.32 $305.15 $305.15 $226.48 $226.48 $235.21 $158.98 $63.60 $305.15 $122.06 $305.15 $305.15 $305.15 $305.15 $305.15 $229.13 $305.15 $305.15 $305.15 $152.58 $152.58 $241.68 $305.15 $244.12 $198.35 $305.15 N/A $177.19 $305.15 $183.09 $305.15 $305.15 $305.15 N/A N/A 1806-4295S SUP Custom 27203010 1806-4295S - BIT DRILL 4.2MM 230MM AO COUPLING TRIFLAT T2 GREEN STERILE BOTH IP/OP $288.50 $213.00 $51.29 $288.15 $288.15 $288.15 $288.15 $288.15 $288.15 $288.15 $51.29 $288.15 $288.15 $213.86 $213.86 $222.11 $150.13 $60.05 $288.15 $115.26 $288.15 $288.15 $288.15 $288.15 $288.15 $216.38 $288.15 $288.15 $288.15 $144.08 $144.08 $228.21 $288.15 $230.52 $187.30 $288.15 N/A $167.33 $288.15 $172.89 $288.15 $288.15 $288.15 N/A N/A 1806-5000S SUP Custom 27203010 1806-5000S - BIT DRL 5MM 230MM STRL AO CPLNG BOTH IP/OP $284.00 $210.00 $50.53 $283.90 $283.90 $283.90 $283.90 $283.90 $283.90 $283.90 $50.53 $283.90 $283.90 $210.71 $210.71 $218.83 $147.91 $59.17 $283.90 $113.56 $283.90 $283.90 $283.90 $283.90 $283.90 $213.00 $283.90 $283.90 $283.90 $141.95 $141.95 $224.85 $283.90 $227.12 $184.54 $283.90 N/A $164.72 $283.90 $170.34 $283.90 $283.90 $283.90 N/A N/A 1806-5005S SUP Custom 27203010 1806-5005S - BIT DRILL 5MM 230MM TRIFLAT T2 STERILE DISPOSABLE BOTH IP/OP $295.00 $218.00 $52.50 $294.95 $294.95 $294.95 $294.95 $294.95 $294.95 $294.95 $52.50 $294.95 $294.95 $218.91 $218.91 $227.35 $153.67 $61.47 $294.95 $117.98 $294.95 $294.95 $294.95 $294.95 $294.95 $221.25 $294.95 $294.95 $294.95 $147.48 $147.48 $233.60 $294.95 $235.96 $191.72 $294.95 N/A $171.10 $294.95 $176.97 $294.95 $294.95 $294.95 N/A N/A 1806-5010S SUP Custom 27203010 1806-5010S - BIT DRILL STANDARD 5MM 180MM AO FIT T2 STERILE BOTH IP/OP $295.00 $218.00 $52.50 $294.95 $294.95 $294.95 $294.95 $294.95 $294.95 $294.95 $52.50 $294.95 $294.95 $218.91 $218.91 $227.35 $153.67 $61.47 $294.95 $117.98 $294.95 $294.95 $294.95 $294.95 $294.95 $221.25 $294.95 $294.95 $294.95 $147.48 $147.48 $233.60 $294.95 $235.96 $191.72 $294.95 N/A $171.10 $294.95 $176.97 $294.95 $294.95 $294.95 N/A N/A 1806-5015S SUP Custom 27203010 1806-5015S - BIT DRILL 5MM 180MM TRIFLAT OPTIONAL T2 STERILE BOTH IP/OP $288.50 $213.00 $51.29 $288.15 $288.15 $288.15 $288.15 $288.15 $288.15 $288.15 $51.29 $288.15 $288.15 $213.86 $213.86 $222.11 $150.13 $60.05 $288.15 $115.26 $288.15 $288.15 $288.15 $288.15 $288.15 $216.38 $288.15 $288.15 $288.15 $144.08 $144.08 $228.21 $288.15 $230.52 $187.30 $288.15 N/A $167.33 $288.15 $172.89 $288.15 $288.15 $288.15 N/A N/A 1806-5020S SUP Custom 27203010 1806-5020S - BIT DRILL 5MM 340MM AO SHAFT END S2 STERILE BOTH IP/OP $305.50 $226.00 $54.32 $325.88 $305.15 $305.15 $305.15 $305.15 $305.15 $305.15 $54.32 $305.15 $305.15 $226.48 $226.48 $235.21 $158.98 $63.60 $305.15 $130.35 $305.15 $305.15 $325.88 $305.15 $305.15 $229.13 $305.15 $305.15 $305.15 $152.58 $152.58 $241.68 $305.15 $244.12 $198.35 $305.15 N/A $177.19 $305.15 $183.09 $305.15 $305.15 $305.15 N/A N/A 1806-5025S SUP Custom 27203010 1806-5025S - BIT DRILL 5MM 340MM TRIFLAT T2 STERILE BOTH IP/OP $288.50 $213.00 $51.29 $288.15 $288.15 $288.15 $288.15 $288.15 $288.15 $288.15 $51.29 $288.15 $288.15 $213.86 $213.86 $222.11 $150.13 $60.05 $288.15 $115.26 $288.15 $288.15 $288.15 $288.15 $288.15 $216.38 $288.15 $288.15 $288.15 $144.08 $144.08 $228.21 $288.15 $230.52 $187.30 $288.15 N/A $167.33 $288.15 $172.89 $288.15 $288.15 $288.15 N/A N/A 1806-5032S SUP HCPCS C1713 1806-5032S - SCREW BONE 5MM 32.5MM T2 TI FULTHD PROX FEM LCK STRL IM NAIL BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1806-8018S SUP Custom 27203010 1806-8018S - BIT DRILL 4.2MM 250MM AO S2 STERILE BOTH IP/OP $288.50 $213.00 $51.29 $288.15 $288.15 $288.15 $288.15 $288.15 $288.15 $288.15 $51.29 $288.15 $288.15 $213.86 $213.86 $222.11 $150.13 $60.05 $288.15 $115.26 $288.15 $288.15 $288.15 $288.15 $288.15 $216.38 $288.15 $288.15 $288.15 $144.08 $144.08 $228.21 $288.15 $230.52 $187.30 $288.15 N/A $167.33 $288.15 $172.89 $288.15 $288.15 $288.15 N/A N/A 180701-2 SUP HCPCS C1776 180701-2 - INSERT TIB 1 9MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180702-1 SUP HCPCS C1776 180702-1 - INSERT TIB 2 8MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180702-2 SUP HCPCS C1776 180702-2 - INSERT TIB 2 9MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180702-3 SUP HCPCS C1776 180702-3 - INSERT TIB 2 10MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180702-5 SUP HCPCS C1776 180702-5 - INSERT TIB 2 12MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180703-1 SUP HCPCS C1776 180703-1 - INSERT TIB 3 8MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180703-2 SUP HCPCS C1776 180703-2 - INSERT TIB 3 9MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180703-3 SUP HCPCS C1776 180703-3 - INSERT TIB 3 10MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180704-1 SUP HCPCS C1776 180704-1 - INSERT TIB 4 8MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180704-2 SUP HCPCS C1776 180704-2 - INSERT TIB 4 9MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180704-3 SUP HCPCS C1776 180704-3 - INSERT TIB 4 10MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180704-5 SUP HCPCS C1776 180704-5 - INSERT TIB 4 12MM STRL RESTORIS ONLAY MULTICOMPARTMENTAL KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180705-1 SUP HCPCS C1776 180705-1 - INSERT TIB 5 8MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180705-3 SUP HCPCS C1776 180705-3 - INSERT TIB 5 10MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180705-4 SUP HCPCS C1776 180705-4 - INSERT TIB 5 10MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180705-6 SUP HCPCS C1776 180705-6 - INSERT TIB 5 13MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180705-7 SUP HCPCS C1776 180705-7 - INSERT TIB 5 14MM ONLAY MULTICOMPARTMENTAL KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180705-8 SUP HCPCS C1776 180705-8 - INSERT TIB 5 15MM ONLAY MULTICOMPARTMENTAL KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180705-9 SUP HCPCS C1776 180705-9 - INSERT TIB 5 16MM ONLAY MULTICOMPARTMENTAL KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180706-1 SUP HCPCS C1776 180706-1 - INSERT TIB 6 8MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180706-2 SUP HCPCS C1776 180706-2 - INSERT TIB 6 9MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180706-3 SUP HCPCS C1776 180706-3 - INSERT TIB 6 10MM ONLAY BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180706-4 SUP HCPCS C1776 180706-4 - INSERT TIB 6 11MM ONLAY MULTICOMPARTMENTAL KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180706-6 SUP HCPCS C1776 180706-6 - INSERT TIB 6 13MM ONLAY MULTICOMPARTMENTAL KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180706-7 SUP HCPCS C1776 180706-7 - INSERT TIB 6 14MM ONLAY MULTICOMPARTMENTAL KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180706-8 SUP HCPCS C1776 180706-8 - INSERT TIB 6 15MM ONLAY MULTICOMPARTMENTAL KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180706-9 SUP HCPCS C1776 180706-9 - INSERT TIB 6 16MM ONLAY MULTICOMPARTMENTAL KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180707-1 SUP HCPCS C1776 180707-1 - INSERT TIB 7 8MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180707-2 SUP HCPCS C1776 180707-2 - INSERT TIB 7 9MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180707-3 SUP HCPCS C1776 180707-3 - INSERT TIB 7 10MM ONLAY KN MCK SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180707-4 SUP HCPCS C1776 180707-4 - INSERT TIB 7 11MM ONLAY KN MULTICOMPARTMENTAL SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180707-6 SUP HCPCS C1776 180707-6 - INSERT TIB 7 13MM ONLAY KN MULTICOMPARTMENTAL SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180707-7 SUP HCPCS C1776 180707-7 - INSERT TIB 7 14MM ONLAY KN MULTICOMPARTMENTAL SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180707-8 SUP HCPCS C1776 180707-8 - INSERT TIB 7 15MM ONLAY KN MULTICOMPARTMENTAL SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180707-9 SUP HCPCS C1776 180707-9 - INSERT TIB 7 16MM ONLAY KN MULTICOMPARTMENTAL SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180708-4 SUP HCPCS C1776 180708-4 - INSERT TIB 8 11MM ONLAY KN MULTICOMPARTMENTAL SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180708-6 SUP HCPCS C1776 180708-6 - INSERT TIB 8 13MM ONLAY KN MULTICOMPARTMENTAL SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180708-7 SUP HCPCS C1776 180708-7 - INSERT TIB 8 14MM ONLAY KN MULTICOMPARTMENTAL SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180708-8 SUP HCPCS C1776 180708-8 - INSERT TIB 8 15MM ONLAY KN MULTICOMPARTMENTAL SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180708-9 SUP HCPCS C1776 180708-9 - INSERT TIB 8 16MM ONLAY KN MULTICOMPARTMENTAL SYS BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 180731-1 SUP HCPCS C1776 180731-1 - INSERT TIB 1 8MM MAKO X3 UNCMP ONLAY KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180731-1-E SUP HCPCS C1776 180731-1-E - INSERT TIB 1 8MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180731-2 SUP HCPCS C1776 180731-2 - INSERT TIB 1 9MM MAKO X3 UNCMP ONLAY KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180731-2-E SUP HCPCS C1776 180731-2-E - INSERT TIB 1 9MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180731-3 SUP HCPCS C1776 180731-3 - INSERT TIB 1 10MM MAKO X3 UNCMP ONLAY KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180731-3-E SUP HCPCS C1776 180731-3-E - INSERT TIB 1 10MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180731-5 SUP HCPCS C1776 180731-5 - INSERT TIB 1 12MM MAKO X3 UNCMP ONLAY KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180731-5-E SUP HCPCS C1776 180731-5-E - INSERT TIB 1 12MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180732-1 SUP HCPCS C1776 180732-1 - INSERT TIB 2 8MM MAKO X3 UNCMP ONLAY KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180732-1-E SUP HCPCS C1776 180732-1-E - INSERT TIB 2 8MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180732-2 SUP HCPCS C1776 180732-2 - INSERT TIB 2 9MM MAKO X3 UNCMP ONLAY KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180732-2-E SUP HCPCS C1776 180732-2-E - INSERT TIB 2 9MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180732-3 SUP HCPCS C1776 180732-3 - INSERT TIB 2 10MM MAKO X3 UNCMP ONLAY KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180732-3-E SUP HCPCS C1776 180732-3-E - INSERT TIB 2 10MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180732-5 SUP HCPCS C1776 180732-5 - INSERT TIB BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180732-5-E SUP HCPCS C1776 180732-5-E - INSERT TIB 2 12MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180733-1 SUP HCPCS C1776 180733-1 - INSERT TIB 3 8MM MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180733-1-E SUP HCPCS C1776 180733-1-E - INSERT TIB 3 8MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180733-2 SUP HCPCS C1776 180733-2 - INSERT TIB 3 9MM MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180733-2-E SUP HCPCS C1776 180733-2-E - INSERT TIB 3 9MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180733-3 SUP HCPCS C1776 180733-3 - INSERT TIB 10MM STRL MAKO BRNG ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180733-3-E SUP HCPCS C1776 180733-3-E - INSERT TIB 3 10MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180733-5 SUP HCPCS C1776 180733-5 - INSERT TIB 3 12MM MAKO X3 UNCMP ONLAY KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180733-5-E SUP HCPCS C1776 180733-5-E - INSERT TIB 3 12MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180734-1 SUP HCPCS C1776 180734-1 - INSERT TIB 4 8MM MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180734-1-E SUP HCPCS C1776 180734-1-E - INSERT TIB 4 8MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180734-2 SUP HCPCS C1776 180734-2 - INSERT TIB 4 9MM MAKO X3 UNCMP ONLAY KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180734-2-E SUP HCPCS C1776 180734-2-E - INSERT TIB 4 9MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180734-3 SUP HCPCS C1776 180734-3 - INSERT TIB 10MM STRL MAKO BRNG ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180734-3-E SUP HCPCS C1776 180734-3-E - INSERT TIB 4 10MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180734-5 SUP HCPCS C1776 180734-5 - INSERT TIB BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180735-1 SUP HCPCS C1776 180735-1 - INSERT TIB 5 8MM MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180735-1-E SUP HCPCS C1776 180735-1-E - INSERT TIB 5 8MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180735-2 SUP HCPCS C1776 180735-2 - INSERT TIB 5 9MM MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180735-2-E SUP HCPCS C1776 180735-2-E - INSERT TIB 5 9MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180735-3 SUP HCPCS C1776 180735-3 - INSERT TIB BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180735-5 SUP HCPCS C1776 180735-5 - INSERT TIB 5 12MM MAKO X3 UNCMP ONLAY KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180735-5-E SUP HCPCS C1776 180735-5-E - INSERT TIB 5 12MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180736-1 SUP HCPCS C1776 180736-1 - INSERT TIB 6 8MM MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180736-1-E SUP HCPCS C1776 180736-1-E - INSERT TIB 6 8MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180736-2 SUP HCPCS C1776 180736-2 - INSERT TIB 6 9MM MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180736-2-E SUP HCPCS C1776 180736-2-E - INSERT TIB 6 9MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180736-3 SUP HCPCS C1776 180736-3 - INSERT TIB 6 10MM MAKO X3 UNCMP ONLAY KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180736-3-E SUP HCPCS C1776 180736-3-E - INSERT TIB 6 10MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180736-5 SUP HCPCS C1776 180736-5 - INSERT TIB BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180736-5-E SUP HCPCS C1776 180736-5-E - INSERT TIB 6 12MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180737-1 SUP HCPCS C1776 180737-1 - INSERT TIB 8MM STRL MAKO BRNG ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180737-1-E SUP HCPCS C1776 180737-1-E - INSERT TIB 7 8MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180737-2 SUP HCPCS C1776 180737-2 - INSERT TIB 7 9MM MAKO X3 UNCMP ONLAY KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180737-2-E SUP HCPCS C1776 180737-2-E - INSERT TIB 7 9MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180737-3 SUP HCPCS C1776 180737-3 - INSERT TIB 7 10MM MAKO X3 UNCMP ONLAY KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180737-3-E SUP HCPCS C1776 180737-3-E - INSERT TIB 7 10MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180737-5 SUP HCPCS C1776 180737-5 - INSERT TIB BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180737-5-E SUP HCPCS C1776 180737-5-E - INSERT TIB 7 12MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180738-1 SUP HCPCS C1776 180738-1 - INSERT TIB 8 8MM MAKO X3 UNCMP ONLAY KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180738-1-E SUP HCPCS C1776 180738-1-E - INSERT TIB 8 8MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180738-2 SUP HCPCS C1776 180738-2 - INSERT TIB BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180738-2-E SUP HCPCS C1776 180738-2-E - INSERT TIB 8 9MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180738-3 SUP HCPCS C1776 180738-3 - INSERT TIB BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180738-3-E SUP HCPCS C1776 180738-3-E - INSERT TIB 8 10MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180738-5 SUP HCPCS C1776 180738-5 - INSERT TIB BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 180738-5-E SUP HCPCS C1776 180738-5-E - INSERT TIB 8 12MM STRL MAKO UNCMP ONLAY X3 KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 18-131 SUP HCPCS C1887 18-131 - CATH GUID 130CM 20CM MCTH STR HYDPHI RNGD STC-18 BOTH IP/OP "$1,225.00" $907.00 $243.13 "$1,225.00" $665.18 $665.18 $665.18 $665.18 "$1,225.00" "$1,225.00" "$1,225.00" $255.32 "$1,225.00" $909.20 $909.20 $944.23 $638.23 $255.30 "$1,225.00" "$1,225.00" $724.59 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $796.25 $243.13 N/A $710.50 "$1,225.00" "$1,225.00" "$1,225.00" $255.29 "$1,225.00" N/A N/A 1818-0001S SUP HCPCS C1713 1818-0001S - SCREW BONE 8MM 14.5MM CANN COMPRESSION PRELOAD T2 TITANIUM BOTH IP/OP $301.00 $223.00 $59.72 $300.90 $135.41 $135.41 $135.41 $135.41 $300.90 $300.90 $300.90 $62.72 $300.90 $300.90 $300.90 $300.90 $300.90 $62.71 $300.90 $300.90 $177.98 $300.90 $300.90 $300.90 $300.90 $225.75 $300.90 $300.90 $300.90 $150.45 $150.45 $238.31 $300.90 $240.72 $135.41 $59.72 N/A $174.58 $300.90 $300.90 $300.90 $62.71 $300.90 N/A N/A 1818-1015S SUP HCPCS C1713 1818-1015S - NAIL INTRAMEDULLARY 10MM 15CM LOCK T2 TITANIUM ANKLE LEFT BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$3,744.25" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$1,497.70" "$1,845.92" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$3,744.25" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1818-1020S SUP HCPCS C1713 1818-1020S - NAIL INTRAMEDULLARY 10MM 20CM LOCK T2 TITANIUM ANKLE LEFT BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$3,744.25" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$3,744.25" "$1,845.92" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$3,744.25" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1818-1030S SUP HCPCS C1713 1818-1030S - NAIL INTRAMEDULLARY 10MM 30CM ARTHDES LOCKING T2 TITANIUM BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$3,744.25" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$3,744.25" "$1,845.92" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$2,246.55" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1818-1115S SUP HCPCS C1713 1818-1115S - NAIL INTRAMEDULLARY 11MM 15CM LOCK T2 TITANIUM ANKLE LEFT BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$3,744.25" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$1,497.70" "$1,845.92" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$3,744.25" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1818-1120S SUP HCPCS C1713 1818-1120S - NAIL INTRAMEDULLARY 11MM 20CM LOCK T2 TITANIUM ANKLE LEFT BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$3,744.25" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$3,744.25" "$1,845.92" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$3,744.25" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1818-1130S SUP HCPCS C1713 1818-1130S - NAIL INTRAMEDULLARY 11MM 30CM ARTHDES LOCKING T2 TITANIUM BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$3,744.25" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$1,497.70" "$1,845.92" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$2,246.55" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1818-1215S SUP HCPCS C1713 1818-1215S - NAIL INTRAMEDULLARY 12MM 15CM ARTHDES LOCKING T2 TITANIUM BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$3,744.25" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$1,497.70" "$1,845.92" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$2,246.55" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1818-1220S SUP HCPCS C1713 1818-1220S - NAIL INTRAMEDULLARY 12MM 20CM LOCK T2 TITANIUM ANKLE LEFT BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$3,744.25" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$1,497.70" "$1,845.92" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$2,246.55" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1818-1230S SUP HCPCS C1713 1818-1230S - T2 ANKLE ARTHRODESIS NAIL LEFT 12MM X 300MM BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$3,744.25" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$3,744.25" "$1,845.92" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$3,744.25" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1819-1015S SUP HCPCS C1713 1819-1015S - NAIL INTRAMEDULLARY 10MM 150MM ARTHDES LOCKING T2 TITANIUM BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$4,552.50" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$1,821.00" "$1,845.92" "$3,744.25" "$4,552.50" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$3,744.25" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1819-1020S SUP HCPCS C1713 1819-1020S - NAIL INTRAMEDULLARY 10MM 20CM LOCK T2 TITANIUM ANKLE RIGHT BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$4,552.50" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$1,821.00" "$1,845.92" "$3,744.25" "$4,552.50" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$3,744.25" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1819-1030S SUP HCPCS C1713 1819-1030S - NAIL INTRAMEDULLARY 10MM 30CM LOCK T2 TITANIUM ANKLE RIGHT BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$4,552.50" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$1,821.00" "$1,845.92" "$3,744.25" "$4,552.50" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$2,246.55" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1819-1115S SUP HCPCS C1713 1819-1115S - NAIL INTRAMEDULLARY 11MM 15CM LOCK T2 TITANIUM ANKLE RIGHT BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$4,552.50" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$4,552.50" "$1,845.92" "$3,744.25" "$4,552.50" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$2,246.55" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1819-1120S SUP HCPCS C1713 1819-1120S - NAIL INTRAMEDULLARY 11MM 20CM ARTHDES LOCKING T2 TITANIUM BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$4,552.50" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$1,821.00" "$1,845.92" "$3,744.25" "$4,552.50" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$3,744.25" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1819-1130S SUP HCPCS C1713 1819-1130S - NAIL INTRAMEDULLARY 11MM 30CM ARTHDES LOCKING T2 TITANIUM BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$4,552.50" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$4,552.50" "$1,845.92" "$3,744.25" "$4,552.50" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$2,246.55" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1819-1215S SUP HCPCS C1713 1819-1215S - NAIL INTRAMEDULLARY 12MM 15CM ARTHDES LOCKING T2 TITANIUM BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$4,552.50" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$1,821.00" "$1,845.92" "$3,744.25" "$4,552.50" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$2,246.55" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1819-1220S SUP HCPCS C1713 1819-1220S - NAIL INTRAMEDULLARY 12MM 20CM LOCK T2 TITANIUM ANKLE RIGHT BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$4,552.50" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$1,821.00" "$1,845.92" "$3,744.25" "$4,552.50" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$2,246.55" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1819-1230S SUP HCPCS C1713 1819-1230S - NAIL INTRAMEDULLARY 12MM 30CM ARTHDES LOCKING T2 TITANIUM BOTH IP/OP "$3,744.50" "$2,771.00" $743.14 "$4,552.50" "$1,684.91" "$1,684.91" "$1,684.91" "$1,684.91" "$3,744.25" "$3,744.25" "$3,744.25" $780.40 "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" "$3,744.25" $780.34 "$3,744.25" "$1,821.00" "$1,845.92" "$3,744.25" "$4,552.50" "$3,744.25" "$3,744.25" "$2,808.38" "$3,744.25" "$3,744.25" "$3,744.25" "$1,872.13" "$1,872.13" "$2,965.45" "$3,744.25" "$2,995.40" "$1,684.91" $743.14 N/A "$2,171.81" "$3,744.25" "$2,246.55" "$3,744.25" $780.30 "$3,744.25" N/A N/A 1822-0001S SUP HCPCS C1713 1822-0001S - SCREW BONE 8MM ADVANCE COMPRESSION T2 TITANIUM TIBIA STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $291.50 $291.50 N/A N/A 1822-0003S SUP HCPCS C1713 1822-0003S - CAP END STANDARD 8MM T2 FEMUR TIBIA STERILE INTRAMEDULLARY BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1822-0004S SUP HCPCS C1713 1822-0004S - CAP END FULTHRD T2 BOTH IP/OP $239.50 $177.00 $47.49 $239.25 $107.66 $107.66 $107.66 $107.66 $239.25 $239.25 $239.25 $49.87 $239.25 $239.25 $239.25 $239.25 $239.25 $49.86 $239.25 $95.70 $141.52 $239.25 $239.25 $239.25 $239.25 $179.63 $239.25 $239.25 $239.25 $119.63 $119.63 $189.49 $239.25 $191.40 $107.66 $47.49 N/A $138.91 $239.25 $239.25 $239.25 $49.86 $239.25 N/A N/A 1822-0005S SUP HCPCS C1713 1822-0005S - CAP END STANDARD 11.5IN 5+ MM T2 TITANIUM ANKLE KNEE STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1822-0010S SUP HCPCS C1713 1822-0010S - CAP END 11.5MM 10+ MM T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1822-0015S SUP HCPCS C1713 1822-0015S - CAP END 15MM T2 TITANIUM FEMUR STERILE INTRAMEDULLARY NAIL BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1822-0824S SUP HCPCS C1713 1822-0824S - NAIL INTRAMEDULLARY STANDARD 8MM 24CM LOCK T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0825S SUP HCPCS C1713 1822-0825S - NAIL INTRAMEDULLARY STANDARD 8MM 25.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0827S SUP HCPCS C1713 1822-0827S - NAIL INTRAMEDULLARY STANDARD 8MM 27CM LOCK T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0828S SUP HCPCS C1713 1822-0828S - NAIL INTRAMEDULLARY STANDARD 8MM 28.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0830S SUP HCPCS C1713 1822-0830S - NAIL INTRAMEDULLARY STANDARD 8MM 30CM LOCK T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0831S SUP HCPCS C1713 1822-0831S - NAIL INTRAMEDULLARY STANDARD 8MM 31.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0833S SUP HCPCS C1713 1822-0833S - NAIL INTRAMEDULLARY STANDARD 8MM 330MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0834S SUP HCPCS C1713 1822-0834S - NAIL INTRAMEDULLARY STANDARD 8MM 345MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0836S SUP HCPCS C1713 1822-0836S - NAIL INTRAMEDULLARY STANDARD 8MM 36CM LOCK T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0837S SUP HCPCS C1713 1822-0837S - NAIL INTRAMEDULLARY STANDARD 8MM 37.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0839S SUP HCPCS C1713 1822-0839S - NAIL INTRAMEDULLARY STANDARD 8MM 39CM LOCK T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0840S SUP HCPCS C1713 1822-0840S - NAIL INTRAMEDULLARY STANDARD 8MM 40.5CM T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0842S SUP HCPCS C1713 1822-0842S - NAIL INTRAMEDULLARY STANDARD 8MM 42CM T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0924S SUP HCPCS C1713 1822-0924S - NAIL INTRAMEDULLARY STANDARD 9MM 24CM LOCK T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0925S SUP HCPCS C1713 1822-0925S - NAIL INTRAMEDULLARY STANDARD 9MM 25.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0927S SUP HCPCS C1713 1822-0927S - NAIL INTRAMEDULLARY STANDARD 9MM 27CM LOCK T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0928S SUP HCPCS C1713 1822-0928S - NAIL INTRAMEDULLARY STANDARD 9MM 28.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0930S SUP HCPCS C1713 1822-0930S - NAIL INTRAMEDULLARY STANDARD 9MM 30CM LOCK T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0931S SUP HCPCS C1713 1822-0931S - NAIL INTRAMEDULLARY STANDARD 9MM 31.5CM BLOCKING SCREW T2 BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0933S SUP HCPCS C1713 1822-0933S - NAIL INTRAMEDULLARY STANDARD 9MM 330MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0934S SUP HCPCS C1713 1822-0934S - NAIL INTRAMEDULLARY STANDARD 9MM 345MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0936S SUP HCPCS C1713 1822-0936S - NAIL INTRAMEDULLARY STANDARD 9MM 36CM LOCK ROTATIONAL BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0937S SUP HCPCS C1713 1822-0937S - NAIL INTRAMEDULLARY STANDARD 9MM 370MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0939S SUP HCPCS C1713 1822-0939S - NAIL INTRAMEDULLARY STANDARD 9MM 390MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0940S SUP HCPCS C1713 1822-0940S - NAIL INTRAMEDULLARY STANDARD 9MM 40.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0942S SUP HCPCS C1713 1822-0942S - NAIL INTRAMEDULLARY STANDARD 9MM 42CM LOCK T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-0945S SUP HCPCS C1713 1822-0945S - NAIL INTRAMEDULLARY STANDARD 9MM 450MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1024S SUP HCPCS C1713 1822-1024S - NAIL INTRAMEDULLARY STANDARD 10MM 24CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1025S SUP HCPCS C1713 1822-1025S - NAIL INTRAMEDULLARY STANDARD 10MM 25.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1027S SUP HCPCS C1713 1822-1027S - NAIL INTRAMEDULLARY STANDARD 10MM 270MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1028S SUP HCPCS C1713 1822-1028S - NAIL INTRAMEDULLARY STANDARD 10MM 285MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1030S SUP HCPCS C1713 1822-1030S - NAIL INTRAMEDULLARY STANDARD 10MM 300MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1031S SUP HCPCS C1713 1822-1031S - NAIL INTRAMEDULLARY STANDARD 10MM 315MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1033S SUP HCPCS C1713 1822-1033S - NAIL INTRAMEDULLARY STANDARD 10MM 330MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1034S SUP HCPCS C1713 1822-1034S - NAIL INTRAMEDULLARY STANDARD 10MM 34.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1036S SUP HCPCS C1713 1822-1036S - NAIL INTRAMEDULLARY STANDARD 10MM 360MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1037S SUP HCPCS C1713 1822-1037S - NAIL INTRAMEDULLARY STANDARD 10MM 375MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1039S SUP HCPCS C1713 1822-1039S - NAIL INTRAMEDULLARY STANDARD 10MM 390MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1040S SUP HCPCS C1713 1822-1040S - NAIL INTRAMEDULLARY STANDARD 10MM 40.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1042S SUP HCPCS C1713 1822-1042S - NAIL INTRAMEDULLARY STANDARD 10MM 420MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1043S SUP HCPCS C1713 1822-1043S - NAIL INTRAMEDULLARY STANDARD 10MM 435MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1045S SUP HCPCS C1713 1822-1045S - NAIL INTRAMEDULLARY STANDARD 10MM 450MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1046S SUP HCPCS C1713 1822-1046S - NAIL INTRAMEDULLARY STANDARD 10MM 465MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1048S SUP HCPCS C1713 1822-1048S - NAIL INTRAMEDULLARY STANDARD 10MM 480MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1124S SUP HCPCS C1713 1822-1124S - NAIL INTRAMEDULLARY STANDARD 11MM 24CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1125S SUP HCPCS C1713 1822-1125S - NAIL INTRAMEDULLARY STANDARD 11MM 25.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" "$2,322.38" "$2,322.38" N/A N/A 1822-1127S SUP HCPCS C1713 1822-1127S - NAIL INTRAMEDULLARY STANDARD 11MM 27CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" "$2,322.38" "$2,322.38" N/A N/A 1822-1128S SUP HCPCS C1713 1822-1128S - NAIL INTRAMEDULLARY STANDARD 11MM 280MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1130S SUP HCPCS C1713 1822-1130S - NAIL INTRAMEDULLARY STANDARD 11MM 30CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1131S SUP HCPCS C1713 1822-1131S - NAIL INTRAMEDULLARY STANDARD 11MM 315MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1133S SUP HCPCS C1713 1822-1133S - NAIL INTRAMEDULLARY STANDARD 11MM 330MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1134S SUP HCPCS C1713 1822-1134S - NAIL INTRAMEDULLARY STANDARD 11MM 345MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1136S SUP HCPCS C1713 1822-1136S - NAIL INTRAMEDULLARY STANDARD 11MM 36CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1137S SUP HCPCS C1713 1822-1137S - NAIL INTRAMEDULLARY STANDARD 11MM 375MM BLOCKING SCREW T2 BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1139S SUP HCPCS C1713 1822-1139S - NAIL INTRAMEDULLARY STANDARD 11MM 390MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1140S SUP HCPCS C1713 1822-1140S - NAIL INTRAMEDULLARY STANDARD 11MM 40.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1142S SUP HCPCS C1713 1822-1142S - NAIL INTRAMEDULLARY STANDARD 11MM 42CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1143S SUP HCPCS C1713 1822-1143S - NAIL INTRAMEDULLARY STANDARD 11MM 435MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1145S SUP HCPCS C1713 1822-1145S - NAIL INTRAMEDULLARY STANDARD 11MM 450MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1146S SUP HCPCS C1713 1822-1146S - NAIL INTRAMEDULLARY STANDARD 11MM 465MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1148S SUP HCPCS C1713 1822-1148S - NAIL INTRAMEDULLARY STANDARD 11MM 480MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1224S SUP HCPCS C1713 1822-1224S - NAIL INTRAMEDULLARY STANDARD 12MM 24CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1225S SUP HCPCS C1713 1822-1225S - NAIL INTRAMEDULLARY STANDARD 12MM 25.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1227S SUP HCPCS C1713 1822-1227S - NAIL INTRAMEDULLARY STANDARD 12MM 270MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" "$2,322.38" "$2,322.38" N/A N/A 1822-1228S SUP HCPCS C1713 1822-1228S - NAIL INTRAMEDULLARY STANDARD 12MM 28.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1230S SUP HCPCS C1713 1822-1230S - NAIL INTRAMEDULLARY STANDARD 12MM 30CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1231S SUP HCPCS C1713 1822-1231S - NAIL INTRAMEDULLARY STANDARD 12MM 315MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" "$2,322.38" "$2,322.38" N/A N/A 1822-1233S SUP HCPCS C1713 1822-1233S - NAIL INTRAMEDULLARY STANDARD 12MM 330MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1234S SUP HCPCS C1713 1822-1234S - NAIL INTRAMEDULLARY STANDARD 12MM 34.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1236S SUP HCPCS C1713 1822-1236S - NAIL INTRAMEDULLARY STANDARD 12MM 360MM BLOCKING SCREW T2 BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1237S SUP HCPCS C1713 1822-1237S - NAIL INTRAMEDULLARY STANDARD 12MM 37.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1239S SUP HCPCS C1713 1822-1239S - NAIL INTRAMEDULLARY STANDARD 12MM 39CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1240S SUP HCPCS C1713 1822-1240S - NAIL INTRAMEDULLARY STANDARD 12MM 405MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1242S SUP HCPCS C1713 1822-1242S - NAIL INTRAMEDULLARY STANDARD 12MM 420MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1245S SUP HCPCS C1713 1822-1245S - NAIL INTRAMEDULLARY STANDARD 12MM 450MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1324S SUP HCPCS C1713 1822-1324S - NAIL INTRAMEDULLARY STANDARD 13MM 240MM T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1325S SUP HCPCS C1713 1822-1325S - NAIL INTRAMEDULLARY STANDARD 13MM 255MM T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1327S SUP HCPCS C1713 1822-1327S - NAIL INTRAMEDULLARY STANDARD 13MM 270MM T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1328S SUP HCPCS C1713 1822-1328S - NAIL INTRAMEDULLARY STANDARD 13MM 285MM T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1330S SUP HCPCS C1713 1822-1330S - NAIL INTRAMEDULLARY STANDARD 13MM 30CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1331S SUP HCPCS C1713 1822-1331S - NAIL INTRAMEDULLARY STANDARD 13MM 31.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1333S SUP HCPCS C1713 1822-1333S - NAIL INTRAMEDULLARY STANDARD 13MM 33CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1334S SUP HCPCS C1713 1822-1334S - NAIL INTRAMEDULLARY STANDARD 13MM 34.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1336S SUP HCPCS C1713 1822-1336S - NAIL INTRAMEDULLARY STANDARD 13MM 36CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1337S SUP HCPCS C1713 1822-1337S - NAIL INTRAMEDULLARY STANDARD 13MM 37.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1339S SUP HCPCS C1713 1822-1339S - NAIL INTRAMEDULLARY STANDARD 13MM 39CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1340S SUP HCPCS C1713 1822-1340S - NAIL INTRAMEDULLARY STANDARD 13MM 40.5CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1342S SUP HCPCS C1713 1822-1342S - NAIL INTRAMEDULLARY STANDARD 13MM 42CM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1424S SUP HCPCS C1713 1822-1424S - NAIL INTRAMEDULLARY STANDARD 14MM 240MM T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1425S SUP HCPCS C1713 1822-1425S - NAIL INTRAMEDULLARY STANDARD 14MM 255MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1427S SUP Custom 27803010 1822-1427S - NAIL INTRAMEDULLARY STANDARD 14MM 270MM T2 ANODIZED TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $413.38 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $413.38 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" "$2,322.38" N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" "$2,322.38" "$2,322.38" N/A N/A 1822-1428S SUP HCPCS C1713 1822-1428S - NAIL INTRAMEDULLARY STANDARD 14MM 285MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1430S SUP HCPCS C1713 1822-1430S - NAIL INTRAMEDULLARY STANDARD 14MM 300MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1431S SUP HCPCS C1713 1822-1431S - NAIL INTRAMEDULLARY STANDARD 14MM 315MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1433S SUP HCPCS C1713 1822-1433S - NAIL INTRAMEDULLARY STANDARD 14MM 330MM T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1434S SUP HCPCS C1713 1822-1434S - NAIL INTRAMEDULLARY STANDARD 14MM 34.5CM T2 TIBIA STERILE BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1436S SUP HCPCS C1713 1822-1436S - NAIL INTRAMEDULLARY STANDARD 14MM 360MM T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1437S SUP HCPCS C1713 1822-1437S - NAIL INTRAMEDULLARY STANDARD 14MM 375MM LOCK T2 TITANIUM BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1439S SUP HCPCS C1713 1822-1439S - NAIL INTRAMEDULLARY STANDARD 14MM 390MM T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1440S SUP HCPCS C1713 1822-1440S - NAIL INTRAMEDULLARY STANDARD 14MM 40.5CM T2 TITANIUM TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1442S SUP HCPCS C1713 1822-1442S - NAIL INTRAMEDULLARY STANDARD 14MM 420MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1524S SUP HCPCS C1713 1822-1524S - NAIL INTRAMEDULLARY STANDARD 15MM 240MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1525S SUP HCPCS C1713 1822-1525S - NAIL INTRAMEDULLARY STANDARD 15MM 255MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1527S SUP HCPCS C1713 1822-1527S - NAIL INTRAMEDULLARY STANDARD 15MM 270MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1528S SUP HCPCS C1713 1822-1528S - NAIL INTRAMEDULLARY STANDARD 15MM 285MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1530S SUP HCPCS C1713 1822-1530S - NAIL INTRAMEDULLARY STANDARD 15MM 300MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1531S SUP HCPCS C1713 1822-1531S - NAIL INTRAMEDULLARY STANDARD 15MM 315MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1533S SUP HCPCS C1713 1822-1533S - NAIL INTRAMEDULLARY STANDARD 15MM 330MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1534S SUP HCPCS C1713 1822-1534S - NAIL INTRAMEDULLARY STANDARD 15MM 345MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1536S SUP HCPCS C1713 1822-1536S - NAIL INTRAMEDULLARY STANDARD 15MM 360MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1537S SUP HCPCS C1713 1822-1537S - NAIL INTRAMEDULLARY STANDARD 15MM 375MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1539S SUP HCPCS C1713 1822-1539S - NAIL INTRAMEDULLARY STANDARD 15MM 390MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" $928.95 "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$1,393.43" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1540S SUP HCPCS C1713 1822-1540S - NAIL INTRAMEDULLARY STANDARD 15MM 330MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1822-1542S SUP HCPCS C1713 1822-1542S - NAIL INTRAMEDULLARY STANDARD 15MM 420MM IMPLANT T2 TIBIA BOTH IP/OP "$2,322.50" "$1,719.00" $460.93 "$2,322.38" "$1,045.07" "$1,045.07" "$1,045.07" "$1,045.07" "$2,322.38" "$2,322.38" "$2,322.38" $484.04 "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" $484.01 "$2,322.38" "$2,322.38" "$1,373.69" "$2,322.38" "$2,322.38" "$2,322.38" "$2,322.38" "$1,741.88" "$2,322.38" "$2,322.38" "$2,322.38" "$1,161.19" "$1,161.19" "$1,839.32" "$2,322.38" "$1,857.90" "$1,045.07" $460.93 N/A "$1,347.05" "$2,322.38" "$2,322.38" "$2,322.38" $483.98 "$2,322.38" N/A N/A 1825-0000S SUP HCPCS C1713 1825-0000S - SCREW BONE STANDARD 8MM COMPRESSION T2 TITANIUM FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1825-0001S SUP HCPCS C1713 1825-0001S - SCREW BONE 8MM ADVANCE COMPRESSION T2 TITANIUM FEMUR STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1825-0005S SUP HCPCS C1713 1825-0005S - SCREW BONE STANDARD 8MM 5MM COMPRESSION T2 TITANIUM FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1825-0010S SUP HCPCS C1713 1825-0010S - SCREW BONE STANDARD 8MM 10MM COMPRESSION T2 TITANIUM FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1825-0015S SUP HCPCS C1713 1825-0015S - SCREW BONE +15MM 8MM COMPRESSION T2 TITANIUM FEMUR STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1825-0814S SUP HCPCS C1713 1825-0814S - NAIL INTRAMEDULLARY 8MM 14CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0816S SUP HCPCS C1713 1825-0816S - NAIL INTRAMEDULLARY 8MM 16CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0818S SUP HCPCS C1713 1825-0818S - NAIL INTRAMEDULLARY 8MM 18CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0820S SUP HCPCS C1713 1825-0820S - NAIL INTRAMEDULLARY 8MM 20CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0822S SUP HCPCS C1713 1825-0822S - NAIL INTRAMEDULLARY 8MM 22CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0824S SUP HCPCS C1713 1825-0824S - NAIL INTRAMEDULLARY 8MM 24CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0826S SUP HCPCS C1713 1825-0826S - NAIL INTRAMEDULLARY 8MM 26CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0828S SUP HCPCS C1713 1825-0828S - NAIL INTRAMEDULLARY 8MM 28CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0830S SUP HCPCS C1713 1825-0830S - NAIL INTRAMEDULLARY 8MM 30CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0832S SUP HCPCS C1713 1825-0832S - NAIL INTRAMEDULLARY 8MM 32CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0834S SUP HCPCS C1713 1825-0834S - NAIL INTRAMEDULLARY 8MM 34CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0836S SUP HCPCS C1713 1825-0836S - NAIL INTRAMEDULLARY 8MM 36CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0838S SUP HCPCS C1713 1825-0838S - NAIL INTRAMEDULLARY 8MM 38CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0840S SUP HCPCS C1713 1825-0840S - NAIL INTRAMEDULLARY 8MM 40CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0842S SUP HCPCS C1713 1825-0842S - NAIL INTRAMEDULLARY 8MM 42CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0844S SUP HCPCS C1713 1825-0844S - NAIL INTRAMEDULLARY 8MM 44CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0846S SUP HCPCS C1713 1825-0846S - NAIL INTRAMEDULLARY 8MM 46CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0848S SUP HCPCS C1713 1825-0848S - NAIL INTRAMEDULLARY 8MM 48CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0914S SUP HCPCS C1713 1825-0914S - NAIL INTRAMEDULLARY 9MM 140MM T2 FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0916S SUP HCPCS C1713 1825-0916S - NAIL INTRAMEDULLARY 9MM 160MM T2 FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0918S SUP HCPCS C1713 1825-0918S - NAIL INTRAMEDULLARY 9MM 18CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0920S SUP HCPCS C1713 1825-0920S - NAIL INTRAMEDULLARY 9MM 20CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0922S SUP HCPCS C1713 1825-0922S - NAIL INTRAMEDULLARY 9MM 22CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0924S SUP HCPCS C1713 1825-0924S - NAIL INTRAMEDULLARY 9MM 24CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0926S SUP HCPCS C1713 1825-0926S - NAIL INTRAMEDULLARY 9MM 260MM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0928S SUP HCPCS C1713 1825-0928S - NAIL INTRAMEDULLARY 9MM 28CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0930S SUP HCPCS C1713 1825-0930S - NAIL INTRAMEDULLARY 9MM 300MM LOCK T2 TITANIUM ALLOY FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0932S SUP HCPCS C1713 1825-0932S - NAIL INTRAMEDULLARY ANTEGRADE RTRGRD 9MM 32CM LOCK T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0934S SUP HCPCS C1713 1825-0934S - NAIL INTRAMEDULLARY 9MM 34CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0936S SUP HCPCS C1713 1825-0936S - NAIL INTRAMEDULLARY 9MM 360MM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0938S SUP HCPCS C1713 1825-0938S - NAIL INTRAMEDULLARY 9MM 380MM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0940S SUP HCPCS C1713 1825-0940S - NAIL INTRAMEDULLARY 9MM 40CM ANTEGRADE RTRGRD LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0942S SUP HCPCS C1713 1825-0942S - NAIL INTRAMEDULLARY 9MM 420MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0944S SUP HCPCS C1713 1825-0944S - NAIL INTRAMEDULLARY 9MM 44CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0946S SUP HCPCS C1713 1825-0946S - NAIL INTRAMEDULLARY 9MM 46CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-0948S SUP HCPCS C1713 1825-0948S - NAIL INTRAMEDULLARY 9MM 48CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1014S SUP HCPCS C1713 1825-1014S - NAIL INTRAMEDULLARY 10MM 140MM T2 FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1016S SUP HCPCS C1713 1825-1016S - NAIL INTRAMEDULLARY 10MM 160MM T2 FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1018S SUP HCPCS C1713 1825-1018S - NAIL INTRAMEDULLARY 10MM 18CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1020S SUP HCPCS C1713 1825-1020S - NAIL INTRAMEDULLARY 10MM 20CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1022S SUP HCPCS C1713 1825-1022S - NAIL INTRAMEDULLARY 10MM 22CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1024S SUP HCPCS C1713 1825-1024S - NAIL INTRAMEDULLARY 10MM 24CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1026S SUP HCPCS C1713 1825-1026S - NAIL INTRAMEDULLARY 10MM 260MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1028S SUP HCPCS C1713 1825-1028S - NAIL INTRAMEDULLARY ANTEGRADE RTRGRD 10MM 28CM LOCK T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1030S SUP HCPCS C1713 1825-1030S - NAIL INTRAMEDULLARY 10MM 30CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1032S SUP HCPCS C1713 1825-1032S - NAIL INTRAMEDULLARY ANTEGRADE RTRGRD 10MM 32CM LOCK T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1034S SUP HCPCS C1713 1825-1034S - NAIL INTRAMEDULLARY ANTEGRADE RTRGRD 10MM 34CM LOCK T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1036S SUP HCPCS C1713 1825-1036S - NAIL INTRAMEDULLARY 10MM 360MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1038S SUP HCPCS C1713 1825-1038S - NAIL INTRAMEDULLARY 10MM 380MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1040S SUP HCPCS C1713 1825-1040S - NAIL INTRAMEDULLARY 10MM 400MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1042S SUP HCPCS C1713 1825-1042S - NAIL INTRAMEDULLARY 10MM 42CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1044S SUP HCPCS C1713 1825-1044S - NAIL INTRAMEDULLARY 10MM 44CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1046S SUP HCPCS C1713 1825-1046S - NAIL INTRAMEDULLARY 10MM 46CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1048S SUP HCPCS C1713 1825-1048S - NAIL INTRAMEDULLARY 10MM 48CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1114S SUP HCPCS C1713 1825-1114S - NAIL INTRAMEDULLARY 11MM 140MM T2 FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1116S SUP HCPCS C1713 1825-1116S - NAIL INTRAMEDULLARY 11MM 160MM T2 FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1118S SUP HCPCS C1713 1825-1118S - NAIL INTRAMEDULLARY 11MM 18CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1120S SUP HCPCS C1713 1825-1120S - NAIL INTRAMEDULLARY 11MM 20CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1122S SUP HCPCS C1713 1825-1122S - NAIL INTRAMEDULLARY 11MM 22CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1124S SUP HCPCS C1713 1825-1124S - NAIL INTRAMEDULLARY 11MM 24CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1126S SUP HCPCS C1713 1825-1126S - NAIL INTRAMEDULLARY 11MM 26CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1128S SUP HCPCS C1713 1825-1128S - NAIL INTRAMEDULLARY ANTEGRADE RTRGRD 11MM 28CM LOCK T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1130S SUP HCPCS C1713 1825-1130S - NAIL INTRAMEDULLARY RTRGRD ANTEGRADE 11MM 30CM LOCK T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1132S SUP HCPCS C1713 1825-1132S - NAIL INTRAMEDULLARY 11MM 320MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1134S SUP HCPCS C1713 1825-1134S - NAIL INTRAMEDULLARY ANTEGRADE RTRGRD 11MM 34CM LOCK T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1136S SUP HCPCS C1713 1825-1136S - NAIL INTRAMEDULLARY 11MM 360MM LOCK T2 TITANIUM TIBIA BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1138S SUP HCPCS C1713 1825-1138S - NAIL INTRAMEDULLARY 11MM 380MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1140S SUP HCPCS C1713 1825-1140S - NAIL INTRAMEDULLARY 11MM 400MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1142S SUP HCPCS C1713 1825-1142S - NAIL INTRAMEDULLARY 11MM 420MM RTRGRD/ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1144S SUP HCPCS C1713 1825-1144S - NAIL INTRAMEDULLARY 11MM 440MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1146S SUP HCPCS C1713 1825-1146S - NAIL INTRAMEDULLARY 11MM 46CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1148S SUP HCPCS C1713 1825-1148S - NAIL INTRAMEDULLARY 11MM 48CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1214S SUP HCPCS C1713 1825-1214S - NAIL INTRAMEDULLARY 12MM 14CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1216S SUP HCPCS C1713 1825-1216S - NAIL INTRAMEDULLARY 12MM 160MM ANTEGRADE RTRGRD STR LOCKING BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1218S SUP HCPCS C1713 1825-1218S - NAIL INTRAMEDULLARY 12MM 18CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1220S SUP HCPCS C1713 1825-1220S - NAIL INTRAMEDULLARY 12MM 20CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1222S SUP HCPCS C1713 1825-1222S - NAIL INTRAMEDULLARY 12MM 22CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1224S SUP HCPCS C1713 1825-1224S - NAIL INTRAMEDULLARY 12MM 24CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1226S SUP HCPCS C1713 1825-1226S - NAIL INTRAMEDULLARY 12MM 260MM LOCK T2 TITANIUM FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1228S SUP HCPCS C1713 1825-1228S - NAIL INTRAMEDULLARY 12MM 280MM LOCK T2 TITANIUM FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1230S SUP HCPCS C1713 1825-1230S - NAIL INTRAMEDULLARY 12MM 300MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1232S SUP HCPCS C1713 1825-1232S - NAIL INTRAMEDULLARY ANTEGRADE RTRGRD 12MM 32CM LOCK T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1234S SUP HCPCS C1713 1825-1234S - NAIL INTRAMEDULLARY 12MM 340MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1236S SUP HCPCS C1713 1825-1236S - NAIL INTRAMEDULLARY 12MM 360MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1238S SUP HCPCS C1713 1825-1238S - NAIL INTRAMEDULLARY 12MM 380MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1240S SUP HCPCS C1713 1825-1240S - NAIL INTRAMEDULLARY 12MM 400MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1242S SUP HCPCS C1713 1825-1242S - NAIL INTRAMEDULLARY 12MM 420MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1244S SUP HCPCS C1713 1825-1244S - NAIL INTRAMEDULLARY ANTEGRADE RTRGRD 12MM 44CM LOCK T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1246S SUP HCPCS C1713 1825-1246S - NAIL INTRAMEDULLARY 12MM 46CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1248S SUP HCPCS C1713 1825-1248S - NAIL INTRAMEDULLARY 12MM 48CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1314S SUP HCPCS C1713 1825-1314S - NAIL INTRAMEDULLARY 13MM 140MM T2 FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1316S SUP HCPCS C1713 1825-1316S - NAIL INTRAMEDULLARY 13MM 160MM T2 FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1318S SUP HCPCS C1713 1825-1318S - NAIL INTRAMEDULLARY 13MM 18CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1320S SUP HCPCS C1713 1825-1320S - NAIL INTRAMEDULLARY 13MM 20CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1322S SUP HCPCS C1713 1825-1322S - NAIL INTRAMEDULLARY 13MM 22CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1324S SUP HCPCS C1713 1825-1324S - NAIL INTRAMEDULLARY 13MM 24CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1326S SUP HCPCS C1713 1825-1326S - NAIL INTRAMEDULLARY 13MM 26CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1328S SUP HCPCS C1713 1825-1328S - NAIL INTRAMEDULLARY 13MM 28CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1330S SUP HCPCS C1713 1825-1330S - NAIL INTRAMEDULLARY 13MM 300MM LOCK T2 TITANIUM FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1332S SUP HCPCS C1713 1825-1332S - NAIL INTRAMEDULLARY 13MM 32CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1334S SUP HCPCS C1713 1825-1334S - NAIL INTRAMEDULLARY 13MM 340MM LOCK T2 TITANIUM FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1336S SUP HCPCS C1713 1825-1336S - NAIL INTRAMEDULLARY 13MM 360MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1338S SUP HCPCS C1713 1825-1338S - NAIL INTRAMEDULLARY RTRGRD ANTEGRADE 13MM 38CM LOCK T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1340S SUP HCPCS C1713 1825-1340S - NAIL INTRAMEDULLARY 13MM 400MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1342S SUP HCPCS C1713 1825-1342S - NAIL INTRAMEDULLARY 13MM 420MM LOCK T2 TITANIUM ALLOY FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1344S SUP HCPCS C1713 1825-1344S - NAIL INTRAMEDULLARY RTRGRD ANTEGRADE 13MM 44CM LOCK T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1346S SUP HCPCS C1713 1825-1346S - NAIL INTRAMEDULLARY 13MM 46CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1348S SUP HCPCS C1713 1825-1348S - NAIL INTRAMEDULLARY 13MM 48CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1414S SUP HCPCS C1713 1825-1414S - NAIL INTRAMEDULLARY 14MM 160MM T2 FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1416S SUP HCPCS C1713 1825-1416S - NAIL INTRAMEDULLARY 14MM 160MM T2 FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1418S SUP HCPCS C1713 1825-1418S - NAIL INTRAMEDULLARY 14MM 18CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1420S SUP HCPCS C1713 1825-1420S - NAIL INTRAMEDULLARY 14MM 20CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1422S SUP HCPCS C1713 1825-1422S - NAIL INTRAMEDULLARY 14MM 22CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1424S SUP HCPCS C1713 1825-1424S - NAIL INTRAMEDULLARY 14MM 24CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1426S SUP HCPCS C1713 1825-1426S - NAIL INTRAMEDULLARY 14MM 26CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1428S SUP HCPCS C1713 1825-1428S - NAIL INTRAMEDULLARY 14MM 28CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1430S SUP HCPCS C1713 1825-1430S - NAIL INTRAMEDULLARY 14MM 30CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1432S SUP HCPCS C1713 1825-1432S - NAIL INTRAMEDULLARY RTRGRD ANTEGRADE 14MM 32CM LOCK T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1434S SUP HCPCS C1713 1825-1434S - NAIL INTRAMEDULLARY 14MM 340MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1436S SUP HCPCS C1713 1825-1436S - NAIL INTRAMEDULLARY 14MM 360MM LOCK T2 TITANIUM FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1438S SUP HCPCS C1713 1825-1438S - NAIL INTRAMEDULLARY 14MM 380MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1440S SUP HCPCS C1713 1825-1440S - NAIL INTRAMEDULLARY 14MM 40CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1442S SUP HCPCS C1713 1825-1442S - NAIL INTRAMEDULLARY 14MM 420MM LOCK T2 TITANIUM FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1444S SUP HCPCS C1713 1825-1444S - NAIL INTRAMEDULLARY 14MM 440MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1446S SUP HCPCS C1713 1825-1446S - NAIL INTRAMEDULLARY 14MM 46CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1448S SUP HCPCS C1713 1825-1448S - NAIL INTRAMEDULLARY 14MM 48CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1514S SUP HCPCS C1713 1825-1514S - NAIL INTRAMEDULLARY 15MM 140MM LOCK T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1516S SUP HCPCS C1713 1825-1516S - NAIL INTRAMEDULLARY 15MM 160MM LOCK T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1518S SUP HCPCS C1713 1825-1518S - NAIL INTRAMEDULLARY 15MM 18CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1520S SUP HCPCS C1713 1825-1520S - NAIL INTRAMEDULLARY 15MM 20CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1522S SUP HCPCS C1713 1825-1522S - NAIL INTRAMEDULLARY 15MM 22CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1524S SUP HCPCS C1713 1825-1524S - NAIL INTRAMEDULLARY 15MM 24CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1526S SUP HCPCS C1713 1825-1526S - NAIL INTRAMEDULLARY 15MM 26CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1528S SUP HCPCS C1713 1825-1528S - NAIL INTRAMEDULLARY 15MM 28CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1530S SUP HCPCS C1713 1825-1530S - NAIL INTRAMEDULLARY 15MM 30CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1532S SUP HCPCS C1713 1825-1532S - NAIL INTRAMEDULLARY 15MM 32CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1534S SUP HCPCS C1713 1825-1534S - NAIL INTRAMEDULLARY 15MM 34CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1536S SUP HCPCS C1713 1825-1536S - NAIL INTRAMEDULLARY 15MM 36CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1538S SUP HCPCS C1713 1825-1538S - NAIL INTRAMEDULLARY 15MM 38CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" "$2,442.00" "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1540S SUP HCPCS C1713 1825-1540S - NAIL INTRAMEDULLARY 15MM 400MM LOCK T2 TITANIUM FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1542S SUP HCPCS C1713 1825-1542S - NAIL INTRAMEDULLARY 15MM 420MM LOCK T2 TITANIUM ALLOY FEMUR BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1544S SUP HCPCS C1713 1825-1544S - NAIL INTRAMEDULLARY 15MM 44CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1546S SUP HCPCS C1713 1825-1546S - NAIL INTRAMEDULLARY 15MM 46CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$2,442.00" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1825-1548S SUP HCPCS C1713 1825-1548S - NAIL INTRAMEDULLARY 15MM 48CM T2 FEMUR STERILE BOTH IP/OP "$2,442.00" "$1,807.00" $484.68 "$2,442.00" "$1,098.90" "$1,098.90" "$1,098.90" "$1,098.90" "$2,442.00" "$2,442.00" "$2,442.00" $508.97 "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" $508.94 "$2,442.00" $976.80 "$1,444.44" "$2,442.00" "$2,442.00" "$2,442.00" "$2,442.00" "$1,831.50" "$2,442.00" "$2,442.00" "$2,442.00" "$1,221.00" "$1,221.00" "$1,934.06" "$2,442.00" "$1,953.60" "$1,098.90" $484.68 N/A "$1,416.36" "$2,442.00" "$1,465.20" "$2,442.00" $508.91 "$2,442.00" N/A N/A 1826-0003S SUP HCPCS C1713 1826-0003S - CAP END 8MM 4MM INSERTION ARTHDES NAIL T2 ANKLE STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1826-0917S SUP HCPCS C1713 1826-0917S - NAIL INTRAMEDULLARY SHORT 9MM 17CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-0920S SUP HCPCS C1713 1826-0920S - NAIL INTRAMEDULLARY SHORT RTRGRD 9MM 20CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-0924S SUP HCPCS C1713 1826-0924S - NAIL INTRAMEDULLARY LONG 9MM 24CM LOCKING RTRGRD T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-0926S SUP HCPCS C1713 1826-0926S - NAIL INTRAMEDULLARY LONG 9MM 26CM LOCKING RTRGRD T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-0928S SUP HCPCS C1713 1826-0928S - NAIL INTRAMEDULLARY LONG 9MM 28CM LOCKING RTRGRD T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-0930S SUP HCPCS C1713 1826-0930S - NAIL INTRAMEDULLARY LONG 9MM 30CM LOCKING RTRGRD T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-0932S SUP HCPCS C1713 1826-0932S - NAIL INTRAMEDULLARY LONG 9MM 32CM LOCKING RTRGRD T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-0934S SUP HCPCS C1713 1826-0934S - NAIL INTRAMEDULLARY LONG 9MM 34CM LOCKING RTRGRD T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-0936S SUP HCPCS C1713 1826-0936S - NAIL INTRAMEDULLARY LONG 9MM 36CM LOCKING RTRGRD T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-0938S SUP HCPCS C1713 1826-0938S - NAIL INTRAMEDULLARY LONG 9MM 38CM LOCKING RTRGRD T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-0940S SUP HCPCS C1713 1826-0940S - NAIL INTRAMEDULLARY LONG 9MM 40CM LOCKING RTRGRD T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-0942S SUP HCPCS C1713 1826-0942S - NAIL INTRAMEDULLARY LONG 9MM 42CM LOCKING RTRGRD T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-0944S SUP HCPCS C1713 1826-0944S - NAIL INTRAMEDULLARY 9MM 440MM T2 SPCNDYL BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1017S SUP HCPCS C1713 1826-1017S - NAIL INTRAMEDULLARY SHORT RTRGRD 10MM 17CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1020S SUP HCPCS C1713 1826-1020S - NAIL INTRAMEDULLARY SHORT RTRGRD 10MM 20CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1024S SUP HCPCS C1713 1826-1024S - NAIL INTRAMEDULLARY LONG RTRGRD 10MM 24CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1026S SUP HCPCS C1713 1826-1026S - NAIL INTRAMEDULLARY LONG RTRGRD 10MM 26CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1028S SUP HCPCS C1713 1826-1028S - NAIL INTRAMEDULLARY LONG RTRGRD 10MM 28CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1030S SUP HCPCS C1713 1826-1030S - NAIL INTRAMEDULLARY LONG RTRGRD 10MM 30CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1032S SUP HCPCS C1713 1826-1032S - NAIL INTRAMEDULLARY LONG 10MM 320MM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1034S SUP HCPCS C1713 1826-1034S - NAIL INTRAMEDULLARY LONG RTRGRD 10MM 34CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1036S SUP HCPCS C1713 1826-1036S - NAIL INTRAMEDULLARY LONG 10MM 36CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1038S SUP HCPCS C1713 1826-1038S - NAIL INTRAMEDULLARY LONG RTRGRD 10MM 38CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1040S SUP HCPCS C1713 1826-1040S - NAIL INTRAMEDULLARY LONG RTRGRD 10MM 40CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1042S SUP HCPCS C1713 1826-1042S - NAIL INTRAMEDULLARY LONG RTRGRD 10MM 42CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1044S SUP HCPCS C1713 1826-1044S - NAIL INTRAMEDULLARY LONG 10MM 44CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1117S SUP HCPCS C1713 1826-1117S - NAIL INTRAMEDULLARY SHORT 11MM 170MM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1120S SUP HCPCS C1713 1826-1120S - NAIL INTRAMEDULLARY SHORT 11MM 200MM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1124S SUP HCPCS C1713 1826-1124S - NAIL INTRAMEDULLARY LONG RTRGRD 11MM 24CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1126S SUP HCPCS C1713 1826-1126S - NAIL INTRAMEDULLARY LONG RTRGRD 11MM 26CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1128S SUP HCPCS C1713 1826-1128S - NAIL INTRAMEDULLARY LONG RTRGRD 11MM 28CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1130S SUP HCPCS C1713 1826-1130S - NAIL INTRAMEDULLARY LONG RTRGRD 11MM 30CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1132S SUP HCPCS C1713 1826-1132S - NAIL INTRAMEDULLARY LONG RTRGRD 11MM 32CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1134S SUP HCPCS C1713 1826-1134S - NAIL INTRAMEDULLARY LONG RTRGRD 11MM 34CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1136S SUP HCPCS C1713 1826-1136S - NAIL INTRAMEDULLARY LONG RTRGRD 11MM 36CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1138S SUP HCPCS C1713 1826-1138S - NAIL INTRAMEDULLARY LONG RTRGRD 11MM 38CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1140S SUP HCPCS C1713 1826-1140S - NAIL INTRAMEDULLARY LONG RTRGRD 11MM 40CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1142S SUP HCPCS C1713 1826-1142S - NAIL INTRAMEDULLARY LONG RTRGRD 11MM 42CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1144S SUP HCPCS C1713 1826-1144S - NAIL INTRAMEDULLARY LONG 11MM 44CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1217S SUP HCPCS C1713 1826-1217S - NAIL INTRAMEDULLARY SHORT RTRGRD 12MM 17CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1220S SUP HCPCS C1713 1826-1220S - NAIL INTRAMEDULLARY SHORT RTRGRD 12MM 20CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1224S SUP HCPCS C1713 1826-1224S - NAIL INTRAMEDULLARY LONG RTRGRD 12MM 24CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1226S SUP HCPCS C1713 1826-1226S - NAIL INTRAMEDULLARY LONG RTRGRD 12MM 26CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1228S SUP HCPCS C1713 1826-1228S - NAIL INTRAMEDULLARY LONG RTRGRD 12MM 28CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1230S SUP HCPCS C1713 1826-1230S - NAIL INTRAMEDULLARY LONG RTRGRD 12MM 30CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1232S SUP HCPCS C1713 1826-1232S - NAIL INTRAMEDULLARY LONG 12MM 320MM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$1,813.35" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1234S SUP HCPCS C1713 1826-1234S - NAIL INTRAMEDULLARY LONG RTRGRD 12MM 34CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1236S SUP HCPCS C1713 1826-1236S - NAIL INTRAMEDULLARY LONG RTRGRD 12MM 36CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1238S SUP HCPCS C1713 1826-1238S - NAIL INTRAMEDULLARY LONG RTRGRD 12MM 38CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1240S SUP HCPCS C1713 1826-1240S - NAIL INTRAMEDULLARY LONG RTRGRD 12MM 40CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1242S SUP HCPCS C1713 1826-1242S - NAIL INTRAMEDULLARY LONG RTRGRD 12MM 42CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1244S SUP HCPCS C1713 1826-1244S - NAIL INTRAMEDULLARY LONG 12MM 44CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1317S SUP HCPCS C1713 1826-1317S - NAIL INTRAMEDULLARY SHORT 13MM 17CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1320S SUP HCPCS C1713 1826-1320S - NAIL INTRAMEDULLARY SHORT 13MM 200MM T2 TITANIUM SPCNDYL BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1324S SUP HCPCS C1713 1826-1324S - NAIL INTRAMEDULLARY LONG 13MM 24CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1326S SUP HCPCS C1713 1826-1326S - NAIL INTRAMEDULLARY LONG 13MM 26CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1328S SUP HCPCS C1713 1826-1328S - NAIL INTRAMEDULLARY LONG RTRGRD 13MM 28CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1330S SUP HCPCS C1713 1826-1330S - NAIL INTRAMEDULLARY LONG 13MM 30CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1332S SUP HCPCS C1713 1826-1332S - NAIL INTRAMEDULLARY LONG RTRGRD 13MM 32CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1334S SUP HCPCS C1713 1826-1334S - NAIL INTRAMEDULLARY LONG RTRGRD 13MM 34CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1336S SUP HCPCS C1713 1826-1336S - NAIL INTRAMEDULLARY LONG 13MM 360MM T2 TITANIUM SPCNDYL BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1338S SUP HCPCS C1713 1826-1338S - NAIL INTRAMEDULLARY LONG 13MM 38CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1340S SUP HCPCS C1713 1826-1340S - NAIL INTRAMEDULLARY LONG 13MM 40CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1342S SUP HCPCS C1713 1826-1342S - NAIL INTRAMEDULLARY LONG 13MM 42CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1344S SUP HCPCS C1713 1826-1344S - NAIL INTRAMEDULLARY LONG 13MM 44CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1417S SUP HCPCS C1713 1826-1417S - NAIL INTRAMEDULLARY SHORT RTRGRD 14MM 17CM LOCK T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1420S SUP HCPCS C1713 1826-1420S - NAIL INTRAMEDULLARY SHORT 14MM 200MM GUN DRILLED T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1424S SUP HCPCS C1713 1826-1424S - NAIL INTRAMEDULLARY LONG 14MM 24CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1426S SUP HCPCS C1713 1826-1426S - NAIL INTRAMEDULLARY LONG 14MM 26CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1428S SUP HCPCS C1713 1826-1428S - NAIL INTRAMEDULLARY LONG 14MM 28CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1430S SUP HCPCS C1713 1826-1430S - NAIL INTRAMEDULLARY LONG 14MM 30CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1432S SUP HCPCS C1713 1826-1432S - NAIL INTRAMEDULLARY LONG 14MM 32CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1434S SUP HCPCS C1713 1826-1434S - NAIL INTRAMEDULLARY LONG STANDARD 14MM 340MM LOCKING RTRGRD BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1436S SUP HCPCS C1713 1826-1436S - NAIL INTRAMEDULLARY LONG 14MM 360MM GUN DRILLED T2 TITANIUM BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1438S SUP HCPCS C1713 1826-1438S - NAIL INTRAMEDULLARY LONG 14MM 38CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1440S SUP HCPCS C1713 1826-1440S - NAIL INTRAMEDULLARY LONG 14MM 40CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$1,208.90" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1442S SUP HCPCS C1713 1826-1442S - NAIL INTRAMEDULLARY LONG 14MM 42CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 1826-1444S SUP HCPCS C1713 1826-1444S - NAIL INTRAMEDULLARY LONG 14MM 44CM LOCKING RTRGRD T2 BOTH IP/OP "$3,022.50" "$2,237.00" $599.84 "$3,022.25" "$1,360.01" "$1,360.01" "$1,360.01" "$1,360.01" "$3,022.25" "$3,022.25" "$3,022.25" $629.91 "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" $629.87 "$3,022.25" "$3,022.25" "$1,489.97" "$3,022.25" "$3,022.25" "$3,022.25" "$3,022.25" "$2,266.88" "$3,022.25" "$3,022.25" "$3,022.25" "$1,511.13" "$1,511.13" "$2,393.62" "$3,022.25" "$2,417.80" "$1,360.01" $599.84 N/A "$1,753.05" "$3,022.25" "$3,022.25" "$3,022.25" $629.84 "$3,022.25" N/A N/A 18-2800 SUP Custom 27803010 18-2800 - HEAD FEMORAL +0MM OFFST C TAPER 28MM HIGH PERFORMANCE BIOLOX BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 18-2805 SUP Custom 27803010 18-2805 - HEAD FEMORAL +5MM OFFST C TAPER 28MM HIGH PERFORMANCE BIOLOX BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 1828-0824S SUP HCPCS C1713 1828-0824S - NAIL INTRAMEDULLARY 8MM 24CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0826S SUP HCPCS C1713 1828-0826S - NAIL INTRAMEDULLARY 8MM 26CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0828S SUP HCPCS C1713 1828-0828S - NAIL INTRAMEDULLARY 8MM 28CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0830S SUP HCPCS C1713 1828-0830S - NAIL INTRAMEDULLARY 8MM 30CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0832S SUP HCPCS C1713 1828-0832S - NAIL INTRAMEDULLARY 8MM 32CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0834S SUP HCPCS C1713 1828-0834S - NAIL INTRAMEDULLARY 8MM 34CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0836S SUP HCPCS C1713 1828-0836S - NAIL INTRAMEDULLARY 8MM 36CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0838S SUP HCPCS C1713 1828-0838S - NAIL INTRAMEDULLARY 8MM 38CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0840S SUP HCPCS C1713 1828-0840S - NAIL INTRAMEDULLARY 8MM 40CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0842S SUP HCPCS C1713 1828-0842S - NAIL INTRAMEDULLARY 8MM 42CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0844S SUP HCPCS C1713 1828-0844S - NAIL INTRAMEDULLARY 8MM 44CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0846S SUP HCPCS C1713 1828-0846S - NAIL INTRAMEDULLARY 8MM 46CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0848S SUP HCPCS C1713 1828-0848S - NAIL INTRAMEDULLARY 8MM 48CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0924S SUP HCPCS C1713 1828-0924S - NAIL INTRAMEDULLARY 9MM 24CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0926S SUP HCPCS C1713 1828-0926S - NAIL INTRAMEDULLARY 9MM 26CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0928S SUP HCPCS C1713 1828-0928S - NAIL INTRAMEDULLARY 9MM 28CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0930S SUP HCPCS C1713 1828-0930S - NAIL INTRAMEDULLARY 9MM 30CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0932S SUP HCPCS C1713 1828-0932S - NAIL INTRAMEDULLARY 9MM 32CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0934S SUP HCPCS C1713 1828-0934S - NAIL INTRAMEDULLARY 9MM 34CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0936S SUP HCPCS C1713 1828-0936S - NAIL INTRAMEDULLARY 9MM 36CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0938S SUP HCPCS C1713 1828-0938S - NAIL INTRAMEDULLARY 9MM 38CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0940S SUP HCPCS C1713 1828-0940S - NAIL INTRAMEDULLARY 9MM 40CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0942S SUP HCPCS C1713 1828-0942S - NAIL INTRAMEDULLARY 9MM 42CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0944S SUP HCPCS C1713 1828-0944S - NAIL INTRAMEDULLARY 9MM 44CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0946S SUP HCPCS C1713 1828-0946S - NAIL INTRAMEDULLARY 9MM 46CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-0948S SUP HCPCS C1713 1828-0948S - NAIL INTRAMEDULLARY 9MM 48CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1024S SUP HCPCS C1713 1828-1024S - NAIL INTRAMEDULLARY 10MM 24CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1026S SUP HCPCS C1713 1828-1026S - NAIL INTRAMEDULLARY 10MM 26CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1028S SUP HCPCS C1713 1828-1028S - NAIL INTRAMEDULLARY 10MM 28CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1030S SUP HCPCS C1713 1828-1030S - NAIL INTRAMEDULLARY 10MM 30CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1032S SUP HCPCS C1713 1828-1032S - NAIL INTRAMEDULLARY 10MM 32CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1034S SUP HCPCS C1713 1828-1034S - NAIL INTRAMEDULLARY 10MM 38CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1036S SUP HCPCS C1713 1828-1036S - NAIL INTRAMEDULLARY 10MM 36CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1038S SUP HCPCS C1713 1828-1038S - NAIL INTRAMEDULLARY 10MM 38CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1040S SUP HCPCS C1713 1828-1040S - NAIL INTRAMEDULLARY 10MM 40CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1042S SUP HCPCS C1713 1828-1042S - NAIL INTRAMEDULLARY 10MM 42CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1044S SUP HCPCS C1713 1828-1044S - NAIL INTRAMEDULLARY 10MM 44CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1046S SUP HCPCS C1713 1828-1046S - NAIL INTRAMEDULLARY 10MM 46CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1048S SUP HCPCS C1713 1828-1048S - NAIL INTRAMEDULLARY 10MM 48CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1124S SUP HCPCS C1713 1828-1124S - NAIL INTRAMEDULLARY 11MM 24CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1126S SUP HCPCS C1713 1828-1126S - NAIL INTRAMEDULLARY 11MM 26CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1128S SUP HCPCS C1713 1828-1128S - NAIL INTRAMEDULLARY 11MM 28CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1130S SUP HCPCS C1713 1828-1130S - NAIL INTRAMEDULLARY 11MM 30CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1132S SUP HCPCS C1713 1828-1132S - T2 FEMORAL NAIL R1500 11MMX320MM BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1134S SUP HCPCS C1713 1828-1134S - NAIL INTRAMEDULLARY 11MM 34CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1136S SUP HCPCS C1713 1828-1136S - NAIL INTRAMEDULLARY 11MM 36CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1138S SUP HCPCS C1713 1828-1138S - NAIL INTRAMEDULLARY 11MM 38CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1140S SUP HCPCS C1713 1828-1140S - NAIL INTRAMEDULLARY ANTEGRADE 11MM 40CM LOCK T2 TITANIUM BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1142S SUP HCPCS C1713 1828-1142S - NAIL INTRAMEDULLARY 11MM 42CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1144S SUP HCPCS C1713 1828-1144S - NAIL INTRAMEDULLARY 11MM 44CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1146S SUP HCPCS C1713 1828-1146S - NAIL INTRAMEDULLARY 11MM 46CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1148S SUP HCPCS C1713 1828-1148S - NAIL INTRAMEDULLARY 11MM 48CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1224S SUP HCPCS C1713 1828-1224S - NAIL INTRAMEDULLARY 12MM 24CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1226S SUP HCPCS C1713 1828-1226S - NAIL INTRAMEDULLARY 12MM 26CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1228S SUP HCPCS C1713 1828-1228S - NAIL INTRAMEDULLARY 12MM 28CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1230S SUP HCPCS C1713 1828-1230S - NAIL INTRAMEDULLARY 12MM 20CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1232S SUP HCPCS C1713 1828-1232S - NAIL INTRAMEDULLARY 12MM 32CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1234S SUP HCPCS C1713 1828-1234S - NAIL INTRAMEDULLARY 12MM 34CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1236S SUP HCPCS C1713 1828-1236S - NAIL INTRAMEDULLARY 12MM 36CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1238S SUP HCPCS C1713 1828-1238S - NAIL INTRAMEDULLARY 12MM 38CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1240S SUP HCPCS C1713 1828-1240S - NAIL INTRAMEDULLARY 12MM 40CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1242S SUP HCPCS C1713 1828-1242S - NAIL INTRAMEDULLARY 12MM 42CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1244S SUP HCPCS C1713 1828-1244S - NAIL INTRAMEDULLARY 12MM 44CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1246S SUP HCPCS C1713 1828-1246S - NAIL INTRAMEDULLARY 12MM 46CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1248S SUP HCPCS C1713 1828-1248S - NAIL INTRAMEDULLARY 12MM 48CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1324S SUP HCPCS C1713 1828-1324S - NAIL INTRAMEDULLARY 13MM 24CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1326S SUP HCPCS C1713 1828-1326S - NAIL INTRAMEDULLARY 13MM 26CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1328S SUP HCPCS C1713 1828-1328S - NAIL INTRAMEDULLARY 13MM 28CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1330S SUP HCPCS C1713 1828-1330S - NAIL INTRAMEDULLARY 13MM 30CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1332S SUP HCPCS C1713 1828-1332S - NAIL INTRAMEDULLARY 13MM 32CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1334S SUP HCPCS C1713 1828-1334S - NAIL INTRAMEDULLARY 13MM 34CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1336S SUP HCPCS C1713 1828-1336S - NAIL INTRAMEDULLARY 13MM 36CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1338S SUP HCPCS C1713 1828-1338S - NAIL INTRAMEDULLARY 13MM 38CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1340S SUP HCPCS C1713 1828-1340S - NAIL INTRAMEDULLARY 13MM 40CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1342S SUP HCPCS C1713 1828-1342S - NAIL INTRAMEDULLARY 13MM 42CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1344S SUP HCPCS C1713 1828-1344S - NAIL INTRAMEDULLARY 13MM 44CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1346S SUP HCPCS C1713 1828-1346S - NAIL INTRAMEDULLARY 13MM 46CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1348S SUP HCPCS C1713 1828-1348S - NAIL INTRAMEDULLARY 13MM 48CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1424S SUP HCPCS C1713 1828-1424S - NAIL INTRAMEDULLARY 14MM 24CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1426S SUP HCPCS C1713 1828-1426S - NAIL INTRAMEDULLARY 14MM 26CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1428S SUP HCPCS C1713 1828-1428S - NAIL INTRAMEDULLARY 14MM 28CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1430S SUP HCPCS C1713 1828-1430S - NAIL INTRAMEDULLARY 14MM 30CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1432S SUP HCPCS C1713 1828-1432S - NAIL INTRAMEDULLARY 14MM 32CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1434S SUP HCPCS C1713 1828-1434S - NAIL INTRAMEDULLARY 14MM 34CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1436S SUP HCPCS C1713 1828-1436S - NAIL INTRAMEDULLARY 14MM 36CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1438S SUP HCPCS C1713 1828-1438S - NAIL INTRAMEDULLARY 14MM 38CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1440S SUP HCPCS C1713 1828-1440S - NAIL INTRAMEDULLARY 14MM 40CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1442S SUP HCPCS C1713 1828-1442S - NAIL INTRAMEDULLARY 14MM 42CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1444S SUP HCPCS C1713 1828-1444S - NAIL INTRAMEDULLARY 14MM 44CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1446S SUP HCPCS C1713 1828-1446S - NAIL INTRAMEDULLARY 14MM 46CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1448S SUP HCPCS C1713 1828-1448S - NAIL INTRAMEDULLARY 14MM 48CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1524S SUP HCPCS C1713 1828-1524S - NAIL INTRAMEDULLARY 15MM 24CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1526S SUP HCPCS C1713 1828-1526S - NAIL INTRAMEDULLARY 15MM 26CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1528S SUP HCPCS C1713 1828-1528S - NAIL INTRAMEDULLARY 15MM 28CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1530S SUP HCPCS C1713 1828-1530S - NAIL INTRAMEDULLARY 15MM 30CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1532S SUP HCPCS C1713 1828-1532S - NAIL INTRAMEDULLARY 15MM 32CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1534S SUP HCPCS C1713 1828-1534S - NAIL INTRAMEDULLARY 15MM 34CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$1,560.90" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1536S SUP HCPCS C1713 1828-1536S - NAIL INTRAMEDULLARY 15MM 36CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1538S SUP HCPCS C1713 1828-1538S - NAIL INTRAMEDULLARY 15MM 38CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1540S SUP HCPCS C1713 1828-1540S - NAIL INTRAMEDULLARY 15MM 40CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1542S SUP HCPCS C1713 1828-1542S - NAIL INTRAMEDULLARY 15MM 42CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$2,601.50" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1544S SUP HCPCS C1713 1828-1544S - NAIL INTRAMEDULLARY 15MM 44CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1546S SUP HCPCS C1713 1828-1546S - NAIL INTRAMEDULLARY 15MM 46CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 1828-1548S SUP HCPCS C1713 1828-1548S - NAIL INTRAMEDULLARY 15MM 48CM LOCK T2 TITANIUM FEMUR STERILE BOTH IP/OP "$2,601.50" "$1,925.00" $516.33 "$2,601.50" "$1,170.68" "$1,170.68" "$1,170.68" "$1,170.68" "$2,601.50" "$2,601.50" "$2,601.50" $542.22 "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" $542.18 "$2,601.50" "$1,040.60" "$1,282.54" "$2,601.50" "$2,601.50" "$2,601.50" "$2,601.50" "$1,951.13" "$2,601.50" "$2,601.50" "$2,601.50" "$1,300.75" "$1,300.75" "$2,060.39" "$2,601.50" "$2,081.20" "$1,170.68" $516.33 N/A "$1,508.87" "$2,601.50" "$2,601.50" "$2,601.50" $542.15 "$2,601.50" N/A N/A 18-2825 SUP Custom 27803010 18-2825 - HEAD FEMORAL +2.5MM OFFST C TAPER 28MM HIGH PERFORMANCE BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 18-28-3 SUP Custom 27803010 18-28-3 - HEAD FEM -2.5MM OFST CTPR 28MM HPRFR BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 1829-1104S SUP HCPCS C1713 1829-1104S - NAIL INTRAMEDULLARY 11.5MM 540MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$10,267.15" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1108S SUP HCPCS C1713 1829-1108S - NAIL INTRAMEDULLARY 11.5MM 580MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1112S SUP HCPCS C1713 1829-1112S - NAIL INTRAMEDULLARY 11.5MM 620MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1116S SUP HCPCS C1713 1829-1116S - NAIL INTRAMEDULLARY 11.5MM 660MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1120S SUP HCPCS C1713 1829-1120S - NAIL INTRAMEDULLARY 11.5MM 700MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$10,267.15" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1124S SUP HCPCS C1713 1829-1124S - NAIL INTRAMEDULLARY 11.5MM 740MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$10,267.15" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1128S SUP HCPCS C1713 1829-1128S - NAIL INTRAMEDULLARY 11.5MM 780MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$10,267.15" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1154S SUP HCPCS C1713 1829-1154S - NAIL INTRAMEDULLARY 11.5MM 540MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$10,267.15" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1158S SUP HCPCS C1713 1829-1158S - NAIL INTRAMEDULLARY 11.5MM 580MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1162S SUP HCPCS C1713 1829-1162S - NAIL INTRAMEDULLARY 11.5MM 620MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1166S SUP HCPCS C1713 1829-1166S - NAIL INTRAMEDULLARY 11.5MM 660MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1170S SUP HCPCS C1713 1829-1170S - NAIL INTRAMEDULLARY 11.5MM 700MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$10,267.15" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1174S SUP HCPCS C1713 1829-1174S - NAIL INTRAMEDULLARY 11.5MM 750MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1178S SUP HCPCS C1713 1829-1178S - NAIL INTRAMEDULLARY 11.5MM 780MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$10,267.15" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1304S SUP HCPCS C1713 1829-1304S - NAIL INTRAMEDULLARY 13MM 540MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$10,267.15" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1308S SUP HCPCS C1713 1829-1308S - NAIL INTRAMEDULLARY 13MM 580MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1312S SUP HCPCS C1713 1829-1312S - NAIL INTRAMEDULLARY 13MM 620MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1316S SUP HCPCS C1713 1829-1316S - NAIL INTRAMEDULLARY 13MM 660MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1320S SUP HCPCS C1713 1829-1320S - NAIL INTRAMEDULLARY 13MM 700MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1324S SUP HCPCS C1713 1829-1324S - NAIL INTRAMEDULLARY 13MM 740MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1328S SUP HCPCS C1713 1829-1328S - NAIL INTRAMEDULLARY 13MM 780MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1354S SUP HCPCS C1713 1829-1354S - NAIL INTRAMEDULLARY 13MM 540MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$10,267.15" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1358S SUP HCPCS C1713 1829-1358S - NAIL INTRAMEDULLARY 13MM 580MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1362S SUP HCPCS C1713 1829-1362S - NAIL INTRAMEDULLARY 13MM 620MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$10,267.15" "$10,267.15" N/A N/A 1829-1366S SUP HCPCS C1713 1829-1366S - NAIL INTRAMEDULLARY 13MM 660MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$10,267.15" "$10,267.15" N/A N/A 1829-1370S SUP HCPCS C1713 1829-1370S - NAIL INTRAMEDULLARY 13MM 700MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1374S SUP HCPCS C1713 1829-1374S - NAIL INTRAMEDULLARY 13MM 740MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-1378S SUP HCPCS C1713 1829-1378S - NAIL INTRAMEDULLARY 13MM 78CM T2 TITANIUM KNEE RIGHT FEMUR BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-2004S SUP HCPCS C1713 1829-2004S - NAIL INTRAMEDULLARY 10MM 540MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-2008S SUP HCPCS C1713 1829-2008S - NAIL INTRAMEDULLARY 10MM 580MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-2012S SUP HCPCS C1713 1829-2012S - NAIL INTRAMEDULLARY 10MM 620MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" N/A N/A 1829-2016S SUP HCPCS C1713 1829-2016S - NAIL INTRAMEDULLARY 10MM 660MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" N/A N/A 1829-2020S SUP HCPCS C1713 1829-2020S - NAIL INTRAMEDULLARY 10MM 700MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$10,267.15" "$10,267.15" N/A N/A 1829-2024S SUP HCPCS C1713 1829-2024S - NAIL INTRAMEDULLARY 10MM 740MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-2028S SUP HCPCS C1713 1829-2028S - NAIL INTRAMEDULLARY 10MM 780MM T2 TITANIUM LEFT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$10,267.15" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-2054S SUP HCPCS C1713 1829-2054S - NAIL INTRAMEDULLARY 10MM 540MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$10,267.15" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-2058S SUP HCPCS C1713 1829-2058S - NAIL INTRAMEDULLARY 10MM 580MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$10,267.15" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$10,267.15" "$10,267.15" N/A N/A 1829-2062S SUP HCPCS C1713 1829-2062S - NAIL INTRAMEDULLARY 10MM 620MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" N/A N/A 1829-2066S SUP HCPCS C1713 1829-2066S - NAIL INTRAMEDULLARY 10MM 660MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-2070S SUP HCPCS C1713 1829-2070S - NAIL INTRAMEDULLARY 10MM 700MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-2074S SUP HCPCS C1713 1829-2074S - NAIL INTRAMEDULLARY 10MM 740MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$4,106.86" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$6,160.29" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1829-2078S SUP HCPCS C1713 1829-2078S - NAIL INTRAMEDULLARY 10MM 780MM T2 TITANIUM RIGHT STERILE BOTH IP/OP "$10,267.50" "$7,598.00" "$2,037.77" "$10,267.15" "$4,620.22" "$4,620.22" "$4,620.22" "$4,620.22" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.93" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.79" "$10,267.15" "$10,267.15" "$5,061.70" "$10,267.15" "$10,267.15" "$10,267.15" "$10,267.15" "$7,700.63" "$10,267.15" "$10,267.15" "$10,267.15" "$5,133.58" "$5,133.58" "$8,131.58" "$10,267.15" "$8,213.72" "$4,620.22" "$2,037.77" N/A "$5,955.15" "$10,267.15" "$10,267.15" "$10,267.15" "$2,139.67" "$10,267.15" N/A N/A 1830-0001S SUP HCPCS C1713 1830-0001S - SCREW BONE 6MM ADVANCE COMPRESSION T2 TITANIUM HUMERUS BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $282.20 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $282.20 $282.20 $58.81 $282.20 N/A N/A 1830-0003S SUP HCPCS C1713 1830-0003S - CAP END 6MM 9MM T2 TITANIUM HUMERUS STERILE INTRAMEDULLARY BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $112.88 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $282.20 $282.20 $58.81 $282.20 N/A N/A 1830-0005S SUP HCPCS C1713 1830-0005S - CAP END 8MM 5+ MM T2 TITANIUM HUMERUS STERILE LOCKING NAIL BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $112.88 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $282.20 $282.20 $58.81 $282.20 N/A N/A 1830-0008S SUP HCPCS C1713 1830-0008S - WASHER ORTHOPEDIC ROUND T2 TITANIUM HUMERUS STERILE BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $112.88 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $282.20 $282.20 $58.81 $282.20 N/A N/A 1830-0009S SUP HCPCS C1713 1830-0009S - WASHER ORTHOPEDIC SQUARE T2 TITANIUM HUMERUS STERILE BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $112.88 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $282.20 $282.20 $58.81 $282.20 N/A N/A 1830-0010S SUP HCPCS C1713 1830-0010S - CAP END +10MM T2 TITANIUM HUMERUS STERILE INTRAMEDULLARY BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $112.88 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $282.20 $282.20 $58.81 $282.20 N/A N/A 1830-0015S SUP HCPCS C1713 1830-0015S - CAP END +15MM T2 TITANIUM HUMERUS STERILE INTRAMEDULLARY BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $112.88 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $282.20 $282.20 $58.81 $282.20 N/A N/A 1830-0020S SUP HCPCS C1713 1830-0020S - CAP END +20MM T2 TITANIUM HUMERUS STERILE INTRAMEDULLARY BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $112.88 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $282.20 $282.20 $58.81 $282.20 N/A N/A 1830-0025S SUP HCPCS C1713 1830-0025S - CAP END +25MM T2 TITANIUM HUMERUS STERILE INTRAMEDULLARY BOTH IP/OP $282.50 $209.00 $56.01 $282.20 $126.99 $126.99 $126.99 $126.99 $282.20 $282.20 $282.20 $58.82 $282.20 $282.20 $282.20 $282.20 $282.20 $58.81 $282.20 $112.88 $166.92 $282.20 $282.20 $282.20 $282.20 $211.88 $282.20 $282.20 $282.20 $141.10 $141.10 $223.50 $282.20 $225.76 $126.99 $56.01 N/A $163.85 $282.20 $282.20 $282.20 $58.81 $282.20 N/A N/A 1830-0714S SUP HCPCS C1713 1830-0714S - NAIL INTRAMEDULLARY 7MM 14CM LOCK T2 TITANIUM HUMERUS BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" N/A N/A 1830-0716S SUP HCPCS C1713 1830-0716S - NAIL INTRAMEDULLARY 7MM 16CM LOCK T2 TITANIUM HUMERUS BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" "$2,353.65" "$2,353.65" N/A N/A 1830-0718S SUP HCPCS C1713 1830-0718S - NAIL INTRAMEDULLARY 7MM 18CM LOCK T2 TITANIUM HUMERUS BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0719S SUP HCPCS C1713 1830-0719S - NAIL INTRAMEDULLARY 7MM 19CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0720S SUP HCPCS C1713 1830-0720S - NAIL INTRAMEDULLARY 7MM 20CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0721S SUP HCPCS C1713 1830-0721S - NAIL INTRAMEDULLARY 7MM 21CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0722S SUP HCPCS C1713 1830-0722S - NAIL INTRAMEDULLARY ANTEGRADE RTRGRD 7MM 220MM LOCK T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0723S SUP HCPCS C1713 1830-0723S - NAIL INTRAMEDULLARY 7MM 230MM LOCKING CANN T2 ANODIZED BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0724S SUP HCPCS C1713 1830-0724S - NAIL INTRAMEDULLARY 7MM 24CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0725S SUP HCPCS C1713 1830-0725S - NAIL INTRAMEDULLARY 7MM 250MM RTRGRD LOCKING T2 TITANIUM BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0726S SUP HCPCS C1713 1830-0726S - NAIL INTRAMEDULLARY 7MM 26CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0727S SUP HCPCS C1713 1830-0727S - NAIL INTRAMEDULLARY 7MM 27CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0728S SUP HCPCS C1713 1830-0728S - NAIL INTRAMEDULLARY 7MM 28CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0729S SUP HCPCS C1713 1830-0729S - NAIL INTRAMEDULLARY 7MM 29CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0730S SUP HCPCS C1713 1830-0730S - NAIL INTRAMEDULLARY 7MM 30CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0731S SUP HCPCS C1713 1830-0731S - NAIL INTRAMEDULLARY 7MM 31CM ANTEGRADE/RTRGRD LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0732S SUP HCPCS C1713 1830-0732S - NAIL INTRAMEDULLARY 7MM 32CM ANTEGRADE/RTRGRD LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0814S SUP HCPCS C1713 1830-0814S - NAIL INTRAMEDULLARY 8MM 14CM ANTEGRADE/RTRGRD LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0816S SUP HCPCS C1713 1830-0816S - NAIL INTRAMEDULLARY 8MM 16CM ANTEGRADE/RTRGRD LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0818S SUP HCPCS C1713 1830-0818S - NAIL INTRAMEDULLARY 8MM 18CM ANTEGRADE/RTRGRD LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0819S SUP HCPCS C1713 1830-0819S - NAIL INTRAMEDULLARY 8MM 19CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0820S SUP HCPCS C1713 1830-0820S - NAIL INTRAMEDULLARY 8MM 20CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0821S SUP HCPCS C1713 1830-0821S - NAIL INTRAMEDULLARY 8MM 21CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0822S SUP HCPCS C1713 1830-0822S - NAIL INTRAMEDULLARY 8MM 22CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0823S SUP HCPCS C1713 1830-0823S - NAIL INTRAMEDULLARY 8MM 230MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0824S SUP HCPCS C1713 1830-0824S - NAIL INTRAMEDULLARY 8MM 240MM LOCK T2 TITANIUM HUMERUS BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$1,412.19" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0825S SUP HCPCS C1713 1830-0825S - NAIL INTRAMEDULLARY 8MM 250MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0826S SUP HCPCS C1713 1830-0826S - NAIL INTRAMEDULLARY 8MM 26CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0827S SUP HCPCS C1713 1830-0827S - NAIL INTRAMEDULLARY 8MM 270MM LOCK T2 TITANIUM HUMERUS BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0828S SUP HCPCS C1713 1830-0828S - NAIL INTRAMEDULLARY 8MM 28CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0829S SUP HCPCS C1713 1830-0829S - NAIL INTRAMEDULLARY 8MM 29CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0830S SUP HCPCS C1713 1830-0830S - NAIL INTRAMEDULLARY 8MM 30CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0831S SUP HCPCS C1713 1830-0831S - NAIL INTRAMEDULLARY 8MM 31CM ANTEGRADE/RTRGRD LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0832S SUP HCPCS C1713 1830-0832S - NAIL INTRAMEDULLARY 8MM 32CM ANTEGRADE/RTRGRD LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0914S SUP HCPCS C1713 1830-0914S - NAIL INTRAMEDULLARY 9MM 14CM ANTEGRADE/RTRGRD LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0916S SUP HCPCS C1713 1830-0916S - NAIL INTRAMEDULLARY 9MM 16CM ANTEGRADE/RTRGRD LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0918S SUP HCPCS C1713 1830-0918S - NAIL INTRAMEDULLARY 9MM 18CM ANTEGRADE/RTRGRD LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0919S SUP HCPCS C1713 1830-0919S - NAIL INTRAMEDULLARY 9MM 19CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0920S SUP HCPCS C1713 1830-0920S - NAIL INTRAMEDULLARY 9MM 20CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0921S SUP HCPCS C1713 1830-0921S - NAIL INTRAMEDULLARY 9MM 210MM LOCK T2 TITANIUM HUMERUS BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0922S SUP HCPCS C1713 1830-0922S - NAIL INTRAMEDULLARY 9MM 220MM LOCK T2 TITANIUM HUMERUS BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0923S SUP HCPCS C1713 1830-0923S - NAIL INTRAMEDULLARY ANTEGRADE RTRGRD 9MM 230MM LOCK T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0924S SUP HCPCS C1713 1830-0924S - NAIL INTRAMEDULLARY 9MM 240MM LOCK T2 TITANIUM ALLOY HUMERUS BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0925S SUP HCPCS C1713 1830-0925S - NAIL INTRAMEDULLARY ANTEGRADE RTRGRD 9MM 250MM LOCK T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0926S SUP HCPCS C1713 1830-0926S - NAIL INTRAMEDULLARY 9MM 260MM LOCK T2 TITANIUM HUMERUS BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0927S SUP HCPCS C1713 1830-0927S - NAIL INTRAMEDULLARY 9MM 270MM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0928S SUP HCPCS C1713 1830-0928S - NAIL INTRAMEDULLARY 9MM 28CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0929S SUP HCPCS C1713 1830-0929S - NAIL INTRAMEDULLARY 9MM 29CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0930S SUP HCPCS C1713 1830-0930S - NAIL INTRAMEDULLARY 9MM 30CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0931S SUP HCPCS C1713 1830-0931S - NAIL INTRAMEDULLARY 9MM 31CM ANTEGRADE/RTRGRD LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" $941.46 "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 1830-0932S SUP HCPCS C1713 1830-0932S - NAIL INTRAMEDULLARY 9MM 32CM ANTEGRADE/RTRGRD LOCKING T2 BOTH IP/OP "$2,354.00" "$1,742.00" $467.14 "$2,353.65" "$1,059.14" "$1,059.14" "$1,059.14" "$1,059.14" "$2,353.65" "$2,353.65" "$2,353.65" $490.56 "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" $490.53 "$2,353.65" "$2,353.65" "$1,392.18" "$2,353.65" "$2,353.65" "$2,353.65" "$2,353.65" "$1,765.50" "$2,353.65" "$2,353.65" "$2,353.65" "$1,176.83" "$1,176.83" "$1,864.09" "$2,353.65" "$1,882.92" "$1,059.14" $467.14 N/A "$1,365.32" "$2,353.65" "$2,353.65" "$2,353.65" $490.50 "$2,353.65" N/A N/A 18-3200 SUP Custom 27803010 18-3200 - HEAD FEMORAL +0MM OFFST C TAPER 32MM HIGH PERFORMANCE BIOLOX BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 1832-0002S SUP HCPCS C1713 1832-0002S - CAP END +2MM T2 TITANIUM PROXIMAL HUMERUS STERILE BOTH IP/OP $285.00 $211.00 $56.52 $284.75 $128.14 $128.14 $128.14 $128.14 $284.75 $284.75 $284.75 $59.35 $284.75 $284.75 $284.75 $284.75 $284.75 $59.35 $284.75 $284.75 $168.43 $284.75 $284.75 $284.75 $284.75 $213.75 $284.75 $284.75 $284.75 $142.38 $142.38 $225.52 $284.75 $227.80 $128.14 $56.52 N/A $165.30 $284.75 $284.75 $284.75 $59.34 $284.75 N/A N/A 1832-0003S SUP HCPCS C1713 1832-0003S - CAP END +3MM T2 TITANIUM HUMERUS PROXIMAL STERILE BOTH IP/OP $285.00 $211.00 $56.52 $284.75 $128.14 $128.14 $128.14 $128.14 $284.75 $284.75 $284.75 $59.35 $284.75 $284.75 $284.75 $284.75 $284.75 $59.35 $284.75 $284.75 $168.43 $284.75 $284.75 $284.75 $284.75 $213.75 $284.75 $284.75 $284.75 $142.38 $142.38 $225.52 $284.75 $227.80 $128.14 $56.52 N/A $165.30 $284.75 $284.75 $284.75 $59.34 $284.75 N/A N/A 1832-0004S SUP HCPCS C1713 1832-0004S - CAP END +4MM 10MM T2 TITANIUM HUMERUS PROXIMAL STERILE BOTH IP/OP $285.00 $211.00 $56.52 $284.75 $128.14 $128.14 $128.14 $128.14 $284.75 $284.75 $284.75 $59.35 $284.75 $284.75 $284.75 $284.75 $284.75 $59.35 $284.75 $113.90 $168.43 $284.75 $284.75 $284.75 $284.75 $213.75 $284.75 $284.75 $284.75 $142.38 $142.38 $225.52 $284.75 $227.80 $128.14 $56.52 N/A $165.30 $284.75 $284.75 $284.75 $59.34 $284.75 N/A N/A 18-3205 SUP Custom 27803010 18-3205 - HEAD FEMORAL +5MM OFFST C TAPER 32MM HIGH PERFORMANCE BIOLOX BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 18-3225 SUP Custom 27803010 18-3225 - HEAD FEMORAL +2.5MM OFFST C TAPER 32MM HIGH PERFORMANCE BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 1832-2822S SUP HCPCS C1713 1832-2822S - NAIL INTRAMEDULLARY ANTEGRADE RTRGRD 8MM 220MM LOCK T2 BOTH IP/OP "$2,918.50" "$2,160.00" $579.16 "$2,918.05" "$1,313.12" "$1,313.12" "$1,313.12" "$1,313.12" "$2,918.05" "$2,918.05" "$2,918.05" $608.19 "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" $608.15 "$2,918.05" "$1,167.22" "$1,438.60" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,188.88" "$2,918.05" "$2,918.05" "$2,918.05" "$1,459.03" "$1,459.03" "$2,311.10" "$2,918.05" "$2,334.44" "$1,313.12" $579.16 N/A "$1,692.73" "$2,918.05" "$2,918.05" "$2,918.05" $608.12 "$2,918.05" N/A N/A 1832-2824S SUP HCPCS C1713 1832-2824S - NAIL INTRAMEDULLARY ANTEGRADE RTRGRD 8MM 24CM LOCK T2 BOTH IP/OP "$2,918.50" "$2,160.00" $579.16 "$2,918.05" "$1,313.12" "$1,313.12" "$1,313.12" "$1,313.12" "$2,918.05" "$2,918.05" "$2,918.05" $608.19 "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" $608.15 "$2,918.05" "$2,918.05" "$1,438.60" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,188.88" "$2,918.05" "$2,918.05" "$2,918.05" "$1,459.03" "$1,459.03" "$2,311.10" "$2,918.05" "$2,334.44" "$1,313.12" $579.16 N/A "$1,692.73" "$2,918.05" "$1,750.83" "$2,918.05" $608.12 "$2,918.05" N/A N/A 1832-2826S SUP HCPCS C1713 1832-2826S - NAIL INTRAMEDULLARY LONG RTRGRD 8MM 260MM GUN DRILL LOCK T2 BOTH IP/OP "$2,918.50" "$2,160.00" $579.16 "$2,918.05" "$1,313.12" "$1,313.12" "$1,313.12" "$1,313.12" "$2,918.05" "$2,918.05" "$2,918.05" $608.19 "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" $608.15 "$2,918.05" "$1,167.22" "$1,438.60" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,188.88" "$2,918.05" "$2,918.05" "$2,918.05" "$1,459.03" "$1,459.03" "$2,311.10" "$2,918.05" "$2,334.44" "$1,313.12" $579.16 N/A "$1,692.73" "$2,918.05" "$2,918.05" "$2,918.05" $608.12 "$2,918.05" N/A N/A 1832-2828S SUP HCPCS C1713 1832-2828S - NAIL INTRAMEDULLARY 8MM 28CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,918.50" "$2,160.00" $579.16 "$2,918.05" "$1,313.12" "$1,313.12" "$1,313.12" "$1,313.12" "$2,918.05" "$2,918.05" "$2,918.05" $608.19 "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" $608.15 "$2,918.05" "$1,167.22" "$1,438.60" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,188.88" "$2,918.05" "$2,918.05" "$2,918.05" "$1,459.03" "$1,459.03" "$2,311.10" "$2,918.05" "$2,334.44" "$1,313.12" $579.16 N/A "$1,692.73" "$2,918.05" "$1,750.83" "$2,918.05" $608.12 "$2,918.05" N/A N/A 1832-2830S SUP HCPCS C1713 1832-2830S - NAIL INTRAMEDULLARY 8MM 30CM RTRGRD ANTEGRADE LOCKING T2 BOTH IP/OP "$2,918.50" "$2,160.00" $579.16 "$2,918.05" "$1,313.12" "$1,313.12" "$1,313.12" "$1,313.12" "$2,918.05" "$2,918.05" "$2,918.05" $608.19 "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" $608.15 "$2,918.05" "$1,167.22" "$1,438.60" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,188.88" "$2,918.05" "$2,918.05" "$2,918.05" "$1,459.03" "$1,459.03" "$2,311.10" "$2,918.05" "$2,334.44" "$1,313.12" $579.16 N/A "$1,692.73" "$2,918.05" "$2,918.05" "$2,918.05" $608.12 "$2,918.05" N/A N/A 18-32-3 SUP Custom 27803010 18-32-3 - HEAD FEMORAL -2.5MM OFFST C TAPER 32MM HIGH PERFORMANCE BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 1832-3822S SUP HCPCS C1713 1832-3822S - NAIL INTRAMEDULLARY LONG RTRGRD 8MM 220MM GUN DRILL LOCK T2 BOTH IP/OP "$2,918.50" "$2,160.00" $579.16 "$2,918.05" "$1,313.12" "$1,313.12" "$1,313.12" "$1,313.12" "$2,918.05" "$2,918.05" "$2,918.05" $608.19 "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" $608.15 "$2,918.05" "$2,918.05" "$1,438.60" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,188.88" "$2,918.05" "$2,918.05" "$2,918.05" "$1,459.03" "$1,459.03" "$2,311.10" "$2,918.05" "$2,334.44" "$1,313.12" $579.16 N/A "$1,692.73" "$2,918.05" "$2,918.05" "$2,918.05" $608.12 "$2,918.05" N/A N/A 1832-3824S SUP HCPCS C1713 1832-3824S - NAIL INTRAMEDULLARY LONG 8MM 24CM RTRGRD ANTEGRADE LOCKING T BOTH IP/OP "$2,918.50" "$2,160.00" $579.16 "$2,918.05" "$1,313.12" "$1,313.12" "$1,313.12" "$1,313.12" "$2,918.05" "$2,918.05" "$2,918.05" $608.19 "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" $608.15 "$2,918.05" "$1,167.22" "$1,438.60" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,188.88" "$2,918.05" "$2,918.05" "$2,918.05" "$1,459.03" "$1,459.03" "$2,311.10" "$2,918.05" "$2,334.44" "$1,313.12" $579.16 N/A "$1,692.73" "$2,918.05" "$2,918.05" "$2,918.05" $608.12 "$2,918.05" N/A N/A 1832-3826S SUP HCPCS C1713 1832-3826S - NAIL INTRAMEDULLARY LONG RTRGRD ANTEGRADE 8MM 26CM LOCK T2 BOTH IP/OP "$2,918.50" "$2,160.00" $579.16 "$2,918.05" "$1,313.12" "$1,313.12" "$1,313.12" "$1,313.12" "$2,918.05" "$2,918.05" "$2,918.05" $608.19 "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" $608.15 "$2,918.05" "$2,918.05" "$1,438.60" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,188.88" "$2,918.05" "$2,918.05" "$2,918.05" "$1,459.03" "$1,459.03" "$2,311.10" "$2,918.05" "$2,334.44" "$1,313.12" $579.16 N/A "$1,692.73" "$2,918.05" "$2,918.05" "$2,918.05" $608.12 "$2,918.05" N/A N/A 1832-3828S SUP HCPCS C1713 1832-3828S - NAIL INTRAMEDULLARY LONG 8MM 28CM RTRGRD ANTEGRADE LOCKING T BOTH IP/OP "$2,918.50" "$2,160.00" $579.16 "$2,918.05" "$1,313.12" "$1,313.12" "$1,313.12" "$1,313.12" "$2,918.05" "$2,918.05" "$2,918.05" $608.19 "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" $608.15 "$2,918.05" "$2,918.05" "$1,438.60" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,188.88" "$2,918.05" "$2,918.05" "$2,918.05" "$1,459.03" "$1,459.03" "$2,311.10" "$2,918.05" "$2,334.44" "$1,313.12" $579.16 N/A "$1,692.73" "$2,918.05" "$2,918.05" "$2,918.05" $608.12 "$2,918.05" N/A N/A 1832-3830S SUP HCPCS C1713 1832-3830S - NAIL INTRAMEDULLARY LONG 8MM 30CM RTRGRD ANTEGRADE LOCKING T BOTH IP/OP "$2,918.50" "$2,160.00" $579.16 "$2,918.05" "$1,313.12" "$1,313.12" "$1,313.12" "$1,313.12" "$2,918.05" "$2,918.05" "$2,918.05" $608.19 "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" $608.15 "$2,918.05" "$2,918.05" "$1,438.60" "$2,918.05" "$2,918.05" "$2,918.05" "$2,918.05" "$2,188.88" "$2,918.05" "$2,918.05" "$2,918.05" "$1,459.03" "$1,459.03" "$2,311.10" "$2,918.05" "$2,334.44" "$1,313.12" $579.16 N/A "$1,692.73" "$2,918.05" "$2,918.05" "$2,918.05" $608.12 "$2,918.05" N/A N/A 18-3600 SUP Custom 27803010 18-3600 - HEAD FEMORAL 0MM OFFST C TAPER 36MM HIGH PERFORMANCE BIOLOX BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 18-3605 SUP Custom 27803010 18-3605 - HEAD FEMORAL +5MM OFFST C TAPER 36MM HIGH PERFORMANCE BIOLOX BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 18-3625 SUP Custom 27803010 18-3625 - HEAD FEMORAL +2.5MM OFFST C TAPER 36MM HIGH PERFORMANCE BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 18-36-3 SUP Custom 27803010 18-36-3 - HEAD FEMORAL -2.5MM OFFST C TAPER 36MM HIGH PERFORMANCE BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 18-36-5 SUP Custom 27803010 18-36-5 - HEAD FEMORAL -5MM OFFST C TAPER 36MM HIGH PERFORMANCE BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 18-3675 SUP Custom 27803010 18-3675 - HEAD FEMORAL +7.5MM 36MM C TAPER BIOLOX DELTA HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 1846-0928S SUP HCPCS C1713 1846-0928S - NAIL INTRAMEDULLARY 9MM 28CM RECONSTRUCTION T2 TITANIUM LEFT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-0930S SUP HCPCS C1713 1846-0930S - NAIL INTRAMEDULLARY 9MM 30CM RECONSTRUCTION T2 TITANIUM LEFT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-0932S SUP HCPCS C1713 1846-0932S - NAIL INTRAMEDULLARY 9MM 32CM RECONSTRUCTION T2 TITANIUM LEFT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-0934S SUP HCPCS C1713 1846-0934S - NAIL INTRAMEDULLARY 9MM 340MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-0936S SUP HCPCS C1713 1846-0936S - NAIL INTRAMEDULLARY 9MM 36CM RECONSTRUCTION T2 TITANIUM LEFT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-0938S SUP HCPCS C1713 1846-0938S - NAIL INTRAMEDULLARY 9MM 380MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-0940S SUP HCPCS C1713 1846-0940S - NAIL INTRAMEDULLARY 9MM 400MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-0942S SUP HCPCS C1713 1846-0942S - NAIL INTRAMEDULLARY 9MM 420MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-0944S SUP HCPCS C1713 1846-0944S - NAIL INTRAMEDULLARY 9MM 44CM RECONSTRUCTION T2 TITANIUM LEFT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-0946S SUP HCPCS C1713 1846-0946S - NAIL INTRAMEDULLARY 9MM 460MM RECONSTRUCTION T2 LEFT STERILE BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-0948S SUP HCPCS C1713 1846-0948S - NAIL INTRAMEDULLARY 9MM 480MM RECONSTRUCTION T2 LEFT STERILE BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1128S SUP HCPCS C1713 1846-1128S - NAIL INTRAMEDULLARY 11MM 28CM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1130S SUP HCPCS C1713 1846-1130S - NAIL INTRAMEDULLARY 11MM 30CM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1132S SUP HCPCS C1713 1846-1132S - NAIL INTRAMEDULLARY 11MM 32CM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" "$3,196.88" "$3,196.88" N/A N/A 1846-1134S SUP HCPCS C1713 1846-1134S - NAIL INTRAMEDULLARY 11MM 340MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" "$3,196.88" "$3,196.88" N/A N/A 1846-1136S SUP HCPCS C1713 1846-1136S - NAIL INTRAMEDULLARY 11MM 360MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1138S SUP HCPCS C1713 1846-1138S - NAIL INTRAMEDULLARY 11MM 380MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1140S SUP HCPCS C1713 1846-1140S - NAIL INTRAMEDULLARY 11MM 400MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1142S SUP HCPCS C1713 1846-1142S - NAIL INTRAMEDULLARY 11MM 420MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1144S SUP HCPCS C1713 1846-1144S - NAIL INTRAMEDULLARY 11MM 440MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1146S SUP HCPCS C1713 1846-1146S - NAIL INTRAMEDULLARY 11MM 460MM RECONSTRUCTION T2 LEFT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1148S SUP HCPCS C1713 1846-1148S - NAIL INTRAMEDULLARY 11MM 480MM RECONSTRUCTION T2 LEFT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1334S SUP HCPCS C1713 1846-1334S - NAIL INTRAMEDULLARY 13MM 340MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1336S SUP HCPCS C1713 1846-1336S - NAIL INTRAMEDULLARY 13MM 360MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1338S SUP HCPCS C1713 1846-1338S - NAIL INTRAMEDULLARY 13MM 380MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1340S SUP HCPCS C1713 1846-1340S - NAIL INTRAMEDULLARY 13MM 400MM RECON T2 TITANIUM LEFT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1342S SUP HCPCS C1713 1846-1342S - NAIL INTRAMEDULLARY 13MM 42CM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1344S SUP HCPCS C1713 1846-1344S - NAIL INTRAMEDULLARY 13MM 440MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1346S SUP HCPCS C1713 1846-1346S - NAIL INTRAMEDULLARY 13MM 460MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1348S SUP HCPCS C1713 1846-1348S - NAIL INTRAMEDULLARY 13MM 480MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1534S SUP HCPCS C1713 1846-1534S - NAIL INTRAMEDULLARY 15MM 340MM RECONSTRUCTION T2 LEFT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1536S SUP HCPCS C1713 1846-1536S - NAIL INTRAMEDULLARY 360MM LOCKING ANTEGADE LEFT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1538S SUP HCPCS C1713 1846-1538S - NAIL INTRAMEDULLARY 15MM 380MM 5MM ANTEGRADE RECONSTRUCTION BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1540S SUP HCPCS C1713 1846-1540S - NAIL INTRAMEDULLARY 400MM LOCKING ANTEGADE LEFT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1542S SUP HCPCS C1713 1846-1542S - NAIL INTRAMEDULLARY 420MM LOCKING ANTEGADE LEFT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1544S SUP HCPCS C1713 1846-1544S - NAIL INTRAMEDULLARY 440MM LOCKING ANTEGADE LEFT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1546S SUP HCPCS C1713 1846-1546S - NAIL INTRAMEDULLARY 460MM LOCKING RECONSTRUCTION TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1846-1548S SUP HCPCS C1713 1846-1548S - NAIL INTRAMEDULLARY 15MM 480MM RECONSTRUCTION T2 LEFT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-0001S SUP HCPCS C1713 1847-0001S - SCREW SET T2 8MM STRL LCK RECON ANGL STAB TI PROX IM NL BOTH IP/OP $289.00 $214.00 $57.31 $288.75 $129.94 $129.94 $129.94 $129.94 $288.75 $288.75 $288.75 $60.18 $288.75 $288.75 $288.75 $288.75 $288.75 $60.18 $288.75 $288.75 $170.80 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $129.94 $57.31 N/A $167.62 $288.75 $173.25 $288.75 $60.18 $288.75 N/A N/A 1847-0002S SUP HCPCS C1713 1847-0002S - SCREW SET 8MM RECONSTRUCTION MODE T2 TITANIUM PROXIMAL BOTH IP/OP $289.00 $214.00 $57.31 $288.75 $129.94 $129.94 $129.94 $129.94 $288.75 $288.75 $288.75 $60.18 $288.75 $288.75 $288.75 $288.75 $288.75 $60.18 $288.75 $115.50 $170.80 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $129.94 $57.31 N/A $167.62 $288.75 $288.75 $288.75 $60.18 $288.75 N/A N/A 1847-0003S SUP HCPCS C1713 1847-0003S - SCREW SET ANTEGRADE 8MM MODE T2 TITANIUM PROXIMAL STERILE BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 1847-0005S SUP HCPCS C1713 1847-0005S - CAP END +5MM RECONSTRUCTION T2 TITANIUM STERILE BOTH IP/OP $285.00 $211.00 $56.52 $284.75 $128.14 $128.14 $128.14 $128.14 $284.75 $284.75 $284.75 $59.35 $284.75 $284.75 $284.75 $284.75 $284.75 $59.35 $284.75 $113.90 $168.43 $284.75 $284.75 $284.75 $284.75 $213.75 $284.75 $284.75 $284.75 $142.38 $142.38 $225.52 $284.75 $227.80 $128.14 $56.52 N/A $165.30 $284.75 $284.75 $284.75 $284.75 $284.75 N/A N/A 1847-0010S SUP HCPCS C1713 1847-0010S - CAP END +10MM RECONSTRUCTION T2 TITANIUM STERILE BOTH IP/OP $285.00 $211.00 $56.52 $284.75 $128.14 $128.14 $128.14 $128.14 $284.75 $284.75 $284.75 $59.35 $284.75 $284.75 $284.75 $284.75 $284.75 $59.35 $284.75 $113.90 $168.43 $284.75 $284.75 $284.75 $284.75 $213.75 $284.75 $284.75 $284.75 $142.38 $142.38 $225.52 $284.75 $227.80 $128.14 $56.52 N/A $165.30 $284.75 $284.75 $284.75 $59.34 $284.75 N/A N/A 1847-0015S SUP HCPCS C1713 1847-0015S - CAP END +15MM RECONSTRUCTION T2 TITANIUM STERILE BOTH IP/OP $285.00 $211.00 $56.52 $284.75 $128.14 $128.14 $128.14 $128.14 $284.75 $284.75 $284.75 $59.35 $284.75 $284.75 $284.75 $284.75 $284.75 $59.35 $284.75 $113.90 $168.43 $284.75 $284.75 $284.75 $284.75 $213.75 $284.75 $284.75 $284.75 $142.38 $142.38 $225.52 $284.75 $227.80 $128.14 $56.52 N/A $165.30 $284.75 $284.75 $284.75 $59.34 $284.75 N/A N/A 1847-0928S SUP HCPCS C1713 1847-0928S - NAIL INTRAMEDULLARY 9MM 28CM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-0930S SUP HCPCS C1713 1847-0930S - NAIL INTRAMEDULLARY 9MM 30CM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-0932S SUP HCPCS C1713 1847-0932S - NAIL INTRAMEDULLARY 9MM 32CM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-0934S SUP HCPCS C1713 1847-0934S - NAIL INTRAMEDULLARY 9MM 340MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-0936S SUP HCPCS C1713 1847-0936S - NAIL INTRAMEDULLARY 9MM 360MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-0938S SUP HCPCS C1713 1847-0938S - NAIL INTRAMEDULLARY 9MM 380MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-0940S SUP HCPCS C1713 1847-0940S - NAIL INTRAMEDULLARY 9MM 400MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-0942S SUP HCPCS C1713 1847-0942S - NAIL INTRAMEDULLARY 9MM 420MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-0944S SUP HCPCS C1713 1847-0944S - NAIL INTRAMEDULLARY 9MM 44CM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-0946S SUP HCPCS C1713 1847-0946S - NAIL INTRAMEDULLARY 9MM 460MM RECONSTRUCTION T2 RIGHT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-0948S SUP HCPCS C1713 1847-0948S - NAIL INTRAMEDULLARY 9MM 480MM RECONSTRUCTION T2 RIGHT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1128S SUP HCPCS C1713 1847-1128S - NAIL INTRAMEDULLARY 11MM 28CM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1130S SUP HCPCS C1713 1847-1130S - NAIL INTRAMEDULLARY 11MM 30CM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1132S SUP HCPCS C1713 1847-1132S - NAIL INTRAMEDULLARY 11MM 32CM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1134S SUP HCPCS C1713 1847-1134S - NAIL INTRAMEDULLARY 11MM 340MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1136S SUP HCPCS C1713 1847-1136S - NAIL INTRAMEDULLARY 11MM 360MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1138S SUP HCPCS C1713 1847-1138S - NAIL INTRAMEDULLARY 11MM 380MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1140S SUP HCPCS C1713 1847-1140S - NAIL INTRAMEDULLARY 11MM 400MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1142S SUP HCPCS C1713 1847-1142S - NAIL INTRAMEDULLARY 11MM 420MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1144S SUP HCPCS C1713 1847-1144S - NAIL INTRAMEDULLARY 11MM 440MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1146S SUP HCPCS C1713 1847-1146S - NAIL INTRAMEDULLARY 11MM 460MM RECONSTRUCTION T2 RIGHT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1148S SUP HCPCS C1713 1847-1148S - NAIL INTRAMEDULLARY 11MM 480MM RECONSTRUCTION T2 RIGHT BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1334S SUP HCPCS C1713 1847-1334S - NAIL INTRAMEDULLARY 13MM 340MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1336S SUP HCPCS C1713 1847-1336S - NAIL INTRAMEDULLARY 13MM 360MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1338S SUP HCPCS C1713 1847-1338S - NAIL INTRAMEDULLARY 13MM 380MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1340S SUP HCPCS C1713 1847-1340S - NAIL INTRAMEDULLARY 13MM 400MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1342S SUP HCPCS C1713 1847-1342S - NAIL INTRAMEDULLARY 13MM 420MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1344S SUP HCPCS C1713 1847-1344S - NAIL INTRAMEDULLARY 13MM 440MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1346S SUP HCPCS C1713 1847-1346S - NAIL INTRAMEDULLARY 13MM 460MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1348S SUP HCPCS C1713 1847-1348S - NAIL INTRAMEDULLARY 13MM 480MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1534S SUP HCPCS C1713 1847-1534S - NAIL INTRAMEDULLARY 15MM 340MM RECON ANTEGADE T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1536S SUP HCPCS C1713 1847-1536S - NAIL INTRAMEDULLARY 15MM 36CM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1538S SUP HCPCS C1713 1847-1538S - NAIL INTRAMEDULLARY 15MM 380MM RECONSTRUCTION T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" N/A N/A 1847-1540S SUP HCPCS C1713 1847-1540S - NAIL INTRAMEDULLARY 15MM 400MM ANTEGRADE RECON T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1542S SUP HCPCS C1713 1847-1542S - NAIL INTRAMEDULLARY 15MM 420MM 5MM LOCKING ANTEGADE RECON T2 BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1544S SUP HCPCS C1713 1847-1544S - NAIL INTRAMEDULLARY 15MM 440MM ANTEGRADE RECON T2 TITANIUM BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" $666.23 "$3,196.88" N/A N/A 1847-1546S SUP HCPCS C1713 1847-1546S - NAIL INTRAMEDULLARY 15MM 460MM RECONSTRUCTION IMPLANT T2 BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$3,196.88" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" "$3,196.88" "$3,196.88" N/A N/A 1847-1548S SUP HCPCS C1713 1847-1548S - NAIL INTRAMEDULLARY 480MM LOCK BOTH IP/OP "$3,197.00" "$2,366.00" $634.50 "$3,196.88" "$1,438.60" "$1,438.60" "$1,438.60" "$1,438.60" "$3,196.88" "$3,196.88" "$3,196.88" $666.31 "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" $666.26 "$3,196.88" "$1,278.75" "$1,576.06" "$3,196.88" "$3,196.88" "$3,196.88" "$3,196.88" "$2,397.75" "$3,196.88" "$3,196.88" "$3,196.88" "$1,598.44" "$1,598.44" "$2,531.93" "$3,196.88" "$2,557.50" "$1,438.60" $634.50 N/A "$1,854.26" "$3,196.88" "$1,918.13" "$3,196.88" "$3,196.88" "$3,196.88" N/A N/A 1850-0002S SUP HCPCS C1713 1850-0002S - CAP END +0MM 8MM T2 TITANIUM FEMUR GREATER TROCHANTER LEFT BOTH IP/OP $279.00 $206.00 $55.33 $278.80 $125.46 $125.46 $125.46 $125.46 $278.80 $278.80 $278.80 $58.11 $278.80 $278.80 $278.80 $278.80 $278.80 $58.10 $278.80 $278.80 $164.91 $278.80 $278.80 $278.80 $278.80 $209.25 $278.80 $278.80 $278.80 $139.40 $139.40 $220.81 $278.80 $223.04 $125.46 $55.33 N/A $161.82 $278.80 $167.28 $278.80 $58.10 $278.80 N/A N/A 1850-0003S SUP HCPCS C1713 1850-0003S - SCREW BONE 8MM CANN COMPRESSION T2 TITANIUM FEMUR GREATER BOTH IP/OP $304.50 $225.00 $60.40 $304.30 $136.94 $136.94 $136.94 $136.94 $304.30 $304.30 $304.30 $63.42 $304.30 $304.30 $304.30 $304.30 $304.30 $63.42 $304.30 $121.72 $179.99 $304.30 $304.30 $304.30 $304.30 $228.38 $304.30 $304.30 $304.30 $152.15 $152.15 $241.01 $304.30 $243.44 $136.94 $60.40 N/A $176.61 $304.30 $182.58 $304.30 $63.42 $304.30 N/A N/A 1850-0005S SUP HCPCS C1713 1850-0005S - CAP END +5MM 11.5MM T2 TITANIUM FEMUR GREATER TROCHANTER BOTH IP/OP $279.00 $206.00 $55.33 $278.80 $125.46 $125.46 $125.46 $125.46 $278.80 $278.80 $278.80 $58.11 $278.80 $278.80 $278.80 $278.80 $278.80 $58.10 $278.80 $111.52 $164.91 $278.80 $278.80 $278.80 $278.80 $209.25 $278.80 $278.80 $278.80 $139.40 $139.40 $220.81 $278.80 $223.04 $125.46 $55.33 N/A $161.82 $278.80 $278.80 $278.80 $58.10 $278.80 N/A N/A 1850-0010S SUP HCPCS C1713 1850-0010S - CAP END +10MM 11.5MM T2 TITANIUM FEMUR GREATER TROCHANTER BOTH IP/OP $279.00 $206.00 $55.33 $278.80 $125.46 $125.46 $125.46 $125.46 $278.80 $278.80 $278.80 $58.11 $278.80 $278.80 $278.80 $278.80 $278.80 $58.10 $278.80 $278.80 $164.91 $278.80 $278.80 $278.80 $278.80 $209.25 $278.80 $278.80 $278.80 $139.40 $139.40 $220.81 $278.80 $223.04 $125.46 $55.33 N/A $161.82 $278.80 $278.80 $278.80 $58.10 $278.80 N/A N/A 1850-0015S SUP HCPCS C1713 1850-0015S - CAP END +15MM 11.5MM T2 TITANIUM FEMUR GREATER TROCHANTER BOTH IP/OP $279.00 $206.00 $55.33 $278.80 $125.46 $125.46 $125.46 $125.46 $278.80 $278.80 $278.80 $58.11 $278.80 $278.80 $278.80 $278.80 $278.80 $58.10 $278.80 $278.80 $164.91 $278.80 $278.80 $278.80 $278.80 $209.25 $278.80 $278.80 $278.80 $139.40 $139.40 $220.81 $278.80 $223.04 $125.46 $55.33 N/A $161.82 $278.80 $167.28 $278.80 $58.10 $278.80 N/A N/A 186002-44 SUP HCPCS C1776 186002-44 - SHELL ACTB 44MM CH POR HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 186002-46 SUP HCPCS C1776 186002-46 - SHELL ACTB HMSPHR 46MM 3.1MM PST RESTORIS CH CUP TI HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 186002-48 SUP HCPCS C1776 186002-48 - SHELL ACTB HMSPHR 48MM 3.2MM PST RESTORIS CH CUP TI HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 186002-50 SUP HCPCS C1776 186002-50 - SHELL ACTB HMSPHR 50MM 3.1MM STRL PST RESTORIS CH TI HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 186002-52 SUP HCPCS C1776 186002-52 - SHELL ACTB HMSPHR 52MM 3.1MM STRL PST RESTORIS CH TI HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 186002-54 SUP HCPCS C1776 186002-54 - SHELL ACTB HMSPHR 54MM 3.5MM STRL PST RESTORIS TI HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 186002-56 SUP HCPCS C1776 186002-56 - SHELL ACTB HMSPHR 56MM 3.7MM STRL PST RESTORIS TI HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 186002-58 SUP HCPCS C1776 186002-58 - SHELL ACTB 58MM CH POR HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 186002-60 SUP HCPCS C1776 186002-60 - SHELL ACTB HMSPHR 60MM 4.8MM PST RESTORIS CH CUP TI HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 186002-62 SUP HCPCS C1776 186002-62 - SHELL ACTB HMSPHR 62MM 4MM STRL PST RESTORIS CH CUP TI HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 186002-64 SUP HCPCS C1776 186002-64 - SHELL ACTB HMSPHR 64MM 5MM PST RESTORIS CH CUP TI HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 186002-66 SUP HCPCS C1776 186002-66 - SHELL ACTB HMSPHR 66MM 4.6MM PST RESTORIS CH CUP TI HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 186002-68 SUP HCPCS C1776 186002-68 - SHELL ACTB HMSPHR 68MM 5.6MM PST RESTORIS CH CUP TI HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 186003-02 SUP HCPCS C1776 186003-02 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186003-03 SUP HCPCS C1776 186003-03 - STEM FEM 3 12/14 TPR STRL RESTORIS STD NK HIP BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186003-04 SUP HCPCS C1776 186003-04 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186003-05 SUP HCPCS C1776 186003-05 - STEM FEM 5 12/14 TPR STRL RESTORIS STD NK HIP BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186003-06 SUP HCPCS C1776 186003-06 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186003-07 SUP HCPCS C1776 186003-07 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186003-08 SUP HCPCS C1776 186003-08 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186003-09 SUP HCPCS C1776 186003-09 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186003-10 SUP HCPCS C1776 186003-10 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186003-11 SUP HCPCS C1776 186003-11 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186003-12 SUP HCPCS C1776 186003-12 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186004-02 SUP HCPCS C1776 186004-02 - STEM FEM 2 12/14 TPR STRL RESTORIS HI OFST NK HIP BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186004-03 SUP HCPCS C1776 186004-03 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186004-04 SUP HCPCS C1776 186004-04 - STEM FEM 4 12/14 TPR STRL RESTORIS HI OFST NK HIP BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186004-05 SUP HCPCS C1776 186004-05 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186004-06 SUP HCPCS C1776 186004-06 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186004-07 SUP HCPCS C1776 186004-07 - STEM FEM 7 12/14 TPR STRL RESTORIS XTD OFST NK HIP BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186004-08 SUP HCPCS C1776 186004-08 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186004-09 SUP HCPCS C1776 186004-09 - STEM FEM 9 12/14 TPR STRL RESTORIS HI OFST NK HIP BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186004-10 SUP HCPCS C1776 186004-10 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186004-11 SUP HCPCS C1776 186004-11 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186004-12 SUP HCPCS C1776 186004-12 - STEM FEM BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 186005-15 SUP HCPCS C1713 186005-15 - SCREW ACTB 6.5MM 15MM ACTB BOTH IP/OP $70.00 $52.00 $13.89 $70.00 $31.50 $31.50 $31.50 $31.50 $70.00 $70.00 $70.00 $14.59 $70.00 $70.00 $70.00 $70.00 $70.00 $14.59 $70.00 $28.00 $41.41 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $31.50 $13.89 N/A $40.60 $70.00 $70.00 $70.00 $14.59 $70.00 N/A N/A 186005-20 SUP HCPCS C1713 186005-20 - SCREW ACTB 6.5MM 20MM ACTB BOTH IP/OP $70.00 $52.00 $13.89 $70.00 $31.50 $31.50 $31.50 $31.50 $70.00 $70.00 $70.00 $14.59 $70.00 $70.00 $70.00 $70.00 $70.00 $14.59 $70.00 $70.00 $41.41 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $31.50 $13.89 N/A $40.60 $70.00 $70.00 $70.00 $14.59 $70.00 N/A N/A 186005-25 SUP HCPCS C1713 186005-25 - SCREW ACTB 6.5MM 25MM ACTB BOTH IP/OP $70.00 $52.00 $13.89 $70.00 $31.50 $31.50 $31.50 $31.50 $70.00 $70.00 $70.00 $14.59 $70.00 $70.00 $70.00 $70.00 $70.00 $14.59 $70.00 $28.00 $41.41 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $31.50 $13.89 N/A $40.60 $70.00 $70.00 $70.00 $14.59 $70.00 N/A N/A 186005-30 SUP HCPCS C1713 186005-30 - SCREW ACTB 6.5MM 30MM ACTB BOTH IP/OP $70.00 $52.00 $13.89 $70.00 $31.50 $31.50 $31.50 $31.50 $70.00 $70.00 $70.00 $14.59 $70.00 $70.00 $70.00 $70.00 $70.00 $14.59 $70.00 $28.00 $41.41 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $31.50 $13.89 N/A $40.60 $70.00 $70.00 $70.00 $14.59 $70.00 N/A N/A 186005-35 SUP HCPCS C1713 186005-35 - SCREW ACTB 6.5MM 35MM ACTB BOTH IP/OP $70.00 $52.00 $13.89 $70.00 $31.50 $31.50 $31.50 $31.50 $70.00 $70.00 $70.00 $14.59 $70.00 $70.00 $70.00 $70.00 $70.00 $14.59 $70.00 $28.00 $41.41 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $31.50 $13.89 N/A $40.60 $70.00 $70.00 $70.00 $14.59 $70.00 N/A N/A 186005-40 SUP HCPCS C1713 186005-40 - SCREW ACTB 6.5MM 40MM STRL RESTORIS BOTH IP/OP $70.00 $52.00 $13.89 $70.00 $31.50 $31.50 $31.50 $31.50 $70.00 $70.00 $70.00 $14.59 $70.00 $70.00 $70.00 $70.00 $70.00 $14.59 $70.00 $70.00 $41.41 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $31.50 $13.89 N/A $40.60 $70.00 $70.00 $70.00 $14.59 $70.00 N/A N/A 186128-44 SUP HCPCS C1776 186128-44 - LINER ACTB 44MM 28MM 7.1MM RESTORIS WR RST OXDT STAB XLVE BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186128-46 SUP HCPCS C1776 186128-46 - LINER ACTB 46MM 28MM 7.1MM RESTORIS WR RST OXDT STAB XLVE BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186128-48 SUP HCPCS C1776 186128-48 - LINER ACTB 48MM 28MM 7.6MM RESTORIS WR RST OXDT STAB XLVE BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186128-50 SUP HCPCS C1776 186128-50 - LINER ACTB 50MM 28MM 8.6MM RESTORIS WR RST OXDT STAB XLVE BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186132-48 SUP HCPCS C1776 186132-48 - LINER ACTB NTRL 48MM 32MM E-POLY HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186132-50 SUP HCPCS C1776 186132-50 - LINER ACTB HMSPHR 50MM 32MM 6.9MM STRL 4.5MM RESTORIS XLVE BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186132-52 SUP HCPCS C1776 186132-52 - LINER ACTB NTRL 52MM 32MM E-POLY HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186132-54 SUP HCPCS C1776 186132-54 - LINER ACTB 54MM 32MM 7.8MM RESTORIS WR RST OXDT STAB XLVE BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186136-52 SUP HCPCS C1776 186136-52 - LINER ACTB HMSPHR 52MM 36MM 6.6MM STRL 3.7MM RESTORIS XLVE BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186136-54 SUP HCPCS C1776 186136-54 - LINER ACTB HMSPHR 36MM 54MM 6.7MM STRL RESTORIS XLVE HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" "$1,440.00" $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186136-56 SUP HCPCS C1776 186136-56 - LINER ACTB HMSPHR 36MM 56MM 7.1MM STRL RESTORIS XLVE HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186136-58 SUP HCPCS C1776 186136-58 - LINER ACTB NTRL DOME TPR 58-60MM 36MM 7.7MM LD BRNG XLVE HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186136-62 SUP HCPCS C1776 186136-62 - LINER ACTB 62-64MM 36MM 9.3MM RESTORIS WR RST OXDT STAB XLVE BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186136-66 SUP HCPCS C1776 186136-66 - LINER ACTB 66-68MM 36MM 10.9MM RESTORIS WR RST OXDT STAB BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186140-56 SUP HCPCS C1776 186140-56 - LINER ACTB 7.5MM BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186140-58 SUP HCPCS C1776 186140-58 - LINER ACTB 8.4MM BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186140-62 SUP HCPCS C1776 186140-62 - LINER ACTB 10.3MM BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186140-66 SUP HCPCS C1776 186140-66 - LINER ACTB 11.9MM BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186228-44 SUP HCPCS C1776 186228-44 - LINER ACTB 44MM 28MM HW E-POLY HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186228-46 SUP HCPCS C1776 186228-46 - LINER ACTB 46MM 28MM HW E-POLY HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186228-48 SUP HCPCS C1776 186228-48 - LINER ACTB BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186228-50 SUP HCPCS C1776 186228-50 - LINER ACTB BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" "$1,440.00" $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186232-48 SUP HCPCS C1776 186232-48 - LINER ACTB 48MM 32MM HW E-POLY HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" "$1,440.00" $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186232-50 SUP HCPCS C1776 186232-50 - LINER ACTB 50MM PST RESTORIS HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" "$1,440.00" $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186232-52 SUP HCPCS C1776 186232-52 - LINER ACTB 52MM 32MM HW E-POLY HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" "$1,440.00" $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186232-54 SUP HCPCS C1776 186232-54 - LINER ACTB BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" "$1,440.00" $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186236-52 SUP HCPCS C1776 186236-52 - LINER ACTB 52MM 36MM HW E-POLY HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" "$1,440.00" $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186236-54 SUP HCPCS C1776 186236-54 - LINER ACTB 54MM 36MM HW E-POLY HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186236-56 SUP HCPCS C1776 186236-56 - LINER ACTB 56MM 36MM HW E-POLY HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" "$1,440.00" $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186236-58 SUP HCPCS C1776 186236-58 - LINER ACTB 58-60MM 36MM HW E-POLY HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186236-62 SUP HCPCS C1776 186236-62 - LINER ACTB 62/63/64MM 36MM STRL RESTORIS HW XLVE HIP BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" "$1,440.00" $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186236-66 SUP HCPCS C1776 186236-66 - LINER ACTB BOTH IP/OP "$1,440.00" "$1,066.00" $285.80 "$1,440.00" $648.00 $648.00 $648.00 $648.00 "$1,440.00" "$1,440.00" "$1,440.00" $300.13 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 $851.76 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 $285.80 N/A $835.20 "$1,440.00" "$1,440.00" "$1,440.00" $300.10 "$1,440.00" N/A N/A 186628-00 SUP HCPCS C1776 186628-00 - HEAD FEM BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" "$1,725.00" "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 186628-01 SUP HCPCS C1776 186628-01 - HEAD FEM BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 186628-02 SUP HCPCS C1776 186628-02 - HEAD FEM BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 186632-00 SUP HCPCS C1776 186632-00 - HEAD FEM SM 32MM RESTORIS CERM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" "$1,725.00" "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 186632-01 SUP HCPCS C1776 186632-01 - SHELL ACTB HMSPHR 50MM 3.1MM STRL PST RESTORIS CH TI HIP BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" "$1,725.00" "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 186632-02 SUP HCPCS C1776 186632-02 - HEAD FEM BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 186632-03 SUP HCPCS C1776 186632-03 - HEAD FEM BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 186636-00 SUP HCPCS C1776 186636-00 - HEAD FEM BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 186636-01 SUP HCPCS C1776 186636-01 - HEAD FEM +0MM 12/14 TPR MED 36MM STRL RESTORIS CERM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 186636-02 SUP HCPCS C1776 186636-02 - HEAD FEM LG 36MM RESTORIS CERM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 186636-03 SUP HCPCS C1776 186636-03 - HEAD FEM XL 36MM RESTORIS CERM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" "$1,725.00" "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 186640-00 SUP HCPCS C1776 186640-00 - HEAD FEM SM 40MM RESTORIS CERM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 186640-01 SUP HCPCS C1776 186640-01 - HEAD FEM MED 40MM RESTORIS CERM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 186640-02 SUP HCPCS C1776 186640-02 - HEAD FEM LG 40MM RESTORIS CERM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 186640-03 SUP HCPCS C1776 186640-03 - HEAD FEM XL 40MM RESTORIS CERM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $776.25 $776.25 $776.25 $776.25 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A 1867.31.430 SUP HCPCS C1713 1867.31.430 - SCREW BN 4.35MM 30MM NS VPR FX PA TI SPNE CORT 5.5MM ROD BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$4,215.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$2,529.00" "$4,215.00" $878.41 "$4,215.00" N/A N/A 1867.31.435 SUP HCPCS C1713 1867.31.435 - SCREW BN 4.35MM 35MM NS VPR FX PA TI SPNE CORT 5.5MM ROD BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$4,215.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$2,529.00" "$4,215.00" $878.41 "$4,215.00" N/A N/A 1867.31.525 SUP HCPCS C1713 1867.31.525 - SCREW BN 5MM 25MM NS VPR XPDM FX PA TI SPNE CORT 5.5MM ROD BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$4,215.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$2,529.00" "$4,215.00" $878.41 "$4,215.00" N/A N/A 1867.31.645 SUP HCPCS C1713 1867.31.645 - SCREW BONE 6MM 45MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$1,686.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$2,529.00" "$4,215.00" $878.41 "$4,215.00" N/A N/A 1867.31.675 SUP HCPCS C1713 1867.31.675 - SCREW BONE 7MM 50MM XPDM TI SPN CORT FIX 5.5MM ROD BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$4,215.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$2,529.00" "$4,215.00" $878.41 "$4,215.00" N/A N/A 1867.31.845 SUP HCPCS C1713 1867.31.845 - SCREW BONE 8MM 45MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$1,686.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$2,529.00" "$4,215.00" $878.41 "$4,215.00" N/A N/A 1867.31.850 SUP HCPCS C1713 1867.31.850 - SCREW BONE 8MM 50MM FIX EXPEDIUM TITANIUM SPN CORTICAL 5.5MM BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$4,215.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$2,529.00" "$4,215.00" $878.41 "$4,215.00" N/A N/A 1867-15-780 SUP HCPCS C1713 1867-15-780 - SCREW BN 7MM 80MM VPR 2 PA CNN TI SPNE MIS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 1882TC/46 SUP HCPCS C1898 1882TC/46 - LEAD PACING 10MM SPACE J HELIX 7FR 46CM IS-1 CONCTR BIPOL BOTH IP/OP $680.00 $503.00 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 N/A $394.40 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 1882TC/52 SUP HCPCS C1898 1882TC/52 - LEAD PACING 10MM SPACE J HELIX 7FR 52CM IS-1 CONCTR BIPOL BOTH IP/OP $680.00 $503.00 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 N/A $394.40 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 18-83525 SUP Custom 27203010 18-83525 - BLADE SHVR 18CM 3.5MM SKMR 15D LRYNG 2 CVD ANG TIP LP IRR BOTH IP/OP "$2,137.50" "$1,582.00" $380.48 "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" $380.48 "$2,137.50" "$2,137.50" "$1,586.45" "$1,586.45" "$1,647.59" "$1,113.64" $445.48 "$2,137.50" $855.00 "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$1,603.13" "$2,137.50" "$2,137.50" "$2,137.50" "$1,068.75" "$1,068.75" "$1,692.90" "$2,137.50" "$1,710.00" "$1,389.38" "$2,137.50" N/A "$1,239.75" "$2,137.50" "$1,282.50" "$2,137.50" "$2,137.50" "$2,137.50" N/A N/A 1888TC/46 SUP HCPCS C1898 1888TC/46 - LEAD PACING STR 6FR 46CM IS-1 BIPOL CONCTR EXTENDABLE BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $271.80 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 1888TC/52 SUP HCPCS C1898 1888TC/52 - LEAD PACING 10MM SPACING 6FR 52CM BIPOL ACTIVE FIX STR BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $272.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 1888TC/58 SUP HCPCS C1898 1888TC/58 - LEAD PCNG STRG THN 6FR 58CM TNDRL ST IS-1 BP CNCT XTD-RETRAC BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $271.80 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 1888TC-65 SUP HCPCS C1898 1888TC-65 - LEAD PCNG THN STRG 6FR 65CM TNDRL ST IS-1 BP CNCT XTD-RETRAC BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 1891-4020S SUP HCPCS C1713 1891-4020S - SCREW BONE PTHRD 4MM 20MM SHAFT T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1891-4022S SUP HCPCS C1713 1891-4022S - SCREW BONE PTHRD 4MM 22MM SHAFT T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $291.50 $291.50 N/A N/A 1891-4024S SUP HCPCS C1713 1891-4024S - SCREW BONE PTHRD 4MM 24MM SHAFT T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $291.50 $291.50 N/A N/A 1891-4025S SUP HCPCS C1713 1891-4025S - SCREW BONE 4MM 25MM SHAFT PTHRD T2 TITANIUM ORTHOPEDIC BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1891-4026S SUP HCPCS C1713 1891-4026S - SCREW BONE PTHRD 4MM 26MM SHAFT T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1891-4028S SUP HCPCS C1713 1891-4028S - SCREW BONE PTHRD 4MM 28MM SHAFT T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1891-4030S SUP HCPCS C1713 1891-4030S - SCREW BONE PTHRD 4MM 30MM SHAFT T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-4032S SUP HCPCS C1713 1891-4032S - SCREW BONE PTHRD 4MM 32MM SHAFT T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-4034S SUP HCPCS C1713 1891-4034S - SCREW BONE PTHRD 4MM 34MM SHAFT T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-4035S SUP HCPCS C1713 1891-4035S - SCREW BONE 4MM 35MM SHAFT PTHRD T2 TITANIUM ORTHOPEDIC BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-4036S SUP HCPCS C1713 1891-4036S - SCREW BONE PTHRD 4MM 36MM SHAFT T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-4038S SUP HCPCS C1713 1891-4038S - SCREW BONE PTHRD 4MM 38MM SHAFT T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-4040S SUP HCPCS C1713 1891-4040S - SCREW BONE PTHRD 4MM 40MM SHAFT T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-4045S SUP HCPCS C1713 1891-4045S - SCREW BONE PTHRD 4MM 45MM LOCK T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-4050S SUP HCPCS C1713 1891-4050S - SCREW BONE PTHRD 4MM 50MM SHAFT PTHRD T2 TITANIUM HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-4055S SUP HCPCS C1713 1891-4055S - SCREW BONE PTHRD 4MM 55MM SHAFT T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-4060S SUP HCPCS C1713 1891-4060S - SCREW BONE PTHRD 4MM 60MM SHAFT T2 TITANIUM HUMERUS STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1891-5025S SUP HCPCS C1713 1891-5025S - NAIL INTRAMEDULLARY T2 TITANIUM HUMERUS RIGHT PROXIMAL BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5030S SUP HCPCS C1713 1891-5030S - SCREW BONE PTHRD 5MM 30MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5035S SUP HCPCS C1713 1891-5035S - SCREW BONE PTHRD 5MM 35MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1891-5040S SUP HCPCS C1713 1891-5040S - SCREW BONE PTHRD 5MM 40MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5045S SUP HCPCS C1713 1891-5045S - SCREW BONE PTHRD 5MM 45MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5050S SUP HCPCS C1713 1891-5050S - SCREW BONE PTHRD 5MM 50MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1891-5055S SUP HCPCS C1713 1891-5055S - SCREW BONE PTHRD 5MM 55MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5060S SUP HCPCS C1713 1891-5060S - SCREW BONE PTHRD 5MM 60MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5065S SUP HCPCS C1713 1891-5065S - SCREW BONE PTHRD 5MM 65MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5070S SUP HCPCS C1713 1891-5070S - SCREW BONE PTHRD 5MM 70MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5075S SUP HCPCS C1713 1891-5075S - SCREW BONE PTHRD 5MM 75MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5080S SUP HCPCS C1713 1891-5080S - SCREW BONE PTHRD 5MM 80MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5085S SUP HCPCS C1713 1891-5085S - SCREW BONE PTHRD 5MM 85MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5090S SUP HCPCS C1713 1891-5090S - SCREW BONE PTHRD 5MM 90MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5095S SUP HCPCS C1713 1891-5095S - SCREW BONE PTHRD 5MM 95MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5100S SUP HCPCS C1713 1891-5100S - SCREW BONE PTHRD 5MM 100MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5105S SUP HCPCS C1713 1891-5105S - SCREW BONE PTHRD 5MM 105MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5110S SUP HCPCS C1713 1891-5110S - SCREW BONE PTHRD 5MM 110MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1891-5115S SUP HCPCS C1713 1891-5115S - SCREW BONE PTHRD 5MM 115MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1891-5120S SUP HCPCS C1713 1891-5120S - SCREW BONE PTHRD 5MM 120MM LOCK T2 TITANIUM FEMUR TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1895-5001S SUP HCPCS C1713 1895-5001S - NUT ORTHOPEDIC 5MM T2 TITANIUM CONDYLE STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1895-5040S SUP HCPCS C1713 1895-5040S - SCREW BONE PTHRD 5MM 40MM LOCK T2 TITANIUM CONDYLE FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1895-5045S SUP HCPCS C1713 1895-5045S - SCREW BONE PTHRD 5MM 45MM LOCK T2 TITANIUM CONDYLE FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1895-5050S SUP HCPCS C1713 1895-5050S - SCREW BONE PTHRD 5MM 50MM LOCK T2 TITANIUM CONDYLE STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1895-5055S SUP HCPCS C1713 1895-5055S - SCREW BONE PTHRD 5MM 55MM LOCK T2 TITANIUM CONDYLE FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1895-5060S SUP HCPCS C1713 1895-5060S - SCREW BONE PTHRD 5MM 60MM CONDYLE T2 TITANIUM CONDYLE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1895-5065S SUP HCPCS C1713 1895-5065S - SCREW BONE PTHRD 5MM 65MM LOCK T2 TITANIUM CONDYLE FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1895-5070S SUP HCPCS C1713 1895-5070S - SCREW BONE PTHRD 5MM 70MM LOCK T2 TITANIUM CONDYLE FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1895-5075S SUP HCPCS C1713 1895-5075S - SCREW BONE PTHRD 5MM 75MM LOCK T2 TITANIUM CONDYLE FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1895-5080S SUP HCPCS C1713 1895-5080S - SCREW BONE PTHRD 5MM 80MM LOCK T2 TITANIUM CONDYLE FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1895-5085S SUP HCPCS C1713 1895-5085S - SCREW BONE PTHRD 5MM 85MM LOCK T2 TITANIUM CONDYLE FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1895-5090S SUP HCPCS C1713 1895-5090S - SCREW BONE PTHRD 5MM 90MM LOCK T2 TITANIUM CONDYLE FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1895-5095S SUP HCPCS C1713 1895-5095S - SCREW BONE PTHRD 5MM 95MM LOCK T2 TITANIUM CONDYLE FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1895-5100S SUP HCPCS C1713 1895-5100S - SCREW BONE PTHRD 5MM 100MM LOCK T2 TITANIUM CONDYLE FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1895-5105S SUP HCPCS C1713 1895-5105S - SCREW BONE PTHRD 5MM 105MM LOCK T2 TITANIUM CONDYLE FEMUR BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1895-5110S SUP HCPCS C1713 1895-5110S - SCREW BONE PTHRD 5MM 110MM LOCK T2 TITANIUM CONDYLE STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1895-5115S SUP HCPCS C1713 1895-5115S - SCREW BONE PTHRD 5MM 115MM LOCK T2 TITANIUM CONDYLE STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1895-5120S SUP HCPCS C1713 1895-5120S - SCREW BONE PTHRD 5MM 120MM LOCK T2 TITANIUM CONDYLE STERILE BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-4020S SUP HCPCS C1713 1896-4020S - SCREW BONE FULTHD 4MM 20MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-4022S SUP HCPCS C1713 1896-4022S - SCREW BONE FULTHD 4MM 22MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-4024S SUP HCPCS C1713 1896-4024S - SCREW BONE FULTHD 4MM 24MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-4025S SUP HCPCS C1713 1896-4025S - SCREW BN FT 4MM 25MM STRL LCK TI T2 NL SYS UNV SYS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-4026S SUP HCPCS C1713 1896-4026S - SCREW BONE FULTHD 4MM 26MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-4028S SUP HCPCS C1713 1896-4028S - SCREW BONE FULTHD 4MM 28MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-4030S SUP HCPCS C1713 1896-4030S - SCREW BONE FULTHD 4MM 30MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-4032S SUP HCPCS C1713 1896-4032S - SCREW BONE FULTHD 4MM 32MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-4034S SUP HCPCS C1713 1896-4034S - SCREW BONE FULTHD 4MM 34MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-4035S SUP HCPCS C1713 1896-4035S - SCREW BONE FULTHD 4MM 35MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-4036S SUP HCPCS C1713 1896-4036S - SCREW BONE FULTHD 4MM 36MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-4038S SUP HCPCS C1713 1896-4038S - SCREW BONE FULTHD 4MM 38MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-4040S SUP HCPCS C1713 1896-4040S - SCREW BONE FULTHD 4MM 40MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-4045S SUP HCPCS C1713 1896-4045S - SCREW BONE FULTHD 4MM 45MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-4050S SUP HCPCS C1713 1896-4050S - SCREW BONE FULTHD 4MM 50MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-4055S SUP HCPCS C1713 1896-4055S - SCREW BONE FULTHD 4MM 55MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-4060S SUP HCPCS C1713 1896-4060S - SCREW BONE FULTHD 4MM 60MM LOCK T2 TITANIUM HUMERUS TIBIA BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5025S SUP HCPCS C1713 1896-5025S - SCREW BONE FULTHD 5MM 25MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-5027S SUP HCPCS C1713 1896-5027S - SCREW BN FT 5MM 27.5MM STRL LCK TI T2 NL SYS UNV SYS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-5030S SUP HCPCS C1713 1896-5030S - SCREW BONE FULTHD 5MM 30MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5032S SUP HCPCS C1713 1896-5032S - SCREW BN FT 5MM 32.5MM STRL LCK TI T2 NL SYS UNV SYS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5035S SUP HCPCS C1713 1896-5035S - SCREW BONE FULTHD 5MM 35MM LOCK T2 TITANIUM FEMUR PROXIMAL BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5037S SUP HCPCS C1713 1896-5037S - SCREW BN FT 5MM 37.5MM STRL LCK TI T2 NL SYS UNV SYS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-5040S SUP HCPCS C1713 1896-5040S - SCREW BONE FULTHD 5MM 40MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-5042S SUP HCPCS C1713 1896-5042S - SCREW BN FT 5MM 42.5MM STRL LCK TI T2 NL SYS UNV SYS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-5045S SUP HCPCS C1713 1896-5045S - SCREW BONE FULTHD 5MM 45MM LOCK T2 TITANIUM HUMERUS PROXIMAL BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5047S SUP HCPCS C1713 1896-5047S - SCREW BN FT 5MM 47.5MM STRL LCK TI T2 NL SYS UNV SYS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-5050S SUP HCPCS C1713 1896-5050S - SCREW BONE FULTHD 5MM 50MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5052S SUP HCPCS C1713 1896-5052S - SCREW BN FT 5MM 52.5MM STRL LCK TI T2 NL SYS UNV SYS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5055S SUP HCPCS C1713 1896-5055S - SCREW BONE FULTHD 5MM 55MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5057S SUP HCPCS C1713 1896-5057S - SCREW BN FT 5MM 57.5MM STRL LCK TI T2 NL SYS UNV SYS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $291.50 $291.50 N/A N/A 1896-5060S SUP HCPCS C1713 1896-5060S - SCREW BONE FULTHD 5MM 60MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5065S SUP HCPCS C1713 1896-5065S - SCREW BN FT 5MM 65MM STRL LCK TI T2 NL SYS UNV SYS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5070S SUP HCPCS C1713 1896-5070S - SCREW BONE FULTHD 5MM 70MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5075S SUP HCPCS C1713 1896-5075S - SCREW BONE FULTHD 5MM 75MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5080S SUP HCPCS C1713 1896-5080S - SCREW BONE FULTHD 5MM 80MM LOCK T2 TITANIUM FEMUR PROXIMAL BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5085S SUP HCPCS C1713 1896-5085S - SCREW BONE FULTHD 5MM 85MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5090S SUP HCPCS C1713 1896-5090S - SCREW BONE FULTHD 5MM 90MM LOCK T2 TITANIUM FEMUR PROXIMAL BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $291.50 $291.50 $60.75 $291.50 N/A N/A 1896-5095S SUP HCPCS C1713 1896-5095S - SCREW BONE FULTHD 5MM 95MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-5100S SUP HCPCS C1713 1896-5100S - SCREW BONE FULTHD 5MM 100MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-5105S SUP HCPCS C1713 1896-5105S - SCREW BONE FULTHD 5MM 105MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-5110S SUP HCPCS C1713 1896-5110S - SCREW BONE FULTHD 5MM 110MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $116.60 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-5115S SUP HCPCS C1713 1896-5115S - SCREW BONE FULTHD 5MM 115MM LOCK T2 TITANIUM FEMUR HUMERUS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1896-5120S SUP HCPCS C1713 1896-5120S - SCREW BN FT 5MM 120MM STRL LCK TI T2 NL SYS UNV SYS BOTH IP/OP $291.50 $216.00 $57.86 $291.50 $131.18 $131.18 $131.18 $131.18 $291.50 $291.50 $291.50 $60.76 $291.50 $291.50 $291.50 $291.50 $291.50 $60.75 $291.50 $291.50 $172.42 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $131.18 $57.86 N/A $169.07 $291.50 $174.90 $291.50 $60.75 $291.50 N/A N/A 1897-6065S SUP HCPCS C1713 1897-6065S - SCREW BONE 6.5MM 65MM LAG RECONSTRUCTION T2 TITANIUM FEMUR BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $152.32 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $380.80 $380.80 $79.36 $380.80 N/A N/A 1897-6070S SUP HCPCS C1713 1897-6070S - SCREW BONE 6.5MM 70MM LAG RECONSTRUCTION T2 TITANIUM FEMUR BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $152.32 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $228.48 $380.80 $79.36 $380.80 N/A N/A 1897-6075S SUP HCPCS C1713 1897-6075S - SCREW BN 6.5MM 75MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $152.32 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $228.48 $380.80 $79.36 $380.80 N/A N/A 1897-6080S SUP HCPCS C1713 1897-6080S - SCREW BN 6.5MM 80MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $380.80 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $228.48 $380.80 $79.36 $380.80 N/A N/A 1897-6085S SUP HCPCS C1713 1897-6085S - SCREW BN 6.5MM 85MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $380.80 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $228.48 $380.80 $79.36 $380.80 N/A N/A 1897-6090S SUP HCPCS C1713 1897-6090S - SCREW BN 6.5MM 90MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $380.80 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $228.48 $380.80 $79.36 $380.80 N/A N/A 1897-6095S SUP HCPCS C1713 1897-6095S - SCREW BN 6.5MM 95MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $380.80 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $228.48 $380.80 $79.36 $380.80 N/A N/A 1897-6100S SUP HCPCS C1713 1897-6100S - SCREW BN 6.5MM 100MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $152.32 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $228.48 $380.80 $79.36 $380.80 N/A N/A 1897-6105S SUP HCPCS C1713 1897-6105S - SCREW BN 6.5MM 105MM BRNZ STRL LG CNN TI FEM T2 RECON NL SYS BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $152.32 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $380.80 $380.80 $79.36 $380.80 N/A N/A 1897-6110S SUP HCPCS C1713 1897-6110S - SCREW BONE 6.5MM 110MM LAG RECONSTRUCTION T2 TITANIUM FEMUR BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $152.32 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $228.48 $380.80 $79.36 $380.80 N/A N/A 1897-6115S SUP HCPCS C1713 1897-6115S - SCREW BONE 6.5MM 115MM LAG RECONSTRUCTION T2 TITANIUM FEMUR BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $152.32 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $228.48 $380.80 $79.36 $380.80 N/A N/A 1897-6120S SUP HCPCS C1713 1897-6120S - SCREW BONE 6.5MM 120MM LAG RECONSTRUCTION T2 TITANIUM FEMUR BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $380.80 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $228.48 $380.80 $79.36 $380.80 N/A N/A 1897-6125S SUP HCPCS C1713 1897-6125S - SCREW BONE 6.5MM 125MM LAG RECONSTRUCTION T2 TITANIUM FEMUR BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $380.80 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $380.80 $380.80 $79.36 $380.80 N/A N/A 1897-6130S SUP HCPCS C1713 1897-6130S - SCREW BONE 6.5MM 130MM LAG RECONSTRUCTION T2 TITANIUM FEMUR BOTH IP/OP $381.00 $282.00 $75.58 $380.80 $171.36 $171.36 $171.36 $171.36 $380.80 $380.80 $380.80 $79.37 $380.80 $380.80 $380.80 $380.80 $380.80 $79.36 $380.80 $152.32 $225.24 $380.80 $380.80 $380.80 $380.80 $285.75 $380.80 $380.80 $380.80 $190.40 $190.40 $301.59 $380.80 $304.64 $171.36 $75.58 N/A $220.98 $380.80 $380.80 $380.80 $79.36 $380.80 N/A N/A 19-0000T SUP Custom 27203010 19-0000T - SLEEVE ADPR +0MM OFST UNV CTPR TI BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 19-0005T SUP Custom 27203010 19-0005T - SLEEVE ADPR 5MM OFST UNV CTPR STRL LF HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 19-0025T SUP Custom 27203010 19-0025T - SLEEVE ADAPTER +2.5MM OFFST UNIVERSAL C TAPER TITANIUM BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 190-151 SUP HCPCS C2617 190-151 - STENT URETERAL 8FR 22CM 2 DUROMETER POLARIS HYDROPLUS BOTH IP/OP $306.50 $227.00 $60.78 $306.25 $137.81 $137.81 $137.81 $137.81 $306.25 $306.25 $306.25 $63.83 $306.25 $306.25 $306.25 $306.25 $306.25 $63.83 $306.25 $306.25 $181.15 $306.25 $306.25 $306.25 $306.25 $229.88 $306.25 $306.25 $306.25 $153.13 $153.13 $242.55 $306.25 $245.00 $137.81 $60.78 N/A $177.77 $306.25 $306.25 $306.25 $63.82 $306.25 N/A N/A 19-0325T SUP Custom 27203010 19-0325T - UNIVERSAL C-TAPER -2.5mm ADAPTER SLEEVE (Ti) BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 190-5091-150 SUP HCPCS C1887 190-5091-150 - CATHETER INFS 90D 5MM MIC 2.1-1.7FR .017IN 155CM .34ML 150CM BOTH IP/OP "$1,687.50" "$1,249.00" $334.93 "$1,687.50" $916.31 $916.31 $916.31 $916.31 "$1,687.50" "$1,687.50" "$1,687.50" $351.72 "$1,687.50" "$1,252.46" "$1,252.46" "$1,300.73" $879.19 $351.69 "$1,687.50" "$1,687.50" $998.16 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" "$1,096.88" $334.93 N/A $978.75 "$1,687.50" "$1,687.50" "$1,687.50" $351.68 "$1,687.50" N/A N/A 190-5092-150 SUP HCPCS C1876 190-5092-150 - CATHETER INFS 90D .014IN MIC STRG 1.9-2.4FR .017IN 155CM .34 BOTH IP/OP "$1,687.50" "$1,249.00" $334.93 "$1,687.50" $759.38 $759.38 $759.38 $759.38 "$1,687.50" "$1,687.50" "$1,687.50" $351.72 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" $351.69 "$1,687.50" "$1,687.50" $998.16 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" $759.38 $334.93 N/A $978.75 "$1,687.50" "$1,687.50" "$1,687.50" $351.68 "$1,687.50" N/A N/A 19-1005 SUP HCPCS C1713 19-1005 - PLATE BN STRG 15MM THINFLAP 2 HL TI CRNMXF BOTH IP/OP $197.50 $146.00 $39.20 $197.50 $88.88 $88.88 $88.88 $88.88 $197.50 $197.50 $197.50 $41.16 $197.50 $197.50 $197.50 $197.50 $197.50 $41.16 $197.50 $197.50 $116.82 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $88.88 $39.20 N/A $114.55 $197.50 $197.50 $197.50 $41.16 $197.50 N/A N/A 19-1010 SUP HCPCS C1713 19-1010 - PLATE BONE WIDE 2 HOLE THINFLAP TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $132.75 $132.75 $132.75 $132.75 $295.00 $295.00 $295.00 $61.49 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $295.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $58.55 N/A $171.10 $295.00 $295.00 $295.00 $61.48 $295.00 N/A N/A 19-1015 SUP HCPCS C1713 19-1015 - PLATE BN SQ 13MM THINFLAP 4 HL TI CRNMXF BOTH IP/OP $780.00 $577.00 $154.81 $780.00 $351.00 $351.00 $351.00 $351.00 $780.00 $780.00 $780.00 $162.57 $780.00 $780.00 $780.00 $780.00 $780.00 $162.56 $780.00 $780.00 $461.37 $780.00 $780.00 $780.00 $780.00 $585.00 $780.00 $780.00 $780.00 $390.00 $390.00 $617.76 $780.00 $624.00 $351.00 $154.81 N/A $452.40 $780.00 $468.00 $780.00 $162.55 $780.00 N/A N/A 19-1019 SUP HCPCS C1713 19-1019 - COVER BURR HOLE 13.5MM BENT SPN BOTH IP/OP $847.50 $627.00 $168.21 $847.50 $381.38 $381.38 $381.38 $381.38 $847.50 $847.50 $847.50 $176.64 $847.50 $847.50 $847.50 $847.50 $847.50 $176.63 $847.50 $339.00 $501.30 $847.50 $847.50 $847.50 $847.50 $635.63 $847.50 $847.50 $847.50 $423.75 $423.75 $671.22 $847.50 $678.00 $381.38 $168.21 N/A $491.55 $847.50 $508.50 $847.50 $176.62 $847.50 N/A N/A 19-1020 SUP HCPCS C1713 19-1020 - PLATE BONE 18.5MM BURR HOLE THINFLAP TITANIUM BOTH IP/OP $847.50 $627.00 $168.21 $847.50 $381.38 $381.38 $381.38 $381.38 $847.50 $847.50 $847.50 $176.64 $847.50 $847.50 $847.50 $847.50 $847.50 $176.63 $847.50 $847.50 $501.30 $847.50 $847.50 $847.50 $847.50 $635.63 $847.50 $847.50 $847.50 $423.75 $423.75 $671.22 $847.50 $678.00 $381.38 $168.21 N/A $491.55 $847.50 $508.50 $847.50 $176.62 $847.50 N/A N/A 19-1021 SUP HCPCS C1713 19-1021 - COVER BURR HOLE BENT LP 24MM THINFLAP CRANIOMAXILLOFACIAL BOTH IP/OP $847.50 $627.00 $168.21 $847.50 $381.38 $381.38 $381.38 $381.38 $847.50 $847.50 $847.50 $176.64 $847.50 $847.50 $847.50 $847.50 $847.50 $176.63 $847.50 $339.00 $501.30 $847.50 $847.50 $847.50 $847.50 $635.63 $847.50 $847.50 $847.50 $423.75 $423.75 $671.22 $847.50 $678.00 $381.38 $168.21 N/A $491.55 $847.50 $847.50 $847.50 $176.62 $847.50 N/A N/A 19-1030 SUP HCPCS C1713 19-1030 - PLATE BONE 85X53X.5MM GRID PANEL THINFLAP TITANIUM BOTH IP/OP "$4,047.50" "$2,995.00" $803.33 "$4,047.50" "$1,821.38" "$1,821.38" "$1,821.38" "$1,821.38" "$4,047.50" "$4,047.50" "$4,047.50" $843.60 "$4,047.50" "$4,047.50" "$4,047.50" "$4,047.50" "$4,047.50" $843.54 "$4,047.50" "$4,047.50" "$1,995.42" "$4,047.50" "$4,047.50" "$4,047.50" "$4,047.50" "$3,035.63" "$4,047.50" "$4,047.50" "$4,047.50" "$2,023.75" "$2,023.75" "$3,205.62" "$4,047.50" "$3,238.00" "$1,821.38" $803.33 N/A "$2,347.55" "$4,047.50" "$2,428.50" "$4,047.50" $843.50 "$4,047.50" N/A N/A 19-1040 SUP HCPCS C1713 19-1040 - PLATE BONE LONG 6 HOLE STR THINFLAP TITANIUM BOTH IP/OP $820.00 $607.00 $162.75 $820.00 $369.00 $369.00 $369.00 $369.00 $820.00 $820.00 $820.00 $170.91 $820.00 $820.00 $820.00 $820.00 $820.00 $170.90 $820.00 $820.00 $485.03 $820.00 $820.00 $820.00 $820.00 $615.00 $820.00 $820.00 $820.00 $410.00 $410.00 $649.44 $820.00 $656.00 $369.00 $162.75 N/A $475.60 $820.00 $492.00 $820.00 $170.89 $820.00 N/A N/A 19-1045 SUP HCPCS C1713 19-1045 - PLATE BONE LONG 4 HOLE STR THINFLAP TITANIUM BOTH IP/OP $405.00 $300.00 $80.38 $405.00 $182.25 $182.25 $182.25 $182.25 $405.00 $405.00 $405.00 $84.41 $405.00 $405.00 $405.00 $405.00 $405.00 $84.41 $405.00 $405.00 $239.56 $405.00 $405.00 $405.00 $405.00 $303.75 $405.00 $405.00 $405.00 $202.50 $202.50 $320.76 $405.00 $324.00 $182.25 $80.38 N/A $234.90 $405.00 $243.00 $405.00 $84.40 $405.00 N/A N/A 19-1050 SUP HCPCS C1713 19-1050 - PLATE BONE STANDARD 6 HOLE CVD THINFLAP TITANIUM CRANFCL BOTH IP/OP $820.00 $607.00 $162.75 $820.00 $369.00 $369.00 $369.00 $369.00 $820.00 $820.00 $820.00 $170.91 $820.00 $820.00 $820.00 $820.00 $820.00 $170.90 $820.00 $820.00 $485.03 $820.00 $820.00 $820.00 $820.00 $615.00 $820.00 $820.00 $820.00 $410.00 $410.00 $649.44 $820.00 $656.00 $369.00 $162.75 N/A $475.60 $820.00 $492.00 $820.00 $170.89 $820.00 N/A N/A 19-1060 SUP HCPCS C1713 19-1060 - PLATE BN 2Y 16MM THINFLAP 6 HL TI CRNMXF BOTH IP/OP $820.00 $607.00 $162.75 $820.00 $369.00 $369.00 $369.00 $369.00 $820.00 $820.00 $820.00 $170.91 $820.00 $820.00 $820.00 $820.00 $820.00 $170.90 $820.00 $820.00 $485.03 $820.00 $820.00 $820.00 $820.00 $615.00 $820.00 $820.00 $820.00 $410.00 $410.00 $649.44 $820.00 $656.00 $369.00 $162.75 N/A $475.60 $820.00 $492.00 $820.00 $170.89 $820.00 N/A N/A 19-1065 SUP HCPCS C1713 19-1065 - PLATE BONE STANDARD 6 HOLE Y THINFLAP TITANIUM BOTH IP/OP $880.00 $651.00 $174.66 $880.00 $396.00 $396.00 $396.00 $396.00 $880.00 $880.00 $880.00 $183.41 $880.00 $880.00 $880.00 $880.00 $880.00 $183.40 $880.00 $352.00 $520.52 $880.00 $880.00 $880.00 $880.00 $660.00 $880.00 $880.00 $880.00 $440.00 $440.00 $696.96 $880.00 $704.00 $396.00 $174.66 N/A $510.40 $880.00 $528.00 $880.00 $183.39 $880.00 N/A N/A 19-1200AU SUP Custom 27203010 19-1200AU - FORCEP BIPOL 8-.7MM HARDY BAYONETTE DISP BOTH IP/OP $372.50 $276.00 $66.31 $372.50 $372.50 $372.50 $372.50 $372.50 $372.50 $372.50 $66.31 $372.50 $372.50 $276.47 $276.47 $287.12 $194.07 $77.63 $372.50 $149.00 $372.50 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $242.13 $372.50 N/A $216.05 $372.50 $223.50 $372.50 $372.50 $372.50 N/A N/A 1924-508 SUP Custom 27203010 1924-508 - CIRCUIT BRTHG CSTM RESP HMD LN UNHT 1.5FT INF 10MM BOTH IP/OP $6.50 $5.00 $1.11 $6.22 $6.22 $6.22 $6.22 $6.22 $6.22 $6.22 $1.11 $6.22 $6.22 $4.62 $4.62 $4.79 $3.24 $1.30 $6.22 $2.49 $6.22 $6.22 $6.22 $6.22 $6.22 $4.88 $6.22 $6.22 $6.22 $3.11 $3.11 $4.93 $6.22 $4.98 $4.04 $6.22 N/A $3.77 $6.22 $3.73 $6.22 $6.22 $6.22 N/A N/A 1944/46 SUP HCPCS C1898 1944/46 - LEAD PCNG 10MM SPC S J 7FR 46CM ISFLX ATCPT IS-1 BP CNCT PSV BOTH IP/OP $680.00 $503.00 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 N/A $394.40 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 1944/52 SUP HCPCS C1898 1944/52 - LEAD PCNG J 7FR 52CM ISFLX IS-1 BP CNCT TINE FX OPTIM STRD BOTH IP/OP $680.00 $503.00 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 N/A $394.40 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 1948/46 SUP HCPCS C1898 1948/46 - LEAD PCNG STRG 46CM STRL LF ISFLX ATCPT TINE FX IS-1 BP CNCT BOTH IP/OP $680.00 $503.00 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 N/A $394.40 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 1948/52 SUP HCPCS C1898 1948/52 - LEAD PCNG 7FR 52CM ISFLX BP PSV FX TINE IS 1 OPTIM STRD BOTH IP/OP $680.00 $503.00 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 N/A $394.40 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 1948/58 SUP HCPCS C1898 1948/58 - LEAD PCNG STRG 7FR 58CM ISFLX ABRSN RST IS-1 BP CNCT TINE FX BOTH IP/OP $680.00 $503.00 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 N/A $394.40 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 1967.89.300 SUP HCPCS C1713 1967.89.300 - ROD SPINAL STR 300MM HEXAGON VIPER 2 COCR BOTH IP/OP "$1,957.50" "$1,449.00" $388.51 "$1,957.50" $880.88 $880.88 $880.88 $880.88 "$1,957.50" "$1,957.50" "$1,957.50" $407.99 "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" $407.96 "$1,957.50" $783.00 "$1,157.86" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$1,468.13" "$1,957.50" "$1,957.50" "$1,957.50" $978.75 $978.75 "$1,550.34" "$1,957.50" "$1,566.00" $880.88 $388.51 N/A "$1,135.35" "$1,957.50" "$1,957.50" "$1,957.50" $407.94 "$1,957.50" N/A N/A 1967.89.480 SUP HCPCS C1713 1967.89.480 - ROD SPINAL STR 480MM VIPER 2 COCR BOTH IP/OP "$2,130.00" "$1,576.00" $422.75 "$2,130.00" $958.50 $958.50 $958.50 $958.50 "$2,130.00" "$2,130.00" "$2,130.00" $443.95 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$1,259.90" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 $422.75 N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" $443.89 "$2,130.00" N/A N/A 197230FLA SUP HCPCS C1894 197230FLA - SHEATH IRRIGATION 45D 4MM ENDO-SCRUB 2 LEFT STERILE BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $373.31 $373.31 $373.31 $373.31 $687.50 $687.50 $687.50 $143.29 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A 199.933S SUP Custom 27203010 199.933S - KIT SCRL BAR THRD 6MM 200MM STRL BOTH IP/OP "$2,308.50" "$1,708.00" $410.85 "$2,347.40" "$2,308.15" "$2,308.15" "$2,308.15" "$2,308.15" "$2,308.15" "$2,308.15" $410.85 "$2,308.15" "$2,308.15" "$1,713.11" "$1,713.11" "$1,779.12" "$1,202.55" $481.04 "$2,308.15" $938.96 "$2,308.15" "$2,308.15" "$2,347.40" "$2,308.15" "$2,308.15" "$1,731.38" "$2,308.15" "$2,308.15" "$2,308.15" "$1,154.08" "$1,154.08" "$1,828.05" "$2,308.15" "$1,846.52" "$1,500.30" "$2,308.15" N/A "$1,338.93" "$2,308.15" "$1,384.89" "$2,308.15" "$2,308.15" "$2,308.15" N/A N/A 199.936S SUP HCPCS C1713 199.936S - BAR SACRAL 6MM 260MM THREAD SPN STERILE BOTH IP/OP "$2,308.50" "$1,708.00" $458.11 "$2,347.40" "$1,038.67" "$1,038.67" "$1,038.67" "$1,038.67" "$2,308.15" "$2,308.15" "$2,308.15" $481.08 "$2,308.15" "$2,308.15" "$2,308.15" "$2,308.15" "$2,308.15" $481.04 "$2,308.15" "$2,347.40" "$1,365.27" "$2,308.15" "$2,347.40" "$2,308.15" "$2,308.15" "$1,731.38" "$2,308.15" "$2,308.15" "$2,308.15" "$1,154.08" "$1,154.08" "$1,828.05" "$2,308.15" "$1,846.52" "$1,038.67" $458.11 N/A "$1,338.93" "$2,308.15" "$1,384.89" "$2,308.15" $481.02 "$2,308.15" N/A N/A 19A001 SUP Custom 27804086 19A001 - GRAFT BONE 4-10MM FREEZE DRIED CANCELLOUS CORTICAL 30ML BOTH IP/OP "$1,022.50" $757.00 $182.01 "$1,105.00" "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $182.01 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $213.10 "$1,022.50" $442.00 "$1,022.50" "$1,022.50" "$1,105.00" "$1,022.50" "$1,022.50" $766.88 "$1,022.50" "$1,022.50" "$1,022.50" $511.25 $511.25 $809.82 "$1,022.50" $818.00 $460.13 "$1,022.50" N/A $593.05 "$1,022.50" $613.50 "$1,022.50" "$1,022.50" "$1,022.50" N/A N/A 19A002 SUP Custom 27804086 19A002 - GRAFT BONE 4-10MM FREEZE DRIED CANCELLOUS CORTICAL 15ML BOTH IP/OP $582.50 $431.00 $103.69 $630.00 $582.50 $582.50 $582.50 $582.50 $582.50 $582.50 $103.69 $582.50 $582.50 $582.50 $582.50 $582.50 $582.50 $121.40 $582.50 $252.00 $582.50 $582.50 $630.00 $582.50 $582.50 $436.88 $582.50 $582.50 $582.50 $291.25 $291.25 $461.34 $582.50 $466.00 $262.13 $582.50 N/A $337.85 $582.50 $349.50 $582.50 $582.50 $582.50 N/A N/A 19AGFN-756 SUP Custom 27803010 19AGFN-756 - VALVE AORTIC 85D 19MM 17.8MM 1 DIGIT GRADIENT MECHANICAL BOTH IP/OP "$11,750.00" "$8,695.00" "$2,091.50" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$2,091.50" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$2,448.83" "$11,750.00" "$4,700.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$8,812.50" "$11,750.00" "$11,750.00" "$11,750.00" "$5,875.00" "$5,875.00" "$9,306.00" "$11,750.00" "$9,400.00" "$5,287.50" "$11,750.00" N/A "$6,815.00" "$11,750.00" "$7,050.00" "$11,750.00" "$11,750.00" "$11,750.00" N/A N/A 1DLMC03 SUP HCPCS C1781 1DLMC03 - MESH SURG THK1MM 15X10CM BIOMATERIAL DUALMESH GORE-TEX SOFT BOTH IP/OP $982.50 $727.00 $195.00 $982.50 $442.13 $442.13 $442.13 $442.13 $982.50 $982.50 $982.50 $204.78 $982.50 $982.50 $982.50 $982.50 $982.50 $204.76 $982.50 $982.50 $581.15 $982.50 $982.50 $982.50 $982.50 $736.88 $982.50 $982.50 $982.50 $491.25 $491.25 $778.14 $982.50 $786.00 $442.13 $195.00 N/A $569.85 $982.50 $982.50 $982.50 $204.75 $982.50 N/A N/A 1DLMC06 SUP HCPCS C1781 1DLMC06 - MESH SRG THK1MM 24X18CM STRL DLMSH BIOMTL GRTX SFT TIS HRN BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 2000-49 SUP HCPCS C1877 2000-49 - SHUNT CARDIO 9FR P-I CRTD OUTLYING T PORT 31CM STRL BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $422.50 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $422.50 $422.50 $88.05 $422.50 N/A N/A 200-120 SUP Custom 27203010 200-120 - KIT DIL .035IN 18GA 180CM GW INS NDL SCPL PCTV SHTH FLSH BOTH IP/OP $422.00 $312.00 $75.06 $421.68 $421.68 $421.68 $421.68 $421.68 $421.68 $421.68 $75.06 $421.68 $421.68 $312.97 $312.97 $325.03 $219.70 $87.88 $421.68 $168.67 $421.68 $421.68 $421.68 $421.68 $421.68 $316.50 $421.68 $421.68 $421.68 $210.84 $210.84 $333.97 $421.68 $337.34 $274.09 $421.68 N/A $244.76 $421.68 $253.01 $421.68 $421.68 $421.68 N/A N/A 2001-2240 SUP Custom 27803010 2001-2240 - INSERT ACETAB 10D 40MM 22MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2242 SUP Custom 27803010 2001-2242 - INSERT ACETAB 10D 42MM 22MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2244 SUP Custom 27803010 2001-2244 - INSERT ACETAB 10D 44MM 22MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2246 SUP Custom 27803010 2001-2246 - INSERT ACETAB 10D 46MM 22MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2248 SUP Custom 27803010 2001-2248 - INSERT ACETAB 10D 48MM 22MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2250 SUP Custom 27803010 2001-2250 - INSERT ACETAB 10D 50MM 22MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2252 SUP Custom 27803010 2001-2252 - INSERT ACETAB 10D 52MM 22MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2254 SUP Custom 27803010 2001-2254 - INSERT ACETAB 10D 54MM 22MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2256 SUP Custom 27803010 2001-2256 - INSERT ACETAB 10D 56MM 22MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2258 SUP Custom 27803010 2001-2258 - INSERT ACETAB 10D 58MM 22MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2261 SUP Custom 27803010 2001-2261 - INSERT ACETAB 10D 61MM 22MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2644 SUP Custom 27803010 2001-2644 - INSERT ACETAB 10D 44MM 26MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2646 SUP Custom 27803010 2001-2646 - INSERT ACETAB 10D 46MM 26MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2648 SUP Custom 27803010 2001-2648 - INSERT ACETAB 10D 48MM 26MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2650 SUP Custom 27803010 2001-2650 - INSERT ACETAB 10D 50MM 26MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2652 SUP Custom 27803010 2001-2652 - INSERT ACETAB 10D 52MM 26MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2654 SUP Custom 27803010 2001-2654 - INSERT ACETAB 10D 54MM 26MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2656 SUP Custom 27803010 2001-2656 - INSERT ACETAB 10D 56MM 26MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2658 SUP Custom 27803010 2001-2658 - INSERT ACETAB 10D 58MM 26MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2661 SUP Custom 27803010 2001-2661 - INSERT ACETAB 10D 61MM 26MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2844 SUP Custom 27803010 2001-2844 - INSERT ACETAB 10D 44MM 28MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2846 SUP Custom 27803010 2001-2846 - INSERT ACETAB 10D 46MM 28MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2848 SUP Custom 27803010 2001-2848 - INSERT ACETAB 10D 48MM 28MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2850 SUP Custom 27803010 2001-2850 - INSERT ACETAB 10D 50MM 28MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2852 SUP Custom 27803010 2001-2852 - INSERT ACETAB 10D 52MM 28MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2854 SUP Custom 27803010 2001-2854 - INSERT ACETAB 10D 54MM 28MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2856 SUP Custom 27803010 2001-2856 - INSERT ACETAB 10D 56MM 28MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2858 SUP Custom 27803010 2001-2858 - INSERT ACETAB 10D 58MM 28MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-2861 SUP Custom 27803010 2001-2861 - INSERT ACETAB 10D 61MM 28MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-3250 SUP Custom 27803010 2001-3250 - INSERT ACETAB 10D 50MM 32MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-3252 SUP Custom 27803010 2001-3252 - INSERT ACETAB 10D 52MM 32MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-3254 SUP Custom 27803010 2001-3254 - INSERT ACETAB 10D 54MM 32MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-3256 SUP Custom 27803010 2001-3256 - INSERT ACETAB 10D 56MM 32MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-3258 SUP Custom 27803010 2001-3258 - INSERT ACETAB 10D 58MM 32MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2001-3261 SUP Custom 27803010 2001-3261 - INSERT ACETAB 10D 61MM 32MM OMNIFIT HIP SERIES I BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2002-000 SUP HCPCS C1729 2002-000 - DRAIN INCS STRL ADLT WET ATR OCN 1 CLT 1 TBE WTRSL SCT CNTRL BOTH IP/OP $53.50 $40.00 $10.58 $53.29 $28.94 $28.94 $28.94 $28.94 $53.29 $53.29 $53.29 $11.11 $53.29 $39.55 $39.55 $41.08 $27.76 $11.11 $53.29 $53.29 $31.52 $53.29 $53.29 $53.29 $53.29 $40.13 $53.29 $53.29 $53.29 $26.65 $26.65 $42.21 $53.29 $42.63 $34.64 $10.58 N/A $31.03 $53.29 $53.29 $53.29 $11.11 $53.29 N/A N/A 20022 B-M SUP Custom 27803010 20022 B-M - SHUNT NEUROSURGICAL SMALL COMPONENT MEDIUM PRESSURE BOTH IP/OP "$7,327.00" "$5,422.00" "$1,304.18" "$7,326.88" "$7,326.88" "$7,326.88" "$7,326.88" "$7,326.88" "$7,326.88" "$7,326.88" "$1,304.18" "$7,326.88" "$7,326.88" "$7,326.88" "$7,326.88" "$7,326.88" "$7,326.88" "$1,527.00" "$7,326.88" "$2,930.75" "$7,326.88" "$7,326.88" "$7,326.88" "$7,326.88" "$7,326.88" "$5,495.25" "$7,326.88" "$7,326.88" "$7,326.88" "$3,663.44" "$3,663.44" "$5,802.89" "$7,326.88" "$5,861.50" "$3,297.10" "$7,326.88" N/A "$4,249.66" "$7,326.88" "$4,396.13" "$7,326.88" "$7,326.88" "$7,326.88" N/A N/A 20026 A-H SUP Custom 27803010 20026 A-H - VALVE SHUNT STANDARD 90CM CSF HIGH PRESSURE BARIUM BOTH IP/OP "$1,544.00" "$1,143.00" $274.79 "$1,543.75" "$1,543.75" "$1,543.75" "$1,543.75" "$1,543.75" "$1,543.75" "$1,543.75" $274.79 "$1,543.75" "$1,543.75" "$1,543.75" "$1,543.75" "$1,543.75" "$1,543.75" $321.73 "$1,543.75" $617.50 "$1,543.75" "$1,543.75" "$1,543.75" "$1,543.75" "$1,543.75" "$1,158.00" "$1,543.75" "$1,543.75" "$1,543.75" $771.88 $771.88 "$1,222.65" "$1,543.75" "$1,235.00" $694.69 "$1,543.75" N/A $895.52 "$1,543.75" $926.25 "$1,543.75" "$1,543.75" "$1,543.75" N/A N/A 20026 A-M SUP Custom 27803010 20026 A-M - VALVE SHUNT STANDARD 90CM CSF MEDIUM PRESSURE BARIUM BOTH IP/OP "$1,700.50" "$1,258.00" $302.69 "$1,700.50" "$1,700.50" "$1,700.50" "$1,700.50" "$1,700.50" "$1,700.50" "$1,700.50" $302.69 "$1,700.50" "$1,700.50" "$1,700.50" "$1,700.50" "$1,700.50" "$1,700.50" $354.40 "$1,700.50" $680.20 "$1,700.50" "$1,700.50" "$1,700.50" "$1,700.50" "$1,700.50" "$1,275.38" "$1,700.50" "$1,700.50" "$1,700.50" $850.25 $850.25 "$1,346.80" "$1,700.50" "$1,360.40" $765.23 "$1,700.50" N/A $986.29 "$1,700.50" "$1,020.30" "$1,700.50" "$1,700.50" "$1,700.50" N/A N/A 2003-01 SUP Custom 27203010 2003-01 - STABILIT FIRST FRACTURE KIT WITH POWERCURVE BOTH IP/OP "$7,000.00" "$5,180.00" "$1,246.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$1,246.00" "$7,000.00" "$7,000.00" "$4,181.12" "$4,181.12" "$5,395.60" "$2,060.15" "$1,458.88" "$7,000.00" "$2,800.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$5,250.00" "$7,000.00" "$7,000.00" "$7,000.00" "$3,500.00" "$3,500.00" "$5,544.00" "$7,000.00" "$5,600.00" "$4,550.00" "$7,000.00" N/A "$4,060.00" "$7,000.00" "$4,200.00" "$7,000.00" "$7,000.00" "$7,000.00" N/A N/A 20038 B SUP Custom 27803010 20038 B - RESERVOIR DRAIN SMALL 12MM 3CM CSF INTEGRAL RIGHT ANG BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 20038 C SUP Custom 27803010 20038 C - DEVICE VENTRICULAR ASSIST 12MM 40MM INFECTION CONTROL BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 20038 D SUP Custom 27803010 20038 D - DEVICE VENTRICULAR ASSIST 12MM 50MM BOTH IP/OP "$1,282.50" $949.00 $228.29 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $228.29 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $267.29 "$1,282.50" $513.00 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $961.88 "$1,282.50" "$1,282.50" "$1,282.50" $641.25 $641.25 "$1,015.74" "$1,282.50" "$1,026.00" $577.13 "$1,282.50" N/A $743.85 "$1,282.50" $769.50 "$1,282.50" "$1,282.50" "$1,282.50" N/A N/A 20040 L SUP Custom 27203010 20040 L - SHUNT NEUROSURGICAL REGULAR CSF FLOW CONTROL LOW PRESSURE BOTH IP/OP "$3,375.00" "$2,498.00" $600.73 "$3,374.88" "$3,374.88" "$3,374.88" "$3,374.88" "$3,374.88" "$3,374.88" "$3,374.88" $600.73 "$3,374.88" "$3,374.88" "$2,504.84" "$2,504.84" "$2,601.36" "$1,758.31" $703.36 "$3,374.88" "$1,349.95" "$3,374.88" "$3,374.88" "$3,374.88" "$3,374.88" "$3,374.88" "$2,531.25" "$3,374.88" "$3,374.88" "$3,374.88" "$1,687.44" "$1,687.44" "$2,672.90" "$3,374.88" "$2,699.90" "$2,193.67" "$3,374.88" N/A "$1,957.50" "$3,374.88" "$2,024.93" "$3,374.88" "$3,374.88" "$3,374.88" N/A N/A 20040 M SUP Custom 27203010 20040 M - KIT SHUNT REGULAR ASMBLY MEDIUM PRESSURE VENTRICULAR BOTH IP/OP "$3,375.00" "$2,498.00" $600.73 "$3,374.88" "$3,374.88" "$3,374.88" "$3,374.88" "$3,374.88" "$3,374.88" "$3,374.88" $600.73 "$3,374.88" "$3,374.88" "$2,504.84" "$2,504.84" "$2,601.36" "$1,758.31" $703.36 "$3,374.88" "$1,349.95" "$3,374.88" "$3,374.88" "$3,374.88" "$3,374.88" "$3,374.88" "$2,531.25" "$3,374.88" "$3,374.88" "$3,374.88" "$1,687.44" "$1,687.44" "$2,672.90" "$3,374.88" "$2,699.90" "$2,193.67" "$3,374.88" N/A "$1,957.50" "$3,374.88" "$2,024.93" "$3,374.88" "$3,374.88" "$3,374.88" N/A N/A 20049 A-H SUP Custom 27803010 20049 A-H - SHUNT NEUROSURGICAL 6CM 2 CHAMBER UNITIZED RESERVOIR STERILE BOTH IP/OP "$1,615.00" "$1,195.00" $287.47 "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" $287.47 "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" $336.58 "$1,615.00" $646.00 "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,211.25" "$1,615.00" "$1,615.00" "$1,615.00" $807.50 $807.50 "$1,279.08" "$1,615.00" "$1,292.00" $726.75 "$1,615.00" N/A $936.70 "$1,615.00" $969.00 "$1,615.00" "$1,615.00" "$1,615.00" N/A N/A 20049 C-H SUP Custom 27803010 20049 C-H - SHUNT NEUROSURGICAL 10CM 2 CHAMBER UNITIZED RESERVOIR BOTH IP/OP "$1,615.00" "$1,195.00" $287.47 "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" $287.47 "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" $336.58 "$1,615.00" $646.00 "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,211.25" "$1,615.00" "$1,615.00" "$1,615.00" $807.50 $807.50 "$1,279.08" "$1,615.00" "$1,292.00" $726.75 "$1,615.00" N/A $936.70 "$1,615.00" $969.00 "$1,615.00" "$1,615.00" "$1,615.00" N/A N/A 2006-2240 SUP Custom 27803010 2006-2240 - INSERT ACETAB 20D 40MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-2242 SUP Custom 27803010 2006-2242 - INSERT ACETAB 20D 42MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-2244 SUP Custom 27803010 2006-2244 - INSERT ACETAB 20D 44MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-2246 SUP Custom 27803010 2006-2246 - INSERT ACETAB 20D 46MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-2248 SUP Custom 27803010 2006-2248 - INSERT ACETAB 20D 48MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-2250 SUP Custom 27803010 2006-2250 - INSERT ACETAB 20D 50MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-2252 SUP Custom 27803010 2006-2252 - INSERT ACETAB 20D 52MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-2254 SUP Custom 27803010 2006-2254 - INSERT ACETAB 20D 54MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-2256 SUP Custom 27803010 2006-2256 - INSERT ACETAB 20D 56MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-2258 SUP Custom 27803010 2006-2258 - INSERT ACETAB 20D 58MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-2261 SUP Custom 27803010 2006-2261 - INSERT ACETAB 20D 61MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-2644 SUP Custom 27803010 2006-2644 - INSERT ACETAB 20D 44MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-2646 SUP Custom 27803010 2006-2646 - INSERT ACETAB 20D 46MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-2648 SUP Custom 27803010 2006-2648 - INSERT ACETAB 20D 48MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-2650 SUP Custom 27803010 2006-2650 - INSERT ACETAB 20D 50MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-2652 SUP Custom 27803010 2006-2652 - INSERT ACETAB 20D 52MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-2654 SUP Custom 27803010 2006-2654 - INSERT ACETAB 20D 54MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-2656 SUP Custom 27803010 2006-2656 - INSERT ACETAB 20D 56MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-2658 SUP Custom 27803010 2006-2658 - INSERT ACETAB 20D 58MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-2661 SUP Custom 27803010 2006-2661 - INSERT ACETAB 20D 61MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-2846 SUP Custom 27803010 2006-2846 - INSERT ACETAB 20D 46MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-2848 SUP Custom 27803010 2006-2848 - INSERT ACETAB 20D 48MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-2850 SUP Custom 27803010 2006-2850 - INSERT ACETAB 20D 50MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-2852 SUP Custom 27803010 2006-2852 - INSERT ACETAB 20D 52MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-2854 SUP Custom 27803010 2006-2854 - INSERT ACETAB 20D 54MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-2856 SUP Custom 27803010 2006-2856 - INSERT ACETAB 20D 54MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-2858 SUP Custom 27803010 2006-2858 - INSERT ACETAB 20D 58MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-2861 SUP Custom 27803010 2006-2861 - INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-3250 SUP Custom 27803010 2006-3250 - INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-3252 SUP Custom 27803010 2006-3252 - INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-3254 SUP Custom 27803010 2006-3254 - INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-3256 SUP Custom 27803010 2006-3256 - INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2006-3258 SUP Custom 27803010 2006-3258 - INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,926.00" "$1,425.00" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $342.76 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" $401.32 "$1,925.63" $770.25 "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,925.63" "$1,444.50" "$1,925.63" "$1,925.63" "$1,925.63" $962.82 $962.82 "$1,525.10" "$1,925.63" "$1,540.50" $866.53 "$1,925.63" N/A "$1,117.08" "$1,925.63" "$1,155.38" "$1,925.63" "$1,925.63" "$1,925.63" N/A N/A 2006-3261 SUP Custom 27803010 2006-3261 - INSERT ACETAB 20D 61MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$2,002.50" "$1,482.00" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $356.45 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" $417.34 "$2,002.50" $801.00 "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$1,501.88" "$2,002.50" "$2,002.50" "$2,002.50" "$1,001.25" "$1,001.25" "$1,585.98" "$2,002.50" "$1,602.00" $901.13 "$2,002.50" N/A "$1,161.45" "$2,002.50" "$1,201.50" "$2,002.50" "$2,002.50" "$2,002.50" N/A N/A 2007-4-211 SUP Custom 27203010 2007-4-211 - DISK SENSITIVITY ALLERGY VITALLIUM BOTH IP/OP $60.50 $45.00 $10.70 $60.13 $60.13 $60.13 $60.13 $60.13 $60.13 $60.13 $10.70 $60.13 $60.13 $44.63 $44.63 $46.35 $31.33 $12.53 $60.13 $24.05 $60.13 $60.13 $60.13 $60.13 $60.13 $45.38 $60.13 $60.13 $60.13 $30.07 $30.07 $47.62 $60.13 $48.10 $39.08 $60.13 N/A $35.09 $60.13 $36.08 $60.13 $60.13 $60.13 N/A N/A 2007-4-212 SUP Custom 27203010 2007-4-212 - TITANIUM ALLERGY DISC BOTH IP/OP $60.50 $45.00 $10.70 $60.13 $60.13 $60.13 $60.13 $60.13 $60.13 $60.13 $10.70 $60.13 $60.13 $44.63 $44.63 $46.35 $31.33 $12.53 $60.13 $24.05 $60.13 $60.13 $60.13 $60.13 $60.13 $45.38 $60.13 $60.13 $60.13 $30.07 $30.07 $47.62 $60.13 $48.10 $39.08 $60.13 N/A $35.09 $60.13 $36.08 $60.13 $60.13 $60.13 N/A N/A 201.356.97 SUP HCPCS C1713 201.356.97 - SCREW BONE T6 LP 2MM 6MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 201.357.97 SUP HCPCS C1713 201.357.97 - SCREW BONE T6 LP 2MM 7MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $67.53 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $13.84 $66.40 N/A N/A 201.358.97 SUP HCPCS C1713 201.358.97 - SCREW BONE T6 LP 2MM 8MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 201.359.97 SUP HCPCS C1713 201.359.97 - SCREW BONE T6 LP 2MM 9MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $67.53 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 201.360.97 SUP HCPCS C1713 201.360.97 - SCREW BONE T6 LP 2MM 10MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $67.53 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 201.361.97 SUP HCPCS C1713 201.361.97 - SCREW BONE T6 LP 2MM 11MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 201.362.97 SUP HCPCS C1713 201.362.97 - SCREW BONE T6 LP 2MM 12MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $67.53 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 201.363.97 SUP HCPCS C1713 201.363.97 - SCREW BONE T6 LP 2MM 13MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 201.364.97 SUP HCPCS C1713 201.364.97 - SCREW BONE T6 LP 2MM 14MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $67.53 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $13.84 $66.40 N/A N/A 201.365.97 SUP HCPCS C1713 201.365.97 - SCREW BN T6 2MM 15MM ST SLF RTN STRDR SS CORT BOTH IP/OP $68.50 $51.00 $13.60 $69.68 $30.83 $30.83 $30.83 $30.83 $68.50 $68.50 $68.50 $14.28 $68.50 $68.50 $68.50 $68.50 $68.50 $14.28 $68.50 $69.68 $40.52 $68.50 $69.68 $68.50 $68.50 $51.38 $68.50 $68.50 $68.50 $34.25 $34.25 $54.25 $68.50 $54.80 $30.83 $13.60 N/A $39.73 $68.50 $68.50 $68.50 $14.28 $68.50 N/A N/A 201.366.97 SUP HCPCS C1713 201.366.97 - SCREW BONE T6 LP 2MM 16MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 201.368.97 SUP HCPCS C1713 201.368.97 - SCREW BONE T6 LP 2MM 18MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $66.40 $66.40 N/A N/A 201.370.97 SUP HCPCS C1713 201.370.97 - SCREW BONE T6 LP 2MM 20MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $67.53 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 201.372.97 SUP HCPCS C1713 201.372.97 - SCREW BONE T6 LP 2MM 22MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $66.40 $66.40 N/A N/A 201.374.97 SUP HCPCS C1713 201.374.97 - SCREW BONE T6 LP 2MM 24MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 201.375.97 SUP HCPCS C1713 201.375.97 - SCREW BONE T6 LP 2MM 26MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 201.376.97 SUP HCPCS C1713 201.376.97 - SCREW BONE T6 LP 2MM 28MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $67.53 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $13.84 $66.40 N/A N/A 201.377.97 SUP HCPCS C1713 201.377.97 - SCREW BONE T6 LP 2MM 30MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 201.378.97 SUP HCPCS C1713 201.378.97 - SCREW BONE T6 LP 2MM 32MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 201.379.97 SUP HCPCS C1713 201.379.97 - SCREW BONE T6 LP 2MM 34MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 201.380.97 SUP HCPCS C1713 201.380.97 - SCREW BONE T6 LP 2MM 36MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $66.40 $66.40 N/A N/A 201.381.97 SUP HCPCS C1713 201.381.97 - SCREW BONE T6 LP 2MM 38MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $13.84 $66.40 N/A N/A 201.382.97 SUP HCPCS C1713 201.382.97 - SCREW BONE T6 LP 2MM 40MM SELF TAP MODULAR STARDRIVE LCP BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $66.40 $66.40 N/A N/A 201.804.98 SUP HCPCS C1713 201.804.98 - SCREW BONE 2MM 3.5MM 4MM SLFTAP CRCIFRM RECESS STAINLESS BOTH IP/OP $119.50 $88.00 $23.69 $119.38 $53.72 $53.72 $53.72 $53.72 $119.38 $119.38 $119.38 $24.88 $119.38 $119.38 $119.38 $119.38 $119.38 $24.88 $119.38 $47.75 $70.61 $119.38 $119.38 $119.38 $119.38 $89.63 $119.38 $119.38 $119.38 $59.69 $59.69 $94.55 $119.38 $95.50 $53.72 $23.69 N/A $69.31 $119.38 $119.38 $119.38 $24.88 $119.38 N/A N/A 201.806.98 SUP HCPCS C1713 201.806.98 - SCREW BONE 2MM 3.5MM 6MM SLFTAP CRCIFRM RECESS STAINLESS BOTH IP/OP $119.50 $88.00 $23.69 $119.38 $53.72 $53.72 $53.72 $53.72 $119.38 $119.38 $119.38 $24.88 $119.38 $119.38 $119.38 $119.38 $119.38 $24.88 $119.38 $119.38 $70.61 $119.38 $119.38 $119.38 $119.38 $89.63 $119.38 $119.38 $119.38 $59.69 $59.69 $94.55 $119.38 $95.50 $53.72 $23.69 N/A $69.31 $119.38 $119.38 $119.38 $24.88 $119.38 N/A N/A 201.808.98 SUP HCPCS C1713 201.808.98 - SCREW BONE 2MM 3.5MM 8MM SLFTAP CRCIFRM RECESS STAINLESS BOTH IP/OP $119.50 $88.00 $23.69 $119.38 $53.72 $53.72 $53.72 $53.72 $119.38 $119.38 $119.38 $24.88 $119.38 $119.38 $119.38 $119.38 $119.38 $24.88 $119.38 $47.75 $70.61 $119.38 $119.38 $119.38 $119.38 $89.63 $119.38 $119.38 $119.38 $59.69 $59.69 $94.55 $119.38 $95.50 $53.72 $23.69 N/A $69.31 $119.38 $119.38 $119.38 $24.88 $119.38 N/A N/A 201.810.98 SUP HCPCS C1713 201.810.98 - SCREW BONE 2MM 3.5MM 10MM SLFTAP CRCIFRM RECESS STAINLESS BOTH IP/OP $119.50 $88.00 $23.69 $119.38 $53.72 $53.72 $53.72 $53.72 $119.38 $119.38 $119.38 $24.88 $119.38 $119.38 $119.38 $119.38 $119.38 $24.88 $119.38 $47.75 $70.61 $119.38 $119.38 $119.38 $119.38 $89.63 $119.38 $119.38 $119.38 $59.69 $59.69 $94.55 $119.38 $95.50 $53.72 $23.69 N/A $69.31 $119.38 $119.38 $119.38 $24.88 $119.38 N/A N/A 201.812.98 SUP HCPCS C1713 201.812.98 - SCREW BONE 2MM 3.5MM 12MM SLFTAP CRCIFRM RECESS STAINLESS BOTH IP/OP $119.50 $88.00 $23.69 $119.38 $53.72 $53.72 $53.72 $53.72 $119.38 $119.38 $119.38 $24.88 $119.38 $119.38 $119.38 $119.38 $119.38 $24.88 $119.38 $47.75 $70.61 $119.38 $119.38 $119.38 $119.38 $89.63 $119.38 $119.38 $119.38 $59.69 $59.69 $94.55 $119.38 $95.50 $53.72 $23.69 N/A $69.31 $119.38 $119.38 $119.38 $119.38 $119.38 N/A N/A 201.814.98 SUP HCPCS C1713 201.814.98 - SCREW BONE 2MM 3.5MM 14MM SLFTAP CRCIFRM RECESS STAINLESS BOTH IP/OP $119.50 $88.00 $23.69 $119.38 $53.72 $53.72 $53.72 $53.72 $119.38 $119.38 $119.38 $24.88 $119.38 $119.38 $119.38 $119.38 $119.38 $24.88 $119.38 $47.75 $70.61 $119.38 $119.38 $119.38 $119.38 $89.63 $119.38 $119.38 $119.38 $59.69 $59.69 $94.55 $119.38 $95.50 $53.72 $23.69 N/A $69.31 $119.38 $119.38 $119.38 $119.38 $119.38 N/A N/A 201.932E SUP HCPCS C1713 201.932E - SCREW BONE 2MM 12MM SLFDRILL STAINLESS STEEL INTERMAXILLARY BOTH IP/OP $288.00 $213.00 $57.16 $288.00 $129.60 $129.60 $129.60 $129.60 $288.00 $288.00 $288.00 $60.03 $288.00 $288.00 $288.00 $288.00 $288.00 $60.02 $288.00 $115.20 $170.35 $288.00 $288.00 $288.00 $288.00 $216.00 $288.00 $288.00 $288.00 $144.00 $144.00 $228.10 $288.00 $230.40 $129.60 $57.16 N/A $167.04 $288.00 $288.00 $288.00 $60.02 $288.00 N/A N/A 2010-01 SUP Custom 27203010 2010-01 - LARYNGECTOMY PULMONARY KIT 9/36 BOTH IP/OP $970.00 $718.00 $172.66 $970.00 $970.00 $970.00 $970.00 $970.00 $970.00 $970.00 $172.66 $970.00 $970.00 $719.93 $719.93 $747.68 $505.37 $202.16 $970.00 $388.00 $970.00 $970.00 $970.00 $970.00 $970.00 $727.50 $970.00 $970.00 $970.00 $485.00 $485.00 $768.24 $970.00 $776.00 $630.50 $970.00 N/A $562.60 $970.00 $582.00 $970.00 $970.00 $970.00 N/A N/A 20100-190 SUP HCPCS C1884 20100-190 - SYSTEM EMBL PRTC .014IN 110UM 3.2FR 6FR 3.5-5.5MM 190CM F EZ BOTH IP/OP "$4,187.50" "$3,099.00" $831.11 "$4,187.50" "$1,884.38" "$1,884.38" "$1,884.38" "$1,884.38" "$4,187.50" "$4,187.50" "$4,187.50" $872.78 "$4,187.50" "$4,187.50" "$4,187.50" "$4,187.50" "$4,187.50" $872.72 "$4,187.50" "$4,187.50" "$2,064.44" "$4,187.50" "$4,187.50" "$4,187.50" "$4,187.50" "$3,140.63" "$4,187.50" "$4,187.50" "$4,187.50" "$2,093.75" "$2,093.75" "$3,316.50" "$4,187.50" "$3,350.00" "$1,884.38" $831.11 N/A "$2,428.75" "$4,187.50" "$4,187.50" "$4,187.50" $872.68 "$4,187.50" N/A N/A 20-1226 SUP Custom 27203010 20-1226 - TUBE NASOGASTRIC 6FR 22IN 2 LUMEN Y PORT RADIOPQ STRIPE BOTH IP/OP $24.00 $18.00 $4.19 $24.95 $23.55 $23.55 $23.55 $23.55 $23.55 $23.55 $4.19 $23.55 $23.55 $17.48 $17.48 $18.15 $12.27 $4.91 $23.55 $9.98 $23.55 $23.55 $24.95 $23.55 $23.55 $18.00 $23.55 $23.55 $23.55 $11.78 $11.78 $18.65 $23.55 $18.84 $15.31 $23.55 N/A $13.92 $23.55 $14.13 $23.55 $23.55 $23.55 N/A N/A 2012-320 SUP HCPCS C1729 2012-320 - DRAIN INCS .25IN 200ML STRL LF OAS WTRSL DRY SCT CNTRL CHMBR BOTH IP/OP $77.50 $57.00 $15.34 $77.27 $41.96 $41.96 $41.96 $41.96 $77.27 $77.27 $77.27 $16.10 $77.27 $57.35 $57.35 $59.56 $40.26 $16.10 $77.27 $77.27 $45.71 $77.27 $77.27 $77.27 $77.27 $58.13 $77.27 $77.27 $77.27 $38.64 $38.64 $61.20 $77.27 $61.82 $50.23 $15.34 N/A $44.95 $77.27 $77.27 $77.27 $16.10 $77.27 N/A N/A 20132-214 SUP Custom 27203010 20132-214 - PROBE ELECTROSURGICAL 2.3MM 220CM FLEXIBLE STR FIRE FIAPC BOTH IP/OP $547.50 $405.00 $97.43 $568.75 $547.38 $547.38 $547.38 $547.38 $547.38 $547.38 $97.43 $547.38 $547.38 $406.27 $406.27 $421.92 $285.18 $114.08 $547.38 $227.50 $547.38 $547.38 $568.75 $547.38 $547.38 $410.63 $547.38 $547.38 $547.38 $273.69 $273.69 $433.52 $547.38 $437.90 $355.80 $547.38 N/A $317.55 $547.38 $328.43 $547.38 $547.38 $547.38 N/A N/A 20-1384KI SUP Custom 27203010 20-1384KI - KIT ESURG .75MM BYNT STRG 7.75IN STRL 3IN OLSN BP FCP SMTH BOTH IP/OP $118.50 $88.00 $21.08 $129.65 $118.41 $118.41 $118.41 $118.41 $118.41 $118.41 $21.08 $118.41 $118.41 $87.88 $87.88 $91.27 $61.69 $24.68 $118.41 $51.86 $118.41 $118.41 $129.65 $118.41 $118.41 $88.88 $118.41 $118.41 $118.41 $59.21 $59.21 $93.78 $118.41 $94.73 $76.97 $118.41 N/A $68.73 $118.41 $71.05 $118.41 $118.41 $118.41 N/A N/A 20-2050 SUP Custom 27203010 20-2050 - SEALANT DURA 5ML DURASEAL PG TRILYSINE AMINE BOTH IP/OP "$8,626.50" "$6,384.00" "$1,535.47" "$8,626.25" "$8,626.25" "$8,626.25" "$8,626.25" "$8,626.25" "$8,626.25" "$8,626.25" "$1,535.47" "$8,626.25" "$8,626.25" "$4,181.12" "$4,181.12" "$6,649.11" "$2,060.15" "$1,797.81" "$8,626.25" "$3,450.50" "$8,626.25" "$8,626.25" "$8,626.25" "$8,626.25" "$8,626.25" "$6,469.88" "$8,626.25" "$8,626.25" "$8,626.25" "$4,313.13" "$4,313.13" "$6,831.99" "$8,626.25" "$6,901.00" "$5,607.06" "$8,626.25" N/A "$5,003.37" "$8,626.25" "$5,175.75" "$8,626.25" "$8,626.25" "$8,626.25" N/A N/A 2020-6520-1 SUP HCPCS C1713 2020-6520-1 - SCREW BONE 6.5MM 20MM CANCELLOUS BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2020-6525-1 SUP HCPCS C1713 2020-6525-1 - SCREW ACETAB 6.5MM 25MM PRIM HIP CANCELLOUS BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2020-6530-1 SUP HCPCS C1713 2020-6530-1 - SCREW BONE 6.5MM 30MM CANCELLOUS BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2020-6535-1 SUP HCPCS C1713 2020-6535-1 - SCREW ACETAB 6.5MM 35MM PRIM HIP CANCELLOUS BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2020-6540-1 SUP HCPCS C1713 2020-6540-1 - SCREW ACETAB 6.5MM 40MM PRIM HIP CANCELLOUS BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2020-6545-1 SUP HCPCS C1713 2020-6545-1 - SCREW ACETAB 6.5MM 45MM PRIM HIP CANCELLOUS BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2020-6550-1 SUP HCPCS C1713 2020-6550-1 - SCREW ACETAB 6.5MM 50MM PRIM HIP CANCELLOUS BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2020-6555-1 SUP HCPCS C1713 2020-6555-1 - SCREW ACETAB 6.5MM 55MM PRIM HIP CANCELLOUS BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 2020-6560-1 SUP HCPCS C1713 2020-6560-1 - SCREW ACETAB 6.5MM 60MM PRIM HIP CANCELLOUS BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 2028-4520-1 SUP HCPCS C1713 2028-4520-1 - SCREW ACETAB 4.5MM 20MM PRIM SECFIT X-TRA HIP CANCELLOUS BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $152.00 $152.00 $31.68 $152.00 N/A N/A 2028-4525-1 SUP HCPCS C1713 2028-4525-1 - SCREW ACETAB 4.5MM 25MM PRIM SECFIT X-TRA HIP CANCELLOUS BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $152.00 $152.00 $31.68 $152.00 N/A N/A 2028-4530-1 SUP HCPCS C1713 2028-4530-1 - SCREW ACETAB 4.5MM 30MM PRIM SECFIT X-TRA HIP CANCELLOUS BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 2028-4535 SUP HCPCS C1713 2028-4535 - S-FIT X-TRA BN SCRW 4.5 MM BOTH IP/OP $127.00 $94.00 $25.21 $127.00 $57.15 $57.15 $57.15 $57.15 $127.00 $127.00 $127.00 $26.47 $127.00 $127.00 $127.00 $127.00 $127.00 $26.47 $127.00 $127.00 $75.12 $127.00 $127.00 $127.00 $127.00 $95.25 $127.00 $127.00 $127.00 $63.50 $63.50 $100.58 $127.00 $101.60 $57.15 $25.21 N/A $73.66 $127.00 $76.20 $127.00 $26.47 $127.00 N/A N/A 2028-4535-1 SUP HCPCS C1713 2028-4535-1 - SCREW BONE 4.5MM 35MM SECFIT X-TRA CANCELLOUS BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 2028-4540-1 SUP HCPCS C1713 2028-4540-1 - SCREW ACETAB 4.5MM 40MM PRIM SECFIT X-TRA HIP CANCELLOUS BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 2028-4545-1 SUP HCPCS C1713 2028-4545-1 - SCREW ACETAB 4.5MM 45MM PRIM SECFIT X-TRA HIP CANCELLOUS BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 2028-4550-1 SUP HCPCS C1713 2028-4550-1 - SCREW ACETAB 4.5MM 50MM PRIM SECFIT X-TRA HIP CANCELLOUS BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 2028-4555-1 SUP HCPCS C1713 2028-4555-1 - SCREW ACETAB 4.5MM 55MM PRIM SECFIT X-TRA HIP CANCELLOUS BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 2028-4560-1 SUP HCPCS C1713 2028-4560-1 - SCREW ACETAB 4.5MM 60MM PRIM SECFIT X-TRA HIP CANCELLOUS BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 2029-5515-1 SUP HCPCS C1713 2029-5515-1 - SCREW BONE 5.5MM 15MM CANCELLOUS BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2029-5520-1 SUP HCPCS C1713 2029-5520-1 - SCREW ACETAB 5.5MM 20MM SECFIT TRIDENT TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2029-5525-1 SUP HCPCS C1713 2029-5525-1 - SCREW ACETAB 5.5MM 25MM SECFIT TRIDENT TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 2029-5530-1 SUP HCPCS C1713 2029-5530-1 - SCREW ACETAB 5.5MM 30MM SECFIT TRIDENT TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 2029-5535-1 SUP HCPCS C1713 2029-5535-1 - SCREW ACETAB 5.5MM 35MM SECFIT TRIDENT TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 2029-5540-1 SUP HCPCS C1713 2029-5540-1 - SCREW ACETAB 5.5MM 40MM SECFIT TRIDENT TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 2029-5545-1 SUP HCPCS C1713 2029-5545-1 - SCREW ACETAB 5.5MM 45MM SECFIT TRIDENT TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2029-5550-1 SUP HCPCS C1713 2029-5550-1 - SCREW ACETAB 5.5MM 50MM SECFIT TRIDENT TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 2029-5555-1 SUP HCPCS C1713 2029-5555-1 - SCREW ACETAB 5.5MM 55MM SECFIT TRIDENT TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2029-5560-1 SUP HCPCS C1713 2029-5560-1 - SCREW ACETAB 5.5MM 60MM SECFIT TRIDENT TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2030-1125S SUP HCPCS C1713 2030-1125S - NAIL INTRAMEDULLARY R2 LONG 300MM GAMMA3 HIP STERILE SET BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2030-1130S SUP HCPCS C1713 2030-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 30CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2030-1135S SUP HCPCS C1713 2030-1135S - NAIL INTRAMEDULLARY 135D R2 LONG 11MM 300MM LOCK GAMA HIP BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2030-1330S SUP HCPCS C1713 2030-1330S - NAIL INTRAMEDULLARY R2 LONG 300MM GAMMA3 ORTHINOX HIP RIGHT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 203-0602-200 SUP HCPCS C1769 203-0602-200 - GUIDEWIRE VASCULAR .012IN .014IN .010IN 175CM 20CM DISTAL BOTH IP/OP $657.50 $487.00 $130.50 $657.50 $357.02 $357.02 $357.02 $357.02 $657.50 $657.50 $657.50 $137.04 $657.50 $488.00 $488.00 $506.80 $342.56 $137.03 $657.50 $625.00 $388.91 $657.50 $657.50 $657.50 $657.50 $493.13 $657.50 $657.50 $657.50 $328.75 $328.75 $520.74 $657.50 $526.00 $427.38 $130.50 N/A $381.35 $657.50 $657.50 $657.50 $137.02 $657.50 N/A N/A 2030-6516-1 SUP HCPCS C1713 2030-6516-1 - SCREW BN 6.5MM 16MM NS TX TI ACTB CANC BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2030-6520-1 SUP HCPCS C1713 2030-6520-1 - SCREW BN 6.5MM 20MM NS TX TI ACTB CANC BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 2030-6525-1 SUP HCPCS C1713 2030-6525-1 - SCREW ACETAB 6.5MM 25MM SECFIT TRIDENT TITANIUM CANCELLOUS BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 2030-6530-1 SUP HCPCS C1713 2030-6530-1 - SCREW BONE 6.5MM 30MM TRIDENT SECFIT TORX TITANIUM ACETAB BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2030-6535-1 SUP HCPCS C1713 2030-6535-1 - SCREW BN 6.5MM 35MM NS TX TI ACTB CANC BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 2030-6540-1 SUP HCPCS C1713 2030-6540-1 - SCREW BN 6.5MM 40MM NS TX TI ACTB CANC BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2030-6545-1 SUP HCPCS C1713 2030-6545-1 - SCREW BN 6.5MM 45MM NS TX TI ACTB CANC BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 2030-6550-1 SUP HCPCS C1713 2030-6550-1 - SCREW BONE HEMISPHERE 6.5MM 50MM TRIDENT TITANIUM ACETAB BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2030-6555-1 SUP HCPCS C1713 2030-6555-1 - SCREW BONE HEMISPHERE 6.5MM 55MM TRIDENT TITANIUM ACETAB BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2030-6560-1 SUP HCPCS C1713 2030-6560-1 - SCREW BONE HEMISPHERE 6.5MM 60MM TRIDENT TITANIUM ACETAB BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 2032-1125S SUP HCPCS C1713 2032-1125S - NAIL INTRAMEDULLARY R2 LONG 320MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2032-1130S SUP HCPCS C1713 2032-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 32CM KIT GAMA HIP RIGHT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2032-1135S SUP HCPCS C1713 2032-1135S - NAIL INTRAMEDULLARY 135D LONG 11MM 320MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2032-1330S SUP HCPCS C1713 2032-1330S - NAIL INTRAMEDULLARY 130D LONG 13MM 32CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2034-1125S SUP HCPCS C1713 2034-1125S - NAIL INTRAMEDULLARY 125D LONG 11MM 340MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2034-1130S SUP HCPCS C1713 2034-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 34CM KIT GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2034-1135S SUP HCPCS C1713 2034-1135S - NAIL INTRAMEDULLARY 135D LONG 11MM 340MM GAMA HIP RIGHT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2034-1330S SUP HCPCS C1713 2034-1330S - NAIL INTRAMEDULLARY 130D LONG 13MM 34CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2036-1125S SUP HCPCS C1713 2036-1125S - NAIL INTRAMEDULLARY 125D LONG 11MM 36CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2036-1130S SUP HCPCS C1713 2036-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 36CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2036-1135S SUP HCPCS C1713 2036-1135S - NAIL INTRAMEDULLARY 135D LONG 11MM 36CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2036-1330S SUP HCPCS C1713 2036-1330S - NAIL INTRAMEDULLARY 130D LONG 13MM 36CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2038-1125S SUP HCPCS C1713 2038-1125S - NAIL INTRAMEDULLARY 130D LONG 11MM 38CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2038-1130S SUP HCPCS C1713 2038-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 38CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2038-1135S SUP HCPCS C1713 2038-1135S - NAIL INTRAMEDULLARY 135D LONG 11MM 38CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2038-1330S SUP HCPCS C1713 2038-1330S - NAIL INTRAMEDULLARY 130D LONG 13MM 38CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2040-1125S SUP HCPCS C1713 2040-1125S - NAIL INTRAMEDULLARY R2 LONG 400MM GAMMA3 HIP LEFT STERILE BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2040-1130S SUP HCPCS C1713 2040-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 40CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2040-1135S SUP HCPCS C1713 2040-1135S - NAIL INTRAMEDULLARY 135D LONG 11MM 40CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2040-1330S SUP HCPCS C1713 2040-1330S - NAIL INTRAMEDULLARY R2 LONG 400MM GAMMA3 ORTHINOX HIP RIGHT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2041-2240 SUP Custom 27803010 2041-2240 - INSERT ACETAB 10D 40MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2242 SUP Custom 27803010 2041-2242 - INSERT ACETAB 10D 42MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2246 SUP Custom 27803010 2041-2246 - INSERT ACETAB 10D 46MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2250 SUP Custom 27803010 2041-2250 - INSERT ACETAB 10D 50MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2254 SUP Custom 27803010 2041-2254 - INSERT ACETAB 10D 54MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2258 SUP Custom 27803010 2041-2258 - INSERT ACETAB 10D 58MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2262 SUP Custom 27803010 2041-2262 - INSERT ACETAB 10D 62MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2266 SUP Custom 27803010 2041-2266 - INSERT ACETAB 10D 66MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2270 SUP Custom 27803010 2041-2270 - INSERT ACETAB 10D 70MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2274 SUP Custom 27803010 2041-2274 - INSERT ACETAB 10D 74MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2642 SUP Custom 27803010 2041-2642 - INSERT ACETAB 10D 42MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2646 SUP Custom 27803010 2041-2646 - INSERT ACETAB 10D 46MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2650 SUP Custom 27803010 2041-2650 - INSERT ACETAB 10D 50-52MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2654 SUP Custom 27803010 2041-2654 - INSERT ACETAB 10D 54-56MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2658 SUP Custom 27803010 2041-2658 - INSERT ACETAB 10D 58-60MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2662 SUP Custom 27803010 2041-2662 - INSERT ACETAB 10D 62-72MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2666 SUP Custom 27803010 2041-2666 - INSERT ACETAB -10D 66MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2670 SUP Custom 27803010 2041-2670 - INSERT ACETAB 10D 70MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2674 SUP Custom 27803010 2041-2674 - INSERT ACETAB 10D 74MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2846 SUP Custom 27803010 2041-2846 - INSERT ACETAB 10D 46MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2850 SUP Custom 27803010 2041-2850 - INSERT ACETAB 10D 50MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2854 SUP Custom 27803010 2041-2854 - INSERT ACETAB 10D 55-56MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2858 SUP Custom 27803010 2041-2858 - INSERT ACETAB 10D 58MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2862 SUP Custom 27803010 2041-2862 - INSERT ACETAB 10D 62MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2866 SUP Custom 27803010 2041-2866 - INSERT ACETAB 10D 70-72MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2870 SUP Custom 27803010 2041-2870 - INSERT ACETAB 10D 74-76MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-2874 SUP Custom 27803010 2041-2874 - INSERT ACETAB 10D 78-80MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-3250 SUP Custom 27803010 2041-3250 - INSERT ACETAB 10D 50-52MM 32MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2041-3254 SUP Custom 27803010 2041-3254 - INSERT ACETAB 10D 54MM 32MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2041-3258 SUP Custom 27803010 2041-3258 - INSERT ACETAB 10D 58MM 32MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-3262 SUP Custom 27803010 2041-3262 - INSERT ACETAB 10D 62MM 32MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-3266 SUP Custom 27803010 2041-3266 - INSERT ACETAB -10D 66MM 32MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-3270 SUP Custom 27803010 2041-3270 - INSERT ACETAB -10D 70MM 32MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041-3274 SUP Custom 27803010 2041-3274 - INSERT ACETAB 10D 74MM 32MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2041C-2244 SUP Custom 27803010 2041C-2244 - INSERT ACETAB 10D 44MM 22MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2248 SUP Custom 27803010 2041C-2248 - INSERT ACETAB 10D 48MM 22MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2252 SUP Custom 27803010 2041C-2252 - INSERT ACETAB 10D 52MM 22MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2256 SUP Custom 27803010 2041C-2256 - INSERT ACETAB 10D 56MM 22MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2642 SUP Custom 27803010 2041C-2642 - INSERT ACETAB 10D 42MM 26MM XFIRE HIP SERIES II BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2041C-2646 SUP Custom 27803010 2041C-2646 - INSERT ACETAB 10D 46MM 26MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2648 SUP Custom 27803010 2041C-2648 - INSERT ACETAB 10D 48MM 26MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2650 SUP Custom 27803010 2041C-2650 - INSERT ACETAB 10D 50MM 26MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2652 SUP Custom 27803010 2041C-2652 - INSERT ACETAB 10D 52MM 26MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2654 SUP Custom 27803010 2041C-2654 - INSERT ACETAB 10D 54MM 26MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2656 SUP Custom 27803010 2041C-2656 - INSERT ACETAB 10D 56MM 26MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2658 SUP Custom 27803010 2041C-2658 - INSERT ACETAB 10D 58MM 26MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2662 SUP Custom 27803010 2041C-2662 - INSERT ACETAB 10D 62MM 26MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2846 SUP Custom 27803010 2041C-2846 - INSERT ACETAB 10D 46MM 28MM XFIRE HIP SERIES II BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2041C-2848 SUP Custom 27803010 2041C-2848 - INSERT ACETAB 10D 48MM 28MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2850 SUP Custom 27803010 2041C-2850 - INSERT ACETAB 10D 50MM 28MM XFIRE HIP SERIES II BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2041C-2852 SUP Custom 27803010 2041C-2852 - INSERT ACETAB 10D 52MM 28MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2854 SUP Custom 27803010 2041C-2854 - INSERT ACETAB 10D 54-56MM 28MM XFIRE HIP SERIES II BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2041C-2856 SUP Custom 27803010 2041C-2856 - INSERT ACETAB 10D 56MM 28MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-2858 SUP Custom 27803010 2041C-2858 - INSERT ACETAB 10D 58MM 28MM XFIRE HIP SERIES II BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2041C-2862 SUP Custom 27803010 2041C-2862 - INSERT ACETAB 10D 62-72MM 28MM XFIRE HIP SERIES II BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2041C-3250 SUP Custom 27803010 2041C-3250 - INSERT ACETAB 10D 50-52MM 32MM XFIRE HIP SERIES II BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2041C-3254 SUP Custom 27803010 2041C-3254 - INSERT ACETAB 10D 54MM 32MM XFIRE HIP SERIES II BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2041C-3256 SUP Custom 27803010 2041C-3256 - INSERT ACETAB 10D 56MM 32MM XFIRE HIP SERIES II BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2041C-3258 SUP Custom 27803010 2041C-3258 - INSERT ACETAB 10D 58-60MM 32MM XFIRE HIP SERIES II BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2041C-3262 SUP Custom 27803010 2041C-3262 - INSERT ACETAB 10D 62MM 32MM XFIRE HIP SERIES II BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2041C-3266 SUP Custom 27803010 2041C-3266 - INSERT ACETAB 10D 66MM 32MM XFIRE HIP SERIES II BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2041C-3270 SUP Custom 27803010 2041C-3270 - INSERT ACETAB 10D 70MM 32MM XFIRE HIP SERIES II BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2041C-3274 SUP Custom 27803010 2041C-3274 - INSERT ACETAB 10D 74MM 32MM XFIRE HIP SERIES II BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2041-H-228 SUP Custom 27803010 2041-H-228 - LINER ACETAB 46-48MM 28MM SERIES II CONSTRAINED HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 2041J-2246 SUP Custom 27803010 2041J-2246 - INSERT ACETAB 10D 46MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 2041-N-228 SUP Custom 27803010 2041-N-228 - LINER ACETAB 46-48MM 28MM SERIES II CONSTRAINED HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 2041-N-532 SUP Custom 27803010 2041-N-532 - LINER ACETAB 58-60MM 32MM SERIES II CONSTRAINED HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 2042-1125S SUP HCPCS C1713 2042-1125S - NAIL INTRAMEDULLARY 125D LONG 11MM 42CM GAMMA3 TITANIUM HIP BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2042-1130S SUP HCPCS C1713 2042-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 42CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2042-1135S SUP HCPCS C1713 2042-1135S - NAIL INTRAMEDULLARY 135D LONG 11MM 420MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2042-1330S SUP HCPCS C1713 2042-1330S - NAIL INTRAMEDULLARY 130D LONG 13MM 42CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2042-2240 SUP Custom 27803010 2042-2240 - INSERT ACETAB 20D 40MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-2242 SUP Custom 27803010 2042-2242 - INSERT ACETAB 20D 42MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-2246 SUP Custom 27803010 2042-2246 - INSERT ACETAB 20D 46MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-2250 SUP Custom 27803010 2042-2250 - INSERT ACETAB 20D 50MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-2254 SUP Custom 27803010 2042-2254 - INSERT ACETAB 20D 54MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-2258 SUP Custom 27803010 2042-2258 - INSERT ACETAB 20D 58MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-2262 SUP Custom 27803010 2042-2262 - INSERT ACETAB 20D 62MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-2266 SUP Custom 27803010 2042-2266 - INSERT ACETAB 20D 66MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-2270 SUP Custom 27803010 2042-2270 - INSERT ACETAB 20D 70MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-2274 SUP Custom 27803010 2042-2274 - INSERT ACETAB 20D 74MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-2642 SUP Custom 27803010 2042-2642 - INSERT ACETAB 20D 42MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-2646 SUP Custom 27803010 2042-2646 - INSERT ACETAB 20D 50MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-2650 SUP Custom 27803010 2042-2650 - INSERT ACETAB 20D 50MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-2654 SUP Custom 27803010 2042-2654 - INSERT ACETAB 20D 54MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-2658 SUP Custom 27803010 2042-2658 - INSERT ACETAB 20D 58MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-2662 SUP Custom 27803010 2042-2662 - INSERT ACETAB 20D 62MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-2666 SUP Custom 27803010 2042-2666 - INSERT ACETAB 20D 66MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-2670 SUP Custom 27803010 2042-2670 - INSERT ACETAB 20D 70MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-2674 SUP Custom 27803010 2042-2674 - INSERT ACETAB 20D 74MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-2846 SUP Custom 27803010 2042-2846 - INSERT ACETAB 20D 46MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-2850 SUP Custom 27803010 2042-2850 - INSERT ACETAB 20D 50MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-2854 SUP Custom 27803010 2042-2854 - INSERT ACETAB 20D 54MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-2858 SUP Custom 27803010 2042-2858 - INSERT ACETAB 20D 58MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-2862 SUP Custom 27803010 2042-2862 - INSERT ACETAB 20D 62-72MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-2866 SUP Custom 27803010 2042-2866 - INSERT ACETAB 20D 66MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-2870 SUP Custom 27803010 2042-2870 - INSERT ACETAB 20D 70MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-2874 SUP Custom 27803010 2042-2874 - INSERT ACETAB 20D 74MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042-3250 SUP Custom 27803010 2042-3250 - INSERT ACETAB 20D 50MM 32MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-3254 SUP Custom 27803010 2042-3254 - INSERT ACETAB 20D 54MM 32MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-3258 SUP Custom 27803010 2042-3258 - INSERT ACETAB 20D 58-60MM 32MM OMNIFIT HIP BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-3262 SUP Custom 27803010 2042-3262 - INSERT ACETAB 20D 62MM 32MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-3266 SUP Custom 27803010 2042-3266 - INSERT ACETAB 20D 66MM 32MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-3270 SUP Custom 27803010 2042-3270 - INSERT ACETAB 20D 70MM 32MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,767.50" "$1,308.00" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $314.62 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" $368.37 "$1,767.50" $707.00 "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,767.50" "$1,325.63" "$1,767.50" "$1,767.50" "$1,767.50" $883.75 $883.75 "$1,399.86" "$1,767.50" "$1,414.00" $795.38 "$1,767.50" N/A "$1,025.15" "$1,767.50" "$1,060.50" "$1,767.50" "$1,767.50" "$1,767.50" N/A N/A 2042-3274 SUP Custom 27803010 2042-3274 - INSERT ACETAB 20D 74MM 32MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2042C-2244 SUP Custom 27803010 2042C-2244 - INSERT ACETAB 20D 22MM XFIRE HIP SERIES II BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2042C-2248 SUP Custom 27803010 2042C-2248 - INSERT ACETAB 20D 22MM XFIRE HIP SERIES II BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2042C-2252 SUP Custom 27803010 2042C-2252 - INSERT ACETAB 20D 22MM XFIRE HIP SERIES II BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2042C-2256 SUP Custom 27803010 2042C-2256 - INSERT ACETAB 20D 22MM XFIRE HIP SERIES II BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2042C-2648 SUP Custom 27803010 2042C-2648 - INSERT ACETAB 20D 26MM XFIRE HIP SERIES II BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2042C-2652 SUP Custom 27803010 2042C-2652 - INSERT ACETAB 20D 26MM XFIRE HIP SERIES II BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2042C-2656 SUP Custom 27803010 2042C-2656 - INSERT ACETAB 20D 26MM XFIRE HIP SERIES II BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2042C-2848 SUP Custom 27803010 2042C-2848 - INSERT ACETAB 20D 48MM 28MM XFIRE HIP SERIES II BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2042C-2852 SUP Custom 27803010 2042C-2852 - INSERT ACETAB 20D 52MM 28MM XFIRE HIP SERIES II BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2042C-2856 SUP Custom 27803010 2042C-2856 - INSERT ACETAB 20D 56MM 28MM XFIRE HIP SERIES II BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2042C-3256 SUP Custom 27803010 2042C-3256 - INSERT ACETAB 20D 56MM 32MM XFIRE HIP SERIES II BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2043-2240 SUP Custom 27803010 2043-2240 - INSERT ACETAB 0D 40MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2242 SUP Custom 27803010 2043-2242 - INSERT ACETAB 0D 42MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2246 SUP Custom 27803010 2043-2246 - INSERT ACETAB 0D 46-48MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2250 SUP Custom 27803010 2043-2250 - INSERT ACETAB 0D 50-52MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2254 SUP Custom 27803010 2043-2254 - INSERT ACETAB 0D 54-56MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2258 SUP Custom 27803010 2043-2258 - INSERT ACETAB 0D 58-60MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2262 SUP Custom 27803010 2043-2262 - INSERT ACETAB 0D 62-72MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2266 SUP Custom 27803010 2043-2266 - INSERT ACETAB 0D 66MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2270 SUP Custom 27803010 2043-2270 - INSERT ACETAB 0D 70MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2274 SUP Custom 27803010 2043-2274 - INSERT ACETAB 0D 74MM 22MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2642 SUP Custom 27803010 2043-2642 - INSERT ACETAB 0D 42MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2646 SUP Custom 27803010 2043-2646 - INSERT ACETAB 0D 46MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2650 SUP Custom 27803010 2043-2650 - INSERT ACETAB 0D 50-52MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2654 SUP Custom 27803010 2043-2654 - INSERT ACETAB 0D 54-56MM 26MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2658 SUP Custom 27803010 2043-2658 - INSERT ACETAB 0D 58MM ID 26MM OMNIFIT HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2662 SUP Custom 27803010 2043-2662 - INSERT ACETAB 0D 62-72MM 26MM OMNIFIT HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2666 SUP Custom 27803010 2043-2666 - INSERT ACETAB 0D 66MM 26MM OMNIFIT HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2670 SUP Custom 27803010 2043-2670 - INSERT ACETAB 0D 70MM 26MM OMNIFIT HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2674 SUP Custom 27803010 2043-2674 - INSERT ACETAB 0D 74MM 26MM OMNIFIT HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2846 SUP Custom 27803010 2043-2846 - INSERT ACETAB 0D 46-48MM 28MM SERIES II OMNIFIT UHMWPE HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2850 SUP Custom 27803010 2043-2850 - INSERT ACETAB 0D 50-52MM 28MM SERIES II OMNIFIT UHMWPE HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2854 SUP Custom 27803010 2043-2854 - INSERT ACETAB 0D 54-56MM 28MM SERIES II OMNIFIT UHMWPE HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2858 SUP Custom 27803010 2043-2858 - INSERT ACETAB 0D 58-60MM 28MM SERIES II OMNIFIT UHMWPE HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2862 SUP Custom 27803010 2043-2862 - INSERT ACETAB 0D 62-72MM 28MM OMNIFIT HIP SERIES II BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2866 SUP Custom 27803010 2043-2866 - INSERT ACETAB 0D 66MM 28MM OMNIFIT HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2870 SUP Custom 27803010 2043-2870 - INSERT ACETAB 0D 70MM 28MM OMNIFIT HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-2874 SUP Custom 27803010 2043-2874 - INSERT ACETAB 0D 74MM 28MM OMNIFIT HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-3246 SUP Custom 27803010 2043-3246 - INSERT ACETAB 0D 46-48MM 32MM OMNIFIT HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-3250 SUP Custom 27803010 2043-3250 - INSERT ACETAB 0D 50-52MM 32MM SERIES II OMNIFIT UHMWPE HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-3254 SUP Custom 27803010 2043-3254 - INSERT ACETAB 0D 54-56MM 32MM SERIES II OMNIFIT UHMWPE HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-3258 SUP Custom 27803010 2043-3258 - INSERT ACETAB 0D 58-60MM 32MM SERIES II OMNIFIT UHMWPE HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-3262 SUP Custom 27803010 2043-3262 - INSERT ACETAB 0D 62-70MM 32MM SERIES II OMNIFIT UHMWPE HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-3266 SUP Custom 27803010 2043-3266 - INSERT ACETAB 0D 66MM 32MM OMNIFIT HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-3270 SUP Custom 27803010 2043-3270 - INSERT ACETAB 0D 70MM 32MM OMNIFIT HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043-3274 SUP Custom 27803010 2043-3274 - INSERT ACETAB 0D 74MM 32MM OMNIFIT HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 2043C-2642 SUP Custom 27803010 2043C-2642 - INSERT ACETAB 0D 42MM 26MM SERIES II XFIRE HIP BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2043C-2646 SUP Custom 27803010 2043C-2646 - INSERT ACETAB 0D 46MM 26MM SERIES II XFIRE HIP BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2043C-2650 SUP Custom 27803010 2043C-2650 - INSERT ACETAB 0D 50-52MM 26MM LINER XFIRE HIP BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2043C-2654 SUP Custom 27803010 2043C-2654 - INSERT ACETAB 0D 54-56MM 28MM LINER XFIRE HIP BOTH IP/OP "$1,610.00" "$1,191.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $286.58 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" $644.00 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 "$1,610.00" N/A $933.80 "$1,610.00" $966.00 "$1,610.00" "$1,610.00" "$1,610.00" N/A N/A 2043C-2846 SUP Custom 27803010 2043C-2846 - INSERT ACETAB 0D 46MM 28MM XFIRE HIP BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2043C-2850 SUP Custom 27803010 2043C-2850 - INSERT ACETAB 0D 50-52MM 28MM SERIES II XFIRE HIP BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2043C-2854 SUP Custom 27803010 2043C-2854 - INSERT ACETAB 0D 54-56MM 28MM 11.4MM SERIES II OMNIFIT XFIRE BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2043C-2858 SUP Custom 27803010 2043C-2858 - INSERT ACETAB 0D 58-60MM 28MM SERIES II XFIRE HIP BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2043C-2862 SUP Custom 27803010 2043C-2862 - INSERT ACETAB 0D 62-72MM 28MM SERIES II XFIRE HIP BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2043C-2866 SUP Custom 27803010 2043C-2866 - INSERT ACETAB 0D 66MM 28MM XFIRE HIP BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2043C-3250 SUP Custom 27803010 2043C-3250 - INSERT ACETAB 0D 50MM 32MM XFIRE HIP BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2043C-3254 SUP Custom 27803010 2043C-3254 - INSERT ACETAB 0D 32MM LINER XFIRE HIP BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2043C-3258 SUP Custom 27803010 2043C-3258 - INSERT ACETAB 0D 58-60MM 32MM SERIES II XFIRE HIP BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2043C-3262 SUP Custom 27803010 2043C-3262 - INSERT ACETAB 10D 62MM 32MM XFIRE HIP BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2043C-3266 SUP Custom 27803010 2043C-3266 - INSERT ACETAB 0D 66MM 32MM XFIRE HIP BOTH IP/OP "$2,397.50" "$1,774.00" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $426.76 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" $499.67 "$2,397.50" $959.00 "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$2,397.50" "$1,798.13" "$2,397.50" "$2,397.50" "$2,397.50" "$1,198.75" "$1,198.75" "$1,898.82" "$2,397.50" "$1,918.00" "$1,078.88" "$2,397.50" N/A "$1,390.55" "$2,397.50" "$1,438.50" "$2,397.50" "$2,397.50" "$2,397.50" N/A N/A 2043C-3270 SUP Custom 27803010 2043C-3270 - INSERT ACETAB 0D 70MM 32MM XFIRE HIP BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2043C-3274 SUP Custom 27803010 2043C-3274 - INSERT ACETAB 0D 74MM 32MM XFIRE HIP BOTH IP/OP "$2,720.00" "$2,013.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $484.16 "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" $566.88 "$2,720.00" "$1,088.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,720.00" "$2,040.00" "$2,720.00" "$2,720.00" "$2,720.00" "$1,360.00" "$1,360.00" "$2,154.24" "$2,720.00" "$2,176.00" "$1,224.00" "$2,720.00" N/A "$1,577.60" "$2,720.00" "$1,632.00" "$2,720.00" "$2,720.00" "$2,720.00" N/A N/A 2044-1125S SUP HCPCS C1713 2044-1125S - NAIL INTRAMEDULLARY R2 LONG 440MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" "$2,908.13" "$2,908.13" N/A N/A 2044-1130S SUP HCPCS C1713 2044-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 44CM GAMA TITANIUM HIP BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" "$2,908.13" "$2,908.13" N/A N/A 2044-1135S SUP HCPCS C1713 2044-1135S - NAIL INTRAMEDULLARY 130D LONG 11MM 44CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2044-1330S SUP HCPCS C1713 2044-1330S - NAIL INTRAMEDULLARY R2 LONG 440MM GAMMA3 ORTHINOX HIP RIGHT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" "$2,908.13" "$2,908.13" N/A N/A 2050-2040 SUP Custom 27803010 2050-2040 - SHELL ACETAB 40MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 2050-2040CS SUP Custom 27803010 2050-2040CS - SHELL ACETAB 40MM SECFIT PSL HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 2050-2042 SUP Custom 27803010 2050-2042 - SHELL ACETAB 42MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 2050-2042CS SUP Custom 27803010 2050-2042CS - SHELL ACETAB 42MM SECFIT PSL HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 2050-2044 SUP Custom 27803010 2050-2044 - SHELL ACETAB 44MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 2050-2044CS SUP Custom 27803010 2050-2044CS - SHELL ACETAB 44MM SECFIT PSL HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 2050-2046 SUP Custom 27803010 2050-2046 - SHELL ACETAB 46MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,377.00" "$1,759.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $495.39 "$2,377.00" $950.80 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$1,782.75" "$2,377.00" "$2,377.00" "$2,377.00" "$1,188.50" "$1,188.50" "$1,882.58" "$2,377.00" "$1,901.60" "$1,069.65" "$2,377.00" N/A "$1,378.66" "$2,377.00" "$1,426.20" "$2,377.00" "$2,377.00" "$2,377.00" N/A N/A 2050-2048 SUP Custom 27803010 2050-2048 - SHELL ACETAB 48MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,377.00" "$1,759.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $495.39 "$2,377.00" $950.80 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$1,782.75" "$2,377.00" "$2,377.00" "$2,377.00" "$1,188.50" "$1,188.50" "$1,882.58" "$2,377.00" "$1,901.60" "$1,069.65" "$2,377.00" N/A "$1,378.66" "$2,377.00" "$1,426.20" "$2,377.00" "$2,377.00" "$2,377.00" N/A N/A 2050-2050 SUP Custom 27803010 2050-2050 - SHELL ACETAB 50MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,377.00" "$1,759.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $495.39 "$2,377.00" $950.80 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$1,782.75" "$2,377.00" "$2,377.00" "$2,377.00" "$1,188.50" "$1,188.50" "$1,882.58" "$2,377.00" "$1,901.60" "$1,069.65" "$2,377.00" N/A "$1,378.66" "$2,377.00" "$1,426.20" "$2,377.00" "$2,377.00" "$2,377.00" N/A N/A 2050-2052 SUP Custom 27803010 2050-2052 - SHELL ACETAB 52MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,377.00" "$1,759.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $495.39 "$2,377.00" $950.80 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$1,782.75" "$2,377.00" "$2,377.00" "$2,377.00" "$1,188.50" "$1,188.50" "$1,882.58" "$2,377.00" "$1,901.60" "$1,069.65" "$2,377.00" N/A "$1,378.66" "$2,377.00" "$1,426.20" "$2,377.00" "$2,377.00" "$2,377.00" N/A N/A 2050-2054 SUP Custom 27803010 2050-2054 - SHELL ACETAB 54MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,377.00" "$1,759.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $495.39 "$2,377.00" $950.80 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$1,782.75" "$2,377.00" "$2,377.00" "$2,377.00" "$1,188.50" "$1,188.50" "$1,882.58" "$2,377.00" "$1,901.60" "$1,069.65" "$2,377.00" N/A "$1,378.66" "$2,377.00" "$1,426.20" "$2,377.00" "$2,377.00" "$2,377.00" N/A N/A 2050-2056 SUP Custom 27803010 2050-2056 - SHELL ACETAB 56MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,377.00" "$1,759.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $495.39 "$2,377.00" $950.80 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$1,782.75" "$2,377.00" "$2,377.00" "$2,377.00" "$1,188.50" "$1,188.50" "$1,882.58" "$2,377.00" "$1,901.60" "$1,069.65" "$2,377.00" N/A "$1,378.66" "$2,377.00" "$1,426.20" "$2,377.00" "$2,377.00" "$2,377.00" N/A N/A 2050-2058 SUP Custom 27803010 2050-2058 - SHELL ACETAB 58MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,377.00" "$1,759.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $495.39 "$2,377.00" $950.80 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$1,782.75" "$2,377.00" "$2,377.00" "$2,377.00" "$1,188.50" "$1,188.50" "$1,882.58" "$2,377.00" "$1,901.60" "$1,069.65" "$2,377.00" N/A "$1,378.66" "$2,377.00" "$1,426.20" "$2,377.00" "$2,377.00" "$2,377.00" N/A N/A 2050-2060 SUP Custom 27803010 2050-2060 - SHELL ACETAB 60MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,377.00" "$1,759.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $495.39 "$2,377.00" $950.80 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$1,782.75" "$2,377.00" "$2,377.00" "$2,377.00" "$1,188.50" "$1,188.50" "$1,882.58" "$2,377.00" "$1,901.60" "$1,069.65" "$2,377.00" N/A "$1,378.66" "$2,377.00" "$1,426.20" "$2,377.00" "$2,377.00" "$2,377.00" N/A N/A 2050-2062 SUP Custom 27803010 2050-2062 - SHELL ACETAB 62MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,377.00" "$1,759.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $495.39 "$2,377.00" $950.80 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$1,782.75" "$2,377.00" "$2,377.00" "$2,377.00" "$1,188.50" "$1,188.50" "$1,882.58" "$2,377.00" "$1,901.60" "$1,069.65" "$2,377.00" N/A "$1,378.66" "$2,377.00" "$1,426.20" "$2,377.00" "$2,377.00" "$2,377.00" N/A N/A 2050-2064 SUP Custom 27803010 2050-2064 - SHELL ACETAB 64MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,377.00" "$1,759.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $423.11 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" $495.39 "$2,377.00" $950.80 "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$2,377.00" "$1,782.75" "$2,377.00" "$2,377.00" "$2,377.00" "$1,188.50" "$1,188.50" "$1,882.58" "$2,377.00" "$1,901.60" "$1,069.65" "$2,377.00" N/A "$1,378.66" "$2,377.00" "$1,426.20" "$2,377.00" "$2,377.00" "$2,377.00" N/A N/A 2050-2066 SUP Custom 27803010 2050-2066 - SHELL ACETAB 66MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 2050-2068 SUP Custom 27803010 2050-2068 - SHELL ACETAB 68MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 2050-2070 SUP Custom 27803010 2050-2070 - SHELL ACETAB 70MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 2050-2072 SUP Custom 27803010 2050-2072 - SHELL ACETAB 72MM CLSHOLE SECFIT PSL HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 2050-3040 SUP Custom 27803010 2050-3040 - SHELL ACETAB 40MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3042 SUP Custom 27803010 2050-3042 - SHELL ACETAB 42MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3044 SUP Custom 27803010 2050-3044 - SHELL ACETAB 44MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3046 SUP Custom 27803010 2050-3046 - SHELL ACETAB 46MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3048 SUP Custom 27803010 2050-3048 - SHELL ACETAB 48MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3050 SUP Custom 27803010 2050-3050 - SHELL ACETAB 50MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3052 SUP Custom 27803010 2050-3052 - SHELL ACETAB 52MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3054 SUP Custom 27803010 2050-3054 - SHELL ACETAB 54MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3056 SUP Custom 27803010 2050-3056 - SHELL ACETAB 56MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3058 SUP Custom 27803010 2050-3058 - SHELL ACETAB 58MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3060 SUP Custom 27803010 2050-3060 - SHELL ACETAB 60MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3062 SUP Custom 27803010 2050-3062 - SHELL ACETAB 62MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3064 SUP Custom 27803010 2050-3064 - SHELL ACETAB 64MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3066 SUP Custom 27803010 2050-3066 - SHELL ACETAB 66MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3068 SUP Custom 27803010 2050-3068 - SHELL ACETAB 68MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3070 SUP Custom 27803010 2050-3070 - SHELL ACETAB 70MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-3072 SUP Custom 27803010 2050-3072 - SHELL ACETAB 72MM SCREWLESS SECFIT PSL HIP BOTH IP/OP "$2,505.00" "$1,854.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $445.89 "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" $522.07 "$2,505.00" "$1,002.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$2,505.00" "$1,878.75" "$2,505.00" "$2,505.00" "$2,505.00" "$1,252.50" "$1,252.50" "$1,983.96" "$2,505.00" "$2,004.00" "$1,127.25" "$2,505.00" N/A "$1,452.90" "$2,505.00" "$1,503.00" "$2,505.00" "$2,505.00" "$2,505.00" N/A N/A 2050-5060P SUP Custom 27803010 2050-5060P - SHELL ACETAB ARC DEPOSIT OPTION SECFIT BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2040 SUP Custom 27803010 2051-2040 - SHELL ACETAB 40MM CLSHOLE SECFIT PSL HA HIP BOTH IP/OP "$2,135.00" "$1,580.00" $380.03 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" $380.03 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" $444.96 "$2,135.00" $854.00 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$1,601.25" "$2,135.00" "$2,135.00" "$2,135.00" "$1,067.50" "$1,067.50" "$1,690.92" "$2,135.00" "$1,708.00" $960.75 "$2,135.00" N/A "$1,238.30" "$2,135.00" "$1,281.00" "$2,135.00" "$2,135.00" "$2,135.00" N/A N/A 2051-2040P SUP Custom 27803010 2051-2040P - CUP ACETAB 40MM CLSHOLE SECFIT PSL HA HIP BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2042 SUP Custom 27803010 2051-2042 - SHELL ACETAB 42MM CLSHOLE SECFIT PSL HA HIP BOTH IP/OP "$2,135.00" "$1,580.00" $380.03 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" $380.03 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" $444.96 "$2,135.00" $854.00 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$1,601.25" "$2,135.00" "$2,135.00" "$2,135.00" "$1,067.50" "$1,067.50" "$1,690.92" "$2,135.00" "$1,708.00" $960.75 "$2,135.00" N/A "$1,238.30" "$2,135.00" "$1,281.00" "$2,135.00" "$2,135.00" "$2,135.00" N/A N/A 2051-2042P SUP Custom 27803010 2051-2042P - SHELL ACETAB 42MM CLSHOLE SECFIT PSL HA HIP BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2044 SUP Custom 27803010 2051-2044 - SHELL ACETAB 44MM CLSHOLE SECFIT PSL HA HIP BOTH IP/OP "$2,135.00" "$1,580.00" $380.03 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" $380.03 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" $444.96 "$2,135.00" $854.00 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$1,601.25" "$2,135.00" "$2,135.00" "$2,135.00" "$1,067.50" "$1,067.50" "$1,690.92" "$2,135.00" "$1,708.00" $960.75 "$2,135.00" N/A "$1,238.30" "$2,135.00" "$1,281.00" "$2,135.00" "$2,135.00" "$2,135.00" N/A N/A 2051-2044P SUP Custom 27803010 2051-2044P - SHELL ACETAB 44MM CLSHOLE SECFIT PSL HA HIP BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2046 SUP Custom 27803010 2051-2046 - SHELL ACETAB 46MM CLSHOLE SECFIT PSL HA HIP BOTH IP/OP "$2,102.00" "$1,555.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $438.08 "$2,102.00" $840.80 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$1,576.50" "$2,102.00" "$2,102.00" "$2,102.00" "$1,051.00" "$1,051.00" "$1,664.78" "$2,102.00" "$1,681.60" $945.90 "$2,102.00" N/A "$1,219.16" "$2,102.00" "$1,261.20" "$2,102.00" "$2,102.00" "$2,102.00" N/A N/A 2051-2046P SUP Custom 27803010 2051-2046P - CUP ACETAB 46MM CLSHOLE SECFIT PSL HA HIP BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2048 SUP Custom 27803010 2051-2048 - SHELL ACETAB 48MM CLUSTER CUP SECFIT PSL HA HIP BOTH IP/OP "$2,102.00" "$1,555.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $438.08 "$2,102.00" $840.80 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$1,576.50" "$2,102.00" "$2,102.00" "$2,102.00" "$1,051.00" "$1,051.00" "$1,664.78" "$2,102.00" "$1,681.60" $945.90 "$2,102.00" N/A "$1,219.16" "$2,102.00" "$1,261.20" "$2,102.00" "$2,102.00" "$2,102.00" N/A N/A 2051-2048P SUP Custom 27803010 2051-2048P - SHELL ACETAB 48MM CLSHOLE SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2050 SUP Custom 27803010 2051-2050 - SHELL ACETAB 50MM CLUSTER CUP SECFIT PSL HA HIP BOTH IP/OP "$2,102.00" "$1,555.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $438.08 "$2,102.00" $840.80 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$1,576.50" "$2,102.00" "$2,102.00" "$2,102.00" "$1,051.00" "$1,051.00" "$1,664.78" "$2,102.00" "$1,681.60" $945.90 "$2,102.00" N/A "$1,219.16" "$2,102.00" "$1,261.20" "$2,102.00" "$2,102.00" "$2,102.00" N/A N/A 2051-2050P SUP Custom 27803010 2051-2050P - SHELL ACETAB 50MM CLSHOLE SECFIT HYDRXAPT PSL HIP BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2052 SUP Custom 27803010 2051-2052 - SHELL ACETAB 52MM CLUSTER CUP SECFIT PSL HA HIP BOTH IP/OP "$2,102.00" "$1,555.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $438.08 "$2,102.00" $840.80 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$1,576.50" "$2,102.00" "$2,102.00" "$2,102.00" "$1,051.00" "$1,051.00" "$1,664.78" "$2,102.00" "$1,681.60" $945.90 "$2,102.00" N/A "$1,219.16" "$2,102.00" "$1,261.20" "$2,102.00" "$2,102.00" "$2,102.00" N/A N/A 2051-2052P SUP Custom 27803010 2051-2052P - SHELL ACETAB 52MM CLSHOLE SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2054 SUP Custom 27803010 2051-2054 - SHELL ACETAB 54MM CLUSTER CUP SECFIT PSL HA HIP BOTH IP/OP "$2,102.00" "$1,555.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $438.08 "$2,102.00" $840.80 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$1,576.50" "$2,102.00" "$2,102.00" "$2,102.00" "$1,051.00" "$1,051.00" "$1,664.78" "$2,102.00" "$1,681.60" $945.90 "$2,102.00" N/A "$1,219.16" "$2,102.00" "$1,261.20" "$2,102.00" "$2,102.00" "$2,102.00" N/A N/A 2051-2054P SUP Custom 27803010 2051-2054P - CUP ACETAB 54MM CLUSTER SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2056 SUP Custom 27803010 2051-2056 - SHELL ACETAB 56MM CLUSTER CUP SECFIT PSL HA HIP BOTH IP/OP "$2,102.00" "$1,555.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $438.08 "$2,102.00" $840.80 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$1,576.50" "$2,102.00" "$2,102.00" "$2,102.00" "$1,051.00" "$1,051.00" "$1,664.78" "$2,102.00" "$1,681.60" $945.90 "$2,102.00" N/A "$1,219.16" "$2,102.00" "$1,261.20" "$2,102.00" "$2,102.00" "$2,102.00" N/A N/A 2051-2056P SUP Custom 27803010 2051-2056P - CUP ACETAB 56MM CLUSTER SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2058 SUP Custom 27803010 2051-2058 - CUP ACETAB 58MM CLUSTER SCREW HOLE SECFIT HYDRXAPT HIP BOTH IP/OP "$2,102.00" "$1,555.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $438.08 "$2,102.00" $840.80 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$1,576.50" "$2,102.00" "$2,102.00" "$2,102.00" "$1,051.00" "$1,051.00" "$1,664.78" "$2,102.00" "$1,681.60" $945.90 "$2,102.00" N/A "$1,219.16" "$2,102.00" "$1,261.20" "$2,102.00" "$2,102.00" "$2,102.00" N/A N/A 2051-2058P SUP Custom 27803010 2051-2058P - CUP ACETAB 58MM CLUSTER SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2060 SUP Custom 27803010 2051-2060 - SHELL ACETAB 60MM CLUSTER CUP SECFIT PSL HA HIP BOTH IP/OP "$2,102.00" "$1,555.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $438.08 "$2,102.00" $840.80 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$1,576.50" "$2,102.00" "$2,102.00" "$2,102.00" "$1,051.00" "$1,051.00" "$1,664.78" "$2,102.00" "$1,681.60" $945.90 "$2,102.00" N/A "$1,219.16" "$2,102.00" "$1,261.20" "$2,102.00" "$2,102.00" "$2,102.00" N/A N/A 2051-2060P SUP Custom 27803010 2051-2060P - CUP ACETAB 60MM CLUSTER SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2062 SUP Custom 27803010 2051-2062 - SHELL ACETAB CLSHOLE SECFIT PSL HYDRXAPT BOTH IP/OP "$2,102.00" "$1,555.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $438.08 "$2,102.00" $840.80 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$1,576.50" "$2,102.00" "$2,102.00" "$2,102.00" "$1,051.00" "$1,051.00" "$1,664.78" "$2,102.00" "$1,681.60" $945.90 "$2,102.00" N/A "$1,219.16" "$2,102.00" "$1,261.20" "$2,102.00" "$2,102.00" "$2,102.00" N/A N/A 2051-2062P SUP Custom 27803010 2051-2062P - CUP ACETAB 62MM CLUSTER SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2064 SUP Custom 27803010 2051-2064 - SHELL ACETAB 64MM CLSHOLE SECFIT PUREFIX HYDRXAPT HIP BOTH IP/OP "$2,102.00" "$1,555.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $374.16 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" $438.08 "$2,102.00" $840.80 "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$2,102.00" "$1,576.50" "$2,102.00" "$2,102.00" "$2,102.00" "$1,051.00" "$1,051.00" "$1,664.78" "$2,102.00" "$1,681.60" $945.90 "$2,102.00" N/A "$1,219.16" "$2,102.00" "$1,261.20" "$2,102.00" "$2,102.00" "$2,102.00" N/A N/A 2051-2064P SUP Custom 27803010 2051-2064P - CUP ACETAB 64MM CLUSTER SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2066 SUP Custom 27803010 2051-2066 - SHELL ACETAB 66MM CLSHOLE SECFIT HYDRXAPT HIP BOTH IP/OP "$2,135.00" "$1,580.00" $380.03 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" $380.03 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" $444.96 "$2,135.00" $854.00 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$1,601.25" "$2,135.00" "$2,135.00" "$2,135.00" "$1,067.50" "$1,067.50" "$1,690.92" "$2,135.00" "$1,708.00" $960.75 "$2,135.00" N/A "$1,238.30" "$2,135.00" "$1,281.00" "$2,135.00" "$2,135.00" "$2,135.00" N/A N/A 2051-2066P SUP Custom 27803010 2051-2066P - CUP ACETAB 66MM CLSHOLE SECFIT PSL HA BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2068 SUP Custom 27803010 2051-2068 - SHELL ACETAB 68MM CLSHOLE SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,135.00" "$1,580.00" $380.03 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" $380.03 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" $444.96 "$2,135.00" $854.00 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$1,601.25" "$2,135.00" "$2,135.00" "$2,135.00" "$1,067.50" "$1,067.50" "$1,690.92" "$2,135.00" "$1,708.00" $960.75 "$2,135.00" N/A "$1,238.30" "$2,135.00" "$1,281.00" "$2,135.00" "$2,135.00" "$2,135.00" N/A N/A 2051-2068P SUP Custom 27803010 2051-2068P - CUP ACETAB 68MM CLSHOLE SECFIT PSL HA BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2070 SUP Custom 27803010 2051-2070 - SHELL ACETAB 70MM CLSHOLE SECFIT HYDRXAPT HIP BOTH IP/OP "$2,135.00" "$1,580.00" $380.03 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" $380.03 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" $444.96 "$2,135.00" $854.00 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$1,601.25" "$2,135.00" "$2,135.00" "$2,135.00" "$1,067.50" "$1,067.50" "$1,690.92" "$2,135.00" "$1,708.00" $960.75 "$2,135.00" N/A "$1,238.30" "$2,135.00" "$1,281.00" "$2,135.00" "$2,135.00" "$2,135.00" N/A N/A 2051-2070P SUP Custom 27803010 2051-2070P - CUP ACETAB 70MM CLSHOLE SECFIT PSL HA BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-2072 SUP Custom 27803010 2051-2072 - SHELL ACETAB 72MM CLSHOLE SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,135.00" "$1,580.00" $380.03 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" $380.03 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" $444.96 "$2,135.00" $854.00 "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$2,135.00" "$1,601.25" "$2,135.00" "$2,135.00" "$2,135.00" "$1,067.50" "$1,067.50" "$1,690.92" "$2,135.00" "$1,708.00" $960.75 "$2,135.00" N/A "$1,238.30" "$2,135.00" "$1,281.00" "$2,135.00" "$2,135.00" "$2,135.00" N/A N/A 2051-2072P SUP Custom 27803010 2051-2072P - SHELL ACETAB 72MM CLSHOLE SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,228.00" "$1,649.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $396.58 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" $464.34 "$2,228.00" $891.20 "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,671.00" "$2,228.00" "$2,228.00" "$2,228.00" "$1,114.00" "$1,114.00" "$1,764.58" "$2,228.00" "$1,782.40" "$1,002.60" "$2,228.00" N/A "$1,292.24" "$2,228.00" "$1,336.80" "$2,228.00" "$2,228.00" "$2,228.00" N/A N/A 2051-3040 SUP Custom 27803010 2051-3040 - SHELL ACETAB 40MM SCREWLESS SECFIT HYDRXAPT HIP BOTH IP/OP "$2,260.00" "$1,672.00" $402.28 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $402.28 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $471.01 "$2,260.00" $904.00 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,695.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,130.00" "$1,130.00" "$1,789.92" "$2,260.00" "$1,808.00" "$1,017.00" "$2,260.00" N/A "$1,310.80" "$2,260.00" "$1,356.00" "$2,260.00" "$2,260.00" "$2,260.00" N/A N/A 2051-3042 SUP Custom 27803010 2051-3042 - SHELL ACETAB 42MM SCREWLESS SECFIT HYDRXAPT HIP BOTH IP/OP "$2,260.00" "$1,672.00" $402.28 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $402.28 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $471.01 "$2,260.00" $904.00 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,695.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,130.00" "$1,130.00" "$1,789.92" "$2,260.00" "$1,808.00" "$1,017.00" "$2,260.00" N/A "$1,310.80" "$2,260.00" "$1,356.00" "$2,260.00" "$2,260.00" "$2,260.00" N/A N/A 2051-3044 SUP Custom 27803010 2051-3044 - CUP ACETAB 44MM SCREWLESS SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,260.00" "$1,672.00" $402.28 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $402.28 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $471.01 "$2,260.00" $904.00 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,695.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,130.00" "$1,130.00" "$1,789.92" "$2,260.00" "$1,808.00" "$1,017.00" "$2,260.00" N/A "$1,310.80" "$2,260.00" "$1,356.00" "$2,260.00" "$2,260.00" "$2,260.00" N/A N/A 2051-3046 SUP Custom 27803010 2051-3046 - CUP ACETAB 46MM SCREWLESS SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,227.00" "$1,648.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $464.13 "$2,227.00" $890.80 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$1,670.25" "$2,227.00" "$2,227.00" "$2,227.00" "$1,113.50" "$1,113.50" "$1,763.78" "$2,227.00" "$1,781.60" "$1,002.15" "$2,227.00" N/A "$1,291.66" "$2,227.00" "$1,336.20" "$2,227.00" "$2,227.00" "$2,227.00" N/A N/A 2051-3048 SUP Custom 27803010 2051-3048 - SHELL ACETAB 48MM SCREWLESS SECFIT PSL HA HIP BOTH IP/OP "$2,227.00" "$1,648.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $464.13 "$2,227.00" $890.80 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$1,670.25" "$2,227.00" "$2,227.00" "$2,227.00" "$1,113.50" "$1,113.50" "$1,763.78" "$2,227.00" "$1,781.60" "$1,002.15" "$2,227.00" N/A "$1,291.66" "$2,227.00" "$1,336.20" "$2,227.00" "$2,227.00" "$2,227.00" N/A N/A 2051-3050 SUP Custom 27803010 2051-3050 - CUP ACETAB 50MM SCREWLESS SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,227.00" "$1,648.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $464.13 "$2,227.00" $890.80 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$1,670.25" "$2,227.00" "$2,227.00" "$2,227.00" "$1,113.50" "$1,113.50" "$1,763.78" "$2,227.00" "$1,781.60" "$1,002.15" "$2,227.00" N/A "$1,291.66" "$2,227.00" "$1,336.20" "$2,227.00" "$2,227.00" "$2,227.00" N/A N/A 2051-3052 SUP Custom 27803010 2051-3052 - SHELL ACETAB 52MM SCREWLESS SECFIT PSL HA HIP BOTH IP/OP "$2,227.00" "$1,648.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $464.13 "$2,227.00" $890.80 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$1,670.25" "$2,227.00" "$2,227.00" "$2,227.00" "$1,113.50" "$1,113.50" "$1,763.78" "$2,227.00" "$1,781.60" "$1,002.15" "$2,227.00" N/A "$1,291.66" "$2,227.00" "$1,336.20" "$2,227.00" "$2,227.00" "$2,227.00" N/A N/A 2051-3054 SUP Custom 27803010 2051-3054 - SHELL ACETAB 54MM NO HOLE SOLID SECFIT PUREFIX HYDRXAPT HIP BOTH IP/OP "$2,227.00" "$1,648.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $464.13 "$2,227.00" $890.80 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$1,670.25" "$2,227.00" "$2,227.00" "$2,227.00" "$1,113.50" "$1,113.50" "$1,763.78" "$2,227.00" "$1,781.60" "$1,002.15" "$2,227.00" N/A "$1,291.66" "$2,227.00" "$1,336.20" "$2,227.00" "$2,227.00" "$2,227.00" N/A N/A 2051-3056 SUP Custom 27803010 2051-3056 - SHELL ACETAB 56MM SCREWLESS SECFIT PSL HA HIP BOTH IP/OP "$2,227.00" "$1,648.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $464.13 "$2,227.00" $890.80 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$1,670.25" "$2,227.00" "$2,227.00" "$2,227.00" "$1,113.50" "$1,113.50" "$1,763.78" "$2,227.00" "$1,781.60" "$1,002.15" "$2,227.00" N/A "$1,291.66" "$2,227.00" "$1,336.20" "$2,227.00" "$2,227.00" "$2,227.00" N/A N/A 2051-3058 SUP Custom 27803010 2051-3058 - SHELL ACETAB 58MM SCREWLESS SECFIT PSL HA HIP BOTH IP/OP "$2,227.00" "$1,648.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $464.13 "$2,227.00" $890.80 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$1,670.25" "$2,227.00" "$2,227.00" "$2,227.00" "$1,113.50" "$1,113.50" "$1,763.78" "$2,227.00" "$1,781.60" "$1,002.15" "$2,227.00" N/A "$1,291.66" "$2,227.00" "$1,336.20" "$2,227.00" "$2,227.00" "$2,227.00" N/A N/A 2051-3060 SUP Custom 27803010 2051-3060 - CUP ACETAB 60MM NO HOLE SOLID SECFIT HYDRXAPT HIP BOTH IP/OP "$2,227.00" "$1,648.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $464.13 "$2,227.00" $890.80 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$1,670.25" "$2,227.00" "$2,227.00" "$2,227.00" "$1,113.50" "$1,113.50" "$1,763.78" "$2,227.00" "$1,781.60" "$1,002.15" "$2,227.00" N/A "$1,291.66" "$2,227.00" "$1,336.20" "$2,227.00" "$2,227.00" "$2,227.00" N/A N/A 2051-3062 SUP Custom 27803010 2051-3062 - CUP ACETAB 62MM SCREWLESS SECFIT PSL HA HIP BOTH IP/OP "$2,227.00" "$1,648.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $464.13 "$2,227.00" $890.80 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$1,670.25" "$2,227.00" "$2,227.00" "$2,227.00" "$1,113.50" "$1,113.50" "$1,763.78" "$2,227.00" "$1,781.60" "$1,002.15" "$2,227.00" N/A "$1,291.66" "$2,227.00" "$1,336.20" "$2,227.00" "$2,227.00" "$2,227.00" N/A N/A 2051-3064 SUP Custom 27803010 2051-3064 - SHELL ACETAB 64MM SCREWLESS SECFIT PSL HA HIP BOTH IP/OP "$2,227.00" "$1,648.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $396.41 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" $464.13 "$2,227.00" $890.80 "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$2,227.00" "$1,670.25" "$2,227.00" "$2,227.00" "$2,227.00" "$1,113.50" "$1,113.50" "$1,763.78" "$2,227.00" "$1,781.60" "$1,002.15" "$2,227.00" N/A "$1,291.66" "$2,227.00" "$1,336.20" "$2,227.00" "$2,227.00" "$2,227.00" N/A N/A 2051-3066 SUP Custom 27803010 2051-3066 - SHELL ACETAB 66MM SCREWLESS SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,260.00" "$1,672.00" $402.28 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $402.28 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $471.01 "$2,260.00" $904.00 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,695.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,130.00" "$1,130.00" "$1,789.92" "$2,260.00" "$1,808.00" "$1,017.00" "$2,260.00" N/A "$1,310.80" "$2,260.00" "$1,356.00" "$2,260.00" "$2,260.00" "$2,260.00" N/A N/A 2051-3068 SUP Custom 27803010 2051-3068 - SHELL ACETAB 68MM SCREWLESS SECFIT PSL HYDRXAPT HIP BOTH IP/OP "$2,260.00" "$1,672.00" $402.28 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $402.28 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $471.01 "$2,260.00" $904.00 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,695.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,130.00" "$1,130.00" "$1,789.92" "$2,260.00" "$1,808.00" "$1,017.00" "$2,260.00" N/A "$1,310.80" "$2,260.00" "$1,356.00" "$2,260.00" "$2,260.00" "$2,260.00" N/A N/A 2051-3070 SUP Custom 27803010 2051-3070 - SHELL ACETAB 70MM SCREWLESS SECFIT HYDRXAPT HIP BOTH IP/OP "$2,260.00" "$1,672.00" $402.28 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $402.28 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $471.01 "$2,260.00" $904.00 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,695.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,130.00" "$1,130.00" "$1,789.92" "$2,260.00" "$1,808.00" "$1,017.00" "$2,260.00" N/A "$1,310.80" "$2,260.00" "$1,356.00" "$2,260.00" "$2,260.00" "$2,260.00" N/A N/A 2051-3072 SUP Custom 27803010 2051-3072 - SHELL ACETAB 72MM SCREWLESS SECFIT HYDRXAPT HIP BOTH IP/OP "$2,260.00" "$1,672.00" $402.28 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $402.28 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" $471.01 "$2,260.00" $904.00 "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,695.00" "$2,260.00" "$2,260.00" "$2,260.00" "$1,130.00" "$1,130.00" "$1,789.92" "$2,260.00" "$1,808.00" "$1,017.00" "$2,260.00" N/A "$1,310.80" "$2,260.00" "$1,356.00" "$2,260.00" "$2,260.00" "$2,260.00" N/A N/A 2053-2048 SUP Custom 27803010 2053-2048 - SHELL ACETAB 48MM CLSHOLE SECFIT X-TRA HYDRXAPT HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2050 SUP Custom 27803010 2053-2050 - SHELL ACETAB 50MM CLSHOLE SECFIT X-TRA HYDRXAPT HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2052 SUP Custom 27803010 2053-2052 - SHELL ACETAB 52MM CLSHOLE SECFIT X-TRA HYDRXAPT HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2054 SUP Custom 27803010 2053-2054 - SHELL ACETAB 54MM CLSHOLE SECFIT X-TRA HYDRXAPT HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2056 SUP Custom 27803010 2053-2056 - SHELL ACETAB 56MM CLSHOLE SECFIT X-TRA HYDRXAPT HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2058 SUP Custom 27803010 2053-2058 - SHELL ACETAB 58MM CLUSTER SECFIT X-TRA HA HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2060 SUP Custom 27803010 2053-2060 - SHELL ACETAB 60MM SECFIT X-TRA PSL HA HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2062 SUP Custom 27803010 2053-2062 - SHELL ACETAB 62MM SECFIT X-TRA PSL HA HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2064 SUP Custom 27803010 2053-2064 - SHELL ACETAB 64MM SECFIT X-TRA PSL HA HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2066 SUP Custom 27803010 2053-2066 - SHELL ACETAB 66MM SECFIT X-TRA PSL HA HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2068 SUP Custom 27803010 2053-2068 - SHELL ACETAB 68MM SECFIT X-TRA PSL HA HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2070 SUP Custom 27803010 2053-2070 - SHELL ACETAB 70MM SECFIT X-TRA PSL HA HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2072 SUP Custom 27803010 2053-2072 - SHELL ACETAB 72MM SECFIT X-TRA PSL HA HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2074 SUP Custom 27803010 2053-2074 - SHELL ACETAB 74MM SECFIT X-TRA PSL HA HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2076 SUP Custom 27803010 2053-2076 - SHELL ACETAB 76MM SECFIT X-TRA PSL HA HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2078 SUP Custom 27803010 2053-2078 - SHELL ACETAB 78MM SECFIT X-TRA PSL HA HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-2080 SUP Custom 27803010 2053-2080 - SHELL ACETAB 80MM SECFIT X-TRA PSL HA HIP BOTH IP/OP "$4,191.00" "$3,101.00" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $745.98 "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" $873.43 "$4,190.88" "$1,676.35" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$4,190.88" "$3,143.25" "$4,190.88" "$4,190.88" "$4,190.88" "$2,095.44" "$2,095.44" "$3,319.18" "$4,190.88" "$3,352.70" "$1,885.90" "$4,190.88" N/A "$2,430.78" "$4,190.88" "$2,514.53" "$4,190.88" "$4,190.88" "$4,190.88" N/A N/A 2053-3048 SUP Custom 27803010 2053-3048 - SHELL ACETAB 48MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3050 SUP Custom 27803010 2053-3050 - SHELL ACETAB 50MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3052 SUP Custom 27803010 2053-3052 - SHELL ACETAB 52MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3054 SUP Custom 27803010 2053-3054 - SHELL ACETAB 54MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3056 SUP Custom 27803010 2053-3056 - SHELL ACETAB 56MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3058 SUP Custom 27803010 2053-3058 - SHELL ACETAB 58MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3060 SUP Custom 27803010 2053-3060 - SHELL ACETAB 60MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3062 SUP Custom 27803010 2053-3062 - SHELL ACETAB 62MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3064 SUP Custom 27803010 2053-3064 - SHELL ACETAB 64MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3066 SUP Custom 27803010 2053-3066 - SHELL ACETAB 66MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3068 SUP Custom 27803010 2053-3068 - SHELL ACETAB 68MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3070 SUP Custom 27803010 2053-3070 - SHELL ACETAB 70MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3072 SUP Custom 27803010 2053-3072 - SHELL ACETAB 72MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3074 SUP Custom 27803010 2053-3074 - SHELL ACETAB 74MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3076 SUP Custom 27803010 2053-3076 - SHELL ACETAB 76MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3078 SUP Custom 27803010 2053-3078 - SHELL ACETAB 78MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2053-3080 SUP Custom 27803010 2053-3080 - SHELL ACETAB 80MM NO DOME HOLE SCREWLESS SECFIT X-TRA PSL HA BOTH IP/OP "$4,423.50" "$3,273.00" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $787.34 "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" $921.85 "$4,423.25" "$1,769.30" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$4,423.25" "$3,317.63" "$4,423.25" "$4,423.25" "$4,423.25" "$2,211.63" "$2,211.63" "$3,503.21" "$4,423.25" "$3,538.60" "$1,990.46" "$4,423.25" N/A "$2,565.63" "$4,423.25" "$2,653.95" "$4,423.25" "$4,423.25" "$4,423.25" N/A N/A 2060-0000 SUP Custom 27803010 2060-0000 - PLUG DOME HOLE ACETAB DOME BOTH IP/OP $127.00 $94.00 $22.61 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $22.61 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $26.47 $127.00 $50.80 $127.00 $127.00 $127.00 $127.00 $127.00 $95.25 $127.00 $127.00 $127.00 $63.50 $63.50 $100.58 $127.00 $101.60 $57.15 $127.00 N/A $73.66 $127.00 $76.20 $127.00 $127.00 $127.00 N/A N/A 2060-0000-1 SUP Custom 27803010 2060-0000-1 - PLUG DOME HL ACTB BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 2078-1330S SUP HCPCS C1713 2078-1330S - NAIL INTRAMEDULLARY R2 LONG 280MM GAMMA3 ORTHINOX HIP RIGHT BOTH IP/OP "$2,090.00" "$1,547.00" $414.81 "$2,090.00" $940.50 $940.50 $940.50 $940.50 "$2,090.00" "$2,090.00" "$2,090.00" $435.61 "$2,090.00" "$2,090.00" "$2,090.00" "$2,090.00" "$2,090.00" $435.58 "$2,090.00" "$2,090.00" "$1,236.24" "$2,090.00" "$2,090.00" "$2,090.00" "$2,090.00" "$1,567.50" "$2,090.00" "$2,090.00" "$2,090.00" "$1,045.00" "$1,045.00" "$1,655.28" "$2,090.00" "$1,672.00" $940.50 $414.81 N/A "$1,212.20" "$2,090.00" "$1,254.00" "$2,090.00" "$2,090.00" "$2,090.00" N/A N/A 2078-1530S SUP HCPCS C1713 2078-1530S - NAIL INTRAMEDULLARY R2 LONG 280MM GAMMA3 HIP LEFT STERILE BOTH IP/OP "$2,090.00" "$1,547.00" $414.81 "$2,090.00" $940.50 $940.50 $940.50 $940.50 "$2,090.00" "$2,090.00" "$2,090.00" $435.61 "$2,090.00" "$2,090.00" "$2,090.00" "$2,090.00" "$2,090.00" $435.58 "$2,090.00" "$2,090.00" "$1,236.24" "$2,090.00" "$2,090.00" "$2,090.00" "$2,090.00" "$1,567.50" "$2,090.00" "$2,090.00" "$2,090.00" "$1,045.00" "$1,045.00" "$1,655.28" "$2,090.00" "$1,672.00" $940.50 $414.81 N/A "$1,212.20" "$2,090.00" "$1,254.00" "$2,090.00" $435.56 "$2,090.00" N/A N/A 2080-0015 SUP HCPCS C1713 2080-0015 - SCREW BN 6.5MM 15MM TX ACTB CANC TRITANIUM MLHL SHL BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $128.25 $128.25 $128.25 $128.25 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $285.00 $285.00 $285.00 $59.40 $285.00 $114.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $128.25 $56.57 N/A $165.30 $285.00 $171.00 $285.00 $285.00 $285.00 N/A N/A 2080-0020 SUP HCPCS C1713 2080-0020 - SCREW BN 6.5MM 20MM TX ACTB CANC TRITANIUM MLHL SHL BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $128.25 $128.25 $128.25 $128.25 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $285.00 $285.00 $285.00 $59.40 $285.00 $114.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $128.25 $56.57 N/A $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 2080-0025 SUP HCPCS C1713 2080-0025 - SCREW BN 6.5MM 25MM TX ACTB CANC TRITANIUM MLHL SHL BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $128.25 $128.25 $128.25 $128.25 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $128.25 $56.57 N/A $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 2080-0030 SUP HCPCS C1713 2080-0030 - SCREW BN 6.5MM 30MM TX ACTB CANC TRITANIUM MLHL SHL BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $128.25 $128.25 $128.25 $128.25 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $285.00 $285.00 $285.00 $59.40 $285.00 $114.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $128.25 $56.57 N/A $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 2080-0035 SUP HCPCS C1713 2080-0035 - SCREW BN 6.5MM 35MM TX ACTB CANC TRITANIUM MLHL SHL BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $128.25 $128.25 $128.25 $128.25 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $285.00 $285.00 $285.00 $59.40 $285.00 $114.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $128.25 $56.57 N/A $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 2080-0040 SUP HCPCS C1713 2080-0040 - SCREW BN 6.5MM 40MM TX ACTB CANC TRITANIUM MLHL SHL BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $128.25 $128.25 $128.25 $128.25 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $128.25 $56.57 N/A $165.30 $285.00 $171.00 $285.00 $285.00 $285.00 N/A N/A 2080-0045 SUP HCPCS C1713 2080-0045 - SCREW BN 6.5MM 45MM TX ACTB CANC TRITANIUM MLHL SHL BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $128.25 $128.25 $128.25 $128.25 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $128.25 $56.57 N/A $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 2080-0050 SUP HCPCS C1713 2080-0050 - SCREW ACETAB 6.5MM 50MM GAP HIP CANCELLOUS BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $128.25 $128.25 $128.25 $128.25 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $128.25 $56.57 N/A $165.30 $285.00 $285.00 $285.00 $59.39 $285.00 N/A N/A 2080-0055 SUP HCPCS C1713 2080-0055 - SCREW ACETAB 6.5MM 55MM PLATE TORX GAP II CANCELLOUS BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $128.25 $128.25 $128.25 $128.25 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $128.25 $56.57 N/A $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 2080-0060 SUP HCPCS C1713 2080-0060 - SCREW ACETAB 6.5MM 60MM GAP II HIP STERILE BOTH IP/OP $285.00 $211.00 $56.57 $285.00 $128.25 $128.25 $128.25 $128.25 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $285.00 $285.00 $285.00 $59.40 $285.00 $285.00 $168.58 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $128.25 $56.57 N/A $165.30 $285.00 $171.00 $285.00 $59.39 $285.00 N/A N/A 2080-1125S SUP HCPCS C1713 2080-1125S - NAIL INTRAMEDULLARY R2 LONG 300MM GAMMA3 ORTHINOX HIP RIGHT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2080-1130S SUP HCPCS C1713 2080-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 30CM GAMA TITANIUM HIP BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2080-1135S SUP HCPCS C1713 2080-1135S - NAIL INTRAMEDULLARY 135D LONG 11MM 300MM GAMMA3 HIP LEFT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2080-1330S SUP HCPCS C1713 2080-1330S - NAIL INTRAMEDULLARY R2 LONG 300MM GAMMA3 ORTHINOX HIP BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2082-0048L SUP Custom 27803010 2082-0048L - SHELL ACETAB 48MM 45MM RSTOR GAP II TITANIUM HIP LEFT BOTH IP/OP "$6,930.00" "$5,128.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,444.29" "$6,930.00" "$2,772.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$5,197.50" "$6,930.00" "$6,930.00" "$6,930.00" "$3,465.00" "$3,465.00" "$5,488.56" "$6,930.00" "$5,544.00" "$3,118.50" "$6,930.00" N/A "$4,019.40" "$6,930.00" "$4,158.00" "$6,930.00" "$6,930.00" "$6,930.00" N/A N/A 2082-0048R SUP Custom 27803010 2082-0048R - SHELL ACETAB 48MM RSTOR GAP II TITANIUM RIGHT HIP BOTH IP/OP "$6,930.00" "$5,128.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,444.29" "$6,930.00" "$2,772.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$5,197.50" "$6,930.00" "$6,930.00" "$6,930.00" "$3,465.00" "$3,465.00" "$5,488.56" "$6,930.00" "$5,544.00" "$3,118.50" "$6,930.00" N/A "$4,019.40" "$6,930.00" "$4,158.00" "$6,930.00" "$6,930.00" "$6,930.00" N/A N/A 2082-0052L SUP Custom 27803010 2082-0052L - SHELL ACETAB 52MM RSTOR GAP II TITANIUM LEFT HIP BOTH IP/OP "$6,930.00" "$5,128.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,444.29" "$6,930.00" "$2,772.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$5,197.50" "$6,930.00" "$6,930.00" "$6,930.00" "$3,465.00" "$3,465.00" "$5,488.56" "$6,930.00" "$5,544.00" "$3,118.50" "$6,930.00" N/A "$4,019.40" "$6,930.00" "$4,158.00" "$6,930.00" "$6,930.00" "$6,930.00" N/A N/A 2082-0052R SUP Custom 27803010 2082-0052R - SHELL ACETAB 52MM RSTOR GAP II TITANIUM RIGHT HIP BOTH IP/OP "$6,930.00" "$5,128.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,444.29" "$6,930.00" "$2,772.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$5,197.50" "$6,930.00" "$6,930.00" "$6,930.00" "$3,465.00" "$3,465.00" "$5,488.56" "$6,930.00" "$5,544.00" "$3,118.50" "$6,930.00" N/A "$4,019.40" "$6,930.00" "$4,158.00" "$6,930.00" "$6,930.00" "$6,930.00" N/A N/A 2082-0056L SUP Custom 27803010 2082-0056L - SHELL ACETAB 56MM 53MM RSTOR GAP II TITANIUM HIP LEFT BOTH IP/OP "$6,930.00" "$5,128.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,444.29" "$6,930.00" "$2,772.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$5,197.50" "$6,930.00" "$6,930.00" "$6,930.00" "$3,465.00" "$3,465.00" "$5,488.56" "$6,930.00" "$5,544.00" "$3,118.50" "$6,930.00" N/A "$4,019.40" "$6,930.00" "$4,158.00" "$6,930.00" "$6,930.00" "$6,930.00" N/A N/A 2082-0056R SUP Custom 27803010 2082-0056R - SHELL ACETAB 56MM RSTOR GAP II TITANIUM RIGHT HIP BOTH IP/OP "$6,930.00" "$5,128.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,444.29" "$6,930.00" "$2,772.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$5,197.50" "$6,930.00" "$6,930.00" "$6,930.00" "$3,465.00" "$3,465.00" "$5,488.56" "$6,930.00" "$5,544.00" "$3,118.50" "$6,930.00" N/A "$4,019.40" "$6,930.00" "$4,158.00" "$6,930.00" "$6,930.00" "$6,930.00" N/A N/A 2082-0060L SUP Custom 27803010 2082-0060L - SHELL ACETAB 60MM 56MM RSTOR GAP II TITANIUM HIP LEFT BOTH IP/OP "$6,930.00" "$5,128.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,444.29" "$6,930.00" "$2,772.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$5,197.50" "$6,930.00" "$6,930.00" "$6,930.00" "$3,465.00" "$3,465.00" "$5,488.56" "$6,930.00" "$5,544.00" "$3,118.50" "$6,930.00" N/A "$4,019.40" "$6,930.00" "$4,158.00" "$6,930.00" "$6,930.00" "$6,930.00" N/A N/A 2082-0060R SUP Custom 27803010 2082-0060R - SHELL ACETAB 60MM RSTOR GAP II TITANIUM RIGHT HIP BOTH IP/OP "$6,930.00" "$5,128.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,444.29" "$6,930.00" "$2,772.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$5,197.50" "$6,930.00" "$6,930.00" "$6,930.00" "$3,465.00" "$3,465.00" "$5,488.56" "$6,930.00" "$5,544.00" "$3,118.50" "$6,930.00" N/A "$4,019.40" "$6,930.00" "$4,158.00" "$6,930.00" "$6,930.00" "$6,930.00" N/A N/A 2082-0064L SUP Custom 27803010 2082-0064L - SHELL ACETAB 64MM 61MM RSTOR GAP II TITANIUM HIP LEFT BOTH IP/OP "$6,930.00" "$5,128.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,444.29" "$6,930.00" "$2,772.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$5,197.50" "$6,930.00" "$6,930.00" "$6,930.00" "$3,465.00" "$3,465.00" "$5,488.56" "$6,930.00" "$5,544.00" "$3,118.50" "$6,930.00" N/A "$4,019.40" "$6,930.00" "$4,158.00" "$6,930.00" "$6,930.00" "$6,930.00" N/A N/A 2082-0064R SUP Custom 27803010 2082-0064R - SHELL ACETAB 64MM RSTOR GAP II TITANIUM RIGHT HIP BOTH IP/OP "$6,930.00" "$5,128.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,444.29" "$6,930.00" "$2,772.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$5,197.50" "$6,930.00" "$6,930.00" "$6,930.00" "$3,465.00" "$3,465.00" "$5,488.56" "$6,930.00" "$5,544.00" "$3,118.50" "$6,930.00" N/A "$4,019.40" "$6,930.00" "$4,158.00" "$6,930.00" "$6,930.00" "$6,930.00" N/A N/A 2082-0068L SUP Custom 27803010 2082-0068L - SHELL ACETAB 68MM 64MM RSTOR GAP II TITANIUM HIP LEFT BOTH IP/OP "$6,930.00" "$5,128.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,444.29" "$6,930.00" "$2,772.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$5,197.50" "$6,930.00" "$6,930.00" "$6,930.00" "$3,465.00" "$3,465.00" "$5,488.56" "$6,930.00" "$5,544.00" "$3,118.50" "$6,930.00" N/A "$4,019.40" "$6,930.00" "$4,158.00" "$6,930.00" "$6,930.00" "$6,930.00" N/A N/A 2082-0068R SUP Custom 27803010 2082-0068R - SHELL ACETAB 68MM RSTOR GAP II TITANIUM RIGHT HIP BOTH IP/OP "$6,930.00" "$5,128.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,444.29" "$6,930.00" "$2,772.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$5,197.50" "$6,930.00" "$6,930.00" "$6,930.00" "$3,465.00" "$3,465.00" "$5,488.56" "$6,930.00" "$5,544.00" "$3,118.50" "$6,930.00" N/A "$4,019.40" "$6,930.00" "$4,158.00" "$6,930.00" "$6,930.00" "$6,930.00" N/A N/A 2082-0072L SUP Custom 27803010 2082-0072L - SHELL ACETAB 72MM 69MM RSTOR GAP II TITANIUM HIP LEFT BOTH IP/OP "$6,930.00" "$5,128.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,444.29" "$6,930.00" "$2,772.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$5,197.50" "$6,930.00" "$6,930.00" "$6,930.00" "$3,465.00" "$3,465.00" "$5,488.56" "$6,930.00" "$5,544.00" "$3,118.50" "$6,930.00" N/A "$4,019.40" "$6,930.00" "$4,158.00" "$6,930.00" "$6,930.00" "$6,930.00" N/A N/A 2082-0072R SUP Custom 27803010 2082-0072R - SHELL ACETAB 72MM RSTOR GAP II TITANIUM RIGHT HIP BOTH IP/OP "$6,930.00" "$5,128.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,233.54" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$1,444.29" "$6,930.00" "$2,772.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$6,930.00" "$5,197.50" "$6,930.00" "$6,930.00" "$6,930.00" "$3,465.00" "$3,465.00" "$5,488.56" "$6,930.00" "$5,544.00" "$3,118.50" "$6,930.00" N/A "$4,019.40" "$6,930.00" "$4,158.00" "$6,930.00" "$6,930.00" "$6,930.00" N/A N/A 2082-1125S SUP HCPCS C1713 2082-1125S - NAIL INTRAMEDULLARY LONG 125D 11MM 320MM LOCKING SCREW GAMA BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2082-1130S SUP HCPCS C1713 2082-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 32CM GAMA TITANIUM HIP BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2082-1135S SUP HCPCS C1713 2082-1135S - NAIL INTRAMEDULLARY 135D LONG 11MM 32CM LOCK GAMA ORTHINOX BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" "$2,908.13" "$2,908.13" N/A N/A 2082-1330S SUP HCPCS C1713 2082-1330S - NAIL INTRAMEDULLARY LONG 130D 13MM 320MM LOCKING SCREW GAMA BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" "$2,908.13" "$2,908.13" N/A N/A 2083-0048 SUP Custom 27803010 2083-0048 - SHELL ACETAB 48MM RING GAP OMNIFIT OSTEOLOCK RSTOR SECFIT BOTH IP/OP "$5,675.00" "$4,200.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,182.73" "$5,675.00" "$2,270.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$4,256.25" "$5,675.00" "$5,675.00" "$5,675.00" "$2,837.50" "$2,837.50" "$4,494.60" "$5,675.00" "$4,540.00" "$2,553.75" "$5,675.00" N/A "$3,291.50" "$5,675.00" "$3,405.00" "$5,675.00" "$5,675.00" "$5,675.00" N/A N/A 2083-0052 SUP Custom 27803010 2083-0052 - RING ACETAB 52MM RSTOR GAP TITANIUM HIP BOTH IP/OP "$5,675.00" "$4,200.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,182.73" "$5,675.00" "$2,270.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$4,256.25" "$5,675.00" "$5,675.00" "$5,675.00" "$2,837.50" "$2,837.50" "$4,494.60" "$5,675.00" "$4,540.00" "$2,553.75" "$5,675.00" N/A "$3,291.50" "$5,675.00" "$3,405.00" "$5,675.00" "$5,675.00" "$5,675.00" N/A N/A 2083-0056 SUP Custom 27803010 2083-0056 - RING ACETAB 56MM RSTOR GAP II TITANIUM HIP BOTH IP/OP "$5,675.00" "$4,200.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,182.73" "$5,675.00" "$2,270.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$4,256.25" "$5,675.00" "$5,675.00" "$5,675.00" "$2,837.50" "$2,837.50" "$4,494.60" "$5,675.00" "$4,540.00" "$2,553.75" "$5,675.00" N/A "$3,291.50" "$5,675.00" "$3,405.00" "$5,675.00" "$5,675.00" "$5,675.00" N/A N/A 2083-0060 SUP Custom 27803010 2083-0060 - RING ACETAB 60MM RSTOR GAP II TITANIUM HIP BOTH IP/OP "$5,675.00" "$4,200.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,182.73" "$5,675.00" "$2,270.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$4,256.25" "$5,675.00" "$5,675.00" "$5,675.00" "$2,837.50" "$2,837.50" "$4,494.60" "$5,675.00" "$4,540.00" "$2,553.75" "$5,675.00" N/A "$3,291.50" "$5,675.00" "$3,405.00" "$5,675.00" "$5,675.00" "$5,675.00" N/A N/A 2083-0064 SUP Custom 27803010 2083-0064 - RING ACETAB 64MM RSTOR GAP II TITANIUM HIP BOTH IP/OP "$5,675.00" "$4,200.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,182.73" "$5,675.00" "$2,270.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$4,256.25" "$5,675.00" "$5,675.00" "$5,675.00" "$2,837.50" "$2,837.50" "$4,494.60" "$5,675.00" "$4,540.00" "$2,553.75" "$5,675.00" N/A "$3,291.50" "$5,675.00" "$3,405.00" "$5,675.00" "$5,675.00" "$5,675.00" N/A N/A 2083-0068 SUP Custom 27803010 2083-0068 - SHELL ACETAB 68MM RING GAP OMNIFIT OSTEOLOCK RSTOR SECFIT BOTH IP/OP "$5,675.00" "$4,200.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,182.73" "$5,675.00" "$2,270.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$4,256.25" "$5,675.00" "$5,675.00" "$5,675.00" "$2,837.50" "$2,837.50" "$4,494.60" "$5,675.00" "$4,540.00" "$2,553.75" "$5,675.00" N/A "$3,291.50" "$5,675.00" "$3,405.00" "$5,675.00" "$5,675.00" "$5,675.00" N/A N/A 2083-0072 SUP Custom 27803010 2083-0072 - RING ACETAB 72MM RSTOR GAP II TITANIUM HIP BOTH IP/OP "$5,675.00" "$4,200.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,182.73" "$5,675.00" "$2,270.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$4,256.25" "$5,675.00" "$5,675.00" "$5,675.00" "$2,837.50" "$2,837.50" "$4,494.60" "$5,675.00" "$4,540.00" "$2,553.75" "$5,675.00" N/A "$3,291.50" "$5,675.00" "$3,405.00" "$5,675.00" "$5,675.00" "$5,675.00" N/A N/A 2084-1125S SUP HCPCS C1713 2084-1125S - NAIL INTRAMEDULLARY 125D LONG 11MM 34CM LOCK GAMA ORTHINOX BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2084-1130S SUP HCPCS C1713 2084-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 34CM LOCK ORTHINOX GAMA BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2084-1135S SUP HCPCS C1713 2084-1135S - NAIL INTRAMEDULLARY 135D LONG 11MM 34CM GAMA HIP LEFT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2084-1330S SUP HCPCS C1713 2084-1330S - NAIL INTRAMEDULLARY 130D LONG 13MM 340MM GAMMA3 HIP LEFT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2086-1125S SUP HCPCS C1713 2086-1125S - NAIL INTRAMEDULLARY 125D LONG 11MM 36CM GAMMA3 TITANIUM HIP BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" "$2,908.13" "$2,908.13" N/A N/A 2086-1130S SUP HCPCS C1713 2086-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 36CM LOCK ORTHINOX GAMA BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" "$2,908.13" "$2,908.13" N/A N/A 2086-1135S SUP HCPCS C1713 2086-1135S - NAIL INTRAMEDULLARY 135D LONG 11MM 36CM GAMA HIP LEFT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2086-1330S SUP HCPCS C1713 2086-1330S - NAIL INTRAMEDULLARY LONG 130D 13MM 360MM LOCKING SCREW GAMA BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2088-1125S SUP HCPCS C1713 2088-1125S - NAIL INTRAMEDULLARY 125D LONG 11MM 380MM GAMMA3 HIP LEFT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" "$2,908.13" "$2,908.13" N/A N/A 2088-1130S SUP HCPCS C1713 2088-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 38CM LOCK ORTHINOX GAMA BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2088-1135S SUP HCPCS C1713 2088-1135S - NAIL INTRAMEDULLARY 135D LONG 11MM 38CM LOCK GAMA ORTHINOX BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2088-1330S SUP HCPCS C1713 2088-1330S - NAIL INTRAMEDULLARY 130D LONG 13MM 380MM GAMMA3 HIP LEFT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2088TC/100 SUP HCPCS C1898 2088TC/100 - LEAD PCNG HLX 6FR 100CM TNDRL STS IS 1 BP CNCT RING ELTRD BOTH IP/OP $680.00 $503.00 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 N/A $394.40 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 2088TC/46 SUP HCPCS C1898 2088TC/46 - LEAD PCNG HLX 6FR 46CM TNDRL STS IS-1 CNCT BP ACTFX XTD STRD BOTH IP/OP $680.00 $503.00 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 N/A $394.40 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 2088TC/52 SUP HCPCS C1898 2088TC/52 - LEAD PCNG 6FR 52CM TNDRL STS IS-1 BP CNCT ACT RTRCT XTD HLX BOTH IP/OP $680.00 $503.00 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 N/A $394.40 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 2088TC/58 SUP HCPCS C1898 2088TC/58 - LEAD PCNG HLX 6FR 58CM TNDRL STS IS 1 CNCT ACTFX BP SFT STRD BOTH IP/OP $680.00 $503.00 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 N/A $394.40 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 2088TC/65 SUP HCPCS C1898 2088TC/65 - LEAD PACING 6FR 65CM IS-1 BIPOL CONCTR OPTIM INSULATION BOTH IP/OP $680.00 $503.00 $141.72 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $680.00 $141.72 $680.00 $272.00 $680.00 $680.00 $680.00 $680.00 $680.00 $510.00 $680.00 $680.00 $680.00 $340.00 $340.00 $538.56 $680.00 $544.00 $306.00 $680.00 N/A $394.40 $680.00 $408.00 $680.00 $680.00 $680.00 N/A N/A 209.740S SUP HCPCS C1713 209.740S - SCREW BN FT 7.3MM 140MM STRL CNN SS BOTH IP/OP $579.50 $429.00 $114.95 $589.00 $260.62 $260.62 $260.62 $260.62 $579.15 $579.15 $579.15 $120.71 $579.15 $579.15 $579.15 $579.15 $579.15 $120.70 $579.15 $235.60 $342.57 $579.15 $589.00 $579.15 $579.15 $434.63 $579.15 $579.15 $579.15 $289.58 $289.58 $458.69 $579.15 $463.32 $260.62 $114.95 N/A $336.11 $579.15 $579.15 $579.15 $120.69 $579.15 N/A N/A 2090-1125S SUP HCPCS C1713 2090-1125S - NAIL INTRAMEDULLARY R2 LONG 400MM GAMMA3 ORTHINOX HIP RIGHT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2090-1130S SUP HCPCS C1713 2090-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 40CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2090-1135S SUP HCPCS C1713 2090-1135S - NAIL INTRAMEDULLARY 135D LONG 11MM 40CM LOCK GAMA ORTHINOX BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2090-1330S SUP HCPCS C1713 2090-1330S - NAIL INTRAMEDULLARY 130D LONG 13MM 400MM GAMMA3 HIP LEFT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$2,908.13" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2092-1125S SUP HCPCS C1713 2092-1125S - NAIL INTRAMEDULLARY LONG 125D 11MM 420MM GAMMA3 HIP LEFT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$2,908.13" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2092-1130S SUP HCPCS C1713 2092-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 42CM LOCK GAMA TITANIUM BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2092-1135S SUP HCPCS C1713 2092-1135S - NAIL INTRAMEDULLARY 135D LONG 11MM 42CM LOCK GAMA ORTHINOX BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2092-1330S SUP HCPCS C1713 2092-1330S - NAIL INTRAMEDULLARY 130D LONG 13MM 42CM LOCK GAMA ORTHINOX BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2092-1530S SUP HCPCS C1713 2092-1530S - NAIL INTRAMEDULLARY 130D LONG 15MM 420MM GAMMA3 HIP LEFT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2092-3-963 SUP HCPCS C1713 2092-3-963 - PIN HALF 5MM 240MM 50MM SLFDRILL APEX BOTH IP/OP $120.00 $89.00 $23.79 $119.85 $53.93 $53.93 $53.93 $53.93 $119.85 $119.85 $119.85 $24.98 $119.85 $119.85 $119.85 $119.85 $119.85 $24.98 $119.85 $47.94 $70.89 $119.85 $119.85 $119.85 $119.85 $90.00 $119.85 $119.85 $119.85 $59.93 $59.93 $94.92 $119.85 $95.88 $53.93 $23.79 N/A $69.60 $119.85 $119.85 $119.85 $24.98 $119.85 N/A N/A 2094-1125S SUP HCPCS C1713 2094-1125S - NAIL INTRAMEDULLARY 125D LONG 11MM 44CM LOCK GAMA ORTHINOX BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2094-1130S SUP HCPCS C1713 2094-1130S - NAIL INTRAMEDULLARY 130D LONG 11MM 44CM LOCK ORTHINOX GAMA BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2094-1135S SUP HCPCS C1713 2094-1135S - NAIL INTRAMEDULLARY 135D LONG 11MM 44CM LOCK GAMA ORTHINOX BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2094-1330S SUP HCPCS C1713 2094-1330S - NAIL INTRAMEDULLARY 130D LONG 13MM 440MM GAMMA3 HIP LEFT BOTH IP/OP "$2,908.50" "$2,152.00" $577.19 "$2,908.13" "$1,308.66" "$1,308.66" "$1,308.66" "$1,308.66" "$2,908.13" "$2,908.13" "$2,908.13" $606.13 "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" $606.09 "$2,908.13" "$1,163.25" "$1,433.71" "$2,908.13" "$2,908.13" "$2,908.13" "$2,908.13" "$2,181.38" "$2,908.13" "$2,908.13" "$2,908.13" "$1,454.07" "$1,454.07" "$2,303.24" "$2,908.13" "$2,326.50" "$1,308.66" $577.19 N/A "$1,686.93" "$2,908.13" "$1,744.88" "$2,908.13" $606.05 "$2,908.13" N/A N/A 2099-2250 SUP Custom 27803010 2099-2250 - INSERT ACETAB 50MM 22MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2252 SUP Custom 27803010 2099-2252 - INSERT ACETAB 52MM 22MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2254 SUP Custom 27803010 2099-2254 - INSERT ACETAB 54MM 22MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2256 SUP Custom 27803010 2099-2256 - INSERT ACETAB 56MM 22MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2258 SUP Custom 27803010 2099-2258 - INSERT ACETAB 58MM 22MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2261 SUP Custom 27803010 2099-2261 - INSERT ACETAB 61MM 22MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2266 SUP Custom 27803010 2099-2266 - INSERT ACETAB 66MM 22MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2270 SUP Custom 27803010 2099-2270 - INSERT ACETAB 70MM 22MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2274 SUP Custom 27803010 2099-2274 - INSERT ACETAB 74MM 22MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2656 SUP Custom 27803010 2099-2656 - INSERT ACETAB 56MM 26MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2658 SUP Custom 27803010 2099-2658 - INSERT ACETAB 58MM 26MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2661 SUP Custom 27803010 2099-2661 - INSERT ACETAB 61MM 26MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2666 SUP Custom 27803010 2099-2666 - INSERT ACETAB 66MM 26MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2670 SUP Custom 27803010 2099-2670 - INSERT ACETAB 70MM 26MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2674 SUP Custom 27803010 2099-2674 - INSERT ACETAB 74MM 26MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2858 SUP Custom 27803010 2099-2858 - INSERT ACETAB 58MM 28MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2861 SUP Custom 27803010 2099-2861 - INSERT ACETAB 61MM 28MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2866 SUP Custom 27803010 2099-2866 - INSERT ACETAB 66MM 28MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2870 SUP Custom 27803010 2099-2870 - INSERT ACETAB 70MM 28MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 2099-2874 SUP Custom 27803010 2099-2874 - INSERT ACETAB 74MM 28MM CONSTRAIN HIP BOTH IP/OP "$6,550.00" "$4,847.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,165.90" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$1,365.09" "$6,550.00" "$2,620.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$6,550.00" "$4,912.50" "$6,550.00" "$6,550.00" "$6,550.00" "$3,275.00" "$3,275.00" "$5,187.60" "$6,550.00" "$5,240.00" "$2,947.50" "$6,550.00" N/A "$3,799.00" "$6,550.00" "$3,930.00" "$6,550.00" "$6,550.00" "$6,550.00" N/A N/A 21000 A SUP Custom 27803010 21000 A - RESERVOIR SHUNT 12MM BURR HOLE CSF VENTRICULAR BOTH IP/OP $888.50 $657.00 $158.11 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $158.11 $888.25 $888.25 $888.25 $888.25 $888.25 $888.25 $185.12 $888.25 $355.30 $888.25 $888.25 $888.25 $888.25 $888.25 $666.38 $888.25 $888.25 $888.25 $444.13 $444.13 $703.49 $888.25 $710.60 $399.71 $888.25 N/A $515.33 $888.25 $532.95 $888.25 $888.25 $888.25 N/A N/A 21000 B SUP Custom 27803010 21000 B - RESERVOIR SHUNT 16MM BURR HOLE CSF VENTRICULAR BOTH IP/OP $997.50 $738.00 $177.56 $997.50 $997.50 $997.50 $997.50 $997.50 $997.50 $997.50 $177.56 $997.50 $997.50 $997.50 $997.50 $997.50 $997.50 $207.89 $997.50 $399.00 $997.50 $997.50 $997.50 $997.50 $997.50 $748.13 $997.50 $997.50 $997.50 $498.75 $498.75 $790.02 $997.50 $798.00 $448.88 $997.50 N/A $578.55 $997.50 $598.50 $997.50 $997.50 $997.50 N/A N/A 21020 A-M SUP Custom 27803010 21020 A-M - SHUNT NEUROSURGICAL SMALL 65CM UNITIZED MEDIUM CLOSING BOTH IP/OP "$1,038.00" $768.00 $184.74 "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" $184.74 "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" $216.31 "$1,037.88" $415.15 "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" $778.50 "$1,037.88" "$1,037.88" "$1,037.88" $518.94 $518.94 $822.00 "$1,037.88" $830.30 $467.05 "$1,037.88" N/A $602.04 "$1,037.88" $622.73 "$1,037.88" "$1,037.88" "$1,037.88" N/A N/A 21020 B-M SUP Custom 27803010 21020 B-M - SHUNT NEUROSURGICAL SMALL 78CM UNITIZED MEDIUM CLOSING BOTH IP/OP "$1,038.00" $768.00 $184.74 "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" $184.74 "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" $216.31 "$1,037.88" $415.15 "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" "$1,037.88" $778.50 "$1,037.88" "$1,037.88" "$1,037.88" $518.94 $518.94 $822.00 "$1,037.88" $830.30 $467.05 "$1,037.88" N/A $602.04 "$1,037.88" $622.73 "$1,037.88" "$1,037.88" "$1,037.88" N/A N/A 2102-1500 SUP HCPCS C9359 2102-1500 - SUBSTITUTE BNGFT 100X25X4MM VOID FILR FOAM STRIP BIOACTIVE BOTH IP/OP "$3,857.50" "$2,855.00" $765.62 "$3,857.50" "$1,735.88" "$1,735.88" "$1,735.88" "$1,735.88" "$3,857.50" "$3,857.50" "$3,857.50" $804.00 "$3,857.50" "$3,857.50" "$3,857.50" "$3,857.50" "$3,857.50" $803.95 "$3,857.50" "$3,857.50" "$1,901.75" "$3,857.50" "$3,857.50" "$3,857.50" "$3,857.50" "$2,893.13" "$3,857.50" "$3,857.50" "$3,857.50" "$1,928.75" "$1,928.75" "$3,055.14" "$3,857.50" "$3,086.00" "$1,735.88" $765.62 N/A "$2,237.35" "$3,857.50" "$3,857.50" "$3,857.50" $803.90 "$3,857.50" N/A N/A 2102-1505 SUP HCPCS C9359 2102-1505 - SUBSTITUTE BNGFT 240X25X4MM VOID FILR FOAM STRIP BIOACTIVE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 2102-1510 SUP HCPCS C9359 2102-1510 - SUBSTITUTE BNGFT 50X25X8MM VOID FILR FOAM STRIP COMPRESSION BOTH IP/OP "$3,997.00" "$2,958.00" $793.30 "$3,997.00" "$1,798.65" "$1,798.65" "$1,798.65" "$1,798.65" "$3,997.00" "$3,997.00" "$3,997.00" $833.07 "$3,997.00" "$3,997.00" "$3,997.00" "$3,997.00" "$3,997.00" $833.02 "$3,997.00" "$3,997.00" "$1,970.52" "$3,997.00" "$3,997.00" "$3,997.00" "$3,997.00" "$2,997.75" "$3,997.00" "$3,997.00" "$3,997.00" "$1,998.50" "$1,998.50" "$3,165.62" "$3,997.00" "$3,197.60" "$1,798.65" $793.30 N/A "$2,318.26" "$3,997.00" "$3,997.00" "$3,997.00" $832.97 "$3,997.00" N/A N/A 2102-1520 SUP HCPCS C9359 2102-1520 - SUBSTITUTE BNGFT 25MMX100MMX8MM 100X25X8MM VOID FILR FOAM BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 2102-1601 SUP HCPCS C9359 2102-1601 - SUBSTITUTE BNGFT FOAM PACK BIOACTIVE VITOSS BTCP COLLAGEN BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 2102-1602 SUP HCPCS C9359 2102-1602 - SUBSTITUTE BNGFT VOID FILR FOAM PACK BIOACTIVE VITOSS BTCP BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A 2102-1605 SUP HCPCS C9359 2102-1605 - SUBSTITUTE BNGFT VOID FILR FOAM PACK BIOACTIVE VITOSS BTCP BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 2102-1610 SUP HCPCS C9359 2102-1610 - SUBSTITUTE BNGFT VOID FILR FOAM PACK BIOACTIVE VITOSS BTCP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 2102-1901 SUP HCPCS C1713 2102-1901 - SUBSTITUTE BNGFT BIOMODAL FOAM PACK VITOSS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 2102-1902 SUP HCPCS C1713 2102-1902 - SUBSTITUTE BNGFT BIOMODAL FOAM PACK VITOSS BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 2102-1905 SUP HCPCS C1713 2102-1905 - SUBSTITUTE BNGFT BIMODAL FOAM PACK VITOSS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2102-1910 SUP HCPCS C1713 2102-1910 - SUBSTITUTE BNGFT BIOMODAL FOAM PACK VITOSS BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$2,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$3,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A 2102-2110 SUP HCPCS C1713 2102-2110 - SUBSTITUTE BNGFT VOID FILR PACK BIOACTIVE COMPRESSION BOTH IP/OP "$4,589.50" "$3,396.00" $910.90 "$4,589.50" "$2,065.28" "$2,065.28" "$2,065.28" "$2,065.28" "$4,589.50" "$4,589.50" "$4,589.50" $956.57 "$4,589.50" "$4,589.50" "$4,589.50" "$4,589.50" "$4,589.50" $956.50 "$4,589.50" "$1,835.80" "$2,262.62" "$4,589.50" "$4,589.50" "$4,589.50" "$4,589.50" "$3,442.13" "$4,589.50" "$4,589.50" "$4,589.50" "$2,294.75" "$2,294.75" "$3,634.88" "$4,589.50" "$3,671.60" "$2,065.28" $910.90 N/A "$2,661.91" "$4,589.50" "$2,753.70" "$4,589.50" $956.45 "$4,589.50" N/A N/A 2108-110-000 SUP Custom 27203010 2108-110-000 - BLADE SAW THK1.3MM 73MM WIDE 25MM 2 CUT SAGITTAL STAINLESS BOTH IP/OP $77.50 $57.00 $13.75 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $13.75 $77.25 $77.25 $57.33 $57.33 $59.54 $40.25 $16.10 $77.25 $30.90 $77.25 $77.25 $77.25 $77.25 $77.25 $58.13 $77.25 $77.25 $77.25 $38.63 $38.63 $61.18 $77.25 $61.80 $50.21 $77.25 N/A $44.95 $77.25 $46.35 $77.25 $77.25 $77.25 N/A N/A 2108-120-000 SUP Custom 27203010 2108-120-000 - BLADE SAW SHORT NARROW THIN 60.5X18.5X.64MM SAGITTAL BOTH IP/OP $77.50 $57.00 $13.75 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $13.75 $77.25 $77.25 $57.33 $57.33 $59.54 $40.25 $16.10 $77.25 $30.90 $77.25 $77.25 $77.25 $77.25 $77.25 $58.13 $77.25 $77.25 $77.25 $38.63 $38.63 $61.18 $77.25 $61.80 $50.21 $77.25 N/A $44.95 $77.25 $46.35 $77.25 $77.25 $77.25 N/A N/A 2108-120-006 SUP Custom 27203010 2108-120-006 - BLADE SAW THK.64MM 63X18.5MM SAGITTAL HEAVY DUTY STAINLESS BOTH IP/OP $77.50 $57.00 $13.75 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $13.75 $77.25 $77.25 $57.33 $57.33 $59.54 $40.25 $16.10 $77.25 $30.90 $77.25 $77.25 $77.25 $77.25 $77.25 $58.13 $77.25 $77.25 $77.25 $38.63 $38.63 $61.18 $77.25 $61.80 $50.21 $77.25 N/A $44.95 $77.25 $46.35 $77.25 $77.25 $77.25 N/A N/A 2108-131-000 SUP Custom 27203010 2108-131-000 - BLADE SAW THK.6MM 46X17MM SAGITTAL CUT EDGE SAFEDGE BOTH IP/OP $77.50 $57.00 $13.75 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $13.75 $77.25 $77.25 $57.33 $57.33 $59.54 $40.25 $16.10 $77.25 $30.90 $77.25 $77.25 $77.25 $77.25 $77.25 $58.13 $77.25 $77.25 $77.25 $38.63 $38.63 $61.18 $77.25 $61.80 $50.21 $77.25 N/A $44.95 $77.25 $46.35 $77.25 $77.25 $77.25 N/A N/A 2108-148-000 SUP Custom 27203010 2108-148-000 - BLADE SAW THK.64MM SHORT NARROW THIN 34.5X9MM SAGITTAL BOTH IP/OP $77.50 $57.00 $13.75 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $13.75 $77.25 $77.25 $57.33 $57.33 $59.54 $40.25 $16.10 $77.25 $30.90 $77.25 $77.25 $77.25 $77.25 $77.25 $58.13 $77.25 $77.25 $77.25 $38.63 $38.63 $61.18 $77.25 $61.80 $50.21 $77.25 N/A $44.95 $77.25 $46.35 $77.25 $77.25 $77.25 N/A N/A 2108-151-000 SUP Custom 27203010 2108-151-000 - BLADE SAW THK1.19MM WIDE THICK 85X25MM SAGITTAL STAINLESS BOTH IP/OP $77.50 $57.00 $13.75 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $13.75 $77.25 $77.25 $57.33 $57.33 $59.54 $40.25 $16.10 $77.25 $30.90 $77.25 $77.25 $77.25 $77.25 $77.25 $58.13 $77.25 $77.25 $77.25 $38.63 $38.63 $61.18 $77.25 $61.80 $50.21 $77.25 N/A $44.95 $77.25 $46.35 $77.25 $77.25 $77.25 N/A N/A 2108-175-000 SUP Custom 27203010 2108-175-000 - BLADE SAW THK1.5MM SHORT NARROW THIN 79.5X25MM SAGITTAL BOTH IP/OP $77.50 $57.00 $13.75 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $13.75 $77.25 $77.25 $57.33 $57.33 $59.54 $40.25 $16.10 $77.25 $30.90 $77.25 $77.25 $77.25 $77.25 $77.25 $58.13 $77.25 $77.25 $77.25 $38.63 $38.63 $61.18 $77.25 $61.80 $50.21 $77.25 N/A $44.95 $77.25 $46.35 $77.25 $77.25 $77.25 N/A N/A 2108-182-000 SUP Custom 27203010 2108-182-000 - BLADE SAW LONG THICK 18MM SAGITTAL NO OFFST STAINLESS STEEL BOTH IP/OP $73.00 $54.00 $12.97 $72.89 $72.89 $72.89 $72.89 $72.89 $72.89 $72.89 $12.97 $72.89 $72.89 $54.10 $54.10 $56.18 $37.98 $15.19 $72.89 $30.90 $72.89 $72.89 $72.89 $72.89 $72.89 $54.75 $72.89 $72.89 $72.89 $36.45 $36.45 $57.73 $72.89 $58.31 $47.38 $72.89 N/A $42.34 $72.89 $43.73 $72.89 $72.89 $72.89 N/A N/A 2108-193-000 SUP Custom 27203010 2108-193-000 - BLADE SAW THK.96MM MEDIUM WIDE 81.5X25MM SAGITTAL STAINLESS BOTH IP/OP $77.50 $57.00 $13.75 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $77.25 $13.75 $77.25 $77.25 $57.33 $57.33 $59.54 $40.25 $16.10 $77.25 $30.90 $77.25 $77.25 $77.25 $77.25 $77.25 $58.13 $77.25 $77.25 $77.25 $38.63 $38.63 $61.18 $77.25 $61.80 $50.21 $77.25 N/A $44.95 $77.25 $46.35 $77.25 $77.25 $77.25 N/A N/A 211.890S SUP HCPCS C1713 211.890S - SCREW BN 2.4MM 90MM STRL LCP DHHS CMPR SS HIP BOTH IP/OP $174.00 $129.00 $34.46 $176.55 $78.12 $78.12 $78.12 $78.12 $173.60 $173.60 $173.60 $36.18 $173.60 $173.60 $173.60 $173.60 $173.60 $36.18 $173.60 $70.62 $102.68 $173.60 $176.55 $173.60 $173.60 $130.50 $173.60 $173.60 $173.60 $86.80 $86.80 $137.49 $173.60 $138.88 $78.12 $34.46 N/A $100.92 $173.60 $173.60 $173.60 $36.18 $173.60 N/A N/A 21-2000-24 SUP HCPCS C1752 21-2000-24 - CATHETER DLYS STRG BLNT 14.7FR 4.9MM 2.6MM 48CM DELTEC BOTH IP/OP $657.50 $487.00 $137.03 $657.50 $657.50 $657.50 $657.50 $657.50 $657.50 $657.50 $657.50 $657.50 $657.50 $657.50 $657.50 $657.50 $657.50 $137.03 $657.50 $263.00 $657.50 $657.50 $657.50 $657.50 $657.50 $493.13 $657.50 $657.50 $657.50 $328.75 $328.75 $520.74 $657.50 $526.00 $295.88 $657.50 N/A $381.35 $657.50 $394.50 $657.50 $657.50 $657.50 N/A N/A 2120F SUP HCPCS C1880 2120F - SYSTEM EMBOLIC PROTECTION 7FR 48CM SNF/SL DELIVERY KIT BOTH IP/OP "$1,937.50" "$1,434.00" $403.80 "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" $403.80 "$1,937.50" $775.00 "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,453.13" "$1,937.50" "$1,937.50" "$1,937.50" $968.75 $968.75 "$1,534.50" "$1,937.50" "$1,550.00" $871.88 "$1,937.50" N/A "$1,123.75" "$1,937.50" "$1,162.50" "$1,937.50" "$1,937.50" "$1,937.50" N/A N/A 21-2369 SUP HCPCS C1751 21-2369 - TRAY CATH 9FR 72.5CM 72.5L VENTRA 2 LUM SIL PERC BOTH IP/OP $387.50 $287.00 $76.91 $387.50 $174.38 $174.38 $174.38 $174.38 $387.50 $387.50 $387.50 $80.76 $387.50 $387.50 $387.50 $387.50 $387.50 $80.76 $387.50 $387.50 $229.21 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $174.38 $76.91 N/A $224.75 $387.50 $387.50 $387.50 $80.76 $387.50 N/A N/A 21-4055 SUP HCPCS C1788 21-4055 - TRAY INFS PORT 7.8FR 11.4MM 1MM 76CM 30.5MMX14.7MM PRTACTH BOTH IP/OP $550.00 $407.00 $109.16 $550.00 $247.50 $247.50 $247.50 $247.50 $550.00 $550.00 $550.00 $114.63 $550.00 $550.00 $550.00 $550.00 $550.00 $114.63 $550.00 $550.00 $325.33 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $247.50 $109.16 N/A $319.00 $550.00 $550.00 $550.00 $114.62 $550.00 N/A N/A 21-4065-24 SUP HCPCS C1788 21-4065-24 - TRAY INFS PORT 8.5FR STRL PRTACTH II 1 LUM CATHETHER PRTL BOTH IP/OP $769.50 $569.00 $152.70 $769.35 $346.21 $346.21 $346.21 $346.21 $769.35 $769.35 $769.35 $160.35 $769.35 $769.35 $769.35 $769.35 $769.35 $160.34 $769.35 $769.35 $455.07 $769.35 $769.35 $769.35 $769.35 $577.13 $769.35 $769.35 $769.35 $384.68 $384.68 $609.33 $769.35 $615.48 $346.21 $152.70 N/A $446.31 $769.35 $769.35 $769.35 $160.33 $769.35 N/A N/A 21-4082 SUP HCPCS C1788 21-4082 - PORT-A-CATHETER II BOTH IP/OP $12.50 $9.00 $2.48 $12.50 $5.63 $5.63 $5.63 $5.63 $12.50 $12.50 $12.50 $2.61 $12.50 $12.50 $12.50 $12.50 $12.50 $2.61 $12.50 $12.50 $7.39 $12.50 $12.50 $12.50 $12.50 $9.38 $12.50 $12.50 $12.50 $6.25 $6.25 $9.90 $12.50 $10.00 $5.63 $2.48 N/A $7.25 $12.50 $12.50 $12.50 $2.61 $12.50 N/A N/A 21-4165-24 SUP HCPCS C1788 21-4165-24 - PROPORT PLASTIC BOTH IP/OP $12.50 $9.00 $2.48 $12.50 $5.63 $5.63 $5.63 $5.63 $12.50 $12.50 $12.50 $2.61 $12.50 $12.50 $12.50 $12.50 $12.50 $2.61 $12.50 $12.50 $7.39 $12.50 $12.50 $12.50 $12.50 $9.38 $12.50 $12.50 $12.50 $6.25 $6.25 $9.90 $12.50 $10.00 $5.63 $2.48 N/A $7.25 $12.50 $12.50 $12.50 $2.61 $12.50 N/A N/A 21-4483-24 SUP Custom 27203010 21-4483-24 - TRAY INFUS PORT LP 6FR 1.9MM 1MM 76CM 1 LUMEN INTROD NEEDLE BOTH IP/OP "$1,693.50" "$1,253.00" $301.40 "$1,693.28" "$1,693.28" "$1,693.28" "$1,693.28" "$1,693.28" "$1,693.28" "$1,693.28" $301.40 "$1,693.28" "$1,693.28" "$1,256.75" "$1,256.75" "$1,305.18" $882.20 $352.90 "$1,693.28" $677.31 "$1,693.28" "$1,693.28" "$1,693.28" "$1,693.28" "$1,693.28" "$1,270.13" "$1,693.28" "$1,693.28" "$1,693.28" $846.64 $846.64 "$1,341.08" "$1,693.28" "$1,354.62" "$1,100.63" "$1,693.28" N/A $982.23 "$1,693.28" "$1,015.97" "$1,693.28" "$1,693.28" "$1,693.28" N/A N/A 21-4572-24 SUP HCPCS C1788 21-4572-24 - KIT INFS PORT 5.8FR PSPRT T2 1 LUM PLFLW CATH INTRO UNAS BOTH IP/OP $562.50 $416.00 $111.64 $562.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $562.50 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $562.50 $562.50 $117.23 $562.50 N/A N/A 21-8067 SUP HCPCS C1751 21-8067 - KIT INFS PORT LOPRFL 10FR 3.2MM 1.4MM 760MM PCTH2 PLFL 2 LUM BOTH IP/OP "$1,070.00" $792.00 $212.37 "$1,070.00" $481.50 $481.50 $481.50 $481.50 "$1,070.00" "$1,070.00" "$1,070.00" $223.01 "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" $223.00 "$1,070.00" "$1,070.00" $632.91 "$1,070.00" "$1,070.00" "$1,070.00" "$1,070.00" $802.50 "$1,070.00" "$1,070.00" "$1,070.00" $535.00 $535.00 $847.44 "$1,070.00" $856.00 $481.50 $212.37 N/A $620.60 "$1,070.00" "$1,070.00" "$1,070.00" $222.99 "$1,070.00" N/A N/A 219.952S SUP Custom 27803010 219.952S - WASHER ORTHOPEDIC SMALL OVAL STAINLESS STEEL STERILE 6.5/7.3 BOTH IP/OP $374.00 $277.00 $66.56 $380.28 $373.93 $373.93 $373.93 $373.93 $373.93 $373.93 $66.56 $373.93 $373.93 $373.93 $373.93 $373.93 $373.93 $77.93 $373.93 $152.11 $373.93 $373.93 $380.28 $373.93 $373.93 $280.50 $373.93 $373.93 $373.93 $186.97 $186.97 $296.15 $373.93 $299.14 $168.27 $373.93 N/A $216.92 $373.93 $224.36 $373.93 $373.93 $373.93 N/A N/A 219.953S SUP Custom 27803010 219.953S - WASHER ORTHOPEDIC LARGE ROUND STAINLESS STEEL STERILE BOTH IP/OP $374.00 $277.00 $66.56 $380.28 $373.93 $373.93 $373.93 $373.93 $373.93 $373.93 $66.56 $373.93 $373.93 $373.93 $373.93 $373.93 $373.93 $77.93 $373.93 $152.11 $373.93 $373.93 $380.28 $373.93 $373.93 $280.50 $373.93 $373.93 $373.93 $186.97 $186.97 $296.15 $373.93 $299.14 $168.27 $373.93 N/A $216.92 $373.93 $224.36 $373.93 $373.93 $373.93 N/A N/A 21AC60 SUP Custom 27203010 21AC60 - TOOL DISSECTING ACORN 6MM 21CM ACORN LEGEND STERILE BOTH IP/OP $338.00 $250.00 $60.14 $337.88 $337.88 $337.88 $337.88 $337.88 $337.88 $337.88 $60.14 $337.88 $337.88 $250.77 $250.77 $260.44 $176.04 $70.42 $337.88 $135.15 $337.88 $337.88 $337.88 $337.88 $337.88 $253.50 $337.88 $337.88 $337.88 $168.94 $168.94 $267.60 $337.88 $270.30 $219.62 $337.88 N/A $196.04 $337.88 $202.73 $337.88 $337.88 $337.88 N/A N/A 21AC75 SUP Custom 27203010 21AC75 - TOOL DISSECTING ACORN 7.5MM 21CM MIDAS REX LEGEND STERILE BOTH IP/OP $338.00 $250.00 $60.14 $337.88 $337.88 $337.88 $337.88 $337.88 $337.88 $337.88 $60.14 $337.88 $337.88 $250.77 $250.77 $260.44 $176.04 $70.42 $337.88 $135.15 $337.88 $337.88 $337.88 $337.88 $337.88 $253.50 $337.88 $337.88 $337.88 $168.94 $168.94 $267.60 $337.88 $270.30 $219.62 $337.88 N/A $196.04 $337.88 $202.73 $337.88 $337.88 $337.88 N/A N/A 21AC90 SUP Custom 27203010 21AC90 - TOOL DISSECTING ACORN 9MM 21CM MIDAS REX LEGEND STERILE BOTH IP/OP $338.00 $250.00 $60.14 $337.88 $337.88 $337.88 $337.88 $337.88 $337.88 $337.88 $60.14 $337.88 $337.88 $250.77 $250.77 $260.44 $176.04 $70.42 $337.88 $135.15 $337.88 $337.88 $337.88 $337.88 $337.88 $253.50 $337.88 $337.88 $337.88 $168.94 $168.94 $267.60 $337.88 $270.30 $219.62 $337.88 N/A $196.04 $337.88 $202.73 $337.88 $337.88 $337.88 N/A N/A 21AGFN-756 SUP Custom 27803010 21AGFN-756 - VALVE AORTIC 85D 21MM 19.6MM 1 DIGIT GRADIENT MECHANICAL BOTH IP/OP "$11,750.00" "$8,695.00" "$2,091.50" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$2,091.50" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$2,448.83" "$11,750.00" "$4,700.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$8,812.50" "$11,750.00" "$11,750.00" "$11,750.00" "$5,875.00" "$5,875.00" "$9,306.00" "$11,750.00" "$9,400.00" "$5,287.50" "$11,750.00" N/A "$6,815.00" "$11,750.00" "$7,050.00" "$11,750.00" "$11,750.00" "$11,750.00" N/A N/A 21AJ-501 SUP Custom 27803010 21AJ-501 - VALVE AOR 85D 2.06SQ CM 1.51SQ CM 21MM 16.7MM MSTR SER MECH BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 21BA50 SUP Custom 27203010 21BA50 - TOOL DISSECTING BALL 5MM 21CM FLUTED LARGE BORE STR ATTCH BOTH IP/OP $484.50 $359.00 $86.24 $484.50 $484.50 $484.50 $484.50 $484.50 $484.50 $484.50 $86.24 $484.50 $484.50 $359.60 $359.60 $373.45 $252.42 $100.98 $484.50 $193.80 $484.50 $484.50 $484.50 $484.50 $484.50 $363.38 $484.50 $484.50 $484.50 $242.25 $242.25 $383.72 $484.50 $387.60 $314.93 $484.50 N/A $281.01 $484.50 $290.70 $484.50 $484.50 $484.50 N/A N/A 21BA50DX SUP Custom 27203010 21BA50DX - TOOL DISSECTING BALL XCOARSE 5MM 21CM STR LARGE BORE BALL BOTH IP/OP $402.00 $297.00 $71.49 $401.63 $401.63 $401.63 $401.63 $401.63 $401.63 $401.63 $71.49 $401.63 $401.63 $298.09 $298.09 $309.58 $209.25 $83.70 $401.63 $160.65 $401.63 $401.63 $401.63 $401.63 $401.63 $301.50 $401.63 $401.63 $401.63 $200.82 $200.82 $318.09 $401.63 $321.30 $261.06 $401.63 N/A $233.16 $401.63 $240.98 $401.63 $401.63 $401.63 N/A N/A 21BA60 SUP Custom 27203010 21BA60 - TOOL DISSECTING BALL 6MM 21CM BALL LEGEND STERILE BOTH IP/OP $402.00 $297.00 $71.49 $401.63 $401.63 $401.63 $401.63 $401.63 $401.63 $401.63 $71.49 $401.63 $401.63 $298.09 $298.09 $309.58 $209.25 $83.70 $401.63 $160.65 $401.63 $401.63 $401.63 $401.63 $401.63 $301.50 $401.63 $401.63 $401.63 $200.82 $200.82 $318.09 $401.63 $321.30 $261.06 $401.63 N/A $233.16 $401.63 $240.98 $401.63 $401.63 $401.63 N/A N/A 21BA70DX SUP Custom 27203010 21BA70DX - TOOL DISSECTING BALL XCOARSE 7MM 21CM DIAMOND LARGE BORE STR BOTH IP/OP $402.00 $297.00 $71.49 $401.63 $401.63 $401.63 $401.63 $401.63 $401.63 $401.63 $71.49 $401.63 $401.63 $298.09 $298.09 $309.58 $209.25 $83.70 $401.63 $160.65 $401.63 $401.63 $401.63 $401.63 $401.63 $301.50 $401.63 $401.63 $401.63 $200.82 $200.82 $318.09 $401.63 $321.30 $261.06 $401.63 N/A $233.16 $401.63 $240.98 $401.63 $401.63 $401.63 N/A N/A 21BA75 SUP Custom 27203010 21BA75 - TOOL DISSECTING 7.5MM 21CM BALL FLUTED LEGEND STERILE BOTH IP/OP $391.00 $289.00 $69.60 $391.00 $391.00 $391.00 $391.00 $391.00 $391.00 $391.00 $69.60 $391.00 $391.00 $290.20 $290.20 $301.38 $203.71 $81.49 $391.00 $156.40 $391.00 $391.00 $391.00 $391.00 $391.00 $293.25 $391.00 $391.00 $391.00 $195.50 $195.50 $309.67 $391.00 $312.80 $254.15 $391.00 N/A $226.78 $391.00 $234.60 $391.00 $391.00 $391.00 N/A N/A 21BA90 SUP Custom 27203010 21BA90 - TOOL DISSECTING BALL 9MM 21CM LARGE BORE STR ATTCH MIDAS REX BOTH IP/OP $385.00 $285.00 $68.46 $384.63 $384.63 $384.63 $384.63 $384.63 $384.63 $384.63 $68.46 $384.63 $384.63 $285.47 $285.47 $296.47 $200.39 $80.16 $384.63 $153.85 $384.63 $384.63 $384.63 $384.63 $384.63 $288.75 $384.63 $384.63 $384.63 $192.32 $192.32 $304.63 $384.63 $307.70 $250.01 $384.63 N/A $223.30 $384.63 $230.78 $384.63 $384.63 $384.63 N/A N/A 21CY64BC SUP Custom 27203010 21CY64BC - TOOL DISSECTING CYLINDER 6.4MM 21CM LATEX FREE LEGEND BOTH IP/OP $374.00 $277.00 $66.57 $374.00 $374.00 $374.00 $374.00 $374.00 $374.00 $374.00 $66.57 $374.00 $374.00 $277.58 $277.58 $288.28 $194.85 $77.95 $374.00 $149.60 $374.00 $374.00 $374.00 $374.00 $374.00 $280.50 $374.00 $374.00 $374.00 $187.00 $187.00 $296.21 $374.00 $299.20 $243.10 $374.00 N/A $216.92 $374.00 $224.40 $374.00 $374.00 $374.00 N/A N/A 21CY65DX SUP Custom 27203010 21CY65DX - TOOL DISSECTING CYLINDER XCOARSE 6.5MM 21CM DIAMOND LARGE BOTH IP/OP $387.00 $286.00 $68.84 $386.75 $386.75 $386.75 $386.75 $386.75 $386.75 $386.75 $68.84 $386.75 $386.75 $287.05 $287.05 $298.11 $201.50 $80.60 $386.75 $154.70 $386.75 $386.75 $386.75 $386.75 $386.75 $290.25 $386.75 $386.75 $386.75 $193.38 $193.38 $306.31 $386.75 $309.40 $251.39 $386.75 N/A $224.46 $386.75 $232.05 $386.75 $386.75 $386.75 N/A N/A 21CY90 SUP Custom 27203010 21CY90 - TOOL DISSECTING CYLINDER 9MM 21CM CYLINDER LEGEND STERILE BOTH IP/OP $336.00 $249.00 $59.76 $335.75 $335.75 $335.75 $335.75 $335.75 $335.75 $335.75 $59.76 $335.75 $335.75 $249.19 $249.19 $258.80 $174.93 $69.97 $335.75 $134.30 $335.75 $335.75 $335.75 $335.75 $335.75 $252.00 $335.75 $335.75 $335.75 $167.88 $167.88 $265.91 $335.75 $268.60 $218.24 $335.75 N/A $194.88 $335.75 $201.45 $335.75 $335.75 $335.75 N/A N/A 21MH30 SUP Custom 27203010 21MH30 - TOOL DISSECTING MATCH HEAD 3MM 21CM BURR MATCH HEAD LEGEND BOTH IP/OP $338.00 $250.00 $60.14 $337.88 $337.88 $337.88 $337.88 $337.88 $337.88 $337.88 $60.14 $337.88 $337.88 $250.77 $250.77 $260.44 $176.04 $70.42 $337.88 $135.15 $337.88 $337.88 $337.88 $337.88 $337.88 $253.50 $337.88 $337.88 $337.88 $168.94 $168.94 $267.60 $337.88 $270.30 $219.62 $337.88 N/A $196.04 $337.88 $202.73 $337.88 $337.88 $337.88 N/A N/A 21MJ-501 SUP Custom 27803010 21MJ-501 - VALVE MTRL 85D STD RING 21MM 16.7MM MSTR MECH LFLT ORFC BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 21TA30 SUP Custom 27203010 21TA30 - TOOL DISSECTING TAPER 3MM 21CM TAPERED MIDAS REX LEGEND BOTH IP/OP $372.00 $275.00 $66.19 $371.88 $371.88 $371.88 $371.88 $371.88 $371.88 $371.88 $66.19 $371.88 $371.88 $276.01 $276.01 $286.65 $193.75 $77.50 $371.88 $148.75 $371.88 $371.88 $371.88 $371.88 $371.88 $279.00 $371.88 $371.88 $371.88 $185.94 $185.94 $294.53 $371.88 $297.50 $241.72 $371.88 N/A $215.76 $371.88 $223.13 $371.88 $371.88 $371.88 N/A N/A 2200-09-0040 SUP Custom 27203010 2200-09-0040 - DRILL SURG DYNANAIL 4MM DISP TIBIOTALOCALCANEAL BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 2200-09-0050 SUP Custom 27203010 2200-09-0050 - DRILL SURG STP DYNANAIL 5MM DISP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 2200-18-4031 SUP Custom 27203010 2200-18-4031 - GUIDEWIRE ORTH 400MM 3.1MM DYNANAIL TROCAR TIP BOTH IP/OP $212.50 $157.00 $37.83 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $37.83 $212.50 $212.50 $157.72 $157.72 $163.80 $110.71 $44.29 $212.50 $85.00 $212.50 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $138.13 $212.50 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A 2200-18-5031 SUP Custom 27203010 2200-18-5031 - GUIDEWIRE ORTH 500MM 3.1MM DYNANAIL BEAD TIP BOTH IP/OP $212.50 $157.00 $37.83 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $37.83 $212.50 $212.50 $157.72 $157.72 $163.80 $110.71 $44.29 $212.50 $85.00 $212.50 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $138.13 $212.50 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A 2200-19-0031 SUP Custom 27203010 2200-19-0031 - PIN FIX 3.1MM DYNANAIL STNM DISP BOTH IP/OP $212.50 $157.00 $37.83 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $37.83 $212.50 $212.50 $157.72 $157.72 $163.80 $110.71 $44.29 $212.50 $85.00 $212.50 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $138.13 $212.50 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A 22002 H SUP Custom 27803010 22002 H - CATHETER NEUROSURGICAL SMALL HIGH CLOSING PRESSURE CARDIAC BOTH IP/OP $748.50 $554.00 $133.17 $748.13 $748.13 $748.13 $748.13 $748.13 $748.13 $748.13 $133.17 $748.13 $748.13 $748.13 $748.13 $748.13 $748.13 $155.92 $748.13 $299.25 $748.13 $748.13 $748.13 $748.13 $748.13 $561.38 $748.13 $748.13 $748.13 $374.07 $374.07 $592.52 $748.13 $598.50 $336.66 $748.13 N/A $434.13 $748.13 $448.88 $748.13 $748.13 $748.13 N/A N/A 22002 L SUP Custom 27803010 22002 L - CATHETER NEUROSURGICAL SMALL PLIANT LOW CLOSURE PRESSURE BOTH IP/OP $748.50 $554.00 $133.17 $748.13 $748.13 $748.13 $748.13 $748.13 $748.13 $748.13 $133.17 $748.13 $748.13 $748.13 $748.13 $748.13 $748.13 $155.92 $748.13 $299.25 $748.13 $748.13 $748.13 $748.13 $748.13 $561.38 $748.13 $748.13 $748.13 $374.07 $374.07 $592.52 $748.13 $598.50 $336.66 $748.13 N/A $434.13 $748.13 $448.88 $748.13 $748.13 $748.13 N/A N/A 22002 M SUP Custom 27803010 22002 M - CATHETER NEUROSURGICAL SMALL MEDIUM CLOSING PRESSURE CARDIAC BOTH IP/OP $748.50 $554.00 $133.17 $748.13 $748.13 $748.13 $748.13 $748.13 $748.13 $748.13 $133.17 $748.13 $748.13 $748.13 $748.13 $748.13 $748.13 $155.92 $748.13 $299.25 $748.13 $748.13 $748.13 $748.13 $748.13 $561.38 $748.13 $748.13 $748.13 $374.07 $374.07 $592.52 $748.13 $598.50 $336.66 $748.13 N/A $434.13 $748.13 $448.88 $748.13 $748.13 $748.13 N/A N/A 22017 A-L SUP Custom 27803010 22017 A-L - SHUNT NEUROSURGICAL ULTRA SMALL 65CM CSF LOW PRESSURE BOTH IP/OP "$2,750.50" "$2,035.00" $489.54 "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" $489.54 "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" $573.18 "$2,750.25" "$1,100.10" "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" "$2,062.88" "$2,750.25" "$2,750.25" "$2,750.25" "$1,375.13" "$1,375.13" "$2,178.20" "$2,750.25" "$2,200.20" "$1,237.61" "$2,750.25" N/A "$1,595.29" "$2,750.25" "$1,650.15" "$2,750.25" "$2,750.25" "$2,750.25" N/A N/A 22017 A-M SUP Custom 27803010 22017 A-M - SHUNT NEUROSURGICAL ULTRA SMALL 65CM CSF MEDIUM PRESSURE BOTH IP/OP "$2,750.50" "$2,035.00" $489.54 "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" $489.54 "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" $573.18 "$2,750.25" "$1,100.10" "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" "$2,750.25" "$2,062.88" "$2,750.25" "$2,750.25" "$2,750.25" "$1,375.13" "$1,375.13" "$2,178.20" "$2,750.25" "$2,200.20" "$1,237.61" "$2,750.25" N/A "$1,595.29" "$2,750.25" "$1,650.15" "$2,750.25" "$2,750.25" "$2,750.25" N/A N/A 22017 B-L SUP Custom 27803010 22017 B-L - SHUNT NEUROSURGICAL ULTRA SMALL 90CM CSF LOW PRESSURE BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 22017 B-M SUP Custom 27803010 22017 B-M - SHUNT NEUROSURGICAL ULTRA SMALL 90CM CSF MEDIUM PRESSURE BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 22017A-LL SUP HCPCS C1713 22017A-LL - SHUNT NEUROSURGICAL ULTRA SMALL 65CM VERY LOW PRESSURE CSF BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" $931.00 "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" N/A N/A 22017B-LL SUP Custom 27803010 22017B-LL - SHUNT NEUROSURGICAL ULTRA SMALL 65CM CSF LOW LOW PRESSURE BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 22050 B SUP Custom 27803010 22050 B - KIT VNCLSTM STD DOME 6MM STRL CSF SNP BOTH IP/OP $629.50 $466.00 $112.03 $629.38 $629.38 $629.38 $629.38 $629.38 $629.38 $629.38 $112.03 $629.38 $629.38 $629.38 $629.38 $629.38 $629.38 $131.17 $629.38 $251.75 $629.38 $629.38 $629.38 $629.38 $629.38 $472.13 $629.38 $629.38 $629.38 $314.69 $314.69 $498.47 $629.38 $503.50 $283.22 $629.38 N/A $365.11 $629.38 $377.63 $629.38 $629.38 $629.38 N/A N/A 22082 F SUP Custom 27803010 22082 F - SHUNT NEUROSURGICAL STANDARD 10CM BARIUM IMPREGNATED BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 22082 G SUP Custom 27803010 22082 G - SHUNT NEUROSURGICAL STANDARD 11CM BARIUM IMPREGNATED BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 22082 H SUP Custom 27803010 22082 H - SHUNT NEUROSURGICAL STANDARD 6.5CM BARIUM IMPREGNATED BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 22082 I SUP Custom 27803010 22082 I - SHUNT NEUROSURGICAL STANDARD 5.5CM BARIUM IMPREGNATED BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 22082 K SUP Custom 27803010 22082 K - SHUNT NEUROSURGICAL STANDARD 4.5CM BARIUM IMPREGNATED BOTH IP/OP $513.00 $380.00 $91.31 $513.00 $513.00 $513.00 $513.00 $513.00 $513.00 $513.00 $91.31 $513.00 $513.00 $513.00 $513.00 $513.00 $513.00 $106.91 $513.00 $205.20 $513.00 $513.00 $513.00 $513.00 $513.00 $384.75 $513.00 $513.00 $513.00 $256.50 $256.50 $406.30 $513.00 $410.40 $230.85 $513.00 N/A $297.54 $513.00 $307.80 $513.00 $513.00 $513.00 N/A N/A 22097 A-L SUP Custom 27803010 22097 A-L - SHUNT NEUROSURGICAL SMALL RIGHT ANG 6CM CSF UNITIZED LOW BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 22097 A-M SUP Custom 27803010 22097 A-M - SHUNT NEUROSURGICAL SMALL 6CM UNITIZED PRESSURE BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 22097 B-L SUP Custom 27803010 22097 B-L - SHUNT NEUROSURGICAL SMALL RIGHT ANG 8CM CSF UNITIZED LOW BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 22097 B-M SUP Custom 27803010 22097 B-M - SHUNT NEUROSURGICAL SMALL RIGHT ANG 8CM CSF UNITIZED MEDIUM BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 22098 B-L SUP Custom 27803010 22098 B-L - SHUNT NEUROSURGICAL REGULAR RIGHT ANG 8CM UNITIZED LOW BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 22098 B-M SUP Custom 27803010 22098 B-M - SHUNT NEUROSURGICAL REGULAR RIGHT ANG 8CM UNITIZED MEDIUM BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 22098 C-L SUP Custom 27803010 22098 C-L - SHUNT NEUROSURGICAL REGULAR RIGHT ANG 10CM UNITIZED LOW BOTH IP/OP "$3,415.50" "$2,527.00" $607.91 "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" $607.91 "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" $711.78 "$3,415.25" "$1,366.10" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$2,561.63" "$3,415.25" "$3,415.25" "$3,415.25" "$1,707.63" "$1,707.63" "$2,704.88" "$3,415.25" "$2,732.20" "$1,536.86" "$3,415.25" N/A "$1,980.99" "$3,415.25" "$2,049.15" "$3,415.25" "$3,415.25" "$3,415.25" N/A N/A 22098 C-M SUP Custom 27803010 22098 C-M - SHUNT NEUROSURGICAL REGULAR RIGHT ANG 10CM UNITIZED MEDIUM BOTH IP/OP "$3,028.50" "$2,241.00" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $539.01 "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" $631.10 "$3,028.13" "$1,211.25" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$3,028.13" "$2,271.38" "$3,028.13" "$3,028.13" "$3,028.13" "$1,514.07" "$1,514.07" "$2,398.28" "$3,028.13" "$2,422.50" "$1,362.66" "$3,028.13" N/A "$1,756.53" "$3,028.13" "$1,816.88" "$3,028.13" "$3,028.13" "$3,028.13" N/A N/A 22101 A SUP Custom 27803010 22101 A - RESERVOIR SHUNT SMALL 3CM INTEGRATED VENTRICULAR CATHETER BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 22101 B SUP Custom 27803010 22101 B - RESERVOIR SHUNT SMALL FLAT DOME 2.5CM CSF INTEGRATE CATHETER BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 22101 C SUP Custom 27803010 22101 C - RESERVOIR SHUNT SMALL 2.5CM BARIUM INTEGRATED VENTRICULAR BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 22101 D SUP Custom 27803010 22101 D - RESERVOIR SHUNT SMALL FLAT DOME 4CM CSF INTEGRATE CATHETER BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 22-1266 SUP Custom 27203010 22-1266 - PROBE ESURG STR BIPOL TPR BLNT PNT WTFLD STRL 20-23GA BOTH IP/OP $425.00 $315.00 $75.65 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $75.65 $425.00 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $170.00 $425.00 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $425.00 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 222.657S SUP HCPCS C1713 222.657S - PLATE BN CRV 170X17.5X5.2MM STRL LCP CMBN 6 HL LOPRFL LMT BOTH IP/OP "$2,979.00" "$2,204.00" $591.19 "$3,029.28" "$1,340.39" "$1,340.39" "$1,340.39" "$1,340.39" "$2,978.65" "$2,978.65" "$2,978.65" $620.83 "$2,978.65" "$2,978.65" "$2,978.65" "$2,978.65" "$2,978.65" $620.78 "$2,978.65" "$3,029.28" "$1,468.47" "$2,978.65" "$3,029.28" "$2,978.65" "$2,978.65" "$2,234.25" "$2,978.65" "$2,978.65" "$2,978.65" "$1,489.33" "$1,489.33" "$2,359.09" "$2,978.65" "$2,382.92" "$1,340.39" $591.19 N/A "$1,727.82" "$2,978.65" "$2,978.65" "$2,978.65" $620.75 "$2,978.65" N/A N/A 222.658S SUP HCPCS C1713 222.658S - PLATE BN CRV 206X17.5X5.2MM STRL LCP CMBN 8 HL LOPRFL LMT BOTH IP/OP "$3,032.50" "$2,244.00" $601.79 "$3,083.63" "$1,364.44" "$1,364.44" "$1,364.44" "$1,364.44" "$3,032.08" "$3,032.08" "$3,032.08" $631.96 "$3,032.08" "$3,032.08" "$3,032.08" "$3,032.08" "$3,032.08" $631.92 "$3,032.08" "$3,083.63" "$1,494.82" "$3,032.08" "$3,083.63" "$3,032.08" "$3,032.08" "$2,274.38" "$3,032.08" "$3,032.08" "$3,032.08" "$1,516.04" "$1,516.04" "$2,401.41" "$3,032.08" "$2,425.66" "$1,364.44" $601.79 N/A "$1,758.85" "$3,032.08" "$3,032.08" "$3,032.08" $631.89 "$3,032.08" N/A N/A 2220J SUP HCPCS C1880 2220J - FILTER CV 7FR 83CM SIM SBCLV DLV KT NTNL JUG VN VC BOTH IP/OP "$2,544.50" "$1,883.00" $530.23 "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" $530.23 "$2,544.16" "$1,017.66" "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" "$1,908.38" "$2,544.16" "$2,544.16" "$2,544.16" "$1,272.08" "$1,272.08" "$2,014.97" "$2,544.16" "$2,035.33" "$1,144.87" "$2,544.16" N/A "$1,475.81" "$2,544.16" "$1,526.50" "$2,544.16" "$2,544.16" "$2,544.16" N/A N/A 224.510. SUP Custom 27803010 224.510. - ROD SPINAL 5.5MM 100MM STR REVERE STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A 22438-19 SUP HCPCS C1884 22438-19 - SYSTEM EMBOLIC PROTECTION .014IN LARGE 4-7MM 5-6FR 190CM BOTH IP/OP "$3,425.00" "$2,535.00" $679.78 "$3,425.00" "$1,541.25" "$1,541.25" "$1,541.25" "$1,541.25" "$3,425.00" "$3,425.00" "$3,425.00" $713.86 "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" $713.81 "$3,425.00" "$3,425.00" "$1,688.53" "$3,425.00" "$3,425.00" "$3,425.00" "$3,425.00" "$2,568.75" "$3,425.00" "$3,425.00" "$3,425.00" "$1,712.50" "$1,712.50" "$2,712.60" "$3,425.00" "$2,740.00" "$1,541.25" $679.78 N/A "$1,986.50" "$3,425.00" "$3,425.00" "$3,425.00" $713.77 "$3,425.00" N/A N/A 22-553 SUP HCPCS C2617 22-553 - STENT URET 8FR 28CM REG DRMTR LG DRAIN HOLE LCK PGTL 22-553 BOTH IP/OP $271.00 $201.00 $53.74 $270.75 $121.84 $121.84 $121.84 $121.84 $270.75 $270.75 $270.75 $56.43 $270.75 $270.75 $270.75 $270.75 $270.75 $56.43 $270.75 $270.75 $160.15 $270.75 $270.75 $270.75 $270.75 $203.25 $270.75 $270.75 $270.75 $135.38 $135.38 $214.43 $270.75 $216.60 $121.84 $53.74 N/A $157.18 $270.75 $270.75 $270.75 $56.42 $270.75 N/A N/A 226.622S SUP HCPCS C1713 226.622S - PLATE BN BRD CRV 229X17.5X5.2MM STRL LCP CMBN 12 HL BOTH IP/OP "$1,431.00" "$1,059.00" $284.02 "$1,455.33" $643.95 $643.95 $643.95 $643.95 "$1,431.00" "$1,431.00" "$1,431.00" $298.26 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $298.24 "$1,431.00" "$1,455.33" $846.44 "$1,431.00" "$1,455.33" "$1,431.00" "$1,431.00" "$1,073.25" "$1,431.00" "$1,431.00" "$1,431.00" $715.50 $715.50 "$1,133.35" "$1,431.00" "$1,144.80" $643.95 $284.02 N/A $829.98 "$1,431.00" "$1,431.00" "$1,431.00" $298.22 "$1,431.00" N/A N/A 226.642S SUP HCPCS C1713 226.642S - PLATE BN BRD CRV 265X17.5X5.2MM STRL LCP CMBN 14 HL SS 4.5MM BOTH IP/OP "$1,583.00" "$1,171.00" $314.15 "$1,609.70" $712.26 $712.26 $712.26 $712.26 "$1,582.80" "$1,582.80" "$1,582.80" $329.90 "$1,582.80" "$1,582.80" "$1,582.80" "$1,582.80" "$1,582.80" $329.87 "$1,582.80" "$1,609.70" $936.23 "$1,582.80" "$1,609.70" "$1,582.80" "$1,582.80" "$1,187.25" "$1,582.80" "$1,582.80" "$1,582.80" $791.40 $791.40 "$1,253.58" "$1,582.80" "$1,266.24" $712.26 $314.15 N/A $918.14 "$1,582.80" "$1,582.80" "$1,582.80" $329.86 "$1,582.80" N/A N/A 226.662S SUP HCPCS C1713 226.662S - PLATE BN BRD CRV 300X17.5X5.2MM STRL LCP CMBN 16 HL SS 4.5MM BOTH IP/OP "$1,903.50" "$1,409.00" $377.76 "$1,935.65" $856.49 $856.49 $856.49 $856.49 "$1,903.30" "$1,903.30" "$1,903.30" $396.70 "$1,903.30" "$1,903.30" "$1,903.30" "$1,903.30" "$1,903.30" $396.67 "$1,903.30" $774.26 "$1,125.80" "$1,903.30" "$1,935.65" "$1,903.30" "$1,903.30" "$1,427.63" "$1,903.30" "$1,903.30" "$1,903.30" $951.65 $951.65 "$1,507.41" "$1,903.30" "$1,522.64" $856.49 $377.76 N/A "$1,104.03" "$1,903.30" "$1,141.98" "$1,903.30" $396.65 "$1,903.30" N/A N/A 226.672S SUP HCPCS C1713 226.672S - PLATE BN BRD CRV 318X17.5X5.2MM STRL LCP CMBN 17 HL SS 4.5MM BOTH IP/OP "$1,989.50" "$1,472.00" $394.78 "$2,022.88" $895.07 $895.07 $895.07 $895.07 "$1,989.05" "$1,989.05" "$1,989.05" $414.57 "$1,989.05" "$1,989.05" "$1,989.05" "$1,989.05" "$1,989.05" $414.54 "$1,989.05" "$2,022.88" "$1,176.52" "$1,989.05" "$2,022.88" "$1,989.05" "$1,989.05" "$1,492.13" "$1,989.05" "$1,989.05" "$1,989.05" $994.53 $994.53 "$1,575.33" "$1,989.05" "$1,591.24" $895.07 $394.78 N/A "$1,153.91" "$1,989.05" "$1,989.05" "$1,989.05" $414.52 "$1,989.05" N/A N/A 226.682S SUP HCPCS C1713 226.682S - PLATE BN BRD CRV 336X17.5X5.2MM STRL LCP CMBN 18 HL SS 4.5MM BOTH IP/OP "$2,159.50" "$1,598.00" $428.54 "$2,195.85" $971.62 $971.62 $971.62 $971.62 "$2,159.15" "$2,159.15" "$2,159.15" $450.02 "$2,159.15" "$2,159.15" "$2,159.15" "$2,159.15" "$2,159.15" $449.99 "$2,159.15" "$2,195.85" "$1,277.14" "$2,159.15" "$2,195.85" "$2,159.15" "$2,159.15" "$1,619.63" "$2,159.15" "$2,159.15" "$2,159.15" "$1,079.58" "$1,079.58" "$1,710.05" "$2,159.15" "$1,727.32" $971.62 $428.54 N/A "$1,252.51" "$2,159.15" "$2,159.15" "$2,159.15" $449.97 "$2,159.15" N/A N/A 226.702S SUP HCPCS C1713 226.702S - PLATE BONE BROAD 372MM 20 HOLE CVD LCP STAINLESS STEEL BOTH IP/OP "$2,443.50" "$1,808.00" $484.89 "$2,484.63" "$1,099.40" "$1,099.40" "$1,099.40" "$1,099.40" "$2,443.10" "$2,443.10" "$2,443.10" $509.20 "$2,443.10" "$2,443.10" "$2,443.10" "$2,443.10" "$2,443.10" $509.17 "$2,443.10" "$2,484.63" "$1,445.09" "$2,443.10" "$2,484.63" "$2,443.10" "$2,443.10" "$1,832.63" "$2,443.10" "$2,443.10" "$2,443.10" "$1,221.55" "$1,221.55" "$1,934.94" "$2,443.10" "$1,954.48" "$1,099.40" $484.89 N/A "$1,417.23" "$2,443.10" "$1,465.86" "$2,443.10" $509.14 "$2,443.10" N/A N/A 226.722S SUP HCPCS C1713 226.722S - PLATE BONE BROAD 408MM 22 HOLE CVD LCP STAINLESS STEEL BOTH IP/OP "$2,759.50" "$2,042.00" $547.67 "$2,806.28" "$1,241.72" "$1,241.72" "$1,241.72" "$1,241.72" "$2,759.38" "$2,759.38" "$2,759.38" $575.12 "$2,759.38" "$2,759.38" "$2,759.38" "$2,759.38" "$2,759.38" $575.09 "$2,759.38" "$1,122.51" "$1,360.37" "$2,759.38" "$2,806.28" "$2,759.38" "$2,759.38" "$2,069.63" "$2,759.38" "$2,759.38" "$2,759.38" "$1,379.69" "$1,379.69" "$2,185.43" "$2,759.38" "$2,207.50" "$1,241.72" $547.67 N/A "$1,600.51" "$2,759.38" "$1,655.63" "$2,759.38" $575.05 "$2,759.38" N/A N/A 226.742S SUP HCPCS C1713 226.742S - PLATE BONE BROAD 443MM 24 HOLE CVD LCP STAINLESS STEEL BOTH IP/OP "$2,996.00" "$2,217.00" $594.54 "$3,046.45" "$1,347.99" "$1,347.99" "$1,347.99" "$1,347.99" "$2,995.53" "$2,995.53" "$2,995.53" $624.34 "$2,995.53" "$2,995.53" "$2,995.53" "$2,995.53" "$2,995.53" $624.30 "$2,995.53" "$1,218.58" "$1,476.80" "$2,995.53" "$3,046.45" "$2,995.53" "$2,995.53" "$2,247.00" "$2,995.53" "$2,995.53" "$2,995.53" "$1,497.77" "$1,497.77" "$2,372.46" "$2,995.53" "$2,396.42" "$1,347.99" $594.54 N/A "$1,737.68" "$2,995.53" "$2,995.53" "$2,995.53" $624.27 "$2,995.53" N/A N/A 226.762S SUP HCPCS C1713 226.762S - PLATE BONE BROAD 479MM 26 HOLE CVD LCP STAINLESS STEEL BOTH IP/OP "$3,234.50" "$2,394.00" $641.97 "$3,289.48" "$1,455.53" "$1,455.53" "$1,455.53" "$1,455.53" "$3,234.50" "$3,234.50" "$3,234.50" $674.15 "$3,234.50" "$3,234.50" "$3,234.50" "$3,234.50" "$3,234.50" $674.11 "$3,234.50" "$3,289.48" "$1,594.61" "$3,234.50" "$3,289.48" "$3,234.50" "$3,234.50" "$2,425.88" "$3,234.50" "$3,234.50" "$3,234.50" "$1,617.25" "$1,617.25" "$2,561.72" "$3,234.50" "$2,587.60" "$1,455.53" $641.97 N/A "$1,876.01" "$3,234.50" "$3,234.50" "$3,234.50" "$3,234.50" "$3,234.50" N/A N/A 2284-0-426 SUP Custom 27803010 2284-0-426 - HEAD FEMORAL 15MM OFFST 26MM PCA HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 2284-0-428 SUP Custom 27803010 2284-0-428 - HEAD FEM +15MM OFST 28MM STRL PCA HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 2284-0-432 SUP Custom 27803010 2284-0-432 - HEAD FEMORAL +15MM OFFST 32MM PCA HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 2296003109S2 SUP Custom 27203010 2296003109S2 - BLADE SW LF CMND II MODIFICATION HVDTY SGTL MNT RT BOTH IP/OP $206.00 $152.00 $36.67 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $206.00 $36.67 $206.00 $206.00 $152.89 $152.89 $158.78 $107.33 $42.93 $206.00 $82.40 $206.00 $206.00 $206.00 $206.00 $206.00 $154.50 $206.00 $206.00 $206.00 $103.00 $103.00 $163.15 $206.00 $164.80 $133.90 $206.00 N/A $119.48 $206.00 $123.60 $206.00 $206.00 $206.00 N/A N/A 2296-003-115 SUP Custom 27203010 2296-003-115 - BLADE SAW THK.38MM LONG MICRO NARROW THIN 29.5X7MM BOTH IP/OP $85.00 $63.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 N/A $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 2296-003-115 SUP Custom 27203010 2296-003-115 - BLADE SW THK.38MM LNG MIC NAR THN 29.5X7MM STRL PRCS OSC/SAG BOTH IP/OP $90.50 $67.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $67.88 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 N/A $52.49 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 2296-003-414 SUP Custom 27203010 2296-003-414 - BLADE SW MIC THN 25X5.5X.38MM STRL PRCS OSC/SAG SS BOTH IP/OP $85.00 $63.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 N/A $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 2296-033-102 SUP Custom 27203010 2296-033-102 - BLADE SAW THK.4MM 18.5MM MEDIUM WIDE 16.5MM OSCILLATING CUT BOTH IP/OP $85.00 $63.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 N/A $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 2296-033-103 SUP Custom 27203010 2296-033-103 - BLADE SAW 25X7X.51MM SAGITTAL OSCILLATE AGGRESSIVE CORE BOTH IP/OP $85.00 $63.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 N/A $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 2296-033-104 SUP Custom 27203010 2296-033-104 - BLADE SAW 34.5MM THK.51MM 16.5MM MICRO OSCILLATING SAGITTAL BOTH IP/OP $85.00 $63.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 N/A $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 2296-033-105 SUP Custom 27203010 2296-033-105 - BLADE SAW THK.4MM MEDIUM 18.5X9MM OSCILLATING SAGITTAL BOTH IP/OP $90.50 $67.00 $16.04 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $16.04 $90.10 $90.10 $66.87 $66.87 $69.45 $46.94 $18.78 $90.10 $36.04 $90.10 $90.10 $90.10 $90.10 $90.10 $67.88 $90.10 $90.10 $90.10 $45.05 $45.05 $71.36 $90.10 $72.08 $58.57 $90.10 N/A $52.49 $90.10 $54.06 $90.10 $90.10 $90.10 N/A N/A 2296-033-111 SUP Custom 27203010 2296-033-111 - BLADE SAW MEDIUM LONG 25X9MM SAGITTAL LATEX FREE STAINLESS BOTH IP/OP $90.50 $67.00 $16.04 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $16.04 $90.10 $90.10 $66.87 $66.87 $69.45 $46.94 $18.78 $90.10 $36.04 $90.10 $90.10 $90.10 $90.10 $90.10 $67.88 $90.10 $90.10 $90.10 $45.05 $45.05 $71.36 $90.10 $72.08 $58.57 $90.10 N/A $52.49 $90.10 $54.06 $90.10 $90.10 $90.10 N/A N/A 2296-033-114 SUP Custom 27203010 2296-033-114 - BLADE SAW MEDIUM 18.5X7X.51MM SAGITTAL OSCILLATE AGGRESSIVE BOTH IP/OP $90.50 $67.00 $16.04 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $16.04 $90.10 $90.10 $66.87 $66.87 $69.45 $46.94 $18.78 $90.10 $36.04 $90.10 $90.10 $90.10 $90.10 $90.10 $67.88 $90.10 $90.10 $90.10 $45.05 $45.05 $71.36 $90.10 $72.08 $58.57 $90.10 N/A $52.49 $90.10 $54.06 $90.10 $90.10 $90.10 N/A N/A 2296-033-125 SUP Custom 27203010 2296-033-125 - BLADE SAW MEDIUM MICRO LONG 31X9MM OSCILLATING SAGITTAL BOTH IP/OP $85.00 $63.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 N/A $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 2296-033-212 SUP Custom 27203010 2296-033-212 - BLADE SAW MEDIUM NARROW 18.5X5.5X.51MM AGGRESSIVE CORE TPS BOTH IP/OP $90.50 $67.00 $16.04 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $16.04 $90.10 $90.10 $66.87 $66.87 $69.45 $46.94 $18.78 $90.10 $36.04 $90.10 $90.10 $90.10 $90.10 $90.10 $67.88 $90.10 $90.10 $90.10 $45.05 $45.05 $71.36 $90.10 $72.08 $58.57 $90.10 N/A $52.49 $90.10 $54.06 $90.10 $90.10 $90.10 N/A N/A 2296-033-411 SUP Custom 27203010 2296-033-411 - BLADE SAW SHORT MEDIUM 11.5X9MM OSCILLATING SAGITTAL TPS BOTH IP/OP $85.00 $63.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 N/A $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 2296-033-411 SUP Custom 27203010 2296-033-411 - BLADE SW SHRT MED 11.5X9MM STRL TPS OSC/SAG BOTH IP/OP $90.50 $67.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $34.00 $85.00 $85.00 $85.00 $85.00 $85.00 $67.88 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 N/A $52.49 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A 2296-100-191 SUP Custom 27203010 2296-100-191 - BURR SURG 3MM 39MM ROUND HEAD DIAMOND STERILE BOTH IP/OP $138.00 $102.00 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 N/A $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 2296-100-193 SUP Custom 27203010 2296-100-193 - BURR SURG 3.5MM 3MM ROUND HEAD DIAMOND STERILE BOTH IP/OP $138.00 $102.00 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 N/A $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 2296-100-195 SUP Custom 27203010 2296-100-195 - BURR SURG 4MM 39MM ROUND HEAD DIAMOND STERILE BOTH IP/OP $138.00 $102.00 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 N/A $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 2296-100-210 SUP Custom 27203010 2296-100-210 - BURR SURG 1MM 44.5MM CROSS CUT FISSURE CARBIDE STERILE BOTH IP/OP $18.50 $14.00 $3.21 $18.02 $18.02 $18.02 $18.02 $18.02 $18.02 $18.02 $3.21 $18.02 $18.02 $13.37 $13.37 $13.89 $9.39 $3.76 $18.02 $7.21 $18.02 $18.02 $18.02 $18.02 $18.02 $13.88 $18.02 $18.02 $18.02 $9.01 $9.01 $14.27 $18.02 $14.42 $11.71 $18.02 N/A $10.73 $18.02 $10.81 $18.02 $18.02 $18.02 N/A N/A 2296-100-212 SUP Custom 27203010 2296-100-212 - BURR SURG 1.2MM 44.5MM CROSS CUT FISSURE CARBIDE STERILE BOTH IP/OP $16.00 $12.00 $2.83 $15.90 $15.90 $15.90 $15.90 $15.90 $15.90 $15.90 $2.83 $15.90 $15.90 $11.80 $11.80 $12.26 $8.28 $3.31 $15.90 $6.36 $15.90 $15.90 $15.90 $15.90 $15.90 $12.00 $15.90 $15.90 $15.90 $7.95 $7.95 $12.59 $15.90 $12.72 $10.34 $15.90 N/A $9.28 $15.90 $9.54 $15.90 $15.90 $15.90 N/A N/A 2296-100-216 SUP Custom 27203010 2296-100-216 - BURR SURG 1.6MM 44.5MM CROSS CUT FISSURE CARBIDE STERILE BOTH IP/OP $16.00 $12.00 $2.83 $15.90 $15.90 $15.90 $15.90 $15.90 $15.90 $15.90 $2.83 $15.90 $15.90 $11.80 $11.80 $12.26 $8.28 $3.31 $15.90 $6.36 $15.90 $15.90 $15.90 $15.90 $15.90 $12.00 $15.90 $15.90 $15.90 $7.95 $7.95 $12.59 $15.90 $12.72 $10.34 $15.90 N/A $9.28 $15.90 $9.54 $15.90 $15.90 $15.90 N/A N/A 2296-100-221 SUP Custom 27203010 2296-100-221 - BURR SURG 2.1MM 44.5MM CROSS CUT FISSURE CARBIDE STERILE BOTH IP/OP $16.00 $12.00 $2.83 $15.90 $15.90 $15.90 $15.90 $15.90 $15.90 $15.90 $2.83 $15.90 $15.90 $11.80 $11.80 $12.26 $8.28 $3.31 $15.90 $6.36 $15.90 $15.90 $15.90 $15.90 $15.90 $12.00 $15.90 $15.90 $15.90 $7.95 $7.95 $12.59 $15.90 $12.72 $10.34 $15.90 N/A $9.28 $15.90 $9.54 $15.90 $15.90 $15.90 N/A N/A 2296-100-240 SUP Custom 27203010 2296-100-240 - BURR SURG SHORT 4MM 39MM 6 FLUTED ROUND HEAD CARBIDE STERILE BOTH IP/OP $138.00 $102.00 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 N/A $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 2296-100-245 SUP Custom 27203010 2296-100-245 - BURR SURG 4.5MM 39MM 6 FLUTED ROUND HEAD CARBIDE STERILE BOTH IP/OP $138.00 $102.00 $24.56 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $138.00 $24.56 $138.00 $138.00 $102.42 $102.42 $106.37 $71.90 $28.76 $138.00 $55.20 $138.00 $138.00 $138.00 $138.00 $138.00 $103.50 $138.00 $138.00 $138.00 $69.00 $69.00 $109.30 $138.00 $110.40 $89.70 $138.00 N/A $80.04 $138.00 $82.80 $138.00 $138.00 $138.00 N/A N/A 2296-100-418 SUP Custom 27203010 2296-100-418 - BURR SURG 1.8MM ROUND HEAD CARBIDE STERILE BOTH IP/OP $16.00 $12.00 $2.83 $15.90 $15.90 $15.90 $15.90 $15.90 $15.90 $15.90 $2.83 $15.90 $15.90 $11.80 $11.80 $12.26 $8.28 $3.31 $15.90 $6.36 $15.90 $15.90 $15.90 $15.90 $15.90 $12.00 $15.90 $15.90 $15.90 $7.95 $7.95 $12.59 $15.90 $12.72 $10.34 $15.90 N/A $9.28 $15.90 $9.54 $15.90 $15.90 $15.90 N/A N/A 2296-100-423 SUP Custom 27203010 2296-100-423 - BURR SURG 2.3MM 45MM 8 FLUTED ROUND HEAD CARBIDE STERILE BOTH IP/OP $16.00 $12.00 $2.83 $15.90 $15.90 $15.90 $15.90 $15.90 $15.90 $15.90 $2.83 $15.90 $15.90 $11.80 $11.80 $12.26 $8.28 $3.31 $15.90 $6.36 $15.90 $15.90 $15.90 $15.90 $15.90 $12.00 $15.90 $15.90 $15.90 $7.95 $7.95 $12.59 $15.90 $12.72 $10.34 $15.90 N/A $9.28 $15.90 $9.54 $15.90 $15.90 $15.90 N/A N/A 2296-101-230 SUP Custom 27203010 2296-101-230 - BURR SURG 3MM 55MM 6 FLUTED ROUND HEAD CARBIDE STERILE BOTH IP/OP $85.00 $63.00 $15.09 $84.80 $84.80 $84.80 $84.80 $84.80 $84.80 $84.80 $15.09 $84.80 $84.80 $62.94 $62.94 $65.36 $44.18 $17.67 $84.80 $33.92 $84.80 $84.80 $84.80 $84.80 $84.80 $63.75 $84.80 $84.80 $84.80 $42.40 $42.40 $67.16 $84.80 $67.84 $55.12 $84.80 N/A $49.30 $84.80 $50.88 $84.80 $84.80 $84.80 N/A N/A 2296-101-418 SUP Custom 27203010 2296-101-418 - BURR SURG 1.8MM ROUND CARBIDE STERILE BOTH IP/OP $16.50 $12.00 $2.92 $16.38 $16.38 $16.38 $16.38 $16.38 $16.38 $16.38 $2.92 $16.38 $16.38 $12.16 $12.16 $12.63 $8.53 $3.41 $16.38 $6.55 $16.38 $16.38 $16.38 $16.38 $16.38 $12.38 $16.38 $16.38 $16.38 $8.19 $8.19 $12.97 $16.38 $13.10 $10.65 $16.38 N/A $9.57 $16.38 $9.83 $16.38 $16.38 $16.38 N/A N/A 2296-101-421 SUP Custom 27203010 2296-101-421 - BURR SURG 2.1MM 58.5MM ROUND HEAD CROSS CUT FISSURE CARBIDE BOTH IP/OP $16.50 $12.00 $2.92 $16.38 $16.38 $16.38 $16.38 $16.38 $16.38 $16.38 $2.92 $16.38 $16.38 $12.16 $12.16 $12.63 $8.53 $3.41 $16.38 $6.55 $16.38 $16.38 $16.38 $16.38 $16.38 $12.38 $16.38 $16.38 $16.38 $8.19 $8.19 $12.97 $16.38 $13.10 $10.65 $16.38 N/A $9.57 $16.38 $9.83 $16.38 $16.38 $16.38 N/A N/A 2296-33-102 SUP Custom 27203010 2296-33-102 - BLADE SW THK.51MM 18.5MM 16.5MM TPS RECIPROCATE BOTH IP/OP $90.50 $67.00 $16.04 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $16.04 $90.10 $90.10 $66.87 $66.87 $69.45 $46.94 $18.78 $90.10 $36.04 $90.10 $90.10 $90.10 $90.10 $90.10 $67.88 $90.10 $90.10 $90.10 $45.05 $45.05 $71.36 $90.10 $72.08 $58.57 $90.10 N/A $52.49 $90.10 $54.06 $90.10 $90.10 $90.10 N/A N/A 2296-33-103 SUP Custom 27203010 2296-33-103 - BLADE SW 25X7X.51MM STRL COR SGTL OSCILLATE AGRS SS BOTH IP/OP $90.50 $67.00 $16.04 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $16.04 $90.10 $90.10 $66.87 $66.87 $69.45 $46.94 $18.78 $90.10 $36.04 $90.10 $90.10 $90.10 $90.10 $90.10 $67.88 $90.10 $90.10 $90.10 $45.05 $45.05 $71.36 $90.10 $72.08 $58.57 $90.10 N/A $52.49 $90.10 $54.06 $90.10 $90.10 $90.10 N/A N/A 2296-33-104 SUP Custom 27203010 2296-33-104 - BLADE SW 34.5MM THK.51MM 16.5MM COR TPS MIC OSC/SAG BOTH IP/OP $90.50 $67.00 $16.04 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $16.04 $90.10 $90.10 $66.87 $66.87 $69.45 $46.94 $18.78 $90.10 $36.04 $90.10 $90.10 $90.10 $90.10 $90.10 $67.88 $90.10 $90.10 $90.10 $45.05 $45.05 $71.36 $90.10 $72.08 $58.57 $90.10 N/A $52.49 $90.10 $54.06 $90.10 $90.10 $90.10 N/A N/A 2296-33-125 SUP Custom 27203010 2296-33-125 - BLADE SW MED MIC LNG 31X9MM STRL OSC/SAG SS BOTH IP/OP $90.50 $67.00 $16.04 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $90.10 $16.04 $90.10 $90.10 $66.87 $66.87 $69.45 $46.94 $18.78 $90.10 $36.04 $90.10 $90.10 $90.10 $90.10 $90.10 $67.88 $90.10 $90.10 $90.10 $45.05 $45.05 $71.36 $90.10 $72.08 $58.57 $90.10 N/A $52.49 $90.10 $54.06 $90.10 $90.10 $90.10 N/A N/A 23011 L SUP Custom 27803010 23011 L - SHUNT NEUROSURGICAL REGULAR LOW PRESSURE INTERIOR SNAP DOME BOTH IP/OP "$3,562.50" "$2,636.00" $634.13 "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" $634.13 "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" $742.46 "$3,562.50" "$1,425.00" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$3,562.50" "$2,671.88" "$3,562.50" "$3,562.50" "$3,562.50" "$1,781.25" "$1,781.25" "$2,821.50" "$3,562.50" "$2,850.00" "$1,603.13" "$3,562.50" N/A "$2,066.25" "$3,562.50" "$2,137.50" "$3,562.50" "$3,562.50" "$3,562.50" N/A N/A 23011 M SUP Custom 27803010 23011 M - SHUNT NEUROSURGICAL REGULAR MEDIUM PRESSURE INTERIOR SNAP BOTH IP/OP "$3,738.50" "$2,766.00" $665.41 "$3,738.25" "$3,738.25" "$3,738.25" "$3,738.25" "$3,738.25" "$3,738.25" "$3,738.25" $665.41 "$3,738.25" "$3,738.25" "$3,738.25" "$3,738.25" "$3,738.25" "$3,738.25" $779.09 "$3,738.25" "$1,495.30" "$3,738.25" "$3,738.25" "$3,738.25" "$3,738.25" "$3,738.25" "$2,803.88" "$3,738.25" "$3,738.25" "$3,738.25" "$1,869.13" "$1,869.13" "$2,960.69" "$3,738.25" "$2,990.60" "$1,682.21" "$3,738.25" N/A "$2,168.33" "$3,738.25" "$2,242.95" "$3,738.25" "$3,738.25" "$3,738.25" N/A N/A 23038 A SUP Custom 27803010 23038 A - RESERVOIR SHUNT SMALL 10MM 2CM CSF CATHETER NEONATE STERILE BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 23038 B SUP Custom 27803010 23038 B - RESERVOIR SHUNT SMALL 10MM 3CM INTEGRAL RIGHT ANG CATHETER BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 23038 C SUP Custom 27803010 23038 C - RESERVOIR SHUNT SMALL 10MM 3.5CM INTEGRAL RIGHT ANG CATHETER BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 23038 D SUP Custom 27803010 23038 D - RESERVOIR SHUNT SMALL 10MM 4CM INTEGRAL RIGHT ANG CATHETER BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 23038 E SUP Custom 27803010 23038 E - RESERVOIR SHUNT RIGHT ANG 5CM 45CM INTEGRAL CATHETER NEONATE BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 23059 L SUP Custom 27803010 23059 L - SHUNT NEUROSURGICAL 90CM LOW PRESSURE CNTOUR INTEGRAL BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 23059 M SUP Custom 27803010 23059 M - SHUNT NEUROSURGICAL 90CM MEDIUM PRESSURE CNTOUR INTEGRAL BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 23064 B SUP Custom 27803010 23064 B - CATHETER DRAIN STANDARD RIGHT ANG 3CM BARIUM IMPREGNATED BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 23066 B SUP Custom 27803010 23066 B - RESERVOIR SHUNT STANDARD TUBE NEONATE VENTRICULAR BOTH IP/OP "$1,401.50" "$1,037.00" $249.42 "$1,401.25" "$1,401.25" "$1,401.25" "$1,401.25" "$1,401.25" "$1,401.25" "$1,401.25" $249.42 "$1,401.25" "$1,401.25" "$1,401.25" "$1,401.25" "$1,401.25" "$1,401.25" $292.04 "$1,401.25" $560.50 "$1,401.25" "$1,401.25" "$1,401.25" "$1,401.25" "$1,401.25" "$1,051.13" "$1,401.25" "$1,401.25" "$1,401.25" $700.63 $700.63 "$1,109.79" "$1,401.25" "$1,121.00" $630.56 "$1,401.25" N/A $812.87 "$1,401.25" $840.75 "$1,401.25" "$1,401.25" "$1,401.25" N/A N/A 23066 C SUP Custom 27803010 23066 C - RESERVOIR SHUNT STANDARD TUBE NEONATE VENTRICULAR BOTH IP/OP "$1,259.00" $932.00 $224.06 "$1,258.75" "$1,258.75" "$1,258.75" "$1,258.75" "$1,258.75" "$1,258.75" "$1,258.75" $224.06 "$1,258.75" "$1,258.75" "$1,258.75" "$1,258.75" "$1,258.75" "$1,258.75" $262.34 "$1,258.75" $503.50 "$1,258.75" "$1,258.75" "$1,258.75" "$1,258.75" "$1,258.75" $944.25 "$1,258.75" "$1,258.75" "$1,258.75" $629.38 $629.38 $996.93 "$1,258.75" "$1,007.00" $566.44 "$1,258.75" N/A $730.22 "$1,258.75" $755.25 "$1,258.75" "$1,258.75" "$1,258.75" N/A N/A 231120M5 SUP HCPCS C1713 231120M5 - SCREW INTERFERENCE 11MM 20MM PROVEN BONE INGROWTH UNIFORMLY BOTH IP/OP $654.00 $484.00 $129.73 $653.63 $294.13 $294.13 $294.13 $294.13 $653.63 $653.63 $653.63 $136.23 $653.63 $653.63 $653.63 $653.63 $653.63 $136.22 $653.63 $653.63 $386.62 $653.63 $653.63 $653.63 $653.63 $490.50 $653.63 $653.63 $653.63 $326.82 $326.82 $517.67 $653.63 $522.90 $294.13 $129.73 N/A $379.32 $653.63 $653.63 $653.63 $136.22 $653.63 N/A N/A 23-112-1 SUP Custom 27011340 23-112-1 - SEALER BIPOL 5.1IN .226IN 2 ELTRD HMST DISP BOTH IP/OP "$1,451.00" "$1,074.00" $258.24 "$1,450.78" "$1,450.78" "$1,450.78" "$1,450.78" "$1,450.78" "$1,450.78" "$1,450.78" $258.24 "$1,450.78" "$1,450.78" "$1,076.77" "$1,076.77" "$1,118.26" $755.86 $302.36 "$1,450.78" $580.31 "$1,450.78" "$1,450.78" "$1,450.78" "$1,450.78" "$1,450.78" "$1,088.25" "$1,450.78" "$1,450.78" "$1,450.78" $725.39 $725.39 "$1,149.02" "$1,450.78" "$1,160.62" $943.01 "$1,450.78" N/A $841.58 "$1,450.78" $870.47 "$1,450.78" "$1,450.78" "$1,450.78" N/A N/A 2320A SUP HCPCS C1884 2320A - SYSTEM EMBOLIC PROTECTION CONE 7FR 103CM DELIVERY KIT BOTH IP/OP "$2,544.50" "$1,883.00" $504.95 "$2,544.16" "$1,144.87" "$1,144.87" "$1,144.87" "$1,144.87" "$2,544.16" "$2,544.16" "$2,544.16" $530.27 "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" $530.23 "$2,544.16" "$2,544.16" "$1,254.27" "$2,544.16" "$2,544.16" "$2,544.16" "$2,544.16" "$1,908.38" "$2,544.16" "$2,544.16" "$2,544.16" "$1,272.08" "$1,272.08" "$2,014.97" "$2,544.16" "$2,035.33" "$1,144.87" $504.95 N/A "$1,475.81" "$2,544.16" "$2,544.16" "$2,544.16" $530.20 "$2,544.16" N/A N/A 2347-15-02 SUP HCPCS C1713 2347-15-02 - PLATE 51MM SS 2 HOLE BONE PERIART RIGHT FIB DISTAL BOTH IP/OP $846.50 $626.00 $167.99 $846.40 $380.88 $380.88 $380.88 $380.88 $846.40 $846.40 $846.40 $176.41 $846.40 $846.40 $846.40 $846.40 $846.40 $176.40 $846.40 $338.56 $500.65 $846.40 $846.40 $846.40 $846.40 $634.88 $846.40 $846.40 $846.40 $423.20 $423.20 $670.35 $846.40 $677.12 $380.88 $167.99 N/A $490.97 $846.40 $507.84 $846.40 $176.39 $846.40 N/A N/A 2347-15-04 SUP HCPCS C1713 2347-15-04 - PLATE 74MM SS 4 HOLE BONE PERIART RIGHT FIB DISTAL BOTH IP/OP $852.50 $631.00 $169.13 $852.15 $383.47 $383.47 $383.47 $383.47 $852.15 $852.15 $852.15 $177.61 $852.15 $852.15 $852.15 $852.15 $852.15 $177.60 $852.15 $340.86 $504.05 $852.15 $852.15 $852.15 $852.15 $639.38 $852.15 $852.15 $852.15 $426.08 $426.08 $674.90 $852.15 $681.72 $383.47 $169.13 N/A $494.45 $852.15 $511.29 $852.15 $177.59 $852.15 N/A N/A 2347-15-06 SUP HCPCS C1713 2347-15-06 - PLATE 95MM SS 6 HOLE BONE PERIART RIGHT FIB DISTAL BOTH IP/OP $864.00 $639.00 $171.41 $863.65 $388.64 $388.64 $388.64 $388.64 $863.65 $863.65 $863.65 $180.01 $863.65 $863.65 $863.65 $863.65 $863.65 $179.99 $863.65 $345.46 $510.85 $863.65 $863.65 $863.65 $863.65 $648.00 $863.65 $863.65 $863.65 $431.83 $431.83 $684.01 $863.65 $690.92 $388.64 $171.41 N/A $501.12 $863.65 $863.65 $863.65 $179.98 $863.65 N/A N/A 2347-15-08 SUP HCPCS C1713 2347-15-08 - PLATE 116MM SS 8 HOLE BONE PERIART RIGHT FIB DISTAL BOTH IP/OP $876.50 $649.00 $173.90 $876.20 $394.29 $394.29 $394.29 $394.29 $876.20 $876.20 $876.20 $182.62 $876.20 $876.20 $876.20 $876.20 $876.20 $182.61 $876.20 $350.48 $518.27 $876.20 $876.20 $876.20 $876.20 $657.38 $876.20 $876.20 $876.20 $438.10 $438.10 $693.95 $876.20 $700.96 $394.29 $173.90 N/A $508.37 $876.20 $525.72 $876.20 $182.60 $876.20 N/A N/A 2347-15-10 SUP HCPCS C1713 2347-15-10 - PLATE 136MM SS 10 HOLE BONE FIB RIGHT DISTAL LAT BOTH IP/OP $891.00 $659.00 $176.84 $891.00 $400.95 $400.95 $400.95 $400.95 $891.00 $891.00 $891.00 $185.71 $891.00 $891.00 $891.00 $891.00 $891.00 $185.69 $891.00 $356.40 $527.03 $891.00 $891.00 $891.00 $891.00 $668.25 $891.00 $891.00 $891.00 $445.50 $445.50 $705.67 $891.00 $712.80 $400.95 $176.84 N/A $516.78 $891.00 $534.60 $891.00 $185.68 $891.00 N/A N/A 2347-15-12 SUP HCPCS C1713 2347-15-12 - PLATE 157MM SS 12 HOLE BONE FIB RIGHT DISTAL LAT BOTH IP/OP "$1,055.00" $781.00 $209.30 "$1,054.55" $474.55 $474.55 $474.55 $474.55 "$1,054.55" "$1,054.55" "$1,054.55" $219.79 "$1,054.55" "$1,054.55" "$1,054.55" "$1,054.55" "$1,054.55" $219.78 "$1,054.55" $421.82 $623.77 "$1,054.55" "$1,054.55" "$1,054.55" "$1,054.55" $791.25 "$1,054.55" "$1,054.55" "$1,054.55" $527.28 $527.28 $835.20 "$1,054.55" $843.64 $474.55 $209.30 N/A $611.90 "$1,054.55" $632.73 "$1,054.55" $219.77 "$1,054.55" N/A N/A 2347-15-14 SUP HCPCS C1713 2347-15-14 - PLATE 178MM SS 14 HOLE BONE FIB RIGHT DISTAL LAT BOTH IP/OP "$1,126.00" $833.00 $223.45 "$1,125.85" $506.63 $506.63 $506.63 $506.63 "$1,125.85" "$1,125.85" "$1,125.85" $234.66 "$1,125.85" "$1,125.85" "$1,125.85" "$1,125.85" "$1,125.85" $234.64 "$1,125.85" "$1,125.85" $665.94 "$1,125.85" "$1,125.85" "$1,125.85" "$1,125.85" $844.50 "$1,125.85" "$1,125.85" "$1,125.85" $562.93 $562.93 $891.67 "$1,125.85" $900.68 $506.63 $223.45 N/A $653.08 "$1,125.85" "$1,125.85" "$1,125.85" $234.63 "$1,125.85" N/A N/A 2347-15-16 SUP HCPCS C1713 2347-15-16 - PLATE 199MM SS 16 HOLE BONE FIB RIGHT DISTAL LAT BOTH IP/OP "$1,220.50" $903.00 $242.17 "$1,220.15" $549.07 $549.07 $549.07 $549.07 "$1,220.15" "$1,220.15" "$1,220.15" $254.31 "$1,220.15" "$1,220.15" "$1,220.15" "$1,220.15" "$1,220.15" $254.29 "$1,220.15" $488.06 $721.72 "$1,220.15" "$1,220.15" "$1,220.15" "$1,220.15" $915.38 "$1,220.15" "$1,220.15" "$1,220.15" $610.08 $610.08 $966.36 "$1,220.15" $976.12 $549.07 $242.17 N/A $707.89 "$1,220.15" $732.09 "$1,220.15" $254.28 "$1,220.15" N/A N/A 2347-15-18 SUP HCPCS C1713 2347-15-18 - PLATE 220MM SS 18 HOLE BONE FIB RIGHT DISTAL LAT BOTH IP/OP "$1,316.00" $974.00 $261.11 "$1,315.60" $592.02 $592.02 $592.02 $592.02 "$1,315.60" "$1,315.60" "$1,315.60" $274.20 "$1,315.60" "$1,315.60" "$1,315.60" "$1,315.60" "$1,315.60" $274.19 "$1,315.60" $526.24 $778.18 "$1,315.60" "$1,315.60" "$1,315.60" "$1,315.60" $987.00 "$1,315.60" "$1,315.60" "$1,315.60" $657.80 $657.80 "$1,041.96" "$1,315.60" "$1,052.48" $592.02 $261.11 N/A $763.28 "$1,315.60" $789.36 "$1,315.60" $274.17 "$1,315.60" N/A N/A 2347-15-20 SUP HCPCS C1713 2347-15-20 - PLATE 241MM SS 20 HOLE BONE FIB RIGHT DISTAL LAT BOTH IP/OP "$1,434.50" "$1,062.00" $284.62 "$1,434.05" $645.32 $645.32 $645.32 $645.32 "$1,434.05" "$1,434.05" "$1,434.05" $298.89 "$1,434.05" "$1,434.05" "$1,434.05" "$1,434.05" "$1,434.05" $298.87 "$1,434.05" "$1,434.05" $848.24 "$1,434.05" "$1,434.05" "$1,434.05" "$1,434.05" "$1,075.88" "$1,434.05" "$1,434.05" "$1,434.05" $717.03 $717.03 "$1,135.77" "$1,434.05" "$1,147.24" $645.32 $284.62 N/A $832.01 "$1,434.05" $860.43 "$1,434.05" $298.86 "$1,434.05" N/A N/A 2347-16-02 SUP HCPCS C1713 2347-16-02 - PLATE 51MM SS 2 HOLE BONE FIB LEFT DISTAL LAT BOTH IP/OP $846.50 $626.00 $167.99 $846.40 $380.88 $380.88 $380.88 $380.88 $846.40 $846.40 $846.40 $176.41 $846.40 $846.40 $846.40 $846.40 $846.40 $176.40 $846.40 $846.40 $500.65 $846.40 $846.40 $846.40 $846.40 $634.88 $846.40 $846.40 $846.40 $423.20 $423.20 $670.35 $846.40 $677.12 $380.88 $167.99 N/A $490.97 $846.40 $846.40 $846.40 $176.39 $846.40 N/A N/A 2347-16-04 SUP HCPCS C1713 2347-16-04 - PLATE 74MM SS 2.7MM 3.5MM CORT PERIART 2.7MM CANC BOTH IP/OP $852.50 $631.00 $169.13 $852.15 $383.47 $383.47 $383.47 $383.47 $852.15 $852.15 $852.15 $177.61 $852.15 $852.15 $852.15 $852.15 $852.15 $177.60 $852.15 $340.86 $504.05 $852.15 $852.15 $852.15 $852.15 $639.38 $852.15 $852.15 $852.15 $426.08 $426.08 $674.90 $852.15 $681.72 $383.47 $169.13 N/A $494.45 $852.15 $511.29 $852.15 $177.59 $852.15 N/A N/A 2347-16-06 SUP HCPCS C1713 2347-16-06 - PLATE 95MM 6 HOLE BONE FIB L/L BOTH IP/OP $864.00 $639.00 $171.46 $863.90 $388.76 $388.76 $388.76 $388.76 $863.90 $863.90 $863.90 $180.06 $863.90 $863.90 $863.90 $863.90 $863.90 $180.05 $863.90 $345.56 $511.00 $863.90 $863.90 $863.90 $863.90 $648.00 $863.90 $863.90 $863.90 $431.95 $431.95 $684.21 $863.90 $691.12 $388.76 $171.46 N/A $501.12 $863.90 $518.34 $863.90 $180.04 $863.90 N/A N/A 2347-16-08 SUP HCPCS C1713 2347-16-08 - PLATE 116MM 8 HOLE BONE FIB L/L BOTH IP/OP $876.50 $649.00 $173.90 $876.20 $394.29 $394.29 $394.29 $394.29 $876.20 $876.20 $876.20 $182.62 $876.20 $876.20 $876.20 $876.20 $876.20 $182.61 $876.20 $350.48 $518.27 $876.20 $876.20 $876.20 $876.20 $657.38 $876.20 $876.20 $876.20 $438.10 $438.10 $693.95 $876.20 $700.96 $394.29 $173.90 N/A $508.37 $876.20 $525.72 $876.20 $182.60 $876.20 N/A N/A 2347-16-10 SUP HCPCS C1713 2347-16-10 - PLATE 135MM 10 HOLE BONE FIB L/L BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $386.40 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $966.00 $966.00 $201.31 $966.00 N/A N/A 2347-16-12 SUP HCPCS C1713 2347-16-12 - PLATE 157MM 12 HOLE BONE FIB L/L BOTH IP/OP "$1,055.00" $781.00 $209.30 "$1,054.55" $474.55 $474.55 $474.55 $474.55 "$1,054.55" "$1,054.55" "$1,054.55" $219.79 "$1,054.55" "$1,054.55" "$1,054.55" "$1,054.55" "$1,054.55" $219.78 "$1,054.55" $421.82 $623.77 "$1,054.55" "$1,054.55" "$1,054.55" "$1,054.55" $791.25 "$1,054.55" "$1,054.55" "$1,054.55" $527.28 $527.28 $835.20 "$1,054.55" $843.64 $474.55 $209.30 N/A $611.90 "$1,054.55" "$1,054.55" "$1,054.55" $219.77 "$1,054.55" N/A N/A 2347-16-14 SUP HCPCS C1713 2347-16-14 - PLATE 178MM 14 HOLE BONE FIB L/L BOTH IP/OP "$1,126.00" $833.00 $223.45 "$1,125.85" $506.63 $506.63 $506.63 $506.63 "$1,125.85" "$1,125.85" "$1,125.85" $234.66 "$1,125.85" "$1,125.85" "$1,125.85" "$1,125.85" "$1,125.85" $234.64 "$1,125.85" $450.34 $665.94 "$1,125.85" "$1,125.85" "$1,125.85" "$1,125.85" $844.50 "$1,125.85" "$1,125.85" "$1,125.85" $562.93 $562.93 $891.67 "$1,125.85" $900.68 $506.63 $223.45 N/A $653.08 "$1,125.85" $675.51 "$1,125.85" $234.63 "$1,125.85" N/A N/A 2347-16-16 SUP HCPCS C1713 2347-16-16 - PLATE 199MM 16 HOLE BONE FIB L/L BOTH IP/OP "$1,220.50" $903.00 $242.17 "$1,220.15" $549.07 $549.07 $549.07 $549.07 "$1,220.15" "$1,220.15" "$1,220.15" $254.31 "$1,220.15" "$1,220.15" "$1,220.15" "$1,220.15" "$1,220.15" $254.29 "$1,220.15" "$1,220.15" $721.72 "$1,220.15" "$1,220.15" "$1,220.15" "$1,220.15" $915.38 "$1,220.15" "$1,220.15" "$1,220.15" $610.08 $610.08 $966.36 "$1,220.15" $976.12 $549.07 $242.17 N/A $707.89 "$1,220.15" $732.09 "$1,220.15" $254.28 "$1,220.15" N/A N/A 2347-16-18 SUP HCPCS C1713 2347-16-18 - PLATE 220MM 18 HOLE BONE FIB L/L BOTH IP/OP "$1,316.00" $974.00 $261.11 "$1,315.60" $592.02 $592.02 $592.02 $592.02 "$1,315.60" "$1,315.60" "$1,315.60" $274.20 "$1,315.60" "$1,315.60" "$1,315.60" "$1,315.60" "$1,315.60" $274.19 "$1,315.60" $526.24 $778.18 "$1,315.60" "$1,315.60" "$1,315.60" "$1,315.60" $987.00 "$1,315.60" "$1,315.60" "$1,315.60" $657.80 $657.80 "$1,041.96" "$1,315.60" "$1,052.48" $592.02 $261.11 N/A $763.28 "$1,315.60" $789.36 "$1,315.60" $274.17 "$1,315.60" N/A N/A 2347-16-20 SUP HCPCS C1713 2347-16-20 - PLATE 241MM 20 HOLE BONE FIB L/L BOTH IP/OP "$1,434.50" "$1,062.00" $284.62 "$1,434.05" $645.32 $645.32 $645.32 $645.32 "$1,434.05" "$1,434.05" "$1,434.05" $298.89 "$1,434.05" "$1,434.05" "$1,434.05" "$1,434.05" "$1,434.05" $298.87 "$1,434.05" $573.62 $848.24 "$1,434.05" "$1,434.05" "$1,434.05" "$1,434.05" "$1,075.88" "$1,434.05" "$1,434.05" "$1,434.05" $717.03 $717.03 "$1,135.77" "$1,434.05" "$1,147.24" $645.32 $284.62 N/A $832.01 "$1,434.05" "$1,434.05" "$1,434.05" $298.86 "$1,434.05" N/A N/A 2347-17-02 SUP HCPCS C1713 2347-17-02 - PLATE 51MM 2 HOLE BONE FIB RIGHT BOTH IP/OP $846.50 $626.00 $167.99 $846.40 $380.88 $380.88 $380.88 $380.88 $846.40 $846.40 $846.40 $176.41 $846.40 $846.40 $846.40 $846.40 $846.40 $176.40 $846.40 $338.56 $500.65 $846.40 $846.40 $846.40 $846.40 $634.88 $846.40 $846.40 $846.40 $423.20 $423.20 $670.35 $846.40 $677.12 $380.88 $167.99 N/A $490.97 $846.40 $507.84 $846.40 $176.39 $846.40 N/A N/A 2347-17-04 SUP HCPCS C1713 2347-17-04 - PLATE 73MM SS 4 HOLE BONE FIB RIGHT DISTAL LAT BOTH IP/OP $852.50 $631.00 $169.13 $852.15 $383.47 $383.47 $383.47 $383.47 $852.15 $852.15 $852.15 $177.61 $852.15 $852.15 $852.15 $852.15 $852.15 $177.60 $852.15 $340.86 $504.05 $852.15 $852.15 $852.15 $852.15 $639.38 $852.15 $852.15 $852.15 $426.08 $426.08 $674.90 $852.15 $681.72 $383.47 $169.13 N/A $494.45 $852.15 $511.29 $852.15 $177.59 $852.15 N/A N/A 2347-17-06 SUP HCPCS C1713 2347-17-06 - PLATE 94MM SS 6 HOLE BONE FIB RIGHT DISTAL LAT BOTH IP/OP $864.00 $639.00 $171.41 $863.65 $388.64 $388.64 $388.64 $388.64 $863.65 $863.65 $863.65 $180.01 $863.65 $863.65 $863.65 $863.65 $863.65 $179.99 $863.65 $345.46 $510.85 $863.65 $863.65 $863.65 $863.65 $648.00 $863.65 $863.65 $863.65 $431.83 $431.83 $684.01 $863.65 $690.92 $388.64 $171.41 N/A $501.12 $863.65 $518.19 $863.65 $179.98 $863.65 N/A N/A 2347-17-08 SUP HCPCS C1713 2347-17-08 - PLATE 115MM SS 8 HOLE BONE FIB RIGHT DISTAL LAT BOTH IP/OP $876.50 $649.00 $173.90 $876.20 $394.29 $394.29 $394.29 $394.29 $876.20 $876.20 $876.20 $182.62 $876.20 $876.20 $876.20 $876.20 $876.20 $182.61 $876.20 $876.20 $518.27 $876.20 $876.20 $876.20 $876.20 $657.38 $876.20 $876.20 $876.20 $438.10 $438.10 $693.95 $876.20 $700.96 $394.29 $173.90 N/A $508.37 $876.20 $876.20 $876.20 $182.60 $876.20 N/A N/A 2347-17-10 SUP HCPCS C1713 2347-17-10 - PLATE 135MM SS 10 HOLE BONE FIB RIGHT DISTAL LAT BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $966.00 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $579.60 $966.00 $201.31 $966.00 N/A N/A 2347-17-12 SUP HCPCS C1713 2347-17-12 - PLATE 156MM SS 12 HOLE BONE PERIART RIGHT FIB BOTH IP/OP "$1,055.00" $781.00 $209.30 "$1,054.55" $474.55 $474.55 $474.55 $474.55 "$1,054.55" "$1,054.55" "$1,054.55" $219.79 "$1,054.55" "$1,054.55" "$1,054.55" "$1,054.55" "$1,054.55" $219.78 "$1,054.55" $421.82 $623.77 "$1,054.55" "$1,054.55" "$1,054.55" "$1,054.55" $791.25 "$1,054.55" "$1,054.55" "$1,054.55" $527.28 $527.28 $835.20 "$1,054.55" $843.64 $474.55 $209.30 N/A $611.90 "$1,054.55" $632.73 "$1,054.55" $219.77 "$1,054.55" N/A N/A 2347-17-14 SUP HCPCS C1713 2347-17-14 - PLATE 177MM SS 14 HOLE BONE PERIART RIGHT FIB BOTH IP/OP "$1,126.00" $833.00 $223.45 "$1,125.85" $506.63 $506.63 $506.63 $506.63 "$1,125.85" "$1,125.85" "$1,125.85" $234.66 "$1,125.85" "$1,125.85" "$1,125.85" "$1,125.85" "$1,125.85" $234.64 "$1,125.85" $450.34 $665.94 "$1,125.85" "$1,125.85" "$1,125.85" "$1,125.85" $844.50 "$1,125.85" "$1,125.85" "$1,125.85" $562.93 $562.93 $891.67 "$1,125.85" $900.68 $506.63 $223.45 N/A $653.08 "$1,125.85" $675.51 "$1,125.85" $234.63 "$1,125.85" N/A N/A 2347-17-16 SUP HCPCS C1713 2347-17-16 - PLATE 198MM SS 16 HOLE BONE PERIART RIGHT FIB BOTH IP/OP "$1,220.50" $903.00 $242.17 "$1,220.15" $549.07 $549.07 $549.07 $549.07 "$1,220.15" "$1,220.15" "$1,220.15" $254.31 "$1,220.15" "$1,220.15" "$1,220.15" "$1,220.15" "$1,220.15" $254.29 "$1,220.15" $488.06 $721.72 "$1,220.15" "$1,220.15" "$1,220.15" "$1,220.15" $915.38 "$1,220.15" "$1,220.15" "$1,220.15" $610.08 $610.08 $966.36 "$1,220.15" $976.12 $549.07 $242.17 N/A $707.89 "$1,220.15" "$1,220.15" "$1,220.15" $254.28 "$1,220.15" N/A N/A 2347-17-18 SUP HCPCS C1713 2347-17-18 - PLATE 219MM SS 18 HOLE BONE PERIART RIGHT FIB BOTH IP/OP "$1,316.00" $974.00 $261.11 "$1,315.60" $592.02 $592.02 $592.02 $592.02 "$1,315.60" "$1,315.60" "$1,315.60" $274.20 "$1,315.60" "$1,315.60" "$1,315.60" "$1,315.60" "$1,315.60" $274.19 "$1,315.60" $526.24 $778.18 "$1,315.60" "$1,315.60" "$1,315.60" "$1,315.60" $987.00 "$1,315.60" "$1,315.60" "$1,315.60" $657.80 $657.80 "$1,041.96" "$1,315.60" "$1,052.48" $592.02 $261.11 N/A $763.28 "$1,315.60" $789.36 "$1,315.60" $274.17 "$1,315.60" N/A N/A 2347-17-20 SUP HCPCS C1713 2347-17-20 - PLATE 239MM SS 20 HOLE BONE PERIART RIGHT FIB BOTH IP/OP "$1,284.50" $951.00 $254.85 "$1,284.05" $577.82 $577.82 $577.82 $577.82 "$1,284.05" "$1,284.05" "$1,284.05" $267.63 "$1,284.05" "$1,284.05" "$1,284.05" "$1,284.05" "$1,284.05" $267.61 "$1,284.05" $513.62 $759.52 "$1,284.05" "$1,284.05" "$1,284.05" "$1,284.05" $963.38 "$1,284.05" "$1,284.05" "$1,284.05" $642.03 $642.03 "$1,016.97" "$1,284.05" "$1,027.24" $577.82 $254.85 N/A $745.01 "$1,284.05" $770.43 "$1,284.05" $267.60 "$1,284.05" N/A N/A 2347-18-02 SUP HCPCS C1713 2347-18-02 - PLATE 51MM SS 2 HOLE BONE PERIART LEFT FIB BOTH IP/OP $846.50 $626.00 $167.99 $846.40 $380.88 $380.88 $380.88 $380.88 $846.40 $846.40 $846.40 $176.41 $846.40 $846.40 $846.40 $846.40 $846.40 $176.40 $846.40 $846.40 $500.65 $846.40 $846.40 $846.40 $846.40 $634.88 $846.40 $846.40 $846.40 $423.20 $423.20 $670.35 $846.40 $677.12 $380.88 $167.99 N/A $490.97 $846.40 $507.84 $846.40 $176.39 $846.40 N/A N/A 2347-18-04 SUP HCPCS C1713 2347-18-04 - PLATE BN 73MM STRL 4 HL SS FIB LT DIST LAT PERIART BOTH IP/OP $852.50 $631.00 $169.13 $852.15 $383.47 $383.47 $383.47 $383.47 $852.15 $852.15 $852.15 $177.61 $852.15 $852.15 $852.15 $852.15 $852.15 $177.60 $852.15 $852.15 $504.05 $852.15 $852.15 $852.15 $852.15 $639.38 $852.15 $852.15 $852.15 $426.08 $426.08 $674.90 $852.15 $681.72 $383.47 $169.13 N/A $494.45 $852.15 $511.29 $852.15 $177.59 $852.15 N/A N/A 2347-18-06 SUP HCPCS C1713 2347-18-06 - PLATE 94MM 6 HOLE BONE LEFT DISTAL LAT FIB BOTH IP/OP $864.00 $639.00 $171.41 $863.65 $388.64 $388.64 $388.64 $388.64 $863.65 $863.65 $863.65 $180.01 $863.65 $863.65 $863.65 $863.65 $863.65 $179.99 $863.65 $863.65 $510.85 $863.65 $863.65 $863.65 $863.65 $648.00 $863.65 $863.65 $863.65 $431.83 $431.83 $684.01 $863.65 $690.92 $388.64 $171.41 N/A $501.12 $863.65 $863.65 $863.65 $179.98 $863.65 N/A N/A 2347-18-08 SUP HCPCS C1713 2347-18-08 - PLATE 115MM SS 8 HOLE BONE FIB LEFT DISTAL LAT BOTH IP/OP $876.50 $649.00 $173.90 $876.20 $394.29 $394.29 $394.29 $394.29 $876.20 $876.20 $876.20 $182.62 $876.20 $876.20 $876.20 $876.20 $876.20 $182.61 $876.20 $350.48 $518.27 $876.20 $876.20 $876.20 $876.20 $657.38 $876.20 $876.20 $876.20 $438.10 $438.10 $693.95 $876.20 $700.96 $394.29 $173.90 N/A $508.37 $876.20 $525.72 $876.20 $182.60 $876.20 N/A N/A 2347-18-10 SUP HCPCS C1713 2347-18-10 - PLATE 135MM SS 10 HOLE BONE FIB LEFT DISTAL LAT BOTH IP/OP $966.00 $715.00 $191.73 $966.00 $434.70 $434.70 $434.70 $434.70 $966.00 $966.00 $966.00 $201.34 $966.00 $966.00 $966.00 $966.00 $966.00 $201.33 $966.00 $386.40 $571.39 $966.00 $966.00 $966.00 $966.00 $724.50 $966.00 $966.00 $966.00 $483.00 $483.00 $765.07 $966.00 $772.80 $434.70 $191.73 N/A $560.28 $966.00 $579.60 $966.00 $201.31 $966.00 N/A N/A 2347-18-12 SUP HCPCS C1713 2347-18-12 - PLATE 156MM SS 12 HOLE BONE FIB LEFT DISTAL LAT BOTH IP/OP "$1,055.00" $781.00 $209.30 "$1,054.55" $474.55 $474.55 $474.55 $474.55 "$1,054.55" "$1,054.55" "$1,054.55" $219.79 "$1,054.55" "$1,054.55" "$1,054.55" "$1,054.55" "$1,054.55" $219.78 "$1,054.55" $421.82 $623.77 "$1,054.55" "$1,054.55" "$1,054.55" "$1,054.55" $791.25 "$1,054.55" "$1,054.55" "$1,054.55" $527.28 $527.28 $835.20 "$1,054.55" $843.64 $474.55 $209.30 N/A $611.90 "$1,054.55" $632.73 "$1,054.55" $219.77 "$1,054.55" N/A N/A 2347-18-14 SUP HCPCS C1713 2347-18-14 - PLATE 177MM SS 14 HOLE BONE FIB LEFT DISTAL LAT BOTH IP/OP "$1,126.00" $833.00 $223.45 "$1,125.85" $506.63 $506.63 $506.63 $506.63 "$1,125.85" "$1,125.85" "$1,125.85" $234.66 "$1,125.85" "$1,125.85" "$1,125.85" "$1,125.85" "$1,125.85" $234.64 "$1,125.85" $450.34 $665.94 "$1,125.85" "$1,125.85" "$1,125.85" "$1,125.85" $844.50 "$1,125.85" "$1,125.85" "$1,125.85" $562.93 $562.93 $891.67 "$1,125.85" $900.68 $506.63 $223.45 N/A $653.08 "$1,125.85" "$1,125.85" "$1,125.85" $234.63 "$1,125.85" N/A N/A 2347-18-16 SUP HCPCS C1713 2347-18-16 - PLATE 198MM SS 16 HOLE BONE FIB LEFT DISTAL LAT BOTH IP/OP "$1,220.50" $903.00 $242.17 "$1,220.15" $549.07 $549.07 $549.07 $549.07 "$1,220.15" "$1,220.15" "$1,220.15" $254.31 "$1,220.15" "$1,220.15" "$1,220.15" "$1,220.15" "$1,220.15" $254.29 "$1,220.15" $488.06 $721.72 "$1,220.15" "$1,220.15" "$1,220.15" "$1,220.15" $915.38 "$1,220.15" "$1,220.15" "$1,220.15" $610.08 $610.08 $966.36 "$1,220.15" $976.12 $549.07 $242.17 N/A $707.89 "$1,220.15" "$1,220.15" "$1,220.15" $254.28 "$1,220.15" N/A N/A 2347-18-18 SUP HCPCS C1713 2347-18-18 - PLATE 219MM SS 18 HOLE BONE FIB LEFT DISTAL LAT BOTH IP/OP "$1,301.00" $963.00 $258.14 "$1,300.60" $585.27 $585.27 $585.27 $585.27 "$1,300.60" "$1,300.60" "$1,300.60" $271.08 "$1,300.60" "$1,300.60" "$1,300.60" "$1,300.60" "$1,300.60" $271.06 "$1,300.60" "$1,300.60" $769.30 "$1,300.60" "$1,300.60" "$1,300.60" "$1,300.60" $975.75 "$1,300.60" "$1,300.60" "$1,300.60" $650.30 $650.30 "$1,030.08" "$1,300.60" "$1,040.48" $585.27 $258.14 N/A $754.58 "$1,300.60" $780.36 "$1,300.60" $271.05 "$1,300.60" N/A N/A 2347-18-20 SUP HCPCS C1713 2347-18-20 - PLATE 239MM SS 20 HOLE BONE FIB LEFT DISTAL LAT BOTH IP/OP "$1,434.50" "$1,062.00" $284.62 "$1,434.05" $645.32 $645.32 $645.32 $645.32 "$1,434.05" "$1,434.05" "$1,434.05" $298.89 "$1,434.05" "$1,434.05" "$1,434.05" "$1,434.05" "$1,434.05" $298.87 "$1,434.05" $573.62 $848.24 "$1,434.05" "$1,434.05" "$1,434.05" "$1,434.05" "$1,075.88" "$1,434.05" "$1,434.05" "$1,434.05" $717.03 $717.03 "$1,135.77" "$1,434.05" "$1,147.24" $645.32 $284.62 N/A $832.01 "$1,434.05" $860.43 "$1,434.05" $298.86 "$1,434.05" N/A N/A 2348-12-35 SUP HCPCS C1713 2348-12-35 - SCREW BN 3.5MM 2.7MM 12MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-14-35 SUP HCPCS C1713 2348-14-35 - SCREW BN 3.5MM 2.7MM 14MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-16-35 SUP HCPCS C1713 2348-16-35 - SCREW BN 3.5MM 2.7MM 16MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-18-35 SUP HCPCS C1713 2348-18-35 - SCREW BONE 3.5MM 2.7MM 18MM SELF TAP STAINLESS STEEL BOTH IP/OP $75.00 $56.00 $14.84 $74.75 $33.64 $33.64 $33.64 $33.64 $74.75 $74.75 $74.75 $15.58 $74.75 $74.75 $74.75 $74.75 $74.75 $15.58 $74.75 $74.75 $44.21 $74.75 $74.75 $74.75 $74.75 $56.25 $74.75 $74.75 $74.75 $37.38 $37.38 $59.20 $74.75 $59.80 $33.64 $14.84 N/A $43.50 $74.75 $74.75 $74.75 $15.58 $74.75 N/A N/A 2348-20-35 SUP HCPCS C1713 2348-20-35 - SCREW BN 2.7MM 3.5MM 20MM ST CORT BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-22-35 SUP HCPCS C1713 2348-22-35 - SCREW BN 3.5MM 2.7MM 22MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-24-35 SUP HCPCS C1713 2348-24-35 - SCREW BN 3.5MM 2.7MM 24MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-26-35 SUP HCPCS C1713 2348-26-35 - SCREW BN 3.5MM 2.7MM 26MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-28-35 SUP HCPCS C1713 2348-28-35 - SCREW BN 3.5MM 2.7MM 28MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-30-35 SUP HCPCS C1713 2348-30-35 - SCREW BN 3.5MM 2.7MM 30MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-32-35 SUP HCPCS C1713 2348-32-35 - SCREW BN 3.5MM 2.7MM 32MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-34-35 SUP HCPCS C1713 2348-34-35 - SCREW BN 3.5MM 2.7MM 34MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $62.10 $62.10 $12.94 $62.10 N/A N/A 2348-36-35 SUP HCPCS C1713 2348-36-35 - SCREW BN 3.5MM 2.7MM 36MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-38-35 SUP HCPCS C1713 2348-38-35 - SCREW BN 3.5MM 2.7MM 38MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-40-35 SUP HCPCS C1713 2348-40-35 - SCREW BN 3.5MM 2.7MM 40MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-42-35 SUP HCPCS C1713 2348-42-35 - SCREW BN 3.5MM 2.7MM 42MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-44-35 SUP HCPCS C1713 2348-44-35 - SCREW BN 3.5MM 2.7MM 44MM NS ST SS ELB CORT PERIART BOTH IP/OP $62.50 $46.00 $12.33 $62.10 $27.95 $27.95 $27.95 $27.95 $62.10 $62.10 $62.10 $12.94 $62.10 $62.10 $62.10 $62.10 $62.10 $12.94 $62.10 $24.84 $36.73 $62.10 $62.10 $62.10 $62.10 $46.88 $62.10 $62.10 $62.10 $31.05 $31.05 $49.18 $62.10 $49.68 $27.95 $12.33 N/A $36.25 $62.10 $37.26 $62.10 $12.94 $62.10 N/A N/A 2348-46-35 SUP HCPCS C1713 2348-46-35 - SCREW BN 3.5MM 2.7MM 46MM NS ST SS ELB CORT PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $24.34 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $36.51 $60.85 $12.68 $60.85 N/A N/A 2348-48-35 SUP HCPCS C1713 2348-48-35 - SCREW BN 3.5MM 2.7MM 48MM NS ST SS ELB CORT PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $24.34 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $36.51 $60.85 $12.68 $60.85 N/A N/A 2348-50-35 SUP HCPCS C1713 2348-50-35 - SCREW BN 3.5MM 2.7MM 50MM NS ST SS ELB CORT PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $24.34 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $60.85 $60.85 $12.68 $60.85 N/A N/A 2348-52-35 SUP HCPCS C1713 2348-52-35 - SCREW BN 3.5MM 2.7MM 52MM NS ST SS ELB CORT PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $24.34 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $60.85 $60.85 $12.68 $60.85 N/A N/A 2348-54-35 SUP HCPCS C1713 2348-54-35 - SCREW BN 3.5MM 2.7MM 54MM NS ST SS ELB CORT PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $24.34 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $36.51 $60.85 $12.68 $60.85 N/A N/A 2348-56-35 SUP HCPCS C1713 2348-56-35 - SCREW BN 3.5MM 2.7MM 56MM NS ST SS ELB CORT PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $24.34 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $36.51 $60.85 $12.68 $60.85 N/A N/A 2348-58-35 SUP HCPCS C1713 2348-58-35 - SCREW BN 3.5MM 58MM PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $36.51 $60.85 $12.68 $60.85 N/A N/A 2348-60-35 SUP HCPCS C1713 2348-60-35 - SCREW BN 3.5MM 2.7MM 60MM NS ST SS ELB CORT PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $24.34 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $36.51 $60.85 $12.68 $60.85 N/A N/A 2348-65-35 SUP HCPCS C1713 2348-65-35 - SCREW BN 3.5MM 2.7MM 65MM NS ST SS ELB CORT PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $24.34 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $60.85 $60.85 $12.68 $60.85 N/A N/A 2348-70-35 SUP HCPCS C1713 2348-70-35 - SCREW BN 3.5MM 2.7MM 70MM NS ST SS ELB CORT PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $24.34 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $60.85 $60.85 $12.68 $60.85 N/A N/A 2348-75-35 SUP HCPCS C1713 2348-75-35 - SCREW BN 3.5MM 2.7MM 75MM NS ST SS ELB CORT PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $60.85 $60.85 $12.68 $60.85 N/A N/A 2348-80-35 SUP HCPCS C1713 2348-80-35 - SCREW BN 3.5MM 2.7MM 80MM NS ST SS ELB CORT PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $24.34 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $60.85 $60.85 $12.68 $60.85 N/A N/A 2348-85-35 SUP HCPCS C1713 2348-85-35 - SCREW BN 3.5MM 2.7MM 85MM NS ST SS ELB CORT PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $24.34 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $60.85 $60.85 $12.68 $60.85 N/A N/A 2348-90-35 SUP HCPCS C1713 2348-90-35 - SCREW BN 3.5MM 2.7MM 90MM NS ST SS ELB CORT PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $24.34 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $60.85 $60.85 $12.68 $60.85 N/A N/A 2348-95-35 SUP HCPCS C1713 2348-95-35 - SCREW BN 3.5MM 2.7MM 95MM NS ST SS ELB CORT PERIART BOTH IP/OP $61.00 $45.00 $12.08 $60.85 $27.38 $27.38 $27.38 $27.38 $60.85 $60.85 $60.85 $12.68 $60.85 $60.85 $60.85 $60.85 $60.85 $12.68 $60.85 $24.34 $35.99 $60.85 $60.85 $60.85 $60.85 $45.75 $60.85 $60.85 $60.85 $30.43 $30.43 $48.19 $60.85 $48.68 $27.38 $12.08 N/A $35.38 $60.85 $60.85 $60.85 $12.68 $60.85 N/A N/A 235-F SUP Custom 27803010 235-F - PLATE BONE STANDARD 128X79X.5MM NONCHAMFERED HOLE MESH PANEL BOTH IP/OP "$1,623.50" "$1,201.00" $288.98 "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" $288.98 "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" $338.36 "$1,623.50" $649.40 "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" "$1,623.50" "$1,217.63" "$1,623.50" "$1,623.50" "$1,623.50" $811.75 $811.75 "$1,285.81" "$1,623.50" "$1,298.80" $730.58 "$1,623.50" N/A $941.63 "$1,623.50" $974.10 "$1,623.50" "$1,623.50" "$1,623.50" N/A N/A 236.502S SUP HCPCS C1713 236.502S - PLATE BN CNTR 86MM STRL LCP CMBN 2 HL ELONGATE HL PROX TAB BOTH IP/OP "$1,736.50" "$1,285.00" $344.56 "$1,765.53" $781.21 $781.21 $781.21 $781.21 "$1,736.03" "$1,736.03" "$1,736.03" $361.83 "$1,736.03" "$1,736.03" "$1,736.03" "$1,736.03" "$1,736.03" $361.81 "$1,736.03" "$1,765.53" "$1,026.86" "$1,736.03" "$1,765.53" "$1,736.03" "$1,736.03" "$1,302.38" "$1,736.03" "$1,736.03" "$1,736.03" $868.02 $868.02 "$1,374.94" "$1,736.03" "$1,388.82" $781.21 $344.56 N/A "$1,007.17" "$1,736.03" "$1,736.03" "$1,736.03" $361.79 "$1,736.03" N/A N/A 236.503S SUP HCPCS C1713 236.503S - PLATE BN CNTR 86MM STRL LCP CMBN 2 HL ELONGATE HL PROX TAB BOTH IP/OP "$1,736.50" "$1,285.00" $344.56 "$1,765.53" $781.21 $781.21 $781.21 $781.21 "$1,736.03" "$1,736.03" "$1,736.03" $361.83 "$1,736.03" "$1,736.03" "$1,736.03" "$1,736.03" "$1,736.03" $361.81 "$1,736.03" "$1,765.53" "$1,026.86" "$1,736.03" "$1,765.53" "$1,736.03" "$1,736.03" "$1,302.38" "$1,736.03" "$1,736.03" "$1,736.03" $868.02 $868.02 "$1,374.94" "$1,736.03" "$1,388.82" $781.21 $344.56 N/A "$1,007.17" "$1,736.03" "$1,736.03" "$1,736.03" $361.79 "$1,736.03" N/A N/A 236.504S SUP HCPCS C1713 236.504S - PLATE BN CNTR 112MM STRL LCP CMBN 4 HL ELONGATE HL PROX TAB BOTH IP/OP "$1,808.00" "$1,338.00" $358.79 "$1,838.45" $813.48 $813.48 $813.48 $813.48 "$1,807.73" "$1,807.73" "$1,807.73" $376.78 "$1,807.73" "$1,807.73" "$1,807.73" "$1,807.73" "$1,807.73" $376.75 "$1,807.73" "$1,838.45" "$1,069.27" "$1,807.73" "$1,838.45" "$1,807.73" "$1,807.73" "$1,356.00" "$1,807.73" "$1,807.73" "$1,807.73" $903.87 $903.87 "$1,431.72" "$1,807.73" "$1,446.18" $813.48 $358.79 N/A "$1,048.64" "$1,807.73" "$1,807.73" "$1,807.73" $376.73 "$1,807.73" N/A N/A 236.505S SUP HCPCS C1713 236.505S - PLATE BN CNTR 112MM STRL LCP CMBN 4 HL ELONGATE HL PROX TAB BOTH IP/OP "$1,808.00" "$1,338.00" $358.79 "$1,838.45" $813.48 $813.48 $813.48 $813.48 "$1,807.73" "$1,807.73" "$1,807.73" $376.78 "$1,807.73" "$1,807.73" "$1,807.73" "$1,807.73" "$1,807.73" $376.75 "$1,807.73" "$1,838.45" "$1,069.27" "$1,807.73" "$1,838.45" "$1,807.73" "$1,807.73" "$1,356.00" "$1,807.73" "$1,807.73" "$1,807.73" $903.87 $903.87 "$1,431.72" "$1,807.73" "$1,446.18" $813.48 $358.79 N/A "$1,048.64" "$1,807.73" "$1,807.73" "$1,807.73" $376.73 "$1,807.73" N/A N/A 236.509S SUP HCPCS C1713 236.509S - PLATE BN CNTR 164MM STRL LCP CMBN 8 HL ELONGATE HL PROX TAB BOTH IP/OP "$1,917.50" "$1,419.00" $380.55 "$1,949.98" $862.82 $862.82 $862.82 $862.82 "$1,917.38" "$1,917.38" "$1,917.38" $399.63 "$1,917.38" "$1,917.38" "$1,917.38" "$1,917.38" "$1,917.38" $399.60 "$1,917.38" "$1,949.98" "$1,134.13" "$1,917.38" "$1,949.98" "$1,917.38" "$1,917.38" "$1,438.13" "$1,917.38" "$1,917.38" "$1,917.38" $958.69 $958.69 "$1,518.56" "$1,917.38" "$1,533.90" $862.82 $380.55 N/A "$1,112.15" "$1,917.38" "$1,917.38" "$1,917.38" $399.58 "$1,917.38" N/A N/A 236-01 SUP HCPCS C1713 236-01 - PLATE BONE STANDARD 123MM 1 HOLE MESH STRAP TIMESH TITANIUM BOTH IP/OP $491.00 $363.00 $97.43 $490.88 $220.90 $220.90 $220.90 $220.90 $490.88 $490.88 $490.88 $102.31 $490.88 $490.88 $490.88 $490.88 $490.88 $102.30 $490.88 $490.88 $290.36 $490.88 $490.88 $490.88 $490.88 $368.25 $490.88 $490.88 $490.88 $245.44 $245.44 $388.78 $490.88 $392.70 $220.90 $97.43 N/A $284.78 $490.88 $490.88 $490.88 $102.30 $490.88 N/A N/A 236-02 SUP HCPCS C1713 236-02 - PLATE BONE STANDARD 123MM 2 HOLE MESH STRAP TIMESH TITANIUM BOTH IP/OP $576.00 $426.00 $114.30 $575.88 $259.15 $259.15 $259.15 $259.15 $575.88 $575.88 $575.88 $120.03 $575.88 $575.88 $575.88 $575.88 $575.88 $120.02 $575.88 $575.88 $340.63 $575.88 $575.88 $575.88 $575.88 $432.00 $575.88 $575.88 $575.88 $287.94 $287.94 $456.10 $575.88 $460.70 $259.15 $114.30 N/A $334.08 $575.88 $575.88 $575.88 $120.01 $575.88 N/A N/A 236-04 SUP HCPCS C1713 236-04 - PLATE BONE 123MM 4 HOLE MESH STRAP TIMESH TITANIUM CRANIAL BOTH IP/OP $735.50 $544.00 $145.93 $735.25 $330.86 $330.86 $330.86 $330.86 $735.25 $735.25 $735.25 $153.24 $735.25 $735.25 $735.25 $735.25 $735.25 $153.23 $735.25 $294.10 $434.90 $735.25 $735.25 $735.25 $735.25 $551.63 $735.25 $735.25 $735.25 $367.63 $367.63 $582.32 $735.25 $588.20 $330.86 $145.93 N/A $426.59 $735.25 $735.25 $735.25 $153.23 $735.25 N/A N/A 237.043S SUP HCPCS C1713 237.043S - PLATE BONE 90D 30MM 4 HOLE LIMITED CONTACT ANGLED BLADE CANN BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" $651.90 $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" $977.85 "$1,629.75" $339.64 "$1,629.75" N/A N/A 237.044S SUP HCPCS C1713 237.044S - PLATE BONE 90D 40MM 4 HOLE LIMITED CONTACT ANGLED BLADE CANN BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" "$1,629.75" $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" $977.85 "$1,629.75" $339.64 "$1,629.75" N/A N/A 237.053S SUP HCPCS C1713 237.053S - PLATE BN 90D 30X11.7MM STRL 5 HL LMT CNTCT CNN SS 4.5MM SCR BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" $651.90 $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" $977.85 "$1,629.75" $339.64 "$1,629.75" N/A N/A 237.054S SUP HCPCS C1713 237.054S - PLATE BONE 90D 40MM 5 HOLE LIMITED CONTACT ANGLED BLADE CANN BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" $651.90 $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" $339.64 "$1,629.75" N/A N/A 237.063S SUP HCPCS C1713 237.063S - PLATE BONE 90D 30MM 6 HOLE LIMITED CONTACT ANGLED BLADE CANN BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" $651.90 $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" $339.64 "$1,629.75" N/A N/A 237.064S SUP HCPCS C1713 237.064S - PLATE BONE 90D 40MM 6 HOLE LIMITED CONTACT ANGLED BLADE CANN BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" $651.90 $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" $339.64 "$1,629.75" N/A N/A 237.083S SUP HCPCS C1713 237.083S - PLATE BONE 90D 30MM 8 HOLE LIMITED CONTACT ANGLED BLADE CANN BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" $651.90 $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" $339.64 "$1,629.75" N/A N/A 237.084S SUP HCPCS C1713 237.084S - PLATE BONE 90D 40MM 8 HOLE LIMITED CONTACT ANGLED BLADE CANN BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" $651.90 $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" $339.64 "$1,629.75" N/A N/A 237.085S SUP HCPCS C1713 237.085S - PLATE BONE 90D 50MM 8 HOLE LIMITED CONTACT ANGLED BLADE CANN BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" $651.90 $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" $339.64 "$1,629.75" N/A N/A 237.086S SUP HCPCS C1713 237.086S - PLATE BN 90D 60X11.7MM STRL 8 HL LMT CNTCT CNN SS 4.5MM SCR BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" $651.90 $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" $339.64 "$1,629.75" N/A N/A 237.103S SUP HCPCS C1713 237.103S - PLATE BONE 90D 30MM 10 HOLE LIMITED CONTACT ANGLED BLADE BOTH IP/OP "$2,135.00" "$1,580.00" $423.66 "$2,134.58" $960.56 $960.56 $960.56 $960.56 "$2,134.58" "$2,134.58" "$2,134.58" $444.90 "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" $444.87 "$2,134.58" "$2,134.58" "$1,262.60" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$1,601.25" "$2,134.58" "$2,134.58" "$2,134.58" "$1,067.29" "$1,067.29" "$1,690.59" "$2,134.58" "$1,707.66" $960.56 $423.66 N/A "$1,238.30" "$2,134.58" "$2,134.58" "$2,134.58" $444.85 "$2,134.58" N/A N/A 237.104S SUP HCPCS C1713 237.104S - PLATE BONE 90D 40MM 10 HOLE LIMITED CONTACT ANGLED BLADE BOTH IP/OP "$2,135.00" "$1,580.00" $423.66 "$2,134.58" $960.56 $960.56 $960.56 $960.56 "$2,134.58" "$2,134.58" "$2,134.58" $444.90 "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" $444.87 "$2,134.58" $853.83 "$1,262.60" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$1,601.25" "$2,134.58" "$2,134.58" "$2,134.58" "$1,067.29" "$1,067.29" "$1,690.59" "$2,134.58" "$1,707.66" $960.56 $423.66 N/A "$1,238.30" "$2,134.58" "$2,134.58" "$2,134.58" $444.85 "$2,134.58" N/A N/A 237.105S SUP HCPCS C1713 237.105S - PLATE BONE 90D 50MM 10 HOLE LIMITED CONTACT ANGLED BLADE BOTH IP/OP "$2,135.00" "$1,580.00" $423.66 "$2,134.58" $960.56 $960.56 $960.56 $960.56 "$2,134.58" "$2,134.58" "$2,134.58" $444.90 "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" $444.87 "$2,134.58" $853.83 "$1,262.60" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$1,601.25" "$2,134.58" "$2,134.58" "$2,134.58" "$1,067.29" "$1,067.29" "$1,690.59" "$2,134.58" "$1,707.66" $960.56 $423.66 N/A "$1,238.30" "$2,134.58" "$2,134.58" "$2,134.58" $444.85 "$2,134.58" N/A N/A 237.106S SUP HCPCS C1713 237.106S - PLATE BONE 90D 60MM 10 HOLE LIMITED CONTACT ANGLED BLADE BOTH IP/OP "$2,135.00" "$1,580.00" $423.66 "$2,134.58" $960.56 $960.56 $960.56 $960.56 "$2,134.58" "$2,134.58" "$2,134.58" $444.90 "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" $444.87 "$2,134.58" $853.83 "$1,262.60" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$1,601.25" "$2,134.58" "$2,134.58" "$2,134.58" "$1,067.29" "$1,067.29" "$1,690.59" "$2,134.58" "$1,707.66" $960.56 $423.66 N/A "$1,238.30" "$2,134.58" "$2,134.58" "$2,134.58" $444.85 "$2,134.58" N/A N/A 237.123S SUP HCPCS C1713 237.123S - PLATE BONE 90D 30MM 12 HOLE LIMITED CONTACT ANGLED BLADE BOTH IP/OP "$2,135.00" "$1,580.00" $423.66 "$2,134.58" $960.56 $960.56 $960.56 $960.56 "$2,134.58" "$2,134.58" "$2,134.58" $444.90 "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" $444.87 "$2,134.58" "$2,134.58" "$1,262.60" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$1,601.25" "$2,134.58" "$2,134.58" "$2,134.58" "$1,067.29" "$1,067.29" "$1,690.59" "$2,134.58" "$1,707.66" $960.56 $423.66 N/A "$1,238.30" "$2,134.58" "$2,134.58" "$2,134.58" $444.85 "$2,134.58" N/A N/A 237.124S SUP HCPCS C1713 237.124S - PLATE BONE 90D 40MM 220MM 12 HOLE SHAFT LCP STAINLESS STEEL BOTH IP/OP "$2,135.00" "$1,580.00" $423.66 "$2,134.58" $960.56 $960.56 $960.56 $960.56 "$2,134.58" "$2,134.58" "$2,134.58" $444.90 "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" $444.87 "$2,134.58" $853.83 "$1,262.60" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$1,601.25" "$2,134.58" "$2,134.58" "$2,134.58" "$1,067.29" "$1,067.29" "$1,690.59" "$2,134.58" "$1,707.66" $960.56 $423.66 N/A "$1,238.30" "$2,134.58" "$2,134.58" "$2,134.58" $444.85 "$2,134.58" N/A N/A 237.125S SUP HCPCS C1713 237.125S - PLATE BONE 90D 50MM 12 HOLE LIMITED CONTACT ANGLED BLADE BOTH IP/OP "$2,135.00" "$1,580.00" $423.66 "$2,134.58" $960.56 $960.56 $960.56 $960.56 "$2,134.58" "$2,134.58" "$2,134.58" $444.90 "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" $444.87 "$2,134.58" $853.83 "$1,262.60" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$1,601.25" "$2,134.58" "$2,134.58" "$2,134.58" "$1,067.29" "$1,067.29" "$1,690.59" "$2,134.58" "$1,707.66" $960.56 $423.66 N/A "$1,238.30" "$2,134.58" "$1,280.75" "$2,134.58" $444.85 "$2,134.58" N/A N/A 237.126S SUP HCPCS C1713 237.126S - PLATE BONE 90D 60MM 12 HOLE LIMITED CONTACT ANGLED BLADE BOTH IP/OP "$2,135.00" "$1,580.00" $423.66 "$2,134.58" $960.56 $960.56 $960.56 $960.56 "$2,134.58" "$2,134.58" "$2,134.58" $444.90 "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" $444.87 "$2,134.58" $853.83 "$1,262.60" "$2,134.58" "$2,134.58" "$2,134.58" "$2,134.58" "$1,601.25" "$2,134.58" "$2,134.58" "$2,134.58" "$1,067.29" "$1,067.29" "$1,690.59" "$2,134.58" "$1,707.66" $960.56 $423.66 N/A "$1,238.30" "$2,134.58" "$2,134.58" "$2,134.58" $444.85 "$2,134.58" N/A N/A 237.143S SUP HCPCS C1713 237.143S - PLATE BONE 90D 30MM 14 HOLE LIMITED CONTACT ANGLED BLADE BOTH IP/OP "$2,710.00" "$2,005.00" $537.79 "$2,709.63" "$1,219.33" "$1,219.33" "$1,219.33" "$1,219.33" "$2,709.63" "$2,709.63" "$2,709.63" $564.75 "$2,709.63" "$2,709.63" "$2,709.63" "$2,709.63" "$2,709.63" $564.72 "$2,709.63" "$2,709.63" "$1,335.85" "$2,709.63" "$2,709.63" "$2,709.63" "$2,709.63" "$2,032.50" "$2,709.63" "$2,709.63" "$2,709.63" "$1,354.82" "$1,354.82" "$2,146.03" "$2,709.63" "$2,167.70" "$1,219.33" $537.79 N/A "$1,571.80" "$2,709.63" "$2,709.63" "$2,709.63" $564.69 "$2,709.63" N/A N/A 237.144S SUP HCPCS C1713 237.144S - PLATE BONE 90D 40MM 14 HOLE LIMITED CONTACT ANGLED BLADE BOTH IP/OP "$2,710.00" "$2,005.00" $537.79 "$2,709.63" "$1,219.33" "$1,219.33" "$1,219.33" "$1,219.33" "$2,709.63" "$2,709.63" "$2,709.63" $564.75 "$2,709.63" "$2,709.63" "$2,709.63" "$2,709.63" "$2,709.63" $564.72 "$2,709.63" "$1,083.85" "$1,335.85" "$2,709.63" "$2,709.63" "$2,709.63" "$2,709.63" "$2,032.50" "$2,709.63" "$2,709.63" "$2,709.63" "$1,354.82" "$1,354.82" "$2,146.03" "$2,709.63" "$2,167.70" "$1,219.33" $537.79 N/A "$1,571.80" "$2,709.63" "$2,709.63" "$2,709.63" $564.69 "$2,709.63" N/A N/A 237.145S SUP HCPCS C1713 237.145S - PLATE BONE 90D 50MM 14 HOLE LIMITED CONTACT ANGLED BLADE BOTH IP/OP "$2,710.00" "$2,005.00" $537.79 "$2,709.63" "$1,219.33" "$1,219.33" "$1,219.33" "$1,219.33" "$2,709.63" "$2,709.63" "$2,709.63" $564.75 "$2,709.63" "$2,709.63" "$2,709.63" "$2,709.63" "$2,709.63" $564.72 "$2,709.63" "$1,083.85" "$1,335.85" "$2,709.63" "$2,709.63" "$2,709.63" "$2,709.63" "$2,032.50" "$2,709.63" "$2,709.63" "$2,709.63" "$1,354.82" "$1,354.82" "$2,146.03" "$2,709.63" "$2,167.70" "$1,219.33" $537.79 N/A "$1,571.80" "$2,709.63" "$1,625.78" "$2,709.63" $564.69 "$2,709.63" N/A N/A 237.146S SUP HCPCS C1713 237.146S - PLATE BONE 90D 60MM 14 HOLE LIMITED CONTACT ANGLED BLADE BOTH IP/OP "$2,710.00" "$2,005.00" $537.79 "$2,709.63" "$1,219.33" "$1,219.33" "$1,219.33" "$1,219.33" "$2,709.63" "$2,709.63" "$2,709.63" $564.75 "$2,709.63" "$2,709.63" "$2,709.63" "$2,709.63" "$2,709.63" $564.72 "$2,709.63" "$1,083.85" "$1,335.85" "$2,709.63" "$2,709.63" "$2,709.63" "$2,709.63" "$2,032.50" "$2,709.63" "$2,709.63" "$2,709.63" "$1,354.82" "$1,354.82" "$2,146.03" "$2,709.63" "$2,167.70" "$1,219.33" $537.79 N/A "$1,571.80" "$2,709.63" "$2,709.63" "$2,709.63" $564.69 "$2,709.63" N/A N/A 237020T5 SUP HCPCS C1713 237020T5 - SCREW INTERFERENCE LP ROUND 7.3MM 20MM ARTHRO CANN BOTH IP/OP $725.00 $537.00 $143.89 $725.00 $326.25 $326.25 $326.25 $326.25 $725.00 $725.00 $725.00 $151.11 $725.00 $725.00 $725.00 $725.00 $725.00 $151.10 $725.00 $725.00 $428.84 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $326.25 $143.89 N/A $420.50 $725.00 $435.00 $725.00 $151.09 $725.00 N/A N/A 238020T5 SUP HCPCS C1713 238020T5 - SCREW INTERFERENCE 8MM 20MM CANN LP ROUNDED HEAD BOTH IP/OP $725.00 $537.00 $143.89 $725.00 $326.25 $326.25 $326.25 $326.25 $725.00 $725.00 $725.00 $151.11 $725.00 $725.00 $725.00 $725.00 $725.00 $151.10 $725.00 $725.00 $428.84 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $326.25 $143.89 N/A $420.50 $725.00 $435.00 $725.00 $151.09 $725.00 N/A N/A 239.955S SUP HCPCS C1713 239.955S - PLATE BN 93MM STRL LCP CMBN 4 HL LMT CNTCT CNTR HD SS TIB LT BOTH IP/OP "$2,747.00" "$2,033.00" $545.16 "$2,793.43" "$1,236.03" "$1,236.03" "$1,236.03" "$1,236.03" "$2,746.73" "$2,746.73" "$2,746.73" $572.49 "$2,746.73" "$2,746.73" "$2,746.73" "$2,746.73" "$2,746.73" $572.45 "$2,746.73" "$2,793.43" "$1,354.14" "$2,746.73" "$2,793.43" "$2,746.73" "$2,746.73" "$2,060.25" "$2,746.73" "$2,746.73" "$2,746.73" "$1,373.37" "$1,373.37" "$2,175.41" "$2,746.73" "$2,197.38" "$1,236.03" $545.16 N/A "$1,593.26" "$2,746.73" "$2,746.73" "$2,746.73" "$2,746.73" "$2,746.73" N/A N/A 239.958S SUP HCPCS C1713 239.958S - PLATE BN 145MM STRL LCP CMBN 8 HL LMT CNTCT CNTR HD SS TIB BOTH IP/OP "$2,814.50" "$2,083.00" $558.55 "$2,862.05" "$1,266.39" "$1,266.39" "$1,266.39" "$1,266.39" "$2,814.20" "$2,814.20" "$2,814.20" $586.55 "$2,814.20" "$2,814.20" "$2,814.20" "$2,814.20" "$2,814.20" $586.51 "$2,814.20" "$2,862.05" "$1,387.40" "$2,814.20" "$2,862.05" "$2,814.20" "$2,814.20" "$2,110.88" "$2,814.20" "$2,814.20" "$2,814.20" "$1,407.10" "$1,407.10" "$2,228.85" "$2,814.20" "$2,251.36" "$1,266.39" $558.55 N/A "$1,632.41" "$2,814.20" "$2,814.20" "$2,814.20" $586.48 "$2,814.20" N/A N/A 239.959S SUP HCPCS C1713 239.959S - PLATE BN CNTR 145MM STRL LCP CMBN 8 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,814.50" "$2,083.00" $558.55 "$2,862.05" "$1,266.39" "$1,266.39" "$1,266.39" "$1,266.39" "$2,814.20" "$2,814.20" "$2,814.20" $586.55 "$2,814.20" "$2,814.20" "$2,814.20" "$2,814.20" "$2,814.20" $586.51 "$2,814.20" "$2,862.05" "$1,387.40" "$2,814.20" "$2,862.05" "$2,814.20" "$2,814.20" "$2,110.88" "$2,814.20" "$2,814.20" "$2,814.20" "$1,407.10" "$1,407.10" "$2,228.85" "$2,814.20" "$2,251.36" "$1,266.39" $558.55 N/A "$1,632.41" "$2,814.20" "$2,814.20" "$2,814.20" $586.48 "$2,814.20" N/A N/A 239.960S SUP HCPCS C1713 239.960S - PLATE BN CNTR 171MM STRL LCP CMBN 10 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,845.50" "$2,106.00" $564.69 "$2,893.50" "$1,280.31" "$1,280.31" "$1,280.31" "$1,280.31" "$2,845.13" "$2,845.13" "$2,845.13" $593.00 "$2,845.13" "$2,845.13" "$2,845.13" "$2,845.13" "$2,845.13" $592.96 "$2,845.13" "$2,893.50" "$1,402.65" "$2,845.13" "$2,893.50" "$2,845.13" "$2,845.13" "$2,134.13" "$2,845.13" "$2,845.13" "$2,845.13" "$1,422.57" "$1,422.57" "$2,253.34" "$2,845.13" "$2,276.10" "$1,280.31" $564.69 N/A "$1,650.39" "$2,845.13" "$2,845.13" "$2,845.13" $592.93 "$2,845.13" N/A N/A 239.961S SUP HCPCS C1713 239.961S - PLATE BN CNTR 171MM STRL LCP CMBN 10 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,845.50" "$2,106.00" $564.69 "$2,893.50" "$1,280.31" "$1,280.31" "$1,280.31" "$1,280.31" "$2,845.13" "$2,845.13" "$2,845.13" $593.00 "$2,845.13" "$2,845.13" "$2,845.13" "$2,845.13" "$2,845.13" $592.96 "$2,845.13" "$2,893.50" "$1,402.65" "$2,845.13" "$2,893.50" "$2,845.13" "$2,845.13" "$2,134.13" "$2,845.13" "$2,845.13" "$2,845.13" "$1,422.57" "$1,422.57" "$2,253.34" "$2,845.13" "$2,276.10" "$1,280.31" $564.69 N/A "$1,650.39" "$2,845.13" "$2,845.13" "$2,845.13" $592.93 "$2,845.13" N/A N/A 239.986S SUP HCPCS C1713 239.986S - PLATE BN CNTR 142MM STRL LCP CMBN 6 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,789.00" "$2,064.00" $553.53 "$2,836.30" "$1,255.01" "$1,255.01" "$1,255.01" "$1,255.01" "$2,788.90" "$2,788.90" "$2,788.90" $581.28 "$2,788.90" "$2,788.90" "$2,788.90" "$2,788.90" "$2,788.90" $581.24 "$2,788.90" "$1,134.52" "$1,374.93" "$2,788.90" "$2,836.30" "$2,788.90" "$2,788.90" "$2,091.75" "$2,788.90" "$2,788.90" "$2,788.90" "$1,394.45" "$1,394.45" "$2,208.81" "$2,788.90" "$2,231.12" "$1,255.01" $553.53 N/A "$1,617.62" "$2,788.90" "$1,673.34" "$2,788.90" $581.21 "$2,788.90" N/A N/A 23AGFN-756 SUP Custom 27803010 23AGFN-756 - VALVE AOR 85D 23MM 21.4MM REGENT FLEXCUFF 1 DGT GRDNT LFLT BOTH IP/OP "$11,750.00" "$8,695.00" "$2,091.50" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$2,091.50" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$2,448.83" "$11,750.00" "$4,700.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$8,812.50" "$11,750.00" "$11,750.00" "$11,750.00" "$5,875.00" "$5,875.00" "$9,306.00" "$11,750.00" "$9,400.00" "$5,287.50" "$11,750.00" N/A "$6,815.00" "$11,750.00" "$7,050.00" "$11,750.00" "$11,750.00" "$11,750.00" N/A N/A 23AJ-501 SUP Custom 27803010 23AJ-501 - VALVE AOR 85D STD 23MM 18.6MM MSTR-SER CUF LFLT OPN CNTRL BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 240.040S SUP HCPCS C1713 240.040S - PLATE BN CNTR 154MM STRL LCP CMBN 8 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,821.50" "$2,088.00" $559.94 "$2,869.18" "$1,269.55" "$1,269.55" "$1,269.55" "$1,269.55" "$2,821.23" "$2,821.23" "$2,821.23" $588.01 "$2,821.23" "$2,821.23" "$2,821.23" "$2,821.23" "$2,821.23" $587.98 "$2,821.23" "$2,869.18" "$1,390.87" "$2,821.23" "$2,869.18" "$2,821.23" "$2,821.23" "$2,116.13" "$2,821.23" "$2,821.23" "$2,821.23" "$1,410.62" "$1,410.62" "$2,234.41" "$2,821.23" "$2,256.98" "$1,269.55" $559.94 N/A "$1,636.47" "$2,821.23" "$2,821.23" "$2,821.23" $587.94 "$2,821.23" N/A N/A 240.041S SUP HCPCS C1713 240.041S - PLATE BN CNTR 154MM STRL LCP CMBN 8 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,821.50" "$2,088.00" $559.94 "$2,869.18" "$1,269.55" "$1,269.55" "$1,269.55" "$1,269.55" "$2,821.23" "$2,821.23" "$2,821.23" $588.01 "$2,821.23" "$2,821.23" "$2,821.23" "$2,821.23" "$2,821.23" $587.98 "$2,821.23" "$2,869.18" "$1,390.87" "$2,821.23" "$2,869.18" "$2,821.23" "$2,821.23" "$2,116.13" "$2,821.23" "$2,821.23" "$2,821.23" "$1,410.62" "$1,410.62" "$2,234.41" "$2,821.23" "$2,256.98" "$1,269.55" $559.94 N/A "$1,636.47" "$2,821.23" "$2,821.23" "$2,821.23" $587.94 "$2,821.23" N/A N/A 240.042S SUP HCPCS C1713 240.042S - PLATE BN CNTR 190MM STRL LCP CMBN 10 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,851.00" "$2,110.00" $565.80 "$2,899.23" "$1,282.84" "$1,282.84" "$1,282.84" "$1,282.84" "$2,850.75" "$2,850.75" "$2,850.75" $594.17 "$2,850.75" "$2,850.75" "$2,850.75" "$2,850.75" "$2,850.75" $594.13 "$2,850.75" "$2,899.23" "$1,405.42" "$2,850.75" "$2,899.23" "$2,850.75" "$2,850.75" "$2,138.25" "$2,850.75" "$2,850.75" "$2,850.75" "$1,425.38" "$1,425.38" "$2,257.79" "$2,850.75" "$2,280.60" "$1,282.84" $565.80 N/A "$1,653.58" "$2,850.75" "$2,850.75" "$2,850.75" $594.10 "$2,850.75" N/A N/A 240.043S SUP HCPCS C1713 240.043S - PLATE BN CNTR 190MM STRL LCP CMBN 10 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,851.00" "$2,110.00" $565.80 "$2,899.23" "$1,282.84" "$1,282.84" "$1,282.84" "$1,282.84" "$2,850.75" "$2,850.75" "$2,850.75" $594.17 "$2,850.75" "$2,850.75" "$2,850.75" "$2,850.75" "$2,850.75" $594.13 "$2,850.75" "$2,899.23" "$1,405.42" "$2,850.75" "$2,899.23" "$2,850.75" "$2,850.75" "$2,138.25" "$2,850.75" "$2,850.75" "$2,850.75" "$1,425.38" "$1,425.38" "$2,257.79" "$2,850.75" "$2,280.60" "$1,282.84" $565.80 N/A "$1,653.58" "$2,850.75" "$2,850.75" "$2,850.75" $594.10 "$2,850.75" N/A N/A 240.044S SUP HCPCS C1713 240.044S - PLATE BN CNTR 226MM STRL LCP CMBN 12 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,883.50" "$2,134.00" $572.22 "$2,932.08" "$1,297.39" "$1,297.39" "$1,297.39" "$1,297.39" "$2,883.08" "$2,883.08" "$2,883.08" $600.91 "$2,883.08" "$2,883.08" "$2,883.08" "$2,883.08" "$2,883.08" $600.87 "$2,883.08" "$1,172.83" "$1,421.36" "$2,883.08" "$2,932.08" "$2,883.08" "$2,883.08" "$2,162.63" "$2,883.08" "$2,883.08" "$2,883.08" "$1,441.54" "$1,441.54" "$2,283.40" "$2,883.08" "$2,306.46" "$1,297.39" $572.22 N/A "$1,672.43" "$2,883.08" "$2,883.08" "$2,883.08" $600.83 "$2,883.08" N/A N/A 240.045S SUP HCPCS C1713 240.045S - PLATE BN CNTR 226MM STRL LCP CMBN 12 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,883.50" "$2,134.00" $572.22 "$2,932.08" "$1,297.39" "$1,297.39" "$1,297.39" "$1,297.39" "$2,883.08" "$2,883.08" "$2,883.08" $600.91 "$2,883.08" "$2,883.08" "$2,883.08" "$2,883.08" "$2,883.08" $600.87 "$2,883.08" "$1,172.83" "$1,421.36" "$2,883.08" "$2,932.08" "$2,883.08" "$2,883.08" "$2,162.63" "$2,883.08" "$2,883.08" "$2,883.08" "$1,441.54" "$1,441.54" "$2,283.40" "$2,883.08" "$2,306.46" "$1,297.39" $572.22 N/A "$1,672.43" "$2,883.08" "$2,883.08" "$2,883.08" $600.83 "$2,883.08" N/A N/A 240.046S SUP HCPCS C1713 240.046S - PLATE BN CNTR 262MM STRL LCP CMBN 14 HL LMT CNTCT SS TIB RT BOTH IP/OP "$2,913.00" "$2,156.00" $578.08 "$2,962.13" "$1,310.67" "$1,310.67" "$1,310.67" "$1,310.67" "$2,912.60" "$2,912.60" "$2,912.60" $607.06 "$2,912.60" "$2,912.60" "$2,912.60" "$2,912.60" "$2,912.60" $607.02 "$2,912.60" "$1,184.85" "$1,435.91" "$2,912.60" "$2,962.13" "$2,912.60" "$2,912.60" "$2,184.75" "$2,912.60" "$2,912.60" "$2,912.60" "$1,456.30" "$1,456.30" "$2,306.78" "$2,912.60" "$2,330.08" "$1,310.67" $578.08 N/A "$1,689.54" "$2,912.60" "$2,912.60" "$2,912.60" $606.99 "$2,912.60" N/A N/A 240.047S SUP HCPCS C1713 240.047S - PLATE BN CNTR 262MM STRL LCP CMBN 14 HL LMT CNTCT SS TIB LT BOTH IP/OP "$2,913.00" "$2,156.00" $578.08 "$2,962.13" "$1,310.67" "$1,310.67" "$1,310.67" "$1,310.67" "$2,912.60" "$2,912.60" "$2,912.60" $607.06 "$2,912.60" "$2,912.60" "$2,912.60" "$2,912.60" "$2,912.60" $607.02 "$2,912.60" "$2,962.13" "$1,435.91" "$2,912.60" "$2,962.13" "$2,912.60" "$2,912.60" "$2,184.75" "$2,912.60" "$2,912.60" "$2,912.60" "$1,456.30" "$1,456.30" "$2,306.78" "$2,912.60" "$2,330.08" "$1,310.67" $578.08 N/A "$1,689.54" "$2,912.60" "$2,912.60" "$2,912.60" $606.99 "$2,912.60" N/A N/A 240.048S SUP HCPCS C1713 240.048S - PLATE BN CNTR 298MM STRL LCP CMBN 4 HL LMT CNTCT TPR END SS BOTH IP/OP "$3,024.00" "$2,238.00" $600.12 "$3,075.05" "$1,360.64" "$1,360.64" "$1,360.64" "$1,360.64" "$3,023.65" "$3,023.65" "$3,023.65" $630.20 "$3,023.65" "$3,023.65" "$3,023.65" "$3,023.65" "$3,023.65" $630.16 "$3,023.65" "$1,230.02" "$1,490.66" "$3,023.65" "$3,075.05" "$3,023.65" "$3,023.65" "$2,268.00" "$3,023.65" "$3,023.65" "$3,023.65" "$1,511.83" "$1,511.83" "$2,394.73" "$3,023.65" "$2,418.92" "$1,360.64" $600.12 N/A "$1,753.92" "$3,023.65" "$1,814.19" "$3,023.65" $630.13 "$3,023.65" N/A N/A 240.049S SUP HCPCS C1713 240.049S - PLATE BONE 298MM 16 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$3,024.00" "$2,238.00" $600.12 "$3,075.05" "$1,360.64" "$1,360.64" "$1,360.64" "$1,360.64" "$3,023.65" "$3,023.65" "$3,023.65" $630.20 "$3,023.65" "$3,023.65" "$3,023.65" "$3,023.65" "$3,023.65" $630.16 "$3,023.65" "$3,075.05" "$1,490.66" "$3,023.65" "$3,075.05" "$3,023.65" "$3,023.65" "$2,268.00" "$3,023.65" "$3,023.65" "$3,023.65" "$1,511.83" "$1,511.83" "$2,394.73" "$3,023.65" "$2,418.92" "$1,360.64" $600.12 N/A "$1,753.92" "$3,023.65" "$1,814.19" "$3,023.65" $630.13 "$3,023.65" N/A N/A 240.052S SUP HCPCS C1713 240.052S - PLATE BONE 334MM 18 HOLE LOCKING LCP STAINLESS STEEL BOTH IP/OP "$3,081.50" "$2,280.00" $611.56 "$3,133.65" "$1,386.58" "$1,386.58" "$1,386.58" "$1,386.58" "$3,081.28" "$3,081.28" "$3,081.28" $642.22 "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" $642.17 "$3,081.28" "$3,133.65" "$1,519.07" "$3,081.28" "$3,133.65" "$3,081.28" "$3,081.28" "$2,311.13" "$3,081.28" "$3,081.28" "$3,081.28" "$1,540.64" "$1,540.64" "$2,440.37" "$3,081.28" "$2,465.02" "$1,386.58" $611.56 N/A "$1,787.27" "$3,081.28" "$1,848.77" "$3,081.28" $642.14 "$3,081.28" N/A N/A 240.053S SUP HCPCS C1713 240.053S - PLATE BONE 334MM 18 HOLE LCP STAINLESS STEEL TIBIA LEFT BOTH IP/OP "$3,081.50" "$2,280.00" $611.56 "$3,133.65" "$1,386.58" "$1,386.58" "$1,386.58" "$1,386.58" "$3,081.28" "$3,081.28" "$3,081.28" $642.22 "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" "$3,081.28" $642.17 "$3,081.28" "$3,133.65" "$1,519.07" "$3,081.28" "$3,133.65" "$3,081.28" "$3,081.28" "$2,311.13" "$3,081.28" "$3,081.28" "$3,081.28" "$1,540.64" "$1,540.64" "$2,440.37" "$3,081.28" "$2,465.02" "$1,386.58" $611.56 N/A "$1,787.27" "$3,081.28" "$1,848.77" "$3,081.28" $642.14 "$3,081.28" N/A N/A 240.054S SUP HCPCS C1713 240.054S - PLATE BONE 370MM 20 HOLE LOCKING LCP STAINLESS STEEL BOTH IP/OP "$3,140.50" "$2,324.00" $623.28 "$3,193.70" "$1,413.15" "$1,413.15" "$1,413.15" "$1,413.15" "$3,140.33" "$3,140.33" "$3,140.33" $654.52 "$3,140.33" "$3,140.33" "$3,140.33" "$3,140.33" "$3,140.33" $654.48 "$3,140.33" "$1,277.48" "$1,548.18" "$3,140.33" "$3,193.70" "$3,140.33" "$3,140.33" "$2,355.38" "$3,140.33" "$3,140.33" "$3,140.33" "$1,570.17" "$1,570.17" "$2,487.14" "$3,140.33" "$2,512.26" "$1,413.15" $623.28 N/A "$1,821.49" "$3,140.33" "$1,884.20" "$3,140.33" $654.44 "$3,140.33" N/A N/A 240.055S SUP HCPCS C1713 240.055S - PLATE BONE 370MM 20 HOLE LOCKING LCP STAINLESS STEEL BOTH IP/OP "$3,140.50" "$2,324.00" $623.28 "$3,193.70" "$1,413.15" "$1,413.15" "$1,413.15" "$1,413.15" "$3,140.33" "$3,140.33" "$3,140.33" $654.52 "$3,140.33" "$3,140.33" "$3,140.33" "$3,140.33" "$3,140.33" $654.48 "$3,140.33" "$1,277.48" "$1,548.18" "$3,140.33" "$3,193.70" "$3,140.33" "$3,140.33" "$2,355.38" "$3,140.33" "$3,140.33" "$3,140.33" "$1,570.17" "$1,570.17" "$2,487.14" "$3,140.33" "$2,512.26" "$1,413.15" $623.28 N/A "$1,821.49" "$3,140.33" "$1,884.20" "$3,140.33" $654.44 "$3,140.33" N/A N/A 24003 L SUP Custom 27803010 24003 L - VALVE SHUNT CSF LOW PRESSURE BUTTON STERILE BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 24003 LL SUP Custom 27803010 24003 LL - VALVE SHUNT CSF LOW LOW PRESSURE BUTTON STERILE BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 24003 M SUP Custom 27803010 24003 M - VALVE SHUNT CSF MEDIUM PRESSURE BUTTON STERILE BOTH IP/OP "$2,147.00" "$1,589.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $382.17 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" $447.46 "$2,147.00" $858.80 "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$2,147.00" "$1,610.25" "$2,147.00" "$2,147.00" "$2,147.00" "$1,073.50" "$1,073.50" "$1,700.42" "$2,147.00" "$1,717.60" $966.15 "$2,147.00" N/A "$1,245.26" "$2,147.00" "$1,288.20" "$2,147.00" "$2,147.00" "$2,147.00" N/A N/A 24004 B SUP Custom 27803010 24004 B - CATHETER DRAIN 2CM INTEGERAL SNAP BASE VENTRICULAR BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 2400-58 SUP Custom 27203010 2400-58 - CATHETER CHOLANGIOGRAM 50CM REDDICK CYSTIC DUCT STERILE BOTH IP/OP "$1,499.50" "$1,110.00" $266.89 "$1,499.38" "$1,499.38" "$1,499.38" "$1,499.38" "$1,499.38" "$1,499.38" "$1,499.38" $266.89 "$1,499.38" "$1,499.38" "$1,112.84" "$1,112.84" "$1,155.72" $781.18 $312.49 "$1,499.38" $599.75 "$1,499.38" "$1,499.38" "$1,499.38" "$1,499.38" "$1,499.38" "$1,124.63" "$1,499.38" "$1,499.38" "$1,499.38" $749.69 $749.69 "$1,187.51" "$1,499.38" "$1,199.50" $974.60 "$1,499.38" N/A $869.71 "$1,499.38" $899.63 "$1,499.38" "$1,499.38" "$1,499.38" N/A N/A 24013-1 SUP Custom 27803010 24013-1 - SHUNT NEUROSURGICAL REGULAR 90CM 13CM CSF PERFORMANCE LEVEL BOTH IP/OP "$4,724.00" "$3,496.00" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $984.51 "$4,723.88" "$1,889.55" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$3,543.00" "$4,723.88" "$4,723.88" "$4,723.88" "$2,361.94" "$2,361.94" "$3,741.31" "$4,723.88" "$3,779.10" "$2,125.75" "$4,723.88" N/A "$2,739.92" "$4,723.88" "$2,834.33" "$4,723.88" "$4,723.88" "$4,723.88" N/A N/A 24013-2 SUP Custom 27803010 24013-2 - SHUNT NEUROSURGICAL REGULAR 90CM 13CM CSF PERFORMANCE LEVEL BOTH IP/OP "$4,724.00" "$3,496.00" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $984.51 "$4,723.88" "$1,889.55" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$3,543.00" "$4,723.88" "$4,723.88" "$4,723.88" "$2,361.94" "$2,361.94" "$3,741.31" "$4,723.88" "$3,779.10" "$2,125.75" "$4,723.88" N/A "$2,739.92" "$4,723.88" "$2,834.33" "$4,723.88" "$4,723.88" "$4,723.88" N/A N/A 24013-5 SUP Custom 27803010 24013-5 - SHUNT NEUROSURGICAL REGULAR 90CM 13CM PERFORMANCE LEVEL 1.5 BOTH IP/OP "$4,724.00" "$3,496.00" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $984.51 "$4,723.88" "$1,889.55" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$3,543.00" "$4,723.88" "$4,723.88" "$4,723.88" "$2,361.94" "$2,361.94" "$3,741.31" "$4,723.88" "$3,779.10" "$2,125.75" "$4,723.88" N/A "$2,739.92" "$4,723.88" "$2,834.33" "$4,723.88" "$4,723.88" "$4,723.88" N/A N/A 24027-1 SUP Custom 27803010 24027-1 - VALVE SHUNT LEVEL 1 SNAP DELTA BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$2,139.64" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 24027-2 SUP Custom 27803010 24027-2 - VALVE SHUNT SMALL PERFORMANCE LEVEL 2 ASMBLY SNAP DELTA CSF BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$2,139.64" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 24027-4 SUP Custom 27803010 24027-4 - SHUNT NEUROSURGICAL INTERIOR SNAP ASMBLY DELTA CSF STERILE BOTH IP/OP "$4,657.50" "$3,447.00" $829.01 "$4,657.38" "$4,657.38" "$4,657.38" "$4,657.38" "$4,657.38" "$4,657.38" "$4,657.38" $829.01 "$4,657.38" "$4,657.38" "$4,657.38" "$4,657.38" "$4,657.38" "$4,657.38" $970.65 "$4,657.38" "$1,862.95" "$4,657.38" "$4,657.38" "$4,657.38" "$4,657.38" "$4,657.38" "$3,493.13" "$4,657.38" "$4,657.38" "$4,657.38" "$2,328.69" "$2,328.69" "$3,688.64" "$4,657.38" "$3,725.90" "$2,095.82" "$4,657.38" N/A "$2,701.35" "$4,657.38" "$2,794.43" "$4,657.38" "$4,657.38" "$4,657.38" N/A N/A 24027-5 SUP Custom 27803010 24027-5 - VALVE SHUNT LEVEL 1.5 SNAP DELTA BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$2,139.64" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 24028-1 SUP Custom 27803010 24028-1 - VALVE SHUNT REGULAR LEVEL 1 CSF SNAP ASMBLY CSF BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$2,139.64" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 24028-2 SUP Custom 27803010 24028-2 - VALVE SHUNT REGULAR PERFORMANCE LEVEL 2 HIGH PRESSURE BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$2,139.64" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 24028-5 SUP Custom 27803010 24028-5 - VALVE SHUNT REGULAR PERFORMANCE LEVEL 1.5 MEDIUM PRESSURE BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$2,139.64" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 24039-1 SUP Custom 27803010 24039-1 - SHUNT NEUROSURGICAL REGULAR PERFORMANCE LEVEL 1 VALVE ASMBLY BOTH IP/OP "$4,094.50" "$3,030.00" $728.82 "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" $728.82 "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" $853.34 "$4,094.50" "$1,637.80" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$3,070.88" "$4,094.50" "$4,094.50" "$4,094.50" "$2,047.25" "$2,047.25" "$3,242.84" "$4,094.50" "$3,275.60" "$1,842.53" "$4,094.50" N/A "$2,374.81" "$4,094.50" "$2,456.70" "$4,094.50" "$4,094.50" "$4,094.50" N/A N/A 24039-2 SUP Custom 27803010 24039-2 - SHUNT NEUROSURGICAL REGULAR PERFORMANCE LEVEL 2 VALVE ASMBLY BOTH IP/OP "$4,094.50" "$3,030.00" $728.82 "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" $728.82 "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" $853.34 "$4,094.50" "$1,637.80" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$3,070.88" "$4,094.50" "$4,094.50" "$4,094.50" "$2,047.25" "$2,047.25" "$3,242.84" "$4,094.50" "$3,275.60" "$1,842.53" "$4,094.50" N/A "$2,374.81" "$4,094.50" "$2,456.70" "$4,094.50" "$4,094.50" "$4,094.50" N/A N/A 24039-5 SUP Custom 27203010 24039-5 - SHUNT NEUROSURGICAL REGULAR PERFORMANCE LEVEL 1.5 VALVE BOTH IP/OP "$4,094.50" "$3,030.00" $728.82 "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" $728.82 "$4,094.50" "$4,094.50" "$3,038.94" "$3,038.94" "$3,156.04" "$2,060.15" $853.34 "$4,094.50" "$1,637.80" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$4,094.50" "$3,070.88" "$4,094.50" "$4,094.50" "$4,094.50" "$2,047.25" "$2,047.25" "$3,242.84" "$4,094.50" "$3,275.60" "$2,661.43" "$4,094.50" N/A "$2,374.81" "$4,094.50" "$2,456.70" "$4,094.50" "$4,094.50" "$4,094.50" N/A N/A 24079-1 SUP Custom 27803010 24079-1 - SHUNT NEUROSURGICAL REGULAR 23CM PERFORMANCE LEVEL 1 CSF BOTH IP/OP "$4,724.00" "$3,496.00" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $984.51 "$4,723.88" "$1,889.55" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$3,543.00" "$4,723.88" "$4,723.88" "$4,723.88" "$2,361.94" "$2,361.94" "$3,741.31" "$4,723.88" "$3,779.10" "$2,125.75" "$4,723.88" N/A "$2,739.92" "$4,723.88" "$2,834.33" "$4,723.88" "$4,723.88" "$4,723.88" N/A N/A 24079-2 SUP Custom 27803010 24079-2 - SHUNT NEUROSURGICAL REGULAR 23CM PERFORMANCE LEVEL 2 CSF BOTH IP/OP "$5,527.00" "$4,090.00" $983.74 "$5,526.63" "$5,526.63" "$5,526.63" "$5,526.63" "$5,526.63" "$5,526.63" "$5,526.63" $983.74 "$5,526.63" "$5,526.63" "$5,526.63" "$5,526.63" "$5,526.63" "$5,526.63" "$1,151.81" "$5,526.63" "$2,210.65" "$5,526.63" "$5,526.63" "$5,526.63" "$5,526.63" "$5,526.63" "$4,145.25" "$5,526.63" "$5,526.63" "$5,526.63" "$2,763.32" "$2,763.32" "$4,377.09" "$5,526.63" "$4,421.30" "$2,486.98" "$5,526.63" N/A "$3,205.66" "$5,526.63" "$3,315.98" "$5,526.63" "$5,526.63" "$5,526.63" N/A N/A 24079-5 SUP Custom 27803010 24079-5 - SHUNT NEUROSURGICAL REGULAR 23CM PERFORMANCE LEVEL 1.5 CSF BOTH IP/OP "$4,724.00" "$3,496.00" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $984.51 "$4,723.88" "$1,889.55" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$3,543.00" "$4,723.88" "$4,723.88" "$4,723.88" "$2,361.94" "$2,361.94" "$3,741.31" "$4,723.88" "$3,779.10" "$2,125.75" "$4,723.88" N/A "$2,739.92" "$4,723.88" "$2,834.33" "$4,723.88" "$4,723.88" "$4,723.88" N/A N/A 24088 C SUP Custom 27803010 24088 C - SHUNT NEUROSURGICAL 6CM CSF VENTRICULAR CATHETER LARGE HOLE BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 24088 D SUP Custom 27803010 24088 D - SHUNT NEUROSURGICAL 7CM CSF VENTRICULAR CATHETER LARGE HOLE BOTH IP/OP $501.50 $371.00 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $89.20 $501.13 $501.13 $501.13 $501.13 $501.13 $501.13 $104.44 $501.13 $200.45 $501.13 $501.13 $501.13 $501.13 $501.13 $376.13 $501.13 $501.13 $501.13 $250.57 $250.57 $396.89 $501.13 $400.90 $225.51 $501.13 N/A $290.87 $501.13 $300.68 $501.13 $501.13 $501.13 N/A N/A 241.072S SUP HCPCS C1713 241.072S - PLATE BN 12MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT BOTH IP/OP "$1,473.50" "$1,090.00" $292.39 "$1,498.23" $662.93 $662.93 $662.93 $662.93 "$1,473.18" "$1,473.18" "$1,473.18" $307.05 "$1,473.18" "$1,473.18" "$1,473.18" "$1,473.18" "$1,473.18" $307.03 "$1,473.18" $599.29 $871.39 "$1,473.18" "$1,498.23" "$1,473.18" "$1,473.18" "$1,105.13" "$1,473.18" "$1,473.18" "$1,473.18" $736.59 $736.59 "$1,166.76" "$1,473.18" "$1,178.54" $662.93 $292.39 N/A $854.63 "$1,473.18" $883.91 "$1,473.18" $307.01 "$1,473.18" N/A N/A 241.073S SUP HCPCS C1713 241.073S - PLATE BONE 12MM 4 HOLE HOOK LCP STAINLESS STEEL LEFT BOTH IP/OP "$1,473.50" "$1,090.00" $292.39 "$1,498.23" $662.93 $662.93 $662.93 $662.93 "$1,473.18" "$1,473.18" "$1,473.18" $307.05 "$1,473.18" "$1,473.18" "$1,473.18" "$1,473.18" "$1,473.18" $307.03 "$1,473.18" $599.29 $871.39 "$1,473.18" "$1,498.23" "$1,473.18" "$1,473.18" "$1,105.13" "$1,473.18" "$1,473.18" "$1,473.18" $736.59 $736.59 "$1,166.76" "$1,473.18" "$1,178.54" $662.93 $292.39 N/A $854.63 "$1,473.18" $883.91 "$1,473.18" $307.01 "$1,473.18" N/A N/A 241.074S SUP HCPCS C1713 241.074S - PLATE BN 15MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT BOTH IP/OP "$1,473.50" "$1,090.00" $292.39 "$1,498.23" $662.93 $662.93 $662.93 $662.93 "$1,473.18" "$1,473.18" "$1,473.18" $307.05 "$1,473.18" "$1,473.18" "$1,473.18" "$1,473.18" "$1,473.18" $307.03 "$1,473.18" "$1,498.23" $871.39 "$1,473.18" "$1,498.23" "$1,473.18" "$1,473.18" "$1,105.13" "$1,473.18" "$1,473.18" "$1,473.18" $736.59 $736.59 "$1,166.76" "$1,473.18" "$1,178.54" $662.93 $292.39 N/A $854.63 "$1,473.18" "$1,473.18" "$1,473.18" "$1,473.18" "$1,473.18" N/A N/A 241.075S SUP HCPCS C1713 241.075S - PLATE BN 15MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT BOTH IP/OP "$1,473.50" "$1,090.00" $292.39 "$1,498.23" $662.93 $662.93 $662.93 $662.93 "$1,473.18" "$1,473.18" "$1,473.18" $307.05 "$1,473.18" "$1,473.18" "$1,473.18" "$1,473.18" "$1,473.18" $307.03 "$1,473.18" $599.29 $871.39 "$1,473.18" "$1,498.23" "$1,473.18" "$1,473.18" "$1,105.13" "$1,473.18" "$1,473.18" "$1,473.18" $736.59 $736.59 "$1,166.76" "$1,473.18" "$1,178.54" $662.93 $292.39 N/A $854.63 "$1,473.18" $883.91 "$1,473.18" $307.01 "$1,473.18" N/A N/A 241.076S SUP HCPCS C1713 241.076S - PLATE BN 18MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT BOTH IP/OP "$1,473.50" "$1,090.00" $292.39 "$1,498.23" $662.93 $662.93 $662.93 $662.93 "$1,473.18" "$1,473.18" "$1,473.18" $307.05 "$1,473.18" "$1,473.18" "$1,473.18" "$1,473.18" "$1,473.18" $307.03 "$1,473.18" $599.29 $871.39 "$1,473.18" "$1,498.23" "$1,473.18" "$1,473.18" "$1,105.13" "$1,473.18" "$1,473.18" "$1,473.18" $736.59 $736.59 "$1,166.76" "$1,473.18" "$1,178.54" $662.93 $292.39 N/A $854.63 "$1,473.18" "$1,473.18" "$1,473.18" $307.01 "$1,473.18" N/A N/A 241.077S SUP HCPCS C1713 241.077S - PLATE BONE 18MM 4 HOLE HOOK PRECONTOUR LCP STAINLESS STEEL BOTH IP/OP "$1,473.50" "$1,090.00" $292.39 "$1,498.23" $662.93 $662.93 $662.93 $662.93 "$1,473.18" "$1,473.18" "$1,473.18" $307.05 "$1,473.18" "$1,473.18" "$1,473.18" "$1,473.18" "$1,473.18" $307.03 "$1,473.18" $599.29 $871.39 "$1,473.18" "$1,498.23" "$1,473.18" "$1,473.18" "$1,105.13" "$1,473.18" "$1,473.18" "$1,473.18" $736.59 $736.59 "$1,166.76" "$1,473.18" "$1,178.54" $662.93 $292.39 N/A $854.63 "$1,473.18" $883.91 "$1,473.18" $307.01 "$1,473.18" N/A N/A 241.082S SUP HCPCS C1713 241.082S - PLATE BONE 12MM 5 HOLE HOOK LCP STAINLESS STEEL RIGHT BOTH IP/OP "$1,541.00" "$1,140.00" $305.78 "$1,566.85" $693.29 $693.29 $693.29 $693.29 "$1,540.65" "$1,540.65" "$1,540.65" $321.11 "$1,540.65" "$1,540.65" "$1,540.65" "$1,540.65" "$1,540.65" $321.09 "$1,540.65" $626.74 $911.29 "$1,540.65" "$1,566.85" "$1,540.65" "$1,540.65" "$1,155.75" "$1,540.65" "$1,540.65" "$1,540.65" $770.33 $770.33 "$1,220.19" "$1,540.65" "$1,232.52" $693.29 $305.78 N/A $893.78 "$1,540.65" $924.39 "$1,540.65" $321.07 "$1,540.65" N/A N/A 241.083S SUP HCPCS C1713 241.083S - PLATE BONE 12MM 5 HOLE HOOK LCP STAINLESS STEEL LEFT BOTH IP/OP "$1,541.00" "$1,140.00" $305.78 "$1,566.85" $693.29 $693.29 $693.29 $693.29 "$1,540.65" "$1,540.65" "$1,540.65" $321.11 "$1,540.65" "$1,540.65" "$1,540.65" "$1,540.65" "$1,540.65" $321.09 "$1,540.65" $626.74 $911.29 "$1,540.65" "$1,566.85" "$1,540.65" "$1,540.65" "$1,155.75" "$1,540.65" "$1,540.65" "$1,540.65" $770.33 $770.33 "$1,220.19" "$1,540.65" "$1,232.52" $693.29 $305.78 N/A $893.78 "$1,540.65" $924.39 "$1,540.65" $321.07 "$1,540.65" N/A N/A 241.084S SUP HCPCS C1713 241.084S - PLATE BN 15MM 85MM STRL LCP CMBN 5 HL HK PRECONTOUR RND SHFT BOTH IP/OP "$1,541.00" "$1,140.00" $305.78 "$1,566.85" $693.29 $693.29 $693.29 $693.29 "$1,540.65" "$1,540.65" "$1,540.65" $321.11 "$1,540.65" "$1,540.65" "$1,540.65" "$1,540.65" "$1,540.65" $321.09 "$1,540.65" $626.74 $911.29 "$1,540.65" "$1,566.85" "$1,540.65" "$1,540.65" "$1,155.75" "$1,540.65" "$1,540.65" "$1,540.65" $770.33 $770.33 "$1,220.19" "$1,540.65" "$1,232.52" $693.29 $305.78 N/A $893.78 "$1,540.65" "$1,540.65" "$1,540.65" $321.07 "$1,540.65" N/A N/A 241.085S SUP HCPCS C1713 241.085S - PLATE BONE 15MM 5 HOLE HOOK LCP STAINLESS STEEL LEFT BOTH IP/OP "$1,541.00" "$1,140.00" $305.78 "$1,566.85" $693.29 $693.29 $693.29 $693.29 "$1,540.65" "$1,540.65" "$1,540.65" $321.11 "$1,540.65" "$1,540.65" "$1,540.65" "$1,540.65" "$1,540.65" $321.09 "$1,540.65" $626.74 $911.29 "$1,540.65" "$1,566.85" "$1,540.65" "$1,540.65" "$1,155.75" "$1,540.65" "$1,540.65" "$1,540.65" $770.33 $770.33 "$1,220.19" "$1,540.65" "$1,232.52" $693.29 $305.78 N/A $893.78 "$1,540.65" "$1,540.65" "$1,540.65" $321.07 "$1,540.65" N/A N/A 241.086S SUP HCPCS C1713 241.086S - PLATE BN 18MM 85MM STRL LCP CMBN 5 HL HK PRECONTOUR RND SHFT BOTH IP/OP "$1,541.00" "$1,140.00" $305.78 "$1,566.85" $693.29 $693.29 $693.29 $693.29 "$1,540.65" "$1,540.65" "$1,540.65" $321.11 "$1,540.65" "$1,540.65" "$1,540.65" "$1,540.65" "$1,540.65" $321.09 "$1,540.65" "$1,566.85" $911.29 "$1,540.65" "$1,566.85" "$1,540.65" "$1,540.65" "$1,155.75" "$1,540.65" "$1,540.65" "$1,540.65" $770.33 $770.33 "$1,220.19" "$1,540.65" "$1,232.52" $693.29 $305.78 N/A $893.78 "$1,540.65" $924.39 "$1,540.65" $321.07 "$1,540.65" N/A N/A 241.087S SUP HCPCS C1713 241.087S - PLATE BN 18MM 85MM STRL LCP CMBN 5 HL HK PRECONTOUR RND SHFT BOTH IP/OP "$1,541.00" "$1,140.00" $305.78 "$1,566.85" $693.29 $693.29 $693.29 $693.29 "$1,540.65" "$1,540.65" "$1,540.65" $321.11 "$1,540.65" "$1,540.65" "$1,540.65" "$1,540.65" "$1,540.65" $321.09 "$1,540.65" $626.74 $911.29 "$1,540.65" "$1,566.85" "$1,540.65" "$1,540.65" "$1,155.75" "$1,540.65" "$1,540.65" "$1,540.65" $770.33 $770.33 "$1,220.19" "$1,540.65" "$1,232.52" $693.29 $305.78 N/A $893.78 "$1,540.65" $924.39 "$1,540.65" $321.07 "$1,540.65" N/A N/A 241.094S SUP HCPCS C1713 241.094S - PLATE BN 15MM 99MM STRL LCP CMBN 6 HL HK PRECONTOUR RND SHFT BOTH IP/OP "$1,584.50" "$1,173.00" $314.43 "$1,611.15" $712.90 $712.90 $712.90 $712.90 "$1,584.23" "$1,584.23" "$1,584.23" $330.19 "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" $330.17 "$1,584.23" $644.46 $937.07 "$1,584.23" "$1,611.15" "$1,584.23" "$1,584.23" "$1,188.38" "$1,584.23" "$1,584.23" "$1,584.23" $792.12 $792.12 "$1,254.71" "$1,584.23" "$1,267.38" $712.90 $314.43 N/A $919.01 "$1,584.23" $950.54 "$1,584.23" $330.15 "$1,584.23" N/A N/A 241.095S SUP HCPCS C1713 241.095S - PLATE BN 15MM 99MM STRL LCP CMBN 6 HL HK PRECONTOUR RND SHFT BOTH IP/OP "$1,584.50" "$1,173.00" $314.43 "$1,611.15" $712.90 $712.90 $712.90 $712.90 "$1,584.23" "$1,584.23" "$1,584.23" $330.19 "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" $330.17 "$1,584.23" "$1,611.15" $937.07 "$1,584.23" "$1,611.15" "$1,584.23" "$1,584.23" "$1,188.38" "$1,584.23" "$1,584.23" "$1,584.23" $792.12 $792.12 "$1,254.71" "$1,584.23" "$1,267.38" $712.90 $314.43 N/A $919.01 "$1,584.23" $950.54 "$1,584.23" $330.15 "$1,584.23" N/A N/A 241.096S SUP HCPCS C1713 241.096S - PLATE BN 18MM 99MM STRL LCP CMBN 6 HL HK PRECONTOUR RND SHFT BOTH IP/OP "$1,584.50" "$1,173.00" $314.43 "$1,611.15" $712.90 $712.90 $712.90 $712.90 "$1,584.23" "$1,584.23" "$1,584.23" $330.19 "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" $330.17 "$1,584.23" "$1,611.15" $937.07 "$1,584.23" "$1,611.15" "$1,584.23" "$1,584.23" "$1,188.38" "$1,584.23" "$1,584.23" "$1,584.23" $792.12 $792.12 "$1,254.71" "$1,584.23" "$1,267.38" $712.90 $314.43 N/A $919.01 "$1,584.23" "$1,584.23" "$1,584.23" $330.15 "$1,584.23" N/A N/A 241.097S SUP HCPCS C1713 241.097S - PLATE BONE 18MM 6 HOLE HOOK LCP STAINLESS STEEL LEFT BOTH IP/OP "$1,584.50" "$1,173.00" $314.43 "$1,611.15" $712.90 $712.90 $712.90 $712.90 "$1,584.23" "$1,584.23" "$1,584.23" $330.19 "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" $330.17 "$1,584.23" $644.46 $937.07 "$1,584.23" "$1,611.15" "$1,584.23" "$1,584.23" "$1,188.38" "$1,584.23" "$1,584.23" "$1,584.23" $792.12 $792.12 "$1,254.71" "$1,584.23" "$1,267.38" $712.90 $314.43 N/A $919.01 "$1,584.23" "$1,584.23" "$1,584.23" $330.15 "$1,584.23" N/A N/A 241.104S SUP HCPCS C1713 241.104S - PLATE BONE 15MM 7 HOLE HOOK LCP STAINLESS STEEL RIGHT BOTH IP/OP "$1,652.00" "$1,222.00" $327.82 "$1,679.78" $743.27 $743.27 $743.27 $743.27 "$1,651.70" "$1,651.70" "$1,651.70" $344.26 "$1,651.70" "$1,651.70" "$1,651.70" "$1,651.70" "$1,651.70" $344.23 "$1,651.70" $671.91 $976.98 "$1,651.70" "$1,679.78" "$1,651.70" "$1,651.70" "$1,239.00" "$1,651.70" "$1,651.70" "$1,651.70" $825.85 $825.85 "$1,308.15" "$1,651.70" "$1,321.36" $743.27 $327.82 N/A $958.16 "$1,651.70" $991.02 "$1,651.70" $344.21 "$1,651.70" N/A N/A 241.105S SUP HCPCS C1713 241.105S - PLATE BONE 15MM 7 HOLE HOOK LCP STAINLESS STEEL LEFT BOTH IP/OP "$1,652.00" "$1,222.00" $327.82 "$1,679.78" $743.27 $743.27 $743.27 $743.27 "$1,651.70" "$1,651.70" "$1,651.70" $344.26 "$1,651.70" "$1,651.70" "$1,651.70" "$1,651.70" "$1,651.70" $344.23 "$1,651.70" $671.91 $976.98 "$1,651.70" "$1,679.78" "$1,651.70" "$1,651.70" "$1,239.00" "$1,651.70" "$1,651.70" "$1,651.70" $825.85 $825.85 "$1,308.15" "$1,651.70" "$1,321.36" $743.27 $327.82 N/A $958.16 "$1,651.70" $991.02 "$1,651.70" $344.21 "$1,651.70" N/A N/A 241.106S SUP HCPCS C1713 241.106S - PLATE BONE 18MM 7 HOLE HOOK LCP STAINLESS STEEL RIGHT BOTH IP/OP "$1,652.00" "$1,222.00" $327.82 "$1,679.78" $743.27 $743.27 $743.27 $743.27 "$1,651.70" "$1,651.70" "$1,651.70" $344.26 "$1,651.70" "$1,651.70" "$1,651.70" "$1,651.70" "$1,651.70" $344.23 "$1,651.70" $671.91 $976.98 "$1,651.70" "$1,679.78" "$1,651.70" "$1,651.70" "$1,239.00" "$1,651.70" "$1,651.70" "$1,651.70" $825.85 $825.85 "$1,308.15" "$1,651.70" "$1,321.36" $743.27 $327.82 N/A $958.16 "$1,651.70" $991.02 "$1,651.70" $344.21 "$1,651.70" N/A N/A 241.107S SUP HCPCS C1713 241.107S - PLATE BONE 18MM 7 HOLE HOOK LCP STAINLESS STEEL LEFT BOTH IP/OP "$1,652.00" "$1,222.00" $327.82 "$1,679.78" $743.27 $743.27 $743.27 $743.27 "$1,651.70" "$1,651.70" "$1,651.70" $344.26 "$1,651.70" "$1,651.70" "$1,651.70" "$1,651.70" "$1,651.70" $344.23 "$1,651.70" $671.91 $976.98 "$1,651.70" "$1,679.78" "$1,651.70" "$1,651.70" "$1,239.00" "$1,651.70" "$1,651.70" "$1,651.70" $825.85 $825.85 "$1,308.15" "$1,651.70" "$1,321.36" $743.27 $327.82 N/A $958.16 "$1,651.70" "$1,651.70" "$1,651.70" $344.21 "$1,651.70" N/A N/A 241.266S SUP HCPCS C1713 241.266S - PLATE BN 116X11X2.5MM STRL LCP CMBN 7 HL PRECONTOUR LMT BOTH IP/OP "$2,204.50" "$1,631.00" $437.46 "$2,241.60" $991.86 $991.86 $991.86 $991.86 "$2,204.13" "$2,204.13" "$2,204.13" $459.40 "$2,204.13" "$2,204.13" "$2,204.13" "$2,204.13" "$2,204.13" $459.36 "$2,204.13" "$2,241.60" "$1,303.74" "$2,204.13" "$2,241.60" "$2,204.13" "$2,204.13" "$1,653.38" "$2,204.13" "$2,204.13" "$2,204.13" "$1,102.07" "$1,102.07" "$1,745.67" "$2,204.13" "$1,763.30" $991.86 $437.46 N/A "$1,278.61" "$2,204.13" "$1,322.48" "$2,204.13" $459.34 "$2,204.13" N/A N/A 241.443S SUP HCPCS C1713 241.443S - PLATE BN 106MM STRL LCP CMBN 7 HL LOPRFL LMT CNTCT TPR TIP BOTH IP/OP "$2,887.50" "$2,137.00" $573.06 "$2,936.38" "$1,299.29" "$1,299.29" "$1,299.29" "$1,299.29" "$2,887.30" "$2,887.30" "$2,887.30" $601.79 "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" "$2,887.30" $601.75 "$2,887.30" "$2,936.38" "$1,423.44" "$2,887.30" "$2,936.38" "$2,887.30" "$2,887.30" "$2,165.63" "$2,887.30" "$2,887.30" "$2,887.30" "$1,443.65" "$1,443.65" "$2,286.74" "$2,887.30" "$2,309.84" "$1,299.29" $573.06 N/A "$1,674.75" "$2,887.30" "$2,887.30" "$2,887.30" $601.71 "$2,887.30" N/A N/A 241.444S SUP HCPCS C1713 241.444S - PLATE BN 132MM STRL LCP CMBN 9 HL LOPRFL LMT CNTCT TPR TIP BOTH IP/OP "$2,915.50" "$2,157.00" $578.63 "$2,964.95" "$1,311.93" "$1,311.93" "$1,311.93" "$1,311.93" "$2,915.40" "$2,915.40" "$2,915.40" $607.64 "$2,915.40" "$2,915.40" "$2,915.40" "$2,915.40" "$2,915.40" $607.60 "$2,915.40" "$2,964.95" "$1,437.29" "$2,915.40" "$2,964.95" "$2,915.40" "$2,915.40" "$2,186.63" "$2,915.40" "$2,915.40" "$2,915.40" "$1,457.70" "$1,457.70" "$2,309.00" "$2,915.40" "$2,332.32" "$1,311.93" $578.63 N/A "$1,690.99" "$2,915.40" "$2,915.40" "$2,915.40" $607.57 "$2,915.40" N/A N/A 241.445S SUP HCPCS C1713 241.445S - PLATE BN 132MM STRL LCP CMBN 9 HL LOPRFL LMT CNTCT TPR TIP BOTH IP/OP "$2,915.50" "$2,157.00" $578.63 "$2,964.95" "$1,311.93" "$1,311.93" "$1,311.93" "$1,311.93" "$2,915.40" "$2,915.40" "$2,915.40" $607.64 "$2,915.40" "$2,915.40" "$2,915.40" "$2,915.40" "$2,915.40" $607.60 "$2,915.40" "$2,964.95" "$1,437.29" "$2,915.40" "$2,964.95" "$2,915.40" "$2,915.40" "$2,186.63" "$2,915.40" "$2,915.40" "$2,915.40" "$1,457.70" "$1,457.70" "$2,309.00" "$2,915.40" "$2,332.32" "$1,311.93" $578.63 N/A "$1,690.99" "$2,915.40" "$2,915.40" "$2,915.40" $607.57 "$2,915.40" N/A N/A 241.446S SUP HCPCS C1713 241.446S - PLATE BN 158MM STRL LCP CMBN 11 HL LOPRFL LMT CNTCT TPR TIP BOTH IP/OP "$2,942.50" "$2,177.00" $583.94 "$2,992.15" "$1,323.96" "$1,323.96" "$1,323.96" "$1,323.96" "$2,942.13" "$2,942.13" "$2,942.13" $613.21 "$2,942.13" "$2,942.13" "$2,942.13" "$2,942.13" "$2,942.13" $613.17 "$2,942.13" "$2,992.15" "$1,450.47" "$2,942.13" "$2,992.15" "$2,942.13" "$2,942.13" "$2,206.88" "$2,942.13" "$2,942.13" "$2,942.13" "$1,471.07" "$1,471.07" "$2,330.17" "$2,942.13" "$2,353.70" "$1,323.96" $583.94 N/A "$1,706.65" "$2,942.13" "$2,942.13" "$2,942.13" $613.14 "$2,942.13" N/A N/A 241.447S SUP HCPCS C1713 241.447S - PLATE BN 158MM STRL LCP CMBN 11 HL LOPRFL LMT CNTCT TPR TIP BOTH IP/OP "$2,942.50" "$2,177.00" $583.94 "$2,992.15" "$1,323.96" "$1,323.96" "$1,323.96" "$1,323.96" "$2,942.13" "$2,942.13" "$2,942.13" $613.21 "$2,942.13" "$2,942.13" "$2,942.13" "$2,942.13" "$2,942.13" $613.17 "$2,942.13" "$1,196.86" "$1,450.47" "$2,942.13" "$2,992.15" "$2,942.13" "$2,942.13" "$2,206.88" "$2,942.13" "$2,942.13" "$2,942.13" "$1,471.07" "$1,471.07" "$2,330.17" "$2,942.13" "$2,353.70" "$1,323.96" $583.94 N/A "$1,706.65" "$2,942.13" "$2,942.13" "$2,942.13" $613.14 "$2,942.13" N/A N/A 241.448S SUP HCPCS C1713 241.448S - PLATE BN 184MM STRL LCP CMBN 13 HL LOPRFL LMT CNTCT TPR TIP BOTH IP/OP "$2,974.50" "$2,201.00" $590.35 "$3,025.03" "$1,338.50" "$1,338.50" "$1,338.50" "$1,338.50" "$2,974.45" "$2,974.45" "$2,974.45" $619.95 "$2,974.45" "$2,974.45" "$2,974.45" "$2,974.45" "$2,974.45" $619.91 "$2,974.45" "$1,210.01" "$1,466.40" "$2,974.45" "$3,025.03" "$2,974.45" "$2,974.45" "$2,230.88" "$2,974.45" "$2,974.45" "$2,974.45" "$1,487.23" "$1,487.23" "$2,355.76" "$2,974.45" "$2,379.56" "$1,338.50" $590.35 N/A "$1,725.21" "$2,974.45" "$2,974.45" "$2,974.45" $619.88 "$2,974.45" N/A N/A 241.449S SUP HCPCS C1713 241.449S - PLATE BN 184MM STRL LCP CMBN 13 HL LOPRFL LMT CNTCT TPR TIP BOTH IP/OP "$2,974.50" "$2,201.00" $590.35 "$3,025.03" "$1,338.50" "$1,338.50" "$1,338.50" "$1,338.50" "$2,974.45" "$2,974.45" "$2,974.45" $619.95 "$2,974.45" "$2,974.45" "$2,974.45" "$2,974.45" "$2,974.45" $619.91 "$2,974.45" "$1,210.01" "$1,466.40" "$2,974.45" "$3,025.03" "$2,974.45" "$2,974.45" "$2,230.88" "$2,974.45" "$2,974.45" "$2,974.45" "$1,487.23" "$1,487.23" "$2,355.76" "$2,974.45" "$2,379.56" "$1,338.50" $590.35 N/A "$1,725.21" "$2,974.45" "$2,974.45" "$2,974.45" $619.88 "$2,974.45" N/A N/A 241.450S SUP HCPCS C1713 241.450S - PLATE BN 210MM STRL LCP CMBN 15 HL LOPRFL LMT CNTCT TPR TIP BOTH IP/OP "$3,012.50" "$2,229.00" $597.89 "$3,063.60" "$1,355.58" "$1,355.58" "$1,355.58" "$1,355.58" "$3,012.40" "$3,012.40" "$3,012.40" $627.86 "$3,012.40" "$3,012.40" "$3,012.40" "$3,012.40" "$3,012.40" $627.82 "$3,012.40" "$3,063.60" "$1,485.11" "$3,012.40" "$3,063.60" "$3,012.40" "$3,012.40" "$2,259.38" "$3,012.40" "$3,012.40" "$3,012.40" "$1,506.20" "$1,506.20" "$2,385.82" "$3,012.40" "$2,409.92" "$1,355.58" $597.89 N/A "$1,747.25" "$3,012.40" "$3,012.40" "$3,012.40" $627.78 "$3,012.40" N/A N/A 241.451S SUP HCPCS C1713 241.451S - PLATE BN 210MM STRL LCP CMBN 15 HL LOPRFL LMT CNTCT TPR TIP BOTH IP/OP "$3,012.50" "$2,229.00" $597.89 "$3,063.60" "$1,355.58" "$1,355.58" "$1,355.58" "$1,355.58" "$3,012.40" "$3,012.40" "$3,012.40" $627.86 "$3,012.40" "$3,012.40" "$3,012.40" "$3,012.40" "$3,012.40" $627.82 "$3,012.40" "$1,225.44" "$1,485.11" "$3,012.40" "$3,063.60" "$3,012.40" "$3,012.40" "$2,259.38" "$3,012.40" "$3,012.40" "$3,012.40" "$1,506.20" "$1,506.20" "$2,385.82" "$3,012.40" "$2,409.92" "$1,355.58" $597.89 N/A "$1,747.25" "$3,012.40" "$3,012.40" "$3,012.40" $627.78 "$3,012.40" N/A N/A 241.452S SUP HCPCS C1713 241.452S - PLATE BN 236MM STRL LCP CMBN 17 HL LOPRFL LMT CNTCT TPR TIP BOTH IP/OP "$3,139.00" "$2,323.00" $622.99 "$3,192.25" "$1,412.51" "$1,412.51" "$1,412.51" "$1,412.51" "$3,138.90" "$3,138.90" "$3,138.90" $654.23 "$3,138.90" "$3,138.90" "$3,138.90" "$3,138.90" "$3,138.90" $654.18 "$3,138.90" "$1,276.90" "$1,547.48" "$3,138.90" "$3,192.25" "$3,138.90" "$3,138.90" "$2,354.25" "$3,138.90" "$3,138.90" "$3,138.90" "$1,569.45" "$1,569.45" "$2,486.01" "$3,138.90" "$2,511.12" "$1,412.51" $622.99 N/A "$1,820.62" "$3,138.90" "$3,138.90" "$3,138.90" $654.15 "$3,138.90" N/A N/A 241.453S SUP HCPCS C1713 241.453S - PLATE BN 236MM STRL LCP CMBN 17 HL LOPRFL LMT CNTCT TPR TIP BOTH IP/OP "$3,139.00" "$2,323.00" $622.99 "$3,192.25" "$1,412.51" "$1,412.51" "$1,412.51" "$1,412.51" "$3,138.90" "$3,138.90" "$3,138.90" $654.23 "$3,138.90" "$3,138.90" "$3,138.90" "$3,138.90" "$3,138.90" $654.18 "$3,138.90" "$1,276.90" "$1,547.48" "$3,138.90" "$3,192.25" "$3,138.90" "$3,138.90" "$2,354.25" "$3,138.90" "$3,138.90" "$3,138.90" "$1,569.45" "$1,569.45" "$2,486.01" "$3,138.90" "$2,511.12" "$1,412.51" $622.99 N/A "$1,820.62" "$3,138.90" "$3,138.90" "$3,138.90" $654.15 "$3,138.90" N/A N/A 241.454S SUP HCPCS C1713 241.454S - PLATE BN 262MM STRL LCP CMBN 19 HL LOPRFL LMT CNTCT TPR TIP BOTH IP/OP "$3,163.00" "$2,341.00" $627.74 "$3,216.58" "$1,423.26" "$1,423.26" "$1,423.26" "$1,423.26" "$3,162.80" "$3,162.80" "$3,162.80" $659.21 "$3,162.80" "$3,162.80" "$3,162.80" "$3,162.80" "$3,162.80" $659.16 "$3,162.80" "$1,286.63" "$1,559.26" "$3,162.80" "$3,216.58" "$3,162.80" "$3,162.80" "$2,372.25" "$3,162.80" "$3,162.80" "$3,162.80" "$1,581.40" "$1,581.40" "$2,504.94" "$3,162.80" "$2,530.24" "$1,423.26" $627.74 N/A "$1,834.54" "$3,162.80" "$3,162.80" "$3,162.80" $659.13 "$3,162.80" N/A N/A 241.455S SUP HCPCS C1713 241.455S - PLATE BN 262MM STRL LCP CMBN 19 HL LOPRFL LMT CNTCT TPR TIP BOTH IP/OP "$3,163.00" "$2,341.00" $627.74 "$3,216.58" "$1,423.26" "$1,423.26" "$1,423.26" "$1,423.26" "$3,162.80" "$3,162.80" "$3,162.80" $659.21 "$3,162.80" "$3,162.80" "$3,162.80" "$3,162.80" "$3,162.80" $659.16 "$3,162.80" "$3,216.58" "$1,559.26" "$3,162.80" "$3,216.58" "$3,162.80" "$3,162.80" "$2,372.25" "$3,162.80" "$3,162.80" "$3,162.80" "$1,581.40" "$1,581.40" "$2,504.94" "$3,162.80" "$2,530.24" "$1,423.26" $627.74 N/A "$1,834.54" "$3,162.80" "$3,162.80" "$3,162.80" $659.13 "$3,162.80" N/A N/A 241.919S SUP HCPCS C1713 241.919S - PLATE BONE LONG 160X12X3.7MM 6 HOLE PRECONTOUR LCP STAINLESS BOTH IP/OP "$3,185.50" "$2,357.00" $632.20 "$3,239.45" "$1,433.39" "$1,433.39" "$1,433.39" "$1,433.39" "$3,185.30" "$3,185.30" "$3,185.30" $663.90 "$3,185.30" "$3,185.30" "$3,185.30" "$3,185.30" "$3,185.30" $663.85 "$3,185.30" "$3,239.45" "$1,570.35" "$3,185.30" "$3,239.45" "$3,185.30" "$3,185.30" "$2,389.13" "$3,185.30" "$3,185.30" "$3,185.30" "$1,592.65" "$1,592.65" "$2,522.76" "$3,185.30" "$2,548.24" "$1,433.39" $632.20 N/A "$1,847.59" "$3,185.30" "$3,185.30" "$3,185.30" $663.82 "$3,185.30" N/A N/A 241.921S SUP HCPCS C1713 241.921S - PLATE BN 196X12X3.7MM STRL LCP CMBN PHLS LNG 8 HL SHFT SS BOTH IP/OP "$3,305.00" "$2,446.00" $655.92 "$3,360.95" "$1,487.15" "$1,487.15" "$1,487.15" "$1,487.15" "$3,304.78" "$3,304.78" "$3,304.78" $688.80 "$3,304.78" "$3,304.78" "$3,304.78" "$3,304.78" "$3,304.78" $688.75 "$3,304.78" "$3,360.95" "$1,629.26" "$3,304.78" "$3,360.95" "$3,304.78" "$3,304.78" "$2,478.75" "$3,304.78" "$3,304.78" "$3,304.78" "$1,652.39" "$1,652.39" "$2,617.39" "$3,304.78" "$2,643.82" "$1,487.15" $655.92 N/A "$1,916.90" "$3,304.78" "$3,304.78" "$3,304.78" $688.72 "$3,304.78" N/A N/A 241-01 SUP HCPCS C1781 241-01 - PLATE BONE 121MM 1 HOLE STRAP FLUSHMESH TITANIUM CRANIAL BOTH IP/OP $465.50 $344.00 $92.37 $465.38 $209.42 $209.42 $209.42 $209.42 $465.38 $465.38 $465.38 $97.00 $465.38 $465.38 $465.38 $465.38 $465.38 $96.99 $465.38 $465.38 $275.27 $465.38 $465.38 $465.38 $465.38 $349.13 $465.38 $465.38 $465.38 $232.69 $232.69 $368.58 $465.38 $372.30 $209.42 $92.37 N/A $269.99 $465.38 $465.38 $465.38 $96.99 $465.38 N/A N/A 241-02 SUP HCPCS C1781 241-02 - PLATE BONE 121MM 2 HOLE STRAP FLUSHMESH TITANIUM CRANIAL BOTH IP/OP $572.00 $423.00 $113.45 $571.63 $257.23 $257.23 $257.23 $257.23 $571.63 $571.63 $571.63 $119.14 $571.63 $571.63 $571.63 $571.63 $571.63 $119.13 $571.63 $571.63 $338.12 $571.63 $571.63 $571.63 $571.63 $429.00 $571.63 $571.63 $571.63 $285.82 $285.82 $452.73 $571.63 $457.30 $257.23 $113.45 N/A $331.76 $571.63 $571.63 $571.63 $119.13 $571.63 N/A N/A 241-02-C SUP HCPCS C1781 241-02-C - PLATE BN 121MM FLEXMESH 2 HL STRP SKL BOTH IP/OP $576.00 $426.00 $114.30 $575.88 $259.15 $259.15 $259.15 $259.15 $575.88 $575.88 $575.88 $120.03 $575.88 $575.88 $575.88 $575.88 $575.88 $120.02 $575.88 $575.88 $340.63 $575.88 $575.88 $575.88 $575.88 $432.00 $575.88 $575.88 $575.88 $287.94 $287.94 $456.10 $575.88 $460.70 $259.15 $114.30 N/A $334.08 $575.88 $575.88 $575.88 $120.01 $575.88 N/A N/A 241-03 SUP HCPCS C1781 241-03 - PLATE BONE ROUND 121MM 3 HOLE STRIP FLUSHMESH SKULL BOTH IP/OP $652.50 $483.00 $129.48 $652.38 $293.57 $293.57 $293.57 $293.57 $652.38 $652.38 $652.38 $135.97 $652.38 $652.38 $652.38 $652.38 $652.38 $135.96 $652.38 $652.38 $385.88 $652.38 $652.38 $652.38 $652.38 $489.38 $652.38 $652.38 $652.38 $326.19 $326.19 $516.68 $652.38 $521.90 $293.57 $129.48 N/A $378.45 $652.38 $652.38 $652.38 $135.96 $652.38 N/A N/A 241-04 SUP HCPCS C1713 241-04 - PLATE BONE ROUND 121MM 4 HOLE STRIP FLUSHMESH SKULL BOTH IP/OP $735.50 $544.00 $145.93 $735.25 $330.86 $330.86 $330.86 $330.86 $735.25 $735.25 $735.25 $153.24 $735.25 $735.25 $735.25 $735.25 $735.25 $153.23 $735.25 $294.10 $434.90 $735.25 $735.25 $735.25 $735.25 $551.63 $735.25 $735.25 $735.25 $367.63 $367.63 $582.32 $735.25 $588.20 $330.86 $145.93 N/A $426.59 $735.25 $735.25 $735.25 $153.23 $735.25 N/A N/A 24106 A SUP Custom 27803010 24106 A - RESERVOIR SHUNT RIGHT ANG 10MM 3CM INTEGRAL VENTRICULAR BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 24106 B SUP Custom 27803010 24106 B - RESERVOIR SHUNT RIGHT ANG 10MM 4CM INTEGRAL VENTRICULAR BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 24106 C SUP Custom 27803010 24106 C - RESERVOIR SHUNT 10MM 5CM RIGHT ANGLED INTEGRAL VENTRICULAR BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 24106 D SUP Custom 27803010 24106 D - RESERVOIR SHUNT 10MM 6CM RIGHT ANGLED INTEGRAL VENTRICULAR BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 24106 E SUP Custom 27803010 24106 E - RESERVOIR SHUNT ANGLE RIGHT 10MM 7CM INTEGRAL CATHETER BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 24106 H SUP HCPCS C1725 24106 H - RESERVOIR SHUNT 10MM 10CM RIGHT ANGLED INTEGRAL VENTRICULAR BOTH IP/OP "$1,221.00" $904.00 $242.29 "$1,220.75" $662.87 $662.87 $662.87 $662.87 "$1,220.75" "$1,220.75" "$1,220.75" $254.43 "$1,220.75" $906.04 $906.04 $940.95 $636.01 $254.42 "$1,220.75" "$1,220.75" $722.07 "$1,220.75" "$1,220.75" "$1,220.75" "$1,220.75" $915.75 "$1,220.75" "$1,220.75" "$1,220.75" $610.38 $610.38 $966.83 "$1,220.75" $976.60 $793.49 $242.29 N/A $708.18 "$1,220.75" "$1,220.75" "$1,220.75" $254.40 "$1,220.75" N/A N/A 24133-1 SUP Custom 27803010 24133-1 - SHUNT NEUROSURGICAL 90D PERFORMANCE LEVEL 1 PERITONEAL BOTH IP/OP "$5,242.00" "$3,879.00" $933.01 "$5,241.63" "$5,241.63" "$5,241.63" "$5,241.63" "$5,241.63" "$5,241.63" "$5,241.63" $933.01 "$5,241.63" "$5,241.63" "$5,241.63" "$5,241.63" "$5,241.63" "$5,241.63" "$1,092.41" "$5,241.63" "$2,096.65" "$5,241.63" "$5,241.63" "$5,241.63" "$5,241.63" "$5,241.63" "$3,931.50" "$5,241.63" "$5,241.63" "$5,241.63" "$2,620.82" "$2,620.82" "$4,151.37" "$5,241.63" "$4,193.30" "$2,358.73" "$5,241.63" N/A "$3,040.36" "$5,241.63" "$3,144.98" "$5,241.63" "$5,241.63" "$5,241.63" N/A N/A 242.531S SUP HCPCS C1713 242.531S - PLATE BONE 46MM 7 HOLE LCP STAINLESS STEEL DISTAL ULNA BOTH IP/OP "$1,562.00" "$1,156.00" $309.96 "$1,588.28" $702.78 $702.78 $702.78 $702.78 "$1,561.73" "$1,561.73" "$1,561.73" $325.50 "$1,561.73" "$1,561.73" "$1,561.73" "$1,561.73" "$1,561.73" $325.48 "$1,561.73" $635.31 $923.76 "$1,561.73" "$1,588.28" "$1,561.73" "$1,561.73" "$1,171.50" "$1,561.73" "$1,561.73" "$1,561.73" $780.87 $780.87 "$1,236.89" "$1,561.73" "$1,249.38" $702.78 $309.96 N/A $905.96 "$1,561.73" "$1,561.73" "$1,561.73" $325.46 "$1,561.73" N/A N/A 24-2050 SUP Custom 27203010 24-2050 - DRILL SURG 1.8MM 50MM 26MM STOP BLADE LORENZ MANDIB BOTH IP/OP $432.50 $320.00 $76.99 $432.50 $432.50 $432.50 $432.50 $432.50 $432.50 $432.50 $76.99 $432.50 $432.50 $321.00 $321.00 $333.37 $225.33 $90.14 $432.50 $173.00 $432.50 $432.50 $432.50 $432.50 $432.50 $324.38 $432.50 $432.50 $432.50 $216.25 $216.25 $342.54 $432.50 $346.00 $281.13 $432.50 N/A $250.85 $432.50 $259.50 $432.50 $432.50 $432.50 N/A N/A 246.354S SUP HCPCS C1713 246.354S - PLATE BONE 27MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS BOTH IP/OP "$1,516.50" "$1,122.00" $300.93 "$1,516.23" $682.30 $682.30 $682.30 $682.30 "$1,516.23" "$1,516.23" "$1,516.23" $316.02 "$1,516.23" "$1,516.23" "$1,516.23" "$1,516.23" "$1,516.23" $316.00 "$1,516.23" $606.49 $896.85 "$1,516.23" "$1,516.23" "$1,516.23" "$1,516.23" "$1,137.38" "$1,516.23" "$1,516.23" "$1,516.23" $758.12 $758.12 "$1,200.85" "$1,516.23" "$1,212.98" $682.30 $300.93 N/A $879.57 "$1,516.23" $909.74 "$1,516.23" $315.98 "$1,516.23" N/A N/A 246.355S SUP HCPCS C1713 246.355S - PLATE BONE 32MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS BOTH IP/OP "$1,516.50" "$1,122.00" $300.93 "$1,516.23" $682.30 $682.30 $682.30 $682.30 "$1,516.23" "$1,516.23" "$1,516.23" $316.02 "$1,516.23" "$1,516.23" "$1,516.23" "$1,516.23" "$1,516.23" $316.00 "$1,516.23" $606.49 $896.85 "$1,516.23" "$1,516.23" "$1,516.23" "$1,516.23" "$1,137.38" "$1,516.23" "$1,516.23" "$1,516.23" $758.12 $758.12 "$1,200.85" "$1,516.23" "$1,212.98" $682.30 $300.93 N/A $879.57 "$1,516.23" $909.74 "$1,516.23" $315.98 "$1,516.23" N/A N/A 247.354S SUP HCPCS C1713 247.354S - PLATE BONE 34MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS BOTH IP/OP "$1,562.00" "$1,156.00" $309.96 "$1,588.28" $702.78 $702.78 $702.78 $702.78 "$1,561.73" "$1,561.73" "$1,561.73" $325.50 "$1,561.73" "$1,561.73" "$1,561.73" "$1,561.73" "$1,561.73" $325.48 "$1,561.73" $635.31 $923.76 "$1,561.73" "$1,588.28" "$1,561.73" "$1,561.73" "$1,171.50" "$1,561.73" "$1,561.73" "$1,561.73" $780.87 $780.87 "$1,236.89" "$1,561.73" "$1,249.38" $702.78 $309.96 N/A $905.96 "$1,561.73" "$1,561.73" "$1,561.73" $325.46 "$1,561.73" N/A N/A 247.355S SUP HCPCS C1713 247.355S - PLATE BONE 40MM 2X5 HOLE ROTATION CORRECTION LCP STAINLESS BOTH IP/OP "$1,562.00" "$1,156.00" $309.96 "$1,588.28" $702.78 $702.78 $702.78 $702.78 "$1,561.73" "$1,561.73" "$1,561.73" $325.50 "$1,561.73" "$1,561.73" "$1,561.73" "$1,561.73" "$1,561.73" $325.48 "$1,561.73" $635.31 $923.76 "$1,561.73" "$1,588.28" "$1,561.73" "$1,561.73" "$1,171.50" "$1,561.73" "$1,561.73" "$1,561.73" $780.87 $780.87 "$1,236.89" "$1,561.73" "$1,249.38" $702.78 $309.96 N/A $905.96 "$1,561.73" "$1,561.73" "$1,561.73" $325.46 "$1,561.73" N/A N/A 2480-10-41 SUP HCPCS C1713 2480-10-41 - SCREW BN FT 4MM 10MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 2480-12-41 SUP HCPCS C1713 2480-12-41 - SCREW BN FT 4MM 12MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $111.55 $111.55 $23.25 $111.55 N/A N/A 2480-14-41 SUP HCPCS C1713 2480-14-41 - SCREW BN FT 4MM 14MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $111.55 $111.55 $23.25 $111.55 N/A N/A 2480-16-41 SUP HCPCS C1713 2480-16-41 - SCREW BN FT 4MM 16MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $111.55 $111.55 $23.25 $111.55 N/A N/A 2480-18-41 SUP HCPCS C1713 2480-18-41 - SCREW BN FT 4MM 18MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $111.55 $111.55 $23.25 $111.55 N/A N/A 2480-20-41 SUP HCPCS C1713 2480-20-41 - SCREW BN FT 4MM 20MM NS FORTE SS PERIART CANC BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 2480-22-41 SUP HCPCS C1713 2480-22-41 - SCREW BN FT 4MM 22MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 2480-24-41 SUP HCPCS C1713 2480-24-41 - SCREW BN FT 4MM 24MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 2480-26-41 SUP HCPCS C1713 2480-26-41 - SCREW BN FT 4MM 26MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 2480-28-41 SUP HCPCS C1713 2480-28-41 - SCREW BN FT 4MM 28MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 2480-30-41 SUP HCPCS C1713 2480-30-41 - SCREW BN FT 4MM 30MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 2480-32-41 SUP HCPCS C1713 2480-32-41 - SCREW BN FT 4MM 32MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 2480-34-41 SUP HCPCS C1713 2480-34-41 - SCREW BN FT 4MM 34MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $111.55 $111.55 $23.25 $111.55 N/A N/A 2480-36-41 SUP HCPCS C1713 2480-36-41 - SCREW BN FT 4MM 36MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $111.55 $111.55 $23.25 $111.55 N/A N/A 2480-38-41 SUP HCPCS C1713 2480-38-41 - SCREW BN FT 4MM 38MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $44.62 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 2480-40-41 SUP HCPCS C1713 2480-40-41 - SCREW BN FT 4MM 40MM NS FORTE SS CANC PERIART BOTH IP/OP $112.00 $83.00 $22.14 $111.55 $50.20 $50.20 $50.20 $50.20 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $111.55 $111.55 $111.55 $23.25 $111.55 $111.55 $65.98 $111.55 $111.55 $111.55 $111.55 $84.00 $111.55 $111.55 $111.55 $55.78 $55.78 $88.35 $111.55 $89.24 $50.20 $22.14 N/A $64.96 $111.55 $66.93 $111.55 $23.25 $111.55 N/A N/A 24B002 SUP HCPCS C9359 24B002 - GRAFT BONE PROX FEM HD FRZN ALLOWASH TCH GAMA IRR BOTH IP/OP "$3,260.00" "$2,412.00" $647.03 "$3,735.00" "$1,467.00" "$1,467.00" "$1,467.00" "$1,467.00" "$3,260.00" "$3,260.00" "$3,260.00" $679.47 "$3,260.00" "$3,260.00" "$3,260.00" "$3,260.00" "$3,260.00" $679.42 "$3,260.00" "$3,735.00" "$1,607.18" "$3,260.00" "$3,735.00" "$3,260.00" "$3,260.00" "$2,445.00" "$3,260.00" "$3,260.00" "$3,260.00" "$1,630.00" "$1,630.00" "$2,581.92" "$3,260.00" "$2,608.00" "$1,467.00" $647.03 N/A "$1,890.80" "$3,260.00" "$3,260.00" "$3,260.00" $679.38 "$3,260.00" N/A N/A 250.25S SUP HCPCS C1713 250.25S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 255MM STAINLESS STEEL BOTH IP/OP "$2,131.50" "$1,577.00" $423.00 "$2,131.25" $959.06 $959.06 $959.06 $959.06 "$2,131.25" "$2,131.25" "$2,131.25" $444.21 "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" $444.18 "$2,131.25" $852.50 "$1,260.63" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$1,598.63" "$2,131.25" "$2,131.25" "$2,131.25" "$1,065.63" "$1,065.63" "$1,687.95" "$2,131.25" "$1,705.00" $959.06 $423.00 N/A "$1,236.27" "$2,131.25" "$2,131.25" "$2,131.25" $444.15 "$2,131.25" N/A N/A 250.27S SUP HCPCS C1713 250.27S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 270MM STAINLESS STEEL BOTH IP/OP "$2,131.50" "$1,577.00" $423.00 "$2,131.25" $959.06 $959.06 $959.06 $959.06 "$2,131.25" "$2,131.25" "$2,131.25" $444.21 "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" $444.18 "$2,131.25" $852.50 "$1,260.63" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$1,598.63" "$2,131.25" "$2,131.25" "$2,131.25" "$1,065.63" "$1,065.63" "$1,687.95" "$2,131.25" "$1,705.00" $959.06 $423.00 N/A "$1,236.27" "$2,131.25" "$1,278.75" "$2,131.25" $444.15 "$2,131.25" N/A N/A 250.28S SUP HCPCS C1713 250.28S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 285MM STAINLESS STEEL BOTH IP/OP "$2,534.00" "$1,875.00" $502.93 "$2,533.98" "$1,140.29" "$1,140.29" "$1,140.29" "$1,140.29" "$2,533.98" "$2,533.98" "$2,533.98" $528.14 "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" $528.11 "$2,533.98" "$1,013.59" "$1,249.25" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$1,900.50" "$2,533.98" "$2,533.98" "$2,533.98" "$1,266.99" "$1,266.99" "$2,006.91" "$2,533.98" "$2,027.18" "$1,140.29" $502.93 N/A "$1,469.72" "$2,533.98" "$1,520.39" "$2,533.98" $528.08 "$2,533.98" N/A N/A 250.30S SUP HCPCS C1713 250.30S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM TITANIUM TIBIA BOTH IP/OP "$2,131.50" "$1,577.00" $423.00 "$2,131.25" $959.06 $959.06 $959.06 $959.06 "$2,131.25" "$2,131.25" "$2,131.25" $444.21 "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" $444.18 "$2,131.25" $852.50 "$1,260.63" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$1,598.63" "$2,131.25" "$2,131.25" "$2,131.25" "$1,065.63" "$1,065.63" "$1,687.95" "$2,131.25" "$1,705.00" $959.06 $423.00 N/A "$1,236.27" "$2,131.25" "$1,278.75" "$2,131.25" $444.15 "$2,131.25" N/A N/A 250.31S SUP HCPCS C1713 250.31S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 315MM STAINLESS STEEL BOTH IP/OP "$2,534.00" "$1,875.00" $502.93 "$2,533.98" "$1,140.29" "$1,140.29" "$1,140.29" "$1,140.29" "$2,533.98" "$2,533.98" "$2,533.98" $528.14 "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" $528.11 "$2,533.98" "$1,013.59" "$1,249.25" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$1,900.50" "$2,533.98" "$2,533.98" "$2,533.98" "$1,266.99" "$1,266.99" "$2,006.91" "$2,533.98" "$2,027.18" "$1,140.29" $502.93 N/A "$1,469.72" "$2,533.98" "$1,520.39" "$2,533.98" $528.08 "$2,533.98" N/A N/A 250.33S SUP HCPCS C1713 250.33S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 330MM STAINLESS STEEL BOTH IP/OP "$2,534.00" "$1,875.00" $502.93 "$2,533.98" "$1,140.29" "$1,140.29" "$1,140.29" "$1,140.29" "$2,533.98" "$2,533.98" "$2,533.98" $528.14 "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" $528.11 "$2,533.98" "$1,013.59" "$1,249.25" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$1,900.50" "$2,533.98" "$2,533.98" "$2,533.98" "$1,266.99" "$1,266.99" "$2,006.91" "$2,533.98" "$2,027.18" "$1,140.29" $502.93 N/A "$1,469.72" "$2,533.98" "$2,533.98" "$2,533.98" $528.08 "$2,533.98" N/A N/A 250.34S SUP HCPCS C1713 250.34S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 345MM STAINLESS STEEL BOTH IP/OP "$2,131.50" "$1,577.00" $423.00 "$2,131.25" $959.06 $959.06 $959.06 $959.06 "$2,131.25" "$2,131.25" "$2,131.25" $444.21 "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" $444.18 "$2,131.25" $852.50 "$1,260.63" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$1,598.63" "$2,131.25" "$2,131.25" "$2,131.25" "$1,065.63" "$1,065.63" "$1,687.95" "$2,131.25" "$1,705.00" $959.06 $423.00 N/A "$1,236.27" "$2,131.25" "$1,278.75" "$2,131.25" $444.15 "$2,131.25" N/A N/A 250.36S SUP HCPCS C1713 250.36S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 360MM STAINLESS STEEL BOTH IP/OP "$2,534.00" "$1,875.00" $502.93 "$2,533.98" "$1,140.29" "$1,140.29" "$1,140.29" "$1,140.29" "$2,533.98" "$2,533.98" "$2,533.98" $528.14 "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" $528.11 "$2,533.98" "$1,013.59" "$1,249.25" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$1,900.50" "$2,533.98" "$2,533.98" "$2,533.98" "$1,266.99" "$1,266.99" "$2,006.91" "$2,533.98" "$2,027.18" "$1,140.29" $502.93 N/A "$1,469.72" "$2,533.98" "$1,520.39" "$2,533.98" $528.08 "$2,533.98" N/A N/A 250.38S SUP HCPCS C1713 250.38S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM STAINLESS STEEL BOTH IP/OP "$2,131.50" "$1,577.00" $423.00 "$2,131.25" $959.06 $959.06 $959.06 $959.06 "$2,131.25" "$2,131.25" "$2,131.25" $444.21 "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" $444.18 "$2,131.25" $852.50 "$1,260.63" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$1,598.63" "$2,131.25" "$2,131.25" "$2,131.25" "$1,065.63" "$1,065.63" "$1,687.95" "$2,131.25" "$1,705.00" $959.06 $423.00 N/A "$1,236.27" "$2,131.25" "$1,278.75" "$2,131.25" $444.15 "$2,131.25" N/A N/A 250.40S SUP HCPCS C1713 250.40S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM STAINLESS STEEL BOTH IP/OP "$2,131.50" "$1,577.00" $423.00 "$2,131.25" $959.06 $959.06 $959.06 $959.06 "$2,131.25" "$2,131.25" "$2,131.25" $444.21 "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" $444.18 "$2,131.25" "$2,131.25" "$1,260.63" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$1,598.63" "$2,131.25" "$2,131.25" "$2,131.25" "$1,065.63" "$1,065.63" "$1,687.95" "$2,131.25" "$1,705.00" $959.06 $423.00 N/A "$1,236.27" "$2,131.25" "$1,278.75" "$2,131.25" $444.15 "$2,131.25" N/A N/A 250.42S SUP HCPCS C1713 250.42S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM STAINLESS STEEL BOTH IP/OP "$2,131.50" "$1,577.00" $423.00 "$2,131.25" $959.06 $959.06 $959.06 $959.06 "$2,131.25" "$2,131.25" "$2,131.25" $444.21 "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" $444.18 "$2,131.25" "$2,131.25" "$1,260.63" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$1,598.63" "$2,131.25" "$2,131.25" "$2,131.25" "$1,065.63" "$1,065.63" "$1,687.95" "$2,131.25" "$1,705.00" $959.06 $423.00 N/A "$1,236.27" "$2,131.25" "$1,278.75" "$2,131.25" $444.15 "$2,131.25" N/A N/A 25000C+10.00 SUP HCPCS V2632 25000C+10.00 - LENS IOL +10 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+10.50 SUP HCPCS V2632 25000C+10.50 - LENS IOL +10.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+11.00 SUP HCPCS V2632 25000C+11.00 - LENS IOL +11 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+11.50 SUP HCPCS V2632 25000C+11.50 - LENS IOL +11.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+12.00 SUP HCPCS V2632 25000C+12.00 - LENS IOL +12 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+12.50 SUP HCPCS V2632 25000C+12.50 - LENS IOL +12.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+13.00 SUP HCPCS V2632 25000C+13.00 - LENS IOL +13 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+13.50 SUP HCPCS V2632 25000C+13.50 - LENS IOL +13.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+14.00 SUP HCPCS V2632 25000C+14.00 - LENS IOL +14 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+14.50 SUP HCPCS V2632 25000C+14.50 - LENS IOL +14.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+15.00 SUP HCPCS V2632 25000C+15.00 - LENS IOL +15 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+15.50 SUP HCPCS V2632 25000C+15.50 - LENS IOL +15.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+16.00 SUP HCPCS V2632 25000C+16.00 - LENS IOL +16 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+16.50 SUP HCPCS V2632 25000C+16.50 - LENS IOL +16.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+17.00 SUP HCPCS V2632 25000C+17.00 - LENS IOL +17 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+17.50 SUP HCPCS V2632 25000C+17.50 - LENS IOL +17.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+18.00 SUP HCPCS V2632 25000C+18.00 - LENS IOL +18 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+18.50 SUP HCPCS V2632 25000C+18.50 - LENS IOL +18.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+19.00 SUP HCPCS V2632 25000C+19.00 - LENS IOL +19 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+19.50 SUP HCPCS V2632 25000C+19.50 - LENS IOL +19.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+20.00 SUP HCPCS V2632 25000C+20.00 - LENS IOL +20 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+20.50 SUP HCPCS V2632 25000C+20.50 - LENS IOL +20.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+21.00 SUP HCPCS V2632 25000C+21.00 - LENS IOL +21 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+21.50 SUP HCPCS V2632 25000C+21.50 - LENS IOL +21.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+22.00 SUP HCPCS V2632 25000C+22.00 - LENS IOL +22 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+22.50 SUP HCPCS V2632 25000C+22.50 - LENS IOL +22.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+23.00 SUP HCPCS V2632 25000C+23.00 - LENS IOL +23 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+23.50 SUP HCPCS V2632 25000C+23.50 - LENS IOL +23.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+24.00 SUP HCPCS V2632 25000C+24.00 - LENS IOL +24 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+24.50 SUP HCPCS V2632 25000C+24.50 - LENS IOL +24.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+25.00 SUP HCPCS V2632 25000C+25.00 - LENS IOL +25 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+25.50 SUP HCPCS V2632 25000C+25.50 - LENS IOL +25.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+26.00 SUP HCPCS V2632 25000C+26.00 - LENS IOL +26 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+26.50 SUP HCPCS V2632 25000C+26.50 - LENS IOL +26.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+27.00 SUP HCPCS V2632 25000C+27.00 - LENS IOL +27 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+27.50 SUP HCPCS V2632 25000C+27.50 - LENS IOL +27.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+28.00 SUP HCPCS V2632 25000C+28.00 - LENS IOL +28 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+28.50 SUP HCPCS V2632 25000C+28.50 - LENS IOL +28.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+29.00 SUP HCPCS V2632 25000C+29.00 - LENS IOL +29 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+29.50 SUP HCPCS V2632 25000C+29.50 - LENS IOL +29.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+30.00 SUP HCPCS V2632 25000C+30.00 - LENS IOL +30 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+6.00 SUP HCPCS V2632 25000C+6.00 - LENS IOL +6 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+6.50 SUP HCPCS V2632 25000C+6.50 - LENS IOL +6.5 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+7.00 SUP HCPCS V2632 25000C+7.00 - LENS IOL +7 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+7.50 SUP HCPCS V2632 25000C+7.50 - LENS IOL +7.5 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+8.00 SUP HCPCS V2632 25000C+8.00 - LENS IOL +8 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+8.50 SUP HCPCS V2632 25000C+8.50 - LENS IOL +8.5 DIOP MOD C 6MM 12.5MM CLR HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+9.00 SUP HCPCS V2632 25000C+9.00 - LENS IOL +9 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25000C+9.50 SUP HCPCS V2632 25000C+9.50 - LENS IOL +9.5 DIOP MOD C 6MM 12.5MM CLR ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25-003-10-09 SUP HCPCS C1713 25-003-10-09 - MESH CRNL 85X50X.3MM SM GRID PNL TI 1.5MM SCR BOTH IP/OP "$1,823.00" "$1,349.00" $361.82 "$1,823.00" $820.35 $820.35 $820.35 $820.35 "$1,823.00" "$1,823.00" "$1,823.00" $379.96 "$1,823.00" "$1,823.00" "$1,823.00" "$1,823.00" "$1,823.00" $379.93 "$1,823.00" $729.20 "$1,078.30" "$1,823.00" "$1,823.00" "$1,823.00" "$1,823.00" "$1,367.25" "$1,823.00" "$1,823.00" "$1,823.00" $911.50 $911.50 "$1,443.82" "$1,823.00" "$1,458.40" $820.35 $361.82 N/A "$1,057.34" "$1,823.00" "$1,093.80" "$1,823.00" $379.91 "$1,823.00" N/A N/A 25-003-14-09 SUP HCPCS C1713 25-003-14-09 - NEURO PLATE ULTRA LOW PROFILE BOX STYLE 2x2-HOLE W/TAB BOTH IP/OP $702.00 $519.00 $139.24 $701.53 $315.69 $315.69 $315.69 $315.69 $701.53 $701.53 $701.53 $146.22 $701.53 $701.53 $701.53 $701.53 $701.53 $146.21 $701.53 $280.61 $414.95 $701.53 $701.53 $701.53 $701.53 $526.50 $701.53 $701.53 $701.53 $350.77 $350.77 $555.61 $701.53 $561.22 $315.69 $139.24 N/A $407.16 $701.53 $701.53 $701.53 $146.20 $701.53 N/A N/A 25-003-21-09 SUP Custom 27803010 25-003-21-09 - COVER BURR HOLE MEDIUM 15MM .3MM HOLE ULTRA LP SMOOTH BOTH IP/OP $790.00 $585.00 $140.54 $789.55 $789.55 $789.55 $789.55 $789.55 $789.55 $789.55 $140.54 $789.55 $789.55 $789.55 $789.55 $789.55 $789.55 $164.55 $789.55 $315.82 $789.55 $789.55 $789.55 $789.55 $789.55 $592.50 $789.55 $789.55 $789.55 $394.78 $394.78 $625.32 $789.55 $631.64 $355.30 $789.55 N/A $458.20 $789.55 $473.73 $789.55 $789.55 $789.55 N/A N/A 25-003-25-09 SUP Custom 27803010 25-003-25-09 - COVER BURR HOLE LARGE 25MM .3MM HOLE ULTRA LP SMOOTH ROUNDED BOTH IP/OP $790.00 $585.00 $140.54 $789.55 $789.55 $789.55 $789.55 $789.55 $789.55 $789.55 $140.54 $789.55 $789.55 $789.55 $789.55 $789.55 $789.55 $164.55 $789.55 $315.82 $789.55 $789.55 $789.55 $789.55 $789.55 $592.50 $789.55 $789.55 $789.55 $394.78 $394.78 $625.32 $789.55 $631.64 $355.30 $789.55 N/A $458.20 $789.55 $473.73 $789.55 $789.55 $789.55 N/A N/A 25-004-70-09 SUP HCPCS C1781 25-004-70-09 - PLATE BONE ROUND MICRO MESH 73MM .6MM PANEL CNTOUR TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 25-007-80-09 SUP HCPCS C1713 25-007-80-09 - MESH CRNL 3D 80X80X.3MM TI 1.5MM SCR BOTH IP/OP "$4,042.50" "$2,991.00" $802.26 "$4,042.10" "$1,818.95" "$1,818.95" "$1,818.95" "$1,818.95" "$4,042.10" "$4,042.10" "$4,042.10" $842.47 "$4,042.10" "$4,042.10" "$4,042.10" "$4,042.10" "$4,042.10" $842.42 "$4,042.10" "$4,042.10" "$1,992.76" "$4,042.10" "$4,042.10" "$4,042.10" "$4,042.10" "$3,031.88" "$4,042.10" "$4,042.10" "$4,042.10" "$2,021.05" "$2,021.05" "$3,201.34" "$4,042.10" "$3,233.68" "$1,818.95" $802.26 N/A "$2,344.65" "$4,042.10" "$2,425.26" "$4,042.10" $842.37 "$4,042.10" N/A N/A 25-008-12-09 SUP HCPCS C1781 25-008-12-09 - PLATE BONE 3D MICRO MESH 120X120X.6MM TITANIUM FRONTAL MAXL BOTH IP/OP "$5,736.50" "$4,245.00" "$1,138.51" "$5,736.28" "$2,581.33" "$2,581.33" "$2,581.33" "$2,581.33" "$5,736.28" "$5,736.28" "$5,736.28" "$1,195.58" "$5,736.28" "$5,736.28" "$5,736.28" "$5,736.28" "$5,736.28" "$1,195.50" "$5,736.28" "$5,736.28" "$2,827.99" "$5,736.28" "$5,736.28" "$5,736.28" "$5,736.28" "$4,302.38" "$5,736.28" "$5,736.28" "$5,736.28" "$2,868.14" "$2,868.14" "$4,543.13" "$5,736.28" "$4,589.02" "$2,581.33" "$1,138.51" N/A "$3,327.17" "$5,736.28" "$5,736.28" "$5,736.28" "$1,195.44" "$5,736.28" N/A N/A 25-008-80-09 SUP HCPCS C1713 25-008-80-09 - PLATE BONE 3D MESH 80X80X.6MM TITANIUM MANDIB 1.5MM SCREW BOTH IP/OP "$3,664.50" "$2,712.00" $727.24 "$3,664.13" "$1,648.86" "$1,648.86" "$1,648.86" "$1,648.86" "$3,664.13" "$3,664.13" "$3,664.13" $763.70 "$3,664.13" "$3,664.13" "$3,664.13" "$3,664.13" "$3,664.13" $763.64 "$3,664.13" "$3,664.13" "$1,806.42" "$3,664.13" "$3,664.13" "$3,664.13" "$3,664.13" "$2,748.38" "$3,664.13" "$3,664.13" "$3,664.13" "$1,832.07" "$1,832.07" "$2,901.99" "$3,664.13" "$2,931.30" "$1,648.86" $727.24 N/A "$2,125.41" "$3,664.13" "$2,198.48" "$3,664.13" $763.60 "$3,664.13" N/A N/A 25014-1 SUP Custom 27803010 25014-1 - SHUNT NEUROSURGICAL SMALL 90CM PERFORMANCE LEVEL 1 CSF BOTH IP/OP "$4,724.00" "$3,496.00" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $984.51 "$4,723.88" "$1,889.55" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$3,543.00" "$4,723.88" "$4,723.88" "$4,723.88" "$2,361.94" "$2,361.94" "$3,741.31" "$4,723.88" "$3,779.10" "$2,125.75" "$4,723.88" N/A "$2,739.92" "$4,723.88" "$2,834.33" "$4,723.88" "$4,723.88" "$4,723.88" N/A N/A 25014-2 SUP Custom 27803010 25014-2 - SHUNT NEUROSURGICAL SMALL 90CM PERFORMANCE LEVEL 2 CSF BOTH IP/OP "$4,724.00" "$3,496.00" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $984.51 "$4,723.88" "$1,889.55" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$3,543.00" "$4,723.88" "$4,723.88" "$4,723.88" "$2,361.94" "$2,361.94" "$3,741.31" "$4,723.88" "$3,779.10" "$2,125.75" "$4,723.88" N/A "$2,739.92" "$4,723.88" "$2,834.33" "$4,723.88" "$4,723.88" "$4,723.88" N/A N/A 25014-5 SUP Custom 27803010 25014-5 - SHUNT NEUROSURGICAL SMALL 90CM PERFORMANCE LEVEL 1.5 CSF BOTH IP/OP "$4,724.00" "$3,496.00" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $840.85 "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" $984.51 "$4,723.88" "$1,889.55" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$4,723.88" "$3,543.00" "$4,723.88" "$4,723.88" "$4,723.88" "$2,361.94" "$2,361.94" "$3,741.31" "$4,723.88" "$3,779.10" "$2,125.75" "$4,723.88" N/A "$2,739.92" "$4,723.88" "$2,834.33" "$4,723.88" "$4,723.88" "$4,723.88" N/A N/A 25-015-04-09 SUP HCPCS C1713 25-015-04-09 - PLATE BONE MICRO SQUARE .6MM 2X2 HOLE TITANIUM FRONTAL MAXL BOTH IP/OP $377.50 $279.00 $74.86 $377.18 $169.73 $169.73 $169.73 $169.73 $377.18 $377.18 $377.18 $78.61 $377.18 $377.18 $377.18 $377.18 $377.18 $78.61 $377.18 $377.18 $223.10 $377.18 $377.18 $377.18 $377.18 $283.13 $377.18 $377.18 $377.18 $188.59 $188.59 $298.73 $377.18 $301.74 $169.73 $74.86 N/A $218.95 $377.18 $226.31 $377.18 $78.60 $377.18 N/A N/A 25-015-06-09 SUP HCPCS C1713 25-015-06-09 - PLATE BONE MICRO SQUARE .6MM 3X2 HOLE TITANIUM MAXFACL 1.5MM BOTH IP/OP $453.00 $335.00 $89.83 $452.60 $203.67 $203.67 $203.67 $203.67 $452.60 $452.60 $452.60 $94.33 $452.60 $452.60 $452.60 $452.60 $452.60 $94.33 $452.60 $181.04 $267.71 $452.60 $452.60 $452.60 $452.60 $339.75 $452.60 $452.60 $452.60 $226.30 $226.30 $358.46 $452.60 $362.08 $203.67 $89.83 N/A $262.74 $452.60 $271.56 $452.60 $94.32 $452.60 N/A N/A 250-208 SUP HCPCS C1892 SHEATH ACCES 36CM 13/15FR NVGTR URET DUAL TPR TIP HYDPHI BOTH IP/OP $286.00 $212.00 $56.76 $286.00 $155.30 $155.30 $155.30 $155.30 $286.00 $286.00 $286.00 $59.61 $286.00 $212.27 $212.27 $220.45 $149.01 $59.61 $286.00 $286.00 $169.17 $286.00 $286.00 $286.00 $286.00 $214.50 $286.00 $286.00 $286.00 $143.00 $143.00 $226.51 $286.00 $228.80 $185.90 $56.76 N/A $165.88 $286.00 $286.00 $286.00 $59.60 $286.00 N/A N/A 25-022-28-09 SUP HCPCS C1713 25-022-28-09 - PLATE BONE 2MMX1MM 2 STRIP MESH BLUE TITANIUM MAXFACL 2MM BOTH IP/OP $609.00 $451.00 $120.80 $608.65 $273.89 $273.89 $273.89 $273.89 $608.65 $608.65 $608.65 $126.86 $608.65 $608.65 $608.65 $608.65 $608.65 $126.85 $608.65 $608.65 $360.02 $608.65 $608.65 $608.65 $608.65 $456.75 $608.65 $608.65 $608.65 $304.33 $304.33 $482.05 $608.65 $486.92 $273.89 $120.80 N/A $353.22 $608.65 $608.65 $608.65 $126.84 $608.65 N/A N/A 25-040-25-09 SUP HCPCS C1713 25-040-25-09 - MESH CRNL 85X54X.2MM SCRN PNL TI 1MM SCR BOTH IP/OP "$1,192.00" $882.00 $236.54 "$1,191.80" $536.31 $536.31 $536.31 $536.31 "$1,191.80" "$1,191.80" "$1,191.80" $248.40 "$1,191.80" "$1,191.80" "$1,191.80" "$1,191.80" "$1,191.80" $248.38 "$1,191.80" $476.72 $704.95 "$1,191.80" "$1,191.80" "$1,191.80" "$1,191.80" $894.00 "$1,191.80" "$1,191.80" "$1,191.80" $595.90 $595.90 $943.91 "$1,191.80" $953.44 $536.31 $236.54 N/A $691.36 "$1,191.80" $715.08 "$1,191.80" $248.37 "$1,191.80" N/A N/A 25-043-01-09 SUP HCPCS C1713 25-043-01-09 - MESH CRNL .3MM TI ORBT FLR 1.5MM SCR BOTH IP/OP "$1,010.50" $748.00 $200.48 "$1,010.08" $454.54 $454.54 $454.54 $454.54 "$1,010.08" "$1,010.08" "$1,010.08" $210.53 "$1,010.08" "$1,010.08" "$1,010.08" "$1,010.08" "$1,010.08" $210.51 "$1,010.08" "$1,010.08" $597.46 "$1,010.08" "$1,010.08" "$1,010.08" "$1,010.08" $757.88 "$1,010.08" "$1,010.08" "$1,010.08" $505.04 $505.04 $799.98 "$1,010.08" $808.06 $454.54 $200.48 N/A $586.09 "$1,010.08" $606.05 "$1,010.08" $210.50 "$1,010.08" N/A N/A 25-043-02-09 SUP HCPCS C1713 25-043-02-09 - MESH CRNL .5MM AU TI ORBT FLR 1.5MM SCR BOTH IP/OP "$1,010.50" $748.00 $200.48 "$1,010.08" $454.54 $454.54 $454.54 $454.54 "$1,010.08" "$1,010.08" "$1,010.08" $210.53 "$1,010.08" "$1,010.08" "$1,010.08" "$1,010.08" "$1,010.08" $210.51 "$1,010.08" $404.03 $597.46 "$1,010.08" "$1,010.08" "$1,010.08" "$1,010.08" $757.88 "$1,010.08" "$1,010.08" "$1,010.08" $505.04 $505.04 $799.98 "$1,010.08" $808.06 $454.54 $200.48 N/A $586.09 "$1,010.08" $606.05 "$1,010.08" $210.50 "$1,010.08" N/A N/A 25-044-02-09 SUP HCPCS C1713 25-044-02-09 - PLATE BN 3D PSHP .4MM TI LT ORBT FLR BOTH IP/OP "$2,758.50" "$2,041.00" $547.45 "$2,758.28" "$1,241.23" "$1,241.23" "$1,241.23" "$1,241.23" "$2,758.28" "$2,758.28" "$2,758.28" $574.89 "$2,758.28" "$2,758.28" "$2,758.28" "$2,758.28" "$2,758.28" $574.86 "$2,758.28" "$2,758.28" "$1,359.83" "$2,758.28" "$2,758.28" "$2,758.28" "$2,758.28" "$2,068.88" "$2,758.28" "$2,758.28" "$2,758.28" "$1,379.14" "$1,379.14" "$2,184.56" "$2,758.28" "$2,206.62" "$1,241.23" $547.45 N/A "$1,599.93" "$2,758.28" "$2,758.28" "$2,758.28" $574.83 "$2,758.28" N/A N/A 25-045-40-09 SUP HCPCS C1713 25-045-40-09 - PLATE BN NS LF LVL 1 CRNMXF ORBT FLR BOTH IP/OP "$3,512.50" "$2,599.00" $697.10 "$3,512.30" "$1,580.54" "$1,580.54" "$1,580.54" "$1,580.54" "$3,512.30" "$3,512.30" "$3,512.30" $732.05 "$3,512.30" "$3,512.30" "$3,512.30" "$3,512.30" "$3,512.30" $732.00 "$3,512.30" "$1,404.92" "$1,731.56" "$3,512.30" "$3,512.30" "$3,512.30" "$3,512.30" "$2,634.38" "$3,512.30" "$3,512.30" "$3,512.30" "$1,756.15" "$1,756.15" "$2,781.74" "$3,512.30" "$2,809.84" "$1,580.54" $697.10 N/A "$2,037.25" "$3,512.30" "$3,512.30" "$3,512.30" $731.96 "$3,512.30" N/A N/A 25-092-38-91 SUP HCPCS C1713 25-092-38-91 - DRILL FREE MAXDRIVE MMF SCREW 2.0MM x 12MM 8MM THD LNGTH BOTH IP/OP $265.00 $196.00 $52.51 $264.55 $119.05 $119.05 $119.05 $119.05 $264.55 $264.55 $264.55 $55.14 $264.55 $264.55 $264.55 $264.55 $264.55 $55.14 $264.55 $105.82 $156.48 $264.55 $264.55 $264.55 $264.55 $198.75 $264.55 $264.55 $264.55 $132.28 $132.28 $209.52 $264.55 $211.64 $119.05 $52.51 N/A $153.70 $264.55 $264.55 $264.55 $55.13 $264.55 N/A N/A 25-092-42-91 SUP HCPCS C1713 25-092-42-91 - DRILL FREE MAXDRIVE MMF SCREW 2.0MM x 16MM 12MM THD LNGTH BOTH IP/OP $265.00 $196.00 $52.51 $264.55 $119.05 $119.05 $119.05 $119.05 $264.55 $264.55 $264.55 $55.14 $264.55 $264.55 $264.55 $264.55 $264.55 $55.14 $264.55 $105.82 $156.48 $264.55 $264.55 $264.55 $264.55 $198.75 $264.55 $264.55 $264.55 $132.28 $132.28 $209.52 $264.55 $211.64 $119.05 $52.51 N/A $153.70 $264.55 $264.55 $264.55 $55.13 $264.55 N/A N/A 251.25S SUP HCPCS C1713 251.25S - NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER TUBULAR 11MM BOTH IP/OP "$2,131.50" "$1,577.00" $423.00 "$2,131.25" $959.06 $959.06 $959.06 $959.06 "$2,131.25" "$2,131.25" "$2,131.25" $444.21 "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" $444.18 "$2,131.25" $852.50 "$1,260.63" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$1,598.63" "$2,131.25" "$2,131.25" "$2,131.25" "$1,065.63" "$1,065.63" "$1,687.95" "$2,131.25" "$1,705.00" $959.06 $423.00 N/A "$1,236.27" "$2,131.25" "$1,278.75" "$2,131.25" $444.15 "$2,131.25" N/A N/A 251.28S SUP HCPCS C1713 251.28S - NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER 11MM 285MMX1.2MM 1 BOTH IP/OP "$2,131.50" "$1,577.00" $423.00 "$2,131.25" $959.06 $959.06 $959.06 $959.06 "$2,131.25" "$2,131.25" "$2,131.25" $444.21 "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" $444.18 "$2,131.25" $852.50 "$1,260.63" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$1,598.63" "$2,131.25" "$2,131.25" "$2,131.25" "$1,065.63" "$1,065.63" "$1,687.95" "$2,131.25" "$1,705.00" $959.06 $423.00 N/A "$1,236.27" "$2,131.25" "$1,278.75" "$2,131.25" $444.15 "$2,131.25" N/A N/A 251.30S SUP HCPCS C1713 251.30S - NAIL INTRAMEDULLARY 11D UNIVERSAL TUBULAR BARREL 11MM BOTH IP/OP "$2,131.50" "$1,577.00" $423.00 "$2,131.25" $959.06 $959.06 $959.06 $959.06 "$2,131.25" "$2,131.25" "$2,131.25" $444.21 "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" $444.18 "$2,131.25" $852.50 "$1,260.63" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$1,598.63" "$2,131.25" "$2,131.25" "$2,131.25" "$1,065.63" "$1,065.63" "$1,687.95" "$2,131.25" "$1,705.00" $959.06 $423.00 N/A "$1,236.27" "$2,131.25" "$1,278.75" "$2,131.25" $444.15 "$2,131.25" N/A N/A 251.31S SUP HCPCS C1713 251.31S - NAIL INTRAMEDULLARY 11D UNIVERSAL TUBULAR BARREL 11MM BOTH IP/OP "$2,534.00" "$1,875.00" $502.93 "$2,533.98" "$1,140.29" "$1,140.29" "$1,140.29" "$1,140.29" "$2,533.98" "$2,533.98" "$2,533.98" $528.14 "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" $528.11 "$2,533.98" "$1,013.59" "$1,249.25" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$1,900.50" "$2,533.98" "$2,533.98" "$2,533.98" "$1,266.99" "$1,266.99" "$2,006.91" "$2,533.98" "$2,027.18" "$1,140.29" $502.93 N/A "$1,469.72" "$2,533.98" "$1,520.39" "$2,533.98" $528.08 "$2,533.98" N/A N/A 251.33S SUP HCPCS C1713 251.33S - NAIL INTRAMEDULLARY 11D UNIVERSAL TUBULAR BARREL 11MM BOTH IP/OP "$2,534.00" "$1,875.00" $502.93 "$2,533.98" "$1,140.29" "$1,140.29" "$1,140.29" "$1,140.29" "$2,533.98" "$2,533.98" "$2,533.98" $528.14 "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" $528.11 "$2,533.98" "$1,013.59" "$1,249.25" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$1,900.50" "$2,533.98" "$2,533.98" "$2,533.98" "$1,266.99" "$1,266.99" "$2,006.91" "$2,533.98" "$2,027.18" "$1,140.29" $502.93 N/A "$1,469.72" "$2,533.98" "$1,520.39" "$2,533.98" $528.08 "$2,533.98" N/A N/A 251.34S SUP HCPCS C1713 251.34S - NAIL INTRAMEDULLARY 11D UNIVERSAL TUBULAR BARREL 11MM BOTH IP/OP "$2,534.00" "$1,875.00" $502.93 "$2,533.98" "$1,140.29" "$1,140.29" "$1,140.29" "$1,140.29" "$2,533.98" "$2,533.98" "$2,533.98" $528.14 "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" $528.11 "$2,533.98" "$1,013.59" "$1,249.25" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$1,900.50" "$2,533.98" "$2,533.98" "$2,533.98" "$1,266.99" "$1,266.99" "$2,006.91" "$2,533.98" "$2,027.18" "$1,140.29" $502.93 N/A "$1,469.72" "$2,533.98" "$1,520.39" "$2,533.98" $528.08 "$2,533.98" N/A N/A 251.36S SUP HCPCS C1713 251.36S - NAIL INTRAMEDULLARY 11D UNIVERSAL TUBULAR BARREL 11MM BOTH IP/OP "$2,534.00" "$1,875.00" $502.93 "$2,533.98" "$1,140.29" "$1,140.29" "$1,140.29" "$1,140.29" "$2,533.98" "$2,533.98" "$2,533.98" $528.14 "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" $528.11 "$2,533.98" "$1,013.59" "$1,249.25" "$2,533.98" "$2,533.98" "$2,533.98" "$2,533.98" "$1,900.50" "$2,533.98" "$2,533.98" "$2,533.98" "$1,266.99" "$1,266.99" "$2,006.91" "$2,533.98" "$2,027.18" "$1,140.29" $502.93 N/A "$1,469.72" "$2,533.98" "$2,533.98" "$2,533.98" $528.08 "$2,533.98" N/A N/A 251.38S SUP HCPCS C1713 251.38S - NAIL INTRAMEDULLARY 11D UNIVERSAL TUBULAR BARREL 11MM BOTH IP/OP "$2,131.50" "$1,577.00" $423.00 "$2,131.25" $959.06 $959.06 $959.06 $959.06 "$2,131.25" "$2,131.25" "$2,131.25" $444.21 "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" $444.18 "$2,131.25" $852.50 "$1,260.63" "$2,131.25" "$2,131.25" "$2,131.25" "$2,131.25" "$1,598.63" "$2,131.25" "$2,131.25" "$2,131.25" "$1,065.63" "$1,065.63" "$1,687.95" "$2,131.25" "$1,705.00" $959.06 $423.00 N/A "$1,236.27" "$2,131.25" "$1,278.75" "$2,131.25" $444.15 "$2,131.25" N/A N/A 251.40S SUP HCPCS C1713 251.40S - NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER 11MM 400MMX1.2MM 1 BOTH IP/OP "$2,135.50" "$1,580.00" $423.82 "$2,135.38" $960.92 $960.92 $960.92 $960.92 "$2,135.38" "$2,135.38" "$2,135.38" $445.07 "$2,135.38" "$2,135.38" "$2,135.38" "$2,135.38" "$2,135.38" $445.04 "$2,135.38" $854.15 "$1,263.08" "$2,135.38" "$2,135.38" "$2,135.38" "$2,135.38" "$1,601.63" "$2,135.38" "$2,135.38" "$2,135.38" "$1,067.69" "$1,067.69" "$1,691.22" "$2,135.38" "$1,708.30" $960.92 $423.82 N/A "$1,238.59" "$2,135.38" "$1,281.23" "$2,135.38" $445.01 "$2,135.38" N/A N/A 251.42S SUP HCPCS C1713 251.42S - NAIL INTRAMEDULLARY 11D UNIVERSAL TAPER 11MM 420MMX1.2MM 1 BOTH IP/OP "$2,135.50" "$1,580.00" $423.82 "$2,135.38" $960.92 $960.92 $960.92 $960.92 "$2,135.38" "$2,135.38" "$2,135.38" $445.07 "$2,135.38" "$2,135.38" "$2,135.38" "$2,135.38" "$2,135.38" $445.04 "$2,135.38" $854.15 "$1,263.08" "$2,135.38" "$2,135.38" "$2,135.38" "$2,135.38" "$1,601.63" "$2,135.38" "$2,135.38" "$2,135.38" "$1,067.69" "$1,067.69" "$1,691.22" "$2,135.38" "$1,708.30" $960.92 $423.82 N/A "$1,238.59" "$2,135.38" "$1,281.23" "$2,135.38" $445.01 "$2,135.38" N/A N/A 25100C+10.00 SUP HCPCS V2632 25100C+10.00 - LENS IOL +10 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+10.50 SUP HCPCS V2632 25100C+10.50 - LENS IOL +10.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+11.00 SUP HCPCS V2632 25100C+11.00 - LENS IOL +11 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+11.50 SUP HCPCS V2632 25100C+11.50 - LENS IOL +11.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+12.00 SUP HCPCS V2632 25100C+12.00 - LENS IOL +12 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+12.50 SUP HCPCS V2632 25100C+12.50 - LENS IOL +12.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+13.00 SUP HCPCS V2632 25100C+13.00 - LENS IOL +13 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+13.50 SUP HCPCS V2632 25100C+13.50 - LENS IOL +13.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+14.00 SUP HCPCS V2632 25100C+14.00 - LENS IOL +14 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+14.50 SUP HCPCS V2632 25100C+14.50 - LENS IOL +14.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+15.00 SUP HCPCS V2632 25100C+15.00 - LENS IOL +15 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+15.50 SUP HCPCS V2632 25100C+15.50 - LENS IOL +15.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+16.00 SUP HCPCS V2632 25100C+16.00 - LENS IOL +16 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+16.50 SUP HCPCS V2632 25100C+16.50 - LENS IOL +16.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+17.00 SUP HCPCS V2632 25100C+17.00 - LENS IOL +17 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+17.50 SUP HCPCS V2632 25100C+17.50 - LENS IOL +17.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+18.00 SUP HCPCS V2632 25100C+18.00 - LENS IOL +18 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+18.50 SUP HCPCS V2632 25100C+18.50 - LENS IOL +18.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+19.00 SUP HCPCS V2632 25100C+19.00 - LENS IOL +19 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+19.50 SUP HCPCS V2632 25100C+19.50 - LENS IOL +19.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+20.00 SUP HCPCS V2632 25100C+20.00 - LENS IOL +20 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+20.50 SUP HCPCS V2632 25100C+20.50 - LENS IOL +20.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+21.00 SUP HCPCS V2632 25100C+21.00 - LENS IOL +21 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $130.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+21.50 SUP HCPCS V2632 25100C+21.50 - LENS IOL +21.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $130.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+22.00 SUP HCPCS V2632 25100C+22.00 - LENS IOL +22 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+22.50 SUP HCPCS V2632 25100C+22.50 - LENS IOL +22.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $130.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+23.00 SUP HCPCS V2632 25100C+23.00 - LENS IOL +23 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+23.50 SUP HCPCS V2632 25100C+23.50 - LENS IOL +23.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+24.00 SUP HCPCS V2632 25100C+24.00 - LENS IOL +24 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+24.50 SUP HCPCS V2632 25100C+24.50 - LENS IOL +24.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+25.00 SUP HCPCS V2632 25100C+25.00 - LENS IOL +25 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+25.50 SUP HCPCS V2632 25100C+25.50 - LENS IOL +25.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+26.00 SUP HCPCS V2632 25100C+26.00 - LENS IOL +26 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+26.50 SUP HCPCS V2632 25100C+26.50 - LENS IOL +26.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+27.00 SUP HCPCS V2632 25100C+27.00 - LENS IOL +27 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+27.50 SUP HCPCS V2632 25100C+27.50 - LENS IOL +27.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+28.00 SUP HCPCS V2632 25100C+28.00 - LENS IOL +28 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+28.50 SUP HCPCS V2632 25100C+28.50 - LENS IOL +28.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+29.00 SUP HCPCS V2632 25100C+29.00 - LENS IOL +29 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+29.50 SUP HCPCS V2632 25100C+29.50 - LENS IOL +29.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+30.00 SUP HCPCS V2632 25100C+30.00 - LENS IOL +30 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+6.00 SUP HCPCS V2632 25100C+6.00 - LENS IOL +6 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+6.50 SUP HCPCS V2632 25100C+6.50 - LENS IOL +6.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+7.00 SUP HCPCS V2632 25100C+7.00 - LENS IOL +7 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+7.50 SUP HCPCS V2632 25100C+7.50 - LENS IOL +7.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+8.50 SUP HCPCS V2632 25100C+8.50 - LENS IOL +8.5 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+9.00 SUP HCPCS V2632 25100C+9.00 - LENS IOL +9 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C+9.50 SUP HCPCS V2632 25100C+9.50 - LENS IOL +9.5 DIOP MOD C 6MM 12.5MM YLW ASPH BAL CRV ISERT BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25100C-8.00 SUP HCPCS V2632 25100C-8.00 - LENS IOL +8 DIOP MOD C 6MM 12.5MM YLW HOYA ISERT ASPH BAL BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $146.25 $146.25 $146.25 $146.25 $325.00 $325.00 $325.00 $67.74 $325.00 $325.00 $325.00 $325.00 $325.00 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $146.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A 25121-1 SUP Custom 27203010 25121-1 - VALVE SHUNT SMALL 120CM PERFORMANCE LEVEL 1 PERITONEAL BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$3,528.98" "$3,528.98" "$3,664.96" "$2,060.15" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$3,090.59" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 25121-2 SUP Custom 27803010 25121-2 - VALVE SHUNT SMALL 120CM PERFORMANCE LEVEL 2 PERITONEAL BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$2,139.64" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 25121-5 SUP Custom 27203010 25121-5 - VALVE SHUNT SMALL 120CM PERFORMANCE LEVEL 1.5 PERITONEAL BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$3,528.98" "$3,528.98" "$3,664.96" "$2,060.15" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$3,090.59" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 25-197-07-71 SUP HCPCS C1713 25-197-07-71 - PLATE BN STRL LVL 1 HBRD CRNMXF BOTH IP/OP $828.00 $613.00 $164.34 $828.00 $372.60 $372.60 $372.60 $372.60 $828.00 $828.00 $828.00 $172.58 $828.00 $828.00 $828.00 $828.00 $828.00 $172.56 $828.00 $828.00 $489.76 $828.00 $828.00 $828.00 $828.00 $621.00 $828.00 $828.00 $828.00 $414.00 $414.00 $655.78 $828.00 $662.40 $372.60 $164.34 N/A $480.24 $828.00 $828.00 $828.00 $172.56 $828.00 N/A N/A 25-198-06-71 SUP HCPCS C1713 25-198-06-71 - SCREW BN STRL LVL 1 MAXDRIVE CRNMXF BOTH IP/OP $358.00 $265.00 $71.05 $358.00 $161.10 $161.10 $161.10 $161.10 $358.00 $358.00 $358.00 $74.62 $358.00 $358.00 $358.00 $358.00 $358.00 $74.61 $358.00 $358.00 $211.76 $358.00 $358.00 $358.00 $358.00 $268.50 $358.00 $358.00 $358.00 $179.00 $179.00 $283.54 $358.00 $286.40 $161.10 $71.05 N/A $207.64 $358.00 $358.00 $358.00 $74.61 $358.00 N/A N/A 25-198-06-75 SUP HCPCS C1713 25-198-06-75 - SCREW BN STRL LVL 1 MAXDRIVE CRNMXF BOTH IP/OP "$1,790.00" "$1,325.00" $355.27 "$1,790.00" $805.50 $805.50 $805.50 $805.50 "$1,790.00" "$1,790.00" "$1,790.00" $373.08 "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" $373.06 "$1,790.00" "$1,790.00" "$1,058.79" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,342.50" "$1,790.00" "$1,790.00" "$1,790.00" $895.00 $895.00 "$1,417.68" "$1,790.00" "$1,432.00" $805.50 $355.27 N/A "$1,038.20" "$1,790.00" "$1,790.00" "$1,790.00" $373.04 "$1,790.00" N/A N/A 253.27S SUP HCPCS C1713 253.27S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 270MM STAINLESS STEEL BOTH IP/OP "$2,135.50" "$1,580.00" $423.82 "$2,135.38" $960.92 $960.92 $960.92 $960.92 "$2,135.38" "$2,135.38" "$2,135.38" $445.07 "$2,135.38" "$2,135.38" "$2,135.38" "$2,135.38" "$2,135.38" $445.04 "$2,135.38" $854.15 "$1,263.08" "$2,135.38" "$2,135.38" "$2,135.38" "$2,135.38" "$1,601.63" "$2,135.38" "$2,135.38" "$2,135.38" "$1,067.69" "$1,067.69" "$1,691.22" "$2,135.38" "$1,708.30" $960.92 $423.82 N/A "$1,238.59" "$2,135.38" "$1,281.23" "$2,135.38" $445.01 "$2,135.38" N/A N/A 25-302-70-91 SUP HCPCS C1713 25-302-70-91 - PLATE BONE MICRO STR MEDIUM .6MM 2 HOLE TITANIUM FRONTAL BOTH IP/OP $113.50 $84.00 $22.46 $113.18 $50.93 $50.93 $50.93 $50.93 $113.18 $113.18 $113.18 $23.59 $113.18 $113.18 $113.18 $113.18 $113.18 $23.59 $113.18 $45.27 $66.95 $113.18 $113.18 $113.18 $113.18 $85.13 $113.18 $113.18 $113.18 $56.59 $56.59 $89.64 $113.18 $90.54 $50.93 $22.46 N/A $65.83 $113.18 $67.91 $113.18 $23.59 $113.18 N/A N/A 25-304-00-91 SUP HCPCS C1713 25-304-00-91 - PLATE BONE MICRO REGULAR STR .6MM 4 HOLE TITANIUM MAXFACL BOTH IP/OP $171.00 $127.00 $33.94 $171.00 $76.95 $76.95 $76.95 $76.95 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $101.15 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $76.95 $33.94 N/A $99.18 $171.00 $171.00 $171.00 $35.64 $171.00 N/A N/A 25-304-55-91 SUP HCPCS C1713 25-304-55-91 - PLATE BONE MICRO MEDIUM STR .6MM 4 HOLE TITANIUM MAXFACL 1.5 BOTH IP/OP $176.50 $131.00 $34.96 $176.13 $79.26 $79.26 $79.26 $79.26 $176.13 $176.13 $176.13 $36.71 $176.13 $176.13 $176.13 $176.13 $176.13 $36.71 $176.13 $176.13 $104.18 $176.13 $176.13 $176.13 $176.13 $132.38 $176.13 $176.13 $176.13 $88.07 $88.07 $139.49 $176.13 $140.90 $79.26 $34.96 N/A $102.37 $176.13 $105.68 $176.13 $36.71 $176.13 N/A N/A 25-306-00-91 SUP HCPCS C1713 25-306-00-91 - PLATE BN MIC STRG .6MM THREADLOCK TS 6 HL TI MXLFCL 1.5MM BOTH IP/OP $230.50 $171.00 $45.75 $230.50 $103.73 $103.73 $103.73 $103.73 $230.50 $230.50 $230.50 $48.04 $230.50 $230.50 $230.50 $230.50 $230.50 $48.04 $230.50 $230.50 $136.34 $230.50 $230.50 $230.50 $230.50 $172.88 $230.50 $230.50 $230.50 $115.25 $115.25 $182.56 $230.50 $184.40 $103.73 $45.75 N/A $133.69 $230.50 $230.50 $230.50 $48.04 $230.50 N/A N/A 25-306-55-91 SUP HCPCS C1713 25-306-55-91 - PLATE BONE MICRO STR MEDIUM .6MM 6 HOLE TITANIUM MIDFAC 1.5 BOTH IP/OP $230.50 $171.00 $45.75 $230.50 $103.73 $103.73 $103.73 $103.73 $230.50 $230.50 $230.50 $48.04 $230.50 $230.50 $230.50 $230.50 $230.50 $48.04 $230.50 $230.50 $136.34 $230.50 $230.50 $230.50 $230.50 $172.88 $230.50 $230.50 $230.50 $115.25 $115.25 $182.56 $230.50 $184.40 $103.73 $45.75 N/A $133.69 $230.50 $138.30 $230.50 $48.04 $230.50 N/A N/A 25-308-00-91 SUP HCPCS C1713 25-308-00-91 - PLATE BONE MICRO STR REGULAR .6MM 8 HOLE TITANIUM RIGHT BOTH IP/OP $254.00 $188.00 $50.37 $253.80 $114.21 $114.21 $114.21 $114.21 $253.80 $253.80 $253.80 $52.90 $253.80 $253.80 $253.80 $253.80 $253.80 $52.89 $253.80 $253.80 $150.12 $253.80 $253.80 $253.80 $253.80 $190.50 $253.80 $253.80 $253.80 $126.90 $126.90 $201.01 $253.80 $203.04 $114.21 $50.37 N/A $147.32 $253.80 $152.28 $253.80 $52.89 $253.80 N/A N/A 25-308-16-09 SUP HCPCS C1713 25-308-16-09 - MIDFACE PLATE MEDIUM 6 HOLE DOUBLE Y 0.8MM THICK BOTH IP/OP $660.50 $489.00 $131.07 $660.40 $297.18 $297.18 $297.18 $297.18 $660.40 $660.40 $660.40 $137.64 $660.40 $660.40 $660.40 $660.40 $660.40 $137.63 $660.40 $660.40 $390.63 $660.40 $660.40 $660.40 $660.40 $495.38 $660.40 $660.40 $660.40 $330.20 $330.20 $523.04 $660.40 $528.32 $297.18 $131.07 N/A $383.09 $660.40 $660.40 $660.40 $137.63 $660.40 N/A N/A 25-310-09-09 SUP HCPCS C1713 25-310-09-09 - PLATE LARGE L-SHAPE W/ TAB 10 HOLE 5x4 1MM BOTH IP/OP $609.00 $451.00 $120.80 $608.65 $273.89 $273.89 $273.89 $273.89 $608.65 $608.65 $608.65 $126.86 $608.65 $608.65 $608.65 $608.65 $608.65 $126.85 $608.65 $243.46 $360.02 $608.65 $608.65 $608.65 $608.65 $456.75 $608.65 $608.65 $608.65 $304.33 $304.33 $482.05 $608.65 $486.92 $273.89 $120.80 N/A $353.22 $608.65 $365.19 $608.65 $126.84 $608.65 N/A N/A 25-310-70-91 SUP HCPCS C1713 25-310-70-91 - PLATE BONE L MICRO .6MM TITANIUM MIDFAC 1.5MM SCREW BOTH IP/OP $388.50 $287.00 $77.11 $388.50 $174.83 $174.83 $174.83 $174.83 $388.50 $388.50 $388.50 $80.97 $388.50 $388.50 $388.50 $388.50 $388.50 $80.97 $388.50 $155.40 $229.80 $388.50 $388.50 $388.50 $388.50 $291.38 $388.50 $388.50 $388.50 $194.25 $194.25 $307.69 $388.50 $310.80 $174.83 $77.11 N/A $225.33 $388.50 $233.10 $388.50 $80.96 $388.50 N/A N/A 25-311-70-91 SUP HCPCS C1713 25-311-70-91 - PLATE BONE L MICRO MEDIUM .6MM TITANIUM RIGHT MIDFAC STERILE BOTH IP/OP $388.50 $287.00 $77.11 $388.50 $174.83 $174.83 $174.83 $174.83 $388.50 $388.50 $388.50 $80.97 $388.50 $388.50 $388.50 $388.50 $388.50 $80.97 $388.50 $155.40 $229.80 $388.50 $388.50 $388.50 $388.50 $291.38 $388.50 $388.50 $388.50 $194.25 $194.25 $307.69 $388.50 $310.80 $174.83 $77.11 N/A $225.33 $388.50 $233.10 $388.50 $80.96 $388.50 N/A N/A 25-311-85-91 SUP HCPCS C1713 25-311-85-91 - PLATE BONE L MICRO LONG .6MM TITANIUM RIGHT MIDFAC STERILE BOTH IP/OP $388.50 $287.00 $77.11 $388.50 $174.83 $174.83 $174.83 $174.83 $388.50 $388.50 $388.50 $80.97 $388.50 $388.50 $388.50 $388.50 $388.50 $80.97 $388.50 $155.40 $229.80 $388.50 $388.50 $388.50 $388.50 $291.38 $388.50 $388.50 $388.50 $194.25 $194.25 $307.69 $388.50 $310.80 $174.83 $77.11 N/A $225.33 $388.50 $233.10 $388.50 $80.96 $388.50 N/A N/A 25-314-85-91 SUP HCPCS C1713 25-314-85-91 - PLATE BN 100D LNG MIC L .6MM THREADLOCK TS 3X2 HL TI MXLFCL BOTH IP/OP $388.50 $287.00 $77.11 $388.50 $174.83 $174.83 $174.83 $174.83 $388.50 $388.50 $388.50 $80.97 $388.50 $388.50 $388.50 $388.50 $388.50 $80.97 $388.50 $155.40 $229.80 $388.50 $388.50 $388.50 $388.50 $291.38 $388.50 $388.50 $388.50 $194.25 $194.25 $307.69 $388.50 $310.80 $174.83 $77.11 N/A $225.33 $388.50 $233.10 $388.50 $80.96 $388.50 N/A N/A 25-315-06-91 SUP HCPCS C1713 25-315-06-91 - PLATE BONE T MICRO REGULAR .6MM TITANIUM MIDFAC STERILE 1.5 BOTH IP/OP $388.50 $287.00 $77.11 $388.50 $174.83 $174.83 $174.83 $174.83 $388.50 $388.50 $388.50 $80.97 $388.50 $388.50 $388.50 $388.50 $388.50 $80.97 $388.50 $155.40 $229.80 $388.50 $388.50 $388.50 $388.50 $291.38 $388.50 $388.50 $388.50 $194.25 $194.25 $307.69 $388.50 $310.80 $174.83 $77.11 N/A $225.33 $388.50 $388.50 $388.50 $80.96 $388.50 N/A N/A 25-315-85-91 SUP HCPCS C1713 25-315-85-91 - PLATE BONE 100D L MICRO .6MM TITANIUM RIGHT MIDFAC STERILE BOTH IP/OP $388.50 $287.00 $77.11 $388.50 $174.83 $174.83 $174.83 $174.83 $388.50 $388.50 $388.50 $80.97 $388.50 $388.50 $388.50 $388.50 $388.50 $80.97 $388.50 $155.40 $229.80 $388.50 $388.50 $388.50 $388.50 $291.38 $388.50 $388.50 $388.50 $194.25 $194.25 $307.69 $388.50 $310.80 $174.83 $77.11 N/A $225.33 $388.50 $233.10 $388.50 $80.96 $388.50 N/A N/A 25-316-00-91 SUP HCPCS C1713 25-316-00-91 - PLATE BONE MICRO .6MM 16 HOLE TITANIUM MIDFAC STERILE 1.5MM BOTH IP/OP $415.00 $307.00 $82.34 $414.88 $186.70 $186.70 $186.70 $186.70 $414.88 $414.88 $414.88 $86.47 $414.88 $414.88 $414.88 $414.88 $414.88 $86.47 $414.88 $165.95 $245.40 $414.88 $414.88 $414.88 $414.88 $311.25 $414.88 $414.88 $414.88 $207.44 $207.44 $328.58 $414.88 $331.90 $186.70 $82.34 N/A $240.70 $414.88 $248.93 $414.88 $86.46 $414.88 N/A N/A 25-320-70-91 SUP HCPCS C1713 25-320-70-91 - PLATE BONE Y MICRO LONG .6MM TITANIUM MIDFAC STERILE 1.5MM BOTH IP/OP $390.00 $289.00 $77.35 $389.73 $175.38 $175.38 $175.38 $175.38 $389.73 $389.73 $389.73 $81.23 $389.73 $389.73 $389.73 $389.73 $389.73 $81.22 $389.73 $155.89 $230.53 $389.73 $389.73 $389.73 $389.73 $292.50 $389.73 $389.73 $389.73 $194.87 $194.87 $308.67 $389.73 $311.78 $175.38 $77.35 N/A $226.20 $389.73 $233.84 $389.73 $81.22 $389.73 N/A N/A 25-322-55-91 SUP HCPCS C1713 25-322-55-91 - PLATE BN MIC SHRT 2Y .6MM THREADLOCK TS 6 HL TI MXLFCL 1.5MM BOTH IP/OP $453.50 $336.00 $89.95 $453.23 $203.95 $203.95 $203.95 $203.95 $453.23 $453.23 $453.23 $94.46 $453.23 $453.23 $453.23 $453.23 $453.23 $94.46 $453.23 $453.23 $268.09 $453.23 $453.23 $453.23 $453.23 $340.13 $453.23 $453.23 $453.23 $226.62 $226.62 $358.96 $453.23 $362.58 $203.95 $89.95 N/A $263.03 $453.23 $271.94 $453.23 $94.45 $453.23 N/A N/A 25-322-70-91 SUP HCPCS C1713 25-322-70-91 - PLATE BONE 2Y MICRO MEDIUM .6MM TITANIUM RIGHT FRONTAL MAXL BOTH IP/OP $440.50 $326.00 $87.33 $440.03 $198.01 $198.01 $198.01 $198.01 $440.03 $440.03 $440.03 $91.71 $440.03 $440.03 $440.03 $440.03 $440.03 $91.71 $440.03 $176.01 $260.28 $440.03 $440.03 $440.03 $440.03 $330.38 $440.03 $440.03 $440.03 $220.02 $220.02 $348.50 $440.03 $352.02 $198.01 $87.33 N/A $255.49 $440.03 $264.02 $440.03 $91.70 $440.03 N/A N/A 25-325-10-91 SUP HCPCS C1713 25-325-10-91 - PLATE BN MIC CRV .6MM THREADLOCK TS 10 HL TI MXLFCL 1.5MM BOTH IP/OP $427.50 $316.00 $84.81 $427.33 $192.30 $192.30 $192.30 $192.30 $427.33 $427.33 $427.33 $89.07 $427.33 $427.33 $427.33 $427.33 $427.33 $89.06 $427.33 $427.33 $252.77 $427.33 $427.33 $427.33 $427.33 $320.63 $427.33 $427.33 $427.33 $213.67 $213.67 $338.45 $427.33 $341.86 $192.30 $84.81 N/A $247.95 $427.33 $427.33 $427.33 $89.06 $427.33 N/A N/A 25-326-55-91 SUP HCPCS C1713 25-326-55-91 - PLATE BONE X MICRO REGULAR .6MM TITANIUM MIDFAC STERILE 1.5 BOTH IP/OP $427.50 $316.00 $84.81 $427.33 $192.30 $192.30 $192.30 $192.30 $427.33 $427.33 $427.33 $89.07 $427.33 $427.33 $427.33 $427.33 $427.33 $89.06 $427.33 $427.33 $252.77 $427.33 $427.33 $427.33 $427.33 $320.63 $427.33 $427.33 $427.33 $213.67 $213.67 $338.45 $427.33 $341.86 $192.30 $84.81 N/A $247.95 $427.33 $256.40 $427.33 $89.06 $427.33 N/A N/A 25-329-05-09 SUP HCPCS C1713 25-329-05-09 - PLATE BONE Y MICRO .6MM 6 HOLE TITANIUM MIDFAC 1.5MM SCREW BOTH IP/OP $414.50 $307.00 $82.24 $414.38 $186.47 $186.47 $186.47 $186.47 $414.38 $414.38 $414.38 $86.37 $414.38 $414.38 $414.38 $414.38 $414.38 $86.36 $414.38 $165.75 $245.11 $414.38 $414.38 $414.38 $414.38 $310.88 $414.38 $414.38 $414.38 $207.19 $207.19 $328.19 $414.38 $331.50 $186.47 $82.24 N/A $240.41 $414.38 $248.63 $414.38 $86.36 $414.38 N/A N/A 25-330-05-09 SUP HCPCS C1713 25-330-05-09 - PLATE BONE 100D L MICRO LEFT ANGLE .6MM 7 HOLE TITANIUM BOTH IP/OP $414.50 $307.00 $82.24 $414.38 $186.47 $186.47 $186.47 $186.47 $414.38 $414.38 $414.38 $86.37 $414.38 $414.38 $414.38 $414.38 $414.38 $86.36 $414.38 $165.75 $245.11 $414.38 $414.38 $414.38 $414.38 $310.88 $414.38 $414.38 $414.38 $207.19 $207.19 $328.19 $414.38 $331.50 $186.47 $82.24 N/A $240.41 $414.38 $248.63 $414.38 $86.36 $414.38 N/A N/A 25-330-07-09 SUP HCPCS C1713 25-330-07-09 - PLATE BONE T MICRO .6MM 6 HOLE TITANIUM MIDFAC 1.5MM SCREW BOTH IP/OP $388.50 $287.00 $77.11 $388.50 $174.83 $174.83 $174.83 $174.83 $388.50 $388.50 $388.50 $80.97 $388.50 $388.50 $388.50 $388.50 $388.50 $80.97 $388.50 $155.40 $229.80 $388.50 $388.50 $388.50 $388.50 $291.38 $388.50 $388.50 $388.50 $194.25 $194.25 $307.69 $388.50 $310.80 $174.83 $77.11 N/A $225.33 $388.50 $233.10 $388.50 $80.96 $388.50 N/A N/A 25-330-24-09 SUP HCPCS C1713 25-330-24-09 - PLATE BN MIC STRG .6MM THREADLOCK TS 24 HL TI MXLFCL 1.5MM BOTH IP/OP $583.00 $431.00 $115.66 $582.75 $262.24 $262.24 $262.24 $262.24 $582.75 $582.75 $582.75 $121.46 $582.75 $582.75 $582.75 $582.75 $582.75 $121.45 $582.75 $582.75 $344.70 $582.75 $582.75 $582.75 $582.75 $437.25 $582.75 $582.75 $582.75 $291.38 $291.38 $461.54 $582.75 $466.20 $262.24 $115.66 N/A $338.14 $582.75 $349.65 $582.75 $121.45 $582.75 N/A N/A 25-331-05-09 SUP HCPCS C1713 25-331-05-09 - PLATE BONE 100D L MICRO RIGHT ANG .6MM 7 HOLE TITANIUM BOTH IP/OP $414.50 $307.00 $82.24 $414.38 $186.47 $186.47 $186.47 $186.47 $414.38 $414.38 $414.38 $86.37 $414.38 $414.38 $414.38 $414.38 $414.38 $86.36 $414.38 $165.75 $245.11 $414.38 $414.38 $414.38 $414.38 $310.88 $414.38 $414.38 $414.38 $207.19 $207.19 $328.19 $414.38 $331.50 $186.47 $82.24 N/A $240.41 $414.38 $248.63 $414.38 $86.36 $414.38 N/A N/A 25-331-85-91 SUP HCPCS C1713 25-331-85-91 - PLATE BONE L MICRO .6MM TITANIUM MIDFAC 1.5MM SCREW BOTH IP/OP $414.50 $307.00 $82.24 $414.38 $186.47 $186.47 $186.47 $186.47 $414.38 $414.38 $414.38 $86.37 $414.38 $414.38 $414.38 $414.38 $414.38 $86.36 $414.38 $165.75 $245.11 $414.38 $414.38 $414.38 $414.38 $310.88 $414.38 $414.38 $414.38 $207.19 $207.19 $328.19 $414.38 $331.50 $186.47 $82.24 N/A $240.41 $414.38 $248.63 $414.38 $86.36 $414.38 N/A N/A 25-332-08-09 SUP HCPCS C1713 25-332-08-09 - PLATE BONE MICRO .6MM 8 HOLE INSERT TITANIUM ORBTL FLOOR BOTH IP/OP $401.50 $297.00 $79.67 $401.43 $180.64 $180.64 $180.64 $180.64 $401.43 $401.43 $401.43 $83.67 $401.43 $401.43 $401.43 $401.43 $401.43 $83.66 $401.43 $160.57 $237.45 $401.43 $401.43 $401.43 $401.43 $301.13 $401.43 $401.43 $401.43 $200.72 $200.72 $317.93 $401.43 $321.14 $180.64 $79.67 N/A $232.87 $401.43 $240.86 $401.43 $83.66 $401.43 N/A N/A 25-377-04 SUP HCPCS C1713 25-377-04 - PLATE MED LEFT MAXFACL L BONE .6MM BOTH IP/OP $325.50 $241.00 $64.60 $325.50 $146.48 $146.48 $146.48 $146.48 $325.50 $325.50 $325.50 $67.84 $325.50 $325.50 $325.50 $325.50 $325.50 $67.84 $325.50 $325.50 $192.53 $325.50 $325.50 $325.50 $325.50 $244.13 $325.50 $325.50 $325.50 $162.75 $162.75 $257.80 $325.50 $260.40 $146.48 $64.60 N/A $188.79 $325.50 $195.30 $325.50 $67.83 $325.50 N/A N/A 254.27S SUP HCPCS C1713 254.27S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 270MM STAINLESS STEEL BOTH IP/OP "$2,221.00" "$1,644.00" $440.74 "$2,220.63" $999.28 $999.28 $999.28 $999.28 "$2,220.63" "$2,220.63" "$2,220.63" $462.83 "$2,220.63" "$2,220.63" "$2,220.63" "$2,220.63" "$2,220.63" $462.80 "$2,220.63" $888.25 "$1,313.50" "$2,220.63" "$2,220.63" "$2,220.63" "$2,220.63" "$1,665.75" "$2,220.63" "$2,220.63" "$2,220.63" "$1,110.32" "$1,110.32" "$1,758.74" "$2,220.63" "$1,776.50" $999.28 $440.74 N/A "$1,288.18" "$2,220.63" "$1,332.38" "$2,220.63" $462.78 "$2,220.63" N/A N/A 254.28S SUP HCPCS C1713 254.28S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 285MM STAINLESS STEEL BOTH IP/OP "$2,221.00" "$1,644.00" $440.74 "$2,220.63" $999.28 $999.28 $999.28 $999.28 "$2,220.63" "$2,220.63" "$2,220.63" $462.83 "$2,220.63" "$2,220.63" "$2,220.63" "$2,220.63" "$2,220.63" $462.80 "$2,220.63" $888.25 "$1,313.50" "$2,220.63" "$2,220.63" "$2,220.63" "$2,220.63" "$1,665.75" "$2,220.63" "$2,220.63" "$2,220.63" "$1,110.32" "$1,110.32" "$1,758.74" "$2,220.63" "$1,776.50" $999.28 $440.74 N/A "$1,288.18" "$2,220.63" "$1,332.38" "$2,220.63" $462.78 "$2,220.63" N/A N/A 25-438-35-07 SUP HCPCS C1713 25-438-35-07 - SCREW BYRD MIDFACE LARGE BOTH IP/OP $640.00 $474.00 $127.02 $640.00 $288.00 $288.00 $288.00 $288.00 $640.00 $640.00 $640.00 $133.39 $640.00 $640.00 $640.00 $640.00 $640.00 $133.38 $640.00 $256.00 $378.56 $640.00 $640.00 $640.00 $640.00 $480.00 $640.00 $640.00 $640.00 $320.00 $320.00 $506.88 $640.00 $512.00 $288.00 $127.02 N/A $371.20 $640.00 $640.00 $640.00 $133.38 $640.00 N/A N/A 25-449-07-91 SUP Custom 27203010 25-449-07-91 - DRILL TWIST 1.5MM 50MM 7MM STOP BOTH IP/OP $290.50 $215.00 $51.63 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $51.63 $290.05 $290.05 $215.28 $215.28 $223.57 $151.12 $60.45 $290.05 $116.02 $290.05 $290.05 $290.05 $290.05 $290.05 $217.88 $290.05 $290.05 $290.05 $145.03 $145.03 $229.72 $290.05 $232.04 $188.53 $290.05 N/A $168.49 $290.05 $174.03 $290.05 $290.05 $290.05 N/A N/A 25-449-16-91 SUP Custom 27100030 25-449-16-91 - DRILL TWIST 1.5MM 50MM 20MM NOTCH STOP STAINLESS STEEL BOTH IP/OP $290.50 $215.00 $51.63 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $51.63 $290.05 $290.05 $215.28 $215.28 $223.57 $151.12 $60.45 $290.05 $116.02 $290.05 $290.05 $290.05 $290.05 $290.05 $217.88 $290.05 $290.05 $290.05 $145.03 $145.03 $229.72 $290.05 $232.04 $188.53 $290.05 N/A $168.49 $290.05 $174.03 $290.05 $290.05 $290.05 N/A N/A 25-452-00-91 SUP Custom 27100030 25-452-00-91 - DRILL TWIST 1.1MM 50MM NOTCH STAINLESS STEEL BOTH IP/OP $290.50 $215.00 $51.63 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $51.63 $290.05 $290.05 $215.28 $215.28 $223.57 $151.12 $60.45 $290.05 $116.02 $290.05 $290.05 $290.05 $290.05 $290.05 $217.88 $290.05 $290.05 $290.05 $145.03 $145.03 $229.72 $290.05 $232.04 $188.53 $290.05 N/A $168.49 $290.05 $174.03 $290.05 $290.05 $290.05 N/A N/A 25-452-05-91 SUP Custom 27100030 25-452-05-91 - DRILL TWST 5MM 1.1MM 50MM J NTCH STP DISP BOTH IP/OP $290.50 $215.00 $51.63 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $51.63 $290.05 $290.05 $215.28 $215.28 $223.57 $151.12 $60.45 $290.05 $116.02 $290.05 $290.05 $290.05 $290.05 $290.05 $217.88 $290.05 $290.05 $290.05 $145.03 $145.03 $229.72 $290.05 $232.04 $188.53 $290.05 N/A $168.49 $290.05 $174.03 $290.05 $290.05 $290.05 N/A N/A 25-452-07-91 SUP Custom 27100030 25-452-07-91 - BIT DRILL 1.1MM 50MM 7MM J NOTCH STOP TWIST STAINLESS STEEL BOTH IP/OP $290.50 $215.00 $51.63 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $51.63 $290.05 $290.05 $215.28 $215.28 $223.57 $151.12 $60.45 $290.05 $116.02 $290.05 $290.05 $290.05 $290.05 $290.05 $217.88 $290.05 $290.05 $290.05 $145.03 $145.03 $229.72 $290.05 $232.04 $188.53 $290.05 N/A $168.49 $290.05 $174.03 $290.05 $290.05 $290.05 N/A N/A 25452-525 SUP Custom 27203010 25452-525 - LEAD CONNCTNG WIRE SNAP BOTH IP/OP $11.00 $8.00 $1.95 $10.94 $10.94 $10.94 $10.94 $10.94 $10.94 $10.94 $1.95 $10.94 $10.94 $8.12 $8.12 $8.43 $5.70 $2.28 $10.94 $4.38 $10.94 $10.94 $10.94 $10.94 $10.94 $8.25 $10.94 $10.94 $10.94 $5.47 $5.47 $8.66 $10.94 $8.75 $7.11 $10.94 N/A $6.38 $10.94 $6.56 $10.94 $10.94 $10.94 N/A N/A 25-458-19-07 SUP Custom 27100030 25-458-19-07 - DRILL TWIST J 1.9MM 50MM NOTCH DISPOSABLE 2.3MM FRAC SYSTEM BOTH IP/OP $290.50 $215.00 $51.63 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $51.63 $290.05 $290.05 $215.28 $215.28 $223.57 $151.12 $60.45 $290.05 $116.02 $290.05 $290.05 $290.05 $290.05 $290.05 $217.88 $290.05 $290.05 $290.05 $145.03 $145.03 $229.72 $290.05 $232.04 $188.53 $290.05 N/A $168.49 $290.05 $174.03 $290.05 $290.05 $290.05 N/A N/A 25-460-19-07 SUP Custom 27100030 25-460-19-07 - DRILL TWIST 1.9MM 70MM STAINLESS STEEL BOTH IP/OP $290.50 $215.00 $51.63 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $51.63 $290.05 $290.05 $215.28 $215.28 $223.57 $151.12 $60.45 $290.05 $116.02 $290.05 $290.05 $290.05 $290.05 $290.05 $217.88 $290.05 $290.05 $290.05 $145.03 $145.03 $229.72 $290.05 $232.04 $188.53 $290.05 N/A $168.49 $290.05 $174.03 $290.05 $290.05 $290.05 N/A N/A 25-469-11-07 SUP Custom 27100030 25-469-11-07 - BIT DRILL TWIST 1.5MM 115MM J NOTCH 2MM SCREW BOTH IP/OP $290.50 $215.00 $51.63 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $51.63 $290.05 $290.05 $215.28 $215.28 $223.57 $151.12 $60.45 $290.05 $116.02 $290.05 $290.05 $290.05 $290.05 $290.05 $217.88 $290.05 $290.05 $290.05 $145.03 $145.03 $229.72 $290.05 $232.04 $188.53 $290.05 N/A $168.49 $290.05 $174.03 $290.05 $290.05 $290.05 N/A N/A 255-000-001 SUP Custom 27203010 255-000-001 - GRASPER LAPSCOP MINI 2.3MM 250MM ALLIGATOR LATEX FREE ALLIS BOTH IP/OP $535.00 $396.00 $95.21 $534.86 $534.86 $534.86 $534.86 $534.86 $534.86 $534.86 $95.21 $534.86 $534.86 $396.97 $396.97 $412.27 $278.66 $111.47 $534.86 $213.94 $534.86 $534.86 $534.86 $534.86 $534.86 $401.25 $534.86 $534.86 $534.86 $267.43 $267.43 $423.61 $534.86 $427.89 $347.66 $534.86 N/A $310.30 $534.86 $320.92 $534.86 $534.86 $534.86 N/A N/A 2552-06-L SUP HCPCS L3935 2552-06-L - TRIGGER FINGER SPLINTS LARGE BOTH IP/OP $0.50 $0.00 $0.09 $159.57 $0.19 $0.19 $0.19 $0.19 $0.42 $0.42 $130.33 $159.57 $0.42 $0.42 $0.42 $0.42 $0.42 $0.09 $0.42 $0.17 $0.25 $0.42 $0.42 $0.42 $0.42 $0.38 $0.42 $0.42 $0.42 $0.21 $0.21 $0.33 $0.42 $0.34 $0.19 $0.42 N/A $0.29 $0.42 $0.25 $0.42 $155.06 $0.42 N/A N/A 2552-06-M SUP HCPCS L3935 2552-06-M - TRIGGER FINGER SPLINTS ME BOTH IP/OP $0.50 $0.00 $0.09 $159.57 $0.19 $0.19 $0.19 $0.19 $0.42 $0.42 $130.33 $159.57 $0.42 $0.42 $0.42 $0.42 $0.42 $0.09 $0.42 $0.17 $0.25 $0.42 $0.42 $0.42 $0.42 $0.38 $0.42 $0.42 $0.42 $0.21 $0.21 $0.33 $0.42 $0.34 $0.19 $0.42 N/A $0.29 $0.42 $0.25 $0.42 $155.06 $0.42 N/A N/A 2552-06-S SUP HCPCS L3935 2552-06-S - TRIGGER FINGER SPLINTS SMALL BOTH IP/OP $0.50 $0.00 $0.09 $159.57 $0.19 $0.19 $0.19 $0.19 $0.42 $0.42 $130.33 $159.57 $0.42 $0.42 $0.42 $0.42 $0.42 $0.09 $0.42 $0.17 $0.25 $0.42 $0.42 $0.42 $0.42 $0.38 $0.42 $0.42 $0.42 $0.21 $0.21 $0.33 $0.42 $0.34 $0.19 $0.42 N/A $0.29 $0.42 $0.25 $0.42 $155.06 $0.42 N/A N/A 25-550-04-91 SUP HCPCS C1713 25-550-04-91 - PLATE BONE MINI REGULAR 1MM 4 HOLE TITANIUM MANDIB 2MM SCREW BOTH IP/OP $179.00 $132.00 $35.47 $178.73 $80.43 $80.43 $80.43 $80.43 $178.73 $178.73 $178.73 $37.25 $178.73 $178.73 $178.73 $178.73 $178.73 $37.25 $178.73 $178.73 $105.72 $178.73 $178.73 $178.73 $178.73 $134.25 $178.73 $178.73 $178.73 $89.37 $89.37 $141.55 $178.73 $142.98 $80.43 $35.47 N/A $103.82 $178.73 $107.24 $178.73 $37.25 $178.73 N/A N/A 25-550-08-91 SUP HCPCS C1713 25-550-08-91 - PLATE BONE MINI REGULAR 1MM 8 HOLE TITANIUM MANDIB 2MM SCREW BOTH IP/OP $220.50 $163.00 $43.69 $220.13 $99.06 $99.06 $99.06 $99.06 $220.13 $220.13 $220.13 $45.88 $220.13 $220.13 $220.13 $220.13 $220.13 $45.88 $220.13 $88.05 $130.21 $220.13 $220.13 $220.13 $220.13 $165.38 $220.13 $220.13 $220.13 $110.07 $110.07 $174.34 $220.13 $176.10 $99.06 $43.69 N/A $127.89 $220.13 $220.13 $220.13 $45.88 $220.13 N/A N/A 25-551-04-91 SUP HCPCS C1713 25-551-04-91 - PLATE BONE MINI MEDIUM STANDARD 1MM 4 HOLE TITANIUM MAXFACL BOTH IP/OP $174.00 $129.00 $34.44 $173.53 $78.09 $78.09 $78.09 $78.09 $173.53 $173.53 $173.53 $36.17 $173.53 $173.53 $173.53 $173.53 $173.53 $36.17 $173.53 $173.53 $102.64 $173.53 $173.53 $173.53 $173.53 $130.50 $173.53 $173.53 $173.53 $86.77 $86.77 $137.44 $173.53 $138.82 $78.09 $34.44 N/A $100.92 $173.53 $173.53 $173.53 $36.16 $173.53 N/A N/A 25-552-04-91 SUP HCPCS C1713 25-552-04-91 - PLATE BONE MINI LONG STANDARD 1MM 4 HOLE TITANIUM MANDIB 2MM BOTH IP/OP $176.50 $131.00 $34.96 $176.13 $79.26 $79.26 $79.26 $79.26 $176.13 $176.13 $176.13 $36.71 $176.13 $176.13 $176.13 $176.13 $176.13 $36.71 $176.13 $70.45 $104.18 $176.13 $176.13 $176.13 $176.13 $132.38 $176.13 $176.13 $176.13 $88.07 $88.07 $139.49 $176.13 $140.90 $79.26 $34.96 N/A $102.37 $176.13 $105.68 $176.13 $36.71 $176.13 N/A N/A 25-552-06-91 SUP HCPCS C1713 25-552-06-91 - PLATE BONE MINI LONG STANDARD 1MM 6 HOLE TITANIUM MAXFACL 2 BOTH IP/OP $205.00 $152.00 $40.60 $204.58 $92.06 $92.06 $92.06 $92.06 $204.58 $204.58 $204.58 $42.64 $204.58 $204.58 $204.58 $204.58 $204.58 $42.64 $204.58 $81.83 $121.01 $204.58 $204.58 $204.58 $204.58 $153.75 $204.58 $204.58 $204.58 $102.29 $102.29 $162.03 $204.58 $163.66 $92.06 $40.60 N/A $118.90 $204.58 $122.75 $204.58 $42.63 $204.58 N/A N/A 25-592-04-1 SUP HCPCS C1713 25-592-04-1 - LOCKING PLATE 4 HOLE BOTH IP/OP $158.50 $117.00 $31.38 $158.10 $71.15 $71.15 $71.15 $71.15 $158.10 $158.10 $158.10 $32.95 $158.10 $158.10 $158.10 $158.10 $158.10 $32.95 $158.10 $63.24 $93.52 $158.10 $158.10 $158.10 $158.10 $118.88 $158.10 $158.10 $158.10 $79.05 $79.05 $125.22 $158.10 $126.48 $71.15 $31.38 N/A $91.93 $158.10 $94.86 $158.10 $32.95 $158.10 N/A N/A 25-672-15-1 SUP HCPCS C1713 25-672-15-1 - SCREW TI 15MM 2MM MAXFACL XDR BONE BOTH IP/OP $100.00 $74.00 $19.84 $99.98 $44.99 $44.99 $44.99 $44.99 $99.98 $99.98 $99.98 $20.84 $99.98 $99.98 $99.98 $99.98 $99.98 $20.84 $99.98 $39.99 $59.14 $99.98 $99.98 $99.98 $99.98 $75.00 $99.98 $99.98 $99.98 $49.99 $49.99 $79.18 $99.98 $79.98 $44.99 $19.84 N/A $58.00 $99.98 $59.99 $99.98 $20.84 $99.98 N/A N/A 25-673-49-1 SUP HCPCS C1713 25-673-49-1 - SCREW TI 9MM 2.3MM MAXFACL XDR ER BONE BOTH IP/OP $593.00 $439.00 $117.67 $592.88 $266.80 $266.80 $266.80 $266.80 $592.88 $592.88 $592.88 $123.57 $592.88 $592.88 $592.88 $592.88 $592.88 $123.56 $592.88 $592.88 $350.69 $592.88 $592.88 $592.88 $592.88 $444.75 $592.88 $592.88 $592.88 $296.44 $296.44 $469.56 $592.88 $474.30 $266.80 $117.67 N/A $343.94 $592.88 $355.73 $592.88 $123.56 $592.88 N/A N/A 25-677-12 SUP HCPCS C1713 25-677-12 - SCREW TI 12MM 2.7MM MAXFACL XDR ER BONE BOTH IP/OP $238.00 $176.00 $47.24 $238.00 $107.10 $107.10 $107.10 $107.10 $238.00 $238.00 $238.00 $49.61 $238.00 $238.00 $238.00 $238.00 $238.00 $49.60 $238.00 $95.20 $140.78 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $107.10 $47.24 N/A $138.04 $238.00 $238.00 $238.00 $49.60 $238.00 N/A N/A 25-677-12-91 SUP HCPCS C1713 25-677-12-91 - SCREW BONE 2.7MM 12MM EMERGENCY CROSS DRIVE TITANIUM MANDIB BOTH IP/OP $270.50 $200.00 $53.62 $270.15 $121.57 $121.57 $121.57 $121.57 $270.15 $270.15 $270.15 $56.31 $270.15 $270.15 $270.15 $270.15 $270.15 $56.30 $270.15 $108.06 $159.79 $270.15 $270.15 $270.15 $270.15 $202.88 $270.15 $270.15 $270.15 $135.08 $135.08 $213.96 $270.15 $216.12 $121.57 $53.62 N/A $156.89 $270.15 $162.09 $270.15 $270.15 $270.15 N/A N/A 25-677-14 SUP HCPCS C1713 25-677-14 - SCREW TI 14MM 2.7MM MAXFACL XDR ER BONE BOTH IP/OP $238.00 $176.00 $47.24 $238.00 $107.10 $107.10 $107.10 $107.10 $238.00 $238.00 $238.00 $49.61 $238.00 $238.00 $238.00 $238.00 $238.00 $49.60 $238.00 $95.20 $140.78 $238.00 $238.00 $238.00 $238.00 $178.50 $238.00 $238.00 $238.00 $119.00 $119.00 $188.50 $238.00 $190.40 $107.10 $47.24 N/A $138.04 $238.00 $142.80 $238.00 $49.60 $238.00 N/A N/A 25-677-14-91 SUP HCPCS C1713 25-677-14-91 - SCREW BONE 2.7MM 14MM NONLOCKING CROSS DRIVE THREADLOCK TS BOTH IP/OP $270.50 $200.00 $53.62 $270.15 $121.57 $121.57 $121.57 $121.57 $270.15 $270.15 $270.15 $56.31 $270.15 $270.15 $270.15 $270.15 $270.15 $56.30 $270.15 $270.15 $159.79 $270.15 $270.15 $270.15 $270.15 $202.88 $270.15 $270.15 $270.15 $135.08 $135.08 $213.96 $270.15 $216.12 $121.57 $53.62 N/A $156.89 $270.15 $162.09 $270.15 $56.30 $270.15 N/A N/A 25-677-16-91 SUP HCPCS C1713 25-677-16-91 - SCREW BONE 2.7MM 16MM NONLOCKING CROSS DRIVE THREADLOCK TS BOTH IP/OP $270.50 $200.00 $53.62 $270.15 $121.57 $121.57 $121.57 $121.57 $270.15 $270.15 $270.15 $56.31 $270.15 $270.15 $270.15 $270.15 $270.15 $56.30 $270.15 $108.06 $159.79 $270.15 $270.15 $270.15 $270.15 $202.88 $270.15 $270.15 $270.15 $135.08 $135.08 $213.96 $270.15 $216.12 $121.57 $53.62 N/A $156.89 $270.15 $162.09 $270.15 $56.30 $270.15 N/A N/A 25-677-52-91 SUP HCPCS C1713 25-677-52-91 - SCREW BONE 3.2MM 12MM EMERGENCY CROSS DRIVE TITANIUM MANDIB BOTH IP/OP $321.50 $238.00 $63.74 $321.15 $144.52 $144.52 $144.52 $144.52 $321.15 $321.15 $321.15 $66.94 $321.15 $321.15 $321.15 $321.15 $321.15 $66.93 $321.15 $128.46 $189.96 $321.15 $321.15 $321.15 $321.15 $241.13 $321.15 $321.15 $321.15 $160.58 $160.58 $254.35 $321.15 $256.92 $144.52 $63.74 N/A $186.47 $321.15 $192.69 $321.15 $66.93 $321.15 N/A N/A 25-750-04-09 SUP HCPCS C1713 25-750-04-09 - PLATE BONE 3D 1MM 4 HOLE THREADLOCK TITANIUM MANDIB BOTH IP/OP $668.50 $495.00 $132.66 $668.38 $300.77 $300.77 $300.77 $300.77 $668.38 $668.38 $668.38 $139.31 $668.38 $668.38 $668.38 $668.38 $668.38 $139.30 $668.38 $267.35 $395.35 $668.38 $668.38 $668.38 $668.38 $501.38 $668.38 $668.38 $668.38 $334.19 $334.19 $529.36 $668.38 $534.70 $300.77 $132.66 N/A $387.73 $668.38 $401.03 $668.38 $139.29 $668.38 N/A N/A 25-750-14-09 SUP HCPCS C1713 25-750-14-09 - PLATE BONE 3D REGULAR 1MM 14 HOLE THREADLOCK TITANIUM MANDIB BOTH IP/OP "$1,309.00" $969.00 $259.78 "$1,308.90" $589.01 $589.01 $589.01 $589.01 "$1,308.90" "$1,308.90" "$1,308.90" $272.81 "$1,308.90" "$1,308.90" "$1,308.90" "$1,308.90" "$1,308.90" $272.79 "$1,308.90" $523.56 $774.21 "$1,308.90" "$1,308.90" "$1,308.90" "$1,308.90" $981.75 "$1,308.90" "$1,308.90" "$1,308.90" $654.45 $654.45 "$1,036.65" "$1,308.90" "$1,047.12" $589.01 $259.78 N/A $759.22 "$1,308.90" "$1,308.90" "$1,308.90" $272.77 "$1,308.90" N/A N/A 25-752-04-09 SUP HCPCS C1713 25-752-04-09 - PLATE BN LNG MN 1MM THREADLOCK TS 4 HL LCK TI MNDB BOTH IP/OP $710.50 $526.00 $140.94 $710.13 $319.56 $319.56 $319.56 $319.56 $710.13 $710.13 $710.13 $148.01 $710.13 $710.13 $710.13 $710.13 $710.13 $148.00 $710.13 $710.13 $420.04 $710.13 $710.13 $710.13 $710.13 $532.88 $710.13 $710.13 $710.13 $355.07 $355.07 $562.42 $710.13 $568.10 $319.56 $140.94 N/A $412.09 $710.13 $426.08 $710.13 $147.99 $710.13 N/A N/A 25-752-06-09 SUP HCPCS C1713 25-752-06-09 - PLATE BONE MINI LONG 1MM 6 HOLE THREADLOCK GREEN TITANIUM BOTH IP/OP $780.00 $577.00 $154.76 $779.75 $350.89 $350.89 $350.89 $350.89 $779.75 $779.75 $779.75 $162.52 $779.75 $779.75 $779.75 $779.75 $779.75 $162.51 $779.75 $779.75 $461.22 $779.75 $779.75 $779.75 $779.75 $585.00 $779.75 $779.75 $779.75 $389.88 $389.88 $617.56 $779.75 $623.80 $350.89 $154.76 N/A $452.40 $779.75 $467.85 $779.75 $162.50 $779.75 N/A N/A 25-774-07-91 SUP HCPCS C1713 25-774-07-91 - SCREW BONE 2.7MM 7MM LOCKING CROSS DRIVE TITANIUM MANDIB BOTH IP/OP $329.00 $243.00 $65.22 $328.63 $147.88 $147.88 $147.88 $147.88 $328.63 $328.63 $328.63 $68.49 $328.63 $328.63 $328.63 $328.63 $328.63 $68.49 $328.63 $328.63 $194.38 $328.63 $328.63 $328.63 $328.63 $246.75 $328.63 $328.63 $328.63 $164.32 $164.32 $260.27 $328.63 $262.90 $147.88 $65.22 N/A $190.82 $328.63 $197.18 $328.63 $68.49 $328.63 N/A N/A 25-774-09-91 SUP HCPCS C1713 25-774-09-91 - SCREW BONE 2.7MM 9MM LOCKING CROSS DRIVE TITANIUM MANDIB BOTH IP/OP $329.00 $243.00 $65.22 $328.63 $147.88 $147.88 $147.88 $147.88 $328.63 $328.63 $328.63 $68.49 $328.63 $328.63 $328.63 $328.63 $328.63 $68.49 $328.63 $328.63 $194.38 $328.63 $328.63 $328.63 $328.63 $246.75 $328.63 $328.63 $328.63 $164.32 $164.32 $260.27 $328.63 $262.90 $147.88 $65.22 N/A $190.82 $328.63 $328.63 $328.63 $68.49 $328.63 N/A N/A 25-774-11-91 SUP HCPCS C1713 25-774-11-91 - SCREW BONE 2.7MM 11MM LOCKING CROSS DRIVE TITANIUM MANDIB BOTH IP/OP $329.00 $243.00 $65.22 $328.63 $147.88 $147.88 $147.88 $147.88 $328.63 $328.63 $328.63 $68.49 $328.63 $328.63 $328.63 $328.63 $328.63 $68.49 $328.63 $328.63 $194.38 $328.63 $328.63 $328.63 $328.63 $246.75 $328.63 $328.63 $328.63 $164.32 $164.32 $260.27 $328.63 $262.90 $147.88 $65.22 N/A $190.82 $328.63 $197.18 $328.63 $68.49 $328.63 N/A N/A 25-774-13-91 SUP HCPCS C1713 25-774-13-91 - SCREW BONE 2.7MM 13MM LOCKING CROSS DRIVE TITANIUM MANDIB BOTH IP/OP $329.00 $243.00 $65.22 $328.63 $147.88 $147.88 $147.88 $147.88 $328.63 $328.63 $328.63 $68.49 $328.63 $328.63 $328.63 $328.63 $328.63 $68.49 $328.63 $328.63 $194.38 $328.63 $328.63 $328.63 $328.63 $246.75 $328.63 $328.63 $328.63 $164.32 $164.32 $260.27 $328.63 $262.90 $147.88 $65.22 N/A $190.82 $328.63 $197.18 $328.63 $68.49 $328.63 N/A N/A 25-774-15-91 SUP HCPCS C1713 25-774-15-91 - SCREW BONE 2.7MM 15MM LOCKING CROSS DRIVE TITANIUM MANDIB BOTH IP/OP $329.00 $243.00 $65.22 $328.63 $147.88 $147.88 $147.88 $147.88 $328.63 $328.63 $328.63 $68.49 $328.63 $328.63 $328.63 $328.63 $328.63 $68.49 $328.63 $328.63 $194.38 $328.63 $328.63 $328.63 $328.63 $246.75 $328.63 $328.63 $328.63 $164.32 $164.32 $260.27 $328.63 $262.90 $147.88 $65.22 N/A $190.82 $328.63 $197.18 $328.63 $68.49 $328.63 N/A N/A 25-780-04-91 SUP HCPCS C1713 25-780-04-91 - NEURO SCREW ULTRA LOW PROFILE 1.5 x 4.0MM BOTH IP/OP $201.50 $149.00 $39.92 $201.15 $90.52 $90.52 $90.52 $90.52 $201.15 $201.15 $201.15 $41.92 $201.15 $201.15 $201.15 $201.15 $201.15 $41.92 $201.15 $80.46 $118.98 $201.15 $201.15 $201.15 $201.15 $151.13 $201.15 $201.15 $201.15 $100.58 $100.58 $159.31 $201.15 $160.92 $90.52 $39.92 N/A $116.87 $201.15 $201.15 $201.15 $41.92 $201.15 N/A N/A 25-872-05-91 SUP HCPCS C1713 25-872-05-91 - SCREW BN 2MM 5MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI BOTH IP/OP $124.50 $92.00 $24.68 $124.33 $55.95 $55.95 $55.95 $55.95 $124.33 $124.33 $124.33 $25.91 $124.33 $124.33 $124.33 $124.33 $124.33 $25.91 $124.33 $124.33 $73.54 $124.33 $124.33 $124.33 $124.33 $93.38 $124.33 $124.33 $124.33 $62.17 $62.17 $98.47 $124.33 $99.46 $55.95 $24.68 N/A $72.21 $124.33 $74.60 $124.33 $25.91 $124.33 N/A N/A 25-872-07-91 SUP HCPCS C1713 25-872-07-91 - SCREW BN 2MM 7MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI BOTH IP/OP $124.50 $92.00 $24.68 $124.33 $55.95 $55.95 $55.95 $55.95 $124.33 $124.33 $124.33 $25.91 $124.33 $124.33 $124.33 $124.33 $124.33 $25.91 $124.33 $124.33 $73.54 $124.33 $124.33 $124.33 $124.33 $93.38 $124.33 $124.33 $124.33 $62.17 $62.17 $98.47 $124.33 $99.46 $55.95 $24.68 N/A $72.21 $124.33 $74.60 $124.33 $25.91 $124.33 N/A N/A 25-872-09-91 SUP HCPCS C1713 25-872-09-91 - SCREW BN 2MM 9MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI BOTH IP/OP $124.50 $92.00 $24.68 $124.33 $55.95 $55.95 $55.95 $55.95 $124.33 $124.33 $124.33 $25.91 $124.33 $124.33 $124.33 $124.33 $124.33 $25.91 $124.33 $49.73 $73.54 $124.33 $124.33 $124.33 $124.33 $93.38 $124.33 $124.33 $124.33 $62.17 $62.17 $98.47 $124.33 $99.46 $55.95 $24.68 N/A $72.21 $124.33 $74.60 $124.33 $25.91 $124.33 N/A N/A 25-872-11-91 SUP HCPCS C1713 25-872-11-91 - SCREW BN 2MM 11MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI BOTH IP/OP $124.50 $92.00 $24.68 $124.33 $55.95 $55.95 $55.95 $55.95 $124.33 $124.33 $124.33 $25.91 $124.33 $124.33 $124.33 $124.33 $124.33 $25.91 $124.33 $49.73 $73.54 $124.33 $124.33 $124.33 $124.33 $93.38 $124.33 $124.33 $124.33 $62.17 $62.17 $98.47 $124.33 $99.46 $55.95 $24.68 N/A $72.21 $124.33 $124.33 $124.33 $25.91 $124.33 N/A N/A 25-872-13-91 SUP HCPCS C1713 25-872-13-91 - SCREW BN 2MM 13MM NS THREADLOCK TS LVL 1 MAXDRIVE CNCV TI BOTH IP/OP $124.50 $92.00 $24.68 $124.33 $55.95 $55.95 $55.95 $55.95 $124.33 $124.33 $124.33 $25.91 $124.33 $124.33 $124.33 $124.33 $124.33 $25.91 $124.33 $124.33 $73.54 $124.33 $124.33 $124.33 $124.33 $93.38 $124.33 $124.33 $124.33 $62.17 $62.17 $98.47 $124.33 $99.46 $55.95 $24.68 N/A $72.21 $124.33 $124.33 $124.33 $25.91 $124.33 N/A N/A 25-873-05-91 SUP HCPCS C1713 25-873-05-91 - SCREW BONE 2.3MM 5MM MAXDRIVE TITANIUM ORAL MAXFACL BOTH IP/OP $161.00 $119.00 $31.87 $160.58 $72.26 $72.26 $72.26 $72.26 $160.58 $160.58 $160.58 $33.47 $160.58 $160.58 $160.58 $160.58 $160.58 $33.47 $160.58 $64.23 $94.98 $160.58 $160.58 $160.58 $160.58 $120.75 $160.58 $160.58 $160.58 $80.29 $80.29 $127.18 $160.58 $128.46 $72.26 $31.87 N/A $93.38 $160.58 $96.35 $160.58 $33.46 $160.58 N/A N/A 25-873-07-91 SUP HCPCS C1713 25-873-07-91 - SCREW BONE 2.3MM 7MM MAXDRIVE TITANIUM ORAL MAXFACL BOTH IP/OP $161.00 $119.00 $31.87 $160.58 $72.26 $72.26 $72.26 $72.26 $160.58 $160.58 $160.58 $33.47 $160.58 $160.58 $160.58 $160.58 $160.58 $33.47 $160.58 $64.23 $94.98 $160.58 $160.58 $160.58 $160.58 $120.75 $160.58 $160.58 $160.58 $80.29 $80.29 $127.18 $160.58 $128.46 $72.26 $31.87 N/A $93.38 $160.58 $160.58 $160.58 $33.46 $160.58 N/A N/A 25-873-09-91 SUP HCPCS C1713 25-873-09-91 - SCREW BONE 2.3MM 9MM MAXDRIVE TITANIUM ORAL MAXFACL BOTH IP/OP $161.00 $119.00 $31.87 $160.58 $72.26 $72.26 $72.26 $72.26 $160.58 $160.58 $160.58 $33.47 $160.58 $160.58 $160.58 $160.58 $160.58 $33.47 $160.58 $64.23 $94.98 $160.58 $160.58 $160.58 $160.58 $120.75 $160.58 $160.58 $160.58 $80.29 $80.29 $127.18 $160.58 $128.46 $72.26 $31.87 N/A $93.38 $160.58 $160.58 $160.58 $33.46 $160.58 N/A N/A 25-873-13-91 SUP HCPCS C1713 25-873-13-91 - SCREW BONE 2.3MM 13MM MAXDRIVE TITANIUM ORAL MAXFACL BOTH IP/OP $161.00 $119.00 $31.87 $160.58 $72.26 $72.26 $72.26 $72.26 $160.58 $160.58 $160.58 $33.47 $160.58 $160.58 $160.58 $160.58 $160.58 $33.47 $160.58 $64.23 $94.98 $160.58 $160.58 $160.58 $160.58 $120.75 $160.58 $160.58 $160.58 $80.29 $80.29 $127.18 $160.58 $128.46 $72.26 $31.87 N/A $93.38 $160.58 $160.58 $160.58 $33.46 $160.58 N/A N/A 25-873-45-91 SUP HCPCS C1713 25-873-45-91 - SCREW BN 2.3MM 5MM NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET ER BOTH IP/OP $161.00 $119.00 $31.87 $160.58 $72.26 $72.26 $72.26 $72.26 $160.58 $160.58 $160.58 $33.47 $160.58 $160.58 $160.58 $160.58 $160.58 $33.47 $160.58 $64.23 $94.98 $160.58 $160.58 $160.58 $160.58 $120.75 $160.58 $160.58 $160.58 $80.29 $80.29 $127.18 $160.58 $128.46 $72.26 $31.87 N/A $93.38 $160.58 $160.58 $160.58 $33.46 $160.58 N/A N/A 25-873-47-91 SUP HCPCS C1713 25-873-47-91 - SCREW BN 2.3MM 7MM NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET ER BOTH IP/OP $161.00 $119.00 $31.87 $160.58 $72.26 $72.26 $72.26 $72.26 $160.58 $160.58 $160.58 $33.47 $160.58 $160.58 $160.58 $160.58 $160.58 $33.47 $160.58 $64.23 $94.98 $160.58 $160.58 $160.58 $160.58 $120.75 $160.58 $160.58 $160.58 $80.29 $80.29 $127.18 $160.58 $128.46 $72.26 $31.87 N/A $93.38 $160.58 $160.58 $160.58 $33.46 $160.58 N/A N/A 25-874-13-91 SUP HCPCS C1713 25-874-13-91 - SCREW BN 2.5MM 13MM NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET BOTH IP/OP $163.50 $121.00 $32.39 $163.18 $73.43 $73.43 $73.43 $73.43 $163.18 $163.18 $163.18 $34.01 $163.18 $163.18 $163.18 $163.18 $163.18 $34.01 $163.18 $163.18 $96.52 $163.18 $163.18 $163.18 $163.18 $122.63 $163.18 $163.18 $163.18 $81.59 $81.59 $129.24 $163.18 $130.54 $73.43 $32.39 N/A $94.83 $163.18 $163.18 $163.18 $34.01 $163.18 N/A N/A 25-875-09-91 SUP HCPCS C1713 25-875-09-91 - SCREW BONE MICRO 1.5MM 9MM MAXDRIVE TITANIUM ORAL MAXFACL BOTH IP/OP $124.50 $92.00 $24.68 $124.33 $55.95 $55.95 $55.95 $55.95 $124.33 $124.33 $124.33 $25.91 $124.33 $124.33 $124.33 $124.33 $124.33 $25.91 $124.33 $124.33 $73.54 $124.33 $124.33 $124.33 $124.33 $93.38 $124.33 $124.33 $124.33 $62.17 $62.17 $98.47 $124.33 $99.46 $55.95 $24.68 N/A $72.21 $124.33 $124.33 $124.33 $25.91 $124.33 N/A N/A 25-876-05-91 SUP HCPCS C1713 25-876-05-91 - SCREW BN MIC 1.8MM 5MM NS LVL 1 MAXDRIVE DRLFR ER TI-6AL-4V BOTH IP/OP $142.50 $105.00 $28.27 $142.43 $64.09 $64.09 $64.09 $64.09 $142.43 $142.43 $142.43 $29.69 $142.43 $142.43 $142.43 $142.43 $142.43 $29.68 $142.43 $142.43 $84.25 $142.43 $142.43 $142.43 $142.43 $106.88 $142.43 $142.43 $142.43 $71.22 $71.22 $112.80 $142.43 $113.94 $64.09 $28.27 N/A $82.65 $142.43 $142.43 $142.43 $29.68 $142.43 N/A N/A 25-876-07-91 SUP HCPCS C1713 25-876-07-91 - SCREW BONE MICRO 1.8MM 5MM EMERGENCY DRILL FREE MAXDRIVE BOTH IP/OP $142.50 $105.00 $28.27 $142.43 $64.09 $64.09 $64.09 $64.09 $142.43 $142.43 $142.43 $29.69 $142.43 $142.43 $142.43 $142.43 $142.43 $29.68 $142.43 $142.43 $84.25 $142.43 $142.43 $142.43 $142.43 $106.88 $142.43 $142.43 $142.43 $71.22 $71.22 $112.80 $142.43 $113.94 $64.09 $28.27 N/A $82.65 $142.43 $85.46 $142.43 $29.68 $142.43 N/A N/A 25-878-04-91 SUP HCPCS C1713 25-878-04-91 - SCREW BN MIC 1.5MM 4MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V BOTH IP/OP $142.50 $105.00 $28.27 $142.43 $64.09 $64.09 $64.09 $64.09 $142.43 $142.43 $142.43 $29.69 $142.43 $142.43 $142.43 $142.43 $142.43 $29.68 $142.43 $142.43 $84.25 $142.43 $142.43 $142.43 $142.43 $106.88 $142.43 $142.43 $142.43 $71.22 $71.22 $112.80 $142.43 $113.94 $64.09 $28.27 N/A $82.65 $142.43 $85.46 $142.43 $29.68 $142.43 N/A N/A 25-878-05-91 SUP HCPCS C1713 25-878-05-91 - SCREW BN MIC 1.5MM 5MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V BOTH IP/OP $142.50 $105.00 $28.27 $142.43 $64.09 $64.09 $64.09 $64.09 $142.43 $142.43 $142.43 $29.69 $142.43 $142.43 $142.43 $142.43 $142.43 $29.68 $142.43 $142.43 $84.25 $142.43 $142.43 $142.43 $142.43 $106.88 $142.43 $142.43 $142.43 $71.22 $71.22 $112.80 $142.43 $113.94 $64.09 $28.27 N/A $82.65 $142.43 $85.46 $142.43 $29.68 $142.43 N/A N/A 25-878-07-91 SUP HCPCS C1713 25-878-07-91 - SCREW BONE MICRO 1.5MM 7MM DRILL FREE MAXDRIVE TITANIUM ORAL BOTH IP/OP $142.50 $105.00 $28.27 $142.43 $64.09 $64.09 $64.09 $64.09 $142.43 $142.43 $142.43 $29.69 $142.43 $142.43 $142.43 $142.43 $142.43 $29.68 $142.43 $142.43 $84.25 $142.43 $142.43 $142.43 $142.43 $106.88 $142.43 $142.43 $142.43 $71.22 $71.22 $112.80 $142.43 $113.94 $64.09 $28.27 N/A $82.65 $142.43 $85.46 $142.43 $29.68 $142.43 N/A N/A 25-879-05-91 SUP HCPCS C1713 25-879-05-91 - SCREW BN MN 2MM 5MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V CRNMXF BOTH IP/OP $135.00 $100.00 $26.73 $134.68 $60.61 $60.61 $60.61 $60.61 $134.68 $134.68 $134.68 $28.07 $134.68 $134.68 $134.68 $134.68 $134.68 $28.07 $134.68 $134.68 $79.66 $134.68 $134.68 $134.68 $134.68 $101.25 $134.68 $134.68 $134.68 $67.34 $67.34 $106.67 $134.68 $107.74 $60.61 $26.73 N/A $78.30 $134.68 $80.81 $134.68 $28.07 $134.68 N/A N/A 25-879-07-91 SUP HCPCS C1713 25-879-07-91 - SCREW BN MN 2MM 7MM NS LVL 1 MAXDRIVE DRLFR TI-6AL-4V CRNMXF BOTH IP/OP $135.00 $100.00 $26.73 $134.68 $60.61 $60.61 $60.61 $60.61 $134.68 $134.68 $134.68 $28.07 $134.68 $134.68 $134.68 $134.68 $134.68 $28.07 $134.68 $134.68 $79.66 $134.68 $134.68 $134.68 $134.68 $101.25 $134.68 $134.68 $134.68 $67.34 $67.34 $106.67 $134.68 $107.74 $60.61 $26.73 N/A $78.30 $134.68 $80.81 $134.68 $28.07 $134.68 N/A N/A 25-882-07-91 SUP HCPCS C1713 25-882-07-91 - SCREW BN 2MM 7MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET BOTH IP/OP $270.50 $200.00 $53.62 $270.15 $121.57 $121.57 $121.57 $121.57 $270.15 $270.15 $270.15 $56.31 $270.15 $270.15 $270.15 $270.15 $270.15 $56.30 $270.15 $108.06 $159.79 $270.15 $270.15 $270.15 $270.15 $202.88 $270.15 $270.15 $270.15 $135.08 $135.08 $213.96 $270.15 $216.12 $121.57 $53.62 N/A $156.89 $270.15 $270.15 $270.15 $56.30 $270.15 N/A N/A 25-882-09-91 SUP HCPCS C1713 25-882-09-91 - SCREW BN 2MM 9MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET BOTH IP/OP $270.50 $200.00 $53.62 $270.15 $121.57 $121.57 $121.57 $121.57 $270.15 $270.15 $270.15 $56.31 $270.15 $270.15 $270.15 $270.15 $270.15 $56.30 $270.15 $270.15 $159.79 $270.15 $270.15 $270.15 $270.15 $202.88 $270.15 $270.15 $270.15 $135.08 $135.08 $213.96 $270.15 $216.12 $121.57 $53.62 N/A $156.89 $270.15 $162.09 $270.15 $56.30 $270.15 N/A N/A 25-882-11-91 SUP HCPCS C1713 25-882-11-91 - SCREW BN 2MM 11MM NS LVL 1 MAXDRIVE LCK TI CRNMXF BOTH IP/OP $270.50 $200.00 $53.62 $270.15 $121.57 $121.57 $121.57 $121.57 $270.15 $270.15 $270.15 $56.31 $270.15 $270.15 $270.15 $270.15 $270.15 $56.30 $270.15 $270.15 $159.79 $270.15 $270.15 $270.15 $270.15 $202.88 $270.15 $270.15 $270.15 $135.08 $135.08 $213.96 $270.15 $216.12 $121.57 $53.62 N/A $156.89 $270.15 $162.09 $270.15 $56.30 $270.15 N/A N/A 25-882-13-91 SUP HCPCS C1713 25-882-13-91 - SCREW BONE 2MM 13MM LOCKING MAXDRIVE TITANIUM ORAL MAXFACL BOTH IP/OP $270.50 $200.00 $53.62 $270.15 $121.57 $121.57 $121.57 $121.57 $270.15 $270.15 $270.15 $56.31 $270.15 $270.15 $270.15 $270.15 $270.15 $56.30 $270.15 $270.15 $159.79 $270.15 $270.15 $270.15 $270.15 $202.88 $270.15 $270.15 $270.15 $135.08 $135.08 $213.96 $270.15 $216.12 $121.57 $53.62 N/A $156.89 $270.15 $270.15 $270.15 $56.30 $270.15 N/A N/A 25-882-15-91 SUP HCPCS C1713 25-882-15-91 - SCREW BN 2MM 15MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE SLFRET BOTH IP/OP $270.50 $200.00 $53.62 $270.15 $121.57 $121.57 $121.57 $121.57 $270.15 $270.15 $270.15 $56.31 $270.15 $270.15 $270.15 $270.15 $270.15 $56.30 $270.15 $270.15 $159.79 $270.15 $270.15 $270.15 $270.15 $202.88 $270.15 $270.15 $270.15 $135.08 $135.08 $213.96 $270.15 $216.12 $121.57 $53.62 N/A $156.89 $270.15 $270.15 $270.15 $56.30 $270.15 N/A N/A 25-883-11-91 SUP HCPCS C1713 25-883-11-91 - SCREW BN 2.3MM 11MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE BOTH IP/OP $301.00 $223.00 $59.69 $300.75 $135.34 $135.34 $135.34 $135.34 $300.75 $300.75 $300.75 $62.68 $300.75 $300.75 $300.75 $300.75 $300.75 $62.68 $300.75 $300.75 $177.89 $300.75 $300.75 $300.75 $300.75 $225.75 $300.75 $300.75 $300.75 $150.38 $150.38 $238.19 $300.75 $240.60 $135.34 $59.69 N/A $174.58 $300.75 $180.45 $300.75 $62.68 $300.75 N/A N/A 25-883-13-91 SUP HCPCS C1713 25-883-13-91 - SCREW BN TPR 2.3MM 13MM GRN NS THREADLOCK TS LVL 1 MAXDRIVE BOTH IP/OP $301.00 $223.00 $120.30 $225.75 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $120.30 N/A N/A N/A N/A N/A $225.75 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $174.58 N/A N/A N/A N/A N/A N/A N/A 25AGFN-756 SUP Custom 27803010 25AGFN-756 - VALVE AORTIC 85D 25MM 23MM 1 DIGIT GRADIENT MECHANICAL BOTH IP/OP "$11,750.00" "$8,695.00" "$2,091.50" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$2,091.50" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$2,448.83" "$11,750.00" "$4,700.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$8,812.50" "$11,750.00" "$11,750.00" "$11,750.00" "$5,875.00" "$5,875.00" "$9,306.00" "$11,750.00" "$9,400.00" "$5,287.50" "$11,750.00" N/A "$6,815.00" "$11,750.00" "$7,050.00" "$11,750.00" "$11,750.00" "$11,750.00" N/A N/A 25AJ-501 SUP Custom 27803010 25AJ-501 - VALVE AORTIC 85D 3.09SQ CM STANDARD RING 25MM 20.4MM CUFF BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 25MJ-501 SUP Custom 27803010 25MJ-501 - VALVE MITRAL 85D STANDARD 25MM 20.4MM MECHANICAL CUFF BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 260-120 SUP Custom 27203010 260-120 - DILAT SURG AMPTZ PTFE COAX STY SF WIRE INTROD 8-10FR BOTH IP/OP $100.00 $74.00 $17.80 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $17.80 $100.00 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $40.00 $100.00 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $100.00 N/A $58.00 $100.00 $60.00 $100.00 $100.00 $100.00 N/A N/A 26026-2 SUP Custom 27803010 26026-2 - SHUNT NEUROSURGICAL 90CM CSF ASMBLY DELTA NEONATE BOTH IP/OP "$3,997.50" "$2,958.00" $711.49 "$3,997.13" "$3,997.13" "$3,997.13" "$3,997.13" "$3,997.13" "$3,997.13" "$3,997.13" $711.49 "$3,997.13" "$3,997.13" "$3,997.13" "$3,997.13" "$3,997.13" "$3,997.13" $833.05 "$3,997.13" "$1,598.85" "$3,997.13" "$3,997.13" "$3,997.13" "$3,997.13" "$3,997.13" "$2,998.13" "$3,997.13" "$3,997.13" "$3,997.13" "$1,998.57" "$1,998.57" "$3,165.73" "$3,997.13" "$3,197.70" "$1,798.71" "$3,997.13" N/A "$2,318.55" "$3,997.13" "$2,398.28" "$3,997.13" "$3,997.13" "$3,997.13" N/A N/A 26026-5 SUP Custom 27803010 26026-5 - SHUNT NEUROSURGICAL 90CM PERFORMANCE LEVEL 1.5 CSF ASMBLY BOTH IP/OP "$4,135.00" "$3,060.00" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $736.01 "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" $861.75 "$4,134.88" "$1,653.95" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$4,134.88" "$3,101.25" "$4,134.88" "$4,134.88" "$4,134.88" "$2,067.44" "$2,067.44" "$3,274.82" "$4,134.88" "$3,307.90" "$1,860.70" "$4,134.88" N/A "$2,398.30" "$4,134.88" "$2,480.93" "$4,134.88" "$4,134.88" "$4,134.88" N/A N/A 2627-2-905 SUP Custom 27803010 2627-2-905 - INSERT TIBIAL STANDARD 5MM CRUC RET KNEE VAK BOTH IP/OP "$3,536.00" "$2,617.00" $629.41 "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" $629.41 "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" $736.94 "$3,536.00" "$1,414.40" "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" "$2,652.00" "$3,536.00" "$3,536.00" "$3,536.00" "$1,768.00" "$1,768.00" "$2,800.51" "$3,536.00" "$2,828.80" "$1,591.20" "$3,536.00" N/A "$2,050.88" "$3,536.00" "$2,121.60" "$3,536.00" "$3,536.00" "$3,536.00" N/A N/A 2627-2-915 SUP Custom 27803010 2627-2-915 - INSERT TIBIAL STANDARD 5MM CRUC RET KNEE VAK BOTH IP/OP "$3,536.00" "$2,617.00" $629.41 "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" $629.41 "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" $736.94 "$3,536.00" "$1,414.40" "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" "$3,536.00" "$2,652.00" "$3,536.00" "$3,536.00" "$3,536.00" "$1,768.00" "$1,768.00" "$2,800.51" "$3,536.00" "$2,828.80" "$1,591.20" "$3,536.00" N/A "$2,050.88" "$3,536.00" "$2,121.60" "$3,536.00" "$3,536.00" "$3,536.00" N/A N/A 2627-6-901 SUP HCPCS C1713 2627-6-901 - PIN FIX SMALL VAK LOCKING ASMBLY ORTHOPEDIC BOTH IP/OP $343.00 $254.00 $68.05 $342.88 $154.30 $154.30 $154.30 $154.30 $342.88 $342.88 $342.88 $71.46 $342.88 $342.88 $342.88 $342.88 $342.88 $71.46 $342.88 $137.15 $202.81 $342.88 $342.88 $342.88 $342.88 $257.25 $342.88 $342.88 $342.88 $171.44 $171.44 $271.56 $342.88 $274.30 $154.30 $68.05 N/A $198.94 $342.88 $205.73 $342.88 $71.46 $342.88 N/A N/A 2642-1-109 SUP Custom 27803010 2642-1-109 - INSERT TIBIAL SMALL 9MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-1-111 SUP Custom 27803010 2642-1-111 - INSERT TIBIAL MEDIUM 11MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-1-113 SUP Custom 27803010 2642-1-113 - INSERT TIBIAL SMALL 13MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-1-116 SUP Custom 27803010 2642-1-116 - INSERT TIBIAL SMALL 16MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-1-119 SUP Custom 27803010 2642-1-119 - INSERT TIBIAL SMALL 19MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-1-122 SUP Custom 27803010 2642-1-122 - INSERT TIBIAL SMALL 22MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-1-125 SUP Custom 27803010 2642-1-125 - INSERT TIBIAL PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-1-128 SUP Custom 27803010 2642-1-128 - INSERT TIBIAL SMALL 28MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-1-131 SUP Custom 27803010 2642-1-131 - INSERT TIBIAL SMALL 31MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-3-111 SUP Custom 27803010 2642-3-111 - INSERT TIBIAL MEDIUM 11MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-3-113 SUP Custom 27803010 2642-3-113 - INSERT TIBIAL MEDIUM 13MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-3-116 SUP Custom 27803010 2642-3-116 - INSERT TIBIAL MEDIUM 16MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-3-119 SUP Custom 27803010 2642-3-119 - INSERT TIBIAL MEDIUM 19MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-3-122 SUP Custom 27803010 2642-3-122 - INSERT TIBIAL MEDIUM 22MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-3-125 SUP Custom 27803010 2642-3-125 - INSERT TIBIAL MEDIUM 25MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-3-128 SUP Custom 27803010 2642-3-128 - INSERT TIBIAL MEDIUM 28MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-3-131 SUP Custom 27803010 2642-3-131 - INSERT TIBIAL MEDIUM 31MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-5-109 SUP Custom 27803010 2642-5-109 - INSERT TIBIAL LARGE 19MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-5-111 SUP Custom 27803010 2642-5-111 - INSERT TIBIAL LARGE 11MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-5-113 SUP Custom 27803010 2642-5-113 - INSERT TIBIAL LARGE 13MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-5-116 SUP Custom 27803010 2642-5-116 - INSERT TIBIAL LARGE 16MM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-5-119 SUP Custom 27803010 2642-5-119 - INSERT TIBIAL LARGE 19MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-5-122 SUP Custom 27803010 2642-5-122 - INSERT TIBIAL LARGE 22MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-5-125 SUP Custom 27803010 2642-5-125 - INSERT TIBIAL LARGE 25MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-5-128 SUP Custom 27803010 2642-5-128 - INSERT TIBIAL LARGE 28MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-5-131 SUP Custom 27803010 2642-5-131 - INSERT TIBIAL LARGE 31MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-6-109 SUP Custom 27803010 2642-6-109 - INSERT TIBIAL XL 9MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-6-111 SUP Custom 27803010 2642-6-111 - INSERT TIBIAL PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-6-113 SUP Custom 27803010 2642-6-113 - INSERT TIBIAL PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-6-116 SUP Custom 27803010 2642-6-116 - INSERT TIBIAL XL 16MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-6-119 SUP Custom 27803010 2642-6-119 - INSERT TIBIAL XL 19MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-6-122 SUP Custom 27803010 2642-6-122 - INSERT TIBIAL XL 22MM PRIM PCA KNEE BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" $968.63 "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A 2642-6-125 SUP Custom 27803010 2642-6-125 - INSERT TIBIAL XL 25MM PRIM PCA KNEE BOTH IP/OP "$2,065.00" "$1,528.00" $367.57 "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" $367.57 "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" $430.37 "$2,065.00" $826.00 "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$1,548.75" "$2,065.00" "$2,065.00" "$2,065.00" "$1,032.50" "$1,032.50" "$1,635.48" "$2,065.00" "$1,652.00" $929.25 "$2,065.00" N/A "$1,197.70" "$2,065.00" "$1,239.00" "$2,065.00" "$2,065.00" "$2,065.00" N/A N/A 2642-6-128 SUP Custom 27803010 2642-6-128 - INSERT TIBIAL XL 28MM PRIM PCA KNEE BOTH IP/OP "$2,065.00" "$1,528.00" $367.57 "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" $367.57 "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" $430.37 "$2,065.00" $826.00 "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$1,548.75" "$2,065.00" "$2,065.00" "$2,065.00" "$1,032.50" "$1,032.50" "$1,635.48" "$2,065.00" "$1,652.00" $929.25 "$2,065.00" N/A "$1,197.70" "$2,065.00" "$1,239.00" "$2,065.00" "$2,065.00" "$2,065.00" N/A N/A 2642-6-131 SUP Custom 27803010 2642-6-131 - INSERT TIBIAL XL 31MM PRIM PCA KNEE BOTH IP/OP "$2,065.00" "$1,528.00" $367.57 "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" $367.57 "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" $430.37 "$2,065.00" $826.00 "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$1,548.75" "$2,065.00" "$2,065.00" "$2,065.00" "$1,032.50" "$1,032.50" "$1,635.48" "$2,065.00" "$1,652.00" $929.25 "$2,065.00" N/A "$1,197.70" "$2,065.00" "$1,239.00" "$2,065.00" "$2,065.00" "$2,065.00" N/A N/A 26AC60 SUP Custom 27203010 26AC60 - TOOL DISSECTING ACORN 6MM 26CM MIDAS REX LEGEND STERILE BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A 26AC75 SUP Custom 27203010 26AC75 - TOOL DISSECTING ACORN 7.5MM 26CM ACORN LEGEND STERILE BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A 26AC90 SUP Custom 27203010 26AC90 - TOOL DISSECTING ACORN 9MM 26CM MIDAS REX LEGEND STERILE BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A 26BA50DX SUP Custom 27203010 26BA50DX - TOOL DISSECTING BALL XCOARSE 5MM 26CM DIAMOND MIDAS REX BOTH IP/OP $412.50 $305.00 $73.38 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $73.38 $412.25 $412.25 $305.97 $305.97 $317.76 $214.78 $85.92 $412.25 $164.90 $412.25 $412.25 $412.25 $412.25 $412.25 $309.38 $412.25 $412.25 $412.25 $206.13 $206.13 $326.50 $412.25 $329.80 $267.96 $412.25 N/A $239.25 $412.25 $247.35 $412.25 $412.25 $412.25 N/A N/A 26BA60 SUP Custom 27203010 26BA60 - TOOL DISSECTING BALL 6MM 26CM FLUTED MIDAS REX LEGEND BOTH IP/OP $385.00 $285.00 $68.46 $384.63 $384.63 $384.63 $384.63 $384.63 $384.63 $384.63 $68.46 $384.63 $384.63 $285.47 $285.47 $296.47 $200.39 $80.16 $384.63 $153.85 $384.63 $384.63 $384.63 $384.63 $384.63 $288.75 $384.63 $384.63 $384.63 $192.32 $192.32 $304.63 $384.63 $307.70 $250.01 $384.63 N/A $223.30 $384.63 $230.78 $384.63 $384.63 $384.63 N/A N/A 26BA70DX SUP Custom 27203010 26BA70DX - TOOL DISSECTING BALL XCOARSE 7MM 26CM DIAMOND MIDAS REX BOTH IP/OP $412.50 $305.00 $73.38 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $73.38 $412.25 $412.25 $305.97 $305.97 $317.76 $214.78 $85.92 $412.25 $164.90 $412.25 $412.25 $412.25 $412.25 $412.25 $309.38 $412.25 $412.25 $412.25 $206.13 $206.13 $326.50 $412.25 $329.80 $267.96 $412.25 N/A $239.25 $412.25 $247.35 $412.25 $412.25 $412.25 N/A N/A 26BA75 SUP Custom 27203010 26BA75 - TOOL DISSECTING BALL 7.5MM 26CM FLUTED MIDAS REX LEGEND BOTH IP/OP $376.50 $279.00 $66.95 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $66.95 $376.13 $376.13 $279.16 $279.16 $289.92 $195.96 $78.39 $376.13 $150.45 $376.13 $376.13 $376.13 $376.13 $376.13 $282.38 $376.13 $376.13 $376.13 $188.07 $188.07 $297.89 $376.13 $300.90 $244.48 $376.13 N/A $218.37 $376.13 $225.68 $376.13 $376.13 $376.13 N/A N/A 26BA90 SUP Custom 27203010 26BA90 - TOOL DISSECTING BALL 9MM 26CM BALL LATEX FREE LEGEND STERILE BOTH IP/OP $376.50 $279.00 $66.95 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $376.13 $66.95 $376.13 $376.13 $279.16 $279.16 $289.92 $195.96 $78.39 $376.13 $150.45 $376.13 $376.13 $376.13 $376.13 $376.13 $282.38 $376.13 $376.13 $376.13 $188.07 $188.07 $297.89 $376.13 $300.90 $244.48 $376.13 N/A $218.37 $376.13 $225.68 $376.13 $376.13 $376.13 N/A N/A 26CY75 SUP Custom 27203010 26CY75 - TOOL DISSECTING CYLINDER 7.5MM 26CM FLUTED MIDAS REX LEGEND BOTH IP/OP $348.50 $258.00 $62.03 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $62.03 $348.50 $348.50 $258.66 $258.66 $268.62 $181.57 $72.63 $348.50 $139.40 $348.50 $348.50 $348.50 $348.50 $348.50 $261.38 $348.50 $348.50 $348.50 $174.25 $174.25 $276.01 $348.50 $278.80 $226.53 $348.50 N/A $202.13 $348.50 $209.10 $348.50 $348.50 $348.50 N/A N/A 26CY90 SUP Custom 27203010 26CY90 - TOOL DISSECTING CYLINDER 9MM 26CM MIDAS REX LEGEND STERILE BOTH IP/OP $348.50 $258.00 $62.03 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $62.03 $348.50 $348.50 $258.66 $258.66 $268.62 $181.57 $72.63 $348.50 $139.40 $348.50 $348.50 $348.50 $348.50 $348.50 $261.38 $348.50 $348.50 $348.50 $174.25 $174.25 $276.01 $348.50 $278.80 $226.53 $348.50 N/A $202.13 $348.50 $209.10 $348.50 $348.50 $348.50 N/A N/A 26MH30 SUP Custom 27203010 26MH30 - TOOL DISSECTING MATCH HEAD 6MM 26CM BALL FLUTED MATCH HEAD BOTH IP/OP $346.50 $256.00 $61.66 $346.38 $346.38 $346.38 $346.38 $346.38 $346.38 $346.38 $61.66 $346.38 $346.38 $257.08 $257.08 $266.99 $180.46 $72.19 $346.38 $138.55 $346.38 $346.38 $346.38 $346.38 $346.38 $259.88 $346.38 $346.38 $346.38 $173.19 $173.19 $274.33 $346.38 $277.10 $225.15 $346.38 N/A $200.97 $346.38 $207.83 $346.38 $346.38 $346.38 N/A N/A 26TA30 SUP Custom 27203010 26TA30 - TOOL DISSECTING TAPER 3MM 26CM 1 VERSATILE SYSTEM MIDAS REX BOTH IP/OP $380.50 $282.00 $67.71 $380.38 $380.38 $380.38 $380.38 $380.38 $380.38 $380.38 $67.71 $380.38 $380.38 $282.32 $282.32 $293.20 $198.18 $79.28 $380.38 $152.15 $380.38 $380.38 $380.38 $380.38 $380.38 $285.38 $380.38 $380.38 $380.38 $190.19 $190.19 $301.26 $380.38 $304.30 $247.25 $380.38 N/A $220.69 $380.38 $228.23 $380.38 $380.38 $380.38 N/A N/A 27-0120 SUP HCPCS C1713 27-0120 - SCREW BN 2.7MM 12MM CNN XTRMT BOTH IP/OP $445.00 $329.00 $88.32 $445.00 $200.25 $200.25 $200.25 $200.25 $445.00 $445.00 $445.00 $92.75 $445.00 $445.00 $445.00 $445.00 $445.00 $92.74 $445.00 $445.00 $263.22 $445.00 $445.00 $445.00 $445.00 $333.75 $445.00 $445.00 $445.00 $222.50 $222.50 $352.44 $445.00 $356.00 $200.25 $88.32 N/A $258.10 $445.00 $445.00 $445.00 $92.74 $445.00 N/A N/A 27-0140 SUP HCPCS C1713 27-0140 - SCREW BN 2.7MM 14MM CNN XTRMT BOTH IP/OP $445.00 $329.00 $88.32 $445.00 $200.25 $200.25 $200.25 $200.25 $445.00 $445.00 $445.00 $92.75 $445.00 $445.00 $445.00 $445.00 $445.00 $92.74 $445.00 $445.00 $263.22 $445.00 $445.00 $445.00 $445.00 $333.75 $445.00 $445.00 $445.00 $222.50 $222.50 $352.44 $445.00 $356.00 $200.25 $88.32 N/A $258.10 $445.00 $445.00 $445.00 $92.74 $445.00 N/A N/A 27-0160 SUP HCPCS C1713 27-0160 - SCREW BN 2.7MM 16MM CNN XTRMT BOTH IP/OP $445.00 $329.00 $88.32 $445.00 $200.25 $200.25 $200.25 $200.25 $445.00 $445.00 $445.00 $92.75 $445.00 $445.00 $445.00 $445.00 $445.00 $92.74 $445.00 $178.00 $263.22 $445.00 $445.00 $445.00 $445.00 $333.75 $445.00 $445.00 $445.00 $222.50 $222.50 $352.44 $445.00 $356.00 $200.25 $88.32 N/A $258.10 $445.00 $445.00 $445.00 $92.74 $445.00 N/A N/A 27-0180 SUP HCPCS C1713 27-0180 - SCREW BN 2.7MM 18MM CNN XTRMT BOTH IP/OP $445.00 $329.00 $88.32 $445.00 $200.25 $200.25 $200.25 $200.25 $445.00 $445.00 $445.00 $92.75 $445.00 $445.00 $445.00 $445.00 $445.00 $92.74 $445.00 $178.00 $263.22 $445.00 $445.00 $445.00 $445.00 $333.75 $445.00 $445.00 $445.00 $222.50 $222.50 $352.44 $445.00 $356.00 $200.25 $88.32 N/A $258.10 $445.00 $267.00 $445.00 $92.74 $445.00 N/A N/A 27020 M SUP Custom 27803010 27020 M - SHUNT NEUROSURGICAL REGULAR 110CM CONTIN CATHETER ASMBLY CSF BOTH IP/OP "$3,080.50" "$2,280.00" $548.31 "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" $548.31 "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" $641.99 "$3,080.38" "$1,232.15" "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" "$3,080.38" "$2,310.38" "$3,080.38" "$3,080.38" "$3,080.38" "$1,540.19" "$1,540.19" "$2,439.66" "$3,080.38" "$2,464.30" "$1,386.17" "$3,080.38" N/A "$1,786.69" "$3,080.38" "$1,848.23" "$3,080.38" "$3,080.38" "$3,080.38" N/A N/A 27-0200 SUP HCPCS C1713 27-0200 - SCREW BN 2.7MM 20MM CNN XTRMT BOTH IP/OP $445.00 $329.00 $88.32 $445.00 $200.25 $200.25 $200.25 $200.25 $445.00 $445.00 $445.00 $92.75 $445.00 $445.00 $445.00 $445.00 $445.00 $92.74 $445.00 $178.00 $263.22 $445.00 $445.00 $445.00 $445.00 $333.75 $445.00 $445.00 $445.00 $222.50 $222.50 $352.44 $445.00 $356.00 $200.25 $88.32 N/A $258.10 $445.00 $267.00 $445.00 $92.74 $445.00 N/A N/A 27-0220 SUP HCPCS C1713 27-0220 - SCREW BN 2.7MM 22MM CNN XTRMT BOTH IP/OP $445.00 $329.00 $88.32 $445.00 $200.25 $200.25 $200.25 $200.25 $445.00 $445.00 $445.00 $92.75 $445.00 $445.00 $445.00 $445.00 $445.00 $92.74 $445.00 $178.00 $263.22 $445.00 $445.00 $445.00 $445.00 $333.75 $445.00 $445.00 $445.00 $222.50 $222.50 $352.44 $445.00 $356.00 $200.25 $88.32 N/A $258.10 $445.00 $445.00 $445.00 $92.74 $445.00 N/A N/A 27-0240 SUP HCPCS C1713 27-0240 - SCREW BN 2.7MM 24MM CNN XTRMT BOTH IP/OP $445.00 $329.00 $88.32 $445.00 $200.25 $200.25 $200.25 $200.25 $445.00 $445.00 $445.00 $92.75 $445.00 $445.00 $445.00 $445.00 $445.00 $92.74 $445.00 $178.00 $263.22 $445.00 $445.00 $445.00 $445.00 $333.75 $445.00 $445.00 $445.00 $222.50 $222.50 $352.44 $445.00 $356.00 $200.25 $88.32 N/A $258.10 $445.00 $445.00 $445.00 $92.74 $445.00 N/A N/A 2703-3-626 SUP Custom 27203010 2703-3-626 - WIRE FX .015IN 72IN VIT BOTH IP/OP $284.50 $211.00 $50.62 $284.38 $284.38 $284.38 $284.38 $284.38 $284.38 $284.38 $50.62 $284.38 $284.38 $211.07 $211.07 $219.20 $148.16 $59.27 $284.38 $113.75 $284.38 $284.38 $284.38 $284.38 $284.38 $213.38 $284.38 $284.38 $284.38 $142.19 $142.19 $225.23 $284.38 $227.50 $184.85 $284.38 N/A $165.01 $284.38 $170.63 $284.38 $284.38 $284.38 N/A N/A 2704-1-024 SUP Custom 27203010 2704-1-024 - WIRE FX .04IN 24MM VIT BOTH IP/OP $11.50 $9.00 $2.03 $11.38 $11.38 $11.38 $11.38 $11.38 $11.38 $11.38 $2.03 $11.38 $11.38 $8.45 $8.45 $8.77 $5.93 $2.37 $11.38 $4.55 $11.38 $11.38 $11.38 $11.38 $11.38 $8.63 $11.38 $11.38 $11.38 $5.69 $5.69 $9.01 $11.38 $9.10 $7.40 $11.38 N/A $6.67 $11.38 $6.83 $11.38 $11.38 $11.38 N/A N/A 2704-3-018 SUP Custom 27203010 2704-3-018 - WIRE FX .046IN 18IN DLMLS VIT 6 PER TUBE BOTH IP/OP $58.50 $43.00 $10.41 $58.50 $58.50 $58.50 $58.50 $58.50 $58.50 $58.50 $10.41 $58.50 $58.50 $43.42 $43.42 $45.09 $30.48 $12.19 $58.50 $23.40 $58.50 $58.50 $58.50 $58.50 $58.50 $43.88 $58.50 $58.50 $58.50 $29.25 $29.25 $46.33 $58.50 $46.80 $38.03 $58.50 N/A $33.93 $58.50 $35.10 $58.50 $58.50 $58.50 N/A N/A 27050KG-S SUP Custom 27203010 27050KG-S - ELTRD ESURG YLW 24-26FR URO RLLR CUT STRL DISP BOTH IP/OP $65.50 $48.00 $11.66 $65.49 $65.49 $65.49 $65.49 $65.49 $65.49 $65.49 $11.66 $65.49 $65.49 $48.61 $48.61 $50.48 $34.12 $13.65 $65.49 $26.20 $65.49 $65.49 $65.49 $65.49 $65.49 $49.13 $65.49 $65.49 $65.49 $32.75 $32.75 $51.87 $65.49 $52.39 $42.57 $65.49 N/A $37.99 $65.49 $39.29 $65.49 $65.49 $65.49 N/A N/A 27050K-S SUP Custom 27203010 27050K-S - ELECTRODE ESURG 27FR 1 PR PNT BV COAG BOTH IP/OP $48.00 $36.00 $8.48 $47.63 $47.63 $47.63 $47.63 $47.63 $47.63 $47.63 $8.48 $47.63 $47.63 $35.35 $35.35 $36.71 $24.82 $9.93 $47.63 $19.05 $47.63 $47.63 $47.63 $47.63 $47.63 $36.00 $47.63 $47.63 $47.63 $23.82 $23.82 $37.72 $47.63 $38.10 $30.96 $47.63 N/A $27.84 $47.63 $28.58 $47.63 $47.63 $47.63 N/A N/A 27065 A SUP Custom 27803010 27065 A - SHUNT NEUROSURGICAL STANDARD 4CM CSF VENTRICULAR CATHETER BOTH IP/OP $665.00 $492.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $138.59 $665.00 $266.00 $665.00 $665.00 $665.00 $665.00 $665.00 $498.75 $665.00 $665.00 $665.00 $332.50 $332.50 $526.68 $665.00 $532.00 $299.25 $665.00 N/A $385.70 $665.00 $399.00 $665.00 $665.00 $665.00 N/A N/A 27065 B SUP Custom 27803010 27065 B - SHUNT NEUROSURGICAL STANDARD 5CM CSF VENTRICULAR CATHETER BOTH IP/OP $665.00 $492.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $138.59 $665.00 $266.00 $665.00 $665.00 $665.00 $665.00 $665.00 $498.75 $665.00 $665.00 $665.00 $332.50 $332.50 $526.68 $665.00 $532.00 $299.25 $665.00 N/A $385.70 $665.00 $399.00 $665.00 $665.00 $665.00 N/A N/A 27065 C SUP Custom 27803010 27065 C - SHUNT NEUROSURGICAL STANDARD 6MM 6CM SNAP VENTRICULAR BOTH IP/OP $665.00 $492.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $138.59 $665.00 $266.00 $665.00 $665.00 $665.00 $665.00 $665.00 $498.75 $665.00 $665.00 $665.00 $332.50 $332.50 $526.68 $665.00 $532.00 $299.25 $665.00 N/A $385.70 $665.00 $399.00 $665.00 $665.00 $665.00 N/A N/A 27065 D SUP Custom 27803010 27065 D - SHUNT NEUROSURGICAL STANDARD 7CM CSF CATHETER SNAP ENDO BOTH IP/OP $665.00 $492.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $138.59 $665.00 $266.00 $665.00 $665.00 $665.00 $665.00 $665.00 $498.75 $665.00 $665.00 $665.00 $332.50 $332.50 $526.68 $665.00 $532.00 $299.25 $665.00 N/A $385.70 $665.00 $399.00 $665.00 $665.00 $665.00 N/A N/A 27065 E SUP Custom 27803010 27065 E - SHUNT NEUROSURGICAL STANDARD 8CM CSF VENTRICULAR CATHETER BOTH IP/OP $665.00 $492.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $138.59 $665.00 $266.00 $665.00 $665.00 $665.00 $665.00 $665.00 $498.75 $665.00 $665.00 $665.00 $332.50 $332.50 $526.68 $665.00 $532.00 $299.25 $665.00 N/A $385.70 $665.00 $399.00 $665.00 $665.00 $665.00 N/A N/A 27065 F SUP Custom 27803010 27065 F - SHUNT NEUROSURGICAL STANDARD 9CM CSF CATHETER SNAP ENDO BOTH IP/OP $665.00 $492.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $138.59 $665.00 $266.00 $665.00 $665.00 $665.00 $665.00 $665.00 $498.75 $665.00 $665.00 $665.00 $332.50 $332.50 $526.68 $665.00 $532.00 $299.25 $665.00 N/A $385.70 $665.00 $399.00 $665.00 $665.00 $665.00 N/A N/A 27065 G SUP Custom 27803010 27065 G - SHUNT NEUROSURGICAL STANDARD 10CM CSF VENTRICULAR CATHETER BOTH IP/OP $665.00 $492.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $138.59 $665.00 $266.00 $665.00 $665.00 $665.00 $665.00 $665.00 $498.75 $665.00 $665.00 $665.00 $332.50 $332.50 $526.68 $665.00 $532.00 $299.25 $665.00 N/A $385.70 $665.00 $399.00 $665.00 $665.00 $665.00 N/A N/A 27065 H SUP Custom 27803010 27065 H - SHUNT NEUROSURGICAL STANDARD 11CM CSF VENTRICULAR CATHETER BOTH IP/OP $665.00 $492.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $138.59 $665.00 $266.00 $665.00 $665.00 $665.00 $665.00 $665.00 $498.75 $665.00 $665.00 $665.00 $332.50 $332.50 $526.68 $665.00 $532.00 $299.25 $665.00 N/A $385.70 $665.00 $399.00 $665.00 $665.00 $665.00 N/A N/A 27065 J SUP Custom 27803010 27065 J - SHUNT NEUROSURGICAL STANDARD 4.5CM CSF VENTRICULAR CATHETER BOTH IP/OP $826.50 $612.00 $147.12 $826.50 $826.50 $826.50 $826.50 $826.50 $826.50 $826.50 $147.12 $826.50 $826.50 $826.50 $826.50 $826.50 $826.50 $172.25 $826.50 $330.60 $826.50 $826.50 $826.50 $826.50 $826.50 $619.88 $826.50 $826.50 $826.50 $413.25 $413.25 $654.59 $826.50 $661.20 $371.93 $826.50 N/A $479.37 $826.50 $495.90 $826.50 $826.50 $826.50 N/A N/A 27065 K SUP Custom 27803010 27065 K - SHUNT NEUROSURGICAL STANDARD 6MM 5.5CM SNAP VENTRICULAR BOTH IP/OP $665.00 $492.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $138.59 $665.00 $266.00 $665.00 $665.00 $665.00 $665.00 $665.00 $498.75 $665.00 $665.00 $665.00 $332.50 $332.50 $526.68 $665.00 $532.00 $299.25 $665.00 N/A $385.70 $665.00 $399.00 $665.00 $665.00 $665.00 N/A N/A 27065 L SUP Custom 27803010 27065 L - SHUNT NEUROSURGICAL STANDARD 6.5CM CSF VENTRICULAR CATHETER BOTH IP/OP $665.00 $492.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $118.37 $665.00 $665.00 $665.00 $665.00 $665.00 $665.00 $138.59 $665.00 $266.00 $665.00 $665.00 $665.00 $665.00 $665.00 $498.75 $665.00 $665.00 $665.00 $332.50 $332.50 $526.68 $665.00 $532.00 $299.25 $665.00 N/A $385.70 $665.00 $399.00 $665.00 $665.00 $665.00 N/A N/A 27065 M SUP Custom 27803010 27065 M - SHUNT NEUROSURGICAL STANDARD 7.5CM CSF VENTRICULAR CATHETER BOTH IP/OP $826.50 $612.00 $147.12 $826.50 $826.50 $826.50 $826.50 $826.50 $826.50 $826.50 $147.12 $826.50 $826.50 $826.50 $826.50 $826.50 $826.50 $172.25 $826.50 $330.60 $826.50 $826.50 $826.50 $826.50 $826.50 $619.88 $826.50 $826.50 $826.50 $413.25 $413.25 $654.59 $826.50 $661.20 $371.93 $826.50 N/A $479.37 $826.50 $495.90 $826.50 $826.50 $826.50 N/A N/A 27065 N SUP Custom 27803010 27065 N - SHUNT NEUROSURGICAL STANDARD 8.5CM CSF VENTRICULAR CATHETER BOTH IP/OP $603.50 $447.00 $107.38 $603.25 $603.25 $603.25 $603.25 $603.25 $603.25 $603.25 $107.38 $603.25 $603.25 $603.25 $603.25 $603.25 $603.25 $125.72 $603.25 $241.30 $603.25 $603.25 $603.25 $603.25 $603.25 $452.63 $603.25 $603.25 $603.25 $301.63 $301.63 $477.77 $603.25 $482.60 $271.46 $603.25 N/A $350.03 $603.25 $361.95 $603.25 $603.25 $603.25 N/A N/A 27065 R SUP Custom 27803010 27065 R - SHUNT NEUROSURGICAL STANDARD 3CM CSF VENTRICULAR CATHETER BOTH IP/OP $826.50 $612.00 $147.12 $826.50 $826.50 $826.50 $826.50 $826.50 $826.50 $826.50 $147.12 $826.50 $826.50 $826.50 $826.50 $826.50 $826.50 $172.25 $826.50 $330.60 $826.50 $826.50 $826.50 $826.50 $826.50 $619.88 $826.50 $826.50 $826.50 $413.25 $413.25 $654.59 $826.50 $661.20 $371.93 $826.50 N/A $479.37 $826.50 $495.90 $826.50 $826.50 $826.50 N/A N/A 27065 T SUP Custom 27803010 27065 T - SHUNT NEUROSURGICAL STANDARD 3.5CM CSF VENTRICULAR CATHETER BOTH IP/OP $826.50 $612.00 $147.12 $826.50 $826.50 $826.50 $826.50 $826.50 $826.50 $826.50 $147.12 $826.50 $826.50 $826.50 $826.50 $826.50 $826.50 $172.25 $826.50 $330.60 $826.50 $826.50 $826.50 $826.50 $826.50 $619.88 $826.50 $826.50 $826.50 $413.25 $413.25 $654.59 $826.50 $661.20 $371.93 $826.50 N/A $479.37 $826.50 $495.90 $826.50 $826.50 $826.50 N/A N/A 27097-1 SUP Custom 27803010 27097-1 - SHUNT NEUROSURGICAL SNAP 2 LATEX FREE DELTA BOTH IP/OP "$3,009.50" "$2,227.00" $535.63 "$3,009.13" "$3,009.13" "$3,009.13" "$3,009.13" "$3,009.13" "$3,009.13" "$3,009.13" $535.63 "$3,009.13" "$3,009.13" "$3,009.13" "$3,009.13" "$3,009.13" "$3,009.13" $627.14 "$3,009.13" "$1,203.65" "$3,009.13" "$3,009.13" "$3,009.13" "$3,009.13" "$3,009.13" "$2,257.13" "$3,009.13" "$3,009.13" "$3,009.13" "$1,504.57" "$1,504.57" "$2,383.23" "$3,009.13" "$2,407.30" "$1,354.11" "$3,009.13" N/A "$1,745.51" "$3,009.13" "$1,805.48" "$3,009.13" "$3,009.13" "$3,009.13" N/A N/A 27167 L SUP Custom 27803010 27167 L - SHUNT NEUROSURGICAL 110CM LOW PRESSURE CSF CATHETER BUTTON BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 27167 M SUP Custom 27803010 27167 M - SHUNT NEUROSURGICAL 110CM MEDIUM PRESSURE CSF CATHETER BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 27183-1 SUP Custom 27803010 27183-1 - SHUNT NEUROSURGICAL SMALL STANDARD PERFORMANCE LEVEL 1 CSF BOTH IP/OP "$5,080.50" "$3,760.00" $904.26 "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" $904.26 "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$1,058.75" "$5,080.13" "$2,032.05" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$3,810.38" "$5,080.13" "$5,080.13" "$5,080.13" "$2,540.07" "$2,540.07" "$4,023.46" "$5,080.13" "$4,064.10" "$2,286.06" "$5,080.13" N/A "$2,946.69" "$5,080.13" "$3,048.08" "$5,080.13" "$5,080.13" "$5,080.13" N/A N/A 27183-2 SUP Custom 27803010 27183-2 - SHUNT NEUROSURGICAL SMALL STANDARD PERFORMANCE LEVEL 2 CSF BOTH IP/OP "$5,080.50" "$3,760.00" $904.26 "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" $904.26 "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$1,058.75" "$5,080.13" "$2,032.05" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$3,810.38" "$5,080.13" "$5,080.13" "$5,080.13" "$2,540.07" "$2,540.07" "$4,023.46" "$5,080.13" "$4,064.10" "$2,286.06" "$5,080.13" N/A "$2,946.69" "$5,080.13" "$3,048.08" "$5,080.13" "$5,080.13" "$5,080.13" N/A N/A 27183-4 SUP Custom 27803010 27183-4 - SHUNT NEUROSURGICAL SMALL STANDARD PERFORMANCE LEVEL .5 CSF BOTH IP/OP "$5,080.50" "$3,760.00" $904.26 "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" $904.26 "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$1,058.75" "$5,080.13" "$2,032.05" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$3,810.38" "$5,080.13" "$5,080.13" "$5,080.13" "$2,540.07" "$2,540.07" "$4,023.46" "$5,080.13" "$4,064.10" "$2,286.06" "$5,080.13" N/A "$2,946.69" "$5,080.13" "$3,048.08" "$5,080.13" "$5,080.13" "$5,080.13" N/A N/A 27183-5 SUP Custom 27803010 27183-5 - SHUNT NEUROSURGICAL SMALL STANDARD PERFORMANCE LEVEL 1.5 CSF BOTH IP/OP "$5,080.50" "$3,760.00" $904.26 "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" $904.26 "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$1,058.75" "$5,080.13" "$2,032.05" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$5,080.13" "$3,810.38" "$5,080.13" "$5,080.13" "$5,080.13" "$2,540.07" "$2,540.07" "$4,023.46" "$5,080.13" "$4,064.10" "$2,286.06" "$5,080.13" N/A "$2,946.69" "$5,080.13" "$3,048.08" "$5,080.13" "$5,080.13" "$5,080.13" N/A N/A 27202-05 SUP HCPCS C1765 27202-05 - BARRIER ADHESION 130X100X.02MM BIORESORBABLE SHEET SURGIWRAP BOTH IP/OP $560.00 $414.00 $111.15 $560.00 $252.00 $252.00 $252.00 $252.00 $560.00 $560.00 $560.00 $116.72 $560.00 $560.00 $560.00 $560.00 $560.00 $116.71 $560.00 $560.00 $331.24 $560.00 $560.00 $560.00 $560.00 $420.00 $560.00 $560.00 $560.00 $280.00 $280.00 $443.52 $560.00 $448.00 $252.00 $111.15 N/A $324.80 $560.00 $560.00 $560.00 $116.70 $560.00 N/A N/A 27203-5 SUP Custom 27203010 27203-5 - SHUNT NEUROSURGICAL RESERVOIR CSF KIT STERILE BOTH IP/OP "$5,472.00" "$4,049.00" $974.02 "$5,472.00" "$5,472.00" "$5,472.00" "$5,472.00" "$5,472.00" "$5,472.00" "$5,472.00" $974.02 "$5,472.00" "$5,472.00" "$4,061.32" "$4,061.32" "$4,217.82" "$2,060.15" "$1,140.42" "$5,472.00" "$2,188.80" "$5,472.00" "$5,472.00" "$5,472.00" "$5,472.00" "$5,472.00" "$4,104.00" "$5,472.00" "$5,472.00" "$5,472.00" "$2,736.00" "$2,736.00" "$4,333.82" "$5,472.00" "$4,377.60" "$3,556.80" "$5,472.00" N/A "$3,173.76" "$5,472.00" "$3,283.20" "$5,472.00" "$5,472.00" "$5,472.00" N/A N/A 27204-05 SUP HCPCS C1765 27204-05 - BARRIER ADHESION 130X100X.02MM BIORESORBABLE SHEET SURGIWRAP BOTH IP/OP $642.50 $475.00 $127.52 $642.50 $289.13 $289.13 $289.13 $289.13 $642.50 $642.50 $642.50 $133.91 $642.50 $642.50 $642.50 $642.50 $642.50 $133.90 $642.50 $642.50 $380.04 $642.50 $642.50 $642.50 $642.50 $481.88 $642.50 $642.50 $642.50 $321.25 $321.25 $508.86 $642.50 $514.00 $289.13 $127.52 N/A $372.65 $642.50 $642.50 $642.50 $133.90 $642.50 N/A N/A 27219-1 SUP Custom 27803010 27219-1 - VALVE SHUNT PERFORMANCE LEVEL 1 CSF LOW PRESSURE INTEGRAL BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 27219-2 SUP Custom 27803010 27219-2 - VALVE SHUNT PERFORMANCE LEVEL 2 CSF LOW PRESSURE INTEGRAL BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 27219-5 SUP Custom 27803010 27219-5 - VALVE SHUNT PERFORMANCE LEVEL 1.5 CSF LOW PRESSURE INTEGRAL BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 27224-1 SUP Custom 27203010 27224-1 - SHUNT NEUROSURGICAL 110CM PERFORMANCE LEVEL 1 SNAP ASMBLY BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$3,528.98" "$3,528.98" "$3,664.96" "$2,060.15" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$3,090.59" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 27224-2 SUP Custom 27203010 27224-2 - SHUNT NEUROSURGICAL 110CM PERFORMANCE LEVEL 2 SNAP ASMBLY BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$3,528.98" "$3,528.98" "$3,664.96" "$2,060.15" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$3,090.59" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 27224-4 SUP Custom 27203010 27224-4 - SHUNT NEUROSURGICAL 110CM PERFORMANCE LEVEL .5 SNAP ASMBLY BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$3,528.98" "$3,528.98" "$3,664.96" "$2,060.15" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$3,090.59" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 27224-5 SUP Custom 27203010 27224-5 - VALVE SHUNT SMALL 110CM CSF PERITONEAL CATHETER SNAP ASMBLY BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$3,528.98" "$3,528.98" "$3,664.96" "$2,060.15" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$3,090.59" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 27241 L SUP Custom 27803010 27241 L - SHUNT NS 10MM 50MM PRTNL CATH NEO BOTH IP/OP "$1,211.50" $897.00 $215.60 "$1,211.25" "$1,211.25" "$1,211.25" "$1,211.25" "$1,211.25" "$1,211.25" "$1,211.25" $215.60 "$1,211.25" "$1,211.25" "$1,211.25" "$1,211.25" "$1,211.25" "$1,211.25" $252.44 "$1,211.25" $484.50 "$1,211.25" "$1,211.25" "$1,211.25" "$1,211.25" "$1,211.25" $908.63 "$1,211.25" "$1,211.25" "$1,211.25" $605.63 $605.63 $959.31 "$1,211.25" $969.00 $545.06 "$1,211.25" N/A $702.67 "$1,211.25" $726.75 "$1,211.25" "$1,211.25" "$1,211.25" N/A N/A 27242 L SUP Custom 27803010 27242 L - SHUNT NEUROSURGICAL LOW PRESSURE CSF BUTTON INTEGRATED BOTH IP/OP "$2,563.00" "$1,897.00" $456.15 "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" $456.15 "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" $534.08 "$2,562.63" "$1,025.05" "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" "$1,922.25" "$2,562.63" "$2,562.63" "$2,562.63" "$1,281.32" "$1,281.32" "$2,029.60" "$2,562.63" "$2,050.10" "$1,153.18" "$2,562.63" N/A "$1,486.54" "$2,562.63" "$1,537.58" "$2,562.63" "$2,562.63" "$2,562.63" N/A N/A 27242 LL SUP Custom 27803010 27242 LL - SHUNT NEUROSURGICAL VERY LOW PRESSURE CSF BUTTON INTEGRATED BOTH IP/OP "$2,563.00" "$1,897.00" $456.15 "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" $456.15 "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" $534.08 "$2,562.63" "$1,025.05" "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" "$2,562.63" "$1,922.25" "$2,562.63" "$2,562.63" "$2,562.63" "$1,281.32" "$1,281.32" "$2,029.60" "$2,562.63" "$2,050.10" "$1,153.18" "$2,562.63" N/A "$1,486.54" "$2,562.63" "$1,537.58" "$2,562.63" "$2,562.63" "$2,562.63" N/A N/A 274.00S SUP HCPCS C1713 274.00S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 340MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" $840.69 "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$2,101.73" "$2,101.73" $438.00 "$2,101.73" N/A N/A 274.01S SUP HCPCS C1713 274.01S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 36CM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" $840.69 "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$1,261.04" "$2,101.73" $438.00 "$2,101.73" N/A N/A 274.02S SUP HCPCS C1713 274.02S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" $840.69 "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$1,261.04" "$2,101.73" $438.00 "$2,101.73" N/A N/A 274.03S SUP HCPCS C1713 274.03S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" $840.69 "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$2,101.73" "$2,101.73" $438.00 "$2,101.73" N/A N/A 274.04S SUP HCPCS C1713 274.04S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" $840.69 "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$2,101.73" "$2,101.73" $438.00 "$2,101.73" N/A N/A 274.05S SUP HCPCS C1713 274.05S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 440MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" "$2,101.73" "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$1,261.04" "$2,101.73" $438.00 "$2,101.73" N/A N/A 274.06S SUP HCPCS C1713 274.06S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 460MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" "$2,101.73" "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$1,261.04" "$2,101.73" $438.00 "$2,101.73" N/A N/A 274.07S SUP HCPCS C1713 274.07S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 480MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" "$2,101.73" "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$1,261.04" "$2,101.73" $438.00 "$2,101.73" N/A N/A 274.08S SUP HCPCS C1713 274.08S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" $840.69 "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$1,261.04" "$2,101.73" "$2,101.73" "$2,101.73" N/A N/A 274.09S SUP HCPCS C1713 274.09S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" "$2,101.73" "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" N/A N/A 274.10S SUP HCPCS C1713 274.10S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 340MM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.11S SUP HCPCS C1713 274.11S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.12S SUP HCPCS C1713 274.12S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 380MM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.13S SUP HCPCS C1713 274.13S - NAIL INTRAMEDULLARY 400MM 11MM 40CM STAINLEES STEEL FEMUR BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.14S SUP HCPCS C1713 274.14S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 420MM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.15S SUP HCPCS C1713 274.15S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 440MM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.16S SUP HCPCS C1713 274.16S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 460MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" "$2,101.73" "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$2,101.73" "$2,101.73" $438.00 "$2,101.73" N/A N/A 274.17S SUP HCPCS C1713 274.17S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 480MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" "$2,101.73" "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$1,261.04" "$2,101.73" $438.00 "$2,101.73" N/A N/A 274.18S SUP HCPCS C1713 274.18S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" "$2,101.73" "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$1,261.04" "$2,101.73" $438.00 "$2,101.73" N/A N/A 274.19S SUP HCPCS C1713 274.19S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 320MM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.20S SUP HCPCS C1713 274.20S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 12MM 34CMX.12CM BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" "$2,101.73" "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$1,261.04" "$2,101.73" $438.00 "$2,101.73" N/A N/A 274.21S SUP HCPCS C1713 274.21S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" "$2,101.73" "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$1,261.04" "$2,101.73" "$2,101.73" "$2,101.73" N/A N/A 274.22S SUP HCPCS C1713 274.22S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" "$2,101.73" "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$1,261.04" "$2,101.73" "$2,101.73" "$2,101.73" N/A N/A 274.23S SUP HCPCS C1713 274.23S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 4000CM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" "$2,101.73" "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$1,261.04" "$2,101.73" $438.00 "$2,101.73" N/A N/A 274.24S SUP HCPCS C1713 274.24S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM STAINLESS STEEL BOTH IP/OP "$2,102.00" "$1,555.00" $417.14 "$2,101.73" $945.78 $945.78 $945.78 $945.78 "$2,101.73" "$2,101.73" "$2,101.73" $438.05 "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" $438.02 "$2,101.73" "$2,101.73" "$1,243.17" "$2,101.73" "$2,101.73" "$2,101.73" "$2,101.73" "$1,576.50" "$2,101.73" "$2,101.73" "$2,101.73" "$1,050.87" "$1,050.87" "$1,664.57" "$2,101.73" "$1,681.38" $945.78 $417.14 N/A "$1,219.16" "$2,101.73" "$1,261.04" "$2,101.73" $438.00 "$2,101.73" N/A N/A 274.25S SUP HCPCS C1713 274.25S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 12MM 44CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.26S SUP HCPCS C1713 274.26S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 12MM 46CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.27S SUP HCPCS C1713 274.27S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 480MM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 274.28S SUP HCPCS C1713 274.28S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 274.29S SUP HCPCS C1713 274.29S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 320MM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.30S SUP HCPCS C1713 274.30S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 34CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 274.31S SUP HCPCS C1713 274.31S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 274.32S SUP HCPCS C1713 274.32S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 38CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.33S SUP HCPCS C1713 274.33S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 40CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 274.34S SUP HCPCS C1713 274.34S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 42CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 274.35S SUP HCPCS C1713 274.35S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 44CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$2,117.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.36S SUP HCPCS C1713 274.36S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 13MM 46CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.37S SUP HCPCS C1713 274.37S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 480CM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 274.38S SUP HCPCS C1713 274.38S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 274.39S SUP HCPCS C1713 274.39S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM FEMUR STERILE BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.40S SUP HCPCS C1713 274.40S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 34CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 274.41S SUP HCPCS C1713 274.41S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 36CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.42S SUP HCPCS C1713 274.42S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 38CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.43S SUP HCPCS C1713 274.43S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 40CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.44S SUP HCPCS C1713 274.44S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 42CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.45S SUP HCPCS C1713 274.45S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 44CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.46S SUP HCPCS C1713 274.46S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 14MM 46CMX.12CM BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.47S SUP HCPCS C1713 274.47S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 480MM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.48S SUP HCPCS C1713 274.48S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 300MM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" $441.29 "$2,117.50" N/A N/A 274.49S SUP HCPCS C1713 274.49S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 320MM STAINLESS STEEL BOTH IP/OP "$2,117.50" "$1,567.00" $420.27 "$2,117.50" $952.88 $952.88 $952.88 $952.88 "$2,117.50" "$2,117.50" "$2,117.50" $441.34 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" "$2,117.50" "$1,252.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 $420.27 N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 274.50S SUP HCPCS C1713 274.50S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 34CMX.12CM BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" "$2,277.00" "$2,277.00" N/A N/A 274.51S SUP HCPCS C1713 274.51S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 36CMX.12CM BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.52S SUP HCPCS C1713 274.52S - NAIL INTRAMEDULLARY UNIVERSAL 15MM 380MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.53S SUP HCPCS C1713 274.53S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 40CMX.12CM BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.54S SUP HCPCS C1713 274.54S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 42CMX.12CM BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.55S SUP HCPCS C1713 274.55S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 44CMX.12CM BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$2,277.00" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.56S SUP HCPCS C1713 274.56S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 15MM 46CMX.12CM BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.57S SUP HCPCS C1713 274.57S - NAIL INTRAMEDULLARY UNIVERSAL 15MM 480MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.58S SUP HCPCS C1713 274.58S - NAIL INTRAMEDULLARY UNIVERSAL 15MM 300MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" "$2,277.00" "$2,277.00" N/A N/A 274.59S SUP HCPCS C1713 274.59S - NAIL INTRAMEDULLARY UNIVERSAL 15MM 320MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" "$2,277.00" "$2,277.00" N/A N/A 274.60S SUP HCPCS C1713 274.60S - NAIL INTRAMEDULLARY UNIVERSAL CONE THREAD TUBE BARREL 16MM BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" "$2,277.00" "$2,277.00" N/A N/A 274.61S SUP HCPCS C1713 274.61S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 36CMX.12CM BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.62S SUP HCPCS C1713 274.62S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 38CMX.12CM BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.63S SUP HCPCS C1713 274.63S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 40CMX.12CM BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.64S SUP HCPCS C1713 274.64S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 42CMX.12CM BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" "$2,277.00" "$2,277.00" N/A N/A 274.65S SUP HCPCS C1713 274.65S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 44CMX.12CM BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" "$2,277.00" "$2,277.00" N/A N/A 274.66S SUP HCPCS C1713 274.66S - NAIL INTRAMEDULLARY UNIVERSAL TUBULAR BARREL 16MM 46CMX.12CM BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.67S SUP HCPCS C1713 274.67S - NAIL INTRAMEDULLARY UNIVERSAL 16MM 480MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.68S SUP HCPCS C1713 274.68S - NAIL INTRAMEDULLARY UNIVERSAL 16MM 300MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.69S SUP HCPCS C1713 274.69S - NAIL INTRAMEDULLARY UNIVERSAL 16MM 320MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.70S SUP HCPCS C1713 274.70S - NAIL INTRAMEDULLARY UNIVERSAL 17MM 34CM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" "$2,277.00" "$2,277.00" N/A N/A 274.71S SUP HCPCS C1713 274.71S - NAIL INTRAMEDULLARY UNIVERSAL 17MM 360MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" "$2,277.00" "$2,277.00" N/A N/A 274.72S SUP HCPCS C1713 274.72S - NAIL INTRAMEDULLARY UNIVERSAL 17MM 380MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" "$2,277.00" "$2,277.00" N/A N/A 274.73S SUP HCPCS C1713 274.73S - NAIL INTRAMEDULLARY UNIVERSAL 17MM 400MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.74S SUP HCPCS C1713 274.74S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 420MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.75S SUP HCPCS C1713 274.75S - NAIL INTRAMEDULLARY UNIVERSAL 17MM 440MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$2,277.00" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.76S SUP HCPCS C1713 274.76S - NAIL INTRAMEDULLARY UNIVERSAL 17MM 460MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$2,277.00" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.77S SUP HCPCS C1713 274.77S - NAIL INTRAMEDULLARY UNIVERSAL 17MM 480MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.78S SUP HCPCS C1713 274.78S - NAIL INTRAMEDULLARY 300MM 17MM 30CM STAINLEES STEEL FEMUR BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.79S SUP HCPCS C1713 274.79S - NAIL INTRAMEDULLARY UNIVERSAL 17MM 320MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.80S SUP HCPCS C1713 274.80S - NAIL INTRAMEDULLARY UNIVERSAL 18MM 340MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.81S SUP HCPCS C1713 274.81S - NAIL INTRAMEDULLARY UNIVERSAL 18MM 360MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" "$2,277.00" "$2,277.00" N/A N/A 274.82S SUP HCPCS C1713 274.82S - NAIL INTRAMEDULLARY UNIVERSAL 18MM 380MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.83S SUP HCPCS C1713 274.83S - NAIL INTRAMEDULLARY UNIVERSAL 18MM 400MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" "$2,277.00" "$2,277.00" N/A N/A 274.84S SUP HCPCS C1713 274.84S - NAIL INTRAMEDULLARY UNIVERSAL 18MM 420MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" "$2,277.00" "$2,277.00" N/A N/A 274.85S SUP HCPCS C1713 274.85S - NAIL INTRAMEDULLARY UNIVERSAL 18MM 18MM 440MM STAINLESS BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.86S SUP HCPCS C1713 274.86S - NAIL INTRAMEDULLARY UNIVERSAL 18MM 460MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.87S SUP HCPCS C1713 274.87S - NAIL INTRAMEDULLARY UNIVERSAL 18MM 480MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.88S SUP HCPCS C1713 274.88S - NAIL INTRAMEDULLARY UNIVERSAL 18MM 300MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.89S SUP HCPCS C1713 274.89S - NAIL INTRAMEDULLARY UNIVERSAL 18MM 320MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" "$2,277.00" "$2,277.00" N/A N/A 274.92S SUP HCPCS C1713 274.92S - NAIL INTRAMEDULLARY UNIVERSAL 19MM 380MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" "$2,277.00" "$2,277.00" N/A N/A 274.93S SUP HCPCS C1713 274.93S - NAIL INTRAMEDULLARY UNIVERSAL 19MM 400MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.94S SUP HCPCS C1713 274.94S - NAIL INTRAMEDULLARY UNIVERSAL 19MM 420MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" $910.80 "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.95S SUP HCPCS C1713 274.95S - NAIL INTRAMEDULLARY UNIVERSAL 19MM 440MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$2,277.00" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.96S SUP HCPCS C1713 274.96S - NAIL INTRAMEDULLARY UNIVERSAL 19MM 460MM STAINLESS STEEL BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 274.97S SUP HCPCS C1713 274.97S - NAIL INTRAMEDULLARY UNIVERSAL 19MM 480MM DCP LC-DCP BOTH IP/OP "$2,277.00" "$1,685.00" $451.93 "$2,277.00" "$1,024.65" "$1,024.65" "$1,024.65" "$1,024.65" "$2,277.00" "$2,277.00" "$2,277.00" $474.58 "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" $474.55 "$2,277.00" "$2,277.00" "$1,346.85" "$2,277.00" "$2,277.00" "$2,277.00" "$2,277.00" "$1,707.75" "$2,277.00" "$2,277.00" "$2,277.00" "$1,138.50" "$1,138.50" "$1,803.38" "$2,277.00" "$1,821.60" "$1,024.65" $451.93 N/A "$1,320.66" "$2,277.00" "$1,366.20" "$2,277.00" $474.53 "$2,277.00" N/A N/A 27448 B SUP Custom 27803010 27448 B - SHUNT NEUROSURGICAL STANDARD 120CM CSF BARIUM IMPREGNATED BOTH IP/OP $418.00 $309.00 $74.40 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $74.40 $418.00 $418.00 $418.00 $418.00 $418.00 $418.00 $87.12 $418.00 $167.20 $418.00 $418.00 $418.00 $418.00 $418.00 $313.50 $418.00 $418.00 $418.00 $209.00 $209.00 $331.06 $418.00 $334.40 $188.10 $418.00 N/A $242.44 $418.00 $250.80 $418.00 $418.00 $418.00 N/A N/A 27451-5 SUP Custom 27803010 27451-5 - SHUNT NEUROSURGICAL SMALL PERFORMANCE LEVEL 1.5 CSF ASMBLY BOTH IP/OP "$4,662.50" "$3,450.00" $829.86 "$4,662.13" "$4,662.13" "$4,662.13" "$4,662.13" "$4,662.13" "$4,662.13" "$4,662.13" $829.86 "$4,662.13" "$4,662.13" "$4,662.13" "$4,662.13" "$4,662.13" "$4,662.13" $971.64 "$4,662.13" "$1,864.85" "$4,662.13" "$4,662.13" "$4,662.13" "$4,662.13" "$4,662.13" "$3,496.88" "$4,662.13" "$4,662.13" "$4,662.13" "$2,331.07" "$2,331.07" "$3,692.41" "$4,662.13" "$3,729.70" "$2,097.96" "$4,662.13" N/A "$2,704.25" "$4,662.13" "$2,797.28" "$4,662.13" "$4,662.13" "$4,662.13" N/A N/A 27490 L SUP Custom 27803010 27490 L - SHUNT NEUROSURGICAL SMALL 120CM CSF LOW PRESSURE PERITONEAL BOTH IP/OP "$2,615.00" "$1,935.00" $465.45 "$2,614.88" "$2,614.88" "$2,614.88" "$2,614.88" "$2,614.88" "$2,614.88" "$2,614.88" $465.45 "$2,614.88" "$2,614.88" "$2,614.88" "$2,614.88" "$2,614.88" "$2,614.88" $544.97 "$2,614.88" "$1,045.95" "$2,614.88" "$2,614.88" "$2,614.88" "$2,614.88" "$2,614.88" "$1,961.25" "$2,614.88" "$2,614.88" "$2,614.88" "$1,307.44" "$1,307.44" "$2,070.98" "$2,614.88" "$2,091.90" "$1,176.70" "$2,614.88" N/A "$1,516.70" "$2,614.88" "$1,568.93" "$2,614.88" "$2,614.88" "$2,614.88" N/A N/A 27496 L SUP Custom 27803010 27496 L - SHUNT NEUROSURGICAL ULTRA SMALL 120CM CSF LOW PRESSURE BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 27496 M SUP Custom 27803010 27496 M - SHUNT NEUROSURGICAL ULTRA SMALL 120CM CSF MEDIUM PRESSURE BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 27499-1 SUP Custom 27803010 27499-1 - SHUNT NEUROSURGICAL SMALL 90CM PERFORMANCE LEVEL 1 CSF BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$2,139.64" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 27499-5 SUP Custom 27803010 27499-5 - SHUNT NEUROSURGICAL SMALL 90CM PERFORMANCE LEVEL 1.5 CSF BOTH IP/OP "$4,755.00" "$3,519.00" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $846.35 "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" $990.94 "$4,754.75" "$1,901.90" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$4,754.75" "$3,566.25" "$4,754.75" "$4,754.75" "$4,754.75" "$2,377.38" "$2,377.38" "$3,765.76" "$4,754.75" "$3,803.80" "$2,139.64" "$4,754.75" N/A "$2,757.90" "$4,754.75" "$2,852.85" "$4,754.75" "$4,754.75" "$4,754.75" N/A N/A 27505-1 SUP Custom 27803010 27505-1 - RESERVOIR SHUNT 120CM PERFORMANCE LEVEL 1 VENTRICULAR BOTH IP/OP "$3,945.00" "$2,919.00" $702.19 "$3,944.88" "$3,944.88" "$3,944.88" "$3,944.88" "$3,944.88" "$3,944.88" "$3,944.88" $702.19 "$3,944.88" "$3,944.88" "$3,944.88" "$3,944.88" "$3,944.88" "$3,944.88" $822.16 "$3,944.88" "$1,577.95" "$3,944.88" "$3,944.88" "$3,944.88" "$3,944.88" "$3,944.88" "$2,958.75" "$3,944.88" "$3,944.88" "$3,944.88" "$1,972.44" "$1,972.44" "$3,124.34" "$3,944.88" "$3,155.90" "$1,775.20" "$3,944.88" N/A "$2,288.10" "$3,944.88" "$2,366.93" "$3,944.88" "$3,944.88" "$3,944.88" N/A N/A 27553 H SUP Custom 27803010 27553 H - VALVE SHUNT SMALL CSF HIGH PRESSURE NONMETALLIC FLOW CONTROL BOTH IP/OP "$3,415.50" "$2,527.00" $607.91 "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" $607.91 "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" $711.78 "$3,415.25" "$1,366.10" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$2,561.63" "$3,415.25" "$3,415.25" "$3,415.25" "$1,707.63" "$1,707.63" "$2,704.88" "$3,415.25" "$2,732.20" "$1,536.86" "$3,415.25" N/A "$1,980.99" "$3,415.25" "$2,049.15" "$3,415.25" "$3,415.25" "$3,415.25" N/A N/A 27553 L SUP Custom 27803010 27553 L - VALVE SHUNT SMALL CSF LOW PRESSURE NONMETALLIC FLOW CONTROL BOTH IP/OP "$3,415.50" "$2,527.00" $607.91 "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" $607.91 "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" $711.78 "$3,415.25" "$1,366.10" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$2,561.63" "$3,415.25" "$3,415.25" "$3,415.25" "$1,707.63" "$1,707.63" "$2,704.88" "$3,415.25" "$2,732.20" "$1,536.86" "$3,415.25" N/A "$1,980.99" "$3,415.25" "$2,049.15" "$3,415.25" "$3,415.25" "$3,415.25" N/A N/A 27553 M SUP Custom 27803010 27553 M - VALVE SHUNT SMALL CSF MEDIUM PRESSURE FLOW CONTROL EXTRACT BOTH IP/OP "$3,415.50" "$2,527.00" $607.91 "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" $607.91 "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" $711.78 "$3,415.25" "$1,366.10" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$3,415.25" "$2,561.63" "$3,415.25" "$3,415.25" "$3,415.25" "$1,707.63" "$1,707.63" "$2,704.88" "$3,415.25" "$2,732.20" "$1,536.86" "$3,415.25" N/A "$1,980.99" "$3,415.25" "$2,049.15" "$3,415.25" "$3,415.25" "$3,415.25" N/A N/A 27554-1 SUP Custom 27803010 27554-1 - VALVE SHUNT SMALL PERFORMANCE LEVEL 1 CSF RESERVOIR DOME BOTH IP/OP "$5,170.50" "$3,826.00" $920.33 "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" $920.33 "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$1,077.56" "$5,170.38" "$2,068.15" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$3,877.88" "$5,170.38" "$5,170.38" "$5,170.38" "$2,585.19" "$2,585.19" "$4,094.94" "$5,170.38" "$4,136.30" "$2,326.67" "$5,170.38" N/A "$2,998.89" "$5,170.38" "$3,102.23" "$5,170.38" "$5,170.38" "$5,170.38" N/A N/A 27554-2 SUP Custom 27803010 27554-2 - VALVE SHUNT SMALL PERFORMANCE LEVEL 2 CSF RESERVOIR DOME BOTH IP/OP "$5,170.50" "$3,826.00" $920.33 "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" $920.33 "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$1,077.56" "$5,170.38" "$2,068.15" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$3,877.88" "$5,170.38" "$5,170.38" "$5,170.38" "$2,585.19" "$2,585.19" "$4,094.94" "$5,170.38" "$4,136.30" "$2,326.67" "$5,170.38" N/A "$2,998.89" "$5,170.38" "$3,102.23" "$5,170.38" "$5,170.38" "$5,170.38" N/A N/A 27554-5 SUP Custom 27803010 27554-5 - VALVE SHUNT SMALL PERFORMANCE LEVEL 5 CSF RESERVOIR DOME BOTH IP/OP "$5,170.50" "$3,826.00" $920.33 "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" $920.33 "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$1,077.56" "$5,170.38" "$2,068.15" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$5,170.38" "$3,877.88" "$5,170.38" "$5,170.38" "$5,170.38" "$2,585.19" "$2,585.19" "$4,094.94" "$5,170.38" "$4,136.30" "$2,326.67" "$5,170.38" N/A "$2,998.89" "$5,170.38" "$3,102.23" "$5,170.38" "$5,170.38" "$5,170.38" N/A N/A 275-637-000 SUP Custom 27203010 275-637-000 - CUTTER ENDSCP FULL RAD 3.5MM ARTHRO SMALL JOINT STERILE BOTH IP/OP $137.00 $101.00 $24.33 $136.70 $136.70 $136.70 $136.70 $136.70 $136.70 $136.70 $24.33 $136.70 $136.70 $101.46 $101.46 $105.37 $71.22 $28.49 $136.70 $54.68 $136.70 $136.70 $136.70 $136.70 $136.70 $102.75 $136.70 $136.70 $136.70 $68.35 $68.35 $108.27 $136.70 $109.36 $88.86 $136.70 N/A $79.46 $136.70 $82.02 $136.70 $136.70 $136.70 N/A N/A 275-641-000 SUP Custom 27203010 275-641-000 - BURR SURG ROUND 2MM ARTHRO SMALL JOINT STERILE BOTH IP/OP $145.00 $107.00 $25.77 $144.78 $144.78 $144.78 $144.78 $144.78 $144.78 $144.78 $25.77 $144.78 $144.78 $107.46 $107.46 $111.60 $75.43 $30.17 $144.78 $57.91 $144.78 $144.78 $144.78 $144.78 $144.78 $108.75 $144.78 $144.78 $144.78 $72.39 $72.39 $114.67 $144.78 $115.82 $94.11 $144.78 N/A $84.10 $144.78 $86.87 $144.78 $144.78 $144.78 N/A N/A 27573A SUP Custom 27803010 27573A - SHUNT NEUROSURGICAL ANGLE RIGHT 2.5MM 90CM VENTRICULAR BOTH IP/OP $653.50 $484.00 $116.26 $653.13 $653.13 $653.13 $653.13 $653.13 $653.13 $653.13 $116.26 $653.13 $653.13 $653.13 $653.13 $653.13 $653.13 $136.12 $653.13 $261.25 $653.13 $653.13 $653.13 $653.13 $653.13 $490.13 $653.13 $653.13 $653.13 $326.57 $326.57 $517.28 $653.13 $522.50 $293.91 $653.13 N/A $379.03 $653.13 $391.88 $653.13 $653.13 $653.13 N/A N/A 27589A SUP Custom 27803010 27589A - RESERVOIR SHUNT RIGHT ANG 12MM 4CM CSF CATHETER CONVERTIBLE BOTH IP/OP $938.50 $694.00 $166.99 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $166.99 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $195.52 $938.13 $375.25 $938.13 $938.13 $938.13 $938.13 $938.13 $703.88 $938.13 $938.13 $938.13 $469.07 $469.07 $743.00 $938.13 $750.50 $422.16 $938.13 N/A $544.33 $938.13 $562.88 $938.13 $938.13 $938.13 N/A N/A 27589B SUP Custom 27803010 27589B - RESERVOIR SHUNT ANGLE RIGHT 12MM 5CM CSF CATHETER BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 27589C SUP Custom 27803010 27589C - RESERVOIR SHUNT ANGLE RIGHT 12MM 6CM CSF CATHETER BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 27589D SUP Custom 27803010 27589D - RESERVOIR SHUNT RIGHT ANG 12MM 7CM CSF CATHETER CONVERTIBLE BOTH IP/OP $938.50 $694.00 $166.99 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $166.99 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $195.52 $938.13 $375.25 $938.13 $938.13 $938.13 $938.13 $938.13 $703.88 $938.13 $938.13 $938.13 $469.07 $469.07 $743.00 $938.13 $750.50 $422.16 $938.13 N/A $544.33 $938.13 $562.88 $938.13 $938.13 $938.13 N/A N/A 27589E SUP Custom 27803010 27589E - RESERVOIR SHUNT RIGHT ANG 12MM 8CM CSF CATHETER CONVERTIBLE BOTH IP/OP $938.50 $694.00 $166.99 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $166.99 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $195.52 $938.13 $375.25 $938.13 $938.13 $938.13 $938.13 $938.13 $703.88 $938.13 $938.13 $938.13 $469.07 $469.07 $743.00 $938.13 $750.50 $422.16 $938.13 N/A $544.33 $938.13 $562.88 $938.13 $938.13 $938.13 N/A N/A 27589F SUP Custom 27803010 27589F - RESERVOIR SHUNT RIGHT ANG 12MM 9CM CSF CATHETER CONVERTIBLE BOTH IP/OP $938.50 $694.00 $166.99 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $166.99 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $195.52 $938.13 $375.25 $938.13 $938.13 $938.13 $938.13 $938.13 $703.88 $938.13 $938.13 $938.13 $469.07 $469.07 $743.00 $938.13 $750.50 $422.16 $938.13 N/A $544.33 $938.13 $562.88 $938.13 $938.13 $938.13 N/A N/A 27589H SUP Custom 27803010 27589H - RESERVOIR SHUNT RIGHT ANG 12MM 11CM CSF CATHETER CONVERTIBLE BOTH IP/OP $938.50 $694.00 $166.99 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $166.99 $938.13 $938.13 $938.13 $938.13 $938.13 $938.13 $195.52 $938.13 $375.25 $938.13 $938.13 $938.13 $938.13 $938.13 $703.88 $938.13 $938.13 $938.13 $469.07 $469.07 $743.00 $938.13 $750.50 $422.16 $938.13 N/A $544.33 $938.13 $562.88 $938.13 $938.13 $938.13 N/A N/A 27607 A SUP Custom 27803010 27607 A - CATHETER DRAIN STANDARD RIGHT ANG 4CM 25CM BARIUM BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 27607 B SUP Custom 27803010 27607 B - CATHETER DRAIN STANDARD RIGHT ANG 5CM 25CM BARIUM BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 27607 C SUP Custom 27803010 27607 C - CATHETER DRAIN STANDARD RIGHT ANG 6CM 25CM BARIUM BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 27607 D SUP Custom 27803010 27607 D - CATHETER DRAIN STANDARD RIGHT ANG 7CM 25CM BARIUM BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 27643L SUP Custom 27803010 27643L - SHUNT NEUROSURGICAL SMALL 130CM LOW PRESSURE PERITONEAL BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 27643M SUP Custom 27803010 27643M - SHUNT NEUROSURGICAL SMALL 130CM MEDIUM PRESSURE PERITONEAL BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 27644DL SUP Custom 27803010 27644DL - SHUNT NEUROSURGICAL 7 SMALL 130CM LOW PRESSURE PERITONEAL BOTH IP/OP "$3,237.50" "$2,396.00" $576.21 "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" $576.21 "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" $674.65 "$3,237.13" "$1,294.85" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$2,428.13" "$3,237.13" "$3,237.13" "$3,237.13" "$1,618.57" "$1,618.57" "$2,563.81" "$3,237.13" "$2,589.70" "$1,456.71" "$3,237.13" N/A "$1,877.75" "$3,237.13" "$1,942.28" "$3,237.13" "$3,237.13" "$3,237.13" N/A N/A 27644DM SUP Custom 27803010 27644DM - SHUNT NEUROSURGICAL 7 SMALL 130CM MEDIUM PRESSURE PERITONEAL BOTH IP/OP "$3,237.50" "$2,396.00" $576.21 "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" $576.21 "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" $674.65 "$3,237.13" "$1,294.85" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$2,428.13" "$3,237.13" "$3,237.13" "$3,237.13" "$1,618.57" "$1,618.57" "$2,563.81" "$3,237.13" "$2,589.70" "$1,456.71" "$3,237.13" N/A "$1,877.75" "$3,237.13" "$1,942.28" "$3,237.13" "$3,237.13" "$3,237.13" N/A N/A 27644HM SUP Custom 27803010 27644HM - SHUNT NEUROSURGICAL 11 SMALL 130CM PERITONEAL CATHETER LATEX BOTH IP/OP "$3,237.50" "$2,396.00" $576.21 "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" $576.21 "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" $674.65 "$3,237.13" "$1,294.85" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$3,237.13" "$2,428.13" "$3,237.13" "$3,237.13" "$3,237.13" "$1,618.57" "$1,618.57" "$2,563.81" "$3,237.13" "$2,589.70" "$1,456.71" "$3,237.13" N/A "$1,877.75" "$3,237.13" "$1,942.28" "$3,237.13" "$3,237.13" "$3,237.13" N/A N/A 27645L SUP Custom 27803010 27645L - SHUNT NEUROSURGICAL REGULAR 130CM LOW PRESSURE PERITONEAL BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 27645M SUP Custom 27803010 27645M - SHUNT NEUROSURGICAL REGULAR 130CM MEDIUM PRESSURE PERITONEAL BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 27683H SUP Custom 27803010 27683H - SHUNT NEUROSURGICAL REGULAR 90CM HIGH PRESSURE STERILE BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 27683L SUP Custom 27803010 27683L - SHUNT NEUROSURGICAL REGULAR 90CM LOW PRESSURE STERILE BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 27683M SUP Custom 27803010 27683M - SHUNT NEUROSURGICAL REGULAR 90CM SNAP ASMBLY STERILE BOTH IP/OP "$3,052.00" "$2,258.00" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $543.23 "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" $636.05 "$3,051.88" "$1,220.75" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$3,051.88" "$2,289.00" "$3,051.88" "$3,051.88" "$3,051.88" "$1,525.94" "$1,525.94" "$2,417.09" "$3,051.88" "$2,441.50" "$1,373.35" "$3,051.88" N/A "$1,770.16" "$3,051.88" "$1,831.13" "$3,051.88" "$3,051.88" "$3,051.88" N/A N/A 27862M SUP Custom 27803010 27862M - SHUNT NEUROSURGICAL SMALL MEDIUM PRESSURE CSF STERILE BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 27-9020 SUP HCPCS C1713 27-9020 - COUNTERSINK DRILL 2.7MM EXTREMITY STAINLESS STEEL 2.7MM BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A 279-251-101 SUP Custom 27203010 279-251-101 - ELECTRODE ELECTROSURGICAL 2.5MM PROBE AARDVARK SERFAS ENERGY BOTH IP/OP $413.50 $306.00 $73.53 $413.09 $413.09 $413.09 $413.09 $413.09 $413.09 $413.09 $73.53 $413.09 $413.09 $306.60 $306.60 $318.41 $215.22 $86.09 $413.09 $165.24 $413.09 $413.09 $413.09 $413.09 $413.09 $310.13 $413.09 $413.09 $413.09 $206.55 $206.55 $327.17 $413.09 $330.47 $268.51 $413.09 N/A $239.83 $413.09 $247.85 $413.09 $413.09 $413.09 N/A N/A 279-351-100 SUP Custom 27203010 279-351-100 - ELECTRODE ELECTROSURGICAL 90D 3.5MM 90MM PROBE SUCTION BOTH IP/OP $433.50 $321.00 $77.08 $433.02 $433.02 $433.02 $433.02 $433.02 $433.02 $433.02 $77.08 $433.02 $433.02 $321.39 $321.39 $333.77 $225.60 $90.25 $433.02 $173.21 $433.02 $433.02 $433.02 $433.02 $433.02 $325.13 $433.02 $433.02 $433.02 $216.51 $216.51 $342.95 $433.02 $346.42 $281.46 $433.02 N/A $251.43 $433.02 $259.81 $433.02 $433.02 $433.02 N/A N/A 279-351-300 SUP Custom 27203010 279-351-300 - PROBE SCT 90MM LF 3.5MM SERFAS ENRG BOTH IP/OP $433.50 $321.00 $77.08 $433.02 $433.02 $433.02 $433.02 $433.02 $433.02 $433.02 $77.08 $433.02 $433.02 $321.39 $321.39 $333.77 $225.60 $90.25 $433.02 $173.21 $433.02 $433.02 $433.02 $433.02 $433.02 $325.13 $433.02 $433.02 $433.02 $216.51 $216.51 $342.95 $433.02 $346.42 $281.46 $433.02 N/A $251.43 $433.02 $259.81 $433.02 $433.02 $433.02 N/A N/A 2793G SUP Custom 27203010 2793G - SUTURE NABSB 9-0 BV100-4 5IN BLU PRLN MFL BOTH IP/OP $57.50 $43.00 $10.21 $59.05 $57.38 $57.38 $57.38 $57.38 $57.38 $57.38 $10.21 $57.38 $57.38 $42.59 $42.59 $44.23 $29.89 $11.96 $57.38 $23.62 $57.38 $57.38 $59.05 $57.38 $57.38 $43.13 $57.38 $57.38 $57.38 $28.69 $28.69 $45.44 $57.38 $45.90 $37.30 $57.38 N/A $33.35 $57.38 $34.43 $57.38 $57.38 $57.38 N/A N/A 279-401-100 SUP Custom 27203010 279-401-100 - PROBE SUCTION 90D 4MM ARTHRO SERFAS ENERGY MAXL STERILE BOTH IP/OP $393.50 $291.00 $69.96 $393.03 $393.03 $393.03 $393.03 $393.03 $393.03 $393.03 $69.96 $393.03 $393.03 $291.71 $291.71 $302.95 $204.77 $81.91 $393.03 $157.21 $393.03 $393.03 $393.03 $393.03 $393.03 $295.13 $393.03 $393.03 $393.03 $196.52 $196.52 $311.28 $393.03 $314.42 $255.47 $393.03 N/A $228.23 $393.03 $235.82 $393.03 $393.03 $393.03 N/A N/A 279-401-200 SUP Custom 27203010 279-401-200 - Surgical Arthroscopic Serfas 90-S 4.0mm Cruise Energ Probe BOTH IP/OP $375.00 $278.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $66.75 $375.00 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $150.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $375.00 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 2794G SUP Custom 27203010 2794G - SUTURE NONABSORBABLE 10-0 BV100-3 5CM MONOFILAMENT PROLENE BOTH IP/OP $64.00 $47.00 $11.34 $63.69 $63.69 $63.69 $63.69 $63.69 $63.69 $63.69 $11.34 $63.69 $63.69 $47.27 $47.27 $49.09 $33.18 $13.27 $63.69 $25.48 $63.69 $63.69 $63.69 $63.69 $63.69 $48.00 $63.69 $63.69 $63.69 $31.85 $31.85 $50.44 $63.69 $50.95 $41.40 $63.69 N/A $37.12 $63.69 $38.21 $63.69 $63.69 $63.69 N/A N/A 27AGFN-756 SUP Custom 27803010 27AGFN-756 - VALVE AORTIC 85D 27MM 24.9MM 1 DIGIT GRADIENT MECHANICAL BOTH IP/OP "$11,750.00" "$8,695.00" "$2,091.50" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$2,091.50" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$2,448.83" "$11,750.00" "$4,700.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$11,750.00" "$8,812.50" "$11,750.00" "$11,750.00" "$11,750.00" "$5,875.00" "$5,875.00" "$9,306.00" "$11,750.00" "$9,400.00" "$5,287.50" "$11,750.00" N/A "$6,815.00" "$11,750.00" "$7,050.00" "$11,750.00" "$11,750.00" "$11,750.00" N/A N/A 27AJ-501 SUP Custom 27803010 27AJ-501 - VALVE AOR 85D 3.67SQ CM 3.08SQ CM 27MM 22.5MM MSTR SER MECH BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 27B006 SUP Custom 27804086 27B006 - GRAFT BONE FEMORAL SHAFT BOTH IP/OP "$2,847.50" "$2,107.00" $506.86 "$3,260.00" "$2,847.50" "$2,847.50" "$2,847.50" "$2,847.50" "$2,847.50" "$2,847.50" $506.86 "$2,847.50" "$2,847.50" "$2,847.50" "$2,847.50" "$2,847.50" "$2,847.50" $593.45 "$2,847.50" "$1,304.00" "$2,847.50" "$2,847.50" "$3,260.00" "$2,847.50" "$2,847.50" "$2,135.63" "$2,847.50" "$2,847.50" "$2,847.50" "$1,423.75" "$1,423.75" "$2,255.22" "$2,847.50" "$2,278.00" "$1,281.38" "$2,847.50" N/A "$1,651.55" "$2,847.50" "$1,708.50" "$2,847.50" "$2,847.50" "$2,847.50" N/A N/A 27MJ-501 SUP Custom 27803010 27MJ-501 - VALVE MTRL 85D 3.67SQ CM STD RING 27MM 22.5MM MSTR SER LFLT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A 280.280S SUP HCPCS C1713 280.280S - SCREW BN 12.7MM 8MM 2.7MM 80MM STRL 22MM DHS DCS LG CNN BOTH IP/OP $732.50 $542.00 $145.36 $744.83 $329.57 $329.57 $329.57 $329.57 $732.38 $732.38 $732.38 $152.65 $732.38 $732.38 $732.38 $732.38 $732.38 $152.64 $732.38 $744.83 $433.20 $732.38 $744.83 $732.38 $732.38 $549.38 $732.38 $732.38 $732.38 $366.19 $366.19 $580.04 $732.38 $585.90 $329.57 $145.36 N/A $424.85 $732.38 $732.38 $732.38 $152.63 $732.38 N/A N/A 280.290S SUP HCPCS C1713 280.290S - SCREW BN 12.7MM 8MM 2.7MM 90MM STRL 22MM DHS DCS LG CNN BOTH IP/OP $732.50 $542.00 $145.36 $744.83 $329.57 $329.57 $329.57 $329.57 $732.38 $732.38 $732.38 $152.65 $732.38 $732.38 $732.38 $732.38 $732.38 $152.64 $732.38 $297.93 $433.20 $732.38 $744.83 $732.38 $732.38 $549.38 $732.38 $732.38 $732.38 $366.19 $366.19 $580.04 $732.38 $585.90 $329.57 $145.36 N/A $424.85 $732.38 $732.38 $732.38 $152.63 $732.38 N/A N/A 280.295S SUP HCPCS C1713 280.295S - SCREW BN 12.7MM 8MM 2.7MM 95MM STRL 22MM DHS DCS LG CNN BOTH IP/OP $732.50 $542.00 $145.36 $744.83 $329.57 $329.57 $329.57 $329.57 $732.38 $732.38 $732.38 $152.65 $732.38 $732.38 $732.38 $732.38 $732.38 $152.64 $732.38 $297.93 $433.20 $732.38 $744.83 $732.38 $732.38 $549.38 $732.38 $732.38 $732.38 $366.19 $366.19 $580.04 $732.38 $585.90 $329.57 $145.36 N/A $424.85 $732.38 $732.38 $732.38 $152.63 $732.38 N/A N/A 280.301S SUP HCPCS C1713 280.301S - SCREW BN 12.7MM 8MM 2.7MM 100MM STRL 22MM DHS DCS LG CNN BOTH IP/OP $732.50 $542.00 $145.36 $744.83 $329.57 $329.57 $329.57 $329.57 $732.38 $732.38 $732.38 $152.65 $732.38 $732.38 $732.38 $732.38 $732.38 $152.64 $732.38 $297.93 $433.20 $732.38 $744.83 $732.38 $732.38 $549.38 $732.38 $732.38 $732.38 $366.19 $366.19 $580.04 $732.38 $585.90 $329.57 $145.36 N/A $424.85 $732.38 $732.38 $732.38 $152.63 $732.38 N/A N/A 280.310S SUP HCPCS C1713 280.310S - SCREW BN 12.7MM 8MM 2.7MM 110MM STRL 22MM DHS DCS LG CNN BOTH IP/OP $732.50 $542.00 $145.36 $744.83 $329.57 $329.57 $329.57 $329.57 $732.38 $732.38 $732.38 $152.65 $732.38 $732.38 $732.38 $732.38 $732.38 $152.64 $732.38 $297.93 $433.20 $732.38 $744.83 $732.38 $732.38 $549.38 $732.38 $732.38 $732.38 $366.19 $366.19 $580.04 $732.38 $585.90 $329.57 $145.36 N/A $424.85 $732.38 $732.38 $732.38 $152.63 $732.38 N/A N/A 280.320S SUP HCPCS C1713 280.320S - SCREW BN 12.7MM 8MM 2.7MM 120MM STRL 22MM DHS DCS LG CNN BOTH IP/OP $732.50 $542.00 $145.36 $744.83 $329.57 $329.57 $329.57 $329.57 $732.38 $732.38 $732.38 $152.65 $732.38 $732.38 $732.38 $732.38 $732.38 $152.64 $732.38 $297.93 $433.20 $732.38 $744.83 $732.38 $732.38 $549.38 $732.38 $732.38 $732.38 $366.19 $366.19 $580.04 $732.38 $585.90 $329.57 $145.36 N/A $424.85 $732.38 $732.38 $732.38 $152.63 $732.38 N/A N/A 280.651S SUP HCPCS C1713 280.651S - SCREW BONE 14MM 50MM LAG DHS/DCS STAINLESS STEEL HIP CONDYLE BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $331.09 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $813.90 $813.90 $169.62 $813.90 N/A N/A 280.655S SUP HCPCS C1713 280.655S - SCREW BONE 14MM 55MM LAG CANN DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $827.73 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $488.34 $813.90 $169.62 $813.90 N/A N/A 280.665S SUP HCPCS C1713 280.665S - SCREW BONE 14MM 65MM LAG CANN DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $827.73 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $488.34 $813.90 $169.62 $813.90 N/A N/A 280.675S SUP HCPCS C1713 280.675S - SCREW BONE 14MM 75MM LAG CANN DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $827.73 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $488.34 $813.90 $813.90 $813.90 N/A N/A 280.685S SUP HCPCS C1713 280.685S - SCREW BONE 14MM 85MM LAG CANN DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $827.73 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $488.34 $813.90 $169.62 $813.90 N/A N/A 280.695S SUP HCPCS C1713 280.695S - SCREW BONE 14MM 95MM LAG CANN DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $827.73 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $813.90 $813.90 $813.90 $813.90 N/A N/A 280.701S SUP HCPCS C1713 280.701S - SCREW BONE 14MM 100MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $827.73 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $813.90 $813.90 $169.62 $813.90 N/A N/A 280.705S SUP HCPCS C1713 280.705S - SCREW BONE 14MM 105MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $331.09 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $813.90 $813.90 $169.62 $813.90 N/A N/A 280.715S SUP HCPCS C1713 280.715S - SCREW BONE 14MM 115MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $331.09 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $813.90 $813.90 $169.62 $813.90 N/A N/A 280.725S SUP HCPCS C1713 280.725S - SCREW BONE 14MM 8.2MM 125MM 22MM 1 STEP LAG CANN DHS/DCS BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $331.09 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $813.90 $813.90 $169.62 $813.90 N/A N/A 280.735S SUP HCPCS C1713 280.735S - SCREW BONE 14MM 135MM 22MM LAG CANN DHS/DCS STAINLESS STEEL BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $331.09 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $488.34 $813.90 $169.62 $813.90 N/A N/A 280.745S SUP HCPCS C1713 280.745S - SCREW BONE 14MM 145MM LAG DHS/DCS STAINLESS STEEL HIP BOTH IP/OP $814.00 $602.00 $161.54 $827.73 $366.26 $366.26 $366.26 $366.26 $813.90 $813.90 $813.90 $169.64 $813.90 $813.90 $813.90 $813.90 $813.90 $169.63 $813.90 $827.73 $481.42 $813.90 $827.73 $813.90 $813.90 $610.50 $813.90 $813.90 $813.90 $406.95 $406.95 $644.61 $813.90 $651.12 $366.26 $161.54 N/A $472.12 $813.90 $813.90 $813.90 $169.62 $813.90 N/A N/A 280.990S SUP HCPCS C1713 280.990S - SCREW BN 12.7MM 36MM STRL DHS DCS CMPR SCKT SS HIP CNDRL 1 BOTH IP/OP $174.00 $129.00 $34.46 $176.55 $78.12 $78.12 $78.12 $78.12 $173.60 $173.60 $173.60 $36.18 $173.60 $173.60 $173.60 $173.60 $173.60 $36.18 $173.60 $176.55 $102.68 $173.60 $176.55 $173.60 $173.60 $130.50 $173.60 $173.60 $173.60 $86.80 $86.80 $137.49 $173.60 $138.88 $78.12 $34.46 N/A $100.92 $173.60 $173.60 $173.60 $36.18 $173.60 N/A N/A 2808G SUP Custom 27203010 2808G - SUTURE NABSB 8-0 BV130-5 5IN BLK ETH MTPS MFL BOTH IP/OP $41.00 $30.00 $7.21 $41.71 $40.53 $40.53 $40.53 $40.53 $40.53 $40.53 $7.21 $40.53 $40.53 $30.08 $30.08 $31.24 $21.12 $8.45 $40.53 $16.68 $40.53 $40.53 $41.71 $40.53 $40.53 $30.75 $40.53 $40.53 $40.53 $20.27 $20.27 $32.10 $40.53 $32.42 $26.34 $40.53 N/A $23.78 $40.53 $24.32 $40.53 $40.53 $40.53 N/A N/A 281.021S SUP HCPCS C1713 281.021S - PLATE BN 130D STD BRL 46X19X5.8MM STRL 38MM DHS 2 HL SS HIP BOTH IP/OP "$1,095.50" $811.00 $217.34 "$1,113.65" $492.76 $492.76 $492.76 $492.76 "$1,095.03" "$1,095.03" "$1,095.03" $228.23 "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" $228.22 "$1,095.03" $445.46 $647.71 "$1,095.03" "$1,113.65" "$1,095.03" "$1,095.03" $821.63 "$1,095.03" "$1,095.03" "$1,095.03" $547.52 $547.52 $867.26 "$1,095.03" $876.02 $492.76 $217.34 N/A $635.39 "$1,095.03" "$1,095.03" "$1,095.03" $228.20 "$1,095.03" N/A N/A 281.031S SUP HCPCS C1713 281.031S - PLATE BN 130D STD BRL 12.6MM 62X19X5.8MM STRL 38MM DHS DCP 3 BOTH IP/OP "$1,095.50" $811.00 $217.34 "$1,113.65" $492.76 $492.76 $492.76 $492.76 "$1,095.03" "$1,095.03" "$1,095.03" $228.23 "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" $228.22 "$1,095.03" $445.46 $647.71 "$1,095.03" "$1,113.65" "$1,095.03" "$1,095.03" $821.63 "$1,095.03" "$1,095.03" "$1,095.03" $547.52 $547.52 $867.26 "$1,095.03" $876.02 $492.76 $217.34 N/A $635.39 "$1,095.03" "$1,095.03" "$1,095.03" $228.20 "$1,095.03" N/A N/A 281.040S SUP HCPCS C1713 281.040S - PLATE BN 130D STD BRL 12.6MM 78X19X5.8MM STRL 38MM DHS DCP 4 BOTH IP/OP "$1,095.50" $811.00 $217.34 "$1,113.65" $492.76 $492.76 $492.76 $492.76 "$1,095.03" "$1,095.03" "$1,095.03" $228.23 "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" $228.22 "$1,095.03" $445.46 $647.71 "$1,095.03" "$1,113.65" "$1,095.03" "$1,095.03" $821.63 "$1,095.03" "$1,095.03" "$1,095.03" $547.52 $547.52 $867.26 "$1,095.03" $876.02 $492.76 $217.34 N/A $635.39 "$1,095.03" "$1,095.03" "$1,095.03" $228.20 "$1,095.03" N/A N/A 281.060S SUP HCPCS C1713 281.060S - PLATE BN 130D STD BRL 110MM STRL 38MM DHS 6 HL SS PROX FEM BOTH IP/OP "$1,095.50" $811.00 $217.34 "$1,113.65" $492.76 $492.76 $492.76 $492.76 "$1,095.03" "$1,095.03" "$1,095.03" $228.23 "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" $228.22 "$1,095.03" $445.46 $647.71 "$1,095.03" "$1,113.65" "$1,095.03" "$1,095.03" $821.63 "$1,095.03" "$1,095.03" "$1,095.03" $547.52 $547.52 $867.26 "$1,095.03" $876.02 $492.76 $217.34 N/A $635.39 "$1,095.03" "$1,095.03" "$1,095.03" $228.20 "$1,095.03" N/A N/A 281.081S SUP HCPCS C1713 281.081S - PLATE BN 130D STD BRL 142MM STRL 38MM DHS/DCP 8 HL SS HIP BOTH IP/OP "$1,425.50" "$1,055.00" $282.90 "$1,449.60" $641.42 $641.42 $641.42 $641.42 "$1,425.38" "$1,425.38" "$1,425.38" $297.08 "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" "$1,425.38" $297.06 "$1,425.38" "$1,449.60" $843.11 "$1,425.38" "$1,449.60" "$1,425.38" "$1,425.38" "$1,069.13" "$1,425.38" "$1,425.38" "$1,425.38" $712.69 $712.69 "$1,128.90" "$1,425.38" "$1,140.30" $641.42 $282.90 N/A $826.79 "$1,425.38" "$1,425.38" "$1,425.38" $297.05 "$1,425.38" N/A N/A 281.102S SUP HCPCS C1713 281.102S - PLATE BN 135D STD BRL 12.6MM 46X19X5.8MM STRL 38MM DHS DCP 2 BOTH IP/OP "$1,095.50" $811.00 $217.34 "$1,113.65" $492.76 $492.76 $492.76 $492.76 "$1,095.03" "$1,095.03" "$1,095.03" $228.23 "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" $228.22 "$1,095.03" $445.46 $647.71 "$1,095.03" "$1,113.65" "$1,095.03" "$1,095.03" $821.63 "$1,095.03" "$1,095.03" "$1,095.03" $547.52 $547.52 $867.26 "$1,095.03" $876.02 $492.76 $217.34 N/A $635.39 "$1,095.03" "$1,095.03" "$1,095.03" $228.20 "$1,095.03" N/A N/A 281.140S SUP HCPCS C1713 281.140S - PLATE BN 135D STD BRL 12.6MM 78X19X5.8MM STRL 38MM DHS DCP 4 BOTH IP/OP "$1,095.50" $811.00 $217.34 "$1,113.65" $492.76 $492.76 $492.76 $492.76 "$1,095.03" "$1,095.03" "$1,095.03" $228.23 "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" $228.22 "$1,095.03" $445.46 $647.71 "$1,095.03" "$1,113.65" "$1,095.03" "$1,095.03" $821.63 "$1,095.03" "$1,095.03" "$1,095.03" $547.52 $547.52 $867.26 "$1,095.03" $876.02 $492.76 $217.34 N/A $635.39 "$1,095.03" "$1,095.03" "$1,095.03" $228.20 "$1,095.03" N/A N/A 281.502S SUP HCPCS C1713 281.502S - PLATE 130D SHRT BRL 46MM SS 2 HOLE DHS/DCP BONE 25MM CNDYLR BOTH IP/OP "$1,163.00" $861.00 $230.75 "$1,162.60" $523.17 $523.17 $523.17 $523.17 "$1,162.60" "$1,162.60" "$1,162.60" $242.31 "$1,162.60" "$1,162.60" "$1,162.60" "$1,162.60" "$1,162.60" $242.30 "$1,162.60" "$1,162.60" $687.68 "$1,162.60" "$1,162.60" "$1,162.60" "$1,162.60" $872.25 "$1,162.60" "$1,162.60" "$1,162.60" $581.30 $581.30 $920.78 "$1,162.60" $930.08 $523.17 $230.75 N/A $674.54 "$1,162.60" $697.56 "$1,162.60" $242.29 "$1,162.60" N/A N/A 281.520S SUP HCPCS C1713 281.520S - PLATE BN 135D SHRT BRL 12.6MM 46X19X5.8MM STRL 25MM DHS DCP BOTH IP/OP "$1,095.50" $811.00 $217.34 "$1,113.65" $492.76 $492.76 $492.76 $492.76 "$1,095.03" "$1,095.03" "$1,095.03" $228.23 "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" $228.22 "$1,095.03" $445.46 $647.71 "$1,095.03" "$1,113.65" "$1,095.03" "$1,095.03" $821.63 "$1,095.03" "$1,095.03" "$1,095.03" $547.52 $547.52 $867.26 "$1,095.03" $876.02 $492.76 $217.34 N/A $635.39 "$1,095.03" "$1,095.03" "$1,095.03" $228.20 "$1,095.03" N/A N/A 281.530S SUP HCPCS C1713 281.530S - PLATE BN 135D SHRT BRL 62MM STRL DHS/DCP 3 HL SS HIP BOTH IP/OP "$1,095.50" $811.00 $217.34 "$1,113.65" $492.76 $492.76 $492.76 $492.76 "$1,095.03" "$1,095.03" "$1,095.03" $228.23 "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" "$1,095.03" $228.22 "$1,095.03" $445.46 $647.71 "$1,095.03" "$1,113.65" "$1,095.03" "$1,095.03" $821.63 "$1,095.03" "$1,095.03" "$1,095.03" $547.52 $547.52 $867.26 "$1,095.03" $876.02 $492.76 $217.34 N/A $635.39 "$1,095.03" "$1,095.03" "$1,095.03" $228.20 "$1,095.03" N/A N/A 2813G SUP Custom 27203010 2813G - SUTURE NABSB 9-0 BV130-4 5IN BLK ETH MFL BOTH IP/OP $41.00 $30.00 $7.27 $42.05 $40.86 $40.86 $40.86 $40.86 $40.86 $40.86 $7.27 $40.86 $40.86 $30.33 $30.33 $31.49 $21.29 $8.52 $40.86 $16.82 $40.86 $40.86 $42.05 $40.86 $40.86 $30.75 $40.86 $40.86 $40.86 $20.43 $20.43 $32.36 $40.86 $32.69 $26.56 $40.86 N/A $23.78 $40.86 $24.52 $40.86 $40.86 $40.86 N/A N/A 28164FGM SUP Custom 27203010 28164FGM - FORCEPS BIPOLAR 45 D L20 CM L1 MM OD3 MM INSERT ANGLED DISTA BOTH IP/OP "$2,490.00" "$1,843.00" $443.22 "$2,490.00" "$2,490.00" "$2,490.00" "$2,490.00" "$2,490.00" "$2,490.00" "$2,490.00" $443.22 "$2,490.00" "$2,490.00" "$1,848.08" "$1,848.08" "$1,919.29" "$1,297.29" $518.94 "$2,490.00" $996.00 "$2,490.00" "$2,490.00" "$2,490.00" "$2,490.00" "$2,490.00" "$1,867.50" "$2,490.00" "$2,490.00" "$2,490.00" "$1,245.00" "$1,245.00" "$1,972.08" "$2,490.00" "$1,992.00" "$1,618.50" "$2,490.00" N/A "$1,444.20" "$2,490.00" "$1,494.00" "$2,490.00" "$2,490.00" "$2,490.00" N/A N/A 282.234S SUP Custom 27803010 282.234S - BLADE INTRAMEDULLARY NAIL HELIX 75MM LCP DHHS STERILE BOTH IP/OP $732.50 $542.00 $130.36 $744.83 $732.38 $732.38 $732.38 $732.38 $732.38 $732.38 $130.36 $732.38 $732.38 $732.38 $732.38 $732.38 $732.38 $152.64 $732.38 $297.93 $732.38 $732.38 $744.83 $732.38 $732.38 $549.38 $732.38 $732.38 $732.38 $366.19 $366.19 $580.04 $732.38 $585.90 $329.57 $732.38 N/A $424.85 $732.38 $439.43 $732.38 $732.38 $732.38 N/A N/A 282.235S SUP Custom 27803010 282.235S - BLADE INTRAMEDULLARY NAIL 80MM LCP DHHS STAINLESS STEEL HIP BOTH IP/OP $732.50 $542.00 $130.36 $744.83 $732.38 $732.38 $732.38 $732.38 $732.38 $732.38 $130.36 $732.38 $732.38 $732.38 $732.38 $732.38 $732.38 $152.64 $732.38 $297.93 $732.38 $732.38 $744.83 $732.38 $732.38 $549.38 $732.38 $732.38 $732.38 $366.19 $366.19 $580.04 $732.38 $585.90 $329.57 $732.38 N/A $424.85 $732.38 $439.43 $732.38 $732.38 $732.38 N/A N/A 282.236S SUP Custom 27803010 282.236S - BLADE SURG 85MM HELICAL STERILE BOTH IP/OP $732.50 $542.00 $130.36 $744.83 $732.38 $732.38 $732.38 $732.38 $732.38 $732.38 $130.36 $732.38 $732.38 $732.38 $732.38 $732.38 $732.38 $152.64 $732.38 $297.93 $732.38 $732.38 $744.83 $732.38 $732.38 $549.38 $732.38 $732.38 $732.38 $366.19 $366.19 $580.04 $732.38 $585.90 $329.57 $732.38 N/A $424.85 $732.38 $439.43 $732.38 $732.38 $732.38 N/A N/A 282.237S SUP Custom 27803010 282.237S - BLADE FIX 90MM HELICAL LCP DHHS STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $732.50 $542.00 $130.36 $744.83 $732.38 $732.38 $732.38 $732.38 $732.38 $732.38 $130.36 $732.38 $732.38 $732.38 $732.38 $732.38 $732.38 $152.64 $732.38 $297.93 $732.38 $732.38 $744.83 $732.38 $732.38 $549.38 $732.38 $732.38 $732.38 $366.19 $366.19 $580.04 $732.38 $585.90 $329.57 $732.38 N/A $424.85 $732.38 $439.43 $732.38 $732.38 $732.38 N/A N/A 282.238S SUP Custom 27803010 282.238S - BLADE FIX 95MM HELICAL LCP DHHS STAINLESS STEEL STERILE BOTH IP/OP $732.50 $542.00 $130.36 $744.83 $732.38 $732.38 $732.38 $732.38 $732.38 $732.38 $130.36 $732.38 $732.38 $732.38 $732.38 $732.38 $732.38 $152.64 $732.38 $297.93 $732.38 $732.38 $744.83 $732.38 $732.38 $549.38 $732.38 $732.38 $732.38 $366.19 $366.19 $580.04 $732.38 $585.90 $329.57 $732.38 N/A $424.85 $732.38 $439.43 $732.38 $732.38 $732.38 N/A N/A 282.239S SUP Custom 27803010 282.239S - BLADE FIX 100MM HELICAL LCP DHHS STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $741.00 $548.00 $131.86 $753.40 $740.80 $740.80 $740.80 $740.80 $740.80 $740.80 $131.86 $740.80 $740.80 $740.80 $740.80 $740.80 $740.80 $154.39 $740.80 $301.36 $740.80 $740.80 $753.40 $740.80 $740.80 $555.75 $740.80 $740.80 $740.80 $370.40 $370.40 $586.71 $740.80 $592.64 $333.36 $740.80 N/A $429.78 $740.80 $444.48 $740.80 $740.80 $740.80 N/A N/A 282.240S SUP Custom 27803010 282.240S - BLADE FIX 105MM LCP DHHS STAINLESS STEEL HIP STERILE BOTH IP/OP $741.00 $548.00 $131.86 $753.40 $740.80 $740.80 $740.80 $740.80 $740.80 $740.80 $131.86 $740.80 $740.80 $740.80 $740.80 $740.80 $740.80 $154.39 $740.80 $301.36 $740.80 $740.80 $753.40 $740.80 $740.80 $555.75 $740.80 $740.80 $740.80 $370.40 $370.40 $586.71 $740.80 $592.64 $333.36 $740.80 N/A $429.78 $740.80 $444.48 $740.80 $740.80 $740.80 N/A N/A 282.241S SUP Custom 27803010 282.241S - BLADE INTRAMEDULLARY NAIL HELIX 110MM LCP DHHS STERILE BOTH IP/OP $741.00 $548.00 $131.86 $753.40 $740.80 $740.80 $740.80 $740.80 $740.80 $740.80 $131.86 $740.80 $740.80 $740.80 $740.80 $740.80 $740.80 $154.39 $740.80 $301.36 $740.80 $740.80 $753.40 $740.80 $740.80 $555.75 $740.80 $740.80 $740.80 $370.40 $370.40 $586.71 $740.80 $592.64 $333.36 $740.80 N/A $429.78 $740.80 $444.48 $740.80 $740.80 $740.80 N/A N/A 282.242S SUP Custom 27803010 282.242S - BLADE INTRAMEDULLARY NAIL HELIX 115MM LCP DHHS STERILE BOTH IP/OP $741.00 $548.00 $131.86 $753.40 $740.80 $740.80 $740.80 $740.80 $740.80 $740.80 $131.86 $740.80 $740.80 $740.80 $740.80 $740.80 $740.80 $154.39 $740.80 $301.36 $740.80 $740.80 $753.40 $740.80 $740.80 $555.75 $740.80 $740.80 $740.80 $370.40 $370.40 $586.71 $740.80 $592.64 $333.36 $740.80 N/A $429.78 $740.80 $444.48 $740.80 $740.80 $740.80 N/A N/A 282.243S SUP Custom 27803010 282.243S - BLADE FIX 120MM LCP DHHS STAINLESS STEEL HIP STERILE BOTH IP/OP $741.00 $548.00 $131.86 $753.40 $740.80 $740.80 $740.80 $740.80 $740.80 $740.80 $131.86 $740.80 $740.80 $740.80 $740.80 $740.80 $740.80 $154.39 $740.80 $301.36 $740.80 $740.80 $753.40 $740.80 $740.80 $555.75 $740.80 $740.80 $740.80 $370.40 $370.40 $586.71 $740.80 $592.64 $333.36 $740.80 N/A $429.78 $740.80 $444.48 $740.80 $740.80 $740.80 N/A N/A 282.244S SUP Custom 27803010 282.244S - BLADE FIX 125MM LCP DHHS STAINLESS STEEL HIP STERILE BOTH IP/OP $741.00 $548.00 $131.86 $753.40 $740.80 $740.80 $740.80 $740.80 $740.80 $740.80 $131.86 $740.80 $740.80 $740.80 $740.80 $740.80 $740.80 $154.39 $740.80 $301.36 $740.80 $740.80 $753.40 $740.80 $740.80 $555.75 $740.80 $740.80 $740.80 $370.40 $370.40 $586.71 $740.80 $592.64 $333.36 $740.80 N/A $429.78 $740.80 $444.48 $740.80 $740.80 $740.80 N/A N/A 282.245S SUP Custom 27803010 282.245S - BLADE FIX 130MM LCP DHHS STAINLESS STEEL HIP STERILE BOTH IP/OP $749.50 $555.00 $133.36 $761.95 $749.23 $749.23 $749.23 $749.23 $749.23 $749.23 $133.36 $749.23 $749.23 $749.23 $749.23 $749.23 $749.23 $156.15 $749.23 $304.78 $749.23 $749.23 $761.95 $749.23 $749.23 $562.13 $749.23 $749.23 $749.23 $374.62 $374.62 $593.39 $749.23 $599.38 $337.15 $749.23 N/A $434.71 $749.23 $449.54 $749.23 $749.23 $749.23 N/A N/A 282.246S SUP Custom 27803010 282.246S - BLADE FIX 135MM LCP DHHS STAINLESS STEEL HIP STERILE BOTH IP/OP $749.50 $555.00 $133.36 $761.95 $749.23 $749.23 $749.23 $749.23 $749.23 $749.23 $133.36 $749.23 $749.23 $749.23 $749.23 $749.23 $749.23 $156.15 $749.23 $304.78 $749.23 $749.23 $761.95 $749.23 $749.23 $562.13 $749.23 $749.23 $749.23 $374.62 $374.62 $593.39 $749.23 $599.38 $337.15 $749.23 N/A $434.71 $749.23 $449.54 $749.23 $749.23 $749.23 N/A N/A 282.247S SUP Custom 27803010 282.247S - BLADE FIX 140MM LCP DHHS STAINLESS STEEL HIP STERILE BOTH IP/OP $749.50 $555.00 $133.36 $761.95 $749.23 $749.23 $749.23 $749.23 $749.23 $749.23 $133.36 $749.23 $749.23 $749.23 $749.23 $749.23 $749.23 $156.15 $749.23 $304.78 $749.23 $749.23 $761.95 $749.23 $749.23 $562.13 $749.23 $749.23 $749.23 $374.62 $374.62 $593.39 $749.23 $599.38 $337.15 $749.23 N/A $434.71 $749.23 $449.54 $749.23 $749.23 $749.23 N/A N/A 282.248S SUP Custom 27803010 282.248S - BLADE FIX 145MM LCP DHHS STAINLESS STEEL HIP STERILE BOTH IP/OP $749.50 $555.00 $133.36 $761.95 $749.23 $749.23 $749.23 $749.23 $749.23 $749.23 $133.36 $749.23 $749.23 $749.23 $749.23 $749.23 $749.23 $156.15 $749.23 $304.78 $749.23 $749.23 $761.95 $749.23 $749.23 $562.13 $749.23 $749.23 $749.23 $374.62 $374.62 $593.39 $749.23 $599.38 $337.15 $749.23 N/A $434.71 $749.23 $449.54 $749.23 $749.23 $749.23 N/A N/A 282.249S SUP Custom 27803010 282.249S - BLADE FIX 150MM LCP DHHS STAINLESS STEEL HIP STERILE BOTH IP/OP $749.50 $555.00 $133.36 $761.95 $749.23 $749.23 $749.23 $749.23 $749.23 $749.23 $133.36 $749.23 $749.23 $749.23 $749.23 $749.23 $749.23 $156.15 $749.23 $304.78 $749.23 $749.23 $761.95 $749.23 $749.23 $562.13 $749.23 $749.23 $749.23 $374.62 $374.62 $593.39 $749.23 $599.38 $337.15 $749.23 N/A $434.71 $749.23 $449.54 $749.23 $749.23 $749.23 N/A N/A 282.601S SUP HCPCS C1713 282.601S - SIDEPLATE BN 130D STD BRL 72MM STRL 38MM LCP DHHS 3 HL SS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" $479.77 $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.605S SUP HCPCS C1713 282.605S - SIDEPLATE BONE 130D STANDARD BARREL 162MM 38MM 8 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" $591.27 $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" $872.09 "$1,453.48" "$1,453.48" "$1,453.48" N/A N/A 282.606S SUP HCPCS C1713 282.606S - SIDEPLATE BONE 130D STANDARD BARREL 198MM 38MM 10 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" $591.27 $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" $872.09 "$1,453.48" $302.91 "$1,453.48" N/A N/A 282.607S SUP HCPCS C1713 282.607S - SIDEPLATE BONE 130D STANDARD BARREL 234MM 38MM 12 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" "$1,478.18" $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" "$1,453.48" "$1,453.48" $302.91 "$1,453.48" N/A N/A 282.608S SUP HCPCS C1713 282.608S - SIDEPLATE BONE 130D STANDARD BARREL 270MM 38MM 14 HOLE LCP BOTH IP/OP "$1,863.00" "$1,379.00" $369.67 "$1,894.23" $838.15 $838.15 $838.15 $838.15 "$1,862.55" "$1,862.55" "$1,862.55" $388.20 "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" $388.18 "$1,862.55" "$1,894.23" "$1,101.70" "$1,862.55" "$1,894.23" "$1,862.55" "$1,862.55" "$1,397.25" "$1,862.55" "$1,862.55" "$1,862.55" $931.28 $931.28 "$1,475.14" "$1,862.55" "$1,490.04" $838.15 $369.67 N/A "$1,080.54" "$1,862.55" "$1,117.53" "$1,862.55" $388.16 "$1,862.55" N/A N/A 282.610S SUP HCPCS C1713 282.610S - SIDEPLATE BN 135D STD BRL 54MM STRL 38MM LCP DHHS 2 HL SS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,179.38" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" "$1,179.38" $697.60 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.611S SUP HCPCS C1713 282.611S - SIDEPLATE BN 135D STD BRL 72MM STRL 38MM LCP DHHS 3 HL BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" $479.77 $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.615S SUP HCPCS C1713 282.615S - SIDEPLATE BONE 135D STANDARD BARREL 162MM 38MM 8 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" "$1,478.18" $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" $872.09 "$1,453.48" "$1,453.48" "$1,453.48" N/A N/A 282.616S SUP HCPCS C1713 282.616S - SIDEPLATE BONE 135D STANDARD BARREL 198MM 38MM 10 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" "$1,478.18" $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" "$1,453.48" "$1,453.48" $302.91 "$1,453.48" N/A N/A 282.617S SUP HCPCS C1713 282.617S - SIDEPLATE BONE 135D STANDARD BARREL 234MM 38MM 12 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" "$1,478.18" $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" N/A N/A 282.618S SUP HCPCS C1713 282.618S - SIDEPLATE BONE 135D STANDARD BARREL 270MM 38MM 14 HOLE LCP BOTH IP/OP "$1,863.00" "$1,379.00" $369.67 "$1,894.23" $838.15 $838.15 $838.15 $838.15 "$1,862.55" "$1,862.55" "$1,862.55" $388.20 "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" $388.18 "$1,862.55" $757.69 "$1,101.70" "$1,862.55" "$1,894.23" "$1,862.55" "$1,862.55" "$1,397.25" "$1,862.55" "$1,862.55" "$1,862.55" $931.28 $931.28 "$1,475.14" "$1,862.55" "$1,490.04" $838.15 $369.67 N/A "$1,080.54" "$1,862.55" "$1,117.53" "$1,862.55" $388.16 "$1,862.55" N/A N/A 282.619S SUP HCPCS C1713 282.619S - SIDEPLATE BONE 135D STANDARD BARREL 306MM 38MM 16 HOLE LCP BOTH IP/OP "$1,863.00" "$1,379.00" $369.67 "$1,894.23" $838.15 $838.15 $838.15 $838.15 "$1,862.55" "$1,862.55" "$1,862.55" $388.20 "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" $388.18 "$1,862.55" $757.69 "$1,101.70" "$1,862.55" "$1,894.23" "$1,862.55" "$1,862.55" "$1,397.25" "$1,862.55" "$1,862.55" "$1,862.55" $931.28 $931.28 "$1,475.14" "$1,862.55" "$1,490.04" $838.15 $369.67 N/A "$1,080.54" "$1,862.55" "$1,117.53" "$1,862.55" $388.16 "$1,862.55" N/A N/A 282.620S SUP HCPCS C1713 282.620S - SIDEPLATE BONE 135D STANDARD BARREL 342MM 38MM 18 HOLE LCP BOTH IP/OP "$1,916.00" "$1,418.00" $380.27 "$1,948.53" $862.18 $862.18 $862.18 $862.18 "$1,915.95" "$1,915.95" "$1,915.95" $399.33 "$1,915.95" "$1,915.95" "$1,915.95" "$1,915.95" "$1,915.95" $399.31 "$1,915.95" "$1,948.53" "$1,133.28" "$1,915.95" "$1,948.53" "$1,915.95" "$1,915.95" "$1,437.00" "$1,915.95" "$1,915.95" "$1,915.95" $957.98 $957.98 "$1,517.43" "$1,915.95" "$1,532.76" $862.18 $380.27 N/A "$1,111.28" "$1,915.95" "$1,149.57" "$1,915.95" $399.28 "$1,915.95" N/A N/A 282.621S SUP HCPCS C1713 282.621S - SIDEPLATE BONE 135D STANDARD BARREL 378MM 38MM 20 HOLE LCP BOTH IP/OP "$1,916.00" "$1,418.00" $380.27 "$1,948.53" $862.18 $862.18 $862.18 $862.18 "$1,915.95" "$1,915.95" "$1,915.95" $399.33 "$1,915.95" "$1,915.95" "$1,915.95" "$1,915.95" "$1,915.95" $399.31 "$1,915.95" "$1,948.53" "$1,133.28" "$1,915.95" "$1,948.53" "$1,915.95" "$1,915.95" "$1,437.00" "$1,915.95" "$1,915.95" "$1,915.95" $957.98 $957.98 "$1,517.43" "$1,915.95" "$1,532.76" $862.18 $380.27 N/A "$1,111.28" "$1,915.95" "$1,915.95" "$1,915.95" $399.28 "$1,915.95" N/A N/A 282.635S SUP HCPCS C1713 282.635S - SIDEPLATE BONE 140D STANDARD BARREL 162MM 38MM 8 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" $591.27 $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" "$1,453.48" "$1,453.48" $302.91 "$1,453.48" N/A N/A 282.636S SUP HCPCS C1713 282.636S - SIDEPLATE BONE 140D STANDARD BARREL 198MM 38MM 10 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" $591.27 $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" "$1,453.48" "$1,453.48" $302.91 "$1,453.48" N/A N/A 282.637S SUP HCPCS C1713 282.637S - SIDEPLATE BONE 140D STANDARD BARREL 234MM 38MM 12 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" $591.27 $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" "$1,453.48" "$1,453.48" $302.91 "$1,453.48" N/A N/A 282.638S SUP HCPCS C1713 282.638S - SIDEPLATE BONE 140D STANDARD BARREL 270MM 38MM 14 HOLE LCP BOTH IP/OP "$1,863.00" "$1,379.00" $369.67 "$1,894.23" $838.15 $838.15 $838.15 $838.15 "$1,862.55" "$1,862.55" "$1,862.55" $388.20 "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" $388.18 "$1,862.55" "$1,894.23" "$1,101.70" "$1,862.55" "$1,894.23" "$1,862.55" "$1,862.55" "$1,397.25" "$1,862.55" "$1,862.55" "$1,862.55" $931.28 $931.28 "$1,475.14" "$1,862.55" "$1,490.04" $838.15 $369.67 N/A "$1,080.54" "$1,862.55" "$1,862.55" "$1,862.55" $388.16 "$1,862.55" N/A N/A 282.639S SUP HCPCS C1713 282.639S - SIDEPLATE BONE 140D STANDARD BARREL 306MM 38MM 16 HOLE LCP BOTH IP/OP "$1,863.00" "$1,379.00" $369.67 "$1,894.23" $838.15 $838.15 $838.15 $838.15 "$1,862.55" "$1,862.55" "$1,862.55" $388.20 "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" $388.18 "$1,862.55" $757.69 "$1,101.70" "$1,862.55" "$1,894.23" "$1,862.55" "$1,862.55" "$1,397.25" "$1,862.55" "$1,862.55" "$1,862.55" $931.28 $931.28 "$1,475.14" "$1,862.55" "$1,490.04" $838.15 $369.67 N/A "$1,080.54" "$1,862.55" "$1,862.55" "$1,862.55" $388.16 "$1,862.55" N/A N/A 282.645S SUP HCPCS C1713 282.645S - SIDEPLATE BONE 145D STANDARD BARREL 162MM 38MM 8 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" "$1,478.18" $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" "$1,453.48" "$1,453.48" $302.91 "$1,453.48" N/A N/A 282.646S SUP HCPCS C1713 282.646S - SIDEPLATE BONE 145D STANDARD BARREL 198MM 38MM 10 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" "$1,478.18" $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" "$1,453.48" "$1,453.48" $302.91 "$1,453.48" N/A N/A 282.647S SUP HCPCS C1713 282.647S - SIDEPLATE BONE 145D STANDARD BARREL 234MM 38MM 12 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" "$1,478.18" $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" "$1,453.48" "$1,453.48" $302.91 "$1,453.48" N/A N/A 282.648S SUP HCPCS C1713 282.648S - SIDEPLATE BONE 145D STANDARD BARREL 270MM 38MM 14 HOLE LCP BOTH IP/OP "$1,863.00" "$1,379.00" $369.67 "$1,894.23" $838.15 $838.15 $838.15 $838.15 "$1,862.55" "$1,862.55" "$1,862.55" $388.20 "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" $388.18 "$1,862.55" "$1,894.23" "$1,101.70" "$1,862.55" "$1,894.23" "$1,862.55" "$1,862.55" "$1,397.25" "$1,862.55" "$1,862.55" "$1,862.55" $931.28 $931.28 "$1,475.14" "$1,862.55" "$1,490.04" $838.15 $369.67 N/A "$1,080.54" "$1,862.55" "$1,862.55" "$1,862.55" $388.16 "$1,862.55" N/A N/A 282.649S SUP HCPCS C1713 282.649S - SIDEPLATE BONE 145D STANDARD BARREL 306MM 38MM 16 HOLE LCP BOTH IP/OP "$1,863.00" "$1,379.00" $369.67 "$1,894.23" $838.15 $838.15 $838.15 $838.15 "$1,862.55" "$1,862.55" "$1,862.55" $388.20 "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" $388.18 "$1,862.55" $757.69 "$1,101.70" "$1,862.55" "$1,894.23" "$1,862.55" "$1,862.55" "$1,397.25" "$1,862.55" "$1,862.55" "$1,862.55" $931.28 $931.28 "$1,475.14" "$1,862.55" "$1,490.04" $838.15 $369.67 N/A "$1,080.54" "$1,862.55" "$1,862.55" "$1,862.55" $388.16 "$1,862.55" N/A N/A 282.655S SUP HCPCS C1713 282.655S - SIDEPLATE BONE 150D STANDARD BARREL 162MM 38MM 8 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" "$1,478.18" $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" "$1,453.48" "$1,453.48" $302.91 "$1,453.48" N/A N/A 282.656S SUP HCPCS C1713 282.656S - SIDEPLATE BONE 150D STANDARD BARREL 198MM 38MM 10 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" $591.27 $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" "$1,453.48" "$1,453.48" $302.91 "$1,453.48" N/A N/A 282.657S SUP HCPCS C1713 282.657S - SIDEPLATE BONE 150D STANDARD BARREL 234MM 38MM 12 HOLE LCP BOTH IP/OP "$1,453.50" "$1,076.00" $288.48 "$1,478.18" $654.07 $654.07 $654.07 $654.07 "$1,453.48" "$1,453.48" "$1,453.48" $302.94 "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" "$1,453.48" $302.92 "$1,453.48" "$1,478.18" $859.73 "$1,453.48" "$1,478.18" "$1,453.48" "$1,453.48" "$1,090.13" "$1,453.48" "$1,453.48" "$1,453.48" $726.74 $726.74 "$1,151.16" "$1,453.48" "$1,162.78" $654.07 $288.48 N/A $843.03 "$1,453.48" "$1,453.48" "$1,453.48" $302.91 "$1,453.48" N/A N/A 282.658S SUP HCPCS C1713 282.658S - SIDEPLATE BONE 150D STANDARD BARREL 270MM 38MM 14 HOLE LCP BOTH IP/OP "$1,863.00" "$1,379.00" $369.67 "$1,894.23" $838.15 $838.15 $838.15 $838.15 "$1,862.55" "$1,862.55" "$1,862.55" $388.20 "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" $388.18 "$1,862.55" $757.69 "$1,101.70" "$1,862.55" "$1,894.23" "$1,862.55" "$1,862.55" "$1,397.25" "$1,862.55" "$1,862.55" "$1,862.55" $931.28 $931.28 "$1,475.14" "$1,862.55" "$1,490.04" $838.15 $369.67 N/A "$1,080.54" "$1,862.55" "$1,862.55" "$1,862.55" $388.16 "$1,862.55" N/A N/A 282.659S SUP HCPCS C1713 282.659S - SIDEPLATE BONE 150D STANDARD BARREL 306MM 38MM 16 HOLE LCP BOTH IP/OP "$1,863.00" "$1,379.00" $369.67 "$1,894.23" $838.15 $838.15 $838.15 $838.15 "$1,862.55" "$1,862.55" "$1,862.55" $388.20 "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" "$1,862.55" $388.18 "$1,862.55" "$1,894.23" "$1,101.70" "$1,862.55" "$1,894.23" "$1,862.55" "$1,862.55" "$1,397.25" "$1,862.55" "$1,862.55" "$1,862.55" $931.28 $931.28 "$1,475.14" "$1,862.55" "$1,490.04" $838.15 $369.67 N/A "$1,080.54" "$1,862.55" "$1,862.55" "$1,862.55" $388.16 "$1,862.55" N/A N/A 282.660S SUP HCPCS C1713 282.660S - SIDEPLATE BONE 150D STANDARD BARREL 342MM 38MM 18 HOLE LCP BOTH IP/OP "$1,916.00" "$1,418.00" $380.27 "$1,948.53" $862.18 $862.18 $862.18 $862.18 "$1,915.95" "$1,915.95" "$1,915.95" $399.33 "$1,915.95" "$1,915.95" "$1,915.95" "$1,915.95" "$1,915.95" $399.31 "$1,915.95" "$1,948.53" "$1,133.28" "$1,915.95" "$1,948.53" "$1,915.95" "$1,915.95" "$1,437.00" "$1,915.95" "$1,915.95" "$1,915.95" $957.98 $957.98 "$1,517.43" "$1,915.95" "$1,532.76" $862.18 $380.27 N/A "$1,111.28" "$1,915.95" "$1,915.95" "$1,915.95" $399.28 "$1,915.95" N/A N/A 282.661S SUP HCPCS C1713 282.661S - SIDEPLATE BONE 150D STANDARD BARREL 378MM 38MM 20 HOLE LCP BOTH IP/OP "$1,916.00" "$1,418.00" $380.27 "$1,948.53" $862.18 $862.18 $862.18 $862.18 "$1,915.95" "$1,915.95" "$1,915.95" $399.33 "$1,915.95" "$1,915.95" "$1,915.95" "$1,915.95" "$1,915.95" $399.31 "$1,915.95" "$1,948.53" "$1,133.28" "$1,915.95" "$1,948.53" "$1,915.95" "$1,915.95" "$1,437.00" "$1,915.95" "$1,915.95" "$1,915.95" $957.98 $957.98 "$1,517.43" "$1,915.95" "$1,532.76" $862.18 $380.27 N/A "$1,111.28" "$1,915.95" "$1,915.95" "$1,915.95" $399.28 "$1,915.95" N/A N/A 282.671S SUP HCPCS C1713 282.671S - SIDEPLATE BONE 130D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" $479.77 $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.673S SUP HCPCS C1713 282.673S - SIDEPLATE BONE 130D SHORT BARREL 5 HOLE LCP DHHS STAINLESS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" $479.77 $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.674S SUP HCPCS C1713 282.674S - SIDEPLATE BONE 130D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" $479.77 $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.677S SUP HCPCS C1713 282.677S - SIDEPLATE BONE 135D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" "$1,199.43" $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" $707.63 "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.679S SUP HCPCS C1713 282.679S - SIDEPLATE BONE 135D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" "$1,199.43" $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" $707.63 "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.680S SUP HCPCS C1713 282.680S - SIDEPLATE BONE 135D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" "$1,199.43" $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" $707.63 "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.681S SUP HCPCS C1713 282.681S - SIDEPLATE BONE 140D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" "$1,199.43" $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.682S SUP HCPCS C1713 282.682S - SIDEPLATE BONE 140D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" $479.77 $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.684S SUP HCPCS C1713 282.684S - SIDEPLATE BONE 140D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" $479.77 $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.685S SUP HCPCS C1713 282.685S - SIDEPLATE BONE 140D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" $479.77 $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.686S SUP HCPCS C1713 282.686S - SIDEPLATE BONE 145D SHORT BARREL 54MM 25MM 2 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" "$1,199.43" $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.687S SUP HCPCS C1713 282.687S - SIDEPLATE BONE 145D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" $479.77 $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" N/A N/A 282.689S SUP HCPCS C1713 282.689S - SIDEPLATE BONE 145D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" $479.77 $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.690S SUP HCPCS C1713 282.690S - SIDEPLATE BONE 145D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" "$1,199.43" $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.692S SUP HCPCS C1713 282.692S - SIDEPLATE BONE 150D SHORT BARREL 72MM 25MM 3 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" $479.77 $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.694S SUP HCPCS C1713 282.694S - SIDEPLATE BONE 150D SHORT BARREL 108MM 25MM 5 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" $479.77 $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 282.695S SUP HCPCS C1713 282.695S - SIDEPLATE BONE 150D SHORT BARREL 126MM 25MM 6 HOLE LCP DHHS BOTH IP/OP "$1,179.50" $873.00 $234.08 "$1,199.43" $530.72 $530.72 $530.72 $530.72 "$1,179.38" "$1,179.38" "$1,179.38" $245.81 "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" "$1,179.38" $245.80 "$1,179.38" $479.77 $697.60 "$1,179.38" "$1,199.43" "$1,179.38" "$1,179.38" $884.63 "$1,179.38" "$1,179.38" "$1,179.38" $589.69 $589.69 $934.07 "$1,179.38" $943.50 $530.72 $234.08 N/A $684.11 "$1,179.38" "$1,179.38" "$1,179.38" $245.78 "$1,179.38" N/A N/A 28-300 SUP Custom 27203010 28-300 - GUIDEPIN THREAD-TIPPED 2.8MM X 300MM BOTH IP/OP $75.00 $56.00 $13.35 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $13.35 $75.00 $75.00 $55.67 $55.67 $57.81 $39.08 $15.63 $75.00 $30.00 $75.00 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $48.75 $75.00 N/A $43.50 $75.00 $45.00 $75.00 $75.00 $75.00 N/A N/A 2850G SUP Custom 27203010 2850G - SUTURE NONABSORBABLE 10-0 BV75-4 5IN MONOFILAMENT ETHILON BOTH IP/OP $69.50 $51.00 $12.37 $71.50 $69.48 $69.48 $69.48 $69.48 $69.48 $69.48 $12.37 $69.48 $69.48 $51.57 $51.57 $53.56 $36.20 $14.48 $69.48 $28.60 $69.48 $69.48 $71.50 $69.48 $69.48 $52.13 $69.48 $69.48 $69.48 $34.74 $34.74 $55.03 $69.48 $55.58 $45.16 $69.48 N/A $40.31 $69.48 $41.69 $69.48 $69.48 $69.48 N/A N/A 2867-05-230 SUP HCPCS C1769 2867-05-230 - GUIDEWIRE ORTH 1.37MM VPR 2 SHRP BOTH IP/OP $575.00 $426.00 $114.12 $575.00 $312.23 $312.23 $312.23 $312.23 $575.00 $575.00 $575.00 $119.84 $575.00 $426.77 $426.77 $443.21 $299.58 $119.84 $575.00 $575.00 $340.11 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $373.75 $114.12 N/A $333.50 $575.00 $575.00 $575.00 $119.83 $575.00 N/A N/A 2894G SUP Custom 27203010 2894G - SUTURE NONABSORBABLE 9-0 V100-3 5IN MONOFILAMENT ETHILON BOTH IP/OP $56.00 $41.00 $9.96 $57.59 $55.97 $55.97 $55.97 $55.97 $55.97 $55.97 $9.96 $55.97 $55.97 $41.54 $41.54 $43.14 $29.16 $11.66 $55.97 $23.04 $55.97 $55.97 $57.59 $55.97 $55.97 $42.00 $55.97 $55.97 $55.97 $27.99 $27.99 $44.33 $55.97 $44.78 $36.38 $55.97 N/A $32.48 $55.97 $33.58 $55.97 $55.97 $55.97 N/A N/A 28-M322090222290U SUP HCPCS C2625 28-M322090222290U - GRAFT EVAS 22mmx100mm RESR MAIN BOTH IP/OP "$25,000.00" "$18,500.00" "$4,961.88" "$25,000.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.63" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.28" "$25,000.00" "$25,000.00" "$12,325.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$18,750.00" "$25,000.00" "$25,000.00" "$25,000.00" "$12,500.00" "$12,500.00" "$19,800.00" "$25,000.00" "$20,000.00" "$11,250.00" "$4,961.88" N/A "$14,500.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.00" "$25,000.00" N/A N/A 28-M322150222290U SUP HCPCS C2625 28-M322150222290U - GRAFT EVAS 22mmX150mm RESR MAIN BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M322190222290U SUP HCPCS C2625 28-M322190222290U - GRAFT EVAS 22mmX200mm RESR MAIN BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M322250222390U SUP HCPCS C2625 28-M322250222390U - GRAFT EVAS 22mmX250mm RESR MAIN BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M324090242290U SUP HCPCS C2625 28-M324090242290U - GRAFT EVAS 24mmx100mm RESR MAIN BOTH IP/OP "$25,000.00" "$18,500.00" "$4,961.88" "$25,000.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.63" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.28" "$25,000.00" "$25,000.00" "$12,325.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$18,750.00" "$25,000.00" "$25,000.00" "$25,000.00" "$12,500.00" "$12,500.00" "$19,800.00" "$25,000.00" "$20,000.00" "$11,250.00" "$4,961.88" N/A "$14,500.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.00" "$25,000.00" N/A N/A 28-M324150242290U SUP HCPCS C2625 28-M324150242290U - GRAFT EVAS 24mmX150mm RESR MAIN BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M324190242290U SUP HCPCS C2625 28-M324190242290U - GRAFT EVAS 24mmX200mm RESR MAIN BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M324250222390U SUP HCPCS C2625 28-M324250222390U - GRAFT EVAS 24mmX250mm RESR MAIN BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M326095262290U SUP HCPCS C2625 28-M326095262290U - GRAFT EVAS 26mmX100mm RESR MAIN BOTH IP/OP "$25,000.00" "$18,500.00" "$4,961.88" "$25,000.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.63" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.28" "$25,000.00" "$25,000.00" "$12,325.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$18,750.00" "$25,000.00" "$25,000.00" "$25,000.00" "$12,500.00" "$12,500.00" "$19,800.00" "$25,000.00" "$20,000.00" "$11,250.00" "$4,961.88" N/A "$14,500.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.00" "$25,000.00" N/A N/A 28-M326155262290U SUP HCPCS C2625 28-M326155262290U - GRAFT EVAS 26mmX150mm RESR MAIN BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M326195262290U SUP HCPCS C2625 28-M326195262290U - GRAFT EVAS 26mmX200mm RESR MAIN BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M326250262390U SUP HCPCS C2625 28-M326250262390U - GRAFT EVAS 26mmX250mm RESR MAIN BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M328095282290U SUP HCPCS C2625 28-M328095282290U - GRAFT EVAS 28mmX100mm RESR MAIN BOTH IP/OP "$25,000.00" "$18,500.00" "$4,961.88" "$25,000.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.63" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.28" "$25,000.00" "$25,000.00" "$12,325.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$18,750.00" "$25,000.00" "$25,000.00" "$25,000.00" "$12,500.00" "$12,500.00" "$19,800.00" "$25,000.00" "$20,000.00" "$11,250.00" "$4,961.88" N/A "$14,500.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.00" "$25,000.00" N/A N/A 28-M328155242290U SUP HCPCS C2625 28-M328155242290U - GRAFT EVAS 28/24x150 TAPERED BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M328155282290U SUP HCPCS C2625 28-M328155282290U - GRAFT EVAS 28mmX150mm RESR MAIN BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M328195242290U SUP HCPCS C2625 28-M328195242290U - GRAFT EVAS 28/24x200 TAPERED BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M328195282290U SUP HCPCS C2625 28-M328195282290U - GRAFT EVAS 28mmX200mm RESR MAIN BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M328250242390U SUP HCPCS C2625 28-M328250242390U - GRAFT EVAS 28/24x250 TAPERED BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M328250282390U SUP HCPCS C2625 28-M328250282390U - GRAFT EVAS 28mmX250mm RESR MAIN BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M330095302290U SUP HCPCS C2625 28-M330095302290U - GRAFT EVAS 30mmX100mm RESR MAIN BOTH IP/OP "$25,000.00" "$18,500.00" "$4,961.88" "$25,000.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.63" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.28" "$25,000.00" "$25,000.00" "$12,325.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$18,750.00" "$25,000.00" "$25,000.00" "$25,000.00" "$12,500.00" "$12,500.00" "$19,800.00" "$25,000.00" "$20,000.00" "$11,250.00" "$4,961.88" N/A "$14,500.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.00" "$25,000.00" N/A N/A 28-M330155262290U SUP HCPCS C2625 28-M330155262290U - GRAFT EVAS 30/26x150 TAPERED BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M330155302290U SUP HCPCS C2625 28-M330155302290U - GRAFT EVAS 30mmX150mm RESR MAIN BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M330200262390U SUP HCPCS C2625 28-M330200262390U - GRAFT EVAS 30/26x200 TAPERED BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M330200302390U SUP HCPCS C2625 28-M330200302390U - GRAFT EVAS 30mmX200mm RESR MAIN BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M330250262390U SUP HCPCS C2625 28-M330250262390U - GRAFT EVAS 30/26x250 TAPERED BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M330250302390U SUP HCPCS C2625 28-M330250302390U - GRAFT EVAS 30mmX250mm RESR MAIN BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M332095322290U SUP HCPCS C2625 28-M332095322290U - GRAFT EVAS 32mmX100mm RESR MAIN BOTH IP/OP "$25,000.00" "$18,500.00" "$4,961.88" "$25,000.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.63" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.28" "$25,000.00" "$25,000.00" "$12,325.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$18,750.00" "$25,000.00" "$25,000.00" "$25,000.00" "$12,500.00" "$12,500.00" "$19,800.00" "$25,000.00" "$20,000.00" "$11,250.00" "$4,961.88" N/A "$14,500.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.00" "$25,000.00" N/A N/A 28-M332155282290U SUP HCPCS C2625 28-M332155282290U - GRAFT EVAS 32/28x150 TAPERED BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M332155322290U SUP HCPCS C2625 28-M332155322290U - GRAFT EVAS 32mmX150mm RESR MAIN BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M332200282390U SUP HCPCS C2625 28-M332200282390U - GRAFT EVAS 32/28x200 TAPERED BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M332200322390U SUP HCPCS C2625 28-M332200322390U - GRAFT EVAS 32mmX200mm RESR MAIN BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M332250282490U SUP HCPCS C2625 28-M332250282490U - GRAFT EVAS 32/28x250 TAPERED BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M332250322490U SUP HCPCS C2625 28-M332250322490U - GRAFT EVAS 32mmX250mm RESR MAIN BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M334100342390U SUP HCPCS C2625 28-M334100342390U - GRAFT EVAS 34mmX100mm RESR MAIN BOTH IP/OP "$42,375.00" "$31,358.00" "$7,712.84" "$42,375.00" "$19,068.75" "$19,068.75" "$19,068.75" "$19,068.75" "$42,375.00" "$42,375.00" "$42,375.00" "$8,832.01" "$42,375.00" "$42,375.00" "$42,375.00" "$42,375.00" "$42,375.00" "$8,831.42" "$42,375.00" "$42,375.00" "$20,890.88" "$42,375.00" "$42,375.00" "$42,375.00" "$42,375.00" "$31,781.25" "$42,375.00" "$42,375.00" "$42,375.00" "$21,187.50" "$21,187.50" "$33,561.00" "$42,375.00" "$33,900.00" "$19,068.75" "$7,712.84" N/A "$24,577.50" "$42,375.00" "$42,375.00" "$42,375.00" "$8,098.48" "$42,375.00" N/A N/A 28-M334145302390U SUP HCPCS C2625 28-M334145302390U - GRAFT EVAS 34/30x150 TAPERED BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M334145342390U SUP HCPCS C2625 28-M334145342390U - GRAFT EVAS 34mmX150mm RESR MAIN BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M334200302490U SUP HCPCS C2625 28-M334200302490U - GRAFT EVAS 34/30x200 TAPERED BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M334200342490U SUP HCPCS C2625 28-M334200342490U - GRAFT EVAS 34mmX200mm RESR MAIN BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M334250302490U SUP HCPCS C2625 28-M334250302490U - GRAFT EVAS 34/30x250 TAPERED BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M334250342490U SUP HCPCS C2625 28-M334250342490U - GRAFT EVAS 34mmX250mm RESR MAIN BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M336100362390U SUP HCPCS C2625 28-M336100362390U - GRAFT EVAS 36mmX100mm RESR MAIN BOTH IP/OP "$25,000.00" "$18,500.00" "$4,961.88" "$25,000.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.63" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.28" "$25,000.00" "$25,000.00" "$12,325.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$18,750.00" "$25,000.00" "$25,000.00" "$25,000.00" "$12,500.00" "$12,500.00" "$19,800.00" "$25,000.00" "$20,000.00" "$11,250.00" "$4,961.88" N/A "$14,500.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.00" "$25,000.00" N/A N/A 28-M336145322490U SUP HCPCS C2625 28-M336145322490U - GRAFT EVAS 36/32x150 TAPERED BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M336145362490U SUP HCPCS C2625 28-M336145362490U - GRAFT EVAS 36mmX150mm RESR MAIN BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M336190322490U SUP HCPCS C2625 28-M336190322490U - GRAFT EVAS 36/32x200 TAPERED BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M336190362490U SUP HCPCS C2625 28-M336190362490U - GRAFT EVAS 36mmX200mm RESR MAIN BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M336250322490U SUP HCPCS C2625 28-M336250322490U - GRAFT EVAS 36/32x250 TAPERED BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M336250362490U SUP HCPCS C2625 28-M336250362490U - GRAFT EVAS 36mmX250mm RESR MAIN BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M338100382490U SUP HCPCS C2625 28-M338100382490U - GRAFT EVAS 38mmX100mm RESR MAIN BOTH IP/OP "$25,000.00" "$18,500.00" "$4,961.88" "$25,000.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.63" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.28" "$25,000.00" "$25,000.00" "$12,325.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$18,750.00" "$25,000.00" "$25,000.00" "$25,000.00" "$12,500.00" "$12,500.00" "$19,800.00" "$25,000.00" "$20,000.00" "$11,250.00" "$4,961.88" N/A "$14,500.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.00" "$25,000.00" N/A N/A 28-M338145342490U SUP HCPCS C2625 28-M338145342490U - GRAFT EVAS 38/34x150 TAPERED BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M338145382490U SUP HCPCS C2625 28-M338145382490U - GRAFT EVAS 38mmX150mm RESR MAIN BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M338190342590U SUP HCPCS C2625 28-M338190342590U - GRAFT EVAS 38/34x200 TAPERED BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M338190382590U SUP HCPCS C2625 28-M338190382590U - GRAFT EVAS 38mmX200mm RESR MAIN BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M338250342590U SUP HCPCS C2625 28-M338250342590U - GRAFT EVAS 38/34x250 TAPERED BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M338250382590U SUP HCPCS C2625 28-M338250382590U - GRAFT EVAS 38mmX250mm RESR MAIN BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M340105402490U SUP HCPCS C2625 28-M340105402490U - GRAFT EVAS 40mmX100mm RESR MAIN BOTH IP/OP "$25,000.00" "$18,500.00" "$4,961.88" "$25,000.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.63" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.28" "$25,000.00" "$25,000.00" "$12,325.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$18,750.00" "$25,000.00" "$25,000.00" "$25,000.00" "$12,500.00" "$12,500.00" "$19,800.00" "$25,000.00" "$20,000.00" "$11,250.00" "$4,961.88" N/A "$14,500.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.00" "$25,000.00" N/A N/A 28-M340145362590U SUP HCPCS C2625 28-M340145362590U - GRAFT EVAS 40/36x150 TAPERED BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M340145402590U SUP HCPCS C2625 28-M340145402590U - GRAFT EVAS 40mmX150mm RESR MAIN BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M340195362590U SUP HCPCS C2625 28-M340195362590U - GRAFT EVAS 40/36x200 TAPERED BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M340195402590U SUP HCPCS C2625 28-M340195402590U - GRAFT EVAS 40mmX200mm RESR MAIN BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M340250362590U SUP HCPCS C2625 28-M340250362590U - GRAFT EVAS 40/36x250 TAPERED BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M340250402590U SUP HCPCS C2625 28-M340250402590U - GRAFT EVAS 40mmX250mm RESR MAIN BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M342105422590U SUP HCPCS C2625 28-M342105422590U - GRAFT EVAS 42mmX100mm RESR MAIN BOTH IP/OP "$25,000.00" "$18,500.00" "$4,961.88" "$25,000.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.63" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.28" "$25,000.00" "$25,000.00" "$12,325.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$18,750.00" "$25,000.00" "$25,000.00" "$25,000.00" "$12,500.00" "$12,500.00" "$19,800.00" "$25,000.00" "$20,000.00" "$11,250.00" "$4,961.88" N/A "$14,500.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.00" "$25,000.00" N/A N/A 28-M342150382590U SUP HCPCS C2625 28-M342150382590U - GRAFT EVAS 42/38x150 TAPERED BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M342150422590U SUP HCPCS C2625 28-M342150422590U - GRAFT EVAS 42mmX150mm RESR MAIN BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M342195382590U SUP HCPCS C2625 28-M342195382590U - GRAFT EVAS 42/38x200 TAPERED BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M342195422590U SUP HCPCS C2625 28-M342195422590U - GRAFT EVAS 42mmX200mm RESR MAIN BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M342250382590U SUP HCPCS C2625 28-M342250382590U - GRAFT EVAS 42/38x250 TAPERED BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M342250422590U SUP HCPCS C2625 28-M342250422590U - GRAFT EVAS 42mmX250mm RESR MAIN BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M344105442590U SUP HCPCS C2625 28-M344105442590U - GRAFT EVAS 44mmX100mm RESR MAIN BOTH IP/OP "$25,000.00" "$18,500.00" "$4,961.88" "$25,000.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.63" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.28" "$25,000.00" "$25,000.00" "$12,325.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$18,750.00" "$25,000.00" "$25,000.00" "$25,000.00" "$12,500.00" "$12,500.00" "$19,800.00" "$25,000.00" "$20,000.00" "$11,250.00" "$4,961.88" N/A "$14,500.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.00" "$25,000.00" N/A N/A 28-M344155402590U SUP HCPCS C2625 28-M344155402590U - GRAFT EVAS 44/40x150 TAPERED BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M344155442590U SUP HCPCS C2625 28-M344155442590U - GRAFT EVAS 44mmX150mm RESR MAIN BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M344200402590U SUP HCPCS C2625 28-M344200402590U - GRAFT EVAS 44/40x200 TAPERED BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M344200442590U SUP HCPCS C2625 28-M344200442590U - GRAFT EVAS 44mmX200mm RESR MAIN BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M344250402690U SUP HCPCS C2625 28-M344250402690U - GRAFT EVAS 44/40x250 TAPERED BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M344250442690U SUP HCPCS C2625 28-M344250442690U - GRAFT EVAS 44mmX250mm RESR MAIN BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M346105462690U SUP HCPCS C2625 28-M346105462690U - GRAFT EVAS 46mmX100mm RESR MAIN BOTH IP/OP "$25,000.00" "$18,500.00" "$4,961.88" "$25,000.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.63" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.28" "$25,000.00" "$25,000.00" "$12,325.00" "$25,000.00" "$25,000.00" "$25,000.00" "$25,000.00" "$18,750.00" "$25,000.00" "$25,000.00" "$25,000.00" "$12,500.00" "$12,500.00" "$19,800.00" "$25,000.00" "$20,000.00" "$11,250.00" "$4,961.88" N/A "$14,500.00" "$25,000.00" "$25,000.00" "$25,000.00" "$5,210.00" "$25,000.00" N/A N/A 28-M346155422690U SUP HCPCS C2625 28-M346155422690U - GRAFT EVAS 46/42x150 TAPERED BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M346155462690U SUP HCPCS C2625 28-M346155462690U - GRAFT EVAS 46mmX150mm RESR MAIN BOTH IP/OP "$30,000.00" "$22,200.00" "$5,954.25" "$30,000.00" "$13,500.00" "$13,500.00" "$13,500.00" "$13,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.75" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$30,000.00" "$14,790.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$5,954.25" N/A "$17,400.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.00" "$30,000.00" N/A N/A 28-M346200422690U SUP HCPCS C2625 28-M346200422690U - GRAFT EVAS 46/42x200 TAPERED BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M346200462690U SUP HCPCS C2625 28-M346200462690U - GRAFT EVAS 46mmX200mm RESR MAIN BOTH IP/OP "$35,000.00" "$25,900.00" "$6,946.63" "$35,000.00" "$15,750.00" "$15,750.00" "$15,750.00" "$15,750.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.88" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.39" "$35,000.00" "$35,000.00" "$17,255.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$15,750.00" "$6,946.63" N/A "$20,300.00" "$35,000.00" "$35,000.00" "$35,000.00" "$7,294.00" "$35,000.00" N/A N/A 28-M346250422690U SUP HCPCS C2625 28-M346250422690U - GRAFT EVAS 46/42x250 TAPERED BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 28-M346250462690U SUP HCPCS C2625 28-M346250462690U - GRAFT EVAS 46mmX250mm RESR MAIN BOTH IP/OP "$40,000.00" "$29,600.00" "$7,712.84" "$40,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$18,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,337.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,336.44" "$40,000.00" "$40,000.00" "$19,720.00" "$40,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$30,000.00" "$40,000.00" "$40,000.00" "$40,000.00" "$20,000.00" "$20,000.00" "$31,680.00" "$40,000.00" "$32,000.00" "$18,000.00" "$7,712.84" N/A "$23,200.00" "$40,000.00" "$40,000.00" "$40,000.00" "$8,098.48" "$40,000.00" N/A N/A 290.20.280 SUP Custom 27203010 290.20.280 - WIRE FX STD 2MM 280MM NS KRSH SS BOTH IP/OP $49.00 $36.00 $8.68 $48.75 $48.75 $48.75 $48.75 $48.75 $48.75 $48.75 $8.68 $48.75 $48.75 $36.18 $36.18 $37.58 $25.40 $10.16 $48.75 $19.50 $48.75 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $31.69 $48.75 N/A $28.42 $48.75 $29.25 $48.75 $48.75 $48.75 N/A N/A 291.230.98 SUP Custom 27203010 291.230.98 - WIRE CERCLAGE .5MM 175MM PRECUT STAINLESS STEEL MANDIB BOTH IP/OP $31.50 $23.00 $5.61 $31.50 $31.50 $31.50 $31.50 $31.50 $31.50 $31.50 $5.61 $31.50 $31.50 $23.38 $23.38 $24.28 $16.41 $6.56 $31.50 $12.60 $31.50 $31.50 $31.50 $31.50 $31.50 $23.63 $31.50 $31.50 $31.50 $15.75 $15.75 $24.95 $31.50 $25.20 $20.48 $31.50 N/A $18.27 $31.50 $18.90 $31.50 $31.50 $31.50 N/A N/A 291.240.98 SUP Custom 27203010 291.240.98 - WIRE CERCLAGE .6MM 175MM PRECUT STAINLESS STEEL MANDIB BOTH IP/OP $27.00 $20.00 $4.81 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $27.00 $4.81 $27.00 $27.00 $20.04 $20.04 $20.81 $14.07 $5.63 $27.00 $10.80 $27.00 $27.00 $27.00 $27.00 $27.00 $20.25 $27.00 $27.00 $27.00 $13.50 $13.50 $21.38 $27.00 $21.60 $17.55 $27.00 N/A $15.66 $27.00 $16.20 $27.00 $27.00 $27.00 N/A N/A 291.911.01S SUP Custom 27803010 291.911.01S - CABLE ORTHOPEDIC 1MM 750MM W/O NEEDLE CRIMPING FERRULE BOTH IP/OP $224.00 $166.00 $39.83 $223.75 $223.75 $223.75 $223.75 $223.75 $223.75 $223.75 $39.83 $223.75 $223.75 $223.75 $223.75 $223.75 $223.75 $46.63 $223.75 $89.50 $223.75 $223.75 $223.75 $223.75 $223.75 $168.00 $223.75 $223.75 $223.75 $111.88 $111.88 $177.21 $223.75 $179.00 $100.69 $223.75 N/A $129.92 $223.75 $134.25 $223.75 $223.75 $223.75 N/A N/A 291.916.01S SUP Custom 27803010 291.916.01S - CABLE ORTHOPEDIC 1MM 750MM NEEDLE CRIMPING FERRULE PARALLEL BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 291.916.03S SUP Custom 27803010 291.916.03S - CABLE ORTHOPEDIC 1MM 750MM NEEDLE CRIMPING FERRULE PARALLEL BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 29-15044 SUP HCPCS C1713 29-15044 - DISK IMPLANT 4MM SLFTAP PRELOADED NONSTRL 1.5MM SCREW BOTH IP/OP "$18,937.00" "$14,013.00" "$3,758.43" "$18,936.55" "$8,521.45" "$8,521.45" "$8,521.45" "$8,521.45" "$18,936.55" "$18,936.55" "$18,936.55" "$3,946.85" "$18,936.55" "$18,936.55" "$18,936.55" "$18,936.55" "$18,936.55" "$3,946.59" "$18,936.55" "$18,936.55" "$9,335.72" "$18,936.55" "$18,936.55" "$18,936.55" "$18,936.55" "$14,202.75" "$18,936.55" "$18,936.55" "$18,936.55" "$9,468.28" "$9,468.28" "$14,997.75" "$18,936.55" "$15,149.24" "$8,521.45" "$3,758.43" N/A "$10,983.46" "$18,936.55" "$11,361.93" "$18,936.55" "$3,946.38" "$18,936.55" N/A N/A 293.48L SUP Custom 27203010 293.48L - PIN FIX 4.5MM 275MM 3 FLAT ROUND TROCAR POINT SMOOTH SHAFT BOTH IP/OP $126.00 $93.00 $22.41 $128.03 $125.88 $125.88 $125.88 $125.88 $125.88 $125.88 $22.41 $125.88 $125.88 $93.43 $93.43 $97.03 $65.58 $26.23 $125.88 $51.21 $125.88 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $81.82 $125.88 N/A $73.08 $125.88 $75.53 $125.88 $125.88 $125.88 N/A N/A 293.48X SUP Custom 27203010 293.48X - PIN FIX 4.5MM 300MM 3 FLAT ROUND TROCAR POINT SMOOTH SHAFT BOTH IP/OP $126.00 $93.00 $22.41 $128.03 $125.88 $125.88 $125.88 $125.88 $125.88 $125.88 $22.41 $125.88 $125.88 $93.43 $93.43 $97.03 $65.58 $26.23 $125.88 $51.21 $125.88 $125.88 $128.03 $125.88 $125.88 $94.50 $125.88 $125.88 $125.88 $62.94 $62.94 $99.70 $125.88 $100.70 $81.82 $125.88 N/A $73.08 $125.88 $75.53 $125.88 $125.88 $125.88 N/A N/A 294.30SHA SUP HCPCS C1713 294.30SHA - SCREW XTRNFX 4MM 3MM 80MM STRL 20MM SCHNZ SPD PNT SS HA SEF BOTH IP/OP $211.00 $156.00 $41.78 $214.10 $94.74 $94.74 $94.74 $94.74 $210.53 $210.53 $210.53 $43.88 $210.53 $210.53 $210.53 $210.53 $210.53 $43.88 $210.53 $214.10 $124.53 $210.53 $214.10 $210.53 $210.53 $158.25 $210.53 $210.53 $210.53 $105.27 $105.27 $166.74 $210.53 $168.42 $94.74 $41.78 N/A $122.38 $210.53 $210.53 $210.53 $43.87 $210.53 N/A N/A 294.43SHA SUP HCPCS C1713 294.43SHA - SCREW XTRNFX 4MM 60MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG BOTH IP/OP $211.00 $156.00 $41.78 $214.10 $94.74 $94.74 $94.74 $94.74 $210.53 $210.53 $210.53 $43.88 $210.53 $210.53 $210.53 $210.53 $210.53 $43.88 $210.53 $214.10 $124.53 $210.53 $214.10 $210.53 $210.53 $158.25 $210.53 $210.53 $210.53 $105.27 $105.27 $166.74 $210.53 $168.42 $94.74 $41.78 N/A $122.38 $210.53 $210.53 $210.53 $43.87 $210.53 N/A N/A 294.44SHA SUP HCPCS C1713 294.44SHA - SCREW XTRNFX 4MM 80MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG BOTH IP/OP $211.00 $156.00 $41.78 $214.10 $94.74 $94.74 $94.74 $94.74 $210.53 $210.53 $210.53 $43.88 $210.53 $210.53 $210.53 $210.53 $210.53 $43.88 $210.53 $214.10 $124.53 $210.53 $214.10 $210.53 $210.53 $158.25 $210.53 $210.53 $210.53 $105.27 $105.27 $166.74 $210.53 $168.42 $94.74 $41.78 N/A $122.38 $210.53 $126.32 $210.53 $43.87 $210.53 N/A N/A 294.45SHA SUP HCPCS C1713 294.45SHA - SCREW XTRNFX 4MM 100MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG BOTH IP/OP $211.00 $156.00 $41.78 $214.10 $94.74 $94.74 $94.74 $94.74 $210.53 $210.53 $210.53 $43.88 $210.53 $210.53 $210.53 $210.53 $210.53 $43.88 $210.53 $214.10 $124.53 $210.53 $214.10 $210.53 $210.53 $158.25 $210.53 $210.53 $210.53 $105.27 $105.27 $166.74 $210.53 $168.42 $94.74 $41.78 N/A $122.38 $210.53 $126.32 $210.53 $43.87 $210.53 N/A N/A 294.46SHA SUP HCPCS C1713 294.46SHA - SCREW XTRNFX 4MM 120MM STRL 25MM SCHNZ SPD PNT SS HA PLVC LG BOTH IP/OP $211.00 $156.00 $41.78 $214.10 $94.74 $94.74 $94.74 $94.74 $210.53 $210.53 $210.53 $43.88 $210.53 $210.53 $210.53 $210.53 $210.53 $43.88 $210.53 $214.10 $124.53 $210.53 $214.10 $210.53 $210.53 $158.25 $210.53 $210.53 $210.53 $105.27 $105.27 $166.74 $210.53 $168.42 $94.74 $41.78 N/A $122.38 $210.53 $210.53 $210.53 $43.87 $210.53 N/A N/A 294.52SHA SUP HCPCS C1713 294.52SHA - SCREW XTRNFX XLNG 5MM 100MM STRL 50MM SCHNZ BLNT TROC PNT SS BOTH IP/OP $211.00 $156.00 $41.78 $214.10 $94.74 $94.74 $94.74 $94.74 $210.53 $210.53 $210.53 $43.88 $210.53 $210.53 $210.53 $210.53 $210.53 $43.88 $210.53 $85.64 $124.53 $210.53 $214.10 $210.53 $210.53 $158.25 $210.53 $210.53 $210.53 $105.27 $105.27 $166.74 $210.53 $168.42 $94.74 $41.78 N/A $122.38 $210.53 $210.53 $210.53 $210.53 $210.53 N/A N/A 294.53SHA SUP HCPCS C1713 294.53SHA - SCREW XTRNFX XLNG 5MM 125MM STRL 50MM SCHNZ BLNT TROC PNT SS BOTH IP/OP $211.00 $156.00 $41.78 $214.10 $94.74 $94.74 $94.74 $94.74 $210.53 $210.53 $210.53 $43.88 $210.53 $210.53 $210.53 $210.53 $210.53 $43.88 $210.53 $85.64 $124.53 $210.53 $214.10 $210.53 $210.53 $158.25 $210.53 $210.53 $210.53 $105.27 $105.27 $166.74 $210.53 $168.42 $94.74 $41.78 N/A $122.38 $210.53 $210.53 $210.53 $43.87 $210.53 N/A N/A 294.54SHA SUP HCPCS C1713 294.54SHA - SCREW XTRNFX XLNG 5MM 150MM STRL 50MM SCHNZ BLNT TROC PNT SS BOTH IP/OP $211.00 $156.00 $41.78 $214.10 $94.74 $94.74 $94.74 $94.74 $210.53 $210.53 $210.53 $43.88 $210.53 $210.53 $210.53 $210.53 $210.53 $43.88 $210.53 $214.10 $124.53 $210.53 $214.10 $210.53 $210.53 $158.25 $210.53 $210.53 $210.53 $105.27 $105.27 $166.74 $210.53 $168.42 $94.74 $41.78 N/A $122.38 $210.53 $210.53 $210.53 $210.53 $210.53 N/A N/A 294.55SHA SUP HCPCS C1713 294.55SHA - PIN HALF 5MM 170MM TROCAR BLUNT SCHANZ STAINLESS STEEL BOTH IP/OP $226.50 $168.00 $44.88 $229.98 $101.76 $101.76 $101.76 $101.76 $226.13 $226.13 $226.13 $47.13 $226.13 $226.13 $226.13 $226.13 $226.13 $47.13 $226.13 $229.98 $133.76 $226.13 $229.98 $226.13 $226.13 $169.88 $226.13 $226.13 $226.13 $113.07 $113.07 $179.09 $226.13 $180.90 $101.76 $44.88 N/A $131.37 $226.13 $226.13 $226.13 $47.13 $226.13 N/A N/A 294.56SHA SUP HCPCS C1713 294.56SHA - SCREW XTRNFX XLNG 5MM 200MM STRL 50MM SCHNZ BLNT TROC PNT SS BOTH IP/OP $226.50 $168.00 $44.88 $229.98 $101.76 $101.76 $101.76 $101.76 $226.13 $226.13 $226.13 $47.13 $226.13 $226.13 $226.13 $226.13 $226.13 $47.13 $226.13 $91.99 $133.76 $226.13 $229.98 $226.13 $226.13 $169.88 $226.13 $226.13 $226.13 $113.07 $113.07 $179.09 $226.13 $180.90 $101.76 $44.88 N/A $131.37 $226.13 $226.13 $226.13 $226.13 $226.13 N/A N/A 294.57SHA SUP HCPCS C1713 294.57SHA - SCREW XTRNFX XLNG 5MM 250MM STRL 50MM SCHNZ BLNT TROC PNT SS BOTH IP/OP $226.50 $168.00 $44.88 $229.98 $101.76 $101.76 $101.76 $101.76 $226.13 $226.13 $226.13 $47.13 $226.13 $226.13 $226.13 $226.13 $226.13 $47.13 $226.13 $91.99 $133.76 $226.13 $229.98 $226.13 $226.13 $169.88 $226.13 $226.13 $226.13 $113.07 $113.07 $179.09 $226.13 $180.90 $101.76 $44.88 N/A $131.37 $226.13 $226.13 $226.13 $47.13 $226.13 N/A N/A 294.67SHA SUP HCPCS C1713 294.67SHA - SCREW XTRNFX 6MM 160MM STRL 50MM SCHNZ SPD PNT SS HA LG BOTH IP/OP $211.00 $156.00 $41.78 $214.10 $94.74 $94.74 $94.74 $94.74 $210.53 $210.53 $210.53 $43.88 $210.53 $210.53 $210.53 $210.53 $210.53 $43.88 $210.53 $85.64 $124.53 $210.53 $214.10 $210.53 $210.53 $158.25 $210.53 $210.53 $210.53 $105.27 $105.27 $166.74 $210.53 $168.42 $94.74 $41.78 N/A $122.38 $210.53 $210.53 $210.53 $43.87 $210.53 N/A N/A 294.68SHA SUP HCPCS C1713 294.68SHA - SCREW XTRNFX 6MM 190MM STRL 50MM SCHNZ SPD PNT SS HA LG BOTH IP/OP $211.00 $156.00 $41.78 $214.10 $94.74 $94.74 $94.74 $94.74 $210.53 $210.53 $210.53 $43.88 $210.53 $210.53 $210.53 $210.53 $210.53 $43.88 $210.53 $85.64 $124.53 $210.53 $214.10 $210.53 $210.53 $158.25 $210.53 $210.53 $210.53 $105.27 $105.27 $166.74 $210.53 $168.42 $94.74 $41.78 N/A $122.38 $210.53 $210.53 $210.53 $43.87 $210.53 N/A N/A 294.73SHA SUP HCPCS C1713 294.73SHA - SCREW XTRNFX ST 4.5MM 125MM STRL 18MM SCHNZ BLNT TROC PNT SS BOTH IP/OP $211.00 $156.00 $41.78 $214.10 $94.74 $94.74 $94.74 $94.74 $210.53 $210.53 $210.53 $43.88 $210.53 $210.53 $210.53 $210.53 $210.53 $43.88 $210.53 $214.10 $124.53 $210.53 $214.10 $210.53 $210.53 $158.25 $210.53 $210.53 $210.53 $105.27 $105.27 $166.74 $210.53 $168.42 $94.74 $41.78 N/A $122.38 $210.53 $126.32 $210.53 $210.53 $210.53 N/A N/A 294.74SHA SUP HCPCS C1713 294.74SHA - SCREW XTRNFX ST 4.5MM 150MM STRL 18MM SCHNZ BLNT TROC PNT SS BOTH IP/OP $211.00 $156.00 $41.78 $214.10 $94.74 $94.74 $94.74 $94.74 $210.53 $210.53 $210.53 $43.88 $210.53 $210.53 $210.53 $210.53 $210.53 $43.88 $210.53 $214.10 $124.53 $210.53 $214.10 $210.53 $210.53 $158.25 $210.53 $210.53 $210.53 $105.27 $105.27 $166.74 $210.53 $168.42 $94.74 $41.78 N/A $122.38 $210.53 $126.32 $210.53 $43.87 $210.53 N/A N/A 294.75SHA SUP HCPCS C1713 294.75SHA - SCREW XTRNFX ST 4.5MM 175MM STRL 18MM SCHNZ BLNT TROC PNT SS BOTH IP/OP $218.50 $162.00 $43.33 $222.03 $98.25 $98.25 $98.25 $98.25 $218.33 $218.33 $218.33 $45.51 $218.33 $218.33 $218.33 $218.33 $218.33 $45.50 $218.33 $88.81 $129.14 $218.33 $222.03 $218.33 $218.33 $163.88 $218.33 $218.33 $218.33 $109.17 $109.17 $172.92 $218.33 $174.66 $98.25 $43.33 N/A $126.73 $218.33 $131.00 $218.33 $45.50 $218.33 N/A N/A 294.76SHA SUP HCPCS C1713 294.76SHA - SCREW XTRNFX ST 4.5MM 200MM STRL 18MM SCHNZ BLNT TROC PNT SS BOTH IP/OP $218.50 $162.00 $43.33 $222.03 $98.25 $98.25 $98.25 $98.25 $218.33 $218.33 $218.33 $45.51 $218.33 $218.33 $218.33 $218.33 $218.33 $45.50 $218.33 $88.81 $129.14 $218.33 $222.03 $218.33 $218.33 $163.88 $218.33 $218.33 $218.33 $109.17 $109.17 $172.92 $218.33 $174.66 $98.25 $43.33 N/A $126.73 $218.33 $131.00 $218.33 $218.33 $218.33 N/A N/A 294.771SHA SUP HCPCS C1713 294.771SHA - SCREW BONE 4/3MM 80MM SLFDRILL SCHANZ STAINLESS STEEL DISTAL BOTH IP/OP $309.00 $229.00 $61.25 $313.83 $138.86 $138.86 $138.86 $138.86 $308.58 $308.58 $308.58 $64.32 $308.58 $308.58 $308.58 $308.58 $308.58 $64.31 $308.58 $125.53 $182.53 $308.58 $313.83 $308.58 $308.58 $231.75 $308.58 $308.58 $308.58 $154.29 $154.29 $244.40 $308.58 $246.86 $138.86 $61.25 N/A $179.22 $308.58 $185.15 $308.58 $308.58 $308.58 N/A N/A 294.775SHA SUP HCPCS C1713 294.775SHA - SCREW XTRNFX 4MM 80MM STRL 20MM SCHNZ SLF DRL SS HA HIP BOTH IP/OP $309.00 $229.00 $61.25 $313.83 $138.86 $138.86 $138.86 $138.86 $308.58 $308.58 $308.58 $64.32 $308.58 $308.58 $308.58 $308.58 $308.58 $64.31 $308.58 $125.53 $182.53 $308.58 $313.83 $308.58 $308.58 $231.75 $308.58 $308.58 $308.58 $154.29 $154.29 $244.40 $308.58 $246.86 $138.86 $61.25 N/A $179.22 $308.58 $185.15 $308.58 $308.58 $308.58 N/A N/A 294.776SHA SUP HCPCS C1713 294.776SHA - SCREW XTRNFX 4MM 100MM STRL 30MM SCHNZ SLF DRL SS HA HIP BOTH IP/OP $309.00 $229.00 $61.25 $313.83 $138.86 $138.86 $138.86 $138.86 $308.58 $308.58 $308.58 $64.32 $308.58 $308.58 $308.58 $308.58 $308.58 $64.31 $308.58 $125.53 $182.53 $308.58 $313.83 $308.58 $308.58 $231.75 $308.58 $308.58 $308.58 $154.29 $154.29 $244.40 $308.58 $246.86 $138.86 $61.25 N/A $179.22 $308.58 $185.15 $308.58 $308.58 $308.58 N/A N/A 294.777SHA SUP HCPCS C1713 294.777SHA - SCREW XTRNFX 4MM 125MM STRL 40MM SCHNZ SLF DRL SS HA HIP BOTH IP/OP $309.00 $229.00 $61.25 $313.83 $138.86 $138.86 $138.86 $138.86 $308.58 $308.58 $308.58 $64.32 $308.58 $308.58 $308.58 $308.58 $308.58 $64.31 $308.58 $313.83 $182.53 $308.58 $313.83 $308.58 $308.58 $231.75 $308.58 $308.58 $308.58 $154.29 $154.29 $244.40 $308.58 $246.86 $138.86 $61.25 N/A $179.22 $308.58 $308.58 $308.58 $308.58 $308.58 N/A N/A 294.778SHA SUP HCPCS C1713 294.778SHA - SCREW XTRNFX 4MM 150MM STRL 40MM SCHNZ SLF DRL SS HA HIP BOTH IP/OP $309.00 $229.00 $61.25 $313.83 $138.86 $138.86 $138.86 $138.86 $308.58 $308.58 $308.58 $64.32 $308.58 $308.58 $308.58 $308.58 $308.58 $64.31 $308.58 $125.53 $182.53 $308.58 $313.83 $308.58 $308.58 $231.75 $308.58 $308.58 $308.58 $154.29 $154.29 $244.40 $308.58 $246.86 $138.86 $61.25 N/A $179.22 $308.58 $185.15 $308.58 $64.31 $308.58 N/A N/A 294.779SHA SUP HCPCS C1713 294.779SHA - SCREW BONE 4MM 175MM SLFDRILL SCHANZ STAINLESS STEEL HA BOTH IP/OP $309.00 $229.00 $61.25 $313.83 $138.86 $138.86 $138.86 $138.86 $308.58 $308.58 $308.58 $64.32 $308.58 $308.58 $308.58 $308.58 $308.58 $64.31 $308.58 $125.53 $182.53 $308.58 $313.83 $308.58 $308.58 $231.75 $308.58 $308.58 $308.58 $154.29 $154.29 $244.40 $308.58 $246.86 $138.86 $61.25 N/A $179.22 $308.58 $185.15 $308.58 $308.58 $308.58 N/A N/A 294.782SHA SUP HCPCS C1713 294.782SHA - SCREW XTRNFX 5MM 100MM STRL 30MM SCHNZ SLF DRL SS HA HIP BOTH IP/OP $341.00 $252.00 $67.66 $346.68 $153.40 $153.40 $153.40 $153.40 $340.88 $340.88 $340.88 $71.05 $340.88 $340.88 $340.88 $340.88 $340.88 $71.04 $340.88 $138.67 $201.63 $340.88 $346.68 $340.88 $340.88 $255.75 $340.88 $340.88 $340.88 $170.44 $170.44 $269.98 $340.88 $272.70 $153.40 $67.66 N/A $197.78 $340.88 $204.53 $340.88 $340.88 $340.88 N/A N/A 294.783SHA SUP HCPCS C1713 294.783SHA - SCREW XTRNFX 5MM 125MM STRL 40MM SCHNZ SLF DRL SS HA HIP BOTH IP/OP $341.00 $252.00 $67.66 $346.68 $153.40 $153.40 $153.40 $153.40 $340.88 $340.88 $340.88 $71.05 $340.88 $340.88 $340.88 $340.88 $340.88 $71.04 $340.88 $138.67 $201.63 $340.88 $346.68 $340.88 $340.88 $255.75 $340.88 $340.88 $340.88 $170.44 $170.44 $269.98 $340.88 $272.70 $153.40 $67.66 N/A $197.78 $340.88 $204.53 $340.88 $340.88 $340.88 N/A N/A 294.784SHA SUP HCPCS C1713 294.784SHA - SCREW BONE 5MM 150MM 60MM SLFDRILL SCHANZ STAINLESS STEEL HA BOTH IP/OP $341.00 $252.00 $67.66 $346.68 $153.40 $153.40 $153.40 $153.40 $340.88 $340.88 $340.88 $71.05 $340.88 $340.88 $340.88 $340.88 $340.88 $71.04 $340.88 $346.68 $201.63 $340.88 $346.68 $340.88 $340.88 $255.75 $340.88 $340.88 $340.88 $170.44 $170.44 $269.98 $340.88 $272.70 $153.40 $67.66 N/A $197.78 $340.88 $204.53 $340.88 $71.04 $340.88 N/A N/A 294.785SHA SUP HCPCS C1713 294.785SHA - SCREW BONE 5MM 175MM 60MM SLFDRILL SCHANZ STAINLESS STEEL HA BOTH IP/OP $341.00 $252.00 $67.66 $346.68 $153.40 $153.40 $153.40 $153.40 $340.88 $340.88 $340.88 $71.05 $340.88 $340.88 $340.88 $340.88 $340.88 $71.04 $340.88 $346.68 $201.63 $340.88 $346.68 $340.88 $340.88 $255.75 $340.88 $340.88 $340.88 $170.44 $170.44 $269.98 $340.88 $272.70 $153.40 $67.66 N/A $197.78 $340.88 $204.53 $340.88 $340.88 $340.88 N/A N/A 294.786SHA SUP HCPCS C1713 294.786SHA - SCREW BONE 5MM 200MM 80MM SLFDRILL SCHANZ STAINLESS STEEL HA BOTH IP/OP $341.00 $252.00 $67.66 $346.68 $153.40 $153.40 $153.40 $153.40 $340.88 $340.88 $340.88 $71.05 $340.88 $340.88 $340.88 $340.88 $340.88 $71.04 $340.88 $346.68 $201.63 $340.88 $346.68 $340.88 $340.88 $255.75 $340.88 $340.88 $340.88 $170.44 $170.44 $269.98 $340.88 $272.70 $153.40 $67.66 N/A $197.78 $340.88 $204.53 $340.88 $340.88 $340.88 N/A N/A 294.788SHA SUP HCPCS C1713 294.788SHA - SCREW XTRNFX 5MM 250MM STRL 80MM SCHNZ SLF DRL SS HA HIP BOTH IP/OP $341.00 $252.00 $67.66 $346.68 $153.40 $153.40 $153.40 $153.40 $340.88 $340.88 $340.88 $71.05 $340.88 $340.88 $340.88 $340.88 $340.88 $71.04 $340.88 $346.68 $201.63 $340.88 $346.68 $340.88 $340.88 $255.75 $340.88 $340.88 $340.88 $170.44 $170.44 $269.98 $340.88 $272.70 $153.40 $67.66 N/A $197.78 $340.88 $204.53 $340.88 $71.04 $340.88 N/A N/A 294.796SHA SUP HCPCS C1713 294.796SHA - SCREW XTRNFX 6MM 200MM STRL 80MM SCHNZ SLF DRL SS HA HIP BOTH IP/OP $361.00 $267.00 $71.64 $367.05 $162.42 $162.42 $162.42 $162.42 $360.93 $360.93 $360.93 $75.23 $360.93 $360.93 $360.93 $360.93 $360.93 $75.22 $360.93 $367.05 $213.49 $360.93 $367.05 $360.93 $360.93 $270.75 $360.93 $360.93 $360.93 $180.47 $180.47 $285.86 $360.93 $288.74 $162.42 $71.64 N/A $209.38 $360.93 $216.56 $360.93 $360.93 $360.93 N/A N/A 2940511S SUP HCPCS C1713 2940511S - SPACER SPINAL 3D SMALL 21MMX9MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 2940512S SUP HCPCS C1713 2940512S - SPACER SPINAL 6D SMALL 21MMX9MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940513S SUP HCPCS C1713 2940513S - SPACER SPINAL 3D SMALL 21MMX11MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940514S SUP HCPCS C1713 2940514S - SPACER SPINAL 6D SMALL 21MMX11MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940515S SUP HCPCS C1713 2940515S - SPACER SPINAL 3D SMALL 21MMX13MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940516S SUP HCPCS C1713 2940516S - SPACER SPINAL 9D SMALL 21MMX9MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940517S SUP HCPCS C1713 2940517S - SPACER SPINAL 9D SMALL 21MMX11MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940521M SUP HCPCS C1713 2940521M - SPACER SPINAL 3D MEDIUM 24MMX9MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940522M SUP HCPCS C1713 2940522M - SPACER SPINAL 6D MEDIUM 24MMX9MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940523M SUP HCPCS C1713 2940523M - SPACER SPINAL 3D MEDIUM 24MMX11MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940524M SUP HCPCS C1713 2940524M - SPACER SPINAL 6D MEDIUM 24MMX11MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 2940525M SUP HCPCS C1713 2940525M - SPACER SPINAL 3D MEDIUM 24MMX13MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 2940526M SUP HCPCS C1713 2940526M - SPACER SPINAL 6D MEDIUM 24MMX13MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940527M SUP HCPCS C1713 2940527M - SPACER SPINAL 9D MEDIUM 24MMX9MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940528M SUP HCPCS C1713 2940528M - SPACER SPINAL 9D MEDIUM 24MMX11MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A 2940531L SUP HCPCS C1713 2940531L - SPACER SPINAL 3D LARGE 27MMX9MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940532L SUP HCPCS C1713 2940532L - SPACER SPINAL 6D LARGE 27MMX9MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940533L SUP HCPCS C1713 2940533L - SPACER SPINAL 3D LARGE 27MMX11MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940534L SUP HCPCS C1713 2940534L - SPACER SPINAL 6D LARGE 27MMX11MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940535L SUP HCPCS C1713 2940535L - SPACER SPINAL 3D LARGE 27MMX13MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940536L SUP HCPCS C1713 2940536L - SPACER SPINAL 6D LARGE 27MMX13MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940537L SUP HCPCS C1713 2940537L - SPACER SPINAL 9D LARGE 27MMX9MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 2940538L SUP HCPCS C1713 2940538L - SPACER SPINAL 9D LARGE 27MMX11MM TLIF LORDOTIC HOURGLASS BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A 298.801.01S SUP Custom 27803010 298.801.01S - CABLE ORTHOPEDIC 1.7MM 750MM CRIMP CERCLAGE LCP STAINLESS BOTH IP/OP $919.50 $680.00 $163.64 $934.95 $919.33 $919.33 $919.33 $919.33 $919.33 $919.33 $163.64 $919.33 $919.33 $919.33 $919.33 $919.33 $919.33 $191.60 $919.33 $373.98 $919.33 $919.33 $934.95 $919.33 $919.33 $689.63 $919.33 $919.33 $919.33 $459.67 $459.67 $728.11 $919.33 $735.46 $413.70 $919.33 N/A $533.31 $919.33 $551.60 $919.33 $919.33 $919.33 N/A N/A 298.803S SUP Custom 27203010 298.803S - PIN POSITIONING 4.5MM CERCLAGE THREADED LCP STAINLESS STEEL BOTH IP/OP $343.00 $254.00 $61.05 $348.83 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $61.05 $343.00 $343.00 $254.57 $254.57 $264.38 $178.70 $71.48 $343.00 $139.53 $343.00 $343.00 $348.83 $343.00 $343.00 $257.25 $343.00 $343.00 $343.00 $171.50 $171.50 $271.66 $343.00 $274.40 $222.95 $343.00 N/A $198.94 $343.00 $205.80 $343.00 $343.00 $343.00 N/A N/A 29AJ-501 SUP Custom 27803010 29AJ-501 - VALVE AOR 85D 29MM 24.2MM MSTR SER MECH STD CUF LFLT OPN BOTH IP/OP "$11,250.00" "$8,325.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$11,250.00" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$11,250.00" "$11,250.00" N/A N/A 29MJ-501 SUP Custom 27803010 29MJ-501 - VALVE MTRL 85D 4.41SQ CM STD RING 29MM 24.2MM MSTR SER LFLT BOTH IP/OP "$11,250.00" "$8,325.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$11,250.00" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$11,250.00" "$11,250.00" N/A N/A 2B1063Q SUP Custom 25803010 SOLUTION IV 5% DEX 0.9% NA CHLOR 500ML VFLX LF BOTH IP/OP $2.00 $1.00 $0.29 $1.63 $1.63 $1.63 $1.63 $1.63 $1.63 $1.63 $0.29 $1.63 $1.63 $1.21 $1.21 $1.26 $0.85 $0.34 $1.63 $0.65 $1.63 $1.63 $1.63 $1.63 $1.63 $1.50 $1.63 $1.63 $1.63 $0.82 $0.82 $1.29 $1.63 $1.30 $1.06 $1.63 N/A $1.16 $1.63 $0.98 $1.63 $1.63 $1.63 N/A N/A 2B1064X SUP Custom 25803010 SOLUTION IV 5% DEX 0.9% NA CHLOR 1L VFLX LF BOTH IP/OP $3.00 $2.00 $0.48 $2.68 $2.68 $2.68 $2.68 $2.68 $2.68 $2.68 $0.48 $2.68 $2.68 $1.99 $1.99 $2.07 $1.40 $0.56 $2.68 $1.07 $2.68 $2.68 $2.68 $2.68 $2.68 $2.25 $2.68 $2.68 $2.68 $1.34 $1.34 $2.12 $2.68 $2.14 $1.74 $2.68 N/A $1.74 $2.68 $1.61 $2.68 $2.68 $2.68 N/A N/A 2B7127 SUP Custom 27203010 2B7127 - SOLUTION IRR 0.9% NA CHLOR URMTC 3L STRL LF BOTH IP/OP $29.00 $21.00 $5.14 $30.55 $28.85 $28.85 $28.85 $28.85 $28.85 $28.85 $5.14 $28.85 $28.85 $21.41 $21.41 $22.24 $15.03 $6.01 $28.85 $12.22 $28.85 $28.85 $30.55 $28.85 $28.85 $21.75 $28.85 $28.85 $28.85 $14.43 $14.43 $22.85 $28.85 $23.08 $18.75 $28.85 N/A $16.82 $28.85 $17.31 $28.85 $28.85 $28.85 N/A N/A 2B7231 SUP Custom 25803010 2B7231 - SOLUTION IRRIGATION BAG USP CONTAINER 0.9% SODIUM CHLORIDE 1 BOTH IP/OP $188.50 $139.00 $33.51 $188.28 $188.28 $188.28 $188.28 $188.28 $188.28 $188.28 $33.51 $188.28 $188.28 $139.74 $139.74 $145.13 $98.09 $39.24 $188.28 $88.08 $188.28 $188.28 $188.28 $188.28 $188.28 $141.38 $188.28 $188.28 $188.28 $94.14 $94.14 $149.12 $188.28 $150.62 $122.38 $188.28 N/A $109.33 $188.28 $112.97 $188.28 $188.28 $188.28 N/A N/A 2C2164 SUP Custom 27203010 2C2164 - TUBINGIRRIGATION-LAPAROS BOTH IP/OP $37.00 $27.00 $6.57 $36.89 $36.89 $36.89 $36.89 $36.89 $36.89 $36.89 $6.57 $36.89 $36.89 $27.38 $27.38 $28.43 $19.22 $7.69 $36.89 $14.76 $36.89 $36.89 $36.89 $36.89 $36.89 $27.75 $36.89 $36.89 $36.89 $18.45 $18.45 $29.22 $36.89 $29.51 $23.98 $36.89 N/A $21.46 $36.89 $22.13 $36.89 $36.89 $36.89 N/A N/A 2N03A SUP Custom 27803010 2N03A - SUTURE NABSB CV-2 THX-22 36IN WHT MFL GRTX BOTH IP/OP $69.00 $51.00 $12.24 $68.75 $68.75 $68.75 $68.75 $68.75 $68.75 $68.75 $12.24 $68.75 $68.75 $68.75 $68.75 $68.75 $68.75 $14.33 $68.75 $27.50 $68.75 $68.75 $68.75 $68.75 $68.75 $51.75 $68.75 $68.75 $68.75 $34.38 $34.38 $54.45 $68.75 $55.00 $30.94 $68.75 N/A $40.02 $68.75 $41.25 $68.75 $68.75 $68.75 N/A N/A 2N05A SUP Custom 27803010 2N05A - SUTURE NABSB CV-2 THX-26 36IN WHT MFL GRTX BOTH IP/OP $69.00 $51.00 $12.24 $68.75 $68.75 $68.75 $68.75 $68.75 $68.75 $68.75 $12.24 $68.75 $68.75 $68.75 $68.75 $68.75 $68.75 $14.33 $68.75 $27.50 $68.75 $68.75 $68.75 $68.75 $68.75 $51.75 $68.75 $68.75 $68.75 $34.38 $34.38 $54.45 $68.75 $55.00 $30.94 $68.75 N/A $40.02 $68.75 $41.25 $68.75 $68.75 $68.75 N/A N/A 2P9 SUP Custom 27803010 2P9 - PATCH VASCULAR THK.45MM 9X2CM XENOSURE BOVINE PERICARDIUM BOTH IP/OP $662.50 $490.00 $117.93 $662.50 $662.50 $662.50 $662.50 $662.50 $662.50 $662.50 $117.93 $662.50 $662.50 $662.50 $662.50 $662.50 $662.50 $138.07 $662.50 $265.00 $662.50 $662.50 $662.50 $662.50 $662.50 $496.88 $662.50 $662.50 $662.50 $331.25 $331.25 $524.70 $662.50 $530.00 $298.13 $662.50 N/A $384.25 $662.50 $397.50 $662.50 $662.50 $662.50 N/A N/A 3.0 NEO SUP Custom 27203010 3.0 NEO - TUBE 30MM 4.5MM 3MM UNCUF OBT TRCH PLVN CHLOR NEO BOTH IP/OP $94.50 $70.00 $16.78 $94.29 $94.29 $94.29 $94.29 $94.29 $94.29 $94.29 $16.78 $94.29 $94.29 $69.98 $69.98 $72.68 $49.13 $19.65 $94.29 $37.72 $94.29 $94.29 $94.29 $94.29 $94.29 $70.88 $94.29 $94.29 $94.29 $47.15 $47.15 $74.68 $94.29 $75.43 $61.29 $94.29 N/A $54.81 $94.29 $56.57 $94.29 $94.29 $94.29 N/A N/A 30-0001 SUP Custom 27203010 30-0001 - TOURNIQUET APL SM 37.5IN BLK C-A-T 1 HND 1 ROUT BCKL BOTH IP/OP $61.50 $46.00 $10.90 $61.25 $61.25 $61.25 $61.25 $61.25 $61.25 $61.25 $10.90 $61.25 $61.25 $45.46 $45.46 $47.21 $31.91 $12.77 $61.25 $24.50 $61.25 $61.25 $61.25 $61.25 $61.25 $46.13 $61.25 $61.25 $61.25 $30.63 $30.63 $48.51 $61.25 $49.00 $39.81 $61.25 N/A $35.67 $61.25 $36.75 $61.25 $61.25 $61.25 N/A N/A 30-0001 SUP Custom 27203010 30-0001 - GUIDE TRGT SCPHD ASMBLY NONSTRL BOTH IP/OP "$4,370.00" "$3,234.00" $10.90 "$3,277.50" $61.25 $61.25 $61.25 $61.25 $61.25 $61.25 $10.90 $61.25 $61.25 $45.46 $45.46 $47.21 $31.91 $12.77 $61.25 $24.50 $61.25 $61.25 $61.25 $61.25 $61.25 "$3,277.50" $61.25 $61.25 $61.25 $30.63 $30.63 $48.51 $61.25 $49.00 $39.81 $61.25 N/A "$2,534.60" $61.25 $36.75 $61.25 $61.25 $61.25 N/A N/A 30-0017-S SUP Custom 27203010 30-0017-S - GUIDE TRGT 1 .035IN SCPHD DISK STRL DISP BOTH IP/OP $652.50 $483.00 $116.15 $652.50 $652.50 $652.50 $652.50 $652.50 $652.50 $652.50 $116.15 $652.50 $652.50 $484.29 $484.29 $502.95 $339.95 $135.99 $652.50 $261.00 $652.50 $652.50 $652.50 $652.50 $652.50 $489.38 $652.50 $652.50 $652.50 $326.25 $326.25 $516.78 $652.50 $522.00 $424.13 $652.50 N/A $378.45 $652.50 $391.50 $652.50 $652.50 $652.50 N/A N/A 30-0018-S SUP Custom 27203010 30-0018-S - GUIDE MINI TRGT SURG SCPHD BOTH IP/OP $652.50 $483.00 $116.15 $652.50 $652.50 $652.50 $652.50 $652.50 $652.50 $652.50 $116.15 $652.50 $652.50 $484.29 $484.29 $502.95 $339.95 $135.99 $652.50 $261.00 $652.50 $652.50 $652.50 $652.50 $652.50 $489.38 $652.50 $652.50 $652.50 $326.25 $326.25 $516.78 $652.50 $522.00 $424.13 $652.50 N/A $378.45 $652.50 $391.50 $652.50 $652.50 $652.50 N/A N/A 30-0019-S SUP Custom 27203010 30-0019-S - GUIDE TRGT 3 .054IN SCPHD DISK STRL BOTH IP/OP $652.50 $483.00 $116.15 $652.50 $652.50 $652.50 $652.50 $652.50 $652.50 $652.50 $116.15 $652.50 $652.50 $484.29 $484.29 $502.95 $339.95 $135.99 $652.50 $261.00 $652.50 $652.50 $652.50 $652.50 $652.50 $489.38 $652.50 $652.50 $652.50 $326.25 $326.25 $516.78 $652.50 $522.00 $424.13 $652.50 N/A $378.45 $652.50 $391.50 $652.50 $652.50 $652.50 N/A N/A 30-0021-S SUP HCPCS C1713 30-0021-S - SCREW BN 5.5MM 25MM ACTRK2 MTP MIDFOOT BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A 30-0023-S SUP HCPCS C1713 30-0023-S - SCREW BN 5.5MM 30MM ACTRK2 MTP MIDFOOT BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A 30-0025-S SUP HCPCS C1713 30-0025-S - SCREW BN 5.5MM 35MM ACUTRACK II BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A 30-0027-S SUP HCPCS C1713 30-0027-S - SCREW BN 5.5MM 40MM ACUTRACK II BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A 30-0029-S SUP HCPCS C1713 30-0029-S - SCREW BN 5.5MM 45MM ACTRK2 MTP MIDFOOT BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A 30-0031-S SUP HCPCS C1713 30-0031-S - SCREW BN 50MM ACTRK2 BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A 30-0033-S SUP HCPCS C1713 30-0033-S - SCREW BONE 6MM 30MM ACTRK FSN DEV HMRTOE SYS BOTH IP/OP $895.00 $662.00 $177.64 $895.00 $402.75 $402.75 $402.75 $402.75 $895.00 $895.00 $895.00 $186.54 $895.00 $895.00 $895.00 $895.00 $895.00 $186.53 $895.00 $358.00 $529.39 $895.00 $895.00 $895.00 $895.00 $671.25 $895.00 $895.00 $895.00 $447.50 $447.50 $708.84 $895.00 $716.00 $402.75 $177.64 N/A $519.10 $895.00 $537.00 $895.00 $186.52 $895.00 N/A N/A 300-070 SUP Custom 27203010 "300-070 - BONE GRAFT HARVESTER, COREX 7MM" BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$1,660.67" "$1,660.67" "$1,724.67" "$1,165.74" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,454.38" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 30-0084-S SUP HCPCS C1713 30-0084-S - SCREW BN 5.5MM 55MM ACTRK BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" $696.00 "$1,160.00" $241.74 "$1,160.00" N/A N/A 30-0085-S SUP HCPCS C1713 30-0085-S - SCREW BN 5.5MM 60MM ACTRK BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" $696.00 "$1,160.00" $241.74 "$1,160.00" N/A N/A 300-090 SUP Custom 27203010 300-090 - HARVESTER BN 9MM STRL LF COREX CANC BN DISP BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$1,660.67" "$1,660.67" "$1,724.67" "$1,165.74" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,454.38" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 30-0093 SUP HCPCS C1713 30-0093 - PLATE SCR ACLC 2 BONE DISTAL VOLR RADL BOTH IP/OP $590.00 $437.00 $117.10 $590.00 $265.50 $265.50 $265.50 $265.50 $590.00 $590.00 $590.00 $122.97 $590.00 $590.00 $590.00 $590.00 $590.00 $122.96 $590.00 $236.00 $348.99 $590.00 $590.00 $590.00 $590.00 $442.50 $590.00 $590.00 $590.00 $295.00 $295.00 $467.28 $590.00 $472.00 $265.50 $117.10 N/A $342.20 $590.00 $590.00 $590.00 $122.96 $590.00 N/A N/A 30-0098 SUP HCPCS C1713 30-0098 - PIN FX 70MM NS TNSNBND BOTH IP/OP $137.50 $102.00 $27.29 $137.50 $61.88 $61.88 $61.88 $61.88 $137.50 $137.50 $137.50 $28.66 $137.50 $137.50 $137.50 $137.50 $137.50 $28.66 $137.50 $55.00 $81.33 $137.50 $137.50 $137.50 $137.50 $103.13 $137.50 $137.50 $137.50 $68.75 $68.75 $108.90 $137.50 $110.00 $61.88 $27.29 N/A $79.75 $137.50 $137.50 $137.50 $28.66 $137.50 N/A N/A 30-0099 SUP HCPCS C1713 30-0099 - PIN FX 90MM NS TNSNBND BOTH IP/OP $137.50 $102.00 $27.29 $137.50 $61.88 $61.88 $61.88 $61.88 $137.50 $137.50 $137.50 $28.66 $137.50 $137.50 $137.50 $137.50 $137.50 $28.66 $137.50 $55.00 $81.33 $137.50 $137.50 $137.50 $137.50 $103.13 $137.50 $137.50 $137.50 $68.75 $68.75 $108.90 $137.50 $110.00 $61.88 $27.29 N/A $79.75 $137.50 $137.50 $137.50 $28.66 $137.50 N/A N/A 30-0232 SUP HCPCS C1713 30-0232 - SCREW BONE 3.5MM 8MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0233 SUP HCPCS C1713 30-0233 - SCREW BONE 3.5MM 10MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0234 SUP HCPCS C1713 30-0234 - SCREW BONE 3.5MM 12MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0235 SUP HCPCS C1713 30-0235 - SCREW BONE 3.5MM 14MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0236 SUP HCPCS C1713 30-0236 - SCREW BONE 3.5MM 16MM LOCK HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0237 SUP HCPCS C1713 30-0237 - SCREW BONE 3.5MM 18MM LOCK HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0238 SUP HCPCS C1713 30-0238 - SCREW BONE 3.5MM 20MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0239 SUP HCPCS C1713 30-0239 - SCREW BONE 3.5MM 22MM LOCK HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0240 SUP HCPCS C1713 30-0240 - SCREW BONE 3.5MM 24MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0241 SUP HCPCS C1713 30-0241 - SCREW BONE 3.5MM 26MM LOCK HEXALOBE ANKLE NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0242 SUP HCPCS C1713 30-0242 - SCREW BONE 3.5MM 28MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0243 SUP HCPCS C1713 30-0243 - SCREW BONE 3.5MM 30MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0244 SUP HCPCS C1713 30-0244 - SCREW BONE 3.5MM 32MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0245 SUP HCPCS C1713 30-0245 - SCREW BONE 3.5MM 34MM LOCK HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0246 SUP HCPCS C1713 30-0246 - SCREW BONE 3.5MM 36MM LOCK HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0247 SUP HCPCS C1713 30-0247 - SCREW BONE 3.5MM 38MM LOCK HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0248 SUP HCPCS C1713 30-0248 - SCREW BONE 3.5MM 40MM LOCK HEXALOBE ANKLE NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0249 SUP HCPCS C1713 30-0249 - SCREW BONE 3.5MM 45MM LOCK HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0250 SUP HCPCS C1713 30-0250 - SCREW BONE 3.5MM 50MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0251 SUP HCPCS C1713 30-0251 - SCREW BONE 3.5MM 55MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0252 SUP HCPCS C1713 30-0252 - SCREW BONE 3.5MM 60MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0255 SUP HCPCS C1713 30-0255 - SCREW BONE 3.5MM 8MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0256 SUP HCPCS C1713 30-0256 - SCREW BN 3.5MM 10MM NS HEXALOBE TI SM FRAG BS SET BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0257 SUP HCPCS C1713 30-0257 - SCREW BN 3.5MM 12MM NS HEXALOBE TI SM FRAG BS SET BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0258 SUP HCPCS C1713 30-0258 - SCREW BN 3.5MM 14MM NS HEXALOBE TI SM FRAG BS SET BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0259 SUP HCPCS C1713 30-0259 - SCREW BONE 3.5MM 16MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0260 SUP HCPCS C1713 30-0260 - SCREW BONE 3.5MM 18MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0261 SUP HCPCS C1713 30-0261 - SCREW BONE 3.5MM 20MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0262 SUP HCPCS C1713 30-0262 - SCREW BONE 3.5MM 22MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0263 SUP HCPCS C1713 30-0263 - SCREW BONE 3.5MM 24MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0264 SUP HCPCS C1713 30-0264 - SCREW BONE 3.5MM 26MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0265 SUP HCPCS C1713 30-0265 - SCREW BONE 3.5MM 28MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0266 SUP HCPCS C1713 30-0266 - SCREW BN 3.5MM 30MM NS HEXALOBE TI SM FRAG BS SET BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0267 SUP HCPCS C1713 30-0267 - SCREW BONE 3.5MM 32MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0268 SUP HCPCS C1713 30-0268 - SCREW BONE 3.5MM 34MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0269 SUP HCPCS C1713 30-0269 - SCREW BONE 3.5MM 36MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0270 SUP HCPCS C1713 30-0270 - SCREW BONE 3.5MM 38MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0271 SUP HCPCS C1713 30-0271 - SCREW BONE 3.5MM 40MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0272 SUP HCPCS C1713 30-0272 - SCREW BONE 3.5MM 45MM HEXALOBE NONLOCK ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0273 SUP HCPCS C1713 30-0273 - SCREW BONE 3.5MM 50MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0274 SUP HCPCS C1713 30-0274 - SCREW BONE 3.5MM 55MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0275 SUP HCPCS C1713 30-0275 - SCREW BONE 3.5MM 60MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0276 SUP HCPCS C1713 30-0276 - SCREW BONE 3.5MM 65MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0278 SUP HCPCS C1713 30-0278 - SCREW BONE 3MM 8MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0279 SUP HCPCS C1713 30-0279 - SCREW BONE 3MM 10MM LOCK HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0280 SUP HCPCS C1713 30-0280 - SCREW BONE 3MM 12MM LOCK HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0281 SUP HCPCS C1713 30-0281 - SCREW BONE 3MM 14MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0282 SUP HCPCS C1713 30-0282 - SCREW BONE 3MM 16MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0283 SUP HCPCS C1713 30-0283 - SCREW BONE 3MM 18MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0284 SUP HCPCS C1713 30-0284 - SCREW BONE 3MM 20MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0285 SUP HCPCS C1713 30-0285 - SCREW BONE 3MM 22MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0286 SUP HCPCS C1713 30-0286 - SCREW BONE 3MM 24MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0287 SUP HCPCS C1713 30-0287 - SCREW BONE 3MM 26MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0288 SUP HCPCS C1713 30-0288 - SCREW BONE 3MM 28MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0289 SUP HCPCS C1713 30-0289 - SCREW BONE 3MM 30MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0290 SUP HCPCS C1713 30-0290 - SCREW BONE 3MM 32MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0291 SUP HCPCS C1713 30-0291 - SCREW BONE 3MM 34MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0292 SUP HCPCS C1713 30-0292 - SCREW BONE 3MM 36MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0293 SUP HCPCS C1713 30-0293 - SCREW BONE 3MM 40MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0294 SUP HCPCS C1713 30-0294 - SCREW BONE 3MM 40MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0295 SUP HCPCS C1713 30-0295 - SCREW BONE 3MM 50MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0296 SUP HCPCS C1713 30-0296 - SCREW BONE 3MM 55MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0297 SUP HCPCS C1713 30-0297 - SCREW BN 3MM 55MM LCK HEXALOBE ELB BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0298 SUP HCPCS C1713 30-0298 - SCREW BONE 3MM 65MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0301 SUP HCPCS C1713 30-0301 - SCREW BONE 3MM 8MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0302 SUP HCPCS C1713 30-0302 - SCREW BONE 3MM 10MM NONLOCK HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0303 SUP HCPCS C1713 30-0303 - SCREW BONE 3MM 12MM NONLOCK HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0304 SUP HCPCS C1713 30-0304 - SCREW BONE 3MM 14MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0305 SUP HCPCS C1713 30-0305 - SCREW BONE 3MM 16MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0306 SUP HCPCS C1713 30-0306 - SCREW BN 3MM 18MM NONLOCK HEXALOBE HD BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0307 SUP HCPCS C1713 30-0307 - SCREW BONE 3MM 20MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0308 SUP HCPCS C1713 30-0308 - SCREW BN 3MM 22MM NS HEXALOBE TI SM FRAG BS SET BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 3003-0822S SUP HCPCS C1713 3003-0822S - SCREW SET 8MM 17.5MM GAMMA3 TITANIUM HIP STERILE LONG NAIL BOTH IP/OP $289.00 $214.00 $57.31 $288.75 $129.94 $129.94 $129.94 $129.94 $288.75 $288.75 $288.75 $60.18 $288.75 $288.75 $288.75 $288.75 $288.75 $60.18 $288.75 $288.75 $170.80 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $129.94 $57.31 N/A $167.62 $288.75 $173.25 $288.75 $60.18 $288.75 N/A N/A 30-0309 SUP HCPCS C1713 30-0309 - SCREW BONE 3MM 24MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0310 SUP HCPCS C1713 30-0310 - SCREW BONE 3MM 26MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0311 SUP HCPCS C1713 30-0311 - SCREW BONE HEXALOBE 3MM 28MM NONLOCKING ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0312 SUP HCPCS C1713 30-0312 - SCREW BONE HEXALOBE 3MM 30MM FT ANKLE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0313 SUP HCPCS C1713 30-0313 - SCREW BONE 3MM 32MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0314 SUP HCPCS C1713 30-0314 - SCREW BONE 3MM 34MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0315 SUP HCPCS C1713 30-0315 - SCREW BONE 3MM 36MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0316 SUP HCPCS C1713 30-0316 - SCREW BONE 3MM 38MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0317 SUP HCPCS C1713 30-0317 - SCREW BONE 3MM 40MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0318 SUP HCPCS C1713 30-0318 - SCREW BONE 3MM 45MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0319 SUP HCPCS C1713 30-0319 - SCREW BN 3MM 50MM NS HEXALOBE TI SM FRAG BS SET BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0320 SUP HCPCS C1713 30-0320 - SCREW BONE 3MM 55MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0321 SUP HCPCS C1713 30-0321 - SCREW BONE 3MM 60MM NONLOCKING HEXALOBE DISTAL VOLAR RADIAL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0322 SUP HCPCS C1713 30-0322 - SCREW BONE 3MM 65MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0324 SUP HCPCS C1713 30-0324 - SCREW BONE 2.7MM 8MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0325 SUP HCPCS C1713 30-0325 - SCREW BONE 2.7MM 10MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0326 SUP HCPCS C1713 30-0326 - SCREW BONE 2.7MM 12MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0327 SUP HCPCS C1713 30-0327 - SCREW BONE 2.7MM 14MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0328 SUP HCPCS C1713 30-0328 - SCREW BN 2.7MM 16MM NS LCK HEXALOBE TI SM FRAG BS SET BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0329 SUP HCPCS C1713 30-0329 - SCREW BONE 2.7MM 18MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0330 SUP HCPCS C1713 30-0330 - SCREW BONE 2.7MM 20MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0331 SUP HCPCS C1713 30-0331 - SCREW BN 2.7MM 22MM NS LCK HEXALOBE TI SM FRAG BS SET BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0332 SUP HCPCS C1713 30-0332 - SCREW BONE 2.7MM 24MM LOCK HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0333 SUP HCPCS C1713 30-0333 - SCREW BONE 2.7MM 26MM LOCK HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0334 SUP HCPCS C1713 30-0334 - SCREW BONE 2.7MM 28MM LOCK HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0335 SUP HCPCS C1713 30-0335 - SCREW BONE 2.7MM 30MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0336 SUP HCPCS C1713 30-0336 - SCREW BONE 2.7MM 32MM LOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0343 SUP HCPCS C1713 30-0343 - SCREW BONE 2.7MM 8MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0344 SUP HCPCS C1713 30-0344 - SCREW BONE 2.7MM 10MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0345 SUP HCPCS C1713 30-0345 - SCREW BONE 2.7MM 12MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0346 SUP HCPCS C1713 30-0346 - SCREW BONE 2.7MM 14MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0347 SUP HCPCS C1713 30-0347 - SCREW BONE 2.7MM 16MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0348 SUP HCPCS C1713 30-0348 - SCREW BONE 2.7MM 18MM NONLOCKING HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0349 SUP HCPCS C1713 30-0349 - SCREW BONE 2.7MM 20MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0350 SUP HCPCS C1713 30-0350 - SCREW BN 2.7MM 22MM NS HEXALOBE TI SM FRAG BS SET BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0351 SUP HCPCS C1713 30-0351 - SCREW BN 2.7MM 24MM NS HEXALOBE TI SM FRAG BS SET BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0352 SUP HCPCS C1713 30-0352 - SCREW BONE 2.7MM 26MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0353 SUP HCPCS C1713 30-0353 - SCREW BONE 2.7MM 28MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0354 SUP HCPCS C1713 30-0354 - SCREW BN 2.7MM 30MM NS HEXALOBE TI SM FRAG BS SET BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0355 SUP HCPCS C1713 30-0355 - SCREW BONE 2.7MM 32MM HEXALOBE ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 30-0370 SUP Custom 27203010 30-0370 - SLEEVE CMPR NS FRAG-LOC BN SCR BOTH IP/OP $650.00 $481.00 $115.70 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $115.70 $650.00 $650.00 $482.43 $482.43 $501.02 $338.65 $135.47 $650.00 $260.00 $650.00 $650.00 $650.00 $650.00 $650.00 $487.50 $650.00 $650.00 $650.00 $325.00 $325.00 $514.80 $650.00 $520.00 $422.50 $650.00 N/A $377.00 $650.00 $390.00 $650.00 $650.00 $650.00 N/A N/A 30-0371 SUP HCPCS C1713 30-0371 - SCREW BN STRL FRAG-LOC CMPR BOTH IP/OP $395.00 $292.00 $78.40 $395.00 $177.75 $177.75 $177.75 $177.75 $395.00 $395.00 $395.00 $82.33 $395.00 $395.00 $395.00 $395.00 $395.00 $82.32 $395.00 $158.00 $233.64 $395.00 $395.00 $395.00 $395.00 $296.25 $395.00 $395.00 $395.00 $197.50 $197.50 $312.84 $395.00 $316.00 $177.75 $78.40 N/A $229.10 $395.00 $237.00 $395.00 $82.32 $395.00 N/A N/A 3004-15010 SUP HCPCS C1713 3004-15010 - SCREW BONE 1.5MM 10MM HEXALOBE MULTI TITANIUM HAND BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 3004-15011 SUP HCPCS C1713 3004-15011 - SCREW BONE 1.5MM 11MM HEXALOBE MULTI TITANIUM HAND BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3004-23009 SUP HCPCS C1713 3004-23009 - SCREW BONE HEXALOBE 2.3MM 9MM MULTI ELBOW NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 3004-23010 SUP HCPCS C1713 3004-23010 - SCREW BONE HEXALOBE 2.3MM 10MM MULTI TITANIUM HAND NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3004-23011 SUP HCPCS C1713 3004-23011 - SCREW BONE 2.3MM 11MM HEXALOBE DRIVER ELBOW BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3004-23012 SUP HCPCS C1713 3004-23012 - SCREW BONE 2.3MM 12MM MULTI HEXALOBE WRIST BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3004-23013 SUP HCPCS C1713 3004-23013 - SCREW BN 2.3MM 13MM MLLK VA HEXALOBE TI HND FX SYS BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 3004-23014 SUP HCPCS C1713 3004-23014 - SCREW BONE 2.3MM 14MM HEXALOBE DRIVER ELBOW BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3004-23016 SUP HCPCS C1713 3004-23016 - SCREW BONE 2.3MM 16MM ELB HEXALOBE DRVR BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 30-0426 SUP HCPCS C1713 30-0426 - SCREW BONE 5.7MM 26MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $169.00 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $253.50 $422.50 $88.05 $422.50 N/A N/A 30-0428 SUP HCPCS C1713 30-0428 - SCREW BONE 5.7MM 28MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $169.00 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $253.50 $422.50 $88.05 $422.50 N/A N/A 30-0430 SUP HCPCS C1713 30-0430 - SCREW BONE 5.7MM 30MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $169.00 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $253.50 $422.50 $88.05 $422.50 N/A N/A 30-0432 SUP HCPCS C1713 30-0432 - SCREW BONE 5.7MM 32MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $169.00 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $253.50 $422.50 $88.05 $422.50 N/A N/A 30-0434 SUP HCPCS C1713 30-0434 - SCREW BONE 5.7MM 34MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $169.00 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $422.50 $422.50 $88.05 $422.50 N/A N/A 30-0436 SUP HCPCS C1713 30-0436 - SCREW BONE 5.7MM 36MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $422.50 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $253.50 $422.50 $88.05 $422.50 N/A N/A 30-0438 SUP HCPCS C1713 30-0438 - SCREW BONE 5.7MM 38MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $422.50 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $253.50 $422.50 $88.05 $422.50 N/A N/A 30-0440 SUP HCPCS C1713 30-0440 - SCREW BONE 5.7MM 40MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $422.50 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $253.50 $422.50 $88.05 $422.50 N/A N/A 30-0442 SUP HCPCS C1713 30-0442 - SCREW BONE 5.7MM 42MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $169.00 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $422.50 $422.50 $88.05 $422.50 N/A N/A 30-0444 SUP HCPCS C1713 30-0444 - SCREW BONE 5.7MM 44MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $422.50 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $253.50 $422.50 $88.05 $422.50 N/A N/A 30-0446 SUP HCPCS C1713 30-0446 - SCREW BONE 5.7MM 46MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $422.50 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $422.50 $422.50 $88.05 $422.50 N/A N/A 30-0448 SUP HCPCS C1713 30-0448 - SCREW BONE 5.7MM 48MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $422.50 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $253.50 $422.50 $88.05 $422.50 N/A N/A 30-0450 SUP HCPCS C1713 30-0450 - SCREW BONE 5.7MM 50MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $422.50 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $253.50 $422.50 $88.05 $422.50 N/A N/A 30-0452 SUP HCPCS C1713 30-0452 - SCREW BONE 5.7MM 52MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $422.50 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $253.50 $422.50 $88.05 $422.50 N/A N/A 30-0454 SUP HCPCS C1713 30-0454 - SCREW BONE 5.7MM 54MM PLRS TI PROX CANC HUM LCK BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $169.00 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $253.50 $422.50 $88.05 $422.50 N/A N/A 3005-1100S SUP HCPCS C1713 3005-1100S - CAP END STANDARD 11MM GAMMA3 TITANIUM HIP FEMUR STERILE BOTH IP/OP $289.00 $214.00 $57.31 $288.75 $129.94 $129.94 $129.94 $129.94 $288.75 $288.75 $288.75 $60.18 $288.75 $288.75 $288.75 $288.75 $288.75 $60.18 $288.75 $115.50 $170.80 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $129.94 $57.31 N/A $167.62 $288.75 $288.75 $288.75 $60.18 $288.75 N/A N/A 3005-1105S SUP HCPCS C1713 3005-1105S - CAP END +5MM GAMMA3 TITANIUM HIP FEMUR STERILE BOTH IP/OP $289.00 $214.00 $57.31 $288.75 $129.94 $129.94 $129.94 $129.94 $288.75 $288.75 $288.75 $60.18 $288.75 $288.75 $288.75 $288.75 $288.75 $60.18 $288.75 $115.50 $170.80 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $129.94 $57.31 N/A $167.62 $288.75 $288.75 $288.75 $60.18 $288.75 N/A N/A 3005-1110S SUP HCPCS C1713 3005-1110S - CAP END STANDARD 15.5MM 10+ MM GAMMA3 TITANIUM HIP FEMUR BOTH IP/OP $289.00 $214.00 $57.31 $288.75 $129.94 $129.94 $129.94 $129.94 $288.75 $288.75 $288.75 $60.18 $288.75 $288.75 $288.75 $288.75 $288.75 $60.18 $288.75 $115.50 $170.80 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $129.94 $57.31 N/A $167.62 $288.75 $288.75 $288.75 $60.18 $288.75 N/A N/A 3006-00 SUP Custom 27203010 3006-00 - PIN SKL BLU STRL DORO ADLT BOTH IP/OP $50.00 $37.00 $8.84 $49.67 $49.67 $49.67 $49.67 $49.67 $49.67 $49.67 $8.84 $49.67 $49.67 $36.87 $36.87 $38.29 $25.88 $10.35 $49.67 $19.87 $49.67 $49.67 $49.67 $49.67 $49.67 $37.50 $49.67 $49.67 $49.67 $24.84 $24.84 $39.34 $49.67 $39.74 $32.29 $49.67 N/A $29.00 $49.67 $29.80 $49.67 $49.67 $49.67 N/A N/A 3006-20 SUP Custom 27203010 3006-20 - PIN SKL TI ADLT CRNL DISP BOTH IP/OP $68.00 $50.00 $12.03 $67.59 $67.59 $67.59 $67.59 $67.59 $67.59 $67.59 $12.03 $67.59 $67.59 $50.17 $50.17 $52.10 $35.21 $14.09 $67.59 $27.04 $67.59 $67.59 $67.59 $67.59 $67.59 $51.00 $67.59 $67.59 $67.59 $33.80 $33.80 $53.53 $67.59 $54.07 $43.93 $67.59 N/A $39.44 $67.59 $40.55 $67.59 $67.59 $67.59 N/A N/A 30-0650 SUP HCPCS C1713 30-0650 - SCREW BONE FULTHD 4.7MM 4.5MM 50MM CANN COMPRESSION SELF BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A 3008 A SUP HCPCS C1713 3008 A - CLIP SURG SMALL RIGHT ANG STERILE BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $152.00 $152.00 $31.68 $152.00 N/A N/A 3008 B SUP HCPCS C1713 3008 B - CLIP SURG STANDARD RIGHT ANG STERILE BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 3012-15008 SUP HCPCS C1713 3012-15008 - SCREW BONE HEXALOBE PTHRD 1.5MM 8MM LAG HAND NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 3012-15009 SUP HCPCS C1713 3012-15009 - SCREW BONE HEXALOBE PTHRD 1.5MM 9MM LAG HAND NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3012-15010 SUP HCPCS C1713 3012-15010 - SCREW BONE HEXALOBE PTHRD 1.5MM 10MM LAG HAND NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 3012-15011 SUP HCPCS C1713 3012-15011 - SCREW BONE 1.5MM 11MM HEXALOBE DRIVER LAG ELBOW BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3012-15013 SUP HCPCS C1713 3012-15013 - SCREW BONE 1.5MM 13MM HEXALOBE DRIVER LAG ELBOW BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3012-15014 SUP HCPCS C1713 3012-15014 - SCREW BONE 1.5MM 14MM HEXALOBE DRIVER LAG ELBOW BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3012-23008 SUP HCPCS C1713 3012-23008 - SCREW BONE HEXALOBE PTHRD 2.3MM 8MM LAG HAND NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3012-23009 SUP HCPCS C1713 3012-23009 - SCREW BONE HEXALOBE 2.3MM 9MM LAG HAND BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3012-23010 SUP HCPCS C1713 3012-23010 - SCREW BONE 2.3MM 10MM HEXALOBE LAG TITANIUM HAND METACARPAL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3012-23012 SUP HCPCS C1713 3012-23012 - SCREW BONE HEXALOBE PTHRD 2.3MM 12MM LAG HAND NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3012-23013 SUP HCPCS C1713 3012-23013 - SCREW BONE 2.3MM 13MM ACUMED TI HEXALOBE MTCRPL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 3012-23016 SUP HCPCS C1713 3012-23016 - SCREW BN HEXALOBE 2.3MM 16MM YLW NS ACUMED LG LOPRFL TI BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3012-23018 SUP HCPCS C1713 3012-23018 - SCREW BONE HEXALOBE PTHRD 2.3MM 18MM LAG HAND NONSTRL BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $322.50 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $322.50 $322.50 $67.21 $322.50 N/A N/A 3013SP SUP Custom 27203010 3013SP - HEMOSTAT ABS SRGCL OXD REGENERATED CLU PWDR BOTH IP/OP $395.00 $292.00 $70.23 $394.57 $394.57 $394.57 $394.57 $394.57 $394.57 $394.57 $70.23 $394.57 $394.57 $292.85 $292.85 $304.13 $205.57 $82.23 $394.57 $157.83 $394.57 $394.57 $394.57 $394.57 $394.57 $296.25 $394.57 $394.57 $394.57 $197.29 $197.29 $312.50 $394.57 $315.66 $256.47 $394.57 N/A $229.10 $394.57 $236.74 $394.57 $394.57 $394.57 N/A N/A 30170007-S SUP HCPCS C1713 30170007-S - SCREW BONE .045IN STANDARD FULTHD TAPER 3.6-4.3MM 16MM BOTH IP/OP "$1,617.50" "$1,197.00" $321.03 "$1,617.50" $727.88 $727.88 $727.88 $727.88 "$1,617.50" "$1,617.50" "$1,617.50" $337.13 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" $337.10 "$1,617.50" "$1,617.50" $956.75 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,213.13" "$1,617.50" "$1,617.50" "$1,617.50" $808.75 $808.75 "$1,281.06" "$1,617.50" "$1,294.00" $727.88 $321.03 N/A $938.15 "$1,617.50" "$1,617.50" "$1,617.50" $337.09 "$1,617.50" N/A N/A 30170008-S SUP HCPCS C1713 30170008-S - SCREW BN 18MM BIOTRAK BOTH IP/OP "$1,617.50" "$1,197.00" $321.03 "$1,617.50" $727.88 $727.88 $727.88 $727.88 "$1,617.50" "$1,617.50" "$1,617.50" $337.13 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" $337.10 "$1,617.50" "$1,617.50" $956.75 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,213.13" "$1,617.50" "$1,617.50" "$1,617.50" $808.75 $808.75 "$1,281.06" "$1,617.50" "$1,294.00" $727.88 $321.03 N/A $938.15 "$1,617.50" "$1,617.50" "$1,617.50" $337.09 "$1,617.50" N/A N/A 30170009-S SUP HCPCS C1713 30170009-S - SCREW BONE STANDARD FULTHD TAPER 3.6-4.5MM 20MM RESORB BOTH IP/OP "$1,617.50" "$1,197.00" $321.03 "$1,617.50" $727.88 $727.88 $727.88 $727.88 "$1,617.50" "$1,617.50" "$1,617.50" $337.13 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" $337.10 "$1,617.50" "$1,617.50" $956.75 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,213.13" "$1,617.50" "$1,617.50" "$1,617.50" $808.75 $808.75 "$1,281.06" "$1,617.50" "$1,294.00" $727.88 $321.03 N/A $938.15 "$1,617.50" "$1,617.50" "$1,617.50" $337.09 "$1,617.50" N/A N/A 30170010-S SUP HCPCS C1713 30170010-S - SCREW BN 22MM BIOTRAK BOTH IP/OP "$1,617.50" "$1,197.00" $321.03 "$1,617.50" $727.88 $727.88 $727.88 $727.88 "$1,617.50" "$1,617.50" "$1,617.50" $337.13 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" $337.10 "$1,617.50" "$1,617.50" $956.75 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,213.13" "$1,617.50" "$1,617.50" "$1,617.50" $808.75 $808.75 "$1,281.06" "$1,617.50" "$1,294.00" $727.88 $321.03 N/A $938.15 "$1,617.50" "$1,617.50" "$1,617.50" $337.09 "$1,617.50" N/A N/A 30170011-S SUP HCPCS C1713 30170011-S - SCREW BN 24MM BIOTRAK BOTH IP/OP "$1,617.50" "$1,197.00" $321.03 "$1,617.50" $727.88 $727.88 $727.88 $727.88 "$1,617.50" "$1,617.50" "$1,617.50" $337.13 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" $337.10 "$1,617.50" $647.00 $956.75 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,213.13" "$1,617.50" "$1,617.50" "$1,617.50" $808.75 $808.75 "$1,281.06" "$1,617.50" "$1,294.00" $727.88 $321.03 N/A $938.15 "$1,617.50" $970.50 "$1,617.50" $337.09 "$1,617.50" N/A N/A 30170057-S SUP HCPCS C1713 30170057-S - SCREW BN MN 16MM BIOTRAK BOTH IP/OP "$1,617.50" "$1,197.00" $321.03 "$1,617.50" $727.88 $727.88 $727.88 $727.88 "$1,617.50" "$1,617.50" "$1,617.50" $337.13 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" $337.10 "$1,617.50" $647.00 $956.75 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,213.13" "$1,617.50" "$1,617.50" "$1,617.50" $808.75 $808.75 "$1,281.06" "$1,617.50" "$1,294.00" $727.88 $321.03 N/A $938.15 "$1,617.50" $970.50 "$1,617.50" $337.09 "$1,617.50" N/A N/A 30170058-S SUP HCPCS C1713 30170058-S - SCREW BN MN 18MM BIOTRAK BOTH IP/OP "$1,617.50" "$1,197.00" $321.03 "$1,617.50" $727.88 $727.88 $727.88 $727.88 "$1,617.50" "$1,617.50" "$1,617.50" $337.13 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" $337.10 "$1,617.50" $647.00 $956.75 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,213.13" "$1,617.50" "$1,617.50" "$1,617.50" $808.75 $808.75 "$1,281.06" "$1,617.50" "$1,294.00" $727.88 $321.03 N/A $938.15 "$1,617.50" "$1,617.50" "$1,617.50" $337.09 "$1,617.50" N/A N/A 30170059-S SUP HCPCS C1713 30170059-S - SCREW BN MN FT TPR 3.2-3.6MM 20MM STRL BIOTRAK RSRB RDLCNT BOTH IP/OP "$1,617.50" "$1,197.00" $321.03 "$1,617.50" $727.88 $727.88 $727.88 $727.88 "$1,617.50" "$1,617.50" "$1,617.50" $337.13 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" $337.10 "$1,617.50" "$1,617.50" $956.75 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,213.13" "$1,617.50" "$1,617.50" "$1,617.50" $808.75 $808.75 "$1,281.06" "$1,617.50" "$1,294.00" $727.88 $321.03 N/A $938.15 "$1,617.50" $970.50 "$1,617.50" $337.09 "$1,617.50" N/A N/A 30170060-S SUP HCPCS C1713 30170060-S - SCREW BN MN FT TPR 3.2-3.7MM 22MM STRL BIOTRAK RSRB RDLCNT BOTH IP/OP "$1,617.50" "$1,197.00" $321.03 "$1,617.50" $727.88 $727.88 $727.88 $727.88 "$1,617.50" "$1,617.50" "$1,617.50" $337.13 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" $337.10 "$1,617.50" "$1,617.50" $956.75 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,213.13" "$1,617.50" "$1,617.50" "$1,617.50" $808.75 $808.75 "$1,281.06" "$1,617.50" "$1,294.00" $727.88 $321.03 N/A $938.15 "$1,617.50" $970.50 "$1,617.50" $337.09 "$1,617.50" N/A N/A 30170061-S SUP HCPCS C1713 30170061-S - SCREW BONE MINI FULTHD TAPER 3.2-3.7MM 24MM RESORB BOTH IP/OP "$1,617.50" "$1,197.00" $321.03 "$1,617.50" $727.88 $727.88 $727.88 $727.88 "$1,617.50" "$1,617.50" "$1,617.50" $337.13 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" $337.10 "$1,617.50" "$1,617.50" $956.75 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,213.13" "$1,617.50" "$1,617.50" "$1,617.50" $808.75 $808.75 "$1,281.06" "$1,617.50" "$1,294.00" $727.88 $321.03 N/A $938.15 "$1,617.50" $970.50 "$1,617.50" $337.09 "$1,617.50" N/A N/A 30170320-S SUP Custom 27203010 30170320-S - PIN FX 20MM BIOTRAK BOTH IP/OP $605.00 $448.00 $107.69 $605.00 $605.00 $605.00 $605.00 $605.00 $605.00 $605.00 $107.69 $605.00 $605.00 $449.03 $449.03 $466.33 $315.21 $126.09 $605.00 $242.00 $605.00 $605.00 $605.00 $605.00 $605.00 $453.75 $605.00 $605.00 $605.00 $302.50 $302.50 $479.16 $605.00 $484.00 $393.25 $605.00 N/A $350.90 $605.00 $363.00 $605.00 $605.00 $605.00 N/A N/A 30170330-S SUP Custom 27203010 30170330-S - PIN FX 30MM BIOTRAK BOTH IP/OP $605.00 $448.00 $107.69 $605.00 $605.00 $605.00 $605.00 $605.00 $605.00 $605.00 $107.69 $605.00 $605.00 $449.03 $449.03 $466.33 $315.21 $126.09 $605.00 $242.00 $605.00 $605.00 $605.00 $605.00 $605.00 $453.75 $605.00 $605.00 $605.00 $302.50 $302.50 $479.16 $605.00 $484.00 $393.25 $605.00 N/A $350.90 $605.00 $363.00 $605.00 $605.00 $605.00 N/A N/A 30170340-S SUP Custom 27203010 30170340-S - PIN FX 40MM BIOTRAK BOTH IP/OP $605.00 $448.00 $107.69 $605.00 $605.00 $605.00 $605.00 $605.00 $605.00 $605.00 $107.69 $605.00 $605.00 $449.03 $449.03 $466.33 $315.21 $126.09 $605.00 $242.00 $605.00 $605.00 $605.00 $605.00 $605.00 $453.75 $605.00 $605.00 $605.00 $302.50 $302.50 $479.16 $605.00 $484.00 $393.25 $605.00 N/A $350.90 $605.00 $363.00 $605.00 $605.00 $605.00 N/A N/A 30-401LITE SUP Custom 27203010 30-401LITE - DEVICE REMOVAL 10FT 3MM 25.25IN 6FT FLEXIBLE DRIVE CABLE BOTH IP/OP "$2,054.50" "$1,520.00" $365.64 "$2,054.17" "$2,054.17" "$2,054.17" "$2,054.17" "$2,054.17" "$2,054.17" "$2,054.17" $365.64 "$2,054.17" "$2,054.17" "$1,524.60" "$1,524.60" "$1,583.35" "$1,070.22" $428.11 "$2,054.17" $821.67 "$2,054.17" "$2,054.17" "$2,054.17" "$2,054.17" "$2,054.17" "$1,540.88" "$2,054.17" "$2,054.17" "$2,054.17" "$1,027.09" "$1,027.09" "$1,626.90" "$2,054.17" "$1,643.34" "$1,335.21" "$2,054.17" N/A "$1,191.61" "$2,054.17" "$1,232.50" "$2,054.17" "$2,054.17" "$2,054.17" N/A N/A 3044-0026 SUP Custom 27803010 3044-0026 - COMPONENT PATLR 26MM RECESSED UHMWPE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 3044-0028 SUP Custom 27803010 3044-0028 - COMPONENT PATLR 28MM RECESSED UHMWPE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 3044-0030 SUP Custom 27803010 3044-0030 - COMPONENT PATLR 30MM RECESSED UHMWPE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 3044-0032 SUP Custom 27803010 3044-0032 - COMPONENT PATLR 32MM RECESSED UHMWPE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 3045-0026 SUP Custom 27803010 3045-0026 - COMPONENT PATLR 26MM 5MM 10MM 1 AXIS BACK RECESS SCORPIO BOTH IP/OP "$1,211.00" $896.00 $215.56 "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" $215.56 "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" $252.39 "$1,211.00" $484.40 "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" $908.25 "$1,211.00" "$1,211.00" "$1,211.00" $605.50 $605.50 $959.11 "$1,211.00" $968.80 $544.95 "$1,211.00" N/A $702.38 "$1,211.00" $726.60 "$1,211.00" "$1,211.00" "$1,211.00" N/A N/A 3045-0028 SUP Custom 27803010 3045-0028 - COMPONENT PATLR 28MM 5MM 10MM 1 AXIS BACK RECESS SCORPIO BOTH IP/OP "$1,211.00" $896.00 $215.56 "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" $215.56 "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" $252.39 "$1,211.00" $484.40 "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" $908.25 "$1,211.00" "$1,211.00" "$1,211.00" $605.50 $605.50 $959.11 "$1,211.00" $968.80 $544.95 "$1,211.00" N/A $702.38 "$1,211.00" $726.60 "$1,211.00" "$1,211.00" "$1,211.00" N/A N/A 3045-0030 SUP Custom 27803010 3045-0030 - COMPONENT PATLR 30MM 5MM 10MM 1 AXIS BACK RECESS SCORPIO BOTH IP/OP "$1,211.00" $896.00 $215.56 "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" $215.56 "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" $252.39 "$1,211.00" $484.40 "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" $908.25 "$1,211.00" "$1,211.00" "$1,211.00" $605.50 $605.50 $959.11 "$1,211.00" $968.80 $544.95 "$1,211.00" N/A $702.38 "$1,211.00" $726.60 "$1,211.00" "$1,211.00" "$1,211.00" N/A N/A 3045-0032 SUP Custom 27803010 3045-0032 - COMPONENT PATLR 32MM 5MM 10MM 1 AXIS BACK RECESS SCORPIO BOTH IP/OP "$1,211.00" $896.00 $215.56 "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" $215.56 "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" $252.39 "$1,211.00" $484.40 "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" "$1,211.00" $908.25 "$1,211.00" "$1,211.00" "$1,211.00" $605.50 $605.50 $959.11 "$1,211.00" $968.80 $544.95 "$1,211.00" N/A $702.38 "$1,211.00" $726.60 "$1,211.00" "$1,211.00" "$1,211.00" N/A N/A 3051-0308 SUP Custom 27803010 3051-0308 - INSERT TIBIAL 3 8MM BEARING KNEE SERIES I BOTH IP/OP $985.00 $729.00 $175.33 $985.00 $985.00 $985.00 $985.00 $985.00 $985.00 $985.00 $175.33 $985.00 $985.00 $985.00 $985.00 $985.00 $985.00 $205.28 $985.00 $394.00 $985.00 $985.00 $985.00 $985.00 $985.00 $738.75 $985.00 $985.00 $985.00 $492.50 $492.50 $780.12 $985.00 $788.00 $443.25 $985.00 N/A $571.30 $985.00 $591.00 $985.00 $985.00 $985.00 N/A N/A 3052-0308 SUP Custom 27803010 3052-0308 - INSERT TIBIAL 3 8MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0310 SUP Custom 27803010 3052-0310 - INSERT TIBIAL 3 10MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0312 SUP Custom 27803010 3052-0312 - INSERT TIBIAL 3 12MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0315 SUP Custom 27803010 3052-0315 - INSERT TIBIAL 3 15MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0318 SUP Custom 27803010 3052-0318 - INSERT TIBIAL 3 18MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0321 SUP Custom 27803010 3052-0321 - INSERT TIBIAL 3 21MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0324 SUP Custom 27803010 3052-0324 - INSERT TIBIAL 3 24MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0508 SUP Custom 27803010 3052-0508 - INSERT TIBIAL 5 8MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0510 SUP Custom 27803010 3052-0510 - INSERT TIBIAL 5 10MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0512 SUP Custom 27803010 3052-0512 - INSERT TIBIAL 5 12MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0515 SUP Custom 27803010 3052-0515 - INSERT TIBIAL 5 15MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0518 SUP Custom 27803010 3052-0518 - INSERT TIBIAL 5 18MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0521 SUP Custom 27803010 3052-0521 - INSERT TIBIAL 5 21MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0524 SUP Custom 27803010 3052-0524 - INSERT TIBIAL 5 24MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0708 SUP Custom 27803010 3052-0708 - INSERT TIBIAL 7 8MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0710 SUP Custom 27803010 3052-0710 - INSERT TIBIAL 7 10MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0712 SUP Custom 27803010 3052-0712 - INSERT TIBIAL 7 12MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0715 SUP Custom 27803010 3052-0715 - INSERT TIBIAL 7 15MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0718 SUP Custom 27803010 3052-0718 - INSERT TIBIAL 7 18MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0721 SUP Custom 27803010 3052-0721 - INSERT TIBIAL 7 21MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0724 SUP Custom 27803010 3052-0724 - INSERT TIBIAL 7 24MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0908 SUP Custom 27803010 3052-0908 - INSERT TIBIAL 9 8MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0910 SUP Custom 27803010 3052-0910 - INSERT TIBIAL 9 10MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0912 SUP Custom 27803010 3052-0912 - INSERT TIBIAL 9 12MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0915 SUP Custom 27803010 3052-0915 - INSERT TIBIAL 9 15MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0918 SUP Custom 27803010 3052-0918 - INSERT TIBIAL 9 18MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0921 SUP Custom 27803010 3052-0921 - INSERT TIBIAL 9 21MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-0924 SUP Custom 27803010 3052-0924 - INSERT TIBIAL 9 24MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-1108 SUP Custom 27803010 3052-1108 - INSERT TIBIAL 11 8MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-1110 SUP Custom 27803010 3052-1110 - INSERT TIBIAL 11 10MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-1112 SUP Custom 27803010 3052-1112 - INSERT TIBIAL 11 12MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-1115 SUP Custom 27803010 3052-1115 - INSERT TIBIAL 11 15MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-1118 SUP Custom 27803010 3052-1118 - INSERT TIBIAL 11 18MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-1121 SUP Custom 27803010 3052-1121 - INSERT TIBIAL 11 21MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 3052-1124 SUP Custom 27803010 3052-1124 - INSERT TIBIAL 11 24MM BEARING KNEE SERIES II BOTH IP/OP "$2,060.00" "$1,524.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $366.68 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" $429.33 "$2,060.00" $824.00 "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,545.00" "$2,060.00" "$2,060.00" "$2,060.00" "$1,030.00" "$1,030.00" "$1,631.52" "$2,060.00" "$1,648.00" $927.00 "$2,060.00" N/A "$1,194.80" "$2,060.00" "$1,236.00" "$2,060.00" "$2,060.00" "$2,060.00" N/A N/A 305C2101 SUP Custom 27803010 305C2101 - VALVE AORTIC 21MM MSC BPRTH CNCH HLDR MODL 305 STRL BOTH IP/OP "$19,000.00" "$14,060.00" "$3,382.00" "$19,000.00" "$19,000.00" "$19,000.00" "$19,000.00" "$19,000.00" "$19,000.00" "$19,000.00" "$3,382.00" "$19,000.00" "$19,000.00" "$19,000.00" "$19,000.00" "$19,000.00" "$19,000.00" "$3,959.81" "$19,000.00" "$7,600.00" "$19,000.00" "$19,000.00" "$19,000.00" "$19,000.00" "$19,000.00" "$14,250.00" "$19,000.00" "$19,000.00" "$19,000.00" "$9,500.00" "$9,500.00" "$15,048.00" "$19,000.00" "$15,200.00" "$8,550.00" "$19,000.00" N/A "$11,020.00" "$19,000.00" "$11,400.00" "$19,000.00" "$19,000.00" "$19,000.00" N/A N/A 305C219 SUP Custom 27803010 305C219 - VALVE AORTIC 19MM 13.5MM BIOPROSTHESIS STENTED HOLDER SEWING BOTH IP/OP "$2,022.50" "$1,497.00" $360.01 "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" $360.01 "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" $421.51 "$2,022.50" $809.00 "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" "$1,516.88" "$2,022.50" "$2,022.50" "$2,022.50" "$1,011.25" "$1,011.25" "$1,601.82" "$2,022.50" "$1,618.00" $910.13 "$2,022.50" N/A "$1,173.05" "$2,022.50" "$1,213.50" "$2,022.50" "$2,022.50" "$2,022.50" N/A N/A 305C221 SUP Custom 27803010 305C221 - VALVE AORTIC RING 21MM 15MM STENT HOLDER SEW MOSAIC CINCH BOTH IP/OP "$19,500.00" "$14,430.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$4,064.01" "$19,500.00" "$7,800.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$14,625.00" "$19,500.00" "$19,500.00" "$19,500.00" "$9,750.00" "$9,750.00" "$15,444.00" "$19,500.00" "$15,600.00" "$8,775.00" "$19,500.00" N/A "$11,310.00" "$19,500.00" "$11,700.00" "$19,500.00" "$19,500.00" "$19,500.00" N/A N/A 305C223 SUP Custom 27803010 305C223 - VALVE AORTIC 23MM 16MM BIOPROSTHESIS STENTED HOLDER SEWING BOTH IP/OP "$19,500.00" "$14,430.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$4,064.01" "$19,500.00" "$7,800.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$14,625.00" "$19,500.00" "$19,500.00" "$19,500.00" "$9,750.00" "$9,750.00" "$15,444.00" "$19,500.00" "$15,600.00" "$8,775.00" "$19,500.00" N/A "$11,310.00" "$19,500.00" "$11,700.00" "$19,500.00" "$19,500.00" "$19,500.00" N/A N/A 305C227 SUP Custom 27803010 305C227 - VALVE AORTIC 27MM 18.5MM BIOPROSTHESIS STENTED HOLDER SEWING BOTH IP/OP "$19,500.00" "$14,430.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$4,064.01" "$19,500.00" "$7,800.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$14,625.00" "$19,500.00" "$19,500.00" "$19,500.00" "$9,750.00" "$9,750.00" "$15,444.00" "$19,500.00" "$15,600.00" "$8,775.00" "$19,500.00" N/A "$11,310.00" "$19,500.00" "$11,700.00" "$19,500.00" "$19,500.00" "$19,500.00" N/A N/A 305C229 SUP Custom 27803010 305C229 - VALVE AORTIC RING 29MM 20MM STENT HOLDER SEW MOSAIC CINCH BOTH IP/OP "$19,500.00" "$14,430.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$4,064.01" "$19,500.00" "$7,800.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$14,625.00" "$19,500.00" "$19,500.00" "$19,500.00" "$9,750.00" "$9,750.00" "$15,444.00" "$19,500.00" "$15,600.00" "$8,775.00" "$19,500.00" N/A "$11,310.00" "$19,500.00" "$11,700.00" "$19,500.00" "$19,500.00" "$19,500.00" N/A N/A 3060-0070S SUP HCPCS C1713 3060-0070S - SCREW BONE 10.5MM 70MM LAG GAMMA3 TITANIUM HIP TROC STERILE BOTH IP/OP $694.50 $514.00 $137.82 $694.38 $312.47 $312.47 $312.47 $312.47 $694.38 $694.38 $694.38 $144.73 $694.38 $694.38 $694.38 $694.38 $694.38 $144.72 $694.38 $277.75 $410.73 $694.38 $694.38 $694.38 $694.38 $520.88 $694.38 $694.38 $694.38 $347.19 $347.19 $549.95 $694.38 $555.50 $312.47 $137.82 N/A $402.81 $694.38 $416.63 $694.38 $144.71 $694.38 N/A N/A 3060-0075S SUP HCPCS C1713 3060-0075S - SCREW BN 10.5MM 75MM STRL GAMMA3 LG TI HIP TROCH NL 180 BOTH IP/OP $804.50 $595.00 $159.65 $804.38 $361.97 $361.97 $361.97 $361.97 $804.38 $804.38 $804.38 $167.65 $804.38 $804.38 $804.38 $804.38 $804.38 $167.64 $804.38 $321.75 $475.79 $804.38 $804.38 $804.38 $804.38 $603.38 $804.38 $804.38 $804.38 $402.19 $402.19 $637.07 $804.38 $643.50 $361.97 $159.65 N/A $466.61 $804.38 $804.38 $804.38 $167.63 $804.38 N/A N/A 3060-0080S SUP HCPCS C1713 3060-0080S - SCREW BONE 10.5MM 80MM LAG SELF TAP THREAD GAMMA3 TITANIUM BOTH IP/OP $804.50 $595.00 $159.65 $804.38 $361.97 $361.97 $361.97 $361.97 $804.38 $804.38 $804.38 $167.65 $804.38 $804.38 $804.38 $804.38 $804.38 $167.64 $804.38 $804.38 $475.79 $804.38 $804.38 $804.38 $804.38 $603.38 $804.38 $804.38 $804.38 $402.19 $402.19 $637.07 $804.38 $643.50 $361.97 $159.65 N/A $466.61 $804.38 $482.63 $804.38 $167.63 $804.38 N/A N/A 3060-0085S SUP HCPCS C1713 3060-0085S - SCREW BN 10.5MM 85MM STRL GAMMA3 LG TI HIP TROCH NL 180 BOTH IP/OP $804.50 $595.00 $159.65 $804.38 $361.97 $361.97 $361.97 $361.97 $804.38 $804.38 $804.38 $167.65 $804.38 $804.38 $804.38 $804.38 $804.38 $167.64 $804.38 $804.38 $475.79 $804.38 $804.38 $804.38 $804.38 $603.38 $804.38 $804.38 $804.38 $402.19 $402.19 $637.07 $804.38 $643.50 $361.97 $159.65 N/A $466.61 $804.38 $804.38 $804.38 $167.63 $804.38 N/A N/A 3060-0090S SUP HCPCS C1713 3060-0090S - SCREW BN 10.5MM 90MM STRL GAMMA3 LG TI HIP TROCH NL 180 BOTH IP/OP $804.50 $595.00 $159.65 $804.38 $361.97 $361.97 $361.97 $361.97 $804.38 $804.38 $804.38 $167.65 $804.38 $804.38 $804.38 $804.38 $804.38 $167.64 $804.38 $804.38 $475.79 $804.38 $804.38 $804.38 $804.38 $603.38 $804.38 $804.38 $804.38 $402.19 $402.19 $637.07 $804.38 $643.50 $361.97 $159.65 N/A $466.61 $804.38 $482.63 $804.38 $167.63 $804.38 N/A N/A 3060-0095S SUP HCPCS C1713 3060-0095S - SCREW BN 10.5MM 95MM STRL GAMMA3 LG TI HIP TROCH NL 180 BOTH IP/OP $804.50 $595.00 $159.65 $804.38 $361.97 $361.97 $361.97 $361.97 $804.38 $804.38 $804.38 $167.65 $804.38 $804.38 $804.38 $804.38 $804.38 $167.64 $804.38 $804.38 $475.79 $804.38 $804.38 $804.38 $804.38 $603.38 $804.38 $804.38 $804.38 $402.19 $402.19 $637.07 $804.38 $643.50 $361.97 $159.65 N/A $466.61 $804.38 $804.38 $804.38 $167.63 $804.38 N/A N/A 3060-0100S SUP HCPCS C1713 3060-0100S - SCREW BN 10.5MM 100MM STRL GAMMA3 LG TI HIP TROCH NL 180 BOTH IP/OP $804.50 $595.00 $159.65 $804.38 $361.97 $361.97 $361.97 $361.97 $804.38 $804.38 $804.38 $167.65 $804.38 $804.38 $804.38 $804.38 $804.38 $167.64 $804.38 $804.38 $475.79 $804.38 $804.38 $804.38 $804.38 $603.38 $804.38 $804.38 $804.38 $402.19 $402.19 $637.07 $804.38 $643.50 $361.97 $159.65 N/A $466.61 $804.38 $804.38 $804.38 $167.63 $804.38 N/A N/A 3060-0105S SUP HCPCS C1713 3060-0105S - SCREW BN 10.5MM 105MM STRL GAMMA3 LG TI HIP TROCH NL 180 BOTH IP/OP $804.50 $595.00 $159.65 $804.38 $361.97 $361.97 $361.97 $361.97 $804.38 $804.38 $804.38 $167.65 $804.38 $804.38 $804.38 $804.38 $804.38 $167.64 $804.38 $804.38 $475.79 $804.38 $804.38 $804.38 $804.38 $603.38 $804.38 $804.38 $804.38 $402.19 $402.19 $637.07 $804.38 $643.50 $361.97 $159.65 N/A $466.61 $804.38 $804.38 $804.38 $167.63 $804.38 N/A N/A 3060-0110S SUP HCPCS C1713 3060-0110S - SCREW BN 10.5MM 110MM STRL GAMMA3 LG TI HIP TROCH NL 180 BOTH IP/OP $804.50 $595.00 $159.65 $804.38 $361.97 $361.97 $361.97 $361.97 $804.38 $804.38 $804.38 $167.65 $804.38 $804.38 $804.38 $804.38 $804.38 $167.64 $804.38 $804.38 $475.79 $804.38 $804.38 $804.38 $804.38 $603.38 $804.38 $804.38 $804.38 $402.19 $402.19 $637.07 $804.38 $643.50 $361.97 $159.65 N/A $466.61 $804.38 $804.38 $804.38 $167.63 $804.38 N/A N/A 3060-0115S SUP HCPCS C1713 3060-0115S - SCREW BN 10.5MM 115MM STRL GAMMA3 LG TI HIP TROCH NL 180 BOTH IP/OP $804.50 $595.00 $159.65 $804.38 $361.97 $361.97 $361.97 $361.97 $804.38 $804.38 $804.38 $167.65 $804.38 $804.38 $804.38 $804.38 $804.38 $167.64 $804.38 $804.38 $475.79 $804.38 $804.38 $804.38 $804.38 $603.38 $804.38 $804.38 $804.38 $402.19 $402.19 $637.07 $804.38 $643.50 $361.97 $159.65 N/A $466.61 $804.38 $804.38 $804.38 $167.63 $804.38 N/A N/A 3060-0120S SUP HCPCS C1713 3060-0120S - SCREW BN 10.5MM 120MM STRL GAMMA3 LG TI HIP TROCH NL 180 BOTH IP/OP $804.50 $595.00 $159.65 $804.38 $361.97 $361.97 $361.97 $361.97 $804.38 $804.38 $804.38 $167.65 $804.38 $804.38 $804.38 $804.38 $804.38 $167.64 $804.38 $804.38 $475.79 $804.38 $804.38 $804.38 $804.38 $603.38 $804.38 $804.38 $804.38 $402.19 $402.19 $637.07 $804.38 $643.50 $361.97 $159.65 N/A $466.61 $804.38 $482.63 $804.38 $167.63 $804.38 N/A N/A 3060-0125S SUP HCPCS C1713 3060-0125S - SCREW BN 10.5MM 125MM STRL GAMMA3 LG TI HIP TROCH NL 180 BOTH IP/OP $756.50 $560.00 $150.10 $756.25 $340.31 $340.31 $340.31 $340.31 $756.25 $756.25 $756.25 $157.62 $756.25 $756.25 $756.25 $756.25 $756.25 $157.61 $756.25 $756.25 $447.32 $756.25 $756.25 $756.25 $756.25 $567.38 $756.25 $756.25 $756.25 $378.13 $378.13 $598.95 $756.25 $605.00 $340.31 $150.10 N/A $438.77 $756.25 $756.25 $756.25 $157.60 $756.25 N/A N/A 3060-0130S SUP HCPCS C1713 3060-0130S - SCREW BN 10.5MM 130MM STRL GAMMA3 LG TI HIP TROCH NL 180 BOTH IP/OP $756.50 $560.00 $150.10 $756.25 $340.31 $340.31 $340.31 $340.31 $756.25 $756.25 $756.25 $157.62 $756.25 $756.25 $756.25 $756.25 $756.25 $157.61 $756.25 $302.50 $447.32 $756.25 $756.25 $756.25 $756.25 $567.38 $756.25 $756.25 $756.25 $378.13 $378.13 $598.95 $756.25 $605.00 $340.31 $150.10 N/A $438.77 $756.25 $453.75 $756.25 $157.60 $756.25 N/A N/A 309.004S SUP Custom 27203010 309.004S - BIT DRL 4MM STRL CRB 3.5MM SCR BOTH IP/OP $524.50 $388.00 $93.33 $533.25 $524.33 $524.33 $524.33 $524.33 $524.33 $524.33 $93.33 $524.33 $524.33 $389.16 $389.16 $404.15 $273.18 $109.28 $524.33 $213.30 $524.33 $524.33 $533.25 $524.33 $524.33 $393.38 $524.33 $524.33 $524.33 $262.17 $262.17 $415.27 $524.33 $419.46 $340.81 $524.33 N/A $304.21 $524.33 $314.60 $524.33 $524.33 $524.33 N/A N/A 309.006S SUP Custom 27203010 309.006S - BIT DRL 6MM STRL CRB BOTH IP/OP $597.50 $442.00 $106.34 $607.58 $597.43 $597.43 $597.43 $597.43 $597.43 $597.43 $106.34 $597.43 $597.43 $443.41 $443.41 $460.50 $311.26 $124.51 $597.43 $243.03 $597.43 $597.43 $607.58 $597.43 $597.43 $448.13 $597.43 $597.43 $597.43 $298.72 $298.72 $473.16 $597.43 $477.94 $388.33 $597.43 N/A $346.55 $597.43 $358.46 $597.43 $597.43 $597.43 N/A N/A 310.11.98 SUP Custom 27203010 310.11.98 - BIT DRILL 1.1MM 60MM QUICK COUPLING NONSTRL 1.3MM SCREW BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 310.15.98 SUP Custom 27203010 310.15.98 - BIT DRILL 1.5MM 85MM QUICK COUPLING NONSTRL 2MM SCREW BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 310.16.98 SUP Custom 27203010 310.16.98 - BIT DRILL 1.5MM 110MM QUICK COUPLING NONSTRL 2MM SCREW BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 310.16J SUP Custom 27203010 310.16J - BIT DRILL 1.5MM 95MM JACOBS CHUCK NONSTRL BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $100.66 $100.66 $104.54 $70.66 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $88.16 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 310.21.98 SUP Custom 27203010 310.21.98 - BIT DRILL 2MM 125MM QUICK COUPLING NONSTRL BOTH IP/OP $234.00 $173.00 $41.65 $234.00 $234.00 $234.00 $234.00 $234.00 $234.00 $234.00 $41.65 $234.00 $234.00 $173.67 $173.67 $180.37 $121.91 $48.77 $234.00 $93.60 $234.00 $234.00 $234.00 $234.00 $234.00 $175.50 $234.00 $234.00 $234.00 $117.00 $117.00 $185.33 $234.00 $187.20 $152.10 $234.00 N/A $135.72 $234.00 $140.40 $234.00 $234.00 $234.00 N/A N/A 310.21J SUP Custom 27203010 310.21J - BIT DRILL LONG 2MM 110MM JACOBS CHUCK DCP STAINLESS STEEL BOTH IP/OP $136.00 $101.00 $24.14 $137.93 $135.63 $135.63 $135.63 $135.63 $135.63 $135.63 $24.14 $135.63 $135.63 $100.66 $100.66 $104.54 $70.66 $28.27 $135.63 $55.17 $135.63 $135.63 $137.93 $135.63 $135.63 $102.00 $135.63 $135.63 $135.63 $67.82 $67.82 $107.42 $135.63 $108.50 $88.16 $135.63 N/A $78.88 $135.63 $81.38 $135.63 $135.63 $135.63 N/A N/A 310.21S SUP Custom 27203010 2.0MM DRILL BIT/QC/125MM STERILE BOTH IP/OP $204.00 $151.00 $36.27 $203.78 $203.78 $203.78 $203.78 $203.78 $203.78 $203.78 $36.27 $203.78 $203.78 $151.25 $151.25 $157.07 $106.17 $42.47 $203.78 $81.51 $203.78 $203.78 $203.78 $203.78 $203.78 $153.00 $203.78 $203.78 $203.78 $101.89 $101.89 $161.39 $203.78 $163.02 $132.46 $203.78 $203.78 $118.32 $203.78 $122.27 $203.78 $203.78 $203.78 N/A N/A 310.21S SUP Custom 27203010 310.21S - BIT DRL 2MM 125MM STRL QC BOTH IP/OP $243.50 $180.00 $36.27 $203.78 $203.78 $203.78 $203.78 $203.78 $203.78 $203.78 $36.27 $203.78 $203.78 $151.25 $151.25 $157.07 $106.17 $42.47 $203.78 $81.51 $203.78 $203.78 $203.78 $203.78 $203.78 $182.63 $203.78 $203.78 $203.78 $101.89 $101.89 $161.39 $203.78 $163.02 $132.46 $203.78 $203.78 $141.23 $203.78 $122.27 $203.78 $203.78 $203.78 N/A N/A 310.221S SUP Custom 27203010 310.221S - BIT DRL 2MM 150MM STRL QC BOTH IP/OP $880.00 $651.00 $162.37 $912.18 $912.18 $912.18 $912.18 $912.18 $912.18 $912.18 $162.37 $912.18 $912.18 $677.02 $677.02 $703.11 $475.25 $190.11 $912.18 $364.87 $912.18 $912.18 $912.18 $912.18 $912.18 $660.00 $912.18 $912.18 $912.18 $456.09 $456.09 $722.45 $912.18 $729.74 $592.92 $912.18 $912.18 $510.40 $912.18 $547.31 $912.18 $912.18 $912.18 N/A N/A 310.221S SUP Custom 27203010 2.0MM CANNULATED DRILL BIT/QC 150MM-STERILE BOTH IP/OP $912.50 $675.00 $162.37 $912.18 $912.18 $912.18 $912.18 $912.18 $912.18 $912.18 $162.37 $912.18 $912.18 $677.02 $677.02 $703.11 $475.25 $190.11 $912.18 $364.87 $912.18 $912.18 $912.18 $912.18 $912.18 $684.38 $912.18 $912.18 $912.18 $456.09 $456.09 $722.45 $912.18 $729.74 $592.92 $912.18 $912.18 $529.25 $912.18 $547.31 $912.18 $912.18 $912.18 N/A N/A 310.25S SUP Custom 27203010 310.25S - BIT DRL 2.5MM 110MM AU STRL LCP QC BOTH IP/OP $227.00 $168.00 $40.41 $230.85 $227.00 $227.00 $227.00 $227.00 $227.00 $227.00 $40.41 $227.00 $227.00 $168.48 $168.48 $174.97 $118.27 $47.31 $227.00 $92.34 $227.00 $227.00 $230.85 $227.00 $227.00 $170.25 $227.00 $227.00 $227.00 $113.50 $113.50 $179.78 $227.00 $181.60 $147.55 $227.00 N/A $131.66 $227.00 $136.20 $227.00 $227.00 $227.00 N/A N/A 310.28J SUP Custom 27203010 310.28J - BIT DRILL 2.7MM 110MM JACOBS CHUCK STERILE BOTH IP/OP $143.50 $106.00 $25.52 $145.80 $143.38 $143.38 $143.38 $143.38 $143.38 $143.38 $25.52 $143.38 $143.38 $106.42 $106.42 $110.52 $74.70 $29.88 $143.38 $58.32 $143.38 $143.38 $145.80 $143.38 $143.38 $107.63 $143.38 $143.38 $143.38 $71.69 $71.69 $113.56 $143.38 $114.70 $93.20 $143.38 N/A $83.23 $143.38 $86.03 $143.38 $143.38 $143.38 N/A N/A 310.31. SUP Custom 27203010 310.31. - DRILL BIT 3.2MM X 145MM QUICK COUPLING BOTH IP/OP $92.00 $68.00 $16.34 $91.79 $91.79 $91.79 $91.79 $91.79 $91.79 $91.79 $16.34 $91.79 $91.79 $68.13 $68.13 $70.75 $47.82 $19.13 $91.79 $36.72 $91.79 $91.79 $91.79 $91.79 $91.79 $69.00 $91.79 $91.79 $91.79 $45.90 $45.90 $72.70 $91.79 $73.43 $59.66 $91.79 N/A $53.36 $91.79 $55.07 $91.79 $91.79 $91.79 N/A N/A 310.31S SUP Custom 27203010 310.31S - BIT DRL 3.2MM 145MM STRL QC BOTH IP/OP $225.00 $167.00 $40.03 $228.73 $224.90 $224.90 $224.90 $224.90 $224.90 $224.90 $40.03 $224.90 $224.90 $166.92 $166.92 $173.35 $117.17 $46.87 $224.90 $91.49 $224.90 $224.90 $228.73 $224.90 $224.90 $168.75 $224.90 $224.90 $224.90 $112.45 $112.45 $178.12 $224.90 $179.92 $146.19 $224.90 N/A $130.50 $224.90 $134.94 $224.90 $224.90 $224.90 N/A N/A 310.37S SUP Custom 27203010 310.37S - BIT DRL 3.5MM 195MM STRL LCP QC BOTH IP/OP $243.50 $180.00 $43.29 $247.30 $243.18 $243.18 $243.18 $243.18 $243.18 $243.18 $43.29 $243.18 $243.18 $180.49 $180.49 $187.44 $126.70 $50.68 $243.18 $98.92 $243.18 $243.18 $247.30 $243.18 $243.18 $182.63 $243.18 $243.18 $243.18 $121.59 $121.59 $192.60 $243.18 $194.54 $158.07 $243.18 N/A $141.23 $243.18 $145.91 $243.18 $243.18 $243.18 N/A N/A 310.60J SUP Custom 27203010 310.60J - BIT DRILL 6MM 195MM JACOBS CHUCK NONSTRL BOTH IP/OP $283.00 $209.00 $50.29 $287.35 $282.55 $282.55 $282.55 $282.55 $282.55 $282.55 $50.29 $282.55 $282.55 $209.71 $209.71 $217.79 $147.21 $58.89 $282.55 $114.94 $282.55 $282.55 $287.35 $282.55 $282.55 $212.25 $282.55 $282.55 $282.55 $141.28 $141.28 $223.78 $282.55 $226.04 $183.66 $282.55 N/A $164.14 $282.55 $169.53 $282.55 $282.55 $282.55 N/A N/A 310.63S SUP Custom 27203010 310.63S - BIT DRL 5MM 2.9MM 300MM STRL LG QC CNN BOTH IP/OP $861.50 $638.00 $169.13 $950.18 $950.18 $950.18 $950.18 $950.18 $950.18 $950.18 $169.13 $950.18 $950.18 $705.22 $705.22 $732.40 $495.04 $198.03 $950.18 $380.07 $950.18 $950.18 $950.18 $950.18 $950.18 $646.13 $950.18 $950.18 $950.18 $475.09 $475.09 $752.54 $950.18 $760.14 $617.62 $950.18 $950.18 $499.67 $950.18 $570.11 $950.18 $950.18 $950.18 N/A N/A 310.63S SUP Custom 27203010 5.0MM CANNULATED DRILL BIT/QC 300MM-STERILE BOTH IP/OP $950.50 $703.00 $169.13 $950.18 $950.18 $950.18 $950.18 $950.18 $950.18 $950.18 $169.13 $950.18 $950.18 $705.22 $705.22 $732.40 $495.04 $198.03 $950.18 $380.07 $950.18 $950.18 $950.18 $950.18 $950.18 $712.88 $950.18 $950.18 $950.18 $475.09 $475.09 $752.54 $950.18 $760.14 $617.62 $950.18 $950.18 $551.29 $950.18 $570.11 $950.18 $950.18 $950.18 N/A N/A 310.67S SUP Custom 27203010 310.67S - BIT DRL 2.7MM 160MM STRL QC CNN BOTH IP/OP $925.00 $685.00 $164.64 $940.68 $924.95 $924.95 $924.95 $924.95 $924.95 $924.95 $164.64 $924.95 $924.95 $686.50 $686.50 $712.95 $481.90 $192.77 $924.95 $376.27 $924.95 $924.95 $940.68 $924.95 $924.95 $693.75 $924.95 $924.95 $924.95 $462.48 $462.48 $732.56 $924.95 $739.96 $601.22 $924.95 N/A $536.50 $924.95 $554.97 $924.95 $924.95 $924.95 N/A N/A 310-25M SUP Custom 27803010 310-25M - VALVE MITRAL 25MM 18MM BIOPROSTHESIS STENTED HOLDER MODEL BOTH IP/OP "$19,500.00" "$14,430.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$4,064.01" "$19,500.00" "$7,800.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$14,625.00" "$19,500.00" "$19,500.00" "$19,500.00" "$9,750.00" "$9,750.00" "$15,444.00" "$19,500.00" "$15,600.00" "$8,775.00" "$19,500.00" N/A "$11,310.00" "$19,500.00" "$11,700.00" "$19,500.00" "$19,500.00" "$19,500.00" N/A N/A 310-31M SUP Custom 27803010 310-31M - VALVE MITRAL 31MM 22MM BIOPROSTHESIS STENTED HOLDER MODEL BOTH IP/OP "$19,500.00" "$14,430.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$4,064.01" "$19,500.00" "$7,800.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$14,625.00" "$19,500.00" "$19,500.00" "$19,500.00" "$9,750.00" "$9,750.00" "$15,444.00" "$19,500.00" "$15,600.00" "$8,775.00" "$19,500.00" N/A "$11,310.00" "$19,500.00" "$11,700.00" "$19,500.00" "$19,500.00" "$19,500.00" N/A N/A 310-33M SUP Custom 27803010 310-33M - VALVE MITRAL 33MM 23MM BIOPROSTHESIS STENTED HOLDER MODEL BOTH IP/OP "$19,500.00" "$14,430.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$4,064.01" "$19,500.00" "$7,800.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$14,625.00" "$19,500.00" "$19,500.00" "$19,500.00" "$9,750.00" "$9,750.00" "$15,444.00" "$19,500.00" "$15,600.00" "$8,775.00" "$19,500.00" N/A "$11,310.00" "$19,500.00" "$11,700.00" "$19,500.00" "$19,500.00" "$19,500.00" N/A N/A 310C29 SUP Custom 27803010 310C29 - VALVE MITRAL RING 29MM 38MM 26MM 20.5MM 15.5MM BIOLOGICAL BOTH IP/OP "$19,500.00" "$14,430.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$3,471.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$4,064.01" "$19,500.00" "$7,800.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$19,500.00" "$14,625.00" "$19,500.00" "$19,500.00" "$19,500.00" "$9,750.00" "$9,750.00" "$15,444.00" "$19,500.00" "$15,600.00" "$8,775.00" "$19,500.00" N/A "$11,310.00" "$19,500.00" "$11,700.00" "$19,500.00" "$19,500.00" "$19,500.00" N/A N/A 311.031.01S SUP HCPCS C1713 311.031.01S - TAP SURG 4MM SLFDRILL MINI QUICK COUPLING STOP STERILE 1.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.032.01S SUP HCPCS C1713 311.032.01S - TAP SURG 6MM SELF DRILL MINI QUICK COUPLING STOP STERILE 1.5 BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $751.50 $751.50 N/A N/A 311.033.01S SUP HCPCS C1713 311.033.01S - TAP SURG 3MM SLFDRILL MINI QUICK COUPLING STOP STERILE 1.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.034.01S SUP HCPCS C1713 311.034.01S - TAP SURG 4MM SLFDRILL MINI QUICK COUPLING STOP STERILE 2MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.035.01S SUP HCPCS C1713 311.035.01S - TAP SURG 5MM SLFDRILL MINI QUICK COUPLING STOP STERILE 1.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.035.97S SUP HCPCS C1713 311.035.97S - TAP SURG 1.5MM 5MM RESORB STOP STERILE CORTICAL SCREW BOTH IP/OP $700.50 $518.00 $138.97 $712.10 $315.09 $315.09 $315.09 $315.09 $700.20 $700.20 $700.20 $145.94 $700.20 $700.20 $700.20 $700.20 $700.20 $145.93 $700.20 $284.84 $414.17 $700.20 $712.10 $700.20 $700.20 $525.38 $700.20 $700.20 $700.20 $350.10 $350.10 $554.56 $700.20 $560.16 $315.09 $138.97 N/A $406.29 $700.20 $420.12 $700.20 $145.92 $700.20 N/A N/A 311.036.01S SUP HCPCS C1713 311.036.01S - TAP SURG 6MM SLFDRILL MINI QUICK COUPLING STOP STERILE 2MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.037.01S SUP HCPCS C1713 311.037.01S - TAP SURG 8MM SLFDRILL MINI QUICK COUPLING STOP STERILE 1.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.038.01S SUP HCPCS C1713 311.038.01S - TAP SURG 8MM SLFDRILL MINI QUICK COUPLING STOP STERILE 2MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.044.01S SUP HCPCS C1713 311.044.01S - TAP SURG 4MM SLFDRILL MINI QUICK COUPLING STOP STERILE 2.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.046.01S SUP HCPCS C1713 311.046.01S - TAP SURG 6MM SLFDRILL MINI QUICK COUPLING STOP STERILE 2.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.048.01S SUP HCPCS C1713 311.048.01S - TAP SURG 8MM SLFDRILL MINI QUICK COUPLING STOP STERILE 2.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.054.01S SUP HCPCS C1713 311.054.01S - TAP SURG 4MM SLFDRILL MINI QUICK COUPLING STOP STERILE 2MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.056.01S SUP HCPCS C1713 311.056.01S - TAP SURG 6MM SLFDRILL MINI QUICK COUPLING STOP STERILE 2MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $751.50 $751.50 N/A N/A 311.056.97S SUP HCPCS C1713 311.056.97S - TAP SURG 6MM STERILE 2MM RESORB CORTICAL SCREW BOTH IP/OP $700.50 $518.00 $138.97 $712.10 $315.09 $315.09 $315.09 $315.09 $700.20 $700.20 $700.20 $145.94 $700.20 $700.20 $700.20 $700.20 $700.20 $145.93 $700.20 $284.84 $414.17 $700.20 $712.10 $700.20 $700.20 $525.38 $700.20 $700.20 $700.20 $350.10 $350.10 $554.56 $700.20 $560.16 $315.09 $138.97 N/A $406.29 $700.20 $420.12 $700.20 $145.92 $700.20 N/A N/A 311.058.01S SUP HCPCS C1713 311.058.01S - TAP SURG 8MM SLFDRILL MINI QUICK COUPLING STOP STERILE 2MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $751.50 $751.50 N/A N/A 311.060.01S SUP HCPCS C1713 311.060.01S - TAP SURG HEXAGON 4MM SELF DRILL STOP COUPLING STERILE 1.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.061.01S SUP HCPCS C1713 311.061.01S - TAP SURG 6MM SLFDRILL STOP HEXAGONAL COUPLING STERILE 1.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.062.01S SUP HCPCS C1713 311.062.01S - TAP SURG 3MM SLFDRILL HEXAGONAL COUPLING STOP STERILE 1.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.063.01S SUP HCPCS C1713 311.063.01S - TAP SURG 4MM HEXAGON SELF DRILL COUPLING STOP CORTICAL BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.064.01S SUP HCPCS C1713 311.064.01S - TAP SURG 6MM STOP SLFDRILL HEXAGONAL COUPLING STERILE 2MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $751.50 $751.50 N/A N/A 311.065.01S SUP HCPCS C1713 311.065.01S - TAP SURG 8MM SLFDRILL HEXAGONAL COUPLING STOP STERILE 2MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.067.01S SUP HCPCS C1713 311.067.01S - TAP SURG 4MM SLFDRILL HEXAGONAL COUPLING STOP STERILE 2MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $751.50 $751.50 N/A N/A 311.068.01S SUP HCPCS C1713 311.068.01S - TAP SURG 6MM SLFDRILL HEXAGONAL COUPLING STOP STERILE 2MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.069.01S SUP HCPCS C1713 311.069.01S - TAP SURG 8MM SLFDRILL HEXAGONAL COUPLING STOP STERILE 2MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.071.01S SUP HCPCS C1713 311.071.01S - TAP SURG 4MM SLFDRILL HEXAGONAL COUPLING STOP STERILE 2.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.072.01S SUP HCPCS C1713 311.072.01S - TAP SURG 6MM SLFDRILL HEXAGONAL COUPLING STOP STERILE 2.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.073.01S SUP HCPCS C1713 311.073.01S - TAP SURG 8MM SLFDRILL HEXAGONAL COUPLING STOP STERILE 2.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.093.01S SUP HCPCS C1713 311.093.01S - TAP SURG 5MM SLFDRILL HEXAGONAL COUPLING STOP STERILE 1.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.094.01S SUP HCPCS C1713 311.094.01S - TAP SURG 8MM SLFDRILL HEXAGONAL COUPLING STOP STERILE 1.5MM BOTH IP/OP $751.50 $556.00 $149.15 $751.50 $338.18 $338.18 $338.18 $338.18 $751.50 $751.50 $751.50 $156.63 $751.50 $751.50 $751.50 $751.50 $751.50 $156.62 $751.50 $751.50 $444.51 $751.50 $751.50 $751.50 $751.50 $563.63 $751.50 $751.50 $751.50 $375.75 $375.75 $595.19 $751.50 $601.20 $338.18 $149.15 N/A $435.87 $751.50 $751.50 $751.50 $156.61 $751.50 N/A N/A 311.100.01S SUP HCPCS C1713 311.100.01S - TAP SURG SLFDRILL ADJUSTABLE LENGTH STERILE 1.5 MM SCREWS BOTH IP/OP "$1,021.50" $756.00 $202.74 "$1,021.50" $459.68 $459.68 $459.68 $459.68 "$1,021.50" "$1,021.50" "$1,021.50" $212.91 "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" $212.89 "$1,021.50" "$1,021.50" $604.22 "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" $766.13 "$1,021.50" "$1,021.50" "$1,021.50" $510.75 $510.75 $809.03 "$1,021.50" $817.20 $459.68 $202.74 N/A $592.47 "$1,021.50" "$1,021.50" "$1,021.50" $212.88 "$1,021.50" N/A N/A 311.101.01S SUP HCPCS C1713 311.101.01S - TAP SURG SLFDRILL ADJUSTABLE LENGTH STERILE 2 MM SCREWS BOTH IP/OP "$1,021.50" $756.00 $202.74 "$1,021.50" $459.68 $459.68 $459.68 $459.68 "$1,021.50" "$1,021.50" "$1,021.50" $212.91 "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" $212.89 "$1,021.50" "$1,021.50" $604.22 "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" $766.13 "$1,021.50" "$1,021.50" "$1,021.50" $510.75 $510.75 $809.03 "$1,021.50" $817.20 $459.68 $202.74 N/A $592.47 "$1,021.50" "$1,021.50" "$1,021.50" $212.88 "$1,021.50" N/A N/A 311.102.01S SUP HCPCS C1713 311.102.01S - TAP SURG SLFDRILL ADJUSTABLE LENGTH STERILE 2.5 MM SCREWS BOTH IP/OP "$1,021.50" $756.00 $202.74 "$1,021.50" $459.68 $459.68 $459.68 $459.68 "$1,021.50" "$1,021.50" "$1,021.50" $212.91 "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" $212.89 "$1,021.50" "$1,021.50" $604.22 "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" $766.13 "$1,021.50" "$1,021.50" "$1,021.50" $510.75 $510.75 $809.03 "$1,021.50" $817.20 $459.68 $202.74 N/A $592.47 "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" N/A N/A 311.110.01S SUP HCPCS C1713 311.110.01S - TAP SURG SLFDRILL HEXAGONAL COUPLING ADJUSTABLE STERILE 1.5 BOTH IP/OP "$1,021.50" $756.00 $202.74 "$1,021.50" $459.68 $459.68 $459.68 $459.68 "$1,021.50" "$1,021.50" "$1,021.50" $212.91 "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" $212.89 "$1,021.50" "$1,021.50" $604.22 "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" $766.13 "$1,021.50" "$1,021.50" "$1,021.50" $510.75 $510.75 $809.03 "$1,021.50" $817.20 $459.68 $202.74 N/A $592.47 "$1,021.50" "$1,021.50" "$1,021.50" $212.88 "$1,021.50" N/A N/A 311.111.01S SUP HCPCS C1713 311.111.01S - TAP SURG SLFDRILL HEXAGONAL COUPLING ADJUSTABLE STERILE 2 MM BOTH IP/OP "$1,021.50" $756.00 $202.74 "$1,021.50" $459.68 $459.68 $459.68 $459.68 "$1,021.50" "$1,021.50" "$1,021.50" $212.91 "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" $212.89 "$1,021.50" "$1,021.50" $604.22 "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" $766.13 "$1,021.50" "$1,021.50" "$1,021.50" $510.75 $510.75 $809.03 "$1,021.50" $817.20 $459.68 $202.74 N/A $592.47 "$1,021.50" "$1,021.50" "$1,021.50" $212.88 "$1,021.50" N/A N/A 311.112.01S SUP HCPCS C1713 311.112.01S - TAP SURG SLFDRILL ADJUSTABLE LENGTH HEXAGONAL COUPLING BOTH IP/OP "$1,021.50" $756.00 $202.74 "$1,021.50" $459.68 $459.68 $459.68 $459.68 "$1,021.50" "$1,021.50" "$1,021.50" $212.91 "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" $212.89 "$1,021.50" "$1,021.50" $604.22 "$1,021.50" "$1,021.50" "$1,021.50" "$1,021.50" $766.13 "$1,021.50" "$1,021.50" "$1,021.50" $510.75 $510.75 $809.03 "$1,021.50" $817.20 $459.68 $202.74 N/A $592.47 "$1,021.50" "$1,021.50" "$1,021.50" $212.88 "$1,021.50" N/A N/A 311.21.98 SUP HCPCS C1713 311.21.98 - TAP SURG LONG 100MM 38MM MINI QUICK COUPLING NONSTRL 2MM BOTH IP/OP $283.50 $210.00 $56.27 $283.50 $127.58 $127.58 $127.58 $127.58 $283.50 $283.50 $283.50 $59.09 $283.50 $283.50 $283.50 $283.50 $283.50 $59.08 $283.50 $283.50 $167.69 $283.50 $283.50 $283.50 $283.50 $212.63 $283.50 $283.50 $283.50 $141.75 $141.75 $224.53 $283.50 $226.80 $127.58 $56.27 N/A $164.43 $283.50 $170.10 $283.50 $283.50 $283.50 N/A N/A 3120-0170S SUP HCPCS C1713 3120-0170S - NAIL INTRAMEDULLARY 120D LONG 10MM 170MM GAMMA3 HIP BOTH IP/OP "$2,711.00" "$2,006.00" $538.00 "$2,710.65" "$1,219.79" "$1,219.79" "$1,219.79" "$1,219.79" "$2,710.65" "$2,710.65" "$2,710.65" $564.97 "$2,710.65" "$2,710.65" "$2,710.65" "$2,710.65" "$2,710.65" $564.93 "$2,710.65" "$1,084.26" "$1,336.35" "$2,710.65" "$2,710.65" "$2,710.65" "$2,710.65" "$2,033.25" "$2,710.65" "$2,710.65" "$2,710.65" "$1,355.33" "$1,355.33" "$2,146.83" "$2,710.65" "$2,168.52" "$1,219.79" $538.00 N/A "$1,572.38" "$2,710.65" "$1,626.39" "$2,710.65" $564.90 "$2,710.65" N/A N/A 3120-1180S SUP HCPCS C1713 3120-1180S - NAIL INTRAMEDULLARY 120D 11MM 180MM CANN CONICAL TIP KIT BOTH IP/OP "$2,124.50" "$1,572.00" $421.64 "$2,124.38" $955.97 $955.97 $955.97 $955.97 "$2,124.38" "$2,124.38" "$2,124.38" $442.77 "$2,124.38" "$2,124.38" "$2,124.38" "$2,124.38" "$2,124.38" $442.74 "$2,124.38" $849.75 "$1,256.57" "$2,124.38" "$2,124.38" "$2,124.38" "$2,124.38" "$1,593.38" "$2,124.38" "$2,124.38" "$2,124.38" "$1,062.19" "$1,062.19" "$1,682.51" "$2,124.38" "$1,699.50" $955.97 $421.64 N/A "$1,232.21" "$2,124.38" "$2,124.38" "$2,124.38" $442.72 "$2,124.38" N/A N/A 3125-0170S SUP HCPCS C1713 3125-0170S - NAIL INTRAMEDULLARY 125D 10MM 170MM GAMMA3 TITANIUM HIP BOTH IP/OP "$2,711.00" "$2,006.00" $538.00 "$2,710.65" "$1,219.79" "$1,219.79" "$1,219.79" "$1,219.79" "$2,710.65" "$2,710.65" "$2,710.65" $564.97 "$2,710.65" "$2,710.65" "$2,710.65" "$2,710.65" "$2,710.65" $564.93 "$2,710.65" "$2,710.65" "$1,336.35" "$2,710.65" "$2,710.65" "$2,710.65" "$2,710.65" "$2,033.25" "$2,710.65" "$2,710.65" "$2,710.65" "$1,355.33" "$1,355.33" "$2,146.83" "$2,710.65" "$2,168.52" "$1,219.79" $538.00 N/A "$1,572.38" "$2,710.65" "$1,626.39" "$2,710.65" $564.90 "$2,710.65" N/A N/A 3125-1180S SUP HCPCS C1713 3125-1180S - NAIL INTRAMEDULLARY 125D 11MM 180MM KIT GAMMA3 TITANIUM HIP BOTH IP/OP "$2,124.50" "$1,572.00" $421.64 "$2,124.38" $955.97 $955.97 $955.97 $955.97 "$2,124.38" "$2,124.38" "$2,124.38" $442.77 "$2,124.38" "$2,124.38" "$2,124.38" "$2,124.38" "$2,124.38" $442.74 "$2,124.38" $849.75 "$1,256.57" "$2,124.38" "$2,124.38" "$2,124.38" "$2,124.38" "$1,593.38" "$2,124.38" "$2,124.38" "$2,124.38" "$1,062.19" "$1,062.19" "$1,682.51" "$2,124.38" "$1,699.50" $955.97 $421.64 N/A "$1,232.21" "$2,124.38" "$1,274.63" "$2,124.38" $442.72 "$2,124.38" N/A N/A 3130-0170S SUP HCPCS C1713 3130-0170S - NAIL INTRAMEDULLARY 130D 15.5-10MM 17CM LOCK KIT ANATOMIC BOTH IP/OP "$2,711.00" "$2,006.00" $538.00 "$2,710.65" "$1,219.79" "$1,219.79" "$1,219.79" "$1,219.79" "$2,710.65" "$2,710.65" "$2,710.65" $564.97 "$2,710.65" "$2,710.65" "$2,710.65" "$2,710.65" "$2,710.65" $564.93 "$2,710.65" "$1,084.26" "$1,336.35" "$2,710.65" "$2,710.65" "$2,710.65" "$2,710.65" "$2,033.25" "$2,710.65" "$2,710.65" "$2,710.65" "$1,355.33" "$1,355.33" "$2,146.83" "$2,710.65" "$2,168.52" "$1,219.79" $538.00 N/A "$1,572.38" "$2,710.65" "$1,626.39" "$2,710.65" $564.90 "$2,710.65" N/A N/A 3130-1180S SUP HCPCS C1713 3130-1180S - NAIL INTRAMEDULLARY 130D 15.5-11MM 180MM KIT CONICAL TIP BOTH IP/OP "$2,124.50" "$1,572.00" $421.64 "$2,124.38" $955.97 $955.97 $955.97 $955.97 "$2,124.38" "$2,124.38" "$2,124.38" $442.77 "$2,124.38" "$2,124.38" "$2,124.38" "$2,124.38" "$2,124.38" $442.74 "$2,124.38" "$2,124.38" "$1,256.57" "$2,124.38" "$2,124.38" "$2,124.38" "$2,124.38" "$1,593.38" "$2,124.38" "$2,124.38" "$2,124.38" "$1,062.19" "$1,062.19" "$1,682.51" "$2,124.38" "$1,699.50" $955.97 $421.64 N/A "$1,232.21" "$2,124.38" "$2,124.38" "$2,124.38" $442.72 "$2,124.38" N/A N/A 313-7034EA SUP Custom 27203010 313-7034EA - MASK CPAP 02 RESQ BITRAC ED WITH 7.5 CM VALVE & FLOW GENERAT BOTH IP/OP $100.00 $74.00 $17.80 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $17.80 $100.00 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $40.00 $100.00 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $100.00 N/A $58.00 $100.00 $60.00 $100.00 $100.00 $100.00 N/A N/A 314.746S SUP Custom 27203010 314.746S - ASSEMBLY TUBE 520MM REAMER IRRIGATOR ASPIRAT STERILE BOTH IP/OP $824.50 $610.00 $146.70 $838.18 $824.18 $824.18 $824.18 $824.18 $824.18 $824.18 $146.70 $824.18 $824.18 $611.71 $611.71 $635.28 $429.40 $171.77 $824.18 $335.27 $824.18 $824.18 $838.18 $824.18 $824.18 $618.38 $824.18 $824.18 $824.18 $412.09 $412.09 $652.75 $824.18 $659.34 $535.72 $824.18 N/A $478.21 $824.18 $494.51 $824.18 $824.18 $824.18 N/A N/A 31-462 SUP HCPCS C1887 31-462 - CATHETER 5FR 65CM COBRA 1 BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A 31-466 SUP HCPCS C1887 31-466 - CATHETER 5FR 65CM COBRA 2 BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A 315.28S SUP Custom 27203010 315.28S - BIT DRL 3 FLUT 125MM STRL QC BOTH IP/OP $308.00 $228.00 $54.80 $313.08 $307.85 $307.85 $307.85 $307.85 $307.85 $307.85 $54.80 $307.85 $307.85 $228.49 $228.49 $237.29 $160.39 $64.16 $307.85 $125.23 $307.85 $307.85 $313.08 $307.85 $307.85 $231.00 $307.85 $307.85 $307.85 $153.93 $153.93 $243.82 $307.85 $246.28 $200.10 $307.85 N/A $178.64 $307.85 $184.71 $307.85 $307.85 $307.85 N/A N/A 315.40S SUP Custom 27203010 315.40S - BIT DRILL 195MM 4MM QC 3 FLT STRL BOTH IP/OP $381.00 $282.00 $67.77 $387.20 $380.73 $380.73 $380.73 $380.73 $380.73 $380.73 $67.77 $380.73 $380.73 $282.58 $282.58 $293.47 $198.36 $79.35 $380.73 $154.88 $380.73 $380.73 $387.20 $380.73 $380.73 $285.75 $380.73 $380.73 $380.73 $190.37 $190.37 $301.54 $380.73 $304.58 $247.47 $380.73 N/A $220.98 $380.73 $228.44 $380.73 $380.73 $380.73 N/A N/A 315.92S SUP Custom 27203010 2.5MM THREE-FLUTED DRILL BIT QC/230MM/200MM CALIB-STERILE BOTH IP/OP $519.50 $384.00 $92.46 $519.45 $519.45 $519.45 $519.45 $519.45 $519.45 $519.45 $92.46 $519.45 $519.45 $385.54 $385.54 $400.39 $270.63 $108.26 $519.45 $207.78 $519.45 $519.45 $519.45 $519.45 $519.45 $389.63 $519.45 $519.45 $519.45 $259.73 $259.73 $411.40 $519.45 $415.56 $337.64 $519.45 $519.45 $301.31 $519.45 $311.67 $519.45 $519.45 $519.45 N/A N/A 315.92S SUP Custom 27203010 315.92S - BIT DRL 200MM CLBRT 2.5MM 230MM STRL QC 3 FLT BOTH IP/OP $553.50 $410.00 $92.46 $519.45 $519.45 $519.45 $519.45 $519.45 $519.45 $519.45 $92.46 $519.45 $519.45 $385.54 $385.54 $400.39 $270.63 $108.26 $519.45 $207.78 $519.45 $519.45 $519.45 $519.45 $519.45 $415.13 $519.45 $519.45 $519.45 $259.73 $259.73 $411.40 $519.45 $415.56 $337.64 $519.45 $519.45 $321.03 $519.45 $311.67 $519.45 $519.45 $519.45 N/A N/A 316.114.96 SUP Custom 27203010 316.114.96 - BIT DRILL 14MM STOP .76MM 44.5MM J LATCH NONSTRL BOTH IP/OP $246.00 $182.00 $43.79 $250.18 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $43.79 $246.00 $246.00 $182.58 $182.58 $189.62 $128.17 $51.27 $246.00 $100.07 $246.00 $246.00 $250.18 $246.00 $246.00 $184.50 $246.00 $246.00 $246.00 $123.00 $123.00 $194.83 $246.00 $196.80 $159.90 $246.00 N/A $142.68 $246.00 $147.60 $246.00 $246.00 $246.00 N/A N/A 316.235.96 SUP Custom 27203010 316.235.96 - BIT DRILL 35MM STOP 1MM 60MM J LATCH NONSTRL BOTH IP/OP $246.00 $182.00 $43.79 $250.18 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $43.79 $246.00 $246.00 $182.58 $182.58 $189.62 $128.17 $51.27 $246.00 $100.07 $246.00 $246.00 $250.18 $246.00 $246.00 $184.50 $246.00 $246.00 $246.00 $123.00 $123.00 $194.83 $246.00 $196.80 $159.90 $246.00 N/A $142.68 $246.00 $147.60 $246.00 $246.00 $246.00 N/A N/A 316.335.96 SUP Custom 27203010 316.335.96 - BIT DRILL 40MM STOP 1.3MM 65MM J LATCH NONSTRL BOTH IP/OP $246.00 $182.00 $43.79 $250.18 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $43.79 $246.00 $246.00 $182.58 $182.58 $189.62 $128.17 $51.27 $246.00 $100.07 $246.00 $246.00 $250.18 $246.00 $246.00 $184.50 $246.00 $246.00 $246.00 $123.00 $123.00 $194.83 $246.00 $196.80 $159.90 $246.00 N/A $142.68 $246.00 $147.60 $246.00 $246.00 $246.00 N/A N/A 317.235.96 SUP Custom 27203010 317.235.96 - BIT DRILL 40MM STOP 1.1MM 65MM J LATCH TITANIUM NONSTRL BOTH IP/OP $246.00 $182.00 $43.79 $250.18 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $43.79 $246.00 $246.00 $182.58 $182.58 $189.62 $128.17 $51.27 $246.00 $100.07 $246.00 $246.00 $250.18 $246.00 $246.00 $184.50 $246.00 $246.00 $246.00 $123.00 $123.00 $194.83 $246.00 $196.80 $159.90 $246.00 N/A $142.68 $246.00 $147.60 $246.00 $246.00 $246.00 N/A N/A 317.435.96 SUP Custom 27203010 317.435.96 - BIT DRILL 60MM STOP 1.5MM 85MM J LATCH NONSTRL BOTH IP/OP $246.00 $182.00 $43.79 $250.18 $246.00 $246.00 $246.00 $246.00 $246.00 $246.00 $43.79 $246.00 $246.00 $182.58 $182.58 $189.62 $128.17 $51.27 $246.00 $100.07 $246.00 $246.00 $250.18 $246.00 $246.00 $184.50 $246.00 $246.00 $246.00 $123.00 $123.00 $194.83 $246.00 $196.80 $159.90 $246.00 N/A $142.68 $246.00 $147.60 $246.00 $246.00 $246.00 N/A N/A 31AJ-501 SUP Custom 27803010 31AJ-501 - VALVE AORTIC 85D 5.18SQ CM 31MM 26.1MM MECHANICAL HEART BOTH IP/OP "$11,250.00" "$8,325.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$11,250.00" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$11,250.00" "$11,250.00" N/A N/A 31MJ-501 SUP Custom 27803010 31MJ-501 - VALVE MTRL 85D 5.18SQ CM STD 31MM 26.1MM MSTR-SER CUF LFLT BOTH IP/OP "$17,425.00" "$12,895.00" "$3,101.65" "$17,425.00" "$17,425.00" "$17,425.00" "$17,425.00" "$17,425.00" "$17,425.00" "$17,425.00" "$3,101.65" "$17,425.00" "$17,425.00" "$17,425.00" "$17,425.00" "$17,425.00" "$17,425.00" "$3,631.56" "$17,425.00" "$6,970.00" "$17,425.00" "$17,425.00" "$17,425.00" "$17,425.00" "$17,425.00" "$13,068.75" "$17,425.00" "$17,425.00" "$17,425.00" "$8,712.50" "$8,712.50" "$13,800.60" "$17,425.00" "$13,940.00" "$7,841.25" "$17,425.00" N/A "$10,106.50" "$17,425.00" "$10,455.00" "$17,425.00" "$17,425.00" "$17,425.00" N/A N/A 32-1256 SUP Custom 27203010 32-1256 - ROPE TRC 10FT STRL LF BOTH IP/OP $203.50 $151.00 $36.15 $213.38 $203.10 $203.10 $203.10 $203.10 $203.10 $203.10 $36.15 $203.10 $203.10 $150.74 $150.74 $156.55 $105.82 $42.33 $203.10 $85.35 $203.10 $203.10 $213.38 $203.10 $203.10 $152.63 $203.10 $203.10 $203.10 $101.55 $101.55 $160.86 $203.10 $162.48 $132.02 $203.10 N/A $118.03 $203.10 $121.86 $203.10 $203.10 $203.10 N/A N/A 3220-0240S SUP HCPCS C1713 3220-0240S - NAIL INTRAMEDULLARY 120D LONG 11MM 240MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" $979.00 "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$1,468.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3220-0260S SUP HCPCS C1713 3220-0260S - NAIL INTRAMEDULLARY 120D LONG 11MM 260MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" $979.00 "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$1,468.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3220-0280S SUP HCPCS C1713 3220-0280S - NAIL INTRAMEDULLARY 120D LONG 11MM 28CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$2,798.50" "$2,071.00" $555.36 "$2,798.13" "$1,259.16" "$1,259.16" "$1,259.16" "$1,259.16" "$2,798.13" "$2,798.13" "$2,798.13" $583.20 "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.16 "$2,798.13" "$1,119.25" "$1,379.48" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,098.88" "$2,798.13" "$2,798.13" "$2,798.13" "$1,399.07" "$1,399.07" "$2,216.12" "$2,798.13" "$2,238.50" "$1,259.16" $555.36 N/A "$1,623.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.13 "$2,798.13" N/A N/A 3220-0300S SUP HCPCS C1713 3220-0300S - NAIL INTRAMEDULLARY 120D LONG 11MM 30CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3220-0320S SUP HCPCS C1713 3220-0320S - NAIL INTRAMEDULLARY 120D LONG 11MM 32CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3220-0340S SUP HCPCS C1713 3220-0340S - NAIL INTRAMEDULLARY 120D LONG R2 11MM 15.5MM 340MM KIT GAMMA BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3220-0360S SUP HCPCS C1713 3220-0360S - NAIL INTRAMEDULLARY 120D LONG 11MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3220-0380S SUP HCPCS C1713 3220-0380S - NAIL INTRAMEDULLARY 120D LONG 11MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3220-0400S SUP HCPCS C1713 3220-0400S - NAIL INTRAMEDULLARY 120D LONG 11MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3220-0420S SUP HCPCS C1713 3220-0420S - NAIL INTRAMEDULLARY 120D LONG 11MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3220-0440S SUP HCPCS C1713 3220-0440S - NAIL INTRAMEDULLARY 120D LONG 11MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3220-0460S SUP HCPCS C1713 3220-0460S - NAIL INTRAMEDULLARY 120D LONG 11MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$2,798.50" "$2,071.00" $555.36 "$2,798.13" "$1,259.16" "$1,259.16" "$1,259.16" "$1,259.16" "$2,798.13" "$2,798.13" "$2,798.13" $583.20 "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.16 "$2,798.13" "$2,798.13" "$1,379.48" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,098.88" "$2,798.13" "$2,798.13" "$2,798.13" "$1,399.07" "$1,399.07" "$2,216.12" "$2,798.13" "$2,238.50" "$1,259.16" $555.36 N/A "$1,623.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.13 "$2,798.13" N/A N/A 3220-3340S SUP HCPCS C1713 3220-3340S - NAIL INTRAMEDULLARY 120D LONG 13MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3220-3360S SUP HCPCS C1713 3220-3360S - NAIL INTRAMEDULLARY 120D LONG 13MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3220-3380S SUP HCPCS C1713 3220-3380S - NAIL INTRAMEDULLARY 120D LONG 13MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3220-3400S SUP HCPCS C1713 3220-3400S - NAIL INTRAMEDULLARY 120D LONG 13MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3220-3420S SUP HCPCS C1713 3220-3420S - NAIL INTRAMEDULLARY 120D LONG 13MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3220-3440S SUP HCPCS C1713 3220-3440S - NAIL INTRAMEDULLARY 120D LONG 13MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3220-3460S SUP HCPCS C1713 3220-3460S - NAIL INTRAMEDULLARY 120D LONG 13MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3220-5340S SUP HCPCS C1713 3220-5340S - NAIL INTRAMEDULLARY 120D LONG 15MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3220-5360S SUP HCPCS C1713 3220-5360S - NAIL INTRAMEDULLARY 120D LONG 15MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3220-5380S SUP HCPCS C1713 3220-5380S - NAIL INTRAMEDULLARY 120D LONG 15MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3220-5400S SUP HCPCS C1713 3220-5400S - NAIL INTRAMEDULLARY 120D LONG 15MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3220-5420S SUP HCPCS C1713 3220-5420S - NAIL INTRAMEDULLARY 120D LONG 15MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$3,293.13" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3220-5440S SUP HCPCS C1713 3220-5440S - NAIL INTRAMEDULLARY 120D LONG 15MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3220-5460S SUP HCPCS C1713 3220-5460S - NAIL INTRAMEDULLARY 120D LONG 15MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 32-250 SUP HCPCS C1713 32-250 - HOLDER NDL CRV 9IN STRATTE INS SHNK TC BOTH IP/OP $373.50 $276.00 $74.10 $373.33 $168.00 $168.00 $168.00 $168.00 $373.33 $373.33 $373.33 $77.81 $373.33 $373.33 $373.33 $373.33 $373.33 $77.81 $373.33 $149.33 $220.82 $373.33 $373.33 $373.33 $373.33 $280.13 $373.33 $373.33 $373.33 $186.67 $186.67 $295.68 $373.33 $298.66 $168.00 $74.10 N/A $216.63 $373.33 $373.33 $373.33 $77.80 $373.33 N/A N/A 3225-0240S SUP HCPCS C1713 3225-0240S - NAIL INTRAMEDULLARY 125D LONG 11MM 240MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,798.50" "$2,071.00" $555.36 "$2,798.13" "$1,259.16" "$1,259.16" "$1,259.16" "$1,259.16" "$2,798.13" "$2,798.13" "$2,798.13" $583.20 "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.16 "$2,798.13" "$2,798.13" "$1,379.48" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,098.88" "$2,798.13" "$2,798.13" "$2,798.13" "$1,399.07" "$1,399.07" "$2,216.12" "$2,798.13" "$2,238.50" "$1,259.16" $555.36 N/A "$1,623.13" "$2,798.13" "$1,678.88" "$2,798.13" $583.13 "$2,798.13" N/A N/A 3225-0260S SUP HCPCS C1713 3225-0260S - NAIL INTRAMEDULLARY 125D LONG 11MM 260MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,688.50" "$1,989.00" $533.53 "$2,688.13" "$1,209.66" "$1,209.66" "$1,209.66" "$1,209.66" "$2,688.13" "$2,688.13" "$2,688.13" $560.27 "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" $560.24 "$2,688.13" "$2,688.13" "$1,325.25" "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" "$2,016.38" "$2,688.13" "$2,688.13" "$2,688.13" "$1,344.07" "$1,344.07" "$2,129.00" "$2,688.13" "$2,150.50" "$1,209.66" $533.53 N/A "$1,559.33" "$2,688.13" "$1,612.88" "$2,688.13" $560.21 "$2,688.13" N/A N/A 3225-0280S SUP HCPCS C1713 3225-0280S - NAIL INTRAMEDULLARY 125D LONG 11MM 28CM KIT GAMMA3 TITANIUM BOTH IP/OP "$2,798.50" "$2,071.00" $555.36 "$2,798.13" "$1,259.16" "$1,259.16" "$1,259.16" "$1,259.16" "$2,798.13" "$2,798.13" "$2,798.13" $583.20 "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.16 "$2,798.13" "$2,798.13" "$1,379.48" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,098.88" "$2,798.13" "$2,798.13" "$2,798.13" "$1,399.07" "$1,399.07" "$2,216.12" "$2,798.13" "$2,238.50" "$1,259.16" $555.36 N/A "$1,623.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.13 "$2,798.13" N/A N/A 3225-0300S SUP HCPCS C1713 3225-0300S - NAIL INTRAMEDULLARY 125D R2 11-15.5MM 30CM GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3225-0320S SUP HCPCS C1713 3225-0320S - NAIL INTRAMEDULLARY 125D R2 11MM 32CM KIT GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3225-0340S SUP HCPCS C1713 3225-0340S - NAIL INTRAMEDULLARY 125D LONG 11MM 34CM KIT GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3225-0360S SUP HCPCS C1713 3225-0360S - NAIL INTRAMEDULLARY 125D LONG 11MM 360MM KIT GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3225-0380S SUP HCPCS C1713 3225-0380S - NAIL INTRAMEDULLARY 125D LONG 15.5-11MM 380MM KIT GAMMA3 BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3225-0400S SUP HCPCS C1713 3225-0400S - NAIL INTRAMEDULLARY 125D R2 LONG 15.5-11MM 400MM KIT SET BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3225-0420S SUP HCPCS C1713 3225-0420S - NAIL INTRAMEDULLARY 125D LONG 15.5-11MM 420MM KIT GAMMA3 BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" "$3,093.75" "$3,093.75" N/A N/A 3225-0440S SUP HCPCS C1713 3225-0440S - NAIL INTRAMEDULLARY 125D LONG 11MM 44CM KIT GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3225-0460S SUP HCPCS C1713 3225-0460S - NAIL INTRAMEDULLARY 125D LONG 11MM 46CM KIT GAMMA3 TITANIUM BOTH IP/OP "$2,798.50" "$2,071.00" $555.36 "$2,798.13" "$1,259.16" "$1,259.16" "$1,259.16" "$1,259.16" "$2,798.13" "$2,798.13" "$2,798.13" $583.20 "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.16 "$2,798.13" "$2,798.13" "$1,379.48" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,098.88" "$2,798.13" "$2,798.13" "$2,798.13" "$1,399.07" "$1,399.07" "$2,216.12" "$2,798.13" "$2,238.50" "$1,259.16" $555.36 N/A "$1,623.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" N/A N/A 3225-3300S SUP HCPCS C1713 3225-3300S - NAIL INTRAMEDULLARY 125D LONG 13MM 300MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,688.50" "$1,989.00" $533.53 "$2,688.13" "$1,209.66" "$1,209.66" "$1,209.66" "$1,209.66" "$2,688.13" "$2,688.13" "$2,688.13" $560.27 "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" $560.24 "$2,688.13" "$2,688.13" "$1,325.25" "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" "$2,016.38" "$2,688.13" "$2,688.13" "$2,688.13" "$1,344.07" "$1,344.07" "$2,129.00" "$2,688.13" "$2,150.50" "$1,209.66" $533.53 N/A "$1,559.33" "$2,688.13" "$1,612.88" "$2,688.13" $560.21 "$2,688.13" N/A N/A 3225-3320S SUP HCPCS C1713 3225-3320S - NAIL INTRAMEDULLARY 125D LONG 13MM 32CM GAMMA3 TITANIUM HIP BOTH IP/OP "$2,688.50" "$1,989.00" $533.53 "$2,688.13" "$1,209.66" "$1,209.66" "$1,209.66" "$1,209.66" "$2,688.13" "$2,688.13" "$2,688.13" $560.27 "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" $560.24 "$2,688.13" "$2,688.13" "$1,325.25" "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" "$2,016.38" "$2,688.13" "$2,688.13" "$2,688.13" "$1,344.07" "$1,344.07" "$2,129.00" "$2,688.13" "$2,150.50" "$1,209.66" $533.53 N/A "$1,559.33" "$2,688.13" "$1,612.88" "$2,688.13" $560.21 "$2,688.13" N/A N/A 3225-3340S SUP HCPCS C1713 3225-3340S - NAIL INTRAMEDULLARY 125D LONG 13MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" "$3,293.13" "$3,293.13" N/A N/A 3225-3360S SUP HCPCS C1713 3225-3360S - NAIL INTRAMEDULLARY 125D LONG 13MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3225-3380S SUP HCPCS C1713 3225-3380S - NAIL INTRAMEDULLARY 125D LONG 13MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3225-3400S SUP HCPCS C1713 3225-3400S - NAIL INTRAMEDULLARY 125D LONG 13MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3225-3420S SUP HCPCS C1713 3225-3420S - NAIL INTRAMEDULLARY 125D LONG 13MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3225-3440S SUP HCPCS C1713 3225-3440S - NAIL INTRAMEDULLARY 125D LONG 13MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3225-3460S SUP HCPCS C1713 3225-3460S - NAIL INTRAMEDULLARY 125D LONG 13MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3225-5300S SUP HCPCS C1713 3225-5300S - NAIL INTRAMEDULLARY 125D LONG 15MM 300MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" "$2,447.50" "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$1,468.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3225-5320S SUP HCPCS C1713 3225-5320S - NAIL INTRAMEDULLARY 125D LONG 15MM 320MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" "$2,447.50" "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$1,468.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3225-5340S SUP HCPCS C1713 3225-5340S - NAIL INTRAMEDULLARY 125D LONG 15MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$3,293.13" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3225-5360S SUP HCPCS C1713 3225-5360S - NAIL INTRAMEDULLARY 125D LONG 15MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$3,293.13" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3225-5380S SUP HCPCS C1713 3225-5380S - NAIL INTRAMEDULLARY 125D LONG 15MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$3,293.13" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3225-5400S SUP HCPCS C1713 3225-5400S - NAIL INTRAMEDULLARY 125D LONG 15MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$3,293.13" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3225-5420S SUP HCPCS C1713 3225-5420S - NAIL INTRAMEDULLARY 125D LONG 15MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$3,293.13" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3225-5440S SUP HCPCS C1713 3225-5440S - NAIL INTRAMEDULLARY 125D LONG 15MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3225-5460S SUP HCPCS C1713 3225-5460S - NAIL INTRAMEDULLARY 125D LONG 15MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3230-0240S SUP HCPCS C1713 3230-0240S - NAIL INTRAMEDULLARY LONG 130D 11MM 240MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" "$2,447.50" "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$1,468.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3230-0260S SUP HCPCS C1713 3230-0260S - NAIL INTRAMEDULLARY 130D LONG 11MM 260MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" "$2,447.50" "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$1,468.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3230-0280S SUP HCPCS C1713 3230-0280S - NAIL INTRAMEDULLARY 130D LONG 11MM 28CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$2,798.50" "$2,071.00" $555.36 "$2,798.13" "$1,259.16" "$1,259.16" "$1,259.16" "$1,259.16" "$2,798.13" "$2,798.13" "$2,798.13" $583.20 "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.16 "$2,798.13" "$2,798.13" "$1,379.48" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,098.88" "$2,798.13" "$2,798.13" "$2,798.13" "$1,399.07" "$1,399.07" "$2,216.12" "$2,798.13" "$2,238.50" "$1,259.16" $555.36 N/A "$1,623.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" N/A N/A 3230-0300S SUP HCPCS C1713 3230-0300S - NAIL INTRAMEDULLARY 130D LONG 11MM 30CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3230-0320S SUP HCPCS C1713 3230-0320S - NAIL INTRAMEDULLARY 130D LONG 11MM 32CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3230-0340S SUP HCPCS C1713 3230-0340S - NAIL INTRAMEDULLARY 130D LONG R2 15.5MM 11MM 34CM KIT GAMMA3 BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3230-0360S SUP HCPCS C1713 3230-0360S - NAIL INTRAMEDULLARY 130D LONG 11MM 360MM LOCK GAMMA3 BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3230-0380S SUP HCPCS C1713 3230-0380S - NAIL INTRAMEDULLARY 130D LONG 11MM 380MM LOCK GAMMA3 BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3230-0400S SUP HCPCS C1713 3230-0400S - NAIL INTRAMEDULLARY 130D R2 LONG 15.5-11MM 400MM KIT SET BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3230-0420S SUP HCPCS C1713 3230-0420S - NAIL INTRAMEDULLARY 130D LONG 11MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3230-0440S SUP HCPCS C1713 3230-0440S - NAIL INTRAMEDULLARY 130D LONG R2 15.5MM 11MM 44CM KIT GAMMA3 BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3230-0460S SUP HCPCS C1713 3230-0460S - NAIL INTRAMEDULLARY 130D LONG 11MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$2,798.50" "$2,071.00" $555.36 "$2,798.13" "$1,259.16" "$1,259.16" "$1,259.16" "$1,259.16" "$2,798.13" "$2,798.13" "$2,798.13" $583.20 "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.16 "$2,798.13" "$2,798.13" "$1,379.48" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,098.88" "$2,798.13" "$2,798.13" "$2,798.13" "$1,399.07" "$1,399.07" "$2,216.12" "$2,798.13" "$2,238.50" "$1,259.16" $555.36 N/A "$1,623.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.13 "$2,798.13" N/A N/A 3230-3300S SUP HCPCS C1713 3230-3300S - NAIL INTRAMEDULLARY 130D LONG 13MM 300MM GAMMA3 HIP RIGHT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" $979.00 "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$1,468.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3230-3320S SUP HCPCS C1713 3230-3320S - NAIL INTRAMEDULLARY LONG 130D 13MM 32CM GAMMA3 HIP RIGHT BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3230-3340S SUP HCPCS C1713 3230-3340S - NAIL INTRAMEDULLARY 130D LONG 13MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3230-3360S SUP HCPCS C1713 3230-3360S - NAIL INTRAMEDULLARY 130D LONG 13MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3230-3380S SUP HCPCS C1713 3230-3380S - NAIL INTRAMEDULLARY 130D LONG 13MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$3,293.13" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3230-3400S SUP HCPCS C1713 3230-3400S - NAIL INTRAMEDULLARY 130D LONG 13MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$3,293.13" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3230-3420S SUP HCPCS C1713 3230-3420S - NAIL INTRAMEDULLARY 130D LONG 13MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3230-3440S SUP HCPCS C1713 3230-3440S - NAIL INTRAMEDULLARY 130D LONG 13MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$3,293.13" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3230-3460S SUP HCPCS C1713 3230-3460S - NAIL INTRAMEDULLARY 130D LONG 13MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 323040R SUP Custom 27803010 323040R - KEEL LARYNGEAL 12MM UMBRELLA SHAPE RADIOPQ MONTGOMERY BOTH IP/OP $235.00 $174.00 $41.83 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $41.83 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $235.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $235.00 N/A $136.30 $235.00 $141.00 $235.00 $235.00 $235.00 N/A N/A 323050R SUP Custom 27803010 323050R - KEEL LARYNGEAL 14MM UMBRELLA SHAPE RADIOPQ MONTGOMERY BOTH IP/OP $235.00 $174.00 $41.83 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $41.83 $235.00 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $235.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $235.00 N/A $136.30 $235.00 $141.00 $235.00 $235.00 $235.00 N/A N/A 3230-5340S SUP HCPCS C1713 3230-5340S - NAIL INTRAMEDULLARY 130D LONG 15MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$3,293.13" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3230-5360S SUP HCPCS C1713 3230-5360S - NAIL INTRAMEDULLARY 130D LONG 15MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3230-5380S SUP HCPCS C1713 3230-5380S - NAIL INTRAMEDULLARY 130D LONG 15MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3230-5400S SUP HCPCS C1713 3230-5400S - NAIL INTRAMEDULLARY 130D LONG 15MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3230-5420S SUP HCPCS C1713 3230-5420S - NAIL INTRAMEDULLARY 130D LONG 15MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3230-5440S SUP HCPCS C1713 3230-5440S - NAIL INTRAMEDULLARY 130D LONG 15MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3230-5460S SUP HCPCS C1713 3230-5460S - NAIL INTRAMEDULLARY 130D LONG 15MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 325014S SUP HCPCS C1713 325014S - SCREW BN P/T LOPRFL RVRS CUT FLUT FLT HEX 4MM 5MM 14MM STRL BOTH IP/OP $267.00 $198.00 $52.94 $266.75 $120.04 $120.04 $120.04 $120.04 $266.75 $266.75 $266.75 $55.60 $266.75 $266.75 $266.75 $266.75 $266.75 $55.59 $266.75 $106.70 $157.78 $266.75 $266.75 $266.75 $266.75 $200.25 $266.75 $266.75 $266.75 $133.38 $133.38 $211.27 $266.75 $213.40 $120.04 $52.94 N/A $154.86 $266.75 $160.05 $266.75 $55.59 $266.75 N/A N/A 325016S SUP HCPCS C1713 325016S - SCREW BONE 4MM 16MM 8MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $267.00 $198.00 $52.94 $266.75 $120.04 $120.04 $120.04 $120.04 $266.75 $266.75 $266.75 $55.60 $266.75 $266.75 $266.75 $266.75 $266.75 $55.59 $266.75 $266.75 $157.78 $266.75 $266.75 $266.75 $266.75 $200.25 $266.75 $266.75 $266.75 $133.38 $133.38 $211.27 $266.75 $213.40 $120.04 $52.94 N/A $154.86 $266.75 $160.05 $266.75 $55.59 $266.75 N/A N/A 325018S SUP HCPCS C1713 325018S - SCREW BN 4MM 18MM STRL ASNS III P/T IMPL SS BOTH IP/OP $267.00 $198.00 $52.94 $266.75 $120.04 $120.04 $120.04 $120.04 $266.75 $266.75 $266.75 $55.60 $266.75 $266.75 $266.75 $266.75 $266.75 $55.59 $266.75 $106.70 $157.78 $266.75 $266.75 $266.75 $266.75 $200.25 $266.75 $266.75 $266.75 $133.38 $133.38 $211.27 $266.75 $213.40 $120.04 $52.94 N/A $154.86 $266.75 $160.05 $266.75 $55.59 $266.75 N/A N/A 325020S SUP HCPCS C1713 325020S - SCREW BONE 4MM 20MM 8MM SELF DRILL SELF TAP CANN ASNIS III BOTH IP/OP $267.00 $198.00 $52.94 $266.75 $120.04 $120.04 $120.04 $120.04 $266.75 $266.75 $266.75 $55.60 $266.75 $266.75 $266.75 $266.75 $266.75 $55.59 $266.75 $106.70 $157.78 $266.75 $266.75 $266.75 $266.75 $200.25 $266.75 $266.75 $266.75 $133.38 $133.38 $211.27 $266.75 $213.40 $120.04 $52.94 N/A $154.86 $266.75 $160.05 $266.75 $55.59 $266.75 N/A N/A 325022S SUP HCPCS C1713 325022S - SCREW BONE PTHRD 4MM 22MM 8MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $267.00 $198.00 $52.94 $266.75 $120.04 $120.04 $120.04 $120.04 $266.75 $266.75 $266.75 $55.60 $266.75 $266.75 $266.75 $266.75 $266.75 $55.59 $266.75 $266.75 $157.78 $266.75 $266.75 $266.75 $266.75 $200.25 $266.75 $266.75 $266.75 $133.38 $133.38 $211.27 $266.75 $213.40 $120.04 $52.94 N/A $154.86 $266.75 $160.05 $266.75 $55.59 $266.75 N/A N/A 325024S SUP HCPCS C1713 325024S - SCREW BONE PTHRD 4MM 24MM 8MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $267.00 $198.00 $52.94 $266.75 $120.04 $120.04 $120.04 $120.04 $266.75 $266.75 $266.75 $55.60 $266.75 $266.75 $266.75 $266.75 $266.75 $55.59 $266.75 $266.75 $157.78 $266.75 $266.75 $266.75 $266.75 $200.25 $266.75 $266.75 $266.75 $133.38 $133.38 $211.27 $266.75 $213.40 $120.04 $52.94 N/A $154.86 $266.75 $160.05 $266.75 $55.59 $266.75 N/A N/A 325026S SUP HCPCS C1713 325026S - SCREW BN P/T 4MM 26MM STRL 9MM ASNS III ST SLF DRL CNN SS BOTH IP/OP $267.00 $198.00 $52.94 $266.75 $120.04 $120.04 $120.04 $120.04 $266.75 $266.75 $266.75 $55.60 $266.75 $266.75 $266.75 $266.75 $266.75 $55.59 $266.75 $106.70 $157.78 $266.75 $266.75 $266.75 $266.75 $200.25 $266.75 $266.75 $266.75 $133.38 $133.38 $211.27 $266.75 $213.40 $120.04 $52.94 N/A $154.86 $266.75 $266.75 $266.75 $55.59 $266.75 N/A N/A 325028S SUP HCPCS C1713 325028S - SCREW BN 4MM 28MM STRL 9.5MM ASNS III SLF DRL ST CNN SS HIP BOTH IP/OP $267.00 $198.00 $52.94 $266.75 $120.04 $120.04 $120.04 $120.04 $266.75 $266.75 $266.75 $55.60 $266.75 $266.75 $266.75 $266.75 $266.75 $55.59 $266.75 $266.75 $157.78 $266.75 $266.75 $266.75 $266.75 $200.25 $266.75 $266.75 $266.75 $133.38 $133.38 $211.27 $266.75 $213.40 $120.04 $52.94 N/A $154.86 $266.75 $266.75 $266.75 $55.59 $266.75 N/A N/A 325030S SUP HCPCS C1713 325030S - SCREW BN P/T 4MM 30MM STRL ASNS III ST SLF DRL CNN SS HIP BOTH IP/OP $267.00 $198.00 $52.94 $266.75 $120.04 $120.04 $120.04 $120.04 $266.75 $266.75 $266.75 $55.60 $266.75 $266.75 $266.75 $266.75 $266.75 $55.59 $266.75 $106.70 $157.78 $266.75 $266.75 $266.75 $266.75 $200.25 $266.75 $266.75 $266.75 $133.38 $133.38 $211.27 $266.75 $213.40 $120.04 $52.94 N/A $154.86 $266.75 $160.05 $266.75 $55.59 $266.75 N/A N/A 325210S SUP HCPCS C1713 325210S - SCREW BONE FULTHD 4MM 10MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 325212S SUP HCPCS C1713 325212S - SCREW BONE FULTHD 4MM 12MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $273.63 $273.63 $57.02 $273.63 N/A N/A 325214S SUP HCPCS C1713 325214S - SCREW BONE FULTHRD 4MM 14MM CANN IMPLANT ASNIS III STAINLESS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $273.63 $273.63 $57.02 $273.63 N/A N/A 325216S SUP HCPCS C1713 325216S - SCREW BONE FULTHD 4MM 16MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 325218S SUP HCPCS C1713 325218S - SCREW BONE FULTHD 4MM 18MM SELF TAP SELF CUT CANNU ASNIS III BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $273.63 $273.63 $57.02 $273.63 N/A N/A 325220S SUP HCPCS C1713 325220S - SCREW BONE FULTHD 4MM 20MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $273.63 $273.63 $57.02 $273.63 N/A N/A 325222S SUP HCPCS C1713 325222S - SCREW BONE FULTHD 4MM 22MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $273.63 $273.63 $57.02 $273.63 N/A N/A 325224S SUP HCPCS C1713 325224S - SCREW BONE FULTHRD 4MM 24MM CANN IMPLANT ASNIS III STAINLESS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $273.63 $273.63 $57.02 $273.63 N/A N/A 325226S SUP HCPCS C1713 325226S - SCREW BONE FULTHD 4MM 26MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $273.63 $273.63 $57.02 $273.63 N/A N/A 325228S SUP HCPCS C1713 325228S - SCREW BONE FULTHD 4MM 28MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 325230S SUP HCPCS C1713 325230S - SCREW BONE FULTHD 4MM 30MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 325232S SUP HCPCS C1713 325232S - SCREW BONE 4MM 32MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 325234S SUP HCPCS C1713 325234S - SCREW BONE FULTHD 4MM 34MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $273.63 $273.63 $57.02 $273.63 N/A N/A 325236S SUP HCPCS C1713 325236S - SCREW BONE FULTHD 4MM 36MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 325238S SUP HCPCS C1713 325238S - SCREW BONE FULTHD 4MM 38MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 325240S SUP HCPCS C1713 325240S - SCREW BONE FULTHD 4MM 40MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 325242S SUP HCPCS C1713 325242S - SCREW BONE 4MM 42MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 325244S SUP HCPCS C1713 325244S - SCREW BONE FULTHD 4MM 44MM CANN SLFTAP SLFDRILL ASNIS III BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $273.63 $273.63 $57.02 $273.63 N/A N/A 325246S SUP HCPCS C1713 325246S - SCREW BONE FULTHD 4MM 46MM SLFDRILL SLFTAP CANN ASNIS III BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 325248S SUP HCPCS C1713 325248S - SCREW BONE FULTHD 4MM 48MM SLFDRILL SLFTAP CANN ASNIS III BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $273.63 $273.63 $57.02 $273.63 N/A N/A 325250S SUP HCPCS C1713 325250S - SCREW BONE PTHRD 4MM 50MM CANN ASNIS III STAINLESS STEEL HIP BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 325260S SUP HCPCS C1713 325260S - SCREW BONE 6.5MM 60MM CANN ASNIS III STAINLESS STEEL HIP BOTH IP/OP $242.50 $179.00 $48.08 $242.25 $109.01 $109.01 $109.01 $109.01 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $242.25 $242.25 $242.25 $50.49 $242.25 $96.90 $143.29 $242.25 $242.25 $242.25 $242.25 $181.88 $242.25 $242.25 $242.25 $121.13 $121.13 $191.86 $242.25 $193.80 $109.01 $48.08 N/A $140.65 $242.25 $145.35 $242.25 $50.48 $242.25 N/A N/A 325265S SUP HCPCS C1713 325265S - SCREW BONE 6.5MM 65MM CANN ASNIS III STAINLESS STEEL HIP BOTH IP/OP $206.50 $153.00 $40.94 $206.25 $92.81 $92.81 $92.81 $92.81 $206.25 $206.25 $206.25 $42.99 $206.25 $206.25 $206.25 $206.25 $206.25 $42.98 $206.25 $82.50 $122.00 $206.25 $206.25 $206.25 $206.25 $154.88 $206.25 $206.25 $206.25 $103.13 $103.13 $163.35 $206.25 $165.00 $92.81 $40.94 N/A $119.77 $206.25 $123.75 $206.25 $42.98 $206.25 N/A N/A 325270S SUP HCPCS C1713 325270S - SCREW BONE 6.5MM 70MM CANN ASNIS III STAINLESS STEEL HIP BOTH IP/OP $206.50 $153.00 $40.94 $206.25 $92.81 $92.81 $92.81 $92.81 $206.25 $206.25 $206.25 $42.99 $206.25 $206.25 $206.25 $206.25 $206.25 $42.98 $206.25 $82.50 $122.00 $206.25 $206.25 $206.25 $206.25 $154.88 $206.25 $206.25 $206.25 $103.13 $103.13 $163.35 $206.25 $165.00 $92.81 $40.94 N/A $119.77 $206.25 $206.25 $206.25 $42.98 $206.25 N/A N/A 325422S SUP HCPCS C1713 325422S - SCREW BONE 5MM 22MM CANN PTHRD ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325424S SUP HCPCS C1713 325424S - SCREW BONE PTHRD 5MM 24MM CANNU ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325426S SUP HCPCS C1713 325426S - SCREW BONE 5MM 26MM CANN PTHRD ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325428S SUP HCPCS C1713 325428S - SCREW BONE 5MM 28MM CANN PTHRD ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $299.75 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325430S SUP HCPCS C1713 325430S - SCREW BONE PTHRD 5MM 30MM CANNU ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 325432S SUP HCPCS C1713 325432S - SCREW BONE 5MM 32MM CANN PTHRD ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $299.75 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 325434S SUP HCPCS C1713 325434S - SCREW BONE 5MM 34MM CANN PTHRD ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $299.75 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 325436S SUP HCPCS C1713 325436S - SCREW BONE PTHRD 5MM 36MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 325438S SUP HCPCS C1713 325438S - SCREW BONE PTHRD 5MM 38MM CANNU ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 325440S SUP HCPCS C1713 325440S - SCREW BONE PTHRD 5MM 40MM CANNU ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 325442S SUP HCPCS C1713 325442S - SCREW BONE PTHRD 5MM 42MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 325444S SUP HCPCS C1713 325444S - SCREW BONE 5MM 44MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 325446S SUP HCPCS C1713 325446S - SCREW BONE PTHRD 5MM 46MM CANNU ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325448S SUP HCPCS C1713 325448S - SCREW BONE 5MM 48MM CANN PTHRD ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $299.75 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 325450S SUP HCPCS C1713 325450S - SCREW BONE 5MM 50MM 17MM CANN PTHRD SLFDRILL SLFTAP ASNIS BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $299.75 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 325455S SUP HCPCS C1713 325455S - SCREW BONE PTHRD 5MM 55MM CANN SLFTAP SLFDRILL ASNIS III BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $299.75 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325460S SUP HCPCS C1713 325460S - SCREW BONE PTHRD 5MM 60MM 20MM CANN ASNIS III STAINLESS BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $299.75 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325465S SUP HCPCS C1713 325465S - SCREW BONE PTHRD 5MM 65MM CANN SLFTAP SLFDRILL ASNIS III BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325470S SUP HCPCS C1713 325470S - SCREW BONE PTHRD 5MM 70MM CANN SLFTAP SLFDRILL ASNIS III BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325475S SUP HCPCS C1713 325475S - SCREW BONE PTHRD 5MM 75MM CANN SLFTAP SLFDRILL ASNIS III BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $299.75 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325480S SUP HCPCS C1713 325480S - SCREW BONE 5MM 80MM SLFTAP SLFDRILL CANN PTHRD ASNIS III BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $299.75 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325620S SUP HCPCS C1713 325620S - SCREW BONE 5MM 20MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325622S SUP HCPCS C1713 325622S - SCREW BONE FULTHRD 5MM 22MM CANN SLFDRILL SLFTAP ASNIS III BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325624S SUP HCPCS C1713 325624S - SCREW BONE FULTHD 5MM 24MM CANN SLFDRILL TAPPING ASNIS III BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325626S SUP HCPCS C1713 325626S - SCREW BONE FULTHD 5MM 26MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 325628S SUP HCPCS C1713 325628S - SCREW BONE FULTHD 5MM 28MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325630S SUP HCPCS C1713 325630S - SCREW BONE FULTHD 5MM 30MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 325632S SUP HCPCS C1713 325632S - SCREW BONE FULTHD 5MM 32MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325634S SUP HCPCS C1713 325634S - SCREW BONE FULTHD 5MM 34MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325636S SUP HCPCS C1713 325636S - SCREW BONE 5MM 36MM FULTHRD IMPLANT STAINLESS STEEL STERILE BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $299.75 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 325638S SUP HCPCS C1713 325638S - SCREW BONE 5MM 38MM SLFTAP SLFDRILL CANN FULTHD ASNIS III BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325640S SUP HCPCS C1713 325640S - SCREW BONE FULTHD 5MM 40MM CANN SLFTAP SLFDRILL ASNIS III BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325642S SUP HCPCS C1713 325642S - SCREW BONE FULTHD 5MM 42MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325644S SUP HCPCS C1713 325644S - SCREW BONE FULTHD 5MM 44MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325646S SUP HCPCS C1713 325646S - SCREW BONE FULTHD 5MM 46MM CANN SLFTAP SLFDRILL ASNIS III BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325650S SUP HCPCS C1713 325650S - SCREW BONE FULTHD 5MM 50MM CANNU ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325655S SUP HCPCS C1713 325655S - SCREW BONE FULTHD 5MM 55MM CANNU ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325660S SUP HCPCS C1713 325660S - SCREW BONE FULTHD 5MM 60MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $299.75 $299.75 $62.47 $299.75 N/A N/A 325665S SUP HCPCS C1713 325665S - SCREW BONE FULTHD 5MM 65MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $299.75 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 325670S SUP HCPCS C1713 325670S - SCREW BONE FULTHD 5MM 70MM CANN SLFTAP SLFDRILL ASNIS III BOTH IP/OP $300.00 $222.00 $59.49 $299.75 $134.89 $134.89 $134.89 $134.89 $299.75 $299.75 $299.75 $62.48 $299.75 $299.75 $299.75 $299.75 $299.75 $62.47 $299.75 $119.90 $177.30 $299.75 $299.75 $299.75 $299.75 $225.00 $299.75 $299.75 $299.75 $149.88 $149.88 $237.40 $299.75 $239.80 $134.89 $59.49 N/A $174.00 $299.75 $179.85 $299.75 $62.47 $299.75 N/A N/A 326040S SUP HCPCS C1713 326040S - SCREW BONE THREADED 6.5MM 40MM 20MM CANN SLFDRILL SLFTAP BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326045S SUP HCPCS C1713 326045S - SCREW BONE 6.5MM 45MM 20MM CANNU ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326050S SUP HCPCS C1713 326050S - SCREW BONE 6.5MM 50MM 20MM CANN ASNIS STAINLESS STEEL FT BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326055S SUP HCPCS C1713 326055S - SCREW BONE 6.5MM 55MM 20MM SELF TAP SELF DRILL CANNU ASNIS BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326060S SUP HCPCS C1713 326060S - SCREW BONE THREAD 6.5MM 60MM 20MM CANN ASNIS III STAINLESS BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326065S SUP HCPCS C1713 326065S - SCREW BONE 6.5MM 65MM 20MM CANNU ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326070S SUP HCPCS C1713 326070S - SCREW BONE PTHRD 6.5MM 70MM 20MM CANN ASNIS STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326075S SUP HCPCS C1713 326075S - SCREW BONE 6.5MM 75MM 20MM CANN ASNIS STAINLESS STEEL HIP BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326080S SUP HCPCS C1713 326080S - SCREW BONE 6.5MM 80MM 20MM CANN ASNIS STAINLESS STEEL SMALL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326085S SUP HCPCS C1713 326085S - SCREW BONE 6.5MM 85MM 20MM SELF DRILL SELF TAP CANN ASNIS BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326090S SUP HCPCS C1713 326090S - SCREW BONE 6.5MM 90MM 20MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326095S SUP HCPCS C1713 326095S - SCREW BONE 6.5MM 95MM 20MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326100S SUP HCPCS C1713 326100S - SCREW BONE THREAD 6.5MM 100MM 20MM CANN ASNIS III STAINLESS BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326105S SUP HCPCS C1713 326105S - SCREW BONE 6.5MM 105MM 20MM CANN ASNIS STAINLESS STEEL FT BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326110S SUP HCPCS C1713 326110S - SCREW BONE 6.5MM 110MM 20MM CANN ASNIS STAINLESS STEEL HIP BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326115S SUP HCPCS C1713 326115S - SCREW BONE 6.5MM 115MM 20MM THREADED IMPLANT ASNIS STAINLESS BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326120S SUP HCPCS C1713 326120S - SCREW BONE 6.5MM 120MM 20MM THREADED IMPLANT ASNIS STAINLESS BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326255S SUP HCPCS C1713 326255S - SCREW BONE 6.5MM 55MM 40MM CANN ASNIS STAINLESS STEEL FT BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326260S SUP HCPCS C1713 326260S - SCREW BONE 6.5MM 60MM 40MM CANN THREADED ASNIS III STAINLESS BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326265S SUP HCPCS C1713 326265S - SCREW BONE 6.5MM 65MM 40MM CANN ASNIS STAINLESS STEEL HIP BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326270S SUP HCPCS C1713 326270S - SCREW BONE PTHRD 6.5MM 70MM 40MM CANN ASNIS STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326275S SUP HCPCS C1713 326275S - SCREW BONE PTHRD 6.5MM 75MM 40MM CANN ASNIS STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326280S SUP HCPCS C1713 326280S - SCREW BONE PTHRD 6.5MM 80MM 40MM CANN ASNIS III STAINLESS BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326285S SUP HCPCS C1713 326285S - SCREW BONE 6.5MM 85MM 40MM CANN SELF TAP SELF DRILL THREAD BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326290S SUP HCPCS C1713 326290S - SCREW BONE 6.5MM 90MM 40MM CANN ASNIS STAINLESS STEEL FT BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326295S SUP HCPCS C1713 326295S - SCREW BONE PTHRD 6.5MM 95MM 20MM CANN ASNIS III STAINLESS BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326300S SUP HCPCS C1713 326300S - SCREW BONE LP 6.5MM 100MM 40MM CANNU TAP DESIGN ASNIS III BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326305S SUP HCPCS C1713 326305S - SCREW BONE 6.5MM 105MM 40MM CANN ASNIS STAINLESS STEEL HIP BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326310S SUP HCPCS C1713 326310S - SCREW BONE 6.5MM 110MM 40MM CANN ASNIS STAINLESS STEEL FT BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326315S SUP HCPCS C1713 326315S - SCREW BONE 6.5MM 115MM 40MM CANN ASNIS STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326320S SUP HCPCS C1713 326320S - SCREW BONE 6.5MM 120MM 40MM CANN ASNIS STAINLESS STEEL FT BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326325S SUP HCPCS C1713 326325S - SCREW BONE 6.5MM 125MM 40MM CANN THREADED ASNIS III BOTH IP/OP $437.00 $323.00 $86.71 $436.90 $196.61 $196.61 $196.61 $196.61 $436.90 $436.90 $436.90 $91.06 $436.90 $436.90 $436.90 $436.90 $436.90 $91.05 $436.90 $174.76 $258.43 $436.90 $436.90 $436.90 $436.90 $327.75 $436.90 $436.90 $436.90 $218.45 $218.45 $346.02 $436.90 $349.52 $196.61 $86.71 N/A $253.46 $436.90 $262.14 $436.90 $91.05 $436.90 N/A N/A 326330S SUP HCPCS C1713 326330S - SCREW BONE 6.5MM 130MM 40MM CANN THREADED ASNIS III BOTH IP/OP $437.00 $323.00 $86.71 $436.90 $196.61 $196.61 $196.61 $196.61 $436.90 $436.90 $436.90 $91.06 $436.90 $436.90 $436.90 $436.90 $436.90 $91.05 $436.90 $174.76 $258.43 $436.90 $436.90 $436.90 $436.90 $327.75 $436.90 $436.90 $436.90 $218.45 $218.45 $346.02 $436.90 $349.52 $196.61 $86.71 N/A $253.46 $436.90 $262.14 $436.90 $91.05 $436.90 N/A N/A 326430S SUP HCPCS C1713 326430S - SCREW BONE FULTHRD 6.5MM 30MM CANN SLFDRILL SLFTAP ASNIS III BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326435S SUP HCPCS C1713 326435S - SCREW BONE FULTHRD 6.5MM 35MM CANN SLFDRILL SLFTAP ASNIS III BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326440S SUP HCPCS C1713 326440S - SCREW BONE FULTHRD 6.5MM 40MM CANN SLFDRILL SLFTAP ASNIS III BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326445S SUP HCPCS C1713 326445S - SCREW BONE 6.5MM 45MM CANN FULTHD SLFDRILL SLFTAP ASNIS III BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326450S SUP HCPCS C1713 326450S - SCREW BONE 6.5MM 50MM CANN FULTHD ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326455S SUP HCPCS C1713 326455S - SCREW BONE 6.5MM 55MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326460S SUP HCPCS C1713 326460S - SCREW BONE 6.5MM 60MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326465S SUP HCPCS C1713 326465S - SCREW BONE 6.5MM 65MM CANN FULTHD SLFDRILL SLFTAP ASNIS III BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326470S SUP HCPCS C1713 326470S - SCREW BONE FULTHD 6.5MM 70MM CANN SLFDRILL SLFTAP ASNIS III BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326475S SUP HCPCS C1713 326475S - SCREW BONE FULTHD 6.5MM 75MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326480S SUP HCPCS C1713 326480S - SCREW BONE FULTHD 6.5MM 80MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326485S SUP HCPCS C1713 326485S - SCREW BONE FULTHD 6.5MM 85MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326490S SUP HCPCS C1713 326490S - SCREW BONE FULTHD 6.5MM 90MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326495S SUP HCPCS C1713 326495S - SCREW BONE FULTHD 6.5MM 95MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326500S SUP HCPCS C1713 326500S - SCREW BONE FULTHD 6.5MM 100MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326505S SUP HCPCS C1713 326505S - SCREW BONE FULTHD 6.5MM 105MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326510S SUP HCPCS C1713 326510S - SCREW BONE FULTHD 6.5MM 110MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326515S SUP HCPCS C1713 326515S - SCREW BONE FULTHD 6.5MM 115MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 326520S SUP HCPCS C1713 326520S - SCREW BONE FULTHD 6.5MM 120MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 326525S SUP HCPCS C1713 326525S - SCREW BONE FULTHRD 6.5MM 125MM CANN ASNIS III STAINLESS BOTH IP/OP $385.50 $285.00 $76.51 $385.50 $173.48 $173.48 $173.48 $173.48 $385.50 $385.50 $385.50 $80.35 $385.50 $385.50 $385.50 $385.50 $385.50 $80.34 $385.50 $385.50 $228.02 $385.50 $385.50 $385.50 $385.50 $289.13 $385.50 $385.50 $385.50 $192.75 $192.75 $305.32 $385.50 $308.40 $173.48 $76.51 N/A $223.59 $385.50 $231.30 $385.50 $80.34 $385.50 N/A N/A 326530S SUP HCPCS C1713 326530S - SCREW BONE FULTHRD 6.5MM 130MM ASNIS III STAINLESS STEEL BOTH IP/OP $385.50 $285.00 $76.51 $385.50 $173.48 $173.48 $173.48 $173.48 $385.50 $385.50 $385.50 $80.35 $385.50 $385.50 $385.50 $385.50 $385.50 $80.34 $385.50 $385.50 $228.02 $385.50 $385.50 $385.50 $385.50 $289.13 $385.50 $385.50 $385.50 $192.75 $192.75 $305.32 $385.50 $308.40 $173.48 $76.51 N/A $223.59 $385.50 $231.30 $385.50 $80.34 $385.50 N/A N/A 326640S SUP HCPCS C1713 326640S - SCREW BONE 8MM 40MM 25MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326645S SUP HCPCS C1713 326645S - SCREW BONE 8MM 45MM 25MM CANN ASNIS STAINLESS STEEL STERILE BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326650S SUP HCPCS C1713 326650S - SCREW BONE 8MM 50MM 25MM CANN ASNIS STAINLESS STEEL STERILE BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326655S SUP HCPCS C1713 326655S - SCREW BONE 8MM 55MM 25MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $385.00 $385.00 $80.23 $385.00 N/A N/A 326660S SUP HCPCS C1713 326660S - SCREW BONE 8MM 60MM 25MM CANN ASNIS STAINLESS STEEL STERILE BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $385.00 $385.00 $80.23 $385.00 N/A N/A 326665S SUP HCPCS C1713 326665S - SCREW BONE 8MM 65MM 25MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $385.00 $385.00 $80.23 $385.00 N/A N/A 326670S SUP HCPCS C1713 326670S - SCREW BONE 8MM 70MM 25MM CANN SLFTAP SLFDRILL THREADED ASNIS BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $385.00 $385.00 $80.23 $385.00 N/A N/A 326675S SUP HCPCS C1713 326675S - SCREW BONE 8MM 75MM 25MM CANN ASNIS STAINLESS STEEL STERILE BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $385.00 $385.00 $80.23 $385.00 N/A N/A 326680S SUP HCPCS C1713 326680S - SCREW BONE 8MM 80MM 25MM CANN SLFTAP SLFDRILL THREADED ASNIS BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326685S SUP HCPCS C1713 326685S - SCREW BONE 8MM 85MM 25MM CANN SLFTAP SLFDRILL THREADED ASNIS BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326690S SUP HCPCS C1713 326690S - SCREW BONE 8MM 90MM 25MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326695S SUP HCPCS C1713 326695S - SCREW BONE 8MM 95MM 25MM CANN SLFTAP SLFDRILL THREADED ASNIS BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $385.00 $385.00 $80.23 $385.00 N/A N/A 326700S SUP HCPCS C1713 326700S - SCREW BONE THREADED 8MM 100MM 25MM CANN ASNIS STAINLESS BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326705S SUP HCPCS C1713 326705S - SCREW BN 8MM 105MM STRL 25MM ASNS III ST SLF DRL CNN SS BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326710S SUP HCPCS C1713 326710S - SCREW BONE 8MM 110MM 25MM CANN SLFTAP SLFDRILL THREADED BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326715S SUP HCPCS C1713 326715S - SCREW BONE 8MM 115MM 25MM SELF TAP SELF DRILL CANN ASNIS III BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326720S SUP HCPCS C1713 326720S - SCREW BONE 8MM 120MM 25MM CANN SLFTAP SLFDRILL THREADED BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326725S SUP HCPCS C1713 326725S - SCREW BONE 8MM 125MM 25MM ASNIS III STAINLESS STEEL HIP BOTH IP/OP $437.00 $323.00 $86.71 $436.90 $196.61 $196.61 $196.61 $196.61 $436.90 $436.90 $436.90 $91.06 $436.90 $436.90 $436.90 $436.90 $436.90 $91.05 $436.90 $436.90 $258.43 $436.90 $436.90 $436.90 $436.90 $327.75 $436.90 $436.90 $436.90 $218.45 $218.45 $346.02 $436.90 $349.52 $196.61 $86.71 N/A $253.46 $436.90 $262.14 $436.90 $91.05 $436.90 N/A N/A 326730S SUP HCPCS C1713 326730S - SCREW BONE 8MM 135MM 25MM THREAD ASNIS III STAINLESS STEEL BOTH IP/OP $437.00 $323.00 $86.71 $436.90 $196.61 $196.61 $196.61 $196.61 $436.90 $436.90 $436.90 $91.06 $436.90 $436.90 $436.90 $436.90 $436.90 $91.05 $436.90 $174.76 $258.43 $436.90 $436.90 $436.90 $436.90 $327.75 $436.90 $436.90 $436.90 $218.45 $218.45 $346.02 $436.90 $349.52 $196.61 $86.71 N/A $253.46 $436.90 $262.14 $436.90 $91.05 $436.90 N/A N/A 326840S SUP HCPCS C1713 326840S - SCREW BONE FULTHD 8MM 40MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $385.00 $385.00 $80.23 $385.00 N/A N/A 326845S SUP HCPCS C1713 326845S - SCREW BONE FULTHD 8MM 45MM CANN SLFDRILL SLFTAP ASNIS III BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326850S SUP HCPCS C1713 326850S - SCREW BONE 8MM 50MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326855S SUP HCPCS C1713 326855S - SCREW BONE FULTHD 8MM 55MM CANN SLFDRILL SLFTAP ASNIS III BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326860S SUP HCPCS C1713 326860S - SCREW BONE FULTHD 8MM 60MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $385.00 $385.00 $80.23 $385.00 N/A N/A 326865S SUP HCPCS C1713 326865S - SCREW BONE 8MM 65MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $385.00 $385.00 $80.23 $385.00 N/A N/A 326870S SUP HCPCS C1713 326870S - SCREW BONE FULTHD 8MM 70MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326875S SUP HCPCS C1713 326875S - SCREW BONE FULTHD 8MM 75MM SLFTAP SLFDRILL CANN ASNIS III BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $385.00 $385.00 $80.23 $385.00 N/A N/A 326880S SUP HCPCS C1713 326880S - SCREW BONE FULTHD 8MM 80MM CANN SLFDRILL SLFTAP ASNIS III BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326885S SUP HCPCS C1713 326885S - SCREW BONE 8MM 85MM CANN PTHRD ASNIS III TITANIUM ORTHOPEDIC BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326890S SUP HCPCS C1713 326890S - SCREW BONE FULTHD LP FLUTE 8MM 90MM CANNU SELF DRILL REVERSE BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326895S SUP HCPCS C1713 326895S - SCREW BONE FULTHD 8MM 95MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $385.00 $385.00 $80.23 $385.00 N/A N/A 326900S SUP HCPCS C1713 326900S - SCREW BONE FULTHD 8MM 100MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $385.00 $385.00 $80.23 $385.00 N/A N/A 326905S SUP HCPCS C1713 326905S - SCREW BONE FULTHD 8MM 105MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326910S SUP HCPCS C1713 326910S - SCREW BONE FULTHD 8MM 110MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326915S SUP HCPCS C1713 326915S - SCREW BONE 8MM 115MM CANN ASNIS III STAINLESS STEEL HIP BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326920S SUP HCPCS C1713 326920S - SCREW BONE 8MM 120MM CANN PTHRD ASNIS III TITANIUM BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $173.25 $173.25 $173.25 $173.25 $385.00 $385.00 $385.00 $80.24 $385.00 $385.00 $385.00 $385.00 $385.00 $80.24 $385.00 $154.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $173.25 $76.41 N/A $223.30 $385.00 $231.00 $385.00 $80.23 $385.00 N/A N/A 326925S SUP HCPCS C1713 326925S - SCREW BONE FULTHRD 8MM 125MM ASNIS III STAINLESS STEEL BOTH IP/OP $385.50 $285.00 $76.51 $385.50 $173.48 $173.48 $173.48 $173.48 $385.50 $385.50 $385.50 $80.35 $385.50 $385.50 $385.50 $385.50 $385.50 $80.34 $385.50 $154.20 $228.02 $385.50 $385.50 $385.50 $385.50 $289.13 $385.50 $385.50 $385.50 $192.75 $192.75 $305.32 $385.50 $308.40 $173.48 $76.51 N/A $223.59 $385.50 $231.30 $385.50 $80.34 $385.50 N/A N/A 326930S SUP HCPCS C1713 326930S - SCREW BONE FULTHRD 8MM 130MM CANN ASNIS III STAINLESS STEEL BOTH IP/OP $385.50 $285.00 $76.51 $385.50 $173.48 $173.48 $173.48 $173.48 $385.50 $385.50 $385.50 $80.35 $385.50 $385.50 $385.50 $385.50 $385.50 $80.34 $385.50 $385.50 $228.02 $385.50 $385.50 $385.50 $385.50 $289.13 $385.50 $385.50 $385.50 $192.75 $192.75 $305.32 $385.50 $308.40 $173.48 $76.51 N/A $223.59 $385.50 $231.30 $385.50 $80.34 $385.50 N/A N/A 327-1010 SUP HCPCS C1713 327-1010 - SCREW BN 2.7MM 10MM ST CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 327-1012 SUP HCPCS C1713 327-1012 - SCREW BN 2.7MM 12MM ST CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 327-1014 SUP HCPCS C1713 327-1014 - SCREW BN 2.7MM 14MM ST CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 327-1016 SUP HCPCS C1713 327-1016 - SCREW BN 2.7MM 16MM ST CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 327-1018 SUP HCPCS C1713 327-1018 - SCREW BN 2.7MM 18MM ST CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 327-1020 SUP HCPCS C1713 327-1020 - SCREW BN 2.7MM 20MM ST CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 327-1022 SUP HCPCS C1713 327-1022 - SCREW BN 2.7MM 22MM ST CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 327-1024 SUP HCPCS C1713 327-1024 - SCREW BN 2.7MM 24MM ST CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 327-1026 SUP HCPCS C1713 327-1026 - SCREW BN 2.7MM 26MM ST CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 327-1028 SUP HCPCS C1713 327-1028 - SCREW BN 2.7MM 28MM ST CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 327-1030 SUP HCPCS C1713 327-1030 - SCREW BN 2.7MM 30MM ST CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 327-1032 SUP HCPCS C1713 327-1032 - SCREW BN 2.7MM 32MM ST CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 3300TFX19MM SUP Custom 27803010 3300TFX19MM - VALVE AOR LOPRFL 19MM CRP-ED PRIMNT MG EASE BPRTH THERMAFIX BOTH IP/OP "$22,275.00" "$16,484.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$4,642.36" "$22,275.00" "$8,910.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$16,706.25" "$22,275.00" "$22,275.00" "$22,275.00" "$11,137.50" "$11,137.50" "$17,641.80" "$22,275.00" "$17,820.00" "$10,023.75" "$22,275.00" N/A "$12,919.50" "$22,275.00" "$13,365.00" "$22,275.00" "$22,275.00" "$22,275.00" N/A N/A 3300TFX21MM SUP Custom 27803010 3300TFX21MM - VALVE AOR 21MM CRP-ED PRIMNT MG EASE THERMAFIX BPRTH STNT BS BOTH IP/OP "$22,275.00" "$16,484.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$4,642.36" "$22,275.00" "$8,910.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$16,706.25" "$22,275.00" "$22,275.00" "$22,275.00" "$11,137.50" "$11,137.50" "$17,641.80" "$22,275.00" "$17,820.00" "$10,023.75" "$22,275.00" N/A "$12,919.50" "$22,275.00" "$13,365.00" "$22,275.00" "$22,275.00" "$22,275.00" N/A N/A 3300TFX23MM SUP Custom 27803010 3300TFX23MM - VALVE AOR 23MM CRP-ED PRIMNT MG EASE THERMAFIX BPRTH STNT BS BOTH IP/OP "$22,275.00" "$16,484.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$4,642.36" "$22,275.00" "$8,910.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$16,706.25" "$22,275.00" "$22,275.00" "$22,275.00" "$11,137.50" "$11,137.50" "$17,641.80" "$22,275.00" "$17,820.00" "$10,023.75" "$22,275.00" N/A "$12,919.50" "$22,275.00" "$13,365.00" "$22,275.00" "$22,275.00" "$22,275.00" N/A N/A 3300TFX25MM SUP Custom 27803010 3300TFX25MM - VALVE AORTIC LP 25MM BIOPROSTHESIS THERMAFIX PROCESS STENT BOTH IP/OP "$22,275.00" "$16,484.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$4,642.36" "$22,275.00" "$8,910.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$16,706.25" "$22,275.00" "$22,275.00" "$22,275.00" "$11,137.50" "$11,137.50" "$17,641.80" "$22,275.00" "$17,820.00" "$10,023.75" "$22,275.00" N/A "$12,919.50" "$22,275.00" "$13,365.00" "$22,275.00" "$22,275.00" "$22,275.00" N/A N/A 3300TFX27MM SUP Custom 27803010 3300TFX27MM - VALVE AORTIC LP 27MM BIOPROSTHESIS THERMAFIX PROCESS STENT BOTH IP/OP "$22,275.00" "$16,484.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$4,642.36" "$22,275.00" "$8,910.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$16,706.25" "$22,275.00" "$22,275.00" "$22,275.00" "$11,137.50" "$11,137.50" "$17,641.80" "$22,275.00" "$17,820.00" "$10,023.75" "$22,275.00" N/A "$12,919.50" "$22,275.00" "$13,365.00" "$22,275.00" "$22,275.00" "$22,275.00" N/A N/A 3300TFX29MM SUP Custom 27803010 3300TFX29MM - VALVE AOR LOPRFL 29MM CRP-ED PRIMNT MG EASE BPRTH THERMAFIX BOTH IP/OP "$22,275.00" "$16,484.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$4,642.36" "$22,275.00" "$8,910.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$16,706.25" "$22,275.00" "$22,275.00" "$22,275.00" "$11,137.50" "$11,137.50" "$17,641.80" "$22,275.00" "$17,820.00" "$10,023.75" "$22,275.00" N/A "$12,919.50" "$22,275.00" "$13,365.00" "$22,275.00" "$22,275.00" "$22,275.00" N/A N/A 3304-G SUP Custom 27203010 3304-G - RING RTRCTR LNSTR NORYL RSN PLST CATH CLIP DISP STRL LATEX BOTH IP/OP $110.00 $81.00 $19.58 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $19.58 $110.00 $110.00 $81.64 $81.64 $84.79 $57.31 $22.93 $110.00 $44.00 $110.00 $110.00 $110.00 $110.00 $110.00 $82.50 $110.00 $110.00 $110.00 $55.00 $55.00 $87.12 $110.00 $88.00 $71.50 $110.00 N/A $63.80 $110.00 $66.00 $110.00 $110.00 $110.00 N/A N/A 3307G SUP Custom 27203010 3307G - RING RTRCTR 14.1X14.1CM STRL LF LNSTR 2 PEEL PCH SLFRET FLXB BOTH IP/OP $169.00 $125.00 $30.06 $180.73 $168.90 $168.90 $168.90 $168.90 $168.90 $168.90 $30.06 $168.90 $168.90 $125.36 $125.36 $130.19 $88.00 $35.20 $168.90 $72.29 $168.90 $168.90 $180.73 $168.90 $168.90 $126.75 $168.90 $168.90 $168.90 $84.45 $84.45 $133.77 $168.90 $135.12 $109.79 $168.90 N/A $98.02 $168.90 $101.34 $168.90 $168.90 $168.90 N/A N/A 3320-0240S SUP HCPCS C1713 3320-0240S - NAIL INTRAMEDULLARY 120D LONG 11MM 240MM GAMMA3 HIP LEFT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" "$2,447.50" "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$2,447.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3320-0260S SUP HCPCS C1713 3320-0260S - NAIL INTRAMEDULLARY 120D LONG 11MM 260MM GAMMA3 HIP LEFT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" "$2,447.50" "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$2,447.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3320-0280S SUP HCPCS C1713 3320-0280S - NAIL INTRAMEDULLARY 120D LONG 11MM 28CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$2,798.50" "$2,071.00" $555.36 "$2,798.13" "$1,259.16" "$1,259.16" "$1,259.16" "$1,259.16" "$2,798.13" "$2,798.13" "$2,798.13" $583.20 "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.16 "$2,798.13" "$1,119.25" "$1,379.48" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,098.88" "$2,798.13" "$2,798.13" "$2,798.13" "$1,399.07" "$1,399.07" "$2,216.12" "$2,798.13" "$2,238.50" "$1,259.16" $555.36 N/A "$1,623.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.13 "$2,798.13" N/A N/A 3320-0300S SUP HCPCS C1713 3320-0300S - NAIL INTRAMEDULLARY 120D LONG 11MM 30CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3320-0320S SUP HCPCS C1713 3320-0320S - NAIL INTRAMEDULLARY 120D LONG 11MM 32CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3320-0340S SUP HCPCS C1713 3320-0340S - NAIL INTRAMEDULLARY 120D LONG 11MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3320-0360S SUP HCPCS C1713 3320-0360S - NAIL INTRAMEDULLARY 120D LONG 11MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3320-0380S SUP HCPCS C1713 3320-0380S - NAIL INTRAMEDULLARY 120D LONG 11MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3320-0400S SUP HCPCS C1713 3320-0400S - NAIL INTRAMEDULLARY 120D R2 LONG 15.5-11MM 400MM KIT SET BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3320-0420S SUP HCPCS C1713 3320-0420S - NAIL INTRAMEDULLARY 120D LONG 11MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3320-0440S SUP HCPCS C1713 3320-0440S - NAIL INTRAMEDULLARY 120D LONG 11MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3320-0460S SUP HCPCS C1713 3320-0460S - NAIL INTRAMEDULLARY 120D LONG 11MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$2,798.50" "$2,071.00" $555.36 "$2,798.13" "$1,259.16" "$1,259.16" "$1,259.16" "$1,259.16" "$2,798.13" "$2,798.13" "$2,798.13" $583.20 "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.16 "$2,798.13" "$1,119.25" "$1,379.48" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,098.88" "$2,798.13" "$2,798.13" "$2,798.13" "$1,399.07" "$1,399.07" "$2,216.12" "$2,798.13" "$2,238.50" "$1,259.16" $555.36 N/A "$1,623.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.13 "$2,798.13" N/A N/A 3320-3340S SUP HCPCS C1713 3320-3340S - NAIL INTRAMEDULLARY 120D LONG 13MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3320-3360S SUP HCPCS C1713 3320-3360S - NAIL INTRAMEDULLARY 120D LONG 13MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3320-3380S SUP HCPCS C1713 3320-3380S - NAIL INTRAMEDULLARY 120D LONG 13MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3320-3400S SUP HCPCS C1713 3320-3400S - NAIL INTRAMEDULLARY 120D LONG 13MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3320-3420S SUP HCPCS C1713 3320-3420S - NAIL INTRAMEDULLARY 120D LONG 13MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3320-3440S SUP HCPCS C1713 3320-3440S - NAIL INTRAMEDULLARY 120D LONG 13MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3320-3460S SUP HCPCS C1713 3320-3460S - NAIL INTRAMEDULLARY 120D LONG 13MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3320-5340S SUP HCPCS C1713 3320-5340S - NAIL INTRAMEDULLARY 120D LONG 15MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3320-5360S SUP HCPCS C1713 3320-5360S - NAIL INTRAMEDULLARY 120D LONG 15MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3320-5380S SUP HCPCS C1713 3320-5380S - NAIL INTRAMEDULLARY 120D LONG 15MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3320-5400S SUP HCPCS C1713 3320-5400S - NAIL INTRAMEDULLARY 120D LONG 15MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3320-5420S SUP HCPCS C1713 3320-5420S - NAIL INTRAMEDULLARY 120D LONG 15MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$3,293.13" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3320-5440S SUP HCPCS C1713 3320-5440S - NAIL INTRAMEDULLARY 120D LONG 15MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3320-5460S SUP HCPCS C1713 3320-5460S - NAIL INTRAMEDULLARY 120D LONG 15MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3325-0240S SUP HCPCS C1713 3325-0240S - NAIL INTRAMEDULLARY 125D LONG 11MM 240MM GAMMA3 HIP LEFT BOTH IP/OP "$2,798.50" "$2,071.00" $555.36 "$2,798.13" "$1,259.16" "$1,259.16" "$1,259.16" "$1,259.16" "$2,798.13" "$2,798.13" "$2,798.13" $583.20 "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.16 "$2,798.13" "$2,798.13" "$1,379.48" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,098.88" "$2,798.13" "$2,798.13" "$2,798.13" "$1,399.07" "$1,399.07" "$2,216.12" "$2,798.13" "$2,238.50" "$1,259.16" $555.36 N/A "$1,623.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.13 "$2,798.13" N/A N/A 3325-0260S SUP HCPCS C1713 3325-0260S - NAIL INTRAMEDULLARY 125D LONG 11MM 260MM GAMMA3 HIP LEFT BOTH IP/OP "$2,688.50" "$1,989.00" $533.53 "$2,688.13" "$1,209.66" "$1,209.66" "$1,209.66" "$1,209.66" "$2,688.13" "$2,688.13" "$2,688.13" $560.27 "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" $560.24 "$2,688.13" "$1,075.25" "$1,325.25" "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" "$2,016.38" "$2,688.13" "$2,688.13" "$2,688.13" "$1,344.07" "$1,344.07" "$2,129.00" "$2,688.13" "$2,150.50" "$1,209.66" $533.53 N/A "$1,559.33" "$2,688.13" "$2,688.13" "$2,688.13" $560.21 "$2,688.13" N/A N/A 3325-0280S SUP HCPCS C1713 3325-0280S - NAIL INTRAMEDULLARY 125D LONG 11MM 28CM KIT GAMMA3 TITANIUM BOTH IP/OP "$2,798.50" "$2,071.00" $555.36 "$2,798.13" "$1,259.16" "$1,259.16" "$1,259.16" "$1,259.16" "$2,798.13" "$2,798.13" "$2,798.13" $583.20 "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.16 "$2,798.13" "$1,119.25" "$1,379.48" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,098.88" "$2,798.13" "$2,798.13" "$2,798.13" "$1,399.07" "$1,399.07" "$2,216.12" "$2,798.13" "$2,238.50" "$1,259.16" $555.36 N/A "$1,623.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.13 "$2,798.13" N/A N/A 3325-0300S SUP HCPCS C1713 3325-0300S - NAIL INTRAMEDULLARY 125D LONG 11MM 30CM KIT GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3325-0320S SUP HCPCS C1713 3325-0320S - NAIL INTRAMEDULLARY 125D LONG 11MM 32CM KIT GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3325-0340S SUP HCPCS C1713 3325-0340S - NAIL INTRAMEDULLARY 125D R2 11MM 34CM KIT GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3325-0360S SUP HCPCS C1713 3325-0360S - NAIL INTRAMEDULLARY 125D LONG 15.5-11MM 360MM KIT GAMMA3 BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3325-0380S SUP HCPCS C1713 3325-0380S - NAIL INTRAMEDULLARY 125D LONG 15.5-11MM 380MM KIT CANN GAMMA BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3325-0400S SUP HCPCS C1713 3325-0400S - NAIL INTRAMEDULLARY 125D LONG 15.5-11MM 400MM LOCKING KIT BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3325-0420S SUP HCPCS C1713 3325-0420S - NAIL INTRAMEDULLARY 125D R2 LONG 15.5-11MM 420MM KIT SET BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3325-0440S SUP HCPCS C1713 3325-0440S - NAIL INTRAMEDULLARY 125D R2 LONG 15.5MM 11MM 44CM GAMMA3 BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3325-0460S SUP HCPCS C1713 3325-0460S - NAIL INTRAMEDULLARY 125D LONG 11MM 46CM KIT GAMMA3 TITANIUM BOTH IP/OP "$2,798.50" "$2,071.00" $555.36 "$2,798.13" "$1,259.16" "$1,259.16" "$1,259.16" "$1,259.16" "$2,798.13" "$2,798.13" "$2,798.13" $583.20 "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.16 "$2,798.13" "$1,119.25" "$1,379.48" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,098.88" "$2,798.13" "$2,798.13" "$2,798.13" "$1,399.07" "$1,399.07" "$2,216.12" "$2,798.13" "$2,238.50" "$1,259.16" $555.36 N/A "$1,623.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.13 "$2,798.13" N/A N/A 3325-3280S SUP HCPCS C1713 3325-3280S - NAIL INTRAMEDULLARY 125D LONG 13MM 280MM GAMMA3 HIP LEFT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" $979.00 "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$2,447.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3325-3300S SUP HCPCS C1713 3325-3300S - NAIL INTRAMEDULLARY 125D LONG 13MM 30CM GAMMA3 TITANIUM HIP BOTH IP/OP "$2,688.50" "$1,989.00" $533.53 "$2,688.13" "$1,209.66" "$1,209.66" "$1,209.66" "$1,209.66" "$2,688.13" "$2,688.13" "$2,688.13" $560.27 "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" $560.24 "$2,688.13" "$1,075.25" "$1,325.25" "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" "$2,016.38" "$2,688.13" "$2,688.13" "$2,688.13" "$1,344.07" "$1,344.07" "$2,129.00" "$2,688.13" "$2,150.50" "$1,209.66" $533.53 N/A "$1,559.33" "$2,688.13" "$2,688.13" "$2,688.13" $560.21 "$2,688.13" N/A N/A 3325-3320S SUP HCPCS C1713 3325-3320S - NAIL INTRAMEDULLARY 125D LONG 13MM 32CM GAMMA3 HIP LEFT BOTH IP/OP "$2,688.50" "$1,989.00" $533.53 "$2,688.13" "$1,209.66" "$1,209.66" "$1,209.66" "$1,209.66" "$2,688.13" "$2,688.13" "$2,688.13" $560.27 "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" $560.24 "$2,688.13" "$1,075.25" "$1,325.25" "$2,688.13" "$2,688.13" "$2,688.13" "$2,688.13" "$2,016.38" "$2,688.13" "$2,688.13" "$2,688.13" "$1,344.07" "$1,344.07" "$2,129.00" "$2,688.13" "$2,150.50" "$1,209.66" $533.53 N/A "$1,559.33" "$2,688.13" "$2,688.13" "$2,688.13" $560.21 "$2,688.13" N/A N/A 3325-3340S SUP HCPCS C1713 3325-3340S - NAIL INTRAMEDULLARY 125D LONG 13MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3325-3360S SUP HCPCS C1713 3325-3360S - NAIL INTRAMEDULLARY 125D LONG 13MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3325-3380S SUP HCPCS C1713 3325-3380S - NAIL INTRAMEDULLARY 125D LONG 13MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3325-3400S SUP HCPCS C1713 3325-3400S - NAIL INTRAMEDULLARY 125D LONG 13MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3325-3420S SUP HCPCS C1713 3325-3420S - NAIL INTRAMEDULLARY 125D LONG 13MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3325-3440S SUP HCPCS C1713 3325-3440S - NAIL INTRAMEDULLARY 125D LONG 13MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$3,293.13" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3325-3460S SUP HCPCS C1713 3325-3460S - NAIL INTRAMEDULLARY 125D LONG 13MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3325-5280S SUP HCPCS C1713 3325-5280S - NAIL INTRAMEDULLARY 125D LONG 15MM 280MM GAMMA3 HIP LEFT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" "$2,447.50" "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$2,447.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3325-5300S SUP HCPCS C1713 3325-5300S - NAIL INTRAMEDULLARY 125D LONG 15MM 300MM GAMMA3 HIP LEFT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" "$2,447.50" "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$2,447.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3325-5320S SUP HCPCS C1713 3325-5320S - NAIL INTRAMEDULLARY 125D LONG 15MM 320MM GAMMA3 HIP LEFT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" "$2,447.50" "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$2,447.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3325-5340S SUP HCPCS C1713 3325-5340S - NAIL INTRAMEDULLARY 125D LONG 15MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3325-5360S SUP HCPCS C1713 3325-5360S - NAIL INTRAMEDULLARY 125D LONG 15MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3325-5380S SUP HCPCS C1713 3325-5380S - NAIL INTRAMEDULLARY 125D LONG 15MM 38CM KIT GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3325-5400S SUP HCPCS C1713 3325-5400S - NAIL INTRAMEDULLARY 125D LONG 15MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3325-5420S SUP HCPCS C1713 3325-5420S - NAIL INTRAMEDULLARY 125D LONG 15MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3325-5440S SUP HCPCS C1713 3325-5440S - NAIL INTRAMEDULLARY 125D LONG 15MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3325-5460S SUP HCPCS C1713 3325-5460S - NAIL INTRAMEDULLARY 125D LONG 15MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$3,293.13" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3330-0240S SUP HCPCS C1713 3330-0240S - NAIL INTRAMEDULLARY 130D LONG 11MM 240MM GAMMA3 HIP LEFT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" $979.00 "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$2,447.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3330-0260S SUP HCPCS C1713 3330-0260S - NAIL INTRAMEDULLARY 130D LONG 11MM 260MM GAMMA3 HIP LEFT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" $979.00 "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$2,447.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3330-0280S SUP HCPCS C1713 3330-0280S - NAIL INTRAMEDULLARY 130D LONG 11MM 28CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$2,798.50" "$2,071.00" $555.36 "$2,798.13" "$1,259.16" "$1,259.16" "$1,259.16" "$1,259.16" "$2,798.13" "$2,798.13" "$2,798.13" $583.20 "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.16 "$2,798.13" "$1,119.25" "$1,379.48" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,098.88" "$2,798.13" "$2,798.13" "$2,798.13" "$1,399.07" "$1,399.07" "$2,216.12" "$2,798.13" "$2,238.50" "$1,259.16" $555.36 N/A "$1,623.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.13 "$2,798.13" N/A N/A 3330-0300S SUP HCPCS C1713 3330-0300S - NAIL INTRAMEDULLARY 130D LONG 11MM 30CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$1,237.50" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3330-0320S SUP HCPCS C1713 3330-0320S - NAIL INTRAMEDULLARY 130D LONG 15.5-11MM 320MM LOCKING KIT BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3330-0340S SUP HCPCS C1713 3330-0340S - NAIL INTRAMEDULLARY 130D LONG 15.5-11MM 340MM LOCKING KIT BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3330-0360S SUP HCPCS C1713 3330-0360S - NAIL INTRAMEDULLARY 130D LONG 15.5-11MM 360MM LOCKING KIT BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3330-0380S SUP HCPCS C1713 3330-0380S - NAIL INTRAMEDULLARY 130D LONG 15.5-11MM 380MM LOCKING KIT BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3330-0400S SUP HCPCS C1713 3330-0400S - NAIL INTRAMEDULLARY 130D LONG 15.5-11MM 400MM LOCKING KIT BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$3,093.75" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3330-0420S SUP HCPCS C1713 3330-0420S - NAIL INTRAMEDULLARY 130D LONG 11MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3330-0440S SUP HCPCS C1713 3330-0440S - NAIL INTRAMEDULLARY 130D LONG 11MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,094.00" "$2,290.00" $614.03 "$3,093.75" "$1,392.19" "$1,392.19" "$1,392.19" "$1,392.19" "$3,093.75" "$3,093.75" "$3,093.75" $644.81 "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" $644.77 "$3,093.75" "$3,093.75" "$1,525.22" "$3,093.75" "$3,093.75" "$3,093.75" "$3,093.75" "$2,320.50" "$3,093.75" "$3,093.75" "$3,093.75" "$1,546.88" "$1,546.88" "$2,450.25" "$3,093.75" "$2,475.00" "$1,392.19" $614.03 N/A "$1,794.52" "$3,093.75" "$1,856.25" "$3,093.75" $644.74 "$3,093.75" N/A N/A 3330-0460S SUP HCPCS C1713 3330-0460S - NAIL INTRAMEDULLARY 130D LONG 11MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$2,798.50" "$2,071.00" $555.36 "$2,798.13" "$1,259.16" "$1,259.16" "$1,259.16" "$1,259.16" "$2,798.13" "$2,798.13" "$2,798.13" $583.20 "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" $583.16 "$2,798.13" "$2,798.13" "$1,379.48" "$2,798.13" "$2,798.13" "$2,798.13" "$2,798.13" "$2,098.88" "$2,798.13" "$2,798.13" "$2,798.13" "$1,399.07" "$1,399.07" "$2,216.12" "$2,798.13" "$2,238.50" "$1,259.16" $555.36 N/A "$1,623.13" "$2,798.13" "$1,678.88" "$2,798.13" $583.13 "$2,798.13" N/A N/A 3330-3300S SUP HCPCS C1713 3330-3300S - NAIL INTRAMEDULLARY 130D LONG 13MM 300MM GAMMA3 HIP LEFT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" $979.00 "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$2,447.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3330-3320S SUP HCPCS C1713 3330-3320S - NAIL INTRAMEDULLARY 125D LONG 13MM 280MM GAMMA3 HIP LEFT BOTH IP/OP "$2,447.50" "$1,811.00" $485.77 "$2,447.50" "$1,101.38" "$1,101.38" "$1,101.38" "$1,101.38" "$2,447.50" "$2,447.50" "$2,447.50" $510.12 "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" $510.09 "$2,447.50" $979.00 "$1,447.70" "$2,447.50" "$2,447.50" "$2,447.50" "$2,447.50" "$1,835.63" "$2,447.50" "$2,447.50" "$2,447.50" "$1,223.75" "$1,223.75" "$1,938.42" "$2,447.50" "$1,958.00" "$1,101.38" $485.77 N/A "$1,419.55" "$2,447.50" "$2,447.50" "$2,447.50" $510.06 "$2,447.50" N/A N/A 3330-3340S SUP HCPCS C1713 3330-3340S - NAIL INTRAMEDULLARY 130D LONG 13MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3330-3360S SUP HCPCS C1713 3330-3360S - NAIL INTRAMEDULLARY 130D LONG 13MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3330-3380S SUP HCPCS C1713 3330-3380S - NAIL INTRAMEDULLARY 130D LONG 13MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3330-3400S SUP HCPCS C1713 3330-3400S - NAIL INTRAMEDULLARY 130D LONG 13MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3330-3420S SUP HCPCS C1713 3330-3420S - NAIL INTRAMEDULLARY 130D LONG 13MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3330-3440S SUP HCPCS C1713 3330-3440S - NAIL INTRAMEDULLARY 130D LONG 13MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3330-3460S SUP HCPCS C1713 3330-3460S - NAIL INTRAMEDULLARY 130D LONG 13MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$3,293.13" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3330-5340S SUP HCPCS C1713 3330-5340S - NAIL INTRAMEDULLARY 130D LONG 15MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3330-5360S SUP HCPCS C1713 3330-5360S - NAIL INTRAMEDULLARY 130D LONG 15MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$1,317.25" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3330-5380S SUP HCPCS C1713 3330-5380S - NAIL INTRAMEDULLARY 130D LONG 15MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3330-5400S SUP HCPCS C1713 3330-5400S - NAIL INTRAMEDULLARY 130D LONG 15MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3330-5420S SUP HCPCS C1713 3330-5420S - NAIL INTRAMEDULLARY 130D LONG 15MM 42CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3330-5440S SUP HCPCS C1713 3330-5440S - NAIL INTRAMEDULLARY 130D LONG 15MM 44CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 3330-5460S SUP HCPCS C1713 3330-5460S - NAIL INTRAMEDULLARY 130D LONG 15MM 46CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,293.50" "$2,437.00" $653.60 "$3,293.13" "$1,481.91" "$1,481.91" "$1,481.91" "$1,481.91" "$3,293.13" "$3,293.13" "$3,293.13" $686.37 "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" $686.32 "$3,293.13" "$3,293.13" "$1,623.51" "$3,293.13" "$3,293.13" "$3,293.13" "$3,293.13" "$2,470.13" "$3,293.13" "$3,293.13" "$3,293.13" "$1,646.57" "$1,646.57" "$2,608.16" "$3,293.13" "$2,634.50" "$1,481.91" $653.60 N/A "$1,910.23" "$3,293.13" "$1,975.88" "$3,293.13" $686.29 "$3,293.13" N/A N/A 333-070-003 SUP Custom 27203010 333-070-003 - OBTURATOR ENDSCP 70MM DRAIN CANNU BOTH IP/OP $203.50 $151.00 $36.14 $203.06 $203.06 $203.06 $203.06 $203.06 $203.06 $203.06 $36.14 $203.06 $203.06 $150.71 $150.71 $156.52 $105.79 $42.32 $203.06 $81.22 $203.06 $203.06 $203.06 $203.06 $203.06 $152.63 $203.06 $203.06 $203.06 $101.53 $101.53 $160.82 $203.06 $162.45 $131.99 $203.06 N/A $118.03 $203.06 $121.84 $203.06 $203.06 $203.06 N/A N/A 335-1012 SUP HCPCS C1713 335-1012 - SCREW BN 3.5MM 12MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1014 SUP HCPCS C1713 335-1014 - SCREW BN 3.5MM 14MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1016 SUP HCPCS C1713 335-1016 - SCREW BN 3.5MM 16MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1018 SUP HCPCS C1713 335-1018 - SCREW BN 3.5MM 18MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1020 SUP HCPCS C1713 335-1020 - SCREW BN 3.5MM 20MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1022 SUP HCPCS C1713 335-1022 - SCREW BN 3.5MM 22MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1024 SUP HCPCS C1713 335-1024 - SCREW BN 3.5MM 24MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1026 SUP HCPCS C1713 335-1026 - SCREW BN 3.5MM 26MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1028 SUP HCPCS C1713 335-1028 - SCREW BN 3.5MM 28MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1030 SUP HCPCS C1713 335-1030 - SCREW BN 3.5MM 30MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1032 SUP HCPCS C1713 335-1032 - SCREW BN 3.5MM 32MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1034 SUP HCPCS C1713 335-1034 - SCREW BN 3.5MM 34MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1036 SUP HCPCS C1713 335-1036 - SCREW BN 3.5MM 36MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1038 SUP HCPCS C1713 335-1038 - SCREW BN 3.5MM 38MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1040 SUP HCPCS C1713 335-1040 - SCREW BN 3.5MM 40MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1042 SUP HCPCS C1713 335-1042 - SCREW BN 3.5MM 42MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1044 SUP HCPCS C1713 335-1044 - SCREW BN 3.5MM 44MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1046 SUP HCPCS C1713 335-1046 - SCREW BN 3.5MM 46MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1048 SUP HCPCS C1713 335-1048 - SCREW BN 3.5MM 48MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1050 SUP HCPCS C1713 335-1050 - SCREW BN 3.5MM 50MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1055 SUP HCPCS C1713 335-1055 - SCREW BN 3.5MM 55MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 335-1060 SUP HCPCS C1713 335-1060 - SCREW BN 3.5MM 60MM NS ST SS CORT BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $167.50 $167.50 $34.91 $167.50 N/A N/A 3362-0-304 SUP HCPCS C1713 3362-0-304 - SIDEPLATE BONE 130D SHORT BARREL 4 HOLE COMPRESSION OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-0-305 SUP HCPCS C1713 3362-0-305 - SIDEPLATE BONE 130D SHORT BARREL 5 HOLE COMPRESSION OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-0-354 SUP HCPCS C1713 3362-0-354 - SIDEPLATE BONE 135D SHORT BARREL 4 HOLE COMPRESSION OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-0-355 SUP HCPCS C1713 3362-0-355 - SIDEPLATE BONE 135D SHORT BARREL 5 HOLE COMPRESSION OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-0-404 SUP HCPCS C1713 3362-0-404 - SIDEPLATE BONE 140D SHORT BARREL 4 HOLE COMPRESSION OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-0-405 SUP HCPCS C1713 3362-0-405 - SIDEPLATE BONE 140D SHORT BARREL 5 HOLE COMPRESSION OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-0-454 SUP HCPCS C1713 3362-0-454 - SIDEPLATE BONE 145D SHORT BARREL 4 HOLE COMPRESSION OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-0-455 SUP HCPCS C1713 3362-0-455 - SIDEPLATE BONE 145D SHORT BARREL 5 HOLE COMPRESSION OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-0-504 SUP HCPCS C1713 3362-0-504 - SIDEPLATE BONE 150D SHORT BARREL 4 HOLE COMPRESSION OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-0-505 SUP HCPCS C1713 3362-0-505 - SIDEPLATE BONE 150D SHORT BARREL 5 HOLE COMPRESSION OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-002 SUP HCPCS C1713 3362-1-002 - SIDEPLATE BONE 130D STANDARD BARREL 2 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-003 SUP HCPCS C1713 3362-1-003 - SIDEPLATE BONE 130D STANDARD BARREL 3 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $859.38 $859.38 $859.38 $859.38 N/A N/A 3362-1-004 SUP HCPCS C1713 3362-1-004 - SIDEPLATE BONE 130D STANDARD BARREL 4 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-1-005 SUP HCPCS C1713 3362-1-005 - SIDEPLATE BONE 130D STANDARD BARREL 5 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-006 SUP HCPCS C1713 3362-1-006 - SIDEPLATE BONE 130D STANDARD BARREL 6 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-1-008 SUP HCPCS C1713 3362-1-008 - SIDEPLATE BONE 130D STANDARD BARREL 8 HOLE COMPRESSION BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" "$1,058.75" "$1,058.75" N/A N/A 3362-1-010 SUP HCPCS C1713 3362-1-010 - SIDEPLATE BONE 130D STANDARD BARREL 10 HOLE COMPRESSION BOTH IP/OP "$1,055.00" $781.00 $209.32 "$1,054.63" $474.58 $474.58 $474.58 $474.58 "$1,054.63" "$1,054.63" "$1,054.63" $219.81 "$1,054.63" "$1,054.63" "$1,054.63" "$1,054.63" "$1,054.63" $219.80 "$1,054.63" "$1,054.63" $623.81 "$1,054.63" "$1,054.63" "$1,054.63" "$1,054.63" $791.25 "$1,054.63" "$1,054.63" "$1,054.63" $527.32 $527.32 $835.27 "$1,054.63" $843.70 $474.58 $209.32 N/A $611.90 "$1,054.63" $632.78 "$1,054.63" $219.78 "$1,054.63" N/A N/A 3362-1-012 SUP HCPCS C1713 3362-1-012 - SIDEPLATE BONE 130D STANDARD BARREL 12 HOLE COMPRESSION BOTH IP/OP "$1,055.00" $781.00 $209.32 "$1,054.63" $474.58 $474.58 $474.58 $474.58 "$1,054.63" "$1,054.63" "$1,054.63" $219.81 "$1,054.63" "$1,054.63" "$1,054.63" "$1,054.63" "$1,054.63" $219.80 "$1,054.63" $421.85 $623.81 "$1,054.63" "$1,054.63" "$1,054.63" "$1,054.63" $791.25 "$1,054.63" "$1,054.63" "$1,054.63" $527.32 $527.32 $835.27 "$1,054.63" $843.70 $474.58 $209.32 N/A $611.90 "$1,054.63" $632.78 "$1,054.63" $219.78 "$1,054.63" N/A N/A 3362-1-102 SUP HCPCS C1713 3362-1-102 - SIDEPLATE BONE 135D 135MM 2 SLOT BARREL OMEGA+ HIP BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-103 SUP HCPCS C1713 3362-1-103 - SIDEPLATE BONE 135D STANDARD BARREL 3 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-104 SUP HCPCS C1713 3362-1-104 - SIDEPLATE BONE 135D 4 HOLE OMEGA+ STAINLESS STEEL HIP BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-105 SUP HCPCS C1713 3362-1-105 - SIDEPLATE BONE 135D STANDARD BARREL 5 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-106 SUP HCPCS C1713 3362-1-106 - SIDEPLATE BONE 135D STANDARD BARREL 6 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $859.38 $859.38 $179.09 $859.38 N/A N/A 3362-1-108 SUP HCPCS C1713 3362-1-108 - SIDEPLATE BONE 135D STANDARD BARREL 8 HOLE COMPRESSION BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" "$1,058.75" $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-1-110 SUP HCPCS C1713 3362-1-110 - SIDEPLATE BONE 135D STANDARD BARREL 10 HOLE COMPRESSION BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-1-112 SUP HCPCS C1713 3362-1-112 - SIDEPLATE BONE 135D STANDARD BARREL 12 HOLE COMPRESSION BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-1-202 SUP HCPCS C1713 3362-1-202 - SIDEPLATE BONE 140D STANDARD BARREL 2 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $859.38 $859.38 $859.38 $859.38 N/A N/A 3362-1-203 SUP HCPCS C1713 3362-1-203 - SIDEPLATE BONE 140D STANDARD BARREL 3 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-1-204 SUP HCPCS C1713 3362-1-204 - SIDEPLATE BONE 140D STANDARD BARREL 4 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-205 SUP HCPCS C1713 3362-1-205 - SIDEPLATE BONE 140D STANDARD BARREL 5 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-206 SUP HCPCS C1713 3362-1-206 - SIDEPLATE BONE 140D STANDARD BARREL 6 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-208 SUP HCPCS C1713 3362-1-208 - SIDEPLATE BONE 140D STANDARD BARREL 8 HOLE COMPRESSION BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" "$1,058.75" $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-1-210 SUP HCPCS C1713 3362-1-210 - SIDEPLATE BONE 140D STANDARD BARREL 10 HOLE COMPRESSION BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-1-212 SUP HCPCS C1713 3362-1-212 - SIDEPLATE BONE 140D STANDARD BARREL 12 HOLE COMPRESSION BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-1-302 SUP HCPCS C1713 3362-1-302 - SIDEPLATE BONE 145D STANDARD BARREL 2 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $859.38 $859.38 $179.09 $859.38 N/A N/A 3362-1-303 SUP HCPCS C1713 3362-1-303 - SIDEPLATE BONE 145D STANDARD BARREL 3 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-304 SUP HCPCS C1713 3362-1-304 - SIDEPLATE BONE 145D STANDARD BARREL 4 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-305 SUP HCPCS C1713 3362-1-305 - SIDEPLATE BONE 145D STANDARD BARREL 5 HOLE COMPRESSION BOTH IP/OP $857.00 $634.00 $170.02 $856.63 $385.48 $385.48 $385.48 $385.48 $856.63 $856.63 $856.63 $178.54 $856.63 $856.63 $856.63 $856.63 $856.63 $178.53 $856.63 $342.65 $506.70 $856.63 $856.63 $856.63 $856.63 $642.75 $856.63 $856.63 $856.63 $428.32 $428.32 $678.45 $856.63 $685.30 $385.48 $170.02 N/A $497.06 $856.63 $513.98 $856.63 $856.63 $856.63 N/A N/A 3362-1-306 SUP HCPCS C1713 3362-1-306 - SIDEPLATE BONE 145D STANDARD BARREL 6 HOLE COMPRESSION BOTH IP/OP $857.00 $634.00 $170.02 $856.63 $385.48 $385.48 $385.48 $385.48 $856.63 $856.63 $856.63 $178.54 $856.63 $856.63 $856.63 $856.63 $856.63 $178.53 $856.63 $342.65 $506.70 $856.63 $856.63 $856.63 $856.63 $642.75 $856.63 $856.63 $856.63 $428.32 $428.32 $678.45 $856.63 $685.30 $385.48 $170.02 N/A $497.06 $856.63 $513.98 $856.63 $178.52 $856.63 N/A N/A 3362-1-308 SUP HCPCS C1713 3362-1-308 - SIDEPLATE BONE 145D STANDARD BARREL 8 HOLE COMPRESSION BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" "$1,058.75" "$1,058.75" N/A N/A 3362-1-310 SUP HCPCS C1713 3362-1-310 - SIDEPLATE BONE 145D STANDARD BARREL 10 HOLE COMPRESSION BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" "$1,058.75" $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-1-312 SUP HCPCS C1713 3362-1-312 - SIDEPLATE BONE 145D STANDARD BARREL 12 HOLE COMPRESSION BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-1-402 SUP HCPCS C1713 3362-1-402 - SIDEPLATE BONE 150D STANDARD BARREL 2 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-403 SUP HCPCS C1713 3362-1-403 - SIDEPLATE BONE 150D STANDARD BARREL 3 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-404 SUP HCPCS C1713 3362-1-404 - SIDEPLATE BONE 150D STANDARD BARREL 4 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-1-405 SUP HCPCS C1713 3362-1-405 - SIDEPLATE BONE 150D STANDARD BARREL 5 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-1-406 SUP HCPCS C1713 3362-1-406 - SIDEPLATE BONE 150D STANDARD BARREL 6 HOLE COMPRESSION BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $859.38 $859.38 $859.38 $859.38 N/A N/A 3362-1-408 SUP HCPCS C1713 3362-1-408 - SIDEPLATE BONE 150D STANDARD BARREL 8 HOLE COMPRESSION BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" "$1,058.75" "$1,058.75" N/A N/A 3362-1-410 SUP HCPCS C1713 3362-1-410 - SIDEPLATE BONE 150D STANDARD BARREL 10 HOLE COMPRESSION BOTH IP/OP "$1,055.00" $781.00 $209.32 "$1,054.63" $474.58 $474.58 $474.58 $474.58 "$1,054.63" "$1,054.63" "$1,054.63" $219.81 "$1,054.63" "$1,054.63" "$1,054.63" "$1,054.63" "$1,054.63" $219.80 "$1,054.63" $421.85 $623.81 "$1,054.63" "$1,054.63" "$1,054.63" "$1,054.63" $791.25 "$1,054.63" "$1,054.63" "$1,054.63" $527.32 $527.32 $835.27 "$1,054.63" $843.70 $474.58 $209.32 N/A $611.90 "$1,054.63" $632.78 "$1,054.63" $219.78 "$1,054.63" N/A N/A 3362-1-412 SUP HCPCS C1713 3362-1-412 - SIDEPLATE BONE 150D STANDARD BARREL 12 HOLE COMPRESSION BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" "$1,058.75" "$1,058.75" N/A N/A 3362-3-002 SUP HCPCS C1713 3362-3-002 - PLATE BONE 130D STANDARD BARREL 2 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-3-003 SUP HCPCS C1713 3362-3-003 - PLATE BONE 130D STANDARD BARREL 3 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-3-004 SUP HCPCS C1713 3362-3-004 - PLATE BONE 130D STANDARD BARREL 4 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $859.38 $859.38 $859.38 $859.38 N/A N/A 3362-3-005 SUP HCPCS C1713 3362-3-005 - PLATE BONE 130D STANDARD BARREL 5 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $859.38 $859.38 $859.38 $859.38 N/A N/A 3362-3-006 SUP HCPCS C1713 3362-3-006 - PLATE BONE 130D STANDARD BARREL 6 HOLE KEYLESS OMEGA+ BOTH IP/OP $857.00 $634.00 $170.02 $856.63 $385.48 $385.48 $385.48 $385.48 $856.63 $856.63 $856.63 $178.54 $856.63 $856.63 $856.63 $856.63 $856.63 $178.53 $856.63 $342.65 $506.70 $856.63 $856.63 $856.63 $856.63 $642.75 $856.63 $856.63 $856.63 $428.32 $428.32 $678.45 $856.63 $685.30 $385.48 $170.02 N/A $497.06 $856.63 $513.98 $856.63 $178.52 $856.63 N/A N/A 3362-3-008 SUP HCPCS C1713 3362-3-008 - PLATE BONE 130D STANDARD BARREL 8 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-3-010 SUP HCPCS C1713 3362-3-010 - PLATE BONE 130D STANDARD BARREL 10 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-3-012 SUP HCPCS C1713 3362-3-012 - PLATE BONE 130D STANDARD BARREL 12 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-3-102 SUP HCPCS C1713 3362-3-102 - PLATE BONE 135D STANDARD BARREL 2 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-3-103 SUP HCPCS C1713 3362-3-103 - PLATE BONE 135D STANDARD BARREL 3 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-3-104 SUP HCPCS C1713 3362-3-104 - PLATE BONE 135D STANDARD BARREL 4 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $859.38 $859.38 $179.09 $859.38 N/A N/A 3362-3-105 SUP HCPCS C1713 3362-3-105 - PLATE BONE 135D STANDARD BARREL 5 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-3-106 SUP HCPCS C1713 3362-3-106 - PLATE BONE 135D STANDARD BARREL 6 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-3-108 SUP HCPCS C1713 3362-3-108 - PLATE BONE 135D STANDARD BARREL 8 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-3-110 SUP HCPCS C1713 3362-3-110 - PLATE BONE 135D STANDARD BARREL 10 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" "$1,058.75" $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" "$1,058.75" "$1,058.75" N/A N/A 3362-3-112 SUP HCPCS C1713 3362-3-112 - PLATE BONE 135D STANDARD BARREL 12 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" "$1,058.75" "$1,058.75" N/A N/A 3362-3-202 SUP HCPCS C1713 3362-3-202 - PLATE BONE 140D STANDARD BARREL 2 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-3-203 SUP HCPCS C1713 3362-3-203 - PLATE BONE 140D STANDARD BARREL 3 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-3-204 SUP HCPCS C1713 3362-3-204 - PLATE BONE 140D STANDARD BARREL 4 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-3-205 SUP HCPCS C1713 3362-3-205 - PLATE BONE 140D STANDARD BARREL 5 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $859.38 $859.38 $859.38 $859.38 N/A N/A 3362-3-206 SUP HCPCS C1713 3362-3-206 - PLATE BONE 140D STANDARD BARREL 6 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-3-208 SUP HCPCS C1713 3362-3-208 - PLATE BONE 140D STANDARD BARREL 8 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-3-210 SUP HCPCS C1713 3362-3-210 - PLATE BONE 140D STANDARD BARREL 10 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,055.00" $781.00 $209.32 "$1,054.63" $474.58 $474.58 $474.58 $474.58 "$1,054.63" "$1,054.63" "$1,054.63" $219.81 "$1,054.63" "$1,054.63" "$1,054.63" "$1,054.63" "$1,054.63" $219.80 "$1,054.63" $421.85 $623.81 "$1,054.63" "$1,054.63" "$1,054.63" "$1,054.63" $791.25 "$1,054.63" "$1,054.63" "$1,054.63" $527.32 $527.32 $835.27 "$1,054.63" $843.70 $474.58 $209.32 N/A $611.90 "$1,054.63" $632.78 "$1,054.63" $219.78 "$1,054.63" N/A N/A 3362-3-212 SUP HCPCS C1713 3362-3-212 - PLATE BONE 140D STANDARD BARREL 12 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-3-302 SUP HCPCS C1713 3362-3-302 - PLATE BONE 145D STANDARD BARREL 3 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-3-303 SUP HCPCS C1713 3362-3-303 - PLATE BONE 145D STANDARD BARREL 3 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-3-304 SUP HCPCS C1713 3362-3-304 - PLATE BONE 145D STANDARD BARREL 4 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-3-305 SUP HCPCS C1713 3362-3-305 - PLATE BONE 145D STANDARD BARREL 5 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-3-306 SUP HCPCS C1713 3362-3-306 - PLATE BONE 145D STANDARD BARREL 6 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-3-308 SUP HCPCS C1713 3362-3-308 - PLATE BONE 145D STANDARD BARREL 8 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-3-310 SUP HCPCS C1713 3362-3-310 - PLATE BONE 145D STANDARD BARREL 10 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-3-312 SUP HCPCS C1713 3362-3-312 - PLATE BONE 145D STANDARD BARREL 12 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-3-402 SUP HCPCS C1713 3362-3-402 - PLATE BONE 150D STANDARD BARREL 2 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-3-403 SUP HCPCS C1713 3362-3-403 - PLATE BONE 150D STANDARD BARREL 3 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-3-404 SUP HCPCS C1713 3362-3-404 - PLATE BONE 150D STANDARD BARREL 4 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $859.38 $859.38 $179.09 $859.38 N/A N/A 3362-3-405 SUP HCPCS C1713 3362-3-405 - PLATE BONE 150D STANDARD BARREL 5 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-3-406 SUP HCPCS C1713 3362-3-406 - PLATE BONE 150D STANDARD BARREL 6 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-3-408 SUP HCPCS C1713 3362-3-408 - PLATE BONE 150D STANDARD BARREL 8 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" $423.50 $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" "$1,058.75" "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-3-410 SUP HCPCS C1713 3362-3-410 - PLATE BONE 150D STANDARD BARREL 10 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" "$1,058.75" $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" $220.64 "$1,058.75" N/A N/A 3362-3-412 SUP HCPCS C1713 3362-3-412 - PLATE BONE 150D STANDARD BARREL 12 HOLE KEYLESS OMEGA+ BOTH IP/OP "$1,059.00" $784.00 $210.14 "$1,058.75" $476.44 $476.44 $476.44 $476.44 "$1,058.75" "$1,058.75" "$1,058.75" $220.67 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $220.66 "$1,058.75" "$1,058.75" $626.25 "$1,058.75" "$1,058.75" "$1,058.75" "$1,058.75" $794.25 "$1,058.75" "$1,058.75" "$1,058.75" $529.38 $529.38 $838.53 "$1,058.75" $847.00 $476.44 $210.14 N/A $614.22 "$1,058.75" $635.25 "$1,058.75" "$1,058.75" "$1,058.75" N/A N/A 3362-4-304 SUP HCPCS C1713 3362-4-304 - PLATE BONE 130D STANDARD BARREL 4 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-4-305 SUP HCPCS C1713 3362-4-305 - PLATE BONE 130D STANDARD BARREL 5 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-4-354 SUP HCPCS C1713 3362-4-354 - PLATE BONE 135D STANDARD BARREL 4 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $859.38 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-4-355 SUP HCPCS C1713 3362-4-355 - PLATE BONE 135D STANDARD BARREL 5 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-4-404 SUP HCPCS C1713 3362-4-404 - PLATE BONE 140D STANDARD BARREL 4 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $859.38 $859.38 $179.09 $859.38 N/A N/A 3362-4-405 SUP HCPCS C1713 3362-4-405 - PLATE BONE 140D STANDARD BARREL 5 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-4-454 SUP HCPCS C1713 3362-4-454 - PLATE BONE 145D STANDARD BARREL 4 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-4-455 SUP HCPCS C1713 3362-4-455 - PLATE BONE 145D STANDARD BARREL 5 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-4-504 SUP HCPCS C1713 3362-4-504 - PLATE BONE 150D STANDARD BARREL 4 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $859.38 $859.38 N/A N/A 3362-4-505 SUP HCPCS C1713 3362-4-505 - PLATE BONE 150D STANDARD BARREL 5 HOLE KEYLESS OMEGA+ BOTH IP/OP $859.50 $636.00 $170.57 $859.38 $386.72 $386.72 $386.72 $386.72 $859.38 $859.38 $859.38 $179.12 $859.38 $859.38 $859.38 $859.38 $859.38 $179.10 $859.38 $343.75 $508.32 $859.38 $859.38 $859.38 $859.38 $644.63 $859.38 $859.38 $859.38 $429.69 $429.69 $680.63 $859.38 $687.50 $386.72 $170.57 N/A $498.51 $859.38 $515.63 $859.38 $179.09 $859.38 N/A N/A 3362-5-050 SUP HCPCS C1713 3362-5-050 - SCREW BONE STANDARD 13MM 50MM LAG OMEGA+ STAINLESS STEEL HIP BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $186.56 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $279.84 $466.40 $97.20 $466.40 N/A N/A 3362-5-055 SUP HCPCS C1713 3362-5-055 - SCREW BONE STANDARD 13MM 55MM LAG OMEGA+ STAINLESS STEEL HIP BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $466.40 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $279.84 $466.40 $97.20 $466.40 N/A N/A 3362-5-060 SUP HCPCS C1713 3362-5-060 - SCREW BONE STANDARD 13MM 60MM 22MM LAG OMEGA3 STAINLESS BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $466.40 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $279.84 $466.40 $97.20 $466.40 N/A N/A 3362-5-065 SUP HCPCS C1713 3362-5-065 - SCREW BONE STANDARD 13MM 65MM 22MM LAG OMEGA3 STAINLESS BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $466.40 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $279.84 $466.40 $97.20 $466.40 N/A N/A 3362-5-070 SUP HCPCS C1713 3362-5-070 - SCREW BONE STANDARD 22MM 70MM 22MM LAG OMEGA3 STAINLESS BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $466.40 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $466.40 $466.40 $97.20 $466.40 N/A N/A 3362-5-075 SUP HCPCS C1713 3362-5-075 - SCREW BONE STANDARD 13MM 75MM 22MM LAG OMEGA3 STAINLESS BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $466.40 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $466.40 $466.40 $97.20 $466.40 N/A N/A 3362-5-080 SUP HCPCS C1713 3362-5-080 - SCREW BONE STANDARD 13MM 80MM 22MM LAG OMEGA3 STAINLESS BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $466.40 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $279.84 $466.40 $97.20 $466.40 N/A N/A 3362-5-085 SUP HCPCS C1713 3362-5-085 - SCREW BONE STANDARD 13MM 85MM 22MM LAG OMEGA3 STAINLESS BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $466.40 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $466.40 $466.40 $97.20 $466.40 N/A N/A 3362-5-090 SUP HCPCS C1713 3362-5-090 - SCREW BONE STANDARD 13MM 90MM 22MM LAG OMEGA3 STAINLESS BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $466.40 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $466.40 $466.40 $97.20 $466.40 N/A N/A 3362-5-095 SUP HCPCS C1713 3362-5-095 - SCREW BONE STANDARD 13MM 95MM 22MM LAG OMEGA3 STAINLESS BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $466.40 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $466.40 $466.40 $97.20 $466.40 N/A N/A 3362-5-100 SUP HCPCS C1713 3362-5-100 - SCREW BONE STANDARD 13MM 100MM 22MM LAG OMEGA3 STAINLESS BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $466.40 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $279.84 $466.40 $97.20 $466.40 N/A N/A 3362-5-105 SUP HCPCS C1713 3362-5-105 - SCREW BONE STANDARD 13MM 105MM 22MM LAG OMEGA3 STAINLESS BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $466.40 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $466.40 $466.40 $97.20 $466.40 N/A N/A 3362-5-110 SUP HCPCS C1713 3362-5-110 - SCREW BONE STANDARD 13MM 110MM 22MM LAG OMEGA3 STAINLESS BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $466.40 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $279.84 $466.40 $97.20 $466.40 N/A N/A 3362-5-115 SUP HCPCS C1713 3362-5-115 - SCREW BONE STANDARD 13MM 115MM 22MM LAG OMEGA3 STAINLESS BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $186.56 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $279.84 $466.40 $97.20 $466.40 N/A N/A 3362-5-120 SUP HCPCS C1713 3362-5-120 - SCREW BONE STANDARD 13MM 120MM LAG OMEGA+ STAINLESS STEEL BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $186.56 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $466.40 $466.40 $97.20 $466.40 N/A N/A 3362-5-125 SUP HCPCS C1713 3362-5-125 - SCREW BONE STANDARD 13MM 125MM LAG OMEGA+ STAINLESS STEEL BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $186.56 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $466.40 $466.40 $97.20 $466.40 N/A N/A 3362-5-130 SUP HCPCS C1713 3362-5-130 - SCREW BONE STANDARD 13MM 130MM LAG OMEGA+ STAINLESS STEEL BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $209.88 $209.88 $209.88 $209.88 $466.40 $466.40 $466.40 $97.21 $466.40 $466.40 $466.40 $466.40 $466.40 $97.20 $466.40 $466.40 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $209.88 $92.57 N/A $270.57 $466.40 $466.40 $466.40 $97.20 $466.40 N/A N/A 3362-6-055 SUP HCPCS C1713 3362-6-055 - SCREW BONE 55MM SUPLAG OMEGA+ STAINLESS STEEL HIP BOTH IP/OP $313.50 $232.00 $62.22 $313.50 $141.08 $141.08 $141.08 $141.08 $313.50 $313.50 $313.50 $65.34 $313.50 $313.50 $313.50 $313.50 $313.50 $65.34 $313.50 $125.40 $185.44 $313.50 $313.50 $313.50 $313.50 $235.13 $313.50 $313.50 $313.50 $156.75 $156.75 $248.29 $313.50 $250.80 $141.08 $62.22 N/A $181.83 $313.50 $188.10 $313.50 $65.33 $313.50 N/A N/A 3362-6-060 SUP HCPCS C1713 3362-6-060 - SCREW BONE 60MM SUPLAG OMEGA+ STAINLESS STEEL HIP BOTH IP/OP $230.00 $170.00 $45.58 $229.63 $103.33 $103.33 $103.33 $103.33 $229.63 $229.63 $229.63 $47.86 $229.63 $229.63 $229.63 $229.63 $229.63 $47.86 $229.63 $91.85 $135.83 $229.63 $229.63 $229.63 $229.63 $172.50 $229.63 $229.63 $229.63 $114.82 $114.82 $181.87 $229.63 $183.70 $103.33 $45.58 N/A $133.40 $229.63 $137.78 $229.63 $47.85 $229.63 N/A N/A 3362-6-070 SUP HCPCS C1713 3362-6-070 - SCREW BONE 70MM SUPLAG OMEGA+ STAINLESS STEEL HIP BOTH IP/OP $313.50 $232.00 $62.22 $313.50 $141.08 $141.08 $141.08 $141.08 $313.50 $313.50 $313.50 $65.34 $313.50 $313.50 $313.50 $313.50 $313.50 $65.34 $313.50 $125.40 $185.44 $313.50 $313.50 $313.50 $313.50 $235.13 $313.50 $313.50 $313.50 $156.75 $156.75 $248.29 $313.50 $250.80 $141.08 $62.22 N/A $181.83 $313.50 $188.10 $313.50 $65.33 $313.50 N/A N/A 3362-6-080 SUP HCPCS C1713 3362-6-080 - SCREW BONE 80MM SUPLAG OMEGA+ STAINLESS STEEL HIP BOTH IP/OP $280.50 $208.00 $55.67 $280.50 $126.23 $126.23 $126.23 $126.23 $280.50 $280.50 $280.50 $58.46 $280.50 $280.50 $280.50 $280.50 $280.50 $58.46 $280.50 $112.20 $165.92 $280.50 $280.50 $280.50 $280.50 $210.38 $280.50 $280.50 $280.50 $140.25 $140.25 $222.16 $280.50 $224.40 $126.23 $55.67 N/A $162.69 $280.50 $168.30 $280.50 $58.46 $280.50 N/A N/A 3362-6-090 SUP HCPCS C1713 3362-6-090 - SCREW BONE 90MM SUPLAG OMEGA+ STAINLESS STEEL HIP BOTH IP/OP $209.00 $155.00 $41.48 $209.00 $94.05 $94.05 $94.05 $94.05 $209.00 $209.00 $209.00 $43.56 $209.00 $209.00 $209.00 $209.00 $209.00 $43.56 $209.00 $209.00 $123.62 $209.00 $209.00 $209.00 $209.00 $156.75 $209.00 $209.00 $209.00 $104.50 $104.50 $165.53 $209.00 $167.20 $94.05 $41.48 N/A $121.22 $209.00 $125.40 $209.00 $43.56 $209.00 N/A N/A 3362-6-100 SUP HCPCS C1713 3362-6-100 - SCREW BONE 100MM SUPLAG OMEGA+ STAINLESS STEEL HIP BOTH IP/OP $345.50 $256.00 $68.50 $345.13 $155.31 $155.31 $155.31 $155.31 $345.13 $345.13 $345.13 $71.93 $345.13 $345.13 $345.13 $345.13 $345.13 $71.93 $345.13 $345.13 $204.14 $345.13 $345.13 $345.13 $345.13 $259.13 $345.13 $345.13 $345.13 $172.57 $172.57 $273.34 $345.13 $276.10 $155.31 $68.50 N/A $200.39 $345.13 $207.08 $345.13 $71.93 $345.13 N/A N/A 3362-6-105 SUP HCPCS C1713 3362-6-105 - SCREW BONE 105MM SUPLAG OMEGA+ STAINLESS STEEL HIP BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $121.00 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $181.50 $302.50 $63.04 $302.50 N/A N/A 3362-6-110 SUP HCPCS C1713 3362-6-110 - SCREW BONE 110MM SUPLAG OMEGA+ STAINLESS STEEL HIP BOTH IP/OP $378.50 $280.00 $75.05 $378.13 $170.16 $170.16 $170.16 $170.16 $378.13 $378.13 $378.13 $78.81 $378.13 $378.13 $378.13 $378.13 $378.13 $78.81 $378.13 $151.25 $223.66 $378.13 $378.13 $378.13 $378.13 $283.88 $378.13 $378.13 $378.13 $189.07 $189.07 $299.48 $378.13 $302.50 $170.16 $75.05 N/A $219.53 $378.13 $226.88 $378.13 $78.80 $378.13 N/A N/A 3362-6-115 SUP HCPCS C1713 3362-6-115 - SCREW BONE 115MM SUPLAG OMEGA+ STAINLESS STEEL HIP BOTH IP/OP $345.50 $256.00 $68.50 $345.13 $155.31 $155.31 $155.31 $155.31 $345.13 $345.13 $345.13 $71.93 $345.13 $345.13 $345.13 $345.13 $345.13 $71.93 $345.13 $138.05 $204.14 $345.13 $345.13 $345.13 $345.13 $259.13 $345.13 $345.13 $345.13 $172.57 $172.57 $273.34 $345.13 $276.10 $155.31 $68.50 N/A $200.39 $345.13 $345.13 $345.13 $71.93 $345.13 N/A N/A 3362-6-120 SUP HCPCS C1713 3362-6-120 - SCREW BONE 120MM SUPLAG OMEGA+ STAINLESS STEEL HIP BOTH IP/OP $313.50 $232.00 $62.22 $313.50 $141.08 $141.08 $141.08 $141.08 $313.50 $313.50 $313.50 $65.34 $313.50 $313.50 $313.50 $313.50 $313.50 $65.34 $313.50 $125.40 $185.44 $313.50 $313.50 $313.50 $313.50 $235.13 $313.50 $313.50 $313.50 $156.75 $156.75 $248.29 $313.50 $250.80 $141.08 $62.22 N/A $181.83 $313.50 $188.10 $313.50 $65.33 $313.50 N/A N/A 3362-6-130 SUP HCPCS C1713 3362-6-130 - SCREW BONE 130MM SUPLAG OMEGA+ STAINLESS STEEL HIP BOTH IP/OP $313.50 $232.00 $62.22 $313.50 $141.08 $141.08 $141.08 $141.08 $313.50 $313.50 $313.50 $65.34 $313.50 $313.50 $313.50 $313.50 $313.50 $65.34 $313.50 $125.40 $185.44 $313.50 $313.50 $313.50 $313.50 $235.13 $313.50 $313.50 $313.50 $156.75 $156.75 $248.29 $313.50 $250.80 $141.08 $62.22 N/A $181.83 $313.50 $313.50 $313.50 $65.33 $313.50 N/A N/A 3363-0-354 SUP HCPCS C1713 3363-0-354 - PLATE BONE 135D 25MM 4 HOLE COMPRESSION OMEGA+ STAINLESS BOTH IP/OP $564.00 $417.00 $111.89 $563.75 $253.69 $253.69 $253.69 $253.69 $563.75 $563.75 $563.75 $117.50 $563.75 $563.75 $563.75 $563.75 $563.75 $117.49 $563.75 $563.75 $333.46 $563.75 $563.75 $563.75 $563.75 $423.00 $563.75 $563.75 $563.75 $281.88 $281.88 $446.49 $563.75 $451.00 $253.69 $111.89 N/A $327.12 $563.75 $338.25 $563.75 $117.49 $563.75 N/A N/A 3363-1-203 SUP HCPCS C1713 3363-1-203 - PLATE BONE 140D 3 HOLE COMPRESSION OMEGA+ STAINLESS STEEL BOTH IP/OP $502.00 $371.00 $99.61 $501.88 $225.85 $225.85 $225.85 $225.85 $501.88 $501.88 $501.88 $104.60 $501.88 $501.88 $501.88 $501.88 $501.88 $104.60 $501.88 $200.75 $296.86 $501.88 $501.88 $501.88 $501.88 $376.50 $501.88 $501.88 $501.88 $250.94 $250.94 $397.49 $501.88 $401.50 $225.85 $99.61 N/A $291.16 $501.88 $301.13 $501.88 $104.59 $501.88 N/A N/A 3363-1-303 SUP HCPCS C1713 3363-1-303 - PLATE BONE 145D 3 HOLE COMPRESSION OMEGA+ STAINLESS STEEL BOTH IP/OP $529.50 $392.00 $105.07 $529.38 $238.22 $238.22 $238.22 $238.22 $529.38 $529.38 $529.38 $110.34 $529.38 $529.38 $529.38 $529.38 $529.38 $110.33 $529.38 $211.75 $313.13 $529.38 $529.38 $529.38 $529.38 $397.13 $529.38 $529.38 $529.38 $264.69 $264.69 $419.27 $529.38 $423.50 $238.22 $105.07 N/A $307.11 $529.38 $317.63 $529.38 $110.32 $529.38 N/A N/A 3363-1-403 SUP HCPCS C1713 3363-1-403 - PLATE BONE 150D 3 HOLE COMPRESSION OMEGA+ STAINLESS STEEL BOTH IP/OP $502.00 $371.00 $99.61 $501.88 $225.85 $225.85 $225.85 $225.85 $501.88 $501.88 $501.88 $104.60 $501.88 $501.88 $501.88 $501.88 $501.88 $104.60 $501.88 $501.88 $296.86 $501.88 $501.88 $501.88 $501.88 $376.50 $501.88 $501.88 $501.88 $250.94 $250.94 $397.49 $501.88 $401.50 $225.85 $99.61 N/A $291.16 $501.88 $301.13 $501.88 $104.59 $501.88 N/A N/A 3363-5-085 SUP HCPCS C1713 3363-5-085 - SCREW BONE 85MM LAG OMEGA+ HIP NONSTRL BOTH IP/OP $488.50 $361.00 $96.88 $488.13 $219.66 $219.66 $219.66 $219.66 $488.13 $488.13 $488.13 $101.74 $488.13 $488.13 $488.13 $488.13 $488.13 $101.73 $488.13 $195.25 $288.73 $488.13 $488.13 $488.13 $488.13 $366.38 $488.13 $488.13 $488.13 $244.07 $244.07 $386.60 $488.13 $390.50 $219.66 $96.88 N/A $283.33 $488.13 $292.88 $488.13 $101.73 $488.13 N/A N/A 3363-7-000 SUP HCPCS C1713 3363-7-000 - SCREW BONE COMPRESSION OMEGA+ STAINLESS STEEL HIP NONSTRL BOTH IP/OP $52.50 $39.00 $10.37 $52.25 $23.51 $23.51 $23.51 $23.51 $52.25 $52.25 $52.25 $10.89 $52.25 $52.25 $52.25 $52.25 $52.25 $10.89 $52.25 $20.90 $30.91 $52.25 $52.25 $52.25 $52.25 $39.38 $52.25 $52.25 $52.25 $26.13 $26.13 $41.38 $52.25 $41.80 $23.51 $10.37 N/A $30.45 $52.25 $31.35 $52.25 $10.89 $52.25 N/A N/A 33661200MR SUP HCPCS C1713 33661200MR - CAP LOCKING LARGE ROUND 12MM SPN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A 33661200SR SUP HCPCS C1713 33661200SR - CAP LOCKING SMALL ROUND 12MM SPN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A 33661205MR SUP HCPCS C1713 33661205MR - ENDCAP SPINAL 5D LARGE ROUND 12MM MODULAR VBOSS BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A 33661205SR SUP Custom 27803010 33661205SR - ENDCAP SPINAL 5D SMALL ROUND 12MM MODULAR VBOSS BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33661400MR SUP Custom 27803010 33661400MR - ENDCAP SPINAL 0D LARGE ROUND 14MM MODULAR VBOSS BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33661400SR SUP Custom 27803010 33661400SR - ENDCAP SPINAL 0D SMALL ROUND 14MM MODULAR VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33661405MR SUP Custom 27803010 33661405MR - ENDCAP SPINAL 5D LARGE ROUND 14MM MODULAR VBOSS BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33661405SR SUP Custom 27803010 33661405SR - ENDCAP SPINAL 5D SMALL ROUND 14MM MODULAR VBOSS BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33661600MR SUP Custom 27803010 33661600MR - ENDCAP SPINAL LARGE 16MM ROUND VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33661600SR SUP Custom 27803010 33661600SR - ENDCAP SPINAL SMALL 16MM ROUND VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33661605MR SUP Custom 27803010 33661605MR - ENDCAP SPINAL 5D LARGE 16MM ROUND VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33661605SR SUP Custom 27803010 33661605SR - ENDCAP SPINAL 5D SMALL 16MM ROUND VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662000MO SUP Custom 27803010 33662000MO - ENDCAP SPINAL LARGE 20MM OVAL VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662000MR SUP Custom 27803010 33662000MR - ENDCAP SPINAL LARGE 20MM ROUND VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662000SO SUP Custom 27803010 33662000SO - ENDCAP SPINAL SMALL 20MM OVAL VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662000SR SUP Custom 27803010 33662000SR - ENDCAP SPINAL SMALL 20MM ROUND VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662005MO SUP Custom 27803010 33662005MO - ENDCAP SPINAL 5D LARGE 20MM OVAL VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662005MR SUP Custom 27803010 33662005MR - ENDCAP SPINAL 5D LARGE 20MM ROUND VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662005SO SUP Custom 27803010 33662005SO - ENDCAP SPINAL 5D SMALL 20MM OVAL VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662005SR SUP Custom 27803010 33662005SR - ENDCAP SPINAL 5D SMALL 20MM ROUND VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662010MO SUP Custom 27803010 33662010MO - ENDCAP SPINAL 10D LARGE 20MM OVAL VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662010SO SUP Custom 27803010 33662010SO - ENDCAP SPINAL 10D SMALL 20MM OVAL VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662500MO SUP Custom 27803010 33662500MO - ENDCAP SPINAL LARGE 25MM OVAL VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662500MR SUP Custom 27803010 33662500MR - ENDCAP SPINAL LARGE 25MM ROUND VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662500SO SUP Custom 27803010 33662500SO - ENDCAP SPINAL SMALL 25MM OVAL VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662500SR SUP Custom 27803010 33662500SR - ENDCAP SPINAL SMALL 25MM ROUND VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662505MO SUP Custom 27803010 33662505MO - ENDCAP SPINAL 5D LARGE 25MM OVAL VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662505MR SUP Custom 27803010 33662505MR - ENDCAP SPINAL 5D LARGE 25MM ROUND VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662505SO SUP Custom 27803010 33662505SO - ENDCAP SPINAL 5D SMALL 25MM OVAL VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662505SR SUP Custom 27803010 33662505SR - ENDCAP SPINAL 5D SMALL 25MM ROUND VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662510MO SUP Custom 27803010 33662510MO - ENDCAP SPINAL 10D LARGE 25MM OVAL VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 33662510SO SUP Custom 27803010 33662510SO - ENDCAP SPINAL 10D SMALL 25MM OVAL VBOSS TITANIUM BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 3370-0-230 SUP HCPCS C1713 3370-0-230 - NAIL INTRAMEDULLARY 130D STANDARD 12MM 21CM GAMA HIP GAMA BOTH IP/OP "$1,499.00" "$1,109.00" $297.46 "$1,498.75" $674.44 $674.44 $674.44 $674.44 "$1,498.75" "$1,498.75" "$1,498.75" $312.38 "$1,498.75" "$1,498.75" "$1,498.75" "$1,498.75" "$1,498.75" $312.36 "$1,498.75" "$1,498.75" $886.51 "$1,498.75" "$1,498.75" "$1,498.75" "$1,498.75" "$1,124.25" "$1,498.75" "$1,498.75" "$1,498.75" $749.38 $749.38 "$1,187.01" "$1,498.75" "$1,199.00" $674.44 $297.46 N/A $869.42 "$1,498.75" "$1,498.75" "$1,498.75" "$1,498.75" "$1,498.75" N/A N/A 3370-0-235 SUP HCPCS C1713 3370-0-235 - NAIL INTRAMEDULLARY 135D STANDARD 12MM 21MM GAMA HIP GAMA BOTH IP/OP "$1,155.00" $855.00 $229.24 "$1,155.00" $519.75 $519.75 $519.75 $519.75 "$1,155.00" "$1,155.00" "$1,155.00" $240.73 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $240.71 "$1,155.00" "$1,155.00" $683.18 "$1,155.00" "$1,155.00" "$1,155.00" "$1,155.00" $866.25 "$1,155.00" "$1,155.00" "$1,155.00" $577.50 $577.50 $914.76 "$1,155.00" $924.00 $519.75 $229.24 N/A $669.90 "$1,155.00" "$1,155.00" "$1,155.00" $240.70 "$1,155.00" N/A N/A 3370-0-430 SUP HCPCS C1713 3370-0-430 - NAIL INTRAMEDULLARY 130D STANDARD 14MM 21CM STANDARD GAMA BOTH IP/OP "$1,052.00" $778.00 $208.77 "$1,051.88" $473.35 $473.35 $473.35 $473.35 "$1,051.88" "$1,051.88" "$1,051.88" $219.24 "$1,051.88" "$1,051.88" "$1,051.88" "$1,051.88" "$1,051.88" $219.22 "$1,051.88" "$1,051.88" $622.19 "$1,051.88" "$1,051.88" "$1,051.88" "$1,051.88" $789.00 "$1,051.88" "$1,051.88" "$1,051.88" $525.94 $525.94 $833.09 "$1,051.88" $841.50 $473.35 $208.77 N/A $610.16 "$1,051.88" "$1,051.88" "$1,051.88" $219.21 "$1,051.88" N/A N/A 3370-0-435 SUP HCPCS C1713 3370-0-435 - NAIL INTRAMEDULLARY 135D STANDARD 14MM 21CM GAMA STAINLESS BOTH IP/OP "$1,361.50" "$1,008.00" $270.17 "$1,361.25" $612.56 $612.56 $612.56 $612.56 "$1,361.25" "$1,361.25" "$1,361.25" $283.72 "$1,361.25" "$1,361.25" "$1,361.25" "$1,361.25" "$1,361.25" $283.70 "$1,361.25" "$1,361.25" $805.18 "$1,361.25" "$1,361.25" "$1,361.25" "$1,361.25" "$1,021.13" "$1,361.25" "$1,361.25" "$1,361.25" $680.63 $680.63 "$1,078.11" "$1,361.25" "$1,089.00" $612.56 $270.17 N/A $789.67 "$1,361.25" "$1,361.25" "$1,361.25" "$1,361.25" "$1,361.25" N/A N/A 3370-1-000 SUP HCPCS C1713 3370-1-000 - SCREW SET 8MM 27MM GMA HIP IM NL BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 3370-1-050 SUP HCPCS C1713 3370-1-050 - CAP END GAMA HIP STERILE INTRAMEDULLARY NAIL BOTH IP/OP $195.50 $145.00 $38.75 $195.25 $87.86 $87.86 $87.86 $87.86 $195.25 $195.25 $195.25 $40.69 $195.25 $195.25 $195.25 $195.25 $195.25 $40.69 $195.25 $78.10 $115.49 $195.25 $195.25 $195.25 $195.25 $146.63 $195.25 $195.25 $195.25 $97.63 $97.63 $154.64 $195.25 $156.20 $87.86 $38.75 N/A $113.39 $195.25 $117.15 $195.25 $40.69 $195.25 N/A N/A 3370-1-060 SUP HCPCS C1713 3370-1-060 - SCREW BONE 12MM 60MM LAG GAMA STAINLESS STEEL HIP FEMUR BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 3370-2-080 SUP HCPCS C1713 3370-2-080 - SCREW BONE 12MM 80MM LAG GAMA STAINLESS STEEL HIP FEMUR BOTH IP/OP $653.50 $484.00 $129.63 $653.13 $293.91 $293.91 $293.91 $293.91 $653.13 $653.13 $653.13 $136.13 $653.13 $653.13 $653.13 $653.13 $653.13 $136.12 $653.13 $653.13 $386.33 $653.13 $653.13 $653.13 $653.13 $490.13 $653.13 $653.13 $653.13 $326.57 $326.57 $517.28 $653.13 $522.50 $293.91 $129.63 N/A $379.03 $653.13 $391.88 $653.13 $136.11 $653.13 N/A N/A 3370-2-085 SUP HCPCS C1713 3370-2-085 - SCREW BONE 12MM 85MM LAG GAMA STAINLESS STEEL HIP FEMUR BOTH IP/OP $653.50 $484.00 $129.63 $653.13 $293.91 $293.91 $293.91 $293.91 $653.13 $653.13 $653.13 $136.13 $653.13 $653.13 $653.13 $653.13 $653.13 $136.12 $653.13 $653.13 $386.33 $653.13 $653.13 $653.13 $653.13 $490.13 $653.13 $653.13 $653.13 $326.57 $326.57 $517.28 $653.13 $522.50 $293.91 $129.63 N/A $379.03 $653.13 $653.13 $653.13 $653.13 $653.13 N/A N/A 3370-2-090 SUP HCPCS C1713 3370-2-090 - SCREW BONE 12MM 90MM LAG GAMA STAINLESS STEEL HIP FEMUR BOTH IP/OP $653.50 $484.00 $129.63 $653.13 $293.91 $293.91 $293.91 $293.91 $653.13 $653.13 $653.13 $136.13 $653.13 $653.13 $653.13 $653.13 $653.13 $136.12 $653.13 $653.13 $386.33 $653.13 $653.13 $653.13 $653.13 $490.13 $653.13 $653.13 $653.13 $326.57 $326.57 $517.28 $653.13 $522.50 $293.91 $129.63 N/A $379.03 $653.13 $391.88 $653.13 $136.11 $653.13 N/A N/A 3370-2-095 SUP HCPCS C1713 3370-2-095 - SCREW BONE 12MM 95MM LAG GAMA STAINLESS STEEL HIP FEMUR BOTH IP/OP $653.50 $484.00 $129.63 $653.13 $293.91 $293.91 $293.91 $293.91 $653.13 $653.13 $653.13 $136.13 $653.13 $653.13 $653.13 $653.13 $653.13 $136.12 $653.13 $653.13 $386.33 $653.13 $653.13 $653.13 $653.13 $490.13 $653.13 $653.13 $653.13 $326.57 $326.57 $517.28 $653.13 $522.50 $293.91 $129.63 N/A $379.03 $653.13 $391.88 $653.13 $136.11 $653.13 N/A N/A 3370-2-100 SUP HCPCS C1713 3370-2-100 - SCREW BONE 12MM 100MM LAG GAMA STAINLESS STEEL HIP FEMUR BOTH IP/OP $653.50 $484.00 $129.63 $653.13 $293.91 $293.91 $293.91 $293.91 $653.13 $653.13 $653.13 $136.13 $653.13 $653.13 $653.13 $653.13 $653.13 $136.12 $653.13 $261.25 $386.33 $653.13 $653.13 $653.13 $653.13 $490.13 $653.13 $653.13 $653.13 $326.57 $326.57 $517.28 $653.13 $522.50 $293.91 $129.63 N/A $379.03 $653.13 $391.88 $653.13 $653.13 $653.13 N/A N/A 3370-2-105 SUP HCPCS C1713 3370-2-105 - SCREW BONE 12MM 105MM LAG GAMA STAINLESS STEEL HIP FEMUR BOTH IP/OP $653.50 $484.00 $129.63 $653.13 $293.91 $293.91 $293.91 $293.91 $653.13 $653.13 $653.13 $136.13 $653.13 $653.13 $653.13 $653.13 $653.13 $136.12 $653.13 $653.13 $386.33 $653.13 $653.13 $653.13 $653.13 $490.13 $653.13 $653.13 $653.13 $326.57 $326.57 $517.28 $653.13 $522.50 $293.91 $129.63 N/A $379.03 $653.13 $391.88 $653.13 $136.11 $653.13 N/A N/A 3370-2-110 SUP HCPCS C1713 3370-2-110 - SCREW BONE 12MM 110MM LAG GAMA HIP INTRAMEDULLARY NAIL BOTH IP/OP $653.50 $484.00 $129.63 $653.13 $293.91 $293.91 $293.91 $293.91 $653.13 $653.13 $653.13 $136.13 $653.13 $653.13 $653.13 $653.13 $653.13 $136.12 $653.13 $653.13 $386.33 $653.13 $653.13 $653.13 $653.13 $490.13 $653.13 $653.13 $653.13 $326.57 $326.57 $517.28 $653.13 $522.50 $293.91 $129.63 N/A $379.03 $653.13 $391.88 $653.13 $136.11 $653.13 N/A N/A 3370-2-120 SUP HCPCS C1713 3370-2-120 - SCREW BONE 12MM 120MM LAG GAMA STAINLESS STEEL HIP BOTH IP/OP $653.50 $484.00 $129.63 $653.13 $293.91 $293.91 $293.91 $293.91 $653.13 $653.13 $653.13 $136.13 $653.13 $653.13 $653.13 $653.13 $653.13 $136.12 $653.13 $261.25 $386.33 $653.13 $653.13 $653.13 $653.13 $490.13 $653.13 $653.13 $653.13 $326.57 $326.57 $517.28 $653.13 $522.50 $293.91 $129.63 N/A $379.03 $653.13 $391.88 $653.13 $136.11 $653.13 N/A N/A 3370-2-130 SUP HCPCS C1713 3370-2-130 - SCREW BONE 12MM 130MM LAG GAMA STAINLESS STEEL HIP FEMUR BOTH IP/OP $653.50 $484.00 $129.63 $653.13 $293.91 $293.91 $293.91 $293.91 $653.13 $653.13 $653.13 $136.13 $653.13 $653.13 $653.13 $653.13 $653.13 $136.12 $653.13 $261.25 $386.33 $653.13 $653.13 $653.13 $653.13 $490.13 $653.13 $653.13 $653.13 $326.57 $326.57 $517.28 $653.13 $522.50 $293.91 $129.63 N/A $379.03 $653.13 $391.88 $653.13 $136.11 $653.13 N/A N/A 3370-3-035 SUP HCPCS C1713 3370-3-035 - SCREW BONE FULTHD 6.28MM 35MM GAMA HIP DISTAL STERILE BOTH IP/OP $179.00 $132.00 $35.48 $178.75 $80.44 $80.44 $80.44 $80.44 $178.75 $178.75 $178.75 $37.26 $178.75 $178.75 $178.75 $178.75 $178.75 $37.25 $178.75 $71.50 $105.73 $178.75 $178.75 $178.75 $178.75 $134.25 $178.75 $178.75 $178.75 $89.38 $89.38 $141.57 $178.75 $143.00 $80.44 $35.48 N/A $103.82 $178.75 $178.75 $178.75 $37.25 $178.75 N/A N/A 3370-3-040 SUP HCPCS C1713 3370-3-040 - SCREW BONE 6.28MM 40MM GAMA STAINLESS STEEL HIP FEMUR BOTH IP/OP $179.00 $132.00 $35.48 $178.75 $80.44 $80.44 $80.44 $80.44 $178.75 $178.75 $178.75 $37.26 $178.75 $178.75 $178.75 $178.75 $178.75 $37.25 $178.75 $71.50 $105.73 $178.75 $178.75 $178.75 $178.75 $134.25 $178.75 $178.75 $178.75 $89.38 $89.38 $141.57 $178.75 $143.00 $80.44 $35.48 N/A $103.82 $178.75 $178.75 $178.75 $37.25 $178.75 N/A N/A 3370-6-025 SUP HCPCS C1713 3370-6-025 - NAIL INTRAMEDULLARY 125D LONG 11MM 34CM LOCK GAMA TITANIUM BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-030 SUP HCPCS C1713 3370-6-030 - NAIL INTRAMEDULLARY 130D LONG 11MM 34CM LOCK GAMA TITANIUM BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" "$2,293.50" "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-035 SUP HCPCS C1713 3370-6-035 - NAIL INTRAMEDULLARY 135D LONG 11MM 34CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" "$2,293.50" "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-125 SUP HCPCS C1713 3370-6-125 - NAIL INTRAMEDULLARY 125D LONG 11MM 36CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$2,293.50" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-130 SUP HCPCS C1713 3370-6-130 - NAIL INTRAMEDULLARY 130D LONG 11MM 36CM GAMA HIP LEFT BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-135 SUP HCPCS C1713 3370-6-135 - NAIL INTRAMEDULLARY 135D LONG 11MM 36CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-225 SUP HCPCS C1713 3370-6-225 - NAIL INTRAMEDULLARY 125D LONG 11MM 38CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$2,293.50" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-230 SUP HCPCS C1713 3370-6-230 - NAIL INTRAMEDULLARY 130D LONG 11MM 38CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-235 SUP HCPCS C1713 3370-6-235 - NAIL INTRAMEDULLARY 135D LONG 11MM 38CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-325 SUP HCPCS C1713 3370-6-325 - NAIL INTRAMEDULLARY 125D LONG 11MM 40CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$2,293.50" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-330 SUP HCPCS C1713 3370-6-330 - NAIL INTRAMEDULLARY 130D LONG 11MM 40CM GAMA HIP LEFT BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-335 SUP HCPCS C1713 3370-6-335 - NAIL INTRAMEDULLARY 135D LONG 11MM 40CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" "$2,293.50" "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-425 SUP HCPCS C1713 3370-6-425 - NAIL INTRAMEDULLARY 125D LONG 11MM 42CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" "$2,293.50" "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-430 SUP HCPCS C1713 3370-6-430 - NAIL INTRAMEDULLARY 130D LONG 11MM 42CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-435 SUP HCPCS C1713 3370-6-435 - NAIL INTRAMEDULLARY 135D LONG 11MM 42CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-525 SUP HCPCS C1713 3370-6-525 - NAIL INTRAMEDULLARY 125D LONG 11MM 44CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-530 SUP HCPCS C1713 3370-6-530 - NAIL INTRAMEDULLARY 130D LONG 11MM 44CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$2,293.50" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-6-535 SUP HCPCS C1713 3370-6-535 - NAIL INTRAMEDULLARY 135D LONG 11MM 44CM LOCK GAMA STAINLESS BOTH IP/OP "$2,413.50" "$1,786.00" $478.95 "$2,413.13" "$1,085.91" "$1,085.91" "$1,085.91" "$1,085.91" "$2,413.13" "$2,413.13" "$2,413.13" $502.96 "$2,413.13" "$2,413.13" "$2,413.13" "$2,413.13" "$2,413.13" $502.92 "$2,413.13" $965.25 "$1,427.37" "$2,413.13" "$2,413.13" "$2,413.13" "$2,413.13" "$1,810.13" "$2,413.13" "$2,413.13" "$2,413.13" "$1,206.57" "$1,206.57" "$1,911.20" "$2,413.13" "$1,930.50" "$1,085.91" $478.95 N/A "$1,399.83" "$2,413.13" "$1,447.88" "$2,413.13" $502.90 "$2,413.13" N/A N/A 3370-7-025 SUP HCPCS C1713 3370-7-025 - NAIL INTRAMEDULLARY 125D LONG 11MM 34CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-030 SUP HCPCS C1713 3370-7-030 - NAIL INTRAMEDULLARY 130D LONG 11MM 34CM LOCK GAMA TITANIUM BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-035 SUP HCPCS C1713 3370-7-035 - NAIL INTRAMEDULLARY 135D LONG 11MM 34CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-125 SUP HCPCS C1713 3370-7-125 - NAIL INTRAMEDULLARY 125D LONG 11MM 36CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-130 SUP HCPCS C1713 3370-7-130 - NAIL INTRAMEDULLARY 130D LONG 11MM 360MM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-135 SUP HCPCS C1713 3370-7-135 - NAIL INTRAMEDULLARY 135D LONG 11MM 36CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-225 SUP HCPCS C1713 3370-7-225 - NAIL INTRAMEDULLARY 125D LONG 11MM 38CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-230 SUP HCPCS C1713 3370-7-230 - NAIL INTRAMEDULLARY 130D LONG 11MM 38CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-235 SUP HCPCS C1713 3370-7-235 - NAIL INTRAMEDULLARY 135D LONG 11MM 38CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-325 SUP HCPCS C1713 3370-7-325 - NAIL INTRAMEDULLARY 125D LONG 11MM 40CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" "$2,293.50" "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-330 SUP HCPCS C1713 3370-7-330 - NAIL INTRAMEDULLARY 130D LONG 11MM 40CM LOCK GAMA HIP RIGHT BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$2,293.50" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-335 SUP HCPCS C1713 3370-7-335 - NAIL INTRAMEDULLARY 135D LONG 11MM 40CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-425 SUP HCPCS C1713 3370-7-425 - NAIL INTRAMEDULLARY 125D LONG 11MM 42CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" $917.40 "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-430 SUP HCPCS C1713 3370-7-430 - NAIL INTRAMEDULLARY 130D LONG 11MM 42CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" "$2,293.50" "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-435 SUP HCPCS C1713 3370-7-435 - NAIL INTRAMEDULLARY 135D LONG 11MM 42CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" "$2,293.50" "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-525 SUP HCPCS C1713 3370-7-525 - NAIL INTRAMEDULLARY 125D LONG 11MM 44CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" "$2,293.50" "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-530 SUP HCPCS C1713 3370-7-530 - NAIL INTRAMEDULLARY 130D LONG 11MM 44CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" "$2,293.50" "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$2,293.50" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-7-535 SUP HCPCS C1713 3370-7-535 - NAIL INTRAMEDULLARY 135D LONG 11MM 44CM LOCK GAMA STAINLESS BOTH IP/OP "$2,293.50" "$1,697.00" $455.20 "$2,293.50" "$1,032.08" "$1,032.08" "$1,032.08" "$1,032.08" "$2,293.50" "$2,293.50" "$2,293.50" $478.02 "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" $477.99 "$2,293.50" "$2,293.50" "$1,356.61" "$2,293.50" "$2,293.50" "$2,293.50" "$2,293.50" "$1,720.13" "$2,293.50" "$2,293.50" "$2,293.50" "$1,146.75" "$1,146.75" "$1,816.45" "$2,293.50" "$1,834.80" "$1,032.08" $455.20 N/A "$1,330.23" "$2,293.50" "$1,376.10" "$2,293.50" $477.97 "$2,293.50" N/A N/A 3370-8-125 SUP HCPCS C1713 3370-8-125 - NAIL INTRAMEDULLARY 125D 11MM 18CM LOCK GAMA STAINLESS STEEL BOTH IP/OP "$1,863.50" "$1,379.00" $369.78 "$1,863.13" $838.41 $838.41 $838.41 $838.41 "$1,863.13" "$1,863.13" "$1,863.13" $388.32 "$1,863.13" "$1,863.13" "$1,863.13" "$1,863.13" "$1,863.13" $388.30 "$1,863.13" "$1,863.13" "$1,102.04" "$1,863.13" "$1,863.13" "$1,863.13" "$1,863.13" "$1,397.63" "$1,863.13" "$1,863.13" "$1,863.13" $931.57 $931.57 "$1,475.60" "$1,863.13" "$1,490.50" $838.41 $369.78 N/A "$1,080.83" "$1,863.13" "$1,863.13" "$1,863.13" "$1,863.13" "$1,863.13" N/A N/A 3370-8-130 SUP HCPCS C1713 3370-8-130 - NAIL INTRAMEDULLARY 130D GAMA HIP TROC BOTH IP/OP "$1,863.50" "$1,379.00" $369.78 "$1,863.13" $838.41 $838.41 $838.41 $838.41 "$1,863.13" "$1,863.13" "$1,863.13" $388.32 "$1,863.13" "$1,863.13" "$1,863.13" "$1,863.13" "$1,863.13" $388.30 "$1,863.13" "$1,863.13" "$1,102.04" "$1,863.13" "$1,863.13" "$1,863.13" "$1,863.13" "$1,397.63" "$1,863.13" "$1,863.13" "$1,863.13" $931.57 $931.57 "$1,475.60" "$1,863.13" "$1,490.50" $838.41 $369.78 N/A "$1,080.83" "$1,863.13" "$1,863.13" "$1,863.13" $388.28 "$1,863.13" N/A N/A 3370-8-135 SUP HCPCS C1713 3370-8-135 - NAIL INTRAMEDULLARY 135D 11MM 18CM LOCK GAMA STAINLESS STEEL BOTH IP/OP "$1,863.50" "$1,379.00" $369.78 "$1,863.13" $838.41 $838.41 $838.41 $838.41 "$1,863.13" "$1,863.13" "$1,863.13" $388.32 "$1,863.13" "$1,863.13" "$1,863.13" "$1,863.13" "$1,863.13" $388.30 "$1,863.13" $745.25 "$1,102.04" "$1,863.13" "$1,863.13" "$1,863.13" "$1,863.13" "$1,397.63" "$1,863.13" "$1,863.13" "$1,863.13" $931.57 $931.57 "$1,475.60" "$1,863.13" "$1,490.50" $838.41 $369.78 N/A "$1,080.83" "$1,863.13" "$1,863.13" "$1,863.13" "$1,863.13" "$1,863.13" N/A N/A 3371-1-015 SUP HCPCS C1769 3371-1-015 - GUIDEWIRE ORTH 3MM STRL BLNT TIP PACKAGED BOTH IP/OP $234.00 $173.00 $46.39 $233.75 $126.93 $126.93 $126.93 $126.93 $233.75 $233.75 $233.75 $48.72 $233.75 $173.49 $173.49 $180.17 $121.78 $48.72 $233.75 $233.75 $138.26 $233.75 $233.75 $233.75 $233.75 $175.50 $233.75 $233.75 $233.75 $116.88 $116.88 $185.13 $233.75 $187.00 $151.94 $46.39 N/A $135.72 $233.75 $233.75 $233.75 $48.71 $233.75 N/A N/A 3371-1-060 SUP HCPCS C1713 3371-1-060 - WIRE FX 3.2MM 450MM KRSH SS GMA NL SYS BOTH IP/OP $192.50 $142.00 $38.21 $192.50 $86.63 $86.63 $86.63 $86.63 $192.50 $192.50 $192.50 $40.12 $192.50 $192.50 $192.50 $192.50 $192.50 $40.12 $192.50 $77.00 $113.86 $192.50 $192.50 $192.50 $192.50 $144.38 $192.50 $192.50 $192.50 $96.25 $96.25 $152.46 $192.50 $154.00 $86.63 $38.21 N/A $111.65 $192.50 $115.50 $192.50 $40.12 $192.50 N/A N/A 3371-1-078 SUP Custom 27203010 3371-1-078 - HEAD FEM +5MM OFST 36MM V40 LFIT COCR HIP BOTH IP/OP "$1,684.50" "$1,247.00" $299.82 "$1,684.38" "$1,684.38" "$1,684.38" "$1,684.38" "$1,684.38" "$1,684.38" "$1,684.38" $299.82 "$1,684.38" "$1,684.38" "$1,250.15" "$1,250.15" "$1,298.32" $877.56 $351.04 "$1,684.38" $673.75 "$1,684.38" "$1,684.38" "$1,684.38" "$1,684.38" "$1,684.38" "$1,263.38" "$1,684.38" "$1,684.38" "$1,684.38" $842.19 $842.19 "$1,334.03" "$1,684.38" "$1,347.50" "$1,094.85" "$1,684.38" N/A $977.01 "$1,684.38" "$1,010.63" "$1,684.38" "$1,684.38" "$1,684.38" N/A N/A 3371-1-085 SUP Custom 27803010 3371-1-085 - TAP SURG LAG SCREW GAMA NAIL SYSTEM BOTH IP/OP "$1,313.50" $972.00 $233.74 "$1,313.13" "$1,313.13" "$1,313.13" "$1,313.13" "$1,313.13" "$1,313.13" "$1,313.13" $233.74 "$1,313.13" "$1,313.13" "$1,313.13" "$1,313.13" "$1,313.13" "$1,313.13" $273.67 "$1,313.13" $525.25 "$1,313.13" "$1,313.13" "$1,313.13" "$1,313.13" "$1,313.13" $985.13 "$1,313.13" "$1,313.13" "$1,313.13" $656.57 $656.57 "$1,040.00" "$1,313.13" "$1,050.50" $590.91 "$1,313.13" N/A $761.83 "$1,313.13" $787.88 "$1,313.13" "$1,313.13" "$1,313.13" N/A N/A 3371-1-180 SUP Custom 27203010 3371-1-180 - BIT DRILL 5.5MM DISTAL GAMA NAIL SYSTEM THIRD FEMORAL BOTH IP/OP $203.50 $151.00 $36.22 $203.50 $203.50 $203.50 $203.50 $203.50 $203.50 $203.50 $36.22 $203.50 $203.50 $151.04 $151.04 $156.86 $106.02 $42.41 $203.50 $81.40 $203.50 $203.50 $203.50 $203.50 $203.50 $152.63 $203.50 $203.50 $203.50 $101.75 $101.75 $161.17 $203.50 $162.80 $132.28 $203.50 N/A $118.03 $203.50 $122.10 $203.50 $203.50 $203.50 N/A N/A 3371-1-185 SUP Custom 27203010 3371-1-185 - SLEEVE DRILL 5.5MM GUIDE NAIL GAMA HIP BOTH IP/OP $467.50 $346.00 $83.22 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $83.22 $467.50 $467.50 $346.98 $346.98 $360.35 $243.57 $97.43 $467.50 $187.00 $467.50 $467.50 $467.50 $467.50 $467.50 $350.63 $467.50 $467.50 $467.50 $233.75 $233.75 $370.26 $467.50 $374.00 $303.88 $467.50 N/A $271.15 $467.50 $280.50 $467.50 $467.50 $467.50 N/A N/A 33MJ-501 SUP Custom 27803010 33MJ-501 - VALVE MTRL 85D 5.18SQ CM 33MM 26.1MM MSTR SER MECH STD CUF BOTH IP/OP "$11,250.00" "$8,325.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$11,250.00" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$11,250.00" "$11,250.00" N/A N/A 3420-0260S SUP HCPCS C1713 3420-0260S - NAIL INTRAMEDULLARY 120D LONG 10MM 26CM GAMMA3 TITANIUM HIP BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" N/A N/A 3420-0280S SUP HCPCS C1713 3420-0280S - NAIL INTRAMEDULLARY 120D LONG 10MM 28CM GAMMA3 TITANIUM HIP BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3420-0300S SUP HCPCS C1713 3420-0300S - NAIL INTRAMEDULLARY 120D LONG 10MM 30CM GAMMA3 TITANIUM HIP BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3420-0320S SUP HCPCS C1713 3420-0320S - NAIL INTRAMEDULLARY 120D LONG 10MM 32CM GAMMA3 TITANIUM HIP BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3420-0340S SUP HCPCS C1713 3420-0340S - NAIL INTRAMEDULLARY 120D LONG 10MM 34CM GAMMA3 TITANIUM HIP BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3420-0360S SUP HCPCS C1713 3420-0360S - NAIL INTRAMEDULLARY 120D LONG 10MM 36CM GAMMA3 TITANIUM HIP BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3420-0380S SUP HCPCS C1713 3420-0380S - NAIL INTRAMEDULLARY 120D LONG 10MM 38CM GAMMA3 TITANIUM HIP BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3420-0400S SUP HCPCS C1713 3420-0400S - NAIL INTRAMEDULLARY 120D LONG 10MM 40CM GAMMA3 TITANIUM HIP BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3420-0420S SUP HCPCS C1713 3420-0420S - GAMMA 3 S NAIL RIGHT 10X420MM X 120 BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" N/A N/A 3420-0440S SUP HCPCS C1713 3420-0440S - NAIL IM 120D 10MM 440MM STRL GAMMA3 RT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3420-0460S SUP HCPCS C1713 3420-0460S - NAIL IM 120D 10MM 460MM STRL GAMMA3 RT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3425-0260S SUP HCPCS C1713 3425-0260S - NAIL INTRAMEDULLARY 125D LONG 10MM 26CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3425-0280S SUP HCPCS C1713 3425-0280S - NAIL INTRAMEDULLARY 125D LONG 10MM 28CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3425-0300S SUP HCPCS C1713 3425-0300S - NAIL INTRAMEDULLARY 125D LONG 10MM 30CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" N/A N/A 3425-0320S SUP HCPCS C1713 3425-0320S - NAIL INTRAMEDULLARY 125D LONG 10MM 32CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3425-0340S SUP HCPCS C1713 3425-0340S - NAIL INTRAMEDULLARY 125D LONG 10MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" "$3,668.60" "$3,668.60" N/A N/A 3425-0360S SUP HCPCS C1713 3425-0360S - NAIL INTRAMEDULLARY 125D LONG 10MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3425-0380S SUP HCPCS C1713 3425-0380S - NAIL INTRAMEDULLARY 125D LONG 10MM 38CM LOCK GAMA TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3425-0400S SUP HCPCS C1713 3425-0400S - NAIL INTRAMEDULLARY 125D LONG 10MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" "$3,668.60" "$3,668.60" N/A N/A 3425-0420S SUP HCPCS C1713 3425-0420S - GAMMA 3 S NAIL RIGHT 10X420MM X 125 BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3425-0440S SUP HCPCS C1713 3425-0440S - GAMMA 3 S NAIL RIGHT 10X440MM X 125 BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3425-0460S SUP HCPCS C1713 3425-0460S - NAIL IM 125D 10MM 460MM STRL GAMMA3 RT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3425-0480S SUP HCPCS C1713 3425-0480S - NAIL IM 10MM 480MM STRL 125MM GAMMA3 RT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3430-0260S SUP HCPCS C1713 3430-0260S - NAIL INTRAMEDULLARY 130D LONG 10MM 26CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3430-0280S SUP HCPCS C1713 3430-0280S - NAIL INTRAMEDULLARY 130D LONG 10MM 28CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3430-0300S SUP HCPCS C1713 3430-0300S - NAIL INTRAMEDULLARY 130D LONG 10MM 30CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" N/A N/A 3430-0320S SUP HCPCS C1713 3430-0320S - NAIL INTRAMEDULLARY 130D LONG 10MM 32CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" N/A N/A 3430-0340S SUP HCPCS C1713 3430-0340S - NAIL INTRAMEDULLARY 130D LONG 10MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3430-0360S SUP HCPCS C1713 3430-0360S - NAIL INTRAMEDULLARY 130D LONG 10MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3430-0380S SUP HCPCS C1713 3430-0380S - NAIL INTRAMEDULLARY 130D LONG 10MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3430-0400S SUP HCPCS C1713 3430-0400S - NAIL INTRAMEDULLARY 130D LONG 10MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3430-0420S SUP HCPCS C1713 3430-0420S - GAMMA 3 S NAIL RIGHT 10x420mm x 130 BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3430-0440S SUP HCPCS C1713 3430-0440S - GAMMA 3 S NAIL RIGHT 10x440mm x 130 BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3430-0460S SUP HCPCS C1713 3430-0460S - NAIL IM 130D 10MM 460MM STRL GAMMA3 RT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 346 367 SUP HCPCS C1898 346 367 - LEAD PACING 15MM TIP TO RING STR 7.2FR 60CM BIPOL PASSIVE BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 3460-7-006 SUP HCPCS C1713 3460-7-006 - SCREW BONE 8MM 19MM OSTMY PEDIATRIC HIP OSTMY BOTH IP/OP $572.00 $423.00 $113.53 $572.00 $257.40 $257.40 $257.40 $257.40 $572.00 $572.00 $572.00 $119.22 $572.00 $572.00 $572.00 $572.00 $572.00 $119.21 $572.00 $228.80 $338.34 $572.00 $572.00 $572.00 $572.00 $429.00 $572.00 $572.00 $572.00 $286.00 $286.00 $453.02 $572.00 $457.60 $257.40 $113.53 N/A $331.76 $572.00 $343.20 $572.00 $119.20 $572.00 N/A N/A 3460-7-007 SUP HCPCS C1713 3460-7-007 - SCREW BONE 8MM 22MM OSTMY PEDIATRIC HIP OSTMY BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 3460-7-030 SUP HCPCS C1713 3460-7-030 - SCREW BONE 8MM 76MM OSTMY PEDIATRIC HIP OSTMY BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A 35-0002 SUP Custom 27203010 35-0002 - PIN FIX 4MM SMOOTH LOCKING STEINMANN STAINLESS STEEL BOTH IP/OP $142.50 $105.00 $25.37 $142.50 $142.50 $142.50 $142.50 $142.50 $142.50 $142.50 $25.37 $142.50 $142.50 $105.76 $105.76 $109.84 $74.24 $29.70 $142.50 $57.00 $142.50 $142.50 $142.50 $142.50 $142.50 $106.88 $142.50 $142.50 $142.50 $71.25 $71.25 $112.86 $142.50 $114.00 $92.63 $142.50 N/A $82.65 $142.50 $85.50 $142.50 $142.50 $142.50 N/A N/A 35-0003 SUP Custom 27203010 35-0003 - PIN FIX 5MM SMOOTH STEINMANN STAINLESS STEEL CALCANEUS BOTH IP/OP $142.50 $105.00 $25.37 $142.50 $142.50 $142.50 $142.50 $142.50 $142.50 $142.50 $25.37 $142.50 $142.50 $105.76 $105.76 $109.84 $74.24 $29.70 $142.50 $57.00 $142.50 $142.50 $142.50 $142.50 $142.50 $106.88 $142.50 $142.50 $142.50 $71.25 $71.25 $112.86 $142.50 $114.00 $92.63 $142.50 N/A $82.65 $142.50 $85.50 $142.50 $142.50 $142.50 N/A N/A 35-0011 SUP HCPCS C1769 35-0011 - GUIDEWIRE ORTHOPEDIC STR .045IN 5.75IN THREAD TITANIUM BOTH IP/OP $17.50 $13.00 $3.47 $17.50 $9.50 $9.50 $9.50 $9.50 $17.50 $17.50 $17.50 $3.65 $17.50 $12.99 $12.99 $13.49 $9.12 $3.65 $17.50 $17.50 $10.35 $17.50 $17.50 $17.50 $17.50 $13.13 $17.50 $17.50 $17.50 $8.75 $8.75 $13.86 $17.50 $14.00 $11.38 $3.47 N/A $10.15 $17.50 $17.50 $17.50 $3.65 $17.50 N/A N/A 350-2001BC SUP HCPCS C1789 350-2001BC - IMPLANT BREAST P3.2CM MODEARTE PROFILE ROUND 10.5CM GEL BOTH IP/OP "$2,187.50" "$1,619.00" $434.16 "$2,500.00" $984.38 $984.38 $984.38 $984.38 "$2,187.50" "$2,187.50" "$2,187.50" $455.93 "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" $455.90 "$2,187.50" "$2,500.00" "$1,293.91" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$1,640.63" "$2,187.50" "$2,187.50" "$2,187.50" "$1,093.75" "$1,093.75" "$1,732.50" "$2,187.50" "$1,750.00" $984.38 $434.16 N/A "$1,268.75" "$2,187.50" "$2,187.50" "$2,187.50" $455.88 "$2,187.50" N/A N/A 350-2500 SUP HCPCS C1789 350-2500 - IMPL BRST 500-600ML STY 2000 SMTH RND SAL P5.9CM MDRT PLUS BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 350-2501BC SUP HCPCS C1789 350-2501BC - IMPLANT BRST P3.4CM MDRT + HI PRFL RND 11.3CM 250ML STRL BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 350-3001BC SUP HCPCS C1789 350-3001BC - IMPLANT BRST P3.6CM RND MDRT + PRFL 12CM 300ML STRL BOTH IP/OP "$2,187.50" "$1,619.00" $434.16 "$2,500.00" $984.38 $984.38 $984.38 $984.38 "$2,187.50" "$2,187.50" "$2,187.50" $455.93 "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" $455.90 "$2,187.50" "$2,500.00" "$1,293.91" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$1,640.63" "$2,187.50" "$2,187.50" "$2,187.50" "$1,093.75" "$1,093.75" "$1,732.50" "$2,187.50" "$1,750.00" $984.38 $434.16 N/A "$1,268.75" "$2,187.50" "$2,187.50" "$2,187.50" $455.88 "$2,187.50" N/A N/A 350-3004BC SUP HCPCS C1789 350-3004BC - IMPLANT BRST P4.5CM HI PRFL RND NAR BS 11.1CM 300CC BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 350-3501BC SUP HCPCS C1789 350-3501BC - IMPLANT BREAST P3.9CM MODERATE PLUS PROFILE ROUND 12.5CM GEL BOTH IP/OP "$2,187.50" "$1,619.00" $434.16 "$2,500.00" $984.38 $984.38 $984.38 $984.38 "$2,187.50" "$2,187.50" "$2,187.50" $455.93 "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" $455.90 "$2,187.50" "$2,500.00" "$1,293.91" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$1,640.63" "$2,187.50" "$2,187.50" "$2,187.50" "$1,093.75" "$1,093.75" "$1,732.50" "$2,187.50" "$1,750.00" $984.38 $434.16 N/A "$1,268.75" "$2,187.50" "$2,187.50" "$2,187.50" $455.88 "$2,187.50" N/A N/A 350-3504BC SUP HCPCS C1789 350-3504BC - IMPLANT BRST P4.8CM HI PRFL RND NAR BS 11.7CM 350CC BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,500.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,500.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 350-4001BC SUP HCPCS C1789 350-4001BC - IMPLANT BRST P4CM MDRT + PRFL RND 13.1CM 400CC MEMORYGEL BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 350-4004BC SUP HCPCS C1789 350-4004BC - IMPLANT BRST P5CM HI PRFL RND NAR BS 12.2CM 400CC MEMORYGEL BOTH IP/OP "$2,325.00" "$1,721.00" $461.45 "$2,500.00" "$1,046.25" "$1,046.25" "$1,046.25" "$1,046.25" "$2,325.00" "$2,325.00" "$2,325.00" $484.59 "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" $484.56 "$2,325.00" "$2,500.00" "$1,375.24" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$1,743.75" "$2,325.00" "$2,325.00" "$2,325.00" "$1,162.50" "$1,162.50" "$1,841.40" "$2,325.00" "$1,860.00" "$1,046.25" $461.45 N/A "$1,348.50" "$2,325.00" "$2,325.00" "$2,325.00" $484.53 "$2,325.00" N/A N/A 350-4501BC SUP HCPCS C1789 350-4501BC - IMPLANT BRST P4.2CM MDRT + PRFL 13.6CM 450ML CHSV I GEL RND BOTH IP/OP "$2,187.50" "$1,619.00" $434.16 "$2,500.00" $984.38 $984.38 $984.38 $984.38 "$2,187.50" "$2,187.50" "$2,187.50" $455.93 "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" $455.90 "$2,187.50" "$2,500.00" "$1,293.91" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$1,640.63" "$2,187.50" "$2,187.50" "$2,187.50" "$1,093.75" "$1,093.75" "$1,732.50" "$2,187.50" "$1,750.00" $984.38 $434.16 N/A "$1,268.75" "$2,187.50" "$2,187.50" "$2,187.50" $455.88 "$2,187.50" N/A N/A 350-4504BC SUP HCPCS C1789 350-4504BC - IMPLANT BRST P5.1CM RND 12.8CM 450ML STRL MEMORYGEL SMTH HI BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,500.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,500.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 350-5001 BC SUP HCPCS C1789 350-5001 BC - IMPLANT BREAST P4.3CM MODERATE PLUS PROFILE ROUND MODERATE BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 350-5001BC SUP HCPCS C1789 350-5001BC - IMPLANT BRST P4.3CM MDRT + PRFL RND MDRT BS 14.1CM 500ML BOTH IP/OP "$2,187.50" "$1,619.00" $434.16 "$2,500.00" $984.38 $984.38 $984.38 $984.38 "$2,187.50" "$2,187.50" "$2,187.50" $455.93 "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" $455.90 "$2,187.50" "$2,500.00" "$1,293.91" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$1,640.63" "$2,187.50" "$2,187.50" "$2,187.50" "$1,093.75" "$1,093.75" "$1,732.50" "$2,187.50" "$1,750.00" $984.38 $434.16 N/A "$1,268.75" "$2,187.50" "$2,187.50" "$2,187.50" $455.88 "$2,187.50" N/A N/A 350-5004BC SUP HCPCS C1789 350-5004BC - IMPLANT BRST P5.3CM HI PRFL RND NAR BS 13.2CM 500ML BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,500.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,500.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 350-5501BC SUP HCPCS C1789 350-5501BC - IMPLANT BREAST P4.5CM MODERATE PLUS PROFILE ROUND MODERATE BOTH IP/OP "$2,187.50" "$1,619.00" $434.16 "$2,500.00" $984.38 $984.38 $984.38 $984.38 "$2,187.50" "$2,187.50" "$2,187.50" $455.93 "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" $455.90 "$2,187.50" "$2,500.00" "$1,293.91" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$1,640.63" "$2,187.50" "$2,187.50" "$2,187.50" "$1,093.75" "$1,093.75" "$1,732.50" "$2,187.50" "$1,750.00" $984.38 $434.16 N/A "$1,268.75" "$2,187.50" "$2,187.50" "$2,187.50" $455.88 "$2,187.50" N/A N/A 350-5504BC SUP HCPCS C1789 350-5504BC - IMPLANT BREAST P5.5CM HIGH PROFILE ROUND 13.6CM SMOOTH BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,500.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,500.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 350-6001BC SUP HCPCS C1789 350-6001BC - IMPLANT BRST P4.6CM MDRT + PRFL RND MDRT BS 15CM 600ML BOTH IP/OP "$2,187.50" "$1,619.00" $434.16 "$2,500.00" $984.38 $984.38 $984.38 $984.38 "$2,187.50" "$2,187.50" "$2,187.50" $455.93 "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" $455.90 "$2,187.50" "$2,500.00" "$1,293.91" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$1,640.63" "$2,187.50" "$2,187.50" "$2,187.50" "$1,093.75" "$1,093.75" "$1,732.50" "$2,187.50" "$1,750.00" $984.38 $434.16 N/A "$1,268.75" "$2,187.50" "$2,187.50" "$2,187.50" $455.88 "$2,187.50" N/A N/A 350-6004BC SUP HCPCS C1789 350-6004BC - IMPLANT BRST P5.6CM HI PRFL RND NAR BS 14CM 600CC MEMORYGEL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,500.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,500.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 350-8001BC SUP HCPCS C1789 350-8001BC - IMPLANT BRST P5.1CM MDRT + PRFL RND 16.5CM 800ML MEMORYGEL BOTH IP/OP "$2,262.50" "$1,674.00" $449.05 "$2,262.50" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$2,262.50" "$2,262.50" "$2,262.50" $471.56 "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" $471.53 "$2,262.50" "$2,262.50" "$1,338.27" "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" "$1,696.88" "$2,262.50" "$2,262.50" "$2,262.50" "$1,131.25" "$1,131.25" "$1,791.90" "$2,262.50" "$1,810.00" "$1,018.13" $449.05 N/A "$1,312.25" "$2,262.50" "$2,262.50" "$2,262.50" $471.51 "$2,262.50" N/A N/A 350-8004BC SUP HCPCS C1789 350-8004BC - IMPLANT BRST P6CM HI PRFL RND NAR BS 15.5CM 800ML STRL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,500.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,500.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 351.16J SUP Custom 27203010 351.16J - CHUCK DRILL CONCTR CANN QUICK COUPLING JACOBS BOTH IP/OP $789.50 $584.00 $140.47 $802.60 $789.18 $789.18 $789.18 $789.18 $789.18 $789.18 $140.47 $789.18 $789.18 $585.73 $585.73 $608.30 $411.16 $164.47 $789.18 $321.04 $789.18 $789.18 $802.60 $789.18 $789.18 $592.13 $789.18 $789.18 $789.18 $394.59 $394.59 $625.03 $789.18 $631.34 $512.97 $789.18 N/A $457.91 $789.18 $473.51 $789.18 $789.18 $789.18 N/A N/A 351.27S SUP Custom 27203010 351.27S - BIT DRL 13MM 300MM STRL CNN BOTH IP/OP "$1,212.50" $897.00 $215.77 "$1,232.80" "$1,212.20" "$1,212.20" "$1,212.20" "$1,212.20" "$1,212.20" "$1,212.20" $215.77 "$1,212.20" "$1,212.20" $899.69 $899.69 $934.36 $631.56 $252.64 "$1,212.20" $493.12 "$1,212.20" "$1,212.20" "$1,232.80" "$1,212.20" "$1,212.20" $909.38 "$1,212.20" "$1,212.20" "$1,212.20" $606.10 $606.10 $960.06 "$1,212.20" $969.76 $787.93 "$1,212.20" N/A $703.25 "$1,212.20" $727.32 "$1,212.20" "$1,212.20" "$1,212.20" N/A N/A 351.704S SUP Custom 27203010 351.704S - ROD REAMER 2.5MM 1150MM BALL TIP EXTN STERILE BOTH IP/OP $242.00 $179.00 $43.04 $245.88 $241.78 $241.78 $241.78 $241.78 $241.78 $241.78 $43.04 $241.78 $241.78 $179.45 $179.45 $186.36 $125.97 $50.39 $241.78 $98.35 $241.78 $241.78 $245.88 $241.78 $241.78 $181.50 $241.78 $241.78 $241.78 $120.89 $120.89 $191.49 $241.78 $193.42 $157.16 $241.78 N/A $140.36 $241.78 $145.07 $241.78 $241.78 $241.78 N/A N/A 351.706S SUP Custom 27203010 351.706S - ROD REAMING 2.5MM 950MM BALL TIP GWIRE STERILE DISPOSABLE BOTH IP/OP $223.50 $165.00 $39.73 $226.98 $223.18 $223.18 $223.18 $223.18 $223.18 $223.18 $39.73 $223.18 $223.18 $165.64 $165.64 $172.03 $116.28 $46.51 $223.18 $90.79 $223.18 $223.18 $226.98 $223.18 $223.18 $167.63 $223.18 $223.18 $223.18 $111.59 $111.59 $176.76 $223.18 $178.54 $145.07 $223.18 N/A $129.63 $223.18 $133.91 $223.18 $223.18 $223.18 N/A N/A 351.707S SUP Custom 27203010 351.707S - ROD REAMING 2.5MM 950MM BALL TIP EXTN STERILE DISPOSABLE BOTH IP/OP $223.50 $165.00 $39.73 $226.98 $223.18 $223.18 $223.18 $223.18 $223.18 $223.18 $39.73 $223.18 $223.18 $165.64 $165.64 $172.03 $116.28 $46.51 $223.18 $90.79 $223.18 $223.18 $226.98 $223.18 $223.18 $167.63 $223.18 $223.18 $223.18 $111.59 $111.59 $176.76 $223.18 $178.54 $145.07 $223.18 N/A $129.63 $223.18 $133.91 $223.18 $223.18 $223.18 N/A N/A 351.708S SUP Custom 27203010 351.708S - ROD REAMING BALL 2.5MM 1150MM STERILE INTRAMEDULLARY NAIL BOTH IP/OP $270.00 $200.00 $48.04 $274.48 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $48.04 $269.88 $269.88 $200.30 $200.30 $208.02 $140.61 $56.25 $269.88 $109.79 $269.88 $269.88 $274.48 $269.88 $269.88 $202.50 $269.88 $269.88 $269.88 $134.94 $134.94 $213.74 $269.88 $215.90 $175.42 $269.88 N/A $156.60 $269.88 $161.93 $269.88 $269.88 $269.88 N/A N/A 351.709S SUP Custom 27203010 351.709S - ROD REAMER 2.5MM 650MM BALL TIP STERILE BOTH IP/OP $238.00 $176.00 $42.32 $241.83 $237.78 $237.78 $237.78 $237.78 $237.78 $237.78 $42.32 $237.78 $237.78 $176.48 $176.48 $183.28 $123.88 $49.56 $237.78 $96.73 $237.78 $237.78 $241.83 $237.78 $237.78 $178.50 $237.78 $237.78 $237.78 $118.89 $118.89 $188.32 $237.78 $190.22 $154.56 $237.78 N/A $138.04 $237.78 $142.67 $237.78 $237.78 $237.78 N/A N/A 351.718S SUP Custom 27203010 351.718S - SEAL DRIVE SHAFT ELASTOMERIC STERILE DISPOSABLE RIA BOTH IP/OP $21.00 $16.00 $3.73 $21.33 $20.96 $20.96 $20.96 $20.96 $20.96 $20.96 $3.73 $20.96 $20.96 $15.56 $15.56 $16.16 $10.92 $4.37 $20.96 $8.53 $20.96 $20.96 $21.33 $20.96 $20.96 $15.75 $20.96 $20.96 $20.96 $10.48 $10.48 $16.60 $20.96 $16.77 $13.62 $20.96 N/A $12.18 $20.96 $12.58 $20.96 $20.96 $20.96 N/A N/A 3515-9-100 SUP HCPCS C1713 3515-9-100 - NAIL INTRAMEDULLARY PLUG GROSSE-KEMPF FEMUR BOTH IP/OP $213.50 $158.00 $42.30 $213.13 $95.91 $95.91 $95.91 $95.91 $213.13 $213.13 $213.13 $44.42 $213.13 $213.13 $213.13 $213.13 $213.13 $44.42 $213.13 $213.13 $126.07 $213.13 $213.13 $213.13 $213.13 $160.13 $213.13 $213.13 $213.13 $106.57 $106.57 $168.80 $213.13 $170.50 $95.91 $42.30 N/A $123.83 $213.13 $127.88 $213.13 $44.42 $213.13 N/A N/A 352.229S SUP Custom 27203010 352.229S - FILTER GRAFT PLUNGER GRADUATED 100ML STERILE DISPOSABLE RIA BOTH IP/OP $617.50 $457.00 $109.83 $627.55 $617.05 $617.05 $617.05 $617.05 $617.05 $617.05 $109.83 $617.05 $617.05 $457.97 $457.97 $475.62 $321.48 $128.60 $617.05 $251.02 $617.05 $617.05 $627.55 $617.05 $617.05 $463.13 $617.05 $617.05 $617.05 $308.53 $308.53 $488.70 $617.05 $493.64 $401.08 $617.05 N/A $358.15 $617.05 $370.23 $617.05 $617.05 $617.05 N/A N/A 352.250S SUP Custom 27203010 352.250S - REAMER SURG 12MM HEAD STERILE DISPOSABLE RIA BOTH IP/OP $684.50 $507.00 $121.78 $695.78 $684.15 $684.15 $684.15 $684.15 $684.15 $684.15 $121.78 $684.15 $684.15 $507.78 $507.78 $527.34 $356.44 $142.58 $684.15 $278.31 $684.15 $684.15 $695.78 $684.15 $684.15 $513.38 $684.15 $684.15 $684.15 $342.08 $342.08 $541.85 $684.15 $547.32 $444.70 $684.15 N/A $397.01 $684.15 $410.49 $684.15 $684.15 $684.15 N/A N/A 352.251S SUP Custom 27203010 352.251S - REAMER SURG 12.5MM HEAD STERILE DISPOSABLE RIA BOTH IP/OP $684.50 $507.00 $121.78 $695.78 $684.15 $684.15 $684.15 $684.15 $684.15 $684.15 $121.78 $684.15 $684.15 $507.78 $507.78 $527.34 $356.44 $142.58 $684.15 $278.31 $684.15 $684.15 $695.78 $684.15 $684.15 $513.38 $684.15 $684.15 $684.15 $342.08 $342.08 $541.85 $684.15 $547.32 $444.70 $684.15 N/A $397.01 $684.15 $410.49 $684.15 $684.15 $684.15 N/A N/A 352.252S SUP Custom 27203010 352.252S - HEAD RMR DP FLUT 13MM STRL CNCL TIP SHRP EDG SS DISP IRR ASP BOTH IP/OP $684.50 $507.00 $121.78 $695.78 $684.15 $684.15 $684.15 $684.15 $684.15 $684.15 $121.78 $684.15 $684.15 $507.78 $507.78 $527.34 $356.44 $142.58 $684.15 $278.31 $684.15 $684.15 $695.78 $684.15 $684.15 $513.38 $684.15 $684.15 $684.15 $342.08 $342.08 $541.85 $684.15 $547.32 $444.70 $684.15 N/A $397.01 $684.15 $410.49 $684.15 $684.15 $684.15 N/A N/A 352.253S SUP Custom 27203010 352.253S - REAMER SURG 13.5MM HEAD STERILE DISPOSABLE RIA BOTH IP/OP $684.50 $507.00 $121.78 $695.78 $684.15 $684.15 $684.15 $684.15 $684.15 $684.15 $121.78 $684.15 $684.15 $507.78 $507.78 $527.34 $356.44 $142.58 $684.15 $278.31 $684.15 $684.15 $695.78 $684.15 $684.15 $513.38 $684.15 $684.15 $684.15 $342.08 $342.08 $541.85 $684.15 $547.32 $444.70 $684.15 N/A $397.01 $684.15 $410.49 $684.15 $684.15 $684.15 N/A N/A 352.254S SUP Custom 27203010 352.254S - REAMER SURG 14MM HEAD STERILE DISPOSABLE RIA BOTH IP/OP $684.50 $507.00 $121.78 $695.78 $684.15 $684.15 $684.15 $684.15 $684.15 $684.15 $121.78 $684.15 $684.15 $507.78 $507.78 $527.34 $356.44 $142.58 $684.15 $278.31 $684.15 $684.15 $695.78 $684.15 $684.15 $513.38 $684.15 $684.15 $684.15 $342.08 $342.08 $541.85 $684.15 $547.32 $444.70 $684.15 N/A $397.01 $684.15 $410.49 $684.15 $684.15 $684.15 N/A N/A 352.255S SUP Custom 27203010 352.255S - REAMER SURG 14.5MM CONICAL TIP DEEP FLUTE SHARP EDGE BOTH IP/OP $684.50 $507.00 $121.78 $695.78 $684.15 $684.15 $684.15 $684.15 $684.15 $684.15 $121.78 $684.15 $684.15 $507.78 $507.78 $527.34 $356.44 $142.58 $684.15 $278.31 $684.15 $684.15 $695.78 $684.15 $684.15 $513.38 $684.15 $684.15 $684.15 $342.08 $342.08 $541.85 $684.15 $547.32 $444.70 $684.15 N/A $397.01 $684.15 $410.49 $684.15 $684.15 $684.15 N/A N/A 352.256S SUP Custom 27203010 352.256S - HEAD RMR DP FLUT 15MM STRL CNCL TIP SHRP EDG SS DISP IRR ASP BOTH IP/OP $684.50 $507.00 $121.78 $695.78 $684.15 $684.15 $684.15 $684.15 $684.15 $684.15 $121.78 $684.15 $684.15 $507.78 $507.78 $527.34 $356.44 $142.58 $684.15 $278.31 $684.15 $684.15 $695.78 $684.15 $684.15 $513.38 $684.15 $684.15 $684.15 $342.08 $342.08 $541.85 $684.15 $547.32 $444.70 $684.15 N/A $397.01 $684.15 $410.49 $684.15 $684.15 $684.15 N/A N/A 352.257S SUP HCPCS C1713 352.257S - HEAD REAMER 15.5MM STERILE IRRIGATOR ASPIRAT BOTH IP/OP $684.50 $507.00 $135.79 $695.78 $307.87 $307.87 $307.87 $307.87 $684.15 $684.15 $684.15 $142.59 $684.15 $684.15 $684.15 $684.15 $684.15 $142.58 $684.15 $278.31 $404.67 $684.15 $695.78 $684.15 $684.15 $513.38 $684.15 $684.15 $684.15 $342.08 $342.08 $541.85 $684.15 $547.32 $307.87 $135.79 N/A $397.01 $684.15 $410.49 $684.15 $142.58 $684.15 N/A N/A 352.258S SUP Custom 27203010 352.258S - REAMER SURG 16MM HEAD STERILE DISPOSABLE RIA BOTH IP/OP $684.50 $507.00 $121.78 $695.78 $684.15 $684.15 $684.15 $684.15 $684.15 $684.15 $121.78 $684.15 $684.15 $507.78 $507.78 $527.34 $356.44 $142.58 $684.15 $278.31 $684.15 $684.15 $695.78 $684.15 $684.15 $513.38 $684.15 $684.15 $684.15 $342.08 $342.08 $541.85 $684.15 $547.32 $444.70 $684.15 N/A $397.01 $684.15 $410.49 $684.15 $684.15 $684.15 N/A N/A 352.259S SUP Custom 27203010 352.259S - REAMER SURG 16.5MM HEAD STERILE DISPOSABLE RIA BOTH IP/OP $684.50 $507.00 $121.78 $695.78 $684.15 $684.15 $684.15 $684.15 $684.15 $684.15 $121.78 $684.15 $684.15 $507.78 $507.78 $527.34 $356.44 $142.58 $684.15 $278.31 $684.15 $684.15 $695.78 $684.15 $684.15 $513.38 $684.15 $684.15 $684.15 $342.08 $342.08 $541.85 $684.15 $547.32 $444.70 $684.15 N/A $397.01 $684.15 $410.49 $684.15 $684.15 $684.15 N/A N/A 352.260S SUP Custom 27203010 352.260S - CLIP LOCKING SECURE ATTCH DRIVE SHAFT TUBE ASMBLY STERILE BOTH IP/OP $137.50 $102.00 $24.41 $139.45 $137.13 $137.13 $137.13 $137.13 $137.13 $137.13 $24.41 $137.13 $137.13 $101.78 $101.78 $105.70 $71.44 $28.58 $137.13 $55.78 $137.13 $137.13 $139.45 $137.13 $137.13 $103.13 $137.13 $137.13 $137.13 $68.57 $68.57 $108.61 $137.13 $109.70 $89.13 $137.13 N/A $79.75 $137.13 $82.28 $137.13 $137.13 $137.13 N/A N/A 3520-0240S SUP HCPCS C1713 3520-0240S - NAIL IM 120D 10MM 240MM STRL GAMMA3 LT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" N/A N/A 3520-0260S SUP HCPCS C1713 3520-0260S - NAIL INTRAMEDULLARY 120D 10MM 260MM GAMMA3 TITANIUM HIP LEFT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" N/A N/A 3520-0280S SUP HCPCS C1713 3520-0280S - NAIL INTRAMEDULLARY 120D 10MM 280MM GAMMA3 TITANIUM HIP LEFT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3520-0300S SUP HCPCS C1713 3520-0300S - NAIL INTRAMEDULLARY 120D 10MM 300MM GAMMA3 TITANIUM HIP LEFT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3520-0320S SUP HCPCS C1713 3520-0320S - NAIL INTRAMEDULLARY 120D 10MM 320MM GAMMA3 TITANIUM HIP LEFT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3520-0340S SUP HCPCS C1713 3520-0340S - NAIL INTRAMEDULLARY 120D 10MM 340MM GAMMA3 TITANIUM HIP LEFT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" N/A N/A 3520-0360S SUP HCPCS C1713 3520-0360S - NAIL INTRAMEDULLARY 120D 10MM 360MM GAMMA3 TITANIUM HIP LEFT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3520-0380S SUP HCPCS C1713 3520-0380S - NAIL INTRAMEDULLARY 120D 10MM 380MM GAMMA3 TITANIUM HIP LEFT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3520-0400S SUP HCPCS C1713 3520-0400S - NAIL INTRAMEDULLARY 120D 10MM 400MM GAMMA3 TITANIUM HIP LEFT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" N/A N/A 3520-0420S SUP HCPCS C1713 3520-0420S - NAIL IM 120D 10MM 420MM STRL GAMMA3 LT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3520-0440S SUP HCPCS C1713 3520-0440S - NAIL IM 120D 10MM 440MM STRL GAMMA3 LT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3520-0460S SUP HCPCS C1713 3520-0460S - NAIL IM 120D 10MM 460MM STRL GAMMA3 LT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3520-9-180 SUP HCPCS C1713 3520-9-180 - NAIL INTRAMEDULLARY 9MM 180MM RECONSTRUCTION LEFT RIGHT BOTH IP/OP "$2,942.50" "$2,177.00" $584.01 "$2,942.50" "$1,324.13" "$1,324.13" "$1,324.13" "$1,324.13" "$2,942.50" "$2,942.50" "$2,942.50" $613.29 "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" $613.25 "$2,942.50" "$1,177.00" "$1,450.65" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,206.88" "$2,942.50" "$2,942.50" "$2,942.50" "$1,471.25" "$1,471.25" "$2,330.46" "$2,942.50" "$2,354.00" "$1,324.13" $584.01 N/A "$1,706.65" "$2,942.50" "$2,942.50" "$2,942.50" $613.22 "$2,942.50" N/A N/A 3520-9-200 SUP HCPCS C1713 3520-9-200 - NAIL INTRAMEDULLARY 9MM 200MM RECONSTRUCTION LEFT RIGHT BOTH IP/OP "$2,942.50" "$2,177.00" $584.01 "$2,942.50" "$1,324.13" "$1,324.13" "$1,324.13" "$1,324.13" "$2,942.50" "$2,942.50" "$2,942.50" $613.29 "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" $613.25 "$2,942.50" "$2,942.50" "$1,450.65" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,206.88" "$2,942.50" "$2,942.50" "$2,942.50" "$1,471.25" "$1,471.25" "$2,330.46" "$2,942.50" "$2,354.00" "$1,324.13" $584.01 N/A "$1,706.65" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" N/A N/A 3520-9-220 SUP HCPCS C1713 3520-9-220 - NAIL INTRAMEDULLARY 9MM 220MM RECONSTRUCTION LEFT RIGHT BOTH IP/OP "$2,942.50" "$2,177.00" $584.01 "$2,942.50" "$1,324.13" "$1,324.13" "$1,324.13" "$1,324.13" "$2,942.50" "$2,942.50" "$2,942.50" $613.29 "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" $613.25 "$2,942.50" "$2,942.50" "$1,450.65" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,206.88" "$2,942.50" "$2,942.50" "$2,942.50" "$1,471.25" "$1,471.25" "$2,330.46" "$2,942.50" "$2,354.00" "$1,324.13" $584.01 N/A "$1,706.65" "$2,942.50" "$2,942.50" "$2,942.50" $613.22 "$2,942.50" N/A N/A 3520-9-240 SUP HCPCS C1713 3520-9-240 - NAIL INTRAMEDULLARY 9MM 240MM RECONSTRUCTION LEFT RIGHT BOTH IP/OP "$2,942.50" "$2,177.00" $584.01 "$2,942.50" "$1,324.13" "$1,324.13" "$1,324.13" "$1,324.13" "$2,942.50" "$2,942.50" "$2,942.50" $613.29 "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" $613.25 "$2,942.50" "$2,942.50" "$1,450.65" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,206.88" "$2,942.50" "$2,942.50" "$2,942.50" "$1,471.25" "$1,471.25" "$2,330.46" "$2,942.50" "$2,354.00" "$1,324.13" $584.01 N/A "$1,706.65" "$2,942.50" "$2,942.50" "$2,942.50" $613.22 "$2,942.50" N/A N/A 3520-9-250 SUP HCPCS C1713 3520-9-250 - NAIL INTRAMEDULLARY 9MM 250MM LOCK HUMERUS BOTH IP/OP "$2,942.50" "$2,177.00" $584.01 "$2,942.50" "$1,324.13" "$1,324.13" "$1,324.13" "$1,324.13" "$2,942.50" "$2,942.50" "$2,942.50" $613.29 "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" $613.25 "$2,942.50" "$2,942.50" "$1,450.65" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,206.88" "$2,942.50" "$2,942.50" "$2,942.50" "$1,471.25" "$1,471.25" "$2,330.46" "$2,942.50" "$2,354.00" "$1,324.13" $584.01 N/A "$1,706.65" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" N/A N/A 3520-9-260 SUP HCPCS C1713 3520-9-260 - NAIL INTRAMEDULLARY 9MM 260MM RECONSTRUCTION LEFT RIGHT BOTH IP/OP "$2,942.50" "$2,177.00" $584.01 "$2,942.50" "$1,324.13" "$1,324.13" "$1,324.13" "$1,324.13" "$2,942.50" "$2,942.50" "$2,942.50" $613.29 "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" $613.25 "$2,942.50" "$1,177.00" "$1,450.65" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,206.88" "$2,942.50" "$2,942.50" "$2,942.50" "$1,471.25" "$1,471.25" "$2,330.46" "$2,942.50" "$2,354.00" "$1,324.13" $584.01 N/A "$1,706.65" "$2,942.50" "$2,942.50" "$2,942.50" $613.22 "$2,942.50" N/A N/A 3520-9-270 SUP HCPCS C1713 3520-9-270 - NAIL INTRAMEDULLARY 9MM 270MM RECONSTRUCTION LEFT RIGHT BOTH IP/OP "$2,942.50" "$2,177.00" $584.01 "$2,942.50" "$1,324.13" "$1,324.13" "$1,324.13" "$1,324.13" "$2,942.50" "$2,942.50" "$2,942.50" $613.29 "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" $613.25 "$2,942.50" "$1,177.00" "$1,450.65" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,206.88" "$2,942.50" "$2,942.50" "$2,942.50" "$1,471.25" "$1,471.25" "$2,330.46" "$2,942.50" "$2,354.00" "$1,324.13" $584.01 N/A "$1,706.65" "$2,942.50" "$2,942.50" "$2,942.50" $613.22 "$2,942.50" N/A N/A 3520-9-280 SUP HCPCS C1713 3520-9-280 - NAIL INTRAMEDULLARY 9MM 280MM RECONSTRUCTION LEFT RIGHT BOTH IP/OP "$2,942.50" "$2,177.00" $584.01 "$2,942.50" "$1,324.13" "$1,324.13" "$1,324.13" "$1,324.13" "$2,942.50" "$2,942.50" "$2,942.50" $613.29 "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" $613.25 "$2,942.50" "$2,942.50" "$1,450.65" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,206.88" "$2,942.50" "$2,942.50" "$2,942.50" "$1,471.25" "$1,471.25" "$2,330.46" "$2,942.50" "$2,354.00" "$1,324.13" $584.01 N/A "$1,706.65" "$2,942.50" "$2,942.50" "$2,942.50" $613.22 "$2,942.50" N/A N/A 3520-9-300 SUP HCPCS C1713 3520-9-300 - NAIL INTRAMEDULLARY 9MM 300MM RECONSTRUCTION LEFT RIGHT BOTH IP/OP "$2,942.50" "$2,177.00" $584.01 "$2,942.50" "$1,324.13" "$1,324.13" "$1,324.13" "$1,324.13" "$2,942.50" "$2,942.50" "$2,942.50" $613.29 "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" $613.25 "$2,942.50" "$2,942.50" "$1,450.65" "$2,942.50" "$2,942.50" "$2,942.50" "$2,942.50" "$2,206.88" "$2,942.50" "$2,942.50" "$2,942.50" "$1,471.25" "$1,471.25" "$2,330.46" "$2,942.50" "$2,354.00" "$1,324.13" $584.01 N/A "$1,706.65" "$2,942.50" "$2,942.50" "$2,942.50" $613.22 "$2,942.50" N/A N/A 3520-9-945 SUP HCPCS C1713 3520-9-945 - NAIL INTRAMEDULLARY 5MM 45MM LOCKING SPREADING SCREW HUMERUS BOTH IP/OP $818.50 $606.00 $162.38 $818.13 $368.16 $368.16 $368.16 $368.16 $818.13 $818.13 $818.13 $170.52 $818.13 $818.13 $818.13 $818.13 $818.13 $170.51 $818.13 $327.25 $483.92 $818.13 $818.13 $818.13 $818.13 $613.88 $818.13 $818.13 $818.13 $409.07 $409.07 $647.96 $818.13 $654.50 $368.16 $162.38 N/A $474.73 $818.13 $490.88 $818.13 $170.50 $818.13 N/A N/A 3525-0260S SUP HCPCS C1713 3525-0260S - NAIL INTRAMEDULLARY 125D LONG 10MM 26CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3525-0280S SUP HCPCS C1713 3525-0280S - NAIL INTRAMEDULLARY 125D LONG 10MM 28CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3525-0300S SUP HCPCS C1713 3525-0300S - NAIL INTRAMEDULLARY 125D 10MM 30CM LOCK GAMMA3 TITANIUM HIP BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3525-0320S SUP HCPCS C1713 3525-0320S - NAIL INTRAMEDULLARY 125D LONG 10MM 32CM LOCK GAMA TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3525-0340S SUP HCPCS C1713 3525-0340S - NAIL INTRAMEDULLARY 125D LONG 10MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3525-0360S SUP HCPCS C1713 3525-0360S - NAIL INTRAMEDULLARY 125D LONG 10MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3525-0380S SUP HCPCS C1713 3525-0380S - NAIL INTRAMEDULLARY 125D LONG 10MM 380MM GAMMA3 TITANIUM HIP BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" "$3,668.60" "$3,668.60" N/A N/A 3525-0400S SUP HCPCS C1713 3525-0400S - NAIL INTRAMEDULLARY 125D LONG 10MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3525-0420S SUP HCPCS C1713 3525-0420S - GAMMA 3 S NAIL LEFT 10x420mm x 125 BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3525-0440S SUP HCPCS C1713 3525-0440S - GAMMA 3 S NAIL LEFT 10x440mm x 125 BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3525-0460S SUP HCPCS C1713 3525-0460S - NAIL IM 125D 10MM 460MM STRL GAMMA3 LT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$1,467.44" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 352506070E SUP HCPCS C1880 352506070E - SYSTEM EMBOLIC PROTECTION 6.5FR 0-32MM 5FR 70CM FILTER KIT BOTH IP/OP "$1,812.50" "$1,341.00" $377.74 "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" $377.74 "$1,812.50" $725.00 "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,359.38" "$1,812.50" "$1,812.50" "$1,812.50" $906.25 $906.25 "$1,435.50" "$1,812.50" "$1,450.00" $815.63 "$1,812.50" N/A "$1,051.25" "$1,812.50" "$1,087.50" "$1,812.50" "$1,812.50" "$1,812.50" N/A N/A 352506100E SUP HCPCS C1880 352506100E - FILTER EMBL 30- MM 5FR 100CM STRL LF OPTIONELITE INTRO SHTH BOTH IP/OP "$2,062.50" "$1,526.00" $429.85 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 "$2,062.50" N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" "$2,062.50" "$2,062.50" N/A N/A 3530-0260S SUP HCPCS C1713 3530-0260S - NAIL INTRAMEDULLARY 130D LONG 10MM 26CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3530-0280S SUP HCPCS C1713 3530-0280S - NAIL INTRAMEDULLARY 130D LONG 10MM 28CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3530-0300S SUP HCPCS C1713 3530-0300S - NAIL INTRAMEDULLARY 130D LONG 10MM 30CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3530-0320S SUP HCPCS C1713 3530-0320S - NAIL INTRAMEDULLARY 130D LONG 10MM 32CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3530-0340S SUP HCPCS C1713 3530-0340S - NAIL INTRAMEDULLARY 130D LONG 10MM 34CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3530-0360S SUP HCPCS C1713 3530-0360S - NAIL INTRAMEDULLARY 130D LONG 10MM 36CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3530-0380S SUP HCPCS C1713 3530-0380S - NAIL INTRAMEDULLARY 130D LONG 10MM 38CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3530-0400S SUP HCPCS C1713 3530-0400S - NAIL INTRAMEDULLARY 130D LONG 10MM 40CM LOCK GAMMA3 TITANIUM BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$3,668.60" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3530-0420S SUP HCPCS C1713 3530-0420S - GAMMA 3 S NAIL LEFT 10x420mm x 130 BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3530-0440S SUP HCPCS C1713 3530-0440S - GAMMA 3 S NAIL LEFT 10x440mm x 130 BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 3530-0460S SUP HCPCS C1713 3530-0460S - NAIL IM 130D 10MM 460MM STRL GAMMA3 LT BOTH IP/OP "$3,669.00" "$2,715.00" $728.13 "$3,668.60" "$1,650.87" "$1,650.87" "$1,650.87" "$1,650.87" "$3,668.60" "$3,668.60" "$3,668.60" $764.63 "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" $764.58 "$3,668.60" "$3,668.60" "$1,808.62" "$3,668.60" "$3,668.60" "$3,668.60" "$3,668.60" "$2,751.75" "$3,668.60" "$3,668.60" "$3,668.60" "$1,834.30" "$1,834.30" "$2,905.53" "$3,668.60" "$2,934.88" "$1,650.87" $728.13 N/A "$2,128.02" "$3,668.60" "$2,201.16" "$3,668.60" $764.54 "$3,668.60" N/A N/A 354-7212 SUP HCPCS C1789 354-7212 - EXPANDER TISS P6.6CM CNTR PRFL 11.7X10CM 350ML SLTX CPX3 STY BOTH IP/OP "$3,412.50" "$2,525.00" $677.30 "$3,412.50" "$1,535.63" "$1,535.63" "$1,535.63" "$1,535.63" "$3,412.50" "$3,412.50" "$3,412.50" $711.25 "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" $711.20 "$3,412.50" "$3,412.50" "$1,682.36" "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" "$2,559.38" "$3,412.50" "$3,412.50" "$3,412.50" "$1,706.25" "$1,706.25" "$2,702.70" "$3,412.50" "$2,730.00" "$1,535.63" $677.30 N/A "$1,979.25" "$3,412.50" "$3,412.50" "$3,412.50" $711.17 "$3,412.50" N/A N/A 354-7213 SUP HCPCS C1789 354-7213 - EXPANDER TISS P7CM MED HT 12.7X10.8CM 450CC STRL CPX3 BOTH IP/OP "$3,312.50" "$2,451.00" $657.45 "$3,312.50" "$1,490.63" "$1,490.63" "$1,490.63" "$1,490.63" "$3,312.50" "$3,312.50" "$3,312.50" $690.41 "$3,312.50" "$3,312.50" "$3,312.50" "$3,312.50" "$3,312.50" $690.36 "$3,312.50" "$3,312.50" "$1,633.06" "$3,312.50" "$3,312.50" "$3,312.50" "$3,312.50" "$2,484.38" "$3,312.50" "$3,312.50" "$3,312.50" "$1,656.25" "$1,656.25" "$2,623.50" "$3,312.50" "$2,650.00" "$1,490.63" $657.45 N/A "$1,921.25" "$3,312.50" "$3,312.50" "$3,312.50" $690.33 "$3,312.50" N/A N/A 354-7214 SUP HCPCS C1789 354-7214 - EXPANDER TISS P7.4CM CNTR PRFL 13.5X11.7CM 550ML SLTX CPX3 BOTH IP/OP "$3,412.50" "$2,525.00" $677.30 "$3,412.50" "$1,535.63" "$1,535.63" "$1,535.63" "$1,535.63" "$3,412.50" "$3,412.50" "$3,412.50" $711.25 "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" $711.20 "$3,412.50" "$3,412.50" "$1,682.36" "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" "$2,559.38" "$3,412.50" "$3,412.50" "$3,412.50" "$1,706.25" "$1,706.25" "$2,702.70" "$3,412.50" "$2,730.00" "$1,535.63" $677.30 N/A "$1,979.25" "$3,412.50" "$3,412.50" "$3,412.50" $711.17 "$3,412.50" N/A N/A 354-7215 SUP HCPCS C1789 354-7215 - EXPANDER TISS P7.6CM CNTR PRFL 14.6X12.6CM 650ML SLTX CPX3 BOTH IP/OP "$3,412.50" "$2,525.00" $677.30 "$3,412.50" "$1,535.63" "$1,535.63" "$1,535.63" "$1,535.63" "$3,412.50" "$3,412.50" "$3,412.50" $711.25 "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" $711.20 "$3,412.50" "$3,412.50" "$1,682.36" "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" "$2,559.38" "$3,412.50" "$3,412.50" "$3,412.50" "$1,706.25" "$1,706.25" "$2,702.70" "$3,412.50" "$2,730.00" "$1,535.63" $677.30 N/A "$1,979.25" "$3,412.50" "$3,412.50" "$3,412.50" $711.17 "$3,412.50" N/A N/A 354-9212 SUP HCPCS C1789 354-9212 - EXPANDER TISS P6.6CM CNTR PRFL MED HT 11.7X10CM 350ML CPX4 BOTH IP/OP "$2,937.50" "$2,174.00" $583.02 "$2,937.50" "$1,321.88" "$1,321.88" "$1,321.88" "$1,321.88" "$2,937.50" "$2,937.50" "$2,937.50" $612.25 "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" $612.21 "$2,937.50" "$2,937.50" "$1,448.19" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,203.13" "$2,937.50" "$2,937.50" "$2,937.50" "$1,468.75" "$1,468.75" "$2,326.50" "$2,937.50" "$2,350.00" "$1,321.88" $583.02 N/A "$1,703.75" "$2,937.50" "$2,937.50" "$2,937.50" $612.18 "$2,937.50" N/A N/A 355.399S SUP Custom 27203010 355.399S - HOOK EXTRACTION 650MM STERILE CANN INTRAMEDULLARY NAIL BOTH IP/OP $651.00 $482.00 $115.81 $661.65 $650.60 $650.60 $650.60 $650.60 $650.60 $650.60 $115.81 $650.60 $650.60 $482.88 $482.88 $501.48 $338.96 $135.59 $650.60 $264.66 $650.60 $650.60 $661.65 $650.60 $650.60 $488.25 $650.60 $650.60 $650.60 $325.30 $325.30 $515.28 $650.60 $520.48 $422.89 $650.60 N/A $377.58 $650.60 $390.36 $650.60 $650.60 $650.60 N/A N/A 3550-0-035 SUP HCPCS C1713 3550-0-035 - SCREW BONE 6.5MM 35MM 16MM GUIDED ASNIS 2 CORTICAL BOTH IP/OP $366.00 $271.00 $72.59 $365.75 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $216.34 $365.75 $365.75 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $365.75 $365.75 $76.22 $365.75 N/A N/A 3550-0-040 SUP HCPCS C1713 3550-0-040 - SCREW BONE 6.5MM 40MM 16MM GUIDE ASNIS II CORTICAL BOTH IP/OP $366.00 $271.00 $72.59 $365.75 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $146.30 $216.34 $365.75 $365.75 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $219.45 $365.75 $76.22 $365.75 N/A N/A 3550-0-045 SUP HCPCS C1713 3550-0-045 - SCREW BONE 6.5MM 45MM 16MM GUIDE ASNIS II CORTICAL BOTH IP/OP $366.00 $271.00 $72.59 $365.75 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $146.30 $216.34 $365.75 $365.75 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $219.45 $365.75 $76.22 $365.75 N/A N/A 3550-0-050 SUP HCPCS C1713 3550-0-050 - SCREW BONE 6.5MM 50MM 20MM CANN THREAD ASNIS CORTICAL BOTH IP/OP $366.00 $271.00 $72.59 $365.75 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $146.30 $216.34 $365.75 $365.75 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $219.45 $365.75 $76.22 $365.75 N/A N/A 3550-0-055 SUP HCPCS C1713 3550-0-055 - SCREW BONE 6.5MM 55MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $366.00 $271.00 $72.59 $365.75 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $216.34 $365.75 $365.75 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $219.45 $365.75 $76.22 $365.75 N/A N/A 3550-0-060 SUP HCPCS C1713 3550-0-060 - SCREW BONE 6.5MM 60MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $366.00 $271.00 $72.59 $365.75 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $216.34 $365.75 $365.75 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $219.45 $365.75 $76.22 $365.75 N/A N/A 3550-0-065 SUP HCPCS C1713 3550-0-065 - SCREW BONE 6.5MM 65MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $366.00 $271.00 $72.59 $365.75 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $216.34 $365.75 $365.75 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $219.45 $365.75 $76.22 $365.75 N/A N/A 3550-0-070 SUP HCPCS C1713 3550-0-070 - SCREW BONE 6.5MM 70MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $366.00 $271.00 $72.59 $365.75 $164.59 $164.59 $164.59 $164.59 $365.75 $365.75 $365.75 $76.23 $365.75 $365.75 $365.75 $365.75 $365.75 $76.23 $365.75 $146.30 $216.34 $365.75 $365.75 $365.75 $365.75 $274.50 $365.75 $365.75 $365.75 $182.88 $182.88 $289.67 $365.75 $292.60 $164.59 $72.59 N/A $212.28 $365.75 $219.45 $365.75 $76.22 $365.75 N/A N/A 3550-0-075 SUP HCPCS C1713 3550-0-075 - SCREW BONE 6.5MM 75MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $403.00 $298.00 $79.96 $402.88 $181.30 $181.30 $181.30 $181.30 $402.88 $402.88 $402.88 $83.97 $402.88 $402.88 $402.88 $402.88 $402.88 $83.96 $402.88 $161.15 $238.30 $402.88 $402.88 $402.88 $402.88 $302.25 $402.88 $402.88 $402.88 $201.44 $201.44 $319.08 $402.88 $322.30 $181.30 $79.96 N/A $233.74 $402.88 $241.73 $402.88 $83.96 $402.88 N/A N/A 3550-0-080 SUP HCPCS C1713 3550-0-080 - SCREW BONE 6.5MM 80MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $165.00 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A 3550-0-085 SUP HCPCS C1713 3550-0-085 - SCREW BONE 6.5MM 85MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $403.00 $298.00 $79.96 $402.88 $181.30 $181.30 $181.30 $181.30 $402.88 $402.88 $402.88 $83.97 $402.88 $402.88 $402.88 $402.88 $402.88 $83.96 $402.88 $402.88 $238.30 $402.88 $402.88 $402.88 $402.88 $302.25 $402.88 $402.88 $402.88 $201.44 $201.44 $319.08 $402.88 $322.30 $181.30 $79.96 N/A $233.74 $402.88 $241.73 $402.88 $83.96 $402.88 N/A N/A 3550-0-090 SUP HCPCS C1713 3550-0-090 - SCREW BONE 6.5MM 90MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A 3550-0-095 SUP HCPCS C1713 3550-0-095 - SCREW BONE 6.5MM 95MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $403.00 $298.00 $79.96 $402.88 $181.30 $181.30 $181.30 $181.30 $402.88 $402.88 $402.88 $83.97 $402.88 $402.88 $402.88 $402.88 $402.88 $83.96 $402.88 $402.88 $238.30 $402.88 $402.88 $402.88 $402.88 $302.25 $402.88 $402.88 $402.88 $201.44 $201.44 $319.08 $402.88 $322.30 $181.30 $79.96 N/A $233.74 $402.88 $241.73 $402.88 $83.96 $402.88 N/A N/A 3550-0-100 SUP HCPCS C1713 3550-0-100 - SCREW BONE 6.5MM 100MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $403.00 $298.00 $79.96 $402.88 $181.30 $181.30 $181.30 $181.30 $402.88 $402.88 $402.88 $83.97 $402.88 $402.88 $402.88 $402.88 $402.88 $83.96 $402.88 $402.88 $238.30 $402.88 $402.88 $402.88 $402.88 $302.25 $402.88 $402.88 $402.88 $201.44 $201.44 $319.08 $402.88 $322.30 $181.30 $79.96 N/A $233.74 $402.88 $402.88 $402.88 $83.96 $402.88 N/A N/A 3550-0-105 SUP HCPCS C1713 3550-0-105 - SCREW BONE 6.5MM 105MM 20MM GUIDED ASNIS 2 CORTICAL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A 3550-0-110 SUP HCPCS C1713 3550-0-110 - SCREW BONE 6.5MM 110MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A 3550-0-115 SUP HCPCS C1713 3550-0-115 - SCREW BONE 6.5MM 115MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A 3550-0-120 SUP HCPCS C1713 3550-0-120 - SCREW BONE 6.5MM 120MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A 3550-0-125 SUP HCPCS C1713 3550-0-125 - SCREW BONE 6.5MM 125MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $165.00 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A 3550-0-130 SUP HCPCS C1713 3550-0-130 - SCREW BONE 6.5MM 130MM 20MM GUIDE ASNIS II CORTICAL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $165.00 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A 3550-4-024 SUP HCPCS C1713 3550-4-024 - ASNIS2 GUIDED SCREW 5.0CANC 24 BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $273.63 $273.63 $57.02 $273.63 N/A N/A 3550-4-026 SUP HCPCS C1713 3550-4-026 - SCREW BONE PTHRD 5MM 26MM GUIDE CANN ASNIS II CANCELLOUS BOTH IP/OP $257.50 $191.00 $51.03 $257.13 $115.71 $115.71 $115.71 $115.71 $257.13 $257.13 $257.13 $53.59 $257.13 $257.13 $257.13 $257.13 $257.13 $53.59 $257.13 $257.13 $152.09 $257.13 $257.13 $257.13 $257.13 $193.13 $257.13 $257.13 $257.13 $128.57 $128.57 $203.65 $257.13 $205.70 $115.71 $51.03 N/A $149.35 $257.13 $257.13 $257.13 $53.59 $257.13 N/A N/A 3550-4-028 SUP HCPCS C1713 3550-4-028 - SCREW BONE PTHRD 5MM 28MM CANN CANCELLOUS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 3550-4-030 SUP HCPCS C1713 3550-4-030 - SCREW BONE PTHRD 5MM 30MM CANN CANCELLOUS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 3550-4-032 SUP HCPCS C1713 3550-4-032 - SCREW BONE PTHRD 5MM 32MM CANN CANCELLOUS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 3550-4-034 SUP HCPCS C1713 3550-4-034 - SCREW BONE PTHRD 5MM 34MM GUIDE CANN ASNIS II STAINLESS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 3550-4-036 SUP HCPCS C1713 3550-4-036 - SCREW BONE PTHRD 5MM 36MM GUIDE CANN ASNIS II CANCELLOUS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 3550-4-038 SUP HCPCS C1713 3550-4-038 - SCREW BONE PTHRD 5MM 38MM CANN CANCELLOUS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 3550-4-040 SUP HCPCS C1713 3550-4-040 - SCREW BONE PTHRD 5MM 40MM CANN CANCELLOUS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $273.63 $273.63 $57.02 $273.63 N/A N/A 3550-4-042 SUP HCPCS C1713 3550-4-042 - SCREW BONE PTHRD 5MM 42MM GUIDE CANN ASNIS II CANCELLOUS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 3550-4-045 SUP HCPCS C1713 3550-4-045 - SCREW BONE PTHRD 5MM 45MM GUIDE CANN ASNIS II CANCELLOUS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 3550-4-055 SUP HCPCS C1713 3550-4-055 - SCREW BONE PTHRD 5MM 55MM CANN ASNIS 2 CANCELLOUS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $273.63 $273.63 $57.02 $273.63 N/A N/A 3550-4-060 SUP HCPCS C1713 3550-4-060 - SCREW BONE PTHRD 5MM 60MM CANN ASNIS 2 CANCELLOUS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $273.63 $273.63 $57.02 $273.63 N/A N/A 3550-4-065 SUP HCPCS C1713 3550-4-065 - SCREW BONE PTHRD 5MM 65MM GUIDE CANN ASNIS II CANCELLOUS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 3550-4-070 SUP HCPCS C1713 3550-4-070 - SCREW BONE PTHRD 5MM 70MM CANN CANCELLOUS BOTH IP/OP $274.00 $203.00 $54.31 $273.63 $123.13 $123.13 $123.13 $123.13 $273.63 $273.63 $273.63 $57.03 $273.63 $273.63 $273.63 $273.63 $273.63 $57.03 $273.63 $109.45 $161.85 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $123.13 $54.31 N/A $158.92 $273.63 $164.18 $273.63 $57.02 $273.63 N/A N/A 3550-5-000 SUP Custom 27803010 3550-5-000 - SMALL WASHER BOTH IP/OP $65.00 $48.00 $11.50 $64.63 $64.63 $64.63 $64.63 $64.63 $64.63 $64.63 $11.50 $64.63 $64.63 $64.63 $64.63 $64.63 $64.63 $13.47 $64.63 $25.85 $64.63 $64.63 $64.63 $64.63 $64.63 $48.75 $64.63 $64.63 $64.63 $32.32 $32.32 $51.19 $64.63 $51.70 $29.08 $64.63 N/A $37.70 $64.63 $38.78 $64.63 $64.63 $64.63 N/A N/A 3600-100 SUP HCPCS C1729 3600-100 - DRAIN INCISION 1 COLLECT 1 CHAMBER 1 PATIENT TUBE DRY BOTH IP/OP $71.00 $53.00 $14.07 $88.65 $38.49 $38.49 $38.49 $38.49 $70.88 $70.88 $70.88 $14.77 $70.88 $52.61 $52.61 $54.63 $36.93 $14.77 $70.88 $88.65 $41.93 $70.88 $88.65 $70.88 $70.88 $53.25 $70.88 $70.88 $70.88 $35.44 $35.44 $56.14 $70.88 $56.70 $46.07 $14.07 N/A $41.18 $70.88 $70.88 $70.88 $14.77 $70.88 N/A N/A 3602519A SUP HCPCS C1713 3602519A - CONNECTOR ROD ANG 19MM OPN SPNE LAT BOTH IP/OP "$1,794.00" "$1,328.00" $356.06 "$1,794.00" $807.30 $807.30 $807.30 $807.30 "$1,794.00" "$1,794.00" "$1,794.00" $373.91 "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" $373.89 "$1,794.00" "$1,794.00" "$1,061.15" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,345.50" "$1,794.00" "$1,794.00" "$1,794.00" $897.00 $897.00 "$1,420.85" "$1,794.00" "$1,435.20" $807.30 $356.06 N/A "$1,040.52" "$1,794.00" "$1,794.00" "$1,794.00" $373.87 "$1,794.00" N/A N/A 360PT3522 SUP HCPCS C1713 360PT3522 - SCREW BN P/T 3.5MM 22MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 360PT3524 SUP HCPCS C1713 360PT3524 - SCREW BN P/T 3.5MM 24MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 360PT3526 SUP HCPCS C1713 360PT3526 - SCREW BN P/T 3.5MM 26MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 360PT3528 SUP HCPCS C1713 360PT3528 - SCREW BN P/T 3.5MM 28MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 360PT3530 SUP HCPCS C1713 360PT3530 - SCREW BN P/T 3.5MM 30MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 360PT4022 SUP HCPCS C1713 360PT4022 - SCREW BN P/T 4MM 22MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 360PT4024 SUP HCPCS C1713 360PT4024 - SCREW BN P/T 4MM 24MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 360PT4026 SUP HCPCS C1713 360PT4026 - SCREW BN P/T 4MM 26MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 360PT4028 SUP HCPCS C1713 360PT4028 - SCREW BN P/T 4MM 28MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 360PT4030 SUP HCPCS C1713 360PT4030 - SCREW BN P/T 4MM 30MM MA SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 3704-0-040 SUP Custom 27803010 3704-0-040 - CABLE/SLEEVE ORTHOPEDIC 1.6MM BEAD SET DALL-MILES STAINLESS BOTH IP/OP $757.50 $561.00 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $303.00 $757.50 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $757.50 N/A $439.35 $757.50 $454.50 $757.50 $757.50 $757.50 N/A N/A 3704-0-050 SUP Custom 27803010 3704-0-050 - CABLE/SLEEVE ORTHOPEDIC LP 2MM BEAD SET DALL-MILES STAINLESS BOTH IP/OP $757.50 $561.00 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $303.00 $757.50 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $757.50 N/A $439.35 $757.50 $454.50 $757.50 $757.50 $757.50 N/A N/A 3704-0-410 SUP Custom 27803010 3704-0-410 - CABLE/SLEEVE ORTHOPEDIC FLAT 1.6MM SET LP DALL-MILES BOTH IP/OP $757.50 $561.00 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $303.00 $757.50 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $757.50 N/A $439.35 $757.50 $454.50 $757.50 $757.50 $757.50 N/A N/A 3704-0-510 SUP Custom 27803010 3704-0-510 - CABLE/SLEEVE ORTHOPEDIC 2MM BEAD SET DALL-MILES STAINLESS BOTH IP/OP $757.50 $561.00 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $303.00 $757.50 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $757.50 N/A $439.35 $757.50 $454.50 $757.50 $757.50 $757.50 N/A N/A 3704-1-100 SUP Custom 27803010 3704-1-100 - SLEEVE CABLE SMALL DALL-MILES STAINLESS STEEL HIP BOTH IP/OP $757.50 $561.00 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $303.00 $757.50 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $757.50 N/A $439.35 $757.50 $454.50 $757.50 $757.50 $757.50 N/A N/A 3704-1-110 SUP Custom 27803010 3704-1-110 - SLEEVE CABLE MEDIUM DALL-MILES STAINLESS STEEL HIP BOTH IP/OP $757.50 $561.00 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $303.00 $757.50 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $757.50 N/A $439.35 $757.50 $454.50 $757.50 $757.50 $757.50 N/A N/A 3704-2-070 SUP Custom 27803010 3704-2-070 - GRIP CABLE SMALL 43MM DALL-MILES STAINLESS STEEL HIP TROC BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 3704-2-080 SUP Custom 27803010 3704-2-080 - GRIP CABLE MEDIUM 48MM DALL-MILES STAINLESS STEEL HIP TROC BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 3704-2-081 SUP HCPCS C1713 3704-2-081 - PLATE BONE MEDIUM 100MM GRIP DALL-MILES STAINLESS STEEL HIP BOTH IP/OP "$2,610.00" "$1,931.00" $518.02 "$2,610.00" "$1,174.50" "$1,174.50" "$1,174.50" "$1,174.50" "$2,610.00" "$2,610.00" "$2,610.00" $543.99 "$2,610.00" "$2,610.00" "$2,610.00" "$2,610.00" "$2,610.00" $543.95 "$2,610.00" "$1,044.00" "$1,286.73" "$2,610.00" "$2,610.00" "$2,610.00" "$2,610.00" "$1,957.50" "$2,610.00" "$2,610.00" "$2,610.00" "$1,305.00" "$1,305.00" "$2,067.12" "$2,610.00" "$2,088.00" "$1,174.50" $518.02 N/A "$1,513.80" "$2,610.00" "$1,566.00" "$2,610.00" $543.92 "$2,610.00" N/A N/A 3704-2-082 SUP Custom 27803010 3704-2-082 - PLATE BONE MEDIUM 150MM GRIP DALL-MILES STAINLESS STEEL HIP BOTH IP/OP "$3,422.50" "$2,533.00" $609.21 "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" $609.21 "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" $713.29 "$3,422.50" "$1,369.00" "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" "$2,566.88" "$3,422.50" "$3,422.50" "$3,422.50" "$1,711.25" "$1,711.25" "$2,710.62" "$3,422.50" "$2,738.00" "$1,540.13" "$3,422.50" N/A "$1,985.05" "$3,422.50" "$2,053.50" "$3,422.50" "$3,422.50" "$3,422.50" N/A N/A 3704-2-083 SUP Custom 27803010 3704-2-083 - PLATE BONE MEDIUM 200MM GRIP DALL-MILES STAINLESS STEEL HIP BOTH IP/OP "$4,240.00" "$3,138.00" $754.72 "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" $754.72 "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" $883.66 "$4,240.00" "$1,696.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$3,180.00" "$4,240.00" "$4,240.00" "$4,240.00" "$2,120.00" "$2,120.00" "$3,358.08" "$4,240.00" "$3,392.00" "$1,908.00" "$4,240.00" N/A "$2,459.20" "$4,240.00" "$2,544.00" "$4,240.00" "$4,240.00" "$4,240.00" N/A N/A 3704-2-090 SUP Custom 27803010 3704-2-090 - GRIP CABLE LARGE 200MM DALL-MILES STAINLESS STEEL HIP TROC BOTH IP/OP "$1,800.00" "$1,332.00" $320.40 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $320.40 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" $375.14 "$1,800.00" $720.00 "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,350.00" "$1,800.00" "$1,800.00" "$1,800.00" $900.00 $900.00 "$1,425.60" "$1,800.00" "$1,440.00" $810.00 "$1,800.00" N/A "$1,044.00" "$1,800.00" "$1,080.00" "$1,800.00" "$1,800.00" "$1,800.00" N/A N/A 3704-2-091 SUP Custom 27803010 3704-2-091 - PLATE BONE LARGE 110MM GRIP DALL-MILES STAINLESS STEEL HIP BOTH IP/OP "$2,217.50" "$1,641.00" $394.72 "$2,217.50" "$2,217.50" "$2,217.50" "$2,217.50" "$2,217.50" "$2,217.50" "$2,217.50" $394.72 "$2,217.50" "$2,217.50" "$2,217.50" "$2,217.50" "$2,217.50" "$2,217.50" $462.15 "$2,217.50" $887.00 "$2,217.50" "$2,217.50" "$2,217.50" "$2,217.50" "$2,217.50" "$1,663.13" "$2,217.50" "$2,217.50" "$2,217.50" "$1,108.75" "$1,108.75" "$1,756.26" "$2,217.50" "$1,774.00" $997.88 "$2,217.50" N/A "$1,286.15" "$2,217.50" "$1,330.50" "$2,217.50" "$2,217.50" "$2,217.50" N/A N/A 3704-2-092 SUP Custom 27803010 3704-2-092 - PLATE BONE LARGE 160MM GRIP DALL-MILES STAINLESS STEEL HIP BOTH IP/OP "$3,422.50" "$2,533.00" $609.21 "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" $609.21 "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" $713.29 "$3,422.50" "$1,369.00" "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" "$3,422.50" "$2,566.88" "$3,422.50" "$3,422.50" "$3,422.50" "$1,711.25" "$1,711.25" "$2,710.62" "$3,422.50" "$2,738.00" "$1,540.13" "$3,422.50" N/A "$1,985.05" "$3,422.50" "$2,053.50" "$3,422.50" "$3,422.50" "$3,422.50" N/A N/A 3704-2-093 SUP Custom 27803010 3704-2-093 - PLATE BONE LARGE 210MM GRIP DALL-MILES STAINLESS STEEL HIP BOTH IP/OP "$4,240.00" "$3,138.00" $754.72 "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" $754.72 "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" $883.66 "$4,240.00" "$1,696.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$4,240.00" "$3,180.00" "$4,240.00" "$4,240.00" "$4,240.00" "$2,120.00" "$2,120.00" "$3,358.08" "$4,240.00" "$3,392.00" "$1,908.00" "$4,240.00" N/A "$2,459.20" "$4,240.00" "$2,544.00" "$4,240.00" "$4,240.00" "$4,240.00" N/A N/A 3704-3-100 SUP HCPCS C1713 3704-3-100 - PLATE BONE BROAD 6.5IN 5 HOLE 6 GROOVE COMPRESSION ROUND END BOTH IP/OP "$1,190.00" $881.00 $236.19 "$1,190.00" $535.50 $535.50 $535.50 $535.50 "$1,190.00" "$1,190.00" "$1,190.00" $248.03 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $248.01 "$1,190.00" "$1,190.00" $703.89 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $892.50 "$1,190.00" "$1,190.00" "$1,190.00" $595.00 $595.00 $942.48 "$1,190.00" $952.00 $535.50 $236.19 N/A $690.20 "$1,190.00" $714.00 "$1,190.00" $248.00 "$1,190.00" N/A N/A 3704-3-110 SUP HCPCS C1713 3704-3-110 - PLATE BONE BROAD 8IN 7 HOLE 8 GROOVE COMPRESSION ROUND END BOTH IP/OP "$1,190.00" $881.00 $236.19 "$1,190.00" $535.50 $535.50 $535.50 $535.50 "$1,190.00" "$1,190.00" "$1,190.00" $248.03 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $248.01 "$1,190.00" "$1,190.00" $703.89 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $892.50 "$1,190.00" "$1,190.00" "$1,190.00" $595.00 $595.00 $942.48 "$1,190.00" $952.00 $535.50 $236.19 N/A $690.20 "$1,190.00" $714.00 "$1,190.00" $248.00 "$1,190.00" N/A N/A 3704-3-120 SUP HCPCS C1713 3704-3-120 - PLATE BONE BROAD 10IN 9 HOLE 10 GROOVE COMPRESSION ROUND END BOTH IP/OP "$1,190.00" $881.00 $236.19 "$1,190.00" $535.50 $535.50 $535.50 $535.50 "$1,190.00" "$1,190.00" "$1,190.00" $248.03 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $248.01 "$1,190.00" $476.00 $703.89 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $892.50 "$1,190.00" "$1,190.00" "$1,190.00" $595.00 $595.00 $942.48 "$1,190.00" $952.00 $535.50 $236.19 N/A $690.20 "$1,190.00" $714.00 "$1,190.00" $248.00 "$1,190.00" N/A N/A 3704-3-130 SUP HCPCS C1713 3704-3-130 - PLATE BONE BROAD 12IN 11 HOLE 12 GROOVE COMPRESSION ROUND BOTH IP/OP "$1,190.00" $881.00 $236.19 "$1,190.00" $535.50 $535.50 $535.50 $535.50 "$1,190.00" "$1,190.00" "$1,190.00" $248.03 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $248.01 "$1,190.00" $476.00 $703.89 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $892.50 "$1,190.00" "$1,190.00" "$1,190.00" $595.00 $595.00 $942.48 "$1,190.00" $952.00 $535.50 $236.19 N/A $690.20 "$1,190.00" $714.00 "$1,190.00" $248.00 "$1,190.00" N/A N/A 3704-8-236 SUP Custom 27803010 3704-8-236 - CABLE ORTHOPEDIC 1.6MM SLEEVE RECONSTRUCTION TRAUMA BOTH IP/OP $757.50 $561.00 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $303.00 $757.50 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $757.50 N/A $439.35 $757.50 $454.50 $757.50 $757.50 $757.50 N/A N/A 3704-8-240 SUP Custom 27803010 3704-8-240 - CABLE ORTHOPEDIC 2MM 650MM DALL-MILES STAINLESS STEEL HIP BOTH IP/OP $757.50 $561.00 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $303.00 $757.50 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $757.50 N/A $439.35 $757.50 $454.50 $757.50 $757.50 $757.50 N/A N/A 370605.S SUP HCPCS A6209 370605.S - DRESSING WND THK10MM 6IN 665X802MM STRL LF ABTHERA VSCR PCTV BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $475.13 $475.13 $475.13 $475.13 $875.00 $875.00 $875.00 $182.37 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A 370642.S SUP HCPCS A6209 370642.S - SET TBG ABTHERA QCK ACC STABLIZED BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 375-535-000 SUP Custom 27203010 375-535-000 - BLADE SHAVER 3.5MM ARTHRO LATEX FREE FORMULA TOMCAT STERILE BOTH IP/OP $187.00 $138.00 $33.21 $186.55 $186.55 $186.55 $186.55 $186.55 $186.55 $186.55 $33.21 $186.55 $186.55 $138.46 $138.46 $143.79 $97.19 $38.88 $186.55 $74.62 $186.55 $186.55 $186.55 $186.55 $186.55 $140.25 $186.55 $186.55 $186.55 $93.28 $93.28 $147.75 $186.55 $149.24 $121.26 $186.55 N/A $108.46 $186.55 $111.93 $186.55 $186.55 $186.55 N/A N/A 375-542-000 SUP Custom 27203010 375-542-000 - BLADE SHAVER 4MM RESECTOR LATEX FREE FORMULA SERIES F BOTH IP/OP $143.50 $106.00 $25.53 $143.43 $143.43 $143.43 $143.43 $143.43 $143.43 $143.43 $25.53 $143.43 $143.43 $106.45 $106.45 $110.56 $74.73 $29.89 $143.43 $57.37 $143.43 $143.43 $143.43 $143.43 $143.43 $107.63 $143.43 $143.43 $143.43 $71.72 $71.72 $113.60 $143.43 $114.74 $93.23 $143.43 N/A $83.23 $143.43 $86.06 $143.43 $143.43 $143.43 N/A N/A 375-544-000 SUP Custom 27203010 375-544-000 - BLADE SHAVER STR 4MM CUTTER ARTHRO LATEX FREE FORMULA BOTH IP/OP $143.50 $106.00 $25.53 $143.43 $143.43 $143.43 $143.43 $143.43 $143.43 $143.43 $25.53 $143.43 $143.43 $106.45 $106.45 $110.56 $74.73 $29.89 $143.43 $57.37 $143.43 $143.43 $143.43 $143.43 $143.43 $107.63 $143.43 $143.43 $143.43 $71.72 $71.72 $113.60 $143.43 $114.74 $93.23 $143.43 N/A $83.23 $143.43 $86.06 $143.43 $143.43 $143.43 N/A N/A 375-545-000 SUP Custom 27203010 375-545-000 - BLADE SHAVER 4MM ARTHRO TOMCAT STERILE BOTH IP/OP $139.00 $103.00 $24.67 $138.58 $138.58 $138.58 $138.58 $138.58 $138.58 $138.58 $24.67 $138.58 $138.58 $102.85 $102.85 $106.82 $72.20 $28.88 $138.58 $55.43 $138.58 $138.58 $138.58 $138.58 $138.58 $104.25 $138.58 $138.58 $138.58 $69.29 $69.29 $109.76 $138.58 $110.86 $90.08 $138.58 N/A $80.62 $138.58 $83.15 $138.58 $138.58 $138.58 N/A N/A 375-554-000 SUP Custom 27203010 375-554-000 - BLADE SHAVER 5MM AGGRESSIVE PLUS ARTHRO FORMULA STERILE BOTH IP/OP $187.00 $138.00 $33.21 $186.55 $186.55 $186.55 $186.55 $186.55 $186.55 $186.55 $33.21 $186.55 $186.55 $138.46 $138.46 $143.79 $97.19 $38.88 $186.55 $74.62 $186.55 $186.55 $186.55 $186.55 $186.55 $140.25 $186.55 $186.55 $186.55 $93.28 $93.28 $147.75 $186.55 $149.24 $121.26 $186.55 N/A $108.46 $186.55 $111.93 $186.55 $186.55 $186.55 N/A N/A 375-555-000 SUP Custom 27203010 375-555-000 - CUTTER ENDSCP 5MM TOMCAT FORMULA STERILE BOTH IP/OP $135.00 $100.00 $24.02 $134.94 $134.94 $134.94 $134.94 $134.94 $134.94 $134.94 $24.02 $134.94 $134.94 $100.15 $100.15 $104.01 $70.30 $28.12 $134.94 $53.98 $134.94 $134.94 $134.94 $134.94 $134.94 $101.25 $134.94 $134.94 $134.94 $67.47 $67.47 $106.87 $134.94 $107.95 $87.71 $134.94 N/A $78.30 $134.94 $80.96 $134.94 $134.94 $134.94 N/A N/A 375-562-000 SUP Custom 27203010 375-562-000 - CUTTER ENDSCP 5.5MM RESECTOR LATEX FREE FORMULA STERILE BOTH IP/OP $139.00 $103.00 $24.67 $138.58 $138.58 $138.58 $138.58 $138.58 $138.58 $138.58 $24.67 $138.58 $138.58 $102.85 $102.85 $106.82 $72.20 $28.88 $138.58 $55.43 $138.58 $138.58 $138.58 $138.58 $138.58 $104.25 $138.58 $138.58 $138.58 $69.29 $69.29 $109.76 $138.58 $110.86 $90.08 $138.58 N/A $80.62 $138.58 $83.15 $138.58 $138.58 $138.58 N/A N/A 375-564-000 SUP Custom 27203010 375-564-000 - BLADE SHAVER 5.5MM AGGRESSIVE PLUS STERILE SERIES F BOTH IP/OP $187.00 $138.00 $33.21 $186.55 $186.55 $186.55 $186.55 $186.55 $186.55 $186.55 $33.21 $186.55 $186.55 $138.46 $138.46 $143.79 $97.19 $38.88 $186.55 $74.62 $186.55 $186.55 $186.55 $186.55 $186.55 $140.25 $186.55 $186.55 $186.55 $93.28 $93.28 $147.75 $186.55 $149.24 $121.26 $186.55 N/A $108.46 $186.55 $111.93 $186.55 $186.55 $186.55 N/A N/A 375-565-000 SUP Custom 27203010 375-565-000 - BLADE SHAVER 5.5MM CUTTER ARTHRO FORMULA TOMCAT STERILE BOTH IP/OP $187.00 $138.00 $33.21 $186.55 $186.55 $186.55 $186.55 $186.55 $186.55 $186.55 $33.21 $186.55 $186.55 $138.46 $138.46 $143.79 $97.19 $38.88 $186.55 $74.62 $186.55 $186.55 $186.55 $186.55 $186.55 $140.25 $186.55 $186.55 $186.55 $93.28 $93.28 $147.75 $186.55 $149.24 $121.26 $186.55 N/A $108.46 $186.55 $111.93 $186.55 $186.55 $186.55 N/A N/A 375-628-000 SUP Custom 27203010 375-628-000 - BLADE SHAVER 2.5MM AGGRESSIVE FORMULA SMALL JOINT STERILE BOTH IP/OP $143.50 $106.00 $25.53 $143.43 $143.43 $143.43 $143.43 $143.43 $143.43 $143.43 $25.53 $143.43 $143.43 $106.45 $106.45 $110.56 $74.73 $29.89 $143.43 $57.37 $143.43 $143.43 $143.43 $143.43 $143.43 $107.63 $143.43 $143.43 $143.43 $71.72 $71.72 $113.60 $143.43 $114.74 $93.23 $143.43 N/A $83.23 $143.43 $86.06 $143.43 $143.43 $143.43 N/A N/A 375-636-000 SUP Custom 27203010 375-636-000 - BLADE SHAVER 3.5MM FULL RAD FORMULA SMALL JOINT STERILE BOTH IP/OP $187.00 $138.00 $33.21 $186.55 $186.55 $186.55 $186.55 $186.55 $186.55 $186.55 $33.21 $186.55 $186.55 $138.46 $138.46 $143.79 $97.19 $38.88 $186.55 $74.62 $186.55 $186.55 $186.55 $186.55 $186.55 $140.25 $186.55 $186.55 $186.55 $93.28 $93.28 $147.75 $186.55 $149.24 $121.26 $186.55 N/A $108.46 $186.55 $111.93 $186.55 $186.55 $186.55 N/A N/A 375-638-000 SUP Custom 27203010 375-638-000 - CUTTER ENDSCP 3.5MM AGGRESSIVE FORMULA SMALL JOINT STERILE BOTH IP/OP $187.00 $138.00 $33.21 $186.55 $186.55 $186.55 $186.55 $186.55 $186.55 $186.55 $33.21 $186.55 $186.55 $138.46 $138.46 $143.79 $97.19 $38.88 $186.55 $74.62 $186.55 $186.55 $186.55 $186.55 $186.55 $140.25 $186.55 $186.55 $186.55 $93.28 $93.28 $147.75 $186.55 $149.24 $121.26 $186.55 N/A $108.46 $186.55 $111.93 $186.55 $186.55 $186.55 N/A N/A 375-641-000 SUP Custom 27203010 375-641-000 - BLADE SHAVER 2MM ABRASION HOODED ARTHRO FORMULA STERILE BOTH IP/OP $197.50 $146.00 $35.07 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $35.07 $197.05 $197.05 $146.25 $146.25 $151.89 $102.66 $41.07 $197.05 $78.82 $197.05 $197.05 $197.05 $197.05 $197.05 $148.13 $197.05 $197.05 $197.05 $98.53 $98.53 $156.06 $197.05 $157.64 $128.08 $197.05 N/A $114.55 $197.05 $118.23 $197.05 $197.05 $197.05 N/A N/A 375-647-000 SUP Custom 27203010 375-647-000 - BURR SHAVER 3MM ABRASION HOODED ARTHRO FORMULA SMALL JOINT BOTH IP/OP $197.50 $146.00 $35.07 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $35.07 $197.05 $197.05 $146.25 $146.25 $151.89 $102.66 $41.07 $197.05 $78.82 $197.05 $197.05 $197.05 $197.05 $197.05 $148.13 $197.05 $197.05 $197.05 $98.53 $98.53 $156.06 $197.05 $157.64 $128.08 $197.05 N/A $114.55 $197.05 $118.23 $197.05 $197.05 $197.05 N/A N/A 375-930-000 SUP Custom 27203010 375-930-000 - BURR SHAVER FLUTE 3.5MM 6MM 6 ABRASION RAPID FORMULA STERILE BOTH IP/OP $151.50 $112.00 $26.97 $151.50 $151.50 $151.50 $151.50 $151.50 $151.50 $151.50 $26.97 $151.50 $151.50 $112.44 $112.44 $116.78 $78.93 $31.57 $151.50 $60.60 $151.50 $151.50 $151.50 $151.50 $151.50 $113.63 $151.50 $151.50 $151.50 $75.75 $75.75 $119.99 $151.50 $121.20 $98.48 $151.50 N/A $87.87 $151.50 $90.90 $151.50 $151.50 $151.50 N/A N/A 375-940-000 SUP Custom 27203010 375-940-000 - BURR SURG 4MM ROUND 6 FLUTED ARTHRO FORMULA STERILE BOTH IP/OP $146.50 $108.00 $26.06 $146.38 $146.38 $146.38 $146.38 $146.38 $146.38 $146.38 $26.06 $146.38 $146.38 $108.64 $108.64 $112.83 $76.26 $30.51 $146.38 $58.55 $146.38 $146.38 $146.38 $146.38 $146.38 $109.88 $146.38 $146.38 $146.38 $73.19 $73.19 $115.93 $146.38 $117.10 $95.15 $146.38 N/A $84.97 $146.38 $87.83 $146.38 $146.38 $146.38 N/A N/A 375-940-012 SUP Custom 27203010 375-940-012 - BURR SHAVER FLUTE HOLLOW 4MM 12 ARTHRO FORMULA STERILE BOTH IP/OP $151.50 $112.00 $26.97 $151.50 $151.50 $151.50 $151.50 $151.50 $151.50 $151.50 $26.97 $151.50 $151.50 $112.44 $112.44 $116.78 $78.93 $31.57 $151.50 $60.60 $151.50 $151.50 $151.50 $151.50 $151.50 $113.63 $151.50 $151.50 $151.50 $75.75 $75.75 $119.99 $151.50 $121.20 $98.48 $151.50 N/A $87.87 $151.50 $90.90 $151.50 $151.50 $151.50 N/A N/A 375-941-000 SUP Custom 27203010 375-941-000 - BURR SRG 6 FLUT BRL 4MM STRL FRML F SER BOTH IP/OP $151.50 $112.00 $26.97 $151.50 $151.50 $151.50 $151.50 $151.50 $151.50 $151.50 $26.97 $151.50 $151.50 $112.44 $112.44 $116.78 $78.93 $31.57 $151.50 $60.60 $151.50 $151.50 $151.50 $151.50 $151.50 $113.63 $151.50 $151.50 $151.50 $75.75 $75.75 $119.99 $151.50 $121.20 $98.48 $151.50 N/A $87.87 $151.50 $90.90 $151.50 $151.50 $151.50 N/A N/A 375-941-012 SUP Custom 27203010 375-941-012 - BURR SHAVER FLUTE BARREL 4MM 12 ARTHRO FORMULA STERILE BOTH IP/OP $197.50 $146.00 $35.07 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $35.07 $197.05 $197.05 $146.25 $146.25 $151.89 $102.66 $41.07 $197.05 $78.82 $197.05 $197.05 $197.05 $197.05 $197.05 $148.13 $197.05 $197.05 $197.05 $98.53 $98.53 $156.06 $197.05 $157.64 $128.08 $197.05 N/A $114.55 $197.05 $118.23 $197.05 $197.05 $197.05 N/A N/A 375-950-012 SUP Custom 27203010 375-950-012 - BURR SHAVER FLUTE 5.5MM 12 ARTHRO FORMULA STERILE BOTH IP/OP $197.50 $146.00 $35.07 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $35.07 $197.05 $197.05 $146.25 $146.25 $151.89 $102.66 $41.07 $197.05 $78.82 $197.05 $197.05 $197.05 $197.05 $197.05 $148.13 $197.05 $197.05 $197.05 $98.53 $98.53 $156.06 $197.05 $157.64 $128.08 $197.05 N/A $114.55 $197.05 $118.23 $197.05 $197.05 $197.05 N/A N/A 375-950-100 SUP Custom 27203010 375-950-100 - BURR SHAVER FLUTE 5MM 6 ARTHRO FORMULA STERILE BOTH IP/OP $151.50 $112.00 $26.97 $151.50 $151.50 $151.50 $151.50 $151.50 $151.50 $151.50 $26.97 $151.50 $151.50 $112.44 $112.44 $116.78 $78.93 $31.57 $151.50 $60.60 $151.50 $151.50 $151.50 $151.50 $151.50 $113.63 $151.50 $151.50 $151.50 $75.75 $75.75 $119.99 $151.50 $121.20 $98.48 $151.50 N/A $87.87 $151.50 $90.90 $151.50 $151.50 $151.50 N/A N/A 375-950-112 SUP Custom 27203010 375-950-112 - BURR SHAVER 5MM 12 FLUTED ROUND ARTHRO FORMULA STERILE BOTH IP/OP $197.50 $146.00 $35.07 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $35.07 $197.05 $197.05 $146.25 $146.25 $151.89 $102.66 $41.07 $197.05 $78.82 $197.05 $197.05 $197.05 $197.05 $197.05 $148.13 $197.05 $197.05 $197.05 $98.53 $98.53 $156.06 $197.05 $157.64 $128.08 $197.05 N/A $114.55 $197.05 $118.23 $197.05 $197.05 $197.05 N/A N/A 375-951-000 SUP Custom 27203010 375-951-000 - BURR SHAVER 6 FLUTE ROUND BARREL 5.5MM ARTHRO FORMULA BOTH IP/OP $146.50 $108.00 $26.06 $146.38 $146.38 $146.38 $146.38 $146.38 $146.38 $146.38 $26.06 $146.38 $146.38 $108.64 $108.64 $112.83 $76.26 $30.51 $146.38 $58.55 $146.38 $146.38 $146.38 $146.38 $146.38 $109.88 $146.38 $146.38 $146.38 $73.19 $73.19 $115.93 $146.38 $117.10 $95.15 $146.38 N/A $84.97 $146.38 $87.83 $146.38 $146.38 $146.38 N/A N/A 375-951-012 SUP Custom 27203010 375-951-012 - BURR SHAVER ROUND 5.5MM BARREL 12 FLUTED ARTHRO FORMULA BOTH IP/OP $197.50 $146.00 $35.07 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $35.07 $197.05 $197.05 $146.25 $146.25 $151.89 $102.66 $41.07 $197.05 $78.82 $197.05 $197.05 $197.05 $197.05 $197.05 $148.13 $197.05 $197.05 $197.05 $98.53 $98.53 $156.06 $197.05 $157.64 $128.08 $197.05 N/A $114.55 $197.05 $118.23 $197.05 $197.05 $197.05 N/A N/A 375-951-100 SUP Custom 27203010 375-951-100 - BURR SHAVER FLUTE BARREL 5MM 6 ARTHRO FORMULA STERILE BOTH IP/OP $197.50 $146.00 $35.07 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $35.07 $197.05 $197.05 $146.25 $146.25 $151.89 $102.66 $41.07 $197.05 $78.82 $197.05 $197.05 $197.05 $197.05 $197.05 $148.13 $197.05 $197.05 $197.05 $98.53 $98.53 $156.06 $197.05 $157.64 $128.08 $197.05 N/A $114.55 $197.05 $118.23 $197.05 $197.05 $197.05 N/A N/A 375-951-112 SUP Custom 27203010 375-951-112 - BURR SHAVER 5MM 12 FLUTED BARREL ARTHRO FORMULA STERILE BOTH IP/OP $197.50 $146.00 $35.07 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $197.05 $35.07 $197.05 $197.05 $146.25 $146.25 $151.89 $102.66 $41.07 $197.05 $78.82 $197.05 $197.05 $197.05 $197.05 $197.05 $148.13 $197.05 $197.05 $197.05 $98.53 $98.53 $156.06 $197.05 $157.64 $128.08 $197.05 N/A $114.55 $197.05 $118.23 $197.05 $197.05 $197.05 N/A N/A 38-051-65 SUP Custom 27203010 38-051-65 - BURR SURG 70MM 2.2MM LNDMN MED NTCH STRL BOTH IP/OP $142.50 $105.00 $25.37 $142.50 $142.50 $142.50 $142.50 $142.50 $142.50 $142.50 $25.37 $142.50 $142.50 $105.76 $105.76 $109.84 $74.24 $29.70 $142.50 $57.00 $142.50 $142.50 $142.50 $142.50 $142.50 $106.88 $142.50 $142.50 $142.50 $71.25 $71.25 $112.86 $142.50 $114.00 $92.63 $142.50 N/A $82.65 $142.50 $85.50 $142.50 $142.50 $142.50 N/A N/A 380-544-100 SUP Custom 27203010 380-544-100 - BLADE SHAVER 4MM ANGLED AGGRESSIVE PLUS ARTHRO FORMULA BOTH IP/OP $202.00 $149.00 $35.95 $201.95 $201.95 $201.95 $201.95 $201.95 $201.95 $201.95 $35.95 $201.95 $201.95 $149.89 $149.89 $155.66 $105.22 $42.09 $201.95 $80.78 $201.95 $201.95 $201.95 $201.95 $201.95 $151.50 $201.95 $201.95 $201.95 $100.98 $100.98 $159.94 $201.95 $161.56 $131.27 $201.95 N/A $117.16 $201.95 $121.17 $201.95 $201.95 $201.95 N/A N/A 380-545-100 SUP Custom 27203010 380-545-100 - CUTTER SURG ANGLE 4MM SHAVER BLADE TOMCAT STERILE BOTH IP/OP $202.00 $149.00 $35.95 $201.95 $201.95 $201.95 $201.95 $201.95 $201.95 $201.95 $35.95 $201.95 $201.95 $149.89 $149.89 $155.66 $105.22 $42.09 $201.95 $80.78 $201.95 $201.95 $201.95 $201.95 $201.95 $151.50 $201.95 $201.95 $201.95 $100.98 $100.98 $159.94 $201.95 $161.56 $131.27 $201.95 N/A $117.16 $201.95 $121.17 $201.95 $201.95 $201.95 N/A N/A 380-545-150 SUP Custom 27203010 380-545-150 - BLADE SHAVER 4.5MM ANGLED TOMCAT LATEX FREE TOMCAT STERILE BOTH IP/OP $202.00 $149.00 $35.95 $201.95 $201.95 $201.95 $201.95 $201.95 $201.95 $201.95 $35.95 $201.95 $201.95 $149.89 $149.89 $155.66 $105.22 $42.09 $201.95 $80.78 $201.95 $201.95 $201.95 $201.95 $201.95 $151.50 $201.95 $201.95 $201.95 $100.98 $100.98 $159.94 $201.95 $161.56 $131.27 $201.95 N/A $117.16 $201.95 $121.17 $201.95 $201.95 $201.95 N/A N/A 380-554-100 SUP Custom 27203010 380-554-100 - CUTTER ENDSCP 5MM ANGLED AGGRESSIVE PLUS FORMULA STERILE BOTH IP/OP $202.00 $149.00 $35.95 $201.95 $201.95 $201.95 $201.95 $201.95 $201.95 $201.95 $35.95 $201.95 $201.95 $149.89 $149.89 $155.66 $105.22 $42.09 $201.95 $80.78 $201.95 $201.95 $201.95 $201.95 $201.95 $151.50 $201.95 $201.95 $201.95 $100.98 $100.98 $159.94 $201.95 $161.56 $131.27 $201.95 N/A $117.16 $201.95 $121.17 $201.95 $201.95 $201.95 N/A N/A 380-555-100 SUP Custom 27203010 380-555-100 - CUTTER ENDSCP ANGLED 5MM TOMCAT FORMULA STERILE BOTH IP/OP $202.00 $149.00 $35.95 $201.95 $201.95 $201.95 $201.95 $201.95 $201.95 $201.95 $35.95 $201.95 $201.95 $149.89 $149.89 $155.66 $105.22 $42.09 $201.95 $80.78 $201.95 $201.95 $201.95 $201.95 $201.95 $151.50 $201.95 $201.95 $201.95 $100.98 $100.98 $159.94 $201.95 $161.56 $131.27 $201.95 N/A $117.16 $201.95 $121.17 $201.95 $201.95 $201.95 N/A N/A 38-130-56 SUP Custom 27203010 38-130-56 - PROP MTH PED DNTL SET BLK BOTH IP/OP $36.00 $27.00 $6.34 $35.63 $35.63 $35.63 $35.63 $35.63 $35.63 $35.63 $6.34 $35.63 $35.63 $26.44 $26.44 $27.46 $18.56 $7.43 $35.63 $14.25 $35.63 $35.63 $35.63 $35.63 $35.63 $27.00 $35.63 $35.63 $35.63 $17.82 $17.82 $28.22 $35.63 $28.50 $23.16 $35.63 N/A $20.88 $35.63 $21.38 $35.63 $35.63 $35.63 N/A N/A 3815-8-920 SUP HCPCS C1713 3815-8-920 - PIN FIX 4MM STEINMANN BOTH IP/OP $69.00 $51.00 $13.65 $68.75 $30.94 $30.94 $30.94 $30.94 $68.75 $68.75 $68.75 $14.33 $68.75 $68.75 $68.75 $68.75 $68.75 $14.33 $68.75 $68.75 $40.67 $68.75 $68.75 $68.75 $68.75 $51.75 $68.75 $68.75 $68.75 $34.38 $34.38 $54.45 $68.75 $55.00 $30.94 $13.65 N/A $40.02 $68.75 $41.25 $68.75 $14.33 $68.75 N/A N/A 3855-4-000 SUP Custom 27203010 3855-4-000 - NAIL INTRAMEDULLARY DRILL STEP MASSIE II CORTICAL BOTH IP/OP $474.50 $351.00 $84.44 $474.38 $474.38 $474.38 $474.38 $474.38 $474.38 $474.38 $84.44 $474.38 $474.38 $352.08 $352.08 $365.65 $247.15 $98.87 $474.38 $189.75 $474.38 $474.38 $474.38 $474.38 $474.38 $355.88 $474.38 $474.38 $474.38 $237.19 $237.19 $375.71 $474.38 $379.50 $308.35 $474.38 N/A $275.21 $474.38 $284.63 $474.38 $474.38 $474.38 N/A N/A 38-709-03-07 SUP HCPCS C1713 38-709-03-07 - INSTRUMENT RDC LG 5IN BYRD ZYG RDC SCR SS OSTSYN BOTH IP/OP $374.50 $277.00 $74.31 $374.38 $168.47 $168.47 $168.47 $168.47 $374.38 $374.38 $374.38 $78.03 $374.38 $374.38 $374.38 $374.38 $374.38 $78.02 $374.38 $149.75 $221.45 $374.38 $374.38 $374.38 $374.38 $280.88 $374.38 $374.38 $374.38 $187.19 $187.19 $296.51 $374.38 $299.50 $168.47 $74.31 N/A $217.21 $374.38 $224.63 $374.38 $78.02 $374.38 N/A N/A 390-110 SUP Custom 27803010 390-110 - STONE CONE COIL BOTH IP/OP $506.00 $374.00 $90.07 $506.00 $506.00 $506.00 $506.00 $506.00 $506.00 $506.00 $90.07 $506.00 $506.00 $506.00 $506.00 $506.00 $506.00 $105.46 $506.00 $202.40 $506.00 $506.00 $506.00 $506.00 $506.00 $379.50 $506.00 $506.00 $506.00 $253.00 $253.00 $400.75 $506.00 $404.80 $227.70 $506.00 N/A $293.48 $506.00 $303.60 $506.00 $506.00 $506.00 N/A N/A 3910-900-020 SUP HCPCS C1713 3910-900-020 - ANCHOR SUTURE 2 38IN NEEDLE STRAND FORCE FIBER BOTH IP/OP $69.50 $51.00 $13.77 $69.38 $31.22 $31.22 $31.22 $31.22 $69.38 $69.38 $69.38 $14.46 $69.38 $69.38 $69.38 $69.38 $69.38 $14.46 $69.38 $69.38 $41.04 $69.38 $69.38 $69.38 $69.38 $52.13 $69.38 $69.38 $69.38 $34.69 $34.69 $54.95 $69.38 $55.50 $31.22 $13.77 N/A $40.31 $69.38 $41.63 $69.38 $14.46 $69.38 N/A N/A 3910-900-050 SUP HCPCS C1713 3910-900-050 - SUTURE NABSB 5 3/8 CRC 38IN WHT BLU STRL FRC FBR NDL CO BRD BOTH IP/OP $88.50 $65.00 $17.53 $88.30 $39.74 $39.74 $39.74 $39.74 $88.30 $88.30 $88.30 $18.40 $88.30 $88.30 $88.30 $88.30 $88.30 $18.40 $88.30 $88.30 $52.23 $88.30 $88.30 $88.30 $88.30 $66.38 $88.30 $88.30 $88.30 $44.15 $44.15 $69.93 $88.30 $70.64 $39.74 $17.53 N/A $51.33 $88.30 $88.30 $88.30 $18.40 $88.30 N/A N/A 394500S SUP Custom 27203010 394500S - HOOK BONE 25MM COMPRESSION SCREW TWIN OMEGA 3 HANSSON BOTH IP/OP $179.00 $132.00 $31.82 $178.75 $178.75 $178.75 $178.75 $178.75 $178.75 $178.75 $31.82 $178.75 $178.75 $132.67 $132.67 $137.78 $93.13 $37.25 $178.75 $71.50 $178.75 $178.75 $178.75 $178.75 $178.75 $134.25 $178.75 $178.75 $178.75 $89.38 $89.38 $141.57 $178.75 $143.00 $116.19 $178.75 N/A $103.82 $178.75 $107.25 $178.75 $178.75 $178.75 N/A N/A 3MAXC SUP HCPCS C1757 3MAXC - CATHETER REPERFUSION 4.7-3.8FR .035IN 164CM 3MAX BOTH IP/OP "$3,725.00" "$2,757.00" $739.32 "$3,725.00" "$2,022.68" "$2,022.68" "$2,022.68" "$2,022.68" "$3,725.00" "$3,725.00" "$3,725.00" $776.38 "$3,725.00" "$2,764.70" "$2,764.70" "$2,871.23" "$1,940.73" $776.33 "$3,725.00" "$3,725.00" "$2,203.34" "$3,725.00" "$3,725.00" "$3,725.00" "$3,725.00" "$2,793.75" "$3,725.00" "$3,725.00" "$3,725.00" "$1,862.50" "$1,862.50" "$2,950.20" "$3,725.00" "$2,980.00" "$2,421.25" $739.32 N/A "$2,160.50" "$3,725.00" "$3,725.00" "$3,725.00" $776.29 "$3,725.00" N/A N/A 3MAXCKIT SUP HCPCS C1757 3MAXCKIT - CATHETER THROMBECTOMY .014IN 4.7-3.8FR .035IN 153CM 157CM BOTH IP/OP "$3,225.00" "$2,387.00" $640.08 "$4,375.00" "$1,751.18" "$1,751.18" "$1,751.18" "$1,751.18" "$3,225.00" "$3,225.00" "$3,225.00" $672.17 "$3,225.00" "$2,393.60" "$2,393.60" "$2,485.83" "$1,680.23" $672.13 "$3,225.00" "$4,375.00" "$1,907.59" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$2,096.25" $640.08 N/A "$1,870.50" "$3,225.00" "$3,225.00" "$3,225.00" $672.09 "$3,225.00" N/A N/A 3MAXS SUP HCPCS C1757 3MAXS - SEPARATOR THROMBECTOMY .03IN 200CM 5MAX REPERFUSION CATHETER BOTH IP/OP "$7,425.00" "$5,495.00" "$1,473.68" "$7,425.00" "$4,031.78" "$4,031.78" "$4,031.78" "$4,031.78" "$7,425.00" "$7,425.00" "$7,425.00" "$1,547.56" "$7,425.00" "$4,181.12" "$4,181.12" "$5,723.19" "$2,060.15" "$1,547.45" "$7,425.00" "$7,425.00" "$3,094.73" "$7,425.00" "$7,425.00" "$7,425.00" "$7,425.00" "$5,568.75" "$7,425.00" "$7,425.00" "$7,425.00" "$3,712.50" "$3,712.50" "$5,880.60" "$7,425.00" "$5,940.00" "$4,826.25" "$1,473.68" N/A "$4,306.50" "$7,425.00" "$7,425.00" "$7,425.00" "$1,547.37" "$7,425.00" N/A N/A 3N02A SUP Custom 27203010 3N02A - SUTURE NONABSORBABLE CV-3 TT-17 36IN 2 ARM MONOFILAMENT BOTH IP/OP $677.50 $501.00 $120.60 $677.50 $677.50 $677.50 $677.50 $677.50 $677.50 $677.50 $120.60 $677.50 $677.50 $502.84 $502.84 $522.22 $352.98 $141.20 $677.50 $271.00 $677.50 $677.50 $677.50 $677.50 $677.50 $508.13 $677.50 $677.50 $677.50 $338.75 $338.75 $536.58 $677.50 $542.00 $440.38 $677.50 N/A $392.95 $677.50 $406.50 $677.50 $677.50 $677.50 N/A N/A 4.0PED SUP Custom 27203010 4.0PED - TUBE 41MM 5.9MM 4MM UNCUF OBT TRCH PLVN CHLOR PED BOTH IP/OP $94.50 $70.00 $16.78 $94.29 $94.29 $94.29 $94.29 $94.29 $94.29 $94.29 $16.78 $94.29 $94.29 $69.98 $69.98 $72.68 $49.13 $19.65 $94.29 $37.72 $94.29 $94.29 $94.29 $94.29 $94.29 $70.88 $94.29 $94.29 $94.29 $47.15 $47.15 $74.68 $94.29 $75.43 $61.29 $94.29 N/A $54.81 $94.29 $56.57 $94.29 $94.29 $94.29 N/A N/A 4.5PED SUP Custom 27203010 4.5PED - TUBE 42MM 6.5MM 4.5MM UNCUF OBT TRCH PLVN CHLOR PED BOTH IP/OP $94.50 $70.00 $16.78 $94.29 $94.29 $94.29 $94.29 $94.29 $94.29 $94.29 $16.78 $94.29 $94.29 $69.98 $69.98 $72.68 $49.13 $19.65 $94.29 $37.72 $94.29 $94.29 $94.29 $94.29 $94.29 $70.88 $94.29 $94.29 $94.29 $47.15 $47.15 $74.68 $94.29 $75.43 $61.29 $94.29 N/A $54.81 $94.29 $56.57 $94.29 $94.29 $94.29 N/A N/A 400.040E SUP HCPCS C1713 400.040E - SCREW BONE 1.5MM 10MM SELF TAP PLUSDRIVE RECESS TITANIUM BOTH IP/OP $144.00 $107.00 $28.58 $144.00 $64.80 $64.80 $64.80 $64.80 $144.00 $144.00 $144.00 $30.01 $144.00 $144.00 $144.00 $144.00 $144.00 $30.01 $144.00 $144.00 $85.18 $144.00 $144.00 $144.00 $144.00 $108.00 $144.00 $144.00 $144.00 $72.00 $72.00 $114.05 $144.00 $115.20 $64.80 $28.58 N/A $83.52 $144.00 $86.40 $144.00 $144.00 $144.00 N/A N/A 400.046E SUP HCPCS C1713 400.046E - SCREW BONE 1.5MM 16MM SLFTAP PLUSDRIVE RECESS TITANIUM BOTH IP/OP $144.00 $107.00 $28.58 $144.00 $64.80 $64.80 $64.80 $64.80 $144.00 $144.00 $144.00 $30.01 $144.00 $144.00 $144.00 $144.00 $144.00 $30.01 $144.00 $144.00 $85.18 $144.00 $144.00 $144.00 $144.00 $108.00 $144.00 $144.00 $144.00 $72.00 $72.00 $114.05 $144.00 $115.20 $64.80 $28.58 N/A $83.52 $144.00 $86.40 $144.00 $30.01 $144.00 N/A N/A 400.048E SUP HCPCS C1713 400.048E - SCREW BONE 1.5MM 18MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $144.00 $107.00 $28.58 $144.00 $64.80 $64.80 $64.80 $64.80 $144.00 $144.00 $144.00 $30.01 $144.00 $144.00 $144.00 $144.00 $144.00 $30.01 $144.00 $144.00 $85.18 $144.00 $144.00 $144.00 $144.00 $108.00 $144.00 $144.00 $144.00 $72.00 $72.00 $114.05 $144.00 $115.20 $64.80 $28.58 N/A $83.52 $144.00 $86.40 $144.00 $30.01 $144.00 N/A N/A 400.054E SUP HCPCS C1713 400.054E - SCREW BONE 1.5MM 2.9MM 4MM SELF DRILL PLUSDRIVE SILVER BOTH IP/OP $173.50 $128.00 $34.39 $173.25 $77.96 $77.96 $77.96 $77.96 $173.25 $173.25 $173.25 $36.11 $173.25 $173.25 $173.25 $173.25 $173.25 $36.11 $173.25 $173.25 $102.48 $173.25 $173.25 $173.25 $173.25 $130.13 $173.25 $173.25 $173.25 $86.63 $86.63 $137.21 $173.25 $138.60 $77.96 $34.39 N/A $100.63 $173.25 $103.95 $173.25 $36.11 $173.25 N/A N/A 400.055E SUP HCPCS C1713 400.055E - SCREW BONE 1.5MM 5MM SLFDRILL PLUSDRIVE RECESS TITANIUM BOTH IP/OP $173.50 $128.00 $34.39 $173.25 $77.96 $77.96 $77.96 $77.96 $173.25 $173.25 $173.25 $36.11 $173.25 $173.25 $173.25 $173.25 $173.25 $36.11 $173.25 $173.25 $102.48 $173.25 $173.25 $173.25 $173.25 $130.13 $173.25 $173.25 $173.25 $86.63 $86.63 $137.21 $173.25 $138.60 $77.96 $34.39 N/A $100.63 $173.25 $103.95 $173.25 $36.11 $173.25 N/A N/A 400.056E SUP HCPCS C1713 400.056E - SCREW BONE 1.5MM 2.9MM 6MM SELF DRILL PLUSDRIVE SILVER BOTH IP/OP $173.50 $128.00 $34.39 $173.25 $77.96 $77.96 $77.96 $77.96 $173.25 $173.25 $173.25 $36.11 $173.25 $173.25 $173.25 $173.25 $173.25 $36.11 $173.25 $173.25 $102.48 $173.25 $173.25 $173.25 $173.25 $130.13 $173.25 $173.25 $173.25 $86.63 $86.63 $137.21 $173.25 $138.60 $77.96 $34.39 N/A $100.63 $173.25 $103.95 $173.25 $36.11 $173.25 N/A N/A 400.280E SUP HCPCS C1713 400.280E - SCREW BONE 2MM 10MM EMERGENCY PLUSDRIVE RECESS TITANIUM BOTH IP/OP $152.00 $112.00 $30.14 $151.88 $68.35 $68.35 $68.35 $68.35 $151.88 $151.88 $151.88 $31.66 $151.88 $151.88 $151.88 $151.88 $151.88 $31.65 $151.88 $151.88 $89.84 $151.88 $151.88 $151.88 $151.88 $114.00 $151.88 $151.88 $151.88 $75.94 $75.94 $120.29 $151.88 $121.50 $68.35 $30.14 N/A $88.16 $151.88 $91.13 $151.88 $31.65 $151.88 N/A N/A 400.282E SUP HCPCS C1713 400.282E - SCREW BONE 2MM 12MM EMERGENCY PLUSDRIVE RECESS TITANIUM BOTH IP/OP $152.00 $112.00 $30.14 $151.88 $68.35 $68.35 $68.35 $68.35 $151.88 $151.88 $151.88 $31.66 $151.88 $151.88 $151.88 $151.88 $151.88 $31.65 $151.88 $151.88 $89.84 $151.88 $151.88 $151.88 $151.88 $114.00 $151.88 $151.88 $151.88 $75.94 $75.94 $120.29 $151.88 $121.50 $68.35 $30.14 N/A $88.16 $151.88 $91.13 $151.88 $31.65 $151.88 N/A N/A 400.284E SUP HCPCS C1713 400.284E - SCREW BONE 2MM 14MM EMERGENCY PLUSDRIVE RECESS TITANIUM BOTH IP/OP $152.00 $112.00 $30.14 $151.88 $68.35 $68.35 $68.35 $68.35 $151.88 $151.88 $151.88 $31.66 $151.88 $151.88 $151.88 $151.88 $151.88 $31.65 $151.88 $151.88 $89.84 $151.88 $151.88 $151.88 $151.88 $114.00 $151.88 $151.88 $151.88 $75.94 $75.94 $120.29 $151.88 $121.50 $68.35 $30.14 N/A $88.16 $151.88 $91.13 $151.88 $31.65 $151.88 N/A N/A 400.286E SUP HCPCS C1713 400.286E - SCREW BONE 2MM 16MM EMERGENCY PLUSDRIVE RECESS TITANIUM BOTH IP/OP $152.00 $112.00 $30.14 $151.88 $68.35 $68.35 $68.35 $68.35 $151.88 $151.88 $151.88 $31.66 $151.88 $151.88 $151.88 $151.88 $151.88 $31.65 $151.88 $60.75 $89.84 $151.88 $151.88 $151.88 $151.88 $114.00 $151.88 $151.88 $151.88 $75.94 $75.94 $120.29 $151.88 $121.50 $68.35 $30.14 N/A $88.16 $151.88 $91.13 $151.88 $31.65 $151.88 N/A N/A 400.288E SUP HCPCS C1713 400.288E - SCREW BONE 2MM 18MM EMERGENCY PLUSDRIVE RECESS TITANIUM BOTH IP/OP $152.00 $112.00 $30.14 $151.88 $68.35 $68.35 $68.35 $68.35 $151.88 $151.88 $151.88 $31.66 $151.88 $151.88 $151.88 $151.88 $151.88 $31.65 $151.88 $60.75 $89.84 $151.88 $151.88 $151.88 $151.88 $114.00 $151.88 $151.88 $151.88 $75.94 $75.94 $120.29 $151.88 $121.50 $68.35 $30.14 N/A $88.16 $151.88 $91.13 $151.88 $31.65 $151.88 N/A N/A 400.404E SUP HCPCS C1713 400.404E - SCREW BONE 1MM 4MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $214.00 $158.00 $42.42 $213.75 $96.19 $96.19 $96.19 $96.19 $213.75 $213.75 $213.75 $44.55 $213.75 $213.75 $213.75 $213.75 $213.75 $44.55 $213.75 $213.75 $126.43 $213.75 $213.75 $213.75 $213.75 $160.50 $213.75 $213.75 $213.75 $106.88 $106.88 $169.29 $213.75 $171.00 $96.19 $42.42 N/A $124.12 $213.75 $213.75 $213.75 $213.75 $213.75 N/A N/A 400.405E SUP HCPCS C1713 400.405E - SCREW BONE 1MM 5MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $214.00 $158.00 $42.42 $213.75 $96.19 $96.19 $96.19 $96.19 $213.75 $213.75 $213.75 $44.55 $213.75 $213.75 $213.75 $213.75 $213.75 $44.55 $213.75 $213.75 $126.43 $213.75 $213.75 $213.75 $213.75 $160.50 $213.75 $213.75 $213.75 $106.88 $106.88 $169.29 $213.75 $171.00 $96.19 $42.42 N/A $124.12 $213.75 $213.75 $213.75 $213.75 $213.75 N/A N/A 400.407E SUP HCPCS C1713 400.407E - SCREW BONE 1MM 1.6MM 7MM SLFTAP PLUSDRIVE RECESS GOLD BOTH IP/OP $191.50 $142.00 $37.96 $191.25 $86.06 $86.06 $86.06 $86.06 $191.25 $191.25 $191.25 $39.86 $191.25 $191.25 $191.25 $191.25 $191.25 $39.86 $191.25 $76.50 $113.12 $191.25 $191.25 $191.25 $191.25 $143.63 $191.25 $191.25 $191.25 $95.63 $95.63 $151.47 $191.25 $153.00 $86.06 $37.96 N/A $111.07 $191.25 $191.25 $191.25 $191.25 $191.25 N/A N/A 400.408E SUP HCPCS C1713 400.408E - SCREW BONE 1MM 8MM SLFTAP TITANIUM CORTICAL NONSTRL BOTH IP/OP $214.00 $158.00 $42.42 $213.75 $96.19 $96.19 $96.19 $96.19 $213.75 $213.75 $213.75 $44.55 $213.75 $213.75 $213.75 $213.75 $213.75 $44.55 $213.75 $85.50 $126.43 $213.75 $213.75 $213.75 $213.75 $160.50 $213.75 $213.75 $213.75 $106.88 $106.88 $169.29 $213.75 $171.00 $96.19 $42.42 N/A $124.12 $213.75 $128.25 $213.75 $44.55 $213.75 N/A N/A 400.409E SUP HCPCS C1713 400.409E - SCREW BONE 1MM 9MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $191.50 $142.00 $37.96 $191.25 $86.06 $86.06 $86.06 $86.06 $191.25 $191.25 $191.25 $39.86 $191.25 $191.25 $191.25 $191.25 $191.25 $39.86 $191.25 $76.50 $113.12 $191.25 $191.25 $191.25 $191.25 $143.63 $191.25 $191.25 $191.25 $95.63 $95.63 $151.47 $191.25 $153.00 $86.06 $37.96 N/A $111.07 $191.25 $114.75 $191.25 $39.86 $191.25 N/A N/A 400.410E SUP HCPCS C1713 400.410E - SCREW BONE 1MM 10MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $214.00 $158.00 $42.42 $213.75 $96.19 $96.19 $96.19 $96.19 $213.75 $213.75 $213.75 $44.55 $213.75 $213.75 $213.75 $213.75 $213.75 $44.55 $213.75 $85.50 $126.43 $213.75 $213.75 $213.75 $213.75 $160.50 $213.75 $213.75 $213.75 $106.88 $106.88 $169.29 $213.75 $171.00 $96.19 $42.42 N/A $124.12 $213.75 $128.25 $213.75 $44.55 $213.75 N/A N/A 400.411E SUP HCPCS C1713 400.411E - SCREW BONE 1MM 11MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $191.50 $142.00 $37.96 $191.25 $86.06 $86.06 $86.06 $86.06 $191.25 $191.25 $191.25 $39.86 $191.25 $191.25 $191.25 $191.25 $191.25 $39.86 $191.25 $76.50 $113.12 $191.25 $191.25 $191.25 $191.25 $143.63 $191.25 $191.25 $191.25 $95.63 $95.63 $151.47 $191.25 $153.00 $86.06 $37.96 N/A $111.07 $191.25 $114.75 $191.25 $39.86 $191.25 N/A N/A 400.412E SUP HCPCS C1713 400.412E - SCREW BONE 1MM 12MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $214.00 $158.00 $42.42 $213.75 $96.19 $96.19 $96.19 $96.19 $213.75 $213.75 $213.75 $44.55 $213.75 $213.75 $213.75 $213.75 $213.75 $44.55 $213.75 $85.50 $126.43 $213.75 $213.75 $213.75 $213.75 $160.50 $213.75 $213.75 $213.75 $106.88 $106.88 $169.29 $213.75 $171.00 $96.19 $42.42 N/A $124.12 $213.75 $213.75 $213.75 $44.55 $213.75 N/A N/A 400.414E SUP HCPCS C1713 400.414E - SCREW BONE 1MM 14MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $214.00 $158.00 $42.42 $213.75 $96.19 $96.19 $96.19 $96.19 $213.75 $213.75 $213.75 $44.55 $213.75 $213.75 $213.75 $213.75 $213.75 $44.55 $213.75 $213.75 $126.43 $213.75 $213.75 $213.75 $213.75 $160.50 $213.75 $213.75 $213.75 $106.88 $106.88 $169.29 $213.75 $171.00 $96.19 $42.42 N/A $124.12 $213.75 $213.75 $213.75 $44.55 $213.75 N/A N/A 400.437E SUP HCPCS C1713 400.437E - SCREW BONE 1.3MM 7MM 3MM SLFTAP DRIVE RECESS TITANIUM BOTH IP/OP $179.00 $132.00 $35.50 $178.88 $80.50 $80.50 $80.50 $80.50 $178.88 $178.88 $178.88 $37.28 $178.88 $178.88 $178.88 $178.88 $178.88 $37.28 $178.88 $178.88 $105.81 $178.88 $178.88 $178.88 $178.88 $134.25 $178.88 $178.88 $178.88 $89.44 $89.44 $141.67 $178.88 $143.10 $80.50 $35.50 N/A $103.82 $178.88 $178.88 $178.88 $37.28 $178.88 N/A N/A 400.439E SUP HCPCS C1713 400.439E - SCREW BONE 1.3MM 9MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $179.00 $132.00 $35.50 $178.88 $80.50 $80.50 $80.50 $80.50 $178.88 $178.88 $178.88 $37.28 $178.88 $178.88 $178.88 $178.88 $178.88 $37.28 $178.88 $71.55 $105.81 $178.88 $178.88 $178.88 $178.88 $134.25 $178.88 $178.88 $178.88 $89.44 $89.44 $141.67 $178.88 $143.10 $80.50 $35.50 N/A $103.82 $178.88 $178.88 $178.88 $37.28 $178.88 N/A N/A 400.440E SUP HCPCS C1713 400.440E - SCREW BONE 1.3MM 10MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $199.50 $148.00 $39.52 $199.13 $89.61 $89.61 $89.61 $89.61 $199.13 $199.13 $199.13 $41.50 $199.13 $199.13 $199.13 $199.13 $199.13 $41.50 $199.13 $79.65 $117.79 $199.13 $199.13 $199.13 $199.13 $149.63 $199.13 $199.13 $199.13 $99.57 $99.57 $157.71 $199.13 $159.30 $89.61 $39.52 N/A $115.71 $199.13 $199.13 $199.13 $41.50 $199.13 N/A N/A 400.442E SUP HCPCS C1713 400.442E - SCREW BONE 1.3MM 12MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $199.50 $148.00 $39.52 $199.13 $89.61 $89.61 $89.61 $89.61 $199.13 $199.13 $199.13 $41.50 $199.13 $199.13 $199.13 $199.13 $199.13 $41.50 $199.13 $199.13 $117.79 $199.13 $199.13 $199.13 $199.13 $149.63 $199.13 $199.13 $199.13 $99.57 $99.57 $157.71 $199.13 $159.30 $89.61 $39.52 N/A $115.71 $199.13 $199.13 $199.13 $41.50 $199.13 N/A N/A 400.444E SUP HCPCS C1713 400.444E - SCREW BONE 1.3MM 14MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $199.50 $148.00 $39.52 $199.13 $89.61 $89.61 $89.61 $89.61 $199.13 $199.13 $199.13 $41.50 $199.13 $199.13 $199.13 $199.13 $199.13 $41.50 $199.13 $79.65 $117.79 $199.13 $199.13 $199.13 $199.13 $149.63 $199.13 $199.13 $199.13 $99.57 $99.57 $157.71 $199.13 $159.30 $89.61 $39.52 N/A $115.71 $199.13 $199.13 $199.13 $41.50 $199.13 N/A N/A 400.446E SUP HCPCS C1713 400.446E - SCREW BONE 1.3MM 16MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $199.50 $148.00 $39.52 $199.13 $89.61 $89.61 $89.61 $89.61 $199.13 $199.13 $199.13 $41.50 $199.13 $199.13 $199.13 $199.13 $199.13 $41.50 $199.13 $79.65 $117.79 $199.13 $199.13 $199.13 $199.13 $149.63 $199.13 $199.13 $199.13 $99.57 $99.57 $157.71 $199.13 $159.30 $89.61 $39.52 N/A $115.71 $199.13 $199.13 $199.13 $41.50 $199.13 N/A N/A 400.448E SUP HCPCS C1713 400.448E - SCREW BONE 1.3MM 18MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $199.50 $148.00 $39.52 $199.13 $89.61 $89.61 $89.61 $89.61 $199.13 $199.13 $199.13 $41.50 $199.13 $199.13 $199.13 $199.13 $199.13 $41.50 $199.13 $79.65 $117.79 $199.13 $199.13 $199.13 $199.13 $149.63 $199.13 $199.13 $199.13 $99.57 $99.57 $157.71 $199.13 $159.30 $89.61 $39.52 N/A $115.71 $199.13 $199.13 $199.13 $41.50 $199.13 N/A N/A 400.454E SUP HCPCS C1713 400.454E - SCREW BONE 1.3MM 4MM SELF DRILL PLUSDRIVE SILVER TITANIUM BOTH IP/OP $205.00 $152.00 $40.64 $204.75 $92.14 $92.14 $92.14 $92.14 $204.75 $204.75 $204.75 $42.68 $204.75 $204.75 $204.75 $204.75 $204.75 $42.67 $204.75 $204.75 $121.11 $204.75 $204.75 $204.75 $204.75 $153.75 $204.75 $204.75 $204.75 $102.38 $102.38 $162.16 $204.75 $163.80 $92.14 $40.64 N/A $118.90 $204.75 $122.85 $204.75 $42.67 $204.75 N/A N/A 400.455E SUP HCPCS C1713 400.455E - SCREW BONE 1.3MM 5MM SLFDRILL PLUSDRIVE RECESS SILVER BOTH IP/OP $205.00 $152.00 $40.64 $204.75 $92.14 $92.14 $92.14 $92.14 $204.75 $204.75 $204.75 $42.68 $204.75 $204.75 $204.75 $204.75 $204.75 $42.67 $204.75 $204.75 $121.11 $204.75 $204.75 $204.75 $204.75 $153.75 $204.75 $204.75 $204.75 $102.38 $102.38 $162.16 $204.75 $163.80 $92.14 $40.64 N/A $118.90 $204.75 $122.85 $204.75 $42.67 $204.75 N/A N/A 400.456E SUP HCPCS C1713 400.456E - SCREW BONE 1.3MM 6MM SLFDRILL PLUSDRIVE RECESS SILVER BOTH IP/OP $205.00 $152.00 $40.64 $204.75 $92.14 $92.14 $92.14 $92.14 $204.75 $204.75 $204.75 $42.68 $204.75 $204.75 $204.75 $204.75 $204.75 $42.67 $204.75 $204.75 $121.11 $204.75 $204.75 $204.75 $204.75 $153.75 $204.75 $204.75 $204.75 $102.38 $102.38 $162.16 $204.75 $163.80 $92.14 $40.64 N/A $118.90 $204.75 $204.75 $204.75 $42.67 $204.75 N/A N/A 400.465E SUP HCPCS C1713 400.465E - SCREW BONE 1.2MM 5MM SLFDRILL PLUSDRIVE RECESS TEAL TITANIUM BOTH IP/OP $220.50 $163.00 $43.76 $220.50 $99.23 $99.23 $99.23 $99.23 $220.50 $220.50 $220.50 $45.96 $220.50 $220.50 $220.50 $220.50 $220.50 $45.95 $220.50 $88.20 $130.43 $220.50 $220.50 $220.50 $220.50 $165.38 $220.50 $220.50 $220.50 $110.25 $110.25 $174.64 $220.50 $176.40 $99.23 $43.76 N/A $127.89 $220.50 $220.50 $220.50 $45.95 $220.50 N/A N/A 400.467E SUP HCPCS C1713 400.467E - SCREW BONE 1.2MM 7MM TITANIUM CRANIOMAXILLOFACIAL NONSTRL BOTH IP/OP $196.00 $145.00 $38.85 $195.75 $88.09 $88.09 $88.09 $88.09 $195.75 $195.75 $195.75 $40.80 $195.75 $195.75 $195.75 $195.75 $195.75 $40.80 $195.75 $78.30 $115.79 $195.75 $195.75 $195.75 $195.75 $147.00 $195.75 $195.75 $195.75 $97.88 $97.88 $155.03 $195.75 $156.60 $88.09 $38.85 N/A $113.68 $195.75 $195.75 $195.75 $40.79 $195.75 N/A N/A 400.469E SUP HCPCS C1713 400.469E - SCREW BONE 1.2MM 1.6MM 9MM EMERGENCY PLUSDRIVE RECESS TEAL BOTH IP/OP $196.00 $145.00 $38.85 $195.75 $88.09 $88.09 $88.09 $88.09 $195.75 $195.75 $195.75 $40.80 $195.75 $195.75 $195.75 $195.75 $195.75 $40.80 $195.75 $195.75 $115.79 $195.75 $195.75 $195.75 $195.75 $147.00 $195.75 $195.75 $195.75 $97.88 $97.88 $155.03 $195.75 $156.60 $88.09 $38.85 N/A $113.68 $195.75 $195.75 $195.75 $40.79 $195.75 N/A N/A 400.470E SUP HCPCS C1713 400.470E - SCREW BONE 1.2MM 1.6MM 10MM EMERGENCY PLUSDRIVE RECESS TEAL BOTH IP/OP $220.50 $163.00 $43.76 $220.50 $99.23 $99.23 $99.23 $99.23 $220.50 $220.50 $220.50 $45.96 $220.50 $220.50 $220.50 $220.50 $220.50 $45.95 $220.50 $220.50 $130.43 $220.50 $220.50 $220.50 $220.50 $165.38 $220.50 $220.50 $220.50 $110.25 $110.25 $174.64 $220.50 $176.40 $99.23 $43.76 N/A $127.89 $220.50 $132.30 $220.50 $45.95 $220.50 N/A N/A 400.471E SUP HCPCS C1713 400.471E - SCREW BONE 1.2MM 1.6MM 11MM EMERGENCY PLUSDRIVE RECESS TEAL BOTH IP/OP $196.00 $145.00 $38.85 $195.75 $88.09 $88.09 $88.09 $88.09 $195.75 $195.75 $195.75 $40.80 $195.75 $195.75 $195.75 $195.75 $195.75 $40.80 $195.75 $78.30 $115.79 $195.75 $195.75 $195.75 $195.75 $147.00 $195.75 $195.75 $195.75 $97.88 $97.88 $155.03 $195.75 $156.60 $88.09 $38.85 N/A $113.68 $195.75 $117.45 $195.75 $40.79 $195.75 N/A N/A 400.472E SUP HCPCS C1713 400.472E - SCREW BONE 1.2MM 1.6MM 12MM EMERGENCY PLUSDRIVE RECESS TEAL BOTH IP/OP $220.50 $163.00 $43.76 $220.50 $99.23 $99.23 $99.23 $99.23 $220.50 $220.50 $220.50 $45.96 $220.50 $220.50 $220.50 $220.50 $220.50 $45.95 $220.50 $88.20 $130.43 $220.50 $220.50 $220.50 $220.50 $165.38 $220.50 $220.50 $220.50 $110.25 $110.25 $174.64 $220.50 $176.40 $99.23 $43.76 N/A $127.89 $220.50 $220.50 $220.50 $45.95 $220.50 N/A N/A 400.474E SUP HCPCS C1713 400.474E - SCREW BONE 1.2MM 1.6MM 14MM EMERGENCY PLUSDRIVE RECESS TEAL BOTH IP/OP $220.50 $163.00 $43.76 $220.50 $99.23 $99.23 $99.23 $99.23 $220.50 $220.50 $220.50 $45.96 $220.50 $220.50 $220.50 $220.50 $220.50 $45.95 $220.50 $88.20 $130.43 $220.50 $220.50 $220.50 $220.50 $165.38 $220.50 $220.50 $220.50 $110.25 $110.25 $174.64 $220.50 $176.40 $99.23 $43.76 N/A $127.89 $220.50 $220.50 $220.50 $45.95 $220.50 N/A N/A 400.483E SUP HCPCS C1713 400.483E - SCREW BONE 1.7MM 3MM EMERGENCY PLUSDRIVE RECESS TITANIUM BOTH IP/OP $207.00 $153.00 $41.08 $207.00 $93.15 $93.15 $93.15 $93.15 $207.00 $207.00 $207.00 $43.14 $207.00 $207.00 $207.00 $207.00 $207.00 $43.14 $207.00 $82.80 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $93.15 $41.08 N/A $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 400.487E SUP HCPCS C1713 400.487E - SCREW BONE 1.7MM 2.4MM 7MM EMERGENCY PLUSDRIVE RECESS TEAL BOTH IP/OP $187.00 $138.00 $37.07 $186.75 $84.04 $84.04 $84.04 $84.04 $186.75 $186.75 $186.75 $38.92 $186.75 $186.75 $186.75 $186.75 $186.75 $38.92 $186.75 $74.70 $110.46 $186.75 $186.75 $186.75 $186.75 $140.25 $186.75 $186.75 $186.75 $93.38 $93.38 $147.91 $186.75 $149.40 $84.04 $37.07 N/A $108.46 $186.75 $186.75 $186.75 $38.92 $186.75 N/A N/A 400.488E SUP HCPCS C1713 400.488E - SCREW BN 1.5MM 8MM NS TI CORT BOTH IP/OP $207.00 $153.00 $41.08 $207.00 $93.15 $93.15 $93.15 $93.15 $207.00 $207.00 $207.00 $43.14 $207.00 $207.00 $207.00 $207.00 $207.00 $43.14 $207.00 $82.80 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $93.15 $41.08 N/A $120.06 $207.00 $124.20 $207.00 $43.14 $207.00 N/A N/A 400.489E SUP HCPCS C1713 400.489E - SCREW BONE 1.7MM 2.4MM 9MM EMERGENCY PLUSDRIVE RECESS TEAL BOTH IP/OP $187.00 $138.00 $37.07 $186.75 $84.04 $84.04 $84.04 $84.04 $186.75 $186.75 $186.75 $38.92 $186.75 $186.75 $186.75 $186.75 $186.75 $38.92 $186.75 $186.75 $110.46 $186.75 $186.75 $186.75 $186.75 $140.25 $186.75 $186.75 $186.75 $93.38 $93.38 $147.91 $186.75 $149.40 $84.04 $37.07 N/A $108.46 $186.75 $112.05 $186.75 $38.92 $186.75 N/A N/A 400.490E SUP HCPCS C1713 400.490E - SCREW BONE 1.7MM 10IN EMERGENCY PLUSDRIVE RECESS TITANIUM BOTH IP/OP $207.00 $153.00 $41.08 $207.00 $93.15 $93.15 $93.15 $93.15 $207.00 $207.00 $207.00 $43.14 $207.00 $207.00 $207.00 $207.00 $207.00 $43.14 $207.00 $82.80 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $93.15 $41.08 N/A $120.06 $207.00 $124.20 $207.00 $43.14 $207.00 N/A N/A 400.492E SUP HCPCS C1713 400.492E - SCREW BONE 1.7MM 2.4MM 12MM EMERGENCY PLUSDRIVE RECESS TEAL BOTH IP/OP $207.00 $153.00 $41.08 $207.00 $93.15 $93.15 $93.15 $93.15 $207.00 $207.00 $207.00 $43.14 $207.00 $207.00 $207.00 $207.00 $207.00 $43.14 $207.00 $82.80 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $93.15 $41.08 N/A $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 400.494E SUP HCPCS C1713 400.494E - SCREW BONE 1.7MM 2.4MM 14MM EMERGENCY PLUSDRIVE RECESS TEAL BOTH IP/OP $207.00 $153.00 $41.08 $207.00 $93.15 $93.15 $93.15 $93.15 $207.00 $207.00 $207.00 $43.14 $207.00 $207.00 $207.00 $207.00 $207.00 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $93.15 $41.08 N/A $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 400.496E SUP HCPCS C1713 400.496E - SCREW BONE 1.7MM 2.4MM 16MM EMERGENCY PLUSDRIVE RECESS TEAL BOTH IP/OP $207.00 $153.00 $41.08 $207.00 $93.15 $93.15 $93.15 $93.15 $207.00 $207.00 $207.00 $43.14 $207.00 $207.00 $207.00 $207.00 $207.00 $43.14 $207.00 $207.00 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $93.15 $41.08 N/A $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 400.498E SUP HCPCS C1713 400.498E - SCREW BONE 1.7MM 2.4MM 18MM EMERGENCY PLUSDRIVE RECESS TEAL BOTH IP/OP $207.00 $153.00 $41.08 $207.00 $93.15 $93.15 $93.15 $93.15 $207.00 $207.00 $207.00 $43.14 $207.00 $207.00 $207.00 $207.00 $207.00 $43.14 $207.00 $82.80 $122.44 $207.00 $207.00 $207.00 $207.00 $155.25 $207.00 $207.00 $207.00 $103.50 $103.50 $163.94 $207.00 $165.60 $93.15 $41.08 N/A $120.06 $207.00 $207.00 $207.00 $43.14 $207.00 N/A N/A 400.806.96 SUP HCPCS C1713 400.806.96 - SCREW BONE LP 1.5MM 3MM 6MM SELF TAP THREAD TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $66.45 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $13.62 $65.35 N/A N/A 400.807.96 SUP HCPCS C1713 400.807.96 - SCREW BONE LP 1.5MM 3MM 7MM SELF TAP THREAD TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $26.58 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $65.35 $65.35 N/A N/A 400.808.96 SUP HCPCS C1713 400.808.96 - SCREW BONE 1.5MM 3MM 8MM SLFTAP TITANIUM HAND CORTICAL BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $26.58 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $13.62 $65.35 N/A N/A 400.809.96 SUP HCPCS C1713 400.809.96 - SCREW BONE 1.5MM 9MM SLFTAP TITANIUM CORTICAL HAND NONSTRL BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $66.45 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $13.62 $65.35 N/A N/A 400.810.96 SUP HCPCS C1713 400.810.96 - SCREW BONE LP 1.5MM 3MM 10MM SELF TAP THREAD TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $26.58 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $65.35 $65.35 N/A N/A 400.811.96 SUP HCPCS C1713 400.811.96 - SCREW BONE LP 1.5MM 3MM 11MM SELF TAP THREAD TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $26.58 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $13.62 $65.35 N/A N/A 400.812.96 SUP HCPCS C1713 400.812.96 - SCREW BONE 1.5MM 3MM 12MM SLFTAP TITANIUM HAND CORTICAL BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $26.58 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $13.62 $65.35 N/A N/A 400.813.96 SUP HCPCS C1713 400.813.96 - SCREW BONE 1.5MM 3MM 13MM SLFTAP LP HEAD THREADED TITANIUM BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $26.58 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $65.35 $65.35 $65.35 $65.35 N/A N/A 400.814.96 SUP HCPCS C1713 400.814.96 - SCREW BONE LP 1.5MM 3MM 14MM SELF TAP THREAD TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $66.45 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $65.35 $65.35 $13.62 $65.35 N/A N/A 400.816.96 SUP HCPCS C1713 400.816.96 - SCREW BONE 1.5MM 16MM SLFTAP TITANIUM CORTICAL HAND NONSTRL BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $26.58 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $13.62 $65.35 N/A N/A 400.818.96 SUP HCPCS C1713 400.818.96 - SCREW BONE LP 1.5MM 3MM 18MM SELF TAP THREAD TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $26.58 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $65.35 $65.35 N/A N/A 400.820.96 SUP HCPCS C1713 400.820.96 - SCREW BONE LP 1.5MM 3MM 20MM SELF TAP THREAD TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $26.58 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $65.35 $65.35 N/A N/A 400.822.96 SUP HCPCS C1713 400.822.96 - SCREW BONE LP 1.5MM 3MM 22MM SELF TAP THREAD TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $26.58 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $39.21 $65.35 $13.62 $65.35 N/A N/A 400.824.96 SUP HCPCS C1713 400.824.96 - SCREW BONE LP 1.5MM 3MM 24MM SELF TAP THREAD TITANIUM HAND BOTH IP/OP $65.50 $48.00 $12.97 $66.45 $29.41 $29.41 $29.41 $29.41 $65.35 $65.35 $65.35 $13.62 $65.35 $65.35 $65.35 $65.35 $65.35 $13.62 $65.35 $26.58 $38.65 $65.35 $66.45 $65.35 $65.35 $49.13 $65.35 $65.35 $65.35 $32.68 $32.68 $51.76 $65.35 $52.28 $29.41 $12.97 N/A $37.99 $65.35 $65.35 $65.35 $13.62 $65.35 N/A N/A 400.843E SUP HCPCS C1713 400.843E - SCREW BONE 1.6MM 3MM SLFTAP LP TITANIUM ALLOY BOTH IP/OP $197.00 $146.00 $39.08 $196.88 $88.60 $88.60 $88.60 $88.60 $196.88 $196.88 $196.88 $41.03 $196.88 $196.88 $196.88 $196.88 $196.88 $41.03 $196.88 $78.75 $116.45 $196.88 $196.88 $196.88 $196.88 $147.75 $196.88 $196.88 $196.88 $98.44 $98.44 $155.93 $196.88 $157.50 $88.60 $39.08 N/A $114.26 $196.88 $196.88 $196.88 $41.03 $196.88 N/A N/A 400.846E SUP HCPCS C1713 400.846E - SCREW BONE 1.6MM 2.9MM 6MM SLFTAP LP TITANIUM BOTH IP/OP $197.00 $146.00 $39.08 $196.88 $88.60 $88.60 $88.60 $88.60 $196.88 $196.88 $196.88 $41.03 $196.88 $196.88 $196.88 $196.88 $196.88 $41.03 $196.88 $78.75 $116.45 $196.88 $196.88 $196.88 $196.88 $147.75 $196.88 $196.88 $196.88 $98.44 $98.44 $155.93 $196.88 $157.50 $88.60 $39.08 N/A $114.26 $196.88 $196.88 $196.88 $41.03 $196.88 N/A N/A 400.855E SUP HCPCS C1713 400.855E - SCREW BONE 2MM 5MM SLFTAP LP EMERGENCY TITANIUM CRANFCL BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 400.856E SUP HCPCS C1713 400.856E - SCREW BONE 2MM 6MM SLFTAP LP EMERGENCY TITANIUM CRANFCL BOTH IP/OP $197.00 $146.00 $39.08 $196.88 $88.60 $88.60 $88.60 $88.60 $196.88 $196.88 $196.88 $41.03 $196.88 $196.88 $196.88 $196.88 $196.88 $41.03 $196.88 $78.75 $116.45 $196.88 $196.88 $196.88 $196.88 $147.75 $196.88 $196.88 $196.88 $98.44 $98.44 $155.93 $196.88 $157.50 $88.60 $39.08 N/A $114.26 $196.88 $196.88 $196.88 $41.03 $196.88 N/A N/A 40-0001-S SUP HCPCS C1713 40-0001-S - ROD XTRNFX CMPR OLCRN BOTH IP/OP "$2,480.00" "$1,835.00" $492.22 "$2,480.00" "$1,116.00" "$1,116.00" "$1,116.00" "$1,116.00" "$2,480.00" "$2,480.00" "$2,480.00" $516.89 "$2,480.00" "$2,480.00" "$2,480.00" "$2,480.00" "$2,480.00" $516.86 "$2,480.00" "$2,480.00" "$1,466.92" "$2,480.00" "$2,480.00" "$2,480.00" "$2,480.00" "$1,860.00" "$2,480.00" "$2,480.00" "$2,480.00" "$1,240.00" "$1,240.00" "$1,964.16" "$2,480.00" "$1,984.00" "$1,116.00" $492.22 N/A "$1,438.40" "$2,480.00" "$1,488.00" "$2,480.00" $516.83 "$2,480.00" N/A N/A 40-0003 SUP Custom 27203010 40-0003 - NUT EXFIX OLCRN GUIDE ASMBLY NONSTRL BOTH IP/OP "$1,140.00" $844.00 $202.92 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $202.92 "$1,140.00" "$1,140.00" $846.11 $846.11 $878.71 $593.94 $237.59 "$1,140.00" $456.00 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $855.00 "$1,140.00" "$1,140.00" "$1,140.00" $570.00 $570.00 $902.88 "$1,140.00" $912.00 $741.00 "$1,140.00" N/A $661.20 "$1,140.00" $684.00 "$1,140.00" "$1,140.00" "$1,140.00" N/A N/A 40-0006 SUP HCPCS C1713 40-0006 - BOLT LCK OLCRN NONSTRL BOTH IP/OP $657.50 $487.00 $130.50 $657.50 $295.88 $295.88 $295.88 $295.88 $657.50 $657.50 $657.50 $137.04 $657.50 $657.50 $657.50 $657.50 $657.50 $137.03 $657.50 $657.50 $388.91 $657.50 $657.50 $657.50 $657.50 $493.13 $657.50 $657.50 $657.50 $328.75 $328.75 $520.74 $657.50 $526.00 $295.88 $130.50 N/A $381.35 $657.50 $394.50 $657.50 $137.02 $657.50 N/A N/A 40-0007 SUP HCPCS C1713 40-0007 - CANNU ORTH TRGT ROD NONSTRL OLCRN BOTH IP/OP "$1,005.00" $744.00 $199.47 "$1,005.00" $452.25 $452.25 $452.25 $452.25 "$1,005.00" "$1,005.00" "$1,005.00" $209.47 "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" $209.45 "$1,005.00" "$1,005.00" $594.46 "$1,005.00" "$1,005.00" "$1,005.00" "$1,005.00" $753.75 "$1,005.00" "$1,005.00" "$1,005.00" $502.50 $502.50 $795.96 "$1,005.00" $804.00 $452.25 $199.47 N/A $582.90 "$1,005.00" $603.00 "$1,005.00" $209.44 "$1,005.00" N/A N/A 40-0008 SUP Custom 27203010 40-0008 - GUIDE TRGT ASMBLY CMPR NUT SURG OLCRN NONSTRL BOTH IP/OP "$1,992.50" "$1,474.00" $354.67 "$1,992.50" "$1,992.50" "$1,992.50" "$1,992.50" "$1,992.50" "$1,992.50" "$1,992.50" $354.67 "$1,992.50" "$1,992.50" "$1,478.83" "$1,478.83" "$1,535.82" "$1,038.09" $415.26 "$1,992.50" $797.00 "$1,992.50" "$1,992.50" "$1,992.50" "$1,992.50" "$1,992.50" "$1,494.38" "$1,992.50" "$1,992.50" "$1,992.50" $996.25 $996.25 "$1,578.06" "$1,992.50" "$1,594.00" "$1,295.13" "$1,992.50" N/A "$1,155.65" "$1,992.50" "$1,195.50" "$1,992.50" "$1,992.50" "$1,992.50" N/A N/A 40-0012 SUP Custom 27203010 40-0012 - DRILL SRG NUT CMPR OLCRN BOTH IP/OP $827.50 $612.00 $147.30 $827.50 $827.50 $827.50 $827.50 $827.50 $827.50 $827.50 $147.30 $827.50 $827.50 $614.17 $614.17 $637.84 $431.13 $172.46 $827.50 $331.00 $827.50 $827.50 $827.50 $827.50 $827.50 $620.63 $827.50 $827.50 $827.50 $413.75 $413.75 $655.38 $827.50 $662.00 $537.88 $827.50 N/A $479.95 $827.50 $496.50 $827.50 $827.50 $827.50 N/A N/A 40-0013-S SUP Custom 27203010 40-0013-S - NUT XTRNFX 6MM CMPR OLCRN BOTH IP/OP $675.00 $500.00 $120.15 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $120.15 $675.00 $675.00 $500.99 $500.99 $520.29 $351.68 $140.68 $675.00 $270.00 $675.00 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $438.75 $675.00 N/A $391.50 $675.00 $405.00 $675.00 $675.00 $675.00 N/A N/A 40-0014-S SUP Custom 27203010 40-0014-S - NUT XTRNFX 8MM CMPR OLCRN BOTH IP/OP $675.00 $500.00 $120.15 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $120.15 $675.00 $675.00 $500.99 $500.99 $520.29 $351.68 $140.68 $675.00 $270.00 $675.00 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $438.75 $675.00 N/A $391.50 $675.00 $405.00 $675.00 $675.00 $675.00 N/A N/A 40-0015-S SUP Custom 27203010 40-0015-S - NUT XTRNFX 10MM CMPR OLCRN BOTH IP/OP $675.00 $500.00 $120.15 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $675.00 $120.15 $675.00 $675.00 $500.99 $500.99 $520.29 $351.68 $140.68 $675.00 $270.00 $675.00 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $438.75 $675.00 N/A $391.50 $675.00 $405.00 $675.00 $675.00 $675.00 N/A N/A 40-0016-S SUP Custom 27803010 40-0016-S - WASHER ORTH SMTH OLCRN BOTH IP/OP $537.50 $398.00 $95.68 $537.50 $537.50 $537.50 $537.50 $537.50 $537.50 $537.50 $95.68 $537.50 $537.50 $537.50 $537.50 $537.50 $537.50 $112.02 $537.50 $215.00 $537.50 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $241.88 $537.50 N/A $311.75 $537.50 $322.50 $537.50 $537.50 $537.50 N/A N/A 40-0021-S SUP HCPCS C1713 40-0021-S - WASHER ORTH THRD OLCRN BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A 40-0026-S SUP HCPCS C1713 40-0026-S - ROD INTRAMEDULLARY 3MM 110MM 2 INTERLOCK SCREW HOLE ANKLE BOTH IP/OP "$2,705.00" "$2,002.00" $536.87 "$2,705.00" "$1,217.25" "$1,217.25" "$1,217.25" "$1,217.25" "$2,705.00" "$2,705.00" "$2,705.00" $563.79 "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" $563.75 "$2,705.00" "$2,705.00" "$1,333.57" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,028.75" "$2,705.00" "$2,705.00" "$2,705.00" "$1,352.50" "$1,352.50" "$2,142.36" "$2,705.00" "$2,164.00" "$1,217.25" $536.87 N/A "$1,568.90" "$2,705.00" "$1,623.00" "$2,705.00" $563.72 "$2,705.00" N/A N/A 40-0027-S SUP HCPCS C1713 40-0027-S - ROD ORTHOPEDIC 3MM 145MM 2 INTLCK SCREW HOLE FIBULA ANKLE BOTH IP/OP "$2,705.00" "$2,002.00" $536.87 "$2,705.00" "$1,217.25" "$1,217.25" "$1,217.25" "$1,217.25" "$2,705.00" "$2,705.00" "$2,705.00" $563.79 "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" $563.75 "$2,705.00" "$2,705.00" "$1,333.57" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,028.75" "$2,705.00" "$2,705.00" "$2,705.00" "$1,352.50" "$1,352.50" "$2,142.36" "$2,705.00" "$2,164.00" "$1,217.25" $536.87 N/A "$1,568.90" "$2,705.00" "$1,623.00" "$2,705.00" $563.72 "$2,705.00" N/A N/A 40-0028-S SUP HCPCS C1713 40-0028-S - ROD ORTHOPEDIC 3MM 180MM 2 INTLCK SCREW HOLE FIBULA ANKLE BOTH IP/OP "$2,705.00" "$2,002.00" $536.87 "$2,705.00" "$1,217.25" "$1,217.25" "$1,217.25" "$1,217.25" "$2,705.00" "$2,705.00" "$2,705.00" $563.79 "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" $563.75 "$2,705.00" "$2,705.00" "$1,333.57" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,028.75" "$2,705.00" "$2,705.00" "$2,705.00" "$1,352.50" "$1,352.50" "$2,142.36" "$2,705.00" "$2,164.00" "$1,217.25" $536.87 N/A "$1,568.90" "$2,705.00" "$1,623.00" "$2,705.00" $563.72 "$2,705.00" N/A N/A 40-0029-S SUP HCPCS C1713 40-0029-S - ROD ORTHOPEDIC 3.6MM 110MM 2 INTLCK SCREW HOLE FIBULA ANKLE BOTH IP/OP "$2,705.00" "$2,002.00" $536.87 "$2,705.00" "$1,217.25" "$1,217.25" "$1,217.25" "$1,217.25" "$2,705.00" "$2,705.00" "$2,705.00" $563.79 "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" $563.75 "$2,705.00" "$2,705.00" "$1,333.57" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,028.75" "$2,705.00" "$2,705.00" "$2,705.00" "$1,352.50" "$1,352.50" "$2,142.36" "$2,705.00" "$2,164.00" "$1,217.25" $536.87 N/A "$1,568.90" "$2,705.00" "$2,705.00" "$2,705.00" $563.72 "$2,705.00" N/A N/A 40-0030-S SUP HCPCS C1713 40-0030-S - ROD XTRNFX 3.6MM 145MM FIB BOTH IP/OP "$2,705.00" "$2,002.00" $536.87 "$2,705.00" "$1,217.25" "$1,217.25" "$1,217.25" "$1,217.25" "$2,705.00" "$2,705.00" "$2,705.00" $563.79 "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" $563.75 "$2,705.00" "$2,705.00" "$1,333.57" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,028.75" "$2,705.00" "$2,705.00" "$2,705.00" "$1,352.50" "$1,352.50" "$2,142.36" "$2,705.00" "$2,164.00" "$1,217.25" $536.87 N/A "$1,568.90" "$2,705.00" "$2,705.00" "$2,705.00" $563.72 "$2,705.00" N/A N/A 40-0031-S SUP Custom 27203010 40-0031-S - ROD INTRAMEDULLARY 3.6MM 180MM 2 INTERLOCK SCREW HOLE ANKLE BOTH IP/OP "$2,705.00" "$2,002.00" $481.49 "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" $481.49 "$2,705.00" "$2,705.00" "$2,007.65" "$2,007.65" "$2,085.01" "$1,409.31" $563.75 "$2,705.00" "$1,082.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,705.00" "$2,028.75" "$2,705.00" "$2,705.00" "$2,705.00" "$1,352.50" "$1,352.50" "$2,142.36" "$2,705.00" "$2,164.00" "$1,758.25" "$2,705.00" N/A "$1,568.90" "$2,705.00" "$1,623.00" "$2,705.00" "$2,705.00" "$2,705.00" N/A N/A 40-0034 SUP HCPCS C1713 40-0034 - BASEPLATE ROD FIB BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,188.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 40-0136 SUP HCPCS C1713 40-0136 - SCREW BONE 3MM 80MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$2,987.50" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$1,792.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A 40-0137 SUP HCPCS C1713 40-0137 - SCREW BONE 3MM 90MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$2,987.50" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$1,792.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A 40-0138 SUP HCPCS C1713 40-0138 - SCREW BONE 3MM 100MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$2,987.50" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$1,792.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A 40-0139 SUP HCPCS C1713 40-0139 - SCREW BONE 3MM 110MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$2,987.50" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$1,792.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A 400-14 SUP Custom 27203010 400-14 - BANDAGE ADH MRDH BOTH IP/OP "$2,470.00" "$1,828.00" $439.66 "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" $439.66 "$2,470.00" "$2,470.00" "$1,833.23" "$1,833.23" "$1,903.88" "$1,286.87" $514.78 "$2,470.00" $988.00 "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" "$2,470.00" "$1,852.50" "$2,470.00" "$2,470.00" "$2,470.00" "$1,235.00" "$1,235.00" "$1,956.24" "$2,470.00" "$1,976.00" "$1,605.50" "$2,470.00" N/A "$1,432.60" "$2,470.00" "$1,482.00" "$2,470.00" "$2,470.00" "$2,470.00" N/A N/A 40-0140 SUP HCPCS C1713 40-0140 - SCREW BONE 3MM 120MM DL TRK TI CLVCL DIFF PTCH CUT FLUT TAIL BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$2,987.50" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$1,792.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A 40-0143 SUP HCPCS C1713 40-0143 - SCREW BONE 3.8MM 80MM DL TRK TI CLVCL DIFF PTCH CUT FLUT BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$2,987.50" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$2,987.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A 40-0144 SUP HCPCS C1713 40-0144 - SCREW BONE 3.8MM 90MM CLVCL DL TRK BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$2,987.50" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$1,792.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A 40-0145 SUP HCPCS C1713 40-0145 - SCREW BONE 3.8MM 100MM DL TRK TI CLVCL DIFF PTCH CUT FLUT BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$2,987.50" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$1,792.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A 40-0146 SUP HCPCS C1713 40-0146 - SCREW BONE 3.8MM 110MM DL TRK TI CLVCL DIFF PTCH CUT FLUT BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$2,987.50" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$1,792.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A 40-0147 SUP HCPCS C1713 40-0147 - SCREW BONE 3.8MM 120MM DL TRK TI CLVCL DIFF PTCH CUT FLUT BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$2,987.50" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$2,987.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A 4002C0306 SUP Custom 27803010 4002C0306 - COIL EMBL .02IN STD CMPLX 3MM 6CM THE PENUMBRA COIL 400 BOTH IP/OP "$5,525.00" "$4,089.00" $983.45 "$5,525.00" "$5,525.00" "$5,525.00" "$5,525.00" "$5,525.00" "$5,525.00" "$5,525.00" $983.45 "$5,525.00" "$5,525.00" "$5,525.00" "$5,525.00" "$5,525.00" "$5,525.00" "$1,151.47" "$5,525.00" "$2,210.00" "$5,525.00" "$5,525.00" "$5,525.00" "$5,525.00" "$5,525.00" "$4,143.75" "$5,525.00" "$5,525.00" "$5,525.00" "$2,762.50" "$2,762.50" "$4,375.80" "$5,525.00" "$4,420.00" "$2,486.25" "$5,525.00" N/A "$3,204.50" "$5,525.00" "$3,315.00" "$5,525.00" "$5,525.00" "$5,525.00" N/A N/A 4002C0310 SUP Custom 27803010 "4002C0310 - Coil 400 Complex Standard, 3 mm x 10 cm" BOTH IP/OP "$5,625.00" "$4,163.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$2,250.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$5,625.00" N/A "$3,262.50" "$5,625.00" "$3,375.00" "$5,625.00" "$5,625.00" "$5,625.00" N/A N/A 4002C0408 SUP Custom 27803010 4002C0408 - COIL EMBL .02IN STD CMPLX 4MM 8CM THE PENUMBRA COIL 400 BOTH IP/OP "$5,017.50" "$3,713.00" $893.12 "$5,017.50" "$5,017.50" "$5,017.50" "$5,017.50" "$5,017.50" "$5,017.50" "$5,017.50" $893.12 "$5,017.50" "$5,017.50" "$5,017.50" "$5,017.50" "$5,017.50" "$5,017.50" "$1,045.70" "$5,017.50" "$2,007.00" "$5,017.50" "$5,017.50" "$5,017.50" "$5,017.50" "$5,017.50" "$3,763.13" "$5,017.50" "$5,017.50" "$5,017.50" "$2,508.75" "$2,508.75" "$3,973.86" "$5,017.50" "$4,014.00" "$2,257.88" "$5,017.50" N/A "$2,910.15" "$5,017.50" "$3,010.50" "$5,017.50" "$5,017.50" "$5,017.50" N/A N/A 4002C0412 SUP Custom 27803010 4002C0412 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 4MM 12CM COMPLEX BOTH IP/OP "$5,675.00" "$4,200.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,010.15" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$1,182.73" "$5,675.00" "$2,270.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$5,675.00" "$4,256.25" "$5,675.00" "$5,675.00" "$5,675.00" "$2,837.50" "$2,837.50" "$4,494.60" "$5,675.00" "$4,540.00" "$2,553.75" "$5,675.00" N/A "$3,291.50" "$5,675.00" "$3,405.00" "$5,675.00" "$5,675.00" "$5,675.00" N/A N/A 4002C0506 SUP Custom 27803010 4002C0506 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 5MM 6CM COMPLEX THE BOTH IP/OP "$4,972.50" "$3,680.00" $885.11 "$4,972.50" "$4,972.50" "$4,972.50" "$4,972.50" "$4,972.50" "$4,972.50" "$4,972.50" $885.11 "$4,972.50" "$4,972.50" "$4,972.50" "$4,972.50" "$4,972.50" "$4,972.50" "$1,036.32" "$4,972.50" "$1,989.00" "$4,972.50" "$4,972.50" "$4,972.50" "$4,972.50" "$4,972.50" "$3,729.38" "$4,972.50" "$4,972.50" "$4,972.50" "$2,486.25" "$2,486.25" "$3,938.22" "$4,972.50" "$3,978.00" "$2,237.63" "$4,972.50" N/A "$2,884.05" "$4,972.50" "$2,983.50" "$4,972.50" "$4,972.50" "$4,972.50" N/A N/A 4002C0510 SUP Custom 27803010 4002C0510 - COIL EMBL STD 5MM 10CM PENUMBRA COIL 400 CMPLX BOTH IP/OP "$5,062.50" "$3,746.00" $901.13 "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" $901.13 "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$1,055.08" "$5,062.50" "$2,025.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$3,796.88" "$5,062.50" "$5,062.50" "$5,062.50" "$2,531.25" "$2,531.25" "$4,009.50" "$5,062.50" "$4,050.00" "$2,278.13" "$5,062.50" N/A "$2,936.25" "$5,062.50" "$3,037.50" "$5,062.50" "$5,062.50" "$5,062.50" N/A N/A 4002C0610 SUP Custom 27803010 4002C0610 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 6MM 10CM COMPLEX BOTH IP/OP "$5,062.50" "$3,746.00" $901.13 "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" $901.13 "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$1,055.08" "$5,062.50" "$2,025.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$3,796.88" "$5,062.50" "$5,062.50" "$5,062.50" "$2,531.25" "$2,531.25" "$4,009.50" "$5,062.50" "$4,050.00" "$2,278.13" "$5,062.50" N/A "$2,936.25" "$5,062.50" "$3,037.50" "$5,062.50" "$5,062.50" "$5,062.50" N/A N/A 4002C0615 SUP Custom 27803010 4002C0615 - COIL EMBL STD 6MM 15CM PENUMBRA COIL 400 CMPLX BOTH IP/OP "$5,175.00" "$3,830.00" $921.15 "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" $921.15 "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$1,078.53" "$5,175.00" "$2,070.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$3,881.25" "$5,175.00" "$5,175.00" "$5,175.00" "$2,587.50" "$2,587.50" "$4,098.60" "$5,175.00" "$4,140.00" "$2,328.75" "$5,175.00" N/A "$3,001.50" "$5,175.00" "$3,105.00" "$5,175.00" "$5,175.00" "$5,175.00" N/A N/A 4002C0710 SUP Custom 27803010 4002C0710 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 7MM 10CM COMPLEX BOTH IP/OP "$5,062.50" "$3,746.00" $901.13 "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" $901.13 "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$1,055.08" "$5,062.50" "$2,025.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$3,796.88" "$5,062.50" "$5,062.50" "$5,062.50" "$2,531.25" "$2,531.25" "$4,009.50" "$5,062.50" "$4,050.00" "$2,278.13" "$5,062.50" N/A "$2,936.25" "$5,062.50" "$3,037.50" "$5,062.50" "$5,062.50" "$5,062.50" N/A N/A 4002C0715 SUP Custom 27803010 4002C0715 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 7MM 15CM COMPLEX BOTH IP/OP "$5,175.00" "$3,830.00" $921.15 "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" $921.15 "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$1,078.53" "$5,175.00" "$2,070.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$3,881.25" "$5,175.00" "$5,175.00" "$5,175.00" "$2,587.50" "$2,587.50" "$4,098.60" "$5,175.00" "$4,140.00" "$2,328.75" "$5,175.00" N/A "$3,001.50" "$5,175.00" "$3,105.00" "$5,175.00" "$5,175.00" "$5,175.00" N/A N/A 4002C0720 SUP Custom 27803010 4002C0720 - COIL EMBL STD 7MM 20CM PENUMBRA COIL 400 CMPLX BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 4002C0815 SUP Custom 27803010 4002C0815 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 8MM 15CM COMPLEX BOTH IP/OP "$5,750.00" "$4,255.00" "$1,023.50" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,023.50" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$2,300.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$5,750.00" N/A "$3,335.00" "$5,750.00" "$3,450.00" "$5,750.00" "$5,750.00" "$5,750.00" N/A N/A 4002C0820 SUP Custom 27803010 4002C0820 - COIL EMBL .02IN STD CMPLX 8MM 20CM THE PENUMBRA COIL 400 BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 4002C0830 SUP Custom 27803010 4002C0830 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 8MM 30CM COMPLEX BOTH IP/OP "$5,512.50" "$4,079.00" $981.23 "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" $981.23 "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$1,148.87" "$5,512.50" "$2,205.00" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$4,134.38" "$5,512.50" "$5,512.50" "$5,512.50" "$2,756.25" "$2,756.25" "$4,365.90" "$5,512.50" "$4,410.00" "$2,480.63" "$5,512.50" N/A "$3,197.25" "$5,512.50" "$3,307.50" "$5,512.50" "$5,512.50" "$5,512.50" N/A N/A 4002C0915 SUP Custom 27803010 4002C0915 - COIL EMBL .02IN STD CMPLX 9MM 15CM THE PENUMBRA COIL 400 BOTH IP/OP "$5,750.00" "$4,255.00" "$1,023.50" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,023.50" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$2,300.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$5,750.00" N/A "$3,335.00" "$5,750.00" "$3,450.00" "$5,750.00" "$5,750.00" "$5,750.00" N/A N/A 4002C0925 SUP Custom 27803010 4002C0925 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 9MM 25CM COMPLEX BOTH IP/OP "$5,400.00" "$3,996.00" $961.20 "$5,400.00" "$5,400.00" "$5,400.00" "$5,400.00" "$5,400.00" "$5,400.00" "$5,400.00" $961.20 "$5,400.00" "$5,400.00" "$5,400.00" "$5,400.00" "$5,400.00" "$5,400.00" "$1,125.42" "$5,400.00" "$2,160.00" "$5,400.00" "$5,400.00" "$5,400.00" "$5,400.00" "$5,400.00" "$4,050.00" "$5,400.00" "$5,400.00" "$5,400.00" "$2,700.00" "$2,700.00" "$4,276.80" "$5,400.00" "$4,320.00" "$2,430.00" "$5,400.00" N/A "$3,132.00" "$5,400.00" "$3,240.00" "$5,400.00" "$5,400.00" "$5,400.00" N/A N/A 4002C0935 SUP Custom 27803010 4002C0935 - COIL EMBL .02IN STD CMPLX 9MM 35CM THE PENUMBRA COIL 400 BOTH IP/OP "$5,570.00" "$4,122.00" $991.46 "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" $991.46 "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$1,160.85" "$5,570.00" "$2,228.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$4,177.50" "$5,570.00" "$5,570.00" "$5,570.00" "$2,785.00" "$2,785.00" "$4,411.44" "$5,570.00" "$4,456.00" "$2,506.50" "$5,570.00" N/A "$3,230.60" "$5,570.00" "$3,342.00" "$5,570.00" "$5,570.00" "$5,570.00" N/A N/A 4002C1020 SUP Custom 27803010 4002C1020 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 10MM 20CM COMPLEX BOTH IP/OP "$5,287.50" "$3,913.00" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" $941.18 "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$1,101.97" "$5,287.50" "$2,115.00" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$5,287.50" "$3,965.63" "$5,287.50" "$5,287.50" "$5,287.50" "$2,643.75" "$2,643.75" "$4,187.70" "$5,287.50" "$4,230.00" "$2,379.38" "$5,287.50" N/A "$3,066.75" "$5,287.50" "$3,172.50" "$5,287.50" "$5,287.50" "$5,287.50" N/A N/A 4002C1030 SUP Custom 27803010 4002C1030 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 10MM 30CM COMPLEX BOTH IP/OP "$5,512.50" "$4,079.00" $981.23 "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" $981.23 "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$1,148.87" "$5,512.50" "$2,205.00" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$4,134.38" "$5,512.50" "$5,512.50" "$5,512.50" "$2,756.25" "$2,756.25" "$4,365.90" "$5,512.50" "$4,410.00" "$2,480.63" "$5,512.50" N/A "$3,197.25" "$5,512.50" "$3,307.50" "$5,512.50" "$5,512.50" "$5,512.50" N/A N/A 4002C1040 SUP Custom 27803010 4002C1040 - COIL EMBL .02IN STD CMPLX 10MM 40CM THE PENUMBRA COIL 400 BOTH IP/OP "$5,625.00" "$4,163.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$2,250.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$5,625.00" N/A "$3,262.50" "$5,625.00" "$3,375.00" "$5,625.00" "$5,625.00" "$5,625.00" N/A N/A 4002C1135 SUP Custom 27803010 4002C1135 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 11MM 35CM COMPLEX BOTH IP/OP "$5,570.00" "$4,122.00" $991.46 "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" $991.46 "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$1,160.85" "$5,570.00" "$2,228.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$4,177.50" "$5,570.00" "$5,570.00" "$5,570.00" "$2,785.00" "$2,785.00" "$4,411.44" "$5,570.00" "$4,456.00" "$2,506.50" "$5,570.00" N/A "$3,230.60" "$5,570.00" "$3,342.00" "$5,570.00" "$5,570.00" "$5,570.00" N/A N/A 4002C1145 SUP Custom 27803010 4002C1145 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 11MM 45CM COMPLEX BOTH IP/OP "$5,682.50" "$4,205.00" "$1,011.49" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$1,011.49" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$1,184.30" "$5,682.50" "$2,273.00" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$4,261.88" "$5,682.50" "$5,682.50" "$5,682.50" "$2,841.25" "$2,841.25" "$4,500.54" "$5,682.50" "$4,546.00" "$2,557.13" "$5,682.50" N/A "$3,295.85" "$5,682.50" "$3,409.50" "$5,682.50" "$5,682.50" "$5,682.50" N/A N/A 4002C1235 SUP Custom 27803010 4002C1235 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 12MM 35CM COMPLEX BOTH IP/OP "$5,570.00" "$4,122.00" $991.46 "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" $991.46 "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$1,160.85" "$5,570.00" "$2,228.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$5,570.00" "$4,177.50" "$5,570.00" "$5,570.00" "$5,570.00" "$2,785.00" "$2,785.00" "$4,411.44" "$5,570.00" "$4,456.00" "$2,506.50" "$5,570.00" N/A "$3,230.60" "$5,570.00" "$3,342.00" "$5,570.00" "$5,570.00" "$5,570.00" N/A N/A 4002C1245 SUP Custom 27803010 4002C1245 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 12MM 45CM COMPLEX BOTH IP/OP "$5,682.50" "$4,205.00" "$1,011.49" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$1,011.49" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$1,184.30" "$5,682.50" "$2,273.00" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$5,682.50" "$4,261.88" "$5,682.50" "$5,682.50" "$5,682.50" "$2,841.25" "$2,841.25" "$4,500.54" "$5,682.50" "$4,546.00" "$2,557.13" "$5,682.50" N/A "$3,295.85" "$5,682.50" "$3,409.50" "$5,682.50" "$5,682.50" "$5,682.50" N/A N/A 4002C1335 SUP Custom 27803010 4002C1335 - COIL EMBOLIZATION STANDARD .02IN 13MM 35CM DETACHABLE BOTH IP/OP "$6,187.50" "$4,579.00" "$1,101.38" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$1,101.38" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$1,289.54" "$6,187.50" "$2,475.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$4,640.63" "$6,187.50" "$6,187.50" "$6,187.50" "$3,093.75" "$3,093.75" "$4,900.50" "$6,187.50" "$4,950.00" "$2,784.38" "$6,187.50" N/A "$3,588.75" "$6,187.50" "$3,712.50" "$6,187.50" "$6,187.50" "$6,187.50" N/A N/A 4002C1348 SUP Custom 27803010 4002C1348 - COIL EMBL STD .02IN 13MM 48CM DTCH CMPLX STRCH RS PLTN BOTH IP/OP "$5,715.00" "$4,229.00" "$1,017.27" "$5,715.00" "$5,715.00" "$5,715.00" "$5,715.00" "$5,715.00" "$5,715.00" "$5,715.00" "$1,017.27" "$5,715.00" "$5,715.00" "$5,715.00" "$5,715.00" "$5,715.00" "$5,715.00" "$1,191.07" "$5,715.00" "$2,286.00" "$5,715.00" "$5,715.00" "$5,715.00" "$5,715.00" "$5,715.00" "$4,286.25" "$5,715.00" "$5,715.00" "$5,715.00" "$2,857.50" "$2,857.50" "$4,526.28" "$5,715.00" "$4,572.00" "$2,571.75" "$5,715.00" N/A "$3,314.70" "$5,715.00" "$3,429.00" "$5,715.00" "$5,715.00" "$5,715.00" N/A N/A 4002C1450 SUP Custom 27803010 4002C1450 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 14MM 50CM COMPLEX BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 4002C1557 SUP Custom 27803010 4002C1557 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 15MM 57CM COMPLEX BOTH IP/OP "$5,817.50" "$4,305.00" "$1,035.52" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$1,035.52" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$1,212.43" "$5,817.50" "$2,327.00" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$4,363.13" "$5,817.50" "$5,817.50" "$5,817.50" "$2,908.75" "$2,908.75" "$4,607.46" "$5,817.50" "$4,654.00" "$2,617.88" "$5,817.50" N/A "$3,374.15" "$5,817.50" "$3,490.50" "$5,817.50" "$5,817.50" "$5,817.50" N/A N/A 4002C1660 SUP Custom 27803010 4002C1660 - COIL EMBL .02IN STD CMPLX 16MM 60CM THE PENUMBRA COIL 400 BOTH IP/OP "$5,850.00" "$4,329.00" "$1,041.30" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$1,041.30" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$1,219.20" "$5,850.00" "$2,340.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$4,387.50" "$5,850.00" "$5,850.00" "$5,850.00" "$2,925.00" "$2,925.00" "$4,633.20" "$5,850.00" "$4,680.00" "$2,632.50" "$5,850.00" N/A "$3,393.00" "$5,850.00" "$3,510.00" "$5,850.00" "$5,850.00" "$5,850.00" N/A N/A 4002C1857 SUP Custom 27803010 4002C1857 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 18MM 57CM COMPLEX BOTH IP/OP "$5,817.50" "$4,305.00" "$1,035.52" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$1,035.52" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$1,212.43" "$5,817.50" "$2,327.00" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$4,363.13" "$5,817.50" "$5,817.50" "$5,817.50" "$2,908.75" "$2,908.75" "$4,607.46" "$5,817.50" "$4,654.00" "$2,617.88" "$5,817.50" N/A "$3,374.15" "$5,817.50" "$3,490.50" "$5,817.50" "$5,817.50" "$5,817.50" N/A N/A 4002C2060 SUP Custom 27803010 4002C2060 - COIL EMBL .02IN STD CMPLX 20MM 60CM THE PENUMBRA COIL 400 BOTH IP/OP "$5,850.00" "$4,329.00" "$1,041.30" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$1,041.30" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$1,219.20" "$5,850.00" "$2,340.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$4,387.50" "$5,850.00" "$5,850.00" "$5,850.00" "$2,925.00" "$2,925.00" "$4,633.20" "$5,850.00" "$4,680.00" "$2,632.50" "$5,850.00" N/A "$3,393.00" "$5,850.00" "$3,510.00" "$5,850.00" "$5,850.00" "$5,850.00" N/A N/A 4002C2260 SUP Custom 27803010 4002C2260 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 22MM 60CM COMPLEX BOTH IP/OP "$5,850.00" "$4,329.00" "$1,041.30" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$1,041.30" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$1,219.20" "$5,850.00" "$2,340.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$4,387.50" "$5,850.00" "$5,850.00" "$5,850.00" "$2,925.00" "$2,925.00" "$4,633.20" "$5,850.00" "$4,680.00" "$2,632.50" "$5,850.00" N/A "$3,393.00" "$5,850.00" "$3,510.00" "$5,850.00" "$5,850.00" "$5,850.00" N/A N/A 4002C2457 SUP Custom 27803010 4002C2457 - COIL EMBL .02IN STD CMPLX 24MM 57CM THE PENUMBRA COIL 400 BOTH IP/OP "$5,817.50" "$4,305.00" "$1,035.52" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$1,035.52" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$1,212.43" "$5,817.50" "$2,327.00" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$5,817.50" "$4,363.13" "$5,817.50" "$5,817.50" "$5,817.50" "$2,908.75" "$2,908.75" "$4,607.46" "$5,817.50" "$4,654.00" "$2,617.88" "$5,817.50" N/A "$3,374.15" "$5,817.50" "$3,490.50" "$5,817.50" "$5,817.50" "$5,817.50" N/A N/A 4002C2860 SUP Custom 27803010 4002C2860 - COIL EMBOLIZATION .02IN STANDARD COMPLEX 28MM 60CM COMPLEX BOTH IP/OP "$6,525.00" "$4,829.00" "$1,161.45" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$1,161.45" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$1,359.88" "$6,525.00" "$2,610.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$4,893.75" "$6,525.00" "$6,525.00" "$6,525.00" "$3,262.50" "$3,262.50" "$5,167.80" "$6,525.00" "$5,220.00" "$2,936.25" "$6,525.00" N/A "$3,784.50" "$6,525.00" "$3,915.00" "$6,525.00" "$6,525.00" "$6,525.00" N/A N/A 4002C3260 SUP Custom 27803010 4002C3260 - COIL EMBL .02IN STD CMPLX 32MM 60CM THE PENUMBRA COIL 400 BOTH IP/OP "$6,525.00" "$4,829.00" "$1,161.45" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$1,161.45" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$1,359.88" "$6,525.00" "$2,610.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$4,893.75" "$6,525.00" "$6,525.00" "$6,525.00" "$3,262.50" "$3,262.50" "$5,167.80" "$6,525.00" "$5,220.00" "$2,936.25" "$6,525.00" N/A "$3,784.50" "$6,525.00" "$3,915.00" "$6,525.00" "$6,525.00" "$6,525.00" N/A N/A 400-3011 SUP Custom 27203010 400-3011 - KIT SUTURE IMPLANT STERILE BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 400-3031B SUP Custom 27203010 400-3031B - ANCHOR SUTURE 3-0 STR BLUNT 3MM 4.5MM 2 NEEDLE MULTIFILAMENT BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A 4004C0303 SUP Custom 27803010 4004C0303 - COIL EMBOLIZATION .02IN COMPLEX 3MM 3CM SOFT THE PENUMBRA BOTH IP/OP "$5,950.00" "$4,403.00" "$1,059.10" "$5,950.00" "$5,950.00" "$5,950.00" "$5,950.00" "$5,950.00" "$5,950.00" "$5,950.00" "$1,059.10" "$5,950.00" "$5,950.00" "$5,950.00" "$5,950.00" "$5,950.00" "$5,950.00" "$1,240.05" "$5,950.00" "$2,380.00" "$5,950.00" "$5,950.00" "$5,950.00" "$5,950.00" "$5,950.00" "$4,462.50" "$5,950.00" "$5,950.00" "$5,950.00" "$2,975.00" "$2,975.00" "$4,712.40" "$5,950.00" "$4,760.00" "$2,677.50" "$5,950.00" N/A "$3,451.00" "$5,950.00" "$3,570.00" "$5,950.00" "$5,950.00" "$5,950.00" N/A N/A 4004C0304 SUP Custom 27803010 4004C0304 - COIL EMBOLIZATION .02IN COMPLEX 3MM 4CM SOFT THE PENUMBRA BOTH IP/OP "$5,975.00" "$4,422.00" "$1,063.55" "$5,975.00" "$5,975.00" "$5,975.00" "$5,975.00" "$5,975.00" "$5,975.00" "$5,975.00" "$1,063.55" "$5,975.00" "$5,975.00" "$5,975.00" "$5,975.00" "$5,975.00" "$5,975.00" "$1,245.26" "$5,975.00" "$2,390.00" "$5,975.00" "$5,975.00" "$5,975.00" "$5,975.00" "$5,975.00" "$4,481.25" "$5,975.00" "$5,975.00" "$5,975.00" "$2,987.50" "$2,987.50" "$4,732.20" "$5,975.00" "$4,780.00" "$2,688.75" "$5,975.00" N/A "$3,465.50" "$5,975.00" "$3,585.00" "$5,975.00" "$5,975.00" "$5,975.00" N/A N/A 4004C0306 SUP Custom 27803010 4004C0306 - COIL EMBL .02IN CMPLX 3MM 6CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$5,422.50" "$4,013.00" $965.21 "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" $965.21 "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$1,130.11" "$5,422.50" "$2,169.00" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$4,066.88" "$5,422.50" "$5,422.50" "$5,422.50" "$2,711.25" "$2,711.25" "$4,294.62" "$5,422.50" "$4,338.00" "$2,440.13" "$5,422.50" N/A "$3,145.05" "$5,422.50" "$3,253.50" "$5,422.50" "$5,422.50" "$5,422.50" N/A N/A 4004C0310 SUP Custom 27803010 4004C0310 - COIL EMBOLIZATION .02IN COMPLEX 3MM 10CM SOFT THE PENUMBRA BOTH IP/OP "$5,512.50" "$4,079.00" $981.23 "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" $981.23 "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$1,148.87" "$5,512.50" "$2,205.00" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$4,134.38" "$5,512.50" "$5,512.50" "$5,512.50" "$2,756.25" "$2,756.25" "$4,365.90" "$5,512.50" "$4,410.00" "$2,480.63" "$5,512.50" N/A "$3,197.25" "$5,512.50" "$3,307.50" "$5,512.50" "$5,512.50" "$5,512.50" N/A N/A 4004C0404 SUP Custom 27803010 4004C0404 - COIL EMBOLIZATION .02IN COMPLEX 4MM 4CM SOFT THE PENUMBRA BOTH IP/OP "$5,377.50" "$3,979.00" $957.20 "$5,377.50" "$5,377.50" "$5,377.50" "$5,377.50" "$5,377.50" "$5,377.50" "$5,377.50" $957.20 "$5,377.50" "$5,377.50" "$5,377.50" "$5,377.50" "$5,377.50" "$5,377.50" "$1,120.73" "$5,377.50" "$2,151.00" "$5,377.50" "$5,377.50" "$5,377.50" "$5,377.50" "$5,377.50" "$4,033.13" "$5,377.50" "$5,377.50" "$5,377.50" "$2,688.75" "$2,688.75" "$4,258.98" "$5,377.50" "$4,302.00" "$2,419.88" "$5,377.50" N/A "$3,118.95" "$5,377.50" "$3,226.50" "$5,377.50" "$5,377.50" "$5,377.50" N/A N/A 4004C0406 SUP Custom 27803010 4004C0406 - COIL EMBOLIZATION .02IN COMPLEX 4MM 6CM SOFT THE PENUMBRA BOTH IP/OP "$5,422.50" "$4,013.00" $965.21 "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" $965.21 "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$1,130.11" "$5,422.50" "$2,169.00" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$4,066.88" "$5,422.50" "$5,422.50" "$5,422.50" "$2,711.25" "$2,711.25" "$4,294.62" "$5,422.50" "$4,338.00" "$2,440.13" "$5,422.50" N/A "$3,145.05" "$5,422.50" "$3,253.50" "$5,422.50" "$5,422.50" "$5,422.50" N/A N/A 4004C0408 SUP Custom 27803010 4004C0408 - COIL EMBL .02IN CMPLX 4MM 8CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$5,467.50" "$4,046.00" $973.22 "$5,467.50" "$5,467.50" "$5,467.50" "$5,467.50" "$5,467.50" "$5,467.50" "$5,467.50" $973.22 "$5,467.50" "$5,467.50" "$5,467.50" "$5,467.50" "$5,467.50" "$5,467.50" "$1,139.49" "$5,467.50" "$2,187.00" "$5,467.50" "$5,467.50" "$5,467.50" "$5,467.50" "$5,467.50" "$4,100.63" "$5,467.50" "$5,467.50" "$5,467.50" "$2,733.75" "$2,733.75" "$4,330.26" "$5,467.50" "$4,374.00" "$2,460.38" "$5,467.50" N/A "$3,171.15" "$5,467.50" "$3,280.50" "$5,467.50" "$5,467.50" "$5,467.50" N/A N/A 4004C0412 SUP Custom 27803010 4004C0412 - COIL EMBOLIZATION .02IN COMPLEX 4MM 12CM SOFT THE PENUMBRA BOTH IP/OP "$5,557.50" "$4,113.00" $989.24 "$5,557.50" "$5,557.50" "$5,557.50" "$5,557.50" "$5,557.50" "$5,557.50" "$5,557.50" $989.24 "$5,557.50" "$5,557.50" "$5,557.50" "$5,557.50" "$5,557.50" "$5,557.50" "$1,158.24" "$5,557.50" "$2,223.00" "$5,557.50" "$5,557.50" "$5,557.50" "$5,557.50" "$5,557.50" "$4,168.13" "$5,557.50" "$5,557.50" "$5,557.50" "$2,778.75" "$2,778.75" "$4,401.54" "$5,557.50" "$4,446.00" "$2,500.88" "$5,557.50" N/A "$3,223.35" "$5,557.50" "$3,334.50" "$5,557.50" "$5,557.50" "$5,557.50" N/A N/A 4004C0509 SUP Custom 27803010 4004C0509 - COIL EMBL .02IN CMPLX 5MM 9CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$5,490.00" "$4,063.00" $977.22 "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" $977.22 "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$1,144.18" "$5,490.00" "$2,196.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$4,117.50" "$5,490.00" "$5,490.00" "$5,490.00" "$2,745.00" "$2,745.00" "$4,348.08" "$5,490.00" "$4,392.00" "$2,470.50" "$5,490.00" N/A "$3,184.20" "$5,490.00" "$3,294.00" "$5,490.00" "$5,490.00" "$5,490.00" N/A N/A 4004C0513 SUP Custom 27803010 4004C0513 - COIL EMBOLIZATION .02IN COMPLEX 5MM 13CM SOFT THE PENUMBRA BOTH IP/OP "$5,580.00" "$4,129.00" $993.24 "$5,580.00" "$5,580.00" "$5,580.00" "$5,580.00" "$5,580.00" "$5,580.00" "$5,580.00" $993.24 "$5,580.00" "$5,580.00" "$5,580.00" "$5,580.00" "$5,580.00" "$5,580.00" "$1,162.93" "$5,580.00" "$2,232.00" "$5,580.00" "$5,580.00" "$5,580.00" "$5,580.00" "$5,580.00" "$4,185.00" "$5,580.00" "$5,580.00" "$5,580.00" "$2,790.00" "$2,790.00" "$4,419.36" "$5,580.00" "$4,464.00" "$2,511.00" "$5,580.00" N/A "$3,236.40" "$5,580.00" "$3,348.00" "$5,580.00" "$5,580.00" "$5,580.00" N/A N/A 4004C0610 SUP Custom 27803010 4004C0610 - COIL EMBL .02IN CMPLX 6MM 10CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$5,512.50" "$4,079.00" $981.23 "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" $981.23 "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$1,148.87" "$5,512.50" "$2,205.00" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$4,134.38" "$5,512.50" "$5,512.50" "$5,512.50" "$2,756.25" "$2,756.25" "$4,365.90" "$5,512.50" "$4,410.00" "$2,480.63" "$5,512.50" N/A "$3,197.25" "$5,512.50" "$3,307.50" "$5,512.50" "$5,512.50" "$5,512.50" N/A N/A 4004C0615 SUP Custom 27803010 4004C0615 - COIL EMBOLIZATION .02IN COMPLEX 6MM 15CM SOFT THE PENUMBRA BOTH IP/OP "$5,625.00" "$4,163.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$2,250.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$5,625.00" N/A "$3,262.50" "$5,625.00" "$3,375.00" "$5,625.00" "$5,625.00" "$5,625.00" N/A N/A 4004C0620 SUP Custom 27803010 4004C0620 - COIL EMBL .02IN CMPLX 6MM 20CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$6,375.00" "$4,718.00" "$1,134.75" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$1,134.75" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$1,328.62" "$6,375.00" "$2,550.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$6,375.00" "$4,781.25" "$6,375.00" "$6,375.00" "$6,375.00" "$3,187.50" "$3,187.50" "$5,049.00" "$6,375.00" "$5,100.00" "$2,868.75" "$6,375.00" N/A "$3,697.50" "$6,375.00" "$3,825.00" "$6,375.00" "$6,375.00" "$6,375.00" N/A N/A 4004C0710 SUP Custom 27803010 4004C0710 - COIL EMBL .02IN CMPLX 7MM 10CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$5,512.50" "$4,079.00" $981.23 "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" $981.23 "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$1,148.87" "$5,512.50" "$2,205.00" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$4,134.38" "$5,512.50" "$5,512.50" "$5,512.50" "$2,756.25" "$2,756.25" "$4,365.90" "$5,512.50" "$4,410.00" "$2,480.63" "$5,512.50" N/A "$3,197.25" "$5,512.50" "$3,307.50" "$5,512.50" "$5,512.50" "$5,512.50" N/A N/A 4004C0715 SUP Custom 27803010 4004C0715 - COIL EMBL .02IN CMPLX 7MM 15CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$5,625.00" "$4,163.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$2,250.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$5,625.00" N/A "$3,262.50" "$5,625.00" "$3,375.00" "$5,625.00" "$5,625.00" "$5,625.00" N/A N/A 4004C0720 SUP Custom 27803010 4004C0720 - COIL EMBOLIZATION .02IN COMPLEX 7MM 20CM SOFT THE PENUMBRA BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 4004C0815 SUP Custom 27803010 4004C0815 - COIL EMBL .02IN CMPLX 8MM 15CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$5,625.00" "$4,163.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$2,250.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$5,625.00" N/A "$3,262.50" "$5,625.00" "$3,375.00" "$5,625.00" "$5,625.00" "$5,625.00" N/A N/A 4004C0820 SUP Custom 27803010 4004C0820 - COIL EMBL .02IN CMPLX 8MM 20CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 4004C0830 SUP Custom 27803010 4004C0830 - COIL EMBOLIZATION .02IN COMPLEX 8MM 30CM SOFT THE PENUMBRA BOTH IP/OP "$6,625.00" "$4,903.00" "$1,179.25" "$6,625.00" "$6,625.00" "$6,625.00" "$6,625.00" "$6,625.00" "$6,625.00" "$6,625.00" "$1,179.25" "$6,625.00" "$6,625.00" "$6,625.00" "$6,625.00" "$6,625.00" "$6,625.00" "$1,380.72" "$6,625.00" "$2,650.00" "$6,625.00" "$6,625.00" "$6,625.00" "$6,625.00" "$6,625.00" "$4,968.75" "$6,625.00" "$6,625.00" "$6,625.00" "$3,312.50" "$3,312.50" "$5,247.00" "$6,625.00" "$5,300.00" "$2,981.25" "$6,625.00" N/A "$3,842.50" "$6,625.00" "$3,975.00" "$6,625.00" "$6,625.00" "$6,625.00" N/A N/A 4004C0925 SUP Custom 27803010 4004C0925 - COIL EMBL .02IN CMPLX 9MM 25CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$5,850.00" "$4,329.00" "$1,041.30" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$1,041.30" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$1,219.20" "$5,850.00" "$2,340.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$5,850.00" "$4,387.50" "$5,850.00" "$5,850.00" "$5,850.00" "$2,925.00" "$2,925.00" "$4,633.20" "$5,850.00" "$4,680.00" "$2,632.50" "$5,850.00" N/A "$3,393.00" "$5,850.00" "$3,510.00" "$5,850.00" "$5,850.00" "$5,850.00" N/A N/A 4004C0935 SUP Custom 27803010 4004C0935 - COIL EMBOLIZATION .02IN COMPLEX 9MM 35CM SOFT THE PENUMBRA BOTH IP/OP "$6,750.00" "$4,995.00" "$1,201.50" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,201.50" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$2,700.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$6,750.00" N/A "$3,915.00" "$6,750.00" "$4,050.00" "$6,750.00" "$6,750.00" "$6,750.00" N/A N/A 4004C1020 SUP Custom 27803010 4004C1020 - COIL EMBL .02IN CMPLX 10MM 20CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 4004C1030 SUP Custom 27803010 4004C1030 - COIL EMBOLIZATION .02IN COMPLEX 10MM 30CM SOFT THE PENUMBRA BOTH IP/OP "$5,962.50" "$4,412.00" "$1,061.33" "$5,962.50" "$5,962.50" "$5,962.50" "$5,962.50" "$5,962.50" "$5,962.50" "$5,962.50" "$1,061.33" "$5,962.50" "$5,962.50" "$5,962.50" "$5,962.50" "$5,962.50" "$5,962.50" "$1,242.65" "$5,962.50" "$2,385.00" "$5,962.50" "$5,962.50" "$5,962.50" "$5,962.50" "$5,962.50" "$4,471.88" "$5,962.50" "$5,962.50" "$5,962.50" "$2,981.25" "$2,981.25" "$4,722.30" "$5,962.50" "$4,770.00" "$2,683.13" "$5,962.50" N/A "$3,458.25" "$5,962.50" "$3,577.50" "$5,962.50" "$5,962.50" "$5,962.50" N/A N/A 4004C1040 SUP Custom 27803010 4004C1040 - COIL EMBL .02IN CMPLX 10MM 40CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$6,875.00" "$5,088.00" "$1,223.75" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$1,223.75" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.83" "$6,875.00" "$2,750.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$3,093.75" "$6,875.00" N/A "$3,987.50" "$6,875.00" "$4,125.00" "$6,875.00" "$6,875.00" "$6,875.00" N/A N/A 4004C1135 SUP Custom 27803010 4004C1135 - COIL EMBOLIZATION .02IN COMPLEX 11MM 35CM SOFT THE PENUMBRA BOTH IP/OP "$6,075.00" "$4,496.00" "$1,081.35" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$1,081.35" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$1,266.10" "$6,075.00" "$2,430.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$4,556.25" "$6,075.00" "$6,075.00" "$6,075.00" "$3,037.50" "$3,037.50" "$4,811.40" "$6,075.00" "$4,860.00" "$2,733.75" "$6,075.00" N/A "$3,523.50" "$6,075.00" "$3,645.00" "$6,075.00" "$6,075.00" "$6,075.00" N/A N/A 4004C1145 SUP Custom 27803010 4004C1145 - COIL EMBL .02IN CMPLX 11MM 45CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$7,000.00" "$5,180.00" "$1,246.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$1,246.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$1,458.88" "$7,000.00" "$2,800.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$5,250.00" "$7,000.00" "$7,000.00" "$7,000.00" "$3,500.00" "$3,500.00" "$5,544.00" "$7,000.00" "$5,600.00" "$3,150.00" "$7,000.00" N/A "$4,060.00" "$7,000.00" "$4,200.00" "$7,000.00" "$7,000.00" "$7,000.00" N/A N/A 4004C1235 SUP Custom 27803010 4004C1235 - COIL EMBL .02IN CMPLX 12MM 35CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$6,075.00" "$4,496.00" "$1,081.35" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$1,081.35" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$1,266.10" "$6,075.00" "$2,430.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$4,556.25" "$6,075.00" "$6,075.00" "$6,075.00" "$3,037.50" "$3,037.50" "$4,811.40" "$6,075.00" "$4,860.00" "$2,733.75" "$6,075.00" N/A "$3,523.50" "$6,075.00" "$3,645.00" "$6,075.00" "$6,075.00" "$6,075.00" N/A N/A 4004C1245 SUP Custom 27803010 4004C1245 - COIL EMBOLIZATION .02IN COMPLEX 12MM 45CM SOFT THE PENUMBRA BOTH IP/OP "$7,000.00" "$5,180.00" "$1,246.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$1,246.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$1,458.88" "$7,000.00" "$2,800.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$5,250.00" "$7,000.00" "$7,000.00" "$7,000.00" "$3,500.00" "$3,500.00" "$5,544.00" "$7,000.00" "$5,600.00" "$3,150.00" "$7,000.00" N/A "$4,060.00" "$7,000.00" "$4,200.00" "$7,000.00" "$7,000.00" "$7,000.00" N/A N/A 4004C1335 SUP Custom 27803010 4004C1335 - COIL EMBOLIZATION .02IN COMPLEX 13MM 35CM SOFT THE PENUMBRA BOTH IP/OP "$6,075.00" "$4,496.00" "$1,081.35" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$1,081.35" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$1,266.10" "$6,075.00" "$2,430.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$6,075.00" "$4,556.25" "$6,075.00" "$6,075.00" "$6,075.00" "$3,037.50" "$3,037.50" "$4,811.40" "$6,075.00" "$4,860.00" "$2,733.75" "$6,075.00" N/A "$3,523.50" "$6,075.00" "$3,645.00" "$6,075.00" "$6,075.00" "$6,075.00" N/A N/A 4004C1348 SUP Custom 27803010 4004C1348 - COIL EMBL .02IN CMPLX 13MM 48CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$7,075.00" "$5,236.00" "$1,259.35" "$7,075.00" "$7,075.00" "$7,075.00" "$7,075.00" "$7,075.00" "$7,075.00" "$7,075.00" "$1,259.35" "$7,075.00" "$7,075.00" "$7,075.00" "$7,075.00" "$7,075.00" "$7,075.00" "$1,474.51" "$7,075.00" "$2,830.00" "$7,075.00" "$7,075.00" "$7,075.00" "$7,075.00" "$7,075.00" "$5,306.25" "$7,075.00" "$7,075.00" "$7,075.00" "$3,537.50" "$3,537.50" "$5,603.40" "$7,075.00" "$5,660.00" "$3,183.75" "$7,075.00" N/A "$4,103.50" "$7,075.00" "$4,245.00" "$7,075.00" "$7,075.00" "$7,075.00" N/A N/A 4004C1440 SUP Custom 27803010 4004C1440 - COIL EMBOLIZATION .02IN COMPLEX 14MM 40CM SOFT THE PENUMBRA BOTH IP/OP "$6,187.50" "$4,579.00" "$1,101.38" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$1,101.38" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$1,289.54" "$6,187.50" "$2,475.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$4,640.63" "$6,187.50" "$6,187.50" "$6,187.50" "$3,093.75" "$3,093.75" "$4,900.50" "$6,187.50" "$4,950.00" "$2,784.38" "$6,187.50" N/A "$3,588.75" "$6,187.50" "$3,712.50" "$6,187.50" "$6,187.50" "$6,187.50" N/A N/A 4004C1450 SUP Custom 27803010 4004C1450 - COIL EMBL .02IN CMPLX 14MM 50CM THE PENUMBRA COIL 400 SFT BOTH IP/OP "$7,125.00" "$5,273.00" "$1,268.25" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$1,268.25" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$1,484.93" "$7,125.00" "$2,850.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$7,125.00" "$5,343.75" "$7,125.00" "$7,125.00" "$7,125.00" "$3,562.50" "$3,562.50" "$5,643.00" "$7,125.00" "$5,700.00" "$3,206.25" "$7,125.00" N/A "$4,132.50" "$7,125.00" "$4,275.00" "$7,125.00" "$7,125.00" "$7,125.00" N/A N/A 4004C1645 SUP Custom 27803010 4004C1645 - COIL EMBOLIZATION 16MM 45CM COMPLEX SOFT BOTH IP/OP "$6,300.00" "$4,662.00" "$1,121.40" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,121.40" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$1,312.99" "$6,300.00" "$2,520.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$6,300.00" "$4,725.00" "$6,300.00" "$6,300.00" "$6,300.00" "$3,150.00" "$3,150.00" "$4,989.60" "$6,300.00" "$5,040.00" "$2,835.00" "$6,300.00" N/A "$3,654.00" "$6,300.00" "$3,780.00" "$6,300.00" "$6,300.00" "$6,300.00" N/A N/A 4004J10 SUP Custom 27803010 4004J10 - COIL EMBOLIZATION 10CM J SOFT FILL COIL 400 NITINOL BOTH IP/OP "$5,670.00" "$4,196.00" "$1,009.26" "$5,670.00" "$5,670.00" "$5,670.00" "$5,670.00" "$5,670.00" "$5,670.00" "$5,670.00" "$1,009.26" "$5,670.00" "$5,670.00" "$5,670.00" "$5,670.00" "$5,670.00" "$5,670.00" "$1,181.69" "$5,670.00" "$2,268.00" "$5,670.00" "$5,670.00" "$5,670.00" "$5,670.00" "$5,670.00" "$4,252.50" "$5,670.00" "$5,670.00" "$5,670.00" "$2,835.00" "$2,835.00" "$4,490.64" "$5,670.00" "$4,536.00" "$2,551.50" "$5,670.00" N/A "$3,288.60" "$5,670.00" "$3,402.00" "$5,670.00" "$5,670.00" "$5,670.00" N/A N/A 4004J15 SUP Custom 27803010 4004J15 - COIL EMBOLIZATION 15CM J COIL 400 BOTH IP/OP "$5,895.00" "$4,362.00" "$1,049.31" "$5,895.00" "$5,895.00" "$5,895.00" "$5,895.00" "$5,895.00" "$5,895.00" "$5,895.00" "$1,049.31" "$5,895.00" "$5,895.00" "$5,895.00" "$5,895.00" "$5,895.00" "$5,895.00" "$1,228.58" "$5,895.00" "$2,358.00" "$5,895.00" "$5,895.00" "$5,895.00" "$5,895.00" "$5,895.00" "$4,421.25" "$5,895.00" "$5,895.00" "$5,895.00" "$2,947.50" "$2,947.50" "$4,668.84" "$5,895.00" "$4,716.00" "$2,652.75" "$5,895.00" N/A "$3,419.10" "$5,895.00" "$3,537.00" "$5,895.00" "$5,895.00" "$5,895.00" N/A N/A 4004J25 SUP Custom 27803010 4004J25 - COIL EMBL 25CM THE PENUMBRA COIL 400 J SFT FIL NTNL BOTH IP/OP "$5,537.50" "$4,098.00" $985.68 "$5,537.50" "$5,537.50" "$5,537.50" "$5,537.50" "$5,537.50" "$5,537.50" "$5,537.50" $985.68 "$5,537.50" "$5,537.50" "$5,537.50" "$5,537.50" "$5,537.50" "$5,537.50" "$1,154.08" "$5,537.50" "$2,215.00" "$5,537.50" "$5,537.50" "$5,537.50" "$5,537.50" "$5,537.50" "$4,153.13" "$5,537.50" "$5,537.50" "$5,537.50" "$2,768.75" "$2,768.75" "$4,385.70" "$5,537.50" "$4,430.00" "$2,491.88" "$5,537.50" N/A "$3,211.75" "$5,537.50" "$3,322.50" "$5,537.50" "$5,537.50" "$5,537.50" N/A N/A 4004J7 SUP Custom 27803010 4004J7 - COIL EMBL 7CM PENUMBRA COIL 400 J SFT FIL NTNL BOTH IP/OP "$5,085.00" "$3,763.00" $905.13 "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" $905.13 "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$5,085.00" N/A "$2,949.30" "$5,085.00" "$3,051.00" "$5,085.00" "$5,085.00" "$5,085.00" N/A N/A 4006C0202 SUP Custom 27803010 4006C0202 - COIL EMBOLIZATION .02IN COMPLEX 2MM 2CM EXTRA SOFT THE BOTH IP/OP "$4,320.00" "$3,197.00" $768.96 "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" $768.96 "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" $900.34 "$4,320.00" "$1,728.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$4,320.00" "$3,240.00" "$4,320.00" "$4,320.00" "$4,320.00" "$2,160.00" "$2,160.00" "$3,421.44" "$4,320.00" "$3,456.00" "$1,944.00" "$4,320.00" N/A "$2,505.60" "$4,320.00" "$2,592.00" "$4,320.00" "$4,320.00" "$4,320.00" N/A N/A 4006C0203 SUP Custom 27803010 4006C0203 - COIL EMBOLIZATION .02IN COMPLEX .02IN 2MM 3CM EXTRA SOFT BOTH IP/OP "$4,557.50" "$3,373.00" $811.24 "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" $811.24 "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" $949.83 "$4,557.50" "$1,823.00" "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" "$3,418.13" "$4,557.50" "$4,557.50" "$4,557.50" "$2,278.75" "$2,278.75" "$3,609.54" "$4,557.50" "$3,646.00" "$2,050.88" "$4,557.50" N/A "$2,643.35" "$4,557.50" "$2,734.50" "$4,557.50" "$4,557.50" "$4,557.50" N/A N/A 4006C0204 SUP Custom 27803010 4006C0204 - COIL EMBOLIZATION .02IN COMPLEX 2MM 4CM XSOFT THE PENUMBRA BOTH IP/OP "$4,792.50" "$3,546.00" $853.07 "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" $853.07 "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" $998.81 "$4,792.50" "$1,917.00" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$3,594.38" "$4,792.50" "$4,792.50" "$4,792.50" "$2,396.25" "$2,396.25" "$3,795.66" "$4,792.50" "$3,834.00" "$2,156.63" "$4,792.50" N/A "$2,779.65" "$4,792.50" "$2,875.50" "$4,792.50" "$4,792.50" "$4,792.50" N/A N/A 4006C0303 SUP Custom 27803010 4006C0303 - COIL EMBL .02IN CMPLX 3MM 3CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$4,557.50" "$3,373.00" $811.24 "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" $811.24 "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" $949.83 "$4,557.50" "$1,823.00" "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" "$4,557.50" "$3,418.13" "$4,557.50" "$4,557.50" "$4,557.50" "$2,278.75" "$2,278.75" "$3,609.54" "$4,557.50" "$3,646.00" "$2,050.88" "$4,557.50" N/A "$2,643.35" "$4,557.50" "$2,734.50" "$4,557.50" "$4,557.50" "$4,557.50" N/A N/A 4006C0304 SUP Custom 27803010 4006C0304 - COIL EMBOLIZATION .02IN COMPLEX 3MM 4CM XSOFT THE PENUMBRA BOTH IP/OP "$4,792.50" "$3,546.00" $853.07 "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" $853.07 "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" $998.81 "$4,792.50" "$1,917.00" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$3,594.38" "$4,792.50" "$4,792.50" "$4,792.50" "$2,396.25" "$2,396.25" "$3,795.66" "$4,792.50" "$3,834.00" "$2,156.63" "$4,792.50" N/A "$2,779.65" "$4,792.50" "$2,875.50" "$4,792.50" "$4,792.50" "$4,792.50" N/A N/A 4006C0305 SUP Custom 27803010 4006C0305 - COIL EMBL .02IN CMPLX 3MM 5CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$5,030.00" "$3,722.00" $895.34 "$5,030.00" "$5,030.00" "$5,030.00" "$5,030.00" "$5,030.00" "$5,030.00" "$5,030.00" $895.34 "$5,030.00" "$5,030.00" "$5,030.00" "$5,030.00" "$5,030.00" "$5,030.00" "$1,048.31" "$5,030.00" "$2,012.00" "$5,030.00" "$5,030.00" "$5,030.00" "$5,030.00" "$5,030.00" "$3,772.50" "$5,030.00" "$5,030.00" "$5,030.00" "$2,515.00" "$2,515.00" "$3,983.76" "$5,030.00" "$4,024.00" "$2,263.50" "$5,030.00" N/A "$2,917.40" "$5,030.00" "$3,018.00" "$5,030.00" "$5,030.00" "$5,030.00" N/A N/A 4006C0306 SUP Custom 27803010 4006C0306 - COIL EMBOLIZATION .02IN COMPLEX .02IN 3MM 6CM EXTRA SOFT BOTH IP/OP "$5,265.00" "$3,896.00" $937.17 "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" $937.17 "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$1,097.28" "$5,265.00" "$2,106.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$3,948.75" "$5,265.00" "$5,265.00" "$5,265.00" "$2,632.50" "$2,632.50" "$4,169.88" "$5,265.00" "$4,212.00" "$2,369.25" "$5,265.00" N/A "$3,053.70" "$5,265.00" "$3,159.00" "$5,265.00" "$5,265.00" "$5,265.00" N/A N/A 4006C0308 SUP Custom 27803010 4006C0308 - COIL EMBL .02IN CMPLX 3MM 8CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 4006C0310 SUP Custom 27803010 4006C0310 - COIL EMBOLIZATION .02IN COMPLEX 3MM 10CM XSOFT THE PENUMBRA BOTH IP/OP "$6,900.00" "$5,106.00" "$1,228.20" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$1,228.20" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$1,438.04" "$6,900.00" "$2,760.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$5,175.00" "$6,900.00" "$6,900.00" "$6,900.00" "$3,450.00" "$3,450.00" "$5,464.80" "$6,900.00" "$5,520.00" "$3,105.00" "$6,900.00" N/A "$4,002.00" "$6,900.00" "$4,140.00" "$6,900.00" "$6,900.00" "$6,900.00" N/A N/A 4006C0404 SUP Custom 27803010 4006C0404 - COIL EMBL .02IN CMPLX 4MM 4CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$4,792.50" "$3,546.00" $853.07 "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" $853.07 "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" $998.81 "$4,792.50" "$1,917.00" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$4,792.50" "$3,594.38" "$4,792.50" "$4,792.50" "$4,792.50" "$2,396.25" "$2,396.25" "$3,795.66" "$4,792.50" "$3,834.00" "$2,156.63" "$4,792.50" N/A "$2,779.65" "$4,792.50" "$2,875.50" "$4,792.50" "$4,792.50" "$4,792.50" N/A N/A 4006C0406 SUP Custom 27803010 4006C0406 - COIL EMBOLIZATION .02IN COMPLEX 4MM 6CM XSOFT THE PENUMBRA BOTH IP/OP "$5,265.00" "$3,896.00" $937.17 "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" $937.17 "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$1,097.28" "$5,265.00" "$2,106.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$5,265.00" "$3,948.75" "$5,265.00" "$5,265.00" "$5,265.00" "$2,632.50" "$2,632.50" "$4,169.88" "$5,265.00" "$4,212.00" "$2,369.25" "$5,265.00" N/A "$3,053.70" "$5,265.00" "$3,159.00" "$5,265.00" "$5,265.00" "$5,265.00" N/A N/A 4006C0408 SUP Custom 27803010 4006C0408 - COIL EMBL .02IN CMPLX 4MM 8CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$5,737.50" "$4,246.00" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,021.28" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$2,295.00" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$5,737.50" N/A "$3,327.75" "$5,737.50" "$3,442.50" "$5,737.50" "$5,737.50" "$5,737.50" N/A N/A 4006C0410 SUP Custom 27803010 4006C0410 - COIL EMBL .02IN CMPLX 4MM 10CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$6,210.00" "$4,595.00" "$1,105.38" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$1,105.38" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$1,294.23" "$6,210.00" "$2,484.00" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$4,657.50" "$6,210.00" "$6,210.00" "$6,210.00" "$3,105.00" "$3,105.00" "$4,918.32" "$6,210.00" "$4,968.00" "$2,794.50" "$6,210.00" N/A "$3,601.80" "$6,210.00" "$3,726.00" "$6,210.00" "$6,210.00" "$6,210.00" N/A N/A 4006U0201 SUP Custom 27803010 4006U0201 - COIL EMBOLIZATION CURVE 2MM 1CM XSOFT THE PENUMBRA COIL 400 BOTH IP/OP "$3,860.00" "$2,856.00" $687.08 "$3,860.00" "$3,860.00" "$3,860.00" "$3,860.00" "$3,860.00" "$3,860.00" "$3,860.00" $687.08 "$3,860.00" "$3,860.00" "$3,860.00" "$3,860.00" "$3,860.00" "$3,860.00" $804.47 "$3,860.00" "$1,544.00" "$3,860.00" "$3,860.00" "$3,860.00" "$3,860.00" "$3,860.00" "$2,895.00" "$3,860.00" "$3,860.00" "$3,860.00" "$1,930.00" "$1,930.00" "$3,057.12" "$3,860.00" "$3,088.00" "$1,737.00" "$3,860.00" N/A "$2,238.80" "$3,860.00" "$2,316.00" "$3,860.00" "$3,860.00" "$3,860.00" N/A N/A 4006U0202 SUP Custom 27803010 4006U0202 - COIL EMBL CRV 2MM 2CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$4,095.00" "$3,030.00" $728.91 "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" $728.91 "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" $853.44 "$4,095.00" "$1,638.00" "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" "$3,071.25" "$4,095.00" "$4,095.00" "$4,095.00" "$2,047.50" "$2,047.50" "$3,243.24" "$4,095.00" "$3,276.00" "$1,842.75" "$4,095.00" N/A "$2,375.10" "$4,095.00" "$2,457.00" "$4,095.00" "$4,095.00" "$4,095.00" N/A N/A 4006U0203 SUP Custom 27803010 4006U0203 - COIL EMBOLIZATION CURVE 2MM 3CM XSOFT THE PENUMBRA COIL 400 BOTH IP/OP "$4,332.50" "$3,206.00" $771.19 "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" $771.19 "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" $902.94 "$4,332.50" "$1,733.00" "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" "$3,249.38" "$4,332.50" "$4,332.50" "$4,332.50" "$2,166.25" "$2,166.25" "$3,431.34" "$4,332.50" "$3,466.00" "$1,949.63" "$4,332.50" N/A "$2,512.85" "$4,332.50" "$2,599.50" "$4,332.50" "$4,332.50" "$4,332.50" N/A N/A 4006U0204 SUP Custom 27803010 4006U0204 - COIL EMBL CRV 2MM 4CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$4,567.50" "$3,380.00" $813.02 "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" $813.02 "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" $951.92 "$4,567.50" "$1,827.00" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$3,425.63" "$4,567.50" "$4,567.50" "$4,567.50" "$2,283.75" "$2,283.75" "$3,617.46" "$4,567.50" "$3,654.00" "$2,055.38" "$4,567.50" N/A "$2,649.15" "$4,567.50" "$2,740.50" "$4,567.50" "$4,567.50" "$4,567.50" N/A N/A 4006U0302 SUP Custom 27803010 4006U0302 - COIL EMBOLIZATION CURVE 3MM 2CM XSOFT THE PENUMBRA COIL 400 BOTH IP/OP "$4,095.00" "$3,030.00" $728.91 "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" $728.91 "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" $853.44 "$4,095.00" "$1,638.00" "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" "$4,095.00" "$3,071.25" "$4,095.00" "$4,095.00" "$4,095.00" "$2,047.50" "$2,047.50" "$3,243.24" "$4,095.00" "$3,276.00" "$1,842.75" "$4,095.00" N/A "$2,375.10" "$4,095.00" "$2,457.00" "$4,095.00" "$4,095.00" "$4,095.00" N/A N/A 4006U0303 SUP Custom 27803010 4006U0303 - COIL EMBL CRV 3MM 3CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$4,332.50" "$3,206.00" $771.19 "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" $771.19 "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" $902.94 "$4,332.50" "$1,733.00" "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" "$4,332.50" "$3,249.38" "$4,332.50" "$4,332.50" "$4,332.50" "$2,166.25" "$2,166.25" "$3,431.34" "$4,332.50" "$3,466.00" "$1,949.63" "$4,332.50" N/A "$2,512.85" "$4,332.50" "$2,599.50" "$4,332.50" "$4,332.50" "$4,332.50" N/A N/A 4006U0304 SUP Custom 27803010 4006U0304 - COIL EMBOLIZATION CURVE 3MM 4CM XSOFT THE PENUMBRA COIL 400 BOTH IP/OP "$4,567.50" "$3,380.00" $813.02 "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" $813.02 "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" $951.92 "$4,567.50" "$1,827.00" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$3,425.63" "$4,567.50" "$4,567.50" "$4,567.50" "$2,283.75" "$2,283.75" "$3,617.46" "$4,567.50" "$3,654.00" "$2,055.38" "$4,567.50" N/A "$2,649.15" "$4,567.50" "$2,740.50" "$4,567.50" "$4,567.50" "$4,567.50" N/A N/A 4006U0305 SUP Custom 27803010 4006U0305 - COIL EMBL CRV 3MM 5CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$4,805.00" "$3,556.00" $855.29 "$4,805.00" "$4,805.00" "$4,805.00" "$4,805.00" "$4,805.00" "$4,805.00" "$4,805.00" $855.29 "$4,805.00" "$4,805.00" "$4,805.00" "$4,805.00" "$4,805.00" "$4,805.00" "$1,001.41" "$4,805.00" "$1,922.00" "$4,805.00" "$4,805.00" "$4,805.00" "$4,805.00" "$4,805.00" "$3,603.75" "$4,805.00" "$4,805.00" "$4,805.00" "$2,402.50" "$2,402.50" "$3,805.56" "$4,805.00" "$3,844.00" "$2,162.25" "$4,805.00" N/A "$2,786.90" "$4,805.00" "$2,883.00" "$4,805.00" "$4,805.00" "$4,805.00" N/A N/A 4006U0306 SUP Custom 27803010 4006U0306 - COIL EMBOLIZATION CURVE 3MM 6CM XSOFT THE PENUMBRA COIL 400 BOTH IP/OP "$5,040.00" "$3,730.00" $897.12 "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" $897.12 "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$1,050.39" "$5,040.00" "$2,016.00" "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$3,780.00" "$5,040.00" "$5,040.00" "$5,040.00" "$2,520.00" "$2,520.00" "$3,991.68" "$5,040.00" "$4,032.00" "$2,268.00" "$5,040.00" N/A "$2,923.20" "$5,040.00" "$3,024.00" "$5,040.00" "$5,040.00" "$5,040.00" N/A N/A 4006U0308 SUP Custom 27803010 4006U0308 - COIL EMBOLIZATION CURVE 3MM 8CM XSOFT THE PENUMBRA COIL 400 BOTH IP/OP "$5,512.50" "$4,079.00" $981.23 "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" $981.23 "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$1,148.87" "$5,512.50" "$2,205.00" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$4,134.38" "$5,512.50" "$5,512.50" "$5,512.50" "$2,756.25" "$2,756.25" "$4,365.90" "$5,512.50" "$4,410.00" "$2,480.63" "$5,512.50" N/A "$3,197.25" "$5,512.50" "$3,307.50" "$5,512.50" "$5,512.50" "$5,512.50" N/A N/A 4006U0310 SUP Custom 27803010 4006U0310 - COIL EMBL CRV 3MM 10CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$6,512.50" "$4,819.00" "$1,159.23" "$6,512.50" "$6,512.50" "$6,512.50" "$6,512.50" "$6,512.50" "$6,512.50" "$6,512.50" "$1,159.23" "$6,512.50" "$6,512.50" "$6,512.50" "$6,512.50" "$6,512.50" "$6,512.50" "$1,357.28" "$6,512.50" "$2,605.00" "$6,512.50" "$6,512.50" "$6,512.50" "$6,512.50" "$6,512.50" "$4,884.38" "$6,512.50" "$6,512.50" "$6,512.50" "$3,256.25" "$3,256.25" "$5,157.90" "$6,512.50" "$5,210.00" "$2,930.63" "$6,512.50" N/A "$3,777.25" "$6,512.50" "$3,907.50" "$6,512.50" "$6,512.50" "$6,512.50" N/A N/A 4006U0404 SUP Custom 27803010 4006U0404 - COIL EMBOLIZATION CURVE 4MM 4CM XSOFT THE PENUMBRA COIL 400 BOTH IP/OP "$4,567.50" "$3,380.00" $813.02 "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" $813.02 "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" $951.92 "$4,567.50" "$1,827.00" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$4,567.50" "$3,425.63" "$4,567.50" "$4,567.50" "$4,567.50" "$2,283.75" "$2,283.75" "$3,617.46" "$4,567.50" "$3,654.00" "$2,055.38" "$4,567.50" N/A "$2,649.15" "$4,567.50" "$2,740.50" "$4,567.50" "$4,567.50" "$4,567.50" N/A N/A 4006U0406 SUP Custom 27803010 4006U0406 - COIL EMBL CRV 4MM 6CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$5,040.00" "$3,730.00" $897.12 "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" $897.12 "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$1,050.39" "$5,040.00" "$2,016.00" "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$5,040.00" "$3,780.00" "$5,040.00" "$5,040.00" "$5,040.00" "$2,520.00" "$2,520.00" "$3,991.68" "$5,040.00" "$4,032.00" "$2,268.00" "$5,040.00" N/A "$2,923.20" "$5,040.00" "$3,024.00" "$5,040.00" "$5,040.00" "$5,040.00" N/A N/A 4006U0408 SUP Custom 27803010 4006U0408 - COIL EMBOLIZATION CURVE 4MM 8CM XSOFT THE PENUMBRA COIL 400 BOTH IP/OP "$5,512.50" "$4,079.00" $981.23 "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" $981.23 "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$1,148.87" "$5,512.50" "$2,205.00" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$5,512.50" "$4,134.38" "$5,512.50" "$5,512.50" "$5,512.50" "$2,756.25" "$2,756.25" "$4,365.90" "$5,512.50" "$4,410.00" "$2,480.63" "$5,512.50" N/A "$3,197.25" "$5,512.50" "$3,307.50" "$5,512.50" "$5,512.50" "$5,512.50" N/A N/A 4006U0410 SUP Custom 27803010 4006U0410 - COIL EMBL CRV 4MM 10CM THE PENUMBRA COIL 400 XSFT BOTH IP/OP "$5,862.50" "$4,338.00" "$1,043.53" "$5,862.50" "$5,862.50" "$5,862.50" "$5,862.50" "$5,862.50" "$5,862.50" "$5,862.50" "$1,043.53" "$5,862.50" "$5,862.50" "$5,862.50" "$5,862.50" "$5,862.50" "$5,862.50" "$1,221.81" "$5,862.50" "$2,345.00" "$5,862.50" "$5,862.50" "$5,862.50" "$5,862.50" "$5,862.50" "$4,396.88" "$5,862.50" "$5,862.50" "$5,862.50" "$2,931.25" "$2,931.25" "$4,643.10" "$5,862.50" "$4,690.00" "$2,638.13" "$5,862.50" N/A "$3,400.25" "$5,862.50" "$3,517.50" "$5,862.50" "$5,862.50" "$5,862.50" N/A N/A 401.042E SUP HCPCS C1713 401.042E - SCREW BONE 2MM 5MM SLFTAP PLUSDRIVE RECESS GOLD TITANIUM BOTH IP/OP $159.00 $118.00 $31.48 $158.63 $71.38 $71.38 $71.38 $71.38 $158.63 $158.63 $158.63 $33.06 $158.63 $158.63 $158.63 $158.63 $158.63 $33.06 $158.63 $158.63 $93.83 $158.63 $158.63 $158.63 $158.63 $119.25 $158.63 $158.63 $158.63 $79.32 $79.32 $125.63 $158.63 $126.90 $71.38 $31.48 N/A $92.22 $158.63 $158.63 $158.63 $33.06 $158.63 N/A N/A 401.050E SUP HCPCS C1713 401.050E - SCREW BONE 2MM 20MM SLFTAP PLUSDRIVE RECESS COARSE PITCH BOTH IP/OP $159.00 $118.00 $31.48 $158.63 $71.38 $71.38 $71.38 $71.38 $158.63 $158.63 $158.63 $33.06 $158.63 $158.63 $158.63 $158.63 $158.63 $33.06 $158.63 $63.45 $93.83 $158.63 $158.63 $158.63 $158.63 $119.25 $158.63 $158.63 $158.63 $79.32 $79.32 $125.63 $158.63 $126.90 $71.38 $31.48 N/A $92.22 $158.63 $158.63 $158.63 $33.06 $158.63 N/A N/A 401.051E SUP HCPCS C1713 401.051E - SCREW BONE 2MM 22MM SLFTAP PLUSDRIVE RECESS COARSE PITCH BOTH IP/OP $159.00 $118.00 $31.48 $158.63 $71.38 $71.38 $71.38 $71.38 $158.63 $158.63 $158.63 $33.06 $158.63 $158.63 $158.63 $158.63 $158.63 $33.06 $158.63 $63.45 $93.83 $158.63 $158.63 $158.63 $158.63 $119.25 $158.63 $158.63 $158.63 $79.32 $79.32 $125.63 $158.63 $126.90 $71.38 $31.48 N/A $92.22 $158.63 $158.63 $158.63 $33.06 $158.63 N/A N/A 401.052E SUP HCPCS C1713 401.052E - SCREW BONE 2MM 24MM SLFTAP PLUSDRIVE RECESS COARSE PITCH BOTH IP/OP $159.00 $118.00 $31.48 $158.63 $71.38 $71.38 $71.38 $71.38 $158.63 $158.63 $158.63 $33.06 $158.63 $158.63 $158.63 $158.63 $158.63 $33.06 $158.63 $63.45 $93.83 $158.63 $158.63 $158.63 $158.63 $119.25 $158.63 $158.63 $158.63 $79.32 $79.32 $125.63 $158.63 $126.90 $71.38 $31.48 N/A $92.22 $158.63 $158.63 $158.63 $33.06 $158.63 N/A N/A 401.061E SUP HCPCS C1713 401.061E - SCREW BONE 2MM 4MM SELF DRILL PLUSDRIVE SILVER TITANIUM BOTH IP/OP $170.00 $126.00 $33.72 $169.88 $76.45 $76.45 $76.45 $76.45 $169.88 $169.88 $169.88 $35.41 $169.88 $169.88 $169.88 $169.88 $169.88 $35.40 $169.88 $67.95 $100.48 $169.88 $169.88 $169.88 $169.88 $127.50 $169.88 $169.88 $169.88 $84.94 $84.94 $134.54 $169.88 $135.90 $76.45 $33.72 N/A $98.60 $169.88 $169.88 $169.88 $35.40 $169.88 N/A N/A 401.062E SUP HCPCS C1713 401.062E - SCREW BONE 2MM 5MM SLFDRILL PLUSDRIVE RECESS SILVER TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 401.063E SUP HCPCS C1713 401.063E - SCREW BONE 2MM 3.3MM 6MM SELF DRILL PLUSDRIVE SILVER BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 401.064E SUP HCPCS C1713 401.064E - SCREW BONE 2MM 7MM SLFDRILL PLUSDRIVE RECESS SILVER TITANIUM BOTH IP/OP $170.00 $126.00 $33.72 $169.88 $76.45 $76.45 $76.45 $76.45 $169.88 $169.88 $169.88 $35.41 $169.88 $169.88 $169.88 $169.88 $169.88 $35.40 $169.88 $67.95 $100.48 $169.88 $169.88 $169.88 $169.88 $127.50 $169.88 $169.88 $169.88 $84.94 $84.94 $134.54 $169.88 $135.90 $76.45 $33.72 N/A $98.60 $169.88 $169.88 $169.88 $35.40 $169.88 N/A N/A 401.065E SUP HCPCS C1713 401.065E - SCREW BONE 2MM 3.3MM 8MM SELF DRILL PLUSDRIVE SILVER BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 401.134.99 SUP HCPCS C1713 401.134.99 - SCREW BONE 2MM 4MM SELF DRILL STARDRIVE ARCH TITANIUM SPN BOTH IP/OP $101.50 $75.00 $20.15 $101.50 $45.68 $45.68 $45.68 $45.68 $101.50 $101.50 $101.50 $21.16 $101.50 $101.50 $101.50 $101.50 $101.50 $21.15 $101.50 $40.60 $60.04 $101.50 $101.50 $101.50 $101.50 $76.13 $101.50 $101.50 $101.50 $50.75 $50.75 $80.39 $101.50 $81.20 $45.68 $20.15 N/A $58.87 $101.50 $60.90 $101.50 $101.50 $101.50 N/A N/A 401.136.99 SUP HCPCS C1713 401.136.99 - SCREW BONE 2MM 6MM SELF DRILL STARDRIVE ARCH TITANIUM SPN BOTH IP/OP $101.50 $75.00 $20.15 $101.50 $45.68 $45.68 $45.68 $45.68 $101.50 $101.50 $101.50 $21.16 $101.50 $101.50 $101.50 $101.50 $101.50 $21.15 $101.50 $40.60 $60.04 $101.50 $101.50 $101.50 $101.50 $76.13 $101.50 $101.50 $101.50 $50.75 $50.75 $80.39 $101.50 $81.20 $45.68 $20.15 N/A $58.87 $101.50 $60.90 $101.50 $101.50 $101.50 N/A N/A 401.138.99 SUP HCPCS C1713 401.138.99 - SCREW BONE 2MM 8MM SELF DRILL STARDRIVE ARCH TITANIUM SPN BOTH IP/OP $101.50 $75.00 $20.15 $101.50 $45.68 $45.68 $45.68 $45.68 $101.50 $101.50 $101.50 $21.16 $101.50 $101.50 $101.50 $101.50 $101.50 $21.15 $101.50 $40.60 $60.04 $101.50 $101.50 $101.50 $101.50 $76.13 $101.50 $101.50 $101.50 $50.75 $50.75 $80.39 $101.50 $81.20 $45.68 $20.15 N/A $58.87 $101.50 $101.50 $101.50 $101.50 $101.50 N/A N/A 401.306E SUP HCPCS C1713 401.306E - SCREW BONE 2.4MM 6MM EMERGENCY CRCIFRM TEAL TITANIUM CRANFCL BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 401.307E SUP HCPCS C1713 401.307E - SCREW BONE 2.4MM 2MM 7MM SLFTAP EMERGENCY STRIPPED TEAL BOTH IP/OP $148.50 $110.00 $29.47 $148.50 $66.83 $66.83 $66.83 $66.83 $148.50 $148.50 $148.50 $30.95 $148.50 $148.50 $148.50 $148.50 $148.50 $30.95 $148.50 $59.40 $87.84 $148.50 $148.50 $148.50 $148.50 $111.38 $148.50 $148.50 $148.50 $74.25 $74.25 $117.61 $148.50 $118.80 $66.83 $29.47 N/A $86.13 $148.50 $148.50 $148.50 $30.95 $148.50 N/A N/A 401.308E SUP HCPCS C1713 401.308E - SCREW BONE 2.4MM 8MM EMERGENCY CRCIFRM TEAL TITANIUM CRANFCL BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 401.309E SUP HCPCS C1713 401.309E - SCREW BONE 2.4MM 2MM 9MM SLFTAP EMERGENCY STRIPPED TEAL BOTH IP/OP $148.50 $110.00 $29.47 $148.50 $66.83 $66.83 $66.83 $66.83 $148.50 $148.50 $148.50 $30.95 $148.50 $148.50 $148.50 $148.50 $148.50 $30.95 $148.50 $59.40 $87.84 $148.50 $148.50 $148.50 $148.50 $111.38 $148.50 $148.50 $148.50 $74.25 $74.25 $117.61 $148.50 $118.80 $66.83 $29.47 N/A $86.13 $148.50 $148.50 $148.50 $30.95 $148.50 N/A N/A 401.311E SUP HCPCS C1713 401.311E - SCREW BONE 2.4MM 11MM EMERGENCY TITANIUM STERILE BOTH IP/OP $148.50 $110.00 $29.47 $148.50 $66.83 $66.83 $66.83 $66.83 $148.50 $148.50 $148.50 $30.95 $148.50 $148.50 $148.50 $148.50 $148.50 $30.95 $148.50 $59.40 $87.84 $148.50 $148.50 $148.50 $148.50 $111.38 $148.50 $148.50 $148.50 $74.25 $74.25 $117.61 $148.50 $118.80 $66.83 $29.47 N/A $86.13 $148.50 $148.50 $148.50 $30.95 $148.50 N/A N/A 401.314E SUP HCPCS C1713 401.314E - SCREW BONE 2.4MM 14MM EMERGENCY CRCIFRM RECESS TEAL TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 401.316E SUP HCPCS C1713 401.316E - SCREW BONE 2.4MM 16MM EMERGENCY CRCIFRM RECESS TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 401.318E SUP HCPCS C1713 401.318E - SCREW BONE 2.4MM 18MM EMERGENCY CRCIFRM RECESS TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 401.356.97 SUP HCPCS C1713 401.356.97 - SCREW BONE 2MM 6MM T6 STARDRIVE RECESS SLFTAP LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 401.357.97 SUP HCPCS C1713 401.357.97 - SCREW BONE 2MM 7MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 401.358.97 SUP HCPCS C1713 401.358.97 - SCREW BONE T6 STARDRIVE 2MM 8MM SELF TAP TITANIUM CORTICAL BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $66.40 $66.40 N/A N/A 401.359.97 SUP HCPCS C1713 401.359.97 - SCREW BONE 2MM 9MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $66.40 $66.40 N/A N/A 401.360.97 SUP HCPCS C1713 401.360.97 - SCREW BONE T6 2MM 10MM SELF TAP STARDRIVE LCP TITANIUM RAD BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 401.361.97 SUP HCPCS C1713 401.361.97 - SCREW BONE 2MM 11MM SLFTAP SELF RETAINING T6 STARDRIVE BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 401.362.97 SUP HCPCS C1713 401.362.97 - SCREW BONE T6 2MM 12MM SELF TAP STARDRIVE LCP TITANIUM RAD BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $66.40 $66.40 N/A N/A 401.363.97 SUP HCPCS C1713 401.363.97 - SCREW BONE T6 2MM 13MM SELF TAP STARDRIVE LCP TITANIUM RAD BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 401.364.97 SUP HCPCS C1713 401.364.97 - SCREW BONE 2MM 14MM T6 STARDRIVE RECESS SLFTAP LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 401.366.97 SUP HCPCS C1713 401.366.97 - SCREW BONE 2MM 16MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 401.368.97 SUP HCPCS C1713 401.368.97 - SCREW BONE 2MM 18MM T6 STARDRIVE RECESS SLFTAP LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $39.84 $66.40 $13.84 $66.40 N/A N/A 401.370.97 SUP HCPCS C1713 401.370.97 - SCREW BONE 2MM 20MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $66.40 $66.40 N/A N/A 401.372.97 SUP HCPCS C1713 401.372.97 - SCREW BONE 2MM 22MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $66.40 $66.40 N/A N/A 401.374.97 SUP HCPCS C1713 401.374.97 - SCREW BONE 2MM 24MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $13.84 $66.40 N/A N/A 401.375.97 SUP HCPCS C1713 401.375.97 - SCREW BONE 2MM 26MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $13.84 $66.40 N/A N/A 401.376.97 SUP HCPCS C1713 401.376.97 - SCREW BONE 2MM 28MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $66.40 $66.40 N/A N/A 401.377.97 SUP HCPCS C1713 401.377.97 - SCREW BONE 2MM 30MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $13.84 $66.40 N/A N/A 401.378.97 SUP HCPCS C1713 401.378.97 - SCREW BONE 2MM 32MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $13.84 $66.40 N/A N/A 401.379.97 SUP HCPCS C1713 401.379.97 - SCREW BONE 2MM 34MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $13.84 $66.40 N/A N/A 401.380.97 SUP HCPCS C1713 401.380.97 - SCREW BONE 2MM 36MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $67.53 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $13.84 $66.40 N/A N/A 401.381.97 SUP HCPCS C1713 401.381.97 - SCREW BONE 2MM 38MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $67.53 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $13.84 $66.40 N/A N/A 401.382.97 SUP HCPCS C1713 401.382.97 - SCREW BONE 2MM 40MM SLFTAP STARDRIVE RECESS LCP TITANIUM BOTH IP/OP $66.50 $49.00 $13.18 $67.53 $29.88 $29.88 $29.88 $29.88 $66.40 $66.40 $66.40 $13.84 $66.40 $66.40 $66.40 $66.40 $66.40 $13.84 $66.40 $27.01 $39.28 $66.40 $67.53 $66.40 $66.40 $49.88 $66.40 $66.40 $66.40 $33.20 $33.20 $52.59 $66.40 $53.12 $29.88 $13.18 N/A $38.57 $66.40 $66.40 $66.40 $13.84 $66.40 N/A N/A 401.506.96 SUP HCPCS C1713 401.506.96 - SCREW BONE 2.4MM 4MM 6MM SELF TAP CRCIFRM RECESS TITANIUM BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $150.40 $150.40 $31.34 $150.40 N/A N/A 401.507.96 SUP HCPCS C1713 401.507.96 - SCREW BONE 2.4MM 4MM 7MM SELF TAP CRCIFRM RECESS TITANIUM BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $150.40 $150.40 $31.34 $150.40 N/A N/A 401.508.96 SUP HCPCS C1713 401.508.96 - SCREW BONE 2.4MM 4.5MM 8MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $152.95 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $90.24 $150.40 $31.34 $150.40 N/A N/A 401.509.96 SUP HCPCS C1713 401.509.96 - SCREW BONE 2.4MM 4MM 9MM SELF TAP CRCIFRM RECESS TITANIUM BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $150.40 $150.40 $31.34 $150.40 N/A N/A 401.510.96 SUP HCPCS C1713 401.510.96 - SCREW BONE 2.4MM 4.5MM 10MM SELF TAP CRCIFRM RECESS TITANIUM BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $152.95 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $90.24 $150.40 $31.34 $150.40 N/A N/A 401.511.96 SUP HCPCS C1713 401.511.96 - SCREW BONE 2.4MM 4.5MM 11MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $150.40 $150.40 $31.34 $150.40 N/A N/A 401.512.96 SUP HCPCS C1713 401.512.96 - SCREW BONE 2.4MM 4.5MM 12MM SELF TAP CRCIFRM RECESS TITANIUM BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $90.24 $150.40 $31.34 $150.40 N/A N/A 401.513.96 SUP HCPCS C1713 401.513.96 - SCREW BONE 2.4MM 4.5MM 13MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $90.24 $150.40 $31.34 $150.40 N/A N/A 401.514.96 SUP HCPCS C1713 401.514.96 - SCREW BONE 2.4MM 4.5MM 14MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $152.95 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $90.24 $150.40 $31.34 $150.40 N/A N/A 401.516.96 SUP HCPCS C1713 401.516.96 - SCREW BONE 2.4MM 4.5MM 16MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $152.95 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $90.24 $150.40 $31.34 $150.40 N/A N/A 401.518.96 SUP HCPCS C1713 401.518.96 - SCREW BONE 2.4MM 4.5MM 18MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $152.95 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $90.24 $150.40 $31.34 $150.40 N/A N/A 401.520.96 SUP HCPCS C1713 401.520.96 - SCREW BONE 2.4MM 4.5MM 20MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $152.95 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $90.24 $150.40 $31.34 $150.40 N/A N/A 401.520E SUP HCPCS C1713 401.520E - SCREW BONE 2.4MM 4MM 20MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $232.00 $172.00 $46.00 $231.75 $104.29 $104.29 $104.29 $104.29 $231.75 $231.75 $231.75 $48.30 $231.75 $231.75 $231.75 $231.75 $231.75 $48.30 $231.75 $92.70 $137.08 $231.75 $231.75 $231.75 $231.75 $174.00 $231.75 $231.75 $231.75 $115.88 $115.88 $183.55 $231.75 $185.40 $104.29 $46.00 N/A $134.56 $231.75 $231.75 $231.75 $48.30 $231.75 N/A N/A 401.522.96 SUP HCPCS C1713 401.522.96 - SCREW BONE 2.4MM 4.5MM 22MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $150.40 $150.40 $31.34 $150.40 N/A N/A 401.524.96 SUP HCPCS C1713 401.524.96 - SCREW BONE 2.4MM 4.5MM 24MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $150.40 $150.40 $31.34 $150.40 N/A N/A 401.524E SUP HCPCS C1713 401.524E - SCREW BONE 2.4MM 24MM SLFTAP TITANIUM CORTICAL HAND NONSTRL BOTH IP/OP $232.00 $172.00 $46.00 $231.75 $104.29 $104.29 $104.29 $104.29 $231.75 $231.75 $231.75 $48.30 $231.75 $231.75 $231.75 $231.75 $231.75 $48.30 $231.75 $92.70 $137.08 $231.75 $231.75 $231.75 $231.75 $174.00 $231.75 $231.75 $231.75 $115.88 $115.88 $183.55 $231.75 $185.40 $104.29 $46.00 N/A $134.56 $231.75 $231.75 $231.75 $48.30 $231.75 N/A N/A 401.526.96 SUP HCPCS C1713 401.526.96 - SCREW BONE 2.4MM 4.5MM 26MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $150.40 $150.40 $31.34 $150.40 N/A N/A 401.526E SUP HCPCS C1713 401.526E - SCREW BONE 2.4MM 26MM SLFTAP TITANIUM CORTICAL HAND NONSTRL BOTH IP/OP $232.00 $172.00 $46.00 $231.75 $104.29 $104.29 $104.29 $104.29 $231.75 $231.75 $231.75 $48.30 $231.75 $231.75 $231.75 $231.75 $231.75 $48.30 $231.75 $92.70 $137.08 $231.75 $231.75 $231.75 $231.75 $174.00 $231.75 $231.75 $231.75 $115.88 $115.88 $183.55 $231.75 $185.40 $104.29 $46.00 N/A $134.56 $231.75 $231.75 $231.75 $48.30 $231.75 N/A N/A 401.528.96 SUP HCPCS C1713 401.528.96 - SCREW BONE 2.4MM 4.5MM 28MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $150.40 $150.40 $31.34 $150.40 N/A N/A 401.528E SUP HCPCS C1713 401.528E - SCREW BONE 2.4MM 28MM SLFTAP TITANIUM CORTICAL HAND NONSTRL BOTH IP/OP $232.00 $172.00 $46.00 $231.75 $104.29 $104.29 $104.29 $104.29 $231.75 $231.75 $231.75 $48.30 $231.75 $231.75 $231.75 $231.75 $231.75 $48.30 $231.75 $231.75 $137.08 $231.75 $231.75 $231.75 $231.75 $174.00 $231.75 $231.75 $231.75 $115.88 $115.88 $183.55 $231.75 $185.40 $104.29 $46.00 N/A $134.56 $231.75 $231.75 $231.75 $48.30 $231.75 N/A N/A 401.530.96 SUP HCPCS C1713 401.530.96 - SCREW BONE 2.4MM 4.5MM 30MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $150.40 $150.40 $31.34 $150.40 N/A N/A 401.530E SUP HCPCS C1713 401.530E - SCREW BONE 2.4MM 30MM SLFTAP MODULAR GOLD TITANIUM BOTH IP/OP $232.00 $172.00 $46.00 $231.75 $104.29 $104.29 $104.29 $104.29 $231.75 $231.75 $231.75 $48.30 $231.75 $231.75 $231.75 $231.75 $231.75 $48.30 $231.75 $92.70 $137.08 $231.75 $231.75 $231.75 $231.75 $174.00 $231.75 $231.75 $231.75 $115.88 $115.88 $183.55 $231.75 $185.40 $104.29 $46.00 N/A $134.56 $231.75 $231.75 $231.75 $48.30 $231.75 N/A N/A 401.532.96 SUP HCPCS C1713 401.532.96 - SCREW BONE 2.4MM 4.5MM 32MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $150.40 $150.40 $31.34 $150.40 N/A N/A 401.534.96 SUP HCPCS C1713 401.534.96 - SCREW BONE 2.4MM 4.5MM 34MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $150.40 $150.40 $31.34 $150.40 N/A N/A 401.534E SUP HCPCS C1713 401.534E - SCREW BONE 2.4MM 34MM SELF TAP MODULAR GOLD TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 401.536.96 SUP HCPCS C1713 401.536.96 - SCREW BONE 2.4MM 4.5MM 36MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $150.40 $150.40 $31.34 $150.40 N/A N/A 401.538.96 SUP HCPCS C1713 401.538.96 - SCREW BONE 2.4MM 4.5MM 38MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $150.40 $150.40 $31.34 $150.40 N/A N/A 401.540.96 SUP HCPCS C1713 401.540.96 - SCREW BONE 2.4MM 4.5MM 40MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $150.50 $111.00 $29.85 $152.95 $67.68 $67.68 $67.68 $67.68 $150.40 $150.40 $150.40 $31.35 $150.40 $150.40 $150.40 $150.40 $150.40 $31.35 $150.40 $61.18 $88.96 $150.40 $152.95 $150.40 $150.40 $112.88 $150.40 $150.40 $150.40 $75.20 $75.20 $119.12 $150.40 $120.32 $67.68 $29.85 N/A $87.29 $150.40 $150.40 $150.40 $31.34 $150.40 N/A N/A 401.542E SUP HCPCS C1713 401.542E - SCREW BONE 2.4MM 42MM SLFTAP MODULAR CORTICAL MANDIB FIX BOTH IP/OP $232.00 $172.00 $46.00 $231.75 $104.29 $104.29 $104.29 $104.29 $231.75 $231.75 $231.75 $48.30 $231.75 $231.75 $231.75 $231.75 $231.75 $48.30 $231.75 $92.70 $137.08 $231.75 $231.75 $231.75 $231.75 $174.00 $231.75 $231.75 $231.75 $115.88 $115.88 $183.55 $231.75 $185.40 $104.29 $46.00 N/A $134.56 $231.75 $231.75 $231.75 $48.30 $231.75 N/A N/A 401.544E SUP HCPCS C1713 401.544E - SCREW BONE 2.4MM 44MM SLFTAP TITANIUM CORTICAL MANDIB BOTH IP/OP $232.00 $172.00 $46.00 $231.75 $104.29 $104.29 $104.29 $104.29 $231.75 $231.75 $231.75 $48.30 $231.75 $231.75 $231.75 $231.75 $231.75 $48.30 $231.75 $92.70 $137.08 $231.75 $231.75 $231.75 $231.75 $174.00 $231.75 $231.75 $231.75 $115.88 $115.88 $183.55 $231.75 $185.40 $104.29 $46.00 N/A $134.56 $231.75 $231.75 $231.75 $48.30 $231.75 N/A N/A 401.546E SUP HCPCS C1713 401.546E - SCREW BONE 2.4MM 46MM SLFTAP LOCKING RECONSTRUCTION TITANIUM BOTH IP/OP $232.00 $172.00 $46.00 $231.75 $104.29 $104.29 $104.29 $104.29 $231.75 $231.75 $231.75 $48.30 $231.75 $231.75 $231.75 $231.75 $231.75 $48.30 $231.75 $231.75 $137.08 $231.75 $231.75 $231.75 $231.75 $174.00 $231.75 $231.75 $231.75 $115.88 $115.88 $183.55 $231.75 $185.40 $104.29 $46.00 N/A $134.56 $231.75 $231.75 $231.75 $48.30 $231.75 N/A N/A 401.548E SUP HCPCS C1713 401.548E - SCREW BONE 2.4MM 48MM SLFTAP LOCKING RECONSTRUCTION TITANIUM BOTH IP/OP $232.00 $172.00 $46.00 $231.75 $104.29 $104.29 $104.29 $104.29 $231.75 $231.75 $231.75 $48.30 $231.75 $231.75 $231.75 $231.75 $231.75 $48.30 $231.75 $231.75 $137.08 $231.75 $231.75 $231.75 $231.75 $174.00 $231.75 $231.75 $231.75 $115.88 $115.88 $183.55 $231.75 $185.40 $104.29 $46.00 N/A $134.56 $231.75 $231.75 $231.75 $48.30 $231.75 N/A N/A 401.558E SUP HCPCS C1713 401.558E - SCREW BONE 2.7MM 8MM EMERGENCY LOCK TITANIUM MANDIB STERILE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 401.560E SUP HCPCS C1713 401.560E - SCREW BONE 2.7MM 10MM EMERGENCY LOCK TITANIUM MANDIB STERILE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 401.566E SUP HCPCS C1713 401.566E - SCREW BONE 2.7MM 16MM EMERGENCY LOCK TITANIUM MANDIB STERILE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 401.568E SUP HCPCS C1713 401.568E - SCREW BONE 2.7MM 18MM EMERGENCY LOCK TITANIUM MANDIB STERILE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 401.594E SUP HCPCS C1713 401.594E - SCREW BONE 2MM 4MM SLFTAP MNOAX TENSION BAND TITANIUM MANDIB BOTH IP/OP $191.50 $142.00 $37.96 $191.25 $86.06 $86.06 $86.06 $86.06 $191.25 $191.25 $191.25 $39.86 $191.25 $191.25 $191.25 $191.25 $191.25 $39.86 $191.25 $76.50 $113.12 $191.25 $191.25 $191.25 $191.25 $143.63 $191.25 $191.25 $191.25 $95.63 $95.63 $151.47 $191.25 $153.00 $86.06 $37.96 N/A $111.07 $191.25 $191.25 $191.25 $39.86 $191.25 N/A N/A 401.596E SUP HCPCS C1713 401.596E - SCREW BONE 2MM 6MM SLFTAP MNOAX TENSION BAND TITANIUM MANDIB BOTH IP/OP $191.50 $142.00 $37.96 $191.25 $86.06 $86.06 $86.06 $86.06 $191.25 $191.25 $191.25 $39.86 $191.25 $191.25 $191.25 $191.25 $191.25 $39.86 $191.25 $191.25 $113.12 $191.25 $191.25 $191.25 $191.25 $143.63 $191.25 $191.25 $191.25 $95.63 $95.63 $151.47 $191.25 $153.00 $86.06 $37.96 N/A $111.07 $191.25 $191.25 $191.25 $39.86 $191.25 N/A N/A 401.797E SUP HCPCS C1713 401.797E - SCREW BONE 2.4MM 3.3MM 14MM EMERGENCY PLUSDRIVE TEAL BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 401.806.96 SUP HCPCS C1713 401.806.96 - SCREW BONE 2MM 3.5MM 6MM SLFTAP CRCIFRM RECESS TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $65.00 $65.00 N/A N/A 401.807.96 SUP HCPCS C1713 401.807.96 - SCREW BONE 2MM 3.5MM 7MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 401.808.96 SUP HCPCS C1713 401.808.96 - SCREW BONE 2MM 3.5MM 8MM SELF TAP CRCIFRM RECESS TITANIUM BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.809.96 SUP HCPCS C1713 401.809.96 - SCREW BONE 2MM 3.5MM 9MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.810.96 SUP HCPCS C1713 401.810.96 - SCREW BONE 2MM 10MM SLFTAP TITANIUM CORTICAL NONSTRL BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.811.96 SUP HCPCS C1713 401.811.96 - SCREW BONE 2MM 3.5MM 11MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.812.96 SUP HCPCS C1713 401.812.96 - SCREW BONE 2MM 3.5MM 12MM SELF TAP CRCIFRM RECESS TITANIUM BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $65.00 $65.00 N/A N/A 401.813.96 SUP HCPCS C1713 401.813.96 - SCREW BONE 2MM 3.5MM 13MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.814.96 SUP HCPCS C1713 401.814.96 - SCREW BONE 2MM 3.5MM 14MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $39.00 $65.00 $13.55 $65.00 N/A N/A 401.816.96 SUP HCPCS C1713 401.816.96 - SCREW BONE 2MM 3.5MM 16MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $65.00 $65.00 N/A N/A 401.818.96 SUP HCPCS C1713 401.818.96 - SCREW BONE 2MM 3.5MM 18MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 401.820.96 SUP HCPCS C1713 401.820.96 - SCREW BONE 2MM 3.5MM 20MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 401.822.96 SUP HCPCS C1713 401.822.96 - SCREW BONE 2MM 3.5MM 22MM SLFTAP CRCIFRM RECESS TITANIUM BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 401.824.96 SUP HCPCS C1713 401.824.96 - SCREW BONE 2MM 3.5MM 24MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 401.826.96 SUP HCPCS C1713 401.826.96 - SCREW BONE 2MM 3.5MM 26MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $66.10 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 401.828.96 SUP HCPCS C1713 401.828.96 - SCREW BONE 2MM 3.5MM 28MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 401.830.96 SUP HCPCS C1713 401.830.96 - SCREW BONE 2MM 3.5MM 30MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 401.832.96 SUP HCPCS C1713 401.832.96 - SCREW BONE 2MM 3.5MM 32MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 401.834.96 SUP HCPCS C1713 401.834.96 - SCREW BONE 2MM 3.5MM 34MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 401.836.96 SUP HCPCS C1713 401.836.96 - SCREW BONE 2MM 3.5MM 36MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A 401.838.96 SUP HCPCS C1713 401.838.96 - SCREW BONE 2MM 3.5MM 38MM SELF TAP CRCIFRM TITANIUM HAND BOTH IP/OP $65.00 $48.00 $12.90 $66.10 $29.25 $29.25 $29.25 $29.25 $65.00 $65.00 $65.00 $13.55 $65.00 $65.00 $65.00 $65.00 $65.00 $13.55 $65.00 $26.44 $38.45 $65.00 $66.10 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $29.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $65.00 $65.00 N/A N/A 401.968.96 SUP Custom 27203010 401.968.96 - PIN FIX 1.8MM 18MM BUTTRESS TITANIUM HAND NONSTRL BOTH IP/OP $115.00 $85.00 $20.39 $116.50 $114.55 $114.55 $114.55 $114.55 $114.55 $114.55 $20.39 $114.55 $114.55 $85.02 $85.02 $88.30 $59.68 $23.87 $114.55 $46.60 $114.55 $114.55 $116.50 $114.55 $114.55 $86.25 $114.55 $114.55 $114.55 $57.28 $57.28 $90.72 $114.55 $91.64 $74.46 $114.55 N/A $66.70 $114.55 $68.73 $114.55 $114.55 $114.55 N/A N/A 40-10102 SUP HCPCS C1713 40-10102 - PLATE BN SM NS VARIAX MESH PA LCK LOPRFL TI FT CALCANEUS BOTH IP/OP "$1,449.00" "$1,072.00" $287.59 "$1,449.00" $652.05 $652.05 $652.05 $652.05 "$1,449.00" "$1,449.00" "$1,449.00" $302.01 "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" $301.99 "$1,449.00" "$1,449.00" $857.08 "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" "$1,086.75" "$1,449.00" "$1,449.00" "$1,449.00" $724.50 $724.50 "$1,147.61" "$1,449.00" "$1,159.20" $652.05 $287.59 N/A $840.42 "$1,449.00" $869.40 "$1,449.00" $301.97 "$1,449.00" N/A N/A 40-10104 SUP HCPCS C1713 40-10104 - PLATE BN MED 69MM NS VARIAX MESH PA LCK LOPRFL TI FT BOTH IP/OP "$1,449.00" "$1,072.00" $287.59 "$1,449.00" $652.05 $652.05 $652.05 $652.05 "$1,449.00" "$1,449.00" "$1,449.00" $302.01 "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" $301.99 "$1,449.00" $579.60 $857.08 "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" "$1,086.75" "$1,449.00" "$1,449.00" "$1,449.00" $724.50 $724.50 "$1,147.61" "$1,449.00" "$1,159.20" $652.05 $287.59 N/A $840.42 "$1,449.00" $869.40 "$1,449.00" "$1,449.00" "$1,449.00" N/A N/A 40-10106 SUP HCPCS C1713 40-10106 - PLATE BN LG NS VARIAX MESH PA LCK LOPRFL TI FT CALCANEUS BOTH IP/OP "$1,449.00" "$1,072.00" $287.59 "$1,449.00" $652.05 $652.05 $652.05 $652.05 "$1,449.00" "$1,449.00" "$1,449.00" $302.01 "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" $301.99 "$1,449.00" $579.60 $857.08 "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" "$1,086.75" "$1,449.00" "$1,449.00" "$1,449.00" $724.50 $724.50 "$1,147.61" "$1,449.00" "$1,159.20" $652.05 $287.59 N/A $840.42 "$1,449.00" $869.40 "$1,449.00" $301.97 "$1,449.00" N/A N/A 40-10112 SUP HCPCS C1713 40-10112 - PLATE BN SM STD 1.5MM NS VARIAX PA LCK LOPRFL TI FT BOTH IP/OP "$1,449.00" "$1,072.00" $287.59 "$1,449.00" $652.05 $652.05 $652.05 $652.05 "$1,449.00" "$1,449.00" "$1,449.00" $302.01 "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" $301.99 "$1,449.00" $579.60 $857.08 "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" "$1,086.75" "$1,449.00" "$1,449.00" "$1,449.00" $724.50 $724.50 "$1,147.61" "$1,449.00" "$1,159.20" $652.05 $287.59 N/A $840.42 "$1,449.00" $869.40 "$1,449.00" $301.97 "$1,449.00" N/A N/A 40-10114 SUP HCPCS C1713 40-10114 - PLATE BN MED STD 64MM NS VARIAX PA LCK LOPRFL TI FT BOTH IP/OP "$1,449.00" "$1,072.00" $287.59 "$1,449.00" $652.05 $652.05 $652.05 $652.05 "$1,449.00" "$1,449.00" "$1,449.00" $302.01 "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" $301.99 "$1,449.00" $579.60 $857.08 "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" "$1,086.75" "$1,449.00" "$1,449.00" "$1,449.00" $724.50 $724.50 "$1,147.61" "$1,449.00" "$1,159.20" $652.05 $287.59 N/A $840.42 "$1,449.00" $869.40 "$1,449.00" "$1,449.00" "$1,449.00" N/A N/A 40-10116 SUP HCPCS C1713 40-10116 - PLATE BN LG STD NS VARIAX PA LCK LOPRFL TI FT CALCANEUS BOTH IP/OP "$1,449.00" "$1,072.00" $287.59 "$1,449.00" $652.05 $652.05 $652.05 $652.05 "$1,449.00" "$1,449.00" "$1,449.00" $302.01 "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" $301.99 "$1,449.00" $579.60 $857.08 "$1,449.00" "$1,449.00" "$1,449.00" "$1,449.00" "$1,086.75" "$1,449.00" "$1,449.00" "$1,449.00" $724.50 $724.50 "$1,147.61" "$1,449.00" "$1,159.20" $652.05 $287.59 N/A $840.42 "$1,449.00" $869.40 "$1,449.00" "$1,449.00" "$1,449.00" N/A N/A 40-12016S SUP HCPCS C1713 40-12016S - 16MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-12018S SUP HCPCS C1713 40-12018S - 18 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-12020S SUP HCPCS C1713 40-12020S - 20 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-12022S SUP HCPCS C1713 40-12022S - 22 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-12024S SUP HCPCS C1713 40-12024S - 24 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-12026S SUP HCPCS C1713 40-12026S - 26 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-12028S SUP HCPCS C1713 40-12028S - 28 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-12030S SUP HCPCS C1713 40-12030S - 30 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-12032S SUP HCPCS C1713 40-12032S - 32 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-12034S SUP HCPCS C1713 40-12034S - 34 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-12036S SUP HCPCS C1713 40-12036S - 36 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-12038S SUP HCPCS C1713 40-12038S - 38MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-12040S SUP HCPCS C1713 40-12040S - 40MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-12042S SUP HCPCS C1713 40-12042S - 42 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-12044S SUP HCPCS C1713 40-12044S - 44 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-12046S SUP HCPCS C1713 40-12046S - 46 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-12048S SUP HCPCS C1713 40-12048S - 48 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-12050S SUP HCPCS C1713 40-12050S - 50 MM LONG THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-13010S SUP HCPCS C1713 40-13010S - 10 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-13012S SUP HCPCS C1713 40-13012S - CANNULATED SCREW PARTIALLY THRD SHORT 4.0 MM x 12 MM BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-13014S SUP HCPCS C1713 40-13014S - 14MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-13016S SUP HCPCS C1713 40-13016S - 16MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-13018S SUP HCPCS C1713 40-13018S - 18 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-13020S SUP HCPCS C1713 40-13020S - 20 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-13022S SUP HCPCS C1713 40-13022S - 22 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-13024S SUP HCPCS C1713 40-13024S - 24 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-13026S SUP HCPCS C1713 40-13026S - 26 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-13028S SUP HCPCS C1713 40-13028S - 28 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-13030S SUP HCPCS C1713 40-13030S - 30 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-13032S SUP HCPCS C1713 40-13032S - 32 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-13034S SUP HCPCS C1713 40-13034S - 34 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-13036S SUP HCPCS C1713 40-13036S - 36 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-13038S SUP HCPCS C1713 40-13038S - 38MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-13040S SUP HCPCS C1713 40-13040S - 40MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-13042S SUP HCPCS C1713 40-13042S - 42 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-13044S SUP HCPCS C1713 40-13044S - 44 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-13046S SUP HCPCS C1713 40-13046S - 46 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A 40-13048S SUP HCPCS C1713 40-13048S - 48 MM SHORT THREAD BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $87.75 $87.75 $87.75 $87.75 $195.00 $195.00 $195.00 $40.64 $195.00 $195.00 $195.00 $195.00 $195.00 $40.64 $195.00 $78.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $87.75 $38.70 N/A $113.10 $195.00 $117.00 $195.00 $40.64 $195.00 N/A N/A 40-13050S SUP HCPCS C1713 40-13050S - CANNULATED SCREW PARTIALLY THRD SHORT 4.0 MM x 50 MM BOTH IP/OP $245.00 $181.00 $48.63 $245.00 $110.25 $110.25 $110.25 $110.25 $245.00 $245.00 $245.00 $51.06 $245.00 $245.00 $245.00 $245.00 $245.00 $51.06 $245.00 $98.00 $144.92 $245.00 $245.00 $245.00 $245.00 $183.75 $245.00 $245.00 $245.00 $122.50 $122.50 $194.04 $245.00 $196.00 $110.25 $48.63 N/A $142.10 $245.00 $147.00 $245.00 $51.06 $245.00 N/A N/A 40-15011 SUP HCPCS C1713 40-15011 - PLATE BN CRV NS VARIAX 4 HL PA LCK LOPRFL TI FT BOTH IP/OP "$1,082.00" $801.00 $214.75 "$1,082.00" $486.90 $486.90 $486.90 $486.90 "$1,082.00" "$1,082.00" "$1,082.00" $225.52 "$1,082.00" "$1,082.00" "$1,082.00" "$1,082.00" "$1,082.00" $225.50 "$1,082.00" $432.80 $640.00 "$1,082.00" "$1,082.00" "$1,082.00" "$1,082.00" $811.50 "$1,082.00" "$1,082.00" "$1,082.00" $541.00 $541.00 $856.94 "$1,082.00" $865.60 $486.90 $214.75 N/A $627.56 "$1,082.00" $649.20 "$1,082.00" $225.49 "$1,082.00" N/A N/A 40-15012 SUP HCPCS C1713 40-15012 - PLATE BN CRV NS VARIAX 5 HL PA LCK LOPRFL TI FT RT BOTH IP/OP "$1,175.00" $870.00 $233.21 "$1,175.00" $528.75 $528.75 $528.75 $528.75 "$1,175.00" "$1,175.00" "$1,175.00" $244.90 "$1,175.00" "$1,175.00" "$1,175.00" "$1,175.00" "$1,175.00" $244.88 "$1,175.00" "$1,175.00" $695.01 "$1,175.00" "$1,175.00" "$1,175.00" "$1,175.00" $881.25 "$1,175.00" "$1,175.00" "$1,175.00" $587.50 $587.50 $930.60 "$1,175.00" $940.00 $528.75 $233.21 N/A $681.50 "$1,175.00" $705.00 "$1,175.00" $244.87 "$1,175.00" N/A N/A 40-15013 SUP HCPCS C1713 40-15013 - PLATE BN CRV NS VARIAX 5 HL PA LCK LOPRFL TI FT LT BOTH IP/OP "$1,175.00" $870.00 $233.21 "$1,175.00" $528.75 $528.75 $528.75 $528.75 "$1,175.00" "$1,175.00" "$1,175.00" $244.90 "$1,175.00" "$1,175.00" "$1,175.00" "$1,175.00" "$1,175.00" $244.88 "$1,175.00" $470.00 $695.01 "$1,175.00" "$1,175.00" "$1,175.00" "$1,175.00" $881.25 "$1,175.00" "$1,175.00" "$1,175.00" $587.50 $587.50 $930.60 "$1,175.00" $940.00 $528.75 $233.21 N/A $681.50 "$1,175.00" $705.00 "$1,175.00" "$1,175.00" "$1,175.00" N/A N/A 40-15014 SUP HCPCS C1713 40-15014 - PLATE BN CRV NS VARIAX 6 HL PA LCK LOPRFL TI FT BOTH IP/OP "$1,321.00" $978.00 $262.19 "$1,321.00" $594.45 $594.45 $594.45 $594.45 "$1,321.00" "$1,321.00" "$1,321.00" $275.33 "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" $275.31 "$1,321.00" $528.40 $781.37 "$1,321.00" "$1,321.00" "$1,321.00" "$1,321.00" $990.75 "$1,321.00" "$1,321.00" "$1,321.00" $660.50 $660.50 "$1,046.23" "$1,321.00" "$1,056.80" $594.45 $262.19 N/A $766.18 "$1,321.00" $792.60 "$1,321.00" $275.30 "$1,321.00" N/A N/A 40-15021 SUP HCPCS C1713 40-15021 - PLATE BN SM H NS VARIAX PA LCK LOPRFL TI FT BOTH IP/OP $918.00 $679.00 $182.20 $918.00 $413.10 $413.10 $413.10 $413.10 $918.00 $918.00 $918.00 $191.33 $918.00 $918.00 $918.00 $918.00 $918.00 $191.32 $918.00 $367.20 $543.00 $918.00 $918.00 $918.00 $918.00 $688.50 $918.00 $918.00 $918.00 $459.00 $459.00 $727.06 $918.00 $734.40 $413.10 $182.20 N/A $532.44 $918.00 $550.80 $918.00 $191.31 $918.00 N/A N/A 40-15022 SUP HCPCS C1713 40-15022 - PLATE BN MED H NS VARIAX PA LCK LOPRFL TI FT BOTH IP/OP "$1,297.00" $960.00 $257.42 "$1,297.00" $583.65 $583.65 $583.65 $583.65 "$1,297.00" "$1,297.00" "$1,297.00" $270.33 "$1,297.00" "$1,297.00" "$1,297.00" "$1,297.00" "$1,297.00" $270.31 "$1,297.00" $518.80 $767.18 "$1,297.00" "$1,297.00" "$1,297.00" "$1,297.00" $972.75 "$1,297.00" "$1,297.00" "$1,297.00" $648.50 $648.50 "$1,027.22" "$1,297.00" "$1,037.60" $583.65 $257.42 N/A $752.26 "$1,297.00" $778.20 "$1,297.00" $270.29 "$1,297.00" N/A N/A 40-15023 SUP HCPCS C1713 40-15023 - PLATE BN LG H NS VARIAX PA LCK LOPRFL TI FT BOTH IP/OP "$1,097.00" $812.00 $217.73 "$1,097.00" $493.65 $493.65 $493.65 $493.65 "$1,097.00" "$1,097.00" "$1,097.00" $228.64 "$1,097.00" "$1,097.00" "$1,097.00" "$1,097.00" "$1,097.00" $228.63 "$1,097.00" $438.80 $648.88 "$1,097.00" "$1,097.00" "$1,097.00" "$1,097.00" $822.75 "$1,097.00" "$1,097.00" "$1,097.00" $548.50 $548.50 $868.82 "$1,097.00" $877.60 $493.65 $217.73 N/A $636.26 "$1,097.00" $658.20 "$1,097.00" $228.61 "$1,097.00" N/A N/A 40-15031 SUP HCPCS C1713 40-15031 - PLATE BONE RECTANGULAR COMPRESSION VARIAX TITANIUM FT BOTH IP/OP "$1,082.00" $801.00 $214.75 "$1,082.00" $486.90 $486.90 $486.90 $486.90 "$1,082.00" "$1,082.00" "$1,082.00" $225.52 "$1,082.00" "$1,082.00" "$1,082.00" "$1,082.00" "$1,082.00" $225.50 "$1,082.00" $432.80 $640.00 "$1,082.00" "$1,082.00" "$1,082.00" "$1,082.00" $811.50 "$1,082.00" "$1,082.00" "$1,082.00" $541.00 $541.00 $856.94 "$1,082.00" $865.60 $486.90 $214.75 N/A $627.56 "$1,082.00" $649.20 "$1,082.00" $225.49 "$1,082.00" N/A N/A 40-15032 SUP HCPCS C1713 40-15032 - PLATE BN 2 RECT NS VARIAX PA LCK LOPRFL TI FT BOTH IP/OP "$1,097.00" $812.00 $217.73 "$1,097.00" $493.65 $493.65 $493.65 $493.65 "$1,097.00" "$1,097.00" "$1,097.00" $228.64 "$1,097.00" "$1,097.00" "$1,097.00" "$1,097.00" "$1,097.00" $228.63 "$1,097.00" $438.80 $648.88 "$1,097.00" "$1,097.00" "$1,097.00" "$1,097.00" $822.75 "$1,097.00" "$1,097.00" "$1,097.00" $548.50 $548.50 $868.82 "$1,097.00" $877.60 $493.65 $217.73 N/A $636.26 "$1,097.00" $658.20 "$1,097.00" $228.61 "$1,097.00" N/A N/A 40-15033 SUP HCPCS C1713 40-15033 - PLATE BN 2 RECT NS VARIAX PA LCK CMPR LOPRFL TI FT BOTH IP/OP "$1,190.00" $881.00 $236.19 "$1,190.00" $535.50 $535.50 $535.50 $535.50 "$1,190.00" "$1,190.00" "$1,190.00" $248.03 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $248.01 "$1,190.00" $476.00 $703.89 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $892.50 "$1,190.00" "$1,190.00" "$1,190.00" $595.00 $595.00 $942.48 "$1,190.00" $952.00 $535.50 $236.19 N/A $690.20 "$1,190.00" $714.00 "$1,190.00" $248.00 "$1,190.00" N/A N/A 40-15041 SUP HCPCS C1713 40-15041 - PLATE BN SHRT BRD STRG NS VARIAX PA LCK LOPRFL TI FT BOTH IP/OP "$1,092.00" $808.00 $216.73 "$1,092.00" $491.40 $491.40 $491.40 $491.40 "$1,092.00" "$1,092.00" "$1,092.00" $227.60 "$1,092.00" "$1,092.00" "$1,092.00" "$1,092.00" "$1,092.00" $227.58 "$1,092.00" "$1,092.00" $645.92 "$1,092.00" "$1,092.00" "$1,092.00" "$1,092.00" $819.00 "$1,092.00" "$1,092.00" "$1,092.00" $546.00 $546.00 $864.86 "$1,092.00" $873.60 $491.40 $216.73 N/A $633.36 "$1,092.00" $655.20 "$1,092.00" $227.57 "$1,092.00" N/A N/A 40-15042 SUP HCPCS C1713 40-15042 - PLATE BN MED BRD STRG NS VARIAX PA LCK LOPRFL TI FT BOTH IP/OP "$1,140.00" $844.00 $226.26 "$1,140.00" $513.00 $513.00 $513.00 $513.00 "$1,140.00" "$1,140.00" "$1,140.00" $237.60 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $237.59 "$1,140.00" $456.00 $674.31 "$1,140.00" "$1,140.00" "$1,140.00" "$1,140.00" $855.00 "$1,140.00" "$1,140.00" "$1,140.00" $570.00 $570.00 $902.88 "$1,140.00" $912.00 $513.00 $226.26 N/A $661.20 "$1,140.00" $684.00 "$1,140.00" $237.58 "$1,140.00" N/A N/A 40-15043 SUP HCPCS C1713 40-15043 - PLATE BN LNG BRD STRG NS VARIAX PA LCK LOPRFL TI FT BOTH IP/OP "$1,254.00" $928.00 $248.89 "$1,254.00" $564.30 $564.30 $564.30 $564.30 "$1,254.00" "$1,254.00" "$1,254.00" $261.36 "$1,254.00" "$1,254.00" "$1,254.00" "$1,254.00" "$1,254.00" $261.35 "$1,254.00" $501.60 $741.74 "$1,254.00" "$1,254.00" "$1,254.00" "$1,254.00" $940.50 "$1,254.00" "$1,254.00" "$1,254.00" $627.00 $627.00 $993.17 "$1,254.00" "$1,003.20" $564.30 $248.89 N/A $727.32 "$1,254.00" $752.40 "$1,254.00" $261.33 "$1,254.00" N/A N/A 40-15061 SUP HCPCS C1713 40-15061 - PLATE BN 3D NS VARIAX PA LCK LOPRFL TI FT LT BOTH IP/OP "$1,384.00" "$1,024.00" $274.69 "$1,384.00" $622.80 $622.80 $622.80 $622.80 "$1,384.00" "$1,384.00" "$1,384.00" $288.46 "$1,384.00" "$1,384.00" "$1,384.00" "$1,384.00" "$1,384.00" $288.44 "$1,384.00" $553.60 $818.64 "$1,384.00" "$1,384.00" "$1,384.00" "$1,384.00" "$1,038.00" "$1,384.00" "$1,384.00" "$1,384.00" $692.00 $692.00 "$1,096.13" "$1,384.00" "$1,107.20" $622.80 $274.69 N/A $802.72 "$1,384.00" $830.40 "$1,384.00" $288.43 "$1,384.00" N/A N/A 40-15062 SUP HCPCS C1713 40-15062 - PLATE BN 3D NS VARIAX PA LCK LOPRFL TI FT RT BOTH IP/OP "$1,384.00" "$1,024.00" $274.69 "$1,384.00" $622.80 $622.80 $622.80 $622.80 "$1,384.00" "$1,384.00" "$1,384.00" $288.46 "$1,384.00" "$1,384.00" "$1,384.00" "$1,384.00" "$1,384.00" $288.44 "$1,384.00" $553.60 $818.64 "$1,384.00" "$1,384.00" "$1,384.00" "$1,384.00" "$1,038.00" "$1,384.00" "$1,384.00" "$1,384.00" $692.00 $692.00 "$1,096.13" "$1,384.00" "$1,107.20" $622.80 $274.69 N/A $802.72 "$1,384.00" "$1,384.00" "$1,384.00" $288.43 "$1,384.00" N/A N/A 40-15071 SUP HCPCS C1713 40-15071 - PLATE BN T OBLQ NS VARIAX PA LCK LOPRFL TI FT LT BOTH IP/OP "$1,101.00" $815.00 $218.52 "$1,101.00" $495.45 $495.45 $495.45 $495.45 "$1,101.00" "$1,101.00" "$1,101.00" $229.48 "$1,101.00" "$1,101.00" "$1,101.00" "$1,101.00" "$1,101.00" $229.46 "$1,101.00" $440.40 $651.24 "$1,101.00" "$1,101.00" "$1,101.00" "$1,101.00" $825.75 "$1,101.00" "$1,101.00" "$1,101.00" $550.50 $550.50 $871.99 "$1,101.00" $880.80 $495.45 $218.52 N/A $638.58 "$1,101.00" $660.60 "$1,101.00" $229.45 "$1,101.00" N/A N/A 40-15072 SUP HCPCS C1713 40-15072 - PLATE BN T OBLQ NS VARIAX PA LCK LOPRFL TI FT RT BOTH IP/OP "$1,101.00" $815.00 $218.52 "$1,101.00" $495.45 $495.45 $495.45 $495.45 "$1,101.00" "$1,101.00" "$1,101.00" $229.48 "$1,101.00" "$1,101.00" "$1,101.00" "$1,101.00" "$1,101.00" $229.46 "$1,101.00" $440.40 $651.24 "$1,101.00" "$1,101.00" "$1,101.00" "$1,101.00" $825.75 "$1,101.00" "$1,101.00" "$1,101.00" $550.50 $550.50 $871.99 "$1,101.00" $880.80 $495.45 $218.52 N/A $638.58 "$1,101.00" $660.60 "$1,101.00" $229.45 "$1,101.00" N/A N/A 40-15081 SUP HCPCS C1713 40-15081 - PLATE BN T NS VARIAX PA LCK LOPRFL TI FT BOTH IP/OP $778.00 $576.00 $154.41 $778.00 $350.10 $350.10 $350.10 $350.10 $778.00 $778.00 $778.00 $162.15 $778.00 $778.00 $778.00 $778.00 $778.00 $162.14 $778.00 $311.20 $460.19 $778.00 $778.00 $778.00 $778.00 $583.50 $778.00 $778.00 $778.00 $389.00 $389.00 $616.18 $778.00 $622.40 $350.10 $154.41 N/A $451.24 $778.00 $466.80 $778.00 $162.14 $778.00 N/A N/A 40-15091 SUP HCPCS C1713 40-15091 - PLATE BN L NS VARIAX PA LCK LOPRFL TI FT LT BOTH IP/OP $778.00 $576.00 $154.41 $778.00 $350.10 $350.10 $350.10 $350.10 $778.00 $778.00 $778.00 $162.15 $778.00 $778.00 $778.00 $778.00 $778.00 $162.14 $778.00 $311.20 $460.19 $778.00 $778.00 $778.00 $778.00 $583.50 $778.00 $778.00 $778.00 $389.00 $389.00 $616.18 $778.00 $622.40 $350.10 $154.41 N/A $451.24 $778.00 $466.80 $778.00 $162.14 $778.00 N/A N/A 40-15092 SUP HCPCS C1713 40-15092 - PLATE BN L NS VARIAX PA LCK LOPRFL TI FT RT BOTH IP/OP $778.00 $576.00 $154.41 $778.00 $350.10 $350.10 $350.10 $350.10 $778.00 $778.00 $778.00 $162.15 $778.00 $778.00 $778.00 $778.00 $778.00 $162.14 $778.00 $311.20 $460.19 $778.00 $778.00 $778.00 $778.00 $583.50 $778.00 $778.00 $778.00 $389.00 $389.00 $616.18 $778.00 $622.40 $350.10 $154.41 N/A $451.24 $778.00 $466.80 $778.00 $162.14 $778.00 N/A N/A 402.110E SUP HCPCS C1713 402.110E - SCREW BONE 2.7MM 10MM HEXAGONAL SOCKET THORP TITANIUM BOTH IP/OP $130.50 $97.00 $25.90 $130.50 $58.73 $58.73 $58.73 $58.73 $130.50 $130.50 $130.50 $27.20 $130.50 $130.50 $130.50 $130.50 $130.50 $27.20 $130.50 $52.20 $77.19 $130.50 $130.50 $130.50 $130.50 $97.88 $130.50 $130.50 $130.50 $65.25 $65.25 $103.36 $130.50 $104.40 $58.73 $25.90 N/A $75.69 $130.50 $130.50 $130.50 $27.20 $130.50 N/A N/A 402.112E SUP HCPCS C1713 402.112E - SCREW BONE 2.7MM 12MM HEXAGONAL SOCKET THORP TITANIUM BOTH IP/OP $130.50 $97.00 $25.90 $130.50 $58.73 $58.73 $58.73 $58.73 $130.50 $130.50 $130.50 $27.20 $130.50 $130.50 $130.50 $130.50 $130.50 $27.20 $130.50 $130.50 $77.19 $130.50 $130.50 $130.50 $130.50 $97.88 $130.50 $130.50 $130.50 $65.25 $65.25 $103.36 $130.50 $104.40 $58.73 $25.90 N/A $75.69 $130.50 $130.50 $130.50 $27.20 $130.50 N/A N/A 402.114E SUP HCPCS C1713 402.114E - SCREW BONE 2.7MM 14MM HEXAGONAL SOCKET THORP TITANIUM BOTH IP/OP $130.50 $97.00 $25.90 $130.50 $58.73 $58.73 $58.73 $58.73 $130.50 $130.50 $130.50 $27.20 $130.50 $130.50 $130.50 $130.50 $130.50 $27.20 $130.50 $52.20 $77.19 $130.50 $130.50 $130.50 $130.50 $97.88 $130.50 $130.50 $130.50 $65.25 $65.25 $103.36 $130.50 $104.40 $58.73 $25.90 N/A $75.69 $130.50 $130.50 $130.50 $27.20 $130.50 N/A N/A 402.116E SUP HCPCS C1713 402.116E - SCREW BONE 2.7MM 16MM HEXAGONAL SOCKET THORP TITANIUM BOTH IP/OP $130.50 $97.00 $25.90 $130.50 $58.73 $58.73 $58.73 $58.73 $130.50 $130.50 $130.50 $27.20 $130.50 $130.50 $130.50 $130.50 $130.50 $27.20 $130.50 $130.50 $77.19 $130.50 $130.50 $130.50 $130.50 $97.88 $130.50 $130.50 $130.50 $65.25 $65.25 $103.36 $130.50 $104.40 $58.73 $25.90 N/A $75.69 $130.50 $130.50 $130.50 $27.20 $130.50 N/A N/A 402.118E SUP HCPCS C1713 402.118E - SCREW BONE 2.7MM 18MM HEXAGONAL SOCKET THORP TITANIUM BOTH IP/OP $130.50 $97.00 $25.90 $130.50 $58.73 $58.73 $58.73 $58.73 $130.50 $130.50 $130.50 $27.20 $130.50 $130.50 $130.50 $130.50 $130.50 $27.20 $130.50 $52.20 $77.19 $130.50 $130.50 $130.50 $130.50 $97.88 $130.50 $130.50 $130.50 $65.25 $65.25 $103.36 $130.50 $104.40 $58.73 $25.90 N/A $75.69 $130.50 $130.50 $130.50 $27.20 $130.50 N/A N/A 4020-005R SUP HCPCS C1713 4020-005R - COMPONENT TIBIAL TRAY 5 KNEE RIGHT BOTH IP/OP "$1,213.00" $898.00 $240.75 "$1,213.00" $545.85 $545.85 $545.85 $545.85 "$1,213.00" "$1,213.00" "$1,213.00" $252.82 "$1,213.00" "$1,213.00" "$1,213.00" "$1,213.00" "$1,213.00" $252.80 "$1,213.00" $485.20 $717.49 "$1,213.00" "$1,213.00" "$1,213.00" "$1,213.00" $909.75 "$1,213.00" "$1,213.00" "$1,213.00" $606.50 $606.50 $960.70 "$1,213.00" $970.40 $545.85 $240.75 N/A $703.54 "$1,213.00" "$1,213.00" "$1,213.00" $252.79 "$1,213.00" N/A N/A 40-20108 SUP HCPCS C1713 40-20108 - SCREW BONE MICRO 2MM 8MM 4MM CANN THREADED ASNIS TITANIUM FT BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $297.00 $297.00 N/A N/A 40-20109 SUP HCPCS C1713 40-20109 - SCREW BONE MICRO 2MM 9MM 4MM CANN THREADED ASNIS TITANIUM FT BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $61.89 $297.00 N/A N/A 40-20110 SUP HCPCS C1713 40-20110 - SCREW BONE MICRO 2MM 10MM 4MM CANN EQUAL SHAFT LP REVERSE BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $61.89 $297.00 N/A N/A 40-20111 SUP HCPCS C1713 40-20111 - SCREW BONE MICRO 2MM 11MM 5MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $61.89 $297.00 N/A N/A 40-20112 SUP HCPCS C1713 40-20112 - SCREW BONE MICRO 2MM 10MM 5MM CANN EQUAL SHAFT LP REVERSE BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $61.89 $297.00 N/A N/A 40-20113 SUP HCPCS C1713 40-20113 - SCREW BONE MICRO REVERSE CUT FLUTE LP 2MM 13MM 6MM SELF CUT BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $61.89 $297.00 N/A N/A 40-20114 SUP HCPCS C1713 40-20114 - SCREW BONE MICRO REVERSE CUT FLUTE LP 2MM 14MM 6MM SELF CUT BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $297.00 $297.00 $61.89 $297.00 N/A N/A 40-20115 SUP HCPCS C1713 40-20115 - SCREW BONE MICRO REVERSE CUT FLUTE LP 2MM 15MM 6MM SELF CUT BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $61.89 $297.00 N/A N/A 40-20116 SUP HCPCS C1713 40-20116 - SCREW BONE MICRO 2MM 16MM 7MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $61.89 $297.00 N/A N/A 40-20117 SUP HCPCS C1713 40-20117 - SCREW BONE MICRO 2MM 17MM 5MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $61.89 $297.00 N/A N/A 40-20118 SUP HCPCS C1713 40-20118 - SCREW BONE MICRO REVERSE CUT FLUTE LP 2MM 18MM 5MM SELF CUT BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $297.00 $297.00 N/A N/A 40-20119 SUP HCPCS C1713 40-20119 - SCREW BONE MICRO 2MM 19MM 5MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $297.00 $297.00 N/A N/A 40-20120 SUP HCPCS C1713 40-20120 - SCREW BN MIC RVRS CUT FLUT 2MM 20MM NS 5MM ASNS SLF CUT CNN BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $297.00 $297.00 N/A N/A 40-20122 SUP HCPCS C1713 40-20122 - SCREW BONE MICRO REVERSE CUT FLUTE LP 2MM 22MM 5MM SELF CUT BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $297.00 $297.00 $61.89 $297.00 N/A N/A 40-20124 SUP HCPCS C1713 40-20124 - SCREW BONE MICRO REVERSE CUT FLUTE LP 2MM 24MM 6MM SELF CUT BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $297.00 $297.00 $297.00 $297.00 N/A N/A 40-20126 SUP HCPCS C1713 40-20126 - SCREW BONE MICRO REVERSE CUT FLUTE LP 2MM 26MM 6MM SELF CUT BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $297.00 $297.00 N/A N/A 40-20128 SUP HCPCS C1713 40-20128 - SCREW BONE MICRO 2MM 28MM 6MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $61.89 $297.00 N/A N/A 40-20130 SUP HCPCS C1713 40-20130 - SCREW BONE MICRO 2MM 32MM 6MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $61.89 $297.00 N/A N/A 40-20217 SUP HCPCS C1713 40-20217 - SCREW BONE MICRO 2MM 17MM 8MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $61.89 $297.00 N/A N/A 40-20218 SUP HCPCS C1713 40-20218 - SCREW BONE MICRO 2MM 18MM 8MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $297.00 $297.00 $297.00 $297.00 N/A N/A 40-20219 SUP HCPCS C1713 40-20219 - SCREW BONE MICRO 2MM 19MM 9MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $297.00 $297.00 N/A N/A 40-20220 SUP HCPCS C1713 40-20220 - SCREW BONE MICRO 2MM 20MM 9MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $297.00 $297.00 $61.89 $297.00 N/A N/A 40-20222 SUP HCPCS C1713 40-20222 - SCREW BONE MICRO REVERSE CUT FLUTE LP 2MM 22MM 10MM SELF CUT BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $61.89 $297.00 N/A N/A 40-20224 SUP HCPCS C1713 40-20224 - SCREW BONE MICRO 2MM 24MM 9MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $61.89 $297.00 N/A N/A 40-20226 SUP HCPCS C1713 40-20226 - SCREW BONE MICRO 2MM 26MM 12MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $297.00 $297.00 $61.89 $297.00 N/A N/A 40-20228 SUP HCPCS C1713 40-20228 - SCREW BONE MICRO 2MM 28MM 12MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $118.80 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $297.00 $297.00 N/A N/A 40-20230 SUP HCPCS C1713 40-20230 - SCREW BONE MICRO 2MM 30MM 14MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $297.00 $220.00 $58.95 $297.00 $133.65 $133.65 $133.65 $133.65 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $297.00 $297.00 $297.00 $61.90 $297.00 $297.00 $175.68 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $133.65 $58.95 N/A $172.26 $297.00 $178.20 $297.00 $297.00 $297.00 N/A N/A 40-20805 SUP HCPCS C1713 40-20805 - PLATE BN STRG 72MMX2MM NS VARIAX 5 HL LCK LOPRFL TI FIB BOTH IP/OP $780.00 $577.00 $154.81 $780.00 $351.00 $351.00 $351.00 $351.00 $780.00 $780.00 $780.00 $162.57 $780.00 $780.00 $780.00 $780.00 $780.00 $162.56 $780.00 $780.00 $461.37 $780.00 $780.00 $780.00 $780.00 $585.00 $780.00 $780.00 $780.00 $390.00 $390.00 $617.76 $780.00 $624.00 $351.00 $154.81 N/A $452.40 $780.00 $780.00 $780.00 $162.55 $780.00 N/A N/A 40-20900 SUP HCPCS C1713 40-20900 - WASHER ORTHOPEDIC MICRO 2MM ASNIS NONSTRL BOTH IP/OP $99.00 $73.00 $19.57 $98.60 $44.37 $44.37 $44.37 $44.37 $98.60 $98.60 $98.60 $20.55 $98.60 $98.60 $98.60 $98.60 $98.60 $20.55 $98.60 $39.44 $58.32 $98.60 $98.60 $98.60 $98.60 $74.25 $98.60 $98.60 $98.60 $49.30 $49.30 $78.09 $98.60 $78.88 $44.37 $19.57 N/A $57.42 $98.60 $98.60 $98.60 $20.55 $98.60 N/A N/A 40-20903 SUP HCPCS C1713 40-20903 - PLATE BN 77X10X2MM NS 16X1.3MM VARIAX 3 HL LCK LOPRFL TI FIB BOTH IP/OP "$1,143.00" $846.00 $226.86 "$1,143.00" $514.35 $514.35 $514.35 $514.35 "$1,143.00" "$1,143.00" "$1,143.00" $238.23 "$1,143.00" "$1,143.00" "$1,143.00" "$1,143.00" "$1,143.00" $238.21 "$1,143.00" "$1,143.00" $676.08 "$1,143.00" "$1,143.00" "$1,143.00" "$1,143.00" $857.25 "$1,143.00" "$1,143.00" "$1,143.00" $571.50 $571.50 $905.26 "$1,143.00" $914.40 $514.35 $226.86 N/A $662.94 "$1,143.00" "$1,143.00" "$1,143.00" $238.20 "$1,143.00" N/A N/A 40-20904 SUP HCPCS C1713 40-20904 - PLATE BN 89X10X2MM NS 16X1.3MM VARIAX 4 HL LCK LOPRFL TI FIB BOTH IP/OP "$1,143.00" $846.00 $226.86 "$1,143.00" $514.35 $514.35 $514.35 $514.35 "$1,143.00" "$1,143.00" "$1,143.00" $238.23 "$1,143.00" "$1,143.00" "$1,143.00" "$1,143.00" "$1,143.00" $238.21 "$1,143.00" "$1,143.00" $676.08 "$1,143.00" "$1,143.00" "$1,143.00" "$1,143.00" $857.25 "$1,143.00" "$1,143.00" "$1,143.00" $571.50 $571.50 $905.26 "$1,143.00" $914.40 $514.35 $226.86 N/A $662.94 "$1,143.00" "$1,143.00" "$1,143.00" $238.20 "$1,143.00" N/A N/A 40-20905 SUP HCPCS C1713 40-20905 - PLATE BN 101X10X2MM NS 16X1.3MM VARIAX 5 HL LCK LOPRFL TI BOTH IP/OP "$1,143.00" $846.00 $226.86 "$1,143.00" $514.35 $514.35 $514.35 $514.35 "$1,143.00" "$1,143.00" "$1,143.00" $238.23 "$1,143.00" "$1,143.00" "$1,143.00" "$1,143.00" "$1,143.00" $238.21 "$1,143.00" $457.20 $676.08 "$1,143.00" "$1,143.00" "$1,143.00" "$1,143.00" $857.25 "$1,143.00" "$1,143.00" "$1,143.00" $571.50 $571.50 $905.26 "$1,143.00" $914.40 $514.35 $226.86 N/A $662.94 "$1,143.00" $685.80 "$1,143.00" $238.20 "$1,143.00" N/A N/A 40-20906 SUP HCPCS C1713 40-20906 - PLATE BN 113X10X2MM NS 16X1.3MM VARIAX 6 HL LCK LOPRFL TI BOTH IP/OP "$1,187.00" $878.00 $235.59 "$1,187.00" $534.15 $534.15 $534.15 $534.15 "$1,187.00" "$1,187.00" "$1,187.00" $247.40 "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" $247.38 "$1,187.00" $474.80 $702.11 "$1,187.00" "$1,187.00" "$1,187.00" "$1,187.00" $890.25 "$1,187.00" "$1,187.00" "$1,187.00" $593.50 $593.50 $940.10 "$1,187.00" $949.60 $534.15 $235.59 N/A $688.46 "$1,187.00" $712.20 "$1,187.00" $247.37 "$1,187.00" N/A N/A 40-20907 SUP HCPCS C1713 40-20907 - PLATE BN 125X10X2MM NS 16X1.3MM VARIAX 7 HL LCK LOPRFL TI BOTH IP/OP "$1,288.00" $953.00 $255.64 "$1,288.00" $579.60 $579.60 $579.60 $579.60 "$1,288.00" "$1,288.00" "$1,288.00" $268.45 "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" $268.43 "$1,288.00" $515.20 $761.85 "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" $966.00 "$1,288.00" "$1,288.00" "$1,288.00" $644.00 $644.00 "$1,020.10" "$1,288.00" "$1,030.40" $579.60 $255.64 N/A $747.04 "$1,288.00" $772.80 "$1,288.00" $268.42 "$1,288.00" N/A N/A 40-20908 SUP HCPCS C1713 40-20908 - PLATE BN 137X10X2MM NS 16X1.3MM VARIAX 8 HL LCK LOPRFL TI BOTH IP/OP "$1,288.00" $953.00 $255.64 "$1,288.00" $579.60 $579.60 $579.60 $579.60 "$1,288.00" "$1,288.00" "$1,288.00" $268.45 "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" $268.43 "$1,288.00" "$1,288.00" $761.85 "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" $966.00 "$1,288.00" "$1,288.00" "$1,288.00" $644.00 $644.00 "$1,020.10" "$1,288.00" "$1,030.40" $579.60 $255.64 N/A $747.04 "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" N/A N/A 40-20909 SUP HCPCS C1713 40-20909 - PLATE BN 149X10X2MM NS 16X1.3MM VARIAX 9 HL LCK LOPRFL TI BOTH IP/OP "$1,288.00" $953.00 $255.64 "$1,288.00" $579.60 $579.60 $579.60 $579.60 "$1,288.00" "$1,288.00" "$1,288.00" $268.45 "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" $268.43 "$1,288.00" $515.20 $761.85 "$1,288.00" "$1,288.00" "$1,288.00" "$1,288.00" $966.00 "$1,288.00" "$1,288.00" "$1,288.00" $644.00 $644.00 "$1,020.10" "$1,288.00" "$1,030.40" $579.60 $255.64 N/A $747.04 "$1,288.00" $772.80 "$1,288.00" "$1,288.00" "$1,288.00" N/A N/A 40-20910S SUP HCPCS C1713 40-20910S - PLATE BONE 161MM 10 HOLE VARIAX LATERAL FIBULAR STERILE BOTH IP/OP "$1,457.00" "$1,078.00" $289.18 "$1,457.00" $655.65 $655.65 $655.65 $655.65 "$1,457.00" "$1,457.00" "$1,457.00" $303.68 "$1,457.00" "$1,457.00" "$1,457.00" "$1,457.00" "$1,457.00" $303.65 "$1,457.00" "$1,457.00" $861.82 "$1,457.00" "$1,457.00" "$1,457.00" "$1,457.00" "$1,092.75" "$1,457.00" "$1,457.00" "$1,457.00" $728.50 $728.50 "$1,153.94" "$1,457.00" "$1,165.60" $655.65 $289.18 N/A $845.06 "$1,457.00" $874.20 "$1,457.00" $303.64 "$1,457.00" N/A N/A 40-20912S SUP HCPCS C1713 40-20912S - PLATE BONE 185MM 12 HOLE VARIAX LATERAL FIBULAR STERILE BOTH IP/OP "$1,457.00" "$1,078.00" $289.18 "$1,457.00" $655.65 $655.65 $655.65 $655.65 "$1,457.00" "$1,457.00" "$1,457.00" $303.68 "$1,457.00" "$1,457.00" "$1,457.00" "$1,457.00" "$1,457.00" $303.65 "$1,457.00" $582.80 $861.82 "$1,457.00" "$1,457.00" "$1,457.00" "$1,457.00" "$1,092.75" "$1,457.00" "$1,457.00" "$1,457.00" $728.50 $728.50 "$1,153.94" "$1,457.00" "$1,165.60" $655.65 $289.18 N/A $845.06 "$1,457.00" $874.20 "$1,457.00" "$1,457.00" "$1,457.00" N/A N/A 40-27008 SUP HCPCS C1713 40-27008 - SCREW BN T7 2.7MM 8MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $40.32 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $21.01 $100.80 N/A N/A 40-27010 SUP HCPCS C1713 40-27010 - SCREW BN T7 2.7MM 10MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $40.32 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $21.01 $100.80 N/A N/A 40-27012 SUP HCPCS C1713 40-27012 - SCREW BN T7 2.7MM 12MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $40.32 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $100.80 $100.80 N/A N/A 40-27014 SUP HCPCS C1713 40-27014 - SCREW BN T7 2.7MM 14MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $100.80 $100.80 N/A N/A 40-27016 SUP HCPCS C1713 40-27016 - SCREW BN T7 2.7MM 16MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $100.80 $100.80 $21.01 $100.80 N/A N/A 40-27018 SUP HCPCS C1713 40-27018 - SCREW BN T7 2.7MM 18MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $21.01 $100.80 N/A N/A 40-27020 SUP HCPCS C1713 40-27020 - SCREW BN T7 2.7MM 20MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $100.80 $100.80 N/A N/A 40-27022 SUP HCPCS C1713 40-27022 - SCREW BN T7 2.7MM 22MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $40.32 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $100.80 $100.80 N/A N/A 40-27024 SUP HCPCS C1713 40-27024 - SCREW BN T7 2.7MM 24MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $40.32 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $21.01 $100.80 N/A N/A 40-27026 SUP HCPCS C1713 40-27026 - SCREW BN T7 2.7MM 26MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $40.32 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $100.80 $100.80 N/A N/A 40-27028 SUP HCPCS C1713 40-27028 - SCREW BN T7 2.7MM 28MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $100.80 $100.80 N/A N/A 40-27030 SUP HCPCS C1713 40-27030 - SCREW BN T7 2.7MM 30MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $21.01 $100.80 N/A N/A 40-27032 SUP HCPCS C1713 40-27032 - SCREW BN T7 2.7MM 32MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $40.32 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $21.01 $100.80 N/A N/A 40-27034 SUP HCPCS C1713 40-27034 - SCREW BN T7 2.7MM 34MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $40.32 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $21.01 $100.80 N/A N/A 40-27036 SUP HCPCS C1713 40-27036 - SCREW BN T7 2.7MM 36MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $40.32 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $21.01 $100.80 N/A N/A 40-27038 SUP HCPCS C1713 40-27038 - SCREW BN T7 2.7MM 38MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $40.32 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $100.80 $100.80 $21.01 $100.80 N/A N/A 40-27040 SUP HCPCS C1713 40-27040 - SCREW BN T7 2.7MM 40MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $21.01 $100.80 N/A N/A 40-27045 SUP HCPCS C1713 40-27045 - SCREW BN T7 2.7MM 45MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $21.01 $100.80 N/A N/A 40-27050 SUP HCPCS C1713 40-27050 - SCREW BN T7 2.7MM 50MM YLW NS VARIAX ST TI FT LCK PLT SYS BOTH IP/OP $101.00 $75.00 $20.01 $100.80 $45.36 $45.36 $45.36 $45.36 $100.80 $100.80 $100.80 $21.01 $100.80 $100.80 $100.80 $100.80 $100.80 $21.01 $100.80 $40.32 $59.62 $100.80 $100.80 $100.80 $100.80 $75.75 $100.80 $100.80 $100.80 $50.40 $50.40 $79.83 $100.80 $80.64 $45.36 $20.01 N/A $58.58 $100.80 $60.48 $100.80 $21.01 $100.80 N/A N/A 40-27608 SUP HCPCS C1713 40-27608 - SCREW BN T7 2.7MM 8MM BLU NS VARIAX LCK ST TI FT LCK PLT SYS BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $221.20 $221.20 N/A N/A 40-27610 SUP HCPCS C1713 40-27610 - SCREW BONE 2.7MM 10MM T7 DRIVE LOCKING VARIAX FT NONSTRL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $221.20 $221.20 N/A N/A 40-27612 SUP HCPCS C1713 40-27612 - SCREW BN T7 2.7MM 12MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-27614 SUP HCPCS C1713 40-27614 - SCREW BN T7 2.7MM 14MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-27616 SUP HCPCS C1713 40-27616 - SCREW BN T7 2.7MM 16MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-27618 SUP HCPCS C1713 40-27618 - SCREW BN T7 2.7MM 18MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $221.20 $221.20 N/A N/A 40-27620 SUP HCPCS C1713 40-27620 - SCREW BN T7 2.7MM 20MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $221.20 $221.20 N/A N/A 40-27622 SUP HCPCS C1713 40-27622 - SCREW BN T7 2.7MM 22MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $46.10 $221.20 N/A N/A 40-27624 SUP HCPCS C1713 40-27624 - SCREW BN T7 2.7MM 24MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-27626 SUP HCPCS C1713 40-27626 - SCREW BN T7 2.7MM 26MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $221.20 $221.20 N/A N/A 40-27628 SUP HCPCS C1713 40-27628 - SCREW BN T7 2.7MM 28MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $221.20 $221.20 N/A N/A 40-27630 SUP HCPCS C1713 40-27630 - SCREW BN T7 2.7MM 30MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $221.20 $221.20 N/A N/A 40-27632 SUP HCPCS C1713 40-27632 - SCREW BN T7 2.7MM 32MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-27634 SUP HCPCS C1713 40-27634 - SCREW BN T7 2.7MM 34MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $221.20 $221.20 N/A N/A 40-27636 SUP HCPCS C1713 40-27636 - SCREW BN T7 2.7MM 36MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $221.20 $221.20 N/A N/A 40-27638 SUP HCPCS C1713 40-27638 - SCREW BN T7 2.7MM 38MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $46.10 $221.20 N/A N/A 40-27640 SUP HCPCS C1713 40-27640 - SCREW BN T7 2.7MM 40MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $46.10 $221.20 N/A N/A 40-27645 SUP HCPCS C1713 40-27645 - SCREW BN T7 2.7MM 45MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-27650 SUP HCPCS C1713 40-27650 - SCREW BN T7 2.7MM 50MM BLU NS VARIAX LCK ST TI FT LCK PLT BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-27900 SUP HCPCS C1713 40-27900 - WASHER ORTHOPEDIC 2.7 MM SCREWS BOTH IP/OP $124.50 $92.00 $24.63 $124.10 $55.85 $55.85 $55.85 $55.85 $124.10 $124.10 $124.10 $25.87 $124.10 $124.10 $124.10 $124.10 $124.10 $25.86 $124.10 $49.64 $73.41 $124.10 $124.10 $124.10 $124.10 $93.38 $124.10 $124.10 $124.10 $62.05 $62.05 $98.29 $124.10 $99.28 $55.85 $24.63 N/A $72.21 $124.10 $124.10 $124.10 $25.86 $124.10 N/A N/A 403.318E SUP HCPCS C1713 403.318E - SCREW BONE 3.2MM 18MM EMERGENCY TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $200.50 $148.00 $39.74 $200.25 $90.11 $90.11 $90.11 $90.11 $200.25 $200.25 $200.25 $41.74 $200.25 $200.25 $200.25 $200.25 $200.25 $41.73 $200.25 $80.10 $118.45 $200.25 $200.25 $200.25 $200.25 $150.38 $200.25 $200.25 $200.25 $100.13 $100.13 $158.60 $200.25 $160.20 $90.11 $39.74 N/A $116.29 $200.25 $200.25 $200.25 $41.73 $200.25 N/A N/A 40-30108 SUP HCPCS C1713 40-30108 - SCREW BONE MICRO 3MM 8MM 4MM CANN THREADED ASNIS TITANIUM FT BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30109 SUP HCPCS C1713 40-30109 - SCREW BONE MICRO 3MM CANN ASNIS BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 40-30110 SUP HCPCS C1713 40-30110 - SCREW BONE MICRO 3MM 10MM 4MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 40-30111 SUP HCPCS C1713 40-30111 - SCREW BONE MICRO 3MM 11MM 4MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30112 SUP HCPCS C1713 40-30112 - SCREW BONE MICRO 3MM 12MM 4MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 40-30113 SUP HCPCS C1713 40-30113 - SCREW BONE MICRO 3MM 13MM 4MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30114 SUP HCPCS C1713 40-30114 - SCREW BONE MICRO 3MM 14MM 4MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30115 SUP HCPCS C1713 40-30115 - SCREW BONE MICRO 4MM 15MM 4MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 40-30116 SUP HCPCS C1713 40-30116 - SCREW BONE MICRO REVERSE CUT FLUTE LP 3MM 16MM 4MM SELF CUT BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $295.63 $295.63 $61.61 $295.63 N/A N/A 40-30117 SUP HCPCS C1713 40-30117 - SCREW BONE MICRO 3MM 17MM 4MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 40-30118 SUP HCPCS C1713 40-30118 - SCREW BONE MICRO REVERSE CUT FLUTE LP 3MM 18MM 5MM SELF CUT BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 40-30119 SUP HCPCS C1713 40-30119 - SCREW BONE MICRO 3MM 19MM 5MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30120 SUP HCPCS C1713 40-30120 - SCREW BONE MICRO REVERSE CUT FLUTE LP 3MM 20MM 5MM SELF CUT BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 40-30121 SUP HCPCS C1713 40-30121 - SCREW BONE MICRO 3MM 21MM 5MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 40-30122 SUP HCPCS C1713 40-30122 - SCREW BONE MICRO REVERSE CUT FLUTE LP 3MM 22MM 5MM SELF CUT BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30123 SUP HCPCS C1713 40-30123 - SCREW BONE MICRO 3MM 23MM 5MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 40-30124 SUP HCPCS C1713 40-30124 - SCREW BONE MICRO REVERSE CUT FLUTE LP 3MM 24MM 6MM SELF CUT BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 40-30125 SUP HCPCS C1713 40-30125 - SCREW BONE MICRO 3MM 25MM 6MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30126 SUP HCPCS C1713 40-30126 - SCREW BONE MICRO REVERSE CUT FLUTE LP 3MM 26MM 6MM SELF CUT BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30127 SUP HCPCS C1713 40-30127 - SCREW BONE MICRO 3MM 27MM 6MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30128 SUP HCPCS C1713 40-30128 - SCREW BONE MICRO REVERSE CUT FLUTE LP 3MM 28MM 6MM SELF CUT BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30129 SUP HCPCS C1713 40-30129 - SCREW BONE MICRO 3MM 29MM 6MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $295.63 $295.63 $61.61 $295.63 N/A N/A 40-30130 SUP HCPCS C1713 40-30130 - SCREW BONE MICRO REVERSE CUT FLUTE LP 3MM 30MM 6MM SELF CUT BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30132 SUP HCPCS C1713 40-30132 - SCREW BONE MICRO REVERSE CUT FLUTE LP 3MM 32MM 6MM SELF CUT BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30134 SUP HCPCS C1713 40-30134 - SCREW BONE MICRO REVERSE CUT FLUTE LP 3MM 34MM 7MM SELF CUT BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 40-30136 SUP HCPCS C1713 40-30136 - SCREW BONE MICRO REVERSE CUT FLUTE LP 3MM 36MM 7MM SELF CUT BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 40-30138 SUP HCPCS C1713 40-30138 - SCREW BONE MICRO REVERSE CUT FLUTE LP 3MM 38MM 8MM SELF CUT BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30140 SUP HCPCS C1713 40-30140 - SCREW BN MIC RVRS CUT FLUT 3MM 40MM NS 8MM ASNS SLF CUT CNN BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30214 SUP HCPCS C1713 40-30214 - SCREW BONE MICRO 3MM 14MM 6MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $295.63 $295.63 $61.61 $295.63 N/A N/A 40-30215 SUP HCPCS C1713 40-30215 - SCREW BONE MICRO 3MM 15MM 7MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 40-30216 SUP HCPCS C1713 40-30216 - SCREW BONE MICRO 3MM 16MM 7MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30217 SUP HCPCS C1713 40-30217 - SCREW BONE MICRO 3MM 17MM 8MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30218 SUP HCPCS C1713 40-30218 - SCREW BONE MICRO 3MM 18MM 8MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30219 SUP HCPCS C1713 40-30219 - SCREW BONE MICRO 3MM 21MM 5MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30220 SUP HCPCS C1713 40-30220 - SCREW BONE MICRO 3MM 20MM 9MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $295.63 $295.63 N/A N/A 40-30221 SUP HCPCS C1713 40-30221 - SCREW BONE MICRO 3MM 21MM 9MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $295.63 $295.63 $295.63 $295.63 N/A N/A 40-30222 SUP HCPCS C1713 40-30222 - SCREW BN MIC RVRS CUT FLUT 3MM 22MM NS 10MM ASNS SLF CUT CNN BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30223 SUP HCPCS C1713 40-30223 - SCREW BONE MICRO 3MM 23MM 10MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30224 SUP HCPCS C1713 40-30224 - SCREW BONE MICRO REVERSE CUT FLUTE LP 3MM 24MM 10MM SELF CUT BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30225 SUP HCPCS C1713 40-30225 - SCREW BONE MICRO 3MM 25MM 10MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30226 SUP HCPCS C1713 40-30226 - SCREW BONE MICRO 3MM 26MM 12MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30227 SUP HCPCS C1713 40-30227 - SCREW BONE MICRO 3MM 27MM 12MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30228 SUP HCPCS C1713 40-30228 - SCREW BONE MICRO 3MM 28MM 12MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $295.63 $295.63 $61.61 $295.63 N/A N/A 40-30229 SUP HCPCS C1713 40-30229 - SCREW BONE MICRO 3MM 29MM 12MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30230 SUP HCPCS C1713 40-30230 - SCREW BONE MICRO 3MM 30MM 14MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $295.63 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30232 SUP HCPCS C1713 40-30232 - SCREW BONE MICRO 32MM 14MM TITANIUM CANCELLOUS BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30234 SUP HCPCS C1713 40-30234 - SCREW BONE MICRO 3MM 34MM 16MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30236 SUP HCPCS C1713 40-30236 - SCREW BONE MICRO 3MM 36MM 16MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30238 SUP HCPCS C1713 40-30238 - SCREW BONE MICRO 2MM 38MM 16MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30240 SUP HCPCS C1713 40-30240 - SCREW BONE MICRO 3MM 40MM 18MM CANN THREADED ASNIS TITANIUM BOTH IP/OP $296.00 $219.00 $58.68 $295.63 $133.03 $133.03 $133.03 $133.03 $295.63 $295.63 $295.63 $61.62 $295.63 $295.63 $295.63 $295.63 $295.63 $61.61 $295.63 $118.25 $174.87 $295.63 $295.63 $295.63 $295.63 $222.00 $295.63 $295.63 $295.63 $147.82 $147.82 $234.14 $295.63 $236.50 $133.03 $58.68 N/A $171.68 $295.63 $177.38 $295.63 $61.61 $295.63 N/A N/A 40-30900 SUP Custom 27803010 40-30900 - WASHER ORTH MIC 3MM ASNS BOTH IP/OP $110.00 $81.00 $19.52 $109.65 $109.65 $109.65 $109.65 $109.65 $109.65 $109.65 $19.52 $109.65 $109.65 $109.65 $109.65 $109.65 $109.65 $22.85 $109.65 $43.86 $109.65 $109.65 $109.65 $109.65 $109.65 $82.50 $109.65 $109.65 $109.65 $54.83 $54.83 $86.84 $109.65 $87.72 $49.34 $109.65 N/A $63.80 $109.65 $65.79 $109.65 $109.65 $109.65 N/A N/A 40-35010 SUP HCPCS C1713 40-35010 - SCREW BN T10 FT 3.5MM 10MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35012 SUP HCPCS C1713 40-35012 - SCREW BN T10 FT 3.5MM 12MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35014 SUP HCPCS C1713 40-35014 - SCREW BN T10 FT 3.5MM 14MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35016 SUP HCPCS C1713 40-35016 - SCREW BN T10 FT 3.5MM 16MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35018 SUP HCPCS C1713 40-35018 - SCREW BN T10 FT 3.5MM 18MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35020 SUP HCPCS C1713 40-35020 - SCREW BN T10 FT 3.5MM 20MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35022 SUP HCPCS C1713 40-35022 - SCREW BN T10 FT 3.5MM 22MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35024 SUP HCPCS C1713 40-35024 - SCREW BN T10 FT 3.5MM 24MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35026 SUP HCPCS C1713 40-35026 - SCREW BN T10 FT 3.5MM 26MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35028 SUP HCPCS C1713 40-35028 - SCREW BN T10 FT 3.5MM 28MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $44.80 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35030 SUP HCPCS C1713 40-35030 - SCREW BN T10 FT 3.5MM 30MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $44.80 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $67.20 $112.00 $23.34 $112.00 N/A N/A 40-35032 SUP HCPCS C1713 40-35032 - SCREW BN T10 FT 3.5MM 32MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $44.80 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $67.20 $112.00 $23.34 $112.00 N/A N/A 40-35034 SUP HCPCS C1713 40-35034 - SCREW BN T10 FT 3.5MM 34MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $44.80 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $67.20 $112.00 $23.34 $112.00 N/A N/A 40-35036 SUP HCPCS C1713 40-35036 - SCREW BN T10 FT 3.5MM 36MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $112.00 $112.00 N/A N/A 40-35038 SUP HCPCS C1713 40-35038 - SCREW BN T10 FT 3.5MM 38MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $44.80 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $112.00 $112.00 N/A N/A 40-35040 SUP HCPCS C1713 40-35040 - SCREW BN T10 FT 3.5MM 40MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $44.80 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $67.20 $112.00 $23.34 $112.00 N/A N/A 40-35042 SUP HCPCS C1713 40-35042 - SCREW BN T10 FT 3.5MM 42MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35044 SUP HCPCS C1713 40-35044 - SCREW BN T10 FT 3.5MM 44MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35046 SUP HCPCS C1713 40-35046 - SCREW BN T10 FT 3.5MM 46MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35048 SUP HCPCS C1713 40-35048 - SCREW BN T10 FT 3.5MM 48MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $67.20 $112.00 $23.34 $112.00 N/A N/A 40-35050 SUP HCPCS C1713 40-35050 - SCREW BN T10 FT 3.5MM 50MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35055 SUP HCPCS C1713 40-35055 - SCREW BN T10 FT 3.5MM 55MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $44.80 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35060 SUP HCPCS C1713 40-35060 - SCREW BN T10 FT 3.5MM 60MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $67.20 $112.00 $23.34 $112.00 N/A N/A 40-35065 SUP HCPCS C1713 40-35065 - SCREW BN T10 FT 3.5MM 65MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35070 SUP HCPCS C1713 40-35070 - SCREW BN T10 FT 3.5MM 70MM YLW NS VARIAX ST TI FT/ANKL LCK BOTH IP/OP $112.00 $83.00 $22.23 $112.00 $50.40 $50.40 $50.40 $50.40 $112.00 $112.00 $112.00 $23.34 $112.00 $112.00 $112.00 $112.00 $112.00 $23.34 $112.00 $44.80 $66.25 $112.00 $112.00 $112.00 $112.00 $84.00 $112.00 $112.00 $112.00 $56.00 $56.00 $88.70 $112.00 $89.60 $50.40 $22.23 N/A $64.96 $112.00 $112.00 $112.00 $23.34 $112.00 N/A N/A 40-35610 SUP HCPCS C1713 40-35610 - SCREW BN T10 FT 3.5MM 10MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $46.10 $221.20 N/A N/A 40-35612 SUP HCPCS C1713 40-35612 - SCREW BN T10 FT 3.5MM 12MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $46.10 $221.20 N/A N/A 40-35614 SUP HCPCS C1713 40-35614 - SCREW BN T10 FT 3.5MM 14MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $46.10 $221.20 N/A N/A 40-35616 SUP HCPCS C1713 40-35616 - SCREW BN T10 FT 3.5MM 16MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $46.10 $221.20 N/A N/A 40-35618 SUP HCPCS C1713 40-35618 - SCREW BN T10 FT 3.5MM 18MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $221.20 $221.20 N/A N/A 40-35620 SUP HCPCS C1713 40-35620 - SCREW BN T10 FT 3.5MM 20MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $46.10 $221.20 N/A N/A 40-35622 SUP HCPCS C1713 40-35622 - SCREW BN T10 FT 3.5MM 22MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $221.20 $221.20 N/A N/A 40-35624 SUP HCPCS C1713 40-35624 - SCREW BN T10 FT 3.5MM 24MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-35626 SUP HCPCS C1713 40-35626 - SCREW BN T10 FT 3.5MM 26MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $46.10 $221.20 N/A N/A 40-35628 SUP HCPCS C1713 40-35628 - SCREW BN T10 FT 3.5MM 28MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-35630 SUP HCPCS C1713 40-35630 - SCREW BN T10 FT 3.5MM 30MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-35632 SUP HCPCS C1713 40-35632 - SCREW BN T10 FT 3.5MM 32MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-35634 SUP HCPCS C1713 40-35634 - SCREW BONE FULTHD T10 HEXALOBE 3.5MM 34MM LOCK VARIAX TORX BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-35636 SUP HCPCS C1713 40-35636 - SCREW BN T10 FT 3.5MM 36MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-35638 SUP HCPCS C1713 40-35638 - SCREW BN T10 FT 3.5MM 38MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $221.20 $221.20 N/A N/A 40-35640 SUP HCPCS C1713 40-35640 - SCREW BN T10 FT 3.5MM 40MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $221.20 $221.20 N/A N/A 40-35642 SUP HCPCS C1713 40-35642 - SCREW BN T10 FT 3.5MM 42MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-35644 SUP HCPCS C1713 40-35644 - SCREW BN T10 FT 3.5MM 44MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-35646 SUP HCPCS C1713 40-35646 - SCREW BN T10 FT 3.5MM 46MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $221.20 $221.20 $46.10 $221.20 N/A N/A 40-35648 SUP HCPCS C1713 40-35648 - SCREW BN T10 FT 3.5MM 48MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $221.20 $221.20 N/A N/A 40-35650 SUP HCPCS C1713 40-35650 - SCREW BN T10 FT 3.5MM 50MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-35655 SUP HCPCS C1713 40-35655 - SCREW BN T10 FT 3.5MM 55MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-35660 SUP HCPCS C1713 40-35660 - SCREW BN T10 FT 3.5MM 60MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $221.20 $221.20 N/A N/A 40-35665 SUP HCPCS C1713 40-35665 - SCREW BN T10 FT 3.5MM 65MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $46.10 $221.20 N/A N/A 40-35670 SUP HCPCS C1713 40-35670 - SCREW BN T10 FT 3.5MM 70MM BLU NS VARIAX LCK ST TI FT/ANKL BOTH IP/OP $221.50 $164.00 $43.90 $221.20 $99.54 $99.54 $99.54 $99.54 $221.20 $221.20 $221.20 $46.10 $221.20 $221.20 $221.20 $221.20 $221.20 $46.10 $221.20 $88.48 $130.84 $221.20 $221.20 $221.20 $221.20 $166.13 $221.20 $221.20 $221.20 $110.60 $110.60 $175.19 $221.20 $176.96 $99.54 $43.90 N/A $128.47 $221.20 $132.72 $221.20 $221.20 $221.20 N/A N/A 40-35900 SUP HCPCS C1713 40-35900 - WASHER ORTHOPEDIC 3.5 MM SCREW BOTH IP/OP $139.50 $103.00 $27.67 $139.40 $62.73 $62.73 $62.73 $62.73 $139.40 $139.40 $139.40 $29.05 $139.40 $139.40 $139.40 $139.40 $139.40 $29.05 $139.40 $55.76 $82.46 $139.40 $139.40 $139.40 $139.40 $104.63 $139.40 $139.40 $139.40 $69.70 $69.70 $110.40 $139.40 $111.52 $62.73 $27.67 N/A $80.91 $139.40 $139.40 $139.40 $29.05 $139.40 N/A N/A 4040-0510R SUP Custom 27803010 4040-0510R - INSERT TIBIAL 5 10MM RIGHT KNEE BOTH IP/OP $858.00 $635.00 $152.72 $858.00 $858.00 $858.00 $858.00 $858.00 $858.00 $858.00 $152.72 $858.00 $858.00 $858.00 $858.00 $858.00 $858.00 $178.82 $858.00 $343.20 $858.00 $858.00 $858.00 $858.00 $858.00 $643.50 $858.00 $858.00 $858.00 $429.00 $429.00 $679.54 $858.00 $686.40 $386.10 $858.00 N/A $497.64 $858.00 $514.80 $858.00 $858.00 $858.00 N/A N/A 4040-0908R SUP Custom 27803010 4040-0908R - INSERT TIBIAL 9 8MM MODULAR UNICOMP RIGHT KNEE BOTH IP/OP $894.00 $662.00 $159.13 $894.00 $894.00 $894.00 $894.00 $894.00 $894.00 $894.00 $159.13 $894.00 $894.00 $894.00 $894.00 $894.00 $894.00 $186.32 $894.00 $357.60 $894.00 $894.00 $894.00 $894.00 $894.00 $670.50 $894.00 $894.00 $894.00 $447.00 $447.00 $708.05 $894.00 $715.20 $402.30 $894.00 N/A $518.52 $894.00 $536.40 $894.00 $894.00 $894.00 N/A N/A 40-5011 SUP HCPCS C1725 40-5011 - CATHETER ANGIOGRAPHIC .038IN 21ML/SEC RADIAL TIGER CURVE STR BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $47.51 $47.51 $47.51 $47.51 $87.50 $87.50 $87.50 $18.24 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $87.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A 40-5012 SUP HCPCS C1725 40-5012 - CATHETER ANGIOGRAPHIC 4.5MM RADIALTIGER CURVE 5FR 100CM 2 BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $47.51 $47.51 $47.51 $47.51 $87.50 $87.50 $87.50 $18.24 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $87.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A 40-5013 SUP HCPCS C1887 40-5013 - CATHETER ANGIO JACKY RADL 3.5 CRV 5FR 110CM OPTITORQUE 2 SD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $47.51 $47.51 $47.51 $47.51 $87.50 $87.50 $87.50 $18.24 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $87.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A 4076-STDJ-185 SUP HCPCS C1769 4076-STDJ-185 - GUIDEWIRE VASCULAR STANDARD J FLOPPY .014IN 185CM 3CM PTFE BOTH IP/OP $184.00 $136.00 $36.47 $183.75 $99.78 $99.78 $99.78 $99.78 $183.75 $183.75 $183.75 $38.30 $183.75 $136.38 $136.38 $141.63 $95.73 $38.30 $183.75 $183.75 $108.69 $183.75 $183.75 $183.75 $183.75 $138.00 $183.75 $183.75 $183.75 $91.88 $91.88 $145.53 $183.75 $147.00 $119.44 $36.47 N/A $106.72 $183.75 $183.75 $183.75 $38.29 $183.75 N/A N/A 4076-STDJ-300 SUP HCPCS C1769 4076-STDJ-300 - GUIDEWIRE VASCULAR STANDARD .014IN 300CM 3CM J TIP FLOPPY BOTH IP/OP $184.00 $136.00 $36.47 $183.75 $99.78 $99.78 $99.78 $99.78 $183.75 $183.75 $183.75 $38.30 $183.75 $136.38 $136.38 $141.63 $95.73 $38.30 $183.75 $183.75 $108.69 $183.75 $183.75 $183.75 $183.75 $138.00 $183.75 $183.75 $183.75 $91.88 $91.88 $145.53 $183.75 $147.00 $119.44 $36.47 N/A $106.72 $183.75 $183.75 $183.75 $38.29 $183.75 N/A N/A 40A002 SUP HCPCS C1762 40A002 - GRAFT BONE SMALL 25X9X14MM WEDGE ILIAC CREST BOTH IP/OP "$2,005.00" "$1,484.00" $397.94 "$2,005.00" $902.25 $902.25 $902.25 $902.25 "$2,005.00" "$2,005.00" "$2,005.00" $417.89 "$2,005.00" "$2,005.00" "$2,005.00" "$2,005.00" "$2,005.00" $417.86 "$2,005.00" "$2,005.00" "$1,185.96" "$2,005.00" "$2,005.00" "$2,005.00" "$2,005.00" "$1,503.75" "$2,005.00" "$2,005.00" "$2,005.00" "$1,002.50" "$1,002.50" "$1,587.96" "$2,005.00" "$1,604.00" $902.25 $397.94 N/A "$1,162.90" "$2,005.00" "$2,005.00" "$2,005.00" $417.84 "$2,005.00" N/A N/A 40A74 SUP HCPCS C1768 40A74 - GRAFT CARDIO 7-4MM 40CM HEMODIALYSIS ACCES SHORT TAPER IMPRA BOTH IP/OP "$1,318.00" $975.00 $261.56 "$1,317.85" $593.03 $593.03 $593.03 $593.03 "$1,317.85" "$1,317.85" "$1,317.85" $274.67 "$1,317.85" "$1,317.85" "$1,317.85" "$1,317.85" "$1,317.85" $274.65 "$1,317.85" "$1,317.85" $779.51 "$1,317.85" "$1,317.85" "$1,317.85" "$1,317.85" $988.50 "$1,317.85" "$1,317.85" "$1,317.85" $658.93 $658.93 "$1,043.74" "$1,317.85" "$1,054.28" $593.03 $261.56 N/A $764.44 "$1,317.85" "$1,317.85" "$1,317.85" $274.64 "$1,317.85" N/A N/A 40S08 SUP HCPCS C1768 40S08 - GRAFT VASC 8MM 40CM IMPRA CARBOFLO PTFE BOTH IP/OP $955.50 $707.00 $189.64 $955.50 $429.98 $429.98 $429.98 $429.98 $955.50 $955.50 $955.50 $199.15 $955.50 $955.50 $955.50 $955.50 $955.50 $199.14 $955.50 $955.50 $565.18 $955.50 $955.50 $955.50 $955.50 $716.63 $955.50 $955.50 $955.50 $477.75 $477.75 $756.76 $955.50 $764.40 $429.98 $189.64 N/A $554.19 $955.50 $955.50 $955.50 $199.13 $955.50 N/A N/A 4100M24 SUP Custom 27803010 4100M24 - RING ANNULOPLASTY ASYMMETRIC 24MM 3D RED CURVATURE SEWING BOTH IP/OP "$9,112.50" "$6,743.00" "$1,622.03" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$1,622.03" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$1,899.15" "$9,112.50" "$3,645.00" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$6,834.38" "$9,112.50" "$9,112.50" "$9,112.50" "$4,556.25" "$4,556.25" "$7,217.10" "$9,112.50" "$7,290.00" "$4,100.63" "$9,112.50" N/A "$5,285.25" "$9,112.50" "$5,467.50" "$9,112.50" "$9,112.50" "$9,112.50" N/A N/A 4100M34 SUP Custom 27803010 4100M34 - RING ANNULOPLASTY ASYMMETRIC 34MM 3D RED CURVATURE SEWING BOTH IP/OP "$9,112.50" "$6,743.00" "$1,622.03" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$1,622.03" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$1,899.15" "$9,112.50" "$3,645.00" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$9,112.50" "$6,834.38" "$9,112.50" "$9,112.50" "$9,112.50" "$4,556.25" "$4,556.25" "$7,217.10" "$9,112.50" "$7,290.00" "$4,100.63" "$9,112.50" N/A "$5,285.25" "$9,112.50" "$5,467.50" "$9,112.50" "$9,112.50" "$9,112.50" N/A N/A 41045-01 SUP HCPCS C1887 41045-01 - CATHETER INFS 5FR 40CM 20CM CRGG-MCNAM CRGG MICROVALVE 1 LUM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $109.96 $109.96 $109.96 $109.96 $202.50 $202.50 $202.50 $42.21 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A 41046-01 SUP HCPCS C1751 41046-01 - CATHETER INFS 5FR 65CM 5CM CRGG-MCNAM CRGG MICROVALVE 1 LUM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $109.96 $109.96 $109.96 $109.96 $202.50 $202.50 $202.50 $42.21 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A 41046-01 SUP HCPCS C1887 41046-01 - CATH INFUS .038IN 5FR 100CM 20CM PERI VLV CRGG-MCNAM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $109.96 $109.96 $109.96 $109.96 $202.50 $202.50 $202.50 $42.21 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A 41050-01 SUP HCPCS C1769 41050-01 - CATHETER INFS 5FR 100CM 10CM CRGG-MCNAM CRGG MICROVALVE 1 BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $142.54 $142.54 $142.54 $142.54 $262.50 $262.50 $262.50 $54.71 $262.50 $194.83 $194.83 $202.34 $136.76 $54.71 $262.50 $262.50 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $170.63 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A 41051-01 SUP HCPCS C1751 41051-01 - CATHETER INFS 5FR 100CM 20CM CRGG-MCNAM CRGG MICROVALVE 1 BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $109.96 $109.96 $109.96 $109.96 $202.50 $202.50 $202.50 $42.21 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A 41053-01 SUP HCPCS C1769 41053-01 - CATHETER INFS .038IN 5FR 100CM 40CM CRGG-MCNAM CRGG BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $160.19 $160.19 $160.19 $160.19 $295.00 $295.00 $295.00 $61.49 $295.00 $218.95 $218.95 $227.39 $153.70 $61.48 $295.00 $295.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $191.75 $58.55 N/A $171.10 $295.00 $295.00 $295.00 $61.48 $295.00 N/A N/A 41055-01 SUP HCPCS C1887 41055-01 - CATHETER INFS 5FR 135CM 5CM CRGG-MCNAM CRGG-MICROVALVE 1 LUM BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $142.54 $142.54 $142.54 $142.54 $262.50 $262.50 $262.50 $54.71 $262.50 $194.83 $194.83 $202.34 $136.76 $54.71 $262.50 $262.50 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $170.63 $52.10 N/A $152.25 $262.50 $262.50 $262.50 $54.71 $262.50 N/A N/A 4105535XL SUP HCPCS C1713 4105535XL - SCREW BONE XL 5.5MM 35MM OSS SPN BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" $912.53 "$1,520.88" $316.95 "$1,520.88" N/A N/A 4105540XL SUP HCPCS C1713 4105540XL - SCREW BONE XL 5.5MM 40MM OSS SPN BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" $608.35 $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" "$1,520.88" "$1,520.88" $316.95 "$1,520.88" N/A N/A 4105545XL SUP HCPCS C1713 4105545XL - SCREW BONE XL 5.5MM 45MM OSS SPN BOTH IP/OP "$1,521.00" "$1,126.00" $301.86 "$1,520.88" $684.40 $684.40 $684.40 $684.40 "$1,520.88" "$1,520.88" "$1,520.88" $316.99 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" $316.97 "$1,520.88" "$1,520.88" $899.60 "$1,520.88" "$1,520.88" "$1,520.88" "$1,520.88" "$1,140.75" "$1,520.88" "$1,520.88" "$1,520.88" $760.44 $760.44 "$1,204.54" "$1,520.88" "$1,216.70" $684.40 $301.86 N/A $882.18 "$1,520.88" "$1,520.88" "$1,520.88" $316.95 "$1,520.88" N/A N/A 41057-01 SUP HCPCS C1769 41057-01 - CATHETER IV .038IN 5FR 135CM 20CM CRGG-MCNAM CRGG MICROVALVE BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $109.96 $109.96 $109.96 $109.96 $202.50 $202.50 $202.50 $42.21 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A 41059-01 SUP HCPCS C1751 41059-01 - CATHETER INFS 5FR 135CM 40CM CRGG-MCNAM CRGG MICROVALVE 1 BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $132.75 $132.75 $132.75 $132.75 $295.00 $295.00 $295.00 $61.49 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $295.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $58.55 N/A $171.10 $295.00 $295.00 $295.00 $61.48 $295.00 N/A N/A 4106545XL SUP HCPCS C1713 4106545XL - SCREW BONE XL 6.5MM 45MM OSS SPN BOTH IP/OP "$1,734.50" "$1,284.00" $344.22 "$1,734.30" $780.44 $780.44 $780.44 $780.44 "$1,734.30" "$1,734.30" "$1,734.30" $361.47 "$1,734.30" "$1,734.30" "$1,734.30" "$1,734.30" "$1,734.30" $361.45 "$1,734.30" $693.72 "$1,025.84" "$1,734.30" "$1,734.30" "$1,734.30" "$1,734.30" "$1,300.88" "$1,734.30" "$1,734.30" "$1,734.30" $867.15 $867.15 "$1,373.57" "$1,734.30" "$1,387.44" $780.44 $344.22 N/A "$1,006.01" "$1,734.30" "$1,040.58" "$1,734.30" $361.43 "$1,734.30" N/A N/A 4106550XL SUP HCPCS C1713 4106550XL - SCREW BONE XL 6.5MM 50MM OSS SPN BOTH IP/OP "$1,651.50" "$1,222.00" $327.72 "$1,651.18" $743.03 $743.03 $743.03 $743.03 "$1,651.18" "$1,651.18" "$1,651.18" $344.15 "$1,651.18" "$1,651.18" "$1,651.18" "$1,651.18" "$1,651.18" $344.12 "$1,651.18" $660.47 $976.67 "$1,651.18" "$1,651.18" "$1,651.18" "$1,651.18" "$1,238.63" "$1,651.18" "$1,651.18" "$1,651.18" $825.59 $825.59 "$1,307.73" "$1,651.18" "$1,320.94" $743.03 $327.72 N/A $957.87 "$1,651.18" "$1,651.18" "$1,651.18" $344.11 "$1,651.18" N/A N/A 4107540XL SUP HCPCS C1713 4107540XL - SCREW BONE XL 7.5MM 40MM OSS SPN BOTH IP/OP "$1,651.50" "$1,222.00" $327.72 "$1,651.18" $743.03 $743.03 $743.03 $743.03 "$1,651.18" "$1,651.18" "$1,651.18" $344.15 "$1,651.18" "$1,651.18" "$1,651.18" "$1,651.18" "$1,651.18" $344.12 "$1,651.18" $660.47 $976.67 "$1,651.18" "$1,651.18" "$1,651.18" "$1,651.18" "$1,238.63" "$1,651.18" "$1,651.18" "$1,651.18" $825.59 $825.59 "$1,307.73" "$1,651.18" "$1,320.94" $743.03 $327.72 N/A $957.87 "$1,651.18" "$1,651.18" "$1,651.18" $344.11 "$1,651.18" N/A N/A 4107545XL SUP HCPCS C1713 4107545XL - SCREW BONE XL 7.5MM 45MM OSS SPN BOTH IP/OP "$1,734.50" "$1,284.00" $344.22 "$1,734.30" $780.44 $780.44 $780.44 $780.44 "$1,734.30" "$1,734.30" "$1,734.30" $361.47 "$1,734.30" "$1,734.30" "$1,734.30" "$1,734.30" "$1,734.30" $361.45 "$1,734.30" $693.72 "$1,025.84" "$1,734.30" "$1,734.30" "$1,734.30" "$1,734.30" "$1,300.88" "$1,734.30" "$1,734.30" "$1,734.30" $867.15 $867.15 "$1,373.57" "$1,734.30" "$1,387.44" $780.44 $344.22 N/A "$1,006.01" "$1,734.30" "$1,734.30" "$1,734.30" $361.43 "$1,734.30" N/A N/A 4108540XL SUP HCPCS C1713 4108540XL - SCREW BONE XL 8.5MM 40MM OSS SPN BOTH IP/OP "$1,651.50" "$1,222.00" $327.72 "$1,651.18" $743.03 $743.03 $743.03 $743.03 "$1,651.18" "$1,651.18" "$1,651.18" $344.15 "$1,651.18" "$1,651.18" "$1,651.18" "$1,651.18" "$1,651.18" $344.12 "$1,651.18" "$1,651.18" $976.67 "$1,651.18" "$1,651.18" "$1,651.18" "$1,651.18" "$1,238.63" "$1,651.18" "$1,651.18" "$1,651.18" $825.59 $825.59 "$1,307.73" "$1,651.18" "$1,320.94" $743.03 $327.72 N/A $957.87 "$1,651.18" "$1,651.18" "$1,651.18" $344.11 "$1,651.18" N/A N/A 4108545XL SUP HCPCS C1713 4108545XL - SCREW BONE XL 8.5MM 45MM OSS SPN BOTH IP/OP "$1,651.50" "$1,222.00" $327.72 "$1,651.18" $743.03 $743.03 $743.03 $743.03 "$1,651.18" "$1,651.18" "$1,651.18" $344.15 "$1,651.18" "$1,651.18" "$1,651.18" "$1,651.18" "$1,651.18" $344.12 "$1,651.18" $660.47 $976.67 "$1,651.18" "$1,651.18" "$1,651.18" "$1,651.18" "$1,238.63" "$1,651.18" "$1,651.18" "$1,651.18" $825.59 $825.59 "$1,307.73" "$1,651.18" "$1,320.94" $743.03 $327.72 N/A $957.87 "$1,651.18" "$1,651.18" "$1,651.18" $344.11 "$1,651.18" N/A N/A 412.113S SUP HCPCS C1713 412.113S - SCREW BN SD15 FT 3.5MM 2.9MM 34MM GRN STRL MULTILOC LCK BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $331.68 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 412.134S SUP HCPCS C1713 412.134S - SCREW BN SD15 FT 3.5MM 2.9MM 44MM GRN STRL MULTILOC LCK BOTH IP/OP $326.50 $242.00 $64.73 $331.68 $146.76 $146.76 $146.76 $146.76 $326.13 $326.13 $326.13 $67.97 $326.13 $326.13 $326.13 $326.13 $326.13 $67.97 $326.13 $132.67 $192.91 $326.13 $331.68 $326.13 $326.13 $244.88 $326.13 $326.13 $326.13 $163.07 $163.07 $258.29 $326.13 $260.90 $146.76 $64.73 N/A $189.37 $326.13 $326.13 $326.13 $67.97 $326.13 N/A N/A 41-2005 SUP HCPCS C1713 41-2005 - SCREW BONE 2MM 5MM CROSSDRIVE NONLOCKING LORENZ SILVER BOTH IP/OP $160.00 $118.00 $31.76 $160.00 $72.00 $72.00 $72.00 $72.00 $160.00 $160.00 $160.00 $33.35 $160.00 $160.00 $160.00 $160.00 $160.00 $33.35 $160.00 $64.00 $94.64 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $72.00 $31.76 N/A $92.80 $160.00 $96.00 $160.00 $33.34 $160.00 N/A N/A 41-2006 SUP HCPCS C1713 41-2006 - SCREW BN 2MM 6MM BLU SLVR X-DRV NONLOCK XDR MNDB LORENZ BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $133.50 $222.50 $46.37 $222.50 N/A N/A 41-2008 SUP HCPCS C1713 41-2008 - SCREW BONE 2MM 8MM X DRIVE TRAUMAONE SILVER MANDIB BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $89.00 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $133.50 $222.50 $46.37 $222.50 N/A N/A 41-2010 SUP HCPCS C1713 41-2010 - SCREW BONE 2MM 10MM NONLOCKING XDRIVE LORENZ SILVER MANDIB BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $89.00 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $222.50 $222.50 $46.37 $222.50 N/A N/A 41-2012 SUP HCPCS C1713 41-2012 - SCREW BONE 2MM 12MM X DRIVE TRAUMAONE SILVER MANDIB BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $89.00 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $222.50 $222.50 $46.37 $222.50 N/A N/A 41-2014 SUP HCPCS C1713 41-2014 - SCREW BONE 2MM 14MM CROSS DRIVE NONLOCKING TRAUMAONE SILVER BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $133.50 $222.50 $46.37 $222.50 N/A N/A 41-2016 SUP HCPCS C1713 41-2016 - SCREW BONE 2MM 16MM NONLOCKING CROSS DRIVE TRAUMAONE SILVER BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $133.50 $222.50 $222.50 $222.50 N/A N/A 41-2018 SUP HCPCS C1713 41-2018 - SCREW BONE 2MM 18MM NONLOCKING CROSS DRIVE TRAUMAONE SILVER BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $133.50 $222.50 $46.37 $222.50 N/A N/A 41-2106 SUP HCPCS C1713 41-2106 - SCREW BN 2.3MM 6MM SLVR X-DRV LCK BOTH IP/OP $390.00 $289.00 $77.41 $390.00 $175.50 $175.50 $175.50 $175.50 $390.00 $390.00 $390.00 $81.29 $390.00 $390.00 $390.00 $390.00 $390.00 $81.28 $390.00 $156.00 $230.69 $390.00 $390.00 $390.00 $390.00 $292.50 $390.00 $390.00 $390.00 $195.00 $195.00 $308.88 $390.00 $312.00 $175.50 $77.41 N/A $226.20 $390.00 $234.00 $390.00 $81.28 $390.00 N/A N/A 41-2108 SUP HCPCS C1713 41-2108 - SCREW BONE 2MM 8MM CROSS DRIVE LOCKING TRAUMAONE SILVER BOTH IP/OP $390.00 $289.00 $77.41 $390.00 $175.50 $175.50 $175.50 $175.50 $390.00 $390.00 $390.00 $81.29 $390.00 $390.00 $390.00 $390.00 $390.00 $81.28 $390.00 $156.00 $230.69 $390.00 $390.00 $390.00 $390.00 $292.50 $390.00 $390.00 $390.00 $195.00 $195.00 $308.88 $390.00 $312.00 $175.50 $77.41 N/A $226.20 $390.00 $390.00 $390.00 $390.00 $390.00 N/A N/A 41-2110 SUP HCPCS C1713 41-2110 - SCREW BONE 2MM 10MM LOCKING CROSS DRIVE TRAUMAONE LORENZ BOTH IP/OP $390.00 $289.00 $77.41 $390.00 $175.50 $175.50 $175.50 $175.50 $390.00 $390.00 $390.00 $81.29 $390.00 $390.00 $390.00 $390.00 $390.00 $81.28 $390.00 $390.00 $230.69 $390.00 $390.00 $390.00 $390.00 $292.50 $390.00 $390.00 $390.00 $195.00 $195.00 $308.88 $390.00 $312.00 $175.50 $77.41 N/A $226.20 $390.00 $234.00 $390.00 $81.28 $390.00 N/A N/A 41-2112 SUP HCPCS C1713 41-2112 - SCREW BONE 2MM 12MM CROSS DRIVE LOCKING TRAUMAONE SILVER BOTH IP/OP $390.00 $289.00 $77.41 $390.00 $175.50 $175.50 $175.50 $175.50 $390.00 $390.00 $390.00 $81.29 $390.00 $390.00 $390.00 $390.00 $390.00 $81.28 $390.00 $390.00 $230.69 $390.00 $390.00 $390.00 $390.00 $292.50 $390.00 $390.00 $390.00 $195.00 $195.00 $308.88 $390.00 $312.00 $175.50 $77.41 N/A $226.20 $390.00 $234.00 $390.00 $81.28 $390.00 N/A N/A 41-2114 SUP HCPCS C1713 41-2114 - SCREW BONE 2MM 14MM CROSS DRIVE LOCKING TRAUMAONE SILVER BOTH IP/OP $390.00 $289.00 $77.41 $390.00 $175.50 $175.50 $175.50 $175.50 $390.00 $390.00 $390.00 $81.29 $390.00 $390.00 $390.00 $390.00 $390.00 $81.28 $390.00 $390.00 $230.69 $390.00 $390.00 $390.00 $390.00 $292.50 $390.00 $390.00 $390.00 $195.00 $195.00 $308.88 $390.00 $312.00 $175.50 $77.41 N/A $226.20 $390.00 $234.00 $390.00 $81.28 $390.00 N/A N/A 41-2116 SUP HCPCS C1713 41-2116 - SCREW BONE 2MM 16MM X-DRIVE LOCKING TRAUMAONE SILVER MANDIB BOTH IP/OP $390.00 $289.00 $77.41 $390.00 $175.50 $175.50 $175.50 $175.50 $390.00 $390.00 $390.00 $81.29 $390.00 $390.00 $390.00 $390.00 $390.00 $81.28 $390.00 $156.00 $230.69 $390.00 $390.00 $390.00 $390.00 $292.50 $390.00 $390.00 $390.00 $195.00 $195.00 $308.88 $390.00 $312.00 $175.50 $77.41 N/A $226.20 $390.00 $234.00 $390.00 $81.28 $390.00 N/A N/A 41-2118 SUP HCPCS C1713 41-2118 - SCREW BONE 2MM 18MM LOCKING CROSS DRIVE MANDUBULAR BOTH IP/OP $390.00 $289.00 $77.41 $390.00 $175.50 $175.50 $175.50 $175.50 $390.00 $390.00 $390.00 $81.29 $390.00 $390.00 $390.00 $390.00 $390.00 $81.28 $390.00 $390.00 $230.69 $390.00 $390.00 $390.00 $390.00 $292.50 $390.00 $390.00 $390.00 $195.00 $195.00 $308.88 $390.00 $312.00 $175.50 $77.41 N/A $226.20 $390.00 $390.00 $390.00 $81.28 $390.00 N/A N/A 41-2205 SUP HCPCS C1713 41-2205 - SCREW BONE 2MM 5MM SELF DRILL X DRIVE TRAUMAONE BLUE MANDIB BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $90.00 $90.00 $90.00 $90.00 $200.00 $200.00 $200.00 $41.69 $200.00 $200.00 $200.00 $200.00 $200.00 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $90.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 41-2305 SUP HCPCS C1713 41-2305 - SCREW BONE 2.3MM 5MM CROSS DRIVE NONLOCKING TRAUMAONE GOLD BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $132.75 $132.75 $132.75 $132.75 $295.00 $295.00 $295.00 $61.49 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $118.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $58.55 N/A $171.10 $295.00 $295.00 $295.00 $61.48 $295.00 N/A N/A 41-2306 SUP HCPCS C1713 41-2306 - SCREW BN 2.3MM 6MM AU X-DRV NONLOCK BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $132.75 $132.75 $132.75 $132.75 $295.00 $295.00 $295.00 $61.49 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $295.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $58.55 N/A $171.10 $295.00 $295.00 $295.00 $61.48 $295.00 N/A N/A 41-2308 SUP HCPCS C1713 41-2308 - SCREW BONE 2.3MM 8MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $132.75 $132.75 $132.75 $132.75 $295.00 $295.00 $295.00 $61.49 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $118.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $58.55 N/A $171.10 $295.00 $177.00 $295.00 $61.48 $295.00 N/A N/A 41-2310 SUP HCPCS C1713 41-2310 - SCREW BONE 2.3MM 10MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $132.75 $132.75 $132.75 $132.75 $295.00 $295.00 $295.00 $61.49 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $118.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $58.55 N/A $171.10 $295.00 $177.00 $295.00 $61.48 $295.00 N/A N/A 41-2312 SUP HCPCS C1713 41-2312 - SCREW BONE 2.3MM 12MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $132.75 $132.75 $132.75 $132.75 $295.00 $295.00 $295.00 $61.49 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $295.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $58.55 N/A $171.10 $295.00 $177.00 $295.00 $61.48 $295.00 N/A N/A 41-2314 SUP HCPCS C1713 41-2314 - SCREW BONE 2.3MM 14MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $132.75 $132.75 $132.75 $132.75 $295.00 $295.00 $295.00 $61.49 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $118.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $58.55 N/A $171.10 $295.00 $177.00 $295.00 $61.48 $295.00 N/A N/A 41-2316 SUP HCPCS C1713 41-2316 - SCREW BONE 2.3MM 16MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $132.75 $132.75 $132.75 $132.75 $295.00 $295.00 $295.00 $61.49 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $295.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $58.55 N/A $171.10 $295.00 $295.00 $295.00 $61.48 $295.00 N/A N/A 41-2318 SUP HCPCS C1713 41-2318 - SCREW BONE 2.3MM 18MM NONLOCKING CROSS DRIVE TRAUMAONE GOLD BOTH IP/OP $295.00 $218.00 $58.55 $295.00 $132.75 $132.75 $132.75 $132.75 $295.00 $295.00 $295.00 $61.49 $295.00 $295.00 $295.00 $295.00 $295.00 $61.48 $295.00 $118.00 $174.49 $295.00 $295.00 $295.00 $295.00 $221.25 $295.00 $295.00 $295.00 $147.50 $147.50 $233.64 $295.00 $236.00 $132.75 $58.55 N/A $171.10 $295.00 $177.00 $295.00 $61.48 $295.00 N/A N/A 41-2406 SUP HCPCS C1713 41-2406 - SCREW BONE 2.3MM 6MM LOCK CROSS DRIVE TRAUMAONE LORENZ GOLD BOTH IP/OP $340.00 $252.00 $67.48 $340.00 $153.00 $153.00 $153.00 $153.00 $340.00 $340.00 $340.00 $70.86 $340.00 $340.00 $340.00 $340.00 $340.00 $70.86 $340.00 $136.00 $201.11 $340.00 $340.00 $340.00 $340.00 $255.00 $340.00 $340.00 $340.00 $170.00 $170.00 $269.28 $340.00 $272.00 $153.00 $67.48 N/A $197.20 $340.00 $340.00 $340.00 $70.86 $340.00 N/A N/A 41-2408 SUP HCPCS C1713 41-2408 - SCREW BONE 2.3MM 8MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD BOTH IP/OP $467.50 $346.00 $92.79 $467.50 $210.38 $210.38 $210.38 $210.38 $467.50 $467.50 $467.50 $97.44 $467.50 $467.50 $467.50 $467.50 $467.50 $97.43 $467.50 $467.50 $276.53 $467.50 $467.50 $467.50 $467.50 $350.63 $467.50 $467.50 $467.50 $233.75 $233.75 $370.26 $467.50 $374.00 $210.38 $92.79 N/A $271.15 $467.50 $280.50 $467.50 $97.43 $467.50 N/A N/A 41-2410 SUP HCPCS C1713 41-2410 - SCREW BONE 2.3MM 10MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD BOTH IP/OP $467.50 $346.00 $92.79 $467.50 $210.38 $210.38 $210.38 $210.38 $467.50 $467.50 $467.50 $97.44 $467.50 $467.50 $467.50 $467.50 $467.50 $97.43 $467.50 $467.50 $276.53 $467.50 $467.50 $467.50 $467.50 $350.63 $467.50 $467.50 $467.50 $233.75 $233.75 $370.26 $467.50 $374.00 $210.38 $92.79 N/A $271.15 $467.50 $280.50 $467.50 $97.43 $467.50 N/A N/A 41-2412 SUP HCPCS C1713 41-2412 - SCREW BONE 2.3MM 12MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD BOTH IP/OP $467.50 $346.00 $92.79 $467.50 $210.38 $210.38 $210.38 $210.38 $467.50 $467.50 $467.50 $97.44 $467.50 $467.50 $467.50 $467.50 $467.50 $97.43 $467.50 $187.00 $276.53 $467.50 $467.50 $467.50 $467.50 $350.63 $467.50 $467.50 $467.50 $233.75 $233.75 $370.26 $467.50 $374.00 $210.38 $92.79 N/A $271.15 $467.50 $467.50 $467.50 $97.43 $467.50 N/A N/A 41-2414 SUP HCPCS C1713 41-2414 - SCREW BONE 2.3MM 14MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD BOTH IP/OP $467.50 $346.00 $92.79 $467.50 $210.38 $210.38 $210.38 $210.38 $467.50 $467.50 $467.50 $97.44 $467.50 $467.50 $467.50 $467.50 $467.50 $97.43 $467.50 $467.50 $276.53 $467.50 $467.50 $467.50 $467.50 $350.63 $467.50 $467.50 $467.50 $233.75 $233.75 $370.26 $467.50 $374.00 $210.38 $92.79 N/A $271.15 $467.50 $467.50 $467.50 $97.43 $467.50 N/A N/A 41-2416 SUP HCPCS C1713 41-2416 - SCREW BONE 2.3MM 16MM CROSS DRIVE LOCK TRAUMAONE LORENZ GOLD BOTH IP/OP $467.50 $346.00 $92.79 $467.50 $210.38 $210.38 $210.38 $210.38 $467.50 $467.50 $467.50 $97.44 $467.50 $467.50 $467.50 $467.50 $467.50 $97.43 $467.50 $187.00 $276.53 $467.50 $467.50 $467.50 $467.50 $350.63 $467.50 $467.50 $467.50 $233.75 $233.75 $370.26 $467.50 $374.00 $210.38 $92.79 N/A $271.15 $467.50 $280.50 $467.50 $97.43 $467.50 N/A N/A 41-2418 SUP HCPCS C1713 41-2418 - SCREW BN 2.3MM 18MM AU X-DRV LCK BOTH IP/OP $467.50 $346.00 $92.79 $467.50 $210.38 $210.38 $210.38 $210.38 $467.50 $467.50 $467.50 $97.44 $467.50 $467.50 $467.50 $467.50 $467.50 $97.43 $467.50 $467.50 $276.53 $467.50 $467.50 $467.50 $467.50 $350.63 $467.50 $467.50 $467.50 $233.75 $233.75 $370.26 $467.50 $374.00 $210.38 $92.79 N/A $271.15 $467.50 $280.50 $467.50 $97.43 $467.50 N/A N/A 4125-127-100 SUP Custom 27203010 4125-127-100 - BLADE SAW THK.05IN MEDIUM 3.937X.984IN 2 CUT SAGITTAL BOTH IP/OP $117.00 $87.00 $20.80 $116.85 $116.85 $116.85 $116.85 $116.85 $116.85 $116.85 $20.80 $116.85 $116.85 $86.73 $86.73 $90.07 $60.88 $24.35 $116.85 $46.74 $116.85 $116.85 $116.85 $116.85 $116.85 $87.75 $116.85 $116.85 $116.85 $58.43 $58.43 $92.55 $116.85 $93.48 $75.95 $116.85 N/A $67.86 $116.85 $70.11 $116.85 $116.85 $116.85 N/A N/A 41-2708 SUP HCPCS C1713 41-2708 - SCREW BONE 2.7MM 8MM EMERGENCY CROSS DRIVE TRAUMAONE MAGENTA BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $297.50 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $178.50 $297.50 $62.00 $297.50 N/A N/A 41-2710 SUP HCPCS C1713 41-2710 - SCREW BN 2.7MM 10MM MAG NLCKG X DRV BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $178.50 $297.50 $62.00 $297.50 N/A N/A 41-2712 SUP HCPCS C1713 41-2712 - SCREW BONE 2.7MM 12MM NONLOCKING X DRIVE LORENZ MAGENTA BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $297.50 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 41-2714 SUP HCPCS C1713 41-2714 - SCREW BONE 2.7MM 14MM NONLOCKING X DRIVE LORENZ MAGENTA BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 41-2716 SUP HCPCS C1713 41-2716 - SCREW BN 2.7MM 17MM LCK XDR ER BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $297.50 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $178.50 $297.50 $62.00 $297.50 N/A N/A 41-2718 SUP HCPCS C1713 41-2718 - SCREW BONE 2.7MM 18MM NONLOCKING X DRIVE LORENZ MAGENTA BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $178.50 $297.50 $62.00 $297.50 N/A N/A 413.590E SUP HCPCS C1713 413.590E - SCREW BONE 3MM 20MM LOCK TITANIUM STERNUM NONSTRL BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $227.25 $227.25 $227.25 $227.25 $505.00 $505.00 $505.00 $105.25 $505.00 $505.00 $505.00 $505.00 $505.00 $105.25 $505.00 $202.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $227.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A 413.592E SUP HCPCS C1713 413.592E - SCREW BONE 3MM 22MM LOCK TITANIUM STERNUM NONSTRL BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $227.25 $227.25 $227.25 $227.25 $505.00 $505.00 $505.00 $105.25 $505.00 $505.00 $505.00 $505.00 $505.00 $105.25 $505.00 $202.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $227.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A 413.594E SUP HCPCS C1713 413.594E - SCREW BONE 3MM 24MM LOCK TITANIUM STERNUM STERILE BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $227.25 $227.25 $227.25 $227.25 $505.00 $505.00 $505.00 $105.25 $505.00 $505.00 $505.00 $505.00 $505.00 $105.25 $505.00 $202.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $227.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A 41645B SUP Custom 27803010 41645B - RELOAD STPLR 3.5MM 45MM BLU STRL LF DVNC SI EWRST REG TISS BOTH IP/OP $450.00 $333.00 $80.10 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $80.10 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $93.78 $450.00 $180.00 $450.00 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $202.50 $450.00 N/A $261.00 $450.00 $270.00 $450.00 $450.00 $450.00 N/A N/A 4170-223 SUP Custom 27203010 4170-223 - TUBING SUCT/IRR FLD MNG INFL STRL DISP BOTH IP/OP $73.00 $54.00 $12.98 $72.94 $72.94 $72.94 $72.94 $72.94 $72.94 $72.94 $12.98 $72.94 $72.94 $54.14 $54.14 $56.22 $38.00 $15.20 $72.94 $29.18 $72.94 $72.94 $72.94 $72.94 $72.94 $54.75 $72.94 $72.94 $72.94 $36.47 $36.47 $57.77 $72.94 $58.35 $47.41 $72.94 N/A $42.34 $72.94 $43.76 $72.94 $72.94 $72.94 N/A N/A 419.952S SUP Custom 27803010 419.952S - WASHER ORTHOPEDIC SMALL OVAL TITANIUM STERILE 6.5/7.3MM CANN BOTH IP/OP $328.50 $243.00 $58.47 $328.50 $328.50 $328.50 $328.50 $328.50 $328.50 $328.50 $58.47 $328.50 $328.50 $328.50 $328.50 $328.50 $328.50 $68.46 $328.50 $131.40 $328.50 $328.50 $328.50 $328.50 $328.50 $246.38 $328.50 $328.50 $328.50 $164.25 $164.25 $260.17 $328.50 $262.80 $147.83 $328.50 N/A $190.53 $328.50 $197.10 $328.50 $328.50 $328.50 N/A N/A 419.953S SUP Custom 27803010 419.953S - WASHER ORTHOPEDIC LARGE ROUND TITANIUM STERILE 6.5/7.3MM BOTH IP/OP $370.00 $274.00 $65.81 $375.98 $369.70 $369.70 $369.70 $369.70 $369.70 $369.70 $65.81 $369.70 $369.70 $369.70 $369.70 $369.70 $369.70 $77.05 $369.70 $150.39 $369.70 $369.70 $375.98 $369.70 $369.70 $277.50 $369.70 $369.70 $369.70 $184.85 $184.85 $292.80 $369.70 $295.76 $166.37 $369.70 N/A $214.60 $369.70 $221.82 $369.70 $369.70 $369.70 N/A N/A 4195-78 SUP HCPCS C1898 4195-78 - LEAD PACING 5FR 78CM IS-1 UNIPOLAR DEPLOYABLE LOBE FIX BOTH IP/OP "$3,492.50" "$2,584.00" $727.88 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 4200-10 SUP Custom 27203010 4200-10 - DISSECTOR SURG MODELING CATHETER MARTIN UNBALLOON BOTH IP/OP "$3,987.50" "$2,951.00" $709.78 "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" $709.78 "$3,987.50" "$3,987.50" "$2,959.52" "$2,959.52" "$3,073.57" "$2,060.15" $831.04 "$3,987.50" "$1,595.00" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$2,990.63" "$3,987.50" "$3,987.50" "$3,987.50" "$1,993.75" "$1,993.75" "$3,158.10" "$3,987.50" "$3,190.00" "$2,591.88" "$3,987.50" N/A "$2,312.75" "$3,987.50" "$2,392.50" "$3,987.50" "$3,987.50" "$3,987.50" N/A N/A 4200-20 SUP HCPCS C1773 4200-20 - DEVICE RETRIEVAL REMOVAL ENDSCP HELIX BOTH IP/OP "$5,237.50" "$3,876.00" "$1,039.51" "$5,237.50" "$2,843.96" "$2,843.96" "$2,843.96" "$2,843.96" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.63" "$5,237.50" "$3,887.27" "$3,887.27" "$4,037.07" "$2,060.15" "$1,091.55" "$5,237.50" "$5,237.50" "$3,094.73" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$3,928.13" "$5,237.50" "$5,237.50" "$5,237.50" "$2,618.75" "$2,618.75" "$4,148.10" "$5,237.50" "$4,190.00" "$3,404.38" "$1,039.51" N/A "$3,037.75" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.50" "$5,237.50" N/A N/A 4200927F SUP Custom 27803010 4200927F - CAGE SPNL 0D 9MM 27MM WHL BD STNDALN BOTH IP/OP "$4,246.00" "$3,142.00" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $884.89 "$4,245.88" "$1,698.35" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$3,184.50" "$4,245.88" "$4,245.88" "$4,245.88" "$2,122.94" "$2,122.94" "$3,362.74" "$4,245.88" "$3,396.70" "$1,910.65" "$4,245.88" N/A "$2,462.68" "$4,245.88" "$2,547.53" "$4,245.88" "$4,245.88" "$4,245.88" N/A N/A 4201127F SUP Custom 27803010 4201127F - CAGE SPNL 0D 11MM 27MM WHL BD STNDALN BOTH IP/OP "$4,246.00" "$3,142.00" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $884.89 "$4,245.88" "$1,698.35" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$3,184.50" "$4,245.88" "$4,245.88" "$4,245.88" "$2,122.94" "$2,122.94" "$3,362.74" "$4,245.88" "$3,396.70" "$1,910.65" "$4,245.88" N/A "$2,462.68" "$4,245.88" "$2,547.53" "$4,245.88" "$4,245.88" "$4,245.88" N/A N/A 4201327F SUP Custom 27803010 4201327F - CAGE SPNL 0D 13MM 27MM WHL BD STNDALN BOTH IP/OP "$4,246.00" "$3,142.00" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $884.89 "$4,245.88" "$1,698.35" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$3,184.50" "$4,245.88" "$4,245.88" "$4,245.88" "$2,122.94" "$2,122.94" "$3,362.74" "$4,245.88" "$3,396.70" "$1,910.65" "$4,245.88" N/A "$2,462.68" "$4,245.88" "$2,547.53" "$4,245.88" "$4,245.88" "$4,245.88" N/A N/A 4201527F SUP Custom 27803010 4201527F - CAGE SPNL 0D 15MM 27MM WHL BD STNDALN BOTH IP/OP "$4,246.00" "$3,142.00" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $884.89 "$4,245.88" "$1,698.35" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$3,184.50" "$4,245.88" "$4,245.88" "$4,245.88" "$2,122.94" "$2,122.94" "$3,362.74" "$4,245.88" "$3,396.70" "$1,910.65" "$4,245.88" N/A "$2,462.68" "$4,245.88" "$2,547.53" "$4,245.88" "$4,245.88" "$4,245.88" N/A N/A 4201727F SUP Custom 27803010 4201727F - CAGE SPNL 0D 17MM 27MM WHL BD STNDALN BOTH IP/OP "$4,246.00" "$3,142.00" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $884.89 "$4,245.88" "$1,698.35" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$3,184.50" "$4,245.88" "$4,245.88" "$4,245.88" "$2,122.94" "$2,122.94" "$3,362.74" "$4,245.88" "$3,396.70" "$1,910.65" "$4,245.88" N/A "$2,462.68" "$4,245.88" "$2,547.53" "$4,245.88" "$4,245.88" "$4,245.88" N/A N/A 420404F SUP Custom 27203010 420404F - CATHETER CHLGM 4FR 40CM STRL 3W LL BVL BIL BOTH IP/OP $68.00 $50.00 $12.04 $162.23 $67.65 $67.65 $67.65 $67.65 $67.65 $67.65 $12.04 $67.65 $67.65 $50.21 $50.21 $52.14 $35.25 $14.10 $67.65 $81.76 $67.65 $67.65 $162.23 $67.65 $67.65 $51.00 $67.65 $67.65 $67.65 $33.83 $33.83 $53.58 $67.65 $54.12 $43.97 $67.65 N/A $39.44 $67.65 $40.59 $67.65 $67.65 $67.65 N/A N/A 420406F SUP Custom 27203010 420406F - CATHETER CHLGM 6FR 40CM BIL BOTH IP/OP $68.00 $50.00 $12.04 $162.23 $67.65 $67.65 $67.65 $67.65 $67.65 $67.65 $12.04 $67.65 $67.65 $50.21 $50.21 $52.14 $35.25 $14.10 $67.65 $81.76 $67.65 $67.65 $162.23 $67.65 $67.65 $51.00 $67.65 $67.65 $67.65 $33.83 $33.83 $53.58 $67.65 $54.12 $43.97 $67.65 N/A $39.44 $67.65 $40.59 $67.65 $67.65 $67.65 N/A N/A 42-1002 SUP HCPCS C1713 42-1002 - PLATE BONE LONG 1MM 6 HOLE Y TRAUMAONE SILVER TITANIUM BOTH IP/OP "$1,402.50" "$1,038.00" $278.36 "$1,402.50" $631.13 $631.13 $631.13 $631.13 "$1,402.50" "$1,402.50" "$1,402.50" $292.32 "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" $292.30 "$1,402.50" "$1,402.50" $829.58 "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" "$1,051.88" "$1,402.50" "$1,402.50" "$1,402.50" $701.25 $701.25 "$1,110.78" "$1,402.50" "$1,122.00" $631.13 $278.36 N/A $813.45 "$1,402.50" $841.50 "$1,402.50" $292.28 "$1,402.50" N/A N/A 42-1003 SUP HCPCS C1713 42-1003 - PLATE BONE 1MM 7 HOLE CVD TRAUMAONE SILVER TITANIUM MANDIB 2 BOTH IP/OP "$1,402.50" "$1,038.00" $278.36 "$1,402.50" $631.13 $631.13 $631.13 $631.13 "$1,402.50" "$1,402.50" "$1,402.50" $292.32 "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" $292.30 "$1,402.50" $561.00 $829.58 "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" "$1,051.88" "$1,402.50" "$1,402.50" "$1,402.50" $701.25 $701.25 "$1,110.78" "$1,402.50" "$1,122.00" $631.13 $278.36 N/A $813.45 "$1,402.50" $841.50 "$1,402.50" $292.28 "$1,402.50" N/A N/A 42-1004 SUP HCPCS C1713 42-1004 - PLATE BONE STR 1MM 4 HOLE GAP TRAUMAONE SILVER TITANIUM BOTH IP/OP "$1,930.00" "$1,428.00" $383.06 "$1,930.00" $868.50 $868.50 $868.50 $868.50 "$1,930.00" "$1,930.00" "$1,930.00" $402.26 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" "$1,930.00" "$1,141.60" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 $383.06 N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" $402.21 "$1,930.00" N/A N/A 42-1005 SUP HCPCS C1713 42-1005 - PLATE BONE 1MM 2X7 HOLE MATRIX STR TRAUMAONE SILVER MANDIB BOTH IP/OP "$1,402.50" "$1,038.00" $278.36 "$1,402.50" $631.13 $631.13 $631.13 $631.13 "$1,402.50" "$1,402.50" "$1,402.50" $292.32 "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" $292.30 "$1,402.50" "$1,402.50" $829.58 "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" "$1,051.88" "$1,402.50" "$1,402.50" "$1,402.50" $701.25 $701.25 "$1,110.78" "$1,402.50" "$1,122.00" $631.13 $278.36 N/A $813.45 "$1,402.50" $841.50 "$1,402.50" $292.28 "$1,402.50" N/A N/A 42-1006 SUP HCPCS C1713 42-1006 - PLATE 2X7 CRVD MATRIX 1.0MM BOTH IP/OP "$1,402.50" "$1,038.00" $278.36 "$1,402.50" $631.13 $631.13 $631.13 $631.13 "$1,402.50" "$1,402.50" "$1,402.50" $292.32 "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" $292.30 "$1,402.50" $561.00 $829.58 "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" "$1,051.88" "$1,402.50" "$1,402.50" "$1,402.50" $701.25 $701.25 "$1,110.78" "$1,402.50" "$1,122.00" $631.13 $278.36 N/A $813.45 "$1,402.50" $841.50 "$1,402.50" $292.28 "$1,402.50" N/A N/A 42-1007 SUP HCPCS C1713 42-1007 - PLATE BONE STR 1MM 7 HOLE TRAUMAONE LORENZ TITANIUM MANDIB BOTH IP/OP "$1,930.00" "$1,428.00" $383.06 "$1,930.00" $868.50 $868.50 $868.50 $868.50 "$1,930.00" "$1,930.00" "$1,930.00" $402.26 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" "$1,930.00" "$1,141.60" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 $383.06 N/A "$1,119.40" "$1,930.00" "$1,930.00" "$1,930.00" $402.21 "$1,930.00" N/A N/A 42-1016 SUP HCPCS C1713 42-1016 - PLATE 16 HOLE STR 1.0MM BOTH IP/OP "$2,295.00" "$1,698.00" $455.50 "$2,295.00" "$1,032.75" "$1,032.75" "$1,032.75" "$1,032.75" "$2,295.00" "$2,295.00" "$2,295.00" $478.34 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$1,357.49" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" $455.50 N/A "$1,331.10" "$2,295.00" "$2,295.00" "$2,295.00" $478.28 "$2,295.00" N/A N/A 4241327F SUP Custom 27803010 4241327F - CAGE SPNL 4D 13MM 27MM WHL BD STNDALN BOTH IP/OP "$4,246.00" "$3,142.00" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $884.89 "$4,245.88" "$1,698.35" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$3,184.50" "$4,245.88" "$4,245.88" "$4,245.88" "$2,122.94" "$2,122.94" "$3,362.74" "$4,245.88" "$3,396.70" "$1,910.65" "$4,245.88" N/A "$2,462.68" "$4,245.88" "$2,547.53" "$4,245.88" "$4,245.88" "$4,245.88" N/A N/A 4241521F SUP Custom 27803010 4241521F - CAGE SPNL 4D 15MM 21MM FRNTL STNDALN BOTH IP/OP "$2,022.00" "$1,496.00" $359.89 "$2,021.88" "$2,021.88" "$2,021.88" "$2,021.88" "$2,021.88" "$2,021.88" "$2,021.88" $359.89 "$2,021.88" "$2,021.88" "$2,021.88" "$2,021.88" "$2,021.88" "$2,021.88" $421.38 "$2,021.88" $808.75 "$2,021.88" "$2,021.88" "$2,021.88" "$2,021.88" "$2,021.88" "$1,516.50" "$2,021.88" "$2,021.88" "$2,021.88" "$1,010.94" "$1,010.94" "$1,601.33" "$2,021.88" "$1,617.50" $909.85 "$2,021.88" N/A "$1,172.76" "$2,021.88" "$1,213.13" "$2,021.88" "$2,021.88" "$2,021.88" N/A N/A 4241527B SUP Custom 27803010 4241527B - CAGE SPNL 4D 15MM 27MM WHL BD STNDALN BOTH IP/OP "$4,246.00" "$3,142.00" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $884.89 "$4,245.88" "$1,698.35" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$3,184.50" "$4,245.88" "$4,245.88" "$4,245.88" "$2,122.94" "$2,122.94" "$3,362.74" "$4,245.88" "$3,396.70" "$1,910.65" "$4,245.88" N/A "$2,462.68" "$4,245.88" "$2,547.53" "$4,245.88" "$4,245.88" "$4,245.88" N/A N/A 4241527F SUP Custom 27803010 4241527F - CAGE SPNL 4D 15MM 27MM WHL BD STNDALN BOTH IP/OP "$4,246.00" "$3,142.00" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $884.89 "$4,245.88" "$1,698.35" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$3,184.50" "$4,245.88" "$4,245.88" "$4,245.88" "$2,122.94" "$2,122.94" "$3,362.74" "$4,245.88" "$3,396.70" "$1,910.65" "$4,245.88" N/A "$2,462.68" "$4,245.88" "$2,547.53" "$4,245.88" "$4,245.88" "$4,245.88" N/A N/A 4241727B SUP Custom 27803010 4241727B - CAGE SPNL 4D 17MM 27MM WHL BD STNDALN BOTH IP/OP "$4,246.00" "$3,142.00" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $884.89 "$4,245.88" "$1,698.35" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$3,184.50" "$4,245.88" "$4,245.88" "$4,245.88" "$2,122.94" "$2,122.94" "$3,362.74" "$4,245.88" "$3,396.70" "$1,910.65" "$4,245.88" N/A "$2,462.68" "$4,245.88" "$2,547.53" "$4,245.88" "$4,245.88" "$4,245.88" N/A N/A 4241727F SUP Custom 27803010 4241727F - CAGE SPNL 4D 17MM 27MM WHL BD STNDALN BOTH IP/OP "$4,246.00" "$3,142.00" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $884.89 "$4,245.88" "$1,698.35" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$3,184.50" "$4,245.88" "$4,245.88" "$4,245.88" "$2,122.94" "$2,122.94" "$3,362.74" "$4,245.88" "$3,396.70" "$1,910.65" "$4,245.88" N/A "$2,462.68" "$4,245.88" "$2,547.53" "$4,245.88" "$4,245.88" "$4,245.88" N/A N/A 426.702S SUP HCPCS C1713 426.702S - PLATE BONE BROAD 372MM 20 HOLE CVD LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$2,443.50" "$1,808.00" $484.89 "$2,484.63" "$1,099.40" "$1,099.40" "$1,099.40" "$1,099.40" "$2,443.10" "$2,443.10" "$2,443.10" $509.20 "$2,443.10" "$2,443.10" "$2,443.10" "$2,443.10" "$2,443.10" $509.17 "$2,443.10" $993.85 "$1,445.09" "$2,443.10" "$2,484.63" "$2,443.10" "$2,443.10" "$1,832.63" "$2,443.10" "$2,443.10" "$2,443.10" "$1,221.55" "$1,221.55" "$1,934.94" "$2,443.10" "$1,954.48" "$1,099.40" $484.89 N/A "$1,417.23" "$2,443.10" "$2,443.10" "$2,443.10" "$2,443.10" "$2,443.10" N/A N/A 426.722S SUP HCPCS C1713 426.722S - PLATE BONE BROAD 408MM 22 HOLE CVD LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$2,669.50" "$1,975.00" $529.81 "$2,714.78" "$1,201.23" "$1,201.23" "$1,201.23" "$1,201.23" "$2,669.40" "$2,669.40" "$2,669.40" $556.37 "$2,669.40" "$2,669.40" "$2,669.40" "$2,669.40" "$2,669.40" $556.33 "$2,669.40" "$1,085.91" "$1,316.01" "$2,669.40" "$2,714.78" "$2,669.40" "$2,669.40" "$2,002.13" "$2,669.40" "$2,669.40" "$2,669.40" "$1,334.70" "$1,334.70" "$2,114.16" "$2,669.40" "$2,135.52" "$1,201.23" $529.81 N/A "$1,548.31" "$2,669.40" "$1,601.64" "$2,669.40" $556.30 "$2,669.40" N/A N/A 426.742S SUP HCPCS C1713 426.742S - PLATE BONE BROAD 443MM 24 HOLE CVD LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$2,897.50" "$2,144.00" $575.01 "$2,946.38" "$1,303.71" "$1,303.71" "$1,303.71" "$1,303.71" "$2,897.13" "$2,897.13" "$2,897.13" $603.83 "$2,897.13" "$2,897.13" "$2,897.13" "$2,897.13" "$2,897.13" $603.79 "$2,897.13" "$2,946.38" "$1,428.29" "$2,897.13" "$2,946.38" "$2,897.13" "$2,897.13" "$2,173.13" "$2,897.13" "$2,897.13" "$2,897.13" "$1,448.57" "$1,448.57" "$2,294.53" "$2,897.13" "$2,317.70" "$1,303.71" $575.01 N/A "$1,680.55" "$2,897.13" "$1,738.28" "$2,897.13" $603.76 "$2,897.13" N/A N/A 426.762S SUP HCPCS C1713 426.762S - PLATE BONE BROAD 479MM 26 HOLE CVD LCP TITANIUM ORTHOPEDIC BOTH IP/OP "$3,129.50" "$2,316.00" $621.04 "$3,182.28" "$1,408.09" "$1,408.09" "$1,408.09" "$1,408.09" "$3,129.08" "$3,129.08" "$3,129.08" $652.18 "$3,129.08" "$3,129.08" "$3,129.08" "$3,129.08" "$3,129.08" $652.13 "$3,129.08" "$3,182.28" "$1,542.64" "$3,129.08" "$3,182.28" "$3,129.08" "$3,129.08" "$2,347.13" "$3,129.08" "$3,129.08" "$3,129.08" "$1,564.54" "$1,564.54" "$2,478.23" "$3,129.08" "$2,503.26" "$1,408.09" $621.04 N/A "$1,815.11" "$3,129.08" "$1,877.45" "$3,129.08" $652.10 "$3,129.08" N/A N/A 42615-05 SUP Custom 27203010 42615-05 - KIT PRESSURE MONITR 3ML/HR 48IN 2 LINE TRANSDUCER MALE TO BOTH IP/OP $36.50 $27.00 $6.47 $36.36 $36.36 $36.36 $36.36 $36.36 $36.36 $36.36 $6.47 $36.36 $36.36 $26.99 $26.99 $28.03 $18.94 $7.58 $36.36 $14.54 $36.36 $36.36 $36.36 $36.36 $36.36 $27.38 $36.36 $36.36 $36.36 $18.18 $18.18 $28.80 $36.36 $29.09 $23.63 $36.36 N/A $21.17 $36.36 $21.82 $36.36 $36.36 $36.36 N/A N/A 42650-06 SUP Custom 27203010 42650-06 - KIT PRESSURE MONITR 84IN TRANSDUCER FLUSH DEVICE TUBE BOTH IP/OP $73.50 $54.00 $13.02 $73.16 $73.16 $73.16 $73.16 $73.16 $73.16 $73.16 $13.02 $73.16 $73.16 $54.30 $54.30 $56.39 $38.12 $15.25 $73.16 $29.26 $73.16 $73.16 $73.16 $73.16 $73.16 $55.13 $73.16 $73.16 $73.16 $36.58 $36.58 $57.94 $73.16 $58.53 $47.55 $73.16 N/A $42.63 $73.16 $43.90 $73.16 $73.16 $73.16 N/A N/A 427022S SUP HCPCS C1713 427022S - PLATE BN 292MM STRL 22 HL CMPR LCK BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 427069S SUP HCPCS C1713 427069S - PLATE BONE 115MM 9 HOLE ONE THIRD TUBULAR SMALL FRAGMENT BOTH IP/OP $237.00 $175.00 $47.00 $236.80 $106.56 $106.56 $106.56 $106.56 $236.80 $236.80 $236.80 $49.36 $236.80 $236.80 $236.80 $236.80 $236.80 $49.35 $236.80 $94.72 $140.07 $236.80 $236.80 $236.80 $236.80 $177.75 $236.80 $236.80 $236.80 $118.40 $118.40 $187.55 $236.80 $189.44 $106.56 $47.00 N/A $137.46 $236.80 $236.80 $236.80 $49.35 $236.80 N/A N/A 4281127B SUP Custom 27803010 4281127B - CAGE SPNL 8D 11MM 27MM WHL BD STNDALN BOTH IP/OP "$4,246.00" "$3,142.00" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $884.89 "$4,245.88" "$1,698.35" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$3,184.50" "$4,245.88" "$4,245.88" "$4,245.88" "$2,122.94" "$2,122.94" "$3,362.74" "$4,245.88" "$3,396.70" "$1,910.65" "$4,245.88" N/A "$2,462.68" "$4,245.88" "$2,547.53" "$4,245.88" "$4,245.88" "$4,245.88" N/A N/A 4281127F SUP Custom 27803010 4281127F - CAGE SPNL 8D 11MM 27MM WHL BD STNDALN BOTH IP/OP "$4,246.00" "$3,142.00" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $884.89 "$4,245.88" "$1,698.35" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$3,184.50" "$4,245.88" "$4,245.88" "$4,245.88" "$2,122.94" "$2,122.94" "$3,362.74" "$4,245.88" "$3,396.70" "$1,910.65" "$4,245.88" N/A "$2,462.68" "$4,245.88" "$2,547.53" "$4,245.88" "$4,245.88" "$4,245.88" N/A N/A 4281327B SUP Custom 27803010 4281327B - CAGE SPNL 8D 13MM 27MM WHL BD STNDALN BOTH IP/OP "$4,246.00" "$3,142.00" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $884.89 "$4,245.88" "$1,698.35" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$3,184.50" "$4,245.88" "$4,245.88" "$4,245.88" "$2,122.94" "$2,122.94" "$3,362.74" "$4,245.88" "$3,396.70" "$1,910.65" "$4,245.88" N/A "$2,462.68" "$4,245.88" "$2,547.53" "$4,245.88" "$4,245.88" "$4,245.88" N/A N/A 4281327F SUP Custom 27803010 4281327F - CAGE SPNL 8D 13MM 27MM WHL BD STNDALN BOTH IP/OP "$4,246.00" "$3,142.00" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $755.77 "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" $884.89 "$4,245.88" "$1,698.35" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$4,245.88" "$3,184.50" "$4,245.88" "$4,245.88" "$4,245.88" "$2,122.94" "$2,122.94" "$3,362.74" "$4,245.88" "$3,396.70" "$1,910.65" "$4,245.88" N/A "$2,462.68" "$4,245.88" "$2,547.53" "$4,245.88" "$4,245.88" "$4,245.88" N/A N/A 4296-78 SUP HCPCS C1900 4296-78 - LEAD PACING 2 CURVE 5.3FR 78CM BIPOL 2 ELECTRODE 2 FIX IS-1 BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 43-1001 SUP HCPCS C1713 43-1001 - PLATE BONE SMALL 1MM ANGLED TRAUMAONE GOLD TITANIUM MANDIB 2 BOTH IP/OP "$3,127.50" "$2,314.00" $620.73 "$3,127.50" "$1,407.38" "$1,407.38" "$1,407.38" "$1,407.38" "$3,127.50" "$3,127.50" "$3,127.50" $651.85 "$3,127.50" "$3,127.50" "$3,127.50" "$3,127.50" "$3,127.50" $651.81 "$3,127.50" "$3,127.50" "$1,541.86" "$3,127.50" "$3,127.50" "$3,127.50" "$3,127.50" "$2,345.63" "$3,127.50" "$3,127.50" "$3,127.50" "$1,563.75" "$1,563.75" "$2,476.98" "$3,127.50" "$2,502.00" "$1,407.38" $620.73 N/A "$1,813.95" "$3,127.50" "$1,876.50" "$3,127.50" $651.77 "$3,127.50" N/A N/A 43-1004 SUP HCPCS C1713 43-1004 - PLATE BONE STR 4 HOLE GAP CRANIOMAXILLOFACIAL BOTH IP/OP "$1,930.00" "$1,428.00" $383.06 "$1,930.00" $868.50 $868.50 $868.50 $868.50 "$1,930.00" "$1,930.00" "$1,930.00" $402.26 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,141.60" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 $383.06 N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" $402.21 "$1,930.00" N/A N/A 43-1005 SUP HCPCS C1713 43-1005 - PLATE BONE 1MM 4 HOLE STR TRAUMAONE GOLD TITANIUM MANDIB BOTH IP/OP "$1,930.00" "$1,428.00" $383.06 "$1,930.00" $868.50 $868.50 $868.50 $868.50 "$1,930.00" "$1,930.00" "$1,930.00" $402.26 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,141.60" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 $383.06 N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" $402.21 "$1,930.00" N/A N/A 43-1007 SUP HCPCS C1713 43-1007 - PLATE BONE 1.6MM 7 HOLE STR BOTH IP/OP "$2,295.00" "$1,698.00" $455.50 "$2,295.00" "$1,032.75" "$1,032.75" "$1,032.75" "$1,032.75" "$2,295.00" "$2,295.00" "$2,295.00" $478.34 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $478.30 "$2,295.00" $918.00 "$1,357.49" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,032.75" $455.50 N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" $478.28 "$2,295.00" N/A N/A 43-1008 SUP HCPCS C1713 43-1008 - PLATE BONE THK1.6MM CVD 7 HOLE LORENZ GOLD MANDIB BOTH IP/OP "$3,127.50" "$2,314.00" $620.73 "$3,127.50" "$1,407.38" "$1,407.38" "$1,407.38" "$1,407.38" "$3,127.50" "$3,127.50" "$3,127.50" $651.85 "$3,127.50" "$3,127.50" "$3,127.50" "$3,127.50" "$3,127.50" $651.81 "$3,127.50" "$3,127.50" "$1,541.86" "$3,127.50" "$3,127.50" "$3,127.50" "$3,127.50" "$2,345.63" "$3,127.50" "$3,127.50" "$3,127.50" "$1,563.75" "$1,563.75" "$2,476.98" "$3,127.50" "$2,502.00" "$1,407.38" $620.73 N/A "$1,813.95" "$3,127.50" "$1,876.50" "$3,127.50" $651.77 "$3,127.50" N/A N/A 43-1016 SUP HCPCS C1713 43-1016 - PLATE BONE 1.6MM 16 HOLE STR TRAUMAONE GOLD MANDIB BOTH IP/OP "$3,552.50" "$2,629.00" $705.08 "$3,552.50" "$1,598.63" "$1,598.63" "$1,598.63" "$1,598.63" "$3,552.50" "$3,552.50" "$3,552.50" $740.43 "$3,552.50" "$3,552.50" "$3,552.50" "$3,552.50" "$3,552.50" $740.38 "$3,552.50" "$3,552.50" "$1,751.38" "$3,552.50" "$3,552.50" "$3,552.50" "$3,552.50" "$2,664.38" "$3,552.50" "$3,552.50" "$3,552.50" "$1,776.25" "$1,776.25" "$2,813.58" "$3,552.50" "$2,842.00" "$1,598.63" $705.08 N/A "$2,060.45" "$3,552.50" "$2,131.50" "$3,552.50" $740.34 "$3,552.50" N/A N/A 43-1280 SUP Custom 27203010 43-1280 - KIT RSN REPR 75 PPM CRNPLST CMPLT SET TY 2 PWDR CRNL BOTH IP/OP "$4,296.50" "$3,179.00" $764.76 "$4,296.40" "$4,296.40" "$4,296.40" "$4,296.40" "$4,296.40" "$4,296.40" "$4,296.40" $764.76 "$4,296.40" "$4,296.40" "$3,188.79" "$3,188.79" "$3,311.67" "$2,060.15" $895.42 "$4,296.40" "$1,718.56" "$4,296.40" "$4,296.40" "$4,296.40" "$4,296.40" "$4,296.40" "$3,222.38" "$4,296.40" "$4,296.40" "$4,296.40" "$2,148.20" "$2,148.20" "$3,402.75" "$4,296.40" "$3,437.12" "$2,792.66" "$4,296.40" N/A "$2,491.97" "$4,296.40" "$2,577.84" "$4,296.40" "$4,296.40" "$4,296.40" N/A N/A 4324A SUP Custom 27203010 4324A - TRAY PROCEDURE 20GA 3.5IN MYELOGRAM PH WATER SOLUBLE CLEAR BOTH IP/OP $25.00 $19.00 $4.40 $48.14 $24.70 $24.70 $24.70 $24.70 $24.70 $24.70 $4.40 $24.70 $24.70 $18.33 $18.33 $19.04 $12.87 $5.15 $24.70 $48.14 $24.70 $24.70 $24.70 $24.70 $24.70 $18.75 $24.70 $24.70 $24.70 $12.35 $12.35 $19.56 $24.70 $19.76 $16.06 $24.70 N/A $14.50 $24.70 $14.82 $24.70 $24.70 $24.70 N/A N/A 433-01 SUP Custom 27203010 433-01 - CUTTER WIRE LONG PLATE CARBIDE BOTH IP/OP "$1,065.00" $788.00 $189.50 "$1,064.63" "$1,064.63" "$1,064.63" "$1,064.63" "$1,064.63" "$1,064.63" "$1,064.63" $189.50 "$1,064.63" "$1,064.63" $790.17 $790.17 $820.62 $554.67 $221.88 "$1,064.63" $425.85 "$1,064.63" "$1,064.63" "$1,064.63" "$1,064.63" "$1,064.63" $798.75 "$1,064.63" "$1,064.63" "$1,064.63" $532.32 $532.32 $843.19 "$1,064.63" $851.70 $692.01 "$1,064.63" N/A $617.70 "$1,064.63" $638.78 "$1,064.63" "$1,064.63" "$1,064.63" N/A N/A 435002S SUP HCPCS C1713 435002S - PLATE BONE 34MM 2 HOLE STAINLESS STEEL PERIARTICULAR LEFT BOTH IP/OP "$1,114.00" $824.00 $221.05 "$1,113.75" $501.19 $501.19 $501.19 $501.19 "$1,113.75" "$1,113.75" "$1,113.75" $232.13 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $232.12 "$1,113.75" $445.50 $658.78 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $835.50 "$1,113.75" "$1,113.75" "$1,113.75" $556.88 $556.88 $882.09 "$1,113.75" $891.00 $501.19 $221.05 N/A $646.12 "$1,113.75" $668.25 "$1,113.75" $232.11 "$1,113.75" N/A N/A 435004S SUP HCPCS C1713 435004S - PLATE BONE 60MM 4 HOLE STAINLESS STEEL PERIARTICULAR LEFT BOTH IP/OP "$1,114.00" $824.00 $221.05 "$1,113.75" $501.19 $501.19 $501.19 $501.19 "$1,113.75" "$1,113.75" "$1,113.75" $232.13 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $232.12 "$1,113.75" $445.50 $658.78 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $835.50 "$1,113.75" "$1,113.75" "$1,113.75" $556.88 $556.88 $882.09 "$1,113.75" $891.00 $501.19 $221.05 N/A $646.12 "$1,113.75" $668.25 "$1,113.75" $232.11 "$1,113.75" N/A N/A 435006S SUP HCPCS C1713 435006S - PLATE BONE 86MM 6 HOLE STAINLESS STEEL PERIARTICULAR LEFT BOTH IP/OP "$1,114.00" $824.00 $221.05 "$1,113.75" $501.19 $501.19 $501.19 $501.19 "$1,113.75" "$1,113.75" "$1,113.75" $232.13 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $232.12 "$1,113.75" $445.50 $658.78 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $835.50 "$1,113.75" "$1,113.75" "$1,113.75" $556.88 $556.88 $882.09 "$1,113.75" $891.00 $501.19 $221.05 N/A $646.12 "$1,113.75" $668.25 "$1,113.75" $232.11 "$1,113.75" N/A N/A 435008S SUP HCPCS C1713 435008S - PLATE BONE 112MM 8 HOLE STAINLESS STEEL PERIARTICULAR LEFT BOTH IP/OP "$1,114.00" $824.00 $221.05 "$1,113.75" $501.19 $501.19 $501.19 $501.19 "$1,113.75" "$1,113.75" "$1,113.75" $232.13 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $232.12 "$1,113.75" $445.50 $658.78 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $835.50 "$1,113.75" "$1,113.75" "$1,113.75" $556.88 $556.88 $882.09 "$1,113.75" $891.00 $501.19 $221.05 N/A $646.12 "$1,113.75" "$1,113.75" "$1,113.75" $232.11 "$1,113.75" N/A N/A 435010S SUP HCPCS C1713 435010S - PLATE BONE 138MM 10 HOLE STAINLESS STEEL PERIARTICULAR LEFT BOTH IP/OP "$1,149.50" $851.00 $228.15 "$1,149.50" $517.28 $517.28 $517.28 $517.28 "$1,149.50" "$1,149.50" "$1,149.50" $239.58 "$1,149.50" "$1,149.50" "$1,149.50" "$1,149.50" "$1,149.50" $239.57 "$1,149.50" $459.80 $679.93 "$1,149.50" "$1,149.50" "$1,149.50" "$1,149.50" $862.13 "$1,149.50" "$1,149.50" "$1,149.50" $574.75 $574.75 $910.40 "$1,149.50" $919.60 $517.28 $228.15 N/A $666.71 "$1,149.50" $689.70 "$1,149.50" $239.56 "$1,149.50" N/A N/A 435012S SUP HCPCS C1713 435012S - PLATE BONE 164MM 12 HOLE STAINLESS STEEL PERIARTICULAR LEFT BOTH IP/OP "$1,149.50" $851.00 $228.15 "$1,149.50" $517.28 $517.28 $517.28 $517.28 "$1,149.50" "$1,149.50" "$1,149.50" $239.58 "$1,149.50" "$1,149.50" "$1,149.50" "$1,149.50" "$1,149.50" $239.57 "$1,149.50" $459.80 $679.93 "$1,149.50" "$1,149.50" "$1,149.50" "$1,149.50" $862.13 "$1,149.50" "$1,149.50" "$1,149.50" $574.75 $574.75 $910.40 "$1,149.50" $919.60 $517.28 $228.15 N/A $666.71 "$1,149.50" $689.70 "$1,149.50" $239.56 "$1,149.50" N/A N/A 435014S SUP HCPCS C1713 435014S - PLATE BONE 190MM 14 HOLE STAINLESS STEEL PERIARTICULAR LEFT BOTH IP/OP "$1,193.50" $883.00 $236.88 "$1,193.50" $537.08 $537.08 $537.08 $537.08 "$1,193.50" "$1,193.50" "$1,193.50" $248.76 "$1,193.50" "$1,193.50" "$1,193.50" "$1,193.50" "$1,193.50" $248.74 "$1,193.50" $477.40 $705.96 "$1,193.50" "$1,193.50" "$1,193.50" "$1,193.50" $895.13 "$1,193.50" "$1,193.50" "$1,193.50" $596.75 $596.75 $945.25 "$1,193.50" $954.80 $537.08 $236.88 N/A $692.23 "$1,193.50" $716.10 "$1,193.50" "$1,193.50" "$1,193.50" N/A N/A 435022S SUP HCPCS C1713 435022S - PLATE BONE 34MM 2 HOLE STAINLESS STEEL PERIARTICULAR RIGHT BOTH IP/OP "$1,114.00" $824.00 $221.05 "$1,113.75" $501.19 $501.19 $501.19 $501.19 "$1,113.75" "$1,113.75" "$1,113.75" $232.13 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $232.12 "$1,113.75" $445.50 $658.78 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $835.50 "$1,113.75" "$1,113.75" "$1,113.75" $556.88 $556.88 $882.09 "$1,113.75" $891.00 $501.19 $221.05 N/A $646.12 "$1,113.75" $668.25 "$1,113.75" $232.11 "$1,113.75" N/A N/A 435024S SUP HCPCS C1713 435024S - PLATE BONE 60MM 4 HOLE STAINLESS STEEL PERIARTICULAR RIGHT BOTH IP/OP "$1,114.00" $824.00 $221.05 "$1,113.75" $501.19 $501.19 $501.19 $501.19 "$1,113.75" "$1,113.75" "$1,113.75" $232.13 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $232.12 "$1,113.75" $445.50 $658.78 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $835.50 "$1,113.75" "$1,113.75" "$1,113.75" $556.88 $556.88 $882.09 "$1,113.75" $891.00 $501.19 $221.05 N/A $646.12 "$1,113.75" $668.25 "$1,113.75" $232.11 "$1,113.75" N/A N/A 435026S SUP HCPCS C1713 435026S - PLATE BONE 86MM 6 HOLE STAINLESS STEEL PERIARTICULAR RIGHT BOTH IP/OP "$1,114.00" $824.00 $221.05 "$1,113.75" $501.19 $501.19 $501.19 $501.19 "$1,113.75" "$1,113.75" "$1,113.75" $232.13 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $232.12 "$1,113.75" $445.50 $658.78 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $835.50 "$1,113.75" "$1,113.75" "$1,113.75" $556.88 $556.88 $882.09 "$1,113.75" $891.00 $501.19 $221.05 N/A $646.12 "$1,113.75" $668.25 "$1,113.75" $232.11 "$1,113.75" N/A N/A 435028S SUP HCPCS C1713 435028S - PLATE BONE 112MM 8 HOLE STAINLESS STEEL PERIARTICULAR RIGHT BOTH IP/OP "$1,114.00" $824.00 $221.05 "$1,113.75" $501.19 $501.19 $501.19 $501.19 "$1,113.75" "$1,113.75" "$1,113.75" $232.13 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $232.12 "$1,113.75" $445.50 $658.78 "$1,113.75" "$1,113.75" "$1,113.75" "$1,113.75" $835.50 "$1,113.75" "$1,113.75" "$1,113.75" $556.88 $556.88 $882.09 "$1,113.75" $891.00 $501.19 $221.05 N/A $646.12 "$1,113.75" $668.25 "$1,113.75" $232.11 "$1,113.75" N/A N/A 435030S SUP HCPCS C1713 435030S - PLATE BONE 138MM 10 HOLE STAINLESS STEEL PERIARTICULAR RIGHT BOTH IP/OP "$1,149.50" $851.00 $228.15 "$1,149.50" $517.28 $517.28 $517.28 $517.28 "$1,149.50" "$1,149.50" "$1,149.50" $239.58 "$1,149.50" "$1,149.50" "$1,149.50" "$1,149.50" "$1,149.50" $239.57 "$1,149.50" "$1,149.50" $679.93 "$1,149.50" "$1,149.50" "$1,149.50" "$1,149.50" $862.13 "$1,149.50" "$1,149.50" "$1,149.50" $574.75 $574.75 $910.40 "$1,149.50" $919.60 $517.28 $228.15 N/A $666.71 "$1,149.50" $689.70 "$1,149.50" "$1,149.50" "$1,149.50" N/A N/A 435032S SUP HCPCS C1713 435032S - PLATE BONE 164MM 12 HOLE STAINLESS STEEL PERIARTICULAR RIGHT BOTH IP/OP "$1,149.50" $851.00 $228.15 "$1,149.50" $517.28 $517.28 $517.28 $517.28 "$1,149.50" "$1,149.50" "$1,149.50" $239.58 "$1,149.50" "$1,149.50" "$1,149.50" "$1,149.50" "$1,149.50" $239.57 "$1,149.50" $459.80 $679.93 "$1,149.50" "$1,149.50" "$1,149.50" "$1,149.50" $862.13 "$1,149.50" "$1,149.50" "$1,149.50" $574.75 $574.75 $910.40 "$1,149.50" $919.60 $517.28 $228.15 N/A $666.71 "$1,149.50" $689.70 "$1,149.50" $239.56 "$1,149.50" N/A N/A 435034S SUP HCPCS C1713 435034S - PLATE BONE 190MM 14 HOLE STAINLESS STEEL PERIARTICULAR RIGHT BOTH IP/OP "$1,193.50" $883.00 $236.88 "$1,193.50" $537.08 $537.08 $537.08 $537.08 "$1,193.50" "$1,193.50" "$1,193.50" $248.76 "$1,193.50" "$1,193.50" "$1,193.50" "$1,193.50" "$1,193.50" $248.74 "$1,193.50" $477.40 $705.96 "$1,193.50" "$1,193.50" "$1,193.50" "$1,193.50" $895.13 "$1,193.50" "$1,193.50" "$1,193.50" $596.75 $596.75 $945.25 "$1,193.50" $954.80 $537.08 $236.88 N/A $692.23 "$1,193.50" $716.10 "$1,193.50" $248.73 "$1,193.50" N/A N/A 435506S SUP HCPCS C1713 435506S - PLATE BONE 6 HOLE SHAFT STAINLESS STEEL PERIARTICULAR LEFT BOTH IP/OP "$1,081.00" $800.00 $214.50 "$1,080.75" $486.34 $486.34 $486.34 $486.34 "$1,080.75" "$1,080.75" "$1,080.75" $225.26 "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" $225.24 "$1,080.75" $432.30 $639.26 "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" $810.75 "$1,080.75" "$1,080.75" "$1,080.75" $540.38 $540.38 $855.95 "$1,080.75" $864.60 $486.34 $214.50 N/A $626.98 "$1,080.75" $648.45 "$1,080.75" "$1,080.75" "$1,080.75" N/A N/A 435508S SUP HCPCS C1713 435508S - PLATE BONE 193MM 8 HOLE STAINLESS STEEL PERIARTICULAR LEFT BOTH IP/OP "$1,081.00" $800.00 $214.50 "$1,080.75" $486.34 $486.34 $486.34 $486.34 "$1,080.75" "$1,080.75" "$1,080.75" $225.26 "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" $225.24 "$1,080.75" "$1,080.75" $639.26 "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" $810.75 "$1,080.75" "$1,080.75" "$1,080.75" $540.38 $540.38 $855.95 "$1,080.75" $864.60 $486.34 $214.50 N/A $626.98 "$1,080.75" "$1,080.75" "$1,080.75" $225.23 "$1,080.75" N/A N/A 435526S SUP HCPCS C1713 435526S - PLATE BONE 157MM 6 HOLE STAINLESS STEEL PERIARTICULAR RIGHT BOTH IP/OP "$1,081.00" $800.00 $214.50 "$1,080.75" $486.34 $486.34 $486.34 $486.34 "$1,080.75" "$1,080.75" "$1,080.75" $225.26 "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" $225.24 "$1,080.75" $432.30 $639.26 "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" $810.75 "$1,080.75" "$1,080.75" "$1,080.75" $540.38 $540.38 $855.95 "$1,080.75" $864.60 $486.34 $214.50 N/A $626.98 "$1,080.75" $648.45 "$1,080.75" $225.23 "$1,080.75" N/A N/A 435528S SUP HCPCS C1713 435528S - PLATE BONE 193MM 8 HOLE STAINLESS STEEL PERIARTICULAR RIGHT BOTH IP/OP "$1,081.00" $800.00 $214.50 "$1,080.75" $486.34 $486.34 $486.34 $486.34 "$1,080.75" "$1,080.75" "$1,080.75" $225.26 "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" $225.24 "$1,080.75" $432.30 $639.26 "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" $810.75 "$1,080.75" "$1,080.75" "$1,080.75" $540.38 $540.38 $855.95 "$1,080.75" $864.60 $486.34 $214.50 N/A $626.98 "$1,080.75" $648.45 "$1,080.75" "$1,080.75" "$1,080.75" N/A N/A 435604S SUP HCPCS C1713 435604S - PLATE BONE 78MM 4 HOLE STAINLESS STEEL PERIARTICULAR LEFT BOTH IP/OP "$1,127.50" $834.00 $223.78 "$1,127.50" $507.38 $507.38 $507.38 $507.38 "$1,127.50" "$1,127.50" "$1,127.50" $235.00 "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" $234.98 "$1,127.50" $451.00 $666.92 "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" $845.63 "$1,127.50" "$1,127.50" "$1,127.50" $563.75 $563.75 $892.98 "$1,127.50" $902.00 $507.38 $223.78 N/A $653.95 "$1,127.50" $676.50 "$1,127.50" $234.97 "$1,127.50" N/A N/A 435606S SUP HCPCS C1713 435606S - PLATE BONE 114MM 6 HOLE STAINLESS STEEL PERIARTICULAR LEFT BOTH IP/OP "$1,056.00" $781.00 $209.59 "$1,056.00" $475.20 $475.20 $475.20 $475.20 "$1,056.00" "$1,056.00" "$1,056.00" $220.10 "$1,056.00" "$1,056.00" "$1,056.00" "$1,056.00" "$1,056.00" $220.08 "$1,056.00" $422.40 $624.62 "$1,056.00" "$1,056.00" "$1,056.00" "$1,056.00" $792.00 "$1,056.00" "$1,056.00" "$1,056.00" $528.00 $528.00 $836.35 "$1,056.00" $844.80 $475.20 $209.59 N/A $612.48 "$1,056.00" $633.60 "$1,056.00" "$1,056.00" "$1,056.00" N/A N/A 435608S SUP HCPCS C1713 435608S - PLATE BONE 150MM 8 HOLE STAINLESS STEEL PERIARTICULAR LEFT BOTH IP/OP "$1,171.50" $867.00 $232.51 "$1,171.50" $527.18 $527.18 $527.18 $527.18 "$1,171.50" "$1,171.50" "$1,171.50" $244.17 "$1,171.50" "$1,171.50" "$1,171.50" "$1,171.50" "$1,171.50" $244.15 "$1,171.50" $468.60 $692.94 "$1,171.50" "$1,171.50" "$1,171.50" "$1,171.50" $878.63 "$1,171.50" "$1,171.50" "$1,171.50" $585.75 $585.75 $927.83 "$1,171.50" $937.20 $527.18 $232.51 N/A $679.47 "$1,171.50" $702.90 "$1,171.50" $244.14 "$1,171.50" N/A N/A 435624S SUP HCPCS C1713 435624S - PLATE BONE 78MM 4 HOLE STAINLESS STEEL PERIARTICULAR RIGHT BOTH IP/OP "$1,127.50" $834.00 $223.78 "$1,127.50" $507.38 $507.38 $507.38 $507.38 "$1,127.50" "$1,127.50" "$1,127.50" $235.00 "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" $234.98 "$1,127.50" $451.00 $666.92 "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" $845.63 "$1,127.50" "$1,127.50" "$1,127.50" $563.75 $563.75 $892.98 "$1,127.50" $902.00 $507.38 $223.78 N/A $653.95 "$1,127.50" "$1,127.50" "$1,127.50" $234.97 "$1,127.50" N/A N/A 435626S SUP HCPCS C1713 435626S - PLATE BONE 114MM 6 HOLE STAINLESS STEEL PERIARTICULAR RIGHT BOTH IP/OP "$1,127.50" $834.00 $223.78 "$1,127.50" $507.38 $507.38 $507.38 $507.38 "$1,127.50" "$1,127.50" "$1,127.50" $235.00 "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" $234.98 "$1,127.50" "$1,127.50" $666.92 "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" $845.63 "$1,127.50" "$1,127.50" "$1,127.50" $563.75 $563.75 $892.98 "$1,127.50" $902.00 $507.38 $223.78 N/A $653.95 "$1,127.50" $676.50 "$1,127.50" "$1,127.50" "$1,127.50" N/A N/A 435628S SUP HCPCS C1713 435628S - PLATE BONE 150MM 8 HOLE STAINLESS STEEL PERIARTICULAR RIGHT BOTH IP/OP "$1,171.50" $867.00 $232.51 "$1,171.50" $527.18 $527.18 $527.18 $527.18 "$1,171.50" "$1,171.50" "$1,171.50" $244.17 "$1,171.50" "$1,171.50" "$1,171.50" "$1,171.50" "$1,171.50" $244.15 "$1,171.50" $468.60 $692.94 "$1,171.50" "$1,171.50" "$1,171.50" "$1,171.50" $878.63 "$1,171.50" "$1,171.50" "$1,171.50" $585.75 $585.75 $927.83 "$1,171.50" $937.20 $527.18 $232.51 N/A $679.47 "$1,171.50" $702.90 "$1,171.50" $244.14 "$1,171.50" N/A N/A 436.504S SUP HCPCS C1713 436.504S - PLATE BONE 4 LCP TITANIUM OLECRANON STERILE 3.5MM SCREWS BOTH IP/OP "$1,865.50" "$1,380.00" $370.23 "$1,897.05" $839.41 $839.41 $839.41 $839.41 "$1,865.35" "$1,865.35" "$1,865.35" $388.79 "$1,865.35" "$1,865.35" "$1,865.35" "$1,865.35" "$1,865.35" $388.76 "$1,865.35" $758.82 "$1,103.35" "$1,865.35" "$1,897.05" "$1,865.35" "$1,865.35" "$1,399.13" "$1,865.35" "$1,865.35" "$1,865.35" $932.68 $932.68 "$1,477.36" "$1,865.35" "$1,492.28" $839.41 $370.23 N/A "$1,081.99" "$1,865.35" "$1,865.35" "$1,865.35" $388.74 "$1,865.35" N/A N/A 436.505S SUP HCPCS C1713 436.505S - PLATE BONE 112MM 4 HOLE LCP TITANIUM LEFT OLECRANON STERILE BOTH IP/OP "$1,865.50" "$1,380.00" $370.23 "$1,897.05" $839.41 $839.41 $839.41 $839.41 "$1,865.35" "$1,865.35" "$1,865.35" $388.79 "$1,865.35" "$1,865.35" "$1,865.35" "$1,865.35" "$1,865.35" $388.76 "$1,865.35" $758.82 "$1,103.35" "$1,865.35" "$1,897.05" "$1,865.35" "$1,865.35" "$1,399.13" "$1,865.35" "$1,865.35" "$1,865.35" $932.68 $932.68 "$1,477.36" "$1,865.35" "$1,492.28" $839.41 $370.23 N/A "$1,081.99" "$1,865.35" "$1,865.35" "$1,865.35" $388.74 "$1,865.35" N/A N/A 436.508S SUP HCPCS C1713 436.508S - PLATE BONE 164MM 8 HOLE LCP TITANIUM RIGHT OLECRANON STERILE BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" $820.02 "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" $420.09 "$2,015.78" N/A N/A 436.509S SUP HCPCS C1713 436.509S - PLATE BONE 164MM 8 HOLE LCP TITANIUM LEFT OLECRANON STERILE BOTH IP/OP "$2,016.00" "$1,492.00" $400.08 "$2,050.05" $907.10 $907.10 $907.10 $907.10 "$2,015.78" "$2,015.78" "$2,015.78" $420.14 "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" $420.11 "$2,015.78" $820.02 "$1,192.33" "$2,015.78" "$2,050.05" "$2,015.78" "$2,015.78" "$1,512.00" "$2,015.78" "$2,015.78" "$2,015.78" "$1,007.89" "$1,007.89" "$1,596.50" "$2,015.78" "$1,612.62" $907.10 $400.08 N/A "$1,169.28" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" "$2,015.78" N/A N/A 436013B SUP HCPCS C1713 436013B - CENTERPIECE 436013B 13MM B-SIZE BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$4,600.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436013C SUP HCPCS C1713 436013C - CENTERPIECE 436013C 13MM C-SIZE BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$4,600.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436013D SUP HCPCS C1713 436013D - CENTERPIECE 436013D 13MM D-SIZE BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$4,600.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436013E SUP HCPCS C1713 436013E - CENTERPIECE 436013E 13MM E-SIZE BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$11,500.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436020A SUP HCPCS C1713 436020A - CENTERPIECE 436020A 20MM A-SIZE BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 436020B SUP HCPCS C1713 436020B - CENTERPIECE 436020B 20MM B-SIZE BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 436020C SUP HCPCS C1713 436020C - CENTERPIECE 436020C 20MM C-SIZE BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 436020D SUP HCPCS C1713 436020D - CENTERPIECE 436020D 20MM D-SIZE BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 436020E SUP HCPCS C1713 436020E - CENTERPIECE 436020E 20MM E-SIZE BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 436025A SUP HCPCS C1713 436025A - CENTERPIECE 436025A 25MM A-SIZE BOTH IP/OP "$14,500.00" "$10,730.00" "$2,877.89" "$14,500.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,022.16" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.96" "$14,500.00" "$5,800.00" "$7,148.50" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$10,875.00" "$14,500.00" "$14,500.00" "$14,500.00" "$7,250.00" "$7,250.00" "$11,484.00" "$14,500.00" "$11,600.00" "$6,525.00" "$2,877.89" N/A "$8,410.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.80" "$14,500.00" N/A N/A 436025B SUP HCPCS C1713 436025B - CENTERPIECE 436025B 25MM B-SIZE BOTH IP/OP "$14,500.00" "$10,730.00" "$2,877.89" "$14,500.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,022.16" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.96" "$14,500.00" "$5,800.00" "$7,148.50" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$10,875.00" "$14,500.00" "$14,500.00" "$14,500.00" "$7,250.00" "$7,250.00" "$11,484.00" "$14,500.00" "$11,600.00" "$6,525.00" "$2,877.89" N/A "$8,410.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" N/A N/A 436025C SUP HCPCS C1713 436025C - CENTERPIECE 436025C 25MM C-SIZE BOTH IP/OP "$14,500.00" "$10,730.00" "$2,877.89" "$14,500.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,022.16" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.96" "$14,500.00" "$5,800.00" "$7,148.50" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$10,875.00" "$14,500.00" "$14,500.00" "$14,500.00" "$7,250.00" "$7,250.00" "$11,484.00" "$14,500.00" "$11,600.00" "$6,525.00" "$2,877.89" N/A "$8,410.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" N/A N/A 436025D SUP HCPCS C1713 436025D - CENTERPIECE 436025D 25MM D-SIZE BOTH IP/OP "$14,500.00" "$10,730.00" "$2,877.89" "$14,500.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,022.16" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.96" "$14,500.00" "$5,800.00" "$7,148.50" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$10,875.00" "$14,500.00" "$14,500.00" "$14,500.00" "$7,250.00" "$7,250.00" "$11,484.00" "$14,500.00" "$11,600.00" "$6,525.00" "$2,877.89" N/A "$8,410.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.80" "$14,500.00" N/A N/A 436025E SUP HCPCS C1713 436025E - CENTERPIECE 436025E 25MM E-SIZE BOTH IP/OP "$14,500.00" "$10,730.00" "$2,877.89" "$14,500.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,022.16" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.96" "$14,500.00" "$14,500.00" "$7,148.50" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$10,875.00" "$14,500.00" "$14,500.00" "$14,500.00" "$7,250.00" "$7,250.00" "$11,484.00" "$14,500.00" "$11,600.00" "$6,525.00" "$2,877.89" N/A "$8,410.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.80" "$14,500.00" N/A N/A 436113A SUP HCPCS C1713 436113A - CAGE 436113A 13MM A-SIZE STERILE BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$11,500.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436113B SUP HCPCS C1713 436113B - CAGE 436113B 13MM B-SIZE STERILE BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$4,600.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436113C SUP HCPCS C1713 436113C - CAGE 436113C 13MM C-SIZE STERILE BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$11,500.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436113D SUP HCPCS C1713 436113D - CAGE 436113D 13MM D-SIZE STERILE BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$4,600.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436113E SUP HCPCS C1713 436113E - CAGE 436113E 13MM E-SIZE STERILE BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$11,500.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436120A SUP HCPCS C1713 436120A - CAGE 436120A 20MM A-SIZE STERILE BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$13,750.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 436120B SUP HCPCS C1713 436120B - CAGE 436120B 20MM B-SIZE STERILE BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 436120C SUP HCPCS C1713 436120C - CAGE 436120C 20MM C-SIZE STERILE BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 436120D SUP HCPCS C1713 436120D - CAGE 436120D 20MM D-SIZE STERILE BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 436120E SUP HCPCS C1713 436120E - CAGE 436120E 20MM E-SIZE STERILE BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A 436125A SUP HCPCS C1713 436125A - CAGE 436125A 25MM A-SIZE STERILE BOTH IP/OP "$14,500.00" "$10,730.00" "$2,877.89" "$14,500.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,022.16" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.96" "$14,500.00" "$5,800.00" "$7,148.50" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$10,875.00" "$14,500.00" "$14,500.00" "$14,500.00" "$7,250.00" "$7,250.00" "$11,484.00" "$14,500.00" "$11,600.00" "$6,525.00" "$2,877.89" N/A "$8,410.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.80" "$14,500.00" N/A N/A 436125B SUP HCPCS C1713 436125B - CAGE 436125B 25MM B-SIZE STERILE BOTH IP/OP "$14,500.00" "$10,730.00" "$2,877.89" "$14,500.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,022.16" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.96" "$14,500.00" "$14,500.00" "$7,148.50" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$10,875.00" "$14,500.00" "$14,500.00" "$14,500.00" "$7,250.00" "$7,250.00" "$11,484.00" "$14,500.00" "$11,600.00" "$6,525.00" "$2,877.89" N/A "$8,410.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.80" "$14,500.00" N/A N/A 436125C SUP HCPCS C1713 436125C - CAGE 436125C 25MM C-SIZE STERILE BOTH IP/OP "$14,500.00" "$10,730.00" "$2,877.89" "$14,500.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,022.16" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.96" "$14,500.00" "$5,800.00" "$7,148.50" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$10,875.00" "$14,500.00" "$14,500.00" "$14,500.00" "$7,250.00" "$7,250.00" "$11,484.00" "$14,500.00" "$11,600.00" "$6,525.00" "$2,877.89" N/A "$8,410.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.80" "$14,500.00" N/A N/A 436125D SUP HCPCS C1713 436125D - CAGE 436125D 25MM D-SIZE STERILE BOTH IP/OP "$14,500.00" "$10,730.00" "$2,877.89" "$14,500.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,022.16" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.96" "$14,500.00" "$14,500.00" "$7,148.50" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$10,875.00" "$14,500.00" "$14,500.00" "$14,500.00" "$7,250.00" "$7,250.00" "$11,484.00" "$14,500.00" "$11,600.00" "$6,525.00" "$2,877.89" N/A "$8,410.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.80" "$14,500.00" N/A N/A 436125E SUP HCPCS C1713 436125E - CAGE 436125E 25MM E-SIZE STERILE BOTH IP/OP "$14,500.00" "$10,730.00" "$2,877.89" "$14,500.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,022.16" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.96" "$14,500.00" "$5,800.00" "$7,148.50" "$14,500.00" "$14,500.00" "$14,500.00" "$14,500.00" "$10,875.00" "$14,500.00" "$14,500.00" "$14,500.00" "$7,250.00" "$7,250.00" "$11,484.00" "$14,500.00" "$11,600.00" "$6,525.00" "$2,877.89" N/A "$8,410.00" "$14,500.00" "$14,500.00" "$14,500.00" "$3,021.80" "$14,500.00" N/A N/A 436213A SUP HCPCS C1713 436213A - CENTERPIECE 436213A 13MM A-SIZE CERVICAL BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$4,600.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436213B SUP HCPCS C1713 436213B - CENTERPIECE 436213B 13MM B-SIZE CERVICAL BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$11,500.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436213C SUP HCPCS C1713 436213C - CENTERPIECE 436213C 13MM C-SIZE CERVICAL BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$4,600.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436213D SUP HCPCS C1713 436213D - CENTERPIECE 436213D 13MM D-SIZE CERVICAL BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$11,500.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436213E SUP HCPCS C1713 436213E - CENTERPIECE 436213E 13MM E-SIZE CERVICAL BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$4,600.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436313A SUP HCPCS C1713 436313A - CENTERPIECE 436313A 13MM A-SIZE CRV STER BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$4,600.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436313B SUP HCPCS C1713 436313B - CENTERPIECE 436313B 13MM B-SIZE CRV STER BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$11,500.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436313C SUP HCPCS C1713 436313C - CENTERPIECE 436313C 13MM C-SIZE CRV STER BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$11,500.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436313D SUP HCPCS C1713 436313D - CENTERPIECE 436313D 13MM D-SIZE CRV STER BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$4,600.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 436313E SUP HCPCS C1713 436313E - CENTERPIECE 436313E 13MM E-SIZE CRV STER BOTH IP/OP "$11,500.00" "$8,510.00" "$2,282.46" "$11,500.00" "$5,175.00" "$5,175.00" "$5,175.00" "$5,175.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.89" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.73" "$11,500.00" "$11,500.00" "$5,669.50" "$11,500.00" "$11,500.00" "$11,500.00" "$11,500.00" "$8,625.00" "$11,500.00" "$11,500.00" "$11,500.00" "$5,750.00" "$5,750.00" "$9,108.00" "$11,500.00" "$9,200.00" "$5,175.00" "$2,282.46" N/A "$6,670.00" "$11,500.00" "$11,500.00" "$11,500.00" "$2,396.60" "$11,500.00" N/A N/A 437.043S SUP HCPCS C1713 437.043S - PLATE BONE 90D 30MM 4 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" "$1,629.75" $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" $339.64 "$1,629.75" N/A N/A 437.044S SUP HCPCS C1713 437.044S - PLATE BONE 90D 40MM 4 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" "$1,629.75" $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" $339.64 "$1,629.75" N/A N/A 437.053S SUP HCPCS C1713 437.053S - PLATE BONE 90D 30MM 5 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" "$1,629.75" $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" $339.64 "$1,629.75" N/A N/A 437.054S SUP HCPCS C1713 437.054S - PLATE BONE 90D 40MM 5 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" "$1,629.75" $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" $339.64 "$1,629.75" N/A N/A 437.063S SUP HCPCS C1713 437.063S - PLATE BONE 90D 30MM 6 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" "$1,629.75" $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" N/A N/A 437.064S SUP HCPCS C1713 437.064S - PLATE BONE 90D 40MM 6 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" "$1,629.75" $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" N/A N/A 437.083S SUP HCPCS C1713 437.083S - PLATE BONE 90D 30MM 8 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" "$1,629.75" $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" $339.64 "$1,629.75" N/A N/A 437.084S SUP HCPCS C1713 437.084S - PLATE BONE 90D 40MM 8 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" "$1,629.75" $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" $339.64 "$1,629.75" N/A N/A 437.085S SUP HCPCS C1713 437.085S - PLATE BONE 90D 50MM 8 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" "$1,629.75" $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" $339.64 "$1,629.75" N/A N/A 437.086S SUP HCPCS C1713 437.086S - PLATE BONE 90D 60MM 8 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$1,630.00" "$1,206.00" $323.46 "$1,629.75" $733.39 $733.39 $733.39 $733.39 "$1,629.75" "$1,629.75" "$1,629.75" $339.68 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" $339.66 "$1,629.75" "$1,629.75" $964.00 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,222.50" "$1,629.75" "$1,629.75" "$1,629.75" $814.88 $814.88 "$1,290.76" "$1,629.75" "$1,303.80" $733.39 $323.46 N/A $945.40 "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" "$1,629.75" N/A N/A 437.103S SUP HCPCS C1713 437.103S - PLATE BONE 90D 30MM 10 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$2,127.00" "$1,574.00" $422.08 "$2,126.63" $956.98 $956.98 $956.98 $956.98 "$2,126.63" "$2,126.63" "$2,126.63" $443.24 "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" $443.21 "$2,126.63" "$2,126.63" "$1,257.90" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$1,595.25" "$2,126.63" "$2,126.63" "$2,126.63" "$1,063.32" "$1,063.32" "$1,684.29" "$2,126.63" "$1,701.30" $956.98 $422.08 N/A "$1,233.66" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" N/A N/A 437.104S SUP HCPCS C1713 437.104S - PLATE BONE 90D 40MM 10 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$2,127.00" "$1,574.00" $422.08 "$2,126.63" $956.98 $956.98 $956.98 $956.98 "$2,126.63" "$2,126.63" "$2,126.63" $443.24 "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" $443.21 "$2,126.63" "$2,126.63" "$1,257.90" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$1,595.25" "$2,126.63" "$2,126.63" "$2,126.63" "$1,063.32" "$1,063.32" "$1,684.29" "$2,126.63" "$1,701.30" $956.98 $422.08 N/A "$1,233.66" "$2,126.63" "$2,126.63" "$2,126.63" $443.19 "$2,126.63" N/A N/A 437.105S SUP HCPCS C1713 437.105S - PLATE BONE 90D 50MM 10 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$2,127.00" "$1,574.00" $422.08 "$2,126.63" $956.98 $956.98 $956.98 $956.98 "$2,126.63" "$2,126.63" "$2,126.63" $443.24 "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" $443.21 "$2,126.63" "$2,126.63" "$1,257.90" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$1,595.25" "$2,126.63" "$2,126.63" "$2,126.63" "$1,063.32" "$1,063.32" "$1,684.29" "$2,126.63" "$1,701.30" $956.98 $422.08 N/A "$1,233.66" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" N/A N/A 437.106S SUP HCPCS C1713 437.106S - PLATE BONE 90D 60MM 10 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$2,127.00" "$1,574.00" $422.08 "$2,126.63" $956.98 $956.98 $956.98 $956.98 "$2,126.63" "$2,126.63" "$2,126.63" $443.24 "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" $443.21 "$2,126.63" $850.65 "$1,257.90" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$1,595.25" "$2,126.63" "$2,126.63" "$2,126.63" "$1,063.32" "$1,063.32" "$1,684.29" "$2,126.63" "$1,701.30" $956.98 $422.08 N/A "$1,233.66" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" N/A N/A 437.123S SUP HCPCS C1713 437.123S - PLATE BONE 90D 30MM 12 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$2,127.00" "$1,574.00" $422.08 "$2,126.63" $956.98 $956.98 $956.98 $956.98 "$2,126.63" "$2,126.63" "$2,126.63" $443.24 "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" $443.21 "$2,126.63" "$2,126.63" "$1,257.90" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$1,595.25" "$2,126.63" "$2,126.63" "$2,126.63" "$1,063.32" "$1,063.32" "$1,684.29" "$2,126.63" "$1,701.30" $956.98 $422.08 N/A "$1,233.66" "$2,126.63" "$2,126.63" "$2,126.63" $443.19 "$2,126.63" N/A N/A 437.124S SUP HCPCS C1713 437.124S - PLATE BONE 90D 40MM 12 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$2,127.00" "$1,574.00" $422.08 "$2,126.63" $956.98 $956.98 $956.98 $956.98 "$2,126.63" "$2,126.63" "$2,126.63" $443.24 "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" $443.21 "$2,126.63" $850.65 "$1,257.90" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$1,595.25" "$2,126.63" "$2,126.63" "$2,126.63" "$1,063.32" "$1,063.32" "$1,684.29" "$2,126.63" "$1,701.30" $956.98 $422.08 N/A "$1,233.66" "$2,126.63" "$2,126.63" "$2,126.63" $443.19 "$2,126.63" N/A N/A 437.125S SUP HCPCS C1713 437.125S - PLATE BONE 90D 50MM 12 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$2,127.00" "$1,574.00" $422.08 "$2,126.63" $956.98 $956.98 $956.98 $956.98 "$2,126.63" "$2,126.63" "$2,126.63" $443.24 "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" $443.21 "$2,126.63" $850.65 "$1,257.90" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$1,595.25" "$2,126.63" "$2,126.63" "$2,126.63" "$1,063.32" "$1,063.32" "$1,684.29" "$2,126.63" "$1,701.30" $956.98 $422.08 N/A "$1,233.66" "$2,126.63" "$2,126.63" "$2,126.63" $443.19 "$2,126.63" N/A N/A 437.126S SUP HCPCS C1713 437.126S - PLATE BONE 90D 60MM 12 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$2,127.00" "$1,574.00" $422.08 "$2,126.63" $956.98 $956.98 $956.98 $956.98 "$2,126.63" "$2,126.63" "$2,126.63" $443.24 "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" $443.21 "$2,126.63" $850.65 "$1,257.90" "$2,126.63" "$2,126.63" "$2,126.63" "$2,126.63" "$1,595.25" "$2,126.63" "$2,126.63" "$2,126.63" "$1,063.32" "$1,063.32" "$1,684.29" "$2,126.63" "$1,701.30" $956.98 $422.08 N/A "$1,233.66" "$2,126.63" "$2,126.63" "$2,126.63" $443.19 "$2,126.63" N/A N/A 437.143S SUP HCPCS C1713 437.143S - PLATE BONE 90D 30MM 14 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$2,706.00" "$2,002.00" $537.00 "$2,705.65" "$1,217.54" "$1,217.54" "$1,217.54" "$1,217.54" "$2,705.65" "$2,705.65" "$2,705.65" $563.93 "$2,705.65" "$2,705.65" "$2,705.65" "$2,705.65" "$2,705.65" $563.89 "$2,705.65" "$1,082.26" "$1,333.89" "$2,705.65" "$2,705.65" "$2,705.65" "$2,705.65" "$2,029.50" "$2,705.65" "$2,705.65" "$2,705.65" "$1,352.83" "$1,352.83" "$2,142.87" "$2,705.65" "$2,164.52" "$1,217.54" $537.00 N/A "$1,569.48" "$2,705.65" "$2,705.65" "$2,705.65" $563.86 "$2,705.65" N/A N/A 437.144S SUP HCPCS C1713 437.144S - PLATE BONE 90D 40MM 14 HOLE CANN LC ANGLED TITANIUM BOTH IP/OP "$2,706.00" "$2,002.00" $537.00 "$2,705.65" "$1,217.54" "$1,217.54" "$1,217.54" "$1,217.54" "$2,705.65" "$2,705.65" "$2,705.65" $563.93 "$2,705.65" "$2,705.65" "$2,705.65" "$2,705.65" "$2,705.65" $563.89 "$2,705.65" "$1,082.26" "$1,333.89" "$2,705.65" "$2,705.65" "$2,705.65" "$2,705.65" "$2,029.50" "$2,705.65" "$2,705.65" "$2,705.65" "$1,352.83" "$1,352.83" "$2,142.87" "$2,705.65" "$2,164.52" "$1,217.54" $537.00 N/A "$1,569.48" "$2,705.65" "$2,705.65" "$2,705.65" $563.86 "$2,705.65" N/A N/A 437.146S SUP HCPCS C1713 437.146S - PLATE BONE 90D 256MM 60X11.7MM 14 HOLE CANN LC ANGLED BLADE BOTH IP/OP "$2,706.00" "$2,002.00" $537.00 "$2,705.65" "$1,217.54" "$1,217.54" "$1,217.54" "$1,217.54" "$2,705.65" "$2,705.65" "$2,705.65" $563.93 "$2,705.65" "$2,705.65" "$2,705.65" "$2,705.65" "$2,705.65" $563.89 "$2,705.65" "$1,082.26" "$1,333.89" "$2,705.65" "$2,705.65" "$2,705.65" "$2,705.65" "$2,029.50" "$2,705.65" "$2,705.65" "$2,705.65" "$1,352.83" "$1,352.83" "$2,142.87" "$2,705.65" "$2,164.52" "$1,217.54" $537.00 N/A "$1,569.48" "$2,705.65" "$2,705.65" "$2,705.65" $563.86 "$2,705.65" N/A N/A 441.072S SUP HCPCS C1713 441.072S - PLATE BONE 12MM 4 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE BOTH IP/OP "$1,514.00" "$1,120.00" $300.48 "$1,539.65" $681.27 $681.27 $681.27 $681.27 "$1,513.93" "$1,513.93" "$1,513.93" $315.54 "$1,513.93" "$1,513.93" "$1,513.93" "$1,513.93" "$1,513.93" $315.52 "$1,513.93" $615.86 $895.49 "$1,513.93" "$1,539.65" "$1,513.93" "$1,513.93" "$1,135.50" "$1,513.93" "$1,513.93" "$1,513.93" $756.97 $756.97 "$1,199.03" "$1,513.93" "$1,211.14" $681.27 $300.48 N/A $878.12 "$1,513.93" $908.36 "$1,513.93" $315.50 "$1,513.93" N/A N/A 441.073S SUP HCPCS C1713 441.073S - PLATE BONE 12MM 4 HOLE HOOK LCP TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,514.00" "$1,120.00" $300.48 "$1,539.65" $681.27 $681.27 $681.27 $681.27 "$1,513.93" "$1,513.93" "$1,513.93" $315.54 "$1,513.93" "$1,513.93" "$1,513.93" "$1,513.93" "$1,513.93" $315.52 "$1,513.93" $615.86 $895.49 "$1,513.93" "$1,539.65" "$1,513.93" "$1,513.93" "$1,135.50" "$1,513.93" "$1,513.93" "$1,513.93" $756.97 $756.97 "$1,199.03" "$1,513.93" "$1,211.14" $681.27 $300.48 N/A $878.12 "$1,513.93" $908.36 "$1,513.93" "$1,513.93" "$1,513.93" N/A N/A 441.074S SUP HCPCS C1713 441.074S - PLATE BN 15MM 70MM STRL LCP CMBN 4 HL HK PRECONTOUR RND SHFT BOTH IP/OP "$1,514.00" "$1,120.00" $300.48 "$1,539.65" $681.27 $681.27 $681.27 $681.27 "$1,513.93" "$1,513.93" "$1,513.93" $315.54 "$1,513.93" "$1,513.93" "$1,513.93" "$1,513.93" "$1,513.93" $315.52 "$1,513.93" $615.86 $895.49 "$1,513.93" "$1,539.65" "$1,513.93" "$1,513.93" "$1,135.50" "$1,513.93" "$1,513.93" "$1,513.93" $756.97 $756.97 "$1,199.03" "$1,513.93" "$1,211.14" $681.27 $300.48 N/A $878.12 "$1,513.93" $908.36 "$1,513.93" "$1,513.93" "$1,513.93" N/A N/A 441.075S SUP HCPCS C1713 441.075S - PLATE BONE 15MM 4 HOLE HOOK LCP TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,514.00" "$1,120.00" $300.48 "$1,539.65" $681.27 $681.27 $681.27 $681.27 "$1,513.93" "$1,513.93" "$1,513.93" $315.54 "$1,513.93" "$1,513.93" "$1,513.93" "$1,513.93" "$1,513.93" $315.52 "$1,513.93" "$1,539.65" $895.49 "$1,513.93" "$1,539.65" "$1,513.93" "$1,513.93" "$1,135.50" "$1,513.93" "$1,513.93" "$1,513.93" $756.97 $756.97 "$1,199.03" "$1,513.93" "$1,211.14" $681.27 $300.48 N/A $878.12 "$1,513.93" "$1,513.93" "$1,513.93" $315.50 "$1,513.93" N/A N/A 441.076S SUP HCPCS C1713 441.076S - PLATE BONE 18MM 4 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE BOTH IP/OP "$1,514.00" "$1,120.00" $300.48 "$1,539.65" $681.27 $681.27 $681.27 $681.27 "$1,513.93" "$1,513.93" "$1,513.93" $315.54 "$1,513.93" "$1,513.93" "$1,513.93" "$1,513.93" "$1,513.93" $315.52 "$1,513.93" "$1,539.65" $895.49 "$1,513.93" "$1,539.65" "$1,513.93" "$1,513.93" "$1,135.50" "$1,513.93" "$1,513.93" "$1,513.93" $756.97 $756.97 "$1,199.03" "$1,513.93" "$1,211.14" $681.27 $300.48 N/A $878.12 "$1,513.93" $908.36 "$1,513.93" $315.50 "$1,513.93" N/A N/A 441.077S SUP HCPCS C1713 441.077S - PLATE BONE 18MM 4 HOLE HOOK LCP TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,514.00" "$1,120.00" $300.48 "$1,539.65" $681.27 $681.27 $681.27 $681.27 "$1,513.93" "$1,513.93" "$1,513.93" $315.54 "$1,513.93" "$1,513.93" "$1,513.93" "$1,513.93" "$1,513.93" $315.52 "$1,513.93" "$1,539.65" $895.49 "$1,513.93" "$1,539.65" "$1,513.93" "$1,513.93" "$1,135.50" "$1,513.93" "$1,513.93" "$1,513.93" $756.97 $756.97 "$1,199.03" "$1,513.93" "$1,211.14" $681.27 $300.48 N/A $878.12 "$1,513.93" "$1,513.93" "$1,513.93" $315.50 "$1,513.93" N/A N/A 441.082S SUP HCPCS C1713 441.082S - PLATE BONE 12MM 5 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE BOTH IP/OP "$1,584.50" "$1,173.00" $314.43 "$1,611.15" $712.90 $712.90 $712.90 $712.90 "$1,584.23" "$1,584.23" "$1,584.23" $330.19 "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" $330.17 "$1,584.23" "$1,611.15" $937.07 "$1,584.23" "$1,611.15" "$1,584.23" "$1,584.23" "$1,188.38" "$1,584.23" "$1,584.23" "$1,584.23" $792.12 $792.12 "$1,254.71" "$1,584.23" "$1,267.38" $712.90 $314.43 N/A $919.01 "$1,584.23" $950.54 "$1,584.23" $330.15 "$1,584.23" N/A N/A 441.083S SUP HCPCS C1713 441.083S - PLATE BONE 12MM 5 HOLE HOOK LCP TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,584.50" "$1,173.00" $314.43 "$1,611.15" $712.90 $712.90 $712.90 $712.90 "$1,584.23" "$1,584.23" "$1,584.23" $330.19 "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" $330.17 "$1,584.23" "$1,611.15" $937.07 "$1,584.23" "$1,611.15" "$1,584.23" "$1,584.23" "$1,188.38" "$1,584.23" "$1,584.23" "$1,584.23" $792.12 $792.12 "$1,254.71" "$1,584.23" "$1,267.38" $712.90 $314.43 N/A $919.01 "$1,584.23" $950.54 "$1,584.23" $330.15 "$1,584.23" N/A N/A 441.084S SUP HCPCS C1713 441.084S - PLATE BONE 15MM 5 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE BOTH IP/OP "$1,584.50" "$1,173.00" $314.43 "$1,611.15" $712.90 $712.90 $712.90 $712.90 "$1,584.23" "$1,584.23" "$1,584.23" $330.19 "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" $330.17 "$1,584.23" "$1,611.15" $937.07 "$1,584.23" "$1,611.15" "$1,584.23" "$1,584.23" "$1,188.38" "$1,584.23" "$1,584.23" "$1,584.23" $792.12 $792.12 "$1,254.71" "$1,584.23" "$1,267.38" $712.90 $314.43 N/A $919.01 "$1,584.23" $950.54 "$1,584.23" "$1,584.23" "$1,584.23" N/A N/A 441.085S SUP HCPCS C1713 441.085S - PLATE BONE 15MM 5 HOLE HOOK LCP TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,584.50" "$1,173.00" $314.43 "$1,611.15" $712.90 $712.90 $712.90 $712.90 "$1,584.23" "$1,584.23" "$1,584.23" $330.19 "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" $330.17 "$1,584.23" "$1,611.15" $937.07 "$1,584.23" "$1,611.15" "$1,584.23" "$1,584.23" "$1,188.38" "$1,584.23" "$1,584.23" "$1,584.23" $792.12 $792.12 "$1,254.71" "$1,584.23" "$1,267.38" $712.90 $314.43 N/A $919.01 "$1,584.23" $950.54 "$1,584.23" "$1,584.23" "$1,584.23" N/A N/A 441.086S SUP HCPCS C1713 441.086S - PLATE BONE 18MM 5 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE BOTH IP/OP "$1,584.50" "$1,173.00" $314.43 "$1,611.15" $712.90 $712.90 $712.90 $712.90 "$1,584.23" "$1,584.23" "$1,584.23" $330.19 "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" $330.17 "$1,584.23" "$1,611.15" $937.07 "$1,584.23" "$1,611.15" "$1,584.23" "$1,584.23" "$1,188.38" "$1,584.23" "$1,584.23" "$1,584.23" $792.12 $792.12 "$1,254.71" "$1,584.23" "$1,267.38" $712.90 $314.43 N/A $919.01 "$1,584.23" $950.54 "$1,584.23" $330.15 "$1,584.23" N/A N/A 441.087S SUP HCPCS C1713 441.087S - PLATE BONE 18MM 5 HOLE HOOK LCP TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,584.50" "$1,173.00" $314.43 "$1,611.15" $712.90 $712.90 $712.90 $712.90 "$1,584.23" "$1,584.23" "$1,584.23" $330.19 "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" "$1,584.23" $330.17 "$1,584.23" "$1,611.15" $937.07 "$1,584.23" "$1,611.15" "$1,584.23" "$1,584.23" "$1,188.38" "$1,584.23" "$1,584.23" "$1,584.23" $792.12 $792.12 "$1,254.71" "$1,584.23" "$1,267.38" $712.90 $314.43 N/A $919.01 "$1,584.23" $950.54 "$1,584.23" "$1,584.23" "$1,584.23" N/A N/A 441.094S SUP HCPCS C1713 441.094S - PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE BOTH IP/OP "$1,629.50" "$1,206.00" $323.36 "$1,656.90" $733.14 $733.14 $733.14 $733.14 "$1,629.20" "$1,629.20" "$1,629.20" $339.57 "$1,629.20" "$1,629.20" "$1,629.20" "$1,629.20" "$1,629.20" $339.54 "$1,629.20" "$1,656.90" $963.67 "$1,629.20" "$1,656.90" "$1,629.20" "$1,629.20" "$1,222.13" "$1,629.20" "$1,629.20" "$1,629.20" $814.60 $814.60 "$1,290.33" "$1,629.20" "$1,303.36" $733.14 $323.36 N/A $945.11 "$1,629.20" $977.52 "$1,629.20" $339.53 "$1,629.20" N/A N/A 441.095S SUP HCPCS C1713 441.095S - PLATE BONE 15MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,629.50" "$1,206.00" $323.36 "$1,656.90" $733.14 $733.14 $733.14 $733.14 "$1,629.20" "$1,629.20" "$1,629.20" $339.57 "$1,629.20" "$1,629.20" "$1,629.20" "$1,629.20" "$1,629.20" $339.54 "$1,629.20" "$1,656.90" $963.67 "$1,629.20" "$1,656.90" "$1,629.20" "$1,629.20" "$1,222.13" "$1,629.20" "$1,629.20" "$1,629.20" $814.60 $814.60 "$1,290.33" "$1,629.20" "$1,303.36" $733.14 $323.36 N/A $945.11 "$1,629.20" $977.52 "$1,629.20" $339.53 "$1,629.20" N/A N/A 441.096S SUP HCPCS C1713 441.096S - PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE BOTH IP/OP "$1,629.50" "$1,206.00" $323.36 "$1,656.90" $733.14 $733.14 $733.14 $733.14 "$1,629.20" "$1,629.20" "$1,629.20" $339.57 "$1,629.20" "$1,629.20" "$1,629.20" "$1,629.20" "$1,629.20" $339.54 "$1,629.20" "$1,656.90" $963.67 "$1,629.20" "$1,656.90" "$1,629.20" "$1,629.20" "$1,222.13" "$1,629.20" "$1,629.20" "$1,629.20" $814.60 $814.60 "$1,290.33" "$1,629.20" "$1,303.36" $733.14 $323.36 N/A $945.11 "$1,629.20" $977.52 "$1,629.20" "$1,629.20" "$1,629.20" N/A N/A 441.097S SUP HCPCS C1713 441.097S - PLATE BONE 18MM 6 HOLE HOOK LCP TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,629.50" "$1,206.00" $323.36 "$1,656.90" $733.14 $733.14 $733.14 $733.14 "$1,629.20" "$1,629.20" "$1,629.20" $339.57 "$1,629.20" "$1,629.20" "$1,629.20" "$1,629.20" "$1,629.20" $339.54 "$1,629.20" "$1,656.90" $963.67 "$1,629.20" "$1,656.90" "$1,629.20" "$1,629.20" "$1,222.13" "$1,629.20" "$1,629.20" "$1,629.20" $814.60 $814.60 "$1,290.33" "$1,629.20" "$1,303.36" $733.14 $323.36 N/A $945.11 "$1,629.20" $977.52 "$1,629.20" $339.53 "$1,629.20" N/A N/A 441.104S SUP HCPCS C1713 441.104S - PLATE BONE 15MM 7 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE BOTH IP/OP "$1,698.50" "$1,257.00" $337.03 "$1,726.95" $764.14 $764.14 $764.14 $764.14 "$1,698.08" "$1,698.08" "$1,698.08" $353.92 "$1,698.08" "$1,698.08" "$1,698.08" "$1,698.08" "$1,698.08" $353.90 "$1,698.08" "$1,726.95" "$1,004.41" "$1,698.08" "$1,726.95" "$1,698.08" "$1,698.08" "$1,273.88" "$1,698.08" "$1,698.08" "$1,698.08" $849.04 $849.04 "$1,344.88" "$1,698.08" "$1,358.46" $764.14 $337.03 N/A $985.13 "$1,698.08" "$1,018.85" "$1,698.08" "$1,698.08" "$1,698.08" N/A N/A 441.105S SUP HCPCS C1713 441.105S - PLATE BONE 15MM 7 HOLE HOOK LCP TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,698.50" "$1,257.00" $337.03 "$1,726.95" $764.14 $764.14 $764.14 $764.14 "$1,698.08" "$1,698.08" "$1,698.08" $353.92 "$1,698.08" "$1,698.08" "$1,698.08" "$1,698.08" "$1,698.08" $353.90 "$1,698.08" "$1,726.95" "$1,004.41" "$1,698.08" "$1,726.95" "$1,698.08" "$1,698.08" "$1,273.88" "$1,698.08" "$1,698.08" "$1,698.08" $849.04 $849.04 "$1,344.88" "$1,698.08" "$1,358.46" $764.14 $337.03 N/A $985.13 "$1,698.08" "$1,018.85" "$1,698.08" $353.88 "$1,698.08" N/A N/A 441.106S SUP HCPCS C1713 441.106S - PLATE BONE 18MM 7 HOLE HOOK LCP TITANIUM RIGHT CLAVICLE BOTH IP/OP "$1,698.50" "$1,257.00" $337.03 "$1,726.95" $764.14 $764.14 $764.14 $764.14 "$1,698.08" "$1,698.08" "$1,698.08" $353.92 "$1,698.08" "$1,698.08" "$1,698.08" "$1,698.08" "$1,698.08" $353.90 "$1,698.08" $690.78 "$1,004.41" "$1,698.08" "$1,726.95" "$1,698.08" "$1,698.08" "$1,273.88" "$1,698.08" "$1,698.08" "$1,698.08" $849.04 $849.04 "$1,344.88" "$1,698.08" "$1,358.46" $764.14 $337.03 N/A $985.13 "$1,698.08" "$1,698.08" "$1,698.08" $353.88 "$1,698.08" N/A N/A 441.107S SUP HCPCS C1713 441.107S - PLATE BONE 18MM 7 HOLE HOOK LCP TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,698.50" "$1,257.00" $337.03 "$1,726.95" $764.14 $764.14 $764.14 $764.14 "$1,698.08" "$1,698.08" "$1,698.08" $353.92 "$1,698.08" "$1,698.08" "$1,698.08" "$1,698.08" "$1,698.08" $353.90 "$1,698.08" $690.78 "$1,004.41" "$1,698.08" "$1,726.95" "$1,698.08" "$1,698.08" "$1,273.88" "$1,698.08" "$1,698.08" "$1,698.08" $849.04 $849.04 "$1,344.88" "$1,698.08" "$1,358.46" $764.14 $337.03 N/A $985.13 "$1,698.08" "$1,698.08" "$1,698.08" "$1,698.08" "$1,698.08" N/A N/A 44-1001 SUP HCPCS C1713 44-1001 - PLATE BONE LARGE 2MM ANGLED TRAUMAONE BLUE TITANIUM MANDIB 2 BOTH IP/OP "$6,255.00" "$4,629.00" "$1,241.46" "$6,255.00" "$2,814.75" "$2,814.75" "$2,814.75" "$2,814.75" "$6,255.00" "$6,255.00" "$6,255.00" "$1,303.70" "$6,255.00" "$6,255.00" "$6,255.00" "$6,255.00" "$6,255.00" "$1,303.61" "$6,255.00" "$2,502.00" "$3,083.72" "$6,255.00" "$6,255.00" "$6,255.00" "$6,255.00" "$4,691.25" "$6,255.00" "$6,255.00" "$6,255.00" "$3,127.50" "$3,127.50" "$4,953.96" "$6,255.00" "$5,004.00" "$2,814.75" "$1,241.46" N/A "$3,627.90" "$6,255.00" "$3,753.00" "$6,255.00" "$1,303.54" "$6,255.00" N/A N/A 44-1002 SUP HCPCS C1713 44-1002 - PLATE BONE SMALL 2MM 2 ANGLED TRAUMAONE BLUE TITANIUM MANDIB BOTH IP/OP "$7,630.00" "$5,646.00" "$1,514.36" "$7,630.00" "$3,433.50" "$3,433.50" "$3,433.50" "$3,433.50" "$7,630.00" "$7,630.00" "$7,630.00" "$1,590.28" "$7,630.00" "$7,630.00" "$7,630.00" "$7,630.00" "$7,630.00" "$1,590.18" "$7,630.00" "$7,630.00" "$3,761.59" "$7,630.00" "$7,630.00" "$7,630.00" "$7,630.00" "$5,722.50" "$7,630.00" "$7,630.00" "$7,630.00" "$3,815.00" "$3,815.00" "$6,042.96" "$7,630.00" "$6,104.00" "$3,433.50" "$1,514.36" N/A "$4,425.40" "$7,630.00" "$7,630.00" "$7,630.00" "$1,590.09" "$7,630.00" N/A N/A 44-1003 SUP HCPCS C1713 44-1003 - PLATE BONE THK2MM MEDIUM 2 ANGLED LORENZ BLUE MANDIB BOTH IP/OP "$8,075.00" "$5,976.00" "$1,602.69" "$8,075.00" "$3,633.75" "$3,633.75" "$3,633.75" "$3,633.75" "$8,075.00" "$8,075.00" "$8,075.00" "$1,683.03" "$8,075.00" "$8,075.00" "$8,075.00" "$8,075.00" "$8,075.00" "$1,682.92" "$8,075.00" "$3,230.00" "$3,980.98" "$8,075.00" "$8,075.00" "$8,075.00" "$8,075.00" "$6,056.25" "$8,075.00" "$8,075.00" "$8,075.00" "$4,037.50" "$4,037.50" "$6,395.40" "$8,075.00" "$6,460.00" "$3,633.75" "$1,602.69" N/A "$4,683.50" "$8,075.00" "$8,075.00" "$8,075.00" "$1,682.83" "$8,075.00" N/A N/A 44-1005 SUP HCPCS C1713 44-1005 - PLATE BONE LARGE 2.6MM ANGLED TRAUMAONE MAGENTA TITANIUM BOTH IP/OP "$6,727.50" "$4,978.00" "$1,335.24" "$6,727.50" "$3,027.38" "$3,027.38" "$3,027.38" "$3,027.38" "$6,727.50" "$6,727.50" "$6,727.50" "$1,402.18" "$6,727.50" "$6,727.50" "$6,727.50" "$6,727.50" "$6,727.50" "$1,402.09" "$6,727.50" "$6,727.50" "$3,316.66" "$6,727.50" "$6,727.50" "$6,727.50" "$6,727.50" "$5,045.63" "$6,727.50" "$6,727.50" "$6,727.50" "$3,363.75" "$3,363.75" "$5,328.18" "$6,727.50" "$5,382.00" "$3,027.38" "$1,335.24" N/A "$3,901.95" "$6,727.50" "$6,727.50" "$6,727.50" "$1,402.01" "$6,727.50" N/A N/A 44-1012 SUP HCPCS C1713 44-1012 - PLATE BONE 2MM 12 HOLE STR TRAUMAONE BLUE TITANIUM MANDIB 2 BOTH IP/OP "$2,765.00" "$2,046.00" $548.78 "$2,765.00" "$1,244.25" "$1,244.25" "$1,244.25" "$1,244.25" "$2,765.00" "$2,765.00" "$2,765.00" $576.30 "$2,765.00" "$2,765.00" "$2,765.00" "$2,765.00" "$2,765.00" $576.26 "$2,765.00" "$1,106.00" "$1,363.15" "$2,765.00" "$2,765.00" "$2,765.00" "$2,765.00" "$2,073.75" "$2,765.00" "$2,765.00" "$2,765.00" "$1,382.50" "$1,382.50" "$2,189.88" "$2,765.00" "$2,212.00" "$1,244.25" $548.78 N/A "$1,603.70" "$2,765.00" "$2,765.00" "$2,765.00" $576.23 "$2,765.00" N/A N/A 44-1022 SUP HCPCS C1713 44-1022 - PLATE BN MED 2 ANG 2MM BLU TRAUMAONE STRG TI MNDB 2MM/2.3MM BOTH IP/OP "$8,072.50" "$5,974.00" "$1,602.19" "$8,072.50" "$3,632.63" "$3,632.63" "$3,632.63" "$3,632.63" "$8,072.50" "$8,072.50" "$8,072.50" "$1,682.51" "$8,072.50" "$8,072.50" "$8,072.50" "$8,072.50" "$8,072.50" "$1,682.40" "$8,072.50" "$8,072.50" "$3,979.74" "$8,072.50" "$8,072.50" "$8,072.50" "$8,072.50" "$6,054.38" "$8,072.50" "$8,072.50" "$8,072.50" "$4,036.25" "$4,036.25" "$6,393.42" "$8,072.50" "$6,458.00" "$3,632.63" "$1,602.19" N/A "$4,682.05" "$8,072.50" "$4,843.50" "$8,072.50" "$1,682.31" "$8,072.50" N/A N/A 44-1023 SUP HCPCS C1713 44-1023 - PLATE BN LG ANG 2.6MM MAG TRAUMAONE STRG TI MNDB 2MM/2.3MM BOTH IP/OP "$6,727.50" "$4,978.00" "$1,335.24" "$6,727.50" "$3,027.38" "$3,027.38" "$3,027.38" "$3,027.38" "$6,727.50" "$6,727.50" "$6,727.50" "$1,402.18" "$6,727.50" "$6,727.50" "$6,727.50" "$6,727.50" "$6,727.50" "$1,402.09" "$6,727.50" "$2,691.00" "$3,316.66" "$6,727.50" "$6,727.50" "$6,727.50" "$6,727.50" "$5,045.63" "$6,727.50" "$6,727.50" "$6,727.50" "$3,363.75" "$3,363.75" "$5,328.18" "$6,727.50" "$5,382.00" "$3,027.38" "$1,335.24" N/A "$3,901.95" "$6,727.50" "$4,036.50" "$6,727.50" "$1,402.01" "$6,727.50" N/A N/A 44-1024 SUP HCPCS C1713 44-1024 - PLATE BONE 2MM 24 HOLE STR TRAUMAONE BLUE TITANIUM MANDIB 2 BOTH IP/OP "$3,805.00" "$2,816.00" $755.20 "$3,805.00" "$1,712.25" "$1,712.25" "$1,712.25" "$1,712.25" "$3,805.00" "$3,805.00" "$3,805.00" $793.06 "$3,805.00" "$3,805.00" "$3,805.00" "$3,805.00" "$3,805.00" $793.00 "$3,805.00" "$3,805.00" "$1,875.87" "$3,805.00" "$3,805.00" "$3,805.00" "$3,805.00" "$2,853.75" "$3,805.00" "$3,805.00" "$3,805.00" "$1,902.50" "$1,902.50" "$3,013.56" "$3,805.00" "$3,044.00" "$1,712.25" $755.20 N/A "$2,206.90" "$3,805.00" "$3,805.00" "$3,805.00" $792.96 "$3,805.00" N/A N/A 442.458TM SUP HCPCS C1713 442.458TM - PLATE BONE 48MM 5X3 HOLE PRECONTOUR LCP TITANIUM RIGHT BOTH IP/OP "$1,820.00" "$1,347.00" $361.13 "$1,819.53" $818.79 $818.79 $818.79 $818.79 "$1,819.53" "$1,819.53" "$1,819.53" $379.24 "$1,819.53" "$1,819.53" "$1,819.53" "$1,819.53" "$1,819.53" $379.21 "$1,819.53" $727.81 "$1,076.25" "$1,819.53" "$1,819.53" "$1,819.53" "$1,819.53" "$1,365.00" "$1,819.53" "$1,819.53" "$1,819.53" $909.77 $909.77 "$1,441.07" "$1,819.53" "$1,455.62" $818.79 $361.13 N/A "$1,055.60" "$1,819.53" "$1,091.72" "$1,819.53" $379.19 "$1,819.53" N/A N/A 442.459TM SUP HCPCS C1713 442.459TM - PLATE BONE 66MM 5X5 HOLE PRECONTOURED LCP TITANIUM RIGHT BOTH IP/OP "$1,929.00" "$1,427.00" $382.85 "$1,928.98" $868.04 $868.04 $868.04 $868.04 "$1,928.98" "$1,928.98" "$1,928.98" $402.05 "$1,928.98" "$1,928.98" "$1,928.98" "$1,928.98" "$1,928.98" $402.02 "$1,928.98" "$1,928.98" "$1,140.99" "$1,928.98" "$1,928.98" "$1,928.98" "$1,928.98" "$1,446.75" "$1,928.98" "$1,928.98" "$1,928.98" $964.49 $964.49 "$1,527.75" "$1,928.98" "$1,543.18" $868.04 $382.85 N/A "$1,118.82" "$1,928.98" "$1,157.39" "$1,928.98" $402.00 "$1,928.98" N/A N/A 442.461TM SUP HCPCS C1713 442.461TM - PLATE BONE 48X6.3X1.6MM 5X3 HOLE LCP TITANIUM EXTART LEFT BOTH IP/OP "$1,820.00" "$1,347.00" $361.13 "$1,819.53" $818.79 $818.79 $818.79 $818.79 "$1,819.53" "$1,819.53" "$1,819.53" $379.24 "$1,819.53" "$1,819.53" "$1,819.53" "$1,819.53" "$1,819.53" $379.21 "$1,819.53" $727.81 "$1,076.25" "$1,819.53" "$1,819.53" "$1,819.53" "$1,819.53" "$1,365.00" "$1,819.53" "$1,819.53" "$1,819.53" $909.77 $909.77 "$1,441.07" "$1,819.53" "$1,455.62" $818.79 $361.13 N/A "$1,055.60" "$1,819.53" "$1,091.72" "$1,819.53" $379.19 "$1,819.53" N/A N/A 442.462TM SUP HCPCS C1713 442.462TM - PLATE BONE 66MM 5X5 HOLE PRECONTOURED LCP TITANIUM LEFT BOTH IP/OP "$1,929.00" "$1,427.00" $382.85 "$1,928.98" $868.04 $868.04 $868.04 $868.04 "$1,928.98" "$1,928.98" "$1,928.98" $402.05 "$1,928.98" "$1,928.98" "$1,928.98" "$1,928.98" "$1,928.98" $402.02 "$1,928.98" $771.59 "$1,140.99" "$1,928.98" "$1,928.98" "$1,928.98" "$1,928.98" "$1,446.75" "$1,928.98" "$1,928.98" "$1,928.98" $964.49 $964.49 "$1,527.75" "$1,928.98" "$1,543.18" $868.04 $382.85 N/A "$1,118.82" "$1,928.98" "$1,157.39" "$1,928.98" $402.00 "$1,928.98" N/A N/A 442.464TM SUP HCPCS C1713 442.464TM - PLATE BN 47X6.3X1.6MM LCP 4 HLE/HD 3 HL SHFT TI RDS RT DIST BOTH IP/OP "$1,820.00" "$1,347.00" $361.13 "$1,819.53" $818.79 $818.79 $818.79 $818.79 "$1,819.53" "$1,819.53" "$1,819.53" $379.24 "$1,819.53" "$1,819.53" "$1,819.53" "$1,819.53" "$1,819.53" $379.21 "$1,819.53" $727.81 "$1,076.25" "$1,819.53" "$1,819.53" "$1,819.53" "$1,819.53" "$1,365.00" "$1,819.53" "$1,819.53" "$1,819.53" $909.77 $909.77 "$1,441.07" "$1,819.53" "$1,455.62" $818.79 $361.13 N/A "$1,055.60" "$1,819.53" "$1,819.53" "$1,819.53" "$1,819.53" "$1,819.53" N/A N/A 442.465TM SUP HCPCS C1713 442.465TM - PLATE BONE 65MM 4X5 HOLE PRECONTOUR LCP TITANIUM RIGHT BOTH IP/OP "$1,929.00" "$1,427.00" $382.85 "$1,928.98" $868.04 $868.04 $868.04 $868.04 "$1,928.98" "$1,928.98" "$1,928.98" $402.05 "$1,928.98" "$1,928.98" "$1,928.98" "$1,928.98" "$1,928.98" $402.02 "$1,928.98" $771.59 "$1,140.99" "$1,928.98" "$1,928.98" "$1,928.98" "$1,928.98" "$1,446.75" "$1,928.98" "$1,928.98" "$1,928.98" $964.49 $964.49 "$1,527.75" "$1,928.98" "$1,543.18" $868.04 $382.85 N/A "$1,118.82" "$1,928.98" "$1,928.98" "$1,928.98" "$1,928.98" "$1,928.98" N/A N/A 442.467TM SUP HCPCS C1713 442.467TM - PLATE BONE 47MM 4X3 HOLE PRECONTOUR LCP TITANIUM LEFT DISTAL BOTH IP/OP "$1,820.00" "$1,347.00" $361.13 "$1,819.53" $818.79 $818.79 $818.79 $818.79 "$1,819.53" "$1,819.53" "$1,819.53" $379.24 "$1,819.53" "$1,819.53" "$1,819.53" "$1,819.53" "$1,819.53" $379.21 "$1,819.53" $727.81 "$1,076.25" "$1,819.53" "$1,819.53" "$1,819.53" "$1,819.53" "$1,365.00" "$1,819.53" "$1,819.53" "$1,819.53" $909.77 $909.77 "$1,441.07" "$1,819.53" "$1,455.62" $818.79 $361.13 N/A "$1,055.60" "$1,819.53" "$1,091.72" "$1,819.53" $379.19 "$1,819.53" N/A N/A 442.468TM SUP HCPCS C1713 442.468TM - PLATE BONE 65MM 4X5 HOLE PRECONTOUR LCP TITANIUM LEFT DISTAL BOTH IP/OP "$1,929.00" "$1,427.00" $382.85 "$1,928.98" $868.04 $868.04 $868.04 $868.04 "$1,928.98" "$1,928.98" "$1,928.98" $402.05 "$1,928.98" "$1,928.98" "$1,928.98" "$1,928.98" "$1,928.98" $402.02 "$1,928.98" $771.59 "$1,140.99" "$1,928.98" "$1,928.98" "$1,928.98" "$1,928.98" "$1,446.75" "$1,928.98" "$1,928.98" "$1,928.98" $964.49 $964.49 "$1,527.75" "$1,928.98" "$1,543.18" $868.04 $382.85 N/A "$1,118.82" "$1,928.98" "$1,157.39" "$1,928.98" "$1,928.98" "$1,928.98" N/A N/A 442.531S SUP HCPCS C1713 442.531S - PLATE BONE 46MM 7 HOLE LCP TITANIUM DISTAL ULNAR STERILE 2MM BOTH IP/OP "$1,591.50" "$1,178.00" $315.82 "$1,618.30" $716.06 $716.06 $716.06 $716.06 "$1,591.25" "$1,591.25" "$1,591.25" $331.66 "$1,591.25" "$1,591.25" "$1,591.25" "$1,591.25" "$1,591.25" $331.63 "$1,591.25" "$1,618.30" $941.22 "$1,591.25" "$1,618.30" "$1,591.25" "$1,591.25" "$1,193.63" "$1,591.25" "$1,591.25" "$1,591.25" $795.63 $795.63 "$1,260.27" "$1,591.25" "$1,273.00" $716.06 $315.82 N/A $923.07 "$1,591.25" $954.75 "$1,591.25" "$1,591.25" "$1,591.25" N/A N/A 443.61.96 SUP HCPCS C1713 443.61.96 - PLATE BN 39X5X1.2MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDYL BOTH IP/OP $568.00 $420.00 $112.71 $577.55 $255.56 $255.56 $255.56 $255.56 $567.90 $567.90 $567.90 $118.36 $567.90 $567.90 $567.90 $567.90 $567.90 $118.36 $567.90 $231.02 $335.91 $567.90 $577.55 $567.90 $567.90 $426.00 $567.90 $567.90 $567.90 $283.95 $283.95 $449.78 $567.90 $454.32 $255.56 $112.71 N/A $329.44 $567.90 $340.74 $567.90 $567.90 $567.90 N/A N/A 443.62.96 SUP HCPCS C1713 443.62.96 - PLATE BN 39X5X1.2MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDRL BOTH IP/OP $568.00 $420.00 $112.71 $577.55 $255.56 $255.56 $255.56 $255.56 $567.90 $567.90 $567.90 $118.36 $567.90 $567.90 $567.90 $567.90 $567.90 $118.36 $567.90 $231.02 $335.91 $567.90 $577.55 $567.90 $567.90 $426.00 $567.90 $567.90 $567.90 $283.95 $283.95 $449.78 $567.90 $454.32 $255.56 $112.71 N/A $329.44 $567.90 $340.74 $567.90 $118.35 $567.90 N/A N/A 4450M26 SUP Custom 27803010 4450M26 - RING ANNULOPLASTY KIDNEY 26MM 30.7MM 24.9MM FLEXIBLE HOLDER BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,318.00" "$8,750.00" "$8,750.00" "$8,295.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 4450M28 SUP Custom 27803010 4450M28 - RING ANNULOPLASTY KIDNEY 28MM 32.9MM 26.9MM FLEXIBLE HOLDER BOTH IP/OP "$8,295.00" "$6,138.00" "$1,476.51" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$1,476.51" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$1,728.77" "$8,295.00" "$3,318.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$6,221.25" "$8,295.00" "$8,295.00" "$8,295.00" "$4,147.50" "$4,147.50" "$6,569.64" "$8,295.00" "$6,636.00" "$3,732.75" "$8,295.00" N/A "$4,811.10" "$8,295.00" "$4,977.00" "$8,295.00" "$8,295.00" "$8,295.00" N/A N/A 4450M30 SUP Custom 27803010 4450M30 - RING ANNULOPLASTY KIDNEY 30MM 34.9MM 28.9MM FLEXIBLE HOLDER BOTH IP/OP "$8,295.00" "$6,138.00" "$1,476.51" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$1,476.51" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$1,728.77" "$8,295.00" "$3,318.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$6,221.25" "$8,295.00" "$8,295.00" "$8,295.00" "$4,147.50" "$4,147.50" "$6,569.64" "$8,295.00" "$6,636.00" "$3,732.75" "$8,295.00" N/A "$4,811.10" "$8,295.00" "$4,977.00" "$8,295.00" "$8,295.00" "$8,295.00" N/A N/A 4450M32 SUP Custom 27803010 4450M32 - RING ANNULOPLASTY KIDNEY 32MM 37.1MM 30.9MM FLEXIBLE HOLDER BOTH IP/OP "$8,295.00" "$6,138.00" "$1,476.51" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$1,476.51" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$1,728.77" "$8,295.00" "$3,318.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$6,221.25" "$8,295.00" "$8,295.00" "$8,295.00" "$4,147.50" "$4,147.50" "$6,569.64" "$8,295.00" "$6,636.00" "$3,732.75" "$8,295.00" N/A "$4,811.10" "$8,295.00" "$4,977.00" "$8,295.00" "$8,295.00" "$8,295.00" N/A N/A 4450M34 SUP Custom 27803010 4450M34 - RING ANNULOPLASTY KIDNEY 34MM 39.1MM 32.9MM FLEXIBLE HOLDER BOTH IP/OP "$8,295.00" "$6,138.00" "$1,476.51" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$1,476.51" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$1,728.77" "$8,295.00" "$3,318.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$8,295.00" "$6,221.25" "$8,295.00" "$8,295.00" "$8,295.00" "$4,147.50" "$4,147.50" "$6,569.64" "$8,295.00" "$6,636.00" "$3,732.75" "$8,295.00" N/A "$4,811.10" "$8,295.00" "$4,977.00" "$8,295.00" "$8,295.00" "$8,295.00" N/A N/A 4450M36 SUP Custom 27803010 4450M36 - RING ANLPLS KNDY 36MM 41.2MM 34.8MM STRL C-E PH FLXB HLDR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,318.00" "$8,750.00" "$8,750.00" "$8,295.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 446.354S SUP HCPCS C1713 446.354S - PLATE BONE 27MM 2 HOLE HEAD 4 HOLE SHAFT ROTATION CORRECTION BOTH IP/OP "$1,545.00" "$1,143.00" $306.62 "$1,544.90" $695.21 $695.21 $695.21 $695.21 "$1,544.90" "$1,544.90" "$1,544.90" $322.00 "$1,544.90" "$1,544.90" "$1,544.90" "$1,544.90" "$1,544.90" $321.97 "$1,544.90" $617.96 $913.81 "$1,544.90" "$1,544.90" "$1,544.90" "$1,544.90" "$1,158.75" "$1,544.90" "$1,544.90" "$1,544.90" $772.45 $772.45 "$1,223.56" "$1,544.90" "$1,235.92" $695.21 $306.62 N/A $896.10 "$1,544.90" $926.94 "$1,544.90" $321.96 "$1,544.90" N/A N/A 446.355S SUP HCPCS C1713 446.355S - PLATE BONE 32MM 2 HOLE HEAD 5 HOLE SHAFT ROTATION CORRECTION BOTH IP/OP "$1,545.00" "$1,143.00" $306.62 "$1,544.90" $695.21 $695.21 $695.21 $695.21 "$1,544.90" "$1,544.90" "$1,544.90" $322.00 "$1,544.90" "$1,544.90" "$1,544.90" "$1,544.90" "$1,544.90" $321.97 "$1,544.90" $617.96 $913.81 "$1,544.90" "$1,544.90" "$1,544.90" "$1,544.90" "$1,158.75" "$1,544.90" "$1,544.90" "$1,544.90" $772.45 $772.45 "$1,223.56" "$1,544.90" "$1,235.92" $695.21 $306.62 N/A $896.10 "$1,544.90" $926.94 "$1,544.90" $321.96 "$1,544.90" N/A N/A 446.63.96 SUP HCPCS C1713 446.63.96 - PLATE BN 36X3.5X.9MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDYL BOTH IP/OP $540.00 $400.00 $107.13 $548.95 $242.90 $242.90 $242.90 $242.90 $539.78 $539.78 $539.78 $112.50 $539.78 $539.78 $539.78 $539.78 $539.78 $112.50 $539.78 $548.95 $319.28 $539.78 $548.95 $539.78 $539.78 $405.00 $539.78 $539.78 $539.78 $269.89 $269.89 $427.51 $539.78 $431.82 $242.90 $107.13 N/A $313.20 $539.78 $539.78 $539.78 $112.49 $539.78 N/A N/A 446.64.96 SUP HCPCS C1713 446.64.96 - PLATE BN 36X3.5X.9MM NS LCP 7 HL LOPRFL PRECONTOUR TI CNDYL BOTH IP/OP $540.00 $400.00 $107.13 $548.95 $242.90 $242.90 $242.90 $242.90 $539.78 $539.78 $539.78 $112.50 $539.78 $539.78 $539.78 $539.78 $539.78 $112.50 $539.78 $548.95 $319.28 $539.78 $548.95 $539.78 $539.78 $405.00 $539.78 $539.78 $539.78 $269.89 $269.89 $427.51 $539.78 $431.82 $242.90 $107.13 N/A $313.20 $539.78 $323.87 $539.78 $112.49 $539.78 N/A N/A 447.354S SUP HCPCS C1713 447.354S - PLATE BONE 34MM 2 HOLE HEAD 4 HOLE SHAFT ROTATION CORRECTION BOTH IP/OP "$1,591.50" "$1,178.00" $315.82 "$1,618.30" $716.06 $716.06 $716.06 $716.06 "$1,591.25" "$1,591.25" "$1,591.25" $331.66 "$1,591.25" "$1,591.25" "$1,591.25" "$1,591.25" "$1,591.25" $331.63 "$1,591.25" $647.32 $941.22 "$1,591.25" "$1,618.30" "$1,591.25" "$1,591.25" "$1,193.63" "$1,591.25" "$1,591.25" "$1,591.25" $795.63 $795.63 "$1,260.27" "$1,591.25" "$1,273.00" $716.06 $315.82 N/A $923.07 "$1,591.25" $954.75 "$1,591.25" $331.62 "$1,591.25" N/A N/A 447.355S SUP HCPCS C1713 447.355S - PLATE BONE 40MM 2 HOLE HEAD 2 HOLE SHAFT ROTATION CORRECTION BOTH IP/OP "$1,591.50" "$1,178.00" $315.82 "$1,618.30" $716.06 $716.06 $716.06 $716.06 "$1,591.25" "$1,591.25" "$1,591.25" $331.66 "$1,591.25" "$1,591.25" "$1,591.25" "$1,591.25" "$1,591.25" $331.63 "$1,591.25" "$1,618.30" $941.22 "$1,591.25" "$1,618.30" "$1,591.25" "$1,591.25" "$1,193.63" "$1,591.25" "$1,591.25" "$1,591.25" $795.63 $795.63 "$1,260.27" "$1,591.25" "$1,273.00" $716.06 $315.82 N/A $923.07 "$1,591.25" $954.75 "$1,591.25" "$1,591.25" "$1,591.25" N/A N/A 450.701S SUP HCPCS C1713 450.701S - NAIL INTRAMEDULLARY 9MM 16CM SOLID AQUA TITANIUM FEMUR BOTH IP/OP "$3,325.00" "$2,461.00" $659.88 "$3,324.75" "$1,496.14" "$1,496.14" "$1,496.14" "$1,496.14" "$3,324.75" "$3,324.75" "$3,324.75" $692.96 "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" $692.91 "$3,324.75" "$1,329.90" "$1,639.10" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$2,493.75" "$3,324.75" "$3,324.75" "$3,324.75" "$1,662.38" "$1,662.38" "$2,633.20" "$3,324.75" "$2,659.80" "$1,496.14" $659.88 N/A "$1,928.50" "$3,324.75" "$1,994.85" "$3,324.75" "$3,324.75" "$3,324.75" N/A N/A 450.702S SUP HCPCS C1713 450.702S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 20CM SOLID EXPERT AQUA BOTH IP/OP "$3,325.00" "$2,461.00" $659.88 "$3,324.75" "$1,496.14" "$1,496.14" "$1,496.14" "$1,496.14" "$3,324.75" "$3,324.75" "$3,324.75" $692.96 "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" $692.91 "$3,324.75" "$1,329.90" "$1,639.10" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$2,493.75" "$3,324.75" "$3,324.75" "$3,324.75" "$1,662.38" "$1,662.38" "$2,633.20" "$3,324.75" "$2,659.80" "$1,496.14" $659.88 N/A "$1,928.50" "$3,324.75" "$1,994.85" "$3,324.75" "$3,324.75" "$3,324.75" N/A N/A 450.703S SUP HCPCS C1713 450.703S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 24CM SOLID EXPERT AQUA BOTH IP/OP "$3,300.00" "$2,442.00" $654.96 "$3,299.98" "$1,484.99" "$1,484.99" "$1,484.99" "$1,484.99" "$3,299.98" "$3,299.98" "$3,299.98" $687.80 "$3,299.98" "$3,299.98" "$3,299.98" "$3,299.98" "$3,299.98" $687.75 "$3,299.98" "$3,299.98" "$1,626.89" "$3,299.98" "$3,299.98" "$3,299.98" "$3,299.98" "$2,475.00" "$3,299.98" "$3,299.98" "$3,299.98" "$1,649.99" "$1,649.99" "$2,613.58" "$3,299.98" "$2,639.98" "$1,484.99" $654.96 N/A "$1,914.00" "$3,299.98" "$1,979.99" "$3,299.98" $687.72 "$3,299.98" N/A N/A 450.704S SUP HCPCS C1713 450.704S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 28CM SOLID EXPERT AQUA BOTH IP/OP "$3,325.00" "$2,461.00" $659.88 "$3,324.75" "$1,496.14" "$1,496.14" "$1,496.14" "$1,496.14" "$3,324.75" "$3,324.75" "$3,324.75" $692.96 "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" $692.91 "$3,324.75" "$3,324.75" "$1,639.10" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$2,493.75" "$3,324.75" "$3,324.75" "$3,324.75" "$1,662.38" "$1,662.38" "$2,633.20" "$3,324.75" "$2,659.80" "$1,496.14" $659.88 N/A "$1,928.50" "$3,324.75" "$3,324.75" "$3,324.75" $692.88 "$3,324.75" N/A N/A 450.705S SUP HCPCS C1713 450.705S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 30CM SOLID EXPERT AQUA BOTH IP/OP "$3,300.00" "$2,442.00" $654.96 "$3,299.98" "$1,484.99" "$1,484.99" "$1,484.99" "$1,484.99" "$3,299.98" "$3,299.98" "$3,299.98" $687.80 "$3,299.98" "$3,299.98" "$3,299.98" "$3,299.98" "$3,299.98" $687.75 "$3,299.98" "$3,299.98" "$1,626.89" "$3,299.98" "$3,299.98" "$3,299.98" "$3,299.98" "$2,475.00" "$3,299.98" "$3,299.98" "$3,299.98" "$1,649.99" "$1,649.99" "$2,613.58" "$3,299.98" "$2,639.98" "$1,484.99" $654.96 N/A "$1,914.00" "$3,299.98" "$1,979.99" "$3,299.98" $687.72 "$3,299.98" N/A N/A 450.706S SUP HCPCS C1713 450.706S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 32CM SOLID EXPERT AQUA BOTH IP/OP "$3,830.00" "$2,834.00" $760.12 "$3,829.78" "$1,723.40" "$1,723.40" "$1,723.40" "$1,723.40" "$3,829.78" "$3,829.78" "$3,829.78" $798.22 "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" $798.17 "$3,829.78" "$3,829.78" "$1,888.08" "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" "$2,872.50" "$3,829.78" "$3,829.78" "$3,829.78" "$1,914.89" "$1,914.89" "$3,033.19" "$3,829.78" "$3,063.82" "$1,723.40" $760.12 N/A "$2,221.40" "$3,829.78" "$3,829.78" "$3,829.78" $798.13 "$3,829.78" N/A N/A 450.707S SUP HCPCS C1713 450.707S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 34CM SOLID EXPERT AQUA BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" "$3,234.00" "$3,234.00" N/A N/A 450.708S SUP HCPCS C1713 450.708S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 360MM SOLID ROUND BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$3,209.90" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" "$3,209.90" "$3,209.90" N/A N/A 450.709S SUP HCPCS C1713 450.709S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 380MM SOLID ROUND BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" "$3,234.00" "$3,234.00" N/A N/A 450.710S SUP HCPCS C1713 450.710S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 40CM SOLID EXPERT AQUA BOTH IP/OP "$3,830.00" "$2,834.00" $760.12 "$3,829.78" "$1,723.40" "$1,723.40" "$1,723.40" "$1,723.40" "$3,829.78" "$3,829.78" "$3,829.78" $798.22 "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" $798.17 "$3,829.78" "$3,829.78" "$1,888.08" "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" "$2,872.50" "$3,829.78" "$3,829.78" "$3,829.78" "$1,914.89" "$1,914.89" "$3,033.19" "$3,829.78" "$3,063.82" "$1,723.40" $760.12 N/A "$2,221.40" "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" N/A N/A 450.711S SUP HCPCS C1713 450.711S - NAIL INTRAMEDULLARY 9MM 42CM SOLID AQUA TITANIUM FEMUR BOTH IP/OP "$3,325.00" "$2,461.00" $659.88 "$3,324.75" "$1,496.14" "$1,496.14" "$1,496.14" "$1,496.14" "$3,324.75" "$3,324.75" "$3,324.75" $692.96 "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" $692.91 "$3,324.75" "$3,324.75" "$1,639.10" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$2,493.75" "$3,324.75" "$3,324.75" "$3,324.75" "$1,662.38" "$1,662.38" "$2,633.20" "$3,324.75" "$2,659.80" "$1,496.14" $659.88 N/A "$1,928.50" "$3,324.75" "$1,994.85" "$3,324.75" "$3,324.75" "$3,324.75" N/A N/A 450.712S SUP HCPCS C1713 450.712S - NAIL INTRAMEDULLARY 9MM 44CM SOLID AQUA TITANIUM FEMUR BOTH IP/OP "$3,300.00" "$2,442.00" $654.96 "$3,299.98" "$1,484.99" "$1,484.99" "$1,484.99" "$1,484.99" "$3,299.98" "$3,299.98" "$3,299.98" $687.80 "$3,299.98" "$3,299.98" "$3,299.98" "$3,299.98" "$3,299.98" $687.75 "$3,299.98" "$3,299.98" "$1,626.89" "$3,299.98" "$3,299.98" "$3,299.98" "$3,299.98" "$2,475.00" "$3,299.98" "$3,299.98" "$3,299.98" "$1,649.99" "$1,649.99" "$2,613.58" "$3,299.98" "$2,639.98" "$1,484.99" $654.96 N/A "$1,914.00" "$3,299.98" "$1,979.99" "$3,299.98" "$3,299.98" "$3,299.98" N/A N/A 450.713S SUP HCPCS C1713 450.713S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 460MM SOLID ROUND BARREL BOTH IP/OP "$3,325.00" "$2,461.00" $659.88 "$3,324.75" "$1,496.14" "$1,496.14" "$1,496.14" "$1,496.14" "$3,324.75" "$3,324.75" "$3,324.75" $692.96 "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" $692.91 "$3,324.75" "$3,324.75" "$1,639.10" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$2,493.75" "$3,324.75" "$3,324.75" "$3,324.75" "$1,662.38" "$1,662.38" "$2,633.20" "$3,324.75" "$2,659.80" "$1,496.14" $659.88 N/A "$1,928.50" "$3,324.75" "$1,994.85" "$3,324.75" $692.88 "$3,324.75" N/A N/A 450.714S SUP HCPCS C1713 450.714S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 180MM SOLID ROUND BARREL BOTH IP/OP "$3,325.00" "$2,461.00" $659.88 "$3,324.75" "$1,496.14" "$1,496.14" "$1,496.14" "$1,496.14" "$3,324.75" "$3,324.75" "$3,324.75" $692.96 "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" $692.91 "$3,324.75" "$1,329.90" "$1,639.10" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$2,493.75" "$3,324.75" "$3,324.75" "$3,324.75" "$1,662.38" "$1,662.38" "$2,633.20" "$3,324.75" "$2,659.80" "$1,496.14" $659.88 N/A "$1,928.50" "$3,324.75" "$1,994.85" "$3,324.75" $692.88 "$3,324.75" N/A N/A 450.715S SUP HCPCS C1713 450.715S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 220MM SOLID ROUND BARREL BOTH IP/OP "$3,325.00" "$2,461.00" $659.88 "$3,324.75" "$1,496.14" "$1,496.14" "$1,496.14" "$1,496.14" "$3,324.75" "$3,324.75" "$3,324.75" $692.96 "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" $692.91 "$3,324.75" "$1,329.90" "$1,639.10" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$2,493.75" "$3,324.75" "$3,324.75" "$3,324.75" "$1,662.38" "$1,662.38" "$2,633.20" "$3,324.75" "$2,659.80" "$1,496.14" $659.88 N/A "$1,928.50" "$3,324.75" "$1,994.85" "$3,324.75" $692.88 "$3,324.75" N/A N/A 450.716S SUP HCPCS C1713 450.716S - NAIL INTRAMEDULLARY UNIVERSAL 9MM 260MM SOLID ROUND BARREL BOTH IP/OP "$3,325.00" "$2,461.00" $659.88 "$3,324.75" "$1,496.14" "$1,496.14" "$1,496.14" "$1,496.14" "$3,324.75" "$3,324.75" "$3,324.75" $692.96 "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" $692.91 "$3,324.75" "$1,329.90" "$1,639.10" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$2,493.75" "$3,324.75" "$3,324.75" "$3,324.75" "$1,662.38" "$1,662.38" "$2,633.20" "$3,324.75" "$2,659.80" "$1,496.14" $659.88 N/A "$1,928.50" "$3,324.75" "$3,324.75" "$3,324.75" $692.88 "$3,324.75" N/A N/A 450.781S SUP HCPCS C1713 450.781S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 160MM CANN ROUND BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.782S SUP HCPCS C1713 450.782S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 200MM CANN ROUND BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$3,209.90" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$3,209.90" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.783S SUP HCPCS C1713 450.783S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 240MM CANN ROUND BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$3,209.90" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.784S SUP HCPCS C1713 450.784S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 280MM CANN ROUND BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$1,283.96" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.785S SUP HCPCS C1713 450.785S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM CANN ROUND BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$1,283.96" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.786S SUP HCPCS C1713 450.786S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM CANN ROUND BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$1,283.96" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$3,209.90" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.787S SUP HCPCS C1713 450.787S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 340MM CANN ROUND BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$1,283.96" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$3,209.90" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.788S SUP HCPCS C1713 450.788S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 360MM CANN ROUND BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$1,283.96" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$3,209.90" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.789S SUP HCPCS C1713 450.789S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM CANN ROUND BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$1,283.96" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.790S SUP HCPCS C1713 450.790S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM CANN ROUND BARREL BOTH IP/OP "$3,830.00" "$2,834.00" $760.12 "$3,829.78" "$1,723.40" "$1,723.40" "$1,723.40" "$1,723.40" "$3,829.78" "$3,829.78" "$3,829.78" $798.22 "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" $798.17 "$3,829.78" "$1,531.91" "$1,888.08" "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" "$2,872.50" "$3,829.78" "$3,829.78" "$3,829.78" "$1,914.89" "$1,914.89" "$3,033.19" "$3,829.78" "$3,063.82" "$1,723.40" $760.12 N/A "$2,221.40" "$3,829.78" "$2,297.87" "$3,829.78" $798.13 "$3,829.78" N/A N/A 450.791S SUP HCPCS C1713 450.791S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM CANN ROUND BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$1,283.96" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.792S SUP HCPCS C1713 450.792S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 440MM CANN ROUND BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$1,293.60" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.793S SUP HCPCS C1713 450.793S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 460MM CANN ROUND BARREL BOTH IP/OP "$3,325.00" "$2,461.00" $659.88 "$3,324.75" "$1,496.14" "$1,496.14" "$1,496.14" "$1,496.14" "$3,324.75" "$3,324.75" "$3,324.75" $692.96 "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" $692.91 "$3,324.75" "$1,329.90" "$1,639.10" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$2,493.75" "$3,324.75" "$3,324.75" "$3,324.75" "$1,662.38" "$1,662.38" "$2,633.20" "$3,324.75" "$2,659.80" "$1,496.14" $659.88 N/A "$1,928.50" "$3,324.75" "$1,994.85" "$3,324.75" $692.88 "$3,324.75" N/A N/A 450.794S SUP HCPCS C1713 450.794S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 180MM CANN ROUND BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$1,293.60" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.795S SUP HCPCS C1713 450.795S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 220MM CANN ROUND BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$1,293.60" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.796S SUP HCPCS C1713 450.796S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 260MM CANN ROUND BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$1,293.60" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.801S SUP HCPCS C1713 450.801S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 160MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$1,293.60" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" N/A N/A 450.802S SUP HCPCS C1713 450.802S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 200MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.803S SUP HCPCS C1713 450.803S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 240MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$1,293.60" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.804S SUP HCPCS C1713 450.804S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 280MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$1,283.96" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$3,209.90" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.805S SUP HCPCS C1713 450.805S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.806S SUP HCPCS C1713 450.806S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 320MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" "$3,234.00" "$3,234.00" N/A N/A 450.807S SUP HCPCS C1713 450.807S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 340MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.808S SUP HCPCS C1713 450.808S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$3,209.90" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.809S SUP HCPCS C1713 450.809S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 380MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$3,209.90" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" "$3,209.90" "$3,209.90" N/A N/A 450.810S SUP HCPCS C1713 450.810S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 400MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" N/A N/A 450.811S SUP HCPCS C1713 450.811S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 420MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" "$3,234.00" "$3,234.00" N/A N/A 450.812S SUP HCPCS C1713 450.812S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 440MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$1,293.60" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.813S SUP HCPCS C1713 450.813S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 460MM CANN FLUTED BARREL BOTH IP/OP "$3,325.00" "$2,461.00" $659.88 "$3,324.75" "$1,496.14" "$1,496.14" "$1,496.14" "$1,496.14" "$3,324.75" "$3,324.75" "$3,324.75" $692.96 "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" $692.91 "$3,324.75" "$3,324.75" "$1,639.10" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$2,493.75" "$3,324.75" "$3,324.75" "$3,324.75" "$1,662.38" "$1,662.38" "$2,633.20" "$3,324.75" "$2,659.80" "$1,496.14" $659.88 N/A "$1,928.50" "$3,324.75" "$1,994.85" "$3,324.75" $692.88 "$3,324.75" N/A N/A 450.814S SUP HCPCS C1713 450.814S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 180MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$1,283.96" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.815S SUP HCPCS C1713 450.815S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 220MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$1,293.60" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.816S SUP HCPCS C1713 450.816S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 260MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$1,293.60" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.821S SUP HCPCS C1713 450.821S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 160MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.822S SUP HCPCS C1713 450.822S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 200MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.823S SUP HCPCS C1713 450.823S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 240MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.824S SUP HCPCS C1713 450.824S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 280MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$1,283.96" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.825S SUP HCPCS C1713 450.825S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 30CM CANN EXPERT AQUA BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$1,293.60" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$3,234.00" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.826S SUP HCPCS C1713 450.826S - NAIL INTRAMEDULLARY 12MM 320MM AQUA TITANIUM DISTAL FEMUR BOTH IP/OP "$3,830.00" "$2,834.00" $760.12 "$3,829.78" "$1,723.40" "$1,723.40" "$1,723.40" "$1,723.40" "$3,829.78" "$3,829.78" "$3,829.78" $798.22 "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" $798.17 "$3,829.78" "$1,531.91" "$1,888.08" "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" "$2,872.50" "$3,829.78" "$3,829.78" "$3,829.78" "$1,914.89" "$1,914.89" "$3,033.19" "$3,829.78" "$3,063.82" "$1,723.40" $760.12 N/A "$2,221.40" "$3,829.78" "$2,297.87" "$3,829.78" "$3,829.78" "$3,829.78" N/A N/A 450.827S SUP HCPCS C1713 450.827S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 340MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$1,283.96" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" "$3,209.90" "$3,209.90" N/A N/A 450.828S SUP HCPCS C1713 450.828S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$1,283.96" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.829S SUP HCPCS C1713 450.829S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$3,209.90" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.830S SUP HCPCS C1713 450.830S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 400MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$3,209.90" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.831S SUP HCPCS C1713 450.831S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$3,209.90" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.832S SUP HCPCS C1713 450.832S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 440MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$1,293.60" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.833S SUP HCPCS C1713 450.833S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 460MM CANN FLUTED BARREL BOTH IP/OP "$3,325.00" "$2,461.00" $659.88 "$3,324.75" "$1,496.14" "$1,496.14" "$1,496.14" "$1,496.14" "$3,324.75" "$3,324.75" "$3,324.75" $692.96 "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" $692.91 "$3,324.75" "$1,329.90" "$1,639.10" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$2,493.75" "$3,324.75" "$3,324.75" "$3,324.75" "$1,662.38" "$1,662.38" "$2,633.20" "$3,324.75" "$2,659.80" "$1,496.14" $659.88 N/A "$1,928.50" "$3,324.75" "$1,994.85" "$3,324.75" $692.88 "$3,324.75" N/A N/A 450.834S SUP HCPCS C1713 450.834S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 180MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$1,293.60" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.835S SUP HCPCS C1713 450.835S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 220MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" "$3,234.00" "$3,234.00" N/A N/A 450.836S SUP HCPCS C1713 450.836S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 260MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" "$3,234.00" "$3,234.00" N/A N/A 450.841S SUP HCPCS C1713 450.841S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 160MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$1,293.60" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.842S SUP HCPCS C1713 450.842S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 200MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.843S SUP HCPCS C1713 450.843S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 240MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.844S SUP HCPCS C1713 450.844S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 280MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$1,283.96" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" "$3,209.90" "$3,209.90" N/A N/A 450.845S SUP HCPCS C1713 450.845S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM CANN FLUTED BARREL BOTH IP/OP "$3,830.00" "$2,834.00" $760.12 "$3,829.78" "$1,723.40" "$1,723.40" "$1,723.40" "$1,723.40" "$3,829.78" "$3,829.78" "$3,829.78" $798.22 "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" $798.17 "$3,829.78" "$3,829.78" "$1,888.08" "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" "$2,872.50" "$3,829.78" "$3,829.78" "$3,829.78" "$1,914.89" "$1,914.89" "$3,033.19" "$3,829.78" "$3,063.82" "$1,723.40" $760.12 N/A "$2,221.40" "$3,829.78" "$2,297.87" "$3,829.78" "$3,829.78" "$3,829.78" N/A N/A 450.846S SUP HCPCS C1713 450.846S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$3,209.90" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.847S SUP HCPCS C1713 450.847S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 340MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" N/A N/A 450.848S SUP HCPCS C1713 450.848S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$3,209.90" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.849S SUP HCPCS C1713 450.849S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 380MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.850S SUP HCPCS C1713 450.850S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 400MM CANN FLUTED BARREL BOTH IP/OP "$3,830.00" "$2,834.00" $760.12 "$3,829.78" "$1,723.40" "$1,723.40" "$1,723.40" "$1,723.40" "$3,829.78" "$3,829.78" "$3,829.78" $798.22 "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" $798.17 "$3,829.78" "$3,829.78" "$1,888.08" "$3,829.78" "$3,829.78" "$3,829.78" "$3,829.78" "$2,872.50" "$3,829.78" "$3,829.78" "$3,829.78" "$1,914.89" "$1,914.89" "$3,033.19" "$3,829.78" "$3,063.82" "$1,723.40" $760.12 N/A "$2,221.40" "$3,829.78" "$3,829.78" "$3,829.78" $798.13 "$3,829.78" N/A N/A 450.851S SUP HCPCS C1713 450.851S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 420MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$3,209.90" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" $668.94 "$3,209.90" N/A N/A 450.852S SUP HCPCS C1713 450.852S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 440MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" "$3,234.00" "$3,234.00" N/A N/A 450.853S SUP HCPCS C1713 450.853S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 460MM CANN FLUTED BARREL BOTH IP/OP "$3,325.00" "$2,461.00" $659.88 "$3,324.75" "$1,496.14" "$1,496.14" "$1,496.14" "$1,496.14" "$3,324.75" "$3,324.75" "$3,324.75" $692.96 "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" $692.91 "$3,324.75" "$3,324.75" "$1,639.10" "$3,324.75" "$3,324.75" "$3,324.75" "$3,324.75" "$2,493.75" "$3,324.75" "$3,324.75" "$3,324.75" "$1,662.38" "$1,662.38" "$2,633.20" "$3,324.75" "$2,659.80" "$1,496.14" $659.88 N/A "$1,928.50" "$3,324.75" "$1,994.85" "$3,324.75" "$3,324.75" "$3,324.75" N/A N/A 450.854S SUP HCPCS C1713 450.854S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 180MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$3,234.00" "$3,234.00" $673.97 "$3,234.00" N/A N/A 450.855S SUP HCPCS C1713 450.855S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 220MM CANN FLUTED BARREL BOTH IP/OP "$3,210.00" "$2,375.00" $637.08 "$3,209.90" "$1,444.46" "$1,444.46" "$1,444.46" "$1,444.46" "$3,209.90" "$3,209.90" "$3,209.90" $669.02 "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" $668.98 "$3,209.90" "$3,209.90" "$1,582.48" "$3,209.90" "$3,209.90" "$3,209.90" "$3,209.90" "$2,407.50" "$3,209.90" "$3,209.90" "$3,209.90" "$1,604.95" "$1,604.95" "$2,542.24" "$3,209.90" "$2,567.92" "$1,444.46" $637.08 N/A "$1,861.80" "$3,209.90" "$1,925.94" "$3,209.90" "$3,209.90" "$3,209.90" N/A N/A 450.856S SUP HCPCS C1713 450.856S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 260MM CANN FLUTED BARREL BOTH IP/OP "$3,234.00" "$2,393.00" $641.87 "$3,234.00" "$1,455.30" "$1,455.30" "$1,455.30" "$1,455.30" "$3,234.00" "$3,234.00" "$3,234.00" $674.05 "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" $674.00 "$3,234.00" "$3,234.00" "$1,594.36" "$3,234.00" "$3,234.00" "$3,234.00" "$3,234.00" "$2,425.50" "$3,234.00" "$3,234.00" "$3,234.00" "$1,617.00" "$1,617.00" "$2,561.33" "$3,234.00" "$2,587.20" "$1,455.30" $641.87 N/A "$1,875.72" "$3,234.00" "$1,940.40" "$3,234.00" "$3,234.00" "$3,234.00" N/A N/A 450.896S SUP Custom 27803010 450.896S - CAP END 8MM DISTAL END AQUA TITANIUM FEMUR DISTAL STERILE BOTH IP/OP $518.50 $384.00 $92.26 $518.33 $518.33 $518.33 $518.33 $518.33 $518.33 $518.33 $92.26 $518.33 $518.33 $518.33 $518.33 $518.33 $518.33 $108.03 $518.33 $207.33 $518.33 $518.33 $518.33 $518.33 $518.33 $388.88 $518.33 $518.33 $518.33 $259.17 $259.17 $410.52 $518.33 $414.66 $233.25 $518.33 N/A $300.73 $518.33 $311.00 $518.33 $518.33 $518.33 N/A N/A 450-1329 SUP HCPCS L8699 450-1329 - PROSTHESIS TESTICULAR LARGE 4.9X2.9CM INFUS LINE NEEDLE BOTH IP/OP "$4,622.50" "$3,421.00" $963.38 "$4,622.50" "$4,622.50" "$4,622.50" "$4,622.50" "$4,622.50" "$4,622.50" "$4,622.50" "$4,622.50" "$4,622.50" "$4,622.50" "$4,622.50" "$4,622.50" "$4,622.50" "$4,622.50" $963.38 "$4,622.50" "$1,849.00" "$4,622.50" "$4,622.50" "$4,622.50" "$4,622.50" "$4,622.50" "$3,466.88" "$4,622.50" "$4,622.50" "$4,622.50" "$2,311.25" "$2,311.25" "$3,661.02" "$4,622.50" "$3,698.00" "$2,080.13" "$4,622.50" N/A "$2,681.05" "$4,622.50" "$2,773.50" "$4,622.50" "$4,622.50" "$4,622.50" N/A N/A 45-018-E2S SUP Custom 27203010 45-018-E2S - CATHETER INFS 2 2/3FR 45CM CLARIVEIN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 450-4251-1 SUP Custom 27803010 450-4251-1 - CLAMP SURG THREADED C1 HALIFAX SPN BOTH IP/OP $483.00 $357.00 $85.97 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $85.97 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $100.66 $483.00 $193.20 $483.00 $483.00 $483.00 $483.00 $483.00 $362.25 $483.00 $483.00 $483.00 $241.50 $241.50 $382.54 $483.00 $386.40 $217.35 $483.00 N/A $280.14 $483.00 $289.80 $483.00 $483.00 $483.00 N/A N/A 450-4253-1 SUP Custom 27803010 450-4253-1 - CLAMP SURG 7MM THREAD HALIFAX SPN BOTH IP/OP $483.00 $357.00 $85.97 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $85.97 $483.00 $483.00 $483.00 $483.00 $483.00 $483.00 $100.66 $483.00 $193.20 $483.00 $483.00 $483.00 $483.00 $483.00 $362.25 $483.00 $483.00 $483.00 $241.50 $241.50 $382.54 $483.00 $386.40 $217.35 $483.00 N/A $280.14 $483.00 $289.80 $483.00 $483.00 $483.00 N/A N/A 451514H0 SUP HCPCS C1725 451514H0 - CATHETER ANGIO VERT CRV 5FR .042IN 100CM CRDS TMP RADOPQ BRD BOTH IP/OP $45.00 $33.00 $8.90 $44.85 $24.35 $24.35 $24.35 $24.35 $44.85 $44.85 $44.85 $9.35 $44.85 $33.29 $33.29 $34.57 $23.37 $9.35 $44.85 $37.38 $26.53 $44.85 $37.38 $44.85 $44.85 $33.75 $44.85 $44.85 $44.85 $22.43 $22.43 $35.52 $44.85 $35.88 $29.15 $8.90 N/A $26.10 $44.85 $44.85 $44.85 $9.35 $44.85 N/A N/A 45-20005 SUP Custom 27203010 45-20005 - DRILL SURG MICRO 1.7MM AO COUPLING CANN ASNIS STERILE BOTH IP/OP $337.00 $249.00 $59.94 $336.75 $336.75 $336.75 $336.75 $336.75 $336.75 $336.75 $59.94 $336.75 $336.75 $249.94 $249.94 $259.57 $175.45 $70.18 $336.75 $134.70 $336.75 $336.75 $336.75 $336.75 $336.75 $252.75 $336.75 $336.75 $336.75 $168.38 $168.38 $266.71 $336.75 $269.40 $218.89 $336.75 N/A $195.46 $336.75 $202.05 $336.75 $336.75 $336.75 N/A N/A 45-20006 SUP Custom 27803010 45-20006 - TAP SURG MICRO 2MM CANN AO COUPLING ASNIS DISPOSABLE BOTH IP/OP $333.00 $246.00 $59.27 $333.00 $333.00 $333.00 $333.00 $333.00 $333.00 $333.00 $59.27 $333.00 $333.00 $333.00 $333.00 $333.00 $333.00 $69.40 $333.00 $133.20 $333.00 $333.00 $333.00 $333.00 $333.00 $249.75 $333.00 $333.00 $333.00 $166.50 $166.50 $263.74 $333.00 $266.40 $149.85 $333.00 N/A $193.14 $333.00 $199.80 $333.00 $333.00 $333.00 N/A N/A 45-20007 SUP Custom 27203010 45-20007 - COUNTERSINK DRILL MICRO 2MM CANN AO COUPLING ASNIS BOTH IP/OP $420.00 $311.00 $74.74 $419.90 $419.90 $419.90 $419.90 $419.90 $419.90 $419.90 $74.74 $419.90 $419.90 $311.65 $311.65 $323.66 $218.77 $87.51 $419.90 $167.96 $419.90 $419.90 $419.90 $419.90 $419.90 $315.00 $419.90 $419.90 $419.90 $209.95 $209.95 $332.56 $419.90 $335.92 $272.94 $419.90 N/A $243.60 $419.90 $251.94 $419.90 $419.90 $419.90 N/A N/A 45-20008 SUP Custom 27203010 45-20008 - SLEEVE DRILL MICRO HOLD ASNIS 2MM SCREW BOTH IP/OP $274.00 $203.00 $48.71 $273.63 $273.63 $273.63 $273.63 $273.63 $273.63 $273.63 $48.71 $273.63 $273.63 $203.09 $203.09 $210.91 $142.56 $57.03 $273.63 $109.45 $273.63 $273.63 $273.63 $273.63 $273.63 $205.50 $273.63 $273.63 $273.63 $136.82 $136.82 $216.71 $273.63 $218.90 $177.86 $273.63 N/A $158.92 $273.63 $164.18 $273.63 $273.63 $273.63 N/A N/A 45-20009 SUP Custom 27203010 45-20009 - GUIDE DRILL MICRO .8MM 1.7MM 2 ASNIS 2MM SCREW BOTH IP/OP $672.50 $498.00 $119.68 $672.38 $672.38 $672.38 $672.38 $672.38 $672.38 $672.38 $119.68 $672.38 $672.38 $499.04 $499.04 $518.27 $350.31 $140.13 $672.38 $268.95 $672.38 $672.38 $672.38 $672.38 $672.38 $504.38 $672.38 $672.38 $672.38 $336.19 $336.19 $532.52 $672.38 $537.90 $437.05 $672.38 N/A $390.05 $672.38 $403.43 $672.38 $672.38 $672.38 N/A N/A 45-20011 SUP Custom 27203010 45-20011 - BIT DRILL 2MM 1.7MM AO COUPLING SOLID ASNIS NONSTRL BOTH IP/OP $122.00 $90.00 $21.64 $125.13 $121.55 $121.55 $121.55 $121.55 $121.55 $121.55 $21.64 $121.55 $121.55 $90.21 $90.21 $93.69 $63.33 $25.33 $121.55 $50.05 $121.55 $121.55 $125.13 $121.55 $121.55 $91.50 $121.55 $121.55 $121.55 $60.78 $60.78 $96.27 $121.55 $97.24 $79.01 $121.55 N/A $70.76 $121.55 $72.93 $121.55 $121.55 $121.55 N/A N/A 45-20014 SUP Custom 27203010 45-20014 - STYLET SURG INSTR .8MM CLEAN ASNIS BOTH IP/OP $34.50 $26.00 $6.12 $34.38 $34.38 $34.38 $34.38 $34.38 $34.38 $34.38 $6.12 $34.38 $34.38 $25.52 $25.52 $26.50 $17.91 $7.17 $34.38 $13.75 $34.38 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $22.35 $34.38 N/A $20.01 $34.38 $20.63 $34.38 $34.38 $34.38 N/A N/A 45-20015 SUP HCPCS C1713 45-20015 - WIRE FX .8MM 100MM NS KRSH DISP 2MM ASNS MIC SCR BOTH IP/OP $69.00 $51.00 $13.65 $68.75 $30.94 $30.94 $30.94 $30.94 $68.75 $68.75 $68.75 $14.33 $68.75 $68.75 $68.75 $68.75 $68.75 $14.33 $68.75 $68.75 $40.67 $68.75 $68.75 $68.75 $68.75 $51.75 $68.75 $68.75 $68.75 $34.38 $34.38 $54.45 $68.75 $55.00 $30.94 $13.65 N/A $40.02 $68.75 $68.75 $68.75 $14.33 $68.75 N/A N/A 45-27005 SUP Custom 27803010 45-27005 - TAP SURG 50MM 2.7MM SCREWS BOTH IP/OP $160.00 $118.00 $28.44 $159.75 $159.75 $159.75 $159.75 $159.75 $159.75 $159.75 $28.44 $159.75 $159.75 $159.75 $159.75 $159.75 $159.75 $33.29 $159.75 $63.90 $159.75 $159.75 $159.75 $159.75 $159.75 $120.00 $159.75 $159.75 $159.75 $79.88 $79.88 $126.52 $159.75 $127.80 $71.89 $159.75 N/A $92.80 $159.75 $95.85 $159.75 $159.75 $159.75 N/A N/A 45-27010 SUP Custom 27203010 45-27010 - DRILL TWIST 2MM 102MM 50MM AO SHAFT END VARIAX NONSTRL BOTH IP/OP $160.00 $118.00 $28.44 $159.75 $159.75 $159.75 $159.75 $159.75 $159.75 $159.75 $28.44 $159.75 $159.75 $118.57 $118.57 $123.14 $83.23 $33.29 $159.75 $63.90 $159.75 $159.75 $159.75 $159.75 $159.75 $120.00 $159.75 $159.75 $159.75 $79.88 $79.88 $126.52 $159.75 $127.80 $103.84 $159.75 N/A $92.80 $159.75 $95.85 $159.75 $159.75 $159.75 N/A N/A 45-30005 SUP Custom 27203010 45-30005 - DRILL SRG MIC 2.1MM STRL AO CPLNG CNN HND FT DISP 3MM ASNS BOTH IP/OP $416.50 $308.00 $74.14 $416.50 $416.50 $416.50 $416.50 $416.50 $416.50 $416.50 $74.14 $416.50 $416.50 $309.13 $309.13 $321.04 $217.00 $86.80 $416.50 $166.60 $416.50 $416.50 $416.50 $416.50 $416.50 $312.38 $416.50 $416.50 $416.50 $208.25 $208.25 $329.87 $416.50 $333.20 $270.73 $416.50 N/A $241.57 $416.50 $249.90 $416.50 $416.50 $416.50 N/A N/A 45-30006 SUP Custom 27803010 45-30006 - TAP SURG MICRO 3MM CANN AO COUPLING ASNIS DISPOSABLE BOTH IP/OP $319.50 $236.00 $56.87 $319.50 $319.50 $319.50 $319.50 $319.50 $319.50 $319.50 $56.87 $319.50 $319.50 $319.50 $319.50 $319.50 $319.50 $66.59 $319.50 $127.80 $319.50 $319.50 $319.50 $319.50 $319.50 $239.63 $319.50 $319.50 $319.50 $159.75 $159.75 $253.04 $319.50 $255.60 $143.78 $319.50 N/A $185.31 $319.50 $191.70 $319.50 $319.50 $319.50 N/A N/A 45-30007 SUP Custom 27203010 45-30007 - COUNTERSINK DRILL 3MM AO COUPLING CANN DISPOSABLE BOTH IP/OP $391.00 $289.00 $69.60 $391.00 $391.00 $391.00 $391.00 $391.00 $391.00 $391.00 $69.60 $391.00 $391.00 $290.20 $290.20 $301.38 $203.71 $81.49 $391.00 $156.40 $391.00 $391.00 $391.00 $391.00 $391.00 $293.25 $391.00 $391.00 $391.00 $195.50 $195.50 $309.67 $391.00 $312.80 $254.15 $391.00 N/A $226.78 $391.00 $234.60 $391.00 $391.00 $391.00 N/A N/A 45-30008 SUP Custom 27203010 45-30008 - SLEEVE DRILL MICRO HOLD ASNIS 3MM SCREW BOTH IP/OP $271.00 $201.00 $48.22 $270.88 $270.88 $270.88 $270.88 $270.88 $270.88 $270.88 $48.22 $270.88 $270.88 $201.05 $201.05 $208.79 $141.13 $56.45 $270.88 $108.35 $270.88 $270.88 $270.88 $270.88 $270.88 $203.25 $270.88 $270.88 $270.88 $135.44 $135.44 $214.54 $270.88 $216.70 $176.07 $270.88 N/A $157.18 $270.88 $162.53 $270.88 $270.88 $270.88 N/A N/A 45-30009 SUP Custom 27203010 45-30009 - GUIDE DRILL MICRO 1.2MM 2.1MM 2 ASNIS BOTH IP/OP $334.50 $248.00 $59.48 $334.13 $334.13 $334.13 $334.13 $334.13 $334.13 $334.13 $59.48 $334.13 $334.13 $247.99 $247.99 $257.55 $174.08 $69.64 $334.13 $133.65 $334.13 $334.13 $334.13 $334.13 $334.13 $250.88 $334.13 $334.13 $334.13 $167.07 $167.07 $264.63 $334.13 $267.30 $217.18 $334.13 N/A $194.01 $334.13 $200.48 $334.13 $334.13 $334.13 N/A N/A 45-30011 SUP Custom 27203010 45-30011 - BIT DRILL MICRO 2.1MM SOLID AO COUPLING ASNIS NONSTRL BOTH IP/OP $123.50 $91.00 $21.94 $123.25 $123.25 $123.25 $123.25 $123.25 $123.25 $123.25 $21.94 $123.25 $123.25 $91.48 $91.48 $95.00 $64.21 $25.69 $123.25 $49.30 $123.25 $123.25 $123.25 $123.25 $123.25 $92.63 $123.25 $123.25 $123.25 $61.63 $61.63 $97.61 $123.25 $98.60 $80.11 $123.25 N/A $71.63 $123.25 $73.95 $123.25 $123.25 $123.25 N/A N/A 45-30014 SUP Custom 27203010 45-30014 - STYLET SURG INSTR 1.2MM CLEAN ASNIS BOTH IP/OP $34.50 $26.00 $6.12 $34.38 $34.38 $34.38 $34.38 $34.38 $34.38 $34.38 $6.12 $34.38 $34.38 $25.52 $25.52 $26.50 $17.91 $7.17 $34.38 $13.75 $34.38 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $22.35 $34.38 N/A $20.01 $34.38 $20.63 $34.38 $34.38 $34.38 N/A N/A 45-30015 SUP HCPCS C1713 45-30015 - WIRE FX 1.2MM 100MM NS KRSH 3MM ASNS MIC SCR BOTH IP/OP $69.00 $51.00 $13.65 $68.75 $30.94 $30.94 $30.94 $30.94 $68.75 $68.75 $68.75 $14.33 $68.75 $68.75 $68.75 $68.75 $68.75 $14.33 $68.75 $27.50 $40.67 $68.75 $68.75 $68.75 $68.75 $51.75 $68.75 $68.75 $68.75 $34.38 $34.38 $54.45 $68.75 $55.00 $30.94 $13.65 N/A $40.02 $68.75 $68.75 $68.75 $14.33 $68.75 N/A N/A 45-35001 SUP Custom 27203010 45-35001 - GAUGE DEPTH MEASURE VARIAX 3.5 MM SCREW BOTH IP/OP $760.50 $563.00 $135.35 $760.38 $760.38 $760.38 $760.38 $760.38 $760.38 $760.38 $135.35 $760.38 $760.38 $564.35 $564.35 $586.10 $396.16 $158.47 $760.38 $304.15 $760.38 $760.38 $760.38 $760.38 $760.38 $570.38 $760.38 $760.38 $760.38 $380.19 $380.19 $602.22 $760.38 $608.30 $494.25 $760.38 N/A $441.09 $760.38 $456.23 $760.38 $760.38 $760.38 N/A N/A 45-35005 SUP Custom 27803010 45-35005 - TAP SURG 70MM 3.5MM SCREWS BOTH IP/OP $188.50 $139.00 $33.51 $188.25 $188.25 $188.25 $188.25 $188.25 $188.25 $188.25 $33.51 $188.25 $188.25 $188.25 $188.25 $188.25 $188.25 $39.23 $188.25 $75.30 $188.25 $188.25 $188.25 $188.25 $188.25 $141.38 $188.25 $188.25 $188.25 $94.13 $94.13 $149.09 $188.25 $150.60 $84.71 $188.25 N/A $109.33 $188.25 $112.95 $188.25 $188.25 $188.25 N/A N/A 45-35010 SUP Custom 27203010 45-35010 - DRILL TWIST 2.6MM 122MM 70MM AO SHAFT END VARIAX NONSTRL FT BOTH IP/OP $188.50 $139.00 $33.51 $188.25 $188.25 $188.25 $188.25 $188.25 $188.25 $188.25 $33.51 $188.25 $188.25 $139.72 $139.72 $145.10 $98.08 $39.23 $188.25 $75.30 $188.25 $188.25 $188.25 $188.25 $188.25 $141.38 $188.25 $188.25 $188.25 $94.13 $94.13 $149.09 $188.25 $150.60 $122.36 $188.25 N/A $109.33 $188.25 $112.95 $188.25 $188.25 $188.25 N/A N/A 45-35015 SUP Custom 27203010 45-35015 - BLADE SCREWDRIVER T10 AO FIT ASNIS BOTH IP/OP $297.00 $220.00 $52.87 $297.00 $297.00 $297.00 $297.00 $297.00 $297.00 $297.00 $52.87 $297.00 $297.00 $220.43 $220.43 $228.93 $154.74 $61.90 $297.00 $118.80 $297.00 $297.00 $297.00 $297.00 $297.00 $222.75 $297.00 $297.00 $297.00 $148.50 $148.50 $235.22 $297.00 $237.60 $193.05 $297.00 N/A $172.26 $297.00 $178.20 $297.00 $297.00 $297.00 N/A N/A 45-35030 SUP Custom 27203010 45-35030 - SLEEVE HOLDING VARIAX 3.5 MM SCREW BOTH IP/OP $664.50 $492.00 $118.22 $664.13 $664.13 $664.13 $664.13 $664.13 $664.13 $664.13 $118.22 $664.13 $664.13 $492.92 $492.92 $511.91 $346.01 $138.41 $664.13 $265.65 $664.13 $664.13 $664.13 $664.13 $664.13 $498.38 $664.13 $664.13 $664.13 $332.07 $332.07 $525.99 $664.13 $531.30 $431.68 $664.13 N/A $385.41 $664.13 $398.48 $664.13 $664.13 $664.13 N/A N/A 456.010S SUP HCPCS C1713 456.010S - SLEEVE LCK 100D 15MM LGHT BLU STRL TI FEM 9-12MM IM NL SPRL BOTH IP/OP $756.50 $560.00 $150.10 $756.25 $340.31 $340.31 $340.31 $340.31 $756.25 $756.25 $756.25 $157.62 $756.25 $756.25 $756.25 $756.25 $756.25 $157.61 $756.25 $302.50 $447.32 $756.25 $756.25 $756.25 $756.25 $567.38 $756.25 $756.25 $756.25 $378.13 $378.13 $598.95 $756.25 $605.00 $340.31 $150.10 N/A $438.77 $756.25 $756.25 $756.25 $157.60 $756.25 N/A N/A 456.011S SUP HCPCS C1713 456.011S - SLEEVE LOCKING 110D 15MM LIGHT BLUE TITANIUM FEMUR STERILE BOTH IP/OP $756.50 $560.00 $150.10 $756.25 $340.31 $340.31 $340.31 $340.31 $756.25 $756.25 $756.25 $157.62 $756.25 $756.25 $756.25 $756.25 $756.25 $157.61 $756.25 $302.50 $447.32 $756.25 $756.25 $756.25 $756.25 $567.38 $756.25 $756.25 $756.25 $378.13 $378.13 $598.95 $756.25 $605.00 $340.31 $150.10 N/A $438.77 $756.25 $453.75 $756.25 $157.60 $756.25 N/A N/A 456.012S SUP HCPCS C1713 456.012S - SLEEVE LCK 120D 15MM LGHT BLU STRL TI FEM 9-12MM IM NL SPRL BOTH IP/OP $756.50 $560.00 $150.10 $756.25 $340.31 $340.31 $340.31 $340.31 $756.25 $756.25 $756.25 $157.62 $756.25 $756.25 $756.25 $756.25 $756.25 $157.61 $756.25 $756.25 $447.32 $756.25 $756.25 $756.25 $756.25 $567.38 $756.25 $756.25 $756.25 $378.13 $378.13 $598.95 $756.25 $605.00 $340.31 $150.10 N/A $438.77 $756.25 $453.75 $756.25 $157.60 $756.25 N/A N/A 456.013S SUP HCPCS C1713 456.013S - SLEEVE LOCKING 130D 15MM PINK TITANIUM FEMUR STERILE SPIRAL BOTH IP/OP $756.50 $560.00 $150.10 $756.25 $340.31 $340.31 $340.31 $340.31 $756.25 $756.25 $756.25 $157.62 $756.25 $756.25 $756.25 $756.25 $756.25 $157.61 $756.25 $756.25 $447.32 $756.25 $756.25 $756.25 $756.25 $567.38 $756.25 $756.25 $756.25 $378.13 $378.13 $598.95 $756.25 $605.00 $340.31 $150.10 N/A $438.77 $756.25 $453.75 $756.25 $157.60 $756.25 N/A N/A 456.100S SUP Custom 27803010 456.100S - BLADE FIX 100MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY BOTH IP/OP "$1,327.00" $982.00 $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $276.54 "$1,326.88" $530.75 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $995.25 "$1,326.88" "$1,326.88" "$1,326.88" $663.44 $663.44 "$1,050.89" "$1,326.88" "$1,061.50" $597.10 "$1,326.88" N/A $769.66 "$1,326.88" $796.13 "$1,326.88" "$1,326.88" "$1,326.88" N/A N/A 456.105S SUP Custom 27803010 456.105S - BLADE FIX 105MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY BOTH IP/OP "$1,327.00" $982.00 $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $276.54 "$1,326.88" $530.75 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $995.25 "$1,326.88" "$1,326.88" "$1,326.88" $663.44 $663.44 "$1,050.89" "$1,326.88" "$1,061.50" $597.10 "$1,326.88" N/A $769.66 "$1,326.88" $796.13 "$1,326.88" "$1,326.88" "$1,326.88" N/A N/A 456.110S SUP Custom 27803010 456.110S - BLADE FIX 110MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY BOTH IP/OP "$1,327.00" $982.00 $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $276.54 "$1,326.88" $530.75 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $995.25 "$1,326.88" "$1,326.88" "$1,326.88" $663.44 $663.44 "$1,050.89" "$1,326.88" "$1,061.50" $597.10 "$1,326.88" N/A $769.66 "$1,326.88" $796.13 "$1,326.88" "$1,326.88" "$1,326.88" N/A N/A 456.115S SUP Custom 27803010 456.115S - BLADE FIX 115MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY BOTH IP/OP "$1,327.00" $982.00 $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $276.54 "$1,326.88" $530.75 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $995.25 "$1,326.88" "$1,326.88" "$1,326.88" $663.44 $663.44 "$1,050.89" "$1,326.88" "$1,061.50" $597.10 "$1,326.88" N/A $769.66 "$1,326.88" $796.13 "$1,326.88" "$1,326.88" "$1,326.88" N/A N/A 456.120S SUP Custom 27803010 456.120S - BLADE FIX 120MM SPIRAL TITANIUM FEMUR STERILE INTRAMEDULLARY BOTH IP/OP "$1,327.00" $982.00 $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $276.54 "$1,326.88" $530.75 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $995.25 "$1,326.88" "$1,326.88" "$1,326.88" $663.44 $663.44 "$1,050.89" "$1,326.88" "$1,061.50" $597.10 "$1,326.88" N/A $769.66 "$1,326.88" $796.13 "$1,326.88" "$1,326.88" "$1,326.88" N/A N/A 456.300S SUP Custom 27803010 456.300S - BLADE INTRAMEDULLARY FIX HELIX 11MM 75MM HELICAL GOLD BOTH IP/OP "$1,257.50" $931.00 $223.82 "$1,278.80" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $223.82 "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $262.06 "$1,257.43" $511.52 "$1,257.43" "$1,257.43" "$1,278.80" "$1,257.43" "$1,257.43" $943.13 "$1,257.43" "$1,257.43" "$1,257.43" $628.72 $628.72 $995.88 "$1,257.43" "$1,005.94" $565.84 "$1,257.43" N/A $729.35 "$1,257.43" $754.46 "$1,257.43" "$1,257.43" "$1,257.43" N/A N/A 456.301S SUP Custom 27803010 456.301S - BLADE INTRAMEDULLARY FIX HELIX 11MM 80MM GOLD TITANIUM BOTH IP/OP "$1,257.50" $931.00 $223.82 "$1,278.80" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $223.82 "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $262.06 "$1,257.43" $511.52 "$1,257.43" "$1,257.43" "$1,278.80" "$1,257.43" "$1,257.43" $943.13 "$1,257.43" "$1,257.43" "$1,257.43" $628.72 $628.72 $995.88 "$1,257.43" "$1,005.94" $565.84 "$1,257.43" N/A $729.35 "$1,257.43" $754.46 "$1,257.43" "$1,257.43" "$1,257.43" N/A N/A 456.302S SUP Custom 27803010 456.302S - BLADE INTRAMEDULLARY FIX HELIX 11MM 85MM CANN GOLD TITANIUM BOTH IP/OP "$1,257.50" $931.00 $223.82 "$1,278.80" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $223.82 "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $262.06 "$1,257.43" $511.52 "$1,257.43" "$1,257.43" "$1,278.80" "$1,257.43" "$1,257.43" $943.13 "$1,257.43" "$1,257.43" "$1,257.43" $628.72 $628.72 $995.88 "$1,257.43" "$1,005.94" $565.84 "$1,257.43" N/A $729.35 "$1,257.43" $754.46 "$1,257.43" "$1,257.43" "$1,257.43" N/A N/A 456.303S SUP Custom 27803010 456.303S - BLADE INTRAMEDULLARY FIX HELIX 11MM 90MM GOLD TITANIUM BOTH IP/OP "$1,257.50" $931.00 $223.82 "$1,278.80" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $223.82 "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $262.06 "$1,257.43" $511.52 "$1,257.43" "$1,257.43" "$1,278.80" "$1,257.43" "$1,257.43" $943.13 "$1,257.43" "$1,257.43" "$1,257.43" $628.72 $628.72 $995.88 "$1,257.43" "$1,005.94" $565.84 "$1,257.43" N/A $729.35 "$1,257.43" $754.46 "$1,257.43" "$1,257.43" "$1,257.43" N/A N/A 456.304S SUP Custom 27803010 456.304S - BLADE INTRAMEDULLARY FIX HELIX 11MM 95MM GOLD TITANIUM BOTH IP/OP "$1,257.50" $931.00 $223.82 "$1,278.80" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $223.82 "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $262.06 "$1,257.43" $511.52 "$1,257.43" "$1,257.43" "$1,278.80" "$1,257.43" "$1,257.43" $943.13 "$1,257.43" "$1,257.43" "$1,257.43" $628.72 $628.72 $995.88 "$1,257.43" "$1,005.94" $565.84 "$1,257.43" N/A $729.35 "$1,257.43" $754.46 "$1,257.43" "$1,257.43" "$1,257.43" N/A N/A 456.305S SUP Custom 27803010 456.305S - BLADE INTRAMEDULLARY FIX HELIX 11MM 100MM GOLD TITANIUM BOTH IP/OP "$1,257.50" $931.00 $223.82 "$1,278.80" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $223.82 "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $262.06 "$1,257.43" $511.52 "$1,257.43" "$1,257.43" "$1,278.80" "$1,257.43" "$1,257.43" $943.13 "$1,257.43" "$1,257.43" "$1,257.43" $628.72 $628.72 $995.88 "$1,257.43" "$1,005.94" $565.84 "$1,257.43" N/A $729.35 "$1,257.43" $754.46 "$1,257.43" "$1,257.43" "$1,257.43" N/A N/A 456.306S SUP HCPCS C1713 456.306S - BLADE INTRAMEDULLARY FIX HELIX 11MM 105MM CANN GOLD TITANIUM BOTH IP/OP "$1,257.50" $931.00 $249.57 "$1,278.80" $565.84 $565.84 $565.84 $565.84 "$1,257.43" "$1,257.43" "$1,257.43" $262.08 "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $262.06 "$1,257.43" "$1,278.80" $743.77 "$1,257.43" "$1,278.80" "$1,257.43" "$1,257.43" $943.13 "$1,257.43" "$1,257.43" "$1,257.43" $628.72 $628.72 $995.88 "$1,257.43" "$1,005.94" $565.84 $249.57 N/A $729.35 "$1,257.43" $754.46 "$1,257.43" $262.05 "$1,257.43" N/A N/A 456.307S SUP Custom 27803010 456.307S - BLADE INTRAMEDULLARY FIX HELIX 11MM 110MM CANN GOLD TITANIUM BOTH IP/OP "$1,257.50" $931.00 $223.82 "$1,278.80" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $223.82 "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $262.06 "$1,257.43" $511.52 "$1,257.43" "$1,257.43" "$1,278.80" "$1,257.43" "$1,257.43" $943.13 "$1,257.43" "$1,257.43" "$1,257.43" $628.72 $628.72 $995.88 "$1,257.43" "$1,005.94" $565.84 "$1,257.43" N/A $729.35 "$1,257.43" $754.46 "$1,257.43" "$1,257.43" "$1,257.43" N/A N/A 456.308S SUP Custom 27803010 456.308S - BLADE INTRAMEDULLARY FIX HELIX 11MM 115MM GOLD TITANIUM BOTH IP/OP "$1,257.50" $931.00 $223.82 "$1,278.80" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $223.82 "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $262.06 "$1,257.43" $511.52 "$1,257.43" "$1,257.43" "$1,278.80" "$1,257.43" "$1,257.43" $943.13 "$1,257.43" "$1,257.43" "$1,257.43" $628.72 $628.72 $995.88 "$1,257.43" "$1,005.94" $565.84 "$1,257.43" N/A $729.35 "$1,257.43" $754.46 "$1,257.43" "$1,257.43" "$1,257.43" N/A N/A 456.309S SUP Custom 27803010 456.309S - BLADE INTRAMEDULLARY FIX HELIX 11MM 120MM GOLD TITANIUM BOTH IP/OP "$1,257.50" $931.00 $223.82 "$1,278.80" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $223.82 "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $262.06 "$1,257.43" $511.52 "$1,257.43" "$1,257.43" "$1,278.80" "$1,257.43" "$1,257.43" $943.13 "$1,257.43" "$1,257.43" "$1,257.43" $628.72 $628.72 $995.88 "$1,257.43" "$1,005.94" $565.84 "$1,257.43" N/A $729.35 "$1,257.43" $754.46 "$1,257.43" "$1,257.43" "$1,257.43" N/A N/A 456.310S SUP Custom 27803010 456.310S - BLADE INTRAMEDULLARY FIX HELIX 11MM 125MM HELICAL GOLD BOTH IP/OP "$1,257.50" $931.00 $223.82 "$1,278.80" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $223.82 "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" "$1,257.43" $262.06 "$1,257.43" $511.52 "$1,257.43" "$1,257.43" "$1,278.80" "$1,257.43" "$1,257.43" $943.13 "$1,257.43" "$1,257.43" "$1,257.43" $628.72 $628.72 $995.88 "$1,257.43" "$1,005.94" $565.84 "$1,257.43" N/A $729.35 "$1,257.43" $754.46 "$1,257.43" "$1,257.43" "$1,257.43" N/A N/A 456.311S SUP Custom 27803010 456.311S - CAP END 0MM GREEN TITANIUM STERILE BOTH IP/OP $404.50 $299.00 $71.93 $410.95 $404.08 $404.08 $404.08 $404.08 $404.08 $404.08 $71.93 $404.08 $404.08 $404.08 $404.08 $404.08 $404.08 $84.21 $404.08 $164.38 $404.08 $404.08 $410.95 $404.08 $404.08 $303.38 $404.08 $404.08 $404.08 $202.04 $202.04 $320.03 $404.08 $323.26 $181.84 $404.08 N/A $234.61 $404.08 $242.45 $404.08 $404.08 $404.08 N/A N/A 456.312S SUP Custom 27803010 456.312S - CAP END 5MM EXTEND GREEN TITANIUM TROC STERILE BOTH IP/OP $404.50 $299.00 $71.93 $410.95 $404.08 $404.08 $404.08 $404.08 $404.08 $404.08 $71.93 $404.08 $404.08 $404.08 $404.08 $404.08 $404.08 $84.21 $404.08 $164.38 $404.08 $404.08 $410.95 $404.08 $404.08 $303.38 $404.08 $404.08 $404.08 $202.04 $202.04 $320.03 $404.08 $323.26 $181.84 $404.08 N/A $234.61 $404.08 $242.45 $404.08 $404.08 $404.08 N/A N/A 456.313S SUP Custom 27803010 456.313S - CAP END 10MM EXTEND GREEN TITANIUM TROC STERILE CANN BOTH IP/OP $404.50 $299.00 $71.93 $410.95 $404.08 $404.08 $404.08 $404.08 $404.08 $404.08 $71.93 $404.08 $404.08 $404.08 $404.08 $404.08 $404.08 $84.21 $404.08 $164.38 $404.08 $404.08 $410.95 $404.08 $404.08 $303.38 $404.08 $404.08 $404.08 $202.04 $202.04 $320.03 $404.08 $323.26 $181.84 $404.08 N/A $234.61 $404.08 $242.45 $404.08 $404.08 $404.08 N/A N/A 456.314S SUP HCPCS C1713 456.314S - NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 10MM 170MM CANN BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$1,578.06" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.315S SUP HCPCS C1713 456.315S - NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 10MM 170MM CANN BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$1,578.06" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.316S SUP HCPCS C1713 456.316S - NAIL FIX 135D 10MM 17CM CANN GREEN TITANIUM TROCHANTER BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$1,578.06" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.317S SUP HCPCS C1713 456.317S - NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 11MM 170MM CANN BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$1,578.06" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.318S SUP HCPCS C1713 456.318S - NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 11MM 170MM CANN BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$1,578.06" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.319S SUP HCPCS C1713 456.319S - NAIL INTRAMEDULLARY 135D SHORT UNIVERSAL 11MM 170MM CANN BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$1,578.06" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.321S SUP HCPCS C1713 456.321S - NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 12MM 170MM CANN BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$2,630.10" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.322S SUP HCPCS C1713 456.322S - NAIL INTRAMEDULLARY 130D SHORT 12MM 170MM CANN STATIC INTLCK BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$1,578.06" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.323S SUP HCPCS C1713 456.323S - NAIL FIX 135D SHORT 12MM 170MM CANN STATIC INTLCK GREEN BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$1,578.06" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.324S SUP HCPCS C1713 456.324S - NAIL INTRAMEDULLARY 125D SHORT UNIVERSAL 10MM 235MM CANN BOTH IP/OP "$2,719.50" "$2,012.00" $539.67 "$2,765.30" "$1,223.59" "$1,223.59" "$1,223.59" "$1,223.59" "$2,719.08" "$2,719.08" "$2,719.08" $566.72 "$2,719.08" "$2,719.08" "$2,719.08" "$2,719.08" "$2,719.08" $566.69 "$2,719.08" "$2,765.30" "$1,340.51" "$2,719.08" "$2,765.30" "$2,719.08" "$2,719.08" "$2,039.63" "$2,719.08" "$2,719.08" "$2,719.08" "$1,359.54" "$1,359.54" "$2,153.51" "$2,719.08" "$2,175.26" "$1,223.59" $539.67 N/A "$1,577.31" "$2,719.08" "$1,631.45" "$2,719.08" $566.66 "$2,719.08" N/A N/A 456.325S SUP HCPCS C1713 456.325S - NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 10MM 235MM CANN BOTH IP/OP "$2,719.50" "$2,012.00" $539.67 "$2,765.30" "$1,223.59" "$1,223.59" "$1,223.59" "$1,223.59" "$2,719.08" "$2,719.08" "$2,719.08" $566.72 "$2,719.08" "$2,719.08" "$2,719.08" "$2,719.08" "$2,719.08" $566.69 "$2,719.08" "$2,765.30" "$1,340.51" "$2,719.08" "$2,765.30" "$2,719.08" "$2,719.08" "$2,039.63" "$2,719.08" "$2,719.08" "$2,719.08" "$1,359.54" "$1,359.54" "$2,153.51" "$2,719.08" "$2,175.26" "$1,223.59" $539.67 N/A "$1,577.31" "$2,719.08" "$1,631.45" "$2,719.08" $566.66 "$2,719.08" N/A N/A 456.326S SUP HCPCS C1713 456.326S - NAIL FIX 135D SHORT 10MM 23.5CM CANN GREEN TITANIUM TROC BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$2,630.10" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.327S SUP HCPCS C1713 456.327S - NAIL FIX 125D SHORT 11MM 23.5CM CANN GREEN TITANIUM BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$1,578.06" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.328S SUP HCPCS C1713 456.328S - NAIL INTRAMEDULLARY 130D SHORT UNIVERSAL 11MM 235MM CANN BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$1,578.06" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.329S SUP HCPCS C1713 456.329S - NAIL FIX 135D SHORT 11MM 23.5CM CANN GREEN TITANIUM BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$1,578.06" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.330S SUP HCPCS C1713 456.330S - NAIL INTRAMEDULLARY 125D LONG 17-10MM 30CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$3,687.70" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.331S SUP HCPCS C1713 456.331S - NAIL INTRAMEDULLARY 125D LONG 10MM 30CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.332S SUP HCPCS C1713 456.332S - NAIL INTRAMEDULLARY 125D LONG 17-10MM 32CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.333S SUP HCPCS C1713 456.333S - NAIL INTRAMEDULLARY 125D LONG 10MM 32CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.334S SUP HCPCS C1713 456.334S - NAIL INTRAMEDULLARY 125D LONG 17-10MM 34CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.335S SUP HCPCS C1713 456.335S - NAIL INTRAMEDULLARY 125D LONG 10MM 34CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.336S SUP HCPCS C1713 456.336S - NAIL INTRAMEDULLARY 125D LONG 17-10MM 36CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.337S SUP HCPCS C1713 456.337S - NAIL INTRAMEDULLARY 125D LONG 10MM 36CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.338S SUP HCPCS C1713 456.338S - NAIL INTRAMEDULLARY 125D LONG 17-10MM 38CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.339S SUP HCPCS C1713 456.339S - NAIL INTRAMEDULLARY 125D LONG 10MM 38CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.340S SUP HCPCS C1713 456.340S - NAIL INTRAMEDULLARY 125D LONG 17-10MM 40CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.341S SUP HCPCS C1713 456.341S - NAIL INTRAMEDULLARY 125D LONG 10MM 40CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.342S SUP HCPCS C1713 456.342S - NAIL INTRAMEDULLARY 125D LONG 17-10MM 42CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$1,500.16" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.343S SUP HCPCS C1713 456.343S - NAIL INTRAMEDULLARY 125D LONG 10MM 42CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$3,687.70" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.344S SUP HCPCS C1713 456.344S - NAIL INTRAMEDULLARY 125D LONG 17-10MM 44CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.345S SUP HCPCS C1713 456.345S - NAIL INTRAMEDULLARY 125D LONG 10MM 44CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.346S SUP HCPCS C1713 456.346S - NAIL INTRAMEDULLARY 125D LONG 17-10MM 46CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.347S SUP HCPCS C1713 456.347S - NAIL INTRAMEDULLARY 125D LONG 10MM 46CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.350S SUP HCPCS C1713 456.350S - NAIL INTRAMEDULLARY 130D LONG 17-10MM 30CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.351S SUP HCPCS C1713 456.351S - NAIL INTRAMEDULLARY 130D LONG 10MM 30CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.352S SUP HCPCS C1713 456.352S - NAIL INTRAMEDULLARY 130D LONG 17-10MM 32CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.353S SUP HCPCS C1713 456.353S - NAIL INTRAMEDULLARY 130D LONG 10MM 320MM CANN PREASSEMBLED BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$3,687.70" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.354S SUP HCPCS C1713 456.354S - NAIL INTRAMEDULLARY 130D LONG 17-10MM 34CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.355S SUP HCPCS C1713 456.355S - NAIL INTRAMEDULLARY 130D 10MM 34CM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.356S SUP HCPCS C1713 456.356S - NAIL INTRAMEDULLARY 130D LONG 17-10MM 36CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.357S SUP HCPCS C1713 456.357S - NAIL FIX 130D 10MM 360MM CANN STATIC INTLCK GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.358S SUP HCPCS C1713 456.358S - NAIL INTRAMEDULLARY 130D LONG 10MM 38CM CANN INTERLOCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.359S SUP HCPCS C1713 456.359S - NAIL INTRAMEDULLARY 130D 10MM 380MM CANN STATIC INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.360S SUP HCPCS C1713 456.360S - NAIL INTRAMEDULLARY 130D LONG 17-10MM 40CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.361S SUP HCPCS C1713 456.361S - NAIL INTRAMEDULLARY 130D LONG 10MM 400MM CANN PREASSEMBLED BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.362S SUP HCPCS C1713 456.362S - NAIL INTRAMEDULLARY 130D LONG 17-10MM 42CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.363S SUP HCPCS C1713 456.363S - NAIL INTRAMEDULLARY 130D LONG 10MM 42CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.364S SUP HCPCS C1713 456.364S - NAIL INTRAMEDULLARY 130D LONG 17-10MM 44CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.365S SUP HCPCS C1713 456.365S - NAIL INTRAMEDULLARY 130D LONG 10MM 44CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.366S SUP HCPCS C1713 456.366S - NAIL INTRAMEDULLARY 130D LONG 17-10MM 46CM CANN INTLCK GREEN BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.367S SUP HCPCS C1713 456.367S - NAIL INTRAMEDULLARY 130D LONG 10MM 46CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.370S SUP HCPCS C1713 456.370S - NAIL INTRAMEDULLARY 135D LONG 10MM 33CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.371S SUP HCPCS C1713 456.371S - NAIL INTRAMEDULLARY 135D LONG 10MM 33CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$3,687.70" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.372S SUP HCPCS C1713 456.372S - NAIL INTRAMEDULLARY 135D LONG 10MM 320MM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.373S SUP HCPCS C1713 456.373S - NAIL INTRAMEDULLARY 135D LONG 10MM 32CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.374S SUP HCPCS C1713 456.374S - NAIL INTRAMEDULLARY 135D LONG 10MM 34CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.375S SUP HCPCS C1713 456.375S - NAIL INTRAMEDULLARY 135D LONG 10MM 34CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.376S SUP HCPCS C1713 456.376S - NAIL INTRAMEDULLARY 135D LONG 10MM 36CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.377S SUP HCPCS C1713 456.377S - NAIL INTRAMEDULLARY 135D LONG 10MM 36CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.378S SUP HCPCS C1713 456.378S - NAIL INTRAMEDULLARY 135D LONG 10MM 38CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$3,687.70" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.379S SUP HCPCS C1713 456.379S - NAIL INTRAMEDULLARY 135D LONG 10MM 38CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.380S SUP HCPCS C1713 456.380S - NAIL INTRAMEDULLARY 135D LONG 10MM 40CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.381S SUP HCPCS C1713 456.381S - NAIL INTRAMEDULLARY 135D LONG 10MM 40CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.382S SUP HCPCS C1713 456.382S - NAIL INTRAMEDULLARY 135D LONG 10MM 42CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.383S SUP HCPCS C1713 456.383S - NAIL INTRAMEDULLARY 135D LONG 10MM 42CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.384S SUP HCPCS C1713 456.384S - NAIL INTRAMEDULLARY 135D LONG 10MM 44CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.385S SUP HCPCS C1713 456.385S - NAIL INTRAMEDULLARY 135D LONG 10MM 44CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.386S SUP HCPCS C1713 456.386S - NAIL INTRAMEDULLARY 135D LONG 10MM 46CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" "$3,687.70" "$3,687.70" N/A N/A 456.387S SUP HCPCS C1713 456.387S - NAIL INTRAMEDULLARY 135D LONG 10MM 46CM CANN GREEN TITANIUM BOTH IP/OP "$3,578.50" "$2,648.00" $710.20 "$3,639.10" "$1,610.23" "$1,610.23" "$1,610.23" "$1,610.23" "$3,578.28" "$3,578.28" "$3,578.28" $745.80 "$3,578.28" "$3,578.28" "$3,578.28" "$3,578.28" "$3,578.28" $745.75 "$3,578.28" "$3,639.10" "$1,764.09" "$3,578.28" "$3,639.10" "$3,578.28" "$3,578.28" "$2,683.88" "$3,578.28" "$3,578.28" "$3,578.28" "$1,789.14" "$1,789.14" "$2,834.00" "$3,578.28" "$2,862.62" "$1,610.23" $710.20 N/A "$2,075.53" "$3,578.28" "$2,146.97" "$3,578.28" $745.71 "$3,578.28" N/A N/A 456.390S SUP HCPCS C1713 456.390S - NAIL INTRAMEDULLARY 125D LONG 17-11MM 33CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.391S SUP HCPCS C1713 456.391S - NAIL INTRAMEDULLARY 125D LONG 11MM 33CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.392S SUP HCPCS C1713 456.392S - NAIL INTRAMEDULLARY 125D LONG 17-11MM 32CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.393S SUP HCPCS C1713 456.393S - NAIL INTRAMEDULLARY 125D LONG 11MM 32CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.394S SUP HCPCS C1713 456.394S - NAIL INTRAMEDULLARY 125D LONG 17-11MM 34CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.395S SUP HCPCS C1713 456.395S - NAIL INTRAMEDULLARY 125D LONG 11MM 34CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.396S SUP HCPCS C1713 456.396S - NAIL INTRAMEDULLARY 125D LONG 17-11MM 36CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.397S SUP HCPCS C1713 456.397S - NAIL INTRAMEDULLARY 125D 11MM 36CM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.398S SUP HCPCS C1713 456.398S - NAIL INTRAMEDULLARY 125D LONG 17-11MM 38CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.399S SUP HCPCS C1713 456.399S - NAIL INTRAMEDULLARY 125D 11MM 38CM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.400S SUP HCPCS C1713 456.400S - NAIL INTRAMEDULLARY 125D LONG 17-11MM 40CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.401S SUP HCPCS C1713 456.401S - NAIL INTRAMEDULLARY 125D 11MM 40CM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.402S SUP HCPCS C1713 456.402S - NAIL INTRAMEDULLARY 125D LONG 17-11MM 42CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.403S SUP HCPCS C1713 456.403S - NAIL INTRAMEDULLARY 125D LONG 11MM 42CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.404S SUP HCPCS C1713 456.404S - NAIL INTRAMEDULLARY 125D LONG 17-11MM 44CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.405S SUP HCPCS C1713 456.405S - NAIL INTRAMEDULLARY 125D LONG 11MM 44CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.406S SUP HCPCS C1713 456.406S - NAIL INTRAMEDULLARY 125D LONG 17-11MM 46CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.407S SUP HCPCS C1713 456.407S - NAIL INTRAMEDULLARY 125D LONG 11MM 46CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.410S SUP HCPCS C1713 456.410S - NAIL INTRAMEDULLARY 130D LONG 11MM 30CM CANN PREASSEMBLE BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.411S SUP HCPCS C1713 456.411S - NAIL FIX 130D SHORT 11MM 300MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.412S SUP HCPCS C1713 456.412S - NAIL FIX 130D SHORT 11MM 320MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.413S SUP HCPCS C1713 456.413S - NAIL FIX 130D SHORT 11MM 320MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.414S SUP HCPCS C1713 456.414S - NAIL FIX 130D 11MM 340MM CANN TITANIUM RIGHT TROCHANTER BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.415S SUP HCPCS C1713 456.415S - NAIL FIX 130D SHORT 11MM 340MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.416S SUP HCPCS C1713 456.416S - NAIL FIX 130D SHORT 11MM 360MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.417S SUP HCPCS C1713 456.417S - NAIL FIX 130D SHORT 11MM 360MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.418S SUP HCPCS C1713 456.418S - NAIL FIX 130D SHORT 11MM 380MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.419S SUP HCPCS C1713 456.419S - NAIL FIX 130D SHORT 11MM 380MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.420S SUP HCPCS C1713 456.420S - NAIL FIX 130D SHORT 11MM 400MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.421S SUP HCPCS C1713 456.421S - NAIL FIX 130D SHORT 11MM 400MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$3,461.58" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.422S SUP HCPCS C1713 456.422S - NAIL FIX 130D SHORT 11MM 420MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.423S SUP HCPCS C1713 456.423S - NAIL FIX 130D SHORT 11MM 420MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$3,461.58" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.424S SUP HCPCS C1713 456.424S - NAIL FIX 130D SHORT 11MM 440MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.425S SUP HCPCS C1713 456.425S - NAIL INTRAMEDULLARY 130D LONG 11MM 440MM CANN PREASSEMBLED BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.426S SUP HCPCS C1713 456.426S - NAIL FIX 130D LONG 11MM 460MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.427S SUP HCPCS C1713 456.427S - NAIL FIX 130D LONG 11MM 460MM CANN PREASSEMBLED LOCKING BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.430S SUP HCPCS C1713 456.430S - NAIL INTRAMEDULLARY 135D LONG 17-11MM 33CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.431S SUP HCPCS C1713 456.431S - NAIL INTRAMEDULLARY 135D LONG 11MM 33CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.432S SUP HCPCS C1713 456.432S - NAIL INTRAMEDULLARY 135D LONG 17-11MM 32CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$3,461.58" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.433S SUP HCPCS C1713 456.433S - NAIL INTRAMEDULLARY 135D LONG 11MM 32CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$3,461.58" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.434S SUP HCPCS C1713 456.434S - NAIL INTRAMEDULLARY 135D LONG 17-11MM 34CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.435S SUP HCPCS C1713 456.435S - NAIL INTRAMEDULLARY 135D 11MM 34CM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.436S SUP HCPCS C1713 456.436S - NAIL INTRAMEDULLARY 135D LONG 17-11MM 36CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.437S SUP HCPCS C1713 456.437S - NAIL INTRAMEDULLARY 135D 11MM 36CM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.438S SUP HCPCS C1713 456.438S - NAIL INTRAMEDULLARY 135D LONG 17-11MM 38CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.439S SUP HCPCS C1713 456.439S - NAIL INTRAMEDULLARY 135D 11MM 38CM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.440S SUP HCPCS C1713 456.440S - NAIL INTRAMEDULLARY 135D LONG 17-11MM 40CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.441S SUP HCPCS C1713 456.441S - NAIL INTRAMEDULLARY 135D 11MM 40CM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.442S SUP HCPCS C1713 456.442S - NAIL INTRAMEDULLARY 135D LONG 17-11MM 42CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$3,461.58" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.443S SUP HCPCS C1713 456.443S - NAIL INTRAMEDULLARY 135D 11MM 42CM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.444S SUP HCPCS C1713 456.444S - NAIL INTRAMEDULLARY 135D LONG 17-11MM 44CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.445S SUP HCPCS C1713 456.445S - NAIL INTRAMEDULLARY 135D LONG 11MM 44CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.446S SUP HCPCS C1713 456.446S - NAIL INTRAMEDULLARY 135D LONG 17-11MM 46CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.447S SUP HCPCS C1713 456.447S - NAIL INTRAMEDULLARY 135D LONG 11MM 46CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.450S SUP HCPCS C1713 456.450S - NAIL INTRAMEDULLARY 125D LONG 17-12MM 30CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.451S SUP HCPCS C1713 456.451S - NAIL INTRAMEDULLARY 125D 12MM 30CM CANN TITANIUM LEFT TROC BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.452S SUP HCPCS C1713 456.452S - NAIL INTRAMEDULLARY 125D LONG 17-12MM 32CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.453S SUP HCPCS C1713 456.453S - NAIL INTRAMEDULLARY 125D LONG 12MM 32CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.454S SUP HCPCS C1713 456.454S - NAIL INTRAMEDULLARY 125D LONG 17-12MM 34CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.455S SUP HCPCS C1713 456.455S - NAIL INTRAMEDULLARY 125D 12MM 34CM CANN TITANIUM LEFT TROC BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.456S SUP HCPCS C1713 456.456S - NAIL INTRAMEDULLARY 125D LONG 17-12MM 36CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.457S SUP HCPCS C1713 456.457S - NAIL INTRAMEDULLARY 125D LONG 12MM 36CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.458S SUP HCPCS C1713 456.458S - NAIL INTRAMEDULLARY 125D LONG 17-12MM 38CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.459S SUP HCPCS C1713 456.459S - NAIL INTRAMEDULLARY 125D LONG 12MM 38CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.460S SUP HCPCS C1713 456.460S - NAIL INTRAMEDULLARY 125D LONG 17-12MM 40CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.461S SUP HCPCS C1713 456.461S - NAIL INTRAMEDULLARY 125D 12MM 40CM CANN TITANIUM LEFT TROC BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.462S SUP HCPCS C1713 456.462S - NAIL INTRAMEDULLARY 125D LONG 17-12MM 42CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.463S SUP HCPCS C1713 456.463S - NAIL INTRAMEDULLARY 125D LONG 12MM 42CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$3,461.58" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.464S SUP HCPCS C1713 456.464S - NAIL INTRAMEDULLARY 125D LONG 17-12MM 44CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$3,461.58" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.465S SUP HCPCS C1713 456.465S - NAIL INTRAMEDULLARY 125D LONG 12MM 44CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$3,461.58" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.466S SUP HCPCS C1713 456.466S - NAIL INTRAMEDULLARY 125D LONG 17-12MM 46CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.467S SUP HCPCS C1713 456.467S - NAIL INTRAMEDULLARY 125D LONG 12MM 46CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.470S SUP HCPCS C1713 456.470S - NAIL INTRAMEDULLARY 130D LONG 17-12MM 30CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.471S SUP HCPCS C1713 456.471S - NAIL INTRAMEDULLARY 130D 12MM 30CM CANN TITANIUM LEFT TROC BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.472S SUP HCPCS C1713 456.472S - NAIL INTRAMEDULLARY 130D LONG 17-12MM 32CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.473S SUP HCPCS C1713 456.473S - NAIL INTRAMEDULLARY 130D LONG 12MM 32CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.474S SUP HCPCS C1713 456.474S - NAIL INTRAMEDULLARY 130D LONG 12MM 34CM CANN PREASSEMBLE BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.475S SUP HCPCS C1713 456.475S - NAIL INTRAMEDULLARY 130D LONG 12MM 34CM CANN PREASSEMBLE BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.476S SUP HCPCS C1713 456.476S - NAIL INTRAMEDULLARY 130D LONG 12MM 36CM CANN PREASSEMBLE BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.477S SUP HCPCS C1713 456.477S - NAIL INTRAMEDULLARY 130D LONG 12MM 36CM CANN PREASSEMBLE BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.478S SUP HCPCS C1713 456.478S - NAIL INTRAMEDULLARY 130D LONG 12MM 380MM CANN PREASSEMBLE BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.479S SUP HCPCS C1713 456.479S - NAIL INTRAMEDULLARY 130D LONG 12MM 380MM CANN PREASSEMBLED BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.480S SUP HCPCS C1713 456.480S - NAIL INTRAMEDULLARY 130D LONG 12MM 400MM CANN PREASSEMBLE BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.481S SUP HCPCS C1713 456.481S - NAIL INTRAMEDULLARY 130D LONG 12MM 40CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.482S SUP HCPCS C1713 456.482S - NAIL INTRAMEDULLARY 130D LONG 12MM 420MM CANN PREASSEMBLE BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$3,461.58" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.483S SUP HCPCS C1713 456.483S - NAIL INTRAMEDULLARY 130D LONG 12MM 420MM CANN PREASSEMBLE BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.484S SUP HCPCS C1713 456.484S - NAIL INTRAMEDULLARY 130D LONG 12MM 440MM CANN PREASSEMBLE BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.485S SUP HCPCS C1713 456.485S - NAIL INTRAMEDULLARY 130D 12MM 44CM CANN TITANIUM LEFT TROC BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.486S SUP HCPCS C1713 456.486S - NAIL INTRAMEDULLARY 130D LONG 12MM 460MM CANN PREASSEMBLE BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.487S SUP HCPCS C1713 456.487S - NAIL INTRAMEDULLARY 130D LONG 12MM 46CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.490S SUP HCPCS C1713 456.490S - NAIL INTRAMEDULLARY 135D LONG 17-12MM 30CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.491S SUP HCPCS C1713 456.491S - NAIL INTRAMEDULLARY 135D LONG 12MM 33CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.492S SUP HCPCS C1713 456.492S - NAIL INTRAMEDULLARY 135D LONG 17-12MM 32CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.493S SUP HCPCS C1713 456.493S - NAIL INTRAMEDULLARY 135D LONG 12MM 32CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$3,461.58" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.494S SUP HCPCS C1713 456.494S - NAIL INTRAMEDULLARY 135D LONG 17-12MM 34CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.495S SUP HCPCS C1713 456.495S - NAIL INTRAMEDULLARY 135D 12MM 34CM CANN TITANIUM LEFT TROC BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.496S SUP HCPCS C1713 456.496S - NAIL INTRAMEDULLARY 135D LONG 17-12MM 36CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" "$3,461.58" "$3,461.58" N/A N/A 456.497S SUP HCPCS C1713 456.497S - NAIL INTRAMEDULLARY 135D 12MM 36CM CANN TITANIUM LEFT TROC BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.498S SUP HCPCS C1713 456.498S - NAIL INTRAMEDULLARY 135D LONG 17-12MM 38CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.499S SUP HCPCS C1713 456.499S - NAIL INTRAMEDULLARY 135D 12MM 38CM CANN TITANIUM LEFT TROC BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$1,408.17" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.500S SUP HCPCS C1713 456.500S - NAIL INTRAMEDULLARY 135D LONG 17-12MM 40CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.501S SUP HCPCS C1713 456.501S - NAIL INTRAMEDULLARY 135D LONG 12MM 40CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$3,461.58" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.502S SUP HCPCS C1713 456.502S - NAIL INTRAMEDULLARY 135D LONG 17-12MM 42CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$3,461.58" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.503S SUP HCPCS C1713 456.503S - NAIL INTRAMEDULLARY 135D 12MM 42CM CANN TITANIUM LEFT TROC BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.504S SUP HCPCS C1713 456.504S - NAIL INTRAMEDULLARY 135D LONG 17-12MM 44CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.505S SUP HCPCS C1713 456.505S - NAIL INTRAMEDULLARY 135D LONG 12MM 44CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.506S SUP HCPCS C1713 456.506S - NAIL INTRAMEDULLARY 135D LONG 17-12MM 46CM CANN INTLCK GREEN BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.507S SUP HCPCS C1713 456.507S - NAIL INTRAMEDULLARY 135D LONG 12MM 46CM CANN GREEN TITANIUM BOTH IP/OP "$3,462.00" "$2,562.00" $687.04 "$3,520.43" "$1,557.71" "$1,557.71" "$1,557.71" "$1,557.71" "$3,461.58" "$3,461.58" "$3,461.58" $721.48 "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" "$3,461.58" $721.43 "$3,461.58" "$3,520.43" "$1,706.56" "$3,461.58" "$3,520.43" "$3,461.58" "$3,461.58" "$2,596.50" "$3,461.58" "$3,461.58" "$3,461.58" "$1,730.79" "$1,730.79" "$2,741.57" "$3,461.58" "$2,769.26" "$1,557.71" $687.04 N/A "$2,007.96" "$3,461.58" "$2,076.95" "$3,461.58" $721.39 "$3,461.58" N/A N/A 456.510S SUP HCPCS C1713 456.510S - NAIL FIX 125D SHORT 12MM 23.5CM CANN PREASSEMBLED LOCKING BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$2,630.10" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.511S SUP HCPCS C1713 456.511S - NAIL FIX 130D SHORT 12MM 23.5CM CANN PREASSEMBLED LOCKING BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$1,578.06" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.512S SUP HCPCS C1713 456.512S - NAIL FIX 135D SHORT 12MM 23.5CM CANN GREEN TITANIUM TROC BOTH IP/OP "$2,630.50" "$1,947.00" $522.01 "$2,674.80" "$1,183.55" "$1,183.55" "$1,183.55" "$1,183.55" "$2,630.10" "$2,630.10" "$2,630.10" $548.18 "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" "$2,630.10" $548.14 "$2,630.10" "$2,674.80" "$1,296.64" "$2,630.10" "$2,674.80" "$2,630.10" "$2,630.10" "$1,972.88" "$2,630.10" "$2,630.10" "$2,630.10" "$1,315.05" "$1,315.05" "$2,083.04" "$2,630.10" "$2,104.08" "$1,183.55" $522.01 N/A "$1,525.69" "$2,630.10" "$1,578.06" "$2,630.10" $548.11 "$2,630.10" N/A N/A 456.630S SUP HCPCS C1713 456.630S - NAIL INTRAMEDULLARY 130D LONG 14MM 30CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.631S SUP HCPCS C1713 456.631S - NAIL INTRAMEDULLARY 130D LONG 14MM 30CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.632S SUP HCPCS C1713 456.632S - NAIL INTRAMEDULLARY 130D 14MM 32CM CANN GREEN TITANIUM RIGHT BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.633S SUP HCPCS C1713 456.633S - NAIL INTRAMEDULLARY 130D 14MM 32CM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.634S SUP HCPCS C1713 456.634S - NAIL INTRAMEDULLARY 130D 14MM 130MM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.635S SUP HCPCS C1713 456.635S - NAIL INTRAMEDULLARY 130D LONG 14MM 34CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$1,500.16" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.636S SUP HCPCS C1713 456.636S - NAIL INTRAMEDULLARY 130D LONG 14MM 36CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.637S SUP HCPCS C1713 456.637S - NAIL INTRAMEDULLARY 130D 14MM 360MM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.638S SUP HCPCS C1713 456.638S - NAIL INTRAMEDULLARY 130D LONG 14MM 38CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$3,687.70" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.639S SUP HCPCS C1713 456.639S - NAIL INTRAMEDULLARY 130D 14MM 380MM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.640S SUP HCPCS C1713 456.640S - NAIL INTRAMEDULLARY 130D 14MM 40CM CANN GREEN TITANIUM RIGHT BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.641S SUP HCPCS C1713 456.641S - NAIL INTRAMEDULLARY 130D 14MM 40CM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.642S SUP HCPCS C1713 456.642S - NAIL INTRAMEDULLARY 130D 14MM 42CM CANN GREEN TITANIUM RIGHT BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.643S SUP HCPCS C1713 456.643S - NAIL INTRAMEDULLARY 130D 14MM 42CM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.644S SUP HCPCS C1713 456.644S - NAIL INTRAMEDULLARY 130D LONG 14MM 44CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.645S SUP HCPCS C1713 456.645S - NAIL INTRAMEDULLARY 130D 14MM 44CM CANN GREEN TITANIUM LEFT BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.646S SUP HCPCS C1713 456.646S - NAIL INTRAMEDULLARY 130D LONG 14MM 46CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$3,750.40" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.647S SUP HCPCS C1713 456.647S - NAIL INTRAMEDULLARY 130D LONG 14MM 46CM CANN GREEN TITANIUM BOTH IP/OP "$3,688.00" "$2,729.00" $731.92 "$3,750.40" "$1,659.47" "$1,659.47" "$1,659.47" "$1,659.47" "$3,687.70" "$3,687.70" "$3,687.70" $768.61 "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" "$3,687.70" $768.56 "$3,687.70" "$1,500.16" "$1,818.04" "$3,687.70" "$3,750.40" "$3,687.70" "$3,687.70" "$2,766.00" "$3,687.70" "$3,687.70" "$3,687.70" "$1,843.85" "$1,843.85" "$2,920.66" "$3,687.70" "$2,950.16" "$1,659.47" $731.92 N/A "$2,139.04" "$3,687.70" "$2,212.62" "$3,687.70" $768.52 "$3,687.70" N/A N/A 456.650S SUP Custom 27803010 456.650S - BLADE FIX 11MM 130MM HELICAL TITANIUM TROC STERILE BOTH IP/OP "$1,255.00" $929.00 $223.31 "$1,275.85" "$1,254.53" "$1,254.53" "$1,254.53" "$1,254.53" "$1,254.53" "$1,254.53" $223.31 "$1,254.53" "$1,254.53" "$1,254.53" "$1,254.53" "$1,254.53" "$1,254.53" $261.46 "$1,254.53" $510.34 "$1,254.53" "$1,254.53" "$1,275.85" "$1,254.53" "$1,254.53" $941.25 "$1,254.53" "$1,254.53" "$1,254.53" $627.27 $627.27 $993.59 "$1,254.53" "$1,003.62" $564.54 "$1,254.53" N/A $727.90 "$1,254.53" $752.72 "$1,254.53" "$1,254.53" "$1,254.53" N/A N/A 456.70S SUP Custom 27803010 456.70S - BLADE FIX 70MM SPIRAL TITANIUM TROC STERILE INTRAMEDULLARY BOTH IP/OP "$1,327.00" $982.00 $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $276.54 "$1,326.88" $530.75 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $995.25 "$1,326.88" "$1,326.88" "$1,326.88" $663.44 $663.44 "$1,050.89" "$1,326.88" "$1,061.50" $597.10 "$1,326.88" N/A $769.66 "$1,326.88" $796.13 "$1,326.88" "$1,326.88" "$1,326.88" N/A N/A 456.75S SUP Custom 27803010 456.75S - BLADE INTRAMEDULLARY FIX 75MM SPIRAL TITANIUM FEMUR STERILE BOTH IP/OP "$1,327.00" $982.00 $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $276.54 "$1,326.88" $530.75 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $995.25 "$1,326.88" "$1,326.88" "$1,326.88" $663.44 $663.44 "$1,050.89" "$1,326.88" "$1,061.50" $597.10 "$1,326.88" N/A $769.66 "$1,326.88" $796.13 "$1,326.88" "$1,326.88" "$1,326.88" N/A N/A 456.80S SUP Custom 27803010 456.80S - BLADE INTRAMEDULLARY FIX 80MM SPIRAL TITANIUM FEMUR STERILE BOTH IP/OP "$1,327.00" $982.00 $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $276.54 "$1,326.88" $530.75 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $995.25 "$1,326.88" "$1,326.88" "$1,326.88" $663.44 $663.44 "$1,050.89" "$1,326.88" "$1,061.50" $597.10 "$1,326.88" N/A $769.66 "$1,326.88" $796.13 "$1,326.88" "$1,326.88" "$1,326.88" N/A N/A 456.85S SUP Custom 27803010 456.85S - BLADE INTRAMEDULLARY FIX 85MM SPIRAL TITANIUM FEMUR STERILE BOTH IP/OP "$1,327.00" $982.00 $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $276.54 "$1,326.88" $530.75 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $995.25 "$1,326.88" "$1,326.88" "$1,326.88" $663.44 $663.44 "$1,050.89" "$1,326.88" "$1,061.50" $597.10 "$1,326.88" N/A $769.66 "$1,326.88" $796.13 "$1,326.88" "$1,326.88" "$1,326.88" N/A N/A 456.90S SUP Custom 27803010 456.90S - BLADE INTRAMEDULLARY FIX 90MM SPIRAL TITANIUM FEMUR STERILE BOTH IP/OP "$1,327.00" $982.00 $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $276.54 "$1,326.88" $530.75 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $995.25 "$1,326.88" "$1,326.88" "$1,326.88" $663.44 $663.44 "$1,050.89" "$1,326.88" "$1,061.50" $597.10 "$1,326.88" N/A $769.66 "$1,326.88" $796.13 "$1,326.88" "$1,326.88" "$1,326.88" N/A N/A 456.95S SUP Custom 27803010 456.95S - BLADE INTRAMEDULLARY FIX 95MM SPIRAL TITANIUM FEMUR STERILE BOTH IP/OP "$1,327.00" $982.00 $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $236.18 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $276.54 "$1,326.88" $530.75 "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" "$1,326.88" $995.25 "$1,326.88" "$1,326.88" "$1,326.88" $663.44 $663.44 "$1,050.89" "$1,326.88" "$1,061.50" $597.10 "$1,326.88" N/A $769.66 "$1,326.88" $796.13 "$1,326.88" "$1,326.88" "$1,326.88" N/A N/A 45-600 SUP HCPCS C1769 45-600 - CATHETER CEN VEN .035IN 5FR 50CM 1 LUMEN GWIRE VAXCEL BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 457.010S SUP Custom 27803010 457.010S - CAP END 0MM 15MM 15MM EXTEND LIGHT BLUE TITANIUM FEMUR BOTH IP/OP $542.50 $401.00 $96.53 $542.30 $542.30 $542.30 $542.30 $542.30 $542.30 $542.30 $96.53 $542.30 $542.30 $542.30 $542.30 $542.30 $542.30 $113.02 $542.30 $216.92 $542.30 $542.30 $542.30 $542.30 $542.30 $406.88 $542.30 $542.30 $542.30 $271.15 $271.15 $429.50 $542.30 $433.84 $244.04 $542.30 N/A $314.65 $542.30 $325.38 $542.30 $542.30 $542.30 N/A N/A 457.011S SUP Custom 27803010 457.011S - CAP END 10MM EXTEND LIGHT BLUE TITANIUM FEMUR STERILE SPIRAL BOTH IP/OP $470.50 $348.00 $83.70 $470.25 $470.25 $470.25 $470.25 $470.25 $470.25 $470.25 $83.70 $470.25 $470.25 $470.25 $470.25 $470.25 $470.25 $98.01 $470.25 $188.10 $470.25 $470.25 $470.25 $470.25 $470.25 $352.88 $470.25 $470.25 $470.25 $235.13 $235.13 $372.44 $470.25 $376.20 $211.61 $470.25 N/A $272.89 $470.25 $282.15 $470.25 $470.25 $470.25 N/A N/A 457.012S SUP Custom 27803010 457.012S - CAP END 20MM 15MM EXTEND LIGHT BLUE TITANIUM FEMUR STERILE BOTH IP/OP $470.50 $348.00 $83.70 $470.25 $470.25 $470.25 $470.25 $470.25 $470.25 $470.25 $83.70 $470.25 $470.25 $470.25 $470.25 $470.25 $470.25 $98.01 $470.25 $188.10 $470.25 $470.25 $470.25 $470.25 $470.25 $352.88 $470.25 $470.25 $470.25 $235.13 $235.13 $372.44 $470.25 $376.20 $211.61 $470.25 N/A $272.89 $470.25 $282.15 $470.25 $470.25 $470.25 N/A N/A 457.210S SUP Custom 27803010 457.210S - CAP END 0MM 15MM EXTENDED LOCKING PINK TITANIUM FEMUR BOTH IP/OP $514.00 $380.00 $91.41 $513.53 $513.53 $513.53 $513.53 $513.53 $513.53 $513.53 $91.41 $513.53 $513.53 $513.53 $513.53 $513.53 $513.53 $107.03 $513.53 $205.41 $513.53 $513.53 $513.53 $513.53 $513.53 $385.50 $513.53 $513.53 $513.53 $256.77 $256.77 $406.72 $513.53 $410.82 $231.09 $513.53 N/A $298.12 $513.53 $308.12 $513.53 $513.53 $513.53 N/A N/A 457.211S SUP Custom 27803010 457.211S - CAP END 130D 10MM 15MM LOCK PINK TITANIUM FEMUR STERILE BOTH IP/OP $447.00 $331.00 $79.54 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $79.54 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $93.13 $446.88 $178.75 $446.88 $446.88 $446.88 $446.88 $446.88 $335.25 $446.88 $446.88 $446.88 $223.44 $223.44 $353.93 $446.88 $357.50 $201.10 $446.88 N/A $259.26 $446.88 $268.13 $446.88 $446.88 $446.88 N/A N/A 457.212S SUP Custom 27803010 457.212S - CAP END 130D 20MM 15MM LOCK PINK TITANIUM FEMUR STERILE BOTH IP/OP $447.00 $331.00 $79.54 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $79.54 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $93.13 $446.88 $178.75 $446.88 $446.88 $446.88 $446.88 $446.88 $335.25 $446.88 $446.88 $446.88 $223.44 $223.44 $353.93 $446.88 $357.50 $201.10 $446.88 N/A $259.26 $446.88 $268.13 $446.88 $446.88 $446.88 N/A N/A 458.10S SUP Custom 27803010 458.10S - CAP END 6MM 15MM EXTEND BLUE TITANIUM TIBIA STERILE SOLID BOTH IP/OP $331.50 $245.00 $58.99 $331.38 $331.38 $331.38 $331.38 $331.38 $331.38 $331.38 $58.99 $331.38 $331.38 $331.38 $331.38 $331.38 $331.38 $69.06 $331.38 $132.55 $331.38 $331.38 $331.38 $331.38 $331.38 $248.63 $331.38 $331.38 $331.38 $165.69 $165.69 $262.45 $331.38 $265.10 $149.12 $331.38 N/A $192.27 $331.38 $198.83 $331.38 $331.38 $331.38 N/A N/A 458.110S SUP Custom 27803010 458.110S - CAP END 15MM 15MM EXTN BLUE TITANIUM TIBIA STERILE SOLID BOTH IP/OP $542.00 $401.00 $96.43 $541.75 $541.75 $541.75 $541.75 $541.75 $541.75 $541.75 $96.43 $541.75 $541.75 $541.75 $541.75 $541.75 $541.75 $112.91 $541.75 $216.70 $541.75 $541.75 $541.75 $541.75 $541.75 $406.50 $541.75 $541.75 $541.75 $270.88 $270.88 $429.07 $541.75 $433.40 $243.79 $541.75 N/A $314.36 $541.75 $325.05 $541.75 $541.75 $541.75 N/A N/A 458.120S SUP Custom 27803010 458.120S - CAP END 8MM 15MM 15MM EXTENDED HEXAGONAL DRIVE GREEN BOTH IP/OP $308.00 $228.00 $54.76 $307.65 $307.65 $307.65 $307.65 $307.65 $307.65 $307.65 $54.76 $307.65 $307.65 $307.65 $307.65 $307.65 $307.65 $64.12 $307.65 $123.06 $307.65 $307.65 $307.65 $307.65 $307.65 $231.00 $307.65 $307.65 $307.65 $153.83 $153.83 $243.66 $307.65 $246.12 $138.44 $307.65 N/A $178.64 $307.65 $184.59 $307.65 $307.65 $307.65 N/A N/A 458.926S SUP HCPCS C1713 458.926S - SCREW BN 3.5MM FT 5MM 8MM 26MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $181.00 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.928S SUP HCPCS C1713 458.928S - SCREW BN 3.5MM FT 5MM 8MM 28MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $452.50 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.930S SUP HCPCS C1713 458.930S - SCREW BN 3.5MM FT 5MM 8MM 30MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $181.00 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $444.93 $444.93 $92.72 $444.93 N/A N/A 458.932S SUP HCPCS C1713 458.932S - SCREW BN 3.5MM FT 5MM 8MM 32MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $181.00 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $444.93 $444.93 N/A N/A 458.934S SUP HCPCS C1713 458.934S - SCREW BN 3.5MM FT 5MM 8MM 34MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $452.50 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.936S SUP HCPCS C1713 458.936S - SCREW BN 3.5MM FT 5MM 8MM 36MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $181.00 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $444.93 $444.93 N/A N/A 458.938S SUP HCPCS C1713 458.938S - SCREW BN 3.5MM FT 5MM 8MM 38MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $181.00 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $444.93 $444.93 N/A N/A 458.940S SUP HCPCS C1713 458.940S - SCREW BN 3.5MM FT 5MM 8MM 40MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $181.00 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $444.93 $444.93 $92.72 $444.93 N/A N/A 458.942S SUP HCPCS C1713 458.942S - SCREW BN 3.5MM FT 5MM 8MM 42MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $181.00 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.944S SUP HCPCS C1713 458.944S - SCREW BN 3.5MM FT 5MM 8MM 44MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $181.00 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $444.93 $444.93 $444.93 $444.93 N/A N/A 458.946S SUP HCPCS C1713 458.946S - SCREW BN 3.5MM FT 5MM 8MM 46MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $181.00 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $444.93 $444.93 N/A N/A 458.948S SUP HCPCS C1713 458.948S - SCREW BN 3.5MM FT 5MM 8MM 48MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $181.00 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.950S SUP HCPCS C1713 458.950S - SCREW BN 3.5MM FT 5MM 8MM 50MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $452.50 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $444.93 $444.93 $92.72 $444.93 N/A N/A 458.952S SUP HCPCS C1713 458.952S - SCREW BN 3.5MM FT 5MM 8MM 52MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $452.50 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.954S SUP HCPCS C1713 458.954S - SCREW BN 3.5MM FT 5MM 8MM 54MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $181.00 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.956S SUP HCPCS C1713 458.956S - SCREW BN 3.5MM FT 5MM 8MM 56MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $452.50 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.958S SUP HCPCS C1713 458.958S - SCREW BN 3.5MM FT 5MM 8MM 58MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $181.00 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.960S SUP HCPCS C1713 458.960S - SCREW BN 3.5MM FT 5MM 8MM 60MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $452.50 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.964S SUP HCPCS C1713 458.964S - SCREW BN 3.5MM FT 5MM 8MM 64MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $181.00 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.968S SUP HCPCS C1713 458.968S - SCREW BN 3.5MM FT 5MM 8MM 68MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $181.00 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $444.93 $444.93 N/A N/A 458.972S SUP HCPCS C1713 458.972S - SCREW BN 3.5MM FT 5MM 8MM 72MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $452.50 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.976S SUP HCPCS C1713 458.976S - SCREW BN 3.5MM FT 5MM 8MM 76MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $452.50 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.980S SUP HCPCS C1713 458.980S - SCREW BN 3.5MM FT 5MM 8MM 80MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $452.50 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $444.93 $444.93 $444.93 $444.93 N/A N/A 458.985S SUP HCPCS C1713 458.985S - SCREW BN 3.5MM FT 5MM 8MM 85MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $452.50 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.990S SUP HCPCS C1713 458.990S - SCREW BN 3.5MM FT 5MM 8MM 90MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $452.50 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $444.93 $444.93 N/A N/A 458.995S SUP HCPCS C1713 458.995S - SCREW BN 3.5MM FT 5MM 8MM 95MM GRN STRL ST LCK 2 LD HEX TI BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $452.50 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 458.999S SUP HCPCS C1713 458.999S - SCREW BN 5MM 100MM GRN STRL NLEX LCK HEX RCS TI FEM TIB BOTH IP/OP $445.00 $329.00 $88.31 $452.50 $200.22 $200.22 $200.22 $200.22 $444.93 $444.93 $444.93 $92.73 $444.93 $444.93 $444.93 $444.93 $444.93 $92.73 $444.93 $452.50 $263.18 $444.93 $452.50 $444.93 $444.93 $333.75 $444.93 $444.93 $444.93 $222.47 $222.47 $352.38 $444.93 $355.94 $200.22 $88.31 N/A $258.10 $444.93 $266.96 $444.93 $92.72 $444.93 N/A N/A 45-80001 SUP Custom 27203010 45-80001 - GUIDE DRILL VARIAX CIRCULAR LOCKING HOLE BOTH IP/OP $851.50 $630.00 $151.50 $851.13 $851.13 $851.13 $851.13 $851.13 $851.13 $851.13 $151.50 $851.13 $851.13 $631.71 $631.71 $656.05 $443.44 $177.38 $851.13 $340.45 $851.13 $851.13 $851.13 $851.13 $851.13 $638.63 $851.13 $851.13 $851.13 $425.57 $425.57 $674.09 $851.13 $680.90 $553.23 $851.13 N/A $493.87 $851.13 $510.68 $851.13 $851.13 $851.13 N/A N/A 45-80005 SUP Custom 27203010 45-80005 - GUIDE DRILL VARIAX OVAL COMPRESSION HOLE BOTH IP/OP $956.00 $707.00 $170.10 $955.63 $955.63 $955.63 $955.63 $955.63 $955.63 $955.63 $170.10 $955.63 $955.63 $709.27 $709.27 $736.60 $497.88 $199.16 $955.63 $382.25 $955.63 $955.63 $955.63 $955.63 $955.63 $717.00 $955.63 $955.63 $955.63 $477.82 $477.82 $756.86 $955.63 $764.50 $621.16 $955.63 N/A $554.48 $955.63 $573.38 $955.63 $955.63 $955.63 N/A N/A 45-80010 SUP HCPCS C1713 45-80010 - PLIERS PLATE BENDING VARIAX BOTH IP/OP $907.50 $672.00 $180.12 $907.50 $408.38 $408.38 $408.38 $408.38 $907.50 $907.50 $907.50 $189.15 $907.50 $907.50 $907.50 $907.50 $907.50 $189.13 $907.50 $907.50 $536.79 $907.50 $907.50 $907.50 $907.50 $680.63 $907.50 $907.50 $907.50 $453.75 $453.75 $718.74 $907.50 $726.00 $408.38 $180.12 N/A $526.35 $907.50 $544.50 $907.50 $189.12 $907.50 N/A N/A 45-80100 SUP HCPCS C1713 45-80100 - WIRE FX FT 1.6MM 200MM NS KRSH VARIAX FT LCK PLT SYS BOTH IP/OP $69.00 $51.00 $13.69 $69.00 $31.05 $31.05 $31.05 $31.05 $69.00 $69.00 $69.00 $14.38 $69.00 $69.00 $69.00 $69.00 $69.00 $14.38 $69.00 $69.00 $40.81 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $31.05 $13.69 N/A $40.02 $69.00 $41.40 $69.00 $14.38 $69.00 N/A N/A 45-80200 SUP HCPCS C1713 45-80200 - WIRE FX 1.4MM 100MM NS KRSH SMTH VARIAX FT LCK PLT SYS BOTH IP/OP $29.50 $22.00 $5.81 $29.25 $13.16 $13.16 $13.16 $13.16 $29.25 $29.25 $29.25 $6.10 $29.25 $29.25 $29.25 $29.25 $29.25 $6.10 $29.25 $29.25 $17.30 $29.25 $29.25 $29.25 $29.25 $22.13 $29.25 $29.25 $29.25 $14.63 $14.63 $23.17 $29.25 $23.40 $13.16 $5.81 N/A $17.11 $29.25 $17.55 $29.25 $6.10 $29.25 N/A N/A 45-80300 SUP Custom 27203010 45-80300 - PIN FIX 2.5MM 100MM SMOOTH STEINMANN STAINLESS STEEL BOTH IP/OP $55.50 $41.00 $9.88 $55.50 $55.50 $55.50 $55.50 $55.50 $55.50 $55.50 $9.88 $55.50 $55.50 $41.19 $41.19 $42.78 $28.92 $11.57 $55.50 $22.20 $55.50 $55.50 $55.50 $55.50 $55.50 $41.63 $55.50 $55.50 $55.50 $27.75 $27.75 $43.96 $55.50 $44.40 $36.08 $55.50 N/A $32.19 $55.50 $33.30 $55.50 $55.50 $55.50 N/A N/A 459.012S SUP Custom 27803010 459.012S - CAP END 0MM 12MM EXTEND GREEN TITANIUM FEMUR STERILE BOTH IP/OP $494.50 $366.00 $87.99 $494.33 $494.33 $494.33 $494.33 $494.33 $494.33 $494.33 $87.99 $494.33 $494.33 $494.33 $494.33 $494.33 $494.33 $103.02 $494.33 $197.73 $494.33 $494.33 $494.33 $494.33 $494.33 $370.88 $494.33 $494.33 $494.33 $247.17 $247.17 $391.51 $494.33 $395.46 $222.45 $494.33 N/A $286.81 $494.33 $296.60 $494.33 $494.33 $494.33 N/A N/A 459.013S SUP Custom 27803010 459.013S - CAP END 10MM 12MM 12MM EXTENDED STANDARD LOCKING GREEN BOTH IP/OP $433.50 $321.00 $77.10 $433.13 $433.13 $433.13 $433.13 $433.13 $433.13 $433.13 $77.10 $433.13 $433.13 $433.13 $433.13 $433.13 $433.13 $90.27 $433.13 $173.25 $433.13 $433.13 $433.13 $433.13 $433.13 $325.13 $433.13 $433.13 $433.13 $216.57 $216.57 $343.04 $433.13 $346.50 $194.91 $433.13 N/A $251.43 $433.13 $259.88 $433.13 $433.13 $433.13 N/A N/A 459.014S SUP Custom 27803010 459.014S - CAP END 20MM 12MM 12MM EXTENDED STANDARD LOCKING GREEN BOTH IP/OP $433.50 $321.00 $77.10 $433.13 $433.13 $433.13 $433.13 $433.13 $433.13 $433.13 $77.10 $433.13 $433.13 $433.13 $433.13 $433.13 $433.13 $90.27 $433.13 $173.25 $433.13 $433.13 $433.13 $433.13 $433.13 $325.13 $433.13 $433.13 $433.13 $216.57 $216.57 $343.04 $433.13 $346.50 $194.91 $433.13 N/A $251.43 $433.13 $259.88 $433.13 $433.13 $433.13 N/A N/A 460.001.01S SUP Custom 27803010 460.001.01S - CLAMP TUBE 13MM TITANIUM CRANIAL FLAP STERILE BOTH IP/OP $940.50 $696.00 $167.41 $940.50 $940.50 $940.50 $940.50 $940.50 $940.50 $940.50 $167.41 $940.50 $940.50 $940.50 $940.50 $940.50 $940.50 $196.01 $940.50 $376.20 $940.50 $940.50 $940.50 $940.50 $940.50 $705.38 $940.50 $940.50 $940.50 $470.25 $470.25 $744.88 $940.50 $752.40 $423.23 $940.50 N/A $545.49 $940.50 $564.30 $940.50 $940.50 $940.50 N/A N/A 460.002.01S SUP Custom 27803010 460.002.01S - CLAMP TUBE 18MM TITANIUM CRANIAL FLAP STERILE BOTH IP/OP $974.50 $721.00 $173.42 $974.25 $974.25 $974.25 $974.25 $974.25 $974.25 $974.25 $173.42 $974.25 $974.25 $974.25 $974.25 $974.25 $974.25 $203.04 $974.25 $389.70 $974.25 $974.25 $974.25 $974.25 $974.25 $730.88 $974.25 $974.25 $974.25 $487.13 $487.13 $771.61 $974.25 $779.40 $438.41 $974.25 N/A $565.21 $974.25 $584.55 $974.25 $974.25 $974.25 N/A N/A 460.003.01S SUP Custom 27803010 460.003.01S - CLAMP TUBE 22MM TITANIUM CRANIAL FLAP STERILE BOTH IP/OP "$1,010.50" $748.00 $179.82 "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" $179.82 "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" $210.55 "$1,010.25" $404.10 "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" $757.88 "$1,010.25" "$1,010.25" "$1,010.25" $505.13 $505.13 $800.12 "$1,010.25" $808.20 $454.61 "$1,010.25" N/A $586.09 "$1,010.25" $606.15 "$1,010.25" "$1,010.25" "$1,010.25" N/A N/A 460.008.01S SUP Custom 27803010 460.008.01S - CLAMP TUBE 13MM TEXTURE TITANIUM CRANIAL FLAP NONSTRL BOTH IP/OP $974.50 $721.00 $173.42 $974.25 $974.25 $974.25 $974.25 $974.25 $974.25 $974.25 $173.42 $974.25 $974.25 $974.25 $974.25 $974.25 $974.25 $203.04 $974.25 $389.70 $974.25 $974.25 $974.25 $974.25 $974.25 $730.88 $974.25 $974.25 $974.25 $487.13 $487.13 $771.61 $974.25 $779.40 $438.41 $974.25 N/A $565.21 $974.25 $584.55 $974.25 $974.25 $974.25 N/A N/A 460.009.01S SUP Custom 27803010 460.009.01S - CLAMP TUBE 18MM TEXTURE TITANIUM CRANIAL FLAP STERILE BOTH IP/OP "$1,010.50" $748.00 $179.82 "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" $179.82 "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" $210.55 "$1,010.25" $404.10 "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" "$1,010.25" $757.88 "$1,010.25" "$1,010.25" "$1,010.25" $505.13 $505.13 $800.12 "$1,010.25" $808.20 $454.61 "$1,010.25" N/A $586.09 "$1,010.25" $606.15 "$1,010.25" "$1,010.25" "$1,010.25" N/A N/A 460.010.01S SUP Custom 27803010 460.010.01S - CLAMP TUBE 22MM TEXTURE TITANIUM CRANIAL FLAP STERILE BOTH IP/OP "$1,051.00" $778.00 $187.03 "$1,050.75" "$1,050.75" "$1,050.75" "$1,050.75" "$1,050.75" "$1,050.75" "$1,050.75" $187.03 "$1,050.75" "$1,050.75" "$1,050.75" "$1,050.75" "$1,050.75" "$1,050.75" $218.99 "$1,050.75" $420.30 "$1,050.75" "$1,050.75" "$1,050.75" "$1,050.75" "$1,050.75" $788.25 "$1,050.75" "$1,050.75" "$1,050.75" $525.38 $525.38 $832.19 "$1,050.75" $840.60 $472.84 "$1,050.75" N/A $609.58 "$1,050.75" $630.45 "$1,050.75" "$1,050.75" "$1,050.75" N/A N/A 460.022.05S SUP HCPCS C1713 460.022.05S - PIN FIX EMERGENCY RELEASE TITANIUM STERNUM STERILE BOTH IP/OP $218.00 $161.00 $43.27 $218.00 $98.10 $98.10 $98.10 $98.10 $218.00 $218.00 $218.00 $45.44 $218.00 $218.00 $218.00 $218.00 $218.00 $45.43 $218.00 $218.00 $128.95 $218.00 $218.00 $218.00 $218.00 $163.50 $218.00 $218.00 $218.00 $109.00 $109.00 $172.66 $218.00 $174.40 $98.10 $43.27 N/A $126.44 $218.00 $130.80 $218.00 $45.43 $218.00 N/A N/A 460.100.01S SUP Custom 27803010 460.100.01S - CLAMP TUBE 11MM FLAPFIX TITANIUM CRANIAL FLAP STERILE BOTH IP/OP $893.50 $661.00 $159.00 $893.25 $893.25 $893.25 $893.25 $893.25 $893.25 $893.25 $159.00 $893.25 $893.25 $893.25 $893.25 $893.25 $893.25 $186.16 $893.25 $357.30 $893.25 $893.25 $893.25 $893.25 $893.25 $670.13 $893.25 $893.25 $893.25 $446.63 $446.63 $707.45 $893.25 $714.60 $401.96 $893.25 N/A $518.23 $893.25 $535.95 $893.25 $893.25 $893.25 N/A N/A 460.107.01S SUP Custom 27803010 460.107.01S - CLAMP TUBE 11MM TEXTURE FLAPFIX TITANIUM CRANIAL FLAP BOTH IP/OP $925.00 $685.00 $164.61 $924.75 $924.75 $924.75 $924.75 $924.75 $924.75 $924.75 $164.61 $924.75 $924.75 $924.75 $924.75 $924.75 $924.75 $192.73 $924.75 $369.90 $924.75 $924.75 $924.75 $924.75 $924.75 $693.75 $924.75 $924.75 $924.75 $462.38 $462.38 $732.40 $924.75 $739.80 $416.14 $924.75 N/A $536.50 $924.75 $554.85 $924.75 $924.75 $924.75 N/A N/A 46-1001T SUP Custom 27203010 46-1001T - TEMPLATE SZ LG ANG PLT BOTH IP/OP $232.50 $172.00 $41.39 $232.50 $232.50 $232.50 $232.50 $232.50 $232.50 $232.50 $41.39 $232.50 $232.50 $172.56 $172.56 $179.21 $121.13 $48.46 $232.50 $93.00 $232.50 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $151.13 $232.50 N/A $134.85 $232.50 $139.50 $232.50 $232.50 $232.50 N/A N/A 46-1002T SUP Custom 27203010 46-1002T - TEMPLATE SZ 2 ANG LCK PLT BOTH IP/OP $232.50 $172.00 $41.39 $232.50 $232.50 $232.50 $232.50 $232.50 $232.50 $232.50 $41.39 $232.50 $232.50 $172.56 $172.56 $179.21 $121.13 $48.46 $232.50 $93.00 $232.50 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $151.13 $232.50 N/A $134.85 $232.50 $139.50 $232.50 $232.50 $232.50 N/A N/A 46-1003T SUP Custom 27203010 46-1003T - TEMPLATE SZ ANG LCK PLT BOTH IP/OP $232.50 $172.00 $41.39 $232.50 $232.50 $232.50 $232.50 $232.50 $232.50 $232.50 $41.39 $232.50 $232.50 $172.56 $172.56 $179.21 $121.13 $48.46 $232.50 $93.00 $232.50 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $151.13 $232.50 N/A $134.85 $232.50 $139.50 $232.50 $232.50 $232.50 N/A N/A 46-1004 SUP Custom 27203010 46-1004 - DRILL TWIST 1.8MM MICRO 26MM 115MM STOP BOTH IP/OP $632.50 $468.00 $112.59 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $112.59 $632.50 $632.50 $469.44 $469.44 $487.53 $329.53 $131.82 $632.50 $253.00 $632.50 $632.50 $632.50 $632.50 $632.50 $474.38 $632.50 $632.50 $632.50 $316.25 $316.25 $500.94 $632.50 $506.00 $411.13 $632.50 N/A $366.85 $632.50 $379.50 $632.50 $632.50 $632.50 N/A N/A 46-1006 SUP Custom 27203010 46-1006 - BIT DRL 1.6MM 50MM 22MM TWST STP LORENZ TRAUMAONE BOTH IP/OP $632.50 $468.00 $112.59 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $112.59 $632.50 $632.50 $469.44 $469.44 $487.53 $329.53 $131.82 $632.50 $253.00 $632.50 $632.50 $632.50 $632.50 $632.50 $474.38 $632.50 $632.50 $632.50 $316.25 $316.25 $500.94 $632.50 $506.00 $411.13 $632.50 N/A $366.85 $632.50 $379.50 $632.50 $632.50 $632.50 N/A N/A 46-1007 SUP Custom 27203010 46-1007 - DRILL SURG 1.6MM 115MM 26MM STOP TRAUMAONE MANDIB BOTH IP/OP $632.50 $468.00 $112.59 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $112.59 $632.50 $632.50 $469.44 $469.44 $487.53 $329.53 $131.82 $632.50 $253.00 $632.50 $632.50 $632.50 $632.50 $632.50 $474.38 $632.50 $632.50 $632.50 $316.25 $316.25 $500.94 $632.50 $506.00 $411.13 $632.50 N/A $366.85 $632.50 $379.50 $632.50 $632.50 $632.50 N/A N/A 46-1024T SUP Custom 27203010 46-1024T - TEMPLATE SZ STRG 24 HL PLT BOTH IP/OP $232.50 $172.00 $41.39 $232.50 $232.50 $232.50 $232.50 $232.50 $232.50 $232.50 $41.39 $232.50 $232.50 $172.56 $172.56 $179.21 $121.13 $48.46 $232.50 $93.00 $232.50 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $151.13 $232.50 N/A $134.85 $232.50 $139.50 $232.50 $232.50 $232.50 N/A N/A 46-123 SUP Custom 27203010 46-123 - DRESSING WOUND LARGE ABSORBENT VEST NONADHERENT MULTILAYER BOTH IP/OP $26.50 $20.00 $4.71 $27.27 $26.47 $26.47 $26.47 $26.47 $26.47 $26.47 $4.71 $26.47 $26.47 $19.65 $19.65 $20.40 $13.79 $5.52 $26.47 $10.91 $26.47 $26.47 $27.27 $26.47 $26.47 $19.88 $26.47 $26.47 $26.47 $13.24 $13.24 $20.96 $26.47 $21.18 $17.21 $26.47 N/A $15.37 $26.47 $15.88 $26.47 $26.47 $26.47 N/A N/A 46-130 SUP Custom 27203010 46-130 - DRESSING HYDROCOLLOID XL ABSORBENT LATEX FREE SOFSORB BOTH IP/OP $750.50 $555.00 $133.50 $750.02 $750.02 $750.02 $750.02 $750.02 $750.02 $750.02 $133.50 $750.02 $750.02 $556.66 $556.66 $578.12 $390.76 $156.31 $750.02 $300.01 $750.02 $750.02 $750.02 $750.02 $750.02 $562.88 $750.02 $750.02 $750.02 $375.01 $375.01 $594.02 $750.02 $600.02 $487.51 $750.02 N/A $435.29 $750.02 $450.01 $750.02 $750.02 $750.02 N/A N/A 46-133 SUP Custom 27203010 46-133 - DRESSING BRN ABS HIP LG BOTH IP/OP $52.50 $39.00 $9.27 $52.10 $52.10 $52.10 $52.10 $52.10 $52.10 $52.10 $9.27 $52.10 $52.10 $38.67 $38.67 $40.16 $27.14 $10.86 $52.10 $20.84 $52.10 $52.10 $52.10 $52.10 $52.10 $39.38 $52.10 $52.10 $52.10 $26.05 $26.05 $41.26 $52.10 $41.68 $33.87 $52.10 N/A $30.45 $52.10 $31.26 $52.10 $52.10 $52.10 N/A N/A 46-152 SUP Custom 27203010 46-152 - DRESSING WND XL STRL LF SFSRB ABS VST HPRFR NADH LTX SAFE BOTH IP/OP $28.50 $21.00 $4.99 $28.88 $28.03 $28.03 $28.03 $28.03 $28.03 $28.03 $4.99 $28.03 $28.03 $20.80 $20.80 $21.61 $14.60 $5.84 $28.03 $11.55 $28.03 $28.03 $28.88 $28.03 $28.03 $21.38 $28.03 $28.03 $28.03 $14.02 $14.02 $22.20 $28.03 $22.42 $18.22 $28.03 N/A $16.53 $28.03 $16.82 $28.03 $28.03 $28.03 N/A N/A 46-155 SUP Custom 27203010 46-155 - DRESSING WND STRL LF SFSRB ABS STDR LINR ADLT HIP LG BOTH IP/OP $31.50 $23.00 $5.52 $31.02 $31.02 $31.02 $31.02 $31.02 $31.02 $31.02 $5.52 $31.02 $31.02 $23.02 $23.02 $23.91 $16.16 $6.46 $31.02 $12.41 $31.02 $31.02 $31.02 $31.02 $31.02 $23.63 $31.02 $31.02 $31.02 $15.51 $15.51 $24.57 $31.02 $24.82 $20.16 $31.02 N/A $18.27 $31.02 $18.61 $31.02 $31.02 $31.02 N/A N/A 462.634S SUP Custom 27803010 462.634S - BLADE FIX 34MM SPIRAL SOLID TITANIUM HUMERUS STERILE BOTH IP/OP "$1,227.00" $908.00 $218.37 "$1,247.65" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" $218.37 "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" $255.68 "$1,226.80" $499.06 "$1,226.80" "$1,226.80" "$1,247.65" "$1,226.80" "$1,226.80" $920.25 "$1,226.80" "$1,226.80" "$1,226.80" $613.40 $613.40 $971.63 "$1,226.80" $981.44 $552.06 "$1,226.80" N/A $711.66 "$1,226.80" $736.08 "$1,226.80" "$1,226.80" "$1,226.80" N/A N/A 462.636S SUP Custom 27803010 462.636S - BLADE INTRAMEDULLARY FIX 13MM 36MMX3.9MM SPIRAL CUTTING BOTH IP/OP "$1,227.00" $908.00 $218.37 "$1,247.65" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" $218.37 "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" $255.68 "$1,226.80" $499.06 "$1,226.80" "$1,226.80" "$1,247.65" "$1,226.80" "$1,226.80" $920.25 "$1,226.80" "$1,226.80" "$1,226.80" $613.40 $613.40 $971.63 "$1,226.80" $981.44 $552.06 "$1,226.80" N/A $711.66 "$1,226.80" $736.08 "$1,226.80" "$1,226.80" "$1,226.80" N/A N/A 462.638S SUP Custom 27803010 462.638S - BLADE FIX 38MM SPIRAL SOLID TITANIUM HUMERUS STERILE BOTH IP/OP "$1,227.00" $908.00 $218.37 "$1,247.65" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" $218.37 "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" $255.68 "$1,226.80" $499.06 "$1,226.80" "$1,226.80" "$1,247.65" "$1,226.80" "$1,226.80" $920.25 "$1,226.80" "$1,226.80" "$1,226.80" $613.40 $613.40 $971.63 "$1,226.80" $981.44 $552.06 "$1,226.80" N/A $711.66 "$1,226.80" $736.08 "$1,226.80" "$1,226.80" "$1,226.80" N/A N/A 462.640S SUP HCPCS C1713 462.640S - NAIL INTRAMEDULLARY 40MM SPIRAL BLADE TITANIUM STERILE BOTH IP/OP "$1,227.00" $908.00 $243.49 "$1,247.65" $552.06 $552.06 $552.06 $552.06 "$1,226.80" "$1,226.80" "$1,226.80" $255.70 "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" $255.68 "$1,226.80" $499.06 $725.65 "$1,226.80" "$1,247.65" "$1,226.80" "$1,226.80" $920.25 "$1,226.80" "$1,226.80" "$1,226.80" $613.40 $613.40 $971.63 "$1,226.80" $981.44 $552.06 $243.49 N/A $711.66 "$1,226.80" $736.08 "$1,226.80" $255.67 "$1,226.80" N/A N/A 462.642S SUP HCPCS C1713 462.642S - BLADE INTRAMEDULLARY FIX 13MM 42MMX3.9MM SPIRAL CUTTING BOTH IP/OP "$1,227.00" $908.00 $243.49 "$1,247.65" $552.06 $552.06 $552.06 $552.06 "$1,226.80" "$1,226.80" "$1,226.80" $255.70 "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" $255.68 "$1,226.80" "$1,247.65" $725.65 "$1,226.80" "$1,247.65" "$1,226.80" "$1,226.80" $920.25 "$1,226.80" "$1,226.80" "$1,226.80" $613.40 $613.40 $971.63 "$1,226.80" $981.44 $552.06 $243.49 N/A $711.66 "$1,226.80" "$1,226.80" "$1,226.80" $255.67 "$1,226.80" N/A N/A 462.644S SUP HCPCS C1713 462.644S - BLADE INTRAMEDULLARY FIX 44MM SPIRAL GOLD TITANIUM ALUMINUM BOTH IP/OP "$1,227.00" $908.00 $243.49 "$1,247.65" $552.06 $552.06 $552.06 $552.06 "$1,226.80" "$1,226.80" "$1,226.80" $255.70 "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" $255.68 "$1,226.80" "$1,247.65" $725.65 "$1,226.80" "$1,247.65" "$1,226.80" "$1,226.80" $920.25 "$1,226.80" "$1,226.80" "$1,226.80" $613.40 $613.40 $971.63 "$1,226.80" $981.44 $552.06 $243.49 N/A $711.66 "$1,226.80" $736.08 "$1,226.80" $255.67 "$1,226.80" N/A N/A 462.646S SUP HCPCS C1713 462.646S - BLADE INTRAMEDULLARY FIX 13MM 46MMX3.9MM SPIRAL CUTTING BOTH IP/OP "$1,227.00" $908.00 $243.49 "$1,247.65" $552.06 $552.06 $552.06 $552.06 "$1,226.80" "$1,226.80" "$1,226.80" $255.70 "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" $255.68 "$1,226.80" $499.06 $725.65 "$1,226.80" "$1,247.65" "$1,226.80" "$1,226.80" $920.25 "$1,226.80" "$1,226.80" "$1,226.80" $613.40 $613.40 $971.63 "$1,226.80" $981.44 $552.06 $243.49 N/A $711.66 "$1,226.80" $736.08 "$1,226.80" $255.67 "$1,226.80" N/A N/A 462.648S SUP HCPCS C1713 462.648S - BLADE INTRAMEDULLARY FIX 48MM SPIRAL NAIL-EX TITANIUM BOTH IP/OP "$1,227.00" $908.00 $243.49 "$1,247.65" $552.06 $552.06 $552.06 $552.06 "$1,226.80" "$1,226.80" "$1,226.80" $255.70 "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" $255.68 "$1,226.80" $499.06 $725.65 "$1,226.80" "$1,247.65" "$1,226.80" "$1,226.80" $920.25 "$1,226.80" "$1,226.80" "$1,226.80" $613.40 $613.40 $971.63 "$1,226.80" $981.44 $552.06 $243.49 N/A $711.66 "$1,226.80" $736.08 "$1,226.80" $255.67 "$1,226.80" N/A N/A 462.650S SUP HCPCS C1713 462.650S - BLADE INTRAMEDULLARY FIX 50MM SPIRAL GOLD TITANIUM ALUMINUM BOTH IP/OP "$1,227.00" $908.00 $243.49 "$1,247.65" $552.06 $552.06 $552.06 $552.06 "$1,226.80" "$1,226.80" "$1,226.80" $255.70 "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" $255.68 "$1,226.80" $499.06 $725.65 "$1,226.80" "$1,247.65" "$1,226.80" "$1,226.80" $920.25 "$1,226.80" "$1,226.80" "$1,226.80" $613.40 $613.40 $971.63 "$1,226.80" $981.44 $552.06 $243.49 N/A $711.66 "$1,226.80" $736.08 "$1,226.80" $255.67 "$1,226.80" N/A N/A 462.652S SUP HCPCS C1713 462.652S - BLADE FIX 52MM CANN SPIRAL SOLID GOLD TITANIUM HUMERUS BOTH IP/OP "$1,227.00" $908.00 $243.49 "$1,247.65" $552.06 $552.06 $552.06 $552.06 "$1,226.80" "$1,226.80" "$1,226.80" $255.70 "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" $255.68 "$1,226.80" $499.06 $725.65 "$1,226.80" "$1,247.65" "$1,226.80" "$1,226.80" $920.25 "$1,226.80" "$1,226.80" "$1,226.80" $613.40 $613.40 $971.63 "$1,226.80" $981.44 $552.06 $243.49 N/A $711.66 "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" N/A N/A 462.654S SUP HCPCS C1713 462.654S - BLADE FIX 54MM CANN SPIRAL NAIL-EX TITANIUM HUMERUS STERILE BOTH IP/OP "$1,227.00" $908.00 $243.49 "$1,247.65" $552.06 $552.06 $552.06 $552.06 "$1,226.80" "$1,226.80" "$1,226.80" $255.70 "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" "$1,226.80" $255.68 "$1,226.80" "$1,247.65" $725.65 "$1,226.80" "$1,247.65" "$1,226.80" "$1,226.80" $920.25 "$1,226.80" "$1,226.80" "$1,226.80" $613.40 $613.40 $971.63 "$1,226.80" $981.44 $552.06 $243.49 N/A $711.66 "$1,226.80" $736.08 "$1,226.80" "$1,226.80" "$1,226.80" N/A N/A 462.660S SUP HCPCS C1713 462.660S - CAP END 0MM T25 STARDRIVE RECESS GOLD TITANIUM HUMERUS BOTH IP/OP $433.50 $321.00 $85.97 $433.13 $194.91 $194.91 $194.91 $194.91 $433.13 $433.13 $433.13 $90.28 $433.13 $433.13 $433.13 $433.13 $433.13 $90.27 $433.13 $433.13 $256.20 $433.13 $433.13 $433.13 $433.13 $325.13 $433.13 $433.13 $433.13 $216.57 $216.57 $343.04 $433.13 $346.50 $194.91 $85.97 N/A $251.43 $433.13 $433.13 $433.13 $90.26 $433.13 N/A N/A 462.665S SUP HCPCS C1713 462.665S - CAP END 5MM 3.5MM HEXAGONAL RECESS GOLD TITANIUM HUMERUS BOTH IP/OP $494.50 $366.00 $98.11 $494.33 $222.45 $222.45 $222.45 $222.45 $494.33 $494.33 $494.33 $103.03 $494.33 $494.33 $494.33 $494.33 $494.33 $103.02 $494.33 $197.73 $292.40 $494.33 $494.33 $494.33 $494.33 $370.88 $494.33 $494.33 $494.33 $247.17 $247.17 $391.51 $494.33 $395.46 $222.45 $98.11 N/A $286.81 $494.33 $494.33 $494.33 $103.02 $494.33 N/A N/A 462.666S SUP HCPCS C1713 462.666S - CAP END 10MM 3.5MM HEXAGONAL RECESS GOLD TITANIUM HUMERUS BOTH IP/OP $433.50 $321.00 $85.97 $433.13 $194.91 $194.91 $194.91 $194.91 $433.13 $433.13 $433.13 $90.28 $433.13 $433.13 $433.13 $433.13 $433.13 $90.27 $433.13 $173.25 $256.20 $433.13 $433.13 $433.13 $433.13 $325.13 $433.13 $433.13 $433.13 $216.57 $216.57 $343.04 $433.13 $346.50 $194.91 $85.97 N/A $251.43 $433.13 $433.13 $433.13 $90.26 $433.13 N/A N/A 462.667S SUP HCPCS C1713 462.667S - CAP END 15MM 3.5MM HEXAGONAL RECESS GOLD TITANIUM HUMERUS BOTH IP/OP $433.50 $321.00 $85.97 $433.13 $194.91 $194.91 $194.91 $194.91 $433.13 $433.13 $433.13 $90.28 $433.13 $433.13 $433.13 $433.13 $433.13 $90.27 $433.13 $173.25 $256.20 $433.13 $433.13 $433.13 $433.13 $325.13 $433.13 $433.13 $433.13 $216.57 $216.57 $343.04 $433.13 $346.50 $194.91 $85.97 N/A $251.43 $433.13 $433.13 $433.13 $90.26 $433.13 N/A N/A 462.719S SUP HCPCS C1713 462.719S - NAIL INTRAMEDULLARY UNIVERSAL 7.5MM 19CM SOLID ROUND CROSS BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$1,304.60" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$1,956.90" "$3,261.50" $679.70 "$3,261.50" N/A N/A 462.723S SUP HCPCS C1713 462.723S - NAIL 7.5MM 23CM HUM IM SLD TI STRL BOTH IP/OP "$3,802.50" "$2,814.00" $754.63 "$3,802.15" "$1,710.97" "$1,710.97" "$1,710.97" "$1,710.97" "$3,802.15" "$3,802.15" "$3,802.15" $792.46 "$3,802.15" "$3,802.15" "$3,802.15" "$3,802.15" "$3,802.15" $792.41 "$3,802.15" "$1,520.86" "$1,874.46" "$3,802.15" "$3,802.15" "$3,802.15" "$3,802.15" "$2,851.88" "$3,802.15" "$3,802.15" "$3,802.15" "$1,901.08" "$1,901.08" "$3,011.30" "$3,802.15" "$3,041.72" "$1,710.97" $754.63 N/A "$2,205.45" "$3,802.15" "$2,281.29" "$3,802.15" $792.37 "$3,802.15" N/A N/A 462.728S SUP HCPCS C1713 462.728S - NAIL INTRAMEDULLARY 7.5MM 280MM SOLID ROUND CROSS SECTION BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$1,304.60" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$1,956.90" "$3,261.50" $679.70 "$3,261.50" N/A N/A 462.729S SUP HCPCS C1713 462.729S - NAIL INTRAMEDULLARY 7.5MM 29.5CM SOLID BLUE TITANIUM HUMERUS BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$3,261.50" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$3,261.50" "$3,261.50" $679.70 "$3,261.50" N/A N/A 462.731S SUP HCPCS C1713 462.731S - NAIL INTRAMEDULLARY 7.5MM 31CM SOLID TITANIUM HUMERUS BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$3,261.50" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$1,956.90" "$3,261.50" $679.70 "$3,261.50" N/A N/A 462.732S SUP HCPCS C1713 462.732S - NAIL INTRAMEDULLARY 7.5MM 32.5CM SOLID TITANIUM HUMERUS BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$3,261.50" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$1,956.90" "$3,261.50" "$3,261.50" "$3,261.50" N/A N/A 462.919S SUP HCPCS C1713 462.919S - NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 19CM SOLID FLUTED CROSS BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$3,261.50" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$1,956.90" "$3,261.50" "$3,261.50" "$3,261.50" N/A N/A 462.920S SUP HCPCS C1713 462.920S - NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 20.5CM SOLID FLUTED BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$3,261.50" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$1,956.90" "$3,261.50" $679.70 "$3,261.50" N/A N/A 462.922S SUP HCPCS C1713 462.922S - NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 22CM SOLID FLUTED CROSS BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$3,261.50" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$3,261.50" "$3,261.50" $679.70 "$3,261.50" N/A N/A 462.923S SUP HCPCS C1713 462.923S - NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 23CM SOLID FLUTED CROSS BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$1,304.60" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" N/A N/A 462.924S SUP HCPCS C1713 462.924S - NAIL INTRAMEDULLARY 9.5MM 240MM SOLID FLUTED CROSS SECTION BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$1,304.60" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$1,956.90" "$3,261.50" "$3,261.50" "$3,261.50" N/A N/A 462.925S SUP HCPCS C1713 462.925S - NAIL 9.5MM 25CM HUM IM SLD TI STRL BOTH IP/OP "$3,802.50" "$2,814.00" $754.63 "$3,802.15" "$1,710.97" "$1,710.97" "$1,710.97" "$1,710.97" "$3,802.15" "$3,802.15" "$3,802.15" $792.46 "$3,802.15" "$3,802.15" "$3,802.15" "$3,802.15" "$3,802.15" $792.41 "$3,802.15" "$1,520.86" "$1,874.46" "$3,802.15" "$3,802.15" "$3,802.15" "$3,802.15" "$2,851.88" "$3,802.15" "$3,802.15" "$3,802.15" "$1,901.08" "$1,901.08" "$3,011.30" "$3,802.15" "$3,041.72" "$1,710.97" $754.63 N/A "$2,205.45" "$3,802.15" "$2,281.29" "$3,802.15" "$3,802.15" "$3,802.15" N/A N/A 462.927S SUP HCPCS C1713 462.927S - NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 27CM SOLID FLUTED CROSS BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$3,261.50" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$1,956.90" "$3,261.50" $679.70 "$3,261.50" N/A N/A 462.928S SUP HCPCS C1713 462.928S - NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 28CM SOLID FLUTED CROSS BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$3,261.50" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$1,956.90" "$3,261.50" $679.70 "$3,261.50" N/A N/A 462.929S SUP HCPCS C1713 462.929S - NAIL INTRAMEDULLARY UNIVERSAL 9.5MM 29.5CM SOLID FLUTED BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$1,304.60" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$1,956.90" "$3,261.50" $679.70 "$3,261.50" N/A N/A 462.931S SUP HCPCS C1713 462.931S - NAIL INTRAMEDULLARY 9.5MM 31CM SOLID TITANIUM HUMERUS BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$1,304.60" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$3,261.50" "$3,261.50" $679.70 "$3,261.50" N/A N/A 462.932S SUP HCPCS C1713 462.932S - NAIL INTRAMEDULLARY 9.5MM 32.5CM SOLID TITANIUM HUMERUS BOTH IP/OP "$3,261.50" "$2,414.00" $647.33 "$3,261.50" "$1,467.68" "$1,467.68" "$1,467.68" "$1,467.68" "$3,261.50" "$3,261.50" "$3,261.50" $679.78 "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" $679.73 "$3,261.50" "$1,304.60" "$1,607.92" "$3,261.50" "$3,261.50" "$3,261.50" "$3,261.50" "$2,446.13" "$3,261.50" "$3,261.50" "$3,261.50" "$1,630.75" "$1,630.75" "$2,583.11" "$3,261.50" "$2,609.20" "$1,467.68" $647.33 N/A "$1,891.67" "$3,261.50" "$1,956.90" "$3,261.50" "$3,261.50" "$3,261.50" N/A N/A 462.950S SUP Custom 27803010 462.950S - CAP END 5MM 2.5MM HEXAGONAL RECESS BLUE TITANIUM HUMERUS BOTH IP/OP $484.00 $358.00 $86.15 $484.00 $484.00 $484.00 $484.00 $484.00 $484.00 $484.00 $86.15 $484.00 $484.00 $484.00 $484.00 $484.00 $484.00 $100.87 $484.00 $193.60 $484.00 $484.00 $484.00 $484.00 $484.00 $363.00 $484.00 $484.00 $484.00 $242.00 $242.00 $383.33 $484.00 $387.20 $217.80 $484.00 N/A $280.72 $484.00 $290.40 $484.00 $484.00 $484.00 N/A N/A 462.955S SUP Custom 27803010 462.955S - CAP END 5MM 3.5MM HEXAGONAL RECESS BLUE TITANIUM STERILE BOTH IP/OP $559.50 $414.00 $99.52 $559.10 $559.10 $559.10 $559.10 $559.10 $559.10 $559.10 $99.52 $559.10 $559.10 $559.10 $559.10 $559.10 $559.10 $116.52 $559.10 $223.64 $559.10 $559.10 $559.10 $559.10 $559.10 $419.63 $559.10 $559.10 $559.10 $279.55 $279.55 $442.81 $559.10 $447.28 $251.60 $559.10 N/A $324.51 $559.10 $335.46 $559.10 $559.10 $559.10 N/A N/A 462.960S SUP Custom 27803010 462.960S - CAP END 10MM 10MM HEXAGON RECESS BLUE TITANIUM HUMERUS BOTH IP/OP $559.50 $414.00 $99.52 $559.10 $559.10 $559.10 $559.10 $559.10 $559.10 $559.10 $99.52 $559.10 $559.10 $559.10 $559.10 $559.10 $559.10 $116.52 $559.10 $223.64 $559.10 $559.10 $559.10 $559.10 $559.10 $419.63 $559.10 $559.10 $559.10 $279.55 $279.55 $442.81 $559.10 $447.28 $251.60 $559.10 N/A $324.51 $559.10 $335.46 $559.10 $559.10 $559.10 N/A N/A 462.965S SUP Custom 27803010 462.965S - CAP END 15MM 3.5MM HEXAGONAL RECESS BLUE TITANIUM HUMERUS BOTH IP/OP $484.00 $358.00 $86.15 $484.00 $484.00 $484.00 $484.00 $484.00 $484.00 $484.00 $86.15 $484.00 $484.00 $484.00 $484.00 $484.00 $484.00 $100.87 $484.00 $193.60 $484.00 $484.00 $484.00 $484.00 $484.00 $363.00 $484.00 $484.00 $484.00 $242.00 $242.00 $383.33 $484.00 $387.20 $217.80 $484.00 N/A $280.72 $484.00 $290.40 $484.00 $484.00 $484.00 N/A N/A 46-305 SUP HCPCS C1769 46-305 - GWIRE VASC STD .035IN 150CM 3CM ANG TIP STF SHFT GLDWR BOTH IP/OP $119.00 $88.00 $23.57 $118.75 $64.48 $64.48 $64.48 $64.48 $118.75 $118.75 $118.75 $24.75 $118.75 $88.14 $88.14 $91.53 $61.87 $24.75 $118.75 $118.75 $70.24 $118.75 $118.75 $118.75 $118.75 $89.25 $118.75 $118.75 $118.75 $59.38 $59.38 $94.05 $118.75 $95.00 $77.19 $23.57 N/A $69.02 $118.75 $118.75 $118.75 $24.75 $118.75 N/A N/A 464.30S SUP HCPCS C1713 464.30S - NAIL INTRAMEDULLARY 9MM 30CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 464.32S SUP HCPCS C1713 464.32S - NAIL INTRAMEDULLARY 9MM 32CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" $821.70 "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 464.34S SUP HCPCS C1713 464.34S - NAIL INTRAMEDULLARY 9MM 34CM SOLID TITANIUM FEMUR STERILE BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" $821.70 "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 464.36S SUP HCPCS C1713 464.36S - NAIL INTRAMEDULLARY 9MM 36CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" $821.70 "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$2,054.25" "$2,054.25" $428.11 "$2,054.25" N/A N/A 464.38S SUP HCPCS C1713 464.38S - NAIL INTRAMEDULLARY 9MM 38CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" $821.70 "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 464.40S SUP HCPCS C1713 464.40S - NAIL INTRAMEDULLARY 9MM 40CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,344.50" "$1,735.00" $465.31 "$2,344.43" "$1,054.99" "$1,054.99" "$1,054.99" "$1,054.99" "$2,344.43" "$2,344.43" "$2,344.43" $488.64 "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" $488.61 "$2,344.43" $937.77 "$1,386.73" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$1,758.38" "$2,344.43" "$2,344.43" "$2,344.43" "$1,172.22" "$1,172.22" "$1,856.79" "$2,344.43" "$1,875.54" "$1,054.99" $465.31 N/A "$1,359.81" "$2,344.43" "$1,406.66" "$2,344.43" $488.58 "$2,344.43" N/A N/A 464.42S SUP HCPCS C1713 464.42S - NAIL INTRAMEDULLARY 9MM 420MM CANN SOLID TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" $821.70 "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" N/A N/A 464.44S SUP HCPCS C1713 464.44S - NAIL INTRAMEDULLARY 9MM 44CM SOLID TITANIUM FEMUR STERILE BOTH IP/OP "$2,344.50" "$1,735.00" $465.31 "$2,344.43" "$1,054.99" "$1,054.99" "$1,054.99" "$1,054.99" "$2,344.43" "$2,344.43" "$2,344.43" $488.64 "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" $488.61 "$2,344.43" "$2,344.43" "$1,386.73" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$1,758.38" "$2,344.43" "$2,344.43" "$2,344.43" "$1,172.22" "$1,172.22" "$1,856.79" "$2,344.43" "$1,875.54" "$1,054.99" $465.31 N/A "$1,359.81" "$2,344.43" "$1,406.66" "$2,344.43" $488.58 "$2,344.43" N/A N/A 464.46S SUP HCPCS C1713 464.46S - NAIL INTRAMEDULLARY 9MM 46CM SOLID TITANIUM FEMUR STERILE BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" "$2,054.25" "$2,054.25" N/A N/A 464.48S SUP HCPCS C1713 464.48S - NAIL INTRAMEDULLARY 9MM 48CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" $821.70 "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" N/A N/A 465.30S SUP HCPCS C1713 465.30S - NAIL INTRAMEDULLARY 10MM 30CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,344.50" "$1,735.00" $465.31 "$2,344.43" "$1,054.99" "$1,054.99" "$1,054.99" "$1,054.99" "$2,344.43" "$2,344.43" "$2,344.43" $488.64 "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" $488.61 "$2,344.43" $937.77 "$1,386.73" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$1,758.38" "$2,344.43" "$2,344.43" "$2,344.43" "$1,172.22" "$1,172.22" "$1,856.79" "$2,344.43" "$1,875.54" "$1,054.99" $465.31 N/A "$1,359.81" "$2,344.43" "$1,406.66" "$2,344.43" $488.58 "$2,344.43" N/A N/A 465.32S SUP HCPCS C1713 465.32S - NAIL INTRAMEDULLARY 10MM 32CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" $821.70 "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 465.34S SUP HCPCS C1713 465.34S - NAIL INTRAMEDULLARY 10MM 34CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" $821.70 "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 465.36S SUP HCPCS C1713 465.36S - NAIL INTRAMEDULLARY 10MM 36CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" $821.70 "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" "$2,054.25" "$2,054.25" N/A N/A 465.38S SUP HCPCS C1713 465.38S - NAIL INTRAMEDULLARY 10MM 38CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,344.50" "$1,735.00" $465.31 "$2,344.43" "$1,054.99" "$1,054.99" "$1,054.99" "$1,054.99" "$2,344.43" "$2,344.43" "$2,344.43" $488.64 "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" $488.61 "$2,344.43" $937.77 "$1,386.73" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$1,758.38" "$2,344.43" "$2,344.43" "$2,344.43" "$1,172.22" "$1,172.22" "$1,856.79" "$2,344.43" "$1,875.54" "$1,054.99" $465.31 N/A "$1,359.81" "$2,344.43" "$1,406.66" "$2,344.43" "$2,344.43" "$2,344.43" N/A N/A 465.40S SUP HCPCS C1713 465.40S - NAIL INTRAMEDULLARY 10MM 40CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" "$2,054.25" "$2,054.25" N/A N/A 465.42S SUP HCPCS C1713 465.42S - NAIL INTRAMEDULLARY 10MM 42CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" $821.70 "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 465.44S SUP HCPCS C1713 465.44S - NAIL INTRAMEDULLARY 10MM 44CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" "$2,054.25" "$2,054.25" N/A N/A 465.46S SUP HCPCS C1713 465.46S - NAIL INTRAMEDULLARY 10MM 46CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,344.50" "$1,735.00" $465.31 "$2,344.43" "$1,054.99" "$1,054.99" "$1,054.99" "$1,054.99" "$2,344.43" "$2,344.43" "$2,344.43" $488.64 "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" $488.61 "$2,344.43" "$2,344.43" "$1,386.73" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$1,758.38" "$2,344.43" "$2,344.43" "$2,344.43" "$1,172.22" "$1,172.22" "$1,856.79" "$2,344.43" "$1,875.54" "$1,054.99" $465.31 N/A "$1,359.81" "$2,344.43" "$1,406.66" "$2,344.43" "$2,344.43" "$2,344.43" N/A N/A 465.48S SUP HCPCS C1713 465.48S - NAIL INTRAMEDULLARY 10MM 48CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$2,054.25" "$2,054.25" $428.11 "$2,054.25" N/A N/A 4655-03 SUP HCPCS C1776 4655-03 - HEAD FEM +5 UNV 32MM BOTH IP/OP "$2,607.50" "$1,930.00" $517.52 "$2,607.50" "$1,173.38" "$1,173.38" "$1,173.38" "$1,173.38" "$2,607.50" "$2,607.50" "$2,607.50" $543.47 "$2,607.50" "$2,607.50" "$2,607.50" "$2,607.50" "$2,607.50" $543.43 "$2,607.50" "$2,607.50" "$1,285.50" "$2,607.50" "$2,607.50" "$2,607.50" "$2,607.50" "$1,955.63" "$2,607.50" "$2,607.50" "$2,607.50" "$1,303.75" "$1,303.75" "$2,065.14" "$2,607.50" "$2,086.00" "$1,173.38" $517.52 N/A "$1,512.35" "$2,607.50" "$2,607.50" "$2,607.50" $543.40 "$2,607.50" N/A N/A 466.30S SUP HCPCS C1713 466.30S - NAIL INTRAMEDULLARY 11MM 30CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" "$2,054.25" "$2,054.25" N/A N/A 466.32S SUP HCPCS C1713 466.32S - NAIL INTRAMEDULLARY 11MM 32CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" $821.70 "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" "$2,054.25" "$2,054.25" N/A N/A 466.34S SUP HCPCS C1713 466.34S - NAIL INTRAMEDULLARY 11MM 34CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 466.36S SUP HCPCS C1713 466.36S - NAIL INTRAMEDULLARY 11MM 36CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,344.50" "$1,735.00" $465.31 "$2,344.43" "$1,054.99" "$1,054.99" "$1,054.99" "$1,054.99" "$2,344.43" "$2,344.43" "$2,344.43" $488.64 "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" $488.61 "$2,344.43" "$2,344.43" "$1,386.73" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$1,758.38" "$2,344.43" "$2,344.43" "$2,344.43" "$1,172.22" "$1,172.22" "$1,856.79" "$2,344.43" "$1,875.54" "$1,054.99" $465.31 N/A "$1,359.81" "$2,344.43" "$1,406.66" "$2,344.43" $488.58 "$2,344.43" N/A N/A 466.38S SUP HCPCS C1713 466.38S - NAIL INTRAMEDULLARY 11MM 38CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 466.40S SUP HCPCS C1713 466.40S - NAIL INTRAMEDULLARY 11MM 40CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,344.50" "$1,735.00" $465.31 "$2,344.43" "$1,054.99" "$1,054.99" "$1,054.99" "$1,054.99" "$2,344.43" "$2,344.43" "$2,344.43" $488.64 "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" $488.61 "$2,344.43" "$2,344.43" "$1,386.73" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$1,758.38" "$2,344.43" "$2,344.43" "$2,344.43" "$1,172.22" "$1,172.22" "$1,856.79" "$2,344.43" "$1,875.54" "$1,054.99" $465.31 N/A "$1,359.81" "$2,344.43" "$1,406.66" "$2,344.43" $488.58 "$2,344.43" N/A N/A 466.42S SUP HCPCS C1713 466.42S - NAIL INTRAMEDULLARY 11MM 42CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 466.44S SUP HCPCS C1713 466.44S - NAIL INTRAMEDULLARY 11MM 44CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 466.46S SUP HCPCS C1713 466.46S - NAIL INTRAMEDULLARY 11MM 46CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$2,054.25" "$2,054.25" $428.11 "$2,054.25" N/A N/A 466.48S SUP HCPCS C1713 466.48S - NAIL INTRAMEDULLARY 11MM 48CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$2,054.25" "$2,054.25" $428.11 "$2,054.25" N/A N/A 46-605 SUP HCPCS C1769 46-605 - GWIRE VASC .018IN 260CM 3CM TIP SHRT TPR SPCL PLTN PLUS GLDX BOTH IP/OP $45.50 $34.00 $8.97 $45.18 $24.53 $24.53 $24.53 $24.53 $45.18 $45.18 $45.18 $9.42 $45.18 $33.53 $33.53 $34.82 $23.54 $9.42 $45.18 $45.18 $26.72 $45.18 $45.18 $45.18 $45.18 $34.13 $45.18 $45.18 $45.18 $22.59 $22.59 $35.78 $45.18 $36.14 $29.37 $8.97 N/A $26.39 $45.18 $45.18 $45.18 $9.42 $45.18 N/A N/A 466P306A SUP HCPCS C1884 466P306A - FILTER EMBL 55CM LF TRPS CATH SHTH INTRO KT BOTH IP/OP "$3,112.50" "$2,303.00" $617.75 "$3,112.50" "$1,400.63" "$1,400.63" "$1,400.63" "$1,400.63" "$3,112.50" "$3,112.50" "$3,112.50" $648.72 "$3,112.50" "$3,112.50" "$3,112.50" "$3,112.50" "$3,112.50" $648.68 "$3,112.50" "$3,112.50" "$1,534.46" "$3,112.50" "$3,112.50" "$3,112.50" "$3,112.50" "$2,334.38" "$3,112.50" "$3,112.50" "$3,112.50" "$1,556.25" "$1,556.25" "$2,465.10" "$3,112.50" "$2,490.00" "$1,400.63" $617.75 N/A "$1,805.25" "$3,112.50" "$3,112.50" "$3,112.50" $648.65 "$3,112.50" N/A N/A 467.30S SUP HCPCS C1713 467.30S - NAIL INTRAMEDULLARY 12MM 30CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,344.50" "$1,735.00" $465.31 "$2,344.43" "$1,054.99" "$1,054.99" "$1,054.99" "$1,054.99" "$2,344.43" "$2,344.43" "$2,344.43" $488.64 "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" $488.61 "$2,344.43" "$2,344.43" "$1,386.73" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$1,758.38" "$2,344.43" "$2,344.43" "$2,344.43" "$1,172.22" "$1,172.22" "$1,856.79" "$2,344.43" "$1,875.54" "$1,054.99" $465.31 N/A "$1,359.81" "$2,344.43" "$1,406.66" "$2,344.43" "$2,344.43" "$2,344.43" N/A N/A 467.32S SUP HCPCS C1713 467.32S - NAIL INTRAMEDULLARY 12MM 32CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" "$2,054.25" "$2,054.25" N/A N/A 467.34S SUP HCPCS C1713 467.34S - NAIL INTRAMEDULLARY 12MM 34CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 467.36S SUP HCPCS C1713 467.36S - NAIL INTRAMEDULLARY 12MM 36CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" $821.70 "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 467.38S SUP HCPCS C1713 467.38S - NAIL INTRAMEDULLARY 12MM 38CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" $821.70 "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 467.40S SUP HCPCS C1713 467.40S - NAIL INTRAMEDULLARY 12MM 40CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,344.50" "$1,735.00" $465.31 "$2,344.43" "$1,054.99" "$1,054.99" "$1,054.99" "$1,054.99" "$2,344.43" "$2,344.43" "$2,344.43" $488.64 "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" $488.61 "$2,344.43" $937.77 "$1,386.73" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$1,758.38" "$2,344.43" "$2,344.43" "$2,344.43" "$1,172.22" "$1,172.22" "$1,856.79" "$2,344.43" "$1,875.54" "$1,054.99" $465.31 N/A "$1,359.81" "$2,344.43" "$1,406.66" "$2,344.43" $488.58 "$2,344.43" N/A N/A 467.42S SUP HCPCS C1713 467.42S - NAIL INTRAMEDULLARY 12MM 420MM SOLID GREEN TITANIUM FEMORAL BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$1,232.55" "$2,054.25" $428.11 "$2,054.25" N/A N/A 467.44S SUP HCPCS C1713 467.44S - NAIL INTRAMEDULLARY 12MM 44CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,054.50" "$1,520.00" $407.72 "$2,054.25" $924.41 $924.41 $924.41 $924.41 "$2,054.25" "$2,054.25" "$2,054.25" $428.16 "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" $428.13 "$2,054.25" "$2,054.25" "$1,215.09" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$1,540.88" "$2,054.25" "$2,054.25" "$2,054.25" "$1,027.13" "$1,027.13" "$1,626.97" "$2,054.25" "$1,643.40" $924.41 $407.72 N/A "$1,191.61" "$2,054.25" "$2,054.25" "$2,054.25" $428.11 "$2,054.25" N/A N/A 467.46S SUP HCPCS C1713 467.46S - NAIL INTRAMEDULLARY 12MM 46CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,344.50" "$1,735.00" $465.31 "$2,344.43" "$1,054.99" "$1,054.99" "$1,054.99" "$1,054.99" "$2,344.43" "$2,344.43" "$2,344.43" $488.64 "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" $488.61 "$2,344.43" "$2,344.43" "$1,386.73" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$1,758.38" "$2,344.43" "$2,344.43" "$2,344.43" "$1,172.22" "$1,172.22" "$1,856.79" "$2,344.43" "$1,875.54" "$1,054.99" $465.31 N/A "$1,359.81" "$2,344.43" "$1,406.66" "$2,344.43" $488.58 "$2,344.43" N/A N/A 467.48S SUP HCPCS C1713 467.48S - NAIL INTRAMEDULLARY 12MM 48CM SOLID GREEN TITANIUM FEMUR BOTH IP/OP "$2,344.50" "$1,735.00" $465.31 "$2,344.43" "$1,054.99" "$1,054.99" "$1,054.99" "$1,054.99" "$2,344.43" "$2,344.43" "$2,344.43" $488.64 "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" $488.61 "$2,344.43" "$2,344.43" "$1,386.73" "$2,344.43" "$2,344.43" "$2,344.43" "$2,344.43" "$1,758.38" "$2,344.43" "$2,344.43" "$2,344.43" "$1,172.22" "$1,172.22" "$1,856.79" "$2,344.43" "$1,875.54" "$1,054.99" $465.31 N/A "$1,359.81" "$2,344.43" "$1,406.66" "$2,344.43" $488.58 "$2,344.43" N/A N/A 46-804 SUP HCPCS C1769 46-804 - GUIDEWIRE TRANSEND EX .014 BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $509.06 $509.06 $509.06 $509.06 $937.50 $937.50 $937.50 $195.40 $937.50 $695.81 $695.81 $722.63 $488.44 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $609.38 $186.07 N/A $543.75 $937.50 $937.50 $937.50 $195.38 $937.50 N/A N/A 46B005 SUP HCPCS V2790 46B005 - GRAFT SFT TIS 25X15X15MM PATLR TNDN TIB STRUT WHL BOTH IP/OP "$8,265.00" "$6,116.00" "$1,640.40" "$9,470.00" "$3,719.25" "$3,719.25" "$3,719.25" "$3,719.25" "$8,265.00" "$8,265.00" "$8,265.00" "$1,722.63" "$8,265.00" "$8,265.00" "$8,265.00" "$8,265.00" "$8,265.00" "$1,722.52" "$8,265.00" "$9,470.00" "$4,074.65" "$8,265.00" "$9,470.00" "$8,265.00" "$8,265.00" "$6,198.75" "$8,265.00" "$8,265.00" "$8,265.00" "$4,132.50" "$4,132.50" "$6,545.88" "$8,265.00" "$6,612.00" "$3,719.25" "$1,640.40" N/A "$4,793.70" "$8,265.00" "$8,265.00" "$8,265.00" "$1,722.43" "$8,265.00" N/A N/A 47-2255-008-01 SUP Custom 27203010 47-2255-008-01 - GUIDEWIRE ORTHOPEDIC BALL 3MM 100CM STERILE BOTH IP/OP $251.50 $186.00 $44.72 $251.25 $251.25 $251.25 $251.25 $251.25 $251.25 $251.25 $44.72 $251.25 $251.25 $186.48 $186.48 $193.66 $130.90 $52.36 $251.25 $100.50 $251.25 $251.25 $251.25 $251.25 $251.25 $188.63 $251.25 $251.25 $251.25 $125.63 $125.63 $198.99 $251.25 $201.00 $163.31 $251.25 N/A $145.87 $251.25 $150.75 $251.25 $251.25 $251.25 N/A N/A 47-2483-060-50 SUP HCPCS C1713 47-2483-060-50 - SCREW BONE PTHRD HEXAGON 5MM 60MM TITANIUM CORTEX DISTAL BOTH IP/OP $381.50 $282.00 $75.69 $381.35 $171.61 $171.61 $171.61 $171.61 $381.35 $381.35 $381.35 $79.48 $381.35 $381.35 $381.35 $381.35 $381.35 $79.48 $381.35 $381.35 $225.57 $381.35 $381.35 $381.35 $381.35 $286.13 $381.35 $381.35 $381.35 $190.68 $190.68 $302.03 $381.35 $305.08 $171.61 $75.69 N/A $221.27 $381.35 $381.35 $381.35 $79.47 $381.35 N/A N/A 47-2483-095-60 SUP HCPCS C1713 47-2483-095-60 - SCREW BONE PTHRD HEXAGON 6MM 3.5MM 95MM TITANIUM CANCELLOUS BOTH IP/OP $426.50 $316.00 $84.61 $426.30 $191.84 $191.84 $191.84 $191.84 $426.30 $426.30 $426.30 $88.85 $426.30 $426.30 $426.30 $426.30 $426.30 $88.85 $426.30 $170.52 $252.16 $426.30 $426.30 $426.30 $426.30 $319.88 $426.30 $426.30 $426.30 $213.15 $213.15 $337.63 $426.30 $341.04 $191.84 $84.61 N/A $247.37 $426.30 $426.30 $426.30 $88.84 $426.30 N/A N/A 47-2484-042-50 SUP HCPCS C1713 47-2484-042-50 - SCREW BONE FIXANG FULTHD HEXAGON 5MM 3.5MM 42.5MM TITANIUM BOTH IP/OP $381.50 $282.00 $75.69 $381.35 $171.61 $171.61 $171.61 $171.61 $381.35 $381.35 $381.35 $79.48 $381.35 $381.35 $381.35 $381.35 $381.35 $79.48 $381.35 $381.35 $225.57 $381.35 $381.35 $381.35 $381.35 $286.13 $381.35 $381.35 $381.35 $190.68 $190.68 $302.03 $381.35 $305.08 $171.61 $75.69 N/A $221.27 $381.35 $381.35 $381.35 $79.47 $381.35 N/A N/A 47-2484-045-50 SUP HCPCS C1713 47-2484-045-50 - SCREW BONE FIXANG FULTHD HEXAGON 5MM 3.5MM 45MM TITANIUM BOTH IP/OP $381.50 $282.00 $75.69 $381.35 $171.61 $171.61 $171.61 $171.61 $381.35 $381.35 $381.35 $79.48 $381.35 $381.35 $381.35 $381.35 $381.35 $79.48 $381.35 $381.35 $225.57 $381.35 $381.35 $381.35 $381.35 $286.13 $381.35 $381.35 $381.35 $190.68 $190.68 $302.03 $381.35 $305.08 $171.61 $75.69 N/A $221.27 $381.35 $228.81 $381.35 $79.47 $381.35 N/A N/A 47-2484-070-60 SUP HCPCS C1713 47-2484-070-60 - SCREW BONE FIXANG FULTHD HEXAGON 6MM 70MM TITANIUM BOTH IP/OP $396.00 $293.00 $78.57 $395.85 $178.13 $178.13 $178.13 $178.13 $395.85 $395.85 $395.85 $82.51 $395.85 $395.85 $395.85 $395.85 $395.85 $82.50 $395.85 $395.85 $234.15 $395.85 $395.85 $395.85 $395.85 $297.00 $395.85 $395.85 $395.85 $197.93 $197.93 $313.51 $395.85 $316.68 $178.13 $78.57 N/A $229.68 $395.85 $237.51 $395.85 $82.50 $395.85 N/A N/A 47-2484-075-50 SUP HCPCS C1713 47-2484-075-50 - SCREW BONE FIXANG FULTHD HEXAGON 5MM 3.5MM 75MM TITANIUM BOTH IP/OP $381.50 $282.00 $75.69 $381.35 $171.61 $171.61 $171.61 $171.61 $381.35 $381.35 $381.35 $79.48 $381.35 $381.35 $381.35 $381.35 $381.35 $79.48 $381.35 $381.35 $225.57 $381.35 $381.35 $381.35 $381.35 $286.13 $381.35 $381.35 $381.35 $190.68 $190.68 $302.03 $381.35 $305.08 $171.61 $75.69 N/A $221.27 $381.35 $228.81 $381.35 $79.47 $381.35 N/A N/A 47-2484-075-60 SUP HCPCS C1713 47-2484-075-60 - SCREW BONE FIXANG FULTHD HEXAGON 6MM 75MM TITANIUM BOTH IP/OP $396.00 $293.00 $78.57 $395.85 $178.13 $178.13 $178.13 $178.13 $395.85 $395.85 $395.85 $82.51 $395.85 $395.85 $395.85 $395.85 $395.85 $82.50 $395.85 $395.85 $234.15 $395.85 $395.85 $395.85 $395.85 $297.00 $395.85 $395.85 $395.85 $197.93 $197.93 $313.51 $395.85 $316.68 $178.13 $78.57 N/A $229.68 $395.85 $237.51 $395.85 $82.50 $395.85 N/A N/A 47-2484-095-60 SUP HCPCS C1713 47-2484-095-60 - SCREW BONE FIXANG FULTHD HEXAGON 6MM 95MM TITANIUM BOTH IP/OP $396.00 $293.00 $78.57 $395.85 $178.13 $178.13 $178.13 $178.13 $395.85 $395.85 $395.85 $82.51 $395.85 $395.85 $395.85 $395.85 $395.85 $82.50 $395.85 $395.85 $234.15 $395.85 $395.85 $395.85 $395.85 $297.00 $395.85 $395.85 $395.85 $197.93 $197.93 $313.51 $395.85 $316.68 $178.13 $78.57 N/A $229.68 $395.85 $395.85 $395.85 $82.50 $395.85 N/A N/A 47-2485-095-10 SUP HCPCS C1713 47-2485-095-10 - SCREW BONE 10.5MM 95MM LAG TITANIUM CEPHALOMEDULLARY STERILE BOTH IP/OP "$1,074.50" $795.00 $213.25 "$1,074.45" $483.50 $483.50 $483.50 $483.50 "$1,074.45" "$1,074.45" "$1,074.45" $223.94 "$1,074.45" "$1,074.45" "$1,074.45" "$1,074.45" "$1,074.45" $223.93 "$1,074.45" "$1,074.45" $635.54 "$1,074.45" "$1,074.45" "$1,074.45" "$1,074.45" $805.88 "$1,074.45" "$1,074.45" "$1,074.45" $537.23 $537.23 $850.96 "$1,074.45" $859.56 $483.50 $213.25 N/A $623.21 "$1,074.45" $644.67 "$1,074.45" $223.92 "$1,074.45" N/A N/A 47-2487-001-00 SUP HCPCS C1713 47-2487-001-00 - CAP END ANTEGRADE 0MM NATURAL NAIL TITANIUM FEMUR BOTH IP/OP $412.00 $305.00 $81.73 $411.80 $185.31 $185.31 $185.31 $185.31 $411.80 $411.80 $411.80 $85.83 $411.80 $411.80 $411.80 $411.80 $411.80 $85.82 $411.80 $411.80 $243.58 $411.80 $411.80 $411.80 $411.80 $309.00 $411.80 $411.80 $411.80 $205.90 $205.90 $326.15 $411.80 $329.44 $185.31 $81.73 N/A $238.96 $411.80 $247.08 $411.80 $85.82 $411.80 N/A N/A 47-2487-002-00 SUP HCPCS C1713 47-2487-002-00 - CAP END 0MM NATURAL NAIL TITANIUM CEPHALOMEDULLARY BOTH IP/OP $396.00 $293.00 $78.57 $395.85 $178.13 $178.13 $178.13 $178.13 $395.85 $395.85 $395.85 $82.51 $395.85 $395.85 $395.85 $395.85 $395.85 $82.50 $395.85 $395.85 $234.15 $395.85 $395.85 $395.85 $395.85 $297.00 $395.85 $395.85 $395.85 $197.93 $197.93 $313.51 $395.85 $316.68 $178.13 $78.57 N/A $229.68 $395.85 $237.51 $395.85 $82.50 $395.85 N/A N/A 47-2487-005-00 SUP HCPCS C1713 47-2487-005-00 - CAP END 0MM NATURAL NAIL TITANIUM TIBIA BOTH IP/OP $412.00 $305.00 $81.73 $411.80 $185.31 $185.31 $185.31 $185.31 $411.80 $411.80 $411.80 $85.83 $411.80 $411.80 $411.80 $411.80 $411.80 $85.82 $411.80 $411.80 $243.58 $411.80 $411.80 $411.80 $411.80 $309.00 $411.80 $411.80 $411.80 $205.90 $205.90 $326.15 $411.80 $329.44 $185.31 $81.73 N/A $238.96 $411.80 $247.08 $411.80 $85.82 $411.80 N/A N/A 47-2487-008-00 SUP HCPCS C1713 47-2487-008-00 - CAP END RTRGRD 0MM NATURAL NAIL TITANIUM KNEE FEMUR BOTH IP/OP $412.00 $305.00 $81.73 $411.80 $185.31 $185.31 $185.31 $185.31 $411.80 $411.80 $411.80 $85.83 $411.80 $411.80 $411.80 $411.80 $411.80 $85.82 $411.80 $411.80 $243.58 $411.80 $411.80 $411.80 $411.80 $309.00 $411.80 $411.80 $411.80 $205.90 $205.90 $326.15 $411.80 $329.44 $185.31 $81.73 N/A $238.96 $411.80 $247.08 $411.80 $85.82 $411.80 N/A N/A 47-2488-000-01 SUP HCPCS C1713 47-2488-000-01 - NUT ORTHOPEDIC NATURAL NAIL TITANIUM KNEE FEMUR CORTICAL BOTH IP/OP $208.00 $154.00 $41.28 $208.00 $93.60 $93.60 $93.60 $93.60 $208.00 $208.00 $208.00 $43.35 $208.00 $208.00 $208.00 $208.00 $208.00 $43.35 $208.00 $83.20 $123.03 $208.00 $208.00 $208.00 $208.00 $156.00 $208.00 $208.00 $208.00 $104.00 $104.00 $164.74 $208.00 $166.40 $93.60 $41.28 N/A $120.64 $208.00 $124.80 $208.00 $43.35 $208.00 N/A N/A 47-2488-000-02 SUP HCPCS C1713 47-2488-000-02 - WASHER ORTHOPEDIC NATURAL NAIL TITANIUM STERILE BOTH IP/OP $175.50 $130.00 $34.83 $175.50 $78.98 $78.98 $78.98 $78.98 $175.50 $175.50 $175.50 $36.58 $175.50 $175.50 $175.50 $175.50 $175.50 $36.58 $175.50 $175.50 $103.81 $175.50 $175.50 $175.50 $175.50 $131.63 $175.50 $175.50 $175.50 $87.75 $87.75 $139.00 $175.50 $140.40 $78.98 $34.83 N/A $101.79 $175.50 $105.30 $175.50 $36.57 $175.50 N/A N/A 47-2491-360-12 SUP HCPCS C1713 47-2491-360-12 - NAIL INTRAMEDULLARY 128D ANTEGRADE STR FLUTE BARREL ANTERIOR BOTH IP/OP "$3,409.00" "$2,523.00" $676.59 "$3,408.95" "$1,534.03" "$1,534.03" "$1,534.03" "$1,534.03" "$3,408.95" "$3,408.95" "$3,408.95" $710.51 "$3,408.95" "$3,408.95" "$3,408.95" "$3,408.95" "$3,408.95" $710.46 "$3,408.95" "$1,363.58" "$1,680.61" "$3,408.95" "$3,408.95" "$3,408.95" "$3,408.95" "$2,556.75" "$3,408.95" "$3,408.95" "$3,408.95" "$1,704.48" "$1,704.48" "$2,699.89" "$3,408.95" "$2,727.16" "$1,534.03" $676.59 N/A "$1,977.22" "$3,408.95" "$3,408.95" "$3,408.95" $710.43 "$3,408.95" N/A N/A 47-2492-360-12 SUP HCPCS C1713 47-2492-360-12 - NAIL INTRAMEDULLARY 132D ANTEGRADE SPIRAL FLUTE BARREL BOTH IP/OP "$3,409.00" "$2,523.00" $676.59 "$3,408.95" "$1,534.03" "$1,534.03" "$1,534.03" "$1,534.03" "$3,408.95" "$3,408.95" "$3,408.95" $710.51 "$3,408.95" "$3,408.95" "$3,408.95" "$3,408.95" "$3,408.95" $710.46 "$3,408.95" "$3,408.95" "$1,680.61" "$3,408.95" "$3,408.95" "$3,408.95" "$3,408.95" "$2,556.75" "$3,408.95" "$3,408.95" "$3,408.95" "$1,704.48" "$1,704.48" "$2,699.89" "$3,408.95" "$2,727.16" "$1,534.03" $676.59 N/A "$1,977.22" "$3,408.95" "$2,045.37" "$3,408.95" $710.43 "$3,408.95" N/A N/A 47-2493-210-11 SUP HCPCS C1713 47-2493-210-11 - NAIL INTRAMEDULLARY 125D CCD RIGHT SHORT 11.5MM 21.5CM BOTH IP/OP "$2,965.50" "$2,194.00" $588.53 "$2,965.25" "$1,334.36" "$1,334.36" "$1,334.36" "$1,334.36" "$2,965.25" "$2,965.25" "$2,965.25" $618.03 "$2,965.25" "$2,965.25" "$2,965.25" "$2,965.25" "$2,965.25" $617.99 "$2,965.25" "$1,186.10" "$1,461.87" "$2,965.25" "$2,965.25" "$2,965.25" "$2,965.25" "$2,224.13" "$2,965.25" "$2,965.25" "$2,965.25" "$1,482.63" "$1,482.63" "$2,348.48" "$2,965.25" "$2,372.20" "$1,334.36" $588.53 N/A "$1,719.99" "$2,965.25" "$1,779.15" "$2,965.25" $617.96 "$2,965.25" N/A N/A 47-2493-360-11 SUP HCPCS C1713 47-2493-360-11 - NAIL INTRAMEDULLARY 125D CCD RIGHT LONG SPIRAL FLUTE BARREL BOTH IP/OP "$4,463.50" "$3,303.00" $885.81 "$4,463.10" "$2,008.40" "$2,008.40" "$2,008.40" "$2,008.40" "$4,463.10" "$4,463.10" "$4,463.10" $930.22 "$4,463.10" "$4,463.10" "$4,463.10" "$4,463.10" "$4,463.10" $930.16 "$4,463.10" "$1,785.24" "$2,200.31" "$4,463.10" "$4,463.10" "$4,463.10" "$4,463.10" "$3,347.63" "$4,463.10" "$4,463.10" "$4,463.10" "$2,231.55" "$2,231.55" "$3,534.78" "$4,463.10" "$3,570.48" "$2,008.40" $885.81 N/A "$2,588.83" "$4,463.10" "$2,677.86" "$4,463.10" $930.11 "$4,463.10" N/A N/A 47-2494-200-11 SUP HCPCS C1713 47-2494-200-11 - NAIL INTRAMEDULLARY RTRGRD SHORT STR FLUTE BARREL ANTERIOR BOTH IP/OP "$4,218.50" "$3,122.00" $837.18 "$4,218.05" "$1,898.12" "$1,898.12" "$1,898.12" "$1,898.12" "$4,218.05" "$4,218.05" "$4,218.05" $879.15 "$4,218.05" "$4,218.05" "$4,218.05" "$4,218.05" "$4,218.05" $879.09 "$4,218.05" "$4,218.05" "$2,079.50" "$4,218.05" "$4,218.05" "$4,218.05" "$4,218.05" "$3,163.88" "$4,218.05" "$4,218.05" "$4,218.05" "$2,109.03" "$2,109.03" "$3,340.70" "$4,218.05" "$3,374.44" "$1,898.12" $837.18 N/A "$2,446.73" "$4,218.05" "$2,530.83" "$4,218.05" $879.04 "$4,218.05" N/A N/A 47-2494-360-11 SUP HCPCS C1713 47-2494-360-11 - NAIL INTRAMEDULLARY RTRGRD LONG STR FLUTE BARREL ANTERIOR BOTH IP/OP "$4,218.50" "$3,122.00" $837.18 "$4,218.05" "$1,898.12" "$1,898.12" "$1,898.12" "$1,898.12" "$4,218.05" "$4,218.05" "$4,218.05" $879.15 "$4,218.05" "$4,218.05" "$4,218.05" "$4,218.05" "$4,218.05" $879.09 "$4,218.05" "$1,687.22" "$2,079.50" "$4,218.05" "$4,218.05" "$4,218.05" "$4,218.05" "$3,163.88" "$4,218.05" "$4,218.05" "$4,218.05" "$2,109.03" "$2,109.03" "$3,340.70" "$4,218.05" "$3,374.44" "$1,898.12" $837.18 N/A "$2,446.73" "$4,218.05" "$2,530.83" "$4,218.05" $879.04 "$4,218.05" N/A N/A 47-2495-320-12 SUP HCPCS C1713 47-2495-320-12 - NAIL INTRAMEDULLARY 10D HERZOG CURVE 2D BOW BOTH IP/OP "$3,241.00" "$2,398.00" $643.21 "$3,240.75" "$1,458.34" "$1,458.34" "$1,458.34" "$1,458.34" "$3,240.75" "$3,240.75" "$3,240.75" $675.45 "$3,240.75" "$3,240.75" "$3,240.75" "$3,240.75" "$3,240.75" $675.41 "$3,240.75" "$3,240.75" "$1,597.69" "$3,240.75" "$3,240.75" "$3,240.75" "$3,240.75" "$2,430.75" "$3,240.75" "$3,240.75" "$3,240.75" "$1,620.38" "$1,620.38" "$2,566.67" "$3,240.75" "$2,592.60" "$1,458.34" $643.21 N/A "$1,879.78" "$3,240.75" "$1,944.45" "$3,240.75" $675.37 "$3,240.75" N/A N/A 474.031S SUP HCPCS C1713 474.031S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 300MM CANN ROUND BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$2,956.30" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" "$2,956.30" "$2,956.30" N/A N/A 474.032S SUP HCPCS C1713 474.032S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 320MM CANN ROUND BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" "$2,492.88" "$2,492.88" N/A N/A 474.034S SUP HCPCS C1713 474.034S - NAIL INTRAMEDULLARY 10MM 34CM CANN GREEN TITANIUM FEMUR BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" $997.15 "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" "$2,492.88" "$2,492.88" N/A N/A 474.036S SUP HCPCS C1713 474.036S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 360MM CANN ROUND BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$1,182.52" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" $616.09 "$2,956.30" N/A N/A 474.038S SUP HCPCS C1713 474.038S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 380MM CANN ROUND BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$1,182.52" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" "$2,956.30" "$2,956.30" N/A N/A 474.041S SUP HCPCS C1713 474.041S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 400MM CANN ROUND BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" N/A N/A 474.042S SUP HCPCS C1713 474.042S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 420MM CANN ROUND BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$1,182.52" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" $616.09 "$2,956.30" N/A N/A 474.044S SUP HCPCS C1713 474.044S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 440MM CANN ROUND BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$1,182.52" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" "$2,956.30" "$2,956.30" N/A N/A 474.046S SUP HCPCS C1713 474.046S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 460MM CANN ROUND BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" $997.15 "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" "$2,492.88" "$2,492.88" N/A N/A 474.048S SUP HCPCS C1713 474.048S - NAIL INTRAMEDULLARY UNIVERSAL 10MM 480MM CANN ROUND BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" N/A N/A 474.131S SUP HCPCS C1713 474.131S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 300MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" $997.15 "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.132S SUP HCPCS C1713 474.132S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 320MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.134S SUP HCPCS C1713 474.134S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 340MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$1,182.52" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$2,956.30" "$2,956.30" $616.09 "$2,956.30" N/A N/A 474.136S SUP HCPCS C1713 474.136S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 360MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$2,956.30" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" "$2,956.30" "$2,956.30" N/A N/A 474.138S SUP HCPCS C1713 474.138S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 380MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$2,956.30" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" $616.09 "$2,956.30" N/A N/A 474.141S SUP HCPCS C1713 474.141S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 400MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$2,956.30" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" "$2,956.30" "$2,956.30" N/A N/A 474.142S SUP HCPCS C1713 474.142S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 420MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$1,182.52" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" "$2,956.30" "$2,956.30" N/A N/A 474.144S SUP HCPCS C1713 474.144S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 440MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$1,182.52" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" "$2,956.30" "$2,956.30" N/A N/A 474.146S SUP HCPCS C1713 474.146S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 460MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$1,182.52" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" $616.09 "$2,956.30" N/A N/A 474.148S SUP HCPCS C1713 474.148S - NAIL INTRAMEDULLARY UNIVERSAL 11MM 480MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.231S SUP HCPCS C1713 474.231S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 300MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" "$2,492.88" "$2,492.88" N/A N/A 474.232S SUP HCPCS C1713 474.232S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 320MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" $997.15 "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" "$2,492.88" "$2,492.88" N/A N/A 474.234S SUP HCPCS C1713 474.234S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 340MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" $997.15 "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" N/A N/A 474.236S SUP HCPCS C1713 474.236S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 360MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" $997.15 "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.238S SUP HCPCS C1713 474.238S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 380MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" "$2,492.88" "$2,492.88" N/A N/A 474.241S SUP HCPCS C1713 474.241S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 400MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.242S SUP HCPCS C1713 474.242S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 420MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$2,956.30" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" $616.09 "$2,956.30" N/A N/A 474.244S SUP HCPCS C1713 474.244S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 440MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$2,956.30" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" "$2,956.30" "$2,956.30" N/A N/A 474.246S SUP HCPCS C1713 474.246S - NAIL INTRAMEDULLARY 12MM 460MM CANN GREEN TITANIUM FEMUR BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.248S SUP HCPCS C1713 474.248S - NAIL INTRAMEDULLARY UNIVERSAL 12MM 480MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" "$2,492.88" "$2,492.88" N/A N/A 474.331S SUP HCPCS C1713 474.331S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 300MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" $997.15 "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" "$2,492.88" "$2,492.88" N/A N/A 474.332S SUP HCPCS C1713 474.332S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 320MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" $997.15 "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.334S SUP HCPCS C1713 474.334S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 340MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$1,182.52" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" $616.09 "$2,956.30" N/A N/A 474.336S SUP HCPCS C1713 474.336S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 360MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$1,182.52" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" "$2,956.30" "$2,956.30" N/A N/A 474.338S SUP HCPCS C1713 474.338S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 380MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$2,956.30" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" "$2,956.30" "$2,956.30" N/A N/A 474.341S SUP HCPCS C1713 474.341S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 400MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$2,956.30" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" $616.09 "$2,956.30" N/A N/A 474.342S SUP HCPCS C1713 474.342S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 420MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" "$2,492.88" "$2,492.88" N/A N/A 474.344S SUP HCPCS C1713 474.344S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 440MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.346S SUP HCPCS C1713 474.346S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 460MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.348S SUP HCPCS C1713 474.348S - NAIL INTRAMEDULLARY UNIVERSAL 13MM 480MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$2,492.88" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.431S SUP HCPCS C1713 474.431S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 300MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$2,956.30" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" "$2,956.30" "$2,956.30" N/A N/A 474.432S SUP HCPCS C1713 474.432S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 320MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" "$2,492.88" "$2,492.88" N/A N/A 474.434S SUP HCPCS C1713 474.434S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 340MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.436S SUP HCPCS C1713 474.436S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 360MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$2,492.88" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.438S SUP HCPCS C1713 474.438S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 380MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" $997.15 "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.441S SUP HCPCS C1713 474.441S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 400MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" $997.15 "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.442S SUP HCPCS C1713 474.442S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 420MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" $997.15 "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.444S SUP HCPCS C1713 474.444S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 440MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.446S SUP HCPCS C1713 474.446S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 460MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.448S SUP HCPCS C1713 474.448S - NAIL INTRAMEDULLARY UNIVERSAL 14MM 480MM CANN FLUTED BARREL BOTH IP/OP "$2,493.00" "$1,845.00" $494.77 "$2,492.88" "$1,121.80" "$1,121.80" "$1,121.80" "$1,121.80" "$2,492.88" "$2,492.88" "$2,492.88" $519.58 "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" $519.54 "$2,492.88" "$2,492.88" "$1,474.54" "$2,492.88" "$2,492.88" "$2,492.88" "$2,492.88" "$1,869.75" "$2,492.88" "$2,492.88" "$2,492.88" "$1,246.44" "$1,246.44" "$1,974.36" "$2,492.88" "$1,994.30" "$1,121.80" $494.77 N/A "$1,445.94" "$2,492.88" "$1,495.73" "$2,492.88" $519.52 "$2,492.88" N/A N/A 474.531S SUP HCPCS C1713 474.531S - NAIL INTRAMEDULLARY UNIVERSAL 15MM 300MM CANN FLUTED BARREL BOTH IP/OP "$2,574.00" "$1,905.00" $510.87 "$2,574.00" "$1,158.30" "$1,158.30" "$1,158.30" "$1,158.30" "$2,574.00" "$2,574.00" "$2,574.00" $536.49 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $536.45 "$2,574.00" "$2,574.00" "$1,268.98" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,158.30" $510.87 N/A "$1,492.92" "$2,574.00" "$2,574.00" "$2,574.00" $536.42 "$2,574.00" N/A N/A 474.532S SUP HCPCS C1713 474.532S - NAIL INTRAMEDULLARY UNIVERSAL 15MM 320MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$2,956.30" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" $616.09 "$2,956.30" N/A N/A 474.534S SUP HCPCS C1713 474.534S - NAIL INTRAMEDULLARY UNIVERSAL 15MM 340MM CANN FLUTED BARREL BOTH IP/OP "$2,574.00" "$1,905.00" $510.87 "$2,574.00" "$1,158.30" "$1,158.30" "$1,158.30" "$1,158.30" "$2,574.00" "$2,574.00" "$2,574.00" $536.49 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $536.45 "$2,574.00" "$2,574.00" "$1,268.98" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,158.30" $510.87 N/A "$1,492.92" "$2,574.00" "$1,544.40" "$2,574.00" $536.42 "$2,574.00" N/A N/A 474.536S SUP HCPCS C1713 474.536S - NAIL INTRAMEDULLARY UNIVERSAL 15MM 360MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$2,956.30" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" $616.09 "$2,956.30" N/A N/A 474.538S SUP HCPCS C1713 474.538S - NAIL INTRAMEDULLARY UNIVERSAL 15MM 380MM CANN FLUTED BARREL BOTH IP/OP "$2,574.00" "$1,905.00" $510.87 "$2,574.00" "$1,158.30" "$1,158.30" "$1,158.30" "$1,158.30" "$2,574.00" "$2,574.00" "$2,574.00" $536.49 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $536.45 "$2,574.00" "$2,574.00" "$1,268.98" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,158.30" $510.87 N/A "$1,492.92" "$2,574.00" "$1,544.40" "$2,574.00" $536.42 "$2,574.00" N/A N/A 474.541S SUP HCPCS C1713 474.541S - NAIL INTRAMEDULLARY UNIVERSAL 15MM 400MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$2,956.30" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" $616.09 "$2,956.30" N/A N/A 474.542S SUP HCPCS C1713 474.542S - NAIL INTRAMEDULLARY UNIVERSAL 15MM 420MM CANN FLUTED BARREL BOTH IP/OP "$2,574.00" "$1,905.00" $510.87 "$2,574.00" "$1,158.30" "$1,158.30" "$1,158.30" "$1,158.30" "$2,574.00" "$2,574.00" "$2,574.00" $536.49 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $536.45 "$2,574.00" "$2,574.00" "$1,268.98" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,158.30" $510.87 N/A "$1,492.92" "$2,574.00" "$1,544.40" "$2,574.00" $536.42 "$2,574.00" N/A N/A 474.544S SUP HCPCS C1713 474.544S - NAIL INTRAMEDULLARY UNIVERSAL 15MM 440MM CANN FLUTED BARREL BOTH IP/OP "$2,956.50" "$2,188.00" $586.75 "$2,956.30" "$1,330.34" "$1,330.34" "$1,330.34" "$1,330.34" "$2,956.30" "$2,956.30" "$2,956.30" $616.17 "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" $616.13 "$2,956.30" "$2,956.30" "$1,457.46" "$2,956.30" "$2,956.30" "$2,956.30" "$2,956.30" "$2,217.38" "$2,956.30" "$2,956.30" "$2,956.30" "$1,478.15" "$1,478.15" "$2,341.39" "$2,956.30" "$2,365.04" "$1,330.34" $586.75 N/A "$1,714.77" "$2,956.30" "$1,773.78" "$2,956.30" $616.09 "$2,956.30" N/A N/A 474.546S SUP HCPCS C1713 474.546S - NAIL INTRAMEDULLARY UNIVERSAL 15MM 460MM CANN FLUTED BARREL BOTH IP/OP "$2,574.00" "$1,905.00" $510.87 "$2,574.00" "$1,158.30" "$1,158.30" "$1,158.30" "$1,158.30" "$2,574.00" "$2,574.00" "$2,574.00" $536.49 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $536.45 "$2,574.00" "$2,574.00" "$1,268.98" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,158.30" $510.87 N/A "$1,492.92" "$2,574.00" "$1,544.40" "$2,574.00" $536.42 "$2,574.00" N/A N/A 474.548S SUP HCPCS C1713 474.548S - NAIL INTRAMEDULLARY UNIVERSAL 15MM 480MM CANN FLUTED BARREL BOTH IP/OP "$2,574.00" "$1,905.00" $510.87 "$2,574.00" "$1,158.30" "$1,158.30" "$1,158.30" "$1,158.30" "$2,574.00" "$2,574.00" "$2,574.00" $536.49 "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" $536.45 "$2,574.00" "$2,574.00" "$1,268.98" "$2,574.00" "$2,574.00" "$2,574.00" "$2,574.00" "$1,930.50" "$2,574.00" "$2,574.00" "$2,574.00" "$1,287.00" "$1,287.00" "$2,038.61" "$2,574.00" "$2,059.20" "$1,158.30" $510.87 N/A "$1,492.92" "$2,574.00" "$1,544.40" "$2,574.00" $536.42 "$2,574.00" N/A N/A 474.900S SUP HCPCS C1713 474.900S - SLEEVE LCK STD GRN STRL TI FEM 13-15MM NL BOTH IP/OP $670.00 $496.00 $132.90 $669.63 $301.33 $301.33 $301.33 $301.33 $669.63 $669.63 $669.63 $139.57 $669.63 $669.63 $669.63 $669.63 $669.63 $139.56 $669.63 $669.63 $396.09 $669.63 $669.63 $669.63 $669.63 $502.50 $669.63 $669.63 $669.63 $334.82 $334.82 $530.35 $669.63 $535.70 $301.33 $132.90 N/A $388.60 $669.63 $401.78 $669.63 $139.55 $669.63 N/A N/A 474.910S SUP HCPCS C1713 474.910S - SLEEVE LOCKING 100D BLUE TITANIUM FEMUR STERILE 13-15MM CANN BOTH IP/OP $756.50 $560.00 $150.10 $756.25 $340.31 $340.31 $340.31 $340.31 $756.25 $756.25 $756.25 $157.62 $756.25 $756.25 $756.25 $756.25 $756.25 $157.61 $756.25 $756.25 $447.32 $756.25 $756.25 $756.25 $756.25 $567.38 $756.25 $756.25 $756.25 $378.13 $378.13 $598.95 $756.25 $605.00 $340.31 $150.10 N/A $438.77 $756.25 $453.75 $756.25 $157.60 $756.25 N/A N/A 474.911S SUP HCPCS C1713 474.911S - SLEEVE LOCKING 110D BLUE TITANIUM FEMUR STERILE 13-15MM CANN BOTH IP/OP $756.50 $560.00 $150.10 $756.25 $340.31 $340.31 $340.31 $340.31 $756.25 $756.25 $756.25 $157.62 $756.25 $756.25 $756.25 $756.25 $756.25 $157.61 $756.25 $302.50 $447.32 $756.25 $756.25 $756.25 $756.25 $567.38 $756.25 $756.25 $756.25 $378.13 $378.13 $598.95 $756.25 $605.00 $340.31 $150.10 N/A $438.77 $756.25 $756.25 $756.25 $157.60 $756.25 N/A N/A 474.912S SUP HCPCS C1713 474.912S - SLEEVE LOCKING 120D BLUE TITANIUM FEMUR STERILE 13-15MM CANN BOTH IP/OP $756.50 $560.00 $150.10 $756.25 $340.31 $340.31 $340.31 $340.31 $756.25 $756.25 $756.25 $157.62 $756.25 $756.25 $756.25 $756.25 $756.25 $157.61 $756.25 $756.25 $447.32 $756.25 $756.25 $756.25 $756.25 $567.38 $756.25 $756.25 $756.25 $378.13 $378.13 $598.95 $756.25 $605.00 $340.31 $150.10 N/A $438.77 $756.25 $453.75 $756.25 $756.25 $756.25 N/A N/A 474.913S SUP HCPCS C1713 474.913S - SLEEVE LOCKING 130D ANTEGRADE PINK TITANIUM FEMUR STERILE BOTH IP/OP $756.50 $560.00 $150.10 $756.25 $340.31 $340.31 $340.31 $340.31 $756.25 $756.25 $756.25 $157.62 $756.25 $756.25 $756.25 $756.25 $756.25 $157.61 $756.25 $756.25 $447.32 $756.25 $756.25 $756.25 $756.25 $567.38 $756.25 $756.25 $756.25 $378.13 $378.13 $598.95 $756.25 $605.00 $340.31 $150.10 N/A $438.77 $756.25 $453.75 $756.25 $756.25 $756.25 N/A N/A 474.920S SUP Custom 27803010 474.920S - CAP END 0MM 15MM EXTEND GREEN TITANIUM FEMUR STERILE 13-15MM BOTH IP/OP $447.00 $331.00 $79.54 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $79.54 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $93.13 $446.88 $178.75 $446.88 $446.88 $446.88 $446.88 $446.88 $335.25 $446.88 $446.88 $446.88 $223.44 $223.44 $353.93 $446.88 $357.50 $201.10 $446.88 N/A $259.26 $446.88 $268.13 $446.88 $446.88 $446.88 N/A N/A 474.921S SUP Custom 27803010 474.921S - CAP END 10MM 15MM EXTEND GREEN TITANIUM FEMUR STERILE 13-15 BOTH IP/OP $447.00 $331.00 $79.54 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $79.54 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $93.13 $446.88 $178.75 $446.88 $446.88 $446.88 $446.88 $446.88 $335.25 $446.88 $446.88 $446.88 $223.44 $223.44 $353.93 $446.88 $357.50 $201.10 $446.88 N/A $259.26 $446.88 $268.13 $446.88 $446.88 $446.88 N/A N/A 474.922S SUP Custom 27803010 474.922S - CAP END 20MM 15MM EXTEND GREEN TITANIUM FEMUR STERILE 13-15 BOTH IP/OP $447.00 $331.00 $79.54 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $79.54 $446.88 $446.88 $446.88 $446.88 $446.88 $446.88 $93.13 $446.88 $178.75 $446.88 $446.88 $446.88 $446.88 $446.88 $335.25 $446.88 $446.88 $446.88 $223.44 $223.44 $353.93 $446.88 $357.50 $201.10 $446.88 N/A $259.26 $446.88 $268.13 $446.88 $446.88 $446.88 N/A N/A 475.900S SUP Custom 27803010 475.900S - CAP END GREEN TITANIUM STERILE 3-4MM ELAST INTRAMEDULLARY BOTH IP/OP $247.50 $183.00 $44.04 $251.60 $247.40 $247.40 $247.40 $247.40 $247.40 $247.40 $44.04 $247.40 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $100.64 $247.40 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $247.40 N/A $143.55 $247.40 $148.44 $247.40 $247.40 $247.40 N/A N/A 475.905S SUP Custom 27803010 475.905S - CAP END ROSE RED TAN STERILE TEN SYSTEM BOTH IP/OP $247.50 $183.00 $44.04 $251.60 $247.40 $247.40 $247.40 $247.40 $247.40 $247.40 $44.04 $247.40 $247.40 $247.40 $247.40 $247.40 $247.40 $51.56 $247.40 $100.64 $247.40 $247.40 $251.60 $247.40 $247.40 $185.63 $247.40 $247.40 $247.40 $123.70 $123.70 $195.94 $247.40 $197.92 $111.33 $247.40 N/A $143.55 $247.40 $148.44 $247.40 $247.40 $247.40 N/A N/A 475.915S SUP HCPCS C1713 475.915S - NAIL INTRAMEDULLARY 1.5MM 300MM ELAST PURPLE TITANIUM BOTH IP/OP $572.50 $424.00 $113.55 $581.85 $257.46 $257.46 $257.46 $257.46 $572.13 $572.13 $572.13 $119.25 $572.13 $572.13 $572.13 $572.13 $572.13 $119.24 $572.13 $581.85 $338.41 $572.13 $581.85 $572.13 $572.13 $429.38 $572.13 $572.13 $572.13 $286.07 $286.07 $453.13 $572.13 $457.70 $257.46 $113.55 N/A $332.05 $572.13 $343.28 $572.13 $119.23 $572.13 N/A N/A 475.920S SUP HCPCS C1713 475.920S - NAIL INTRAMEDULLARY 2MM 440MM ELAST GREEN TITANIUM OLECRANON BOTH IP/OP $604.50 $447.00 $119.97 $614.73 $272.00 $272.00 $272.00 $272.00 $604.45 $604.45 $604.45 $125.98 $604.45 $604.45 $604.45 $604.45 $604.45 $125.97 $604.45 $614.73 $357.53 $604.45 $614.73 $604.45 $604.45 $453.38 $604.45 $604.45 $604.45 $302.23 $302.23 $478.72 $604.45 $483.56 $272.00 $119.97 N/A $350.61 $604.45 $604.45 $604.45 $125.97 $604.45 N/A N/A 475.925S SUP HCPCS C1713 475.925S - NAIL INTRAMEDULLARY 2.5MM 440MM ELAST PINK TITANIUM BOTH IP/OP $642.50 $475.00 $127.50 $653.33 $289.08 $289.08 $289.08 $289.08 $642.40 $642.40 $642.40 $133.89 $642.40 $642.40 $642.40 $642.40 $642.40 $133.88 $642.40 $653.33 $379.98 $642.40 $653.33 $642.40 $642.40 $481.88 $642.40 $642.40 $642.40 $321.20 $321.20 $508.78 $642.40 $513.92 $289.08 $127.50 N/A $372.65 $642.40 $385.44 $642.40 $133.88 $642.40 N/A N/A 475.930S SUP HCPCS C1713 475.930S - NAIL INTRAMEDULLARY 3MM 440MM ELAST GOLD TITANIUM OLECRANON BOTH IP/OP $675.00 $500.00 $133.92 $686.20 $303.63 $303.63 $303.63 $303.63 $674.73 $674.73 $674.73 $140.63 $674.73 $674.73 $674.73 $674.73 $674.73 $140.62 $674.73 $686.20 $399.10 $674.73 $686.20 $674.73 $674.73 $506.25 $674.73 $674.73 $674.73 $337.37 $337.37 $534.39 $674.73 $539.78 $303.63 $133.92 N/A $391.50 $674.73 $404.84 $674.73 $674.73 $674.73 N/A N/A 475.935S SUP HCPCS C1713 475.935S - NAIL INTRAMEDULLARY 3.5MM 440MM ELAST BLUE TITANIUM BOTH IP/OP $707.50 $524.00 $140.34 $719.10 $318.19 $318.19 $318.19 $318.19 $707.08 $707.08 $707.08 $147.37 $707.08 $707.08 $707.08 $707.08 $707.08 $147.36 $707.08 $719.10 $418.24 $707.08 $719.10 $707.08 $707.08 $530.63 $707.08 $707.08 $707.08 $353.54 $353.54 $560.01 $707.08 $565.66 $318.19 $140.34 N/A $410.35 $707.08 $424.25 $707.08 $707.08 $707.08 N/A N/A 475.940S SUP HCPCS C1713 475.940S - NAIL INTRAMEDULLARY 4MM 440MM ELAST PURPLE TITANIUM BOTH IP/OP $752.50 $557.00 $149.26 $764.83 $338.42 $338.42 $338.42 $338.42 $752.05 $752.05 $752.05 $156.75 $752.05 $752.05 $752.05 $752.05 $752.05 $156.74 $752.05 $305.93 $444.84 $752.05 $764.83 $752.05 $752.05 $564.38 $752.05 $752.05 $752.05 $376.03 $376.03 $595.62 $752.05 $601.64 $338.42 $149.26 N/A $436.45 $752.05 $451.23 $752.05 $156.73 $752.05 N/A N/A 47525P SUP HCPCS C1713 47525P - SCREW BN 4.75MM 25MM SPRL R90D MULTIANGLE LCK TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 47525S SUP HCPCS C1713 47525S - SCREW BN STD 4.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 47530P SUP HCPCS C1713 47530P - SCREW BN 4.75MM 30MM SPRL R90D MULTIANGLE LCK TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 47530S SUP HCPCS C1713 47530S - SCREW BN STD 4.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 47535P SUP HCPCS C1713 47535P - SCREW BN 4.75MM 35MM SPRL R90D MULTIANGLE LCK TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 47535S SUP HCPCS C1713 47535S - SCREW BN STD 4.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 47540P SUP HCPCS C1713 47540P - SCREW BN 4.75MM 40MM SPRL R90D MULTIANGLE LCK TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 47540S SUP HCPCS C1713 47540S - SCREW BN STD 4.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 47545P SUP HCPCS C1713 47545P - SCREW BN 4.75MM 45MM SPRL R90D MULTIANGLE LCK TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 47545S SUP HCPCS C1713 47545S - SCREW BN STD 4.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 47550P SUP HCPCS C1713 47550P - SCREW BN 4.75MM 50MM SPRL R90D MULTIANGLE LCK TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 47550S SUP HCPCS C1713 47550S - SCREW BN STD 4.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 47555P SUP HCPCS C1713 47555P - SCREW BN 4.75MM 55MM SPRL R90D MULTIANGLE LCK TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 47555S SUP HCPCS C1713 47555S - SCREW BN STD 4.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 476.25S SUP HCPCS C1713 476.25S - NAIL INTRAMEDULLARY 10MM 25.5CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$1,007.05" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" $524.67 "$2,517.63" N/A N/A 476.27S SUP HCPCS C1713 476.27S - NAIL INTRAMEDULLARY 10MM 27CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$1,007.05" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" $524.67 "$2,517.63" N/A N/A 476.28S SUP HCPCS C1713 476.28S - NAIL INTRAMEDULLARY 10MM 28.5CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$1,007.05" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" "$2,517.63" "$2,517.63" N/A N/A 476.30S SUP HCPCS C1713 476.30S - NAIL INTRAMEDULLARY 10MM 30CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$2,517.63" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" "$2,517.63" "$2,517.63" N/A N/A 476.31S SUP HCPCS C1713 476.31S - NAIL INTRAMEDULLARY 10MM 31.5CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$2,517.63" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" $524.67 "$2,517.63" N/A N/A 476.33S SUP HCPCS C1713 476.33S - NAIL INTRAMEDULLARY 10MM 33CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$2,517.63" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" $524.67 "$2,517.63" N/A N/A 476.34S SUP HCPCS C1713 476.34S - NAIL INTRAMEDULLARY 10MM 34.5CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$1,007.05" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" $524.67 "$2,517.63" N/A N/A 476.36S SUP HCPCS C1713 476.36S - NAIL INTRAMEDULLARY 10MM 36CM SOLID BLUE TITANIUM TIBIA BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$1,007.05" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" "$2,517.63" "$2,517.63" N/A N/A 476.38S SUP HCPCS C1713 476.38S - NAIL INTRAMEDULLARY 10MM 38CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$1,007.05" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" N/A N/A 476.40S SUP HCPCS C1713 476.40S - NAIL INTRAMEDULLARY 10MM 40CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$2,517.63" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" $524.67 "$2,517.63" N/A N/A 476.42S SUP HCPCS C1713 476.42S - NAIL INTRAMEDULLARY 10MM 42CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$2,517.63" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" $524.67 "$2,517.63" N/A N/A 478.25S SUP HCPCS C1713 478.25S - NAIL INTRAMEDULLARY 8MM 25.5CM SOLID BLUE TITANIUM TIBIA BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$2,517.63" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" $524.67 "$2,517.63" N/A N/A 478.27S SUP HCPCS C1713 478.27S - NAIL INTRAMEDULLARY 8MM 27CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,815.00" "$2,083.00" $558.65 "$2,814.73" "$1,266.63" "$1,266.63" "$1,266.63" "$1,266.63" "$2,814.73" "$2,814.73" "$2,814.73" $586.66 "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" $586.62 "$2,814.73" "$2,814.73" "$1,387.66" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" "$2,111.25" "$2,814.73" "$2,814.73" "$2,814.73" "$1,407.37" "$1,407.37" "$2,229.27" "$2,814.73" "$2,251.78" "$1,266.63" $558.65 N/A "$1,632.70" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" N/A N/A 478.28S SUP HCPCS C1713 478.28S - NAIL INTRAMEDULLARY 8MM 28.5CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,450.50" "$1,813.00" $486.31 "$2,450.25" "$1,102.61" "$1,102.61" "$1,102.61" "$1,102.61" "$2,450.25" "$2,450.25" "$2,450.25" $510.69 "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" $510.66 "$2,450.25" "$2,450.25" "$1,449.32" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$1,837.88" "$2,450.25" "$2,450.25" "$2,450.25" "$1,225.13" "$1,225.13" "$1,940.60" "$2,450.25" "$1,960.20" "$1,102.61" $486.31 N/A "$1,421.29" "$2,450.25" "$1,470.15" "$2,450.25" "$2,450.25" "$2,450.25" N/A N/A 478.30S SUP HCPCS C1713 478.30S - NAIL INTRAMEDULLARY 8MM 30CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,450.50" "$1,813.00" $486.31 "$2,450.25" "$1,102.61" "$1,102.61" "$1,102.61" "$1,102.61" "$2,450.25" "$2,450.25" "$2,450.25" $510.69 "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" $510.66 "$2,450.25" "$2,450.25" "$1,449.32" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$1,837.88" "$2,450.25" "$2,450.25" "$2,450.25" "$1,225.13" "$1,225.13" "$1,940.60" "$2,450.25" "$1,960.20" "$1,102.61" $486.31 N/A "$1,421.29" "$2,450.25" "$1,470.15" "$2,450.25" $510.63 "$2,450.25" N/A N/A 478.31S SUP HCPCS C1713 478.31S - NAIL INTRAMEDULLARY 8MM 31.5CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,815.00" "$2,083.00" $558.65 "$2,814.73" "$1,266.63" "$1,266.63" "$1,266.63" "$1,266.63" "$2,814.73" "$2,814.73" "$2,814.73" $586.66 "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" $586.62 "$2,814.73" "$2,814.73" "$1,387.66" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" "$2,111.25" "$2,814.73" "$2,814.73" "$2,814.73" "$1,407.37" "$1,407.37" "$2,229.27" "$2,814.73" "$2,251.78" "$1,266.63" $558.65 N/A "$1,632.70" "$2,814.73" "$1,688.84" "$2,814.73" "$2,814.73" "$2,814.73" N/A N/A 478.33S SUP HCPCS C1713 478.33S - NAIL INTRAMEDULLARY 8MM 33CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,815.00" "$2,083.00" $558.65 "$2,814.73" "$1,266.63" "$1,266.63" "$1,266.63" "$1,266.63" "$2,814.73" "$2,814.73" "$2,814.73" $586.66 "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" $586.62 "$2,814.73" "$2,814.73" "$1,387.66" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" "$2,111.25" "$2,814.73" "$2,814.73" "$2,814.73" "$1,407.37" "$1,407.37" "$2,229.27" "$2,814.73" "$2,251.78" "$1,266.63" $558.65 N/A "$1,632.70" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" N/A N/A 478.34S SUP HCPCS C1713 478.34S - NAIL INTRAMEDULLARY 8MM 34.5CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,815.00" "$2,083.00" $558.65 "$2,814.73" "$1,266.63" "$1,266.63" "$1,266.63" "$1,266.63" "$2,814.73" "$2,814.73" "$2,814.73" $586.66 "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" $586.62 "$2,814.73" "$2,814.73" "$1,387.66" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" "$2,111.25" "$2,814.73" "$2,814.73" "$2,814.73" "$1,407.37" "$1,407.37" "$2,229.27" "$2,814.73" "$2,251.78" "$1,266.63" $558.65 N/A "$1,632.70" "$2,814.73" "$1,688.84" "$2,814.73" "$2,814.73" "$2,814.73" N/A N/A 478.36S SUP HCPCS C1713 478.36S - NAIL INTRAMEDULLARY 8MM 36CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,815.00" "$2,083.00" $558.65 "$2,814.73" "$1,266.63" "$1,266.63" "$1,266.63" "$1,266.63" "$2,814.73" "$2,814.73" "$2,814.73" $586.66 "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" $586.62 "$2,814.73" "$2,814.73" "$1,387.66" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" "$2,111.25" "$2,814.73" "$2,814.73" "$2,814.73" "$1,407.37" "$1,407.37" "$2,229.27" "$2,814.73" "$2,251.78" "$1,266.63" $558.65 N/A "$1,632.70" "$2,814.73" "$1,688.84" "$2,814.73" $586.59 "$2,814.73" N/A N/A 478.38S SUP HCPCS C1713 478.38S - NAIL INTRAMEDULLARY 8MM 38CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,450.50" "$1,813.00" $486.31 "$2,450.25" "$1,102.61" "$1,102.61" "$1,102.61" "$1,102.61" "$2,450.25" "$2,450.25" "$2,450.25" $510.69 "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" $510.66 "$2,450.25" "$2,450.25" "$1,449.32" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$1,837.88" "$2,450.25" "$2,450.25" "$2,450.25" "$1,225.13" "$1,225.13" "$1,940.60" "$2,450.25" "$1,960.20" "$1,102.61" $486.31 N/A "$1,421.29" "$2,450.25" "$1,470.15" "$2,450.25" $510.63 "$2,450.25" N/A N/A 478.40S SUP HCPCS C1713 478.40S - NAIL INTRAMEDULLARY 8MM 40CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,815.00" "$2,083.00" $558.65 "$2,814.73" "$1,266.63" "$1,266.63" "$1,266.63" "$1,266.63" "$2,814.73" "$2,814.73" "$2,814.73" $586.66 "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" $586.62 "$2,814.73" "$2,814.73" "$1,387.66" "$2,814.73" "$2,814.73" "$2,814.73" "$2,814.73" "$2,111.25" "$2,814.73" "$2,814.73" "$2,814.73" "$1,407.37" "$1,407.37" "$2,229.27" "$2,814.73" "$2,251.78" "$1,266.63" $558.65 N/A "$1,632.70" "$2,814.73" "$1,688.84" "$2,814.73" $586.59 "$2,814.73" N/A N/A 478.42S SUP HCPCS C1713 478.42S - NAIL INTRAMEDULLARY 8MM 42CM SOLID BLUE TITANIUM TIBIA BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$2,517.63" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" $524.67 "$2,517.63" N/A N/A 479.25S SUP HCPCS C1713 479.25S - NAIL INTRAMEDULLARY 9MM 25.5CM SOLID BLUE TITANIUM TIBIA BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$2,517.63" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" N/A N/A 479.27S SUP HCPCS C1713 479.27S - NAIL INTRAMEDULLARY 9MM 27CM SOLID BLUE TITANIUM TIBIA BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$2,517.63" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" $524.67 "$2,517.63" N/A N/A 479.28S SUP HCPCS C1713 479.28S - NAIL INTRAMEDULLARY 9MM 28.5CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$2,517.63" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" $524.67 "$2,517.63" N/A N/A 479.30S SUP HCPCS C1713 479.30S - NAIL INTRAMEDULLARY 9MM 30CM SOLID BLUE TITANIUM TIBIA BOTH IP/OP "$2,450.50" "$1,813.00" $486.31 "$2,450.25" "$1,102.61" "$1,102.61" "$1,102.61" "$1,102.61" "$2,450.25" "$2,450.25" "$2,450.25" $510.69 "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" $510.66 "$2,450.25" "$2,450.25" "$1,449.32" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$1,837.88" "$2,450.25" "$2,450.25" "$2,450.25" "$1,225.13" "$1,225.13" "$1,940.60" "$2,450.25" "$1,960.20" "$1,102.61" $486.31 N/A "$1,421.29" "$2,450.25" "$1,470.15" "$2,450.25" $510.63 "$2,450.25" N/A N/A 479.31S SUP HCPCS C1713 479.31S - NAIL INTRAMEDULLARY 9MM 315MM SOLID BLUE TITANIUM TIBIAL BOTH IP/OP "$2,450.50" "$1,813.00" $486.31 "$2,450.25" "$1,102.61" "$1,102.61" "$1,102.61" "$1,102.61" "$2,450.25" "$2,450.25" "$2,450.25" $510.69 "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" $510.66 "$2,450.25" "$2,450.25" "$1,449.32" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$1,837.88" "$2,450.25" "$2,450.25" "$2,450.25" "$1,225.13" "$1,225.13" "$1,940.60" "$2,450.25" "$1,960.20" "$1,102.61" $486.31 N/A "$1,421.29" "$2,450.25" "$1,470.15" "$2,450.25" $510.63 "$2,450.25" N/A N/A 479.33S SUP HCPCS C1713 479.33S - NAIL INTRAMEDULLARY 9MM 330MM SOLID BLUE TITANIUM TIBIAL BOTH IP/OP "$2,450.50" "$1,813.00" $486.31 "$2,450.25" "$1,102.61" "$1,102.61" "$1,102.61" "$1,102.61" "$2,450.25" "$2,450.25" "$2,450.25" $510.69 "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" $510.66 "$2,450.25" "$2,450.25" "$1,449.32" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$1,837.88" "$2,450.25" "$2,450.25" "$2,450.25" "$1,225.13" "$1,225.13" "$1,940.60" "$2,450.25" "$1,960.20" "$1,102.61" $486.31 N/A "$1,421.29" "$2,450.25" "$1,470.15" "$2,450.25" $510.63 "$2,450.25" N/A N/A 479.34S SUP HCPCS C1713 479.34S - NAIL INTRAMEDULLARY 9MM 34.5CM SOLID BLUE TITANIUM TIBIA BOTH IP/OP "$2,450.50" "$1,813.00" $486.31 "$2,450.25" "$1,102.61" "$1,102.61" "$1,102.61" "$1,102.61" "$2,450.25" "$2,450.25" "$2,450.25" $510.69 "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" $510.66 "$2,450.25" "$2,450.25" "$1,449.32" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$1,837.88" "$2,450.25" "$2,450.25" "$2,450.25" "$1,225.13" "$1,225.13" "$1,940.60" "$2,450.25" "$1,960.20" "$1,102.61" $486.31 N/A "$1,421.29" "$2,450.25" "$1,470.15" "$2,450.25" $510.63 "$2,450.25" N/A N/A 479.36S SUP HCPCS C1713 479.36S - NAIL INTRAMEDULLARY 9MM 36CM SOLID BLUE TITANIUM TIBIA BOTH IP/OP "$2,450.50" "$1,813.00" $486.31 "$2,450.25" "$1,102.61" "$1,102.61" "$1,102.61" "$1,102.61" "$2,450.25" "$2,450.25" "$2,450.25" $510.69 "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" $510.66 "$2,450.25" "$2,450.25" "$1,449.32" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$1,837.88" "$2,450.25" "$2,450.25" "$2,450.25" "$1,225.13" "$1,225.13" "$1,940.60" "$2,450.25" "$1,960.20" "$1,102.61" $486.31 N/A "$1,421.29" "$2,450.25" "$1,470.15" "$2,450.25" $510.63 "$2,450.25" N/A N/A 479.38S SUP HCPCS C1713 479.38S - NAIL INTRAMEDULLARY 9MM 38CM SOLID TITANIUM TIBIA STERILE BOTH IP/OP "$2,450.50" "$1,813.00" $486.31 "$2,450.25" "$1,102.61" "$1,102.61" "$1,102.61" "$1,102.61" "$2,450.25" "$2,450.25" "$2,450.25" $510.69 "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" $510.66 "$2,450.25" "$2,450.25" "$1,449.32" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$1,837.88" "$2,450.25" "$2,450.25" "$2,450.25" "$1,225.13" "$1,225.13" "$1,940.60" "$2,450.25" "$1,960.20" "$1,102.61" $486.31 N/A "$1,421.29" "$2,450.25" "$1,470.15" "$2,450.25" $510.63 "$2,450.25" N/A N/A 479.40S SUP HCPCS C1713 479.40S - NAIL INTRAMEDULLARY 9MM 40CM SOLID BLUE TITANIUM TIBIA BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$1,007.05" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" $524.67 "$2,517.63" N/A N/A 479.42S SUP HCPCS C1713 479.42S - NAIL INTRAMEDULLARY 9MM 42CM SOLID BLUE TITANIUM TIBIA BOTH IP/OP "$2,518.00" "$1,863.00" $499.69 "$2,517.63" "$1,132.93" "$1,132.93" "$1,132.93" "$1,132.93" "$2,517.63" "$2,517.63" "$2,517.63" $524.74 "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" $524.70 "$2,517.63" "$1,007.05" "$1,241.19" "$2,517.63" "$2,517.63" "$2,517.63" "$2,517.63" "$1,888.50" "$2,517.63" "$2,517.63" "$2,517.63" "$1,258.82" "$1,258.82" "$1,993.96" "$2,517.63" "$2,014.10" "$1,132.93" $499.69 N/A "$1,460.44" "$2,517.63" "$1,510.58" "$2,517.63" $524.67 "$2,517.63" N/A N/A 4806-100-20 SUP Custom 27203010 4806-100-20 - BIT DRL 2MM 100MM QCK CNCT BOTH IP/OP $137.00 $101.00 $24.36 $136.85 $136.85 $136.85 $136.85 $136.85 $136.85 $136.85 $24.36 $136.85 $136.85 $101.57 $101.57 $105.48 $71.30 $28.52 $136.85 $54.74 $136.85 $136.85 $136.85 $136.85 $136.85 $102.75 $136.85 $136.85 $136.85 $68.43 $68.43 $108.39 $136.85 $109.48 $88.95 $136.85 N/A $79.46 $136.85 $82.11 $136.85 $136.85 $136.85 N/A N/A 4806-100-27 SUP Custom 27203010 4806-100-27 - BIT DRL 2.7MM BOTH IP/OP $137.00 $101.00 $24.36 $136.85 $136.85 $136.85 $136.85 $136.85 $136.85 $136.85 $24.36 $136.85 $136.85 $101.57 $101.57 $105.48 $71.30 $28.52 $136.85 $54.74 $136.85 $136.85 $136.85 $136.85 $136.85 $102.75 $136.85 $136.85 $136.85 $68.43 $68.43 $108.39 $136.85 $109.48 $88.95 $136.85 N/A $79.46 $136.85 $82.11 $136.85 $136.85 $136.85 N/A N/A 4806-110-25 SUP Custom 27203010 4806-110-25 - BIT DRL 2.5MM 110MM QCK CNCT BOTH IP/OP $137.00 $101.00 $24.36 $136.85 $136.85 $136.85 $136.85 $136.85 $136.85 $136.85 $24.36 $136.85 $136.85 $101.57 $101.57 $105.48 $71.30 $28.52 $136.85 $54.74 $136.85 $136.85 $136.85 $136.85 $136.85 $102.75 $136.85 $136.85 $136.85 $68.43 $68.43 $108.39 $136.85 $109.48 $88.95 $136.85 N/A $79.46 $136.85 $82.11 $136.85 $136.85 $136.85 N/A N/A 4806-110-35 SUP Custom 27203010 4806-110-35 - BIT DRL 3.5MM BOTH IP/OP $137.00 $101.00 $24.36 $136.85 $136.85 $136.85 $136.85 $136.85 $136.85 $136.85 $24.36 $136.85 $136.85 $101.57 $101.57 $105.48 $71.30 $28.52 $136.85 $54.74 $136.85 $136.85 $136.85 $136.85 $136.85 $102.75 $136.85 $136.85 $136.85 $68.43 $68.43 $108.39 $136.85 $109.48 $88.95 $136.85 N/A $79.46 $136.85 $82.11 $136.85 $136.85 $136.85 N/A N/A 4807-180-25 SUP Custom 27203010 4807-180-25 - BIT DRILL 180MM 2.5MM SS QC NONSTRL BOTH IP/OP $137.00 $101.00 $24.36 $136.85 $136.85 $136.85 $136.85 $136.85 $136.85 $136.85 $24.36 $136.85 $136.85 $101.57 $101.57 $105.48 $71.30 $28.52 $136.85 $54.74 $136.85 $136.85 $136.85 $136.85 $136.85 $102.75 $136.85 $136.85 $136.85 $68.43 $68.43 $108.39 $136.85 $109.48 $88.95 $136.85 N/A $79.46 $136.85 $82.11 $136.85 $136.85 $136.85 N/A N/A 4809-27 SUP Custom 27203010 "4809-27 - COUNTERSINK, Q-C, FOR 2.7MM SCREWS" BOTH IP/OP $212.00 $157.00 $37.66 $211.60 $211.60 $211.60 $211.60 $211.60 $211.60 $211.60 $37.66 $211.60 $211.60 $157.05 $157.05 $163.10 $110.24 $44.10 $211.60 $84.64 $211.60 $211.60 $211.60 $211.60 $211.60 $159.00 $211.60 $211.60 $211.60 $105.80 $105.80 $167.59 $211.60 $169.28 $137.54 $211.60 N/A $122.96 $211.60 $126.96 $211.60 $211.60 $211.60 N/A N/A 4811-100-27 SUP Custom 27203010 4811-100-27 - TAP 100MM QC SURG SS PERIART 2.7MM SCR NONSTRL BOTH IP/OP $163.50 $121.00 $29.07 $163.30 $163.30 $163.30 $163.30 $163.30 $163.30 $163.30 $29.07 $163.30 $163.30 $121.20 $121.20 $125.87 $85.08 $34.03 $163.30 $65.32 $163.30 $163.30 $163.30 $163.30 $163.30 $122.63 $163.30 $163.30 $163.30 $81.65 $81.65 $129.33 $163.30 $130.64 $106.15 $163.30 N/A $94.83 $163.30 $97.98 $163.30 $163.30 $163.30 N/A N/A 4811-110-35 SUP Custom 27203010 4811-110-35 - TAP 110MM QC SURG SS PERIART 3.5MM SCR NONSTRL BOTH IP/OP $163.50 $121.00 $29.07 $163.30 $163.30 $163.30 $163.30 $163.30 $163.30 $163.30 $29.07 $163.30 $163.30 $121.20 $121.20 $125.87 $85.08 $34.03 $163.30 $65.32 $163.30 $163.30 $163.30 $163.30 $163.30 $122.63 $163.30 $163.30 $163.30 $81.65 $81.65 $129.33 $163.30 $130.64 $106.15 $163.30 N/A $94.83 $163.30 $97.98 $163.30 $163.30 $163.30 N/A N/A 4811-110-40 SUP Custom 27203010 4811-110-40 - TAP 110MM QC SURG SS PERIART 4MM SCR NONSTRL BOTH IP/OP $163.50 $121.00 $29.07 $163.30 $163.30 $163.30 $163.30 $163.30 $163.30 $163.30 $29.07 $163.30 $163.30 $121.20 $121.20 $125.87 $85.08 $34.03 $163.30 $65.32 $163.30 $163.30 $163.30 $163.30 $163.30 $122.63 $163.30 $163.30 $163.30 $81.65 $81.65 $129.33 $163.30 $130.64 $106.15 $163.30 N/A $94.83 $163.30 $97.98 $163.30 $163.30 $163.30 N/A N/A 48210-025 SUP Custom 27203010 48210-025 - TAPE DRSG 72YDX.5IN TWL BLCH CTTN WHT BOTH IP/OP $156.50 $116.00 $27.77 $156.02 $156.02 $156.02 $156.02 $156.02 $156.02 $156.02 $27.77 $156.02 $156.02 $115.80 $115.80 $120.26 $81.29 $32.52 $156.02 $62.41 $156.02 $156.02 $156.02 $156.02 $156.02 $117.38 $156.02 $156.02 $156.02 $78.01 $78.01 $123.57 $156.02 $124.82 $101.41 $156.02 N/A $90.77 $156.02 $93.61 $156.02 $156.02 $156.02 N/A N/A 48230260R SUP Custom 27803010 48230260R - HOOK SPNL XIA 3 TI AL VNDM SCRL RT BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 4845-0101 SUP HCPCS C1776 4845-0101 - STEM FEM 1 8.5MM 100MM ABG II V40 TMZF HA HIP RT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0102 SUP HCPCS C1776 4845-0102 - STEM FEM 2 8.5MM 100MM ABG II V40 TMZF HA HIP RT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0103 SUP HCPCS C1776 4845-0103 - STEM FEM 3 9MM 110MM ABG II V40 TMZF HA HIP RT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0104 SUP HCPCS C1776 4845-0104 - STEM FEM 4 10MM 115MM ABG II V40 TMZF HA HIP RT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0105 SUP HCPCS C1776 4845-0105 - STEM FEM 5 11MM 120MM ABG II V40 TMZF HA HIP RT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0106 SUP HCPCS C1776 4845-0106 - STEM FEM 6 12MM 125MM ABG II V40 TMZF HA HIP RT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0107 SUP HCPCS C1776 4845-0107 - STEM FEM 7 13MM 135MM ABG II V40 TMZF HA HIP RT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0108 SUP HCPCS C1776 4845-0108 - STEM FEM 8 14MM 145MM ABG II V40 TMZF HA HIP RT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0201 SUP HCPCS C1776 4845-0201 - STEM FEM 1 8.5MM 100MM ABG II V40 TMZF HA HIP LT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0202 SUP HCPCS C1776 4845-0202 - STEM FEM 2 8.5MM 100MM ABG II V40 TMZF HA HIP LT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0203 SUP HCPCS C1776 4845-0203 - STEM FEM 3 9MM 110MM ABG II V40 TMZF HA HIP LT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0204 SUP HCPCS C1776 4845-0204 - STEM FEM 4 10MM 115MM ABG II V40 TMZF HA HIP LT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0205 SUP HCPCS C1776 4845-0205 - STEM FEM 5 11MM 120MM ABG II V40 TMZF HA HIP LT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0206 SUP HCPCS C1776 4845-0206 - STEM FEM 6 12MM 125MM ABG II V40 TMZF HA HIP LT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0207 SUP HCPCS C1776 4845-0207 - STEM FEM 7 13MM 135MM ABG II V40 TMZF HA HIP LT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-0208 SUP HCPCS C1776 4845-0208 - STEM FEM 8 14MM 145MM ABG II V40 TMZF HA HIP LT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 4845-7-101 SUP HCPCS C1776 4845-7-101 - STEM FEM 130D 1 37MM OFST 99MM STRL ANATO ANTEVERT HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-102 SUP HCPCS C1776 4845-7-102 - STEM FEM 130D 2 39MM OFST 99MM STRL ANATO ANTEVERT HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-103 SUP HCPCS C1776 4845-7-103 - STEM FEM 130D 3 42MM OFST 110MM STRL ANATO ANTEVERT HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-104 SUP HCPCS C1776 4845-7-104 - STEM FEM 130D 4 44MM OFST 115MM STRL ANATO ANTEVERT HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-105 SUP HCPCS C1776 4845-7-105 - STEM FEM 130D 5 44MM OFST 120MM STRL ANATO ANTEVERT HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-106 SUP HCPCS C1776 4845-7-106 - STEM FEM 130D 6 47MM OFST 120MM STRL ANATO ANTEVERT HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-107 SUP HCPCS C1776 4845-7-107 - STEM FEM 130D 7 50MM OFST 120MM STRL ANATO ANTEVERT HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-108 SUP HCPCS C1776 4845-7-108 - STEM FEM 130D 8 53MM OFST 120MM STRL ANATO ANTEVERT HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-111 SUP HCPCS C1776 4845-7-111 - STEM FEM 130D 1 37MM OFST 99MM STRL ANATO HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-112 SUP HCPCS C1776 4845-7-112 - STEM FEM 130D 2 39MM OFST 99MM STRL ANATO HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-114 SUP HCPCS C1776 4845-7-114 - STEM FEM 130D 4 44MM OFST 115MM STRL ANATO HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-115 SUP HCPCS C1776 4845-7-115 - STEM FEM 130D 5 44MM OFST 120MM STRL ANATO HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-116 SUP HCPCS C1776 4845-7-116 - STEM FEM 130D 6 47MM OFST 120MM STRL ANATO HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-117 SUP HCPCS C1776 4845-7-117 - STEM FEM 130D 7 50MM OFST 120MM STRL ANATO HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-118 SUP HCPCS C1776 4845-7-118 - STEM FEM 130D 8 53MM OFST 120MM STRL ANATO HIP RT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-201 SUP HCPCS C1776 4845-7-201 - STEM FEM 130D 1 37MM OFST 99MM STRL ANATO ANTEVERT HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-202 SUP HCPCS C1776 4845-7-202 - STEM FEM 130D 2 39MM OFST 99MM STRL ANATO ANTEVERT HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-203 SUP HCPCS C1776 4845-7-203 - STEM FEM 130D 3 42MM OFST 110MM STRL ANATO ANTEVERT HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-204 SUP HCPCS C1776 4845-7-204 - STEM FEM 130D 4 44MM OFST 115MM STRL ANATO ANTEVERT HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-205 SUP HCPCS C1776 4845-7-205 - STEM FEM 130D 5 44MM OFST 120MM STRL ANATO ANTEVERT HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-206 SUP HCPCS C1776 4845-7-206 - STEM FEM 130D 6 47MM OFST 120MM STRL ANATO ANTEVERT HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-207 SUP HCPCS C1776 4845-7-207 - STEM FEM 130D 7 50MM OFST 120MM STRL ANATO ANTEVERT HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-208 SUP HCPCS C1776 4845-7-208 - STEM FEM 130D 8 53MM OFST 120MM STRL ANATO ANTEVERT HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-211 SUP HCPCS C1776 4845-7-211 - STEM FEM 130D 1 37MM OFST 99MM STRL ANATO HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-212 SUP HCPCS C1776 4845-7-212 - STEM FEM 130D 2 39MM OFST 99MM STRL ANATO HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-213 SUP HCPCS C1776 4845-7-213 - STEM FEM 130D 3 42MM OFST 110MM STRL ANATO HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-214 SUP HCPCS C1776 4845-7-214 - STEM FEM 130D 4 44MM OFST 115MM STRL ANATO HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-215 SUP HCPCS C1776 4845-7-215 - STEM FEM 130D 5 44MM OFST 120MM STRL ANATO HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-216 SUP HCPCS C1776 4845-7-216 - STEM FEM 130D 6 47MM OFST 120MM STRL ANATO HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-217 SUP HCPCS C1776 4845-7-217 - STEM FEM 130D 7 50MM OFST 120MM STRL ANATO HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 4845-7-218 SUP HCPCS C1776 4845-7-218 - STEM FEM 130D 8 53MM OFST 120MM STRL ANATO HIP LT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 48485540XL SUP HCPCS C1713 48485540XL - SCREW BONE LONG ARM 5.5MM 40MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48485545XL SUP HCPCS C1713 48485545XL - SCREW BONE LONG ARM 5.5MM 45MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48486735XL SUP HCPCS C1713 48486735XL - SCREW BONE LONG ARM 6.7MM 35MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48486740XL SUP HCPCS C1713 48486740XL - SCREW BONE LONG ARM 6.7MM 40MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48486745XL SUP HCPCS C1713 48486745XL - SCREW BONE LONG ARM 6.7MM 45MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48486750XL SUP HCPCS C1713 48486750XL - SCREW BONE LONG ARM 6.7MM 50MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48486755XL SUP HCPCS C1713 48486755XL - SCREW BONE LONG ARM 6.7MM 55MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48486760XL SUP HCPCS C1713 48486760XL - SCREW BONE LONG ARM 6.7MM 60MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48487740XL SUP HCPCS C1713 48487740XL - SCREW BONE LONG ARM 7.7MM 40MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48487745XL SUP HCPCS C1713 48487745XL - SCREW BONE LONG ARM 7.7MM 45MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48487750XL SUP HCPCS C1713 48487750XL - SCREW BONE LONG ARM 7.7MM 50MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48487755XL SUP HCPCS C1713 48487755XL - SCREW BONE LONG ARM 7.7MM 55MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48487760XL SUP HCPCS C1713 48487760XL - SCREW BONE LONG ARM 7.7MM 60MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48488050XL SUP HCPCS C1713 48488050XL - SCREW BONE LONG ARM 8MM 50MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48488055XL SUP HCPCS C1713 48488055XL - SCREW BONE LONG ARM 8MM 55MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 48488060XL SUP HCPCS C1713 48488060XL - SCREW BONE LONG ARM 8MM 60MM DIAPASON OSS TITANIUM SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 485.025S SUP HCPCS C1713 485.025S - NAIL INTRAMEDULLARY 10MM 25.5CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.027S SUP HCPCS C1713 485.027S - NAIL INTRAMEDULLARY 10MM 27CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.028S SUP HCPCS C1713 485.028S - NAIL INTRAMEDULLARY 10MM 28.5CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" "$2,484.63" "$2,484.63" N/A N/A 485.030S SUP HCPCS C1713 485.030S - NAIL INTRAMEDULLARY 10MM 30CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" N/A N/A 485.031S SUP HCPCS C1713 485.031S - NAIL INTRAMEDULLARY 10MM 31.5CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.033S SUP HCPCS C1713 485.033S - NAIL INTRAMEDULLARY 10MM 33CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.034S SUP HCPCS C1713 485.034S - NAIL INTRAMEDULLARY 10MM 34.5CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.036S SUP HCPCS C1713 485.036S - NAIL INTRAMEDULLARY 10MM 36CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,853.50" "$2,112.00" $566.27 "$2,853.10" "$1,283.90" "$1,283.90" "$1,283.90" "$1,283.90" "$2,853.10" "$2,853.10" "$2,853.10" $594.66 "$2,853.10" "$2,853.10" "$2,853.10" "$2,853.10" "$2,853.10" $594.62 "$2,853.10" "$2,853.10" "$1,406.58" "$2,853.10" "$2,853.10" "$2,853.10" "$2,853.10" "$2,140.13" "$2,853.10" "$2,853.10" "$2,853.10" "$1,426.55" "$1,426.55" "$2,259.66" "$2,853.10" "$2,282.48" "$1,283.90" $566.27 N/A "$1,655.03" "$2,853.10" "$1,711.86" "$2,853.10" $594.59 "$2,853.10" N/A N/A 485.038S SUP HCPCS C1713 485.038S - NAIL INTRAMEDULLARY 10MM 380MM CANN TITANIUM TIBIA STERILE BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.040S SUP HCPCS C1713 485.040S - NAIL INTRAMEDULLARY 10MM 40CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.042S SUP HCPCS C1713 485.042S - NAIL INTRAMEDULLARY 10MM 42CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,553.50" "$1,890.00" $506.78 "$2,553.38" "$1,149.02" "$1,149.02" "$1,149.02" "$1,149.02" "$2,553.38" "$2,553.38" "$2,553.38" $532.19 "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" $532.15 "$2,553.38" "$2,553.38" "$1,258.82" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$1,915.13" "$2,553.38" "$2,553.38" "$2,553.38" "$1,276.69" "$1,276.69" "$2,022.28" "$2,553.38" "$2,042.70" "$1,149.02" $506.78 N/A "$1,481.03" "$2,553.38" "$1,532.03" "$2,553.38" $532.12 "$2,553.38" N/A N/A 485.125S SUP HCPCS C1713 485.125S - NAIL INTRAMEDULLARY 11MM 25.5CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$2,484.63" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.127S SUP HCPCS C1713 485.127S - NAIL INTRAMEDULLARY 11MM 27CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.128S SUP HCPCS C1713 485.128S - NAIL INTRAMEDULLARY 11MM 28.5CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.130S SUP HCPCS C1713 485.130S - NAIL INTRAMEDULLARY 11MM 30CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.131S SUP HCPCS C1713 485.131S - NAIL INTRAMEDULLARY 11MM 315MM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$2,484.63" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.133S SUP HCPCS C1713 485.133S - NAIL INTRAMEDULLARY 11MM 330MM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.134S SUP HCPCS C1713 485.134S - NAIL INTRAMEDULLARY 11MM 34.5CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.136S SUP HCPCS C1713 485.136S - NAIL INTRAMEDULLARY 11MM 360MM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.138S SUP HCPCS C1713 485.138S - NAIL INTRAMEDULLARY 11MM 38CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$2,484.63" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.140S SUP HCPCS C1713 485.140S - NAIL INTRAMEDULLARY 11MM 400MM CANN GREEN TITANIUM TIBIAL BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" $993.85 "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.142S SUP HCPCS C1713 485.142S - NAIL INTRAMEDULLARY 11MM 42CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,553.50" "$1,890.00" $506.78 "$2,553.38" "$1,149.02" "$1,149.02" "$1,149.02" "$1,149.02" "$2,553.38" "$2,553.38" "$2,553.38" $532.19 "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" $532.15 "$2,553.38" "$2,553.38" "$1,258.82" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$1,915.13" "$2,553.38" "$2,553.38" "$2,553.38" "$1,276.69" "$1,276.69" "$2,022.28" "$2,553.38" "$2,042.70" "$1,149.02" $506.78 N/A "$1,481.03" "$2,553.38" "$1,532.03" "$2,553.38" $532.12 "$2,553.38" N/A N/A 485.225S SUP HCPCS C1713 485.225S - NAIL INTRAMEDULLARY 12MM 25.5CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,553.50" "$1,890.00" $506.78 "$2,553.38" "$1,149.02" "$1,149.02" "$1,149.02" "$1,149.02" "$2,553.38" "$2,553.38" "$2,553.38" $532.19 "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" $532.15 "$2,553.38" "$2,553.38" "$1,258.82" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$1,915.13" "$2,553.38" "$2,553.38" "$2,553.38" "$1,276.69" "$1,276.69" "$2,022.28" "$2,553.38" "$2,042.70" "$1,149.02" $506.78 N/A "$1,481.03" "$2,553.38" "$1,532.03" "$2,553.38" $532.12 "$2,553.38" N/A N/A 485.227S SUP HCPCS C1713 485.227S - NAIL INTRAMEDULLARY 12MM 27CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,553.50" "$1,890.00" $506.78 "$2,553.38" "$1,149.02" "$1,149.02" "$1,149.02" "$1,149.02" "$2,553.38" "$2,553.38" "$2,553.38" $532.19 "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" $532.15 "$2,553.38" "$2,553.38" "$1,258.82" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$1,915.13" "$2,553.38" "$2,553.38" "$2,553.38" "$1,276.69" "$1,276.69" "$2,022.28" "$2,553.38" "$2,042.70" "$1,149.02" $506.78 N/A "$1,481.03" "$2,553.38" "$1,532.03" "$2,553.38" $532.12 "$2,553.38" N/A N/A 485.228S SUP HCPCS C1713 485.228S - NAIL INTRAMEDULLARY 12MM 285MM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,553.50" "$1,890.00" $506.78 "$2,553.38" "$1,149.02" "$1,149.02" "$1,149.02" "$1,149.02" "$2,553.38" "$2,553.38" "$2,553.38" $532.19 "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" $532.15 "$2,553.38" "$2,553.38" "$1,258.82" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$1,915.13" "$2,553.38" "$2,553.38" "$2,553.38" "$1,276.69" "$1,276.69" "$2,022.28" "$2,553.38" "$2,042.70" "$1,149.02" $506.78 N/A "$1,481.03" "$2,553.38" "$1,532.03" "$2,553.38" $532.12 "$2,553.38" N/A N/A 485.230S SUP HCPCS C1713 485.230S - NAIL INTRAMEDULLARY 12MM 30CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" $993.85 "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.231S SUP HCPCS C1713 485.231S - NAIL INTRAMEDULLARY 12MM 31.5CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" $993.85 "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.233S SUP HCPCS C1713 485.233S - NAIL INTRAMEDULLARY 12MM 33CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.234S SUP HCPCS C1713 485.234S - NAIL INTRAMEDULLARY 12MM 34.5CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$2,484.63" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.236S SUP HCPCS C1713 485.236S - NAIL INTRAMEDULLARY 12MM 36CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.238S SUP HCPCS C1713 485.238S - NAIL INTRAMEDULLARY 12MM 38CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" $993.85 "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.240S SUP HCPCS C1713 485.240S - NAIL INTRAMEDULLARY 12MM 40CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" $993.85 "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.242S SUP HCPCS C1713 485.242S - NAIL INTRAMEDULLARY 12MM 42CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,553.50" "$1,890.00" $506.78 "$2,553.38" "$1,149.02" "$1,149.02" "$1,149.02" "$1,149.02" "$2,553.38" "$2,553.38" "$2,553.38" $532.19 "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" $532.15 "$2,553.38" "$2,553.38" "$1,258.82" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$1,915.13" "$2,553.38" "$2,553.38" "$2,553.38" "$1,276.69" "$1,276.69" "$2,022.28" "$2,553.38" "$2,042.70" "$1,149.02" $506.78 N/A "$1,481.03" "$2,553.38" "$2,553.38" "$2,553.38" $532.12 "$2,553.38" N/A N/A 485.325S SUP HCPCS C1713 485.325S - NAIL INTRAMEDULLARY 13MM 25.5CM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,553.50" "$1,890.00" $506.78 "$2,553.38" "$1,149.02" "$1,149.02" "$1,149.02" "$1,149.02" "$2,553.38" "$2,553.38" "$2,553.38" $532.19 "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" $532.15 "$2,553.38" "$2,553.38" "$1,258.82" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$1,915.13" "$2,553.38" "$2,553.38" "$2,553.38" "$1,276.69" "$1,276.69" "$2,022.28" "$2,553.38" "$2,042.70" "$1,149.02" $506.78 N/A "$1,481.03" "$2,553.38" "$2,553.38" "$2,553.38" $532.12 "$2,553.38" N/A N/A 485.327S SUP HCPCS C1713 485.327S - NAIL INTRAMEDULLARY 13MM 270MM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,853.50" "$2,112.00" $566.27 "$2,853.10" "$1,283.90" "$1,283.90" "$1,283.90" "$1,283.90" "$2,853.10" "$2,853.10" "$2,853.10" $594.66 "$2,853.10" "$2,853.10" "$2,853.10" "$2,853.10" "$2,853.10" $594.62 "$2,853.10" "$2,853.10" "$1,406.58" "$2,853.10" "$2,853.10" "$2,853.10" "$2,853.10" "$2,140.13" "$2,853.10" "$2,853.10" "$2,853.10" "$1,426.55" "$1,426.55" "$2,259.66" "$2,853.10" "$2,282.48" "$1,283.90" $566.27 N/A "$1,655.03" "$2,853.10" "$1,711.86" "$2,853.10" $594.59 "$2,853.10" N/A N/A 485.328S SUP HCPCS C1713 485.328S - NAIL INTRAMEDULLARY 13MM 285MM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,553.50" "$1,890.00" $506.78 "$2,553.38" "$1,149.02" "$1,149.02" "$1,149.02" "$1,149.02" "$2,553.38" "$2,553.38" "$2,553.38" $532.19 "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" $532.15 "$2,553.38" "$2,553.38" "$1,258.82" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$1,915.13" "$2,553.38" "$2,553.38" "$2,553.38" "$1,276.69" "$1,276.69" "$2,022.28" "$2,553.38" "$2,042.70" "$1,149.02" $506.78 N/A "$1,481.03" "$2,553.38" "$1,532.03" "$2,553.38" $532.12 "$2,553.38" N/A N/A 485.330S SUP HCPCS C1713 485.330S - NAIL INTRAMEDULLARY 13MM 300MM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.331S SUP HCPCS C1713 485.331S - NAIL INTRAMEDULLARY 13MM 315MM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.333S SUP HCPCS C1713 485.333S - NAIL INTRAMEDULLARY 13MM 330MM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.334S SUP HCPCS C1713 485.334S - NAIL INTRAMEDULLARY 13MM 345MM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$2,484.63" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.336S SUP HCPCS C1713 485.336S - NAIL INTRAMEDULLARY 13MM 360MM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,853.50" "$2,112.00" $566.27 "$2,853.10" "$1,283.90" "$1,283.90" "$1,283.90" "$1,283.90" "$2,853.10" "$2,853.10" "$2,853.10" $594.66 "$2,853.10" "$2,853.10" "$2,853.10" "$2,853.10" "$2,853.10" $594.62 "$2,853.10" "$2,853.10" "$1,406.58" "$2,853.10" "$2,853.10" "$2,853.10" "$2,853.10" "$2,140.13" "$2,853.10" "$2,853.10" "$2,853.10" "$1,426.55" "$1,426.55" "$2,259.66" "$2,853.10" "$2,282.48" "$1,283.90" $566.27 N/A "$1,655.03" "$2,853.10" "$1,711.86" "$2,853.10" $594.59 "$2,853.10" N/A N/A 485.338S SUP HCPCS C1713 485.338S - NAIL INTRAMEDULLARY 13MM 380MM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,485.00" "$1,839.00" $493.14 "$2,484.63" "$1,118.08" "$1,118.08" "$1,118.08" "$1,118.08" "$2,484.63" "$2,484.63" "$2,484.63" $517.86 "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" $517.82 "$2,484.63" "$2,484.63" "$1,469.66" "$2,484.63" "$2,484.63" "$2,484.63" "$2,484.63" "$1,863.75" "$2,484.63" "$2,484.63" "$2,484.63" "$1,242.32" "$1,242.32" "$1,967.83" "$2,484.63" "$1,987.70" "$1,118.08" $493.14 N/A "$1,441.30" "$2,484.63" "$1,490.78" "$2,484.63" $517.80 "$2,484.63" N/A N/A 485.340S SUP HCPCS C1713 485.340S - NAIL INTRAMEDULLARY 13MM 400MM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,853.50" "$2,112.00" $566.27 "$2,853.10" "$1,283.90" "$1,283.90" "$1,283.90" "$1,283.90" "$2,853.10" "$2,853.10" "$2,853.10" $594.66 "$2,853.10" "$2,853.10" "$2,853.10" "$2,853.10" "$2,853.10" $594.62 "$2,853.10" "$2,853.10" "$1,406.58" "$2,853.10" "$2,853.10" "$2,853.10" "$2,853.10" "$2,140.13" "$2,853.10" "$2,853.10" "$2,853.10" "$1,426.55" "$1,426.55" "$2,259.66" "$2,853.10" "$2,282.48" "$1,283.90" $566.27 N/A "$1,655.03" "$2,853.10" "$1,711.86" "$2,853.10" $594.59 "$2,853.10" N/A N/A 485.342S SUP HCPCS C1713 485.342S - NAIL INTRAMEDULLARY 13MM 420MM CANN GREEN TITANIUM TIBIA BOTH IP/OP "$2,553.50" "$1,890.00" $506.78 "$2,553.38" "$1,149.02" "$1,149.02" "$1,149.02" "$1,149.02" "$2,553.38" "$2,553.38" "$2,553.38" $532.19 "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" $532.15 "$2,553.38" "$2,553.38" "$1,258.82" "$2,553.38" "$2,553.38" "$2,553.38" "$2,553.38" "$1,915.13" "$2,553.38" "$2,553.38" "$2,553.38" "$1,276.69" "$1,276.69" "$2,022.28" "$2,553.38" "$2,042.70" "$1,149.02" $506.78 N/A "$1,481.03" "$2,553.38" "$1,532.03" "$2,553.38" $532.12 "$2,553.38" N/A N/A 48551041L SUP HCPCS C1713 48551041L - PLATE BONE 130D PRECONTOUR OASYS TITANIUM SPN LEFT THORACIC BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 48551041R SUP HCPCS C1713 48551041R - PLATE BONE 130D PRECONTOUR OASYS TITANIUM SPN RIGHT THORACIC BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 48551043L SUP HCPCS C1713 48551043L - PLATE BONE 100D PRECONTOUR OASYS TITANIUM SPN LEFT THORACIC BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 48551043R SUP HCPCS C1713 48551043R - PLATE BONE 100D PRECONTOUR OASYS TITANIUM SPN RIGHT THORACIC BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 4900-40-51 SUP HCPCS C1713 4900-40-51 - WASHER 7MM SM ORTH 2.7-4MM SCR NONSTRL BOTH IP/OP $71.50 $53.00 $14.15 $71.30 $32.09 $32.09 $32.09 $32.09 $71.30 $71.30 $71.30 $14.86 $71.30 $71.30 $71.30 $71.30 $71.30 $14.86 $71.30 $71.30 $42.17 $71.30 $71.30 $71.30 $71.30 $53.63 $71.30 $71.30 $71.30 $35.65 $35.65 $56.47 $71.30 $57.04 $32.09 $14.15 N/A $41.47 $71.30 $42.78 $71.30 $14.86 $71.30 N/A N/A 4900T26 SUP Custom 27803010 4900T26 - RING ANLPLS 26MM STRL ED MC3 SEAM 2 WRP TI PLSTR SIL RBR BOTH IP/OP "$7,995.00" "$5,916.00" "$1,423.11" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$1,423.11" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$1,666.25" "$7,995.00" "$3,198.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$5,996.25" "$7,995.00" "$7,995.00" "$7,995.00" "$3,997.50" "$3,997.50" "$6,332.04" "$7,995.00" "$6,396.00" "$3,597.75" "$7,995.00" N/A "$4,637.10" "$7,995.00" "$4,797.00" "$7,995.00" "$7,995.00" "$7,995.00" N/A N/A 4900T28 SUP Custom 27803010 4900T28 - RING ANLPLS 28MM STRL ED MC3 SEAM 2 WRP TI PLSTR SIL RBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,198.00" "$8,750.00" "$8,750.00" "$7,995.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A 4900T30 SUP Custom 27803010 4900T30 - RING ANLPLS 30MM STRL ED MC3 1 SEAM 2 WRP ANTM TI SIL RBR BOTH IP/OP "$7,995.00" "$5,916.00" "$1,423.11" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$1,423.11" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$1,666.25" "$7,995.00" "$3,198.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$5,996.25" "$7,995.00" "$7,995.00" "$7,995.00" "$3,997.50" "$3,997.50" "$6,332.04" "$7,995.00" "$6,396.00" "$3,597.75" "$7,995.00" N/A "$4,637.10" "$7,995.00" "$4,797.00" "$7,995.00" "$7,995.00" "$7,995.00" N/A N/A 4900T32 SUP Custom 27803010 4900T32 - RING ANLPLS 3D ANG DNWRD 32MM ED MC3 RGD TRCSD BOTH IP/OP "$7,995.00" "$5,916.00" "$1,423.11" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$1,423.11" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$1,666.25" "$7,995.00" "$3,198.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$5,996.25" "$7,995.00" "$7,995.00" "$7,995.00" "$3,997.50" "$3,997.50" "$6,332.04" "$7,995.00" "$6,396.00" "$3,597.75" "$7,995.00" N/A "$4,637.10" "$7,995.00" "$4,797.00" "$7,995.00" "$7,995.00" "$7,995.00" N/A N/A 4900T34 SUP Custom 27803010 4900T34 - RING ANNULOPLASTY 34MM 1 SEAM 2 WRAP ANATOMIC EDWARDS MC3 BOTH IP/OP "$7,995.00" "$5,916.00" "$1,423.11" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$1,423.11" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$1,666.25" "$7,995.00" "$3,198.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$5,996.25" "$7,995.00" "$7,995.00" "$7,995.00" "$3,997.50" "$3,997.50" "$6,332.04" "$7,995.00" "$6,396.00" "$3,597.75" "$7,995.00" N/A "$4,637.10" "$7,995.00" "$4,797.00" "$7,995.00" "$7,995.00" "$7,995.00" N/A N/A 4900T36 SUP HCPCS C1713 4900T36 - RING ANLPLS 36MM STRL ED MC3 1 SEAM 2 WRP ANTM TI SIL RBR BOTH IP/OP "$8,750.00" "$6,475.00" "$1,736.66" "$8,750.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.72" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,198.00" "$4,313.75" "$8,750.00" "$7,995.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$1,736.66" N/A "$5,075.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.50" "$8,750.00" N/A N/A 491B SUP Custom 27203010 491B - PROBE THRMTR SM STAT STRL STRPRB TEMP ESPH RCTM DISP BOTH IP/OP $13.00 $10.00 $2.27 $12.74 $12.74 $12.74 $12.74 $12.74 $12.74 $12.74 $2.27 $12.74 $12.74 $9.46 $9.46 $9.82 $6.64 $2.66 $12.74 $5.10 $12.74 $12.74 $12.74 $12.74 $12.74 $9.75 $12.74 $12.74 $12.74 $6.37 $6.37 $10.09 $12.74 $10.19 $8.28 $12.74 N/A $7.54 $12.74 $7.64 $12.74 $12.74 $12.74 N/A N/A 4920-0-000 SUP Custom 27203010 4920-0-000 - DEVICE EXFIX STANDARD 40MM TUBE DYNAMIZATION DISTRACTION BOTH IP/OP "$3,734.50" "$2,764.00" $664.74 "$3,734.50" "$3,734.50" "$3,734.50" "$3,734.50" "$3,734.50" "$3,734.50" "$3,734.50" $664.74 "$3,734.50" "$3,734.50" "$2,771.75" "$2,771.75" "$2,878.55" "$1,945.67" $778.31 "$3,734.50" "$1,493.80" "$3,734.50" "$3,734.50" "$3,734.50" "$3,734.50" "$3,734.50" "$2,800.88" "$3,734.50" "$3,734.50" "$3,734.50" "$1,867.25" "$1,867.25" "$2,957.72" "$3,734.50" "$2,987.60" "$2,427.43" "$3,734.50" N/A "$2,166.01" "$3,734.50" "$2,240.70" "$3,734.50" "$3,734.50" "$3,734.50" N/A N/A 4920-0-015 SUP Custom 27203010 4920-0-015 - TUBE XTRNFX STD 40MM HFMN2 CMPR DSTRCT BOTH IP/OP $965.50 $714.00 $171.81 $965.25 $965.25 $965.25 $965.25 $965.25 $965.25 $965.25 $171.81 $965.25 $965.25 $716.41 $716.41 $744.01 $502.90 $201.17 $965.25 $386.10 $965.25 $965.25 $965.25 $965.25 $965.25 $724.13 $965.25 $965.25 $965.25 $482.63 $482.63 $764.48 $965.25 $772.20 $627.41 $965.25 N/A $559.99 $965.25 $579.15 $965.25 $965.25 $965.25 N/A N/A 4920-1-010 SUP Custom 27203010 4920-1-010 - CLAMP EXFIX STANDARD NONMRI SAFE HOFFMANN II CARFBR BOTH IP/OP $854.00 $632.00 $151.99 $853.88 $853.88 $853.88 $853.88 $853.88 $853.88 $853.88 $151.99 $853.88 $853.88 $633.75 $633.75 $658.17 $444.87 $177.96 $853.88 $341.55 $853.88 $853.88 $853.88 $853.88 $853.88 $640.50 $853.88 $853.88 $853.88 $426.94 $426.94 $676.27 $853.88 $683.10 $555.02 $853.88 N/A $495.32 $853.88 $512.33 $853.88 $853.88 $853.88 N/A N/A 4920-1-010R SUP Custom 27203010 4920-1-010R - COUPLING EXFIX 8MM ROD TO ROD POST HOFFMANN II BOTH IP/OP $854.00 $632.00 $151.99 $853.88 $853.88 $853.88 $853.88 $853.88 $853.88 $853.88 $151.99 $853.88 $853.88 $633.75 $633.75 $658.17 $444.87 $177.96 $853.88 $341.55 $853.88 $853.88 $853.88 $853.88 $853.88 $640.50 $853.88 $853.88 $853.88 $426.94 $426.94 $676.27 $853.88 $683.10 $555.02 $853.88 N/A $495.32 $853.88 $512.33 $853.88 $853.88 $853.88 N/A N/A 4920-1-020 SUP Custom 27203010 4920-1-020 - COUPLING EXFIX 4-5MM 8MM PIN TO ROD HOFFMANN II BOTH IP/OP $854.00 $632.00 $151.99 $853.88 $853.88 $853.88 $853.88 $853.88 $853.88 $853.88 $151.99 $853.88 $853.88 $633.75 $633.75 $658.17 $444.87 $177.96 $853.88 $341.55 $853.88 $853.88 $853.88 $853.88 $853.88 $640.50 $853.88 $853.88 $853.88 $426.94 $426.94 $676.27 $853.88 $683.10 $555.02 $853.88 N/A $495.32 $853.88 $512.33 $853.88 $853.88 $853.88 N/A N/A 4920-1-020R SUP Custom 27203010 4920-1-020R - COUPLING EXFIX 8MM 4-5MM PIN TO ROD POST HOFFMANN II BOTH IP/OP $854.00 $632.00 $151.99 $853.88 $853.88 $853.88 $853.88 $853.88 $853.88 $853.88 $151.99 $853.88 $853.88 $633.75 $633.75 $658.17 $444.87 $177.96 $853.88 $341.55 $853.88 $853.88 $853.88 $853.88 $853.88 $640.50 $853.88 $853.88 $853.88 $426.94 $426.94 $676.27 $853.88 $683.10 $555.02 $853.88 N/A $495.32 $853.88 $512.33 $853.88 $853.88 $853.88 N/A N/A 4920-1-030 SUP Custom 27203010 4920-1-030 - COUPLING XTRNFX 4 5/8MM HFMN2 INVERT PIN TO ROD BOTH IP/OP $854.00 $632.00 $151.99 $853.88 $853.88 $853.88 $853.88 $853.88 $853.88 $853.88 $151.99 $853.88 $853.88 $633.75 $633.75 $658.17 $444.87 $177.96 $853.88 $341.55 $853.88 $853.88 $853.88 $853.88 $853.88 $640.50 $853.88 $853.88 $853.88 $426.94 $426.94 $676.27 $853.88 $683.10 $555.02 $853.88 N/A $495.32 $853.88 $512.33 $853.88 $853.88 $853.88 N/A N/A 4920-1-030R SUP Custom 27203010 4920-1-030R - COUPLING EXFIX 8MM 4-5MM INVERTED PIN TO ROD POST HOFFMANN BOTH IP/OP $854.00 $632.00 $151.99 $853.88 $853.88 $853.88 $853.88 $853.88 $853.88 $853.88 $151.99 $853.88 $853.88 $633.75 $633.75 $658.17 $444.87 $177.96 $853.88 $341.55 $853.88 $853.88 $853.88 $853.88 $853.88 $640.50 $853.88 $853.88 $853.88 $426.94 $426.94 $676.27 $853.88 $683.10 $555.02 $853.88 N/A $495.32 $853.88 $512.33 $853.88 $853.88 $853.88 N/A N/A 4920-1-100 SUP Custom 27203010 4920-1-100 - COUPLING XTRNFX STD 20MM 8MM HFMN2 TUBE TO ROD DYN BOTH IP/OP $949.00 $702.00 $168.88 $948.75 $948.75 $948.75 $948.75 $948.75 $948.75 $948.75 $168.88 $948.75 $948.75 $704.16 $704.16 $731.30 $494.30 $197.73 $948.75 $379.50 $948.75 $948.75 $948.75 $948.75 $948.75 $711.75 $948.75 $948.75 $948.75 $474.38 $474.38 $751.41 $948.75 $759.00 $616.69 $948.75 N/A $550.42 $948.75 $569.25 $948.75 $948.75 $948.75 N/A N/A 4920-2-020 SUP Custom 27203010 4920-2-020 - CLAMP EXFIX 8MM 4-5MM PIN ASMBLY 5 HOLE W/O POST HOFFMANN II BOTH IP/OP $901.00 $667.00 $160.31 $900.63 $900.63 $900.63 $900.63 $900.63 $900.63 $900.63 $160.31 $900.63 $900.63 $668.45 $668.45 $694.21 $469.23 $187.70 $900.63 $360.25 $900.63 $900.63 $900.63 $900.63 $900.63 $675.75 $900.63 $900.63 $900.63 $450.32 $450.32 $713.30 $900.63 $720.50 $585.41 $900.63 N/A $522.58 $900.63 $540.38 $900.63 $900.63 $900.63 N/A N/A 4920-2-060 SUP Custom 27203010 4920-2-060 - CLAMP EXFIX STANDARD 10 HOLE HOFFMANN II CARFBR 4/5/6MM PIN BOTH IP/OP "$1,517.00" "$1,123.00" $269.96 "$1,516.63" "$1,516.63" "$1,516.63" "$1,516.63" "$1,516.63" "$1,516.63" "$1,516.63" $269.96 "$1,516.63" "$1,516.63" "$1,125.64" "$1,125.64" "$1,169.02" $790.16 $316.08 "$1,516.63" $606.65 "$1,516.63" "$1,516.63" "$1,516.63" "$1,516.63" "$1,516.63" "$1,137.75" "$1,516.63" "$1,516.63" "$1,516.63" $758.32 $758.32 "$1,201.17" "$1,516.63" "$1,213.30" $985.81 "$1,516.63" N/A $879.86 "$1,516.63" $909.98 "$1,516.63" "$1,516.63" "$1,516.63" N/A N/A 4920-2-060R SUP Custom 27203010 4920-2-060R - CLAMP EXFIX 4-6MM 10 HOLE PIN COMPONENT HOFFMANN II BOTH IP/OP "$1,517.00" "$1,123.00" $269.96 "$1,516.63" "$1,516.63" "$1,516.63" "$1,516.63" "$1,516.63" "$1,516.63" "$1,516.63" $269.96 "$1,516.63" "$1,516.63" "$1,125.64" "$1,125.64" "$1,169.02" $790.16 $316.08 "$1,516.63" $606.65 "$1,516.63" "$1,516.63" "$1,516.63" "$1,516.63" "$1,516.63" "$1,137.75" "$1,516.63" "$1,516.63" "$1,516.63" $758.32 $758.32 "$1,201.17" "$1,516.63" "$1,213.30" $985.81 "$1,516.63" N/A $879.86 "$1,516.63" $909.98 "$1,516.63" "$1,516.63" "$1,516.63" N/A N/A 4920-2-080 SUP Custom 27203010 4920-2-080 - CLAMP EXFIX COMPONENT HOFFMANN II PELVIC 4 MM 5 MM 6 MM PINS BOTH IP/OP "$1,328.50" $983.00 $236.43 "$1,328.25" "$1,328.25" "$1,328.25" "$1,328.25" "$1,328.25" "$1,328.25" "$1,328.25" $236.43 "$1,328.25" "$1,328.25" $985.83 $985.83 "$1,023.82" $692.02 $276.82 "$1,328.25" $531.30 "$1,328.25" "$1,328.25" "$1,328.25" "$1,328.25" "$1,328.25" $996.38 "$1,328.25" "$1,328.25" "$1,328.25" $664.13 $664.13 "$1,051.97" "$1,328.25" "$1,062.60" $863.36 "$1,328.25" N/A $770.53 "$1,328.25" $796.95 "$1,328.25" "$1,328.25" "$1,328.25" N/A N/A 4920-2-120 SUP Custom 27203010 4920-2-120 - POST XTRNFX STRG 8MM NS LF HFMN2 CMPNT SS DISP BOTH IP/OP $172.00 $127.00 $30.59 $171.88 $171.88 $171.88 $171.88 $171.88 $171.88 $171.88 $30.59 $171.88 $171.88 $127.57 $127.57 $132.49 $89.55 $35.82 $171.88 $68.75 $171.88 $171.88 $171.88 $171.88 $171.88 $129.00 $171.88 $171.88 $171.88 $85.94 $85.94 $136.13 $171.88 $137.50 $111.72 $171.88 N/A $99.76 $171.88 $103.13 $171.88 $171.88 $171.88 N/A N/A 4920-2-120R SUP Custom 27203010 4920-2-120R - POST XTRNFX STRG 8MM NS LF HFMN2 CMPNT SS DISP REPRO BOTH IP/OP $172.00 $127.00 $30.59 $171.88 $171.88 $171.88 $171.88 $171.88 $171.88 $171.88 $30.59 $171.88 $171.88 $127.57 $127.57 $132.49 $89.55 $35.82 $171.88 $68.75 $171.88 $171.88 $171.88 $171.88 $171.88 $129.00 $171.88 $171.88 $171.88 $85.94 $85.94 $136.13 $171.88 $137.50 $111.72 $171.88 N/A $99.76 $171.88 $103.13 $171.88 $171.88 $171.88 N/A N/A 4920-2-140 SUP Custom 27203010 4920-2-140 - POST XTRNFX 30D HFMN2 AL SS CFBR BOTH IP/OP $172.00 $127.00 $30.59 $171.88 $171.88 $171.88 $171.88 $171.88 $171.88 $171.88 $30.59 $171.88 $171.88 $127.57 $127.57 $132.49 $89.55 $35.82 $171.88 $68.75 $171.88 $171.88 $171.88 $171.88 $171.88 $129.00 $171.88 $171.88 $171.88 $85.94 $85.94 $136.13 $171.88 $137.50 $111.72 $171.88 N/A $99.76 $171.88 $103.13 $171.88 $171.88 $171.88 N/A N/A 4920-2-140R SUP Custom 27203010 4920-2-140R - POST XTRNFX 30D 8MM NS LF HFMN2 CMPNT SS DISP REPRO BOTH IP/OP $172.00 $127.00 $30.59 $171.88 $171.88 $171.88 $171.88 $171.88 $171.88 $171.88 $30.59 $171.88 $171.88 $127.57 $127.57 $132.49 $89.55 $35.82 $171.88 $68.75 $171.88 $171.88 $171.88 $171.88 $171.88 $129.00 $171.88 $171.88 $171.88 $85.94 $85.94 $136.13 $171.88 $137.50 $111.72 $171.88 N/A $99.76 $171.88 $103.13 $171.88 $171.88 $171.88 N/A N/A 4920-2-160 SUP Custom 27203010 4920-2-160 - POST EXFIX 90D ANGLED COMPONENT HOFFMANN II STAINLESS STEEL BOTH IP/OP $199.50 $148.00 $35.49 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $35.49 $199.38 $199.38 $147.98 $147.98 $153.68 $103.88 $41.55 $199.38 $79.75 $199.38 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $129.60 $199.38 N/A $115.71 $199.38 $119.63 $199.38 $199.38 $199.38 N/A N/A 4920-2-160R SUP Custom 27203010 4920-2-160R - POST XTRNFX 90D NS LF HFMN2 CMPNT SS DISP REPRO BOTH IP/OP $199.50 $148.00 $35.49 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $35.49 $199.38 $199.38 $147.98 $147.98 $153.68 $103.88 $41.55 $199.38 $79.75 $199.38 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $129.60 $199.38 N/A $115.71 $199.38 $119.63 $199.38 $199.38 $199.38 N/A N/A 4920-2-180 SUP Custom 27203010 4920-2-180 - POST EXFIX MIAMI HOFFMAN II BOTH IP/OP $199.50 $148.00 $35.49 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $35.49 $199.38 $199.38 $147.98 $147.98 $153.68 $103.88 $41.55 $199.38 $79.75 $199.38 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $129.60 $199.38 N/A $115.71 $199.38 $119.63 $199.38 $199.38 $199.38 N/A N/A 4920-3-010 SUP Custom 27203010 4920-3-010 - COUPLING XTRNFX ROD TO WRE BOTH IP/OP $936.50 $693.00 $166.68 $936.38 $936.38 $936.38 $936.38 $936.38 $936.38 $936.38 $166.68 $936.38 $936.38 $694.98 $694.98 $721.76 $487.85 $195.15 $936.38 $374.55 $936.38 $936.38 $936.38 $936.38 $936.38 $702.38 $936.38 $936.38 $936.38 $468.19 $468.19 $741.61 $936.38 $749.10 $608.65 $936.38 N/A $543.17 $936.38 $561.83 $936.38 $936.38 $936.38 N/A N/A 4920-9-810 SUP Custom 27203010 4920-9-810 - SET EXFIX T KIT ROD TO ROD COUPLING MULTIPIN CLMP SOFT BOTH IP/OP "$6,227.50" "$4,608.00" "$1,108.47" "$6,227.38" "$6,227.38" "$6,227.38" "$6,227.38" "$6,227.38" "$6,227.38" "$6,227.38" "$1,108.47" "$6,227.38" "$6,227.38" "$4,181.12" "$4,181.12" "$4,800.06" "$2,060.15" "$1,297.85" "$6,227.38" "$2,490.95" "$6,227.38" "$6,227.38" "$6,227.38" "$6,227.38" "$6,227.38" "$4,670.63" "$6,227.38" "$6,227.38" "$6,227.38" "$3,113.69" "$3,113.69" "$4,932.08" "$6,227.38" "$4,981.90" "$4,047.80" "$6,227.38" N/A "$3,611.95" "$6,227.38" "$3,736.43" "$6,227.38" "$6,227.38" "$6,227.38" N/A N/A 4920-9-830 SUP Custom 27203010 4920-9-830 - SET EXFIX 430MM 307MM 65MM T KIT ROD TO ROD COUPLING BOTH IP/OP "$6,539.50" "$4,839.00" "$1,164.03" "$6,539.50" "$6,539.50" "$6,539.50" "$6,539.50" "$6,539.50" "$6,539.50" "$6,539.50" "$1,164.03" "$6,539.50" "$6,539.50" "$4,181.12" "$4,181.12" "$5,040.65" "$2,060.15" "$1,362.90" "$6,539.50" "$2,615.80" "$6,539.50" "$6,539.50" "$6,539.50" "$6,539.50" "$6,539.50" "$4,904.63" "$6,539.50" "$6,539.50" "$6,539.50" "$3,269.75" "$3,269.75" "$5,179.28" "$6,539.50" "$5,231.60" "$4,250.68" "$6,539.50" N/A "$3,792.91" "$6,539.50" "$3,923.70" "$6,539.50" "$6,539.50" "$6,539.50" N/A N/A 4920-9-900 SUP Custom 27203010 4920-9-900 - KIT EXFIX HOFFMANN II STERILE BOTH IP/OP "$4,117.00" "$3,047.00" $732.78 "$4,116.75" "$4,116.75" "$4,116.75" "$4,116.75" "$4,116.75" "$4,116.75" "$4,116.75" $732.78 "$4,116.75" "$4,116.75" "$3,055.45" "$3,055.45" "$3,173.19" "$2,060.15" $857.98 "$4,116.75" "$1,646.70" "$4,116.75" "$4,116.75" "$4,116.75" "$4,116.75" "$4,116.75" "$3,087.75" "$4,116.75" "$4,116.75" "$4,116.75" "$2,058.38" "$2,058.38" "$3,260.47" "$4,116.75" "$3,293.40" "$2,675.89" "$4,116.75" N/A "$2,387.86" "$4,116.75" "$2,470.05" "$4,116.75" "$4,116.75" "$4,116.75" N/A N/A 4920-9-920 SUP Custom 27203010 4920-9-920 - KIT EXFIX HOFFMANN II STERILE BOTH IP/OP "$3,431.00" "$2,539.00" $610.65 "$3,430.63" "$3,430.63" "$3,430.63" "$3,430.63" "$3,430.63" "$3,430.63" "$3,430.63" $610.65 "$3,430.63" "$3,430.63" "$2,546.21" "$2,546.21" "$2,644.33" "$1,787.36" $714.98 "$3,430.63" "$1,372.25" "$3,430.63" "$3,430.63" "$3,430.63" "$3,430.63" "$3,430.63" "$2,573.25" "$3,430.63" "$3,430.63" "$3,430.63" "$1,715.32" "$1,715.32" "$2,717.06" "$3,430.63" "$2,744.50" "$2,229.91" "$3,430.63" N/A "$1,989.98" "$3,430.63" "$2,058.38" "$3,430.63" "$3,430.63" "$3,430.63" N/A N/A 4920-9-930 SUP Custom 27203010 4920-9-930 - SET EXFIX T KIT ROD TO ROD COUPLING MULTIPIN CLMP SOFT BOTH IP/OP "$8,418.00" "$6,229.00" "$1,498.36" "$8,417.75" "$8,417.75" "$8,417.75" "$8,417.75" "$8,417.75" "$8,417.75" "$8,417.75" "$1,498.36" "$8,417.75" "$8,417.75" "$4,181.12" "$4,181.12" "$6,488.40" "$2,060.15" "$1,754.35" "$8,417.75" "$3,367.10" "$8,417.75" "$8,417.75" "$8,417.75" "$8,417.75" "$8,417.75" "$6,313.50" "$8,417.75" "$8,417.75" "$8,417.75" "$4,208.88" "$4,208.88" "$6,666.86" "$8,417.75" "$6,734.20" "$5,471.54" "$8,417.75" N/A "$4,882.44" "$8,417.75" "$5,050.65" "$8,417.75" "$8,417.75" "$8,417.75" N/A N/A 4920-9-952 SUP Custom 27203010 4920-9-952 - SET EXFIX KIT MILITARY MULTI PIN CLMP SLFDRILL APEX PIN BOTH IP/OP "$4,139.00" "$3,063.00" $736.70 "$4,138.75" "$4,138.75" "$4,138.75" "$4,138.75" "$4,138.75" "$4,138.75" "$4,138.75" $736.70 "$4,138.75" "$4,138.75" "$3,071.78" "$3,071.78" "$3,190.15" "$2,060.15" $862.56 "$4,138.75" "$1,655.50" "$4,138.75" "$4,138.75" "$4,138.75" "$4,138.75" "$4,138.75" "$3,104.25" "$4,138.75" "$4,138.75" "$4,138.75" "$2,069.38" "$2,069.38" "$3,277.89" "$4,138.75" "$3,311.00" "$2,690.19" "$4,138.75" N/A "$2,400.62" "$4,138.75" "$2,483.25" "$4,138.75" "$4,138.75" "$4,138.75" N/A N/A 4921-0-000 SUP Custom 27203010 4921-0-000 - TUBE XTRNFX HFMN 3 DYN MRI SAFE BOTH IP/OP "$4,234.00" "$3,133.00" $753.59 "$4,233.63" "$4,233.63" "$4,233.63" "$4,233.63" "$4,233.63" "$4,233.63" "$4,233.63" $753.59 "$4,233.63" "$4,233.63" "$3,142.20" "$3,142.20" "$3,263.28" "$2,060.15" $882.34 "$4,233.63" "$1,693.45" "$4,233.63" "$4,233.63" "$4,233.63" "$4,233.63" "$4,233.63" "$3,175.50" "$4,233.63" "$4,233.63" "$4,233.63" "$2,116.82" "$2,116.82" "$3,353.03" "$4,233.63" "$3,386.90" "$2,751.86" "$4,233.63" N/A "$2,455.72" "$4,233.63" "$2,540.18" "$4,233.63" "$4,233.63" "$4,233.63" N/A N/A 4921-0-015 SUP Custom 27203010 4921-0-015 - TUBE XTRNFX 20MM HFMN2 CMPR DSTRCT MRI SAFE BOTH IP/OP $946.00 $700.00 $168.39 $946.00 $946.00 $946.00 $946.00 $946.00 $946.00 $946.00 $168.39 $946.00 $946.00 $702.12 $702.12 $729.18 $492.87 $197.16 $946.00 $378.40 $946.00 $946.00 $946.00 $946.00 $946.00 $709.50 $946.00 $946.00 $946.00 $473.00 $473.00 $749.23 $946.00 $756.80 $614.90 $946.00 N/A $548.68 $946.00 $567.60 $946.00 $946.00 $946.00 N/A N/A 4921-1-010 SUP Custom 27203010 4921-1-010 - COUPLING EXFIX 8MM ROD TO ROD HOFFMANN II GREEN BOTH IP/OP $976.00 $722.00 $173.71 $975.88 $975.88 $975.88 $975.88 $975.88 $975.88 $975.88 $173.71 $975.88 $975.88 $724.30 $724.30 $752.21 $508.43 $203.38 $975.88 $390.35 $975.88 $975.88 $975.88 $975.88 $975.88 $732.00 $975.88 $975.88 $975.88 $487.94 $487.94 $772.90 $975.88 $780.70 $634.32 $975.88 N/A $566.08 $975.88 $585.53 $975.88 $975.88 $975.88 N/A N/A 4921-1-020 SUP Custom 27203010 4921-1-020 - CLAMP EXFIX 8MM 4-5MM COLOR CODED REASSEMBLE GOLD HEADED BOTH IP/OP $909.50 $673.00 $161.85 $909.28 $909.28 $909.28 $909.28 $909.28 $909.28 $909.28 $161.85 $909.28 $909.28 $674.87 $674.87 $700.87 $473.73 $189.50 $909.28 $363.71 $909.28 $909.28 $909.28 $909.28 $909.28 $682.13 $909.28 $909.28 $909.28 $454.64 $454.64 $720.15 $909.28 $727.42 $591.03 $909.28 N/A $527.51 $909.28 $545.57 $909.28 $909.28 $909.28 N/A N/A 4921-1-030 SUP Custom 27203010 4921-1-030 - COUPLING XTRNFX HFMN2 INVERT PIN TO ROD MRI CLR CD 4-5 MM BOTH IP/OP $876.00 $648.00 $155.91 $875.88 $875.88 $875.88 $875.88 $875.88 $875.88 $875.88 $155.91 $875.88 $875.88 $650.08 $650.08 $675.13 $456.33 $182.54 $875.88 $350.35 $875.88 $875.88 $875.88 $875.88 $875.88 $657.00 $875.88 $875.88 $875.88 $437.94 $437.94 $693.70 $875.88 $700.70 $569.32 $875.88 N/A $508.08 $875.88 $525.53 $875.88 $875.88 $875.88 N/A N/A 4921-1-100 SUP Custom 27203010 4921-1-100 - DEVICE EXFIX FRAME 6 PIN HOFFMANN II MRI YELLOW BOTH IP/OP $876.00 $648.00 $155.91 $875.88 $875.88 $875.88 $875.88 $875.88 $875.88 $875.88 $155.91 $875.88 $875.88 $650.08 $650.08 $675.13 $456.33 $182.54 $875.88 $350.35 $875.88 $875.88 $875.88 $875.88 $875.88 $657.00 $875.88 $875.88 $875.88 $437.94 $437.94 $693.70 $875.88 $700.70 $569.32 $875.88 N/A $508.08 $875.88 $525.53 $875.88 $875.88 $875.88 N/A N/A 4921-1-140 SUP Custom 27203010 4921-1-140 - POST EXFIX 8MM HFMN2 30D MRI SAFE CMPNT GOLD TIP BOTH IP/OP $166.50 $123.00 $29.62 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $29.62 $166.38 $166.38 $123.49 $123.49 $128.25 $86.68 $34.68 $166.38 $66.55 $166.38 $166.38 $166.38 $166.38 $166.38 $124.88 $166.38 $166.38 $166.38 $83.19 $83.19 $131.77 $166.38 $133.10 $108.15 $166.38 N/A $96.57 $166.38 $99.83 $166.38 $166.38 $166.38 N/A N/A 4921-2-020 SUP Custom 27203010 4921-2-020 - CLAMP EXFIX 4/5/6MM 4/5/6MM 5 HOLE PIN HOFFMANN II GREEN MRI BOTH IP/OP "$1,035.50" $766.00 $184.24 "$1,035.08" "$1,035.08" "$1,035.08" "$1,035.08" "$1,035.08" "$1,035.08" "$1,035.08" $184.24 "$1,035.08" "$1,035.08" $768.24 $768.24 $797.84 $539.28 $215.72 "$1,035.08" $414.03 "$1,035.08" "$1,035.08" "$1,035.08" "$1,035.08" "$1,035.08" $776.63 "$1,035.08" "$1,035.08" "$1,035.08" $517.54 $517.54 $819.78 "$1,035.08" $828.06 $672.80 "$1,035.08" N/A $600.59 "$1,035.08" $621.05 "$1,035.08" "$1,035.08" "$1,035.08" N/A N/A 4921-2-060 SUP Custom 27203010 4921-2-060 - CLAMP EXFIX 4/5/6MM 10 HOLE PIN MRI SAFE HOFFMANN II GREEN BOTH IP/OP "$1,379.50" "$1,021.00" $245.49 "$1,379.18" "$1,379.18" "$1,379.18" "$1,379.18" "$1,379.18" "$1,379.18" "$1,379.18" $245.49 "$1,379.18" "$1,379.18" "$1,023.63" "$1,023.63" "$1,063.07" $718.55 $287.44 "$1,379.18" $551.67 "$1,379.18" "$1,379.18" "$1,379.18" "$1,379.18" "$1,379.18" "$1,034.63" "$1,379.18" "$1,379.18" "$1,379.18" $689.59 $689.59 "$1,092.31" "$1,379.18" "$1,103.34" $896.47 "$1,379.18" N/A $800.11 "$1,379.18" $827.51 "$1,379.18" "$1,379.18" "$1,379.18" N/A N/A 4921-2-080 SUP Custom 27203010 4921-2-080 - CLAMP EXFIX HOFFMANN II MRI PELVIC BOTH IP/OP "$1,496.00" "$1,107.00" $266.29 "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" $266.29 "$1,496.00" "$1,496.00" "$1,110.33" "$1,110.33" "$1,153.12" $779.42 $311.78 "$1,496.00" $598.40 "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" "$1,496.00" "$1,122.00" "$1,496.00" "$1,496.00" "$1,496.00" $748.00 $748.00 "$1,184.83" "$1,496.00" "$1,196.80" $972.40 "$1,496.00" N/A $867.68 "$1,496.00" $897.60 "$1,496.00" "$1,496.00" "$1,496.00" N/A N/A 4921-2-120 SUP Custom 27203010 4921-2-120 - POST XTRNFX STRG 8MM HFMN 3 CLR CD MRI SAFE BOTH IP/OP $226.00 $167.00 $40.17 $225.70 $225.70 $225.70 $225.70 $225.70 $225.70 $225.70 $40.17 $225.70 $225.70 $167.51 $167.51 $173.97 $117.59 $47.04 $225.70 $90.28 $225.70 $225.70 $225.70 $225.70 $225.70 $169.50 $225.70 $225.70 $225.70 $112.85 $112.85 $178.75 $225.70 $180.56 $146.71 $225.70 N/A $131.08 $225.70 $135.42 $225.70 $225.70 $225.70 N/A N/A 4921-2-140 SUP Custom 27203010 4921-2-140 - POST XTRNFX 30D 8MM HFMN2 CLR CD MRI SAFE BOTH IP/OP $173.00 $128.00 $30.79 $172.98 $172.98 $172.98 $172.98 $172.98 $172.98 $172.98 $30.79 $172.98 $172.98 $128.39 $128.39 $133.33 $90.12 $36.05 $172.98 $69.19 $172.98 $172.98 $172.98 $172.98 $172.98 $129.75 $172.98 $172.98 $172.98 $86.49 $86.49 $137.00 $172.98 $138.38 $112.44 $172.98 N/A $100.34 $172.98 $103.79 $172.98 $172.98 $172.98 N/A N/A 4921-2-160 SUP Custom 27203010 4921-2-160 - POST XTRNFX 90D 8MM HFMN2 MRI SAFE H BOTH IP/OP $265.00 $196.00 $47.09 $264.55 $264.55 $264.55 $264.55 $264.55 $264.55 $264.55 $47.09 $264.55 $264.55 $196.35 $196.35 $203.92 $137.83 $55.14 $264.55 $105.82 $264.55 $264.55 $264.55 $264.55 $264.55 $198.75 $264.55 $264.55 $264.55 $132.28 $132.28 $209.52 $264.55 $211.64 $171.96 $264.55 N/A $153.70 $264.55 $158.73 $264.55 $264.55 $264.55 N/A N/A 4921-9-985 SUP Custom 27203010 4921-9-985 - BAR XTRNFX 30D HFMN2 STOR LWR BOTH IP/OP $780.00 $577.00 $138.77 $779.63 $779.63 $779.63 $779.63 $779.63 $779.63 $779.63 $138.77 $779.63 $779.63 $578.64 $578.64 $600.94 $406.19 $162.48 $779.63 $311.85 $779.63 $779.63 $779.63 $779.63 $779.63 $585.00 $779.63 $779.63 $779.63 $389.82 $389.82 $617.47 $779.63 $623.70 $506.76 $779.63 N/A $452.40 $779.63 $467.78 $779.63 $779.63 $779.63 N/A N/A 4922-1-010 SUP Custom 27203010 4922-1-010 - COUPLING EXFIX 5MM 8MM ROD TO ROD BOTH IP/OP "$1,360.50" "$1,007.00" $242.16 "$1,360.45" "$1,360.45" "$1,360.45" "$1,360.45" "$1,360.45" "$1,360.45" "$1,360.45" $242.16 "$1,360.45" "$1,360.45" "$1,009.73" "$1,009.73" "$1,048.63" $708.79 $283.53 "$1,360.45" $544.18 "$1,360.45" "$1,360.45" "$1,360.45" "$1,360.45" "$1,360.45" "$1,020.38" "$1,360.45" "$1,360.45" "$1,360.45" $680.23 $680.23 "$1,077.48" "$1,360.45" "$1,088.36" $884.29 "$1,360.45" N/A $789.09 "$1,360.45" $816.27 "$1,360.45" "$1,360.45" "$1,360.45" N/A N/A 4922-1-020 SUP Custom 27203010 4922-1-020 - COUPLING EXFIX 5/8IN 4IN 5 HOLE PIN TO ROD APEX PIN CLMP BOTH IP/OP "$1,245.50" $922.00 $221.69 "$1,245.45" "$1,245.45" "$1,245.45" "$1,245.45" "$1,245.45" "$1,245.45" "$1,245.45" $221.69 "$1,245.45" "$1,245.45" $924.37 $924.37 $959.99 $648.88 $259.57 "$1,245.45" $498.18 "$1,245.45" "$1,245.45" "$1,245.45" "$1,245.45" "$1,245.45" $934.13 "$1,245.45" "$1,245.45" "$1,245.45" $622.73 $622.73 $986.40 "$1,245.45" $996.36 $809.54 "$1,245.45" N/A $722.39 "$1,245.45" $747.27 "$1,245.45" "$1,245.45" "$1,245.45" N/A N/A 4922-1-030 SUP Custom 27203010 4922-1-030 - COUPLING EXFIX 5MM 8MM PIN TO ROD BOTH IP/OP "$1,360.50" "$1,007.00" $242.16 "$1,360.45" "$1,360.45" "$1,360.45" "$1,360.45" "$1,360.45" "$1,360.45" "$1,360.45" $242.16 "$1,360.45" "$1,360.45" "$1,009.73" "$1,009.73" "$1,048.63" $708.79 $283.53 "$1,360.45" $544.18 "$1,360.45" "$1,360.45" "$1,360.45" "$1,360.45" "$1,360.45" "$1,020.38" "$1,360.45" "$1,360.45" "$1,360.45" $680.23 $680.23 "$1,077.48" "$1,360.45" "$1,088.36" $884.29 "$1,360.45" N/A $789.09 "$1,360.45" $816.27 "$1,360.45" "$1,360.45" "$1,360.45" N/A N/A 4922-2-020 SUP Custom 27203010 4922-2-020 - CLAMP EXFIX 4/5/6MM 5 HOLE MULTIPIN MODULAR HOFFMANN III BOTH IP/OP "$1,402.00" "$1,037.00" $249.53 "$1,401.85" "$1,401.85" "$1,401.85" "$1,401.85" "$1,401.85" "$1,401.85" "$1,401.85" $249.53 "$1,401.85" "$1,401.85" "$1,040.45" "$1,040.45" "$1,080.55" $730.36 $292.16 "$1,401.85" $560.74 "$1,401.85" "$1,401.85" "$1,401.85" "$1,401.85" "$1,401.85" "$1,051.50" "$1,401.85" "$1,401.85" "$1,401.85" $700.93 $700.93 "$1,110.27" "$1,401.85" "$1,121.48" $911.20 "$1,401.85" N/A $813.16 "$1,401.85" $841.11 "$1,401.85" "$1,401.85" "$1,401.85" N/A N/A 4922-2-140 SUP Custom 27203010 4922-2-140 - POST XTRNFX 30D 11MM HFMN 3 BOTH IP/OP $246.50 $182.00 $43.81 $246.10 $246.10 $246.10 $246.10 $246.10 $246.10 $246.10 $43.81 $246.10 $246.10 $182.66 $182.66 $189.69 $128.22 $51.29 $246.10 $98.44 $246.10 $246.10 $246.10 $246.10 $246.10 $184.88 $246.10 $246.10 $246.10 $123.05 $123.05 $194.91 $246.10 $196.88 $159.97 $246.10 N/A $142.97 $246.10 $147.66 $246.10 $246.10 $246.10 N/A N/A 4922-2-240 SUP Custom 27203010 4922-2-240 - CLAMP EXFIX 30D 11MM 5 HOLE PIN POST MODULAR HOFFMANN III BOTH IP/OP "$1,482.00" "$1,097.00" $263.74 "$1,481.70" "$1,481.70" "$1,481.70" "$1,481.70" "$1,481.70" "$1,481.70" "$1,481.70" $263.74 "$1,481.70" "$1,481.70" "$1,099.72" "$1,099.72" "$1,142.09" $771.97 $308.80 "$1,481.70" $592.68 "$1,481.70" "$1,481.70" "$1,481.70" "$1,481.70" "$1,481.70" "$1,111.50" "$1,481.70" "$1,481.70" "$1,481.70" $740.85 $740.85 "$1,173.51" "$1,481.70" "$1,185.36" $963.11 "$1,481.70" N/A $859.56 "$1,481.70" $889.02 "$1,481.70" "$1,481.70" "$1,481.70" N/A N/A 4922-8-150 SUP Custom 27203010 4922-8-150 - ROD EXFIX 11MM 150MM CONNCTNG BOTH IP/OP $646.00 $478.00 $114.93 $645.70 $645.70 $645.70 $645.70 $645.70 $645.70 $645.70 $114.93 $645.70 $645.70 $479.24 $479.24 $497.71 $336.41 $134.57 $645.70 $258.28 $645.70 $645.70 $645.70 $645.70 $645.70 $484.50 $645.70 $645.70 $645.70 $322.85 $322.85 $511.39 $645.70 $516.56 $419.71 $645.70 N/A $374.68 $645.70 $387.42 $645.70 $645.70 $645.70 N/A N/A 4922-8-200 SUP Custom 27203010 4922-8-200 - ROD EXFIX 11MM 200MM CONNCTNG MRI HOFFMANN 3 CARB BOTH IP/OP $662.50 $490.00 $117.87 $662.20 $662.20 $662.20 $662.20 $662.20 $662.20 $662.20 $117.87 $662.20 $662.20 $491.48 $491.48 $510.42 $345.01 $138.01 $662.20 $264.88 $662.20 $662.20 $662.20 $662.20 $662.20 $496.88 $662.20 $662.20 $662.20 $331.10 $331.10 $524.46 $662.20 $529.76 $430.43 $662.20 N/A $384.25 $662.20 $397.32 $662.20 $662.20 $662.20 N/A N/A 4922-8-250 SUP Custom 27203010 4922-8-250 - ROD EXFIX 11MM 250MM CONNCTNG BOTH IP/OP $662.50 $490.00 $117.87 $662.20 $662.20 $662.20 $662.20 $662.20 $662.20 $662.20 $117.87 $662.20 $662.20 $491.48 $491.48 $510.42 $345.01 $138.01 $662.20 $264.88 $662.20 $662.20 $662.20 $662.20 $662.20 $496.88 $662.20 $662.20 $662.20 $331.10 $331.10 $524.46 $662.20 $529.76 $430.43 $662.20 N/A $384.25 $662.20 $397.32 $662.20 $662.20 $662.20 N/A N/A 4922-8-300 SUP Custom 27203010 4922-8-300 - ROD EXFIX 11MM 300MM CONNCTNG MRI SAFE HOFFMANN III CARB BOTH IP/OP $680.00 $503.00 $121.00 $679.80 $679.80 $679.80 $679.80 $679.80 $679.80 $679.80 $121.00 $679.80 $679.80 $504.55 $504.55 $523.99 $354.18 $141.68 $679.80 $271.92 $679.80 $679.80 $679.80 $679.80 $679.80 $510.00 $679.80 $679.80 $679.80 $339.90 $339.90 $538.40 $679.80 $543.84 $441.87 $679.80 N/A $394.40 $679.80 $407.88 $679.80 $679.80 $679.80 N/A N/A 4922-8-350 SUP Custom 27203010 4922-8-350 - ROD EXFIX 11MM 350MM CONNCTNG MRI HOFFMANN 3 CARB BOTH IP/OP $680.00 $503.00 $121.00 $679.80 $679.80 $679.80 $679.80 $679.80 $679.80 $679.80 $121.00 $679.80 $679.80 $504.55 $504.55 $523.99 $354.18 $141.68 $679.80 $271.92 $679.80 $679.80 $679.80 $679.80 $679.80 $510.00 $679.80 $679.80 $679.80 $339.90 $339.90 $538.40 $679.80 $543.84 $441.87 $679.80 N/A $394.40 $679.80 $407.88 $679.80 $679.80 $679.80 N/A N/A 4922-8-400 SUP Custom 27203010 4922-8-400 - ROD EXFIX 11MM 400MM CONNCTNG MRI HOFFMANN 3 CARB BOTH IP/OP $778.00 $576.00 $138.43 $777.70 $777.70 $777.70 $777.70 $777.70 $777.70 $777.70 $138.43 $777.70 $777.70 $577.21 $577.21 $599.45 $405.18 $162.08 $777.70 $311.08 $777.70 $777.70 $777.70 $777.70 $777.70 $583.50 $777.70 $777.70 $777.70 $388.85 $388.85 $615.94 $777.70 $622.16 $505.51 $777.70 N/A $451.24 $777.70 $466.62 $777.70 $777.70 $777.70 N/A N/A 4922-8-500 SUP HCPCS C1713 4922-8-500 - ROD EXFIX 11MM 500MM CONNECT MRI SAFE MODULAR HOFFMANN III BOTH IP/OP $888.00 $657.00 $176.19 $887.70 $399.47 $399.47 $399.47 $399.47 $887.70 $887.70 $887.70 $185.02 $887.70 $887.70 $887.70 $887.70 $887.70 $185.01 $887.70 $355.08 $525.07 $887.70 $887.70 $887.70 $887.70 $666.00 $887.70 $887.70 $887.70 $443.85 $443.85 $703.06 $887.70 $710.16 $399.47 $176.19 N/A $515.04 $887.70 $532.62 $887.70 $185.00 $887.70 N/A N/A 493.100.01S SUP Custom 27803010 493.100.01S - WIRE FX 26GA 500MM STRL NDL TI BOTH IP/OP $277.50 $205.00 $49.40 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $49.40 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $57.83 $277.50 $111.00 $277.50 $277.50 $277.50 $277.50 $277.50 $208.13 $277.50 $277.50 $277.50 $138.75 $138.75 $219.78 $277.50 $222.00 $124.88 $277.50 N/A $160.95 $277.50 $166.50 $277.50 $277.50 $277.50 N/A N/A 493.101.01S SUP Custom 27803010 493.101.01S - WIRE FX 28GA 500MM STRL NDL TI BOTH IP/OP $229.50 $170.00 $40.85 $229.50 $229.50 $229.50 $229.50 $229.50 $229.50 $229.50 $40.85 $229.50 $229.50 $229.50 $229.50 $229.50 $229.50 $47.83 $229.50 $91.80 $229.50 $229.50 $229.50 $229.50 $229.50 $172.13 $229.50 $229.50 $229.50 $114.75 $114.75 $181.76 $229.50 $183.60 $103.28 $229.50 N/A $133.11 $229.50 $137.70 $229.50 $229.50 $229.50 N/A N/A 493.102.01S SUP Custom 27803010 493.102.01S - WIRE SPINAL .25MM 500MM NEEDLE TITANIUM STERILE BOTH IP/OP $277.50 $205.00 $49.40 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $49.40 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $57.83 $277.50 $111.00 $277.50 $277.50 $277.50 $277.50 $277.50 $208.13 $277.50 $277.50 $277.50 $138.75 $138.75 $219.78 $277.50 $222.00 $124.88 $277.50 N/A $160.95 $277.50 $166.50 $277.50 $277.50 $277.50 N/A N/A 493.103.01S SUP Custom 27803010 493.103.01S - WIRE SPINAL .2MM 500MM NEEDLE TITANIUM STERILE BOTH IP/OP $277.50 $205.00 $49.40 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $49.40 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $57.83 $277.50 $111.00 $277.50 $277.50 $277.50 $277.50 $277.50 $208.13 $277.50 $277.50 $277.50 $138.75 $138.75 $219.78 $277.50 $222.00 $124.88 $277.50 N/A $160.95 $277.50 $166.50 $277.50 $277.50 $277.50 N/A N/A 493.104.01S SUP Custom 27803010 493.104.01S - WIRE FX 28GA 500MM STRL BRB NDL TI BOTH IP/OP $900.00 $666.00 $160.20 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $160.20 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $360.00 $900.00 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $900.00 N/A $522.00 $900.00 $540.00 $900.00 $900.00 $900.00 N/A N/A 494.771SHA SUP HCPCS C1713 494.771SHA - SCREW BONE 4/3MM 80MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC BOTH IP/OP $338.00 $250.00 $66.99 $343.28 $151.89 $151.89 $151.89 $151.89 $337.53 $337.53 $337.53 $70.35 $337.53 $337.53 $337.53 $337.53 $337.53 $70.34 $337.53 $343.28 $199.65 $337.53 $343.28 $337.53 $337.53 $253.50 $337.53 $337.53 $337.53 $168.77 $168.77 $267.32 $337.53 $270.02 $151.89 $66.99 N/A $196.04 $337.53 $337.53 $337.53 $70.34 $337.53 N/A N/A 494.784SHA SUP HCPCS C1713 494.784SHA - SCREW BONE 5MM 150MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC BOTH IP/OP $382.50 $283.00 $75.83 $388.58 $171.94 $171.94 $171.94 $171.94 $382.08 $382.08 $382.08 $79.64 $382.08 $382.08 $382.08 $382.08 $382.08 $79.63 $382.08 $155.43 $226.00 $382.08 $388.58 $382.08 $382.08 $286.88 $382.08 $382.08 $382.08 $191.04 $191.04 $302.61 $382.08 $305.66 $171.94 $75.83 N/A $221.85 $382.08 $229.25 $382.08 $79.63 $382.08 N/A N/A 494.785SHA SUP HCPCS C1713 494.785SHA - SCREW BONE 5MM 175MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC BOTH IP/OP $382.50 $283.00 $75.83 $388.58 $171.94 $171.94 $171.94 $171.94 $382.08 $382.08 $382.08 $79.64 $382.08 $382.08 $382.08 $382.08 $382.08 $79.63 $382.08 $388.58 $226.00 $382.08 $388.58 $382.08 $382.08 $286.88 $382.08 $382.08 $382.08 $191.04 $191.04 $302.61 $382.08 $305.66 $171.94 $75.83 N/A $221.85 $382.08 $382.08 $382.08 $79.63 $382.08 N/A N/A 494.786SHA SUP HCPCS C1713 494.786SHA - SCREW BONE 5MM 200MM SLFDRILL SCHANZ HYDRXAPT ORTHOPEDIC BOTH IP/OP $382.50 $283.00 $75.83 $388.58 $171.94 $171.94 $171.94 $171.94 $382.08 $382.08 $382.08 $79.64 $382.08 $382.08 $382.08 $382.08 $382.08 $79.63 $382.08 $155.43 $226.00 $382.08 $388.58 $382.08 $382.08 $286.88 $382.08 $382.08 $382.08 $191.04 $191.04 $302.61 $382.08 $305.66 $171.94 $75.83 N/A $221.85 $382.08 $229.25 $382.08 $382.08 $382.08 N/A N/A 4940-0-015 SUP Custom 27203010 4940-0-015 - TUBE XTRNFX SM 15MM 5MM HFMN2 C CMPR DSTRCT C BOTH IP/OP $844.50 $625.00 $150.28 $844.25 $844.25 $844.25 $844.25 $844.25 $844.25 $844.25 $150.28 $844.25 $844.25 $626.60 $626.60 $650.75 $439.85 $175.95 $844.25 $337.70 $844.25 $844.25 $844.25 $844.25 $844.25 $633.38 $844.25 $844.25 $844.25 $422.13 $422.13 $668.65 $844.25 $675.40 $548.76 $844.25 N/A $489.81 $844.25 $506.55 $844.25 $844.25 $844.25 N/A N/A 4940-1-010 SUP Custom 27203010 4940-1-010 - COUPLING XTRNFX NS HFMN2 C ROD TO ROD 5 MM ROD/POST BOTH IP/OP $522.50 $387.00 $93.01 $522.50 $522.50 $522.50 $522.50 $522.50 $522.50 $522.50 $93.01 $522.50 $522.50 $387.80 $387.80 $402.74 $272.22 $108.89 $522.50 $209.00 $522.50 $522.50 $522.50 $522.50 $522.50 $391.88 $522.50 $522.50 $522.50 $261.25 $261.25 $413.82 $522.50 $418.00 $339.63 $522.50 N/A $303.05 $522.50 $313.50 $522.50 $522.50 $522.50 N/A N/A 4940-1-015 SUP Custom 27203010 4940-1-015 - CLAMP EXFIX COUPLING HOFFMANN II COMPACT KNEE BOTH IP/OP $584.50 $433.00 $104.02 $584.38 $584.38 $584.38 $584.38 $584.38 $584.38 $584.38 $104.02 $584.38 $584.38 $433.73 $433.73 $450.44 $304.46 $121.79 $584.38 $233.75 $584.38 $584.38 $584.38 $584.38 $584.38 $438.38 $584.38 $584.38 $584.38 $292.19 $292.19 $462.83 $584.38 $467.50 $379.85 $584.38 N/A $339.01 $584.38 $350.63 $584.38 $584.38 $584.38 N/A N/A 4940-1-020 SUP Custom 27203010 4940-1-020 - COUPLING EXFIX 5MM 3-4MM PIN TO ROD COMPACT HOFFMANN II BOTH IP/OP $522.50 $387.00 $93.01 $522.50 $522.50 $522.50 $522.50 $522.50 $522.50 $522.50 $93.01 $522.50 $522.50 $387.80 $387.80 $402.74 $272.22 $108.89 $522.50 $209.00 $522.50 $522.50 $522.50 $522.50 $522.50 $391.88 $522.50 $522.50 $522.50 $261.25 $261.25 $413.82 $522.50 $418.00 $339.63 $522.50 N/A $303.05 $522.50 $313.50 $522.50 $522.50 $522.50 N/A N/A 4940-1-058 SUP Custom 27203010 4940-1-058 - COUPLING EXFIX 8MM 5MM ROD TO ROD COMPACT HOFFMANN II BOTH IP/OP $807.50 $598.00 $143.67 $807.13 $807.13 $807.13 $807.13 $807.13 $807.13 $807.13 $143.67 $807.13 $807.13 $599.05 $599.05 $622.14 $420.51 $168.21 $807.13 $322.85 $807.13 $807.13 $807.13 $807.13 $807.13 $605.63 $807.13 $807.13 $807.13 $403.57 $403.57 $639.25 $807.13 $645.70 $524.63 $807.13 N/A $468.35 $807.13 $484.28 $807.13 $807.13 $807.13 N/A N/A 4940-1-100 SUP Custom 27203010 4940-1-100 - DEVICE EXFIX COMPRESSION DISTRACTION ROD TO TUBE COUPLING BOTH IP/OP $522.50 $387.00 $93.01 $522.50 $522.50 $522.50 $522.50 $522.50 $522.50 $522.50 $93.01 $522.50 $522.50 $387.80 $387.80 $402.74 $272.22 $108.89 $522.50 $209.00 $522.50 $522.50 $522.50 $522.50 $522.50 $391.88 $522.50 $522.50 $522.50 $261.25 $261.25 $413.82 $522.50 $418.00 $339.63 $522.50 N/A $303.05 $522.50 $313.50 $522.50 $522.50 $522.50 N/A N/A 4940-2-020 SUP Custom 27203010 4940-2-020 - CLAMP EXFIX STR 4 HOLE PIN HOFFMANN II BOTH IP/OP "$1,576.00" "$1,166.00" $280.51 "$1,575.90" "$1,575.90" "$1,575.90" "$1,575.90" "$1,575.90" "$1,575.90" "$1,575.90" $280.51 "$1,575.90" "$1,575.90" "$1,169.63" "$1,169.63" "$1,214.70" $821.04 $328.43 "$1,575.90" $630.36 "$1,575.90" "$1,575.90" "$1,575.90" "$1,575.90" "$1,575.90" "$1,182.00" "$1,575.90" "$1,575.90" "$1,575.90" $787.95 $787.95 "$1,248.11" "$1,575.90" "$1,260.72" "$1,024.34" "$1,575.90" N/A $914.08 "$1,575.90" $945.54 "$1,575.90" "$1,575.90" "$1,575.90" N/A N/A 4940-2-120 SUP Custom 27203010 4940-2-120 - POST XTRNFX STRG 5MM HFMN2 C SS BOTH IP/OP $299.00 $221.00 $53.17 $298.70 $298.70 $298.70 $298.70 $298.70 $298.70 $298.70 $53.17 $298.70 $298.70 $221.70 $221.70 $230.24 $155.62 $62.25 $298.70 $119.48 $298.70 $298.70 $298.70 $298.70 $298.70 $224.25 $298.70 $298.70 $298.70 $149.35 $149.35 $236.57 $298.70 $238.96 $194.16 $298.70 N/A $173.42 $298.70 $179.22 $298.70 $298.70 $298.70 N/A N/A 4940-2-140 SUP Custom 27203010 4940-2-140 - POST XTRNFX 30D 5MM HFMN2 C SS BOTH IP/OP $299.00 $221.00 $53.17 $298.70 $298.70 $298.70 $298.70 $298.70 $298.70 $298.70 $53.17 $298.70 $298.70 $221.70 $221.70 $230.24 $155.62 $62.25 $298.70 $119.48 $298.70 $298.70 $298.70 $298.70 $298.70 $224.25 $298.70 $298.70 $298.70 $149.35 $149.35 $236.57 $298.70 $238.96 $194.16 $298.70 N/A $173.42 $298.70 $179.22 $298.70 $298.70 $298.70 N/A N/A 4941-0-015 SUP Custom 27203010 4941-0-015 - TUBE XTRNFX 15MM 350MM YLW HFMN2 C CMPR DSTRCT MRI SAFE C BOTH IP/OP $737.00 $545.00 $131.19 $737.00 $737.00 $737.00 $737.00 $737.00 $737.00 $737.00 $131.19 $737.00 $737.00 $547.00 $547.00 $568.08 $383.98 $153.60 $737.00 $294.80 $737.00 $737.00 $737.00 $737.00 $737.00 $552.75 $737.00 $737.00 $737.00 $368.50 $368.50 $583.70 $737.00 $589.60 $479.05 $737.00 N/A $427.46 $737.00 $442.20 $737.00 $737.00 $737.00 N/A N/A 4941-1-010 SUP Custom 27203010 4941-1-010 - COUPLING EXFIX ROD TO ROD COMPACT HOFFMANN II 5 MM ROD OR BOTH IP/OP $514.50 $381.00 $91.54 $514.25 $514.25 $514.25 $514.25 $514.25 $514.25 $514.25 $91.54 $514.25 $514.25 $381.68 $381.68 $396.38 $267.92 $107.18 $514.25 $205.70 $514.25 $514.25 $514.25 $514.25 $514.25 $385.88 $514.25 $514.25 $514.25 $257.13 $257.13 $407.29 $514.25 $411.40 $334.26 $514.25 N/A $298.41 $514.25 $308.55 $514.25 $514.25 $514.25 N/A N/A 4941-1-020 SUP Custom 27203010 4941-1-020 - CLAMP EXFIX PIN TO ROD COUPLING MRI HOFFMANN II MRI 5 MM ROD BOTH IP/OP $514.50 $381.00 $91.54 $514.25 $514.25 $514.25 $514.25 $514.25 $514.25 $514.25 $91.54 $514.25 $514.25 $381.68 $381.68 $396.38 $267.92 $107.18 $514.25 $205.70 $514.25 $514.25 $514.25 $514.25 $514.25 $385.88 $514.25 $514.25 $514.25 $257.13 $257.13 $407.29 $514.25 $411.40 $334.26 $514.25 N/A $298.41 $514.25 $308.55 $514.25 $514.25 $514.25 N/A N/A 4941-1-058 SUP Custom 27203010 4941-1-058 - COUPLING XTRNFX HFMN2 C MR SF 5 MM 8 MM ROD BOTH IP/OP $747.00 $553.00 $132.90 $746.63 $746.63 $746.63 $746.63 $746.63 $746.63 $746.63 $132.90 $746.63 $746.63 $554.15 $554.15 $575.50 $388.99 $155.61 $746.63 $298.65 $746.63 $746.63 $746.63 $746.63 $746.63 $560.25 $746.63 $746.63 $746.63 $373.32 $373.32 $591.33 $746.63 $597.30 $485.31 $746.63 N/A $433.26 $746.63 $447.98 $746.63 $746.63 $746.63 N/A N/A 4941-1-100 SUP Custom 27203010 4941-1-100 - SYSTEM EXFIX 5MM 15MM DISTRACTION TUBE ROD COUPLING POSTS BOTH IP/OP $456.50 $338.00 $81.26 $456.50 $456.50 $456.50 $456.50 $456.50 $456.50 $456.50 $81.26 $456.50 $456.50 $338.81 $338.81 $351.87 $237.84 $95.14 $456.50 $182.60 $456.50 $456.50 $456.50 $456.50 $456.50 $342.38 $456.50 $456.50 $456.50 $228.25 $228.25 $361.55 $456.50 $365.20 $296.73 $456.50 N/A $264.77 $456.50 $273.90 $456.50 $456.50 $456.50 N/A N/A 4941-2-020 SUP Custom 27203010 4941-2-020 - CLAMP EXFIX STR 4 HOLE HOFFMANN II COMPACT ORANGE BOTH IP/OP $621.50 $460.00 $110.63 $621.50 $621.50 $621.50 $621.50 $621.50 $621.50 $621.50 $110.63 $621.50 $621.50 $461.28 $461.28 $479.05 $323.80 $129.53 $621.50 $248.60 $621.50 $621.50 $621.50 $621.50 $621.50 $466.13 $621.50 $621.50 $621.50 $310.75 $310.75 $492.23 $621.50 $497.20 $403.98 $621.50 N/A $360.47 $621.50 $372.90 $621.50 $621.50 $621.50 N/A N/A 4941-2-120 SUP Custom 27203010 4941-2-120 - POST XTRNFX 30D STRG AU HFMN2 C MDLR MRI SAFE AL TI BOTH IP/OP $117.00 $87.00 $20.80 $116.88 $116.88 $116.88 $116.88 $116.88 $116.88 $116.88 $20.80 $116.88 $116.88 $86.75 $86.75 $90.09 $60.89 $24.36 $116.88 $46.75 $116.88 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $75.97 $116.88 N/A $67.86 $116.88 $70.13 $116.88 $116.88 $116.88 N/A N/A 4941-2-140 SUP Custom 27203010 4941-2-140 - POST XTRNFX 30D HFMN2 C MRI SAFE BOTH IP/OP $117.00 $87.00 $20.80 $116.88 $116.88 $116.88 $116.88 $116.88 $116.88 $116.88 $20.80 $116.88 $116.88 $86.75 $86.75 $90.09 $60.89 $24.36 $116.88 $46.75 $116.88 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $75.97 $116.88 N/A $67.86 $116.88 $70.13 $116.88 $116.88 $116.88 N/A N/A 4941-2-200 SUP Custom 27203010 4941-2-200 - CLAMP EXFIX STR PIN COMPACT COMPACT HOFFMANN II BOTH IP/OP $621.50 $460.00 $110.63 $621.50 $621.50 $621.50 $621.50 $621.50 $621.50 $621.50 $110.63 $621.50 $621.50 $461.28 $461.28 $479.05 $323.80 $129.53 $621.50 $248.60 $621.50 $621.50 $621.50 $621.50 $621.50 $466.13 $621.50 $621.50 $621.50 $310.75 $310.75 $492.23 $621.50 $497.20 $403.98 $621.50 N/A $360.47 $621.50 $372.90 $621.50 $621.50 $621.50 N/A N/A 4960-1-010 SUP Custom 27203010 4960-1-010 - COUPLING EXFIX 3MM 3MM ROD TO ROD MICRO HOFFMANN II HAND BOTH IP/OP $841.50 $623.00 $149.79 $841.50 $841.50 $841.50 $841.50 $841.50 $841.50 $841.50 $149.79 $841.50 $841.50 $624.56 $624.56 $648.63 $438.42 $175.38 $841.50 $336.60 $841.50 $841.50 $841.50 $841.50 $841.50 $631.13 $841.50 $841.50 $841.50 $420.75 $420.75 $666.47 $841.50 $673.20 $546.98 $841.50 N/A $488.07 $841.50 $504.90 $841.50 $841.50 $841.50 N/A N/A 4960-1-020 SUP Custom 27203010 4960-1-020 - COUPLING EXFIX 1.65-2MM 3MM PIN TO ROD MICRO HOFFMANN II BOTH IP/OP $734.50 $544.00 $130.70 $734.25 $734.25 $734.25 $734.25 $734.25 $734.25 $734.25 $130.70 $734.25 $734.25 $544.96 $544.96 $565.96 $382.54 $153.03 $734.25 $293.70 $734.25 $734.25 $734.25 $734.25 $734.25 $550.88 $734.25 $734.25 $734.25 $367.13 $367.13 $581.53 $734.25 $587.40 $477.26 $734.25 N/A $426.01 $734.25 $440.55 $734.25 $734.25 $734.25 N/A N/A 4960-1-060 SUP Custom 27203010 4960-1-060 - COUPLING EXFIX 5MM 3MM ROD TO ROD MICRO HOFFMANN II HAND BOTH IP/OP $856.00 $633.00 $152.32 $855.75 $855.75 $855.75 $855.75 $855.75 $855.75 $855.75 $152.32 $855.75 $855.75 $635.14 $635.14 $659.61 $445.85 $178.35 $855.75 $342.30 $855.75 $855.75 $855.75 $855.75 $855.75 $642.00 $855.75 $855.75 $855.75 $427.88 $427.88 $677.75 $855.75 $684.60 $556.24 $855.75 N/A $496.48 $855.75 $513.45 $855.75 $855.75 $855.75 N/A N/A 4960-2-020 SUP Custom 27203010 4960-2-020 - CLAMP EXFIX MICRO MULTIPIN HOFFMANN II BOTH IP/OP $856.00 $633.00 $152.32 $855.75 $855.75 $855.75 $855.75 $855.75 $855.75 $855.75 $152.32 $855.75 $855.75 $635.14 $635.14 $659.61 $445.85 $178.35 $855.75 $342.30 $855.75 $855.75 $855.75 $855.75 $855.75 $642.00 $855.75 $855.75 $855.75 $427.88 $427.88 $677.75 $855.75 $684.60 $556.24 $855.75 N/A $496.48 $855.75 $513.45 $855.75 $855.75 $855.75 N/A N/A 4960-3-000 SUP Custom 27203010 4960-3-000 - ASSEMBLY FIX MICRO LENGTHENER HOFFMANN II BOTH IP/OP "$4,581.00" "$3,390.00" $815.42 "$4,581.00" "$4,581.00" "$4,581.00" "$4,581.00" "$4,581.00" "$4,581.00" "$4,581.00" $815.42 "$4,581.00" "$4,581.00" "$3,400.02" "$3,400.02" "$3,531.03" "$2,060.15" $954.73 "$4,581.00" "$1,832.40" "$4,581.00" "$4,581.00" "$4,581.00" "$4,581.00" "$4,581.00" "$3,435.75" "$4,581.00" "$4,581.00" "$4,581.00" "$2,290.50" "$2,290.50" "$3,628.15" "$4,581.00" "$3,664.80" "$2,977.65" "$4,581.00" N/A "$2,656.98" "$4,581.00" "$2,748.60" "$4,581.00" "$4,581.00" "$4,581.00" N/A N/A 4960-3-015 SUP Custom 27203010 4960-3-015 - CLAMP EXFIX MICRO MULTIPIN LENGTHENER COMPONENT HOFFMANN II BOTH IP/OP $64.50 $48.00 $11.48 $64.50 $64.50 $64.50 $64.50 $64.50 $64.50 $64.50 $11.48 $64.50 $64.50 $47.87 $47.87 $49.72 $33.60 $13.44 $64.50 $25.80 $64.50 $64.50 $64.50 $64.50 $64.50 $48.38 $64.50 $64.50 $64.50 $32.25 $32.25 $51.08 $64.50 $51.60 $41.93 $64.50 N/A $37.41 $64.50 $38.70 $64.50 $64.50 $64.50 N/A N/A 4960-3-020 SUP Custom 27203010 4960-3-020 - CLAMP EXFIX MICRO MULTIPIN LENGTHENER COMPONENT HOFFMANN II BOTH IP/OP "$1,524.00" "$1,128.00" $271.27 "$1,524.00" "$1,524.00" "$1,524.00" "$1,524.00" "$1,524.00" "$1,524.00" "$1,524.00" $271.27 "$1,524.00" "$1,524.00" "$1,131.11" "$1,131.11" "$1,174.70" $794.00 $317.62 "$1,524.00" $609.60 "$1,524.00" "$1,524.00" "$1,524.00" "$1,524.00" "$1,524.00" "$1,143.00" "$1,524.00" "$1,524.00" "$1,524.00" $762.00 $762.00 "$1,207.01" "$1,524.00" "$1,219.20" $990.60 "$1,524.00" N/A $883.92 "$1,524.00" $914.40 "$1,524.00" "$1,524.00" "$1,524.00" N/A N/A 4960-3-025 SUP Custom 27203010 4960-3-025 - CLAMP EXFIX MULTIPIN LENGTHENER HOFFMANN II PERIARTICULAR BOTH IP/OP "$1,524.00" "$1,128.00" $271.27 "$1,524.00" "$1,524.00" "$1,524.00" "$1,524.00" "$1,524.00" "$1,524.00" "$1,524.00" $271.27 "$1,524.00" "$1,524.00" "$1,131.11" "$1,131.11" "$1,174.70" $794.00 $317.62 "$1,524.00" $609.60 "$1,524.00" "$1,524.00" "$1,524.00" "$1,524.00" "$1,524.00" "$1,143.00" "$1,524.00" "$1,524.00" "$1,524.00" $762.00 $762.00 "$1,207.01" "$1,524.00" "$1,219.20" $990.60 "$1,524.00" N/A $883.92 "$1,524.00" $914.40 "$1,524.00" "$1,524.00" "$1,524.00" N/A N/A 4960-3-030 SUP Custom 27203010 4960-3-030 - CLAMP EXFIX MICRO THUMBWHEEL LENGTHENER HOFFMANN II BOTH IP/OP $238.50 $176.00 $42.45 $238.50 $238.50 $238.50 $238.50 $238.50 $238.50 $238.50 $42.45 $238.50 $238.50 $177.01 $177.01 $183.84 $124.26 $49.71 $238.50 $95.40 $238.50 $238.50 $238.50 $238.50 $238.50 $178.88 $238.50 $238.50 $238.50 $119.25 $119.25 $188.89 $238.50 $190.80 $155.03 $238.50 N/A $138.33 $238.50 $143.10 $238.50 $238.50 $238.50 N/A N/A 497.668E SUP HCPCS C1713 497.668E - SCREW BONE LP 2.4MM 8MM 2 LEAD SELF TAP LOCK PURPLE TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 497.670E SUP HCPCS C1713 497.670E - SCREW BONE LP 2.4MM 10MM 2 LEAD SELF TAP LOCK PURPLE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 497.672E SUP HCPCS C1713 497.672E - SCREW BONE LP 2.4MM 12MM 2 LEAD SELF TAP LOCK PURPLE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 497.674E SUP HCPCS C1713 497.674E - SCREW BONE LP 2.4MM 14MM 2 LEAD SELF TAP LOCK PURPLE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 497.676E SUP HCPCS C1713 497.676E - SCREW BONE LP 2.4MM 16MM 2 LEAD SELF TAP LOCK PURPLE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 497.678E SUP HCPCS C1713 497.678E - SCREW BONE LP 2.4MM 18MM 2 LEAD SELF TAP LOCK PURPLE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 497.680E SUP HCPCS C1713 497.680E - SCREW BONE 2.4MM 20MM LOCK TITANIUM MANDIB STERILE BOTH IP/OP $389.50 $288.00 $77.26 $389.25 $175.16 $175.16 $175.16 $175.16 $389.25 $389.25 $389.25 $81.13 $389.25 $389.25 $389.25 $389.25 $389.25 $81.12 $389.25 $155.70 $230.24 $389.25 $389.25 $389.25 $389.25 $292.13 $389.25 $389.25 $389.25 $194.63 $194.63 $308.29 $389.25 $311.40 $175.16 $77.26 N/A $225.91 $389.25 $233.55 $389.25 $389.25 $389.25 N/A N/A 497.682E SUP HCPCS C1713 497.682E - SCREW BONE 2.4MM 22MM LOCK TITANIUM MANDIB STERILE BOTH IP/OP $389.50 $288.00 $77.26 $389.25 $175.16 $175.16 $175.16 $175.16 $389.25 $389.25 $389.25 $81.13 $389.25 $389.25 $389.25 $389.25 $389.25 $81.12 $389.25 $389.25 $230.24 $389.25 $389.25 $389.25 $389.25 $292.13 $389.25 $389.25 $389.25 $194.63 $194.63 $308.29 $389.25 $311.40 $175.16 $77.26 N/A $225.91 $389.25 $389.25 $389.25 $81.12 $389.25 N/A N/A 497.684E SUP HCPCS C1713 497.684E - SCREW BONE 2.4MM 24MM LOCK TITANIUM MANDIB STERILE BOTH IP/OP $389.50 $288.00 $77.26 $389.25 $175.16 $175.16 $175.16 $175.16 $389.25 $389.25 $389.25 $81.13 $389.25 $389.25 $389.25 $389.25 $389.25 $81.12 $389.25 $389.25 $230.24 $389.25 $389.25 $389.25 $389.25 $292.13 $389.25 $389.25 $389.25 $194.63 $194.63 $308.29 $389.25 $311.40 $175.16 $77.26 N/A $225.91 $389.25 $233.55 $389.25 $81.12 $389.25 N/A N/A 497.689E SUP HCPCS C1713 497.689E - SCREW BONE 2.4MM BENDING INSERT TITANIUM STERNUM NONSTRL BOTH IP/OP $114.00 $84.00 $22.55 $113.63 $51.13 $51.13 $51.13 $51.13 $113.63 $113.63 $113.63 $23.68 $113.63 $113.63 $113.63 $113.63 $113.63 $23.68 $113.63 $113.63 $67.21 $113.63 $113.63 $113.63 $113.63 $85.50 $113.63 $113.63 $113.63 $56.82 $56.82 $89.99 $113.63 $90.90 $51.13 $22.55 N/A $66.12 $113.63 $68.18 $113.63 $23.68 $113.63 N/A N/A 497.690E SUP HCPCS C1713 497.690E - SCREW BONE 3MM 8MM SLFTAP LOCKING TITANIUM MANDIB STERILE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 497.691E SUP HCPCS C1713 497.691E - SCREW BONE 3MM 10MM SLFTAP LOCKING TITANIUM MANDIB STERILE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 497.692E SUP HCPCS C1713 497.692E - SCREW BONE 3MM 12MM SLFTAP LOCKING TITANIUM MANDIB STERILE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 497.693E SUP HCPCS C1713 497.693E - SCREW BONE 3MM 14MM SLFTAP LOCKING TITANIUM MANDIB STERILE BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 497.694E SUP HCPCS C1713 497.694E - SCREW BONE 3MM 16MM SLFTAP LOCKING TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 497.695E SUP HCPCS C1713 497.695E - SCREW BONE 3MM 18MM SLFTAP LOCKING TITANIUM BOTH IP/OP $1.00 $1.00 $0.20 $1.00 $0.45 $0.45 $0.45 $0.45 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $1.00 $0.59 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $0.20 N/A $0.58 $1.00 $1.00 $1.00 $0.21 $1.00 N/A N/A 497.696E SUP HCPCS C1713 497.696E - SCREW BONE 3MM 20MM SLFTAP LOCKING LP COLOR CODED TITANIUM BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 497.697E SUP HCPCS C1713 497.697E - SCREW BONE 3MM 22MM LOCK TITANIUM ORTHOPEDIC NONSTRL BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $452.25 $452.25 $94.25 $452.25 N/A N/A 497.698E SUP HCPCS C1713 497.698E - SCREW BONE 3MM 4MM 24MM LOCKING SLFTAP CRCIFRM RECESS BOTH IP/OP $452.50 $335.00 $89.76 $452.25 $203.51 $203.51 $203.51 $203.51 $452.25 $452.25 $452.25 $94.26 $452.25 $452.25 $452.25 $452.25 $452.25 $94.25 $452.25 $452.25 $267.51 $452.25 $452.25 $452.25 $452.25 $339.38 $452.25 $452.25 $452.25 $226.13 $226.13 $358.18 $452.25 $361.80 $203.51 $89.76 N/A $262.45 $452.25 $271.35 $452.25 $94.25 $452.25 N/A N/A 497.78.98 SUP HCPCS C1713 497.78.98 - SCREW BONE 1.8MM 5MM LOCK THORP TITANIUM MAXFACL NONSTRL BOTH IP/OP $85.50 $63.00 $16.97 $85.50 $38.48 $38.48 $38.48 $38.48 $85.50 $85.50 $85.50 $17.82 $85.50 $85.50 $85.50 $85.50 $85.50 $17.82 $85.50 $85.50 $50.57 $85.50 $85.50 $85.50 $85.50 $64.13 $85.50 $85.50 $85.50 $42.75 $42.75 $67.72 $85.50 $68.40 $38.48 $16.97 N/A $49.59 $85.50 $51.30 $85.50 $17.82 $85.50 N/A N/A 497-670 SUP HCPCS C1713 497-670 - SCREW TI 10MM 2.4MM MANDIB SLFTAP LCK RECON BONE NONSTRL BOTH IP/OP $272.50 $202.00 $54.03 $272.25 $122.51 $122.51 $122.51 $122.51 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $272.25 $272.25 $272.25 $56.74 $272.25 $272.25 $161.04 $272.25 $272.25 $272.25 $272.25 $204.38 $272.25 $272.25 $272.25 $136.13 $136.13 $215.62 $272.25 $217.80 $122.51 $54.03 N/A $158.05 $272.25 $163.35 $272.25 $56.74 $272.25 N/A N/A 498.800.01S SUP Custom 27803010 498.800.01S - CABLE ORTHOPEDIC 1MM 750MM CRIMP TITANIUM STERILE BOTH IP/OP $919.50 $680.00 $163.64 $934.95 $919.33 $919.33 $919.33 $919.33 $919.33 $919.33 $163.64 $919.33 $919.33 $919.33 $919.33 $919.33 $919.33 $191.60 $919.33 $373.98 $919.33 $919.33 $934.95 $919.33 $919.33 $689.63 $919.33 $919.33 $919.33 $459.67 $459.67 $728.11 $919.33 $735.46 $413.70 $919.33 N/A $533.31 $919.33 $551.60 $919.33 $919.33 $919.33 N/A N/A 498.803S SUP Custom 27203010 498.803S - POSITIONER IMPLANT 4.5MM THREAD CERCLAGE TITANIUM STERILE BOTH IP/OP $343.00 $254.00 $61.05 $348.83 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $61.05 $343.00 $343.00 $254.57 $254.57 $264.38 $178.70 $71.48 $343.00 $139.53 $343.00 $343.00 $348.83 $343.00 $343.00 $257.25 $343.00 $343.00 $343.00 $171.50 $171.50 $271.66 $343.00 $274.40 $222.95 $343.00 N/A $198.94 $343.00 $205.80 $343.00 $343.00 $343.00 N/A N/A 498.806S SUP Custom 27803010 498.806S - SYSTEM CABLE STANDARD REATTACHMENT DEVICE TITANIUM COCR BOTH IP/OP "$3,645.00" "$2,697.00" $648.80 "$3,706.93" "$3,644.95" "$3,644.95" "$3,644.95" "$3,644.95" "$3,644.95" "$3,644.95" $648.80 "$3,644.95" "$3,644.95" "$3,644.95" "$3,644.95" "$3,644.95" "$3,644.95" $759.65 "$3,644.95" "$1,482.77" "$3,644.95" "$3,644.95" "$3,706.93" "$3,644.95" "$3,644.95" "$2,733.75" "$3,644.95" "$3,644.95" "$3,644.95" "$1,822.48" "$1,822.48" "$2,886.80" "$3,644.95" "$2,915.96" "$1,640.23" "$3,644.95" N/A "$2,114.10" "$3,644.95" "$2,186.97" "$3,644.95" "$3,644.95" "$3,644.95" N/A N/A 498.807S SUP Custom 27803010 498.807S - SYSTEM CABLE LONG TITANIUM COCR TROC STERILE REATTACHMENT BOTH IP/OP "$5,252.00" "$3,886.00" $934.80 "$5,340.95" "$5,251.68" "$5,251.68" "$5,251.68" "$5,251.68" "$5,251.68" "$5,251.68" $934.80 "$5,251.68" "$5,251.68" "$5,251.68" "$5,251.68" "$5,251.68" "$5,251.68" "$1,094.51" "$5,251.68" "$2,136.38" "$5,251.68" "$5,251.68" "$5,340.95" "$5,251.68" "$5,251.68" "$3,939.00" "$5,251.68" "$5,251.68" "$5,251.68" "$2,625.84" "$2,625.84" "$4,159.33" "$5,251.68" "$4,201.34" "$2,363.26" "$5,251.68" N/A "$3,046.16" "$5,251.68" "$3,151.01" "$5,251.68" "$5,251.68" "$5,251.68" N/A N/A 498.821S SUP Custom 27803010 498.821S - CABLE ORTHOPEDIC 1MM 750MM NEEDLE CRIMP TITANIUM STERILE BOTH IP/OP "$1,032.00" $764.00 $183.66 "$1,049.33" "$1,031.78" "$1,031.78" "$1,031.78" "$1,031.78" "$1,031.78" "$1,031.78" $183.66 "$1,031.78" "$1,031.78" "$1,031.78" "$1,031.78" "$1,031.78" "$1,031.78" $215.03 "$1,031.78" $419.73 "$1,031.78" "$1,031.78" "$1,049.33" "$1,031.78" "$1,031.78" $774.00 "$1,031.78" "$1,031.78" "$1,031.78" $515.89 $515.89 $817.17 "$1,031.78" $825.42 $464.30 "$1,031.78" N/A $598.56 "$1,031.78" $619.07 "$1,031.78" "$1,031.78" "$1,031.78" N/A N/A 498.822S SUP Custom 27803010 498.822S - CABLE ORTHOPEDIC CRIMP TITANIUM STERILE BOTH IP/OP $68.00 $50.00 $12.07 $68.98 $67.83 $67.83 $67.83 $67.83 $67.83 $67.83 $12.07 $67.83 $67.83 $67.83 $67.83 $67.83 $67.83 $14.14 $67.83 $27.59 $67.83 $67.83 $68.98 $67.83 $67.83 $51.00 $67.83 $67.83 $67.83 $33.92 $33.92 $53.72 $67.83 $54.26 $30.52 $67.83 N/A $39.44 $67.83 $40.70 $67.83 $67.83 $67.83 N/A N/A 498.837S SUP Custom 27203010 498.837S - PIN FIX 3.5MM CERCLAGE POSITION STR TITANIUM ORTHOPEDIC BOTH IP/OP $343.00 $254.00 $61.05 $348.83 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $61.05 $343.00 $343.00 $254.57 $254.57 $264.38 $178.70 $71.48 $343.00 $139.53 $343.00 $343.00 $348.83 $343.00 $343.00 $257.25 $343.00 $343.00 $343.00 $171.50 $171.50 $271.66 $343.00 $274.40 $222.95 $343.00 N/A $198.94 $343.00 $205.80 $343.00 $343.00 $343.00 N/A N/A 498.838S SUP HCPCS C1713 498.838S - PIN FIX 3.5MM THREADED CERCLAGE POSITIONING TITANIUM BOTH IP/OP $343.00 $254.00 $68.08 $348.83 $154.35 $154.35 $154.35 $154.35 $343.00 $343.00 $343.00 $71.49 $343.00 $343.00 $343.00 $343.00 $343.00 $71.48 $343.00 $139.53 $202.88 $343.00 $348.83 $343.00 $343.00 $257.25 $343.00 $343.00 $343.00 $171.50 $171.50 $271.66 $343.00 $274.40 $154.35 $68.08 N/A $198.94 $343.00 $205.80 $343.00 $71.48 $343.00 N/A N/A 498.839S SUP Custom 27203010 498.839S - POSITIONER SURG 4.5MM CERCLAGE NONTHREADED PIN TITANIUM BOTH IP/OP $343.00 $254.00 $61.05 $348.83 $343.00 $343.00 $343.00 $343.00 $343.00 $343.00 $61.05 $343.00 $343.00 $254.57 $254.57 $264.38 $178.70 $71.48 $343.00 $139.53 $343.00 $343.00 $348.83 $343.00 $343.00 $257.25 $343.00 $343.00 $343.00 $171.50 $171.50 $271.66 $343.00 $274.40 $222.95 $343.00 N/A $198.94 $343.00 $205.80 $343.00 $343.00 $343.00 N/A N/A 4981-1-010S SUP Custom 27203010 4981-1-010S - COUPLING EXFIX UNIVERSAL 15/15MM 4 5/15MM HOFFMANN XPRESS BOTH IP/OP $696.50 $515.00 $123.98 $696.50 $696.50 $696.50 $696.50 $696.50 $696.50 $696.50 $123.98 $696.50 $696.50 $516.94 $516.94 $536.86 $362.88 $145.16 $696.50 $278.60 $696.50 $696.50 $696.50 $696.50 $696.50 $522.38 $696.50 $696.50 $696.50 $348.25 $348.25 $551.63 $696.50 $557.20 $452.73 $696.50 N/A $403.97 $696.50 $417.90 $696.50 $696.50 $696.50 N/A N/A 4981-1-020S SUP Custom 27203010 4981-1-020S - COUPLING XTRNFX UNV 5MM 6MM BOTH IP/OP $846.00 $626.00 $150.52 $845.63 $845.63 $845.63 $845.63 $845.63 $845.63 $845.63 $150.52 $845.63 $845.63 $627.63 $627.63 $651.81 $440.57 $176.24 $845.63 $338.25 $845.63 $845.63 $845.63 $845.63 $845.63 $634.50 $845.63 $845.63 $845.63 $422.82 $422.82 $669.74 $845.63 $676.50 $549.66 $845.63 N/A $490.68 $845.63 $507.38 $845.63 $845.63 $845.63 N/A N/A 4A0002 SUP HCPCS C1725 4A0002 - CATHETER ANGIO JR4 CRV 4FR 100CM STSR BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 4A0004 SUP HCPCS C1887 4A0004 - CATHETER ANGIOGRAPHIC JR5 CURVE 4FR 100CM SITESEER BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 4A0010 SUP HCPCS C1725 4A0010 - CATHETER ANGIOGRAPHIC JL3.5 CURVE 4FR 100CM SITESEER BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 4A0011 SUP HCPCS C1725 4A0011 - CATHETER ANGIO JL4 CRV 4FR 100CM STSR BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 4A0012 SUP HCPCS C1725 4A0012 - CATHETER ANGIOGRAPHIC JL5 CURVE 4FR 100CM SITESEER BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 4A002 SUP HCPCS C1887 4A002 - CATHETER GD JR CRV 4FR BOTH IP/OP $17.50 $13.00 $3.47 $17.50 $9.50 $9.50 $9.50 $9.50 $17.50 $17.50 $17.50 $3.65 $17.50 $12.99 $12.99 $13.49 $9.12 $3.65 $17.50 $17.50 $10.35 $17.50 $17.50 $17.50 $17.50 $13.13 $17.50 $17.50 $17.50 $8.75 $8.75 $13.86 $17.50 $14.00 $11.38 $3.47 N/A $10.15 $17.50 $17.50 $17.50 $3.65 $17.50 N/A N/A 4A0022 SUP HCPCS C1725 4A0022 - CATHETER ANGIOGRAPHIC MPA2 CURVE 4FR 100CM 2 SIDEHOLE BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 4DCFN SUP Custom 27203010 4DCFN - TUBE TRCH 4 9.4MM 5MM 62MM STRL LF SHLY CUFLS DISP INR CNN BOTH IP/OP $84.00 $62.00 $14.91 $83.74 $83.74 $83.74 $83.74 $83.74 $83.74 $83.74 $14.91 $83.74 $83.74 $62.15 $62.15 $64.55 $43.63 $17.45 $83.74 $33.50 $83.74 $83.74 $83.74 $83.74 $83.74 $63.00 $83.74 $83.74 $83.74 $41.87 $41.87 $66.32 $83.74 $66.99 $54.43 $83.74 N/A $48.72 $83.74 $50.24 $83.74 $83.74 $83.74 N/A N/A 4DFEN SUP Custom 27203010 4DFEN - TUBE TRCH 4 9.4MM 5MM 62MM STRL LF SHLY CUF DISP INR CNN RND BOTH IP/OP $99.50 $74.00 $17.70 $99.43 $99.43 $99.43 $99.43 $99.43 $99.43 $99.43 $17.70 $99.43 $99.43 $73.80 $73.80 $76.64 $51.80 $20.72 $99.43 $39.77 $99.43 $99.43 $99.43 $99.43 $99.43 $74.63 $99.43 $99.43 $99.43 $49.72 $49.72 $78.75 $99.43 $79.54 $64.63 $99.43 N/A $57.71 $99.43 $59.66 $99.43 $99.43 $99.43 N/A N/A 4MAXC SUP HCPCS C1757 4MAXC - CATHETER REPERFUSION 6-4.3FR .041IN 143CM 4MAX BOTH IP/OP "$3,725.00" "$2,757.00" $739.32 "$3,725.00" "$2,022.68" "$2,022.68" "$2,022.68" "$2,022.68" "$3,725.00" "$3,725.00" "$3,725.00" $776.38 "$3,725.00" "$2,764.70" "$2,764.70" "$2,871.23" "$1,940.73" $776.33 "$3,725.00" "$3,725.00" "$2,203.34" "$3,725.00" "$3,725.00" "$3,725.00" "$3,725.00" "$2,793.75" "$3,725.00" "$3,725.00" "$3,725.00" "$1,862.50" "$1,862.50" "$2,950.20" "$3,725.00" "$2,980.00" "$2,421.25" $739.32 N/A "$2,160.50" "$3,725.00" "$3,725.00" "$3,725.00" $776.29 "$3,725.00" N/A N/A 4MAXCKIT SUP HCPCS C1757 4MAXCKIT - CATHETER REPERFUSION 4MAX BOTH IP/OP "$3,225.00" "$2,387.00" $640.08 "$4,375.00" "$1,751.18" "$1,751.18" "$1,751.18" "$1,751.18" "$3,225.00" "$3,225.00" "$3,225.00" $672.17 "$3,225.00" "$2,393.60" "$2,393.60" "$2,485.83" "$1,680.23" $672.13 "$3,225.00" "$4,375.00" "$1,907.59" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$2,096.25" $640.08 N/A "$1,870.50" "$3,225.00" "$3,225.00" "$3,225.00" $672.09 "$3,225.00" N/A N/A 4N06A SUP Custom 27803010 4N06A - SUTURE NABSB CV-4 TH-26 36IN WHT 2 ARM MFL GRTX BOTH IP/OP $67.50 $50.00 $12.02 $67.50 $67.50 $67.50 $67.50 $67.50 $67.50 $67.50 $12.02 $67.50 $67.50 $67.50 $67.50 $67.50 $67.50 $14.07 $67.50 $27.00 $67.50 $67.50 $67.50 $67.50 $67.50 $50.63 $67.50 $67.50 $67.50 $33.75 $33.75 $53.46 $67.50 $54.00 $30.38 $67.50 N/A $39.15 $67.50 $40.50 $67.50 $67.50 $67.50 N/A N/A 4UN65H SUP Custom 27203010 4UN65H - TUBE TRCH 4 9.4MM 5MM 62MM STRL LF SHLY CUFLS DISP INR CNN BOTH IP/OP $89.00 $66.00 $15.77 $104.53 $88.58 $88.58 $88.58 $88.58 $88.58 $88.58 $15.77 $88.58 $88.58 $65.74 $65.74 $68.28 $46.15 $18.46 $88.58 $41.81 $88.58 $88.58 $104.53 $88.58 $88.58 $66.75 $88.58 $88.58 $88.58 $44.29 $44.29 $70.16 $88.58 $70.86 $57.58 $88.58 N/A $51.62 $88.58 $53.15 $88.58 $88.58 $88.58 N/A N/A 4UN65H SUP Custom 27203010 4UN65H - TUBE TRCH 4 9.4MM 62MM SHLY UNCUF DISP INR CNN BVL TIP INTGR BOTH IP/OP $101.50 $75.00 $15.77 $104.53 $88.58 $88.58 $88.58 $88.58 $88.58 $88.58 $15.77 $88.58 $88.58 $65.74 $65.74 $68.28 $46.15 $18.46 $88.58 $41.81 $88.58 $88.58 $104.53 $88.58 $88.58 $76.13 $88.58 $88.58 $88.58 $44.29 $44.29 $70.16 $88.58 $70.86 $57.58 $88.58 N/A $58.87 $88.58 $53.15 $88.58 $88.58 $88.58 N/A N/A 50000LTS SUP HCPCS C1713 50000LTS - CAP LCK SPRL R90D TI SPNE WDG LCK CLSR MECH BOTH IP/OP $696.50 $515.00 $138.22 $696.43 $313.39 $313.39 $313.39 $313.39 $696.43 $696.43 $696.43 $145.15 $696.43 $696.43 $696.43 $696.43 $696.43 $145.14 $696.43 $278.57 $411.94 $696.43 $696.43 $696.43 $696.43 $522.38 $696.43 $696.43 $696.43 $348.22 $348.22 $551.57 $696.43 $557.14 $313.39 $138.22 N/A $403.97 $696.43 $696.43 $696.43 $145.14 $696.43 N/A N/A 500-01-42A SUP Custom 27803010 500-01-42A - SHELL ACETAB A HEMISPHERICAL 42MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-44B SUP Custom 27803010 500-01-44B - SHELL ACETAB B HEMISPHERICAL 44MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-46C SUP Custom 27803010 500-01-46C - SHELL ACETAB C HEMISPHERICAL 46MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-48D SUP Custom 27803010 500-01-48D - SHELL ACETAB D HEMISPHERICAL 48MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-50D SUP Custom 27803010 500-01-50D - SHELL ACETAB D HEMISPHERICAL 50MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-52E SUP Custom 27803010 500-01-52E - SHELL ACETAB E HEMISPHERICAL 52MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-54E SUP Custom 27803010 500-01-54E - SHELL ACETAB E HEMISPHERICAL 54MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-56F SUP Custom 27803010 500-01-56F - SHELL ACETAB F HEMISPHERICAL 56MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-58F SUP Custom 27803010 500-01-58F - SHELL ACETAB F HEMISPHERICAL 58MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-60G SUP Custom 27803010 500-01-60G - SHELL ACETAB G HEMISPHERICAL 60MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-62G SUP Custom 27803010 500-01-62G - SHELL ACETAB G HEMISPHERICAL 62MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-64H SUP Custom 27803010 500-01-64H - SHELL ACETAB H HEMISPHERICAL 64MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-66H SUP Custom 27803010 500-01-66H - SHELL ACETAB H HEMISPHERICAL 66MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-68I SUP Custom 27803010 500-01-68I - SHELL ACETAB I HEMISPHERICAL 68MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-70I SUP Custom 27803010 500-01-70I - SHELL ACETAB I HEMISPHERICAL 70MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-72J SUP Custom 27803010 500-01-72J - SHELL ACETAB J HEMISPHERICAL 72MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-01-74J SUP Custom 27803010 500-01-74J - SHELL ACETAB J HEMISPHERICAL 74MM SOLID BACK TRIDENT HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-03-44A SUP Custom 27803010 500-03-44A - SHELL ACETAB A HEMISPHERICAL 44MM SOLID BACK TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 500-03-46B SUP Custom 27803010 500-03-46B - SHELL ACETAB B HEMISPHERICAL 46MM SOLID BACK TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 500-03-48C SUP Custom 27803010 500-03-48C - SHELL ACETAB C HEMISPHERICAL 48MM SOLID BACK TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 500-03-50D SUP Custom 27803010 500-03-50D - SHELL ACETAB D HEMISPHERICAL 50MM SOLID BACK TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 500-03-52D SUP Custom 27803010 500-03-52D - SHELL ACETAB D HEMISPHERICAL 52MM SOLID BACK TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 500-03-54E SUP Custom 27803010 500-03-54E - SHELL ACETAB E HEMISPHERICAL 54MM SOLID BACK PRIM TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 500-03-56E SUP Custom 27803010 500-03-56E - SHELL ACETAB E HEMISPHERICAL 56MM SOLID BACK PRIM TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 500-03-58F SUP Custom 27803010 500-03-58F - SHELL ACETAB F HEMISPHERICAL 58MM SOLID BACK PRIM TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 500-03-60F SUP Custom 27803010 500-03-60F - SHELL ACETAB F HEMISPHERICAL 60MM SOLID BACK PRIM TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 500-03-62G SUP Custom 27803010 500-03-62G - SHELL ACETAB F HEMISPHERICAL 60MM SOLID BACK PRIM TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 500-03-64G SUP Custom 27803010 500-03-64G - SHELL ACETAB G HEMISPHERICAL 64MM SOLID BACK PRIM TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 500-03-66H SUP Custom 27803010 500-03-66H - SHELL ACETAB H HEMISPHERICAL 66MM SOLID BACK PRIM TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 5000L SUP Custom 27803010 5000L - CONNECTOR ROD LNG SPRL R90D VAR CX TI SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 5000M SUP Custom 27803010 5000M - CONNECTOR ROD MED SPRL R90D VAR CX TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 5000S SUP Custom 27803010 5000S - CONNECTOR ROD SM SPRL R90D VAR CX TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 50010X SUP Custom 27803010 50010X - CONNECTOR ROD 10MM SPRL R90D FX CX TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 500-11-42A SUP Custom 27803010 500-11-42A - SHELL ACETAB A HEMISPHERICAL 42MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-44B SUP Custom 27803010 500-11-44B - SHELL ACETAB B HEMISPHERICAL 44MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-46C SUP Custom 27803010 500-11-46C - SHELL ACETAB C HEMISPHERICAL 46MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-48D SUP Custom 27803010 500-11-48D - SHELL ACETAB D HEMISPHERICAL 48MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-50D SUP Custom 27803010 500-11-50D - SHELL ACETAB D HEMISPHERICAL 50MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-52E SUP Custom 27803010 500-11-52E - SHELL ACETAB E HEMISPHERICAL 52MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-54E SUP Custom 27803010 500-11-54E - SHELL ACETAB E HEMISPHERICAL 54MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-56F SUP Custom 27803010 500-11-56F - SHELL ACETAB F HEMISPHERICAL 56MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-58F SUP Custom 27803010 500-11-58F - SHELL ACETAB F HEMISPHERICAL 58MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-60G SUP Custom 27803010 500-11-60G - SHELL ACETAB G HEMISPHERICAL 60MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-62G SUP Custom 27803010 500-11-62G - SHELL ACETAB G HEMISPHERICAL 62MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-64H SUP Custom 27803010 500-11-64H - SHELL ACETAB H HEMISPHERICAL 64MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-66H SUP Custom 27803010 500-11-66H - SHELL ACETAB H HEMISPHERICAL 66MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-68I SUP Custom 27803010 500-11-68I - SHELL ACETAB I HEMISPHERICAL 68MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-70I SUP Custom 27803010 500-11-70I - SHELL ACETAB I HEMISPHERICAL 70MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-72J SUP Custom 27803010 500-11-72J - SHELL ACETAB J HEMISPHERICAL 72MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 500-11-74J SUP Custom 27803010 500-11-74J - SHELL ACETAB J HEMISPHERICAL 74MM SOLID BACK TRIDENT METAL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 50012X SUP Custom 27803010 50012X - CONNECTOR ROD 12MM SPRL R90D FX CX TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 50014X SUP Custom 27803010 50014X - CONNECTOR ROD 14MM SPRL R90D FX CX TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 50016X SUP Custom 27803010 50016X - CONNECTOR ROD 16MM SPRL R90D FX CX TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 50018X SUP Custom 27803010 50018X - CONNECTOR ROD 18MM SPRL R90D FX CX TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 50020X SUP Custom 27803010 50020X - CONNECTOR ROD 20MM SPRL R90D VAR CX TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 50-022-01-07 SUP Custom 27100030 50-022-01-07 - DRILL TWIST 2.7MM 2.2MM 70MM J NOTCH GLIDING 2.7MM SCREW 2.1 BOTH IP/OP $290.50 $215.00 $51.63 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $51.63 $290.05 $290.05 $215.28 $215.28 $223.57 $151.12 $60.45 $290.05 $116.02 $290.05 $290.05 $290.05 $290.05 $290.05 $217.88 $290.05 $290.05 $290.05 $145.03 $145.03 $229.72 $290.05 $232.04 $188.53 $290.05 N/A $168.49 $290.05 $174.03 $290.05 $290.05 $290.05 N/A N/A 50-022-15-07 SUP Custom 27100030 50-022-15-07 - DRILL TWIST 2.2MM 115MM STERILE BOTH IP/OP $290.50 $215.00 $51.63 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $51.63 $290.05 $290.05 $215.28 $215.28 $223.57 $151.12 $60.45 $290.05 $116.02 $290.05 $290.05 $290.05 $290.05 $290.05 $217.88 $290.05 $290.05 $290.05 $145.03 $145.03 $229.72 $290.05 $232.04 $188.53 $290.05 N/A $168.49 $290.05 $174.03 $290.05 $290.05 $290.05 N/A N/A 50022X SUP Custom 27803010 50022X - CONNECTOR ROD 22MM SPRL R90D VAR CX TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 50024X SUP Custom 27803010 50024X - CONNECTOR ROD 24MM SPRL R90D VAR CX TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 50026X SUP Custom 27803010 50026X - CONNECTOR ROD 26MM SPRL R90D CX TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 50028X SUP Custom 27803010 50028X - CONNECTOR ROD 28MM SPRL R90D CX TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 50030X SUP Custom 27803010 50030X - CONNECTOR ROD 30MM SPRL R90D CX TI THORLMBR SPNE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 5005 A SUP Custom 27803010 5005 A - CATHETER DRAIN STANDARD RIGHT ANG 7CM VENTRICLE BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 5005 B SUP Custom 27803010 5005 B - CATHETER DRAIN STANDARD ANGLE RIGHT 2.5MM 1.3MM 9CM BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 5005 C SUP Custom 27803010 5005 C - CATHETER DRAIN STANDARD ANGLE RIGHT 11CM VENTRICLE BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 5005 E SUP Custom 27803010 5005 E - CATHETER DRAIN STANDARD RIGHT ANG 5CM VENTRICLE BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 5005 F SUP Custom 27803010 5005 F - CATHETER DRAIN STANDARD RIGHT ANG 4CM VENTRICLE BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 5005 G SUP Custom 27803010 5005 G - CATHETER DRAIN STANDARD RIGHT ANG 6CM VENTRICLE BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 5005 H SUP Custom 27803010 5005 H - CATHETER DRAIN ANGLE RIGHT STANDARD 10CM VENTRICLE BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 5005 I SUP Custom 27803010 5005 I - CATHETER DRAIN ANGLE RIGHT STANDARD 8CM VENTRICLE BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 500-580C-10U SUP Custom 27803010 500-580C-10U - DEVICE HMSTS 5-7FR CARDIVA CTLST II INTRO SHTH NTR ELC RECL BOTH IP/OP $375.00 $278.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $375.00 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 500-580C-10U SUP Custom 27803010 500-580C-10U - CLIP HMSTS 5FR BMRNG CTLST 2 SYS ART VASC CATH ACCES ST BOTH IP/OP $375.00 $278.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $375.00 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A 50100-1500 SUP HCPCS C1884 50100-1500 - SHEATH RTRVL 4FR F EZ .014IN BNTP BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $90.00 $90.00 $90.00 $90.00 $200.00 $200.00 $200.00 $41.69 $200.00 $200.00 $200.00 $200.00 $200.00 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $90.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A 50-12003 SUP HCPCS C1713 50-12003 - SCREW BONE 1.2MM 3MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL BOTH IP/OP $28.00 $21.00 $5.51 $27.75 $12.49 $12.49 $12.49 $12.49 $27.75 $27.75 $27.75 $5.78 $27.75 $27.75 $27.75 $27.75 $27.75 $5.78 $27.75 $27.75 $16.41 $27.75 $27.75 $27.75 $27.75 $21.00 $27.75 $27.75 $27.75 $13.88 $13.88 $21.98 $27.75 $22.20 $12.49 $5.51 N/A $16.24 $27.75 $27.75 $27.75 $5.78 $27.75 N/A N/A 50-12004 SUP HCPCS C1713 50-12004 - SCREW BONE 1.2MM 4MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL BOTH IP/OP $277.50 $205.00 $55.08 $277.50 $124.88 $124.88 $124.88 $124.88 $277.50 $277.50 $277.50 $57.84 $277.50 $277.50 $277.50 $277.50 $277.50 $57.83 $277.50 $111.00 $164.14 $277.50 $277.50 $277.50 $277.50 $208.13 $277.50 $277.50 $277.50 $138.75 $138.75 $219.78 $277.50 $222.00 $124.88 $55.08 N/A $160.95 $277.50 $277.50 $277.50 $57.83 $277.50 N/A N/A 50-12005 SUP HCPCS C1713 50-12005 - SCREW BONE 1.2MM 5MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL BOTH IP/OP $277.50 $205.00 $55.08 $277.50 $124.88 $124.88 $124.88 $124.88 $277.50 $277.50 $277.50 $57.84 $277.50 $277.50 $277.50 $277.50 $277.50 $57.83 $277.50 $277.50 $164.14 $277.50 $277.50 $277.50 $277.50 $208.13 $277.50 $277.50 $277.50 $138.75 $138.75 $219.78 $277.50 $222.00 $124.88 $55.08 N/A $160.95 $277.50 $166.50 $277.50 $57.83 $277.50 N/A N/A 50-12006 SUP HCPCS C1713 50-12006 - SCREW BONE 1.2MM 6MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL BOTH IP/OP $277.50 $205.00 $55.08 $277.50 $124.88 $124.88 $124.88 $124.88 $277.50 $277.50 $277.50 $57.84 $277.50 $277.50 $277.50 $277.50 $277.50 $57.83 $277.50 $277.50 $164.14 $277.50 $277.50 $277.50 $277.50 $208.13 $277.50 $277.50 $277.50 $138.75 $138.75 $219.78 $277.50 $222.00 $124.88 $55.08 N/A $160.95 $277.50 $166.50 $277.50 $57.83 $277.50 N/A N/A 50-12007 SUP HCPCS C1713 50-12007 - SCREW BONE 1.2MM 7MM SLFTAP TITANIUM UPPERFACIAL BOTH IP/OP $111.50 $83.00 $22.08 $111.25 $50.06 $50.06 $50.06 $50.06 $111.25 $111.25 $111.25 $23.19 $111.25 $111.25 $111.25 $111.25 $111.25 $23.19 $111.25 $44.50 $65.80 $111.25 $111.25 $111.25 $111.25 $83.63 $111.25 $111.25 $111.25 $55.63 $55.63 $88.11 $111.25 $89.00 $50.06 $22.08 N/A $64.67 $111.25 $111.25 $111.25 $23.18 $111.25 N/A N/A 50-12008 SUP HCPCS C1713 50-12008 - SCREW BONE 1.2MM 8MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL BOTH IP/OP $111.50 $83.00 $22.08 $111.25 $50.06 $50.06 $50.06 $50.06 $111.25 $111.25 $111.25 $23.19 $111.25 $111.25 $111.25 $111.25 $111.25 $23.19 $111.25 $111.25 $65.80 $111.25 $111.25 $111.25 $111.25 $83.63 $111.25 $111.25 $111.25 $55.63 $55.63 $88.11 $111.25 $89.00 $50.06 $22.08 N/A $64.67 $111.25 $111.25 $111.25 $23.18 $111.25 N/A N/A 50-12010 SUP HCPCS C1713 50-12010 - SCREW BONE 1.2MM 10MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL BOTH IP/OP $111.50 $83.00 $22.08 $111.25 $50.06 $50.06 $50.06 $50.06 $111.25 $111.25 $111.25 $23.19 $111.25 $111.25 $111.25 $111.25 $111.25 $23.19 $111.25 $44.50 $65.80 $111.25 $111.25 $111.25 $111.25 $83.63 $111.25 $111.25 $111.25 $55.63 $55.63 $88.11 $111.25 $89.00 $50.06 $22.08 N/A $64.67 $111.25 $111.25 $111.25 $23.18 $111.25 N/A N/A 50-12012 SUP HCPCS C1713 50-12012 - SCREW BONE 1.2MM 12MM SLFTAP XPIN GOLD TITANIUM UPPERFACIAL BOTH IP/OP $111.50 $83.00 $22.08 $111.25 $50.06 $50.06 $50.06 $50.06 $111.25 $111.25 $111.25 $23.19 $111.25 $111.25 $111.25 $111.25 $111.25 $23.19 $111.25 $44.50 $65.80 $111.25 $111.25 $111.25 $111.25 $83.63 $111.25 $111.25 $111.25 $55.63 $55.63 $88.11 $111.25 $89.00 $50.06 $22.08 N/A $64.67 $111.25 $111.25 $111.25 $23.18 $111.25 N/A N/A 50-12903 SUP HCPCS C1713 50-12903 - SCREW BONE 1.2MM 3MM SLFDRILL XPIN HEAD LEIBINGER UNIVERSAL BOTH IP/OP $312.50 $231.00 $172.56 $869.45 $391.25 $391.25 $391.25 $391.25 $869.45 $869.45 $869.45 $181.22 $869.45 $869.45 $869.45 $869.45 $869.45 $181.20 $869.45 $347.78 $514.28 $869.45 $869.45 $869.45 $869.45 $234.38 $869.45 $869.45 $869.45 $434.73 $434.73 $688.60 $869.45 $695.56 $391.25 $172.56 N/A $181.25 $869.45 $869.45 $869.45 $181.19 $869.45 N/A N/A 50-12903 SUP HCPCS C1713 50-12903 - SCREW BN 1.2MM 3MM NS LEIBINGER UNV 2 SLF DRL XPN TI UPFC BOTH IP/OP $869.50 $643.00 $172.56 $869.45 $391.25 $391.25 $391.25 $391.25 $869.45 $869.45 $869.45 $181.22 $869.45 $869.45 $869.45 $869.45 $869.45 $181.20 $869.45 $347.78 $514.28 $869.45 $869.45 $869.45 $869.45 $652.13 $869.45 $869.45 $869.45 $434.73 $434.73 $688.60 $869.45 $695.56 $391.25 $172.56 N/A $504.31 $869.45 $869.45 $869.45 $181.19 $869.45 N/A N/A 50-12904 SUP HCPCS C1713 50-12904 - SCREW BONE 1.2MM 4MM SELF DRILL XPIN TITANIUM UPPERFACIAL BOTH IP/OP $62.50 $46.00 $12.40 $62.50 $28.13 $28.13 $28.13 $28.13 $62.50 $62.50 $62.50 $13.03 $62.50 $62.50 $62.50 $62.50 $62.50 $13.03 $62.50 $62.50 $36.97 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $28.13 $12.40 N/A $36.25 $62.50 $37.50 $62.50 $13.03 $62.50 N/A N/A 5013-2-120S SUP HCPCS C1713 5013-2-120S - PIN FIX 4MM 120MM 20MM SLFTAP DRILLING THREAD SHAFT APEX HA BOTH IP/OP $229.00 $169.00 $45.38 $228.65 $102.89 $102.89 $102.89 $102.89 $228.65 $228.65 $228.65 $47.66 $228.65 $228.65 $228.65 $228.65 $228.65 $47.65 $228.65 $91.46 $135.25 $228.65 $228.65 $228.65 $228.65 $171.75 $228.65 $228.65 $228.65 $114.33 $114.33 $181.09 $228.65 $182.92 $102.89 $45.38 N/A $132.82 $228.65 $228.65 $228.65 $47.65 $228.65 N/A N/A 5013-3-090S SUP HCPCS C1713 5013-3-090S - PIN FIX 4MM 90MM 30MM SLFTAP DRILLING THREAD SHAFT APEX HA BOTH IP/OP $229.00 $169.00 $45.38 $228.65 $102.89 $102.89 $102.89 $102.89 $228.65 $228.65 $228.65 $47.66 $228.65 $228.65 $228.65 $228.65 $228.65 $47.65 $228.65 $91.46 $135.25 $228.65 $228.65 $228.65 $228.65 $171.75 $228.65 $228.65 $228.65 $114.33 $114.33 $181.09 $228.65 $182.92 $102.89 $45.38 N/A $132.82 $228.65 $228.65 $228.65 $47.65 $228.65 N/A N/A 50-14003 SUP HCPCS C1713 50-14003 - SCREW BONE 1.4MM 3MM SELF TAP XPIN EMERGENCY TITANIUM BOTH IP/OP $282.50 $209.00 $56.07 $282.50 $127.13 $127.13 $127.13 $127.13 $282.50 $282.50 $282.50 $58.88 $282.50 $282.50 $282.50 $282.50 $282.50 $58.88 $282.50 $282.50 $167.10 $282.50 $282.50 $282.50 $282.50 $211.88 $282.50 $282.50 $282.50 $141.25 $141.25 $223.74 $282.50 $226.00 $127.13 $56.07 N/A $163.85 $282.50 $169.50 $282.50 $58.87 $282.50 N/A N/A 50-14005 SUP HCPCS C1713 50-14005 - SCREW BONE 1.4MM 5MM SELF TAP XPIN HEAD EMERGENCY LEIBINGER BOTH IP/OP $282.50 $209.00 $56.07 $282.50 $127.13 $127.13 $127.13 $127.13 $282.50 $282.50 $282.50 $58.88 $282.50 $282.50 $282.50 $282.50 $282.50 $58.88 $282.50 $113.00 $167.10 $282.50 $282.50 $282.50 $282.50 $211.88 $282.50 $282.50 $282.50 $141.25 $141.25 $223.74 $282.50 $226.00 $127.13 $56.07 N/A $163.85 $282.50 $169.50 $282.50 $58.87 $282.50 N/A N/A 50-14007 SUP HCPCS C1713 50-14007 - SCREW BONE 1.4MM 7MM SLFTAP XPIN EMERGENCY TITANIUM BOTH IP/OP $120.50 $89.00 $23.89 $120.38 $54.17 $54.17 $54.17 $54.17 $120.38 $120.38 $120.38 $25.09 $120.38 $120.38 $120.38 $120.38 $120.38 $25.09 $120.38 $48.15 $71.20 $120.38 $120.38 $120.38 $120.38 $90.38 $120.38 $120.38 $120.38 $60.19 $60.19 $95.34 $120.38 $96.30 $54.17 $23.89 N/A $69.89 $120.38 $120.38 $120.38 $25.09 $120.38 N/A N/A 50-14009 SUP HCPCS C1713 50-14009 - SCREW BONE 1.4MM 9MM SLFTAP XPIN EMERGENCY TITANIUM BOTH IP/OP $120.50 $89.00 $23.89 $120.38 $54.17 $54.17 $54.17 $54.17 $120.38 $120.38 $120.38 $25.09 $120.38 $120.38 $120.38 $120.38 $120.38 $25.09 $120.38 $48.15 $71.20 $120.38 $120.38 $120.38 $120.38 $90.38 $120.38 $120.38 $120.38 $60.19 $60.19 $95.34 $120.38 $96.30 $54.17 $23.89 N/A $69.89 $120.38 $120.38 $120.38 $120.38 $120.38 N/A N/A 5014-2-120S SUP HCPCS C1713 5014-2-120S - PIN FIX 6MM 120MM 30MM SLFTAP/DRILLING THREAD SHAFT APEX HA BOTH IP/OP $260.00 $192.00 $51.58 $259.88 $116.95 $116.95 $116.95 $116.95 $259.88 $259.88 $259.88 $54.17 $259.88 $259.88 $259.88 $259.88 $259.88 $54.16 $259.88 $259.88 $153.72 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $116.95 $51.58 N/A $150.80 $259.88 $155.93 $259.88 $54.16 $259.88 N/A N/A 5014-3-150S SUP HCPCS C1713 5014-3-150S - PIN FIX 6MM 150MM 30MM SLFTAP/DRILLING THREAD SHAFT APEX HA BOTH IP/OP $260.00 $192.00 $51.58 $259.88 $116.95 $116.95 $116.95 $116.95 $259.88 $259.88 $259.88 $54.17 $259.88 $259.88 $259.88 $259.88 $259.88 $54.16 $259.88 $259.88 $153.72 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $116.95 $51.58 N/A $150.80 $259.88 $155.93 $259.88 $54.16 $259.88 N/A N/A 5014-3-180S SUP HCPCS C1713 5014-3-180S - PIN HALF 6MM 180MM 30MM SLFDRILL SLFTAP THREADED SHAFT APEX BOTH IP/OP $260.00 $192.00 $51.58 $259.88 $116.95 $116.95 $116.95 $116.95 $259.88 $259.88 $259.88 $54.17 $259.88 $259.88 $259.88 $259.88 $259.88 $54.16 $259.88 $259.88 $153.72 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $116.95 $51.58 N/A $150.80 $259.88 $155.93 $259.88 $54.16 $259.88 N/A N/A 5014-3-200S SUP HCPCS C1713 5014-3-200S - PIN FIX 6MM 200MM 30MM SLFTAP/DRILLING THREAD SHAFT APEX HA BOTH IP/OP $268.50 $199.00 $53.22 $268.13 $120.66 $120.66 $120.66 $120.66 $268.13 $268.13 $268.13 $55.88 $268.13 $268.13 $268.13 $268.13 $268.13 $55.88 $268.13 $268.13 $158.60 $268.13 $268.13 $268.13 $268.13 $201.38 $268.13 $268.13 $268.13 $134.07 $134.07 $212.36 $268.13 $214.50 $120.66 $53.22 N/A $155.73 $268.13 $160.88 $268.13 $55.88 $268.13 N/A N/A 5014-4-150S SUP HCPCS C1713 5014-4-150S - PIN FIX 6MM 150MM 40MM SLFTAP/DRILLING THREAD SHAFT APEX HA BOTH IP/OP $260.00 $192.00 $51.58 $259.88 $116.95 $116.95 $116.95 $116.95 $259.88 $259.88 $259.88 $54.17 $259.88 $259.88 $259.88 $259.88 $259.88 $54.16 $259.88 $259.88 $153.72 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $116.95 $51.58 N/A $150.80 $259.88 $155.93 $259.88 $54.16 $259.88 N/A N/A 5014-4-180S SUP HCPCS C1713 5014-4-180S - PIN HALF 6MM 180MM 40MM SLFDRILL SLFTAP APEX HA STAINLESS BOTH IP/OP $260.00 $192.00 $51.58 $259.88 $116.95 $116.95 $116.95 $116.95 $259.88 $259.88 $259.88 $54.17 $259.88 $259.88 $259.88 $259.88 $259.88 $54.16 $259.88 $259.88 $153.72 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $116.95 $51.58 N/A $150.80 $259.88 $259.88 $259.88 $54.16 $259.88 N/A N/A 5014-4-200S SUP HCPCS C1713 5014-4-200S - PIN FIX 6MM 200MM 40MM SLFTAP/DRILLING THREAD SHAFT APEX HA BOTH IP/OP $268.50 $199.00 $53.22 $268.13 $120.66 $120.66 $120.66 $120.66 $268.13 $268.13 $268.13 $55.88 $268.13 $268.13 $268.13 $268.13 $268.13 $55.88 $268.13 $268.13 $158.60 $268.13 $268.13 $268.13 $268.13 $201.38 $268.13 $268.13 $268.13 $134.07 $134.07 $212.36 $268.13 $214.50 $120.66 $53.22 N/A $155.73 $268.13 $268.13 $268.13 $55.88 $268.13 N/A N/A 5014-5-150S SUP HCPCS C1713 5014-5-150S - PIN HALF 6MM 150MM 50MM SLFDRILL SLFTAP APEX HA STAINLESS BOTH IP/OP $260.00 $192.00 $51.58 $259.88 $116.95 $116.95 $116.95 $116.95 $259.88 $259.88 $259.88 $54.17 $259.88 $259.88 $259.88 $259.88 $259.88 $54.16 $259.88 $259.88 $153.72 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $116.95 $51.58 N/A $150.80 $259.88 $155.93 $259.88 $54.16 $259.88 N/A N/A 5014-5-180S SUP HCPCS C1713 5014-5-180S - PIN HALF 6MM 180MM 50MM SLFDRILL SLFTAP THREADED SHAFT APEX BOTH IP/OP $260.00 $192.00 $51.58 $259.88 $116.95 $116.95 $116.95 $116.95 $259.88 $259.88 $259.88 $54.17 $259.88 $259.88 $259.88 $259.88 $259.88 $54.16 $259.88 $259.88 $153.72 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $116.95 $51.58 N/A $150.80 $259.88 $155.93 $259.88 $54.16 $259.88 N/A N/A 5014-5-200S SUP HCPCS C1713 5014-5-200S - PIN FIX 6MM 200MM 50MM SLFTAP/DRILLING THREAD SHAFT APEX HA BOTH IP/OP $268.50 $199.00 $53.22 $268.13 $120.66 $120.66 $120.66 $120.66 $268.13 $268.13 $268.13 $55.88 $268.13 $268.13 $268.13 $268.13 $268.13 $55.88 $268.13 $268.13 $158.60 $268.13 $268.13 $268.13 $268.13 $201.38 $268.13 $268.13 $268.13 $134.07 $134.07 $212.36 $268.13 $214.50 $120.66 $53.22 N/A $155.73 $268.13 $160.88 $268.13 $268.13 $268.13 N/A N/A 5014-6-150S SUP HCPCS C1713 5014-6-150S - PIN FIX 6MM 150MM 60MM SLFTAP/DRILLING THREAD SHAFT APEX HA BOTH IP/OP $260.00 $192.00 $51.58 $259.88 $116.95 $116.95 $116.95 $116.95 $259.88 $259.88 $259.88 $54.17 $259.88 $259.88 $259.88 $259.88 $259.88 $54.16 $259.88 $259.88 $153.72 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $116.95 $51.58 N/A $150.80 $259.88 $155.93 $259.88 $259.88 $259.88 N/A N/A 5014-6-180S SUP HCPCS C1713 5014-6-180S - PIN FIX 6MM 180MM 60MM SLFTAP/DRILLING THREAD SHAFT APEX HA BOTH IP/OP $260.00 $192.00 $51.58 $259.88 $116.95 $116.95 $116.95 $116.95 $259.88 $259.88 $259.88 $54.17 $259.88 $259.88 $259.88 $259.88 $259.88 $54.16 $259.88 $259.88 $153.72 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $116.95 $51.58 N/A $150.80 $259.88 $155.93 $259.88 $259.88 $259.88 N/A N/A 5014-6-200S SUP HCPCS C1713 5014-6-200S - PIN FIX 6MM 200MM 60MM SLFTAP/DRILLING THREAD SHAFT APEX HA BOTH IP/OP $268.50 $199.00 $53.22 $268.13 $120.66 $120.66 $120.66 $120.66 $268.13 $268.13 $268.13 $55.88 $268.13 $268.13 $268.13 $268.13 $268.13 $55.88 $268.13 $268.13 $158.60 $268.13 $268.13 $268.13 $268.13 $201.38 $268.13 $268.13 $268.13 $134.07 $134.07 $212.36 $268.13 $214.50 $120.66 $53.22 N/A $155.73 $268.13 $160.88 $268.13 $55.88 $268.13 N/A N/A 5014-7-250S SUP HCPCS C1713 5014-7-250S - PIN HALF 6MM 250MM 70MM SELF DRILL SELF TAP THREAD APEX BOTH IP/OP $275.00 $204.00 $54.58 $275.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $275.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A 5014-8-150S SUP HCPCS C1713 5014-8-150S - PIN FIX 6MM 150MM 25MM SLFDRILL SLFTAP THREAD SHAFT APEX HA BOTH IP/OP $260.00 $192.00 $51.58 $259.88 $116.95 $116.95 $116.95 $116.95 $259.88 $259.88 $259.88 $54.17 $259.88 $259.88 $259.88 $259.88 $259.88 $54.16 $259.88 $259.88 $153.72 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $116.95 $51.58 N/A $150.80 $259.88 $155.93 $259.88 $259.88 $259.88 N/A N/A 5014-8-250S SUP HCPCS C1713 5014-8-250S - PIN FIX 6MM 150MM 80MM SLFDRILL SLFTAP THREAD SHAFT APEX HA BOTH IP/OP $275.00 $204.00 $54.58 $275.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $275.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A 5014-9-250S SUP HCPCS C1713 5014-9-250S - PIN FIX 6MM 250MM 90MM SLFDRILL SLFTAP THREAD SHAFT APEX HA BOTH IP/OP $275.00 $204.00 $54.58 $275.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $275.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $165.00 $275.00 $57.31 $275.00 N/A N/A 50-15006 SUP HCPCS C1713 50-15006 - SCREW BN 1.5MM 6MM ST CROSSPIN TI CRNMXF BOTH IP/OP $141.00 $104.00 $27.92 $140.68 $63.31 $63.31 $63.31 $63.31 $140.68 $140.68 $140.68 $29.32 $140.68 $140.68 $140.68 $140.68 $140.68 $29.32 $140.68 $140.68 $83.21 $140.68 $140.68 $140.68 $140.68 $105.75 $140.68 $140.68 $140.68 $70.34 $70.34 $111.42 $140.68 $112.54 $63.31 $27.92 N/A $81.78 $140.68 $84.41 $140.68 $29.32 $140.68 N/A N/A 5015-3-120 SUP HCPCS C1713 5015-3-120 - SCREW BONE THREADED 5MM 120MM 35MM APEX CANCELLOUS BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A 5015-4-150 SUP HCPCS C1713 5015-4-150 - PIN FIX 5MM 150MM 40MM APEX TITANIUM CANCELLOUS BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A 5015-5-150 SUP HCPCS C1713 5015-5-150 - SCREW BONE THREADED 5MM 150MM 50MM APEX CANCELLOUS BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A 5015-6-180 SUP HCPCS C1713 5015-6-180 - SCREW BONE 5MM 180MM 60MM APEX STAINLESS STEEL CANCELLOUS BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A 5015-7-250 SUP HCPCS C1713 5015-7-250 - PIN HALF 5MM 250MM 70MM THREAD APEX HOFFMANN II STAINLESS BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A 50-15904 SUP HCPCS C1713 50-15904 - SCREW BONE 1.5MM 4MM SELF DRILL XPIN HEAD TITANIUM BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 50-15905 SUP HCPCS C1713 50-15905 - SCREW BONE 1.5MM 5MM SELF DRILL XPIN HEAD TITANIUM BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 5016-5-111 SUP HCPCS C1713 5016-5-111 - PIN HALF 5MMX120MM 35MM THREADS SELF-DRILLING SELF-TAPPING BOTH IP/OP $237.50 $176.00 $47.07 $237.15 $106.72 $106.72 $106.72 $106.72 $237.15 $237.15 $237.15 $49.43 $237.15 $237.15 $237.15 $237.15 $237.15 $49.42 $237.15 $94.86 $140.27 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $106.72 $47.07 N/A $137.75 $237.15 $142.29 $237.15 $49.42 $237.15 N/A N/A 5016-5-117 SUP HCPCS C1713 5016-5-117 - PIN FIX 5MM 150MM 40MM SLFDRILL SLFTAP APEX TITANIUM BOTH IP/OP $237.50 $176.00 $47.07 $237.15 $106.72 $106.72 $106.72 $106.72 $237.15 $237.15 $237.15 $49.43 $237.15 $237.15 $237.15 $237.15 $237.15 $49.42 $237.15 $94.86 $140.27 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $106.72 $47.07 N/A $137.75 $237.15 $142.29 $237.15 $49.42 $237.15 N/A N/A 5016-5-118 SUP HCPCS C1713 5016-5-118 - PIN HALF 50MM 5MMX150MM SELF-DRILLING SELF-TAPPING FOR EXFIX BOTH IP/OP $237.50 $176.00 $47.07 $237.15 $106.72 $106.72 $106.72 $106.72 $237.15 $237.15 $237.15 $49.43 $237.15 $237.15 $237.15 $237.15 $237.15 $49.42 $237.15 $237.15 $140.27 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $106.72 $47.07 N/A $137.75 $237.15 $237.15 $237.15 $49.42 $237.15 N/A N/A 5016-5-122 SUP HCPCS C1713 5016-5-122 - PIN HALF 50MM 5MMX180MM SELF-DRILLING SELF-TAPPING FOR EXFIX BOTH IP/OP $237.50 $176.00 $47.07 $237.15 $106.72 $106.72 $106.72 $106.72 $237.15 $237.15 $237.15 $49.43 $237.15 $237.15 $237.15 $237.15 $237.15 $49.42 $237.15 $94.86 $140.27 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $106.72 $47.07 N/A $137.75 $237.15 $237.15 $237.15 $49.42 $237.15 N/A N/A 50-17003 SUP HCPCS C1713 50-17003 - SCREW BONE 1.7MM 3MM SLFTAP XPIN TITANIUM MIDFAC BOTH IP/OP $49.50 $37.00 $9.82 $49.50 $22.28 $22.28 $22.28 $22.28 $49.50 $49.50 $49.50 $10.32 $49.50 $49.50 $49.50 $49.50 $49.50 $10.32 $49.50 $49.50 $29.28 $49.50 $49.50 $49.50 $49.50 $37.13 $49.50 $49.50 $49.50 $24.75 $24.75 $39.20 $49.50 $39.60 $22.28 $9.82 N/A $28.71 $49.50 $49.50 $49.50 $10.32 $49.50 N/A N/A 50-17004 SUP HCPCS C1713 50-17004 - SCREW BONE 1.7MM 4MM SLFTAP XPIN TITANIUM MIDFAC BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 50-17006 SUP HCPCS C1713 50-17006 - SCREW BONE 1.7MM 6MM SLFTAP XPIN TITANIUM MIDFAC BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $148.50 $247.50 $51.58 $247.50 N/A N/A 50-17007 SUP HCPCS C1713 50-17007 - SCREW BONE 1.7MM 7MM SLFTAP XPIN TITANIUM MIDFAC BOTH IP/OP $94.50 $70.00 $18.71 $94.25 $42.41 $42.41 $42.41 $42.41 $94.25 $94.25 $94.25 $19.64 $94.25 $94.25 $94.25 $94.25 $94.25 $19.64 $94.25 $37.70 $55.75 $94.25 $94.25 $94.25 $94.25 $70.88 $94.25 $94.25 $94.25 $47.13 $47.13 $74.65 $94.25 $75.40 $42.41 $18.71 N/A $54.81 $94.25 $94.25 $94.25 $19.64 $94.25 N/A N/A 50-17008 SUP HCPCS C1713 50-17008 - SCREW BONE 1.7MM 8MM SELF TAP XPIN TITANIUM MIDFAC BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $148.50 $247.50 $51.58 $247.50 N/A N/A 50-17010 SUP HCPCS C1713 50-17010 - SCREW BONE 1.7MM 10MM SELF TAP XPIN TITANIUM MIDFAC BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $148.50 $247.50 $51.58 $247.50 N/A N/A 50-17012 SUP HCPCS C1713 50-17012 - SCREW BONE 1.7MM 12MM SLFTAP XPIN TITANIUM MIDFAC BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 5017-2-150S SUP HCPCS C1713 5017-2-150S - PIN FIX 5MM 150MM 20MM SLFDRILL SLFTAP THREAD SHAFT APEX HA BOTH IP/OP $253.00 $187.00 $50.21 $253.00 $113.85 $113.85 $113.85 $113.85 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $149.65 $253.00 $253.00 $253.00 $253.00 $189.75 $253.00 $253.00 $253.00 $126.50 $126.50 $200.38 $253.00 $202.40 $113.85 $50.21 N/A $146.74 $253.00 $151.80 $253.00 $253.00 $253.00 N/A N/A 50-17304 SUP HCPCS C1713 50-17304 - SCREW BN 1.7MM 4MM NS UNV NEURO 2 ST XPN ER CRNMXF BOTH IP/OP $126.00 $93.00 $24.95 $125.70 $56.57 $56.57 $56.57 $56.57 $125.70 $125.70 $125.70 $26.20 $125.70 $125.70 $125.70 $125.70 $125.70 $26.20 $125.70 $50.28 $74.35 $125.70 $125.70 $125.70 $125.70 $94.50 $125.70 $125.70 $125.70 $62.85 $62.85 $99.55 $125.70 $100.56 $56.57 $24.95 N/A $73.08 $125.70 $75.42 $125.70 $26.20 $125.70 N/A N/A 5017-3-150S SUP Custom 27203010 5017-3-150S - PIN XTRNFX 5MM 150MM STRL 30MM APX SLF DRL ST SS HA BOTH IP/OP $253.00 $187.00 $45.03 $253.00 $253.00 $253.00 $253.00 $253.00 $253.00 $253.00 $45.03 $253.00 $253.00 $187.78 $187.78 $195.01 $131.81 $52.73 $253.00 $101.20 $253.00 $253.00 $253.00 $253.00 $253.00 $189.75 $253.00 $253.00 $253.00 $126.50 $126.50 $200.38 $253.00 $202.40 $164.45 $253.00 N/A $146.74 $253.00 $151.80 $253.00 $253.00 $253.00 N/A N/A 5017-3-180S SUP HCPCS C1713 5017-3-180S - PIN HALF 5MM 180MM 30MM SLFDRILL SLFTAP THREADED APEX BOTH IP/OP $253.00 $187.00 $50.21 $253.00 $113.85 $113.85 $113.85 $113.85 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $149.65 $253.00 $253.00 $253.00 $253.00 $189.75 $253.00 $253.00 $253.00 $126.50 $126.50 $200.38 $253.00 $202.40 $113.85 $50.21 N/A $146.74 $253.00 $151.80 $253.00 $253.00 $253.00 N/A N/A 50-174-01-09 SUP HCPCS C1713 50-174-01-09 - IMPLANT PRT JNT TI RT CNDYL 3 MM RECON PLT BOTH IP/OP "$3,141.50" "$2,325.00" $623.48 "$3,141.33" "$1,413.60" "$1,413.60" "$1,413.60" "$1,413.60" "$3,141.33" "$3,141.33" "$3,141.33" $654.73 "$3,141.33" "$3,141.33" "$3,141.33" "$3,141.33" "$3,141.33" $654.69 "$3,141.33" "$3,141.33" "$1,548.68" "$3,141.33" "$3,141.33" "$3,141.33" "$3,141.33" "$2,356.13" "$3,141.33" "$3,141.33" "$3,141.33" "$1,570.67" "$1,570.67" "$2,487.93" "$3,141.33" "$2,513.06" "$1,413.60" $623.48 N/A "$1,822.07" "$3,141.33" "$1,884.80" "$3,141.33" $654.65 "$3,141.33" N/A N/A 50-174-03-09 SUP HCPCS C1713 50-174-03-09 - SCREW BN FX XDR TI CNDYL 3 MM RECON PLT BOTH IP/OP "$1,008.50" $746.00 $200.09 "$1,008.13" $453.66 $453.66 $453.66 $453.66 "$1,008.13" "$1,008.13" "$1,008.13" $210.12 "$1,008.13" "$1,008.13" "$1,008.13" "$1,008.13" "$1,008.13" $210.11 "$1,008.13" "$1,008.13" $596.31 "$1,008.13" "$1,008.13" "$1,008.13" "$1,008.13" $756.38 "$1,008.13" "$1,008.13" "$1,008.13" $504.07 $504.07 $798.44 "$1,008.13" $806.50 $453.66 $200.09 N/A $584.93 "$1,008.13" $604.88 "$1,008.13" $210.09 "$1,008.13" N/A N/A 5017-4-150S SUP HCPCS C1713 5017-4-150S - PIN HALF 5MM 150MM 40MM SLFTAP SLFDRILL APEX STAINLESS STEEL BOTH IP/OP $253.00 $187.00 $50.21 $253.00 $113.85 $113.85 $113.85 $113.85 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $149.65 $253.00 $253.00 $253.00 $253.00 $189.75 $253.00 $253.00 $253.00 $126.50 $126.50 $200.38 $253.00 $202.40 $113.85 $50.21 N/A $146.74 $253.00 $151.80 $253.00 $52.73 $253.00 N/A N/A 5017-4-180S SUP HCPCS C1713 5017-4-180S - PIN HALF 5MM 180MM APEX HA EXFIX BOTH IP/OP $253.00 $187.00 $50.21 $253.00 $113.85 $113.85 $113.85 $113.85 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $149.65 $253.00 $253.00 $253.00 $253.00 $189.75 $253.00 $253.00 $253.00 $126.50 $126.50 $200.38 $253.00 $202.40 $113.85 $50.21 N/A $146.74 $253.00 $151.80 $253.00 $253.00 $253.00 N/A N/A 50-17504 SUP HCPCS C1713 50-17504 - SCREW BONE 1.7MM 4MM LOCK GRAY TITANIUM MIDFAC BOTH IP/OP $140.00 $104.00 $27.73 $139.70 $62.87 $62.87 $62.87 $62.87 $139.70 $139.70 $139.70 $29.12 $139.70 $139.70 $139.70 $139.70 $139.70 $29.12 $139.70 $55.88 $82.63 $139.70 $139.70 $139.70 $139.70 $105.00 $139.70 $139.70 $139.70 $69.85 $69.85 $110.64 $139.70 $111.76 $62.87 $27.73 N/A $81.20 $139.70 $139.70 $139.70 $29.11 $139.70 N/A N/A 50-17505 SUP HCPCS C1713 50-17505 - SCREW BONE 1.7MM 5MM LOCKING XPIN GRAY TITANIUM MIDFAC BOTH IP/OP $140.00 $104.00 $27.73 $139.70 $62.87 $62.87 $62.87 $62.87 $139.70 $139.70 $139.70 $29.12 $139.70 $139.70 $139.70 $139.70 $139.70 $29.12 $139.70 $139.70 $82.63 $139.70 $139.70 $139.70 $139.70 $105.00 $139.70 $139.70 $139.70 $69.85 $69.85 $110.64 $139.70 $111.76 $62.87 $27.73 N/A $81.20 $139.70 $83.82 $139.70 $29.11 $139.70 N/A N/A 50-17506 SUP HCPCS C1713 50-17506 - SCREW BONE 1.7MM 6MM SLFDRILL SLFTAP LOCKING XPIN TITANIUM BOTH IP/OP $140.00 $104.00 $27.73 $139.70 $62.87 $62.87 $62.87 $62.87 $139.70 $139.70 $139.70 $29.12 $139.70 $139.70 $139.70 $139.70 $139.70 $29.12 $139.70 $55.88 $82.63 $139.70 $139.70 $139.70 $139.70 $105.00 $139.70 $139.70 $139.70 $69.85 $69.85 $110.64 $139.70 $111.76 $62.87 $27.73 N/A $81.20 $139.70 $139.70 $139.70 $29.11 $139.70 N/A N/A 5017-5-150S SUP HCPCS C1713 5017-5-150S - PIN HLF SLFDRL ORTH BOTH IP/OP $253.00 $187.00 $50.21 $253.00 $113.85 $113.85 $113.85 $113.85 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $253.00 $253.00 $253.00 $52.73 $253.00 $101.20 $149.65 $253.00 $253.00 $253.00 $253.00 $189.75 $253.00 $253.00 $253.00 $126.50 $126.50 $200.38 $253.00 $202.40 $113.85 $50.21 N/A $146.74 $253.00 $151.80 $253.00 $52.73 $253.00 N/A N/A 5017-5-180S SUP HCPCS C1713 5017-5-180S - PIN HALF 5MM 180MM 50MM SLFDRILL SLFTAP THREADED APEX BOTH IP/OP $253.00 $187.00 $50.21 $253.00 $113.85 $113.85 $113.85 $113.85 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $149.65 $253.00 $253.00 $253.00 $253.00 $189.75 $253.00 $253.00 $253.00 $126.50 $126.50 $200.38 $253.00 $202.40 $113.85 $50.21 N/A $146.74 $253.00 $151.80 $253.00 $52.73 $253.00 N/A N/A 5017-6-150S SUP HCPCS C1713 5017-6-150S - PIN FIX 5MM 150MM 60MM SLFTAP/DRILLING THREAD SHAFT APEX HA BOTH IP/OP $253.00 $187.00 $50.21 $253.00 $113.85 $113.85 $113.85 $113.85 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $149.65 $253.00 $253.00 $253.00 $253.00 $189.75 $253.00 $253.00 $253.00 $126.50 $126.50 $200.38 $253.00 $202.40 $113.85 $50.21 N/A $146.74 $253.00 $151.80 $253.00 $52.73 $253.00 N/A N/A 5017-6-200S SUP HCPCS C1713 5017-6-200S - PIN HALF 5MM 200MM 60MM SLFTAP SLFDRILL APEX STAINLESS STEEL BOTH IP/OP $260.00 $192.00 $51.58 $259.88 $116.95 $116.95 $116.95 $116.95 $259.88 $259.88 $259.88 $54.17 $259.88 $259.88 $259.88 $259.88 $259.88 $54.16 $259.88 $259.88 $153.72 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $116.95 $51.58 N/A $150.80 $259.88 $155.93 $259.88 $54.16 $259.88 N/A N/A 5017-7-200S SUP HCPCS C1713 5017-7-200S - PIN HALF 5MM 200MM 70MM SLFTAP SLFDRILL APEX STAINLESS STEEL BOTH IP/OP $260.00 $192.00 $51.58 $259.88 $116.95 $116.95 $116.95 $116.95 $259.88 $259.88 $259.88 $54.17 $259.88 $259.88 $259.88 $259.88 $259.88 $54.16 $259.88 $103.95 $153.72 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $116.95 $51.58 N/A $150.80 $259.88 $155.93 $259.88 $259.88 $259.88 N/A N/A 5017-8-150S SUP HCPCS C1713 5017-8-150S - PIN HALF 5MM 150MM 25MM SLFDRILL SLFTAP THREADED SHAFT APEX BOTH IP/OP $253.00 $187.00 $50.21 $253.00 $113.85 $113.85 $113.85 $113.85 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $253.00 $253.00 $253.00 $52.73 $253.00 $101.20 $149.65 $253.00 $253.00 $253.00 $253.00 $189.75 $253.00 $253.00 $253.00 $126.50 $126.50 $200.38 $253.00 $202.40 $113.85 $50.21 N/A $146.74 $253.00 $151.80 $253.00 $253.00 $253.00 N/A N/A 50-17903 SUP HCPCS C1713 50-17903 - SCREW BONE 1.7MM 3MM SELF DRILL XPIN TITANIUM MIDFAC BOTH IP/OP "$1,400.00" "$1,036.00" $277.87 "$1,400.00" $630.00 $630.00 $630.00 $630.00 "$1,400.00" "$1,400.00" "$1,400.00" $291.80 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $291.78 "$1,400.00" $560.00 $828.10 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,050.00" "$1,400.00" "$1,400.00" "$1,400.00" $700.00 $700.00 "$1,108.80" "$1,400.00" "$1,120.00" $630.00 $277.87 N/A $812.00 "$1,400.00" "$1,400.00" "$1,400.00" $291.76 "$1,400.00" N/A N/A 50-17904 SUP HCPCS C1713 50-17904 - SCREW BONE 1.7MM 4MM SELF DRILL XPIN TITANIUM MIDFAC BOTH IP/OP $280.00 $207.00 $55.57 $280.00 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $112.00 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A 50-17905 SUP HCPCS C1713 50-17905 - SCREW BONE 1.7MM 5MM SLFDRILL XPIN TITANIUM MIDFAC BOTH IP/OP "$1,400.00" "$1,036.00" $277.87 "$1,400.00" $630.00 $630.00 $630.00 $630.00 "$1,400.00" "$1,400.00" "$1,400.00" $291.80 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $291.78 "$1,400.00" $560.00 $828.10 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,050.00" "$1,400.00" "$1,400.00" "$1,400.00" $700.00 $700.00 "$1,108.80" "$1,400.00" "$1,120.00" $630.00 $277.87 N/A $812.00 "$1,400.00" "$1,400.00" "$1,400.00" $291.76 "$1,400.00" N/A N/A 50-17906 SUP HCPCS C1713 50-17906 - SCREW BONE 1.7MM 6MM SLFDRILL XPIN TITANIUM MIDFAC BOTH IP/OP $103.50 $77.00 $20.52 $103.40 $46.53 $46.53 $46.53 $46.53 $103.40 $103.40 $103.40 $21.55 $103.40 $103.40 $103.40 $103.40 $103.40 $21.55 $103.40 $41.36 $61.16 $103.40 $103.40 $103.40 $103.40 $77.63 $103.40 $103.40 $103.40 $51.70 $51.70 $81.89 $103.40 $82.72 $46.53 $20.52 N/A $60.03 $103.40 $62.04 $103.40 $21.55 $103.40 N/A N/A 5017-9-120S SUP HCPCS C1713 5017-9-120S - PIN FIX 5MM 120MM 35MM SLFDRILL SLFTAP THREAD SHAFT APEX HA BOTH IP/OP $253.00 $187.00 $50.21 $253.00 $113.85 $113.85 $113.85 $113.85 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $253.00 $253.00 $253.00 $52.73 $253.00 $101.20 $149.65 $253.00 $253.00 $253.00 $253.00 $189.75 $253.00 $253.00 $253.00 $126.50 $126.50 $200.38 $253.00 $202.40 $113.85 $50.21 N/A $146.74 $253.00 $151.80 $253.00 $52.73 $253.00 N/A N/A 5017-9-150S SUP HCPCS C1713 5017-9-150S - PIN HALF 5MM 150MM SLFDRILL APEX HYDRXAPT EXFIX BOTH IP/OP $253.00 $187.00 $50.21 $253.00 $113.85 $113.85 $113.85 $113.85 $253.00 $253.00 $253.00 $52.73 $253.00 $253.00 $253.00 $253.00 $253.00 $52.73 $253.00 $101.20 $149.65 $253.00 $253.00 $253.00 $253.00 $189.75 $253.00 $253.00 $253.00 $126.50 $126.50 $200.38 $253.00 $202.40 $113.85 $50.21 N/A $146.74 $253.00 $151.80 $253.00 $52.73 $253.00 N/A N/A 5018-3-120 SUP Custom 27203010 5018-3-120 - PIN HLF 5MM 120MM 30MM APX ST SLFDRL THRD SS FT/ANKL BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 5018-3-180 SUP HCPCS C1713 5018-3-180 - PIN HALF 5MM 180MM 35MM SLFDRILL THREAD SHAFT SLFTAP APEX BOTH IP/OP $237.50 $176.00 $47.07 $237.15 $106.72 $106.72 $106.72 $106.72 $237.15 $237.15 $237.15 $49.43 $237.15 $237.15 $237.15 $237.15 $237.15 $49.42 $237.15 $94.86 $140.27 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $106.72 $47.07 N/A $137.75 $237.15 $142.29 $237.15 $49.42 $237.15 N/A N/A 5018-5-120 SUP Custom 27203010 5018-5-120 - PIN HALF 5MM 120MM 35MM SLFTAP SLFDRILL THREADED APEX BOTH IP/OP $237.50 $176.00 $42.21 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $42.21 $237.15 $237.15 $176.01 $176.01 $182.80 $123.56 $49.42 $237.15 $94.86 $237.15 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $154.15 $237.15 N/A $137.75 $237.15 $142.29 $237.15 $237.15 $237.15 N/A N/A 5018-5-150 SUP Custom 27203010 5018-5-150 - PIN HALF 5MM 150MM 40MM THREADED SLFDRILL SLFTAP APEX BOTH IP/OP $237.50 $176.00 $42.21 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $42.21 $237.15 $237.15 $176.01 $176.01 $182.80 $123.56 $49.42 $237.15 $94.86 $237.15 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $154.15 $237.15 N/A $137.75 $237.15 $142.29 $237.15 $237.15 $237.15 N/A N/A 5018-5-200 SUP Custom 27203010 5018-5-200 - PIN HALF 5MM 200MM 50MM SLFDRILL APEX STAINLESS STEEL EXFIX BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 5018-5-250 SUP Custom 27203010 5018-5-250 - PIN HALF 5MM 250MM 50MM SLFTAP SLFDRILL THREAD SHAFT APEX BOTH IP/OP $237.50 $176.00 $42.21 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $42.21 $237.15 $237.15 $176.01 $176.01 $182.80 $123.56 $49.42 $237.15 $94.86 $237.15 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $154.15 $237.15 N/A $137.75 $237.15 $142.29 $237.15 $237.15 $237.15 N/A N/A 5018-6-150 SUP Custom 27203010 5018-6-150 - PIN HALF 5MM 150MM 50MM SELF TAP SELF DRILL THREAD APEX BOTH IP/OP $237.50 $176.00 $42.21 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $42.21 $237.15 $237.15 $176.01 $176.01 $182.80 $123.56 $49.42 $237.15 $94.86 $237.15 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $154.15 $237.15 N/A $137.75 $237.15 $142.29 $237.15 $237.15 $237.15 N/A N/A 5018-6-180S SUP HCPCS C1713 5018-6-180S - PIN HALF 5MM 180MM 50MM SLFTAP SLFDRILL APEX STAINLESS STEEL BOTH IP/OP $237.50 $176.00 $47.07 $237.15 $106.72 $106.72 $106.72 $106.72 $237.15 $237.15 $237.15 $49.43 $237.15 $237.15 $237.15 $237.15 $237.15 $49.42 $237.15 $237.15 $140.27 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $106.72 $47.07 N/A $137.75 $237.15 $142.29 $237.15 $49.42 $237.15 N/A N/A 5018-6-200 SUP Custom 27203010 5018-6-200 - PIN HALF 5MM 200MM 60MM THREAD APEX HOFFMANN II STAINLESS BOTH IP/OP $206.00 $152.00 $36.61 $205.70 $205.70 $205.70 $205.70 $205.70 $205.70 $205.70 $36.61 $205.70 $205.70 $152.67 $152.67 $158.55 $107.17 $42.87 $205.70 $82.28 $205.70 $205.70 $205.70 $205.70 $205.70 $154.50 $205.70 $205.70 $205.70 $102.85 $102.85 $162.91 $205.70 $164.56 $133.71 $205.70 N/A $119.48 $205.70 $123.42 $205.70 $205.70 $205.70 N/A N/A 5018-7-250 SUP Custom 27203010 5018-7-250 - PIN HALF 5MM 250MM 70MM SELF TAP SELF DRILL THREAD APEX BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 5018-8-180 SUP Custom 27203010 5018-8-180 - PIN HALF 5MM 180MM 60MM SLFTAP SLFDRILL THREADED APEX BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 50-19003 SUP HCPCS C1713 50-19003 - SCREW BONE 1.9MM 3MM EMERGENCY TITANIUM MIDFAC BOTH IP/OP "$1,362.50" "$1,008.00" $270.42 "$1,362.50" $613.13 $613.13 $613.13 $613.13 "$1,362.50" "$1,362.50" "$1,362.50" $283.98 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" $283.96 "$1,362.50" $545.00 $805.92 "$1,362.50" "$1,362.50" "$1,362.50" "$1,362.50" "$1,021.88" "$1,362.50" "$1,362.50" "$1,362.50" $681.25 $681.25 "$1,079.10" "$1,362.50" "$1,090.00" $613.13 $270.42 N/A $790.25 "$1,362.50" $817.50 "$1,362.50" $283.95 "$1,362.50" N/A N/A 50-19005 SUP HCPCS C1713 50-19005 - SCREW BONE 1.9MM 5MM EMERGENCY TITANIUM MIDFAC BOTH IP/OP $54.50 $40.00 $10.82 $54.50 $24.53 $24.53 $24.53 $24.53 $54.50 $54.50 $54.50 $11.36 $54.50 $54.50 $54.50 $54.50 $54.50 $11.36 $54.50 $54.50 $32.24 $54.50 $54.50 $54.50 $54.50 $40.88 $54.50 $54.50 $54.50 $27.25 $27.25 $43.16 $54.50 $43.60 $24.53 $10.82 N/A $31.61 $54.50 $32.70 $54.50 $11.36 $54.50 N/A N/A 50-19007 SUP HCPCS C1713 50-19007 - SCREW BONE 1.9MM 7MM SLFTAP XPIN EMERGENCY TITANIUM MAXFACL BOTH IP/OP $107.00 $79.00 $21.22 $106.93 $48.12 $48.12 $48.12 $48.12 $106.93 $106.93 $106.93 $22.29 $106.93 $106.93 $106.93 $106.93 $106.93 $22.29 $106.93 $42.77 $63.25 $106.93 $106.93 $106.93 $106.93 $80.25 $106.93 $106.93 $106.93 $53.47 $53.47 $84.69 $106.93 $85.54 $48.12 $21.22 N/A $62.06 $106.93 $64.16 $106.93 $22.28 $106.93 N/A N/A 50-19009 SUP HCPCS C1713 50-19009 - SCREW BONE 1.9MM 9MM SLFTAP XPIN EMERGENCY TITANIUM MAXFACL BOTH IP/OP $107.00 $79.00 $21.22 $106.93 $48.12 $48.12 $48.12 $48.12 $106.93 $106.93 $106.93 $22.29 $106.93 $106.93 $106.93 $106.93 $106.93 $22.29 $106.93 $42.77 $63.25 $106.93 $106.93 $106.93 $106.93 $80.25 $106.93 $106.93 $106.93 $53.47 $53.47 $84.69 $106.93 $85.54 $48.12 $21.22 N/A $62.06 $106.93 $64.16 $106.93 $22.28 $106.93 N/A N/A 5019-1-180 SUP HCPCS C1713 5019-1-180 - PIN HALF 5MM 120MM 50MM SLFTAP CONTIN THREAD APEX STAINLESS BOTH IP/OP $237.50 $176.00 $47.07 $237.15 $106.72 $106.72 $106.72 $106.72 $237.15 $237.15 $237.15 $49.43 $237.15 $237.15 $237.15 $237.15 $237.15 $49.42 $237.15 $94.86 $140.27 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $106.72 $47.07 N/A $137.75 $237.15 $142.29 $237.15 $237.15 $237.15 N/A N/A 5019-7-120 SUP HCPCS C1713 5019-7-120 - PIN HALF 6MM 120MM 50MM BLUNT CONTIN THREAD APEX HOFFMANN BOTH IP/OP $258.50 $191.00 $51.31 $258.50 $116.33 $116.33 $116.33 $116.33 $258.50 $258.50 $258.50 $53.88 $258.50 $258.50 $258.50 $258.50 $258.50 $53.87 $258.50 $258.50 $152.90 $258.50 $258.50 $258.50 $258.50 $193.88 $258.50 $258.50 $258.50 $129.25 $129.25 $204.73 $258.50 $206.80 $116.33 $51.31 N/A $149.93 $258.50 $155.10 $258.50 $53.87 $258.50 N/A N/A 5019-7-150 SUP HCPCS C1713 5019-7-150 - PIN HALF BLUNT 6MM 150MM 50MM CONTIN THREAD APEX STAINLESS BOTH IP/OP $237.50 $176.00 $47.07 $237.15 $106.72 $106.72 $106.72 $106.72 $237.15 $237.15 $237.15 $49.43 $237.15 $237.15 $237.15 $237.15 $237.15 $49.42 $237.15 $94.86 $140.27 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $106.72 $47.07 N/A $137.75 $237.15 $237.15 $237.15 $49.42 $237.15 N/A N/A 502-01-42A SUP Custom 27803010 502-01-42A - SHELL ACETAB A HEMISPHERICAL 42MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-44B SUP Custom 27803010 502-01-44B - SHELL ACETAB B HEMISPHERICAL 44MM 3 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-46C SUP Custom 27803010 502-01-46C - SHELL ACETAB C HEMISPHERICAL 46MM 3 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-48D SUP Custom 27803010 502-01-48D - SHELL ACETAB 48MM HIP HMSPHR CLSTR TRDNT D BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-50D SUP Custom 27803010 502-01-50D - SHELL ACETAB 50MM HIP HMSPHR CLSTR TRDNT D BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-52E SUP Custom 27803010 502-01-52E - SHELL ACETAB 52MM HIP HMSPHR CLSTR TRDNT E BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-54E SUP Custom 27803010 502-01-54E - SHELL ACETAB 54MM HIP HMSPHR CLSTR TRDNT E BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-56F SUP Custom 27803010 502-01-56F - SHELL ACETAB F HEMISPHERICAL 56MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-58F SUP Custom 27803010 502-01-58F - SHELL ACETAB 58MM HIP HMSPHR CLSTR TRDNT F BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-60G SUP Custom 27803010 502-01-60G - SHELL ACETAB G HEMISPHERICAL 60MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-62G SUP Custom 27803010 502-01-62G - SHELL ACETAB G HEMISPHERICAL 62MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-64H SUP Custom 27803010 502-01-64H - SHELL ACETAB H HEMISPHERICAL 64MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-66H SUP Custom 27803010 502-01-66H - SHELL ACETAB H HEMISPHERICAL 66MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-68I SUP Custom 27803010 502-01-68I - SHELL ACTB I HMSPHR 68MM TRDNT 5 SCR HL CLSTR MTL HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-70I SUP Custom 27803010 502-01-70I - SHELL ACETAB I HEMISPHERICAL 70MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-72J SUP Custom 27803010 502-01-72J - SHELL ACETAB J HEMISPHERICAL 72MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-01-74J SUP Custom 27803010 502-01-74J - SHELL ACETAB J HEMISPHERICAL 74MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 5020-2-150 SUP Custom 27203010 5020-2-150 - PIN HLF 5MM 150MM 20MM APX BLNT BOTH IP/OP $260.00 $192.00 $46.26 $259.88 $259.88 $259.88 $259.88 $259.88 $259.88 $259.88 $46.26 $259.88 $259.88 $192.88 $192.88 $200.32 $135.40 $54.16 $259.88 $103.95 $259.88 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $168.92 $259.88 N/A $150.80 $259.88 $155.93 $259.88 $259.88 $259.88 N/A N/A 5020-2-180 SUP Custom 27203010 5020-2-180 - PIN HLF 5MM 180MM 20MM APX BLNT BOTH IP/OP $260.00 $192.00 $46.26 $259.88 $259.88 $259.88 $259.88 $259.88 $259.88 $259.88 $46.26 $259.88 $259.88 $192.88 $192.88 $200.32 $135.40 $54.16 $259.88 $103.95 $259.88 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $168.92 $259.88 N/A $150.80 $259.88 $155.93 $259.88 $259.88 $259.88 N/A N/A 5020-2-200 SUP Custom 27203010 5020-2-200 - PIN HLF 5MM 200MM 20MM APX BLNT BOTH IP/OP $260.00 $192.00 $46.26 $259.88 $259.88 $259.88 $259.88 $259.88 $259.88 $259.88 $46.26 $259.88 $259.88 $192.88 $192.88 $200.32 $135.40 $54.16 $259.88 $103.95 $259.88 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $168.92 $259.88 N/A $150.80 $259.88 $155.93 $259.88 $259.88 $259.88 N/A N/A 5020-2-250 SUP Custom 27203010 5020-2-250 - PIN HLF 5MM 250MM 20MM APX BLNT BOTH IP/OP $260.00 $192.00 $46.26 $259.88 $259.88 $259.88 $259.88 $259.88 $259.88 $259.88 $46.26 $259.88 $259.88 $192.88 $192.88 $200.32 $135.40 $54.16 $259.88 $103.95 $259.88 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $168.92 $259.88 N/A $150.80 $259.88 $155.93 $259.88 $259.88 $259.88 N/A N/A 5020-3-120 SUP Custom 27203010 5020-3-120 - PIN HALF 5MM 120MM 30MM CONTIN THREAD BLUNT TIP APEX BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 5020-3-150 SUP Custom 27203010 5020-3-150 - PIN HALF 5MM 150MM 40MM CONTIN THREAD BLUNT TIP APEX BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 502-03-44A SUP Custom 27803010 502-03-44A - SHELL ACETAB A HEMISPHERICAL 44MM PRIM RIM CLSHOLE TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 502-03-46B SUP Custom 27803010 502-03-46B - SHELL ACETAB B HEMISPHERICAL 46MM PRIM RIM CLSHOLE TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 502-03-48C SUP Custom 27803010 502-03-48C - SHELL ACETAB C HEMISPHERICAL 48MM PRIM RIM CLSHOLE TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 502-03-50D SUP Custom 27803010 502-03-50D - SHELL ACETAB D HEMISPHERICAL 50MM PRIM RIM CLSHOLE TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 502-03-52D SUP Custom 27803010 502-03-52D - SHELL ACETAB D 52MM PRIM HEMISPHERICAL CLSHOLE TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 502-03-54E SUP Custom 27803010 502-03-54E - SHELL ACETAB E HEMISPHERICAL 54MM PRIM RIM CLSHOLE TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 502-03-56E SUP Custom 27803010 502-03-56E - SHELL ACETAB E HEMISPHERICAL 56MM PRIM RIM CLSHOLE TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 50-20358 SUP HCPCS C1713 50-20358 - SCREW BN 2MM 8MM NS LEIBINGER UNV 2 MMF SLF DRL XPN LGT WRE BOTH IP/OP $560.00 $414.00 $111.15 $560.00 $252.00 $252.00 $252.00 $252.00 $560.00 $560.00 $560.00 $116.72 $560.00 $560.00 $560.00 $560.00 $560.00 $116.71 $560.00 $560.00 $331.24 $560.00 $560.00 $560.00 $560.00 $420.00 $560.00 $560.00 $560.00 $280.00 $280.00 $443.52 $560.00 $448.00 $252.00 $111.15 N/A $324.80 $560.00 $336.00 $560.00 $116.70 $560.00 N/A N/A 502-03-58F SUP Custom 27803010 502-03-58F - SHELL ACETAB F HEMISPHERICAL 58MM PRIM RIM CLSHOLE TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 502-03-60F SUP Custom 27803010 502-03-60F - SHELL ACETAB F HEMISPHERICAL 60MM PRIM RIM CLSHOLE TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 50-20362 SUP HCPCS C1713 50-20362 - SCREW BONE 2MM 12MM SELF DRILL TITANIUM MANDIB BOTH IP/OP $560.00 $414.00 $111.15 $560.00 $252.00 $252.00 $252.00 $252.00 $560.00 $560.00 $560.00 $116.72 $560.00 $560.00 $560.00 $560.00 $560.00 $116.71 $560.00 $560.00 $331.24 $560.00 $560.00 $560.00 $560.00 $420.00 $560.00 $560.00 $560.00 $280.00 $280.00 $443.52 $560.00 $448.00 $252.00 $111.15 N/A $324.80 $560.00 $560.00 $560.00 $116.70 $560.00 N/A N/A 502-03-62G SUP Custom 27803010 502-03-62G - SHELL ACETAB G 62MM PRIM HEMISPHERICAL CLSHOLE TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 502-03-64G SUP Custom 27803010 502-03-64G - SHELL ACETAB G HEMISPHERICAL 64MM PRIM RIM CLSHOLE TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 502-03-66H SUP Custom 27803010 502-03-66H - SHELL ACETAB H HEMISPHERICAL 66MM PRIM RIM CLSHOLE TRITANIUM BOTH IP/OP "$2,302.50" "$1,704.00" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $409.85 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" "$2,302.50" N/A "$1,335.45" "$2,302.50" "$1,381.50" "$2,302.50" "$2,302.50" "$2,302.50" N/A N/A 50-20404 SUP HCPCS C1713 50-20404 - SCREW BONE 2MM 4MM XPIN TITANIUM MAXFACL BOTH IP/OP $126.00 $93.00 $24.99 $125.93 $56.67 $56.67 $56.67 $56.67 $125.93 $125.93 $125.93 $26.25 $125.93 $125.93 $125.93 $125.93 $125.93 $26.25 $125.93 $50.37 $74.49 $125.93 $125.93 $125.93 $125.93 $94.50 $125.93 $125.93 $125.93 $62.97 $62.97 $99.74 $125.93 $100.74 $56.67 $24.99 N/A $73.08 $125.93 $125.93 $125.93 $26.24 $125.93 N/A N/A 50-20405 SUP HCPCS C1713 50-20405 - SCREW BONE 2MM 5MM XPIN TITANIUM MAXFACL BOTH IP/OP $240.00 $178.00 $47.63 $240.00 $108.00 $108.00 $108.00 $108.00 $240.00 $240.00 $240.00 $50.02 $240.00 $240.00 $240.00 $240.00 $240.00 $50.02 $240.00 $240.00 $141.96 $240.00 $240.00 $240.00 $240.00 $180.00 $240.00 $240.00 $240.00 $120.00 $120.00 $190.08 $240.00 $192.00 $108.00 $47.63 N/A $139.20 $240.00 $240.00 $240.00 $50.02 $240.00 N/A N/A 50-20407 SUP HCPCS C1713 50-20407 - SCREW BONE 2MM 7MM XPIN TITANIUM MAXFACL BOTH IP/OP $240.00 $178.00 $47.63 $240.00 $108.00 $108.00 $108.00 $108.00 $240.00 $240.00 $240.00 $50.02 $240.00 $240.00 $240.00 $240.00 $240.00 $50.02 $240.00 $96.00 $141.96 $240.00 $240.00 $240.00 $240.00 $180.00 $240.00 $240.00 $240.00 $120.00 $120.00 $190.08 $240.00 $192.00 $108.00 $47.63 N/A $139.20 $240.00 $240.00 $240.00 $240.00 $240.00 N/A N/A 50-20408 SUP HCPCS C1713 50-20408 - SCREW BONE 2MM 8MM XPIN TITANIUM MAXFACL BOTH IP/OP $240.00 $178.00 $47.63 $240.00 $108.00 $108.00 $108.00 $108.00 $240.00 $240.00 $240.00 $50.02 $240.00 $240.00 $240.00 $240.00 $240.00 $50.02 $240.00 $240.00 $141.96 $240.00 $240.00 $240.00 $240.00 $180.00 $240.00 $240.00 $240.00 $120.00 $120.00 $190.08 $240.00 $192.00 $108.00 $47.63 N/A $139.20 $240.00 $144.00 $240.00 $50.02 $240.00 N/A N/A 50-20410 SUP HCPCS C1713 50-20410 - SCREW BONE 2MM 10MM XPIN TITANIUM MAXFACL BOTH IP/OP $126.00 $93.00 $47.63 $240.00 $108.00 $108.00 $108.00 $108.00 $240.00 $240.00 $240.00 $50.02 $240.00 $240.00 $240.00 $240.00 $240.00 $50.02 $240.00 $96.00 $141.96 $240.00 $240.00 $240.00 $240.00 $94.50 $240.00 $240.00 $240.00 $120.00 $120.00 $190.08 $240.00 $192.00 $108.00 $47.63 N/A $73.08 $240.00 $240.00 $240.00 $50.02 $240.00 N/A N/A 50-20410 SUP HCPCS C1713 50-20410 - SCREW BN 2MM 10MM AU NS LEIBINGER UNV 2 ST XPN TI MXLFCL BOTH IP/OP $240.00 $178.00 $47.63 $240.00 $108.00 $108.00 $108.00 $108.00 $240.00 $240.00 $240.00 $50.02 $240.00 $240.00 $240.00 $240.00 $240.00 $50.02 $240.00 $96.00 $141.96 $240.00 $240.00 $240.00 $240.00 $180.00 $240.00 $240.00 $240.00 $120.00 $120.00 $190.08 $240.00 $192.00 $108.00 $47.63 N/A $139.20 $240.00 $240.00 $240.00 $50.02 $240.00 N/A N/A 50-20412 SUP HCPCS C1713 50-20412 - SCREW BONE 2MM 12MM XPIN TITANIUM MAXFACL BOTH IP/OP $240.00 $178.00 $47.63 $240.00 $108.00 $108.00 $108.00 $108.00 $240.00 $240.00 $240.00 $50.02 $240.00 $240.00 $240.00 $240.00 $240.00 $50.02 $240.00 $96.00 $141.96 $240.00 $240.00 $240.00 $240.00 $180.00 $240.00 $240.00 $240.00 $120.00 $120.00 $190.08 $240.00 $192.00 $108.00 $47.63 N/A $139.20 $240.00 $144.00 $240.00 $50.02 $240.00 N/A N/A 50-20414 SUP HCPCS C1713 50-20414 - SCREW BONE 2MM 14MM XPIN TITANIUM MANDIB BOTH IP/OP $240.00 $178.00 $47.63 $240.00 $108.00 $108.00 $108.00 $108.00 $240.00 $240.00 $240.00 $50.02 $240.00 $240.00 $240.00 $240.00 $240.00 $50.02 $240.00 $240.00 $141.96 $240.00 $240.00 $240.00 $240.00 $180.00 $240.00 $240.00 $240.00 $120.00 $120.00 $190.08 $240.00 $192.00 $108.00 $47.63 N/A $139.20 $240.00 $144.00 $240.00 $50.02 $240.00 N/A N/A 50-20416 SUP HCPCS C1713 50-20416 - SCREW BONE 2MM 16MM XPIN TITANIUM MANDIB BOTH IP/OP $90.00 $67.00 $17.78 $89.60 $40.32 $40.32 $40.32 $40.32 $89.60 $89.60 $89.60 $18.67 $89.60 $89.60 $89.60 $89.60 $89.60 $18.67 $89.60 $89.60 $53.00 $89.60 $89.60 $89.60 $89.60 $67.50 $89.60 $89.60 $89.60 $44.80 $44.80 $70.96 $89.60 $71.68 $40.32 $17.78 N/A $52.20 $89.60 $89.60 $89.60 $18.67 $89.60 N/A N/A 50-20418 SUP HCPCS C1713 50-20418 - SCREW BONE 2MM 18MM XPIN TITANIUM MANDIB BOTH IP/OP $113.50 $84.00 $22.49 $113.30 $50.99 $50.99 $50.99 $50.99 $113.30 $113.30 $113.30 $23.61 $113.30 $113.30 $113.30 $113.30 $113.30 $23.61 $113.30 $45.32 $67.02 $113.30 $113.30 $113.30 $113.30 $85.13 $113.30 $113.30 $113.30 $56.65 $56.65 $89.73 $113.30 $90.64 $50.99 $22.49 N/A $65.83 $113.30 $113.30 $113.30 $113.30 $113.30 N/A N/A 50-20420 SUP HCPCS C1713 50-20420 - SCREW BONE 2MM 20MM SLFTAP XPIN TITANIUM MANDIB BOTH IP/OP $113.50 $84.00 $22.49 $113.30 $50.99 $50.99 $50.99 $50.99 $113.30 $113.30 $113.30 $23.61 $113.30 $113.30 $113.30 $113.30 $113.30 $23.61 $113.30 $45.32 $67.02 $113.30 $113.30 $113.30 $113.30 $85.13 $113.30 $113.30 $113.30 $56.65 $56.65 $89.73 $113.30 $90.64 $50.99 $22.49 N/A $65.83 $113.30 $113.30 $113.30 $113.30 $113.30 N/A N/A 50-20504 SUP HCPCS C1713 50-20504 - SCREW BONE 2MM 4MM LOCKING XPIN TITANIUM MAXFACL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 50-20505 SUP HCPCS C1713 50-20505 - SCREW BN 2MM 5MM GRY NS LEIBINGER UNV 2 LCK XPN TI MXLFCL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 50-20506 SUP HCPCS C1713 50-20506 - SCREW BONE 2MM 6MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2 BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 50-20507 SUP HCPCS C1713 50-20507 - SCREW BONE 2MM 7MM LOCKING XPIN TITANIUM MAXFACL BOTH IP/OP $427.50 $316.00 $84.85 $427.50 $192.38 $192.38 $192.38 $192.38 $427.50 $427.50 $427.50 $89.10 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $84.85 N/A $247.95 $427.50 $427.50 $427.50 $427.50 $427.50 N/A N/A 50-20508 SUP HCPCS C1713 50-20508 - SCREW BN 2MM 8MM GRY NS LEIBINGER UNV 2 LCK XPN TI MNDB BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 50-20510 SUP HCPCS C1713 50-20510 - SCREW BONE 2MM 10MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2 BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 50-20512 SUP HCPCS C1713 50-20512 - SCREW BONE 2MM 12MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2 BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 50-20514 SUP HCPCS C1713 50-20514 - SCREW BONE 2MM 14MM LOCKING XPIN TITANIUM MAXFACL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 5020-5-150 SUP Custom 27203010 5020-5-150 - PIN HALF BLUNT 5MM 150MM 25MM CONTIN THREAD APEX HOFFMANN II BOTH IP/OP $237.50 $176.00 $42.21 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $42.21 $237.15 $237.15 $176.01 $176.01 $182.80 $123.56 $49.42 $237.15 $94.86 $237.15 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $154.15 $237.15 N/A $137.75 $237.15 $142.29 $237.15 $237.15 $237.15 N/A N/A 50-20516 SUP HCPCS C1713 50-20516 - SCREW BONE 2MM 16MM LOCKING XPIN LEIBINGER UNIVERSAL 2 BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 50-20518 SUP HCPCS C1713 50-20518 - SCREW BONE 2MM 18MM LOCKING XPIN TITANIUM MANDIB BOTH IP/OP $162.50 $120.00 $32.20 $162.23 $73.00 $73.00 $73.00 $73.00 $162.23 $162.23 $162.23 $33.81 $162.23 $162.23 $162.23 $162.23 $162.23 $33.81 $162.23 $64.89 $95.96 $162.23 $162.23 $162.23 $162.23 $121.88 $162.23 $162.23 $162.23 $81.12 $81.12 $128.49 $162.23 $129.78 $73.00 $32.20 N/A $94.25 $162.23 $162.23 $162.23 $162.23 $162.23 N/A N/A 50-20520 SUP HCPCS C1713 50-20520 - SCREW BONE 2MM 20MM LOCKING XPIN TITANIUM MAXFACL BOTH IP/OP $162.50 $120.00 $32.20 $162.23 $73.00 $73.00 $73.00 $73.00 $162.23 $162.23 $162.23 $33.81 $162.23 $162.23 $162.23 $162.23 $162.23 $33.81 $162.23 $64.89 $95.96 $162.23 $162.23 $162.23 $162.23 $121.88 $162.23 $162.23 $162.23 $81.12 $81.12 $128.49 $162.23 $129.78 $73.00 $32.20 N/A $94.25 $162.23 $162.23 $162.23 $33.81 $162.23 N/A N/A 50-20596 SUP HCPCS C1713 50-20596 - SCREW BN 2MM 6MM NS LEIBINGER UNV 2 SMARTLOCK SLF DRL LCK TI BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A 50-20598 SUP HCPCS C1713 50-20598 - SCREW BN 2MM 8MM NS LEIBINGER UNV 2 SMARTLOCK SLF DRL LCK TI BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A 5020-6-120 SUP Custom 27203010 5020-6-120 - PIN HALF 5MM 120MM 35MM THREAD SHAFT BLUNT PREDRILLING APEX BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 5020-6-200 SUP Custom 27203010 5020-6-200 - PIN HALF 5MM 200MM 60MM THREAD SHAFT BLUNT PREDRILLING APEX BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 50-20704 SUP HCPCS C1713 50-20704 - SCREW BONE 2MM 4MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $118.50 $88.00 $23.45 $118.13 $53.16 $53.16 $53.16 $53.16 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $118.13 $118.13 $118.13 $24.62 $118.13 $47.25 $69.87 $118.13 $118.13 $118.13 $118.13 $88.88 $118.13 $118.13 $118.13 $59.07 $59.07 $93.56 $118.13 $94.50 $53.16 $23.45 N/A $68.73 $118.13 $118.13 $118.13 $24.62 $118.13 N/A N/A 50-20705 SUP HCPCS C1713 50-20705 - SCREW BONE 2MM 5MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A 50-20706 SUP HCPCS C1713 50-20706 - SCREW BONE 2MM 6MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $118.50 $88.00 $23.45 $118.13 $53.16 $53.16 $53.16 $53.16 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $69.87 $118.13 $118.13 $118.13 $118.13 $88.88 $118.13 $118.13 $118.13 $59.07 $59.07 $93.56 $118.13 $94.50 $53.16 $23.45 N/A $68.73 $118.13 $118.13 $118.13 $24.62 $118.13 N/A N/A 50-20708 SUP HCPCS C1713 50-20708 - SCREW BONE 2MM 8MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $118.50 $88.00 $23.45 $118.13 $53.16 $53.16 $53.16 $53.16 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $69.87 $118.13 $118.13 $118.13 $118.13 $88.88 $118.13 $118.13 $118.13 $59.07 $59.07 $93.56 $118.13 $94.50 $53.16 $23.45 N/A $68.73 $118.13 $118.13 $118.13 $24.62 $118.13 N/A N/A 50-20710 SUP HCPCS C1713 50-20710 - SCREW BONE 2MM 10MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $118.50 $88.00 $23.45 $118.13 $53.16 $53.16 $53.16 $53.16 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $69.87 $118.13 $118.13 $118.13 $118.13 $88.88 $118.13 $118.13 $118.13 $59.07 $59.07 $93.56 $118.13 $94.50 $53.16 $23.45 N/A $68.73 $118.13 $70.88 $118.13 $24.62 $118.13 N/A N/A 50-20712 SUP HCPCS C1713 50-20712 - SCREW BONE 2MM 12MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $118.50 $88.00 $23.45 $118.13 $53.16 $53.16 $53.16 $53.16 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $69.87 $118.13 $118.13 $118.13 $118.13 $88.88 $118.13 $118.13 $118.13 $59.07 $59.07 $93.56 $118.13 $94.50 $53.16 $23.45 N/A $68.73 $118.13 $70.88 $118.13 $24.62 $118.13 N/A N/A 50-20714 SUP HCPCS C1713 50-20714 - SCREW BONE 2MM 14MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $118.50 $88.00 $23.45 $118.13 $53.16 $53.16 $53.16 $53.16 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $118.13 $118.13 $118.13 $24.62 $118.13 $47.25 $69.87 $118.13 $118.13 $118.13 $118.13 $88.88 $118.13 $118.13 $118.13 $59.07 $59.07 $93.56 $118.13 $94.50 $53.16 $23.45 N/A $68.73 $118.13 $70.88 $118.13 $24.62 $118.13 N/A N/A 5020-7-150 SUP Custom 27203010 5020-7-150 - PIN HALF BLUNT 5MM 150MM 50MM CONTIN THREAD APEX HOFFMANN II BOTH IP/OP $237.50 $176.00 $42.21 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $42.21 $237.15 $237.15 $176.01 $176.01 $182.80 $123.56 $49.42 $237.15 $94.86 $237.15 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $154.15 $237.15 N/A $137.75 $237.15 $142.29 $237.15 $237.15 $237.15 N/A N/A 50-20716 SUP HCPCS C1713 50-20716 - SCREW BONE 2MM 16MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $118.50 $88.00 $23.45 $118.13 $53.16 $53.16 $53.16 $53.16 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $69.87 $118.13 $118.13 $118.13 $118.13 $88.88 $118.13 $118.13 $118.13 $59.07 $59.07 $93.56 $118.13 $94.50 $53.16 $23.45 N/A $68.73 $118.13 $70.88 $118.13 $24.62 $118.13 N/A N/A 50-20718 SUP HCPCS C1713 50-20718 - SCREW BONE 2MM 18MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $118.50 $88.00 $23.45 $118.13 $53.16 $53.16 $53.16 $53.16 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $69.87 $118.13 $118.13 $118.13 $118.13 $88.88 $118.13 $118.13 $118.13 $59.07 $59.07 $93.56 $118.13 $94.50 $53.16 $23.45 N/A $68.73 $118.13 $70.88 $118.13 $24.62 $118.13 N/A N/A 5020-7-180 SUP Custom 27203010 5020-7-180 - PIN HALF BLUNT 5MM 180MM 50MM CONTIN THREAD APEX HOFFMANN II BOTH IP/OP $237.50 $176.00 $42.21 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $42.21 $237.15 $237.15 $176.01 $176.01 $182.80 $123.56 $49.42 $237.15 $94.86 $237.15 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $154.15 $237.15 N/A $137.75 $237.15 $142.29 $237.15 $237.15 $237.15 N/A N/A 50-20720 SUP HCPCS C1713 50-20720 - SCREW BONE 2MM 20MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $118.50 $88.00 $23.45 $118.13 $53.16 $53.16 $53.16 $53.16 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $118.13 $118.13 $118.13 $24.62 $118.13 $118.13 $69.87 $118.13 $118.13 $118.13 $118.13 $88.88 $118.13 $118.13 $118.13 $59.07 $59.07 $93.56 $118.13 $94.50 $53.16 $23.45 N/A $68.73 $118.13 $70.88 $118.13 $24.62 $118.13 N/A N/A 5020-7-200 SUP Custom 27203010 5020-7-200 - PIN HALF BLUNT 5MM 200MM 50MM CONTIN THREAD APEX HOFFMANN II BOTH IP/OP $237.50 $176.00 $42.21 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $42.21 $237.15 $237.15 $176.01 $176.01 $182.80 $123.56 $49.42 $237.15 $94.86 $237.15 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $154.15 $237.15 N/A $137.75 $237.15 $142.29 $237.15 $237.15 $237.15 N/A N/A 5020-7-250 SUP Custom 27203010 5020-7-250 - PIN HALF BLUNT 5MM 250MM 50MM CONTIN THREAD APEX HOFFMANN II BOTH IP/OP $237.50 $176.00 $42.21 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $237.15 $42.21 $237.15 $237.15 $176.01 $176.01 $182.80 $123.56 $49.42 $237.15 $94.86 $237.15 $237.15 $237.15 $237.15 $237.15 $178.13 $237.15 $237.15 $237.15 $118.58 $118.58 $187.82 $237.15 $189.72 $154.15 $237.15 N/A $137.75 $237.15 $142.29 $237.15 $237.15 $237.15 N/A N/A 5020-8-180 SUP Custom 27203010 5020-8-180 - PIN HALF 5MM 180MM 60MM BLUNT TIP APEX STAINLESS STEEL EXFIX BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 5020-8-250 SUP Custom 27203010 5020-8-250 - PIN HALF 5MM 250MM 70MM BLUNT TIP APEX STAINLESS STEEL EXFIX BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 50-20904 SUP HCPCS C1713 50-20904 - SCREW BONE 2MM 4MM SLFDRILL XPIN TITANIUM MAXFACL BOTH IP/OP $144.50 $107.00 $28.68 $144.50 $65.03 $65.03 $65.03 $65.03 $144.50 $144.50 $144.50 $30.12 $144.50 $144.50 $144.50 $144.50 $144.50 $30.12 $144.50 $144.50 $85.47 $144.50 $144.50 $144.50 $144.50 $108.38 $144.50 $144.50 $144.50 $72.25 $72.25 $114.44 $144.50 $115.60 $65.03 $28.68 N/A $83.81 $144.50 $144.50 $144.50 $30.11 $144.50 N/A N/A 50-20905 SUP HCPCS C1713 50-20905 - SCREW BONE 2MM 5MM SLFDRILL XPIN TITANIUM MAXFACL BOTH IP/OP $342.50 $253.00 $67.98 $342.50 $154.13 $154.13 $154.13 $154.13 $342.50 $342.50 $342.50 $71.39 $342.50 $342.50 $342.50 $342.50 $342.50 $71.38 $342.50 $342.50 $202.59 $342.50 $342.50 $342.50 $342.50 $256.88 $342.50 $342.50 $342.50 $171.25 $171.25 $271.26 $342.50 $274.00 $154.13 $67.98 N/A $198.65 $342.50 $342.50 $342.50 $71.38 $342.50 N/A N/A 50-20906 SUP HCPCS C1713 50-20906 - SCREW BONE 2MM 6MM SLFDRILL XPIN TITANIUM MAXFACL BOTH IP/OP $126.50 $94.00 $25.08 $126.35 $56.86 $56.86 $56.86 $56.86 $126.35 $126.35 $126.35 $26.33 $126.35 $126.35 $126.35 $126.35 $126.35 $26.33 $126.35 $126.35 $74.74 $126.35 $126.35 $126.35 $126.35 $94.88 $126.35 $126.35 $126.35 $63.18 $63.18 $100.07 $126.35 $101.08 $56.86 $25.08 N/A $73.37 $126.35 $126.35 $126.35 $26.33 $126.35 N/A N/A 502-11-42A SUP Custom 27803010 502-11-42A - SHELL ACETAB A HEMISPHERICAL 42MM 3 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-44B SUP Custom 27803010 502-11-44B - SHELL ACETAB B HEMISPHERICAL 44MM 3 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-46C SUP Custom 27803010 502-11-46C - SHELL ACETAB C HEMISPHERICAL 46MM 3 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-48D SUP Custom 27803010 502-11-48D - SHELL ACETAB D HEMISPHERICAL 48MM 3 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-50D SUP Custom 27803010 502-11-50D - SHELL ACETAB D HEMISPHERICAL 50MM 3 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-52E SUP Custom 27803010 502-11-52E - SHELL ACETAB E HEMISPHERICAL 52MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-54E SUP Custom 27803010 502-11-54E - SHELL ACETAB E HEMISPHERICAL 54MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-56F SUP Custom 27803010 502-11-56F - SHELL ACTB F HMSPHR 56MM TRDNT CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-58F SUP Custom 27803010 502-11-58F - SHELL ACETAB F HEMISPHERICAL 58MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-60G SUP Custom 27803010 502-11-60G - SHELL ACETAB G HEMISPHERICAL 60MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-62G SUP Custom 27803010 502-11-62G - SHELL ACETAB G HEMISPHERICAL 62MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-64H SUP Custom 27803010 502-11-64H - SHELL ACETAB H HEMISPHERICAL 64MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-66H SUP Custom 27803010 502-11-66H - SHELL ACETAB H HEMISPHERICAL 66MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-68I SUP Custom 27803010 502-11-68I - SHELL ACETAB I HEMISPHERICAL 68MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-70I SUP Custom 27803010 502-11-70I - SHELL ACETAB I HEMISPHERICAL 70MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-72J SUP Custom 27803010 502-11-72J - SHELL ACETAB D HEMISPHERICAL 72MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-74J SUP Custom 27803010 502-11-74J - SHELL ACETAB J HEMISPHERICAL 74MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 502-11-80L SUP Custom 27803010 502-11-80L - SHELL ACETAB L HEMISPHERICAL 80MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,506.00" "$1,854.00" $446.07 "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" $446.07 "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" $522.28 "$2,506.00" "$1,002.40" "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" "$1,879.50" "$2,506.00" "$2,506.00" "$2,506.00" "$1,253.00" "$1,253.00" "$1,984.75" "$2,506.00" "$2,004.80" "$1,127.70" "$2,506.00" N/A "$1,453.48" "$2,506.00" "$1,503.60" "$2,506.00" "$2,506.00" "$2,506.00" N/A N/A 502-11-82L SUP Custom 27803010 502-11-82L - SHELL ACETAB L HEMISPHERICAL 82MM 5 SCREW HOLE CLUSTER BOTH IP/OP "$2,506.00" "$1,854.00" $446.07 "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" $446.07 "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" $522.28 "$2,506.00" "$1,002.40" "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" "$2,506.00" "$1,879.50" "$2,506.00" "$2,506.00" "$2,506.00" "$1,253.00" "$1,253.00" "$1,984.75" "$2,506.00" "$2,004.80" "$1,127.70" "$2,506.00" N/A "$1,453.48" "$2,506.00" "$1,503.60" "$2,506.00" "$2,506.00" "$2,506.00" N/A N/A 5021-7-150 SUP Custom 27203010 5021-7-150 - PIN HALF 6MM 150MM 50MM SLFDRILL THREAD SHAFT SLFTAP APEX BOTH IP/OP $213.50 $158.00 $37.94 $213.13 $213.13 $213.13 $213.13 $213.13 $213.13 $213.13 $37.94 $213.13 $213.13 $158.19 $158.19 $164.28 $111.04 $44.42 $213.13 $85.25 $213.13 $213.13 $213.13 $213.13 $213.13 $160.13 $213.13 $213.13 $213.13 $106.57 $106.57 $168.80 $213.13 $170.50 $138.53 $213.13 N/A $123.83 $213.13 $127.88 $213.13 $213.13 $213.13 N/A N/A 5021-7-200 SUP Custom 27203010 5021-7-200 - PIN HALF 6MM 200MM 60MM SLFDRILL THREADED APEX STAINLESS BOTH IP/OP $209.50 $155.00 $37.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $209.25 $37.25 $209.25 $209.25 $155.31 $155.31 $161.29 $109.02 $43.61 $209.25 $83.70 $209.25 $209.25 $209.25 $209.25 $209.25 $157.13 $209.25 $209.25 $209.25 $104.63 $104.63 $165.73 $209.25 $167.40 $136.01 $209.25 N/A $121.51 $209.25 $125.55 $209.25 $209.25 $209.25 N/A N/A 5023-1-090 SUP Custom 27203010 5023-1-090 - PIN HALF 4MM 90MM 10MM SLFTAP SLFDRILL THREAD APEX STAINLESS BOTH IP/OP $169.50 $125.00 $30.17 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $30.17 $169.50 $169.50 $125.80 $125.80 $130.65 $88.31 $35.33 $169.50 $67.80 $169.50 $169.50 $169.50 $169.50 $169.50 $127.13 $169.50 $169.50 $169.50 $84.75 $84.75 $134.24 $169.50 $135.60 $110.18 $169.50 N/A $98.31 $169.50 $101.70 $169.50 $169.50 $169.50 N/A N/A 5023-2-090 SUP Custom 27203010 5023-2-090 - PIN HALF 4MM 90MM 20MM SELF TAP SELF DRILL THREAD APEX BOTH IP/OP $169.50 $125.00 $30.17 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $30.17 $169.50 $169.50 $125.80 $125.80 $130.65 $88.31 $35.33 $169.50 $67.80 $169.50 $169.50 $169.50 $169.50 $169.50 $127.13 $169.50 $169.50 $169.50 $84.75 $84.75 $134.24 $169.50 $135.60 $110.18 $169.50 N/A $98.31 $169.50 $101.70 $169.50 $169.50 $169.50 N/A N/A 5023-3-090 SUP Custom 27203010 5023-3-090 - PIN HALF 4MM 90MM 30MM SELF TAP SELF DRILL THREAD APEX BOTH IP/OP $169.50 $125.00 $30.17 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $30.17 $169.50 $169.50 $125.80 $125.80 $130.65 $88.31 $35.33 $169.50 $67.80 $169.50 $169.50 $169.50 $169.50 $169.50 $127.13 $169.50 $169.50 $169.50 $84.75 $84.75 $134.24 $169.50 $135.60 $110.18 $169.50 N/A $98.31 $169.50 $101.70 $169.50 $169.50 $169.50 N/A N/A 5023-3-120 SUP Custom 27203010 5023-3-120 - PIN HALF 4MM 120MM 30MM SLFDRILL SLFTAP THREADED APEX BOTH IP/OP $169.50 $125.00 $30.17 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $30.17 $169.50 $169.50 $125.80 $125.80 $130.65 $88.31 $35.33 $169.50 $67.80 $169.50 $169.50 $169.50 $169.50 $169.50 $127.13 $169.50 $169.50 $169.50 $84.75 $84.75 $134.24 $169.50 $135.60 $110.18 $169.50 N/A $98.31 $169.50 $101.70 $169.50 $169.50 $169.50 N/A N/A 50-23404 SUP HCPCS C1713 50-23404 - SCREW BONE 2.3MM 4MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $280.00 $207.00 $55.57 $280.00 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $112.00 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $168.00 $280.00 $58.35 $280.00 N/A N/A 50-23406 SUP HCPCS C1713 50-23406 - SCREW BONE 2.3MM 6MM SELF TAP XPIN TITANIUM MAXFACL NONSTRL BOTH IP/OP $280.00 $207.00 $55.57 $280.00 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $168.00 $280.00 $58.35 $280.00 N/A N/A 50-23408 SUP HCPCS C1713 50-23408 - SCREW BONE 2.3MM 8MM SELF TAP XPIN TITANIUM MANDIB BOTH IP/OP $280.00 $207.00 $55.57 $280.00 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $112.00 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $168.00 $280.00 $58.35 $280.00 N/A N/A 50-23410 SUP HCPCS C1713 50-23410 - SCREW BONE 2.3MM 10MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL BOTH IP/OP $280.00 $207.00 $55.57 $280.00 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A 50-23412 SUP HCPCS C1713 50-23412 - SCREW BONE 2.3MM 12MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL BOTH IP/OP $280.00 $207.00 $55.57 $280.00 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A 5023-4-120 SUP Custom 27203010 5023-4-120 - PIN HALF 4MM 120MM 45MM SLFDRILL SLFTAP THREADED APEX BOTH IP/OP $169.50 $125.00 $30.17 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $30.17 $169.50 $169.50 $125.80 $125.80 $130.65 $88.31 $35.33 $169.50 $67.80 $169.50 $169.50 $169.50 $169.50 $169.50 $127.13 $169.50 $169.50 $169.50 $84.75 $84.75 $134.24 $169.50 $135.60 $110.18 $169.50 N/A $98.31 $169.50 $101.70 $169.50 $169.50 $169.50 N/A N/A 50-23414 SUP HCPCS C1713 50-23414 - SCREW BONE 2.3MM 14MM SELF TAP XPIN HEAD LEIBINGER UNIVERSAL BOTH IP/OP $115.50 $85.00 $22.92 $115.50 $51.98 $51.98 $51.98 $51.98 $115.50 $115.50 $115.50 $24.07 $115.50 $115.50 $115.50 $115.50 $115.50 $24.07 $115.50 $115.50 $68.32 $115.50 $115.50 $115.50 $115.50 $86.63 $115.50 $115.50 $115.50 $57.75 $57.75 $91.48 $115.50 $92.40 $51.98 $22.92 N/A $66.99 $115.50 $115.50 $115.50 $24.07 $115.50 N/A N/A 50-23416 SUP HCPCS C1713 50-23416 - SCREW BONE 2.3MM 16MM SELF TAP XPIN TITANIUM MANDIB BOTH IP/OP $115.50 $85.00 $22.92 $115.50 $51.98 $51.98 $51.98 $51.98 $115.50 $115.50 $115.50 $24.07 $115.50 $115.50 $115.50 $115.50 $115.50 $24.07 $115.50 $115.50 $68.32 $115.50 $115.50 $115.50 $115.50 $86.63 $115.50 $115.50 $115.50 $57.75 $57.75 $91.48 $115.50 $92.40 $51.98 $22.92 N/A $66.99 $115.50 $115.50 $115.50 $24.07 $115.50 N/A N/A 50-23418 SUP HCPCS C1713 50-23418 - SCREW BONE 2.3MM 18MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $118.50 $88.00 $23.51 $118.45 $53.30 $53.30 $53.30 $53.30 $118.45 $118.45 $118.45 $24.69 $118.45 $118.45 $118.45 $118.45 $118.45 $24.69 $118.45 $118.45 $70.06 $118.45 $118.45 $118.45 $118.45 $88.88 $118.45 $118.45 $118.45 $59.23 $59.23 $93.81 $118.45 $94.76 $53.30 $23.51 N/A $68.73 $118.45 $118.45 $118.45 $24.68 $118.45 N/A N/A 5023-4-180 SUP Custom 27203010 5023-4-180 - PIN HLF 4MM 180MM 40MM HFMN2 APX SLF DRL ST THRD SS FT/ANKL BOTH IP/OP $169.50 $125.00 $30.17 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $30.17 $169.50 $169.50 $125.80 $125.80 $130.65 $88.31 $35.33 $169.50 $67.80 $169.50 $169.50 $169.50 $169.50 $169.50 $127.13 $169.50 $169.50 $169.50 $84.75 $84.75 $134.24 $169.50 $135.60 $110.18 $169.50 N/A $98.31 $169.50 $101.70 $169.50 $169.50 $169.50 N/A N/A 50-23420 SUP HCPCS C1713 50-23420 - SCREW BONE 2.3MM 20MM SLFTAP XPIN TITANIUM MANDIB BOTH IP/OP $118.50 $88.00 $23.51 $118.45 $53.30 $53.30 $53.30 $53.30 $118.45 $118.45 $118.45 $24.69 $118.45 $118.45 $118.45 $118.45 $118.45 $24.69 $118.45 $47.38 $70.06 $118.45 $118.45 $118.45 $118.45 $88.88 $118.45 $118.45 $118.45 $59.23 $59.23 $93.81 $118.45 $94.76 $53.30 $23.51 N/A $68.73 $118.45 $118.45 $118.45 $24.68 $118.45 N/A N/A 50-23504 SUP HCPCS C1713 50-23504 - SCREW BONE 2.3MM 4MM LOCKING XPIN TITANIUM MAXFACL BOTH IP/OP "$1,299.50" $962.00 $257.86 "$1,299.22" $584.65 $584.65 $584.65 $584.65 "$1,299.22" "$1,299.22" "$1,299.22" $270.79 "$1,299.22" "$1,299.22" "$1,299.22" "$1,299.22" "$1,299.22" $270.77 "$1,299.22" "$1,299.22" $768.49 "$1,299.22" "$1,299.22" "$1,299.22" "$1,299.22" $974.63 "$1,299.22" "$1,299.22" "$1,299.22" $649.61 $649.61 "$1,028.98" "$1,299.22" "$1,039.38" $584.65 $257.86 N/A $753.71 "$1,299.22" "$1,299.22" "$1,299.22" $270.76 "$1,299.22" N/A N/A 50-23506 SUP HCPCS C1713 50-23506 - SCREW BN 2.3MM 6MM NS LEIBINGER UNV 2 LCK XPN TI MXLFCL BOTH IP/OP $197.50 $146.00 $39.17 $197.35 $88.81 $88.81 $88.81 $88.81 $197.35 $197.35 $197.35 $41.13 $197.35 $197.35 $197.35 $197.35 $197.35 $41.13 $197.35 $78.94 $116.73 $197.35 $197.35 $197.35 $197.35 $148.13 $197.35 $197.35 $197.35 $98.68 $98.68 $156.30 $197.35 $157.88 $88.81 $39.17 N/A $114.55 $197.35 $118.41 $197.35 $41.13 $197.35 N/A N/A 50-23508 SUP HCPCS C1713 50-23508 - SCREW BONE 2.3MM 8MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2 BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A 50-23508 SUP HCPCS C1713 50-23508 - SCREW BN 2.3MM 8MM NS LEIBINGER UNV 2 LCK XPN TI MXLFCL BOTH IP/OP "$1,299.50" $962.00 $94.28 $974.63 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $974.63 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $753.71 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A 5023-5-090 SUP Custom 27203010 5023-5-090 - PIN HALF 4MM 90MM 40MM SELF DRILL SELF TAP THREAD APEX BOTH IP/OP $192.50 $142.00 $34.19 $192.10 $192.10 $192.10 $192.10 $192.10 $192.10 $192.10 $34.19 $192.10 $192.10 $142.58 $142.58 $148.07 $100.08 $40.04 $192.10 $76.84 $192.10 $192.10 $192.10 $192.10 $192.10 $144.38 $192.10 $192.10 $192.10 $96.05 $96.05 $152.14 $192.10 $153.68 $124.87 $192.10 N/A $111.65 $192.10 $115.26 $192.10 $192.10 $192.10 N/A N/A 50-23510 SUP HCPCS C1713 50-23510 - SCREW BONE 2.3MM 10MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2 BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $190.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A 50-23512 SUP HCPCS C1713 50-23512 - SCREW BONE 2.3MM 12MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2 BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $190.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A 5023-5-120 SUP Custom 27203010 5023-5-120 - PIN HALF 4MM 120MM 35MM SLFDRILL SLFTAP APEX STAINLESS STEEL BOTH IP/OP $169.50 $125.00 $30.17 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $30.17 $169.50 $169.50 $125.80 $125.80 $130.65 $88.31 $35.33 $169.50 $67.80 $169.50 $169.50 $169.50 $169.50 $169.50 $127.13 $169.50 $169.50 $169.50 $84.75 $84.75 $134.24 $169.50 $135.60 $110.18 $169.50 N/A $98.31 $169.50 $101.70 $169.50 $169.50 $169.50 N/A N/A 50-23514 SUP HCPCS C1713 50-23514 - SCREW BONE 2.3MM 14MM LOCKING XPIN LEIBINGER UNIVERSAL 2 BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A 5023-5-150 SUP Custom 27203010 5023-5-150 - PIN HALF 4MM 150MM 40MM SELF TAP SELF DRILL APEX HOFFMANN II BOTH IP/OP $169.50 $125.00 $30.17 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $30.17 $169.50 $169.50 $125.80 $125.80 $130.65 $88.31 $35.33 $169.50 $67.80 $169.50 $169.50 $169.50 $169.50 $169.50 $127.13 $169.50 $169.50 $169.50 $84.75 $84.75 $134.24 $169.50 $135.60 $110.18 $169.50 N/A $98.31 $169.50 $101.70 $169.50 $169.50 $169.50 N/A N/A 50-23516 SUP HCPCS C1713 50-23516 - SCREW BONE 2.3MM 16MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2 BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $190.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A 50-23518 SUP HCPCS C1713 50-23518 - SCREW BONE 2.3MM 18MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2 BOTH IP/OP $197.50 $146.00 $39.17 $197.35 $88.81 $88.81 $88.81 $88.81 $197.35 $197.35 $197.35 $41.13 $197.35 $197.35 $197.35 $197.35 $197.35 $41.13 $197.35 $197.35 $116.73 $197.35 $197.35 $197.35 $197.35 $148.13 $197.35 $197.35 $197.35 $98.68 $98.68 $156.30 $197.35 $157.88 $88.81 $39.17 N/A $114.55 $197.35 $197.35 $197.35 $41.13 $197.35 N/A N/A 50-23520 SUP HCPCS C1713 50-23520 - SCREW BONE 2.3MM 20MM LOCKING XPIN TITANIUM MAXFACL BOTH IP/OP $197.50 $146.00 $39.17 $197.35 $88.81 $88.81 $88.81 $88.81 $197.35 $197.35 $197.35 $41.13 $197.35 $197.35 $197.35 $197.35 $197.35 $41.13 $197.35 $78.94 $116.73 $197.35 $197.35 $197.35 $197.35 $148.13 $197.35 $197.35 $197.35 $98.68 $98.68 $156.30 $197.35 $157.88 $88.81 $39.17 N/A $114.55 $197.35 $197.35 $197.35 $41.13 $197.35 N/A N/A 5023-6-150 SUP Custom 27203010 5023-6-150 - PIN HALF 4MM 150MM 50MM SLFDRILL SLFTAP THREADED APEX BOTH IP/OP $169.50 $125.00 $30.17 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $30.17 $169.50 $169.50 $125.80 $125.80 $130.65 $88.31 $35.33 $169.50 $67.80 $169.50 $169.50 $169.50 $169.50 $169.50 $127.13 $169.50 $169.50 $169.50 $84.75 $84.75 $134.24 $169.50 $135.60 $110.18 $169.50 N/A $98.31 $169.50 $101.70 $169.50 $169.50 $169.50 N/A N/A 5023-6-180 SUP Custom 27203010 5023-6-180 - PIN FIX 4MM 180MM 50MM SLFDRILL SLFTAP APEX STAINLESS STEEL BOTH IP/OP $169.50 $125.00 $30.17 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $169.50 $30.17 $169.50 $169.50 $125.80 $125.80 $130.65 $88.31 $35.33 $169.50 $67.80 $169.50 $169.50 $169.50 $169.50 $169.50 $127.13 $169.50 $169.50 $169.50 $84.75 $84.75 $134.24 $169.50 $135.60 $110.18 $169.50 N/A $98.31 $169.50 $101.70 $169.50 $169.50 $169.50 N/A N/A 5023-6-200 SUP Custom 27203010 5023-6-200 - PIN HALF 4MM 200MM 40MM SELF DRILL SELF TAP THREAD APEX BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A 5023-6-250 SUP Custom 27203010 5023-6-250 - PIN HALF 4MM 250MM 50MM SELF DRILL SELF TAP THREAD APEX BOTH IP/OP $199.50 $148.00 $35.49 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $35.49 $199.38 $199.38 $147.98 $147.98 $153.68 $103.88 $41.55 $199.38 $79.75 $199.38 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $129.60 $199.38 N/A $115.71 $199.38 $119.63 $199.38 $199.38 $199.38 N/A N/A 50-23706 SUP HCPCS C1713 50-23706 - SCREW BONE 2.3MM 6MM SLFTAP XFIT TITANIUM MAXFACL BOTH IP/OP $132.50 $98.00 $26.20 $132.03 $59.41 $59.41 $59.41 $59.41 $132.03 $132.03 $132.03 $27.52 $132.03 $132.03 $132.03 $132.03 $132.03 $27.52 $132.03 $132.03 $78.10 $132.03 $132.03 $132.03 $132.03 $99.38 $132.03 $132.03 $132.03 $66.02 $66.02 $104.57 $132.03 $105.62 $59.41 $26.20 N/A $76.85 $132.03 $132.03 $132.03 $27.52 $132.03 N/A N/A 50-23708 SUP HCPCS C1713 50-23708 - SCREW BONE 2.3MM 8MM SLFTAP XPIN EMERGENCY TITANIUM MAXFACL BOTH IP/OP $132.50 $98.00 $26.20 $132.03 $59.41 $59.41 $59.41 $59.41 $132.03 $132.03 $132.03 $27.52 $132.03 $132.03 $132.03 $132.03 $132.03 $27.52 $132.03 $132.03 $78.10 $132.03 $132.03 $132.03 $132.03 $99.38 $132.03 $132.03 $132.03 $66.02 $66.02 $104.57 $132.03 $105.62 $59.41 $26.20 N/A $76.85 $132.03 $79.22 $132.03 $27.52 $132.03 N/A N/A 50-23710 SUP HCPCS C1713 50-23710 - SCREW BONE 2.3MM 10MM SLFTAP EMERGENCY XPIN TITANIUM MAXFACL BOTH IP/OP $132.50 $98.00 $26.20 $132.03 $59.41 $59.41 $59.41 $59.41 $132.03 $132.03 $132.03 $27.52 $132.03 $132.03 $132.03 $132.03 $132.03 $27.52 $132.03 $132.03 $78.10 $132.03 $132.03 $132.03 $132.03 $99.38 $132.03 $132.03 $132.03 $66.02 $66.02 $104.57 $132.03 $105.62 $59.41 $26.20 N/A $76.85 $132.03 $79.22 $132.03 $27.52 $132.03 N/A N/A 50-23712 SUP HCPCS C1713 50-23712 - SCREW BONE 2.3MM 12MM SLFTAP EMERGENCY XPIN TITANIUM MAXFACL BOTH IP/OP $132.50 $98.00 $26.20 $132.03 $59.41 $59.41 $59.41 $59.41 $132.03 $132.03 $132.03 $27.52 $132.03 $132.03 $132.03 $132.03 $132.03 $27.52 $132.03 $132.03 $78.10 $132.03 $132.03 $132.03 $132.03 $99.38 $132.03 $132.03 $132.03 $66.02 $66.02 $104.57 $132.03 $105.62 $59.41 $26.20 N/A $76.85 $132.03 $132.03 $132.03 $27.52 $132.03 N/A N/A 50-23714 SUP HCPCS C1713 50-23714 - SCREW BONE 2.3MM 14MM SLFTAP EMERGENCY XPIN TITANIUM MAXFACL BOTH IP/OP $132.50 $98.00 $26.20 $132.03 $59.41 $59.41 $59.41 $59.41 $132.03 $132.03 $132.03 $27.52 $132.03 $132.03 $132.03 $132.03 $132.03 $27.52 $132.03 $132.03 $78.10 $132.03 $132.03 $132.03 $132.03 $99.38 $132.03 $132.03 $132.03 $66.02 $66.02 $104.57 $132.03 $105.62 $59.41 $26.20 N/A $76.85 $132.03 $132.03 $132.03 $27.52 $132.03 N/A N/A 50-23716 SUP HCPCS C1713 50-23716 - SCREW BONE 2.3MM 16MM EMERGENCY XPIN TITANIUM MAXFACL BOTH IP/OP $132.50 $98.00 $26.20 $132.03 $59.41 $59.41 $59.41 $59.41 $132.03 $132.03 $132.03 $27.52 $132.03 $132.03 $132.03 $132.03 $132.03 $27.52 $132.03 $132.03 $78.10 $132.03 $132.03 $132.03 $132.03 $99.38 $132.03 $132.03 $132.03 $66.02 $66.02 $104.57 $132.03 $105.62 $59.41 $26.20 N/A $76.85 $132.03 $132.03 $132.03 $27.52 $132.03 N/A N/A 5023-7-250 SUP Custom 27203010 5023-7-250 - PIN HALF 4MM 250MM 70MM SLFDRILL SLFTAP THREADED APEX BOTH IP/OP $96.50 $71.00 $17.13 $96.25 $96.25 $96.25 $96.25 $96.25 $96.25 $96.25 $17.13 $96.25 $96.25 $71.44 $71.44 $74.19 $50.15 $20.06 $96.25 $38.50 $96.25 $96.25 $96.25 $96.25 $96.25 $72.38 $96.25 $96.25 $96.25 $48.13 $48.13 $76.23 $96.25 $77.00 $62.56 $96.25 N/A $55.97 $96.25 $57.75 $96.25 $96.25 $96.25 N/A N/A 5027-1-040 SUP Custom 27803010 5027-1-040 - CAP PROTECTIVE 4MM 4MM 4MM TIP SHAFT HOFFMANN XPRESS WHITE BOTH IP/OP $70.00 $52.00 $12.41 $69.70 $69.70 $69.70 $69.70 $69.70 $69.70 $69.70 $12.41 $69.70 $69.70 $69.70 $69.70 $69.70 $69.70 $14.53 $69.70 $27.88 $69.70 $69.70 $69.70 $69.70 $69.70 $52.50 $69.70 $69.70 $69.70 $34.85 $34.85 $55.20 $69.70 $55.76 $31.37 $69.70 N/A $40.60 $69.70 $41.82 $69.70 $69.70 $69.70 N/A N/A 5027-1-050 SUP Custom 27803010 5027-1-050 - CAP PROTECTIVE BLUNT 5MM 50MM CONTIN THREAD SHAFT HOFFMANN BOTH IP/OP $72.50 $54.00 $12.86 $72.25 $72.25 $72.25 $72.25 $72.25 $72.25 $72.25 $12.86 $72.25 $72.25 $72.25 $72.25 $72.25 $72.25 $15.06 $72.25 $28.90 $72.25 $72.25 $72.25 $72.25 $72.25 $54.38 $72.25 $72.25 $72.25 $36.13 $36.13 $57.22 $72.25 $57.80 $32.51 $72.25 N/A $42.05 $72.25 $43.35 $72.25 $72.25 $72.25 N/A N/A 5027-1-090 SUP Custom 27203010 5027-1-090 - PIN HALF 4MM 90MM 10MM BLUNT TIP APEX STAINLESS STEEL EXFIX BOTH IP/OP $124.00 $92.00 $22.03 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $22.03 $123.75 $123.75 $91.85 $91.85 $95.39 $64.47 $25.79 $123.75 $49.50 $123.75 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $80.44 $123.75 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 5027-2-090 SUP Custom 27203010 5027-2-090 - PIN HALF 4MM 90MM 20MM BLUNT TIP APEX STAINLESS STEEL EXFIX BOTH IP/OP $124.00 $92.00 $22.03 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $22.03 $123.75 $123.75 $91.85 $91.85 $95.39 $64.47 $25.79 $123.75 $49.50 $123.75 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $80.44 $123.75 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 5027-3-090 SUP Custom 27203010 5027-3-090 - PIN HALF 4MM 90MM 30MM BLUNT TIP APEX STAINLESS STEEL EXFIX BOTH IP/OP $124.00 $92.00 $22.03 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $22.03 $123.75 $123.75 $91.85 $91.85 $95.39 $64.47 $25.79 $123.75 $49.50 $123.75 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $80.44 $123.75 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 5027-3-120 SUP Custom 27203010 5027-3-120 - PIN HALF BLUNT 4MM 120MM 30MM APEX STAINLESS STEEL EXFIX BOTH IP/OP $124.00 $92.00 $22.03 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $22.03 $123.75 $123.75 $91.85 $91.85 $95.39 $64.47 $25.79 $123.75 $49.50 $123.75 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $80.44 $123.75 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 50-27405 SUP HCPCS C1713 50-27405 - SCREW BONE 2.7MM 5MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $327.50 $242.00 $65.00 $327.50 $147.38 $147.38 $147.38 $147.38 $327.50 $327.50 $327.50 $68.26 $327.50 $327.50 $327.50 $327.50 $327.50 $68.25 $327.50 $131.00 $193.72 $327.50 $327.50 $327.50 $327.50 $245.63 $327.50 $327.50 $327.50 $163.75 $163.75 $259.38 $327.50 $262.00 $147.38 $65.00 N/A $189.95 $327.50 $196.50 $327.50 $68.25 $327.50 N/A N/A 50-27408 SUP HCPCS C1713 50-27408 - SCREW BONE 2.7MM 8MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $65.50 $48.00 $13.00 $65.50 $29.48 $29.48 $29.48 $29.48 $65.50 $65.50 $65.50 $13.65 $65.50 $65.50 $65.50 $65.50 $65.50 $13.65 $65.50 $65.50 $38.74 $65.50 $65.50 $65.50 $65.50 $49.13 $65.50 $65.50 $65.50 $32.75 $32.75 $51.88 $65.50 $52.40 $29.48 $13.00 N/A $37.99 $65.50 $65.50 $65.50 $13.65 $65.50 N/A N/A 50-27410 SUP HCPCS C1713 50-27410 - SCREW BONE 2.7MM 10MM SELF TAP XPIN EMERGENCY TITANIUM BOTH IP/OP $140.00 $104.00 $27.76 $139.88 $62.95 $62.95 $62.95 $62.95 $139.88 $139.88 $139.88 $29.15 $139.88 $139.88 $139.88 $139.88 $139.88 $29.15 $139.88 $139.88 $82.74 $139.88 $139.88 $139.88 $139.88 $105.00 $139.88 $139.88 $139.88 $69.94 $69.94 $110.78 $139.88 $111.90 $62.95 $27.76 N/A $81.20 $139.88 $139.88 $139.88 $29.15 $139.88 N/A N/A 50-27412 SUP HCPCS C1713 50-27412 - SCREW BONE 2 UNIVERSAL 2.7MM 12MM SELF TAP XPIN EMERGENCY BOTH IP/OP $327.50 $242.00 $65.00 $327.50 $147.38 $147.38 $147.38 $147.38 $327.50 $327.50 $327.50 $68.26 $327.50 $327.50 $327.50 $327.50 $327.50 $68.25 $327.50 $131.00 $193.72 $327.50 $327.50 $327.50 $327.50 $245.63 $327.50 $327.50 $327.50 $163.75 $163.75 $259.38 $327.50 $262.00 $147.38 $65.00 N/A $189.95 $327.50 $196.50 $327.50 $68.25 $327.50 N/A N/A 5027-4-120 SUP Custom 27203010 5027-4-120 - PIN HALF 4MM 120MM 35MM BLUNT TIP APEX STAINLESS STEEL EXFIX BOTH IP/OP $124.00 $92.00 $22.03 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $22.03 $123.75 $123.75 $91.85 $91.85 $95.39 $64.47 $25.79 $123.75 $49.50 $123.75 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $80.44 $123.75 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 50-27414 SUP HCPCS C1713 50-27414 - SCREW BONE 2.7MM 14MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $327.50 $242.00 $65.00 $327.50 $147.38 $147.38 $147.38 $147.38 $327.50 $327.50 $327.50 $68.26 $327.50 $327.50 $327.50 $327.50 $327.50 $68.25 $327.50 $327.50 $193.72 $327.50 $327.50 $327.50 $327.50 $245.63 $327.50 $327.50 $327.50 $163.75 $163.75 $259.38 $327.50 $262.00 $147.38 $65.00 N/A $189.95 $327.50 $196.50 $327.50 $68.25 $327.50 N/A N/A 5027-4-150 SUP Custom 27203010 5027-4-150 - PIN HALF 4MM 150MM 40MM BLUNT TIP APEX STAINLESS STEEL EXFIX BOTH IP/OP $124.00 $92.00 $22.03 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $22.03 $123.75 $123.75 $91.85 $91.85 $95.39 $64.47 $25.79 $123.75 $49.50 $123.75 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $80.44 $123.75 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 50-27416 SUP HCPCS C1713 50-27416 - SCREW BONE 2.7MM 16MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $140.00 $104.00 $27.76 $139.88 $62.95 $62.95 $62.95 $62.95 $139.88 $139.88 $139.88 $29.15 $139.88 $139.88 $139.88 $139.88 $139.88 $29.15 $139.88 $55.95 $82.74 $139.88 $139.88 $139.88 $139.88 $105.00 $139.88 $139.88 $139.88 $69.94 $69.94 $110.78 $139.88 $111.90 $62.95 $27.76 N/A $81.20 $139.88 $139.88 $139.88 $29.15 $139.88 N/A N/A 50-27418 SUP HCPCS C1713 50-27418 - SCREW BONE 2.7MM 18MM SLFTAP XPIN TITANIUM MAXFACL BOTH IP/OP $140.00 $104.00 $27.76 $139.88 $62.95 $62.95 $62.95 $62.95 $139.88 $139.88 $139.88 $29.15 $139.88 $139.88 $139.88 $139.88 $139.88 $29.15 $139.88 $55.95 $82.74 $139.88 $139.88 $139.88 $139.88 $105.00 $139.88 $139.88 $139.88 $69.94 $69.94 $110.78 $139.88 $111.90 $62.95 $27.76 N/A $81.20 $139.88 $139.88 $139.88 $139.88 $139.88 N/A N/A 5027-4-180 SUP Custom 27203010 5027-4-180 - PIN HALF 4MM 180MM 40MM BLUNT TIP APEX STAINLESS STEEL EXFIX BOTH IP/OP $124.00 $92.00 $22.03 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $22.03 $123.75 $123.75 $91.85 $91.85 $95.39 $64.47 $25.79 $123.75 $49.50 $123.75 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $80.44 $123.75 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 50-27420 SUP HCPCS C1713 50-27420 - SCREW BONE 2.7MM 20MM XPIN EMERGENCY TITANIUM MAXFACL BOTH IP/OP $140.00 $104.00 $27.76 $139.88 $62.95 $62.95 $62.95 $62.95 $139.88 $139.88 $139.88 $29.15 $139.88 $139.88 $139.88 $139.88 $139.88 $29.15 $139.88 $55.95 $82.74 $139.88 $139.88 $139.88 $139.88 $105.00 $139.88 $139.88 $139.88 $69.94 $69.94 $110.78 $139.88 $111.90 $62.95 $27.76 N/A $81.20 $139.88 $139.88 $139.88 $139.88 $139.88 N/A N/A 50-27505 SUP HCPCS C1713 50-27505 - SCREW BONE 2.7MM 5MM LOCKING XPIN EMERGENCY TITANIUM MAXFACL BOTH IP/OP $234.00 $173.00 $46.41 $233.85 $105.23 $105.23 $105.23 $105.23 $233.85 $233.85 $233.85 $48.74 $233.85 $233.85 $233.85 $233.85 $233.85 $48.74 $233.85 $233.85 $138.32 $233.85 $233.85 $233.85 $233.85 $175.50 $233.85 $233.85 $233.85 $116.93 $116.93 $185.21 $233.85 $187.08 $105.23 $46.41 N/A $135.72 $233.85 $233.85 $233.85 $48.73 $233.85 N/A N/A 50-27508 SUP HCPCS C1713 50-27508 - SCREW BONE 2.7MM 8MM LOCKING XPIN EMERGENCY TITANIUM MAXFACL BOTH IP/OP $234.00 $173.00 $46.41 $233.85 $105.23 $105.23 $105.23 $105.23 $233.85 $233.85 $233.85 $48.74 $233.85 $233.85 $233.85 $233.85 $233.85 $48.74 $233.85 $93.54 $138.32 $233.85 $233.85 $233.85 $233.85 $175.50 $233.85 $233.85 $233.85 $116.93 $116.93 $185.21 $233.85 $187.08 $105.23 $46.41 N/A $135.72 $233.85 $233.85 $233.85 $48.73 $233.85 N/A N/A 50-27510 SUP HCPCS C1713 50-27510 - SCREW BONE 2.7MM 10MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2 BOTH IP/OP $234.00 $173.00 $46.41 $233.85 $105.23 $105.23 $105.23 $105.23 $233.85 $233.85 $233.85 $48.74 $233.85 $233.85 $233.85 $233.85 $233.85 $48.74 $233.85 $233.85 $138.32 $233.85 $233.85 $233.85 $233.85 $175.50 $233.85 $233.85 $233.85 $116.93 $116.93 $185.21 $233.85 $187.08 $105.23 $46.41 N/A $135.72 $233.85 $233.85 $233.85 $48.73 $233.85 N/A N/A 50-27512 SUP HCPCS C1713 50-27512 - SCREW BONE 2.7MM 12MM LOCK XPIN HEAD LEIBINGER UNIVERSAL 2 BOTH IP/OP $234.00 $173.00 $46.41 $233.85 $105.23 $105.23 $105.23 $105.23 $233.85 $233.85 $233.85 $48.74 $233.85 $233.85 $233.85 $233.85 $233.85 $48.74 $233.85 $93.54 $138.32 $233.85 $233.85 $233.85 $233.85 $175.50 $233.85 $233.85 $233.85 $116.93 $116.93 $185.21 $233.85 $187.08 $105.23 $46.41 N/A $135.72 $233.85 $233.85 $233.85 $48.73 $233.85 N/A N/A 50-27514 SUP HCPCS C1713 50-27514 - SCREW BONE 2.7MM 14MM LOCKING XPIN EMERGENCY TITANIUM BOTH IP/OP $234.00 $173.00 $46.41 $233.85 $105.23 $105.23 $105.23 $105.23 $233.85 $233.85 $233.85 $48.74 $233.85 $233.85 $233.85 $233.85 $233.85 $48.74 $233.85 $233.85 $138.32 $233.85 $233.85 $233.85 $233.85 $175.50 $233.85 $233.85 $233.85 $116.93 $116.93 $185.21 $233.85 $187.08 $105.23 $46.41 N/A $135.72 $233.85 $233.85 $233.85 $48.73 $233.85 N/A N/A 5027-5-150 SUP Custom 27203010 5027-5-150 - PIN HALF BLUNT 4MM 150MM 50MM APEX STAINLESS STEEL EXFIX BOTH IP/OP $124.00 $92.00 $22.03 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $22.03 $123.75 $123.75 $91.85 $91.85 $95.39 $64.47 $25.79 $123.75 $49.50 $123.75 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $80.44 $123.75 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 50-27516 SUP HCPCS C1713 50-27516 - SCREW BONE 2.7MM 16MM LOCKING XPIN EMERGENCY TITANIUM BOTH IP/OP $234.00 $173.00 $46.41 $233.85 $105.23 $105.23 $105.23 $105.23 $233.85 $233.85 $233.85 $48.74 $233.85 $233.85 $233.85 $233.85 $233.85 $48.74 $233.85 $93.54 $138.32 $233.85 $233.85 $233.85 $233.85 $175.50 $233.85 $233.85 $233.85 $116.93 $116.93 $185.21 $233.85 $187.08 $105.23 $46.41 N/A $135.72 $233.85 $140.31 $233.85 $48.73 $233.85 N/A N/A 50-27518 SUP HCPCS C1713 50-27518 - SCREW BONE 2.7MM 18MM LOCKING XPIN EMERGENCY TITANIUM BOTH IP/OP $234.00 $173.00 $46.41 $233.85 $105.23 $105.23 $105.23 $105.23 $233.85 $233.85 $233.85 $48.74 $233.85 $233.85 $233.85 $233.85 $233.85 $48.74 $233.85 $93.54 $138.32 $233.85 $233.85 $233.85 $233.85 $175.50 $233.85 $233.85 $233.85 $116.93 $116.93 $185.21 $233.85 $187.08 $105.23 $46.41 N/A $135.72 $233.85 $140.31 $233.85 $48.73 $233.85 N/A N/A 5027-5-180 SUP Custom 27203010 5027-5-180 - PIN FIX BLUNT 4MM 180MM 50MM APEX STAINLESS STEEL BOTH IP/OP $124.00 $92.00 $22.03 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $22.03 $123.75 $123.75 $91.85 $91.85 $95.39 $64.47 $25.79 $123.75 $49.50 $123.75 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $80.44 $123.75 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 50-27520 SUP HCPCS C1713 50-27520 - SCREW BONE 2.7MM 20MM LOCKING XPIN EMERGENCY TITANIUM BOTH IP/OP $234.00 $173.00 $46.41 $233.85 $105.23 $105.23 $105.23 $105.23 $233.85 $233.85 $233.85 $48.74 $233.85 $233.85 $233.85 $233.85 $233.85 $48.74 $233.85 $233.85 $138.32 $233.85 $233.85 $233.85 $233.85 $175.50 $233.85 $233.85 $233.85 $116.93 $116.93 $185.21 $233.85 $187.08 $105.23 $46.41 N/A $135.72 $233.85 $233.85 $233.85 $48.73 $233.85 N/A N/A 5028-7-030 SUP Custom 27203010 5028-7-030 - ROD EXFIX 8MM 174MM SEMI CIRCULAR HOFFMANN II MRI CARB BOTH IP/OP $595.50 $441.00 $105.93 $595.10 $595.10 $595.10 $595.10 $595.10 $595.10 $595.10 $105.93 $595.10 $595.10 $441.68 $441.68 $458.70 $310.05 $124.03 $595.10 $238.04 $595.10 $595.10 $595.10 $595.10 $595.10 $446.63 $595.10 $595.10 $595.10 $297.55 $297.55 $471.32 $595.10 $476.08 $386.82 $595.10 N/A $345.39 $595.10 $357.06 $595.10 $595.10 $595.10 N/A N/A 5028-8-065 SUP Custom 27203010 5028-8-065 - ROD EXFIX 8MM 65MM CONNCTNG MRI SAFE NONCONDUCTIVE BOTH IP/OP $415.50 $307.00 $73.96 $415.50 $415.50 $415.50 $415.50 $415.50 $415.50 $415.50 $73.96 $415.50 $415.50 $308.38 $308.38 $320.27 $216.48 $86.59 $415.50 $166.20 $415.50 $415.50 $415.50 $415.50 $415.50 $311.63 $415.50 $415.50 $415.50 $207.75 $207.75 $329.08 $415.50 $332.40 $270.08 $415.50 N/A $240.99 $415.50 $249.30 $415.50 $415.50 $415.50 N/A N/A 5028-8-150 SUP Custom 27203010 5028-8-150 - ROD EXFIX 8MM 150MM CONNCTNG HOFFMANN II CARB BOTH IP/OP $415.50 $307.00 $73.96 $415.50 $415.50 $415.50 $415.50 $415.50 $415.50 $415.50 $73.96 $415.50 $415.50 $308.38 $308.38 $320.27 $216.48 $86.59 $415.50 $166.20 $415.50 $415.50 $415.50 $415.50 $415.50 $311.63 $415.50 $415.50 $415.50 $207.75 $207.75 $329.08 $415.50 $332.40 $270.08 $415.50 N/A $240.99 $415.50 $249.30 $415.50 $415.50 $415.50 N/A N/A 5028-8-200 SUP Custom 27203010 5028-8-200 - ROD EXFIX 8MM 200MM CONNCTNG HOFFMANN II CARB BOTH IP/OP $427.00 $316.00 $75.96 $426.75 $426.75 $426.75 $426.75 $426.75 $426.75 $426.75 $75.96 $426.75 $426.75 $316.73 $316.73 $328.94 $222.34 $88.94 $426.75 $170.70 $426.75 $426.75 $426.75 $426.75 $426.75 $320.25 $426.75 $426.75 $426.75 $213.38 $213.38 $337.99 $426.75 $341.40 $277.39 $426.75 N/A $247.66 $426.75 $256.05 $426.75 $426.75 $426.75 N/A N/A 5028-8-250 SUP Custom 27203010 5028-8-250 - ROD EXFIX 8MM 250MM CONNCTNG MRI SAFE NONCONDUCTIVE BOTH IP/OP $427.00 $316.00 $75.96 $426.75 $426.75 $426.75 $426.75 $426.75 $426.75 $426.75 $75.96 $426.75 $426.75 $316.73 $316.73 $328.94 $222.34 $88.94 $426.75 $170.70 $426.75 $426.75 $426.75 $426.75 $426.75 $320.25 $426.75 $426.75 $426.75 $213.38 $213.38 $337.99 $426.75 $341.40 $277.39 $426.75 N/A $247.66 $426.75 $256.05 $426.75 $426.75 $426.75 N/A N/A 5028-8-350 SUP Custom 27203010 5028-8-350 - ROD EXFIX STR 8MM 350MM CONNCTNG MRI HOFFMANN II YELLOW CARB BOTH IP/OP $439.50 $325.00 $78.23 $439.50 $439.50 $439.50 $439.50 $439.50 $439.50 $439.50 $78.23 $439.50 $439.50 $326.20 $326.20 $338.77 $228.98 $91.60 $439.50 $175.80 $439.50 $439.50 $439.50 $439.50 $439.50 $329.63 $439.50 $439.50 $439.50 $219.75 $219.75 $348.08 $439.50 $351.60 $285.68 $439.50 N/A $254.91 $439.50 $263.70 $439.50 $439.50 $439.50 N/A N/A 5029-8-720 SUP Custom 27203010 5029-8-720 - ROD EXFIX 8MM 200MM CONNCTNG HOFFMANN II CARB BOTH IP/OP $253.00 $187.00 $45.03 $253.00 $253.00 $253.00 $253.00 $253.00 $253.00 $253.00 $45.03 $253.00 $253.00 $187.78 $187.78 $195.01 $131.81 $52.73 $253.00 $101.20 $253.00 $253.00 $253.00 $253.00 $253.00 $189.75 $253.00 $253.00 $253.00 $126.50 $126.50 $200.38 $253.00 $202.40 $164.45 $253.00 N/A $146.74 $253.00 $151.80 $253.00 $253.00 $253.00 N/A N/A 5029-8-725 SUP Custom 27203010 5029-8-725 - ROD EXFIX 8MM 250MM CONNCTNG HOFFMANN II CARB BOTH IP/OP $253.00 $187.00 $45.03 $253.00 $253.00 $253.00 $253.00 $253.00 $253.00 $253.00 $45.03 $253.00 $253.00 $187.78 $187.78 $195.01 $131.81 $52.73 $253.00 $101.20 $253.00 $253.00 $253.00 $253.00 $253.00 $189.75 $253.00 $253.00 $253.00 $126.50 $126.50 $200.38 $253.00 $202.40 $164.45 $253.00 N/A $146.74 $253.00 $151.80 $253.00 $253.00 $253.00 N/A N/A 5029-8-805 SUP Custom 27203010 5029-8-805 - ROD EXFIX 8MM 65MM CONNCTNG BRAIDED HOFFMANN II CARFBR BOTH IP/OP $302.50 $224.00 $53.80 $302.25 $302.25 $302.25 $302.25 $302.25 $302.25 $302.25 $53.80 $302.25 $302.25 $224.33 $224.33 $232.97 $157.47 $62.99 $302.25 $120.90 $302.25 $302.25 $302.25 $302.25 $302.25 $226.88 $302.25 $302.25 $302.25 $151.13 $151.13 $239.38 $302.25 $241.80 $196.46 $302.25 N/A $175.45 $302.25 $181.35 $302.25 $302.25 $302.25 N/A N/A 5029-8-810 SUP Custom 27203010 5029-8-810 - ROD EXFIX 8MM 100MM CONNCTNG HOFFMANN II CARB BOTH IP/OP $302.50 $224.00 $53.80 $302.25 $302.25 $302.25 $302.25 $302.25 $302.25 $302.25 $53.80 $302.25 $302.25 $224.33 $224.33 $232.97 $157.47 $62.99 $302.25 $120.90 $302.25 $302.25 $302.25 $302.25 $302.25 $226.88 $302.25 $302.25 $302.25 $151.13 $151.13 $239.38 $302.25 $241.80 $196.46 $302.25 N/A $175.45 $302.25 $181.35 $302.25 $302.25 $302.25 N/A N/A 5029-8-815 SUP Custom 27203010 5029-8-815 - ROD EXFIX 8MM 150MM CONNCTNG BRAIDED HOFFMANN II CARFBR BOTH IP/OP $302.50 $224.00 $53.80 $302.25 $302.25 $302.25 $302.25 $302.25 $302.25 $302.25 $53.80 $302.25 $302.25 $224.33 $224.33 $232.97 $157.47 $62.99 $302.25 $120.90 $302.25 $302.25 $302.25 $302.25 $302.25 $226.88 $302.25 $302.25 $302.25 $151.13 $151.13 $239.38 $302.25 $241.80 $196.46 $302.25 N/A $175.45 $302.25 $181.35 $302.25 $302.25 $302.25 N/A N/A 5029-8-820 SUP Custom 27203010 5029-8-820 - ROD EXFIX STR 8MM 200MM CONNCTNG HOFFMANN II CARFBR LONG BOTH IP/OP $329.50 $244.00 $58.61 $329.25 $329.25 $329.25 $329.25 $329.25 $329.25 $329.25 $58.61 $329.25 $329.25 $244.37 $244.37 $253.79 $171.54 $68.62 $329.25 $131.70 $329.25 $329.25 $329.25 $329.25 $329.25 $247.13 $329.25 $329.25 $329.25 $164.63 $164.63 $260.77 $329.25 $263.40 $214.01 $329.25 N/A $191.11 $329.25 $197.55 $329.25 $329.25 $329.25 N/A N/A 5029-8-825 SUP Custom 27203010 5029-8-825 - ROD EXFIX STR 8MM 250MM CONNCTNG BRAIDED HOFFMANN II CARFBR BOTH IP/OP $329.50 $244.00 $58.61 $329.25 $329.25 $329.25 $329.25 $329.25 $329.25 $329.25 $58.61 $329.25 $329.25 $244.37 $244.37 $253.79 $171.54 $68.62 $329.25 $131.70 $329.25 $329.25 $329.25 $329.25 $329.25 $247.13 $329.25 $329.25 $329.25 $164.63 $164.63 $260.77 $329.25 $263.40 $214.01 $329.25 N/A $191.11 $329.25 $197.55 $329.25 $329.25 $329.25 N/A N/A 5029-8-830 SUP Custom 27203010 5029-8-830 - ROD EXFIX 8MM 300MM CONNCTNG BRAIDED HOFFMANN II CARFBR BOTH IP/OP $329.50 $244.00 $58.61 $329.25 $329.25 $329.25 $329.25 $329.25 $329.25 $329.25 $58.61 $329.25 $329.25 $244.37 $244.37 $253.79 $171.54 $68.62 $329.25 $131.70 $329.25 $329.25 $329.25 $329.25 $329.25 $247.13 $329.25 $329.25 $329.25 $164.63 $164.63 $260.77 $329.25 $263.40 $214.01 $329.25 N/A $191.11 $329.25 $197.55 $329.25 $329.25 $329.25 N/A N/A 5029-8-835 SUP Custom 27203010 5029-8-835 - ROD XTRNFX 8MM 350MM HFMN2 CNCT BRD CFBR BOTH IP/OP $353.50 $262.00 $62.88 $353.25 $353.25 $353.25 $353.25 $353.25 $353.25 $353.25 $62.88 $353.25 $353.25 $262.18 $262.18 $272.29 $184.04 $73.62 $353.25 $141.30 $353.25 $353.25 $353.25 $353.25 $353.25 $265.13 $353.25 $353.25 $353.25 $176.63 $176.63 $279.77 $353.25 $282.60 $229.61 $353.25 N/A $205.03 $353.25 $211.95 $353.25 $353.25 $353.25 N/A N/A 5029-8-840 SUP Custom 27203010 5029-8-840 - ROD EXFIX 8MM 400MM CONNCTNG BRAIDED HOFFMANN II CARFBR BOTH IP/OP $353.50 $262.00 $62.88 $353.25 $353.25 $353.25 $353.25 $353.25 $353.25 $353.25 $62.88 $353.25 $353.25 $262.18 $262.18 $272.29 $184.04 $73.62 $353.25 $141.30 $353.25 $353.25 $353.25 $353.25 $353.25 $265.13 $353.25 $353.25 $353.25 $176.63 $176.63 $279.77 $353.25 $282.60 $229.61 $353.25 N/A $205.03 $353.25 $211.95 $353.25 $353.25 $353.25 N/A N/A 5029-8-845 SUP Custom 27203010 5029-8-845 - ROD EXFIX STR 8MM 450MM CONNCTNG HOFFMANN II CARB LONG BONE BOTH IP/OP $403.50 $299.00 $71.82 $403.50 $403.50 $403.50 $403.50 $403.50 $403.50 $403.50 $71.82 $403.50 $403.50 $299.48 $299.48 $311.02 $210.22 $84.09 $403.50 $161.40 $403.50 $403.50 $403.50 $403.50 $403.50 $302.63 $403.50 $403.50 $403.50 $201.75 $201.75 $319.57 $403.50 $322.80 $262.28 $403.50 N/A $234.03 $403.50 $242.10 $403.50 $403.50 $403.50 N/A N/A 5029-8-850 SUP Custom 27203010 5029-8-850 - ROD EXFIX 8MM 500MM BRAID HOFFMANN II CARFBR BOTH IP/OP $403.50 $299.00 $71.82 $403.50 $403.50 $403.50 $403.50 $403.50 $403.50 $403.50 $71.82 $403.50 $403.50 $299.48 $299.48 $311.02 $210.22 $84.09 $403.50 $161.40 $403.50 $403.50 $403.50 $403.50 $403.50 $302.63 $403.50 $403.50 $403.50 $201.75 $201.75 $319.57 $403.50 $322.80 $262.28 $403.50 N/A $234.03 $403.50 $242.10 $403.50 $403.50 $403.50 N/A N/A 5030-3-200 SUP Custom 27203010 5030-3-200 - PIN FIX 5MM 4MM 200MM 35MM CENTRL THREAD TRANSFIX APEX BOTH IP/OP $221.00 $164.00 $39.34 $255.75 $221.00 $221.00 $221.00 $221.00 $221.00 $221.00 $39.34 $221.00 $221.00 $164.03 $164.03 $170.35 $115.14 $46.06 $221.00 $102.30 $221.00 $221.00 $255.75 $221.00 $221.00 $165.75 $221.00 $221.00 $221.00 $110.50 $110.50 $175.03 $221.00 $176.80 $143.65 $221.00 N/A $128.18 $221.00 $132.60 $221.00 $221.00 $221.00 N/A N/A 5030-3-250 SUP Custom 27203010 5030-3-250 - PIN FIX 5MM 4MM 250MM 35MM TRANSFIXING APEX STAINLESS STEEL BOTH IP/OP $221.00 $164.00 $39.34 $255.75 $221.00 $221.00 $221.00 $221.00 $221.00 $221.00 $39.34 $221.00 $221.00 $164.03 $164.03 $170.35 $115.14 $46.06 $221.00 $102.30 $221.00 $221.00 $255.75 $221.00 $221.00 $165.75 $221.00 $221.00 $221.00 $110.50 $110.50 $175.03 $221.00 $176.80 $143.65 $221.00 N/A $128.18 $221.00 $132.60 $221.00 $221.00 $221.00 N/A N/A 5030-4-200 SUP Custom 27203010 5030-4-200 - PIN HALF 4MM 200MM 40MM MODULAR THREADED TRANSFIXATION APEX BOTH IP/OP $221.00 $164.00 $39.34 $255.75 $221.00 $221.00 $221.00 $221.00 $221.00 $221.00 $39.34 $221.00 $221.00 $164.03 $164.03 $170.35 $115.14 $46.06 $221.00 $102.30 $221.00 $221.00 $255.75 $221.00 $221.00 $165.75 $221.00 $221.00 $221.00 $110.50 $110.50 $175.03 $221.00 $176.80 $143.65 $221.00 N/A $128.18 $221.00 $132.60 $221.00 $221.00 $221.00 N/A N/A 5030-4-250 SUP Custom 27203010 5030-4-250 - PIN HALF 5MM 4MM 250MM 40MM TRANSFIXATION SELF TAP SELF BOTH IP/OP $221.00 $164.00 $39.34 $255.75 $221.00 $221.00 $221.00 $221.00 $221.00 $221.00 $39.34 $221.00 $221.00 $164.03 $164.03 $170.35 $115.14 $46.06 $221.00 $102.30 $221.00 $221.00 $255.75 $221.00 $221.00 $165.75 $221.00 $221.00 $221.00 $110.50 $110.50 $175.03 $221.00 $176.80 $143.65 $221.00 N/A $128.18 $221.00 $132.60 $221.00 $221.00 $221.00 N/A N/A 5030-5-200 SUP Custom 27203010 5030-5-200 - PIN HALF 5MM 4MM 200MM 50MM TRANSFIXATION SELF TAP SELF BOTH IP/OP $221.00 $164.00 $39.34 $221.00 $221.00 $221.00 $221.00 $221.00 $221.00 $221.00 $39.34 $221.00 $221.00 $164.03 $164.03 $170.35 $115.14 $46.06 $221.00 $88.40 $221.00 $221.00 $221.00 $221.00 $221.00 $165.75 $221.00 $221.00 $221.00 $110.50 $110.50 $175.03 $221.00 $176.80 $143.65 $221.00 N/A $128.18 $221.00 $132.60 $221.00 $221.00 $221.00 N/A N/A 5030-5-250 SUP HCPCS C1713 5030-5-250 - PIN HALF 5MM 4MM 250MM 50MM TRANSFIXATION SELF TAP SELF BOTH IP/OP $221.00 $164.00 $43.86 $221.00 $99.45 $99.45 $99.45 $99.45 $221.00 $221.00 $221.00 $46.06 $221.00 $221.00 $221.00 $221.00 $221.00 $46.06 $221.00 $88.40 $130.72 $221.00 $221.00 $221.00 $221.00 $165.75 $221.00 $221.00 $221.00 $110.50 $110.50 $175.03 $221.00 $176.80 $99.45 $43.86 N/A $128.18 $221.00 $221.00 $221.00 $46.06 $221.00 N/A N/A 5030-5-300 SUP Custom 27203010 5030-5-300 - PIN HLF 5MM 4MM 300MM NS 50MM HFMN2 APX TRNFX ST SLF DRL BOTH IP/OP $221.00 $164.00 $39.34 $221.00 $221.00 $221.00 $221.00 $221.00 $221.00 $221.00 $39.34 $221.00 $221.00 $164.03 $164.03 $170.35 $115.14 $46.06 $221.00 $88.40 $221.00 $221.00 $221.00 $221.00 $221.00 $165.75 $221.00 $221.00 $221.00 $110.50 $110.50 $175.03 $221.00 $176.80 $143.65 $221.00 N/A $128.18 $221.00 $132.60 $221.00 $221.00 $221.00 N/A N/A 5030-5-300 SUP Custom 27203010 5030-5-300 - PIN HLF 5MM 4MM 300MM NS 50MM HFMN2 APX TRNFX ST SLF DRL BOTH IP/OP $221.00 $164.00 $39.34 $221.00 $221.00 $221.00 $221.00 $221.00 $221.00 $221.00 $39.34 $221.00 $221.00 $164.03 $164.03 $170.35 $115.14 $46.06 $221.00 $88.40 $221.00 $221.00 $221.00 $221.00 $221.00 $165.75 $221.00 $221.00 $221.00 $110.50 $110.50 $175.03 $221.00 $176.80 $143.65 $221.00 N/A $128.18 $221.00 $132.60 $221.00 $221.00 $221.00 N/A N/A 5030-6-250 SUP Custom 27203010 5030-6-250 - PIN HALF 5MM 4MM 250MM 60MM TRANSFIXATION SELF TAP SELF BOTH IP/OP $221.00 $164.00 $39.34 $255.75 $221.00 $221.00 $221.00 $221.00 $221.00 $221.00 $39.34 $221.00 $221.00 $164.03 $164.03 $170.35 $115.14 $46.06 $221.00 $102.30 $221.00 $221.00 $255.75 $221.00 $221.00 $165.75 $221.00 $221.00 $221.00 $110.50 $110.50 $175.03 $221.00 $176.80 $143.65 $221.00 N/A $128.18 $221.00 $132.60 $221.00 $221.00 $221.00 N/A N/A 50-306-40-04 SUP Custom 27803010 50-306-40-04 - RESORB MESH ORBITAL BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 5030-7-300 SUP Custom 27203010 5030-7-300 - PIN FX 5MM 4MM 300MM 70MM APX TRNFX SS FT/ANKL CANC BOTH IP/OP $221.00 $164.00 $39.34 $255.75 $221.00 $221.00 $221.00 $221.00 $221.00 $221.00 $39.34 $221.00 $221.00 $164.03 $164.03 $170.35 $115.14 $46.06 $221.00 $102.30 $221.00 $221.00 $255.75 $221.00 $221.00 $165.75 $221.00 $221.00 $221.00 $110.50 $110.50 $175.03 $221.00 $176.80 $143.65 $221.00 N/A $128.18 $221.00 $132.60 $221.00 $221.00 $221.00 N/A N/A 50-310-27-09 SUP Custom 27803010 50-310-27-09 - COVER BURR HOLE 17MM .3MM CNTOUR TITANIUM CRANIUM 1.5MM BOTH IP/OP $465.50 $344.00 $82.80 $465.18 $465.18 $465.18 $465.18 $465.18 $465.18 $465.18 $82.80 $465.18 $465.18 $465.18 $465.18 $465.18 $465.18 $96.95 $465.18 $186.07 $465.18 $465.18 $465.18 $465.18 $465.18 $349.13 $465.18 $465.18 $465.18 $232.59 $232.59 $368.42 $465.18 $372.14 $209.33 $465.18 N/A $269.99 $465.18 $279.11 $465.18 $465.18 $465.18 N/A N/A 50-320-08-09 SUP HCPCS C1713 50-320-08-09 - PLATE BONE MINI REGULAR 1MM 8 HOLE RIGID LIGHTWEIGHT BLUE BOTH IP/OP $272.00 $201.00 $53.98 $271.95 $122.38 $122.38 $122.38 $122.38 $271.95 $271.95 $271.95 $56.68 $271.95 $271.95 $271.95 $271.95 $271.95 $56.68 $271.95 $271.95 $160.86 $271.95 $271.95 $271.95 $271.95 $204.00 $271.95 $271.95 $271.95 $135.98 $135.98 $215.38 $271.95 $217.56 $122.38 $53.98 N/A $157.76 $271.95 $271.95 $271.95 $56.67 $271.95 N/A N/A 50-321-04-09 SUP HCPCS C1713 50-321-04-09 - PLATE BONE MINI MEDIUM 1MM 4 HOLE RIGID LIGHTWEIGHT BLUE BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $222.75 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $133.65 $222.75 $46.42 $222.75 N/A N/A 50-322-04-09 SUP HCPCS C1713 50-322-04-09 - PLATE BONE LONG 1MM 4 HOLE RIGID LIGHTWEIGHT BLUE TITANIUM BOTH IP/OP $223.00 $165.00 $44.21 $222.75 $100.24 $100.24 $100.24 $100.24 $222.75 $222.75 $222.75 $46.43 $222.75 $222.75 $222.75 $222.75 $222.75 $46.42 $222.75 $222.75 $131.76 $222.75 $222.75 $222.75 $222.75 $167.25 $222.75 $222.75 $222.75 $111.38 $111.38 $176.42 $222.75 $178.20 $100.24 $44.21 N/A $129.34 $222.75 $222.75 $222.75 $46.42 $222.75 N/A N/A 50-325-01-07 SUP Custom 27100030 50-325-01-07 - CLAMP SURG 6IN SHARP STAINLESS STEEL BOTH IP/OP $576.50 $427.00 $102.57 $576.23 $576.23 $576.23 $576.23 $576.23 $576.23 $576.23 $102.57 $576.23 $576.23 $427.68 $427.68 $444.16 $300.22 $120.09 $576.23 $230.49 $576.23 $576.23 $576.23 $576.23 $576.23 $432.38 $576.23 $576.23 $576.23 $288.12 $288.12 $456.37 $576.23 $460.98 $374.55 $576.23 N/A $334.37 $576.23 $345.74 $576.23 $576.23 $576.23 N/A N/A 50-330-06-09 SUP HCPCS C1713 50-330-06-09 - PLATE BONE MINI MEDIUM CVD FLAT 1MM 6 HOLE SAGITTAL RIGID BOTH IP/OP $388.50 $287.00 $77.11 $388.50 $174.83 $174.83 $174.83 $174.83 $388.50 $388.50 $388.50 $80.97 $388.50 $388.50 $388.50 $388.50 $388.50 $80.97 $388.50 $388.50 $229.80 $388.50 $388.50 $388.50 $388.50 $291.38 $388.50 $388.50 $388.50 $194.25 $194.25 $307.69 $388.50 $310.80 $174.83 $77.11 N/A $225.33 $388.50 $233.10 $388.50 $80.96 $388.50 N/A N/A 50-331-06-09 SUP HCPCS C1713 50-331-06-09 - PLATE BONE LONG CVD FLAT 1MM 6 HOLE SAGITTAL RIGID BOTH IP/OP $388.50 $287.00 $77.11 $388.50 $174.83 $174.83 $174.83 $174.83 $388.50 $388.50 $388.50 $80.97 $388.50 $388.50 $388.50 $388.50 $388.50 $80.97 $388.50 $388.50 $229.80 $388.50 $388.50 $388.50 $388.50 $291.38 $388.50 $388.50 $388.50 $194.25 $194.25 $307.69 $388.50 $310.80 $174.83 $77.11 N/A $225.33 $388.50 $233.10 $388.50 $80.96 $388.50 N/A N/A 50-332-06-09 SUP HCPCS C1713 50-332-06-09 - PLATE BONE XLONG CVD FLAT 1MM 6 HOLE SAGITTAL RIGID BOTH IP/OP $388.50 $287.00 $77.11 $388.50 $174.83 $174.83 $174.83 $174.83 $388.50 $388.50 $388.50 $80.97 $388.50 $388.50 $388.50 $388.50 $388.50 $80.97 $388.50 $388.50 $229.80 $388.50 $388.50 $388.50 $388.50 $291.38 $388.50 $388.50 $388.50 $194.25 $194.25 $307.69 $388.50 $310.80 $174.83 $77.11 N/A $225.33 $388.50 $233.10 $388.50 $80.96 $388.50 N/A N/A 5036-1-080 SUP Custom 27203010 5036-1-080 - PIN HALF 3MM 80MM 10MM BLUNT TIP APEX STAINLESS STEEL EXFIX BOTH IP/OP $312.00 $231.00 $55.54 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $55.54 $312.00 $312.00 $231.57 $231.57 $240.49 $162.55 $65.02 $312.00 $124.80 $312.00 $312.00 $312.00 $312.00 $312.00 $234.00 $312.00 $312.00 $312.00 $156.00 $156.00 $247.10 $312.00 $249.60 $202.80 $312.00 N/A $180.96 $312.00 $187.20 $312.00 $312.00 $312.00 N/A N/A 5036-1-110 SUP Custom 27203010 5036-1-110 - PIN HALF 3MM 110MM 10MM BLUNT TIP APEX STAINLESS STEEL EXFIX BOTH IP/OP $312.00 $231.00 $55.54 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $55.54 $312.00 $312.00 $231.57 $231.57 $240.49 $162.55 $65.02 $312.00 $124.80 $312.00 $312.00 $312.00 $312.00 $312.00 $234.00 $312.00 $312.00 $312.00 $156.00 $156.00 $247.10 $312.00 $249.60 $202.80 $312.00 N/A $180.96 $312.00 $187.20 $312.00 $312.00 $312.00 N/A N/A 5036-1-580 SUP Custom 27203010 5036-1-580 - PIN HALF 3MM 80MM 15MM BLUNT TIP APEX STAINLESS STEEL EXFIX BOTH IP/OP $312.00 $231.00 $55.54 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $55.54 $312.00 $312.00 $231.57 $231.57 $240.49 $162.55 $65.02 $312.00 $124.80 $312.00 $312.00 $312.00 $312.00 $312.00 $234.00 $312.00 $312.00 $312.00 $156.00 $156.00 $247.10 $312.00 $249.60 $202.80 $312.00 N/A $180.96 $312.00 $187.20 $312.00 $312.00 $312.00 N/A N/A 5036-2-060 SUP Custom 27203010 5036-2-060 - PIN HALF 3MM 60MM 10MM BLUNT TIP APEX STAINLESS STEEL EXFIX BOTH IP/OP $124.00 $92.00 $22.03 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $22.03 $123.75 $123.75 $91.85 $91.85 $95.39 $64.47 $25.79 $123.75 $49.50 $123.75 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $80.44 $123.75 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 5036-2-080 SUP Custom 27203010 5036-2-080 - PIN HALF 3MM 80MM 20MM BLUNT TIP APEX STAINLESS STEEL EXFIX BOTH IP/OP $312.00 $231.00 $55.54 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $55.54 $312.00 $312.00 $231.57 $231.57 $240.49 $162.55 $65.02 $312.00 $124.80 $312.00 $312.00 $312.00 $312.00 $312.00 $234.00 $312.00 $312.00 $312.00 $156.00 $156.00 $247.10 $312.00 $249.60 $202.80 $312.00 N/A $180.96 $312.00 $187.20 $312.00 $312.00 $312.00 N/A N/A 5036-2-110 SUP Custom 27203010 5036-2-110 - PIN HLF 3MM 110MM 25MM HFMN2 APX BLNT TIP SS BOTH IP/OP $312.00 $231.00 $55.54 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $312.00 $55.54 $312.00 $312.00 $231.57 $231.57 $240.49 $162.55 $65.02 $312.00 $124.80 $312.00 $312.00 $312.00 $312.00 $312.00 $234.00 $312.00 $312.00 $312.00 $156.00 $156.00 $247.10 $312.00 $249.60 $202.80 $312.00 N/A $180.96 $312.00 $187.20 $312.00 $312.00 $312.00 N/A N/A 50-368-16-91 SUP HCPCS C1713 50-368-16-91 - PLATE BONE MINI REGULAR .6MM 16 HOLE LP TITANIUM MANDIB 2MM BOTH IP/OP $324.00 $240.00 $64.26 $323.75 $145.69 $145.69 $145.69 $145.69 $323.75 $323.75 $323.75 $67.48 $323.75 $323.75 $323.75 $323.75 $323.75 $67.47 $323.75 $323.75 $191.50 $323.75 $323.75 $323.75 $323.75 $243.00 $323.75 $323.75 $323.75 $161.88 $161.88 $256.41 $323.75 $259.00 $145.69 $64.26 N/A $187.92 $323.75 $194.25 $323.75 $67.47 $323.75 N/A N/A 50-369-06 SUP HCPCS C1713 50-369-06 - X PLATE BOTH IP/OP $349.00 $258.00 $69.22 $348.75 $156.94 $156.94 $156.94 $156.94 $348.75 $348.75 $348.75 $72.69 $348.75 $348.75 $348.75 $348.75 $348.75 $72.68 $348.75 $139.50 $206.29 $348.75 $348.75 $348.75 $348.75 $261.75 $348.75 $348.75 $348.75 $174.38 $174.38 $276.21 $348.75 $279.00 $156.94 $69.22 N/A $202.42 $348.75 $209.25 $348.75 $72.68 $348.75 N/A N/A 50-375-04-91 SUP HCPCS C1713 50-375-04-91 - PLATE BN MED MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $145.04 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $362.60 $362.60 $75.57 $362.60 N/A N/A 50-377-04-91 SUP HCPCS C1713 50-377-04-91 - PLATE BN MED MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $217.56 $362.60 $75.57 $362.60 N/A N/A 50-379-04-91 SUP HCPCS C1713 50-379-04-91 - PLATE BN LNG MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $217.56 $362.60 $75.57 $362.60 N/A N/A 50-381-04-91 SUP HCPCS C1713 50-381-04-91 - PLATE BN LNG MN L .6MM NS THREADLOCK TS 4 HL LOPRFL TI BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $362.60 $362.60 $75.57 $362.60 N/A N/A 50-381-05-09 SUP HCPCS C1713 50-381-05-09 - PLATE BN LNG MN L .7MM NS THREADLOCK TS 5 HL LOPRFL TI BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $217.56 $362.60 $75.57 $362.60 N/A N/A 5038-1-080 SUP Custom 27203010 5038-1-080 - PIN FIX 3MM 80MM 10MM SELF DRILL SELF TAP APEX STAINLESS BOTH IP/OP $215.00 $159.00 $38.24 $214.83 $214.83 $214.83 $214.83 $214.83 $214.83 $214.83 $38.24 $214.83 $214.83 $159.45 $159.45 $165.59 $111.93 $44.77 $214.83 $85.93 $214.83 $214.83 $214.83 $214.83 $214.83 $161.25 $214.83 $214.83 $214.83 $107.42 $107.42 $170.15 $214.83 $171.86 $139.64 $214.83 N/A $124.70 $214.83 $128.90 $214.83 $214.83 $214.83 N/A N/A 5038-1-110 SUP Custom 27203010 5038-1-110 - PIN HALF 3MM 110MM 10MM SLFDRILL SLFTAP THREADED APEX BOTH IP/OP $215.00 $159.00 $38.24 $214.83 $214.83 $214.83 $214.83 $214.83 $214.83 $214.83 $38.24 $214.83 $214.83 $159.45 $159.45 $165.59 $111.93 $44.77 $214.83 $85.93 $214.83 $214.83 $214.83 $214.83 $214.83 $161.25 $214.83 $214.83 $214.83 $107.42 $107.42 $170.15 $214.83 $171.86 $139.64 $214.83 N/A $124.70 $214.83 $128.90 $214.83 $214.83 $214.83 N/A N/A 5038-2-080 SUP Custom 27203010 5038-2-080 - PIN HALF 3MM 80MM 15MM SLFDRILL SLFTAP THREADED APEX BOTH IP/OP $215.00 $159.00 $38.24 $214.83 $214.83 $214.83 $214.83 $214.83 $214.83 $214.83 $38.24 $214.83 $214.83 $159.45 $159.45 $165.59 $111.93 $44.77 $214.83 $85.93 $214.83 $214.83 $214.83 $214.83 $214.83 $161.25 $214.83 $214.83 $214.83 $107.42 $107.42 $170.15 $214.83 $171.86 $139.64 $214.83 N/A $124.70 $214.83 $128.90 $214.83 $214.83 $214.83 N/A N/A 5038-2-110 SUP Custom 27203010 5038-2-110 - PIN HALF 3MM 110MM 25MM BLUNT APEX STAINLESS STEEL STERILE BOTH IP/OP $215.00 $159.00 $38.24 $214.83 $214.83 $214.83 $214.83 $214.83 $214.83 $214.83 $38.24 $214.83 $214.83 $159.45 $159.45 $165.59 $111.93 $44.77 $214.83 $85.93 $214.83 $214.83 $214.83 $214.83 $214.83 $161.25 $214.83 $214.83 $214.83 $107.42 $107.42 $170.15 $214.83 $171.86 $139.64 $214.83 N/A $124.70 $214.83 $128.90 $214.83 $214.83 $214.83 N/A N/A 50-383-05-09 SUP HCPCS C1713 50-383-05-09 - PLATE BN LNG MN L .7MM NS THREADLOCK TS 5 HL LOPRFL TI BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $217.56 $362.60 $75.57 $362.60 N/A N/A 5038-5-060 SUP Custom 27203010 5038-5-060 - PIN HALF 3MM 60MM 10MM SLFDRILL SLFTAP THREADED APEX BOTH IP/OP $215.00 $159.00 $38.24 $214.83 $214.83 $214.83 $214.83 $214.83 $214.83 $214.83 $38.24 $214.83 $214.83 $159.45 $159.45 $165.59 $111.93 $44.77 $214.83 $85.93 $214.83 $214.83 $214.83 $214.83 $214.83 $161.25 $214.83 $214.83 $214.83 $107.42 $107.42 $170.15 $214.83 $171.86 $139.64 $214.83 N/A $124.70 $214.83 $128.90 $214.83 $214.83 $214.83 N/A N/A 5038-5-080 SUP Custom 27203010 5038-5-080 - PIN HALF 3MM 80MM 20MM SLFDRILL SLFTAP THREADED APEX BOTH IP/OP $124.00 $92.00 $22.03 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $123.75 $22.03 $123.75 $123.75 $91.85 $91.85 $95.39 $64.47 $25.79 $123.75 $49.50 $123.75 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $80.44 $123.75 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 5038-5-110 SUP Custom 27203010 5038-5-110 - PIN HALF 3MM 110MM 22MM SELF DRILL SELF TAP CONTIN THREAD BOTH IP/OP $89.50 $66.00 $15.91 $89.38 $89.38 $89.38 $89.38 $89.38 $89.38 $89.38 $15.91 $89.38 $89.38 $66.34 $66.34 $68.89 $46.57 $18.63 $89.38 $35.75 $89.38 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $58.10 $89.38 N/A $51.91 $89.38 $53.63 $89.38 $89.38 $89.38 N/A N/A 50-386-06-91 SUP HCPCS C1713 50-386-06-91 - PLATE BONE T MINI REGULAR .6MM LP TITANIUM MANDIB 2MM SCREW BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $217.56 $362.60 $75.57 $362.60 N/A N/A 50-390-05-91 SUP HCPCS C1713 50-390-05-91 - PLATE BN MN SHRT Y .6MM THREADLOCK TS 5 HL LOPRFL TI MXLFCL BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $217.56 $362.60 $75.57 $362.60 N/A N/A 50-395-04 SUP HCPCS C1713 50-395-04 - L PLATE RIGHT BOTH IP/OP $325.50 $241.00 $64.60 $325.50 $146.48 $146.48 $146.48 $146.48 $325.50 $325.50 $325.50 $67.84 $325.50 $325.50 $325.50 $325.50 $325.50 $67.84 $325.50 $130.20 $192.53 $325.50 $325.50 $325.50 $325.50 $244.13 $325.50 $325.50 $325.50 $162.75 $162.75 $257.80 $325.50 $260.40 $146.48 $64.60 N/A $188.79 $325.50 $195.30 $325.50 $67.83 $325.50 N/A N/A 50-396-06-91 SUP HCPCS C1713 50-396-06-91 - PLATE BONE MINI REGULAR Y LP .6MM 2 TITANIUM MANDIB 2MM BOTH IP/OP $388.50 $287.00 $77.11 $388.50 $174.83 $174.83 $174.83 $174.83 $388.50 $388.50 $388.50 $80.97 $388.50 $388.50 $388.50 $388.50 $388.50 $80.97 $388.50 $155.40 $229.80 $388.50 $388.50 $388.50 $388.50 $291.38 $388.50 $388.50 $388.50 $194.25 $194.25 $307.69 $388.50 $310.80 $174.83 $77.11 N/A $225.33 $388.50 $388.50 $388.50 $80.96 $388.50 N/A N/A 504-02-54C-L SUP HCPCS C1776 504-02-54C-L - SHELL ACTB 54MM RSTR ANTM HIP LT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$3,783.00" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-54C-R SUP HCPCS C1776 504-02-54C-R - SHELL ACTB 54MM RSTR ANTM HIP RT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-56D-L SUP HCPCS C1776 504-02-56D-L - SHELL ACTB 56MM RSTR ANTM HIP LT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-56D-R SUP HCPCS C1776 504-02-56D-R - SHELL ACTB 56MM RSTR ANTM HIP RT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-58D-L SUP HCPCS C1776 504-02-58D-L - SHELL ACTB 58MM RSTR ANTM HIP LT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$3,783.00" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-58D-R SUP HCPCS C1776 504-02-58D-R - SHELL ACTB 58MM RSTR ANTM HIP RT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-60D-L SUP HCPCS C1776 504-02-60D-L - SHELL ACTB 60MM RSTR ANTM HIP LT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$3,783.00" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-60D-R SUP HCPCS C1776 504-02-60D-R - SHELL ACTB 60MM RSTR ANTM HIP RT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-62E-L SUP HCPCS C1776 504-02-62E-L - SHELL ACTB 62MM RSTR ANTM HIP LT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-62E-R SUP HCPCS C1776 504-02-62E-R - SHELL ACTB 62MM RSTR ANTM HIP RT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-64E-L SUP HCPCS C1776 504-02-64E-L - SHELL ACTB 64MM RSTR ANTM HIP LT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-64E-R SUP HCPCS C1776 504-02-64E-R - SHELL ACTB 64MM RSTR ANTM HIP RT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-66F-L SUP HCPCS C1776 504-02-66F-L - SHELL ACTB 66MM RSTR ANTM HIP LT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-66F-R SUP HCPCS C1776 504-02-66F-R - SHELL ACTB 66MM RSTR ANTM HIP RT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-68F-L SUP HCPCS C1776 504-02-68F-L - SHELL ACTB 68MM RSTR ANTM HIP LT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-68F-R SUP HCPCS C1776 504-02-68F-R - SHELL ACTB 68MM RSTR ANTM HIP RT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-70G-L SUP HCPCS C1776 504-02-70G-L - SHELL ACTB 70MM RSTR ANTM HIP LT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-70G-R SUP HCPCS C1776 504-02-70G-R - SHELL ACTB 70MM RSTR ANTM HIP RT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-72G-L SUP HCPCS C1776 504-02-72G-L - SHELL ACTB 72MM RSTR ANTM HIP LT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-72G-R SUP HCPCS C1776 504-02-72G-R - SHELL ACTB 72MM RSTR ANTM HIP RT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-74H-L SUP HCPCS C1776 504-02-74H-L - SHELL ACTB 74MM RSTR ANTM HIP LT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-74H-R SUP HCPCS C1776 504-02-74H-R - SHELL ACTB 74MM RSTR ANTM HIP RT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-76H-L SUP HCPCS C1776 504-02-76H-L - SHELL ACTB 76MM RSTR ANTM HIP LT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$3,783.00" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-76H-R SUP HCPCS C1776 504-02-76H-R - SHELL ACTB 76MM RSTR ANTM HIP RT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-78H-L SUP HCPCS C1776 504-02-78H-L - SHELL ACTB 78MM RSTR ANTM HIP LT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$3,783.00" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-78H-R SUP HCPCS C1776 504-02-78H-R - SHELL ACTB 78MM RSTR ANTM HIP RT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-80H-L SUP HCPCS C1776 504-02-80H-L - SHELL ACTB 80MM RSTR ANTM HIP LT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$3,783.00" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 504-02-80H-R SUP HCPCS C1776 504-02-80H-R - SHELL ACTB 80MM RSTR ANTM HIP RT BOTH IP/OP "$9,457.50" "$6,999.00" "$1,877.08" "$9,457.50" "$4,255.88" "$4,255.88" "$4,255.88" "$4,255.88" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.18" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$1,971.05" "$9,457.50" "$9,457.50" "$4,662.55" "$9,457.50" "$9,457.50" "$9,457.50" "$9,457.50" "$7,093.13" "$9,457.50" "$9,457.50" "$9,457.50" "$4,728.75" "$4,728.75" "$7,490.34" "$9,457.50" "$7,566.00" "$4,255.88" "$1,877.08" N/A "$5,485.35" "$9,457.50" "$9,457.50" "$9,457.50" "$1,970.94" "$9,457.50" N/A N/A 50-405-07-09 SUP HCPCS C1713 50-405-07-09 - PLATE BONE 100D L MINI .7MM 7 HOLE TITANIUM MANDIB 2MM SCREW BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $145.04 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $362.60 $362.60 $75.57 $362.60 N/A N/A 50-405-09-09 SUP HCPCS C1713 50-405-09-09 - PLATE BONE 100D L MINI .7MM 9 HOLE INSERT FRAC TITANIUM BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $362.60 $362.60 $75.57 $362.60 N/A N/A 50-405-12-09 SUP HCPCS C1713 50-405-12-09 - PLATE BN MN .7MM THREADLOCK TS 12 HL LOPRFL TI ORBT FLR 2MM BOTH IP/OP $401.50 $297.00 $79.67 $401.43 $180.64 $180.64 $180.64 $180.64 $401.43 $401.43 $401.43 $83.67 $401.43 $401.43 $401.43 $401.43 $401.43 $83.66 $401.43 $160.57 $237.45 $401.43 $401.43 $401.43 $401.43 $301.13 $401.43 $401.43 $401.43 $200.72 $200.72 $317.93 $401.43 $321.14 $180.64 $79.67 N/A $232.87 $401.43 $240.86 $401.43 $83.66 $401.43 N/A N/A 50-405-17-09 SUP HCPCS C1713 50-405-17-09 - PLATE BN MN STRG 1MM NS THREADLOCK TS 20 HL LOPRFL CMPR TI BOTH IP/OP $570.00 $422.00 $113.09 $569.80 $256.41 $256.41 $256.41 $256.41 $569.80 $569.80 $569.80 $118.76 $569.80 $569.80 $569.80 $569.80 $569.80 $118.75 $569.80 $227.92 $337.04 $569.80 $569.80 $569.80 $569.80 $427.50 $569.80 $569.80 $569.80 $284.90 $284.90 $451.28 $569.80 $455.84 $256.41 $113.09 N/A $330.60 $569.80 $341.88 $569.80 $118.75 $569.80 N/A N/A 50-406-04-91 SUP HCPCS C1713 50-406-04-91 - PLATE BONE Z MINI 6MM LP TITANIUM LEFT MANDIB 2MM SCREW BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $145.04 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $362.60 $362.60 $75.57 $362.60 N/A N/A 50-406-17-09 SUP HCPCS C1713 50-406-17-09 - PLATE BONE STR 1MM 17 HOLE RIGID LIGHTWEIGHT LP BLUE BOTH IP/OP $531.00 $393.00 $105.38 $530.95 $238.93 $238.93 $238.93 $238.93 $530.95 $530.95 $530.95 $110.66 $530.95 $530.95 $530.95 $530.95 $530.95 $110.66 $530.95 $212.38 $314.06 $530.95 $530.95 $530.95 $530.95 $398.25 $530.95 $530.95 $530.95 $265.48 $265.48 $420.51 $530.95 $424.76 $238.93 $105.38 N/A $307.98 $530.95 $318.57 $530.95 $110.65 $530.95 N/A N/A 50-407-07-09 SUP HCPCS C1713 50-407-07-09 - PLATE BN MN STRG L .7MM THREADLOCK TS 20 HL LOPRFL TI MXLFCL BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $362.60 $362.60 $75.57 $362.60 N/A N/A 50-407-09-09 SUP HCPCS C1713 50-407-09-09 - PLATE BONE 100D L MINI 9 HOLE INSERT FRAC TITANIUM MANDIB 2 BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $362.60 $362.60 $75.57 $362.60 N/A N/A 50-408-04-91 SUP HCPCS C1713 50-408-04-91 - PLATE BONE Z LEFT ANGLE LONG .6MM LP FRAC TITANIUM MANDIB BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $145.04 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $217.56 $362.60 $75.57 $362.60 N/A N/A 50-409-04-91 SUP HCPCS C1713 50-409-04-91 - PLATE BN 100D LNG MN Z .6MM THREADLOCK TS 4 HL LOPRFL TI BOTH IP/OP $363.00 $269.00 $71.97 $362.60 $163.17 $163.17 $163.17 $163.17 $362.60 $362.60 $362.60 $75.57 $362.60 $362.60 $362.60 $362.60 $362.60 $75.57 $362.60 $145.04 $214.48 $362.60 $362.60 $362.60 $362.60 $272.25 $362.60 $362.60 $362.60 $181.30 $181.30 $287.18 $362.60 $290.08 $163.17 $71.97 N/A $210.54 $362.60 $217.56 $362.60 $75.57 $362.60 N/A N/A 5045-5-150 SUP Custom 27203010 5045-5-150 - PIN HALF 3MM 150MM SMOOTH TRANSFIX SELF DRILL APEX HOFFMANN BOTH IP/OP $213.50 $158.00 $37.94 $213.13 $213.13 $213.13 $213.13 $213.13 $213.13 $213.13 $37.94 $213.13 $213.13 $158.19 $158.19 $164.28 $111.04 $44.42 $213.13 $85.25 $213.13 $213.13 $213.13 $213.13 $213.13 $160.13 $213.13 $213.13 $213.13 $106.57 $106.57 $168.80 $213.13 $170.50 $138.53 $213.13 N/A $123.83 $213.13 $127.88 $213.13 $213.13 $213.13 N/A N/A 5045-5-200 SUP Custom 27203010 5045-5-200 - PIN HLF 3MM 200MM NS APX TRNFX ST SLF DRL THRD SS BOTH IP/OP $208.00 $154.00 $36.96 $207.63 $207.63 $207.63 $207.63 $207.63 $207.63 $207.63 $36.96 $207.63 $207.63 $154.10 $154.10 $160.04 $108.18 $43.27 $207.63 $83.05 $207.63 $207.63 $207.63 $207.63 $207.63 $156.00 $207.63 $207.63 $207.63 $103.82 $103.82 $164.44 $207.63 $166.10 $134.96 $207.63 N/A $120.64 $207.63 $124.58 $207.63 $207.63 $207.63 N/A N/A 504605A SUP HCPCS C1894 504605A - INTRODUCER SHTH STD HEXACUSPID 5FR 11CM GRY AVNT+ ROT SUT BOTH IP/OP $20.00 $15.00 $3.95 $19.88 $10.79 $10.79 $10.79 $10.79 $19.88 $19.88 $19.88 $4.14 $19.88 $14.75 $14.75 $15.32 $10.36 $4.14 $19.88 $19.88 $11.76 $19.88 $19.88 $19.88 $19.88 $15.00 $19.88 $19.88 $19.88 $9.94 $9.94 $15.74 $19.88 $15.90 $12.92 $3.95 N/A $11.60 $19.88 $19.88 $19.88 $4.14 $19.88 N/A N/A 504606T SUP HCPCS C1894 504606T - INTRODUCER SHTH MID LGTH 6FR 23CM GRN AVNT+ NO MN GW NO OBT BOTH IP/OP $55.00 $41.00 $10.89 $54.88 $29.80 $29.80 $29.80 $29.80 $54.88 $54.88 $54.88 $11.44 $54.88 $40.73 $40.73 $42.30 $28.59 $11.44 $54.88 $54.88 $32.46 $54.88 $54.88 $54.88 $54.88 $41.25 $54.88 $54.88 $54.88 $27.44 $27.44 $43.46 $54.88 $43.90 $35.67 $10.89 N/A $31.90 $54.88 $54.88 $54.88 $11.44 $54.88 N/A N/A 5047-1-030 SUP Custom 27203010 5047-1-030 - CAP END 3MM APEX HOFFMANN YELLOW DISPOSABLE BOTH IP/OP $71.00 $53.00 $12.56 $70.55 $70.55 $70.55 $70.55 $70.55 $70.55 $70.55 $12.56 $70.55 $70.55 $52.36 $52.36 $54.38 $36.76 $14.70 $70.55 $28.22 $70.55 $70.55 $70.55 $70.55 $70.55 $53.25 $70.55 $70.55 $70.55 $35.28 $35.28 $55.88 $70.55 $56.44 $45.86 $70.55 N/A $41.18 $70.55 $42.33 $70.55 $70.55 $70.55 N/A N/A 5048-5-065 SUP Custom 27203010 5048-5-065 - ROD EXFIX 5MM 65MM CONNCTNG HOFFMANN II MRI COMPACT CARB BOTH IP/OP $166.50 $123.00 $29.62 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $29.62 $166.38 $166.38 $123.49 $123.49 $128.25 $86.68 $34.68 $166.38 $66.55 $166.38 $166.38 $166.38 $166.38 $166.38 $124.88 $166.38 $166.38 $166.38 $83.19 $83.19 $131.77 $166.38 $133.10 $108.15 $166.38 N/A $96.57 $166.38 $99.83 $166.38 $166.38 $166.38 N/A N/A 5048-5-100 SUP Custom 27203010 5048-5-100 - ROD EXFIX 5MM 100MM CONNCTNG HOFFMANN II COMPACT MRI YELLOW BOTH IP/OP $166.50 $123.00 $29.62 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $29.62 $166.38 $166.38 $123.49 $123.49 $128.25 $86.68 $34.68 $166.38 $66.55 $166.38 $166.38 $166.38 $166.38 $166.38 $124.88 $166.38 $166.38 $166.38 $83.19 $83.19 $131.77 $166.38 $133.10 $108.15 $166.38 N/A $96.57 $166.38 $99.83 $166.38 $166.38 $166.38 N/A N/A 5048-5-150 SUP Custom 27203010 5048-5-150 - ROD EXFIX 5MM 150MM CONNCTNG HOFFMANN II COMPACT MRI YELLOW BOTH IP/OP $166.50 $123.00 $29.62 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $29.62 $166.38 $166.38 $123.49 $123.49 $128.25 $86.68 $34.68 $166.38 $66.55 $166.38 $166.38 $166.38 $166.38 $166.38 $124.88 $166.38 $166.38 $166.38 $83.19 $83.19 $131.77 $166.38 $133.10 $108.15 $166.38 N/A $96.57 $166.38 $99.83 $166.38 $166.38 $166.38 N/A N/A 5048-5-200 SUP Custom 27203010 5048-5-200 - ROD EXFIX 5MM 200MM CONNCTNG HOFFMANN II MRI COMPACT YELLOW BOTH IP/OP $166.50 $123.00 $29.62 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $29.62 $166.38 $166.38 $123.49 $123.49 $128.25 $86.68 $34.68 $166.38 $66.55 $166.38 $166.38 $166.38 $166.38 $166.38 $124.88 $166.38 $166.38 $166.38 $83.19 $83.19 $131.77 $166.38 $133.10 $108.15 $166.38 N/A $96.57 $166.38 $99.83 $166.38 $166.38 $166.38 N/A N/A 5048-5-250 SUP Custom 27203010 5048-5-250 - ROD EXFIX 5MM 250MM CONNCTNG HOFFMANN II COMPACT MRI CARB BOTH IP/OP $166.50 $123.00 $29.62 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $29.62 $166.38 $166.38 $123.49 $123.49 $128.25 $86.68 $34.68 $166.38 $66.55 $166.38 $166.38 $166.38 $166.38 $166.38 $124.88 $166.38 $166.38 $166.38 $83.19 $83.19 $131.77 $166.38 $133.10 $108.15 $166.38 N/A $96.57 $166.38 $99.83 $166.38 $166.38 $166.38 N/A N/A 5048-5-300 SUP Custom 27203010 5048-5-300 - ROD EXFIX 8MM 100MM MRI CONNCTNG HOFFMANN II COMPACT BOTH IP/OP $201.00 $149.00 $35.73 $200.75 $200.75 $200.75 $200.75 $200.75 $200.75 $200.75 $35.73 $200.75 $200.75 $149.00 $149.00 $154.74 $104.59 $41.84 $200.75 $80.30 $200.75 $200.75 $200.75 $200.75 $200.75 $150.75 $200.75 $200.75 $200.75 $100.38 $100.38 $158.99 $200.75 $160.60 $130.49 $200.75 N/A $116.58 $200.75 $120.45 $200.75 $200.75 $200.75 N/A N/A 5049-5-505 SUP Custom 27203010 5049-5-505 - ROD EXFIX 5MM 100MM CONNCTNG HOFFMANN CARFBR BOTH IP/OP $177.00 $131.00 $31.51 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $31.51 $177.00 $177.00 $131.37 $131.37 $136.43 $92.22 $36.89 $177.00 $70.80 $177.00 $177.00 $177.00 $177.00 $177.00 $132.75 $177.00 $177.00 $177.00 $88.50 $88.50 $140.18 $177.00 $141.60 $115.05 $177.00 N/A $102.66 $177.00 $106.20 $177.00 $177.00 $177.00 N/A N/A 5049-5-510 SUP Custom 27203010 5049-5-510 - ROD EXFIX STR 5MM 100MM CONNECT RADIOLUCENCY RELATIVE BOTH IP/OP $177.00 $131.00 $31.51 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $177.00 $31.51 $177.00 $177.00 $131.37 $131.37 $136.43 $92.22 $36.89 $177.00 $70.80 $177.00 $177.00 $177.00 $177.00 $177.00 $132.75 $177.00 $177.00 $177.00 $88.50 $88.50 $140.18 $177.00 $141.60 $115.05 $177.00 N/A $102.66 $177.00 $106.20 $177.00 $177.00 $177.00 N/A N/A 5049-5-515 SUP Custom 27203010 5049-5-515 - ROD EXFIX 5MM 150MM CONNCTNG BRAIDED HOFFMANN II CARFBR BOTH IP/OP $199.50 $148.00 $35.51 $199.50 $199.50 $199.50 $199.50 $199.50 $199.50 $199.50 $35.51 $199.50 $199.50 $148.07 $148.07 $153.77 $103.94 $41.58 $199.50 $79.80 $199.50 $199.50 $199.50 $199.50 $199.50 $149.63 $199.50 $199.50 $199.50 $99.75 $99.75 $158.00 $199.50 $159.60 $129.68 $199.50 N/A $115.71 $199.50 $119.70 $199.50 $199.50 $199.50 N/A N/A 5049-5-520 SUP Custom 27203010 5049-5-520 - ROD EXFIX 5MM 200MM CONNCTNG BRAIDED HOFFMANN II CARFBR BOTH IP/OP $199.50 $148.00 $35.51 $199.50 $199.50 $199.50 $199.50 $199.50 $199.50 $199.50 $35.51 $199.50 $199.50 $148.07 $148.07 $153.77 $103.94 $41.58 $199.50 $79.80 $199.50 $199.50 $199.50 $199.50 $199.50 $149.63 $199.50 $199.50 $199.50 $99.75 $99.75 $158.00 $199.50 $159.60 $129.68 $199.50 N/A $115.71 $199.50 $119.70 $199.50 $199.50 $199.50 N/A N/A 5049-5-525 SUP Custom 27803010 5049-5-525 - ROD EXFIX 5MM 15MM 250MM CONNECT TUBE HOFFMANN II COMPACT BOTH IP/OP $301.50 $223.00 $53.63 $301.28 $301.28 $301.28 $301.28 $301.28 $301.28 $301.28 $53.63 $301.28 $301.28 $301.28 $301.28 $301.28 $301.28 $62.79 $301.28 $120.51 $301.28 $301.28 $301.28 $301.28 $301.28 $226.13 $301.28 $301.28 $301.28 $150.64 $150.64 $238.61 $301.28 $241.02 $135.58 $301.28 N/A $174.87 $301.28 $180.77 $301.28 $301.28 $301.28 N/A N/A 5049-5-530 SUP Custom 27203010 5049-5-530 - ROD EXFIX 5MM 300MM CONNCTNG BRAIDED HOFFMANN II COMPACT BOTH IP/OP $376.00 $278.00 $66.92 $375.95 $375.95 $375.95 $375.95 $375.95 $375.95 $375.95 $66.92 $375.95 $375.95 $279.03 $279.03 $289.78 $195.87 $78.35 $375.95 $150.38 $375.95 $375.95 $375.95 $375.95 $375.95 $282.00 $375.95 $375.95 $375.95 $187.98 $187.98 $297.75 $375.95 $300.76 $244.37 $375.95 N/A $218.08 $375.95 $225.57 $375.95 $375.95 $375.95 N/A N/A 5049-7-018 SUP Custom 27203010 5049-7-018 - ROD EXFIX CVD SEMI CIR 111MM HOFFMANN II COMPACT CARFBR BOTH IP/OP $367.50 $272.00 $65.35 $367.13 $367.13 $367.13 $367.13 $367.13 $367.13 $367.13 $65.35 $367.13 $367.13 $272.48 $272.48 $282.98 $191.27 $76.51 $367.13 $146.85 $367.13 $367.13 $367.13 $367.13 $367.13 $275.63 $367.13 $367.13 $367.13 $183.57 $183.57 $290.77 $367.13 $293.70 $238.63 $367.13 N/A $213.15 $367.13 $220.28 $367.13 $367.13 $367.13 N/A N/A 5049-7-020 SUP Custom 27203010 5049-7-020 - ROD EXFIX CVD SEMICIRCLE 146MM HOFFMANN II COMPACT CARFBR BOTH IP/OP $179.00 $132.00 $31.82 $178.75 $178.75 $178.75 $178.75 $178.75 $178.75 $178.75 $31.82 $178.75 $178.75 $132.67 $132.67 $137.78 $93.13 $37.25 $178.75 $71.50 $178.75 $178.75 $178.75 $178.75 $178.75 $134.25 $178.75 $178.75 $178.75 $89.38 $89.38 $141.57 $178.75 $143.00 $116.19 $178.75 N/A $103.82 $178.75 $107.25 $178.75 $178.75 $178.75 N/A N/A 50-501-31-07 SUP HCPCS C1713 50-501-31-07 - GUIDE DRILL LONG 2.7MM RECONSTRUCTION THREADLOCK TS BOTH IP/OP $348.50 $258.00 $69.10 $348.13 $156.66 $156.66 $156.66 $156.66 $348.13 $348.13 $348.13 $72.56 $348.13 $348.13 $348.13 $348.13 $348.13 $72.55 $348.13 $348.13 $205.92 $348.13 $348.13 $348.13 $348.13 $261.38 $348.13 $348.13 $348.13 $174.07 $174.07 $275.72 $348.13 $278.50 $156.66 $69.10 N/A $202.13 $348.13 $208.88 $348.13 $72.55 $348.13 N/A N/A 50-504-23-07 SUP HCPCS C1713 50-504-23-07 - CUTTER SURG 8.5MM BENDER STAINLESS STEEL 1.5/2/3MM THICK BOTH IP/OP "$2,479.00" "$1,834.00" $491.93 "$2,478.55" "$1,115.35" "$1,115.35" "$1,115.35" "$1,115.35" "$2,478.55" "$2,478.55" "$2,478.55" $516.59 "$2,478.55" "$2,478.55" "$2,478.55" "$2,478.55" "$2,478.55" $516.56 "$2,478.55" $991.42 "$1,466.06" "$2,478.55" "$2,478.55" "$2,478.55" "$2,478.55" "$1,859.25" "$2,478.55" "$2,478.55" "$2,478.55" "$1,239.28" "$1,239.28" "$1,963.01" "$2,478.55" "$1,982.84" "$1,115.35" $491.93 N/A "$1,437.82" "$2,478.55" "$2,478.55" "$2,478.55" $516.53 "$2,478.55" N/A N/A 50-504-24-07 SUP HCPCS C1713 50-504-24-07 - CUTTER SURG 8.5MM BENDER STAINLESS STEEL 1.5/2/3MM THICK BOTH IP/OP "$2,562.50" "$1,896.00" $508.51 "$2,562.08" "$1,152.94" "$1,152.94" "$1,152.94" "$1,152.94" "$2,562.08" "$2,562.08" "$2,562.08" $534.00 "$2,562.08" "$2,562.08" "$2,562.08" "$2,562.08" "$2,562.08" $533.97 "$2,562.08" "$2,562.08" "$1,263.11" "$2,562.08" "$2,562.08" "$2,562.08" "$2,562.08" "$1,921.88" "$2,562.08" "$2,562.08" "$2,562.08" "$1,281.04" "$1,281.04" "$2,029.17" "$2,562.08" "$2,049.66" "$1,152.94" $508.51 N/A "$1,486.25" "$2,562.08" "$2,562.08" "$2,562.08" "$2,562.08" "$2,562.08" N/A N/A 5050-4-300 SUP HCPCS C1713 5050-4-300 - PIN FIX 5/6MM 300MM 40MM SLFDRILL THREAD APEX TRANSFIX BOTH IP/OP $221.00 $164.00 $43.86 $221.00 $99.45 $99.45 $99.45 $99.45 $221.00 $221.00 $221.00 $46.06 $221.00 $221.00 $221.00 $221.00 $221.00 $46.06 $221.00 $88.40 $130.72 $221.00 $221.00 $221.00 $221.00 $165.75 $221.00 $221.00 $221.00 $110.50 $110.50 $175.03 $221.00 $176.80 $99.45 $43.86 N/A $128.18 $221.00 $221.00 $221.00 $46.06 $221.00 N/A N/A 5050-5-250 SUP Custom 27203010 5050-5-250 - PIN HALF 5MM 4MM 250MM 50MM TRANSFIXATION APEX STAINLESS BOTH IP/OP $263.00 $195.00 $46.75 $262.65 $262.65 $262.65 $262.65 $262.65 $262.65 $262.65 $46.75 $262.65 $262.65 $194.94 $194.94 $202.45 $136.84 $54.74 $262.65 $105.06 $262.65 $262.65 $262.65 $262.65 $262.65 $197.25 $262.65 $262.65 $262.65 $131.33 $131.33 $208.02 $262.65 $210.12 $170.72 $262.65 N/A $152.54 $262.65 $157.59 $262.65 $262.65 $262.65 N/A N/A 5050-5-300 SUP Custom 27203010 5050-5-300 - PIN FIX 6MM 5MM 300MM 50MM TRANSFIXATION CENTRL THREAD APEX BOTH IP/OP $249.50 $185.00 $44.33 $249.05 $249.05 $249.05 $249.05 $249.05 $249.05 $249.05 $44.33 $249.05 $249.05 $184.84 $184.84 $191.97 $129.76 $51.90 $249.05 $99.62 $249.05 $249.05 $249.05 $249.05 $249.05 $187.13 $249.05 $249.05 $249.05 $124.53 $124.53 $197.25 $249.05 $199.24 $161.88 $249.05 N/A $144.71 $249.05 $149.43 $249.05 $249.05 $249.05 N/A N/A 50-519-15-07 SUP Custom 27100030 50-519-15-07 - DRILL TWIST 1.9MM 115MM J NOTCH STEEL 2/2.3MM SCREW BOTH IP/OP $290.50 $215.00 $51.63 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $290.05 $51.63 $290.05 $290.05 $215.28 $215.28 $223.57 $151.12 $60.45 $290.05 $116.02 $290.05 $290.05 $290.05 $290.05 $290.05 $217.88 $290.05 $290.05 $290.05 $145.03 $145.03 $229.72 $290.05 $232.04 $188.53 $290.05 N/A $168.49 $290.05 $174.03 $290.05 $290.05 $290.05 N/A N/A 5054-2-001 SUP Custom 27203010 5054-2-001 - INSERTER SURG T HANDLE PIN BOTH IP/OP $289.00 $214.00 $51.40 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $51.40 $288.75 $288.75 $214.31 $214.31 $222.57 $150.44 $60.18 $288.75 $115.50 $288.75 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $187.69 $288.75 N/A $167.62 $288.75 $173.25 $288.75 $288.75 $288.75 N/A N/A 5054-2-002 SUP Custom 27203010 5054-2-002 - BRACE DRILL 2 W/O CHUCK HOFFMAN BOTH IP/OP $804.50 $595.00 $143.18 $804.38 $804.38 $804.38 $804.38 $804.38 $804.38 $804.38 $143.18 $804.38 $804.38 $597.01 $597.01 $620.02 $419.08 $167.64 $804.38 $321.75 $804.38 $804.38 $804.38 $804.38 $804.38 $603.38 $804.38 $804.38 $804.38 $402.19 $402.19 $637.07 $804.38 $643.50 $522.85 $804.38 N/A $466.61 $804.38 $482.63 $804.38 $804.38 $804.38 N/A N/A 5054-3-080 SUP Custom 27203010 5054-3-080 - SLEEVE XTRNFX 3MM 80MM HFMN2 2 TROC BOTH IP/OP $433.50 $321.00 $77.10 $433.13 $433.13 $433.13 $433.13 $433.13 $433.13 $433.13 $77.10 $433.13 $433.13 $321.47 $321.47 $333.86 $225.66 $90.27 $433.13 $173.25 $433.13 $433.13 $433.13 $433.13 $433.13 $325.13 $433.13 $433.13 $433.13 $216.57 $216.57 $343.04 $433.13 $346.50 $281.53 $433.13 N/A $251.43 $433.13 $259.88 $433.13 $433.13 $433.13 N/A N/A 5054-3-093 SUP Custom 27203010 5054-3-093 - TROCAR SURG 3MM 93MM 2 SLEEVE ASMBLY BOTH IP/OP $378.50 $280.00 $67.31 $378.13 $378.13 $378.13 $378.13 $378.13 $378.13 $378.13 $67.31 $378.13 $378.13 $280.65 $280.65 $291.46 $197.01 $78.81 $378.13 $151.25 $378.13 $378.13 $378.13 $378.13 $378.13 $283.88 $378.13 $378.13 $378.13 $189.07 $189.07 $299.48 $378.13 $302.50 $245.78 $378.13 N/A $219.53 $378.13 $226.88 $378.13 $378.13 $378.13 N/A N/A 5054-4-120 SUP Custom 27203010 5054-4-120 - SLEEVE XTRNFX 4MM 120MM HFMN2 2 TROC BOTH IP/OP $426.50 $316.00 $75.87 $426.25 $426.25 $426.25 $426.25 $426.25 $426.25 $426.25 $75.87 $426.25 $426.25 $316.36 $316.36 $328.55 $222.08 $88.84 $426.25 $170.50 $426.25 $426.25 $426.25 $426.25 $426.25 $319.88 $426.25 $426.25 $426.25 $213.13 $213.13 $337.59 $426.25 $341.00 $277.06 $426.25 N/A $247.37 $426.25 $255.75 $426.25 $426.25 $426.25 N/A N/A 5054-4-150 SUP Custom 27203010 5054-4-150 - SLEEVE XTRNFX 4MM 150MM HFMN2 2 TROC BOTH IP/OP $422.50 $313.00 $75.14 $422.13 $422.13 $422.13 $422.13 $422.13 $422.13 $422.13 $75.14 $422.13 $422.13 $313.30 $313.30 $325.38 $219.93 $87.98 $422.13 $168.85 $422.13 $422.13 $422.13 $422.13 $422.13 $316.88 $422.13 $422.13 $422.13 $211.07 $211.07 $334.33 $422.13 $337.70 $274.38 $422.13 N/A $245.05 $422.13 $253.28 $422.13 $422.13 $422.13 N/A N/A 5054-4-180 SUP Custom 27203010 5054-4-180 - SLEEVE XTRNFX 4MM 180MM HFMN2 2 TROC BOTH IP/OP $172.00 $127.00 $30.59 $171.88 $171.88 $171.88 $171.88 $171.88 $171.88 $171.88 $30.59 $171.88 $171.88 $127.57 $127.57 $132.49 $89.55 $35.82 $171.88 $68.75 $171.88 $171.88 $171.88 $171.88 $171.88 $129.00 $171.88 $171.88 $171.88 $85.94 $85.94 $136.13 $171.88 $137.50 $111.72 $171.88 N/A $99.76 $171.88 $103.13 $171.88 $171.88 $171.88 N/A N/A 5054-6-120 SUP Custom 27203010 5054-6-120 - SET EXFIX 6MM 2 SLEEVE TROCAR HOFFMANN II BOTH IP/OP $480.00 $355.00 $85.42 $479.88 $479.88 $479.88 $479.88 $479.88 $479.88 $479.88 $85.42 $479.88 $479.88 $356.17 $356.17 $369.89 $250.02 $100.01 $479.88 $191.95 $479.88 $479.88 $479.88 $479.88 $479.88 $360.00 $479.88 $479.88 $479.88 $239.94 $239.94 $380.06 $479.88 $383.90 $311.92 $479.88 N/A $278.40 $479.88 $287.93 $479.88 $479.88 $479.88 N/A N/A 5054-6-150 SUP Custom 27203010 5054-6-150 - TROCAR SURG 6MM 150MM 2 SLEEVE ASMBLY BOTH IP/OP $480.00 $355.00 $85.42 $479.88 $479.88 $479.88 $479.88 $479.88 $479.88 $479.88 $85.42 $479.88 $479.88 $356.17 $356.17 $369.89 $250.02 $100.01 $479.88 $191.95 $479.88 $479.88 $479.88 $479.88 $479.88 $360.00 $479.88 $479.88 $479.88 $239.94 $239.94 $380.06 $479.88 $383.90 $311.92 $479.88 N/A $278.40 $479.88 $287.93 $479.88 $479.88 $479.88 N/A N/A 5054-6-180 SUP Custom 27203010 5054-6-180 - TROCAR SURG 6MM 180MM 2 SLEEVE ASMBLY BOTH IP/OP $480.00 $355.00 $85.42 $479.88 $479.88 $479.88 $479.88 $479.88 $479.88 $479.88 $85.42 $479.88 $479.88 $356.17 $356.17 $369.89 $250.02 $100.01 $479.88 $191.95 $479.88 $479.88 $479.88 $479.88 $479.88 $360.00 $479.88 $479.88 $479.88 $239.94 $239.94 $380.06 $479.88 $383.90 $311.92 $479.88 N/A $278.40 $479.88 $287.93 $479.88 $479.88 $479.88 N/A N/A 5054-6-200 SUP Custom 27203010 5054-6-200 - TROCAR SURG 6MM 200MM 2 SLEEVE ASMBLY BOTH IP/OP $480.00 $355.00 $85.42 $479.88 $479.88 $479.88 $479.88 $479.88 $479.88 $479.88 $85.42 $479.88 $479.88 $356.17 $356.17 $369.89 $250.02 $100.01 $479.88 $191.95 $479.88 $479.88 $479.88 $479.88 $479.88 $360.00 $479.88 $479.88 $479.88 $239.94 $239.94 $380.06 $479.88 $383.90 $311.92 $479.88 N/A $278.40 $479.88 $287.93 $479.88 $479.88 $479.88 N/A N/A 5057-0-100 SUP Custom 27203010 5057-0-100 - GUIDE DRILL ASMBLY APEX BOTH IP/OP $173.50 $128.00 $30.84 $173.25 $173.25 $173.25 $173.25 $173.25 $173.25 $173.25 $30.84 $173.25 $173.25 $128.59 $128.59 $133.54 $90.26 $36.11 $173.25 $69.30 $173.25 $173.25 $173.25 $173.25 $173.25 $130.13 $173.25 $173.25 $173.25 $86.63 $86.63 $137.21 $173.25 $138.60 $112.61 $173.25 N/A $100.63 $173.25 $103.95 $173.25 $173.25 $173.25 N/A N/A 5057-0-200 SUP Custom 27203010 5057-0-200 - ASSEMBLY DRILL BRACE APEX BOTH IP/OP $817.00 $605.00 $145.38 $816.75 $816.75 $816.75 $816.75 $816.75 $816.75 $816.75 $145.38 $816.75 $816.75 $606.19 $606.19 $629.55 $425.53 $170.22 $816.75 $326.70 $816.75 $816.75 $816.75 $816.75 $816.75 $612.75 $816.75 $816.75 $816.75 $408.38 $408.38 $646.87 $816.75 $653.40 $530.89 $816.75 N/A $473.86 $816.75 $490.05 $816.75 $816.75 $816.75 N/A N/A 5057-0-300 SUP Custom 27203010 5057-0-300 - ASSEMBLY DRILL 3-6MM BRACE APEX BOTH IP/OP $766.00 $567.00 $136.33 $765.88 $765.88 $765.88 $765.88 $765.88 $765.88 $765.88 $136.33 $765.88 $765.88 $568.44 $568.44 $590.34 $399.02 $159.62 $765.88 $306.35 $765.88 $765.88 $765.88 $765.88 $765.88 $574.50 $765.88 $765.88 $765.88 $382.94 $382.94 $606.58 $765.88 $612.70 $497.82 $765.88 N/A $444.28 $765.88 $459.53 $765.88 $765.88 $765.88 N/A N/A 5057-1-117 SUP Custom 27203010 5057-1-117 - GUIDE DRILL 4 HOLE BLOCK COMPACT HOFFMANN II BOTH IP/OP $495.00 $366.00 $88.11 $495.00 $495.00 $495.00 $495.00 $495.00 $495.00 $495.00 $88.11 $495.00 $495.00 $367.39 $367.39 $381.55 $257.90 $103.16 $495.00 $198.00 $495.00 $495.00 $495.00 $495.00 $495.00 $371.25 $495.00 $495.00 $495.00 $247.50 $247.50 $392.04 $495.00 $396.00 $321.75 $495.00 N/A $287.10 $495.00 $297.00 $495.00 $495.00 $495.00 N/A N/A 5057-1-118 SUP Custom 27203010 5057-1-118 - GUIDE DRILL 4 HOLE BLOCK CLMP HOFFMANN II COMPACT BOTH IP/OP $495.00 $366.00 $88.11 $495.00 $495.00 $495.00 $495.00 $495.00 $495.00 $495.00 $88.11 $495.00 $495.00 $367.39 $367.39 $381.55 $257.90 $103.16 $495.00 $198.00 $495.00 $495.00 $495.00 $495.00 $495.00 $371.25 $495.00 $495.00 $495.00 $247.50 $247.50 $392.04 $495.00 $396.00 $321.75 $495.00 N/A $287.10 $495.00 $297.00 $495.00 $495.00 $495.00 N/A N/A 5057-1-119 SUP Custom 27203010 5057-1-119 - GUIDE DRILL 4 HOLE BLOCK MONOTUBE TRIAX APEX BLUE RED BOTH IP/OP $469.00 $347.00 $83.46 $468.88 $468.88 $468.88 $468.88 $468.88 $468.88 $468.88 $83.46 $468.88 $468.88 $348.00 $348.00 $361.41 $244.29 $97.72 $468.88 $187.55 $468.88 $468.88 $468.88 $468.88 $468.88 $351.75 $468.88 $468.88 $468.88 $234.44 $234.44 $371.35 $468.88 $375.10 $304.77 $468.88 N/A $272.02 $468.88 $281.33 $468.88 $468.88 $468.88 N/A N/A 5057-1-120 SUP Custom 27203010 5057-1-120 - GUIDE DRILL 2 HOLE BLOCK MONOTUBE TRIAX APEX YELLOW BOTH IP/OP $469.00 $347.00 $83.46 $468.88 $468.88 $468.88 $468.88 $468.88 $468.88 $468.88 $83.46 $468.88 $468.88 $348.00 $348.00 $361.41 $244.29 $97.72 $468.88 $187.55 $468.88 $468.88 $468.88 $468.88 $468.88 $351.75 $468.88 $468.88 $468.88 $234.44 $234.44 $371.35 $468.88 $375.10 $304.77 $468.88 N/A $272.02 $468.88 $281.33 $468.88 $468.88 $468.88 N/A N/A 5057-3-000 SUP Custom 27203010 5057-3-000 - ASSEMBLY DRL XSH 3MM PREDRILLING BOTH IP/OP $219.00 $162.00 $38.92 $218.63 $218.63 $218.63 $218.63 $218.63 $218.63 $218.63 $38.92 $218.63 $218.63 $162.27 $162.27 $168.52 $113.91 $45.56 $218.63 $87.45 $218.63 $218.63 $218.63 $218.63 $218.63 $164.25 $218.63 $218.63 $218.63 $109.32 $109.32 $173.15 $218.63 $174.90 $142.11 $218.63 N/A $127.02 $218.63 $131.18 $218.63 $218.63 $218.63 N/A N/A 5057-3-100 SUP Custom 27203010 5057-3-100 - SLEEVE DRILL SHORT 3MM PREDRILL APEX BOTH IP/OP $511.50 $379.00 $91.03 $511.43 $511.43 $511.43 $511.43 $511.43 $511.43 $511.43 $91.03 $511.43 $511.43 $379.58 $379.58 $394.21 $266.46 $106.59 $511.43 $204.57 $511.43 $511.43 $511.43 $511.43 $511.43 $383.63 $511.43 $511.43 $511.43 $255.72 $255.72 $405.05 $511.43 $409.14 $332.43 $511.43 N/A $296.67 $511.43 $306.86 $511.43 $511.43 $511.43 N/A N/A 5057-3-200 SUP Custom 27203010 5057-3-200 - SLEEVE DRILL LONG 3MM PREDRILL APEX BOTH IP/OP $511.50 $379.00 $91.03 $511.43 $511.43 $511.43 $511.43 $511.43 $511.43 $511.43 $91.03 $511.43 $511.43 $379.58 $379.58 $394.21 $266.46 $106.59 $511.43 $204.57 $511.43 $511.43 $511.43 $511.43 $511.43 $383.63 $511.43 $511.43 $511.43 $255.72 $255.72 $405.05 $511.43 $409.14 $332.43 $511.43 N/A $296.67 $511.43 $306.86 $511.43 $511.43 $511.43 N/A N/A 5057-4-000 SUP Custom 27203010 5057-4-000 - GUIDE DRILL XSHORT 4MM 35MM PREDRILLING ASMBLY APEX HYDRXAPT BOTH IP/OP $235.50 $174.00 $41.85 $235.13 $235.13 $235.13 $235.13 $235.13 $235.13 $235.13 $41.85 $235.13 $235.13 $174.51 $174.51 $181.24 $122.50 $49.00 $235.13 $94.05 $235.13 $235.13 $235.13 $235.13 $235.13 $176.63 $235.13 $235.13 $235.13 $117.57 $117.57 $186.22 $235.13 $188.10 $152.83 $235.13 N/A $136.59 $235.13 $141.08 $235.13 $235.13 $235.13 N/A N/A 5057-4-100 SUP Custom 27203010 5057-4-100 - SLEEVE DRILL SHORT 4MM PREDRILL APEX BOTH IP/OP $231.00 $171.00 $41.12 $231.00 $231.00 $231.00 $231.00 $231.00 $231.00 $231.00 $41.12 $231.00 $231.00 $171.45 $171.45 $178.05 $120.35 $48.14 $231.00 $92.40 $231.00 $231.00 $231.00 $231.00 $231.00 $173.25 $231.00 $231.00 $231.00 $115.50 $115.50 $182.95 $231.00 $184.80 $150.15 $231.00 N/A $133.98 $231.00 $138.60 $231.00 $231.00 $231.00 N/A N/A 5057-4-200 SUP Custom 27203010 5057-4-200 - GUIDE DRILL LONG 4MM 100MM PREDRILLING ASMBLY PROTECTION BOTH IP/OP $231.00 $171.00 $41.12 $231.00 $231.00 $231.00 $231.00 $231.00 $231.00 $231.00 $41.12 $231.00 $231.00 $171.45 $171.45 $178.05 $120.35 $48.14 $231.00 $92.40 $231.00 $231.00 $231.00 $231.00 $231.00 $173.25 $231.00 $231.00 $231.00 $115.50 $115.50 $182.95 $231.00 $184.80 $150.15 $231.00 N/A $133.98 $231.00 $138.60 $231.00 $231.00 $231.00 N/A N/A 5057-5-000 SUP Custom 27203010 5057-5-000 - ASSEMBLY DRILL XSHORT 5MM 50MM PREDRILLING PROTECTION LENGTH BOTH IP/OP $250.50 $185.00 $44.54 $250.25 $250.25 $250.25 $250.25 $250.25 $250.25 $250.25 $44.54 $250.25 $250.25 $185.74 $185.74 $192.89 $130.38 $52.15 $250.25 $100.10 $250.25 $250.25 $250.25 $250.25 $250.25 $187.88 $250.25 $250.25 $250.25 $125.13 $125.13 $198.20 $250.25 $200.20 $162.66 $250.25 N/A $145.29 $250.25 $150.15 $250.25 $250.25 $250.25 N/A N/A 5057-5-100 SUP Custom 27203010 5057-5-100 - GUIDE SURG SHORT 5MM PREDRILL TROCAR ASMBLY APEX BOTH IP/OP $250.50 $185.00 $44.54 $250.25 $250.25 $250.25 $250.25 $250.25 $250.25 $250.25 $44.54 $250.25 $250.25 $185.74 $185.74 $192.89 $130.38 $52.15 $250.25 $100.10 $250.25 $250.25 $250.25 $250.25 $250.25 $187.88 $250.25 $250.25 $250.25 $125.13 $125.13 $198.20 $250.25 $200.20 $162.66 $250.25 N/A $145.29 $250.25 $150.15 $250.25 $250.25 $250.25 N/A N/A 5057-5-200 SUP Custom 27203010 5057-5-200 - ASSEMBLY DRILL LONG 5MM BOTH IP/OP $250.50 $185.00 $44.54 $250.25 $250.25 $250.25 $250.25 $250.25 $250.25 $250.25 $44.54 $250.25 $250.25 $185.74 $185.74 $192.89 $130.38 $52.15 $250.25 $100.10 $250.25 $250.25 $250.25 $250.25 $250.25 $187.88 $250.25 $250.25 $250.25 $125.13 $125.13 $198.20 $250.25 $200.20 $162.66 $250.25 N/A $145.29 $250.25 $150.15 $250.25 $250.25 $250.25 N/A N/A 5057-6-000 SUP Custom 27203010 5057-6-000 - ASSEMBLY DRILL XSHORT 6MM 60MM PREDRILLING PROTECTION LENGTH BOTH IP/OP $267.00 $198.00 $47.48 $266.75 $266.75 $266.75 $266.75 $266.75 $266.75 $266.75 $47.48 $266.75 $266.75 $197.98 $197.98 $205.61 $138.98 $55.59 $266.75 $106.70 $266.75 $266.75 $266.75 $266.75 $266.75 $200.25 $266.75 $266.75 $266.75 $133.38 $133.38 $211.27 $266.75 $213.40 $173.39 $266.75 N/A $154.86 $266.75 $160.05 $266.75 $266.75 $266.75 N/A N/A 5057-6-100 SUP Custom 27203010 5057-6-100 - ASSEMBLY DRILL 6MM SHORT PREDRILLING BOTH IP/OP $267.00 $198.00 $47.48 $266.75 $266.75 $266.75 $266.75 $266.75 $266.75 $266.75 $47.48 $266.75 $266.75 $197.98 $197.98 $205.61 $138.98 $55.59 $266.75 $106.70 $266.75 $266.75 $266.75 $266.75 $266.75 $200.25 $266.75 $266.75 $266.75 $133.38 $133.38 $211.27 $266.75 $213.40 $173.39 $266.75 N/A $154.86 $266.75 $160.05 $266.75 $266.75 $266.75 N/A N/A 5057-6-200 SUP Custom 27203010 5057-6-200 - GUIDE DRILL LONG 6MM 120MM PREDRILL APEX HA BOTH IP/OP $267.00 $198.00 $47.48 $266.75 $266.75 $266.75 $266.75 $266.75 $266.75 $266.75 $47.48 $266.75 $266.75 $197.98 $197.98 $205.61 $138.98 $55.59 $266.75 $106.70 $266.75 $266.75 $266.75 $266.75 $266.75 $200.25 $266.75 $266.75 $266.75 $133.38 $133.38 $211.27 $266.75 $213.40 $173.39 $266.75 N/A $154.86 $266.75 $160.05 $266.75 $266.75 $266.75 N/A N/A 5057-6-300 SUP Custom 27203010 5057-6-300 - CUTTER PIN 4-6MM EXTN HANDLE APEX BOTH IP/OP "$3,898.50" "$2,885.00" $693.87 "$3,898.13" "$3,898.13" "$3,898.13" "$3,898.13" "$3,898.13" "$3,898.13" "$3,898.13" $693.87 "$3,898.13" "$3,898.13" "$2,893.19" "$2,893.19" "$3,004.68" "$2,030.93" $812.41 "$3,898.13" "$1,559.25" "$3,898.13" "$3,898.13" "$3,898.13" "$3,898.13" "$3,898.13" "$2,923.88" "$3,898.13" "$3,898.13" "$3,898.13" "$1,949.07" "$1,949.07" "$3,087.32" "$3,898.13" "$3,118.50" "$2,533.78" "$3,898.13" N/A "$2,261.13" "$3,898.13" "$2,338.88" "$3,898.13" "$3,898.13" "$3,898.13" N/A N/A 5057-9-900 SUP Custom 27203010 5057-9-900 - TRAY STERILIZATION PIN AND INSTRUMENTATION STORAGE APEX BOTH IP/OP "$3,267.00" "$2,418.00" $581.53 "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" $581.53 "$3,267.00" "$3,267.00" "$2,424.77" "$2,424.77" "$2,518.20" "$1,702.11" $680.88 "$3,267.00" "$1,306.80" "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" "$3,267.00" "$2,450.25" "$3,267.00" "$3,267.00" "$3,267.00" "$1,633.50" "$1,633.50" "$2,587.46" "$3,267.00" "$2,613.60" "$2,123.55" "$3,267.00" N/A "$1,894.86" "$3,267.00" "$1,960.20" "$3,267.00" "$3,267.00" "$3,267.00" N/A N/A 50638-311 SUP Custom 27100030 50638-311 - BRACE POSITIONING DROP STOP ECONOMY LATEX FREE SPAN+AIDS BOTH IP/OP $37.50 $28.00 $6.63 $37.23 $37.23 $37.23 $37.23 $37.23 $37.23 $37.23 $6.63 $37.23 $37.23 $27.63 $27.63 $28.70 $19.40 $7.76 $37.23 $14.89 $37.23 $37.23 $37.23 $37.23 $37.23 $28.13 $37.23 $37.23 $37.23 $18.62 $18.62 $29.49 $37.23 $29.78 $24.20 $37.23 N/A $21.75 $37.23 $22.34 $37.23 $37.23 $37.23 N/A N/A 5065-3-312 SUP Custom 27203010 5065-3-312 - PIN HALF MINI BLUNT 2MM 33MM 12MM SELF TAP CONTIN THREAD BOTH IP/OP $111.00 $82.00 $19.76 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $19.76 $111.00 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $44.40 $111.00 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $111.00 N/A $64.38 $111.00 $66.60 $111.00 $111.00 $111.00 N/A N/A 5065-3-615 SUP Custom 27203010 5065-3-615 - PIN HALF BLUNT 2MM 36MM 15MM SELF TAP CONTIN THREAD APEX BOTH IP/OP $111.00 $82.00 $19.76 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $19.76 $111.00 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $44.40 $111.00 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $111.00 N/A $64.38 $111.00 $66.60 $111.00 $111.00 $111.00 N/A N/A 5065-3-918 SUP Custom 27203010 5065-3-918 - PIN HALF MINI BLUNT 2MM 39MM 18MM SELF TAP CONTIN THREAD BOTH IP/OP $111.00 $82.00 $19.76 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $19.76 $111.00 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $44.40 $111.00 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $111.00 N/A $64.38 $111.00 $66.60 $111.00 $111.00 $111.00 N/A N/A 5065-4-520 SUP Custom 27203010 5065-4-520 - PIN HALF MINI BLUNT 2MM 45MM 20MM SELF TAP CONTIN THREAD BOTH IP/OP $111.00 $82.00 $19.76 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $19.76 $111.00 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $44.40 $111.00 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $111.00 N/A $64.38 $111.00 $66.60 $111.00 $111.00 $111.00 N/A N/A 5065-5-020 SUP Custom 27203010 5065-5-020 - PIN HALF 2MM 50MM 20MM BLUNT SLFTAP CONTIN THREADED APEX BOTH IP/OP $111.00 $82.00 $19.76 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $19.76 $111.00 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $44.40 $111.00 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $111.00 N/A $64.38 $111.00 $66.60 $111.00 $111.00 $111.00 N/A N/A 5065-6-020 SUP Custom 27203010 5065-6-020 - PIN HALF 2MM 60MM 20MM BLUNT SLFTAP CONTIN THREADED APEX BOTH IP/OP $111.00 $82.00 $19.76 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $19.76 $111.00 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $44.40 $111.00 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $111.00 N/A $64.38 $111.00 $66.60 $111.00 $111.00 $111.00 N/A N/A 5065-9-015 SUP Custom 27203010 5065-9-015 - PIN HALF MINI BLUNT 2MM 90MM 15MM CONTIN THREAD APEX BOTH IP/OP $111.00 $82.00 $19.76 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $111.00 $19.76 $111.00 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $44.40 $111.00 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $111.00 N/A $64.38 $111.00 $66.60 $111.00 $111.00 $111.00 N/A N/A 50-7000B SUP HCPCS A7042 50-7000B - KIT DRAIN 15.5FR PLEURAL CATHETER CHLORAPREP APPLICATOR BOTH IP/OP "$2,413.00" "$1,786.00" $429.46 "$2,412.70" "$2,412.70" "$2,412.70" "$2,412.70" "$2,412.70" "$2,412.70" "$2,412.70" $429.46 "$2,412.70" "$2,412.70" "$2,412.70" "$2,412.70" "$2,412.70" "$2,412.70" $502.83 "$2,412.70" $965.08 "$2,412.70" "$2,412.70" "$2,412.70" "$2,412.70" "$2,412.70" "$1,809.75" "$2,412.70" "$2,412.70" "$2,412.70" "$1,206.35" "$1,206.35" "$1,910.86" "$2,412.70" "$1,930.16" "$1,085.72" "$2,412.70" N/A "$1,399.54" "$2,412.70" "$1,447.62" "$2,412.70" "$2,412.70" "$2,412.70" N/A N/A 5070-3-310 SUP Custom 27203010 5070-3-310 - PIN EXFIX 1.5MM MINI 2MM 33MM 10MM CONTIN THREAD TRANSFIX BOTH IP/OP $137.50 $102.00 $24.48 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $24.48 $137.50 $137.50 $102.05 $102.05 $105.99 $71.64 $28.66 $137.50 $55.00 $137.50 $137.50 $137.50 $137.50 $137.50 $103.13 $137.50 $137.50 $137.50 $68.75 $68.75 $108.90 $137.50 $110.00 $89.38 $137.50 N/A $79.75 $137.50 $82.50 $137.50 $137.50 $137.50 N/A N/A 5070-3-810 SUP Custom 27203010 5070-3-810 - PIN XTRNFX 2MM 38MM 10MM TRNFX SMTH SS BOTH IP/OP $131.00 $97.00 $23.25 $130.63 $130.63 $130.63 $130.63 $130.63 $130.63 $130.63 $23.25 $130.63 $130.63 $96.95 $96.95 $100.69 $68.06 $27.22 $130.63 $52.25 $130.63 $130.63 $130.63 $130.63 $130.63 $98.25 $130.63 $130.63 $130.63 $65.32 $65.32 $103.46 $130.63 $104.50 $84.91 $130.63 N/A $75.98 $130.63 $78.38 $130.63 $130.63 $130.63 N/A N/A 5070-4-312 SUP Custom 27203010 5070-4-312 - PIN EXFIX 2MM 43MM 13MM SMOOTH TRANSFX STAINLESS STEEL BOTH IP/OP $131.00 $97.00 $23.25 $130.63 $130.63 $130.63 $130.63 $130.63 $130.63 $130.63 $23.25 $130.63 $130.63 $96.95 $96.95 $100.69 $68.06 $27.22 $130.63 $52.25 $130.63 $130.63 $130.63 $130.63 $130.63 $98.25 $130.63 $130.63 $130.63 $65.32 $65.32 $103.46 $130.63 $104.50 $84.91 $130.63 N/A $75.98 $130.63 $78.38 $130.63 $130.63 $130.63 N/A N/A 5070-4-812 SUP Custom 27203010 5070-4-812 - PIN EXFIX 1.5MM MINI 2MM 48MM 12MM CONTIN THREAD TRANSFIX BOTH IP/OP $131.00 $97.00 $23.25 $130.63 $130.63 $130.63 $130.63 $130.63 $130.63 $130.63 $23.25 $130.63 $130.63 $96.95 $96.95 $100.69 $68.06 $27.22 $130.63 $52.25 $130.63 $130.63 $130.63 $130.63 $130.63 $98.25 $130.63 $130.63 $130.63 $65.32 $65.32 $103.46 $130.63 $104.50 $84.91 $130.63 N/A $75.98 $130.63 $78.38 $130.63 $130.63 $130.63 N/A N/A 5070-5-312 SUP Custom 27203010 5070-5-312 - PIN EXFIX 1.5MM MINI 2MM 53MM 12MM CONTIN THREAD TRANSFIX BOTH IP/OP $131.00 $97.00 $23.25 $130.63 $130.63 $130.63 $130.63 $130.63 $130.63 $130.63 $23.25 $130.63 $130.63 $96.95 $96.95 $100.69 $68.06 $27.22 $130.63 $52.25 $130.63 $130.63 $130.63 $130.63 $130.63 $98.25 $130.63 $130.63 $130.63 $65.32 $65.32 $103.46 $130.63 $104.50 $84.91 $130.63 N/A $75.98 $130.63 $78.38 $130.63 $130.63 $130.63 N/A N/A 5070-5-815 SUP Custom 27203010 5070-5-815 - PIN EXFIX 2MM 58MM 16MM SMOOTH TRANSFX STAINLESS STEEL BOTH IP/OP $131.00 $97.00 $23.25 $130.63 $130.63 $130.63 $130.63 $130.63 $130.63 $130.63 $23.25 $130.63 $130.63 $96.95 $96.95 $100.69 $68.06 $27.22 $130.63 $52.25 $130.63 $130.63 $130.63 $130.63 $130.63 $98.25 $130.63 $130.63 $130.63 $65.32 $65.32 $103.46 $130.63 $104.50 $84.91 $130.63 N/A $75.98 $130.63 $78.38 $130.63 $130.63 $130.63 N/A N/A 5070-6-315 SUP Custom 27203010 5070-6-315 - PIN EXFIX 1.5MM MINI 2MM 63MM 15MM CONTIN THREAD TRANSFIX BOTH IP/OP $137.50 $102.00 $24.48 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $24.48 $137.50 $137.50 $102.05 $102.05 $105.99 $71.64 $28.66 $137.50 $55.00 $137.50 $137.50 $137.50 $137.50 $137.50 $103.13 $137.50 $137.50 $137.50 $68.75 $68.75 $108.90 $137.50 $110.00 $89.38 $137.50 N/A $79.75 $137.50 $82.50 $137.50 $137.50 $137.50 N/A N/A 5070-7-820 SUP Custom 27203010 5070-7-820 - PIN EXFIX 1.5MM MINI 2MM 78MM 20MM CONTIN THREAD TRANSFIX BOTH IP/OP $137.50 $102.00 $24.48 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $24.48 $137.50 $137.50 $102.05 $102.05 $105.99 $71.64 $28.66 $137.50 $55.00 $137.50 $137.50 $137.50 $137.50 $137.50 $103.13 $137.50 $137.50 $137.50 $68.75 $68.75 $108.90 $137.50 $110.00 $89.38 $137.50 N/A $79.75 $137.50 $82.50 $137.50 $137.50 $137.50 N/A N/A 50-712-04-09 SUP HCPCS C1713 50-712-04-09 - PLATE BONE 28MM 4 HOLE LOCKING FRAC TITANIUM MANDIB STERILE BOTH IP/OP $933.00 $690.00 $185.16 $932.93 $419.82 $419.82 $419.82 $419.82 $932.93 $932.93 $932.93 $194.45 $932.93 $932.93 $932.93 $932.93 $932.93 $194.43 $932.93 $373.17 $551.83 $932.93 $932.93 $932.93 $932.93 $699.75 $932.93 $932.93 $932.93 $466.47 $466.47 $738.88 $932.93 $746.34 $419.82 $185.16 N/A $541.14 $932.93 $559.76 $932.93 $194.42 $932.93 N/A N/A 5071-35 SUP HCPCS C1898 5071-35 - LEAD PCNG 6.6FR 35CM IS-1 UNPLR FX SCR SIL MYOCARDIUM BOTH IP/OP $992.50 $734.00 $206.85 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $206.85 $992.50 $397.00 $992.50 $992.50 $992.50 $992.50 $992.50 $744.38 $992.50 $992.50 $992.50 $496.25 $496.25 $786.06 $992.50 $794.00 $446.63 $992.50 N/A $575.65 $992.50 $595.50 $992.50 $992.50 $992.50 N/A N/A 50-714-04-09 SUP HCPCS C1713 50-714-04-09 - PLATE BONE 33MM 4 HOLE FRAC TITANIUM MANDIB STERILE BOTH IP/OP $975.00 $722.00 $193.46 $974.73 $438.63 $438.63 $438.63 $438.63 $974.73 $974.73 $974.73 $203.16 $974.73 $974.73 $974.73 $974.73 $974.73 $203.14 $974.73 $389.89 $576.55 $974.73 $974.73 $974.73 $974.73 $731.25 $974.73 $974.73 $974.73 $487.37 $487.37 $771.99 $974.73 $779.78 $438.63 $193.46 N/A $565.50 $974.73 $584.84 $974.73 $203.13 $974.73 N/A N/A 50-716-06-09 SUP HCPCS C1713 50-716-06-09 - PLATE BONE 16MMX1.5IN 6 HOLE FRAC TITANIUM MANDIB BOTH IP/OP "$1,128.00" $835.00 $223.86 "$1,127.88" $507.55 $507.55 $507.55 $507.55 "$1,127.88" "$1,127.88" "$1,127.88" $235.08 "$1,127.88" "$1,127.88" "$1,127.88" "$1,127.88" "$1,127.88" $235.06 "$1,127.88" $451.15 $667.14 "$1,127.88" "$1,127.88" "$1,127.88" "$1,127.88" $846.00 "$1,127.88" "$1,127.88" "$1,127.88" $563.94 $563.94 $893.28 "$1,127.88" $902.30 $507.55 $223.86 N/A $654.24 "$1,127.88" $676.73 "$1,127.88" $235.05 "$1,127.88" N/A N/A 50-722-12-09 SUP HCPCS C1713 50-722-12-09 - PLATE BONE 1.5IN 2X6 HOLE LOCKING FRAC TITANIUM MANDIB BOTH IP/OP "$1,072.50" $794.00 $212.80 "$1,072.18" $482.48 $482.48 $482.48 $482.48 "$1,072.18" "$1,072.18" "$1,072.18" $223.47 "$1,072.18" "$1,072.18" "$1,072.18" "$1,072.18" "$1,072.18" $223.45 "$1,072.18" "$1,072.18" $634.19 "$1,072.18" "$1,072.18" "$1,072.18" "$1,072.18" $804.38 "$1,072.18" "$1,072.18" "$1,072.18" $536.09 $536.09 $849.17 "$1,072.18" $857.74 $482.48 $212.80 N/A $622.05 "$1,072.18" $643.31 "$1,072.18" $223.44 "$1,072.18" N/A N/A 50-723-12-09 SUP HCPCS C1713 50-723-12-09 - PLATE BONE MINI CVD 1MM 12 HOLE LOCKING THREADLOCK TITANIUM BOTH IP/OP "$1,100.50" $814.00 $218.33 "$1,100.03" $495.01 $495.01 $495.01 $495.01 "$1,100.03" "$1,100.03" "$1,100.03" $229.27 "$1,100.03" "$1,100.03" "$1,100.03" "$1,100.03" "$1,100.03" $229.26 "$1,100.03" "$1,100.03" $650.67 "$1,100.03" "$1,100.03" "$1,100.03" "$1,100.03" $825.38 "$1,100.03" "$1,100.03" "$1,100.03" $550.02 $550.02 $871.22 "$1,100.03" $880.02 $495.01 $218.33 N/A $638.29 "$1,100.03" "$1,100.03" "$1,100.03" $229.25 "$1,100.03" N/A N/A 50-730-04-09 SUP HCPCS C1713 50-730-04-09 - PLATE BONE CVD SHORT 1.5MM LOCKING FRAC TITANIUM MANDIB BOTH IP/OP "$1,281.50" $948.00 $254.25 "$1,281.03" $576.46 $576.46 $576.46 $576.46 "$1,281.03" "$1,281.03" "$1,281.03" $267.00 "$1,281.03" "$1,281.03" "$1,281.03" "$1,281.03" "$1,281.03" $266.98 "$1,281.03" $512.41 $757.73 "$1,281.03" "$1,281.03" "$1,281.03" "$1,281.03" $961.13 "$1,281.03" "$1,281.03" "$1,281.03" $640.52 $640.52 "$1,014.58" "$1,281.03" "$1,024.82" $576.46 $254.25 N/A $743.27 "$1,281.03" $768.62 "$1,281.03" $266.97 "$1,281.03" N/A N/A 50-730-06-09 SUP HCPCS C1713 50-730-06-09 - PLATE BONE CVD MEDIUM 1MM 6 HOLE LOCKING FRAC TITANIUM BOTH IP/OP $877.50 $649.00 $174.11 $877.23 $394.75 $394.75 $394.75 $394.75 $877.23 $877.23 $877.23 $182.84 $877.23 $877.23 $877.23 $877.23 $877.23 $182.82 $877.23 $350.89 $518.88 $877.23 $877.23 $877.23 $877.23 $658.13 $877.23 $877.23 $877.23 $438.62 $438.62 $694.77 $877.23 $701.78 $394.75 $174.11 N/A $508.95 $877.23 $526.34 $877.23 $182.81 $877.23 N/A N/A 50-731-06-09 SUP HCPCS C1713 50-731-06-09 - PLATE BN CRV LNG 1MM THREADLOCK TS 6 HL LCK TI MNDB 2MM SCR BOTH IP/OP $877.50 $649.00 $174.11 $877.23 $394.75 $394.75 $394.75 $394.75 $877.23 $877.23 $877.23 $182.84 $877.23 $877.23 $877.23 $877.23 $877.23 $182.82 $877.23 $350.89 $518.88 $877.23 $877.23 $877.23 $877.23 $658.13 $877.23 $877.23 $877.23 $438.62 $438.62 $694.77 $877.23 $701.78 $394.75 $174.11 N/A $508.95 $877.23 $526.34 $877.23 $182.81 $877.23 N/A N/A 50-732-04-09 SUP HCPCS C1713 50-732-04-09 - PLATE BONE CVD LONG 1.5MM 6 HOLE LOCKING FRAC TITANIUM BOTH IP/OP "$1,281.50" $948.00 $254.25 "$1,281.03" $576.46 $576.46 $576.46 $576.46 "$1,281.03" "$1,281.03" "$1,281.03" $267.00 "$1,281.03" "$1,281.03" "$1,281.03" "$1,281.03" "$1,281.03" $266.98 "$1,281.03" "$1,281.03" $757.73 "$1,281.03" "$1,281.03" "$1,281.03" "$1,281.03" $961.13 "$1,281.03" "$1,281.03" "$1,281.03" $640.52 $640.52 "$1,014.58" "$1,281.03" "$1,024.82" $576.46 $254.25 N/A $743.27 "$1,281.03" $768.62 "$1,281.03" $266.97 "$1,281.03" N/A N/A 50-732-06-09 SUP HCPCS C1713 50-732-06-09 - PLATE BONE CVD XLONG 1MM 6 HOLE LOCKING FRAC TITANIUM MANDIB BOTH IP/OP $877.50 $649.00 $174.11 $877.23 $394.75 $394.75 $394.75 $394.75 $877.23 $877.23 $877.23 $182.84 $877.23 $877.23 $877.23 $877.23 $877.23 $182.82 $877.23 $877.23 $518.88 $877.23 $877.23 $877.23 $877.23 $658.13 $877.23 $877.23 $877.23 $438.62 $438.62 $694.77 $877.23 $701.78 $394.75 $174.11 N/A $508.95 $877.23 $877.23 $877.23 $182.81 $877.23 N/A N/A 50-746-22-09 SUP HCPCS C1713 50-746-22-09 - PLATE SM 2.8MM SMRT BONE RIGHT BOTH IP/OP "$7,532.00" "$5,574.00" "$1,494.89" "$7,531.88" "$3,389.35" "$3,389.35" "$3,389.35" "$3,389.35" "$7,531.88" "$7,531.88" "$7,531.88" "$1,569.83" "$7,531.88" "$7,531.88" "$7,531.88" "$7,531.88" "$7,531.88" "$1,569.73" "$7,531.88" "$3,012.75" "$3,713.22" "$7,531.88" "$7,531.88" "$7,531.88" "$7,531.88" "$5,649.00" "$7,531.88" "$7,531.88" "$7,531.88" "$3,765.94" "$3,765.94" "$5,965.25" "$7,531.88" "$6,025.50" "$3,389.35" "$1,494.89" N/A "$4,368.56" "$7,531.88" "$4,519.13" "$7,531.88" "$1,569.64" "$7,531.88" N/A N/A 50-747-22-09 SUP HCPCS C1713 50-747-22-09 - PLATE BN SM 2.8MM SMRT LT BOTH IP/OP "$7,532.00" "$5,574.00" "$1,494.89" "$7,531.88" "$3,389.35" "$3,389.35" "$3,389.35" "$3,389.35" "$7,531.88" "$7,531.88" "$7,531.88" "$1,569.83" "$7,531.88" "$7,531.88" "$7,531.88" "$7,531.88" "$7,531.88" "$1,569.73" "$7,531.88" "$3,012.75" "$3,713.22" "$7,531.88" "$7,531.88" "$7,531.88" "$7,531.88" "$5,649.00" "$7,531.88" "$7,531.88" "$7,531.88" "$3,765.94" "$3,765.94" "$5,965.25" "$7,531.88" "$6,025.50" "$3,389.35" "$1,494.89" N/A "$4,368.56" "$7,531.88" "$4,519.13" "$7,531.88" "$1,569.64" "$7,531.88" N/A N/A 50-750-06-09 SUP HCPCS C1713 50-750-06-09 - PLATE BONE ANGLED 1.5MM 3X3 HOLE LOCKING FRAC TITANIUM BOTH IP/OP "$1,782.50" "$1,319.00" $353.74 "$1,782.30" $802.04 $802.04 $802.04 $802.04 "$1,782.30" "$1,782.30" "$1,782.30" $371.48 "$1,782.30" "$1,782.30" "$1,782.30" "$1,782.30" "$1,782.30" $371.45 "$1,782.30" $712.92 "$1,054.23" "$1,782.30" "$1,782.30" "$1,782.30" "$1,782.30" "$1,336.88" "$1,782.30" "$1,782.30" "$1,782.30" $891.15 $891.15 "$1,411.58" "$1,782.30" "$1,425.84" $802.04 $353.74 N/A "$1,033.85" "$1,782.30" "$1,069.38" "$1,782.30" $371.43 "$1,782.30" N/A N/A 50-750-08-09 SUP HCPCS C1713 50-750-08-09 - PLATE BONE ANGLED 1.5MM 4X4 HOLE LOCKING FRAC TITANIUM BOTH IP/OP "$1,810.50" "$1,340.00" $359.28 "$1,810.18" $814.58 $814.58 $814.58 $814.58 "$1,810.18" "$1,810.18" "$1,810.18" $377.29 "$1,810.18" "$1,810.18" "$1,810.18" "$1,810.18" "$1,810.18" $377.26 "$1,810.18" $724.07 "$1,070.72" "$1,810.18" "$1,810.18" "$1,810.18" "$1,810.18" "$1,357.88" "$1,810.18" "$1,810.18" "$1,810.18" $905.09 $905.09 "$1,433.66" "$1,810.18" "$1,448.14" $814.58 $359.28 N/A "$1,050.09" "$1,810.18" "$1,086.11" "$1,810.18" $377.24 "$1,810.18" N/A N/A 50-754-05-09 SUP HCPCS C1713 50-754-05-09 - PLATE BN MN LNG 110MM THREADLOCK TS LVL 1 4 HL LCK BAR TI BOTH IP/OP $855.00 $633.00 $169.69 $854.95 $384.73 $384.73 $384.73 $384.73 $854.95 $854.95 $854.95 $178.19 $854.95 $854.95 $854.95 $854.95 $854.95 $178.18 $854.95 $854.95 $505.70 $854.95 $854.95 $854.95 $854.95 $641.25 $854.95 $854.95 $854.95 $427.48 $427.48 $677.12 $854.95 $683.96 $384.73 $169.69 N/A $495.90 $854.95 $512.97 $854.95 $178.17 $854.95 N/A N/A 50-754-07-09 SUP HCPCS C1713 50-754-07-09 - PLATE BN 110D MN LNG L LVL 1 4 HL LCK BAR CRNL BOTH IP/OP $855.00 $633.00 $169.69 $854.95 $384.73 $384.73 $384.73 $384.73 $854.95 $854.95 $854.95 $178.19 $854.95 $854.95 $854.95 $854.95 $854.95 $178.18 $854.95 $854.95 $505.70 $854.95 $854.95 $854.95 $854.95 $641.25 $854.95 $854.95 $854.95 $427.48 $427.48 $677.12 $854.95 $683.96 $384.73 $169.69 N/A $495.90 $854.95 $854.95 $854.95 $178.17 $854.95 N/A N/A 50-754-26-09 SUP HCPCS C1713 50-754-26-09 - PLATE SMART TS LOCKING 2.0MM MAND RECON ANG RT TI 26 HOLE BOTH IP/OP "$6,815.00" "$5,043.00" "$1,352.52" "$6,814.55" "$3,066.55" "$3,066.55" "$3,066.55" "$3,066.55" "$6,814.55" "$6,814.55" "$6,814.55" "$1,420.32" "$6,814.55" "$6,814.55" "$6,814.55" "$6,814.55" "$6,814.55" "$1,420.23" "$6,814.55" "$2,725.82" "$3,359.57" "$6,814.55" "$6,814.55" "$6,814.55" "$6,814.55" "$5,111.25" "$6,814.55" "$6,814.55" "$6,814.55" "$3,407.28" "$3,407.28" "$5,397.12" "$6,814.55" "$5,451.64" "$3,066.55" "$1,352.52" N/A "$3,952.70" "$6,814.55" "$6,814.55" "$6,814.55" "$1,420.15" "$6,814.55" N/A N/A 50-760-12-09 SUP HCPCS C1713 50-760-12-09 - PLATE BONE STR 2.5MM LOCK 12 HOLE TITANIUM BOTH IP/OP "$2,796.00" "$2,069.00" $554.94 "$2,796.00" "$1,258.20" "$1,258.20" "$1,258.20" "$1,258.20" "$2,796.00" "$2,796.00" "$2,796.00" $582.76 "$2,796.00" "$2,796.00" "$2,796.00" "$2,796.00" "$2,796.00" $582.72 "$2,796.00" "$2,796.00" "$1,378.43" "$2,796.00" "$2,796.00" "$2,796.00" "$2,796.00" "$2,097.00" "$2,796.00" "$2,796.00" "$2,796.00" "$1,398.00" "$1,398.00" "$2,214.43" "$2,796.00" "$2,236.80" "$1,258.20" $554.94 N/A "$1,621.68" "$2,796.00" "$1,677.60" "$2,796.00" $582.69 "$2,796.00" N/A N/A 50-760-20-09 SUP HCPCS C1713 50-760-20-09 - PLATE BN STRG 2.5MM 20 HL LCK TI BOTH IP/OP "$4,074.50" "$3,015.00" $808.64 "$4,074.25" "$1,833.41" "$1,833.41" "$1,833.41" "$1,833.41" "$4,074.25" "$4,074.25" "$4,074.25" $849.18 "$4,074.25" "$4,074.25" "$4,074.25" "$4,074.25" "$4,074.25" $849.12 "$4,074.25" "$4,074.25" "$2,008.61" "$4,074.25" "$4,074.25" "$4,074.25" "$4,074.25" "$3,055.88" "$4,074.25" "$4,074.25" "$4,074.25" "$2,037.13" "$2,037.13" "$3,226.81" "$4,074.25" "$3,259.40" "$1,833.41" $808.64 N/A "$2,363.21" "$4,074.25" "$2,444.55" "$4,074.25" $849.07 "$4,074.25" N/A N/A 50-764-04-09 SUP HCPCS C1713 50-764-04-09 - LOCKING FRACTURE PLATE 4 HOLE 33MM NON-COMPRESSION 2.0MM BOTH IP/OP "$1,242.00" $919.00 $246.46 "$1,241.75" $558.79 $558.79 $558.79 $558.79 "$1,241.75" "$1,241.75" "$1,241.75" $258.81 "$1,241.75" "$1,241.75" "$1,241.75" "$1,241.75" "$1,241.75" $258.79 "$1,241.75" "$1,241.75" $734.50 "$1,241.75" "$1,241.75" "$1,241.75" "$1,241.75" $931.50 "$1,241.75" "$1,241.75" "$1,241.75" $620.88 $620.88 $983.47 "$1,241.75" $993.40 $558.79 $246.46 N/A $720.36 "$1,241.75" "$1,241.75" "$1,241.75" $258.78 "$1,241.75" N/A N/A 5076-52 SUP HCPCS C1898 5076-52 - LEAD PACING 10MM SPACE SMALL STR 6.2FR 2MM 52CM 20-110CM BOTH IP/OP $992.50 $734.00 $206.85 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $206.85 $992.50 $350.00 $992.50 $992.50 $875.00 $992.50 $992.50 $744.38 $992.50 $992.50 $992.50 $496.25 $496.25 $786.06 $992.50 $794.00 $446.63 $992.50 N/A $575.65 $992.50 $595.50 $992.50 $992.50 $992.50 N/A N/A 5076-58 SUP HCPCS C1898 5076-58 - LEAD PACING 10MM SPACE SMALL STR 6.2FR 2MM 58CM 20-110CM BOTH IP/OP $992.50 $734.00 $206.85 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $992.50 $206.85 $992.50 $350.00 $992.50 $992.50 $875.00 $992.50 $992.50 $744.38 $992.50 $992.50 $992.50 $496.25 $496.25 $786.06 $992.50 $794.00 $446.63 $992.50 N/A $575.65 $992.50 $595.50 $992.50 $992.50 $992.50 N/A N/A 50-766-06-09 SUP HCPCS C1713 50-766-06-09 - PLATE BN 43MMX2MM NS LVL 1 6 HL LCK TI CRNMXF 2MM SCR BOTH IP/OP "$1,242.00" $919.00 $246.46 "$1,241.75" $558.79 $558.79 $558.79 $558.79 "$1,241.75" "$1,241.75" "$1,241.75" $258.81 "$1,241.75" "$1,241.75" "$1,241.75" "$1,241.75" "$1,241.75" $258.79 "$1,241.75" $496.70 $734.50 "$1,241.75" "$1,241.75" "$1,241.75" "$1,241.75" $931.50 "$1,241.75" "$1,241.75" "$1,241.75" $620.88 $620.88 $983.47 "$1,241.75" $993.40 $558.79 $246.46 N/A $720.36 "$1,241.75" "$1,241.75" "$1,241.75" $258.78 "$1,241.75" N/A N/A 50-771-26-09 SUP HCPCS C1713 50-771-26-09 - PLATE BONE PREBENT ANGLED 2MM 26 HOLE RECONSTRUCTION LOCKING BOTH IP/OP "$3,551.00" "$2,628.00" $704.73 "$3,550.70" "$1,597.82" "$1,597.82" "$1,597.82" "$1,597.82" "$3,550.70" "$3,550.70" "$3,550.70" $740.05 "$3,550.70" "$3,550.70" "$3,550.70" "$3,550.70" "$3,550.70" $740.00 "$3,550.70" "$1,420.28" "$1,750.50" "$3,550.70" "$3,550.70" "$3,550.70" "$3,550.70" "$2,663.25" "$3,550.70" "$3,550.70" "$3,550.70" "$1,775.35" "$1,775.35" "$2,812.15" "$3,550.70" "$2,840.56" "$1,597.82" $704.73 N/A "$2,059.58" "$3,550.70" "$2,130.42" "$3,550.70" $739.97 "$3,550.70" N/A N/A 50-773-26-09 SUP HCPCS C1713 50-773-26-09 - PLATE BONE PREBENT ANGLED 2MM 26 HOLE RECONSTRUCTION LOCKING BOTH IP/OP "$3,551.00" "$2,628.00" $704.73 "$3,550.70" "$1,597.82" "$1,597.82" "$1,597.82" "$1,597.82" "$3,550.70" "$3,550.70" "$3,550.70" $740.05 "$3,550.70" "$3,550.70" "$3,550.70" "$3,550.70" "$3,550.70" $740.00 "$3,550.70" "$3,550.70" "$1,750.50" "$3,550.70" "$3,550.70" "$3,550.70" "$3,550.70" "$2,663.25" "$3,550.70" "$3,550.70" "$3,550.70" "$1,775.35" "$1,775.35" "$2,812.15" "$3,550.70" "$2,840.56" "$1,597.82" $704.73 N/A "$2,059.58" "$3,550.70" "$3,550.70" "$3,550.70" $739.97 "$3,550.70" N/A N/A 50-774-20-09 SUP HCPCS C1713 50-774-20-09 - PLATE BN STRG 2MM THREADLOCK TS 20 HL RECON BRDG LCK TI MNDB BOTH IP/OP "$2,186.50" "$1,618.00" $433.89 "$2,186.13" $983.76 $983.76 $983.76 $983.76 "$2,186.13" "$2,186.13" "$2,186.13" $455.64 "$2,186.13" "$2,186.13" "$2,186.13" "$2,186.13" "$2,186.13" $455.61 "$2,186.13" "$2,186.13" "$1,293.10" "$2,186.13" "$2,186.13" "$2,186.13" "$2,186.13" "$1,639.88" "$2,186.13" "$2,186.13" "$2,186.13" "$1,093.07" "$1,093.07" "$1,731.41" "$2,186.13" "$1,748.90" $983.76 $433.89 N/A "$1,268.17" "$2,186.13" "$2,186.13" "$2,186.13" $455.59 "$2,186.13" N/A N/A 50-775-26-09 SUP HCPCS C1713 50-775-26-09 - PLATE BONE 2MM 26 HOLE PRIM RECONSTRUCTION THREADLOCK GREEN BOTH IP/OP "$3,481.50" "$2,576.00" $690.91 "$3,481.10" "$1,566.50" "$1,566.50" "$1,566.50" "$1,566.50" "$3,481.10" "$3,481.10" "$3,481.10" $725.55 "$3,481.10" "$3,481.10" "$3,481.10" "$3,481.10" "$3,481.10" $725.50 "$3,481.10" "$3,481.10" "$1,716.18" "$3,481.10" "$3,481.10" "$3,481.10" "$3,481.10" "$2,611.13" "$3,481.10" "$3,481.10" "$3,481.10" "$1,740.55" "$1,740.55" "$2,757.03" "$3,481.10" "$2,784.88" "$1,566.50" $690.91 N/A "$2,019.27" "$3,481.10" "$3,481.10" "$3,481.10" $725.46 "$3,481.10" N/A N/A 50-777-26-09 SUP HCPCS C1713 50-777-26-09 - PLATE BONE LEFT ANGLE 2MM 26 HOLE LOCKING RECONSTRUCTION BOTH IP/OP "$3,481.50" "$2,576.00" $690.91 "$3,481.10" "$1,566.50" "$1,566.50" "$1,566.50" "$1,566.50" "$3,481.10" "$3,481.10" "$3,481.10" $725.55 "$3,481.10" "$3,481.10" "$3,481.10" "$3,481.10" "$3,481.10" $725.50 "$3,481.10" "$3,481.10" "$1,716.18" "$3,481.10" "$3,481.10" "$3,481.10" "$3,481.10" "$2,611.13" "$3,481.10" "$3,481.10" "$3,481.10" "$1,740.55" "$1,740.55" "$2,757.03" "$3,481.10" "$2,784.88" "$1,566.50" $690.91 N/A "$2,019.27" "$3,481.10" "$3,481.10" "$3,481.10" $725.46 "$3,481.10" N/A N/A 50-781-76-09 SUP HCPCS C1713 50-781-76-09 - TEMPLATE SIZING PREBENT 26 HOLE RECONSTRUCTION LOCKING BOTH IP/OP $139.50 $103.00 $27.64 $139.25 $62.66 $62.66 $62.66 $62.66 $139.25 $139.25 $139.25 $29.02 $139.25 $139.25 $139.25 $139.25 $139.25 $29.02 $139.25 $139.25 $82.37 $139.25 $139.25 $139.25 $139.25 $104.63 $139.25 $139.25 $139.25 $69.63 $69.63 $110.29 $139.25 $111.40 $62.66 $27.64 N/A $80.91 $139.25 $139.25 $139.25 $29.02 $139.25 N/A N/A 50-784-70-09 SUP HCPCS C1713 50-784-70-09 - TEMPLATE BNDRG 20MMX2.3MM LCK PLT BOTH IP/OP $139.50 $103.00 $27.64 $139.25 $62.66 $62.66 $62.66 $62.66 $139.25 $139.25 $139.25 $29.02 $139.25 $139.25 $139.25 $139.25 $139.25 $29.02 $139.25 $139.25 $82.37 $139.25 $139.25 $139.25 $139.25 $104.63 $139.25 $139.25 $139.25 $69.63 $69.63 $110.29 $139.25 $111.40 $62.66 $27.64 N/A $80.91 $139.25 $139.25 $139.25 $29.02 $139.25 N/A N/A 50-785-76-09 SUP HCPCS C1713 50-785-76-09 - TEMPLATE BENDING 26 HOLE PRIM PLATE RECONSTRUCTION TITANIUM BOTH IP/OP $139.50 $103.00 $27.64 $139.25 $62.66 $62.66 $62.66 $62.66 $139.25 $139.25 $139.25 $29.02 $139.25 $139.25 $139.25 $139.25 $139.25 $29.02 $139.25 $55.70 $82.37 $139.25 $139.25 $139.25 $139.25 $104.63 $139.25 $139.25 $139.25 $69.63 $69.63 $110.29 $139.25 $111.40 $62.66 $27.64 N/A $80.91 $139.25 $139.25 $139.25 $29.02 $139.25 N/A N/A 50-790-06-09 SUP HCPCS C1713 50-790-06-09 - PLATE BN 155D 3MM GRN NS THREADLOCK TS 6 HL RECON CX TI MNDB BOTH IP/OP "$2,339.50" "$1,731.00" $464.29 "$2,339.28" "$1,052.68" "$1,052.68" "$1,052.68" "$1,052.68" "$2,339.28" "$2,339.28" "$2,339.28" $487.56 "$2,339.28" "$2,339.28" "$2,339.28" "$2,339.28" "$2,339.28" $487.53 "$2,339.28" $935.71 "$1,383.68" "$2,339.28" "$2,339.28" "$2,339.28" "$2,339.28" "$1,754.63" "$2,339.28" "$2,339.28" "$2,339.28" "$1,169.64" "$1,169.64" "$1,852.71" "$2,339.28" "$1,871.42" "$1,052.68" $464.29 N/A "$1,356.91" "$2,339.28" "$2,339.28" "$2,339.28" $487.51 "$2,339.28" N/A N/A 5079-1-010 SUP Custom 27203010 5079-1-010 - CLAMP EXFIX MINI SWIVEL HOFFMANN II STAINLESS STEEL BOTH IP/OP "$1,339.50" $991.00 $238.43 "$1,339.50" "$1,339.50" "$1,339.50" "$1,339.50" "$1,339.50" "$1,339.50" "$1,339.50" $238.43 "$1,339.50" "$1,339.50" $994.18 $994.18 "$1,032.49" $697.88 $279.17 "$1,339.50" $535.80 "$1,339.50" "$1,339.50" "$1,339.50" "$1,339.50" "$1,339.50" "$1,004.63" "$1,339.50" "$1,339.50" "$1,339.50" $669.75 $669.75 "$1,060.88" "$1,339.50" "$1,071.60" $870.68 "$1,339.50" N/A $776.91 "$1,339.50" $803.70 "$1,339.50" "$1,339.50" "$1,339.50" N/A N/A 5079-1-020 SUP Custom 27203010 5079-1-020 - CLAMP EXFIX MINI 20MM SIMPLE HOFFMANN HM20 BOTH IP/OP $970.50 $718.00 $172.75 $970.50 $970.50 $970.50 $970.50 $970.50 $970.50 $970.50 $172.75 $970.50 $970.50 $720.31 $720.31 $748.06 $505.63 $202.26 $970.50 $388.20 $970.50 $970.50 $970.50 $970.50 $970.50 $727.88 $970.50 $970.50 $970.50 $485.25 $485.25 $768.64 $970.50 $776.40 $630.83 $970.50 N/A $562.89 $970.50 $582.30 $970.50 $970.50 $970.50 N/A N/A 50-791-26-09 SUP HCPCS C1713 50-791-26-09 - PLATE BONE RIGHT ANG 3MM 26 HOLE RECONSTRUCTION TITANIUM BOTH IP/OP "$4,177.50" "$3,091.00" $829.09 "$4,177.30" "$1,879.79" "$1,879.79" "$1,879.79" "$1,879.79" "$4,177.30" "$4,177.30" "$4,177.30" $870.65 "$4,177.30" "$4,177.30" "$4,177.30" "$4,177.30" "$4,177.30" $870.60 "$4,177.30" "$4,177.30" "$2,059.41" "$4,177.30" "$4,177.30" "$4,177.30" "$4,177.30" "$3,133.13" "$4,177.30" "$4,177.30" "$4,177.30" "$2,088.65" "$2,088.65" "$3,308.42" "$4,177.30" "$3,341.84" "$1,879.79" $829.09 N/A "$2,422.95" "$4,177.30" "$4,177.30" "$4,177.30" $870.55 "$4,177.30" N/A N/A 50-791-76-09 SUP HCPCS C1713 50-791-76-09 - TEMPLATE BENDING PREBENT 26 HOLE THREADLOCK TITANIUM MANDIB BOTH IP/OP $139.50 $103.00 $27.64 $139.25 $62.66 $62.66 $62.66 $62.66 $139.25 $139.25 $139.25 $29.02 $139.25 $139.25 $139.25 $139.25 $139.25 $29.02 $139.25 $139.25 $82.37 $139.25 $139.25 $139.25 $139.25 $104.63 $139.25 $139.25 $139.25 $69.63 $69.63 $110.29 $139.25 $111.40 $62.66 $27.64 N/A $80.91 $139.25 $139.25 $139.25 $29.02 $139.25 N/A N/A 5079-2-031 SUP Custom 27203010 5079-2-031 - FIXATOR EXFIX MINI 31MM INSULATED VISE HOFFMANN HIP BOTH IP/OP $265.00 $196.00 $47.13 $264.75 $264.75 $264.75 $264.75 $264.75 $264.75 $264.75 $47.13 $264.75 $264.75 $196.50 $196.50 $204.07 $137.93 $55.18 $264.75 $105.90 $264.75 $264.75 $264.75 $264.75 $264.75 $198.75 $264.75 $264.75 $264.75 $132.38 $132.38 $209.68 $264.75 $211.80 $172.09 $264.75 N/A $153.70 $264.75 $158.85 $264.75 $264.75 $264.75 N/A N/A 5079-2-032 SUP Custom 27203010 5079-2-032 - PIN XTRNFX 32MM MN HFMN INSL BOTH IP/OP $176.00 $130.00 $31.33 $176.00 $176.00 $176.00 $176.00 $176.00 $176.00 $176.00 $31.33 $176.00 $176.00 $130.63 $130.63 $135.66 $91.70 $36.68 $176.00 $70.40 $176.00 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $114.40 $176.00 N/A $102.08 $176.00 $105.60 $176.00 $176.00 $176.00 N/A N/A 5079-2-034 SUP Custom 27203010 5079-2-034 - FIXATOR XTRNFX MN HFMN2 INSL BOTH IP/OP $179.00 $132.00 $31.82 $178.75 $178.75 $178.75 $178.75 $178.75 $178.75 $178.75 $31.82 $178.75 $178.75 $132.67 $132.67 $137.78 $93.13 $37.25 $178.75 $71.50 $178.75 $178.75 $178.75 $178.75 $178.75 $134.25 $178.75 $178.75 $178.75 $89.38 $89.38 $141.57 $178.75 $143.00 $116.19 $178.75 N/A $103.82 $178.75 $107.25 $178.75 $178.75 $178.75 N/A N/A 5079-2-035 SUP Custom 27203010 5079-2-035 - VISE XTRNFX 35MM HFMN2 ROD 3 HL MDLR HM BOTH IP/OP $394.00 $292.00 $70.09 $393.75 $393.75 $393.75 $393.75 $393.75 $393.75 $393.75 $70.09 $393.75 $393.75 $292.24 $292.24 $303.50 $205.14 $82.06 $393.75 $157.50 $393.75 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $255.94 $393.75 N/A $228.52 $393.75 $236.25 $393.75 $393.75 $393.75 N/A N/A 5079-2-036 SUP Custom 27203010 5079-2-036 - FIXATOR EXFIX 3MM MINI 36MM 2 ROD 3 HOLE MODULAR HOFFMANN BOTH IP/OP $378.50 $280.00 $67.31 $378.13 $378.13 $378.13 $378.13 $378.13 $378.13 $378.13 $67.31 $378.13 $378.13 $280.65 $280.65 $291.46 $197.01 $78.81 $378.13 $151.25 $378.13 $378.13 $378.13 $378.13 $378.13 $283.88 $378.13 $378.13 $378.13 $189.07 $189.07 $299.48 $378.13 $302.50 $245.78 $378.13 N/A $219.53 $378.13 $226.88 $378.13 $378.13 $378.13 N/A N/A 50-792-06-09 SUP HCPCS C1713 50-792-06-09 - PLATE BONE 120D 3MM 6 HOLE RECONSTRUCTION THREADLOCK GREEN BOTH IP/OP "$2,339.50" "$1,731.00" $464.29 "$2,339.28" "$1,052.68" "$1,052.68" "$1,052.68" "$1,052.68" "$2,339.28" "$2,339.28" "$2,339.28" $487.56 "$2,339.28" "$2,339.28" "$2,339.28" "$2,339.28" "$2,339.28" $487.53 "$2,339.28" $935.71 "$1,383.68" "$2,339.28" "$2,339.28" "$2,339.28" "$2,339.28" "$1,754.63" "$2,339.28" "$2,339.28" "$2,339.28" "$1,169.64" "$1,169.64" "$1,852.71" "$2,339.28" "$1,871.42" "$1,052.68" $464.29 N/A "$1,356.91" "$2,339.28" "$2,339.28" "$2,339.28" $487.51 "$2,339.28" N/A N/A 50-792-08-09 SUP HCPCS C1713 50-792-08-09 - PLATE BONE 120D 3MM 8 HOLE RECONSTRUCTION THREADLOCK GREEN BOTH IP/OP "$2,423.00" "$1,793.00" $480.88 "$2,422.85" "$1,090.28" "$1,090.28" "$1,090.28" "$1,090.28" "$2,422.85" "$2,422.85" "$2,422.85" $504.98 "$2,422.85" "$2,422.85" "$2,422.85" "$2,422.85" "$2,422.85" $504.95 "$2,422.85" "$2,422.85" "$1,433.12" "$2,422.85" "$2,422.85" "$2,422.85" "$2,422.85" "$1,817.25" "$2,422.85" "$2,422.85" "$2,422.85" "$1,211.43" "$1,211.43" "$1,918.90" "$2,422.85" "$1,938.28" "$1,090.28" $480.88 N/A "$1,405.34" "$2,422.85" "$2,422.85" "$2,422.85" $504.92 "$2,422.85" N/A N/A 5079-2-113 SUP Custom 27203010 5079-2-113 - COUPLING EXFIX 13MM 3X3MM LOCKABLE HOFFMANN BOTH IP/OP $787.50 $583.00 $140.18 $787.50 $787.50 $787.50 $787.50 $787.50 $787.50 $787.50 $140.18 $787.50 $787.50 $584.48 $584.48 $607.01 $410.29 $164.12 $787.50 $315.00 $787.50 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $511.88 $787.50 N/A $456.75 $787.50 $472.50 $787.50 $787.50 $787.50 N/A N/A 5079-2-123 SUP Custom 27203010 5079-2-123 - COUPLING XTRNFX 2MM MN 3MM HFMN ARTC CPL BOTH IP/OP $797.50 $590.00 $141.96 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $797.50 $141.96 $797.50 $797.50 $591.90 $591.90 $614.71 $415.50 $166.21 $797.50 $319.00 $797.50 $797.50 $797.50 $797.50 $797.50 $598.13 $797.50 $797.50 $797.50 $398.75 $398.75 $631.62 $797.50 $638.00 $518.38 $797.50 N/A $462.55 $797.50 $478.50 $797.50 $797.50 $797.50 N/A N/A 5079-3-040 SUP Custom 27203010 5079-3-040 - HOLDER IMPLANT STR PIN HOFFMANN II STERILE BOTH IP/OP $273.00 $202.00 $48.59 $273.00 $273.00 $273.00 $273.00 $273.00 $273.00 $273.00 $48.59 $273.00 $273.00 $202.62 $202.62 $210.43 $142.23 $56.90 $273.00 $109.20 $273.00 $273.00 $273.00 $273.00 $273.00 $204.75 $273.00 $273.00 $273.00 $136.50 $136.50 $216.22 $273.00 $218.40 $177.45 $273.00 N/A $158.34 $273.00 $163.80 $273.00 $273.00 $273.00 N/A N/A 5079-3-041 SUP Custom 27203010 5079-3-041 - HOLDER IMPLANT MINI OFFST HOFFMANN 1.5-2MM PIN BOTH IP/OP $337.00 $249.00 $59.96 $336.88 $336.88 $336.88 $336.88 $336.88 $336.88 $336.88 $59.96 $336.88 $336.88 $250.03 $250.03 $259.67 $175.51 $70.21 $336.88 $134.75 $336.88 $336.88 $336.88 $336.88 $336.88 $252.75 $336.88 $336.88 $336.88 $168.44 $168.44 $266.81 $336.88 $269.50 $218.97 $336.88 N/A $195.46 $336.88 $202.13 $336.88 $336.88 $336.88 N/A N/A 5079-3-042 SUP Custom 27203010 5079-3-042 - HOLDER IMPLANT MINI STR OFFST PIN HOFFMANN II BOTH IP/OP $337.00 $249.00 $59.96 $336.88 $336.88 $336.88 $336.88 $336.88 $336.88 $336.88 $59.96 $336.88 $336.88 $250.03 $250.03 $259.67 $175.51 $70.21 $336.88 $134.75 $336.88 $336.88 $336.88 $336.88 $336.88 $252.75 $336.88 $336.88 $336.88 $168.44 $168.44 $266.81 $336.88 $269.50 $218.97 $336.88 N/A $195.46 $336.88 $202.13 $336.88 $336.88 $336.88 N/A N/A 50-793-26-09 SUP HCPCS C1713 50-793-26-09 - PLATE BONE PREBENT ANGLED 3MM 26 HOLE RECONSTRUCTION LOCKING BOTH IP/OP "$4,177.50" "$3,091.00" $829.09 "$4,177.30" "$1,879.79" "$1,879.79" "$1,879.79" "$1,879.79" "$4,177.30" "$4,177.30" "$4,177.30" $870.65 "$4,177.30" "$4,177.30" "$4,177.30" "$4,177.30" "$4,177.30" $870.60 "$4,177.30" "$4,177.30" "$2,059.41" "$4,177.30" "$4,177.30" "$4,177.30" "$4,177.30" "$3,133.13" "$4,177.30" "$4,177.30" "$4,177.30" "$2,088.65" "$2,088.65" "$3,308.42" "$4,177.30" "$3,341.84" "$1,879.79" $829.09 N/A "$2,422.95" "$4,177.30" "$4,177.30" "$4,177.30" $870.55 "$4,177.30" N/A N/A 5079-3-413 SUP Custom 27203010 5079-3-413 - BURR SURG MINI OFFST 3MM SHANK HOLDER HOFFMANN STERILE BOTH IP/OP $352.00 $260.00 $62.61 $351.75 $351.75 $351.75 $351.75 $351.75 $351.75 $351.75 $62.61 $351.75 $351.75 $261.07 $261.07 $271.13 $183.26 $73.31 $351.75 $140.70 $351.75 $351.75 $351.75 $351.75 $351.75 $264.00 $351.75 $351.75 $351.75 $175.88 $175.88 $278.59 $351.75 $281.40 $228.64 $351.75 N/A $204.16 $351.75 $211.05 $351.75 $351.75 $351.75 N/A N/A 5079-4-012 SUP Custom 27203010 5079-4-012 - FIXATOR EXFIX 2-3MM MINI 12MM LINK PIVOT HOFFMANN BOTH IP/OP $294.00 $218.00 $52.33 $294.00 $294.00 $294.00 $294.00 $294.00 $294.00 $294.00 $52.33 $294.00 $294.00 $218.21 $218.21 $226.62 $153.17 $61.27 $294.00 $117.60 $294.00 $294.00 $294.00 $294.00 $294.00 $220.50 $294.00 $294.00 $294.00 $147.00 $147.00 $232.85 $294.00 $235.20 $191.10 $294.00 N/A $170.52 $294.00 $176.40 $294.00 $294.00 $294.00 N/A N/A 5079-4-050 SUP Custom 27203010 5079-4-050 - SOCKET XTRNFX 4MM MN 5MM HFMN INSL BOTH IP/OP $179.00 $132.00 $31.82 $178.75 $178.75 $178.75 $178.75 $178.75 $178.75 $178.75 $31.82 $178.75 $178.75 $132.67 $132.67 $137.78 $93.13 $37.25 $178.75 $71.50 $178.75 $178.75 $178.75 $178.75 $178.75 $134.25 $178.75 $178.75 $178.75 $89.38 $89.38 $141.57 $178.75 $143.00 $116.19 $178.75 N/A $103.82 $178.75 $107.25 $178.75 $178.75 $178.75 N/A N/A 50-794-20-09 SUP HCPCS C1713 50-794-20-09 - PLATE BONE STR 3MM 20 HOLE RECONSTRUCTION THREADLOCK GREEN BOTH IP/OP "$2,771.00" "$2,051.00" $549.96 "$2,770.93" "$1,246.92" "$1,246.92" "$1,246.92" "$1,246.92" "$2,770.93" "$2,770.93" "$2,770.93" $577.53 "$2,770.93" "$2,770.93" "$2,770.93" "$2,770.93" "$2,770.93" $577.49 "$2,770.93" "$2,770.93" "$1,366.07" "$2,770.93" "$2,770.93" "$2,770.93" "$2,770.93" "$2,078.25" "$2,770.93" "$2,770.93" "$2,770.93" "$1,385.47" "$1,385.47" "$2,194.58" "$2,770.93" "$2,216.74" "$1,246.92" $549.96 N/A "$1,607.18" "$2,770.93" "$2,770.93" "$2,770.93" $577.46 "$2,770.93" N/A N/A 50-794-70-09 SUP HCPCS C1713 50-794-70-09 - TEMPLATE BENDING STR 20 HOLE THREADLOCK TITANIUM BOTH IP/OP $139.50 $103.00 $27.64 $139.25 $62.66 $62.66 $62.66 $62.66 $139.25 $139.25 $139.25 $29.02 $139.25 $139.25 $139.25 $139.25 $139.25 $29.02 $139.25 $139.25 $82.37 $139.25 $139.25 $139.25 $139.25 $104.63 $139.25 $139.25 $139.25 $69.63 $69.63 $110.29 $139.25 $111.40 $62.66 $27.64 N/A $80.91 $139.25 $139.25 $139.25 $29.02 $139.25 N/A N/A 5079-5-030 SUP Custom 27203010 5079-5-030 - ROD EXFIX MICRO 3MM 30MM CONNECT HOFFMANN II STAINLESS STEEL BOTH IP/OP $70.50 $52.00 $12.48 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $12.48 $70.13 $70.13 $52.05 $52.05 $54.06 $36.54 $14.62 $70.13 $28.05 $70.13 $70.13 $70.13 $70.13 $70.13 $52.88 $70.13 $70.13 $70.13 $35.07 $35.07 $55.54 $70.13 $56.10 $45.58 $70.13 N/A $40.89 $70.13 $42.08 $70.13 $70.13 $70.13 N/A N/A 5079-5-040 SUP Custom 27203010 5079-5-040 - ROD EXFIX MICRO 3MM 40MM CONNECT HOFFMANN II STAINLESS STEEL BOTH IP/OP $70.50 $52.00 $12.48 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $12.48 $70.13 $70.13 $52.05 $52.05 $54.06 $36.54 $14.62 $70.13 $28.05 $70.13 $70.13 $70.13 $70.13 $70.13 $52.88 $70.13 $70.13 $70.13 $35.07 $35.07 $55.54 $70.13 $56.10 $45.58 $70.13 N/A $40.89 $70.13 $42.08 $70.13 $70.13 $70.13 N/A N/A 5079-5-050 SUP Custom 27203010 5079-5-050 - ROD EXFIX MICRO 3MM 50MM CONNECT HOFFMANN II STAINLESS STEEL BOTH IP/OP $70.50 $52.00 $12.48 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $12.48 $70.13 $70.13 $52.05 $52.05 $54.06 $36.54 $14.62 $70.13 $28.05 $70.13 $70.13 $70.13 $70.13 $70.13 $52.88 $70.13 $70.13 $70.13 $35.07 $35.07 $55.54 $70.13 $56.10 $45.58 $70.13 N/A $40.89 $70.13 $42.08 $70.13 $70.13 $70.13 N/A N/A 5079-5-060 SUP Custom 27203010 5079-5-060 - ROD EXFIX MICRO 3MM 60MM CONNCTNG HOFFMANN II STAINLESS BOTH IP/OP $68.50 $51.00 $12.15 $68.25 $68.25 $68.25 $68.25 $68.25 $68.25 $68.25 $12.15 $68.25 $68.25 $50.66 $50.66 $52.61 $35.56 $14.22 $68.25 $27.30 $68.25 $68.25 $68.25 $68.25 $68.25 $51.38 $68.25 $68.25 $68.25 $34.13 $34.13 $54.05 $68.25 $54.60 $44.36 $68.25 N/A $39.73 $68.25 $40.95 $68.25 $68.25 $68.25 N/A N/A 5079-5-070 SUP Custom 27203010 5079-5-070 - ROD EXFIX MICRO 3MM 70MM CONNECT HOFFMANN II STAINLESS STEEL BOTH IP/OP $70.50 $52.00 $12.48 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $12.48 $70.13 $70.13 $52.05 $52.05 $54.06 $36.54 $14.62 $70.13 $28.05 $70.13 $70.13 $70.13 $70.13 $70.13 $52.88 $70.13 $70.13 $70.13 $35.07 $35.07 $55.54 $70.13 $56.10 $45.58 $70.13 N/A $40.89 $70.13 $42.08 $70.13 $70.13 $70.13 N/A N/A 5079-5-080 SUP Custom 27203010 5079-5-080 - ROD EXFIX MICRO 3MM 80MM CONNCTNG HOFFMANN II STAINLESS BOTH IP/OP $68.50 $51.00 $12.15 $68.25 $68.25 $68.25 $68.25 $68.25 $68.25 $68.25 $12.15 $68.25 $68.25 $50.66 $50.66 $52.61 $35.56 $14.22 $68.25 $27.30 $68.25 $68.25 $68.25 $68.25 $68.25 $51.38 $68.25 $68.25 $68.25 $34.13 $34.13 $54.05 $68.25 $54.60 $44.36 $68.25 N/A $39.73 $68.25 $40.95 $68.25 $68.25 $68.25 N/A N/A 5079-5-090 SUP Custom 27203010 5079-5-090 - ROD EXFIX MICRO 3MM 90MM CONNECT HOFFMANN II STAINLESS STEEL BOTH IP/OP $70.50 $52.00 $12.48 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $12.48 $70.13 $70.13 $52.05 $52.05 $54.06 $36.54 $14.62 $70.13 $28.05 $70.13 $70.13 $70.13 $70.13 $70.13 $52.88 $70.13 $70.13 $70.13 $35.07 $35.07 $55.54 $70.13 $56.10 $45.58 $70.13 N/A $40.89 $70.13 $42.08 $70.13 $70.13 $70.13 N/A N/A 5079-5-120 SUP Custom 27203010 5079-5-120 - ROD EXFIX MICRO 3MM 120MM CONNCTNG HOFFMANN II STAINLESS BOTH IP/OP $70.50 $52.00 $12.48 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $12.48 $70.13 $70.13 $52.05 $52.05 $54.06 $36.54 $14.62 $70.13 $28.05 $70.13 $70.13 $70.13 $70.13 $70.13 $52.88 $70.13 $70.13 $70.13 $35.07 $35.07 $55.54 $70.13 $56.10 $45.58 $70.13 N/A $40.89 $70.13 $42.08 $70.13 $70.13 $70.13 N/A N/A 5079-5-150 SUP Custom 27203010 5079-5-150 - ROD EXFIX MICRO 3MM 150MM CONNECT HOFFMANN II STAINLESS BOTH IP/OP $70.50 $52.00 $12.48 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $12.48 $70.13 $70.13 $52.05 $52.05 $54.06 $36.54 $14.62 $70.13 $28.05 $70.13 $70.13 $70.13 $70.13 $70.13 $52.88 $70.13 $70.13 $70.13 $35.07 $35.07 $55.54 $70.13 $56.10 $45.58 $70.13 N/A $40.89 $70.13 $42.08 $70.13 $70.13 $70.13 N/A N/A 5079-5-180 SUP Custom 27203010 5079-5-180 - ROD EXFIX MICRO 3MM 180MM CONNCTNG HOFFMANN II STAINLESS BOTH IP/OP $70.50 $52.00 $12.48 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $12.48 $70.13 $70.13 $52.05 $52.05 $54.06 $36.54 $14.62 $70.13 $28.05 $70.13 $70.13 $70.13 $70.13 $70.13 $52.88 $70.13 $70.13 $70.13 $35.07 $35.07 $55.54 $70.13 $56.10 $45.58 $70.13 N/A $40.89 $70.13 $42.08 $70.13 $70.13 $70.13 N/A N/A 5079-5-250 SUP Custom 27203010 5079-5-250 - ROD EXFIX MICRO 3MM 250MM CONNECT HOFFMANN II STAINLESS BOTH IP/OP $78.00 $58.00 $13.88 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $13.88 $78.00 $78.00 $57.89 $57.89 $60.12 $40.64 $16.26 $78.00 $31.20 $78.00 $78.00 $78.00 $78.00 $78.00 $58.50 $78.00 $78.00 $78.00 $39.00 $39.00 $61.78 $78.00 $62.40 $50.70 $78.00 N/A $45.24 $78.00 $46.80 $78.00 $78.00 $78.00 N/A N/A 50-795-26-09 SUP HCPCS C1713 50-795-26-09 - PLATE BONE RIGHT ANG 3MM 26 HOLE RECONSTRUCTION THREADLOCK BOTH IP/OP "$4,275.00" "$3,164.00" $848.43 "$4,274.75" "$1,923.64" "$1,923.64" "$1,923.64" "$1,923.64" "$4,274.75" "$4,274.75" "$4,274.75" $890.96 "$4,274.75" "$4,274.75" "$4,274.75" "$4,274.75" "$4,274.75" $890.90 "$4,274.75" "$4,274.75" "$2,107.45" "$4,274.75" "$4,274.75" "$4,274.75" "$4,274.75" "$3,206.25" "$4,274.75" "$4,274.75" "$4,274.75" "$2,137.38" "$2,137.38" "$3,385.60" "$4,274.75" "$3,419.80" "$1,923.64" $848.43 N/A "$2,479.50" "$4,274.75" "$4,274.75" "$4,274.75" $890.86 "$4,274.75" N/A N/A 5079-5-300 SUP Custom 27203010 5079-5-300 - ROD EXFIX MICRO 3MM 300MM CONNECT HOFFMANN II STAINLESS BOTH IP/OP $78.00 $58.00 $13.88 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $78.00 $13.88 $78.00 $78.00 $57.89 $57.89 $60.12 $40.64 $16.26 $78.00 $31.20 $78.00 $78.00 $78.00 $78.00 $78.00 $58.50 $78.00 $78.00 $78.00 $39.00 $39.00 $61.78 $78.00 $62.40 $50.70 $78.00 N/A $45.24 $78.00 $46.80 $78.00 $78.00 $78.00 N/A N/A 50-795-76-09 SUP Custom 27203010 50-795-76-09 - TEMPLATE BENDING 26 HOLE THREADLOCK TITANIUM MANDIB BOTH IP/OP $139.50 $103.00 $24.79 $139.25 $139.25 $139.25 $139.25 $139.25 $139.25 $139.25 $24.79 $139.25 $139.25 $103.35 $103.35 $107.33 $72.55 $29.02 $139.25 $55.70 $139.25 $139.25 $139.25 $139.25 $139.25 $104.63 $139.25 $139.25 $139.25 $69.63 $69.63 $110.29 $139.25 $111.40 $90.51 $139.25 N/A $80.91 $139.25 $83.55 $139.25 $139.25 $139.25 N/A N/A 5079-6-030 SUP Custom 27203010 5079-6-030 - ROD EXFIX MICRO 3MM 30MM CONNECT HOFFMANN II CARB BOTH IP/OP $113.00 $84.00 $20.07 $112.75 $112.75 $112.75 $112.75 $112.75 $112.75 $112.75 $20.07 $112.75 $112.75 $83.68 $83.68 $86.91 $58.74 $23.50 $112.75 $45.10 $112.75 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $73.29 $112.75 N/A $65.54 $112.75 $67.65 $112.75 $112.75 $112.75 N/A N/A 5079-6-040 SUP Custom 27203010 5079-6-040 - ROD EXFIX MICRO 3MM 40MM CONNECT HOFFMANN II CARB BOTH IP/OP $113.00 $84.00 $20.07 $112.75 $112.75 $112.75 $112.75 $112.75 $112.75 $112.75 $20.07 $112.75 $112.75 $83.68 $83.68 $86.91 $58.74 $23.50 $112.75 $45.10 $112.75 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $73.29 $112.75 N/A $65.54 $112.75 $67.65 $112.75 $112.75 $112.75 N/A N/A 5079-6-050 SUP Custom 27203010 5079-6-050 - ROD EXFIX MICRO 3MM 50MM CONNECT HOFFMANN II CARB BOTH IP/OP $113.00 $84.00 $20.07 $112.75 $112.75 $112.75 $112.75 $112.75 $112.75 $112.75 $20.07 $112.75 $112.75 $83.68 $83.68 $86.91 $58.74 $23.50 $112.75 $45.10 $112.75 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $73.29 $112.75 N/A $65.54 $112.75 $67.65 $112.75 $112.75 $112.75 N/A N/A 5079-6-060 SUP Custom 27203010 5079-6-060 - ROD EXFIX MICRO 3MM 60MM CONNECT HOFFMANN II CARB BOTH IP/OP $113.00 $84.00 $20.07 $112.75 $112.75 $112.75 $112.75 $112.75 $112.75 $112.75 $20.07 $112.75 $112.75 $83.68 $83.68 $86.91 $58.74 $23.50 $112.75 $45.10 $112.75 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $73.29 $112.75 N/A $65.54 $112.75 $67.65 $112.75 $112.75 $112.75 N/A N/A 50-796-06-09 SUP HCPCS C1713 50-796-06-09 - PLATE BN STRG 3MM GRN NS THREADLOCK TS 6 HL RECON BAR CX TI BOTH IP/OP "$1,991.50" "$1,474.00" $395.20 "$1,991.18" $896.03 $896.03 $896.03 $896.03 "$1,991.18" "$1,991.18" "$1,991.18" $415.01 "$1,991.18" "$1,991.18" "$1,991.18" "$1,991.18" "$1,991.18" $414.98 "$1,991.18" "$1,991.18" "$1,177.78" "$1,991.18" "$1,991.18" "$1,991.18" "$1,991.18" "$1,493.63" "$1,991.18" "$1,991.18" "$1,991.18" $995.59 $995.59 "$1,577.01" "$1,991.18" "$1,592.94" $896.03 $395.20 N/A "$1,155.07" "$1,991.18" "$1,194.71" "$1,991.18" $414.96 "$1,991.18" N/A N/A 5079-6-090 SUP Custom 27203010 5079-6-090 - ROD EXFIX MICRO 3MM 90MM CONNECT HOFFMANN II CARB BOTH IP/OP $113.00 $84.00 $20.07 $112.75 $112.75 $112.75 $112.75 $112.75 $112.75 $112.75 $20.07 $112.75 $112.75 $83.68 $83.68 $86.91 $58.74 $23.50 $112.75 $45.10 $112.75 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $73.29 $112.75 N/A $65.54 $112.75 $67.65 $112.75 $112.75 $112.75 N/A N/A 5079-6-120 SUP Custom 27203010 5079-6-120 - ROD EXFIX MICRO 3MM 120MM CONNECT HOFFMANN II CARB BOTH IP/OP $113.00 $84.00 $20.07 $112.75 $112.75 $112.75 $112.75 $112.75 $112.75 $112.75 $20.07 $112.75 $112.75 $83.68 $83.68 $86.91 $58.74 $23.50 $112.75 $45.10 $112.75 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $73.29 $112.75 N/A $65.54 $112.75 $67.65 $112.75 $112.75 $112.75 N/A N/A 5079-6-150 SUP Custom 27203010 5079-6-150 - ROD EXFIX MICRO 3MM 150MM CONNECT HOFFMANN II CARB BOTH IP/OP $113.00 $84.00 $20.07 $112.75 $112.75 $112.75 $112.75 $112.75 $112.75 $112.75 $20.07 $112.75 $112.75 $83.68 $83.68 $86.91 $58.74 $23.50 $112.75 $45.10 $112.75 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $73.29 $112.75 N/A $65.54 $112.75 $67.65 $112.75 $112.75 $112.75 N/A N/A 50-797-26-09 SUP HCPCS C1713 50-797-26-09 - PLATE BONE 3MM RECONSTRUCTION THREADLOCK GREEN TITANIUM LEFT BOTH IP/OP "$4,275.00" "$3,164.00" $848.43 "$4,274.75" "$1,923.64" "$1,923.64" "$1,923.64" "$1,923.64" "$4,274.75" "$4,274.75" "$4,274.75" $890.96 "$4,274.75" "$4,274.75" "$4,274.75" "$4,274.75" "$4,274.75" $890.90 "$4,274.75" "$1,709.90" "$2,107.45" "$4,274.75" "$4,274.75" "$4,274.75" "$4,274.75" "$3,206.25" "$4,274.75" "$4,274.75" "$4,274.75" "$2,137.38" "$2,137.38" "$3,385.60" "$4,274.75" "$3,419.80" "$1,923.64" $848.43 N/A "$2,479.50" "$4,274.75" "$4,274.75" "$4,274.75" $890.86 "$4,274.75" N/A N/A 50-799-32-09 SUP HCPCS C1713 50-799-32-09 - PLATE BONE 3MM 32 HOLE LOCKING RECONSTRUCTION TITANIUM BOTH IP/OP "$4,748.50" "$3,514.00" $942.40 "$4,748.20" "$2,136.69" "$2,136.69" "$2,136.69" "$2,136.69" "$4,748.20" "$4,748.20" "$4,748.20" $989.64 "$4,748.20" "$4,748.20" "$4,748.20" "$4,748.20" "$4,748.20" $989.58 "$4,748.20" "$4,748.20" "$2,340.86" "$4,748.20" "$4,748.20" "$4,748.20" "$4,748.20" "$3,561.38" "$4,748.20" "$4,748.20" "$4,748.20" "$2,374.10" "$2,374.10" "$3,760.57" "$4,748.20" "$3,798.56" "$2,136.69" $942.40 N/A "$2,754.13" "$4,748.20" "$4,748.20" "$4,748.20" $989.52 "$4,748.20" N/A N/A 50-799-34-09 SUP HCPCS C1713 50-799-34-09 - PLATE BN ANG 3MM LVL 1 34 HL LCK RECON TI CRNMXF 2.7MM SCR BOTH IP/OP "$5,082.50" "$3,761.00" "$1,008.73" "$5,082.38" "$2,287.07" "$2,287.07" "$2,287.07" "$2,287.07" "$5,082.38" "$5,082.38" "$5,082.38" "$1,059.30" "$5,082.38" "$5,082.38" "$5,082.38" "$5,082.38" "$5,082.38" "$1,059.22" "$5,082.38" "$5,082.38" "$2,505.61" "$5,082.38" "$5,082.38" "$5,082.38" "$5,082.38" "$3,811.88" "$5,082.38" "$5,082.38" "$5,082.38" "$2,541.19" "$2,541.19" "$4,025.24" "$5,082.38" "$4,065.90" "$2,287.07" "$1,008.73" N/A "$2,947.85" "$5,082.38" "$3,049.43" "$5,082.38" "$1,059.17" "$5,082.38" N/A N/A 50-8001 SUP Custom 27011340 50-8001 - OXYGEN DELIVERY SYSTEM W/ADLT MASK 10/CS BOTH IP/OP $41.00 $30.00 $7.26 $40.81 $40.81 $40.81 $40.81 $40.81 $40.81 $40.81 $7.26 $40.81 $40.81 $30.29 $30.29 $31.46 $21.26 $8.51 $40.81 $16.32 $40.81 $40.81 $40.81 $40.81 $40.81 $30.75 $40.81 $40.81 $40.81 $20.41 $20.41 $32.32 $40.81 $32.65 $26.53 $40.81 N/A $23.78 $40.81 $24.49 $40.81 $40.81 $40.81 N/A N/A 5080-1-612 SUP Custom 27203010 5080-1-612 - PIN HALF MICRO 1.65MM 45MM 12MM SELF DRILL SELF TAP THREAD BOTH IP/OP $129.00 $95.00 $22.96 $129.00 $129.00 $129.00 $129.00 $129.00 $129.00 $129.00 $22.96 $129.00 $129.00 $95.74 $95.74 $99.43 $67.21 $26.89 $129.00 $51.60 $129.00 $129.00 $129.00 $129.00 $129.00 $96.75 $129.00 $129.00 $129.00 $64.50 $64.50 $102.17 $129.00 $103.20 $83.85 $129.00 N/A $74.82 $129.00 $77.40 $129.00 $129.00 $129.00 N/A N/A 5080-1-620 SUP Custom 27203010 5080-1-620 - PIN HALF MICRO 1.65MM 45MM 20MM SLFDRILL SLFTAP THREADED BOTH IP/OP $129.00 $95.00 $22.96 $129.00 $129.00 $129.00 $129.00 $129.00 $129.00 $129.00 $22.96 $129.00 $129.00 $95.74 $95.74 $99.43 $67.21 $26.89 $129.00 $51.60 $129.00 $129.00 $129.00 $129.00 $129.00 $96.75 $129.00 $129.00 $129.00 $64.50 $64.50 $102.17 $129.00 $103.20 $83.85 $129.00 N/A $74.82 $129.00 $77.40 $129.00 $129.00 $129.00 N/A N/A 5080-2-012 SUP Custom 27203010 5080-2-012 - PIN HALF MICRO 2MM 45MM 12MM SLFDRILL SLFTAP HOFFMANN II BOTH IP/OP $129.00 $95.00 $22.96 $129.00 $129.00 $129.00 $129.00 $129.00 $129.00 $129.00 $22.96 $129.00 $129.00 $95.74 $95.74 $99.43 $67.21 $26.89 $129.00 $51.60 $129.00 $129.00 $129.00 $129.00 $129.00 $96.75 $129.00 $129.00 $129.00 $64.50 $64.50 $102.17 $129.00 $103.20 $83.85 $129.00 N/A $74.82 $129.00 $77.40 $129.00 $129.00 $129.00 N/A N/A 5080-2-020 SUP Custom 27203010 5080-2-020 - PIN HALF MICRO 2MM 45MM 20MM SLFTAP SLFDRILL HOFFMANN II BOTH IP/OP $129.00 $95.00 $22.96 $129.00 $129.00 $129.00 $129.00 $129.00 $129.00 $129.00 $22.96 $129.00 $129.00 $95.74 $95.74 $99.43 $67.21 $26.89 $129.00 $51.60 $129.00 $129.00 $129.00 $129.00 $129.00 $96.75 $129.00 $129.00 $129.00 $64.50 $64.50 $102.17 $129.00 $103.20 $83.85 $129.00 N/A $74.82 $129.00 $77.40 $129.00 $129.00 $129.00 N/A N/A 508-11-42A SUP Custom 27803010 508-11-42A - SHELL ACETAB A HEMISPHERE 42MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-44B SUP Custom 27803010 508-11-44B - SHELL ACETAB B HEMISPHERE 44MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-46C SUP Custom 27803010 508-11-46C - SHELL ACETAB C HEMISPHERE 46MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-48D SUP Custom 27803010 508-11-48D - SHELL ACETAB D HEMISPHERE 48MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-50D SUP Custom 27803010 508-11-50D - SHELL ACETAB D HEMISPHERE 50MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-52E SUP Custom 27803010 508-11-52E - SHELL ACETAB E HEMISPHERE 52MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-54E SUP Custom 27803010 508-11-54E - SHELL ACETAB E HEMISPHERE 54MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-56F SUP Custom 27803010 508-11-56F - SHELL ACETAB F HEMISPHERE 56MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-58F SUP Custom 27803010 508-11-58F - SHELL ACETAB F HEMISPHERE 58MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-60G SUP Custom 27803010 508-11-60G - SHELL ACETAB G HEMISPHERE 60MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-62G SUP Custom 27803010 508-11-62G - SHELL ACETAB G HEMISPHERE 62MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-64H SUP Custom 27803010 508-11-64H - SHELL ACETAB H HEMISPHERE 64MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-66H SUP Custom 27803010 508-11-66H - SHELL ACETAB H HEMISPHERE 66MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-68I SUP Custom 27803010 508-11-68I - SHELL ACETAB I HEMISPHERE 68MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-70I SUP Custom 27803010 508-11-70I - SHELL ACETAB I HEMISPHERE 70MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-72J SUP Custom 27803010 508-11-72J - SHELL ACETAB J HEMISPHERE 72MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 508-11-74J SUP Custom 27803010 508-11-74J - SHELL ACETAB J HEMISPHERE 74MM MULTIHOLE TRIDENT HIP BOTH IP/OP "$4,207.50" "$3,114.00" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $748.94 "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" $876.89 "$4,207.50" "$1,683.00" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$4,207.50" "$3,155.63" "$4,207.50" "$4,207.50" "$4,207.50" "$2,103.75" "$2,103.75" "$3,332.34" "$4,207.50" "$3,366.00" "$1,893.38" "$4,207.50" N/A "$2,440.35" "$4,207.50" "$2,524.50" "$4,207.50" "$4,207.50" "$4,207.50" N/A N/A 50-820-07-07 SUP Custom 27100030 50-820-07-07 - DRILL TWIST 1.5MM 40MM 7MM HEXAGONAL ATTCH STOP STAINLESS BOTH IP/OP $312.00 $231.00 $55.52 $311.90 $311.90 $311.90 $311.90 $311.90 $311.90 $311.90 $55.52 $311.90 $311.90 $231.49 $231.49 $240.41 $162.50 $65.00 $311.90 $124.76 $311.90 $311.90 $311.90 $311.90 $311.90 $234.00 $311.90 $311.90 $311.90 $155.95 $155.95 $247.02 $311.90 $249.52 $202.74 $311.90 N/A $180.96 $311.90 $187.14 $311.90 $311.90 $311.90 N/A N/A 5082-200 SUP Custom 27203010 5082-200 - BLOOD PRESSURE CONNECTOR/MALE BOTH IP/OP $50.00 $37.00 $8.90 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $8.90 $50.00 $50.00 $37.11 $37.11 $38.54 $26.05 $10.42 $50.00 $20.00 $50.00 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $32.50 $50.00 N/A $29.00 $50.00 $30.00 $50.00 $50.00 $50.00 N/A N/A 5084-1-100 SUP Custom 27203010 5084-1-100 - GUIDE DRILL MINI 1.5-2MM BOTH IP/OP $516.00 $382.00 $91.78 $515.63 $515.63 $515.63 $515.63 $515.63 $515.63 $515.63 $91.78 $515.63 $515.63 $382.70 $382.70 $397.45 $268.64 $107.46 $515.63 $206.25 $515.63 $515.63 $515.63 $515.63 $515.63 $387.00 $515.63 $515.63 $515.63 $257.82 $257.82 $408.38 $515.63 $412.50 $335.16 $515.63 N/A $299.28 $515.63 $309.38 $515.63 $515.63 $515.63 N/A N/A 5085-2-015 SUP Custom 27203010 5085-2-015 - BIT DRILL 1.5MM 75MM HOFFMANN STERILE BOTH IP/OP $87.00 $64.00 $15.43 $86.70 $86.70 $86.70 $86.70 $86.70 $86.70 $86.70 $15.43 $86.70 $86.70 $64.35 $64.35 $66.83 $45.17 $18.07 $86.70 $34.68 $86.70 $86.70 $86.70 $86.70 $86.70 $65.25 $86.70 $86.70 $86.70 $43.35 $43.35 $68.67 $86.70 $69.36 $56.36 $86.70 N/A $50.46 $86.70 $52.02 $86.70 $86.70 $86.70 N/A N/A 5090-2-120 SUP Custom 27203010 5090-2-120 - PIN HALF 3MM 4MM 120MM SLFDRILL APEX BOTH IP/OP $146.50 $108.00 $26.02 $146.20 $146.20 $146.20 $146.20 $146.20 $146.20 $146.20 $26.02 $146.20 $146.20 $108.51 $108.51 $112.69 $76.17 $30.47 $146.20 $58.48 $146.20 $146.20 $146.20 $146.20 $146.20 $109.88 $146.20 $146.20 $146.20 $73.10 $73.10 $115.79 $146.20 $116.96 $95.03 $146.20 N/A $84.97 $146.20 $87.72 $146.20 $146.20 $146.20 N/A N/A 509-02-54E SUP Custom 27803010 509-02-54E - SHELL ACETAB E HEMISPHERE 54MM MULTIHOLE RIM MDM TRIDENT BOTH IP/OP "$6,782.50" "$5,019.00" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$6,782.50" N/A "$3,933.85" "$6,782.50" "$4,069.50" "$6,782.50" "$6,782.50" "$6,782.50" N/A N/A 509-02-56E SUP Custom 27803010 509-02-56E - SHELL ACETAB E HEMISPHERE 56MM MULTIHOLE RIM MDM TRIDENT BOTH IP/OP "$6,782.50" "$5,019.00" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$6,782.50" N/A "$3,933.85" "$6,782.50" "$4,069.50" "$6,782.50" "$6,782.50" "$6,782.50" N/A N/A 509-02-58F SUP Custom 27803010 509-02-58F - SHELL ACETAB F HEMISPHERE 58MM MULTIHOLE RIM MDM TRIDENT BOTH IP/OP "$6,782.50" "$5,019.00" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$6,782.50" N/A "$3,933.85" "$6,782.50" "$4,069.50" "$6,782.50" "$6,782.50" "$6,782.50" N/A N/A 509-02-60F SUP Custom 27803010 509-02-60F - SHELL ACETAB F HEMISPHERE 60MM MULTIHOLE RIM MDM TRIDENT BOTH IP/OP "$6,782.50" "$5,019.00" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$6,782.50" N/A "$3,933.85" "$6,782.50" "$4,069.50" "$6,782.50" "$6,782.50" "$6,782.50" N/A N/A 509-02-62G SUP Custom 27803010 509-02-62G - SHELL ACETAB G HEMISPHERE 62MM MULTIHOLE RIM MDM TRIDENT BOTH IP/OP "$6,782.50" "$5,019.00" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$6,782.50" N/A "$3,933.85" "$6,782.50" "$4,069.50" "$6,782.50" "$6,782.50" "$6,782.50" N/A N/A 509-02-64G SUP Custom 27803010 509-02-64G - SHELL ACETAB G HEMISPHERE 64MM MULTIHOLE RIM MDM TRIDENT BOTH IP/OP "$6,782.50" "$5,019.00" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$6,782.50" N/A "$3,933.85" "$6,782.50" "$4,069.50" "$6,782.50" "$6,782.50" "$6,782.50" N/A N/A 509-02-66H SUP Custom 27803010 509-02-66H - SHELL ACETAB H HEMISPHERE 66MM MULTIHOLE RIM MDM TRIDENT BOTH IP/OP "$6,782.50" "$5,019.00" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$6,782.50" N/A "$3,933.85" "$6,782.50" "$4,069.50" "$6,782.50" "$6,782.50" "$6,782.50" N/A N/A 509-02-68H SUP Custom 27803010 509-02-68H - SHELL ACETAB H HEMISPHERE 68MM MULTIHOLE RIM MDM TRIDENT BOTH IP/OP "$6,782.50" "$5,019.00" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$6,782.50" N/A "$3,933.85" "$6,782.50" "$4,069.50" "$6,782.50" "$6,782.50" "$6,782.50" N/A N/A 509-02-70I SUP Custom 27803010 509-02-70I - SHELL ACETAB I HEMISPHERE 70MM MULTIHOLE RIM MDM TRIDENT BOTH IP/OP "$6,782.50" "$5,019.00" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$6,782.50" N/A "$3,933.85" "$6,782.50" "$4,069.50" "$6,782.50" "$6,782.50" "$6,782.50" N/A N/A 509-02-72I SUP Custom 27803010 509-02-72I - SHELL ACETAB I HEMISPHERE 72MM MULTIHOLE RIM MDM TRIDENT BOTH IP/OP "$6,782.50" "$5,019.00" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$6,782.50" N/A "$3,933.85" "$6,782.50" "$4,069.50" "$6,782.50" "$6,782.50" "$6,782.50" N/A N/A 509-02-74J SUP Custom 27803010 509-02-74J - SHELL ACETAB J HEMISPHERE 74MM MULTIHOLE RIM MDM TRIDENT BOTH IP/OP "$6,782.50" "$5,019.00" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$6,782.50" N/A "$3,933.85" "$6,782.50" "$4,069.50" "$6,782.50" "$6,782.50" "$6,782.50" N/A N/A 509-02-76J SUP Custom 27803010 509-02-76J - SHELL ACETAB 76MM MULTIHOLE REVISION TRITANIUM BOTH IP/OP "$6,782.50" "$5,019.00" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$6,782.50" N/A "$3,933.85" "$6,782.50" "$4,069.50" "$6,782.50" "$6,782.50" "$6,782.50" N/A N/A 509-02-78J SUP Custom 27803010 509-02-78J - SHELL ACETAB 78MM MULTIHOLE REVISION TRITANIUM BOTH IP/OP "$6,782.50" "$5,019.00" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$6,782.50" N/A "$3,933.85" "$6,782.50" "$4,069.50" "$6,782.50" "$6,782.50" "$6,782.50" N/A N/A 509-02-80J SUP Custom 27803010 509-02-80J - SHELL ACETAB 80MM MULTIHOLE REVISION TRITANIUM BOTH IP/OP "$6,782.50" "$5,019.00" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,207.29" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$6,782.50" N/A "$3,933.85" "$6,782.50" "$4,069.50" "$6,782.50" "$6,782.50" "$6,782.50" N/A N/A 5094-0-202 SUP Custom 27203010 5094-0-202 - FIXATOR XTRNFX HFMN2 LENGTHEN SS BOTH IP/OP "$4,054.50" "$3,000.00" $721.70 "$4,054.50" "$4,054.50" "$4,054.50" "$4,054.50" "$4,054.50" "$4,054.50" "$4,054.50" $721.70 "$4,054.50" "$4,054.50" "$3,009.25" "$3,009.25" "$3,125.21" "$2,060.15" $845.00 "$4,054.50" "$1,621.80" "$4,054.50" "$4,054.50" "$4,054.50" "$4,054.50" "$4,054.50" "$3,040.88" "$4,054.50" "$4,054.50" "$4,054.50" "$2,027.25" "$2,027.25" "$3,211.16" "$4,054.50" "$3,243.60" "$2,635.43" "$4,054.50" N/A "$2,351.61" "$4,054.50" "$2,432.70" "$4,054.50" "$4,054.50" "$4,054.50" N/A N/A 5096-4615 SUP HCPCS C1776 5096-4615 - AUGMENT ACTB WDG 46MM 15MM RSTR HIP BOTH IP/OP "$4,817.50" "$3,565.00" $956.15 "$4,817.50" "$2,167.88" "$2,167.88" "$2,167.88" "$2,167.88" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.09" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.02" "$4,817.50" "$1,927.00" "$2,375.03" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$3,613.13" "$4,817.50" "$4,817.50" "$4,817.50" "$2,408.75" "$2,408.75" "$3,815.46" "$4,817.50" "$3,854.00" "$2,167.88" $956.15 N/A "$2,794.15" "$4,817.50" "$4,817.50" "$4,817.50" "$1,003.97" "$4,817.50" N/A N/A 5096-4620 SUP HCPCS C1776 5096-4620 - AUGMENT ACTB WDG 46MM 20MM RSTR HIP BOTH IP/OP "$4,817.50" "$3,565.00" $956.15 "$4,817.50" "$2,167.88" "$2,167.88" "$2,167.88" "$2,167.88" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.09" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.02" "$4,817.50" "$4,817.50" "$2,375.03" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$3,613.13" "$4,817.50" "$4,817.50" "$4,817.50" "$2,408.75" "$2,408.75" "$3,815.46" "$4,817.50" "$3,854.00" "$2,167.88" $956.15 N/A "$2,794.15" "$4,817.50" "$4,817.50" "$4,817.50" "$1,003.97" "$4,817.50" N/A N/A 5096-5015 SUP HCPCS C1776 5096-5015 - AUGMENT ACTB WDG 50MM 15MM RSTR HIP BOTH IP/OP "$4,817.50" "$3,565.00" $956.15 "$4,817.50" "$2,167.88" "$2,167.88" "$2,167.88" "$2,167.88" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.09" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.02" "$4,817.50" "$1,927.00" "$2,375.03" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$3,613.13" "$4,817.50" "$4,817.50" "$4,817.50" "$2,408.75" "$2,408.75" "$3,815.46" "$4,817.50" "$3,854.00" "$2,167.88" $956.15 N/A "$2,794.15" "$4,817.50" "$4,817.50" "$4,817.50" "$1,003.97" "$4,817.50" N/A N/A 5096-5020 SUP HCPCS C1776 5096-5020 - AUGMENT ACTB WDG 50MM 20MM RSTR HIP BOTH IP/OP "$4,817.50" "$3,565.00" $956.15 "$4,817.50" "$2,167.88" "$2,167.88" "$2,167.88" "$2,167.88" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.09" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.02" "$4,817.50" "$4,817.50" "$2,375.03" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$3,613.13" "$4,817.50" "$4,817.50" "$4,817.50" "$2,408.75" "$2,408.75" "$3,815.46" "$4,817.50" "$3,854.00" "$2,167.88" $956.15 N/A "$2,794.15" "$4,817.50" "$4,817.50" "$4,817.50" "$1,003.97" "$4,817.50" N/A N/A 5096-5025 SUP HCPCS C1776 5096-5025 - AUGMENT ACTB WDG 50MM 25MM RSTR HIP BOTH IP/OP "$4,817.50" "$3,565.00" $956.15 "$4,817.50" "$2,167.88" "$2,167.88" "$2,167.88" "$2,167.88" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.09" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.02" "$4,817.50" "$1,927.00" "$2,375.03" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$3,613.13" "$4,817.50" "$4,817.50" "$4,817.50" "$2,408.75" "$2,408.75" "$3,815.46" "$4,817.50" "$3,854.00" "$2,167.88" $956.15 N/A "$2,794.15" "$4,817.50" "$4,817.50" "$4,817.50" "$1,003.97" "$4,817.50" N/A N/A 5096-5415 SUP HCPCS C1776 5096-5415 - AUGMENT ACTB WDG 54MM 15MM RSTR HIP BOTH IP/OP "$4,817.50" "$3,565.00" $956.15 "$4,817.50" "$2,167.88" "$2,167.88" "$2,167.88" "$2,167.88" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.09" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.02" "$4,817.50" "$4,817.50" "$2,375.03" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$3,613.13" "$4,817.50" "$4,817.50" "$4,817.50" "$2,408.75" "$2,408.75" "$3,815.46" "$4,817.50" "$3,854.00" "$2,167.88" $956.15 N/A "$2,794.15" "$4,817.50" "$4,817.50" "$4,817.50" "$1,003.97" "$4,817.50" N/A N/A 5096-5815 SUP HCPCS C1776 5096-5815 - AUGMENT ACTB WDG 58MM 15MM RSTR HIP BOTH IP/OP "$4,817.50" "$3,565.00" $956.15 "$4,817.50" "$2,167.88" "$2,167.88" "$2,167.88" "$2,167.88" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.09" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.02" "$4,817.50" "$1,927.00" "$2,375.03" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$3,613.13" "$4,817.50" "$4,817.50" "$4,817.50" "$2,408.75" "$2,408.75" "$3,815.46" "$4,817.50" "$3,854.00" "$2,167.88" $956.15 N/A "$2,794.15" "$4,817.50" "$4,817.50" "$4,817.50" "$1,003.97" "$4,817.50" N/A N/A 5096-5825 SUP HCPCS C1776 5096-5825 - AUGMENT ACTB WDG 58MM 25MM RSTR HIP BOTH IP/OP "$4,817.50" "$3,565.00" $956.15 "$4,817.50" "$2,167.88" "$2,167.88" "$2,167.88" "$2,167.88" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.09" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.02" "$4,817.50" "$1,927.00" "$2,375.03" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$3,613.13" "$4,817.50" "$4,817.50" "$4,817.50" "$2,408.75" "$2,408.75" "$3,815.46" "$4,817.50" "$3,854.00" "$2,167.88" $956.15 N/A "$2,794.15" "$4,817.50" "$4,817.50" "$4,817.50" "$1,003.97" "$4,817.50" N/A N/A 5096-6220 SUP HCPCS C1776 5096-6220 - AUGMENT ACTB WDG 62MM 20MM RSTR HIP BOTH IP/OP "$4,817.50" "$3,565.00" $956.15 "$4,817.50" "$2,167.88" "$2,167.88" "$2,167.88" "$2,167.88" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.09" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.02" "$4,817.50" "$4,817.50" "$2,375.03" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$3,613.13" "$4,817.50" "$4,817.50" "$4,817.50" "$2,408.75" "$2,408.75" "$3,815.46" "$4,817.50" "$3,854.00" "$2,167.88" $956.15 N/A "$2,794.15" "$4,817.50" "$4,817.50" "$4,817.50" "$1,003.97" "$4,817.50" N/A N/A 5096-6225 SUP HCPCS C1776 5096-6225 - AUGMENT ACTB WDG 62MM 25MM RSTR HIP BOTH IP/OP "$4,817.50" "$3,565.00" $956.15 "$4,817.50" "$2,167.88" "$2,167.88" "$2,167.88" "$2,167.88" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.09" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.02" "$4,817.50" "$1,927.00" "$2,375.03" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$3,613.13" "$4,817.50" "$4,817.50" "$4,817.50" "$2,408.75" "$2,408.75" "$3,815.46" "$4,817.50" "$3,854.00" "$2,167.88" $956.15 N/A "$2,794.15" "$4,817.50" "$4,817.50" "$4,817.50" "$1,003.97" "$4,817.50" N/A N/A 5096-6615 SUP HCPCS C1776 5096-6615 - AUGMENT ACTB WDG 66MM 15MM RSTR HIP BOTH IP/OP "$4,817.50" "$3,565.00" $956.15 "$4,817.50" "$2,167.88" "$2,167.88" "$2,167.88" "$2,167.88" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.09" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.02" "$4,817.50" "$4,817.50" "$2,375.03" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$3,613.13" "$4,817.50" "$4,817.50" "$4,817.50" "$2,408.75" "$2,408.75" "$3,815.46" "$4,817.50" "$3,854.00" "$2,167.88" $956.15 N/A "$2,794.15" "$4,817.50" "$4,817.50" "$4,817.50" "$1,003.97" "$4,817.50" N/A N/A 5096-6620 SUP HCPCS C1776 5096-6620 - AUGMENT ACTB WDG 66MM 20MM RSTR BOTH IP/OP "$4,817.50" "$3,565.00" $956.15 "$4,817.50" "$2,167.88" "$2,167.88" "$2,167.88" "$2,167.88" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.09" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.02" "$4,817.50" "$1,927.00" "$2,375.03" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$3,613.13" "$4,817.50" "$4,817.50" "$4,817.50" "$2,408.75" "$2,408.75" "$3,815.46" "$4,817.50" "$3,854.00" "$2,167.88" $956.15 N/A "$2,794.15" "$4,817.50" "$4,817.50" "$4,817.50" "$1,003.97" "$4,817.50" N/A N/A 5096-6625 SUP HCPCS C1776 5096-6625 - AUGMENT ACTB WDG 66MM 25MM RSTR HIP BOTH IP/OP "$4,817.50" "$3,565.00" $956.15 "$4,817.50" "$2,167.88" "$2,167.88" "$2,167.88" "$2,167.88" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.09" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$1,004.02" "$4,817.50" "$4,817.50" "$2,375.03" "$4,817.50" "$4,817.50" "$4,817.50" "$4,817.50" "$3,613.13" "$4,817.50" "$4,817.50" "$4,817.50" "$2,408.75" "$2,408.75" "$3,815.46" "$4,817.50" "$3,854.00" "$2,167.88" $956.15 N/A "$2,794.15" "$4,817.50" "$4,817.50" "$4,817.50" "$1,003.97" "$4,817.50" N/A N/A 5100-001 SUP HCPCS Q4116 5100-001 - GRAFT SKIN 0-175SQ CM CRYOPRESERVED SPLIT NONMESHED BOTH IP/OP "$1,184.50" $877.00 $235.00 "$1,184.05" $532.82 $532.82 $532.82 $532.82 "$1,184.05" "$1,184.05" "$1,184.05" $246.79 "$1,184.05" "$1,184.05" "$1,184.05" "$1,184.05" "$1,184.05" $246.77 "$1,184.05" "$1,184.05" $700.37 "$1,184.05" "$1,184.05" "$1,184.05" "$1,184.05" $888.38 "$1,184.05" "$1,184.05" "$1,184.05" $592.03 $592.03 $937.77 "$1,184.05" $947.24 $532.82 $235.00 N/A $687.01 "$1,184.05" "$1,184.05" "$1,184.05" $246.76 "$1,184.05" N/A N/A 5100-037-012 SUP Custom 27203010 5100-037-012 - BLADE SAW SHORT LONG MICRO 33.5X.64MM RECIPROCATE TPS BOTH IP/OP $196.50 $145.00 $34.91 $196.10 $196.10 $196.10 $196.10 $196.10 $196.10 $196.10 $34.91 $196.10 $196.10 $145.55 $145.55 $151.15 $102.17 $40.87 $196.10 $78.44 $196.10 $196.10 $196.10 $196.10 $196.10 $147.38 $196.10 $196.10 $196.10 $98.05 $98.05 $155.31 $196.10 $156.88 $127.47 $196.10 N/A $113.97 $196.10 $117.66 $196.10 $196.10 $196.10 N/A N/A 5100-137-233 SUP Custom 27203010 5100-137-233 - BLADE SAW SHORT 27X.38MM RECIPROCATING TAPERED PRECISION BOTH IP/OP $196.50 $145.00 $34.91 $196.10 $196.10 $196.10 $196.10 $196.10 $196.10 $196.10 $34.91 $196.10 $196.10 $145.55 $145.55 $151.15 $102.17 $40.87 $196.10 $78.44 $196.10 $196.10 $196.10 $196.10 $196.10 $147.38 $196.10 $196.10 $196.10 $98.05 $98.05 $155.31 $196.10 $156.88 $127.47 $196.10 N/A $113.97 $196.10 $117.66 $196.10 $196.10 $196.10 N/A N/A 510038SIM2 SUP HCPCS C1725 510038SIM2 - CATHETER ANGIOGRAPHIC SIDEWINDER SIMMONS TECHNIQUE 2 CURVE 5 BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A 5101-1-450 SUP HCPCS C1713 5101-1-450 - WIRE XTRNFX 1.5MM 450MM KRSH BOTH IP/OP $104.00 $77.00 $20.58 $103.70 $46.67 $46.67 $46.67 $46.67 $103.70 $103.70 $103.70 $21.61 $103.70 $103.70 $103.70 $103.70 $103.70 $21.61 $103.70 $41.48 $61.34 $103.70 $103.70 $103.70 $103.70 $78.00 $103.70 $103.70 $103.70 $51.85 $51.85 $82.13 $103.70 $82.96 $46.67 $20.58 N/A $60.32 $103.70 $62.22 $103.70 $21.61 $103.70 N/A N/A 5101-2-450 SUP HCPCS C1713 5101-2-450 - WIRE XTRNFX 2MM 450MM KRSH BOTH IP/OP $104.00 $77.00 $20.58 $103.70 $46.67 $46.67 $46.67 $46.67 $103.70 $103.70 $103.70 $21.61 $103.70 $103.70 $103.70 $103.70 $103.70 $21.61 $103.70 $103.70 $61.34 $103.70 $103.70 $103.70 $103.70 $78.00 $103.70 $103.70 $103.70 $51.85 $51.85 $82.13 $103.70 $82.96 $46.67 $20.58 N/A $60.32 $103.70 $62.22 $103.70 $21.61 $103.70 N/A N/A 5101302P2 SUP HCPCS C1713 5101302P2 - CAGE SPNL 12D 30X10X11MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5101308P2 SUP HCPCS C1713 5101308P2 - CAGE SPNL 8D 30X10X11MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5102-1-246 SUP Custom 27203010 5102-1-246 - HOLDER IMPLANT SLIDING CLMP SPACER WIRE MONTICELLI-SPINELLI BOTH IP/OP $384.00 $284.00 $68.29 $383.63 $383.63 $383.63 $383.63 $383.63 $383.63 $383.63 $68.29 $383.63 $383.63 $284.73 $284.73 $295.70 $199.87 $79.95 $383.63 $153.45 $383.63 $383.63 $383.63 $383.63 $383.63 $288.00 $383.63 $383.63 $383.63 $191.82 $191.82 $303.83 $383.63 $306.90 $249.36 $383.63 N/A $222.72 $383.63 $230.18 $383.63 $383.63 $383.63 N/A N/A 5102-1-250 SUP Custom 27203010 5102-1-250 - CLAMP XTRNFX M-S HBRD BOTH IP/OP "$1,218.50" $902.00 $216.85 "$1,218.25" "$1,218.25" "$1,218.25" "$1,218.25" "$1,218.25" "$1,218.25" "$1,218.25" $216.85 "$1,218.25" "$1,218.25" $904.19 $904.19 $939.03 $634.71 $253.90 "$1,218.25" $487.30 "$1,218.25" "$1,218.25" "$1,218.25" "$1,218.25" "$1,218.25" $913.88 "$1,218.25" "$1,218.25" "$1,218.25" $609.13 $609.13 $964.85 "$1,218.25" $974.60 $791.86 "$1,218.25" N/A $706.73 "$1,218.25" $730.95 "$1,218.25" "$1,218.25" "$1,218.25" N/A N/A 5102-1-260 SUP Custom 27203010 5102-1-260 - HOLDER KWR 60MM M-S 2 BOTH IP/OP "$1,215.50" $899.00 $216.36 "$1,215.50" "$1,215.50" "$1,215.50" "$1,215.50" "$1,215.50" "$1,215.50" "$1,215.50" $216.36 "$1,215.50" "$1,215.50" $902.14 $902.14 $936.91 $633.28 $253.32 "$1,215.50" $486.20 "$1,215.50" "$1,215.50" "$1,215.50" "$1,215.50" "$1,215.50" $911.63 "$1,215.50" "$1,215.50" "$1,215.50" $607.75 $607.75 $962.68 "$1,215.50" $972.40 $790.08 "$1,215.50" N/A $704.99 "$1,215.50" $729.30 "$1,215.50" "$1,215.50" "$1,215.50" N/A N/A 5102-1-270 SUP Custom 27203010 5102-1-270 - HOLDER KWR 80MM M-S 2 BOTH IP/OP "$1,215.50" $899.00 $216.36 "$1,215.50" "$1,215.50" "$1,215.50" "$1,215.50" "$1,215.50" "$1,215.50" "$1,215.50" $216.36 "$1,215.50" "$1,215.50" $902.14 $902.14 $936.91 $633.28 $253.32 "$1,215.50" $486.20 "$1,215.50" "$1,215.50" "$1,215.50" "$1,215.50" "$1,215.50" $911.63 "$1,215.50" "$1,215.50" "$1,215.50" $607.75 $607.75 $962.68 "$1,215.50" $972.40 $790.08 "$1,215.50" N/A $704.99 "$1,215.50" $729.30 "$1,215.50" "$1,215.50" "$1,215.50" N/A N/A 5102-1-330 SUP Custom 27203010 5102-1-330 - FIXATOR XTRNFX 70D M-S BALL JNT BOTH IP/OP $803.00 $594.00 $142.93 $803.00 $803.00 $803.00 $803.00 $803.00 $803.00 $803.00 $142.93 $803.00 $803.00 $595.99 $595.99 $618.95 $418.36 $167.35 $803.00 $321.20 $803.00 $803.00 $803.00 $803.00 $803.00 $602.25 $803.00 $803.00 $803.00 $401.50 $401.50 $635.98 $803.00 $642.40 $521.95 $803.00 N/A $465.74 $803.00 $481.80 $803.00 $803.00 $803.00 N/A N/A 5102-8-330 SUP Custom 27203010 5102-8-330 - ROD EXFIX 8MM 330MM THREAD MONTICELLI-SPINELLI BOTH IP/OP $81.50 $60.00 $14.44 $81.13 $81.13 $81.13 $81.13 $81.13 $81.13 $81.13 $14.44 $81.13 $81.13 $60.21 $60.21 $62.54 $42.27 $16.91 $81.13 $32.45 $81.13 $81.13 $81.13 $81.13 $81.13 $61.13 $81.13 $81.13 $81.13 $40.57 $40.57 $64.25 $81.13 $64.90 $52.73 $81.13 N/A $47.27 $81.13 $48.68 $81.13 $81.13 $81.13 N/A N/A 5102-8-395 SUP Custom 27203010 5102-8-395 - FIXATOR EXFIX 8MM 395MM CONNCTNG ROD THREADED BOTH IP/OP $82.50 $61.00 $14.69 $82.50 $82.50 $82.50 $82.50 $82.50 $82.50 $82.50 $14.69 $82.50 $82.50 $61.23 $61.23 $63.59 $42.98 $17.19 $82.50 $33.00 $82.50 $82.50 $82.50 $82.50 $82.50 $61.88 $82.50 $82.50 $82.50 $41.25 $41.25 $65.34 $82.50 $66.00 $53.63 $82.50 N/A $47.85 $82.50 $49.50 $82.50 $82.50 $82.50 N/A N/A 510410R SUP HCPCS C1758 510410R - CATHETER URETHRAL 10FR LATEX ROBINSON RED RUBBER STERILE RRL BOTH IP/OP $11.00 $8.00 $2.10 $10.58 $5.74 $5.74 $5.74 $5.74 $10.58 $10.58 $10.58 $2.21 $10.58 $7.85 $7.85 $8.16 $5.51 $2.20 $10.58 $10.58 $6.26 $10.58 $10.58 $10.58 $10.58 $8.25 $10.58 $10.58 $10.58 $5.29 $5.29 $8.38 $10.58 $8.46 $6.88 $2.10 N/A $6.38 $10.58 $10.58 $10.58 $2.20 $10.58 N/A N/A 510420R SUP HCPCS C1758 510420R - CATHETER URTH RBNSN 20FR 16IN 2 STGR EYLT XRY BOTH IP/OP $11.00 $8.00 $2.10 $10.58 $5.74 $5.74 $5.74 $5.74 $10.58 $10.58 $10.58 $2.21 $10.58 $7.85 $7.85 $8.16 $5.51 $2.20 $10.58 $10.58 $6.26 $10.58 $10.58 $10.58 $10.58 $8.25 $10.58 $10.58 $10.58 $5.29 $5.29 $8.38 $10.58 $8.46 $6.88 $2.10 N/A $6.38 $10.58 $10.58 $10.58 $2.20 $10.58 N/A N/A 5104308P2 SUP HCPCS C1713 5104308P2 - CAGE SPNL 8D 30X10X14MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5109302P2 SUP HCPCS C1713 5109302P2 - CAGE SPNL 12D 30X10X9MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5109308P2 SUP HCPCS C1713 5109308P2 - CAGE SPNL 8D 30X10X9MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5111302P2 SUP HCPCS C1713 5111302P2 - CAGE SPNL 12D 30X11X11MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5111308P2 SUP HCPCS C1713 5111308P2 - CAGE SPNL 8D 30X11X11MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 51114V SUP Custom 27203010 51114V - CLIP INTNL MED LG SMTR VESOLOCK BOTH IP/OP $851.50 $630.00 $151.52 $851.23 $851.23 $851.23 $851.23 $851.23 $851.23 $851.23 $151.52 $851.23 $851.23 $631.78 $631.78 $656.13 $443.49 $177.41 $851.23 $340.49 $851.23 $851.23 $851.23 $851.23 $851.23 $638.63 $851.23 $851.23 $851.23 $425.62 $425.62 $674.17 $851.23 $680.98 $553.30 $851.23 N/A $493.87 $851.23 $510.74 $851.23 $851.23 $851.23 N/A N/A 51-17304 SUP HCPCS C1713 51-17304 - SCREW BONE 1.7MM 4MM EMERGENCY TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 5118-1-300 SUP Custom 27203010 5118-1-300 - RING XTRNFX SM 147MM BLU M-S .75 HP BOTH IP/OP $642.50 $475.00 $114.30 $642.13 $642.13 $642.13 $642.13 $642.13 $642.13 $642.13 $114.30 $642.13 $642.13 $476.59 $476.59 $494.95 $334.55 $133.83 $642.13 $256.85 $642.13 $642.13 $642.13 $642.13 $642.13 $481.88 $642.13 $642.13 $642.13 $321.07 $321.07 $508.57 $642.13 $513.70 $417.38 $642.13 N/A $372.65 $642.13 $385.28 $642.13 $642.13 $642.13 N/A N/A 5118-1-301 SUP Custom 27203010 5118-1-301 - RING XTRNFX SM 165MM GRN M-S .75 HP BOTH IP/OP $738.50 $546.00 $131.43 $738.38 $738.38 $738.38 $738.38 $738.38 $738.38 $738.38 $131.43 $738.38 $738.38 $548.03 $548.03 $569.14 $384.70 $153.89 $738.38 $295.35 $738.38 $738.38 $738.38 $738.38 $738.38 $553.88 $738.38 $738.38 $738.38 $369.19 $369.19 $584.80 $738.38 $590.70 $479.95 $738.38 N/A $428.33 $738.38 $443.03 $738.38 $738.38 $738.38 N/A N/A 5118-1-302 SUP Custom 27203010 5118-1-302 - RING XTRNFX SM 187MM WHT M-S .75 HP BOTH IP/OP $796.50 $589.00 $141.71 $796.13 $796.13 $796.13 $796.13 $796.13 $796.13 $796.13 $141.71 $796.13 $796.13 $590.89 $590.89 $613.66 $414.78 $165.92 $796.13 $318.45 $796.13 $796.13 $796.13 $796.13 $796.13 $597.38 $796.13 $796.13 $796.13 $398.07 $398.07 $630.53 $796.13 $636.90 $517.48 $796.13 N/A $461.97 $796.13 $477.68 $796.13 $796.13 $796.13 N/A N/A 5118-1-303 SUP Custom 27203010 5118-1-303 - RING XTRNFX SM 147MM BLU M-S .25 HP BOTH IP/OP $374.00 $277.00 $66.57 $374.00 $374.00 $374.00 $374.00 $374.00 $374.00 $374.00 $66.57 $374.00 $374.00 $277.58 $277.58 $288.28 $194.85 $77.95 $374.00 $149.60 $374.00 $374.00 $374.00 $374.00 $374.00 $280.50 $374.00 $374.00 $374.00 $187.00 $187.00 $296.21 $374.00 $299.20 $243.10 $374.00 N/A $216.92 $374.00 $224.40 $374.00 $374.00 $374.00 N/A N/A 5118-1-304 SUP Custom 27203010 5118-1-304 - RING XTRNFX MED 165MM GRN M-S .25 HP BOTH IP/OP $441.50 $327.00 $78.57 $441.38 $441.38 $441.38 $441.38 $441.38 $441.38 $441.38 $78.57 $441.38 $441.38 $327.59 $327.59 $340.22 $229.96 $91.99 $441.38 $176.55 $441.38 $441.38 $441.38 $441.38 $441.38 $331.13 $441.38 $441.38 $441.38 $220.69 $220.69 $349.57 $441.38 $353.10 $286.90 $441.38 N/A $256.07 $441.38 $264.83 $441.38 $441.38 $441.38 N/A N/A 5118-1-305 SUP Custom 27203010 5118-1-305 - RING XTRNFX LG 187MM WHT M-S .25 HP BOTH IP/OP $566.50 $419.00 $100.84 $566.50 $566.50 $566.50 $566.50 $566.50 $566.50 $566.50 $100.84 $566.50 $566.50 $420.46 $420.46 $436.66 $295.15 $118.06 $566.50 $226.60 $566.50 $566.50 $566.50 $566.50 $566.50 $424.88 $566.50 $566.50 $566.50 $283.25 $283.25 $448.67 $566.50 $453.20 $368.23 $566.50 N/A $328.57 $566.50 $339.90 $566.50 $566.50 $566.50 N/A N/A 5118-1-306 SUP Custom 27203010 5118-1-306 - PIN XTRNFX 50MM KRSH M-S RECON CLP WRE HLDR BOTH IP/OP $265.50 $196.00 $47.24 $265.38 $265.38 $265.38 $265.38 $265.38 $265.38 $265.38 $47.24 $265.38 $265.38 $196.97 $196.97 $204.55 $138.26 $55.31 $265.38 $106.15 $265.38 $265.38 $265.38 $265.38 $265.38 $199.13 $265.38 $265.38 $265.38 $132.69 $132.69 $210.18 $265.38 $212.30 $172.50 $265.38 N/A $153.99 $265.38 $159.23 $265.38 $265.38 $265.38 N/A N/A 5118-1-307 SUP Custom 27203010 5118-1-307 - PIN EXFIX 100MM CLMP BOTH IP/OP $320.50 $237.00 $57.03 $320.38 $320.38 $320.38 $320.38 $320.38 $320.38 $320.38 $57.03 $320.38 $320.38 $237.79 $237.79 $246.95 $166.92 $66.77 $320.38 $128.15 $320.38 $320.38 $320.38 $320.38 $320.38 $240.38 $320.38 $320.38 $320.38 $160.19 $160.19 $253.74 $320.38 $256.30 $208.25 $320.38 N/A $185.89 $320.38 $192.23 $320.38 $320.38 $320.38 N/A N/A 5118-1-308 SUP Custom 27203010 5118-1-308 - COUPLING EXFIX ARTICULATION BOTH IP/OP $736.00 $545.00 $130.94 $735.63 $735.63 $735.63 $735.63 $735.63 $735.63 $735.63 $130.94 $735.63 $735.63 $545.98 $545.98 $567.02 $383.26 $153.31 $735.63 $294.25 $735.63 $735.63 $735.63 $735.63 $735.63 $552.00 $735.63 $735.63 $735.63 $367.82 $367.82 $582.62 $735.63 $588.50 $478.16 $735.63 N/A $426.88 $735.63 $441.38 $735.63 $735.63 $735.63 N/A N/A 5118-1-311 SUP Custom 27203010 5118-1-311 - HOLDER XTRNFX KRSH M-S ARTC CPLNG BOTH IP/OP $949.00 $702.00 $168.88 $948.75 $948.75 $948.75 $948.75 $948.75 $948.75 $948.75 $168.88 $948.75 $948.75 $704.16 $704.16 $731.30 $494.30 $197.73 $948.75 $379.50 $948.75 $948.75 $948.75 $948.75 $948.75 $711.75 $948.75 $948.75 $948.75 $474.38 $474.38 $751.41 $948.75 $759.00 $616.69 $948.75 N/A $550.42 $948.75 $569.25 $948.75 $948.75 $948.75 N/A N/A 5118-1-320 SUP HCPCS C1713 5118-1-320 - WIRE XTRNFX OLV 1.5MM 450MM KRSH STP NUT SS BOTH IP/OP $217.00 $161.00 $43.02 $216.75 $97.54 $97.54 $97.54 $97.54 $216.75 $216.75 $216.75 $45.18 $216.75 $216.75 $216.75 $216.75 $216.75 $45.17 $216.75 $86.70 $128.21 $216.75 $216.75 $216.75 $216.75 $162.75 $216.75 $216.75 $216.75 $108.38 $108.38 $171.67 $216.75 $173.40 $97.54 $43.02 N/A $125.86 $216.75 $130.05 $216.75 $45.17 $216.75 N/A N/A 5118-1-340 SUP HCPCS C1713 5118-1-340 - WIRE XTRNFX OLV 2MM 450MM KRSH STP SS BOTH IP/OP $217.00 $161.00 $43.02 $216.75 $97.54 $97.54 $97.54 $97.54 $216.75 $216.75 $216.75 $45.18 $216.75 $216.75 $216.75 $216.75 $216.75 $45.17 $216.75 $216.75 $128.21 $216.75 $216.75 $216.75 $216.75 $162.75 $216.75 $216.75 $216.75 $108.38 $108.38 $171.67 $216.75 $173.40 $97.54 $43.02 N/A $125.86 $216.75 $130.05 $216.75 $45.17 $216.75 N/A N/A 5118-1-350 SUP Custom 27203010 5118-1-350 - HINGE XTRNFX M-S BOTH IP/OP $481.50 $356.00 $85.66 $481.25 $481.25 $481.25 $481.25 $481.25 $481.25 $481.25 $85.66 $481.25 $481.25 $357.18 $357.18 $370.95 $250.73 $100.30 $481.25 $192.50 $481.25 $481.25 $481.25 $481.25 $481.25 $361.13 $481.25 $481.25 $481.25 $240.63 $240.63 $381.15 $481.25 $385.00 $312.81 $481.25 N/A $279.27 $481.25 $288.75 $481.25 $481.25 $481.25 N/A N/A 5119302P2 SUP HCPCS C1713 5119302P2 - CAGE SPNL 12D 30X11X9MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5119308P2 SUP HCPCS C1713 5119308P2 - CAGE SPNL 8D 30X11X9MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5120-0-010 SUP Custom 27203010 5120-0-010 - FIXATOR EXFIX .75 RING 100MM MONTICELLI-SPINELLI GRAY BOTH IP/OP $516.00 $382.00 $91.78 $515.63 $515.63 $515.63 $515.63 $515.63 $515.63 $515.63 $91.78 $515.63 $515.63 $382.70 $382.70 $397.45 $268.64 $107.46 $515.63 $206.25 $515.63 $515.63 $515.63 $515.63 $515.63 $387.00 $515.63 $515.63 $515.63 $257.82 $257.82 $408.38 $515.63 $412.50 $335.16 $515.63 N/A $299.28 $515.63 $309.38 $515.63 $515.63 $515.63 N/A N/A 5120-0-040 SUP Custom 27203010 5120-0-040 - FIXATOR EXFIX .25 RING 115MM MONTICELLI-SPINELLI BOTH IP/OP $323.50 $239.00 $57.52 $323.13 $323.13 $323.13 $323.13 $323.13 $323.13 $323.13 $57.52 $323.13 $323.13 $239.83 $239.83 $249.07 $168.35 $67.34 $323.13 $129.25 $323.13 $323.13 $323.13 $323.13 $323.13 $242.63 $323.13 $323.13 $323.13 $161.57 $161.57 $255.92 $323.13 $258.50 $210.03 $323.13 N/A $187.63 $323.13 $193.88 $323.13 $323.13 $323.13 N/A N/A 5120-0-050 SUP Custom 27203010 5120-0-050 - FIXATOR EXFIX .75 RING 130MM MONTICELLI-SPINELLI BOTH IP/OP $591.50 $438.00 $105.24 $591.25 $591.25 $591.25 $591.25 $591.25 $591.25 $591.25 $105.24 $591.25 $591.25 $438.83 $438.83 $455.74 $308.04 $123.22 $591.25 $236.50 $591.25 $591.25 $591.25 $591.25 $591.25 $443.63 $591.25 $591.25 $591.25 $295.63 $295.63 $468.27 $591.25 $473.00 $384.31 $591.25 N/A $343.07 $591.25 $354.75 $591.25 $591.25 $591.25 N/A N/A 5120-0-060 SUP Custom 27203010 5120-0-060 - FIXATOR EXFIX .25 RING 130MM MONTICELLI-SPINELLI RED BOTH IP/OP $367.50 $272.00 $65.35 $367.13 $367.13 $367.13 $367.13 $367.13 $367.13 $367.13 $65.35 $367.13 $367.13 $272.48 $272.48 $282.98 $191.27 $76.51 $367.13 $146.85 $367.13 $367.13 $367.13 $367.13 $367.13 $275.63 $367.13 $367.13 $367.13 $183.57 $183.57 $290.77 $367.13 $293.70 $238.63 $367.13 N/A $213.15 $367.13 $220.28 $367.13 $367.13 $367.13 N/A N/A 5120-0-070 SUP Custom 27203010 5120-0-070 - FIXATOR EXFIX .75 RING 210MM MONTICELLI-SPINELLI BRONZE BOTH IP/OP $782.50 $579.00 $139.26 $782.38 $782.38 $782.38 $782.38 $782.38 $782.38 $782.38 $139.26 $782.38 $782.38 $580.68 $580.68 $603.06 $407.62 $163.06 $782.38 $312.95 $782.38 $782.38 $782.38 $782.38 $782.38 $586.88 $782.38 $782.38 $782.38 $391.19 $391.19 $619.64 $782.38 $625.90 $508.55 $782.38 N/A $453.85 $782.38 $469.43 $782.38 $782.38 $782.38 N/A N/A 5120-0-080 SUP Custom 27203010 5120-0-080 - FIXATOR EXFIX .25 RING 210MM MONTICELLI-SPINELLI BRONZE BOTH IP/OP $623.00 $461.00 $110.87 $622.88 $622.88 $622.88 $622.88 $622.88 $622.88 $622.88 $110.87 $622.88 $622.88 $462.30 $462.30 $480.12 $324.52 $129.82 $622.88 $249.15 $622.88 $622.88 $622.88 $622.88 $622.88 $467.25 $622.88 $622.88 $622.88 $311.44 $311.44 $493.32 $622.88 $498.30 $404.87 $622.88 N/A $361.34 $622.88 $373.73 $622.88 $622.88 $622.88 N/A N/A 5121302P2 SUP HCPCS C1713 5121302P2 - CAGE SPNL 12D 30X12X11MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5121308P2 SUP HCPCS C1713 5121308P2 - CAGE SPNL 8D 30X12X11MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5124308P2 SUP HCPCS C1713 5124308P2 - CAGE SPNL 8D 30X12X14MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5129302P2 SUP HCPCS C1713 5129302P2 - CAGE SPNL 12D 30X12X9MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5129308P2 SUP HCPCS C1713 5129308P2 - CAGE SPNL 8D 30X12X9MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5130-080-030 SUP Custom 27203010 5130-080-030 - RASP SURG LONG 3.2MM HELICOIDAL 3.2MM 18.3MM BOTH IP/OP $316.50 $234.00 $56.29 $316.25 $316.25 $316.25 $316.25 $316.25 $316.25 $316.25 $56.29 $316.25 $316.25 $234.72 $234.72 $243.77 $164.77 $65.91 $316.25 $126.50 $316.25 $316.25 $316.25 $316.25 $316.25 $237.38 $316.25 $316.25 $316.25 $158.13 $158.13 $250.47 $316.25 $253.00 $205.56 $316.25 N/A $183.57 $316.25 $189.75 $316.25 $316.25 $316.25 N/A N/A 5141302P2 SUP HCPCS C1713 5141302P2 - CAGE SPNL 12D 30X14X11MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5141308P2 SUP HCPCS C1713 5141308P2 - CAGE SPNL 8D 30X14X11MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5144308P2 SUP HCPCS C1713 5144308P2 - CAGE SPNL 8D 30X14X14MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5149302P2 SUP HCPCS C1713 5149302P2 - CAGE SPNL 12D 30X14X9MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5149308P2 SUP HCPCS C1713 5149308P2 - CAGE SPNL 8D 30X9X14MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5150-0-400 SUP Custom 27203010 5150-0-400 - TUBE XTRNFX 25MM RD MNTB TRX XTD DYNMC C BOTH IP/OP "$2,083.50" "$1,542.00" $370.80 "$2,083.13" "$2,083.13" "$2,083.13" "$2,083.13" "$2,083.13" "$2,083.13" "$2,083.13" $370.80 "$2,083.13" "$2,083.13" "$1,546.10" "$1,546.10" "$1,605.68" "$1,085.31" $434.15 "$2,083.13" $833.25 "$2,083.13" "$2,083.13" "$2,083.13" "$2,083.13" "$2,083.13" "$1,562.63" "$2,083.13" "$2,083.13" "$2,083.13" "$1,041.57" "$1,041.57" "$1,649.84" "$2,083.13" "$1,666.50" "$1,354.03" "$2,083.13" N/A "$1,208.43" "$2,083.13" "$1,249.88" "$2,083.13" "$2,083.13" "$2,083.13" N/A N/A 5150-0-410 SUP Custom 27203010 5150-0-410 - TUBE XTRNFX 20MM RD MNTB TRX XTD DYNMC C BOTH IP/OP "$2,186.50" "$1,618.00" $389.15 "$2,186.25" "$2,186.25" "$2,186.25" "$2,186.25" "$2,186.25" "$2,186.25" "$2,186.25" $389.15 "$2,186.25" "$2,186.25" "$1,622.63" "$1,622.63" "$1,685.16" "$1,139.04" $455.64 "$2,186.25" $874.50 "$2,186.25" "$2,186.25" "$2,186.25" "$2,186.25" "$2,186.25" "$1,639.88" "$2,186.25" "$2,186.25" "$2,186.25" "$1,093.13" "$1,093.13" "$1,731.51" "$2,186.25" "$1,749.00" "$1,421.06" "$2,186.25" N/A "$1,268.17" "$2,186.25" "$1,311.75" "$2,186.25" "$2,186.25" "$2,186.25" N/A N/A 5150-0-420 SUP Custom 27203010 5150-0-420 - TUBE XTRNFX 15MM RD MNTB TRX XTD DYNMC C BOTH IP/OP "$2,186.50" "$1,618.00" $389.15 "$2,186.25" "$2,186.25" "$2,186.25" "$2,186.25" "$2,186.25" "$2,186.25" "$2,186.25" $389.15 "$2,186.25" "$2,186.25" "$1,622.63" "$1,622.63" "$1,685.16" "$1,139.04" $455.64 "$2,186.25" $874.50 "$2,186.25" "$2,186.25" "$2,186.25" "$2,186.25" "$2,186.25" "$1,639.88" "$2,186.25" "$2,186.25" "$2,186.25" "$1,093.13" "$1,093.13" "$1,731.51" "$2,186.25" "$1,749.00" "$1,421.06" "$2,186.25" N/A "$1,268.17" "$2,186.25" "$1,311.75" "$2,186.25" "$2,186.25" "$2,186.25" N/A N/A 5150-0-465 SUP Custom 27203010 5150-0-465 - TUBE XTRNFX SM 15MM YLW MNTB TRX DYNMC SNPFT C BOTH IP/OP "$2,845.00" "$2,105.00" $506.39 "$2,844.88" "$2,844.88" "$2,844.88" "$2,844.88" "$2,844.88" "$2,844.88" "$2,844.88" $506.39 "$2,844.88" "$2,844.88" "$2,111.47" "$2,111.47" "$2,192.83" "$1,482.18" $592.90 "$2,844.88" "$1,137.95" "$2,844.88" "$2,844.88" "$2,844.88" "$2,844.88" "$2,844.88" "$2,133.75" "$2,844.88" "$2,844.88" "$2,844.88" "$1,422.44" "$1,422.44" "$2,253.14" "$2,844.88" "$2,275.90" "$1,849.17" "$2,844.88" N/A "$1,650.10" "$2,844.88" "$1,706.93" "$2,844.88" "$2,844.88" "$2,844.88" N/A N/A 5150-0-470 SUP Custom 27203010 5150-0-470 - TUBE XTRNFX MED 20MM BLU MNTB TRX DYNMC C BOTH IP/OP "$2,997.00" "$2,218.00" $533.44 "$2,996.88" "$2,996.88" "$2,996.88" "$2,996.88" "$2,996.88" "$2,996.88" "$2,996.88" $533.44 "$2,996.88" "$2,996.88" "$2,224.28" "$2,224.28" "$2,310.00" "$1,561.37" $624.58 "$2,996.88" "$1,198.75" "$2,996.88" "$2,996.88" "$2,996.88" "$2,996.88" "$2,996.88" "$2,247.75" "$2,996.88" "$2,996.88" "$2,996.88" "$1,498.44" "$1,498.44" "$2,373.53" "$2,996.88" "$2,397.50" "$1,947.97" "$2,996.88" N/A "$1,738.26" "$2,996.88" "$1,798.13" "$2,996.88" "$2,996.88" "$2,996.88" N/A N/A 5150-0-475 SUP Custom 27203010 5150-0-475 - TUBE XTRNFX 25MM RD MNTB TRX DYNMC C BOTH IP/OP "$3,068.00" "$2,270.00" $546.06 "$3,067.75" "$3,067.75" "$3,067.75" "$3,067.75" "$3,067.75" "$3,067.75" "$3,067.75" $546.06 "$3,067.75" "$3,067.75" "$2,276.88" "$2,276.88" "$2,364.62" "$1,598.30" $639.35 "$3,067.75" "$1,227.10" "$3,067.75" "$3,067.75" "$3,067.75" "$3,067.75" "$3,067.75" "$2,301.00" "$3,067.75" "$3,067.75" "$3,067.75" "$1,533.88" "$1,533.88" "$2,429.66" "$3,067.75" "$2,454.20" "$1,994.04" "$3,067.75" N/A "$1,779.44" "$3,067.75" "$1,840.65" "$3,067.75" "$3,067.75" "$3,067.75" N/A N/A 5150-0-575 SUP Custom 27203010 5150-0-575 - TUBE XTRNFX 25MM RD MNTB TRX XTD DYNMC C BOTH IP/OP "$3,651.00" "$2,702.00" $649.81 "$3,650.63" "$3,650.63" "$3,650.63" "$3,650.63" "$3,650.63" "$3,650.63" "$3,650.63" $649.81 "$3,650.63" "$3,650.63" "$2,709.50" "$2,709.50" "$2,813.91" "$1,901.98" $760.83 "$3,650.63" "$1,460.25" "$3,650.63" "$3,650.63" "$3,650.63" "$3,650.63" "$3,650.63" "$2,738.25" "$3,650.63" "$3,650.63" "$3,650.63" "$1,825.32" "$1,825.32" "$2,891.30" "$3,650.63" "$2,920.50" "$2,372.91" "$3,650.63" N/A "$2,117.58" "$3,650.63" "$2,190.38" "$3,650.63" "$3,650.63" "$3,650.63" N/A N/A 5150-2-520 SUP HCPCS C1713 5150-2-520 - CAP END SPARE MONOTUBE TRIAX BLUE 20MM TUBE BOTH IP/OP $88.00 $65.00 $17.47 $88.00 $39.60 $39.60 $39.60 $39.60 $88.00 $88.00 $88.00 $18.34 $88.00 $88.00 $88.00 $88.00 $88.00 $18.34 $88.00 $35.20 $52.05 $88.00 $88.00 $88.00 $88.00 $66.00 $88.00 $88.00 $88.00 $44.00 $44.00 $69.70 $88.00 $70.40 $39.60 $17.47 N/A $51.04 $88.00 $88.00 $88.00 $18.34 $88.00 N/A N/A 5150-2-615 SUP Custom 27203010 5150-2-615 - TUBE XTRNFX 15MM YLW MNTB TRX END CAP UNLAT C BOTH IP/OP $38.50 $28.00 $6.81 $38.25 $38.25 $38.25 $38.25 $38.25 $38.25 $38.25 $6.81 $38.25 $38.25 $28.39 $28.39 $29.48 $19.93 $7.97 $38.25 $15.30 $38.25 $38.25 $38.25 $38.25 $38.25 $28.88 $38.25 $38.25 $38.25 $19.13 $19.13 $30.29 $38.25 $30.60 $24.86 $38.25 N/A $22.33 $38.25 $22.95 $38.25 $38.25 $38.25 N/A N/A 5150-2-620 SUP Custom 27203010 5150-2-620 - SET EXFIX 20MM TUBE END CAP ASMBLY BLUE CARB BOTH IP/OP $36.00 $27.00 $6.36 $35.75 $35.75 $35.75 $35.75 $35.75 $35.75 $35.75 $6.36 $35.75 $35.75 $26.53 $26.53 $27.56 $18.63 $7.45 $35.75 $14.30 $35.75 $35.75 $35.75 $35.75 $35.75 $27.00 $35.75 $35.75 $35.75 $17.88 $17.88 $28.31 $35.75 $28.60 $23.24 $35.75 N/A $20.88 $35.75 $21.45 $35.75 $35.75 $35.75 N/A N/A 5150-2-625 SUP Custom 27203010 5150-2-625 - SET EXFIX CAP ASMBLY RED CARB TUBE BOTH IP/OP $38.50 $28.00 $6.85 $38.50 $38.50 $38.50 $38.50 $38.50 $38.50 $38.50 $6.85 $38.50 $38.50 $28.57 $28.57 $29.68 $20.06 $8.02 $38.50 $15.40 $38.50 $38.50 $38.50 $38.50 $38.50 $28.88 $38.50 $38.50 $38.50 $19.25 $19.25 $30.49 $38.50 $30.80 $25.03 $38.50 N/A $22.33 $38.50 $23.10 $38.50 $38.50 $38.50 N/A N/A 5150-3-015 SUP Custom 27203010 5150-3-015 - CLAMP SURG 15MM PIN YELLOW BOTH IP/OP $824.00 $610.00 $146.61 $823.63 $823.63 $823.63 $823.63 $823.63 $823.63 $823.63 $146.61 $823.63 $823.63 $611.30 $611.30 $634.85 $429.11 $171.65 $823.63 $329.45 $823.63 $823.63 $823.63 $823.63 $823.63 $618.00 $823.63 $823.63 $823.63 $411.82 $411.82 $652.31 $823.63 $658.90 $535.36 $823.63 N/A $477.92 $823.63 $494.18 $823.63 $823.63 $823.63 N/A N/A 5150-3-020 SUP Custom 27203010 5150-3-020 - CLAMP EXFIX 20MM PIN MONOTUBE TRIAX BLUE BOTH IP/OP "$1,154.50" $854.00 $205.44 "$1,154.13" "$1,154.13" "$1,154.13" "$1,154.13" "$1,154.13" "$1,154.13" "$1,154.13" $205.44 "$1,154.13" "$1,154.13" $856.60 $856.60 $889.60 $601.30 $240.53 "$1,154.13" $461.65 "$1,154.13" "$1,154.13" "$1,154.13" "$1,154.13" "$1,154.13" $865.88 "$1,154.13" "$1,154.13" "$1,154.13" $577.07 $577.07 $914.07 "$1,154.13" $923.30 $750.18 "$1,154.13" N/A $669.61 "$1,154.13" $692.48 "$1,154.13" "$1,154.13" "$1,154.13" N/A N/A 5150-3-025 SUP Custom 27203010 5150-3-025 - CLAMP EXFIX 25MM PIN MONOTUBE TRIAX RED BOTH IP/OP "$1,273.50" $942.00 $226.64 "$1,273.25" "$1,273.25" "$1,273.25" "$1,273.25" "$1,273.25" "$1,273.25" "$1,273.25" $226.64 "$1,273.25" "$1,273.25" $945.01 $945.01 $981.42 $663.36 $265.36 "$1,273.25" $509.30 "$1,273.25" "$1,273.25" "$1,273.25" "$1,273.25" "$1,273.25" $955.13 "$1,273.25" "$1,273.25" "$1,273.25" $636.63 $636.63 "$1,008.41" "$1,273.25" "$1,018.60" $827.61 "$1,273.25" N/A $738.63 "$1,273.25" $763.95 "$1,273.25" "$1,273.25" "$1,273.25" N/A N/A 5150-3-065 SUP Custom 27203010 5150-3-065 - CLAMP EXFIX STANDARD 15MM PIN COMPRESSION SLEEVE TIGHTEN BOTH IP/OP $969.50 $717.00 $172.55 $969.38 $969.38 $969.38 $969.38 $969.38 $969.38 $969.38 $172.55 $969.38 $969.38 $719.47 $719.47 $747.20 $505.05 $202.03 $969.38 $387.75 $969.38 $969.38 $969.38 $969.38 $969.38 $727.13 $969.38 $969.38 $969.38 $484.69 $484.69 $767.75 $969.38 $775.50 $630.10 $969.38 N/A $562.31 $969.38 $581.63 $969.38 $969.38 $969.38 N/A N/A 5150-3-070 SUP Custom 27203010 5150-3-070 - CLAMP EXFIX STANDARD 20MM PIN COMPRESSION SLEEVE TIGHTEN BOTH IP/OP "$1,687.00" "$1,248.00" $300.29 "$1,687.00" "$1,687.00" "$1,687.00" "$1,687.00" "$1,687.00" "$1,687.00" "$1,687.00" $300.29 "$1,687.00" "$1,687.00" "$1,252.09" "$1,252.09" "$1,300.34" $878.93 $351.59 "$1,687.00" $674.80 "$1,687.00" "$1,687.00" "$1,687.00" "$1,687.00" "$1,687.00" "$1,265.25" "$1,687.00" "$1,687.00" "$1,687.00" $843.50 $843.50 "$1,336.10" "$1,687.00" "$1,349.60" "$1,096.55" "$1,687.00" N/A $978.46 "$1,687.00" "$1,012.20" "$1,687.00" "$1,687.00" "$1,687.00" N/A N/A 5150-3-075 SUP Custom 27203010 5150-3-075 - CLAMP EXFIX STANDARD 25MM PIN COMPRESSION SLEEVE TIGHTEN BOTH IP/OP "$1,992.50" "$1,474.00" $354.64 "$1,992.38" "$1,992.38" "$1,992.38" "$1,992.38" "$1,992.38" "$1,992.38" "$1,992.38" $354.64 "$1,992.38" "$1,992.38" "$1,478.74" "$1,478.74" "$1,535.73" "$1,038.03" $415.23 "$1,992.38" $796.95 "$1,992.38" "$1,992.38" "$1,992.38" "$1,992.38" "$1,992.38" "$1,494.38" "$1,992.38" "$1,992.38" "$1,992.38" $996.19 $996.19 "$1,577.96" "$1,992.38" "$1,593.90" "$1,295.05" "$1,992.38" N/A "$1,155.65" "$1,992.38" "$1,195.43" "$1,992.38" "$1,992.38" "$1,992.38" N/A N/A 5150-3-165 SUP Custom 27203010 5150-3-165 - CLAMP EXFIX 15MM .75MM 1 PIN TOP LOCK SERRATE INTERLOCK FIRM BOTH IP/OP "$1,045.00" $773.00 $186.01 "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" $186.01 "$1,045.00" "$1,045.00" $775.60 $775.60 $805.49 $544.45 $217.79 "$1,045.00" $418.00 "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" "$1,045.00" $783.75 "$1,045.00" "$1,045.00" "$1,045.00" $522.50 $522.50 $827.64 "$1,045.00" $836.00 $679.25 "$1,045.00" N/A $606.10 "$1,045.00" $627.00 "$1,045.00" "$1,045.00" "$1,045.00" N/A N/A 5150-3-170 SUP Custom 27203010 5150-3-170 - CLAMP EXFIX 20MM 4/5MM 1 PIN TOP LOCK SERRATE FIRM GRIP BOTH IP/OP "$1,069.50" $791.00 $190.33 "$1,069.25" "$1,069.25" "$1,069.25" "$1,069.25" "$1,069.25" "$1,069.25" "$1,069.25" $190.33 "$1,069.25" "$1,069.25" $793.60 $793.60 $824.18 $557.08 $222.84 "$1,069.25" $427.70 "$1,069.25" "$1,069.25" "$1,069.25" "$1,069.25" "$1,069.25" $802.13 "$1,069.25" "$1,069.25" "$1,069.25" $534.63 $534.63 $846.85 "$1,069.25" $855.40 $695.01 "$1,069.25" N/A $620.31 "$1,069.25" $641.55 "$1,069.25" "$1,069.25" "$1,069.25" N/A N/A 5150-3-175 SUP Custom 27203010 5150-3-175 - CLAMP EXFIX 25MM 5/6MM 1 PIN TOP LOCK SERRATE INTERLOCK FIRM BOTH IP/OP "$1,102.00" $815.00 $196.09 "$1,101.63" "$1,101.63" "$1,101.63" "$1,101.63" "$1,101.63" "$1,101.63" "$1,101.63" $196.09 "$1,101.63" "$1,101.63" $817.63 $817.63 $849.14 $573.95 $229.59 "$1,101.63" $440.65 "$1,101.63" "$1,101.63" "$1,101.63" "$1,101.63" "$1,101.63" $826.50 "$1,101.63" "$1,101.63" "$1,101.63" $550.82 $550.82 $872.49 "$1,101.63" $881.30 $716.06 "$1,101.63" N/A $639.16 "$1,101.63" $660.98 "$1,101.63" "$1,101.63" "$1,101.63" N/A N/A 5150-3-315 SUP Custom 27203010 5150-3-315 - CLAMP EXFIX SMALL T MONOTUBE TRIAX YELLOW BOTH IP/OP "$1,279.00" $946.00 $227.62 "$1,278.75" "$1,278.75" "$1,278.75" "$1,278.75" "$1,278.75" "$1,278.75" "$1,278.75" $227.62 "$1,278.75" "$1,278.75" $949.09 $949.09 $985.66 $666.23 $266.51 "$1,278.75" $511.50 "$1,278.75" "$1,278.75" "$1,278.75" "$1,278.75" "$1,278.75" $959.25 "$1,278.75" "$1,278.75" "$1,278.75" $639.38 $639.38 "$1,012.77" "$1,278.75" "$1,023.00" $831.19 "$1,278.75" N/A $741.82 "$1,278.75" $767.25 "$1,278.75" "$1,278.75" "$1,278.75" N/A N/A 5150-3-320 SUP Custom 27203010 5150-3-320 - CLAMP EXFIX MEDIUM T MONOTUBE TRIAX BLUE BOTH IP/OP "$1,363.00" "$1,009.00" $242.55 "$1,362.63" "$1,362.63" "$1,362.63" "$1,362.63" "$1,362.63" "$1,362.63" "$1,362.63" $242.55 "$1,362.63" "$1,362.63" "$1,011.34" "$1,011.34" "$1,050.32" $709.93 $283.99 "$1,362.63" $545.05 "$1,362.63" "$1,362.63" "$1,362.63" "$1,362.63" "$1,362.63" "$1,022.25" "$1,362.63" "$1,362.63" "$1,362.63" $681.32 $681.32 "$1,079.20" "$1,362.63" "$1,090.10" $885.71 "$1,362.63" N/A $790.54 "$1,362.63" $817.58 "$1,362.63" "$1,362.63" "$1,362.63" N/A N/A 5150-3-415 SUP Custom 27203010 5150-3-415 - CLAMP EXFIX 15MM 7MM 2 JAW TUBE TO TUBE SERRATE TEETH TRIAX BOTH IP/OP "$1,345.00" $995.00 $239.37 "$1,344.75" "$1,344.75" "$1,344.75" "$1,344.75" "$1,344.75" "$1,344.75" "$1,344.75" $239.37 "$1,344.75" "$1,344.75" $998.07 $998.07 "$1,036.53" $700.61 $280.26 "$1,344.75" $537.90 "$1,344.75" "$1,344.75" "$1,344.75" "$1,344.75" "$1,344.75" "$1,008.75" "$1,344.75" "$1,344.75" "$1,344.75" $672.38 $672.38 "$1,065.04" "$1,344.75" "$1,075.80" $874.09 "$1,344.75" N/A $780.10 "$1,344.75" $806.85 "$1,344.75" "$1,344.75" "$1,344.75" N/A N/A 5150-3-420 SUP Custom 27203010 5150-3-420 - CLAMP EXFIX 20MM 7MM 2 JAW TUBE TO TUBE SERRATE TEETH TRIAX BOTH IP/OP "$1,394.00" "$1,032.00" $248.11 "$1,393.88" "$1,393.88" "$1,393.88" "$1,393.88" "$1,393.88" "$1,393.88" "$1,393.88" $248.11 "$1,393.88" "$1,393.88" "$1,034.54" "$1,034.54" "$1,074.40" $726.21 $290.50 "$1,393.88" $557.55 "$1,393.88" "$1,393.88" "$1,393.88" "$1,393.88" "$1,393.88" "$1,045.50" "$1,393.88" "$1,393.88" "$1,393.88" $696.94 $696.94 "$1,103.95" "$1,393.88" "$1,115.10" $906.02 "$1,393.88" N/A $808.52 "$1,393.88" $836.33 "$1,393.88" "$1,393.88" "$1,393.88" N/A N/A 5150-3-425 SUP Custom 27203010 5150-3-425 - CLAMP EXFIX 25MM 7MM 2 JAW TUBE TO TUBE SERRATE TEETH TRIAX BOTH IP/OP "$1,409.00" "$1,043.00" $250.76 "$1,408.75" "$1,408.75" "$1,408.75" "$1,408.75" "$1,408.75" "$1,408.75" "$1,408.75" $250.76 "$1,408.75" "$1,408.75" "$1,045.57" "$1,045.57" "$1,085.86" $733.96 $293.60 "$1,408.75" $563.50 "$1,408.75" "$1,408.75" "$1,408.75" "$1,408.75" "$1,408.75" "$1,056.75" "$1,408.75" "$1,408.75" "$1,408.75" $704.38 $704.38 "$1,115.73" "$1,408.75" "$1,127.00" $915.69 "$1,408.75" N/A $817.22 "$1,408.75" $845.25 "$1,408.75" "$1,408.75" "$1,408.75" N/A N/A 5150-3-435 SUP Custom 27203010 5150-3-435 - CLAMP EXFIX 20MM 15MM 2 JAW TUBE TO TUBE SERRATE TEETH TRIAX BOTH IP/OP "$1,398.50" "$1,035.00" $248.91 "$1,398.38" "$1,398.38" "$1,398.38" "$1,398.38" "$1,398.38" "$1,398.38" "$1,398.38" $248.91 "$1,398.38" "$1,398.38" "$1,037.88" "$1,037.88" "$1,077.87" $728.56 $291.44 "$1,398.38" $559.35 "$1,398.38" "$1,398.38" "$1,398.38" "$1,398.38" "$1,398.38" "$1,048.88" "$1,398.38" "$1,398.38" "$1,398.38" $699.19 $699.19 "$1,107.52" "$1,398.38" "$1,118.70" $908.95 "$1,398.38" N/A $811.13 "$1,398.38" $839.03 "$1,398.38" "$1,398.38" "$1,398.38" N/A N/A 5150-3-445 SUP Custom 27203010 5150-3-445 - CLAMP EXFIX 25MM 20MM 2 JAW TUBE TO TUBE SERRATE TEETH TRIAX BOTH IP/OP "$1,409.00" "$1,043.00" $250.76 "$1,408.75" "$1,408.75" "$1,408.75" "$1,408.75" "$1,408.75" "$1,408.75" "$1,408.75" $250.76 "$1,408.75" "$1,408.75" "$1,045.57" "$1,045.57" "$1,085.86" $733.96 $293.60 "$1,408.75" $563.50 "$1,408.75" "$1,408.75" "$1,408.75" "$1,408.75" "$1,408.75" "$1,056.75" "$1,408.75" "$1,408.75" "$1,408.75" $704.38 $704.38 "$1,115.73" "$1,408.75" "$1,127.00" $915.69 "$1,408.75" N/A $817.22 "$1,408.75" $845.25 "$1,408.75" "$1,408.75" "$1,408.75" N/A N/A 5150-4-065 SUP Custom 27203010 5150-4-065 - ADAPTER XTRNFX T 15MM YLW MNTB TRX PIN CLP BOTH IP/OP $676.50 $501.00 $120.42 $676.50 $676.50 $676.50 $676.50 $676.50 $676.50 $676.50 $120.42 $676.50 $676.50 $502.10 $502.10 $521.45 $352.46 $140.99 $676.50 $270.60 $676.50 $676.50 $676.50 $676.50 $676.50 $507.38 $676.50 $676.50 $676.50 $338.25 $338.25 $535.79 $676.50 $541.20 $439.73 $676.50 N/A $392.37 $676.50 $405.90 $676.50 $676.50 $676.50 N/A N/A 5150-4-070 SUP Custom 27203010 5150-4-070 - CLAMP EXFIX 20MM T ADAPTER MONOTUBE TRIAX BLUE BOTH IP/OP $695.00 $514.00 $123.67 $694.75 $694.75 $694.75 $694.75 $694.75 $694.75 $694.75 $123.67 $694.75 $694.75 $515.64 $515.64 $535.51 $361.96 $144.79 $694.75 $277.90 $694.75 $694.75 $694.75 $694.75 $694.75 $521.25 $694.75 $694.75 $694.75 $347.38 $347.38 $550.24 $694.75 $555.80 $451.59 $694.75 N/A $403.10 $694.75 $416.85 $694.75 $694.75 $694.75 N/A N/A 5150-4-075 SUP Custom 27203010 5150-4-075 - CLAMP EXFIX 25MM T ADAPTER MONOTUBE TRIAX RED BOTH IP/OP $710.50 $526.00 $126.47 $710.50 $710.50 $710.50 $710.50 $710.50 $710.50 $710.50 $126.47 $710.50 $710.50 $527.33 $527.33 $547.65 $370.17 $148.08 $710.50 $284.20 $710.50 $710.50 $710.50 $710.50 $710.50 $532.88 $710.50 $710.50 $710.50 $355.25 $355.25 $562.72 $710.50 $568.40 $461.83 $710.50 N/A $412.09 $710.50 $426.30 $710.50 $710.50 $710.50 N/A N/A 5150-5-020 SUP Custom 27203010 5150-5-020 - HOLDER XTRNFX 20MM BLU MNTB TRX PIN BOTH IP/OP "$2,864.50" "$2,120.00" $509.82 "$2,864.13" "$2,864.13" "$2,864.13" "$2,864.13" "$2,864.13" "$2,864.13" "$2,864.13" $509.82 "$2,864.13" "$2,864.13" "$2,125.76" "$2,125.76" "$2,207.67" "$1,492.21" $596.92 "$2,864.13" "$1,145.65" "$2,864.13" "$2,864.13" "$2,864.13" "$2,864.13" "$2,864.13" "$2,148.38" "$2,864.13" "$2,864.13" "$2,864.13" "$1,432.07" "$1,432.07" "$2,268.39" "$2,864.13" "$2,291.30" "$1,861.68" "$2,864.13" N/A "$1,661.41" "$2,864.13" "$1,718.48" "$2,864.13" "$2,864.13" "$2,864.13" N/A N/A 5150-5-025 SUP Custom 27203010 5150-5-025 - HOLDER XTRNFX 25MM RD MNTB TRX PIN BOTH IP/OP "$2,864.50" "$2,120.00" $509.82 "$2,864.13" "$2,864.13" "$2,864.13" "$2,864.13" "$2,864.13" "$2,864.13" "$2,864.13" $509.82 "$2,864.13" "$2,864.13" "$2,125.76" "$2,125.76" "$2,207.67" "$1,492.21" $596.92 "$2,864.13" "$1,145.65" "$2,864.13" "$2,864.13" "$2,864.13" "$2,864.13" "$2,864.13" "$2,148.38" "$2,864.13" "$2,864.13" "$2,864.13" "$1,432.07" "$1,432.07" "$2,268.39" "$2,864.13" "$2,291.30" "$1,861.68" "$2,864.13" N/A "$1,661.41" "$2,864.13" "$1,718.48" "$2,864.13" "$2,864.13" "$2,864.13" N/A N/A 5150-7-020 SUP Custom 27203010 5150-7-020 - O RING XTRNFX YLW MNTB TRX BOTH IP/OP $24.50 $18.00 $4.29 $24.08 $24.08 $24.08 $24.08 $24.08 $24.08 $24.08 $4.29 $24.08 $24.08 $17.87 $17.87 $18.56 $12.55 $5.02 $24.08 $9.63 $24.08 $24.08 $24.08 $24.08 $24.08 $18.38 $24.08 $24.08 $24.08 $12.04 $12.04 $19.07 $24.08 $19.26 $15.65 $24.08 N/A $14.21 $24.08 $14.45 $24.08 $24.08 $24.08 N/A N/A 5150-9-465 SUP Custom 27203010 5150-9-465 - DEVICE COMPRESSION/DISTRCT 15MM TRIAX MONOTUBE YELLOW BOTH IP/OP "$1,697.00" "$1,256.00" $302.02 "$1,696.75" "$1,696.75" "$1,696.75" "$1,696.75" "$1,696.75" "$1,696.75" "$1,696.75" $302.02 "$1,696.75" "$1,696.75" "$1,259.33" "$1,259.33" "$1,307.85" $884.01 $353.62 "$1,696.75" $678.70 "$1,696.75" "$1,696.75" "$1,696.75" "$1,696.75" "$1,696.75" "$1,272.75" "$1,696.75" "$1,696.75" "$1,696.75" $848.38 $848.38 "$1,343.83" "$1,696.75" "$1,357.40" "$1,102.89" "$1,696.75" N/A $984.26 "$1,696.75" "$1,018.05" "$1,696.75" "$1,696.75" "$1,696.75" N/A N/A 5150-9-535 SUP Custom 27203010 5150-9-535 - SLEEVE DRILL SMALL MONOTUBE 3 MMBLOCKS BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A 5150-9-545 SUP Custom 27203010 5150-9-545 - SLEEVE DRILL SMALL MONOTUBE 4 MMBLOCKS BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A 5150-9-950 SUP Custom 27203010 5150-9-950 - KIT EXFIX MONOTUBE YELLOW STERILE BOTH IP/OP "$2,716.00" "$2,010.00" $483.38 "$2,715.63" "$2,715.63" "$2,715.63" "$2,715.63" "$2,715.63" "$2,715.63" "$2,715.63" $483.38 "$2,715.63" "$2,715.63" "$2,015.54" "$2,015.54" "$2,093.21" "$1,414.84" $565.97 "$2,715.63" "$1,086.25" "$2,715.63" "$2,715.63" "$2,715.63" "$2,715.63" "$2,715.63" "$2,037.00" "$2,715.63" "$2,715.63" "$2,715.63" "$1,357.82" "$1,357.82" "$2,150.78" "$2,715.63" "$2,172.50" "$1,765.16" "$2,715.63" N/A "$1,575.28" "$2,715.63" "$1,629.38" "$2,715.63" "$2,715.63" "$2,715.63" N/A N/A 5150-9-960 SUP Custom 27203010 5150-9-960 - SET EXFIX 15MM 310X130X36MM T WRENCH PIN CLMP CARFBR TUBE BOTH IP/OP "$2,570.50" "$1,902.00" $457.50 "$2,570.25" "$2,570.25" "$2,570.25" "$2,570.25" "$2,570.25" "$2,570.25" "$2,570.25" $457.50 "$2,570.25" "$2,570.25" "$1,907.64" "$1,907.64" "$1,981.15" "$1,339.10" $535.67 "$2,570.25" "$1,028.10" "$2,570.25" "$2,570.25" "$2,570.25" "$2,570.25" "$2,570.25" "$1,927.88" "$2,570.25" "$2,570.25" "$2,570.25" "$1,285.13" "$1,285.13" "$2,035.64" "$2,570.25" "$2,056.20" "$1,670.66" "$2,570.25" N/A "$1,490.89" "$2,570.25" "$1,542.15" "$2,570.25" "$2,570.25" "$2,570.25" N/A N/A 515-203 SUP HCPCS C1713 515-203 - SCREW BONE 1.5MM 3MM SELF DRILL QUADRIVE TIMESH TITANIUM SPN BOTH IP/OP $92.00 $68.00 $18.21 $91.73 $41.28 $41.28 $41.28 $41.28 $91.73 $91.73 $91.73 $19.12 $91.73 $91.73 $91.73 $91.73 $91.73 $19.12 $91.73 $36.69 $54.26 $91.73 $91.73 $91.73 $91.73 $69.00 $91.73 $91.73 $91.73 $45.87 $45.87 $72.65 $91.73 $73.38 $41.28 $18.21 N/A $53.36 $91.73 $91.73 $91.73 $19.12 $91.73 N/A N/A 515-204 SUP HCPCS C1713 515-204 - SCREW BONE 1.5MM 4MM TIMESH QUADRIVE TITANIUM CRANFCL BOTH IP/OP $92.00 $68.00 $18.21 $91.73 $41.28 $41.28 $41.28 $41.28 $91.73 $91.73 $91.73 $19.12 $91.73 $91.73 $91.73 $91.73 $91.73 $19.12 $91.73 $36.69 $54.26 $91.73 $91.73 $91.73 $91.73 $69.00 $91.73 $91.73 $91.73 $45.87 $45.87 $72.65 $91.73 $73.38 $41.28 $18.21 N/A $53.36 $91.73 $91.73 $91.73 $19.12 $91.73 N/A N/A 515-205 SUP HCPCS C1713 515-205 - SCREW BONE 1.5MM 5MM SELF DRILL QUADRIVE TIMESH TITANIUM SPN BOTH IP/OP $96.50 $71.00 $19.12 $96.33 $43.35 $43.35 $43.35 $43.35 $96.33 $96.33 $96.33 $20.08 $96.33 $96.33 $96.33 $96.33 $96.33 $20.08 $96.33 $38.53 $56.98 $96.33 $96.33 $96.33 $96.33 $72.38 $96.33 $96.33 $96.33 $48.17 $48.17 $76.29 $96.33 $77.06 $43.35 $19.12 N/A $55.97 $96.33 $96.33 $96.33 $20.08 $96.33 N/A N/A 515-206 SUP HCPCS C1713 515-206 - SCREW BONE 1.5MM 6MM SELF DRILL QUADRIVE TIMESH TITANIUM SPN BOTH IP/OP $98.00 $73.00 $19.40 $97.75 $43.99 $43.99 $43.99 $43.99 $97.75 $97.75 $97.75 $20.37 $97.75 $97.75 $97.75 $97.75 $97.75 $20.37 $97.75 $39.10 $57.82 $97.75 $97.75 $97.75 $97.75 $73.50 $97.75 $97.75 $97.75 $48.88 $48.88 $77.42 $97.75 $78.20 $43.99 $19.40 N/A $56.84 $97.75 $97.75 $97.75 $20.37 $97.75 N/A N/A 515-633 SUP HCPCS C1781 515-633 - PLATE BONE SMALL 33X18MM MESH TIMESH TITANIUM TEMPORAL BOTH IP/OP $814.00 $602.00 $161.53 $813.88 $366.25 $366.25 $366.25 $366.25 $813.88 $813.88 $813.88 $169.63 $813.88 $813.88 $813.88 $813.88 $813.88 $169.62 $813.88 $813.88 $481.41 $813.88 $813.88 $813.88 $813.88 $610.50 $813.88 $813.88 $813.88 $406.94 $406.94 $644.59 $813.88 $651.10 $366.25 $161.53 N/A $472.12 $813.88 $813.88 $813.88 $169.61 $813.88 N/A N/A 5157M/S SUP HCPCS C1786 5157M/S - PACEMAKER CARDIAC THK6MM 52X42MM 1 CHAMBER RATE RESPONSIVE BOTH IP/OP "$7,425.00" "$5,495.00" "$1,473.68" "$7,425.00" "$3,341.25" "$3,341.25" "$3,341.25" "$3,341.25" "$7,425.00" "$7,425.00" "$7,425.00" "$1,547.56" "$7,425.00" "$7,425.00" "$7,425.00" "$7,425.00" "$7,425.00" "$1,547.45" "$7,425.00" "$7,425.00" "$3,660.53" "$7,425.00" "$7,425.00" "$7,425.00" "$7,425.00" "$5,568.75" "$7,425.00" "$7,425.00" "$7,425.00" "$3,712.50" "$3,712.50" "$5,880.60" "$7,425.00" "$5,940.00" "$3,341.25" "$1,473.68" N/A "$4,306.50" "$7,425.00" "$7,425.00" "$7,425.00" "$1,547.37" "$7,425.00" N/A N/A 51-672-01-09 SUP Custom 27803010 51-672-01-09 - ROD EXFIX FULL PREBENT MANDIB BOTH IP/OP "$1,844.00" "$1,365.00" $328.16 "$1,843.58" "$1,843.58" "$1,843.58" "$1,843.58" "$1,843.58" "$1,843.58" "$1,843.58" $328.16 "$1,843.58" "$1,843.58" "$1,843.58" "$1,843.58" "$1,843.58" "$1,843.58" $384.22 "$1,843.58" $737.43 "$1,843.58" "$1,843.58" "$1,843.58" "$1,843.58" "$1,843.58" "$1,383.00" "$1,843.58" "$1,843.58" "$1,843.58" $921.79 $921.79 "$1,460.12" "$1,843.58" "$1,474.86" $829.61 "$1,843.58" N/A "$1,069.52" "$1,843.58" "$1,106.15" "$1,843.58" "$1,843.58" "$1,843.58" N/A N/A 51-672-05-09 SUP Custom 27803010 51-672-05-09 - ROD EXFIX .5 PREBENT MANDIB BOTH IP/OP "$1,317.50" $975.00 $234.47 "$1,317.25" "$1,317.25" "$1,317.25" "$1,317.25" "$1,317.25" "$1,317.25" "$1,317.25" $234.47 "$1,317.25" "$1,317.25" "$1,317.25" "$1,317.25" "$1,317.25" "$1,317.25" $274.53 "$1,317.25" $526.90 "$1,317.25" "$1,317.25" "$1,317.25" "$1,317.25" "$1,317.25" $988.13 "$1,317.25" "$1,317.25" "$1,317.25" $658.63 $658.63 "$1,043.26" "$1,317.25" "$1,053.80" $592.76 "$1,317.25" N/A $764.15 "$1,317.25" $790.35 "$1,317.25" "$1,317.25" "$1,317.25" N/A N/A 51-673-09-09 SUP Custom 27803010 51-673-09-09 - PIN XTRNFX 4MM 2.7MM 80MM LF 9MM X-FX THRD TI CRNMXF BOTH IP/OP $543.50 $402.00 $96.66 $543.05 $543.05 $543.05 $543.05 $543.05 $543.05 $543.05 $96.66 $543.05 $543.05 $543.05 $543.05 $543.05 $543.05 $113.18 $543.05 $217.22 $543.05 $543.05 $543.05 $543.05 $543.05 $407.63 $543.05 $543.05 $543.05 $271.53 $271.53 $430.10 $543.05 $434.44 $244.37 $543.05 N/A $315.23 $543.05 $325.83 $543.05 $543.05 $543.05 N/A N/A 51-673-13-09 SUP Custom 27803010 51-673-13-09 - PIN XTRNFX 4MM 2.7MM 80MM LF 13MM X-FX THRD TI CRNMXF BOTH IP/OP $543.50 $402.00 $96.66 $543.05 $543.05 $543.05 $543.05 $543.05 $543.05 $543.05 $96.66 $543.05 $543.05 $543.05 $543.05 $543.05 $543.05 $113.18 $543.05 $217.22 $543.05 $543.05 $543.05 $543.05 $543.05 $407.63 $543.05 $543.05 $543.05 $271.53 $271.53 $430.10 $543.05 $434.44 $244.37 $543.05 N/A $315.23 $543.05 $325.83 $543.05 $543.05 $543.05 N/A N/A 518-032 SUP HCPCS C1887 518-032 - CATHETER GUID .014IN 15MM SPACE 1.5FR 135CM RADIOPQ MARKER BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A 518-033 SUP HCPCS C1887 518-033 - CATHETER GUID .018IN 3.4-2.2FR 90CM LOW CROSSING PROFILE 3 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A 518-034 SUP HCPCS C1887 518-034 - CATHETER GUID .018IN 3.4-2.3FR 135CM RADIOPQ MARKER GWIRE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A 518-035 SUP HCPCS C1887 518-035 - CATHETER GUID .018IN 15MM SPACING 1.8FR 150CM RADIOPQ MARKER BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A 518-036 SUP HCPCS C1887 518-036 - CATHETER GUID .035IN 4.8-3.7FR 90CM LOW CROSSING PROFILE 3 BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A 518-037 SUP HCPCS C1887 518-037 - CATHETER GUID .035IN 50MM SPACE 3.1FR 135CM RADIOPQ MARKER BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A 518-038 SUP HCPCS C1887 518-038 - CATHETER GUID .035IN 5MM SPACING 3.1FR 150CM LP TAPERED TIP BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A 518-065 SUP HCPCS C1887 518-065 - CATHETER GUID .014IN 3-1.9FR 150CM 3 RADIOPQ MARKER LOW BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A 518-066 SUP HCPCS C1887 518-066 - CATHETER GUID .035IN 4.8-3.7FR 65CM LOW CROSSING PROFILE 3 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A 518-076 SUP HCPCS C1887 518-076 - CATHETER GUID .035IN 50MM SPACING 4.5FR 65CM STR TIP RADIOPQ BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-077 SUP HCPCS C1887 518-077 - CATHETER GUID .035IN 4FR 65CM ANGLED TIP QUICK-CROSS BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-078 SUP HCPCS C1887 518-078 - CATHETER GUID .035IN 50MM SPACING 4.5FR 90CM 70CM STR TIP BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-079 SUP HCPCS C1887 518-079 - CATHETER GUID .035IN 4FR 90CM SUPPORT ANGLED TIP QUICK-CROSS BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-080 SUP HCPCS C1887 518-080 - CATHETER SPRT .035IN STRG 135CM QKCRS BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-081 SUP HCPCS C1887 518-081 - CATHETER GUID 45D 50MM SPACE LP .052-.059IN 135CM 7MM 3 BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-082 SUP HCPCS C1887 518-082 - CATHETER GUID .035IN 50MM SPACING 4.5FR 150CM 130CM STR TIP BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-083 SUP HCPCS C1887 518-083 - CATHETER GUID .035IN 4FR 150CM 3 RADIOPQ MARKER SUPPORT BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-084 SUP HCPCS C1887 518-084 - CATHETER GD 15MM SPC 1.9FR 135CM STRL QKCRS XTRM RADOPQ BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-085 SUP HCPCS C1887 518-085 - CATHETER GUID 45D .014IN 15MM SPACING 3.2FR 135CM 100CM BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-086 SUP HCPCS C1887 518-086 - CATHETER GUID .014IN 15MM SPACING 3.2FR 150CM 100CM STR TIP BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-087 SUP HCPCS C1887 518-087 - CATHETER GUID .014IN 150CM 3 RADIOPQ MARKER LOW CROSSING BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-088 SUP HCPCS C1887 518-088 - CATHETER GUID .018IN 15MM SPACING 3.4FR 90CM 60CM STR TIP BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-089 SUP HCPCS C1887 518-089 - CATHETER GUID .018IN 15MM SPACING 3.4FR 90CM 60CM ANGLED TIP BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-090 SUP HCPCS C1887 518-090 - CATHETER GUID .018IN 15MM SPACING 3.2FR 135CM 100CM STR TIP BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-091 SUP HCPCS C1887 518-091 - CATHETER GUID .018IN 15MM SPACING 3.4FR 135CM 100CM ANGLED BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 518-092 SUP HCPCS C1887 518-092 - CATHETER GUID .018IN 15MM SPACING 3.4FR 150CM 100CM STR TIP BOTH IP/OP $507.50 $376.00 $100.73 $507.50 $275.57 $275.57 $275.57 $275.57 $507.50 $507.50 $507.50 $105.78 $507.50 $376.67 $376.67 $391.18 $264.41 $105.77 $507.50 $507.50 $300.19 $507.50 $507.50 $507.50 $507.50 $380.63 $507.50 $507.50 $507.50 $253.75 $253.75 $401.94 $507.50 $406.00 $329.88 $100.73 N/A $294.35 $507.50 $507.50 $507.50 $105.76 $507.50 N/A N/A 5181302P2 SUP HCPCS C1713 5181302P2 - CAGE SPNL 12D 30X8X11MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5181308P2 SUP HCPCS C1713 5181308P2 - CAGE SPNL 8D 30X8X11MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 518-203 SUP HCPCS C1713 518-203 - SCREW BONE 1.8MM 3MM SELF DRILL QUADRIVE RESCUE TITANIUM SPN BOTH IP/OP $96.50 $71.00 $19.12 $96.33 $43.35 $43.35 $43.35 $43.35 $96.33 $96.33 $96.33 $20.08 $96.33 $96.33 $96.33 $96.33 $96.33 $20.08 $96.33 $38.53 $56.98 $96.33 $96.33 $96.33 $96.33 $72.38 $96.33 $96.33 $96.33 $48.17 $48.17 $76.29 $96.33 $77.06 $43.35 $19.12 N/A $55.97 $96.33 $57.80 $96.33 $20.08 $96.33 N/A N/A 518-205 SUP HCPCS C1713 518-205 - SCREW BONE 1.8MM 5MM SELF DRILL QUADRIVE RESCUE TITANIUM SPN BOTH IP/OP $96.50 $71.00 $19.12 $96.33 $43.35 $43.35 $43.35 $43.35 $96.33 $96.33 $96.33 $20.08 $96.33 $96.33 $96.33 $96.33 $96.33 $20.08 $96.33 $38.53 $56.98 $96.33 $96.33 $96.33 $96.33 $72.38 $96.33 $96.33 $96.33 $48.17 $48.17 $76.29 $96.33 $77.06 $43.35 $19.12 N/A $55.97 $96.33 $57.80 $96.33 $20.08 $96.33 N/A N/A 518-306 SUP HCPCS C1713 518-306 - SCREW BONE 6MM QUADRIVE SPN BOTH IP/OP $80.00 $59.00 $15.82 $79.70 $35.87 $35.87 $35.87 $35.87 $79.70 $79.70 $79.70 $16.61 $79.70 $79.70 $79.70 $79.70 $79.70 $16.61 $79.70 $79.70 $47.14 $79.70 $79.70 $79.70 $79.70 $60.00 $79.70 $79.70 $79.70 $39.85 $39.85 $63.12 $79.70 $63.76 $35.87 $15.82 N/A $46.40 $79.70 $79.70 $79.70 $16.61 $79.70 N/A N/A 5184308P2 SUP HCPCS C1713 5184308P2 - CAGE SPNL 8D 30X8X14MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5189302P2 SUP HCPCS C1713 5189302P2 - CAGE SPNL 12D 30X8X9MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5189308P2 SUP HCPCS C1713 5189308P2 - CAGE SPNL 8D 30X8X9MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5190-0-010 SUP Custom 27203010 5190-0-010 - SET ORTHOPEDIC Y BODY ASMBLY BOTH IP/OP "$1,588.50" "$1,175.00" $282.69 "$1,588.13" "$1,588.13" "$1,588.13" "$1,588.13" "$1,588.13" "$1,588.13" "$1,588.13" $282.69 "$1,588.13" "$1,588.13" "$1,178.71" "$1,178.71" "$1,224.13" $827.42 $330.98 "$1,588.13" $635.25 "$1,588.13" "$1,588.13" "$1,588.13" "$1,588.13" "$1,588.13" "$1,191.38" "$1,588.13" "$1,588.13" "$1,588.13" $794.07 $794.07 "$1,257.80" "$1,588.13" "$1,270.50" "$1,032.28" "$1,588.13" N/A $921.33 "$1,588.13" $952.88 "$1,588.13" "$1,588.13" "$1,588.13" N/A N/A 5190-0-020 SUP Custom 27203010 5190-0-020 - COUPLING EXFIX PIN TO ROD BOTH IP/OP $598.50 $443.00 $106.47 $598.13 $598.13 $598.13 $598.13 $598.13 $598.13 $598.13 $106.47 $598.13 $598.13 $443.93 $443.93 $461.04 $311.63 $124.66 $598.13 $239.25 $598.13 $598.13 $598.13 $598.13 $598.13 $448.88 $598.13 $598.13 $598.13 $299.07 $299.07 $473.72 $598.13 $478.50 $388.78 $598.13 N/A $347.13 $598.13 $358.88 $598.13 $598.13 $598.13 N/A N/A 5190-0-110 SUP Custom 27203010 5190-0-110 - SET ORTHOPEDIC STR BODY ASMBLY BOTH IP/OP "$1,052.00" $778.00 $187.23 "$1,051.88" "$1,051.88" "$1,051.88" "$1,051.88" "$1,051.88" "$1,051.88" "$1,051.88" $187.23 "$1,051.88" "$1,051.88" $780.71 $780.71 $810.79 $548.03 $219.22 "$1,051.88" $420.75 "$1,051.88" "$1,051.88" "$1,051.88" "$1,051.88" "$1,051.88" $789.00 "$1,051.88" "$1,051.88" "$1,051.88" $525.94 $525.94 $833.09 "$1,051.88" $841.50 $683.72 "$1,051.88" N/A $610.16 "$1,051.88" $631.13 "$1,051.88" "$1,051.88" "$1,051.88" N/A N/A 5190-0-200 SUP HCPCS C1713 5190-0-200 - PIN DISTRACTION STOP COLLAR BOTH IP/OP $241.00 $178.00 $47.76 $240.63 $108.28 $108.28 $108.28 $108.28 $240.63 $240.63 $240.63 $50.15 $240.63 $240.63 $240.63 $240.63 $240.63 $50.15 $240.63 $96.25 $142.33 $240.63 $240.63 $240.63 $240.63 $180.75 $240.63 $240.63 $240.63 $120.32 $120.32 $190.58 $240.63 $192.50 $108.28 $47.76 N/A $139.78 $240.63 $240.63 $240.63 $50.15 $240.63 N/A N/A 5190-0-210 SUP Custom 27203010 5190-0-210 - ROD EXFIX STR THREADED BOTH IP/OP $131.00 $97.00 $23.25 $130.63 $130.63 $130.63 $130.63 $130.63 $130.63 $130.63 $23.25 $130.63 $130.63 $96.95 $96.95 $100.69 $68.06 $27.22 $130.63 $52.25 $130.63 $130.63 $130.63 $130.63 $130.63 $98.25 $130.63 $130.63 $130.63 $65.32 $65.32 $103.46 $130.63 $104.50 $84.91 $130.63 N/A $75.98 $130.63 $78.38 $130.63 $130.63 $130.63 N/A N/A 5191302P2 SUP HCPCS C1713 5191302P2 - CAGE SPNL 12D 30X11X9MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5191308P2 SUP HCPCS C1713 5191308P2 - CAGE SPNL 8D 30X11X9MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5195-000-010 SUP Custom 27203010 5195-000-010 - BODY XTRNFX NS DJD II CMPNT BOTH IP/OP "$3,081.50" "$2,280.00" $548.49 "$3,081.38" "$3,081.38" "$3,081.38" "$3,081.38" "$3,081.38" "$3,081.38" "$3,081.38" $548.49 "$3,081.38" "$3,081.38" "$2,287.00" "$2,287.00" "$2,375.13" "$1,605.40" $642.19 "$3,081.38" "$1,232.55" "$3,081.38" "$3,081.38" "$3,081.38" "$3,081.38" "$3,081.38" "$2,311.13" "$3,081.38" "$3,081.38" "$3,081.38" "$1,540.69" "$1,540.69" "$2,440.45" "$3,081.38" "$2,465.10" "$2,002.90" "$3,081.38" N/A "$1,787.27" "$3,081.38" "$1,848.83" "$3,081.38" "$3,081.38" "$3,081.38" N/A N/A 5195-1-011 SUP Custom 27203010 5195-1-011 - SCREW XTRNFX DJD II GD HUM BOTH IP/OP $70.50 $52.00 $12.48 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $70.13 $12.48 $70.13 $70.13 $52.05 $52.05 $54.06 $36.54 $14.62 $70.13 $28.05 $70.13 $70.13 $70.13 $70.13 $70.13 $52.88 $70.13 $70.13 $70.13 $35.07 $35.07 $55.54 $70.13 $56.10 $45.58 $70.13 N/A $40.89 $70.13 $42.08 $70.13 $70.13 $70.13 N/A N/A 5195-1-020 SUP Custom 27203010 5195-1-020 - DRILL SURG OSTEOSTAT STERILE BOTH IP/OP $158.50 $117.00 $28.15 $158.13 $158.13 $158.13 $158.13 $158.13 $158.13 $158.13 $28.15 $158.13 $158.13 $117.36 $117.36 $121.89 $82.39 $32.96 $158.13 $63.25 $158.13 $158.13 $158.13 $158.13 $158.13 $118.88 $158.13 $158.13 $158.13 $79.07 $79.07 $125.24 $158.13 $126.50 $102.78 $158.13 N/A $91.93 $158.13 $94.88 $158.13 $158.13 $158.13 N/A N/A 5195-1-030 SUP Custom 27203010 5195-1-030 - GUIDE SURG 4MM HING INSERTION DJD II DYNAMIC ELBOW JOINT BOTH IP/OP $158.50 $117.00 $28.15 $158.13 $158.13 $158.13 $158.13 $158.13 $158.13 $158.13 $28.15 $158.13 $158.13 $117.36 $117.36 $121.89 $82.39 $32.96 $158.13 $63.25 $158.13 $158.13 $158.13 $158.13 $158.13 $118.88 $158.13 $158.13 $158.13 $79.07 $79.07 $125.24 $158.13 $126.50 $102.78 $158.13 N/A $91.93 $158.13 $94.88 $158.13 $158.13 $158.13 N/A N/A 5195-1-035 SUP Custom 27203010 5195-1-035 - GUIDE FOR HALF-PINS BOTH IP/OP $158.50 $117.00 $28.15 $158.13 $158.13 $158.13 $158.13 $158.13 $158.13 $158.13 $28.15 $158.13 $158.13 $117.36 $117.36 $121.89 $82.39 $32.96 $158.13 $63.25 $158.13 $158.13 $158.13 $158.13 $158.13 $118.88 $158.13 $158.13 $158.13 $79.07 $79.07 $125.24 $158.13 $126.50 $102.78 $158.13 N/A $91.93 $158.13 $94.88 $158.13 $158.13 $158.13 N/A N/A 5199302P2 SUP HCPCS C1713 5199302P2 - CAGE SPNL 12D 30X9X9MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5199308P2 SUP HCPCS C1713 5199308P2 - CAGE SPNL 8D 30X9X9MM NS CRNT PEEK ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5201300P2 SUP HCPCS C1713 5201300P2 - CAGE SPNL 0D 30X10X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5201302P2 SUP HCPCS C1713 5201302P2 - CAGE SPNL 12D 30X10X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5201308P2 SUP HCPCS C1713 5201308P2 - CAGE SPNL 8D 30X10X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 52-022-01 SUP Custom 27203010 52-022-01 - DRILL BIT 2.7 BOTH IP/OP $260.50 $193.00 $46.35 $260.40 $260.40 $260.40 $260.40 $260.40 $260.40 $260.40 $46.35 $260.40 $260.40 $193.27 $193.27 $200.72 $135.67 $54.27 $260.40 $104.16 $260.40 $260.40 $260.40 $260.40 $260.40 $195.38 $260.40 $260.40 $260.40 $130.20 $130.20 $206.24 $260.40 $208.32 $169.26 $260.40 N/A $151.09 $260.40 $156.24 $260.40 $260.40 $260.40 N/A N/A 5204300P2 SUP HCPCS C1713 5204300P2 - CAGE SPNL 0D 30X10X14MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5204308P2 SUP HCPCS C1713 5204308P2 - CAGE SPNL 8D 30X10X14MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5209300P2 SUP HCPCS C1713 5209300P2 - CAGE SPNL 0D 30X10X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5209302P2 SUP HCPCS C1713 5209302P2 - CAGE SPNL 12D 30X10X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5209308P2 SUP HCPCS C1713 5209308P2 - CAGE SPNL 8D 30X10X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5210-3-165 SUP HCPCS C1713 5210-3-165 - SCREW BONE FULTHD 5MM 65MM BOTH IP/OP $203.50 $151.00 $40.39 $203.50 $91.58 $91.58 $91.58 $91.58 $203.50 $203.50 $203.50 $42.41 $203.50 $203.50 $203.50 $203.50 $203.50 $42.41 $203.50 $203.50 $120.37 $203.50 $203.50 $203.50 $203.50 $152.63 $203.50 $203.50 $203.50 $101.75 $101.75 $161.17 $203.50 $162.80 $91.58 $40.39 N/A $118.03 $203.50 $122.10 $203.50 $203.50 $203.50 N/A N/A 5210-3-190 SUP HCPCS C1713 5210-3-190 - SCREW BONE FULTHD 5MM 90MM BOTH IP/OP $203.50 $151.00 $40.39 $203.50 $91.58 $91.58 $91.58 $91.58 $203.50 $203.50 $203.50 $42.41 $203.50 $203.50 $203.50 $203.50 $203.50 $42.41 $203.50 $81.40 $120.37 $203.50 $203.50 $203.50 $203.50 $152.63 $203.50 $203.50 $203.50 $101.75 $101.75 $161.17 $203.50 $162.80 $91.58 $40.39 N/A $118.03 $203.50 $122.10 $203.50 $42.41 $203.50 N/A N/A 5211300P2 SUP HCPCS C1713 5211300P2 - CAGE SPNL 0D 30X11X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5211302P2 SUP HCPCS C1713 5211302P2 - CAGE SPNL 12D 30X11X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5211308P2 SUP HCPCS C1713 5211308P2 - CAGE SPNL 8D 30X11X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5213-42 SUP HCPCS C1776 5213-42 - COMPONENT GLENOID 40MM 42MM UHMWPE STERILE BOTH IP/OP "$2,055.50" "$1,521.00" $407.88 "$2,055.08" $924.79 $924.79 $924.79 $924.79 "$2,055.08" "$2,055.08" "$2,055.08" $428.33 "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" $428.30 "$2,055.08" $822.03 "$1,215.58" "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" "$1,541.63" "$2,055.08" "$2,055.08" "$2,055.08" "$1,027.54" "$1,027.54" "$1,627.62" "$2,055.08" "$1,644.06" $924.79 $407.88 N/A "$1,192.19" "$2,055.08" "$2,055.08" "$2,055.08" $428.28 "$2,055.08" N/A N/A 5213-44 SUP HCPCS C1776 5213-44 - SOCKET GLENOID 44MM SHOULDER STERILE BOTH IP/OP "$2,055.50" "$1,521.00" $407.88 "$2,055.08" $924.79 $924.79 $924.79 $924.79 "$2,055.08" "$2,055.08" "$2,055.08" $428.33 "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" $428.30 "$2,055.08" "$2,055.08" "$1,215.58" "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" "$1,541.63" "$2,055.08" "$2,055.08" "$2,055.08" "$1,027.54" "$1,027.54" "$1,627.62" "$2,055.08" "$1,644.06" $924.79 $407.88 N/A "$1,192.19" "$2,055.08" "$2,055.08" "$2,055.08" $428.28 "$2,055.08" N/A N/A 5213-46 SUP HCPCS C1776 5213-46 - COMPONENT GLENOID 46MM UHMWPE STERILE BOTH IP/OP "$2,055.50" "$1,521.00" $407.88 "$2,055.08" $924.79 $924.79 $924.79 $924.79 "$2,055.08" "$2,055.08" "$2,055.08" $428.33 "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" $428.30 "$2,055.08" $822.03 "$1,215.58" "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" "$1,541.63" "$2,055.08" "$2,055.08" "$2,055.08" "$1,027.54" "$1,027.54" "$1,627.62" "$2,055.08" "$1,644.06" $924.79 $407.88 N/A "$1,192.19" "$2,055.08" "$2,055.08" "$2,055.08" $428.28 "$2,055.08" N/A N/A 5213-48 SUP HCPCS C1776 5213-48 - COMPONENT GLENOID 48MM UHMWPE NONSTRL BOTH IP/OP "$2,055.50" "$1,521.00" $407.88 "$2,055.08" $924.79 $924.79 $924.79 $924.79 "$2,055.08" "$2,055.08" "$2,055.08" $428.33 "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" $428.30 "$2,055.08" "$2,055.08" "$1,215.58" "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" "$1,541.63" "$2,055.08" "$2,055.08" "$2,055.08" "$1,027.54" "$1,027.54" "$1,627.62" "$2,055.08" "$1,644.06" $924.79 $407.88 N/A "$1,192.19" "$2,055.08" "$2,055.08" "$2,055.08" $428.28 "$2,055.08" N/A N/A 5213-50 SUP HCPCS C1776 5213-50 - COMPONENT GLENOID 50MM UHMWPE NONSTRL BOTH IP/OP "$2,055.50" "$1,521.00" $407.88 "$2,055.08" $924.79 $924.79 $924.79 $924.79 "$2,055.08" "$2,055.08" "$2,055.08" $428.33 "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" $428.30 "$2,055.08" $822.03 "$1,215.58" "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" "$1,541.63" "$2,055.08" "$2,055.08" "$2,055.08" "$1,027.54" "$1,027.54" "$1,627.62" "$2,055.08" "$1,644.06" $924.79 $407.88 N/A "$1,192.19" "$2,055.08" "$2,055.08" "$2,055.08" $428.28 "$2,055.08" N/A N/A 5213-52 SUP HCPCS C1776 5213-52 - COMPONENT GLENOID 52MM UHMWPE STERILE BOTH IP/OP "$2,055.50" "$1,521.00" $407.88 "$2,055.08" $924.79 $924.79 $924.79 $924.79 "$2,055.08" "$2,055.08" "$2,055.08" $428.33 "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" $428.30 "$2,055.08" "$2,055.08" "$1,215.58" "$2,055.08" "$2,055.08" "$2,055.08" "$2,055.08" "$1,541.63" "$2,055.08" "$2,055.08" "$2,055.08" "$1,027.54" "$1,027.54" "$1,627.62" "$2,055.08" "$1,644.06" $924.79 $407.88 N/A "$1,192.19" "$2,055.08" "$2,055.08" "$2,055.08" $428.28 "$2,055.08" N/A N/A 5213-54 SUP HCPCS C1776 5213-54 - SOCKET GLENOID 54MM SHOULDER STERILE BOTH IP/OP "$2,095.00" "$1,550.00" $415.77 "$2,094.83" $942.67 $942.67 $942.67 $942.67 "$2,094.83" "$2,094.83" "$2,094.83" $436.61 "$2,094.83" "$2,094.83" "$2,094.83" "$2,094.83" "$2,094.83" $436.59 "$2,094.83" $837.93 "$1,239.09" "$2,094.83" "$2,094.83" "$2,094.83" "$2,094.83" "$1,571.25" "$2,094.83" "$2,094.83" "$2,094.83" "$1,047.42" "$1,047.42" "$1,659.11" "$2,094.83" "$1,675.86" $942.67 $415.77 N/A "$1,215.10" "$2,094.83" "$2,094.83" "$2,094.83" $436.56 "$2,094.83" N/A N/A 5213-56 SUP HCPCS C1776 5213-56 - COMPONENT GLENOID 56MM UHMWPE STERILE BOTH IP/OP "$2,095.00" "$1,550.00" $415.77 "$2,094.83" $942.67 $942.67 $942.67 $942.67 "$2,094.83" "$2,094.83" "$2,094.83" $436.61 "$2,094.83" "$2,094.83" "$2,094.83" "$2,094.83" "$2,094.83" $436.59 "$2,094.83" "$2,094.83" "$1,239.09" "$2,094.83" "$2,094.83" "$2,094.83" "$2,094.83" "$1,571.25" "$2,094.83" "$2,094.83" "$2,094.83" "$1,047.42" "$1,047.42" "$1,659.11" "$2,094.83" "$1,675.86" $942.67 $415.77 N/A "$1,215.10" "$2,094.83" "$2,094.83" "$2,094.83" $436.56 "$2,094.83" N/A N/A 5213-58 SUP HCPCS C1776 5213-58 - COMPONENT GLENOID 58MM UHMWPE STERILE BOTH IP/OP "$2,095.00" "$1,550.00" $415.77 "$2,094.83" $942.67 $942.67 $942.67 $942.67 "$2,094.83" "$2,094.83" "$2,094.83" $436.61 "$2,094.83" "$2,094.83" "$2,094.83" "$2,094.83" "$2,094.83" $436.59 "$2,094.83" $837.93 "$1,239.09" "$2,094.83" "$2,094.83" "$2,094.83" "$2,094.83" "$1,571.25" "$2,094.83" "$2,094.83" "$2,094.83" "$1,047.42" "$1,047.42" "$1,659.11" "$2,094.83" "$1,675.86" $942.67 $415.77 N/A "$1,215.10" "$2,094.83" "$2,094.83" "$2,094.83" $436.56 "$2,094.83" N/A N/A 5219300P2 SUP HCPCS C1713 5219300P2 - CAGE SPNL 0D 30X11X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5219302P2 SUP HCPCS C1713 5219302P2 - CAGE SPNL 12D 30X11X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5219308P2 SUP HCPCS C1713 5219308P2 - CAGE SPNL 8D 30X11X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 52-20358 SUP HCPCS C1713 52-20358 - SCREW BONE 2MM 8MM SLFTAP XFIT TITANIUM INTERMAXILLARY BOTH IP/OP $221.50 $164.00 $43.89 $221.15 $99.52 $99.52 $99.52 $99.52 $221.15 $221.15 $221.15 $46.09 $221.15 $221.15 $221.15 $221.15 $221.15 $46.09 $221.15 $221.15 $130.81 $221.15 $221.15 $221.15 $221.15 $166.13 $221.15 $221.15 $221.15 $110.58 $110.58 $175.15 $221.15 $176.92 $99.52 $43.89 N/A $128.47 $221.15 $132.69 $221.15 $46.09 $221.15 N/A N/A 52-20364 SUP HCPCS C1713 52-20364 - SCREW BONE 2MM 14MM SLFTAP XFIT CROSS-FIT TITANIUM BOTH IP/OP $221.50 $164.00 $43.89 $221.15 $99.52 $99.52 $99.52 $99.52 $221.15 $221.15 $221.15 $46.09 $221.15 $221.15 $221.15 $221.15 $221.15 $46.09 $221.15 $221.15 $130.81 $221.15 $221.15 $221.15 $221.15 $166.13 $221.15 $221.15 $221.15 $110.58 $110.58 $175.15 $221.15 $176.92 $99.52 $43.89 N/A $128.47 $221.15 $132.69 $221.15 $46.09 $221.15 N/A N/A 52-20616 SUP HCPCS C1713 52-20616 - PEG FIX 2MM 16MM LOCK VARIAX RAD DISTAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 52-20618 SUP HCPCS C1713 52-20618 - PEG FIX 2MM 18MM LOCK VARIAX RAD DISTAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-20618E SUP HCPCS C1713 52-20618E - PEG FIX 2MM 18MM LOCK XPIN VARIAX TITANIUM RAD DISTAL PLATE BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $123.75 $123.75 N/A N/A 52-20620 SUP HCPCS C1713 52-20620 - PEG FIX 2MM 20MM LOCK VARIAX RAD DISTAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 52-20622 SUP HCPCS C1713 52-20622 - PEG FIX 2MM 22MM LOCK TITANIUM RAD BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-20624 SUP HCPCS C1713 52-20624 - PEG FIX 2MM 24MM LOCK VARIAX RAD DISTAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-20626 SUP HCPCS C1713 52-20626 - SCREW BONE 2MM 26MM LOCKING XPIN VARIAX TITANIUM DISTAL RAD BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 5221300P2 SUP HCPCS C1713 5221300P2 - CAGE SPNL 0D 30X12X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5221302P2 SUP HCPCS C1713 5221302P2 - CAGE SPNL 12D 30X12X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5221308P2 SUP HCPCS C1713 5221308P2 - CAGE SPNL 8D 30X12X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 52-23010 SUP HCPCS C1713 52-23010 - SCREW BN 2.3MM 10MM VARIAX ST XPN TI DIST RDS LCK PLT SYS BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-23010E SUP HCPCS C1713 52-23010E - SCREW BONE 2.3MM 10MM XPIN VARIAX TITANIUM HAND RAD DISTAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-23012 SUP HCPCS C1713 52-23012 - SCREW BONE 2.3MM 12MM SELF TAP LOCK XPIN SMARTLOCK VARIAX BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-23012E SUP HCPCS C1713 52-23012E - SCREW BONE 2.3MM 12MM XPIN LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-23014 SUP HCPCS C1713 52-23014 - SCREW BONE 2.3MM 14MM SELF TAP LOCK XPIN SMARTLOCK VARIAX BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-23016 SUP HCPCS C1713 52-23016 - SCREW BONE 2.3MM 16MM SELF TAP XPIN HEAD VARIAX SMARTLOCK BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 52-23016E SUP HCPCS C1713 52-23016E - SCREW BONE 2.3MM 16MM XPIN LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-23018 SUP HCPCS C1713 52-23018 - SCREW BONE 2.3MM 18MM SELF TAP XPIN HEAD VARIAX SMARTLOCK BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 52-23018E SUP HCPCS C1713 52-23018E - SCREW BONE 2.3MM 18MM XPIN VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 52-23020E SUP HCPCS C1713 52-23020E - SCREW BONE 2.3MM 20MM NONLOCKING XPIN HEAD VARIAX TITANIUM BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-23022 SUP HCPCS C1713 52-23022 - SCREW BONE 2.3MM 22MM SELF TAP XPIN HEAD VARIAX SMARTLOCK BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 52-23022E SUP HCPCS C1713 52-23022E - SCREW BONE 2.3MM 22MM XPIN VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 52-23024 SUP HCPCS C1713 52-23024 - SCREW BONE 2.3MM 24MM LOCK VARIAX TITANIUM RAD DISTAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-23024E SUP HCPCS C1713 52-23024E - SCREW BONE 2.3MM 24MM XPIN LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $123.75 $123.75 N/A N/A 52-23026 SUP HCPCS C1713 52-23026 - SCREW BONE 2.3MM 26MM SELF TAP XPIN HEAD VARIAX SMARTLOCK BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 52-23028 SUP HCPCS C1713 52-23028 - SCREW BN 2.3MM 28MM VARIAX LCK TI DIST RADL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-23028E SUP HCPCS C1713 52-23028E - SCREW BN XPN BLNT 2.3MM 28MM STRL VARIAX OPTM AX STAB TI RDS BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-23030 SUP HCPCS C1713 52-23030 - SCREW BONE 2.3MM 30MM LOCK VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-23030E SUP HCPCS C1713 52-23030E - SCREW BONE 2.3MM 30MM LOCK VARIAX TITANIUM STERILE BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 52-23032 SUP HCPCS C1713 52-23032 - SCREW BONE 2.3MM 32MM LOCK VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 52-23032E SUP HCPCS C1713 52-23032E - SCREW BONE 2.3MM 32MM XPIN VARIAX TITANIUM RAD STERILE BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 52-23034 SUP HCPCS C1713 52-23034 - SCREW BONE 2.3MM 34MM LOCK VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-23034E SUP HCPCS C1713 52-23034E - SCREW BONE 2.3MM 34MM XPIN VARIAX TITANIUM RAD STERILE BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 52-23036 SUP HCPCS C1713 52-23036 - SCREW BONE 2.3MM 36MM LOCK VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 52-23036E SUP HCPCS C1713 52-23036E - SCREW BONE 2.3MM 36MM XPIN VARIAX TITANIUM RAD STERILE BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-23038 SUP HCPCS C1713 52-23038 - SCREW BONE 2.3MM 38MM LOCK VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 52-23038E SUP HCPCS C1713 52-23038E - SCREW BONE 2.3MM 38MM XPIN VARIAX TITANIUM RAD STERILE BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 52-23610 SUP HCPCS C1713 52-23610 - SCREW BONE 2.3MM 10MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $144.38 $144.38 N/A N/A 52-23610E SUP HCPCS C1713 52-23610E - SCREW BONE 2.3MM 10MM LOCK VARIAX TITANIUM DISTAL RAD BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $144.38 $144.38 N/A N/A 52-23612 SUP HCPCS C1713 52-23612 - SCREW BONE 2.3MM 12MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $144.38 $144.38 N/A N/A 52-23612E SUP HCPCS C1713 52-23612E - SCREW BONE 2.3MM 12MM LOCK BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-23614 SUP HCPCS C1713 52-23614 - SCREW BONE 2.3MM 14MM LOCKING XPIN VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $144.38 $144.38 N/A N/A 52-23614E SUP HCPCS C1713 52-23614E - SCREW BONE 2.3MM 14MM XPIN LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-23616 SUP HCPCS C1713 52-23616 - SCREW BONE 2.3MM 16MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-23616E SUP HCPCS C1713 52-23616E - SCREW BONE 2.3MM 16MM XPIN LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-23618 SUP HCPCS C1713 52-23618 - SCREW BONE 2.3MM 18MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-23618E SUP HCPCS C1713 52-23618E - SCREW BONE 2.3MM 18MM LOCK XPIN VARIAX TITANIUM RAD DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-23620 SUP HCPCS C1713 52-23620 - SCREW BONE 2.3MM 20MM LOCKING XPIN SLFTAP SMARTLOCK VARIAX BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $144.38 $144.38 N/A N/A 52-23620E SUP HCPCS C1713 52-23620E - SCREW BONE 2.3MM 20MM XPIN LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $144.38 $144.38 N/A N/A 52-23622 SUP HCPCS C1713 52-23622 - SCREW BONE 2.3MM 22MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-23624 SUP HCPCS C1713 52-23624 - SCREW BONE 2.3MM 24MM LOCKING CROOS PIN VARIAX TITANIUM BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-23626 SUP HCPCS C1713 52-23626 - SCREW BONE 2.3MM 26MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-23626E SUP HCPCS C1713 52-23626E - SCREW BONE 2.3MM 26MM LOCK VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-23628 SUP HCPCS C1713 52-23628 - SCREW BONE 2.3MM 28MM LOCK SMARTLOCK VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $144.38 $144.38 N/A N/A 52-23628E SUP HCPCS C1713 52-23628E - SCREW BONE 2.3MM 28MM LOCKING XPIN VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $30.09 $144.38 N/A N/A 52-23630 SUP HCPCS C1713 52-23630 - SCREW BONE 2.3MM 30MM LOCK VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-23632 SUP HCPCS C1713 52-23632 - SCREW BONE 2.3MM 32MM LOCK SMARTLOCK TITANIUM RAD BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-23634 SUP HCPCS C1713 52-23634 - SCREW BONE 2.3MM 34MM LOCK VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-23636 SUP HCPCS C1713 52-23636 - SCREW BONE 2.3MM 36MM LOCK VARIAX TITANIUM RAD DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-23638 SUP HCPCS C1713 52-23638 - SCREW BONE 2.3MM 38MM LOCK VARIAX TITANIUM RAD DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $144.38 $144.38 N/A N/A 5224300P2 SUP HCPCS C1713 5224300P2 - CAGE SPNL 0D 30X12X14MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5224308P2 SUP HCPCS C1713 5224308P2 - CAGE SPNL 8D 30X12X14MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 52-27010 SUP HCPCS C1713 52-27010 - SCREW BONE 2.7MM 10MM LOCK XPIN VARIAX TITANIUM RAD DISTAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-27010E SUP HCPCS C1713 52-27010E - SCREW BONE 2.7MM 10MM XPIN NONLOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 52-27012 SUP HCPCS C1713 52-27012 - SCREW BONE 2.7MM 12MM VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-27012E SUP HCPCS C1713 52-27012E - SCREW BONE 2.7MM 12MM XPIN NONLOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-27014 SUP HCPCS C1713 52-27014 - SCREW BONE 2.7MM 14MM SELF TAP XPIN HEAD VARIAX SMARTLOCK BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-27014E SUP HCPCS C1713 52-27014E - SCREW BONE 2.7MM 14MM STABILITY FRICTION FIT XPIN VARIAX BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-27016 SUP HCPCS C1713 52-27016 - SCREW BONE 2.7MM 16MM NONLOCKING XPIN VARIAX TITANIUM DISTAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-27016E SUP HCPCS C1713 52-27016E - SCREW BONE 2.7MM 16MM STABILITY FRICTION FIT XPIN VARIAX BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 52-27018 SUP HCPCS C1713 52-27018 - SCREW BN 2.7MM 18MM VARIAX LCK TI DIST RADL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 52-27018E SUP HCPCS C1713 52-27018E - SCREW BN 2.7MM 18MM STRL VARIAX XPN NLCKG TI DIST RADL WR BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $123.75 $123.75 N/A N/A 52-27020 SUP HCPCS C1713 52-27020 - SCREW BONE 2.7MM 20MM XPIN VARIAX TITANIUM RAD DISTAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-27022 SUP HCPCS C1713 52-27022 - SCREW BONE 2.7MM 22MM XPIN VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-27022E SUP HCPCS C1713 52-27022E - SCREW BONE 2.7MM 22MM LOCK SMARTLOCK TITANIUM CORTICAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-27024 SUP HCPCS C1713 52-27024 - SCREW BONE 2.7MM 24MM SELF TAP XPIN HEAD VARIAX SMARTLOCK BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-27024E SUP HCPCS C1713 52-27024E - SCREW BONE 2.7MM 24MM LOCK SMARTLOCK TITANIUM CORTICAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $49.50 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $74.25 $123.75 $25.79 $123.75 N/A N/A 52-27026 SUP HCPCS C1713 52-27026 - SCREW BONE 2.7MM 26MM XPIN SMARTLOCK TITANIUM RAD STERILE BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 52-27026E SUP HCPCS C1713 52-27026E - SCREW BONE 2.7MM 26MM XPIN VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $124.00 $92.00 $24.56 $123.75 $55.69 $55.69 $55.69 $55.69 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $123.75 $123.75 $123.75 $25.79 $123.75 $123.75 $73.20 $123.75 $123.75 $123.75 $123.75 $93.00 $123.75 $123.75 $123.75 $61.88 $61.88 $98.01 $123.75 $99.00 $55.69 $24.56 N/A $71.92 $123.75 $123.75 $123.75 $25.79 $123.75 N/A N/A 52-27116 SUP HCPCS C1713 52-27116 - SCREW BN 2.7MM 16MM VARIAX LCK P/T TI DIST RADL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $30.09 $144.38 N/A N/A 52-27116E SUP HCPCS C1713 52-27116E - SCREW BN P/T 2.7MM 16MM VARIAX NLCKG XPN TI DIST RDS BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $30.09 $144.38 N/A N/A 52-27118 SUP HCPCS C1713 52-27118 - SCREW BONE PTHRD 2.7MM 18MM LOCK XPIN VARIAX TITANIUM RAD BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $30.09 $144.38 N/A N/A 52-27120 SUP HCPCS C1713 52-27120 - SCREW BN 2.7MM 20MM VARIAX LCK P/T TI DIST RADL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $144.38 $144.38 N/A N/A 52-27120E SUP HCPCS C1713 52-27120E - SCREW BN P/T 2.7MM 20MM VARIAX NLCKG XPN TI DIST RDS BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $144.38 $144.38 N/A N/A 52-27122 SUP HCPCS C1713 52-27122 - SCREW BN 2.7MM 22MM VARIAX LCK P/T TI DIST RADL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $30.09 $144.38 N/A N/A 52-27122E SUP HCPCS C1713 52-27122E - SCREW BN P/T 2.7MM 22MM VARIAX NLCKG XPN TI DIST RDS BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $144.38 $144.38 N/A N/A 52-27124 SUP HCPCS C1713 52-27124 - SCREW BONE PTHRD 2.7MM 24MM LOCK XPIN VARIAX TITANIUM RAD BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $144.38 $144.38 N/A N/A 52-27126 SUP HCPCS C1713 52-27126 - SCREW BONE PTHRD 2.7MM 26MM SELF TAP XPIN HEAD VARIAX BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $30.09 $144.38 N/A N/A 52-27208 SUP HCPCS C1713 52-27208 - SCREW BONE 2.7MM 8MM SELF TAP RECONSTRUCTION SMARTLOCK BOTH IP/OP $132.50 $98.00 $26.26 $132.30 $59.54 $59.54 $59.54 $59.54 $132.30 $132.30 $132.30 $27.57 $132.30 $132.30 $132.30 $132.30 $132.30 $27.57 $132.30 $52.92 $78.26 $132.30 $132.30 $132.30 $132.30 $99.38 $132.30 $132.30 $132.30 $66.15 $66.15 $104.78 $132.30 $105.84 $59.54 $26.26 N/A $76.85 $132.30 $132.30 $132.30 $132.30 $132.30 N/A N/A 52-27210 SUP HCPCS C1713 52-27210 - SCREW BONE 2.7MM 10MM SELF TAP RECONSTRUCTION SMARTLOCK BOTH IP/OP $132.50 $98.00 $26.26 $132.30 $59.54 $59.54 $59.54 $59.54 $132.30 $132.30 $132.30 $27.57 $132.30 $132.30 $132.30 $132.30 $132.30 $27.57 $132.30 $132.30 $78.26 $132.30 $132.30 $132.30 $132.30 $99.38 $132.30 $132.30 $132.30 $66.15 $66.15 $104.78 $132.30 $105.84 $59.54 $26.26 N/A $76.85 $132.30 $132.30 $132.30 $132.30 $132.30 N/A N/A 52-27212 SUP HCPCS C1713 52-27212 - SCREW BONE 2.7MM 12MM MATRIX-SMARTLOCK DISTAL RADIAL BOTH IP/OP $132.50 $98.00 $26.26 $132.30 $59.54 $59.54 $59.54 $59.54 $132.30 $132.30 $132.30 $27.57 $132.30 $132.30 $132.30 $132.30 $132.30 $27.57 $132.30 $132.30 $78.26 $132.30 $132.30 $132.30 $132.30 $99.38 $132.30 $132.30 $132.30 $66.15 $66.15 $104.78 $132.30 $105.84 $59.54 $26.26 N/A $76.85 $132.30 $132.30 $132.30 $27.57 $132.30 N/A N/A 52-27214 SUP HCPCS C1713 52-27214 - SCREW BONE 2.7MM 14MM MATRIX-SMARTLOCK DISTAL RADIAL BOTH IP/OP $132.50 $98.00 $26.26 $132.30 $59.54 $59.54 $59.54 $59.54 $132.30 $132.30 $132.30 $27.57 $132.30 $132.30 $132.30 $132.30 $132.30 $27.57 $132.30 $52.92 $78.26 $132.30 $132.30 $132.30 $132.30 $99.38 $132.30 $132.30 $132.30 $66.15 $66.15 $104.78 $132.30 $105.84 $59.54 $26.26 N/A $76.85 $132.30 $132.30 $132.30 $132.30 $132.30 N/A N/A 52-27216 SUP HCPCS C1713 52-27216 - SCREW BONE 2.7MM 16MM MATRIX-SMARTLOCK DISTAL RADIAL BOTH IP/OP $132.50 $98.00 $26.26 $132.30 $59.54 $59.54 $59.54 $59.54 $132.30 $132.30 $132.30 $27.57 $132.30 $132.30 $132.30 $132.30 $132.30 $27.57 $132.30 $52.92 $78.26 $132.30 $132.30 $132.30 $132.30 $99.38 $132.30 $132.30 $132.30 $66.15 $66.15 $104.78 $132.30 $105.84 $59.54 $26.26 N/A $76.85 $132.30 $132.30 $132.30 $132.30 $132.30 N/A N/A 52-27218 SUP HCPCS C1713 52-27218 - SCREW BONE 2.7MM 18MM MATRIX-SMARTLOCK DISTAL RADIAL BOTH IP/OP $151.50 $112.00 $30.02 $151.25 $68.06 $68.06 $68.06 $68.06 $151.25 $151.25 $151.25 $31.52 $151.25 $151.25 $151.25 $151.25 $151.25 $31.52 $151.25 $151.25 $89.46 $151.25 $151.25 $151.25 $151.25 $113.63 $151.25 $151.25 $151.25 $75.63 $75.63 $119.79 $151.25 $121.00 $68.06 $30.02 N/A $87.87 $151.25 $151.25 $151.25 $31.52 $151.25 N/A N/A 52-27220 SUP HCPCS C1713 52-27220 - SCREW BONE 2.7MM 20MM SELF TAP RECONSTRUCTION SMARTLOCK BOTH IP/OP $151.50 $112.00 $30.02 $151.25 $68.06 $68.06 $68.06 $68.06 $151.25 $151.25 $151.25 $31.52 $151.25 $151.25 $151.25 $151.25 $151.25 $31.52 $151.25 $60.50 $89.46 $151.25 $151.25 $151.25 $151.25 $113.63 $151.25 $151.25 $151.25 $75.63 $75.63 $119.79 $151.25 $121.00 $68.06 $30.02 N/A $87.87 $151.25 $151.25 $151.25 $31.52 $151.25 N/A N/A 52-27222 SUP HCPCS C1713 52-27222 - SCREW BONE 2.7MM 22MM SELF TAP RECONSTRUCTION SMARTLOCK BOTH IP/OP $151.50 $112.00 $30.02 $151.25 $68.06 $68.06 $68.06 $68.06 $151.25 $151.25 $151.25 $31.52 $151.25 $151.25 $151.25 $151.25 $151.25 $31.52 $151.25 $60.50 $89.46 $151.25 $151.25 $151.25 $151.25 $113.63 $151.25 $151.25 $151.25 $75.63 $75.63 $119.79 $151.25 $121.00 $68.06 $30.02 N/A $87.87 $151.25 $151.25 $151.25 $31.52 $151.25 N/A N/A 52-27224 SUP HCPCS C1713 52-27224 - SCREW BONE 2.7MM 24MM MATRIX-SMARTLOCK DISTAL RADIAL BOTH IP/OP $151.50 $112.00 $30.02 $151.25 $68.06 $68.06 $68.06 $68.06 $151.25 $151.25 $151.25 $31.52 $151.25 $151.25 $151.25 $151.25 $151.25 $31.52 $151.25 $151.25 $89.46 $151.25 $151.25 $151.25 $151.25 $113.63 $151.25 $151.25 $151.25 $75.63 $75.63 $119.79 $151.25 $121.00 $68.06 $30.02 N/A $87.87 $151.25 $151.25 $151.25 $151.25 $151.25 N/A N/A 52-27226 SUP HCPCS C1713 52-27226 - SCREW BONE 2.7MM 26MM SELF TAP RECONSTRUCTION SMARTLOCK BOTH IP/OP $151.50 $112.00 $30.02 $151.25 $68.06 $68.06 $68.06 $68.06 $151.25 $151.25 $151.25 $31.52 $151.25 $151.25 $151.25 $151.25 $151.25 $31.52 $151.25 $60.50 $89.46 $151.25 $151.25 $151.25 $151.25 $113.63 $151.25 $151.25 $151.25 $75.63 $75.63 $119.79 $151.25 $121.00 $68.06 $30.02 N/A $87.87 $151.25 $90.75 $151.25 $31.52 $151.25 N/A N/A 52-27228 SUP HCPCS C1713 52-27228 - SCREW BONE 2.7MM 28MM MATRIX-SMARTLOCK DISTAL RADIAL BOTH IP/OP $151.50 $112.00 $30.02 $151.25 $68.06 $68.06 $68.06 $68.06 $151.25 $151.25 $151.25 $31.52 $151.25 $151.25 $151.25 $151.25 $151.25 $31.52 $151.25 $60.50 $89.46 $151.25 $151.25 $151.25 $151.25 $113.63 $151.25 $151.25 $151.25 $75.63 $75.63 $119.79 $151.25 $121.00 $68.06 $30.02 N/A $87.87 $151.25 $90.75 $151.25 $31.52 $151.25 N/A N/A 52-27230 SUP HCPCS C1713 52-27230 - SCREW BONE 2.7MM 30MM SELF TAP RECONSTRUCTION SMARTLOCK BOTH IP/OP $151.50 $112.00 $30.02 $151.25 $68.06 $68.06 $68.06 $68.06 $151.25 $151.25 $151.25 $31.52 $151.25 $151.25 $151.25 $151.25 $151.25 $31.52 $151.25 $60.50 $89.46 $151.25 $151.25 $151.25 $151.25 $113.63 $151.25 $151.25 $151.25 $75.63 $75.63 $119.79 $151.25 $121.00 $68.06 $30.02 N/A $87.87 $151.25 $90.75 $151.25 $31.52 $151.25 N/A N/A 52-27232 SUP HCPCS C1713 52-27232 - SCREW BONE 2.7MM 32MM SELF TAP RECONSTRUCTION SMARTLOCK BOTH IP/OP $151.50 $112.00 $30.02 $151.25 $68.06 $68.06 $68.06 $68.06 $151.25 $151.25 $151.25 $31.52 $151.25 $151.25 $151.25 $151.25 $151.25 $31.52 $151.25 $60.50 $89.46 $151.25 $151.25 $151.25 $151.25 $113.63 $151.25 $151.25 $151.25 $75.63 $75.63 $119.79 $151.25 $121.00 $68.06 $30.02 N/A $87.87 $151.25 $151.25 $151.25 $31.52 $151.25 N/A N/A 52-27234 SUP HCPCS C1713 52-27234 - SCREW BONE 2.7MM 34MM SELF TAP RECONSTRUCTION SMARTLOCK BOTH IP/OP $161.00 $119.00 $31.89 $160.65 $72.29 $72.29 $72.29 $72.29 $160.65 $160.65 $160.65 $33.48 $160.65 $160.65 $160.65 $160.65 $160.65 $33.48 $160.65 $64.26 $95.02 $160.65 $160.65 $160.65 $160.65 $120.75 $160.65 $160.65 $160.65 $80.33 $80.33 $127.23 $160.65 $128.52 $72.29 $31.89 N/A $93.38 $160.65 $160.65 $160.65 $33.48 $160.65 N/A N/A 52-27236 SUP HCPCS C1713 52-27236 - SCREW BONE 2.7MM 36MM SELF TAP RECONSTRUCTION SMARTLOCK BOTH IP/OP $161.00 $119.00 $31.89 $160.65 $72.29 $72.29 $72.29 $72.29 $160.65 $160.65 $160.65 $33.48 $160.65 $160.65 $160.65 $160.65 $160.65 $33.48 $160.65 $64.26 $95.02 $160.65 $160.65 $160.65 $160.65 $120.75 $160.65 $160.65 $160.65 $80.33 $80.33 $127.23 $160.65 $128.52 $72.29 $31.89 N/A $93.38 $160.65 $160.65 $160.65 $33.48 $160.65 N/A N/A 52-27238 SUP HCPCS C1713 52-27238 - SCREW BONE 2.7MM 38MM SELF TAP RECONSTRUCTION SMARTLOCK BOTH IP/OP $161.00 $119.00 $31.89 $160.65 $72.29 $72.29 $72.29 $72.29 $160.65 $160.65 $160.65 $33.48 $160.65 $160.65 $160.65 $160.65 $160.65 $33.48 $160.65 $64.26 $95.02 $160.65 $160.65 $160.65 $160.65 $120.75 $160.65 $160.65 $160.65 $80.33 $80.33 $127.23 $160.65 $128.52 $72.29 $31.89 N/A $93.38 $160.65 $96.39 $160.65 $33.48 $160.65 N/A N/A 52-27610 SUP HCPCS C1713 52-27610 - SCREW BONE PTHRD 2.7MM 10MM LOCK VARIAX TITANIUM RAD DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $30.09 $144.38 N/A N/A 52-27610E SUP HCPCS C1713 52-27610E - SCREW BONE 2.7MM 10MM PTTHRD LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-27612 SUP HCPCS C1713 52-27612 - SCREW BONE 2.7MM 12MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-27614 SUP HCPCS C1713 52-27614 - SCREW BONE 2.7MM 14MM LOCKING XPIN VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-27614E SUP HCPCS C1713 52-27614E - SCREW BONE 2.7MM 14MM XPIN LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-27616 SUP HCPCS C1713 52-27616 - SCREW BONE 2.7MM 16MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $30.09 $144.38 N/A N/A 52-27618 SUP HCPCS C1713 52-27618 - SCREW BN 2.7MM 18MM VARIAX LCK TI DIST RADL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $30.09 $144.38 N/A N/A 52-27618E SUP HCPCS C1713 52-27618E - SCREW BN 2.7MM 18MM STRL LCK XPN TI RDS DIST VARIAX LCK PLT BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $30.09 $144.38 N/A N/A 52-27620 SUP HCPCS C1713 52-27620 - SCREW BONE 2.7MM 20MM PTTHRD LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $30.09 $144.38 N/A N/A 52-27620E SUP HCPCS C1713 52-27620E - SCREW BONE 2.7MM 20MM XPIN LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $144.38 $144.38 N/A N/A 52-27622 SUP HCPCS C1713 52-27622 - SCREW BONE 2.7MM 22MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $30.09 $144.38 N/A N/A 52-27624 SUP HCPCS C1713 52-27624 - SCREW BONE 2.7MM 24MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-27626 SUP HCPCS C1713 52-27626 - SCREW BN 2.7MM 26MM VARIAX LCK TI DIST RADL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $144.38 $144.38 N/A N/A 52-27626E SUP HCPCS C1713 52-27626E - SCREW BN 2.7MM 26MM STRL LCK XPN TI RDS DIST VARIAX LCK PLT BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $144.38 $144.38 N/A N/A 52-27716 SUP HCPCS C1713 52-27716 - PEG FIX 2.7MM 16MM PTTHRD LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-27716E SUP HCPCS C1713 52-27716E - PEG FIX PTHRD 2.7MM 16MM XPIN LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $144.38 $144.38 N/A N/A 52-27718 SUP HCPCS C1713 52-27718 - PEG FIX 2.7MM 18MM PTTHRD LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-27718E SUP HCPCS C1713 52-27718E - PEG FIX PTHRD 2.7MM 18MM XPIN LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $144.38 $144.38 N/A N/A 52-27720 SUP HCPCS C1713 52-27720 - PEG FIX 2.7MM 20MM PTTHRD LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-27722 SUP HCPCS C1713 52-27722 - PEG FIX 2.7MM 22MM LOCKING PTHRD SMARTLOCK TITANIUM BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $30.09 $144.38 N/A N/A 52-27722E SUP HCPCS C1713 52-27722E - PEG FIX PTHRD 2.7MM 22MM SMARTLOCK LOCKING TECHNOLOGY VARIAX BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $30.09 $144.38 N/A N/A 52-27724 SUP HCPCS C1713 52-27724 - PEG FIX 2.7MM 24MM PTTHRD LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $144.38 $144.38 N/A N/A 52-27724E SUP HCPCS C1713 52-27724E - PEG FIX PTHRD 2.7MM 24MM XPIN LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $144.38 $144.38 N/A N/A 52-27726 SUP HCPCS C1713 52-27726 - PEG FIX 2.7MM 26MM PTTHRD LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $86.63 $144.38 $144.38 $144.38 N/A N/A 52-27726E SUP HCPCS C1713 52-27726E - PEG FIX PTHRD 2.7MM 26MM XPIN LOCKING VARIAX TITANIUM DISTAL BOTH IP/OP $144.50 $107.00 $28.66 $144.38 $64.97 $64.97 $64.97 $64.97 $144.38 $144.38 $144.38 $30.09 $144.38 $144.38 $144.38 $144.38 $144.38 $30.09 $144.38 $57.75 $85.40 $144.38 $144.38 $144.38 $144.38 $108.38 $144.38 $144.38 $144.38 $72.19 $72.19 $114.35 $144.38 $115.50 $64.97 $28.66 N/A $83.81 $144.38 $144.38 $144.38 $144.38 $144.38 N/A N/A 52-27844 SUP HCPCS C1713 52-27844 - SCREW BONE 2.7MM 14MM HEXAGON TITANIUM FRFT BOTH IP/OP $125.50 $93.00 $24.84 $125.13 $56.31 $56.31 $56.31 $56.31 $125.13 $125.13 $125.13 $26.08 $125.13 $125.13 $125.13 $125.13 $125.13 $26.08 $125.13 $50.05 $74.01 $125.13 $125.13 $125.13 $125.13 $94.13 $125.13 $125.13 $125.13 $62.57 $62.57 $99.10 $125.13 $100.10 $56.31 $24.84 N/A $72.79 $125.13 $125.13 $125.13 $26.08 $125.13 N/A N/A 52-27846 SUP HCPCS C1713 52-27846 - SCREW BONE 2.7MM 16MM HEXAGON TITANIUM FRFT BOTH IP/OP $125.50 $93.00 $24.84 $125.13 $56.31 $56.31 $56.31 $56.31 $125.13 $125.13 $125.13 $26.08 $125.13 $125.13 $125.13 $125.13 $125.13 $26.08 $125.13 $50.05 $74.01 $125.13 $125.13 $125.13 $125.13 $94.13 $125.13 $125.13 $125.13 $62.57 $62.57 $99.10 $125.13 $100.10 $56.31 $24.84 N/A $72.79 $125.13 $125.13 $125.13 $125.13 $125.13 N/A N/A 52-27850 SUP HCPCS C1713 52-27850 - SCREW BONE 2.7MM 20MM HEXAGON TITANIUM FRFT BOTH IP/OP $125.50 $93.00 $24.84 $125.13 $56.31 $56.31 $56.31 $56.31 $125.13 $125.13 $125.13 $26.08 $125.13 $125.13 $125.13 $125.13 $125.13 $26.08 $125.13 $50.05 $74.01 $125.13 $125.13 $125.13 $125.13 $94.13 $125.13 $125.13 $125.13 $62.57 $62.57 $99.10 $125.13 $100.10 $56.31 $24.84 N/A $72.79 $125.13 $125.13 $125.13 $125.13 $125.13 N/A N/A 52-27852 SUP HCPCS C1713 52-27852 - SCREW BONE 2.7MM 22MM HEXAGONAL BUN TIAL TITANIUM FRFT BOTH IP/OP $121.00 $90.00 $24.02 $121.00 $54.45 $54.45 $54.45 $54.45 $121.00 $121.00 $121.00 $25.22 $121.00 $121.00 $121.00 $121.00 $121.00 $25.22 $121.00 $121.00 $71.57 $121.00 $121.00 $121.00 $121.00 $90.75 $121.00 $121.00 $121.00 $60.50 $60.50 $95.83 $121.00 $96.80 $54.45 $24.02 N/A $70.18 $121.00 $121.00 $121.00 $25.22 $121.00 N/A N/A 5229300P2 SUP HCPCS C1713 5229300P2 - CAGE SPNL 0D 30X12X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5229302P2 SUP HCPCS C1713 5229302P2 - CAGE SPNL 12D 30X12X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5229308P2 SUP HCPCS C1713 5229308P2 - CAGE SPNL 8D 30X12X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 52-30056 SUP HCPCS C1713 52-30056 - SCREW BONE 3MM 16MM HEXAGON TITANIUM FRFT BOTH IP/OP $125.50 $93.00 $24.84 $125.13 $56.31 $56.31 $56.31 $56.31 $125.13 $125.13 $125.13 $26.08 $125.13 $125.13 $125.13 $125.13 $125.13 $26.08 $125.13 $50.05 $74.01 $125.13 $125.13 $125.13 $125.13 $94.13 $125.13 $125.13 $125.13 $62.57 $62.57 $99.10 $125.13 $100.10 $56.31 $24.84 N/A $72.79 $125.13 $125.13 $125.13 $125.13 $125.13 N/A N/A 52-30308 SUP HCPCS C1713 52-30308 - SCREW BONE 3MM 8MM SELF TAP SMARTLOCK CROSSFIT TITANIUM RAD BOTH IP/OP $166.00 $123.00 $32.93 $165.90 $74.66 $74.66 $74.66 $74.66 $165.90 $165.90 $165.90 $34.58 $165.90 $165.90 $165.90 $165.90 $165.90 $34.58 $165.90 $66.36 $98.13 $165.90 $165.90 $165.90 $165.90 $124.50 $165.90 $165.90 $165.90 $82.95 $82.95 $131.39 $165.90 $132.72 $74.66 $32.93 N/A $96.28 $165.90 $165.90 $165.90 $34.57 $165.90 N/A N/A 52-30310 SUP HCPCS C1713 52-30310 - SCREW BONE 3MM 10MM SELF TAP SMARTLOCK CROSSFIT TITANIUM RAD BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $185.63 $185.63 $38.69 $185.63 N/A N/A 52-30312 SUP HCPCS C1713 52-30312 - SCREW BONE 3MM 12MM SELF TAP SMARTLOCK CROSSFIT TITANIUM RAD BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $185.63 $185.63 $185.63 $185.63 N/A N/A 52-30314 SUP HCPCS C1713 52-30314 - SCREW BONE 3MM 14MM SELF TAP SMARTLOCK CROSSFIT TITANIUM RAD BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $185.63 $185.63 $185.63 $185.63 N/A N/A 52-30316 SUP HCPCS C1713 52-30316 - SCREW BONE 3MM 16MM SELF TAP SMARTLOCK CROSSFIT TITANIUM RAD BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $185.63 $185.63 $38.69 $185.63 N/A N/A 52-30318 SUP HCPCS C1713 52-30318 - SCREW BONE 3MM 18MM SELF TAP SMARTLOCK CROSSFIT TITANIUM RAD BOTH IP/OP $206.50 $153.00 $40.94 $206.25 $92.81 $92.81 $92.81 $92.81 $206.25 $206.25 $206.25 $42.99 $206.25 $206.25 $206.25 $206.25 $206.25 $42.98 $206.25 $206.25 $122.00 $206.25 $206.25 $206.25 $206.25 $154.88 $206.25 $206.25 $206.25 $103.13 $103.13 $163.35 $206.25 $165.00 $92.81 $40.94 N/A $119.77 $206.25 $206.25 $206.25 $42.98 $206.25 N/A N/A 52-30320 SUP HCPCS C1713 52-30320 - SCREW BONE 3MM 20MM SELF TAP SMARTLOCK CROSSFIT TITANIUM RAD BOTH IP/OP $206.50 $153.00 $40.94 $206.25 $92.81 $92.81 $92.81 $92.81 $206.25 $206.25 $206.25 $42.99 $206.25 $206.25 $206.25 $206.25 $206.25 $42.98 $206.25 $206.25 $122.00 $206.25 $206.25 $206.25 $206.25 $154.88 $206.25 $206.25 $206.25 $103.13 $103.13 $163.35 $206.25 $165.00 $92.81 $40.94 N/A $119.77 $206.25 $206.25 $206.25 $42.98 $206.25 N/A N/A 52-30322 SUP HCPCS C1713 52-30322 - SCREW BONE 3MM 22MM SELF TAP SMARTLOCK CROSSFIT TITANIUM RAD BOTH IP/OP $206.50 $153.00 $40.94 $206.25 $92.81 $92.81 $92.81 $92.81 $206.25 $206.25 $206.25 $42.99 $206.25 $206.25 $206.25 $206.25 $206.25 $42.98 $206.25 $206.25 $122.00 $206.25 $206.25 $206.25 $206.25 $154.88 $206.25 $206.25 $206.25 $103.13 $103.13 $163.35 $206.25 $165.00 $92.81 $40.94 N/A $119.77 $206.25 $206.25 $206.25 $42.98 $206.25 N/A N/A 52-30324 SUP HCPCS C1713 52-30324 - SCREW BONE 3MM 24MM SLFTAP CROSSFIT TITANIUM CANCELLOUS BOTH IP/OP $206.50 $153.00 $40.94 $206.25 $92.81 $92.81 $92.81 $92.81 $206.25 $206.25 $206.25 $42.99 $206.25 $206.25 $206.25 $206.25 $206.25 $42.98 $206.25 $82.50 $122.00 $206.25 $206.25 $206.25 $206.25 $154.88 $206.25 $206.25 $206.25 $103.13 $103.13 $163.35 $206.25 $165.00 $92.81 $40.94 N/A $119.77 $206.25 $206.25 $206.25 $42.98 $206.25 N/A N/A 52-30326 SUP HCPCS C1713 52-30326 - SCREW BONE 3MM 26MM SELF TAP SMARTLOCK CROSSFIT TITANIUM RAD BOTH IP/OP $200.00 $148.00 $39.65 $199.75 $89.89 $89.89 $89.89 $89.89 $199.75 $199.75 $199.75 $41.63 $199.75 $199.75 $199.75 $199.75 $199.75 $41.63 $199.75 $79.90 $118.15 $199.75 $199.75 $199.75 $199.75 $150.00 $199.75 $199.75 $199.75 $99.88 $99.88 $158.20 $199.75 $159.80 $89.89 $39.65 N/A $116.00 $199.75 $199.75 $199.75 $41.63 $199.75 N/A N/A 52-30328 SUP HCPCS C1713 52-30328 - SCREW BONE 3MM 28MM SELF TAP SMARTLOCK CROSSFIT TITANIUM RAD BOTH IP/OP $200.00 $148.00 $39.65 $199.75 $89.89 $89.89 $89.89 $89.89 $199.75 $199.75 $199.75 $41.63 $199.75 $199.75 $199.75 $199.75 $199.75 $41.63 $199.75 $79.90 $118.15 $199.75 $199.75 $199.75 $199.75 $150.00 $199.75 $199.75 $199.75 $99.88 $99.88 $158.20 $199.75 $159.80 $89.89 $39.65 N/A $116.00 $199.75 $199.75 $199.75 $41.63 $199.75 N/A N/A 52-30330 SUP HCPCS C1713 52-30330 - SCREW BONE 3MM 30MM SELF TAP SMARTLOCK CROSSFIT TITANIUM RAD BOTH IP/OP $200.00 $148.00 $39.65 $199.75 $89.89 $89.89 $89.89 $89.89 $199.75 $199.75 $199.75 $41.63 $199.75 $199.75 $199.75 $199.75 $199.75 $41.63 $199.75 $199.75 $118.15 $199.75 $199.75 $199.75 $199.75 $150.00 $199.75 $199.75 $199.75 $99.88 $99.88 $158.20 $199.75 $159.80 $89.89 $39.65 N/A $116.00 $199.75 $199.75 $199.75 $41.63 $199.75 N/A N/A 52-30332 SUP HCPCS C1713 52-30332 - SCREW BONE 3MM 32MM SELF TAP SMARTLOCK CROSSFIT TITANIUM RAD BOTH IP/OP $200.00 $148.00 $39.65 $199.75 $89.89 $89.89 $89.89 $89.89 $199.75 $199.75 $199.75 $41.63 $199.75 $199.75 $199.75 $199.75 $199.75 $41.63 $199.75 $199.75 $118.15 $199.75 $199.75 $199.75 $199.75 $150.00 $199.75 $199.75 $199.75 $99.88 $99.88 $158.20 $199.75 $159.80 $89.89 $39.65 N/A $116.00 $199.75 $199.75 $199.75 $41.63 $199.75 N/A N/A 52-30334 SUP HCPCS C1713 52-30334 - SCREW BONE 3MM 34MM SELF TAP SMARTLOCK CROSSFIT TITANIUM RAD BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $199.38 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $199.38 $199.38 $41.55 $199.38 N/A N/A 52-306-23-04 SUP HCPCS C1781 52-306-23-04 - MESH CRNL 3ANG 23MMX.6MM STRL RSRBX PDLLA ORBT FLR BOTH IP/OP "$1,416.50" "$1,048.00" $281.09 "$1,531.68" $637.31 $637.31 $637.31 $637.31 "$1,416.25" "$1,416.25" "$1,416.25" $295.18 "$1,416.25" "$1,416.25" "$1,416.25" "$1,416.25" "$1,416.25" $295.16 "$1,416.25" "$1,531.68" $837.71 "$1,416.25" "$1,416.25" "$1,416.25" "$1,416.25" "$1,062.38" "$1,416.25" "$1,416.25" "$1,416.25" $708.13 $708.13 "$1,121.67" "$1,416.25" "$1,133.00" $637.31 $281.09 N/A $821.57 "$1,416.25" "$1,416.25" "$1,416.25" $295.15 "$1,416.25" N/A N/A 52-306-40-04 SUP HCPCS C1713 52-306-40-04 - MESH SURG 40X40X.6MM RX ORBTL FLOOR BOTH IP/OP "$1,671.00" "$1,237.00" $331.64 "$1,670.93" $751.92 $751.92 $751.92 $751.92 "$1,670.93" "$1,670.93" "$1,670.93" $348.26 "$1,670.93" "$1,670.93" "$1,670.93" "$1,670.93" "$1,670.93" $348.24 "$1,670.93" $668.37 $988.36 "$1,670.93" "$1,670.93" "$1,670.93" "$1,670.93" "$1,253.25" "$1,670.93" "$1,670.93" "$1,670.93" $835.47 $835.47 "$1,323.38" "$1,670.93" "$1,336.74" $751.92 $331.64 N/A $969.18 "$1,670.93" "$1,002.56" "$1,670.93" $348.22 "$1,670.93" N/A N/A 52-306-51-04 SUP HCPCS C1781 52-306-51-04 - MESH DYNAMIC 51X51X.6MM RESORB LARGE GRID FLEXIBLE ROUNDED BOTH IP/OP "$2,228.00" "$1,649.00" $442.18 "$2,227.90" "$1,002.56" "$1,002.56" "$1,002.56" "$1,002.56" "$2,227.90" "$2,227.90" "$2,227.90" $464.35 "$2,227.90" "$2,227.90" "$2,227.90" "$2,227.90" "$2,227.90" $464.32 "$2,227.90" "$2,227.90" "$1,317.80" "$2,227.90" "$2,227.90" "$2,227.90" "$2,227.90" "$1,671.00" "$2,227.90" "$2,227.90" "$2,227.90" "$1,113.95" "$1,113.95" "$1,764.50" "$2,227.90" "$1,782.32" "$1,002.56" $442.18 N/A "$1,292.24" "$2,227.90" "$2,227.90" "$2,227.90" $464.29 "$2,227.90" N/A N/A 52-310-31-04 SUP HCPCS C1713 52-310-31-04 - MESH CRANIAL 106X31X1MM RESORB SMALL GRID RESORB-X SONICWELD BOTH IP/OP "$3,203.00" "$2,370.00" $635.64 "$3,202.60" "$1,441.17" "$1,441.17" "$1,441.17" "$1,441.17" "$3,202.60" "$3,202.60" "$3,202.60" $667.50 "$3,202.60" "$3,202.60" "$3,202.60" "$3,202.60" "$3,202.60" $667.46 "$3,202.60" "$3,202.60" "$1,578.88" "$3,202.60" "$3,202.60" "$3,202.60" "$3,202.60" "$2,402.25" "$3,202.60" "$3,202.60" "$3,202.60" "$1,601.30" "$1,601.30" "$2,536.46" "$3,202.60" "$2,562.08" "$1,441.17" $635.64 N/A "$1,857.74" "$3,202.60" "$1,921.56" "$3,202.60" $667.42 "$3,202.60" N/A N/A 5235-1-846 SUP Custom 27203010 5235-1-846 - BIT DRILL 4.3MM 250MM TRIFLAT ALTA BOTH IP/OP $188.50 $139.00 $33.53 $188.38 $188.38 $188.38 $188.38 $188.38 $188.38 $188.38 $33.53 $188.38 $188.38 $139.82 $139.82 $145.20 $98.15 $39.26 $188.38 $75.35 $188.38 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $122.45 $188.38 N/A $109.33 $188.38 $113.03 $188.38 $188.38 $188.38 N/A N/A 5235-1-916 SUP Custom 27203010 5235-1-916 - GUIDE DRILL 4.3MM SLEEVE BOTH IP/OP $469.00 $347.00 $83.46 $468.88 $468.88 $468.88 $468.88 $468.88 $468.88 $468.88 $83.46 $468.88 $468.88 $348.00 $348.00 $361.41 $244.29 $97.72 $468.88 $187.55 $468.88 $468.88 $468.88 $468.88 $468.88 $351.75 $468.88 $468.88 $468.88 $234.44 $234.44 $371.35 $468.88 $375.10 $304.77 $468.88 N/A $272.02 $468.88 $281.33 $468.88 $468.88 $468.88 N/A N/A 5235-7-110 SUP HCPCS C1713 5235-7-110 - REAMER SURG LAG SCREW ALTA HIP BOTH IP/OP "$5,328.50" "$3,943.00" "$1,057.50" "$5,328.13" "$2,397.66" "$2,397.66" "$2,397.66" "$2,397.66" "$5,328.13" "$5,328.13" "$5,328.13" "$1,110.52" "$5,328.13" "$5,328.13" "$5,328.13" "$5,328.13" "$5,328.13" "$1,110.44" "$5,328.13" "$2,131.25" "$2,626.77" "$5,328.13" "$5,328.13" "$5,328.13" "$5,328.13" "$3,996.38" "$5,328.13" "$5,328.13" "$5,328.13" "$2,664.07" "$2,664.07" "$4,219.88" "$5,328.13" "$4,262.50" "$2,397.66" "$1,057.50" N/A "$3,090.53" "$5,328.13" "$5,328.13" "$5,328.13" "$1,110.38" "$5,328.13" N/A N/A 52-400-00 SUP Custom 27203010 52-400-00 - PEN MRKNG TIP HEAT RSRBX BOTH IP/OP $212.50 $157.00 $37.83 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $37.83 $212.50 $212.50 $157.72 $157.72 $163.80 $110.71 $44.29 $212.50 $85.00 $212.50 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $138.13 $212.50 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A 5241300P2 SUP HCPCS C1713 5241300P2 - CAGE SPNL 0D 30X14X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5241302P2 SUP HCPCS C1713 5241302P2 - CAGE SPNL 12D 30X14X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5241308P2 SUP HCPCS C1713 5241308P2 - CAGE SPNL 8D 30X14X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5244300P2 SUP HCPCS C1713 5244300P2 - CAGE SPNL 0D 30X14X14MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5244308P2 SUP HCPCS C1713 5244308P2 - CAGE SPNL 8D 30X14X14MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5249300P2 SUP HCPCS C1713 5249300P2 - CAGE SPNL 0D 30X14X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5249302P2 SUP HCPCS C1713 5249302P2 - CAGE SPNL 12D 30X14X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5249308P2 SUP HCPCS C1713 5249308P2 - CAGE SPNL 8D 30X14X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5255-1-255 SUP Custom 27203010 5255-1-255 - BIT DRILL 3.2MM 250MM AO BOTH IP/OP $188.50 $139.00 $33.53 $188.38 $188.38 $188.38 $188.38 $188.38 $188.38 $188.38 $33.53 $188.38 $188.38 $139.82 $139.82 $145.20 $98.15 $39.26 $188.38 $75.35 $188.38 $188.38 $188.38 $188.38 $188.38 $141.38 $188.38 $188.38 $188.38 $94.19 $94.19 $149.20 $188.38 $150.70 $122.45 $188.38 N/A $109.33 $188.38 $113.03 $188.38 $188.38 $188.38 N/A N/A 5260-4-000 SUP Custom 27803010 5260-4-000 - SHELL ACETAB SCREW PLUG OSTEOLOCK APICAL HIP BOTH IP/OP $141.00 $104.00 $25.10 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $25.10 $141.00 $141.00 $141.00 $141.00 $141.00 $141.00 $29.39 $141.00 $56.40 $141.00 $141.00 $141.00 $141.00 $141.00 $105.75 $141.00 $141.00 $141.00 $70.50 $70.50 $111.67 $141.00 $112.80 $63.45 $141.00 N/A $81.78 $141.00 $84.60 $141.00 $141.00 $141.00 N/A N/A 5260-5-012 SUP HCPCS C1713 5260-5-012 - SCREW ACETAB 6.5MM 12MM HEXAGON OSTEOLOCK TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5260-5-014 SUP HCPCS C1713 5260-5-014 - SCREW ACETAB 6.5MM 14MM HEXAGON OSTEOLOCK TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5260-5-016 SUP HCPCS C1713 5260-5-016 - SCREW BN 6.5MM 16MM OSTLK CANC BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5260-5-018 SUP HCPCS C1713 5260-5-018 - SCREW ACETAB 6.5MM 18MM HEXAGON OSTEOLOCK TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5260-5-020 SUP HCPCS C1713 5260-5-020 - SCREW ACETAB 6.5MM 20MM HEXAGON OSTEOLOCK TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5260-5-022 SUP HCPCS C1713 5260-5-022 - SCREW ACETAB 6.5MM 22MM HEXAGON OSTEOLOCK TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 5260-5-024 SUP HCPCS C1713 5260-5-024 - SCREW ACETAB 6.5MM 24MM HEXAGON OSTEOLOCK TITANIUM HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5260-5-026 SUP HCPCS C1713 5260-5-026 - SCREW BONE HEXAGON 6.5MM 26MM WEDGE RSTOR OSTEOLOCK TITANIUM BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5260-5-028 SUP HCPCS C1713 5260-5-028 - SCREW BONE HEXAGON 6.5MM 28MM WEDGE RSTOR OSTEOLOCK TITANIUM BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 5260-5-030 SUP HCPCS C1713 5260-5-030 - SCREW BONE HEXAGON 6.5MM 30MM WEDGE RSTOR OSTEOLOCK TITANIUM BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 5260-5-035 SUP HCPCS C1713 5260-5-035 - SCREW BONE HEXAGON 6.5MM 35MM WEDGE RSTOR OSTEOLOCK TITANIUM BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5260-5-040 SUP HCPCS C1713 5260-5-040 - SCREW BONE HEXAGON 6.5MM 40MM WEDGE RSTOR OSTEOLOCK TITANIUM BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5260-5-045 SUP HCPCS C1713 5260-5-045 - SCREW BONE HEXAGON 6.5MM 45MM WEDGE RSTOR OSTEOLOCK TITANIUM BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5260-5-050 SUP HCPCS C1713 5260-5-050 - SCREW BONE HEXAGON 6.5MM 50MM WEDGE RSTOR OSTEOLOCK TITANIUM BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5281300P2 SUP HCPCS C1713 5281300P2 - CAGE SPNL 0D 30X8X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5281302P2 SUP HCPCS C1713 5281302P2 - CAGE SPNL 12D 30X8X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5281308P2 SUP HCPCS C1713 5281308P2 - CAGE SPNL 8D 30X8X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5284300P2 SUP HCPCS C1713 5284300P2 - CAGE SPNL 0D 30X8X14MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5284308P2 SUP HCPCS C1713 5284308P2 - CAGE SPNL 8D 30X8X14MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5289300P2 SUP HCPCS C1713 5289300P2 - CAGE SPNL 0D 30X8X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5289302P2 SUP HCPCS C1713 5289302P2 - CAGE SPNL 12D 30X8X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5289308P2 SUP HCPCS C1713 5289308P2 - CAGE SPNL 8D 30X8X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5291300P2 SUP HCPCS C1713 5291300P2 - CAGE SPNL 0D 30X9X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5291302P2 SUP HCPCS C1713 5291302P2 - CAGE SPNL 12D 30X9X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5291308P2 SUP HCPCS C1713 5291308P2 - CAGE SPNL 8D 30X9X11MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5299300P2 SUP HCPCS C1713 5299300P2 - CAGE SPNL 0D 30X9X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5299302P2 SUP HCPCS C1713 5299302P2 - CAGE SPNL 12D 30X9X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 5299308P2 SUP HCPCS C1713 5299308P2 - CAGE SPNL 8D 30X9X9MM NS CRNT TI ANT TLIF BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$3,420.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$5,130.00" "$8,550.00" "$8,550.00" "$8,550.00" N/A N/A 5300-010-941 SUP Custom 27203010 5300-010-941 - DERMABRADER SURG MEDIUM STR 4MM STR TPS STERILE BOTH IP/OP $191.00 $141.00 $33.96 $190.80 $190.80 $190.80 $190.80 $190.80 $190.80 $190.80 $33.96 $190.80 $190.80 $141.61 $141.61 $147.07 $99.41 $39.76 $190.80 $76.32 $190.80 $190.80 $190.80 $190.80 $190.80 $143.25 $190.80 $190.80 $190.80 $95.40 $95.40 $151.11 $190.80 $152.64 $124.02 $190.80 N/A $110.78 $190.80 $114.48 $190.80 $190.80 $190.80 N/A N/A 5300-010-943 SUP Custom 27203010 5300-010-943 - DERMABRADER SURG MEDIUM STR 7MM STR X-CHANGE III BOTH IP/OP $191.00 $141.00 $33.96 $190.80 $190.80 $190.80 $190.80 $190.80 $190.80 $190.80 $33.96 $190.80 $190.80 $141.61 $141.61 $147.07 $99.41 $39.76 $190.80 $76.32 $190.80 $190.80 $190.80 $190.80 $190.80 $143.25 $190.80 $190.80 $190.80 $95.40 $95.40 $151.11 $190.80 $152.64 $124.02 $190.80 N/A $110.78 $190.80 $114.48 $190.80 $190.80 $190.80 N/A N/A 5300-010-945 SUP Custom 27203010 5300-010-945 - DERMABRADER SURG MEDIUM STR 12MM 50MM BUR STR TPS STERILE BOTH IP/OP $191.00 $141.00 $33.96 $190.80 $190.80 $190.80 $190.80 $190.80 $190.80 $190.80 $33.96 $190.80 $190.80 $141.61 $141.61 $147.07 $99.41 $39.76 $190.80 $76.32 $190.80 $190.80 $190.80 $190.80 $190.80 $143.25 $190.80 $190.80 $190.80 $95.40 $95.40 $151.11 $190.80 $152.64 $124.02 $190.80 N/A $110.78 $190.80 $114.48 $190.80 $190.80 $190.80 N/A N/A 5300-010-947 SUP Custom 27203010 5300-010-947 - DERMABRADER SURG MEDIUM 10MM TAPERED TPS STERILE BOTH IP/OP $191.00 $141.00 $33.96 $190.80 $190.80 $190.80 $190.80 $190.80 $190.80 $190.80 $33.96 $190.80 $190.80 $141.61 $141.61 $147.07 $99.41 $39.76 $190.80 $76.32 $190.80 $190.80 $190.80 $190.80 $190.80 $143.25 $190.80 $190.80 $190.80 $95.40 $95.40 $151.11 $190.80 $152.64 $124.02 $190.80 N/A $110.78 $190.80 $114.48 $190.80 $190.80 $190.80 N/A N/A 53-00324 SUP HCPCS C1713 53-00324 - PLATE BN 47X29X.3MM UNV NEURO III CLS OUTR FRM TI TMPR 1.5MM BOTH IP/OP "$3,067.50" "$2,270.00" $608.82 "$3,067.50" "$1,380.38" "$1,380.38" "$1,380.38" "$1,380.38" "$3,067.50" "$3,067.50" "$3,067.50" $639.34 "$3,067.50" "$3,067.50" "$3,067.50" "$3,067.50" "$3,067.50" $639.30 "$3,067.50" "$3,067.50" "$1,512.28" "$3,067.50" "$3,067.50" "$3,067.50" "$3,067.50" "$2,300.63" "$3,067.50" "$3,067.50" "$3,067.50" "$1,533.75" "$1,533.75" "$2,429.46" "$3,067.50" "$2,454.00" "$1,380.38" $608.82 N/A "$1,779.15" "$3,067.50" "$3,067.50" "$3,067.50" $639.27 "$3,067.50" N/A N/A 53-00466 SUP HCPCS C1713 53-00466 - PLATE BN LG RND 58MM .4MM NS UNV NEURO III CLS OUTR FRM RGD BOTH IP/OP "$3,675.00" "$2,720.00" $729.40 "$3,675.00" "$1,653.75" "$1,653.75" "$1,653.75" "$1,653.75" "$3,675.00" "$3,675.00" "$3,675.00" $765.96 "$3,675.00" "$3,675.00" "$3,675.00" "$3,675.00" "$3,675.00" $765.91 "$3,675.00" "$3,675.00" "$1,811.78" "$3,675.00" "$3,675.00" "$3,675.00" "$3,675.00" "$2,756.25" "$3,675.00" "$3,675.00" "$3,675.00" "$1,837.50" "$1,837.50" "$2,910.60" "$3,675.00" "$2,940.00" "$1,653.75" $729.40 N/A "$2,131.50" "$3,675.00" "$2,205.00" "$3,675.00" $765.87 "$3,675.00" N/A N/A 53-05164 SUP HCPCS C1713 53-05164 - PLATE BONE STR LP 16 HOLE TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $478.50 $354.00 $94.90 $478.13 $215.16 $215.16 $215.16 $215.16 $478.13 $478.13 $478.13 $99.65 $478.13 $478.13 $478.13 $478.13 $478.13 $99.65 $478.13 $191.25 $282.81 $478.13 $478.13 $478.13 $478.13 $358.88 $478.13 $478.13 $478.13 $239.07 $239.07 $378.68 $478.13 $382.50 $215.16 $94.90 N/A $277.53 $478.13 $286.88 $478.13 $478.13 $478.13 N/A N/A 53-05212 SUP HCPCS C1713 53-05212 - PLATE BN 12MM NS UNV NEURO II 2 HL LOPRFL BAR TI CRNMXF 1.5 BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $187.88 $187.88 $187.88 $187.88 $417.50 $417.50 $417.50 $87.02 $417.50 $417.50 $417.50 $417.50 $417.50 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $187.88 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A 53-05216 SUP HCPCS C1713 53-05216 - PLATE BN 16MM NS UNV NEURO II 2 HL LOPRFL BAR TI CRNMXF 1.5 BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $92.25 $92.25 $92.25 $92.25 $205.00 $205.00 $205.00 $42.73 $205.00 $205.00 $205.00 $205.00 $205.00 $42.72 $205.00 $82.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $92.25 $40.69 N/A $118.90 $205.00 $123.00 $205.00 $42.72 $205.00 N/A N/A 53-05228 SUP HCPCS C1713 53-05228 - PLATE BN 3D BX 28MM NS UNV NEURO II 2X2 HL LOPRFL TI CRNMXF BOTH IP/OP $327.50 $242.00 $64.98 $327.38 $147.32 $147.32 $147.32 $147.32 $327.38 $327.38 $327.38 $68.23 $327.38 $327.38 $327.38 $327.38 $327.38 $68.23 $327.38 $130.95 $193.65 $327.38 $327.38 $327.38 $327.38 $245.63 $327.38 $327.38 $327.38 $163.69 $163.69 $259.28 $327.38 $261.90 $147.32 $64.98 N/A $189.95 $327.38 $196.43 $327.38 $68.23 $327.38 N/A N/A 53-05240 SUP HCPCS C1713 53-05240 - PLATE BN 3D LG BX 40MM NS UNV NEURO II 2X2 HL LOPRFL TI BOTH IP/OP "$1,012.50" $749.00 $200.96 "$1,012.50" $455.63 $455.63 $455.63 $455.63 "$1,012.50" "$1,012.50" "$1,012.50" $211.03 "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" $211.02 "$1,012.50" "$1,012.50" $598.89 "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" $759.38 "$1,012.50" "$1,012.50" "$1,012.50" $506.25 $506.25 $801.90 "$1,012.50" $810.00 $455.63 $200.96 N/A $587.25 "$1,012.50" $607.50 "$1,012.50" $211.01 "$1,012.50" N/A N/A 53-05406 SUP HCPCS C1713 53-05406 - PLATE BONE 6MM 4 HOLE LP BAR TITANIUM CRANIUM NONSTRL 1.5MM BOTH IP/OP $199.50 $148.00 $39.60 $199.50 $89.78 $89.78 $89.78 $89.78 $199.50 $199.50 $199.50 $41.58 $199.50 $199.50 $199.50 $199.50 $199.50 $41.58 $199.50 $199.50 $118.00 $199.50 $199.50 $199.50 $199.50 $149.63 $199.50 $199.50 $199.50 $99.75 $99.75 $158.00 $199.50 $159.60 $89.78 $39.60 N/A $115.71 $199.50 $119.70 $199.50 $41.58 $199.50 N/A N/A 53-05507 SUP Custom 27803010 53-05507 - COVER BURR HOLE 7MM LP TAB TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $807.50 $598.00 $143.74 $807.50 $807.50 $807.50 $807.50 $807.50 $807.50 $807.50 $143.74 $807.50 $807.50 $807.50 $807.50 $807.50 $807.50 $168.29 $807.50 $323.00 $807.50 $807.50 $807.50 $807.50 $807.50 $605.63 $807.50 $807.50 $807.50 $403.75 $403.75 $639.54 $807.50 $646.00 $363.38 $807.50 N/A $468.35 $807.50 $484.50 $807.50 $807.50 $807.50 N/A N/A 53-05510 SUP Custom 27803010 53-05510 - COVER BURR HOLE MEDIUM 10MM LP TAB TITANIUM CRANIAL NONSTRL BOTH IP/OP $807.50 $598.00 $143.74 $807.50 $807.50 $807.50 $807.50 $807.50 $807.50 $807.50 $143.74 $807.50 $807.50 $807.50 $807.50 $807.50 $807.50 $168.29 $807.50 $323.00 $807.50 $807.50 $807.50 $807.50 $807.50 $605.63 $807.50 $807.50 $807.50 $403.75 $403.75 $639.54 $807.50 $646.00 $363.38 $807.50 N/A $468.35 $807.50 $484.50 $807.50 $807.50 $807.50 N/A N/A 53-05514 SUP Custom 27803010 53-05514 - COVER BURR HOLE LP 14MM TAB TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $807.50 $598.00 $143.74 $807.50 $807.50 $807.50 $807.50 $807.50 $807.50 $807.50 $143.74 $807.50 $807.50 $807.50 $807.50 $807.50 $807.50 $168.29 $807.50 $323.00 $807.50 $807.50 $807.50 $807.50 $807.50 $605.63 $807.50 $807.50 $807.50 $403.75 $403.75 $639.54 $807.50 $646.00 $363.38 $807.50 N/A $468.35 $807.50 $484.50 $807.50 $807.50 $807.50 N/A N/A 53-05520 SUP Custom 27803010 53-05520 - COVER BURR HOLE 20MM LP TAB TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $892.50 $660.00 $158.87 $892.50 $892.50 $892.50 $892.50 $892.50 $892.50 $892.50 $158.87 $892.50 $892.50 $892.50 $892.50 $892.50 $892.50 $186.01 $892.50 $357.00 $892.50 $892.50 $892.50 $892.50 $892.50 $669.38 $892.50 $892.50 $892.50 $446.25 $446.25 $706.86 $892.50 $714.00 $401.63 $892.50 N/A $517.65 $892.50 $535.50 $892.50 $892.50 $892.50 N/A N/A 53-05608 SUP HCPCS C1713 53-05608 - PLATE BONE 2Y LP 8MM 6 HOLE GAP TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $965.00 $714.00 $191.53 $965.00 $434.25 $434.25 $434.25 $434.25 $965.00 $965.00 $965.00 $201.13 $965.00 $965.00 $965.00 $965.00 $965.00 $201.12 $965.00 $965.00 $570.80 $965.00 $965.00 $965.00 $965.00 $723.75 $965.00 $965.00 $965.00 $482.50 $482.50 $764.28 $965.00 $772.00 $434.25 $191.53 N/A $559.70 $965.00 $965.00 $965.00 $201.11 $965.00 N/A N/A 53-05612 SUP HCPCS C1713 53-05612 - PLATE BONE SMALL LP GAP TITANIUM CRANIOMAXILLOFACIAL NONSTRL BOTH IP/OP $494.00 $366.00 $97.95 $493.53 $222.09 $222.09 $222.09 $222.09 $493.53 $493.53 $493.53 $102.86 $493.53 $493.53 $493.53 $493.53 $493.53 $102.86 $493.53 $197.41 $291.92 $493.53 $493.53 $493.53 $493.53 $370.50 $493.53 $493.53 $493.53 $246.77 $246.77 $390.88 $493.53 $394.82 $222.09 $97.95 N/A $286.52 $493.53 $296.12 $493.53 $102.85 $493.53 N/A N/A 53-05622 SUP HCPCS C1713 53-05622 - PLATE BN LG GAP 22MM NS UNV NEURO II LOPRFL TI CRNMXF 1.5MM BOTH IP/OP "$1,247.50" $923.00 $247.60 "$1,247.50" $561.38 $561.38 $561.38 $561.38 "$1,247.50" "$1,247.50" "$1,247.50" $260.01 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" $499.00 $737.90 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 $247.60 N/A $723.55 "$1,247.50" $748.50 "$1,247.50" $259.98 "$1,247.50" N/A N/A 53-05630 SUP HCPCS C1713 53-05630 - PLATE BONE X LP TITANIUM CRANIOMAXILLOFACIAL NONSTRL BOTH IP/OP $965.00 $714.00 $191.53 $965.00 $434.25 $434.25 $434.25 $434.25 $965.00 $965.00 $965.00 $201.13 $965.00 $965.00 $965.00 $965.00 $965.00 $201.12 $965.00 $386.00 $570.80 $965.00 $965.00 $965.00 $965.00 $723.75 $965.00 $965.00 $965.00 $482.50 $482.50 $764.28 $965.00 $772.00 $434.25 $191.53 N/A $559.70 $965.00 $579.00 $965.00 $201.11 $965.00 N/A N/A 53-05804 SUP HCPCS C1713 53-05804 - PLATE BONE STR LP 8 HOLE TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A 53-06212 SUP HCPCS C1713 53-06212 - PLATE BN 12MM NS UNV NEURO II QUIKFLAP 2 HL BAR X RGD LOPRFL BOTH IP/OP $141.50 $105.00 $28.03 $141.25 $63.56 $63.56 $63.56 $63.56 $141.25 $141.25 $141.25 $29.44 $141.25 $141.25 $141.25 $141.25 $141.25 $29.44 $141.25 $141.25 $83.55 $141.25 $141.25 $141.25 $141.25 $106.13 $141.25 $141.25 $141.25 $70.63 $70.63 $111.87 $141.25 $113.00 $63.56 $28.03 N/A $82.07 $141.25 $84.75 $141.25 $29.44 $141.25 N/A N/A 53-17005 SUP HCPCS C1713 53-17005 - SCREW BONE 1.7MM 5MM LOCK HAND BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $56.28 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $140.70 $140.70 $29.32 $140.70 N/A N/A 53-17005E SUP HCPCS C1713 53-17005E - SCREW BONE 1.7MM 5MM LOCKING SLFTAP XPIN HEAD LP VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $56.28 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $140.70 $140.70 $29.32 $140.70 N/A N/A 53-17006E SUP HCPCS C1713 53-17006E - SCREW BONE LP 1.7MM 6MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $140.70 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $140.70 $140.70 $29.32 $140.70 N/A N/A 53-17007E SUP HCPCS C1713 53-17007E - SCREW BONE LP 1.7MM 7MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $56.28 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $140.70 $140.70 $29.32 $140.70 N/A N/A 53-17008E SUP HCPCS C1713 53-17008E - SCREW BONE LP 1.7MM 8MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $140.70 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $84.42 $140.70 $29.32 $140.70 N/A N/A 53-17009E SUP HCPCS C1713 53-17009E - SCREW BONE LP 1.7MM 9MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $56.28 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $84.42 $140.70 $29.32 $140.70 N/A N/A 53-17010 SUP HCPCS C1713 53-17010 - SCREW BONE 1.7MM 10MM LOCK HAND BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $56.28 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $140.70 $140.70 $29.32 $140.70 N/A N/A 53-17010E SUP HCPCS C1713 53-17010E - SCREW BONE LP 1.7MM 10MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $56.28 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $140.70 $140.70 $29.32 $140.70 N/A N/A 53-17011E SUP HCPCS C1713 53-17011E - SCREW BONE LP 1.7MM 11MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $56.28 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $140.70 $140.70 $29.32 $140.70 N/A N/A 53-17012E SUP HCPCS C1713 53-17012E - SCREW BONE LP 1.7MM 12MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $56.28 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $84.42 $140.70 $29.32 $140.70 N/A N/A 53-17013E SUP HCPCS C1713 53-17013E - SCREW BONE LP 1.7MM 13MM LOCK SELF TAP XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $56.28 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $84.42 $140.70 $29.32 $140.70 N/A N/A 53-17014E SUP HCPCS C1713 53-17014E - SCREW BONE LP 1.7MM 14MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $56.28 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $140.70 $140.70 $29.32 $140.70 N/A N/A 53-17015 SUP HCPCS C1713 53-17015 - SCREW BONE 1.7MM 15MM LOCK BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $56.28 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $140.70 $140.70 $29.32 $140.70 N/A N/A 53-17015E SUP HCPCS C1713 53-17015E - SCREW BONE LP 1.7MM 15MM LOCK SELF TAP XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $56.28 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $140.70 $140.70 $29.32 $140.70 N/A N/A 53-17016 SUP HCPCS C1713 53-17016 - SCREW BONE 1.7MM 16MM LOCK BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $140.70 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $84.42 $140.70 $29.32 $140.70 N/A N/A 53-17016E SUP HCPCS C1713 53-17016E - SCREW BONE LP 1.7MM 16MM LOCK SELF TAP XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $140.70 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $140.70 $140.70 $29.32 $140.70 N/A N/A 53-17018 SUP HCPCS C1713 53-17018 - SCREW BONE 1.7MM 18MM LOCK BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $140.70 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $84.42 $140.70 $29.32 $140.70 N/A N/A 53-17018E SUP HCPCS C1713 53-17018E - SCREW BONE LP 1.7MM 18MM LOCK SELF TAP XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $140.70 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $84.42 $140.70 $29.32 $140.70 N/A N/A 53-17020 SUP HCPCS C1713 53-17020 - SCREW BONE 1.7MM 20MM LOCK BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $140.70 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $84.42 $140.70 $29.32 $140.70 N/A N/A 53-17020E SUP HCPCS C1713 53-17020E - SCREW BONE LP 1.7MM 20MM LOCK SELF TAP XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $140.70 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $140.70 $140.70 $29.32 $140.70 N/A N/A 53-17022 SUP HCPCS C1713 53-17022 - SCREW BN 1.7MM 22MM NS VARIAX ST LCK XPN BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $140.70 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $84.42 $140.70 $29.32 $140.70 N/A N/A 53-17022E SUP HCPCS C1713 53-17022E - SCREW BONE LP 1.7MM 22MM LOCK SELF TAP XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $140.70 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $84.42 $140.70 $29.32 $140.70 N/A N/A 53-17024 SUP HCPCS C1713 53-17024 - SCREW BN 1.7MM 24MM NS VARIAX ST LCK XPN BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $56.28 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $84.42 $140.70 $29.32 $140.70 N/A N/A 53-17024E SUP HCPCS C1713 53-17024E - SCREW BONE LP 1.7MM 24MM LOCK SELF TAP XPIN HEAD VARIAX BOTH IP/OP $141.00 $104.00 $27.93 $140.70 $63.32 $63.32 $63.32 $63.32 $140.70 $140.70 $140.70 $29.33 $140.70 $140.70 $140.70 $140.70 $140.70 $29.32 $140.70 $140.70 $83.22 $140.70 $140.70 $140.70 $140.70 $105.75 $140.70 $140.70 $140.70 $70.35 $70.35 $111.43 $140.70 $112.56 $63.32 $27.93 N/A $81.78 $140.70 $140.70 $140.70 $29.32 $140.70 N/A N/A 53-20424 SUP HCPCS C1713 53-20424 - SCREW BONE 2MM 24MM SLFTAP XPIN LAG TITANIUM MAXFACL BOTH IP/OP $117.00 $87.00 $23.22 $117.00 $52.65 $52.65 $52.65 $52.65 $117.00 $117.00 $117.00 $24.39 $117.00 $117.00 $117.00 $117.00 $117.00 $24.38 $117.00 $117.00 $69.21 $117.00 $117.00 $117.00 $117.00 $87.75 $117.00 $117.00 $117.00 $58.50 $58.50 $92.66 $117.00 $93.60 $52.65 $23.22 N/A $67.86 $117.00 $70.20 $117.00 $117.00 $117.00 N/A N/A 53-20427 SUP HCPCS C1713 53-20427 - SCREW BONE 2MM 27MM SLFTAP XPIN LAG CRANIOMAXILLOFACIAL BOTH IP/OP $117.00 $87.00 $23.22 $117.00 $52.65 $52.65 $52.65 $52.65 $117.00 $117.00 $117.00 $24.39 $117.00 $117.00 $117.00 $117.00 $117.00 $24.38 $117.00 $117.00 $69.21 $117.00 $117.00 $117.00 $117.00 $87.75 $117.00 $117.00 $117.00 $58.50 $58.50 $92.66 $117.00 $93.60 $52.65 $23.22 N/A $67.86 $117.00 $70.20 $117.00 $24.38 $117.00 N/A N/A 53-20430 SUP HCPCS C1713 53-20430 - SCREW BONE 2MM 30MM SLFTAP XPIN LAG TITANIUM MAXFACL BOTH IP/OP $117.00 $87.00 $23.22 $117.00 $52.65 $52.65 $52.65 $52.65 $117.00 $117.00 $117.00 $24.39 $117.00 $117.00 $117.00 $117.00 $117.00 $24.38 $117.00 $117.00 $69.21 $117.00 $117.00 $117.00 $117.00 $87.75 $117.00 $117.00 $117.00 $58.50 $58.50 $92.66 $117.00 $93.60 $52.65 $23.22 N/A $67.86 $117.00 $70.20 $117.00 $117.00 $117.00 N/A N/A 53-20433 SUP HCPCS C1713 53-20433 - SCREW BONE 2MM 33MM SLFTAP XPIN LAG MAXFACL BOTH IP/OP $117.00 $87.00 $23.22 $117.00 $52.65 $52.65 $52.65 $52.65 $117.00 $117.00 $117.00 $24.39 $117.00 $117.00 $117.00 $117.00 $117.00 $24.38 $117.00 $117.00 $69.21 $117.00 $117.00 $117.00 $117.00 $87.75 $117.00 $117.00 $117.00 $58.50 $58.50 $92.66 $117.00 $93.60 $52.65 $23.22 N/A $67.86 $117.00 $70.20 $117.00 $24.38 $117.00 N/A N/A 53-20436 SUP HCPCS C1713 53-20436 - SCREW BONE 2MM 36MM SLFTAP XPIN LAG TITANIUM MAXFACL BOTH IP/OP $117.00 $87.00 $23.22 $117.00 $52.65 $52.65 $52.65 $52.65 $117.00 $117.00 $117.00 $24.39 $117.00 $117.00 $117.00 $117.00 $117.00 $24.38 $117.00 $117.00 $69.21 $117.00 $117.00 $117.00 $117.00 $87.75 $117.00 $117.00 $117.00 $58.50 $58.50 $92.66 $117.00 $93.60 $52.65 $23.22 N/A $67.86 $117.00 $70.20 $117.00 $24.38 $117.00 N/A N/A 53-20439 SUP HCPCS C1713 53-20439 - SCREW BONE 2MM 39MM SLFTAP XPIN LAG MANDIB NONSTRL BOTH IP/OP $117.00 $87.00 $23.22 $117.00 $52.65 $52.65 $52.65 $52.65 $117.00 $117.00 $117.00 $24.39 $117.00 $117.00 $117.00 $117.00 $117.00 $24.38 $117.00 $46.80 $69.21 $117.00 $117.00 $117.00 $117.00 $87.75 $117.00 $117.00 $117.00 $58.50 $58.50 $92.66 $117.00 $93.60 $52.65 $23.22 N/A $67.86 $117.00 $117.00 $117.00 $117.00 $117.00 N/A N/A 53-20442 SUP HCPCS C1713 53-20442 - SCREW BONE 2MM 42MM SLFTAP XPIN LAG MANDIB NONSTRL BOTH IP/OP $117.00 $87.00 $23.22 $117.00 $52.65 $52.65 $52.65 $52.65 $117.00 $117.00 $117.00 $24.39 $117.00 $117.00 $117.00 $117.00 $117.00 $24.38 $117.00 $46.80 $69.21 $117.00 $117.00 $117.00 $117.00 $87.75 $117.00 $117.00 $117.00 $58.50 $58.50 $92.66 $117.00 $93.60 $52.65 $23.22 N/A $67.86 $117.00 $70.20 $117.00 $117.00 $117.00 N/A N/A 53-20616E SUP HCPCS C1713 53-20616E - PEG FIX 2MM 16MM LOCK T7 DRIVE SCREW VARIAX TITANIUM RAD BOTH IP/OP $172.00 $127.00 $34.11 $171.88 $77.35 $77.35 $77.35 $77.35 $171.88 $171.88 $171.88 $35.82 $171.88 $171.88 $171.88 $171.88 $171.88 $35.82 $171.88 $171.88 $101.67 $171.88 $171.88 $171.88 $171.88 $129.00 $171.88 $171.88 $171.88 $85.94 $85.94 $136.13 $171.88 $137.50 $77.35 $34.11 N/A $99.76 $171.88 $103.13 $171.88 $35.82 $171.88 N/A N/A 53-20618E SUP HCPCS C1713 53-20618E - PEG FIX 2MM 18MM LOCKING T7 DRIVE SCREW VARIAX TITANIUM RAD BOTH IP/OP $172.00 $127.00 $34.11 $171.88 $77.35 $77.35 $77.35 $77.35 $171.88 $171.88 $171.88 $35.82 $171.88 $171.88 $171.88 $171.88 $171.88 $35.82 $171.88 $171.88 $101.67 $171.88 $171.88 $171.88 $171.88 $129.00 $171.88 $171.88 $171.88 $85.94 $85.94 $136.13 $171.88 $137.50 $77.35 $34.11 N/A $99.76 $171.88 $103.13 $171.88 $35.82 $171.88 N/A N/A 53-20620E SUP HCPCS C1713 53-20620E - PEG FIX 2MM 20MM LOCKING T7 DRIVE SCREW VARIAX TITANIUM RAD BOTH IP/OP $172.00 $127.00 $34.11 $171.88 $77.35 $77.35 $77.35 $77.35 $171.88 $171.88 $171.88 $35.82 $171.88 $171.88 $171.88 $171.88 $171.88 $35.82 $171.88 $171.88 $101.67 $171.88 $171.88 $171.88 $171.88 $129.00 $171.88 $171.88 $171.88 $85.94 $85.94 $136.13 $171.88 $137.50 $77.35 $34.11 N/A $99.76 $171.88 $103.13 $171.88 $35.82 $171.88 N/A N/A 53-20622E SUP HCPCS C1713 53-20622E - PEG FIX 2MM 22MM LOCKING T7 DRIVE SCREW VARIAX TITANIUM RAD BOTH IP/OP $172.00 $127.00 $34.11 $171.88 $77.35 $77.35 $77.35 $77.35 $171.88 $171.88 $171.88 $35.82 $171.88 $171.88 $171.88 $171.88 $171.88 $35.82 $171.88 $171.88 $101.67 $171.88 $171.88 $171.88 $171.88 $129.00 $171.88 $171.88 $171.88 $85.94 $85.94 $136.13 $171.88 $137.50 $77.35 $34.11 N/A $99.76 $171.88 $103.13 $171.88 $35.82 $171.88 N/A N/A 53-20624E SUP HCPCS C1713 53-20624E - PEG FIX 2MM 24MM LOCKING T7 DRIVE SCREW VARIAX TITANIUM RAD BOTH IP/OP $172.00 $127.00 $34.11 $171.88 $77.35 $77.35 $77.35 $77.35 $171.88 $171.88 $171.88 $35.82 $171.88 $171.88 $171.88 $171.88 $171.88 $35.82 $171.88 $68.75 $101.67 $171.88 $171.88 $171.88 $171.88 $129.00 $171.88 $171.88 $171.88 $85.94 $85.94 $136.13 $171.88 $137.50 $77.35 $34.11 N/A $99.76 $171.88 $103.13 $171.88 $35.82 $171.88 N/A N/A 53-20626E SUP HCPCS C1713 53-20626E - PEG FIX 2MM 26MM LOCKING T7 DRIVE SCREW VARIAX TITANIUM BOTH IP/OP $172.00 $127.00 $34.11 $171.88 $77.35 $77.35 $77.35 $77.35 $171.88 $171.88 $171.88 $35.82 $171.88 $171.88 $171.88 $171.88 $171.88 $35.82 $171.88 $171.88 $101.67 $171.88 $171.88 $171.88 $171.88 $129.00 $171.88 $171.88 $171.88 $85.94 $85.94 $136.13 $171.88 $137.50 $77.35 $34.11 N/A $99.76 $171.88 $103.13 $171.88 $35.82 $171.88 N/A N/A 53-23006 SUP HCPCS C1713 53-23006 - SCREW BONE 2.3MM 6MM LOCKING SLFTAP XPIN HEAD LP VARIAX BOTH IP/OP $146.00 $108.00 $28.90 $145.60 $65.52 $65.52 $65.52 $65.52 $145.60 $145.60 $145.60 $30.35 $145.60 $145.60 $145.60 $145.60 $145.60 $30.34 $145.60 $145.60 $86.12 $145.60 $145.60 $145.60 $145.60 $109.50 $145.60 $145.60 $145.60 $72.80 $72.80 $115.32 $145.60 $116.48 $65.52 $28.90 N/A $84.68 $145.60 $87.36 $145.60 $30.34 $145.60 N/A N/A 53-23006E SUP HCPCS C1713 53-23006E - SCREW BONE LP 2.3MM 6MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $141.50 $105.00 $28.06 $141.40 $63.63 $63.63 $63.63 $63.63 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $141.40 $141.40 $141.40 $29.47 $141.40 $56.56 $83.64 $141.40 $141.40 $141.40 $141.40 $106.13 $141.40 $141.40 $141.40 $70.70 $70.70 $111.99 $141.40 $113.12 $63.63 $28.06 N/A $82.07 $141.40 $84.84 $141.40 $29.47 $141.40 N/A N/A 53-23008 SUP HCPCS C1713 53-23008 - SCREW BONE 2.3MM 8MM SLFTAP XPIN VARIAX HAND BOTH IP/OP $146.00 $108.00 $28.90 $145.60 $65.52 $65.52 $65.52 $65.52 $145.60 $145.60 $145.60 $30.35 $145.60 $145.60 $145.60 $145.60 $145.60 $30.34 $145.60 $58.24 $86.12 $145.60 $145.60 $145.60 $145.60 $109.50 $145.60 $145.60 $145.60 $72.80 $72.80 $115.32 $145.60 $116.48 $65.52 $28.90 N/A $84.68 $145.60 $87.36 $145.60 $30.34 $145.60 N/A N/A 53-23008E SUP HCPCS C1713 53-23008E - SCREW BN 2.3MM 8MM STRL VARIAX ST LCK LOPRFL XPN HD TI HND BOTH IP/OP $141.50 $105.00 $28.06 $141.40 $63.63 $63.63 $63.63 $63.63 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $83.64 $141.40 $141.40 $141.40 $141.40 $106.13 $141.40 $141.40 $141.40 $70.70 $70.70 $111.99 $141.40 $113.12 $63.63 $28.06 N/A $82.07 $141.40 $84.84 $141.40 $29.47 $141.40 N/A N/A 53-23009 SUP HCPCS C1713 53-23009 - SCREW BN BLNT 2.3MM 9MM LCK ST XPN HD LOPRFL HND BOTH IP/OP $146.00 $108.00 $28.90 $145.60 $65.52 $65.52 $65.52 $65.52 $145.60 $145.60 $145.60 $30.35 $145.60 $145.60 $145.60 $145.60 $145.60 $30.34 $145.60 $145.60 $86.12 $145.60 $145.60 $145.60 $145.60 $109.50 $145.60 $145.60 $145.60 $72.80 $72.80 $115.32 $145.60 $116.48 $65.52 $28.90 N/A $84.68 $145.60 $87.36 $145.60 $30.34 $145.60 N/A N/A 53-23009E SUP HCPCS C1713 53-23009E - SCREW BN LOPRFL 2.3MM 9MM NS VARIAX ST LCK XPN HD TI HND BOTH IP/OP $141.50 $105.00 $28.06 $141.40 $63.63 $63.63 $63.63 $63.63 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $141.40 $141.40 $141.40 $29.47 $141.40 $56.56 $83.64 $141.40 $141.40 $141.40 $141.40 $106.13 $141.40 $141.40 $141.40 $70.70 $70.70 $111.99 $141.40 $113.12 $63.63 $28.06 N/A $82.07 $141.40 $141.40 $141.40 $29.47 $141.40 N/A N/A 53-23010 SUP HCPCS C1713 53-23010 - SCREW BONE 2.3MM 10MM HAND LCK SLFTAP CROSSPIN BOTH IP/OP $117.00 $87.00 $23.20 $116.88 $52.60 $52.60 $52.60 $52.60 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $69.13 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $52.60 $23.20 N/A $67.86 $116.88 $116.88 $116.88 $24.36 $116.88 N/A N/A 53-23010E SUP HCPCS C1713 53-23010E - SCREW BN 2.3MM 10MM STRL VARIAX ST LCK LOPRFL XPN HD TI HND BOTH IP/OP $141.50 $105.00 $28.06 $141.40 $63.63 $63.63 $63.63 $63.63 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $83.64 $141.40 $141.40 $141.40 $141.40 $106.13 $141.40 $141.40 $141.40 $70.70 $70.70 $111.99 $141.40 $113.12 $63.63 $28.06 N/A $82.07 $141.40 $141.40 $141.40 $29.47 $141.40 N/A N/A 53-23011 SUP HCPCS C1713 53-23011 - SCREW BONE 2.3MM 11MM SLFTAP XPIN VARIAX HAND BOTH IP/OP $146.00 $108.00 $28.90 $145.60 $65.52 $65.52 $65.52 $65.52 $145.60 $145.60 $145.60 $30.35 $145.60 $145.60 $145.60 $145.60 $145.60 $30.34 $145.60 $145.60 $86.12 $145.60 $145.60 $145.60 $145.60 $109.50 $145.60 $145.60 $145.60 $72.80 $72.80 $115.32 $145.60 $116.48 $65.52 $28.90 N/A $84.68 $145.60 $145.60 $145.60 $30.34 $145.60 N/A N/A 53-23011E SUP HCPCS C1713 53-23011E - SCREW BONE LP 2.3MM 11MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $141.50 $105.00 $28.06 $141.40 $63.63 $63.63 $63.63 $63.63 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $83.64 $141.40 $141.40 $141.40 $141.40 $106.13 $141.40 $141.40 $141.40 $70.70 $70.70 $111.99 $141.40 $113.12 $63.63 $28.06 N/A $82.07 $141.40 $141.40 $141.40 $29.47 $141.40 N/A N/A 53-23012 SUP HCPCS C1713 53-23012 - SCREW BONE BLUNT 2.3MM 12MM SLFTAP LOCKING LP ROUND HEAD BOTH IP/OP $146.00 $108.00 $28.90 $145.60 $65.52 $65.52 $65.52 $65.52 $145.60 $145.60 $145.60 $30.35 $145.60 $145.60 $145.60 $145.60 $145.60 $30.34 $145.60 $145.60 $86.12 $145.60 $145.60 $145.60 $145.60 $109.50 $145.60 $145.60 $145.60 $72.80 $72.80 $115.32 $145.60 $116.48 $65.52 $28.90 N/A $84.68 $145.60 $87.36 $145.60 $30.34 $145.60 N/A N/A 53-23012E SUP HCPCS C1713 53-23012E - SCREW BN 2.3MM 12MM STRL VARIAX ST LCK LOPRFL CROSSPIN HD TI BOTH IP/OP $141.50 $105.00 $28.06 $141.40 $63.63 $63.63 $63.63 $63.63 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $83.64 $141.40 $141.40 $141.40 $141.40 $106.13 $141.40 $141.40 $141.40 $70.70 $70.70 $111.99 $141.40 $113.12 $63.63 $28.06 N/A $82.07 $141.40 $84.84 $141.40 $29.47 $141.40 N/A N/A 53-23013E SUP HCPCS C1713 53-23013E - SCREW BONE LP 2.3MM 13MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $141.50 $105.00 $28.06 $141.40 $63.63 $63.63 $63.63 $63.63 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $83.64 $141.40 $141.40 $141.40 $141.40 $106.13 $141.40 $141.40 $141.40 $70.70 $70.70 $111.99 $141.40 $113.12 $63.63 $28.06 N/A $82.07 $141.40 $84.84 $141.40 $29.47 $141.40 N/A N/A 53-23014 SUP HCPCS C1713 53-23014 - SCREW BONE 2.3MM 14MM LOCK TITANIUM HAND BOTH IP/OP $146.00 $108.00 $28.90 $145.60 $65.52 $65.52 $65.52 $65.52 $145.60 $145.60 $145.60 $30.35 $145.60 $145.60 $145.60 $145.60 $145.60 $30.34 $145.60 $145.60 $86.12 $145.60 $145.60 $145.60 $145.60 $109.50 $145.60 $145.60 $145.60 $72.80 $72.80 $115.32 $145.60 $116.48 $65.52 $28.90 N/A $84.68 $145.60 $87.36 $145.60 $30.34 $145.60 N/A N/A 53-23015E SUP HCPCS C1713 53-23015E - SCREW BONE LP 2.3MM 15MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $141.50 $105.00 $28.06 $141.40 $63.63 $63.63 $63.63 $63.63 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $83.64 $141.40 $141.40 $141.40 $141.40 $106.13 $141.40 $141.40 $141.40 $70.70 $70.70 $111.99 $141.40 $113.12 $63.63 $28.06 N/A $82.07 $141.40 $84.84 $141.40 $29.47 $141.40 N/A N/A 53-23016 SUP HCPCS C1713 53-23016 - SCREW BONE 2.3MM 16MM HAND LCK SLFTAP CROSSPIN BOTH IP/OP $117.00 $87.00 $23.20 $116.88 $52.60 $52.60 $52.60 $52.60 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $69.13 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $52.60 $23.20 N/A $67.86 $116.88 $70.13 $116.88 $24.36 $116.88 N/A N/A 53-23016E SUP HCPCS C1713 53-23016E - SCREW BONE LP 2.3MM 16MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $141.50 $105.00 $28.06 $141.40 $63.63 $63.63 $63.63 $63.63 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $141.40 $141.40 $141.40 $29.47 $141.40 $56.56 $83.64 $141.40 $141.40 $141.40 $141.40 $106.13 $141.40 $141.40 $141.40 $70.70 $70.70 $111.99 $141.40 $113.12 $63.63 $28.06 N/A $82.07 $141.40 $141.40 $141.40 $29.47 $141.40 N/A N/A 53-23018 SUP HCPCS C1713 53-23018 - SCREW BONE 2.3MM 18MM LOCK SELF TAP XPIN VARIAX HAND BOTH IP/OP $146.00 $108.00 $28.90 $145.60 $65.52 $65.52 $65.52 $65.52 $145.60 $145.60 $145.60 $30.35 $145.60 $145.60 $145.60 $145.60 $145.60 $30.34 $145.60 $58.24 $86.12 $145.60 $145.60 $145.60 $145.60 $109.50 $145.60 $145.60 $145.60 $72.80 $72.80 $115.32 $145.60 $116.48 $65.52 $28.90 N/A $84.68 $145.60 $145.60 $145.60 $30.34 $145.60 N/A N/A 53-23018E SUP HCPCS C1713 53-23018E - SCREW BONE LP 2.3MM 18MM SELF TAP LOCK XPIN HEAD VARIAX BOTH IP/OP $141.50 $105.00 $28.06 $141.40 $63.63 $63.63 $63.63 $63.63 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $83.64 $141.40 $141.40 $141.40 $141.40 $106.13 $141.40 $141.40 $141.40 $70.70 $70.70 $111.99 $141.40 $113.12 $63.63 $28.06 N/A $82.07 $141.40 $141.40 $141.40 $29.47 $141.40 N/A N/A 53-23020 SUP HCPCS C1713 53-23020 - SCREW BONE 2.3MM 20MM LOCK BOTH IP/OP $146.00 $108.00 $28.90 $145.60 $65.52 $65.52 $65.52 $65.52 $145.60 $145.60 $145.60 $30.35 $145.60 $145.60 $145.60 $145.60 $145.60 $30.34 $145.60 $58.24 $86.12 $145.60 $145.60 $145.60 $145.60 $109.50 $145.60 $145.60 $145.60 $72.80 $72.80 $115.32 $145.60 $116.48 $65.52 $28.90 N/A $84.68 $145.60 $87.36 $145.60 $30.34 $145.60 N/A N/A 53-23020E SUP HCPCS C1713 53-23020E - SCREW BONE 2.3MM 20MM LOCKING SLFTAP XPIN HEAD LP VARIAX BOTH IP/OP $141.50 $105.00 $28.06 $141.40 $63.63 $63.63 $63.63 $63.63 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $141.40 $141.40 $141.40 $29.47 $141.40 $56.56 $83.64 $141.40 $141.40 $141.40 $141.40 $106.13 $141.40 $141.40 $141.40 $70.70 $70.70 $111.99 $141.40 $113.12 $63.63 $28.06 N/A $82.07 $141.40 $141.40 $141.40 $29.47 $141.40 N/A N/A 53-23022 SUP HCPCS C1713 53-23022 - SCREW BONE 2MM 22MM RAD BOTH IP/OP $146.00 $108.00 $28.90 $145.60 $65.52 $65.52 $65.52 $65.52 $145.60 $145.60 $145.60 $30.35 $145.60 $145.60 $145.60 $145.60 $145.60 $30.34 $145.60 $58.24 $86.12 $145.60 $145.60 $145.60 $145.60 $109.50 $145.60 $145.60 $145.60 $72.80 $72.80 $115.32 $145.60 $116.48 $65.52 $28.90 N/A $84.68 $145.60 $87.36 $145.60 $30.34 $145.60 N/A N/A 53-23022E SUP HCPCS C1713 53-23022E - SCREW BONE 2.3MM 22MM LOCK XPIN SELF TAP VARIAX TITANIUM BOTH IP/OP $141.50 $105.00 $28.06 $141.40 $63.63 $63.63 $63.63 $63.63 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $141.40 $141.40 $141.40 $29.47 $141.40 $56.56 $83.64 $141.40 $141.40 $141.40 $141.40 $106.13 $141.40 $141.40 $141.40 $70.70 $70.70 $111.99 $141.40 $113.12 $63.63 $28.06 N/A $82.07 $141.40 $141.40 $141.40 $29.47 $141.40 N/A N/A 53-23024 SUP HCPCS C1713 53-23024 - SCREW BN LOPRFL BLNT RND 2.3MM 24MM GRN VARIAX PRFL 1 STP BOTH IP/OP $146.00 $108.00 $28.90 $145.60 $65.52 $65.52 $65.52 $65.52 $145.60 $145.60 $145.60 $30.35 $145.60 $145.60 $145.60 $145.60 $145.60 $30.34 $145.60 $145.60 $86.12 $145.60 $145.60 $145.60 $145.60 $109.50 $145.60 $145.60 $145.60 $72.80 $72.80 $115.32 $145.60 $116.48 $65.52 $28.90 N/A $84.68 $145.60 $87.36 $145.60 $30.34 $145.60 N/A N/A 53-23024E SUP HCPCS C1713 53-23024E - SCREW BN 2.3MM 24MM VARIAX LCK ST XPN HD LOPRFL TI WR HND BOTH IP/OP $141.50 $105.00 $28.06 $141.40 $63.63 $63.63 $63.63 $63.63 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $141.40 $141.40 $141.40 $29.47 $141.40 $56.56 $83.64 $141.40 $141.40 $141.40 $141.40 $106.13 $141.40 $141.40 $141.40 $70.70 $70.70 $111.99 $141.40 $113.12 $63.63 $28.06 N/A $82.07 $141.40 $84.84 $141.40 $29.47 $141.40 N/A N/A 53-23026 SUP HCPCS C1713 53-23026 - SCREW BONE 2.3MM 26MM LOCK BOTH IP/OP $146.00 $108.00 $28.90 $145.60 $65.52 $65.52 $65.52 $65.52 $145.60 $145.60 $145.60 $30.35 $145.60 $145.60 $145.60 $145.60 $145.60 $30.34 $145.60 $58.24 $86.12 $145.60 $145.60 $145.60 $145.60 $109.50 $145.60 $145.60 $145.60 $72.80 $72.80 $115.32 $145.60 $116.48 $65.52 $28.90 N/A $84.68 $145.60 $87.36 $145.60 $30.34 $145.60 N/A N/A 53-23026E SUP HCPCS C1713 53-23026E - SCREW BONE LP 2.3MM 26MM LOCK SELF TAP XPIN HEAD VARIAX BOTH IP/OP $141.50 $105.00 $28.06 $141.40 $63.63 $63.63 $63.63 $63.63 $141.40 $141.40 $141.40 $29.47 $141.40 $141.40 $141.40 $141.40 $141.40 $29.47 $141.40 $56.56 $83.64 $141.40 $141.40 $141.40 $141.40 $106.13 $141.40 $141.40 $141.40 $70.70 $70.70 $111.99 $141.40 $113.12 $63.63 $28.06 N/A $82.07 $141.40 $84.84 $141.40 $29.47 $141.40 N/A N/A 53-23210E SUP HCPCS C1713 53-23210E - SCREW BONE T7 FULTHD 2.3MM 10MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-23212E SUP HCPCS C1713 53-23212E - SCREW BONE 2.3MM 12MM T7 DRIVE VARIAX TITANIUM DISTAL RAD BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-23214E SUP HCPCS C1713 53-23214E - SCREW BONE T7 FULTHD 2.3MM 14MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-23216E SUP HCPCS C1713 53-23216E - SCREW BONE 2.3MM 16MM T7 DRIVE VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-23218E SUP HCPCS C1713 53-23218E - SCREW BONE 2.3MM 18MM T7 DRIVE VARIAX TITANIUM DISTAL RAD BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $134.30 $134.30 $27.99 $134.30 N/A N/A 53-23220E SUP HCPCS C1713 53-23220E - SCREW BONE T7 FULTHD 2.3MM 20MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-23222E SUP HCPCS C1713 53-23222E - SCREW BONE 2.3MM 22MM T7 DRIVE VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-23224E SUP HCPCS C1713 53-23224E - SCREW BONE 2.3MM 24MM LOCK T7 DRIVE VARIAX TITANIUM RAD BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $134.30 $134.30 $27.99 $134.30 N/A N/A 53-23226E SUP HCPCS C1713 53-23226E - SCREW BONE T7 FULTHD 2.3MM 26MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $134.30 $134.30 $27.99 $134.30 N/A N/A 53-23228E SUP HCPCS C1713 53-23228E - SCREW BONE T7 FULTHD 2.3MM 28MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-23230E SUP HCPCS C1713 53-23230E - SCREW BONE T7 FULTHD 2.3MM 30MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-23232E SUP HCPCS C1713 53-23232E - SCREW BONE T7 FULTHD 2.3MM 32MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-23234E SUP HCPCS C1713 53-23234E - SCREW BONE T7 FULTHD 2.3MM 34MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-23236E SUP HCPCS C1713 53-23236E - SCREW BONE T7 FULTHD 2.3MM 36MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-23238E SUP HCPCS C1713 53-23238E - SCREW BONE T7 FULTHD 2.3MM 38MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $134.30 $134.30 $27.99 $134.30 N/A N/A 53-23610E SUP HCPCS C1713 53-23610E - SCREW BONE 2.3MM 10MM T7 DRIVE VARIAX TITANIUM DISTAL RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $71.74 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-23612E SUP HCPCS C1713 53-23612E - SCREW BONE T7 FULTHD 2.3MM 12MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $71.74 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-23614E SUP HCPCS C1713 53-23614E - SCREW BONE T7 FULTHD 2.3MM 14MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $71.74 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-23616E SUP HCPCS C1713 53-23616E - SCREW BONE T7 FULTHD 2.3MM 16MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-23618E SUP HCPCS C1713 53-23618E - SCREW BONE T7 FULTHD 2.3MM 18MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $179.35 $179.35 $37.38 $179.35 N/A N/A 53-23620E SUP HCPCS C1713 53-23620E - SCREW BONE 2.3MM 20MM T7 DRIVE VARIAX TITANIUM DISTAL RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-23622E SUP HCPCS C1713 53-23622E - SCREW BONE 2.3MM 22MM T7 DRIVE VARIAX TITANIUM DISTAL RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-23624E SUP HCPCS C1713 53-23624E - SCREW BONE 2.3MM 24MM T7 DRIVE VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-23626E SUP HCPCS C1713 53-23626E - SCREW BONE 2.3MM 26MM LOCK T7 DRIVE VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $179.35 $179.35 $37.38 $179.35 N/A N/A 53-23628E SUP HCPCS C1713 53-23628E - SCREW BONE 2.3MM 28MM T7 DRIVE VARIAX TITANIUM DISTAL RADIAL BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-23630E SUP HCPCS C1713 53-23630E - SCREW BONE T7 FULTHD 2.3MM 30MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-23632E SUP HCPCS C1713 53-23632E - SCREW BONE T7 FULTHD 2.3MM 32MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-23634E SUP HCPCS C1713 53-23634E - SCREW BONE T7 FULTHD 2.3MM 34MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-23636E SUP HCPCS C1713 53-23636E - SCREW BONE T7 FULTHD 2.3MM 36MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-23638E SUP HCPCS C1713 53-23638E - SCREW BONE T7 FULTHD 2.3MM 38MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 532650S SUP HCPCS C1725 532650S - CATHETER ANGIO PGTL CRV 6FR 110CM ST 6 SH BRD PU VNTRC ACPT BOTH IP/OP $106.00 $78.00 $20.96 $105.63 $57.36 $57.36 $57.36 $57.36 $105.63 $105.63 $105.63 $22.02 $105.63 $78.40 $78.40 $81.42 $55.03 $22.01 $105.63 $105.63 $62.48 $105.63 $105.63 $105.63 $105.63 $79.50 $105.63 $105.63 $105.63 $52.82 $52.82 $83.66 $105.63 $84.50 $68.66 $20.96 N/A $61.48 $105.63 $105.63 $105.63 $22.01 $105.63 N/A N/A 532652S SUP HCPCS C1725 532652S - CATHETER ANGIO 145D PGTL CRV 6FR .051IN .042IN 110CM ST BOTH IP/OP $19.50 $14.00 $3.85 $62.50 $10.52 $10.52 $10.52 $10.52 $19.38 $19.38 $19.38 $4.04 $19.38 $14.38 $14.38 $14.94 $10.10 $4.04 $19.38 $62.50 $11.46 $19.38 $62.50 $19.38 $19.38 $14.63 $19.38 $19.38 $19.38 $9.69 $9.69 $15.35 $19.38 $15.50 $12.60 $3.85 N/A $11.31 $19.38 $19.38 $19.38 $4.04 $19.38 N/A N/A 53-27116E SUP HCPCS C1713 53-27116E - SCREW BONE T7 PTHRD 2.7MM 16MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $174.50 $129.00 $34.58 $174.25 $78.41 $78.41 $78.41 $78.41 $174.25 $174.25 $174.25 $36.32 $174.25 $174.25 $174.25 $174.25 $174.25 $36.32 $174.25 $174.25 $103.07 $174.25 $174.25 $174.25 $174.25 $130.88 $174.25 $174.25 $174.25 $87.13 $87.13 $138.01 $174.25 $139.40 $78.41 $34.58 N/A $101.21 $174.25 $104.55 $174.25 $36.31 $174.25 N/A N/A 53-27118E SUP HCPCS C1713 53-27118E - SCREW BONE T7 PTHRD 2.7MM 18MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $174.50 $129.00 $34.58 $174.25 $78.41 $78.41 $78.41 $78.41 $174.25 $174.25 $174.25 $36.32 $174.25 $174.25 $174.25 $174.25 $174.25 $36.32 $174.25 $174.25 $103.07 $174.25 $174.25 $174.25 $174.25 $130.88 $174.25 $174.25 $174.25 $87.13 $87.13 $138.01 $174.25 $139.40 $78.41 $34.58 N/A $101.21 $174.25 $104.55 $174.25 $36.31 $174.25 N/A N/A 53-27120E SUP HCPCS C1713 53-27120E - SCREW BONE T7 PTHRD 2.7MM 20MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $174.50 $129.00 $34.58 $174.25 $78.41 $78.41 $78.41 $78.41 $174.25 $174.25 $174.25 $36.32 $174.25 $174.25 $174.25 $174.25 $174.25 $36.32 $174.25 $69.70 $103.07 $174.25 $174.25 $174.25 $174.25 $130.88 $174.25 $174.25 $174.25 $87.13 $87.13 $138.01 $174.25 $139.40 $78.41 $34.58 N/A $101.21 $174.25 $174.25 $174.25 $36.31 $174.25 N/A N/A 53-27122E SUP HCPCS C1713 53-27122E - SCREW BONE T7 PTHRD 2.7MM 22MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $174.50 $129.00 $34.58 $174.25 $78.41 $78.41 $78.41 $78.41 $174.25 $174.25 $174.25 $36.32 $174.25 $174.25 $174.25 $174.25 $174.25 $36.32 $174.25 $174.25 $103.07 $174.25 $174.25 $174.25 $174.25 $130.88 $174.25 $174.25 $174.25 $87.13 $87.13 $138.01 $174.25 $139.40 $78.41 $34.58 N/A $101.21 $174.25 $174.25 $174.25 $36.31 $174.25 N/A N/A 53-27124E SUP HCPCS C1713 53-27124E - SCREW BONE T7 PTHRD 2.7MM 24MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $174.50 $129.00 $34.58 $174.25 $78.41 $78.41 $78.41 $78.41 $174.25 $174.25 $174.25 $36.32 $174.25 $174.25 $174.25 $174.25 $174.25 $36.32 $174.25 $69.70 $103.07 $174.25 $174.25 $174.25 $174.25 $130.88 $174.25 $174.25 $174.25 $87.13 $87.13 $138.01 $174.25 $139.40 $78.41 $34.58 N/A $101.21 $174.25 $174.25 $174.25 $36.31 $174.25 N/A N/A 53-27126E SUP HCPCS C1713 53-27126E - SCREW BONE T7 PTHRD 2.7MM 26MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $174.50 $129.00 $34.58 $174.25 $78.41 $78.41 $78.41 $78.41 $174.25 $174.25 $174.25 $36.32 $174.25 $174.25 $174.25 $174.25 $174.25 $36.32 $174.25 $174.25 $103.07 $174.25 $174.25 $174.25 $174.25 $130.88 $174.25 $174.25 $174.25 $87.13 $87.13 $138.01 $174.25 $139.40 $78.41 $34.58 N/A $101.21 $174.25 $104.55 $174.25 $36.31 $174.25 N/A N/A 53-27210E SUP HCPCS C1713 53-27210E - SCREW BONE T7 FULTHD 2.7MM 10MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-27212E SUP HCPCS C1713 53-27212E - SCREW BONE T7 FULTHD 2.7MM 12MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-27214E SUP HCPCS C1713 53-27214E - SCREW BONE T7 FULTHD 2.7MM 14MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-27216E SUP HCPCS C1713 53-27216E - SCREW BONE T7 FULTHD 2.7MM 16MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-27218E SUP HCPCS C1713 53-27218E - SCREW BONE T7 FULTHD 2.7MM 18MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $134.30 $134.30 $27.99 $134.30 N/A N/A 53-27220E SUP HCPCS C1713 53-27220E - SCREW BONE 2.7MM 20MM T7 DRIVE VARIAX TITANIUM DISTAL RAD BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-27222E SUP HCPCS C1713 53-27222E - SCREW BONE T7 FULTHD 2.7MM 22MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-27224E SUP HCPCS C1713 53-27224E - SCREW BONE T7 FULTHD 2.7MM 24MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $134.30 $134.30 $27.99 $134.30 N/A N/A 53-27226E SUP HCPCS C1713 53-27226E - SCREW BONE T7 FULTHD 2.7MM 26MM VARIAX TITANIUM RAD DISTAL BOTH IP/OP $134.50 $100.00 $26.66 $134.30 $60.44 $60.44 $60.44 $60.44 $134.30 $134.30 $134.30 $27.99 $134.30 $134.30 $134.30 $134.30 $134.30 $27.99 $134.30 $53.72 $79.44 $134.30 $134.30 $134.30 $134.30 $100.88 $134.30 $134.30 $134.30 $67.15 $67.15 $106.37 $134.30 $107.44 $60.44 $26.66 N/A $78.01 $134.30 $80.58 $134.30 $27.99 $134.30 N/A N/A 53-27610E SUP HCPCS C1713 53-27610E - SCREW BONE T7 FULTHD 2.7MM 10MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $71.74 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $179.35 $179.35 $37.38 $179.35 N/A N/A 53-27612E SUP HCPCS C1713 53-27612E - SCREW BONE T7 FULTHD 2.7MM 12MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-27614E SUP HCPCS C1713 53-27614E - SCREW BONE T7 FULTHD 2.7MM 14MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $71.74 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $179.35 $179.35 $37.38 $179.35 N/A N/A 53-27616E SUP HCPCS C1713 53-27616E - SCREW BONE T7 FULTHD 2.7MM 16MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $71.74 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-27618E SUP HCPCS C1713 53-27618E - SCREW BONE T7 FULTHD 2.7MM 18MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $71.74 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-27620E SUP HCPCS C1713 53-27620E - SCREW BONE T7 FULTHD 2.7MM 20MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-27622E SUP HCPCS C1713 53-27622E - SCREW BN T7 FT 2.7MM 22MM NS VARIAX LCK TI DIST RDS LCK PLT BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $71.74 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-27624E SUP HCPCS C1713 53-27624E - SCREW BONE T7 FULTHD 2.7MM 24MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-27626E SUP HCPCS C1713 53-27626E - SCREW BONE T7 FULTHD 2.7MM 26MM LOCK VARIAX TITANIUM RAD BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $179.35 $179.35 $37.38 $179.35 N/A N/A 53-27716E SUP HCPCS C1713 53-27716E - PEG FIX 2.7MM 16MM PTTHRD LOCKING TITANIUM NONSTRL BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-27718E SUP HCPCS C1713 53-27718E - PEG FIX PTHRD 2.7MM 18MM T7 DRIVE LOCKING VARIAX TITANIUM BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-27720E SUP HCPCS C1713 53-27720E - PEG FIX PTHRD 2.7MM 20MM T7 DRIVE LOCKING VARIAX TITANIUM BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $179.35 $179.35 $37.38 $179.35 N/A N/A 53-27722E SUP HCPCS C1713 53-27722E - PEG FIX PTHRD 2.7MM 22MM T7 DRIVE LOCKING VARIAX TITANIUM BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-27724E SUP HCPCS C1713 53-27724E - PEG FIX PTHRD 2.7MM 24MM T7 DRIVE LOCKING VARIAX TITANIUM BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $71.74 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $107.61 $179.35 $37.38 $179.35 N/A N/A 53-27726E SUP HCPCS C1713 53-27726E - PEG FIX PTHRD 2.7MM 26MM T7 DRIVE LOCKING VARIAX TITANIUM BOTH IP/OP $179.50 $133.00 $35.60 $179.35 $80.71 $80.71 $80.71 $80.71 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $179.35 $179.35 $179.35 $37.38 $179.35 $179.35 $106.09 $179.35 $179.35 $179.35 $179.35 $134.63 $179.35 $179.35 $179.35 $89.68 $89.68 $142.05 $179.35 $143.48 $80.71 $35.60 N/A $104.11 $179.35 $179.35 $179.35 $37.38 $179.35 N/A N/A 5331-40/15 SUP HCPCS C1776 5331-40/15 - HEAD HUMERAL 40MM 15MM EPOCA COCR ALLOY SHOULDER STERILE BOTH IP/OP "$4,288.00" "$3,173.00" $851.00 "$4,287.70" "$1,929.47" "$1,929.47" "$1,929.47" "$1,929.47" "$4,287.70" "$4,287.70" "$4,287.70" $893.66 "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" $893.60 "$4,287.70" "$1,715.08" "$2,113.84" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$3,216.00" "$4,287.70" "$4,287.70" "$4,287.70" "$2,143.85" "$2,143.85" "$3,395.86" "$4,287.70" "$3,430.16" "$1,929.47" $851.00 N/A "$2,487.04" "$4,287.70" "$4,287.70" "$4,287.70" $893.56 "$4,287.70" N/A N/A 5331-42/15 SUP HCPCS C1776 5331-42/15 - HEAD HUMERAL 42MM 15.75MM COCR SHOULDER NONSTRL BOTH IP/OP "$4,288.00" "$3,173.00" $851.00 "$4,287.70" "$1,929.47" "$1,929.47" "$1,929.47" "$1,929.47" "$4,287.70" "$4,287.70" "$4,287.70" $893.66 "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" $893.60 "$4,287.70" "$1,715.08" "$2,113.84" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$3,216.00" "$4,287.70" "$4,287.70" "$4,287.70" "$2,143.85" "$2,143.85" "$3,395.86" "$4,287.70" "$3,430.16" "$1,929.47" $851.00 N/A "$2,487.04" "$4,287.70" "$4,287.70" "$4,287.70" $893.56 "$4,287.70" N/A N/A 5331-44/16 SUP HCPCS C1776 5331-44/16 - HEAD HUM 44MM 16.5MM STRL COCR SHLDR BOTH IP/OP "$4,288.00" "$3,173.00" $851.00 "$4,287.70" "$1,929.47" "$1,929.47" "$1,929.47" "$1,929.47" "$4,287.70" "$4,287.70" "$4,287.70" $893.66 "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" $893.60 "$4,287.70" "$1,715.08" "$2,113.84" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$3,216.00" "$4,287.70" "$4,287.70" "$4,287.70" "$2,143.85" "$2,143.85" "$3,395.86" "$4,287.70" "$3,430.16" "$1,929.47" $851.00 N/A "$2,487.04" "$4,287.70" "$4,287.70" "$4,287.70" $893.56 "$4,287.70" N/A N/A 5331-46/17 SUP HCPCS C1776 5331-46/17 - HEAD HUM 46MM 17.25MM STRL COCR SHLDR BOTH IP/OP "$4,288.00" "$3,173.00" $851.00 "$4,287.70" "$1,929.47" "$1,929.47" "$1,929.47" "$1,929.47" "$4,287.70" "$4,287.70" "$4,287.70" $893.66 "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" $893.60 "$4,287.70" "$1,715.08" "$2,113.84" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$3,216.00" "$4,287.70" "$4,287.70" "$4,287.70" "$2,143.85" "$2,143.85" "$3,395.86" "$4,287.70" "$3,430.16" "$1,929.47" $851.00 N/A "$2,487.04" "$4,287.70" "$4,287.70" "$4,287.70" $893.56 "$4,287.70" N/A N/A 5331-48/18 SUP HCPCS C1776 5331-48/18 - HEAD HUM 48MM 18MM STRL COCR SHLDR BOTH IP/OP "$4,288.00" "$3,173.00" $851.00 "$4,287.70" "$1,929.47" "$1,929.47" "$1,929.47" "$1,929.47" "$4,287.70" "$4,287.70" "$4,287.70" $893.66 "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" $893.60 "$4,287.70" "$1,715.08" "$2,113.84" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$3,216.00" "$4,287.70" "$4,287.70" "$4,287.70" "$2,143.85" "$2,143.85" "$3,395.86" "$4,287.70" "$3,430.16" "$1,929.47" $851.00 N/A "$2,487.04" "$4,287.70" "$4,287.70" "$4,287.70" $893.56 "$4,287.70" N/A N/A 5331-50/18 SUP HCPCS C1776 5331-50/18 - HEAD HUM 50MM 18.75MM STRL COCR SHLDR BOTH IP/OP "$4,288.00" "$3,173.00" $851.00 "$4,287.70" "$1,929.47" "$1,929.47" "$1,929.47" "$1,929.47" "$4,287.70" "$4,287.70" "$4,287.70" $893.66 "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" $893.60 "$4,287.70" "$4,287.70" "$2,113.84" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$3,216.00" "$4,287.70" "$4,287.70" "$4,287.70" "$2,143.85" "$2,143.85" "$3,395.86" "$4,287.70" "$3,430.16" "$1,929.47" $851.00 N/A "$2,487.04" "$4,287.70" "$4,287.70" "$4,287.70" $893.56 "$4,287.70" N/A N/A 5331-52/19 SUP HCPCS C1776 5331-52/19 - HEAD HUMERAL 52MM 19.5MM EPOCA COCR SHOULDER STERILE BOTH IP/OP "$4,288.00" "$3,173.00" $851.00 "$4,287.70" "$1,929.47" "$1,929.47" "$1,929.47" "$1,929.47" "$4,287.70" "$4,287.70" "$4,287.70" $893.66 "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" $893.60 "$4,287.70" "$4,287.70" "$2,113.84" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$3,216.00" "$4,287.70" "$4,287.70" "$4,287.70" "$2,143.85" "$2,143.85" "$3,395.86" "$4,287.70" "$3,430.16" "$1,929.47" $851.00 N/A "$2,487.04" "$4,287.70" "$2,572.62" "$4,287.70" $893.56 "$4,287.70" N/A N/A 5331-54/20 SUP HCPCS C1776 5331-54/20 - HEAD HUMERAL 54MM 20.25MM COCR SHOULDER NONSTRL BOTH IP/OP "$4,288.00" "$3,173.00" $851.00 "$4,287.70" "$1,929.47" "$1,929.47" "$1,929.47" "$1,929.47" "$4,287.70" "$4,287.70" "$4,287.70" $893.66 "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" $893.60 "$4,287.70" "$1,715.08" "$2,113.84" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$3,216.00" "$4,287.70" "$4,287.70" "$4,287.70" "$2,143.85" "$2,143.85" "$3,395.86" "$4,287.70" "$3,430.16" "$1,929.47" $851.00 N/A "$2,487.04" "$4,287.70" "$4,287.70" "$4,287.70" $893.56 "$4,287.70" N/A N/A 5331-56/21 SUP HCPCS C1776 5331-56/21 - HEAD FEMORAL 56MM 21MM COCR HIP STERILE BOTH IP/OP "$4,288.00" "$3,173.00" $851.00 "$4,287.70" "$1,929.47" "$1,929.47" "$1,929.47" "$1,929.47" "$4,287.70" "$4,287.70" "$4,287.70" $893.66 "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" $893.60 "$4,287.70" "$1,715.08" "$2,113.84" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$3,216.00" "$4,287.70" "$4,287.70" "$4,287.70" "$2,143.85" "$2,143.85" "$3,395.86" "$4,287.70" "$3,430.16" "$1,929.47" $851.00 N/A "$2,487.04" "$4,287.70" "$4,287.70" "$4,287.70" $893.56 "$4,287.70" N/A N/A 5331-58/22 SUP HCPCS C1776 5331-58/22 - HEAD FEMORAL 58MM 21.75MM COCR HIP STERILE BOTH IP/OP "$4,288.00" "$3,173.00" $851.00 "$4,287.70" "$1,929.47" "$1,929.47" "$1,929.47" "$1,929.47" "$4,287.70" "$4,287.70" "$4,287.70" $893.66 "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" $893.60 "$4,287.70" "$1,715.08" "$2,113.84" "$4,287.70" "$4,287.70" "$4,287.70" "$4,287.70" "$3,216.00" "$4,287.70" "$4,287.70" "$4,287.70" "$2,143.85" "$2,143.85" "$3,395.86" "$4,287.70" "$3,430.16" "$1,929.47" $851.00 N/A "$2,487.04" "$4,287.70" "$4,287.70" "$4,287.70" $893.56 "$4,287.70" N/A N/A 53-34164 SUP HCPCS C1713 53-34164 - PLATE BN STRG .4MM NS UNV NEURO III 16 HL LOPRFL TI CRNMXF BOTH IP/OP "$1,147.50" $849.00 $227.75 "$1,147.50" $516.38 $516.38 $516.38 $516.38 "$1,147.50" "$1,147.50" "$1,147.50" $239.17 "$1,147.50" "$1,147.50" "$1,147.50" "$1,147.50" "$1,147.50" $239.15 "$1,147.50" "$1,147.50" $678.75 "$1,147.50" "$1,147.50" "$1,147.50" "$1,147.50" $860.63 "$1,147.50" "$1,147.50" "$1,147.50" $573.75 $573.75 $908.82 "$1,147.50" $918.00 $516.38 $227.75 N/A $665.55 "$1,147.50" $688.50 "$1,147.50" $239.14 "$1,147.50" N/A N/A 53-34212 SUP HCPCS C1713 53-34212 - PLATE BN STRG .4MM NS UNV NEURO III 2 HL LOPRFL BAR TAB TI BOTH IP/OP $457.50 $339.00 $90.80 $457.50 $205.88 $205.88 $205.88 $205.88 $457.50 $457.50 $457.50 $95.35 $457.50 $457.50 $457.50 $457.50 $457.50 $95.35 $457.50 $457.50 $270.61 $457.50 $457.50 $457.50 $457.50 $343.13 $457.50 $457.50 $457.50 $228.75 $228.75 $362.34 $457.50 $366.00 $205.88 $90.80 N/A $265.35 $457.50 $274.50 $457.50 $95.34 $457.50 N/A N/A 53-34216 SUP HCPCS C1713 53-34216 - PLATE BN DOG 16MMX.4MM NS UNV NEURO III 2 HL LOPRFL BAR TI BOTH IP/OP $562.50 $416.00 $111.64 $562.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $562.50 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $562.50 $562.50 $117.23 $562.50 N/A N/A 53-34228 SUP HCPCS C1713 53-34228 - PLATE BN SM BX .4MM NS UNV NEURO III 2X2 HL LOPRFL TI CRNMXF BOTH IP/OP $717.50 $531.00 $142.41 $717.50 $322.88 $322.88 $322.88 $322.88 $717.50 $717.50 $717.50 $149.54 $717.50 $717.50 $717.50 $717.50 $717.50 $149.53 $717.50 $717.50 $424.40 $717.50 $717.50 $717.50 $717.50 $538.13 $717.50 $717.50 $717.50 $358.75 $358.75 $568.26 $717.50 $574.00 $322.88 $142.41 N/A $416.15 $717.50 $430.50 $717.50 $149.53 $717.50 N/A N/A 53-34240 SUP HCPCS C1713 53-34240 - PLATE BN LG BX .4MM NS UNV NEURO III 2X2 HL LOPRFL TI CRNMXF BOTH IP/OP "$1,112.50" $823.00 $220.80 "$1,112.50" $500.63 $500.63 $500.63 $500.63 "$1,112.50" "$1,112.50" "$1,112.50" $231.87 "$1,112.50" "$1,112.50" "$1,112.50" "$1,112.50" "$1,112.50" $231.86 "$1,112.50" "$1,112.50" $658.04 "$1,112.50" "$1,112.50" "$1,112.50" "$1,112.50" $834.38 "$1,112.50" "$1,112.50" "$1,112.50" $556.25 $556.25 $881.10 "$1,112.50" $890.00 $500.63 $220.80 N/A $645.25 "$1,112.50" $667.50 "$1,112.50" $231.85 "$1,112.50" N/A N/A 53-34300 SUP HCPCS C1713 53-34300 - PLATE BN RECT .4MM NS UNV NEURO III 2X2 HL LOPRFL TI CRNMXF BOTH IP/OP "$1,092.50" $808.00 $216.83 "$1,092.50" $491.63 $491.63 $491.63 $491.63 "$1,092.50" "$1,092.50" "$1,092.50" $227.70 "$1,092.50" "$1,092.50" "$1,092.50" "$1,092.50" "$1,092.50" $227.69 "$1,092.50" "$1,092.50" $646.21 "$1,092.50" "$1,092.50" "$1,092.50" "$1,092.50" $819.38 "$1,092.50" "$1,092.50" "$1,092.50" $546.25 $546.25 $865.26 "$1,092.50" $874.00 $491.63 $216.83 N/A $633.65 "$1,092.50" $655.50 "$1,092.50" $227.68 "$1,092.50" N/A N/A 53-34406 SUP HCPCS C1713 53-34406 - PLATE BN STRG 6MMX.4MM NS UNV NEURO III 4 HL LOPRFL BAR TI BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $227.25 $227.25 $227.25 $227.25 $505.00 $505.00 $505.00 $105.25 $505.00 $505.00 $505.00 $505.00 $505.00 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $227.25 $100.23 N/A $292.90 $505.00 $303.00 $505.00 $105.24 $505.00 N/A N/A 53-34507 SUP HCPCS C1713 53-34507 - COVER BUR HL LOPRFL 7MM STRL MDPR TAB TI BOTH IP/OP $915.00 $677.00 $181.60 $915.00 $411.75 $411.75 $411.75 $411.75 $915.00 $915.00 $915.00 $190.71 $915.00 $915.00 $915.00 $915.00 $915.00 $190.70 $915.00 $915.00 $541.22 $915.00 $915.00 $915.00 $915.00 $686.25 $915.00 $915.00 $915.00 $457.50 $457.50 $724.68 $915.00 $732.00 $411.75 $181.60 N/A $530.70 $915.00 $915.00 $915.00 $190.69 $915.00 N/A N/A 53-34510 SUP HCPCS C1713 53-34510 - COVER BURR HOLE LP 10MM TAB UNIVERSAL NEURO III BOTH IP/OP $915.00 $677.00 $181.60 $915.00 $411.75 $411.75 $411.75 $411.75 $915.00 $915.00 $915.00 $190.71 $915.00 $915.00 $915.00 $915.00 $915.00 $190.70 $915.00 $915.00 $541.22 $915.00 $915.00 $915.00 $915.00 $686.25 $915.00 $915.00 $915.00 $457.50 $457.50 $724.68 $915.00 $732.00 $411.75 $181.60 N/A $530.70 $915.00 $549.00 $915.00 $190.69 $915.00 N/A N/A 53-34514 SUP HCPCS C1713 53-34514 - COVER BURR HOLE LP 14MM TAB UNIVERSAL NEURO III BOTH IP/OP $915.00 $677.00 $181.60 $915.00 $411.75 $411.75 $411.75 $411.75 $915.00 $915.00 $915.00 $190.71 $915.00 $915.00 $915.00 $915.00 $915.00 $190.70 $915.00 $915.00 $541.22 $915.00 $915.00 $915.00 $915.00 $686.25 $915.00 $915.00 $915.00 $457.50 $457.50 $724.68 $915.00 $732.00 $411.75 $181.60 N/A $530.70 $915.00 $915.00 $915.00 $190.69 $915.00 N/A N/A 53-34608 SUP HCPCS C1713 53-34608 - PLATE BN 2Y .4MM NS UNV NEURO III 6 HL LOPRFL BAR TI CRNMXF BOTH IP/OP "$1,002.50" $742.00 $198.97 "$1,002.50" $451.13 $451.13 $451.13 $451.13 "$1,002.50" "$1,002.50" "$1,002.50" $208.95 "$1,002.50" "$1,002.50" "$1,002.50" "$1,002.50" "$1,002.50" $208.93 "$1,002.50" "$1,002.50" $592.98 "$1,002.50" "$1,002.50" "$1,002.50" "$1,002.50" $751.88 "$1,002.50" "$1,002.50" "$1,002.50" $501.25 $501.25 $793.98 "$1,002.50" $802.00 $451.13 $198.97 N/A $581.45 "$1,002.50" $601.50 "$1,002.50" $208.92 "$1,002.50" N/A N/A 53-34612 SUP HCPCS C1713 53-34612 - PLATE BN SM GAP .4MM NS UNV NEURO III 6 HL LOPRFL TI CRNMXF BOTH IP/OP "$1,240.00" $918.00 $246.11 "$1,240.00" $558.00 $558.00 $558.00 $558.00 "$1,240.00" "$1,240.00" "$1,240.00" $258.45 "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" $258.43 "$1,240.00" "$1,240.00" $733.46 "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" $930.00 "$1,240.00" "$1,240.00" "$1,240.00" $620.00 $620.00 $982.08 "$1,240.00" $992.00 $558.00 $246.11 N/A $719.20 "$1,240.00" $744.00 "$1,240.00" $258.42 "$1,240.00" N/A N/A 53-34614 SUP HCPCS C1713 53-34614 - COVER BUR HL 14MMX.4MM NS UNV NEURO III LOPRFL SHNT TAB TI BOTH IP/OP "$1,002.50" $742.00 $198.97 "$1,002.50" $451.13 $451.13 $451.13 $451.13 "$1,002.50" "$1,002.50" "$1,002.50" $208.95 "$1,002.50" "$1,002.50" "$1,002.50" "$1,002.50" "$1,002.50" $208.93 "$1,002.50" $401.00 $592.98 "$1,002.50" "$1,002.50" "$1,002.50" "$1,002.50" $751.88 "$1,002.50" "$1,002.50" "$1,002.50" $501.25 $501.25 $793.98 "$1,002.50" $802.00 $451.13 $198.97 N/A $581.45 "$1,002.50" "$1,002.50" "$1,002.50" $208.92 "$1,002.50" N/A N/A 53-34620 SUP HCPCS C1713 53-34620 - COVER BUR HL 20MMX.4MM NS UNV NEURO III LOPRFL SHNT TAB TI BOTH IP/OP "$1,100.00" $814.00 $218.32 "$1,100.00" $495.00 $495.00 $495.00 $495.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.27 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $229.25 "$1,100.00" $440.00 $650.65 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $495.00 $218.32 N/A $638.00 "$1,100.00" $660.00 "$1,100.00" $229.24 "$1,100.00" N/A N/A 53-34622 SUP HCPCS C1713 53-34622 - PLATE BN LG GAP .4MM NS UNV NEURO III 6 HL LOPRFL TI CRNMXF BOTH IP/OP "$1,320.00" $977.00 $261.99 "$1,320.00" $594.00 $594.00 $594.00 $594.00 "$1,320.00" "$1,320.00" "$1,320.00" $275.12 "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" $275.10 "$1,320.00" "$1,320.00" $780.78 "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" $990.00 "$1,320.00" "$1,320.00" "$1,320.00" $660.00 $660.00 "$1,045.44" "$1,320.00" "$1,056.00" $594.00 $261.99 N/A $765.60 "$1,320.00" $792.00 "$1,320.00" $275.09 "$1,320.00" N/A N/A 53-34804 SUP HCPCS C1713 53-34804 - PLATE BN STRG .4MM NS UNV NEURO III 8 HL LOPRFL TI CRNMXF BOTH IP/OP $655.00 $485.00 $130.00 $655.00 $294.75 $294.75 $294.75 $294.75 $655.00 $655.00 $655.00 $136.52 $655.00 $655.00 $655.00 $655.00 $655.00 $136.51 $655.00 $655.00 $387.43 $655.00 $655.00 $655.00 $655.00 $491.25 $655.00 $655.00 $655.00 $327.50 $327.50 $518.76 $655.00 $524.00 $294.75 $130.00 N/A $379.90 $655.00 $393.00 $655.00 $136.50 $655.00 N/A N/A 53-36212 SUP HCPCS C1713 53-36212 - PLATE BN DOG 12MMX.6MM NS UNV NEURO III 2 HL LOPRFL RGD TI BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A 534521T SUP HCPCS C1887 534521T - CATHETER ANGIO JR 4 CRV 5FR .047IN 100CM INFNT THRLMN RADOPQ BOTH IP/OP $28.00 $21.00 $5.52 $62.50 $15.10 $15.10 $15.10 $15.10 $27.81 $27.81 $27.81 $5.80 $27.81 $20.64 $20.64 $21.44 $14.49 $5.80 $27.81 $62.50 $16.45 $27.81 $62.50 $27.81 $27.81 $21.00 $27.81 $27.81 $27.81 $13.91 $13.91 $22.03 $27.81 $22.25 $18.08 $5.52 N/A $16.24 $27.81 $27.81 $27.81 $5.80 $27.81 N/A N/A 534521T SUP HCPCS C1887 534521T - CATHETER ANGIO JR 4 CRV 5FR .047IN 100CM INFNT THRLMN RADOPQ BOTH IP/OP $97.00 $72.00 $5.52 $72.75 $15.10 $15.10 $15.10 $15.10 $27.81 $27.81 $27.81 $5.80 $27.81 $20.64 $20.64 $21.44 $14.49 $5.80 $27.81 $62.50 $16.45 $27.81 $62.50 $27.81 $27.81 $72.75 $27.81 $27.81 $27.81 $13.91 $13.91 $22.03 $27.81 $22.25 $18.08 $5.52 N/A $56.26 $27.81 $27.81 $27.81 $5.80 $27.81 N/A N/A 534-676T SUP HCPCS C1725 534-676T - CATHETER ANGIO 3D RIGHT CORON CURVE THNWL 6FR .057 BOTH IP/OP $19.50 $14.00 $3.85 $62.50 $10.52 $10.52 $10.52 $10.52 $19.38 $19.38 $19.38 $4.04 $19.38 $14.38 $14.38 $14.94 $10.10 $4.04 $19.38 $62.50 $11.46 $19.38 $62.50 $19.38 $19.38 $14.63 $19.38 $19.38 $19.38 $9.69 $9.69 $15.35 $19.38 $15.50 $12.60 $3.85 N/A $11.31 $19.38 $19.38 $19.38 $4.04 $19.38 N/A N/A 5357M/S SUP HCPCS C1785 5357M/S - PACEMAKER CRD 11ML VR XL 2 CHMBR BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A 539G SUP Custom 27203010 539G - SUTURE NONABSORBABLE 4-0 V-26 TS 14IN MONOFILAMENT 2 STRAND BOTH IP/OP $23.00 $17.00 $4.05 $22.74 $22.74 $22.74 $22.74 $22.74 $22.74 $22.74 $4.05 $22.74 $22.74 $16.88 $16.88 $17.53 $11.85 $4.74 $22.74 $9.10 $22.74 $22.74 $22.74 $22.74 $22.74 $17.25 $22.74 $22.74 $22.74 $11.37 $11.37 $18.01 $22.74 $18.19 $14.78 $22.74 N/A $13.34 $22.74 $13.64 $22.74 $22.74 $22.74 N/A N/A 54-00261 SUP HCPCS C1713 54-00261 - PLATE BONE 120X60X.1MM MICROMESH TITANIUM BOTH IP/OP "$1,873.00" "$1,386.00" $371.67 "$1,872.65" $842.69 $842.69 $842.69 $842.69 "$1,872.65" "$1,872.65" "$1,872.65" $390.31 "$1,872.65" "$1,872.65" "$1,872.65" "$1,872.65" "$1,872.65" $390.28 "$1,872.65" $749.06 "$1,107.67" "$1,872.65" "$1,872.65" "$1,872.65" "$1,872.65" "$1,404.75" "$1,872.65" "$1,872.65" "$1,872.65" $936.33 $936.33 "$1,483.14" "$1,872.65" "$1,498.12" $842.69 $371.67 N/A "$1,086.34" "$1,872.65" "$1,872.65" "$1,872.65" $390.26 "$1,872.65" N/A N/A 54-00262 SUP HCPCS C1713 54-00262 - MESH DYNAMIC MICRO ULTRA-THIN 60X60X.1MM MALBLE UNIVERSAL BOTH IP/OP "$1,085.50" $803.00 $215.42 "$1,085.40" $488.43 $488.43 $488.43 $488.43 "$1,085.40" "$1,085.40" "$1,085.40" $226.22 "$1,085.40" "$1,085.40" "$1,085.40" "$1,085.40" "$1,085.40" $226.21 "$1,085.40" "$1,085.40" $642.01 "$1,085.40" "$1,085.40" "$1,085.40" "$1,085.40" $814.13 "$1,085.40" "$1,085.40" "$1,085.40" $542.70 $542.70 $859.64 "$1,085.40" $868.32 $488.43 $215.42 N/A $629.59 "$1,085.40" $651.24 "$1,085.40" $226.20 "$1,085.40" N/A N/A 54-00272 SUP HCPCS C1713 54-00272 - MESH CRNL MIC 60X60X.2MM NS UNV NEURO III TI CRNMXF 1.2MM BOTH IP/OP "$1,085.50" $803.00 $215.42 "$1,085.40" $488.43 $488.43 $488.43 $488.43 "$1,085.40" "$1,085.40" "$1,085.40" $226.22 "$1,085.40" "$1,085.40" "$1,085.40" "$1,085.40" "$1,085.40" $226.21 "$1,085.40" "$1,085.40" $642.01 "$1,085.40" "$1,085.40" "$1,085.40" "$1,085.40" $814.13 "$1,085.40" "$1,085.40" "$1,085.40" $542.70 $542.70 $859.64 "$1,085.40" $868.32 $488.43 $215.42 N/A $629.59 "$1,085.40" $651.24 "$1,085.40" $226.20 "$1,085.40" N/A N/A 54-00345 SUP HCPCS C1713 54-00345 - MESH DYNAMIC LP 120X120X.3MM MALBLE BLUE TITANIUM BOTH IP/OP "$10,045.00" "$7,433.00" "$1,993.68" "$10,045.00" "$4,520.25" "$4,520.25" "$4,520.25" "$4,520.25" "$10,045.00" "$10,045.00" "$10,045.00" "$2,093.63" "$10,045.00" "$10,045.00" "$10,045.00" "$10,045.00" "$10,045.00" "$2,093.49" "$10,045.00" "$4,018.00" "$4,952.19" "$10,045.00" "$10,045.00" "$10,045.00" "$10,045.00" "$7,533.75" "$10,045.00" "$10,045.00" "$10,045.00" "$5,022.50" "$5,022.50" "$7,955.64" "$10,045.00" "$8,036.00" "$4,520.25" "$1,993.68" N/A "$5,826.10" "$10,045.00" "$10,045.00" "$10,045.00" "$2,093.38" "$10,045.00" N/A N/A 54-00346 SUP HCPCS C1713 54-00346 - MESH DYNAMIC LP 90X90X.3MM MALBLE BLUE TITANIUM BOTH IP/OP "$2,448.50" "$1,812.00" $485.96 "$2,448.48" "$1,101.82" "$1,101.82" "$1,101.82" "$1,101.82" "$2,448.48" "$2,448.48" "$2,448.48" $510.32 "$2,448.48" "$2,448.48" "$2,448.48" "$2,448.48" "$2,448.48" $510.29 "$2,448.48" "$2,448.48" "$1,448.28" "$2,448.48" "$2,448.48" "$2,448.48" "$2,448.48" "$1,836.38" "$2,448.48" "$2,448.48" "$2,448.48" "$1,224.24" "$1,224.24" "$1,939.20" "$2,448.48" "$1,958.78" "$1,101.82" $485.96 N/A "$1,420.13" "$2,448.48" "$1,469.09" "$2,448.48" $510.26 "$2,448.48" N/A N/A 54-00642 SUP HCPCS C1713 54-00642 - PLATE BONE 90X90X.6MM DYNAMIC MESH TITANIUM BOTH IP/OP "$2,990.00" "$2,213.00" $593.41 "$2,989.85" "$1,345.43" "$1,345.43" "$1,345.43" "$1,345.43" "$2,989.85" "$2,989.85" "$2,989.85" $623.16 "$2,989.85" "$2,989.85" "$2,989.85" "$2,989.85" "$2,989.85" $623.12 "$2,989.85" "$2,989.85" "$1,474.00" "$2,989.85" "$2,989.85" "$2,989.85" "$2,989.85" "$2,242.50" "$2,989.85" "$2,989.85" "$2,989.85" "$1,494.93" "$1,494.93" "$2,367.96" "$2,989.85" "$2,391.88" "$1,345.43" $593.41 N/A "$1,734.20" "$2,989.85" "$1,793.91" "$2,989.85" $623.08 "$2,989.85" N/A N/A 54-00643 SUP HCPCS C1713 54-00643 - PLATE BONE STANDARD 120X120X.6MM DYNAMIC MESH TITANIUM BOTH IP/OP "$5,197.50" "$3,846.00" "$1,031.55" "$5,197.40" "$2,338.83" "$2,338.83" "$2,338.83" "$2,338.83" "$5,197.40" "$5,197.40" "$5,197.40" "$1,083.27" "$5,197.40" "$5,197.40" "$5,197.40" "$5,197.40" "$5,197.40" "$1,083.20" "$5,197.40" "$5,197.40" "$2,562.32" "$5,197.40" "$5,197.40" "$5,197.40" "$5,197.40" "$3,898.13" "$5,197.40" "$5,197.40" "$5,197.40" "$2,598.70" "$2,598.70" "$4,116.34" "$5,197.40" "$4,157.92" "$2,338.83" "$1,031.55" N/A "$3,014.55" "$5,197.40" "$3,118.44" "$5,197.40" "$1,083.14" "$5,197.40" N/A N/A 54-00645 SUP HCPCS C1713 54-00645 - MESH DYNAMIC STANDARD 120X120X.6MM GOLD TITANIUM BOTH IP/OP "$10,365.00" "$7,670.00" "$2,057.19" "$10,365.00" "$4,664.25" "$4,664.25" "$4,664.25" "$4,664.25" "$10,365.00" "$10,365.00" "$10,365.00" "$2,160.33" "$10,365.00" "$10,365.00" "$10,365.00" "$10,365.00" "$10,365.00" "$2,160.18" "$10,365.00" "$10,365.00" "$5,109.95" "$10,365.00" "$10,365.00" "$10,365.00" "$10,365.00" "$7,773.75" "$10,365.00" "$10,365.00" "$10,365.00" "$5,182.50" "$5,182.50" "$8,209.08" "$10,365.00" "$8,292.00" "$4,664.25" "$2,057.19" N/A "$6,011.70" "$10,365.00" "$6,219.00" "$10,365.00" "$2,160.07" "$10,365.00" N/A N/A 54-00646 SUP HCPCS C1713 54-00646 - MESH DYNAMIC STANDARD 90X90X.6MM GOLD TITANIUM BOTH IP/OP "$2,448.50" "$1,812.00" $485.96 "$2,448.48" "$1,101.82" "$1,101.82" "$1,101.82" "$1,101.82" "$2,448.48" "$2,448.48" "$2,448.48" $510.32 "$2,448.48" "$2,448.48" "$2,448.48" "$2,448.48" "$2,448.48" $510.29 "$2,448.48" "$2,448.48" "$1,448.28" "$2,448.48" "$2,448.48" "$2,448.48" "$2,448.48" "$1,836.38" "$2,448.48" "$2,448.48" "$2,448.48" "$1,224.24" "$1,224.24" "$1,939.20" "$2,448.48" "$1,958.78" "$1,101.82" $485.96 N/A "$1,420.13" "$2,448.48" "$2,448.48" "$2,448.48" $510.26 "$2,448.48" N/A N/A 54-00647 SUP HCPCS C1713 54-00647 - MESH DYNAMIC STANDARD 200X200X.6MM GOLD TITANIUM BOTH IP/OP "$13,364.00" "$9,889.00" "$2,652.41" "$13,363.95" "$6,013.78" "$6,013.78" "$6,013.78" "$6,013.78" "$13,363.95" "$13,363.95" "$13,363.95" "$2,785.38" "$13,363.95" "$13,363.95" "$13,363.95" "$13,363.95" "$13,363.95" "$2,785.19" "$13,363.95" "$13,363.95" "$6,588.43" "$13,363.95" "$13,363.95" "$13,363.95" "$13,363.95" "$10,023.00" "$13,363.95" "$13,363.95" "$13,363.95" "$6,681.98" "$6,681.98" "$10,584.25" "$13,363.95" "$10,691.16" "$6,013.78" "$2,652.41" N/A "$7,751.12" "$13,363.95" "$13,363.95" "$13,363.95" "$2,785.05" "$13,363.95" N/A N/A 5400-701-000 SUP Custom 27203010 5400-701-000 - MILL BONE BIOP MEDIUM 5MM COARSE BLADE LATEX FREE DISPOSABLE BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $400.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A 540-11-40A SUP Custom 27803010 540-11-40A - SHELL ACETAB A 40MM 41.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-42B SUP Custom 27803010 540-11-42B - SHELL ACETAB B 42MM 43.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-44C SUP Custom 27803010 540-11-44C - SHELL ACETAB C 44MM 45.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-46D SUP Custom 27803010 540-11-46D - SHELL ACETAB D 46MM 47.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-48D SUP Custom 27803010 540-11-48D - SHELL ACETAB D 48MM 49.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-50E SUP Custom 27803010 540-11-50E - SHELL ACETAB E 50MM 51.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-52E SUP Custom 27803010 540-11-52E - SHELL ACETAB E 52MM SOLID BACK DOME HOLE PLUG TRIDENT PSL HA BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-54F SUP Custom 27803010 540-11-54F - SHELL ACETAB F 54MM 55.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-56F SUP Custom 27803010 540-11-56F - SHELL ACETAB F 56MM 57.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-58G SUP Custom 27803010 540-11-58G - SHELL ACETAB G 58MM 59.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-60G SUP Custom 27803010 540-11-60G - SHELL ACETAB G 60MM 61.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-62H SUP Custom 27803010 540-11-62H - SHELL ACETAB H 62MM 63.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-64H SUP Custom 27803010 540-11-64H - SHELL ACETAB H 64MM 65.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-66I SUP Custom 27803010 540-11-66I - SHELL ACETAB I 66MM 67.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-68I SUP Custom 27803010 540-11-68I - SHELL ACETAB I 68MM 69.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-70J SUP Custom 27803010 540-11-70J - SHELL ACETAB J 70MM 71.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 540-11-72J SUP Custom 27803010 540-11-72J - SHELL ACETAB J 72MM 73.8MM SOLID BACK RIM TRIDENT PSL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 54-03000 SUP HCPCS C1713 54-03000 - TEMPLATE SZ SM STD 1.2MM CMBN ORBT PLT BOTH IP/OP $102.00 $75.00 $20.20 $101.80 $45.81 $45.81 $45.81 $45.81 $101.80 $101.80 $101.80 $21.22 $101.80 $101.80 $101.80 $101.80 $101.80 $21.22 $101.80 $40.72 $60.21 $101.80 $101.80 $101.80 $101.80 $76.50 $101.80 $101.80 $101.80 $50.90 $50.90 $80.63 $101.80 $81.44 $45.81 $20.20 N/A $59.16 $101.80 $101.80 $101.80 $21.22 $101.80 N/A N/A 54-03001 SUP HCPCS C1713 54-03001 - PLATE BONE LARGE 39X34X.3MM COMPLEX TITANIUM ORBTL FLOOR 1.2 BOTH IP/OP "$1,618.50" "$1,198.00" $321.20 "$1,618.33" $728.25 $728.25 $728.25 $728.25 "$1,618.33" "$1,618.33" "$1,618.33" $337.30 "$1,618.33" "$1,618.33" "$1,618.33" "$1,618.33" "$1,618.33" $337.28 "$1,618.33" "$1,618.33" $957.24 "$1,618.33" "$1,618.33" "$1,618.33" "$1,618.33" "$1,213.88" "$1,618.33" "$1,618.33" "$1,618.33" $809.17 $809.17 "$1,281.72" "$1,618.33" "$1,294.66" $728.25 $321.20 N/A $938.73 "$1,618.33" $971.00 "$1,618.33" $337.26 "$1,618.33" N/A N/A 54-03002 SUP HCPCS C1713 54-03002 - PLATE BONE MEDIUM .3MM MALBLE BASIC UPPER FACE ORBTL FLOOR BOTH IP/OP "$3,477.50" "$2,573.00" $690.20 "$3,477.50" "$1,564.88" "$1,564.88" "$1,564.88" "$1,564.88" "$3,477.50" "$3,477.50" "$3,477.50" $724.80 "$3,477.50" "$3,477.50" "$3,477.50" "$3,477.50" "$3,477.50" $724.75 "$3,477.50" "$3,477.50" "$1,714.41" "$3,477.50" "$3,477.50" "$3,477.50" "$3,477.50" "$2,608.13" "$3,477.50" "$3,477.50" "$3,477.50" "$1,738.75" "$1,738.75" "$2,754.18" "$3,477.50" "$2,782.00" "$1,564.88" $690.20 N/A "$2,016.95" "$3,477.50" "$2,086.50" "$3,477.50" $724.71 "$3,477.50" N/A N/A 54-03003 SUP HCPCS C1713 54-03003 - PLATE BONE SMALL 20X18X.3MM ISOLATED TITANIUM ORBTL FLOOR BOTH IP/OP "$3,260.00" "$2,412.00" $647.03 "$3,260.00" "$1,467.00" "$1,467.00" "$1,467.00" "$1,467.00" "$3,260.00" "$3,260.00" "$3,260.00" $679.47 "$3,260.00" "$3,260.00" "$3,260.00" "$3,260.00" "$3,260.00" $679.42 "$3,260.00" "$3,260.00" "$1,607.18" "$3,260.00" "$3,260.00" "$3,260.00" "$3,260.00" "$2,445.00" "$3,260.00" "$3,260.00" "$3,260.00" "$1,630.00" "$1,630.00" "$2,581.92" "$3,260.00" "$2,608.00" "$1,467.00" $647.03 N/A "$1,890.80" "$3,260.00" "$1,956.00" "$3,260.00" $679.38 "$3,260.00" N/A N/A 54-04000 SUP HCPCS C1713 54-04000 - TEMPLATE SZ LG STD 1.2MM CMBN ORBT PLT BOTH IP/OP $97.50 $72.00 $19.34 $97.45 $43.85 $43.85 $43.85 $43.85 $97.45 $97.45 $97.45 $20.31 $97.45 $97.45 $97.45 $97.45 $97.45 $20.31 $97.45 $38.98 $57.64 $97.45 $97.45 $97.45 $97.45 $73.13 $97.45 $97.45 $97.45 $48.73 $48.73 $77.18 $97.45 $77.96 $43.85 $19.34 N/A $56.55 $97.45 $97.45 $97.45 $20.31 $97.45 N/A N/A 54-04001 SUP HCPCS C1713 54-04001 - PLATE BONE LARGE 30X32X.4MM COMPLEX TITANIUM ORBTL FLOOR 1.2 BOTH IP/OP "$3,705.00" "$2,742.00" $735.35 "$3,705.00" "$1,667.25" "$1,667.25" "$1,667.25" "$1,667.25" "$3,705.00" "$3,705.00" "$3,705.00" $772.21 "$3,705.00" "$3,705.00" "$3,705.00" "$3,705.00" "$3,705.00" $772.16 "$3,705.00" "$3,705.00" "$1,826.57" "$3,705.00" "$3,705.00" "$3,705.00" "$3,705.00" "$2,778.75" "$3,705.00" "$3,705.00" "$3,705.00" "$1,852.50" "$1,852.50" "$2,934.36" "$3,705.00" "$2,964.00" "$1,667.25" $735.35 N/A "$2,148.90" "$3,705.00" "$2,223.00" "$3,705.00" $772.12 "$3,705.00" N/A N/A 54-04002 SUP HCPCS C1713 54-04002 - PLATE BN MED BSC STD .4MM NS LEIBINGER UNV 2 TI ORBT FLR 1.2 BOTH IP/OP "$1,518.00" "$1,123.00" $301.22 "$1,517.68" $682.96 $682.96 $682.96 $682.96 "$1,517.68" "$1,517.68" "$1,517.68" $316.32 "$1,517.68" "$1,517.68" "$1,517.68" "$1,517.68" "$1,517.68" $316.30 "$1,517.68" "$1,517.68" $897.71 "$1,517.68" "$1,517.68" "$1,517.68" "$1,517.68" "$1,138.50" "$1,517.68" "$1,517.68" "$1,517.68" $758.84 $758.84 "$1,202.00" "$1,517.68" "$1,214.14" $682.96 $301.22 N/A $880.44 "$1,517.68" $910.61 "$1,517.68" $316.28 "$1,517.68" N/A N/A 54-04004 SUP HCPCS C1713 54-04004 - PLATE BONE 3D SMALL PREBENT ORBTL FLOOR RIGHT BOTH IP/OP "$3,482.50" "$2,577.00" $691.13 "$3,482.20" "$1,566.99" "$1,566.99" "$1,566.99" "$1,566.99" "$3,482.20" "$3,482.20" "$3,482.20" $725.78 "$3,482.20" "$3,482.20" "$3,482.20" "$3,482.20" "$3,482.20" $725.73 "$3,482.20" "$1,392.88" "$1,716.72" "$3,482.20" "$3,482.20" "$3,482.20" "$3,482.20" "$2,611.88" "$3,482.20" "$3,482.20" "$3,482.20" "$1,741.10" "$1,741.10" "$2,757.90" "$3,482.20" "$2,785.76" "$1,566.99" $691.13 N/A "$2,019.85" "$3,482.20" "$2,089.32" "$3,482.20" $725.69 "$3,482.20" N/A N/A 54-04007 SUP HCPCS C1713 54-04007 - PLATE BONE 3D LARGE PREBENT ORBTL FLOOR LEFT BOTH IP/OP "$3,482.50" "$2,577.00" $691.13 "$3,482.20" "$1,566.99" "$1,566.99" "$1,566.99" "$1,566.99" "$3,482.20" "$3,482.20" "$3,482.20" $725.78 "$3,482.20" "$3,482.20" "$3,482.20" "$3,482.20" "$3,482.20" $725.73 "$3,482.20" "$3,482.20" "$1,716.72" "$3,482.20" "$3,482.20" "$3,482.20" "$3,482.20" "$2,611.88" "$3,482.20" "$3,482.20" "$3,482.20" "$1,741.10" "$1,741.10" "$2,757.90" "$3,482.20" "$2,785.76" "$1,566.99" $691.13 N/A "$2,019.85" "$3,482.20" "$2,089.32" "$3,482.20" $725.69 "$3,482.20" N/A N/A 54-05100 SUP Custom 27803010 54-05100 - CLIP FIX TITANIUM CRANIAL 1.5 MM 1.7 MM SCREW BOTH IP/OP $352.00 $260.00 $62.62 $351.80 $351.80 $351.80 $351.80 $351.80 $351.80 $351.80 $62.62 $351.80 $351.80 $351.80 $351.80 $351.80 $351.80 $73.32 $351.80 $140.72 $351.80 $351.80 $351.80 $351.80 $351.80 $264.00 $351.80 $351.80 $351.80 $175.90 $175.90 $278.63 $351.80 $281.44 $158.31 $351.80 N/A $204.16 $351.80 $211.08 $351.80 $351.80 $351.80 N/A N/A 54051T SUP HCPCS Q4108 54051T - DRESSING WND THN 5X4IN STRL BVN CLGN GAG DISP BOTH IP/OP "$8,047.00" "$5,955.00" $402.33 "$8,046.58" "$3,620.96" "$3,620.96" "$3,620.96" "$3,620.96" "$8,046.58" "$8,046.58" "$8,046.58" "$1,677.11" "$8,046.58" "$8,046.58" "$8,046.58" "$8,046.58" "$8,046.58" "$1,677.00" "$8,046.58" $402.33 "$3,966.96" "$8,046.58" "$8,046.58" "$8,046.58" "$8,046.58" "$6,035.25" "$8,046.58" "$8,046.58" "$8,046.58" "$4,023.29" "$4,023.29" "$6,372.89" "$8,046.58" "$6,437.26" "$3,620.96" "$1,597.04" N/A "$4,667.26" "$8,046.58" "$8,046.58" "$8,046.58" "$1,676.91" "$8,046.58" N/A N/A 5407FA1015 SUP Custom 27203010 5407FA1015 - ROUTER POWER TAPER 1.5MM 12MM LATEX FREE BOTH IP/OP $302.00 $223.00 $53.70 $301.68 $301.68 $301.68 $301.68 $301.68 $301.68 $301.68 $53.70 $301.68 $301.68 $223.91 $223.91 $232.53 $157.18 $62.87 $301.68 $120.67 $301.68 $301.68 $301.68 $301.68 $301.68 $226.50 $301.68 $301.68 $301.68 $150.84 $150.84 $238.93 $301.68 $241.34 $196.09 $301.68 N/A $175.16 $301.68 $181.01 $301.68 $301.68 $301.68 N/A N/A 5407FA2023 SUP Custom 27203010 5407FA2023 - ROUTER POWER TAPER 2.3MM LATEX FREE BOTH IP/OP $280.00 $207.00 $49.84 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $280.00 $49.84 $280.00 $280.00 $207.82 $207.82 $215.82 $145.88 $58.36 $280.00 $112.00 $280.00 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $182.00 $280.00 N/A $162.40 $280.00 $168.00 $280.00 $280.00 $280.00 N/A N/A 5407FA3030 SUP Custom 27203010 5407FA3030 - BURR SRG TPR 3MM WHT ROUT BOTH IP/OP $289.00 $214.00 $51.40 $288.78 $288.78 $288.78 $288.78 $288.78 $288.78 $288.78 $51.40 $288.78 $288.78 $214.33 $214.33 $222.59 $150.45 $60.18 $288.78 $115.51 $288.78 $288.78 $288.78 $288.78 $288.78 $216.75 $288.78 $288.78 $288.78 $144.39 $144.39 $228.71 $288.78 $231.02 $187.71 $288.78 N/A $167.62 $288.78 $173.27 $288.78 $288.78 $288.78 N/A N/A 54101T SUP HCPCS Q4104 54101T - MATRIX TISS THN 10X4IN STRL INTGR IMD CVRGLS CLGN GAG BOTH IP/OP "$13,213.00" "$9,778.00" "$2,622.44" "$13,212.95" "$5,945.83" "$5,945.83" "$5,945.83" "$5,945.83" "$13,212.95" "$13,212.95" "$13,212.95" "$2,753.91" "$13,212.95" "$13,212.95" "$13,212.95" "$13,212.95" "$13,212.95" "$2,753.72" "$13,212.95" "$13,212.95" "$6,513.98" "$13,212.95" "$13,212.95" "$13,212.95" "$13,212.95" "$9,909.75" "$13,212.95" "$13,212.95" "$13,212.95" "$6,606.48" "$6,606.48" "$10,464.66" "$13,212.95" "$10,570.36" "$5,945.83" "$2,622.44" N/A "$7,663.54" "$13,212.95" "$13,212.95" "$13,212.95" "$2,753.58" "$13,212.95" N/A N/A 5413-20/5 SUP HCPCS C1713 5413-20/5 - COMPONENT HUM STD ECCENTER STRL EPOCA TI SHLDR BOTH IP/OP "$1,004.50" $743.00 $199.34 "$1,004.35" $451.96 $451.96 $451.96 $451.96 "$1,004.35" "$1,004.35" "$1,004.35" $209.33 "$1,004.35" "$1,004.35" "$1,004.35" "$1,004.35" "$1,004.35" $209.32 "$1,004.35" "$1,004.35" $594.07 "$1,004.35" "$1,004.35" "$1,004.35" "$1,004.35" $753.38 "$1,004.35" "$1,004.35" "$1,004.35" $502.18 $502.18 $795.45 "$1,004.35" $803.48 $451.96 $199.34 N/A $582.61 "$1,004.35" $602.61 "$1,004.35" $209.31 "$1,004.35" N/A N/A 542-11-40A SUP Custom 27803010 542-11-40A - SHELL ACETAB A 40MM 41.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-42B SUP Custom 27803010 542-11-42B - SHELL ACETAB B 42MM 43.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-44C SUP Custom 27803010 542-11-44C - SHELL ACETAB C 44MM 45.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-46D SUP Custom 27803010 542-11-46D - SHELL ACETAB D 46MM 47.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-48D SUP Custom 27803010 542-11-48D - SHELL ACETAB D 48MM 49.8MM 3 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-50E SUP Custom 27803010 542-11-50E - SHELL ACETAB E 50MM 51.8MM 5 HOLE CLUSTER TRIDENT PSL BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-52E SUP Custom 27803010 542-11-52E - SHELL ACETAB E 52MM 53.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-54F SUP Custom 27803010 542-11-54F - SHELL ACETAB F 54MM 55.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-56F SUP Custom 27803010 542-11-56F - SHELL ACETAB F 56MM 57.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-58G SUP Custom 27803010 542-11-58G - SHELL ACETAB G 58MM 59.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-60G SUP Custom 27803010 542-11-60G - SHELL ACETAB G 60MM 61.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-62H SUP Custom 27803010 542-11-62H - SHELL ACETAB H 62MM 63.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-64H SUP Custom 27803010 542-11-64H - SHELL ACETAB H 64MM 65.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-66I SUP Custom 27803010 542-11-66I - SHELL ACETAB I 66MM 67.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-68I SUP Custom 27803010 542-11-68I - SHELL ACETAB I 68MM 69.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-70J SUP Custom 27803010 542-11-70J - SHELL ACETAB J 70MM 71.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 542-11-72J SUP Custom 27803010 542-11-72J - SHELL ACETAB J 72MM 73.8MM 5 SCREW HOLE CLUSTER RIM TRIDENT BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 54-25240 SUP HCPCS C1713 54-25240 - PLATE BONE SHORT 8 HOLE RECONSTRUCTION RIGHT RADIAL 2.7MM BOTH IP/OP $495.00 $366.00 $98.25 $495.00 $222.75 $222.75 $222.75 $222.75 $495.00 $495.00 $495.00 $103.17 $495.00 $495.00 $495.00 $495.00 $495.00 $103.16 $495.00 $495.00 $292.79 $495.00 $495.00 $495.00 $495.00 $371.25 $495.00 $495.00 $495.00 $247.50 $247.50 $392.04 $495.00 $396.00 $222.75 $98.25 N/A $287.10 $495.00 $495.00 $495.00 $103.16 $495.00 N/A N/A 54-25241 SUP HCPCS C1713 54-25241 - PLATE BONE SMALL 8 HOLE RECONSTRUCTION RIGHT RADIAL 2.7MM BOTH IP/OP $495.00 $366.00 $98.25 $495.00 $222.75 $222.75 $222.75 $222.75 $495.00 $495.00 $495.00 $103.17 $495.00 $495.00 $495.00 $495.00 $495.00 $103.16 $495.00 $198.00 $292.79 $495.00 $495.00 $495.00 $495.00 $371.25 $495.00 $495.00 $495.00 $247.50 $247.50 $392.04 $495.00 $396.00 $222.75 $98.25 N/A $287.10 $495.00 $495.00 $495.00 $103.16 $495.00 N/A N/A 54-25242 SUP HCPCS C1713 54-25242 - PLATE BONE SHORT 8 HOLE RECONSTRUCTION LEFT RADIAL 2.7MM BOTH IP/OP $495.00 $366.00 $98.25 $495.00 $222.75 $222.75 $222.75 $222.75 $495.00 $495.00 $495.00 $103.17 $495.00 $495.00 $495.00 $495.00 $495.00 $103.16 $495.00 $198.00 $292.79 $495.00 $495.00 $495.00 $495.00 $371.25 $495.00 $495.00 $495.00 $247.50 $247.50 $392.04 $495.00 $396.00 $222.75 $98.25 N/A $287.10 $495.00 $495.00 $495.00 $103.16 $495.00 N/A N/A 54-25243 SUP HCPCS C1713 54-25243 - PLATE BONE SMALL 8 HOLE RECONSTRUCTION LEFT RADIAL 2.7MM BOTH IP/OP $495.00 $366.00 $98.25 $495.00 $222.75 $222.75 $222.75 $222.75 $495.00 $495.00 $495.00 $103.17 $495.00 $495.00 $495.00 $495.00 $495.00 $103.16 $495.00 $198.00 $292.79 $495.00 $495.00 $495.00 $495.00 $371.25 $495.00 $495.00 $495.00 $247.50 $247.50 $392.04 $495.00 $396.00 $222.75 $98.25 N/A $287.10 $495.00 $495.00 $495.00 $103.16 $495.00 N/A N/A 54-25244 SUP HCPCS C1713 54-25244 - PLATE BONE LONG 11 HOLE RECONSTRUCTION RIGHT RADIAL 2.7MM BOTH IP/OP $591.50 $438.00 $117.35 $591.25 $266.06 $266.06 $266.06 $266.06 $591.25 $591.25 $591.25 $123.23 $591.25 $591.25 $591.25 $591.25 $591.25 $123.22 $591.25 $591.25 $349.72 $591.25 $591.25 $591.25 $591.25 $443.63 $591.25 $591.25 $591.25 $295.63 $295.63 $468.27 $591.25 $473.00 $266.06 $117.35 N/A $343.07 $591.25 $591.25 $591.25 $123.22 $591.25 N/A N/A 54-25246 SUP HCPCS C1713 54-25246 - PLATE BONE LONG 11 HOLE RECONSTRUCTION LEFT RADIAL 2.7MM BOTH IP/OP $591.50 $438.00 $117.35 $591.25 $266.06 $266.06 $266.06 $266.06 $591.25 $591.25 $591.25 $123.23 $591.25 $591.25 $591.25 $591.25 $591.25 $123.22 $591.25 $236.50 $349.72 $591.25 $591.25 $591.25 $591.25 $443.63 $591.25 $591.25 $591.25 $295.63 $295.63 $468.27 $591.25 $473.00 $266.06 $117.35 N/A $343.07 $591.25 $354.75 $591.25 $591.25 $591.25 N/A N/A 54-25250 SUP HCPCS C1713 54-25250 - PLATE BONE REGULAR 6 HOLE RECONSTRUCTION RIGHT RADIAL 2.7MM BOTH IP/OP $433.50 $321.00 $85.97 $433.13 $194.91 $194.91 $194.91 $194.91 $433.13 $433.13 $433.13 $90.28 $433.13 $433.13 $433.13 $433.13 $433.13 $90.27 $433.13 $433.13 $256.20 $433.13 $433.13 $433.13 $433.13 $325.13 $433.13 $433.13 $433.13 $216.57 $216.57 $343.04 $433.13 $346.50 $194.91 $85.97 N/A $251.43 $433.13 $259.88 $433.13 $90.26 $433.13 N/A N/A 54-25251 SUP HCPCS C1713 54-25251 - PLATE BONE REGULAR 6 HOLE RECONSTRUCTION LEFT RADIAL 2.7MM BOTH IP/OP $433.50 $321.00 $85.97 $433.13 $194.91 $194.91 $194.91 $194.91 $433.13 $433.13 $433.13 $90.28 $433.13 $433.13 $433.13 $433.13 $433.13 $90.27 $433.13 $433.13 $256.20 $433.13 $433.13 $433.13 $433.13 $325.13 $433.13 $433.13 $433.13 $216.57 $216.57 $343.04 $433.13 $346.50 $194.91 $85.97 N/A $251.43 $433.13 $259.88 $433.13 $90.26 $433.13 N/A N/A 54-25252 SUP HCPCS C1713 54-25252 - PLATE BONE REGULAR 7 HOLE RECONSTRUCTION RIGHT RADIAL 2.7MM BOTH IP/OP $474.50 $351.00 $94.15 $474.38 $213.47 $213.47 $213.47 $213.47 $474.38 $474.38 $474.38 $98.87 $474.38 $474.38 $474.38 $474.38 $474.38 $98.87 $474.38 $474.38 $280.60 $474.38 $474.38 $474.38 $474.38 $355.88 $474.38 $474.38 $474.38 $237.19 $237.19 $375.71 $474.38 $379.50 $213.47 $94.15 N/A $275.21 $474.38 $474.38 $474.38 $98.86 $474.38 N/A N/A 54-25253 SUP HCPCS C1713 54-25253 - PLATE BONE REGULAR 7 HOLE RECONSTRUCTION LEFT RADIAL 2.7MM BOTH IP/OP $474.50 $351.00 $94.15 $474.38 $213.47 $213.47 $213.47 $213.47 $474.38 $474.38 $474.38 $98.87 $474.38 $474.38 $474.38 $474.38 $474.38 $98.87 $474.38 $474.38 $280.60 $474.38 $474.38 $474.38 $474.38 $355.88 $474.38 $474.38 $474.38 $237.19 $237.19 $375.71 $474.38 $379.50 $213.47 $94.15 N/A $275.21 $474.38 $284.63 $474.38 $98.86 $474.38 N/A N/A 54-25254 SUP HCPCS C1713 54-25254 - PLATE BONE REGULAR 8 HOLE RECONSTRUCTION RIGHT RADIAL 2.7MM BOTH IP/OP $577.50 $427.00 $114.62 $577.50 $259.88 $259.88 $259.88 $259.88 $577.50 $577.50 $577.50 $120.37 $577.50 $577.50 $577.50 $577.50 $577.50 $120.36 $577.50 $577.50 $341.59 $577.50 $577.50 $577.50 $577.50 $433.13 $577.50 $577.50 $577.50 $288.75 $288.75 $457.38 $577.50 $462.00 $259.88 $114.62 N/A $334.95 $577.50 $346.50 $577.50 $577.50 $577.50 N/A N/A 54-25255 SUP HCPCS C1713 54-25255 - PLATE BONE REGULAR 8 HOLE RECONSTRUCTION LEFT RADIAL 2.7MM BOTH IP/OP $577.50 $427.00 $114.62 $577.50 $259.88 $259.88 $259.88 $259.88 $577.50 $577.50 $577.50 $120.37 $577.50 $577.50 $577.50 $577.50 $577.50 $120.36 $577.50 $231.00 $341.59 $577.50 $577.50 $577.50 $577.50 $433.13 $577.50 $577.50 $577.50 $288.75 $288.75 $457.38 $577.50 $462.00 $259.88 $114.62 N/A $334.95 $577.50 $346.50 $577.50 $577.50 $577.50 N/A N/A 54-25270 SUP HCPCS C1713 54-25270 - PLATE BONE MEDIUM PALMAR RADIAL BOTH IP/OP $791.00 $585.00 $156.92 $790.63 $355.78 $355.78 $355.78 $355.78 $790.63 $790.63 $790.63 $164.79 $790.63 $790.63 $790.63 $790.63 $790.63 $164.78 $790.63 $790.63 $467.66 $790.63 $790.63 $790.63 $790.63 $593.25 $790.63 $790.63 $790.63 $395.32 $395.32 $626.18 $790.63 $632.50 $355.78 $156.92 N/A $458.78 $790.63 $790.63 $790.63 $164.77 $790.63 N/A N/A 54-25271 SUP HCPCS C1713 54-25271 - PLATE BONE MEDIUM LEFT DORSAL RADIAL BOTH IP/OP $791.00 $585.00 $156.92 $790.63 $355.78 $355.78 $355.78 $355.78 $790.63 $790.63 $790.63 $164.79 $790.63 $790.63 $790.63 $790.63 $790.63 $164.78 $790.63 $790.63 $467.66 $790.63 $790.63 $790.63 $790.63 $593.25 $790.63 $790.63 $790.63 $395.32 $395.32 $626.18 $790.63 $632.50 $355.78 $156.92 N/A $458.78 $790.63 $474.38 $790.63 $164.77 $790.63 N/A N/A 54-25272 SUP HCPCS C1713 54-25272 - PLATE BONE MEDIUM LEFT DORSAL RADIAL BOTH IP/OP $791.00 $585.00 $156.92 $790.63 $355.78 $355.78 $355.78 $355.78 $790.63 $790.63 $790.63 $164.79 $790.63 $790.63 $790.63 $790.63 $790.63 $164.78 $790.63 $316.25 $467.66 $790.63 $790.63 $790.63 $790.63 $593.25 $790.63 $790.63 $790.63 $395.32 $395.32 $626.18 $790.63 $632.50 $355.78 $156.92 N/A $458.78 $790.63 $474.38 $790.63 $164.77 $790.63 N/A N/A 54-25273 SUP HCPCS C1713 54-25273 - PLATE BONE LARGE LEFT DORSAL RADIAL BOTH IP/OP $791.00 $585.00 $156.92 $790.63 $355.78 $355.78 $355.78 $355.78 $790.63 $790.63 $790.63 $164.79 $790.63 $790.63 $790.63 $790.63 $790.63 $164.78 $790.63 $790.63 $467.66 $790.63 $790.63 $790.63 $790.63 $593.25 $790.63 $790.63 $790.63 $395.32 $395.32 $626.18 $790.63 $632.50 $355.78 $156.92 N/A $458.78 $790.63 $474.38 $790.63 $164.77 $790.63 N/A N/A 54-25274 SUP HCPCS C1713 54-25274 - PLATE BONE MEDIUM RIGHT DORSAL RADIAL BOTH IP/OP $791.00 $585.00 $156.92 $790.63 $355.78 $355.78 $355.78 $355.78 $790.63 $790.63 $790.63 $164.79 $790.63 $790.63 $790.63 $790.63 $790.63 $164.78 $790.63 $316.25 $467.66 $790.63 $790.63 $790.63 $790.63 $593.25 $790.63 $790.63 $790.63 $395.32 $395.32 $626.18 $790.63 $632.50 $355.78 $156.92 N/A $458.78 $790.63 $790.63 $790.63 $164.77 $790.63 N/A N/A 54-25275 SUP HCPCS C1713 54-25275 - PLATE BONE LARGE RIGHT DORSAL RADIAL BOTH IP/OP $791.00 $585.00 $156.92 $790.63 $355.78 $355.78 $355.78 $355.78 $790.63 $790.63 $790.63 $164.79 $790.63 $790.63 $790.63 $790.63 $790.63 $164.78 $790.63 $790.63 $467.66 $790.63 $790.63 $790.63 $790.63 $593.25 $790.63 $790.63 $790.63 $395.32 $395.32 $626.18 $790.63 $632.50 $355.78 $156.92 N/A $458.78 $790.63 $474.38 $790.63 $164.77 $790.63 N/A N/A 54-25290 SUP HCPCS C1713 54-25290 - PLATE BN STD VARIAX LCK TI RDS RT DIST DRSL BOTH IP/OP "$1,656.00" "$1,225.00" $328.67 "$1,656.00" $745.20 $745.20 $745.20 $745.20 "$1,656.00" "$1,656.00" "$1,656.00" $345.15 "$1,656.00" "$1,656.00" "$1,656.00" "$1,656.00" "$1,656.00" $345.13 "$1,656.00" "$1,656.00" $979.52 "$1,656.00" "$1,656.00" "$1,656.00" "$1,656.00" "$1,242.00" "$1,656.00" "$1,656.00" "$1,656.00" $828.00 $828.00 "$1,311.55" "$1,656.00" "$1,324.80" $745.20 $328.67 N/A $960.48 "$1,656.00" "$1,656.00" "$1,656.00" $345.11 "$1,656.00" N/A N/A 54-25291 SUP HCPCS C1713 54-25291 - PLATE BONE STANDARD LOCK VARIAX SMARTLOCK TITANIUM RAD LEFT BOTH IP/OP "$1,656.00" "$1,225.00" $328.67 "$1,656.00" $745.20 $745.20 $745.20 $745.20 "$1,656.00" "$1,656.00" "$1,656.00" $345.15 "$1,656.00" "$1,656.00" "$1,656.00" "$1,656.00" "$1,656.00" $345.13 "$1,656.00" "$1,656.00" $979.52 "$1,656.00" "$1,656.00" "$1,656.00" "$1,656.00" "$1,242.00" "$1,656.00" "$1,656.00" "$1,656.00" $828.00 $828.00 "$1,311.55" "$1,656.00" "$1,324.80" $745.20 $328.67 N/A $960.48 "$1,656.00" "$1,656.00" "$1,656.00" $345.11 "$1,656.00" N/A N/A 54-25292 SUP HCPCS C1713 54-25292 - PLATE BONE WIDE 60MMX1.5MM VARIAX SMARTLOCK TITANIUM RAD BOTH IP/OP "$1,656.00" "$1,225.00" $328.67 "$1,656.00" $745.20 $745.20 $745.20 $745.20 "$1,656.00" "$1,656.00" "$1,656.00" $345.15 "$1,656.00" "$1,656.00" "$1,656.00" "$1,656.00" "$1,656.00" $345.13 "$1,656.00" "$1,656.00" $979.52 "$1,656.00" "$1,656.00" "$1,656.00" "$1,656.00" "$1,242.00" "$1,656.00" "$1,656.00" "$1,656.00" $828.00 $828.00 "$1,311.55" "$1,656.00" "$1,324.80" $745.20 $328.67 N/A $960.48 "$1,656.00" $993.60 "$1,656.00" $345.11 "$1,656.00" N/A N/A 54-25293 SUP HCPCS C1713 54-25293 - PLATE BONE WIDE LOCK VARIAX LEFT DISTAL DORSAL RADIAL BOTH IP/OP "$1,656.00" "$1,225.00" $328.67 "$1,656.00" $745.20 $745.20 $745.20 $745.20 "$1,656.00" "$1,656.00" "$1,656.00" $345.15 "$1,656.00" "$1,656.00" "$1,656.00" "$1,656.00" "$1,656.00" $345.13 "$1,656.00" "$1,656.00" $979.52 "$1,656.00" "$1,656.00" "$1,656.00" "$1,656.00" "$1,242.00" "$1,656.00" "$1,656.00" "$1,656.00" $828.00 $828.00 "$1,311.55" "$1,656.00" "$1,324.80" $745.20 $328.67 N/A $960.48 "$1,656.00" "$1,656.00" "$1,656.00" $345.11 "$1,656.00" N/A N/A 54-25294 SUP HCPCS C1713 54-25294 - PLATE BONE STANDARD XLONG LOCK VARIAX RIGHT DISTAL DORSAL BOTH IP/OP "$1,911.00" "$1,414.00" $379.29 "$1,911.00" $859.95 $859.95 $859.95 $859.95 "$1,911.00" "$1,911.00" "$1,911.00" $398.30 "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" $398.27 "$1,911.00" "$1,911.00" "$1,130.36" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,433.25" "$1,911.00" "$1,911.00" "$1,911.00" $955.50 $955.50 "$1,513.51" "$1,911.00" "$1,528.80" $859.95 $379.29 N/A "$1,108.38" "$1,911.00" "$1,146.60" "$1,911.00" $398.25 "$1,911.00" N/A N/A 54-25295 SUP HCPCS C1713 54-25295 - PLATE BONE STANDARD XLONG LOCK VARIAX LEFT DISTAL DORSAL BOTH IP/OP "$1,911.00" "$1,414.00" $379.29 "$1,911.00" $859.95 $859.95 $859.95 $859.95 "$1,911.00" "$1,911.00" "$1,911.00" $398.30 "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" $398.27 "$1,911.00" "$1,911.00" "$1,130.36" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,433.25" "$1,911.00" "$1,911.00" "$1,911.00" $955.50 $955.50 "$1,513.51" "$1,911.00" "$1,528.80" $859.95 $379.29 N/A "$1,108.38" "$1,911.00" "$1,146.60" "$1,911.00" $398.25 "$1,911.00" N/A N/A 54-25296 SUP HCPCS C1713 54-25296 - PLATE BONE XLONG LOCKING WIDE VARIAX RIGHT DISTAL DORSAL BOTH IP/OP "$1,911.00" "$1,414.00" $379.29 "$1,911.00" $859.95 $859.95 $859.95 $859.95 "$1,911.00" "$1,911.00" "$1,911.00" $398.30 "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" $398.27 "$1,911.00" "$1,911.00" "$1,130.36" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,433.25" "$1,911.00" "$1,911.00" "$1,911.00" $955.50 $955.50 "$1,513.51" "$1,911.00" "$1,528.80" $859.95 $379.29 N/A "$1,108.38" "$1,911.00" "$1,146.60" "$1,911.00" $398.25 "$1,911.00" N/A N/A 54-25297 SUP HCPCS C1713 54-25297 - PLATE BONE XLONG LOCKING WIDE VARIAX LEFT DISTAL DORSAL BOTH IP/OP "$1,911.00" "$1,414.00" $379.29 "$1,911.00" $859.95 $859.95 $859.95 $859.95 "$1,911.00" "$1,911.00" "$1,911.00" $398.30 "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" $398.27 "$1,911.00" "$1,911.00" "$1,130.36" "$1,911.00" "$1,911.00" "$1,911.00" "$1,911.00" "$1,433.25" "$1,911.00" "$1,911.00" "$1,911.00" $955.50 $955.50 "$1,513.51" "$1,911.00" "$1,528.80" $859.95 $379.29 N/A "$1,108.38" "$1,911.00" "$1,911.00" "$1,911.00" $398.25 "$1,911.00" N/A N/A 54-25374 SUP HCPCS C1713 54-25374 - PLATE BONE NARROW ANATOMICAL VARIAX LEFT DISTAL VOLAR RADIAL BOTH IP/OP "$1,625.00" "$1,203.00" $322.52 "$1,625.00" $731.25 $731.25 $731.25 $731.25 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" $650.00 $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 $322.52 N/A $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 54-25375 SUP HCPCS C1713 54-25375 - PLATE BONE NARROW LONG LOCK SCREW ANATOMIC VARIAX RAD LEFT BOTH IP/OP "$1,877.00" "$1,389.00" $372.54 "$1,877.00" $844.65 $844.65 $844.65 $844.65 "$1,877.00" "$1,877.00" "$1,877.00" $391.21 "$1,877.00" "$1,877.00" "$1,877.00" "$1,877.00" "$1,877.00" $391.19 "$1,877.00" "$1,877.00" "$1,110.25" "$1,877.00" "$1,877.00" "$1,877.00" "$1,877.00" "$1,407.75" "$1,877.00" "$1,877.00" "$1,877.00" $938.50 $938.50 "$1,486.58" "$1,877.00" "$1,501.60" $844.65 $372.54 N/A "$1,088.66" "$1,877.00" "$1,877.00" "$1,877.00" $391.17 "$1,877.00" N/A N/A 54-25376 SUP HCPCS C1713 54-25376 - PLATE BONE STANDARD ANATOMICAL VARIAX TITANIUM LEFT DISTAL BOTH IP/OP "$1,625.00" "$1,203.00" $322.52 "$1,625.00" $731.25 $731.25 $731.25 $731.25 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" $650.00 $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 $322.52 N/A $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A 54-25377 SUP HCPCS C1713 54-25377 - PLATE BONE STANDARD LONG ANATOMICAL VARIAX LEFT DISTAL VOLAR BOTH IP/OP "$1,877.00" "$1,389.00" $372.54 "$1,877.00" $844.65 $844.65 $844.65 $844.65 "$1,877.00" "$1,877.00" "$1,877.00" $391.21 "$1,877.00" "$1,877.00" "$1,877.00" "$1,877.00" "$1,877.00" $391.19 "$1,877.00" $750.80 "$1,110.25" "$1,877.00" "$1,877.00" "$1,877.00" "$1,877.00" "$1,407.75" "$1,877.00" "$1,877.00" "$1,877.00" $938.50 $938.50 "$1,486.58" "$1,877.00" "$1,501.60" $844.65 $372.54 N/A "$1,088.66" "$1,877.00" "$1,877.00" "$1,877.00" $391.17 "$1,877.00" N/A N/A 54-25384 SUP HCPCS C1713 54-25384 - PLATE BONE NARROW LOCK SCREW ANATOMIC VARIAX RAD RIGHT VOLAR BOTH IP/OP "$1,625.00" "$1,203.00" $322.52 "$1,625.00" $731.25 $731.25 $731.25 $731.25 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 $322.52 N/A $942.50 "$1,625.00" $975.00 "$1,625.00" $338.65 "$1,625.00" N/A N/A 54-25385 SUP HCPCS C1713 54-25385 - PLATE BN NAR LNG VARIAX ANTM LCK TI RADL RT DIST VOLR BOTH IP/OP "$1,877.00" "$1,389.00" $372.54 "$1,877.00" $844.65 $844.65 $844.65 $844.65 "$1,877.00" "$1,877.00" "$1,877.00" $391.21 "$1,877.00" "$1,877.00" "$1,877.00" "$1,877.00" "$1,877.00" $391.19 "$1,877.00" "$1,877.00" "$1,110.25" "$1,877.00" "$1,877.00" "$1,877.00" "$1,877.00" "$1,407.75" "$1,877.00" "$1,877.00" "$1,877.00" $938.50 $938.50 "$1,486.58" "$1,877.00" "$1,501.60" $844.65 $372.54 N/A "$1,088.66" "$1,877.00" "$1,877.00" "$1,877.00" $391.17 "$1,877.00" N/A N/A 54-25386 SUP HCPCS C1713 54-25386 - PLATE BONE STANDARD ANATOMICAL VARIAX TITANIUM RIGHT DISTAL BOTH IP/OP "$1,625.00" "$1,203.00" $322.52 "$1,625.00" $731.25 $731.25 $731.25 $731.25 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 $322.52 N/A $942.50 "$1,625.00" $975.00 "$1,625.00" $338.65 "$1,625.00" N/A N/A 54-25387 SUP HCPCS C1713 54-25387 - PLATE BONE STANDARD LONG ANATOMICAL VARIAX STAINLESS STEEL BOTH IP/OP "$1,877.00" "$1,389.00" $372.54 "$1,877.00" $844.65 $844.65 $844.65 $844.65 "$1,877.00" "$1,877.00" "$1,877.00" $391.21 "$1,877.00" "$1,877.00" "$1,877.00" "$1,877.00" "$1,877.00" $391.19 "$1,877.00" $750.80 "$1,110.25" "$1,877.00" "$1,877.00" "$1,877.00" "$1,877.00" "$1,407.75" "$1,877.00" "$1,877.00" "$1,877.00" $938.50 $938.50 "$1,486.58" "$1,877.00" "$1,501.60" $844.65 $372.54 N/A "$1,088.66" "$1,877.00" "$1,877.00" "$1,877.00" $391.17 "$1,877.00" N/A N/A 54-25391 SUP HCPCS C1713 54-25391 - PLATE BONE NARROW XLONG UNIVERSAL LOCK VARIAX TITANIUM LEFT BOTH IP/OP "$1,469.00" "$1,087.00" $291.56 "$1,469.00" $661.05 $661.05 $661.05 $661.05 "$1,469.00" "$1,469.00" "$1,469.00" $306.18 "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" $306.16 "$1,469.00" $587.60 $868.91 "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" "$1,101.75" "$1,469.00" "$1,469.00" "$1,469.00" $734.50 $734.50 "$1,163.45" "$1,469.00" "$1,175.20" $661.05 $291.56 N/A $852.02 "$1,469.00" $881.40 "$1,469.00" $306.14 "$1,469.00" N/A N/A 54-25392 SUP HCPCS C1713 54-25392 - PLATE BONE XLONG STANDARD UNIVERSAL LOCK VARIAX TITANIUM BOTH IP/OP "$1,469.00" "$1,087.00" $291.56 "$1,469.00" $661.05 $661.05 $661.05 $661.05 "$1,469.00" "$1,469.00" "$1,469.00" $306.18 "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" $306.16 "$1,469.00" "$1,469.00" $868.91 "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" "$1,101.75" "$1,469.00" "$1,469.00" "$1,469.00" $734.50 $734.50 "$1,163.45" "$1,469.00" "$1,175.20" $661.05 $291.56 N/A $852.02 "$1,469.00" $881.40 "$1,469.00" $306.14 "$1,469.00" N/A N/A 54-25393 SUP HCPCS C1713 54-25393 - PLATE BONE XLONG UNIVERSAL LOCKING WIDE VARIAX TITANIUM LEFT BOTH IP/OP "$1,469.00" "$1,087.00" $291.56 "$1,469.00" $661.05 $661.05 $661.05 $661.05 "$1,469.00" "$1,469.00" "$1,469.00" $306.18 "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" $306.16 "$1,469.00" $587.60 $868.91 "$1,469.00" "$1,469.00" "$1,469.00" "$1,469.00" "$1,101.75" "$1,469.00" "$1,469.00" "$1,469.00" $734.50 $734.50 "$1,163.45" "$1,469.00" "$1,175.20" $661.05 $291.56 N/A $852.02 "$1,469.00" $881.40 "$1,469.00" $306.14 "$1,469.00" N/A N/A 54-25394 SUP HCPCS C1713 54-25394 - PLATE BONE SHORT UNIVERSAL NARROW LOCK VARIAX TITANIUM HAND BOTH IP/OP "$1,373.00" "$1,016.00" $272.51 "$1,373.00" $617.85 $617.85 $617.85 $617.85 "$1,373.00" "$1,373.00" "$1,373.00" $286.17 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" $286.15 "$1,373.00" $549.20 $812.13 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" "$1,029.75" "$1,373.00" "$1,373.00" "$1,373.00" $686.50 $686.50 "$1,087.42" "$1,373.00" "$1,098.40" $617.85 $272.51 N/A $796.34 "$1,373.00" "$1,373.00" "$1,373.00" $286.13 "$1,373.00" N/A N/A 54-25395 SUP HCPCS C1713 54-25395 - PLATE BONE NARROW LONG UNIVERSAL 73MMX2MM LP VARIAX TITANIUM BOTH IP/OP "$1,373.00" "$1,016.00" $272.51 "$1,373.00" $617.85 $617.85 $617.85 $617.85 "$1,373.00" "$1,373.00" "$1,373.00" $286.17 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" $286.15 "$1,373.00" $549.20 $812.13 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" "$1,029.75" "$1,373.00" "$1,373.00" "$1,373.00" $686.50 $686.50 "$1,087.42" "$1,373.00" "$1,098.40" $617.85 $272.51 N/A $796.34 "$1,373.00" $823.80 "$1,373.00" $286.13 "$1,373.00" N/A N/A 54-25396 SUP HCPCS C1713 54-25396 - PLATE BONE UNIVERSAL STANDARD SHORT LOCK VARIAX DISTAL VOLAR BOTH IP/OP "$1,373.00" "$1,016.00" $272.51 "$1,373.00" $617.85 $617.85 $617.85 $617.85 "$1,373.00" "$1,373.00" "$1,373.00" $286.17 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" $286.15 "$1,373.00" "$1,373.00" $812.13 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" "$1,029.75" "$1,373.00" "$1,373.00" "$1,373.00" $686.50 $686.50 "$1,087.42" "$1,373.00" "$1,098.40" $617.85 $272.51 N/A $796.34 "$1,373.00" $823.80 "$1,373.00" $286.13 "$1,373.00" N/A N/A 54-25397 SUP HCPCS C1713 54-25397 - PLATE BONE UNIVERSAL STANDARD LONG LOCK VARIAX RADIAL DISTAL BOTH IP/OP "$1,373.00" "$1,016.00" $272.51 "$1,373.00" $617.85 $617.85 $617.85 $617.85 "$1,373.00" "$1,373.00" "$1,373.00" $286.17 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" $286.15 "$1,373.00" "$1,373.00" $812.13 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" "$1,029.75" "$1,373.00" "$1,373.00" "$1,373.00" $686.50 $686.50 "$1,087.42" "$1,373.00" "$1,098.40" $617.85 $272.51 N/A $796.34 "$1,373.00" $823.80 "$1,373.00" $286.13 "$1,373.00" N/A N/A 54-25398 SUP HCPCS C1713 54-25398 - PLATE BONE UNIVERSAL WIDE SHORT LOCK VARIAX RADIAL DISTAL BOTH IP/OP "$1,373.00" "$1,016.00" $272.51 "$1,373.00" $617.85 $617.85 $617.85 $617.85 "$1,373.00" "$1,373.00" "$1,373.00" $286.17 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" $286.15 "$1,373.00" $549.20 $812.13 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" "$1,029.75" "$1,373.00" "$1,373.00" "$1,373.00" $686.50 $686.50 "$1,087.42" "$1,373.00" "$1,098.40" $617.85 $272.51 N/A $796.34 "$1,373.00" "$1,373.00" "$1,373.00" $286.13 "$1,373.00" N/A N/A 54-25399 SUP HCPCS C1713 54-25399 - PLATE BONE LONG UNIVERSAL WIDE LOCK VARIAX RAD DISTAL VOLAR BOTH IP/OP "$1,373.00" "$1,016.00" $272.51 "$1,373.00" $617.85 $617.85 $617.85 $617.85 "$1,373.00" "$1,373.00" "$1,373.00" $286.17 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" $286.15 "$1,373.00" $549.20 $812.13 "$1,373.00" "$1,373.00" "$1,373.00" "$1,373.00" "$1,029.75" "$1,373.00" "$1,373.00" "$1,373.00" $686.50 $686.50 "$1,087.42" "$1,373.00" "$1,098.40" $617.85 $272.51 N/A $796.34 "$1,373.00" "$1,373.00" "$1,373.00" $286.13 "$1,373.00" N/A N/A 54-25400 SUP HCPCS C1713 54-25400 - PLATE BONE SHORT 44MMX1MM COLUMN FRAGMENT SPECIFIC VARIAX BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" $252.16 "$1,210.00" N/A N/A 54-25401 SUP HCPCS C1713 54-25401 - PLATE BONE LONG COLUMN SMARTLOCK TITANIUM RAD DISTAL VOLAR BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" $484.00 $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" $252.16 "$1,210.00" N/A N/A 54-25402 SUP HCPCS C1713 54-25402 - PLATE BONE SHORT LOCK COLUMN FRAGMENT SPECIFIC VARIAX RAD BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" $252.16 "$1,210.00" N/A N/A 54-25403 SUP HCPCS C1713 54-25403 - PLATE BN SHRT 40MMX1MM VARIAX LCK CLMN TI ULNA LT FRAG SPC BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" $252.16 "$1,210.00" N/A N/A 54-25404 SUP HCPCS C1713 54-25404 - PLATE BONE LONG LOCKING COLUMN FRAGMENT SPECIFIC VARIAX BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" $252.16 "$1,210.00" N/A N/A 54-25405 SUP HCPCS C1713 54-25405 - PLATE BONE LONG COLUMN SMARTLOCK TITANIUM LEFT RADIAL DISTAL BOTH IP/OP "$1,210.00" $895.00 $240.15 "$1,210.00" $544.50 $544.50 $544.50 $544.50 "$1,210.00" "$1,210.00" "$1,210.00" $252.19 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $252.18 "$1,210.00" "$1,210.00" $715.72 "$1,210.00" "$1,210.00" "$1,210.00" "$1,210.00" $907.50 "$1,210.00" "$1,210.00" "$1,210.00" $605.00 $605.00 $958.32 "$1,210.00" $968.00 $544.50 $240.15 N/A $701.80 "$1,210.00" $726.00 "$1,210.00" $252.16 "$1,210.00" N/A N/A 54-25420S SUP HCPCS C1713 54-25420S - PLATE BONE 2XL 189MMX3MM 15 HOLE ANATOMICAL VARIAX LEFT BOTH IP/OP "$3,145.00" "$2,327.00" $624.20 "$3,145.00" "$1,415.25" "$1,415.25" "$1,415.25" "$1,415.25" "$3,145.00" "$3,145.00" "$3,145.00" $655.50 "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" $655.45 "$3,145.00" "$1,258.00" "$1,550.49" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$2,358.75" "$3,145.00" "$3,145.00" "$3,145.00" "$1,572.50" "$1,572.50" "$2,490.84" "$3,145.00" "$2,516.00" "$1,415.25" $624.20 N/A "$1,824.10" "$3,145.00" "$1,887.00" "$3,145.00" $655.42 "$3,145.00" N/A N/A 54-25422S SUP HCPCS C1713 54-25422S - PLATE BONE 2XL THK3MM 2.7MM 189MM 15 HOLE ANATOMICAL STAND BOTH IP/OP "$3,145.00" "$2,327.00" $624.20 "$3,145.00" "$1,415.25" "$1,415.25" "$1,415.25" "$1,415.25" "$3,145.00" "$3,145.00" "$3,145.00" $655.50 "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" $655.45 "$3,145.00" "$3,145.00" "$1,550.49" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$2,358.75" "$3,145.00" "$3,145.00" "$3,145.00" "$1,572.50" "$1,572.50" "$2,490.84" "$3,145.00" "$2,516.00" "$1,415.25" $624.20 N/A "$1,824.10" "$3,145.00" "$1,887.00" "$3,145.00" "$3,145.00" "$3,145.00" N/A N/A 54-25424S SUP HCPCS C1713 54-25424S - PLATE BN 2XL 189MMX3MM STRL 15 HL ANTM STND RADL RT DIST BOTH IP/OP "$3,145.00" "$2,327.00" $624.20 "$3,145.00" "$1,415.25" "$1,415.25" "$1,415.25" "$1,415.25" "$3,145.00" "$3,145.00" "$3,145.00" $655.50 "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" $655.45 "$3,145.00" "$1,258.00" "$1,550.49" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$2,358.75" "$3,145.00" "$3,145.00" "$3,145.00" "$1,572.50" "$1,572.50" "$2,490.84" "$3,145.00" "$2,516.00" "$1,415.25" $624.20 N/A "$1,824.10" "$3,145.00" "$1,887.00" "$3,145.00" "$3,145.00" "$3,145.00" N/A N/A 54-25426S SUP HCPCS C1713 54-25426S - PLATE BONE 2XL STANDARD 145MM 11 HOLE ANATOMICAL VARIAX LEFT BOTH IP/OP "$3,145.00" "$2,327.00" $624.20 "$3,145.00" "$1,415.25" "$1,415.25" "$1,415.25" "$1,415.25" "$3,145.00" "$3,145.00" "$3,145.00" $655.50 "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" $655.45 "$3,145.00" "$3,145.00" "$1,550.49" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$2,358.75" "$3,145.00" "$3,145.00" "$3,145.00" "$1,572.50" "$1,572.50" "$2,490.84" "$3,145.00" "$2,516.00" "$1,415.25" $624.20 N/A "$1,824.10" "$3,145.00" "$1,887.00" "$3,145.00" $655.42 "$3,145.00" N/A N/A 54-25428S SUP HCPCS C1713 54-25428S - PLATE BONE 2XL THK3MM STANDARD 100MM 8 HOLE ANATOMICAL LEFT BOTH IP/OP "$2,751.00" "$2,036.00" $546.00 "$2,751.00" "$1,237.95" "$1,237.95" "$1,237.95" "$1,237.95" "$2,751.00" "$2,751.00" "$2,751.00" $573.38 "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" $573.34 "$2,751.00" "$1,100.40" "$1,356.24" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,063.25" "$2,751.00" "$2,751.00" "$2,751.00" "$1,375.50" "$1,375.50" "$2,178.79" "$2,751.00" "$2,200.80" "$1,237.95" $546.00 N/A "$1,595.58" "$2,751.00" "$1,650.60" "$2,751.00" $573.31 "$2,751.00" N/A N/A 54-25430S SUP HCPCS C1713 54-25430S - PLATE BONE 2XL STANDARD 100MMX3MM 8 HOLE ANATOMICAL RIGHT BOTH IP/OP "$2,751.00" "$2,036.00" $546.00 "$2,751.00" "$1,237.95" "$1,237.95" "$1,237.95" "$1,237.95" "$2,751.00" "$2,751.00" "$2,751.00" $573.38 "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" $573.34 "$2,751.00" "$2,751.00" "$1,356.24" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,063.25" "$2,751.00" "$2,751.00" "$2,751.00" "$1,375.50" "$1,375.50" "$2,178.79" "$2,751.00" "$2,200.80" "$1,237.95" $546.00 N/A "$1,595.58" "$2,751.00" "$1,650.60" "$2,751.00" $573.31 "$2,751.00" N/A N/A 54-25432S SUP HCPCS C1713 54-25432S - PLATE BONE 2XL THK3MM 2.7MM 74MM 5 HOLE VARIAX LEFT DISTAL BOTH IP/OP "$2,751.00" "$2,036.00" $546.00 "$2,751.00" "$1,237.95" "$1,237.95" "$1,237.95" "$1,237.95" "$2,751.00" "$2,751.00" "$2,751.00" $573.38 "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" $573.34 "$2,751.00" "$1,100.40" "$1,356.24" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,063.25" "$2,751.00" "$2,751.00" "$2,751.00" "$1,375.50" "$1,375.50" "$2,178.79" "$2,751.00" "$2,200.80" "$1,237.95" $546.00 N/A "$1,595.58" "$2,751.00" "$1,650.60" "$2,751.00" $573.31 "$2,751.00" N/A N/A 54-25434S SUP HCPCS C1713 54-25434S - PLATE BONE 2XL THK3MM 2.7MM 74MM 5 HOLE ANATOMICAL STAND BOTH IP/OP "$2,751.00" "$2,036.00" $546.00 "$2,751.00" "$1,237.95" "$1,237.95" "$1,237.95" "$1,237.95" "$2,751.00" "$2,751.00" "$2,751.00" $573.38 "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" $573.34 "$2,751.00" "$1,100.40" "$1,356.24" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,063.25" "$2,751.00" "$2,751.00" "$2,751.00" "$1,375.50" "$1,375.50" "$2,178.79" "$2,751.00" "$2,200.80" "$1,237.95" $546.00 N/A "$1,595.58" "$2,751.00" "$1,650.60" "$2,751.00" $573.31 "$2,751.00" N/A N/A 54-25436S SUP HCPCS C1713 54-25436S - PLATE BONE 2XL THK3MM 2.7MM 189MM 15 HOLE ANATOMICAL NARROW BOTH IP/OP "$3,145.00" "$2,327.00" $624.20 "$3,145.00" "$1,415.25" "$1,415.25" "$1,415.25" "$1,415.25" "$3,145.00" "$3,145.00" "$3,145.00" $655.50 "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" $655.45 "$3,145.00" "$3,145.00" "$1,550.49" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$2,358.75" "$3,145.00" "$3,145.00" "$3,145.00" "$1,572.50" "$1,572.50" "$2,490.84" "$3,145.00" "$2,516.00" "$1,415.25" $624.20 N/A "$1,824.10" "$3,145.00" "$1,887.00" "$3,145.00" $655.42 "$3,145.00" N/A N/A 54-25438S SUP HCPCS C1713 54-25438S - PLATE BONE 2XL THK3MM 2.7MM 189MM 15 HOLE ANATOMICAL NARROW BOTH IP/OP "$3,145.00" "$2,327.00" $624.20 "$3,145.00" "$1,415.25" "$1,415.25" "$1,415.25" "$1,415.25" "$3,145.00" "$3,145.00" "$3,145.00" $655.50 "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" $655.45 "$3,145.00" "$1,258.00" "$1,550.49" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$2,358.75" "$3,145.00" "$3,145.00" "$3,145.00" "$1,572.50" "$1,572.50" "$2,490.84" "$3,145.00" "$2,516.00" "$1,415.25" $624.20 N/A "$1,824.10" "$3,145.00" "$1,887.00" "$3,145.00" $655.42 "$3,145.00" N/A N/A 54-25440S SUP HCPCS C1713 54-25440S - PLATE BONE 2XL THK3MM 2.7MM 145MM 11 HOLE ANATOMICAL NARROW BOTH IP/OP "$3,145.00" "$2,327.00" $624.20 "$3,145.00" "$1,415.25" "$1,415.25" "$1,415.25" "$1,415.25" "$3,145.00" "$3,145.00" "$3,145.00" $655.50 "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" $655.45 "$3,145.00" "$3,145.00" "$1,550.49" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$2,358.75" "$3,145.00" "$3,145.00" "$3,145.00" "$1,572.50" "$1,572.50" "$2,490.84" "$3,145.00" "$2,516.00" "$1,415.25" $624.20 N/A "$1,824.10" "$3,145.00" "$3,145.00" "$3,145.00" $655.42 "$3,145.00" N/A N/A 54-25442S SUP HCPCS C1713 54-25442S - PLATE BONE 2XL 145MMX3MM 11 HOLE ANATOMICAL NARROW VARIAX BOTH IP/OP "$3,145.00" "$2,327.00" $624.20 "$3,145.00" "$1,415.25" "$1,415.25" "$1,415.25" "$1,415.25" "$3,145.00" "$3,145.00" "$3,145.00" $655.50 "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" $655.45 "$3,145.00" "$1,258.00" "$1,550.49" "$3,145.00" "$3,145.00" "$3,145.00" "$3,145.00" "$2,358.75" "$3,145.00" "$3,145.00" "$3,145.00" "$1,572.50" "$1,572.50" "$2,490.84" "$3,145.00" "$2,516.00" "$1,415.25" $624.20 N/A "$1,824.10" "$3,145.00" "$1,887.00" "$3,145.00" $655.42 "$3,145.00" N/A N/A 54-25444S SUP HCPCS C1713 54-25444S - PLATE BONE 2XL NARROW 100MMX3MM 8 HOLE ANATOMICAL LEFT BOTH IP/OP "$2,751.00" "$2,036.00" $546.00 "$2,751.00" "$1,237.95" "$1,237.95" "$1,237.95" "$1,237.95" "$2,751.00" "$2,751.00" "$2,751.00" $573.38 "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" $573.34 "$2,751.00" "$2,751.00" "$1,356.24" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,063.25" "$2,751.00" "$2,751.00" "$2,751.00" "$1,375.50" "$1,375.50" "$2,178.79" "$2,751.00" "$2,200.80" "$1,237.95" $546.00 N/A "$1,595.58" "$2,751.00" "$1,650.60" "$2,751.00" $573.31 "$2,751.00" N/A N/A 54-25446S SUP HCPCS C1713 54-25446S - PLATE BONE 2XL 100MMX3MM 8 HOLE ANATOMICAL NARROW VARIAX BOTH IP/OP "$2,751.00" "$2,036.00" $546.00 "$2,751.00" "$1,237.95" "$1,237.95" "$1,237.95" "$1,237.95" "$2,751.00" "$2,751.00" "$2,751.00" $573.38 "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" $573.34 "$2,751.00" "$1,100.40" "$1,356.24" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,063.25" "$2,751.00" "$2,751.00" "$2,751.00" "$1,375.50" "$1,375.50" "$2,178.79" "$2,751.00" "$2,200.80" "$1,237.95" $546.00 N/A "$1,595.58" "$2,751.00" "$1,650.60" "$2,751.00" "$2,751.00" "$2,751.00" N/A N/A 54-25448S SUP HCPCS C1713 54-25448S - PLATE BONE 2XL NARROW 5 HOLE ANATOMICAL LEFT DISTAL VOLAR BOTH IP/OP "$2,751.00" "$2,036.00" $546.00 "$2,751.00" "$1,237.95" "$1,237.95" "$1,237.95" "$1,237.95" "$2,751.00" "$2,751.00" "$2,751.00" $573.38 "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" $573.34 "$2,751.00" "$2,751.00" "$1,356.24" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,063.25" "$2,751.00" "$2,751.00" "$2,751.00" "$1,375.50" "$1,375.50" "$2,178.79" "$2,751.00" "$2,200.80" "$1,237.95" $546.00 N/A "$1,595.58" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" N/A N/A 54-25450S SUP HCPCS C1713 54-25450S - PLATE BONE 2XL 74MMX3MM 5 HOLE ANATOMICAL NARROW VARIAX BOTH IP/OP "$2,751.00" "$2,036.00" $546.00 "$2,751.00" "$1,237.95" "$1,237.95" "$1,237.95" "$1,237.95" "$2,751.00" "$2,751.00" "$2,751.00" $573.38 "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" $573.34 "$2,751.00" "$1,100.40" "$1,356.24" "$2,751.00" "$2,751.00" "$2,751.00" "$2,751.00" "$2,063.25" "$2,751.00" "$2,751.00" "$2,751.00" "$1,375.50" "$1,375.50" "$2,178.79" "$2,751.00" "$2,200.80" "$1,237.95" $546.00 N/A "$1,595.58" "$2,751.00" "$1,650.60" "$2,751.00" $573.31 "$2,751.00" N/A N/A 542T-11-42A SUP Custom 27803010 542T-11-42A - SHELL ACETAB T 42MM TRIDENT PSL HA BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 542T-11-44B SUP Custom 27803010 542T-11-44B - SHELL ACETAB T 44MM TRIDENT PSL HA BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 542T-11-46C SUP Custom 27803010 542T-11-46C - SHELL ACETAB T 46MM TRIDENT PSL HA BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 542T-11-50D SUP Custom 27803010 542T-11-50D - SHELL ACETAB T 50MM TRIDENT PSL HA BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 542T-11-54E SUP Custom 27803010 542T-11-54E - SHELL ACETAB T 54MM TRIDENT PSL HA BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 542T-11-58F SUP Custom 27803010 542T-11-58F - SHELL ACETAB T 58MM TRIDENT PSL HA BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 542T-11-62G SUP Custom 27803010 542T-11-62G - SHELL ACETAB T 62MM TRIDENT PSL HA BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 542T-11-66H SUP Custom 27803010 542T-11-66H - SHELL ACETAB T 66MM TRIDENT PSL HA BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 542T-11-70I SUP Custom 27803010 542T-11-70I - SHELL ACETAB T 70MM TRIDENT PSL HA BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 5444-0-110 SUP HCPCS C1895 5444-0-110 - GRAFT SYNTH TISSUE SMALL CUSTOMIZE MEDPOR BOTH IP/OP "$25,394.00" "$18,792.00" "$5,040.02" "$25,393.75" "$11,427.19" "$11,427.19" "$11,427.19" "$11,427.19" "$25,393.75" "$25,393.75" "$25,393.75" "$5,292.69" "$25,393.75" "$25,393.75" "$25,393.75" "$25,393.75" "$25,393.75" "$5,292.34" "$25,393.75" "$25,393.75" "$12,519.12" "$25,393.75" "$25,393.75" "$25,393.75" "$25,393.75" "$19,045.50" "$25,393.75" "$25,393.75" "$25,393.75" "$12,696.88" "$12,696.88" "$20,111.85" "$25,393.75" "$20,315.00" "$11,427.19" "$5,040.02" N/A "$14,728.52" "$25,393.75" "$25,393.75" "$25,393.75" "$5,292.06" "$25,393.75" N/A N/A 5444-0-210 SUP HCPCS C1895 5444-0-210 - GRAFT SYNTH TISSUE MEDIUM CUSTOMIZE MEDPOR BOTH IP/OP "$38,395.00" "$28,412.00" "$7,620.45" "$38,395.00" "$17,277.75" "$17,277.75" "$17,277.75" "$17,277.75" "$38,395.00" "$38,395.00" "$38,395.00" "$8,002.48" "$38,395.00" "$38,395.00" "$38,395.00" "$38,395.00" "$38,395.00" "$8,001.94" "$38,395.00" "$38,395.00" "$18,928.74" "$38,395.00" "$38,395.00" "$38,395.00" "$38,395.00" "$28,796.25" "$38,395.00" "$38,395.00" "$38,395.00" "$19,197.50" "$19,197.50" "$30,408.84" "$38,395.00" "$30,716.00" "$17,277.75" "$7,620.45" N/A "$22,269.10" "$38,395.00" "$38,395.00" "$38,395.00" "$8,001.52" "$38,395.00" N/A N/A 5444-0-310 SUP HCPCS C1895 5444-0-310 - GRAFT SYNTH TISSUE LARGE CUSTOMIZE MEDPOR BOTH IP/OP "$45,842.50" "$33,923.00" "$7,712.84" "$45,842.50" "$20,629.13" "$20,629.13" "$20,629.13" "$20,629.13" "$45,842.50" "$45,842.50" "$45,842.50" "$9,417.94" "$45,842.50" "$45,842.50" "$45,842.50" "$45,842.50" "$45,842.50" "$9,554.08" "$45,842.50" "$45,842.50" "$22,600.35" "$45,842.50" "$45,842.50" "$45,842.50" "$45,842.50" "$34,381.88" "$45,842.50" "$45,842.50" "$45,842.50" "$22,921.25" "$22,921.25" "$36,307.26" "$45,842.50" "$36,674.00" "$20,629.13" "$7,712.84" N/A "$26,588.65" "$45,842.50" "$45,842.50" "$45,842.50" "$8,098.48" "$45,842.50" N/A N/A 5444-0-410 SUP HCPCS C1895 5444-0-410 - GRAFT SYNTH TISSUE XL CUSTOMIZE MEDPOR BOTH IP/OP "$54,737.50" "$40,506.00" "$7,712.84" "$54,737.50" "$24,631.88" "$24,631.88" "$24,631.88" "$24,631.88" "$54,737.50" "$54,737.50" "$54,737.50" "$9,417.94" "$54,737.50" "$54,737.50" "$54,737.50" "$54,737.50" "$54,737.50" "$11,407.90" "$54,737.50" "$54,737.50" "$26,985.59" "$54,737.50" "$54,737.50" "$54,737.50" "$54,737.50" "$41,053.13" "$54,737.50" "$54,737.50" "$54,737.50" "$27,368.75" "$27,368.75" "$43,352.10" "$54,737.50" "$43,790.00" "$24,631.88" "$7,712.84" N/A "$31,747.75" "$54,737.50" "$54,737.50" "$54,737.50" "$8,098.48" "$54,737.50" N/A N/A 5444-0-510 SUP HCPCS C1895 5444-0-510 - GRAFT SYNTH TISSUE CUSTOMIZE MEDPOR MIDFAC BOTH IP/OP "$42,120.00" "$31,169.00" "$7,712.84" "$42,120.00" "$18,954.00" "$18,954.00" "$18,954.00" "$18,954.00" "$42,120.00" "$42,120.00" "$42,120.00" "$8,778.86" "$42,120.00" "$42,120.00" "$42,120.00" "$42,120.00" "$42,120.00" "$8,778.27" "$42,120.00" "$42,120.00" "$20,765.16" "$42,120.00" "$42,120.00" "$42,120.00" "$42,120.00" "$31,590.00" "$42,120.00" "$42,120.00" "$42,120.00" "$21,060.00" "$21,060.00" "$33,359.04" "$42,120.00" "$33,696.00" "$18,954.00" "$7,712.84" N/A "$24,429.60" "$42,120.00" "$42,120.00" "$42,120.00" "$8,098.48" "$42,120.00" N/A N/A 5444-0-610 SUP HCPCS C1895 5444-0-610 - GRAFT SYNTH TISSUE CUSTOMIZE AUGMENTATION LATEX FREE MEDPOR BOTH IP/OP "$20,182.50" "$14,935.00" "$4,005.72" "$20,182.50" "$9,082.13" "$9,082.13" "$9,082.13" "$9,082.13" "$20,182.50" "$20,182.50" "$20,182.50" "$4,206.54" "$20,182.50" "$20,182.50" "$20,182.50" "$20,182.50" "$20,182.50" "$4,206.26" "$20,182.50" "$20,182.50" "$9,949.97" "$20,182.50" "$20,182.50" "$20,182.50" "$20,182.50" "$15,136.88" "$20,182.50" "$20,182.50" "$20,182.50" "$10,091.25" "$10,091.25" "$15,984.54" "$20,182.50" "$16,146.00" "$9,082.13" "$4,005.72" N/A "$11,705.85" "$20,182.50" "$20,182.50" "$20,182.50" "$4,206.03" "$20,182.50" N/A N/A 5450-800-315 SUP Custom 27203010 5450-800-315 - TIP ASP LNG 4.6IN STRL LF SPTZLR MIC CLW MIC CLW BN DISP BOTH IP/OP "$8,925.00" "$6,605.00" "$1,588.65" "$8,925.00" "$8,925.00" "$8,925.00" "$8,925.00" "$8,925.00" "$8,925.00" "$8,925.00" "$1,588.65" "$8,925.00" "$8,925.00" "$4,181.12" "$4,181.12" "$6,879.39" "$2,060.15" "$1,860.07" "$8,925.00" "$3,570.00" "$8,925.00" "$8,925.00" "$8,925.00" "$8,925.00" "$8,925.00" "$6,693.75" "$8,925.00" "$8,925.00" "$8,925.00" "$4,462.50" "$4,462.50" "$7,068.60" "$8,925.00" "$7,140.00" "$5,801.25" "$8,925.00" N/A "$5,176.50" "$8,925.00" "$5,355.00" "$8,925.00" "$8,925.00" "$8,925.00" N/A N/A 55.26.25E SUP Custom 27203010 55.26.25E - PROBE LSR 25GA STRL DRCT XTD DISP BOTH IP/OP $337.50 $250.00 $60.08 $430.86 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $60.08 $337.50 $337.50 $250.49 $250.49 $260.15 $175.84 $70.34 $337.50 $172.34 $337.50 $337.50 $430.86 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $219.38 $337.50 N/A $195.75 $337.50 $202.50 $337.50 $337.50 $337.50 N/A N/A 55-0001 SUP HCPCS C1713 55-0001 - NAIL HELICAL 20 MM IMPLANT BOTH IP/OP $657.50 $487.00 $130.50 $657.50 $295.88 $295.88 $295.88 $295.88 $657.50 $657.50 $657.50 $137.04 $657.50 $657.50 $657.50 $657.50 $657.50 $137.03 $657.50 $263.00 $388.91 $657.50 $657.50 $657.50 $657.50 $493.13 $657.50 $657.50 $657.50 $328.75 $328.75 $520.74 $657.50 $526.00 $295.88 $130.50 N/A $381.35 $657.50 $657.50 $657.50 $137.02 $657.50 N/A N/A 55-0002 SUP HCPCS C1713 55-0002 - NAIL HELICAL 30 MM IMPLANT BOTH IP/OP $657.50 $487.00 $130.50 $657.50 $295.88 $295.88 $295.88 $295.88 $657.50 $657.50 $657.50 $137.04 $657.50 $657.50 $657.50 $657.50 $657.50 $137.03 $657.50 $657.50 $388.91 $657.50 $657.50 $657.50 $657.50 $493.13 $657.50 $657.50 $657.50 $328.75 $328.75 $520.74 $657.50 $526.00 $295.88 $130.50 N/A $381.35 $657.50 $657.50 $657.50 $137.02 $657.50 N/A N/A 55-0003 SUP HCPCS C1713 55-0003 - NAIL HELICAL 40 MM IMPLANT BOTH IP/OP $657.50 $487.00 $130.50 $657.50 $295.88 $295.88 $295.88 $295.88 $657.50 $657.50 $657.50 $137.04 $657.50 $657.50 $657.50 $657.50 $657.50 $137.03 $657.50 $657.50 $388.91 $657.50 $657.50 $657.50 $657.50 $493.13 $657.50 $657.50 $657.50 $328.75 $328.75 $520.74 $657.50 $526.00 $295.88 $130.50 N/A $381.35 $657.50 $394.50 $657.50 $137.02 $657.50 N/A N/A 5500696SP SUP Custom 27203010 5500696SP - KIT TISS CLSR 10ML ARTISS DUO PREFL SYR HMN FBRN SLNT SPRY BOTH IP/OP "$1,494.50" "$1,106.00" $265.97 "$1,494.23" "$1,494.23" "$1,494.23" "$1,494.23" "$1,494.23" "$1,494.23" "$1,494.23" $265.97 "$1,494.23" "$1,494.23" "$1,109.02" "$1,109.02" "$1,151.75" $778.49 $311.41 "$1,494.23" $597.69 "$1,494.23" "$1,494.23" "$1,494.23" "$1,494.23" "$1,494.23" "$1,120.88" "$1,494.23" "$1,494.23" "$1,494.23" $747.12 $747.12 "$1,183.43" "$1,494.23" "$1,195.38" $971.25 "$1,494.23" N/A $866.81 "$1,494.23" $896.54 "$1,494.23" "$1,494.23" "$1,494.23" N/A N/A 550-120 SUP HCPCS C1713 550-120 - FORCEPS SURG PLATE HOLD BOTH IP/OP $242.50 $179.00 $48.08 $242.25 $109.01 $109.01 $109.01 $109.01 $242.25 $242.25 $242.25 $50.49 $242.25 $242.25 $242.25 $242.25 $242.25 $50.49 $242.25 $96.90 $143.29 $242.25 $242.25 $242.25 $242.25 $181.88 $242.25 $242.25 $242.25 $121.13 $121.13 $191.86 $242.25 $193.80 $109.01 $48.08 N/A $140.65 $242.25 $145.35 $242.25 $50.48 $242.25 N/A N/A 55-02950 SUP HCPCS C1713 55-02950 - PLATE BN NS HBRD MMF MXLMNDB BOTH IP/OP $870.00 $644.00 $172.67 $870.00 $391.50 $391.50 $391.50 $391.50 $870.00 $870.00 $870.00 $181.33 $870.00 $870.00 $870.00 $870.00 $870.00 $181.32 $870.00 $870.00 $514.61 $870.00 $870.00 $870.00 $870.00 $652.50 $870.00 $870.00 $870.00 $435.00 $435.00 $689.04 $870.00 $696.00 $391.50 $172.67 N/A $504.60 $870.00 $522.00 $870.00 $181.31 $870.00 N/A N/A 55-02951 SUP HCPCS C1713 55-02951 - PLATE BONE SMARTLOCK SMALL MAXILLOFACIAL HYBRID BOTH IP/OP $870.00 $644.00 $172.67 $870.00 $391.50 $391.50 $391.50 $391.50 $870.00 $870.00 $870.00 $181.33 $870.00 $870.00 $870.00 $870.00 $870.00 $181.32 $870.00 $870.00 $514.61 $870.00 $870.00 $870.00 $870.00 $652.50 $870.00 $870.00 $870.00 $435.00 $435.00 $689.04 $870.00 $696.00 $391.50 $172.67 N/A $504.60 $870.00 $522.00 $870.00 $181.31 $870.00 N/A N/A 55-03731 SUP HCPCS C1713 55-03731 - PLATE BONE 3D LP .55MM 2X2 HOLE MALBLE UNIVERSAL 2 TITANIUM BOTH IP/OP $767.50 $568.00 $152.33 $767.50 $345.38 $345.38 $345.38 $345.38 $767.50 $767.50 $767.50 $159.97 $767.50 $767.50 $767.50 $767.50 $767.50 $159.96 $767.50 $767.50 $453.98 $767.50 $767.50 $767.50 $767.50 $575.63 $767.50 $767.50 $767.50 $383.75 $383.75 $607.86 $767.50 $614.00 $345.38 $152.33 N/A $445.15 $767.50 $460.50 $767.50 $159.95 $767.50 N/A N/A 55-03733 SUP HCPCS C1713 55-03733 - PLATE BONE 3D LP .55MM 6X2 HOLE MALBLE UNIVERSAL 2 TITANIUM BOTH IP/OP $947.50 $701.00 $188.06 $947.50 $426.38 $426.38 $426.38 $426.38 $947.50 $947.50 $947.50 $197.48 $947.50 $947.50 $947.50 $947.50 $947.50 $197.47 $947.50 $379.00 $560.45 $947.50 $947.50 $947.50 $947.50 $710.63 $947.50 $947.50 $947.50 $473.75 $473.75 $750.42 $947.50 $758.00 $426.38 $188.06 N/A $549.55 $947.50 $568.50 $947.50 $197.46 $947.50 N/A N/A 55-04218 SUP HCPCS C1713 55-04218 - PLATE BONE STR LP .5MM 18 HOLE MALBLE UNIVERSAL 2 TITANIUM BOTH IP/OP $958.50 $709.00 $190.21 $958.35 $431.26 $431.26 $431.26 $431.26 $958.35 $958.35 $958.35 $199.74 $958.35 $958.35 $958.35 $958.35 $958.35 $199.73 $958.35 $958.35 $566.86 $958.35 $958.35 $958.35 $958.35 $718.88 $958.35 $958.35 $958.35 $479.18 $479.18 $759.01 $958.35 $766.68 $431.26 $190.21 N/A $555.93 $958.35 $575.01 $958.35 $199.72 $958.35 N/A N/A 55-04231 SUP HCPCS C1713 55-04231 - PLATE BONE 3D .5MM 2X2 HOLE MALBLE 3D TITANIUM UPPERFACIAL BOTH IP/OP $439.50 $325.00 $87.16 $439.13 $197.61 $197.61 $197.61 $197.61 $439.13 $439.13 $439.13 $91.53 $439.13 $439.13 $439.13 $439.13 $439.13 $91.52 $439.13 $439.13 $259.75 $439.13 $439.13 $439.13 $439.13 $329.63 $439.13 $439.13 $439.13 $219.57 $219.57 $347.79 $439.13 $351.30 $197.61 $87.16 N/A $254.91 $439.13 $439.13 $439.13 $91.51 $439.13 N/A N/A 55-04233 SUP HCPCS C1713 55-04233 - PLATE BONE .5MM 6X2 HOLE MALBLE 3D TITANIUM UPPERFACIAL 1.2 BOTH IP/OP $789.50 $584.00 $156.65 $789.25 $355.16 $355.16 $355.16 $355.16 $789.25 $789.25 $789.25 $164.50 $789.25 $789.25 $789.25 $789.25 $789.25 $164.49 $789.25 $789.25 $466.84 $789.25 $789.25 $789.25 $789.25 $592.13 $789.25 $789.25 $789.25 $394.63 $394.63 $625.09 $789.25 $631.40 $355.16 $156.65 N/A $457.91 $789.25 $473.55 $789.25 $164.48 $789.25 N/A N/A 55-04235 SUP HCPCS C1713 55-04235 - PLATE BONE 3D .5MM 6X6 HOLE MALBLE 3D UNIVERSAL2 TITANIUM BOTH IP/OP "$1,818.50" "$1,346.00" $360.91 "$1,818.43" $818.29 $818.29 $818.29 $818.29 "$1,818.43" "$1,818.43" "$1,818.43" $379.01 "$1,818.43" "$1,818.43" "$1,818.43" "$1,818.43" "$1,818.43" $378.98 "$1,818.43" $727.37 "$1,075.60" "$1,818.43" "$1,818.43" "$1,818.43" "$1,818.43" "$1,363.88" "$1,818.43" "$1,818.43" "$1,818.43" $909.22 $909.22 "$1,440.20" "$1,818.43" "$1,454.74" $818.29 $360.91 N/A "$1,054.73" "$1,818.43" "$1,818.43" "$1,818.43" $378.96 "$1,818.43" N/A N/A 55-04237 SUP HCPCS C1713 55-04237 - PLATE BONE .5MM 10X10 HOLE MALBLE 3D TITANIUM UPPERFACIAL BOTH IP/OP "$2,481.00" "$1,836.00" $492.35 "$2,480.68" "$1,116.31" "$1,116.31" "$1,116.31" "$1,116.31" "$2,480.68" "$2,480.68" "$2,480.68" $517.04 "$2,480.68" "$2,480.68" "$2,480.68" "$2,480.68" "$2,480.68" $517.00 "$2,480.68" $992.27 "$1,467.32" "$2,480.68" "$2,480.68" "$2,480.68" "$2,480.68" "$1,860.75" "$2,480.68" "$2,480.68" "$2,480.68" "$1,240.34" "$1,240.34" "$1,964.70" "$2,480.68" "$1,984.54" "$1,116.31" $492.35 N/A "$1,438.98" "$2,480.68" "$1,488.41" "$2,480.68" $516.97 "$2,480.68" N/A N/A 55-04240 SUP HCPCS C1713 55-04240 - PLATE BONE 2Y LP .5MM 7 HOLE MALBLE UNIVERSAL 2 TITANIUM BOTH IP/OP $837.50 $620.00 $166.22 $837.50 $376.88 $376.88 $376.88 $376.88 $837.50 $837.50 $837.50 $174.56 $837.50 $837.50 $837.50 $837.50 $837.50 $174.54 $837.50 $837.50 $495.38 $837.50 $837.50 $837.50 $837.50 $628.13 $837.50 $837.50 $837.50 $418.75 $418.75 $663.30 $837.50 $670.00 $376.88 $166.22 N/A $485.75 $837.50 $502.50 $837.50 $174.54 $837.50 N/A N/A 55-04250 SUP HCPCS C1713 55-04250 - PLATE BONE CURVE .5MM 10 HOLE MALBLE UNIVERSAL 2 TITANIUM BOTH IP/OP $426.50 $316.00 $84.62 $426.33 $191.85 $191.85 $191.85 $191.85 $426.33 $426.33 $426.33 $88.86 $426.33 $426.33 $426.33 $426.33 $426.33 $88.85 $426.33 $426.33 $252.17 $426.33 $426.33 $426.33 $426.33 $319.88 $426.33 $426.33 $426.33 $213.17 $213.17 $337.65 $426.33 $341.06 $191.85 $84.62 N/A $247.37 $426.33 $255.80 $426.33 $88.85 $426.33 N/A N/A 55-04424 SUP HCPCS C1713 55-04424 - PLATE BONE .5MM 24 HOLE STR MALBLE CONDENSED TITANIUM BOTH IP/OP "$1,021.50" $756.00 $202.69 "$1,021.25" $459.56 $459.56 $459.56 $459.56 "$1,021.25" "$1,021.25" "$1,021.25" $212.85 "$1,021.25" "$1,021.25" "$1,021.25" "$1,021.25" "$1,021.25" $212.84 "$1,021.25" "$1,021.25" $604.07 "$1,021.25" "$1,021.25" "$1,021.25" "$1,021.25" $766.13 "$1,021.25" "$1,021.25" "$1,021.25" $510.63 $510.63 $808.83 "$1,021.25" $817.00 $459.56 $202.69 N/A $592.47 "$1,021.25" $612.75 "$1,021.25" $212.83 "$1,021.25" N/A N/A 55-04720 SUP HCPCS C1713 55-04720 - PLATE BONE STR .5MM 20 HOLE MALBLE TITANIUM MIDFAC 1.7MM BOTH IP/OP "$1,002.50" $742.00 $198.92 "$1,002.25" $451.01 $451.01 $451.01 $451.01 "$1,002.25" "$1,002.25" "$1,002.25" $208.89 "$1,002.25" "$1,002.25" "$1,002.25" "$1,002.25" "$1,002.25" $208.88 "$1,002.25" $400.90 $592.83 "$1,002.25" "$1,002.25" "$1,002.25" "$1,002.25" $751.88 "$1,002.25" "$1,002.25" "$1,002.25" $501.13 $501.13 $793.78 "$1,002.25" $801.80 $451.01 $198.92 N/A $581.45 "$1,002.25" $601.35 "$1,002.25" $208.87 "$1,002.25" N/A N/A 55-04724 SUP HCPCS C1713 55-04724 - PLATE BONE 24 HOLE STR MALBLE CONDENSED TITANIUM MIDFAC 1.7 BOTH IP/OP "$1,037.50" $768.00 $205.85 "$1,037.18" $466.73 $466.73 $466.73 $466.73 "$1,037.18" "$1,037.18" "$1,037.18" $216.17 "$1,037.18" "$1,037.18" "$1,037.18" "$1,037.18" "$1,037.18" $216.16 "$1,037.18" $414.87 $613.49 "$1,037.18" "$1,037.18" "$1,037.18" "$1,037.18" $778.13 "$1,037.18" "$1,037.18" "$1,037.18" $518.59 $518.59 $821.45 "$1,037.18" $829.74 $466.73 $205.85 N/A $601.75 "$1,037.18" $622.31 "$1,037.18" "$1,037.18" "$1,037.18" N/A N/A 55-04760 SUP HCPCS C1713 55-04760 - PLATE BONE 100D 2MM ADVANCEMENT 5 HOLE L MALBLE TITANIUM BOTH IP/OP $391.50 $290.00 $77.64 $391.20 $176.04 $176.04 $176.04 $176.04 $391.20 $391.20 $391.20 $81.54 $391.20 $391.20 $391.20 $391.20 $391.20 $81.53 $391.20 $156.48 $231.39 $391.20 $391.20 $391.20 $391.20 $293.63 $391.20 $391.20 $391.20 $195.60 $195.60 $309.83 $391.20 $312.96 $176.04 $77.64 N/A $227.07 $391.20 $234.72 $391.20 $391.20 $391.20 N/A N/A 55-04761 SUP HCPCS C1713 55-04761 - PLATE BONE 100D 2MM ADVANCEMENT L 5 HOLE MALBLE RIGHT ANGLED BOTH IP/OP $391.50 $290.00 $77.64 $391.20 $176.04 $176.04 $176.04 $176.04 $391.20 $391.20 $391.20 $81.54 $391.20 $391.20 $391.20 $391.20 $391.20 $81.53 $391.20 $156.48 $231.39 $391.20 $391.20 $391.20 $391.20 $293.63 $391.20 $391.20 $391.20 $195.60 $195.60 $309.83 $391.20 $312.96 $176.04 $77.64 N/A $227.07 $391.20 $391.20 $391.20 $81.53 $391.20 N/A N/A 55-04762 SUP HCPCS C1713 55-04762 - PLATE BONE 100D LEFT 5MM L 5 HOLE MALBLE TITANIUM MIDFAC 1.7 BOTH IP/OP $402.00 $297.00 $79.79 $402.00 $180.90 $180.90 $180.90 $180.90 $402.00 $402.00 $402.00 $83.79 $402.00 $402.00 $402.00 $402.00 $402.00 $83.78 $402.00 $160.80 $237.78 $402.00 $402.00 $402.00 $402.00 $301.50 $402.00 $402.00 $402.00 $201.00 $201.00 $318.38 $402.00 $321.60 $180.90 $79.79 N/A $233.16 $402.00 $402.00 $402.00 $83.78 $402.00 N/A N/A 55-04763 SUP HCPCS C1713 55-04763 - PLATE BONE 100D 5MM ADVANCEMENT L 5 HOLE MALBLE RIGHT ANGLED BOTH IP/OP $402.00 $297.00 $79.79 $402.00 $180.90 $180.90 $180.90 $180.90 $402.00 $402.00 $402.00 $83.79 $402.00 $402.00 $402.00 $402.00 $402.00 $83.78 $402.00 $160.80 $237.78 $402.00 $402.00 $402.00 $402.00 $301.50 $402.00 $402.00 $402.00 $201.00 $201.00 $318.38 $402.00 $321.60 $180.90 $79.79 N/A $233.16 $402.00 $241.20 $402.00 $83.78 $402.00 N/A N/A 55-04764 SUP HCPCS C1713 55-04764 - PLATE BONE 100D 8MM ADVANCEMENT 6 HOLE L MALBLE TITANIUM BOTH IP/OP $415.50 $307.00 $82.41 $415.20 $186.84 $186.84 $186.84 $186.84 $415.20 $415.20 $415.20 $86.54 $415.20 $415.20 $415.20 $415.20 $415.20 $86.53 $415.20 $415.20 $245.59 $415.20 $415.20 $415.20 $415.20 $311.63 $415.20 $415.20 $415.20 $207.60 $207.60 $328.84 $415.20 $332.16 $186.84 $82.41 N/A $240.99 $415.20 $249.12 $415.20 $86.53 $415.20 N/A N/A 55-04765 SUP HCPCS C1713 55-04765 - PLATE BONE 100D 8MM L 6 HOLE MALBLE TITANIUM MIDFAC RIGHT BOTH IP/OP $415.50 $307.00 $82.41 $415.20 $186.84 $186.84 $186.84 $186.84 $415.20 $415.20 $415.20 $86.54 $415.20 $415.20 $415.20 $415.20 $415.20 $86.53 $415.20 $415.20 $245.59 $415.20 $415.20 $415.20 $415.20 $311.63 $415.20 $415.20 $415.20 $207.60 $207.60 $328.84 $415.20 $332.16 $186.84 $82.41 N/A $240.99 $415.20 $249.12 $415.20 $86.53 $415.20 N/A N/A 55-04766 SUP HCPCS C1713 55-04766 - PLATE BONE 100D 12MM ADVANCEMENT 6 HOLE L MALBLE TITANIUM BOTH IP/OP $426.00 $315.00 $84.55 $426.00 $191.70 $191.70 $191.70 $191.70 $426.00 $426.00 $426.00 $88.79 $426.00 $426.00 $426.00 $426.00 $426.00 $88.78 $426.00 $170.40 $251.98 $426.00 $426.00 $426.00 $426.00 $319.50 $426.00 $426.00 $426.00 $213.00 $213.00 $337.39 $426.00 $340.80 $191.70 $84.55 N/A $247.08 $426.00 $255.60 $426.00 $88.78 $426.00 N/A N/A 55-04767 SUP HCPCS C1713 55-04767 - PLATE BONE 100D 12MM ADVANCEMENT 6 HOLE L MALBLE TITANIUM BOTH IP/OP $426.00 $315.00 $84.55 $426.00 $191.70 $191.70 $191.70 $191.70 $426.00 $426.00 $426.00 $88.79 $426.00 $426.00 $426.00 $426.00 $426.00 $88.78 $426.00 $170.40 $251.98 $426.00 $426.00 $426.00 $426.00 $319.50 $426.00 $426.00 $426.00 $213.00 $213.00 $337.39 $426.00 $340.80 $191.70 $84.55 N/A $247.08 $426.00 $255.60 $426.00 $88.78 $426.00 N/A N/A 55-05151 SUP HCPCS C1713 55-05151 - PLATE BONE STANDARD Y 4MMX.6MM 5 HOLE BAR UNIVERSAL 2 BOTH IP/OP $329.50 $244.00 $65.33 $329.15 $148.12 $148.12 $148.12 $148.12 $329.15 $329.15 $329.15 $68.60 $329.15 $329.15 $329.15 $329.15 $329.15 $68.60 $329.15 $131.66 $194.69 $329.15 $329.15 $329.15 $329.15 $247.13 $329.15 $329.15 $329.15 $164.58 $164.58 $260.69 $329.15 $263.32 $148.12 $65.33 N/A $191.11 $329.15 $197.49 $329.15 $68.59 $329.15 N/A N/A 55-05152 SUP HCPCS C1713 55-05152 - PLATE BONE STANDARD Y 8MMX.6MM 5 HOLE BAR UNIVERSAL 2 BOTH IP/OP $350.00 $259.00 $69.39 $349.63 $157.33 $157.33 $157.33 $157.33 $349.63 $349.63 $349.63 $72.87 $349.63 $349.63 $349.63 $349.63 $349.63 $72.87 $349.63 $349.63 $206.81 $349.63 $349.63 $349.63 $349.63 $262.50 $349.63 $349.63 $349.63 $174.82 $174.82 $276.91 $349.63 $279.70 $157.33 $69.39 N/A $203.00 $349.63 $209.78 $349.63 $72.86 $349.63 N/A N/A 55-05164 SUP HCPCS C1713 55-05164 - PLATE BONE UNIVERSAL STANDARD 2Y .6MM 7 HOLE MALBLE TITANIUM BOTH IP/OP $877.50 $649.00 $174.16 $877.50 $394.88 $394.88 $394.88 $394.88 $877.50 $877.50 $877.50 $182.89 $877.50 $877.50 $877.50 $877.50 $877.50 $182.88 $877.50 $877.50 $519.04 $877.50 $877.50 $877.50 $877.50 $658.13 $877.50 $877.50 $877.50 $438.75 $438.75 $694.98 $877.50 $702.00 $394.88 $174.16 N/A $508.95 $877.50 $877.50 $877.50 $182.87 $877.50 N/A N/A 55-05188 SUP HCPCS C1713 55-05188 - PLATE BONE STANDARD CURVE .6MM 6 HOLE BAR UNIVERSAL 2 BOTH IP/OP $982.50 $727.00 $195.00 $982.50 $442.13 $442.13 $442.13 $442.13 $982.50 $982.50 $982.50 $204.78 $982.50 $982.50 $982.50 $982.50 $982.50 $204.76 $982.50 $982.50 $581.15 $982.50 $982.50 $982.50 $982.50 $736.88 $982.50 $982.50 $982.50 $491.25 $491.25 $778.14 $982.50 $786.00 $442.13 $195.00 N/A $569.85 $982.50 $589.50 $982.50 $204.75 $982.50 N/A N/A 55-05716 SUP HCPCS C1713 55-05716 - PLATE BONE 16 HOLE LOCKING TITANIUM MIDFAC 1.7 MM SCREW BOTH IP/OP $730.50 $541.00 $144.99 $730.50 $328.73 $328.73 $328.73 $328.73 $730.50 $730.50 $730.50 $152.25 $730.50 $730.50 $730.50 $730.50 $730.50 $152.24 $730.50 $730.50 $432.09 $730.50 $730.50 $730.50 $730.50 $547.88 $730.50 $730.50 $730.50 $365.25 $365.25 $578.56 $730.50 $584.40 $328.73 $144.99 N/A $423.69 $730.50 $730.50 $730.50 $152.24 $730.50 N/A N/A 55-05731 SUP HCPCS C1713 55-05731 - PLATE BONE 3D .8MM 2X2 HOLE LOCK UNIVERSAL 2 TITANIUM MIDFAC BOTH IP/OP $502.50 $372.00 $99.65 $502.08 $225.94 $225.94 $225.94 $225.94 $502.08 $502.08 $502.08 $104.65 $502.08 $502.08 $502.08 $502.08 $502.08 $104.64 $502.08 $502.08 $296.98 $502.08 $502.08 $502.08 $502.08 $376.88 $502.08 $502.08 $502.08 $251.04 $251.04 $397.65 $502.08 $401.66 $225.94 $99.65 N/A $291.45 $502.08 $502.08 $502.08 $104.63 $502.08 N/A N/A 55-05733 SUP HCPCS C1713 55-05733 - PLATE BONE 2X6 HOLE LOCKING 3D TITANIUM MIDFAC 1.7 MM SCREW BOTH IP/OP "$1,159.50" $858.00 $230.13 "$1,159.48" $521.77 $521.77 $521.77 $521.77 "$1,159.48" "$1,159.48" "$1,159.48" $241.66 "$1,159.48" "$1,159.48" "$1,159.48" "$1,159.48" "$1,159.48" $241.65 "$1,159.48" $463.79 $685.83 "$1,159.48" "$1,159.48" "$1,159.48" "$1,159.48" $869.63 "$1,159.48" "$1,159.48" "$1,159.48" $579.74 $579.74 $918.31 "$1,159.48" $927.58 $521.77 $230.13 N/A $672.51 "$1,159.48" $695.69 "$1,159.48" $241.64 "$1,159.48" N/A N/A 55-05742 SUP HCPCS C1713 55-05742 - PLATE BONE 2Y .8MM 7 HOLE LOCK UNIVERSAL 2 TITANIUM MIDFAC BOTH IP/OP $574.50 $425.00 $113.94 $574.08 $258.34 $258.34 $258.34 $258.34 $574.08 $574.08 $574.08 $119.65 $574.08 $574.08 $574.08 $574.08 $574.08 $119.64 $574.08 $229.63 $339.57 $574.08 $574.08 $574.08 $574.08 $430.88 $574.08 $574.08 $574.08 $287.04 $287.04 $454.67 $574.08 $459.26 $258.34 $113.94 N/A $333.21 $574.08 $344.45 $574.08 $119.64 $574.08 N/A N/A 55-05751 SUP HCPCS C1713 55-05751 - PLATE BONE Y 4MMX.8MM 5 HOLE LOCK BAR UNIVERSAL 2 TITANIUM BOTH IP/OP $451.00 $334.00 $89.49 $450.88 $202.90 $202.90 $202.90 $202.90 $450.88 $450.88 $450.88 $93.97 $450.88 $450.88 $450.88 $450.88 $450.88 $93.97 $450.88 $180.35 $266.70 $450.88 $450.88 $450.88 $450.88 $338.25 $450.88 $450.88 $450.88 $225.44 $225.44 $357.10 $450.88 $360.70 $202.90 $89.49 N/A $261.58 $450.88 $270.53 $450.88 $450.88 $450.88 N/A N/A 55-05752 SUP HCPCS C1713 55-05752 - PLATE BONE 8MM ADVANCEMENT 8MM 5 HOLE Y LOCKING BAR TITANIUM BOTH IP/OP $451.00 $334.00 $89.49 $450.88 $202.90 $202.90 $202.90 $202.90 $450.88 $450.88 $450.88 $93.97 $450.88 $450.88 $450.88 $450.88 $450.88 $93.97 $450.88 $180.35 $266.70 $450.88 $450.88 $450.88 $450.88 $338.25 $450.88 $450.88 $450.88 $225.44 $225.44 $357.10 $450.88 $360.70 $202.90 $89.49 N/A $261.58 $450.88 $270.53 $450.88 $93.96 $450.88 N/A N/A 55-05758 SUP HCPCS C1713 55-05758 - PLATE BONE 8 HOLE CVD LOCKING TITANIUM MIDFAC 1.7 MM SCREW BOTH IP/OP $355.00 $263.00 $70.42 $354.80 $159.66 $159.66 $159.66 $159.66 $354.80 $354.80 $354.80 $73.95 $354.80 $354.80 $354.80 $354.80 $354.80 $73.94 $354.80 $141.92 $209.86 $354.80 $354.80 $354.80 $354.80 $266.25 $354.80 $354.80 $354.80 $177.40 $177.40 $281.00 $354.80 $283.84 $159.66 $70.42 N/A $205.90 $354.80 $212.88 $354.80 $73.94 $354.80 N/A N/A 55-05761 SUP HCPCS C1713 55-05761 - PLATE BONE 2MM ADVANCEMENT 2MMX.8MM 5 HOLE L LOCKING BOTH IP/OP $414.00 $306.00 $82.08 $413.55 $186.10 $186.10 $186.10 $186.10 $413.55 $413.55 $413.55 $86.19 $413.55 $413.55 $413.55 $413.55 $413.55 $86.19 $413.55 $165.42 $244.61 $413.55 $413.55 $413.55 $413.55 $310.50 $413.55 $413.55 $413.55 $206.78 $206.78 $327.53 $413.55 $330.84 $186.10 $82.08 N/A $240.12 $413.55 $248.13 $413.55 $86.18 $413.55 N/A N/A 55-05763 SUP HCPCS C1713 55-05763 - PLATE BONE 5MM ADVANCEMENT L 5MMX.8MM 5 HOLE LOCK TITANIUM BOTH IP/OP $439.50 $325.00 $87.16 $439.13 $197.61 $197.61 $197.61 $197.61 $439.13 $439.13 $439.13 $91.53 $439.13 $439.13 $439.13 $439.13 $439.13 $91.52 $439.13 $439.13 $259.75 $439.13 $439.13 $439.13 $439.13 $329.63 $439.13 $439.13 $439.13 $219.57 $219.57 $347.79 $439.13 $351.30 $197.61 $87.16 N/A $254.91 $439.13 $263.48 $439.13 $91.51 $439.13 N/A N/A 55-05765 SUP HCPCS C1713 55-05765 - PLATE BONE 100D L 8MMX.8MM 6 HOLE LOCK BAR UNIVERSAL 2 BOTH IP/OP $464.00 $343.00 $92.04 $463.73 $208.68 $208.68 $208.68 $208.68 $463.73 $463.73 $463.73 $96.65 $463.73 $463.73 $463.73 $463.73 $463.73 $96.65 $463.73 $185.49 $274.30 $463.73 $463.73 $463.73 $463.73 $348.00 $463.73 $463.73 $463.73 $231.87 $231.87 $367.27 $463.73 $370.98 $208.68 $92.04 N/A $269.12 $463.73 $278.24 $463.73 $96.64 $463.73 N/A N/A 55-05767 SUP HCPCS C1713 55-05767 - PLATE BONE 100D L 12MMX.8MM 6 HOLE LOCK BAR UNIVERSAL 2 BOTH IP/OP $475.00 $352.00 $94.24 $474.80 $213.66 $213.66 $213.66 $213.66 $474.80 $474.80 $474.80 $98.96 $474.80 $474.80 $474.80 $474.80 $474.80 $98.95 $474.80 $189.92 $280.84 $474.80 $474.80 $474.80 $474.80 $356.25 $474.80 $474.80 $474.80 $237.40 $237.40 $376.04 $474.80 $379.84 $213.66 $94.24 N/A $275.50 $474.80 $284.88 $474.80 $98.95 $474.80 N/A N/A 55-05779 SUP HCPCS C1713 55-05779 - PLATE BONE Y .8MM 8 HOLE LOCK UNIVERSAL 2 TITANIUM MIDFAC BOTH IP/OP $524.00 $388.00 $103.98 $523.88 $235.75 $235.75 $235.75 $235.75 $523.88 $523.88 $523.88 $109.19 $523.88 $523.88 $523.88 $523.88 $523.88 $109.18 $523.88 $209.55 $309.88 $523.88 $523.88 $523.88 $523.88 $393.00 $523.88 $523.88 $523.88 $261.94 $261.94 $414.91 $523.88 $419.10 $235.75 $103.98 N/A $303.92 $523.88 $314.33 $523.88 $109.18 $523.88 N/A N/A 55-06208 SUP HCPCS C1713 55-06208 - PLATE BONE STANDARD STR .6MM 8 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP "$1,055.00" $781.00 $209.39 "$1,055.00" $474.75 $474.75 $474.75 $474.75 "$1,055.00" "$1,055.00" "$1,055.00" $219.89 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $219.87 "$1,055.00" "$1,055.00" $624.03 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $791.25 "$1,055.00" "$1,055.00" "$1,055.00" $527.50 $527.50 $835.56 "$1,055.00" $844.00 $474.75 $209.39 N/A $611.90 "$1,055.00" "$1,055.00" "$1,055.00" $219.86 "$1,055.00" N/A N/A 55-06224 SUP HCPCS C1713 55-06224 - PLATE BONE STANDARD STR .6MM 24 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP $883.50 $654.00 $175.33 $883.38 $397.52 $397.52 $397.52 $397.52 $883.38 $883.38 $883.38 $184.12 $883.38 $883.38 $883.38 $883.38 $883.38 $184.11 $883.38 $883.38 $522.52 $883.38 $883.38 $883.38 $883.38 $662.63 $883.38 $883.38 $883.38 $441.69 $441.69 $699.64 $883.38 $706.70 $397.52 $175.33 N/A $512.43 $883.38 $530.03 $883.38 $184.10 $883.38 N/A N/A 55-06231 SUP HCPCS C1713 55-06231 - PLATE BONE STANDARD 3D .6MM 2X2 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $405.00 $405.00 $405.00 $405.00 $900.00 $900.00 $900.00 $187.58 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $900.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $178.63 N/A $522.00 $900.00 $540.00 $900.00 $187.56 $900.00 N/A N/A 55-06233 SUP HCPCS C1713 55-06233 - PLATE BONE STANDARD .6MM 6X2 HOLE 3D TITANIUM UPPERFACIAL BOTH IP/OP $736.00 $545.00 $145.99 $735.58 $331.01 $331.01 $331.01 $331.01 $735.58 $735.58 $735.58 $153.31 $735.58 $735.58 $735.58 $735.58 $735.58 $153.30 $735.58 $735.58 $435.10 $735.58 $735.58 $735.58 $735.58 $552.00 $735.58 $735.58 $735.58 $367.79 $367.79 $582.58 $735.58 $588.46 $331.01 $145.99 N/A $426.88 $735.58 $441.35 $735.58 $153.29 $735.58 N/A N/A 55-06235 SUP HCPCS C1713 55-06235 - PLATE BONE STANDARD 3D .6MM 6X6 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP "$1,789.00" "$1,324.00" $355.02 "$1,788.75" $804.94 $804.94 $804.94 $804.94 "$1,788.75" "$1,788.75" "$1,788.75" $372.82 "$1,788.75" "$1,788.75" "$1,788.75" "$1,788.75" "$1,788.75" $372.80 "$1,788.75" $715.50 "$1,058.05" "$1,788.75" "$1,788.75" "$1,788.75" "$1,788.75" "$1,341.75" "$1,788.75" "$1,788.75" "$1,788.75" $894.38 $894.38 "$1,416.69" "$1,788.75" "$1,431.00" $804.94 $355.02 N/A "$1,037.62" "$1,788.75" "$1,073.25" "$1,788.75" $372.78 "$1,788.75" N/A N/A 55-06237 SUP HCPCS C1713 55-06237 - PLATE BONE 10X10 HOLE 3D TITANIUM UPPERFACIAL 1.2 MM SCREW BOTH IP/OP "$2,420.00" "$1,791.00" $480.31 "$2,420.00" "$1,089.00" "$1,089.00" "$1,089.00" "$1,089.00" "$2,420.00" "$2,420.00" "$2,420.00" $504.39 "$2,420.00" "$2,420.00" "$2,420.00" "$2,420.00" "$2,420.00" $504.35 "$2,420.00" "$2,420.00" "$1,431.43" "$2,420.00" "$2,420.00" "$2,420.00" "$2,420.00" "$1,815.00" "$2,420.00" "$2,420.00" "$2,420.00" "$1,210.00" "$1,210.00" "$1,916.64" "$2,420.00" "$1,936.00" "$1,089.00" $480.31 N/A "$1,403.60" "$2,420.00" "$1,452.00" "$2,420.00" $504.33 "$2,420.00" N/A N/A 55-06240 SUP HCPCS C1713 55-06240 - PLATE BONE STANDARD 2Y .6MM 7 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP $760.00 $562.00 $150.84 $760.00 $342.00 $342.00 $342.00 $342.00 $760.00 $760.00 $760.00 $158.40 $760.00 $760.00 $760.00 $760.00 $760.00 $158.39 $760.00 $760.00 $449.54 $760.00 $760.00 $760.00 $760.00 $570.00 $760.00 $760.00 $760.00 $380.00 $380.00 $601.92 $760.00 $608.00 $342.00 $150.84 N/A $440.80 $760.00 $760.00 $760.00 $158.38 $760.00 N/A N/A 55-06250 SUP HCPCS C1713 55-06250 - PLATE BONE STANDARD CURVE .6MM 10 HOLE LEIBINGER UNIVERSAL 2 BOTH IP/OP $947.50 $701.00 $188.06 $947.50 $426.38 $426.38 $426.38 $426.38 $947.50 $947.50 $947.50 $197.48 $947.50 $947.50 $947.50 $947.50 $947.50 $197.47 $947.50 $947.50 $560.45 $947.50 $947.50 $947.50 $947.50 $710.63 $947.50 $947.50 $947.50 $473.75 $473.75 $750.42 $947.50 $758.00 $426.38 $188.06 N/A $549.55 $947.50 $568.50 $947.50 $197.46 $947.50 N/A N/A 55-06254 SUP HCPCS C1713 55-06254 - PLATE BONE STANDARD CURVE .6MM 4 HOLE LEIBINGER UNIVERSAL 2 BOTH IP/OP $470.00 $348.00 $93.28 $470.00 $211.50 $211.50 $211.50 $211.50 $470.00 $470.00 $470.00 $97.96 $470.00 $470.00 $470.00 $470.00 $470.00 $97.95 $470.00 $188.00 $278.01 $470.00 $470.00 $470.00 $470.00 $352.50 $470.00 $470.00 $470.00 $235.00 $235.00 $372.24 $470.00 $376.00 $211.50 $93.28 N/A $272.60 $470.00 $470.00 $470.00 $97.95 $470.00 N/A N/A 55-06260 SUP HCPCS C1713 55-06260 - PLATE BONE 90D .6MM 8 HOLE L TITANIUM LEFT UPPERFACIAL 1.2MM BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A 55-06261 SUP HCPCS C1713 55-06261 - PLATE BONE 90D STANDARD L .6MM 8 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP $331.50 $245.00 $65.76 $331.35 $149.11 $149.11 $149.11 $149.11 $331.35 $331.35 $331.35 $69.06 $331.35 $331.35 $331.35 $331.35 $331.35 $69.06 $331.35 $331.35 $195.99 $331.35 $331.35 $331.35 $331.35 $248.63 $331.35 $331.35 $331.35 $165.68 $165.68 $262.43 $331.35 $265.08 $149.11 $65.76 N/A $192.27 $331.35 $198.81 $331.35 $69.05 $331.35 N/A N/A 55-06270 SUP HCPCS C1713 55-06270 - PLATE BONE STANDARD T .6MM 7 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP $337.00 $249.00 $66.82 $336.65 $151.49 $151.49 $151.49 $151.49 $336.65 $336.65 $336.65 $70.17 $336.65 $336.65 $336.65 $336.65 $336.65 $70.16 $336.65 $336.65 $199.13 $336.65 $336.65 $336.65 $336.65 $252.75 $336.65 $336.65 $336.65 $168.33 $168.33 $266.63 $336.65 $269.32 $151.49 $66.82 N/A $195.46 $336.65 $201.99 $336.65 $70.16 $336.65 N/A N/A 55-06310 SUP HCPCS C1713 55-06310 - PLATE BONE MINI 3D SQUARE .6MM 2X2 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP $398.50 $295.00 $79.04 $398.25 $179.21 $179.21 $179.21 $179.21 $398.25 $398.25 $398.25 $83.01 $398.25 $398.25 $398.25 $398.25 $398.25 $83.00 $398.25 $159.30 $235.56 $398.25 $398.25 $398.25 $398.25 $298.88 $398.25 $398.25 $398.25 $199.13 $199.13 $315.41 $398.25 $318.60 $179.21 $79.04 N/A $231.13 $398.25 $238.95 $398.25 $83.00 $398.25 N/A N/A 55-06312 SUP HCPCS C1713 55-06312 - PLATE BONE MINI 3D RECTANGLE .6MM 2X2 HOLE UNIVERSAL 2 BOTH IP/OP $398.50 $295.00 $79.04 $398.25 $179.21 $179.21 $179.21 $179.21 $398.25 $398.25 $398.25 $83.01 $398.25 $398.25 $398.25 $398.25 $398.25 $83.00 $398.25 $398.25 $235.56 $398.25 $398.25 $398.25 $398.25 $298.88 $398.25 $398.25 $398.25 $199.13 $199.13 $315.41 $398.25 $318.60 $179.21 $79.04 N/A $231.13 $398.25 $238.95 $398.25 $83.00 $398.25 N/A N/A 55-06320 SUP HCPCS C1713 55-06320 - PLATE BONE MINI 3D SQUARE .6MM 3X2 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP $442.50 $327.00 $87.75 $442.13 $198.96 $198.96 $198.96 $198.96 $442.13 $442.13 $442.13 $92.15 $442.13 $442.13 $442.13 $442.13 $442.13 $92.14 $442.13 $442.13 $261.52 $442.13 $442.13 $442.13 $442.13 $331.88 $442.13 $442.13 $442.13 $221.07 $221.07 $350.17 $442.13 $353.70 $198.96 $87.75 N/A $256.65 $442.13 $442.13 $442.13 $92.14 $442.13 N/A N/A 55-06370 SUP HCPCS C1713 55-06370 - PLATE BONE STANDARD 14MM BURR HOLE COVER TITANIUM MAXFACL BOTH IP/OP $405.50 $300.00 $80.43 $405.25 $182.36 $182.36 $182.36 $182.36 $405.25 $405.25 $405.25 $84.46 $405.25 $405.25 $405.25 $405.25 $405.25 $84.46 $405.25 $162.10 $239.71 $405.25 $405.25 $405.25 $405.25 $304.13 $405.25 $405.25 $405.25 $202.63 $202.63 $320.96 $405.25 $324.20 $182.36 $80.43 N/A $235.19 $405.25 $243.15 $405.25 $84.45 $405.25 N/A N/A 55-06371 SUP HCPCS C1713 55-06371 - PLATE BONE 20MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2 BOTH IP/OP $452.50 $335.00 $89.75 $452.18 $203.48 $203.48 $203.48 $203.48 $452.18 $452.18 $452.18 $94.25 $452.18 $452.18 $452.18 $452.18 $452.18 $94.24 $452.18 $180.87 $267.46 $452.18 $452.18 $452.18 $452.18 $339.38 $452.18 $452.18 $452.18 $226.09 $226.09 $358.13 $452.18 $361.74 $203.48 $89.75 N/A $262.45 $452.18 $271.31 $452.18 $94.23 $452.18 N/A N/A 55-06372 SUP HCPCS C1713 55-06372 - PLATE BONE STANDARD 10MM .6MM BURR HOLE COVER UNIVERSAL 2 BOTH IP/OP $405.50 $300.00 $80.43 $405.25 $182.36 $182.36 $182.36 $182.36 $405.25 $405.25 $405.25 $84.46 $405.25 $405.25 $405.25 $405.25 $405.25 $84.46 $405.25 $162.10 $239.71 $405.25 $405.25 $405.25 $405.25 $304.13 $405.25 $405.25 $405.25 $202.63 $202.63 $320.96 $405.25 $324.20 $182.36 $80.43 N/A $235.19 $405.25 $243.15 $405.25 $84.45 $405.25 N/A N/A 55-06373 SUP HCPCS C1713 55-06373 - PLATE BONE 14MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2 BOTH IP/OP $454.50 $336.00 $90.12 $454.05 $204.32 $204.32 $204.32 $204.32 $454.05 $454.05 $454.05 $94.64 $454.05 $454.05 $454.05 $454.05 $454.05 $94.63 $454.05 $181.62 $268.57 $454.05 $454.05 $454.05 $454.05 $340.88 $454.05 $454.05 $454.05 $227.03 $227.03 $359.61 $454.05 $363.24 $204.32 $90.12 N/A $263.61 $454.05 $454.05 $454.05 $94.62 $454.05 N/A N/A 55-06374 SUP HCPCS C1713 55-06374 - PLATE BONE 10MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2 BOTH IP/OP $454.50 $336.00 $90.12 $454.05 $204.32 $204.32 $204.32 $204.32 $454.05 $454.05 $454.05 $94.64 $454.05 $454.05 $454.05 $454.05 $454.05 $94.63 $454.05 $181.62 $268.57 $454.05 $454.05 $454.05 $454.05 $340.88 $454.05 $454.05 $454.05 $227.03 $227.03 $359.61 $454.05 $363.24 $204.32 $90.12 N/A $263.61 $454.05 $454.05 $454.05 $94.62 $454.05 N/A N/A 55-06375 SUP HCPCS C1713 55-06375 - PLATE BONE STANDARD 7MM BURR HOLE COVER TITANIUM MAXFACL 1.2 BOTH IP/OP $405.50 $300.00 $80.43 $405.25 $182.36 $182.36 $182.36 $182.36 $405.25 $405.25 $405.25 $84.46 $405.25 $405.25 $405.25 $405.25 $405.25 $84.46 $405.25 $405.25 $239.71 $405.25 $405.25 $405.25 $405.25 $304.13 $405.25 $405.25 $405.25 $202.63 $202.63 $320.96 $405.25 $324.20 $182.36 $80.43 N/A $235.19 $405.25 $243.15 $405.25 $84.45 $405.25 N/A N/A 55-06376 SUP HCPCS C1713 55-06376 - PLATE BONE 7MM BURR HOLE COVER MALBLE TITANIUM MAXFACL 1.2MM BOTH IP/OP $451.00 $334.00 $89.49 $450.88 $202.90 $202.90 $202.90 $202.90 $450.88 $450.88 $450.88 $93.97 $450.88 $450.88 $450.88 $450.88 $450.88 $93.97 $450.88 $450.88 $266.70 $450.88 $450.88 $450.88 $450.88 $338.25 $450.88 $450.88 $450.88 $225.44 $225.44 $357.10 $450.88 $360.70 $202.90 $89.49 N/A $261.58 $450.88 $450.88 $450.88 $93.96 $450.88 N/A N/A 55-06704 SUP HCPCS C1713 55-06704 - PLATE BONE STANDARD STR .55MM 4 HOLE BAR UNIVERSAL 2 BOTH IP/OP $495.00 $366.00 $98.25 $495.00 $222.75 $222.75 $222.75 $222.75 $495.00 $495.00 $495.00 $103.17 $495.00 $495.00 $495.00 $495.00 $495.00 $103.16 $495.00 $495.00 $292.79 $495.00 $495.00 $495.00 $495.00 $371.25 $495.00 $495.00 $495.00 $247.50 $247.50 $392.04 $495.00 $396.00 $222.75 $98.25 N/A $287.10 $495.00 $495.00 $495.00 $103.16 $495.00 N/A N/A 55-06708 SUP HCPCS C1713 55-06708 - PLATE BONE STANDARD STR 8 HOLE UNIVERSAL 2 TITANIUM MIDFAC BOTH IP/OP "$1,090.00" $807.00 $216.34 "$1,090.00" $490.50 $490.50 $490.50 $490.50 "$1,090.00" "$1,090.00" "$1,090.00" $227.18 "$1,090.00" "$1,090.00" "$1,090.00" "$1,090.00" "$1,090.00" $227.17 "$1,090.00" "$1,090.00" $644.74 "$1,090.00" "$1,090.00" "$1,090.00" "$1,090.00" $817.50 "$1,090.00" "$1,090.00" "$1,090.00" $545.00 $545.00 $863.28 "$1,090.00" $872.00 $490.50 $216.34 N/A $632.20 "$1,090.00" "$1,090.00" "$1,090.00" $227.16 "$1,090.00" N/A N/A 55-06724 SUP HCPCS C1713 55-06724 - PLATE BONE STANDARD .6MM 24 HOLE STR TITANIUM MIDFAC 1.7MM BOTH IP/OP "$2,080.00" "$1,539.00" $412.83 "$2,080.00" $936.00 $936.00 $936.00 $936.00 "$2,080.00" "$2,080.00" "$2,080.00" $433.52 "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" $433.49 "$2,080.00" "$2,080.00" "$1,230.32" "$2,080.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,560.00" "$2,080.00" "$2,080.00" "$2,080.00" "$1,040.00" "$1,040.00" "$1,647.36" "$2,080.00" "$1,664.00" $936.00 $412.83 N/A "$1,206.40" "$2,080.00" "$1,248.00" "$2,080.00" $433.47 "$2,080.00" N/A N/A 55-06731 SUP HCPCS C1713 55-06731 - PLATE BONE STANDARD .6MM 2X2 HOLE 3D TITANIUM MIDFAC 1.7MM BOTH IP/OP $481.00 $356.00 $95.46 $480.98 $216.44 $216.44 $216.44 $216.44 $480.98 $480.98 $480.98 $100.25 $480.98 $480.98 $480.98 $480.98 $480.98 $100.24 $480.98 $480.98 $284.50 $480.98 $480.98 $480.98 $480.98 $360.75 $480.98 $480.98 $480.98 $240.49 $240.49 $380.94 $480.98 $384.78 $216.44 $95.46 N/A $278.98 $480.98 $288.59 $480.98 $100.24 $480.98 N/A N/A 55-06733 SUP HCPCS C1713 55-06733 - PLATE BONE STANDARD .6MM 2X6 HOLE 3D TITANIUM MIDFAC 1.7MM BOTH IP/OP "$1,810.00" "$1,339.00" $359.24 "$1,810.00" $814.50 $814.50 $814.50 $814.50 "$1,810.00" "$1,810.00" "$1,810.00" $377.25 "$1,810.00" "$1,810.00" "$1,810.00" "$1,810.00" "$1,810.00" $377.22 "$1,810.00" "$1,810.00" "$1,070.62" "$1,810.00" "$1,810.00" "$1,810.00" "$1,810.00" "$1,357.50" "$1,810.00" "$1,810.00" "$1,810.00" $905.00 $905.00 "$1,433.52" "$1,810.00" "$1,448.00" $814.50 $359.24 N/A "$1,049.80" "$1,810.00" "$1,086.00" "$1,810.00" $377.20 "$1,810.00" N/A N/A 55-06750 SUP HCPCS C1713 55-06750 - PLATE BONE STANDARD CURVE .6MM 10 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP "$1,150.00" $851.00 $228.25 "$1,150.00" $517.50 $517.50 $517.50 $517.50 "$1,150.00" "$1,150.00" "$1,150.00" $239.69 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" "$1,150.00" $680.23 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 $228.25 N/A $667.00 "$1,150.00" "$1,150.00" "$1,150.00" $239.66 "$1,150.00" N/A N/A 55-06754 SUP HCPCS C1713 55-06754 - PLATE BONE STANDARD 4 HOLE CVD BAR TITANIUM MIDFAC 1.7MM BOTH IP/OP $610.00 $451.00 $121.07 $610.00 $274.50 $274.50 $274.50 $274.50 $610.00 $610.00 $610.00 $127.14 $610.00 $610.00 $610.00 $610.00 $610.00 $127.13 $610.00 $610.00 $360.82 $610.00 $610.00 $610.00 $610.00 $457.50 $610.00 $610.00 $610.00 $305.00 $305.00 $483.12 $610.00 $488.00 $274.50 $121.07 N/A $353.80 $610.00 $610.00 $610.00 $127.12 $610.00 N/A N/A 55-06760 SUP HCPCS C1713 55-06760 - PLATE BONE 100D STANDARD 2MM ADVANCEMENT 5 HOLE L TITANIUM BOTH IP/OP $350.00 $259.00 $69.39 $349.60 $157.32 $157.32 $157.32 $157.32 $349.60 $349.60 $349.60 $72.87 $349.60 $349.60 $349.60 $349.60 $349.60 $72.86 $349.60 $139.84 $206.79 $349.60 $349.60 $349.60 $349.60 $262.50 $349.60 $349.60 $349.60 $174.80 $174.80 $276.88 $349.60 $279.68 $157.32 $69.39 N/A $203.00 $349.60 $209.76 $349.60 $72.86 $349.60 N/A N/A 55-06761 SUP HCPCS C1713 55-06761 - PLATE BONE 100D STANDARD 2MM ADVANCEMENT 5 HOLE L TITANIUM BOTH IP/OP $350.00 $259.00 $69.39 $349.60 $157.32 $157.32 $157.32 $157.32 $349.60 $349.60 $349.60 $72.87 $349.60 $349.60 $349.60 $349.60 $349.60 $72.86 $349.60 $139.84 $206.79 $349.60 $349.60 $349.60 $349.60 $262.50 $349.60 $349.60 $349.60 $174.80 $174.80 $276.88 $349.60 $279.68 $157.32 $69.39 N/A $203.00 $349.60 $209.76 $349.60 $72.86 $349.60 N/A N/A 55-06762 SUP HCPCS C1713 55-06762 - PLATE BONE 100D 5 HOLE L TITANIUM LEFT MIDFAC BOTH IP/OP $361.50 $268.00 $71.67 $361.10 $162.50 $162.50 $162.50 $162.50 $361.10 $361.10 $361.10 $75.26 $361.10 $361.10 $361.10 $361.10 $361.10 $75.26 $361.10 $144.44 $213.59 $361.10 $361.10 $361.10 $361.10 $271.13 $361.10 $361.10 $361.10 $180.55 $180.55 $285.99 $361.10 $288.88 $162.50 $71.67 N/A $209.67 $361.10 $216.66 $361.10 $75.25 $361.10 N/A N/A 55-06763 SUP HCPCS C1713 55-06763 - PLATE BONE 100D STANDARD 5MM 5 HOLE L BAR TITANIUM RIGHT BOTH IP/OP $361.50 $268.00 $71.67 $361.10 $162.50 $162.50 $162.50 $162.50 $361.10 $361.10 $361.10 $75.26 $361.10 $361.10 $361.10 $361.10 $361.10 $75.26 $361.10 $144.44 $213.59 $361.10 $361.10 $361.10 $361.10 $271.13 $361.10 $361.10 $361.10 $180.55 $180.55 $285.99 $361.10 $288.88 $162.50 $71.67 N/A $209.67 $361.10 $361.10 $361.10 $75.25 $361.10 N/A N/A 55-06764 SUP HCPCS C1713 55-06764 - PLATE BONE 100D 6 HOLE L TITANIUM LEFT MIDFAC 1.7MM SCREW BOTH IP/OP $384.50 $285.00 $76.23 $384.10 $172.85 $172.85 $172.85 $172.85 $384.10 $384.10 $384.10 $80.06 $384.10 $384.10 $384.10 $384.10 $384.10 $80.05 $384.10 $384.10 $227.20 $384.10 $384.10 $384.10 $384.10 $288.38 $384.10 $384.10 $384.10 $192.05 $192.05 $304.21 $384.10 $307.28 $172.85 $76.23 N/A $223.01 $384.10 $230.46 $384.10 $80.05 $384.10 N/A N/A 55-06765 SUP HCPCS C1713 55-06765 - PLATE BONE 100D 8MM 6 HOLE L TITANIUM RIGHT MAXFACL 1.7MM BOTH IP/OP $384.50 $285.00 $76.23 $384.10 $172.85 $172.85 $172.85 $172.85 $384.10 $384.10 $384.10 $80.06 $384.10 $384.10 $384.10 $384.10 $384.10 $80.05 $384.10 $384.10 $227.20 $384.10 $384.10 $384.10 $384.10 $288.38 $384.10 $384.10 $384.10 $192.05 $192.05 $304.21 $384.10 $307.28 $172.85 $76.23 N/A $223.01 $384.10 $230.46 $384.10 $80.05 $384.10 N/A N/A 55-06766 SUP HCPCS C1713 55-06766 - PLATE BONE 100D STANDARD 12MM ADVANCEMENT 12MM 6 HOLE LEFT L BOTH IP/OP $392.50 $290.00 $77.83 $392.15 $176.47 $176.47 $176.47 $176.47 $392.15 $392.15 $392.15 $81.73 $392.15 $392.15 $392.15 $392.15 $392.15 $81.73 $392.15 $156.86 $231.96 $392.15 $392.15 $392.15 $392.15 $294.38 $392.15 $392.15 $392.15 $196.08 $196.08 $310.58 $392.15 $313.72 $176.47 $77.83 N/A $227.65 $392.15 $392.15 $392.15 $81.72 $392.15 N/A N/A 55-06767 SUP HCPCS C1713 55-06767 - PLATE BONE 100D STANDARD 12MM BAR L .6MM 6 HOLE LEIBINGER BOTH IP/OP $392.50 $290.00 $77.83 $392.15 $176.47 $176.47 $176.47 $176.47 $392.15 $392.15 $392.15 $81.73 $392.15 $392.15 $392.15 $392.15 $392.15 $81.73 $392.15 $156.86 $231.96 $392.15 $392.15 $392.15 $392.15 $294.38 $392.15 $392.15 $392.15 $196.08 $196.08 $310.58 $392.15 $313.72 $176.47 $77.83 N/A $227.65 $392.15 $235.29 $392.15 $81.72 $392.15 N/A N/A 55-06771 SUP HCPCS C1713 55-06771 - PLATE BONE STANDARD T 5 HOLE T TITANIUM MIDFAC 1.7MM SCREWS BOTH IP/OP $293.50 $217.00 $58.20 $293.25 $131.96 $131.96 $131.96 $131.96 $293.25 $293.25 $293.25 $61.12 $293.25 $293.25 $293.25 $293.25 $293.25 $61.12 $293.25 $117.30 $173.46 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $131.96 $58.20 N/A $170.23 $293.25 $293.25 $293.25 $61.11 $293.25 N/A N/A 55-07760 SUP HCPCS C1713 55-07760 - PLATE BONE 100D 2MM ADVANCEMENT .6MM 5 HOLE L TITANIUM LEFT BOTH IP/OP $382.50 $283.00 $75.88 $382.30 $172.04 $172.04 $172.04 $172.04 $382.30 $382.30 $382.30 $79.68 $382.30 $382.30 $382.30 $382.30 $382.30 $79.68 $382.30 $152.92 $226.13 $382.30 $382.30 $382.30 $382.30 $286.88 $382.30 $382.30 $382.30 $191.15 $191.15 $302.78 $382.30 $305.84 $172.04 $75.88 N/A $221.85 $382.30 $229.38 $382.30 $79.67 $382.30 N/A N/A 55-07761 SUP HCPCS C1713 55-07761 - PLATE BONE 100D 2MM ADVANCEMENT .6MM 5 HOLE L TITANIUM RIGHT BOTH IP/OP $382.50 $283.00 $75.88 $382.30 $172.04 $172.04 $172.04 $172.04 $382.30 $382.30 $382.30 $79.68 $382.30 $382.30 $382.30 $382.30 $382.30 $79.68 $382.30 $152.92 $226.13 $382.30 $382.30 $382.30 $382.30 $286.88 $382.30 $382.30 $382.30 $191.15 $191.15 $302.78 $382.30 $305.84 $172.04 $75.88 N/A $221.85 $382.30 $229.38 $382.30 $382.30 $382.30 N/A N/A 55-07762 SUP HCPCS C1713 55-07762 - PLATE BONE 100D 5MM ADVANCEMENT .6MM 5 HOLE L TITANIUM LEFT BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $157.50 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $236.25 $393.75 $82.06 $393.75 N/A N/A 55-07763 SUP HCPCS C1713 55-07763 - PLATE BONE 100D 5MM ADVANCEMENT .6MM 5 HOLE L TITANIUM RIGHT BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $157.50 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $393.75 $393.75 $82.06 $393.75 N/A N/A 55-07764 SUP HCPCS C1713 55-07764 - PLATE BONE 100D 8MM ADVANCEMENT .8MM 6 HOLE L TITANIUM LEFT BOTH IP/OP $410.00 $303.00 $81.32 $409.73 $184.38 $184.38 $184.38 $184.38 $409.73 $409.73 $409.73 $85.40 $409.73 $409.73 $409.73 $409.73 $409.73 $85.39 $409.73 $163.89 $242.36 $409.73 $409.73 $409.73 $409.73 $307.50 $409.73 $409.73 $409.73 $204.87 $204.87 $324.51 $409.73 $327.78 $184.38 $81.32 N/A $237.80 $409.73 $409.73 $409.73 $85.39 $409.73 N/A N/A 55-07765 SUP HCPCS C1713 55-07765 - PLATE BONE 100D 8MM ADVANCEMENT .8MM 6 HOLE L TITANIUM RIGHT BOTH IP/OP $410.00 $303.00 $81.32 $409.73 $184.38 $184.38 $184.38 $184.38 $409.73 $409.73 $409.73 $85.40 $409.73 $409.73 $409.73 $409.73 $409.73 $85.39 $409.73 $163.89 $242.36 $409.73 $409.73 $409.73 $409.73 $307.50 $409.73 $409.73 $409.73 $204.87 $204.87 $324.51 $409.73 $327.78 $184.38 $81.32 N/A $237.80 $409.73 $245.84 $409.73 $85.39 $409.73 N/A N/A 55-07766 SUP HCPCS C1713 55-07766 - PLATE BONE 100D 12MM ADVANCEMENT .55MM 6 HOLE L TITANIUM BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $376.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A 55-07767 SUP HCPCS C1713 55-07767 - PLATE BONE 100D 12MM ADVANCEMENT .55MM 6 HOLE L TITANIUM BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $376.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A 55-08203 SUP HCPCS C1713 55-08203 - PLATE BONE MINI STR 4MMX1MM 4 HOLE BAR UNIVERSAL 2 TITANIUM BOTH IP/OP $308.50 $228.00 $61.16 $308.13 $138.66 $138.66 $138.66 $138.66 $308.13 $308.13 $308.13 $64.22 $308.13 $308.13 $308.13 $308.13 $308.13 $64.22 $308.13 $308.13 $182.26 $308.13 $308.13 $308.13 $308.13 $231.38 $308.13 $308.13 $308.13 $154.07 $154.07 $244.04 $308.13 $246.50 $138.66 $61.16 N/A $178.93 $308.13 $308.13 $308.13 $64.21 $308.13 N/A N/A 55-08204 SUP HCPCS C1713 55-08204 - PLATE BONE MINI REGULAR STR 1MM 4 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP $255.50 $189.00 $50.69 $255.38 $114.92 $114.92 $114.92 $114.92 $255.38 $255.38 $255.38 $53.23 $255.38 $255.38 $255.38 $255.38 $255.38 $53.22 $255.38 $255.38 $151.06 $255.38 $255.38 $255.38 $255.38 $191.63 $255.38 $255.38 $255.38 $127.69 $127.69 $202.26 $255.38 $204.30 $114.92 $50.69 N/A $148.19 $255.38 $255.38 $255.38 $53.22 $255.38 N/A N/A 55-08205 SUP HCPCS C1713 55-08205 - PLATE BONE MINI STR 8MMX1MM 4 HOLE BAR UNIVERSAL 2 TITANIUM BOTH IP/OP $308.50 $228.00 $61.16 $308.13 $138.66 $138.66 $138.66 $138.66 $308.13 $308.13 $308.13 $64.22 $308.13 $308.13 $308.13 $308.13 $308.13 $64.22 $308.13 $308.13 $182.26 $308.13 $308.13 $308.13 $308.13 $231.38 $308.13 $308.13 $308.13 $154.07 $154.07 $244.04 $308.13 $246.50 $138.66 $61.16 N/A $178.93 $308.13 $308.13 $308.13 $64.21 $308.13 N/A N/A 55-08206 SUP HCPCS C1713 55-08206 - PLATE BONE MINI STR 6 HOLE STR TITANIUM LEFT BOTH IP/OP $466.00 $345.00 $92.43 $465.68 $209.56 $209.56 $209.56 $209.56 $465.68 $465.68 $465.68 $97.06 $465.68 $465.68 $465.68 $465.68 $465.68 $97.05 $465.68 $465.68 $275.45 $465.68 $465.68 $465.68 $465.68 $349.50 $465.68 $465.68 $465.68 $232.84 $232.84 $368.82 $465.68 $372.54 $209.56 $92.43 N/A $270.28 $465.68 $279.41 $465.68 $97.05 $465.68 N/A N/A 55-08216 SUP HCPCS C1713 55-08216 - PLATE BONE MINI REGULAR STR 1MM 16 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP $906.00 $670.00 $179.76 $905.70 $407.57 $407.57 $407.57 $407.57 $905.70 $905.70 $905.70 $188.77 $905.70 $905.70 $905.70 $905.70 $905.70 $188.76 $905.70 $905.70 $535.72 $905.70 $905.70 $905.70 $905.70 $679.50 $905.70 $905.70 $905.70 $452.85 $452.85 $717.31 $905.70 $724.56 $407.57 $179.76 N/A $525.48 $905.70 $543.42 $905.70 $188.75 $905.70 N/A N/A 55-08230 SUP HCPCS C1713 55-08230 - PLATE BONE MINI REGULAR L 1MM 4 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP $382.50 $283.00 $75.84 $382.13 $171.96 $171.96 $171.96 $171.96 $382.13 $382.13 $382.13 $79.65 $382.13 $382.13 $382.13 $382.13 $382.13 $79.64 $382.13 $382.13 $226.03 $382.13 $382.13 $382.13 $382.13 $286.88 $382.13 $382.13 $382.13 $191.07 $191.07 $302.65 $382.13 $305.70 $171.96 $75.84 N/A $221.85 $382.13 $229.28 $382.13 $79.64 $382.13 N/A N/A 55-08231 SUP HCPCS C1713 55-08231 - PLATE BONE MINI REGULAR L 1MM 4 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP $382.50 $283.00 $75.84 $382.13 $171.96 $171.96 $171.96 $171.96 $382.13 $382.13 $382.13 $79.65 $382.13 $382.13 $382.13 $382.13 $382.13 $79.64 $382.13 $382.13 $226.03 $382.13 $382.13 $382.13 $382.13 $286.88 $382.13 $382.13 $382.13 $191.07 $191.07 $302.65 $382.13 $305.70 $171.96 $75.84 N/A $221.85 $382.13 $382.13 $382.13 $79.64 $382.13 N/A N/A 55-08232 SUP HCPCS C1713 55-08232 - PLATE BONE 8MM 4 HOLE L BAR TITANIUM RIGHT BOTH IP/OP $391.00 $289.00 $77.60 $391.00 $175.95 $175.95 $175.95 $175.95 $391.00 $391.00 $391.00 $81.49 $391.00 $391.00 $391.00 $391.00 $391.00 $81.49 $391.00 $156.40 $231.28 $391.00 $391.00 $391.00 $391.00 $293.25 $391.00 $391.00 $391.00 $195.50 $195.50 $309.67 $391.00 $312.80 $175.95 $77.60 N/A $226.78 $391.00 $391.00 $391.00 $81.48 $391.00 N/A N/A 55-08233 SUP HCPCS C1713 55-08233 - PLATE BONE 8MM 4 HOLE L BAR TITANIUM LEFT BOTH IP/OP $391.00 $289.00 $77.60 $391.00 $175.95 $175.95 $175.95 $175.95 $391.00 $391.00 $391.00 $81.49 $391.00 $391.00 $391.00 $391.00 $391.00 $81.49 $391.00 $156.40 $231.28 $391.00 $391.00 $391.00 $391.00 $293.25 $391.00 $391.00 $391.00 $195.50 $195.50 $309.67 $391.00 $312.80 $175.95 $77.60 N/A $226.78 $391.00 $391.00 $391.00 $81.48 $391.00 N/A N/A 55-08234 SUP HCPCS C1713 55-08234 - PLATE BONE MINI L 4MMX1MM 4 HOLE BAR UNIVERSAL 2 TITANIUM BOTH IP/OP $407.00 $301.00 $80.76 $406.90 $183.11 $183.11 $183.11 $183.11 $406.90 $406.90 $406.90 $84.81 $406.90 $406.90 $406.90 $406.90 $406.90 $84.80 $406.90 $406.90 $240.68 $406.90 $406.90 $406.90 $406.90 $305.25 $406.90 $406.90 $406.90 $203.45 $203.45 $322.26 $406.90 $325.52 $183.11 $80.76 N/A $236.06 $406.90 $406.90 $406.90 $84.80 $406.90 N/A N/A 55-08235 SUP HCPCS C1713 55-08235 - PLATE BONE 4MM 4 HOLE L BAR TITANIUM LEFT BOTH IP/OP $407.00 $301.00 $80.76 $406.90 $183.11 $183.11 $183.11 $183.11 $406.90 $406.90 $406.90 $84.81 $406.90 $406.90 $406.90 $406.90 $406.90 $84.80 $406.90 $406.90 $240.68 $406.90 $406.90 $406.90 $406.90 $305.25 $406.90 $406.90 $406.90 $203.45 $203.45 $322.26 $406.90 $325.52 $183.11 $80.76 N/A $236.06 $406.90 $244.14 $406.90 $84.80 $406.90 N/A N/A 55-08236 SUP HCPCS C1713 55-08236 - PLATE BONE MINI L 8MMX1MM 5 HOLE BAR UNIVERSAL 2 TITANIUM BOTH IP/OP $422.00 $312.00 $83.72 $421.83 $189.82 $189.82 $189.82 $189.82 $421.83 $421.83 $421.83 $87.92 $421.83 $421.83 $421.83 $421.83 $421.83 $87.91 $421.83 $168.73 $249.51 $421.83 $421.83 $421.83 $421.83 $316.50 $421.83 $421.83 $421.83 $210.92 $210.92 $334.09 $421.83 $337.46 $189.82 $83.72 N/A $244.76 $421.83 $253.10 $421.83 $87.91 $421.83 N/A N/A 55-08237 SUP HCPCS C1713 55-08237 - PLATE BONE MINI L 8MMX1MM 5 HOLE BAR UNIVERSAL 2 TITANIUM BOTH IP/OP $422.00 $312.00 $83.72 $421.83 $189.82 $189.82 $189.82 $189.82 $421.83 $421.83 $421.83 $87.92 $421.83 $421.83 $421.83 $421.83 $421.83 $87.91 $421.83 $168.73 $249.51 $421.83 $421.83 $421.83 $421.83 $316.50 $421.83 $421.83 $421.83 $210.92 $210.92 $334.09 $421.83 $337.46 $189.82 $83.72 N/A $244.76 $421.83 $253.10 $421.83 $87.91 $421.83 N/A N/A 55-08240 SUP HCPCS C1713 55-08240 - PLATE BONE MINI REGULAR T 1MM 6 HOLE UNIVERSAL 2 TITANIUM BOTH IP/OP $320.00 $237.00 $63.46 $319.73 $143.88 $143.88 $143.88 $143.88 $319.73 $319.73 $319.73 $66.64 $319.73 $319.73 $319.73 $319.73 $319.73 $66.64 $319.73 $127.89 $189.12 $319.73 $319.73 $319.73 $319.73 $240.00 $319.73 $319.73 $319.73 $159.87 $159.87 $253.23 $319.73 $255.78 $143.88 $63.46 N/A $185.60 $319.73 $191.84 $319.73 $66.63 $319.73 N/A N/A 55-08250 SUP HCPCS C1713 55-08250 - PLATE BONE MINI 5 HOLE Y W/O BAR TITANIUM MAXFACL BOTH IP/OP $365.00 $270.00 $72.44 $364.98 $164.24 $164.24 $164.24 $164.24 $364.98 $364.98 $364.98 $76.07 $364.98 $364.98 $364.98 $364.98 $364.98 $76.07 $364.98 $145.99 $215.89 $364.98 $364.98 $364.98 $364.98 $273.75 $364.98 $364.98 $364.98 $182.49 $182.49 $289.06 $364.98 $291.98 $164.24 $72.44 N/A $211.70 $364.98 $218.99 $364.98 $76.06 $364.98 N/A N/A 55-08251 SUP HCPCS C1713 55-08251 - PLATE BONE MINI Y 8MMX1MM 5 HOLE BAR UNIVERSAL 2 TITANIUM BOTH IP/OP $365.00 $270.00 $72.44 $364.98 $164.24 $164.24 $164.24 $164.24 $364.98 $364.98 $364.98 $76.07 $364.98 $364.98 $364.98 $364.98 $364.98 $76.07 $364.98 $145.99 $215.89 $364.98 $364.98 $364.98 $364.98 $273.75 $364.98 $364.98 $364.98 $182.49 $182.49 $289.06 $364.98 $291.98 $164.24 $72.44 N/A $211.70 $364.98 $218.99 $364.98 $364.98 $364.98 N/A N/A 55-08260 SUP HCPCS C1713 55-08260 - PLATE BONE 2Y 6 HOLE TITANIUM MAXFACL 2MM SCREW BOTH IP/OP $397.50 $294.00 $78.84 $397.25 $178.76 $178.76 $178.76 $178.76 $397.25 $397.25 $397.25 $82.80 $397.25 $397.25 $397.25 $397.25 $397.25 $82.79 $397.25 $158.90 $234.97 $397.25 $397.25 $397.25 $397.25 $298.13 $397.25 $397.25 $397.25 $198.63 $198.63 $314.62 $397.25 $317.80 $178.76 $78.84 N/A $230.55 $397.25 $397.25 $397.25 $82.79 $397.25 N/A N/A 55-08262 SUP HCPCS C1713 55-08262 - PLATE BONE MINI 2Y 8MMX1MM 6 HOLE BAR UNIVERSAL 2 TITANIUM BOTH IP/OP $397.50 $294.00 $78.84 $397.25 $178.76 $178.76 $178.76 $178.76 $397.25 $397.25 $397.25 $82.80 $397.25 $397.25 $397.25 $397.25 $397.25 $82.79 $397.25 $397.25 $234.97 $397.25 $397.25 $397.25 $397.25 $298.13 $397.25 $397.25 $397.25 $198.63 $198.63 $314.62 $397.25 $317.80 $178.76 $78.84 N/A $230.55 $397.25 $238.35 $397.25 $82.79 $397.25 N/A N/A 55-08510 SUP HCPCS C1713 55-08510 - PLATE BONE .75MM 30 HOLE STR LP TITANIUM MAXFACL BOTH IP/OP "$1,030.00" $762.00 $204.42 "$1,029.93" $463.47 $463.47 $463.47 $463.47 "$1,029.93" "$1,029.93" "$1,029.93" $214.66 "$1,029.93" "$1,029.93" "$1,029.93" "$1,029.93" "$1,029.93" $214.65 "$1,029.93" "$1,029.93" $609.20 "$1,029.93" "$1,029.93" "$1,029.93" "$1,029.93" $772.50 "$1,029.93" "$1,029.93" "$1,029.93" $514.97 $514.97 $815.70 "$1,029.93" $823.94 $463.47 $204.42 N/A $597.40 "$1,029.93" $617.96 "$1,029.93" $214.64 "$1,029.93" N/A N/A 55-08520 SUP HCPCS C1713 55-08520 - PLATE BONE 100D L .75MM 9 HOLE LP RIGHT ANGLED TITANIUM BOTH IP/OP $489.00 $362.00 $96.98 $488.65 $219.89 $219.89 $219.89 $219.89 $488.65 $488.65 $488.65 $101.85 $488.65 $488.65 $488.65 $488.65 $488.65 $101.84 $488.65 $195.46 $289.04 $488.65 $488.65 $488.65 $488.65 $366.75 $488.65 $488.65 $488.65 $244.33 $244.33 $387.01 $488.65 $390.92 $219.89 $96.98 N/A $283.62 $488.65 $293.19 $488.65 $101.83 $488.65 N/A N/A 55-08521 SUP HCPCS C1713 55-08521 - PLATE BONE 100D L .75MM 9 HOLE LP LEFT ANGLED TITANIUM BOTH IP/OP $489.00 $362.00 $96.98 $488.65 $219.89 $219.89 $219.89 $219.89 $488.65 $488.65 $488.65 $101.85 $488.65 $488.65 $488.65 $488.65 $488.65 $101.84 $488.65 $195.46 $289.04 $488.65 $488.65 $488.65 $488.65 $366.75 $488.65 $488.65 $488.65 $244.33 $244.33 $387.01 $488.65 $390.92 $219.89 $96.98 N/A $283.62 $488.65 $488.65 $488.65 $101.83 $488.65 N/A N/A 55-08542 SUP HCPCS C1713 55-08542 - PLATE BONE .75MM 8 HOLE T LP TITANIUM MAXFACL BOTH IP/OP $481.00 $356.00 $95.42 $480.75 $216.34 $216.34 $216.34 $216.34 $480.75 $480.75 $480.75 $100.20 $480.75 $480.75 $480.75 $480.75 $480.75 $100.19 $480.75 $192.30 $284.36 $480.75 $480.75 $480.75 $480.75 $360.75 $480.75 $480.75 $480.75 $240.38 $240.38 $380.75 $480.75 $384.60 $216.34 $95.42 N/A $278.98 $480.75 $480.75 $480.75 $480.75 $480.75 N/A N/A 55-08579 SUP HCPCS C1713 55-08579 - PLATE BONE .75MM 8 HOLE Y TITANIUM MAXFACL BOTH IP/OP $481.00 $356.00 $95.42 $480.75 $216.34 $216.34 $216.34 $216.34 $480.75 $480.75 $480.75 $100.20 $480.75 $480.75 $480.75 $480.75 $480.75 $100.19 $480.75 $480.75 $284.36 $480.75 $480.75 $480.75 $480.75 $360.75 $480.75 $480.75 $480.75 $240.38 $240.38 $380.75 $480.75 $384.60 $216.34 $95.42 N/A $278.98 $480.75 $480.75 $480.75 $100.19 $480.75 N/A N/A 55-08586 SUP HCPCS C1713 55-08586 - PLATE BONE CURVE .75MM 12 HOLE LP TITANIUM MAXFACL BOTH IP/OP $489.00 $362.00 $96.98 $488.65 $219.89 $219.89 $219.89 $219.89 $488.65 $488.65 $488.65 $101.85 $488.65 $488.65 $488.65 $488.65 $488.65 $101.84 $488.65 $488.65 $289.04 $488.65 $488.65 $488.65 $488.65 $366.75 $488.65 $488.65 $488.65 $244.33 $244.33 $387.01 $488.65 $390.92 $219.89 $96.98 N/A $283.62 $488.65 $488.65 $488.65 $101.83 $488.65 N/A N/A 55-09104 SUP HCPCS C1713 55-09104 - PLATE BONE 4MM BAR TITANIUM CHIN 2MM SCREW BOTH IP/OP $481.00 $356.00 $95.42 $480.75 $216.34 $216.34 $216.34 $216.34 $480.75 $480.75 $480.75 $100.20 $480.75 $480.75 $480.75 $480.75 $480.75 $100.19 $480.75 $480.75 $284.36 $480.75 $480.75 $480.75 $480.75 $360.75 $480.75 $480.75 $480.75 $240.38 $240.38 $380.75 $480.75 $384.60 $216.34 $95.42 N/A $278.98 $480.75 $480.75 $480.75 $100.19 $480.75 N/A N/A 55-09106 SUP HCPCS C1713 55-09106 - PLATE BONE 6MM BAR TITANIUM CHIN BOTH IP/OP $489.00 $362.00 $96.98 $488.65 $219.89 $219.89 $219.89 $219.89 $488.65 $488.65 $488.65 $101.85 $488.65 $488.65 $488.65 $488.65 $488.65 $101.84 $488.65 $195.46 $289.04 $488.65 $488.65 $488.65 $488.65 $366.75 $488.65 $488.65 $488.65 $244.33 $244.33 $387.01 $488.65 $390.92 $219.89 $96.98 N/A $283.62 $488.65 $488.65 $488.65 $101.83 $488.65 N/A N/A 55-09108 SUP HCPCS C1713 55-09108 - PLATE BONE 8MM BAR TITANIUM CHIN 2MM SCREW BOTH IP/OP $527.50 $390.00 $104.66 $527.33 $237.30 $237.30 $237.30 $237.30 $527.33 $527.33 $527.33 $109.91 $527.33 $527.33 $527.33 $527.33 $527.33 $109.90 $527.33 $210.93 $311.92 $527.33 $527.33 $527.33 $527.33 $395.63 $527.33 $527.33 $527.33 $263.67 $263.67 $417.65 $527.33 $421.86 $237.30 $104.66 N/A $305.95 $527.33 $527.33 $527.33 $109.90 $527.33 N/A N/A 55-09110 SUP HCPCS C1713 55-09110 - PLATE BONE 10MM BAR TITANIUM CHIN 2MM SCREW BOTH IP/OP $551.00 $408.00 $109.32 $550.78 $247.85 $247.85 $247.85 $247.85 $550.78 $550.78 $550.78 $114.80 $550.78 $550.78 $550.78 $550.78 $550.78 $114.79 $550.78 $220.31 $325.79 $550.78 $550.78 $550.78 $550.78 $413.25 $550.78 $550.78 $550.78 $275.39 $275.39 $436.22 $550.78 $440.62 $247.85 $109.32 N/A $319.58 $550.78 $330.47 $550.78 $550.78 $550.78 N/A N/A 55-10503 SUP HCPCS C1713 55-10503 - PLATE BONE LONG 4 HOLE LOCKING STR BAR TITANIUM MANDIB 2MM BOTH IP/OP $595.00 $440.00 $118.09 $595.00 $267.75 $267.75 $267.75 $267.75 $595.00 $595.00 $595.00 $124.01 $595.00 $595.00 $595.00 $595.00 $595.00 $124.00 $595.00 $595.00 $351.94 $595.00 $595.00 $595.00 $595.00 $446.25 $595.00 $595.00 $595.00 $297.50 $297.50 $471.24 $595.00 $476.00 $267.75 $118.09 N/A $345.10 $595.00 $357.00 $595.00 $124.00 $595.00 N/A N/A 55-10504 SUP HCPCS C1713 55-10504 - PLATE BN MN STRG 1MM BLU SMRT LCK LEIBINGER UNV 2 4 HL TI BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $159.00 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A 55-10505 SUP HCPCS C1713 55-10505 - PLATE BN MN STRG 4MMX1MM BLU SMRT LCK LEIBINGER UNV 2 4 HL BOTH IP/OP $452.50 $335.00 $89.81 $452.50 $203.63 $203.63 $203.63 $203.63 $452.50 $452.50 $452.50 $94.31 $452.50 $452.50 $452.50 $452.50 $452.50 $94.31 $452.50 $452.50 $267.65 $452.50 $452.50 $452.50 $452.50 $339.38 $452.50 $452.50 $452.50 $226.25 $226.25 $358.38 $452.50 $362.00 $203.63 $89.81 N/A $262.45 $452.50 $452.50 $452.50 $94.30 $452.50 N/A N/A 55-10506 SUP HCPCS C1713 55-10506 - PLATE BN MN STRG 1MM BLU SMRT LCK LEIBINGER UNV 2 6 HL TI BOTH IP/OP $517.50 $383.00 $102.71 $517.50 $232.88 $232.88 $232.88 $232.88 $517.50 $517.50 $517.50 $107.86 $517.50 $517.50 $517.50 $517.50 $517.50 $107.85 $517.50 $517.50 $306.10 $517.50 $517.50 $517.50 $517.50 $388.13 $517.50 $517.50 $517.50 $258.75 $258.75 $409.86 $517.50 $414.00 $232.88 $102.71 N/A $300.15 $517.50 $310.50 $517.50 $107.85 $517.50 N/A N/A 55-10507 SUP HCPCS C1713 55-10507 - PLATE BN MN STRG 8MMX1MM BLU SMRT LCK LEIBINGER UNV 2 6 HL BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" $400.00 $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" $600.00 "$1,000.00" $208.40 "$1,000.00" N/A N/A 55-10515 SUP HCPCS C1713 55-10515 - PLATE BONE MINI 8MM 16 HOLE STR CONDENSED TITANIUM MANDIB 2 BOTH IP/OP $756.00 $559.00 $150.00 $755.75 $340.09 $340.09 $340.09 $340.09 $755.75 $755.75 $755.75 $157.52 $755.75 $755.75 $755.75 $755.75 $755.75 $157.51 $755.75 $755.75 $447.03 $755.75 $755.75 $755.75 $755.75 $567.00 $755.75 $755.75 $755.75 $377.88 $377.88 $598.55 $755.75 $604.60 $340.09 $150.00 N/A $438.48 $755.75 $755.75 $755.75 $157.50 $755.75 N/A N/A 55-10516 SUP HCPCS C1713 55-10516 - PLATE BONE STR MINI 16 HOLE LOCK TITANIUM MAXFACL 2/2.3MM BOTH IP/OP $303.00 $224.00 $60.11 $302.88 $136.30 $136.30 $136.30 $136.30 $302.88 $302.88 $302.88 $63.13 $302.88 $302.88 $302.88 $302.88 $302.88 $63.12 $302.88 $121.15 $179.15 $302.88 $302.88 $302.88 $302.88 $227.25 $302.88 $302.88 $302.88 $151.44 $151.44 $239.88 $302.88 $242.30 $136.30 $60.11 N/A $175.74 $302.88 $181.73 $302.88 $63.12 $302.88 N/A N/A 55-10532 SUP HCPCS C1713 55-10532 - PLATE BONE MINI RECTANGLE 3X2 HOLE RECTANGULAR 3D TITANIUM BOTH IP/OP $612.50 $453.00 $121.50 $612.18 $275.48 $275.48 $275.48 $275.48 $612.18 $612.18 $612.18 $127.59 $612.18 $612.18 $612.18 $612.18 $612.18 $127.59 $612.18 $244.87 $362.10 $612.18 $612.18 $612.18 $612.18 $459.38 $612.18 $612.18 $612.18 $306.09 $306.09 $484.85 $612.18 $489.74 $275.48 $121.50 N/A $355.25 $612.18 $367.31 $612.18 $127.58 $612.18 N/A N/A 55-10542 SUP HCPCS C1713 55-10542 - PLATE BONE 4X2 HOLE 3D LOCKING TITANIUM MAXFACL 2/2.3 MM BOTH IP/OP $689.00 $510.00 $136.66 $688.55 $309.85 $309.85 $309.85 $309.85 $688.55 $688.55 $688.55 $143.51 $688.55 $688.55 $688.55 $688.55 $688.55 $143.50 $688.55 $688.55 $407.28 $688.55 $688.55 $688.55 $688.55 $516.75 $688.55 $688.55 $688.55 $344.28 $344.28 $545.33 $688.55 $550.84 $309.85 $136.66 N/A $399.62 $688.55 $413.13 $688.55 $143.49 $688.55 N/A N/A 55-10562 SUP HCPCS C1713 55-10562 - PLATE BONE MINI CVD 6X2 HOLE 3D LOCKING CVD TITANIUM MAXFACL BOTH IP/OP $770.00 $570.00 $152.75 $769.63 $346.33 $346.33 $346.33 $346.33 $769.63 $769.63 $769.63 $160.41 $769.63 $769.63 $769.63 $769.63 $769.63 $160.40 $769.63 $307.85 $455.24 $769.63 $769.63 $769.63 $769.63 $577.50 $769.63 $769.63 $769.63 $384.82 $384.82 $609.55 $769.63 $615.70 $346.33 $152.75 N/A $446.60 $769.63 $769.63 $769.63 $769.63 $769.63 N/A N/A 55-10563 SUP HCPCS C1713 55-10563 - PLATE BONE MINI 4 HOLE REINFORCED BAR TITANIUM MANDIB 2/2.3 BOTH IP/OP $709.50 $525.00 $140.74 $709.10 $319.10 $319.10 $319.10 $319.10 $709.10 $709.10 $709.10 $147.79 $709.10 $709.10 $709.10 $709.10 $709.10 $147.78 $709.10 $283.64 $419.43 $709.10 $709.10 $709.10 $709.10 $532.13 $709.10 $709.10 $709.10 $354.55 $354.55 $561.61 $709.10 $567.28 $319.10 $140.74 N/A $411.51 $709.10 $425.46 $709.10 $147.78 $709.10 N/A N/A 5510-F-101 SUP HCPCS C1776 5510-F-101 - COMPONENT FEMORAL 1 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-102 SUP HCPCS C1776 5510-F-102 - COMPONENT FEMORAL 1 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-201 SUP HCPCS C1776 5510-F-201 - COMPONENT FEMORAL 2 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-202 SUP HCPCS C1776 5510-F-202 - COMPONENT FEMORAL 2 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-301 SUP HCPCS C1776 5510-F-301 - COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-302 SUP HCPCS C1776 5510-F-302 - COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-401 SUP HCPCS C1776 5510-F-401 - COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-402 SUP HCPCS C1776 5510-F-402 - COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-501 SUP HCPCS C1776 5510-F-501 - COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-502 SUP HCPCS C1776 5510-F-502 - COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-601 SUP HCPCS C1776 5510-F-601 - COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-602 SUP HCPCS C1776 5510-F-602 - COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-701 SUP HCPCS C1776 5510-F-701 - COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-702 SUP HCPCS C1776 5510-F-702 - COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-801 SUP HCPCS C1776 5510-F-801 - COMPONENT FEMORAL 8 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5510-F-802 SUP HCPCS C1776 5510-F-802 - COMPONENT FEMORAL 8 CRUCIATE RETAIN CEMENTED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5512-F-101 SUP HCPCS C1776 5512-F-101 - COMPONENT FEMORAL 1 TOT STABILIZE TRIATHLON COCR KNEE LEFT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$5,587.00" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-102 SUP HCPCS C1776 5512-F-102 - COMPONENT FEMORAL 1 TOT STABILIZE TRIATHLON COCR KNEE RIGHT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$13,967.50" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-201 SUP HCPCS C1776 5512-F-201 - COMPONENT FEMORAL 2 TOT STABILIZE TRIATHLON COCR KNEE LEFT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$5,587.00" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-202 SUP HCPCS C1776 5512-F-202 - COMPONENT FEMORAL 2 TOT STABILIZE TRIATHLON COCR KNEE RIGHT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$5,587.00" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-301 SUP HCPCS C1776 5512-F-301 - COMPONENT FEMORAL 3 TOT STABILIZER TRIATHLON COCR KNEE LEFT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$13,967.50" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-302 SUP HCPCS C1776 5512-F-302 - COMPONENT FEMORAL 3 TOT STABILIZER TRIATHLON COCR KNEE RIGHT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$5,587.00" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-401 SUP HCPCS C1776 5512-F-401 - COMPONENT FEMORAL 4 TOT STABILIZER TRIATHLON COCR KNEE LEFT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$5,587.00" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-402 SUP HCPCS C1776 5512-F-402 - COMPONENT FEMORAL 4 TOT STABILIZER TRIATHLON COCR KNEE RIGHT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$5,587.00" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-501 SUP HCPCS C1776 5512-F-501 - COMPONENT FEMORAL 5 TOT STABILIZE TRIATHLON COCR KNEE LEFT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$5,587.00" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-502 SUP HCPCS C1776 5512-F-502 - COMPONENT FEMORAL 5 TOT STABILIZER TRIATHLON COCR KNEE RIGHT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$13,967.50" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-601 SUP HCPCS C1776 5512-F-601 - COMPONENT FEMORAL 6 TOT STABILIZE TRIATHLON COCR KNEE LEFT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$5,587.00" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-602 SUP HCPCS C1776 5512-F-602 - COMPONENT FEMORAL 6 TOT STABILIZE TRIATHLON COCR KNEE RIGHT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$13,967.50" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$8,380.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-701 SUP HCPCS C1776 5512-F-701 - COMPONENT FEMORAL 7 TOT STABILIZE TRIATHLON COCR KNEE LEFT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$5,587.00" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-702 SUP HCPCS C1776 5512-F-702 - COMPONENT FEMORAL 7 TOT STABILIZE TRIATHLON COCR KNEE RIGHT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$5,587.00" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-801 SUP HCPCS C1776 5512-F-801 - COMPONENT FEMORAL 8 TOT STABILIZE TRIATHLON COCR KNEE LEFT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$5,587.00" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5512-F-802 SUP HCPCS C1776 5512-F-802 - COMPONENT FEMORAL 8 TOT STABILIZE TRIATHLON COCR KNEE RIGHT BOTH IP/OP "$13,967.50" "$10,336.00" "$2,772.20" "$13,967.50" "$6,285.38" "$6,285.38" "$6,285.38" "$6,285.38" "$13,967.50" "$13,967.50" "$13,967.50" "$2,911.18" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.98" "$13,967.50" "$13,967.50" "$6,885.98" "$13,967.50" "$13,967.50" "$13,967.50" "$13,967.50" "$10,475.63" "$13,967.50" "$13,967.50" "$13,967.50" "$6,983.75" "$6,983.75" "$11,062.26" "$13,967.50" "$11,174.00" "$6,285.38" "$2,772.20" N/A "$8,101.15" "$13,967.50" "$13,967.50" "$13,967.50" "$2,910.83" "$13,967.50" N/A N/A 5513-F-101 SUP HCPCS C1776 5513-F-101 - COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-102 SUP HCPCS C1776 5513-F-102 - COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-201 SUP HCPCS C1776 5513-F-201 - COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-202 SUP HCPCS C1776 5513-F-202 - COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-301 SUP HCPCS C1776 5513-F-301 - COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-302 SUP HCPCS C1776 5513-F-302 - COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-401 SUP HCPCS C1776 5513-F-401 - COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-402 SUP HCPCS C1776 5513-F-402 - COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-501 SUP HCPCS C1776 5513-F-501 - COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-502 SUP HCPCS C1776 5513-F-502 - COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-601 SUP HCPCS C1776 5513-F-601 - COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-602 SUP HCPCS C1776 5513-F-602 - COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-701 SUP HCPCS C1776 5513-F-701 - COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-702 SUP HCPCS C1776 5513-F-702 - COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-801 SUP HCPCS C1776 5513-F-801 - COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON KNEE LEFT BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5513-F-802 SUP HCPCS C1776 5513-F-802 - COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-101 SUP HCPCS C1776 5514-F-101 - COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-102 SUP HCPCS C1776 5514-F-102 - COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-201 SUP HCPCS C1776 5514-F-201 - COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-202 SUP HCPCS C1776 5514-F-202 - COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-301 SUP HCPCS C1776 5514-F-301 - COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-302 SUP HCPCS C1776 5514-F-302 - COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-401 SUP HCPCS C1776 5514-F-401 - COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-402 SUP HCPCS C1776 5514-F-402 - COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-501 SUP HCPCS C1776 5514-F-501 - COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-502 SUP HCPCS C1776 5514-F-502 - COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-601 SUP HCPCS C1776 5514-F-601 - COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-602 SUP HCPCS C1776 5514-F-602 - COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-701 SUP HCPCS C1776 5514-F-701 - COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-702 SUP HCPCS C1776 5514-F-702 - COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-801 SUP HCPCS C1776 5514-F-801 - COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5514-F-802 SUP HCPCS C1776 5514-F-802 - COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 55-15504 SUP HCPCS C1713 55-15504 - PLATE BONE STR MINI 1.5MM 4 HOLE TITANIUM MAXFACL 2.3MM BOTH IP/OP "$1,600.00" "$1,184.00" $317.56 "$1,600.00" $720.00 $720.00 $720.00 $720.00 "$1,600.00" "$1,600.00" "$1,600.00" $333.48 "$1,600.00" "$1,600.00" "$1,600.00" "$1,600.00" "$1,600.00" $333.46 "$1,600.00" "$1,600.00" $946.40 "$1,600.00" "$1,600.00" "$1,600.00" "$1,600.00" "$1,200.00" "$1,600.00" "$1,600.00" "$1,600.00" $800.00 $800.00 "$1,267.20" "$1,600.00" "$1,280.00" $720.00 $317.56 N/A $928.00 "$1,600.00" "$1,600.00" "$1,600.00" $333.44 "$1,600.00" N/A N/A 55-15505 SUP HCPCS C1713 55-15505 - PLATE BONE 4 HOLE BAR LOCKING TITANIUM MAXFACL BOTH IP/OP "$1,610.00" "$1,191.00" $319.54 "$1,610.00" $724.50 $724.50 $724.50 $724.50 "$1,610.00" "$1,610.00" "$1,610.00" $335.56 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" $335.54 "$1,610.00" "$1,610.00" $952.32 "$1,610.00" "$1,610.00" "$1,610.00" "$1,610.00" "$1,207.50" "$1,610.00" "$1,610.00" "$1,610.00" $805.00 $805.00 "$1,275.12" "$1,610.00" "$1,288.00" $724.50 $319.54 N/A $933.80 "$1,610.00" "$1,610.00" "$1,610.00" $335.52 "$1,610.00" N/A N/A 55-15506 SUP HCPCS C1713 55-15506 - PLATE BONE 6 HOLE LOCKING TITANIUM MANDIB 2 MM SCREW BOTH IP/OP "$1,887.50" "$1,397.00" $374.62 "$1,887.50" $849.38 $849.38 $849.38 $849.38 "$1,887.50" "$1,887.50" "$1,887.50" $393.40 "$1,887.50" "$1,887.50" "$1,887.50" "$1,887.50" "$1,887.50" $393.38 "$1,887.50" "$1,887.50" "$1,116.46" "$1,887.50" "$1,887.50" "$1,887.50" "$1,887.50" "$1,415.63" "$1,887.50" "$1,887.50" "$1,887.50" $943.75 $943.75 "$1,494.90" "$1,887.50" "$1,510.00" $849.38 $374.62 N/A "$1,094.75" "$1,887.50" "$1,887.50" "$1,887.50" $393.36 "$1,887.50" N/A N/A 55-15507 SUP HCPCS C1713 55-15507 - PLATE BONE 6 HOLE BAR TITANIUM MANDIB 2.3/2.7 MM SCREW BOTH IP/OP "$2,045.00" "$1,513.00" $405.88 "$2,045.00" $920.25 $920.25 $920.25 $920.25 "$2,045.00" "$2,045.00" "$2,045.00" $426.23 "$2,045.00" "$2,045.00" "$2,045.00" "$2,045.00" "$2,045.00" $426.20 "$2,045.00" "$2,045.00" "$1,209.62" "$2,045.00" "$2,045.00" "$2,045.00" "$2,045.00" "$1,533.75" "$2,045.00" "$2,045.00" "$2,045.00" "$1,022.50" "$1,022.50" "$1,619.64" "$2,045.00" "$1,636.00" $920.25 $405.88 N/A "$1,186.10" "$2,045.00" "$2,045.00" "$2,045.00" $426.18 "$2,045.00" N/A N/A 55-15514 SUP HCPCS C1713 55-15514 - PLATE BONE 14 HOLE LOCKING TITANIUM MAXFACL 2.3/2.7 MM SCREW BOTH IP/OP "$1,270.50" $940.00 $252.11 "$1,270.23" $571.60 $571.60 $571.60 $571.60 "$1,270.23" "$1,270.23" "$1,270.23" $264.75 "$1,270.23" "$1,270.23" "$1,270.23" "$1,270.23" "$1,270.23" $264.73 "$1,270.23" $508.09 $751.34 "$1,270.23" "$1,270.23" "$1,270.23" "$1,270.23" $952.88 "$1,270.23" "$1,270.23" "$1,270.23" $635.12 $635.12 "$1,006.02" "$1,270.23" "$1,016.18" $571.60 $252.11 N/A $736.89 "$1,270.23" $762.14 "$1,270.23" $264.72 "$1,270.23" N/A N/A 55-15524 SUP HCPCS C1713 55-15524 - PLATE BONE 4 HOLE TITANIUM MAXFACL BOTH IP/OP "$1,710.00" "$1,265.00" $339.39 "$1,710.00" $769.50 $769.50 $769.50 $769.50 "$1,710.00" "$1,710.00" "$1,710.00" $356.41 "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" $356.38 "$1,710.00" "$1,710.00" "$1,011.47" "$1,710.00" "$1,710.00" "$1,710.00" "$1,710.00" "$1,282.50" "$1,710.00" "$1,710.00" "$1,710.00" $855.00 $855.00 "$1,354.32" "$1,710.00" "$1,368.00" $769.50 $339.39 N/A $991.80 "$1,710.00" "$1,026.00" "$1,710.00" $356.36 "$1,710.00" N/A N/A 55-15526 SUP HCPCS C1713 55-15526 - PLATE BONE 115D 1.5MM 4 HOLE ANGLED TITANIUM MANDIB 2MM BOTH IP/OP "$2,840.00" "$2,102.00" $563.67 "$2,840.00" "$1,278.00" "$1,278.00" "$1,278.00" "$1,278.00" "$2,840.00" "$2,840.00" "$2,840.00" $591.93 "$2,840.00" "$2,840.00" "$2,840.00" "$2,840.00" "$2,840.00" $591.89 "$2,840.00" "$1,136.00" "$1,400.12" "$2,840.00" "$2,840.00" "$2,840.00" "$2,840.00" "$2,130.00" "$2,840.00" "$2,840.00" "$2,840.00" "$1,420.00" "$1,420.00" "$2,249.28" "$2,840.00" "$2,272.00" "$1,278.00" $563.67 N/A "$1,647.20" "$2,840.00" "$1,704.00" "$2,840.00" $591.86 "$2,840.00" N/A N/A 55-15536 SUP HCPCS C1713 55-15536 - PLATE BN 140D 1.5MM NS LEIBINGER UNV 2 6 HL BAR TI MNDB BOTH IP/OP "$2,820.00" "$2,087.00" $559.70 "$2,820.00" "$1,269.00" "$1,269.00" "$1,269.00" "$1,269.00" "$2,820.00" "$2,820.00" "$2,820.00" $587.76 "$2,820.00" "$2,820.00" "$2,820.00" "$2,820.00" "$2,820.00" $587.72 "$2,820.00" "$1,128.00" "$1,390.26" "$2,820.00" "$2,820.00" "$2,820.00" "$2,820.00" "$2,115.00" "$2,820.00" "$2,820.00" "$2,820.00" "$1,410.00" "$1,410.00" "$2,233.44" "$2,820.00" "$2,256.00" "$1,269.00" $559.70 N/A "$1,635.60" "$2,820.00" "$1,692.00" "$2,820.00" "$2,820.00" "$2,820.00" N/A N/A 55-15570 SUP HCPCS C1713 55-15570 - PLATE BONE UNIVERSAL 1.5MM 4 HOLE COMPRESSION TITANIUM BOTH IP/OP $586.50 $434.00 $116.37 $586.33 $263.85 $263.85 $263.85 $263.85 $586.33 $586.33 $586.33 $122.21 $586.33 $586.33 $586.33 $586.33 $586.33 $122.20 $586.33 $234.53 $346.81 $586.33 $586.33 $586.33 $586.33 $439.88 $586.33 $586.33 $586.33 $293.17 $293.17 $464.37 $586.33 $469.06 $263.85 $116.37 N/A $340.17 $586.33 $586.33 $586.33 $122.19 $586.33 N/A N/A 55-15575 SUP HCPCS C1713 55-15575 - PLATE BONE 4 HOLE COMPRESSION TITANIUM MANDIB 2.3 MM SCREWS BOTH IP/OP $586.50 $434.00 $116.37 $586.33 $263.85 $263.85 $263.85 $263.85 $586.33 $586.33 $586.33 $122.21 $586.33 $586.33 $586.33 $586.33 $586.33 $122.20 $586.33 $586.33 $346.81 $586.33 $586.33 $586.33 $586.33 $439.88 $586.33 $586.33 $586.33 $293.17 $293.17 $464.37 $586.33 $469.06 $263.85 $116.37 N/A $340.17 $586.33 $586.33 $586.33 $122.19 $586.33 N/A N/A 55-15580 SUP HCPCS C1713 55-15580 - PLATE BONE STR 6 HOLE COMPRESSION TITANIUM MAXFACL 2MM SCREW BOTH IP/OP $893.50 $661.00 $177.24 $893.03 $401.86 $401.86 $401.86 $401.86 $893.03 $893.03 $893.03 $186.13 $893.03 $893.03 $893.03 $893.03 $893.03 $186.12 $893.03 $357.21 $528.23 $893.03 $893.03 $893.03 $893.03 $670.13 $893.03 $893.03 $893.03 $446.52 $446.52 $707.28 $893.03 $714.42 $401.86 $177.24 N/A $518.23 $893.03 $893.03 $893.03 $186.11 $893.03 N/A N/A 55-15585 SUP HCPCS C1713 55-15585 - PLATE BONE 6 HOLE COMPRESSION TITANIUM MANDIB 2.3 MM SCREWS BOTH IP/OP $893.50 $661.00 $177.24 $893.03 $401.86 $401.86 $401.86 $401.86 $893.03 $893.03 $893.03 $186.13 $893.03 $893.03 $893.03 $893.03 $893.03 $186.12 $893.03 $357.21 $528.23 $893.03 $893.03 $893.03 $893.03 $670.13 $893.03 $893.03 $893.03 $446.52 $446.52 $707.28 $893.03 $714.42 $401.86 $177.24 N/A $518.23 $893.03 $535.82 $893.03 $893.03 $893.03 N/A N/A 55-15911 SUP HCPCS C1713 55-15911 - PLATE BONE STR 11 HOLE PRIM RECONSTRUCTION TITANIUM MANDIB BOTH IP/OP "$1,366.00" "$1,011.00" $271.05 "$1,365.68" $614.56 $614.56 $614.56 $614.56 "$1,365.68" "$1,365.68" "$1,365.68" $284.64 "$1,365.68" "$1,365.68" "$1,365.68" "$1,365.68" "$1,365.68" $284.62 "$1,365.68" $546.27 $807.80 "$1,365.68" "$1,365.68" "$1,365.68" "$1,365.68" "$1,024.50" "$1,365.68" "$1,365.68" "$1,365.68" $682.84 $682.84 "$1,081.62" "$1,365.68" "$1,092.54" $614.56 $271.05 N/A $792.28 "$1,365.68" $819.41 "$1,365.68" $284.61 "$1,365.68" N/A N/A 55-15917 SUP HCPCS C1713 55-15917 - PLATE BONE STR 17 HOLE PRIM RECONSTRUCTION TEMPLATE TITANIUM BOTH IP/OP "$1,735.50" "$1,284.00" $344.42 "$1,735.33" $780.90 $780.90 $780.90 $780.90 "$1,735.33" "$1,735.33" "$1,735.33" $361.69 "$1,735.33" "$1,735.33" "$1,735.33" "$1,735.33" "$1,735.33" $361.66 "$1,735.33" $694.13 "$1,026.45" "$1,735.33" "$1,735.33" "$1,735.33" "$1,735.33" "$1,301.63" "$1,735.33" "$1,735.33" "$1,735.33" $867.67 $867.67 "$1,374.38" "$1,735.33" "$1,388.26" $780.90 $344.42 N/A "$1,006.59" "$1,735.33" "$1,735.33" "$1,735.33" $361.64 "$1,735.33" N/A N/A 55-15920 SUP HCPCS C1713 55-15920 - PLATE BN HMSPHR 1.5MM AU SMRT LCK LEIBINGER UNV 2 5X17 HL TI BOTH IP/OP "$2,445.50" "$1,810.00" $485.32 "$2,445.23" "$1,100.35" "$1,100.35" "$1,100.35" "$1,100.35" "$2,445.23" "$2,445.23" "$2,445.23" $509.65 "$2,445.23" "$2,445.23" "$2,445.23" "$2,445.23" "$2,445.23" $509.61 "$2,445.23" "$2,445.23" "$1,446.35" "$2,445.23" "$2,445.23" "$2,445.23" "$2,445.23" "$1,834.13" "$2,445.23" "$2,445.23" "$2,445.23" "$1,222.62" "$1,222.62" "$1,936.62" "$2,445.23" "$1,956.18" "$1,100.35" $485.32 N/A "$1,418.39" "$2,445.23" "$1,467.14" "$2,445.23" $509.59 "$2,445.23" N/A N/A 55-15922 SUP HCPCS C1713 55-15922 - PLATE BN HMSPHR 1.5MM SMRT LCK LEIBINGER UNV 2 5X17 HL TI BOTH IP/OP "$2,445.50" "$1,810.00" $485.32 "$2,445.23" "$1,100.35" "$1,100.35" "$1,100.35" "$1,100.35" "$2,445.23" "$2,445.23" "$2,445.23" $509.65 "$2,445.23" "$2,445.23" "$2,445.23" "$2,445.23" "$2,445.23" $509.61 "$2,445.23" "$2,445.23" "$1,446.35" "$2,445.23" "$2,445.23" "$2,445.23" "$2,445.23" "$1,834.13" "$2,445.23" "$2,445.23" "$2,445.23" "$1,222.62" "$1,222.62" "$1,936.62" "$2,445.23" "$1,956.18" "$1,100.35" $485.32 N/A "$1,418.39" "$2,445.23" "$1,467.14" "$2,445.23" $509.59 "$2,445.23" N/A N/A 5515-F-101 SUP HCPCS C1776 5515-F-101 - COMPONENT FEMORAL 1 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-102 SUP HCPCS C1776 5515-F-102 - COMPONENT FEMORAL 1 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-201 SUP HCPCS C1776 5515-F-201 - COMPONENT FEMORAL 2 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-202 SUP HCPCS C1776 5515-F-202 - COMPONENT FEMORAL 2 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-301 SUP HCPCS C1776 5515-F-301 - COMPONENT FEMORAL 3 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-302 SUP HCPCS C1776 5515-F-302 - COMPONENT FEMORAL 3 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-401 SUP HCPCS C1776 5515-F-401 - COMPONENT FEMORAL 4 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-402 SUP HCPCS C1776 5515-F-402 - COMPONENT FEMORAL 4 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-501 SUP HCPCS C1776 5515-F-501 - COMPONENT FEMORAL 5 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-502 SUP HCPCS C1776 5515-F-502 - COMPONENT FEMORAL 5 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-601 SUP HCPCS C1776 5515-F-601 - COMPONENT FEMORAL 6 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-602 SUP HCPCS C1776 5515-F-602 - COMPONENT FEMORAL 6 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-701 SUP HCPCS C1776 5515-F-701 - COMPONENT FEMORAL 7 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-702 SUP HCPCS C1776 5515-F-702 - COMPONENT FEMORAL 7 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-801 SUP HCPCS C1776 5515-F-801 - COMPONENT FEMORAL 8 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5515-F-802 SUP HCPCS C1776 5515-F-802 - COMPONENT FEMORAL 8 CEMENTED POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5516-F-101 SUP HCPCS C1776 5516-F-101 - COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-102 SUP HCPCS C1776 5516-F-102 - COMPONENT FEMORAL 1 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-201 SUP HCPCS C1776 5516-F-201 - COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-202 SUP HCPCS C1776 5516-F-202 - COMPONENT FEMORAL 2 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-301 SUP HCPCS C1776 5516-F-301 - COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-302 SUP HCPCS C1776 5516-F-302 - COMPONENT FEMORAL 3 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-401 SUP HCPCS C1776 5516-F-401 - COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-402 SUP HCPCS C1776 5516-F-402 - COMPONENT FEMORAL 4 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-501 SUP HCPCS C1776 5516-F-501 - COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-502 SUP HCPCS C1776 5516-F-502 - COMPONENT FEMORAL 5 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-601 SUP HCPCS C1776 5516-F-601 - COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-602 SUP HCPCS C1776 5516-F-602 - COMPONENT FEMORAL 6 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-701 SUP HCPCS C1776 5516-F-701 - COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-702 SUP HCPCS C1776 5516-F-702 - COMPONENT FEMORAL 7 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-801 SUP HCPCS C1776 5516-F-801 - COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5516-F-802 SUP HCPCS C1776 5516-F-802 - COMPONENT FEMORAL 8 POSTERIOR STABILIZE BEAD TRIATHLON PA BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-101 SUP HCPCS C1776 5517-F-101 - COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-102 SUP HCPCS C1776 5517-F-102 - COMPONENT FEMORAL 1 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-201 SUP HCPCS C1776 5517-F-201 - COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-202 SUP HCPCS C1776 5517-F-202 - COMPONENT FEMORAL 2 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-301 SUP HCPCS C1776 5517-F-301 - COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-302 SUP HCPCS C1776 5517-F-302 - COMPONENT FEMORAL 3 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-401 SUP HCPCS C1776 5517-F-401 - COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-402 SUP HCPCS C1776 5517-F-402 - COMPONENT FEMORAL 4 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-501 SUP HCPCS C1776 5517-F-501 - COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-502 SUP HCPCS C1776 5517-F-502 - COMPONENT FEMORAL 5 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-601 SUP HCPCS C1776 5517-F-601 - COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-602 SUP HCPCS C1776 5517-F-602 - COMPONENT FEMORAL 6 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-701 SUP HCPCS C1776 5517-F-701 - COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-702 SUP HCPCS C1776 5517-F-702 - COMPONENT FEMORAL 7 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-801 SUP HCPCS C1776 5517-F-801 - COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5517-F-802 SUP HCPCS C1776 5517-F-802 - COMPONENT FEMORAL 8 CRUCIATE RETAIN BEAD TRIATHLON PA KNEE BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 5520-B-100 SUP HCPCS C1776 5520-B-100 - BASEPLATE TIBIAL 1 PRIM CEMENT TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" $932.00 "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$1,398.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-B-200 SUP HCPCS C1776 5520-B-200 - BASEPLATE TIBIAL 2 PRIM CEMENT TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" "$2,330.00" "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$1,398.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-B-300 SUP HCPCS C1776 5520-B-300 - BASEPLATE TIB 3 TRTHLN PRM CMNT KN BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" "$2,330.00" "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$1,398.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-B-400 SUP HCPCS C1776 5520-B-400 - BASEPLATE TIBIAL 4 PRIM CEMENT TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" $932.00 "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-B-500 SUP HCPCS C1776 5520-B-500 - BASEPLATE TIBIAL 5 PRIM CEMENT TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" "$2,330.00" "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$1,398.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-B-600 SUP HCPCS C1776 5520-B-600 - BASEPLATE TIBIAL 6 PRIM CEMENT TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" "$2,330.00" "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$1,398.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-B-700 SUP HCPCS C1776 5520-B-700 - BASEPLATE TIBIAL 7 PRIM CEMENT TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" "$2,330.00" "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-B-800 SUP HCPCS C1776 5520-B-800 - BASEPLATE TIBIAL 8 PRIM CEMENT TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" "$2,330.00" "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-M-100 SUP HCPCS C1776 5520-M-100 - BASEPLATE TIBIAL 1 LP TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" $932.00 "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-M-200 SUP HCPCS C1776 5520-M-200 - BASEPLATE TIBIAL 2 LP TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" "$2,330.00" "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-M-300 SUP HCPCS C1776 5520-M-300 - BASEPLATE TIBIAL 3 LP TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" $932.00 "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$1,398.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-M-400 SUP HCPCS C1776 5520-M-400 - BASEPLATE TIBIAL 4 LP TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" "$2,330.00" "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$1,398.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-M-500 SUP HCPCS C1776 5520-M-500 - BASEPLATE TIBIAL 5 LP TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" $932.00 "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$1,398.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-M-600 SUP HCPCS C1776 5520-M-600 - BASEPLATE TIBIAL 6 LP TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" $932.00 "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$1,398.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-M-700 SUP HCPCS C1776 5520-M-700 - BASEPLATE TIBIAL 7 LP TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" "$2,330.00" "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5520-M-800 SUP HCPCS C1776 5520-M-800 - BASEPLATE TIBIAL 8 LP TRIATHLON KNEE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" $932.00 "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 5521-B-100 SUP HCPCS C1776 5521-B-100 - BASEPLATE TIB 1 UNV TRTHLN COCR KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5521-B-200 SUP HCPCS C1776 5521-B-200 - BASEPLATE TIB 2 UNV TRTHLN COCR KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5521-B-300 SUP HCPCS C1776 5521-B-300 - BASEPLATE TIB 3 UNV TRTHLN COCR KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5521-B-400 SUP HCPCS C1776 5521-B-400 - BASEPLATE TIB 4 UNV TRTHLN COCR KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5521-B-500 SUP HCPCS C1776 5521-B-500 - BASEPLATE TIB 5 UNV TRTHLN COCR KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5521-B-600 SUP HCPCS C1776 5521-B-600 - BASEPLATE TIB 6 UNV TRTHLN COCR KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5521-B-700 SUP HCPCS C1776 5521-B-700 - BASEPLATE TIB 7 UNV TRTHLN COCR KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5521-B-800 SUP HCPCS C1776 5521-B-800 - BASEPLATE TIB 8 UNV TRTHLN COCR KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5523-B-100 SUP HCPCS C1776 5523-B-100 - BASEPLATE TIBIAL 1 PRIM BEADED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5523-B-200 SUP HCPCS C1776 5523-B-200 - BASEPLATE TIBIAL 2 PRIM BEADED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5523-B-300 SUP HCPCS C1776 5523-B-300 - BASEPLATE TIBIAL 3 PRIM BEADED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5523-B-400 SUP HCPCS C1776 5523-B-400 - BASEPLATE TIBIAL 4 PRIM BEADED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5523-B-500 SUP HCPCS C1776 5523-B-500 - BASEPLATE TIBIAL 5 PRIM BEADED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5523-B-600 SUP HCPCS C1776 5523-B-600 - BASEPLATE TIBIAL 6 PRIM BEADED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5523-B-700 SUP HCPCS C1776 5523-B-700 - BASEPLATE TIBIAL 7 PRIM BEADED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5523-B-800 SUP HCPCS C1776 5523-B-800 - BASEPLATE TIBIAL 8 PRIM BEADED TRIATHLON KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5524-B-100 SUP HCPCS C1776 5524-B-100 - BASEPLATE TIBIAL 1 CEMENTLESS TRIATHLON KNEE SCREW FIX BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5524-B-200 SUP HCPCS C1776 5524-B-200 - BASEPLATE TIBIAL 2 CEMENTLESS TRIATHLON KNEE SCREW FIX BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5524-B-300 SUP HCPCS C1776 5524-B-300 - BASEPLATE TIBIAL 3 BEAD TRIATHLON VITALLIUM KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5524-B-400 SUP HCPCS C1776 5524-B-400 - BASEPLATE TIBIAL 4 CEMENTLESS TRIATHLON KNEE SCREW FIX BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5524-B-500 SUP HCPCS C1776 5524-B-500 - BASEPLATE TIBIAL 5 CEMENTLESS TRIATHLON KNEE SCREW FIX BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5524-B-600 SUP HCPCS C1776 5524-B-600 - BASEPLATE TIBIAL 6 CEMENTLESS TRIATHLON KNEE SCREW FIX BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5524-B-700 SUP HCPCS C1776 5524-B-700 - BASEPLATE TIBIAL 7 CEMENTLESS TRIATHLON KNEE SCREW FIX BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5524-B-800 SUP HCPCS C1776 5524-B-800 - BASEPLATE TIBIAL 8 CEMENTLESS TRIATHLON KNEE SCREW FIX BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5526-B-100 SUP HCPCS C1776 5526-B-100 - BASEPLATE TIBIAL 1 PRIM BEADED TRIATHLON PERIAPT KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5526-B-200 SUP HCPCS C1776 5526-B-200 - BASEPLATE TIBIAL 2 PRIM BEADED TRIATHLON PERIAPT KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5526-B-300 SUP HCPCS C1776 5526-B-300 - BASEPLATE TIBIAL 3 PRIM BEADED TRIATHLON PERIAPT KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5526-B-400 SUP HCPCS C1776 5526-B-400 - BASEPLATE TIBIAL 4 PRIM BEADED TRIATHLON PERIAPT KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5526-B-500 SUP HCPCS C1776 5526-B-500 - BASEPLATE TIBIAL 5 PRIM BEADED TRIATHLON PERIAPT KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5526-B-600 SUP HCPCS C1776 5526-B-600 - BASEPLATE TIBIAL 6 PRIM BEADED TRIATHLON PERIAPT KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5526-B-700 SUP HCPCS C1776 5526-B-700 - BASEPLATE TIBIAL 7 PRIM BEADED TRIATHLON PERIAPT KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5526-B-800 SUP HCPCS C1776 5526-B-800 - BASEPLATE TIBIAL 8 PRIM BEADED TRIATHLON PERIAPT KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5527-B-100 SUP HCPCS C1776 5527-B-100 - BASEPLATE TIBIAL 1 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5527-B-200 SUP HCPCS C1776 5527-B-200 - BASEPLATE TIBIAL 2 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5527-B-300 SUP HCPCS C1776 5527-B-300 - BASEPLATE TIBIAL 3 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5527-B-400 SUP HCPCS C1776 5527-B-400 - BASEPLATE TIBIAL 4 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5527-B-500 SUP HCPCS C1776 5527-B-500 - BASEPLATE TIBIAL 5 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5527-B-600 SUP HCPCS C1776 5527-B-600 - BASEPLATE TIBIAL 6 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5527-B-700 SUP HCPCS C1776 5527-B-700 - BASEPLATE TIBIAL 7 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5527-B-800 SUP HCPCS C1776 5527-B-800 - BASEPLATE TIBIAL 8 CEMENTLESS TRIATHLON PERIAPT KNEE SCREW BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 55-28911 SUP HCPCS C1713 55-28911 - PLATE BONE 11 HOLE RECONSTRUCTION TEMPLATE TITANIUM MAXFACL BOTH IP/OP "$1,609.50" "$1,191.00" $319.42 "$1,609.38" $724.22 $724.22 $724.22 $724.22 "$1,609.38" "$1,609.38" "$1,609.38" $335.44 "$1,609.38" "$1,609.38" "$1,609.38" "$1,609.38" "$1,609.38" $335.41 "$1,609.38" "$1,609.38" $951.95 "$1,609.38" "$1,609.38" "$1,609.38" "$1,609.38" "$1,207.13" "$1,609.38" "$1,609.38" "$1,609.38" $804.69 $804.69 "$1,274.63" "$1,609.38" "$1,287.50" $724.22 $319.42 N/A $933.51 "$1,609.38" "$1,609.38" "$1,609.38" $335.39 "$1,609.38" N/A N/A 55-28917 SUP HCPCS C1713 55-28917 - PLATE BONE 17 HOLE RECONSTRUCTION TEMPLATE TITANIUM MAXFACL BOTH IP/OP "$2,168.00" "$1,604.00" $430.22 "$2,167.63" $975.43 $975.43 $975.43 $975.43 "$2,167.63" "$2,167.63" "$2,167.63" $451.79 "$2,167.63" "$2,167.63" "$2,167.63" "$2,167.63" "$2,167.63" $451.76 "$2,167.63" "$2,167.63" "$1,282.15" "$2,167.63" "$2,167.63" "$2,167.63" "$2,167.63" "$1,626.00" "$2,167.63" "$2,167.63" "$2,167.63" "$1,083.82" "$1,083.82" "$1,716.76" "$2,167.63" "$1,734.10" $975.43 $430.22 N/A "$1,257.44" "$2,167.63" "$2,167.63" "$2,167.63" $451.73 "$2,167.63" N/A N/A 55-28920 SUP HCPCS C1713 55-28920 - PLATE BONE 6X17 HOLE RECONSTRUCTION HEMISPHERE TEMPLATE BOTH IP/OP "$2,725.00" "$2,017.00" $540.83 "$2,724.95" "$1,226.23" "$1,226.23" "$1,226.23" "$1,226.23" "$2,724.95" "$2,724.95" "$2,724.95" $567.95 "$2,724.95" "$2,724.95" "$2,724.95" "$2,724.95" "$2,724.95" $567.91 "$2,724.95" "$1,089.98" "$1,343.40" "$2,724.95" "$2,724.95" "$2,724.95" "$2,724.95" "$2,043.75" "$2,724.95" "$2,724.95" "$2,724.95" "$1,362.48" "$1,362.48" "$2,158.16" "$2,724.95" "$2,179.96" "$1,226.23" $540.83 N/A "$1,580.50" "$2,724.95" "$2,724.95" "$2,724.95" $567.88 "$2,724.95" N/A N/A 55-28922 SUP HCPCS C1713 55-28922 - PLATE BONE 6X17 HOLE RECONSTRUCTION HEMISPHERE TEMPLATE BOTH IP/OP "$2,725.00" "$2,017.00" $540.83 "$2,724.95" "$1,226.23" "$1,226.23" "$1,226.23" "$1,226.23" "$2,724.95" "$2,724.95" "$2,724.95" $567.95 "$2,724.95" "$2,724.95" "$2,724.95" "$2,724.95" "$2,724.95" $567.91 "$2,724.95" "$1,089.98" "$1,343.40" "$2,724.95" "$2,724.95" "$2,724.95" "$2,724.95" "$2,043.75" "$2,724.95" "$2,724.95" "$2,724.95" "$1,362.48" "$1,362.48" "$2,158.16" "$2,724.95" "$2,179.96" "$1,226.23" $540.83 N/A "$1,580.50" "$2,724.95" "$2,724.95" "$2,724.95" $567.88 "$2,724.95" N/A N/A 55-28925 SUP HCPCS C1713 55-28925 - PLATE BN HMSPHR 1.5MM SMRT LCK LEIBINGER UNV 2 6X17 HL TI BOTH IP/OP "$5,907.50" "$4,372.00" "$1,172.49" "$5,907.50" "$2,658.38" "$2,658.38" "$2,658.38" "$2,658.38" "$5,907.50" "$5,907.50" "$5,907.50" "$1,231.27" "$5,907.50" "$5,907.50" "$5,907.50" "$5,907.50" "$5,907.50" "$1,231.19" "$5,907.50" "$5,907.50" "$2,912.40" "$5,907.50" "$5,907.50" "$5,907.50" "$5,907.50" "$4,430.63" "$5,907.50" "$5,907.50" "$5,907.50" "$2,953.75" "$2,953.75" "$4,678.74" "$5,907.50" "$4,726.00" "$2,658.38" "$1,172.49" N/A "$3,426.35" "$5,907.50" "$5,907.50" "$5,907.50" "$1,231.12" "$5,907.50" N/A N/A 55-28926 SUP HCPCS C1713 55-28926 - PLATE BN HMSPHR 1.5MM SMRT LCK LEIBINGER UNV 2 6X17 HL TI BOTH IP/OP "$5,907.50" "$4,372.00" "$1,172.49" "$5,907.50" "$2,658.38" "$2,658.38" "$2,658.38" "$2,658.38" "$5,907.50" "$5,907.50" "$5,907.50" "$1,231.27" "$5,907.50" "$5,907.50" "$5,907.50" "$5,907.50" "$5,907.50" "$1,231.19" "$5,907.50" "$5,907.50" "$2,912.40" "$5,907.50" "$5,907.50" "$5,907.50" "$5,907.50" "$4,430.63" "$5,907.50" "$5,907.50" "$5,907.50" "$2,953.75" "$2,953.75" "$4,678.74" "$5,907.50" "$4,726.00" "$2,658.38" "$1,172.49" N/A "$3,426.35" "$5,907.50" "$5,907.50" "$5,907.50" "$1,231.12" "$5,907.50" N/A N/A 55-28930 SUP HCPCS C1713 55-28930 - PLATE BONE 6+17+6 HOLE FULL TITANIUM MANDIB BOTH IP/OP "$3,496.00" "$2,587.00" $693.81 "$3,495.70" "$1,573.07" "$1,573.07" "$1,573.07" "$1,573.07" "$3,495.70" "$3,495.70" "$3,495.70" $728.59 "$3,495.70" "$3,495.70" "$3,495.70" "$3,495.70" "$3,495.70" $728.54 "$3,495.70" "$1,398.28" "$1,723.38" "$3,495.70" "$3,495.70" "$3,495.70" "$3,495.70" "$2,622.00" "$3,495.70" "$3,495.70" "$3,495.70" "$1,747.85" "$1,747.85" "$2,768.59" "$3,495.70" "$2,796.56" "$1,573.07" $693.81 N/A "$2,027.68" "$3,495.70" "$3,495.70" "$3,495.70" $728.50 "$3,495.70" N/A N/A 55-28932 SUP HCPCS C1713 55-28932 - PLATE BONE 6X15X6 HOLE FULL RECONSTRUCTION TEMPLATE TITANIUM BOTH IP/OP "$3,370.00" "$2,494.00" $668.78 "$3,369.60" "$1,516.32" "$1,516.32" "$1,516.32" "$1,516.32" "$3,369.60" "$3,369.60" "$3,369.60" $702.31 "$3,369.60" "$3,369.60" "$3,369.60" "$3,369.60" "$3,369.60" $702.26 "$3,369.60" "$1,347.84" "$1,661.21" "$3,369.60" "$3,369.60" "$3,369.60" "$3,369.60" "$2,527.50" "$3,369.60" "$3,369.60" "$3,369.60" "$1,684.80" "$1,684.80" "$2,668.72" "$3,369.60" "$2,695.68" "$1,516.32" $668.78 N/A "$1,954.60" "$3,369.60" "$3,369.60" "$3,369.60" "$3,369.60" "$3,369.60" N/A N/A 55-28934 SUP HCPCS C1713 55-28934 - PLATE BONE 6+13+6 HOLE SECONDARY RECONSTRUCTION FULL BOTH IP/OP "$3,305.00" "$2,446.00" $655.92 "$3,304.78" "$1,487.15" "$1,487.15" "$1,487.15" "$1,487.15" "$3,304.78" "$3,304.78" "$3,304.78" $688.80 "$3,304.78" "$3,304.78" "$3,304.78" "$3,304.78" "$3,304.78" $688.75 "$3,304.78" "$1,321.91" "$1,629.26" "$3,304.78" "$3,304.78" "$3,304.78" "$3,304.78" "$2,478.75" "$3,304.78" "$3,304.78" "$3,304.78" "$1,652.39" "$1,652.39" "$2,617.39" "$3,304.78" "$2,643.82" "$1,487.15" $655.92 N/A "$1,916.90" "$3,304.78" "$3,304.78" "$3,304.78" $688.72 "$3,304.78" N/A N/A 5530-G-109 SUP Custom 27803010 5530-G-109 - INSERT TIBIAL 1 9MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-109-E SUP HCPCS C1776 5530-G-109-E - INSERT TIB 1 9MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-110-E SUP HCPCS C1776 5530-G-110-E - INSERT TIB 1 10MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-111 SUP Custom 27803010 5530-G-111 - INSERT TIBIAL 1 11MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-111-E SUP HCPCS C1776 5530-G-111-E - INSERT TIB 1 11MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-112-E SUP HCPCS C1776 5530-G-112-E - INSERT TIB 1 12MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-113 SUP Custom 27803010 5530-G-113 - INSERT TIBIAL 1 13MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-113-E SUP HCPCS C1776 5530-G-113-E - INSERT TIB 1 13MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-114-E SUP HCPCS C1776 5530-G-114-E - INSERT TIB 1 14MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-116 SUP Custom 27803010 5530-G-116 - INSERT TIBIAL 1 16MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-116-E SUP HCPCS C1776 5530-G-116-E - INSERT TIB 1 16MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-119 SUP Custom 27803010 5530-G-119 - INSERT TIBIAL 1 19MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-119-E SUP HCPCS C1776 5530-G-119-E - INSERT TIB 1 19MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-209 SUP Custom 27803010 5530-G-209 - INSERT TIBIAL 2 9MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-209-E SUP HCPCS C1776 5530-G-209-E - INSERT TIB 2 9MM STRL TRTHLN BRNG CRCTE RTN CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-210-E SUP HCPCS C1776 5530-G-210-E - INSERT TIB 2 10MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-211 SUP Custom 27803010 5530-G-211 - INSERT TIBIAL 2 11MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-211-E SUP HCPCS C1776 5530-G-211-E - INSERT TIB 2 11MM STRL TRTHLN BRNG CRCTE RTN CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-212-E SUP HCPCS C1776 5530-G-212-E - INSERT TIB 2 12MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-213 SUP Custom 27803010 5530-G-213 - INSERT TIBIAL 2 13MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-213-E SUP HCPCS C1776 5530-G-213-E - INSERT TIB 2 13MM STRL TRTHLN BRNG CRCTE RTN CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-214-E SUP HCPCS C1776 5530-G-214-E - INSERT TIB 2 14MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-216 SUP Custom 27803010 5530-G-216 - INSERT TIBIAL 2 16MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-216-E SUP HCPCS C1776 5530-G-216-E - INSERT TIB 2 16MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-219 SUP Custom 27803010 5530-G-219 - INSERT TIBIAL 2 19MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-219-E SUP HCPCS C1776 5530-G-219-E - INSERT TIB 2 19MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-309 SUP Custom 27803010 5530-G-309 - INSERT TIBIAL 3 9MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-309-E SUP HCPCS C1776 5530-G-309-E - INSERT TIB 3 9MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-310-E SUP HCPCS C1776 5530-G-310-E - INSERT TIB 3 10MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-311 SUP Custom 27803010 5530-G-311 - INSERT TIBIAL 3 11MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-311-E SUP HCPCS C1776 5530-G-311-E - INSERT TIB 3 11MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-312-E SUP HCPCS C1776 5530-G-312-E - INSERT TIB 3 12MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-313 SUP Custom 27803010 5530-G-313 - INSERT TIBIAL 3 13MM CRUCIATE RETAIN TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-313-E SUP HCPCS C1776 5530-G-313-E - INSERT TIB 3 13MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-314-E SUP HCPCS C1776 5530-G-314-E - INSERT TIB 3 14MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-316 SUP Custom 27803010 5530-G-316 - INSERT TIBIAL 3 16MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-316-E SUP HCPCS C1776 5530-G-316-E - INSERT TIB 3 16MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-319 SUP Custom 27803010 5530-G-319 - INSERT TIBIAL 3 19MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-319-E SUP HCPCS C1776 5530-G-319-E - INSERT TIB 3 19MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-409 SUP Custom 27803010 5530-G-409 - INSERT TIBIAL 4 9MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-409-E SUP HCPCS C1776 5530-G-409-E - INSERT TIB 4 9MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-410-E SUP HCPCS C1776 5530-G-410-E - INSERT TIB 4 10MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-411 SUP Custom 27803010 5530-G-411 - INSERT TIBIAL 4 11MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-411-E SUP HCPCS C1776 5530-G-411-E - INSERT TIB 4 11MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-412-E SUP HCPCS C1776 5530-G-412-E - INSERT TIB 4 12MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-413 SUP Custom 27803010 5530-G-413 - INSERT TIBIAL 4 13MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-413-E SUP HCPCS C1776 5530-G-413-E - INSERT TIB 4 13MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-414-E SUP HCPCS C1776 5530-G-414-E - INSERT TIB 4 14MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-416 SUP Custom 27803010 5530-G-416 - INSERT TIBIAL 4 16MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-416-E SUP HCPCS C1776 5530-G-416-E - INSERT TIB 4 16MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-419 SUP Custom 27803010 5530-G-419 - INSERT TIBIAL 4 19MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-419-E SUP HCPCS C1776 5530-G-419-E - INSERT TIB 4 19MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-509 SUP Custom 27803010 5530-G-509 - INSERT TIBIAL 5 9MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-509-E SUP HCPCS C1776 5530-G-509-E - INSERT TIB 5 9MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-510-E SUP HCPCS C1776 5530-G-510-E - INSERT TIB 5 10MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-511 SUP Custom 27803010 5530-G-511 - INSERT TIBIAL 5 11MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-511-E SUP HCPCS C1776 5530-G-511-E - INSERT TIB 5 11MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-512-E SUP HCPCS C1776 5530-G-512-E - INSERT TIB 5 12MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-513 SUP Custom 27803010 5530-G-513 - INSERT TIBIAL 5 13MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-513-E SUP HCPCS C1776 5530-G-513-E - INSERT TIB 5 13MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-514-E SUP HCPCS C1776 5530-G-514-E - INSERT TIB 5 14MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-516 SUP Custom 27803010 5530-G-516 - INSERT TIBIAL 5 16MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-516-E SUP HCPCS C1776 5530-G-516-E - INSERT TIB 5 16MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-519 SUP Custom 27803010 5530-G-519 - INSERT TIBIAL 5 19MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-519-E SUP HCPCS C1776 5530-G-519-E - INSERT TIB 5 19MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-609 SUP Custom 27803010 5530-G-609 - INSERT TIBIAL 6 9MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-609-E SUP HCPCS C1776 5530-G-609-E - INSERT TIB 6 9MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-610-E SUP HCPCS C1776 5530-G-610-E - INSERT TIB 6 10MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-611 SUP Custom 27803010 5530-G-611 - INSERT TIBIAL 6 11MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-611-E SUP HCPCS C1776 5530-G-611-E - INSERT TIB 6 11MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-612-E SUP HCPCS C1776 5530-G-612-E - INSERT TIB 6 12MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-613 SUP Custom 27803010 5530-G-613 - INSERT TIBIAL 6 13MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-613-E SUP HCPCS C1776 5530-G-613-E - INSERT TIB 6 13MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-614-E SUP HCPCS C1776 5530-G-614-E - INSERT TIB 6 14MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-616 SUP Custom 27803010 5530-G-616 - INSERT TIBIAL 6 16MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-616-E SUP HCPCS C1776 5530-G-616-E - INSERT TIB 6 16MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-619 SUP Custom 27803010 5530-G-619 - INSERT TIBIAL 6 19MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-619-E SUP HCPCS C1776 5530-G-619-E - INSERT TIB 6 19MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-709 SUP Custom 27803010 5530-G-709 - INSERT TIBIAL 7 9MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-709-E SUP HCPCS C1776 5530-G-709-E - INSERT TIB 7 9MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-710-E SUP HCPCS C1776 5530-G-710-E - INSERT TIB 7 10MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-711 SUP Custom 27803010 5530-G-711 - INSERT TIBIAL 7 11MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-711-E SUP HCPCS C1776 5530-G-711-E - INSERT TIB 7 11MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-712-E SUP HCPCS C1776 5530-G-712-E - INSERT TIB 7 12MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-713 SUP Custom 27803010 5530-G-713 - INSERT TIBIAL 7 13MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-713-E SUP HCPCS C1776 5530-G-713-E - INSERT TIB 7 13MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-714-E SUP HCPCS C1776 5530-G-714-E - INSERT TIB 7 14MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-716 SUP Custom 27803010 5530-G-716 - INSERT TIBIAL 7 16MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-716-E SUP HCPCS C1776 5530-G-716-E - INSERT TIB 7 16MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-719 SUP Custom 27803010 5530-G-719 - INSERT TIBIAL 7 19MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-719-E SUP HCPCS C1776 5530-G-719-E - INSERT TIB 7 19MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-809 SUP Custom 27803010 5530-G-809 - INSERT TIBIAL 8 9MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-809-E SUP HCPCS C1776 5530-G-809-E - INSERT TIB 8 9MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-810-E SUP HCPCS C1776 5530-G-810-E - INSERT TIB 8 10MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-811 SUP Custom 27803010 5530-G-811 - INSERT TIBIAL 8 11MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-811-E SUP HCPCS C1776 5530-G-811-E - INSERT TIB 8 11MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-812-E SUP HCPCS C1776 5530-G-812-E - INSERT TIB 8 12MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-813 SUP Custom 27803010 5530-G-813 - INSERT TIBIAL 8 13MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-813-E SUP HCPCS C1776 5530-G-813-E - INSERT TIB 8 13MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-814-E SUP HCPCS C1776 5530-G-814-E - INSERT TIB 8 14MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-816 SUP Custom 27803010 5530-G-816 - INSERT TIBIAL 8 16MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-816-E SUP HCPCS C1776 5530-G-816-E - INSERT TIB 8 16MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-G-819 SUP Custom 27803010 5530-G-819 - INSERT TIBIAL 8 19MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5530-G-819-E SUP HCPCS C1776 5530-G-819-E - INSERT TIB 8 19MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5530-P-109 SUP Custom 27803010 5530-P-109 - INSERT TIBIAL 1 9MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-110 SUP HCPCS C1776 5530-P-110 - INSERT TIB 1 10MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-111 SUP Custom 27803010 5530-P-111 - INSERT TIBIAL 1 11MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-112 SUP HCPCS C1776 5530-P-112 - INSERT TIB 1 12MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-113 SUP Custom 27803010 5530-P-113 - INSERT TIBIAL 1 13MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-114 SUP HCPCS C1776 5530-P-114 - INSERT TIB 1 14MM STRL TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-116 SUP Custom 27803010 5530-P-116 - INSERT TIBIAL 1 P 16MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-119 SUP Custom 27803010 5530-P-119 - INSERT TIBIAL 1 P 19MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-209 SUP Custom 27803010 5530-P-209 - INSERT TIBIAL 2 9MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-210 SUP HCPCS C1776 5530-P-210 - INSERT TIB 2 10MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-211 SUP Custom 27803010 5530-P-211 - INSERT TIBIAL 2 11MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-212 SUP HCPCS C1776 5530-P-212 - INSERT TIB 2 12MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-213 SUP Custom 27803010 5530-P-213 - INSERT TIBIAL 2 13MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-214 SUP HCPCS C1776 5530-P-214 - INSERT TIB 2 14MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-216 SUP Custom 27803010 5530-P-216 - INSERT TIBIAL 2 16MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-219 SUP Custom 27803010 5530-P-219 - INSERT TIBIAL 2 P 19MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-309 SUP Custom 27803010 5530-P-309 - INSERT TIBIAL 3 9MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-310 SUP HCPCS C1776 5530-P-310 - INSERT TIB 3 10MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-311 SUP Custom 27803010 5530-P-311 - INSERT TIBIAL 3 11MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-312 SUP HCPCS C1776 5530-P-312 - INSERT TIB 3 12MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-313 SUP Custom 27803010 5530-P-313 - INSERT TIBIAL 3 13MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-314 SUP HCPCS C1776 5530-P-314 - INSERT TIB 3 14MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-316 SUP Custom 27803010 5530-P-316 - INSERT TIBIAL 3 16MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-319 SUP Custom 27803010 5530-P-319 - INSERT TIBIAL 3 19MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-409 SUP Custom 27803010 5530-P-409 - INSERT TIBIAL 4 9MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-410 SUP HCPCS C1776 5530-P-410 - INSERT TIB 4 10MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-411 SUP Custom 27803010 5530-P-411 - INSERT TIBIAL 4 11MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-412 SUP HCPCS C1776 5530-P-412 - INSERT TIB 4 12MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-413 SUP Custom 27803010 5530-P-413 - INSERT TIBIAL 4 13MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-414 SUP HCPCS C1776 5530-P-414 - INSERT TIB 4 14MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-416 SUP Custom 27803010 5530-P-416 - INSERT TIBIAL 4 16MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-419 SUP Custom 27803010 5530-P-419 - INSERT TIBIAL 4 19MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-509 SUP Custom 27803010 5530-P-509 - INSERT TIBIAL 5 9MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-510 SUP HCPCS C1776 5530-P-510 - INSERT TIB 5 10MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-511 SUP Custom 27803010 5530-P-511 - INSERT TIBIAL 5 11MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-512 SUP HCPCS C1776 5530-P-512 - INSERT TIB 5 12MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-513 SUP Custom 27803010 5530-P-513 - INSERT TIBIAL 5 13MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-514 SUP HCPCS C1776 5530-P-514 - INSERT TIB 5 14MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-516 SUP Custom 27803010 5530-P-516 - INSERT TIBIAL 5 16MM CRUCIATE RETAIN TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-519 SUP Custom 27803010 5530-P-519 - INSERT TIBIAL 5 19MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-609 SUP Custom 27803010 5530-P-609 - INSERT TIBIAL 6 9MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-610 SUP HCPCS C1776 5530-P-610 - INSERT TIB 6 10MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-611 SUP Custom 27803010 5530-P-611 - INSERT TIBIAL 6 11MM CRUC RET TRIATHLON X3 KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-612 SUP HCPCS C1776 5530-P-612 - INSERT TIB 6 12MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-613 SUP Custom 27803010 5530-P-613 - INSERT TIBIAL 6 13MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-614 SUP HCPCS C1776 5530-P-614 - INSERT TIB 6 14MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-616 SUP Custom 27803010 5530-P-616 - INSERT TIBIAL 6 16MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-619 SUP Custom 27803010 5530-P-619 - INSERT TIBIAL 6 19MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-709 SUP Custom 27803010 5530-P-709 - INSERT TIBIAL 7 9MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-710 SUP HCPCS C1776 5530-P-710 - INSERT TIB 7 10MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-711 SUP Custom 27803010 5530-P-711 - INSERT TIBIAL 7 11MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-712 SUP HCPCS C1776 5530-P-712 - INSERT TIB 7 12MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-713 SUP Custom 27803010 5530-P-713 - INSERT TIBIAL 7 13MM CRUCIATE RETAIN TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-714 SUP HCPCS C1776 5530-P-714 - INSERT TIB 7 14MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-716 SUP Custom 27803010 5530-P-716 - INSERT TIBIAL 7 16MM CRUCIATE RETAIN TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-719 SUP Custom 27803010 5530-P-719 - INSERT TIBIAL 7 19MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-809 SUP Custom 27803010 5530-P-809 - INSERT TIBIAL 8 9MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-810 SUP HCPCS C1776 5530-P-810 - INSERT TIB 8 10MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-811 SUP Custom 27803010 5530-P-811 - INSERT TIBIAL 8 11MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-812 SUP HCPCS C1776 5530-P-812 - INSERT TIB 8 12MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-813 SUP Custom 27803010 5530-P-813 - INSERT TIBIAL 8 13MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-814 SUP HCPCS C1776 5530-P-814 - INSERT TIB 8 14MM STRL LF TRTHLN BRNG CRCTE RTN KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5530-P-816 SUP Custom 27803010 5530-P-816 - INSERT TIBIAL 8 16MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5530-P-819 SUP Custom 27803010 5530-P-819 - INSERT TIBIAL 8 19MM CRUC RET TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-G-109 SUP Custom 27803010 5531-G-109 - INSERT TIBIAL 1 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-109-E SUP HCPCS C1776 5531-G-109-E - INSERT TIB 1 9MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-110-E SUP HCPCS C1776 5531-G-110-E - INSERT TIB 1 10MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-111 SUP Custom 27803010 5531-G-111 - INSERT TIBIAL 1 G 11MM TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-111-E SUP HCPCS C1776 5531-G-111-E - INSERT TIB 1 11MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-112-E SUP HCPCS C1776 5531-G-112-E - INSERT TIB 1 12MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-113 SUP Custom 27803010 5531-G-113 - INSERT TIBIAL 1 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-113-E SUP HCPCS C1776 5531-G-113-E - INSERT TIB 1 13MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-114-E SUP HCPCS C1776 5531-G-114-E - INSERT TIB 1 14MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-116 SUP Custom 27803010 5531-G-116 - INSERT TIBIAL 1 16MM CRUC SUB TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-116-E SUP HCPCS C1776 5531-G-116-E - INSERT TIB 1 16MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-119 SUP Custom 27803010 5531-G-119 - INSERT TIBIAL 1 19MM CRUC SUB TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-119-E SUP HCPCS C1776 5531-G-119-E - INSERT TIB 1 19MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-122 SUP Custom 27803010 5531-G-122 - INSERT TIBIAL 1 22MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-122-E SUP HCPCS C1776 5531-G-122-E - INSERT TIB 1 22MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-125 SUP Custom 27803010 5531-G-125 - INSERT TIBIAL 1 25MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-209 SUP Custom 27803010 5531-G-209 - INSERT TIBIAL 2 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-209-E SUP HCPCS C1776 5531-G-209-E - INSERT TIB 2 9MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-210-E SUP HCPCS C1776 5531-G-210-E - INSERT TIB 2 10MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-211 SUP Custom 27803010 5531-G-211 - INSERT TIBIAL 2 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-211-E SUP HCPCS C1776 5531-G-211-E - INSERT TIB 2 11MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-212-E SUP HCPCS C1776 5531-G-212-E - INSERT TIB 2 12MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-213 SUP Custom 27803010 5531-G-213 - INSERT TIBIAL 2 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-213-E SUP HCPCS C1776 5531-G-213-E - INSERT TIB 2 13MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-214-E SUP HCPCS C1776 5531-G-214-E - INSERT TIB 2 14MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-216 SUP Custom 27803010 5531-G-216 - INSERT TIBIAL 2 16MM CRUC SUB REVISION FLEXION TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-216-E SUP HCPCS C1776 5531-G-216-E - INSERT TIB 2 16MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-219 SUP Custom 27803010 5531-G-219 - INSERT TIBIAL 2 19MM CRUC SUB TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-219-E SUP HCPCS C1776 5531-G-219-E - INSERT TIB 2 19MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-222 SUP Custom 27803010 5531-G-222 - INSERT TIBIAL 2 22MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-222-E SUP HCPCS C1776 5531-G-222-E - INSERT TIB 2 22MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-225 SUP Custom 27803010 5531-G-225 - INSERT TIBIAL 2 25MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-309 SUP Custom 27803010 5531-G-309 - INSERT TIBIAL 3 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-309-E SUP HCPCS C1776 5531-G-309-E - INSERT TIB 3 9MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-310-E SUP HCPCS C1776 5531-G-310-E - INSERT TIB 3 10MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-311 SUP Custom 27803010 5531-G-311 - INSERT TIBIAL 3 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-311-E SUP HCPCS C1776 5531-G-311-E - INSERT TIB 3 11MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-312-E SUP HCPCS C1776 5531-G-312-E - INSERT TIB 3 12MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-313 SUP Custom 27803010 5531-G-313 - INSERT TIBIAL 3 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-313-E SUP HCPCS C1776 5531-G-313-E - INSERT TIB 3 13MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-314-E SUP HCPCS C1776 5531-G-314-E - INSERT TIB 3 14MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-316 SUP Custom 27803010 5531-G-316 - INSERT TIBIAL 3 16MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-316-E SUP HCPCS C1776 5531-G-316-E - INSERT TIB 3 16MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-319 SUP Custom 27803010 5531-G-319 - INSERT TIBIAL 3 19MM CNDYLR STABILIZED PRIM TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-319-E SUP HCPCS C1776 5531-G-319-E - INSERT TIB 3 19MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-322 SUP Custom 27803010 5531-G-322 - INSERT TIBIAL 3 22MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-322-E SUP HCPCS C1776 5531-G-322-E - INSERT TIB 3 22MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-325 SUP Custom 27803010 5531-G-325 - INSERT TIBIAL 3 25MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-409 SUP Custom 27803010 5531-G-409 - INSERT TIBIAL 4 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-409-E SUP HCPCS C1776 5531-G-409-E - INSERT TIB 4 9MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-410-E SUP HCPCS C1776 5531-G-410-E - INSERT TIB 4 10MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-411 SUP Custom 27803010 5531-G-411 - INSERT TIBIAL 4 11MM CNDYLR STABILIZED PRIM TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-411-E SUP HCPCS C1776 5531-G-411-E - INSERT TIB 4 11MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-412-E SUP HCPCS C1776 5531-G-412-E - INSERT TIB 4 12MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-413 SUP Custom 27803010 5531-G-413 - INSERT TIBIAL 4 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-413-E SUP HCPCS C1776 5531-G-413-E - INSERT TIB 4 13MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-414-E SUP HCPCS C1776 5531-G-414-E - INSERT TIB 4 14MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-416 SUP Custom 27803010 5531-G-416 - INSERT TIBIAL 4 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-416-E SUP HCPCS C1776 5531-G-416-E - INSERT TIB 4 16MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-419 SUP Custom 27803010 5531-G-419 - INSERT TIBIAL 4 19MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-419-E SUP HCPCS C1776 5531-G-419-E - INSERT TIB 4 19MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-422 SUP Custom 27803010 5531-G-422 - INSERT TIBIAL 4 22MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-422-E SUP HCPCS C1776 5531-G-422-E - INSERT TIB 4 22MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-425 SUP Custom 27803010 5531-G-425 - INSERT TIBIAL 4 25MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-509 SUP Custom 27803010 5531-G-509 - INSERT TIBIAL 5 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-509-E SUP HCPCS C1776 5531-G-509-E - INSERT TIB 5 9MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-510-E SUP HCPCS C1776 5531-G-510-E - INSERT TIB 5 10MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-511 SUP Custom 27803010 5531-G-511 - INSERT TIBIAL 5 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-511-E SUP HCPCS C1776 5531-G-511-E - INSERT TIB 5 11MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-512-E SUP HCPCS C1776 5531-G-512-E - INSERT TIB 5 12MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-513 SUP Custom 27803010 5531-G-513 - INSERT TIBIAL 5 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-513-E SUP HCPCS C1776 5531-G-513-E - INSERT TIB 5 13MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-514-E SUP HCPCS C1776 5531-G-514-E - INSERT TIB 5 14MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-516 SUP Custom 27803010 5531-G-516 - INSERT TIBIAL 5 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-516-E SUP HCPCS C1776 5531-G-516-E - INSERT TIB 5 16MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-519 SUP Custom 27803010 5531-G-519 - INSERT TIBIAL 5 19MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-519-E SUP HCPCS C1776 5531-G-519-E - INSERT TIB 5 19MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-522 SUP Custom 27803010 5531-G-522 - INSERT TIBIAL 5 22MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-522-E SUP HCPCS C1776 5531-G-522-E - INSERT TIB 5 22MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-525 SUP Custom 27803010 5531-G-525 - INSERT TIBIAL 5 25MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-609 SUP Custom 27803010 5531-G-609 - INSERT TIBIAL 6 9MM CNDYLR STABILIZED PRIM TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-609-E SUP HCPCS C1776 5531-G-609-E - INSERT TIB 6 9MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-610-E SUP HCPCS C1776 5531-G-610-E - INSERT TIB 6 10MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-611 SUP Custom 27803010 5531-G-611 - INSERT TIBIAL 6 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-611-E SUP HCPCS C1776 5531-G-611-E - INSERT TIB 6 11MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-612-E SUP HCPCS C1776 5531-G-612-E - INSERT TIB 6 12MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-613 SUP Custom 27803010 5531-G-613 - INSERT TIBIAL 6 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-613-E SUP HCPCS C1776 5531-G-613-E - INSERT TIB 6 13MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-614-E SUP HCPCS C1776 5531-G-614-E - INSERT TIB 6 14MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-616 SUP Custom 27803010 5531-G-616 - INSERT TIBIAL 6 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-616-E SUP HCPCS C1776 5531-G-616-E - INSERT TIB 6 16MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-619 SUP Custom 27803010 5531-G-619 - INSERT TIBIAL 6 19MM CRUC SUB TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-619-E SUP HCPCS C1776 5531-G-619-E - INSERT TIB 6 19MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-622 SUP Custom 27803010 5531-G-622 - INSERT TIBIAL 6 22MM CRUC SUB TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-622-E SUP HCPCS C1776 5531-G-622-E - INSERT TIB 6 22MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-625 SUP Custom 27803010 5531-G-625 - INSERT TIBIAL 6 25MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-709 SUP Custom 27803010 5531-G-709 - INSERT TIBIAL 7 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-709-E SUP HCPCS C1776 5531-G-709-E - INSERT TIB 7 9MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-710-E SUP HCPCS C1776 5531-G-710-E - INSERT TIB 7 10MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-711 SUP Custom 27803010 5531-G-711 - INSERT TIBIAL 7 11MM CNDYLR STABILIZED PRIM TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-711-E SUP HCPCS C1776 5531-G-711-E - INSERT TIB 7 11MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-712-E SUP HCPCS C1776 5531-G-712-E - INSERT TIB 7 12MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-713 SUP Custom 27803010 5531-G-713 - INSERT TIBIAL 7 13MM CRUC SUB TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-713-E SUP HCPCS C1776 5531-G-713-E - INSERT TIB 7 13MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-714-E SUP HCPCS C1776 5531-G-714-E - INSERT TIB 7 14MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-716 SUP Custom 27803010 5531-G-716 - INSERT TIBIAL 7 16MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-716-E SUP HCPCS C1776 5531-G-716-E - INSERT TIB 7 16MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-719 SUP Custom 27803010 5531-G-719 - INSERT TIBIAL 7 19MM CRUC SUB TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-719-E SUP HCPCS C1776 5531-G-719-E - INSERT TIB 7 19MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-722 SUP Custom 27803010 5531-G-722 - INSERT TIBIAL 7 22MM CRUC SUB TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-722-E SUP HCPCS C1776 5531-G-722-E - INSERT TIB 7 22MM STRL TRTHLN CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-725 SUP Custom 27803010 5531-G-725 - INSERT TIBIAL 7 25MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-809 SUP Custom 27803010 5531-G-809 - INSERT TIBIAL 8 9MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-809-E SUP HCPCS C1776 5531-G-809-E - INSERT TIB 8 9MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-810-E SUP HCPCS C1776 5531-G-810-E - INSERT TIB 8 10MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-811 SUP Custom 27803010 5531-G-811 - INSERT TIBIAL 8 11MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-811-E SUP HCPCS C1776 5531-G-811-E - INSERT TIB 8 11MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-812-E SUP HCPCS C1776 5531-G-812-E - INSERT TIB 8 12MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-813 SUP Custom 27803010 5531-G-813 - INSERT TIBIAL 8 13MM CNDYLR STABILIZED TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-813-E SUP HCPCS C1776 5531-G-813-E - INSERT TIB 8 13MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-814-E SUP HCPCS C1776 5531-G-814-E - INSERT TIB 8 14MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-816 SUP Custom 27803010 5531-G-816 - INSERT TIBIAL 8 16MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-816-E SUP HCPCS C1776 5531-G-816-E - INSERT TIB 8 16MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-819 SUP Custom 27803010 5531-G-819 - INSERT TIBIAL 8 19MM CRUC SUB TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-819-E SUP HCPCS C1776 5531-G-819-E - INSERT TIB 8 19MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-822 SUP Custom 27803010 5531-G-822 - INSERT TIBIAL 8 22MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-G-822-E SUP HCPCS C1776 5531-G-822-E - INSERT TIB 8 22MM STRL TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5531-G-825 SUP Custom 27803010 5531-G-825 - INSERT TIBIAL 8 25MM CRUC SUB TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5531-P-109 SUP Custom 27803010 5531-P-109 - INSERT TIBIAL 1 9MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-110 SUP HCPCS C1776 5531-P-110 - INSERT TIB 1 10MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-111 SUP Custom 27803010 5531-P-111 - INSERT TIBIAL 1 11MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-112 SUP HCPCS C1776 5531-P-112 - INSERT TIB 1 12MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-113 SUP Custom 27803010 5531-P-113 - INSERT TIBIAL 1 13MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-114 SUP HCPCS C1776 5531-P-114 - INSERT TIB 1 14MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-116 SUP Custom 27803010 5531-P-116 - INSERT TIBIAL 1 16MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-119 SUP Custom 27803010 5531-P-119 - INSERT TIBIAL 1 19MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-122 SUP Custom 27803010 5531-P-122 - INSERT TIBIAL 1 22MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-125 SUP Custom 27803010 5531-P-125 - INSERT TIBIAL 1 25MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-209 SUP Custom 27803010 5531-P-209 - INSERT TIBIAL 2 9MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-210 SUP HCPCS C1776 5531-P-210 - INSERT TIB 2 10MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-211 SUP Custom 27803010 5531-P-211 - INSERT TIBIAL 2 11MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-212 SUP HCPCS C1776 5531-P-212 - INSERT TIB 2 12MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-213 SUP Custom 27803010 5531-P-213 - INSERT TIBIAL 2 13MM CRUC SUB TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-214 SUP HCPCS C1776 5531-P-214 - INSERT TIB 2 14MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-216 SUP Custom 27803010 5531-P-216 - INSERT TIBIAL 2 16MM CRUC SUB TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-219 SUP Custom 27803010 5531-P-219 - INSERT TIBIAL 2 19MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-222 SUP Custom 27803010 5531-P-222 - INSERT TIBIAL 2 22MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-225 SUP Custom 27803010 5531-P-225 - INSERT TIBIAL 2 25MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-309 SUP Custom 27803010 5531-P-309 - INSERT TIBIAL 3 8-9MM TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-310 SUP HCPCS C1776 5531-P-310 - INSERT TIB 3 10MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-311 SUP Custom 27803010 5531-P-311 - INSERT TIBIAL 3 11MM BEARING TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-312 SUP HCPCS C1776 5531-P-312 - INSERT TIB 3 13MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-313 SUP Custom 27803010 5531-P-313 - INSERT TIBIAL 3 13MM TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-314 SUP HCPCS C1776 5531-P-314 - INSERT TIB 3 14MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-316 SUP Custom 27803010 5531-P-316 - INSERT TIBIAL 3 16MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-319 SUP Custom 27803010 5531-P-319 - INSERT TIBIAL 3 19MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-322 SUP Custom 27803010 5531-P-322 - INSERT TIBIAL 3 22MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-325 SUP Custom 27803010 5531-P-325 - INSERT TIBIAL 3 25MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-409 SUP Custom 27803010 5531-P-409 - INSERT TIBIAL 4 9MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-410 SUP HCPCS C1776 5531-P-410 - INSERT TIB 4 10MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-411 SUP Custom 27803010 5531-P-411 - INSERT TIBIAL 4 11MM CRUC SUB TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-412 SUP HCPCS C1776 5531-P-412 - INSERT TIB 4 12MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-413 SUP Custom 27803010 5531-P-413 - INSERT TIBIAL 4 13MM CRUC SUB TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-414 SUP HCPCS C1776 5531-P-414 - INSERT TIB 4 14MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-416 SUP Custom 27803010 5531-P-416 - INSERT TIBIAL 4 16MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-419 SUP Custom 27803010 5531-P-419 - INSERT TIBIAL 4 19MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-422 SUP Custom 27803010 5531-P-422 - INSERT TIBIAL 4 22MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-425 SUP Custom 27803010 5531-P-425 - INSERT TIBIAL 4 25MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-509 SUP Custom 27803010 5531-P-509 - INSERT TIBIAL 5 9MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-510 SUP HCPCS C1776 5531-P-510 - INSERT TIB 5 10MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-511 SUP Custom 27803010 5531-P-511 - INSERT TIBIAL 5 11MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-512 SUP HCPCS C1776 5531-P-512 - INSERT TIB 5 12MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-513 SUP Custom 27803010 5531-P-513 - INSERT TIBIAL 5 13MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-514 SUP HCPCS C1776 5531-P-514 - INSERT TIB 5 14MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-516 SUP Custom 27803010 5531-P-516 - INSERT TIBIAL 5 16MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-519 SUP Custom 27803010 5531-P-519 - INSERT TIBIAL 5 19MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-522 SUP Custom 27803010 5531-P-522 - INSERT TIBIAL 5 22MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-525 SUP Custom 27803010 5531-P-525 - INSERT TIBIAL 5 25MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-609 SUP Custom 27803010 5531-P-609 - INSERT TIBIAL 6 9MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-610 SUP HCPCS C1776 5531-P-610 - INSERT TIB 6 10MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-611 SUP Custom 27803010 5531-P-611 - INSERT TIBIAL 6 11MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-612 SUP HCPCS C1776 5531-P-612 - INSERT TIB 6 12MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-613 SUP Custom 27803010 5531-P-613 - INSERT TIBIAL 6 13MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-614 SUP HCPCS C1776 5531-P-614 - INSERT TIB 6 14MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-616 SUP Custom 27803010 5531-P-616 - INSERT TIBIAL 6 16MM CRUC SUB TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-619 SUP Custom 27803010 5531-P-619 - INSERT TIBIAL 6 19MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-622 SUP Custom 27803010 5531-P-622 - INSERT TIBIAL 6 22MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-625 SUP Custom 27803010 5531-P-625 - INSERT TIBIAL 6 25MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-709 SUP Custom 27803010 5531-P-709 - INSERT TIBIAL 7 9MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-710 SUP HCPCS C1776 5531-P-710 - INSERT TIB 7 10MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-711 SUP Custom 27803010 5531-P-711 - INSERT TIBIAL 7 11MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-712 SUP HCPCS C1776 5531-P-712 - INSERT TIB 7 12MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-713 SUP Custom 27803010 5531-P-713 - INSERT TIBIAL 7 13MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-714 SUP HCPCS C1776 5531-P-714 - INSERT TIB 7 14MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-716 SUP Custom 27803010 5531-P-716 - INSERT TIBIAL 7 16MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-719 SUP Custom 27803010 5531-P-719 - INSERT TIBIAL 7 19MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-722 SUP Custom 27803010 5531-P-722 - INSERT TIBIAL 7 22MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-725 SUP Custom 27803010 5531-P-725 - INSERT TIBIAL 7 25MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-809 SUP Custom 27803010 5531-P-809 - INSERT TIBIAL 8 9MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-810 SUP HCPCS C1776 5531-P-810 - INSERT TIB 8 10MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-811 SUP Custom 27803010 5531-P-811 - INSERT TIBIAL 8 11MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-812 SUP HCPCS C1776 5531-P-812 - INSERT TIB 8 12MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-813 SUP Custom 27803010 5531-P-813 - INSERT TIBIAL 8 13MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-814 SUP HCPCS C1776 5531-P-814 - INSERT TIB 8 14MM STRL LF TRTHLN BRNG CNDRL STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5531-P-816 SUP Custom 27803010 5531-P-816 - INSERT TIBIAL 8 16MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-819 SUP Custom 27803010 5531-P-819 - INSERT TIBIAL 8 19MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-822 SUP Custom 27803010 5531-P-822 - INSERT TIBIAL 8 22MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5531-P-825 SUP Custom 27803010 5531-P-825 - INSERT TIBIAL 8 25MM STABILIZE TRIATHLON KNEE CONDYLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-G-109 SUP Custom 27803010 5532-G-109 - INSERT TIBIAL 1 9MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-109-E SUP HCPCS C1776 5532-G-109-E - INSERT TIB 1 9MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-110-E SUP HCPCS C1776 5532-G-110-E - INSERT TIB 1 10MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-111 SUP Custom 27803010 5532-G-111 - INSERT TIBIAL 1 11MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-111-E SUP HCPCS C1776 5532-G-111-E - INSERT TIB 1 11MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-112-E SUP HCPCS C1776 5532-G-112-E - INSERT TIB 1 12MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-113 SUP Custom 27803010 5532-G-113 - INSERT TIBIAL 1 13MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-113-E SUP HCPCS C1776 5532-G-113-E - INSERT TIB 1 13MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-114-E SUP HCPCS C1776 5532-G-114-E - INSERT TIB 1 14MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-116 SUP Custom 27803010 5532-G-116 - INSERT TIBIAL 1 16MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-116-E SUP HCPCS C1776 5532-G-116-E - INSERT TIB 1 16MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-119 SUP Custom 27803010 5532-G-119 - INSERT TIBIAL 1 19MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-119-E SUP HCPCS C1776 5532-G-119-E - INSERT TIB 1 19MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-122 SUP Custom 27803010 5532-G-122 - INSERT TIBIAL 1 22MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-122-E SUP HCPCS C1776 5532-G-122-E - INSERT TIB 1 22MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-125 SUP Custom 27803010 5532-G-125 - INSERT TIBIAL 1 25MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-209 SUP Custom 27803010 5532-G-209 - INSERT TIBIAL 2 9MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-209-E SUP HCPCS C1776 5532-G-209-E - INSERT TIB 2 9MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-210-E SUP HCPCS C1776 5532-G-210-E - INSERT TIB 2 10MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-211 SUP Custom 27803010 5532-G-211 - INSERT TIBIAL 2 11MM POSTERIOR STABILIZE TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-211-E SUP HCPCS C1776 5532-G-211-E - INSERT TIB 2 11MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-212-E SUP HCPCS C1776 5532-G-212-E - INSERT TIB 2 12MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-213 SUP Custom 27803010 5532-G-213 - INSERT TIBIAL 2 13MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-213-E SUP HCPCS C1776 5532-G-213-E - INSERT TIB 2 13MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-214-E SUP HCPCS C1776 5532-G-214-E - INSERT TIB 2 14MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-216 SUP Custom 27803010 5532-G-216 - INSERT TIBIAL 2 16MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-216-E SUP HCPCS C1776 5532-G-216-E - INSERT TIB 2 16MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-219 SUP Custom 27803010 5532-G-219 - INSERT TIBIAL 2 19MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-219-E SUP HCPCS C1776 5532-G-219-E - INSERT TIB 2 19MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-222 SUP Custom 27803010 5532-G-222 - INSERT TIBIAL 2 22MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-222-E SUP HCPCS C1776 5532-G-222-E - INSERT TIB 2 22MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-225 SUP Custom 27803010 5532-G-225 - INSERT TIBIAL 2 25MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-309 SUP Custom 27803010 5532-G-309 - INSERT TIBIAL 3 9MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-309-E SUP HCPCS C1776 5532-G-309-E - INSERT TIB 3 9MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-310-E SUP HCPCS C1776 5532-G-310-E - INSERT TIB 3 10MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-311 SUP Custom 27803010 5532-G-311 - INSERT TIBIAL 3 11MM POSTERIOR STABILIZED PRIM TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-311-E SUP HCPCS C1776 5532-G-311-E - INSERT TIB 3 11MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-312-E SUP HCPCS C1776 5532-G-312-E - INSERT TIB 3 12MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-313 SUP Custom 27803010 5532-G-313 - INSERT TIBIAL 3 13MM BEARING POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-313-E SUP HCPCS C1776 5532-G-313-E - INSERT TIB 3 13MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-314-E SUP HCPCS C1776 5532-G-314-E - INSERT TIB 3 14MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-316 SUP Custom 27803010 5532-G-316 - INSERT TIBIAL 3 16MM BEARING POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-316-E SUP HCPCS C1776 5532-G-316-E - INSERT TIB 3 16MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-319 SUP Custom 27803010 5532-G-319 - INSERT TIBIAL 3 19MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-319-E SUP HCPCS C1776 5532-G-319-E - INSERT TIB 3 19MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-322 SUP Custom 27803010 5532-G-322 - INSERT TIBIAL 3 22MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-322-E SUP HCPCS C1776 5532-G-322-E - INSERT TIB 3 22MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-325 SUP Custom 27803010 5532-G-325 - INSERT TIBIAL 3 25MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-409 SUP Custom 27803010 5532-G-409 - INSERT TIBIAL 4 9MM POSTERIOR STABILIZE TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-409-E SUP HCPCS C1776 5532-G-409-E - INSERT TIB 4 9MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-410-E SUP HCPCS C1776 5532-G-410-E - INSERT TIB 4 10MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-411 SUP Custom 27803010 5532-G-411 - INSERT TIBIAL 4 11MM BEARING POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-411-E SUP HCPCS C1776 5532-G-411-E - INSERT TIB 4 11MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-412-E SUP HCPCS C1776 5532-G-412-E - INSERT TIB 4 12MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-413 SUP Custom 27803010 5532-G-413 - INSERT TIBIAL 4 13MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-413-E SUP HCPCS C1776 5532-G-413-E - INSERT TIB 4 13MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-414-E SUP HCPCS C1776 5532-G-414-E - INSERT TIB 4 14MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-416 SUP Custom 27803010 5532-G-416 - INSERT TIBIAL 4 16MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-416-E SUP HCPCS C1776 5532-G-416-E - INSERT TIB 4 16MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-419 SUP Custom 27803010 5532-G-419 - INSERT TIBIAL 4 19MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-419-E SUP HCPCS C1776 5532-G-419-E - INSERT TIB 4 19MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-422 SUP Custom 27803010 5532-G-422 - INSERT TIBIAL 4 22MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-422-E SUP HCPCS C1776 5532-G-422-E - INSERT TIB 4 22MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-425 SUP Custom 27803010 5532-G-425 - INSERT TIBIAL 4 25MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-509 SUP Custom 27803010 5532-G-509 - INSERT TIBIAL 5 9MM BEARING POSTERIOR STABILIZE TRIATHLON X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-509-E SUP HCPCS C1776 5532-G-509-E - INSERT TIB 5 9MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-510-E SUP HCPCS C1776 5532-G-510-E - INSERT TIB 5 10MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-511 SUP Custom 27803010 5532-G-511 - INSERT TIBIAL 5 11MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-511-E SUP HCPCS C1776 5532-G-511-E - INSERT TIB 5 11MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-512-E SUP HCPCS C1776 5532-G-512-E - INSERT TIB 5 12MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-513 SUP Custom 27803010 5532-G-513 - INSERT TIBIAL 5 13MM POSTERIOR STABILIZE BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-513-E SUP HCPCS C1776 5532-G-513-E - INSERT TIB 5 13MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-514-E SUP HCPCS C1776 5532-G-514-E - INSERT TIB 5 14MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-516 SUP Custom 27803010 5532-G-516 - INSERT TIBIAL 5 16MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-516-E SUP HCPCS C1776 5532-G-516-E - INSERT TIB 5 16MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-519 SUP Custom 27803010 5532-G-519 - INSERT TIBIAL 5 19MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-519-E SUP HCPCS C1776 5532-G-519-E - INSERT TIB 5 19MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-522 SUP Custom 27803010 5532-G-522 - INSERT TIBIAL 5 22MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-522-E SUP HCPCS C1776 5532-G-522-E - INSERT TIB 5 22MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-525 SUP Custom 27803010 5532-G-525 - INSERT TIBIAL 5 25MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-609 SUP Custom 27803010 5532-G-609 - INSERT TIBIAL 6 9MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-609-E SUP HCPCS C1776 5532-G-609-E - INSERT TIB 6 9MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-610-E SUP HCPCS C1776 5532-G-610-E - INSERT TIB 6 10MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-611 SUP Custom 27803010 5532-G-611 - INSERT TIBIAL 6 11MM BEARING POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-611-E SUP HCPCS C1776 5532-G-611-E - INSERT TIB 6 11MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-612-E SUP HCPCS C1776 5532-G-612-E - INSERT TIB 6 12MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-613 SUP Custom 27803010 5532-G-613 - INSERT TIBIAL 6 13MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-613-E SUP HCPCS C1776 5532-G-613-E - INSERT TIB 6 13MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-614-E SUP HCPCS C1776 5532-G-614-E - INSERT TIB 6 14MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-616 SUP Custom 27803010 5532-G-616 - INSERT TIBIAL 6 16MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-616-E SUP HCPCS C1776 5532-G-616-E - INSERT TIB 6 16MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-619 SUP Custom 27803010 5532-G-619 - INSERT TIBIAL 6 19MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-619-E SUP HCPCS C1776 5532-G-619-E - INSERT TIB 6 19MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-622 SUP Custom 27803010 5532-G-622 - INSERT TIBIAL 6 22MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-622-E SUP HCPCS C1776 5532-G-622-E - INSERT TIB 6 22MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-625 SUP Custom 27803010 5532-G-625 - INSERT TIBIAL 6 25MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-709 SUP Custom 27803010 5532-G-709 - INSERT TIBIAL 7 9MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-709-E SUP HCPCS C1776 5532-G-709-E - INSERT TIB 7 9MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-710-E SUP HCPCS C1776 5532-G-710-E - INSERT TIB 7 10MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-711 SUP Custom 27803010 5532-G-711 - INSERT TIBIAL 7 11MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-711-E SUP HCPCS C1776 5532-G-711-E - INSERT TIB 7 11MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-712-E SUP HCPCS C1776 5532-G-712-E - INSERT TIB 7 12MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-713 SUP Custom 27803010 5532-G-713 - INSERT TIBIAL 7 13MM POSTERIOR STABILIZE TRIATHLON X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-713-E SUP HCPCS C1776 5532-G-713-E - INSERT TIB 7 13MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-714-E SUP HCPCS C1776 5532-G-714-E - INSERT TIB 7 14MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-716 SUP Custom 27803010 5532-G-716 - INSERT TIBIAL 7 16MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-716-E SUP HCPCS C1776 5532-G-716-E - INSERT TIB 7 16MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-719 SUP Custom 27803010 5532-G-719 - INSERT TIBIAL 7 19MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-719-E SUP HCPCS C1776 5532-G-719-E - INSERT TIB 7 19MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-722 SUP Custom 27803010 5532-G-722 - INSERT TIBIAL 7 22MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-722-E SUP HCPCS C1776 5532-G-722-E - INSERT TIB 7 22MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-725 SUP Custom 27803010 5532-G-725 - INSERT TIBIAL 7 25MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-809 SUP Custom 27803010 5532-G-809 - INSERT TIBIAL 8 9MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-809-E SUP HCPCS C1776 5532-G-809-E - INSERT TIB 8 9MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-810-E SUP HCPCS C1776 5532-G-810-E - INSERT TIB 8 10MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-811 SUP Custom 27803010 5532-G-811 - INSERT TIBIAL 8 11MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-811-E SUP HCPCS C1776 5532-G-811-E - INSERT TIB 8 11MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-812-E SUP HCPCS C1776 5532-G-812-E - INSERT TIB 8 12MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-813 SUP Custom 27803010 5532-G-813 - INSERT TIBIAL 8 13MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-813-E SUP HCPCS C1776 5532-G-813-E - INSERT TIB 8 13MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-814-E SUP HCPCS C1776 5532-G-814-E - INSERT TIB 8 14MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-816 SUP Custom 27803010 5532-G-816 - INSERT TIBIAL 8 16MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-816-E SUP HCPCS C1776 5532-G-816-E - INSERT TIB 8 16MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-819 SUP Custom 27803010 5532-G-819 - INSERT TIBIAL 8 19MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-819-E SUP HCPCS C1776 5532-G-819-E - INSERT TIB 8 19MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-822 SUP Custom 27803010 5532-G-822 - INSERT TIBIAL 8 22MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-G-822-E SUP HCPCS C1776 5532-G-822-E - INSERT TIB 8 22MM STRL TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 5532-G-825 SUP Custom 27803010 5532-G-825 - INSERT TIBIAL 8 25MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 5532-P-109 SUP Custom 27803010 5532-P-109 - INSERT TIBIAL 1 9MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-110 SUP HCPCS C1776 5532-P-110 - INSERT TIB 1 10MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-111 SUP Custom 27803010 5532-P-111 - INSERT TIBIAL 1 11MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-112 SUP HCPCS C1776 5532-P-112 - INSERT TIB 1 12MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-113 SUP Custom 27803010 5532-P-113 - INSERT TIBIAL 1 13MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-114 SUP HCPCS C1776 5532-P-114 - INSERT TIB 1 14MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-116 SUP Custom 27803010 5532-P-116 - INSERT TIBIAL 1 16MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-119 SUP Custom 27803010 5532-P-119 - INSERT TIBIAL 1 19MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-122 SUP Custom 27803010 5532-P-122 - INSERT TIBIAL 1 22MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-125 SUP Custom 27803010 5532-P-125 - INSERT TIBIAL 1 25MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-209 SUP Custom 27803010 5532-P-209 - INSERT TIBIAL 2 9MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-210 SUP HCPCS C1776 5532-P-210 - INSERT TIB 2 10MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-211 SUP Custom 27803010 5532-P-211 - INSERT TIBIAL 2 11MM POSTERIOR STABILIZE TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-212 SUP HCPCS C1776 5532-P-212 - INSERT TIB 2 12MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-213 SUP Custom 27803010 5532-P-213 - INSERT TIBIAL 2 13MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-214 SUP HCPCS C1776 5532-P-214 - INSERT TIB 2 14MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-216 SUP Custom 27803010 5532-P-216 - INSERT TIBIAL 2 16MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-219 SUP Custom 27803010 5532-P-219 - INSERT TIBIAL 2 P 19MM POSTERIOR STABILIZE TRIATHLON X3 KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-222 SUP Custom 27803010 5532-P-222 - INSERT TIBIAL 2 22MM POSTERIOR STABILIZE TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-225 SUP Custom 27803010 5532-P-225 - INSERT TIBIAL 2 25MM POSTERIOR STABILIZE TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-309 SUP Custom 27803010 5532-P-309 - INSERT TIBIAL 3 9MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-310 SUP HCPCS C1776 5532-P-310 - INSERT TIB 3 10MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-311 SUP Custom 27803010 5532-P-311 - INSERT TIBIAL 3 11MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-312 SUP HCPCS C1776 5532-P-312 - INSERT TIB 3 12MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-313 SUP Custom 27803010 5532-P-313 - INSERT TIBIAL 3 13MM POSTERIOR STABILIZED PRIM TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-314 SUP HCPCS C1776 5532-P-314 - INSERT TIB 3 14MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-316 SUP Custom 27803010 5532-P-316 - INSERT TIBIAL 3 16MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-319 SUP Custom 27803010 5532-P-319 - INSERT TIBIAL 3 19MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-322 SUP Custom 27803010 5532-P-322 - INSERT TIBIAL 3 22MM POSTERIOR STABILIZE TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-325 SUP Custom 27803010 5532-P-325 - INSERT TIBIAL 3 25MM POSTERIOR STABILIZE TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-409 SUP Custom 27803010 5532-P-409 - INSERT TIBIAL 4 9MM POSTERIOR STABILIZE BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-410 SUP HCPCS C1776 5532-P-410 - INSERT TIB 4 10MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-411 SUP Custom 27803010 5532-P-411 - INSERT TIBIAL 4 11MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-412 SUP HCPCS C1776 5532-P-412 - INSERT TIB 4 12MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-413 SUP Custom 27803010 5532-P-413 - INSERT TIBIAL 4 13MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-416 SUP Custom 27803010 5532-P-416 - INSERT TIBIAL 4 16MM POSTERIOR STABILIZE BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-419 SUP Custom 27803010 5532-P-419 - INSERT TIBIAL 4 19MM POSTERIOR STABILIZE BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-422 SUP Custom 27803010 5532-P-422 - INSERT TIBIAL 4 22MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-425 SUP Custom 27803010 5532-P-425 - INSERT TIBIAL 4 25MM POSTERIOR STABILIZE TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-509 SUP Custom 27803010 5532-P-509 - INSERT TIBIAL 5 9MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-510 SUP HCPCS C1776 5532-P-510 - INSERT TIB 5 10MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-511 SUP Custom 27803010 5532-P-511 - INSERT TIBIAL 5 11MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-512 SUP HCPCS C1776 5532-P-512 - INSERT TIB 5 12MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-513 SUP Custom 27803010 5532-P-513 - INSERT TIBIAL 5 13MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-514 SUP HCPCS C1776 5532-P-514 - INSERT TIB 5 14MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-516 SUP Custom 27803010 5532-P-516 - INSERT TIBIAL 5 16MM POSTERIOR STABILIZED PRIM TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-519 SUP Custom 27803010 5532-P-519 - INSERT TIBIAL 5 P 19MM POSTERIOR STABILIZE TRIATHLON N2/VAC BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-522 SUP Custom 27803010 5532-P-522 - INSERT TIBIAL 5 22MM POSTERIOR STABILIZE TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-525 SUP Custom 27803010 5532-P-525 - INSERT TIBIAL 5 25MM POSTERIOR STABILIZE TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-609 SUP Custom 27803010 5532-P-609 - INSERT TIBIAL 6 9IN POSTERIOR STABILIZED PLASMA SPRAY BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-610 SUP HCPCS C1776 5532-P-610 - INSERT TIB 6 10MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-611 SUP Custom 27803010 5532-P-611 - INSERT TIBIAL 6 11MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-612 SUP HCPCS C1776 5532-P-612 - INSERT TIB 6 12MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-613 SUP Custom 27803010 5532-P-613 - INSERT TIBIAL 6 13MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-614 SUP HCPCS C1776 5532-P-614 - INSERT TIB 6 14MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-616 SUP Custom 27803010 5532-P-616 - INSERT TIBIAL 6 16MM POSTERIOR STABILIZE BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-619 SUP Custom 27803010 5532-P-619 - INSERT TIBIAL 6 19MM POSTERIOR STABILIZE TRIATHLON NONSTRL BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-622 SUP Custom 27803010 5532-P-622 - INSERT TIBIAL 6 22MM POSTERIOR STABILIZE TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-625 SUP Custom 27803010 5532-P-625 - INSERT TIBIAL POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-709 SUP Custom 27803010 5532-P-709 - INSERT TIBIAL 7 9MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-710 SUP HCPCS C1776 5532-P-710 - INSERT TIB 7 10MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" "$1,200.00" $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-711 SUP Custom 27803010 5532-P-711 - INSERT TIBIAL 7 11MM POSTERIOR STABILIZE BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-712 SUP HCPCS C1776 5532-P-712 - INSERT TIB 7 12MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-713 SUP Custom 27803010 5532-P-713 - INSERT TIBIAL 13MM POSTERIOR STABILIZE TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-714 SUP HCPCS C1776 5532-P-714 - INSERT TIB 7 14MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-716 SUP Custom 27803010 5532-P-716 - INSERT TIBIAL 7 16MM POSTERIOR STABILIZE BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-719 SUP Custom 27803010 5532-P-719 - INSERT TIBIAL 7 19MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-722 SUP Custom 27803010 5532-P-722 - INSERT TIBIAL 7 22MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-725 SUP Custom 27803010 5532-P-725 - INSERT TIBIAL 7 25MM POSTERIOR STABILIZE TRIATHLON KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-809 SUP Custom 27803010 5532-P-809 - INSERT TIBIAL 8 9MM POSTERIOR STABILIZE BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-810 SUP HCPCS C1776 5532-P-810 - INSERT TIB 8 10MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-811 SUP Custom 27803010 5532-P-811 - INSERT TIBIAL 8 11MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-812 SUP HCPCS C1776 5532-P-812 - INSERT TIB 8 12MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-813 SUP Custom 27803010 5532-P-813 - INSERT TIBIAL 8 13MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-814 SUP HCPCS C1776 5532-P-814 - INSERT TIB 8 14MM STRL LF TRTHLN BRNG POST STAB KN BOTH IP/OP "$1,200.00" $888.00 $238.17 "$1,200.00" $540.00 $540.00 $540.00 $540.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.11 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 $709.80 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 $238.17 N/A $696.00 "$1,200.00" "$1,200.00" "$1,200.00" $250.08 "$1,200.00" N/A N/A 5532-P-816 SUP Custom 27803010 5532-P-816 - INSERT TIBIAL 8 16MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-819 SUP Custom 27803010 5532-P-819 - INSERT TIBIAL 8 19MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-822 SUP Custom 27803010 5532-P-822 - INSERT TIBIAL 8 22MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5532-P-825 SUP Custom 27803010 5532-P-825 - INSERT TIBIAL 8 25MM POSTERIOR STABILIZED BEARING TRIATHLON BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 5534-A-109 SUP HCPCS C1776 5534-A-109 - COMPONENT TIB 1 9MM CRCTE STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-111 SUP HCPCS C1776 5534-A-111 - INSERT TIB 1 11MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-113 SUP HCPCS C1776 5534-A-113 - INSERT TIB 1 13MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-116 SUP HCPCS C1776 5534-A-116 - INSERT TIB 1 16MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-209 SUP HCPCS C1776 5534-A-209 - INSERT TIB 2 9MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-211 SUP HCPCS C1776 5534-A-211 - INSERT TIB 2 11MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-213 SUP HCPCS C1776 5534-A-213 - INSERT TIB 2 13MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-216 SUP HCPCS C1776 5534-A-216 - INSERT TIB 2 16MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-309 SUP HCPCS C1776 5534-A-309 - INSERT TIB 3 9MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-311 SUP HCPCS C1776 5534-A-311 - INSERT TIB 3 11MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-313 SUP HCPCS C1776 5534-A-313 - COMPONENT TIB 3 13MM CRCTE STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-316 SUP HCPCS C1776 5534-A-316 - COMPONENT TIB 3 16MM CRCTE STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-409 SUP HCPCS C1776 5534-A-409 - INSERT TIB 4 9MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-411 SUP HCPCS C1776 5534-A-411 - INSERT TIB 4 11MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-413 SUP HCPCS C1776 5534-A-413 - INSERT TIB 4 13MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-416 SUP HCPCS C1776 5534-A-416 - COMPONENT TIB 4 16MM CRCTE STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-509 SUP HCPCS C1776 5534-A-509 - INSERT TIB 5 9MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-511 SUP HCPCS C1776 5534-A-511 - INSERT TIB 5 11MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-513 SUP HCPCS C1776 5534-A-513 - TRAY TIB 5 13MM STRL TRTHLN CNDRL STAB ALPLY KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-516 SUP HCPCS C1776 5534-A-516 - INSERT TIB 5 16MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-609 SUP HCPCS C1776 5534-A-609 - INSERT TIB 6 9MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-611 SUP HCPCS C1776 5534-A-611 - INSERT TIB 6 11MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-613 SUP HCPCS C1776 5534-A-613 - INSERT TIB 6 13MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-616 SUP HCPCS C1776 5534-A-616 - INSERT TIB 6 16MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-709 SUP HCPCS C1776 5534-A-709 - INSERT TIB 7 9MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-711 SUP HCPCS C1776 5534-A-711 - INSERT TIB 7 11MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-713 SUP HCPCS C1776 5534-A-713 - INSERT TIB 7 13MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-716 SUP HCPCS C1776 5534-A-716 - TRAY TIB 7 16MM STRL TRTHLN CNDRL STAB ALPLY KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-809 SUP HCPCS C1776 5534-A-809 - INSERT TIB 8 9MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-811 SUP HCPCS C1776 5534-A-811 - INSERT TIB 8 11MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-813 SUP HCPCS C1776 5534-A-813 - INSERT TIB 8 13MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5534-A-816 SUP HCPCS C1776 5534-A-816 - INSERT TIB 8 16MM CNDRL STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-109 SUP HCPCS C1776 5535-A-109 - INSERT TIB 1 9MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-111 SUP HCPCS C1776 5535-A-111 - INSERT TIB 1 11MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-113 SUP HCPCS C1776 5535-A-113 - INSERT TIB 1 13MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-116 SUP HCPCS C1776 5535-A-116 - INSERT TIB 1 16MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-209 SUP HCPCS C1776 5535-A-209 - INSERT TIB 2 9MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-211 SUP HCPCS C1776 5535-A-211 - INSERT TIB 2 11MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-213 SUP HCPCS C1776 5535-A-213 - INSERT TIB 2 13MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-216 SUP HCPCS C1776 5535-A-216 - INSERT TIB 2 16MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-309 SUP HCPCS C1776 5535-A-309 - INSERT TIB 3 9MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-311 SUP HCPCS C1776 5535-A-311 - COMPONENT TIB 3 11MM POST STAB PE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-313 SUP HCPCS C1776 5535-A-313 - INSERT TIB 3 13MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-316 SUP HCPCS C1776 5535-A-316 - INSERT TIB 3 16MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-409 SUP HCPCS C1776 5535-A-409 - INSERT TIB 4 9MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-411 SUP HCPCS C1776 5535-A-411 - COMPONENT TIB 4 11MM POST STAB ALPLY KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-413 SUP HCPCS C1776 5535-A-413 - TRAY TIB 4 13MM STRL TRTHLN POST STAB ALPLY KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-416 SUP HCPCS C1776 5535-A-416 - INSERT TIB 4 16MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-509 SUP HCPCS C1776 5535-A-509 - INSERT TIB 5 9MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-511 SUP HCPCS C1776 5535-A-511 - COMPONENT TIB 5 11MM POST STAB ALPLY KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-513 SUP HCPCS C1776 5535-A-513 - INSERT TIB 5 13MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-516 SUP HCPCS C1776 5535-A-516 - INSERT TIB 5 16MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-609 SUP HCPCS C1776 5535-A-609 - COMPONENT TIB 6 9MM POST STAB PE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-611 SUP HCPCS C1776 5535-A-611 - COMPONENT TIB 6 11MM POST STAB PE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-613 SUP HCPCS C1776 5535-A-613 - INSERT TIB 6 13MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-616 SUP HCPCS C1776 5535-A-616 - INSERT TIB 6 16MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-709 SUP HCPCS C1776 5535-A-709 - TRAY TIB 7 9MM STRL TRTHLN POST STAB ALPLY KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-711 SUP HCPCS C1776 5535-A-711 - INSERT TIB 7 11MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-713 SUP HCPCS C1776 5535-A-713 - INSERT TIB 7 13MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-716 SUP HCPCS C1776 5535-A-716 - INSERT TIB 7 16MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-809 SUP HCPCS C1776 5535-A-809 - INSERT TIB 8 9MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-811 SUP HCPCS C1776 5535-A-811 - INSERT TIB 8 11MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-813 SUP HCPCS C1776 5535-A-813 - INSERT TIB 8 13MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5535-A-816 SUP HCPCS C1776 5535-A-816 - INSERT TIB 8 16MM POST STAB ALL PE KN BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 5536-B-100 SUP HCPCS C1776 5536-B-100 - BASEPLATE TIB 1 7MM 40X40MM 61MM TRTHLN 4 CRFRM PG KEEL BOTH IP/OP "$3,602.50" "$2,666.00" $715.01 "$3,602.50" "$1,621.13" "$1,621.13" "$1,621.13" "$1,621.13" "$3,602.50" "$3,602.50" "$3,602.50" $750.85 "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" $750.80 "$3,602.50" "$3,602.50" "$1,776.03" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$2,701.88" "$3,602.50" "$3,602.50" "$3,602.50" "$1,801.25" "$1,801.25" "$2,853.18" "$3,602.50" "$2,882.00" "$1,621.13" $715.01 N/A "$2,089.45" "$3,602.50" "$3,602.50" "$3,602.50" $750.76 "$3,602.50" N/A N/A 5536-B-200 SUP HCPCS C1776 5536-B-200 - COMPONENT TIB 2 STRL LF TRTHLN KN BOTH IP/OP "$3,602.50" "$2,666.00" $715.01 "$3,602.50" "$1,621.13" "$1,621.13" "$1,621.13" "$1,621.13" "$3,602.50" "$3,602.50" "$3,602.50" $750.85 "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" $750.80 "$3,602.50" "$3,602.50" "$1,776.03" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$2,701.88" "$3,602.50" "$3,602.50" "$3,602.50" "$1,801.25" "$1,801.25" "$2,853.18" "$3,602.50" "$2,882.00" "$1,621.13" $715.01 N/A "$2,089.45" "$3,602.50" "$3,602.50" "$3,602.50" $750.76 "$3,602.50" N/A N/A 5536-B-300 SUP HCPCS C1776 5536-B-300 - BASEPLATE TIB 3 TRTHLN TRITANIUM KN BOTH IP/OP "$3,602.50" "$2,666.00" $715.01 "$3,602.50" "$1,621.13" "$1,621.13" "$1,621.13" "$1,621.13" "$3,602.50" "$3,602.50" "$3,602.50" $750.85 "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" $750.80 "$3,602.50" "$1,441.00" "$1,776.03" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$2,701.88" "$3,602.50" "$3,602.50" "$3,602.50" "$1,801.25" "$1,801.25" "$2,853.18" "$3,602.50" "$2,882.00" "$1,621.13" $715.01 N/A "$2,089.45" "$3,602.50" "$3,602.50" "$3,602.50" $750.76 "$3,602.50" N/A N/A 5536-B-400 SUP HCPCS C1776 5536-B-400 - BASEPLATE TIB 4 TRTHLN TRITANIUM KN BOTH IP/OP "$3,602.50" "$2,666.00" $715.01 "$3,602.50" "$1,621.13" "$1,621.13" "$1,621.13" "$1,621.13" "$3,602.50" "$3,602.50" "$3,602.50" $750.85 "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" $750.80 "$3,602.50" "$3,602.50" "$1,776.03" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$2,701.88" "$3,602.50" "$3,602.50" "$3,602.50" "$1,801.25" "$1,801.25" "$2,853.18" "$3,602.50" "$2,882.00" "$1,621.13" $715.01 N/A "$2,089.45" "$3,602.50" "$3,602.50" "$3,602.50" $750.76 "$3,602.50" N/A N/A 5536-B-500 SUP HCPCS C1776 5536-B-500 - BASEPLATE TIB 5 TRTHLN TRITANIUM KN BOTH IP/OP "$3,602.50" "$2,666.00" $715.01 "$3,602.50" "$1,621.13" "$1,621.13" "$1,621.13" "$1,621.13" "$3,602.50" "$3,602.50" "$3,602.50" $750.85 "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" $750.80 "$3,602.50" "$1,441.00" "$1,776.03" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$2,701.88" "$3,602.50" "$3,602.50" "$3,602.50" "$1,801.25" "$1,801.25" "$2,853.18" "$3,602.50" "$2,882.00" "$1,621.13" $715.01 N/A "$2,089.45" "$3,602.50" "$3,602.50" "$3,602.50" $750.76 "$3,602.50" N/A N/A 5536-B-600 SUP HCPCS C1776 5536-B-600 - BASEPLATE TIB 6 TRTHLN TRITANIUM KN BOTH IP/OP "$3,602.50" "$2,666.00" $715.01 "$3,602.50" "$1,621.13" "$1,621.13" "$1,621.13" "$1,621.13" "$3,602.50" "$3,602.50" "$3,602.50" $750.85 "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" $750.80 "$3,602.50" "$3,602.50" "$1,776.03" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$2,701.88" "$3,602.50" "$3,602.50" "$3,602.50" "$1,801.25" "$1,801.25" "$2,853.18" "$3,602.50" "$2,882.00" "$1,621.13" $715.01 N/A "$2,089.45" "$3,602.50" "$3,602.50" "$3,602.50" $750.76 "$3,602.50" N/A N/A 5536-B-700 SUP HCPCS C1776 5536-B-700 - BASEPLATE TIB 7 TRTHLN TRITANIUM KN BOTH IP/OP "$3,602.50" "$2,666.00" $715.01 "$3,602.50" "$1,621.13" "$1,621.13" "$1,621.13" "$1,621.13" "$3,602.50" "$3,602.50" "$3,602.50" $750.85 "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" $750.80 "$3,602.50" "$1,441.00" "$1,776.03" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$2,701.88" "$3,602.50" "$3,602.50" "$3,602.50" "$1,801.25" "$1,801.25" "$2,853.18" "$3,602.50" "$2,882.00" "$1,621.13" $715.01 N/A "$2,089.45" "$3,602.50" "$3,602.50" "$3,602.50" $750.76 "$3,602.50" N/A N/A 5536-B-800 SUP HCPCS C1776 5536-B-800 - BASEPLATE TIB 8 TRTHLN TRITANIUM KN BOTH IP/OP "$3,602.50" "$2,666.00" $715.01 "$3,602.50" "$1,621.13" "$1,621.13" "$1,621.13" "$1,621.13" "$3,602.50" "$3,602.50" "$3,602.50" $750.85 "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" $750.80 "$3,602.50" "$3,602.50" "$1,776.03" "$3,602.50" "$3,602.50" "$3,602.50" "$3,602.50" "$2,701.88" "$3,602.50" "$3,602.50" "$3,602.50" "$1,801.25" "$1,801.25" "$2,853.18" "$3,602.50" "$2,882.00" "$1,621.13" $715.01 N/A "$2,089.45" "$3,602.50" "$3,602.50" "$3,602.50" $750.76 "$3,602.50" N/A N/A 5537-14/13 SUP HCPCS C1776 5537-14/13 - STEM HUMERAL 14MM 135MM PRESS FIT HUMERAL TITANIUM SHOULDER BOTH IP/OP "$6,567.00" "$4,860.00" "$1,303.33" "$6,566.70" "$2,955.02" "$2,955.02" "$2,955.02" "$2,955.02" "$6,566.70" "$6,566.70" "$6,566.70" "$1,368.66" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$1,368.57" "$6,566.70" "$6,566.70" "$3,237.38" "$6,566.70" "$6,566.70" "$6,566.70" "$6,566.70" "$4,925.25" "$6,566.70" "$6,566.70" "$6,566.70" "$3,283.35" "$3,283.35" "$5,200.83" "$6,566.70" "$5,253.36" "$2,955.02" "$1,303.33" N/A "$3,808.86" "$6,566.70" "$6,566.70" "$6,566.70" "$1,368.50" "$6,566.70" N/A N/A 5537-G-109 SUP HCPCS C1776 5537-G-109 - INSERT TIBIAL 1 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-109-E SUP HCPCS C1776 5537-G-109-E - INSERT TIB 1 9MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-111 SUP HCPCS C1776 5537-G-111 - INSERT TIBIAL 1 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-111-E SUP HCPCS C1776 5537-G-111-E - INSERT TIB 1 11MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-113 SUP HCPCS C1776 5537-G-113 - INSERT TIBIAL 1 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-113-E SUP HCPCS C1776 5537-G-113-E - INSERT TIB 1 13MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-116 SUP HCPCS C1776 5537-G-116 - INSERT TIBIAL 1 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-116-E SUP HCPCS C1776 5537-G-116-E - INSERT TIB 1 16MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-119 SUP HCPCS C1776 5537-G-119 - INSERT TIBIAL 1 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-119-E SUP HCPCS C1776 5537-G-119-E - INSERT TIB 1 19MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-122 SUP HCPCS C1776 5537-G-122 - INSERT TIBIAL 1 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-122-E SUP HCPCS C1776 5537-G-122-E - INSERT TIB 1 22MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-125 SUP HCPCS C1776 5537-G-125 - INSERT TIBIAL 1 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-125-E SUP HCPCS C1776 5537-G-125-E - INSERT TIB 1 25MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-128 SUP HCPCS C1776 5537-G-128 - INSERT TIBIAL 1 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-128-E SUP HCPCS C1776 5537-G-128-E - INSERT TIB 1 28MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-131 SUP HCPCS C1776 5537-G-131 - INSERT TIBIAL 1 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-131-E SUP HCPCS C1776 5537-G-131-E - INSERT TIB 1 31MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-209 SUP HCPCS C1776 5537-G-209 - INSERT TIBIAL 2 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-209-E SUP HCPCS C1776 5537-G-209-E - INSERT TIB 2 9MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-211 SUP HCPCS C1776 5537-G-211 - INSERT TIBIAL 2 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-211-E SUP HCPCS C1776 5537-G-211-E - INSERT TIB 2 11MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-213 SUP HCPCS C1776 5537-G-213 - INSERT TIBIAL 2 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-213-E SUP HCPCS C1776 5537-G-213-E - INSERT TIB 2 13MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-216 SUP HCPCS C1776 5537-G-216 - INSERT TIBIAL 2 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-216-E SUP HCPCS C1776 5537-G-216-E - INSERT TIB 2 16MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-219 SUP HCPCS C1776 5537-G-219 - INSERT TIBIAL 2 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-219-E SUP HCPCS C1776 5537-G-219-E - INSERT TIB 2 19MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-222 SUP HCPCS C1776 5537-G-222 - INSERT TIBIAL 2 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-222-E SUP HCPCS C1776 5537-G-222-E - INSERT TIB 2 22MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-225 SUP HCPCS C1776 5537-G-225 - INSERT TIBIAL 2 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-225-E SUP HCPCS C1776 5537-G-225-E - INSERT TIB 2 25MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-228 SUP HCPCS C1776 5537-G-228 - INSERT TIBIAL 2 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-228-E SUP HCPCS C1776 5537-G-228-E - INSERT TIB 2 28MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-231 SUP HCPCS C1776 5537-G-231 - INSERT TIBIAL 2 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-231-E SUP HCPCS C1776 5537-G-231-E - INSERT TIB 2 31MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-309 SUP HCPCS C1776 5537-G-309 - INSERT TIBIAL 2 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-309-E SUP HCPCS C1776 5537-G-309-E - INSERT TIB 3 9MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-311 SUP HCPCS C1776 5537-G-311 - INSERT TIBIAL 3 11MM TOT STABILIZED PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-311-E SUP HCPCS C1776 5537-G-311-E - INSERT TIB 3 11MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-313 SUP HCPCS C1776 5537-G-313 - INSERT TIBIAL 3 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-313-E SUP HCPCS C1776 5537-G-313-E - INSERT TIB 3 13MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-316 SUP HCPCS C1776 5537-G-316 - INSERT TIBIAL 3 16MM TOT STABILIZED PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-316-E SUP HCPCS C1776 5537-G-316-E - INSERT TIB 3 16MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-319 SUP HCPCS C1776 5537-G-319 - INSERT TIBIAL 3 19MM TOT STABILIZED PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-319-E SUP HCPCS C1776 5537-G-319-E - INSERT TIB 3 19MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-322 SUP HCPCS C1776 5537-G-322 - INSERT TIBIAL 3 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-322-E SUP HCPCS C1776 5537-G-322-E - INSERT TIB 3 22MM STRL TRTHLN TS + X3 KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-325 SUP HCPCS C1776 5537-G-325 - INSERT TIBIAL 3 25MM TOT STABILIZED PLUS TRIATHLON X3 BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-325-E SUP HCPCS C1776 5537-G-325-E - INSERT TIB 3 25MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-328 SUP HCPCS C1776 5537-G-328 - INSERT TIBIAL 3 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-328-E SUP HCPCS C1776 5537-G-328-E - INSERT TIB 3 28MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-331 SUP HCPCS C1776 5537-G-331 - INSERT TIBIAL 3 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-331-E SUP HCPCS C1776 5537-G-331-E - INSERT TIB 3 31MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-409 SUP HCPCS C1776 5537-G-409 - INSERT TIBIAL 4 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-409-E SUP HCPCS C1776 5537-G-409-E - INSERT TIB 4 9MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-411 SUP HCPCS C1776 5537-G-411 - INSERT TIBIAL 4 11MM TOT STABILIZED PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-411-E SUP HCPCS C1776 5537-G-411-E - INSERT TIB 4 11MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-413 SUP HCPCS C1776 5537-G-413 - INSERT TIBIAL 4 13MM TOT STABILIZED PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-413-E SUP HCPCS C1776 5537-G-413-E - INSERT TIB 4 13MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-416 SUP HCPCS C1776 5537-G-416 - INSERT TIBIAL 4 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-416-E SUP HCPCS C1776 5537-G-416-E - INSERT TIB 4 16MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-419 SUP HCPCS C1776 5537-G-419 - INSERT TIBIAL 4 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-419-E SUP HCPCS C1776 5537-G-419-E - INSERT TIB 4 19MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-422 SUP HCPCS C1776 5537-G-422 - INSERT TIBIAL 4 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-422-E SUP HCPCS C1776 5537-G-422-E - INSERT TIB 4 22MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-425 SUP HCPCS C1776 5537-G-425 - INSERT TIBIAL 4 25MM TOT STABILIZED PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-425-E SUP HCPCS C1776 5537-G-425-E - INSERT TIB 4 25MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-428 SUP HCPCS C1776 5537-G-428 - INSERT TIBIAL 4 28MM TOT STABILIZED PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-428-E SUP HCPCS C1776 5537-G-428-E - INSERT TIB 4 28MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-431 SUP HCPCS C1776 5537-G-431 - INSERT TIBIAL 4 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-431-E SUP HCPCS C1776 5537-G-431-E - INSERT TIB 4 31MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-509 SUP HCPCS C1776 5537-G-509 - INSERT TIBIAL 5 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-509-E SUP HCPCS C1776 5537-G-509-E - INSERT TIB 5 9MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-511 SUP HCPCS C1776 5537-G-511 - INSERT TIBIAL 5 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-511-E SUP HCPCS C1776 5537-G-511-E - INSERT TIB 5 11MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-513 SUP HCPCS C1776 5537-G-513 - INSERT TIBIAL 5 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-513-E SUP HCPCS C1776 5537-G-513-E - INSERT TIB 5 13MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-516 SUP HCPCS C1776 5537-G-516 - INSERT TIBIAL 5 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-516-E SUP HCPCS C1776 5537-G-516-E - INSERT TIB 5 16MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-519 SUP HCPCS C1776 5537-G-519 - INSERT TIBIAL 5 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-519-E SUP HCPCS C1776 5537-G-519-E - INSERT TIB 5 19MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-522 SUP HCPCS C1776 5537-G-522 - INSERT TIBIAL 5 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-522-E SUP HCPCS C1776 5537-G-522-E - INSERT TIB 5 22MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-525 SUP HCPCS C1776 5537-G-525 - INSERT TIBIAL 5 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-525-E SUP HCPCS C1776 5537-G-525-E - INSERT TIB 5 25MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-528 SUP HCPCS C1776 5537-G-528 - INSERT TIBIAL 5 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-528-E SUP HCPCS C1776 5537-G-528-E - INSERT TIB 5 28MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-531 SUP HCPCS C1776 5537-G-531 - INSERT TIBIAL 5 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-531-E SUP HCPCS C1776 5537-G-531-E - INSERT TIB 5 31MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-609 SUP HCPCS C1776 5537-G-609 - INSERT TIBIAL 6 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-609-E SUP HCPCS C1776 5537-G-609-E - INSERT TIB 6 9MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-611 SUP HCPCS C1776 5537-G-611 - INSERT TIBIAL 6 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-611-E SUP HCPCS C1776 5537-G-611-E - INSERT TIB 6 11MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-613 SUP HCPCS C1776 5537-G-613 - INSERT TIBIAL 6 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-613-E SUP HCPCS C1776 5537-G-613-E - INSERT TIB 6 13MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-616 SUP HCPCS C1776 5537-G-616 - INSERT TIBIAL 6 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-616-E SUP HCPCS C1776 5537-G-616-E - INSERT TIB 6 16MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-619 SUP HCPCS C1776 5537-G-619 - INSERT TIBIAL 6 19MM TOT STABILIZED PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-619-E SUP HCPCS C1776 5537-G-619-E - INSERT TIB 6 19MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-622 SUP HCPCS C1776 5537-G-622 - INSERT TIBIAL 6 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-622-E SUP HCPCS C1776 5537-G-622-E - INSERT TIB 6 22MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-625 SUP HCPCS C1776 5537-G-625 - INSERT TIBIAL 6 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-625-E SUP HCPCS C1776 5537-G-625-E - INSERT TIB 6 25MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-628 SUP HCPCS C1776 5537-G-628 - INSERT TIBIAL 6 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-628-E SUP HCPCS C1776 5537-G-628-E - INSERT TIB 6 28MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-631 SUP HCPCS C1776 5537-G-631 - INSERT TIBIAL 6 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-631-E SUP HCPCS C1776 5537-G-631-E - INSERT TIB 6 31MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-709 SUP HCPCS C1776 5537-G-709 - INSERT TIBIAL 7 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-709-E SUP HCPCS C1776 5537-G-709-E - INSERT TIB 7 9MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-711 SUP HCPCS C1776 5537-G-711 - INSERT TIBIAL 7 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-711-E SUP HCPCS C1776 5537-G-711-E - INSERT TIB 7 11MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-713 SUP HCPCS C1776 5537-G-713 - INSERT TIBIAL 7 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-713-E SUP HCPCS C1776 5537-G-713-E - INSERT TIB 7 13MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-716 SUP HCPCS C1776 5537-G-716 - INSERT TIBIAL 7 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-716-E SUP HCPCS C1776 5537-G-716-E - INSERT TIB 7 16MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-719 SUP HCPCS C1776 5537-G-719 - INSERT TIBIAL 7 19MM TOT STABILIZE TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-719-E SUP HCPCS C1776 5537-G-719-E - INSERT TIB 7 19MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-722 SUP HCPCS C1776 5537-G-722 - INSERT TIBIAL 7 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-722-E SUP HCPCS C1776 5537-G-722-E - INSERT TIB 7 22MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-725 SUP HCPCS C1776 5537-G-725 - INSERT TIBIAL 7 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-725-E SUP HCPCS C1776 5537-G-725-E - INSERT TIB 7 25MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-728 SUP HCPCS C1776 5537-G-728 - INSERT TIBIAL 7 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-728-E SUP HCPCS C1776 5537-G-728-E - INSERT TIB 7 28MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-731 SUP HCPCS C1776 5537-G-731 - INSERT TIBIAL 7 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-731-E SUP HCPCS C1776 5537-G-731-E - INSERT TIB 7 31MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-809 SUP HCPCS C1776 5537-G-809 - INSERT TIBIAL 8 9MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-809-E SUP HCPCS C1776 5537-G-809-E - INSERT TIB 8 9MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-811 SUP HCPCS C1776 5537-G-811 - INSERT TIBIAL 8 11MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-811-E SUP HCPCS C1776 5537-G-811-E - INSERT TIB 8 11MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-813 SUP HCPCS C1776 5537-G-813 - INSERT TIBIAL 8 13MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-813-E SUP HCPCS C1776 5537-G-813-E - INSERT TIB 8 13MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-816 SUP HCPCS C1776 5537-G-816 - INSERT TIBIAL 8 16MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-816-E SUP HCPCS C1776 5537-G-816-E - INSERT TIB 8 16MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-819 SUP HCPCS C1776 5537-G-819 - INSERT TIBIAL 8 19MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-819-E SUP HCPCS C1776 5537-G-819-E - INSERT TIB 8 19MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-822 SUP HCPCS C1776 5537-G-822 - INSERT TIBIAL 8 22MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-822-E SUP HCPCS C1776 5537-G-822-E - INSERT TIB 8 22MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-825 SUP HCPCS C1776 5537-G-825 - INSERT TIBIAL 8 25MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-825-E SUP HCPCS C1776 5537-G-825-E - INSERT TIB 8 25MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-828 SUP HCPCS C1776 5537-G-828 - INSERT TIBIAL 8 28MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$5,255.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-828-E SUP HCPCS C1776 5537-G-828-E - INSERT TIB 8 28MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-831 SUP HCPCS C1776 5537-G-831 - INSERT TIBIAL 8 31MM TOT STABILIZE PLUS TRIATHLON X3 KNEE BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5537-G-831-E SUP HCPCS C1776 5537-G-831-E - INSERT TIB 8 31MM STRL TRTHLN TS + KN BOTH IP/OP "$5,255.00" "$3,889.00" "$1,042.99" "$5,255.00" "$2,364.75" "$2,364.75" "$2,364.75" "$2,364.75" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.27" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.20" "$5,255.00" "$2,102.00" "$2,590.72" "$5,255.00" "$5,255.00" "$5,255.00" "$5,255.00" "$3,941.25" "$5,255.00" "$5,255.00" "$5,255.00" "$2,627.50" "$2,627.50" "$4,161.96" "$5,255.00" "$4,204.00" "$2,364.75" "$1,042.99" N/A "$3,047.90" "$5,255.00" "$5,255.00" "$5,255.00" "$1,095.14" "$5,255.00" N/A N/A 5540-14/13 SUP HCPCS C1776 5540-14/13 - STEM HUMERAL 14MM 135MM PRESS FIT TITANIUM HA STERILE BOTH IP/OP "$6,943.00" "$5,138.00" "$1,378.01" "$6,943.00" "$3,124.35" "$3,124.35" "$3,124.35" "$3,124.35" "$6,943.00" "$6,943.00" "$6,943.00" "$1,447.09" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$1,447.00" "$6,943.00" "$6,943.00" "$3,422.90" "$6,943.00" "$6,943.00" "$6,943.00" "$6,943.00" "$5,207.25" "$6,943.00" "$6,943.00" "$6,943.00" "$3,471.50" "$3,471.50" "$5,498.86" "$6,943.00" "$5,554.40" "$3,124.35" "$1,378.01" N/A "$4,026.94" "$6,943.00" "$6,943.00" "$6,943.00" "$1,446.92" "$6,943.00" N/A N/A 5540-A-101 SUP Custom 27803010 5540-A-101 - AUGMENT FEMORAL 1 5MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-102 SUP Custom 27803010 5540-A-102 - AUGMENT FEMORAL 1 5MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-201 SUP Custom 27803010 5540-A-201 - AUGMENT FEMORAL 2 5MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-202 SUP Custom 27803010 5540-A-202 - AUGMENT FEMORAL 2 5MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-301 SUP Custom 27803010 5540-A-301 - AUGMENT FEMORAL 3 5MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-302 SUP Custom 27803010 5540-A-302 - AUGMENT FEMORAL 3 5MM TOT STABILIZED TRIATHLON RIGHT DISTAL BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-401 SUP Custom 27803010 5540-A-401 - AUGMENT FEMORAL 4 5MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-402 SUP Custom 27803010 5540-A-402 - AUGMENT FEMORAL 4 5MM TOT STABILIZED TRIATHLON RIGHT DISTAL BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-501 SUP Custom 27803010 5540-A-501 - AUGMENT FEMORAL 5 5MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-502 SUP Custom 27803010 5540-A-502 - AUGMENT FEMORAL 5 5MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-601 SUP Custom 27803010 5540-A-601 - AUGMENT FEMORAL 6 5MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-602 SUP Custom 27803010 5540-A-602 - AUGMENT FEMORAL 6 5MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-701 SUP Custom 27803010 5540-A-701 - AUGMENT FEMORAL 7 5MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-702 SUP Custom 27803010 5540-A-702 - AUGMENT FEMORAL 7 5MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-801 SUP Custom 27803010 5540-A-801 - AUGMENT FEMORAL 8 5MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5540-A-802 SUP Custom 27803010 5540-A-802 - AUGMENT FEMORAL 8 5MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A 5541-A-101 SUP Custom 27803010 5541-A-101 - AUGMENT FEMORAL 1 10MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-102 SUP Custom 27803010 5541-A-102 - AUGMENT FEMORAL 1 10MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-201 SUP Custom 27803010 5541-A-201 - AUGMENT FEMORAL 2 10MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-202 SUP Custom 27803010 5541-A-202 - AUGMENT FEMORAL 2 10MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-301 SUP Custom 27803010 5541-A-301 - AUGMENT FEMORAL 3 10MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-302 SUP Custom 27803010 5541-A-302 - AUGMENT FEMORAL 3 10MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-401 SUP Custom 27803010 5541-A-401 - AUGMENT FEMORAL 4 10MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-402 SUP Custom 27803010 5541-A-402 - AUGMENT FEMORAL 4 10MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-501 SUP Custom 27803010 5541-A-501 - AUGMENT FEMORAL 5 10MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-502 SUP Custom 27803010 5541-A-502 - AUGMENT FEMORAL 5 10MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-601 SUP Custom 27803010 5541-A-601 - AUGMENT FEMORAL 6 10MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-602 SUP Custom 27803010 5541-A-602 - AUGMENT FEMORAL 6 10MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-701 SUP Custom 27803010 5541-A-701 - AUGMENT FEMORAL 7 10MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-702 SUP Custom 27803010 5541-A-702 - AUGMENT FEMORAL 7 10MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-801 SUP Custom 27803010 5541-A-801 - AUGMENT FEMORAL 8 10MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5541-A-802 SUP Custom 27803010 5541-A-802 - AUGMENT FEMORAL 8 10MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5542-A-101 SUP Custom 27803010 5542-A-101 - AUGMENT FEMORAL 1 15MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-102 SUP Custom 27803010 5542-A-102 - AUGMENT FEMORAL 1 15MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-201 SUP Custom 27803010 5542-A-201 - AUGMENT FEMORAL 2 15MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-202 SUP Custom 27803010 5542-A-202 - AUGMENT FEMORAL 2 15MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-301 SUP Custom 27803010 5542-A-301 - AUGMENT FEMORAL 3 15MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-302 SUP Custom 27803010 5542-A-302 - AUGMENT FEMORAL 3 15MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-401 SUP Custom 27803010 5542-A-401 - AUGMENT FEMORAL 4 15MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-402 SUP Custom 27803010 5542-A-402 - AUGMENT FEMORAL 4 15MM TOT STABILIZE TRIATHLON KNEEL RIGHT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-501 SUP Custom 27803010 5542-A-501 - AUGMENT FEMORAL 5 15MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-502 SUP Custom 27803010 5542-A-502 - AUGMENT FEMORAL 5 15MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-601 SUP Custom 27803010 5542-A-601 - AUGMENT FEMORAL 6 15MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-602 SUP Custom 27803010 5542-A-602 - AUGMENT FEMORAL 6 15MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-701 SUP Custom 27803010 5542-A-701 - AUGMENT FEMORAL 7 15MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-702 SUP Custom 27803010 5542-A-702 - AUGMENT FEMORAL 7 15MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-801 SUP Custom 27803010 5542-A-801 - AUGMENT FEMORAL 8 15MM TOT STABILIZE TRIATHLON KNEE LEFT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5542-A-802 SUP Custom 27803010 5542-A-802 - AUGMENT FEMORAL 8 15MM TOT STABILIZE TRIATHLON KNEE RIGHT BOTH IP/OP "$2,467.50" "$1,826.00" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $439.22 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" $514.25 "$2,467.50" $987.00 "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$2,467.50" "$1,850.63" "$2,467.50" "$2,467.50" "$2,467.50" "$1,233.75" "$1,233.75" "$1,954.26" "$2,467.50" "$1,974.00" "$1,110.38" "$2,467.50" N/A "$1,431.15" "$2,467.50" "$1,480.50" "$2,467.50" "$2,467.50" "$2,467.50" N/A N/A 5543-A-100 SUP Custom 27803010 5543-A-100 - AUGMENT FEMORAL 1 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5543-A-200 SUP Custom 27803010 5543-A-200 - AUGMENT FEMORAL 2 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5543-A-300 SUP Custom 27803010 5543-A-300 - AUGMENT FEMORAL 3 5MM TOT STABILIZED TRIATHLON POSTERIOR BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5543-A-400 SUP Custom 27803010 5543-A-400 - AUGMENT FEMORAL 4 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5543-A-500 SUP Custom 27803010 5543-A-500 - AUGMENT FEMORAL 5 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5543-A-600 SUP Custom 27803010 5543-A-600 - AUGMENT FEMORAL 6 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5543-A-700 SUP Custom 27803010 5543-A-700 - AUGMENT FEMORAL 7 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5543-A-800 SUP Custom 27803010 5543-A-800 - AUGMENT FEMORAL 8 5MM TOT STABILIZE TRIATHLON KNEE POSTERIOR BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5544-A-100 SUP Custom 27803010 5544-A-100 - AUGMENT FEMORAL 1 10MM TOT STABILIZE TRIATHLON KNEE BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5544-A-200 SUP Custom 27803010 5544-A-200 - AUGMENT FEMORAL 2 10MM TOT STABILIZE TRIATHLON KNEE BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5544-A-300 SUP Custom 27803010 5544-A-300 - AUGMENT FEMORAL 3 10MM TOT STABILIZED BACKWARD BLOCK BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5544-A-400 SUP Custom 27803010 5544-A-400 - AUGMENT FEMORAL 4 10MM TOT STABILIZE TRIATHLON KNEE BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5544-A-500 SUP Custom 27803010 5544-A-500 - AUGMENT FEMORAL 5 10MM TOT STABILIZE TRIATHLON KNEE BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5544-A-600 SUP Custom 27803010 5544-A-600 - AUGMENT FEMORAL 6 10MM TOT STABILIZE TRIATHLON KNEE BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5544-A-700 SUP Custom 27803010 5544-A-700 - AUGMENT FEMORAL 7 10MM TOT STABILIZE TRIATHLON KNEE BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5544-A-800 SUP Custom 27803010 5544-A-800 - AUGMENT FEMORAL 8 10MM TOT STABILIZE TRIATHLON KNEE BOTH IP/OP "$2,352.50" "$1,741.00" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $418.75 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" $490.29 "$2,352.50" $941.00 "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$2,352.50" "$1,764.38" "$2,352.50" "$2,352.50" "$2,352.50" "$1,176.25" "$1,176.25" "$1,863.18" "$2,352.50" "$1,882.00" "$1,058.63" "$2,352.50" N/A "$1,364.45" "$2,352.50" "$1,411.50" "$2,352.50" "$2,352.50" "$2,352.50" N/A N/A 5545-A-101 SUP Custom 27803010 5545-A-101 - AUGMENT TIBIAL 1 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-102 SUP Custom 27803010 5545-A-102 - AUGMENT TIBIAL 1 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-201 SUP Custom 27803010 5545-A-201 - AUGMENT TIBIAL 2 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-202 SUP Custom 27803010 5545-A-202 - AUGMENT TIBIAL 2 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-301 SUP Custom 27803010 5545-A-301 - AUGMENT TIBIAL 3 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-302 SUP Custom 27803010 5545-A-302 - AUGMENT TIBIAL 3 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-401 SUP Custom 27803010 5545-A-401 - AUGMENT TIBIAL 4 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-402 SUP Custom 27803010 5545-A-402 - AUGMENT TIBIAL 4 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-501 SUP Custom 27803010 5545-A-501 - AUGMENT TIBIAL 5 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-502 SUP Custom 27803010 5545-A-502 - AUGMENT TIBIAL 5 5MM TRIATHLON RIGHT MEDIAL LEFT LATERAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-601 SUP Custom 27803010 5545-A-601 - AUGMENT TIBIAL 6 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-602 SUP Custom 27803010 5545-A-602 - AUGMENT TIBIAL 6 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-701 SUP Custom 27803010 5545-A-701 - AUGMENT TIBIAL 7 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-702 SUP Custom 27803010 5545-A-702 - AUGMENT TIBIAL 7 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-801 SUP Custom 27803010 5545-A-801 - AUGMENT TIBIAL 8 5MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5545-A-802 SUP Custom 27803010 5545-A-802 - AUGMENT TIBIAL 8 5MM TOT STABILIZE TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,130.00" "$1,576.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $379.14 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 "$2,130.00" N/A "$1,235.40" "$2,130.00" "$1,278.00" "$2,130.00" "$2,130.00" "$2,130.00" N/A N/A 5546-A-101 SUP Custom 27803010 5546-A-101 - AUGMENT TIBIAL 1 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-102 SUP Custom 27803010 5546-A-102 - AUGMENT TIBIAL 1 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-201 SUP Custom 27803010 5546-A-201 - AUGMENT TIBIAL 2 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-202 SUP Custom 27803010 5546-A-202 - AUGMENT TIBIAL 2 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-301 SUP Custom 27803010 5546-A-301 - AUGMENT TIBIAL 3 10MM TOT STABILIZED FIXING SCREW TRIATHLON BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-302 SUP Custom 27803010 5546-A-302 - AUGMENT TIBIAL 3 10MM TOAL STABILIZED TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-401 SUP Custom 27803010 5546-A-401 - AUGMENT TIBIAL 4 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-402 SUP Custom 27803010 5546-A-402 - AUGMENT TIBIAL 4 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-501 SUP Custom 27803010 5546-A-501 - AUGMENT TIBIAL 5 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-502 SUP Custom 27803010 5546-A-502 - AUGMENT TIBIAL 5 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-601 SUP Custom 27803010 5546-A-601 - AUGMENT TIBIAL 6 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-602 SUP Custom 27803010 5546-A-602 - AUGMENT TIBIAL 6 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-701 SUP Custom 27803010 5546-A-701 - AUGMENT TIBIAL 7 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-702 SUP Custom 27803010 5546-A-702 - AUGMENT TIBIAL 7 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-801 SUP Custom 27803010 5546-A-801 - AUGMENT TIBIAL 8 10MM TOT STABILIZE TRIATHLON LEFT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5546-A-802 SUP Custom 27803010 5546-A-802 - AUGMENT TIBIAL 8 10MM TOT STABILIZE TRIATHLON RIGHT MEDIAL BOTH IP/OP "$2,095.00" "$1,550.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $372.91 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" $436.62 "$2,095.00" $838.00 "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$2,095.00" "$1,571.25" "$2,095.00" "$2,095.00" "$2,095.00" "$1,047.50" "$1,047.50" "$1,659.24" "$2,095.00" "$1,676.00" $942.75 "$2,095.00" N/A "$1,215.10" "$2,095.00" "$1,257.00" "$2,095.00" "$2,095.00" "$2,095.00" N/A N/A 5549-A-110 SUP HCPCS C1776 5549-A-110 - AUGMENT TIB A CONE STRL LF TRTHLN SMTR TRITANIUM BOTH IP/OP "$8,495.00" "$6,286.00" "$1,686.05" "$8,495.00" "$3,822.75" "$3,822.75" "$3,822.75" "$3,822.75" "$8,495.00" "$8,495.00" "$8,495.00" "$1,770.57" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$1,770.45" "$8,495.00" "$3,398.00" "$4,188.04" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$6,371.25" "$8,495.00" "$8,495.00" "$8,495.00" "$4,247.50" "$4,247.50" "$6,728.04" "$8,495.00" "$6,796.00" "$3,822.75" "$1,686.05" N/A "$4,927.10" "$8,495.00" "$8,495.00" "$8,495.00" "$1,770.36" "$8,495.00" N/A N/A 5549-A-120 SUP HCPCS C1776 5549-A-120 - AUGMENT TIB B CONE STRL LF TRTHLN SMTR TRITANIUM BOTH IP/OP "$8,495.00" "$6,286.00" "$1,686.05" "$8,495.00" "$3,822.75" "$3,822.75" "$3,822.75" "$3,822.75" "$8,495.00" "$8,495.00" "$8,495.00" "$1,770.57" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$1,770.45" "$8,495.00" "$3,398.00" "$4,188.04" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$6,371.25" "$8,495.00" "$8,495.00" "$8,495.00" "$4,247.50" "$4,247.50" "$6,728.04" "$8,495.00" "$6,796.00" "$3,822.75" "$1,686.05" N/A "$4,927.10" "$8,495.00" "$8,495.00" "$8,495.00" "$1,770.36" "$8,495.00" N/A N/A 5549-A-140 SUP HCPCS C1776 5549-A-140 - AUGMENT TIB D CONE TRTHLN SMTR REV TRITANIUM KN BOTH IP/OP "$8,495.00" "$6,286.00" "$1,686.05" "$8,495.00" "$3,822.75" "$3,822.75" "$3,822.75" "$3,822.75" "$8,495.00" "$8,495.00" "$8,495.00" "$1,770.57" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$1,770.45" "$8,495.00" "$3,398.00" "$4,188.04" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$6,371.25" "$8,495.00" "$8,495.00" "$8,495.00" "$4,247.50" "$4,247.50" "$6,728.04" "$8,495.00" "$6,796.00" "$3,822.75" "$1,686.05" N/A "$4,927.10" "$8,495.00" "$8,495.00" "$8,495.00" "$1,770.36" "$8,495.00" N/A N/A 5549-A-150 SUP HCPCS C1776 5549-A-150 - AUGMENT TIB E CONE TRTHLN SMTR REV TRITANIUM KN BOTH IP/OP "$8,495.00" "$6,286.00" "$1,686.05" "$8,495.00" "$3,822.75" "$3,822.75" "$3,822.75" "$3,822.75" "$8,495.00" "$8,495.00" "$8,495.00" "$1,770.57" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$1,770.45" "$8,495.00" "$8,495.00" "$4,188.04" "$8,495.00" "$8,495.00" "$8,495.00" "$8,495.00" "$6,371.25" "$8,495.00" "$8,495.00" "$8,495.00" "$4,247.50" "$4,247.50" "$6,728.04" "$8,495.00" "$6,796.00" "$3,822.75" "$1,686.05" N/A "$4,927.10" "$8,495.00" "$8,495.00" "$8,495.00" "$1,770.36" "$8,495.00" N/A N/A 5549-A-221 SUP HCPCS C1776 5549-A-221 - AUGMENT TIB B CONE TRTHLN ASYM TRITANIUM KN LT MDL RL REV BOTH IP/OP "$9,085.00" "$6,723.00" "$1,803.15" "$9,085.00" "$4,088.25" "$4,088.25" "$4,088.25" "$4,088.25" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.54" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.41" "$9,085.00" "$3,634.00" "$4,478.91" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$6,813.75" "$9,085.00" "$9,085.00" "$9,085.00" "$4,542.50" "$4,542.50" "$7,195.32" "$9,085.00" "$7,268.00" "$4,088.25" "$1,803.15" N/A "$5,269.30" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.31" "$9,085.00" N/A N/A 5549-A-222 SUP HCPCS C1776 5549-A-222 - AUGMENT TIB B CONE STRL TRTHLN ASYM TRITANIUM KN RMLL BOTH IP/OP "$9,085.00" "$6,723.00" "$1,803.15" "$9,085.00" "$4,088.25" "$4,088.25" "$4,088.25" "$4,088.25" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.54" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.41" "$9,085.00" "$9,085.00" "$4,478.91" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$6,813.75" "$9,085.00" "$9,085.00" "$9,085.00" "$4,542.50" "$4,542.50" "$7,195.32" "$9,085.00" "$7,268.00" "$4,088.25" "$1,803.15" N/A "$5,269.30" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.31" "$9,085.00" N/A N/A 5549-A-231 SUP HCPCS C1776 5549-A-231 - AUGMENT TIB C CONE TRTHLN ASYM TRITANIUM KN LT MDL RL REV BOTH IP/OP "$9,085.00" "$6,723.00" "$1,803.15" "$9,085.00" "$4,088.25" "$4,088.25" "$4,088.25" "$4,088.25" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.54" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.41" "$9,085.00" "$3,634.00" "$4,478.91" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$6,813.75" "$9,085.00" "$9,085.00" "$9,085.00" "$4,542.50" "$4,542.50" "$7,195.32" "$9,085.00" "$7,268.00" "$4,088.25" "$1,803.15" N/A "$5,269.30" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.31" "$9,085.00" N/A N/A 5549-A-232 SUP HCPCS C1776 5549-A-232 - AUGMENT TIB C CONE TRTHLN ASYM REV TRITANIUM KN RMLL BOTH IP/OP "$9,085.00" "$6,723.00" "$1,803.15" "$9,085.00" "$4,088.25" "$4,088.25" "$4,088.25" "$4,088.25" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.54" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.41" "$9,085.00" "$9,085.00" "$4,478.91" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$6,813.75" "$9,085.00" "$9,085.00" "$9,085.00" "$4,542.50" "$4,542.50" "$7,195.32" "$9,085.00" "$7,268.00" "$4,088.25" "$1,803.15" N/A "$5,269.30" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.31" "$9,085.00" N/A N/A 5549-A-241 SUP HCPCS C1776 5549-A-241 - AUGMENT TIB D CONE TRTHLN ASYM TRITANIUM KN LT MDL RL REV BOTH IP/OP "$9,085.00" "$6,723.00" "$1,803.15" "$9,085.00" "$4,088.25" "$4,088.25" "$4,088.25" "$4,088.25" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.54" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.41" "$9,085.00" "$3,634.00" "$4,478.91" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$6,813.75" "$9,085.00" "$9,085.00" "$9,085.00" "$4,542.50" "$4,542.50" "$7,195.32" "$9,085.00" "$7,268.00" "$4,088.25" "$1,803.15" N/A "$5,269.30" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.31" "$9,085.00" N/A N/A 5549-A-242 SUP HCPCS C1776 5549-A-242 - AUGMENT TIB D CONE TRTHLN ASYM TRITANIUM KN RMLL REV SYS BOTH IP/OP "$9,085.00" "$6,723.00" "$1,803.15" "$9,085.00" "$4,088.25" "$4,088.25" "$4,088.25" "$4,088.25" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.54" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.41" "$9,085.00" "$9,085.00" "$4,478.91" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$6,813.75" "$9,085.00" "$9,085.00" "$9,085.00" "$4,542.50" "$4,542.50" "$7,195.32" "$9,085.00" "$7,268.00" "$4,088.25" "$1,803.15" N/A "$5,269.30" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.31" "$9,085.00" N/A N/A 5549-A-251 SUP HCPCS C1776 5549-A-251 - AUGMENT TIB E CONE TRTHLN ASYM REV TRITANIUM KN LT MDL RL BOTH IP/OP "$9,085.00" "$6,723.00" "$1,803.15" "$9,085.00" "$4,088.25" "$4,088.25" "$4,088.25" "$4,088.25" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.54" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.41" "$9,085.00" "$9,085.00" "$4,478.91" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$6,813.75" "$9,085.00" "$9,085.00" "$9,085.00" "$4,542.50" "$4,542.50" "$7,195.32" "$9,085.00" "$7,268.00" "$4,088.25" "$1,803.15" N/A "$5,269.30" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.31" "$9,085.00" N/A N/A 5549-A-252 SUP HCPCS C1776 5549-A-252 - AUGMENT TIB E CONE TRTHLN ASYM REV TRITANIUM KN RMLL BOTH IP/OP "$9,085.00" "$6,723.00" "$1,803.15" "$9,085.00" "$4,088.25" "$4,088.25" "$4,088.25" "$4,088.25" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.54" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.41" "$9,085.00" "$3,634.00" "$4,478.91" "$9,085.00" "$9,085.00" "$9,085.00" "$9,085.00" "$6,813.75" "$9,085.00" "$9,085.00" "$9,085.00" "$4,542.50" "$4,542.50" "$7,195.32" "$9,085.00" "$7,268.00" "$4,088.25" "$1,803.15" N/A "$5,269.30" "$9,085.00" "$9,085.00" "$9,085.00" "$1,893.31" "$9,085.00" N/A N/A 5549-A-321 SUP HCPCS C1776 5549-A-321 - AUGMENT FEM 1 2 CONE TRTHLN TRITANIUM KN LT REV SYS BOTH IP/OP "$9,675.00" "$7,160.00" "$1,920.25" "$9,675.00" "$4,353.75" "$4,353.75" "$4,353.75" "$4,353.75" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.51" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.38" "$9,675.00" "$3,870.00" "$4,769.78" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$7,256.25" "$9,675.00" "$9,675.00" "$9,675.00" "$4,837.50" "$4,837.50" "$7,662.60" "$9,675.00" "$7,740.00" "$4,353.75" "$1,920.25" N/A "$5,611.50" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.27" "$9,675.00" N/A N/A 5549-A-322 SUP HCPCS C1776 5549-A-322 - AUGMENT FEM 1 2 CONE TRTHLN REV TRITANIUM KN RT BOTH IP/OP "$9,675.00" "$7,160.00" "$1,920.25" "$9,675.00" "$4,353.75" "$4,353.75" "$4,353.75" "$4,353.75" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.51" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.38" "$9,675.00" "$9,675.00" "$4,769.78" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$7,256.25" "$9,675.00" "$9,675.00" "$9,675.00" "$4,837.50" "$4,837.50" "$7,662.60" "$9,675.00" "$7,740.00" "$4,353.75" "$1,920.25" N/A "$5,611.50" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.27" "$9,675.00" N/A N/A 5549-A-331 SUP HCPCS C1776 5549-A-331 - AUGMENT FEM 3 CONE TRTHLN REV TRITANIUM KN LT BOTH IP/OP "$9,675.00" "$7,160.00" "$1,920.25" "$9,675.00" "$4,353.75" "$4,353.75" "$4,353.75" "$4,353.75" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.51" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.38" "$9,675.00" "$3,870.00" "$4,769.78" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$7,256.25" "$9,675.00" "$9,675.00" "$9,675.00" "$4,837.50" "$4,837.50" "$7,662.60" "$9,675.00" "$7,740.00" "$4,353.75" "$1,920.25" N/A "$5,611.50" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.27" "$9,675.00" N/A N/A 5549-A-332 SUP HCPCS C1776 5549-A-332 - AUGMENT FEM 3 CONE TRTHLN TRITANIUM KN RT REV SYS BOTH IP/OP "$9,675.00" "$7,160.00" "$1,920.25" "$9,675.00" "$4,353.75" "$4,353.75" "$4,353.75" "$4,353.75" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.51" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.38" "$9,675.00" "$3,870.00" "$4,769.78" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$7,256.25" "$9,675.00" "$9,675.00" "$9,675.00" "$4,837.50" "$4,837.50" "$7,662.60" "$9,675.00" "$7,740.00" "$4,353.75" "$1,920.25" N/A "$5,611.50" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.27" "$9,675.00" N/A N/A 5549-A-341 SUP HCPCS C1776 5549-A-341 - AUGMENT FEM 4 CONE TRTHLN REV TRITANIUM KN LT BOTH IP/OP "$9,675.00" "$7,160.00" "$1,920.25" "$9,675.00" "$4,353.75" "$4,353.75" "$4,353.75" "$4,353.75" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.51" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.38" "$9,675.00" "$9,675.00" "$4,769.78" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$7,256.25" "$9,675.00" "$9,675.00" "$9,675.00" "$4,837.50" "$4,837.50" "$7,662.60" "$9,675.00" "$7,740.00" "$4,353.75" "$1,920.25" N/A "$5,611.50" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.27" "$9,675.00" N/A N/A 5549-A-342 SUP HCPCS C1776 5549-A-342 - AUGMENT FEM 4 CONE TRTHLN TRITANIUM KN RT REV SYS BOTH IP/OP "$9,675.00" "$7,160.00" "$1,920.25" "$9,675.00" "$4,353.75" "$4,353.75" "$4,353.75" "$4,353.75" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.51" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.38" "$9,675.00" "$3,870.00" "$4,769.78" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$7,256.25" "$9,675.00" "$9,675.00" "$9,675.00" "$4,837.50" "$4,837.50" "$7,662.60" "$9,675.00" "$7,740.00" "$4,353.75" "$1,920.25" N/A "$5,611.50" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.27" "$9,675.00" N/A N/A 5549-A-351 SUP HCPCS C1776 5549-A-351 - AUGMENT FEM 5 CONE TRTHLN TRITANIUM KN LT REV SYS BOTH IP/OP "$9,675.00" "$7,160.00" "$1,920.25" "$9,675.00" "$4,353.75" "$4,353.75" "$4,353.75" "$4,353.75" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.51" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.38" "$9,675.00" "$3,870.00" "$4,769.78" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$7,256.25" "$9,675.00" "$9,675.00" "$9,675.00" "$4,837.50" "$4,837.50" "$7,662.60" "$9,675.00" "$7,740.00" "$4,353.75" "$1,920.25" N/A "$5,611.50" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.27" "$9,675.00" N/A N/A 5549-A-352 SUP HCPCS C1776 5549-A-352 - AUGMENT FEM 5 CONE TRTHLN REV TRITANIUM KN RT BOTH IP/OP "$9,675.00" "$7,160.00" "$1,920.25" "$9,675.00" "$4,353.75" "$4,353.75" "$4,353.75" "$4,353.75" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.51" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.38" "$9,675.00" "$3,870.00" "$4,769.78" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$7,256.25" "$9,675.00" "$9,675.00" "$9,675.00" "$4,837.50" "$4,837.50" "$7,662.60" "$9,675.00" "$7,740.00" "$4,353.75" "$1,920.25" N/A "$5,611.50" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.27" "$9,675.00" N/A N/A 5549-A-361 SUP HCPCS C1776 5549-A-361 - AUGMENT FEM 6 CONE TRTHLN REV TRITANIUM KN LT BOTH IP/OP "$9,675.00" "$7,160.00" "$1,920.25" "$9,675.00" "$4,353.75" "$4,353.75" "$4,353.75" "$4,353.75" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.51" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.38" "$9,675.00" "$3,870.00" "$4,769.78" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$7,256.25" "$9,675.00" "$9,675.00" "$9,675.00" "$4,837.50" "$4,837.50" "$7,662.60" "$9,675.00" "$7,740.00" "$4,353.75" "$1,920.25" N/A "$5,611.50" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.27" "$9,675.00" N/A N/A 5549-A-362 SUP HCPCS C1776 5549-A-362 - AUGMENT FEM 6 CONE TRTHLN REV TRITANIUM KN RT BOTH IP/OP "$9,675.00" "$7,160.00" "$1,920.25" "$9,675.00" "$4,353.75" "$4,353.75" "$4,353.75" "$4,353.75" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.51" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.38" "$9,675.00" "$3,870.00" "$4,769.78" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$7,256.25" "$9,675.00" "$9,675.00" "$9,675.00" "$4,837.50" "$4,837.50" "$7,662.60" "$9,675.00" "$7,740.00" "$4,353.75" "$1,920.25" N/A "$5,611.50" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.27" "$9,675.00" N/A N/A 5549-A-371 SUP HCPCS C1776 5549-A-371 - AUGMENT FEM 7 8 CONE TRTHLN TRITANIUM KN LT REV SYS BOTH IP/OP "$9,675.00" "$7,160.00" "$1,920.25" "$9,675.00" "$4,353.75" "$4,353.75" "$4,353.75" "$4,353.75" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.51" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.38" "$9,675.00" "$3,870.00" "$4,769.78" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$7,256.25" "$9,675.00" "$9,675.00" "$9,675.00" "$4,837.50" "$4,837.50" "$7,662.60" "$9,675.00" "$7,740.00" "$4,353.75" "$1,920.25" N/A "$5,611.50" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.27" "$9,675.00" N/A N/A 5549-A-372 SUP HCPCS C1776 5549-A-372 - AUGMENT FEM 7 8 CONE TRTHLN REV TRITANIUM KN RT BOTH IP/OP "$9,675.00" "$7,160.00" "$1,920.25" "$9,675.00" "$4,353.75" "$4,353.75" "$4,353.75" "$4,353.75" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.51" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.38" "$9,675.00" "$3,870.00" "$4,769.78" "$9,675.00" "$9,675.00" "$9,675.00" "$9,675.00" "$7,256.25" "$9,675.00" "$9,675.00" "$9,675.00" "$4,837.50" "$4,837.50" "$7,662.60" "$9,675.00" "$7,740.00" "$4,353.75" "$1,920.25" N/A "$5,611.50" "$9,675.00" "$9,675.00" "$9,675.00" "$2,016.27" "$9,675.00" N/A N/A 5550-G-278 SUP Custom 27803010 5550-G-278 - COMPONENT PATLR 27MM 8MM SYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 5550-G-278-E SUP HCPCS C1776 5550-G-278-E - COMPONENT PTLR 27MM 8MM STRL TRTHLN SMTR KN BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 5550-G-298 SUP Custom 27803010 5550-G-298 - COMPONENT PATLR 29MM 8MM SYMMETRIC TRIATHLON X3 TOT KNEE BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 5550-G-298-E SUP HCPCS C1776 5550-G-298-E - COMPONENT PTLR 29MM 8MM STRL TRTHLN SMTR KN BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 5550-G-319 SUP Custom 27803010 5550-G-319 - COMPONENT PATLR 31MM 9MM SYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 5550-G-319-E SUP HCPCS C1776 5550-G-319-E - COMPONENT PTLR 31MM 9MM STRL TRTHLN SMTR KN BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 5550-G-339 SUP Custom 27803010 5550-G-339 - COMPONENT PATLR 33MM 9MM SYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 5550-G-339-E SUP HCPCS C1776 5550-G-339-E - COMPONENT PTLR 33MM 9MM STRL TRTHLN SMTR KN BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 5550-G-360 SUP Custom 27803010 5550-G-360 - COMPONENT PATLR 36MM 10MM SYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 5550-G-360-E SUP HCPCS C1776 5550-G-360-E - COMPONENT PTLR 36MM 10MM STRL TRTHLN SMTR KN BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 5550-G-391 SUP Custom 27803010 5550-G-391 - COMPONENT PATLR 39MM 11MM SYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 5550-G-391-E SUP HCPCS C1776 5550-G-391-E - COMPONENT PTLR 39MM 11MM STRL TRTHLN SMTR KN BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 5550-L-278 SUP Custom 27803010 5550-L-278 - COMPONENT PATLR 27MM 8MM SYMMETRIC TRIATHLON KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 5550-L-298 SUP Custom 27803010 5550-L-298 - COMPONENT PATLR 29MM 8MM SYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 5550-L-319 SUP Custom 27803010 5550-L-319 - COMPONENT PATLR 31MM 9MM SYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 5550-L-339 SUP Custom 27803010 5550-L-339 - COMPONENT PATLR 33MM 9MM SYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 5550-L-360 SUP Custom 27803010 5550-L-360 - COMPONENT PATLR 36MM 10MM SYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 5550-L-391 SUP Custom 27803010 5550-L-391 - COMPONENT PATLR 39MM 11MM SYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 5551-G-299 SUP Custom 27803010 5551-G-299 - COMPONENT PATLR ASYMMETRIC 29MM 9MM TRIATHLON X3 TOT KNEE BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 5551-G-299-E SUP HCPCS C1776 5551-G-299-E - COMPONENT PTLR 29MM 9MM STRL TRTHLN ASYM KN BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 5551-G-320 SUP Custom 27803010 5551-G-320 - COMPONENT PATLR ASYMMETRIC 32MM 10MM TRIATHLON X3 KNEE BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 5551-G-320-E SUP HCPCS C1776 5551-G-320-E - COMPONENT PTLR 32MM 10MM STRL TRTHLN ASYM KN BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 5551-G-350 SUP Custom 27803010 5551-G-350 - COMPONENT PATLR 35MM 10MM ASYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 5551-G-350-E SUP HCPCS C1776 5551-G-350-E - COMPONENT PTLR 35MM 10MM STRL TRTHLN ASYM KN BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 5551-G-381 SUP Custom 27803010 5551-G-381 - COMPONENT PATLR 38MM 11MM ASYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 5551-G-381-E SUP HCPCS C1776 5551-G-381-E - COMPONENT PTLR 38MM 11MM STRL TRTHLN ASYM KN BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 5551-G-401 SUP Custom 27803010 5551-G-401 - COMPONENT PATLR 40MM 11MM ASYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 5551-G-401-E SUP HCPCS C1776 5551-G-401-E - COMPONENT PTLR 40MM 11MM STRL TRTHLN ASYM KN BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A 5551-L-299 SUP Custom 27803010 5551-L-299 - COMPONENT PATLR 29MM 9MM ASYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 5551-L-320 SUP Custom 27803010 5551-L-320 - COMPONENT PATLR 32MM 10MM ASYMMETRIC TRIATHLON KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 5551-L-350 SUP Custom 27803010 5551-L-350 - COMPONENT PATLR 35MM 10MM ASYMMETRIC TRIATHLON KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 5551-L-381 SUP Custom 27803010 5551-L-381 - COMPONENT PATLR 38MM 11MM ASYMMETRIC TRIATHLON BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 5551-L-401 SUP Custom 27803010 5551-L-401 - COMPONENT PATLR 40MM 11MM ASYMMETRIC TRIATHLON X3 KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 5552-L-299 SUP HCPCS C1776 5552-L-299 - COMPONENT PTLR 29MM 9MM TRITANIUM ASYM MTL KN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 5552-L-320 SUP HCPCS C1776 5552-L-320 - COMPONENT PTLR 32MM 10MM ASYM TRITANIUM BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 5552-L-350 SUP HCPCS C1776 5552-L-350 - COMPONENT PTLR 35MM 10MM ASYM TRITANIUM MTL KN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 5552-L-381 SUP HCPCS C1776 5552-L-381 - COMPONENT PTLR 38MM 11MM TRITANIUM ASYM MTL KN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 5552-L-401 SUP HCPCS C1776 5552-L-401 - COMPONENT PTLR 40MM 11MM TRITANIUM ASYM MTL KN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 5554-L-320 SUP Custom 27803010 5554-L-320 - COMPONENT PATLR 32MM 10MM ASYMMETRIC METAL BACKED BEADED BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 5554-L-350 SUP Custom 27803010 5554-L-350 - COMPONENT PATLR 35MM BEAD BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 5554-L-381 SUP Custom 27803010 5554-L-381 - COMPONENT PATLR 38MM 11MM ASYMMETRIC METAL BACKED BEADED BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 5554-L-401 SUP Custom 27803010 5554-L-401 - COMPONENT PATLR 40MM BEAD TRIATHLON PERI-APATITE KNEE BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 5555-2901 SUP Custom 27203010 5555-2901 - BLOCK CUTTING 1 PRECISION KIT TRIATHLON BOTH IP/OP $89.00 $66.00 $15.84 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $15.84 $89.00 $89.00 $66.06 $66.06 $68.60 $46.37 $18.55 $89.00 $35.60 $89.00 $89.00 $89.00 $89.00 $89.00 $66.75 $89.00 $89.00 $89.00 $44.50 $44.50 $70.49 $89.00 $71.20 $57.85 $89.00 N/A $51.62 $89.00 $53.40 $89.00 $89.00 $89.00 N/A N/A 5555-2902 SUP Custom 27203010 5555-2902 - BLOCK CUTTING 2 PRECISION KIT TRIATHLON BOTH IP/OP $89.00 $66.00 $15.84 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $15.84 $89.00 $89.00 $66.06 $66.06 $68.60 $46.37 $18.55 $89.00 $35.60 $89.00 $89.00 $89.00 $89.00 $89.00 $66.75 $89.00 $89.00 $89.00 $44.50 $44.50 $70.49 $89.00 $71.20 $57.85 $89.00 N/A $51.62 $89.00 $53.40 $89.00 $89.00 $89.00 N/A N/A 5555-2903 SUP Custom 27203010 5555-2903 - BLOCK CUTTING 3 PRECISION KIT TRIATHLON BOTH IP/OP $89.00 $66.00 $15.84 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $15.84 $89.00 $89.00 $66.06 $66.06 $68.60 $46.37 $18.55 $89.00 $35.60 $89.00 $89.00 $89.00 $89.00 $89.00 $66.75 $89.00 $89.00 $89.00 $44.50 $44.50 $70.49 $89.00 $71.20 $57.85 $89.00 N/A $51.62 $89.00 $53.40 $89.00 $89.00 $89.00 N/A N/A 5555-2904 SUP Custom 27203010 5555-2904 - BLOCK CUTTING 4 PRECISION KIT TRIATHLON BOTH IP/OP $89.00 $66.00 $15.84 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $15.84 $89.00 $89.00 $66.06 $66.06 $68.60 $46.37 $18.55 $89.00 $35.60 $89.00 $89.00 $89.00 $89.00 $89.00 $66.75 $89.00 $89.00 $89.00 $44.50 $44.50 $70.49 $89.00 $71.20 $57.85 $89.00 N/A $51.62 $89.00 $53.40 $89.00 $89.00 $89.00 N/A N/A 5555-2905 SUP Custom 27203010 5555-2905 - BLOCK CUTTING 5 PRECISION KIT TRIATHLON BOTH IP/OP $89.00 $66.00 $15.84 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $15.84 $89.00 $89.00 $66.06 $66.06 $68.60 $46.37 $18.55 $89.00 $35.60 $89.00 $89.00 $89.00 $89.00 $89.00 $66.75 $89.00 $89.00 $89.00 $44.50 $44.50 $70.49 $89.00 $71.20 $57.85 $89.00 N/A $51.62 $89.00 $53.40 $89.00 $89.00 $89.00 N/A N/A 5555-2906 SUP Custom 27203010 5555-2906 - BLOCK CUTTING 6 PRECISION KIT TRIATHLON BOTH IP/OP $89.00 $66.00 $15.84 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $15.84 $89.00 $89.00 $66.06 $66.06 $68.60 $46.37 $18.55 $89.00 $35.60 $89.00 $89.00 $89.00 $89.00 $89.00 $66.75 $89.00 $89.00 $89.00 $44.50 $44.50 $70.49 $89.00 $71.20 $57.85 $89.00 N/A $51.62 $89.00 $53.40 $89.00 $89.00 $89.00 N/A N/A 5555-2907 SUP Custom 27203010 5555-2907 - BLOCK CUTTING 7 PRECISION KIT TRIATHLON BOTH IP/OP $89.00 $66.00 $15.84 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $15.84 $89.00 $89.00 $66.06 $66.06 $68.60 $46.37 $18.55 $89.00 $35.60 $89.00 $89.00 $89.00 $89.00 $89.00 $66.75 $89.00 $89.00 $89.00 $44.50 $44.50 $70.49 $89.00 $71.20 $57.85 $89.00 N/A $51.62 $89.00 $53.40 $89.00 $89.00 $89.00 N/A N/A 5555-2908 SUP Custom 27203010 5555-2908 - BLOCK CUTTING 8 PRECISION KIT TRIATHLON BOTH IP/OP $89.00 $66.00 $15.84 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $15.84 $89.00 $89.00 $66.06 $66.06 $68.60 $46.37 $18.55 $89.00 $35.60 $89.00 $89.00 $89.00 $89.00 $89.00 $66.75 $89.00 $89.00 $89.00 $44.50 $44.50 $70.49 $89.00 $71.20 $57.85 $89.00 N/A $51.62 $89.00 $53.40 $89.00 $89.00 $89.00 N/A N/A 5555-3201 SUP Custom 27203010 5555-3201 - SET TRAUMA FIX CRUC RET PRECISION TRIATHLON TIBIAL KNEE BOTH IP/OP $168.00 $124.00 $29.90 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $29.90 $168.00 $168.00 $124.69 $124.69 $129.49 $87.53 $35.01 $168.00 $67.20 $168.00 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $109.20 $168.00 N/A $97.44 $168.00 $100.80 $168.00 $168.00 $168.00 N/A N/A 5555-3202 SUP Custom 27203010 5555-3202 - SET TRAUMA FIX CRUC RET PRECISION TRIATHLON TIBIAL KNEE BOTH IP/OP $168.00 $124.00 $29.90 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $29.90 $168.00 $168.00 $124.69 $124.69 $129.49 $87.53 $35.01 $168.00 $67.20 $168.00 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $109.20 $168.00 N/A $97.44 $168.00 $100.80 $168.00 $168.00 $168.00 N/A N/A 5555-3203 SUP Custom 27203010 5555-3203 - SET TRAUMA FIX 3 PRECISION PREPARATION KIT TIBIA CR STD BOTH IP/OP $168.00 $124.00 $29.90 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $29.90 $168.00 $168.00 $124.69 $124.69 $129.49 $87.53 $35.01 $168.00 $67.20 $168.00 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $109.20 $168.00 N/A $97.44 $168.00 $100.80 $168.00 $168.00 $168.00 N/A N/A 5555-3204 SUP Custom 27203010 5555-3204 - SET TRAUMA FIX 4 STANDARD CRUC RET PRECISION PREPARATION KIT BOTH IP/OP $168.00 $124.00 $29.90 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $29.90 $168.00 $168.00 $124.69 $124.69 $129.49 $87.53 $35.01 $168.00 $67.20 $168.00 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $109.20 $168.00 N/A $97.44 $168.00 $100.80 $168.00 $168.00 $168.00 N/A N/A 5555-3205 SUP Custom 27203010 5555-3205 - SET ORTHOPEDIC 5 PREP TRIATHLON BOTH IP/OP $168.00 $124.00 $29.90 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $29.90 $168.00 $168.00 $124.69 $124.69 $129.49 $87.53 $35.01 $168.00 $67.20 $168.00 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $109.20 $168.00 N/A $97.44 $168.00 $100.80 $168.00 $168.00 $168.00 N/A N/A 5555-3206 SUP Custom 27203010 5555-3206 - KIT PREP 6 PRECISION TIBIAL CRUC RET STANDARD TRIATHLON BOTH IP/OP $168.00 $124.00 $29.90 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $29.90 $168.00 $168.00 $124.69 $124.69 $129.49 $87.53 $35.01 $168.00 $67.20 $168.00 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $109.20 $168.00 N/A $97.44 $168.00 $100.80 $168.00 $168.00 $168.00 N/A N/A 5555-3207 SUP Custom 27203010 5555-3207 - SET TRAUMA FIX 7 STANDARD CRUC RET PRECISION PREPARATION KIT BOTH IP/OP $168.00 $124.00 $29.90 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $29.90 $168.00 $168.00 $124.69 $124.69 $129.49 $87.53 $35.01 $168.00 $67.20 $168.00 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $109.20 $168.00 N/A $97.44 $168.00 $100.80 $168.00 $168.00 $168.00 N/A N/A 5555-3208 SUP HCPCS C1713 5555-3208 - SYSTEM BONE CEMENT PREP KIT BIOPREP TIBIA BOTH IP/OP $168.00 $124.00 $33.34 $168.00 $75.60 $75.60 $75.60 $75.60 $168.00 $168.00 $168.00 $35.02 $168.00 $168.00 $168.00 $168.00 $168.00 $35.01 $168.00 $67.20 $99.37 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $75.60 $33.34 N/A $97.44 $168.00 $168.00 $168.00 $35.01 $168.00 N/A N/A 5555-3301 SUP Custom 27203010 5555-3301 - SET TRAUMA FIX CRUC RET PRECISION TRIATHLON TIBIAL KNEE BOTH IP/OP $126.00 $93.00 $22.43 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $22.43 $126.00 $126.00 $93.52 $93.52 $97.12 $65.65 $26.26 $126.00 $50.40 $126.00 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $81.90 $126.00 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 5555-3302 SUP Custom 27203010 5555-3302 - SET TRAUMA FIX CRUC RET PRECISION TRIATHLON TIBIAL KNEE BOTH IP/OP $126.00 $93.00 $22.43 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $22.43 $126.00 $126.00 $93.52 $93.52 $97.12 $65.65 $26.26 $126.00 $50.40 $126.00 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $81.90 $126.00 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 5555-3303 SUP Custom 27203010 5555-3303 - SET TRAUMA FIX CRUC RET PRECISION TRIATHLON TIBIAL KNEE BOTH IP/OP $126.00 $93.00 $22.43 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $22.43 $126.00 $126.00 $93.52 $93.52 $97.12 $65.65 $26.26 $126.00 $50.40 $126.00 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $81.90 $126.00 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 5555-3305 SUP Custom 27203010 5555-3305 - SET ORTHOPEDIC 5 PREP TRIATHLON ECT BOTH IP/OP $126.00 $93.00 $22.43 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $22.43 $126.00 $126.00 $93.52 $93.52 $97.12 $65.65 $26.26 $126.00 $50.40 $126.00 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $81.90 $126.00 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 5555-3306 SUP Custom 27203010 5555-3306 - SET TRAUMA FIX CRUC RET PRECISION TRIATHLON TIBIAL KNEE BOTH IP/OP $126.00 $93.00 $22.43 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $22.43 $126.00 $126.00 $93.52 $93.52 $97.12 $65.65 $26.26 $126.00 $50.40 $126.00 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $81.90 $126.00 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 5555-3307 SUP Custom 27203010 5555-3307 - SET TRAUMA FIX CRUC RET PRECISION TRIATHLON TIBIAL KNEE BOTH IP/OP $126.00 $93.00 $22.43 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $22.43 $126.00 $126.00 $93.52 $93.52 $97.12 $65.65 $26.26 $126.00 $50.40 $126.00 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $81.90 $126.00 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 5555-3308 SUP Custom 27203010 5555-3308 - SET TRAUMA FIX CRUC RET PRECISION TRIATHLON TIBIAL KNEE BOTH IP/OP $126.00 $93.00 $22.43 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $126.00 $22.43 $126.00 $126.00 $93.52 $93.52 $97.12 $65.65 $26.26 $126.00 $50.40 $126.00 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $81.90 $126.00 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 5555-3501 SUP Custom 27203010 5555-3501 - SET TRAUMA FIX POSTERIOR STABILIZED PRECISION TRIATHLON BOTH IP/OP $184.00 $136.00 $32.75 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $32.75 $184.00 $184.00 $136.56 $136.56 $141.83 $95.86 $38.35 $184.00 $73.60 $184.00 $184.00 $184.00 $184.00 $184.00 $138.00 $184.00 $184.00 $184.00 $92.00 $92.00 $145.73 $184.00 $147.20 $119.60 $184.00 N/A $106.72 $184.00 $110.40 $184.00 $184.00 $184.00 N/A N/A 5555-3502 SUP Custom 27203010 5555-3502 - SET TRAUMA FIX POSTERIOR STABILIZED PRECISION TRIATHLON BOTH IP/OP $184.00 $136.00 $32.75 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $32.75 $184.00 $184.00 $136.56 $136.56 $141.83 $95.86 $38.35 $184.00 $73.60 $184.00 $184.00 $184.00 $184.00 $184.00 $138.00 $184.00 $184.00 $184.00 $92.00 $92.00 $145.73 $184.00 $147.20 $119.60 $184.00 N/A $106.72 $184.00 $110.40 $184.00 $184.00 $184.00 N/A N/A 5555-3503 SUP HCPCS C1713 5555-3503 - SYSTEM BONE CEMENT 3 PREPARATION KIT TIBIA BOTH IP/OP $184.00 $136.00 $36.52 $184.00 $82.80 $82.80 $82.80 $82.80 $184.00 $184.00 $184.00 $38.35 $184.00 $184.00 $184.00 $184.00 $184.00 $38.35 $184.00 $73.60 $108.84 $184.00 $184.00 $184.00 $184.00 $138.00 $184.00 $184.00 $184.00 $92.00 $92.00 $145.73 $184.00 $147.20 $82.80 $36.52 N/A $106.72 $184.00 $184.00 $184.00 $184.00 $184.00 N/A N/A 5555-3504 SUP Custom 27203010 5555-3504 - SET TRAUMA FIX 4 STANDARD POSTERIOR STABILIZED PRECISION BOTH IP/OP $184.00 $136.00 $32.75 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $32.75 $184.00 $184.00 $136.56 $136.56 $141.83 $95.86 $38.35 $184.00 $73.60 $184.00 $184.00 $184.00 $184.00 $184.00 $138.00 $184.00 $184.00 $184.00 $92.00 $92.00 $145.73 $184.00 $147.20 $119.60 $184.00 N/A $106.72 $184.00 $110.40 $184.00 $184.00 $184.00 N/A N/A 5555-3505 SUP Custom 27203010 5555-3505 - SET TRAUMA FIX 5 STANDARD POSTERIOR STABILIZED PRECISION BOTH IP/OP $184.00 $136.00 $32.75 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $32.75 $184.00 $184.00 $136.56 $136.56 $141.83 $95.86 $38.35 $184.00 $73.60 $184.00 $184.00 $184.00 $184.00 $184.00 $138.00 $184.00 $184.00 $184.00 $92.00 $92.00 $145.73 $184.00 $147.20 $119.60 $184.00 N/A $106.72 $184.00 $110.40 $184.00 $184.00 $184.00 N/A N/A 5555-3506 SUP Custom 27203010 5555-3506 - SET TRAUMA FIX POSTERIOR STABILIZED PRECISION TRIATHLON BOTH IP/OP $184.00 $136.00 $32.75 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $32.75 $184.00 $184.00 $136.56 $136.56 $141.83 $95.86 $38.35 $184.00 $73.60 $184.00 $184.00 $184.00 $184.00 $184.00 $138.00 $184.00 $184.00 $184.00 $92.00 $92.00 $145.73 $184.00 $147.20 $119.60 $184.00 N/A $106.72 $184.00 $110.40 $184.00 $184.00 $184.00 N/A N/A 5555-3507 SUP Custom 27203010 5555-3507 - SET TRAUMA FIX POSTERIOR STABILIZED PRECISION TRIATHLON BOTH IP/OP $184.00 $136.00 $32.75 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $184.00 $32.75 $184.00 $184.00 $136.56 $136.56 $141.83 $95.86 $38.35 $184.00 $73.60 $184.00 $184.00 $184.00 $184.00 $184.00 $138.00 $184.00 $184.00 $184.00 $92.00 $92.00 $145.73 $184.00 $147.20 $119.60 $184.00 N/A $106.72 $184.00 $110.40 $184.00 $184.00 $184.00 N/A N/A 5555-3508 SUP HCPCS C1713 5555-3508 - SYSTEM BONE CEMENT 8 PREPARATION KIT TIBIA BOTH IP/OP $184.00 $136.00 $36.52 $184.00 $82.80 $82.80 $82.80 $82.80 $184.00 $184.00 $184.00 $38.35 $184.00 $184.00 $184.00 $184.00 $184.00 $38.35 $184.00 $73.60 $108.84 $184.00 $184.00 $184.00 $184.00 $138.00 $184.00 $184.00 $184.00 $92.00 $92.00 $145.73 $184.00 $147.20 $82.80 $36.52 N/A $106.72 $184.00 $184.00 $184.00 $38.35 $184.00 N/A N/A 5555-3701 SUP Custom 27803010 5555-3701 - SET TRAUMA FIX 1 POSTERIOR STABILIZED PRECISION TRIATHLON BOTH IP/OP $158.00 $117.00 $28.12 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $28.12 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $32.93 $158.00 $63.20 $158.00 $158.00 $158.00 $158.00 $158.00 $118.50 $158.00 $158.00 $158.00 $79.00 $79.00 $125.14 $158.00 $126.40 $71.10 $158.00 N/A $91.64 $158.00 $94.80 $158.00 $158.00 $158.00 N/A N/A 5555-3702 SUP Custom 27803010 5555-3702 - SET TRAUMA FIX 2 POSTERIOR STABILIZED PRECISION TRIATHLON BOTH IP/OP $158.00 $117.00 $28.12 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $28.12 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $32.93 $158.00 $63.20 $158.00 $158.00 $158.00 $158.00 $158.00 $118.50 $158.00 $158.00 $158.00 $79.00 $79.00 $125.14 $158.00 $126.40 $71.10 $158.00 N/A $91.64 $158.00 $94.80 $158.00 $158.00 $158.00 N/A N/A 5555-3703 SUP Custom 27203010 5555-3703 - SET TRAUMA FIX 3 POSTERIOR STABILIZED PRECISION TRIATHLON BOTH IP/OP $158.00 $117.00 $28.12 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $28.12 $158.00 $158.00 $117.27 $117.27 $121.79 $82.32 $32.93 $158.00 $63.20 $158.00 $158.00 $158.00 $158.00 $158.00 $118.50 $158.00 $158.00 $158.00 $79.00 $79.00 $125.14 $158.00 $126.40 $102.70 $158.00 N/A $91.64 $158.00 $94.80 $158.00 $158.00 $158.00 N/A N/A 5555-3704 SUP Custom 27203010 5555-3704 - SET TRAUMA FIX 4 POSTERIOR STABILIZED PRECISION TRIATHLON BOTH IP/OP $158.00 $117.00 $28.12 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $28.12 $158.00 $158.00 $117.27 $117.27 $121.79 $82.32 $32.93 $158.00 $63.20 $158.00 $158.00 $158.00 $158.00 $158.00 $118.50 $158.00 $158.00 $158.00 $79.00 $79.00 $125.14 $158.00 $126.40 $102.70 $158.00 N/A $91.64 $158.00 $94.80 $158.00 $158.00 $158.00 N/A N/A 5555-3705 SUP Custom 27203010 5555-3705 - SET TRAUMA FIX 5 POSTERIOR STABILIZED PRECISION TRIATHLON BOTH IP/OP $158.00 $117.00 $28.12 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $28.12 $158.00 $158.00 $117.27 $117.27 $121.79 $82.32 $32.93 $158.00 $63.20 $158.00 $158.00 $158.00 $158.00 $158.00 $118.50 $158.00 $158.00 $158.00 $79.00 $79.00 $125.14 $158.00 $126.40 $102.70 $158.00 N/A $91.64 $158.00 $94.80 $158.00 $158.00 $158.00 N/A N/A 5555-3706 SUP Custom 27203010 5555-3706 - SET TRAUMA FIX 6 POSTERIOR STABILIZED PRECISION TRIATHLON BOTH IP/OP $158.00 $117.00 $28.12 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $28.12 $158.00 $158.00 $117.27 $117.27 $121.79 $82.32 $32.93 $158.00 $63.20 $158.00 $158.00 $158.00 $158.00 $158.00 $118.50 $158.00 $158.00 $158.00 $79.00 $79.00 $125.14 $158.00 $126.40 $102.70 $158.00 N/A $91.64 $158.00 $94.80 $158.00 $158.00 $158.00 N/A N/A 5555-3707 SUP Custom 27203010 5555-3707 - SET TRAUMA FIX 7 POSTERIOR STABILIZED PRECISION TRIATHLON BOTH IP/OP $158.00 $117.00 $28.12 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $28.12 $158.00 $158.00 $117.27 $117.27 $121.79 $82.32 $32.93 $158.00 $63.20 $158.00 $158.00 $158.00 $158.00 $158.00 $118.50 $158.00 $158.00 $158.00 $79.00 $79.00 $125.14 $158.00 $126.40 $102.70 $158.00 N/A $91.64 $158.00 $94.80 $158.00 $158.00 $158.00 N/A N/A 5555-3708 SUP Custom 27803010 5555-3708 - SET TRAUMA FIX 8 POSTERIOR STABILIZED PRECISION TRIATHLON BOTH IP/OP $158.00 $117.00 $28.12 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $28.12 $158.00 $158.00 $158.00 $158.00 $158.00 $158.00 $32.93 $158.00 $63.20 $158.00 $158.00 $158.00 $158.00 $158.00 $118.50 $158.00 $158.00 $158.00 $79.00 $79.00 $125.14 $158.00 $126.40 $71.10 $158.00 N/A $91.64 $158.00 $94.80 $158.00 $158.00 $158.00 N/A N/A 5555-4201 SUP Custom 27203010 5555-4201 - SET TRAUMA FIX CRUC RET PRECISION TRIATHLON KNEE FEMUR BOTH IP/OP $315.00 $233.00 $56.07 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $56.07 $315.00 $315.00 $233.79 $233.79 $242.80 $164.12 $65.65 $315.00 $126.00 $315.00 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $204.75 $315.00 N/A $182.70 $315.00 $189.00 $315.00 $315.00 $315.00 N/A N/A 5555-4202 SUP Custom 27203010 5555-4202 - KIT THR 2 CRUC RET TRIATHLON BOTH IP/OP $315.00 $233.00 $56.07 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $56.07 $315.00 $315.00 $233.79 $233.79 $242.80 $164.12 $65.65 $315.00 $126.00 $315.00 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $204.75 $315.00 N/A $182.70 $315.00 $189.00 $315.00 $315.00 $315.00 N/A N/A 5555-4203 SUP Custom 27203010 5555-4203 - SET ORTHOPEDIC 3 PREP TRIATHLON FEMUR BOTH IP/OP $315.00 $233.00 $56.07 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $56.07 $315.00 $315.00 $233.79 $233.79 $242.80 $164.12 $65.65 $315.00 $126.00 $315.00 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $204.75 $315.00 N/A $182.70 $315.00 $189.00 $315.00 $315.00 $315.00 N/A N/A 5555-4204 SUP Custom 27203010 5555-4204 - SET TRAUMA FIX 4 CRUC RET PRECISION PREPARATION KIT BOTH IP/OP $315.00 $233.00 $56.07 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $56.07 $315.00 $315.00 $233.79 $233.79 $242.80 $164.12 $65.65 $315.00 $126.00 $315.00 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $204.75 $315.00 N/A $182.70 $315.00 $189.00 $315.00 $315.00 $315.00 N/A N/A 5555-4205 SUP Custom 27203010 5555-4205 - SET ORTHOPEDIC 5 PREP TRIATHLON TIBIA BOTH IP/OP $315.00 $233.00 $56.07 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $56.07 $315.00 $315.00 $233.79 $233.79 $242.80 $164.12 $65.65 $315.00 $126.00 $315.00 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $204.75 $315.00 N/A $182.70 $315.00 $189.00 $315.00 $315.00 $315.00 N/A N/A 5555-4206 SUP Custom 27203010 5555-4206 - SET TRAUMA FIX 6 CRUC RET PRECISION PREPARATION KIT BOTH IP/OP $315.00 $233.00 $56.07 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $56.07 $315.00 $315.00 $233.79 $233.79 $242.80 $164.12 $65.65 $315.00 $126.00 $315.00 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $204.75 $315.00 N/A $182.70 $315.00 $189.00 $315.00 $315.00 $315.00 N/A N/A 5555-4207 SUP Custom 27203010 5555-4207 - KIT PREP 7 PRECISION FEMORAL CRUC RET STANDARD TRIATHLON BOTH IP/OP $315.00 $233.00 $56.07 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $56.07 $315.00 $315.00 $233.79 $233.79 $242.80 $164.12 $65.65 $315.00 $126.00 $315.00 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $204.75 $315.00 N/A $182.70 $315.00 $189.00 $315.00 $315.00 $315.00 N/A N/A 5555-4208 SUP HCPCS C1713 5555-4208 - SYSTEM BONE CEMENT PREP KIT BIOPREP FEMUR BOTH IP/OP $315.00 $233.00 $62.52 $315.00 $141.75 $141.75 $141.75 $141.75 $315.00 $315.00 $315.00 $65.65 $315.00 $315.00 $315.00 $315.00 $315.00 $65.65 $315.00 $315.00 $186.32 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $141.75 $62.52 N/A $182.70 $315.00 $315.00 $315.00 $65.65 $315.00 N/A N/A 5555-4301 SUP Custom 27203010 5555-4301 - TRIATHLON PS PRECISION FEMORAL PREP KIT SIZE 1 BOTH IP/OP $341.00 $252.00 $60.70 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $60.70 $341.00 $341.00 $253.09 $253.09 $262.84 $177.66 $71.07 $341.00 $136.40 $341.00 $341.00 $341.00 $341.00 $341.00 $255.75 $341.00 $341.00 $341.00 $170.50 $170.50 $270.07 $341.00 $272.80 $221.65 $341.00 N/A $197.78 $341.00 $204.60 $341.00 $341.00 $341.00 N/A N/A 5555-4302 SUP Custom 27203010 5555-4302 - SET TRAUMA FIX POSTERIOR STABILIZED PRECISION TRIATHLON KNEE BOTH IP/OP $341.00 $252.00 $60.70 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $60.70 $341.00 $341.00 $253.09 $253.09 $262.84 $177.66 $71.07 $341.00 $136.40 $341.00 $341.00 $341.00 $341.00 $341.00 $255.75 $341.00 $341.00 $341.00 $170.50 $170.50 $270.07 $341.00 $272.80 $221.65 $341.00 N/A $197.78 $341.00 $204.60 $341.00 $341.00 $341.00 N/A N/A 5555-4303 SUP HCPCS C1713 5555-4303 - SYSTEM BONE CEMENT 3 PREPARATION KIT FEMUR BOTH IP/OP $341.00 $252.00 $67.68 $341.00 $153.45 $153.45 $153.45 $153.45 $341.00 $341.00 $341.00 $71.07 $341.00 $341.00 $341.00 $341.00 $341.00 $71.07 $341.00 $341.00 $201.70 $341.00 $341.00 $341.00 $341.00 $255.75 $341.00 $341.00 $341.00 $170.50 $170.50 $270.07 $341.00 $272.80 $153.45 $67.68 N/A $197.78 $341.00 $341.00 $341.00 $71.06 $341.00 N/A N/A 5555-4304 SUP Custom 27203010 5555-4304 - SET TRAUMA FIX 4 POSTERIOR STABILIZED PRECISION PREPARATION BOTH IP/OP $341.00 $252.00 $60.70 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $60.70 $341.00 $341.00 $253.09 $253.09 $262.84 $177.66 $71.07 $341.00 $136.40 $341.00 $341.00 $341.00 $341.00 $341.00 $255.75 $341.00 $341.00 $341.00 $170.50 $170.50 $270.07 $341.00 $272.80 $221.65 $341.00 N/A $197.78 $341.00 $204.60 $341.00 $341.00 $341.00 N/A N/A 5555-4305 SUP Custom 27203010 5555-4305 - SET TRAUMA FIX 5 POSTERIOR STABILIZED PRECISION PREPARATION BOTH IP/OP $341.00 $252.00 $60.70 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $60.70 $341.00 $341.00 $253.09 $253.09 $262.84 $177.66 $71.07 $341.00 $136.40 $341.00 $341.00 $341.00 $341.00 $341.00 $255.75 $341.00 $341.00 $341.00 $170.50 $170.50 $270.07 $341.00 $272.80 $221.65 $341.00 N/A $197.78 $341.00 $204.60 $341.00 $341.00 $341.00 N/A N/A 5555-4306 SUP HCPCS C1713 5555-4306 - SYSTEM BONE CEMENT 6 PREPARATION KIT FEMUR BOTH IP/OP $341.00 $252.00 $67.68 $341.00 $153.45 $153.45 $153.45 $153.45 $341.00 $341.00 $341.00 $71.07 $341.00 $341.00 $341.00 $341.00 $341.00 $71.07 $341.00 $136.40 $201.70 $341.00 $341.00 $341.00 $341.00 $255.75 $341.00 $341.00 $341.00 $170.50 $170.50 $270.07 $341.00 $272.80 $153.45 $67.68 N/A $197.78 $341.00 $341.00 $341.00 $71.06 $341.00 N/A N/A 5555-4307 SUP Custom 27203010 5555-4307 - SET TRAUMA FIX POSTERIOR STABILIZED PRECISION TRIATHLON KNEE BOTH IP/OP $341.00 $252.00 $60.70 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $341.00 $60.70 $341.00 $341.00 $253.09 $253.09 $262.84 $177.66 $71.07 $341.00 $136.40 $341.00 $341.00 $341.00 $341.00 $341.00 $255.75 $341.00 $341.00 $341.00 $170.50 $170.50 $270.07 $341.00 $272.80 $221.65 $341.00 N/A $197.78 $341.00 $204.60 $341.00 $341.00 $341.00 N/A N/A 5555-4308 SUP HCPCS C1713 5555-4308 - SYSTEM BONE CEMENT 8 PREPARATION KIT FEMUR BOTH IP/OP $341.00 $252.00 $67.68 $341.00 $153.45 $153.45 $153.45 $153.45 $341.00 $341.00 $341.00 $71.07 $341.00 $341.00 $341.00 $341.00 $341.00 $71.07 $341.00 $136.40 $201.70 $341.00 $341.00 $341.00 $341.00 $255.75 $341.00 $341.00 $341.00 $170.50 $170.50 $270.07 $341.00 $272.80 $153.45 $67.68 N/A $197.78 $341.00 $341.00 $341.00 $71.06 $341.00 N/A N/A 5555-4600 SUP Custom 27203010 5555-4600 - SYSTEM KN TRL 1-8 TRTHLN TIB BOTH IP/OP $100.00 $74.00 $17.80 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $17.80 $100.00 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $40.00 $100.00 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $100.00 N/A $58.00 $100.00 $60.00 $100.00 $100.00 $100.00 N/A N/A 5556-L-319 SUP HCPCS C1776 5556-L-319 - COMPONENT PTLR S 31X9MM STRL LF TRITANIUM BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 5556-L-339 SUP HCPCS C1776 5556-L-339 - COMPONENT PTLR 33MM 9MM SMTR TRITANIUM KN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 5556-L-360 SUP HCPCS C1776 5556-L-360 - COMPONENT PTLR 36MM 10MM TRITANIUM SMTR MTL KN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 5556-L-391 SUP HCPCS C1776 5556-L-391 - COMPONENT PTLR 39MM 11MM TRITANIUM SMTR MTL KN BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" "$1,500.00" $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.60 "$1,500.00" N/A N/A 5560-S-109 SUP Custom 27803010 5560-S-109 - STEM FEMORAL 9MM 50MM CEMENTED TOT STABILIZE TRIATHLON COCR BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 5560-S-112 SUP Custom 27803010 5560-S-112 - STEM FEMORAL 12MM 50MM CEMENTED TOT STABILIZED TRIATHLON BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 5560-S-115 SUP Custom 27803010 5560-S-115 - STEM FEMORAL 15MM 50MM CEMENTED TOT STABILIZE TRIATHLON COCR BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 5560-S-209 SUP Custom 27803010 5560-S-209 - STEM FEMORAL 9MM 100MM CEMENTED TOT STABILIZE TRIATHLON COCR BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 5560-S-212 SUP Custom 27803010 5560-S-212 - STEM FEMORAL 12MM 100MM CEMENTED TOT STABILIZED TRIATHLON BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 5560-S-215 SUP Custom 27803010 5560-S-215 - STEM FEMORAL 15MM 100MM CEMENTED TOT STABILIZE TRIATHLON BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 5560-S-309 SUP Custom 27803010 5560-S-309 - STEM FEMORAL 9MM 150MM CEMENTED TOT STABILIZE TRIATHLON COCR BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 5560-S-312 SUP Custom 27803010 5560-S-312 - STEM FEMORAL 12MM 150MM CEMENTED TOT STABILIZE TRIATHLON BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 5560-S-315 SUP Custom 27803010 5560-S-315 - STEM FEMORAL 15MM 150MM CEMENTED TOT STABILIZE TRIATHLON BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 556-25890 SUP HCPCS C1887 556-25890 - CATH GUID MPD CURVE 5FR .056IN 90CM PTFE ENV BOTH IP/OP $825.00 $611.00 $163.74 $825.00 $447.98 $447.98 $447.98 $447.98 $825.00 $825.00 $825.00 $171.95 $825.00 $612.32 $612.32 $635.91 $429.83 $171.94 $825.00 $825.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $536.25 $163.74 N/A $478.50 $825.00 $825.00 $825.00 $171.93 $825.00 N/A N/A 5565-S-010 SUP Custom 27803010 5565-S-010 - STEM FEMORAL 10MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-011 SUP Custom 27803010 5565-S-011 - STEM FEMORAL 11MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-012 SUP Custom 27803010 5565-S-012 - STEM FEMORAL 12MM 100MM CEMENTLESS TOT STABILIZED TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-013 SUP Custom 27803010 5565-S-013 - STEM FEMORAL 13MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-014 SUP Custom 27803010 5565-S-014 - STEM FEMORAL 14MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-015 SUP Custom 27803010 5565-S-015 - STEM FEMORAL 15MM 100MM CEMENTLESS TOT STABILIZED TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-016 SUP Custom 27803010 5565-S-016 - STEM FEMORAL 16MM 105MM CEMENTLESS TOT STABILIZED TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-017 SUP Custom 27803010 5565-S-017 - STEM FEMORAL 17MM 100MM CEMENTLESS TOT STABILIZED TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-018 SUP Custom 27803010 5565-S-018 - STEM FEMORAL 18MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-019 SUP Custom 27803010 5565-S-019 - STEM FEMORAL 19MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-020 SUP Custom 27803010 5565-S-020 - STEM FEMORAL 20MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-021 SUP Custom 27803010 5565-S-021 - STEM FEMORAL 21MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-022 SUP Custom 27803010 5565-S-022 - STEM FEMORAL 22MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-023 SUP Custom 27803010 5565-S-023 - STEM FEMORAL 23MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-024 SUP Custom 27803010 5565-S-024 - STEM FEMORAL 24MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5565-S-025 SUP Custom 27803010 5565-S-025 - STEM FEMORAL 25MM 100MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,530.00" "$1,872.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $450.34 "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" $527.28 "$2,530.00" "$1,012.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$2,530.00" "$1,897.50" "$2,530.00" "$2,530.00" "$2,530.00" "$1,265.00" "$1,265.00" "$2,003.76" "$2,530.00" "$2,024.00" "$1,138.50" "$2,530.00" N/A "$1,467.40" "$2,530.00" "$1,518.00" "$2,530.00" "$2,530.00" "$2,530.00" N/A N/A 5566-S-010 SUP Custom 27803010 5566-S-010 - STEM FEMORAL 20MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-011 SUP Custom 27803010 5566-S-011 - STEM FEMORAL 11MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-012 SUP Custom 27803010 5566-S-012 - STEM FEMORAL 12MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-013 SUP Custom 27803010 5566-S-013 - STEM FEMORAL 13MM 150MM CEMENTLESS TOT STABILIZED TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-014 SUP Custom 27803010 5566-S-014 - STEM FEMORAL 14MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-015 SUP Custom 27803010 5566-S-015 - STEM FEMORAL 15MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-016 SUP Custom 27803010 5566-S-016 - STEM FEMORAL 16MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-017 SUP Custom 27803010 5566-S-017 - STEM FEMORAL 17MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-018 SUP Custom 27803010 5566-S-018 - STEM FEMORAL 18MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-019 SUP Custom 27803010 5566-S-019 - STEM FEMORAL 19MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-020 SUP Custom 27803010 5566-S-020 - STEM FEMORAL 20MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-021 SUP Custom 27803010 5566-S-021 - STEM FEMORAL 21MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-022 SUP Custom 27803010 5566-S-022 - STEM FEMORAL 22MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-023 SUP Custom 27803010 5566-S-023 - STEM FEMORAL 23MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-024 SUP Custom 27803010 5566-S-024 - STEM FEMORAL 24MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5566-S-025 SUP Custom 27803010 5566-S-025 - STEM FEMORAL 25MM 150MM CEMENTLESS TOT STABILIZE TRIATHLON BOTH IP/OP "$2,635.00" "$1,950.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $469.03 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$1,054.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" "$2,635.00" N/A "$1,528.30" "$2,635.00" "$1,581.00" "$2,635.00" "$2,635.00" "$2,635.00" N/A N/A 5570-S-020 SUP Custom 27803010 5570-S-020 - ADAPTER FEMORAL 2MM OFFST TOT STABILIZE TRIATHLON KNEE BOTH IP/OP "$2,582.50" "$1,911.00" $459.69 "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" $459.69 "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" $538.22 "$2,582.50" "$1,033.00" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$1,936.88" "$2,582.50" "$2,582.50" "$2,582.50" "$1,291.25" "$1,291.25" "$2,045.34" "$2,582.50" "$2,066.00" "$1,162.13" "$2,582.50" N/A "$1,497.85" "$2,582.50" "$1,549.50" "$2,582.50" "$2,582.50" "$2,582.50" N/A N/A 5570-S-040 SUP Custom 27803010 5570-S-040 - ADAPTER FEMORAL 4MM OFFST TOT STABILIZE TRIATHLON KNEE BOTH IP/OP "$2,582.50" "$1,911.00" $459.69 "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" $459.69 "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" $538.22 "$2,582.50" "$1,033.00" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$1,936.88" "$2,582.50" "$2,582.50" "$2,582.50" "$1,291.25" "$1,291.25" "$2,045.34" "$2,582.50" "$2,066.00" "$1,162.13" "$2,582.50" N/A "$1,497.85" "$2,582.50" "$1,549.50" "$2,582.50" "$2,582.50" "$2,582.50" N/A N/A 5570-S-060 SUP Custom 27803010 5570-S-060 - ADAPTER FEMORAL 6MM OFFST TOT STABILIZE TRIATHLON KNEE BOTH IP/OP "$2,582.50" "$1,911.00" $459.69 "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" $459.69 "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" $538.22 "$2,582.50" "$1,033.00" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$1,936.88" "$2,582.50" "$2,582.50" "$2,582.50" "$1,291.25" "$1,291.25" "$2,045.34" "$2,582.50" "$2,066.00" "$1,162.13" "$2,582.50" N/A "$1,497.85" "$2,582.50" "$1,549.50" "$2,582.50" "$2,582.50" "$2,582.50" N/A N/A 5570-S-080 SUP Custom 27803010 5570-S-080 - ADAPTER FEMORAL 8MM OFFST TOT STABILIZE TRIATHLON KNEE BOTH IP/OP "$2,582.50" "$1,911.00" $459.69 "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" $459.69 "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" $538.22 "$2,582.50" "$1,033.00" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$2,582.50" "$1,936.88" "$2,582.50" "$2,582.50" "$2,582.50" "$1,291.25" "$1,291.25" "$2,045.34" "$2,582.50" "$2,066.00" "$1,162.13" "$2,582.50" N/A "$1,497.85" "$2,582.50" "$1,549.50" "$2,582.50" "$2,582.50" "$2,582.50" N/A N/A 5571-S-025 SUP Custom 27803010 5571-S-025 - EXTENSION STEM 25MM TOT STABILIZE TRIATHLON KNEE FEMUR BOTH IP/OP "$2,402.50" "$1,778.00" $427.65 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $427.65 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" "$2,402.50" N/A "$1,393.45" "$2,402.50" "$1,441.50" "$2,402.50" "$2,402.50" "$2,402.50" N/A N/A 5571-S-050 SUP Custom 27803010 5571-S-050 - EXTENSION STEM 50MM TOT STABILIZE TRIATHLON KNEE FEMUR BOTH IP/OP "$2,402.50" "$1,778.00" $427.65 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $427.65 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" "$2,402.50" N/A "$1,393.45" "$2,402.50" "$1,441.50" "$2,402.50" "$2,402.50" "$2,402.50" N/A N/A 5575-X-000 SUP HCPCS C1713 5575-X-000 - PEG FIX MODULAR TRIATHLON DISTAL FEMUR KNEE BOTH IP/OP $880.00 $651.00 $174.66 $880.00 $396.00 $396.00 $396.00 $396.00 $880.00 $880.00 $880.00 $183.41 $880.00 $880.00 $880.00 $880.00 $880.00 $183.40 $880.00 $352.00 $520.52 $880.00 $880.00 $880.00 $880.00 $660.00 $880.00 $880.00 $880.00 $440.00 $440.00 $696.96 $880.00 $704.00 $396.00 $174.66 N/A $510.40 $880.00 $880.00 $880.00 $183.39 $880.00 N/A N/A 558-10-48D SUP Custom 27803010 558-10-48D - SHELL ACETAB D 48MM TRIDENT PUREFIX ARC-2F HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 558-10-50D SUP Custom 27803010 558-10-50D - SHELL ACETAB D 50MM TRIDENT PUREFIX ARC-2F HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 558-10-52E SUP Custom 27803010 558-10-52E - SHELL ACETAB E 52MM TRIDENT PUREFIX ARC-2F HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 558-10-54E SUP Custom 27803010 558-10-54E - SHELL ACETAB E 54MM TRIDENT PUREFIX ARC-2F HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 558-10-56F SUP Custom 27803010 558-10-56F - SHELL ACETAB F 56MM TRIDENT PUREFIX ARC-2F HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 558-10-58F SUP Custom 27803010 558-10-58F - SHELL ACETAB F 58MM TRIDENT PUREFIX ARC-2F HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 558-10-60G SUP Custom 27803010 558-10-60G - SHELL ACETAB G 60MM TRIDENT PUREFIX ARC-2F HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 558-10-62G SUP Custom 27803010 558-10-62G - SHELL ACETAB G 62MM TRIDENT PUREFIX ARC-2F HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 558-10-64H SUP Custom 27803010 558-10-64H - SHELL ACETAB H 64MM TRIDENT PUREFIX ARC-2F HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 558-10-66H SUP Custom 27803010 558-10-66H - SHELL ACETAB H 66MM TRIDENT PUREFIX ARC-2F HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 558-10-68I SUP Custom 27803010 558-10-68I - SHELL ACETAB I 68MM TRIDENT PUREFIX ARC-2F HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 558-10-70I SUP Custom 27803010 558-10-70I - SHELL ACETAB I 70MM TRIDENT PUREFIX ARC-2F HIP BOTH IP/OP "$2,409.00" "$1,783.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $428.80 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" $502.06 "$2,409.00" $963.60 "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$2,409.00" "$1,806.75" "$2,409.00" "$2,409.00" "$2,409.00" "$1,204.50" "$1,204.50" "$1,907.93" "$2,409.00" "$1,927.20" "$1,084.05" "$2,409.00" N/A "$1,397.22" "$2,409.00" "$1,445.40" "$2,409.00" "$2,409.00" "$2,409.00" N/A N/A 5583-A3 SUP HCPCS C1725 5583-A3 - CATHETER ANGIOGRAPHIC .035IN VERT CURVE 5FR .046IN 100CM BOTH IP/OP $30.50 $23.00 $6.05 $30.50 $16.56 $16.56 $16.56 $16.56 $30.50 $30.50 $30.50 $6.36 $30.50 $22.64 $22.64 $23.51 $15.89 $6.36 $30.50 $30.50 $18.04 $30.50 $30.50 $30.50 $30.50 $22.88 $30.50 $30.50 $30.50 $15.25 $15.25 $24.16 $30.50 $24.40 $19.83 $6.05 N/A $17.69 $30.50 $30.50 $30.50 $6.36 $30.50 N/A N/A 5585-C-016 SUP HCPCS C1713 5585-C-016 - SCREW BN 6.5MM 16MM TRTHLN VIT CANC T/K SYS BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5585-C-020 SUP HCPCS C1713 5585-C-020 - SCREW BASEPLATE 6.5MM 20MM TRIATHLON VITALLIUM KNEE TIBIA BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 5585-C-025 SUP HCPCS C1713 5585-C-025 - SCREW BASEPLATE 6.5MM 25MM TRIATHLON VITALLIUM KNEE TIBIA BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5585-C-030 SUP HCPCS C1713 5585-C-030 - SCREW BASEPLATE 6.5MM 30MM TRIATHLON VITALLIUM KNEE TIBIA BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5585-C-035 SUP HCPCS C1713 5585-C-035 - SCREW BASEPLATE 6.5MM 35MM TRIATHLON VITALLIUM KNEE TIBIA BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5585-C-040 SUP HCPCS C1713 5585-C-040 - SCREW BASEPLATE 6.5MM 40MM TRIATHLON VITALLIUM KNEE TIBIA BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5585-C-045 SUP HCPCS C1713 5585-C-045 - SCREW BASEPLATE 6.5MM 45MM TRIATHLON VITALLIUM KNEE TIBIA BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5585-C-050 SUP HCPCS C1713 5585-C-050 - SCREW BASEPLATE 6.5MM 50MM TRIATHLON VITALLIUM KNEE TIBIA BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 5585-C-055 SUP HCPCS C1713 5585-C-055 - SCREW BN 6.5MM 55MM TRTHLN VIT CANC BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 5585-C-060 SUP HCPCS C1713 5585-C-060 - SCREW BN 6.5MM 60MM TRTHLN VIT CANC BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 5591-B3 SUP HCPCS C1725 5591-B3 - CATHETER ANGIOGRAPHIC MOTARJEME CURVE 5FR .046IN 100CM BRAID BOTH IP/OP $30.00 $22.00 $5.88 $29.65 $16.10 $16.10 $16.10 $16.10 $29.65 $29.65 $29.65 $6.18 $29.65 $22.01 $22.01 $22.85 $15.45 $6.18 $29.65 $29.65 $17.54 $29.65 $29.65 $29.65 $29.65 $22.50 $29.65 $29.65 $29.65 $14.83 $14.83 $23.48 $29.65 $23.72 $19.27 $5.88 N/A $17.40 $29.65 $29.65 $29.65 $6.18 $29.65 N/A N/A 55-969-30-04 SUP HCPCS C1713 55-969-30-04 - TRAY INSTR 30X30CM MODULE LEVEL 1 BOTH IP/OP "$2,413.00" "$1,786.00" $478.88 "$2,412.78" "$1,085.75" "$1,085.75" "$1,085.75" "$1,085.75" "$2,412.78" "$2,412.78" "$2,412.78" $502.88 "$2,412.78" "$2,412.78" "$2,412.78" "$2,412.78" "$2,412.78" $502.85 "$2,412.78" $965.11 "$1,427.16" "$2,412.78" "$2,412.78" "$2,412.78" "$2,412.78" "$1,809.75" "$2,412.78" "$2,412.78" "$2,412.78" "$1,206.39" "$1,206.39" "$1,910.92" "$2,412.78" "$1,930.22" "$1,085.75" $478.88 N/A "$1,399.54" "$2,412.78" "$2,412.78" "$2,412.78" "$2,412.78" "$2,412.78" N/A N/A 55-969-98-04 SUP Custom 27803010 55-969-98-04 - CLIP INSTR 3 STACK LEFT LEVEL I SYSTEM BOTH IP/OP $579.50 $429.00 $103.13 $579.38 $579.38 $579.38 $579.38 $579.38 $579.38 $579.38 $103.13 $579.38 $579.38 $579.38 $579.38 $579.38 $579.38 $120.75 $579.38 $231.75 $579.38 $579.38 $579.38 $579.38 $579.38 $434.63 $579.38 $579.38 $579.38 $289.69 $289.69 $458.87 $579.38 $463.50 $260.72 $579.38 N/A $336.11 $579.38 $347.63 $579.38 $579.38 $579.38 N/A N/A 55-969-99-04 SUP Custom 27803010 55-969-99-04 - CLIP INSTR 3 STACK RIGHT LEVEL I SYSTEM BOTH IP/OP $579.50 $429.00 $103.13 $579.38 $579.38 $579.38 $579.38 $579.38 $579.38 $579.38 $103.13 $579.38 $579.38 $579.38 $579.38 $579.38 $579.38 $120.75 $579.38 $231.75 $579.38 $579.38 $579.38 $579.38 $579.38 $434.63 $579.38 $579.38 $579.38 $289.69 $289.69 $458.87 $579.38 $463.50 $260.72 $579.38 N/A $336.11 $579.38 $347.63 $579.38 $579.38 $579.38 N/A N/A 56-00400 SUP HCPCS C1713 56-00400 - WASHER SPINAL BICONCAVE 4MM SALZBURG TITANIUM BOTH IP/OP $74.50 $55.00 $14.70 $74.08 $33.34 $33.34 $33.34 $33.34 $74.08 $74.08 $74.08 $15.44 $74.08 $74.08 $74.08 $74.08 $74.08 $15.44 $74.08 $29.63 $43.82 $74.08 $74.08 $74.08 $74.08 $55.88 $74.08 $74.08 $74.08 $37.04 $37.04 $58.67 $74.08 $59.26 $33.34 $14.70 N/A $43.21 $74.08 $44.45 $74.08 $15.44 $74.08 N/A N/A 5601-0-901 SUP HCPCS C1713 5601-0-901 - TRAY STERILIZATION ICS SEMI TUBULAR PLATE BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $302.50 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $181.50 $302.50 $63.04 $302.50 N/A N/A 5601-0-902 SUP HCPCS C1713 5601-0-902 - TRAY STERILIZATION ICS NARROW PLATE BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $302.50 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $302.50 $302.50 N/A N/A 5601-0-903 SUP HCPCS C1713 5601-0-903 - TRAY STERILIZATION ICS BROAD PLATE BOTH IP/OP $302.50 $224.00 $60.04 $302.50 $136.13 $136.13 $136.13 $136.13 $302.50 $302.50 $302.50 $63.05 $302.50 $302.50 $302.50 $302.50 $302.50 $63.04 $302.50 $302.50 $178.93 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $136.13 $60.04 N/A $175.45 $302.50 $302.50 $302.50 $63.04 $302.50 N/A N/A 5601-0-904 SUP Custom 27203010 5601-0-904 - CASE STERILIZATION LARGE SCREWS BOTH IP/OP $459.50 $340.00 $81.75 $459.25 $459.25 $459.25 $459.25 $459.25 $459.25 $459.25 $81.75 $459.25 $459.25 $340.86 $340.86 $353.99 $239.27 $95.71 $459.25 $183.70 $459.25 $459.25 $459.25 $459.25 $459.25 $344.63 $459.25 $459.25 $459.25 $229.63 $229.63 $363.73 $459.25 $367.40 $298.51 $459.25 N/A $266.51 $459.25 $275.55 $459.25 $459.25 $459.25 N/A N/A 5601-0-908 SUP Custom 27203010 5601-0-908 - TRAY STERILIZATION ICS DRILL TAPS BOTH IP/OP $481.50 $356.00 $85.66 $481.25 $481.25 $481.25 $481.25 $481.25 $481.25 $481.25 $85.66 $481.25 $481.25 $357.18 $357.18 $370.95 $250.73 $100.30 $481.25 $192.50 $481.25 $481.25 $481.25 $481.25 $481.25 $361.13 $481.25 $481.25 $481.25 $240.63 $240.63 $381.15 $481.25 $385.00 $312.81 $481.25 N/A $279.27 $481.25 $288.75 $481.25 $481.25 $481.25 N/A N/A 5601-0-909 SUP Custom 27203010 5601-0-909 - TRAY STERILIZATION ICS DRILL GUIDES BOTH IP/OP $302.50 $224.00 $53.85 $302.50 $302.50 $302.50 $302.50 $302.50 $302.50 $302.50 $53.85 $302.50 $302.50 $224.52 $224.52 $233.17 $157.60 $63.04 $302.50 $121.00 $302.50 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $196.63 $302.50 N/A $175.45 $302.50 $181.50 $302.50 $302.50 $302.50 N/A N/A 5601-1-900 SUP Custom 27203010 5601-1-900 - CASE STERILIZATION ICS FRAGMENTATION BOTH IP/OP $461.00 $341.00 $81.99 $460.63 $460.63 $460.63 $460.63 $460.63 $460.63 $460.63 $81.99 $460.63 $460.63 $341.88 $341.88 $355.05 $239.99 $96.00 $460.63 $184.25 $460.63 $460.63 $460.63 $460.63 $460.63 $345.75 $460.63 $460.63 $460.63 $230.32 $230.32 $364.82 $460.63 $368.50 $299.41 $460.63 N/A $267.38 $460.63 $276.38 $460.63 $460.63 $460.63 N/A N/A 5601-1-901 SUP Custom 27203010 5601-1-901 - RACK STERILIZATION SMALL SCREW ICS BOTH IP/OP $726.00 $537.00 $129.23 $726.00 $726.00 $726.00 $726.00 $726.00 $726.00 $726.00 $129.23 $726.00 $726.00 $538.84 $538.84 $559.60 $378.25 $151.31 $726.00 $290.40 $726.00 $726.00 $726.00 $726.00 $726.00 $544.50 $726.00 $726.00 $726.00 $363.00 $363.00 $574.99 $726.00 $580.80 $471.90 $726.00 N/A $421.08 $726.00 $435.60 $726.00 $726.00 $726.00 N/A N/A 5601-1-902 SUP HCPCS C1713 5601-1-902 - TRAY STERILIZATION ICS SMALL PLATE BOTH IP/OP $481.50 $356.00 $95.52 $481.25 $216.56 $216.56 $216.56 $216.56 $481.25 $481.25 $481.25 $100.30 $481.25 $481.25 $481.25 $481.25 $481.25 $100.30 $481.25 $192.50 $284.66 $481.25 $481.25 $481.25 $481.25 $361.13 $481.25 $481.25 $481.25 $240.63 $240.63 $381.15 $481.25 $385.00 $216.56 $95.52 N/A $279.27 $481.25 $288.75 $481.25 $481.25 $481.25 N/A N/A 5601-1-911 SUP Custom 27203010 5601-1-911 - TRAY STERILIZATION ICS SMALL TAP DRILL SLEEVE BOTH IP/OP $357.50 $265.00 $63.64 $357.50 $357.50 $357.50 $357.50 $357.50 $357.50 $357.50 $63.64 $357.50 $357.50 $265.34 $265.34 $275.56 $186.26 $74.51 $357.50 $143.00 $357.50 $357.50 $357.50 $357.50 $357.50 $268.13 $357.50 $357.50 $357.50 $178.75 $178.75 $283.14 $357.50 $286.00 $232.38 $357.50 N/A $207.35 $357.50 $214.50 $357.50 $357.50 $357.50 N/A N/A 5601-1-912 SUP Custom 27203010 5601-1-912 - TRAY STERILIZATION ICS FORCEP BOTH IP/OP $357.50 $265.00 $63.64 $357.50 $357.50 $357.50 $357.50 $357.50 $357.50 $357.50 $63.64 $357.50 $357.50 $265.34 $265.34 $275.56 $186.26 $74.51 $357.50 $143.00 $357.50 $357.50 $357.50 $357.50 $357.50 $268.13 $357.50 $357.50 $357.50 $178.75 $178.75 $283.14 $357.50 $286.00 $232.38 $357.50 N/A $207.35 $357.50 $214.50 $357.50 $357.50 $357.50 N/A N/A 5601-1-913 SUP Custom 27203010 5601-1-913 - TRAY STERILIZATION ICS SMALL DRILL TAPS BOTH IP/OP $357.50 $265.00 $63.64 $357.50 $357.50 $357.50 $357.50 $357.50 $357.50 $357.50 $63.64 $357.50 $357.50 $265.34 $265.34 $275.56 $186.26 $74.51 $357.50 $143.00 $357.50 $357.50 $357.50 $357.50 $357.50 $268.13 $357.50 $357.50 $357.50 $178.75 $178.75 $283.14 $357.50 $286.00 $232.38 $357.50 N/A $207.35 $357.50 $214.50 $357.50 $357.50 $357.50 N/A N/A 5610-F-101 SUP HCPCS C1776 5610-F-101 - COMPONENT FEM 1 TRTHLN PRT KN RSRFC KN LT MDL RL BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$3,302.50" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 5610-F-102 SUP HCPCS C1776 5610-F-102 - COMPONENT FEM 1 TRTHLN RMLL BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$1,321.00" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 5610-F-201 SUP HCPCS C1776 5610-F-201 - COMPONENT FEM 2 TRTHLN PRT KN RSRFC LT MDL RL BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$1,321.00" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 5610-F-202 SUP HCPCS C1776 5610-F-202 - COMPONENT FEM 2 TRTHLN PRT KN RSRFC RMLL BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$1,321.00" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 5610-F-301 SUP HCPCS C1776 5610-F-301 - COMPONENT FEM 3 TRTHLN PRT KN RSRFC LT MDL RL BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$1,321.00" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 5610-F-302 SUP HCPCS C1776 5610-F-302 - COMPONENT FEM 3 TRTHLN PRT KN RSRFC RMLL BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$1,321.00" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 5610-F-401 SUP HCPCS C1776 5610-F-401 - COMPONENT FEM 4 TRTHLN PRT KN RSRFC LT MDL RL BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$3,302.50" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 5610-F-402 SUP HCPCS C1776 5610-F-402 - COMPONENT FEM 4 TRTHLN PRT KN RSRFC RMLL BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$3,302.50" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 5610-F-501 SUP HCPCS C1776 5610-F-501 - COMPONENT FEM 5 TRTHLN PRT KN RSRFC LT MDL RL BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$1,321.00" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 5610-F-502 SUP HCPCS C1776 5610-F-502 - COMPONENT FEM 5 TRTHLN PRT KN RSRFC RMLL BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$1,321.00" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 5610-F-601 SUP HCPCS C1776 5610-F-601 - COMPONENT FEM 6 TRTHLN PRT KN RSRFC LT MDL RL BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$3,302.50" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 5610-F-602 SUP HCPCS C1776 5610-F-602 - COMPONENT FEM 6 TRTHLN PRT KN RSRFC RMLL BOTH IP/OP "$3,302.50" "$2,444.00" $655.46 "$3,302.50" "$1,486.13" "$1,486.13" "$1,486.13" "$1,486.13" "$3,302.50" "$3,302.50" "$3,302.50" $688.32 "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" $688.28 "$3,302.50" "$3,302.50" "$1,628.13" "$3,302.50" "$3,302.50" "$3,302.50" "$3,302.50" "$2,476.88" "$3,302.50" "$3,302.50" "$3,302.50" "$1,651.25" "$1,651.25" "$2,615.58" "$3,302.50" "$2,642.00" "$1,486.13" $655.46 N/A "$1,915.45" "$3,302.50" "$3,302.50" "$3,302.50" $688.24 "$3,302.50" N/A N/A 56-15904 SUP HCPCS C1713 56-15904 - SCREW BONE 1.5MM 4MM SELF DRILL UN3 CRANIOMAXILLOFACIAL BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $99.00 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $148.50 $247.50 $51.58 $247.50 N/A N/A 56-15934 SUP HCPCS C1713 56-15934 - SCREW BN 1.5MM 4MM NS LF UNV NEURO 3 SLF DRL AX STAB BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $148.50 $247.50 $51.58 $247.50 N/A N/A 56-15935 SUP HCPCS C1713 56-15935 - SCREW BN 1.5MM 5MM NS LF UNV NEURO 3 SLF DRL AX STAB BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $247.50 $146.40 $247.50 $247.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A 56-17005 SUP HCPCS C1713 56-17005 - SCREW BN 1.7MM 5MM ST AX STAB LWR PRFL BOTH IP/OP $120.50 $89.00 $23.89 $120.38 $54.17 $54.17 $54.17 $54.17 $120.38 $120.38 $120.38 $25.09 $120.38 $120.38 $120.38 $120.38 $120.38 $25.09 $120.38 $120.38 $71.20 $120.38 $120.38 $120.38 $120.38 $90.38 $120.38 $120.38 $120.38 $60.19 $60.19 $95.34 $120.38 $96.30 $54.17 $23.89 N/A $69.89 $120.38 $120.38 $120.38 $25.09 $120.38 N/A N/A 56-17904 SUP HCPCS C1713 56-17904 - SCREW BN 1.9MM 5MM ER AX STAB LWR PRFL BOTH IP/OP $135.00 $100.00 $26.79 $135.00 $60.75 $60.75 $60.75 $60.75 $135.00 $135.00 $135.00 $28.14 $135.00 $135.00 $135.00 $135.00 $135.00 $28.14 $135.00 $135.00 $79.85 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $60.75 $26.79 N/A $78.30 $135.00 $135.00 $135.00 $28.13 $135.00 N/A N/A 56-19005 SUP HCPCS C1713 56-19005 - NAIL IM 11.5MM 36CM STRL TRGN 2M POST BW RT HINDFOOT FSN BOTH IP/OP $133.00 $98.00 $26.35 $132.75 $59.74 $59.74 $59.74 $59.74 $132.75 $132.75 $132.75 $27.67 $132.75 $132.75 $132.75 $132.75 $132.75 $27.67 $132.75 $132.75 $78.52 $132.75 $132.75 $132.75 $132.75 $99.75 $132.75 $132.75 $132.75 $66.38 $66.38 $105.14 $132.75 $106.20 $59.74 $26.35 N/A $77.14 $132.75 $132.75 $132.75 $27.67 $132.75 N/A N/A 5620-B-101 SUP HCPCS C1776 5620-B-101 - BASEPLATE TIB 1 TRTHLN PRT KN RSRFC LT MDL RL BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 5620-B-102 SUP HCPCS C1776 5620-B-102 - BASEPLATE TIB 1 TRTHLN PRT KN RSRFC RMLL BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 5620-B-201 SUP HCPCS C1776 5620-B-201 - BASEPLATE TIB 2 TRTHLN PRT KN RSRFC LT MDL RL BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 5620-B-202 SUP HCPCS C1776 5620-B-202 - BASEPLATE TIB 2 TRTHLN PRT KN RSRFC RMLL BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" "$2,402.50" "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 5620-B-301 SUP HCPCS C1776 5620-B-301 - BASEPLATE TIB 3 TRTHLN PRT KN RSRFC LT MDL RL BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 5620-B-302 SUP HCPCS C1776 5620-B-302 - BASEPLATE TIB 3 TRTHLN PRT KN RSRFC RMLL BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" "$2,402.50" "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 5620-B-401 SUP HCPCS C1776 5620-B-401 - BASEPLATE TIB 4 TRTHLN PRT KN RSRFC LT MDL RL BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 5620-B-402 SUP HCPCS C1776 5620-B-402 - BASEPLATE TIB 4 TRTHLN PRT KN RSRFC RMLL BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 5620-B-501 SUP HCPCS C1776 5620-B-501 - BASEPLATE TIB 5 TRTHLN PRT KN RSRFC LT MDL RL BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" "$2,402.50" "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 5620-B-502 SUP HCPCS C1776 5620-B-502 - BASEPLATE TIB 5 TRTHLN PRT KN RSRFC RMLL BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 5620-B-601 SUP HCPCS C1776 5620-B-601 - BASEPLATE TIB 6 TRTHLN PRT KN RSRFC LT MDL RL BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 5620-B-602 SUP HCPCS C1776 5620-B-602 - BASEPLATE TIB 6 TRTHLN PRT KN RSRFC RMLL BOTH IP/OP "$2,402.50" "$1,778.00" $476.84 "$2,402.50" "$1,081.13" "$1,081.13" "$1,081.13" "$1,081.13" "$2,402.50" "$2,402.50" "$2,402.50" $500.74 "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" $500.71 "$2,402.50" $961.00 "$1,421.08" "$2,402.50" "$2,402.50" "$2,402.50" "$2,402.50" "$1,801.88" "$2,402.50" "$2,402.50" "$2,402.50" "$1,201.25" "$1,201.25" "$1,902.78" "$2,402.50" "$1,922.00" "$1,081.13" $476.84 N/A "$1,393.45" "$2,402.50" "$2,402.50" "$2,402.50" $500.68 "$2,402.50" N/A N/A 5624-10/16L SUP HCPCS C1776 5624-10/16L - STEM HUMERAL 10MM 165MM CEMENTED IMPLANT COCR STERILE BOTH IP/OP "$6,511.50" "$4,819.00" "$1,292.28" "$6,511.05" "$2,929.97" "$2,929.97" "$2,929.97" "$2,929.97" "$6,511.05" "$6,511.05" "$6,511.05" "$1,357.07" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$1,356.97" "$6,511.05" "$2,604.42" "$3,209.95" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$4,883.63" "$6,511.05" "$6,511.05" "$6,511.05" "$3,255.53" "$3,255.53" "$5,156.75" "$6,511.05" "$5,208.84" "$2,929.97" "$1,292.28" N/A "$3,776.67" "$6,511.05" "$6,511.05" "$6,511.05" "$1,356.90" "$6,511.05" N/A N/A 5624-10/20XL SUP HCPCS C1776 5624-10/20XL - STEM HUMERAL 10MM 205MM CEMENTED IMPLANT COCR STERILE BOTH IP/OP "$7,004.00" "$5,183.00" "$1,390.11" "$7,003.95" "$3,151.78" "$3,151.78" "$3,151.78" "$3,151.78" "$7,003.95" "$7,003.95" "$7,003.95" "$1,459.80" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$1,459.70" "$7,003.95" "$2,801.58" "$3,452.95" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$5,253.00" "$7,003.95" "$7,003.95" "$7,003.95" "$3,501.98" "$3,501.98" "$5,547.13" "$7,003.95" "$5,603.16" "$3,151.78" "$1,390.11" N/A "$4,062.32" "$7,003.95" "$7,003.95" "$7,003.95" "$1,459.62" "$7,003.95" N/A N/A 5624-12/17L SUP HCPCS C1776 5624-12/17L - STEM HUMERAL 12MM 170MM CEMENTED IMPLANT COCR STERILE BOTH IP/OP "$6,511.50" "$4,819.00" "$1,292.28" "$6,511.05" "$2,929.97" "$2,929.97" "$2,929.97" "$2,929.97" "$6,511.05" "$6,511.05" "$6,511.05" "$1,357.07" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$1,356.97" "$6,511.05" "$2,604.42" "$3,209.95" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$4,883.63" "$6,511.05" "$6,511.05" "$6,511.05" "$3,255.53" "$3,255.53" "$5,156.75" "$6,511.05" "$5,208.84" "$2,929.97" "$1,292.28" N/A "$3,776.67" "$6,511.05" "$6,511.05" "$6,511.05" "$1,356.90" "$6,511.05" N/A N/A 5624-12/21XL SUP HCPCS C1776 5624-12/21XL - STEM HUMERAL 12MM 210MM CEMENTED IMPLANT COCR STERILE BOTH IP/OP "$7,004.00" "$5,183.00" "$1,390.11" "$7,003.95" "$3,151.78" "$3,151.78" "$3,151.78" "$3,151.78" "$7,003.95" "$7,003.95" "$7,003.95" "$1,459.80" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$1,459.70" "$7,003.95" "$7,003.95" "$3,452.95" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$5,253.00" "$7,003.95" "$7,003.95" "$7,003.95" "$3,501.98" "$3,501.98" "$5,547.13" "$7,003.95" "$5,603.16" "$3,151.78" "$1,390.11" N/A "$4,062.32" "$7,003.95" "$7,003.95" "$7,003.95" "$1,459.62" "$7,003.95" N/A N/A 5624-14/13 SUP HCPCS C1776 5624-14/13 - STEM HUMERAL 14 135MM CEMENTED ANATOMICAL COCR STERILE BOTH IP/OP "$5,769.50" "$4,269.00" "$1,145.01" "$5,769.05" "$2,596.07" "$2,596.07" "$2,596.07" "$2,596.07" "$5,769.05" "$5,769.05" "$5,769.05" "$1,202.41" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$1,202.33" "$5,769.05" "$2,307.62" "$2,844.14" "$5,769.05" "$5,769.05" "$5,769.05" "$5,769.05" "$4,327.13" "$5,769.05" "$5,769.05" "$5,769.05" "$2,884.53" "$2,884.53" "$4,569.09" "$5,769.05" "$4,615.24" "$2,596.07" "$1,145.01" N/A "$3,346.31" "$5,769.05" "$5,769.05" "$5,769.05" "$1,202.27" "$5,769.05" N/A N/A 5624-14/17L SUP HCPCS C1776 5624-14/17L - STEM HUMERAL 14MM 175MM CEMENTED IMPLANT COCR STERILE BOTH IP/OP "$6,511.50" "$4,819.00" "$1,292.28" "$6,511.05" "$2,929.97" "$2,929.97" "$2,929.97" "$2,929.97" "$6,511.05" "$6,511.05" "$6,511.05" "$1,357.07" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$1,356.97" "$6,511.05" "$6,511.05" "$3,209.95" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$4,883.63" "$6,511.05" "$6,511.05" "$6,511.05" "$3,255.53" "$3,255.53" "$5,156.75" "$6,511.05" "$5,208.84" "$2,929.97" "$1,292.28" N/A "$3,776.67" "$6,511.05" "$3,906.63" "$6,511.05" "$1,356.90" "$6,511.05" N/A N/A 5624-14/21XL SUP HCPCS C1776 5624-14/21XL - STEM HUMERAL 14MM 215MM CEMENTED IMPLANT COCR STERILE BOTH IP/OP "$7,004.00" "$5,183.00" "$1,390.11" "$7,003.95" "$3,151.78" "$3,151.78" "$3,151.78" "$3,151.78" "$7,003.95" "$7,003.95" "$7,003.95" "$1,459.80" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$1,459.70" "$7,003.95" "$2,801.58" "$3,452.95" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$5,253.00" "$7,003.95" "$7,003.95" "$7,003.95" "$3,501.98" "$3,501.98" "$5,547.13" "$7,003.95" "$5,603.16" "$3,151.78" "$1,390.11" N/A "$4,062.32" "$7,003.95" "$4,202.37" "$7,003.95" "$1,459.62" "$7,003.95" N/A N/A 5624-6/15L SUP HCPCS C1776 5624-6/15L - STEM HUMERAL 6MM 155MM CEMENTED IMPLANT COCR STERILE BOTH IP/OP "$6,511.50" "$4,819.00" "$1,292.28" "$6,511.05" "$2,929.97" "$2,929.97" "$2,929.97" "$2,929.97" "$6,511.05" "$6,511.05" "$6,511.05" "$1,357.07" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$1,356.97" "$6,511.05" "$2,604.42" "$3,209.95" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$4,883.63" "$6,511.05" "$6,511.05" "$6,511.05" "$3,255.53" "$3,255.53" "$5,156.75" "$6,511.05" "$5,208.84" "$2,929.97" "$1,292.28" N/A "$3,776.67" "$6,511.05" "$3,906.63" "$6,511.05" "$1,356.90" "$6,511.05" N/A N/A 5624-6/19XL SUP HCPCS C1776 5624-6/19XL - STEM HUMERAL 6MM 195MM CEMENTED IMPLANT COCR STERILE BOTH IP/OP "$7,004.00" "$5,183.00" "$1,390.11" "$7,003.95" "$3,151.78" "$3,151.78" "$3,151.78" "$3,151.78" "$7,003.95" "$7,003.95" "$7,003.95" "$1,459.80" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$1,459.70" "$7,003.95" "$7,003.95" "$3,452.95" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$5,253.00" "$7,003.95" "$7,003.95" "$7,003.95" "$3,501.98" "$3,501.98" "$5,547.13" "$7,003.95" "$5,603.16" "$3,151.78" "$1,390.11" N/A "$4,062.32" "$7,003.95" "$7,003.95" "$7,003.95" "$1,459.62" "$7,003.95" N/A N/A 5624-8/16L SUP HCPCS C1776 5624-8/16L - STEM HUMERAL 8MM 160MM CEMENTED IMPLANT COCR STERILE BOTH IP/OP "$6,511.50" "$4,819.00" "$1,292.28" "$6,511.05" "$2,929.97" "$2,929.97" "$2,929.97" "$2,929.97" "$6,511.05" "$6,511.05" "$6,511.05" "$1,357.07" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$1,356.97" "$6,511.05" "$6,511.05" "$3,209.95" "$6,511.05" "$6,511.05" "$6,511.05" "$6,511.05" "$4,883.63" "$6,511.05" "$6,511.05" "$6,511.05" "$3,255.53" "$3,255.53" "$5,156.75" "$6,511.05" "$5,208.84" "$2,929.97" "$1,292.28" N/A "$3,776.67" "$6,511.05" "$3,906.63" "$6,511.05" "$1,356.90" "$6,511.05" N/A N/A 5624-8/20XL SUP HCPCS C1776 5624-8/20XL - STEM HUMERAL 8MM 200MM CEMENTED IMPLANT COCR STERILE BOTH IP/OP "$7,004.00" "$5,183.00" "$1,390.11" "$7,003.95" "$3,151.78" "$3,151.78" "$3,151.78" "$3,151.78" "$7,003.95" "$7,003.95" "$7,003.95" "$1,459.80" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$1,459.70" "$7,003.95" "$7,003.95" "$3,452.95" "$7,003.95" "$7,003.95" "$7,003.95" "$7,003.95" "$5,253.00" "$7,003.95" "$7,003.95" "$7,003.95" "$3,501.98" "$3,501.98" "$5,547.13" "$7,003.95" "$5,603.16" "$3,151.78" "$1,390.11" N/A "$4,062.32" "$7,003.95" "$4,202.37" "$7,003.95" "$1,459.62" "$7,003.95" N/A N/A 56-25000 SUP HCPCS C1713 56-25000 - SCREW BONE FASTENING TITANIUM CONDYLE MANDIB BOTH IP/OP $246.50 $182.00 $48.92 $246.50 $110.93 $110.93 $110.93 $110.93 $246.50 $246.50 $246.50 $51.38 $246.50 $246.50 $246.50 $246.50 $246.50 $51.37 $246.50 $246.50 $145.80 $246.50 $246.50 $246.50 $246.50 $184.88 $246.50 $246.50 $246.50 $123.25 $123.25 $195.23 $246.50 $197.20 $110.93 $48.92 N/A $142.97 $246.50 $246.50 $246.50 $51.37 $246.50 N/A N/A 56-25001 SUP Custom 27803010 56-25001 - PROSTHESIS TEMPORARY MARX CONDYLE LEFT BOTH IP/OP "$2,382.50" "$1,763.00" $424.04 "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" $424.04 "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" $496.48 "$2,382.23" $952.89 "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" "$1,786.88" "$2,382.23" "$2,382.23" "$2,382.23" "$1,191.12" "$1,191.12" "$1,886.73" "$2,382.23" "$1,905.78" "$1,072.00" "$2,382.23" N/A "$1,381.85" "$2,382.23" "$1,429.34" "$2,382.23" "$2,382.23" "$2,382.23" N/A N/A 56-25002 SUP Custom 27803010 56-25002 - PROSTHESIS TEMPORARY MARX CONDYLE RIGHT BOTH IP/OP "$2,382.50" "$1,763.00" $424.04 "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" $424.04 "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" $496.48 "$2,382.23" $952.89 "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" "$2,382.23" "$1,786.88" "$2,382.23" "$2,382.23" "$2,382.23" "$1,191.12" "$1,191.12" "$1,886.73" "$2,382.23" "$1,905.78" "$1,072.00" "$2,382.23" N/A "$1,381.85" "$2,382.23" "$1,429.34" "$2,382.23" "$2,382.23" "$2,382.23" N/A N/A 5630-G-108 SUP HCPCS C1776 5630-G-108 - INSERT TIB 1 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-109 SUP HCPCS C1776 5630-G-109 - INSERT TIB 1 9MM TRTHLN X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-110 SUP HCPCS C1776 5630-G-110 - INSERT TIB 1 10MM TRTHLN X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-112 SUP HCPCS C1776 5630-G-112 - INSERT TIB 1 12MM TRTHLN X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-120 SUP HCPCS C1776 5630-G-120 - INSERT TIB 1 10MM TRTHLN X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-122 SUP HCPCS C1776 5630-G-122 - INSERT TIB 1 12MM TRTHLN X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-128 SUP HCPCS C1776 5630-G-128 - INSERT TIB 1 8MM TRTHLN X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-129 SUP HCPCS C1776 5630-G-129 - INSERT TIB 1 9MM TRTHLN X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-208 SUP HCPCS C1776 5630-G-208 - INSERT TIB 2 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-209 SUP HCPCS C1776 5630-G-209 - INSERT TIB 2 9MM TRTHLN STRG KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-210 SUP HCPCS C1776 5630-G-210 - INSERT TIB 2 10MM TRTHLN PRT KN RSRFC X3 LT MDL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-212 SUP HCPCS C1776 5630-G-212 - INSERT TIB 2 12MM TRTHLN X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-220 SUP HCPCS C1776 5630-G-220 - INSERT TIB 2 10MM TRTHLN X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-222 SUP HCPCS C1776 5630-G-222 - INSERT TIB 2 12MM TRTHLN X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-228 SUP HCPCS C1776 5630-G-228 - INSERT TIB 2 8MM TRTHLN PRT KN RSRFC X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-229 SUP HCPCS C1776 5630-G-229 - INSERT TIB 2 29MM TRTHLN PRT RSRFC X3 KN RT MDL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-308 SUP HCPCS C1776 5630-G-308 - INSERT TIB 3 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-309 SUP HCPCS C1776 5630-G-309 - INSERT TIB 3 9MM TRTHLN PRT KN RSRFC X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-310 SUP HCPCS C1776 5630-G-310 - INSERT TIB 3 10MM TRTHLN X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-312 SUP HCPCS C1776 5630-G-312 - INSERT TIB 3 12MM TRTHLN X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-320 SUP HCPCS C1776 5630-G-320 - INSERT TIB 3 20MM TRTHLN PRT RSRFC X3 KN RT MDL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-322 SUP HCPCS C1776 5630-G-322 - INSERT TIB 3 12MM TRTHLN X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-328 SUP HCPCS C1776 5630-G-328 - INSERT TIB 3 8MM TRTHLN PRT KN RSRFC X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-329 SUP HCPCS C1776 5630-G-329 - INSERT TIB 3 29MM TRTHLN PRT RSRFC X3 KN RT MDL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-408 SUP HCPCS C1776 5630-G-408 - INSERT TIB 4 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-409 SUP HCPCS C1776 5630-G-409 - INSERT TIB 4 9MM TRTHLN PRT KN RSRFC X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-410 SUP HCPCS C1776 5630-G-410 - INSERT TIB 4 10MM TRTHLN X3 LT MDL RL KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-412 SUP HCPCS C1776 5630-G-412 - INSERT TIB 4 12MM TRTHLN X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-420 SUP HCPCS C1776 5630-G-420 - INSERT TIB 4 10MM TRTHLN X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-422 SUP HCPCS C1776 5630-G-422 - INSERT TIB 4 12MM TRTHLN X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-428 SUP HCPCS C1776 5630-G-428 - INSERT TIB 4 8MM TRTHLN PRT KN RSRFC X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-429 SUP HCPCS C1776 5630-G-429 - INSERT TIB 4 9MM TRTHLN PRT KN RSRFC X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-508 SUP HCPCS C1776 5630-G-508 - INSERT TIB 5 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-509 SUP HCPCS C1776 5630-G-509 - INSERT TIB 5 9MM TRTHLN X3 LT MDL RL KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-510 SUP HCPCS C1776 5630-G-510 - INSERT TIB 5 10MM TRTHLN X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-512 SUP HCPCS C1776 5630-G-512 - INSERT TIB 5 12MM TRTHLN X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-520 SUP HCPCS C1776 5630-G-520 - INSERT TIB 5 10MM TRTHLN X3 RMLL KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-522 SUP HCPCS C1776 5630-G-522 - INSERT TIB 5 12MM TRTHLN X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-528 SUP HCPCS C1776 5630-G-528 - INSERT TIB 5 8MM TRTHLN PRT KN RSRFC X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-529 SUP HCPCS C1776 5630-G-529 - INSERT TIB 5 9MM TRTHLN X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-608 SUP HCPCS C1776 5630-G-608 - INSERT TIB 6 8MM TRTHLN PRT KN RSRFC X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-609 SUP HCPCS C1776 5630-G-609 - INSERT TIB 9 60MM TRTHLN STRG KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-610 SUP HCPCS C1776 5630-G-610 - INSERT TIB 6 10MM TRTHLN X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-612 SUP HCPCS C1776 5630-G-612 - INSERT TIB 6 12MM TRTHLN X3 LT MDL RL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-620 SUP HCPCS C1776 5630-G-620 - INSERT TIB 62MM TRTHLN STRG KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-622 SUP HCPCS C1776 5630-G-622 - INSERT TIB 6 12MM TRTHLN X3 RMLL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-628 SUP HCPCS C1776 5630-G-628 - INSERT TIB 6 TRTHLN PRT RSRFC X3 KN RT MDL BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5630-G-629 SUP HCPCS C1776 5630-G-629 - INSERT TIB 6 9MM TRTHLN KN BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A 5639-0-010 SUP HCPCS C1713 5639-0-010 - SCREW BONE PTHRD 4MM 10MM 5MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $13.75 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $7.16 $34.38 N/A N/A 5639-0-012 SUP HCPCS C1713 5639-0-012 - SCREW BONE PTHRD 4MM 12MM 5MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $13.75 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $7.16 $34.38 N/A N/A 5639-0-014 SUP HCPCS C1713 5639-0-014 - SCREW BONE PTHRD 4MM 14MM 5MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $13.75 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $7.16 $34.38 N/A N/A 5639-0-016 SUP HCPCS C1713 5639-0-016 - SCREW BONE PTHRD 4MM 16MM 6MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $13.75 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $7.16 $34.38 N/A N/A 5639-0-018 SUP HCPCS C1713 5639-0-018 - SCREW BONE PTHRD 4MM 18MM 7MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $7.16 $34.38 N/A N/A 5639-0-020 SUP HCPCS C1713 5639-0-020 - SCREW BONE PTHRD 4MM 20MM 8MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $7.16 $34.38 N/A N/A 5639-0-022 SUP HCPCS C1713 5639-0-022 - SCREW BONE PTHRD 4MM 22MM 9MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $13.75 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $7.16 $34.38 N/A N/A 5639-0-024 SUP HCPCS C1713 5639-0-024 - SCREW BONE PTHRD 4MM 24MM 10MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $13.75 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $7.16 $34.38 N/A N/A 5639-0-026 SUP HCPCS C1713 5639-0-026 - SCREW BONE PTHRD 4MM 26MM 12MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $7.16 $34.38 N/A N/A 5639-0-028 SUP HCPCS C1713 5639-0-028 - SCREW BONE PTHRD 4MM 28MM 14MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $7.16 $34.38 N/A N/A 5639-0-030 SUP HCPCS C1713 5639-0-030 - SCREW BONE PTHRD 4MM 30MM 14MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $7.16 $34.38 N/A N/A 5639-0-035 SUP HCPCS C1713 5639-0-035 - SCREW BONE PTHRD 4MM 35MM 14MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $13.75 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $7.16 $34.38 N/A N/A 5639-0-040 SUP HCPCS C1713 5639-0-040 - SCREW BONE PTHRD 4MM 40MM 14MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $13.75 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $34.38 $34.38 N/A N/A 5639-0-045 SUP HCPCS C1713 5639-0-045 - SCREW BONE PTHRD 4MM 45MM 15MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $34.38 $34.38 N/A N/A 5639-0-050 SUP HCPCS C1713 5639-0-050 - SCREW BONE PTHRD 4MM 50MM 15MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $34.50 $26.00 $6.82 $34.38 $15.47 $15.47 $15.47 $15.47 $34.38 $34.38 $34.38 $7.17 $34.38 $34.38 $34.38 $34.38 $34.38 $7.17 $34.38 $13.75 $20.34 $34.38 $34.38 $34.38 $34.38 $25.88 $34.38 $34.38 $34.38 $17.19 $17.19 $27.23 $34.38 $27.50 $15.47 $6.82 N/A $20.01 $34.38 $34.38 $34.38 $7.16 $34.38 N/A N/A 56-40281 SUP Custom 27803010 56-40281 - WIRE FX 1.4MM 17MM KRSH OLV STP DIST RDS LCK PLT SYS BOTH IP/OP $46.00 $34.00 $8.14 $45.75 $45.75 $45.75 $45.75 $45.75 $45.75 $45.75 $8.14 $45.75 $45.75 $45.75 $45.75 $45.75 $45.75 $9.53 $45.75 $18.30 $45.75 $45.75 $45.75 $45.75 $45.75 $34.50 $45.75 $45.75 $45.75 $22.88 $22.88 $36.23 $45.75 $36.60 $20.59 $45.75 N/A $26.68 $45.75 $27.45 $45.75 $45.75 $45.75 N/A N/A 5645-0-0160 SUP HCPCS C1713 5645-0-0160 - SCREW BONE 4.5MM 16MM SLFTAP CORTICAL BOTH IP/OP $22.00 $16.00 $4.37 $22.00 $9.90 $9.90 $9.90 $9.90 $22.00 $22.00 $22.00 $4.59 $22.00 $22.00 $22.00 $22.00 $22.00 $4.59 $22.00 $22.00 $13.01 $22.00 $22.00 $22.00 $22.00 $16.50 $22.00 $22.00 $22.00 $11.00 $11.00 $17.42 $22.00 $17.60 $9.90 $4.37 N/A $12.76 $22.00 $22.00 $22.00 $4.58 $22.00 N/A N/A 5645-1-014 SUP HCPCS C1713 5645-1-014 - SCREW BONE FULTHD 4.5MM 14MM SLFTAP HEXAGONAL HEAD TITANIUM BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $15.68 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $39.20 $39.20 $39.20 $39.20 N/A N/A 5645-1-016 SUP HCPCS C1713 5645-1-016 - SCREW BONE FULTHD HEXAGON 4.5MM 16MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $15.68 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $39.20 $39.20 $39.20 $39.20 N/A N/A 5645-1-018 SUP HCPCS C1713 5645-1-018 - SCREW BONE FULTHD HEXAGON 4.5MM 18MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $15.68 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $39.20 $39.20 $8.17 $39.20 N/A N/A 5645-1-020 SUP HCPCS C1713 5645-1-020 - SCREW BONE FULTHD HEXAGON 4.5MM 20MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $15.68 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $39.20 $39.20 $8.17 $39.20 N/A N/A 5645-1-022 SUP HCPCS C1713 5645-1-022 - SCREW BONE FULTHD HEXAGON 4.5MM 22MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $15.68 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $39.20 $39.20 $8.17 $39.20 N/A N/A 5645-1-024 SUP HCPCS C1713 5645-1-024 - SCREW BONE FULTHD HEXAGON 4.5MM 24MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $39.20 $39.20 $39.20 $39.20 N/A N/A 5645-1-026 SUP HCPCS C1713 5645-1-026 - SCREW BONE FULTHD HEXAGON 4.5MM 26MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $39.20 $39.20 $39.20 $39.20 N/A N/A 5645-1-028 SUP HCPCS C1713 5645-1-028 - SCREW BONE FULTHD HEXAGON 4.5MM 28MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $15.68 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $8.17 $39.20 N/A N/A 5645-1-030 SUP HCPCS C1713 5645-1-030 - SCREW BONE FULTHD HEXAGON 4.5MM 30MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $39.20 $39.20 N/A N/A 5645-1-032 SUP HCPCS C1713 5645-1-032 - SCREW BONE FULTHD HEXAGON 4.5MM 32MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $39.20 $39.20 N/A N/A 5645-1-034 SUP HCPCS C1713 5645-1-034 - SCREW BONE FULTHD HEXAGON 4.5MM 34MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $39.20 $39.20 $39.20 $39.20 N/A N/A 5645-1-036 SUP HCPCS C1713 5645-1-036 - SCREW BONE FULTHD HEXAGON 4.5MM 36MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $39.20 $39.20 $8.17 $39.20 N/A N/A 5645-1-038 SUP HCPCS C1713 5645-1-038 - SCREW BONE FULTHD HEXAGON 4.5MM 38MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $8.17 $39.20 N/A N/A 5645-1-040 SUP HCPCS C1713 5645-1-040 - SCREW BONE FULTHD HEXAGON 4.5MM 40MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $8.17 $39.20 N/A N/A 5645-1-042 SUP HCPCS C1713 5645-1-042 - SCREW BONE FULTHD HEXAGON 4.5MM 42MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $8.17 $39.20 N/A N/A 5645-1-044 SUP HCPCS C1713 5645-1-044 - SCREW BONE FULTHD HEXAGON 4.5MM 44MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $15.68 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $8.17 $39.20 N/A N/A 5645-1-046 SUP HCPCS C1713 5645-1-046 - SCREW BONE FULTHD HEXAGON 4.5MM 46MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $15.68 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $39.20 $39.20 N/A N/A 5645-1-048 SUP HCPCS C1713 5645-1-048 - SCREW BONE FULTHD HEXAGON 4.5MM 48MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $15.68 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $39.20 $39.20 N/A N/A 5645-1-050 SUP HCPCS C1713 5645-1-050 - SCREW BONE FULTHD HEXAGON 4.5MM 50MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $39.20 $39.20 $39.20 $39.20 N/A N/A 5645-1-052 SUP HCPCS C1713 5645-1-052 - SCREW BONE FULTHD HEXAGON 4.5MM 52MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $39.20 $39.20 N/A N/A 5645-1-054 SUP HCPCS C1713 5645-1-054 - SCREW BONE FULTHD HEXAGON 4.5MM 54MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $15.68 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $39.20 $39.20 N/A N/A 5645-1-056 SUP HCPCS C1713 5645-1-056 - SCREW BONE FULTHD HEXAGON 4.5MM 56MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $15.68 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $8.17 $39.20 N/A N/A 5645-1-058 SUP HCPCS C1713 5645-1-058 - SCREW BONE FULTHD HEXAGON 4.5MM 58MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $15.68 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $39.20 $39.20 $8.17 $39.20 N/A N/A 5645-1-060 SUP HCPCS C1713 5645-1-060 - SCREW BONE FULTHD HEXAGON 4.5MM 60MM SELF TAP CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $15.68 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $8.17 $39.20 N/A N/A 5645-1-064 SUP HCPCS C1713 5645-1-064 - SCREW BONE FULTHD 4.5MM 64MM SLFTAP HEXAGONAL HEAD CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $8.17 $39.20 N/A N/A 5645-1-070 SUP HCPCS C1713 5645-1-070 - SCREW BONE FULTHD 4.5MM 70MM SLFTAP HEXAGONAL HEAD CORTICAL BOTH IP/OP $39.50 $29.00 $7.78 $39.20 $17.64 $17.64 $17.64 $17.64 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $39.20 $39.20 $39.20 $8.17 $39.20 $39.20 $23.19 $39.20 $39.20 $39.20 $39.20 $29.63 $39.20 $39.20 $39.20 $19.60 $19.60 $31.05 $39.20 $31.36 $17.64 $7.78 N/A $22.91 $39.20 $23.52 $39.20 $8.17 $39.20 N/A N/A 5678-1-005 SUP HCPCS C1713 5678-1-005 - PLATE BONE 5 HOLE CORTICAL 3.5 MM SCREWS BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $391.88 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $235.13 $391.88 $81.67 $391.88 N/A N/A 5678-1-010 SUP HCPCS C1713 5678-1-010 - PLATE BONE 10 HOLE CORTICAL 3.5 MM SCREWS BOTH IP/OP $157.00 $116.00 $31.11 $156.75 $70.54 $70.54 $70.54 $70.54 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $156.75 $156.75 $156.75 $32.67 $156.75 $156.75 $92.72 $156.75 $156.75 $156.75 $156.75 $117.75 $156.75 $156.75 $156.75 $78.38 $78.38 $124.15 $156.75 $125.40 $70.54 $31.11 N/A $91.06 $156.75 $94.05 $156.75 $32.67 $156.75 N/A N/A 5680-0-025 SUP HCPCS C1713 5680-0-025 - SCREW BONE PTHRD 6.5MM 25MM 16MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $60.50 $60.50 N/A N/A 5680-0-030 SUP HCPCS C1713 5680-0-030 - SCREW BONE PTHRD 6.5MM 30MM 16MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $60.50 $60.50 N/A N/A 5680-0-035 SUP HCPCS C1713 5680-0-035 - SCREW BONE PTHRD 6.5MM 35MM 16MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $12.61 $60.50 N/A N/A 5680-0-040 SUP HCPCS C1713 5680-0-040 - SCREW BONE HEXAGON 6.5MM 40MM 16MM CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $11.34 $54.40 N/A N/A 5680-0-045 SUP HCPCS C1713 5680-0-045 - SCREW BONE HEXAGON 6.5MM 45MM 16MM CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $54.40 $54.40 N/A N/A 5680-0-050 SUP HCPCS C1713 5680-0-050 - SCREW BONE HEXAGON 6.5MM 50MM 16MM CANCELLOUS BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $24.20 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $60.50 $60.50 N/A N/A 5680-0-055 SUP HCPCS C1713 5680-0-055 - SCREW BONE HEXAGON 6.5MM 55MM 16MM CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $21.76 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $11.34 $54.40 N/A N/A 5680-0-060 SUP HCPCS C1713 5680-0-060 - SCREW BONE HEXAGON 6.5MM 60MM 16MM CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $21.76 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $54.40 $54.40 N/A N/A 5680-0-065 SUP HCPCS C1713 5680-0-065 - SCREW BONE HEXAGON 6.5MM 65MM 16MM CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $11.34 $54.40 N/A N/A 5680-0-070 SUP HCPCS C1713 5680-0-070 - SCREW BONE HEXAGON 6.5MM 70MM 16MM CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $21.76 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $11.34 $54.40 N/A N/A 5680-0-075 SUP HCPCS C1713 5680-0-075 - SCREW BONE HEXAGON 6.5MM 75MM 16MM CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $21.76 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $11.34 $54.40 N/A N/A 5680-0-080 SUP HCPCS C1713 5680-0-080 - SCREW BONE HEXAGON 6.5MM 80MM 16MM CANCELLOUS BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $12.61 $60.50 N/A N/A 5680-0-085 SUP HCPCS C1713 5680-0-085 - SCREW BONE PTHRD 6.5MM 85MM 16MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $54.40 $54.40 $11.34 $54.40 N/A N/A 5680-0-090 SUP HCPCS C1713 5680-0-090 - SCREW BONE PTHRD 6.5MM 90MM 16MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $60.50 $60.50 N/A N/A 5680-0-095 SUP HCPCS C1713 5680-0-095 - SCREW BONE PTHRD 6.5MM 95MM 16MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $24.20 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $60.50 $60.50 N/A N/A 5680-0-100 SUP HCPCS C1713 5680-0-100 - SCREW BONE PTHRD 6.5MM 100MM 16MM HEXAGONAL HEAD ALTA BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $60.50 $60.50 $12.61 $60.50 N/A N/A 5680-0-105 SUP HCPCS C1713 5680-0-105 - SCREW BONE PTHRD 6.5MM 105MM 16MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $12.61 $60.50 N/A N/A 5680-0-110 SUP HCPCS C1713 5680-0-110 - SCREW BONE PTHRD 6.5MM 110MM 16MM HEXAGONAL HEAD TITANIUM BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $12.61 $60.50 N/A N/A 5681-0-030 SUP HCPCS C1713 5681-0-030 - SCREW BONE PTHRD 6.5MM 30MM 20MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $11.34 $54.40 N/A N/A 5681-0-035 SUP HCPCS C1713 5681-0-035 - SCREW BONE PTHRD 6.5MM 35MM 27MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $12.61 $60.50 N/A N/A 5681-0-040 SUP HCPCS C1713 5681-0-040 - SCREW BONE PTHRD 6.5MM 40MM 32MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $21.76 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $11.34 $54.40 N/A N/A 5681-0-045 SUP HCPCS C1713 5681-0-045 - SCREW BONE PTHRD 6.5MM 45MM 32MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $21.76 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $11.34 $54.40 N/A N/A 5681-0-050 SUP HCPCS C1713 5681-0-050 - SCREW BONE PTHRD 6.5MM 50MM 32MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $21.76 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $11.34 $54.40 N/A N/A 5681-0-055 SUP HCPCS C1713 5681-0-055 - SCREW BONE HEXAGON 6.5MM 55MM 32MM CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $54.40 $54.40 $11.34 $54.40 N/A N/A 5681-0-060 SUP HCPCS C1713 5681-0-060 - SCREW BONE HEXAGON 6.5MM 60MM 32MM CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $21.76 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $11.34 $54.40 N/A N/A 5681-0-065 SUP HCPCS C1713 5681-0-065 - SCREW BONE HEXAGON 6.5MM 65MM 32MM CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $21.76 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $11.34 $54.40 N/A N/A 5681-0-070 SUP HCPCS C1713 5681-0-070 - SCREW BONE HEXAGON 6.5MM 70MM 32MM CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $21.76 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $11.34 $54.40 N/A N/A 5681-0-075 SUP HCPCS C1713 5681-0-075 - SCREW BONE HEXAGON 6.5MM 75MM 32MM CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $21.76 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $54.40 $54.40 N/A N/A 5681-0-080 SUP HCPCS C1713 5681-0-080 - SCREW BONE HEXAGON 6.5MM 80MM 32MM CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $21.76 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $11.34 $54.40 N/A N/A 5681-0-085 SUP HCPCS C1713 5681-0-085 - SCREW BONE PTHRD 6.5MM 85MM 32MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $24.48 $24.48 $24.48 $24.48 $54.40 $54.40 $54.40 $11.34 $54.40 $54.40 $54.40 $54.40 $54.40 $11.34 $54.40 $21.76 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $24.48 $10.80 N/A $31.61 $54.40 $32.64 $54.40 $11.34 $54.40 N/A N/A 5681-0-090 SUP HCPCS C1713 5681-0-090 - SCREW BONE PTHRD 6.5MM 90MM 32MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $24.20 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $60.50 $60.50 $12.61 $60.50 N/A N/A 5681-0-095 SUP HCPCS C1713 5681-0-095 - SCREW BONE PTHRD 6.5MM 95MM 32MM HEXAGONAL HEAD TITANIUM BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $12.61 $60.50 N/A N/A 5681-0-100 SUP HCPCS C1713 5681-0-100 - SCREW BONE PTHRD 6.5MM 100MM 32MM HEXAGONAL HEAD TITANIUM BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $12.61 $60.50 N/A N/A 5681-0-105 SUP HCPCS C1713 5681-0-105 - SCREW BONE PTHRD 6.5MM 105MM 32MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $12.61 $60.50 N/A N/A 5681-0-110 SUP HCPCS C1713 5681-0-110 - SCREW BONE PTHRD 6.5MM 110MM 32MM HEXAGONAL HEAD CANCELLOUS BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $12.61 $60.50 N/A N/A 57-05101 SUP HCPCS C1713 57-05101 - PLATE BONE XS 4 HOLE STR PROFYLE TITANIUM HAND 1.2MM SCREWS BOTH IP/OP $321.50 $238.00 $63.77 $321.30 $144.59 $144.59 $144.59 $144.59 $321.30 $321.30 $321.30 $66.97 $321.30 $321.30 $321.30 $321.30 $321.30 $66.96 $321.30 $321.30 $190.05 $321.30 $321.30 $321.30 $321.30 $241.13 $321.30 $321.30 $321.30 $160.65 $160.65 $254.47 $321.30 $257.04 $144.59 $63.77 N/A $186.47 $321.30 $192.78 $321.30 $66.96 $321.30 N/A N/A 57-05116 SUP HCPCS C1713 57-05116 - PLATE BONE XS .55MM 16 HOLE STR PROFYLE TITANIUM HAND 1.2MM BOTH IP/OP $519.00 $384.00 $102.95 $518.70 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $518.70 $306.81 $518.70 $518.70 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 57-05140 SUP HCPCS C1713 57-05140 - PLATE BONE 90D XS STANDARD T NARROW .55MM 5 HOLE FIX PROFYLE BOTH IP/OP $321.50 $238.00 $63.77 $321.30 $144.59 $144.59 $144.59 $144.59 $321.30 $321.30 $321.30 $66.97 $321.30 $321.30 $321.30 $321.30 $321.30 $66.96 $321.30 $321.30 $190.05 $321.30 $321.30 $321.30 $321.30 $241.13 $321.30 $321.30 $321.30 $160.65 $160.65 $254.47 $321.30 $257.04 $144.59 $63.77 N/A $186.47 $321.30 $192.78 $321.30 $66.96 $321.30 N/A N/A 57-05142 SUP HCPCS C1713 57-05142 - PLATE BONE T XS NARROW STANDARD .55MM 8 HOLE PROFYLE HAND BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $166.95 $166.95 $166.95 $166.95 $371.00 $371.00 $371.00 $77.33 $371.00 $371.00 $371.00 $371.00 $371.00 $77.32 $371.00 $371.00 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $166.95 $73.63 N/A $215.18 $371.00 $222.60 $371.00 $371.00 $371.00 N/A N/A 57-05150 SUP HCPCS C1713 57-05150 - PLATE BONE 90D XS STANDARD T OBLIQUE .55MM 5 HOLE PROFILE BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $166.95 $166.95 $166.95 $166.95 $371.00 $371.00 $371.00 $77.33 $371.00 $371.00 $371.00 $371.00 $371.00 $77.32 $371.00 $371.00 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $166.95 $73.63 N/A $215.18 $371.00 $222.60 $371.00 $77.32 $371.00 N/A N/A 57-05151 SUP HCPCS C1713 57-05151 - PLATE BONE XS STANDARD .55MM 5 HOLE T OBLIQUE PROFYLE BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $166.95 $166.95 $166.95 $166.95 $371.00 $371.00 $371.00 $77.33 $371.00 $371.00 $371.00 $371.00 $371.00 $77.32 $371.00 $371.00 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $166.95 $73.63 N/A $215.18 $371.00 $222.60 $371.00 $371.00 $371.00 N/A N/A 57-05170 SUP HCPCS C1713 57-05170 - PLATE BONE Y XS STANDARD NARROW .55MM 5 HOLE FIX PROFYLE BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $166.95 $166.95 $166.95 $166.95 $371.00 $371.00 $371.00 $77.33 $371.00 $371.00 $371.00 $371.00 $371.00 $77.32 $371.00 $371.00 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $166.95 $73.63 N/A $215.18 $371.00 $222.60 $371.00 $77.32 $371.00 N/A N/A 57-05190 SUP HCPCS C1713 57-05190 - PLATE BONE XS 3D 2X2 HOLE MODULAR FIX PROFYLE TITANIUM HAND BOTH IP/OP $519.00 $384.00 $102.95 $518.70 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $518.70 $306.81 $518.70 $518.70 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 57-05191 SUP HCPCS C1713 57-05191 - PLATE BONE XS STANDARD .55MM 3D 3X2HOLE PROFILE PROFYLE BOTH IP/OP $554.50 $410.00 $109.98 $554.13 $249.36 $249.36 $249.36 $249.36 $554.13 $554.13 $554.13 $115.49 $554.13 $554.13 $554.13 $554.13 $554.13 $115.49 $554.13 $554.13 $327.77 $554.13 $554.13 $554.13 $554.13 $415.88 $554.13 $554.13 $554.13 $277.07 $277.07 $438.87 $554.13 $443.30 $249.36 $109.98 N/A $321.61 $554.13 $332.48 $554.13 $554.13 $554.13 N/A N/A 57-05192 SUP HCPCS C1713 57-05192 - PLATE BONE XS STANDARD .55MM 4X2 HOLE 3D PROFYLE TITANIUM BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 57-05195 SUP HCPCS C1713 57-05195 - PLATE BONE XS STANDARD 3D .55MM 4X2 HOLE REPLANTATION BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 57-05197 SUP HCPCS C1713 57-05197 - PLATE BONE XS 2X2+2 HOLE 3D PROFILE PROFYLE TITANIUM HAND BOTH IP/OP $554.50 $410.00 $109.98 $554.13 $249.36 $249.36 $249.36 $249.36 $554.13 $554.13 $554.13 $115.49 $554.13 $554.13 $554.13 $554.13 $554.13 $115.49 $554.13 $554.13 $327.77 $554.13 $554.13 $554.13 $554.13 $415.88 $554.13 $554.13 $554.13 $277.07 $277.07 $438.87 $554.13 $443.30 $249.36 $109.98 N/A $321.61 $554.13 $332.48 $554.13 $115.48 $554.13 N/A N/A 57-05201 SUP HCPCS C1713 57-05201 - PLATE BONE SMALL .55MM 4 HOLE FIX STR MODULAR PROFYLE BOTH IP/OP $321.50 $238.00 $63.77 $321.30 $144.59 $144.59 $144.59 $144.59 $321.30 $321.30 $321.30 $66.97 $321.30 $321.30 $321.30 $321.30 $321.30 $66.96 $321.30 $321.30 $190.05 $321.30 $321.30 $321.30 $321.30 $241.13 $321.30 $321.30 $321.30 $160.65 $160.65 $254.47 $321.30 $257.04 $144.59 $63.77 N/A $186.47 $321.30 $192.78 $321.30 $66.96 $321.30 N/A N/A 57-05202 SUP HCPCS C1713 57-05202 - PLATE BONE SMALL .55MM 4 HOLE FIX STR BAR MODULAR PROFYLE BOTH IP/OP $321.50 $238.00 $63.77 $321.30 $144.59 $144.59 $144.59 $144.59 $321.30 $321.30 $321.30 $66.97 $321.30 $321.30 $321.30 $321.30 $321.30 $66.96 $321.30 $321.30 $190.05 $321.30 $321.30 $321.30 $321.30 $241.13 $321.30 $321.30 $321.30 $160.65 $160.65 $254.47 $321.30 $257.04 $144.59 $63.77 N/A $186.47 $321.30 $192.78 $321.30 $66.96 $321.30 N/A N/A 57-05210 SUP HCPCS C1713 57-05210 - PLATE BONE SMALL WIDE STANDARD T .55MM 8 HOLE PROFILE BOTH IP/OP $489.00 $362.00 $97.05 $489.00 $220.05 $220.05 $220.05 $220.05 $489.00 $489.00 $489.00 $101.92 $489.00 $489.00 $489.00 $489.00 $489.00 $101.91 $489.00 $195.60 $289.24 $489.00 $489.00 $489.00 $489.00 $366.75 $489.00 $489.00 $489.00 $244.50 $244.50 $387.29 $489.00 $391.20 $220.05 $97.05 N/A $283.62 $489.00 $293.40 $489.00 $101.91 $489.00 N/A N/A 57-05216 SUP HCPCS C1713 57-05216 - PLATE BONE SMALL .55MM 16 HOLE FIX STR MODULAR PROFYLE HAND BOTH IP/OP $519.00 $384.00 $102.95 $518.70 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $207.48 $306.81 $518.70 $518.70 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $518.70 $518.70 $108.10 $518.70 N/A N/A 57-05220 SUP HCPCS C1713 57-05220 - PLATE BONE 90D REGULAR SMALL L 6 HOLE PROFYLE TITANIUM HA BOTH IP/OP $321.50 $238.00 $63.77 $321.30 $144.59 $144.59 $144.59 $144.59 $321.30 $321.30 $321.30 $66.97 $321.30 $321.30 $321.30 $321.30 $321.30 $66.96 $321.30 $321.30 $190.05 $321.30 $321.30 $321.30 $321.30 $241.13 $321.30 $321.30 $321.30 $160.65 $160.65 $254.47 $321.30 $257.04 $144.59 $63.77 N/A $186.47 $321.30 $192.78 $321.30 $66.96 $321.30 N/A N/A 57-05221 SUP HCPCS C1713 57-05221 - PLATE BONE SMALL .55MM 6 HOLE FIX L MODULAR PROFYLE TITANIUM BOTH IP/OP $321.50 $238.00 $63.77 $321.30 $144.59 $144.59 $144.59 $144.59 $321.30 $321.30 $321.30 $66.97 $321.30 $321.30 $321.30 $321.30 $321.30 $66.96 $321.30 $128.52 $190.05 $321.30 $321.30 $321.30 $321.30 $241.13 $321.30 $321.30 $321.30 $160.65 $160.65 $254.47 $321.30 $257.04 $144.59 $63.77 N/A $186.47 $321.30 $192.78 $321.30 $66.96 $321.30 N/A N/A 57-05230 SUP HCPCS C1713 57-05230 - PLATE BONE SMALL .55MM 6 HOLE L OBLIQUE PROFYLE TITANIUM BOTH IP/OP $366.50 $271.00 $72.66 $366.10 $164.75 $164.75 $164.75 $164.75 $366.10 $366.10 $366.10 $76.30 $366.10 $366.10 $366.10 $366.10 $366.10 $76.30 $366.10 $146.44 $216.55 $366.10 $366.10 $366.10 $366.10 $274.88 $366.10 $366.10 $366.10 $183.05 $183.05 $289.95 $366.10 $292.88 $164.75 $72.66 N/A $212.57 $366.10 $366.10 $366.10 $366.10 $366.10 N/A N/A 57-05231 SUP HCPCS C1713 57-05231 - PLATE BONE SMALL .55MM 6 HOLE PROFYLE TITANIUM LEFT OBLIQUE BOTH IP/OP $366.50 $271.00 $72.66 $366.10 $164.75 $164.75 $164.75 $164.75 $366.10 $366.10 $366.10 $76.30 $366.10 $366.10 $366.10 $366.10 $366.10 $76.30 $366.10 $146.44 $216.55 $366.10 $366.10 $366.10 $366.10 $274.88 $366.10 $366.10 $366.10 $183.05 $183.05 $289.95 $366.10 $292.88 $164.75 $72.66 N/A $212.57 $366.10 $219.66 $366.10 $366.10 $366.10 N/A N/A 57-05240 SUP HCPCS C1713 57-05240 - PLATE BONE T SMALL 6 HOLE MODULAR FIX PROFYLE TITANIUM HAND BOTH IP/OP $329.00 $243.00 $65.22 $328.63 $147.88 $147.88 $147.88 $147.88 $328.63 $328.63 $328.63 $68.49 $328.63 $328.63 $328.63 $328.63 $328.63 $68.49 $328.63 $131.45 $194.38 $328.63 $328.63 $328.63 $328.63 $246.75 $328.63 $328.63 $328.63 $164.32 $164.32 $260.27 $328.63 $262.90 $147.88 $65.22 N/A $190.82 $328.63 $197.18 $328.63 $68.49 $328.63 N/A N/A 57-05250 SUP HCPCS C1713 57-05250 - PLATE BONE SMALL 6 HOLE T FIX MODULAR PROFYLE TITANIUM HAND BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $166.95 $166.95 $166.95 $166.95 $371.00 $371.00 $371.00 $77.33 $371.00 $371.00 $371.00 $371.00 $371.00 $77.32 $371.00 $148.40 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $166.95 $73.63 N/A $215.18 $371.00 $222.60 $371.00 $77.32 $371.00 N/A N/A 57-05251 SUP HCPCS C1713 57-05251 - PLATE BONE SMALL NARROW 6 HOLE T OBLIQUE PROFYLE TITANIUM BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $166.95 $166.95 $166.95 $166.95 $371.00 $371.00 $371.00 $77.33 $371.00 $371.00 $371.00 $371.00 $371.00 $77.32 $371.00 $148.40 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $166.95 $73.63 N/A $215.18 $371.00 $222.60 $371.00 $371.00 $371.00 N/A N/A 57-05260 SUP HCPCS C1713 57-05260 - PLATE BONE 90D SMALL STANDARD REGULAR T .55MM 7 HOLE PROFYLE BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $166.95 $166.95 $166.95 $166.95 $371.00 $371.00 $371.00 $77.33 $371.00 $371.00 $371.00 $371.00 $371.00 $77.32 $371.00 $148.40 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $166.95 $73.63 N/A $215.18 $371.00 $371.00 $371.00 $371.00 $371.00 N/A N/A 57-05262 SUP HCPCS C1713 57-05262 - PLATE BONE SMALL STANDARD T NARROW .55MM 10 HOLE FIX PROFYLE BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $166.95 $166.95 $166.95 $166.95 $371.00 $371.00 $371.00 $77.33 $371.00 $371.00 $371.00 $371.00 $371.00 $77.32 $371.00 $148.40 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $166.95 $73.63 N/A $215.18 $371.00 $222.60 $371.00 $77.32 $371.00 N/A N/A 57-05270 SUP HCPCS C1713 57-05270 - PLATE BONE Y SMALL .55MM 7 HOLE PROFYLE TITANIUM HAND 1.7MM BOTH IP/OP $371.00 $275.00 $73.63 $371.00 $166.95 $166.95 $166.95 $166.95 $371.00 $371.00 $371.00 $77.33 $371.00 $371.00 $371.00 $371.00 $371.00 $77.32 $371.00 $148.40 $219.45 $371.00 $371.00 $371.00 $371.00 $278.25 $371.00 $371.00 $371.00 $185.50 $185.50 $293.83 $371.00 $296.80 $166.95 $73.63 N/A $215.18 $371.00 $222.60 $371.00 $77.32 $371.00 N/A N/A 57-05279 SUP HCPCS C1713 57-05279 - PLATE BONE STANDARD Z NARROW .55MM 9 HOLE PROFYLE TITANIUM BOTH IP/OP $519.00 $384.00 $102.95 $518.70 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $207.48 $306.81 $518.70 $518.70 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 57-05280 SUP HCPCS C1713 57-05280 - PLATE BONE SMALL .55MM 5 HOLE FIX MODULAR PROFYLE TITANIUM BOTH IP/OP $519.00 $384.00 $102.95 $518.70 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $207.48 $306.81 $518.70 $518.70 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 57-05281 SUP HCPCS C1713 57-05281 - PLATE BONE SMALL .55MM 5 HOLE FIX MODULAR PROFYLE TITANIUM BOTH IP/OP $519.00 $384.00 $102.95 $518.70 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $207.48 $306.81 $518.70 $518.70 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 57-05282 SUP HCPCS C1713 57-05282 - PLATE BONE SMALL STANDARD .55MM 5 HOLE BLADE PROFYLE BOTH IP/OP $519.00 $384.00 $102.95 $518.70 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $518.70 $306.81 $518.70 $518.70 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $518.70 $518.70 N/A N/A 57-05283 SUP HCPCS C1713 57-05283 - PLATE BONE SMALL STANDARD .55MM 5 HOLE BLADE PROFYLE BOTH IP/OP $519.00 $384.00 $102.95 $518.70 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $518.70 $306.81 $518.70 $518.70 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $518.70 $518.70 N/A N/A 57-05285 SUP HCPCS C1713 57-05285 - PLATE BONE SMALL STANDARD .55MM 1 HOLE PRONG PROFYLE BOTH IP/OP $519.00 $384.00 $102.95 $518.70 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $207.48 $306.81 $518.70 $518.70 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $518.70 $518.70 $108.10 $518.70 N/A N/A 57-05290 SUP HCPCS C1713 57-05290 - PLATE BONE 3D SMALL STANDARD .55MM 2X2 HOLE NONLOCKING BOTH IP/OP $519.00 $384.00 $102.95 $518.70 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $207.48 $306.81 $518.70 $518.70 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 57-05291 SUP HCPCS C1713 57-05291 - PLATE BONE 3D SMALL STANDARD .55MM 3X2 HOLE NONLOCKING BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $222.30 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 57-05292 SUP HCPCS C1713 57-05292 - PLATE BONE 3D SMALL STANDARD .55MM 4X2 HOLE PROFYLE TITANIUM BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 57-05295 SUP HCPCS C1713 57-05295 - PLATE BONE SMALL STANDARD .55MM 4X2 HOLE 3D REPLANTATION BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $222.30 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 57-05297 SUP HCPCS C1713 57-05297 - PLATE BONE SMALL STANDARD 3D .55MM 2X2 HOLE PROFYLE TITANIUM BOTH IP/OP $556.00 $411.00 $110.30 $555.75 $250.09 $250.09 $250.09 $250.09 $555.75 $555.75 $555.75 $115.83 $555.75 $555.75 $555.75 $555.75 $555.75 $115.82 $555.75 $555.75 $328.73 $555.75 $555.75 $555.75 $555.75 $417.00 $555.75 $555.75 $555.75 $277.88 $277.88 $440.15 $555.75 $444.60 $250.09 $110.30 N/A $322.48 $555.75 $333.45 $555.75 $115.82 $555.75 N/A N/A 57-08212 SUP HCPCS C1713 57-08212 - PLATE BONE 12 HOLE STR PROFYLE TITANIUM RIGHT HAND 1.7 MM BOTH IP/OP $519.00 $384.00 $102.95 $518.70 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $207.48 $306.81 $518.70 $518.70 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 57-08213 SUP HCPCS C1713 57-08213 - PLATE BONE 12 HOLE STR PROFYLE TITANIUM LEFT HAND 1.7 MM BOTH IP/OP $519.00 $384.00 $102.95 $518.70 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $207.48 $306.81 $518.70 $518.70 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 57-08216 SUP HCPCS C1713 57-08216 - PLATE BONE 16 HOLE STR PROFYLE TITANIUM HAND 1.7 MM SCREWS BOTH IP/OP $519.00 $384.00 $102.95 $518.70 $233.42 $233.42 $233.42 $233.42 $518.70 $518.70 $518.70 $108.11 $518.70 $518.70 $518.70 $518.70 $518.70 $108.10 $518.70 $207.48 $306.81 $518.70 $518.70 $518.70 $518.70 $389.25 $518.70 $518.70 $518.70 $259.35 $259.35 $410.81 $518.70 $414.96 $233.42 $102.95 N/A $301.02 $518.70 $311.22 $518.70 $108.10 $518.70 N/A N/A 57-10101 SUP HCPCS C1713 57-10101 - PLATE BONE MEDIUM LARGE STANDARD STR 1MM 4 HOLE PROFYLE BOTH IP/OP $459.00 $340.00 $91.10 $459.00 $206.55 $206.55 $206.55 $206.55 $459.00 $459.00 $459.00 $95.67 $459.00 $459.00 $459.00 $459.00 $459.00 $95.66 $459.00 $183.60 $271.50 $459.00 $459.00 $459.00 $459.00 $344.25 $459.00 $459.00 $459.00 $229.50 $229.50 $363.53 $459.00 $367.20 $206.55 $91.10 N/A $266.22 $459.00 $459.00 $459.00 $95.66 $459.00 N/A N/A 57-10102 SUP HCPCS C1713 57-10102 - PLATE BONE STR MEDIUM STANDARD 1MM 4 HOLE BAR PROFYLE HAND BOTH IP/OP $459.00 $340.00 $91.10 $459.00 $206.55 $206.55 $206.55 $206.55 $459.00 $459.00 $459.00 $95.67 $459.00 $459.00 $459.00 $459.00 $459.00 $95.66 $459.00 $183.60 $271.50 $459.00 $459.00 $459.00 $459.00 $344.25 $459.00 $459.00 $459.00 $229.50 $229.50 $363.53 $459.00 $367.20 $206.55 $91.10 N/A $266.22 $459.00 $275.40 $459.00 $95.66 $459.00 N/A N/A 57-10116 SUP HCPCS C1713 57-10116 - PLATE BONE MEDIUM STANDARD 1MM 16 HOLE STR PROFYLE TITANIUM BOTH IP/OP $741.00 $548.00 $147.07 $741.00 $333.45 $333.45 $333.45 $333.45 $741.00 $741.00 $741.00 $154.44 $741.00 $741.00 $741.00 $741.00 $741.00 $154.43 $741.00 $296.40 $438.30 $741.00 $741.00 $741.00 $741.00 $555.75 $741.00 $741.00 $741.00 $370.50 $370.50 $586.87 $741.00 $592.80 $333.45 $147.07 N/A $429.78 $741.00 $444.60 $741.00 $154.42 $741.00 N/A N/A 57-10120 SUP HCPCS C1713 57-10120 - PLATE BONE MEDIUM STANDARD L 1MM 6 HOLE PROFILE PROFYLE BOTH IP/OP $530.00 $392.00 $105.19 $530.00 $238.50 $238.50 $238.50 $238.50 $530.00 $530.00 $530.00 $110.47 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $313.50 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $105.19 N/A $307.40 $530.00 $318.00 $530.00 $110.45 $530.00 N/A N/A 57-10121 SUP HCPCS C1713 57-10121 - PLATE BONE MEDIUM STANDARD 1MM 6 HOLE L PROFYLE TITANIUM BOTH IP/OP $530.00 $392.00 $105.19 $530.00 $238.50 $238.50 $238.50 $238.50 $530.00 $530.00 $530.00 $110.47 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $313.50 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $105.19 N/A $307.40 $530.00 $530.00 $530.00 $110.45 $530.00 N/A N/A 57-10130 SUP HCPCS C1713 57-10130 - PLATE BONE MEDIUM 1MM 6 HOLE L PROFYLE HAND 2.3MM SCREWS BOTH IP/OP $530.00 $392.00 $105.19 $530.00 $238.50 $238.50 $238.50 $238.50 $530.00 $530.00 $530.00 $110.47 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $530.00 $313.50 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $105.19 N/A $307.40 $530.00 $530.00 $530.00 $110.45 $530.00 N/A N/A 57-10131 SUP HCPCS C1713 57-10131 - PLATE BONE MEDIUM 6 HOLE L OBLIQUE PROFYLE TITANIUM LEFT BOTH IP/OP $530.00 $392.00 $105.19 $530.00 $238.50 $238.50 $238.50 $238.50 $530.00 $530.00 $530.00 $110.47 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $313.50 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $105.19 N/A $307.40 $530.00 $318.00 $530.00 $530.00 $530.00 N/A N/A 57-10140 SUP HCPCS C1713 57-10140 - PLATE BONE MEDIUM STANDARD NARROW T 1MM 6 HOLE PROFYLE HAND BOTH IP/OP $530.00 $392.00 $105.19 $530.00 $238.50 $238.50 $238.50 $238.50 $530.00 $530.00 $530.00 $110.47 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $313.50 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $105.19 N/A $307.40 $530.00 $318.00 $530.00 $110.45 $530.00 N/A N/A 57-10150 SUP HCPCS C1713 57-10150 - PLATE BONE MEDIUM 1MM 6 HOLE T PROFYLE HAND 2.3MM SCREWS BOTH IP/OP $530.00 $392.00 $105.19 $530.00 $238.50 $238.50 $238.50 $238.50 $530.00 $530.00 $530.00 $110.47 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $313.50 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $105.19 N/A $307.40 $530.00 $318.00 $530.00 $530.00 $530.00 N/A N/A 57-10151 SUP HCPCS C1713 57-10151 - PLATE BONE MEDIUM NARROW 6 HOLE T OBLIQUE PROFYLE TITANIUM BOTH IP/OP $530.00 $392.00 $105.19 $530.00 $238.50 $238.50 $238.50 $238.50 $530.00 $530.00 $530.00 $110.47 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $313.50 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $105.19 N/A $307.40 $530.00 $318.00 $530.00 $110.45 $530.00 N/A N/A 57-10160 SUP HCPCS C1713 57-10160 - PLATE BONE MEDIUM STANDARD 1MM 7 HOLE T PROFYLE HAND 2.3MM BOTH IP/OP $530.00 $392.00 $105.19 $530.00 $238.50 $238.50 $238.50 $238.50 $530.00 $530.00 $530.00 $110.47 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $212.00 $313.50 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $105.19 N/A $307.40 $530.00 $318.00 $530.00 $110.45 $530.00 N/A N/A 57-10161 SUP HCPCS C1713 57-10161 - PLATE BONE T WIDE MEDIUM STANDARD 1MM 8 HOLE PROFYLE HAND BOTH IP/OP $489.00 $362.00 $97.05 $489.00 $220.05 $220.05 $220.05 $220.05 $489.00 $489.00 $489.00 $101.92 $489.00 $489.00 $489.00 $489.00 $489.00 $101.91 $489.00 $489.00 $289.24 $489.00 $489.00 $489.00 $489.00 $366.75 $489.00 $489.00 $489.00 $244.50 $244.50 $387.29 $489.00 $391.20 $220.05 $97.05 N/A $283.62 $489.00 $489.00 $489.00 $101.91 $489.00 N/A N/A 57-10170 SUP HCPCS C1713 57-10170 - PLATE BONE MEDIUM STANDARD NARROW 1MM 7 HOLE Y PROFYLE HAND BOTH IP/OP $530.00 $392.00 $105.19 $530.00 $238.50 $238.50 $238.50 $238.50 $530.00 $530.00 $530.00 $110.47 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $530.00 $313.50 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $105.19 N/A $307.40 $530.00 $318.00 $530.00 $110.45 $530.00 N/A N/A 57-10179 SUP HCPCS C1713 57-10179 - PLATE BONE MEDIUM STANDARD NARROW 1MM 13 HOLE Z PROFYLE HAND BOTH IP/OP $741.00 $548.00 $147.07 $741.00 $333.45 $333.45 $333.45 $333.45 $741.00 $741.00 $741.00 $154.44 $741.00 $741.00 $741.00 $741.00 $741.00 $154.43 $741.00 $741.00 $438.30 $741.00 $741.00 $741.00 $741.00 $555.75 $741.00 $741.00 $741.00 $370.50 $370.50 $586.87 $741.00 $592.80 $333.45 $147.07 N/A $429.78 $741.00 $444.60 $741.00 $154.42 $741.00 N/A N/A 57-10180 SUP HCPCS C1713 57-10180 - PLATE BONE MEDIUM M ROTATION PROFYLE TITANIUM PHALANGEAL BOTH IP/OP $734.00 $543.00 $145.68 $734.00 $330.30 $330.30 $330.30 $330.30 $734.00 $734.00 $734.00 $152.98 $734.00 $734.00 $734.00 $734.00 $734.00 $152.97 $734.00 $734.00 $434.16 $734.00 $734.00 $734.00 $734.00 $550.50 $734.00 $734.00 $734.00 $367.00 $367.00 $581.33 $734.00 $587.20 $330.30 $145.68 N/A $425.72 $734.00 $440.40 $734.00 $152.97 $734.00 N/A N/A 57-10185 SUP HCPCS C1713 57-10185 - PLATE BONE STANDARD MEDIUM 1MM 5 HOLE ROTATION PROFYLE HAND BOTH IP/OP $944.00 $699.00 $187.36 $944.00 $424.80 $424.80 $424.80 $424.80 $944.00 $944.00 $944.00 $196.75 $944.00 $944.00 $944.00 $944.00 $944.00 $196.74 $944.00 $944.00 $558.38 $944.00 $944.00 $944.00 $944.00 $708.00 $944.00 $944.00 $944.00 $472.00 $472.00 $747.65 $944.00 $755.20 $424.80 $187.36 N/A $547.52 $944.00 $566.40 $944.00 $196.73 $944.00 N/A N/A 57-10190 SUP HCPCS C1713 57-10190 - PLATE BONE 3D MEDIUM STANDARD 1MM 2X2 HOLE PROFYLE HAND 2.3 BOTH IP/OP $530.00 $392.00 $105.19 $530.00 $238.50 $238.50 $238.50 $238.50 $530.00 $530.00 $530.00 $110.47 $530.00 $530.00 $530.00 $530.00 $530.00 $110.46 $530.00 $530.00 $313.50 $530.00 $530.00 $530.00 $530.00 $397.50 $530.00 $530.00 $530.00 $265.00 $265.00 $419.76 $530.00 $424.00 $238.50 $105.19 N/A $307.40 $530.00 $318.00 $530.00 $110.45 $530.00 N/A N/A 57-10191 SUP HCPCS C1713 57-10191 - PLATE BONE MEDIUM STANDARD 1MM 3X2 HOLE 3D PROFYLE HAND 2.3 BOTH IP/OP $741.00 $548.00 $147.07 $741.00 $333.45 $333.45 $333.45 $333.45 $741.00 $741.00 $741.00 $154.44 $741.00 $741.00 $741.00 $741.00 $741.00 $154.43 $741.00 $741.00 $438.30 $741.00 $741.00 $741.00 $741.00 $555.75 $741.00 $741.00 $741.00 $370.50 $370.50 $586.87 $741.00 $592.80 $333.45 $147.07 N/A $429.78 $741.00 $444.60 $741.00 $154.42 $741.00 N/A N/A 57-10192 SUP HCPCS C1713 57-10192 - PLATE BONE MEDIUM 4X2 HOLE 3D PROFYLE HYDRXAPT TITANIUM 2.3 BOTH IP/OP $741.00 $548.00 $147.07 $741.00 $333.45 $333.45 $333.45 $333.45 $741.00 $741.00 $741.00 $154.44 $741.00 $741.00 $741.00 $741.00 $741.00 $154.43 $741.00 $741.00 $438.30 $741.00 $741.00 $741.00 $741.00 $555.75 $741.00 $741.00 $741.00 $370.50 $370.50 $586.87 $741.00 $592.80 $333.45 $147.07 N/A $429.78 $741.00 $741.00 $741.00 $154.42 $741.00 N/A N/A 57-10193 SUP HCPCS C1713 57-10193 - PLATE BONE MEDIUM 3D PROFYLE TITANIUM HAND WRIST 2.3MM BOTH IP/OP $741.00 $548.00 $147.07 $741.00 $333.45 $333.45 $333.45 $333.45 $741.00 $741.00 $741.00 $154.44 $741.00 $741.00 $741.00 $741.00 $741.00 $154.43 $741.00 $741.00 $438.30 $741.00 $741.00 $741.00 $741.00 $555.75 $741.00 $741.00 $741.00 $370.50 $370.50 $586.87 $741.00 $592.80 $333.45 $147.07 N/A $429.78 $741.00 $444.60 $741.00 $154.42 $741.00 N/A N/A 57-10195 SUP HCPCS C1713 57-10195 - PLATE BONE 3D MEDIUM STANDARD 1MM 4X2 HOLE REPLANTATION BOTH IP/OP $741.00 $548.00 $147.07 $741.00 $333.45 $333.45 $333.45 $333.45 $741.00 $741.00 $741.00 $154.44 $741.00 $741.00 $741.00 $741.00 $741.00 $154.43 $741.00 $741.00 $438.30 $741.00 $741.00 $741.00 $741.00 $555.75 $741.00 $741.00 $741.00 $370.50 $370.50 $586.87 $741.00 $592.80 $333.45 $147.07 N/A $429.78 $741.00 $741.00 $741.00 $154.42 $741.00 N/A N/A 57-10197 SUP HCPCS C1713 57-10197 - PLATE BONE MEDIUM 1MM 2X2+ 2 HOLE 3D FIX PROFYLE TITANIUM BOTH IP/OP $741.00 $548.00 $147.07 $741.00 $333.45 $333.45 $333.45 $333.45 $741.00 $741.00 $741.00 $154.44 $741.00 $741.00 $741.00 $741.00 $741.00 $154.43 $741.00 $296.40 $438.30 $741.00 $741.00 $741.00 $741.00 $555.75 $741.00 $741.00 $741.00 $370.50 $370.50 $586.87 $741.00 $592.80 $333.45 $147.07 N/A $429.78 $741.00 $741.00 $741.00 $154.42 $741.00 N/A N/A 57-10201 SUP HCPCS C1713 57-10201 - PLATE BONE MEDIUM 4 HOLE STR COMPRESSION PROFYLE TITANIUM BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $132.13 $634.00 N/A N/A 57-10202 SUP HCPCS C1713 57-10202 - PLATE BONE MEDIUM 4 HOLE STR COMPRESSION BAR PROFYLE BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $634.00 $634.00 N/A N/A 57-10204 SUP HCPCS C1713 57-10204 - PLATE BONE MEDIUM 1MM 5 HOLE COMPRESSION STR PROFYLE BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $634.00 $634.00 N/A N/A 57-10207 SUP HCPCS C1713 57-10207 - PLATE BONE MEDIUM 1MM 6 HOLE COMPRESSION STR PROFYLE BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $132.13 $634.00 N/A N/A 57-10208 SUP HCPCS C1713 57-10208 - PLATE BONE MEDIUM 7 HOLE STR COMPRESSION PROFYLE TITANIUM BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $634.00 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $132.13 $634.00 N/A N/A 57-10220 SUP HCPCS C1713 57-10220 - PLATE BONE 90D MEDIUM 6 HOLE L COMPRESSION PROFYLE TITANIUM BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $634.00 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $132.13 $634.00 N/A N/A 57-10221 SUP HCPCS C1713 57-10221 - PLATE BONE 90D MEDIUM 6 HOLE L COMPRESSION PROFYLE TITANIUM BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $634.00 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $132.13 $634.00 N/A N/A 57-10230 SUP HCPCS C1713 57-10230 - PLATE BONE MEDIUM 6 HOLE L OBLIQUE COMPRESSION PROFYLE BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $634.00 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $132.13 $634.00 N/A N/A 57-10231 SUP HCPCS C1713 57-10231 - PLATE BONE MEDIUM 6 HOLE L OBLIQUE COMPRESSION PROFYLE BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $634.00 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $132.13 $634.00 N/A N/A 57-10240 SUP HCPCS C1713 57-10240 - PLATE BONE MEDIUM 1MM 6 HOLE COMPRESSION T PROFYLE TITANIUM BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $132.13 $634.00 N/A N/A 57-10250 SUP HCPCS C1713 57-10250 - PLATE BONE MEDIUM NARROW 6 HOLE T OBLIQUE COMPRESSION BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $634.00 $634.00 $132.13 $634.00 N/A N/A 57-10251 SUP HCPCS C1713 57-10251 - PLATE BONE MEDIUM NARROW 6 HOLE T OBLIQUE COMPRESSION BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $132.13 $634.00 N/A N/A 57-10260 SUP HCPCS C1713 57-10260 - PLATE BONE 90D MEDIUM REGULAR 7 HOLE T COMPRESSION PROFYLE BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $634.00 $634.00 N/A N/A 57-10262 SUP HCPCS C1713 57-10262 - PLATE BONE 90D REGULAR 10 HOLE T COMPRESSION PROFYLE BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $132.13 $634.00 N/A N/A 57-10270 SUP HCPCS C1713 57-10270 - PLATE BONE MEDIUM 1MM 7 HOLE COMPRESSION Y PROFYLE TITANIUM BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $132.13 $634.00 N/A N/A 57-10280 SUP HCPCS C1713 57-10280 - PLATE BONE MEDIUM 5 HOLE PROFYLE TITANIUM CONDYLE RIGHT 2.3 BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $634.00 $634.00 N/A N/A 57-10281 SUP HCPCS C1713 57-10281 - PLATE BONE MEDIUM 5 HOLE PROFYLE TITANIUM CONDYLE LEFT 2.3MM BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $634.00 $634.00 $132.13 $634.00 N/A N/A 57-10282 SUP HCPCS C1713 57-10282 - PLATE BONE MEDIUM 6 HOLE PROFYLE TITANIUM CONDYLE RIGHT 2.3 BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $634.00 $634.00 N/A N/A 57-10283 SUP HCPCS C1713 57-10283 - PLATE BONE MEDIUM LARGE 6 HOLE PROFYLE TITANIUM HAND LEFT BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $634.00 $634.00 N/A N/A 57-10284 SUP HCPCS C1713 57-10284 - PLATE BONE MEDIUM 6 HOLE LONG PIN PROFYLE TITANIUM HAND BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $630.00 $630.00 $131.29 $630.00 N/A N/A 57-10285 SUP HCPCS C1713 57-10285 - PLATE BONE MEDIUM 6 HOLE LONG PIN PROFYLE TITANIUM HAND LEFT BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $131.29 $630.00 N/A N/A 57-10304 SUP HCPCS C1713 57-10304 - PLATE BONE SMALL 1MM 4 HOLE STR LOCKING VARIAX HAND 1.7MM BOTH IP/OP $725.00 $537.00 $143.89 $725.00 $326.25 $326.25 $326.25 $326.25 $725.00 $725.00 $725.00 $151.11 $725.00 $725.00 $725.00 $725.00 $725.00 $151.10 $725.00 $290.00 $428.84 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $326.25 $143.89 N/A $420.50 $725.00 $435.00 $725.00 $151.09 $725.00 N/A N/A 57-10310 SUP HCPCS C1713 57-10310 - PLATE BONE T SMALL NARROW 1MM 10 HOLE LOCKING PROFILE VARIAX BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $391.60 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-10316 SUP HCPCS C1713 57-10316 - PLATE BONE SMALL STR 1MM 16 HOLE LOCKING VARIAX HAND 1.7MM BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $391.60 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-10320 SUP HCPCS C1713 57-10320 - PLATE BONE SMALL 1.7MM 1MM 6 HOLE L LOCKING VARIAX RIGHT BOTH IP/OP $725.00 $537.00 $143.89 $725.00 $326.25 $326.25 $326.25 $326.25 $725.00 $725.00 $725.00 $151.11 $725.00 $725.00 $725.00 $725.00 $725.00 $151.10 $725.00 $725.00 $428.84 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $326.25 $143.89 N/A $420.50 $725.00 $435.00 $725.00 $151.09 $725.00 N/A N/A 57-10321 SUP HCPCS C1713 57-10321 - PLATE BONE SMALL 1.7MM 1MM 6 HOLE L LOCKING VARIAX LEFT HAND BOTH IP/OP $725.00 $537.00 $143.89 $725.00 $326.25 $326.25 $326.25 $326.25 $725.00 $725.00 $725.00 $151.11 $725.00 $725.00 $725.00 $725.00 $725.00 $151.10 $725.00 $725.00 $428.84 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $326.25 $143.89 N/A $420.50 $725.00 $435.00 $725.00 $151.09 $725.00 N/A N/A 57-10340 SUP HCPCS C1713 57-10340 - PLATE BONE T SMALL NARROW 1MM 6 HOLE LOCKING PROFILE VARIAX BOTH IP/OP $725.00 $537.00 $143.89 $725.00 $326.25 $326.25 $326.25 $326.25 $725.00 $725.00 $725.00 $151.11 $725.00 $725.00 $725.00 $725.00 $725.00 $151.10 $725.00 $725.00 $428.84 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $326.25 $143.89 N/A $420.50 $725.00 $435.00 $725.00 $151.09 $725.00 N/A N/A 57-10360 SUP HCPCS C1713 57-10360 - PLATE BONE T SMALL 1MM 7 HOLE LOCKING PROFILE VARIAX HAND BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $979.00 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $979.00 $979.00 $204.02 $979.00 N/A N/A 57-10368 SUP HCPCS C1713 57-10368 - PLATE BONE T SMALL WIDE 1MM 8 HOLE LOCKING PROFILE VARIAX BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $979.00 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $979.00 $979.00 $204.02 $979.00 N/A N/A 57-10379 SUP HCPCS C1713 57-10379 - PLATE BONE Z SMALL NARROW 1MM 9 HOLE LOCKING PROFILE VARIAX BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $979.00 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-10380 SUP HCPCS C1713 57-10380 - PLATE BONE SMALL 1MM 5 HOLE ROTATION LOCKING VARIAX HAND 1.7 BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $979.00 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-10390 SUP HCPCS C1713 57-10390 - PLATE BONE SMALL 1.7MM 1MM 2X2 HOLE 3D LOCKING VARIAX HAND BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $979.00 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-10391 SUP HCPCS C1713 57-10391 - PLATE BONE SMALL 3D 1MM 6 HOLE LOCK PROFILE VARIAX HAND BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $979.00 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-10392 SUP HCPCS C1713 57-10392 - PLATE BONE 3D SMALL 1.7MM 1MM 4X2 HOLE LOCKING VARIAX HAND BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $979.00 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-10395 SUP HCPCS C1713 57-10395 - PLATE BONE SMALL 1MM 8 HOLE 3D LOCKING PROFILE REPLANTATION BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $391.60 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $979.00 $979.00 $204.02 $979.00 N/A N/A 57-10397 SUP HCPCS C1713 57-10397 - PLATE BONE SMALL 1MM 2X2+2 HOLE 3D LOCKING VARIAX HAND 1.7MM BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $979.00 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-10402 SUP HCPCS C1713 57-10402 - PLATE BONE MEDIUM 1MM 4 HOLE STR COMPRESSION PROFYLE HAND BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $630.00 $630.00 $131.29 $630.00 N/A N/A 57-10407 SUP HCPCS C1713 57-10407 - PLATE BONE STR MEDIUM 1MM 6 HOLE COMPRESSION PROFILE PROFYLE BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $131.29 $630.00 N/A N/A 57-10420 SUP HCPCS C1713 57-10420 - PLATE BONE MEDIUM 1MM 6 HOLE L COMPRESSION PROFYLE RIGHT BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $131.29 $630.00 N/A N/A 57-10421 SUP HCPCS C1713 57-10421 - PLATE BONE MEDIUM 1MM 6 HOLE L COMPRESSION PROFYLE LEFT HAND BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $131.29 $630.00 N/A N/A 57-10440 SUP HCPCS C1713 57-10440 - PLATE BONE MEDIUM NARROW 1MM 6 HOLE T COMPRESSION PROFYLE BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $630.00 $630.00 $131.29 $630.00 N/A N/A 57-10460 SUP HCPCS C1713 57-10460 - PLATE BONE MEDIUM 1MM 7 HOLE T COMPRESSION PROFYLE HAND 2.3 BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $131.29 $630.00 N/A N/A 57-10470 SUP HCPCS C1713 57-10470 - PLATE BONE NARROW MEDIUM 1MM 7 HOLE Y COMPRESSION PROFYLE BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $131.29 $630.00 N/A N/A 57-10482 SUP HCPCS C1713 57-10482 - PLATE BONE MEDIUM 2.3MM 1MM 6 HOLE BLADE COMPRESSION PROFYLE BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $131.29 $630.00 N/A N/A 57-10483 SUP HCPCS C1713 57-10483 - PLATE BONE MEDIUM 1MM 6 HOLE BLADE COMPRESSION PROFYLE LEFT BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $131.29 $630.00 N/A N/A 57-13102 SUP HCPCS C1713 57-13102 - PLATE BONE LARGE 1.3MM 4 HOLE STR BAR COMPRESSION PROFYLE BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $634.00 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $634.00 $634.00 $132.13 $634.00 N/A N/A 57-13105 SUP HCPCS C1713 57-13105 - PLATE BONE LARGE 1.3MM 5 HOLE STR BAR COMPRESSION PROFYLE BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $634.00 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $132.13 $634.00 N/A N/A 57-13108 SUP HCPCS C1713 57-13108 - PLATE BONE LARGE 1.3MM 6 HOLE STR BAR COMPRESSION PROFYLE BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $634.00 $634.00 N/A N/A 57-13109 SUP HCPCS C1713 57-13109 - PLATE BONE LARGE 1.3MM 7 HOLE STR BAR COMPRESSION PROFYLE BOTH IP/OP $634.00 $469.00 $125.83 $634.00 $285.30 $285.30 $285.30 $285.30 $634.00 $634.00 $634.00 $132.14 $634.00 $634.00 $634.00 $634.00 $634.00 $132.13 $634.00 $253.60 $375.01 $634.00 $634.00 $634.00 $634.00 $475.50 $634.00 $634.00 $634.00 $317.00 $317.00 $502.13 $634.00 $507.20 $285.30 $125.83 N/A $367.72 $634.00 $380.40 $634.00 $634.00 $634.00 N/A N/A 57-13110 SUP HCPCS C1713 57-13110 - PLATE BONE LARGE 1.3MM 8 HOLE STR BAR COMPRESSION PROFYLE BOTH IP/OP $444.00 $329.00 $88.08 $443.80 $199.71 $199.71 $199.71 $199.71 $443.80 $443.80 $443.80 $92.50 $443.80 $443.80 $443.80 $443.80 $443.80 $92.49 $443.80 $177.52 $262.51 $443.80 $443.80 $443.80 $443.80 $333.00 $443.80 $443.80 $443.80 $221.90 $221.90 $351.49 $443.80 $355.04 $199.71 $88.08 N/A $257.52 $443.80 $266.28 $443.80 $92.49 $443.80 N/A N/A 57-13120 SUP HCPCS C1713 57-13120 - PLATE BONE LARGE 1.3MM 6 HOLE L COMPRESSION PROFYLE TITANIUM BOTH IP/OP $444.00 $329.00 $88.08 $443.80 $199.71 $199.71 $199.71 $199.71 $443.80 $443.80 $443.80 $92.50 $443.80 $443.80 $443.80 $443.80 $443.80 $92.49 $443.80 $443.80 $262.51 $443.80 $443.80 $443.80 $443.80 $333.00 $443.80 $443.80 $443.80 $221.90 $221.90 $351.49 $443.80 $355.04 $199.71 $88.08 N/A $257.52 $443.80 $266.28 $443.80 $92.49 $443.80 N/A N/A 57-13121 SUP HCPCS C1713 57-13121 - PLATE BONE LARGE 1.3MM 6 HOLE L COMPRESSION PROFYLE TITANIUM BOTH IP/OP $444.00 $329.00 $88.08 $443.80 $199.71 $199.71 $199.71 $199.71 $443.80 $443.80 $443.80 $92.50 $443.80 $443.80 $443.80 $443.80 $443.80 $92.49 $443.80 $443.80 $262.51 $443.80 $443.80 $443.80 $443.80 $333.00 $443.80 $443.80 $443.80 $221.90 $221.90 $351.49 $443.80 $355.04 $199.71 $88.08 N/A $257.52 $443.80 $443.80 $443.80 $92.49 $443.80 N/A N/A 57-13140 SUP HCPCS C1713 57-13140 - PLATE BONE LARGE 1.3MM 6 HOLE T COMPRESSION PROFYLE TITANIUM BOTH IP/OP $444.00 $329.00 $88.08 $443.80 $199.71 $199.71 $199.71 $199.71 $443.80 $443.80 $443.80 $92.50 $443.80 $443.80 $443.80 $443.80 $443.80 $92.49 $443.80 $443.80 $262.51 $443.80 $443.80 $443.80 $443.80 $333.00 $443.80 $443.80 $443.80 $221.90 $221.90 $351.49 $443.80 $355.04 $199.71 $88.08 N/A $257.52 $443.80 $266.28 $443.80 $92.49 $443.80 N/A N/A 57-13142 SUP HCPCS C1713 57-13142 - PLATE BONE LARGE 1.3MM 10 HOLE T BAR COMPRESSION PROFYLE BOTH IP/OP $444.00 $329.00 $88.08 $443.80 $199.71 $199.71 $199.71 $199.71 $443.80 $443.80 $443.80 $92.50 $443.80 $443.80 $443.80 $443.80 $443.80 $92.49 $443.80 $443.80 $262.51 $443.80 $443.80 $443.80 $443.80 $333.00 $443.80 $443.80 $443.80 $221.90 $221.90 $351.49 $443.80 $355.04 $199.71 $88.08 N/A $257.52 $443.80 $266.28 $443.80 $92.49 $443.80 N/A N/A 57-13150 SUP HCPCS C1713 57-13150 - PLATE BONE LARGE 1.3MM 6 HOLE T COMPRESSION PROFYLE TITANIUM BOTH IP/OP $444.00 $329.00 $88.08 $443.80 $199.71 $199.71 $199.71 $199.71 $443.80 $443.80 $443.80 $92.50 $443.80 $443.80 $443.80 $443.80 $443.80 $92.49 $443.80 $443.80 $262.51 $443.80 $443.80 $443.80 $443.80 $333.00 $443.80 $443.80 $443.80 $221.90 $221.90 $351.49 $443.80 $355.04 $199.71 $88.08 N/A $257.52 $443.80 $443.80 $443.80 $92.49 $443.80 N/A N/A 57-13151 SUP HCPCS C1713 57-13151 - PLATE BONE LARGE 1.3MM 6 HOLE T COMPRESSION PROFYLE TITANIUM BOTH IP/OP $444.00 $329.00 $88.08 $443.80 $199.71 $199.71 $199.71 $199.71 $443.80 $443.80 $443.80 $92.50 $443.80 $443.80 $443.80 $443.80 $443.80 $92.49 $443.80 $443.80 $262.51 $443.80 $443.80 $443.80 $443.80 $333.00 $443.80 $443.80 $443.80 $221.90 $221.90 $351.49 $443.80 $355.04 $199.71 $88.08 N/A $257.52 $443.80 $266.28 $443.80 $92.49 $443.80 N/A N/A 57-13180 SUP HCPCS C1713 57-13180 - PLATE BONE LARGE 5 HOLE MODULAR ROTATIONAL PROFYLE TITANIUM BOTH IP/OP $550.50 $407.00 $109.26 $550.50 $247.73 $247.73 $247.73 $247.73 $550.50 $550.50 $550.50 $114.74 $550.50 $550.50 $550.50 $550.50 $550.50 $114.73 $550.50 $550.50 $325.62 $550.50 $550.50 $550.50 $550.50 $412.88 $550.50 $550.50 $550.50 $275.25 $275.25 $436.00 $550.50 $440.40 $247.73 $109.26 N/A $319.29 $550.50 $330.30 $550.50 $114.72 $550.50 N/A N/A 57-13185 SUP HCPCS C1713 57-13185 - PLATE BONE STANDARD WIDE MEDIUM 2.3MM 1MM 5 HOLE ROTATION BOTH IP/OP $944.00 $699.00 $187.36 $944.00 $424.80 $424.80 $424.80 $424.80 $944.00 $944.00 $944.00 $196.75 $944.00 $944.00 $944.00 $944.00 $944.00 $196.74 $944.00 $944.00 $558.38 $944.00 $944.00 $944.00 $944.00 $708.00 $944.00 $944.00 $944.00 $472.00 $472.00 $747.65 $944.00 $755.20 $424.80 $187.36 N/A $547.52 $944.00 $566.40 $944.00 $196.73 $944.00 N/A N/A 57-13402 SUP HCPCS C1713 57-13402 - PLATE BONE 1.3MM 4 HOLE L COMPRESSION STR PROFYLE HAND 2.3MM BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $176.40 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $264.60 $441.00 $91.90 $441.00 N/A N/A 57-13405 SUP HCPCS C1713 57-13405 - PLATE BONE L STR 1.3MM 5 HOLE COMPRESSION PROFYLE HAND 2.3MM BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $176.40 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $264.60 $441.00 $91.90 $441.00 N/A N/A 57-13408 SUP HCPCS C1713 57-13408 - PLATE BONE L LARGE STR 2.3MM 1.3MM 6 HOLE COMPRESSION BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $176.40 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $264.60 $441.00 $91.90 $441.00 N/A N/A 57-13410 SUP HCPCS C1713 57-13410 - PLATE BONE LARGE 1.3MM 8 HOLE L COMPRESSION STR PROFYLE HAND BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $176.40 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $441.00 $441.00 $91.90 $441.00 N/A N/A 57-13420 SUP HCPCS C1713 57-13420 - PLATE BONE LARGE 1.3MM 6 HOLE L COMPRESSION PROFYLE RIGHT BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $441.00 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $264.60 $441.00 $91.90 $441.00 N/A N/A 57-13421 SUP HCPCS C1713 57-13421 - PLATE BONE L LARGE 1.3MM 6 HOLE COMPRESSION PROFYLE LEFT 2.3 BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $176.40 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $264.60 $441.00 $91.90 $441.00 N/A N/A 57-13440 SUP HCPCS C1713 57-13440 - PLATE BONE T NARROW LARGE 1.3MM 6 HOLE COMPRESSION PROFYLE BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $176.40 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $441.00 $441.00 $91.90 $441.00 N/A N/A 57-13442 SUP HCPCS C1713 57-13442 - PLATE BONE NARROW 2.3MM 1.3MM 10 HOLE T COMPRESSION PROFYLE BOTH IP/OP $454.00 $336.00 $90.06 $453.75 $204.19 $204.19 $204.19 $204.19 $453.75 $453.75 $453.75 $94.57 $453.75 $453.75 $453.75 $453.75 $453.75 $94.57 $453.75 $453.75 $268.39 $453.75 $453.75 $453.75 $453.75 $340.50 $453.75 $453.75 $453.75 $226.88 $226.88 $359.37 $453.75 $363.00 $204.19 $90.06 N/A $263.32 $453.75 $272.25 $453.75 $94.56 $453.75 N/A N/A 57-13450 SUP HCPCS C1713 57-13450 - PLATE BONE LARGE 1.3MM 6 HOLE T COMPRESSION OBLIQUE PROFYLE BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $176.40 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $264.60 $441.00 $91.90 $441.00 N/A N/A 57-13451 SUP HCPCS C1713 57-13451 - PLATE BONE T LARGE OBLIQUE 1.3MM 6 HOLE COMPRESSION PROFYLE BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $441.00 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $264.60 $441.00 $91.90 $441.00 N/A N/A 57-13906 SUP HCPCS C1713 57-13906 - PLATE BONE LARGE 1.3MM 6 HOLE T COMPRESSION PROFYLE HAND 2.3 BOTH IP/OP $441.00 $326.00 $87.53 $441.00 $198.45 $198.45 $198.45 $198.45 $441.00 $441.00 $441.00 $91.92 $441.00 $441.00 $441.00 $441.00 $441.00 $91.91 $441.00 $176.40 $260.85 $441.00 $441.00 $441.00 $441.00 $330.75 $441.00 $441.00 $441.00 $220.50 $220.50 $349.27 $441.00 $352.80 $198.45 $87.53 N/A $255.78 $441.00 $441.00 $441.00 $91.90 $441.00 N/A N/A 57-15301 SUP HCPCS C1713 57-15301 - PLATE BN MED STRG 1.5MM VARIAX 4 HL LCK PRECONTOUR HND 2.3MM BOTH IP/OP $725.00 $537.00 $143.89 $725.00 $326.25 $326.25 $326.25 $326.25 $725.00 $725.00 $725.00 $151.11 $725.00 $725.00 $725.00 $725.00 $725.00 $151.10 $725.00 $725.00 $428.84 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $326.25 $143.89 N/A $420.50 $725.00 $725.00 $725.00 $151.09 $725.00 N/A N/A 57-15302 SUP HCPCS C1713 57-15302 - PLATE BONE MEDIUM 1.5MM 4 HOLE LOCKING STR BAR VARIAX HAND BOTH IP/OP $725.00 $537.00 $143.89 $725.00 $326.25 $326.25 $326.25 $326.25 $725.00 $725.00 $725.00 $151.11 $725.00 $725.00 $725.00 $725.00 $725.00 $151.10 $725.00 $290.00 $428.84 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $326.25 $143.89 N/A $420.50 $725.00 $725.00 $725.00 $151.09 $725.00 N/A N/A 57-15316 SUP HCPCS C1713 57-15316 - PLATE BONE STR MEDIUM NARROW 1.5MM 16 HOLE LOCKING PROFILE BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $979.00 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-15320 SUP HCPCS C1713 57-15320 - PLATE BONE L MEDIUM 2.3MM 1.5MM 6 HOLE LOCKING VARIAX RIGHT BOTH IP/OP $725.00 $537.00 $143.89 $725.00 $326.25 $326.25 $326.25 $326.25 $725.00 $725.00 $725.00 $151.11 $725.00 $725.00 $725.00 $725.00 $725.00 $151.10 $725.00 $290.00 $428.84 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $326.25 $143.89 N/A $420.50 $725.00 $725.00 $725.00 $151.09 $725.00 N/A N/A 57-15321 SUP HCPCS C1713 57-15321 - PLATE BONE L MEDIUM 2.3MM 1.5MM 6 HOLE LOCKING VARIAX LEFT BOTH IP/OP $725.00 $537.00 $143.89 $725.00 $326.25 $326.25 $326.25 $326.25 $725.00 $725.00 $725.00 $151.11 $725.00 $725.00 $725.00 $725.00 $725.00 $151.10 $725.00 $290.00 $428.84 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $326.25 $143.89 N/A $420.50 $725.00 $725.00 $725.00 $151.09 $725.00 N/A N/A 57-15324 SUP HCPCS C1713 57-15324 - PLATE BONE MEDIUM V NARROW 1.5MM 5 HOLE MC5 LOCK VARIAX HAND BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $979.00 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-15325 SUP HCPCS C1713 57-15325 - PLATE BONE MEDIUM 2.3MM 1.5MM 5 HOLE MC5 LOCKING VARIAX BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $979.00 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $979.00 $979.00 $204.02 $979.00 N/A N/A 57-15340 SUP HCPCS C1713 57-15340 - PLATE BN MED NAR T 1.5MM VARIAX 6 HL LCK PRECONTOUR HND 2.3 BOTH IP/OP $725.00 $537.00 $143.89 $725.00 $326.25 $326.25 $326.25 $326.25 $725.00 $725.00 $725.00 $151.11 $725.00 $725.00 $725.00 $725.00 $725.00 $151.10 $725.00 $290.00 $428.84 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $326.25 $143.89 N/A $420.50 $725.00 $435.00 $725.00 $151.09 $725.00 N/A N/A 57-15360 SUP HCPCS C1713 57-15360 - PLATE BONE T MEDIUM 1.5MM 7 HOLE LOCKING VARIAX HAND 2.3MM BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $391.60 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-15361 SUP HCPCS C1713 57-15361 - PLATE BONE T MEDIUM WIDE 1.5MM 8 HOLE LOCK VARIAX HAND 2.3MM BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $391.60 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-15370 SUP HCPCS C1713 57-15370 - PLATE BN MED NAR T 1.5MM VARIAX 7 HL LCK PRECONTOUR HND 2.3 BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $391.60 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $979.00 $979.00 $204.02 $979.00 N/A N/A 57-15379 SUP HCPCS C1713 57-15379 - PLATE BONE Z MEDIUM NARROW 1.5MM 13 HOLE LOCKING PROFILE BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $391.60 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-15385 SUP HCPCS C1713 57-15385 - PLATE BONE MEDIUM 1.5MM 5 HOLE LOCKING PROFILE ROTATION BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $391.60 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $979.00 $979.00 $204.02 $979.00 N/A N/A 57-15390 SUP HCPCS C1713 57-15390 - PLATE BONE 3D MEDIUM 2.3MM 1.5MM 2X2 HOLE LOCKING VARIAX BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $391.60 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-15391 SUP HCPCS C1713 57-15391 - PLATE BONE 3D MEDIUM 2.3MM 1.5MM 3X2 HOLE LOCKING VARIAX BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $979.00 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-15392 SUP HCPCS C1713 57-15392 - PLATE BONE 3D MEDIUM 1.5MM 4X2 HOLE LOCKING VARIAX HAND 2.3 BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $979.00 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $587.40 $979.00 $204.02 $979.00 N/A N/A 57-15395 SUP HCPCS C1713 57-15395 - PLATE BONE 3D MEDIUM NARROW 1.5MM 4X2 HOLE LOCKING PROFILE BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $391.60 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $979.00 $979.00 $204.02 $979.00 N/A N/A 57-15397 SUP HCPCS C1713 57-15397 - PLATE BONE MEDIUM 2.3MM 1.5MM 2X2+ 2 HOLE 3D LOCKING VARIAX BOTH IP/OP $979.00 $724.00 $194.31 $979.00 $440.55 $440.55 $440.55 $440.55 $979.00 $979.00 $979.00 $204.05 $979.00 $979.00 $979.00 $979.00 $979.00 $204.03 $979.00 $391.60 $579.08 $979.00 $979.00 $979.00 $979.00 $734.25 $979.00 $979.00 $979.00 $489.50 $489.50 $775.37 $979.00 $783.20 $440.55 $194.31 N/A $567.82 $979.00 $979.00 $979.00 $204.02 $979.00 N/A N/A 57525P SUP HCPCS C1713 57525P - SCREW BN 5.75MM 25MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57525S SUP HCPCS C1713 57525S - SCREW BN STD 5.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57530P SUP HCPCS C1713 57530P - SCREW BN 5.75MM 30MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57530S SUP HCPCS C1713 57530S - SCREW BN STD 5.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57535P SUP HCPCS C1713 57535P - SCREW BN 5.75MM 35MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57535S SUP HCPCS C1713 57535S - SCREW BN STD 5.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57540P SUP HCPCS C1713 57540P - SCREW BN 5.75MM 40MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57540S SUP HCPCS C1713 57540S - SCREW BN STD 5.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57545P SUP HCPCS C1713 57545P - SCREW BN 5.75MM 45MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57545S SUP HCPCS C1713 57545S - SCREW BN STD 5.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57550P SUP HCPCS C1713 57550P - SCREW BN 5.75MM 50MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57550S SUP HCPCS C1713 57550S - SCREW BN STD 5.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57555P SUP HCPCS C1713 57555P - SCREW BN 5.75MM 55MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57555S SUP HCPCS C1713 57555S - SCREW BN STD 5.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57560P SUP HCPCS C1713 57560P - SCREW BN 5.75MM 60MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 57560S SUP HCPCS C1713 57560S - SCREW BN STD 5.75MM 60MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$1,233.50" $913.00 $244.79 "$1,233.33" $555.00 $555.00 $555.00 $555.00 "$1,233.33" "$1,233.33" "$1,233.33" $257.06 "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" $257.04 "$1,233.33" "$1,233.33" $729.51 "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" $925.13 "$1,233.33" "$1,233.33" "$1,233.33" $616.67 $616.67 $976.80 "$1,233.33" $986.66 $555.00 $244.79 N/A $715.43 "$1,233.33" $740.00 "$1,233.33" $257.03 "$1,233.33" N/A N/A 57565P SUP HCPCS C1713 57565P - SCREW BN 5.75MM 65MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$1,622.00" "$1,200.00" $321.92 "$1,621.98" $729.89 $729.89 $729.89 $729.89 "$1,621.98" "$1,621.98" "$1,621.98" $338.06 "$1,621.98" "$1,621.98" "$1,621.98" "$1,621.98" "$1,621.98" $338.04 "$1,621.98" $648.79 $959.40 "$1,621.98" "$1,621.98" "$1,621.98" "$1,621.98" "$1,216.50" "$1,621.98" "$1,621.98" "$1,621.98" $810.99 $810.99 "$1,284.61" "$1,621.98" "$1,297.58" $729.89 $321.92 N/A $940.76 "$1,621.98" "$1,621.98" "$1,621.98" $338.02 "$1,621.98" N/A N/A 57565S SUP HCPCS C1713 57565S - SCREW BN STD 5.75MM 65MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$1,233.50" $913.00 $244.79 "$1,233.33" $555.00 $555.00 $555.00 $555.00 "$1,233.33" "$1,233.33" "$1,233.33" $257.06 "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" $257.04 "$1,233.33" "$1,233.33" $729.51 "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" $925.13 "$1,233.33" "$1,233.33" "$1,233.33" $616.67 $616.67 $976.80 "$1,233.33" $986.66 $555.00 $244.79 N/A $715.43 "$1,233.33" $740.00 "$1,233.33" $257.03 "$1,233.33" N/A N/A 5770-1-000 SUP Custom 27203010 5770-1-000 - SET ORTHOPEDIC 3.2MM DRILL GUIDE BOTH IP/OP $382.50 $283.00 $68.04 $382.25 $382.25 $382.25 $382.25 $382.25 $382.25 $382.25 $68.04 $382.25 $382.25 $283.71 $283.71 $294.64 $199.15 $79.67 $382.25 $152.90 $382.25 $382.25 $382.25 $382.25 $382.25 $286.88 $382.25 $382.25 $382.25 $191.13 $191.13 $302.74 $382.25 $305.80 $248.46 $382.25 N/A $221.85 $382.25 $229.35 $382.25 $382.25 $382.25 N/A N/A 5770-3-000 SUP Custom 27203010 5770-3-000 - SET ORTHOPEDIC 3.2MM DRILL GUIDE NEUTRAL BOTH IP/OP $137.50 $102.00 $24.48 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $24.48 $137.50 $137.50 $102.05 $102.05 $105.99 $71.64 $28.66 $137.50 $55.00 $137.50 $137.50 $137.50 $137.50 $137.50 $103.13 $137.50 $137.50 $137.50 $68.75 $68.75 $108.90 $137.50 $110.00 $89.38 $137.50 N/A $79.75 $137.50 $82.50 $137.50 $137.50 $137.50 N/A N/A 5770-4-000 SUP Custom 27203010 5770-4-000 - SET ORTHOPEDIC 3.6MM DRILL GUIDE BOTH IP/OP $494.00 $366.00 $87.87 $493.63 $493.63 $493.63 $493.63 $493.63 $493.63 $493.63 $87.87 $493.63 $493.63 $366.37 $366.37 $380.49 $257.18 $102.88 $493.63 $197.45 $493.63 $493.63 $493.63 $493.63 $493.63 $370.50 $493.63 $493.63 $493.63 $246.82 $246.82 $390.95 $493.63 $394.90 $320.86 $493.63 N/A $286.52 $493.63 $296.18 $493.63 $493.63 $493.63 N/A N/A 5770-5-000 SUP Custom 27203010 5770-5-000 - SET ORTHOPEDIC 2MM DRILL GUIDE BOTH IP/OP $422.50 $313.00 $75.14 $422.13 $422.13 $422.13 $422.13 $422.13 $422.13 $422.13 $75.14 $422.13 $422.13 $313.30 $313.30 $325.38 $219.93 $87.98 $422.13 $168.85 $422.13 $422.13 $422.13 $422.13 $422.13 $316.88 $422.13 $422.13 $422.13 $211.07 $211.07 $334.33 $422.13 $337.70 $274.38 $422.13 N/A $245.05 $422.13 $253.28 $422.13 $422.13 $422.13 N/A N/A 5780-0-035 SUP HCPCS C1713 5780-0-035 - SCREW BONE TAP CORTICAL BOTH IP/OP $106.00 $78.00 $21.01 $105.88 $47.65 $47.65 $47.65 $47.65 $105.88 $105.88 $105.88 $22.07 $105.88 $105.88 $105.88 $105.88 $105.88 $22.07 $105.88 $105.88 $62.63 $105.88 $105.88 $105.88 $105.88 $79.50 $105.88 $105.88 $105.88 $52.94 $52.94 $83.86 $105.88 $84.70 $47.65 $21.01 N/A $61.48 $105.88 $63.53 $105.88 $22.07 $105.88 N/A N/A 5780-0-045 SUP HCPCS C1713 5780-0-045 - SCREW BONE TAP CORTICAL BOTH IP/OP $411.50 $305.00 $81.60 $411.13 $185.01 $185.01 $185.01 $185.01 $411.13 $411.13 $411.13 $85.69 $411.13 $411.13 $411.13 $411.13 $411.13 $85.68 $411.13 $411.13 $243.18 $411.13 $411.13 $411.13 $411.13 $308.63 $411.13 $411.13 $411.13 $205.57 $205.57 $325.61 $411.13 $328.90 $185.01 $81.60 N/A $238.67 $411.13 $246.68 $411.13 $411.13 $411.13 N/A N/A 5780-1-045 SUP Custom 27803010 5780-1-045 - TAP CORTICAL BONE SCREW BOTH IP/OP $411.50 $305.00 $73.18 $411.13 $411.13 $411.13 $411.13 $411.13 $411.13 $411.13 $73.18 $411.13 $411.13 $411.13 $411.13 $411.13 $411.13 $85.68 $411.13 $164.45 $411.13 $411.13 $411.13 $411.13 $411.13 $308.63 $411.13 $411.13 $411.13 $205.57 $205.57 $325.61 $411.13 $328.90 $185.01 $411.13 N/A $238.67 $411.13 $246.68 $411.13 $411.13 $411.13 N/A N/A 5781-0-014 SUP Custom 27203010 5781-0-014 - SLEEVE DRILL 1.4-2MM ICS BOTH IP/OP $186.00 $138.00 $33.04 $185.63 $185.63 $185.63 $185.63 $185.63 $185.63 $185.63 $33.04 $185.63 $185.63 $137.77 $137.77 $143.08 $96.71 $38.69 $185.63 $74.25 $185.63 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $120.66 $185.63 N/A $107.88 $185.63 $111.38 $185.63 $185.63 $185.63 N/A N/A 5781-0-027 SUP Custom 27203010 5781-0-027 - SLEEVE DRILL 2MM INSERT BOTH IP/OP $103.50 $77.00 $18.36 $103.13 $103.13 $103.13 $103.13 $103.13 $103.13 $103.13 $18.36 $103.13 $103.13 $76.54 $76.54 $79.49 $53.73 $21.49 $103.13 $41.25 $103.13 $103.13 $103.13 $103.13 $103.13 $77.63 $103.13 $103.13 $103.13 $51.57 $51.57 $81.68 $103.13 $82.50 $67.03 $103.13 N/A $60.03 $103.13 $61.88 $103.13 $103.13 $103.13 N/A N/A 5781-0-045 SUP Custom 27203010 5781-0-045 - SLEEVE DRILL 4.5MM TAP BOTH IP/OP $180.50 $134.00 $32.06 $180.13 $180.13 $180.13 $180.13 $180.13 $180.13 $180.13 $32.06 $180.13 $180.13 $133.69 $133.69 $138.84 $93.85 $37.54 $180.13 $72.05 $180.13 $180.13 $180.13 $180.13 $180.13 $135.38 $180.13 $180.13 $180.13 $90.07 $90.07 $142.66 $180.13 $144.10 $117.08 $180.13 N/A $104.69 $180.13 $108.08 $180.13 $180.13 $180.13 N/A N/A 5781-0-480 SUP Custom 27203010 5781-0-480 - SLEEVE DRILL 48MM BOTH IP/OP $89.50 $66.00 $15.91 $89.38 $89.38 $89.38 $89.38 $89.38 $89.38 $89.38 $15.91 $89.38 $89.38 $66.34 $66.34 $68.89 $46.57 $18.63 $89.38 $35.75 $89.38 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $58.10 $89.38 N/A $51.91 $89.38 $53.63 $89.38 $89.38 $89.38 N/A N/A 5781-0-530 SUP Custom 27203010 5781-0-530 - SLEEVE DRILL 53MM BOTH IP/OP $89.50 $66.00 $15.91 $89.38 $89.38 $89.38 $89.38 $89.38 $89.38 $89.38 $15.91 $89.38 $89.38 $66.34 $66.34 $68.89 $46.57 $18.63 $89.38 $35.75 $89.38 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $58.10 $89.38 N/A $51.91 $89.38 $53.63 $89.38 $89.38 $89.38 N/A N/A 5781-3-035 SUP Custom 27203010 5781-3-035 - GUIDE DRILL SMALL POINT BOTH IP/OP $165.00 $122.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $165.00 N/A $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A 5781-3-045 SUP Custom 27203010 5781-3-045 - GUIDE DRILL POINT BOTH IP/OP $241.00 $178.00 $42.83 $240.63 $240.63 $240.63 $240.63 $240.63 $240.63 $240.63 $42.83 $240.63 $240.63 $178.60 $178.60 $185.48 $125.37 $50.15 $240.63 $96.25 $240.63 $240.63 $240.63 $240.63 $240.63 $180.75 $240.63 $240.63 $240.63 $120.32 $120.32 $190.58 $240.63 $192.50 $156.41 $240.63 N/A $139.78 $240.63 $144.38 $240.63 $240.63 $240.63 N/A N/A 5785-0-002 SUP Custom 27203010 5785-0-002 - FORCEPS SURG LONG SCREW BOTH IP/OP $67.50 $50.00 $11.99 $67.38 $67.38 $67.38 $67.38 $67.38 $67.38 $67.38 $11.99 $67.38 $67.38 $50.01 $50.01 $51.94 $35.10 $14.04 $67.38 $26.95 $67.38 $67.38 $67.38 $67.38 $67.38 $50.63 $67.38 $67.38 $67.38 $33.69 $33.69 $53.36 $67.38 $53.90 $43.80 $67.38 N/A $39.15 $67.38 $40.43 $67.38 $67.38 $67.38 N/A N/A 5785-0-003 SUP Custom 27203010 5785-0-003 - FORCEPS SURG ICS PLATE BOTH IP/OP $287.50 $213.00 $51.15 $287.38 $287.38 $287.38 $287.38 $287.38 $287.38 $287.38 $51.15 $287.38 $287.38 $213.29 $213.29 $221.51 $149.72 $59.89 $287.38 $114.95 $287.38 $287.38 $287.38 $287.38 $287.38 $215.63 $287.38 $287.38 $287.38 $143.69 $143.69 $227.60 $287.38 $229.90 $186.80 $287.38 N/A $166.75 $287.38 $172.43 $287.38 $287.38 $287.38 N/A N/A 58-12004E SUP HCPCS C1713 58-12004E - SCREW BONE BLUNT 1.2MM 4MM SELF TAP CROSSPIN VARIAX HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $46.48 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-12005E SUP HCPCS C1713 58-12005E - SCREW BONE 1.2MM 5MM HAND WRIST STERILE BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $46.48 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-12006E SUP HCPCS C1713 58-12006E - SCREW BONE BLUNT 1.2MM 6MM SELF TAP CROSSPIN VARIAX HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $46.48 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-12007E SUP HCPCS C1713 58-12007E - SCREW BONE 1.2MM 7MM NONLOCKING SLFTAP CROSSPIN HAND STERILE BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $46.48 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-12008E SUP HCPCS C1713 58-12008E - SCREW BONE 1.2MM 8MM XPIN SELF TAP HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $46.48 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-12009E SUP HCPCS C1713 58-12009E - SCREW BONE BLUNT 1.2MM 9MM SELF TAP CROSSPIN VARIAX HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $46.48 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-12010E SUP HCPCS C1713 58-12010E - SCREW BONE 1.2MM 10MM TITANIUM HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $46.48 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-12012E SUP HCPCS C1713 58-12012E - SCREW BONE 1.2MM 12MM NONLOCKING SLFTAP CROSSPIN HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $46.48 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-12014E SUP HCPCS C1713 58-12014E - SCREW BONE 1.2MM 14MM NONLOCKING SLFTAP CROSSPIN HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-12016E SUP HCPCS C1713 58-12016E - SCREW BONE 1.2MM 16MM NONLOCKING SLFTAP CROSSPIN HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-12018E SUP HCPCS C1713 58-12018E - SCREW BONE 1.2MM 18MM SLFTAP NONLOCKING HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-12020E SUP HCPCS C1713 58-12020E - SCREW BONE 1.2MM 20MM SLFTAP NONLOCKING HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-14003E SUP HCPCS C1713 58-14003E - SCREW BONE 1.4MM 3MM NONLOCKING SLFTAP CROSSPIN HAND STERILE BOTH IP/OP $117.00 $87.00 $23.20 $116.88 $52.60 $52.60 $52.60 $52.60 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $69.13 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $52.60 $23.20 N/A $67.86 $116.88 $116.88 $116.88 $24.36 $116.88 N/A N/A 58-14005E SUP HCPCS C1713 58-14005E - SCREW BONE 1.4MM 5MM NONLOCKING SLFTAP CROSSPIN HAND STERILE BOTH IP/OP $117.00 $87.00 $23.20 $116.88 $52.60 $52.60 $52.60 $52.60 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $69.13 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $52.60 $23.20 N/A $67.86 $116.88 $116.88 $116.88 $24.36 $116.88 N/A N/A 58-14007E SUP HCPCS C1713 58-14007E - SCREW BONE 1.4MM 7MM EMERGENCY SLFTAP NONLOCKING HAND BOTH IP/OP $117.00 $87.00 $23.20 $116.88 $52.60 $52.60 $52.60 $52.60 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $69.13 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $52.60 $23.20 N/A $67.86 $116.88 $116.88 $116.88 $24.36 $116.88 N/A N/A 58-14009E SUP HCPCS C1713 58-14009E - SCREW BONE BLUNT 1.4MM 9MM EMERGENCY SELF TAP CROSSPIN BOTH IP/OP $117.00 $87.00 $23.20 $116.88 $52.60 $52.60 $52.60 $52.60 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $116.88 $116.88 $116.88 $24.36 $116.88 $46.75 $69.13 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $52.60 $23.20 N/A $67.86 $116.88 $116.88 $116.88 $24.36 $116.88 N/A N/A 58-17005 SUP HCPCS C1713 58-17005 - SCREW BONE 1.7MM 5MM LOCKING SLFTAP BLUNT TIP LP ROUNDED BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-17005E SUP HCPCS C1713 58-17005E - SCREW BONE BLUNT 1.7MM 5MM SELF TAP XPIN HEAD VARIAX HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $46.48 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $69.72 $116.20 $24.22 $116.20 N/A N/A 58-17006 SUP HCPCS C1713 58-17006 - SCREW BONE 1.7MM 6MM TITANIUM HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $120.40 $120.40 $25.09 $120.40 N/A N/A 58-17007 SUP HCPCS C1713 58-17007 - SCREW BN 1.7MM 7MM HND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-17008 SUP HCPCS C1713 58-17008 - SCREW BONE 1.7MM 8MM LOCKING SLFTAP CROSSPIN VARIAX HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-17008E SUP HCPCS C1713 58-17008E - SCREW BONE 1.7MM 8MM HAND NLCKG SLFTAP CROSSPIN STRL BOTH IP/OP $110.00 $81.00 $21.83 $110.00 $49.50 $49.50 $49.50 $49.50 $110.00 $110.00 $110.00 $22.93 $110.00 $110.00 $110.00 $110.00 $110.00 $22.93 $110.00 $44.00 $65.07 $110.00 $110.00 $110.00 $110.00 $82.50 $110.00 $110.00 $110.00 $55.00 $55.00 $87.12 $110.00 $88.00 $49.50 $21.83 N/A $63.80 $110.00 $110.00 $110.00 $22.92 $110.00 N/A N/A 58-17009 SUP HCPCS C1713 58-17009 - SCREW BONE BLUNT 1.7MM 9MM SELF TAP CROSSPIN VARIAX HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-17010 SUP HCPCS C1713 58-17010 - SCREW BONE BLUNT 1.7MM 10MM SELF TAP XPIN HEAD VARIAX HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $120.40 $120.40 $25.09 $120.40 N/A N/A 58-17011 SUP HCPCS C1713 58-17011 - SCREW BONE 1.7MM 11MM LOCKING SLFTAP CROSSPIN VARIAX HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-17012 SUP HCPCS C1713 58-17012 - SCREW BONE BLUNT 1.7MM 12MM SELF TAP XPIN HEAD VARIAX HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-17013 SUP HCPCS C1713 58-17013 - SCREW BONE BLUNT 1.7MM 13MM SELF TAP CROSSPIN VARIAX HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-17013E SUP HCPCS C1713 58-17013E - SCREW BONE BLUNT 1.7MM 13MM SELF TAP XPIN HEAD VARIAX HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $46.48 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-17014 SUP HCPCS C1713 58-17014 - SCREW BONE 1.7MM 14MM NONLOCKING SLFTAP CROSSPIN HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-17015 SUP HCPCS C1713 58-17015 - SCREW BONE BLUNT 1.7MM 15MM SELF TAP CROSSPIN VARIAX HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $120.40 $120.40 N/A N/A 58-17015E SUP HCPCS C1713 58-17015E - SCREW BONE 1.7MM 15MM SELF TAP CROSSPIN BLUNT VARIAX HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $46.48 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-17016 SUP HCPCS C1713 58-17016 - SCREW BONE 1.7MM 16MM XPIN TITANIUM HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $120.40 $120.40 $25.09 $120.40 N/A N/A 58-17018 SUP HCPCS C1713 58-17018 - SCREW BONE BLUNT 1.7MM 18MM SELF TAP CROSSPIN VARIAX HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-17018E SUP HCPCS C1713 58-17018E - SCREW BONE BLUNT 1.7MM 18MM SELF TAP CROSSPIN VARIAX HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $46.48 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-17020 SUP HCPCS C1713 58-17020 - SCREW BN 1.7MM 20MM NS VARIAX ST XPN BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-17020E SUP HCPCS C1713 58-17020E - SCREW BONE BLUNT 1.7MM 20MM SELF TAP CROSSPIN VARIAX HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $46.48 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-17022 SUP HCPCS C1713 58-17022 - SCREW BONE BLUNT 1.7MM 22MM SELF TAP CROSSPIN VARIAX HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $120.40 $120.40 $25.09 $120.40 N/A N/A 58-17022E SUP HCPCS C1713 58-17022E - SCREW BONE BLUNT 1.7MM 22MM SELF TAP CROSSPIN VARIAX HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $46.48 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-17024 SUP HCPCS C1713 58-17024 - SCREW BONE 1.7MM 24MM BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $120.40 $120.40 $120.40 $120.40 N/A N/A 58-17024E SUP HCPCS C1713 58-17024E - SCREW BONE BLUNT 1.7MM 24MM SELF TAP CROSSPIN VARIAX HAND BOTH IP/OP $116.50 $86.00 $23.06 $116.20 $52.29 $52.29 $52.29 $52.29 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $116.20 $116.20 $116.20 $24.22 $116.20 $116.20 $68.73 $116.20 $116.20 $116.20 $116.20 $87.38 $116.20 $116.20 $116.20 $58.10 $58.10 $92.03 $116.20 $92.96 $52.29 $23.06 N/A $67.57 $116.20 $116.20 $116.20 $24.22 $116.20 N/A N/A 58-19005 SUP HCPCS C1713 58-19005 - SCREW BONE 1.9MM 5MM EMERGENCY BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $120.40 $120.40 N/A N/A 58-19005E SUP HCPCS C1713 58-19005E - SCREW BONE 1.9MM 5MM NONLOCKING SLFTAP CROSSPIN EMERGENCY BOTH IP/OP $117.00 $87.00 $23.20 $116.88 $52.60 $52.60 $52.60 $52.60 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $69.13 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $52.60 $23.20 N/A $67.86 $116.88 $116.88 $116.88 $24.36 $116.88 N/A N/A 58-19008 SUP HCPCS C1713 58-19008 - SCREW BONE 1.9MM 8MM EMERGENCY BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $120.40 $120.40 $25.09 $120.40 N/A N/A 58-19008E SUP HCPCS C1713 58-19008E - SCREW BONE 1.9MM 8MM NONLOCKING SLFTAP CROSSPIN EMERGENCY BOTH IP/OP $117.00 $87.00 $23.20 $116.88 $52.60 $52.60 $52.60 $52.60 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $69.13 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $52.60 $23.20 N/A $67.86 $116.88 $116.88 $116.88 $24.36 $116.88 N/A N/A 58-19010 SUP HCPCS C1713 58-19010 - SCREW BONE 2.5MM 10MM BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $120.40 $120.40 $25.09 $120.40 N/A N/A 58-19010E SUP HCPCS C1713 58-19010E - SCREW BONE 1.9MM 10MM SELF TAP EMERGENCY CROSSPIN HAND BOTH IP/OP $117.00 $87.00 $23.20 $116.88 $52.60 $52.60 $52.60 $52.60 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $116.88 $116.88 $116.88 $24.36 $116.88 $46.75 $69.13 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $52.60 $23.20 N/A $67.86 $116.88 $116.88 $116.88 $24.36 $116.88 N/A N/A 58-19012 SUP HCPCS C1713 58-19012 - SCREW BONE 1.9MM 12MM EMERGENCY HAND NONSTRL BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $120.40 $120.40 $25.09 $120.40 N/A N/A 5820-009-030 SUP Custom 27203010 5820-009-030 - BURR SURG 3MM PRECISION BOTH IP/OP $506.00 $374.00 $90.05 $505.88 $505.88 $505.88 $505.88 $505.88 $505.88 $505.88 $90.05 $505.88 $505.88 $375.46 $375.46 $389.93 $263.56 $105.43 $505.88 $202.35 $505.88 $505.88 $505.88 $505.88 $505.88 $379.50 $505.88 $505.88 $505.88 $252.94 $252.94 $400.66 $505.88 $404.70 $328.82 $505.88 N/A $293.48 $505.88 $303.53 $505.88 $505.88 $505.88 N/A N/A 5820-009-040 SUP Custom 27203010 5820-009-040 - BURR SURG 4MM PRECISION BOTH IP/OP $506.00 $374.00 $90.05 $505.88 $505.88 $505.88 $505.88 $505.88 $505.88 $505.88 $90.05 $505.88 $505.88 $375.46 $375.46 $389.93 $263.56 $105.43 $505.88 $202.35 $505.88 $505.88 $505.88 $505.88 $505.88 $379.50 $505.88 $505.88 $505.88 $252.94 $252.94 $400.66 $505.88 $404.70 $328.82 $505.88 N/A $293.48 $505.88 $303.53 $505.88 $505.88 $505.88 N/A N/A 5820-009-050 SUP Custom 27203010 5820-009-050 - BURR SURG 5MM PRECISION BOTH IP/OP $506.00 $374.00 $90.05 $505.88 $505.88 $505.88 $505.88 $505.88 $505.88 $505.88 $90.05 $505.88 $505.88 $375.46 $375.46 $389.93 $263.56 $105.43 $505.88 $202.35 $505.88 $505.88 $505.88 $505.88 $505.88 $379.50 $505.88 $505.88 $505.88 $252.94 $252.94 $400.66 $505.88 $404.70 $328.82 $505.88 N/A $293.48 $505.88 $303.53 $505.88 $505.88 $505.88 N/A N/A 5820-010-120 SUP Custom 27203010 5820-010-120 - BURR SURG ROUND FLUTE 2MM 5 NOTCH SOFT TOUCH SMOOTH CUT GOOD BOTH IP/OP $289.00 $214.00 $51.40 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $51.40 $288.75 $288.75 $214.31 $214.31 $222.57 $150.44 $60.18 $288.75 $115.50 $288.75 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $187.69 $288.75 N/A $167.62 $288.75 $173.25 $288.75 $288.75 $288.75 N/A N/A 5820-010-130 SUP Custom 27203010 5820-010-130 - BURR SURG ROUND FLUTE 3MM 5 NOTCH SOFT TOUCH SMOOTH CUT GOOD BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 5820-010-140 SUP Custom 27203010 5820-010-140 - BURR SURG ROUND 4MM ROUND SOFT TOUCH LATEX FREE ELITE BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 5820-012-030 SUP Custom 27203010 5820-012-030 - BURR SURG ROUND DIAMOND 3MM 5 STEP NOTCH NUMBERED SAFETY BOTH IP/OP $304.00 $225.00 $54.07 $303.78 $303.78 $303.78 $303.78 $303.78 $303.78 $303.78 $54.07 $303.78 $303.78 $225.47 $225.47 $234.15 $158.27 $63.31 $303.78 $121.51 $303.78 $303.78 $303.78 $303.78 $303.78 $228.00 $303.78 $303.78 $303.78 $151.89 $151.89 $240.59 $303.78 $243.02 $197.46 $303.78 N/A $176.32 $303.78 $182.27 $303.78 $303.78 $303.78 N/A N/A 5820-012-040 SUP Custom 27203010 5820-012-040 - BURR SURG ROUND DIAMOND 4MM 5 NOTCH SMOOTH CUT GOOD CONTROL BOTH IP/OP $304.00 $225.00 $54.07 $303.78 $303.78 $303.78 $303.78 $303.78 $303.78 $303.78 $54.07 $303.78 $303.78 $225.47 $225.47 $234.15 $158.27 $63.31 $303.78 $121.51 $303.78 $303.78 $303.78 $303.78 $303.78 $228.00 $303.78 $303.78 $303.78 $151.89 $151.89 $240.59 $303.78 $243.02 $197.46 $303.78 N/A $176.32 $303.78 $182.27 $303.78 $303.78 $303.78 N/A N/A 5820-015-050 SUP Custom 27203010 5820-015-050 - BURR SURG 5MM EGG HEAD TPS ELITE BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 5820-015-060 SUP Custom 27203010 5820-015-060 - BURR SURG 6MM EGG HEAD TPS ELITE BOTH IP/OP $310.50 $230.00 $55.27 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $310.50 $55.27 $310.50 $310.50 $230.45 $230.45 $239.33 $161.77 $64.71 $310.50 $124.20 $310.50 $310.50 $310.50 $310.50 $310.50 $232.88 $310.50 $310.50 $310.50 $155.25 $155.25 $245.92 $310.50 $248.40 $201.83 $310.50 N/A $180.09 $310.50 $186.30 $310.50 $310.50 $310.50 N/A N/A 5820107430S1 SUP Custom 27203010 5820107430S1 - BIT DRILL 3MM 3.8MM LESS AGGRESSIVE NEURO STERILE BOTH IP/OP $300.50 $222.00 $53.45 $300.30 $300.30 $300.30 $300.30 $300.30 $300.30 $300.30 $53.45 $300.30 $300.30 $222.88 $222.88 $231.47 $156.46 $62.59 $300.30 $120.12 $300.30 $300.30 $300.30 $300.30 $300.30 $225.38 $300.30 $300.30 $300.30 $150.15 $150.15 $237.84 $300.30 $240.24 $195.20 $300.30 N/A $174.29 $300.30 $180.18 $300.30 $300.30 $300.30 N/A N/A 5820107530S3 SUP Custom 27203010 5820107530S3 - BIT DRILL 1.7MM NEURO BOTH IP/OP $289.00 $214.00 $51.40 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $288.75 $51.40 $288.75 $288.75 $214.31 $214.31 $222.57 $150.44 $60.18 $288.75 $115.50 $288.75 $288.75 $288.75 $288.75 $288.75 $216.75 $288.75 $288.75 $288.75 $144.38 $144.38 $228.69 $288.75 $231.00 $187.69 $288.75 N/A $167.62 $288.75 $173.25 $288.75 $288.75 $288.75 N/A N/A 58-23006 SUP HCPCS C1713 58-23006 - SCREW BONE 2.3MM 6MM SELF TAP CROSSPIN HAND STERILE BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-23008 SUP HCPCS C1713 58-23008 - SCREW BONE BLUNT 2.3MM 8MM SELF TAP XPIN HEAD VARIAX HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-23009 SUP HCPCS C1713 58-23009 - SCREW BONE 2.3MM 9MM LOCKING SLFTAP BLUNT TIP LP ROUNDED BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-23009E SUP HCPCS C1713 58-23009E - SCREW BONE 2.3MM 9MM NONLOCKING SLFTAP CROSSPIN HAND STERILE BOTH IP/OP $117.00 $87.00 $23.20 $116.90 $52.61 $52.61 $52.61 $52.61 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $69.15 $116.90 $116.90 $116.90 $116.90 $87.75 $116.90 $116.90 $116.90 $58.45 $58.45 $92.58 $116.90 $93.52 $52.61 $23.20 N/A $67.86 $116.90 $70.14 $116.90 $24.36 $116.90 N/A N/A 58-23010 SUP HCPCS C1713 58-23010 - SCREW BONE 2.3MM 10MM NONLOCKING SLFTAP CROSSPIN HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $120.40 $120.40 $25.09 $120.40 N/A N/A 58-23011 SUP HCPCS C1713 58-23011 - SCREW BONE 2.3MM 11MM HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-23011E SUP HCPCS C1713 58-23011E - SCREW BONE BLUNT 2.3MM 11MM SELF TAP XPIN HEAD VARIAX HAND BOTH IP/OP $117.00 $87.00 $23.20 $116.90 $52.61 $52.61 $52.61 $52.61 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $116.90 $116.90 $116.90 $24.36 $116.90 $46.76 $69.15 $116.90 $116.90 $116.90 $116.90 $87.75 $116.90 $116.90 $116.90 $58.45 $58.45 $92.58 $116.90 $93.52 $52.61 $23.20 N/A $67.86 $116.90 $70.14 $116.90 $24.36 $116.90 N/A N/A 58-23012 SUP HCPCS C1713 58-23012 - SCREW BONE 2.3MM 12MM LOCKING ROUNDED HEAD LP BLUNT TIP BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $120.40 $120.40 $25.09 $120.40 N/A N/A 58-23012E SUP HCPCS C1713 58-23012E - SCREW BN 2.3MM 12MM STRL VARIAX PRFL ST LOPRFL RND XPN HD TI BOTH IP/OP $117.00 $87.00 $23.20 $116.90 $52.61 $52.61 $52.61 $52.61 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $69.15 $116.90 $116.90 $116.90 $116.90 $87.75 $116.90 $116.90 $116.90 $58.45 $58.45 $92.58 $116.90 $93.52 $52.61 $23.20 N/A $67.86 $116.90 $116.90 $116.90 $24.36 $116.90 N/A N/A 58-23013E SUP HCPCS C1713 58-23013E - SCREW BONE BLUNT 2.3MM 13MM SELF TAP XPIN HEAD VARIAX HAND BOTH IP/OP $117.00 $87.00 $23.20 $116.90 $52.61 $52.61 $52.61 $52.61 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $116.90 $116.90 $116.90 $24.36 $116.90 $46.76 $69.15 $116.90 $116.90 $116.90 $116.90 $87.75 $116.90 $116.90 $116.90 $58.45 $58.45 $92.58 $116.90 $93.52 $52.61 $23.20 N/A $67.86 $116.90 $116.90 $116.90 $24.36 $116.90 N/A N/A 58-23014 SUP HCPCS C1713 58-23014 - SCREW BONE 2.3MM 14MM NONLOCKING SLFTAP CROSSPIN HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $120.40 $120.40 $25.09 $120.40 N/A N/A 58-23014E SUP HCPCS C1713 58-23014E - SCREW BN 2.3MM 14MM STRL VARIAX PRFL ST LOPRFL RND XPN HD TI BOTH IP/OP $117.00 $87.00 $23.20 $116.90 $52.61 $52.61 $52.61 $52.61 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $69.15 $116.90 $116.90 $116.90 $116.90 $87.75 $116.90 $116.90 $116.90 $58.45 $58.45 $92.58 $116.90 $93.52 $52.61 $23.20 N/A $67.86 $116.90 $116.90 $116.90 $24.36 $116.90 N/A N/A 58-23015 SUP HCPCS C1713 58-23015 - SCREW BONE 2.3MM 15MM NLCKG SLFTAP CROSSPIN STRL BOTH IP/OP $110.00 $81.00 $21.83 $110.00 $49.50 $49.50 $49.50 $49.50 $110.00 $110.00 $110.00 $22.93 $110.00 $110.00 $110.00 $110.00 $110.00 $22.93 $110.00 $110.00 $65.07 $110.00 $110.00 $110.00 $110.00 $82.50 $110.00 $110.00 $110.00 $55.00 $55.00 $87.12 $110.00 $88.00 $49.50 $21.83 N/A $63.80 $110.00 $110.00 $110.00 $22.92 $110.00 N/A N/A 58-23015E SUP HCPCS C1713 58-23015E - SCREW BONE 2.3MM 15MM NONLOCKING SLFTAP CROSSPIN HAND BOTH IP/OP $117.00 $87.00 $23.20 $116.90 $52.61 $52.61 $52.61 $52.61 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $69.15 $116.90 $116.90 $116.90 $116.90 $87.75 $116.90 $116.90 $116.90 $58.45 $58.45 $92.58 $116.90 $93.52 $52.61 $23.20 N/A $67.86 $116.90 $70.14 $116.90 $24.36 $116.90 N/A N/A 58-23016 SUP HCPCS C1713 58-23016 - SCREW BONE 2.3MM 16MM NONLOCKING SLFTAP CROSSPIN HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $120.40 $120.40 $25.09 $120.40 N/A N/A 58-23016E SUP HCPCS C1713 58-23016E - SCREW BONE BLUNT 2.3MM 16MM SELF TAP XPIN HEAD VARIAX HAND BOTH IP/OP $117.00 $87.00 $23.20 $116.90 $52.61 $52.61 $52.61 $52.61 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $69.15 $116.90 $116.90 $116.90 $116.90 $87.75 $116.90 $116.90 $116.90 $58.45 $58.45 $92.58 $116.90 $93.52 $52.61 $23.20 N/A $67.86 $116.90 $70.14 $116.90 $24.36 $116.90 N/A N/A 58-23018 SUP HCPCS C1713 58-23018 - SCREW BONE 2.3MM 18MM SELF TAP CROSSPIN HAND BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-23018E SUP HCPCS C1713 58-23018E - SCREW BONE 2.3MM 18MM NONLOCKING SLFTAP CROSSPIN HAND BOTH IP/OP $117.00 $87.00 $23.20 $116.90 $52.61 $52.61 $52.61 $52.61 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $69.15 $116.90 $116.90 $116.90 $116.90 $87.75 $116.90 $116.90 $116.90 $58.45 $58.45 $92.58 $116.90 $93.52 $52.61 $23.20 N/A $67.86 $116.90 $116.90 $116.90 $24.36 $116.90 N/A N/A 58-23020 SUP HCPCS C1713 58-23020 - SCREW BONE 2.3MM 20MM LOCKING SLFTAP BLUNT TIP LP ROUNDED BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-23020E SUP HCPCS C1713 58-23020E - SCREW BONE 2.3MM 20MM NONLOCKING SLFTAP CROSSPIN HAND BOTH IP/OP $117.00 $87.00 $23.20 $116.90 $52.61 $52.61 $52.61 $52.61 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $69.15 $116.90 $116.90 $116.90 $116.90 $87.75 $116.90 $116.90 $116.90 $58.45 $58.45 $92.58 $116.90 $93.52 $52.61 $23.20 N/A $67.86 $116.90 $116.90 $116.90 $24.36 $116.90 N/A N/A 58-23022 SUP HCPCS C1713 58-23022 - SCREW BONE 2.3MM 22MM ORTHOPEDIC BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $120.40 $120.40 N/A N/A 58-23022E SUP HCPCS C1713 58-23022E - SCREW BONE BLUNT 2.3MM 22MM SELF TAP CROSSPIN VARIAX HAND BOTH IP/OP $117.00 $87.00 $23.20 $116.90 $52.61 $52.61 $52.61 $52.61 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $69.15 $116.90 $116.90 $116.90 $116.90 $87.75 $116.90 $116.90 $116.90 $58.45 $58.45 $92.58 $116.90 $93.52 $52.61 $23.20 N/A $67.86 $116.90 $116.90 $116.90 $24.36 $116.90 N/A N/A 58-23024 SUP HCPCS C1713 58-23024 - SCREW BONE 2.3MM 24MM BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-23024E SUP HCPCS C1713 58-23024E - SCREW BONE BLUNT 2.3MM 24MM SELF TAP CROSSPIN VARIAX HAND BOTH IP/OP $117.00 $87.00 $23.20 $116.90 $52.61 $52.61 $52.61 $52.61 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $69.15 $116.90 $116.90 $116.90 $116.90 $87.75 $116.90 $116.90 $116.90 $58.45 $58.45 $92.58 $116.90 $93.52 $52.61 $23.20 N/A $67.86 $116.90 $116.90 $116.90 $24.36 $116.90 N/A N/A 58-23026 SUP HCPCS C1713 58-23026 - SCREW BONE 2.3MM 26MM BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $120.40 $120.40 N/A N/A 58-23026E SUP HCPCS C1713 58-23026E - SCREW BONE 2.3MM 26MM NONLOCKING SLFTAP CROSSPIN HAND BOTH IP/OP $117.00 $87.00 $23.20 $116.90 $52.61 $52.61 $52.61 $52.61 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $116.90 $116.90 $116.90 $24.36 $116.90 $116.90 $69.15 $116.90 $116.90 $116.90 $116.90 $87.75 $116.90 $116.90 $116.90 $58.45 $58.45 $92.58 $116.90 $93.52 $52.61 $23.20 N/A $67.86 $116.90 $116.90 $116.90 $24.36 $116.90 N/A N/A 58-25006 SUP HCPCS C1713 58-25006 - SCREW BONE 2.5MM 6MM EMERGENCY BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-25006E SUP HCPCS C1713 58-25006E - SCREW BONE 2.5MM 6MM NONLOCKING SLFTAP CROSSPIN EMERGENCY BOTH IP/OP $117.00 $87.00 $23.20 $116.88 $52.60 $52.60 $52.60 $52.60 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $69.13 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $52.60 $23.20 N/A $67.86 $116.88 $116.88 $116.88 $24.36 $116.88 N/A N/A 58-25008 SUP HCPCS C1713 58-25008 - SCREW BONE 2.5MM 8MM EMERGENCY BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-25008E SUP HCPCS C1713 58-25008E - SCREW BONE 2.5MM 8MM NONLOCKING SLFTAP CROSSPIN EMERGENCY BOTH IP/OP $117.00 $87.00 $23.20 $116.88 $52.60 $52.60 $52.60 $52.60 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $69.13 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $52.60 $23.20 N/A $67.86 $116.88 $116.88 $116.88 $24.36 $116.88 N/A N/A 58-25010 SUP HCPCS C1713 58-25010 - SCREW BONE 2.5MM 10MM EMERGENCY BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-25010E SUP HCPCS C1713 58-25010E - SCREW BONE 2.5MM 10MM NONLOCKING SLFTAP CROSSPIN EMERGENCY BOTH IP/OP $117.00 $87.00 $23.20 $116.88 $52.60 $52.60 $52.60 $52.60 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $69.13 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $52.60 $23.20 N/A $67.86 $116.88 $70.13 $116.88 $24.36 $116.88 N/A N/A 58-25012 SUP HCPCS C1713 58-25012 - SCREW BONE 2.5MM 12MM EMERGENCY BOTH IP/OP $120.50 $89.00 $23.90 $120.40 $54.18 $54.18 $54.18 $54.18 $120.40 $120.40 $120.40 $25.09 $120.40 $120.40 $120.40 $120.40 $120.40 $25.09 $120.40 $48.16 $71.22 $120.40 $120.40 $120.40 $120.40 $90.38 $120.40 $120.40 $120.40 $60.20 $60.20 $95.36 $120.40 $96.32 $54.18 $23.90 N/A $69.89 $120.40 $72.24 $120.40 $25.09 $120.40 N/A N/A 58-25012E SUP HCPCS C1713 58-25012E - SCREW BONE 2.5MM 12MM NONLOCKING SLFTAP CROSSPIN EMERGENCY BOTH IP/OP $117.00 $87.00 $23.20 $116.88 $52.60 $52.60 $52.60 $52.60 $116.88 $116.88 $116.88 $24.36 $116.88 $116.88 $116.88 $116.88 $116.88 $24.36 $116.88 $46.75 $69.13 $116.88 $116.88 $116.88 $116.88 $87.75 $116.88 $116.88 $116.88 $58.44 $58.44 $92.57 $116.88 $93.50 $52.60 $23.20 N/A $67.86 $116.88 $70.13 $116.88 $24.36 $116.88 N/A N/A 5858-0-000 SUP Custom 27203010 5858-0-000 - GAUGE DEPTH SCREW BOTH IP/OP "$1,024.50" $758.00 $182.34 "$1,024.38" "$1,024.38" "$1,024.38" "$1,024.38" "$1,024.38" "$1,024.38" "$1,024.38" $182.34 "$1,024.38" "$1,024.38" $760.29 $760.29 $789.59 $533.70 $213.49 "$1,024.38" $409.75 "$1,024.38" "$1,024.38" "$1,024.38" "$1,024.38" "$1,024.38" $768.38 "$1,024.38" "$1,024.38" "$1,024.38" $512.19 $512.19 $811.31 "$1,024.38" $819.50 $665.85 "$1,024.38" N/A $594.21 "$1,024.38" $614.63 "$1,024.38" "$1,024.38" "$1,024.38" N/A N/A 5866-45 SUP Custom 27803010 5866-45 - SLEEVE ADAPTER 5-6MM 1IN 1 CHAMBER RATE RESPONSIVE UNIPOLAR BOTH IP/OP $47.50 $35.00 $8.46 $47.50 $47.50 $47.50 $47.50 $47.50 $47.50 $47.50 $8.46 $47.50 $47.50 $47.50 $47.50 $47.50 $47.50 $9.90 $47.50 $19.00 $47.50 $47.50 $47.50 $47.50 $47.50 $35.63 $47.50 $47.50 $47.50 $23.75 $23.75 $37.62 $47.50 $38.00 $21.38 $47.50 N/A $27.55 $47.50 $28.50 $47.50 $47.50 $47.50 N/A N/A 5873W SUP Custom 27203010 5873W - KIT NEUROSTIMULATOR WRENCH LEAD BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A 59-12004 SUP HCPCS C1713 59-12004 - SCREW BONE 1.2MM 4MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-12005 SUP HCPCS C1713 59-12005 - SCREW BONE 1.2MM 5MM SLFTAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 59-12006 SUP HCPCS C1713 59-12006 - SCREW BONE 1.2MM 6MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 59-12007 SUP HCPCS C1713 59-12007 - SCREW BONE 1.2MM 7MM MODULAR PROFYLE TITANIUM HAND SMALL BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-12008 SUP HCPCS C1713 59-12008 - SCREW BONE 1.2MM 8MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-12009 SUP HCPCS C1713 59-12009 - SCREW BONE 1.2MM 9MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-12010 SUP HCPCS C1713 59-12010 - SCREW BONE 1.2MM 10MM SLFTAP XFIT PROFYLE TITANIUM HAND BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-12011 SUP HCPCS C1713 59-12011 - SCREW BONE 1.2MM 11MM SLFTAP XFIT PROFYLE TITANIUM HAND BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 59-12012 SUP HCPCS C1713 59-12012 - SCREW BONE 1.2MM 12MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 59-12013 SUP HCPCS C1713 59-12013 - SCREW BONE 1.2MM 13MM SELF TAP XFIT PROFYLE TITANIUM HAND BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-12014 SUP HCPCS C1713 59-12014 - SCREW BONE 1.2MM 14MM SLFTAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $113.00 $84.00 $22.38 $112.75 $50.74 $50.74 $50.74 $50.74 $112.75 $112.75 $112.75 $23.50 $112.75 $112.75 $112.75 $112.75 $112.75 $23.50 $112.75 $45.10 $66.69 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $50.74 $22.38 N/A $65.54 $112.75 $67.65 $112.75 $23.50 $112.75 N/A N/A 59-12016 SUP HCPCS C1713 59-12016 - SCREW BONE 1.2MM 16MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $113.00 $84.00 $22.38 $112.75 $50.74 $50.74 $50.74 $50.74 $112.75 $112.75 $112.75 $23.50 $112.75 $112.75 $112.75 $112.75 $112.75 $23.50 $112.75 $45.10 $66.69 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $50.74 $22.38 N/A $65.54 $112.75 $112.75 $112.75 $23.50 $112.75 N/A N/A 59-12018 SUP HCPCS C1713 59-12018 - PLATE BONE 1.2MM 18MM SLFTAP XFIT PROFYLE TITANIUM HAND BOTH IP/OP $113.00 $84.00 $22.38 $112.75 $50.74 $50.74 $50.74 $50.74 $112.75 $112.75 $112.75 $23.50 $112.75 $112.75 $112.75 $112.75 $112.75 $23.50 $112.75 $45.10 $66.69 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $50.74 $22.38 N/A $65.54 $112.75 $67.65 $112.75 $112.75 $112.75 N/A N/A 59-12020 SUP HCPCS C1713 59-12020 - PLATE BONE 1.2MM 20MM SLFTAP XFIT PROFYLE TITANIUM HAND BOTH IP/OP $113.00 $84.00 $22.38 $112.75 $50.74 $50.74 $50.74 $50.74 $112.75 $112.75 $112.75 $23.50 $112.75 $112.75 $112.75 $112.75 $112.75 $23.50 $112.75 $45.10 $66.69 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $50.74 $22.38 N/A $65.54 $112.75 $67.65 $112.75 $112.75 $112.75 N/A N/A 59-12049 SUP HCPCS C1713 59-12049 - WASHER ORTHOPEDIC 1.2MM PROFYLE WRIST BOTH IP/OP $53.50 $40.00 $10.56 $53.20 $23.94 $23.94 $23.94 $23.94 $53.20 $53.20 $53.20 $11.09 $53.20 $53.20 $53.20 $53.20 $53.20 $11.09 $53.20 $53.20 $31.47 $53.20 $53.20 $53.20 $53.20 $40.13 $53.20 $53.20 $53.20 $26.60 $26.60 $42.13 $53.20 $42.56 $23.94 $10.56 N/A $31.03 $53.20 $31.92 $53.20 $11.09 $53.20 N/A N/A 59-12049E SUP HCPCS C1713 59-12049E - WASHER ORTHOPEDIC STERILE 1.2 MM SCREW BOTH IP/OP $53.50 $40.00 $10.56 $53.20 $23.94 $23.94 $23.94 $23.94 $53.20 $53.20 $53.20 $11.09 $53.20 $53.20 $53.20 $53.20 $53.20 $11.09 $53.20 $53.20 $31.47 $53.20 $53.20 $53.20 $53.20 $40.13 $53.20 $53.20 $53.20 $26.60 $26.60 $42.13 $53.20 $42.56 $23.94 $10.56 N/A $31.03 $53.20 $53.20 $53.20 $53.20 $53.20 N/A N/A 59-14003 SUP HCPCS C1713 59-14003 - SCREW BONE 1.4MM 3MM EMERGENCY SELF TAP XFIT PROFYLE BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-14005 SUP HCPCS C1713 59-14005 - SCREW BONE 1.4MM 5MM EMERGENCY SELF TAP XFIT PROFYLE BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 59-14007 SUP HCPCS C1713 59-14007 - SCREW BONE 1.4MM 7MM SLFTAP XFIT EMERGENCY PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-14009 SUP HCPCS C1713 59-14009 - SCREW BONE 1.4MM 9MM SLFTAP XFIT EMERGENCY PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-17005 SUP HCPCS C1713 59-17005 - SCREW BONE 1.7MM 5MM SLFTAP XFIT PROFYLE TITANIUM HAND BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-17006 SUP HCPCS C1713 59-17006 - SCREW BONE 1.7MM 6MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-17007 SUP HCPCS C1713 59-17007 - SCREW BONE 1.7MM 7MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $113.00 $84.00 $22.38 $112.75 $50.74 $50.74 $50.74 $50.74 $112.75 $112.75 $112.75 $23.50 $112.75 $112.75 $112.75 $112.75 $112.75 $23.50 $112.75 $45.10 $66.69 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $50.74 $22.38 N/A $65.54 $112.75 $67.65 $112.75 $23.50 $112.75 N/A N/A 59-17008 SUP HCPCS C1713 59-17008 - SCREW BONE 1.7MM 8MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $113.00 $84.00 $22.38 $112.75 $50.74 $50.74 $50.74 $50.74 $112.75 $112.75 $112.75 $23.50 $112.75 $112.75 $112.75 $112.75 $112.75 $23.50 $112.75 $112.75 $66.69 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $50.74 $22.38 N/A $65.54 $112.75 $112.75 $112.75 $23.50 $112.75 N/A N/A 59-17009 SUP HCPCS C1713 59-17009 - SCREW BONE 1.7MM 9MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $113.00 $84.00 $22.38 $112.75 $50.74 $50.74 $50.74 $50.74 $112.75 $112.75 $112.75 $23.50 $112.75 $112.75 $112.75 $112.75 $112.75 $23.50 $112.75 $45.10 $66.69 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $50.74 $22.38 N/A $65.54 $112.75 $67.65 $112.75 $23.50 $112.75 N/A N/A 59-17010 SUP HCPCS C1713 59-17010 - SCREW BONE 1.7MM 10MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $113.00 $84.00 $22.38 $112.75 $50.74 $50.74 $50.74 $50.74 $112.75 $112.75 $112.75 $23.50 $112.75 $112.75 $112.75 $112.75 $112.75 $23.50 $112.75 $45.10 $66.69 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $50.74 $22.38 N/A $65.54 $112.75 $67.65 $112.75 $23.50 $112.75 N/A N/A 59-17011 SUP HCPCS C1713 59-17011 - SCREW BONE 1.7MM 11MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $113.00 $84.00 $22.38 $112.75 $50.74 $50.74 $50.74 $50.74 $112.75 $112.75 $112.75 $23.50 $112.75 $112.75 $112.75 $112.75 $112.75 $23.50 $112.75 $45.10 $66.69 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $50.74 $22.38 N/A $65.54 $112.75 $112.75 $112.75 $23.50 $112.75 N/A N/A 59-17012 SUP HCPCS C1713 59-17012 - SCREW BONE 1.7MM 12MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $113.00 $84.00 $22.38 $112.75 $50.74 $50.74 $50.74 $50.74 $112.75 $112.75 $112.75 $23.50 $112.75 $112.75 $112.75 $112.75 $112.75 $23.50 $112.75 $45.10 $66.69 $112.75 $112.75 $112.75 $112.75 $84.75 $112.75 $112.75 $112.75 $56.38 $56.38 $89.30 $112.75 $90.20 $50.74 $22.38 N/A $65.54 $112.75 $112.75 $112.75 $23.50 $112.75 N/A N/A 59-17013 SUP HCPCS C1713 59-17013 - SCREW BONE 1.7MM 13MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-17014 SUP HCPCS C1713 59-17014 - SCREW BONE 1.7MM 14MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-17015 SUP HCPCS C1713 59-17015 - SCREW BONE 1.7MM 15MM SLFTAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-17016 SUP HCPCS C1713 59-17016 - SCREW BONE 1.7MM 16MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 59-17017 SUP HCPCS C1713 59-17017 - SCREW BONE 1.7MM 17MM SLFTAP XFIT PROFYLE TITANIUM HAND BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 59-17018 SUP HCPCS C1713 59-17018 - SCREW BONE 1.7MM 18MM SLFTAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-17019 SUP HCPCS C1713 59-17019 - SCREW BONE 1.7MM 19MM SLFTAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-17020 SUP HCPCS C1713 59-17020 - SCREW BONE 1.7MM 20MM SLFTAP XFIT PROFYLE TITANIUM HAND BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-17021 SUP HCPCS C1713 59-17021 - SCREW BONE 1.7MM 21MM SLFTAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-17022 SUP HCPCS C1713 59-17022 - SCREW BONE 1.7MM 22MM SLFTAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 59-17023 SUP HCPCS C1713 59-17023 - SCREW BONE 1.7MM 23MM SLFTAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-17024 SUP HCPCS C1713 59-17024 - SCREW BONE 1.7MM 24MM SLFTAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-17049 SUP HCPCS C1713 59-17049 - WASHER ORTHOPEDIC 1.7MM PROFYLE TITANIUM BOTH IP/OP $53.50 $40.00 $10.56 $53.20 $23.94 $23.94 $23.94 $23.94 $53.20 $53.20 $53.20 $11.09 $53.20 $53.20 $53.20 $53.20 $53.20 $11.09 $53.20 $21.28 $31.47 $53.20 $53.20 $53.20 $53.20 $40.13 $53.20 $53.20 $53.20 $26.60 $26.60 $42.13 $53.20 $42.56 $23.94 $10.56 N/A $31.03 $53.20 $31.92 $53.20 $11.09 $53.20 N/A N/A 59-17049E SUP HCPCS C1713 59-17049E - WASHER ORTHOPEDIC HAND WRIST STERILE 1.7 MM SCREW BOTH IP/OP $53.50 $40.00 $10.56 $53.20 $23.94 $23.94 $23.94 $23.94 $53.20 $53.20 $53.20 $11.09 $53.20 $53.20 $53.20 $53.20 $53.20 $11.09 $53.20 $53.20 $31.47 $53.20 $53.20 $53.20 $53.20 $40.13 $53.20 $53.20 $53.20 $26.60 $26.60 $42.13 $53.20 $42.56 $23.94 $10.56 N/A $31.03 $53.20 $53.20 $53.20 $53.20 $53.20 N/A N/A 59-19005 SUP HCPCS C1713 59-19005 - SCREW BONE 1.9MM 5MM XFIT SLFTAP EMERGENCY PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 59-19008 SUP HCPCS C1713 59-19008 - SCREW BONE 1.9MM 8MM XFIT SLFTAP EMERGENCY PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 59-19010 SUP HCPCS C1713 59-19010 - SCREW BONE 1.9MM 10MM EMERGENCY SELF TAP XFIT PROFYLE BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-19012 SUP HCPCS C1713 59-19012 - SCREW BONE 1.9MM 12MM XFIT SLFTAP EMERGENCY PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 59-23006 SUP HCPCS C1713 59-23006 - SCREW BONE 2.3MM 6MM SLFTAP XFIT PROFYLE TITANIUM HAND BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-23007 SUP HCPCS C1713 59-23007 - SCREW BONE 2.3MM 7MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 59-23008 SUP HCPCS C1713 59-23008 - SCREW BONE 2.3MM 8MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $126.00 $126.00 N/A N/A 59-23009 SUP HCPCS C1713 59-23009 - SCREW BONE 2.3MM 9MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 59-23010 SUP HCPCS C1713 59-23010 - SCREW BONE 2.3MM 10MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-23011 SUP HCPCS C1713 59-23011 - SCREW BONE 2.3MM 11MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-23012 SUP HCPCS C1713 59-23012 - SCREW BONE 2.3MM 12MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-23013 SUP HCPCS C1713 59-23013 - SCREW BONE 2.3MM 13MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 59-23014 SUP HCPCS C1713 59-23014 - SCREW BONE 2.3MM 14MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 59-23015 SUP HCPCS C1713 59-23015 - SCREW BONE 2.3MM 15MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 59-23016 SUP HCPCS C1713 59-23016 - SCREW BONE 2.3MM 16MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 59-23017 SUP HCPCS C1713 59-23017 - SCREW BONE 2.3MM 17MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-23018 SUP HCPCS C1713 59-23018 - SCREW BONE 2.3MM 18MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-23019 SUP HCPCS C1713 59-23019 - SCREW BONE 2.3MM 19MM XFIT SLFTAP MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-23020 SUP HCPCS C1713 59-23020 - SCREW BONE 2.3MM 20MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 59-23021 SUP HCPCS C1713 59-23021 - SCREW BONE 2.3MM 21MM XFIT SLFTAP MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 59-23022 SUP HCPCS C1713 59-23022 - SCREW BONE 2.3MM 22MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-23023 SUP HCPCS C1713 59-23023 - SCREW BONE 2.3MM 23MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-23024 SUP HCPCS C1713 59-23024 - SCREW BONE 2.3MM 24MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-23026 SUP HCPCS C1713 59-23026 - SCREW BONE 2.3MM 26MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 59-23028 SUP HCPCS C1713 59-23028 - SCREW BONE 2.3MM 28MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 59-23030 SUP HCPCS C1713 59-23030 - SCREW BONE 2.3MM 30MM SELF TAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-23032 SUP HCPCS C1713 59-23032 - SCREW BONE 2.3MM 32MM SLFTAP XFIT PROFYLE TITANIUM HAND BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $26.26 $126.00 N/A N/A 59-23034 SUP HCPCS C1713 59-23034 - SCREW BONE 2.3MM 34MM SLFTAP XFIT PROFYLE TITANIUM HAND BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $126.00 $126.00 $126.00 $126.00 N/A N/A 59-23036 SUP HCPCS C1713 59-23036 - SCREW BONE 2.3MM 36MM SLFTAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $126.00 $126.00 N/A N/A 59-23038 SUP HCPCS C1713 59-23038 - SCREW BONE 2.3MM 38MM SLFTAP XFIT MODULAR PROFYLE TITANIUM BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-23049 SUP HCPCS C1713 59-23049 - WASHER ORTHOPEDIC 2.3MM PLATE PROFYLE NONSTRL BOTH IP/OP $53.50 $40.00 $10.56 $53.20 $23.94 $23.94 $23.94 $23.94 $53.20 $53.20 $53.20 $11.09 $53.20 $53.20 $53.20 $53.20 $53.20 $11.09 $53.20 $21.28 $31.47 $53.20 $53.20 $53.20 $53.20 $40.13 $53.20 $53.20 $53.20 $26.60 $26.60 $42.13 $53.20 $42.56 $23.94 $10.56 N/A $31.03 $53.20 $53.20 $53.20 $11.09 $53.20 N/A N/A 59-23049E SUP HCPCS C1713 59-23049E - WASHER ORTHOPEDIC HAND WRIST STERILE 2.3 MM SCREW BOTH IP/OP $53.50 $40.00 $10.56 $53.20 $23.94 $23.94 $23.94 $23.94 $53.20 $53.20 $53.20 $11.09 $53.20 $53.20 $53.20 $53.20 $53.20 $11.09 $53.20 $21.28 $31.47 $53.20 $53.20 $53.20 $53.20 $40.13 $53.20 $53.20 $53.20 $26.60 $26.60 $42.13 $53.20 $42.56 $23.94 $10.56 N/A $31.03 $53.20 $31.92 $53.20 $11.09 $53.20 N/A N/A 59-25006 SUP HCPCS C1713 59-25006 - SCREW BONE 2.5MM 6MM EMERGENCY SELF TAP XFIT PROFYLE BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-25008 SUP HCPCS C1713 59-25008 - SCREW BONE 2.5MM 8MM EMERGENCY SELF TAP XFIT PROFYLE BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-25010 SUP HCPCS C1713 59-25010 - SCREW BONE 2.5MM 10MM MODULAR XFIT SLFTAP EMERGENCY PROFYLE BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 59-25012 SUP HCPCS C1713 59-25012 - SCREW BONE 2.5MM 12MM MODULAR XFIT SLFTAP EMERGENCY PROFYLE BOTH IP/OP $126.00 $93.00 $25.01 $126.00 $56.70 $56.70 $56.70 $56.70 $126.00 $126.00 $126.00 $26.26 $126.00 $126.00 $126.00 $126.00 $126.00 $26.26 $126.00 $50.40 $74.53 $126.00 $126.00 $126.00 $126.00 $94.50 $126.00 $126.00 $126.00 $63.00 $63.00 $99.79 $126.00 $100.80 $56.70 $25.01 N/A $73.08 $126.00 $75.60 $126.00 $26.26 $126.00 N/A N/A 595000S SUP HCPCS C1713 595000S - SCREW BONE COMPRESSION OHS OCS ORTHOPEDIC HIP BOTH IP/OP $99.00 $73.00 $19.65 $99.00 $44.55 $44.55 $44.55 $44.55 $99.00 $99.00 $99.00 $20.63 $99.00 $99.00 $99.00 $99.00 $99.00 $20.63 $99.00 $39.60 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $44.55 $19.65 N/A $57.42 $99.00 $59.40 $99.00 $20.63 $99.00 N/A N/A 596001S SUP HCPCS C1713 596001S - SCREW BONE 3MM 32.2MM COMPRESSION OMEGA 2 STAINLESS STEEL BOTH IP/OP $117.00 $87.00 $23.18 $116.80 $52.56 $52.56 $52.56 $52.56 $116.80 $116.80 $116.80 $24.34 $116.80 $116.80 $116.80 $116.80 $116.80 $24.34 $116.80 $116.80 $69.09 $116.80 $116.80 $116.80 $116.80 $87.75 $116.80 $116.80 $116.80 $58.40 $58.40 $92.51 $116.80 $93.44 $52.56 $23.18 N/A $67.86 $116.80 $116.80 $116.80 $24.34 $116.80 N/A N/A 597002S SUP HCPCS C1713 597002S - PLATE BONE 130D STANDARD BARREL 47MM 2 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597003S SUP HCPCS C1713 597003S - PLATE BONE 130D STANDARD BARREL 47MM 3 HOLE LP KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597004S SUP HCPCS C1713 597004S - PLATE BONE 130D STANDARD BARREL 79MM 4 HOLE LP KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $749.38 $749.38 $156.17 $749.38 N/A N/A 597005S SUP HCPCS C1713 597005S - PLATE BONE 130D STANDARD BARREL 95MM 5 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $749.38 $749.38 $156.17 $749.38 N/A N/A 597006S SUP HCPCS C1713 597006S - PLATE BONE 130D 111MM 6 HOLE STANDARD BARREL KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597008S SUP HCPCS C1713 597008S - PLATE BONE 130D STANDARD BARREL 143MM 8 HOLE KEY OMEGA 3 BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $366.40 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597010S SUP HCPCS C1713 597010S - PLATE BONE 130D STANDARD BARREL 175MM 10 HOLE KEY OMEGA 3 BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $366.40 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597012S SUP HCPCS C1713 597012S - PLATE BONE 130D STANDARD BARREL 207MM 12 HOLE KEY OMEGA 3 BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $366.40 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597022S SUP HCPCS C1713 597022S - PLATE BONE 135D STANDARD BARREL 47MM 2 HOLE KEY LP OMEGA3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $749.38 $749.38 $156.17 $749.38 N/A N/A 597023S SUP HCPCS C1713 597023S - PLATE BONE 135D STANDARD BARREL 63MM 4 HOLE LP KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $749.38 $749.38 $156.17 $749.38 N/A N/A 597024S SUP HCPCS C1713 597024S - PLATE BONE 135D STANDARD BARREL 79MM 4 HOLE LP KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $749.38 $749.38 $156.17 $749.38 N/A N/A 597025S SUP HCPCS C1713 597025S - PLATE BONE 135D STANDARD BARREL 95MM 5 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $749.38 $749.38 N/A N/A 597026S SUP HCPCS C1713 597026S - PLATE BONE 135D STANDARD BARREL 111MM 6 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597028S SUP HCPCS C1713 597028S - PLATE BONE 135D STANDARD BARREL 143MM 8 HOLE KEY OMEGA 3 BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597030S SUP HCPCS C1713 597030S - PLATE BONE 135D STANDARD BARREL 175MM 10 HOLE KEY OMEGA 3 BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $366.40 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $916.00 $916.00 N/A N/A 597032S SUP HCPCS C1713 597032S - PLATE BONE 135D STANDARD BARREL 207MM 12 HOLE KEY OMEGA 3 BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $366.40 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597042S SUP HCPCS C1713 597042S - PLATE BONE 140D STANDARD BARREL 47MM 2 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $749.38 $749.38 $749.38 $749.38 N/A N/A 597043S SUP HCPCS C1713 597043S - PLATE BONE 140D STANDARD BARREL 63MM 3 HOLE LP KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $749.38 $749.38 N/A N/A 597044S SUP HCPCS C1713 597044S - PLATE BONE 140D STANDARD BARREL 79MM 4 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597045S SUP HCPCS C1713 597045S - PLATE BONE 140D STANDARD BARREL 95MM 5 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $749.38 $749.38 N/A N/A 597046S SUP HCPCS C1713 597046S - PLATE BONE 140D STANDARD BARREL 111MM 6 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597048S SUP HCPCS C1713 597048S - PLATE BONE 140D STANDARD BARREL 143MM 8 HOLE KEY OMEGA 3 BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $366.40 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597050S SUP HCPCS C1713 597050S - PLATE BONE 140D STANDARD BARREL 175MM 10 HOLE KEY OMEGA 3 BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $916.00 $916.00 N/A N/A 597052S SUP HCPCS C1713 597052S - PLATE BONE 140D STANDARD BARREL 207MM 12 HOLE KEY OMEGA 3 BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597062S SUP HCPCS C1713 597062S - PLATE BONE 145D STANDARD BARREL 47MM 2 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $749.38 $749.38 N/A N/A 597063S SUP HCPCS C1713 597063S - PLATE BONE 145D STANDARD BARREL 63MM 3 HOLE ANGLED KEYLESS BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $749.38 $749.38 N/A N/A 597064S SUP HCPCS C1713 597064S - PLATE BONE 145D STANDARD BARREL 79MM 4 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $749.38 $749.38 N/A N/A 597065S SUP HCPCS C1713 597065S - PLATE BONE 145D STANDARD BARREL 95MM 5 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597066S SUP HCPCS C1713 597066S - PLATE BONE 145D STANDARD BARREL 111MM 6 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597068S SUP HCPCS C1713 597068S - PLATE BONE 145D STANDARD BARREL 143MM 8 HOLE ANGLED KEYLESS BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $916.00 $916.00 N/A N/A 597070S SUP HCPCS C1713 597070S - PLATE BONE 145D STANDARD BARREL 175MM 10 HOLE ANGLED KEYLESS BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597072S SUP HCPCS C1713 597072S - PLATE BONE 145D STANDARD BARREL 207MM 12 HOLE ANGLED KEYLESS BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597082S SUP HCPCS C1713 597082S - PLATE BONE 150D STANDARD BARREL 47MM 2 HOLE ANGLED KEYLESS BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597083S SUP HCPCS C1713 597083S - PLATE BONE 150D STANDARD BARREL 63MM 3 HOLE ANGLED KEYLESS BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597084S SUP HCPCS C1713 597084S - PLATE BONE 150D STANDARD BARREL 79MM 4 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597085S SUP HCPCS C1713 597085S - PLATE BONE 150D STANDARD BARREL 95MM 5 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597086S SUP HCPCS C1713 597086S - PLATE BONE 150D STANDARD BARREL 111MM 6 HOLE KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597088S SUP HCPCS C1713 597088S - PLATE BONE 150D STANDARD BARREL 143MM 8 HOLE KEY OMEGA 3 BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597090S SUP HCPCS C1713 597090S - PLATE BONE 150D STANDARD BARREL 175MM 10 HOLE ANGLED KEYLESS BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597092S SUP HCPCS C1713 597092S - PLATE BONE 150D STANDARD BARREL 207MM 12 HOLE ANGLED KEYLESS BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597102S SUP HCPCS C1713 597102S - PLATE BONE 130D STANDARD BARREL 47MM 2 HOLE KEYLESS LP OMEGA BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597103S SUP HCPCS C1713 597103S - PLATE BONE 130D STANDARD BARREL 63MM 3 HOLE LP KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597104S SUP HCPCS C1713 597104S - PLATE BONE 135D STANDARD BARREL 32MM 4 HOLE LP KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597105S SUP HCPCS C1713 597105S - PLATE BONE 130D STANDARD BARREL 95MM 5 HOLE KEYLESS OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597106S SUP HCPCS C1713 597106S - PLATE BONE 130D STANDARD BARREL 111MM 6 HOLE KEYLESS LP BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597108S SUP HCPCS C1713 597108S - PLATE BONE 130D STANDARD BARREL 143MM 8 HOLE LP KEYLESS BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $366.40 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597110S SUP HCPCS C1713 597110S - PLATE BONE 130D STANDARD BARREL 10 HOLE KEYLESS OMEGA 3 HIP BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $366.40 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597112S SUP HCPCS C1713 597112S - PLATE BONE 130D STANDARD BARREL 207MM 12 HOLE ANGLED KEYLESS BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $366.40 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597122S SUP HCPCS C1713 597122S - PLATE BONE 135D STANDARD BARREL 47MM 2 HOLE KEYLESS LP OMEGA BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597123S SUP HCPCS C1713 597123S - PLATE BONE 135D STANDARD BARREL 63MM 3 HOLE LP KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597124S SUP HCPCS C1713 597124S - PLATE BONE 135D STANDARD BARREL 79MM 4 HOLE KEYLESS OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597125S SUP HCPCS C1713 597125S - PLATE BONE 135D 5 HOLE OMEGA 3 STERILE BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597126S SUP HCPCS C1713 597126S - PLATE BONE STANDARD BARREL KEYLESS OMEGA 3 HIP STERILE BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597128S SUP HCPCS C1713 597128S - PLATE BONE 8 HOLE OMEGA 3 HIP STERILE BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $366.40 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597130S SUP HCPCS C1713 597130S - PLATE BONE 135D STANDARD BARREL 175MM 10 HOLE KEYLESS LP BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597132S SUP HCPCS C1713 597132S - PLATE BONE 135D STANDARD BARREL 135MM 12 HOLE KEYLESS LP BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $916.00 $916.00 N/A N/A 597142S SUP HCPCS C1713 597142S - PLATE BONE 140D STANDARD BARREL 47MM 2 HOLE ANGLED KEYLESS BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $749.38 $749.38 N/A N/A 597143S SUP HCPCS C1713 597143S - PLATE BONE 140D STANDARD BARREL 63MM 3 HOLE LP KEY OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597144S SUP HCPCS C1713 597144S - PLATE BONE 140D STANDARD BARREL 79MM 4 HOLE KEYLESS OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597145S SUP HCPCS C1713 597145S - PLATE BONE 140D STANDARD BARREL 5 HOLE OMEGA 3 STAINLESS BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597146S SUP HCPCS C1713 597146S - PLATE BONE 140D STANDARD BARREL 111MM 6 HOLE KEYLESS LP BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597148S SUP HCPCS C1713 597148S - PLATE BONE 140D STANDARD BARREL 143MM 8 HOLE KEYLESS LP BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $366.40 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597150S SUP HCPCS C1713 597150S - PLATE BONE 140D STANDARD BARREL 175MM 10 HOLE KEYLESS OMEGA BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597152S SUP HCPCS C1713 597152S - PLATE BONE 140D STANDARD BARREL 207MM 12 HOLE KEYLESS OMEGA BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $916.00 $916.00 $190.89 $916.00 N/A N/A 597162S SUP HCPCS C1713 597162S - PLATE BONE 145D STANDARD BARREL 47MM 2 HOLE KEYLESS OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $749.38 $749.38 N/A N/A 597163S SUP HCPCS C1713 597163S - PLATE BONE 145D STANDARD BARREL 63MM 3 HOLE KEYLESS OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $749.38 $749.38 N/A N/A 597164S SUP HCPCS C1713 597164S - PLATE BONE STANDARD BARREL 4 HOLE KEYLESS OMEGA 3 HIP BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597165S SUP HCPCS C1713 597165S - PLATE BONE 145D STANDARD BARREL 95MM 5 HOLE KEYLESS OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597166S SUP HCPCS C1713 597166S - PLATE BONE 145D STANDARD BARREL 111MM 6 HOLE KEYLESS LP BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $299.75 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597168S SUP HCPCS C1713 597168S - PLATE BONE 145D STANDARD BARREL 143MM 8 HOLE KEYLESS OMEGA 3 BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597170S SUP HCPCS C1713 597170S - PLATE BONE 145D STANDARD BARREL 175MM 10 HOLE KEYLESS OMEGA BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597172S SUP HCPCS C1713 597172S - PLATE BONE 145D STANDARD BARREL 207MM 12 HOLE KEYLESS OMEGA BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $916.00 $916.00 N/A N/A 597182S SUP HCPCS C1713 597182S - PLATE BONE 150D STANDARD BARREL 47MM 2 HOLE KEYLESS OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $749.38 $749.38 $749.38 $749.38 N/A N/A 597183S SUP HCPCS C1713 597183S - PLATE BONE 150D STANDARD BARRREL 63MM 3 HOLE KEYLESS OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $156.17 $749.38 N/A N/A 597184S SUP HCPCS C1713 597184S - PLATE BONE 150D STANDARD BARRREL 79MM 4 HOLE KEYLESS OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $749.38 $749.38 N/A N/A 597185S SUP HCPCS C1713 597185S - PLATE BONE 150D STANDARD BARRREL 95MM 5 HOLE KEYLESS OMEGA 3 BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $749.38 $749.38 N/A N/A 597186S SUP HCPCS C1713 597186S - PLATE BONE 150D STANDARD BARREL 111MM 6 HOLE KEYLESS LP BOTH IP/OP $749.50 $555.00 $148.73 $749.38 $337.22 $337.22 $337.22 $337.22 $749.38 $749.38 $749.38 $156.19 $749.38 $749.38 $749.38 $749.38 $749.38 $156.18 $749.38 $749.38 $443.26 $749.38 $749.38 $749.38 $749.38 $562.13 $749.38 $749.38 $749.38 $374.69 $374.69 $593.51 $749.38 $599.50 $337.22 $148.73 N/A $434.71 $749.38 $449.63 $749.38 $749.38 $749.38 N/A N/A 597188S SUP HCPCS C1713 597188S - PLATE BONE 150D STANDARD BARRREL 143MM 8 HOLE KEYLESS OMEGA BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597190S SUP HCPCS C1713 597190S - PLATE BONE 150D STANDARD BARRREL 175MM 10 HOLE KEYLESS OMEGA BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597192S SUP HCPCS C1713 597192S - PLATE BONE 150D STANDARD BARRREL 207MM 12 HOLE KEYLESS OMEGA BOTH IP/OP $916.00 $678.00 $181.80 $916.00 $412.20 $412.20 $412.20 $412.20 $916.00 $916.00 $916.00 $190.92 $916.00 $916.00 $916.00 $916.00 $916.00 $190.90 $916.00 $916.00 $541.81 $916.00 $916.00 $916.00 $916.00 $687.00 $916.00 $916.00 $916.00 $458.00 $458.00 $725.47 $916.00 $732.80 $412.20 $181.80 N/A $531.28 $916.00 $549.60 $916.00 $190.89 $916.00 N/A N/A 597202S SUP HCPCS C1713 597202S - PLATE BONE 130D SHORT BARREL 47MM 2 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $289.60 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597203S SUP HCPCS C1713 597203S - PLATE BONE 130D SHORT BARREL 3 HOLE ANGLED KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $724.00 $724.00 $150.88 $724.00 N/A N/A 597204S SUP HCPCS C1713 597204S - PLATE BONE 130D SHORT BARREL 79MM 4 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $289.60 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597205S SUP HCPCS C1713 597205S - PLATE BONE 130D SHORT BARREL 95MM 5 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597212S SUP HCPCS C1713 597212S - PLATE BONE 135D SHORT BARREL 2 HOLE ANGLED KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $289.60 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $724.00 $724.00 $150.88 $724.00 N/A N/A 597213S SUP HCPCS C1713 597213S - PLATE BONE 135D SHORT BARREL 3 HOLE ANGLED KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $289.60 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $724.00 $724.00 $150.88 $724.00 N/A N/A 597214S SUP HCPCS C1713 597214S - PLATE BONE 135D SHORT BARREL 79MM 4 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $289.60 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597215S SUP HCPCS C1713 597215S - PLATE BONE 135D SHORT BARREL 95MM 5 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $289.60 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $724.00 $724.00 $150.88 $724.00 N/A N/A 597222S SUP HCPCS C1713 597222S - PLATE BONE 140D SHORT BARRREL 47MM 2 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597223S SUP HCPCS C1713 597223S - PLATE BONE 140D SHORT BARRREL 63MM 3 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $289.60 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597224S SUP HCPCS C1713 597224S - PLATE BONE 140D SHORT BARREL 79MM 4 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597225S SUP HCPCS C1713 597225S - PLATE BONE 140D SHORT BARREL 95MM 5 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $724.00 $724.00 $150.88 $724.00 N/A N/A 597232S SUP HCPCS C1713 597232S - PLATE BONE 145D SHORT BARRREL 47MM 2 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $289.60 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $724.00 $724.00 $150.88 $724.00 N/A N/A 597233S SUP HCPCS C1713 597233S - PLATE BONE 145D SHORT BARRREL 63MM 3 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $289.60 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597234S SUP HCPCS C1713 597234S - PLATE BONE 145D SHORT BARREL 79MM 4 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $289.60 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597235S SUP HCPCS C1713 597235S - PLATE BONE 145D SHORT BARREL 95MM 5 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $289.60 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597242S SUP HCPCS C1713 597242S - PLATE BONE 150D SHORT BARRREL 47MM 2 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $289.60 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $724.00 $724.00 $150.88 $724.00 N/A N/A 597243S SUP HCPCS C1713 597243S - PLATE BONE 150D SHORT BARRREL 63MM 3 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $724.00 $724.00 $150.88 $724.00 N/A N/A 597244S SUP HCPCS C1713 597244S - PLATE BONE 150D SHORT BARREL 79MM 4 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $289.60 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $724.00 $724.00 $150.88 $724.00 N/A N/A 597245S SUP HCPCS C1713 597245S - PLATE BONE 150D SHORT BARREL 95MM 5 HOLE KEY OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $289.60 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597254S SUP HCPCS C1713 597254S - PLATE BONE 130D SHORT BARREL KEYLESS HIP STERILE BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $724.00 $724.00 N/A N/A 597255S SUP HCPCS C1713 597255S - PLATE BONE 130D SHORT BARREL 95MM 5 HOLE KEYLESS COMPRESSION BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $724.00 $724.00 N/A N/A 597264S SUP HCPCS C1713 597264S - PLATE BONE 135D STANDARD BARREL 63MM 4 HOLE LP KEYLESS OMEGA BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597265S SUP HCPCS C1713 597265S - PLATE BONE 135D SHORT BARREL 95MM 5 HOLE KEYLESS LP OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $724.00 $724.00 N/A N/A 597274S SUP HCPCS C1713 597274S - PLATE BONE 140D SHORT BARREL 4 HOLE OMEGA 3 STAINLESS STEEL BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597275S SUP HCPCS C1713 597275S - PLATE BONE 140D SHORT BARRREL 95MM 5 HOLE KEYLESS OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597284S SUP HCPCS C1713 597284S - PLATE BONE 145D SHORT BARREL 79MM 4 HOLE KEYLESS LP OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597285S SUP HCPCS C1713 597285S - PLATE BONE 145D SHORT BARRREL 95MM 5 HOLE KEYLESS OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $724.00 $724.00 $150.88 $724.00 N/A N/A 597294S SUP HCPCS C1713 597294S - PLATE BONE 150D SHORT BARRREL 79MM 4 HOLE KEYLESS OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597295S SUP HCPCS C1713 597295S - PLATE BONE 150D SHORT BARRREL 25MM 5 HOLE KEYLESS OMEGA 3 BOTH IP/OP $724.00 $536.00 $143.70 $724.00 $325.80 $325.80 $325.80 $325.80 $724.00 $724.00 $724.00 $150.90 $724.00 $724.00 $724.00 $724.00 $724.00 $150.89 $724.00 $724.00 $428.25 $724.00 $724.00 $724.00 $724.00 $543.00 $724.00 $724.00 $724.00 $362.00 $362.00 $573.41 $724.00 $579.20 $325.80 $143.70 N/A $419.92 $724.00 $434.40 $724.00 $150.88 $724.00 N/A N/A 597404S SUP HCPCS C1713 597404S - PLATE BONE 135D 150MM 4 HOLE STABILIZING OMEGA 3 STAINLESS BOTH IP/OP "$1,228.00" $909.00 $243.73 "$1,228.00" $552.60 $552.60 $552.60 $552.60 "$1,228.00" "$1,228.00" "$1,228.00" $255.95 "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" $255.93 "$1,228.00" "$1,228.00" $726.36 "$1,228.00" "$1,228.00" "$1,228.00" "$1,228.00" $921.00 "$1,228.00" "$1,228.00" "$1,228.00" $614.00 $614.00 $972.58 "$1,228.00" $982.40 $552.60 $243.73 N/A $712.24 "$1,228.00" $736.80 "$1,228.00" $255.92 "$1,228.00" N/A N/A 5A0002 SUP HCPCS C1725 5A0002 - CATHETER ANGIO JR4 CRV 5FR 100CM STSR BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 5A0007 SUP HCPCS C1725 5A0007 - CATHETER ANGIOGRAPHIC 3DRCB CURVE 5FR 100CM SITESEER BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 5A0018 SUP HCPCS C1725 5A0018 - CATHETER ANGIO AL1 CRV 5FR 100CM STSR BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 5A0021 SUP HCPCS C1725 5A0021 - CATHETER ANGIOGRAPHIC MPA1 CURVE 5FR 100CM SITESEER BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 5A0031 SUP HCPCS C1725 5A0031 - CATHETER ANGIOGRAPHIC IM CURVE 5FR 100CM SITESEER BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 5A0070 SUP HCPCS C1725 5A0070 - CATHETER ANGIOGRAPHIC PIGTAIL 145 CURVE 5FR 110CM 6 SIDEHOLE BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 5A0084 SUP HCPCS C1725 5A0084 - CATHETER ANGIO JL3.5 CRV 5FR 100CM STSR BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 5A0085 SUP HCPCS C1725 5A0085 - CATHETER ANGIOGRAPHIC JL4 CURVE 5FR 100CM SITESEER BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 5A0087 SUP HCPCS C1725 5A0087 - CATHETER ANGIOGRAPHIC JL5 CURVE 5FR 100CM SITESEER BOTH IP/OP $22.00 $16.00 $4.34 $21.88 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $21.88 $12.94 $21.88 $21.88 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A 5MAXACE132 SUP HCPCS C1757 5MAXACE132 - CATHETER THRMB 132CM LF PENUMBRA SYS 5MAX ACE REPERFUSION BOTH IP/OP "$5,725.00" "$4,237.00" "$1,136.27" "$5,725.00" "$3,108.68" "$3,108.68" "$3,108.68" "$3,108.68" "$5,725.00" "$5,725.00" "$5,725.00" "$1,193.23" "$5,725.00" "$4,181.12" "$4,181.12" "$4,412.83" "$2,060.15" "$1,193.15" "$5,725.00" "$5,725.00" "$3,094.73" "$5,725.00" "$5,725.00" "$5,725.00" "$5,725.00" "$4,293.75" "$5,725.00" "$5,725.00" "$5,725.00" "$2,862.50" "$2,862.50" "$4,534.20" "$5,725.00" "$4,580.00" "$3,721.25" "$1,136.27" N/A "$3,320.50" "$5,725.00" "$5,725.00" "$5,725.00" "$1,193.09" "$5,725.00" N/A N/A 5MAXACE132KIT SUP HCPCS C1887 5MAXACE132KIT - CATHETER REPERFUSION BOTH IP/OP "$6,175.00" "$4,570.00" "$1,225.58" "$6,175.00" "$3,353.03" "$3,353.03" "$3,353.03" "$3,353.03" "$6,175.00" "$6,175.00" "$6,175.00" "$1,287.02" "$6,175.00" "$4,181.12" "$4,181.12" "$4,759.69" "$2,060.15" "$1,286.94" "$6,175.00" "$6,062.50" "$3,094.73" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$4,631.25" "$6,175.00" "$6,175.00" "$6,175.00" "$3,087.50" "$3,087.50" "$4,890.60" "$6,175.00" "$4,940.00" "$4,013.75" "$1,225.58" N/A "$3,581.50" "$6,175.00" "$6,175.00" "$6,175.00" "$1,286.87" "$6,175.00" N/A N/A 60.116.521 SUP HCPCS C1713 60.116.521 - PIN PUSH SCREW TYPE VAR ANG LOCKING GRAPHIC CASES NONSTRL BOTH IP/OP $113.50 $84.00 $22.48 $113.25 $50.96 $50.96 $50.96 $50.96 $113.25 $113.25 $113.25 $23.60 $113.25 $113.25 $113.25 $113.25 $113.25 $23.60 $113.25 $113.25 $66.99 $113.25 $113.25 $113.25 $113.25 $85.13 $113.25 $113.25 $113.25 $56.63 $56.63 $89.69 $113.25 $90.60 $50.96 $22.48 N/A $65.83 $113.25 $113.25 $113.25 $23.60 $113.25 N/A N/A 60-00120 SUP Custom 27203010 60-00120 - GUIDE DRILL 14.5CM 2 END BOTH IP/OP $646.50 $478.00 $115.03 $646.25 $646.25 $646.25 $646.25 $646.25 $646.25 $646.25 $115.03 $646.25 $646.25 $479.65 $479.65 $498.13 $336.70 $134.69 $646.25 $258.50 $646.25 $646.25 $646.25 $646.25 $646.25 $484.88 $646.25 $646.25 $646.25 $323.13 $323.13 $511.83 $646.25 $517.00 $420.06 $646.25 N/A $374.97 $646.25 $387.75 $646.25 $646.25 $646.25 N/A N/A 6000-215 SUP HCPCS C1713 6000-215 - SUB BNGFT 40X15MM PLEXUR 15D BCMPS VOID FILR WDG RESORB BOTH IP/OP "$1,370.00" "$1,014.00" $271.91 "$1,370.00" $616.50 $616.50 $616.50 $616.50 "$1,370.00" "$1,370.00" "$1,370.00" $285.54 "$1,370.00" "$1,370.00" "$1,370.00" "$1,370.00" "$1,370.00" $285.52 "$1,370.00" $548.00 $810.36 "$1,370.00" "$1,370.00" "$1,370.00" "$1,370.00" "$1,027.50" "$1,370.00" "$1,370.00" "$1,370.00" $685.00 $685.00 "$1,085.04" "$1,370.00" "$1,096.00" $616.50 $271.91 N/A $794.60 "$1,370.00" $822.00 "$1,370.00" $285.51 "$1,370.00" N/A N/A 6000BL SUP Custom 27803010 6000BL - HOOK SPNL SPRL R90D LT OBLQ TI BOTH IP/OP "$1,662.50" "$1,230.00" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $346.47 "$1,662.43" $664.97 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,246.88" "$1,662.43" "$1,662.43" "$1,662.43" $831.22 $831.22 "$1,316.64" "$1,662.43" "$1,329.94" $748.09 "$1,662.43" N/A $964.25 "$1,662.43" $997.46 "$1,662.43" "$1,662.43" "$1,662.43" N/A N/A 6000BR SUP Custom 27803010 6000BR - HOOK SPNL SPRL R90D RT OBLQ TI BOTH IP/OP "$1,662.50" "$1,230.00" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $346.47 "$1,662.43" $664.97 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,246.88" "$1,662.43" "$1,662.43" "$1,662.43" $831.22 $831.22 "$1,316.64" "$1,662.43" "$1,329.94" $748.09 "$1,662.43" N/A $964.25 "$1,662.43" $997.46 "$1,662.43" "$1,662.43" "$1,662.43" N/A N/A 6000LL SUP Custom 27803010 6000LL - HOOK SPNL LG SPRL R90D TI LMR BOTH IP/OP "$1,662.50" "$1,230.00" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $346.47 "$1,662.43" $664.97 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,246.88" "$1,662.43" "$1,662.43" "$1,662.43" $831.22 $831.22 "$1,316.64" "$1,662.43" "$1,329.94" $748.09 "$1,662.43" N/A $964.25 "$1,662.43" $997.46 "$1,662.43" "$1,662.43" "$1,662.43" N/A N/A 6000LP SUP Custom 27803010 6000LP - HOOK SPNL LG SPRL R90D TI PDCL BOTH IP/OP "$1,662.50" "$1,230.00" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $346.47 "$1,662.43" $664.97 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,246.88" "$1,662.43" "$1,662.43" "$1,662.43" $831.22 $831.22 "$1,316.64" "$1,662.43" "$1,329.94" $748.09 "$1,662.43" N/A $964.25 "$1,662.43" $997.46 "$1,662.43" "$1,662.43" "$1,662.43" N/A N/A 6000ME SUP Custom 27803010 6000ME - HOOK SPNL MED SPRL R90D XTD TI LMR THOR BOTH IP/OP "$1,746.00" "$1,292.00" $310.71 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" $310.71 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" $363.79 "$1,745.55" $698.22 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,309.50" "$1,745.55" "$1,745.55" "$1,745.55" $872.78 $872.78 "$1,382.48" "$1,745.55" "$1,396.44" $785.50 "$1,745.55" N/A "$1,012.68" "$1,745.55" "$1,047.33" "$1,745.55" "$1,745.55" "$1,745.55" N/A N/A 6000ML SUP Custom 27803010 6000ML - HOOK SPNL MED SPRL R90D TI LMR BOTH IP/OP "$1,662.50" "$1,230.00" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $346.47 "$1,662.43" $664.97 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,246.88" "$1,662.43" "$1,662.43" "$1,662.43" $831.22 $831.22 "$1,316.64" "$1,662.43" "$1,329.94" $748.09 "$1,662.43" N/A $964.25 "$1,662.43" $997.46 "$1,662.43" "$1,662.43" "$1,662.43" N/A N/A 6000MW SUP Custom 27803010 6000MW - HOOK SPNL MED SPRL R90D W TI LMR BOTH IP/OP "$1,662.50" "$1,230.00" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $346.47 "$1,662.43" $664.97 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,246.88" "$1,662.43" "$1,662.43" "$1,662.43" $831.22 $831.22 "$1,316.64" "$1,662.43" "$1,329.94" $748.09 "$1,662.43" N/A $964.25 "$1,662.43" $997.46 "$1,662.43" "$1,662.43" "$1,662.43" N/A N/A 6000SE SUP Custom 27803010 6000SE - HOOK SPNL SM SPRL R90D XTD TI LMR BOTH IP/OP "$1,746.00" "$1,292.00" $310.71 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" $310.71 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" $363.79 "$1,745.55" $698.22 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,309.50" "$1,745.55" "$1,745.55" "$1,745.55" $872.78 $872.78 "$1,382.48" "$1,745.55" "$1,396.44" $785.50 "$1,745.55" N/A "$1,012.68" "$1,745.55" "$1,047.33" "$1,745.55" "$1,745.55" "$1,745.55" N/A N/A 6000SL SUP Custom 27803010 6000SL - HOOK SPNL SM SPRL R90D TI LMR BOTH IP/OP "$1,662.50" "$1,230.00" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $346.47 "$1,662.43" $664.97 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,246.88" "$1,662.43" "$1,662.43" "$1,662.43" $831.22 $831.22 "$1,316.64" "$1,662.43" "$1,329.94" $748.09 "$1,662.43" N/A $964.25 "$1,662.43" $997.46 "$1,662.43" "$1,662.43" "$1,662.43" N/A N/A 6000SP SUP Custom 27803010 6000SP - HOOK SPNL SM SPRL R90D TI PDCL BOTH IP/OP "$1,662.50" "$1,230.00" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $346.47 "$1,662.43" $664.97 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,246.88" "$1,662.43" "$1,662.43" "$1,662.43" $831.22 $831.22 "$1,316.64" "$1,662.43" "$1,329.94" $748.09 "$1,662.43" N/A $964.25 "$1,662.43" $997.46 "$1,662.43" "$1,662.43" "$1,662.43" N/A N/A 6000SW SUP Custom 27803010 6000SW - HOOK SPNL SM SPRL R90D W TI LMR BOTH IP/OP "$1,662.50" "$1,230.00" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $346.47 "$1,662.43" $664.97 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,246.88" "$1,662.43" "$1,662.43" "$1,662.43" $831.22 $831.22 "$1,316.64" "$1,662.43" "$1,329.94" $748.09 "$1,662.43" N/A $964.25 "$1,662.43" $997.46 "$1,662.43" "$1,662.43" "$1,662.43" N/A N/A 6000TH SUP Custom 27803010 6000TH - HOOK SPNL SPRL R90D TI LMR THOR BOTH IP/OP "$1,662.50" "$1,230.00" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $295.91 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" $346.47 "$1,662.43" $664.97 "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,662.43" "$1,246.88" "$1,662.43" "$1,662.43" "$1,662.43" $831.22 $831.22 "$1,316.64" "$1,662.43" "$1,329.94" $748.09 "$1,662.43" N/A $964.25 "$1,662.43" $997.46 "$1,662.43" "$1,662.43" "$1,662.43" N/A N/A 6001-2200 SUP Custom 27803010 6001-2200 - HEAD FEMORAL +0MM C TAPER 22MM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6001-2205 SUP Custom 27803010 6001-2205 - HEAD FEMORAL +5MM C TAPER 22MM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6001-2600 SUP Custom 27803010 6001-2600 - HEAD FEMORAL +0MM C TAPER 26MM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6001-2605 SUP Custom 27803010 6001-2605 - HEAD FEMORAL +5MM C TAPER 26MM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6001-2610 SUP Custom 27803010 6001-2610 - HEAD FEMORAL +10MM C TAPER 26MM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6001-2800 SUP Custom 27803010 6001-2800 - HEAD FEMORAL +0MM C TAPER 28MM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6001-2805 SUP Custom 27803010 6001-2805 - HEAD FEMORAL +5MM C TAPER 28MM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6001-2810 SUP Custom 27803010 6001-2810 - HEAD FEMORAL +10MM C TAPER 28MM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6001-3200 SUP Custom 27803010 6001-3200 - HEAD FEMORAL +0MM C TAPER 32MM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6001-3205 SUP Custom 27803010 6001-3205 - HEAD FEMORAL +5MM C TAPER 32MM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6001-3210 SUP Custom 27803010 6001-3210 - HEAD FEMORAL +10MM C TAPER 32MM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6001-3299 SUP Custom 27803010 6001-3299 - HEAD FEMORAL -5MM C TAPER 32MM COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6003-003-090 SUP HCPCS C1713 6003-003-090 - PIN FIX .125IN 3.54IN PRELOADED PINABALL NONSTRL BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A 6005LO SUP Custom 27803010 6005LO - HOOK SPNL 5MM SPRL R90D LT OFST TI BOTH IP/OP "$1,746.00" "$1,292.00" $310.71 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" $310.71 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" $363.79 "$1,745.55" $698.22 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,309.50" "$1,745.55" "$1,745.55" "$1,745.55" $872.78 $872.78 "$1,382.48" "$1,745.55" "$1,396.44" $785.50 "$1,745.55" N/A "$1,012.68" "$1,745.55" "$1,047.33" "$1,745.55" "$1,745.55" "$1,745.55" N/A N/A 6005RO SUP Custom 27803010 6005RO - HOOK SPNL 5MM SPRL R90D RT OFST TI BOTH IP/OP "$1,746.00" "$1,292.00" $310.71 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" $310.71 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" $363.79 "$1,745.55" $698.22 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,309.50" "$1,745.55" "$1,745.55" "$1,745.55" $872.78 $872.78 "$1,382.48" "$1,745.55" "$1,396.44" $785.50 "$1,745.55" N/A "$1,012.68" "$1,745.55" "$1,047.33" "$1,745.55" "$1,745.55" "$1,745.55" N/A N/A 60-09504 SUP Custom 27100030 60-09504 - DRILL TWST .9MM 46MM 4MM STRYK SHFT 1.2MM SCR BOTH IP/OP $555.00 $411.00 $98.79 $555.00 $555.00 $555.00 $555.00 $555.00 $555.00 $555.00 $98.79 $555.00 $555.00 $411.92 $411.92 $427.79 $289.16 $115.67 $555.00 $222.00 $555.00 $555.00 $555.00 $555.00 $555.00 $416.25 $555.00 $555.00 $555.00 $277.50 $277.50 $439.56 $555.00 $444.00 $360.75 $555.00 N/A $321.90 $555.00 $333.00 $555.00 $555.00 $555.00 N/A N/A 60-10115 SUP Custom 27203010 60-10115 - DRILL TWIST 1.8MM 83MM 15MM SHAFT END FIX MODULAR PROFYLE BOTH IP/OP $161.50 $120.00 $28.75 $161.50 $161.50 $161.50 $161.50 $161.50 $161.50 $161.50 $28.75 $161.50 $161.50 $119.87 $119.87 $124.48 $84.14 $33.66 $161.50 $64.60 $161.50 $161.50 $161.50 $161.50 $161.50 $121.13 $161.50 $161.50 $161.50 $80.75 $80.75 $127.91 $161.50 $129.20 $104.98 $161.50 N/A $93.67 $161.50 $96.90 $161.50 $161.50 $161.50 N/A N/A 60-10122 SUP Custom 27203010 60-10122 - BIT DRILL TWIST 1MM 90MM 22MM SHAFT END FIX MODULAR STOP BOTH IP/OP $159.50 $118.00 $28.39 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $28.39 $159.50 $159.50 $118.38 $118.38 $122.94 $83.10 $33.24 $159.50 $63.80 $159.50 $159.50 $159.50 $159.50 $159.50 $119.63 $159.50 $159.50 $159.50 $79.75 $79.75 $126.32 $159.50 $127.60 $103.68 $159.50 N/A $92.51 $159.50 $95.70 $159.50 $159.50 $159.50 N/A N/A 60-10315 SUP Custom 27203010 60-10315 - DRILL TWIST 1MM 76MM 15MM SHAFT END FIX MODULAR PROFYLE HAND BOTH IP/OP $164.00 $121.00 $29.13 $163.63 $163.63 $163.63 $163.63 $163.63 $163.63 $163.63 $29.13 $163.63 $163.63 $121.45 $121.45 $126.13 $85.25 $34.10 $163.63 $65.45 $163.63 $163.63 $163.63 $163.63 $163.63 $123.00 $163.63 $163.63 $163.63 $81.82 $81.82 $129.59 $163.63 $130.90 $106.36 $163.63 N/A $95.12 $163.63 $98.18 $163.63 $163.63 $163.63 N/A N/A 60-10322 SUP Custom 27203010 60-10322 - BIT DRL 22MM AO SHFT QCK 1.2MM SCR BOTH IP/OP $168.50 $125.00 $29.96 $168.30 $168.30 $168.30 $168.30 $168.30 $168.30 $168.30 $29.96 $168.30 $168.30 $124.91 $124.91 $129.73 $87.68 $35.08 $168.30 $67.32 $168.30 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $109.40 $168.30 N/A $97.73 $168.30 $100.98 $168.30 $168.30 $168.30 N/A N/A 60-10415 SUP Custom 27203010 60-10415 - DRILL DENTAL 1MM 16MM BIT TWIST STOP BOTH IP/OP $164.00 $121.00 $29.13 $163.63 $163.63 $163.63 $163.63 $163.63 $163.63 $163.63 $29.13 $163.63 $163.63 $121.45 $121.45 $126.13 $85.25 $34.10 $163.63 $65.45 $163.63 $163.63 $163.63 $163.63 $163.63 $123.00 $163.63 $163.63 $163.63 $81.82 $81.82 $129.59 $163.63 $130.90 $106.36 $163.63 N/A $95.12 $163.63 $98.18 $163.63 $163.63 $163.63 N/A N/A 60-10422 SUP Custom 27203010 60-10422 - BIT DRILL TWIST 1MM 73MM 22MM SHAFT END FIX MODULAR STOP BOTH IP/OP $159.50 $118.00 $28.39 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $28.39 $159.50 $159.50 $118.38 $118.38 $122.94 $83.10 $33.24 $159.50 $63.80 $159.50 $159.50 $159.50 $159.50 $159.50 $119.63 $159.50 $159.50 $159.50 $79.75 $79.75 $126.32 $159.50 $127.60 $103.68 $159.50 N/A $92.51 $159.50 $95.70 $159.50 $159.50 $159.50 N/A N/A 60-10506 SUP Custom 27100030 60-10506 - BIT DRILL TWIST 1MM 50MM 6MM STOP PROFYLE HAND STERILE SMALL BOTH IP/OP $224.50 $166.00 $39.90 $224.18 $224.18 $224.18 $224.18 $224.18 $224.18 $224.18 $39.90 $224.18 $224.18 $166.39 $166.39 $172.80 $116.80 $46.72 $224.18 $89.67 $224.18 $224.18 $224.18 $224.18 $224.18 $168.38 $224.18 $224.18 $224.18 $112.09 $112.09 $177.55 $224.18 $179.34 $145.72 $224.18 N/A $130.21 $224.18 $134.51 $224.18 $224.18 $224.18 N/A N/A 60-10512 SUP Custom 27100030 60-10512 - BIT DRILL 12MM STOP 1MM 54MM 12MM TWIST STOP STERILE BOTH IP/OP $224.50 $166.00 $39.90 $224.18 $224.18 $224.18 $224.18 $224.18 $224.18 $224.18 $39.90 $224.18 $224.18 $166.39 $166.39 $172.80 $116.80 $46.72 $224.18 $89.67 $224.18 $224.18 $224.18 $224.18 $224.18 $168.38 $224.18 $224.18 $224.18 $112.09 $112.09 $177.55 $224.18 $179.34 $145.72 $224.18 N/A $130.21 $224.18 $134.51 $224.18 $224.18 $224.18 N/A N/A 6010LO SUP Custom 27803010 6010LO - HOOK SPNL 10MM SPRL R90D LT OFST TI BOTH IP/OP "$1,746.00" "$1,292.00" $310.71 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" $310.71 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" $363.79 "$1,745.55" $698.22 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,309.50" "$1,745.55" "$1,745.55" "$1,745.55" $872.78 $872.78 "$1,382.48" "$1,745.55" "$1,396.44" $785.50 "$1,745.55" N/A "$1,012.68" "$1,745.55" "$1,047.33" "$1,745.55" "$1,745.55" "$1,745.55" N/A N/A 6010RO SUP Custom 27803010 6010RO - HOOK SPNL 10MM SPRL R90D RT OFST TI BOTH IP/OP "$1,746.00" "$1,292.00" $310.71 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" $310.71 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" $363.79 "$1,745.55" $698.22 "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,745.55" "$1,309.50" "$1,745.55" "$1,745.55" "$1,745.55" $872.78 $872.78 "$1,382.48" "$1,745.55" "$1,396.44" $785.50 "$1,745.55" N/A "$1,012.68" "$1,745.55" "$1,047.33" "$1,745.55" "$1,745.55" "$1,745.55" N/A N/A 6012-0711 SUP HCPCS C1776 6012-0711 - STEM FEMORAL 7 11MM 155MM RSTOR TITANIUM HA HIP BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6012-0713 SUP HCPCS C1776 6012-0713 - STEM FEMORAL 7 13MM 155MM RSTOR TITANIUM HA HIP BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6012-0812 SUP HCPCS C1776 6012-0812 - STEM FEMORAL 8 12MM 155MM RSTOR TITANIUM HA HIP BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6012-0814 SUP HCPCS C1776 6012-0814 - STEM FEMORAL 8 14MM 155MM RSTOR TITANIUM HA HIP BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6012-0913 SUP HCPCS C1776 6012-0913 - STEM FEMORAL 9 13MM 155MM RSTOR TITANIUM HA HIP BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6012-0915 SUP HCPCS C1776 6012-0915 - STEM FEMORAL 9 15MM 155MM RSTOR TITANIUM HA HIP BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6012-1014 SUP HCPCS C1776 6012-1014 - STEM FEMORAL 10 14MM 155MM RSTOR TITANIUM HA HIP BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6012-1016 SUP HCPCS C1776 6012-1016 - STEM FEMORAL 10 16MM 155MM RSTOR TITANIUM HA HIP BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6012-1115 SUP HCPCS C1776 6012-1115 - STEM FEMORAL 11 15MM 155MM RSTOR TITANIUM HA HIP BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6012-1117 SUP HCPCS C1776 6012-1117 - STEM FEMORAL 11 17MM 155MM RSTOR TITANIUM HA HIP BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6012-1216 SUP HCPCS C1776 6012-1216 - STEM FEMORAL 12 16MM 155MM RSTOR TITANIUM HA HIP BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6012-1218 SUP HCPCS C1776 6012-1218 - STEM FEMORAL 12 18MM 155MM RSTOR TITANIUM HA HIP BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 601251X SUP HCPCS C1751 601251X - MICROCATHETER CRBRVASC 2.3-2.8FR .021IN 150CM 50CM BOTH IP/OP "$1,775.50" "$1,314.00" $352.31 "$1,920.65" $798.80 $798.80 $798.80 $798.80 "$1,775.10" "$1,775.10" "$1,775.10" $369.98 "$1,775.10" "$1,775.10" "$1,775.10" "$1,775.10" "$1,775.10" $369.95 "$1,775.10" "$1,920.65" "$1,049.97" "$1,775.10" "$1,775.10" "$1,775.10" "$1,775.10" "$1,331.63" "$1,775.10" "$1,775.10" "$1,775.10" $887.55 $887.55 "$1,405.88" "$1,775.10" "$1,420.08" $798.80 $352.31 N/A "$1,029.79" "$1,775.10" "$1,775.10" "$1,775.10" $369.93 "$1,775.10" N/A N/A 6013-0812 SUP HCPCS C1776 6013-0812 - STEM FEMORAL 8 12MM 205MM RSTOR TITANIUM HA HIP BOTH IP/OP "$12,550.00" "$9,287.00" "$2,490.86" "$12,550.00" "$5,647.50" "$5,647.50" "$5,647.50" "$5,647.50" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.73" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.56" "$12,550.00" "$5,020.00" "$6,187.15" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$9,412.50" "$12,550.00" "$12,550.00" "$12,550.00" "$6,275.00" "$6,275.00" "$9,939.60" "$12,550.00" "$10,040.00" "$5,647.50" "$2,490.86" N/A "$7,279.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.42" "$12,550.00" N/A N/A 6013-0814 SUP HCPCS C1776 6013-0814 - STEM FEMORAL 8 14MM 205MM RSTOR TITANIUM HA HIP BOTH IP/OP "$12,550.00" "$9,287.00" "$2,490.86" "$12,550.00" "$5,647.50" "$5,647.50" "$5,647.50" "$5,647.50" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.73" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.56" "$12,550.00" "$12,550.00" "$6,187.15" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$9,412.50" "$12,550.00" "$12,550.00" "$12,550.00" "$6,275.00" "$6,275.00" "$9,939.60" "$12,550.00" "$10,040.00" "$5,647.50" "$2,490.86" N/A "$7,279.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.42" "$12,550.00" N/A N/A 6013-0913 SUP HCPCS C1776 6013-0913 - STEM FEMORAL 9 13MM 205MM RSTOR TITANIUM HA HIP BOTH IP/OP "$12,550.00" "$9,287.00" "$2,490.86" "$12,550.00" "$5,647.50" "$5,647.50" "$5,647.50" "$5,647.50" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.73" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.56" "$12,550.00" "$5,020.00" "$6,187.15" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$9,412.50" "$12,550.00" "$12,550.00" "$12,550.00" "$6,275.00" "$6,275.00" "$9,939.60" "$12,550.00" "$10,040.00" "$5,647.50" "$2,490.86" N/A "$7,279.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.42" "$12,550.00" N/A N/A 6013-0915 SUP HCPCS C1776 6013-0915 - STEM FEMORAL 9 15MM 205MM RSTOR TITANIUM HA HIP BOTH IP/OP "$12,550.00" "$9,287.00" "$2,490.86" "$12,550.00" "$5,647.50" "$5,647.50" "$5,647.50" "$5,647.50" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.73" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.56" "$12,550.00" "$12,550.00" "$6,187.15" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$9,412.50" "$12,550.00" "$12,550.00" "$12,550.00" "$6,275.00" "$6,275.00" "$9,939.60" "$12,550.00" "$10,040.00" "$5,647.50" "$2,490.86" N/A "$7,279.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.42" "$12,550.00" N/A N/A 6013-1014 SUP HCPCS C1776 6013-1014 - STEM FEMORAL 10 14MM 205MM RSTOR TITANIUM HA HIP BOTH IP/OP "$12,550.00" "$9,287.00" "$2,490.86" "$12,550.00" "$5,647.50" "$5,647.50" "$5,647.50" "$5,647.50" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.73" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.56" "$12,550.00" "$5,020.00" "$6,187.15" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$9,412.50" "$12,550.00" "$12,550.00" "$12,550.00" "$6,275.00" "$6,275.00" "$9,939.60" "$12,550.00" "$10,040.00" "$5,647.50" "$2,490.86" N/A "$7,279.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.42" "$12,550.00" N/A N/A 6013-1016 SUP HCPCS C1776 6013-1016 - STEM FEMORAL 10 16MM 205MM RSTOR TITANIUM HA HIP BOTH IP/OP "$12,550.00" "$9,287.00" "$2,490.86" "$12,550.00" "$5,647.50" "$5,647.50" "$5,647.50" "$5,647.50" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.73" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.56" "$12,550.00" "$12,550.00" "$6,187.15" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$9,412.50" "$12,550.00" "$12,550.00" "$12,550.00" "$6,275.00" "$6,275.00" "$9,939.60" "$12,550.00" "$10,040.00" "$5,647.50" "$2,490.86" N/A "$7,279.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.42" "$12,550.00" N/A N/A 6013-1115 SUP HCPCS C1776 6013-1115 - STEM FEMORAL 11 15MM 205MM RSTOR TITANIUM HA HIP BOTH IP/OP "$12,550.00" "$9,287.00" "$2,490.86" "$12,550.00" "$5,647.50" "$5,647.50" "$5,647.50" "$5,647.50" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.73" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.56" "$12,550.00" "$5,020.00" "$6,187.15" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$9,412.50" "$12,550.00" "$12,550.00" "$12,550.00" "$6,275.00" "$6,275.00" "$9,939.60" "$12,550.00" "$10,040.00" "$5,647.50" "$2,490.86" N/A "$7,279.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.42" "$12,550.00" N/A N/A 6013-1117 SUP HCPCS C1776 6013-1117 - STEM FEMORAL 11 17MM 205MM RSTOR TITANIUM HA HIP BOTH IP/OP "$12,550.00" "$9,287.00" "$2,490.86" "$12,550.00" "$5,647.50" "$5,647.50" "$5,647.50" "$5,647.50" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.73" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.56" "$12,550.00" "$12,550.00" "$6,187.15" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$9,412.50" "$12,550.00" "$12,550.00" "$12,550.00" "$6,275.00" "$6,275.00" "$9,939.60" "$12,550.00" "$10,040.00" "$5,647.50" "$2,490.86" N/A "$7,279.00" "$12,550.00" "$7,530.00" "$12,550.00" "$2,615.42" "$12,550.00" N/A N/A 6013-1216 SUP HCPCS C1776 6013-1216 - STEM FEMORAL 12 16MM 205MM RSTOR TITANIUM HA HIP BOTH IP/OP "$12,550.00" "$9,287.00" "$2,490.86" "$12,550.00" "$5,647.50" "$5,647.50" "$5,647.50" "$5,647.50" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.73" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.56" "$12,550.00" "$5,020.00" "$6,187.15" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$9,412.50" "$12,550.00" "$12,550.00" "$12,550.00" "$6,275.00" "$6,275.00" "$9,939.60" "$12,550.00" "$10,040.00" "$5,647.50" "$2,490.86" N/A "$7,279.00" "$12,550.00" "$7,530.00" "$12,550.00" "$2,615.42" "$12,550.00" N/A N/A 6013-1218 SUP HCPCS C1776 6013-1218 - STEM FEMORAL 12 18MM 205MM RSTOR TITANIUM HA HIP BOTH IP/OP "$12,550.00" "$9,287.00" "$2,490.86" "$12,550.00" "$5,647.50" "$5,647.50" "$5,647.50" "$5,647.50" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.73" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.56" "$12,550.00" "$12,550.00" "$6,187.15" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$9,412.50" "$12,550.00" "$12,550.00" "$12,550.00" "$6,275.00" "$6,275.00" "$9,939.60" "$12,550.00" "$10,040.00" "$5,647.50" "$2,490.86" N/A "$7,279.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.42" "$12,550.00" N/A N/A 6013-1317 SUP HCPCS C1776 6013-1317 - STEM FEMORAL 13 17MM 205MM RSTOR TITANIUM HA HIP BOTH IP/OP "$12,550.00" "$9,287.00" "$2,490.86" "$12,550.00" "$5,647.50" "$5,647.50" "$5,647.50" "$5,647.50" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.73" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.56" "$12,550.00" "$5,020.00" "$6,187.15" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$9,412.50" "$12,550.00" "$12,550.00" "$12,550.00" "$6,275.00" "$6,275.00" "$9,939.60" "$12,550.00" "$10,040.00" "$5,647.50" "$2,490.86" N/A "$7,279.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.42" "$12,550.00" N/A N/A 6013-1319 SUP HCPCS C1776 6013-1319 - STEM FEMORAL 13 19MM 205MM RSTOR TITANIUM HA HIP BOTH IP/OP "$12,550.00" "$9,287.00" "$2,490.86" "$12,550.00" "$5,647.50" "$5,647.50" "$5,647.50" "$5,647.50" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.73" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.56" "$12,550.00" "$12,550.00" "$6,187.15" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$9,412.50" "$12,550.00" "$12,550.00" "$12,550.00" "$6,275.00" "$6,275.00" "$9,939.60" "$12,550.00" "$10,040.00" "$5,647.50" "$2,490.86" N/A "$7,279.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.42" "$12,550.00" N/A N/A 6013-1418 SUP HCPCS C1776 6013-1418 - STEM FEMORAL 14 18MM 205MM RSTOR TITANIUM HA HIP BOTH IP/OP "$12,550.00" "$9,287.00" "$2,490.86" "$12,550.00" "$5,647.50" "$5,647.50" "$5,647.50" "$5,647.50" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.73" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.56" "$12,550.00" "$5,020.00" "$6,187.15" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$9,412.50" "$12,550.00" "$12,550.00" "$12,550.00" "$6,275.00" "$6,275.00" "$9,939.60" "$12,550.00" "$10,040.00" "$5,647.50" "$2,490.86" N/A "$7,279.00" "$12,550.00" "$7,530.00" "$12,550.00" "$2,615.42" "$12,550.00" N/A N/A 6013-1420 SUP HCPCS C1776 6013-1420 - STEM FEMORAL 14 20MM 205MM RSTOR TITANIUM HA HIP BOTH IP/OP "$12,550.00" "$9,287.00" "$2,490.86" "$12,550.00" "$5,647.50" "$5,647.50" "$5,647.50" "$5,647.50" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.73" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$2,615.56" "$12,550.00" "$12,550.00" "$6,187.15" "$12,550.00" "$12,550.00" "$12,550.00" "$12,550.00" "$9,412.50" "$12,550.00" "$12,550.00" "$12,550.00" "$6,275.00" "$6,275.00" "$9,939.60" "$12,550.00" "$10,040.00" "$5,647.50" "$2,490.86" N/A "$7,279.00" "$12,550.00" "$7,530.00" "$12,550.00" "$2,615.42" "$12,550.00" N/A N/A 60-13506 SUP Custom 27100030 60-13506 - BIT DRILL 6MM STOP 1.3MM 50MM 6MM TWIST STOP STERILE BOTH IP/OP $550.00 $407.00 $97.90 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $97.90 $550.00 $550.00 $408.21 $408.21 $423.94 $286.55 $114.63 $550.00 $220.00 $550.00 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $357.50 $550.00 N/A $319.00 $550.00 $330.00 $550.00 $550.00 $550.00 N/A N/A 60-13512 SUP Custom 27100030 60-13512 - DRILL TWST 1.3MM 54MM STRL 12MM LEIBINGER UNV 2 12MM SCR BOTH IP/OP $236.50 $175.00 $42.05 $236.25 $236.25 $236.25 $236.25 $236.25 $236.25 $236.25 $42.05 $236.25 $236.25 $175.34 $175.34 $182.10 $123.09 $49.24 $236.25 $94.50 $236.25 $236.25 $236.25 $236.25 $236.25 $177.38 $236.25 $236.25 $236.25 $118.13 $118.13 $187.11 $236.25 $189.00 $153.56 $236.25 N/A $137.17 $236.25 $141.75 $236.25 $236.25 $236.25 N/A N/A 60-13570 SUP Custom 27100030 60-13570 - BIT DRILL 12MM STOP 1.3MM 79MM TWIST STERILE BOTH IP/OP $242.50 $179.00 $43.10 $242.15 $242.15 $242.15 $242.15 $242.15 $242.15 $242.15 $43.10 $242.15 $242.15 $179.72 $179.72 $186.65 $126.16 $50.47 $242.15 $96.86 $242.15 $242.15 $242.15 $242.15 $242.15 $181.88 $242.15 $242.15 $242.15 $121.08 $121.08 $191.78 $242.15 $193.72 $157.40 $242.15 N/A $140.65 $242.15 $145.29 $242.15 $242.15 $242.15 N/A N/A 60-13712 SUP Custom 27100030 60-13712 - BIT DRILL STERILE 12 MM SCREW BOTH IP/OP $273.00 $202.00 $48.52 $272.60 $272.60 $272.60 $272.60 $272.60 $272.60 $272.60 $48.52 $272.60 $272.60 $202.32 $202.32 $210.12 $142.02 $56.81 $272.60 $109.04 $272.60 $272.60 $272.60 $272.60 $272.60 $204.75 $272.60 $272.60 $272.60 $136.30 $136.30 $215.90 $272.60 $218.08 $177.19 $272.60 N/A $158.34 $272.60 $163.56 $272.60 $272.60 $272.60 N/A N/A 60-14008 SUP Custom 27100030 60-14008 - BIT DRILL 1.4MM 8MM TWIST STERILE BOTH IP/OP $255.00 $189.00 $45.35 $254.80 $254.80 $254.80 $254.80 $254.80 $254.80 $254.80 $45.35 $254.80 $254.80 $189.11 $189.11 $196.40 $132.75 $53.10 $254.80 $101.92 $254.80 $254.80 $254.80 $254.80 $254.80 $191.25 $254.80 $254.80 $254.80 $127.40 $127.40 $201.80 $254.80 $203.84 $165.62 $254.80 N/A $147.90 $254.80 $152.88 $254.80 $254.80 $254.80 N/A N/A 6014-0812L SUP HCPCS C1776 6014-0812L - STEM FEMORAL 8 12MM 255MM BOWED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6014-0812R SUP HCPCS C1776 6014-0812R - STEM FEMORAL 8 12MM 255MM RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$13,745.88" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6014-0913L SUP HCPCS C1776 6014-0913L - STEM FEMORAL 9 13MM 255MM BOWED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6014-0913R SUP HCPCS C1776 6014-0913R - STEM FEMORAL 9 13MM 255MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6014-1014L SUP HCPCS C1776 6014-1014L - STEM FEMORAL 10 14MM 255MM BOWED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$13,745.88" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6014-1014R SUP HCPCS C1776 6014-1014R - STEM FEMORAL 10 14MM 255MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6014-1115L SUP HCPCS C1776 6014-1115L - STEM FEMORAL 11 15MM 255MM BOWED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$13,745.88" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6014-1115R SUP HCPCS C1776 6014-1115R - STEM FEMORAL 11 15MM 255MM BOWED RSTOR HYDRXAPT RIGHT BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6014-1216L SUP HCPCS C1776 6014-1216L - STEM FEMORAL 12 LONG 16MM 255MM BOWED RSTOR HA LEFT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6014-1216R SUP HCPCS C1776 6014-1216R - STEM FEMORAL 12 16MM 255MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$13,745.88" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 60-14126 SUP Custom 27203010 60-14126 - BIT DRILL TWIST 1.4MM 94MM 27MM SHAFT END FIX MODULAR STOP BOTH IP/OP $159.50 $118.00 $28.39 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $28.39 $159.50 $159.50 $118.38 $118.38 $122.94 $83.10 $33.24 $159.50 $63.80 $159.50 $159.50 $159.50 $159.50 $159.50 $119.63 $159.50 $159.50 $159.50 $79.75 $79.75 $126.32 $159.50 $127.60 $103.68 $159.50 N/A $92.51 $159.50 $95.70 $159.50 $159.50 $159.50 N/A N/A 6014-1317L SUP HCPCS C1776 6014-1317L - STEM FEMORAL 13 17MM 255MM BOWED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6014-1317R SUP HCPCS C1776 6014-1317R - STEM FEMORAL 13 17MM 255MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$13,745.88" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6014-1418L SUP HCPCS C1776 6014-1418L - STEM FEMORAL 14 18MM 255MM BOWED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6014-1418R SUP HCPCS C1776 6014-1418R - STEM FEMORAL 14 18MM 255MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$13,745.88" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 60-14326 SUP Custom 27203010 60-14326 - DRILL TWIST 1.4MM 87MM 15MM SHAFT END FIX MODULAR PROFYLE BOTH IP/OP $159.50 $118.00 $28.39 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $28.39 $159.50 $159.50 $118.38 $118.38 $122.94 $83.10 $33.24 $159.50 $63.80 $159.50 $159.50 $159.50 $159.50 $159.50 $119.63 $159.50 $159.50 $159.50 $79.75 $79.75 $126.32 $159.50 $127.60 $103.68 $159.50 N/A $92.51 $159.50 $95.70 $159.50 $159.50 $159.50 N/A N/A 60-14426 SUP Custom 27203010 60-14426 - BIT DRILL XS TWIST 1.4MM 77MM 27MM SHAFT END FIX MODULAR BOTH IP/OP $159.50 $118.00 $28.39 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $28.39 $159.50 $159.50 $118.38 $118.38 $122.94 $83.10 $33.24 $159.50 $63.80 $159.50 $159.50 $159.50 $159.50 $159.50 $119.63 $159.50 $159.50 $159.50 $79.75 $79.75 $126.32 $159.50 $127.60 $103.68 $159.50 N/A $92.51 $159.50 $95.70 $159.50 $159.50 $159.50 N/A N/A 60-15008 SUP Custom 27100030 60-15008 - BIT DRILL 1.5MM 50MM 8MM TWIST STOP STERILE BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A 60-15020 SUP Custom 27100030 60-15020 - BIT DRILL TWIST 1.5MM 58MM 20MM STOP STERILE 20MM SCREW BOTH IP/OP $265.50 $196.00 $47.26 $265.50 $265.50 $265.50 $265.50 $265.50 $265.50 $265.50 $47.26 $265.50 $265.50 $197.05 $197.05 $204.65 $138.33 $55.33 $265.50 $106.20 $265.50 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $172.58 $265.50 N/A $153.99 $265.50 $159.30 $265.50 $265.50 $265.50 N/A N/A 6015-0814L SUP HCPCS C1776 6015-0814L - STEM FEMORAL 8 BOW 14MM 205MM RSTOR HA HIP LEFT BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6015-0814R SUP HCPCS C1776 6015-0814R - STEM FEMORAL 8 14MM 205MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6015-0915L SUP HCPCS C1776 6015-0915L - STEM FEMORAL 9 BOW 15MM 205MM RSTOR HA HIP LEFT BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6015-0915R SUP HCPCS C1776 6015-0915R - STEM FEMORAL 9 15MM 205MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6015-1016L SUP HCPCS C1776 6015-1016L - STEM FEMORAL 10 BOW 16MM 205MM RSTOR HA HIP LEFT BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6015-1016R SUP HCPCS C1776 6015-1016R - STEM FEMORAL 10 16MM 205MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 60-15105 SUP Custom 27100030 60-15105 - BIT DRILL 5MM STOP 1.5MM 50MM 5MM TWIST STERILE 5MM SCREW BOTH IP/OP $265.50 $196.00 $47.26 $265.50 $265.50 $265.50 $265.50 $265.50 $265.50 $265.50 $47.26 $265.50 $265.50 $197.05 $197.05 $204.65 $138.33 $55.33 $265.50 $106.20 $265.50 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $172.58 $265.50 N/A $153.99 $265.50 $159.30 $265.50 $265.50 $265.50 N/A N/A 6015-1117L SUP HCPCS C1776 6015-1117L - STEM FEMORAL 11 BOW 17MM 205MM RSTOR HA HIP LEFT BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6015-1117R SUP HCPCS C1776 6015-1117R - STEM FEMORAL 11 17MM 205MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6015-1218L SUP HCPCS C1776 6015-1218L - STEM FEMORAL 12 BOW 18MM 205MM RSTOR HA HIP LEFT BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6015-1218R SUP HCPCS C1776 6015-1218R - STEM FEMORAL 12 18MM 205 BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6015-1319L SUP HCPCS C1776 6015-1319L - STEM FEMORAL 13 BOW 19MM 205MM RSTOR HA HIP LEFT BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6015-1319R SUP HCPCS C1776 6015-1319R - STEM FEMORAL 13 19MM 205MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6015-1420L SUP HCPCS C1776 6015-1420L - STEM FEMORAL 14 BOW 20MM 205MM RSTOR HA HIP LEFT BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6015-1420R SUP HCPCS C1776 6015-1420R - STEM FEMORAL 14 20MM 205MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 60-15920 SUP Custom 27100030 60-15920 - BIT DRILL 20MM STOP 1.5MM 107MM TWIST STERILE BOTH IP/OP $334.50 $248.00 $59.50 $334.28 $334.28 $334.28 $334.28 $334.28 $334.28 $334.28 $59.50 $334.28 $334.28 $248.10 $248.10 $257.66 $174.16 $69.67 $334.28 $133.71 $334.28 $334.28 $334.28 $334.28 $334.28 $250.88 $334.28 $334.28 $334.28 $167.14 $167.14 $264.75 $334.28 $267.42 $217.28 $334.28 N/A $194.01 $334.28 $200.57 $334.28 $334.28 $334.28 N/A N/A 60-15998 SUP Custom 27203010 60-15998 - DRILL TWST 1.5MM 19MM 8MM BOTH IP/OP $827.50 $612.00 $147.30 $827.50 $827.50 $827.50 $827.50 $827.50 $827.50 $827.50 $147.30 $827.50 $827.50 $614.17 $614.17 $637.84 $431.13 $172.46 $827.50 $331.00 $827.50 $827.50 $827.50 $827.50 $827.50 $620.63 $827.50 $827.50 $827.50 $413.75 $413.75 $655.38 $827.50 $662.00 $537.88 $827.50 N/A $479.95 $827.50 $496.50 $827.50 $827.50 $827.50 N/A N/A 60-16005 SUP Custom 27203010 60-16005 - DRILL TWST 1.6MM 5MM BOTH IP/OP $532.50 $394.00 $94.79 $532.50 $532.50 $532.50 $532.50 $532.50 $532.50 $532.50 $94.79 $532.50 $532.50 $395.22 $395.22 $410.45 $277.43 $110.98 $532.50 $213.00 $532.50 $532.50 $532.50 $532.50 $532.50 $399.38 $532.50 $532.50 $532.50 $266.25 $266.25 $421.74 $532.50 $426.00 $346.13 $532.50 N/A $308.85 $532.50 $319.50 $532.50 $532.50 $532.50 N/A N/A 60-16007 SUP Custom 27203010 60-16007 - DRILL TWST 1.6MM 50MM STRL 7MM STP BOTH IP/OP $570.00 $422.00 $101.46 $570.00 $570.00 $570.00 $570.00 $570.00 $570.00 $570.00 $101.46 $570.00 $570.00 $423.05 $423.05 $439.36 $296.97 $118.79 $570.00 $228.00 $570.00 $570.00 $570.00 $570.00 $570.00 $427.50 $570.00 $570.00 $570.00 $285.00 $285.00 $451.44 $570.00 $456.00 $370.50 $570.00 N/A $330.60 $570.00 $342.00 $570.00 $570.00 $570.00 N/A N/A 60-16035 SUP Custom 27100030 60-16035 - BIT DRILL 1.6MM 115MM TWIST NONSTRL 20MM SCREW BOTH IP/OP $642.50 $475.00 $114.37 $642.50 $642.50 $642.50 $642.50 $642.50 $642.50 $642.50 $114.37 $642.50 $642.50 $476.86 $476.86 $495.24 $334.74 $133.90 $642.50 $257.00 $642.50 $642.50 $642.50 $642.50 $642.50 $481.88 $642.50 $642.50 $642.50 $321.25 $321.25 $508.86 $642.50 $514.00 $417.63 $642.50 N/A $372.65 $642.50 $385.50 $642.50 $642.50 $642.50 N/A N/A 60-16050 SUP Custom 27100030 60-16050 - BIT DRILL 1.6MM 125MM PILOT SHAFT END STERILE 50MM SCREW BOTH IP/OP $308.00 $228.00 $54.74 $307.55 $307.55 $307.55 $307.55 $307.55 $307.55 $307.55 $54.74 $307.55 $307.55 $228.26 $228.26 $237.06 $160.23 $64.10 $307.55 $123.02 $307.55 $307.55 $307.55 $307.55 $307.55 $231.00 $307.55 $307.55 $307.55 $153.78 $153.78 $243.58 $307.55 $246.04 $199.91 $307.55 N/A $178.64 $307.55 $184.53 $307.55 $307.55 $307.55 N/A N/A 60-16407 SUP Custom 27100030 60-16407 - BIT DRL 1.6MM 50MM NS 7MM DNTL SHFT END 2/2.3MM SCR BOTH IP/OP $256.00 $189.00 $45.54 $255.85 $255.85 $255.85 $255.85 $255.85 $255.85 $255.85 $45.54 $255.85 $255.85 $189.89 $189.89 $197.21 $133.30 $53.32 $255.85 $102.34 $255.85 $255.85 $255.85 $255.85 $255.85 $192.00 $255.85 $255.85 $255.85 $127.93 $127.93 $202.63 $255.85 $204.68 $166.30 $255.85 N/A $148.48 $255.85 $153.51 $255.85 $255.85 $255.85 N/A N/A 60-16435 SUP Custom 27100030 60-16435 - BIT DRL 1.6MM 115MM NS 20MM DNTL SHFT END 2/2.3MM SCR BOTH IP/OP $296.50 $219.00 $52.76 $296.43 $296.43 $296.43 $296.43 $296.43 $296.43 $296.43 $52.76 $296.43 $296.43 $220.01 $220.01 $228.49 $154.44 $61.78 $296.43 $118.57 $296.43 $296.43 $296.43 $296.43 $296.43 $222.38 $296.43 $296.43 $296.43 $148.22 $148.22 $234.77 $296.43 $237.14 $192.68 $296.43 N/A $171.97 $296.43 $177.86 $296.43 $296.43 $296.43 N/A N/A 60-16526 SUP Custom 27203010 60-16526 - BIT DRILL TWIST 1.6MM 58MM 20MM STOP LEIBINGER HAND STERILE BOTH IP/OP $249.50 $185.00 $44.39 $249.38 $249.38 $249.38 $249.38 $249.38 $249.38 $249.38 $44.39 $249.38 $249.38 $185.09 $185.09 $192.22 $129.93 $51.97 $249.38 $99.75 $249.38 $249.38 $249.38 $249.38 $249.38 $187.13 $249.38 $249.38 $249.38 $124.69 $124.69 $197.51 $249.38 $199.50 $162.10 $249.38 N/A $144.71 $249.38 $149.63 $249.38 $249.38 $249.38 N/A N/A 60-16535 SUP Custom 27100030 60-16535 - BIT DRILL TWIST 1.6MM 85MM 26MM STOP STERILE 20MM SCREW BOTH IP/OP $258.50 $191.00 $45.98 $258.33 $258.33 $258.33 $258.33 $258.33 $258.33 $258.33 $45.98 $258.33 $258.33 $191.73 $191.73 $199.12 $134.59 $53.84 $258.33 $103.33 $258.33 $258.33 $258.33 $258.33 $258.33 $193.88 $258.33 $258.33 $258.33 $129.17 $129.17 $204.60 $258.33 $206.66 $167.91 $258.33 N/A $149.93 $258.33 $155.00 $258.33 $258.33 $258.33 N/A N/A 60-16908 SUP Custom 27100030 60-16908 - BIT DRILL 90D 8MM STOP 1.6MM 19MM 8MM DENTAL END STERILE 8MM BOTH IP/OP $239.00 $177.00 $42.50 $238.75 $238.75 $238.75 $238.75 $238.75 $238.75 $238.75 $42.50 $238.75 $238.75 $177.20 $177.20 $184.03 $124.39 $49.76 $238.75 $95.50 $238.75 $238.75 $238.75 $238.75 $238.75 $179.25 $238.75 $238.75 $238.75 $119.38 $119.38 $189.09 $238.75 $191.00 $155.19 $238.75 N/A $138.62 $238.75 $143.25 $238.75 $238.75 $238.75 N/A N/A 60-16918 SUP Custom 27100030 60-16918 - BIT DRL 1.6MM 29MM NS 18MM DNTL SHFT END 2/2.3MM SCR BOTH IP/OP $239.00 $177.00 $42.50 $238.75 $238.75 $238.75 $238.75 $238.75 $238.75 $238.75 $42.50 $238.75 $238.75 $177.20 $177.20 $184.03 $124.39 $49.76 $238.75 $95.50 $238.75 $238.75 $238.75 $238.75 $238.75 $179.25 $238.75 $238.75 $238.75 $119.38 $119.38 $189.09 $238.75 $191.00 $155.19 $238.75 N/A $138.62 $238.75 $143.25 $238.75 $238.75 $238.75 N/A N/A 6017-0425A SUP HCPCS C1776 6017-0425A - STEM FEMORAL 4 25MM C TAPER OMNIFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6017-0525A SUP HCPCS C1776 6017-0525A - STEM FEMORAL 5 25MM C TAPER OMNIFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6017-0625A SUP HCPCS C1776 6017-0625A - STEM FEMORAL 6 25MM C TAPER OMNIFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6017-0730A SUP HCPCS C1776 6017-0730A - STEM FEMORAL 7 30MM C TAPER OMNIFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6017-0830A SUP HCPCS C1776 6017-0830A - STEM FEMORAL 8 30MM C TAPER OMNIFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6017-0935A SUP HCPCS C1776 6017-0935A - STEM FEMORAL 9 35MM C TAPER OMNIFIT HA HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6017-1035A SUP HCPCS C1776 6017-1035A - STEM FEMORAL 10 35MM C TAPER OMNIFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6017-1140A SUP HCPCS C1776 6017-1140A - STEM FEMORAL 11 40MM C TAPER OMNIFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6017-1240A SUP HCPCS C1776 6017-1240A - STEM FEMORAL 12 40MM C TAPER OMNIFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6017-1340A SUP HCPCS C1776 6017-1340A - STEM FEMORAL 13 40MM C TAPER OMNIFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6017-1440A SUP HCPCS C1776 6017-1440A - STEM FEMORAL 14 40MM C TAPER OMNIFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6018-0814 SUP HCPCS C1776 6018-0814 - STEM FEMORAL 1.5 14MM 205MM RSTOR HYDRXAPT CALCAR HIP BOTH IP/OP "$15,140.00" "$11,204.00" "$3,004.91" "$15,140.00" "$6,813.00" "$6,813.00" "$6,813.00" "$6,813.00" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.55" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.34" "$15,140.00" "$6,056.00" "$7,464.02" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$11,355.00" "$15,140.00" "$15,140.00" "$15,140.00" "$7,570.00" "$7,570.00" "$11,990.88" "$15,140.00" "$12,112.00" "$6,813.00" "$3,004.91" N/A "$8,781.20" "$15,140.00" "$9,084.00" "$15,140.00" "$3,155.18" "$15,140.00" N/A N/A 6018-0915 SUP HCPCS C1776 6018-0915 - STEM FEMORAL 9 15MM 205MM REPLACEMENT RESECTION LEVEL SYSTEM BOTH IP/OP "$15,140.00" "$11,204.00" "$3,004.91" "$15,140.00" "$6,813.00" "$6,813.00" "$6,813.00" "$6,813.00" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.55" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.34" "$15,140.00" "$15,140.00" "$7,464.02" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$11,355.00" "$15,140.00" "$15,140.00" "$15,140.00" "$7,570.00" "$7,570.00" "$11,990.88" "$15,140.00" "$12,112.00" "$6,813.00" "$3,004.91" N/A "$8,781.20" "$15,140.00" "$9,084.00" "$15,140.00" "$3,155.18" "$15,140.00" N/A N/A 6018-1016 SUP HCPCS C1776 6018-1016 - STEM FEMORAL 10 16MM 205MM REPLACEMENT RESECTION LEVEL BOTH IP/OP "$15,140.00" "$11,204.00" "$3,004.91" "$15,140.00" "$6,813.00" "$6,813.00" "$6,813.00" "$6,813.00" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.55" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.34" "$15,140.00" "$6,056.00" "$7,464.02" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$11,355.00" "$15,140.00" "$15,140.00" "$15,140.00" "$7,570.00" "$7,570.00" "$11,990.88" "$15,140.00" "$12,112.00" "$6,813.00" "$3,004.91" N/A "$8,781.20" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.18" "$15,140.00" N/A N/A 6018-1117 SUP HCPCS C1776 6018-1117 - STEM FEMORAL 11 17MM 205MM REVISION RSTOR HYDRXAPT CALCAR BOTH IP/OP "$15,140.00" "$11,204.00" "$3,004.91" "$15,140.00" "$6,813.00" "$6,813.00" "$6,813.00" "$6,813.00" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.55" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.34" "$15,140.00" "$6,056.00" "$7,464.02" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$11,355.00" "$15,140.00" "$15,140.00" "$15,140.00" "$7,570.00" "$7,570.00" "$11,990.88" "$15,140.00" "$12,112.00" "$6,813.00" "$3,004.91" N/A "$8,781.20" "$15,140.00" "$9,084.00" "$15,140.00" "$3,155.18" "$15,140.00" N/A N/A 6018-1218 SUP HCPCS C1776 6018-1218 - STEM FEMORAL 12 18MM 205MM RSTOR HYDRXAPT CALCAR HIP BOTH IP/OP "$15,140.00" "$11,204.00" "$3,004.91" "$15,140.00" "$6,813.00" "$6,813.00" "$6,813.00" "$6,813.00" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.55" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.34" "$15,140.00" "$6,056.00" "$7,464.02" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$11,355.00" "$15,140.00" "$15,140.00" "$15,140.00" "$7,570.00" "$7,570.00" "$11,990.88" "$15,140.00" "$12,112.00" "$6,813.00" "$3,004.91" N/A "$8,781.20" "$15,140.00" "$9,084.00" "$15,140.00" "$3,155.18" "$15,140.00" N/A N/A 6018-1319 SUP HCPCS C1776 6018-1319 - STEM FEMORAL 13 19MM 205MM REVISION RSTOR HYDRXAPT CALCAR BOTH IP/OP "$15,140.00" "$11,204.00" "$3,004.91" "$15,140.00" "$6,813.00" "$6,813.00" "$6,813.00" "$6,813.00" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.55" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.34" "$15,140.00" "$6,056.00" "$7,464.02" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$11,355.00" "$15,140.00" "$15,140.00" "$15,140.00" "$7,570.00" "$7,570.00" "$11,990.88" "$15,140.00" "$12,112.00" "$6,813.00" "$3,004.91" N/A "$8,781.20" "$15,140.00" "$9,084.00" "$15,140.00" "$3,155.18" "$15,140.00" N/A N/A 6018-1420 SUP HCPCS C1776 6018-1420 - STEM FEMORAL 14 20MM 205MM REVISION RSTOR HYDRXAPT CALCAR BOTH IP/OP "$15,140.00" "$11,204.00" "$3,004.91" "$15,140.00" "$6,813.00" "$6,813.00" "$6,813.00" "$6,813.00" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.55" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$3,155.34" "$15,140.00" "$6,056.00" "$7,464.02" "$15,140.00" "$15,140.00" "$15,140.00" "$15,140.00" "$11,355.00" "$15,140.00" "$15,140.00" "$15,140.00" "$7,570.00" "$7,570.00" "$11,990.88" "$15,140.00" "$12,112.00" "$6,813.00" "$3,004.91" N/A "$8,781.20" "$15,140.00" "$9,084.00" "$15,140.00" "$3,155.18" "$15,140.00" N/A N/A 60-19035 SUP Custom 27100030 60-19035 - BIT DRILL TWIST 1.9MM 115MM 35MM SHAFT END STOP STERILE BOTH IP/OP $322.50 $239.00 $57.39 $322.43 $322.43 $322.43 $322.43 $322.43 $322.43 $322.43 $57.39 $322.43 $322.43 $239.31 $239.31 $248.53 $167.99 $67.20 $322.43 $128.97 $322.43 $322.43 $322.43 $322.43 $322.43 $241.88 $322.43 $322.43 $322.43 $161.22 $161.22 $255.36 $322.43 $257.94 $209.58 $322.43 N/A $187.05 $322.43 $193.46 $322.43 $322.43 $322.43 N/A N/A 6019-0814 SUP HCPCS C1776 6019-0814 - STEM FEMORAL 3 14MM 205MM RSTOR HYDRXAPT CALCAR HIP BOTH IP/OP "$13,980.00" "$10,345.00" "$2,774.66" "$13,979.88" "$6,290.95" "$6,290.95" "$6,290.95" "$6,290.95" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.76" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.56" "$13,979.88" "$13,979.88" "$6,892.08" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$10,485.00" "$13,979.88" "$13,979.88" "$13,979.88" "$6,989.94" "$6,989.94" "$11,072.06" "$13,979.88" "$11,183.90" "$6,290.95" "$2,774.66" N/A "$8,108.40" "$13,979.88" "$8,387.93" "$13,979.88" "$2,913.41" "$13,979.88" N/A N/A 6019-0915 SUP HCPCS C1776 6019-0915 - STEM FEMORAL 3 RSTOR HYDRXAPT CALCAR BOTH IP/OP "$13,980.00" "$10,345.00" "$2,774.66" "$13,979.88" "$6,290.95" "$6,290.95" "$6,290.95" "$6,290.95" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.76" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.56" "$13,979.88" "$5,591.95" "$6,892.08" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$10,485.00" "$13,979.88" "$13,979.88" "$13,979.88" "$6,989.94" "$6,989.94" "$11,072.06" "$13,979.88" "$11,183.90" "$6,290.95" "$2,774.66" N/A "$8,108.40" "$13,979.88" "$8,387.93" "$13,979.88" "$2,913.41" "$13,979.88" N/A N/A 6019-1016 SUP HCPCS C1776 6019-1016 - STEM FEMORAL 3 16MM 205MM RSTOR HYDRXAPT CALCAR HIP BOTH IP/OP "$13,980.00" "$10,345.00" "$2,774.66" "$13,979.88" "$6,290.95" "$6,290.95" "$6,290.95" "$6,290.95" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.76" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.56" "$13,979.88" "$13,979.88" "$6,892.08" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$10,485.00" "$13,979.88" "$13,979.88" "$13,979.88" "$6,989.94" "$6,989.94" "$11,072.06" "$13,979.88" "$11,183.90" "$6,290.95" "$2,774.66" N/A "$8,108.40" "$13,979.88" "$8,387.93" "$13,979.88" "$2,913.41" "$13,979.88" N/A N/A 6019-1117 SUP HCPCS C1776 6019-1117 - STEM FEMORAL 11 17MM 205MM REVISION RSTOR HYDRXAPT CALCAR BOTH IP/OP "$13,980.00" "$10,345.00" "$2,774.66" "$13,979.88" "$6,290.95" "$6,290.95" "$6,290.95" "$6,290.95" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.76" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.56" "$13,979.88" "$5,591.95" "$6,892.08" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$10,485.00" "$13,979.88" "$13,979.88" "$13,979.88" "$6,989.94" "$6,989.94" "$11,072.06" "$13,979.88" "$11,183.90" "$6,290.95" "$2,774.66" N/A "$8,108.40" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.41" "$13,979.88" N/A N/A 6019-1218 SUP HCPCS C1776 6019-1218 - STEM FEMORAL 12 18MM 205MM REVISION RSTOR HYDRXAPT CALCAR BOTH IP/OP "$13,980.00" "$10,345.00" "$2,774.66" "$13,979.88" "$6,290.95" "$6,290.95" "$6,290.95" "$6,290.95" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.76" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.56" "$13,979.88" "$13,979.88" "$6,892.08" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$10,485.00" "$13,979.88" "$13,979.88" "$13,979.88" "$6,989.94" "$6,989.94" "$11,072.06" "$13,979.88" "$11,183.90" "$6,290.95" "$2,774.66" N/A "$8,108.40" "$13,979.88" "$8,387.93" "$13,979.88" "$2,913.41" "$13,979.88" N/A N/A 60-19126 SUP Custom 27203010 60-19126 - DRILL TWST 1.9MM 27MM STRYK END BOTH IP/OP $159.50 $118.00 $28.39 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $28.39 $159.50 $159.50 $118.38 $118.38 $122.94 $83.10 $33.24 $159.50 $63.80 $159.50 $159.50 $159.50 $159.50 $159.50 $119.63 $159.50 $159.50 $159.50 $79.75 $79.75 $126.32 $159.50 $127.60 $103.68 $159.50 N/A $92.51 $159.50 $95.70 $159.50 $159.50 $159.50 N/A N/A 6019-1319 SUP HCPCS C1776 6019-1319 - STEM FEMORAL 13 19MM 205MM REVISION RSTOR HYDRXAPT CALCAR BOTH IP/OP "$13,980.00" "$10,345.00" "$2,774.66" "$13,979.88" "$6,290.95" "$6,290.95" "$6,290.95" "$6,290.95" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.76" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.56" "$13,979.88" "$5,591.95" "$6,892.08" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$10,485.00" "$13,979.88" "$13,979.88" "$13,979.88" "$6,989.94" "$6,989.94" "$11,072.06" "$13,979.88" "$11,183.90" "$6,290.95" "$2,774.66" N/A "$8,108.40" "$13,979.88" "$8,387.93" "$13,979.88" "$2,913.41" "$13,979.88" N/A N/A 60-19140 SUP Custom 27203010 60-19140 - DRILL TWIST 1.9MM SHAFT END VARIAX RAD DISTAL STERILE BOTH IP/OP $166.50 $123.00 $29.62 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $29.62 $166.38 $166.38 $123.49 $123.49 $128.25 $86.68 $34.68 $166.38 $66.55 $166.38 $166.38 $166.38 $166.38 $166.38 $124.88 $166.38 $166.38 $166.38 $83.19 $83.19 $131.77 $166.38 $133.10 $108.15 $166.38 N/A $96.57 $166.38 $99.83 $166.38 $166.38 $166.38 N/A N/A 6019-1420 SUP HCPCS C1776 6019-1420 - STEM FEMORAL 14 20MM 205MM REVISION RSTOR HYDRXAPT CALCAR BOTH IP/OP "$13,980.00" "$10,345.00" "$2,774.66" "$13,979.88" "$6,290.95" "$6,290.95" "$6,290.95" "$6,290.95" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.76" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$2,913.56" "$13,979.88" "$13,979.88" "$6,892.08" "$13,979.88" "$13,979.88" "$13,979.88" "$13,979.88" "$10,485.00" "$13,979.88" "$13,979.88" "$13,979.88" "$6,989.94" "$6,989.94" "$11,072.06" "$13,979.88" "$11,183.90" "$6,290.95" "$2,774.66" N/A "$8,108.40" "$13,979.88" "$8,387.93" "$13,979.88" "$2,913.41" "$13,979.88" N/A N/A 60-19326 SUP Custom 27203010 60-19326 - BIT DRILL TWIST 1.9MM 87MM 27MM AO MODULAR SHAFT END STOP BOTH IP/OP $159.50 $118.00 $28.39 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $28.39 $159.50 $159.50 $118.38 $118.38 $122.94 $83.10 $33.24 $159.50 $63.80 $159.50 $159.50 $159.50 $159.50 $159.50 $119.63 $159.50 $159.50 $159.50 $79.75 $79.75 $126.32 $159.50 $127.60 $103.68 $159.50 N/A $92.51 $159.50 $95.70 $159.50 $159.50 $159.50 N/A N/A 60-19340 SUP Custom 27203010 60-19340 - BIT DRILL TWIST 1.9MM 105MM AO SHAFT END VARIAX DISTAL BOTH IP/OP $166.50 $123.00 $29.62 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $29.62 $166.38 $166.38 $123.49 $123.49 $128.25 $86.68 $34.68 $166.38 $66.55 $166.38 $166.38 $166.38 $166.38 $166.38 $124.88 $166.38 $166.38 $166.38 $83.19 $83.19 $131.77 $166.38 $133.10 $108.15 $166.38 N/A $96.57 $166.38 $99.83 $166.38 $166.38 $166.38 N/A N/A 60-19426 SUP Custom 27203010 60-19426 - DRILL TWIST 1.9MM 77MM 27MM SHAFT END FIX MODULAR PROFYLE BOTH IP/OP $159.50 $118.00 $28.39 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $28.39 $159.50 $159.50 $118.38 $118.38 $122.94 $83.10 $33.24 $159.50 $63.80 $159.50 $159.50 $159.50 $159.50 $159.50 $119.63 $159.50 $159.50 $159.50 $79.75 $79.75 $126.32 $159.50 $127.60 $103.68 $159.50 N/A $92.51 $159.50 $95.70 $159.50 $159.50 $159.50 N/A N/A 60-19435 SUP Custom 27100030 60-19435 - DRILL TWIST 1.9MM 115MM 35MM STOP STERILE 2.3MM SCREW BOTH IP/OP $335.50 $248.00 $59.70 $335.40 $335.40 $335.40 $335.40 $335.40 $335.40 $335.40 $59.70 $335.40 $335.40 $248.93 $248.93 $258.53 $174.74 $69.90 $335.40 $134.16 $335.40 $335.40 $335.40 $335.40 $335.40 $251.63 $335.40 $335.40 $335.40 $167.70 $167.70 $265.64 $335.40 $268.32 $218.01 $335.40 N/A $194.59 $335.40 $201.24 $335.40 $335.40 $335.40 N/A N/A 60-19440 SUP Custom 27203010 60-19440 - DRILL TWIST 1.9MM 91MM 41MM SHAFT END FIX MODULAR PROFYLE BOTH IP/OP $168.50 $125.00 $29.96 $168.30 $168.30 $168.30 $168.30 $168.30 $168.30 $168.30 $29.96 $168.30 $168.30 $124.91 $124.91 $129.73 $87.68 $35.08 $168.30 $67.32 $168.30 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $109.40 $168.30 N/A $97.73 $168.30 $100.98 $168.30 $168.30 $168.30 N/A N/A 60-19526 SUP Custom 27203010 60-19526 - BIT DRILL 1.9MM 58MM SHAFT END STERILE 20MM SCREW BOTH IP/OP $321.50 $238.00 $57.18 $321.25 $321.25 $321.25 $321.25 $321.25 $321.25 $321.25 $57.18 $321.25 $321.25 $238.43 $238.43 $247.62 $167.37 $66.95 $321.25 $128.50 $321.25 $321.25 $321.25 $321.25 $321.25 $241.13 $321.25 $321.25 $321.25 $160.63 $160.63 $254.43 $321.25 $257.00 $208.81 $321.25 N/A $186.47 $321.25 $192.75 $321.25 $321.25 $321.25 N/A N/A 60-19535 SUP Custom 27100030 60-19535 - BIT DRILL 1.9MM 85MM SHAFT END STERILE 20MM SCREW BOTH IP/OP $246.00 $182.00 $43.76 $245.85 $245.85 $245.85 $245.85 $245.85 $245.85 $245.85 $43.76 $245.85 $245.85 $182.47 $182.47 $189.50 $128.09 $51.24 $245.85 $98.34 $245.85 $245.85 $245.85 $245.85 $245.85 $184.50 $245.85 $245.85 $245.85 $122.93 $122.93 $194.71 $245.85 $196.68 $159.80 $245.85 N/A $142.68 $245.85 $147.51 $245.85 $245.85 $245.85 N/A N/A 60-19908 SUP Custom 27100030 60-19908 - BIT DRILL 90D 8MM STOP 1.9MM 19MM DENTAL END STERILE 8MM BOTH IP/OP $239.00 $177.00 $42.50 $238.75 $238.75 $238.75 $238.75 $238.75 $238.75 $238.75 $42.50 $238.75 $238.75 $177.20 $177.20 $184.03 $124.39 $49.76 $238.75 $95.50 $238.75 $238.75 $238.75 $238.75 $238.75 $179.25 $238.75 $238.75 $238.75 $119.38 $119.38 $189.09 $238.75 $191.00 $155.19 $238.75 N/A $138.62 $238.75 $143.25 $238.75 $238.75 $238.75 N/A N/A 60-19918 SUP Custom 27100030 60-19918 - BIT DRILL 90D 18MM STOP 1.9MM 29MM DENTAL END STERILE 18MM BOTH IP/OP $239.00 $177.00 $42.50 $238.75 $238.75 $238.75 $238.75 $238.75 $238.75 $238.75 $42.50 $238.75 $238.75 $177.20 $177.20 $184.03 $124.39 $49.76 $238.75 $95.50 $238.75 $238.75 $238.75 $238.75 $238.75 $179.25 $238.75 $238.75 $238.75 $119.38 $119.38 $189.09 $238.75 $191.00 $155.19 $238.75 N/A $138.62 $238.75 $143.25 $238.75 $238.75 $238.75 N/A N/A 6020-0030 SUP HCPCS C1776 6020-0030 - STEM FEMORAL 132D 0 33MM OFFST 86MM 30MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 60-20012 SUP Custom 27100030 60-20012 - BIT DRILL TWIST 2MM 62MM 13MM REPOSITION PIN STOP STERILE BOTH IP/OP $670.00 $496.00 $119.26 $670.00 $670.00 $670.00 $670.00 $670.00 $670.00 $670.00 $119.26 $670.00 $670.00 $497.27 $497.27 $516.44 $349.07 $139.64 $670.00 $268.00 $670.00 $670.00 $670.00 $670.00 $670.00 $502.50 $670.00 $670.00 $670.00 $335.00 $335.00 $530.64 $670.00 $536.00 $435.50 $670.00 N/A $388.60 $670.00 $402.00 $670.00 $670.00 $670.00 N/A N/A 6020-0130 SUP HCPCS C1776 6020-0130 - STEM FEMORAL 132D 1 34MM OFFST 110MM 30MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6020-0230 SUP HCPCS C1776 6020-0230 - STEM FEMORAL 130D 2 35MM OFFST 115MM 30MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6020-0335 SUP HCPCS C1776 6020-0335 - STEM FEMORAL 132D 3 39MM OFFST 120MM 35MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6020-0435 SUP HCPCS C1776 6020-0435 - STEM FEMORAL 132D 4 40MM OFFST 125MM 35MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 60-20050 SUP Custom 27100030 60-20050 - BIT DRL 2MM 125MM NS 50MM STRYK SHFT END 2MM LG SCR BOTH IP/OP $369.00 $273.00 $65.64 $368.75 $368.75 $368.75 $368.75 $368.75 $368.75 $368.75 $65.64 $368.75 $368.75 $273.69 $273.69 $284.23 $192.12 $76.85 $368.75 $147.50 $368.75 $368.75 $368.75 $368.75 $368.75 $276.75 $368.75 $368.75 $368.75 $184.38 $184.38 $292.05 $368.75 $295.00 $239.69 $368.75 N/A $214.02 $368.75 $221.25 $368.75 $368.75 $368.75 N/A N/A 6020-0537 SUP HCPCS C1776 6020-0537 - STEM FEMORAL 132D 5 44MM OFFST 130MM 37MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6020-0637 SUP HCPCS C1776 6020-0637 - STEM FEMORAL 132D 6 45MM OFFST 135MM 37MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6020-0740 SUP HCPCS C1776 6020-0740 - STEM FEMORAL 132D 7 48MM OFFST 140MM 40MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6020-0840 SUP HCPCS C1776 6020-0840 - STEM FEMORAL 132D 8 49MM OFFST 145MM 40MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 60-20185 SUP Custom 27203010 60-20185 - BIT DRILL TWIST 2MM 100MM 40MM DENTAL SHAFT END STOP STERILE BOTH IP/OP $166.50 $123.00 $29.62 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $29.62 $166.38 $166.38 $123.49 $123.49 $128.25 $86.68 $34.68 $166.38 $66.55 $166.38 $166.38 $166.38 $166.38 $166.38 $124.88 $166.38 $166.38 $166.38 $83.19 $83.19 $131.77 $166.38 $133.10 $108.15 $166.38 N/A $96.57 $166.38 $99.83 $166.38 $166.38 $166.38 N/A N/A 6020-2530 SUP HCPCS C1776 6020-2530 - STEM FEMORAL 132D 2.5 36MM OFFST 118MM 30MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6020-3535 SUP HCPCS C1776 6020-3535 - STEM FEMORAL 132D 3.5 39MM OFFST 124MM 35MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 60-20385 SUP Custom 27203010 60-20385 - DRILL TWST 2MM 105MM STRL 40MM AO SHFT END STP DIST VARIAX BOTH IP/OP $166.50 $123.00 $29.62 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $166.38 $29.62 $166.38 $166.38 $123.49 $123.49 $128.25 $86.68 $34.68 $166.38 $66.55 $166.38 $166.38 $166.38 $166.38 $166.38 $124.88 $166.38 $166.38 $166.38 $83.19 $83.19 $131.77 $166.38 $133.10 $108.15 $166.38 N/A $96.57 $166.38 $99.83 $166.38 $166.38 $166.38 N/A N/A 6020-4535 SUP HCPCS C1776 6020-4535 - STEM FEMORAL 132D 4.5 41MM OFFST 129MM 35MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 60-20485 SUP Custom 27203010 60-20485 - DRILL TWIST 2MM 100MM 40MM DENTAL SHAFT END FIX MODULAR BOTH IP/OP $165.00 $122.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $165.00 N/A $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A 6020-5537 SUP HCPCS C1776 6020-5537 - STEM FEMORAL 132D 5.5 45MM OFFST 133MM 37MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6021-0030 SUP HCPCS C1776 6021-0030 - STEM FEMORAL 127D 0 37MM OFFST 86MM 30MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6021-0130 SUP HCPCS C1776 6021-0130 - STEM FEMORAL 127D 1 38MM OFFST 110MM 30MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6021-0230 SUP HCPCS C1776 6021-0230 - STEM FEMORAL 127D 2 39MM OFFST 115MM 30MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6021-0335 SUP HCPCS C1776 6021-0335 - STEM FEMORAL 127D 3 43MM OFFST 120MM 35MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6021-0435 SUP HCPCS C1776 6021-0435 - STEM FEMORAL 127D 4 44MM OFFST 125MM 35MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6021-0537 SUP HCPCS C1776 6021-0537 - STEM FEMORAL 127D 5 48MM OFFST 130MM 37MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6021-0637 SUP HCPCS C1776 6021-0637 - STEM FEMORAL 127D 6 49MM OFFST 135MM 37MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6021-0740 SUP HCPCS C1776 6021-0740 - STEM FEMORAL 127D 7 53MM OFFST 140MM 40MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6021-0840 SUP HCPCS C1776 6021-0840 - STEM FEMORAL 127D 8 54MM OFFST 145MM 40MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6021-2530 SUP HCPCS C1776 6021-2530 - STEM FEMORAL 127D 2.5 40MM OFFST 118MM 30MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6021-3535 SUP HCPCS C1776 6021-3535 - STEM FEMORAL 127D 3.5 43MM OFFST 124MM 35MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6021-4535 SUP HCPCS C1776 6021-4535 - STEM FEMORAL 127D 4.5 45MM OFFST 129MM 35MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6021-5537 SUP HCPCS C1776 6021-5537 - STEM FEMORAL 127D 5.5 49MM OFFST 133MM 37MM CEMENTLESS NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 60-23141 SUP Custom 27203010 60-23141 - DRILL TWST 2.3MM BOTH IP/OP $165.00 $122.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $165.00 N/A $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A 60-23341 SUP Custom 27203010 60-23341 - DRILL TWIST 2.3MM AO SHAFT END RAD VARIAX DISTAL STERILE BOTH IP/OP $168.50 $125.00 $29.96 $168.30 $168.30 $168.30 $168.30 $168.30 $168.30 $168.30 $29.96 $168.30 $168.30 $124.91 $124.91 $129.73 $87.68 $35.08 $168.30 $67.32 $168.30 $168.30 $168.30 $168.30 $168.30 $126.38 $168.30 $168.30 $168.30 $84.15 $84.15 $133.29 $168.30 $134.64 $109.40 $168.30 N/A $97.73 $168.30 $100.98 $168.30 $168.30 $168.30 N/A N/A 60-23441 SUP Custom 27203010 60-23441 - DRILL TWIST 2.3MM DENTAL SHAFT END BOTH IP/OP $165.00 $122.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $165.00 N/A $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A 60-25126 SUP Custom 27203010 60-25126 - DRILL TWIST 2.5MM 94MM 26MM SHAFT END FIX MODULAR PROFYLE BOTH IP/OP $159.50 $118.00 $28.39 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $28.39 $159.50 $159.50 $118.38 $118.38 $122.94 $83.10 $33.24 $159.50 $63.80 $159.50 $159.50 $159.50 $159.50 $159.50 $119.63 $159.50 $159.50 $159.50 $79.75 $79.75 $126.32 $159.50 $127.60 $103.68 $159.50 N/A $92.51 $159.50 $95.70 $159.50 $159.50 $159.50 N/A N/A 60-25326 SUP Custom 27203010 60-25326 - DRILL TWIST 2.5MM 87MM 26MM SHAFT END FIX MODULAR PROFYLE BOTH IP/OP $159.50 $118.00 $28.39 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $28.39 $159.50 $159.50 $118.38 $118.38 $122.94 $83.10 $33.24 $159.50 $63.80 $159.50 $159.50 $159.50 $159.50 $159.50 $119.63 $159.50 $159.50 $159.50 $79.75 $79.75 $126.32 $159.50 $127.60 $103.68 $159.50 N/A $92.51 $159.50 $95.70 $159.50 $159.50 $159.50 N/A N/A 60-25426 SUP Custom 27203010 60-25426 - DRILL TWST 25MM 27MM WKG LN BOTH IP/OP $159.50 $118.00 $28.39 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $159.50 $28.39 $159.50 $159.50 $118.38 $118.38 $122.94 $83.10 $33.24 $159.50 $63.80 $159.50 $159.50 $159.50 $159.50 $159.50 $119.63 $159.50 $159.50 $159.50 $79.75 $79.75 $126.32 $159.50 $127.60 $103.68 $159.50 N/A $92.51 $159.50 $95.70 $159.50 $159.50 $159.50 N/A N/A 602640S SUP HCPCS C1713 602640S - SCREW BN THRD 6.5MM 40MM STRL 20MM ASNS III CNN THRD TI HIP BOTH IP/OP $392.00 $290.00 $77.78 $391.88 $176.35 $176.35 $176.35 $176.35 $391.88 $391.88 $391.88 $81.68 $391.88 $391.88 $391.88 $391.88 $391.88 $81.67 $391.88 $156.75 $231.80 $391.88 $391.88 $391.88 $391.88 $294.00 $391.88 $391.88 $391.88 $195.94 $195.94 $310.37 $391.88 $313.50 $176.35 $77.78 N/A $227.36 $391.88 $391.88 $391.88 $81.67 $391.88 N/A N/A 6033-0425 SUP HCPCS C1776 6033-0425 - STEM FEMORAL 4 25MM CEMENTED COLLARLESS NORMALIZE OMNIFIT BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6033-0525 SUP HCPCS C1776 6033-0525 - STEM FEMORAL 5 25MM CEMENTED COLLARLESS NORMALIZE OMNIFIT BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6033-0625 SUP HCPCS C1776 6033-0625 - STEM FEMORAL 6 25MM CEMENTED COLLARLESS NORMALIZE OMNIFIT BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6033-0730 SUP HCPCS C1776 6033-0730 - STEM FEMORAL 7 30MM CEMENTED COLLARLESS NORMALIZE OMNIFIT BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6033-0830 SUP HCPCS C1776 6033-0830 - STEM FEMORAL 8 30MM CEMENTED COLLARLESS NORMALIZE OMNIFIT BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6033-0935 SUP HCPCS C1776 6033-0935 - STEM FEMORAL 9 35MM CEMENTED COLLARLESS NORMALIZE OMNIFIT BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6033-1035 SUP HCPCS C1776 6033-1035 - STEM FEMORAL 10 35MM CEMENTED COLLARLESS NORMALIZE OMNIFIT BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6033-1140 SUP HCPCS C1776 6033-1140 - STEM FEMORAL 11 40MM CEMENTED COLLARLESS NORMALIZE OMNIFIT BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6033-1240 SUP HCPCS C1776 6033-1240 - STEM FEMORAL 12 40MM CEMENTED COLLARLESS NORMALIZE OMNIFIT BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6033-1340 SUP HCPCS C1776 6033-1340 - STEM FEMORAL 13 40MM CEMENTED COLLARLESS NORMALIZE OMNIFIT BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6034-0425 SUP HCPCS C1776 6034-0425 - STEM FEMORAL 4 25MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6034-0525 SUP HCPCS C1776 6034-0525 - STEM FEMORAL 5 25MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6034-0625 SUP HCPCS C1776 6034-0625 - STEM FEMORAL 6 25MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6034-0730 SUP HCPCS C1776 6034-0730 - STEM FEMORAL 7 30MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6034-0830 SUP HCPCS C1776 6034-0830 - STEM FEMORAL 8 30MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6034-0935 SUP HCPCS C1776 6034-0935 - STEM FEMORAL 9 35MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6034-1035 SUP HCPCS C1776 6034-1035 - STEM FEMORAL 10 35MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6034-1140 SUP HCPCS C1776 6034-1140 - STEM FEMORAL 11 40MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6034-1240 SUP HCPCS C1776 6034-1240 - STEM FEMORAL 12 40MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6034-1340 SUP HCPCS C1776 6034-1340 - STEM FEMORAL 13 40MM CEMENTED COLLAR NORMALIZE OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6041-1140 SUP HCPCS C1776 6041-1140 - STEM FEMORAL 11 40MM OMNIFIT HA HIP BOTH IP/OP "$5,592.00" "$4,138.00" "$1,109.87" "$5,592.00" "$2,516.40" "$2,516.40" "$2,516.40" "$2,516.40" "$5,592.00" "$5,592.00" "$5,592.00" "$1,165.51" "$5,592.00" "$5,592.00" "$5,592.00" "$5,592.00" "$5,592.00" "$1,165.43" "$5,592.00" "$5,592.00" "$2,756.86" "$5,592.00" "$5,592.00" "$5,592.00" "$5,592.00" "$4,194.00" "$5,592.00" "$5,592.00" "$5,592.00" "$2,796.00" "$2,796.00" "$4,428.86" "$5,592.00" "$4,473.60" "$2,516.40" "$1,109.87" N/A "$3,243.36" "$5,592.00" "$5,592.00" "$5,592.00" "$1,165.37" "$5,592.00" N/A N/A 6041-1240 SUP HCPCS C1776 6041-1240 - STEM FEMORAL MORSE TAPER 12MM 40MM OSTEONICS HA HIP BOTH IP/OP "$5,592.00" "$4,138.00" "$1,109.87" "$5,592.00" "$2,516.40" "$2,516.40" "$2,516.40" "$2,516.40" "$5,592.00" "$5,592.00" "$5,592.00" "$1,165.51" "$5,592.00" "$5,592.00" "$5,592.00" "$5,592.00" "$5,592.00" "$1,165.43" "$5,592.00" "$5,592.00" "$2,756.86" "$5,592.00" "$5,592.00" "$5,592.00" "$5,592.00" "$4,194.00" "$5,592.00" "$5,592.00" "$5,592.00" "$2,796.00" "$2,796.00" "$4,428.86" "$5,592.00" "$4,473.60" "$2,516.40" "$1,109.87" N/A "$3,243.36" "$5,592.00" "$5,592.00" "$5,592.00" "$1,165.37" "$5,592.00" N/A N/A 6046-0625 SUP HCPCS C1776 6046-0625 - STEM FEMORAL 6 OMNIFLEX HYDRXAPT HIP BOTH IP/OP "$6,546.00" "$4,844.00" "$1,299.22" "$6,546.00" "$2,945.70" "$2,945.70" "$2,945.70" "$2,945.70" "$6,546.00" "$6,546.00" "$6,546.00" "$1,364.35" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$1,364.26" "$6,546.00" "$6,546.00" "$3,227.18" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$4,909.50" "$6,546.00" "$6,546.00" "$6,546.00" "$3,273.00" "$3,273.00" "$5,184.43" "$6,546.00" "$5,236.80" "$2,945.70" "$1,299.22" N/A "$3,796.68" "$6,546.00" "$6,546.00" "$6,546.00" "$1,364.19" "$6,546.00" N/A N/A 6046-0830 SUP HCPCS C1776 6046-0830 - STEM FEMORAL 8 OMNIFLEX HYDRXAPT HIP BOTH IP/OP "$6,546.00" "$4,844.00" "$1,299.22" "$6,546.00" "$2,945.70" "$2,945.70" "$2,945.70" "$2,945.70" "$6,546.00" "$6,546.00" "$6,546.00" "$1,364.35" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$1,364.26" "$6,546.00" "$6,546.00" "$3,227.18" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$4,909.50" "$6,546.00" "$6,546.00" "$6,546.00" "$3,273.00" "$3,273.00" "$5,184.43" "$6,546.00" "$5,236.80" "$2,945.70" "$1,299.22" N/A "$3,796.68" "$6,546.00" "$6,546.00" "$6,546.00" "$1,364.19" "$6,546.00" N/A N/A 6046-1440 SUP HCPCS C1776 6046-1440 - STEM FEMORAL 14 OMNIFLEX HA HIP BOTH IP/OP "$6,546.00" "$4,844.00" "$1,299.22" "$6,546.00" "$2,945.70" "$2,945.70" "$2,945.70" "$2,945.70" "$6,546.00" "$6,546.00" "$6,546.00" "$1,364.35" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$1,364.26" "$6,546.00" "$2,618.40" "$3,227.18" "$6,546.00" "$6,546.00" "$6,546.00" "$6,546.00" "$4,909.50" "$6,546.00" "$6,546.00" "$6,546.00" "$3,273.00" "$3,273.00" "$5,184.43" "$6,546.00" "$5,236.80" "$2,945.70" "$1,299.22" N/A "$3,796.68" "$6,546.00" "$3,927.60" "$6,546.00" "$1,364.19" "$6,546.00" N/A N/A 6048-58 SUP Custom 27203010 6048-58 - KIT STYLET BLUNT STR .014IN 58CM LEAD KNOB GREEN BOTH IP/OP $77.50 $57.00 $13.80 $77.50 $77.50 $77.50 $77.50 $77.50 $77.50 $77.50 $13.80 $77.50 $77.50 $57.52 $57.52 $59.74 $40.38 $16.15 $77.50 $31.00 $77.50 $77.50 $77.50 $77.50 $77.50 $58.13 $77.50 $77.50 $77.50 $38.75 $38.75 $61.38 $77.50 $62.00 $50.38 $77.50 N/A $44.95 $77.50 $46.50 $77.50 $77.50 $77.50 N/A N/A 6050-0530 SUP HCPCS C1776 6050-0530 - STEM FEMORAL 5 30MM HEAD NECK OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6050-0735 SUP HCPCS C1776 6050-0735 - IMPLANT KN 69 68.9MM ANT/POSTERIORX70.1MM MEDI STRL IB2MKS BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6050-0745 SUP HCPCS C1776 6050-0745 - STEM FEMORAL 7 45MM CEMENTED HEAD/NECK OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6050-0935 SUP HCPCS C1776 6050-0935 - STEM FEMORAL 9 C TAPER 12MM 160MM 35MM OMNIFIT HEAD NECK HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6050-0945 SUP HCPCS C1776 6050-0945 - STEM FEMORAL 9 45MM 160MM CEMENTED HEAD/NECK OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6050-0955 SUP HCPCS C1776 6050-0955 - STEM FEMORAL 55MM 55MM 9MM HEAD NECK OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6050-1135 SUP HCPCS C1776 6050-1135 - STEM FEMORAL 11 CEMENT OMNIFIT HIP BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6051-0425A SUP HCPCS C1776 6051-0425A - STEM FEMORAL 4 8.1MM 100MM 25MM CEMENTLESS SECFIT HYDRXAPT BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$6,665.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$3,999.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 6051-0425S SUP HCPCS C1776 6051-0425S - STEM FEMORAL 132D 4 29MM OFFST 8.1MM 100MM 25MM NECK SECFIT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6051-0525A SUP HCPCS C1776 6051-0525A - STEM FEMORAL 5 8.9MM 110MM 25MM CEMENTLESS SECFIT HYDRXAPT BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6051-0525S SUP HCPCS C1776 6051-0525S - STEM FEMORAL 132D 5 29MM OFFST 8.9MM 110MM 25MM NECK SECFIT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6051-0625A SUP HCPCS C1776 6051-0625A - STEM FEMORAL 6 25MM CEMENTLESS C TAPER COLLARLESS SECFIT BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6051-0625S SUP HCPCS C1776 6051-0625S - STEM FEMORAL 132D 6 30MM OFFST 9.6MM 120MM 25MM NECK SECFIT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6051-0730A SUP HCPCS C1776 6051-0730A - STEM FEM 7 10.4MM 13CM 30MM SCRFT BS NK DIST TIP HA HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6051-0730S SUP HCPCS C1776 6051-0730S - STEM FEMORAL 132D 7 35MM OFFST 10.4MM 130MM 30MM NECK SECFIT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6051-0830A SUP HCPCS C1776 6051-0830A - STEM FEMORAL 8 11.2MM 140MM 30MM CEMENTLESS SECFIT HYDRXAPT BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6051-0830S SUP HCPCS C1776 6051-0830S - STEM FEMORAL 132D 8 36MM OFFST 11.2MM 140MM 30MM NECK SECFIT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6051-0935A SUP HCPCS C1776 6051-0935A - STEM FEMORAL 9 40.8 11.9MM 15CM 35MM OFFST SECFIT HA HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6051-0935S SUP HCPCS C1776 6051-0935S - STEM FEMORAL 132D 9 40.8MM 11.9MM 15CM 35MM SECFIT MAX HA BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6051-1035A SUP HCPCS C1776 6051-1035A - STEM FEMORAL 10 12.7MM 160MM 35MM CEMENTLESS SECFIT HYDRXAPT BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6051-1035S SUP HCPCS C1776 6051-1035S - STEM FEMORAL 132D 10 42MM OFFST 12.7MM 160MM 35MM NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6051-1140A SUP HCPCS C1776 6051-1140A - STEM FEMORAL 132D 11 46.5MM 13.5MM 17CM 40MM SECFIT MAX HA BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6051-1140S SUP HCPCS C1776 6051-1140S - STEM FEMORAL 132D 11 46.5MM 13.5MM 17CM 40MM SECFIT MAX HA BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6051-1240A SUP HCPCS C1776 6051-1240A - STEM FEMORAL 12 14.7MM 170MM 40MM CEMENTLESS SECFIT HYDRXAPT BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6051-1240S SUP HCPCS C1776 6051-1240S - STEM FEMORAL 132D 12 47MM OFFST 14.7MM 170MM 40MM NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6051-1340A SUP HCPCS C1776 6051-1340A - STEM FEM 13 48.2MM OFST 16MM 17CM 40MM SCRFT HA HIP BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$6,665.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$6,665.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 6051-1340S SUP HCPCS C1776 6051-1340S - STEM FEM 13 16MM 17CM 40MM SCRFT BS OFST HAP HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6051-1440A SUP HCPCS C1776 6051-1440A - STEM FEMORAL 14 17.2MM 170MM 40MM CEMENTLESS SECFIT HYDRXAPT BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$6,665.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$6,665.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 6051-1440S SUP HCPCS C1776 6051-1440S - STEM FEMORAL 132D 14 49MM OFFST 17.2MM 170MM 40MM NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6052-0625A SUP HCPCS C1776 6052-0625A - STEM FEMORAL 6 CEMENTLESS SECFIT HYDRXAPT HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6052-0625S SUP HCPCS C1776 6052-0625S - STEM FEMORAL 127D 6 33MM OFFST 9.6MM 120MM 25MM NECK SECFIT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6052-0730A SUP HCPCS C1776 6052-0730A - STEM FEMORAL 127D 7 30MM SECFIT MAX HA HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6052-0730S SUP HCPCS C1776 6052-0730S - STEM FEMORAL 127D 7 39MM OFFST 10.4MM 130MM 30MM NECK SECFIT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6052-0830A SUP HCPCS C1776 6052-0830A - STEM FEMORAL 8 SECFIT HYDRXAPT HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6052-0830S SUP HCPCS C1776 6052-0830S - STEM FEMORAL 127D 8 40MM OFFST 11.2MM 140MM 30MM NECK SECFIT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6052-0935A SUP HCPCS C1776 6052-0935A - STEM FEMORAL 127D 9 SECFIT HYDRXAPT HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6052-0935S SUP HCPCS C1776 6052-0935S - STEM FEMORAL 127D 9 45MM OFFST 11.9MM 150MM 35MM NECK SECFIT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6052-1035A SUP HCPCS C1776 6052-1035A - STEM FEMORAL 127D 10 SECFIT HYDRXAPT HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6052-1035S SUP HCPCS C1776 6052-1035S - STEM FEMORAL 127D 10 46MM OFFST 12.7MM 160MM 35MM NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6052-1140A SUP HCPCS C1776 6052-1140A - STEM FEMORAL 127D 11 SECFIT HYDRXAPT HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6052-1140S SUP HCPCS C1776 6052-1140S - STEM FEMORAL 127D 11 51MM OFFST 13.5MM 170MM 40MM NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6052-1240A SUP HCPCS C1776 6052-1240A - STEM FEMORAL 127D 12 CEMENTLESS SECFIT HYDRXAPT HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6052-1240S SUP HCPCS C1776 6052-1240S - STEM FEMORAL 127D 12 52MM OFFST 14.7MM 170MM 40MM NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6052-1340A SUP HCPCS C1776 6052-1340A - STEM FEMORAL 127D 13 CEMENTLESS SECFIT HYDRXAPT HIP BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$6,665.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$6,665.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 6052-1340S SUP HCPCS C1776 6052-1340S - STEM FEMORAL 127D 13 53MM OFFST 16MM 170MM 40MM NECK SECFIT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-0509A SUP HCPCS C1776 6054-0509A - STEM FEM 5 32MM OFST 9MM 110MM 25MM SCRFT + PRM HA HIP BOTH IP/OP "$6,861.00" "$5,077.00" "$1,361.74" "$6,861.00" "$3,087.45" "$3,087.45" "$3,087.45" "$3,087.45" "$6,861.00" "$6,861.00" "$6,861.00" "$1,430.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.91" "$6,861.00" "$6,861.00" "$3,382.47" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$5,145.75" "$6,861.00" "$6,861.00" "$6,861.00" "$3,430.50" "$3,430.50" "$5,433.91" "$6,861.00" "$5,488.80" "$3,087.45" "$1,361.74" N/A "$3,979.38" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.83" "$6,861.00" N/A N/A 6054-0509S SUP HCPCS C1776 6054-0509S - STEM FEM 127D 5 32MM OFST 9MM 110MM 25MM SCRFT+ MX PLSH NK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-0511A SUP HCPCS C1776 6054-0511A - STEM FEM 5 32MM OFST 11MM 110MM 25MM SCRFT + PRM HA HIP BOTH IP/OP "$6,861.00" "$5,077.00" "$1,361.74" "$6,861.00" "$3,087.45" "$3,087.45" "$3,087.45" "$3,087.45" "$6,861.00" "$6,861.00" "$6,861.00" "$1,430.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.91" "$6,861.00" "$6,861.00" "$3,382.47" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$5,145.75" "$6,861.00" "$6,861.00" "$6,861.00" "$3,430.50" "$3,430.50" "$5,433.91" "$6,861.00" "$5,488.80" "$3,087.45" "$1,361.74" N/A "$3,979.38" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.83" "$6,861.00" N/A N/A 6054-0511S SUP HCPCS C1776 6054-0511S - STEM FEM 5 11MM STRL SCRFT + HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-0610A SUP HCPCS C1776 6054-0610A - STEM FEMORAL 6 10MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,861.00" "$5,077.00" "$1,361.74" "$6,861.00" "$3,087.45" "$3,087.45" "$3,087.45" "$3,087.45" "$6,861.00" "$6,861.00" "$6,861.00" "$1,430.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.91" "$6,861.00" "$6,861.00" "$3,382.47" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$5,145.75" "$6,861.00" "$6,861.00" "$6,861.00" "$3,430.50" "$3,430.50" "$5,433.91" "$6,861.00" "$5,488.80" "$3,087.45" "$1,361.74" N/A "$3,979.38" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.83" "$6,861.00" N/A N/A 6054-0610S SUP HCPCS C1776 6054-0610S - STEM FEMORAL 127D 6 33MM OFFST 10MM 120MM 25MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-0612A SUP HCPCS C1776 6054-0612A - STEM FEMORAL 6 12MM CEMENTLESS PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,861.00" "$5,077.00" "$1,361.74" "$6,861.00" "$3,087.45" "$3,087.45" "$3,087.45" "$3,087.45" "$6,861.00" "$6,861.00" "$6,861.00" "$1,430.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.91" "$6,861.00" "$6,861.00" "$3,382.47" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$5,145.75" "$6,861.00" "$6,861.00" "$6,861.00" "$3,430.50" "$3,430.50" "$5,433.91" "$6,861.00" "$5,488.80" "$3,087.45" "$1,361.74" N/A "$3,979.38" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.83" "$6,861.00" N/A N/A 6054-0612S SUP HCPCS C1776 6054-0612S - STEM FEMORAL 127D 6 33MM OFFST 12MM 120MM 25MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-0711A SUP HCPCS C1776 6054-0711A - STEM FEMORAL 7 38.6MM 11MM 13CM 30MM PRIM SECFIT PLUS HA HIP BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$6,538.00" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6054-0711S SUP HCPCS C1776 6054-0711S - STEM FEMORAL 127D 7 39MM OFFST 11MM 130MM 30MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-0713A SUP HCPCS C1776 6054-0713A - STEM FEMORAL 7 13MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6054-0713S SUP HCPCS C1776 6054-0713S - STEM FEMORAL 127D 7 39MM OFFST 13MM 130MM 30MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-0812A SUP HCPCS C1776 6054-0812A - STEM FEMORAL 8 12MM 140MM 30MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6054-0812S SUP HCPCS C1776 6054-0812S - STEM FEMORAL 127D 8 40MM OFFST 12MM 140MM 30MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-0814A SUP HCPCS C1776 6054-0814A - STEM FEMORAL 8 SECFIT PLUS HIP BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$6,538.00" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$3,922.80" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6054-0814S SUP HCPCS C1776 6054-0814S - STEM FEMORAL 127D 8 40MM OFFST 14MM 140MM 30MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-0913A SUP HCPCS C1776 6054-0913A - STEM FEMORAL 127D 9 13MM PRIM POLISH NECK DISTAL TRISLOT BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6054-0913S SUP HCPCS C1776 6054-0913S - STEM FEMORAL 127D 9 45MM OFFST 13MM 150MM 35MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-0915A SUP HCPCS C1776 6054-0915A - STEM FEMORAL 9 PRIM CEMENTLESS SECFIT PLUS HIP BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6054-0915S SUP HCPCS C1776 6054-0915S - STEM FEMORAL 127D 9 45MM OFFST 15MM 150MM 35MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-1014A SUP HCPCS C1776 6054-1014A - STEM FEMORAL 10 14MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6054-1014S SUP HCPCS C1776 6054-1014S - STEM FEMORAL 127D 10 46MM OFFST 14MM 160MM 35MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-1016A SUP HCPCS C1776 6054-1016A - STEM FEMORAL 10 16MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6054-1016S SUP HCPCS C1776 6054-1016S - STEM FEMORAL 127D 10 46MM OFFST 16MM 160MM 35MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-1115A SUP HCPCS C1776 6054-1115A - STEM FEMORAL 11 15MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6054-1115S SUP HCPCS C1776 6054-1115S - STEM FEMORAL 127D 11 51MM OFFST 15MM 170MM 40MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-1117A SUP HCPCS C1776 6054-1117A - STEM FEMORAL 11 17MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$3,922.80" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6054-1117S SUP HCPCS C1776 6054-1117S - STEM FEMORAL 127D 11 51MM OFFST 17MM 170MM 40MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-1216S SUP HCPCS C1776 6054-1216S - STEM FEMORAL 127D 12 52MM OFFST 16MM 170MM 40MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-1218A SUP HCPCS C1776 6054-1218A - STEM FEMORAL 12 18MM CEMENTLESS PRIM SECFIT PLUS HYDRXAPT BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$6,538.00" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6054-1218S SUP HCPCS C1776 6054-1218S - STEM FEMORAL 127D 12 52MM OFFST 18MM 170MM 40MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-1317S SUP HCPCS C1776 6054-1317S - STEM FEMORAL 13 17MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-1319S SUP HCPCS C1776 6054-1319S - STEM FEMORAL 127D 13 53MM OFFST 19MM 170MM 40MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-1418S SUP HCPCS C1776 6054-1418S - STEM FEMORAL 14 18MM CEMENTLESS PRIM SECFIT PLUS HYDRXAPT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6054-1420S SUP HCPCS C1776 6054-1420S - STEM FEMORAL 127D 14 54MM OFFST 20MM 170MM 40MM POLISH NECK BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6057-0230D SUP HCPCS C1776 6057-0230D - STEM FEMORAL 127D 2 39MM OFFST 124MM 30MM CEMENTED NECK BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6057-0335D SUP HCPCS C1776 6057-0335D - STEM FEMORAL 127D 3 43MM OFFST 131MM 35MM CEMENTED NECK BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6057-0435D SUP HCPCS C1776 6057-0435D - STEM FEMORAL 127D 4 46MM OFFST 137MM 35MM CEMENTED NECK BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6057-0537D SUP HCPCS C1776 6057-0537D - STEM FEMORAL 127D 5 48MM OFFST 145MM 37MM NECK CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6057-0637D SUP HCPCS C1776 6057-0637D - STEM FEMORAL 127D 6 49MM OFFST 158MM 37MM CEMENTED NECK BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6057-0740D SUP HCPCS C1776 6057-0740D - STEM FEMORAL 127D 7 52MM OFFST 158MM 40MM CEMENTED NECK BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6057-52 SUP Custom 27203010 6057-52 - STYLET LEAD STR BALL .014IN 52CM KIT EXTENDED TAPER BLUE BOTH IP/OP $77.50 $57.00 $13.80 $77.50 $77.50 $77.50 $77.50 $77.50 $77.50 $77.50 $13.80 $77.50 $77.50 $57.52 $57.52 $59.74 $40.38 $16.15 $77.50 $31.00 $77.50 $77.50 $77.50 $77.50 $77.50 $58.13 $77.50 $77.50 $77.50 $38.75 $38.75 $61.38 $77.50 $62.00 $50.38 $77.50 N/A $44.95 $77.50 $46.50 $77.50 $77.50 $77.50 N/A N/A 6058-0230D SUP HCPCS C1776 6058-0230D - STEM FEMORAL 132D 2 35MM OFFST 124MM 30MM CEMENTED NECK BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6058-0335D SUP HCPCS C1776 6058-0335D - STEM FEMORAL 132D 3 39MM OFFST 131MM 35MM CEMENTED NECK BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6058-0435D SUP HCPCS C1776 6058-0435D - STEM FEMORAL 132D 4 42MM OFFST 137MM 35MM CEMENTED NECK BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6058-0537D SUP HCPCS C1776 6058-0537D - STEM FEMORAL 132D 5 44MM OFFST 145MM 37MM CEMENTED NECK BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6058-0637D SUP HCPCS C1776 6058-0637D - STEM FEMORAL 132D 6 45MM OFFST 158MM 37MM CEMENTED NECK BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6058-0740D SUP HCPCS C1776 6058-0740D - STEM FEMORAL 132D 4 48MM OFFST 158MM 40MM CEMENTED NECK BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 606-004-103 SUP HCPCS Q4130 606-004-103 - MATRIX TISS THK1MM SEMIOVAL 16X8CM STRL SURGIMEND PRS BOTH IP/OP "$5,760.00" "$4,262.00" "$1,200.45" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$1,200.45" "$5,760.00" "$2,304.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$5,760.00" "$4,320.00" "$5,760.00" "$5,760.00" "$5,760.00" "$2,880.00" "$2,880.00" "$4,561.92" "$5,760.00" "$4,608.00" "$2,592.00" "$5,760.00" N/A "$3,340.80" "$5,760.00" "$3,456.00" "$5,760.00" "$5,760.00" "$5,760.00" N/A N/A 60-6085-200A SUP Custom 27203010 60-6085-200A - RETRACTOR/ELEVATOR LAPSCP SM 32MM STRL LF VCARE 2 CUP LCK BOTH IP/OP $233.50 $173.00 $41.55 $233.40 $233.40 $233.40 $233.40 $233.40 $233.40 $233.40 $41.55 $233.40 $233.40 $173.23 $173.23 $179.90 $121.60 $48.64 $233.40 $93.36 $233.40 $233.40 $233.40 $233.40 $233.40 $175.13 $233.40 $233.40 $233.40 $116.70 $116.70 $184.85 $233.40 $186.72 $151.71 $233.40 N/A $135.43 $233.40 $140.04 $233.40 $233.40 $233.40 N/A N/A 60-6085-201A SUP Custom 27203010 60-6085-201A - RETRACTOR/ELEVATOR LAPSCOP MEDIUM 34MM 2 CUP LOCK SCREW HOLE BOTH IP/OP $233.50 $173.00 $41.55 $233.40 $233.40 $233.40 $233.40 $233.40 $233.40 $233.40 $41.55 $233.40 $233.40 $173.23 $173.23 $179.90 $121.60 $48.64 $233.40 $93.36 $233.40 $233.40 $233.40 $233.40 $233.40 $175.13 $233.40 $233.40 $233.40 $116.70 $116.70 $184.85 $233.40 $186.72 $151.71 $233.40 N/A $135.43 $233.40 $140.04 $233.40 $233.40 $233.40 N/A N/A 60-6085-202 SUP Custom 27203010 60-6085-202 - RETRACTOR/ELEVATOR LAPSCOP LARGE 37MM 2 CUP HOLE MANIPULATOR BOTH IP/OP $196.50 $145.00 $34.90 $209.78 $196.05 $196.05 $196.05 $196.05 $196.05 $196.05 $34.90 $196.05 $196.05 $145.51 $145.51 $151.12 $102.14 $40.86 $196.05 $83.91 $196.05 $196.05 $209.78 $196.05 $196.05 $147.38 $196.05 $196.05 $196.05 $98.03 $98.03 $155.27 $196.05 $156.84 $127.43 $196.05 N/A $113.97 $196.05 $117.63 $196.05 $196.05 $196.05 N/A N/A 606-200-004 SUP HCPCS C9360 606-200-004 - MATRIX TISSUE SURGIMEND BOVINE COLLAGEN THK2 MM RECTANGLE L1 BOTH IP/OP "$2,700.00" "$1,998.00" $535.88 "$2,700.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$2,700.00" "$2,700.00" "$2,700.00" $562.75 "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" $562.71 "$2,700.00" "$2,700.00" "$1,331.10" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,025.00" "$2,700.00" "$2,700.00" "$2,700.00" "$1,350.00" "$1,350.00" "$2,138.40" "$2,700.00" "$2,160.00" "$1,215.00" $535.88 N/A "$1,566.00" "$2,700.00" "$2,700.00" "$2,700.00" $562.68 "$2,700.00" N/A N/A 60-660-01-04 SUP HCPCS C1713 60-660-01-04 - PLATE BONE CSTM PROPHYLACTIC CRANIAL IRR BOTH IP/OP "$17,487.50" "$12,941.00" "$3,470.83" "$17,487.50" "$7,869.38" "$7,869.38" "$7,869.38" "$7,869.38" "$17,487.50" "$17,487.50" "$17,487.50" "$3,644.83" "$17,487.50" "$17,487.50" "$17,487.50" "$17,487.50" "$17,487.50" "$3,644.59" "$17,487.50" "$6,995.00" "$8,621.34" "$17,487.50" "$17,487.50" "$17,487.50" "$17,487.50" "$13,115.63" "$17,487.50" "$17,487.50" "$17,487.50" "$8,743.75" "$8,743.75" "$13,850.10" "$17,487.50" "$13,990.00" "$7,869.38" "$3,470.83" N/A "$10,142.75" "$17,487.50" "$10,492.50" "$17,487.50" "$3,644.40" "$17,487.50" N/A N/A 606S255MX SUP HCPCS C1725 606S255MX - MICROCATHETER CRBRVASC 90D 2.3-2.8FR .021IN 150CM 5CM PRWLR BOTH IP/OP "$2,175.50" "$1,610.00" $431.73 "$2,411.48" "$1,181.16" "$1,181.16" "$1,181.16" "$1,181.16" "$2,175.25" "$2,175.25" "$2,175.25" $453.38 "$2,175.25" "$1,614.47" "$1,614.47" "$1,676.68" "$1,133.31" $453.35 "$2,175.25" "$2,411.48" "$1,286.66" "$2,175.25" "$2,175.25" "$2,175.25" "$2,175.25" "$1,631.63" "$2,175.25" "$2,175.25" "$2,175.25" "$1,087.63" "$1,087.63" "$1,722.80" "$2,175.25" "$1,740.20" "$1,413.91" $431.73 N/A "$1,261.79" "$2,175.25" "$2,175.25" "$2,175.25" $453.32 "$2,175.25" N/A N/A 6070-0525A SUP Custom 27803010 6070-0525A - STEM FEMORAL 132D 5 25MM PRIM OMNIFIT HFX HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6070-0625A SUP Custom 27803010 6070-0625A - STEM FEMORAL 132D 6 30MM OFFST 120MM 25MM CEMENTED NECK BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6070-0730A SUP Custom 27803010 6070-0730A - STEM FEMORAL 132D 7 35MM OFFST 130MM 30MM CEMENTED NECK BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6070-0830A SUP Custom 27803010 6070-0830A - STEM FEMORAL 132D 8 36MM OFFST 140MM 30MM CEMENTED NECK BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6070-0935A SUP Custom 27803010 6070-0935A - STEM FEMORAL 132D 9 41MM OFFST 150MM 35MM CEMENTED NECK BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6070-1035A SUP Custom 27803010 6070-1035A - STEM FEMORAL 132D 10 35MM CEMENT OMNIFIT HFX HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6070-1140A SUP Custom 27803010 6070-1140A - STEM FEMORAL 132D 11 46MM OFFST 170MM 40MM CEMENTED NECK BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6072-0625 SUP Custom 27803010 6072-0625 - STEM FEMORAL 6 25MM CEMENTED ODC-FX HIP BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 6072-0730 SUP Custom 27803010 6072-0730 - STEM FEMORAL 7 30MM CEMENTED ODC-FX HIP BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 6072-0830 SUP Custom 27803010 6072-0830 - STEM FEMORAL 8 30MM CEMENTED ODC-FX HIP BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 6072-0935 SUP Custom 27803010 6072-0935 - STEM FEMORAL 9 35MM CEMENTED ODC-FX HIP BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 6072-1035 SUP Custom 27803010 6072-1035 - STEM FEMORAL 10 35MM CEMENTED ODC-FX HIP BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 6073-0525 SUP Custom 27803010 6073-0525 - STEM FEM ODC HIP BOTH IP/OP "$2,024.00" "$1,498.00" $360.27 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" $360.27 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" $421.82 "$2,024.00" $809.60 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$1,518.00" "$2,024.00" "$2,024.00" "$2,024.00" "$1,012.00" "$1,012.00" "$1,603.01" "$2,024.00" "$1,619.20" $910.80 "$2,024.00" N/A "$1,173.92" "$2,024.00" "$1,214.40" "$2,024.00" "$2,024.00" "$2,024.00" N/A N/A 6073-0625 SUP Custom 27803010 6073-0625 - STEM FEM ODC HIP BOTH IP/OP "$2,024.00" "$1,498.00" $360.27 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" $360.27 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" $421.82 "$2,024.00" $809.60 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$1,518.00" "$2,024.00" "$2,024.00" "$2,024.00" "$1,012.00" "$1,012.00" "$1,603.01" "$2,024.00" "$1,619.20" $910.80 "$2,024.00" N/A "$1,173.92" "$2,024.00" "$1,214.40" "$2,024.00" "$2,024.00" "$2,024.00" N/A N/A 6073-0730 SUP Custom 27803010 6073-0730 - STEM FEM ODC HIP BOTH IP/OP "$2,024.00" "$1,498.00" $360.27 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" $360.27 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" $421.82 "$2,024.00" $809.60 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$1,518.00" "$2,024.00" "$2,024.00" "$2,024.00" "$1,012.00" "$1,012.00" "$1,603.01" "$2,024.00" "$1,619.20" $910.80 "$2,024.00" N/A "$1,173.92" "$2,024.00" "$1,214.40" "$2,024.00" "$2,024.00" "$2,024.00" N/A N/A 6073-0830 SUP Custom 27803010 6073-0830 - STEM FEM ODC HIP BOTH IP/OP "$2,024.00" "$1,498.00" $360.27 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" $360.27 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" $421.82 "$2,024.00" $809.60 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$1,518.00" "$2,024.00" "$2,024.00" "$2,024.00" "$1,012.00" "$1,012.00" "$1,603.01" "$2,024.00" "$1,619.20" $910.80 "$2,024.00" N/A "$1,173.92" "$2,024.00" "$1,214.40" "$2,024.00" "$2,024.00" "$2,024.00" N/A N/A 6073-0935 SUP Custom 27803010 6073-0935 - STEM FEMORAL 9 35MM CEMENT ODC HIP BOTH IP/OP "$2,024.00" "$1,498.00" $360.27 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" $360.27 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" $421.82 "$2,024.00" $809.60 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$1,518.00" "$2,024.00" "$2,024.00" "$2,024.00" "$1,012.00" "$1,012.00" "$1,603.01" "$2,024.00" "$1,619.20" $910.80 "$2,024.00" N/A "$1,173.92" "$2,024.00" "$1,214.40" "$2,024.00" "$2,024.00" "$2,024.00" N/A N/A 6073-1035 SUP Custom 27803010 6073-1035 - STEM FEM ODC HIP BOTH IP/OP "$2,024.00" "$1,498.00" $360.27 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" $360.27 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" $421.82 "$2,024.00" $809.60 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$1,518.00" "$2,024.00" "$2,024.00" "$2,024.00" "$1,012.00" "$1,012.00" "$1,603.01" "$2,024.00" "$1,619.20" $910.80 "$2,024.00" N/A "$1,173.92" "$2,024.00" "$1,214.40" "$2,024.00" "$2,024.00" "$2,024.00" N/A N/A 6073-1140 SUP Custom 27803010 6073-1140 - STEM FEMORAL ODC HIP BOTH IP/OP "$2,024.00" "$1,498.00" $360.27 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" $360.27 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" $421.82 "$2,024.00" $809.60 "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$2,024.00" "$1,518.00" "$2,024.00" "$2,024.00" "$2,024.00" "$1,012.00" "$1,012.00" "$1,603.01" "$2,024.00" "$1,619.20" $910.80 "$2,024.00" N/A "$1,173.92" "$2,024.00" "$1,214.40" "$2,024.00" "$2,024.00" "$2,024.00" N/A N/A 6076-0525A SUP Custom 27803010 6076-0525A - STEM FEMORAL 127D 5 35MM 110MM 25MM CEMENT HFX OMNIFIT HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6076-0625A SUP Custom 27803010 6076-0625A - STEM FEMORAL 127D 6 120MM 25MM CEMENT OMNIFIT HFX HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6076-0730A SUP Custom 27803010 6076-0730A - STEM FEMORAL 7 OMNIFIT HFX HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6076-0830A SUP Custom 27803010 6076-0830A - STEM FEMORAL 127D 8 135MM 30MM CEMENT OMNIFIT HFX HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6076-0935A SUP Custom 27803010 6076-0935A - STEM FEMORAL 127D 9 140MM 35MM CEMENT OMNIFIT HFX HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6076-1035A SUP Custom 27803010 6076-1035A - STEM FEMORAL 127D 10 145MM 35MM CEMENT OMNIFIT HFX HIP BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6077-0130 SUP Custom 27803010 6077-0130 - STEM FEMORAL 127D 1 38MM OFFST 110MM 30MM CEMENTLESS NECK BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6077-0230 SUP Custom 27803010 6077-0230 - STEM FEMORAL 127D 2 39MM OFFST 115MM 30MM CEMENTLESS NECK BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6077-0335 SUP Custom 27803010 6077-0335 - STEM FEMORAL 127D 3 43MM OFFST 120MM 35MM CEMENTLESS NECK BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6077-0435 SUP Custom 27803010 6077-0435 - STEM FEMORAL 127D 4 44MM OFFST 125MM 35MM CEMENTLESS NECK BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6077-0537 SUP Custom 27803010 6077-0537 - STEM FEMORAL 127D 5 48MM OFFST 130MM 37MM CEMENTLESS NECK BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6077-0637 SUP Custom 27803010 6077-0637 - STEM FEMORAL 127D 6 49MM OFFST 135MM 37MM CEMENTLESS NECK BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6077-0740 SUP Custom 27803010 6077-0740 - STEM FEMORAL 127D 7 53MM OFFST 140MM 40MM CEMENTLESS NECK BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6077-0840 SUP Custom 27803010 6077-0840 - STEM FEMORAL 127D 8 54MM OFFST 145MM 40MM CEMENTLESS NECK BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6080-0530-200L SUP HCPCS C1776 6080-0530-200L - STEM FEMORAL 5 LONG 10.9MM 200MM 30MM CEMENTED HEAD NECK BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$10,099.38" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6080-0530-200R SUP HCPCS C1776 6080-0530-200R - STEM FEMORAL 5 LONG 12MM 200MM 30MM CEMENT OMNIFIT RIGHT HIP BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$10,099.38" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$6,059.63" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6080-0735-200L SUP HCPCS C1776 6080-0735-200L - STEM FEMORAL 7 LONG 14.5MM 200MM 35MM CEMENTED HEAD NECK BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$10,099.38" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6080-0735-200R SUP HCPCS C1776 6080-0735-200R - STEM FEMORAL 7 LONG 12.4MM 200MM 35MM CEMENTED HEAD NECK BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$4,039.75" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6080-0745-200L SUP HCPCS C1776 6080-0745-200L - STEM FEMORAL 7 LONG 12.4MM 200MM 45MM CEMENTED HEAD NECK BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$10,099.38" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6080-0745-200R SUP HCPCS C1776 6080-0745-200R - STEM FEMORAL 7 LONG 14.5MM 200MM 45MM CEMENT OMNIFIT RIGHT BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$4,039.75" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$6,059.63" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6080-0935-250L SUP HCPCS C1776 6080-0935-250L - STEM FEMORAL 9 LONG 14MM 250MM 45MM CEMENT OMNIFIT LEFT HIP BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$4,039.75" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$6,059.63" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6080-0935-250R SUP HCPCS C1776 6080-0935-250R - STEM FEMORAL 9 LONG 14MM 200MM 35MM CEMENTED HEAD/NECK BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$4,039.75" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$6,059.63" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6080-0945-250L SUP HCPCS C1776 6080-0945-250L - STEM FEMORAL 9 LONG 14MM 250MM 45MM CEMENTED HEAD/NECK BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$10,099.38" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$6,059.63" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6080-0945-250R SUP HCPCS C1776 6080-0945-250R - STEM FEMORAL 9 LONG 14MM 250MM 45MM CEMENTED HEAD/NECK BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$10,099.38" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$6,059.63" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 60-80317 SUP Custom 27203010 60-80317 - COUNTERSINK DRILL 47 AO SHAFT END BOTH IP/OP $213.50 $158.00 $37.94 $213.13 $213.13 $213.13 $213.13 $213.13 $213.13 $213.13 $37.94 $213.13 $213.13 $158.19 $158.19 $164.28 $111.04 $44.42 $213.13 $85.25 $213.13 $213.13 $213.13 $213.13 $213.13 $160.13 $213.13 $213.13 $213.13 $106.57 $106.57 $168.80 $213.13 $170.50 $138.53 $213.13 N/A $123.83 $213.13 $127.88 $213.13 $213.13 $213.13 N/A N/A 60-80323 SUP Custom 27203010 60-80323 - COUNTERSINK DRILL 2.3MM 48MM AO SHAFT END STERILE BOTH IP/OP $213.50 $158.00 $37.94 $213.13 $213.13 $213.13 $213.13 $213.13 $213.13 $213.13 $37.94 $213.13 $213.13 $158.19 $158.19 $164.28 $111.04 $44.42 $213.13 $85.25 $213.13 $213.13 $213.13 $213.13 $213.13 $160.13 $213.13 $213.13 $213.13 $106.57 $106.57 $168.80 $213.13 $170.50 $138.53 $213.13 N/A $123.83 $213.13 $127.88 $213.13 $213.13 $213.13 N/A N/A 6082-52 SUP Custom 27203010 6082-52 - STYLET LEAD .014IN 52CM KIT STR BALL TIP EXTENDED TAPER GRAY BOTH IP/OP $77.50 $57.00 $13.80 $77.50 $77.50 $77.50 $77.50 $77.50 $77.50 $77.50 $13.80 $77.50 $77.50 $57.52 $57.52 $59.74 $40.38 $16.15 $77.50 $31.00 $77.50 $77.50 $77.50 $77.50 $77.50 $58.13 $77.50 $77.50 $77.50 $38.75 $38.75 $61.38 $77.50 $62.00 $50.38 $77.50 N/A $44.95 $77.50 $46.50 $77.50 $77.50 $77.50 N/A N/A 6082-65 SUP Custom 27203010 6082-65 - KIT STY STRG XTD TPR .014IN 65CM GRY BALL TIP KNOB BOTH IP/OP $77.50 $57.00 $13.80 $77.50 $77.50 $77.50 $77.50 $77.50 $77.50 $77.50 $13.80 $77.50 $77.50 $57.52 $57.52 $59.74 $40.38 $16.15 $77.50 $31.00 $77.50 $77.50 $77.50 $77.50 $77.50 $58.13 $77.50 $77.50 $77.50 $38.75 $38.75 $61.38 $77.50 $62.00 $50.38 $77.50 N/A $44.95 $77.50 $46.50 $77.50 $77.50 $77.50 N/A N/A 6088-0525-200L SUP HCPCS C1776 6088-0525-200L - STEM FEMORAL 5 LONG 10.9MM 200MM 25MM CEMENT OMNIFIT LEFT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$4,749.00" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$7,123.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0525-200R SUP HCPCS C1776 6088-0525-200R - STEM FEMORAL 5 LONG 10.9MM 200MM 25MM CEMENT OMNIFIT RIGHT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$4,749.00" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0525-250L SUP HCPCS C1776 6088-0525-250L - STEM FEMORAL 5 LONG 10.9MM 250MM 25MM CEMENT OMNIFIT LEFT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$4,749.00" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$7,123.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0525-250R SUP HCPCS C1776 6088-0525-250R - STEM FEMORAL 5 LONG 250MM CEMENTED REVISION OMNIFIT DISTAL BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$4,749.00" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0525-300L SUP HCPCS C1776 6088-0525-300L - STEM FEMORAL 5 LONG 10.9MM 300MM 25MM CEMENT OMNIFIT LEFT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$4,749.00" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0525-300R SUP HCPCS C1776 6088-0525-300R - STEM FEMORAL 5 LONG 10.9MM 300MM 25MM CEMENT OMNIFIT RIGHT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$11,872.50" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0525-350L SUP HCPCS C1776 6088-0525-350L - TRIAL SURG LONG 10.9MM 350MM 25MM STEM CEMENTED IMPLANTS BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$10,099.38" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$6,059.63" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6088-0525-350R SUP HCPCS C1776 6088-0525-350R - STEM FEMORAL 5 LONG 10.9MM 350MM 25MM CEMENT OMNIFIT RIGHT BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$4,039.75" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6088-0730-200L SUP HCPCS C1776 6088-0730-200L - STEM FEMORAL 7 LONG 12.4MM 200MM 30MM CEMENT OMNIFIT LEFT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$4,749.00" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0730-200R SUP HCPCS C1776 6088-0730-200R - STEM FEMORAL 7 LONG 12.4MM 200MM 30MM CEMENT OMNIFIT RIGHT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$4,749.00" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0730-250L SUP HCPCS C1776 6088-0730-250L - STEM FEMORAL 7 LONG 12.4MM 250MM 30MM CEMENT OMNIFIT LEFT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$11,872.50" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$7,123.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0730-250R SUP HCPCS C1776 6088-0730-250R - STEM FEMORAL 7 LONG 12.4MM 250MM 30MM CEMENT OMNIFIT RIGHT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$11,872.50" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$7,123.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0730-300L SUP HCPCS C1776 6088-0730-300L - STEM FEMORAL 7 LONG 12.4MM 300MM 30MM CEMENT OMNIFIT LEFT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$11,872.50" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$7,123.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0730-300R SUP HCPCS C1776 6088-0730-300R - STEM FEMORAL 7 LONG 12.4MM 300MM 30MM CEMENT OMNIFIT RIGHT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$11,872.50" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$7,123.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0730-350L SUP HCPCS C1776 6088-0730-350L - STEM FEMORAL 7 LONG 12.4MM 350MM 30MM CEMENT OMNIFIT LEFT BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$10,099.38" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$6,059.63" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6088-0730-350R SUP HCPCS C1776 6088-0730-350R - STEM FEMORAL LONG 12.4MM 350MM 30MM CEMENT OMNIFIT HIP BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$4,039.75" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$6,059.63" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6088-0935-200L SUP HCPCS C1776 6088-0935-200L - STEM FEMORAL 9 LONG 14MM 200MM 35MM CEMENT OMNIFIT LEFT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$4,749.00" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0935-200R SUP HCPCS C1776 6088-0935-200R - STEM FEM 200MM 14MM REV CMNT NECK TRL OMFT 9 LNG 35MM HIP BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$4,749.00" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$7,123.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0935-250L SUP HCPCS C1776 6088-0935-250L - STEM FEMORAL 9 LONG 14MM 250MM 35MM CEMENT OMNIFIT LEFT HIP BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$4,749.00" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$7,123.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0935-250R SUP HCPCS C1776 6088-0935-250R - STEM FEMORAL 9 LONG 14MM 250MM 35MM CEMENT OMNIFIT HIP RIGHT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$11,872.50" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$7,123.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0935-300L SUP HCPCS C1776 6088-0935-300L - STEM FEMORAL 9 LONG 14MM 300MM 35MM CEMENT OMNIFIT LEFT HIP BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$11,872.50" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$7,123.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0935-300R SUP HCPCS C1776 6088-0935-300R - STEM FEMORAL 9 LONG 14MM 300MM 35MM CEMENT OMNIFIT RIGHT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$11,872.50" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-0935-350L SUP HCPCS C1776 6088-0935-350L - STEM FEMORAL 9 LONG 14MM 350MM 35MM CEMENT OMNIFIT LEFT HIP BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$10,099.38" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$6,059.63" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6088-0935-350R SUP HCPCS C1776 6088-0935-350R - STEM FEMORAL 9 LONG 14MM 350MM 35MM CEMENT OMNIFIT RIGHT HIP BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$10,099.38" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$6,059.63" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6088-1140-200L SUP HCPCS C1776 6088-1140-200L - STEM FEMORAL 11 LONG 15.5MM 200MM 40MM CEMENT OMNIFIT LEFT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$11,872.50" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-1140-200R SUP HCPCS C1776 6088-1140-200R - STEM FEMORAL 11 LONG 15.5MM 200MM 40MM CEMENT OMNIFIT RIGHT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$11,872.50" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-1140-250L SUP HCPCS C1776 6088-1140-250L - STEM FEMORAL 11 LONG 15.5MM 250MM 40MM CEMENT OMNIFIT LEFT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$11,872.50" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$7,123.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-1140-250R SUP HCPCS C1776 6088-1140-250R - STEM FEMORAL 11 LONG 15.5MM 250MM 40MM CEMENT OMNIFIT RIGHT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$11,872.50" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-1140-300L SUP HCPCS C1776 6088-1140-300L - STEM FEMORAL 11 LONG 15.5MM 300MM 40MM CEMENT OMNIFIT LEFT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$11,872.50" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-1140-300R SUP HCPCS C1776 6088-1140-300R - STEM FEMORAL 11 LONG 15.5MM 300MM 40MM CEMENT OMNIFIT RIGHT BOTH IP/OP "$11,872.50" "$8,786.00" "$2,356.39" "$11,872.50" "$5,342.63" "$5,342.63" "$5,342.63" "$5,342.63" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.53" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.36" "$11,872.50" "$11,872.50" "$5,853.14" "$11,872.50" "$11,872.50" "$11,872.50" "$11,872.50" "$8,904.38" "$11,872.50" "$11,872.50" "$11,872.50" "$5,936.25" "$5,936.25" "$9,403.02" "$11,872.50" "$9,498.00" "$5,342.63" "$2,356.39" N/A "$6,886.05" "$11,872.50" "$11,872.50" "$11,872.50" "$2,474.23" "$11,872.50" N/A N/A 6088-1140-350L SUP HCPCS C1776 6088-1140-350L - STEM FEMORAL 11 LONG 15.5MM 350MM 40MM CEMENT OMNIFIT LEFT BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$10,099.38" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$6,059.63" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 6088-1140-350R SUP HCPCS C1776 6088-1140-350R - STEM FEMORAL 11 LONG 15.5MM 350MM 40MM CEMENT OMNIFIT RIGHT BOTH IP/OP "$10,099.50" "$7,474.00" "$2,004.47" "$10,099.38" "$4,544.72" "$4,544.72" "$4,544.72" "$4,544.72" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.96" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.82" "$10,099.38" "$10,099.38" "$4,978.99" "$10,099.38" "$10,099.38" "$10,099.38" "$10,099.38" "$7,574.63" "$10,099.38" "$10,099.38" "$10,099.38" "$5,049.69" "$5,049.69" "$7,998.71" "$10,099.38" "$8,079.50" "$4,544.72" "$2,004.47" N/A "$5,857.71" "$10,099.38" "$10,099.38" "$10,099.38" "$2,104.71" "$10,099.38" N/A N/A 60-94120 SUP HCPCS C1713 60-94120 - COUNTERSINK DRILL BICONCAVE WASHER BOTH IP/OP $436.00 $323.00 $86.47 $435.68 $196.06 $196.06 $196.06 $196.06 $435.68 $435.68 $435.68 $90.81 $435.68 $435.68 $435.68 $435.68 $435.68 $90.80 $435.68 $174.27 $257.70 $435.68 $435.68 $435.68 $435.68 $327.00 $435.68 $435.68 $435.68 $217.84 $217.84 $345.06 $435.68 $348.54 $196.06 $86.47 N/A $252.88 $435.68 $261.41 $435.68 $90.80 $435.68 N/A N/A 6097-0425 SUP HCPCS C1776 6097-0425 - STEM FEMORAL 127D 4 33MM OFFST 8.1MM 100MM 25MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6097-0530 SUP HCPCS C1776 6097-0530 - STEM FEMORAL 127D 5 39MM OFFST 8.9MM 110MM 30MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6097-0630 SUP HCPCS C1776 6097-0630 - STEM FEMORAL 127D 6 40MM OFFST 9.6MM 120MM 30MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6097-0735 SUP HCPCS C1776 6097-0735 - STEM FEMORAL 127D 7 45MM OFFST 10.4MM 130MM 35MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$2,590.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6097-0835 SUP HCPCS C1776 6097-0835 - STEM FEMORAL 127D 8 46MM OFFST 11.3MM 135MM 35MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6097-0940 SUP HCPCS C1776 6097-0940 - STEM FEMORAL 127D 9 51MM OFFST 12.6MM 140MM 40MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6097-1040 SUP HCPCS C1776 6097-1040 - STEM FEMORAL 127D 10 52MM OFFST 13.8MM 145MM 40MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6097-1140 SUP HCPCS C1776 6097-1140 - STEM FEMORAL 127D 11 53MM OFFST 14.8MM 150MM 40MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6098-0425 SUP HCPCS C1776 6098-0425 - STEM FEMORAL 132D 4 29MM OFFST 8.1MM 100MM 25MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6098-0530 SUP HCPCS C1776 6098-0530 - STEM FEMORAL 132D 5 35MM OFFST 8.9MM 110MM 30MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6098-0630 SUP HCPCS C1776 6098-0630 - STEM FEMORAL 132D 6 36MM OFFST 9.6MM 120MM 30MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6098-0735 SUP HCPCS C1776 6098-0735 - STEM FEMORAL 132D 7 41MM OFFST 10.4MM 130MM 35MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6098-0835 SUP HCPCS C1776 6098-0835 - STEM FEMORAL 132D 8 42MM OFFST 11.3MM 135MM 35MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$1,727.00" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6098-0940 SUP HCPCS C1776 6098-0940 - STEM FEMORAL 132D 9 46MM OFFST 12.6MM 140MM 40MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6098-1040 SUP HCPCS C1776 6098-1040 - STEM FEMORAL 132D 10 47MM OFFST 13.8MM 145MM 40MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 6098-1140 SUP HCPCS C1776 6098-1140 - STEM FEMORAL 132D 11 48MM OFFST 14.8MM 150MM 40MM CEMENTED BOTH IP/OP "$4,317.50" "$3,195.00" $856.92 "$4,317.50" "$1,942.88" "$1,942.88" "$1,942.88" "$1,942.88" "$4,317.50" "$4,317.50" "$4,317.50" $899.87 "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" $899.81 "$4,317.50" "$4,317.50" "$2,128.53" "$4,317.50" "$4,317.50" "$4,317.50" "$4,317.50" "$3,238.13" "$4,317.50" "$4,317.50" "$4,317.50" "$2,158.75" "$2,158.75" "$3,419.46" "$4,317.50" "$3,454.00" "$1,942.88" $856.92 N/A "$2,504.15" "$4,317.50" "$4,317.50" "$4,317.50" $899.77 "$4,317.50" N/A N/A 60XLTCD SUP Custom 27203010 60XLTCD - TUBE TRCH 38MM 49MM 11MM 6MM 95MM STRL LF 8MM SHLY XLT CUF BOTH IP/OP $160.00 $118.00 $28.42 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $28.42 $159.65 $159.65 $118.49 $118.49 $123.06 $83.18 $33.27 $159.65 $63.86 $159.65 $159.65 $159.65 $159.65 $159.65 $120.00 $159.65 $159.65 $159.65 $79.83 $79.83 $126.44 $159.65 $127.72 $103.77 $159.65 N/A $92.80 $159.65 $95.79 $159.65 $159.65 $159.65 N/A N/A 60XLTCP SUP HCPCS A7520 60XLTCP - TUBE TRCH 38MM 34MM 11MM 6MM 95MM STRL LF 23MM SHLY XLT CUF BOTH IP/OP $160.00 $118.00 $33.27 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $33.95 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $33.27 $159.65 $63.86 $159.65 $159.65 $159.65 $159.65 $159.65 $120.00 $159.65 $159.65 $159.65 $79.83 $79.83 $126.44 $159.65 $127.72 $71.84 $159.65 N/A $92.80 $159.65 $95.79 $159.65 $159.65 $159.65 N/A N/A 60XLTUD SUP Custom 27203010 60XLTUD - TUBE TRCH 38MM 49MM 11MM 6MM 95MM STRL LF 8MM SHLY XLT CUFLS BOTH IP/OP $160.00 $118.00 $28.42 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $28.42 $159.65 $159.65 $118.49 $118.49 $123.06 $83.18 $33.27 $159.65 $63.86 $159.65 $159.65 $159.65 $159.65 $159.65 $120.00 $159.65 $159.65 $159.65 $79.83 $79.83 $126.44 $159.65 $127.72 $103.77 $159.65 N/A $92.80 $159.65 $95.79 $159.65 $159.65 $159.65 N/A N/A 60XLTUP SUP Custom 27203010 60XLTUP - TUBE TRCH 38MM 34MM 11MM 6MM 95MM STRL LF 23MM SHLY XLT BOTH IP/OP $160.00 $118.00 $28.42 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $28.42 $159.65 $159.65 $118.49 $118.49 $123.06 $83.18 $33.27 $159.65 $63.86 $159.65 $159.65 $159.65 $159.65 $159.65 $120.00 $159.65 $159.65 $159.65 $79.83 $79.83 $126.44 $159.65 $127.72 $103.77 $159.65 N/A $92.80 $159.65 $95.79 $159.65 $159.65 $159.65 N/A N/A 61.231.017 SUP HCPCS C1713 61.231.017 - GRAPHIC CASE FOR 4.5MM VA-LCP INSTRUMENT AND SCREW SET BOTH IP/OP "$4,703.50" "$3,481.00" $933.52 "$4,783.40" "$2,116.55" "$2,116.55" "$2,116.55" "$2,116.55" "$4,703.45" "$4,703.45" "$4,703.45" $980.32 "$4,703.45" "$4,703.45" "$4,703.45" "$4,703.45" "$4,703.45" $980.25 "$4,703.45" "$4,783.40" "$2,318.80" "$4,703.45" "$4,783.40" "$4,703.45" "$4,703.45" "$3,527.63" "$4,703.45" "$4,703.45" "$4,703.45" "$2,351.73" "$2,351.73" "$3,725.13" "$4,703.45" "$3,762.76" "$2,116.55" $933.52 N/A "$2,728.03" "$4,703.45" "$2,822.07" "$4,703.45" $980.20 "$4,703.45" N/A N/A 611.105.01S SUP Custom 27803010 611.105.01S - CABLE ORTHOPEDIC 1.7MM 750MM TITANIUM CRIMP CERCLAGE COCR BOTH IP/OP $921.00 $682.00 $163.89 $936.38 $920.73 $920.73 $920.73 $920.73 $920.73 $920.73 $163.89 $920.73 $920.73 $920.73 $920.73 $920.73 $920.73 $191.89 $920.73 $374.55 $920.73 $920.73 $936.38 $920.73 $920.73 $690.75 $920.73 $920.73 $920.73 $460.37 $460.37 $729.22 $920.73 $736.58 $414.33 $920.73 N/A $534.18 $920.73 $552.44 $920.73 $920.73 $920.73 N/A N/A 61114V SUP Custom 27203010 61114V - CLIP INTNL LG SMTR VESOLOCK BOTH IP/OP $62.50 $46.00 $11.11 $62.41 $62.41 $62.41 $62.41 $62.41 $62.41 $62.41 $11.11 $62.41 $62.41 $46.32 $46.32 $48.11 $32.52 $13.01 $62.41 $24.96 $62.41 $62.41 $62.41 $62.41 $62.41 $46.88 $62.41 $62.41 $62.41 $31.21 $31.21 $49.43 $62.41 $49.93 $40.57 $62.41 N/A $36.25 $62.41 $37.45 $62.41 $62.41 $62.41 N/A N/A 6-1221 SUP Custom 27803010 6-1221 - CAGE SPNL 12MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF BOTH IP/OP "$8,031.50" "$5,943.00" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,673.80" "$8,031.25" "$3,212.50" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$6,023.63" "$8,031.25" "$8,031.25" "$8,031.25" "$4,015.63" "$4,015.63" "$6,360.75" "$8,031.25" "$6,425.00" "$3,614.06" "$8,031.25" N/A "$4,658.27" "$8,031.25" "$4,818.75" "$8,031.25" "$8,031.25" "$8,031.25" N/A N/A 61-2244 SUP Custom 27803010 61-2244 - CUP ACETAB 44MM 22MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2248 SUP Custom 27803010 61-2248 - CUP ACETAB 48MM 22MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2252 SUP Custom 27803010 61-2252 - CUP ACETAB 52MM 22MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2256 SUP Custom 27803010 61-2256 - CUP ACETAB 56MM 22MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 6-1226 SUP Custom 27803010 6-1226 - CAGE SPNL 12MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF BOTH IP/OP "$8,031.50" "$5,943.00" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,673.80" "$8,031.25" "$3,212.50" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$6,023.63" "$8,031.25" "$8,031.25" "$8,031.25" "$4,015.63" "$4,015.63" "$6,360.75" "$8,031.25" "$6,425.00" "$3,614.06" "$8,031.25" N/A "$4,658.27" "$8,031.25" "$4,818.75" "$8,031.25" "$8,031.25" "$8,031.25" N/A N/A 61-2261 SUP Custom 27803010 61-2261 - CUP ACETAB 61MM 22MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2644 SUP Custom 27803010 61-2644 - CUP ACETAB 44MM 26MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2646 SUP Custom 27803010 61-2646 - CUP ACETAB 46MM 26MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2648 SUP Custom 27803010 61-2648 - CUP ACETAB 48MM 26MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2652 SUP Custom 27803010 61-2652 - CUP ACETAB 52MM 26MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2656 SUP Custom 27803010 61-2656 - CUP ACETAB 56MM 26MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2658 SUP Custom 27803010 61-2658 - CUP ACETAB 58MM 26MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2661 SUP Custom 27803010 61-2661 - CUP ACETAB 61MM 26MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2844 SUP Custom 27803010 61-2844 - CUP ACETAB 44MM 28MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2846 SUP Custom 27803010 61-2846 - CUP ACETAB 46MM 28MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2848 SUP Custom 27803010 61-2848 - CUP ACETAB 48MM 28MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2850 SUP Custom 27803010 61-2850 - CUP ACETAB 50MM 28MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2852 SUP Custom 27803010 61-2852 - CUP ACETAB 52MM 28MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2854 SUP Custom 27803010 61-2854 - CUP ACETAB 54MM 28MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2856 SUP Custom 27803010 61-2856 - CUP ACETAB 56MM 28MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2858 SUP Custom 27803010 61-2858 - CUP ACETAB 58MM 28MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-2861 SUP Custom 27803010 61-2861 - CUP ACETAB 61MM 28MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 613.03.01S SUP HCPCS C1713 613.03.01S - CEMENT BONE PUTTY NORIAN CRS FAST SET 3ML STERILE BOTH IP/OP "$2,151.00" "$1,592.00" $426.92 "$2,151.00" $967.95 $967.95 $967.95 $967.95 "$2,151.00" "$2,151.00" "$2,151.00" $448.32 "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" $448.29 "$2,151.00" $860.40 "$1,272.32" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$1,613.25" "$2,151.00" "$2,151.00" "$2,151.00" "$1,075.50" "$1,075.50" "$1,703.59" "$2,151.00" "$1,720.80" $967.95 $426.92 N/A "$1,247.58" "$2,151.00" "$1,290.60" "$2,151.00" "$2,151.00" "$2,151.00" N/A N/A 613.05.01S SUP HCPCS C1713 613.05.01S - CEMENT BONE PUTTY NORIAN CRS FAST SET 5ML STERILE BOTH IP/OP "$3,532.50" "$2,614.00" $701.11 "$3,532.50" "$1,589.63" "$1,589.63" "$1,589.63" "$1,589.63" "$3,532.50" "$3,532.50" "$3,532.50" $736.26 "$3,532.50" "$3,532.50" "$3,532.50" "$3,532.50" "$3,532.50" $736.21 "$3,532.50" "$1,413.00" "$1,741.52" "$3,532.50" "$3,532.50" "$3,532.50" "$3,532.50" "$2,649.38" "$3,532.50" "$3,532.50" "$3,532.50" "$1,766.25" "$1,766.25" "$2,797.74" "$3,532.50" "$2,826.00" "$1,589.63" $701.11 N/A "$2,048.85" "$3,532.50" "$2,119.50" "$3,532.50" "$3,532.50" "$3,532.50" N/A N/A 613.10.01S SUP HCPCS C1713 613.10.01S - CEMENT BONE PUTTY NORIAN CRS FAST SET CALCIUM PHOSPHATE BOTH IP/OP "$6,946.00" "$5,140.00" "$1,378.56" "$6,945.75" "$3,125.59" "$3,125.59" "$3,125.59" "$3,125.59" "$6,945.75" "$6,945.75" "$6,945.75" "$1,447.67" "$6,945.75" "$6,945.75" "$6,945.75" "$6,945.75" "$6,945.75" "$1,447.57" "$6,945.75" "$2,778.30" "$3,424.25" "$6,945.75" "$6,945.75" "$6,945.75" "$6,945.75" "$5,209.50" "$6,945.75" "$6,945.75" "$6,945.75" "$3,472.88" "$3,472.88" "$5,501.03" "$6,945.75" "$5,556.60" "$3,125.59" "$1,378.56" N/A "$4,028.68" "$6,945.75" "$4,167.45" "$6,945.75" "$1,447.49" "$6,945.75" N/A N/A 613.15.01S SUP HCPCS C1713 613.15.01S - CEMENT BONE PUTTY NORIAN CRS FAST SET 15ML STERILE BOTH IP/OP "$10,195.00" "$7,544.00" "$2,023.40" "$10,194.75" "$4,587.64" "$4,587.64" "$4,587.64" "$4,587.64" "$10,194.75" "$10,194.75" "$10,194.75" "$2,124.84" "$10,194.75" "$10,194.75" "$10,194.75" "$10,194.75" "$10,194.75" "$2,124.70" "$10,194.75" "$4,077.90" "$5,026.01" "$10,194.75" "$10,194.75" "$10,194.75" "$10,194.75" "$7,646.25" "$10,194.75" "$10,194.75" "$10,194.75" "$5,097.38" "$5,097.38" "$8,074.24" "$10,194.75" "$8,155.80" "$4,587.64" "$2,023.40" N/A "$5,913.10" "$10,194.75" "$6,116.85" "$10,194.75" "$2,124.59" "$10,194.75" N/A N/A 61-3248 SUP Custom 27803010 61-3248 - CUP ACETAB 48MM 32MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-3252 SUP Custom 27803010 61-3252 - CUP ACETAB 52MM 32MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-3254 SUP Custom 27803010 61-3254 - CUP ACETAB 54MM 32MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-3256 SUP Custom 27803010 61-3256 - CUP ACETAB 56MM 32MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-3258 SUP Custom 27803010 61-3258 - CUP ACETAB 58MM 32MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 61-3261 SUP Custom 27803010 61-3261 - CUP ACETAB 61MM 32MM CEMENTED UHMWPE HIP BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 614.03.01S SUP HCPCS C1713 614.03.01S - CEMENT BONE ROTATORY MIX NORIAN CRS 3ML STERILE ROTARY MIXER BOTH IP/OP "$2,151.00" "$1,592.00" $426.92 "$2,151.00" $967.95 $967.95 $967.95 $967.95 "$2,151.00" "$2,151.00" "$2,151.00" $448.32 "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" $448.29 "$2,151.00" $860.40 "$1,272.32" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$1,613.25" "$2,151.00" "$2,151.00" "$2,151.00" "$1,075.50" "$1,075.50" "$1,703.59" "$2,151.00" "$1,720.80" $967.95 $426.92 N/A "$1,247.58" "$2,151.00" "$1,290.60" "$2,151.00" $448.27 "$2,151.00" N/A N/A 614.05.01S SUP HCPCS C1713 614.05.01S - CEMENT BONE ROTATORY MIX NORIAN CRS 5ML STERILE ROTARY MIXER BOTH IP/OP "$3,532.50" "$2,614.00" $701.11 "$3,532.50" "$1,589.63" "$1,589.63" "$1,589.63" "$1,589.63" "$3,532.50" "$3,532.50" "$3,532.50" $736.26 "$3,532.50" "$3,532.50" "$3,532.50" "$3,532.50" "$3,532.50" $736.21 "$3,532.50" "$1,413.00" "$1,741.52" "$3,532.50" "$3,532.50" "$3,532.50" "$3,532.50" "$2,649.38" "$3,532.50" "$3,532.50" "$3,532.50" "$1,766.25" "$1,766.25" "$2,797.74" "$3,532.50" "$2,826.00" "$1,589.63" $701.11 N/A "$2,048.85" "$3,532.50" "$2,119.50" "$3,532.50" "$3,532.50" "$3,532.50" N/A N/A 614.10.01S SUP HCPCS C1713 614.10.01S - CEMENT BONE ROTATORY MIX NORIAN CRS 10ML STERILE ROTARY BOTH IP/OP "$6,946.00" "$5,140.00" "$1,378.56" "$6,945.75" "$3,125.59" "$3,125.59" "$3,125.59" "$3,125.59" "$6,945.75" "$6,945.75" "$6,945.75" "$1,447.67" "$6,945.75" "$6,945.75" "$6,945.75" "$6,945.75" "$6,945.75" "$1,447.57" "$6,945.75" "$2,778.30" "$3,424.25" "$6,945.75" "$6,945.75" "$6,945.75" "$6,945.75" "$5,209.50" "$6,945.75" "$6,945.75" "$6,945.75" "$3,472.88" "$3,472.88" "$5,501.03" "$6,945.75" "$5,556.60" "$3,125.59" "$1,378.56" N/A "$4,028.68" "$6,945.75" "$4,167.45" "$6,945.75" "$6,945.75" "$6,945.75" N/A N/A 6-1421 SUP Custom 27803010 6-1421 - CAGE SPNL 14MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF BOTH IP/OP "$8,031.50" "$5,943.00" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,673.80" "$8,031.25" "$3,212.50" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$6,023.63" "$8,031.25" "$8,031.25" "$8,031.25" "$4,015.63" "$4,015.63" "$6,360.75" "$8,031.25" "$6,425.00" "$3,614.06" "$8,031.25" N/A "$4,658.27" "$8,031.25" "$4,818.75" "$8,031.25" "$8,031.25" "$8,031.25" N/A N/A 6-1426 SUP Custom 27803010 6-1426 - CAGE SPNL 14MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF BOTH IP/OP "$8,031.50" "$5,943.00" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,673.80" "$8,031.25" "$3,212.50" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$6,023.63" "$8,031.25" "$8,031.25" "$8,031.25" "$4,015.63" "$4,015.63" "$6,360.75" "$8,031.25" "$6,425.00" "$3,614.06" "$8,031.25" N/A "$4,658.27" "$8,031.25" "$4,818.75" "$8,031.25" "$8,031.25" "$8,031.25" N/A N/A 615-02 SUP Custom 27203010 615-02 - BIT DRILL 1.5MM 16MM HALL BOTH IP/OP $268.00 $198.00 $47.66 $267.75 $267.75 $267.75 $267.75 $267.75 $267.75 $267.75 $47.66 $267.75 $267.75 $198.72 $198.72 $206.38 $139.50 $55.80 $267.75 $107.10 $267.75 $267.75 $267.75 $267.75 $267.75 $201.00 $267.75 $267.75 $267.75 $133.88 $133.88 $212.06 $267.75 $214.20 $174.04 $267.75 N/A $155.44 $267.75 $160.65 $267.75 $267.75 $267.75 N/A N/A 6154-50-32 SUP HCPCS C1776 6154-50-32 - LINER ACETAB TRLG STD 6.3MM 50/52/54MM 32MM TIV BOTH IP/OP "$7,425.00" "$5,495.00" "$1,473.68" "$7,425.00" "$3,341.25" "$3,341.25" "$3,341.25" "$3,341.25" "$7,425.00" "$7,425.00" "$7,425.00" "$1,547.56" "$7,425.00" "$7,425.00" "$7,425.00" "$7,425.00" "$7,425.00" "$1,547.45" "$7,425.00" "$7,425.00" "$3,660.53" "$7,425.00" "$7,425.00" "$7,425.00" "$7,425.00" "$5,568.75" "$7,425.00" "$7,425.00" "$7,425.00" "$3,712.50" "$3,712.50" "$5,880.60" "$7,425.00" "$5,940.00" "$3,341.25" "$1,473.68" N/A "$4,306.50" "$7,425.00" "$7,425.00" "$7,425.00" "$1,547.37" "$7,425.00" N/A N/A 6-1626 SUP Custom 27803010 6-1626 - CAGE SPNL 16MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF BOTH IP/OP "$8,031.50" "$5,943.00" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,673.80" "$8,031.25" "$3,212.50" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$6,023.63" "$8,031.25" "$8,031.25" "$8,031.25" "$4,015.63" "$4,015.63" "$6,360.75" "$8,031.25" "$6,425.00" "$3,614.06" "$8,031.25" N/A "$4,658.27" "$8,031.25" "$4,818.75" "$8,031.25" "$8,031.25" "$8,031.25" N/A N/A 617-03 SUP Custom 27203010 617-03 - BIT DRILL LONG 1.7MM 25MM CLOWARD BURGUARD STOP HALL HALL BOTH IP/OP $274.50 $203.00 $48.80 $274.13 $274.13 $274.13 $274.13 $274.13 $274.13 $274.13 $48.80 $274.13 $274.13 $203.46 $203.46 $211.30 $142.82 $57.13 $274.13 $109.65 $274.13 $274.13 $274.13 $274.13 $274.13 $205.88 $274.13 $274.13 $274.13 $137.07 $137.07 $217.11 $274.13 $219.30 $178.18 $274.13 N/A $159.21 $274.13 $164.48 $274.13 $274.13 $274.13 N/A N/A 617-12 SUP Custom 27203010 617-12 - BIT DRILL 4.5MM STOP 1.7MM 4MM TIMESH BOTH IP/OP $268.00 $198.00 $47.66 $267.75 $267.75 $267.75 $267.75 $267.75 $267.75 $267.75 $47.66 $267.75 $267.75 $198.72 $198.72 $206.38 $139.50 $55.80 $267.75 $107.10 $267.75 $267.75 $267.75 $267.75 $267.75 $201.00 $267.75 $267.75 $267.75 $133.88 $133.88 $212.06 $267.75 $214.20 $174.04 $267.75 N/A $155.44 $267.75 $160.65 $267.75 $267.75 $267.75 N/A N/A 6-1821 SUP Custom 27803010 6-1821 - CAGE SPNL 18MM 21MM RYTFC UNT THRD CNCT TI PLIF TLIF BOTH IP/OP "$8,031.50" "$5,943.00" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,673.80" "$8,031.25" "$3,212.50" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$6,023.63" "$8,031.25" "$8,031.25" "$8,031.25" "$4,015.63" "$4,015.63" "$6,360.75" "$8,031.25" "$6,425.00" "$3,614.06" "$8,031.25" N/A "$4,658.27" "$8,031.25" "$4,818.75" "$8,031.25" "$8,031.25" "$8,031.25" N/A N/A 6-1826 SUP Custom 27803010 6-1826 - CAGE SPNL 18MM 26MM RYTFC UNT THRD CNCT TI PLIF TLIF BOTH IP/OP "$8,031.50" "$5,943.00" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,429.56" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$1,673.80" "$8,031.25" "$3,212.50" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$8,031.25" "$6,023.63" "$8,031.25" "$8,031.25" "$8,031.25" "$4,015.63" "$4,015.63" "$6,360.75" "$8,031.25" "$6,425.00" "$3,614.06" "$8,031.25" N/A "$4,658.27" "$8,031.25" "$4,818.75" "$8,031.25" "$8,031.25" "$8,031.25" N/A N/A 6183-2-006 SUP HCPCS C1762 6183-2-006 - SPACER ALGRF 6MM ALLOCRAFT C DBM ACDF BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 6183-2-007 SUP HCPCS C1762 6183-2-007 - SPACER ALGRF 7MM ALLOCRAFT C DBM ACDF BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 6183-2-008 SUP Custom 27803010 6183-2-008 - SPACER ALGRF 8MM ALLOCRAFT C DBM ACDF BOTH IP/OP "$6,675.00" "$4,940.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$6,675.00" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$6,675.00" "$6,675.00" N/A N/A 6183-3-006 SUP HCPCS C1762 6183-3-006 - GRAFT BONE 6MM ALLOCRAFT CERV BOTH IP/OP "$2,626.00" "$1,943.00" $521.13 "$2,625.68" "$1,181.56" "$1,181.56" "$1,181.56" "$1,181.56" "$2,625.68" "$2,625.68" "$2,625.68" $547.26 "$2,625.68" "$2,625.68" "$2,625.68" "$2,625.68" "$2,625.68" $547.22 "$2,625.68" "$2,625.68" "$1,294.46" "$2,625.68" "$2,625.68" "$2,625.68" "$2,625.68" "$1,969.50" "$2,625.68" "$2,625.68" "$2,625.68" "$1,312.84" "$1,312.84" "$2,079.54" "$2,625.68" "$2,100.54" "$1,181.56" $521.13 N/A "$1,523.08" "$2,625.68" "$2,625.68" "$2,625.68" $547.19 "$2,625.68" N/A N/A 6183-3-007 SUP HCPCS C1762 6183-3-007 - GRAFT BONE 7MM ALLOCRAFT CERV BOTH IP/OP "$2,626.00" "$1,943.00" $521.13 "$2,625.68" "$1,181.56" "$1,181.56" "$1,181.56" "$1,181.56" "$2,625.68" "$2,625.68" "$2,625.68" $547.26 "$2,625.68" "$2,625.68" "$2,625.68" "$2,625.68" "$2,625.68" $547.22 "$2,625.68" "$2,625.68" "$1,294.46" "$2,625.68" "$2,625.68" "$2,625.68" "$2,625.68" "$1,969.50" "$2,625.68" "$2,625.68" "$2,625.68" "$1,312.84" "$1,312.84" "$2,079.54" "$2,625.68" "$2,100.54" "$1,181.56" $521.13 N/A "$1,523.08" "$2,625.68" "$2,625.68" "$2,625.68" $547.19 "$2,625.68" N/A N/A 6183-3-008 SUP HCPCS C1762 6183-3-008 - SPACER ALLOGRAFT 8MM C RING ACDF BOTH IP/OP "$2,626.00" "$1,943.00" $521.13 "$2,625.68" "$1,181.56" "$1,181.56" "$1,181.56" "$1,181.56" "$2,625.68" "$2,625.68" "$2,625.68" $547.26 "$2,625.68" "$2,625.68" "$2,625.68" "$2,625.68" "$2,625.68" $547.22 "$2,625.68" "$2,625.68" "$1,294.46" "$2,625.68" "$2,625.68" "$2,625.68" "$2,625.68" "$1,969.50" "$2,625.68" "$2,625.68" "$2,625.68" "$1,312.84" "$1,312.84" "$2,079.54" "$2,625.68" "$2,100.54" "$1,181.56" $521.13 N/A "$1,523.08" "$2,625.68" "$2,625.68" "$2,625.68" $547.19 "$2,625.68" N/A N/A 6183-3-010 SUP HCPCS C1762 6183-3-010 - GRAFT BONE 10MM SPACER ANTERIOR CERV INTERBODY FUSION C-RING BOTH IP/OP "$2,626.00" "$1,943.00" $521.13 "$2,625.68" "$1,181.56" "$1,181.56" "$1,181.56" "$1,181.56" "$2,625.68" "$2,625.68" "$2,625.68" $547.26 "$2,625.68" "$2,625.68" "$2,625.68" "$2,625.68" "$2,625.68" $547.22 "$2,625.68" "$2,625.68" "$1,294.46" "$2,625.68" "$2,625.68" "$2,625.68" "$2,625.68" "$1,969.50" "$2,625.68" "$2,625.68" "$2,625.68" "$1,312.84" "$1,312.84" "$2,079.54" "$2,625.68" "$2,100.54" "$1,181.56" $521.13 N/A "$1,523.08" "$2,625.68" "$2,625.68" "$2,625.68" $547.19 "$2,625.68" N/A N/A 6183-4-006 SUP HCPCS C1762 6183-4-006 - GRAFT BONE 6MM ALLOCRAFT CERV BOTH IP/OP "$3,535.00" "$2,616.00" $701.53 "$3,534.58" "$1,590.56" "$1,590.56" "$1,590.56" "$1,590.56" "$3,534.58" "$3,534.58" "$3,534.58" $736.69 "$3,534.58" "$3,534.58" "$3,534.58" "$3,534.58" "$3,534.58" $736.65 "$3,534.58" "$3,534.58" "$1,742.55" "$3,534.58" "$3,534.58" "$3,534.58" "$3,534.58" "$2,651.25" "$3,534.58" "$3,534.58" "$3,534.58" "$1,767.29" "$1,767.29" "$2,799.39" "$3,534.58" "$2,827.66" "$1,590.56" $701.53 N/A "$2,050.30" "$3,534.58" "$3,534.58" "$3,534.58" $736.61 "$3,534.58" N/A N/A 6183-4-007 SUP HCPCS C1762 6183-4-007 - GRAFT BONE 7MM ALLOCRAFT CERV BOTH IP/OP "$3,535.00" "$2,616.00" $701.53 "$3,534.58" "$1,590.56" "$1,590.56" "$1,590.56" "$1,590.56" "$3,534.58" "$3,534.58" "$3,534.58" $736.69 "$3,534.58" "$3,534.58" "$3,534.58" "$3,534.58" "$3,534.58" $736.65 "$3,534.58" "$3,534.58" "$1,742.55" "$3,534.58" "$3,534.58" "$3,534.58" "$3,534.58" "$2,651.25" "$3,534.58" "$3,534.58" "$3,534.58" "$1,767.29" "$1,767.29" "$2,799.39" "$3,534.58" "$2,827.66" "$1,590.56" $701.53 N/A "$2,050.30" "$3,534.58" "$3,534.58" "$3,534.58" $736.61 "$3,534.58" N/A N/A 6183-5-005 SUP HCPCS C1762 6183-5-005 - GRAFT BONE 5MM LORDOTIC CERV BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 6183-5-006 SUP HCPCS C1762 6183-5-006 - SPACER ALLOGRAFT 6MM ANTERIOR CERV INTERBODY FUSION LORDOTIC BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 6183-5-007 SUP Custom 27803010 6183-5-007 - SPACER ALLOGRAFT 7MM ANTERIOR CERV INTERBODY FUSION LORDOTIC BOTH IP/OP "$6,675.00" "$4,940.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$6,675.00" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$6,675.00" "$6,675.00" N/A N/A 6183-5-008 SUP Custom 27803010 6183-5-008 - SPACER ALGRF 8MM ALLOCRAFT CL DBM ACDF BOTH IP/OP "$6,675.00" "$4,940.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,188.15" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$2,670.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$6,675.00" N/A "$3,871.50" "$6,675.00" "$4,005.00" "$6,675.00" "$6,675.00" "$6,675.00" N/A N/A 6183-5-009 SUP HCPCS C1762 6183-5-009 - SPACER ALLOGRAFT 9MM ANTERIOR CERV INTERBODY FUSION LORDOTIC BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 6183-6-007 SUP HCPCS C1762 6183-6-007 - GRAFT BONE 7MM CERV SPN BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 6183-7-005 SUP HCPCS C1762 6183-7-005 - GRAFT BONE 14X11X5MM LORDOTIC CANCELLOUS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 6183-7-006 SUP HCPCS C1762 6183-7-006 - GRAFT BONE LORDOTIC 14X11X6MM ALLOCRAFT CANCELLOUS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 6183-7-007 SUP HCPCS C1762 6183-7-007 - GRAFT BONE LORDOTIC 14X11X7MM ALLOGRAFT ALLOCRAFT CANCELLOUS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 6183-7-008 SUP HCPCS C1762 6183-7-008 - GRAFT BONE 14X11X8MM LORDOTIC ALLOGRAFT CANCELLOUS CERV BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 6183-7-009 SUP HCPCS C1762 6183-7-009 - GRAFT BONE 14X11X9MM LORDOTIC CANCELLOUS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 6183-7-010 SUP HCPCS C1762 6183-7-010 - GRAFT BONE 14X11X10MM LORDOTIC CANCELLOUS BOTH IP/OP "$6,675.00" "$4,940.00" "$1,324.82" "$6,675.00" "$3,003.75" "$3,003.75" "$3,003.75" "$3,003.75" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.24" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.14" "$6,675.00" "$6,675.00" "$3,290.78" "$6,675.00" "$6,675.00" "$6,675.00" "$6,675.00" "$5,006.25" "$6,675.00" "$6,675.00" "$6,675.00" "$3,337.50" "$3,337.50" "$5,286.60" "$6,675.00" "$5,340.00" "$3,003.75" "$1,324.82" N/A "$3,871.50" "$6,675.00" "$6,675.00" "$6,675.00" "$1,391.07" "$6,675.00" N/A N/A 6184-0-025 SUP HCPCS C1713 6184-0-025 - CEMENT BONE PASTE BONESOURCE CALCIUM PHOSPHATE HYDRXAPT 2.5 BOTH IP/OP "$1,079.00" $798.00 $214.11 "$1,078.80" $485.46 $485.46 $485.46 $485.46 "$1,078.80" "$1,078.80" "$1,078.80" $224.85 "$1,078.80" "$1,078.80" "$1,078.80" "$1,078.80" "$1,078.80" $224.83 "$1,078.80" $431.52 $638.11 "$1,078.80" "$1,078.80" "$1,078.80" "$1,078.80" $809.25 "$1,078.80" "$1,078.80" "$1,078.80" $539.40 $539.40 $854.41 "$1,078.80" $863.04 $485.46 $214.11 N/A $625.82 "$1,078.80" $647.28 "$1,078.80" $224.82 "$1,078.80" N/A N/A 6184-0-050 SUP HCPCS C1713 6184-0-050 - CEMENT BONE PASTE BONESOURCE CALCIUM PHOSPHATE HA 5GM BOTH IP/OP "$1,816.00" "$1,344.00" $360.40 "$1,815.83" $817.12 $817.12 $817.12 $817.12 "$1,815.83" "$1,815.83" "$1,815.83" $378.46 "$1,815.83" "$1,815.83" "$1,815.83" "$1,815.83" "$1,815.83" $378.44 "$1,815.83" $726.33 "$1,074.06" "$1,815.83" "$1,815.83" "$1,815.83" "$1,815.83" "$1,362.00" "$1,815.83" "$1,815.83" "$1,815.83" $907.92 $907.92 "$1,438.14" "$1,815.83" "$1,452.66" $817.12 $360.40 N/A "$1,053.28" "$1,815.83" "$1,089.50" "$1,815.83" $378.42 "$1,815.83" N/A N/A 6184-0-100 SUP HCPCS C1713 6184-0-100 - CEMENT BONE PASTE FILR BONESOURCE HYDRXAPT 10GM STERILE BOTH IP/OP "$3,555.00" "$2,631.00" $705.56 "$3,554.93" "$1,599.72" "$1,599.72" "$1,599.72" "$1,599.72" "$3,554.93" "$3,554.93" "$3,554.93" $740.94 "$3,554.93" "$3,554.93" "$3,554.93" "$3,554.93" "$3,554.93" $740.89 "$3,554.93" "$1,421.97" "$1,752.58" "$3,554.93" "$3,554.93" "$3,554.93" "$3,554.93" "$2,666.25" "$3,554.93" "$3,554.93" "$3,554.93" "$1,777.47" "$1,777.47" "$2,815.50" "$3,554.93" "$2,843.94" "$1,599.72" $705.56 N/A "$2,061.90" "$3,554.93" "$2,132.96" "$3,554.93" $740.85 "$3,554.93" N/A N/A 6184-0-250 SUP HCPCS C1713 6184-0-250 - CEMENT BONE PASTE FILR BONESOURCE HYDRXAPT 25GM STERILE BOTH IP/OP "$7,617.00" "$5,637.00" "$1,511.72" "$7,616.70" "$3,427.52" "$3,427.52" "$3,427.52" "$3,427.52" "$7,616.70" "$7,616.70" "$7,616.70" "$1,587.51" "$7,616.70" "$7,616.70" "$7,616.70" "$7,616.70" "$7,616.70" "$1,587.40" "$7,616.70" "$3,046.68" "$3,755.03" "$7,616.70" "$7,616.70" "$7,616.70" "$7,616.70" "$5,712.75" "$7,616.70" "$7,616.70" "$7,616.70" "$3,808.35" "$3,808.35" "$6,032.43" "$7,616.70" "$6,093.36" "$3,427.52" "$1,511.72" N/A "$4,417.86" "$7,616.70" "$4,570.02" "$7,616.70" "$1,587.32" "$7,616.70" N/A N/A 6184-0-500 SUP HCPCS C1713 6184-0-500 - CEMENT BONE PASTE BONESOURCE 50GM STERILE BOTH IP/OP "$12,683.00" "$9,385.00" "$2,517.23" "$12,682.88" "$5,707.30" "$5,707.30" "$5,707.30" "$5,707.30" "$12,682.88" "$12,682.88" "$12,682.88" "$2,643.43" "$12,682.88" "$12,682.88" "$12,682.88" "$12,682.88" "$12,682.88" "$2,643.25" "$12,682.88" "$5,073.15" "$6,252.66" "$12,682.88" "$12,682.88" "$12,682.88" "$12,682.88" "$9,512.25" "$12,682.88" "$12,682.88" "$12,682.88" "$6,341.44" "$6,341.44" "$10,044.84" "$12,682.88" "$10,146.30" "$5,707.30" "$2,517.23" N/A "$7,356.14" "$12,682.88" "$12,682.88" "$12,682.88" "$2,643.11" "$12,682.88" N/A N/A 6184-1-003 SUP HCPCS C1713 6184-1-003 - CEMENT BONE INJECTABLE BIOCOMPATIBLE OSTEOCONDUCTIVE BOTH IP/OP "$2,362.50" "$1,748.00" $468.84 "$2,362.20" "$1,062.99" "$1,062.99" "$1,062.99" "$1,062.99" "$2,362.20" "$2,362.20" "$2,362.20" $492.34 "$2,362.20" "$2,362.20" "$2,362.20" "$2,362.20" "$2,362.20" $492.31 "$2,362.20" $944.88 "$1,397.24" "$2,362.20" "$2,362.20" "$2,362.20" "$2,362.20" "$1,771.88" "$2,362.20" "$2,362.20" "$2,362.20" "$1,181.10" "$1,181.10" "$1,870.86" "$2,362.20" "$1,889.76" "$1,062.99" $468.84 N/A "$1,370.25" "$2,362.20" "$2,362.20" "$2,362.20" $492.28 "$2,362.20" N/A N/A 6184-1-005 SUP HCPCS C1713 6184-1-005 - CEMENT BONE HYDROSET CALCIUM PHOSPHATE 5ML ORTHOPEDIC BOTH IP/OP "$3,785.50" "$2,801.00" $751.25 "$3,785.10" "$1,703.30" "$1,703.30" "$1,703.30" "$1,703.30" "$3,785.10" "$3,785.10" "$3,785.10" $788.91 "$3,785.10" "$3,785.10" "$3,785.10" "$3,785.10" "$3,785.10" $788.86 "$3,785.10" "$1,514.04" "$1,866.05" "$3,785.10" "$3,785.10" "$3,785.10" "$3,785.10" "$2,839.13" "$3,785.10" "$3,785.10" "$3,785.10" "$1,892.55" "$1,892.55" "$2,997.80" "$3,785.10" "$3,028.08" "$1,703.30" $751.25 N/A "$2,195.59" "$3,785.10" "$3,785.10" "$3,785.10" $788.81 "$3,785.10" N/A N/A 6184-1-010 SUP HCPCS C1713 6184-1-010 - CEMENT BONE HYDROSET SUB VOID FILR CALCIUM PHOS 10ML INJ BOTH IP/OP "$7,287.00" "$5,392.00" "$1,446.20" "$7,286.55" "$3,278.95" "$3,278.95" "$3,278.95" "$3,278.95" "$7,286.55" "$7,286.55" "$7,286.55" "$1,518.70" "$7,286.55" "$7,286.55" "$7,286.55" "$7,286.55" "$7,286.55" "$1,518.60" "$7,286.55" "$2,914.62" "$3,592.27" "$7,286.55" "$7,286.55" "$7,286.55" "$7,286.55" "$5,465.25" "$7,286.55" "$7,286.55" "$7,286.55" "$3,643.28" "$3,643.28" "$5,770.95" "$7,286.55" "$5,829.24" "$3,278.95" "$1,446.20" N/A "$4,226.46" "$7,286.55" "$7,286.55" "$7,286.55" "$1,518.52" "$7,286.55" N/A N/A 6184-1-015 SUP HCPCS C1713 6184-1-015 - CEMENT BONE INJECTABLE BIOCOMPATIBLE HYDROSET CALCIUM BOTH IP/OP "$10,460.50" "$7,741.00" "$2,076.08" "$10,460.18" "$4,707.08" "$4,707.08" "$4,707.08" "$4,707.08" "$10,460.18" "$10,460.18" "$10,460.18" "$2,180.16" "$10,460.18" "$10,460.18" "$10,460.18" "$10,460.18" "$10,460.18" "$2,180.02" "$10,460.18" "$4,184.07" "$5,156.87" "$10,460.18" "$10,460.18" "$10,460.18" "$10,460.18" "$7,845.38" "$10,460.18" "$10,460.18" "$10,460.18" "$5,230.09" "$5,230.09" "$8,284.46" "$10,460.18" "$8,368.14" "$4,707.08" "$2,076.08" N/A "$6,067.09" "$10,460.18" "$10,460.18" "$10,460.18" "$2,179.90" "$10,460.18" N/A N/A 6184-5-100 SUP HCPCS C1762 6184-5-100 - GRAFT BONE PELLET STACK 5ML BOTH IP/OP "$1,274.50" $943.00 $252.88 "$1,274.10" $573.35 $573.35 $573.35 $573.35 "$1,274.10" "$1,274.10" "$1,274.10" $265.55 "$1,274.10" "$1,274.10" "$1,274.10" "$1,274.10" "$1,274.10" $265.54 "$1,274.10" "$1,274.10" $753.63 "$1,274.10" "$1,274.10" "$1,274.10" "$1,274.10" $955.88 "$1,274.10" "$1,274.10" "$1,274.10" $637.05 $637.05 "$1,009.09" "$1,274.10" "$1,019.28" $573.35 $252.88 N/A $739.21 "$1,274.10" "$1,274.10" "$1,274.10" $265.52 "$1,274.10" N/A N/A 6184-5-300 SUP HCPCS C1762 6184-5-300 - GRAFT BONE 4MM PELLET 300 BOTH IP/OP "$2,262.50" "$1,674.00" $449.00 "$2,262.23" "$1,018.00" "$1,018.00" "$1,018.00" "$1,018.00" "$2,262.23" "$2,262.23" "$2,262.23" $471.51 "$2,262.23" "$2,262.23" "$2,262.23" "$2,262.23" "$2,262.23" $471.47 "$2,262.23" "$2,262.23" "$1,338.11" "$2,262.23" "$2,262.23" "$2,262.23" "$2,262.23" "$1,696.88" "$2,262.23" "$2,262.23" "$2,262.23" "$1,131.12" "$1,131.12" "$1,791.69" "$2,262.23" "$1,809.78" "$1,018.00" $449.00 N/A "$1,312.25" "$2,262.23" "$2,262.23" "$2,262.23" $471.45 "$2,262.23" N/A N/A 6184-9-220 SUP HCPCS C1713 6184-9-220 - CEMENT BONE 4-6MM GRANULES BONESAVE TRICALCIUM PHOSPHATE HA BOTH IP/OP "$3,074.00" "$2,275.00" $610.04 "$3,073.65" "$1,383.14" "$1,383.14" "$1,383.14" "$1,383.14" "$3,073.65" "$3,073.65" "$3,073.65" $640.63 "$3,073.65" "$3,073.65" "$3,073.65" "$3,073.65" "$3,073.65" $640.58 "$3,073.65" "$1,229.46" "$1,515.31" "$3,073.65" "$3,073.65" "$3,073.65" "$3,073.65" "$2,305.50" "$3,073.65" "$3,073.65" "$3,073.65" "$1,536.83" "$1,536.83" "$2,434.33" "$3,073.65" "$2,458.92" "$1,383.14" $610.04 N/A "$1,782.92" "$3,073.65" "$3,073.65" "$3,073.65" $640.55 "$3,073.65" N/A N/A 6188-1-001 SUP HCPCS C1713 6188-1-001 - CEMENT BONE RADIOPQ HALF DOSE SIMPLEX P BOTH IP/OP $130.00 $96.00 $25.80 $130.00 $58.50 $58.50 $58.50 $58.50 $130.00 $130.00 $130.00 $27.10 $130.00 $130.00 $130.00 $130.00 $130.00 $27.09 $130.00 $118.75 $76.90 $130.00 $118.75 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $65.00 $65.00 $102.96 $130.00 $104.00 $58.50 $25.80 N/A $75.40 $130.00 $130.00 $130.00 $27.09 $130.00 N/A N/A 6188-1-010 SUP HCPCS C1713 6188-1-010 - CEMENT BONE RADIOPQ HALF DOSE SIMPLEX P STERILE BOTH IP/OP $130.00 $96.00 $25.80 $130.00 $58.50 $58.50 $58.50 $58.50 $130.00 $130.00 $130.00 $27.10 $130.00 $130.00 $130.00 $130.00 $130.00 $27.09 $130.00 $118.75 $76.90 $130.00 $118.75 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $65.00 $65.00 $102.96 $130.00 $104.00 $58.50 $25.80 N/A $75.40 $130.00 $78.00 $130.00 $27.09 $130.00 N/A N/A 6191-1-001 SUP HCPCS C1713 6191-1-001 - CEMENT BONE RADIOPQ FULL DOSE SIMPLEX P BOTH IP/OP $170.00 $126.00 $33.74 $170.00 $76.50 $76.50 $76.50 $76.50 $170.00 $170.00 $170.00 $35.43 $170.00 $170.00 $170.00 $170.00 $170.00 $35.43 $170.00 $55.00 $100.56 $170.00 $137.50 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $76.50 $33.74 N/A $98.60 $170.00 $170.00 $170.00 $35.43 $170.00 N/A N/A 6191-1-010 SUP HCPCS C1713 6191-1-010 - CEMENT BONE RADIOPQ FULL DOSE SIMPLEX P STERILE BOTH IP/OP $170.00 $126.00 $33.74 $170.00 $76.50 $76.50 $76.50 $76.50 $170.00 $170.00 $170.00 $35.43 $170.00 $170.00 $170.00 $170.00 $170.00 $35.43 $170.00 $137.50 $100.56 $170.00 $137.50 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $76.50 $33.74 N/A $98.60 $170.00 $170.00 $170.00 $35.43 $170.00 N/A N/A 6192-1-001 SUP HCPCS C1713 6192-1-001 - CEMENT BONE FULL DOSE INDIVIDUAL SIMPLEX P SPEEDSET BOTH IP/OP $170.00 $126.00 $33.74 $170.00 $76.50 $76.50 $76.50 $76.50 $170.00 $170.00 $170.00 $35.43 $170.00 $170.00 $170.00 $170.00 $170.00 $35.43 $170.00 $137.50 $100.56 $170.00 $137.50 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $76.50 $33.74 N/A $98.60 $170.00 $170.00 $170.00 $35.43 $170.00 N/A N/A 6192-1-010 SUP HCPCS C1713 6192-1-010 - CEMENT BONE SMPX P SPEEDSET FD FST SET STRL BOTH IP/OP $170.00 $126.00 $33.74 $170.00 $76.50 $76.50 $76.50 $76.50 $170.00 $170.00 $170.00 $35.43 $170.00 $170.00 $170.00 $170.00 $170.00 $35.43 $170.00 $55.00 $100.56 $170.00 $137.50 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $76.50 $33.74 N/A $98.60 $170.00 $170.00 $170.00 $35.43 $170.00 N/A N/A 6194-1-001 SUP HCPCS C1713 6194-1-001 - CEMENT BN SMPX HVISC BOTH IP/OP $170.00 $126.00 $33.74 $170.00 $76.50 $76.50 $76.50 $76.50 $170.00 $170.00 $170.00 $35.43 $170.00 $170.00 $170.00 $170.00 $170.00 $35.43 $170.00 $55.00 $100.56 $170.00 $137.50 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $76.50 $33.74 N/A $98.60 $170.00 $170.00 $170.00 $35.43 $170.00 N/A N/A 6194-1-010 SUP HCPCS C1713 6194-1-010 - CEMENT BN 20ML STRL SMPX HVISC 40GM BOTH IP/OP $170.00 $126.00 $33.74 $170.00 $76.50 $76.50 $76.50 $76.50 $170.00 $170.00 $170.00 $35.43 $170.00 $170.00 $170.00 $170.00 $170.00 $35.43 $170.00 $55.00 $100.56 $170.00 $137.50 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $76.50 $33.74 N/A $98.60 $170.00 $170.00 $170.00 $35.43 $170.00 N/A N/A 6195-1-001 SUP HCPCS C1713 6195-1-001 - CEMENT BN SMPX HVISC GNTA 40GM BOTH IP/OP $462.50 $342.00 $91.79 $462.50 $208.13 $208.13 $208.13 $208.13 $462.50 $462.50 $462.50 $96.40 $462.50 $462.50 $462.50 $462.50 $462.50 $96.39 $462.50 $167.50 $273.57 $462.50 $418.75 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $208.13 $91.79 N/A $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 6195-1-010 SUP HCPCS C1713 6195-1-010 - CEMENT BN 20ML STRL SMPX HVISC GNTA 40GM BOTH IP/OP $462.50 $342.00 $91.79 $462.50 $208.13 $208.13 $208.13 $208.13 $462.50 $462.50 $462.50 $96.40 $462.50 $462.50 $462.50 $462.50 $462.50 $96.39 $462.50 $418.75 $273.57 $462.50 $418.75 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $208.13 $91.79 N/A $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A 6197-9-001 SUP HCPCS C1713 6197-9-001 - CEMENT BN STRL SMPX PTBR FD RADOPQ PREBLEND BOTH IP/OP $700.00 $518.00 $138.93 $700.00 $315.00 $315.00 $315.00 $315.00 $700.00 $700.00 $700.00 $145.90 $700.00 $700.00 $700.00 $700.00 $700.00 $145.89 $700.00 $637.50 $414.05 $700.00 $637.50 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $350.00 $350.00 $554.40 $700.00 $560.00 $315.00 $138.93 N/A $406.00 $700.00 $700.00 $700.00 $145.88 $700.00 N/A N/A 6197-9-010 SUP HCPCS C1713 6197-9-010 - CEMENT BONE FULL DOSE RADIOPQ PREBLEND SIMPLEX P TOBRAMYCIN BOTH IP/OP $700.00 $518.00 $138.93 $700.00 $315.00 $315.00 $315.00 $315.00 $700.00 $700.00 $700.00 $145.90 $700.00 $700.00 $700.00 $700.00 $700.00 $145.89 $700.00 $637.50 $414.05 $700.00 $637.50 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $350.00 $350.00 $554.40 $700.00 $560.00 $315.00 $138.93 N/A $406.00 $700.00 $420.00 $700.00 $145.88 $700.00 N/A N/A 61C-2242 SUP Custom 27803010 61C-2242 - CUP ACETAB UHMWPE XFIRE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2244 SUP Custom 27803010 61C-2244 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2246 SUP Custom 27803010 61C-2246 - CUP ACETAB UHMWPE XFIRE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2248 SUP Custom 27803010 61C-2248 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2250 SUP Custom 27803010 61C-2250 - CUP ACETAB UHMWPE XFIRE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2252 SUP Custom 27803010 61C-2252 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2254 SUP Custom 27803010 61C-2254 - CUP ACETAB UHMWPE XFIRE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2256 SUP Custom 27803010 61C-2256 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2258 SUP Custom 27803010 61C-2258 - CUP ACETAB UHMWPE XFIRE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2261 SUP Custom 27803010 61C-2261 - CUP ACETAB 61MM 22MM CEMENT UHMWPE HIP BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2642 SUP Custom 27803010 61C-2642 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2644 SUP Custom 27803010 61C-2644 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2646 SUP Custom 27803010 61C-2646 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2648 SUP Custom 27803010 61C-2648 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2650 SUP Custom 27803010 61C-2650 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2652 SUP Custom 27803010 61C-2652 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2654 SUP Custom 27803010 61C-2654 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2656 SUP Custom 27803010 61C-2656 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2658 SUP Custom 27803010 61C-2658 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2661 SUP Custom 27803010 61C-2661 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2844 SUP Custom 27803010 61C-2844 - CUP ACETAB LOW UHMWPE HIP BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2846 SUP Custom 27803010 61C-2846 - CUP ACETAB UHMWPE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2848 SUP Custom 27803010 61C-2848 - CUP ACETAB ALL POLY XFIRE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2850 SUP Custom 27803010 61C-2850 - CUP ACETAB ALL POLY XFIRE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2852 SUP Custom 27803010 61C-2852 - CUP ACETAB 52MM 28MM CEMENT ALL POLY XFIRE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2854 SUP Custom 27803010 61C-2854 - CUP ACETAB 54MM 28MM CEMENT ALL POLY XFIRE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2856 SUP Custom 27803010 61C-2856 - CUP ACETAB ALL POLY XFIRE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2858 SUP Custom 27803010 61C-2858 - CUP ACETAB ALL POLY XFIRE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 61C-2861 SUP Custom 27803010 61C-2861 - CUP ACETAB ALL POLY XFIRE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A 620-00-28D SUP Custom 27803010 620-00-28D - INSERT ACETAB 0D D 28MM TRIDENT POLYETHYLENE HIP BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 620-00-28E SUP Custom 27803010 620-00-28E - INSERT ACETAB 0D E 28MM TRIDENT POLYETHYLENE HIP BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 620-00-28F SUP Custom 27803010 620-00-28F - INSERT ACETAB 0D F 28MM TRIDENT POLYETHYLENE HIP BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 620-00-28G SUP Custom 27803010 620-00-28G - INSERT ACETAB 0D G 28MM TRIDENT POLYETHYLENE HIP BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 620-00-28H SUP Custom 27803010 620-00-28H - INSERT ACETAB 0D H 28MM TRIDENT POLYETHYLENE HIP BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 620-00-28I SUP Custom 27803010 620-00-28I - INSERT ACETAB 0D I 28MM TRIDENT POLYETHYLENE HIP BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 620-00-28J SUP Custom 27803010 620-00-28J - INSERT ACETAB 0D J 28MM TRIDENT POLYETHYLENE HIP BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 620-005 SUP HCPCS C1713 620-005 - CEMENT BN 5ML STIMULAN RPD CURE KT BOTH IP/OP "$2,425.00" "$1,795.00" $481.30 "$2,425.00" "$1,091.25" "$1,091.25" "$1,091.25" "$1,091.25" "$2,425.00" "$2,425.00" "$2,425.00" $505.43 "$2,425.00" "$2,425.00" "$2,425.00" "$2,425.00" "$2,425.00" $505.40 "$2,425.00" $970.00 "$1,434.39" "$2,425.00" "$2,425.00" "$2,425.00" "$2,425.00" "$1,818.75" "$2,425.00" "$2,425.00" "$2,425.00" "$1,212.50" "$1,212.50" "$1,920.60" "$2,425.00" "$1,940.00" "$1,091.25" $481.30 N/A "$1,406.50" "$2,425.00" "$1,455.00" "$2,425.00" $505.37 "$2,425.00" N/A N/A 620-010 SUP HCPCS C9359 620-010 - FILLER BN VOID CA SLF BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$3,125.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 62-00146 SUP Custom 27100030 62-00146 - GUIDE DRILL 1.6MM LAG PILOT BOTH IP/OP $914.50 $677.00 $162.73 $914.20 $914.20 $914.20 $914.20 $914.20 $914.20 $914.20 $162.73 $914.20 $914.20 $678.52 $678.52 $704.67 $476.30 $190.53 $914.20 $365.68 $914.20 $914.20 $914.20 $914.20 $914.20 $685.88 $914.20 $914.20 $914.20 $457.10 $457.10 $724.05 $914.20 $731.36 $594.23 $914.20 N/A $530.41 $914.20 $548.52 $914.20 $914.20 $914.20 N/A N/A 62-00148 SUP Custom 27100030 62-00148 - GUIDE DRILL 2MM LAG OVERDRILL BOTH IP/OP $998.50 $739.00 $177.73 $998.50 $998.50 $998.50 $998.50 $998.50 $998.50 $998.50 $177.73 $998.50 $998.50 $741.09 $741.09 $769.64 $520.22 $208.10 $998.50 $399.40 $998.50 $998.50 $998.50 $998.50 $998.50 $748.88 $998.50 $998.50 $998.50 $499.25 $499.25 $790.81 $998.50 $798.80 $649.03 $998.50 N/A $579.13 $998.50 $599.10 $998.50 $998.50 $998.50 N/A N/A 620-020 SUP HCPCS C1713 620-020 - CEMENT BONE STIMULAN RPD CURE CALCIUM SLF 20ML KIT BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$1,400.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A 62-00231 SUP Custom 27203010 62-00231 - GUIDE DRILL XS SERRATED CENTRIC BOTH IP/OP $164.00 $121.00 $29.13 $163.63 $163.63 $163.63 $163.63 $163.63 $163.63 $163.63 $29.13 $163.63 $163.63 $121.45 $121.45 $126.13 $85.25 $34.10 $163.63 $65.45 $163.63 $163.63 $163.63 $163.63 $163.63 $123.00 $163.63 $163.63 $163.63 $81.82 $81.82 $129.59 $163.63 $130.90 $106.36 $163.63 N/A $95.12 $163.63 $98.18 $163.63 $163.63 $163.63 N/A N/A 62-00233 SUP Custom 27203010 62-00233 - GUIDE DRILL SMALL SERRATED CENTRIC LEIBINGER BOTH IP/OP $164.00 $121.00 $29.13 $163.63 $163.63 $163.63 $163.63 $163.63 $163.63 $163.63 $29.13 $163.63 $163.63 $121.45 $121.45 $126.13 $85.25 $34.10 $163.63 $65.45 $163.63 $163.63 $163.63 $163.63 $163.63 $123.00 $163.63 $163.63 $163.63 $81.82 $81.82 $129.59 $163.63 $130.90 $106.36 $163.63 N/A $95.12 $163.63 $98.18 $163.63 $163.63 $163.63 N/A N/A 62-00235 SUP Custom 27203010 62-00235 - GUIDE SURG MEDIUM LARGE DRILL SERRATED CENTRIC BOTH IP/OP $164.00 $121.00 $29.13 $163.63 $163.63 $163.63 $163.63 $163.63 $163.63 $163.63 $29.13 $163.63 $163.63 $121.45 $121.45 $126.13 $85.25 $34.10 $163.63 $65.45 $163.63 $163.63 $163.63 $163.63 $163.63 $123.00 $163.63 $163.63 $163.63 $81.82 $81.82 $129.59 $163.63 $130.90 $106.36 $163.63 N/A $95.12 $163.63 $98.18 $163.63 $163.63 $163.63 N/A N/A 62-00237 SUP Custom 27203010 62-00237 - GUIDE SURG MEDIUM DRILL ECCENTRIC BOTH IP/OP $139.00 $103.00 $24.72 $138.88 $138.88 $138.88 $138.88 $138.88 $138.88 $138.88 $24.72 $138.88 $138.88 $103.08 $103.08 $107.05 $72.36 $28.94 $138.88 $55.55 $138.88 $138.88 $138.88 $138.88 $138.88 $104.25 $138.88 $138.88 $138.88 $69.44 $69.44 $109.99 $138.88 $111.10 $90.27 $138.88 N/A $80.62 $138.88 $83.33 $138.88 $138.88 $138.88 N/A N/A 62-00239 SUP Custom 27203010 62-00239 - GUIDE SURG LARGE DRILL ECCENTRIC BOTH IP/OP $139.00 $103.00 $24.72 $138.88 $138.88 $138.88 $138.88 $138.88 $138.88 $138.88 $24.72 $138.88 $138.88 $103.08 $103.08 $107.05 $72.36 $28.94 $138.88 $55.55 $138.88 $138.88 $138.88 $138.88 $138.88 $104.25 $138.88 $138.88 $138.88 $69.44 $69.44 $109.99 $138.88 $111.10 $90.27 $138.88 N/A $80.62 $138.88 $83.33 $138.88 $138.88 $138.88 N/A N/A 62-00241 SUP Custom 27203010 62-00241 - GUIDE DRILL 2.7MM ECCENTRIC BOTH IP/OP $82.50 $61.00 $14.69 $82.50 $82.50 $82.50 $82.50 $82.50 $82.50 $82.50 $14.69 $82.50 $82.50 $61.23 $61.23 $63.59 $42.98 $17.19 $82.50 $33.00 $82.50 $82.50 $82.50 $82.50 $82.50 $61.88 $82.50 $82.50 $82.50 $41.25 $41.25 $65.34 $82.50 $66.00 $53.63 $82.50 N/A $47.85 $82.50 $49.50 $82.50 $82.50 $82.50 N/A N/A 62-00249 SUP Custom 27203010 62-00249 - GUIDE DRILL 2.7MM SERRATED CENTRIC BOTH IP/OP $205.00 $152.00 $36.47 $204.88 $204.88 $204.88 $204.88 $204.88 $204.88 $204.88 $36.47 $204.88 $204.88 $152.06 $152.06 $157.92 $106.74 $42.70 $204.88 $81.95 $204.88 $204.88 $204.88 $204.88 $204.88 $153.75 $204.88 $204.88 $204.88 $102.44 $102.44 $162.26 $204.88 $163.90 $133.17 $204.88 N/A $118.90 $204.88 $122.93 $204.88 $204.88 $204.88 N/A N/A 62-00254 SUP Custom 27203010 62-00254 - GUIDE SURG DRILL HANDLE CENTRIC BOTH IP/OP $687.50 $509.00 $122.38 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $122.38 $687.50 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $275.00 $687.50 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $687.50 N/A $398.75 $687.50 $412.50 $687.50 $687.50 $687.50 N/A N/A 62-00270 SUP Custom 27203010 62-00270 - GUIDE DRILL REDX BOTH IP/OP $172.00 $127.00 $30.59 $171.88 $171.88 $171.88 $171.88 $171.88 $171.88 $171.88 $30.59 $171.88 $171.88 $127.57 $127.57 $132.49 $89.55 $35.82 $171.88 $68.75 $171.88 $171.88 $171.88 $171.88 $171.88 $129.00 $171.88 $171.88 $171.88 $85.94 $85.94 $136.13 $171.88 $137.50 $111.72 $171.88 N/A $99.76 $171.88 $103.13 $171.88 $171.88 $171.88 N/A N/A 62-00605 SUP Custom 27803010 62-00605 - SPACER SPNL HBRD MMF BOTH IP/OP $930.00 $688.00 $165.54 $930.00 $930.00 $930.00 $930.00 $930.00 $930.00 $930.00 $165.54 $930.00 $930.00 $930.00 $930.00 $930.00 $930.00 $193.82 $930.00 $372.00 $930.00 $930.00 $930.00 $930.00 $930.00 $697.50 $930.00 $930.00 $930.00 $465.00 $465.00 $736.56 $930.00 $744.00 $418.50 $930.00 N/A $539.40 $930.00 $558.00 $930.00 $930.00 $930.00 N/A N/A 620-10-28D SUP Custom 27803010 620-10-28D - INSERT ACETAB 10D D 28MM TRIDENT POLYETHYLENE HIP BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 620-10-28E SUP Custom 27803010 620-10-28E - INSERT ACETAB 10D E 28MM TRIDENT POLYETHYLENE HIP BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 620-10-28F SUP Custom 27803010 620-10-28F - INSERT ACETAB 10D F 28MM TRIDENT POLYETHYLENE HIP BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 620-10-28G SUP Custom 27803010 620-10-28G - INSERT ACETAB 10D G 28MM TRIDENT POLYETHYLENE HIP BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 620-10-28H SUP Custom 27803010 620-10-28H - INSERT ACETAB 10D H 28MM TRIDENT POLYETHYLENE HIP BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 620-10-28I SUP Custom 27803010 620-10-28I - INSERT ACETAB 10D I 28MM TRIDENT POLYETHYLENE HIP BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 62-01245 SUP Custom 27203010 62-01245 - GUIDE DRILL 2.3MM SMARTLOCK FEMUR BOTH IP/OP $535.00 $396.00 $95.21 $534.88 $534.88 $534.88 $534.88 $534.88 $534.88 $534.88 $95.21 $534.88 $534.88 $396.99 $396.99 $412.29 $278.67 $111.47 $534.88 $213.95 $534.88 $534.88 $534.88 $534.88 $534.88 $401.25 $534.88 $534.88 $534.88 $267.44 $267.44 $423.62 $534.88 $427.90 $347.67 $534.88 N/A $310.30 $534.88 $320.93 $534.88 $534.88 $534.88 N/A N/A 62-01246 SUP Custom 27203010 62-01246 - GUIDE DRILL FEMUR 2.7 MM SCREW BOTH IP/OP $535.00 $396.00 $95.21 $534.88 $534.88 $534.88 $534.88 $534.88 $534.88 $534.88 $95.21 $534.88 $534.88 $396.99 $396.99 $412.29 $278.67 $111.47 $534.88 $213.95 $534.88 $534.88 $534.88 $534.88 $534.88 $401.25 $534.88 $534.88 $534.88 $267.44 $267.44 $423.62 $534.88 $427.90 $347.67 $534.88 N/A $310.30 $534.88 $320.93 $534.88 $534.88 $534.88 N/A N/A 62-01250 SUP Custom 27203010 62-01250 - GUIDE SURG CENTRIC DRILL HANDLE BOTH IP/OP $484.00 $358.00 $86.15 $484.00 $484.00 $484.00 $484.00 $484.00 $484.00 $484.00 $86.15 $484.00 $484.00 $359.22 $359.22 $373.07 $252.16 $100.87 $484.00 $193.60 $484.00 $484.00 $484.00 $484.00 $484.00 $363.00 $484.00 $484.00 $484.00 $242.00 $242.00 $383.33 $484.00 $387.20 $314.60 $484.00 N/A $280.72 $484.00 $290.40 $484.00 $484.00 $484.00 N/A N/A 6201FAS SUP HCPCS C1760 6201FAS - TOOL LEAD DELIVERY 15MM 22CM FLEXIBLE FASTAC BOTH IP/OP $935.00 $692.00 $185.57 $935.00 $420.75 $420.75 $420.75 $420.75 $935.00 $935.00 $935.00 $194.88 $935.00 $935.00 $935.00 $935.00 $935.00 $194.86 $935.00 $935.00 $553.05 $935.00 $935.00 $935.00 $935.00 $701.25 $935.00 $935.00 $935.00 $467.50 $467.50 $740.52 $935.00 $748.00 $420.75 $185.57 N/A $542.30 $935.00 $935.00 $935.00 $194.85 $935.00 N/A N/A 6208-3-010 SUP HCPCS C1713 6208-3-010 - PLUG BONE CEMENT 10MM INTRAMEDULLARY SEIDEL BOTH IP/OP $165.00 $122.00 $32.75 $165.00 $74.25 $74.25 $74.25 $74.25 $165.00 $165.00 $165.00 $34.39 $165.00 $165.00 $165.00 $165.00 $165.00 $34.39 $165.00 $165.00 $97.60 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $74.25 $32.75 N/A $95.70 $165.00 $165.00 $165.00 $34.39 $165.00 N/A N/A 6208-3-016 SUP HCPCS C1713 6208-3-016 - PLUG BONE CEMENT 16MM INTRAMEDULLARY SEIDEL BOTH IP/OP $165.00 $122.00 $32.75 $165.00 $74.25 $74.25 $74.25 $74.25 $165.00 $165.00 $165.00 $34.39 $165.00 $165.00 $165.00 $165.00 $165.00 $34.39 $165.00 $165.00 $97.60 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $74.25 $32.75 N/A $95.70 $165.00 $165.00 $165.00 $34.39 $165.00 N/A N/A 621-00-22A SUP Custom 27803010 621-00-22A - INSERT ACETAB 0D A 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-22B SUP Custom 27803010 621-00-22B - INSERT ACETAB 0D B 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-22C SUP Custom 27803010 621-00-22C - INSERT ACETAB 0D C 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-22D SUP Custom 27803010 621-00-22D - INSERT ACETAB 0D D 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-22E SUP Custom 27803010 621-00-22E - INSERT ACETAB 0D E 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-22F SUP Custom 27803010 621-00-22F - INSERT ACETAB 0D F 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-22G SUP Custom 27803010 621-00-22G - INSERT ACETAB 0D G 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-22H SUP Custom 27803010 621-00-22H - INSERT ACETAB 0D H 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-22I SUP Custom 27803010 621-00-22I - INSERT ACETAB 0D I 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-22J SUP Custom 27803010 621-00-22J - INSERT ACETAB 0D J 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-26C SUP Custom 27803010 621-00-26C - INSERT ACETAB 0D C 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-26D SUP Custom 27803010 621-00-26D - INSERT ACETAB 0D D 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-26E SUP Custom 27803010 621-00-26E - INSERT ACETAB 0D E 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-26F SUP Custom 27803010 621-00-26F - INSERT ACETAB 0D F 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-26G SUP Custom 27803010 621-00-26G - INSERT ACETAB 0D G 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-26H SUP Custom 27803010 621-00-26H - INSERT ACETAB 0D H 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-26I SUP Custom 27803010 621-00-26I - INSERT ACETAB 0D I 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-26J SUP Custom 27803010 621-00-26J - INSERT ACETAB 0D J 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-28C SUP Custom 27803010 621-00-28C - INSERT ACETAB 0D C 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-28D SUP Custom 27803010 621-00-28D - INSERT ACETAB 0D D 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-28E SUP Custom 27803010 621-00-28E - INSERT ACETAB 0D E 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-28F SUP Custom 27803010 621-00-28F - INSERT ACETAB 0D F 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-28G SUP Custom 27803010 621-00-28G - INSERT ACETAB 0D G 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-28H SUP Custom 27803010 621-00-28H - INSERT ACETAB 0D H 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-28I SUP Custom 27803010 621-00-28I - INSERT ACETAB 0D I 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-28J SUP Custom 27803010 621-00-28J - INSERT ACETAB 0D J 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-32D SUP Custom 27803010 621-00-32D - INSERT ACETAB 0D D 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-32E SUP Custom 27803010 621-00-32E - INSERT ACETAB 0D E 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-32F SUP Custom 27803010 621-00-32F - INSERT ACETAB 0D F 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-32G SUP Custom 27803010 621-00-32G - INSERT ACETAB 0D G 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-32H SUP Custom 27803010 621-00-32H - INSERT ACETAB 0D H 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-32I SUP Custom 27803010 621-00-32I - INSERT ACETAB 0D I 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-32J SUP Custom 27803010 621-00-32J - INSERT ACETAB 0D J 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-36E SUP Custom 27803010 621-00-36E - INSERT ACETAB 0D E 36MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-36F SUP Custom 27803010 621-00-36F - INSERT ACETAB 0D F 36MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-36G SUP Custom 27803010 621-00-36G - INSERT ACETAB 0D G 36MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-36H SUP Custom 27803010 621-00-36H - INSERT ACETAB 0D H 36MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-36I SUP Custom 27803010 621-00-36I - INSERT ACETAB 0D I 36MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-00-36J SUP Custom 27803010 621-00-36J - INSERT ACETAB 0D J 36MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6210-0-710 SUP Custom 27203010 6210-0-710 - OSTEOTOME SURG 12MM 120MM FLEXIBLE GRAY STERILE BOTH IP/OP "$1,422.50" "$1,053.00" $253.21 "$1,422.50" "$1,422.50" "$1,422.50" "$1,422.50" "$1,422.50" "$1,422.50" "$1,422.50" $253.21 "$1,422.50" "$1,422.50" "$1,055.78" "$1,055.78" "$1,096.46" $741.12 $296.46 "$1,422.50" $569.00 "$1,422.50" "$1,422.50" "$1,422.50" "$1,422.50" "$1,422.50" "$1,066.88" "$1,422.50" "$1,422.50" "$1,422.50" $711.25 $711.25 "$1,126.62" "$1,422.50" "$1,138.00" $924.63 "$1,422.50" N/A $825.05 "$1,422.50" $853.50 "$1,422.50" "$1,422.50" "$1,422.50" N/A N/A 6210-0-740 SUP Custom 27203010 6210-0-740 - OSTEOTOME SURG 12MMX93MM FLEXIBLE GRAY STERILE BOTH IP/OP "$1,422.50" "$1,053.00" $253.21 "$1,422.50" "$1,422.50" "$1,422.50" "$1,422.50" "$1,422.50" "$1,422.50" "$1,422.50" $253.21 "$1,422.50" "$1,422.50" "$1,055.78" "$1,055.78" "$1,096.46" $741.12 $296.46 "$1,422.50" $569.00 "$1,422.50" "$1,422.50" "$1,422.50" "$1,422.50" "$1,422.50" "$1,066.88" "$1,422.50" "$1,422.50" "$1,422.50" $711.25 $711.25 "$1,126.62" "$1,422.50" "$1,138.00" $924.63 "$1,422.50" N/A $825.05 "$1,422.50" $853.50 "$1,422.50" "$1,422.50" "$1,422.50" N/A N/A 621-10-22A SUP Custom 27803010 621-10-22A - INSERT ACETAB 10D A 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-22B SUP Custom 27803010 621-10-22B - INSERT ACETAB 10D B 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-22C SUP Custom 27803010 621-10-22C - INSERT ACETAB 10D C 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-22D SUP Custom 27803010 621-10-22D - INSERT ACETAB 10D D 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-22E SUP Custom 27803010 621-10-22E - INSERT ACETAB 10D E 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-22F SUP Custom 27803010 621-10-22F - INSERT ACETAB 10D F 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-22G SUP Custom 27803010 621-10-22G - INSERT ACETAB 10D G 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-22H SUP Custom 27803010 621-10-22H - INSERT ACETAB 10D H 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-22I SUP Custom 27803010 621-10-22I - INSERT ACETAB 10D I 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-22J SUP Custom 27803010 621-10-22J - INSERT ACETAB 10D J 22MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-26C SUP Custom 27803010 621-10-26C - INSERT ACETAB 10D C 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-26D SUP Custom 27803010 621-10-26D - INSERT ACETAB 10D D 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-26E SUP Custom 27803010 621-10-26E - INSERT ACETAB 10D E 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-26F SUP Custom 27803010 621-10-26F - INSERT ACETAB 10D F 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-26G SUP Custom 27803010 621-10-26G - INSERT ACETAB 10D G 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-26H SUP Custom 27803010 621-10-26H - INSERT ACETAB 10D H 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-26I SUP Custom 27803010 621-10-26I - INSERT ACETAB 10D I 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-26J SUP Custom 27803010 621-10-26J - INSERT ACETAB 10D J 26MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-28C SUP Custom 27803010 621-10-28C - INSERT ACETAB 10D C 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-28D SUP Custom 27803010 621-10-28D - INSERT ACETAB 10D D 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-28E SUP Custom 27803010 621-10-28E - INSERT ACETAB 10D E 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-28F SUP Custom 27803010 621-10-28F - INSERT ACETAB 10D F 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-28G SUP Custom 27803010 621-10-28G - INSERT ACETAB 10D G 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-28H SUP Custom 27803010 621-10-28H - INSERT ACETAB 10D H 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-28I SUP Custom 27803010 621-10-28I - INSERT ACETAB 10D I 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-28J SUP Custom 27803010 621-10-28J - INSERT ACETAB 10D J 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-32D SUP Custom 27803010 621-10-32D - INSERT ACETAB 10D D 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-32E SUP Custom 27803010 621-10-32E - INSERT ACETAB 10D E 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-32F SUP Custom 27803010 621-10-32F - INSERT ACETAB 10D F 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-32G SUP Custom 27803010 621-10-32G - INSERT ACETAB 10D G 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-32H SUP HCPCS C1713 621-10-32H - INSERT ACETAB 10D H 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $228.25 "$1,150.00" $517.50 $517.50 $517.50 $517.50 "$1,150.00" "$1,150.00" "$1,150.00" $239.69 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" "$1,150.00" $680.23 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 $228.25 N/A $667.00 "$1,150.00" $690.00 "$1,150.00" $239.66 "$1,150.00" N/A N/A 621-10-32I SUP Custom 27803010 621-10-32I - INSERT ACETAB 10D I 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-32J SUP Custom 27803010 621-10-32J - INSERT ACETAB 10D J 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-36E SUP Custom 27803010 621-10-36E - INSERT ACETAB 10D E 36MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-36F SUP Custom 27803010 621-10-36F - INSERT ACETAB 10D F 36MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-36G SUP Custom 27803010 621-10-36G - INSERT ACETAB 10D G 36MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-36H SUP Custom 27803010 621-10-36H - INSERT ACETAB 10D H 36MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-36I SUP Custom 27803010 621-10-36I - INSERT ACETAB 10D I 36MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 621-10-36J SUP Custom 27803010 621-10-36J - INSERT ACETAB 10D J 36MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 62-12002 SUP Custom 27203010 62-12002 - BLADE SCREWDRIVER 1.2MM XFIT DENTAL SHAFT END BOTH IP/OP $362.00 $268.00 $64.37 $361.63 $361.63 $361.63 $361.63 $361.63 $361.63 $361.63 $64.37 $361.63 $361.63 $268.40 $268.40 $278.74 $188.41 $75.37 $361.63 $144.65 $361.63 $361.63 $361.63 $361.63 $361.63 $271.50 $361.63 $361.63 $361.63 $180.82 $180.82 $286.41 $361.63 $289.30 $235.06 $361.63 N/A $209.96 $361.63 $216.98 $361.63 $361.63 $361.63 N/A N/A 62-12333 SUP Custom 27203010 62-12333 - BLADE SCREWDRIVER 1.2MM XPIN BOTH IP/OP $275.00 $204.00 $48.95 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $48.95 $275.00 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $110.00 $275.00 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $275.00 N/A $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A 62-12335 SUP Custom 27203010 62-12335 - BLADE SCREWDRIVER 1.2MM REMOVAL BOTH IP/OP $310.00 $229.00 $55.13 $309.70 $309.70 $309.70 $309.70 $309.70 $309.70 $309.70 $55.13 $309.70 $309.70 $229.86 $229.86 $238.72 $161.35 $64.54 $309.70 $123.88 $309.70 $309.70 $309.70 $309.70 $309.70 $232.50 $309.70 $309.70 $309.70 $154.85 $154.85 $245.28 $309.70 $247.76 $201.31 $309.70 N/A $179.80 $309.70 $185.82 $309.70 $309.70 $309.70 N/A N/A 62-12503 SUP Custom 27803010 62-12503 - TAP SURG 1.2 MM SCREWS BOTH IP/OP $199.50 $148.00 $35.49 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $35.49 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $199.38 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $199.38 N/A $115.71 $199.38 $119.63 $199.38 $199.38 $199.38 N/A N/A 6215-5-001 SUP HCPCS C1713 6215-5-001 - PLUG BN CMNT SM 18.5MM STRL IM CNL BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 6215-5-011 SUP HCPCS C1713 6215-5-011 - PLUG BN CMNT MED 25MM STRL IM CNL BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 6215-5-021 SUP HCPCS C1713 6215-5-021 - PLUG BN CMNT LG 30MM STRL IM CNL BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 621573S SUP HCPCS C1713 621573S - PLATE BONE 81MM 3 HOLE SMALL FRAGMENT SET SHAFT TITANIUM BOTH IP/OP $284.00 $210.00 $56.37 $284.00 $127.80 $127.80 $127.80 $127.80 $284.00 $284.00 $284.00 $59.19 $284.00 $284.00 $284.00 $284.00 $284.00 $59.19 $284.00 $284.00 $167.99 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $127.80 $56.37 N/A $164.72 $284.00 $284.00 $284.00 $59.19 $284.00 N/A N/A 621574S SUP HCPCS C1713 621574S - PLATE BONE 93MM 4 HOLE SMALL FRAGMENT SET SHAFT TITANIUM BOTH IP/OP $284.00 $210.00 $56.37 $284.00 $127.80 $127.80 $127.80 $127.80 $284.00 $284.00 $284.00 $59.19 $284.00 $284.00 $284.00 $284.00 $284.00 $59.19 $284.00 $113.60 $167.99 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $127.80 $56.37 N/A $164.72 $284.00 $284.00 $284.00 $59.19 $284.00 N/A N/A 621575S SUP HCPCS C1713 621575S - PLATE BONE 105MM 5 HOLE SMALL FRAGMENT SET SHAFT TITANIUM BOTH IP/OP $284.00 $210.00 $56.37 $284.00 $127.80 $127.80 $127.80 $127.80 $284.00 $284.00 $284.00 $59.19 $284.00 $284.00 $284.00 $284.00 $284.00 $59.19 $284.00 $284.00 $167.99 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $127.80 $56.37 N/A $164.72 $284.00 $170.40 $284.00 $59.19 $284.00 N/A N/A 621576S SUP HCPCS C1713 621576S - PLATE BONE 117MM 6 HOLE SMALL FRAGMENT SET SHAFT TITANIUM BOTH IP/OP $284.00 $210.00 $56.37 $284.00 $127.80 $127.80 $127.80 $127.80 $284.00 $284.00 $284.00 $59.19 $284.00 $284.00 $284.00 $284.00 $284.00 $59.19 $284.00 $113.60 $167.99 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $127.80 $56.37 N/A $164.72 $284.00 $170.40 $284.00 $59.19 $284.00 N/A N/A 621577S SUP HCPCS C1713 621577S - PLATE BONE 129MM 7 HOLE SMALL FRAGMENT SET SHAFT TITANIUM BOTH IP/OP $284.00 $210.00 $56.37 $284.00 $127.80 $127.80 $127.80 $127.80 $284.00 $284.00 $284.00 $59.19 $284.00 $284.00 $284.00 $284.00 $284.00 $59.19 $284.00 $284.00 $167.99 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $127.80 $56.37 N/A $164.72 $284.00 $170.40 $284.00 $59.19 $284.00 N/A N/A 621578S SUP HCPCS C1713 621578S - PLATE BONE 141MM 8 HOLE SMALL FRAGMENT SET SHAFT TITANIUM BOTH IP/OP $284.00 $210.00 $56.37 $284.00 $127.80 $127.80 $127.80 $127.80 $284.00 $284.00 $284.00 $59.19 $284.00 $284.00 $284.00 $284.00 $284.00 $59.19 $284.00 $113.60 $167.99 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $127.80 $56.37 N/A $164.72 $284.00 $170.40 $284.00 $59.19 $284.00 N/A N/A 621579S SUP HCPCS C1713 621579S - PLATE BONE 153MM 9 HOLE SMALL FRAGMENT SET SHAFT TITANIUM BOTH IP/OP $284.00 $210.00 $56.37 $284.00 $127.80 $127.80 $127.80 $127.80 $284.00 $284.00 $284.00 $59.19 $284.00 $284.00 $284.00 $284.00 $284.00 $59.19 $284.00 $284.00 $167.99 $284.00 $284.00 $284.00 $284.00 $213.00 $284.00 $284.00 $284.00 $142.00 $142.00 $224.93 $284.00 $227.20 $127.80 $56.37 N/A $164.72 $284.00 $170.40 $284.00 $59.19 $284.00 N/A N/A 62-17005 SUP Custom 27203010 62-17005 - BLADE SCRDRVR 1.7MM XFT BOTH IP/OP $362.00 $268.00 $64.37 $361.63 $361.63 $361.63 $361.63 $361.63 $361.63 $361.63 $64.37 $361.63 $361.63 $268.40 $268.40 $278.74 $188.41 $75.37 $361.63 $144.65 $361.63 $361.63 $361.63 $361.63 $361.63 $271.50 $361.63 $361.63 $361.63 $180.82 $180.82 $286.41 $361.63 $289.30 $235.06 $361.63 N/A $209.96 $361.63 $216.98 $361.63 $361.63 $361.63 N/A N/A 62-17333 SUP Custom 27203010 62-17333 - BLADE SCREWDRIVER 1.7MM XPIN BOTH IP/OP $241.00 $178.00 $42.83 $240.63 $240.63 $240.63 $240.63 $240.63 $240.63 $240.63 $42.83 $240.63 $240.63 $178.60 $178.60 $185.48 $125.37 $50.15 $240.63 $96.25 $240.63 $240.63 $240.63 $240.63 $240.63 $180.75 $240.63 $240.63 $240.63 $120.32 $120.32 $190.58 $240.63 $192.50 $156.41 $240.63 N/A $139.78 $240.63 $144.38 $240.63 $240.63 $240.63 N/A N/A 62-17335 SUP Custom 27203010 62-17335 - BLADE SCREWDRIVER 1.7MM REMOVAL BOTH IP/OP $310.00 $229.00 $55.13 $309.70 $309.70 $309.70 $309.70 $309.70 $309.70 $309.70 $55.13 $309.70 $309.70 $229.86 $229.86 $238.72 $161.35 $64.54 $309.70 $123.88 $309.70 $309.70 $309.70 $309.70 $309.70 $232.50 $309.70 $309.70 $309.70 $154.85 $154.85 $245.28 $309.70 $247.76 $201.31 $309.70 N/A $179.80 $309.70 $185.82 $309.70 $309.70 $309.70 N/A N/A 62-17503 SUP Custom 27803010 62-17503 - TAP SURG 1.7MM MAXFACL BOTH IP/OP $199.50 $148.00 $35.49 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $35.49 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $199.38 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $199.38 N/A $115.71 $199.38 $119.63 $199.38 $199.38 $199.38 N/A N/A 62-20125 SUP Custom 27203010 62-20125 - CUTTER SURG PLATE BOTH IP/OP "$2,457.00" "$1,818.00" $437.35 "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" $437.35 "$2,457.00" "$2,457.00" "$1,823.59" "$1,823.59" "$1,893.86" "$1,280.10" $512.07 "$2,457.00" $982.80 "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" "$2,457.00" "$1,842.75" "$2,457.00" "$2,457.00" "$2,457.00" "$1,228.50" "$1,228.50" "$1,945.94" "$2,457.00" "$1,965.60" "$1,597.05" "$2,457.00" N/A "$1,425.06" "$2,457.00" "$1,474.20" "$2,457.00" "$2,457.00" "$2,457.00" N/A N/A 62-21723 SUP HCPCS C1713 62-21723 - BENDER PLATE XS PLIER BOTH IP/OP $715.50 $529.00 $141.98 $715.35 $321.91 $321.91 $321.91 $321.91 $715.35 $715.35 $715.35 $149.10 $715.35 $715.35 $715.35 $715.35 $715.35 $149.09 $715.35 $715.35 $423.13 $715.35 $715.35 $715.35 $715.35 $536.63 $715.35 $715.35 $715.35 $357.68 $357.68 $566.56 $715.35 $572.28 $321.91 $141.98 N/A $414.99 $715.35 $429.21 $715.35 $149.08 $715.35 N/A N/A 62-23005 SUP Custom 27203010 62-23005 - BLADE SCREWDRIVER 2.3MM XFIT DENTAL SHAFT END BOTH IP/OP $362.00 $268.00 $64.37 $361.63 $361.63 $361.63 $361.63 $361.63 $361.63 $361.63 $64.37 $361.63 $361.63 $268.40 $268.40 $278.74 $188.41 $75.37 $361.63 $144.65 $361.63 $361.63 $361.63 $361.63 $361.63 $271.50 $361.63 $361.63 $361.63 $180.82 $180.82 $286.41 $361.63 $289.30 $235.06 $361.63 N/A $209.96 $361.63 $216.98 $361.63 $361.63 $361.63 N/A N/A 62-23333 SUP Custom 27203010 62-23333 - BLADE SCREWDRIVER 2.3MM XPIN BOTH IP/OP $241.00 $178.00 $42.83 $240.63 $240.63 $240.63 $240.63 $240.63 $240.63 $240.63 $42.83 $240.63 $240.63 $178.60 $178.60 $185.48 $125.37 $50.15 $240.63 $96.25 $240.63 $240.63 $240.63 $240.63 $240.63 $180.75 $240.63 $240.63 $240.63 $120.32 $120.32 $190.58 $240.63 $192.50 $156.41 $240.63 N/A $139.78 $240.63 $144.38 $240.63 $240.63 $240.63 N/A N/A 62-23335 SUP HCPCS C1713 62-23335 - SCREW REMOVAL BLADE 2.3 DENTAL BOTH IP/OP $310.00 $229.00 $61.47 $309.70 $139.37 $139.37 $139.37 $139.37 $309.70 $309.70 $309.70 $64.55 $309.70 $309.70 $309.70 $309.70 $309.70 $64.54 $309.70 $123.88 $183.19 $309.70 $309.70 $309.70 $309.70 $232.50 $309.70 $309.70 $309.70 $154.85 $154.85 $245.28 $309.70 $247.76 $139.37 $61.47 N/A $179.80 $309.70 $185.82 $309.70 $64.54 $309.70 N/A N/A 62-23503 SUP Custom 27803010 62-23503 - TAP SURG 2.3 MM SCREW BOTH IP/OP $213.50 $158.00 $37.94 $213.13 $213.13 $213.13 $213.13 $213.13 $213.13 $213.13 $37.94 $213.13 $213.13 $213.13 $213.13 $213.13 $213.13 $44.42 $213.13 $85.25 $213.13 $213.13 $213.13 $213.13 $213.13 $160.13 $213.13 $213.13 $213.13 $106.57 $106.57 $168.80 $213.13 $170.50 $95.91 $213.13 N/A $123.83 $213.13 $127.88 $213.13 $213.13 $213.13 N/A N/A 62-27015 SUP Custom 27203010 62-27015 - BLADE SCREWDRIVER 2.3-2.7MM T7 VARIAX 2.3/2.7MM SCREW BOTH IP/OP $502.00 $371.00 $89.33 $501.88 $501.88 $501.88 $501.88 $501.88 $501.88 $501.88 $89.33 $501.88 $501.88 $372.50 $372.50 $386.85 $261.48 $104.60 $501.88 $200.75 $501.88 $501.88 $501.88 $501.88 $501.88 $376.50 $501.88 $501.88 $501.88 $250.94 $250.94 $397.49 $501.88 $401.50 $326.22 $501.88 N/A $291.16 $501.88 $301.13 $501.88 $501.88 $501.88 N/A N/A 6227DEF04 SUP Custom 27203010 6227DEF04 - CATHETER GD 9.9FR 45CM STRL LF ATN PRVL LD DLV SYS DFLC CS BOTH IP/OP "$1,242.50" $919.00 $221.17 "$1,242.50" "$1,242.50" "$1,242.50" "$1,242.50" "$1,242.50" "$1,242.50" "$1,242.50" $221.17 "$1,242.50" "$1,242.50" $922.18 $922.18 $957.72 $647.34 $258.95 "$1,242.50" $497.00 "$1,242.50" "$1,242.50" "$1,242.50" "$1,242.50" "$1,242.50" $931.88 "$1,242.50" "$1,242.50" "$1,242.50" $621.25 $621.25 $984.06 "$1,242.50" $994.00 $807.63 "$1,242.50" N/A $720.65 "$1,242.50" $745.50 "$1,242.50" "$1,242.50" "$1,242.50" N/A N/A 623-00-22A SUP Custom 27803010 623-00-22A - LINER ACETAB 0D A 22MM 7.8MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-22B SUP Custom 27803010 623-00-22B - LINER ACETAB 0D B 22MM 8.8MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-22C SUP Custom 27803010 623-00-22C - LINER ACETAB 0D C 22MM 9.8MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-22D SUP Custom 27803010 623-00-22D - LINER ACETAB 0D D 22MM 10.8MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-22E SUP Custom 27803010 623-00-22E - LINER ACETAB 0D E 22MM 12.8MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-22F SUP Custom 27803010 623-00-22F - LINER ACETAB 0D F 22MM 14.8MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-22G SUP Custom 27803010 623-00-22G - LINER ACETAB 0D G 22MM 16.3MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-22H SUP Custom 27803010 623-00-22H - LINER ACETAB 0D H 22MM 18.1MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-22I SUP Custom 27803010 623-00-22I - LINER ACETAB 0D I 22MM 19.6MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-22J SUP Custom 27803010 623-00-22J - LINER ACETAB 0D J 22MM 21.6MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-26C SUP Custom 27803010 623-00-26C - LINER ACETAB 0D C 26MM 7.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-26D SUP Custom 27803010 623-00-26D - LINER ACETAB 0D D 26MM 8.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-26E SUP Custom 27803010 623-00-26E - LINER ACETAB 0D E 26MM 10.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-26F SUP Custom 27803010 623-00-26F - LINER ACETAB 0D F 26MM 12.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-26G SUP Custom 27803010 623-00-26G - LINER ACETAB 0D G 26MM 14.4MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-26H SUP Custom 27803010 623-00-26H - LINER ACETAB 0D H 26MM 16.2MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-26I SUP Custom 27803010 623-00-26I - LINER ACETAB 0D I 26MM 17.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-26J SUP Custom 27803010 623-00-26J - LINER ACETAB 0D J 26MM 19.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-28A SUP Custom 27803010 623-00-28A - LINER ACETAB 0D A 28MM 4.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-28B SUP Custom 27803010 623-00-28B - LINER ACETAB 0D B 28MM 5.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-28C SUP Custom 27803010 623-00-28C - LINER ACETAB 0D C 28MM 6.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-28D SUP Custom 27803010 623-00-28D - LINER ACETAB 0D D 28MM 7.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-28E SUP Custom 27803010 623-00-28E - LINER ACETAB 0D E 28MM 9.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-28F SUP Custom 27803010 623-00-28F - LINER ACETAB 0D F 28MM 11.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-28G SUP Custom 27803010 623-00-28G - LINER ACETAB 0D G 28MM 13.4MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-28H SUP Custom 27803010 623-00-28H - LINER ACETAB 0D H 28MM 15.2MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-28I SUP Custom 27803010 623-00-28I - LINER ACETAB 0D I 28MM 16.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-28J SUP Custom 27803010 623-00-28J - LINER ACETAB 0D J 28MM 18.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-32B SUP Custom 27803010 623-00-32B - LINER ACETAB 0D B 32MM 3.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-32C SUP Custom 27803010 623-00-32C - LINER ACETAB 0D C 32MM 4.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-32D SUP Custom 27803010 623-00-32D - LINER ACETAB 0D D 32MM 5.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-32E SUP Custom 27803010 623-00-32E - LINER ACETAB 0D E 32MM 7.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-32F SUP Custom 27803010 623-00-32F - LINER ACETAB 0D F 32MM 9.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-32G SUP Custom 27803010 623-00-32G - LINER ACETAB 0D G 32MM 11.4MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-32H SUP Custom 27803010 623-00-32H - LINER ACETAB 0D H 32MM 13.2MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-32I SUP Custom 27803010 623-00-32I - LINER ACETAB 0D I 32MM 14.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-32J SUP Custom 27803010 623-00-32J - LINER ACETAB 0D J 32MM 16.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-36D SUP Custom 27803010 623-00-36D - LINER ACETAB 0D D 36MM 3.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-36E SUP Custom 27803010 623-00-36E - LINER ACETAB 0D E 36MM 5.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-36F SUP Custom 27803010 623-00-36F - LINER ACETAB 0D F 36MM 7.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-36G SUP Custom 27803010 623-00-36G - LINER ACETAB 0D G 36MM 9.4MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-36H SUP Custom 27803010 623-00-36H - LINER ACETAB 0D H 36MM 11.2MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-36I SUP Custom 27803010 623-00-36I - LINER ACETAB 0D I 36MM 12.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-36J SUP Custom 27803010 623-00-36J - LINER ACETAB 0D J 36MM 14.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-40E SUP Custom 27803010 623-00-40E - INSERT ACETAB 0D E 40MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-40F SUP Custom 27803010 623-00-40F - LINER ACETAB 0D F 40MM 5.8MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-40G SUP Custom 27803010 623-00-40G - LINER ACETAB 0D G 40MM 7.4MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-40H SUP Custom 27803010 623-00-40H - LINER ACETAB 0D H 40MM 9.1MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-40I SUP Custom 27803010 623-00-40I - LINER ACETAB 0D I 40MM 10.6MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-40J SUP Custom 27803010 623-00-40J - LINER ACETAB 0D J 40MM 12.6MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-44F SUP Custom 27803010 623-00-44F - LINER ACETAB 0D B F 44MM 3.8MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-44G SUP Custom 27803010 623-00-44G - LINER ACETAB 0D G 44MM 5.4MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-44H SUP Custom 27803010 623-00-44H - LINER ACETAB 0D H 44MM 7.1MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-44I SUP Custom 27803010 623-00-44I - LINER ACETAB 0D I 44MM 8.6MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-00-44J SUP Custom 27803010 623-00-44J - LINER ACETAB 0D J 44MM 10.6MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 6230UNI SUP Custom 27203010 6230UNI - SLITTER CATHETER UNIVERSAL UNIVERSAL II BOTH IP/OP $70.00 $52.00 $12.46 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $12.46 $70.00 $70.00 $51.95 $51.95 $53.96 $36.47 $14.59 $70.00 $28.00 $70.00 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $45.50 $70.00 N/A $40.60 $70.00 $42.00 $70.00 $70.00 $70.00 N/A N/A 623-10-22A SUP Custom 27803010 623-10-22A - LINER ACETAB 10D A 22MM 7.8MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-22B SUP Custom 27803010 623-10-22B - LINER ACETAB 10D B 22MM 8.8MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-22C SUP Custom 27803010 623-10-22C - LINER ACETAB 10D C 22MM 9.8MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-22D SUP Custom 27803010 623-10-22D - LINER ACETAB 10D D 22MM 10.8MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-22E SUP Custom 27803010 623-10-22E - LINER ACETAB 10D E 22MM 12.8MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-22F SUP Custom 27803010 623-10-22F - LINER ACETAB 10D F 22MM 14.8MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-22G SUP Custom 27803010 623-10-22G - LINER ACETAB 10D G 22MM 16.3MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-22H SUP Custom 27803010 623-10-22H - LINER ACETAB 10D H 22MM 18.1MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-22I SUP Custom 27803010 623-10-22I - LINER ACETAB 10D I 22MM 19.6MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-22J SUP Custom 27803010 623-10-22J - LINER ACETAB 10D J 22MM 21.6MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-26C SUP Custom 27803010 623-10-26C - LINER ACETAB 10D C 26MM 7.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-26D SUP Custom 27803010 623-10-26D - LINER ACETAB 10D D 26MM 8.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-26E SUP Custom 27803010 623-10-26E - LINER ACETAB 10D E 26MM 10.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-26F SUP Custom 27803010 623-10-26F - LINER ACETAB 10D F 26MM 12.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-26G SUP Custom 27803010 623-10-26G - LINER ACETAB 10D G 26MM 14.4MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-26H SUP Custom 27803010 623-10-26H - LINER ACETAB 10D H 26MM 16.2MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-26I SUP Custom 27803010 623-10-26I - LINER ACETAB 10D I 26MM 17.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-26J SUP Custom 27803010 623-10-26J - LINER ACETAB 10D J 26MM 19.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-28C SUP Custom 27803010 623-10-28C - LINER ACETAB 10D C 28MM 6.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-28D SUP Custom 27803010 623-10-28D - LINER ACETAB 10D D 28MM 7.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-28E SUP Custom 27803010 623-10-28E - LINER ACETAB 10D E 28MM 9.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-28F SUP Custom 27803010 623-10-28F - LINER ACETAB 10D F 28MM 11.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-28G SUP Custom 27803010 623-10-28G - LINER ACETAB 10D G 28MM 13.4MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-28H SUP Custom 27803010 623-10-28H - LINER ACETAB 10D H 28MM 15.2MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-28I SUP Custom 27803010 623-10-28I - LINER ACETAB 10D I 28MM 16.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-28J SUP Custom 27803010 623-10-28J - LINER ACETAB 10D J 28MM 18.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-32D SUP Custom 27803010 623-10-32D - LINER ACETAB 10D D 32MM 5.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-32E SUP Custom 27803010 623-10-32E - INSERT ACETAB 10D E 32MM PRIM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-32F SUP Custom 27803010 623-10-32F - LINER ACETAB 10D F 32MM 9.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-32G SUP Custom 27803010 623-10-32G - LINER ACETAB 10D G 32MM 11.4MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-32H SUP Custom 27803010 623-10-32H - LINER ACETAB 10D H 32MM 13.2MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-32I SUP Custom 27803010 623-10-32I - LINER ACETAB 10D I 32MM 14.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-32J SUP Custom 27803010 623-10-32J - LINER ACETAB 10D J 32MM 16.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-36E SUP Custom 27803010 623-10-36E - INSERT ACETAB 10D E 36MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-36F SUP Custom 27803010 623-10-36F - LINER ACETAB 10D F 36MM 7.9MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-36G SUP Custom 27803010 623-10-36G - LINER ACETAB 10D G 36MM 9.4MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-36H SUP Custom 27803010 623-10-36H - LINER ACETAB 10D H 36MM 11.2MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-36I SUP Custom 27803010 623-10-36I - LINER ACETAB 10D I 36MM 12.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 623-10-36J SUP Custom 27803010 623-10-36J - LINER ACETAB 10D J 36MM 14.7MM X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 62-32440 SUP Custom 27803010 62-32440 - POSITIONER IMPL 3.2MM UNV REPOSITION PIN BOTH IP/OP "$1,892.50" "$1,400.00" $336.87 "$1,892.50" "$1,892.50" "$1,892.50" "$1,892.50" "$1,892.50" "$1,892.50" "$1,892.50" $336.87 "$1,892.50" "$1,892.50" "$1,892.50" "$1,892.50" "$1,892.50" "$1,892.50" $394.42 "$1,892.50" $757.00 "$1,892.50" "$1,892.50" "$1,892.50" "$1,892.50" "$1,892.50" "$1,419.38" "$1,892.50" "$1,892.50" "$1,892.50" $946.25 $946.25 "$1,498.86" "$1,892.50" "$1,514.00" $851.63 "$1,892.50" N/A "$1,097.65" "$1,892.50" "$1,135.50" "$1,892.50" "$1,892.50" "$1,892.50" N/A N/A 6232ADJ SUP Custom 27203010 6232ADJ - SLITTER CATHETER ADJUSTABLE SHEATH BOTH IP/OP $70.00 $52.00 $12.46 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $12.46 $70.00 $70.00 $51.95 $51.95 $53.96 $36.47 $14.59 $70.00 $28.00 $70.00 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $45.50 $70.00 N/A $40.60 $70.00 $42.00 $70.00 $70.00 $70.00 N/A N/A 624.027S SUP Custom 27203010 624.027S - KIT SURG PEDICLE ACCES SPN REVERE BOTH IP/OP "$2,827.50" "$2,092.00" $503.30 "$2,827.50" "$2,827.50" "$2,827.50" "$2,827.50" "$2,827.50" "$2,827.50" "$2,827.50" $503.30 "$2,827.50" "$2,827.50" "$2,098.57" "$2,098.57" "$2,179.44" "$1,473.13" $589.28 "$2,827.50" "$1,131.00" "$2,827.50" "$2,827.50" "$2,827.50" "$2,827.50" "$2,827.50" "$2,120.63" "$2,827.50" "$2,827.50" "$2,827.50" "$1,413.75" "$1,413.75" "$2,239.38" "$2,827.50" "$2,262.00" "$1,837.88" "$2,827.50" N/A "$1,639.95" "$2,827.50" "$1,696.50" "$2,827.50" "$2,827.50" "$2,827.50" N/A N/A 6248130D02 SUP Custom 27203010 6248130D02 - CATHETER GD 130D 7.1FR 65CM STRL LF ATN SLCT II SUREVALVE BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A 624890D02 SUP Custom 27203010 624890D02 - CATHETER GD 90D 7.1FR 65CM STRL LF ATN SLCT II SUREVALVE BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A 6248V-90L SUP HCPCS C1887 6248V-90L - CATHETER GD 90D LNG 7.1FR 5.7FR 65CM ATN SLCT II SUREVALVE BOTH IP/OP $402.50 $298.00 $79.89 $402.50 $218.56 $218.56 $218.56 $218.56 $402.50 $402.50 $402.50 $83.89 $402.50 $298.74 $298.74 $310.25 $209.70 $83.89 $402.50 $402.50 $238.08 $402.50 $402.50 $402.50 $402.50 $301.88 $402.50 $402.50 $402.50 $201.25 $201.25 $318.78 $402.50 $322.00 $261.63 $79.89 N/A $233.45 $402.50 $402.50 $402.50 $83.88 $402.50 N/A N/A 62-50201 SUP Custom 27203010 62-50201 - PACK BTRY VARISPEED BOTH IP/OP $780.00 $577.00 $138.84 $780.00 $780.00 $780.00 $780.00 $780.00 $780.00 $780.00 $138.84 $780.00 $780.00 $578.92 $578.92 $601.22 $406.38 $162.56 $780.00 $312.00 $780.00 $780.00 $780.00 $780.00 $780.00 $585.00 $780.00 $780.00 $780.00 $390.00 $390.00 $617.76 $780.00 $624.00 $507.00 $780.00 N/A $452.40 $780.00 $468.00 $780.00 $780.00 $780.00 N/A N/A 6250EH02 SUP Custom 27203010 6250EH02 - CATHETER GD EH CRV 9FR 50CM STRL LF ATN CMND SUREVALVE 2 BRD BOTH IP/OP $460.00 $340.00 $81.88 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $81.88 $460.00 $460.00 $341.41 $341.41 $354.57 $239.66 $95.87 $460.00 $184.00 $460.00 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $299.00 $460.00 N/A $266.80 $460.00 $276.00 $460.00 $460.00 $460.00 N/A N/A 6250MB202 SUP Custom 27203010 6250MB202 - CATHETER GD MB2 CRV 9FR 45CM STRL LF ATN CMND SUREVALVE 2 BOTH IP/OP $460.00 $340.00 $81.88 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $81.88 $460.00 $460.00 $341.41 $341.41 $354.57 $239.66 $95.87 $460.00 $184.00 $460.00 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $299.00 $460.00 N/A $266.80 $460.00 $276.00 $460.00 $460.00 $460.00 N/A N/A 625-0T-28D SUP Custom 27803010 625-0T-28D - INSERT ACETAB D 28MM TRIDENT ALUM CERAMIC HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 625-0T-32E SUP Custom 27803010 625-0T-32E - INSERT ACETAB E 32MM TRIDENT ALUM CERAMIC HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 625-0T-32F SUP Custom 27803010 625-0T-32F - INSERT ACETAB F 32MM TRIDENT ALUM CERAMIC HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 625-0T-36G SUP Custom 27803010 625-0T-36G - INSERT ACETAB G 36MM TRIDENT ALUM CERAMIC HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 625-0T-36H SUP Custom 27803010 625-0T-36H - INSERT ACETAB H 36MM TRIDENT ALUM CERAMIC HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 625-0T-36I SUP Custom 27803010 625-0T-36I - INSERT ACETAB I 36MM TRIDENT ALUM CERAMIC HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 62-51217 SUP Custom 27203010 62-51217 - GUIDE DRILL STANDARD 1.2MM 1.7MM BOTH IP/OP $687.50 $509.00 $122.38 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $122.38 $687.50 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $275.00 $687.50 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $687.50 N/A $398.75 $687.50 $412.50 $687.50 $687.50 $687.50 N/A N/A 62-51723 SUP Custom 27203010 62-51723 - GUIDE DRILL 1.7MM 2.3MM POLYAX LOCKING BOTH IP/OP $667.00 $494.00 $118.70 $666.88 $666.88 $666.88 $666.88 $666.88 $666.88 $666.88 $118.70 $666.88 $666.88 $494.96 $494.96 $514.03 $347.44 $138.99 $666.88 $266.75 $666.88 $666.88 $666.88 $666.88 $666.88 $500.25 $666.88 $666.88 $666.88 $333.44 $333.44 $528.17 $666.88 $533.50 $433.47 $666.88 N/A $386.86 $666.88 $400.13 $666.88 $666.88 $666.88 N/A N/A 62-52323 SUP Custom 27203010 62-52323 - GUIDE DRILL 2.3MM COMPRESSION BOTH IP/OP $736.00 $545.00 $130.94 $735.63 $735.63 $735.63 $735.63 $735.63 $735.63 $735.63 $130.94 $735.63 $735.63 $545.98 $545.98 $567.02 $383.26 $153.31 $735.63 $294.25 $735.63 $735.63 $735.63 $735.63 $735.63 $552.00 $735.63 $735.63 $735.63 $367.82 $367.82 $582.62 $735.63 $588.50 $478.16 $735.63 N/A $426.88 $735.63 $441.38 $735.63 $735.63 $735.63 N/A N/A 62-52325 SUP Custom 27203010 62-52325 - GUIDE DRILL STANDARD 2.3MM 2.5MM BOTH IP/OP $687.50 $509.00 $122.38 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $122.38 $687.50 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $275.00 $687.50 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $687.50 N/A $398.75 $687.50 $412.50 $687.50 $687.50 $687.50 N/A N/A 6259-8-080 SUP Custom 27803010 6259-8-080 - CENTRALIZER STEM 8MM RELIANCE FEMUR DISTAL BOTH IP/OP $168.00 $124.00 $29.90 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $29.90 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $35.01 $168.00 $67.20 $168.00 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $75.60 $168.00 N/A $97.44 $168.00 $100.80 $168.00 $168.00 $168.00 N/A N/A 6259-8-090 SUP Custom 27803010 6259-8-090 - CENTRALIZER STEM 9MM RELIANCE FEMUR DISTAL BOTH IP/OP $168.00 $124.00 $29.90 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $29.90 $168.00 $168.00 $168.00 $168.00 $168.00 $168.00 $35.01 $168.00 $67.20 $168.00 $168.00 $168.00 $168.00 $168.00 $126.00 $168.00 $168.00 $168.00 $84.00 $84.00 $133.06 $168.00 $134.40 $75.60 $168.00 N/A $97.44 $168.00 $100.80 $168.00 $168.00 $168.00 N/A N/A 6259-8-100 SUP Custom 27803010 6259-8-100 - CENTRALIZER STEM 10MM RELIANCE HIP FEMUR FRAC PRODUCTS F R BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 6259-8-110 SUP HCPCS C1713 6259-8-110 - CENTRALIZER STEM 11MM PRIM RELIANCE HIP FEMUR BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 6259-8-120 SUP Custom 27803010 6259-8-120 - CENTRALIZER STEM 12MM PRIM RELIANCE DISTAL FEMUR HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 6259-8-130 SUP HCPCS C1713 6259-8-130 - CENTRALIZER STEM 13MM PRIM RELIANCE HIP FEMUR BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 6259-8-140 SUP HCPCS C1713 6259-8-140 - CENTRALIZER STEM 14MM RELIANCE HIP FEMUR BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 6259-8-150 SUP HCPCS C1713 6259-8-150 - CENTRALIZER STEM 15MM RELIANCE HIP FEMUR BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A 6259-8-160 SUP Custom 27803010 6259-8-160 - CENTRALIZER STEM 16MM 16MM ACCESSORIES BONE PLUG CENTRALIZER BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 6259-8-170 SUP Custom 27803010 6259-8-170 - CENTRALIZER STEM 17MM 17MM BONE PLUGS ACCESSORIES HIP FRAC BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 6259-8-180 SUP Custom 27803010 6259-8-180 - CENTRALIZER STEM 18MM RELIANCE HIP FEMUR DISTAL BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 626-00-36C SUP HCPCS C1776 626-00-36C - LINER ACTB C 36MM MDM COCR HIP 22.2MM FEM HD BOTH IP/OP "$2,347.50" "$1,737.00" $465.92 "$2,347.50" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$2,347.50" "$2,347.50" "$2,347.50" $489.28 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" "$2,347.50" "$1,388.55" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" $465.92 N/A "$1,361.55" "$2,347.50" "$2,347.50" "$2,347.50" $489.22 "$2,347.50" N/A N/A 626-00-38D SUP HCPCS C1776 626-00-38D - LINER ACTB D 38MM MDLR 2 MBL COCR HIP BOTH IP/OP "$2,347.50" "$1,737.00" $465.92 "$2,347.50" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$2,347.50" "$2,347.50" "$2,347.50" $489.28 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$1,388.55" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" $465.92 N/A "$1,361.55" "$2,347.50" "$2,347.50" "$2,347.50" $489.22 "$2,347.50" N/A N/A 626-00-42E SUP HCPCS C1776 626-00-42E - LINER ACTB E 42MM MDM 2 MBL MDLR COCR HIP BOTH IP/OP "$2,347.50" "$1,737.00" $465.92 "$2,347.50" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$2,347.50" "$2,347.50" "$2,347.50" $489.28 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$1,388.55" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" $465.92 N/A "$1,361.55" "$2,347.50" "$2,347.50" "$2,347.50" $489.22 "$2,347.50" N/A N/A 626-00-52H SUP HCPCS C1776 626-00-52H - LINER ACTB H 52MM MDM COCR HIP 28MM FEM HD BOTH IP/OP "$2,347.50" "$1,737.00" $465.92 "$2,347.50" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$2,347.50" "$2,347.50" "$2,347.50" $489.28 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" "$2,347.50" "$1,388.55" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" $465.92 N/A "$1,361.55" "$2,347.50" "$2,347.50" "$2,347.50" $489.22 "$2,347.50" N/A N/A 626-00-54I SUP HCPCS C1776 626-00-54I - LINER ACTB I 54MM MDM COCR HIP 28MM FEM HD BOTH IP/OP "$2,347.50" "$1,737.00" $465.92 "$2,347.50" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$2,347.50" "$2,347.50" "$2,347.50" $489.28 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$1,388.55" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" $465.92 N/A "$1,361.55" "$2,347.50" "$2,347.50" "$2,347.50" $489.22 "$2,347.50" N/A N/A 626-00-58J SUP HCPCS C1776 626-00-58J - LINER ACTB J 58MM MDM COCR HIP 28MM FEM HD BOTH IP/OP "$2,347.50" "$1,737.00" $465.92 "$2,347.50" "$1,056.38" "$1,056.38" "$1,056.38" "$1,056.38" "$2,347.50" "$2,347.50" "$2,347.50" $489.28 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" "$2,347.50" "$1,388.55" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" $465.92 N/A "$1,361.55" "$2,347.50" "$2,347.50" "$2,347.50" $489.22 "$2,347.50" N/A N/A 6260-1-212 SUP HCPCS C1776 6260-1-212 - STEM FEMORAL 2 BOW 12MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-1-313 SUP HCPCS C1776 6260-1-313 - STEM FEMORAL 3 BOW 13MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-1-414 SUP HCPCS C1776 6260-1-414 - STEM FEMORAL 4 BOW 14MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-1-515 SUP HCPCS C1776 6260-1-515 - STEM FEMORAL 5 BOW 15MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-1-616 SUP HCPCS C1776 6260-1-616 - STEM FEMORAL 6 BOW 16MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-1-717 SUP HCPCS C1776 6260-1-717 - STEM FEMORAL 7 BOW 17MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-1-719 SUP HCPCS C1776 6260-1-719 - STEM FEMORAL 7 BOW 19MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-1-818 SUP HCPCS C1776 6260-1-818 - STEM FEMORAL 8 BOW 18MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-1-820 SUP HCPCS C1776 6260-1-820 - STEM FEMORAL 8 BOW 20MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-1-921 SUP HCPCS C1776 6260-1-921 - STEM FEMORAL 9 BOW 21MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-2-212 SUP HCPCS C1776 6260-2-212 - STEM FEMORAL 2 BOW 12MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-2-313 SUP HCPCS C1776 6260-2-313 - STEM FEMORAL 3 BOW 13MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-2-414 SUP HCPCS C1776 6260-2-414 - STEM FEMORAL 4 BOW 14MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-2-515 SUP HCPCS C1776 6260-2-515 - STEM FEMORAL 5 BOW 15MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-2-616 SUP HCPCS C1776 6260-2-616 - STEM FEMORAL 6 BOW 16MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-2-717 SUP HCPCS C1776 6260-2-717 - STEM FEMORAL 7 BOW 17MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-2-719 SUP HCPCS C1776 6260-2-719 - STEM FEMORAL 7 BOW 19MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-2-818 SUP HCPCS C1776 6260-2-818 - STEM FEMORAL 8 BOW 18MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-2-820 SUP HCPCS C1776 6260-2-820 - STEM FEMORAL 8 BOW 20MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-2-921 SUP HCPCS C1776 6260-2-921 - STEM FEMORAL 9 BOW 21MM 155MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6260-4-122 SUP Custom 27803010 6260-4-122 - HEAD FEM +0MM 22.2MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-4-222 SUP Custom 27803010 6260-4-222 - HEAD FEM +3MM 22.2MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-4-322 SUP Custom 27803010 6260-4-322 - HEAD FEMORAL +8MM TAPER 22.2MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-026 SUP Custom 27803010 6260-5-026 - HEAD FEMORAL -3MM TAPER 26MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-028 SUP Custom 27803010 6260-5-028 - HEAD FEMORAL -4MM TAPER 28MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-032 SUP Custom 27803010 6260-5-032 - HEAD FEMORAL -4MM TAPER 32MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-126 SUP Custom 27803010 6260-5-126 - HEAD FEMORAL +0MM TAPER 26MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-128 SUP Custom 27803010 6260-5-128 - HEAD FEMORAL +0MM TAPER 28MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-132 SUP Custom 27803010 6260-5-132 - HEAD FEMORAL +0MM TAPER 32MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-226 SUP Custom 27803010 6260-5-226 - HEAD FEMORAL +4MM TAPER 26MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-228 SUP Custom 27803010 6260-5-228 - HEAD FEMORAL +4MM TAPER 28MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-232 SUP Custom 27803010 6260-5-232 - HEAD FEMORAL +4MM TAPER 32MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-326 SUP Custom 27803010 6260-5-326 - HEAD FEMORAL +8MM TAPER 26MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-328 SUP Custom 27803010 6260-5-328 - HEAD FEMORAL +8MM TAPER 28MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-332 SUP Custom 27803010 6260-5-332 - HEAD FEMORAL +8MM TAPER 32MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-426 SUP Custom 27803010 6260-5-426 - HEAD FEMORAL +1MM TAPER 26MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-428 SUP Custom 27803010 6260-5-428 - HEAD FEMORAL +12MM TAPER 28MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-432 SUP Custom 27803010 6260-5-432 - HEAD FEMORAL +12MM TAPER 32MM V40 COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-5-628 SUP Custom 27803010 6260-5-628 - HEAD FEMORAL +6MM TAPER 28MM V40 COCR HIP BOTH IP/OP "$1,302.50" $964.00 $231.85 "$1,302.50" "$1,302.50" "$1,302.50" "$1,302.50" "$1,302.50" "$1,302.50" "$1,302.50" $231.85 "$1,302.50" "$1,302.50" "$1,302.50" "$1,302.50" "$1,302.50" "$1,302.50" $271.46 "$1,302.50" $521.00 "$1,302.50" "$1,302.50" "$1,302.50" "$1,302.50" "$1,302.50" $976.88 "$1,302.50" "$1,302.50" "$1,302.50" $651.25 $651.25 "$1,031.58" "$1,302.50" "$1,042.00" $586.13 "$1,302.50" N/A $755.45 "$1,302.50" $781.50 "$1,302.50" "$1,302.50" "$1,302.50" N/A N/A 6260-6-111 SUP HCPCS C1776 6260-6-111 - STEM FEMORAL 1 STR 11MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-113 SUP HCPCS C1776 6260-6-113 - STEM FEMORAL 1 STR 13MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-212 SUP HCPCS C1776 6260-6-212 - STEM FEMORAL 2 STR 12MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-214 SUP HCPCS C1776 6260-6-214 - STEM FEMORAL 2 STR 14MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-313 SUP HCPCS C1776 6260-6-313 - STEM FEMORAL 3 STR 13MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-315 SUP HCPCS C1776 6260-6-315 - STEM FEMORAL 3 STR 15MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-414 SUP HCPCS C1776 6260-6-414 - STEM FEMORAL 4 STR 14MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-416 SUP HCPCS C1776 6260-6-416 - STEM FEMORAL 4 STR 16MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-515 SUP HCPCS C1776 6260-6-515 - STEM FEMORAL 5 STR 15MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-517 SUP HCPCS C1776 6260-6-517 - STEM FEMORAL 5 STR 17MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-616 SUP HCPCS C1776 6260-6-616 - STEM FEMORAL 6 STR 16MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-618 SUP HCPCS C1776 6260-6-618 - STEM FEMORAL 6 STR 18MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-717 SUP HCPCS C1776 6260-6-717 - STEM FEMORAL 7 STR 17MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-719 SUP HCPCS C1776 6260-6-719 - STEM FEMORAL 7 STR 19MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-818 SUP HCPCS C1776 6260-6-818 - STEM FEMORAL 8 STR 18MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-820 SUP HCPCS C1776 6260-6-820 - STEM FEMORAL 8 STR 20MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-6-921 SUP HCPCS C1776 6260-6-921 - STEM FEMORAL 9 STR 21MM 165MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-036 SUP Custom 27803010 6260-8-036 - HEAD FEMORAL -4MM 36MM V40 LFIT COCR HIP BOTH IP/OP "$2,035.00" "$1,506.00" $362.23 "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" $362.23 "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" $424.12 "$2,035.00" $814.00 "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$1,526.25" "$2,035.00" "$2,035.00" "$2,035.00" "$1,017.50" "$1,017.50" "$1,611.72" "$2,035.00" "$1,628.00" $915.75 "$2,035.00" N/A "$1,180.30" "$2,035.00" "$1,221.00" "$2,035.00" "$2,035.00" "$2,035.00" N/A N/A 6260-8-111 SUP HCPCS C1776 6260-8-111 - STEM FEMORAL 1 STR 11MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-113 SUP HCPCS C1776 6260-8-113 - STEM FEMORAL 1 STR 13MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-212 SUP HCPCS C1776 6260-8-212 - STEM FEMORAL 2 STR 12MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-214 SUP HCPCS C1776 6260-8-214 - STEM FEMORAL 2 STR 14MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-236 SUP Custom 27803010 6260-8-236 - HEAD FEMORAL +4MM 36MM V40 LFIT COCR HIP BOTH IP/OP "$2,035.00" "$1,506.00" $362.23 "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" $362.23 "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" $424.12 "$2,035.00" $814.00 "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$1,526.25" "$2,035.00" "$2,035.00" "$2,035.00" "$1,017.50" "$1,017.50" "$1,611.72" "$2,035.00" "$1,628.00" $915.75 "$2,035.00" N/A "$1,180.30" "$2,035.00" "$1,221.00" "$2,035.00" "$2,035.00" "$2,035.00" N/A N/A 6260-8-313 SUP HCPCS C1776 6260-8-313 - STEM FEMORAL 3 STR 13MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-315 SUP HCPCS C1776 6260-8-315 - STEM FEMORAL 3 STR 15MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-336 SUP Custom 27803010 6260-8-336 - HEAD FEMORAL +8MM 36MM V40 LFIT COCR HIP BOTH IP/OP "$2,035.00" "$1,506.00" $362.23 "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" $362.23 "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" $424.12 "$2,035.00" $814.00 "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$2,035.00" "$1,526.25" "$2,035.00" "$2,035.00" "$2,035.00" "$1,017.50" "$1,017.50" "$1,611.72" "$2,035.00" "$1,628.00" $915.75 "$2,035.00" N/A "$1,180.30" "$2,035.00" "$1,221.00" "$2,035.00" "$2,035.00" "$2,035.00" N/A N/A 6260-8-414 SUP HCPCS C1776 6260-8-414 - STEM FEMORAL 4 STR 14MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-416 SUP HCPCS C1776 6260-8-416 - STEM FEMORAL 4 STR 16MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-515 SUP HCPCS C1776 6260-8-515 - STEM FEMORAL 5 STR 15MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-517 SUP HCPCS C1776 6260-8-517 - STEM FEMORAL 5 STR 17MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-616 SUP HCPCS C1776 6260-8-616 - STEM FEMORAL 6 STR 16MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-618 SUP HCPCS C1776 6260-8-618 - STEM FEMORAL 6 STR 18MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$13,152.50" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$7,891.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-717 SUP HCPCS C1776 6260-8-717 - STEM FEMORAL 7 STR 17MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-719 SUP HCPCS C1776 6260-8-719 - STEM FEMORAL 7 STR 19MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-818 SUP HCPCS C1776 6260-8-818 - STEM FEMORAL 8 STR 18MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-820 SUP HCPCS C1776 6260-8-820 - STEM FEMORAL 8 STR 20MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-8-921 SUP HCPCS C1776 6260-8-921 - STEM FEMORAL 9 STR 21MM 203MM RSTOR TITANIUM PLASMA SPRAY BOTH IP/OP "$13,152.50" "$9,733.00" "$2,610.44" "$13,152.50" "$5,918.63" "$5,918.63" "$5,918.63" "$5,918.63" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.31" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$2,741.13" "$13,152.50" "$5,261.00" "$6,484.18" "$13,152.50" "$13,152.50" "$13,152.50" "$13,152.50" "$9,864.38" "$13,152.50" "$13,152.50" "$13,152.50" "$6,576.25" "$6,576.25" "$10,416.78" "$13,152.50" "$10,522.00" "$5,918.63" "$2,610.44" N/A "$7,628.45" "$13,152.50" "$13,152.50" "$13,152.50" "$2,740.98" "$13,152.50" N/A N/A 6260-9-026 SUP Custom 27803010 6260-9-026 - HEAD FEMORAL -3MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-028 SUP Custom 27803010 6260-9-028 - HEAD FEM -4MM OFST TPR 28MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-032 SUP Custom 27803010 6260-9-032 - HEAD FEM -4MM OFST 32MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-036 SUP Custom 27803010 6260-9-036 - HEAD FEM -5MM OFST TPR 36MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-040 SUP Custom 27803010 6260-9-040 - HEAD FEM -4MM OFST TPR 40MM V40 LFIT COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 6260-9-044 SUP Custom 27803010 6260-9-044 - HEAD FEM -4MM OFST TPR 44MM V40 LFIT COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 6260-9-122 SUP Custom 27803010 6260-9-122 - HEAD FEM +0MM OFST TPR 22MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-126 SUP Custom 27803010 6260-9-126 - HEAD FEMORAL +0MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-128 SUP Custom 27803010 6260-9-128 - HEAD FEM +0MM OFST 28MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-132 SUP Custom 27803010 6260-9-132 - HEAD FEMORAL +0MM OFFST TAPER 32MM PRIM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-136 SUP Custom 27803010 6260-9-136 - HEAD FEMORAL +0MM OFFST TAPER 36MM PRIM ANATOMIC V40 LFIT BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-140 SUP Custom 27803010 6260-9-140 - HEAD FEMORAL +0MM OFFST TAPER 40MM PRIM ANATOMIC V40 LFIT BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 6260-9-144 SUP Custom 27803010 6260-9-144 - HEAD FEM +0MM OFST TPR 44MM V40 LFIT COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 6260-9-222 SUP Custom 27803010 6260-9-222 - HEAD FEM +3MM OFST 22.2MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-226 SUP Custom 27803010 6260-9-226 - HEAD FEMORAL +4MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-228 SUP Custom 27803010 6260-9-228 - HEAD FEM +4MM OFST 28MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-232 SUP Custom 27803010 6260-9-232 - HEAD FEM +4MM OFST TPR 32MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-236 SUP Custom 27803010 6260-9-236 - HEAD FEM +5MM OFST TPR 36MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-240 SUP Custom 27803010 6260-9-240 - HEAD FEMORAL +4MM OFFST TAPER 40MM PRIM ANATOMIC V40 LFIT BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 6260-9-244 SUP Custom 27803010 6260-9-244 - HEAD FEMORAL +4MM OFFST TAPER 44MM PRIM ANATOMIC V40 LFIT BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 6260-9-322 SUP Custom 27803010 6260-9-322 - HEAD FEM +8MM OFST TPR 22MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-326 SUP Custom 27803010 6260-9-326 - HEAD FEMORAL +8MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-328 SUP Custom 27803010 6260-9-328 - HEAD FEM +8MM OFST TPR 28MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-332 SUP Custom 27803010 6260-9-332 - HEAD FEMORAL +8MM OFFST TAPER 32MM PRIM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-336 SUP Custom 27803010 6260-9-336 - HEAD FEM +10MM OFST TPR 36MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-340 SUP Custom 27803010 6260-9-340 - HEAD FEM +8MM OFST TPR 40MM V40 LFIT COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 6260-9-344 SUP Custom 27803010 6260-9-344 - HEAD FEMORAL +8MM OFFST TAPER 44MM PRIM ANATOMIC V40 LFIT BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 6260-9-426 SUP Custom 27803010 6260-9-426 - HEAD FEMORAL +12MM OFFST TAPER 26MM PRIM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-428 SUP Custom 27803010 6260-9-428 - HEAD FEM +12MM OFST TPR 28MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-432 SUP Custom 27803010 6260-9-432 - HEAD FEM +12MM OFST TPR 32MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6260-9-440 SUP Custom 27803010 6260-9-440 - HEAD FEM +12MM OFST TPR 40MM V40 LFIT COCR HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 6260-9-444 SUP Custom 27803010 6260-9-444 - HEAD FEMORAL +12MM OFFST TAPER 44MM PRIM ANATOMIC V40 LFIT BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 6260-9-628 SUP Custom 27803010 6260-9-628 - HEAD FEMORAL +6MM 28MM V40 LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6261-0-001 SUP HCPCS C1776 6261-0-001 - STEM FEMORAL 132D 00 28MM OFFST 9MM 110MM 26MM COLLARLESS BOTH IP/OP "$6,861.00" "$5,077.00" "$1,361.74" "$6,861.00" "$3,087.45" "$3,087.45" "$3,087.45" "$3,087.45" "$6,861.00" "$6,861.00" "$6,861.00" "$1,430.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.91" "$6,861.00" "$2,744.40" "$3,382.47" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$5,145.75" "$6,861.00" "$6,861.00" "$6,861.00" "$3,430.50" "$3,430.50" "$5,433.91" "$6,861.00" "$5,488.80" "$3,087.45" "$1,361.74" N/A "$3,979.38" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.83" "$6,861.00" N/A N/A 6261-0-002 SUP HCPCS C1776 6261-0-002 - STEM FEMORAL 132D 0 34MM OFFST 10MM 115MM 31MM COLLARLESS BOTH IP/OP "$6,861.00" "$5,077.00" "$1,361.74" "$6,861.00" "$3,087.45" "$3,087.45" "$3,087.45" "$3,087.45" "$6,861.00" "$6,861.00" "$6,861.00" "$1,430.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.91" "$6,861.00" "$2,744.40" "$3,382.47" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$5,145.75" "$6,861.00" "$6,861.00" "$6,861.00" "$3,430.50" "$3,430.50" "$5,433.91" "$6,861.00" "$5,488.80" "$3,087.45" "$1,361.74" N/A "$3,979.38" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.83" "$6,861.00" N/A N/A 6261-0-003 SUP HCPCS C1776 6261-0-003 - STEM FEMORAL 132D 1 34MM OFFST 11MM 115MM 31MM COLLARLESS BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6261-0-004 SUP HCPCS C1776 6261-0-004 - STEM FEMORAL 132D 2 36MM OFFST 10MM 130MM 32MM COLLARLESS BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6261-0-005 SUP HCPCS C1776 6261-0-005 - STEM FEMORAL 132D 2 36MM OFFST 12MM 130MM 32MM COLLARLESS BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6261-0-006 SUP HCPCS C1776 6261-0-006 - STEM FEMORAL 132D 3 40MM OFFST 11MM 130MM 34MM COLLARLESS BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6261-0-007 SUP HCPCS C1776 6261-0-007 - STEM FEMORAL 132D 3 40MM OFFST 13MM 130MM 34MM COLLARLESS BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6261-0-008 SUP HCPCS C1776 6261-0-008 - STEM FEMORAL 132D 4 44MM OFFST 12MM 140MM 35MM COLLARLESS BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$6,538.00" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6261-0-009 SUP HCPCS C1776 6261-0-009 - STEM FEMORAL 132D 4 44MM OFFST 14MM 140MM 35MM COLLARLESS BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$6,538.00" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6261-0-010 SUP HCPCS C1776 6261-0-010 - STEM FEMORAL 132D 5 47MM OFFST 13MM 140MM 37MM COLLARLESS BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$6,538.00" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6261-0-011 SUP HCPCS C1776 6261-0-011 - STEM FEMORAL 132D 5 47MM OFFST 15MM 140MM 37MM COLLARLESS BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$6,538.00" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6261-0-012 SUP HCPCS C1776 6261-0-012 - STEM FEMORAL 132D 6 50MM OFFST 14MM 150MM 37MM COLLARLESS BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$6,538.00" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6261-0-013 SUP HCPCS C1776 6261-0-013 - STEM FEMORAL 132D 6 50MM OFFST 16MM 150MM 37MM COLLARLESS BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6261-0-014 SUP HCPCS C1776 6261-0-014 - STEM FEMORAL 132D 7 52MM OFFST 15MM 150MM 39MM COLLARLESS BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6261-0-015 SUP HCPCS C1776 6261-0-015 - STEM FEMORAL 132D 7 52MM OFFST 17MM 150MM 39MM COLLARLESS BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$2,615.20" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6261-0-016 SUP HCPCS C1776 6261-0-016 - STEM FEMORAL 132D 8 55MM OFFST 16MM 160MM 42MM COLLARLESS BOTH IP/OP "$6,861.00" "$5,077.00" "$1,361.74" "$6,861.00" "$3,087.45" "$3,087.45" "$3,087.45" "$3,087.45" "$6,861.00" "$6,861.00" "$6,861.00" "$1,430.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.91" "$6,861.00" "$6,861.00" "$3,382.47" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$5,145.75" "$6,861.00" "$6,861.00" "$6,861.00" "$3,430.50" "$3,430.50" "$5,433.91" "$6,861.00" "$5,488.80" "$3,087.45" "$1,361.74" N/A "$3,979.38" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.83" "$6,861.00" N/A N/A 6261-0-017 SUP HCPCS C1776 6261-0-017 - STEM FEMORAL 132D 8 55MM OFFST 18MM 160MM 42MM COLLARLESS BOTH IP/OP "$6,861.00" "$5,077.00" "$1,361.74" "$6,861.00" "$3,087.45" "$3,087.45" "$3,087.45" "$3,087.45" "$6,861.00" "$6,861.00" "$6,861.00" "$1,430.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.91" "$6,861.00" "$6,861.00" "$3,382.47" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$5,145.75" "$6,861.00" "$6,861.00" "$6,861.00" "$3,430.50" "$3,430.50" "$5,433.91" "$6,861.00" "$5,488.80" "$3,087.45" "$1,361.74" N/A "$3,979.38" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.83" "$6,861.00" N/A N/A 6261-0-018 SUP HCPCS C1776 6261-0-018 - STEM FEMORAL 132D 9 55MM OFFST 19MM 160MM 42MM COLLARLESS BOTH IP/OP "$6,861.00" "$5,077.00" "$1,361.74" "$6,861.00" "$3,087.45" "$3,087.45" "$3,087.45" "$3,087.45" "$6,861.00" "$6,861.00" "$6,861.00" "$1,430.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.91" "$6,861.00" "$2,744.40" "$3,382.47" "$6,861.00" "$6,861.00" "$6,861.00" "$6,861.00" "$5,145.75" "$6,861.00" "$6,861.00" "$6,861.00" "$3,430.50" "$3,430.50" "$5,433.91" "$6,861.00" "$5,488.80" "$3,087.45" "$1,361.74" N/A "$3,979.38" "$6,861.00" "$6,861.00" "$6,861.00" "$1,429.83" "$6,861.00" N/A N/A 6265-0-010 SUP HCPCS C1776 6265-0-010 - STEM FEMORAL 5 13MM CEMENTLESS MERIDIAN ST VITALLIUM POROUS BOTH IP/OP "$6,538.00" "$4,838.00" "$1,297.63" "$6,538.00" "$2,942.10" "$2,942.10" "$2,942.10" "$2,942.10" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.68" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.59" "$6,538.00" "$6,538.00" "$3,223.23" "$6,538.00" "$6,538.00" "$6,538.00" "$6,538.00" "$4,903.50" "$6,538.00" "$6,538.00" "$6,538.00" "$3,269.00" "$3,269.00" "$5,178.10" "$6,538.00" "$5,230.40" "$2,942.10" "$1,297.63" N/A "$3,792.04" "$6,538.00" "$6,538.00" "$6,538.00" "$1,362.52" "$6,538.00" N/A N/A 6265-1-001 SUP HCPCS C1776 6265-1-001 - STEM FEMORAL 132D 00 28MM OFFST 9MM 110MM 26MM COLLARLESS BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$2,666.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$6,665.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 6265-1-002 SUP HCPCS C1776 6265-1-002 - STEM FEMORAL 132D 0 34MM OFFST 10MM 115MM 31MM COLLARLESS BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$2,666.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$6,665.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 6265-1-003 SUP HCPCS C1776 6265-1-003 - STEM FEMORAL 132D 1 34MM OFFST 11MM 115MM 31MM COLLARLESS BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6265-1-004 SUP HCPCS C1776 6265-1-004 - STEM FEMORAL 132D 2 36MM OFFST 10MM 130MM 32MM COLLARLESS BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6265-1-005 SUP HCPCS C1776 6265-1-005 - STEM FEMORAL 132D 2 36MM OFFST 12MM 130MM 32MM COLLARLESS BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6265-1-006 SUP HCPCS C1776 6265-1-006 - STEM FEM 3-11MM BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6265-1-007 SUP HCPCS C1776 6265-1-007 - STEM FEMORAL 132D 3 40MM OFFST 13MM 130MM 34MM COLLARLESS BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6265-1-008 SUP HCPCS C1776 6265-1-008 - STEM FEM 4-12MM BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6265-1-009 SUP HCPCS C1776 6265-1-009 - STEM FEMORAL 132D 4 44MM OFFST 14MM 140MM 35MM COLLARLESS BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6265-1-010 SUP HCPCS C1776 6265-1-010 - STEM FEMORAL 132D 5 47MM OFFST 13MM 140MM 37MM COLLARLESS BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6265-1-011 SUP HCPCS C1776 6265-1-011 - STEM FEMORAL 132D 5 47MM OFFST 15MM 140MM 37MM COLLARLESS BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6265-1-012 SUP HCPCS C1776 6265-1-012 - STEM FEMORAL 132D 6 50MM OFFST 14MM 150MM 37MM COLLARLESS BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6265-1-013 SUP HCPCS C1776 6265-1-013 - STEM FEMORAL 132D 6 50MM OFFST 16MM 150MM 37MM COLLARLESS BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6265-1-014 SUP HCPCS C1776 6265-1-014 - STEM FEMORAL 132D 7 52MM OFFST 15MM 150MM 39MM COLLARLESS BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6265-1-015 SUP HCPCS C1776 6265-1-015 - STEM FEMORAL 132D 7 52MM OFFST 17MM 150MM 39MM COLLARLESS BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 6265-1-016 SUP HCPCS C1776 6265-1-016 - STEM FEMORAL 132D 8 55MM OFFST 16MM 160MM 42MM COLLARLESS BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$2,666.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$6,665.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 6265-1-017 SUP HCPCS C1776 6265-1-017 - STEM FEMORAL 132D 8 55MM OFFST 18MM 160MM 42MM COLLARLESS BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$2,666.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$3,999.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 6265-1-018 SUP HCPCS C1776 6265-1-018 - STEM FEMORAL 132D 9 55MM OFFST 19MM 160MM 42MM COLLARLESS BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$6,665.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$3,999.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 6265-2-000 SUP Custom 27803010 6265-2-000 - STEM FEMORAL 132D 0 10MM 115MM 31MM COLLAR PRESS FIT BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6265-2-001 SUP Custom 27803010 6265-2-001 - STEM FEMORAL 132D 1 11MM 115MM 31MM COLLAR PRESS FIT BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6265-2-002 SUP Custom 27803010 6265-2-002 - STEM FEMORAL 132D 2 12MM 130MM 32MM COLLAR PRESS FIT BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6265-2-003 SUP Custom 27803010 6265-2-003 - STEM FEMORAL 132D 3 13MM 130MM 34MM COLLAR PRESS FIT BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6265-2-004 SUP Custom 27803010 6265-2-004 - STEM FEMORAL 132D 4 14MM 140MM 35MM COLLAR PRESS FIT BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6265-2-005 SUP Custom 27803010 6265-2-005 - STEM FEMORAL 5 15MM CEMENTED COLLARED PRESS FIT RELIANCE PF BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6265-2-006 SUP Custom 27803010 6265-2-006 - STEM FEMORAL 132D 6 16MM 150MM 37MM COLLAR PRESS FIT BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6265-2-007 SUP Custom 27803010 6265-2-007 - STEM FEMORAL 132D 7 17MM 150MM 39MM COLLAR PRESS FIT BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6265-3-099 SUP Custom 27803010 6265-3-099 - STEM FEMORAL 138D 00 100MM 25MM CEMENT COLLAR DEFINITION PM BOTH IP/OP "$4,488.00" "$3,321.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" N/A "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 6265-3-100 SUP Custom 27803010 6265-3-100 - STEM FEMORAL 138D 0 100MM 25MM CEMENT COLLAR DEFINITION PM BOTH IP/OP "$4,488.00" "$3,321.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $798.86 "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" $935.35 "$4,488.00" "$1,795.20" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$4,488.00" "$3,366.00" "$4,488.00" "$4,488.00" "$4,488.00" "$2,244.00" "$2,244.00" "$3,554.50" "$4,488.00" "$3,590.40" "$2,019.60" "$4,488.00" N/A "$2,603.04" "$4,488.00" "$2,692.80" "$4,488.00" "$4,488.00" "$4,488.00" N/A N/A 6265-3-101 SUP Custom 27803010 6265-3-101 - STEM FEM 132D 1 34MM OFST 10MM 115MM 26MM CITN PUREFIX TMZF BOTH IP/OP "$4,123.00" "$3,051.00" $733.89 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $733.89 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $859.28 "$4,123.00" "$1,649.20" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$3,092.25" "$4,123.00" "$4,123.00" "$4,123.00" "$2,061.50" "$2,061.50" "$3,265.42" "$4,123.00" "$3,298.40" "$1,855.35" "$4,123.00" N/A "$2,391.34" "$4,123.00" "$2,473.80" "$4,123.00" "$4,123.00" "$4,123.00" N/A N/A 6265-3-102 SUP Custom 27803010 6265-3-102 - STEM FEMORAL 132D 2 36MM 115MM 32MM CEMENTED COLLARED BASE BOTH IP/OP "$4,123.00" "$3,051.00" $733.89 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $733.89 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $859.28 "$4,123.00" "$1,649.20" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$3,092.25" "$4,123.00" "$4,123.00" "$4,123.00" "$2,061.50" "$2,061.50" "$3,265.42" "$4,123.00" "$3,298.40" "$1,855.35" "$4,123.00" N/A "$2,391.34" "$4,123.00" "$2,473.80" "$4,123.00" "$4,123.00" "$4,123.00" N/A N/A 6265-3-103 SUP Custom 27803010 6265-3-103 - STEM FEMORAL 132D 3 115MM 34MM CEMENTED COLLARED DEFINITION BOTH IP/OP "$4,123.00" "$3,051.00" $733.89 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $733.89 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $859.28 "$4,123.00" "$1,649.20" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$3,092.25" "$4,123.00" "$4,123.00" "$4,123.00" "$2,061.50" "$2,061.50" "$3,265.42" "$4,123.00" "$3,298.40" "$1,855.35" "$4,123.00" N/A "$2,391.34" "$4,123.00" "$2,473.80" "$4,123.00" "$4,123.00" "$4,123.00" N/A N/A 6265-3-104 SUP Custom 27803010 6265-3-104 - STEM FEMORAL 132D 4 125MM 35MM CEMENT COLLAR DEFINITION PM BOTH IP/OP "$4,123.00" "$3,051.00" $733.89 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $733.89 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $859.28 "$4,123.00" "$1,649.20" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$3,092.25" "$4,123.00" "$4,123.00" "$4,123.00" "$2,061.50" "$2,061.50" "$3,265.42" "$4,123.00" "$3,298.40" "$1,855.35" "$4,123.00" N/A "$2,391.34" "$4,123.00" "$2,473.80" "$4,123.00" "$4,123.00" "$4,123.00" N/A N/A 6265-3-105 SUP Custom 27803010 6265-3-105 - STEM FEMORAL 5 CEMENT DEFINITION PM HIP BOTH IP/OP "$4,123.00" "$3,051.00" $733.89 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $733.89 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $859.28 "$4,123.00" "$1,649.20" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$3,092.25" "$4,123.00" "$4,123.00" "$4,123.00" "$2,061.50" "$2,061.50" "$3,265.42" "$4,123.00" "$3,298.40" "$1,855.35" "$4,123.00" N/A "$2,391.34" "$4,123.00" "$2,473.80" "$4,123.00" "$4,123.00" "$4,123.00" N/A N/A 6265-3-106 SUP Custom 27803010 6265-3-106 - STEM FEMORAL 6 CEMENT DEFINITION PM HIP BOTH IP/OP "$4,123.00" "$3,051.00" $733.89 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $733.89 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $859.28 "$4,123.00" "$1,649.20" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$3,092.25" "$4,123.00" "$4,123.00" "$4,123.00" "$2,061.50" "$2,061.50" "$3,265.42" "$4,123.00" "$3,298.40" "$1,855.35" "$4,123.00" N/A "$2,391.34" "$4,123.00" "$2,473.80" "$4,123.00" "$4,123.00" "$4,123.00" N/A N/A 6265-3-107 SUP Custom 27803010 6265-3-107 - STEM FEMORAL 7 CEMENT DEFINITION PM HIP BOTH IP/OP "$4,123.00" "$3,051.00" $733.89 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $733.89 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $859.28 "$4,123.00" "$1,649.20" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$3,092.25" "$4,123.00" "$4,123.00" "$4,123.00" "$2,061.50" "$2,061.50" "$3,265.42" "$4,123.00" "$3,298.40" "$1,855.35" "$4,123.00" N/A "$2,391.34" "$4,123.00" "$2,473.80" "$4,123.00" "$4,123.00" "$4,123.00" N/A N/A 6265-3-111 SUP Custom 27803010 6265-3-111 - STEM FEMORAL 132D 1 34MM OFFST 100MM 31MM BASE HEAD CEMENT BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6265-3-112 SUP Custom 27803010 6265-3-112 - STEM FEMORAL 132D 2 36MM OFFST 115MM 32MM BASE HEAD CEMENT BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6265-3-113 SUP Custom 27803010 6265-3-113 - STEM FEMORAL 132D 3 40MM OFFST 115MM 34MM BASE HEAD CEMENT BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6265-3-114 SUP Custom 27803010 6265-3-114 - STEM FEMORAL 132D 4 44MM OFFST 125MM 35MM BASE HEAD CEMENT BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6265-3-115 SUP Custom 27803010 6265-3-115 - STEM FEMORAL 132D 5 47MM OFFST 125MM 37MM BASE HEAD CEMENT BOTH IP/OP "$2,877.50" "$2,129.00" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $512.20 "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" $599.70 "$2,877.50" "$1,151.00" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,877.50" "$2,158.13" "$2,877.50" "$2,877.50" "$2,877.50" "$1,438.75" "$1,438.75" "$2,278.98" "$2,877.50" "$2,302.00" "$1,294.88" "$2,877.50" N/A "$1,668.95" "$2,877.50" "$1,726.50" "$2,877.50" "$2,877.50" "$2,877.50" N/A N/A 6265-4-010 SUP Custom 27803010 6265-4-010 - CENTRALIZER STEM 10MM TYPE AA TAPERED DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-011 SUP Custom 27803010 6265-4-011 - CENTRALIZER STEM 11MM TYPE AA TAPERED DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-103 SUP HCPCS C1776 6265-4-103 - STEM FEMORAL 3 115MM CEMENTED STANDARD OFFST DEFINITION PM BOTH IP/OP "$4,123.00" "$3,051.00" $818.31 "$4,123.00" "$1,855.35" "$1,855.35" "$1,855.35" "$1,855.35" "$4,123.00" "$4,123.00" "$4,123.00" $859.34 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $859.28 "$4,123.00" "$1,649.20" "$2,032.64" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$3,092.25" "$4,123.00" "$4,123.00" "$4,123.00" "$2,061.50" "$2,061.50" "$3,265.42" "$4,123.00" "$3,298.40" "$1,855.35" $818.31 N/A "$2,391.34" "$4,123.00" "$2,473.80" "$4,123.00" $859.23 "$4,123.00" N/A N/A 6265-4-105 SUP HCPCS C1776 6265-4-105 - STEM FEMORAL 5 125MM CEMENTED STANDARD OFFST DEFINITION PM BOTH IP/OP "$4,123.00" "$3,051.00" $818.31 "$4,123.00" "$1,855.35" "$1,855.35" "$1,855.35" "$1,855.35" "$4,123.00" "$4,123.00" "$4,123.00" $859.34 "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" $859.28 "$4,123.00" "$1,649.20" "$2,032.64" "$4,123.00" "$4,123.00" "$4,123.00" "$4,123.00" "$3,092.25" "$4,123.00" "$4,123.00" "$4,123.00" "$2,061.50" "$2,061.50" "$3,265.42" "$4,123.00" "$3,298.40" "$1,855.35" $818.31 N/A "$2,391.34" "$4,123.00" "$4,123.00" "$4,123.00" $859.23 "$4,123.00" N/A N/A 6265-4-411 SUP Custom 27803010 6265-4-411 - CENTRALIZER STEM 11MM TYPE A MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-412 SUP Custom 27803010 6265-4-412 - CENTRALIZER STEM 12MM TYPE A MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-413 SUP Custom 27803010 6265-4-413 - CENTRALIZER STEM 13MM TYPE A MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-414 SUP Custom 27803010 6265-4-414 - CENTRALIZER STEM 14MM TYPE A MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-415 SUP Custom 27803010 6265-4-415 - CENTRALIZER STEM 15MM TYPE A MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-416 SUP Custom 27803010 6265-4-416 - CENTRALIZER STEM 16MM TYPE A MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-417 SUP Custom 27803010 6265-4-417 - CENTRALIZER STEM 17MM TYPE A MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-418 SUP Custom 27803010 6265-4-418 - CENTRALIZER STEM 18MM TYPE A MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-515 SUP Custom 27803010 6265-4-515 - CENTRALIZER STEM 15MM TYPE B MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-516 SUP Custom 27803010 6265-4-516 - CENTRALIZER STEM 16MM TYPE B MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-517 SUP Custom 27803010 6265-4-517 - CENTRALIZER STEM 17MM TYPE B MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-518 SUP Custom 27803010 6265-4-518 - CENTRALIZER STEM 18MM TYPE B MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-519 SUP Custom 27803010 6265-4-519 - CENTRALIZER STEM 19MM TYPE B MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-520 SUP Custom 27803010 6265-4-520 - CENTRALIZER STEM 20MM TYPE B MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-521 SUP Custom 27803010 6265-4-521 - CENTRALIZER STEM 21MM TYPE B MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-4-522 SUP Custom 27803010 6265-4-522 - CENTRALIZER STEM 22MM TYPE B MODIFY DEFINITION HIP FEMUR BOTH IP/OP $188.00 $139.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $33.46 $188.00 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $75.20 $188.00 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $188.00 N/A $109.04 $188.00 $112.80 $188.00 $188.00 $188.00 N/A N/A 6265-5-100 SUP HCPCS C1776 6265-5-100 - STEM FEMORAL 132D 0 34MM OFFST 9MM 110MM 26MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-101 SUP HCPCS C1776 6265-5-101 - STEM FEMORAL 132D 1 34MM OFFST 10MM 115MM 26MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-102 SUP HCPCS C1776 6265-5-102 - STEM FEMORAL 132D 2 36MM OFFST 11MM 120MM 26MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-103 SUP HCPCS C1776 6265-5-103 - STEM FEMORAL 132D 3 40MM OFFST 12MM 125MM 28MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-104 SUP HCPCS C1776 6265-5-104 - STEM FEMORAL 132D 4 44MM OFFST 13MM 130MM 30MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-105 SUP HCPCS C1776 6265-5-105 - STEM FEMORAL 132D 5 47MM OFFST 14MM 135MM 31MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-106 SUP HCPCS C1776 6265-5-106 - STEM FEMORAL 132D 6 50MM OFFST 15MM 140MM 32MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-107 SUP HCPCS C1776 6265-5-107 - STEM FEMORAL 132D 7 52MM OFFST 16MM 140MM 34MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-108 SUP HCPCS C1776 6265-5-108 - STEM FEMORAL 132D 8 55MM OFFST 17MM 145MM 39MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-109 SUP HCPCS C1776 6265-5-109 - STEM FEMORAL 132D 9 55MM OFFST 18MM 150MM 39MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-110 SUP HCPCS C1776 6265-5-110 - STEM FEMORAL 132D 0 34MM OFFST 9MM 110MM 26MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-111 SUP HCPCS C1776 6265-5-111 - STEM FEMORAL 132D 1 34MM OFFST 10MM 115MM 26MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-112 SUP HCPCS C1776 6265-5-112 - STEM FEMORAL 132D 2 36MM OFFST 11MM 120MM 26MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-113 SUP HCPCS C1776 6265-5-113 - STEM FEMORAL 132D 3 40MM OFFST 12MM 125MM 28MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-114 SUP HCPCS C1776 6265-5-114 - STEM FEMORAL 132D 4 44MM OFFST 13MM 130MM 30MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-115 SUP HCPCS C1776 6265-5-115 - STEM FEMORAL 132D 5 47MM OFFST 14MM 135MM 31MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-116 SUP HCPCS C1776 6265-5-116 - STEM FEMORAL 132D 6 50MM OFFST 15MM 140MM 32MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-117 SUP HCPCS C1776 6265-5-117 - STEM FEMORAL 132D 7 52MM OFFST 16MM 140MM 34MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-118 SUP HCPCS C1776 6265-5-118 - STEM FEMORAL 132D 8 55MM OFFST 17MM 145MM 39MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5-119 SUP HCPCS C1776 6265-5-119 - STEM FEMORAL 132D 9 55MM OFFST 18MM 150MM 39MM CITATION BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5200 SUP HCPCS C1776 6265-5200 - STEM FEMORAL 0 SHORT CITATION TMZF HYDRXAPT LEFT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5201 SUP HCPCS C1776 6265-5201 - STEM FEMORAL 1 SHORT CITATION TMZF HYDRXAPT LEFT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5202 SUP HCPCS C1776 6265-5202 - STEM FEMORAL 2 SHORT CITATION TMZF HYDRXAPT LEFT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5203 SUP HCPCS C1776 6265-5203 - STEM FEMORAL 3 SHORT CITATION TMZF HYDRXAPT LEFT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5204 SUP HCPCS C1776 6265-5204 - STEM FEMORAL 4 SHORT CITATION TMZF HYDRXAPT LEFT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5205 SUP HCPCS C1776 6265-5205 - STEM FEMORAL 5 SHORT CITATION TMZF HYDRXAPT LEFT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5206 SUP HCPCS C1776 6265-5206 - STEM FEMORAL 6 SHORT CITATION TMZF HYDRXAPT LEFT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5207 SUP HCPCS C1776 6265-5207 - STEM FEMORAL 7 SHORT CITATION TMZF HYDRXAPT LEFT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5208 SUP HCPCS C1776 6265-5208 - STEM FEMORAL 8 SHORT CITATION TMZF HYDRXAPT LEFT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5209 SUP HCPCS C1776 6265-5209 - STEM FEMORAL 9 SHORT CITATION TMZF HYDRXAPT LEFT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5210 SUP HCPCS C1776 6265-5210 - STEM FEMORAL 0 SHORT CITATION TMZF HYDRXAPT RIGHT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5211 SUP HCPCS C1776 6265-5211 - STEM FEMORAL 1 SHORT CITATION TMZF HYDRXAPT RIGHT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5212 SUP HCPCS C1776 6265-5212 - STEM FEMORAL 2 SHORT CITATION TMZF HYDRXAPT RIGHT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5213 SUP HCPCS C1776 6265-5213 - STEM FEMORAL 3 SHORT CITATION TMZF HYDRXAPT RIGHT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5214 SUP HCPCS C1776 6265-5214 - STEM FEMORAL 4 SHORT CITATION TMZF HYDRXAPT RIGHT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5215 SUP HCPCS C1776 6265-5215 - STEM FEMORAL 5 SHORT CITATION TMZF HYDRXAPT RIGHT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5216 SUP HCPCS C1776 6265-5216 - STEM FEMORAL 6 SHORT CITATION TMZF HYDRXAPT RIGHT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5217 SUP HCPCS C1776 6265-5217 - STEM FEMORAL 7 SHORT CITATION TMZF HYDRXAPT RIGHT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5218 SUP HCPCS C1776 6265-5218 - STEM FEMORAL 8 SHORT CITATION TMZF HYDRXAPT RIGHT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 6265-5219 SUP HCPCS C1776 6265-5219 - STEM FEMORAL 9 SHORT CITATION TMZF HYDRXAPT RIGHT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A 626631US SUP Custom 27803010 626631US - KIT PRESSURE MONITR 14GA BASIC TRANSDUCER TUOHY NEEDLE BOTH IP/OP "$2,044.00" "$1,513.00" $363.83 "$2,043.98" "$2,043.98" "$2,043.98" "$2,043.98" "$2,043.98" "$2,043.98" "$2,043.98" $363.83 "$2,043.98" "$2,043.98" "$2,043.98" "$2,043.98" "$2,043.98" "$2,043.98" $425.99 "$2,043.98" $817.59 "$2,043.98" "$2,043.98" "$2,043.98" "$2,043.98" "$2,043.98" "$1,533.00" "$2,043.98" "$2,043.98" "$2,043.98" "$1,021.99" "$1,021.99" "$1,618.83" "$2,043.98" "$1,635.18" $919.79 "$2,043.98" N/A "$1,185.52" "$2,043.98" "$1,226.39" "$2,043.98" "$2,043.98" "$2,043.98" N/A N/A 626653US SUP Custom 27803010 626653US - KIT PRESSURE MONITR 38CM TRANSDUCER CATHETER TUNNELING BOTH IP/OP "$2,210.50" "$1,636.00" $393.44 "$2,210.35" "$2,210.35" "$2,210.35" "$2,210.35" "$2,210.35" "$2,210.35" "$2,210.35" $393.44 "$2,210.35" "$2,210.35" "$2,210.35" "$2,210.35" "$2,210.35" "$2,210.35" $460.66 "$2,210.35" $884.14 "$2,210.35" "$2,210.35" "$2,210.35" "$2,210.35" "$2,210.35" "$1,657.88" "$2,210.35" "$2,210.35" "$2,210.35" "$1,105.18" "$1,105.18" "$1,750.60" "$2,210.35" "$1,768.28" $994.66 "$2,210.35" N/A "$1,282.09" "$2,210.35" "$1,326.21" "$2,210.35" "$2,210.35" "$2,210.35" N/A N/A 6269-1-212 SUP HCPCS C1776 6269-1-212 - STEM FEMORAL 2 12MM 10IN BOWED RSTOR TITANIUM LEFT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$13,745.88" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-1-414 SUP HCPCS C1776 6269-1-414 - STEM FEMORAL 4 14MM 10IN BOWED RSTOR TITANIUM LEFT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$13,745.88" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-1-719 SUP HCPCS C1776 6269-1-719 - STEM FEMORAL 7 19MM 10IN BOWED RSTOR TITANIUM LEFT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$13,745.88" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-1-818 SUP HCPCS C1776 6269-1-818 - STEM FEMORAL 8 18MM 10IN BOWED RSTOR TITANIUM LEFT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-1-820 SUP HCPCS C1776 6269-1-820 - STEM FEMORAL 8 20MM 10IN BOWED RSTOR TITANIUM LEFT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-1-921 SUP HCPCS C1776 6269-1-921 - STEM FEMORAL 9 21MM 10IN BOWED RSTOR TITANIUM LEFT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-2-212 SUP HCPCS C1776 6269-2-212 - STEM FEMORAL 2 12MM 10IN BOWED RSTOR TITANIUM RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-2-313 SUP HCPCS C1776 6269-2-313 - STEM FEMORAL 3 13MM 10IN BOWED RSTOR TITANIUM RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-2-414 SUP HCPCS C1776 6269-2-414 - STEM FEMORAL 4 14MM 10IN BOWED RSTOR TITANIUM RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-2-515 SUP HCPCS C1776 6269-2-515 - STEM FEMORAL 5 15MM 10IN BOWED RSTOR TITANIUM RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$13,745.88" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-2-616 SUP HCPCS C1776 6269-2-616 - STEM FEMORAL 6 16MM 10IN BOWED RSTOR TITANIUM RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$13,745.88" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-2-717 SUP HCPCS C1776 6269-2-717 - STEM FEMORAL 7 17MM 10IN BOWED RSTOR TITANIUM RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$8,247.53" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-2-719 SUP HCPCS C1776 6269-2-719 - STEM FEMORAL 7 19MM 10IN BOWED RSTOR TITANIUM RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-2-818 SUP HCPCS C1776 6269-2-818 - STEM FEMORAL 8 18MM 10IN BOWED RSTOR TITANIUM RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-2-820 SUP HCPCS C1776 6269-2-820 - STEM FEMORAL 8 20MM 10IN BOWED RSTOR TITANIUM RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-2-921 SUP HCPCS C1776 6269-2-921 - STEM FEMORAL 9 21MM 10IN BOWED RSTOR TITANIUM RIGHT HIP BOTH IP/OP "$13,746.00" "$10,172.00" "$2,728.21" "$13,745.88" "$6,185.65" "$6,185.65" "$6,185.65" "$6,185.65" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.99" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.79" "$13,745.88" "$5,498.35" "$6,776.72" "$13,745.88" "$13,745.88" "$13,745.88" "$13,745.88" "$10,309.50" "$13,745.88" "$13,745.88" "$13,745.88" "$6,872.94" "$6,872.94" "$10,886.74" "$13,745.88" "$10,996.70" "$6,185.65" "$2,728.21" N/A "$7,972.68" "$13,745.88" "$13,745.88" "$13,745.88" "$2,864.64" "$13,745.88" N/A N/A 6269-3-111 SUP HCPCS C1776 6269-3-111 - STEM FEMORAL 1 BOW 11MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-3-113 SUP HCPCS C1776 6269-3-113 - STEM FEMORAL 1 BOW 13MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-3-212 SUP HCPCS C1776 6269-3-212 - STEM FEMORAL 2 BOW 12MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-3-214 SUP HCPCS C1776 6269-3-214 - STEM FEMORAL 2 BOW 14MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-3-313 SUP HCPCS C1776 6269-3-313 - STEM FEMORAL 3 BOW 13MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-3-315 SUP HCPCS C1776 6269-3-315 - STEM FEMORAL 3 BOW 15MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-3-414 SUP HCPCS C1776 6269-3-414 - STEM FEMORAL 4 BOW 14MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-3-416 SUP HCPCS C1776 6269-3-416 - STEM FEMORAL 4 BOW 16MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-3-515 SUP HCPCS C1776 6269-3-515 - STEM FEMORAL 5 BOW 15MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-3-517 SUP HCPCS C1776 6269-3-517 - STEM FEMORAL 5 BOW 17MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-3-616 SUP HCPCS C1776 6269-3-616 - STEM FEMORAL 6 BOW 16MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-3-618 SUP HCPCS C1776 6269-3-618 - STEM FEMORAL 6 BOW 18MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-3-717 SUP HCPCS C1776 6269-3-717 - STEM FEMORAL 7 BOW 17MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-3-818 SUP HCPCS C1776 6269-3-818 - STEM FEMORAL 8 BOW 18MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-3-820 SUP HCPCS C1776 6269-3-820 - STEM FEMORAL 8 BOW 20MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-111 SUP HCPCS C1776 6269-4-111 - STEM FEMORAL 1 BOW 11MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-113 SUP HCPCS C1776 6269-4-113 - STEM FEMORAL 1 BOW 13MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-212 SUP HCPCS C1776 6269-4-212 - STEM FEMORAL 2 BOW 12MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-214 SUP HCPCS C1776 6269-4-214 - STEM FEMORAL 2 BOW 14MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-313 SUP HCPCS C1776 6269-4-313 - STEM FEMORAL 3 BOW 13MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-315 SUP HCPCS C1776 6269-4-315 - STEM FEMORAL 3 BOW 15MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-414 SUP HCPCS C1776 6269-4-414 - STEM FEMORAL 4 BOW 14MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-416 SUP HCPCS C1776 6269-4-416 - STEM FEMORAL 4 BOW 16MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-515 SUP HCPCS C1776 6269-4-515 - STEM FEMORAL 5 BOW 15MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-517 SUP HCPCS C1776 6269-4-517 - STEM FEMORAL 5 BOW 17MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-616 SUP HCPCS C1776 6269-4-616 - STEM FEMORAL 6 BOW 16MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-618 SUP HCPCS C1776 6269-4-618 - STEM FEMORAL 6 BOW 18MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-717 SUP HCPCS C1776 6269-4-717 - STEM FEMORAL 7 BOW 17MM 10IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-719 SUP HCPCS C1776 6269-4-719 - STEM FEMORAL 7 BOW 19MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-818 SUP HCPCS C1776 6269-4-818 - STEM FEMORAL 8 BOW 18MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-820 SUP HCPCS C1776 6269-4-820 - STEM FEMORAL 8 BOW 20MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$5,312.45" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$7,968.68" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6269-4-921 SUP HCPCS C1776 6269-4-921 - STEM FEMORAL 9 BOW 21MM 8IN RSTOR TITANIUM PLASMA SPRAY HIP BOTH IP/OP "$13,281.50" "$9,828.00" "$2,635.97" "$13,281.13" "$5,976.51" "$5,976.51" "$5,976.51" "$5,976.51" "$13,281.13" "$13,281.13" "$13,281.13" "$2,768.12" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.93" "$13,281.13" "$13,281.13" "$6,547.60" "$13,281.13" "$13,281.13" "$13,281.13" "$13,281.13" "$9,961.13" "$13,281.13" "$13,281.13" "$13,281.13" "$6,640.57" "$6,640.57" "$10,518.65" "$13,281.13" "$10,624.90" "$5,976.51" "$2,635.97" N/A "$7,703.27" "$13,281.13" "$13,281.13" "$13,281.13" "$2,767.79" "$13,281.13" N/A N/A 6276-1-019 SUP HCPCS C1776 6276-1-019 - BODY CONE +0MM STANDARD 19MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-021 SUP HCPCS C1776 6276-1-021 - BODY CONE +0MM STANDARD 21MM MODULAR REVISION BOLT RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-023 SUP HCPCS C1776 6276-1-023 - BODY CONE +0MM STANDARD 23MM 23MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-025 SUP HCPCS C1776 6276-1-025 - BODY CONE +0MM STANDARD 25MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-027 SUP HCPCS C1776 6276-1-027 - BODY CONE +0MM STANDARD 27MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-029 SUP HCPCS C1776 6276-1-029 - BODY CONE +0MM STANDARD 29MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-031 SUP HCPCS C1776 6276-1-031 - BODY CONE +0MM STANDARD 31MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-119 SUP HCPCS C1776 6276-1-119 - BODY CONE +10MM 19MM MODULAR RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-121 SUP HCPCS C1776 6276-1-121 - BODY CONE +10MM 21MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-123 SUP HCPCS C1776 6276-1-123 - BODY CONE +10MM 23MM RSTR MDLR REV TI HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-125 SUP HCPCS C1776 6276-1-125 - BODY CONE +10MM 25MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-127 SUP HCPCS C1776 6276-1-127 - BODY CONE +10MM 27MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-129 SUP HCPCS C1776 6276-1-129 - BODY CONE +10MM 29MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-131 SUP HCPCS C1776 6276-1-131 - BODY CONE +10MM 31MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-219 SUP HCPCS C1776 6276-1-219 - BODY CONE +20MM 19MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-221 SUP HCPCS C1776 6276-1-221 - BODY CONE +20MM 21MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-223 SUP HCPCS C1776 6276-1-223 - BODY CONE +20MM 23MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-225 SUP HCPCS C1776 6276-1-225 - BODY CONE +20MM 25MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-227 SUP HCPCS C1776 6276-1-227 - BODY CONE +20MM 27MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-229 SUP HCPCS C1776 6276-1-229 - BODY CONE +20MM 29MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-231 SUP HCPCS C1776 6276-1-231 - BODY CONE +20MM 31MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-319 SUP HCPCS C1776 6276-1-319 - BODY CONE +30MM 19MM MODULAR RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-321 SUP HCPCS C1776 6276-1-321 - BODY CONE +30MM 21MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-323 SUP HCPCS C1776 6276-1-323 - BODY CONE +30MM 23MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-325 SUP HCPCS C1776 6276-1-325 - BODY CONE +30MM 25MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-327 SUP HCPCS C1776 6276-1-327 - BODY CONE +30MM 27MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-329 SUP HCPCS C1776 6276-1-329 - BODY CONE +30MM 29MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-1-331 SUP HCPCS C1776 6276-1-331 - BODY CONE +30MM 31MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-019 SUP HCPCS C1776 6276-2-019 - BODY MILLED 19MM MODULAR SHALLOW RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-021 SUP HCPCS C1776 6276-2-021 - BODY MILLED 21MM MODULAR SHALLOW RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-023 SUP HCPCS C1776 6276-2-023 - BODY MILLED 23MM MODULAR SHALLOW RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-025 SUP HCPCS C1776 6276-2-025 - BODY MILLED 25MM MODULAR SHALLOW RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-027 SUP HCPCS C1776 6276-2-027 - BODY MILLED 27MM MODULAR SHALLOW RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-029 SUP HCPCS C1776 6276-2-029 - BODY MILLED 29MM MODULAR SHALLOW RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-031 SUP HCPCS C1776 6276-2-031 - BODY MILLED 31MM MODULAR SHALLOW RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-119 SUP HCPCS C1776 6276-2-119 - BODY MILLED 19MM MODULAR DEEP RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-121 SUP HCPCS C1776 6276-2-121 - BODY MILLED 21MM MODULAR DEEP RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-123 SUP HCPCS C1776 6276-2-123 - BODY MILLED 23MM MODULAR DEEP RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-125 SUP HCPCS C1776 6276-2-125 - BODY MILLED 25MM MODULAR DEEP RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-127 SUP HCPCS C1776 6276-2-127 - BODY MILLED 27MM MODULAR DEEP RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$5,653.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-129 SUP HCPCS C1776 6276-2-129 - BODY MILLED 29MM MODULAR DEEP RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-131 SUP HCPCS C1776 6276-2-131 - BODY MILLED 31MM MODULAR DEEP RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-227 SUP HCPCS C1776 6276-2-227 - BODY MILLED 27MM MODULAR EXTRA DEEP RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-229 SUP HCPCS C1776 6276-2-229 - BODY MILLED 29MM MODULAR EXTRA DEEP RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-2-231 SUP HCPCS C1776 6276-2-231 - BODY MILLED 31MM MODULAR EXTRA DEEP RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-3-001 SUP HCPCS C1776 6276-3-001 - BODY BROACHED 1 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-3-002 SUP HCPCS C1776 6276-3-002 - BODY BROACHED 2 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-3-003 SUP HCPCS C1776 6276-3-003 - BODY BROACHED 3 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-3-004 SUP HCPCS C1776 6276-3-004 - BODY BROACHED 4 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-3-005 SUP HCPCS C1776 6276-3-005 - BODY BROACHED 5 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-3-006 SUP HCPCS C1776 6276-3-006 - BODY BROACHED 6 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-3-007 SUP HCPCS C1776 6276-3-007 - BODY BROACHED 7 REVISION MODULAR RSTOR HIP FEMUR BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$9,422.50" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-3-008 SUP HCPCS C1776 6276-3-008 - BODY BROACHED 8 REVISION MODULAR RSTOR HIP FEMUR PROXIMAL BOTH IP/OP "$9,422.50" "$6,973.00" "$1,870.13" "$9,422.50" "$4,240.13" "$4,240.13" "$4,240.13" "$4,240.13" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.88" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.75" "$9,422.50" "$3,769.00" "$4,645.29" "$9,422.50" "$9,422.50" "$9,422.50" "$9,422.50" "$7,066.88" "$9,422.50" "$9,422.50" "$9,422.50" "$4,711.25" "$4,711.25" "$7,462.62" "$9,422.50" "$7,538.00" "$4,240.13" "$1,870.13" N/A "$5,465.05" "$9,422.50" "$9,422.50" "$9,422.50" "$1,963.65" "$9,422.50" N/A N/A 6276-4-119 SUP HCPCS C1776 6276-4-119 - BODY CALCAR +10MM OFFST 19MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$9,827.50" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-121 SUP HCPCS C1776 6276-4-121 - BODY CALCAR +10MM OFFST 21MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-123 SUP HCPCS C1776 6276-4-123 - BODY CALCAR +10MM OFFST 23MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-125 SUP HCPCS C1776 6276-4-125 - BODY CALCAR +10MM OFFST 25MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$9,827.50" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-127 SUP HCPCS C1776 6276-4-127 - BODY CALCAR +10MM OFFST 27MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-129 SUP HCPCS C1776 6276-4-129 - BODY CALCAR +10MM OFFST 29MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$9,827.50" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-131 SUP HCPCS C1776 6276-4-131 - BODY CALCAR +10MM OFFST 31MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-219 SUP HCPCS C1776 6276-4-219 - BODY CALCAR +20MM OFFST 19MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-221 SUP HCPCS C1776 6276-4-221 - BODY CALCAR +20MM OFFST 21MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-223 SUP HCPCS C1776 6276-4-223 - BODY CALCAR +20MM OFFST 23MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-225 SUP HCPCS C1776 6276-4-225 - BODY CALCAR +20MM OFFST 25MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-227 SUP HCPCS C1776 6276-4-227 - BODY CALCAR +20MM OFFST 27MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-229 SUP HCPCS C1776 6276-4-229 - BODY CALCAR +20MM OFFST 29MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-231 SUP HCPCS C1776 6276-4-231 - BODY CALCAR +20MM OFFST 31MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-319 SUP HCPCS C1776 6276-4-319 - BODY CALCAR +30MM OFFST 19MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-321 SUP HCPCS C1776 6276-4-321 - BODY CALCAR +30MM OFFST 21MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-323 SUP HCPCS C1776 6276-4-323 - BODY CALCAR +30MM OFFST 23MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$9,827.50" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-325 SUP HCPCS C1776 6276-4-325 - BODY CALCAR +30MM OFFST 25MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-327 SUP HCPCS C1776 6276-4-327 - BODY CALCAR +30MM OFFST 27MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$3,931.00" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-329 SUP HCPCS C1776 6276-4-329 - BODY CALCAR +30MM OFFST 29MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$9,827.50" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-4-331 SUP HCPCS C1776 6276-4-331 - BODY CALCAR +30MM OFFST 31MM MODULAR RSTOR HIP BOTH IP/OP "$9,827.50" "$7,272.00" "$1,950.51" "$9,827.50" "$4,422.38" "$4,422.38" "$4,422.38" "$4,422.38" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.30" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$2,048.16" "$9,827.50" "$9,827.50" "$4,844.96" "$9,827.50" "$9,827.50" "$9,827.50" "$9,827.50" "$7,370.63" "$9,827.50" "$9,827.50" "$9,827.50" "$4,913.75" "$4,913.75" "$7,783.38" "$9,827.50" "$7,862.00" "$4,422.38" "$1,950.51" N/A "$5,699.95" "$9,827.50" "$5,896.50" "$9,827.50" "$2,048.05" "$9,827.50" N/A N/A 6276-5-011 SUP HCPCS C1776 6276-5-011 - STEM FEMORAL STR 11MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-012 SUP HCPCS C1776 6276-5-012 - STEM FEMORAL STR 12MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-013 SUP HCPCS C1776 6276-5-013 - STEM FEMORAL STR 13MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$2,967.00" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-014 SUP HCPCS C1776 6276-5-014 - STEM FEMORAL STR 14MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$2,967.00" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-015 SUP HCPCS C1776 6276-5-015 - STEM FEMORAL STR 15MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-016 SUP HCPCS C1776 6276-5-016 - STEM FEMORAL STR 16MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-017 SUP HCPCS C1776 6276-5-017 - STEM FEMORAL STR 17MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$2,967.00" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-018 SUP HCPCS C1776 6276-5-018 - STEM FEMORAL STR 18MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$2,967.00" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-019 SUP HCPCS C1776 6276-5-019 - STEM FEMORAL STR 19MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$2,967.00" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-020 SUP HCPCS C1776 6276-5-020 - STEM FEMORAL STR 20MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$2,967.00" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-021 SUP HCPCS C1776 6276-5-021 - STEM FEMORAL STR 21MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$2,967.00" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-022 SUP HCPCS C1776 6276-5-022 - STEM FEMORAL STR 22MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$2,967.00" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-023 SUP HCPCS C1776 6276-5-023 - STEM FEMORAL STR 23MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$2,967.00" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-024 SUP HCPCS C1776 6276-5-024 - STEM FEMORAL STR 24MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-025 SUP HCPCS C1776 6276-5-025 - STEM FEMORAL STR 25MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-026 SUP HCPCS C1776 6276-5-026 - STEM FEMORAL STR 26MM 127MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-111 SUP HCPCS C1776 6276-5-111 - STEM FEMORAL 11MM 167MM MODULAR STR PLASMA RSTOR DISTAL BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-112 SUP HCPCS C1776 6276-5-112 - STEM FEMORAL STR 12MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-113 SUP HCPCS C1776 6276-5-113 - STEM FEMORAL STR 13MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-114 SUP HCPCS C1776 6276-5-114 - STEM FEMORAL STR 14MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-115 SUP HCPCS C1776 6276-5-115 - STEM FEMORAL STR 15MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-116 SUP HCPCS C1776 6276-5-116 - STEM FEMORAL STR 16MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-117 SUP HCPCS C1776 6276-5-117 - STEM FEMORAL STR 17MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-118 SUP HCPCS C1776 6276-5-118 - STEM FEMORAL STR 18MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-119 SUP HCPCS C1776 6276-5-119 - STEM FEMORAL STR 19MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-120 SUP HCPCS C1776 6276-5-120 - STEM FEMORAL STR 20MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$2,967.00" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-121 SUP HCPCS C1776 6276-5-121 - STEM FEMORAL STR 21MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-122 SUP HCPCS C1776 6276-5-122 - STEM FEMORAL STR 22MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-123 SUP HCPCS C1776 6276-5-123 - STEM FEMORAL STR 23MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-124 SUP HCPCS C1776 6276-5-124 - STEM FEMORAL STR 24MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-125 SUP HCPCS C1776 6276-5-125 - STEM FEMORAL STR 25MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-126 SUP HCPCS C1776 6276-5-126 - STEM FEMORAL STR 26MM 167MM MODULAR RSTOR HA POROUS PLASMA BOTH IP/OP "$7,417.50" "$5,489.00" "$1,472.19" "$7,417.50" "$3,337.88" "$3,337.88" "$3,337.88" "$3,337.88" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.99" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$1,545.89" "$7,417.50" "$7,417.50" "$3,656.83" "$7,417.50" "$7,417.50" "$7,417.50" "$7,417.50" "$5,563.13" "$7,417.50" "$7,417.50" "$7,417.50" "$3,708.75" "$3,708.75" "$5,874.66" "$7,417.50" "$5,934.00" "$3,337.88" "$1,472.19" N/A "$4,302.15" "$7,417.50" "$4,450.50" "$7,417.50" "$1,545.81" "$7,417.50" N/A N/A 6276-5-211 SUP HCPCS C1776 6276-5-211 - STEM FEMORAL BOWED 11MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-212 SUP HCPCS C1776 6276-5-212 - STEM FEMORAL BOWED 12MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-213 SUP HCPCS C1776 6276-5-213 - STEM FEMORAL BOWED 13MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-214 SUP HCPCS C1776 6276-5-214 - STEM FEMORAL BOWED 14MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-215 SUP HCPCS C1776 6276-5-215 - STEM FEMORAL BOWED 15MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-216 SUP HCPCS C1776 6276-5-216 - STEM FEMORAL BOWED 16MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-217 SUP HCPCS C1776 6276-5-217 - STEM FEMORAL BOWED 17MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-218 SUP HCPCS C1776 6276-5-218 - STEM FEMORAL BOWED 18MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-219 SUP HCPCS C1776 6276-5-219 - STEM FEMORAL BOWED 19MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-220 SUP HCPCS C1776 6276-5-220 - STEM FEMORAL BOWED 20MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-221 SUP HCPCS C1776 6276-5-221 - STEM FEMORAL BOWED 21MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-222 SUP HCPCS C1776 6276-5-222 - STEM FEMORAL BOWED 22MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-223 SUP HCPCS C1776 6276-5-223 - STEM FEMORAL BOWED 23MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-224 SUP HCPCS C1776 6276-5-224 - STEM FEMORAL BOWED 24MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-225 SUP HCPCS C1776 6276-5-225 - STEM FEMORAL BOWED 25MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-226 SUP HCPCS C1776 6276-5-226 - STEM FEMORAL BOWED 26MM 167MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-411 SUP HCPCS C1776 6276-5-411 - STEM FEMORAL BOWED 11MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-412 SUP HCPCS C1776 6276-5-412 - STEM FEMORAL BOWED 12MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-413 SUP HCPCS C1776 6276-5-413 - STEM FEMORAL BOWED 13MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-414 SUP HCPCS C1776 6276-5-414 - STEM FEMORAL BOWED 14MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-415 SUP HCPCS C1776 6276-5-415 - STEM FEMORAL BOWED 15MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-416 SUP HCPCS C1776 6276-5-416 - STEM FEMORAL BOWED 16MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-417 SUP HCPCS C1776 6276-5-417 - STEM FEMORAL BOWED 17MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-418 SUP HCPCS C1776 6276-5-418 - STEM FEMORAL BOWED 18MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-419 SUP HCPCS C1776 6276-5-419 - STEM FEMORAL BOWED 19MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-420 SUP HCPCS C1776 6276-5-420 - STEM FEMORAL BOWED 20MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-421 SUP HCPCS C1776 6276-5-421 - STEM FEMORAL BOWED 21MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-422 SUP HCPCS C1776 6276-5-422 - STEM FEMORAL BOWED 22MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-423 SUP HCPCS C1776 6276-5-423 - STEM FEMORAL BOWED 23MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-424 SUP HCPCS C1776 6276-5-424 - STEM FEMORAL BOWED 24MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-425 SUP HCPCS C1776 6276-5-425 - STEM FEMORAL BOWED 25MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-426 SUP HCPCS C1776 6276-5-426 - STEM FEMORAL BOWED 26MM 217MM MODULAR PLASMA SPRAYED RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-511 SUP HCPCS C1776 6276-5-511 - STEM FEMORAL 11MM 267MM BOWED PLASMA REVISION MODULAR RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-512 SUP HCPCS C1776 6276-5-512 - STEM FEMORAL 12MM 267MM MODULAR BOWED PLASMA RSTOR DISTAL BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-513 SUP HCPCS C1776 6276-5-513 - STEM FEMORAL 13MM 267MM BOWED PLASMA REVISION MODULAR RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-514 SUP HCPCS C1776 6276-5-514 - STEM FEMORAL 14MM 267MM BOWED PLASMA REVISION MODULAR RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-515 SUP HCPCS C1776 6276-5-515 - STEM FEMORAL 15MM 267MM BOWED PLASMA REVISION MODULAR RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-516 SUP HCPCS C1776 6276-5-516 - STEM FEMORAL 16MM 267MM BOWED PLASMA REVISION MODULAR RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-517 SUP HCPCS C1776 6276-5-517 - STEM FEMORAL 17MM 267MM BOWED PLASMA REVISION MODULAR RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-518 SUP HCPCS C1776 6276-5-518 - STEM FEMORAL 18MM 267MM BOWED PLASMA MODULAR RSTOR DISTAL BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-519 SUP HCPCS C1776 6276-5-519 - STEM FEMORAL 19MM 267MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-520 SUP HCPCS C1776 6276-5-520 - STEM FEMORAL 20MM 267MM BOWED PLASMA MODULAR RSTOR DISTAL BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-521 SUP HCPCS C1776 6276-5-521 - STEM FEMORAL 21MM 267MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-522 SUP HCPCS C1776 6276-5-522 - STEM FEMORAL 22MM 267MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-523 SUP HCPCS C1776 6276-5-523 - STEM FEMORAL 23MM 267MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-524 SUP HCPCS C1776 6276-5-524 - STEM FEMORAL 24MM 267MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-525 SUP HCPCS C1776 6276-5-525 - STEM FEMORAL 25MM 267MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-526 SUP HCPCS C1776 6276-5-526 - STEM FEMORAL 26MM 267MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$3,368.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-611 SUP HCPCS C1776 6276-5-611 - STEM FEMORAL 11MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-612 SUP HCPCS C1776 6276-5-612 - STEM FEMORAL 12MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-613 SUP HCPCS C1776 6276-5-613 - STEM FEMORAL 13MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-614 SUP HCPCS C1776 6276-5-614 - STEM FEMORAL 14MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-615 SUP HCPCS C1776 6276-5-615 - STEM FEMORAL 15MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-616 SUP HCPCS C1776 6276-5-616 - STEM FEMORAL 16MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-617 SUP HCPCS C1776 6276-5-617 - STEM FEMORAL 17MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-618 SUP HCPCS C1776 6276-5-618 - STEM FEMORAL 18MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-619 SUP HCPCS C1776 6276-5-619 - STEM FEMORAL 19MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-620 SUP HCPCS C1776 6276-5-620 - STEM FEMORAL 20MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-621 SUP HCPCS C1776 6276-5-621 - STEM FEMORAL 21MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$5,052.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-622 SUP HCPCS C1776 6276-5-622 - STEM FEMORAL 22MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-623 SUP HCPCS C1776 6276-5-623 - STEM FEMORAL 23MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-624 SUP HCPCS C1776 6276-5-624 - STEM FEMORAL 24MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-625 SUP HCPCS C1776 6276-5-625 - STEM FEMORAL 25MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-5-626 SUP HCPCS C1776 6276-5-626 - STEM FEMORAL 26MM 317MM BOWED PLASMA MODULAR REVISION RSTOR BOTH IP/OP "$8,420.00" "$6,231.00" "$1,671.16" "$8,420.00" "$3,789.00" "$3,789.00" "$3,789.00" "$3,789.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.94" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.82" "$8,420.00" "$8,420.00" "$4,151.06" "$8,420.00" "$8,420.00" "$8,420.00" "$8,420.00" "$6,315.00" "$8,420.00" "$8,420.00" "$8,420.00" "$4,210.00" "$4,210.00" "$6,668.64" "$8,420.00" "$6,736.00" "$3,789.00" "$1,671.16" N/A "$4,883.60" "$8,420.00" "$8,420.00" "$8,420.00" "$1,754.73" "$8,420.00" N/A N/A 6276-6-011 SUP HCPCS C1776 6276-6-011 - STEM FEMORAL STR FLUTE 11MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$5,762.50" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-012 SUP HCPCS C1776 6276-6-012 - STEM FEMORAL STR FLUTE 12MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$5,762.50" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-013 SUP HCPCS C1776 6276-6-013 - STEM FEMORAL STR FLUTE 13MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-014 SUP HCPCS C1776 6276-6-014 - STEM FEMORAL STR FLUTE 14MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$5,762.50" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-015 SUP HCPCS C1776 6276-6-015 - STEM FEMORAL STR FLUTE 15MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-016 SUP HCPCS C1776 6276-6-016 - STEM FEMORAL STR FLUTE 16MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-017 SUP HCPCS C1776 6276-6-017 - STEM FEMORAL STR FLUTE 17MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-018 SUP HCPCS C1776 6276-6-018 - STEM FEMORAL STR FLUTE 18MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-019 SUP HCPCS C1776 6276-6-019 - STEM FEMORAL STR FLUTE 19MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-020 SUP HCPCS C1776 6276-6-020 - STEM FEMORAL STR FLUTE 20MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-021 SUP HCPCS C1776 6276-6-021 - STEM FEMORAL STR FLUTE 21MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-022 SUP HCPCS C1776 6276-6-022 - STEM FEMORAL STR FLUTE 22MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-023 SUP HCPCS C1776 6276-6-023 - STEM FEMORAL STR FLUTE 23MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-024 SUP HCPCS C1776 6276-6-024 - STEM FEMORAL STR FLUTE 24MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$5,762.50" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-025 SUP HCPCS C1776 6276-6-025 - STEM FEMORAL STR FLUTE 25MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$3,457.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-026 SUP HCPCS C1776 6276-6-026 - STEM FEMORAL STR FLUTE 26MM 127MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$3,457.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-111 SUP HCPCS C1776 6276-6-111 - STEM FEMORAL STR FLUTE 11MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$5,762.50" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-112 SUP HCPCS C1776 6276-6-112 - STEM FEMORAL STR FLUTE 12MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$5,762.50" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$3,457.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-113 SUP HCPCS C1776 6276-6-113 - STEM FEMORAL STR FLUTE 13MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$5,762.50" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$3,457.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-114 SUP HCPCS C1776 6276-6-114 - STEM FEMORAL STR FLUTE 14MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$5,762.50" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$3,457.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-115 SUP HCPCS C1776 6276-6-115 - STEM FEMORAL STR FLUTE 15MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$5,762.50" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$3,457.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-116 SUP HCPCS C1776 6276-6-116 - STEM FEMORAL STR FLUTE 16MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$5,762.50" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-117 SUP HCPCS C1776 6276-6-117 - STEM FEMORAL STR FLUTE 17MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-118 SUP HCPCS C1776 6276-6-118 - STEM FEMORAL STR FLUTE 18MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-119 SUP HCPCS C1776 6276-6-119 - STEM FEMORAL STR FLUTE 19MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-120 SUP HCPCS C1776 6276-6-120 - STEM FEMORAL STR FLUTE 20MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$5,762.50" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$3,457.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-121 SUP HCPCS C1776 6276-6-121 - STEM FEMORAL STR FLUTE 21MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$5,762.50" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$3,457.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-122 SUP HCPCS C1776 6276-6-122 - STEM FEMORAL STR FLUTE 22MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-123 SUP HCPCS C1776 6276-6-123 - STEM FEMORAL STR FLUTE 23MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-124 SUP HCPCS C1776 6276-6-124 - STEM FEMORAL STR FLUTE 24MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$5,762.50" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-125 SUP HCPCS C1776 6276-6-125 - STEM FEMORAL STR FLUTE 25MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$3,457.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-126 SUP HCPCS C1776 6276-6-126 - STEM FEMORAL STR FLUTE 26MM 167MM MODULAR RSTOR HIP BOTH IP/OP "$5,762.50" "$4,264.00" "$1,143.71" "$5,762.50" "$2,593.13" "$2,593.13" "$2,593.13" "$2,593.13" "$5,762.50" "$5,762.50" "$5,762.50" "$1,201.05" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$1,200.97" "$5,762.50" "$2,305.00" "$2,840.91" "$5,762.50" "$5,762.50" "$5,762.50" "$5,762.50" "$4,321.88" "$5,762.50" "$5,762.50" "$5,762.50" "$2,881.25" "$2,881.25" "$4,563.90" "$5,762.50" "$4,610.00" "$2,593.13" "$1,143.71" N/A "$3,342.25" "$5,762.50" "$3,457.50" "$5,762.50" "$1,200.91" "$5,762.50" N/A N/A 6276-6-211 SUP HCPCS C1776 6276-6-211 - STEM FEMORAL 11MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$4,656.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-212 SUP HCPCS C1776 6276-6-212 - STEM FEMORAL 12MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$4,656.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-213 SUP HCPCS C1776 6276-6-213 - STEM FEMORAL 13MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-214 SUP HCPCS C1776 6276-6-214 - STEM FEMORAL 14MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$7,760.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-215 SUP HCPCS C1776 6276-6-215 - STEM FEMORAL 15MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$7,760.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$4,656.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-216 SUP HCPCS C1776 6276-6-216 - STEM FEMORAL 16MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$4,656.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-217 SUP HCPCS C1776 6276-6-217 - STEM FEMORAL 17MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$4,656.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-218 SUP HCPCS C1776 6276-6-218 - STEM FEMORAL 18MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$7,760.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-219 SUP HCPCS C1776 6276-6-219 - STEM FEMORAL 19MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$7,760.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-220 SUP HCPCS C1776 6276-6-220 - STEM FEMORAL 20MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-221 SUP HCPCS C1776 6276-6-221 - STEM FEMORAL 21MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$7,760.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-222 SUP HCPCS C1776 6276-6-222 - STEM FEMORAL 22MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$7,760.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-223 SUP HCPCS C1776 6276-6-223 - STEM FEMORAL 23MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$7,760.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-224 SUP HCPCS C1776 6276-6-224 - STEM FEMORAL 24MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-225 SUP HCPCS C1776 6276-6-225 - STEM FEMORAL 25MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-226 SUP HCPCS C1776 6276-6-226 - STEM FEMORAL 26MM 167MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-411 SUP HCPCS C1776 6276-6-411 - STEM FEMORAL 11MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$7,760.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-412 SUP HCPCS C1776 6276-6-412 - STEM FEMORAL 12MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-413 SUP HCPCS C1776 6276-6-413 - STEM FEMORAL 13MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-414 SUP HCPCS C1776 6276-6-414 - STEM FEMORAL 14MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-415 SUP HCPCS C1776 6276-6-415 - STEM FEMORAL 15MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-416 SUP HCPCS C1776 6276-6-416 - STEM FEMORAL 16MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-417 SUP HCPCS C1776 6276-6-417 - STEM FEMORAL 17MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-418 SUP HCPCS C1776 6276-6-418 - STEM FEMORAL 18MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-419 SUP HCPCS C1776 6276-6-419 - STEM FEMORAL 19MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$4,656.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-420 SUP HCPCS C1776 6276-6-420 - STEM FEMORAL 20MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$4,656.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-421 SUP HCPCS C1776 6276-6-421 - STEM FEMORAL 21MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$7,760.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$4,656.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-422 SUP HCPCS C1776 6276-6-422 - STEM FEMORAL 22MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$7,760.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-423 SUP HCPCS C1776 6276-6-423 - STEM FEMORAL 23MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-424 SUP HCPCS C1776 6276-6-424 - STEM FEMORAL 24MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$3,104.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-425 SUP HCPCS C1776 6276-6-425 - STEM FEMORAL 25MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$7,760.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-426 SUP HCPCS C1776 6276-6-426 - STEM FEMORAL 26MM 217MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,760.00" "$5,742.00" "$1,540.17" "$7,760.00" "$3,492.00" "$3,492.00" "$3,492.00" "$3,492.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.38" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.27" "$7,760.00" "$7,760.00" "$3,825.68" "$7,760.00" "$7,760.00" "$7,760.00" "$7,760.00" "$5,820.00" "$7,760.00" "$7,760.00" "$7,760.00" "$3,880.00" "$3,880.00" "$6,145.92" "$7,760.00" "$6,208.00" "$3,492.00" "$1,540.17" N/A "$4,500.80" "$7,760.00" "$7,760.00" "$7,760.00" "$1,617.18" "$7,760.00" N/A N/A 6276-6-511 SUP HCPCS C1776 6276-6-511 - STEM FEMORAL 11MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-512 SUP HCPCS C1776 6276-6-512 - STEM FEMORAL 12MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-513 SUP HCPCS C1776 6276-6-513 - STEM FEMORAL 13MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-514 SUP HCPCS C1776 6276-6-514 - STEM FEMORAL 14MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-515 SUP HCPCS C1776 6276-6-515 - STEM FEMORAL 15MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-516 SUP HCPCS C1776 6276-6-516 - STEM FEMORAL 16MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-517 SUP HCPCS C1776 6276-6-517 - STEM FEMORAL 17MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-518 SUP HCPCS C1776 6276-6-518 - STEM FEMORAL 18MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-519 SUP HCPCS C1776 6276-6-519 - STEM FEMORAL 19MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-520 SUP HCPCS C1776 6276-6-520 - STEM FEMORAL 20MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-521 SUP HCPCS C1776 6276-6-521 - STEM FEMORAL 21MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-522 SUP HCPCS C1776 6276-6-522 - STEM FEMORAL 22MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-523 SUP HCPCS C1776 6276-6-523 - STEM FEMORAL 23MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-524 SUP HCPCS C1776 6276-6-524 - STEM FEMORAL 24MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-525 SUP HCPCS C1776 6276-6-525 - STEM FEMORAL 25MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-526 SUP HCPCS C1776 6276-6-526 - STEM FEMORAL 26MM 267MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-611 SUP HCPCS C1776 6276-6-611 - STEM FEMORAL 11MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-612 SUP HCPCS C1776 6276-6-612 - STEM FEMORAL 12MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-613 SUP HCPCS C1776 6276-6-613 - STEM FEMORAL 13MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-614 SUP HCPCS C1776 6276-6-614 - STEM FEMORAL 14MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-615 SUP HCPCS C1776 6276-6-615 - STEM FEMORAL 15MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-616 SUP HCPCS C1776 6276-6-616 - STEM FEMORAL 16MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-617 SUP HCPCS C1776 6276-6-617 - STEM FEMORAL 17MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-618 SUP HCPCS C1776 6276-6-618 - STEM FEMORAL 18MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-619 SUP HCPCS C1776 6276-6-619 - STEM FEMORAL 19MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-620 SUP HCPCS C1776 6276-6-620 - STEM FEMORAL 20MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-621 SUP HCPCS C1776 6276-6-621 - STEM FEMORAL 21MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-622 SUP HCPCS C1776 6276-6-622 - STEM FEMORAL 22MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-623 SUP HCPCS C1776 6276-6-623 - STEM FEMORAL 23MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-624 SUP HCPCS C1776 6276-6-624 - STEM FEMORAL 24MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-625 SUP HCPCS C1776 6276-6-625 - STEM FEMORAL 25MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-6-626 SUP HCPCS C1776 6276-6-626 - STEM FEMORAL 26MM 317MM BOWED FLUTED MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-014 SUP HCPCS C1776 6276-7-014 - STEM FEMORAL STR CONE 14MM 155MM MODULAR RSTOR HA HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$2,701.00" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-015 SUP HCPCS C1776 6276-7-015 - STEM FEMORAL CONICAL 15MM 155MM MODULAR DISTAL HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$2,701.00" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-016 SUP HCPCS C1776 6276-7-016 - STEM FEMORAL CONICAL 16MM 155MM MODULAR DISTAL HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$2,701.00" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$4,051.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-017 SUP HCPCS C1776 6276-7-017 - STEM FEMORAL CONICAL 17MM 155MM MODULAR RSTOR HA DISTAL HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$2,701.00" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$4,051.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-018 SUP HCPCS C1776 6276-7-018 - STEM FEMORAL STR CONE 18MM 155MM MODULAR RSTOR HA HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$6,752.50" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$4,051.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-019 SUP HCPCS C1776 6276-7-019 - STEM FEMORAL CONICAL 19MM 155MM MODULAR RSTOR HA DISTAL HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$2,701.00" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$4,051.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-020 SUP HCPCS C1776 6276-7-020 - STEM FEMORAL STR CONE 20MM 155MM MODULAR RSTOR HA HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$6,752.50" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$4,051.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-021 SUP HCPCS C1776 6276-7-021 - STEM FEMORAL STR CONE 21MM 155MM MODULAR RSTOR HA HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$2,701.00" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$4,051.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-022 SUP HCPCS C1776 6276-7-022 - STEM FEMORAL STR CONE 22MM 155MM MODULAR RSTOR HA HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$6,752.50" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$4,051.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-023 SUP HCPCS C1776 6276-7-023 - STEM FEMORAL STR CONE 23MM 155MM MODULAR RSTOR HA HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$2,701.00" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$4,051.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-024 SUP HCPCS C1776 6276-7-024 - STEM FEMORAL STR CONE 24MM 155MM MODULAR RSTOR HA HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$6,752.50" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-025 SUP HCPCS C1776 6276-7-025 - STEM FEMORAL STR CONE 25MM 155MM MODULAR RSTOR HA HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$6,752.50" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$4,051.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-026 SUP HCPCS C1776 6276-7-026 - STEM FEMORAL STR CONE 26MM 155MM MODULAR RSTOR HA HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$2,701.00" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-027 SUP HCPCS C1776 6276-7-027 - STEM FEMORAL STR CONE 27MM 155MM MODULAR RSTOR HA HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$6,752.50" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-028 SUP HCPCS C1776 6276-7-028 - STEM FEMORAL STR CONE 28MM 155MM MODULAR RSTOR HA HIP BOTH IP/OP "$6,752.50" "$4,997.00" "$1,340.20" "$6,752.50" "$3,038.63" "$3,038.63" "$3,038.63" "$3,038.63" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.39" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.30" "$6,752.50" "$2,701.00" "$3,328.98" "$6,752.50" "$6,752.50" "$6,752.50" "$6,752.50" "$5,064.38" "$6,752.50" "$6,752.50" "$6,752.50" "$3,376.25" "$3,376.25" "$5,347.98" "$6,752.50" "$5,402.00" "$3,038.63" "$1,340.20" N/A "$3,916.45" "$6,752.50" "$6,752.50" "$6,752.50" "$1,407.22" "$6,752.50" N/A N/A 6276-7-114 SUP HCPCS C1776 6276-7-114 - STEM FEMORAL STR CONE 14MM 195MM MODULAR RSTOR HA HIP BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$7,150.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-115 SUP HCPCS C1776 6276-7-115 - STEM FEMORAL STR CONE 15MM 195MM MODULAR RSTOR HA HIP BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$7,150.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-116 SUP HCPCS C1776 6276-7-116 - STEM FEMORAL CONE STR 16MM 195MM MODULAR RSTOR HA HIP DISTAL BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$7,150.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-117 SUP HCPCS C1776 6276-7-117 - STEM FEMORAL STR CONE 17MM 195MM MODULAR RSTOR HA HIP BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$2,860.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-118 SUP HCPCS C1776 6276-7-118 - STEM FEMORAL STR CONE 18MM 195MM MODULAR RSTOR HA HIP BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$2,860.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$4,290.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-119 SUP HCPCS C1776 6276-7-119 - STEM FEMORAL STR CONE 19MM 195MM MODULAR RSTOR HA HIP BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$2,860.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$4,290.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-120 SUP HCPCS C1776 6276-7-120 - STEM FEMORAL STR CONE 20MM 195MM MODULAR RSTOR HIP BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$2,860.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-121 SUP HCPCS C1776 6276-7-121 - STEM FEMORAL STR CONE 21MM 195MM MODULAR RSTOR HIP BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$7,150.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-122 SUP HCPCS C1776 6276-7-122 - STEM FEMORAL STR CONE 22MM 195MM MODULAR RSTOR HIP BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$7,150.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-123 SUP HCPCS C1776 6276-7-123 - STEM FEMORAL STR CONE 23MM 195MM MODULAR RSTOR HIP BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$2,860.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$4,290.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-124 SUP HCPCS C1776 6276-7-124 - STEM FEMORAL STR CONE 24MM 195MM MODULAR RSTOR HIP BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$2,860.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-125 SUP HCPCS C1776 6276-7-125 - STEM FEMORAL STR CONE 25MM 195MM MODULAR RSTOR HIP BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$2,860.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-126 SUP HCPCS C1776 6276-7-126 - STEM FEMORAL STR CONE 26MM 195MM MODULAR RSTOR HIP BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$7,150.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-127 SUP HCPCS C1776 6276-7-127 - STEM FEMORAL STR CONE 27MM 195MM MODULAR RSTOR HIP BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$7,150.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-128 SUP HCPCS C1776 6276-7-128 - STEM FEMORAL STR CONE 28MM 195MM MODULAR RSTOR HIP BOTH IP/OP "$7,150.00" "$5,291.00" "$1,419.10" "$7,150.00" "$3,217.50" "$3,217.50" "$3,217.50" "$3,217.50" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.24" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.14" "$7,150.00" "$2,860.00" "$3,524.95" "$7,150.00" "$7,150.00" "$7,150.00" "$7,150.00" "$5,362.50" "$7,150.00" "$7,150.00" "$7,150.00" "$3,575.00" "$3,575.00" "$5,662.80" "$7,150.00" "$5,720.00" "$3,217.50" "$1,419.10" N/A "$4,147.00" "$7,150.00" "$7,150.00" "$7,150.00" "$1,490.06" "$7,150.00" N/A N/A 6276-7-214 SUP HCPCS C1776 6276-7-214 - STEM FEMORAL CONICAL 14MM 195MM MODULAR RSTOR DISTAL HIP BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-215 SUP HCPCS C1776 6276-7-215 - STEM FEMORAL CONICAL 15MM 195MM BOWED MODULAR RSTOR HIP BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-216 SUP HCPCS C1776 6276-7-216 - STEM FEMORAL BOW CONE 16MM 195MM MODULAR REVISION RSTOR BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-217 SUP HCPCS C1776 6276-7-217 - STEM FEMORAL BOWED CONICAL 17MM 195MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-218 SUP HCPCS C1776 6276-7-218 - STEM FEMORAL CONICAL 18MM 195MM BOWED MODULAR RSTOR HA HIP BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-219 SUP HCPCS C1776 6276-7-219 - STEM FEMORAL BOWED CONICAL 19MM 195MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-220 SUP HCPCS C1776 6276-7-220 - STEM FEMORAL CONICAL 20MM 195MM BOWED MODULAR RSTOR HIP BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-221 SUP HCPCS C1776 6276-7-221 - STEM FEMORAL BOWED CONICAL 21MM 195MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-222 SUP HCPCS C1776 6276-7-222 - STEM FEMORAL BOWED CONICAL 22MM 195MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-223 SUP HCPCS C1776 6276-7-223 - STEM FEMORAL BOWED CONICAL 23MM 195MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-224 SUP HCPCS C1776 6276-7-224 - STEM FEMORAL BOWED CONICAL 24MM 195MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-225 SUP HCPCS C1776 6276-7-225 - STEM FEMORAL CONE 25MM 195MM MODULAR REVISION RSTOR HIP BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-226 SUP HCPCS C1776 6276-7-226 - STEM FEMORAL BOWED CONICAL 26MM 195MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$3,019.00" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-227 SUP HCPCS C1776 6276-7-227 - STEM FEMORAL BOWED CONICAL 27MM 195MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-228 SUP HCPCS C1776 6276-7-228 - STEM FEMORAL BOWED CONICAL 28MM 195MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,547.50" "$5,585.00" "$1,497.99" "$7,547.50" "$3,396.38" "$3,396.38" "$3,396.38" "$3,396.38" "$7,547.50" "$7,547.50" "$7,547.50" "$1,573.09" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$1,572.98" "$7,547.50" "$7,547.50" "$3,720.92" "$7,547.50" "$7,547.50" "$7,547.50" "$7,547.50" "$5,660.63" "$7,547.50" "$7,547.50" "$7,547.50" "$3,773.75" "$3,773.75" "$5,977.62" "$7,547.50" "$6,038.00" "$3,396.38" "$1,497.99" N/A "$4,377.55" "$7,547.50" "$4,528.50" "$7,547.50" "$1,572.90" "$7,547.50" N/A N/A 6276-7-314 SUP HCPCS C1776 6276-7-314 - STEM FEMORAL BOWED CONICAL 14MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$3,177.00" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-7-315 SUP HCPCS C1776 6276-7-315 - STEM FEMORAL BOWED CONICAL 15MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$3,177.00" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$4,765.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-7-316 SUP HCPCS C1776 6276-7-316 - STEM FEMORAL BOWED CONICAL 16MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$3,177.00" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$4,765.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-7-317 SUP HCPCS C1776 6276-7-317 - STEM FEMORAL BOWED CONICAL 17MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$7,942.50" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-7-318 SUP HCPCS C1776 6276-7-318 - STEM FEMORAL BOWED CONICAL 18MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$7,942.50" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-7-319 SUP HCPCS C1776 6276-7-319 - STEM FEMORAL BOWED CONICAL 19MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$7,942.50" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$4,765.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-7-320 SUP HCPCS C1776 6276-7-320 - STEM FEMORAL BOWED CONICAL 20MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$3,177.00" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-7-321 SUP HCPCS C1776 6276-7-321 - STEM FEMORAL BOWED CONICAL 21MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$3,177.00" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-7-322 SUP HCPCS C1776 6276-7-322 - STEM FEMORAL BOWED CONICAL 22MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$7,942.50" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$4,765.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-7-323 SUP HCPCS C1776 6276-7-323 - STEM FEMORAL BOWED CONICAL 23MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$3,177.00" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$4,765.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-7-324 SUP HCPCS C1776 6276-7-324 - STEM FEMORAL BOWED CONICAL 24MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$3,177.00" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$4,765.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-7-325 SUP HCPCS C1776 6276-7-325 - STEM FEMORAL BOWED CONICAL 25MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$3,177.00" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-7-326 SUP HCPCS C1776 6276-7-326 - STEM FEMORAL BOWED CONICAL 26MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$3,177.00" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-7-327 SUP HCPCS C1776 6276-7-327 - STEM FEMORAL BOWED CONICAL 27MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$3,177.00" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$4,765.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-7-328 SUP HCPCS C1776 6276-7-328 - STEM FEMORAL BOWED CONICAL 28MM 235MM MODULAR RSTOR DISTAL BOTH IP/OP "$7,942.50" "$5,877.00" "$1,576.39" "$7,942.50" "$3,574.13" "$3,574.13" "$3,574.13" "$3,574.13" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.42" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$1,655.30" "$7,942.50" "$3,177.00" "$3,915.65" "$7,942.50" "$7,942.50" "$7,942.50" "$7,942.50" "$5,956.88" "$7,942.50" "$7,942.50" "$7,942.50" "$3,971.25" "$3,971.25" "$6,290.46" "$7,942.50" "$6,354.00" "$3,574.13" "$1,576.39" N/A "$4,606.65" "$7,942.50" "$4,765.50" "$7,942.50" "$1,655.22" "$7,942.50" N/A N/A 6276-8-213 SUP HCPCS C1776 6276-8-213 - STEM FEMORAL 13MM 167MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,260.00" "$6,112.00" "$1,639.40" "$8,260.00" "$3,717.00" "$3,717.00" "$3,717.00" "$3,717.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.59" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.47" "$8,260.00" "$8,260.00" "$4,072.18" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$6,195.00" "$8,260.00" "$8,260.00" "$8,260.00" "$4,130.00" "$4,130.00" "$6,541.92" "$8,260.00" "$6,608.00" "$3,717.00" "$1,639.40" N/A "$4,790.80" "$8,260.00" "$4,956.00" "$8,260.00" "$1,721.38" "$8,260.00" N/A N/A 6276-8-214 SUP HCPCS C1776 6276-8-214 - STEM FEMORAL 14MM 167MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,260.00" "$6,112.00" "$1,639.40" "$8,260.00" "$3,717.00" "$3,717.00" "$3,717.00" "$3,717.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.59" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.47" "$8,260.00" "$3,304.00" "$4,072.18" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$6,195.00" "$8,260.00" "$8,260.00" "$8,260.00" "$4,130.00" "$4,130.00" "$6,541.92" "$8,260.00" "$6,608.00" "$3,717.00" "$1,639.40" N/A "$4,790.80" "$8,260.00" "$4,956.00" "$8,260.00" "$1,721.38" "$8,260.00" N/A N/A 6276-8-215 SUP HCPCS C1776 6276-8-215 - STEM FEMORAL 15MM 167MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,260.00" "$6,112.00" "$1,639.40" "$8,260.00" "$3,717.00" "$3,717.00" "$3,717.00" "$3,717.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.59" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.47" "$8,260.00" "$8,260.00" "$4,072.18" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$6,195.00" "$8,260.00" "$8,260.00" "$8,260.00" "$4,130.00" "$4,130.00" "$6,541.92" "$8,260.00" "$6,608.00" "$3,717.00" "$1,639.40" N/A "$4,790.80" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.38" "$8,260.00" N/A N/A 6276-8-216 SUP HCPCS C1776 6276-8-216 - STEM FEMORAL 16MM 167MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,260.00" "$6,112.00" "$1,639.40" "$8,260.00" "$3,717.00" "$3,717.00" "$3,717.00" "$3,717.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.59" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.47" "$8,260.00" "$3,304.00" "$4,072.18" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$6,195.00" "$8,260.00" "$8,260.00" "$8,260.00" "$4,130.00" "$4,130.00" "$6,541.92" "$8,260.00" "$6,608.00" "$3,717.00" "$1,639.40" N/A "$4,790.80" "$8,260.00" "$4,956.00" "$8,260.00" "$1,721.38" "$8,260.00" N/A N/A 6276-8-217 SUP HCPCS C1776 6276-8-217 - STEM FEMORAL 17MM 167MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,260.00" "$6,112.00" "$1,639.40" "$8,260.00" "$3,717.00" "$3,717.00" "$3,717.00" "$3,717.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.59" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.47" "$8,260.00" "$8,260.00" "$4,072.18" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$6,195.00" "$8,260.00" "$8,260.00" "$8,260.00" "$4,130.00" "$4,130.00" "$6,541.92" "$8,260.00" "$6,608.00" "$3,717.00" "$1,639.40" N/A "$4,790.80" "$8,260.00" "$4,956.00" "$8,260.00" "$1,721.38" "$8,260.00" N/A N/A 6276-8-218 SUP HCPCS C1776 6276-8-218 - STEM FEMORAL 18MM 167MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,260.00" "$6,112.00" "$1,639.40" "$8,260.00" "$3,717.00" "$3,717.00" "$3,717.00" "$3,717.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.59" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.47" "$8,260.00" "$3,304.00" "$4,072.18" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$6,195.00" "$8,260.00" "$8,260.00" "$8,260.00" "$4,130.00" "$4,130.00" "$6,541.92" "$8,260.00" "$6,608.00" "$3,717.00" "$1,639.40" N/A "$4,790.80" "$8,260.00" "$4,956.00" "$8,260.00" "$1,721.38" "$8,260.00" N/A N/A 6276-8-219 SUP HCPCS C1776 6276-8-219 - STEM FEMORAL 19MM 167MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,260.00" "$6,112.00" "$1,639.40" "$8,260.00" "$3,717.00" "$3,717.00" "$3,717.00" "$3,717.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.59" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.47" "$8,260.00" "$8,260.00" "$4,072.18" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$6,195.00" "$8,260.00" "$8,260.00" "$8,260.00" "$4,130.00" "$4,130.00" "$6,541.92" "$8,260.00" "$6,608.00" "$3,717.00" "$1,639.40" N/A "$4,790.80" "$8,260.00" "$4,956.00" "$8,260.00" "$1,721.38" "$8,260.00" N/A N/A 6276-8-220 SUP HCPCS C1776 6276-8-220 - STEM FEMORAL 20MM 167MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,260.00" "$6,112.00" "$1,639.40" "$8,260.00" "$3,717.00" "$3,717.00" "$3,717.00" "$3,717.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.59" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.47" "$8,260.00" "$3,304.00" "$4,072.18" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$6,195.00" "$8,260.00" "$8,260.00" "$8,260.00" "$4,130.00" "$4,130.00" "$6,541.92" "$8,260.00" "$6,608.00" "$3,717.00" "$1,639.40" N/A "$4,790.80" "$8,260.00" "$4,956.00" "$8,260.00" "$1,721.38" "$8,260.00" N/A N/A 6276-8-221 SUP HCPCS C1776 6276-8-221 - STEM FEMORAL 21MM 167MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,260.00" "$6,112.00" "$1,639.40" "$8,260.00" "$3,717.00" "$3,717.00" "$3,717.00" "$3,717.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.59" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.47" "$8,260.00" "$8,260.00" "$4,072.18" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$6,195.00" "$8,260.00" "$8,260.00" "$8,260.00" "$4,130.00" "$4,130.00" "$6,541.92" "$8,260.00" "$6,608.00" "$3,717.00" "$1,639.40" N/A "$4,790.80" "$8,260.00" "$4,956.00" "$8,260.00" "$1,721.38" "$8,260.00" N/A N/A 6276-8-222 SUP HCPCS C1776 6276-8-222 - STEM FEMORAL 22MM 167MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,260.00" "$6,112.00" "$1,639.40" "$8,260.00" "$3,717.00" "$3,717.00" "$3,717.00" "$3,717.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.59" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.47" "$8,260.00" "$3,304.00" "$4,072.18" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$6,195.00" "$8,260.00" "$8,260.00" "$8,260.00" "$4,130.00" "$4,130.00" "$6,541.92" "$8,260.00" "$6,608.00" "$3,717.00" "$1,639.40" N/A "$4,790.80" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.38" "$8,260.00" N/A N/A 6276-8-223 SUP HCPCS C1776 6276-8-223 - STEM FEMORAL 23MM 167MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,260.00" "$6,112.00" "$1,639.40" "$8,260.00" "$3,717.00" "$3,717.00" "$3,717.00" "$3,717.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.59" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.47" "$8,260.00" "$3,304.00" "$4,072.18" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$6,195.00" "$8,260.00" "$8,260.00" "$8,260.00" "$4,130.00" "$4,130.00" "$6,541.92" "$8,260.00" "$6,608.00" "$3,717.00" "$1,639.40" N/A "$4,790.80" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.38" "$8,260.00" N/A N/A 6276-8-224 SUP HCPCS C1776 6276-8-224 - STEM FEMORAL 24MM 167MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,260.00" "$6,112.00" "$1,639.40" "$8,260.00" "$3,717.00" "$3,717.00" "$3,717.00" "$3,717.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.59" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.47" "$8,260.00" "$8,260.00" "$4,072.18" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$6,195.00" "$8,260.00" "$8,260.00" "$8,260.00" "$4,130.00" "$4,130.00" "$6,541.92" "$8,260.00" "$6,608.00" "$3,717.00" "$1,639.40" N/A "$4,790.80" "$8,260.00" "$4,956.00" "$8,260.00" "$1,721.38" "$8,260.00" N/A N/A 6276-8-225 SUP HCPCS C1776 6276-8-225 - STEM FEMORAL 25MM 167MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,260.00" "$6,112.00" "$1,639.40" "$8,260.00" "$3,717.00" "$3,717.00" "$3,717.00" "$3,717.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.59" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.47" "$8,260.00" "$3,304.00" "$4,072.18" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$6,195.00" "$8,260.00" "$8,260.00" "$8,260.00" "$4,130.00" "$4,130.00" "$6,541.92" "$8,260.00" "$6,608.00" "$3,717.00" "$1,639.40" N/A "$4,790.80" "$8,260.00" "$4,956.00" "$8,260.00" "$1,721.38" "$8,260.00" N/A N/A 6276-8-226 SUP HCPCS C1776 6276-8-226 - STEM FEMORAL 26MM 167MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,260.00" "$6,112.00" "$1,639.40" "$8,260.00" "$3,717.00" "$3,717.00" "$3,717.00" "$3,717.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.59" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$1,721.47" "$8,260.00" "$8,260.00" "$4,072.18" "$8,260.00" "$8,260.00" "$8,260.00" "$8,260.00" "$6,195.00" "$8,260.00" "$8,260.00" "$8,260.00" "$4,130.00" "$4,130.00" "$6,541.92" "$8,260.00" "$6,608.00" "$3,717.00" "$1,639.40" N/A "$4,790.80" "$8,260.00" "$4,956.00" "$8,260.00" "$1,721.38" "$8,260.00" N/A N/A 6276-8-413 SUP HCPCS C1776 6276-8-413 - STEM FEMORAL 13MM 217MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,640.00" "$6,394.00" "$1,714.82" "$8,640.00" "$3,888.00" "$3,888.00" "$3,888.00" "$3,888.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.79" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.67" "$8,640.00" "$3,456.00" "$4,259.52" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$6,480.00" "$8,640.00" "$8,640.00" "$8,640.00" "$4,320.00" "$4,320.00" "$6,842.88" "$8,640.00" "$6,912.00" "$3,888.00" "$1,714.82" N/A "$5,011.20" "$8,640.00" "$5,184.00" "$8,640.00" "$1,800.58" "$8,640.00" N/A N/A 6276-8-414 SUP HCPCS C1776 6276-8-414 - STEM FEMORAL 14MM 217MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,640.00" "$6,394.00" "$1,714.82" "$8,640.00" "$3,888.00" "$3,888.00" "$3,888.00" "$3,888.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.79" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.67" "$8,640.00" "$8,640.00" "$4,259.52" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$6,480.00" "$8,640.00" "$8,640.00" "$8,640.00" "$4,320.00" "$4,320.00" "$6,842.88" "$8,640.00" "$6,912.00" "$3,888.00" "$1,714.82" N/A "$5,011.20" "$8,640.00" "$5,184.00" "$8,640.00" "$1,800.58" "$8,640.00" N/A N/A 6276-8-415 SUP HCPCS C1776 6276-8-415 - STEM FEMORAL 15MM 217MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,640.00" "$6,394.00" "$1,714.82" "$8,640.00" "$3,888.00" "$3,888.00" "$3,888.00" "$3,888.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.79" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.67" "$8,640.00" "$3,456.00" "$4,259.52" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$6,480.00" "$8,640.00" "$8,640.00" "$8,640.00" "$4,320.00" "$4,320.00" "$6,842.88" "$8,640.00" "$6,912.00" "$3,888.00" "$1,714.82" N/A "$5,011.20" "$8,640.00" "$5,184.00" "$8,640.00" "$1,800.58" "$8,640.00" N/A N/A 6276-8-416 SUP HCPCS C1776 6276-8-416 - STEM FEMORAL 16MM 1217MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,640.00" "$6,394.00" "$1,714.82" "$8,640.00" "$3,888.00" "$3,888.00" "$3,888.00" "$3,888.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.79" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.67" "$8,640.00" "$8,640.00" "$4,259.52" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$6,480.00" "$8,640.00" "$8,640.00" "$8,640.00" "$4,320.00" "$4,320.00" "$6,842.88" "$8,640.00" "$6,912.00" "$3,888.00" "$1,714.82" N/A "$5,011.20" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.58" "$8,640.00" N/A N/A 6276-8-417 SUP HCPCS C1776 6276-8-417 - STEM FEMORAL 17MM 217MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,640.00" "$6,394.00" "$1,714.82" "$8,640.00" "$3,888.00" "$3,888.00" "$3,888.00" "$3,888.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.79" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.67" "$8,640.00" "$3,456.00" "$4,259.52" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$6,480.00" "$8,640.00" "$8,640.00" "$8,640.00" "$4,320.00" "$4,320.00" "$6,842.88" "$8,640.00" "$6,912.00" "$3,888.00" "$1,714.82" N/A "$5,011.20" "$8,640.00" "$5,184.00" "$8,640.00" "$1,800.58" "$8,640.00" N/A N/A 6276-8-418 SUP HCPCS C1776 6276-8-418 - STEM FEMORAL 18MM 217MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,640.00" "$6,394.00" "$1,714.82" "$8,640.00" "$3,888.00" "$3,888.00" "$3,888.00" "$3,888.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.79" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.67" "$8,640.00" "$8,640.00" "$4,259.52" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$6,480.00" "$8,640.00" "$8,640.00" "$8,640.00" "$4,320.00" "$4,320.00" "$6,842.88" "$8,640.00" "$6,912.00" "$3,888.00" "$1,714.82" N/A "$5,011.20" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.58" "$8,640.00" N/A N/A 6276-8-419 SUP HCPCS C1776 6276-8-419 - STEM FEMORAL 19MM 1217MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,640.00" "$6,394.00" "$1,714.82" "$8,640.00" "$3,888.00" "$3,888.00" "$3,888.00" "$3,888.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.79" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.67" "$8,640.00" "$3,456.00" "$4,259.52" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$6,480.00" "$8,640.00" "$8,640.00" "$8,640.00" "$4,320.00" "$4,320.00" "$6,842.88" "$8,640.00" "$6,912.00" "$3,888.00" "$1,714.82" N/A "$5,011.20" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.58" "$8,640.00" N/A N/A 6276-8-420 SUP HCPCS C1776 6276-8-420 - STEM FEMORAL 20MM 1217MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,640.00" "$6,394.00" "$1,714.82" "$8,640.00" "$3,888.00" "$3,888.00" "$3,888.00" "$3,888.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.79" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.67" "$8,640.00" "$8,640.00" "$4,259.52" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$6,480.00" "$8,640.00" "$8,640.00" "$8,640.00" "$4,320.00" "$4,320.00" "$6,842.88" "$8,640.00" "$6,912.00" "$3,888.00" "$1,714.82" N/A "$5,011.20" "$8,640.00" "$5,184.00" "$8,640.00" "$1,800.58" "$8,640.00" N/A N/A 6276-8-421 SUP HCPCS C1776 6276-8-421 - STEM FEMORAL 21MM 1217MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,640.00" "$6,394.00" "$1,714.82" "$8,640.00" "$3,888.00" "$3,888.00" "$3,888.00" "$3,888.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.79" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.67" "$8,640.00" "$3,456.00" "$4,259.52" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$6,480.00" "$8,640.00" "$8,640.00" "$8,640.00" "$4,320.00" "$4,320.00" "$6,842.88" "$8,640.00" "$6,912.00" "$3,888.00" "$1,714.82" N/A "$5,011.20" "$8,640.00" "$5,184.00" "$8,640.00" "$1,800.58" "$8,640.00" N/A N/A 6276-8-422 SUP HCPCS C1776 6276-8-422 - STEM FEMORAL 22MM 217MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,640.00" "$6,394.00" "$1,714.82" "$8,640.00" "$3,888.00" "$3,888.00" "$3,888.00" "$3,888.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.79" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.67" "$8,640.00" "$8,640.00" "$4,259.52" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$6,480.00" "$8,640.00" "$8,640.00" "$8,640.00" "$4,320.00" "$4,320.00" "$6,842.88" "$8,640.00" "$6,912.00" "$3,888.00" "$1,714.82" N/A "$5,011.20" "$8,640.00" "$5,184.00" "$8,640.00" "$1,800.58" "$8,640.00" N/A N/A 6276-8-423 SUP HCPCS C1776 6276-8-423 - STEM FEMORAL 23MM 217MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,640.00" "$6,394.00" "$1,714.82" "$8,640.00" "$3,888.00" "$3,888.00" "$3,888.00" "$3,888.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.79" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.67" "$8,640.00" "$3,456.00" "$4,259.52" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$6,480.00" "$8,640.00" "$8,640.00" "$8,640.00" "$4,320.00" "$4,320.00" "$6,842.88" "$8,640.00" "$6,912.00" "$3,888.00" "$1,714.82" N/A "$5,011.20" "$8,640.00" "$5,184.00" "$8,640.00" "$1,800.58" "$8,640.00" N/A N/A 6276-8-424 SUP HCPCS C1776 6276-8-424 - STEM FEMORAL 24MM 217MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,640.00" "$6,394.00" "$1,714.82" "$8,640.00" "$3,888.00" "$3,888.00" "$3,888.00" "$3,888.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.79" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.67" "$8,640.00" "$8,640.00" "$4,259.52" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$6,480.00" "$8,640.00" "$8,640.00" "$8,640.00" "$4,320.00" "$4,320.00" "$6,842.88" "$8,640.00" "$6,912.00" "$3,888.00" "$1,714.82" N/A "$5,011.20" "$8,640.00" "$5,184.00" "$8,640.00" "$1,800.58" "$8,640.00" N/A N/A 6276-8-425 SUP HCPCS C1776 6276-8-425 - STEM FEMORAL 25MM 217MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,640.00" "$6,394.00" "$1,714.82" "$8,640.00" "$3,888.00" "$3,888.00" "$3,888.00" "$3,888.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.79" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.67" "$8,640.00" "$3,456.00" "$4,259.52" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$6,480.00" "$8,640.00" "$8,640.00" "$8,640.00" "$4,320.00" "$4,320.00" "$6,842.88" "$8,640.00" "$6,912.00" "$3,888.00" "$1,714.82" N/A "$5,011.20" "$8,640.00" "$5,184.00" "$8,640.00" "$1,800.58" "$8,640.00" N/A N/A 6276-8-426 SUP HCPCS C1776 6276-8-426 - STEM FEMORAL 26MM 217MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$8,640.00" "$6,394.00" "$1,714.82" "$8,640.00" "$3,888.00" "$3,888.00" "$3,888.00" "$3,888.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.79" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$1,800.67" "$8,640.00" "$8,640.00" "$4,259.52" "$8,640.00" "$8,640.00" "$8,640.00" "$8,640.00" "$6,480.00" "$8,640.00" "$8,640.00" "$8,640.00" "$4,320.00" "$4,320.00" "$6,842.88" "$8,640.00" "$6,912.00" "$3,888.00" "$1,714.82" N/A "$5,011.20" "$8,640.00" "$5,184.00" "$8,640.00" "$1,800.58" "$8,640.00" N/A N/A 6276-8-513 SUP HCPCS C1776 6276-8-513 - STEM FEMORAL 13MM 267MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,027.50" "$6,680.00" "$1,791.73" "$9,027.50" "$4,062.38" "$4,062.38" "$4,062.38" "$4,062.38" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.43" "$9,027.50" "$3,611.00" "$4,450.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$6,770.63" "$9,027.50" "$9,027.50" "$9,027.50" "$4,513.75" "$4,513.75" "$7,149.78" "$9,027.50" "$7,222.00" "$4,062.38" "$1,791.73" N/A "$5,235.95" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.33" "$9,027.50" N/A N/A 6276-8-514 SUP HCPCS C1776 6276-8-514 - STEM FEMORAL 14MM 267MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,027.50" "$6,680.00" "$1,791.73" "$9,027.50" "$4,062.38" "$4,062.38" "$4,062.38" "$4,062.38" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.43" "$9,027.50" "$9,027.50" "$4,450.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$6,770.63" "$9,027.50" "$9,027.50" "$9,027.50" "$4,513.75" "$4,513.75" "$7,149.78" "$9,027.50" "$7,222.00" "$4,062.38" "$1,791.73" N/A "$5,235.95" "$9,027.50" "$5,416.50" "$9,027.50" "$1,881.33" "$9,027.50" N/A N/A 6276-8-515 SUP HCPCS C1776 6276-8-515 - STEM FEMORAL 15MM 267MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,027.50" "$6,680.00" "$1,791.73" "$9,027.50" "$4,062.38" "$4,062.38" "$4,062.38" "$4,062.38" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.43" "$9,027.50" "$3,611.00" "$4,450.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$6,770.63" "$9,027.50" "$9,027.50" "$9,027.50" "$4,513.75" "$4,513.75" "$7,149.78" "$9,027.50" "$7,222.00" "$4,062.38" "$1,791.73" N/A "$5,235.95" "$9,027.50" "$5,416.50" "$9,027.50" "$1,881.33" "$9,027.50" N/A N/A 6276-8-516 SUP HCPCS C1776 6276-8-516 - STEM FEMORAL 16MM 267MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,027.50" "$6,680.00" "$1,791.73" "$9,027.50" "$4,062.38" "$4,062.38" "$4,062.38" "$4,062.38" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.43" "$9,027.50" "$9,027.50" "$4,450.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$6,770.63" "$9,027.50" "$9,027.50" "$9,027.50" "$4,513.75" "$4,513.75" "$7,149.78" "$9,027.50" "$7,222.00" "$4,062.38" "$1,791.73" N/A "$5,235.95" "$9,027.50" "$5,416.50" "$9,027.50" "$1,881.33" "$9,027.50" N/A N/A 6276-8-517 SUP HCPCS C1776 6276-8-517 - STEM FEMORAL 17MM 267MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,027.50" "$6,680.00" "$1,791.73" "$9,027.50" "$4,062.38" "$4,062.38" "$4,062.38" "$4,062.38" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.43" "$9,027.50" "$3,611.00" "$4,450.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$6,770.63" "$9,027.50" "$9,027.50" "$9,027.50" "$4,513.75" "$4,513.75" "$7,149.78" "$9,027.50" "$7,222.00" "$4,062.38" "$1,791.73" N/A "$5,235.95" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.33" "$9,027.50" N/A N/A 6276-8-518 SUP HCPCS C1776 6276-8-518 - STEM FEMORAL 18MM 267MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,027.50" "$6,680.00" "$1,791.73" "$9,027.50" "$4,062.38" "$4,062.38" "$4,062.38" "$4,062.38" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.43" "$9,027.50" "$9,027.50" "$4,450.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$6,770.63" "$9,027.50" "$9,027.50" "$9,027.50" "$4,513.75" "$4,513.75" "$7,149.78" "$9,027.50" "$7,222.00" "$4,062.38" "$1,791.73" N/A "$5,235.95" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.33" "$9,027.50" N/A N/A 6276-8-519 SUP HCPCS C1776 6276-8-519 - STEM FEMORAL 19MM 267MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,027.50" "$6,680.00" "$1,791.73" "$9,027.50" "$4,062.38" "$4,062.38" "$4,062.38" "$4,062.38" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.43" "$9,027.50" "$3,611.00" "$4,450.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$6,770.63" "$9,027.50" "$9,027.50" "$9,027.50" "$4,513.75" "$4,513.75" "$7,149.78" "$9,027.50" "$7,222.00" "$4,062.38" "$1,791.73" N/A "$5,235.95" "$9,027.50" "$5,416.50" "$9,027.50" "$1,881.33" "$9,027.50" N/A N/A 6276-8-520 SUP HCPCS C1776 6276-8-520 - STEM FEMORAL 20MM 267MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,027.50" "$6,680.00" "$1,791.73" "$9,027.50" "$4,062.38" "$4,062.38" "$4,062.38" "$4,062.38" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.43" "$9,027.50" "$9,027.50" "$4,450.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$6,770.63" "$9,027.50" "$9,027.50" "$9,027.50" "$4,513.75" "$4,513.75" "$7,149.78" "$9,027.50" "$7,222.00" "$4,062.38" "$1,791.73" N/A "$5,235.95" "$9,027.50" "$5,416.50" "$9,027.50" "$1,881.33" "$9,027.50" N/A N/A 6276-8-521 SUP HCPCS C1776 6276-8-521 - STEM FEMORAL 21MM 267MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,027.50" "$6,680.00" "$1,791.73" "$9,027.50" "$4,062.38" "$4,062.38" "$4,062.38" "$4,062.38" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.43" "$9,027.50" "$3,611.00" "$4,450.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$6,770.63" "$9,027.50" "$9,027.50" "$9,027.50" "$4,513.75" "$4,513.75" "$7,149.78" "$9,027.50" "$7,222.00" "$4,062.38" "$1,791.73" N/A "$5,235.95" "$9,027.50" "$5,416.50" "$9,027.50" "$1,881.33" "$9,027.50" N/A N/A 6276-8-522 SUP HCPCS C1776 6276-8-522 - STEM FEMORAL 22MM 267MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,027.50" "$6,680.00" "$1,791.73" "$9,027.50" "$4,062.38" "$4,062.38" "$4,062.38" "$4,062.38" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.43" "$9,027.50" "$9,027.50" "$4,450.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$6,770.63" "$9,027.50" "$9,027.50" "$9,027.50" "$4,513.75" "$4,513.75" "$7,149.78" "$9,027.50" "$7,222.00" "$4,062.38" "$1,791.73" N/A "$5,235.95" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.33" "$9,027.50" N/A N/A 6276-8-523 SUP HCPCS C1776 6276-8-523 - STEM FEMORAL 23MM 267MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,027.50" "$6,680.00" "$1,791.73" "$9,027.50" "$4,062.38" "$4,062.38" "$4,062.38" "$4,062.38" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.43" "$9,027.50" "$3,611.00" "$4,450.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$6,770.63" "$9,027.50" "$9,027.50" "$9,027.50" "$4,513.75" "$4,513.75" "$7,149.78" "$9,027.50" "$7,222.00" "$4,062.38" "$1,791.73" N/A "$5,235.95" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.33" "$9,027.50" N/A N/A 6276-8-524 SUP HCPCS C1776 6276-8-524 - STEM FEMORAL 24MM 267MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,027.50" "$6,680.00" "$1,791.73" "$9,027.50" "$4,062.38" "$4,062.38" "$4,062.38" "$4,062.38" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.43" "$9,027.50" "$3,611.00" "$4,450.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$6,770.63" "$9,027.50" "$9,027.50" "$9,027.50" "$4,513.75" "$4,513.75" "$7,149.78" "$9,027.50" "$7,222.00" "$4,062.38" "$1,791.73" N/A "$5,235.95" "$9,027.50" "$5,416.50" "$9,027.50" "$1,881.33" "$9,027.50" N/A N/A 6276-8-525 SUP HCPCS C1776 6276-8-525 - STEM FEMORAL 25MM 267MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,027.50" "$6,680.00" "$1,791.73" "$9,027.50" "$4,062.38" "$4,062.38" "$4,062.38" "$4,062.38" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.43" "$9,027.50" "$9,027.50" "$4,450.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$6,770.63" "$9,027.50" "$9,027.50" "$9,027.50" "$4,513.75" "$4,513.75" "$7,149.78" "$9,027.50" "$7,222.00" "$4,062.38" "$1,791.73" N/A "$5,235.95" "$9,027.50" "$5,416.50" "$9,027.50" "$1,881.33" "$9,027.50" N/A N/A 6276-8-526 SUP HCPCS C1776 6276-8-526 - STEM FEMORAL 26MM 267MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,027.50" "$6,680.00" "$1,791.73" "$9,027.50" "$4,062.38" "$4,062.38" "$4,062.38" "$4,062.38" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.43" "$9,027.50" "$9,027.50" "$4,450.56" "$9,027.50" "$9,027.50" "$9,027.50" "$9,027.50" "$6,770.63" "$9,027.50" "$9,027.50" "$9,027.50" "$4,513.75" "$4,513.75" "$7,149.78" "$9,027.50" "$7,222.00" "$4,062.38" "$1,791.73" N/A "$5,235.95" "$9,027.50" "$9,027.50" "$9,027.50" "$1,881.33" "$9,027.50" N/A N/A 6276-8-613 SUP HCPCS C1776 6276-8-613 - STEM FEMORAL 13MM 317MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,410.00" "$6,963.00" "$1,867.65" "$9,410.00" "$4,234.50" "$4,234.50" "$4,234.50" "$4,234.50" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.28" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.15" "$9,410.00" "$9,410.00" "$4,639.13" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$7,057.50" "$9,410.00" "$9,410.00" "$9,410.00" "$4,705.00" "$4,705.00" "$7,452.72" "$9,410.00" "$7,528.00" "$4,234.50" "$1,867.65" N/A "$5,457.80" "$9,410.00" "$5,646.00" "$9,410.00" "$1,961.04" "$9,410.00" N/A N/A 6276-8-614 SUP HCPCS C1776 6276-8-614 - STEM FEMORAL 14MM 317MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,410.00" "$6,963.00" "$1,867.65" "$9,410.00" "$4,234.50" "$4,234.50" "$4,234.50" "$4,234.50" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.28" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.15" "$9,410.00" "$3,764.00" "$4,639.13" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$7,057.50" "$9,410.00" "$9,410.00" "$9,410.00" "$4,705.00" "$4,705.00" "$7,452.72" "$9,410.00" "$7,528.00" "$4,234.50" "$1,867.65" N/A "$5,457.80" "$9,410.00" "$5,646.00" "$9,410.00" "$1,961.04" "$9,410.00" N/A N/A 6276-8-615 SUP HCPCS C1776 6276-8-615 - STEM FEMORAL 15MM 317MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,410.00" "$6,963.00" "$1,867.65" "$9,410.00" "$4,234.50" "$4,234.50" "$4,234.50" "$4,234.50" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.28" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.15" "$9,410.00" "$3,764.00" "$4,639.13" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$7,057.50" "$9,410.00" "$9,410.00" "$9,410.00" "$4,705.00" "$4,705.00" "$7,452.72" "$9,410.00" "$7,528.00" "$4,234.50" "$1,867.65" N/A "$5,457.80" "$9,410.00" "$5,646.00" "$9,410.00" "$1,961.04" "$9,410.00" N/A N/A 6276-8-616 SUP HCPCS C1776 6276-8-616 - STEM FEMORAL 16MM 317MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,410.00" "$6,963.00" "$1,867.65" "$9,410.00" "$4,234.50" "$4,234.50" "$4,234.50" "$4,234.50" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.28" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.15" "$9,410.00" "$3,764.00" "$4,639.13" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$7,057.50" "$9,410.00" "$9,410.00" "$9,410.00" "$4,705.00" "$4,705.00" "$7,452.72" "$9,410.00" "$7,528.00" "$4,234.50" "$1,867.65" N/A "$5,457.80" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.04" "$9,410.00" N/A N/A 6276-8-617 SUP HCPCS C1776 6276-8-617 - STEM FEMORAL 17MM 317MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,410.00" "$6,963.00" "$1,867.65" "$9,410.00" "$4,234.50" "$4,234.50" "$4,234.50" "$4,234.50" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.28" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.15" "$9,410.00" "$9,410.00" "$4,639.13" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$7,057.50" "$9,410.00" "$9,410.00" "$9,410.00" "$4,705.00" "$4,705.00" "$7,452.72" "$9,410.00" "$7,528.00" "$4,234.50" "$1,867.65" N/A "$5,457.80" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.04" "$9,410.00" N/A N/A 6276-8-618 SUP HCPCS C1776 6276-8-618 - STEM FEMORAL 18MM 317MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,410.00" "$6,963.00" "$1,867.65" "$9,410.00" "$4,234.50" "$4,234.50" "$4,234.50" "$4,234.50" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.28" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.15" "$9,410.00" "$3,764.00" "$4,639.13" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$7,057.50" "$9,410.00" "$9,410.00" "$9,410.00" "$4,705.00" "$4,705.00" "$7,452.72" "$9,410.00" "$7,528.00" "$4,234.50" "$1,867.65" N/A "$5,457.80" "$9,410.00" "$5,646.00" "$9,410.00" "$1,961.04" "$9,410.00" N/A N/A 6276-8-619 SUP HCPCS C1776 6276-8-619 - STEM FEMORAL 19MM 317MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,410.00" "$6,963.00" "$1,867.65" "$9,410.00" "$4,234.50" "$4,234.50" "$4,234.50" "$4,234.50" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.28" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.15" "$9,410.00" "$3,764.00" "$4,639.13" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$7,057.50" "$9,410.00" "$9,410.00" "$9,410.00" "$4,705.00" "$4,705.00" "$7,452.72" "$9,410.00" "$7,528.00" "$4,234.50" "$1,867.65" N/A "$5,457.80" "$9,410.00" "$5,646.00" "$9,410.00" "$1,961.04" "$9,410.00" N/A N/A 6276-8-620 SUP HCPCS C1776 6276-8-620 - STEM FEMORAL 20MM 317MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,410.00" "$6,963.00" "$1,867.65" "$9,410.00" "$4,234.50" "$4,234.50" "$4,234.50" "$4,234.50" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.28" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.15" "$9,410.00" "$3,764.00" "$4,639.13" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$7,057.50" "$9,410.00" "$9,410.00" "$9,410.00" "$4,705.00" "$4,705.00" "$7,452.72" "$9,410.00" "$7,528.00" "$4,234.50" "$1,867.65" N/A "$5,457.80" "$9,410.00" "$5,646.00" "$9,410.00" "$1,961.04" "$9,410.00" N/A N/A 6276-8-621 SUP HCPCS C1776 6276-8-621 - STEM FEMORAL 21MM 317MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,410.00" "$6,963.00" "$1,867.65" "$9,410.00" "$4,234.50" "$4,234.50" "$4,234.50" "$4,234.50" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.28" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.15" "$9,410.00" "$9,410.00" "$4,639.13" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$7,057.50" "$9,410.00" "$9,410.00" "$9,410.00" "$4,705.00" "$4,705.00" "$7,452.72" "$9,410.00" "$7,528.00" "$4,234.50" "$1,867.65" N/A "$5,457.80" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.04" "$9,410.00" N/A N/A 6276-8-622 SUP HCPCS C1776 6276-8-622 - STEM FEMORAL 22MM 317MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,410.00" "$6,963.00" "$1,867.65" "$9,410.00" "$4,234.50" "$4,234.50" "$4,234.50" "$4,234.50" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.28" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.15" "$9,410.00" "$9,410.00" "$4,639.13" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$7,057.50" "$9,410.00" "$9,410.00" "$9,410.00" "$4,705.00" "$4,705.00" "$7,452.72" "$9,410.00" "$7,528.00" "$4,234.50" "$1,867.65" N/A "$5,457.80" "$9,410.00" "$5,646.00" "$9,410.00" "$1,961.04" "$9,410.00" N/A N/A 6276-8-623 SUP HCPCS C1776 6276-8-623 - STEM FEMORAL 23MM 317MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,410.00" "$6,963.00" "$1,867.65" "$9,410.00" "$4,234.50" "$4,234.50" "$4,234.50" "$4,234.50" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.28" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.15" "$9,410.00" "$3,764.00" "$4,639.13" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$7,057.50" "$9,410.00" "$9,410.00" "$9,410.00" "$4,705.00" "$4,705.00" "$7,452.72" "$9,410.00" "$7,528.00" "$4,234.50" "$1,867.65" N/A "$5,457.80" "$9,410.00" "$5,646.00" "$9,410.00" "$1,961.04" "$9,410.00" N/A N/A 6276-8-624 SUP HCPCS C1776 6276-8-624 - STEM FEMORAL 24MM 317MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,410.00" "$6,963.00" "$1,867.65" "$9,410.00" "$4,234.50" "$4,234.50" "$4,234.50" "$4,234.50" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.28" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.15" "$9,410.00" "$3,764.00" "$4,639.13" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$7,057.50" "$9,410.00" "$9,410.00" "$9,410.00" "$4,705.00" "$4,705.00" "$7,452.72" "$9,410.00" "$7,528.00" "$4,234.50" "$1,867.65" N/A "$5,457.80" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.04" "$9,410.00" N/A N/A 6276-8-625 SUP HCPCS C1776 6276-8-625 - STEM FEMORAL 25MM 317MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,410.00" "$6,963.00" "$1,867.65" "$9,410.00" "$4,234.50" "$4,234.50" "$4,234.50" "$4,234.50" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.28" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.15" "$9,410.00" "$9,410.00" "$4,639.13" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$7,057.50" "$9,410.00" "$9,410.00" "$9,410.00" "$4,705.00" "$4,705.00" "$7,452.72" "$9,410.00" "$7,528.00" "$4,234.50" "$1,867.65" N/A "$5,457.80" "$9,410.00" "$5,646.00" "$9,410.00" "$1,961.04" "$9,410.00" N/A N/A 6276-8-626 SUP HCPCS C1776 6276-8-626 - STEM FEMORAL 26MM 317MM BOWED SLOTTED PLASMA HIP BOTH IP/OP "$9,410.00" "$6,963.00" "$1,867.65" "$9,410.00" "$4,234.50" "$4,234.50" "$4,234.50" "$4,234.50" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.28" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$1,961.15" "$9,410.00" "$9,410.00" "$4,639.13" "$9,410.00" "$9,410.00" "$9,410.00" "$9,410.00" "$7,057.50" "$9,410.00" "$9,410.00" "$9,410.00" "$4,705.00" "$4,705.00" "$7,452.72" "$9,410.00" "$7,528.00" "$4,234.50" "$1,867.65" N/A "$5,457.80" "$9,410.00" "$5,646.00" "$9,410.00" "$1,961.04" "$9,410.00" N/A N/A 6280-0-036 SUP Custom 27803010 6280-0-036 - HEAD FEM -3MM 36MM PCA OFST BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-126 SUP Custom 27803010 6280-0-126 - HEAD FEMORAL STANDARD OFFST 26MM PCA VITALLIUM HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-128 SUP Custom 27803010 6280-0-128 - HEAD FEM +0MM OFST 28MM STRL PCA VIT HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-132 SUP Custom 27803010 6280-0-132 - HEAD FEM +0MM OFST 32MM STRL PCA VIT HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-136 SUP Custom 27803010 6280-0-136 - HEAD FEM 36MM PCA BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-226 SUP Custom 27803010 6280-0-226 - HEAD FEMORAL +5MM 26MM PCA VITALLIUM HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-228 SUP Custom 27803010 6280-0-228 - HEAD FEM +5MM OFST 28MM STRL PCA VIT HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-232 SUP Custom 27803010 6280-0-232 - HEAD FEM +5MM OFST 32MM STRL PCA VIT HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-236 SUP Custom 27803010 6280-0-236 - HEAD FEM +5MM OFST 36MM STRL PCA VIT HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-326 SUP Custom 27803010 6280-0-326 - HEAD FEMORAL +10MM 26MM PCA VITALLIUM HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-328 SUP Custom 27803010 6280-0-328 - HEAD FEM +10MM OFST 28MM PCA HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-332 SUP Custom 27803010 6280-0-332 - HEAD FEMORAL +10MM TAPER 32MM PCA VITALLIUM HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-336 SUP Custom 27803010 6280-0-336 - HEAD FEM +10MM 36MM HIP OFFST PCA BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-436 SUP Custom 27803010 6280-0-436 - HEAD FEM +15MM 36MM OFFST PCA BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-622 SUP Custom 27803010 6280-0-622 - HEAD FEM +2MM OFST 22.2MM STRL PCA VIT HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-722 SUP Custom 27803010 6280-0-722 - HEAD FEMORAL +5MM 22.2MM PCA VITALLIUM HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-0-822 SUP Custom 27803010 6280-0-822 - HEAD FEMORAL +10MM 22MM PCA VITALLIUM HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6280-3-032 SUP Custom 27803010 6280-3-032 - HEAD FEMORAL +3MM 32MM PCA VITALLIUM HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6290-7-012 SUP HCPCS C1713 6290-7-012 - SCREW BONE FULTHD HEXAGON 6.2MM 12MM SELF TAP VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $152.00 $152.00 $152.00 $152.00 N/A N/A 6290-7-015 SUP HCPCS C1713 6290-7-015 - SCREW BONE FULTHD HEXAGON 6.2MM 15MM SELF TAP VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6290-7-020 SUP HCPCS C1713 6290-7-020 - SCREW BONE FULTHD HEXAGON 6.2MM 20MM SELF TAP VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $152.00 $152.00 $31.68 $152.00 N/A N/A 6290-7-025 SUP HCPCS C1713 6290-7-025 - SCREW BONE FULTHD HEXAGON 6.2MM 25MM SELF TAP VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6290-7-030 SUP HCPCS C1713 6290-7-030 - SCREW BONE FULTHD HEXAGON 6.2MM 30MM SELF TAP VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6290-7-035 SUP HCPCS C1713 6290-7-035 - SCREW BONE FULTHD HEXAGON 6.2MM 35MM SELF TAP VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6290-7-040 SUP HCPCS C1713 6290-7-040 - SCREW BONE FULTHD HEXAGON 6.2MM 40MM SELF TAP VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $152.00 $152.00 $31.68 $152.00 N/A N/A 6290-7-045 SUP HCPCS C1713 6290-7-045 - SCREW BONE FULTHD HEXAGON 6.2MM 45MM SELF TAP VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6290-7-050 SUP HCPCS C1713 6290-7-050 - SCREW BONE FULTHD HEXAGON 6.2MM 50MM SELF TAP VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $152.00 $152.00 $31.68 $152.00 N/A N/A 6290-7-055 SUP HCPCS C1713 6290-7-055 - SCREW BONE FULTHD HEXAGON 6.2MM 55MM SELF TAP VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $152.00 $152.00 $31.68 $152.00 N/A N/A 6290-7-060 SUP HCPCS C1713 6290-7-060 - SCREW BONE FULTHD HEXAGON 6.2MM 60MM SELF TAP VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $152.00 $152.00 $31.68 $152.00 N/A N/A 6290-7-065 SUP HCPCS C1713 6290-7-065 - SCREW BONE FULTHD HEXAGON 6.2MM 65MM SELF TAP VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6290-8-620 SUP HCPCS C1713 6290-8-620 - WASHER ORTHOPEDIC 6.2MM SCREW VITALLIUM 6.2MM SCREW BOTH IP/OP $75.00 $56.00 $14.89 $75.00 $33.75 $33.75 $33.75 $33.75 $75.00 $75.00 $75.00 $15.63 $75.00 $75.00 $75.00 $75.00 $75.00 $15.63 $75.00 $30.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $33.75 $14.89 N/A $43.50 $75.00 $45.00 $75.00 $15.63 $75.00 N/A N/A 629210S SUP HCPCS C1713 629210S - PLATE BONE 176MM 10 SHAFT HOLE LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" "$2,384.00" "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629212S SUP HCPCS C1713 629212S - PLATE BONE 203MM 12 SHAFT HOLE LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" "$2,384.00" "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629230S SUP HCPCS C1713 629230S - PLATE BONE 176MM 10 SHAFT HOLE LOCKING VARIAX TITANIUM ELBOW BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" "$2,384.00" "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629232S SUP HCPCS C1713 629232S - PLATE BONE 203MM 12 SHAFT HOLE REDX CLMP SLFTAP TITANIUM BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629250S SUP HCPCS C1713 629250S - PLATE BN 173MM STRL VARIAX 10 HL TI HUM LT P/L BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629252S SUP HCPCS C1713 629252S - PLATE BN 196MM STRL VARIAX 12 HL TI HUM LT P/L BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629254S SUP HCPCS C1713 629254S - PLATE BONE PRECONTOUR 217MM 14 SHAFT HOLE LOCK VARIAX BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629270S SUP HCPCS C1713 629270S - PLATE BN 173MM STRL VARIAX 10 HL TI HUM RT P/L BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629272S SUP HCPCS C1713 629272S - PLATE BN 196MM STRL VARIAX 12 HL TI HUM RT P/L BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629274S SUP HCPCS C1713 629274S - PLATE BN 218MM STRL VARIAX 14 HL TI HUM RT P/L BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629290S SUP HCPCS C1713 629290S - PLATE BONE 167MM 10 SHAFT HOLE LOCKING EXTENDED VARIAX BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629292S SUP HCPCS C1713 629292S - PLATE BONE 191MM 12 HOLE EXTENDED VARIAX TITANIUM MEDIAL BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" "$2,384.00" "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629294S SUP HCPCS C1713 629294S - PLATE BONE 215MM 14 SHAFT HOLE LOCKING EXTENDED VARIAX BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 6293-0-000 SUP Custom 27803010 6293-0-000 - HEAD FEMORAL STANDARD 32MM PCA HIP BOTH IP/OP "$2,180.00" "$1,613.00" $388.04 "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" $388.04 "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" $454.34 "$2,180.00" $872.00 "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$1,635.00" "$2,180.00" "$2,180.00" "$2,180.00" "$1,090.00" "$1,090.00" "$1,726.56" "$2,180.00" "$1,744.00" $981.00 "$2,180.00" N/A "$1,264.40" "$2,180.00" "$1,308.00" "$2,180.00" "$2,180.00" "$2,180.00" N/A N/A 6293-0-005 SUP Custom 27803010 6293-0-005 - HEAD FEMORAL +5 32MM PCA HIP BOTH IP/OP "$2,180.00" "$1,613.00" $388.04 "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" $388.04 "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" $454.34 "$2,180.00" $872.00 "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$2,180.00" "$1,635.00" "$2,180.00" "$2,180.00" "$2,180.00" "$1,090.00" "$1,090.00" "$1,726.56" "$2,180.00" "$1,744.00" $981.00 "$2,180.00" N/A "$1,264.40" "$2,180.00" "$1,308.00" "$2,180.00" "$2,180.00" "$2,180.00" N/A N/A 629310S SUP HCPCS C1713 629310S - PLATE BONE 175MM 10 SHAFT HOLE TITANIUM LEFT POSTERIOR BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629312S SUP HCPCS C1713 629312S - PLATE BONE 199MM 12 SHAFT HOLE LOCKING VARIAX TITANIUM LEFT BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629330S SUP HCPCS C1713 629330S - PLATE BONE 175MM 10 SHAFT HOLE LOCKING VARIAX TITANIUM RIGHT BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629332S SUP HCPCS C1713 629332S - PLATE BONE 199MM 12 HOLE LOCKING VARIAX TITANIUM RIGHT BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629350S SUP HCPCS C1713 629350S - PLATE BN 161MM NS VARIAX 10 HL TI OLCRN LT BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629352S SUP HCPCS C1713 629352S - PLATE BONE 184MM 12 SHAFT HOLE LOCKING VARIAX TITANIUM LEFT BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629370S SUP HCPCS C1713 629370S - PLATE BONE 161MM 12 SHAFT HOLE LOCK VARIAX TITANIUM ELBOW BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629372S SUP HCPCS C1713 629372S - PLATE BONE 184MM 12 SHAFT HOLE LOCKING VARIAX TITANIUM RIGHT BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629390S SUP HCPCS C1713 629390S - PLATE BONE 163MM 10 HOLE LOCKING VARIAX TITANIUM MEDIAL BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" $953.60 "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$2,384.00" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629392S SUP HCPCS C1713 629392S - PLATE BONE 187MM 12 SHAFT HOLE LOCKING VARIAX TITANIUM LEFT BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" "$2,384.00" "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 629394S SUP HCPCS C1713 629394S - PLATE BONE 211MM 14 SHAFT HOLE LOCKING VARIAX TITANIUM LEFT BOTH IP/OP "$2,384.00" "$1,764.00" $473.16 "$2,384.00" "$1,072.80" "$1,072.80" "$1,072.80" "$1,072.80" "$2,384.00" "$2,384.00" "$2,384.00" $496.89 "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" $496.85 "$2,384.00" "$2,384.00" "$1,410.14" "$2,384.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,788.00" "$2,384.00" "$2,384.00" "$2,384.00" "$1,192.00" "$1,192.00" "$1,888.13" "$2,384.00" "$1,907.20" "$1,072.80" $473.16 N/A "$1,382.72" "$2,384.00" "$1,430.40" "$2,384.00" $496.83 "$2,384.00" N/A N/A 6299-2-403 SUP Custom 27803010 6299-2-403 - INSERT ACETAB 0D NEUTRAL 40-43MM 26MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-2-469 SUP Custom 27803010 6299-2-469 - INSERT ACETAB 0D NEUTRAL 46-49MM 26MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-2-525 SUP Custom 27803010 6299-2-525 - INSERT ACETAB 0D NEUTRAL 52-55MM 26MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-2-581 SUP Custom 27803010 6299-2-581 - INSERT ACETAB 0D NEUTRAL 58-61MM 26MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-3-469 SUP Custom 27803010 6299-3-469 - INSERT ACETAB 0D NEUTRAL 46-49MM 28MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-3-525 SUP Custom 27803010 6299-3-525 - INSERT ACETAB 0D NEUTRAL 52-55MM 28MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-3-581 SUP Custom 27803010 6299-3-581 - INSERT ACETAB 0D NEUTRAL 58-61MM 28MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-3-647 SUP Custom 27803010 6299-3-647 - INSERT ACETAB 0D NEUTRAL 64-67MM 28MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-4-469 SUP Custom 27803010 6299-4-469 - INSERT ACETAB 0D NEUTRAL 46-49MM 32MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-4-525 SUP Custom 27803010 6299-4-525 - INSERT ACETAB 0D NEUTRAL 52-55MM 32MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-4-581 SUP Custom 27803010 6299-4-581 - INSERT ACETAB 0D NEUTRAL 58-61MM 32MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-4-647 SUP Custom 27803010 6299-4-647 - INSERT ACETAB 0D NEUTRAL 64-67MM 32MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-5-403 SUP Custom 27803010 6299-5-403 - INSERT ACETAB 10D 40-43MM 26MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-5-469 SUP Custom 27803010 6299-5-469 - INSERT ACETAB 10D 46-49MM 26MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-5-525 SUP Custom 27803010 6299-5-525 - INSERT ACETAB 10D 52-55MM 26MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-5-581 SUP Custom 27803010 6299-5-581 - INSERT ACETAB 10D 58-61MM 26MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-6-469 SUP Custom 27803010 6299-6-469 - INSERT ACETAB 10D 46-49MM 28MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-6-525 SUP Custom 27803010 6299-6-525 - INSERT ACETAB 10D 52-55MM 28MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-6-581 SUP Custom 27803010 6299-6-581 - INSERT ACETAB 10D 58-61MM 28MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-6-647 SUP Custom 27803010 6299-6-647 - INSERT ACETAB 10D 64-67MM 28MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-7-469 SUP Custom 27803010 6299-7-469 - INSERT ACETAB 10D 46-49MM 32MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-7-525 SUP Custom 27803010 6299-7-525 - INSERT ACETAB 10D 52-55MM 32MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-7-581 SUP Custom 27803010 6299-7-581 - INSERT ACETAB 10D 58-61MM 32MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-7-647 SUP Custom 27803010 6299-7-647 - INSERT ACETAB 10D 64-67MM 32MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-8-403 SUP Custom 27803010 6299-8-403 - INSERT ACETAB 10D 40-43MM 22MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-8-469 SUP Custom 27803010 6299-8-469 - INSERT ACETAB 10D 46-49MM 22MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-8-525 SUP Custom 27803010 6299-8-525 - INSERT ACETAB 10D 52-55MM 22MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-8-581 SUP Custom 27803010 6299-8-581 - INSERT ACETAB 10D 52-55MM 22MM PCA DUR HIP BOTH IP/OP "$2,117.50" "$1,567.00" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $376.92 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" $441.31 "$2,117.50" $847.00 "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$2,117.50" "$1,588.13" "$2,117.50" "$2,117.50" "$2,117.50" "$1,058.75" "$1,058.75" "$1,677.06" "$2,117.50" "$1,694.00" $952.88 "$2,117.50" N/A "$1,228.15" "$2,117.50" "$1,270.50" "$2,117.50" "$2,117.50" "$2,117.50" N/A N/A 6299-H-332 SUP Custom 27803010 6299-H-332 - LINER ACETAB 10D C 32MM CONSTRAIN PCA HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6299-N-332 SUP Custom 27803010 6299-N-332 - LINER ACETAB NEUTRAL 32MM CONSTRAIN PCA HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6302-3-012 SUP HCPCS C1713 6302-3-012 - SCREW ACETAB 6.5MM 12MM PLUG VITALOCK VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6302-3-014 SUP HCPCS C1713 6302-3-014 - SCREW ACETAB 6.5MM 14MM PLUG VITALOCK VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $152.00 $152.00 $31.68 $152.00 N/A N/A 6302-3-016 SUP HCPCS C1713 6302-3-016 - SCREW ACETAB 6.5MM 16MM PLUG VITALOCK VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6302-3-018 SUP HCPCS C1713 6302-3-018 - SCREW ACETAB 6.5MM 18MM PLUG VITALOCK VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6302-3-020 SUP HCPCS C1713 6302-3-020 - SCREW ACETAB 6.5MM 20MM PLUG VITALOCK VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6302-3-022 SUP HCPCS C1713 6302-3-022 - SCREW ACETAB 6.5MM 22MM PLUG VITALOCK VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6302-3-024 SUP HCPCS C1713 6302-3-024 - SCREW ACETAB 6.5MM 24MM PLUG VITALOCK VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6302-3-026 SUP HCPCS C1713 6302-3-026 - SCREW ACETAB 6.5MM 26MM PLUG VITALOCK VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6302-3-028 SUP HCPCS C1713 6302-3-028 - SCREW ACETAB 6.5MM 28MM PLUG VITALOCK VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6302-3-030 SUP HCPCS C1713 6302-3-030 - SCREW ACETAB 6.5MM 30MM PLUG VITALOCK VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $152.00 $152.00 $31.68 $152.00 N/A N/A 6302-3-035 SUP HCPCS C1713 6302-3-035 - SCREW ACETAB 6.5MM 35MM PLUG VITALOCK VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6302-3-040 SUP HCPCS C1713 6302-3-040 - SCREW ACETAB 6.5MM 40MM PLUG VITALOCK VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $91.20 $152.00 $31.68 $152.00 N/A N/A 6302-3-045 SUP HCPCS C1713 6302-3-045 - SCREW ACETAB 6.5MM 45MM PLUG VITALOCK VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $152.00 $152.00 $31.68 $152.00 N/A N/A 6302-3-050 SUP HCPCS C1713 6302-3-050 - SCREW ACETAB 6.5MM 50MM PLUG VITALOCK VITALLIUM HIP BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $60.80 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $152.00 $152.00 $31.68 $152.00 N/A N/A 6302-4-000 SUP HCPCS C1713 6302-4-000 - PLUG DOME HL PRM RECON VIT APCL BOTH IP/OP $152.00 $112.00 $30.17 $152.00 $68.40 $68.40 $68.40 $68.40 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $152.00 $152.00 $152.00 $31.68 $152.00 $152.00 $89.91 $152.00 $152.00 $152.00 $152.00 $114.00 $152.00 $152.00 $152.00 $76.00 $76.00 $120.38 $152.00 $121.60 $68.40 $30.17 N/A $88.16 $152.00 $152.00 $152.00 $31.68 $152.00 N/A N/A 6302-5-000 SUP Custom 27803010 6302-5-000 - INSERT ACETAB P0 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-001 SUP Custom 27803010 6302-5-001 - INSERT ACETAB P1 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-002 SUP Custom 27803010 6302-5-002 - INSERT ACETAB P2 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-003 SUP Custom 27803010 6302-5-003 - INSERT ACETAB P3 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-004 SUP Custom 27803010 6302-5-004 - INSERT ACETAB P4 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-005 SUP Custom 27803010 6302-5-005 - INSERT ACETAB P5 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-006 SUP Custom 27803010 6302-5-006 - INSERT ACETAB P6 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-007 SUP Custom 27803010 6302-5-007 - INSERT ACETAB P7 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-008 SUP Custom 27803010 6302-5-008 - INSERT ACETAB P8 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-009 SUP Custom 27803010 6302-5-009 - INSERT ACETAB P9 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-010 SUP Custom 27803010 6302-5-010 - INSERT ACETAB 10D P0 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-011 SUP Custom 27803010 6302-5-011 - INSERT ACETAB 10D P1 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-012 SUP Custom 27803010 6302-5-012 - INSERT ACETAB 10D P2 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-013 SUP Custom 27803010 6302-5-013 - INSERT ACETAB 10D P3 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-014 SUP Custom 27803010 6302-5-014 - INSERT ACETAB 10D P4 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-015 SUP Custom 27803010 6302-5-015 - INSERT ACETAB 10D P5 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-016 SUP Custom 27803010 6302-5-016 - INSERT ACETAB 10D P6 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-017 SUP Custom 27803010 6302-5-017 - INSERT ACETAB 10D P7 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-018 SUP Custom 27803010 6302-5-018 - INSERT ACETAB 10D P8 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-019 SUP Custom 27803010 6302-5-019 - INSERT ACETAB 10D P9 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-020 SUP Custom 27803010 6302-5-020 - INSERT ACETAB 15D P0 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-021 SUP Custom 27803010 6302-5-021 - INSERT ACETAB 15D P1 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-022 SUP Custom 27803010 6302-5-022 - INSERT ACETAB 15D P2 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-023 SUP Custom 27803010 6302-5-023 - INSERT ACETAB 15D P3 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-024 SUP Custom 27803010 6302-5-024 - INSERT ACETAB 15D P4 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-025 SUP Custom 27803010 6302-5-025 - INSERT ACETAB 15D P5 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-026 SUP Custom 27803010 6302-5-026 - INSERT ACETAB 15D P6 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-027 SUP Custom 27803010 6302-5-027 - INSERT ACETAB 15D P7 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-028 SUP Custom 27803010 6302-5-028 - INSERT ACETAB 15D P8 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-029 SUP Custom 27803010 6302-5-029 - INSERT ACETAB 15D P9 NEUTRAL 22.2MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-030 SUP Custom 27803010 6302-5-030 - INSERT ACETAB P1 NEUTRAL 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-032 SUP Custom 27803010 6302-5-032 - INSERT ACETAB P2 NEUTRAL 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-033 SUP Custom 27803010 6302-5-033 - INSERT ACETAB P3 NEUTRAL 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-034 SUP Custom 27803010 6302-5-034 - INSERT ACETAB P4 NEUTRAL 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-035 SUP Custom 27803010 6302-5-035 - INSERT ACETAB P5 NEUTRAL 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-036 SUP Custom 27803010 6302-5-036 - INSERT ACETAB P6 NEUTRAL 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-037 SUP Custom 27803010 6302-5-037 - INSERT ACETAB P7 NEUTRAL 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-038 SUP Custom 27803010 6302-5-038 - INSERT ACETAB P8 NEUTRAL 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-039 SUP Custom 27803010 6302-5-039 - INSERT ACETAB P9 NEUTRAL 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-040 SUP Custom 27803010 6302-5-040 - INSERT ACETAB 10D P1 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-042 SUP Custom 27803010 6302-5-042 - INSERT ACETAB 10D P2 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-043 SUP Custom 27803010 6302-5-043 - INSERT ACETAB 10D P3 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-044 SUP Custom 27803010 6302-5-044 - INSERT ACETAB 10D P4 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-045 SUP Custom 27803010 6302-5-045 - INSERT ACETAB 10D P5 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-046 SUP Custom 27803010 6302-5-046 - INSERT ACETAB 10D P6 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-047 SUP Custom 27803010 6302-5-047 - INSERT ACETAB 10D P7 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-048 SUP Custom 27803010 6302-5-048 - INSERT ACETAB 10D P8 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-049 SUP Custom 27803010 6302-5-049 - INSERT ACETAB 10D P9 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-050 SUP Custom 27803010 6302-5-050 - INSERT ACETAB 15D P1 26MM SYSTEM 12 DUR POLYETHYLENE HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-052 SUP Custom 27803010 6302-5-052 - INSERT ACETAB 15D P2 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-053 SUP Custom 27803010 6302-5-053 - INSERT ACETAB 15D P3 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-054 SUP Custom 27803010 6302-5-054 - INSERT ACETAB 15D P4 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-055 SUP Custom 27803010 6302-5-055 - INSERT ACETAB 15D P5 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-056 SUP Custom 27803010 6302-5-056 - INSERT ACETAB 15D P6 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-057 SUP Custom 27803010 6302-5-057 - INSERT ACETAB 15D P7 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-058 SUP Custom 27803010 6302-5-058 - INSERT ACETAB 15D P8 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-059 SUP Custom 27803010 6302-5-059 - INSERT ACETAB 15D P9 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-062 SUP Custom 27803010 6302-5-062 - INSERT ACETAB P2 NEUTRAL 28MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-063 SUP Custom 27803010 6302-5-063 - INSERT ACETAB P3 NEUTRAL 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-064 SUP Custom 27803010 6302-5-064 - INSERT ACETAB P4 NEUTRAL 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-065 SUP Custom 27803010 6302-5-065 - INSERT ACETAB P5 NEUTRAL 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-066 SUP Custom 27803010 6302-5-066 - INSERT ACETAB P6 NEUTRAL 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-067 SUP Custom 27803010 6302-5-067 - INSERT ACETAB P7 NEUTRAL 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-068 SUP Custom 27803010 6302-5-068 - INSERT ACETAB P8 NEUTRAL 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-069 SUP Custom 27803010 6302-5-069 - INSERT ACETAB P9 NEUTRAL 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-072 SUP Custom 27803010 6302-5-072 - INSERT ACETAB 10D P2 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-073 SUP Custom 27803010 6302-5-073 - INSERT ACETAB 10D P3 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-074 SUP Custom 27803010 6302-5-074 - INSERT ACETAB 10D P4 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-075 SUP Custom 27803010 6302-5-075 - INSERT ACETAB 10D P5 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-076 SUP Custom 27803010 6302-5-076 - INSERT ACETAB 10D P6 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-077 SUP Custom 27803010 6302-5-077 - INSERT ACETAB 10D P7 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-078 SUP Custom 27803010 6302-5-078 - INSERT ACETAB 10D P8 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-079 SUP Custom 27803010 6302-5-079 - INSERT ACETAB 10D P9 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-082 SUP Custom 27803010 6302-5-082 - INSERT ACETAB 15D P2 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-083 SUP Custom 27803010 6302-5-083 - INSERT ACETAB 15D P3 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-084 SUP Custom 27803010 6302-5-084 - INSERT ACETAB 15D P4 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-085 SUP Custom 27803010 6302-5-085 - INSERT ACETAB 15D P5 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-086 SUP Custom 27803010 6302-5-086 - INSERT ACETAB 15D P6 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-087 SUP Custom 27803010 6302-5-087 - INSERT ACETAB 15D P7 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-088 SUP Custom 27803010 6302-5-088 - INSERT ACETAB 15D P8 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-089 SUP Custom 27803010 6302-5-089 - INSERT ACETAB 15D P9 28MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-093 SUP Custom 27803010 6302-5-093 - INSERT ACETAB 15D P3 32MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-094 SUP Custom 27803010 6302-5-094 - INSERT ACETAB 15D P4 32MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-095 SUP Custom 27803010 6302-5-095 - INSERT ACETAB 15D P5 32MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-096 SUP Custom 27803010 6302-5-096 - INSERT ACETAB 15D P6 32MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-097 SUP Custom 27803010 6302-5-097 - INSERT ACETAB P7 NEUTRAL 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-098 SUP Custom 27803010 6302-5-098 - INSERT ACETAB 15D P8 32MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-099 SUP Custom 27803010 6302-5-099 - INSERT ACETAB 15D P9 32MM SYSTEM 12 OSTEOLOCK DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-103 SUP Custom 27803010 6302-5-103 - INSERT ACETAB 10D P3 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-104 SUP Custom 27803010 6302-5-104 - INSERT ACETAB 10D P4 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-105 SUP Custom 27803010 6302-5-105 - INSERT ACETAB 10D P5 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-106 SUP Custom 27803010 6302-5-106 - INSERT ACETAB 10D P6 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-107 SUP Custom 27803010 6302-5-107 - INSERT ACETAB 10D P7 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-108 SUP Custom 27803010 6302-5-108 - INSERT ACETAB 10D P8 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-109 SUP Custom 27803010 6302-5-109 - INSERT ACETAB 10D P9 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-113 SUP Custom 27803010 6302-5-113 - INSERT ACETAB 10D P3 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-114 SUP Custom 27803010 6302-5-114 - INSERT ACETAB 15D P4 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-115 SUP Custom 27803010 6302-5-115 - INSERT ACETAB 15D P5 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-116 SUP Custom 27803010 6302-5-116 - INSERT ACETAB 15D P6 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-117 SUP Custom 27803010 6302-5-117 - INSERT ACETAB 15D P7 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A 6302-5-118 SUP Custom 27803010 6302-5-118 - INSERT ACETAB 15D P8 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-5-119 SUP Custom 27803010 6302-5-119 - INSERT ACETAB 15D P9 32MM SYSTEM 12 DUR HIP BOTH IP/OP "$1,942.50" "$1,437.00" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $345.77 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" $404.84 "$1,942.50" $777.00 "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,942.50" "$1,456.88" "$1,942.50" "$1,942.50" "$1,942.50" $971.25 $971.25 "$1,538.46" "$1,942.50" "$1,554.00" $874.13 "$1,942.50" N/A "$1,126.65" "$1,942.50" "$1,165.50" "$1,942.50" "$1,942.50" "$1,942.50" N/A N/A 6302-6-007 SUP Custom 27803010 6302-6-007 - INSERT ACETAB 10D P7 26MM SYSTEM 12 DUR HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-008 SUP Custom 27803010 6302-6-008 - INSERT ACETAB 10D +4MM P8 26MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-009 SUP Custom 27803010 6302-6-009 - INSERT ACETAB 10D +4MM P9 26MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-102 SUP Custom 27803010 6302-6-102 - INSERT ACETAB 10D +4MM P2 28MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-103 SUP Custom 27803010 6302-6-103 - INSERT ACETAB 10D +4MM P3 28MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-104 SUP Custom 27803010 6302-6-104 - INSERT ACETAB 10D +4MM P4 28MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-105 SUP Custom 27803010 6302-6-105 - INSERT ACETAB 10D +4MM P5 28MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-106 SUP Custom 27803010 6302-6-106 - INSERT ACETAB 10D +4MM P6 28MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-107 SUP Custom 27803010 6302-6-107 - INSERT ACETAB 10D +4MM P7 28MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-108 SUP Custom 27803010 6302-6-108 - INSERT ACETAB 10D +4MM P8 28MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-109 SUP Custom 27803010 6302-6-109 - INSERT ACETAB 10D +4MM P9 28MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-220 SUP Custom 27803010 6302-6-220 - INSERT ACETAB +4MM P0 NEUTRAL 22.2MM SYSTEM 12 BOTH IP/OP $928.00 $687.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $165.18 $928.00 $928.00 $928.00 $928.00 $928.00 $928.00 $193.41 $928.00 $371.20 $928.00 $928.00 $928.00 $928.00 $928.00 $696.00 $928.00 $928.00 $928.00 $464.00 $464.00 $734.98 $928.00 $742.40 $417.60 $928.00 N/A $538.24 $928.00 $556.80 $928.00 $928.00 $928.00 N/A N/A 6302-6-303 SUP Custom 27803010 6302-6-303 - INSERT ACETAB 10D +4MM P3 32MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-304 SUP Custom 27803010 6302-6-304 - INSERT ACETAB 10D +4MM P4 32MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-305 SUP Custom 27803010 6302-6-305 - INSERT ACTB 10D P4 32MM S12 LATRILIZING RT BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-306 SUP Custom 27803010 6302-6-306 - INSERT ACETAB 10D +4MM P6 32MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-307 SUP Custom 27803010 6302-6-307 - INSERT ACETAB 10D +4MM P7 32MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-308 SUP Custom 27803010 6302-6-308 - INSERT ACETAB 10D +4MM P8 32MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-6-309 SUP Custom 27803010 6302-6-309 - INSERT ACETAB 10D +4MM P9 32MM SYSTEM 12 HIP BOTH IP/OP "$2,315.00" "$1,713.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $412.07 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" "$2,315.00" N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" "$2,315.00" "$2,315.00" N/A N/A 6302-H-328 SUP Custom 27803010 6302-H-328 - LINER ACETAB 10D 28MM CONSTRAIN HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6302-H-428 SUP Custom 27803010 6302-H-428 - LINER ACETAB 10D 28MM CONSTRAIN HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6302-H-432 SUP Custom 27803010 6302-H-432 - LINER ACETAB 10D 32MM CONSTRAIN HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6302-H-528 SUP Custom 27803010 6302-H-528 - LINER ACETAB 10D 28MM CONSTRAIN HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6302-H-532 SUP Custom 27803010 6302-H-532 - LINER ACETAB 10D 32MM CONSTRAIN HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6302-H-628 SUP Custom 27803010 6302-H-628 - LINER ACETAB 10D 28MM CONSTRAIN HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6302-H-632 SUP Custom 27803010 6302-H-632 - LINER ACETAB 10D 32MM CONSTRAIN HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6302-N-222 SUP Custom 27803010 6302-N-222 - LINER ACETAB NEUTRAL 22MM CONSTRAIN HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6302-N-328 SUP Custom 27803010 6302-N-328 - LINER ACETAB NEUTRAL 28MM CONSTRAIN TRIDENT BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6302-N-426 SUP Custom 27803010 6302-N-426 - LINER ACETAB NEUTRAL 26MM CONSTRAIN HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6302-N-428 SUP Custom 27803010 6302-N-428 - LINER ACETAB NEUTRAL 28MM CONSTRAIN HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6302-N-432 SUP Custom 27803010 6302-N-432 - LINER ACETAB NEUTRAL 32MM CONSTRAIN HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6302-N-532 SUP Custom 27803010 6302-N-532 - LINER ACETAB NEUTRAL 32MM CONSTRAIN HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6302-N-632 SUP Custom 27803010 6302-N-632 - LINER ACETAB NEUTRAL 32MM CONSTRAIN HIP BOTH IP/OP "$2,950.00" "$2,183.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $525.10 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$1,180.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" "$2,950.00" N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" "$2,950.00" "$2,950.00" N/A N/A 6309-2-240 SUP HCPCS C1776 6309-2-240 - CUP ACTB 40MM 22MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" $931.00 "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-2-242 SUP HCPCS C1776 6309-2-242 - CUP ACTB 42MM 22MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" "$2,327.50" "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-2-244 SUP HCPCS C1776 6309-2-244 - CUP ACTB 44MM 22MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" $931.00 "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-2-844 SUP HCPCS C1776 6309-2-844 - CUP ACTB 44MM 28MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" "$2,327.50" "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-2-846 SUP HCPCS C1776 6309-2-846 - CUP ACTB 46MM 28MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" $931.00 "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-2-848 SUP HCPCS C1776 6309-2-848 - CUP ACTB 48MM 28MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" "$2,327.50" "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-2-850 SUP HCPCS C1776 6309-2-850 - CUP ACTB 50MM 28MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" $931.00 "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-2-852 SUP HCPCS C1776 6309-2-852 - CUP ACTB 52MM 28MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" "$2,327.50" "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-2-854 SUP HCPCS C1776 6309-2-854 - CUP ACTB 54MM 28MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" $931.00 "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-2-856 SUP HCPCS C1776 6309-2-856 - CUP ACTB 56MM 28MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" "$2,327.50" "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-2-858 SUP HCPCS C1776 6309-2-858 - CUP ACTB 58MM 28MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" "$2,327.50" "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-2-860 SUP HCPCS C1776 6309-2-860 - CUP ACTB 60MM 28MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" $931.00 "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-3-248 SUP HCPCS C1776 6309-3-248 - CUP ACTB 48MM 32MM EXTR RIMFIT X3 HIP BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" "$2,327.50" "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-3-250 SUP HCPCS C1776 6309-3-250 - CUP ACTB 50MM 32MM EXTR RIMFIT X3 HIP BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" $931.00 "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-3-252 SUP HCPCS C1776 6309-3-252 - CUP ACTB 52MM 32MM EXTR X3 RIMFIT HIP BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" "$2,327.50" "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-3-254 SUP HCPCS C1776 6309-3-254 - CUP ACTB 54MM 32MM EXTR X3 RIMFIT HIP BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" $931.00 "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-3-256 SUP HCPCS C1776 6309-3-256 - CUP ACTB 56MM 32MM EXTR X3 RIMFIT HIP BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" "$2,327.50" "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-3-258 SUP HCPCS C1776 6309-3-258 - CUP ACTB 58MM 32MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" $931.00 "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-3-260 SUP HCPCS C1776 6309-3-260 - CUP ACTB 60MM 32MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" "$2,327.50" "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-3-652 SUP HCPCS C1776 6309-3-652 - CUP ACTB 52MM 36MM EXTR RIMFIT X3 HIP BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" $931.00 "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-3-654 SUP HCPCS C1776 6309-3-654 - CUP ACTB 54MM 36MM EXTR X3 RIMFIT HIP BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" "$2,327.50" "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-3-656 SUP HCPCS C1776 6309-3-656 - CUP ACTB 56MM 36MM EXTR RIMFIT X3 HIP BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" $931.00 "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-3-658 SUP HCPCS C1776 6309-3-658 - CUP ACTB 58MM 36MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" "$2,327.50" "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-3-660 SUP HCPCS C1776 6309-3-660 - CUP ACTB 60MM 36MM EXTR RIMFIT X3 HIP BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" $931.00 "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-4-056 SUP HCPCS C1776 6309-4-056 - CUP ACTB 56MM 40MM EXTR RIMFIT X3 HIP BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" "$2,327.50" "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-4-058 SUP HCPCS C1776 6309-4-058 - CUP ACTB 58MM 40MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" $931.00 "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 6309-4-060 SUP HCPCS C1776 6309-4-060 - CUP ACTB 58MM 60MM STRL EXTR RIMFIT X3 BOTH IP/OP "$2,327.50" "$1,722.00" $461.95 "$2,327.50" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$2,327.50" "$2,327.50" "$2,327.50" $485.11 "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" $485.08 "$2,327.50" "$2,327.50" "$1,376.72" "$2,327.50" "$2,327.50" "$2,327.50" "$2,327.50" "$1,745.63" "$2,327.50" "$2,327.50" "$2,327.50" "$1,163.75" "$1,163.75" "$1,843.38" "$2,327.50" "$1,862.00" "$1,047.38" $461.95 N/A "$1,349.95" "$2,327.50" "$2,327.50" "$2,327.50" $485.05 "$2,327.50" N/A N/A 632.414S SUP Custom 27803010 632.414S - PORT RTRCT BVL 22MM 40MM MRS BOTH IP/OP $897.50 $664.00 $159.76 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $159.76 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $187.05 $897.50 $359.00 $897.50 $897.50 $897.50 $897.50 $897.50 $673.13 $897.50 $897.50 $897.50 $448.75 $448.75 $710.82 $897.50 $718.00 $403.88 $897.50 N/A $520.55 $897.50 $538.50 $897.50 $897.50 $897.50 N/A N/A 632.415S SUP Custom 27803010 632.415S - PORT RTRCT BVL 22MM 50MM MRS BOTH IP/OP $897.50 $664.00 $159.76 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $159.76 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $187.05 $897.50 $359.00 $897.50 $897.50 $897.50 $897.50 $897.50 $673.13 $897.50 $897.50 $897.50 $448.75 $448.75 $710.82 $897.50 $718.00 $403.88 $897.50 N/A $520.55 $897.50 $538.50 $897.50 $897.50 $897.50 N/A N/A 632.416S SUP Custom 27803010 632.416S - RETRACTOR SURG 60X22IN MARS SPN DISPOSABLE BOTH IP/OP $897.50 $664.00 $159.76 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $159.76 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $187.05 $897.50 $359.00 $897.50 $897.50 $897.50 $897.50 $897.50 $673.13 $897.50 $897.50 $897.50 $448.75 $448.75 $710.82 $897.50 $718.00 $403.88 $897.50 N/A $520.55 $897.50 $538.50 $897.50 $897.50 $897.50 N/A N/A 632.417S SUP Custom 27803010 632.417S - PORT RTRCT BVL 22MM 70MM MRS BOTH IP/OP "$1,055.00" $781.00 $187.79 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $187.79 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $219.87 "$1,055.00" $422.00 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $791.25 "$1,055.00" "$1,055.00" "$1,055.00" $527.50 $527.50 $835.56 "$1,055.00" $844.00 $474.75 "$1,055.00" N/A $611.90 "$1,055.00" $633.00 "$1,055.00" "$1,055.00" "$1,055.00" N/A N/A 632.418S SUP Custom 27803010 632.418S - PORT RTRCT BVL 22MM 80MM MRS BOTH IP/OP "$1,055.00" $781.00 $187.79 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $187.79 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $219.87 "$1,055.00" $422.00 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $791.25 "$1,055.00" "$1,055.00" "$1,055.00" $527.50 $527.50 $835.56 "$1,055.00" $844.00 $474.75 "$1,055.00" N/A $611.90 "$1,055.00" $633.00 "$1,055.00" "$1,055.00" "$1,055.00" N/A N/A 632.419S SUP Custom 27803010 632.419S - PORT RTRCT BVL 22MM 90MM MRS BOTH IP/OP "$1,055.00" $781.00 $187.79 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $187.79 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $219.87 "$1,055.00" $422.00 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $791.25 "$1,055.00" "$1,055.00" "$1,055.00" $527.50 $527.50 $835.56 "$1,055.00" $844.00 $474.75 "$1,055.00" N/A $611.90 "$1,055.00" $633.00 "$1,055.00" "$1,055.00" "$1,055.00" N/A N/A 632.420S SUP Custom 27803010 632.420S - PORT RTRCT BVL 22MM 100MM MRS BOTH IP/OP "$1,232.50" $912.00 $219.39 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $219.39 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $256.87 "$1,232.50" $493.00 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $924.38 "$1,232.50" "$1,232.50" "$1,232.50" $616.25 $616.25 $976.14 "$1,232.50" $986.00 $554.63 "$1,232.50" N/A $714.85 "$1,232.50" $739.50 "$1,232.50" "$1,232.50" "$1,232.50" N/A N/A 632.421S SUP Custom 27803010 632.421S - PORT RTRCT BVL 22MM 110MM MRS BOTH IP/OP "$1,232.50" $912.00 $219.39 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $219.39 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $256.87 "$1,232.50" $493.00 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $924.38 "$1,232.50" "$1,232.50" "$1,232.50" $616.25 $616.25 $976.14 "$1,232.50" $986.00 $554.63 "$1,232.50" N/A $714.85 "$1,232.50" $739.50 "$1,232.50" "$1,232.50" "$1,232.50" N/A N/A 632.422S SUP Custom 27803010 632.422S - PORT RTRCT BVL 22MM 120MM MRS BOTH IP/OP "$1,232.50" $912.00 $219.39 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $219.39 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $256.87 "$1,232.50" $493.00 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $924.38 "$1,232.50" "$1,232.50" "$1,232.50" $616.25 $616.25 $976.14 "$1,232.50" $986.00 $554.63 "$1,232.50" N/A $714.85 "$1,232.50" $739.50 "$1,232.50" "$1,232.50" "$1,232.50" N/A N/A 632.424S SUP Custom 27803010 632.424S - PORT RTRCT STRG 22MM 40MM MRS BOTH IP/OP $860.00 $636.00 $153.08 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $153.08 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $344.00 $860.00 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $860.00 N/A $498.80 $860.00 $516.00 $860.00 $860.00 $860.00 N/A N/A 632.425S SUP Custom 27803010 632.425S - SET SPINAL 22MM 50MM STR PORT MARS BOTH IP/OP $860.00 $636.00 $153.08 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $153.08 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $344.00 $860.00 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $860.00 N/A $498.80 $860.00 $516.00 $860.00 $860.00 $860.00 N/A N/A 632.426S SUP Custom 27803010 632.426S - SET SPINAL 22MM 60MM STR PORT BOTH IP/OP $860.00 $636.00 $153.08 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $153.08 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $344.00 $860.00 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $860.00 N/A $498.80 $860.00 $516.00 $860.00 $860.00 $860.00 N/A N/A 632.427S SUP Custom 27803010 632.427S - PORT RTRCT STRG 22MM 70MM BOTH IP/OP $975.00 $722.00 $173.55 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $173.55 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $203.20 $975.00 $390.00 $975.00 $975.00 $975.00 $975.00 $975.00 $731.25 $975.00 $975.00 $975.00 $487.50 $487.50 $772.20 $975.00 $780.00 $438.75 $975.00 N/A $565.50 $975.00 $585.00 $975.00 $975.00 $975.00 N/A N/A 632.428S SUP Custom 27803010 632.428S - PORT RTRCT STRG 22MM 80MM MRS BOTH IP/OP $975.00 $722.00 $173.55 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $173.55 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $203.20 $975.00 $390.00 $975.00 $975.00 $975.00 $975.00 $975.00 $731.25 $975.00 $975.00 $975.00 $487.50 $487.50 $772.20 $975.00 $780.00 $438.75 $975.00 N/A $565.50 $975.00 $585.00 $975.00 $975.00 $975.00 N/A N/A 632.429S SUP Custom 27803010 632.429S - PORT RTRCT STRG 22MM 90MM MRS BOTH IP/OP $975.00 $722.00 $173.55 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $173.55 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $203.20 $975.00 $390.00 $975.00 $975.00 $975.00 $975.00 $975.00 $731.25 $975.00 $975.00 $975.00 $487.50 $487.50 $772.20 $975.00 $780.00 $438.75 $975.00 N/A $565.50 $975.00 $585.00 $975.00 $975.00 $975.00 N/A N/A 632.430S SUP Custom 27803010 632.430S - PORT RTRCT STRG 22MM 100MM MRS BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 632.431S SUP Custom 27803010 632.431S - PORT RTRCT STRG 22MM 110MM MRS BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 632.432S SUP Custom 27803010 632.432S - PORT RTRCT STRG 22MM 120MM MRS BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 632.434S SUP Custom 27803010 632.434S - PORT RTRCT BVL 19MM 40MM MRS BOTH IP/OP $897.50 $664.00 $159.76 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $159.76 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $187.05 $897.50 $359.00 $897.50 $897.50 $897.50 $897.50 $897.50 $673.13 $897.50 $897.50 $897.50 $448.75 $448.75 $710.82 $897.50 $718.00 $403.88 $897.50 N/A $520.55 $897.50 $538.50 $897.50 $897.50 $897.50 N/A N/A 632.435S SUP Custom 27803010 632.435S - PORT RTRCT BVL 19MM 50MM MRS BOTH IP/OP $897.50 $664.00 $159.76 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $159.76 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $187.05 $897.50 $359.00 $897.50 $897.50 $897.50 $897.50 $897.50 $673.13 $897.50 $897.50 $897.50 $448.75 $448.75 $710.82 $897.50 $718.00 $403.88 $897.50 N/A $520.55 $897.50 $538.50 $897.50 $897.50 $897.50 N/A N/A 632.436S SUP Custom 27803010 632.436S - PORT RTRCT BVL 19MM 60MM MRS BOTH IP/OP $897.50 $664.00 $159.76 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $159.76 $897.50 $897.50 $897.50 $897.50 $897.50 $897.50 $187.05 $897.50 $359.00 $897.50 $897.50 $897.50 $897.50 $897.50 $673.13 $897.50 $897.50 $897.50 $448.75 $448.75 $710.82 $897.50 $718.00 $403.88 $897.50 N/A $520.55 $897.50 $538.50 $897.50 $897.50 $897.50 N/A N/A 632.437S SUP Custom 27803010 632.437S - PORT RTRCT BVL 19MM 70MM MRS BOTH IP/OP "$1,055.00" $781.00 $187.79 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $187.79 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $219.87 "$1,055.00" $422.00 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $791.25 "$1,055.00" "$1,055.00" "$1,055.00" $527.50 $527.50 $835.56 "$1,055.00" $844.00 $474.75 "$1,055.00" N/A $611.90 "$1,055.00" $633.00 "$1,055.00" "$1,055.00" "$1,055.00" N/A N/A 632.438S SUP Custom 27803010 632.438S - PORT RTRCT BVL 19MM 80MM MRS BOTH IP/OP "$1,055.00" $781.00 $187.79 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $187.79 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $219.87 "$1,055.00" $422.00 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $791.25 "$1,055.00" "$1,055.00" "$1,055.00" $527.50 $527.50 $835.56 "$1,055.00" $844.00 $474.75 "$1,055.00" N/A $611.90 "$1,055.00" $633.00 "$1,055.00" "$1,055.00" "$1,055.00" N/A N/A 632.439S SUP Custom 27803010 632.439S - SET SPINAL 19MM 90MM BEVELED PORT BOTH IP/OP "$1,055.00" $781.00 $187.79 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $187.79 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $219.87 "$1,055.00" $422.00 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $791.25 "$1,055.00" "$1,055.00" "$1,055.00" $527.50 $527.50 $835.56 "$1,055.00" $844.00 $474.75 "$1,055.00" N/A $611.90 "$1,055.00" $633.00 "$1,055.00" "$1,055.00" "$1,055.00" N/A N/A 632.440S SUP Custom 27803010 632.440S - PORT RTRCT BVL 19MM 100MM MRS BOTH IP/OP "$1,232.50" $912.00 $219.39 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $219.39 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $256.87 "$1,232.50" $493.00 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $924.38 "$1,232.50" "$1,232.50" "$1,232.50" $616.25 $616.25 $976.14 "$1,232.50" $986.00 $554.63 "$1,232.50" N/A $714.85 "$1,232.50" $739.50 "$1,232.50" "$1,232.50" "$1,232.50" N/A N/A 632.441S SUP Custom 27803010 632.441S - PORT RTRCT BVL 19MM 110MM MRS BOTH IP/OP "$1,232.50" $912.00 $219.39 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $219.39 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $256.87 "$1,232.50" $493.00 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $924.38 "$1,232.50" "$1,232.50" "$1,232.50" $616.25 $616.25 $976.14 "$1,232.50" $986.00 $554.63 "$1,232.50" N/A $714.85 "$1,232.50" $739.50 "$1,232.50" "$1,232.50" "$1,232.50" N/A N/A 632.442S SUP Custom 27803010 632.442S - PORT RTRCT BVL 19MM 120MM MRS BOTH IP/OP "$1,232.50" $912.00 $219.39 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $219.39 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $256.87 "$1,232.50" $493.00 "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" "$1,232.50" $924.38 "$1,232.50" "$1,232.50" "$1,232.50" $616.25 $616.25 $976.14 "$1,232.50" $986.00 $554.63 "$1,232.50" N/A $714.85 "$1,232.50" $739.50 "$1,232.50" "$1,232.50" "$1,232.50" N/A N/A 632.444S SUP Custom 27803010 632.444S - PORT RTRCT STRG 19MM 40MM MRS BOTH IP/OP $860.00 $636.00 $153.08 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $153.08 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $344.00 $860.00 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $860.00 N/A $498.80 $860.00 $516.00 $860.00 $860.00 $860.00 N/A N/A 632.445S SUP Custom 27803010 632.445S - PORT RTRCT STRG 19MM 50MM MRS BOTH IP/OP $860.00 $636.00 $153.08 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $153.08 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $344.00 $860.00 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $860.00 N/A $498.80 $860.00 $516.00 $860.00 $860.00 $860.00 N/A N/A 632.446S SUP Custom 27803010 632.446S - PORT RTRCT STRG 19MM 60MM BOTH IP/OP $860.00 $636.00 $153.08 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $153.08 $860.00 $860.00 $860.00 $860.00 $860.00 $860.00 $179.23 $860.00 $344.00 $860.00 $860.00 $860.00 $860.00 $860.00 $645.00 $860.00 $860.00 $860.00 $430.00 $430.00 $681.12 $860.00 $688.00 $387.00 $860.00 N/A $498.80 $860.00 $516.00 $860.00 $860.00 $860.00 N/A N/A 632.447S SUP Custom 27803010 632.447S - PORT RTRCT STRG 19MM 70MM MRS BOTH IP/OP $975.00 $722.00 $173.55 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $173.55 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $203.20 $975.00 $390.00 $975.00 $975.00 $975.00 $975.00 $975.00 $731.25 $975.00 $975.00 $975.00 $487.50 $487.50 $772.20 $975.00 $780.00 $438.75 $975.00 N/A $565.50 $975.00 $585.00 $975.00 $975.00 $975.00 N/A N/A 632.448S SUP Custom 27803010 632.448S - PORT RTRCT STRG 19MM 80MM MRS BOTH IP/OP $975.00 $722.00 $173.55 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $173.55 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $203.20 $975.00 $390.00 $975.00 $975.00 $975.00 $975.00 $975.00 $731.25 $975.00 $975.00 $975.00 $487.50 $487.50 $772.20 $975.00 $780.00 $438.75 $975.00 N/A $565.50 $975.00 $585.00 $975.00 $975.00 $975.00 N/A N/A 632.449S SUP Custom 27803010 632.449S - PORT RTRCT STRG 19MM 90MM MRS BOTH IP/OP $975.00 $722.00 $173.55 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $173.55 $975.00 $975.00 $975.00 $975.00 $975.00 $975.00 $203.20 $975.00 $390.00 $975.00 $975.00 $975.00 $975.00 $975.00 $731.25 $975.00 $975.00 $975.00 $487.50 $487.50 $772.20 $975.00 $780.00 $438.75 $975.00 N/A $565.50 $975.00 $585.00 $975.00 $975.00 $975.00 N/A N/A 632.450S SUP Custom 27803010 632.450S - PORT RTRCT STRG 19MM 100MM MRS BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 632.451S SUP Custom 27803010 632.451S - PORT RTRCT STRG 19MM 110MM MRS BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 632.452S SUP Custom 27803010 632.452S - PORT RTRCT STRG 19MM 120MM MRS BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 632.454S SUP Custom 27803010 632.454S - PORT RTRCT BVL 26MM 40MM MRS BOTH IP/OP "$1,197.50" $886.00 $213.16 "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" $213.16 "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" $249.57 "$1,197.50" $479.00 "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" $898.13 "$1,197.50" "$1,197.50" "$1,197.50" $598.75 $598.75 $948.42 "$1,197.50" $958.00 $538.88 "$1,197.50" N/A $694.55 "$1,197.50" $718.50 "$1,197.50" "$1,197.50" "$1,197.50" N/A N/A 632.455S SUP Custom 27803010 632.455S - PORT RTRCT BVL 26MM 50MM MRS BOTH IP/OP "$1,197.50" $886.00 $213.16 "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" $213.16 "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" $249.57 "$1,197.50" $479.00 "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" $898.13 "$1,197.50" "$1,197.50" "$1,197.50" $598.75 $598.75 $948.42 "$1,197.50" $958.00 $538.88 "$1,197.50" N/A $694.55 "$1,197.50" $718.50 "$1,197.50" "$1,197.50" "$1,197.50" N/A N/A 632.456S SUP Custom 27803010 632.456S - PORT RTRCT BVL 26MM 60MM MRS BOTH IP/OP "$1,197.50" $886.00 $213.16 "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" $213.16 "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" $249.57 "$1,197.50" $479.00 "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" "$1,197.50" $898.13 "$1,197.50" "$1,197.50" "$1,197.50" $598.75 $598.75 $948.42 "$1,197.50" $958.00 $538.88 "$1,197.50" N/A $694.55 "$1,197.50" $718.50 "$1,197.50" "$1,197.50" "$1,197.50" N/A N/A 632.457S SUP Custom 27803010 632.457S - PORT RTRCT BVL 26MM 70MM MRS BOTH IP/OP "$1,307.50" $968.00 $232.74 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $232.74 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $272.50 "$1,307.50" $523.00 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $980.63 "$1,307.50" "$1,307.50" "$1,307.50" $653.75 $653.75 "$1,035.54" "$1,307.50" "$1,046.00" $588.38 "$1,307.50" N/A $758.35 "$1,307.50" $784.50 "$1,307.50" "$1,307.50" "$1,307.50" N/A N/A 632.458S SUP Custom 27803010 632.458S - PORT RTRCT BVL 26MM 80MM MRS BOTH IP/OP "$1,307.50" $968.00 $232.74 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $232.74 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $272.50 "$1,307.50" $523.00 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $980.63 "$1,307.50" "$1,307.50" "$1,307.50" $653.75 $653.75 "$1,035.54" "$1,307.50" "$1,046.00" $588.38 "$1,307.50" N/A $758.35 "$1,307.50" $784.50 "$1,307.50" "$1,307.50" "$1,307.50" N/A N/A 632.459S SUP Custom 27803010 632.459S - PORT RTRCT BVL 26MM 90MM MRS BOTH IP/OP "$1,307.50" $968.00 $232.74 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $232.74 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $272.50 "$1,307.50" $523.00 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $980.63 "$1,307.50" "$1,307.50" "$1,307.50" $653.75 $653.75 "$1,035.54" "$1,307.50" "$1,046.00" $588.38 "$1,307.50" N/A $758.35 "$1,307.50" $784.50 "$1,307.50" "$1,307.50" "$1,307.50" N/A N/A 632.460S SUP Custom 27803010 632.460S - PORT RTRCT BVL 26MM 100MM MRS BOTH IP/OP "$1,400.00" "$1,036.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $291.78 "$1,400.00" $560.00 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,050.00" "$1,400.00" "$1,400.00" "$1,400.00" $700.00 $700.00 "$1,108.80" "$1,400.00" "$1,120.00" $630.00 "$1,400.00" N/A $812.00 "$1,400.00" $840.00 "$1,400.00" "$1,400.00" "$1,400.00" N/A N/A 632.461S SUP Custom 27803010 632.461S - PORT RTRCT BVL 26MM 110MM MRS BOTH IP/OP "$1,400.00" "$1,036.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $291.78 "$1,400.00" $560.00 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,050.00" "$1,400.00" "$1,400.00" "$1,400.00" $700.00 $700.00 "$1,108.80" "$1,400.00" "$1,120.00" $630.00 "$1,400.00" N/A $812.00 "$1,400.00" $840.00 "$1,400.00" "$1,400.00" "$1,400.00" N/A N/A 632.462S SUP Custom 27803010 632.462S - PORT RTRCT BVL 26MM 120MM MRS BOTH IP/OP "$1,400.00" "$1,036.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $291.78 "$1,400.00" $560.00 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,050.00" "$1,400.00" "$1,400.00" "$1,400.00" $700.00 $700.00 "$1,108.80" "$1,400.00" "$1,120.00" $630.00 "$1,400.00" N/A $812.00 "$1,400.00" $840.00 "$1,400.00" "$1,400.00" "$1,400.00" N/A N/A 632.464S SUP Custom 27803010 632.464S - PORT RTRCT STRG 26MM 40MM MRS BOTH IP/OP "$1,167.50" $864.00 $207.82 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $207.82 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $243.32 "$1,167.50" $467.00 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $875.63 "$1,167.50" "$1,167.50" "$1,167.50" $583.75 $583.75 $924.66 "$1,167.50" $934.00 $525.38 "$1,167.50" N/A $677.15 "$1,167.50" $700.50 "$1,167.50" "$1,167.50" "$1,167.50" N/A N/A 632.465S SUP Custom 27803010 632.465S - PORT RTRCT STRG 26MM 50MM MRS BOTH IP/OP "$1,167.50" $864.00 $207.82 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $207.82 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $243.32 "$1,167.50" $467.00 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $875.63 "$1,167.50" "$1,167.50" "$1,167.50" $583.75 $583.75 $924.66 "$1,167.50" $934.00 $525.38 "$1,167.50" N/A $677.15 "$1,167.50" $700.50 "$1,167.50" "$1,167.50" "$1,167.50" N/A N/A 632.466S SUP Custom 27803010 632.466S - PORT RTRCT STRG 26MM 60MM MRS BOTH IP/OP "$1,167.50" $864.00 $207.82 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $207.82 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $243.32 "$1,167.50" $467.00 "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" "$1,167.50" $875.63 "$1,167.50" "$1,167.50" "$1,167.50" $583.75 $583.75 $924.66 "$1,167.50" $934.00 $525.38 "$1,167.50" N/A $677.15 "$1,167.50" $700.50 "$1,167.50" "$1,167.50" "$1,167.50" N/A N/A 632.467S SUP Custom 27803010 632.467S - PORT RTRCT STRG 26MM 70MM MRS BOTH IP/OP "$1,307.50" $968.00 $232.74 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $232.74 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $272.50 "$1,307.50" $523.00 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $980.63 "$1,307.50" "$1,307.50" "$1,307.50" $653.75 $653.75 "$1,035.54" "$1,307.50" "$1,046.00" $588.38 "$1,307.50" N/A $758.35 "$1,307.50" $784.50 "$1,307.50" "$1,307.50" "$1,307.50" N/A N/A 632.468S SUP Custom 27803010 632.468S - PORT RTRCT STRG 26MM 80MM STRL MRS SPNE BOTH IP/OP "$1,307.50" $968.00 $232.74 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $232.74 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $272.50 "$1,307.50" $523.00 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $980.63 "$1,307.50" "$1,307.50" "$1,307.50" $653.75 $653.75 "$1,035.54" "$1,307.50" "$1,046.00" $588.38 "$1,307.50" N/A $758.35 "$1,307.50" $784.50 "$1,307.50" "$1,307.50" "$1,307.50" N/A N/A 632.469S SUP Custom 27803010 632.469S - PORT RTRCT STRG 26MM 90MM MRS BOTH IP/OP "$1,307.50" $968.00 $232.74 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $232.74 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $272.50 "$1,307.50" $523.00 "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" "$1,307.50" $980.63 "$1,307.50" "$1,307.50" "$1,307.50" $653.75 $653.75 "$1,035.54" "$1,307.50" "$1,046.00" $588.38 "$1,307.50" N/A $758.35 "$1,307.50" $784.50 "$1,307.50" "$1,307.50" "$1,307.50" N/A N/A 632.470S SUP Custom 27803010 632.470S - PORT RTRCT STRG 26MM 100MM MRS BOTH IP/OP "$1,400.00" "$1,036.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $291.78 "$1,400.00" $560.00 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,050.00" "$1,400.00" "$1,400.00" "$1,400.00" $700.00 $700.00 "$1,108.80" "$1,400.00" "$1,120.00" $630.00 "$1,400.00" N/A $812.00 "$1,400.00" $840.00 "$1,400.00" "$1,400.00" "$1,400.00" N/A N/A 632.471S SUP Custom 27803010 632.471S - PORT RTRCT STRG 26MM 110MM MRS BOTH IP/OP "$1,400.00" "$1,036.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $291.78 "$1,400.00" $560.00 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,050.00" "$1,400.00" "$1,400.00" "$1,400.00" $700.00 $700.00 "$1,108.80" "$1,400.00" "$1,120.00" $630.00 "$1,400.00" N/A $812.00 "$1,400.00" $840.00 "$1,400.00" "$1,400.00" "$1,400.00" N/A N/A 632.472S SUP Custom 27803010 632.472S - PORT RTRCT STRG 26MM 120MM MRS BOTH IP/OP "$1,400.00" "$1,036.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $291.78 "$1,400.00" $560.00 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,050.00" "$1,400.00" "$1,400.00" "$1,400.00" $700.00 $700.00 "$1,108.80" "$1,400.00" "$1,120.00" $630.00 "$1,400.00" N/A $812.00 "$1,400.00" $840.00 "$1,400.00" "$1,400.00" "$1,400.00" N/A N/A 6352-5-062 SUP Custom 27803010 6352-5-062 - INSERT ACETAB 0D P2 46/48MM 28MM LINER CONGRUENT ROBUST LOCK BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-063 SUP Custom 27803010 6352-5-063 - INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12 BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-064 SUP Custom 27803010 6352-5-064 - INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12 BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-065 SUP Custom 27803010 6352-5-065 - INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12 BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-065300 SUP Custom 27803010 6352-5-065300 - INSERT ACETAB 0D 28MM SYSTEM 12 XFIRE BOTH IP/OP "$1,707.00" "$1,263.00" $303.85 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" $303.85 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" $355.76 "$1,707.00" $682.80 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,280.25" "$1,707.00" "$1,707.00" "$1,707.00" $853.50 $853.50 "$1,351.94" "$1,707.00" "$1,365.60" $768.15 "$1,707.00" N/A $990.06 "$1,707.00" "$1,024.20" "$1,707.00" "$1,707.00" "$1,707.00" N/A N/A 6352-5-066 SUP Custom 27803010 6352-5-066 - INSERT ACETAB 0D 28MM LINER CONGRUENT ROBUST LOCK SYSTEM 12 BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-066300 SUP Custom 27803010 6352-5-066300 - INSERT ACETAB 0D 28MM SYSTEM 12 XFIRE BOTH IP/OP "$1,707.00" "$1,263.00" $303.85 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" $303.85 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" $355.76 "$1,707.00" $682.80 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,280.25" "$1,707.00" "$1,707.00" "$1,707.00" $853.50 $853.50 "$1,351.94" "$1,707.00" "$1,365.60" $768.15 "$1,707.00" N/A $990.06 "$1,707.00" "$1,024.20" "$1,707.00" "$1,707.00" "$1,707.00" N/A N/A 6352-5-072 SUP Custom 27803010 6352-5-072 - INSERT ACETAB 0D P2 46/48MM 28MM 5MM LINER CONGRUENT ROBUST BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-073 SUP HCPCS C1776 6352-5-073 - INSERT ACTB 10D P3 50/52MM 28MM S12 LINR CNGR RBST LCK XFR BOTH IP/OP "$2,642.50" "$1,955.00" $524.47 "$2,642.50" "$1,189.13" "$1,189.13" "$1,189.13" "$1,189.13" "$2,642.50" "$2,642.50" "$2,642.50" $550.76 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$1,302.75" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" $524.47 N/A "$1,532.65" "$2,642.50" "$2,642.50" "$2,642.50" $550.70 "$2,642.50" N/A N/A 6352-5-073300 SUP Custom 27803010 6352-5-073300 - INSERT ACETAB 10D 28MM SYSTEM 12 XFIRE HIP BOTH IP/OP "$1,707.00" "$1,263.00" $303.85 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" $303.85 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" $355.76 "$1,707.00" $682.80 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,280.25" "$1,707.00" "$1,707.00" "$1,707.00" $853.50 $853.50 "$1,351.94" "$1,707.00" "$1,365.60" $768.15 "$1,707.00" N/A $990.06 "$1,707.00" "$1,024.20" "$1,707.00" "$1,707.00" "$1,707.00" N/A N/A 6352-5-074 SUP HCPCS C1776 6352-5-074 - INSERT ACTB 10D P4 54/46MM 28MM S12 LINR CNGR RBST LCK XFR BOTH IP/OP "$2,642.50" "$1,955.00" $524.47 "$2,642.50" "$1,189.13" "$1,189.13" "$1,189.13" "$1,189.13" "$2,642.50" "$2,642.50" "$2,642.50" $550.76 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$1,302.75" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" $524.47 N/A "$1,532.65" "$2,642.50" "$2,642.50" "$2,642.50" $550.70 "$2,642.50" N/A N/A 6352-5-074300 SUP Custom 27803010 6352-5-074300 - INSERT ACETAB 10D 28MM SYSTEM 12 XFIRE HIP BOTH IP/OP "$1,707.00" "$1,263.00" $303.85 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" $303.85 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" $355.76 "$1,707.00" $682.80 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,280.25" "$1,707.00" "$1,707.00" "$1,707.00" $853.50 $853.50 "$1,351.94" "$1,707.00" "$1,365.60" $768.15 "$1,707.00" N/A $990.06 "$1,707.00" "$1,024.20" "$1,707.00" "$1,707.00" "$1,707.00" N/A N/A 6352-5-075 SUP Custom 27803010 6352-5-075 - INSERT ACETAB 10D P5 58/60MM 28MM LINER CONGRUENT ROBUST BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-076 SUP HCPCS C1776 6352-5-076 - INSERT ACTB 10D P6 62/64MM 28MM S12 LINR CNGR RBST LCK XFR BOTH IP/OP "$2,642.50" "$1,955.00" $524.47 "$2,642.50" "$1,189.13" "$1,189.13" "$1,189.13" "$1,189.13" "$2,642.50" "$2,642.50" "$2,642.50" $550.76 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$1,302.75" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" $524.47 N/A "$1,532.65" "$2,642.50" "$2,642.50" "$2,642.50" $550.70 "$2,642.50" N/A N/A 6352-5-076300 SUP Custom 27803010 6352-5-076300 - INSERT ACETAB 10D 28MM SYSTEM 12 XFIRE HIP BOTH IP/OP "$1,707.00" "$1,263.00" $303.85 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" $303.85 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" $355.76 "$1,707.00" $682.80 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,280.25" "$1,707.00" "$1,707.00" "$1,707.00" $853.50 $853.50 "$1,351.94" "$1,707.00" "$1,365.60" $768.15 "$1,707.00" N/A $990.06 "$1,707.00" "$1,024.20" "$1,707.00" "$1,707.00" "$1,707.00" N/A N/A 6352-5-093 SUP Custom 27803010 6352-5-093 - INSERT ACETAB 0D P3 50/52MM 32MM LINER CONGRUENT ROBUST LOCK BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-094 SUP Custom 27803010 6352-5-094 - INSERT ACETAB 0D P4 54/46MM 32MM LINER CONGRUENT ROBUST LOCK BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-095 SUP Custom 27803010 6352-5-095 - INSERT ACETAB 0D P5 58/60MM 32MM 8MM LINER CONGRUENT ROBUST BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-096 SUP Custom 27803010 6352-5-096 - INSERT ACETAB 0D 32MM LINER CONGRUENT ROBUST LOCK SYSTEM 12 BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-097 SUP HCPCS C1776 6352-5-097 - INSERT ACTB 0D P7 32MM STRL S12 LINR CNGR RBST LCK XFR HIP BOTH IP/OP "$2,642.50" "$1,955.00" $524.47 "$2,642.50" "$1,189.13" "$1,189.13" "$1,189.13" "$1,189.13" "$2,642.50" "$2,642.50" "$2,642.50" $550.76 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$2,642.50" "$1,302.75" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" $524.47 N/A "$1,532.65" "$2,642.50" "$2,642.50" "$2,642.50" $550.70 "$2,642.50" N/A N/A 6352-5-097300 SUP Custom 27803010 6352-5-097300 - INSERT ACETAB 0D 32MM LINER CONGRUENT ROBUST LOCK SYSTEM 12 BOTH IP/OP "$1,707.00" "$1,263.00" $303.85 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" $303.85 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" $355.76 "$1,707.00" $682.80 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,280.25" "$1,707.00" "$1,707.00" "$1,707.00" $853.50 $853.50 "$1,351.94" "$1,707.00" "$1,365.60" $768.15 "$1,707.00" N/A $990.06 "$1,707.00" "$1,024.20" "$1,707.00" "$1,707.00" "$1,707.00" N/A N/A 6352-5-098 SUP HCPCS C1776 6352-5-098 - INSERT ACTB 0D P8 70/72MM 32MM S12 LINR CNGR XFR HIP BOTH IP/OP "$2,642.50" "$1,955.00" $524.47 "$2,642.50" "$1,189.13" "$1,189.13" "$1,189.13" "$1,189.13" "$2,642.50" "$2,642.50" "$2,642.50" $550.76 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$1,302.75" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" $524.47 N/A "$1,532.65" "$2,642.50" "$2,642.50" "$2,642.50" $550.70 "$2,642.50" N/A N/A 6352-5-098300 SUP Custom 27803010 6352-5-098300 - INSERT ACETAB 0D P8 32MM SYSTEM 12 XFIRE HIP BOTH IP/OP "$1,707.00" "$1,263.00" $303.85 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" $303.85 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" $355.76 "$1,707.00" $682.80 "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,707.00" "$1,280.25" "$1,707.00" "$1,707.00" "$1,707.00" $853.50 $853.50 "$1,351.94" "$1,707.00" "$1,365.60" $768.15 "$1,707.00" N/A $990.06 "$1,707.00" "$1,024.20" "$1,707.00" "$1,707.00" "$1,707.00" N/A N/A 6352-5-103 SUP Custom 27803010 6352-5-103 - INSERT ACETAB 10D P3 50/52MM 32MM LINER CONGRUENT ROBUST BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-104 SUP Custom 27803010 6352-5-104 - INSERT ACETAB 10D 32MM LINER CONGRUENT ROBUST LOCK SYSTEM 12 BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-105 SUP Custom 27803010 6352-5-105 - INSERT ACETAB 10D P5 58/60MM 32MM LINER CONGRUENT ROBUST BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-106 SUP Custom 27803010 6352-5-106 - INSERT ACETAB 10D P6 62/64MM 32MM LINER CONGRUENT ROBUST BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-107 SUP Custom 27803010 6352-5-107 - INSERT ACETAB 10D 32MM LINER CONGRUENT ROBUST LOCK SYSTEM 12 BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6352-5-108 SUP Custom 27803010 6352-5-108 - INSERT ACETAB 10D P8 70/72MM 32MM LINER CONGRUENT ROBUST BOTH IP/OP "$2,642.50" "$1,955.00" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $470.37 "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" $550.73 "$2,642.50" "$1,057.00" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$2,642.50" "$1,981.88" "$2,642.50" "$2,642.50" "$2,642.50" "$1,321.25" "$1,321.25" "$2,092.86" "$2,642.50" "$2,114.00" "$1,189.13" "$2,642.50" N/A "$1,532.65" "$2,642.50" "$1,585.50" "$2,642.50" "$2,642.50" "$2,642.50" N/A N/A 6364-2-026 SUP Custom 27803010 6364-2-026 - HEAD FEMORAL -3MM 26MM NECK V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-028 SUP Custom 27803010 6364-2-028 - HEAD FEMORAL -4MM 28MM NECK V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-032 SUP Custom 27803010 6364-2-032 - HEAD FEMORAL -4MM 32MM TAPER V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-036 SUP Custom 27803010 6364-2-036 - HEAD FEMORAL -5MM 36MM TAPER V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-122 SUP Custom 27803010 6364-2-122 - HEAD FEMORAL 0MM 22MM V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-126 SUP Custom 27803010 6364-2-126 - HEAD FEMORAL 0MM 26MM TAPER V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-128 SUP Custom 27803010 6364-2-128 - HEAD FEMORAL 0MM 28MM TAPER V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-132 SUP Custom 27803010 6364-2-132 - HEAD FEMORAL 0MM 32MM TAPER V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-136 SUP Custom 27803010 6364-2-136 - HEAD FEMORAL 0MM 36MM V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-226 SUP Custom 27803010 6364-2-226 - HEAD FEMORAL +4MM 26MM NECK V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-228 SUP Custom 27803010 6364-2-228 - HEAD FEMORAL +4MM 28MM TAPER V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-232 SUP Custom 27803010 6364-2-232 - HEAD FEMORAL +4MM TAPER 32MM V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-236 SUP Custom 27803010 6364-2-236 - HEAD FEMORAL +5MM 36MM TAPER V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-322 SUP Custom 27803010 6364-2-322 - HEAD FEMORAL +8MM 22MM V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-326 SUP Custom 27803010 6364-2-326 - HEAD FEMORAL +8MM 26MM NECK V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-328 SUP Custom 27803010 6364-2-328 - HEAD FEMORAL +8MM 28MM V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6364-2-332 SUP Custom 27803010 6364-2-332 - HEAD FEMORAL +8MM 32MM EXETER V40 ORTHINOX HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A 6366-9-220 SUP HCPCS C1776 6366-9-220 - GUIDE PIN ORTH HMRS AXIS BOTH IP/OP "$2,030.00" "$1,502.00" $402.90 "$2,030.00" $913.50 $913.50 $913.50 $913.50 "$2,030.00" "$2,030.00" "$2,030.00" $423.10 "$2,030.00" "$2,030.00" "$2,030.00" "$2,030.00" "$2,030.00" $423.07 "$2,030.00" "$2,030.00" "$1,200.75" "$2,030.00" "$2,030.00" "$2,030.00" "$2,030.00" "$1,522.50" "$2,030.00" "$2,030.00" "$2,030.00" "$1,015.00" "$1,015.00" "$1,607.76" "$2,030.00" "$1,624.00" $913.50 $402.90 N/A "$1,177.40" "$2,030.00" "$2,030.00" "$2,030.00" $423.05 "$2,030.00" N/A N/A 640301S SUP HCPCS C1713 640301S - SCREW BONE STANDARD COMPRESSION T2 STERILE BOTH IP/OP $190.00 $141.00 $37.66 $189.75 $85.39 $85.39 $85.39 $85.39 $189.75 $189.75 $189.75 $39.55 $189.75 $189.75 $189.75 $189.75 $189.75 $39.55 $189.75 $189.75 $112.24 $189.75 $189.75 $189.75 $189.75 $142.50 $189.75 $189.75 $189.75 $94.88 $94.88 $150.28 $189.75 $151.80 $85.39 $37.66 N/A $110.20 $189.75 $113.85 $189.75 $39.54 $189.75 N/A N/A 640302S SUP HCPCS C1713 640302S - SCREW BONE 2 COMPRESSION T2 SPN STERILE BOTH IP/OP $199.50 $148.00 $39.57 $199.38 $89.72 $89.72 $89.72 $89.72 $199.38 $199.38 $199.38 $41.56 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $117.93 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $39.57 N/A $115.71 $199.38 $119.63 $199.38 $199.38 $199.38 N/A N/A 640303S SUP HCPCS C1713 640303S - SCREW BONE 3 COMPRESSION T2 SPN STERILE BOTH IP/OP $170.50 $126.00 $33.84 $170.50 $76.73 $76.73 $76.73 $76.73 $170.50 $170.50 $170.50 $35.54 $170.50 $170.50 $170.50 $170.50 $170.50 $35.53 $170.50 $68.20 $100.85 $170.50 $170.50 $170.50 $170.50 $127.88 $170.50 $170.50 $170.50 $85.25 $85.25 $135.04 $170.50 $136.40 $76.73 $33.84 N/A $98.89 $170.50 $170.50 $170.50 $170.50 $170.50 N/A N/A 640304S SUP HCPCS C1713 640304S - SCREW BONE 4 COMPRESSION T2 SPN STERILE BOTH IP/OP $170.50 $126.00 $33.84 $170.50 $76.73 $76.73 $76.73 $76.73 $170.50 $170.50 $170.50 $35.54 $170.50 $170.50 $170.50 $170.50 $170.50 $35.53 $170.50 $170.50 $100.85 $170.50 $170.50 $170.50 $170.50 $127.88 $170.50 $170.50 $170.50 $85.25 $85.25 $135.04 $170.50 $136.40 $76.73 $33.84 N/A $98.89 $170.50 $170.50 $170.50 $35.53 $170.50 N/A N/A 640320S SUP HCPCS C1713 640320S - WASHER ORTHOPEDIC SCREW T2 STERILE BOTH IP/OP $60.50 $45.00 $12.01 $60.50 $27.23 $27.23 $27.23 $27.23 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $60.50 $60.50 $60.50 $12.61 $60.50 $60.50 $35.79 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $27.23 $12.01 N/A $35.09 $60.50 $36.30 $60.50 $12.61 $60.50 N/A N/A 641-00-28C SUP Custom 27803010 641-00-28C - INSERT ACETAB C 28MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-28D SUP Custom 27803010 641-00-28D - INSERT ACETAB D 28MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-28E SUP Custom 27803010 641-00-28E - INSERT ACETAB E 28MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-28F SUP Custom 27803010 641-00-28F - INSERT ACETAB F 28MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-28G SUP Custom 27803010 641-00-28G - INSERT ACETAB G 28MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-28H SUP Custom 27803010 641-00-28H - INSERT ACETAB H 28MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-28I SUP Custom 27803010 641-00-28I - INSERT ACETAB I 28MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-28J SUP Custom 27803010 641-00-28J - INSERT ACETAB J 28MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-32E SUP Custom 27803010 641-00-32E - INSERT ACETAB 0D E 32MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-32F SUP Custom 27803010 641-00-32F - INSERT ACETAB F 32MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-32G SUP Custom 27803010 641-00-32G - INSERT ACETAB G 32MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-32H SUP Custom 27803010 641-00-32H - INSERT ACETAB H 32MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-32I SUP Custom 27803010 641-00-32I - INSERT ACETAB I 32MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-32J SUP Custom 27803010 641-00-32J - INSERT ACETAB J 32MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-36E SUP Custom 27803010 641-00-36E - INSERT ACETAB E 36MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-36F SUP Custom 27803010 641-00-36F - INSERT ACETAB F 36MM ELEVATED RIM TRIDENT X3 HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-36G SUP Custom 27803010 641-00-36G - INSERT ACETAB G 36MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-36H SUP Custom 27803010 641-00-36H - INSERT ACETAB H 36MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-36I SUP Custom 27803010 641-00-36I - INSERT ACETAB I 36MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 641-00-36J SUP Custom 27803010 641-00-36J - INSERT ACETAB J 36MM ELEVATED RIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6430-0-020 SUP Custom 27803010 6430-0-020 - COMPONENT PATLR SMALL 20MM AVON KNEE BOTH IP/OP "$2,170.00" "$1,606.00" $386.26 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" $386.26 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" $452.25 "$2,170.00" $868.00 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$1,627.50" "$2,170.00" "$2,170.00" "$2,170.00" "$1,085.00" "$1,085.00" "$1,718.64" "$2,170.00" "$1,736.00" $976.50 "$2,170.00" N/A "$1,258.60" "$2,170.00" "$1,302.00" "$2,170.00" "$2,170.00" "$2,170.00" N/A N/A 6430-0-030 SUP Custom 27803010 6430-0-030 - COMPONENT PATLR MEDIUM 30MM AVON KNEE BOTH IP/OP "$2,170.00" "$1,606.00" $386.26 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" $386.26 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" $452.25 "$2,170.00" $868.00 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$1,627.50" "$2,170.00" "$2,170.00" "$2,170.00" "$1,085.00" "$1,085.00" "$1,718.64" "$2,170.00" "$1,736.00" $976.50 "$2,170.00" N/A "$1,258.60" "$2,170.00" "$1,302.00" "$2,170.00" "$2,170.00" "$2,170.00" N/A N/A 6430-0-040 SUP Custom 27803010 6430-0-040 - COMPONENT PATLR LARGE 40MM AVON KNEE BOTH IP/OP "$2,170.00" "$1,606.00" $386.26 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" $386.26 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" $452.25 "$2,170.00" $868.00 "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$2,170.00" "$1,627.50" "$2,170.00" "$2,170.00" "$2,170.00" "$1,085.00" "$1,085.00" "$1,718.64" "$2,170.00" "$1,736.00" $976.50 "$2,170.00" N/A "$1,258.60" "$2,170.00" "$1,302.00" "$2,170.00" "$2,170.00" "$2,170.00" N/A N/A 6430-0-050 SUP HCPCS C1776 6430-0-050 - COMPONENT FEMORAL XS 50MM AVON KNEE BOTH IP/OP "$9,682.50" "$7,165.00" "$1,921.73" "$9,682.50" "$4,357.13" "$4,357.13" "$4,357.13" "$4,357.13" "$9,682.50" "$9,682.50" "$9,682.50" "$2,018.08" "$9,682.50" "$9,682.50" "$9,682.50" "$9,682.50" "$9,682.50" "$2,017.94" "$9,682.50" "$3,873.00" "$4,773.47" "$9,682.50" "$9,682.50" "$9,682.50" "$9,682.50" "$7,261.88" "$9,682.50" "$9,682.50" "$9,682.50" "$4,841.25" "$4,841.25" "$7,668.54" "$9,682.50" "$7,746.00" "$4,357.13" "$1,921.73" N/A "$5,615.85" "$9,682.50" "$5,809.50" "$9,682.50" "$2,017.83" "$9,682.50" N/A N/A 6430-0-100 SUP HCPCS C1776 6430-0-100 - COMPONENT FEMORAL SMALL AVON KNEE BOTH IP/OP "$9,682.50" "$7,165.00" "$1,921.73" "$9,682.50" "$4,357.13" "$4,357.13" "$4,357.13" "$4,357.13" "$9,682.50" "$9,682.50" "$9,682.50" "$2,018.08" "$9,682.50" "$9,682.50" "$9,682.50" "$9,682.50" "$9,682.50" "$2,017.94" "$9,682.50" "$3,873.00" "$4,773.47" "$9,682.50" "$9,682.50" "$9,682.50" "$9,682.50" "$7,261.88" "$9,682.50" "$9,682.50" "$9,682.50" "$4,841.25" "$4,841.25" "$7,668.54" "$9,682.50" "$7,746.00" "$4,357.13" "$1,921.73" N/A "$5,615.85" "$9,682.50" "$5,809.50" "$9,682.50" "$2,017.83" "$9,682.50" N/A N/A 6430-0-200 SUP HCPCS C1776 6430-0-200 - COMPONENT FEMORAL MEDIUM AVON KNEE BOTH IP/OP "$9,682.50" "$7,165.00" "$1,921.73" "$9,682.50" "$4,357.13" "$4,357.13" "$4,357.13" "$4,357.13" "$9,682.50" "$9,682.50" "$9,682.50" "$2,018.08" "$9,682.50" "$9,682.50" "$9,682.50" "$9,682.50" "$9,682.50" "$2,017.94" "$9,682.50" "$9,682.50" "$4,773.47" "$9,682.50" "$9,682.50" "$9,682.50" "$9,682.50" "$7,261.88" "$9,682.50" "$9,682.50" "$9,682.50" "$4,841.25" "$4,841.25" "$7,668.54" "$9,682.50" "$7,746.00" "$4,357.13" "$1,921.73" N/A "$5,615.85" "$9,682.50" "$9,682.50" "$9,682.50" "$2,017.83" "$9,682.50" N/A N/A 643-00-28C SUP Custom 27803010 643-00-28C - INSERT ACETAB C 28MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,130.00" "$2,316.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $652.33 "$3,130.00" "$1,252.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$2,347.50" "$3,130.00" "$3,130.00" "$3,130.00" "$1,565.00" "$1,565.00" "$2,478.96" "$3,130.00" "$2,504.00" "$1,408.50" "$3,130.00" N/A "$1,815.40" "$3,130.00" "$1,878.00" "$3,130.00" "$3,130.00" "$3,130.00" N/A N/A 643-00-28D SUP Custom 27803010 643-00-28D - INSERT ACETAB D 28MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,130.00" "$2,316.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $652.33 "$3,130.00" "$1,252.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$2,347.50" "$3,130.00" "$3,130.00" "$3,130.00" "$1,565.00" "$1,565.00" "$2,478.96" "$3,130.00" "$2,504.00" "$1,408.50" "$3,130.00" N/A "$1,815.40" "$3,130.00" "$1,878.00" "$3,130.00" "$3,130.00" "$3,130.00" N/A N/A 643-00-28E SUP Custom 27803010 643-00-28E - INSERT ACETAB E 28MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,130.00" "$2,316.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $652.33 "$3,130.00" "$1,252.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$2,347.50" "$3,130.00" "$3,130.00" "$3,130.00" "$1,565.00" "$1,565.00" "$2,478.96" "$3,130.00" "$2,504.00" "$1,408.50" "$3,130.00" N/A "$1,815.40" "$3,130.00" "$1,878.00" "$3,130.00" "$3,130.00" "$3,130.00" N/A N/A 643-00-28F SUP Custom 27803010 643-00-28F - INSERT ACETAB F 28MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,130.00" "$2,316.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $652.33 "$3,130.00" "$1,252.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$2,347.50" "$3,130.00" "$3,130.00" "$3,130.00" "$1,565.00" "$1,565.00" "$2,478.96" "$3,130.00" "$2,504.00" "$1,408.50" "$3,130.00" N/A "$1,815.40" "$3,130.00" "$1,878.00" "$3,130.00" "$3,130.00" "$3,130.00" N/A N/A 643-00-28G SUP Custom 27803010 643-00-28G - INSERT ACETAB G 28MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,130.00" "$2,316.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $652.33 "$3,130.00" "$1,252.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$2,347.50" "$3,130.00" "$3,130.00" "$3,130.00" "$1,565.00" "$1,565.00" "$2,478.96" "$3,130.00" "$2,504.00" "$1,408.50" "$3,130.00" N/A "$1,815.40" "$3,130.00" "$1,878.00" "$3,130.00" "$3,130.00" "$3,130.00" N/A N/A 643-00-28H SUP Custom 27803010 643-00-28H - INSERT ACETAB H 28MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,130.00" "$2,316.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $652.33 "$3,130.00" "$1,252.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$2,347.50" "$3,130.00" "$3,130.00" "$3,130.00" "$1,565.00" "$1,565.00" "$2,478.96" "$3,130.00" "$2,504.00" "$1,408.50" "$3,130.00" N/A "$1,815.40" "$3,130.00" "$1,878.00" "$3,130.00" "$3,130.00" "$3,130.00" N/A N/A 643-00-28I SUP Custom 27803010 643-00-28I - INSERT ACETAB I 28MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,130.00" "$2,316.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $652.33 "$3,130.00" "$1,252.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$2,347.50" "$3,130.00" "$3,130.00" "$3,130.00" "$1,565.00" "$1,565.00" "$2,478.96" "$3,130.00" "$2,504.00" "$1,408.50" "$3,130.00" N/A "$1,815.40" "$3,130.00" "$1,878.00" "$3,130.00" "$3,130.00" "$3,130.00" N/A N/A 643-00-28J SUP Custom 27803010 643-00-28J - INSERT ACETAB J 28MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,130.00" "$2,316.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $652.33 "$3,130.00" "$1,252.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$2,347.50" "$3,130.00" "$3,130.00" "$3,130.00" "$1,565.00" "$1,565.00" "$2,478.96" "$3,130.00" "$2,504.00" "$1,408.50" "$3,130.00" N/A "$1,815.40" "$3,130.00" "$1,878.00" "$3,130.00" "$3,130.00" "$3,130.00" N/A N/A 6430-0-300 SUP HCPCS C1776 6430-0-300 - COMPONENT FEMORAL LARGE AVON KNEE BOTH IP/OP "$9,682.50" "$7,165.00" "$1,921.73" "$9,682.50" "$4,357.13" "$4,357.13" "$4,357.13" "$4,357.13" "$9,682.50" "$9,682.50" "$9,682.50" "$2,018.08" "$9,682.50" "$9,682.50" "$9,682.50" "$9,682.50" "$9,682.50" "$2,017.94" "$9,682.50" "$3,873.00" "$4,773.47" "$9,682.50" "$9,682.50" "$9,682.50" "$9,682.50" "$7,261.88" "$9,682.50" "$9,682.50" "$9,682.50" "$4,841.25" "$4,841.25" "$7,668.54" "$9,682.50" "$7,746.00" "$4,357.13" "$1,921.73" N/A "$5,615.85" "$9,682.50" "$5,809.50" "$9,682.50" "$2,017.83" "$9,682.50" N/A N/A 643-00-32E SUP Custom 27803010 643-00-32E - INSERT ACETAB E 32MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,130.00" "$2,316.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $652.33 "$3,130.00" "$1,252.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$2,347.50" "$3,130.00" "$3,130.00" "$3,130.00" "$1,565.00" "$1,565.00" "$2,478.96" "$3,130.00" "$2,504.00" "$1,408.50" "$3,130.00" N/A "$1,815.40" "$3,130.00" "$1,878.00" "$3,130.00" "$3,130.00" "$3,130.00" N/A N/A 643-00-32F SUP Custom 27803010 643-00-32F - INSERT ACETAB F 32MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,130.00" "$2,316.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $652.33 "$3,130.00" "$1,252.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$2,347.50" "$3,130.00" "$3,130.00" "$3,130.00" "$1,565.00" "$1,565.00" "$2,478.96" "$3,130.00" "$2,504.00" "$1,408.50" "$3,130.00" N/A "$1,815.40" "$3,130.00" "$1,878.00" "$3,130.00" "$3,130.00" "$3,130.00" N/A N/A 643-00-32G SUP Custom 27803010 643-00-32G - INSERT ACETAB G 32MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,130.00" "$2,316.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $652.33 "$3,130.00" "$1,252.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$2,347.50" "$3,130.00" "$3,130.00" "$3,130.00" "$1,565.00" "$1,565.00" "$2,478.96" "$3,130.00" "$2,504.00" "$1,408.50" "$3,130.00" N/A "$1,815.40" "$3,130.00" "$1,878.00" "$3,130.00" "$3,130.00" "$3,130.00" N/A N/A 643-00-32H SUP Custom 27803010 643-00-32H - INSERT ACETAB H 32MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,130.00" "$2,316.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $652.33 "$3,130.00" "$1,252.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$2,347.50" "$3,130.00" "$3,130.00" "$3,130.00" "$1,565.00" "$1,565.00" "$2,478.96" "$3,130.00" "$2,504.00" "$1,408.50" "$3,130.00" N/A "$1,815.40" "$3,130.00" "$1,878.00" "$3,130.00" "$3,130.00" "$3,130.00" N/A N/A 643-00-32I SUP Custom 27803010 643-00-32I - INSERT ACETAB I 32MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,130.00" "$2,316.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $652.33 "$3,130.00" "$1,252.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$2,347.50" "$3,130.00" "$3,130.00" "$3,130.00" "$1,565.00" "$1,565.00" "$2,478.96" "$3,130.00" "$2,504.00" "$1,408.50" "$3,130.00" N/A "$1,815.40" "$3,130.00" "$1,878.00" "$3,130.00" "$3,130.00" "$3,130.00" N/A N/A 643-00-32J SUP Custom 27803010 643-00-32J - INSERT ACETAB J 32MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,130.00" "$2,316.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $557.14 "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" $652.33 "$3,130.00" "$1,252.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$3,130.00" "$2,347.50" "$3,130.00" "$3,130.00" "$3,130.00" "$1,565.00" "$1,565.00" "$2,478.96" "$3,130.00" "$2,504.00" "$1,408.50" "$3,130.00" N/A "$1,815.40" "$3,130.00" "$1,878.00" "$3,130.00" "$3,130.00" "$3,130.00" N/A N/A 643-00-36E SUP Custom 27803010 643-00-36E - INSERT ACETAB E 36MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,345.00" "$2,475.00" $595.41 "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" $595.41 "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" $697.13 "$3,345.00" "$1,338.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$2,508.75" "$3,345.00" "$3,345.00" "$3,345.00" "$1,672.50" "$1,672.50" "$2,649.24" "$3,345.00" "$2,676.00" "$1,505.25" "$3,345.00" N/A "$1,940.10" "$3,345.00" "$2,007.00" "$3,345.00" "$3,345.00" "$3,345.00" N/A N/A 643-00-36F SUP Custom 27803010 643-00-36F - INSERT ACETAB F 36MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,345.00" "$2,475.00" $595.41 "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" $595.41 "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" $697.13 "$3,345.00" "$1,338.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$2,508.75" "$3,345.00" "$3,345.00" "$3,345.00" "$1,672.50" "$1,672.50" "$2,649.24" "$3,345.00" "$2,676.00" "$1,505.25" "$3,345.00" N/A "$1,940.10" "$3,345.00" "$2,007.00" "$3,345.00" "$3,345.00" "$3,345.00" N/A N/A 643-00-36G SUP Custom 27803010 643-00-36G - INSERT ACETAB G 36MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,345.00" "$2,475.00" $595.41 "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" $595.41 "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" $697.13 "$3,345.00" "$1,338.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$2,508.75" "$3,345.00" "$3,345.00" "$3,345.00" "$1,672.50" "$1,672.50" "$2,649.24" "$3,345.00" "$2,676.00" "$1,505.25" "$3,345.00" N/A "$1,940.10" "$3,345.00" "$2,007.00" "$3,345.00" "$3,345.00" "$3,345.00" N/A N/A 643-00-36H SUP Custom 27803010 643-00-36H - INSERT ACETAB H 36MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,345.00" "$2,475.00" $595.41 "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" $595.41 "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" $697.13 "$3,345.00" "$1,338.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$2,508.75" "$3,345.00" "$3,345.00" "$3,345.00" "$1,672.50" "$1,672.50" "$2,649.24" "$3,345.00" "$2,676.00" "$1,505.25" "$3,345.00" N/A "$1,940.10" "$3,345.00" "$2,007.00" "$3,345.00" "$3,345.00" "$3,345.00" N/A N/A 643-00-36I SUP Custom 27803010 643-00-36I - INSERT ACETAB I 36MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,345.00" "$2,475.00" $595.41 "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" $595.41 "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" $697.13 "$3,345.00" "$1,338.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$2,508.75" "$3,345.00" "$3,345.00" "$3,345.00" "$1,672.50" "$1,672.50" "$2,649.24" "$3,345.00" "$2,676.00" "$1,505.25" "$3,345.00" N/A "$1,940.10" "$3,345.00" "$2,007.00" "$3,345.00" "$3,345.00" "$3,345.00" N/A N/A 643-00-36J SUP Custom 27803010 643-00-36J - INSERT ACETAB J 36MM ELEVATE RIM TRIDENT X3 HIP BOTH IP/OP "$3,345.00" "$2,475.00" $595.41 "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" $595.41 "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" $697.13 "$3,345.00" "$1,338.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$3,345.00" "$2,508.75" "$3,345.00" "$3,345.00" "$3,345.00" "$1,672.50" "$1,672.50" "$2,649.24" "$3,345.00" "$2,676.00" "$1,505.25" "$3,345.00" N/A "$1,940.10" "$3,345.00" "$2,007.00" "$3,345.00" "$3,345.00" "$3,345.00" N/A N/A 6471-0-808 SUP Custom 27803010 6471-0-808 - INSERT TIBIAL XS 8MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$2,192.50" "$1,622.00" $390.20 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" $390.20 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" $456.86 "$2,192.13" $876.85 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$1,644.38" "$2,192.13" "$2,192.13" "$2,192.13" "$1,096.07" "$1,096.07" "$1,736.17" "$2,192.13" "$1,753.70" $986.46 "$2,192.13" N/A "$1,271.65" "$2,192.13" "$1,315.28" "$2,192.13" "$2,192.13" "$2,192.13" N/A N/A 6471-0-811 SUP Custom 27803010 6471-0-811 - INSERT TIBIAL XS 11MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$2,192.50" "$1,622.00" $390.20 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" $390.20 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" $456.86 "$2,192.13" $876.85 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$1,644.38" "$2,192.13" "$2,192.13" "$2,192.13" "$1,096.07" "$1,096.07" "$1,736.17" "$2,192.13" "$1,753.70" $986.46 "$2,192.13" N/A "$1,271.65" "$2,192.13" "$1,315.28" "$2,192.13" "$2,192.13" "$2,192.13" N/A N/A 6471-0-813 SUP Custom 27803010 6471-0-813 - INSERT TIBIAL XS 13MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$2,192.50" "$1,622.00" $390.20 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" $390.20 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" $456.86 "$2,192.13" $876.85 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$1,644.38" "$2,192.13" "$2,192.13" "$2,192.13" "$1,096.07" "$1,096.07" "$1,736.17" "$2,192.13" "$1,753.70" $986.46 "$2,192.13" N/A "$1,271.65" "$2,192.13" "$1,315.28" "$2,192.13" "$2,192.13" "$2,192.13" N/A N/A 6471-0-816 SUP Custom 27803010 6471-0-816 - INSERT TIBIAL XS 16MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$2,192.50" "$1,622.00" $390.20 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" $390.20 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" $456.86 "$2,192.13" $876.85 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$1,644.38" "$2,192.13" "$2,192.13" "$2,192.13" "$1,096.07" "$1,096.07" "$1,736.17" "$2,192.13" "$1,753.70" $986.46 "$2,192.13" N/A "$1,271.65" "$2,192.13" "$1,315.28" "$2,192.13" "$2,192.13" "$2,192.13" N/A N/A 6471-1-808 SUP Custom 27803010 6471-1-808 - INSERT TIBIAL SMALL 8MM MODULAR KIMEMAX II CONDYLE BOTH IP/OP "$1,510.00" "$1,117.00" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $314.62 "$1,509.63" $603.85 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,132.50" "$1,509.63" "$1,509.63" "$1,509.63" $754.82 $754.82 "$1,195.63" "$1,509.63" "$1,207.70" $679.33 "$1,509.63" N/A $875.80 "$1,509.63" $905.78 "$1,509.63" "$1,509.63" "$1,509.63" N/A N/A 6471-1-811 SUP Custom 27803010 6471-1-811 - INSERT TIBIAL SMALL 11MM MODULAR KIMEMAX II CONDYLE BOTH IP/OP "$2,283.50" "$1,690.00" $406.40 "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" $406.40 "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" $475.83 "$2,283.13" $913.25 "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" "$1,712.63" "$2,283.13" "$2,283.13" "$2,283.13" "$1,141.57" "$1,141.57" "$1,808.24" "$2,283.13" "$1,826.50" "$1,027.41" "$2,283.13" N/A "$1,324.43" "$2,283.13" "$1,369.88" "$2,283.13" "$2,283.13" "$2,283.13" N/A N/A 6471-1-813 SUP Custom 27803010 6471-1-813 - INSERT TIBIAL SMALL 13MM MODULAR KIMEMAX II CONDYLE BOTH IP/OP "$1,510.00" "$1,117.00" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $314.62 "$1,509.63" $603.85 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,132.50" "$1,509.63" "$1,509.63" "$1,509.63" $754.82 $754.82 "$1,195.63" "$1,509.63" "$1,207.70" $679.33 "$1,509.63" N/A $875.80 "$1,509.63" $905.78 "$1,509.63" "$1,509.63" "$1,509.63" N/A N/A 6471-1-816 SUP Custom 27803010 6471-1-816 - INSERT TIBIAL SMALL 16MM MODULAR KIMEMAX II CONDYLE BOTH IP/OP "$1,510.00" "$1,117.00" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $314.62 "$1,509.63" $603.85 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,132.50" "$1,509.63" "$1,509.63" "$1,509.63" $754.82 $754.82 "$1,195.63" "$1,509.63" "$1,207.70" $679.33 "$1,509.63" N/A $875.80 "$1,509.63" $905.78 "$1,509.63" "$1,509.63" "$1,509.63" N/A N/A 6471-3-808 SUP Custom 27803010 6471-3-808 - INSERT TIBIAL MEDIUM 8MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$1,510.00" "$1,117.00" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $314.62 "$1,509.63" $603.85 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,132.50" "$1,509.63" "$1,509.63" "$1,509.63" $754.82 $754.82 "$1,195.63" "$1,509.63" "$1,207.70" $679.33 "$1,509.63" N/A $875.80 "$1,509.63" $905.78 "$1,509.63" "$1,509.63" "$1,509.63" N/A N/A 6471-3-811 SUP Custom 27803010 6471-3-811 - INSERT TIBIAL MEDIUM 11MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$1,510.00" "$1,117.00" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $314.62 "$1,509.63" $603.85 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,132.50" "$1,509.63" "$1,509.63" "$1,509.63" $754.82 $754.82 "$1,195.63" "$1,509.63" "$1,207.70" $679.33 "$1,509.63" N/A $875.80 "$1,509.63" $905.78 "$1,509.63" "$1,509.63" "$1,509.63" N/A N/A 6471-3-813 SUP Custom 27803010 6471-3-813 - INSERT TIBIAL MEDIUM 13MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$1,510.00" "$1,117.00" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $314.62 "$1,509.63" $603.85 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,132.50" "$1,509.63" "$1,509.63" "$1,509.63" $754.82 $754.82 "$1,195.63" "$1,509.63" "$1,207.70" $679.33 "$1,509.63" N/A $875.80 "$1,509.63" $905.78 "$1,509.63" "$1,509.63" "$1,509.63" N/A N/A 6471-3-816 SUP Custom 27803010 6471-3-816 - INSERT TIBIAL MEDIUM 16MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$1,510.00" "$1,117.00" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $314.62 "$1,509.63" $603.85 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,132.50" "$1,509.63" "$1,509.63" "$1,509.63" $754.82 $754.82 "$1,195.63" "$1,509.63" "$1,207.70" $679.33 "$1,509.63" N/A $875.80 "$1,509.63" $905.78 "$1,509.63" "$1,509.63" "$1,509.63" N/A N/A 6471-5-808 SUP Custom 27803010 6471-5-808 - INSERT TIBIAL LARGE 8MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$1,510.00" "$1,117.00" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $314.62 "$1,509.63" $603.85 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,132.50" "$1,509.63" "$1,509.63" "$1,509.63" $754.82 $754.82 "$1,195.63" "$1,509.63" "$1,207.70" $679.33 "$1,509.63" N/A $875.80 "$1,509.63" $905.78 "$1,509.63" "$1,509.63" "$1,509.63" N/A N/A 6471-5-811 SUP Custom 27803010 6471-5-811 - INSERT TIBIAL LARGE 11MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$2,283.50" "$1,690.00" $406.40 "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" $406.40 "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" $475.83 "$2,283.13" $913.25 "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" "$2,283.13" "$1,712.63" "$2,283.13" "$2,283.13" "$2,283.13" "$1,141.57" "$1,141.57" "$1,808.24" "$2,283.13" "$1,826.50" "$1,027.41" "$2,283.13" N/A "$1,324.43" "$2,283.13" "$1,369.88" "$2,283.13" "$2,283.13" "$2,283.13" N/A N/A 6471-5-813 SUP Custom 27803010 6471-5-813 - INSERT TIBIAL LARGE 13MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$1,510.00" "$1,117.00" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $314.62 "$1,509.63" $603.85 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,132.50" "$1,509.63" "$1,509.63" "$1,509.63" $754.82 $754.82 "$1,195.63" "$1,509.63" "$1,207.70" $679.33 "$1,509.63" N/A $875.80 "$1,509.63" $905.78 "$1,509.63" "$1,509.63" "$1,509.63" N/A N/A 6471-5-816 SUP Custom 27803010 6471-5-816 - INSERT TIBIAL LARGE 16MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$1,510.00" "$1,117.00" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $268.71 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" $314.62 "$1,509.63" $603.85 "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,509.63" "$1,132.50" "$1,509.63" "$1,509.63" "$1,509.63" $754.82 $754.82 "$1,195.63" "$1,509.63" "$1,207.70" $679.33 "$1,509.63" N/A $875.80 "$1,509.63" $905.78 "$1,509.63" "$1,509.63" "$1,509.63" N/A N/A 6471-6-808 SUP Custom 27803010 6471-6-808 - INSERT TIBIAL XL 8MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$1,349.00" $998.00 $240.12 "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" $240.12 "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" $281.15 "$1,349.00" $539.60 "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" "$1,011.75" "$1,349.00" "$1,349.00" "$1,349.00" $674.50 $674.50 "$1,068.41" "$1,349.00" "$1,079.20" $607.05 "$1,349.00" N/A $782.42 "$1,349.00" $809.40 "$1,349.00" "$1,349.00" "$1,349.00" N/A N/A 6471-6-811 SUP Custom 27803010 6471-6-811 - INSERT TIBIAL XL 11MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$2,192.50" "$1,622.00" $390.20 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" $390.20 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" $456.86 "$2,192.13" $876.85 "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$2,192.13" "$1,644.38" "$2,192.13" "$2,192.13" "$2,192.13" "$1,096.07" "$1,096.07" "$1,736.17" "$2,192.13" "$1,753.70" $986.46 "$2,192.13" N/A "$1,271.65" "$2,192.13" "$1,315.28" "$2,192.13" "$2,192.13" "$2,192.13" N/A N/A 6471-6-813 SUP Custom 27803010 6471-6-813 - INSERT TIBIAL XL 13MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$1,349.00" $998.00 $240.12 "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" $240.12 "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" $281.15 "$1,349.00" $539.60 "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" "$1,349.00" "$1,011.75" "$1,349.00" "$1,349.00" "$1,349.00" $674.50 $674.50 "$1,068.41" "$1,349.00" "$1,079.20" $607.05 "$1,349.00" N/A $782.42 "$1,349.00" $809.40 "$1,349.00" "$1,349.00" "$1,349.00" N/A N/A 6471-6-816 SUP Custom 27803010 6471-6-816 - INSERT TIBIAL XL 16MM MODULAR KINEMATIC II CONDYLE BOTH IP/OP "$1,116.00" $826.00 $198.65 "$1,116.00" "$1,116.00" "$1,116.00" "$1,116.00" "$1,116.00" "$1,116.00" "$1,116.00" $198.65 "$1,116.00" "$1,116.00" "$1,116.00" "$1,116.00" "$1,116.00" "$1,116.00" $232.59 "$1,116.00" $446.40 "$1,116.00" "$1,116.00" "$1,116.00" "$1,116.00" "$1,116.00" $837.00 "$1,116.00" "$1,116.00" "$1,116.00" $558.00 $558.00 $883.87 "$1,116.00" $892.80 $502.20 "$1,116.00" N/A $647.28 "$1,116.00" $669.60 "$1,116.00" "$1,116.00" "$1,116.00" N/A N/A 6472-0-808 SUP Custom 27803010 6472-0-808 - INSERT TIBIAL XS 8MM MODULAR STABILIZE KINEMATIC II KNEE BOTH IP/OP "$1,398.00" "$1,035.00" $248.84 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" $248.84 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" $291.36 "$1,398.00" $559.20 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,048.50" "$1,398.00" "$1,398.00" "$1,398.00" $699.00 $699.00 "$1,107.22" "$1,398.00" "$1,118.40" $629.10 "$1,398.00" N/A $810.84 "$1,398.00" $838.80 "$1,398.00" "$1,398.00" "$1,398.00" N/A N/A 6472-0-813 SUP Custom 27803010 6472-0-813 - INSERT TIBIAL XS 13MM MODULAR STABILIZE KINEMATIC II KNEE BOTH IP/OP "$1,398.00" "$1,035.00" $248.84 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" $248.84 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" $291.36 "$1,398.00" $559.20 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,048.50" "$1,398.00" "$1,398.00" "$1,398.00" $699.00 $699.00 "$1,107.22" "$1,398.00" "$1,118.40" $629.10 "$1,398.00" N/A $810.84 "$1,398.00" $838.80 "$1,398.00" "$1,398.00" "$1,398.00" N/A N/A 6472-0-816 SUP Custom 27803010 6472-0-816 - INSERT TIBIAL XS 16MM MODULAR STABILIZE KINEMATIC II KNEE BOTH IP/OP "$1,398.00" "$1,035.00" $248.84 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" $248.84 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" $291.36 "$1,398.00" $559.20 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,048.50" "$1,398.00" "$1,398.00" "$1,398.00" $699.00 $699.00 "$1,107.22" "$1,398.00" "$1,118.40" $629.10 "$1,398.00" N/A $810.84 "$1,398.00" $838.80 "$1,398.00" "$1,398.00" "$1,398.00" N/A N/A 6472-1-808 SUP Custom 27803010 6472-1-808 - INSERT TIBIAL SMALL 8MM MODULAR STABILIZE KINEMATIC II KNEE BOTH IP/OP "$1,398.00" "$1,035.00" $248.84 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" $248.84 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" $291.36 "$1,398.00" $559.20 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,048.50" "$1,398.00" "$1,398.00" "$1,398.00" $699.00 $699.00 "$1,107.22" "$1,398.00" "$1,118.40" $629.10 "$1,398.00" N/A $810.84 "$1,398.00" $838.80 "$1,398.00" "$1,398.00" "$1,398.00" N/A N/A 6472-1-816 SUP Custom 27803010 6472-1-816 - INSERT TIBIAL SMALL 16MM MODULAR STABILIZE KINEMATIC II KNEE BOTH IP/OP "$1,398.00" "$1,035.00" $248.84 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" $248.84 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" $291.36 "$1,398.00" $559.20 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,048.50" "$1,398.00" "$1,398.00" "$1,398.00" $699.00 $699.00 "$1,107.22" "$1,398.00" "$1,118.40" $629.10 "$1,398.00" N/A $810.84 "$1,398.00" $838.80 "$1,398.00" "$1,398.00" "$1,398.00" N/A N/A 6472-6-808 SUP Custom 27803010 6472-6-808 - INSERT TIBIAL XL 8MM MODULAR STABILIZE KINEMATIC II KNEE BOTH IP/OP "$1,456.00" "$1,077.00" $259.17 "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" $259.17 "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" $303.45 "$1,456.00" $582.40 "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,092.00" "$1,456.00" "$1,456.00" "$1,456.00" $728.00 $728.00 "$1,153.15" "$1,456.00" "$1,164.80" $655.20 "$1,456.00" N/A $844.48 "$1,456.00" $873.60 "$1,456.00" "$1,456.00" "$1,456.00" N/A N/A 6472-6-811 SUP Custom 27803010 6472-6-811 - INSERT TIBIAL XL 11MM MODULAR STABILIZE KINEMATIC II KNEE BOTH IP/OP "$1,456.00" "$1,077.00" $259.17 "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" $259.17 "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" $303.45 "$1,456.00" $582.40 "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,092.00" "$1,456.00" "$1,456.00" "$1,456.00" $728.00 $728.00 "$1,153.15" "$1,456.00" "$1,164.80" $655.20 "$1,456.00" N/A $844.48 "$1,456.00" $873.60 "$1,456.00" "$1,456.00" "$1,456.00" N/A N/A 6472-6-813 SUP Custom 27803010 6472-6-813 - INSERT TIBIAL XL 13MM MODULAR STABILIZE KINEMATIC II KNEE BOTH IP/OP "$1,456.00" "$1,077.00" $259.17 "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" $259.17 "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" $303.45 "$1,456.00" $582.40 "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,456.00" "$1,092.00" "$1,456.00" "$1,456.00" "$1,456.00" $728.00 $728.00 "$1,153.15" "$1,456.00" "$1,164.80" $655.20 "$1,456.00" N/A $844.48 "$1,456.00" $873.60 "$1,456.00" "$1,456.00" "$1,456.00" N/A N/A 6472-6-816 SUP Custom 27803010 6472-6-816 - INSERT TIBIAL XL 16MM MODULAR STABILIZE KINEMATIC II KNEE BOTH IP/OP "$1,398.00" "$1,035.00" $248.84 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" $248.84 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" $291.36 "$1,398.00" $559.20 "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,398.00" "$1,048.50" "$1,398.00" "$1,398.00" "$1,398.00" $699.00 $699.00 "$1,107.22" "$1,398.00" "$1,118.40" $629.10 "$1,398.00" N/A $810.84 "$1,398.00" $838.80 "$1,398.00" "$1,398.00" "$1,398.00" N/A N/A 6475-3-933 SUP HCPCS C1776 6475-3-933 - BEARING TIBIAL LONG COMPRESSION ROTATE HINGE MRS MRH KNEE BOTH IP/OP "$5,895.00" "$4,362.00" "$1,170.01" "$5,895.00" "$2,652.75" "$2,652.75" "$2,652.75" "$2,652.75" "$5,895.00" "$5,895.00" "$5,895.00" "$1,228.67" "$5,895.00" "$5,895.00" "$5,895.00" "$5,895.00" "$5,895.00" "$1,228.58" "$5,895.00" "$5,895.00" "$2,906.24" "$5,895.00" "$5,895.00" "$5,895.00" "$5,895.00" "$4,421.25" "$5,895.00" "$5,895.00" "$5,895.00" "$2,947.50" "$2,947.50" "$4,668.84" "$5,895.00" "$4,716.00" "$2,652.75" "$1,170.01" N/A "$3,419.10" "$5,895.00" "$5,895.00" "$5,895.00" "$1,228.52" "$5,895.00" N/A N/A 6475-3-940 SUP Custom 27803010 6475-3-940 - AXLE FEMORAL STANDARD ROTATE HINGE MRS KINEMATIC KNEE BOTH IP/OP "$2,065.00" "$1,528.00" $367.57 "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" $367.57 "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" $430.37 "$2,065.00" $826.00 "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$2,065.00" "$1,548.75" "$2,065.00" "$2,065.00" "$2,065.00" "$1,032.50" "$1,032.50" "$1,635.48" "$2,065.00" "$1,652.00" $929.25 "$2,065.00" N/A "$1,197.70" "$2,065.00" "$1,239.00" "$2,065.00" "$2,065.00" "$2,065.00" N/A N/A 6476-0-100 SUP Custom 27803010 6476-0-100 - WEDGE TIBIAL XS FULL 10MM KINEMAX PLUS BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6476-0-110 SUP Custom 27203010 6476-0-110 - TRIAL SURG XS 10MM HALF BLOCK WEDGE KINEMAX BLACK LEFT BOTH IP/OP $776.00 $574.00 $138.13 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $138.13 $776.00 $776.00 $575.95 $575.95 $598.14 $404.30 $161.73 $776.00 $310.40 $776.00 $776.00 $776.00 $776.00 $776.00 $582.00 $776.00 $776.00 $776.00 $388.00 $388.00 $614.59 $776.00 $620.80 $504.40 $776.00 N/A $450.08 $776.00 $465.60 $776.00 $776.00 $776.00 N/A N/A 6476-0-120 SUP Custom 27803010 6476-0-120 - WEDGE TIBIAL XS 10MM BLOCK KX+ LEFT MEDIAL RIGHT LAT BOTH IP/OP $808.00 $598.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $168.40 $808.00 $323.20 $808.00 $808.00 $808.00 $808.00 $808.00 $606.00 $808.00 $808.00 $808.00 $404.00 $404.00 $639.94 $808.00 $646.40 $363.60 $808.00 N/A $468.64 $808.00 $484.80 $808.00 $808.00 $808.00 N/A N/A 6476-0-130 SUP Custom 27803010 6476-0-130 - WEDGE TIBIAL XS 5MM BLOCK KINEMAX PLUS RIGHT MEDIAL LEFT BOTH IP/OP $776.00 $574.00 $138.13 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $138.13 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $161.73 $776.00 $310.40 $776.00 $776.00 $776.00 $776.00 $776.00 $582.00 $776.00 $776.00 $776.00 $388.00 $388.00 $614.59 $776.00 $620.80 $349.20 $776.00 N/A $450.08 $776.00 $465.60 $776.00 $776.00 $776.00 N/A N/A 6476-0-140 SUP Custom 27803010 6476-0-140 - WEDGE TIBIAL XS 5MM BLOCK KINEMAX PLUS LEFT MEDIAL RIGHT LAT BOTH IP/OP $776.00 $574.00 $138.13 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $138.13 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $161.73 $776.00 $310.40 $776.00 $776.00 $776.00 $776.00 $776.00 $582.00 $776.00 $776.00 $776.00 $388.00 $388.00 $614.59 $776.00 $620.80 $349.20 $776.00 N/A $450.08 $776.00 $465.60 $776.00 $776.00 $776.00 N/A N/A 6476-0-150 SUP Custom 27803010 6476-0-150 - WEDGE TIBIAL XS FULL ANGLE KX+ LEFT LATERAL RIGHT MEDIAL BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 6476-0-160 SUP Custom 27803010 6476-0-160 - WEDGE TIBIAL XS FULL ANGLE FULL ANGLE KX+ BI-THALLIUM LEFT BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6476-0-310 SUP Custom 27803010 6476-0-310 - BASEPLATE TIBIAL XS 70X45MM MODULAR KINEMAX II ANTERIOR BOTH IP/OP "$2,274.00" "$1,683.00" $404.77 "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" $404.77 "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" $473.93 "$2,274.00" $909.60 "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" "$1,705.50" "$2,274.00" "$2,274.00" "$2,274.00" "$1,137.00" "$1,137.00" "$1,801.01" "$2,274.00" "$1,819.20" "$1,023.30" "$2,274.00" N/A "$1,318.92" "$2,274.00" "$1,364.40" "$2,274.00" "$2,274.00" "$2,274.00" N/A N/A 6476-0-400 SUP Custom 27803010 6476-0-400 - BASEPLATE TIBIAL XS KINEMAX PLUS KNEE BOTH IP/OP "$3,125.00" "$2,313.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" N/A "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 6476-1-100 SUP Custom 27803010 6476-1-100 - WEDGE TIBIAL SMALL 10MM FULL BLOCK KINEMAX PLUS LEFT MEDIAL BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 6476-1-110 SUP Custom 27803010 6476-1-110 - WEDGE TIBIAL SMALL 10MM HALF BLOCK KINEMAX PLUS RIGHT MEDIAL BOTH IP/OP $808.00 $598.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $168.40 $808.00 $323.20 $808.00 $808.00 $808.00 $808.00 $808.00 $606.00 $808.00 $808.00 $808.00 $404.00 $404.00 $639.94 $808.00 $646.40 $363.60 $808.00 N/A $468.64 $808.00 $484.80 $808.00 $808.00 $808.00 N/A N/A 6476-1-120 SUP Custom 27803010 6476-1-120 - WEDGE TIBIAL SMALL 10MM HALF BLOCK KINEMAX PLUS LEFT MEDIAL BOTH IP/OP $808.00 $598.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $168.40 $808.00 $323.20 $808.00 $808.00 $808.00 $808.00 $808.00 $606.00 $808.00 $808.00 $808.00 $404.00 $404.00 $639.94 $808.00 $646.40 $363.60 $808.00 N/A $468.64 $808.00 $484.80 $808.00 $808.00 $808.00 N/A N/A 6476-1-130 SUP Custom 27803010 6476-1-130 - WEDGE TIBIAL SMALL 5MM HALF BLOCK KINEMAX PLUS RIGHT MEDIAL BOTH IP/OP $673.00 $498.00 $119.79 $673.00 $673.00 $673.00 $673.00 $673.00 $673.00 $673.00 $119.79 $673.00 $673.00 $673.00 $673.00 $673.00 $673.00 $140.26 $673.00 $269.20 $673.00 $673.00 $673.00 $673.00 $673.00 $504.75 $673.00 $673.00 $673.00 $336.50 $336.50 $533.02 $673.00 $538.40 $302.85 $673.00 N/A $390.34 $673.00 $403.80 $673.00 $673.00 $673.00 N/A N/A 6476-1-140 SUP Custom 27803010 6476-1-140 - WEDGE TIBIAL SMALL 5MM HALF BLOCK KINEMAX PLUS LEFT MEDIAL BOTH IP/OP $808.00 $598.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $168.40 $808.00 $323.20 $808.00 $808.00 $808.00 $808.00 $808.00 $606.00 $808.00 $808.00 $808.00 $404.00 $404.00 $639.94 $808.00 $646.40 $363.60 $808.00 N/A $468.64 $808.00 $484.80 $808.00 $808.00 $808.00 N/A N/A 6476-1-150 SUP Custom 27803010 6476-1-150 - WEDGE TIBIAL SMALL FULL ANGLE KINEMAX PLUS RIGHT MEDIAL LEFT BOTH IP/OP "$1,248.00" $924.00 $222.14 "$1,248.00" "$1,248.00" "$1,248.00" "$1,248.00" "$1,248.00" "$1,248.00" "$1,248.00" $222.14 "$1,248.00" "$1,248.00" "$1,248.00" "$1,248.00" "$1,248.00" "$1,248.00" $260.10 "$1,248.00" $499.20 "$1,248.00" "$1,248.00" "$1,248.00" "$1,248.00" "$1,248.00" $936.00 "$1,248.00" "$1,248.00" "$1,248.00" $624.00 $624.00 $988.42 "$1,248.00" $998.40 $561.60 "$1,248.00" N/A $723.84 "$1,248.00" $748.80 "$1,248.00" "$1,248.00" "$1,248.00" N/A N/A 6476-1-160 SUP Custom 27803010 6476-1-160 - WEDGE TIBIAL SMALL FULL ANGLE KINEMAX PLUS LEFT MEDIAL RIGHT BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6476-1-310 SUP Custom 27803010 6476-1-310 - BASEPLATE TIBIAL SMALL REGULAR STEM KINEMAX KNEE BOTH IP/OP "$2,146.00" "$1,588.00" $381.99 "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" $381.99 "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" $447.25 "$2,146.00" $858.40 "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$1,609.50" "$2,146.00" "$2,146.00" "$2,146.00" "$1,073.00" "$1,073.00" "$1,699.63" "$2,146.00" "$1,716.80" $965.70 "$2,146.00" N/A "$1,244.68" "$2,146.00" "$1,287.60" "$2,146.00" "$2,146.00" "$2,146.00" N/A N/A 6476-1-400 SUP Custom 27803010 6476-1-400 - BASEPLATE TIBIAL SMALL KINEMAX PLUS KNEE BOTH IP/OP "$4,920.00" "$3,641.00" $875.76 "$4,920.00" "$4,920.00" "$4,920.00" "$4,920.00" "$4,920.00" "$4,920.00" "$4,920.00" $875.76 "$4,920.00" "$4,920.00" "$4,920.00" "$4,920.00" "$4,920.00" "$4,920.00" "$1,025.38" "$4,920.00" "$1,968.00" "$4,920.00" "$4,920.00" "$4,920.00" "$4,920.00" "$4,920.00" "$3,690.00" "$4,920.00" "$4,920.00" "$4,920.00" "$2,460.00" "$2,460.00" "$3,896.64" "$4,920.00" "$3,936.00" "$2,214.00" "$4,920.00" N/A "$2,853.60" "$4,920.00" "$2,952.00" "$4,920.00" "$4,920.00" "$4,920.00" N/A N/A 6476-3-100 SUP Custom 27803010 6476-3-100 - WEDGE TIBIAL MEDIUM FULL 10MM KINEMAX PLUS BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 6476-3-110 SUP Custom 27803010 6476-3-110 - WEDGE TIBIAL MEDIUM 10MM HALF BLOCK KINEMAX PLUS RIGHT BOTH IP/OP $808.00 $598.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $168.40 $808.00 $323.20 $808.00 $808.00 $808.00 $808.00 $808.00 $606.00 $808.00 $808.00 $808.00 $404.00 $404.00 $639.94 $808.00 $646.40 $363.60 $808.00 N/A $468.64 $808.00 $484.80 $808.00 $808.00 $808.00 N/A N/A 6476-3-120 SUP Custom 27803010 6476-3-120 - WEDGE TIBIAL MEDIUM 10MM HALF BLOCK KINEMAX PLUS LEFT MEDIAL BOTH IP/OP $808.00 $598.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $168.40 $808.00 $323.20 $808.00 $808.00 $808.00 $808.00 $808.00 $606.00 $808.00 $808.00 $808.00 $404.00 $404.00 $639.94 $808.00 $646.40 $363.60 $808.00 N/A $468.64 $808.00 $484.80 $808.00 $808.00 $808.00 N/A N/A 6476-3-130 SUP Custom 27803010 6476-3-130 - WEDGE TIBIAL MEDIUM 5MM HALF BLOCK KINEMAX PLUS RIGHT MEDIAL BOTH IP/OP $808.00 $598.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $168.40 $808.00 $323.20 $808.00 $808.00 $808.00 $808.00 $808.00 $606.00 $808.00 $808.00 $808.00 $404.00 $404.00 $639.94 $808.00 $646.40 $363.60 $808.00 N/A $468.64 $808.00 $484.80 $808.00 $808.00 $808.00 N/A N/A 6476-3-140 SUP Custom 27803010 6476-3-140 - WEDGE TIBIAL MEDIUM 5MM HALF BLOCK KINEMAX PLUS LEFT MEDIAL BOTH IP/OP $808.00 $598.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $168.40 $808.00 $323.20 $808.00 $808.00 $808.00 $808.00 $808.00 $606.00 $808.00 $808.00 $808.00 $404.00 $404.00 $639.94 $808.00 $646.40 $363.60 $808.00 N/A $468.64 $808.00 $484.80 $808.00 $808.00 $808.00 N/A N/A 6476-3-150 SUP Custom 27803010 6476-3-150 - WEDGE TIBIAL MEDIUM FULL ANGLE KINEMAX PLUS RIGHT MEDIAL BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6476-3-160 SUP Custom 27803010 6476-3-160 - WEDGE TIBIAL MEDIUM FULL ANGLE KINEMAX PLUS RIGHT MEDIAL BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6476-3-310 SUP Custom 27803010 6476-3-310 - BASEPLATE TIBIAL MEDIUM MODULAR KINEMAX II KNEE BOTH IP/OP "$2,146.00" "$1,588.00" $381.99 "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" $381.99 "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" $447.25 "$2,146.00" $858.40 "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$1,609.50" "$2,146.00" "$2,146.00" "$2,146.00" "$1,073.00" "$1,073.00" "$1,699.63" "$2,146.00" "$1,716.80" $965.70 "$2,146.00" N/A "$1,244.68" "$2,146.00" "$1,287.60" "$2,146.00" "$2,146.00" "$2,146.00" N/A N/A 6476-3-400 SUP Custom 27803010 6476-3-400 - BASEPLATE TIBIAL MEDIUM KINEMAX PLUS KNEE BOTH IP/OP "$2,996.00" "$2,217.00" $533.29 "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" $533.29 "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" $624.40 "$2,996.00" "$1,198.40" "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" "$2,247.00" "$2,996.00" "$2,996.00" "$2,996.00" "$1,498.00" "$1,498.00" "$2,372.83" "$2,996.00" "$2,396.80" "$1,348.20" "$2,996.00" N/A "$1,737.68" "$2,996.00" "$1,797.60" "$2,996.00" "$2,996.00" "$2,996.00" N/A N/A 6476-5-100 SUP Custom 27803010 6476-5-100 - WEDGE TIBIAL LARGE FULL 10MM KINEMAX PLUS BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 6476-5-110 SUP Custom 27803010 6476-5-110 - WEDGE TIBIAL LARGE 10MM HALF BLOCK KINEMAX PLUS RIGHT MEDIAL BOTH IP/OP $808.00 $598.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $168.40 $808.00 $323.20 $808.00 $808.00 $808.00 $808.00 $808.00 $606.00 $808.00 $808.00 $808.00 $404.00 $404.00 $639.94 $808.00 $646.40 $363.60 $808.00 N/A $468.64 $808.00 $484.80 $808.00 $808.00 $808.00 N/A N/A 6476-5-120 SUP Custom 27803010 6476-5-120 - WEDGE TIBIAL LARGE 10MM HALF BLOCK KINEMAX PLUS LEFT MEDIAL BOTH IP/OP $673.00 $498.00 $119.79 $673.00 $673.00 $673.00 $673.00 $673.00 $673.00 $673.00 $119.79 $673.00 $673.00 $673.00 $673.00 $673.00 $673.00 $140.26 $673.00 $269.20 $673.00 $673.00 $673.00 $673.00 $673.00 $504.75 $673.00 $673.00 $673.00 $336.50 $336.50 $533.02 $673.00 $538.40 $302.85 $673.00 N/A $390.34 $673.00 $403.80 $673.00 $673.00 $673.00 N/A N/A 6476-5-130 SUP Custom 27803010 6476-5-130 - WEDGE TIBIAL LARGE 5MM HALF BLOCK KINEMAX PLUS RIGHT MEDIAL BOTH IP/OP $808.00 $598.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $168.40 $808.00 $323.20 $808.00 $808.00 $808.00 $808.00 $808.00 $606.00 $808.00 $808.00 $808.00 $404.00 $404.00 $639.94 $808.00 $646.40 $363.60 $808.00 N/A $468.64 $808.00 $484.80 $808.00 $808.00 $808.00 N/A N/A 6476-5-140 SUP Custom 27803010 6476-5-140 - WEDGE TIBIAL LARGE 5MM HALF BLOCK KINEMAX PLUS LEFT MEDIAL BOTH IP/OP $808.00 $598.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $168.40 $808.00 $323.20 $808.00 $808.00 $808.00 $808.00 $808.00 $606.00 $808.00 $808.00 $808.00 $404.00 $404.00 $639.94 $808.00 $646.40 $363.60 $808.00 N/A $468.64 $808.00 $484.80 $808.00 $808.00 $808.00 N/A N/A 6476-5-150 SUP Custom 27803010 6476-5-150 - WEDGE TIBIAL LARGE FULL ANGLE KINEMAX PLUS RIGHT MEDIAL LEFT BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6476-5-160 SUP Custom 27803010 6476-5-160 - WEDGE TIBIAL LARGE FULL ANGLE KINEMAX PLUS LEFT MEDIAL RIGHT BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6476-5-310 SUP Custom 27803010 6476-5-310 - BASEPLATE TIBIAL LARGE 51X81MM CEMENTED MODULAR KINEMAX II BOTH IP/OP "$2,146.00" "$1,588.00" $381.99 "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" $381.99 "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" $447.25 "$2,146.00" $858.40 "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$2,146.00" "$1,609.50" "$2,146.00" "$2,146.00" "$2,146.00" "$1,073.00" "$1,073.00" "$1,699.63" "$2,146.00" "$1,716.80" $965.70 "$2,146.00" N/A "$1,244.68" "$2,146.00" "$1,287.60" "$2,146.00" "$2,146.00" "$2,146.00" N/A N/A 6476-5-400 SUP Custom 27803010 6476-5-400 - BASEPLATE TIBIAL LARGE KINEMAX PLUS KNEE BOTH IP/OP "$2,996.00" "$2,217.00" $533.29 "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" $533.29 "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" $624.40 "$2,996.00" "$1,198.40" "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" "$2,996.00" "$2,247.00" "$2,996.00" "$2,996.00" "$2,996.00" "$1,498.00" "$1,498.00" "$2,372.83" "$2,996.00" "$2,396.80" "$1,348.20" "$2,996.00" N/A "$1,737.68" "$2,996.00" "$1,797.60" "$2,996.00" "$2,996.00" "$2,996.00" N/A N/A 6476-6-100 SUP Custom 27803010 6476-6-100 - WEDGE TIBIAL ANGLE FULL XL 10MM KINEMAX PLUS KNEE BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6476-6-110 SUP Custom 27803010 6476-6-110 - WEDGE TIBIAL XL 10MM BLOCK KINEMAX PLUS VITALLIUM LEFT BOTH IP/OP $776.00 $574.00 $138.13 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $138.13 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $161.73 $776.00 $310.40 $776.00 $776.00 $776.00 $776.00 $776.00 $582.00 $776.00 $776.00 $776.00 $388.00 $388.00 $614.59 $776.00 $620.80 $349.20 $776.00 N/A $450.08 $776.00 $465.60 $776.00 $776.00 $776.00 N/A N/A 6476-6-120 SUP Custom 27803010 6476-6-120 - WEDGE TIBIAL XL 10MM BLOCK KX+ LEFT MEDIAL RIGHT LAT BOTH IP/OP $776.00 $574.00 $138.13 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $138.13 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $161.73 $776.00 $310.40 $776.00 $776.00 $776.00 $776.00 $776.00 $582.00 $776.00 $776.00 $776.00 $388.00 $388.00 $614.59 $776.00 $620.80 $349.20 $776.00 N/A $450.08 $776.00 $465.60 $776.00 $776.00 $776.00 N/A N/A 6476-6-130 SUP Custom 27803010 6476-6-130 - WEDGE TIBIAL XL 5MM BLOCK KINEMAX PLUS RIGHT MEDIAL LEFT BOTH IP/OP $776.00 $574.00 $138.13 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $138.13 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $161.73 $776.00 $310.40 $776.00 $776.00 $776.00 $776.00 $776.00 $582.00 $776.00 $776.00 $776.00 $388.00 $388.00 $614.59 $776.00 $620.80 $349.20 $776.00 N/A $450.08 $776.00 $465.60 $776.00 $776.00 $776.00 N/A N/A 6476-6-140 SUP Custom 27803010 6476-6-140 - WEDGE TIBIAL XL 5MM BLOCK KINEMAX PLUS LEFT MEDIAL RIGHT LAT BOTH IP/OP $776.00 $574.00 $138.13 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $138.13 $776.00 $776.00 $776.00 $776.00 $776.00 $776.00 $161.73 $776.00 $310.40 $776.00 $776.00 $776.00 $776.00 $776.00 $582.00 $776.00 $776.00 $776.00 $388.00 $388.00 $614.59 $776.00 $620.80 $349.20 $776.00 N/A $450.08 $776.00 $465.60 $776.00 $776.00 $776.00 N/A N/A 6476-6-150 SUP Custom 27803010 6476-6-150 - WEDGE TIBIAL XL FULL ANGLE KX+ LEFT LATERAL RIGHT MEDIAL BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6476-6-160 SUP Custom 27803010 6476-6-160 - WEDGE TIBIAL XL FULL ANGLE 5MM BLOCK KINEMAX PLUS LEFT BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6476-6-310 SUP Custom 27803010 6476-6-310 - BASEPLATE TIBIAL XL MODULAR KINEMAX II KNEE BOTH IP/OP "$2,274.00" "$1,683.00" $404.77 "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" $404.77 "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" $473.93 "$2,274.00" $909.60 "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" "$2,274.00" "$1,705.50" "$2,274.00" "$2,274.00" "$2,274.00" "$1,137.00" "$1,137.00" "$1,801.01" "$2,274.00" "$1,819.20" "$1,023.30" "$2,274.00" N/A "$1,318.92" "$2,274.00" "$1,364.40" "$2,274.00" "$2,274.00" "$2,274.00" N/A N/A 6476-6-400 SUP Custom 27803010 6476-6-400 - BASEPLATE TIBIAL XL KINEMAX PLUS BOTH IP/OP "$3,125.00" "$2,313.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $556.25 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,250.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" "$3,125.00" N/A "$1,812.50" "$3,125.00" "$1,875.00" "$3,125.00" "$3,125.00" "$3,125.00" N/A N/A 6476-8-170 SUP Custom 27803010 6476-8-170 - WEDGE TIBIAL FIX SCREW KINEMAX PLUS BOTH IP/OP $103.00 $76.00 $18.33 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $18.33 $103.00 $103.00 $103.00 $103.00 $103.00 $103.00 $21.47 $103.00 $41.20 $103.00 $103.00 $103.00 $103.00 $103.00 $77.25 $103.00 $103.00 $103.00 $51.50 $51.50 $81.58 $103.00 $82.40 $46.35 $103.00 N/A $59.74 $103.00 $61.80 $103.00 $103.00 $103.00 N/A N/A 6476-8-180 SUP Custom 27803010 6476-8-180 - WEDGE TIBIAL 15MM FIX PEG KINEMAX PLUS BOTH IP/OP $218.00 $161.00 $38.80 $218.00 $218.00 $218.00 $218.00 $218.00 $218.00 $218.00 $38.80 $218.00 $218.00 $218.00 $218.00 $218.00 $218.00 $45.43 $218.00 $87.20 $218.00 $218.00 $218.00 $218.00 $218.00 $163.50 $218.00 $218.00 $218.00 $109.00 $109.00 $172.66 $218.00 $174.40 $98.10 $218.00 N/A $126.44 $218.00 $130.80 $218.00 $218.00 $218.00 N/A N/A 6476-8-242 SUP Custom 27803010 6476-8-242 - STEM FEMORAL XS 40MM CEMENTED COCR KNEE TIBIA BOTH IP/OP "$1,839.50" "$1,361.00" $327.43 "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" $327.43 "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" $383.37 "$1,839.50" $735.80 "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" "$1,379.63" "$1,839.50" "$1,839.50" "$1,839.50" $919.75 $919.75 "$1,456.88" "$1,839.50" "$1,471.60" $827.78 "$1,839.50" N/A "$1,066.91" "$1,839.50" "$1,103.70" "$1,839.50" "$1,839.50" "$1,839.50" N/A N/A 6476-8-244 SUP Custom 27803010 6476-8-244 - STEM FEMORAL XS 80MM CEMENTED COCR KNEE TIBIA BOTH IP/OP "$1,839.50" "$1,361.00" $327.43 "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" $327.43 "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" $383.37 "$1,839.50" $735.80 "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" "$1,839.50" "$1,379.63" "$1,839.50" "$1,839.50" "$1,839.50" $919.75 $919.75 "$1,456.88" "$1,839.50" "$1,471.60" $827.78 "$1,839.50" N/A "$1,066.91" "$1,839.50" "$1,103.70" "$1,839.50" "$1,839.50" "$1,839.50" N/A N/A 6476-8-246 SUP Custom 27803010 6476-8-246 - STEM FEMORAL XS 155MM CEMENTED COCR KNEE TIBIA BOTH IP/OP "$1,861.00" "$1,377.00" $331.19 "$1,860.63" "$1,860.63" "$1,860.63" "$1,860.63" "$1,860.63" "$1,860.63" "$1,860.63" $331.19 "$1,860.63" "$1,860.63" "$1,860.63" "$1,860.63" "$1,860.63" "$1,860.63" $387.78 "$1,860.63" $744.25 "$1,860.63" "$1,860.63" "$1,860.63" "$1,860.63" "$1,860.63" "$1,395.75" "$1,860.63" "$1,860.63" "$1,860.63" $930.32 $930.32 "$1,473.62" "$1,860.63" "$1,488.50" $837.28 "$1,860.63" N/A "$1,079.38" "$1,860.63" "$1,116.38" "$1,860.63" "$1,860.63" "$1,860.63" N/A N/A 6476-8-250 SUP Custom 27803010 6476-8-250 - EXTENSION STEM XS 40MM CEMENTED KINEMAX COCR KNEE FEMORAL BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6476-8-260 SUP Custom 27803010 6476-8-260 - STEM FEMORAL 80MM CEMENT KINEMAX COCR KNEE BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6476-8-270 SUP Custom 27803010 6476-8-270 - EXTENSION STEM XS 155MM CEMENTED KINEMAX COCR KNEE FEMORAL BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6476-8-315 SUP Custom 27803010 6476-8-315 - WEDGE TIBIAL LARGE KINEMAX PLUS BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6476-8-320 SUP Custom 27803010 6476-8-320 - WEDGE TIBIAL XL KINEMAX PLUS BOTH IP/OP $808.00 $598.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $143.82 $808.00 $808.00 $808.00 $808.00 $808.00 $808.00 $168.40 $808.00 $323.20 $808.00 $808.00 $808.00 $808.00 $808.00 $606.00 $808.00 $808.00 $808.00 $404.00 $404.00 $639.94 $808.00 $646.40 $363.60 $808.00 N/A $468.64 $808.00 $484.80 $808.00 $808.00 $808.00 N/A N/A 6478-6-020 SUP Custom 27803010 6478-6-020 - WEDGE TIBIAL 20MM PEG FIX KINEMAX BOTH IP/OP $446.00 $330.00 $79.39 $446.00 $446.00 $446.00 $446.00 $446.00 $446.00 $446.00 $79.39 $446.00 $446.00 $446.00 $446.00 $446.00 $446.00 $92.95 $446.00 $178.40 $446.00 $446.00 $446.00 $446.00 $446.00 $334.50 $446.00 $446.00 $446.00 $223.00 $223.00 $353.23 $446.00 $356.80 $200.70 $446.00 N/A $258.68 $446.00 $267.60 $446.00 $446.00 $446.00 N/A N/A 6478-6-100 SUP Custom 27803010 6478-6-100 - WEDGE TIBIAL XS SMALL KINEMAX PLUS STAINLESS STEEL KNEE BOTH IP/OP $687.00 $508.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $143.18 $687.00 $274.80 $687.00 $687.00 $687.00 $687.00 $687.00 $515.25 $687.00 $687.00 $687.00 $343.50 $343.50 $544.10 $687.00 $549.60 $309.15 $687.00 N/A $398.46 $687.00 $412.20 $687.00 $687.00 $687.00 N/A N/A 6478-6-110 SUP Custom 27803010 6478-6-110 - WEDGE TIBIAL SMALL MEDIUM KINEMAX PLUS STAINLESS STEEL KNEE BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6478-6-120 SUP Custom 27803010 6478-6-120 - WEDGE TIBIAL MEDIUM LARGE KINEMAX PLUS STAINLESS STEEL KNEE BOTH IP/OP $687.00 $508.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $143.18 $687.00 $274.80 $687.00 $687.00 $687.00 $687.00 $687.00 $515.25 $687.00 $687.00 $687.00 $343.50 $343.50 $544.10 $687.00 $549.60 $309.15 $687.00 N/A $398.46 $687.00 $412.20 $687.00 $687.00 $687.00 N/A N/A 6478-6-395 SUP Custom 27803010 6478-6-395 - EXTENSION STEM 10MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-396 SUP Custom 27803010 6478-6-396 - EXTENSION STEM 11MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-397 SUP Custom 27803010 6478-6-397 - EXTENSION STEM 12MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-398 SUP Custom 27803010 6478-6-398 - TRIAL KNEE 13MM 80MM 1 AXIS PRESS FIT CEMENTED STEM EXTN BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-399 SUP Custom 27803010 6478-6-399 - EXTENSION STEM 14MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-400 SUP Custom 27803010 6478-6-400 - TRIAL KNEE 15MM 80MM 1 AXIS PRESS FIT CEMENTED STEM EXTN BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-405 SUP Custom 27803010 6478-6-405 - EXTENSION STEM 16MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-410 SUP Custom 27803010 6478-6-410 - EXTENSION STEM 17MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-415 SUP Custom 27803010 6478-6-415 - EXTENSION STEM 18MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-420 SUP Custom 27803010 6478-6-420 - EXTENSION STEM 19MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-425 SUP Custom 27803010 6478-6-425 - EXTENSION STEM 21MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-430 SUP Custom 27803010 6478-6-430 - EXTENSION STEM 23MM 80MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-435 SUP Custom 27803010 6478-6-435 - EXTENSION STEM 10MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-436 SUP Custom 27803010 6478-6-436 - EXTENSION STEM 11MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-437 SUP Custom 27803010 6478-6-437 - TRIAL KNEE 12MM 155MM 1 AXIS PRESS FIT CEMENTED STEM EXTN BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-438 SUP Custom 27803010 6478-6-438 - EXTENSION STEM 13MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-439 SUP Custom 27803010 6478-6-439 - EXTENSION STEM 14MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-440 SUP Custom 27803010 6478-6-440 - EXTENSION STEM 15MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-445 SUP Custom 27803010 6478-6-445 - EXTENSION STEM 16MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-450 SUP Custom 27803010 6478-6-450 - EXTENSION STEM 17MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-455 SUP Custom 27803010 6478-6-455 - EXTENSION STEM 18MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-460 SUP Custom 27803010 6478-6-460 - EXTENSION STEM 19MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-465 SUP Custom 27803010 6478-6-465 - EXTENSION STEM 21MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-470 SUP Custom 27803010 6478-6-470 - EXTENSION STEM 23MM 155MM 1 AXIS PRESS FIT CEMENTED SCORPIO BOTH IP/OP "$1,915.00" "$1,417.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $340.87 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" $399.11 "$1,915.00" $766.00 "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,915.00" "$1,436.25" "$1,915.00" "$1,915.00" "$1,915.00" $957.50 $957.50 "$1,516.68" "$1,915.00" "$1,532.00" $861.75 "$1,915.00" N/A "$1,110.70" "$1,915.00" "$1,149.00" "$1,915.00" "$1,915.00" "$1,915.00" N/A N/A 6478-6-490 SUP Custom 27803010 6478-6-490 - ADAPTER STEM 4MM OFFST JAM NUT SCORPIO KNEE BOTH IP/OP "$2,220.00" "$1,643.00" $395.16 "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" $395.16 "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" $462.67 "$2,220.00" $888.00 "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$1,665.00" "$2,220.00" "$2,220.00" "$2,220.00" "$1,110.00" "$1,110.00" "$1,758.24" "$2,220.00" "$1,776.00" $999.00 "$2,220.00" N/A "$1,287.60" "$2,220.00" "$1,332.00" "$2,220.00" "$2,220.00" "$2,220.00" N/A N/A 6478-6-495 SUP Custom 27803010 6478-6-495 - ADAPTER STM 6MM OFST SCRP JAM NUT TIB 1 AXIS KN SYS BOTH IP/OP "$2,220.00" "$1,643.00" $395.16 "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" $395.16 "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" $462.67 "$2,220.00" $888.00 "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$1,665.00" "$2,220.00" "$2,220.00" "$2,220.00" "$1,110.00" "$1,110.00" "$1,758.24" "$2,220.00" "$1,776.00" $999.00 "$2,220.00" N/A "$1,287.60" "$2,220.00" "$1,332.00" "$2,220.00" "$2,220.00" "$2,220.00" N/A N/A 6478-6-500 SUP Custom 27803010 6478-6-500 - ADAPTER STM 8MM OFST SCRP JAM NUT TIB 1 AXIS KN SYS BOTH IP/OP "$2,220.00" "$1,643.00" $395.16 "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" $395.16 "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" $462.67 "$2,220.00" $888.00 "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$1,665.00" "$2,220.00" "$2,220.00" "$2,220.00" "$1,110.00" "$1,110.00" "$1,758.24" "$2,220.00" "$1,776.00" $999.00 "$2,220.00" N/A "$1,287.60" "$2,220.00" "$1,332.00" "$2,220.00" "$2,220.00" "$2,220.00" N/A N/A 6478-6-585 SUP Custom 27803010 6478-6-585 - ADAPTER STM 2MM OFST SCRP JAM NUT FEM 1 AXIS KN SYS BOTH IP/OP "$2,220.00" "$1,643.00" $395.16 "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" $395.16 "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" $462.67 "$2,220.00" $888.00 "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$2,220.00" "$1,665.00" "$2,220.00" "$2,220.00" "$2,220.00" "$1,110.00" "$1,110.00" "$1,758.24" "$2,220.00" "$1,776.00" $999.00 "$2,220.00" N/A "$1,287.60" "$2,220.00" "$1,332.00" "$2,220.00" "$2,220.00" "$2,220.00" N/A N/A 6478-6-600 SUP Custom 27803010 6478-6-600 - STEM TIBIAL FLUTE 10MM 80MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-605 SUP Custom 27803010 6478-6-605 - STEM TIBIAL FLUTE 11MM 80MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-610 SUP Custom 27803010 6478-6-610 - STEM TIBIAL FLUTE 12MM 80MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-615 SUP Custom 27803010 6478-6-615 - STEM TIBIAL FLUTE 13MM 80MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-620 SUP Custom 27803010 6478-6-620 - STEM TIBIAL FLUTE 14MM 80MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-625 SUP Custom 27803010 6478-6-625 - STEM TIBIAL FLUTE 15MM 80MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-630 SUP Custom 27803010 6478-6-630 - STEM TIBIAL FLUTE 16MM 80MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-635 SUP Custom 27803010 6478-6-635 - STEM TIBIAL FLUTE 17MM 80MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-640 SUP Custom 27803010 6478-6-640 - STEM TIBIAL FLUTE 18MM 80MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-645 SUP Custom 27803010 6478-6-645 - STEM TIBIAL FLUTE 19MM 80MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-655 SUP Custom 27803010 6478-6-655 - STEM TIBIAL FLUTE 21MM 80MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-665 SUP Custom 27803010 6478-6-665 - STEM TIBIAL FLUTE 23MM 80MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-680 SUP Custom 27803010 6478-6-680 - STEM TIBIAL FLUTE 10MM 115MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-685 SUP Custom 27803010 6478-6-685 - STEM TIBIAL FLUTE 11MM 115MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-690 SUP Custom 27803010 6478-6-690 - STEM TIBIAL FLUTE 12MM 115MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-695 SUP Custom 27803010 6478-6-695 - STEM TIBIAL FLUTE 13MM 115MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-705 SUP Custom 27803010 6478-6-705 - STEM TIBIAL FLUTE 14MM 115MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-710 SUP Custom 27803010 6478-6-710 - STEM TIBIAL FLUTE 15MM 115MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-715 SUP Custom 27803010 6478-6-715 - STEM TIBIAL FLUTE 16MM 115MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-720 SUP Custom 27803010 6478-6-720 - STEM TIBIAL FLUTE 17MM 115MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-725 SUP Custom 27803010 6478-6-725 - STEM TIBIAL FLUTE 18MM 115MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-730 SUP Custom 27803010 6478-6-730 - STEM TIBIAL FLUTE 19MM 115MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-740 SUP Custom 27803010 6478-6-740 - STEM TIBIAL FLUTE 21MM 115MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6478-6-750 SUP Custom 27803010 6478-6-750 - STEM TIBIAL FLUTE 23MM 115MM GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$2,342.50" "$1,733.00" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $416.97 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" $488.20 "$2,342.50" $937.00 "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$2,342.50" "$1,756.88" "$2,342.50" "$2,342.50" "$2,342.50" "$1,171.25" "$1,171.25" "$1,855.26" "$2,342.50" "$1,874.00" "$1,054.13" "$2,342.50" N/A "$1,358.65" "$2,342.50" "$1,405.50" "$2,342.50" "$2,342.50" "$2,342.50" N/A N/A 6479-0-050 SUP HCPCS C1776 6479-0-050 - COMPONENT FEMORAL XS KINEMAX PLUS CONDYLE BOTH IP/OP "$3,596.00" "$2,661.00" $713.72 "$3,596.00" "$1,618.20" "$1,618.20" "$1,618.20" "$1,618.20" "$3,596.00" "$3,596.00" "$3,596.00" $749.50 "$3,596.00" "$3,596.00" "$3,596.00" "$3,596.00" "$3,596.00" $749.45 "$3,596.00" "$3,596.00" "$1,772.83" "$3,596.00" "$3,596.00" "$3,596.00" "$3,596.00" "$2,697.00" "$3,596.00" "$3,596.00" "$3,596.00" "$1,798.00" "$1,798.00" "$2,848.03" "$3,596.00" "$2,876.80" "$1,618.20" $713.72 N/A "$2,085.68" "$3,596.00" "$3,596.00" "$3,596.00" $749.41 "$3,596.00" N/A N/A 6479-0-100 SUP HCPCS C1776 6479-0-100 - COMPONENT FEMORAL SMALL KINEMAX PLUS CONDYLE BOTH IP/OP "$3,467.00" "$2,566.00" $688.11 "$3,467.00" "$1,560.15" "$1,560.15" "$1,560.15" "$1,560.15" "$3,467.00" "$3,467.00" "$3,467.00" $722.61 "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" $722.56 "$3,467.00" "$1,386.80" "$1,709.23" "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" "$2,600.25" "$3,467.00" "$3,467.00" "$3,467.00" "$1,733.50" "$1,733.50" "$2,745.86" "$3,467.00" "$2,773.60" "$1,560.15" $688.11 N/A "$2,010.86" "$3,467.00" "$3,467.00" "$3,467.00" $722.52 "$3,467.00" N/A N/A 6479-0-150 SUP HCPCS C1776 6479-0-150 - COMPONENT FEMORAL MEDIUM KINEMAX PLUS CONDYLE BOTH IP/OP "$3,467.00" "$2,566.00" $688.11 "$3,467.00" "$1,560.15" "$1,560.15" "$1,560.15" "$1,560.15" "$3,467.00" "$3,467.00" "$3,467.00" $722.61 "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" $722.56 "$3,467.00" "$1,386.80" "$1,709.23" "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" "$2,600.25" "$3,467.00" "$3,467.00" "$3,467.00" "$1,733.50" "$1,733.50" "$2,745.86" "$3,467.00" "$2,773.60" "$1,560.15" $688.11 N/A "$2,010.86" "$3,467.00" "$3,467.00" "$3,467.00" $722.52 "$3,467.00" N/A N/A 6479-0-200 SUP HCPCS C1776 6479-0-200 - COMPONENT FEMORAL LARGE KINEMAX PLUS CONDYLE BOTH IP/OP "$3,467.00" "$2,566.00" $688.11 "$3,467.00" "$1,560.15" "$1,560.15" "$1,560.15" "$1,560.15" "$3,467.00" "$3,467.00" "$3,467.00" $722.61 "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" $722.56 "$3,467.00" "$1,386.80" "$1,709.23" "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" "$2,600.25" "$3,467.00" "$3,467.00" "$3,467.00" "$1,733.50" "$1,733.50" "$2,745.86" "$3,467.00" "$2,773.60" "$1,560.15" $688.11 N/A "$2,010.86" "$3,467.00" "$3,467.00" "$3,467.00" $722.52 "$3,467.00" N/A N/A 6479-0-250 SUP HCPCS C1776 6479-0-250 - COMPONENT FEMORAL XL KINEMAX PLUS CONDYLE BOTH IP/OP "$3,467.00" "$2,566.00" $688.11 "$3,467.00" "$1,560.15" "$1,560.15" "$1,560.15" "$1,560.15" "$3,467.00" "$3,467.00" "$3,467.00" $722.61 "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" $722.56 "$3,467.00" "$1,386.80" "$1,709.23" "$3,467.00" "$3,467.00" "$3,467.00" "$3,467.00" "$2,600.25" "$3,467.00" "$3,467.00" "$3,467.00" "$1,733.50" "$1,733.50" "$2,745.86" "$3,467.00" "$2,773.60" "$1,560.15" $688.11 N/A "$2,010.86" "$3,467.00" "$3,467.00" "$3,467.00" $722.52 "$3,467.00" N/A N/A 6479-0-300 SUP HCPCS C1776 6479-0-300 - COMPONENT FEMORAL 2XL KINEMAX PLUS CONDYLE BOTH IP/OP "$3,596.00" "$2,661.00" $713.72 "$3,596.00" "$1,618.20" "$1,618.20" "$1,618.20" "$1,618.20" "$3,596.00" "$3,596.00" "$3,596.00" $749.50 "$3,596.00" "$3,596.00" "$3,596.00" "$3,596.00" "$3,596.00" $749.45 "$3,596.00" "$1,438.40" "$1,772.83" "$3,596.00" "$3,596.00" "$3,596.00" "$3,596.00" "$2,697.00" "$3,596.00" "$3,596.00" "$3,596.00" "$1,798.00" "$1,798.00" "$2,848.03" "$3,596.00" "$2,876.80" "$1,618.20" $713.72 N/A "$2,085.68" "$3,596.00" "$3,596.00" "$3,596.00" $749.41 "$3,596.00" N/A N/A 6479-4-900 SUP Custom 27803010 6479-4-900 - COMPONENT PATLR SMALL KINEMAX PLUS DUR BOTH IP/OP "$1,133.00" $838.00 $201.67 "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" $201.67 "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" $236.13 "$1,133.00" $453.20 "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" $849.75 "$1,133.00" "$1,133.00" "$1,133.00" $566.50 $566.50 $897.34 "$1,133.00" $906.40 $509.85 "$1,133.00" N/A $657.14 "$1,133.00" $679.80 "$1,133.00" "$1,133.00" "$1,133.00" N/A N/A 6479-4-911 SUP Custom 27803010 6479-4-911 - COMPONENT PATLR MEDIUM KINEMAX PLUS DUR BOTH IP/OP "$1,133.00" $838.00 $201.67 "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" $201.67 "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" $236.13 "$1,133.00" $453.20 "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" $849.75 "$1,133.00" "$1,133.00" "$1,133.00" $566.50 $566.50 $897.34 "$1,133.00" $906.40 $509.85 "$1,133.00" N/A $657.14 "$1,133.00" $679.80 "$1,133.00" "$1,133.00" "$1,133.00" N/A N/A 6479-4-920 SUP Custom 27803010 6479-4-920 - COMPONENT PATLR LARGE KINEMAX PLUS DUR BOTH IP/OP "$1,133.00" $838.00 $201.67 "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" $201.67 "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" $236.13 "$1,133.00" $453.20 "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" "$1,133.00" $849.75 "$1,133.00" "$1,133.00" "$1,133.00" $566.50 $566.50 $897.34 "$1,133.00" $906.40 $509.85 "$1,133.00" N/A $657.14 "$1,133.00" $679.80 "$1,133.00" "$1,133.00" "$1,133.00" N/A N/A 6479-5-008 SUP Custom 27803010 6479-5-008 - INSERT TIBIAL XS 65X41X8MM LATERAL STABILIZE CRUCIATE RETAIN BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-010 SUP Custom 27803010 6479-5-010 - INSERT TIBIAL XS 65X41X10MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-012 SUP Custom 27803010 6479-5-012 - INSERT TIBIAL XS 65X41X12MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-015 SUP Custom 27803010 6479-5-015 - INSERT TIBIAL XS 65X41X15MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-018 SUP Custom 27803010 6479-5-018 - INSERT TIBIAL XS 65X41X18MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-021 SUP Custom 27803010 6479-5-021 - INSERT TIBIAL XS 21MM LATERAL STABILIZED CRUC RET KINEMAX BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-025 SUP Custom 27803010 6479-5-025 - INSERT TIBIAL XS 65X41X25MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-108 SUP Custom 27803010 6479-5-108 - INSERT TIBIAL SMALL 8MM LATERAL STABILIZED KINEMAX PLUS DUR BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-110 SUP Custom 27803010 6479-5-110 - INSERT TIBIAL SMALL 10MM LATERAL STABILIZED KINEMAX PLUS DUR BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-112 SUP Custom 27803010 6479-5-112 - INSERT TIBIAL SMALL 12MM LATERAL STABILIZED KINEMAX PLUS DUR BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-115 SUP Custom 27803010 6479-5-115 - INSERT TIBIAL SMALL 15MM LATERAL STABILIZED KINEMAX PLUS DUR BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-118 SUP Custom 27803010 6479-5-118 - INSERT TIBIAL SMALL 71X44X18MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-121 SUP Custom 27803010 6479-5-121 - INSERT TIBIAL SMALL 21MM LATERAL STABILIZED CRUC RET KINEMAX BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-125 SUP Custom 27803010 6479-5-125 - INSERT TIBIAL SMALL 71X44X25MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-208 SUP Custom 27803010 6479-5-208 - INSERT TIBIAL MEDIUM 8MM LATERAL STABILIZED KINEMAX PLUS DUR BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-210 SUP Custom 27803010 6479-5-210 - INSERT TIBIAL MEDIUM 76X48X10MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-212 SUP Custom 27803010 6479-5-212 - INSERT TIBIAL MEDIUM 12MM LATERAL STABILIZED KINEMAX PLUS BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-215 SUP Custom 27803010 6479-5-215 - INSERT TIBIAL MEDIUM 15MM LATERAL STABILIZED KINEMAX PLUS BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-218 SUP Custom 27803010 6479-5-218 - INSERT TIBIAL MEDIUM 18MM LATERAL STABILIZED KINEMAX PLUS BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-221 SUP Custom 27803010 6479-5-221 - INSERT TIBIAL MEDIUM 76X48X21MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-225 SUP Custom 27803010 6479-5-225 - INSERT TIBIAL MEDIUM 76X48X25MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-308 SUP Custom 27803010 6479-5-308 - INSERT TIBIAL LARGE 8MM LATERAL STABILIZED KINEMAX PLUS DUR BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-310 SUP Custom 27803010 6479-5-310 - INSERT TIBIAL LARGE 81X51X10MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-312 SUP Custom 27803010 6479-5-312 - INSERT TIBIAL LARGE 12MM LATERAL STABILIZED KINEMAX PLUS DUR BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-315 SUP Custom 27803010 6479-5-315 - INSERT TIBIAL LARGE 81X51X15MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-318 SUP Custom 27803010 6479-5-318 - INSERT TIBIAL LARGE 81X51X18MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-321 SUP Custom 27803010 6479-5-321 - INSERT TIBIAL LARGE 81X51X21MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-325 SUP Custom 27803010 6479-5-325 - INSERT TIBIAL LARGE 81X51X25MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-408 SUP Custom 27803010 6479-5-408 - INSERT TIBIAL XL 86X54X8MM LATERAL STABILIZE CRUCIATE RETAIN BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-410 SUP Custom 27803010 6479-5-410 - INSERT TIBIAL XL 86X54X10MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-412 SUP Custom 27803010 6479-5-412 - INSERT TIBIAL XL 86X54X12MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-415 SUP Custom 27803010 6479-5-415 - INSERT TIBIAL XL 86X54X15MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-418 SUP Custom 27803010 6479-5-418 - INSERT TIBIAL XL 86X54X18MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-421 SUP Custom 27803010 6479-5-421 - INSERT TIBIAL XL 86X54X21MM LATERAL STABILIZE CRUCIATE BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-425 SUP Custom 27803010 6479-5-425 - INSERT TIBIAL XL 25MM LATERAL STABILIZED KINEMAX PLUS DUR BOTH IP/OP "$2,265.00" "$1,676.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $403.17 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" $472.05 "$2,265.00" $906.00 "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$2,265.00" "$1,698.75" "$2,265.00" "$2,265.00" "$2,265.00" "$1,132.50" "$1,132.50" "$1,793.88" "$2,265.00" "$1,812.00" "$1,019.25" "$2,265.00" N/A "$1,313.70" "$2,265.00" "$1,359.00" "$2,265.00" "$2,265.00" "$2,265.00" N/A N/A 6479-5-508 SUP Custom 27803010 6479-5-508 - INSERT TIBIAL XS 65X41X8MM POSTERIOR STABILIZE KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-510 SUP Custom 27803010 6479-5-510 - INSERT TIBIAL XS 65X41X10MM POSTERIOR STABILIZE KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-512 SUP Custom 27803010 6479-5-512 - INSERT TIBIAL XS 65X41X12MM POSTERIOR STABILIZE KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-515 SUP Custom 27803010 6479-5-515 - INSERT TIBIAL XS 65X41X15MM POSTERIOR STABILIZE KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-518 SUP Custom 27803010 6479-5-518 - INSERT TIBIAL XS 65X41X18MM POSTERIOR STABILIZE KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-521 SUP Custom 27803010 6479-5-521 - INSERT TIBIAL XS 65X41X21MM POSTERIOR STABILIZE KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-525 SUP Custom 27803010 6479-5-525 - INSERT TIBIAL XS 65X41X25MM POSTERIOR STABILIZE KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-608 SUP Custom 27803010 6479-5-608 - INSERT TIBIAL SMALL 70X45X8MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-610 SUP Custom 27803010 6479-5-610 - INSERT TIBIAL SMALL 10MM LATERAL STABILIZED KINEMAX PLUS DUR BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-612 SUP Custom 27803010 6479-5-612 - INSERT TIBIAL SMALL 12MM LATERAL STABILIZED KINEMAX PLUS DUR BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-615 SUP Custom 27803010 6479-5-615 - INSERT TIBIAL SMALL 70X45X15MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-618 SUP Custom 27803010 6479-5-618 - INSERT TIBIAL SMALL 70X45X18MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-621 SUP Custom 27803010 6479-5-621 - INSERT TIBIAL SMALL 70X45X21MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-625 SUP Custom 27803010 6479-5-625 - INSERT TIBIAL SMALL 70X45X25MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-708 SUP Custom 27803010 6479-5-708 - INSERT TIBIAL MEDIUM 76X48X8MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-710 SUP Custom 27803010 6479-5-710 - INSERT TIBIAL MEDIUM 76X48X10MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-712 SUP Custom 27803010 6479-5-712 - INSERT TIBIAL MEDIUM 76X48X12MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-715 SUP Custom 27803010 6479-5-715 - INSERT TIBIAL MEDIUM 76X48X15MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-718 SUP Custom 27803010 6479-5-718 - INSERT TIBIAL MEDIUM 18MM LATERAL STABILIZED KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-721 SUP Custom 27803010 6479-5-721 - INSERT TIBIAL MEDIUM 76X48X21MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-725 SUP Custom 27803010 6479-5-725 - INSERT TIBIAL MEDIUM 76X48X25MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-808 SUP Custom 27803010 6479-5-808 - INSERT TIBIAL LARGE 81X51X8MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-810 SUP Custom 27803010 6479-5-810 - INSERT TIBIAL LARGE 81X51X10MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-812 SUP Custom 27803010 6479-5-812 - INSERT TIBIAL LARGE 81X51X12MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-815 SUP Custom 27803010 6479-5-815 - INSERT TIBIAL LARGE 81X51X15MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-818 SUP Custom 27803010 6479-5-818 - INSERT TIBIAL LARGE 81X51X18MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-821 SUP Custom 27803010 6479-5-821 - INSERT TIBIAL LARGE 81X51X21MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-825 SUP Custom 27803010 6479-5-825 - INSERT TIBIAL LARGE 81X51X25MM POSTERIOR STABILIZE KINEMAX BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-908 SUP Custom 27803010 6479-5-908 - INSERT TIBIAL XL 86X54X8MM POSTERIOR STABILIZE KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-910 SUP Custom 27803010 6479-5-910 - INSERT TIBIAL XL 86X54X10MM POSTERIOR STABILIZE KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-912 SUP Custom 27803010 6479-5-912 - INSERT TIBIAL XL 86X54X12MM POSTERIOR STABILIZE KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-915 SUP Custom 27803010 6479-5-915 - INSERT TIBIAL XL 86X54X15MM POSTERIOR STABILIZE KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-918 SUP Custom 27803010 6479-5-918 - INSERT TIBIAL XL 86X54X18MM POSTERIOR STABILIZE KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-921 SUP Custom 27803010 6479-5-921 - INSERT TIBIAL XL 86X54X21MM POSTERIOR STABILIZE KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6479-5-925 SUP Custom 27803010 6479-5-925 - INSERT TIBIAL XL 86X54X25MM POSTERIOR STABILIZE KINEMAX PLUS BOTH IP/OP "$2,347.50" "$1,737.00" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $417.86 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" $489.24 "$2,347.50" $939.00 "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$2,347.50" "$1,760.63" "$2,347.50" "$2,347.50" "$2,347.50" "$1,173.75" "$1,173.75" "$1,859.22" "$2,347.50" "$1,878.00" "$1,056.38" "$2,347.50" N/A "$1,361.55" "$2,347.50" "$1,408.50" "$2,347.50" "$2,347.50" "$2,347.50" N/A N/A 6480-0-050 SUP HCPCS C1776 6480-0-050 - COMPONENT FEMORAL XS STABILIZE KINEMAX PLUS KNEE BOTH IP/OP "$5,787.50" "$4,283.00" "$1,148.67" "$5,787.50" "$2,604.38" "$2,604.38" "$2,604.38" "$2,604.38" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.26" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.18" "$5,787.50" "$2,315.00" "$2,853.24" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$4,340.63" "$5,787.50" "$5,787.50" "$5,787.50" "$2,893.75" "$2,893.75" "$4,583.70" "$5,787.50" "$4,630.00" "$2,604.38" "$1,148.67" N/A "$3,356.75" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.12" "$5,787.50" N/A N/A 6480-0-100 SUP HCPCS C1776 6480-0-100 - COMPONENT FEMORAL SMALL STABILIZE KINEMAX PLUS KNEE BOTH IP/OP "$5,787.50" "$4,283.00" "$1,148.67" "$5,787.50" "$2,604.38" "$2,604.38" "$2,604.38" "$2,604.38" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.26" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.18" "$5,787.50" "$2,315.00" "$2,853.24" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$4,340.63" "$5,787.50" "$5,787.50" "$5,787.50" "$2,893.75" "$2,893.75" "$4,583.70" "$5,787.50" "$4,630.00" "$2,604.38" "$1,148.67" N/A "$3,356.75" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.12" "$5,787.50" N/A N/A 6480-0-150 SUP HCPCS C1776 6480-0-150 - COMPONENT FEMORAL MEDIUM STABILIZE KINEMAX PLUS KNEE BOTH IP/OP "$5,787.50" "$4,283.00" "$1,148.67" "$5,787.50" "$2,604.38" "$2,604.38" "$2,604.38" "$2,604.38" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.26" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.18" "$5,787.50" "$5,787.50" "$2,853.24" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$4,340.63" "$5,787.50" "$5,787.50" "$5,787.50" "$2,893.75" "$2,893.75" "$4,583.70" "$5,787.50" "$4,630.00" "$2,604.38" "$1,148.67" N/A "$3,356.75" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.12" "$5,787.50" N/A N/A 6480-0-200 SUP HCPCS C1776 6480-0-200 - COMPONENT FEMORAL LARGE STABILIZE KINEMAX PLUS KNEE BOTH IP/OP "$5,787.50" "$4,283.00" "$1,148.67" "$5,787.50" "$2,604.38" "$2,604.38" "$2,604.38" "$2,604.38" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.26" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.18" "$5,787.50" "$5,787.50" "$2,853.24" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$4,340.63" "$5,787.50" "$5,787.50" "$5,787.50" "$2,893.75" "$2,893.75" "$4,583.70" "$5,787.50" "$4,630.00" "$2,604.38" "$1,148.67" N/A "$3,356.75" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.12" "$5,787.50" N/A N/A 6480-0-250 SUP HCPCS C1776 6480-0-250 - COMPONENT FEMORAL XL STABILIZE KINEMAX PLUS KNEE BOTH IP/OP "$5,787.50" "$4,283.00" "$1,148.67" "$5,787.50" "$2,604.38" "$2,604.38" "$2,604.38" "$2,604.38" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.26" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.18" "$5,787.50" "$5,787.50" "$2,853.24" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$4,340.63" "$5,787.50" "$5,787.50" "$5,787.50" "$2,893.75" "$2,893.75" "$4,583.70" "$5,787.50" "$4,630.00" "$2,604.38" "$1,148.67" N/A "$3,356.75" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.12" "$5,787.50" N/A N/A 6480-0-300 SUP HCPCS C1776 6480-0-300 - COMPONENT FEMORAL 2XL STABILIZE KINEMAX PLUS KNEE BOTH IP/OP "$5,787.50" "$4,283.00" "$1,148.67" "$5,787.50" "$2,604.38" "$2,604.38" "$2,604.38" "$2,604.38" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.26" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.18" "$5,787.50" "$5,787.50" "$2,853.24" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$4,340.63" "$5,787.50" "$5,787.50" "$5,787.50" "$2,893.75" "$2,893.75" "$4,583.70" "$5,787.50" "$4,630.00" "$2,604.38" "$1,148.67" N/A "$3,356.75" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.12" "$5,787.50" N/A N/A 6481-1-100 SUP HCPCS C1776 6481-1-100 - COMPONENT FEMORAL XS 60X54MM MODULAR ROTATE HINGE KNEE LEFT BOTH IP/OP "$10,780.00" "$7,977.00" "$2,139.56" "$10,780.00" "$4,851.00" "$4,851.00" "$4,851.00" "$4,851.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.82" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.67" "$10,780.00" "$10,780.00" "$5,314.54" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$8,085.00" "$10,780.00" "$10,780.00" "$10,780.00" "$5,390.00" "$5,390.00" "$8,537.76" "$10,780.00" "$8,624.00" "$4,851.00" "$2,139.56" N/A "$6,252.40" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.55" "$10,780.00" N/A N/A 6481-1-101 SUP HCPCS C1776 6481-1-101 - COMPONENT FEMORAL XS 60X54MM MODULAR ROTATE HINGE GMRS BOTH IP/OP "$10,780.00" "$7,977.00" "$2,139.56" "$10,780.00" "$4,851.00" "$4,851.00" "$4,851.00" "$4,851.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.82" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.67" "$10,780.00" "$4,312.00" "$5,314.54" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$8,085.00" "$10,780.00" "$10,780.00" "$10,780.00" "$5,390.00" "$5,390.00" "$8,537.76" "$10,780.00" "$8,624.00" "$4,851.00" "$2,139.56" N/A "$6,252.40" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.55" "$10,780.00" N/A N/A 6481-1-110 SUP HCPCS C1776 6481-1-110 - COMPONENT FEMORAL SMALL 65X55MM MODULAR ROTATE HINGE GMRS BOTH IP/OP "$10,780.00" "$7,977.00" "$2,139.56" "$10,780.00" "$4,851.00" "$4,851.00" "$4,851.00" "$4,851.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.82" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.67" "$10,780.00" "$4,312.00" "$5,314.54" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$8,085.00" "$10,780.00" "$10,780.00" "$10,780.00" "$5,390.00" "$5,390.00" "$8,537.76" "$10,780.00" "$8,624.00" "$4,851.00" "$2,139.56" N/A "$6,252.40" "$10,780.00" "$6,468.00" "$10,780.00" "$2,246.55" "$10,780.00" N/A N/A 6481-1-111 SUP HCPCS C1776 6481-1-111 - COMPONENT FEMORAL SMALL 65X55MM MODULAR ROTATE HINGE GMRS BOTH IP/OP "$10,780.00" "$7,977.00" "$2,139.56" "$10,780.00" "$4,851.00" "$4,851.00" "$4,851.00" "$4,851.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.82" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.67" "$10,780.00" "$4,312.00" "$5,314.54" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$8,085.00" "$10,780.00" "$10,780.00" "$10,780.00" "$5,390.00" "$5,390.00" "$8,537.76" "$10,780.00" "$8,624.00" "$4,851.00" "$2,139.56" N/A "$6,252.40" "$10,780.00" "$6,468.00" "$10,780.00" "$2,246.55" "$10,780.00" N/A N/A 6481-1-120 SUP HCPCS C1776 6481-1-120 - COMPONENT FEMORAL MEDIUM 70X61MM MODULAR ROTATE HINGE GMRS BOTH IP/OP "$10,780.00" "$7,977.00" "$2,139.56" "$10,780.00" "$4,851.00" "$4,851.00" "$4,851.00" "$4,851.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.82" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.67" "$10,780.00" "$4,312.00" "$5,314.54" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$8,085.00" "$10,780.00" "$10,780.00" "$10,780.00" "$5,390.00" "$5,390.00" "$8,537.76" "$10,780.00" "$8,624.00" "$4,851.00" "$2,139.56" N/A "$6,252.40" "$10,780.00" "$6,468.00" "$10,780.00" "$2,246.55" "$10,780.00" N/A N/A 6481-1-121 SUP HCPCS C1776 6481-1-121 - COMPONENT FEMORAL MEDIUM 70X61MM MODULAR ROTATE HINGE GMRS BOTH IP/OP "$10,780.00" "$7,977.00" "$2,139.56" "$10,780.00" "$4,851.00" "$4,851.00" "$4,851.00" "$4,851.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.82" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.67" "$10,780.00" "$4,312.00" "$5,314.54" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$8,085.00" "$10,780.00" "$10,780.00" "$10,780.00" "$5,390.00" "$5,390.00" "$8,537.76" "$10,780.00" "$8,624.00" "$4,851.00" "$2,139.56" N/A "$6,252.40" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.55" "$10,780.00" N/A N/A 6481-1-130 SUP HCPCS C1776 6481-1-130 - COMPONENT FEMORAL LARGE 75X64MM MODULAR ROTATE HINGE GMRS BOTH IP/OP "$10,780.00" "$7,977.00" "$2,139.56" "$10,780.00" "$4,851.00" "$4,851.00" "$4,851.00" "$4,851.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.82" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.67" "$10,780.00" "$4,312.00" "$5,314.54" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$8,085.00" "$10,780.00" "$10,780.00" "$10,780.00" "$5,390.00" "$5,390.00" "$8,537.76" "$10,780.00" "$8,624.00" "$4,851.00" "$2,139.56" N/A "$6,252.40" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.55" "$10,780.00" N/A N/A 6481-1-131 SUP HCPCS C1776 6481-1-131 - COMPONENT FEMORAL LARGE 75X64MM MODULAR ROTATE HINGE GMRS BOTH IP/OP "$10,780.00" "$7,977.00" "$2,139.56" "$10,780.00" "$4,851.00" "$4,851.00" "$4,851.00" "$4,851.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.82" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.67" "$10,780.00" "$4,312.00" "$5,314.54" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$8,085.00" "$10,780.00" "$10,780.00" "$10,780.00" "$5,390.00" "$5,390.00" "$8,537.76" "$10,780.00" "$8,624.00" "$4,851.00" "$2,139.56" N/A "$6,252.40" "$10,780.00" "$6,468.00" "$10,780.00" "$2,246.55" "$10,780.00" N/A N/A 6481-1-140 SUP HCPCS C1776 6481-1-140 - COMPONENT FEMORAL XL 80X66MM MODULAR ROTATE HINGE GMRS BOTH IP/OP "$10,780.00" "$7,977.00" "$2,139.56" "$10,780.00" "$4,851.00" "$4,851.00" "$4,851.00" "$4,851.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.82" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.67" "$10,780.00" "$4,312.00" "$5,314.54" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$8,085.00" "$10,780.00" "$10,780.00" "$10,780.00" "$5,390.00" "$5,390.00" "$8,537.76" "$10,780.00" "$8,624.00" "$4,851.00" "$2,139.56" N/A "$6,252.40" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.55" "$10,780.00" N/A N/A 6481-1-141 SUP HCPCS C1776 6481-1-141 - COMPONENT FEMORAL XL 80X66MM MODULAR ROTATE HINGE GMRS BOTH IP/OP "$10,780.00" "$7,977.00" "$2,139.56" "$10,780.00" "$4,851.00" "$4,851.00" "$4,851.00" "$4,851.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.82" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.67" "$10,780.00" "$4,312.00" "$5,314.54" "$10,780.00" "$10,780.00" "$10,780.00" "$10,780.00" "$8,085.00" "$10,780.00" "$10,780.00" "$10,780.00" "$5,390.00" "$5,390.00" "$8,537.76" "$10,780.00" "$8,624.00" "$4,851.00" "$2,139.56" N/A "$6,252.40" "$10,780.00" "$10,780.00" "$10,780.00" "$2,246.55" "$10,780.00" N/A N/A 6481-1-200 SUP Custom 27803010 6481-1-200 - BLOCK AUGMENTATION XS 10MM GMRS FEMORAL DISTAL BOTH IP/OP "$1,455.00" "$1,077.00" $258.99 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" $258.99 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" $303.24 "$1,455.00" $582.00 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,091.25" "$1,455.00" "$1,455.00" "$1,455.00" $727.50 $727.50 "$1,152.36" "$1,455.00" "$1,164.00" $654.75 "$1,455.00" N/A $843.90 "$1,455.00" $873.00 "$1,455.00" "$1,455.00" "$1,455.00" N/A N/A 6481-1-210 SUP Custom 27803010 6481-1-210 - BLOCK AUGMENTATION SMALL 10MM GMRS FEMORAL DISTAL BOTH IP/OP "$1,455.00" "$1,077.00" $258.99 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" $258.99 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" $303.24 "$1,455.00" $582.00 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,091.25" "$1,455.00" "$1,455.00" "$1,455.00" $727.50 $727.50 "$1,152.36" "$1,455.00" "$1,164.00" $654.75 "$1,455.00" N/A $843.90 "$1,455.00" $873.00 "$1,455.00" "$1,455.00" "$1,455.00" N/A N/A 6481-1-220 SUP Custom 27803010 6481-1-220 - BLOCK AUGMENTATION MEDIUM 10MM GMRS FEMORAL DISTAL BOTH IP/OP "$1,455.00" "$1,077.00" $258.99 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" $258.99 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" $303.24 "$1,455.00" $582.00 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,091.25" "$1,455.00" "$1,455.00" "$1,455.00" $727.50 $727.50 "$1,152.36" "$1,455.00" "$1,164.00" $654.75 "$1,455.00" N/A $843.90 "$1,455.00" $873.00 "$1,455.00" "$1,455.00" "$1,455.00" N/A N/A 6481-1-230 SUP Custom 27803010 6481-1-230 - BLOCK AUGMENTATION LARGE 10MM GMRS FEMORAL DISTAL BOTH IP/OP "$1,455.00" "$1,077.00" $258.99 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" $258.99 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" $303.24 "$1,455.00" $582.00 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,091.25" "$1,455.00" "$1,455.00" "$1,455.00" $727.50 $727.50 "$1,152.36" "$1,455.00" "$1,164.00" $654.75 "$1,455.00" N/A $843.90 "$1,455.00" $873.00 "$1,455.00" "$1,455.00" "$1,455.00" N/A N/A 6481-1-240 SUP Custom 27803010 6481-1-240 - BLOCK AUGMENTATION XL 10MM GMRS FEMORAL DISTAL BOTH IP/OP "$1,455.00" "$1,077.00" $258.99 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" $258.99 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" $303.24 "$1,455.00" $582.00 "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,455.00" "$1,091.25" "$1,455.00" "$1,455.00" "$1,455.00" $727.50 $727.50 "$1,152.36" "$1,455.00" "$1,164.00" $654.75 "$1,455.00" N/A $843.90 "$1,455.00" $873.00 "$1,455.00" "$1,455.00" "$1,455.00" N/A N/A 6481-2-100 SUP HCPCS C1776 6481-2-100 - COMPONENT TIB XS-XL MNGR MDLR ROT HNG KN BOTH IP/OP "$6,265.00" "$4,636.00" "$1,243.45" "$6,265.00" "$2,819.25" "$2,819.25" "$2,819.25" "$2,819.25" "$6,265.00" "$6,265.00" "$6,265.00" "$1,305.78" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$1,305.69" "$6,265.00" "$2,506.00" "$3,088.65" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$4,698.75" "$6,265.00" "$6,265.00" "$6,265.00" "$3,132.50" "$3,132.50" "$4,961.88" "$6,265.00" "$5,012.00" "$2,819.25" "$1,243.45" N/A "$3,633.70" "$6,265.00" "$6,265.00" "$6,265.00" "$1,305.63" "$6,265.00" N/A N/A 6481-2-101 SUP HCPCS C1776 6481-2-101 - COMPONENT TIBIAL LARGE XL MOBILE ROTATE HINGE MRS KNEE BOTH IP/OP "$6,265.00" "$4,636.00" "$1,243.45" "$6,265.00" "$2,819.25" "$2,819.25" "$2,819.25" "$2,819.25" "$6,265.00" "$6,265.00" "$6,265.00" "$1,305.78" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$1,305.69" "$6,265.00" "$2,506.00" "$3,088.65" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$4,698.75" "$6,265.00" "$6,265.00" "$6,265.00" "$3,132.50" "$3,132.50" "$4,961.88" "$6,265.00" "$5,012.00" "$2,819.25" "$1,243.45" N/A "$3,633.70" "$6,265.00" "$6,265.00" "$6,265.00" "$1,305.63" "$6,265.00" N/A N/A 6481-2-103 SUP HCPCS C1776 6481-2-103 - COMPONENT TIBIAL XS LONG XL BEARING CROSSOVER MODULAR ROTATE BOTH IP/OP "$6,265.00" "$4,636.00" "$1,243.45" "$6,265.00" "$2,819.25" "$2,819.25" "$2,819.25" "$2,819.25" "$6,265.00" "$6,265.00" "$6,265.00" "$1,305.78" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$1,305.69" "$6,265.00" "$2,506.00" "$3,088.65" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$4,698.75" "$6,265.00" "$6,265.00" "$6,265.00" "$3,132.50" "$3,132.50" "$4,961.88" "$6,265.00" "$5,012.00" "$2,819.25" "$1,243.45" N/A "$3,633.70" "$6,265.00" "$3,759.00" "$6,265.00" "$1,305.63" "$6,265.00" N/A N/A 6481-2-104 SUP HCPCS C1776 6481-2-104 - COMPONENT TIBIAL XS XL SHORT BEARING CROSSOVER MODULAR BOTH IP/OP "$6,265.00" "$4,636.00" "$1,243.45" "$6,265.00" "$2,819.25" "$2,819.25" "$2,819.25" "$2,819.25" "$6,265.00" "$6,265.00" "$6,265.00" "$1,305.78" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$1,305.69" "$6,265.00" "$2,506.00" "$3,088.65" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$4,698.75" "$6,265.00" "$6,265.00" "$6,265.00" "$3,132.50" "$3,132.50" "$4,961.88" "$6,265.00" "$5,012.00" "$2,819.25" "$1,243.45" N/A "$3,633.70" "$6,265.00" "$3,759.00" "$6,265.00" "$1,305.63" "$6,265.00" N/A N/A 6481-2-107 SUP HCPCS C1776 6481-2-107 - COMPONENT TIBIAL BEARING GMRS ALL POLY PEDIATRIC KNEE BOTH IP/OP "$5,752.50" "$4,257.00" "$1,141.73" "$5,752.50" "$2,588.63" "$2,588.63" "$2,588.63" "$2,588.63" "$5,752.50" "$5,752.50" "$5,752.50" "$1,198.96" "$5,752.50" "$5,752.50" "$5,752.50" "$5,752.50" "$5,752.50" "$1,198.88" "$5,752.50" "$2,301.00" "$2,835.98" "$5,752.50" "$5,752.50" "$5,752.50" "$5,752.50" "$4,314.38" "$5,752.50" "$5,752.50" "$5,752.50" "$2,876.25" "$2,876.25" "$4,555.98" "$5,752.50" "$4,602.00" "$2,588.63" "$1,141.73" N/A "$3,336.45" "$5,752.50" "$5,752.50" "$5,752.50" "$1,198.82" "$5,752.50" N/A N/A 6481-2-108 SUP HCPCS C1776 6481-2-108 - COMPONENT TIBIAL BEARING CROSSOVER MODULAR ROTATE HINGE MRS BOTH IP/OP "$6,265.00" "$4,636.00" "$1,243.45" "$6,265.00" "$2,819.25" "$2,819.25" "$2,819.25" "$2,819.25" "$6,265.00" "$6,265.00" "$6,265.00" "$1,305.78" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$1,305.69" "$6,265.00" "$6,265.00" "$3,088.65" "$6,265.00" "$6,265.00" "$6,265.00" "$6,265.00" "$4,698.75" "$6,265.00" "$6,265.00" "$6,265.00" "$3,132.50" "$3,132.50" "$4,961.88" "$6,265.00" "$5,012.00" "$2,819.25" "$1,243.45" N/A "$3,633.70" "$6,265.00" "$6,265.00" "$6,265.00" "$1,305.63" "$6,265.00" N/A N/A 6481-2-110 SUP Custom 27803010 6481-2-110 - BUSHING FEMORAL MODULAR ROTATE HINGE KNEE BOTH IP/OP $617.50 $457.00 $109.92 $617.50 $617.50 $617.50 $617.50 $617.50 $617.50 $617.50 $109.92 $617.50 $617.50 $617.50 $617.50 $617.50 $617.50 $128.69 $617.50 $247.00 $617.50 $617.50 $617.50 $617.50 $617.50 $463.13 $617.50 $617.50 $617.50 $308.75 $308.75 $489.06 $617.50 $494.00 $277.88 $617.50 N/A $358.15 $617.50 $370.50 $617.50 $617.50 $617.50 N/A N/A 6481-2-120 SUP Custom 27803010 6481-2-120 - AXLE FEMORAL MODULAR ROTATE HINGE KNEE BOTH IP/OP "$2,122.50" "$1,571.00" $377.81 "$2,122.50" "$2,122.50" "$2,122.50" "$2,122.50" "$2,122.50" "$2,122.50" "$2,122.50" $377.81 "$2,122.50" "$2,122.50" "$2,122.50" "$2,122.50" "$2,122.50" "$2,122.50" $442.35 "$2,122.50" $849.00 "$2,122.50" "$2,122.50" "$2,122.50" "$2,122.50" "$2,122.50" "$1,591.88" "$2,122.50" "$2,122.50" "$2,122.50" "$1,061.25" "$1,061.25" "$1,681.02" "$2,122.50" "$1,698.00" $955.13 "$2,122.50" N/A "$1,231.05" "$2,122.50" "$1,273.50" "$2,122.50" "$2,122.50" "$2,122.50" N/A N/A 6481-2-130 SUP Custom 27803010 6481-2-130 - INSERT BUMPER NEUTRAL MODULAR ROTATE HINGE GMRS KNEE BOTH IP/OP "$1,272.50" $942.00 $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $265.20 "$1,272.50" $509.00 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $954.38 "$1,272.50" "$1,272.50" "$1,272.50" $636.25 $636.25 "$1,007.82" "$1,272.50" "$1,018.00" $572.63 "$1,272.50" N/A $738.05 "$1,272.50" $763.50 "$1,272.50" "$1,272.50" "$1,272.50" N/A N/A 6481-2-133 SUP Custom 27803010 6481-2-133 - INSERT BUMPER 3D MODULAR ROTATE HINGE GMRS KNEE PROXIMAL BOTH IP/OP "$1,272.50" $942.00 $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $226.51 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $265.20 "$1,272.50" $509.00 "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" "$1,272.50" $954.38 "$1,272.50" "$1,272.50" "$1,272.50" $636.25 $636.25 "$1,007.82" "$1,272.50" "$1,018.00" $572.63 "$1,272.50" N/A $738.05 "$1,272.50" $763.50 "$1,272.50" "$1,272.50" "$1,272.50" N/A N/A 6481-2-140 SUP Custom 27203010 6481-2-140 - SLEEVE TIBIAL MODULAR ROTATE HINGE KNEE BOTH IP/OP "$1,065.00" $788.00 $189.57 "$1,065.00" "$1,065.00" "$1,065.00" "$1,065.00" "$1,065.00" "$1,065.00" "$1,065.00" $189.57 "$1,065.00" "$1,065.00" $790.44 $790.44 $820.90 $554.87 $221.96 "$1,065.00" $426.00 "$1,065.00" "$1,065.00" "$1,065.00" "$1,065.00" "$1,065.00" $798.75 "$1,065.00" "$1,065.00" "$1,065.00" $532.50 $532.50 $843.48 "$1,065.00" $852.00 $692.25 "$1,065.00" N/A $617.70 "$1,065.00" $639.00 "$1,065.00" "$1,065.00" "$1,065.00" N/A N/A 6481-2-150 SUP HCPCS C1776 6481-2-150 - COMPONENT FEMORAL PACK CROSSLINK GMRS POLYETHYLENE KNEE BOTH IP/OP "$3,347.50" "$2,477.00" $664.40 "$3,347.50" "$1,506.38" "$1,506.38" "$1,506.38" "$1,506.38" "$3,347.50" "$3,347.50" "$3,347.50" $697.70 "$3,347.50" "$3,347.50" "$3,347.50" "$3,347.50" "$3,347.50" $697.66 "$3,347.50" "$1,339.00" "$1,650.32" "$3,347.50" "$3,347.50" "$3,347.50" "$3,347.50" "$2,510.63" "$3,347.50" "$3,347.50" "$3,347.50" "$1,673.75" "$1,673.75" "$2,651.22" "$3,347.50" "$2,678.00" "$1,506.38" $664.40 N/A "$1,941.55" "$3,347.50" "$2,008.50" "$3,347.50" $697.62 "$3,347.50" N/A N/A 6481-3-110 SUP HCPCS C1776 6481-3-110 - BASEPLATE TIB 1 SM MDLR ROT HNG KN BOTH IP/OP "$6,730.00" "$4,980.00" "$1,335.74" "$6,730.00" "$3,028.50" "$3,028.50" "$3,028.50" "$3,028.50" "$6,730.00" "$6,730.00" "$6,730.00" "$1,402.70" "$6,730.00" "$6,730.00" "$6,730.00" "$6,730.00" "$6,730.00" "$1,402.61" "$6,730.00" "$6,730.00" "$3,317.89" "$6,730.00" "$6,730.00" "$6,730.00" "$6,730.00" "$5,047.50" "$6,730.00" "$6,730.00" "$6,730.00" "$3,365.00" "$3,365.00" "$5,330.16" "$6,730.00" "$5,384.00" "$3,028.50" "$1,335.74" N/A "$3,903.40" "$6,730.00" "$4,038.00" "$6,730.00" "$1,402.53" "$6,730.00" N/A N/A 6481-3-111 SUP HCPCS C1776 6481-3-111 - BASEPLATE TIB 2 SM MDLR ROT HNG KN BOTH IP/OP "$6,730.00" "$4,980.00" "$1,335.74" "$6,730.00" "$3,028.50" "$3,028.50" "$3,028.50" "$3,028.50" "$6,730.00" "$6,730.00" "$6,730.00" "$1,402.70" "$6,730.00" "$6,730.00" "$6,730.00" "$6,730.00" "$6,730.00" "$1,402.61" "$6,730.00" "$2,692.00" "$3,317.89" "$6,730.00" "$6,730.00" "$6,730.00" "$6,730.00" "$5,047.50" "$6,730.00" "$6,730.00" "$6,730.00" "$3,365.00" "$3,365.00" "$5,330.16" "$6,730.00" "$5,384.00" "$3,028.50" "$1,335.74" N/A "$3,903.40" "$6,730.00" "$4,038.00" "$6,730.00" "$1,402.53" "$6,730.00" N/A N/A 6481-3-112 SUP HCPCS C1776 6481-3-112 - BASEPLATE TIB 2 MED MDLR ROT HNG KN BOTH IP/OP "$6,730.00" "$4,980.00" "$1,335.74" "$6,730.00" "$3,028.50" "$3,028.50" "$3,028.50" "$3,028.50" "$6,730.00" "$6,730.00" "$6,730.00" "$1,402.70" "$6,730.00" "$6,730.00" "$6,730.00" "$6,730.00" "$6,730.00" "$1,402.61" "$6,730.00" "$2,692.00" "$3,317.89" "$6,730.00" "$6,730.00" "$6,730.00" "$6,730.00" "$5,047.50" "$6,730.00" "$6,730.00" "$6,730.00" "$3,365.00" "$3,365.00" "$5,330.16" "$6,730.00" "$5,384.00" "$3,028.50" "$1,335.74" N/A "$3,903.40" "$6,730.00" "$6,730.00" "$6,730.00" "$1,402.53" "$6,730.00" N/A N/A 6481-3-113 SUP HCPCS C1776 6481-3-113 - BASEPLATE TIB 2 LG MDLR ROT HNG KN BOTH IP/OP "$6,730.00" "$4,980.00" "$1,335.74" "$6,730.00" "$3,028.50" "$3,028.50" "$3,028.50" "$3,028.50" "$6,730.00" "$6,730.00" "$6,730.00" "$1,402.70" "$6,730.00" "$6,730.00" "$6,730.00" "$6,730.00" "$6,730.00" "$1,402.61" "$6,730.00" "$6,730.00" "$3,317.89" "$6,730.00" "$6,730.00" "$6,730.00" "$6,730.00" "$5,047.50" "$6,730.00" "$6,730.00" "$6,730.00" "$3,365.00" "$3,365.00" "$5,330.16" "$6,730.00" "$5,384.00" "$3,028.50" "$1,335.74" N/A "$3,903.40" "$6,730.00" "$4,038.00" "$6,730.00" "$1,402.53" "$6,730.00" N/A N/A 6481-3-210 SUP Custom 27803010 6481-3-210 - INSERT TIBIAL THK10MM S1 S2 MODULAR ROTATE HINGE GMRS BOTH IP/OP "$2,367.50" "$1,752.00" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $493.41 "$2,367.50" $947.00 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$1,775.63" "$2,367.50" "$2,367.50" "$2,367.50" "$1,183.75" "$1,183.75" "$1,875.06" "$2,367.50" "$1,894.00" "$1,065.38" "$2,367.50" N/A "$1,373.15" "$2,367.50" "$1,420.50" "$2,367.50" "$2,367.50" "$2,367.50" N/A N/A 6481-3-213 SUP Custom 27803010 6481-3-213 - INSERT TIBIAL THK13MM S1 S2 MODULAR ROTATE HINGE GMRS BOTH IP/OP "$2,367.50" "$1,752.00" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $493.41 "$2,367.50" $947.00 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$1,775.63" "$2,367.50" "$2,367.50" "$2,367.50" "$1,183.75" "$1,183.75" "$1,875.06" "$2,367.50" "$1,894.00" "$1,065.38" "$2,367.50" N/A "$1,373.15" "$2,367.50" "$1,420.50" "$2,367.50" "$2,367.50" "$2,367.50" N/A N/A 6481-3-216 SUP Custom 27803010 6481-3-216 - INSERT TIBIAL THK16MM S1 S2 MODULAR ROTATE HINGE GMRS BOTH IP/OP "$2,367.50" "$1,752.00" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $493.41 "$2,367.50" $947.00 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$1,775.63" "$2,367.50" "$2,367.50" "$2,367.50" "$1,183.75" "$1,183.75" "$1,875.06" "$2,367.50" "$1,894.00" "$1,065.38" "$2,367.50" N/A "$1,373.15" "$2,367.50" "$1,420.50" "$2,367.50" "$2,367.50" "$2,367.50" N/A N/A 6481-3-220 SUP Custom 27803010 6481-3-220 - INSERT TIBIAL THK20MM S1 S2 MODULAR ROTATE HINGE GMRS BOTH IP/OP "$2,367.50" "$1,752.00" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $493.41 "$2,367.50" $947.00 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$1,775.63" "$2,367.50" "$2,367.50" "$2,367.50" "$1,183.75" "$1,183.75" "$1,875.06" "$2,367.50" "$1,894.00" "$1,065.38" "$2,367.50" N/A "$1,373.15" "$2,367.50" "$1,420.50" "$2,367.50" "$2,367.50" "$2,367.50" N/A N/A 6481-3-224 SUP Custom 27803010 6481-3-224 - INSERT TIBIAL THK24MM S1 S2 MODULAR ROTATE HINGE GMRS BOTH IP/OP "$2,367.50" "$1,752.00" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $493.41 "$2,367.50" $947.00 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$1,775.63" "$2,367.50" "$2,367.50" "$2,367.50" "$1,183.75" "$1,183.75" "$1,875.06" "$2,367.50" "$1,894.00" "$1,065.38" "$2,367.50" N/A "$1,373.15" "$2,367.50" "$1,420.50" "$2,367.50" "$2,367.50" "$2,367.50" N/A N/A 6481-3-310 SUP Custom 27803010 6481-3-310 - INSERT TIBIAL MEDIUM LARGE M2 2 10MM BEARING MODULAR BOTH IP/OP "$2,387.50" "$1,767.00" $424.98 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" $424.98 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" $497.58 "$2,387.50" $955.00 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$1,790.63" "$2,387.50" "$2,387.50" "$2,387.50" "$1,193.75" "$1,193.75" "$1,890.90" "$2,387.50" "$1,910.00" "$1,074.38" "$2,387.50" N/A "$1,384.75" "$2,387.50" "$1,432.50" "$2,387.50" "$2,387.50" "$2,387.50" N/A N/A 6481-3-313 SUP Custom 27803010 6481-3-313 - INSERT TIBIAL THK13MM M2 2 BEARING MODULAR ROTATE HINGE GMRS BOTH IP/OP "$2,387.50" "$1,767.00" $424.98 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" $424.98 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" $497.58 "$2,387.50" $955.00 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$1,790.63" "$2,387.50" "$2,387.50" "$2,387.50" "$1,193.75" "$1,193.75" "$1,890.90" "$2,387.50" "$1,910.00" "$1,074.38" "$2,387.50" N/A "$1,384.75" "$2,387.50" "$1,432.50" "$2,387.50" "$2,387.50" "$2,387.50" N/A N/A 6481-3-316 SUP Custom 27803010 6481-3-316 - INSERT TIBIAL THK16MM M2 2 BEARING MODULAR ROTATE HINGE GMRS BOTH IP/OP "$2,387.50" "$1,767.00" $424.98 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" $424.98 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" $497.58 "$2,387.50" $955.00 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$1,790.63" "$2,387.50" "$2,387.50" "$2,387.50" "$1,193.75" "$1,193.75" "$1,890.90" "$2,387.50" "$1,910.00" "$1,074.38" "$2,387.50" N/A "$1,384.75" "$2,387.50" "$1,432.50" "$2,387.50" "$2,387.50" "$2,387.50" N/A N/A 6481-3-320 SUP Custom 27803010 6481-3-320 - INSERT TIBIAL THK20MM M2 2 BEARING MODULAR ROTATE HINGE GMRS BOTH IP/OP "$2,387.50" "$1,767.00" $424.98 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" $424.98 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" $497.58 "$2,387.50" $955.00 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$1,790.63" "$2,387.50" "$2,387.50" "$2,387.50" "$1,193.75" "$1,193.75" "$1,890.90" "$2,387.50" "$1,910.00" "$1,074.38" "$2,387.50" N/A "$1,384.75" "$2,387.50" "$1,432.50" "$2,387.50" "$2,387.50" "$2,387.50" N/A N/A 6481-3-324 SUP Custom 27803010 6481-3-324 - INSERT TIBIAL THK24MM M2 2 BEARING MODULAR ROTATE HINGE GMRS BOTH IP/OP "$2,387.50" "$1,767.00" $424.98 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" $424.98 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" $497.58 "$2,387.50" $955.00 "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$2,387.50" "$1,790.63" "$2,387.50" "$2,387.50" "$2,387.50" "$1,193.75" "$1,193.75" "$1,890.90" "$2,387.50" "$1,910.00" "$1,074.38" "$2,387.50" N/A "$1,384.75" "$2,387.50" "$1,432.50" "$2,387.50" "$2,387.50" "$2,387.50" N/A N/A 6485-0-020 SUP HCPCS C1776 6485-0-020 - COMPONENT FEMORAL MRS KNEE RIGHT CONDYLE BOTH IP/OP "$14,193.00" "$10,503.00" "$2,816.91" "$14,192.75" "$6,386.74" "$6,386.74" "$6,386.74" "$6,386.74" "$14,192.75" "$14,192.75" "$14,192.75" "$2,958.12" "$14,192.75" "$14,192.75" "$14,192.75" "$14,192.75" "$14,192.75" "$2,957.93" "$14,192.75" "$14,192.75" "$6,997.03" "$14,192.75" "$14,192.75" "$14,192.75" "$14,192.75" "$10,644.75" "$14,192.75" "$14,192.75" "$14,192.75" "$7,096.38" "$7,096.38" "$11,240.66" "$14,192.75" "$11,354.20" "$6,386.74" "$2,816.91" N/A "$8,231.94" "$14,192.75" "$8,515.65" "$14,192.75" "$2,957.77" "$14,192.75" N/A N/A 6485-0-025 SUP HCPCS C1776 6485-0-025 - COMPONENT FEMORAL SMALL 75MM ROTATE HINGE MRS CONDYLE LEFT BOTH IP/OP "$14,193.00" "$10,503.00" "$2,816.91" "$14,192.75" "$6,386.74" "$6,386.74" "$6,386.74" "$6,386.74" "$14,192.75" "$14,192.75" "$14,192.75" "$2,958.12" "$14,192.75" "$14,192.75" "$14,192.75" "$14,192.75" "$14,192.75" "$2,957.93" "$14,192.75" "$14,192.75" "$6,997.03" "$14,192.75" "$14,192.75" "$14,192.75" "$14,192.75" "$10,644.75" "$14,192.75" "$14,192.75" "$14,192.75" "$7,096.38" "$7,096.38" "$11,240.66" "$14,192.75" "$11,354.20" "$6,386.74" "$2,816.91" N/A "$8,231.94" "$14,192.75" "$14,192.75" "$14,192.75" "$2,957.77" "$14,192.75" N/A N/A 6485-0-045 SUP HCPCS C1776 6485-0-045 - COMPONENT FEMORAL SMALL 85MM ROTATE HINGE MRS CONDYLE LEFT BOTH IP/OP "$14,193.00" "$10,503.00" "$2,816.91" "$14,192.75" "$6,386.74" "$6,386.74" "$6,386.74" "$6,386.74" "$14,192.75" "$14,192.75" "$14,192.75" "$2,958.12" "$14,192.75" "$14,192.75" "$14,192.75" "$14,192.75" "$14,192.75" "$2,957.93" "$14,192.75" "$5,677.10" "$6,997.03" "$14,192.75" "$14,192.75" "$14,192.75" "$14,192.75" "$10,644.75" "$14,192.75" "$14,192.75" "$14,192.75" "$7,096.38" "$7,096.38" "$11,240.66" "$14,192.75" "$11,354.20" "$6,386.74" "$2,816.91" N/A "$8,231.94" "$14,192.75" "$8,515.65" "$14,192.75" "$2,957.77" "$14,192.75" N/A N/A 6485-0-050 SUP HCPCS C1776 6485-0-050 - COMPONENT FEMORAL XS STABILIZE REVISION KINEMAX PLUS KNEE BOTH IP/OP "$5,216.00" "$3,860.00" "$1,035.25" "$5,216.00" "$2,347.20" "$2,347.20" "$2,347.20" "$2,347.20" "$5,216.00" "$5,216.00" "$5,216.00" "$1,087.14" "$5,216.00" "$5,216.00" "$5,216.00" "$5,216.00" "$5,216.00" "$1,087.07" "$5,216.00" "$5,216.00" "$2,571.49" "$5,216.00" "$5,216.00" "$5,216.00" "$5,216.00" "$3,912.00" "$5,216.00" "$5,216.00" "$5,216.00" "$2,608.00" "$2,608.00" "$4,131.07" "$5,216.00" "$4,172.80" "$2,347.20" "$1,035.25" N/A "$3,025.28" "$5,216.00" "$3,129.60" "$5,216.00" "$1,087.01" "$5,216.00" N/A N/A 6485-0-060 SUP HCPCS C1776 6485-0-060 - COMPONENT FEMORAL XS STABILIZE REVISION KINEMAX PLUS KNEE BOTH IP/OP "$5,189.00" "$3,840.00" "$1,029.89" "$5,189.00" "$2,335.05" "$2,335.05" "$2,335.05" "$2,335.05" "$5,189.00" "$5,189.00" "$5,189.00" "$1,081.52" "$5,189.00" "$5,189.00" "$5,189.00" "$5,189.00" "$5,189.00" "$1,081.44" "$5,189.00" "$2,075.60" "$2,558.18" "$5,189.00" "$5,189.00" "$5,189.00" "$5,189.00" "$3,891.75" "$5,189.00" "$5,189.00" "$5,189.00" "$2,594.50" "$2,594.50" "$4,109.69" "$5,189.00" "$4,151.20" "$2,335.05" "$1,029.89" N/A "$3,009.62" "$5,189.00" "$5,189.00" "$5,189.00" "$1,081.39" "$5,189.00" N/A N/A 6485-0-075 SUP HCPCS C1776 6485-0-075 - COMPONENT FEMORAL SMALL 95MM MRS CONDYLE RIGHT BOTH IP/OP "$10,857.00" "$8,034.00" "$2,154.77" "$10,856.63" "$4,885.48" "$4,885.48" "$4,885.48" "$4,885.48" "$10,856.63" "$10,856.63" "$10,856.63" "$2,262.79" "$10,856.63" "$10,856.63" "$10,856.63" "$10,856.63" "$10,856.63" "$2,262.64" "$10,856.63" "$10,856.63" "$5,352.32" "$10,856.63" "$10,856.63" "$10,856.63" "$10,856.63" "$8,142.75" "$10,856.63" "$10,856.63" "$10,856.63" "$5,428.32" "$5,428.32" "$8,598.45" "$10,856.63" "$8,685.30" "$4,885.48" "$2,154.77" N/A "$6,297.06" "$10,856.63" "$6,513.98" "$10,856.63" "$2,262.52" "$10,856.63" N/A N/A 6485-0-100 SUP HCPCS C1776 6485-0-100 - COMPONENT FEMORAL SMALL STABILIZE REVISION KINEMAX PLUS KNEE BOTH IP/OP "$5,407.00" "$4,001.00" "$1,073.15" "$5,407.00" "$2,433.15" "$2,433.15" "$2,433.15" "$2,433.15" "$5,407.00" "$5,407.00" "$5,407.00" "$1,126.95" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$1,126.88" "$5,407.00" "$2,162.80" "$2,665.65" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$4,055.25" "$5,407.00" "$5,407.00" "$5,407.00" "$2,703.50" "$2,703.50" "$4,282.34" "$5,407.00" "$4,325.60" "$2,433.15" "$1,073.15" N/A "$3,136.06" "$5,407.00" "$3,244.20" "$5,407.00" "$1,126.82" "$5,407.00" N/A N/A 6485-0-110 SUP HCPCS C1776 6485-0-110 - COMPONENT FEMORAL SMALL REVISION STABILIZE KINEMAX PLUS KNEE BOTH IP/OP "$5,189.00" "$3,840.00" "$1,029.89" "$5,189.00" "$2,335.05" "$2,335.05" "$2,335.05" "$2,335.05" "$5,189.00" "$5,189.00" "$5,189.00" "$1,081.52" "$5,189.00" "$5,189.00" "$5,189.00" "$5,189.00" "$5,189.00" "$1,081.44" "$5,189.00" "$5,189.00" "$2,558.18" "$5,189.00" "$5,189.00" "$5,189.00" "$5,189.00" "$3,891.75" "$5,189.00" "$5,189.00" "$5,189.00" "$2,594.50" "$2,594.50" "$4,109.69" "$5,189.00" "$4,151.20" "$2,335.05" "$1,029.89" N/A "$3,009.62" "$5,189.00" "$3,113.40" "$5,189.00" "$1,081.39" "$5,189.00" N/A N/A 6485-0-150 SUP HCPCS C1776 6485-0-150 - COMPONENT FEMORAL MEDIUM REVISION STABILIZE KINEMAX PLUS BOTH IP/OP "$5,407.00" "$4,001.00" "$1,073.15" "$5,407.00" "$2,433.15" "$2,433.15" "$2,433.15" "$2,433.15" "$5,407.00" "$5,407.00" "$5,407.00" "$1,126.95" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$1,126.88" "$5,407.00" "$2,162.80" "$2,665.65" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$4,055.25" "$5,407.00" "$5,407.00" "$5,407.00" "$2,703.50" "$2,703.50" "$4,282.34" "$5,407.00" "$4,325.60" "$2,433.15" "$1,073.15" N/A "$3,136.06" "$5,407.00" "$5,407.00" "$5,407.00" "$1,126.82" "$5,407.00" N/A N/A 6485-0-160 SUP HCPCS C1776 6485-0-160 - COMPONENT FEMORAL MEDIUM REVISION STABILIZE KINEMAX PLUS BOTH IP/OP "$5,407.00" "$4,001.00" "$1,073.15" "$5,407.00" "$2,433.15" "$2,433.15" "$2,433.15" "$2,433.15" "$5,407.00" "$5,407.00" "$5,407.00" "$1,126.95" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$1,126.88" "$5,407.00" "$5,407.00" "$2,665.65" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$4,055.25" "$5,407.00" "$5,407.00" "$5,407.00" "$2,703.50" "$2,703.50" "$4,282.34" "$5,407.00" "$4,325.60" "$2,433.15" "$1,073.15" N/A "$3,136.06" "$5,407.00" "$3,244.20" "$5,407.00" "$1,126.82" "$5,407.00" N/A N/A 6485-0-200 SUP HCPCS C1776 6485-0-200 - COMPONENT FEMORAL LARGE REVISION STABILIZE KINEMAX PLUS KNEE BOTH IP/OP "$5,407.00" "$4,001.00" "$1,073.15" "$5,407.00" "$2,433.15" "$2,433.15" "$2,433.15" "$2,433.15" "$5,407.00" "$5,407.00" "$5,407.00" "$1,126.95" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$1,126.88" "$5,407.00" "$2,162.80" "$2,665.65" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$4,055.25" "$5,407.00" "$5,407.00" "$5,407.00" "$2,703.50" "$2,703.50" "$4,282.34" "$5,407.00" "$4,325.60" "$2,433.15" "$1,073.15" N/A "$3,136.06" "$5,407.00" "$3,244.20" "$5,407.00" "$1,126.82" "$5,407.00" N/A N/A 6485-0-210 SUP HCPCS C1776 6485-0-210 - COMPONENT FEMORAL LARGE REVISION STABILIZE KINEMAX PLUS KNEE BOTH IP/OP "$5,407.00" "$4,001.00" "$1,073.15" "$5,407.00" "$2,433.15" "$2,433.15" "$2,433.15" "$2,433.15" "$5,407.00" "$5,407.00" "$5,407.00" "$1,126.95" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$1,126.88" "$5,407.00" "$2,162.80" "$2,665.65" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$4,055.25" "$5,407.00" "$5,407.00" "$5,407.00" "$2,703.50" "$2,703.50" "$4,282.34" "$5,407.00" "$4,325.60" "$2,433.15" "$1,073.15" N/A "$3,136.06" "$5,407.00" "$5,407.00" "$5,407.00" "$1,126.82" "$5,407.00" N/A N/A 6485-0-250 SUP HCPCS C1776 6485-0-250 - COMPONENT FEMORAL XL MODULAR STABILIZE KINEMAX PLUS KNEE BOTH IP/OP "$5,407.00" "$4,001.00" "$1,073.15" "$5,407.00" "$2,433.15" "$2,433.15" "$2,433.15" "$2,433.15" "$5,407.00" "$5,407.00" "$5,407.00" "$1,126.95" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$1,126.88" "$5,407.00" "$2,162.80" "$2,665.65" "$5,407.00" "$5,407.00" "$5,407.00" "$5,407.00" "$4,055.25" "$5,407.00" "$5,407.00" "$5,407.00" "$2,703.50" "$2,703.50" "$4,282.34" "$5,407.00" "$4,325.60" "$2,433.15" "$1,073.15" N/A "$3,136.06" "$5,407.00" "$3,244.20" "$5,407.00" "$1,126.82" "$5,407.00" N/A N/A 6485-0-260 SUP HCPCS C1776 6485-0-260 - COMPONENT FEMORAL XL MODULAR STABILIZE KINEMAX PLUS KNEE BOTH IP/OP "$4,552.00" "$3,368.00" $903.46 "$4,552.00" "$2,048.40" "$2,048.40" "$2,048.40" "$2,048.40" "$4,552.00" "$4,552.00" "$4,552.00" $948.75 "$4,552.00" "$4,552.00" "$4,552.00" "$4,552.00" "$4,552.00" $948.69 "$4,552.00" "$1,820.80" "$2,244.14" "$4,552.00" "$4,552.00" "$4,552.00" "$4,552.00" "$3,414.00" "$4,552.00" "$4,552.00" "$4,552.00" "$2,276.00" "$2,276.00" "$3,605.18" "$4,552.00" "$3,641.60" "$2,048.40" $903.46 N/A "$2,640.16" "$4,552.00" "$2,731.20" "$4,552.00" $948.64 "$4,552.00" N/A N/A 6485-1-915 SUP Custom 27803010 6485-1-915 - COMPONENT PATLR SMALL ROTATE HINGE KRH DUR BOTH IP/OP "$1,705.00" "$1,262.00" $303.49 "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" $303.49 "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" $355.34 "$1,705.00" $682.00 "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,278.75" "$1,705.00" "$1,705.00" "$1,705.00" $852.50 $852.50 "$1,350.36" "$1,705.00" "$1,364.00" $767.25 "$1,705.00" N/A $988.90 "$1,705.00" "$1,023.00" "$1,705.00" "$1,705.00" "$1,705.00" N/A N/A 6485-2-008 SUP HCPCS C1776 6485-2-008 - INSERT TIBIAL XS 8MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-011 SUP HCPCS C1776 6485-2-011 - INSERT TIBIAL XS 11MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$3,142.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-016 SUP HCPCS C1776 6485-2-016 - INSERT TIBIAL XS 16MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$3,142.50" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$3,142.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-021 SUP HCPCS C1776 6485-2-021 - INSERT TIBIAL XS 21MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$3,142.50" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-108 SUP HCPCS C1776 6485-2-108 - INSERT TIBIAL SMALL 8MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-111 SUP HCPCS C1776 6485-2-111 - INSERT TIBIAL SMALL 11MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$3,142.50" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-116 SUP HCPCS C1776 6485-2-116 - INSERT TIBIAL SMALL 16MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-121 SUP HCPCS C1776 6485-2-121 - INSERT TIBIAL SMALL 21MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$3,142.50" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-208 SUP HCPCS C1776 6485-2-208 - INSERT TIBIAL MEDIUM 8MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-211 SUP HCPCS C1776 6485-2-211 - COMPONENT TIBIAL MEDIUM 11MM ROTATING HINGE KRH ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-216 SUP HCPCS C1776 6485-2-216 - INSERT TIBIAL MEDIUM 16MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-221 SUP HCPCS C1776 6485-2-221 - INSERT TIBIAL MEDIUM 21MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-308 SUP HCPCS C1776 6485-2-308 - INSERT TIBIAL LARGE 8MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$3,142.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-311 SUP HCPCS C1776 6485-2-311 - INSERT TIBIAL LARGE 11MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$3,142.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-316 SUP HCPCS C1776 6485-2-316 - INSERT TIBIAL LARGE 16MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$3,142.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-321 SUP HCPCS C1776 6485-2-321 - INSERT TIBIAL LARGE 21MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-408 SUP HCPCS C1776 6485-2-408 - INSERT TIBIAL XL 8MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-411 SUP HCPCS C1776 6485-2-411 - INSERT TIBIAL XL 11MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-416 SUP HCPCS C1776 6485-2-416 - INSERT TIBIAL XL 16MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$1,257.00" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-421 SUP HCPCS C1776 6485-2-421 - INSERT TIBIAL XL 21MM GMRS ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$3,142.50" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$3,142.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-460 SUP Custom 27803010 6485-2-460 - BUSHING FEMORAL STANDARD ROTATE HINGE KINEMATIC DUR BOTH IP/OP $632.50 $468.00 $112.59 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $112.59 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $131.82 $632.50 $253.00 $632.50 $632.50 $632.50 $632.50 $632.50 $474.38 $632.50 $632.50 $632.50 $316.25 $316.25 $500.94 $632.50 $506.00 $284.63 $632.50 N/A $366.85 $632.50 $379.50 $632.50 $632.50 $632.50 N/A N/A 6485-2-465 SUP Custom 27803010 6485-2-465 - BUSHING FEMORAL SMALL ROTATE HINGE KINEMATIC DUR BOTH IP/OP $632.50 $468.00 $112.59 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $112.59 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $131.82 $632.50 $253.00 $632.50 $632.50 $632.50 $632.50 $632.50 $474.38 $632.50 $632.50 $632.50 $316.25 $316.25 $500.94 $632.50 $506.00 $284.63 $632.50 N/A $366.85 $632.50 $379.50 $632.50 $632.50 $632.50 N/A N/A 6485-2-508 SUP HCPCS C1776 6485-2-508 - INSERT TIBIAL 3XS 8MM MRS POLYETHYLENE KNEE BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$3,142.50" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-511 SUP HCPCS C1776 6485-2-511 - COMPONENT TIBIAL 3XS PT1 11MM MRS MRH KRH DUR BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$3,142.50" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-608 SUP HCPCS C1776 6485-2-608 - INSERT TIBIAL 2XS 8MM MRS POLYETHYLENE KNEE BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$3,142.50" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-2-611 SUP HCPCS C1776 6485-2-611 - COMPONENT TIBIAL 2XS PT2 11MM KRH ALL POLY BOTH IP/OP "$3,142.50" "$2,325.00" $623.71 "$3,142.50" "$1,414.13" "$1,414.13" "$1,414.13" "$1,414.13" "$3,142.50" "$3,142.50" "$3,142.50" $654.98 "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" $654.93 "$3,142.50" "$3,142.50" "$1,549.25" "$3,142.50" "$3,142.50" "$3,142.50" "$3,142.50" "$2,356.88" "$3,142.50" "$3,142.50" "$3,142.50" "$1,571.25" "$1,571.25" "$2,488.86" "$3,142.50" "$2,514.00" "$1,414.13" $623.71 N/A "$1,822.65" "$3,142.50" "$1,885.50" "$3,142.50" $654.90 "$3,142.50" N/A N/A 6485-3-000 SUP HCPCS C1776 6485-3-000 - STEM FEMORAL SMALL 10MM 102MM MRS HIP BOTH IP/OP "$7,977.50" "$5,903.00" "$1,583.33" "$7,977.50" "$3,589.88" "$3,589.88" "$3,589.88" "$3,589.88" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.71" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.60" "$7,977.50" "$3,191.00" "$3,932.91" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$5,983.13" "$7,977.50" "$7,977.50" "$7,977.50" "$3,988.75" "$3,988.75" "$6,318.18" "$7,977.50" "$6,382.00" "$3,589.88" "$1,583.33" N/A "$4,626.95" "$7,977.50" "$4,786.50" "$7,977.50" "$1,662.51" "$7,977.50" N/A N/A 6485-3-008 SUP HCPCS C1776 6485-3-008 - STEM FEMORAL SMALL 8MM 102MM MRS HIP BOTH IP/OP "$7,977.50" "$5,903.00" "$1,583.33" "$7,977.50" "$3,589.88" "$3,589.88" "$3,589.88" "$3,589.88" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.71" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.60" "$7,977.50" "$7,977.50" "$3,932.91" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$5,983.13" "$7,977.50" "$7,977.50" "$7,977.50" "$3,988.75" "$3,988.75" "$6,318.18" "$7,977.50" "$6,382.00" "$3,589.88" "$1,583.33" N/A "$4,626.95" "$7,977.50" "$4,786.50" "$7,977.50" "$1,662.51" "$7,977.50" N/A N/A 6485-3-009 SUP HCPCS C1776 6485-3-009 - STEM FEMORAL SMALL 9MM 102MM MRS HIP BOTH IP/OP "$7,977.50" "$5,903.00" "$1,583.33" "$7,977.50" "$3,589.88" "$3,589.88" "$3,589.88" "$3,589.88" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.71" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.60" "$7,977.50" "$3,191.00" "$3,932.91" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$5,983.13" "$7,977.50" "$7,977.50" "$7,977.50" "$3,988.75" "$3,988.75" "$6,318.18" "$7,977.50" "$6,382.00" "$3,589.88" "$1,583.33" N/A "$4,626.95" "$7,977.50" "$4,786.50" "$7,977.50" "$1,662.51" "$7,977.50" N/A N/A 6485-3-010 SUP HCPCS C1776 6485-3-010 - STEM FEMORAL SMALL 10MM 102MM MRS HIP BOTH IP/OP "$5,780.00" "$4,277.00" "$1,147.19" "$5,780.00" "$2,601.00" "$2,601.00" "$2,601.00" "$2,601.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.70" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.62" "$5,780.00" "$2,312.00" "$2,849.54" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$4,335.00" "$5,780.00" "$5,780.00" "$5,780.00" "$2,890.00" "$2,890.00" "$4,577.76" "$5,780.00" "$4,624.00" "$2,601.00" "$1,147.19" N/A "$3,352.40" "$5,780.00" "$3,468.00" "$5,780.00" "$1,204.55" "$5,780.00" N/A N/A 6485-3-011 SUP HCPCS C1776 6485-3-011 - STEM FEMORAL STANDARD STR 11MM 127MM CEMENTED BODY SECTION BOTH IP/OP "$7,977.50" "$5,903.00" "$1,583.33" "$7,977.50" "$3,589.88" "$3,589.88" "$3,589.88" "$3,589.88" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.71" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.60" "$7,977.50" "$7,977.50" "$3,932.91" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$5,983.13" "$7,977.50" "$7,977.50" "$7,977.50" "$3,988.75" "$3,988.75" "$6,318.18" "$7,977.50" "$6,382.00" "$3,589.88" "$1,583.33" N/A "$4,626.95" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.51" "$7,977.50" N/A N/A 6485-3-013 SUP HCPCS C1776 6485-3-013 - STEM FEMORAL STANDARD STR 13MM 127MM CEMENTED BODY SECTION BOTH IP/OP "$7,977.50" "$5,903.00" "$1,583.33" "$7,977.50" "$3,589.88" "$3,589.88" "$3,589.88" "$3,589.88" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.71" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.60" "$7,977.50" "$3,191.00" "$3,932.91" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$5,983.13" "$7,977.50" "$7,977.50" "$7,977.50" "$3,988.75" "$3,988.75" "$6,318.18" "$7,977.50" "$6,382.00" "$3,589.88" "$1,583.33" N/A "$4,626.95" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.51" "$7,977.50" N/A N/A 6485-3-015 SUP HCPCS C1776 6485-3-015 - STEM FEMORAL STANDARD 15MM 127MM MODULAR ROTATE HINGE MRS BOTH IP/OP "$7,977.50" "$5,903.00" "$1,583.33" "$7,977.50" "$3,589.88" "$3,589.88" "$3,589.88" "$3,589.88" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.71" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.60" "$7,977.50" "$7,977.50" "$3,932.91" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$5,983.13" "$7,977.50" "$7,977.50" "$7,977.50" "$3,988.75" "$3,988.75" "$6,318.18" "$7,977.50" "$6,382.00" "$3,589.88" "$1,583.33" N/A "$4,626.95" "$7,977.50" "$4,786.50" "$7,977.50" "$1,662.51" "$7,977.50" N/A N/A 6485-3-017 SUP HCPCS C1776 6485-3-017 - STEM FEMORAL 17MM 127MM CEMENTED BODY SECTION MRS HIP BOTH IP/OP "$7,977.50" "$5,903.00" "$1,583.33" "$7,977.50" "$3,589.88" "$3,589.88" "$3,589.88" "$3,589.88" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.71" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.60" "$7,977.50" "$7,977.50" "$3,932.91" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$5,983.13" "$7,977.50" "$7,977.50" "$7,977.50" "$3,988.75" "$3,988.75" "$6,318.18" "$7,977.50" "$6,382.00" "$3,589.88" "$1,583.33" N/A "$4,626.95" "$7,977.50" "$4,786.50" "$7,977.50" "$1,662.51" "$7,977.50" N/A N/A 6485-3-018 SUP HCPCS C1776 6485-3-018 - STEM FEMORAL SMALL 8MM 102MM MRS HIP BOTH IP/OP "$5,780.00" "$4,277.00" "$1,147.19" "$5,780.00" "$2,601.00" "$2,601.00" "$2,601.00" "$2,601.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.70" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.62" "$5,780.00" "$2,312.00" "$2,849.54" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$4,335.00" "$5,780.00" "$5,780.00" "$5,780.00" "$2,890.00" "$2,890.00" "$4,577.76" "$5,780.00" "$4,624.00" "$2,601.00" "$1,147.19" N/A "$3,352.40" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.55" "$5,780.00" N/A N/A 6485-3-019 SUP HCPCS C1776 6485-3-019 - STEM FEMORAL SMALL 9MM 102MM MRS HIP BOTH IP/OP "$5,780.00" "$4,277.00" "$1,147.19" "$5,780.00" "$2,601.00" "$2,601.00" "$2,601.00" "$2,601.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.70" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.62" "$5,780.00" "$2,312.00" "$2,849.54" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$4,335.00" "$5,780.00" "$5,780.00" "$5,780.00" "$2,890.00" "$2,890.00" "$4,577.76" "$5,780.00" "$4,624.00" "$2,601.00" "$1,147.19" N/A "$3,352.40" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.55" "$5,780.00" N/A N/A 6485-3-111 SUP HCPCS C1776 6485-3-111 - STEM FEMORAL 11MM 127MM MRS KNEE BOTH IP/OP "$5,780.00" "$4,277.00" "$1,147.19" "$5,780.00" "$2,601.00" "$2,601.00" "$2,601.00" "$2,601.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.70" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.62" "$5,780.00" "$2,312.00" "$2,849.54" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$4,335.00" "$5,780.00" "$5,780.00" "$5,780.00" "$2,890.00" "$2,890.00" "$4,577.76" "$5,780.00" "$4,624.00" "$2,601.00" "$1,147.19" N/A "$3,352.40" "$5,780.00" "$3,468.00" "$5,780.00" "$1,204.55" "$5,780.00" N/A N/A 6485-3-113 SUP HCPCS C1776 6485-3-113 - STEM FEMORAL STR 13MM 127MM CEMENTED BODY SECTION GMRS HIP BOTH IP/OP "$5,780.00" "$4,277.00" "$1,147.19" "$5,780.00" "$2,601.00" "$2,601.00" "$2,601.00" "$2,601.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.70" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.62" "$5,780.00" "$5,780.00" "$2,849.54" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$4,335.00" "$5,780.00" "$5,780.00" "$5,780.00" "$2,890.00" "$2,890.00" "$4,577.76" "$5,780.00" "$4,624.00" "$2,601.00" "$1,147.19" N/A "$3,352.40" "$5,780.00" "$3,468.00" "$5,780.00" "$1,204.55" "$5,780.00" N/A N/A 6485-3-115 SUP HCPCS C1776 6485-3-115 - STEM FEMORAL STR 15MM 127MM CEMENTED BODY SECTION MRS KNEE BOTH IP/OP "$5,780.00" "$4,277.00" "$1,147.19" "$5,780.00" "$2,601.00" "$2,601.00" "$2,601.00" "$2,601.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.70" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.62" "$5,780.00" "$2,312.00" "$2,849.54" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$4,335.00" "$5,780.00" "$5,780.00" "$5,780.00" "$2,890.00" "$2,890.00" "$4,577.76" "$5,780.00" "$4,624.00" "$2,601.00" "$1,147.19" N/A "$3,352.40" "$5,780.00" "$3,468.00" "$5,780.00" "$1,204.55" "$5,780.00" N/A N/A 6485-3-117 SUP HCPCS C1776 6485-3-117 - STEM FEMORAL 17MM 127MM MRS KNEE BOTH IP/OP "$5,780.00" "$4,277.00" "$1,147.19" "$5,780.00" "$2,601.00" "$2,601.00" "$2,601.00" "$2,601.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.70" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.62" "$5,780.00" "$2,312.00" "$2,849.54" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$4,335.00" "$5,780.00" "$5,780.00" "$5,780.00" "$2,890.00" "$2,890.00" "$4,577.76" "$5,780.00" "$4,624.00" "$2,601.00" "$1,147.19" N/A "$3,352.40" "$5,780.00" "$3,468.00" "$5,780.00" "$1,204.55" "$5,780.00" N/A N/A 6485-3-211 SUP HCPCS C1776 6485-3-211 - STEM FEMORAL TAPER 11MM 127MM MRS HIP BOTH IP/OP "$5,275.00" "$3,904.00" "$1,046.96" "$5,275.00" "$2,373.75" "$2,373.75" "$2,373.75" "$2,373.75" "$5,275.00" "$5,275.00" "$5,275.00" "$1,099.44" "$5,275.00" "$5,275.00" "$5,275.00" "$5,275.00" "$5,275.00" "$1,099.37" "$5,275.00" "$2,110.00" "$2,600.58" "$5,275.00" "$5,275.00" "$5,275.00" "$5,275.00" "$3,956.25" "$5,275.00" "$5,275.00" "$5,275.00" "$2,637.50" "$2,637.50" "$4,177.80" "$5,275.00" "$4,220.00" "$2,373.75" "$1,046.96" N/A "$3,059.50" "$5,275.00" "$3,165.00" "$5,275.00" "$1,099.31" "$5,275.00" N/A N/A 6485-3-213 SUP HCPCS C1776 6485-3-213 - STEM FEMORAL TAPER 13MM 127MM MRS HIP BOTH IP/OP "$5,275.00" "$3,904.00" "$1,046.96" "$5,275.00" "$2,373.75" "$2,373.75" "$2,373.75" "$2,373.75" "$5,275.00" "$5,275.00" "$5,275.00" "$1,099.44" "$5,275.00" "$5,275.00" "$5,275.00" "$5,275.00" "$5,275.00" "$1,099.37" "$5,275.00" "$2,110.00" "$2,600.58" "$5,275.00" "$5,275.00" "$5,275.00" "$5,275.00" "$3,956.25" "$5,275.00" "$5,275.00" "$5,275.00" "$2,637.50" "$2,637.50" "$4,177.80" "$5,275.00" "$4,220.00" "$2,373.75" "$1,046.96" N/A "$3,059.50" "$5,275.00" "$5,275.00" "$5,275.00" "$1,099.31" "$5,275.00" N/A N/A 6485-3-215 SUP HCPCS C1776 6485-3-215 - STEM FEMORAL TAPER 15MM 127MM MRS HIP BOTH IP/OP "$5,275.00" "$3,904.00" "$1,046.96" "$5,275.00" "$2,373.75" "$2,373.75" "$2,373.75" "$2,373.75" "$5,275.00" "$5,275.00" "$5,275.00" "$1,099.44" "$5,275.00" "$5,275.00" "$5,275.00" "$5,275.00" "$5,275.00" "$1,099.37" "$5,275.00" "$2,110.00" "$2,600.58" "$5,275.00" "$5,275.00" "$5,275.00" "$5,275.00" "$3,956.25" "$5,275.00" "$5,275.00" "$5,275.00" "$2,637.50" "$2,637.50" "$4,177.80" "$5,275.00" "$4,220.00" "$2,373.75" "$1,046.96" N/A "$3,059.50" "$5,275.00" "$5,275.00" "$5,275.00" "$1,099.31" "$5,275.00" N/A N/A 6485-3-217 SUP HCPCS C1776 6485-3-217 - STEM FEMORAL TAPER 17MM 127MM MRS HIP BOTH IP/OP "$5,275.00" "$3,904.00" "$1,046.96" "$5,275.00" "$2,373.75" "$2,373.75" "$2,373.75" "$2,373.75" "$5,275.00" "$5,275.00" "$5,275.00" "$1,099.44" "$5,275.00" "$5,275.00" "$5,275.00" "$5,275.00" "$5,275.00" "$1,099.37" "$5,275.00" "$2,110.00" "$2,600.58" "$5,275.00" "$5,275.00" "$5,275.00" "$5,275.00" "$3,956.25" "$5,275.00" "$5,275.00" "$5,275.00" "$2,637.50" "$2,637.50" "$4,177.80" "$5,275.00" "$4,220.00" "$2,373.75" "$1,046.96" N/A "$3,059.50" "$5,275.00" "$3,165.00" "$5,275.00" "$1,099.31" "$5,275.00" N/A N/A 6485-3-300 SUP HCPCS C1776 6485-3-300 - STEM FEMORAL SMALL CURVE 10MM 102MM MRS HIP BOTH IP/OP "$7,977.50" "$5,903.00" "$1,583.33" "$7,977.50" "$3,589.88" "$3,589.88" "$3,589.88" "$3,589.88" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.71" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.60" "$7,977.50" "$7,977.50" "$3,932.91" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$5,983.13" "$7,977.50" "$7,977.50" "$7,977.50" "$3,988.75" "$3,988.75" "$6,318.18" "$7,977.50" "$6,382.00" "$3,589.88" "$1,583.33" N/A "$4,626.95" "$7,977.50" "$4,786.50" "$7,977.50" "$1,662.51" "$7,977.50" N/A N/A 6485-3-308 SUP HCPCS C1776 6485-3-308 - STEM FEMORAL SMALL CURVE 8MM 102MM MRS HIP BOTH IP/OP "$7,977.50" "$5,903.00" "$1,583.33" "$7,977.50" "$3,589.88" "$3,589.88" "$3,589.88" "$3,589.88" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.71" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.60" "$7,977.50" "$7,977.50" "$3,932.91" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$5,983.13" "$7,977.50" "$7,977.50" "$7,977.50" "$3,988.75" "$3,988.75" "$6,318.18" "$7,977.50" "$6,382.00" "$3,589.88" "$1,583.33" N/A "$4,626.95" "$7,977.50" "$4,786.50" "$7,977.50" "$1,662.51" "$7,977.50" N/A N/A 6485-3-309 SUP HCPCS C1776 6485-3-309 - STEM FEMORAL SMALL CURVE 9MM 102MM MRS HIP BOTH IP/OP "$7,977.50" "$5,903.00" "$1,583.33" "$7,977.50" "$3,589.88" "$3,589.88" "$3,589.88" "$3,589.88" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.71" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.60" "$7,977.50" "$7,977.50" "$3,932.91" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$5,983.13" "$7,977.50" "$7,977.50" "$7,977.50" "$3,988.75" "$3,988.75" "$6,318.18" "$7,977.50" "$6,382.00" "$3,589.88" "$1,583.33" N/A "$4,626.95" "$7,977.50" "$4,786.50" "$7,977.50" "$1,662.51" "$7,977.50" N/A N/A 6485-3-310 SUP HCPCS C1776 6485-3-310 - STEM FEMORAL SMALL CURVE 10MM 102MM MRS KNEE BOTH IP/OP "$5,780.00" "$4,277.00" "$1,147.19" "$5,780.00" "$2,601.00" "$2,601.00" "$2,601.00" "$2,601.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.70" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.62" "$5,780.00" "$2,312.00" "$2,849.54" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$4,335.00" "$5,780.00" "$5,780.00" "$5,780.00" "$2,890.00" "$2,890.00" "$4,577.76" "$5,780.00" "$4,624.00" "$2,601.00" "$1,147.19" N/A "$3,352.40" "$5,780.00" "$3,468.00" "$5,780.00" "$1,204.55" "$5,780.00" N/A N/A 6485-3-311 SUP HCPCS C1776 6485-3-311 - STEM FEMORAL 11MM 203MM MRS KNEE BOTH IP/OP "$10,430.00" "$7,718.00" "$2,070.09" "$10,430.00" "$4,693.50" "$4,693.50" "$4,693.50" "$4,693.50" "$10,430.00" "$10,430.00" "$10,430.00" "$2,173.87" "$10,430.00" "$10,430.00" "$10,430.00" "$10,430.00" "$10,430.00" "$2,173.73" "$10,430.00" "$4,172.00" "$5,141.99" "$10,430.00" "$10,430.00" "$10,430.00" "$10,430.00" "$7,822.50" "$10,430.00" "$10,430.00" "$10,430.00" "$5,215.00" "$5,215.00" "$8,260.56" "$10,430.00" "$8,344.00" "$4,693.50" "$2,070.09" N/A "$6,049.40" "$10,430.00" "$6,258.00" "$10,430.00" "$2,173.61" "$10,430.00" N/A N/A 6485-3-313 SUP HCPCS C1776 6485-3-313 - STEM FEMORAL LONG BOW 13MM 203MM CEMENTED BODY SECTION GMRS BOTH IP/OP "$10,430.00" "$7,718.00" "$2,070.09" "$10,430.00" "$4,693.50" "$4,693.50" "$4,693.50" "$4,693.50" "$10,430.00" "$10,430.00" "$10,430.00" "$2,173.87" "$10,430.00" "$10,430.00" "$10,430.00" "$10,430.00" "$10,430.00" "$2,173.73" "$10,430.00" "$4,172.00" "$5,141.99" "$10,430.00" "$10,430.00" "$10,430.00" "$10,430.00" "$7,822.50" "$10,430.00" "$10,430.00" "$10,430.00" "$5,215.00" "$5,215.00" "$8,260.56" "$10,430.00" "$8,344.00" "$4,693.50" "$2,070.09" N/A "$6,049.40" "$10,430.00" "$6,258.00" "$10,430.00" "$2,173.61" "$10,430.00" N/A N/A 6485-3-315 SUP HCPCS C1776 6485-3-315 - STEM FEMORAL LONG BOW 15MM 203MM CEMENTED BODY SECTION GMRS BOTH IP/OP "$10,430.00" "$7,718.00" "$2,070.09" "$10,430.00" "$4,693.50" "$4,693.50" "$4,693.50" "$4,693.50" "$10,430.00" "$10,430.00" "$10,430.00" "$2,173.87" "$10,430.00" "$10,430.00" "$10,430.00" "$10,430.00" "$10,430.00" "$2,173.73" "$10,430.00" "$10,430.00" "$5,141.99" "$10,430.00" "$10,430.00" "$10,430.00" "$10,430.00" "$7,822.50" "$10,430.00" "$10,430.00" "$10,430.00" "$5,215.00" "$5,215.00" "$8,260.56" "$10,430.00" "$8,344.00" "$4,693.50" "$2,070.09" N/A "$6,049.40" "$10,430.00" "$10,430.00" "$10,430.00" "$2,173.61" "$10,430.00" N/A N/A 6485-3-317 SUP HCPCS C1776 6485-3-317 - STEM FEMORAL 17MM 203MM MRS KNEE BOTH IP/OP "$10,430.00" "$7,718.00" "$2,070.09" "$10,430.00" "$4,693.50" "$4,693.50" "$4,693.50" "$4,693.50" "$10,430.00" "$10,430.00" "$10,430.00" "$2,173.87" "$10,430.00" "$10,430.00" "$10,430.00" "$10,430.00" "$10,430.00" "$2,173.73" "$10,430.00" "$10,430.00" "$5,141.99" "$10,430.00" "$10,430.00" "$10,430.00" "$10,430.00" "$7,822.50" "$10,430.00" "$10,430.00" "$10,430.00" "$5,215.00" "$5,215.00" "$8,260.56" "$10,430.00" "$8,344.00" "$4,693.50" "$2,070.09" N/A "$6,049.40" "$10,430.00" "$6,258.00" "$10,430.00" "$2,173.61" "$10,430.00" N/A N/A 6485-3-318 SUP HCPCS C1776 6485-3-318 - STEM FEMORAL SMALL CURVE 8MM 102MM MRS HIP BOTH IP/OP "$5,780.00" "$4,277.00" "$1,147.19" "$5,780.00" "$2,601.00" "$2,601.00" "$2,601.00" "$2,601.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.70" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.62" "$5,780.00" "$5,780.00" "$2,849.54" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$4,335.00" "$5,780.00" "$5,780.00" "$5,780.00" "$2,890.00" "$2,890.00" "$4,577.76" "$5,780.00" "$4,624.00" "$2,601.00" "$1,147.19" N/A "$3,352.40" "$5,780.00" "$3,468.00" "$5,780.00" "$1,204.55" "$5,780.00" N/A N/A 6485-3-319 SUP HCPCS C1776 6485-3-319 - STEM FEMORAL SMALL CURVE 9MM 102MM MRS HIP BOTH IP/OP "$5,780.00" "$4,277.00" "$1,147.19" "$5,780.00" "$2,601.00" "$2,601.00" "$2,601.00" "$2,601.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.70" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.62" "$5,780.00" "$2,312.00" "$2,849.54" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$4,335.00" "$5,780.00" "$5,780.00" "$5,780.00" "$2,890.00" "$2,890.00" "$4,577.76" "$5,780.00" "$4,624.00" "$2,601.00" "$1,147.19" N/A "$3,352.40" "$5,780.00" "$3,468.00" "$5,780.00" "$1,204.55" "$5,780.00" N/A N/A 6485-3-611 SUP HCPCS C1776 6485-3-611 - STEM FEMORAL LONG CURVE 11MM 203MM CEMENTED BODY SECTION BOTH IP/OP "$8,115.00" "$6,005.00" "$1,610.62" "$8,115.00" "$3,651.75" "$3,651.75" "$3,651.75" "$3,651.75" "$8,115.00" "$8,115.00" "$8,115.00" "$1,691.37" "$8,115.00" "$8,115.00" "$8,115.00" "$8,115.00" "$8,115.00" "$1,691.26" "$8,115.00" "$3,246.00" "$4,000.70" "$8,115.00" "$8,115.00" "$8,115.00" "$8,115.00" "$6,086.25" "$8,115.00" "$8,115.00" "$8,115.00" "$4,057.50" "$4,057.50" "$6,427.08" "$8,115.00" "$6,492.00" "$3,651.75" "$1,610.62" N/A "$4,706.70" "$8,115.00" "$4,869.00" "$8,115.00" "$1,691.17" "$8,115.00" N/A N/A 6485-3-613 SUP HCPCS C1776 6485-3-613 - STEM FEMORAL LONG CURVE 13MM 203MM CEMENT GMRS HIP DISTAL BOTH IP/OP "$8,115.00" "$6,005.00" "$1,610.62" "$8,115.00" "$3,651.75" "$3,651.75" "$3,651.75" "$3,651.75" "$8,115.00" "$8,115.00" "$8,115.00" "$1,691.37" "$8,115.00" "$8,115.00" "$8,115.00" "$8,115.00" "$8,115.00" "$1,691.26" "$8,115.00" "$3,246.00" "$4,000.70" "$8,115.00" "$8,115.00" "$8,115.00" "$8,115.00" "$6,086.25" "$8,115.00" "$8,115.00" "$8,115.00" "$4,057.50" "$4,057.50" "$6,427.08" "$8,115.00" "$6,492.00" "$3,651.75" "$1,610.62" N/A "$4,706.70" "$8,115.00" "$4,869.00" "$8,115.00" "$1,691.17" "$8,115.00" N/A N/A 6485-3-615 SUP HCPCS C1776 6485-3-615 - STEM FEMORAL LONG BOW CURVE 15MM 203MM CEMENTED BODY SECTION BOTH IP/OP "$8,115.00" "$6,005.00" "$1,610.62" "$8,115.00" "$3,651.75" "$3,651.75" "$3,651.75" "$3,651.75" "$8,115.00" "$8,115.00" "$8,115.00" "$1,691.37" "$8,115.00" "$8,115.00" "$8,115.00" "$8,115.00" "$8,115.00" "$1,691.26" "$8,115.00" "$8,115.00" "$4,000.70" "$8,115.00" "$8,115.00" "$8,115.00" "$8,115.00" "$6,086.25" "$8,115.00" "$8,115.00" "$8,115.00" "$4,057.50" "$4,057.50" "$6,427.08" "$8,115.00" "$6,492.00" "$3,651.75" "$1,610.62" N/A "$4,706.70" "$8,115.00" "$4,869.00" "$8,115.00" "$1,691.17" "$8,115.00" N/A N/A 6485-3-617 SUP HCPCS C1776 6485-3-617 - STEM FEMORAL LONG BOW 17MM 203MM CEMENTED BODY SECTION GMRS BOTH IP/OP "$8,115.00" "$6,005.00" "$1,610.62" "$8,115.00" "$3,651.75" "$3,651.75" "$3,651.75" "$3,651.75" "$8,115.00" "$8,115.00" "$8,115.00" "$1,691.37" "$8,115.00" "$8,115.00" "$8,115.00" "$8,115.00" "$8,115.00" "$1,691.26" "$8,115.00" "$3,246.00" "$4,000.70" "$8,115.00" "$8,115.00" "$8,115.00" "$8,115.00" "$6,086.25" "$8,115.00" "$8,115.00" "$8,115.00" "$4,057.50" "$4,057.50" "$6,427.08" "$8,115.00" "$6,492.00" "$3,651.75" "$1,610.62" N/A "$4,706.70" "$8,115.00" "$4,869.00" "$8,115.00" "$1,691.17" "$8,115.00" N/A N/A 6485-3-711 SUP HCPCS C1776 6485-3-711 - STEM FEMORAL CURVE 11MM 127MM MRS KNEE BOTH IP/OP "$7,977.50" "$5,903.00" "$1,583.33" "$7,977.50" "$3,589.88" "$3,589.88" "$3,589.88" "$3,589.88" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.71" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.60" "$7,977.50" "$3,191.00" "$3,932.91" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$5,983.13" "$7,977.50" "$7,977.50" "$7,977.50" "$3,988.75" "$3,988.75" "$6,318.18" "$7,977.50" "$6,382.00" "$3,589.88" "$1,583.33" N/A "$4,626.95" "$7,977.50" "$4,786.50" "$7,977.50" "$1,662.51" "$7,977.50" N/A N/A 6485-3-713 SUP HCPCS C1776 6485-3-713 - STEM FEMORAL CURVE 13MM 127MM MRS KNEE BOTH IP/OP "$7,977.50" "$5,903.00" "$1,583.33" "$7,977.50" "$3,589.88" "$3,589.88" "$3,589.88" "$3,589.88" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.71" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.60" "$7,977.50" "$3,191.00" "$3,932.91" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$5,983.13" "$7,977.50" "$7,977.50" "$7,977.50" "$3,988.75" "$3,988.75" "$6,318.18" "$7,977.50" "$6,382.00" "$3,589.88" "$1,583.33" N/A "$4,626.95" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.51" "$7,977.50" N/A N/A 6485-3-715 SUP HCPCS C1776 6485-3-715 - STEM FEMORAL CURVE 15MM 127MM MRS KNEE BOTH IP/OP "$7,977.50" "$5,903.00" "$1,583.33" "$7,977.50" "$3,589.88" "$3,589.88" "$3,589.88" "$3,589.88" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.71" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.60" "$7,977.50" "$7,977.50" "$3,932.91" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$5,983.13" "$7,977.50" "$7,977.50" "$7,977.50" "$3,988.75" "$3,988.75" "$6,318.18" "$7,977.50" "$6,382.00" "$3,589.88" "$1,583.33" N/A "$4,626.95" "$7,977.50" "$4,786.50" "$7,977.50" "$1,662.51" "$7,977.50" N/A N/A 6485-3-717 SUP HCPCS C1776 6485-3-717 - STEM FEMORAL CURVE 17MM 127MM MRS HIP BOTH IP/OP "$7,977.50" "$5,903.00" "$1,583.33" "$7,977.50" "$3,589.88" "$3,589.88" "$3,589.88" "$3,589.88" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.71" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$1,662.60" "$7,977.50" "$7,977.50" "$3,932.91" "$7,977.50" "$7,977.50" "$7,977.50" "$7,977.50" "$5,983.13" "$7,977.50" "$7,977.50" "$7,977.50" "$3,988.75" "$3,988.75" "$6,318.18" "$7,977.50" "$6,382.00" "$3,589.88" "$1,583.33" N/A "$4,626.95" "$7,977.50" "$4,786.50" "$7,977.50" "$1,662.51" "$7,977.50" N/A N/A 6485-3-811 SUP HCPCS C1776 6485-3-811 - STEM FEMORAL CURVE 11MM 127MM MRS KNEE BOTH IP/OP "$5,780.00" "$4,277.00" "$1,147.19" "$5,780.00" "$2,601.00" "$2,601.00" "$2,601.00" "$2,601.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.70" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.62" "$5,780.00" "$2,312.00" "$2,849.54" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$4,335.00" "$5,780.00" "$5,780.00" "$5,780.00" "$2,890.00" "$2,890.00" "$4,577.76" "$5,780.00" "$4,624.00" "$2,601.00" "$1,147.19" N/A "$3,352.40" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.55" "$5,780.00" N/A N/A 6485-3-813 SUP HCPCS C1776 6485-3-813 - STEM FEMORAL CURVE 13MM 127MM MRS KNEE BOTH IP/OP "$5,780.00" "$4,277.00" "$1,147.19" "$5,780.00" "$2,601.00" "$2,601.00" "$2,601.00" "$2,601.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.70" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.62" "$5,780.00" "$2,312.00" "$2,849.54" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$4,335.00" "$5,780.00" "$5,780.00" "$5,780.00" "$2,890.00" "$2,890.00" "$4,577.76" "$5,780.00" "$4,624.00" "$2,601.00" "$1,147.19" N/A "$3,352.40" "$5,780.00" "$3,468.00" "$5,780.00" "$1,204.55" "$5,780.00" N/A N/A 6485-3-815 SUP HCPCS C1776 6485-3-815 - STEM FEMORAL CURVE 15MM 127MM MRS HIP BOTH IP/OP "$5,780.00" "$4,277.00" "$1,147.19" "$5,780.00" "$2,601.00" "$2,601.00" "$2,601.00" "$2,601.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.70" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.62" "$5,780.00" "$2,312.00" "$2,849.54" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$4,335.00" "$5,780.00" "$5,780.00" "$5,780.00" "$2,890.00" "$2,890.00" "$4,577.76" "$5,780.00" "$4,624.00" "$2,601.00" "$1,147.19" N/A "$3,352.40" "$5,780.00" "$3,468.00" "$5,780.00" "$1,204.55" "$5,780.00" N/A N/A 6485-3-817 SUP HCPCS C1776 6485-3-817 - STEM FEMORAL CURVE 17MM 127MM MRS HIP BOTH IP/OP "$5,780.00" "$4,277.00" "$1,147.19" "$5,780.00" "$2,601.00" "$2,601.00" "$2,601.00" "$2,601.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.70" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$1,204.62" "$5,780.00" "$5,780.00" "$2,849.54" "$5,780.00" "$5,780.00" "$5,780.00" "$5,780.00" "$4,335.00" "$5,780.00" "$5,780.00" "$5,780.00" "$2,890.00" "$2,890.00" "$4,577.76" "$5,780.00" "$4,624.00" "$2,601.00" "$1,147.19" N/A "$3,352.40" "$5,780.00" "$3,468.00" "$5,780.00" "$1,204.55" "$5,780.00" N/A N/A 6485-3-915 SUP Custom 27803010 6485-3-915 - COMPONENT PATLR MEDIUM ROTATE HINGE KRH DUR BOTH IP/OP "$1,705.00" "$1,262.00" $303.49 "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" $303.49 "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" $355.34 "$1,705.00" $682.00 "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,705.00" "$1,278.75" "$1,705.00" "$1,705.00" "$1,705.00" $852.50 $852.50 "$1,350.36" "$1,705.00" "$1,364.00" $767.25 "$1,705.00" N/A $988.90 "$1,705.00" "$1,023.00" "$1,705.00" "$1,705.00" "$1,705.00" N/A N/A 6485-4-100 SUP Custom 27803010 6485-4-100 - COMPONENT FEMORAL STANDARD 10MM ROTATE HINGE BUMPER BOTH IP/OP "$1,282.50" $949.00 $228.29 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $228.29 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $267.29 "$1,282.50" $513.00 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $961.88 "$1,282.50" "$1,282.50" "$1,282.50" $641.25 $641.25 "$1,015.74" "$1,282.50" "$1,026.00" $577.13 "$1,282.50" N/A $743.85 "$1,282.50" $769.50 "$1,282.50" "$1,282.50" "$1,282.50" N/A N/A 6485-4-111 SUP Custom 27803010 6485-4-111 - INSERT TIBIAL SMALL 11MM MRS DUR METASUL KNEE ENCAPSULATE BOTH IP/OP "$3,120.00" "$2,309.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $650.24 "$3,120.00" "$1,248.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$2,340.00" "$3,120.00" "$3,120.00" "$3,120.00" "$1,560.00" "$1,560.00" "$2,471.04" "$3,120.00" "$2,496.00" "$1,404.00" "$3,120.00" N/A "$1,809.60" "$3,120.00" "$1,872.00" "$3,120.00" "$3,120.00" "$3,120.00" N/A N/A 6485-4-113 SUP Custom 27803010 6485-4-113 - INSERT TIBIAL SMALL 13MM MRS DUR METASUL KNEE ENCAPSULATE BOTH IP/OP "$3,120.00" "$2,309.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $650.24 "$3,120.00" "$1,248.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$2,340.00" "$3,120.00" "$3,120.00" "$3,120.00" "$1,560.00" "$1,560.00" "$2,471.04" "$3,120.00" "$2,496.00" "$1,404.00" "$3,120.00" N/A "$1,809.60" "$3,120.00" "$1,872.00" "$3,120.00" "$3,120.00" "$3,120.00" N/A N/A 6485-4-116 SUP Custom 27803010 6485-4-116 - INSERT TIBIAL SMALL 16MM MRS DUR KNEE ENCAP BOTH IP/OP "$3,120.00" "$2,309.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $650.24 "$3,120.00" "$1,248.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$2,340.00" "$3,120.00" "$3,120.00" "$3,120.00" "$1,560.00" "$1,560.00" "$2,471.04" "$3,120.00" "$2,496.00" "$1,404.00" "$3,120.00" N/A "$1,809.60" "$3,120.00" "$1,872.00" "$3,120.00" "$3,120.00" "$3,120.00" N/A N/A 6485-4-121 SUP Custom 27803010 6485-4-121 - INSERT TIBIAL SMALL 21MM MRS DUR KNEE ENCAP BOTH IP/OP "$3,120.00" "$2,309.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $650.24 "$3,120.00" "$1,248.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$2,340.00" "$3,120.00" "$3,120.00" "$3,120.00" "$1,560.00" "$1,560.00" "$2,471.04" "$3,120.00" "$2,496.00" "$1,404.00" "$3,120.00" N/A "$1,809.60" "$3,120.00" "$1,872.00" "$3,120.00" "$3,120.00" "$3,120.00" N/A N/A 6485-4-125 SUP Custom 27803010 6485-4-125 - INSERT TIBIAL 12.5MM BUMPER KRH DUR KNEE BOTH IP/OP "$1,282.50" $949.00 $228.29 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $228.29 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $267.29 "$1,282.50" $513.00 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $961.88 "$1,282.50" "$1,282.50" "$1,282.50" $641.25 $641.25 "$1,015.74" "$1,282.50" "$1,026.00" $577.13 "$1,282.50" N/A $743.85 "$1,282.50" $769.50 "$1,282.50" "$1,282.50" "$1,282.50" N/A N/A 6485-4-145 SUP Custom 27803010 6485-4-145 - INSERT TIBIAL 14.5MM 14.5MM BUMPER MRS MRH KRH DUR BOTH IP/OP "$1,282.50" $949.00 $228.29 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $228.29 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $267.29 "$1,282.50" $513.00 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $961.88 "$1,282.50" "$1,282.50" "$1,282.50" $641.25 $641.25 "$1,015.74" "$1,282.50" "$1,026.00" $577.13 "$1,282.50" N/A $743.85 "$1,282.50" $769.50 "$1,282.50" "$1,282.50" "$1,282.50" N/A N/A 6485-4-160 SUP Custom 27803010 6485-4-160 - INSERT TIBIAL 16MM BUMPER KRH DUR KNEE BOTH IP/OP "$1,282.50" $949.00 $228.29 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $228.29 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $267.29 "$1,282.50" $513.00 "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" $961.88 "$1,282.50" "$1,282.50" "$1,282.50" $641.25 $641.25 "$1,015.74" "$1,282.50" "$1,026.00" $577.13 "$1,282.50" N/A $743.85 "$1,282.50" $769.50 "$1,282.50" "$1,282.50" "$1,282.50" N/A N/A 6485-4-211 SUP Custom 27803010 6485-4-211 - INSERT TIBIAL MEDIUM 11MM MRS DUR KNEE ENCAP BOTH IP/OP "$3,120.00" "$2,309.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $650.24 "$3,120.00" "$1,248.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$2,340.00" "$3,120.00" "$3,120.00" "$3,120.00" "$1,560.00" "$1,560.00" "$2,471.04" "$3,120.00" "$2,496.00" "$1,404.00" "$3,120.00" N/A "$1,809.60" "$3,120.00" "$1,872.00" "$3,120.00" "$3,120.00" "$3,120.00" N/A N/A 6485-4-213 SUP Custom 27803010 6485-4-213 - INSERT TIBIAL MEDIUM 13MM MRS DUR KNEE ENCAP BOTH IP/OP "$3,120.00" "$2,309.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $650.24 "$3,120.00" "$1,248.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$2,340.00" "$3,120.00" "$3,120.00" "$3,120.00" "$1,560.00" "$1,560.00" "$2,471.04" "$3,120.00" "$2,496.00" "$1,404.00" "$3,120.00" N/A "$1,809.60" "$3,120.00" "$1,872.00" "$3,120.00" "$3,120.00" "$3,120.00" N/A N/A 6485-4-216 SUP Custom 27803010 6485-4-216 - INSERT TIBIAL MEDIUM 16MM MRS DUR KNEE ENCAP BOTH IP/OP "$3,120.00" "$2,309.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $650.24 "$3,120.00" "$1,248.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$2,340.00" "$3,120.00" "$3,120.00" "$3,120.00" "$1,560.00" "$1,560.00" "$2,471.04" "$3,120.00" "$2,496.00" "$1,404.00" "$3,120.00" N/A "$1,809.60" "$3,120.00" "$1,872.00" "$3,120.00" "$3,120.00" "$3,120.00" N/A N/A 6485-4-221 SUP Custom 27803010 6485-4-221 - INSERT TIBIAL MEDIUM 21MM MRS DUR KNEE ENCAP BOTH IP/OP "$3,120.00" "$2,309.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $555.36 "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" $650.24 "$3,120.00" "$1,248.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$3,120.00" "$2,340.00" "$3,120.00" "$3,120.00" "$3,120.00" "$1,560.00" "$1,560.00" "$2,471.04" "$3,120.00" "$2,496.00" "$1,404.00" "$3,120.00" N/A "$1,809.60" "$3,120.00" "$1,872.00" "$3,120.00" "$3,120.00" "$3,120.00" N/A N/A 6485-5-010 SUP Custom 27803010 6485-5-010 - SPACER FEMORAL XS 10MM LOCK STEM SCREW KINEMAX PLUS KNEE BOTH IP/OP $98.00 $73.00 $17.44 $98.00 $98.00 $98.00 $98.00 $98.00 $98.00 $98.00 $17.44 $98.00 $98.00 $98.00 $98.00 $98.00 $98.00 $20.42 $98.00 $39.20 $98.00 $98.00 $98.00 $98.00 $98.00 $73.50 $98.00 $98.00 $98.00 $49.00 $49.00 $77.62 $98.00 $78.40 $44.10 $98.00 N/A $56.84 $98.00 $58.80 $98.00 $98.00 $98.00 N/A N/A 6485-5-050 SUP Custom 27803010 6485-5-050 - SPACER FEMORAL XS 5MM KINEMAX PLUS KNEE LEFT MEDIAL BOTH IP/OP $549.00 $406.00 $97.72 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $97.72 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $114.42 $549.00 $219.60 $549.00 $549.00 $549.00 $549.00 $549.00 $411.75 $549.00 $549.00 $549.00 $274.50 $274.50 $434.81 $549.00 $439.20 $247.05 $549.00 N/A $318.42 $549.00 $329.40 $549.00 $549.00 $549.00 N/A N/A 6485-5-051 SUP Custom 27803010 6485-5-051 - SPACER FEMORAL XS 10MM KINEMAX PLUS KNEE LEFT MEDIAL BOTH IP/OP $687.00 $508.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $143.18 $687.00 $274.80 $687.00 $687.00 $687.00 $687.00 $687.00 $515.25 $687.00 $687.00 $687.00 $343.50 $343.50 $544.10 $687.00 $549.60 $309.15 $687.00 N/A $398.46 $687.00 $412.20 $687.00 $687.00 $687.00 N/A N/A 6485-5-052 SUP Custom 27803010 6485-5-052 - SPACER FEMORAL XS 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-053 SUP Custom 27803010 6485-5-053 - SPACER FEMORAL XS 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $549.00 $406.00 $97.72 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $97.72 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $114.42 $549.00 $219.60 $549.00 $549.00 $549.00 $549.00 $549.00 $411.75 $549.00 $549.00 $549.00 $274.50 $274.50 $434.81 $549.00 $439.20 $247.05 $549.00 N/A $318.42 $549.00 $329.40 $549.00 $549.00 $549.00 N/A N/A 6485-5-060 SUP Custom 27803010 6485-5-060 - SPACER FEMORAL XS 5MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-061 SUP Custom 27803010 6485-5-061 - SPACER FEMORAL XS 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-062 SUP Custom 27803010 6485-5-062 - SPACER FEMORAL XS MEDIUM 10MM KINEMAX PLUS KNEE BOTH IP/OP $549.00 $406.00 $97.72 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $97.72 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $114.42 $549.00 $219.60 $549.00 $549.00 $549.00 $549.00 $549.00 $411.75 $549.00 $549.00 $549.00 $274.50 $274.50 $434.81 $549.00 $439.20 $247.05 $549.00 N/A $318.42 $549.00 $329.40 $549.00 $549.00 $549.00 N/A N/A 6485-5-063 SUP Custom 27803010 6485-5-063 - SPACER FEMORAL XS 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $549.00 $406.00 $97.72 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $97.72 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $114.42 $549.00 $219.60 $549.00 $549.00 $549.00 $549.00 $549.00 $411.75 $549.00 $549.00 $549.00 $274.50 $274.50 $434.81 $549.00 $439.20 $247.05 $549.00 N/A $318.42 $549.00 $329.40 $549.00 $549.00 $549.00 N/A N/A 6485-5-100 SUP Custom 27803010 6485-5-100 - SPACER FEMORAL SMALL 5MM KINEMAX PLUS KNEE LEFT MEDIAL BOTH IP/OP $687.00 $508.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $143.18 $687.00 $274.80 $687.00 $687.00 $687.00 $687.00 $687.00 $515.25 $687.00 $687.00 $687.00 $343.50 $343.50 $544.10 $687.00 $549.60 $309.15 $687.00 N/A $398.46 $687.00 $412.20 $687.00 $687.00 $687.00 N/A N/A 6485-5-101 SUP Custom 27803010 6485-5-101 - SPACER FEMORAL SMALL 10MM KINEMAX PLUS LEFT DISTAL MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-102 SUP Custom 27803010 6485-5-102 - SPACER FEMORAL SMALL 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-103 SUP Custom 27803010 6485-5-103 - SPACER FEMORAL SMALL 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $549.00 $406.00 $97.72 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $97.72 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $114.42 $549.00 $219.60 $549.00 $549.00 $549.00 $549.00 $549.00 $411.75 $549.00 $549.00 $549.00 $274.50 $274.50 $434.81 $549.00 $439.20 $247.05 $549.00 N/A $318.42 $549.00 $329.40 $549.00 $549.00 $549.00 N/A N/A 6485-5-110 SUP Custom 27803010 6485-5-110 - SPACER FEMORAL SMALL 5MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-111 SUP Custom 27803010 6485-5-111 - SPACER FEMORAL SMALL 10MM KINEMAX PLUS RIGHT DISTAL MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-112 SUP Custom 27803010 6485-5-112 - SPACER FEMORAL SMALL 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $687.00 $508.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $143.18 $687.00 $274.80 $687.00 $687.00 $687.00 $687.00 $687.00 $515.25 $687.00 $687.00 $687.00 $343.50 $343.50 $544.10 $687.00 $549.60 $309.15 $687.00 N/A $398.46 $687.00 $412.20 $687.00 $687.00 $687.00 N/A N/A 6485-5-113 SUP Custom 27803010 6485-5-113 - SPACER FEMORAL SMALL 10MM KINEMAX PLUS RIGHT DISTAL MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-150 SUP Custom 27803010 6485-5-150 - SPACER FEMORAL MEDIUM 5MM KINEMAX PLUS KNEE LEFT MEDIAL BOTH IP/OP $816.00 $604.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $170.06 $816.00 $326.40 $816.00 $816.00 $816.00 $816.00 $816.00 $612.00 $816.00 $816.00 $816.00 $408.00 $408.00 $646.27 $816.00 $652.80 $367.20 $816.00 N/A $473.28 $816.00 $489.60 $816.00 $816.00 $816.00 N/A N/A 6485-5-151 SUP Custom 27803010 6485-5-151 - SPACER FEMORAL MEDIUM 10MM KINEMAX PLUS KNEE LEFT MEDIAL BOTH IP/OP $816.00 $604.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $170.06 $816.00 $326.40 $816.00 $816.00 $816.00 $816.00 $816.00 $612.00 $816.00 $816.00 $816.00 $408.00 $408.00 $646.27 $816.00 $652.80 $367.20 $816.00 N/A $473.28 $816.00 $489.60 $816.00 $816.00 $816.00 N/A N/A 6485-5-152 SUP Custom 27803010 6485-5-152 - SPACER FEMORAL MEDIUM 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-153 SUP Custom 27803010 6485-5-153 - SPACER FEMORAL MEDIUM 10MM KINEMAX PLUS RIGHT DISTAL MEDIAL BOTH IP/OP $816.00 $604.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $170.06 $816.00 $326.40 $816.00 $816.00 $816.00 $816.00 $816.00 $612.00 $816.00 $816.00 $816.00 $408.00 $408.00 $646.27 $816.00 $652.80 $367.20 $816.00 N/A $473.28 $816.00 $489.60 $816.00 $816.00 $816.00 N/A N/A 6485-5-160 SUP Custom 27803010 6485-5-160 - SPACER FEMORAL MEDIUM 5MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $816.00 $604.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $170.06 $816.00 $326.40 $816.00 $816.00 $816.00 $816.00 $816.00 $612.00 $816.00 $816.00 $816.00 $408.00 $408.00 $646.27 $816.00 $652.80 $367.20 $816.00 N/A $473.28 $816.00 $489.60 $816.00 $816.00 $816.00 N/A N/A 6485-5-161 SUP Custom 27803010 6485-5-161 - SPACER FEMORAL MEDIUM 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $816.00 $604.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $170.06 $816.00 $326.40 $816.00 $816.00 $816.00 $816.00 $816.00 $612.00 $816.00 $816.00 $816.00 $408.00 $408.00 $646.27 $816.00 $652.80 $367.20 $816.00 N/A $473.28 $816.00 $489.60 $816.00 $816.00 $816.00 N/A N/A 6485-5-162 SUP Custom 27803010 6485-5-162 - SPACER FEMORAL MEDIUM 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $816.00 $604.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $170.06 $816.00 $326.40 $816.00 $816.00 $816.00 $816.00 $816.00 $612.00 $816.00 $816.00 $816.00 $408.00 $408.00 $646.27 $816.00 $652.80 $367.20 $816.00 N/A $473.28 $816.00 $489.60 $816.00 $816.00 $816.00 N/A N/A 6485-5-163 SUP Custom 27803010 6485-5-163 - SPACER FEMORAL MEDIUM 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $816.00 $604.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $170.06 $816.00 $326.40 $816.00 $816.00 $816.00 $816.00 $816.00 $612.00 $816.00 $816.00 $816.00 $408.00 $408.00 $646.27 $816.00 $652.80 $367.20 $816.00 N/A $473.28 $816.00 $489.60 $816.00 $816.00 $816.00 N/A N/A 6485-5-200 SUP Custom 27803010 6485-5-200 - SPACER FEMORAL LARGE 5MM KINEMAX PLUS KNEE LEFT MEDIAL BOTH IP/OP $687.00 $508.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $143.18 $687.00 $274.80 $687.00 $687.00 $687.00 $687.00 $687.00 $515.25 $687.00 $687.00 $687.00 $343.50 $343.50 $544.10 $687.00 $549.60 $309.15 $687.00 N/A $398.46 $687.00 $412.20 $687.00 $687.00 $687.00 N/A N/A 6485-5-201 SUP Custom 27803010 6485-5-201 - SPACER FEMORAL LARGE 10MM KINEMAX PLUS KNEE LEFT MEDIAL BOTH IP/OP $572.00 $423.00 $101.82 $572.00 $572.00 $572.00 $572.00 $572.00 $572.00 $572.00 $101.82 $572.00 $572.00 $572.00 $572.00 $572.00 $572.00 $119.21 $572.00 $228.80 $572.00 $572.00 $572.00 $572.00 $572.00 $429.00 $572.00 $572.00 $572.00 $286.00 $286.00 $453.02 $572.00 $457.60 $257.40 $572.00 N/A $331.76 $572.00 $343.20 $572.00 $572.00 $572.00 N/A N/A 6485-5-202 SUP Custom 27803010 6485-5-202 - SPACER FEMORAL LARGE 10MM KINEMAX PLUS RIGHT DISTAL MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-203 SUP Custom 27803010 6485-5-203 - SPACER FEMORAL MEDIUM 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-210 SUP Custom 27803010 6485-5-210 - SPACER FEMORAL LARGE 5MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $572.00 $423.00 $101.82 $572.00 $572.00 $572.00 $572.00 $572.00 $572.00 $572.00 $101.82 $572.00 $572.00 $572.00 $572.00 $572.00 $572.00 $119.21 $572.00 $228.80 $572.00 $572.00 $572.00 $572.00 $572.00 $429.00 $572.00 $572.00 $572.00 $286.00 $286.00 $453.02 $572.00 $457.60 $257.40 $572.00 N/A $331.76 $572.00 $343.20 $572.00 $572.00 $572.00 N/A N/A 6485-5-211 SUP Custom 27803010 6485-5-211 - SPACER FEMORAL MEDIUM 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $687.00 $508.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $143.18 $687.00 $274.80 $687.00 $687.00 $687.00 $687.00 $687.00 $515.25 $687.00 $687.00 $687.00 $343.50 $343.50 $544.10 $687.00 $549.60 $309.15 $687.00 N/A $398.46 $687.00 $412.20 $687.00 $687.00 $687.00 N/A N/A 6485-5-212 SUP Custom 27803010 6485-5-212 - SPACER FEMORAL LARGE 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-213 SUP Custom 27803010 6485-5-213 - SPACER FEMORAL LARGE 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-250 SUP Custom 27803010 6485-5-250 - SPACER FEMORAL XL 5MM KINEMAX PLUS KNEE LEFT MEDIAL BOTH IP/OP $549.00 $406.00 $97.72 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $97.72 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $114.42 $549.00 $219.60 $549.00 $549.00 $549.00 $549.00 $549.00 $411.75 $549.00 $549.00 $549.00 $274.50 $274.50 $434.81 $549.00 $439.20 $247.05 $549.00 N/A $318.42 $549.00 $329.40 $549.00 $549.00 $549.00 N/A N/A 6485-5-251 SUP Custom 27803010 6485-5-251 - SPACER FEMORAL MEDIUM XL 10MM KINEMAX PLUS KNEE BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-252 SUP Custom 27803010 6485-5-252 - SPACER FEMORAL XL 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-253 SUP Custom 27803010 6485-5-253 - SPACER FEMORAL XL 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-260 SUP Custom 27803010 6485-5-260 - SPACER FEMORAL 2XL 5MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $816.00 $604.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $145.25 $816.00 $816.00 $816.00 $816.00 $816.00 $816.00 $170.06 $816.00 $326.40 $816.00 $816.00 $816.00 $816.00 $816.00 $612.00 $816.00 $816.00 $816.00 $408.00 $408.00 $646.27 $816.00 $652.80 $367.20 $816.00 N/A $473.28 $816.00 $489.60 $816.00 $816.00 $816.00 N/A N/A 6485-5-261 SUP Custom 27803010 6485-5-261 - SPACER FEMORAL XL 10MM KINEMAX PLUS KNEE RIGHT MEDIAL BOTH IP/OP $549.00 $406.00 $97.72 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $97.72 $549.00 $549.00 $549.00 $549.00 $549.00 $549.00 $114.42 $549.00 $219.60 $549.00 $549.00 $549.00 $549.00 $549.00 $411.75 $549.00 $549.00 $549.00 $274.50 $274.50 $434.81 $549.00 $439.20 $247.05 $549.00 N/A $318.42 $549.00 $329.40 $549.00 $549.00 $549.00 N/A N/A 6485-5-262 SUP Custom 27803010 6485-5-262 - SPACER FEMORAL XL 10MM KINEMAX PLUS RIGHT DISTAL MEDIAL BOTH IP/OP $687.00 $508.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $122.29 $687.00 $687.00 $687.00 $687.00 $687.00 $687.00 $143.18 $687.00 $274.80 $687.00 $687.00 $687.00 $687.00 $687.00 $515.25 $687.00 $687.00 $687.00 $343.50 $343.50 $544.10 $687.00 $549.60 $309.15 $687.00 N/A $398.46 $687.00 $412.20 $687.00 $687.00 $687.00 N/A N/A 6485-5-263 SUP Custom 27803010 6485-5-263 - SPACER FEMORAL XL 10MM MODULAR STABILIZER KINEMAX PLUS KNEE BOTH IP/OP $659.00 $488.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $117.30 $659.00 $659.00 $659.00 $659.00 $659.00 $659.00 $137.34 $659.00 $263.60 $659.00 $659.00 $659.00 $659.00 $659.00 $494.25 $659.00 $659.00 $659.00 $329.50 $329.50 $521.93 $659.00 $527.20 $296.55 $659.00 N/A $382.22 $659.00 $395.40 $659.00 $659.00 $659.00 N/A N/A 6485-5-915 SUP Custom 27803010 6485-5-915 - COMPONENT PATLR LARGE KINEMATIC BOTH IP/OP "$1,640.00" "$1,214.00" $291.85 "$1,639.63" "$1,639.63" "$1,639.63" "$1,639.63" "$1,639.63" "$1,639.63" "$1,639.63" $291.85 "$1,639.63" "$1,639.63" "$1,639.63" "$1,639.63" "$1,639.63" "$1,639.63" $341.72 "$1,639.63" $655.85 "$1,639.63" "$1,639.63" "$1,639.63" "$1,639.63" "$1,639.63" "$1,230.00" "$1,639.63" "$1,639.63" "$1,639.63" $819.82 $819.82 "$1,298.59" "$1,639.63" "$1,311.70" $737.83 "$1,639.63" N/A $951.20 "$1,639.63" $983.78 "$1,639.63" "$1,639.63" "$1,639.63" N/A N/A 6485-6-409 SUP HCPCS C1776 6485-6-409 - STEM TIBIAL 9MM MRS KNEE BOTH IP/OP "$7,905.00" "$5,850.00" "$1,568.94" "$7,905.00" "$3,557.25" "$3,557.25" "$3,557.25" "$3,557.25" "$7,905.00" "$7,905.00" "$7,905.00" "$1,647.60" "$7,905.00" "$7,905.00" "$7,905.00" "$7,905.00" "$7,905.00" "$1,647.49" "$7,905.00" "$7,905.00" "$3,897.17" "$7,905.00" "$7,905.00" "$7,905.00" "$7,905.00" "$5,928.75" "$7,905.00" "$7,905.00" "$7,905.00" "$3,952.50" "$3,952.50" "$6,260.76" "$7,905.00" "$6,324.00" "$3,557.25" "$1,568.94" N/A "$4,584.90" "$7,905.00" "$7,905.00" "$7,905.00" "$1,647.40" "$7,905.00" N/A N/A 6485-6-411 SUP HCPCS C1776 6485-6-411 - STEM TIBIAL 11MM MRS KNEE BOTH IP/OP "$7,905.00" "$5,850.00" "$1,568.94" "$7,905.00" "$3,557.25" "$3,557.25" "$3,557.25" "$3,557.25" "$7,905.00" "$7,905.00" "$7,905.00" "$1,647.60" "$7,905.00" "$7,905.00" "$7,905.00" "$7,905.00" "$7,905.00" "$1,647.49" "$7,905.00" "$7,905.00" "$3,897.17" "$7,905.00" "$7,905.00" "$7,905.00" "$7,905.00" "$5,928.75" "$7,905.00" "$7,905.00" "$7,905.00" "$3,952.50" "$3,952.50" "$6,260.76" "$7,905.00" "$6,324.00" "$3,557.25" "$1,568.94" N/A "$4,584.90" "$7,905.00" "$4,743.00" "$7,905.00" "$1,647.40" "$7,905.00" N/A N/A 6485-6-413 SUP HCPCS C1776 6485-6-413 - STEM TIBIAL 13MM MRS KNEE BOTH IP/OP "$7,905.00" "$5,850.00" "$1,568.94" "$7,905.00" "$3,557.25" "$3,557.25" "$3,557.25" "$3,557.25" "$7,905.00" "$7,905.00" "$7,905.00" "$1,647.60" "$7,905.00" "$7,905.00" "$7,905.00" "$7,905.00" "$7,905.00" "$1,647.49" "$7,905.00" "$3,162.00" "$3,897.17" "$7,905.00" "$7,905.00" "$7,905.00" "$7,905.00" "$5,928.75" "$7,905.00" "$7,905.00" "$7,905.00" "$3,952.50" "$3,952.50" "$6,260.76" "$7,905.00" "$6,324.00" "$3,557.25" "$1,568.94" N/A "$4,584.90" "$7,905.00" "$4,743.00" "$7,905.00" "$1,647.40" "$7,905.00" N/A N/A 6485-6-509 SUP HCPCS C1776 6485-6-509 - STEM TIBIAL 9MM 127MM MRS KNEE BOTH IP/OP "$5,722.50" "$4,235.00" "$1,135.77" "$5,722.50" "$2,575.13" "$2,575.13" "$2,575.13" "$2,575.13" "$5,722.50" "$5,722.50" "$5,722.50" "$1,192.71" "$5,722.50" "$5,722.50" "$5,722.50" "$5,722.50" "$5,722.50" "$1,192.63" "$5,722.50" "$5,722.50" "$2,821.19" "$5,722.50" "$5,722.50" "$5,722.50" "$5,722.50" "$4,291.88" "$5,722.50" "$5,722.50" "$5,722.50" "$2,861.25" "$2,861.25" "$4,532.22" "$5,722.50" "$4,578.00" "$2,575.13" "$1,135.77" N/A "$3,319.05" "$5,722.50" "$5,722.50" "$5,722.50" "$1,192.57" "$5,722.50" N/A N/A 6485-6-511 SUP HCPCS C1776 6485-6-511 - STEM TIBIAL 11MM 127MM MRS KNEE BOTH IP/OP "$5,722.50" "$4,235.00" "$1,135.77" "$5,722.50" "$2,575.13" "$2,575.13" "$2,575.13" "$2,575.13" "$5,722.50" "$5,722.50" "$5,722.50" "$1,192.71" "$5,722.50" "$5,722.50" "$5,722.50" "$5,722.50" "$5,722.50" "$1,192.63" "$5,722.50" "$2,289.00" "$2,821.19" "$5,722.50" "$5,722.50" "$5,722.50" "$5,722.50" "$4,291.88" "$5,722.50" "$5,722.50" "$5,722.50" "$2,861.25" "$2,861.25" "$4,532.22" "$5,722.50" "$4,578.00" "$2,575.13" "$1,135.77" N/A "$3,319.05" "$5,722.50" "$3,433.50" "$5,722.50" "$1,192.57" "$5,722.50" N/A N/A 6485-6-513 SUP HCPCS C1776 6485-6-513 - STEM TIBIAL 13MM MRS KNEE BOTH IP/OP "$5,722.50" "$4,235.00" "$1,135.77" "$5,722.50" "$2,575.13" "$2,575.13" "$2,575.13" "$2,575.13" "$5,722.50" "$5,722.50" "$5,722.50" "$1,192.71" "$5,722.50" "$5,722.50" "$5,722.50" "$5,722.50" "$5,722.50" "$1,192.63" "$5,722.50" "$5,722.50" "$2,821.19" "$5,722.50" "$5,722.50" "$5,722.50" "$5,722.50" "$4,291.88" "$5,722.50" "$5,722.50" "$5,722.50" "$2,861.25" "$2,861.25" "$4,532.22" "$5,722.50" "$4,578.00" "$2,575.13" "$1,135.77" N/A "$3,319.05" "$5,722.50" "$3,433.50" "$5,722.50" "$1,192.57" "$5,722.50" N/A N/A 6485-8-435 SUP HCPCS C1776 6485-8-435 - COMPONENT TIBIAL SHORT BEARING MRS KNEE BOTH IP/OP "$6,005.00" "$4,444.00" "$1,191.84" "$6,005.00" "$2,702.25" "$2,702.25" "$2,702.25" "$2,702.25" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.59" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.51" "$6,005.00" "$2,402.00" "$2,960.47" "$6,005.00" "$6,005.00" "$6,005.00" "$6,005.00" "$4,503.75" "$6,005.00" "$6,005.00" "$6,005.00" "$3,002.50" "$3,002.50" "$4,755.96" "$6,005.00" "$4,804.00" "$2,702.25" "$1,191.84" N/A "$3,482.90" "$6,005.00" "$6,005.00" "$6,005.00" "$1,251.44" "$6,005.00" N/A N/A 6485-8-450 SUP HCPCS C1776 6485-8-450 - COMPONENT TIBIAL 3XS BEARING KRH KNEE BOTH IP/OP "$6,122.50" "$4,531.00" "$1,215.16" "$6,122.50" "$2,755.13" "$2,755.13" "$2,755.13" "$2,755.13" "$6,122.50" "$6,122.50" "$6,122.50" "$1,276.08" "$6,122.50" "$6,122.50" "$6,122.50" "$6,122.50" "$6,122.50" "$1,276.00" "$6,122.50" "$2,449.00" "$3,018.39" "$6,122.50" "$6,122.50" "$6,122.50" "$6,122.50" "$4,591.88" "$6,122.50" "$6,122.50" "$6,122.50" "$3,061.25" "$3,061.25" "$4,849.02" "$6,122.50" "$4,898.00" "$2,755.13" "$1,215.16" N/A "$3,551.05" "$6,122.50" "$6,122.50" "$6,122.50" "$1,275.93" "$6,122.50" N/A N/A 6485-8-460 SUP HCPCS C1895 6485-8-460 - AXLE FEMORAL SMALL ROTATE HINGE MODULE KINEMATIC KNEE BOTH IP/OP "$2,182.50" "$1,615.00" $433.17 "$2,182.50" $982.13 $982.13 $982.13 $982.13 "$2,182.50" "$2,182.50" "$2,182.50" $454.89 "$2,182.50" "$2,182.50" "$2,182.50" "$2,182.50" "$2,182.50" $454.86 "$2,182.50" "$2,182.50" "$1,290.95" "$2,182.50" "$2,182.50" "$2,182.50" "$2,182.50" "$1,636.88" "$2,182.50" "$2,182.50" "$2,182.50" "$1,091.25" "$1,091.25" "$1,728.54" "$2,182.50" "$1,746.00" $982.13 $433.17 N/A "$1,265.85" "$2,182.50" "$2,182.50" "$2,182.50" $454.83 "$2,182.50" N/A N/A 6487-1-040 SUP HCPCS C1776 6487-1-040 - BODY HUMERAL TAPER 40MM MALE TO FMALE MRS BOTH IP/OP "$5,680.00" "$4,203.00" "$1,127.34" "$5,680.00" "$2,556.00" "$2,556.00" "$2,556.00" "$2,556.00" "$5,680.00" "$5,680.00" "$5,680.00" "$1,183.85" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$1,183.77" "$5,680.00" "$5,680.00" "$2,800.24" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$4,260.00" "$5,680.00" "$5,680.00" "$5,680.00" "$2,840.00" "$2,840.00" "$4,498.56" "$5,680.00" "$4,544.00" "$2,556.00" "$1,127.34" N/A "$3,294.40" "$5,680.00" "$3,408.00" "$5,680.00" "$1,183.71" "$5,680.00" N/A N/A 6487-1-060 SUP HCPCS C1776 6487-1-060 - BODY HUMERAL TAPER 60MM MALE TO FMALE MRS BOTH IP/OP "$5,680.00" "$4,203.00" "$1,127.34" "$5,680.00" "$2,556.00" "$2,556.00" "$2,556.00" "$2,556.00" "$5,680.00" "$5,680.00" "$5,680.00" "$1,183.85" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$1,183.77" "$5,680.00" "$5,680.00" "$2,800.24" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$4,260.00" "$5,680.00" "$5,680.00" "$5,680.00" "$2,840.00" "$2,840.00" "$4,498.56" "$5,680.00" "$4,544.00" "$2,556.00" "$1,127.34" N/A "$3,294.40" "$5,680.00" "$3,408.00" "$5,680.00" "$1,183.71" "$5,680.00" N/A N/A 6487-1-080 SUP HCPCS C1776 6487-1-080 - BODY HUMERAL 80MM MALE/FMALE TAPERED MRS SHOULDER BOTH IP/OP "$5,680.00" "$4,203.00" "$1,127.34" "$5,680.00" "$2,556.00" "$2,556.00" "$2,556.00" "$2,556.00" "$5,680.00" "$5,680.00" "$5,680.00" "$1,183.85" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$1,183.77" "$5,680.00" "$5,680.00" "$2,800.24" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$4,260.00" "$5,680.00" "$5,680.00" "$5,680.00" "$2,840.00" "$2,840.00" "$4,498.56" "$5,680.00" "$4,544.00" "$2,556.00" "$1,127.34" N/A "$3,294.40" "$5,680.00" "$5,680.00" "$5,680.00" "$1,183.71" "$5,680.00" N/A N/A 6487-1-100 SUP HCPCS C1776 6487-1-100 - BODY HUMERAL TAPER 100MM MALE TO FMALE MRS BOTH IP/OP "$5,680.00" "$4,203.00" "$1,127.34" "$5,680.00" "$2,556.00" "$2,556.00" "$2,556.00" "$2,556.00" "$5,680.00" "$5,680.00" "$5,680.00" "$1,183.85" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$1,183.77" "$5,680.00" "$2,272.00" "$2,800.24" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$4,260.00" "$5,680.00" "$5,680.00" "$5,680.00" "$2,840.00" "$2,840.00" "$4,498.56" "$5,680.00" "$4,544.00" "$2,556.00" "$1,127.34" N/A "$3,294.40" "$5,680.00" "$3,408.00" "$5,680.00" "$1,183.71" "$5,680.00" N/A N/A 6487-1-120 SUP HCPCS C1776 6487-1-120 - BODY HUMERAL TAPER 120MM MALE TO FMALE MRS BOTH IP/OP "$5,680.00" "$4,203.00" "$1,127.34" "$5,680.00" "$2,556.00" "$2,556.00" "$2,556.00" "$2,556.00" "$5,680.00" "$5,680.00" "$5,680.00" "$1,183.85" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$1,183.77" "$5,680.00" "$5,680.00" "$2,800.24" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$4,260.00" "$5,680.00" "$5,680.00" "$5,680.00" "$2,840.00" "$2,840.00" "$4,498.56" "$5,680.00" "$4,544.00" "$2,556.00" "$1,127.34" N/A "$3,294.40" "$5,680.00" "$3,408.00" "$5,680.00" "$1,183.71" "$5,680.00" N/A N/A 6487-1-140 SUP HCPCS C1776 6487-1-140 - BODY HUMERAL TAPER 140MM MALE TO FMALE MRS BOTH IP/OP "$5,680.00" "$4,203.00" "$1,127.34" "$5,680.00" "$2,556.00" "$2,556.00" "$2,556.00" "$2,556.00" "$5,680.00" "$5,680.00" "$5,680.00" "$1,183.85" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$1,183.77" "$5,680.00" "$2,272.00" "$2,800.24" "$5,680.00" "$5,680.00" "$5,680.00" "$5,680.00" "$4,260.00" "$5,680.00" "$5,680.00" "$5,680.00" "$2,840.00" "$2,840.00" "$4,498.56" "$5,680.00" "$4,544.00" "$2,556.00" "$1,127.34" N/A "$3,294.40" "$5,680.00" "$3,408.00" "$5,680.00" "$1,183.71" "$5,680.00" N/A N/A 6487-2-075 SUP HCPCS C1776 6487-2-075 - STEM HUMERAL 7MM 75MM MRS MRH SHOULDER BOTH IP/OP "$7,480.00" "$5,535.00" "$1,484.59" "$7,480.00" "$3,366.00" "$3,366.00" "$3,366.00" "$3,366.00" "$7,480.00" "$7,480.00" "$7,480.00" "$1,559.02" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$1,558.91" "$7,480.00" "$7,480.00" "$3,687.64" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$5,610.00" "$7,480.00" "$7,480.00" "$7,480.00" "$3,740.00" "$3,740.00" "$5,924.16" "$7,480.00" "$5,984.00" "$3,366.00" "$1,484.59" N/A "$4,338.40" "$7,480.00" "$4,488.00" "$7,480.00" "$1,558.83" "$7,480.00" N/A N/A 6487-2-115 SUP HCPCS C1776 6487-2-115 - STEM HUMERAL 7MM 115MM MRS SHOULDER BOTH IP/OP "$7,480.00" "$5,535.00" "$1,484.59" "$7,480.00" "$3,366.00" "$3,366.00" "$3,366.00" "$3,366.00" "$7,480.00" "$7,480.00" "$7,480.00" "$1,559.02" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$1,558.91" "$7,480.00" "$2,992.00" "$3,687.64" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$5,610.00" "$7,480.00" "$7,480.00" "$7,480.00" "$3,740.00" "$3,740.00" "$5,924.16" "$7,480.00" "$5,984.00" "$3,366.00" "$1,484.59" N/A "$4,338.40" "$7,480.00" "$4,488.00" "$7,480.00" "$1,558.83" "$7,480.00" N/A N/A 6487-3-075 SUP HCPCS C1776 6487-3-075 - STEM HUMERAL 9MM 75MM MRS SHOULDER BOTH IP/OP "$7,480.00" "$5,535.00" "$1,484.59" "$7,480.00" "$3,366.00" "$3,366.00" "$3,366.00" "$3,366.00" "$7,480.00" "$7,480.00" "$7,480.00" "$1,559.02" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$1,558.91" "$7,480.00" "$7,480.00" "$3,687.64" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$5,610.00" "$7,480.00" "$7,480.00" "$7,480.00" "$3,740.00" "$3,740.00" "$5,924.16" "$7,480.00" "$5,984.00" "$3,366.00" "$1,484.59" N/A "$4,338.40" "$7,480.00" "$4,488.00" "$7,480.00" "$1,558.83" "$7,480.00" N/A N/A 6487-3-115 SUP HCPCS C1776 6487-3-115 - STEM HUMERAL 9MM 115MM MRS SHOULDER BOTH IP/OP "$7,480.00" "$5,535.00" "$1,484.59" "$7,480.00" "$3,366.00" "$3,366.00" "$3,366.00" "$3,366.00" "$7,480.00" "$7,480.00" "$7,480.00" "$1,559.02" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$1,558.91" "$7,480.00" "$2,992.00" "$3,687.64" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$5,610.00" "$7,480.00" "$7,480.00" "$7,480.00" "$3,740.00" "$3,740.00" "$5,924.16" "$7,480.00" "$5,984.00" "$3,366.00" "$1,484.59" N/A "$4,338.40" "$7,480.00" "$4,488.00" "$7,480.00" "$1,558.83" "$7,480.00" N/A N/A 6487-4-075 SUP HCPCS C1776 6487-4-075 - STEM HUMERAL 11MM 75MM MRS SHOULDER BOTH IP/OP "$7,480.00" "$5,535.00" "$1,484.59" "$7,480.00" "$3,366.00" "$3,366.00" "$3,366.00" "$3,366.00" "$7,480.00" "$7,480.00" "$7,480.00" "$1,559.02" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$1,558.91" "$7,480.00" "$7,480.00" "$3,687.64" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$5,610.00" "$7,480.00" "$7,480.00" "$7,480.00" "$3,740.00" "$3,740.00" "$5,924.16" "$7,480.00" "$5,984.00" "$3,366.00" "$1,484.59" N/A "$4,338.40" "$7,480.00" "$4,488.00" "$7,480.00" "$1,558.83" "$7,480.00" N/A N/A 6487-4-115 SUP HCPCS C1776 6487-4-115 - STEM HUMERAL 11MM 115MM MRS SHOULDER BOTH IP/OP "$7,480.00" "$5,535.00" "$1,484.59" "$7,480.00" "$3,366.00" "$3,366.00" "$3,366.00" "$3,366.00" "$7,480.00" "$7,480.00" "$7,480.00" "$1,559.02" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$1,558.91" "$7,480.00" "$2,992.00" "$3,687.64" "$7,480.00" "$7,480.00" "$7,480.00" "$7,480.00" "$5,610.00" "$7,480.00" "$7,480.00" "$7,480.00" "$3,740.00" "$3,740.00" "$5,924.16" "$7,480.00" "$5,984.00" "$3,366.00" "$1,484.59" N/A "$4,338.40" "$7,480.00" "$4,488.00" "$7,480.00" "$1,558.83" "$7,480.00" N/A N/A 6487-5-010 SUP HCPCS C1713 6487-5-010 - SCREW BONE INTERCALARY MRS HUMERUS BOTH IP/OP $932.50 $690.00 $185.08 $932.50 $419.63 $419.63 $419.63 $419.63 $932.50 $932.50 $932.50 $194.36 $932.50 $932.50 $932.50 $932.50 $932.50 $194.34 $932.50 $373.00 $551.57 $932.50 $932.50 $932.50 $932.50 $699.38 $932.50 $932.50 $932.50 $466.25 $466.25 $738.54 $932.50 $746.00 $419.63 $185.08 N/A $540.85 $932.50 $559.50 $932.50 $194.33 $932.50 N/A N/A 6487-5-040 SUP HCPCS C1776 6487-5-040 - HEAD HUM 40MM STRL MRS SHLDR PROX BOTH IP/OP "$7,317.50" "$5,415.00" "$1,452.34" "$7,317.50" "$3,292.88" "$3,292.88" "$3,292.88" "$3,292.88" "$7,317.50" "$7,317.50" "$7,317.50" "$1,525.15" "$7,317.50" "$7,317.50" "$7,317.50" "$7,317.50" "$7,317.50" "$1,525.05" "$7,317.50" "$7,317.50" "$3,607.53" "$7,317.50" "$7,317.50" "$7,317.50" "$7,317.50" "$5,488.13" "$7,317.50" "$7,317.50" "$7,317.50" "$3,658.75" "$3,658.75" "$5,795.46" "$7,317.50" "$5,854.00" "$3,292.88" "$1,452.34" N/A "$4,244.15" "$7,317.50" "$4,390.50" "$7,317.50" "$1,524.97" "$7,317.50" N/A N/A 6487-5-044 SUP HCPCS C1776 6487-5-044 - HEAD HUM 44MM STRL MRS SHLDR PROX BOTH IP/OP "$7,317.50" "$5,415.00" "$1,452.34" "$7,317.50" "$3,292.88" "$3,292.88" "$3,292.88" "$3,292.88" "$7,317.50" "$7,317.50" "$7,317.50" "$1,525.15" "$7,317.50" "$7,317.50" "$7,317.50" "$7,317.50" "$7,317.50" "$1,525.05" "$7,317.50" "$2,927.00" "$3,607.53" "$7,317.50" "$7,317.50" "$7,317.50" "$7,317.50" "$5,488.13" "$7,317.50" "$7,317.50" "$7,317.50" "$3,658.75" "$3,658.75" "$5,795.46" "$7,317.50" "$5,854.00" "$3,292.88" "$1,452.34" N/A "$4,244.15" "$7,317.50" "$4,390.50" "$7,317.50" "$1,524.97" "$7,317.50" N/A N/A 6487-5-051 SUP HCPCS C1776 6487-5-051 - STEM HUMERAL 50MM 25MM BODY MRS SHOULDER BOTH IP/OP "$4,054.50" "$3,000.00" $804.69 "$4,054.38" "$1,824.47" "$1,824.47" "$1,824.47" "$1,824.47" "$4,054.38" "$4,054.38" "$4,054.38" $845.03 "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" $844.98 "$4,054.38" "$4,054.38" "$1,998.81" "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" "$3,040.88" "$4,054.38" "$4,054.38" "$4,054.38" "$2,027.19" "$2,027.19" "$3,211.07" "$4,054.38" "$3,243.50" "$1,824.47" $804.69 N/A "$2,351.61" "$4,054.38" "$2,432.63" "$4,054.38" $844.93 "$4,054.38" N/A N/A 6487-5-075 SUP HCPCS C1776 6487-5-075 - STEM HUMERAL 7MM 75MM MRS SHOULDER BOTH IP/OP "$5,420.00" "$4,011.00" "$1,075.73" "$5,420.00" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.66" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.59" "$5,420.00" "$2,168.00" "$2,672.06" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$4,065.00" "$5,420.00" "$5,420.00" "$5,420.00" "$2,710.00" "$2,710.00" "$4,292.64" "$5,420.00" "$4,336.00" "$2,439.00" "$1,075.73" N/A "$3,143.60" "$5,420.00" "$3,252.00" "$5,420.00" "$1,129.53" "$5,420.00" N/A N/A 6487-5-076 SUP HCPCS C1776 6487-5-076 - STEM HUMERAL 75MM 25MM BODY MRS MRH SHOULDER BOTH IP/OP "$5,420.00" "$4,011.00" "$1,075.73" "$5,420.00" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.66" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.59" "$5,420.00" "$5,420.00" "$2,672.06" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$4,065.00" "$5,420.00" "$5,420.00" "$5,420.00" "$2,710.00" "$2,710.00" "$4,292.64" "$5,420.00" "$4,336.00" "$2,439.00" "$1,075.73" N/A "$3,143.60" "$5,420.00" "$3,252.00" "$5,420.00" "$1,129.53" "$5,420.00" N/A N/A 6487-5-101 SUP HCPCS C1776 6487-5-101 - STEM HUMERAL 100MM 25MM BODY MRS SHOULDER BOTH IP/OP "$5,420.00" "$4,011.00" "$1,075.73" "$5,420.00" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.66" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.59" "$5,420.00" "$5,420.00" "$2,672.06" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$4,065.00" "$5,420.00" "$5,420.00" "$5,420.00" "$2,710.00" "$2,710.00" "$4,292.64" "$5,420.00" "$4,336.00" "$2,439.00" "$1,075.73" N/A "$3,143.60" "$5,420.00" "$3,252.00" "$5,420.00" "$1,129.53" "$5,420.00" N/A N/A 6487-5-115 SUP HCPCS C1776 6487-5-115 - STEM HUMERAL 7MM 115MM MRS BOTH IP/OP "$5,420.00" "$4,011.00" "$1,075.73" "$5,420.00" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.66" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.59" "$5,420.00" "$5,420.00" "$2,672.06" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$4,065.00" "$5,420.00" "$5,420.00" "$5,420.00" "$2,710.00" "$2,710.00" "$4,292.64" "$5,420.00" "$4,336.00" "$2,439.00" "$1,075.73" N/A "$3,143.60" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.53" "$5,420.00" N/A N/A 6487-5-126 SUP HCPCS C1776 6487-5-126 - STEM HUMERAL 125MM 25MM BODY MRS SHOULDER BOTH IP/OP "$4,054.50" "$3,000.00" $804.69 "$4,054.38" "$1,824.47" "$1,824.47" "$1,824.47" "$1,824.47" "$4,054.38" "$4,054.38" "$4,054.38" $845.03 "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" $844.98 "$4,054.38" "$4,054.38" "$1,998.81" "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" "$3,040.88" "$4,054.38" "$4,054.38" "$4,054.38" "$2,027.19" "$2,027.19" "$3,211.07" "$4,054.38" "$3,243.50" "$1,824.47" $804.69 N/A "$2,351.61" "$4,054.38" "$2,432.63" "$4,054.38" $844.93 "$4,054.38" N/A N/A 6487-6-051 SUP HCPCS C1776 6487-6-051 - STEM HUMERAL 50MM BODY MRS SHOULDER BOTH IP/OP "$4,054.50" "$3,000.00" $804.69 "$4,054.38" "$1,824.47" "$1,824.47" "$1,824.47" "$1,824.47" "$4,054.38" "$4,054.38" "$4,054.38" $845.03 "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" $844.98 "$4,054.38" "$4,054.38" "$1,998.81" "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" "$3,040.88" "$4,054.38" "$4,054.38" "$4,054.38" "$2,027.19" "$2,027.19" "$3,211.07" "$4,054.38" "$3,243.50" "$1,824.47" $804.69 N/A "$2,351.61" "$4,054.38" "$2,432.63" "$4,054.38" $844.93 "$4,054.38" N/A N/A 6487-6-075 SUP HCPCS C1776 6487-6-075 - STEM HUMERAL 9MM 75MM MRS BOTH IP/OP "$5,420.00" "$4,011.00" "$1,075.73" "$5,420.00" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.66" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.59" "$5,420.00" "$5,420.00" "$2,672.06" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$4,065.00" "$5,420.00" "$5,420.00" "$5,420.00" "$2,710.00" "$2,710.00" "$4,292.64" "$5,420.00" "$4,336.00" "$2,439.00" "$1,075.73" N/A "$3,143.60" "$5,420.00" "$3,252.00" "$5,420.00" "$1,129.53" "$5,420.00" N/A N/A 6487-6-076 SUP HCPCS C1776 6487-6-076 - STEM HUMERAL 50MM 75MM BODY MRS BOTH IP/OP "$5,420.00" "$4,011.00" "$1,075.73" "$5,420.00" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.66" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.59" "$5,420.00" "$2,168.00" "$2,672.06" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$4,065.00" "$5,420.00" "$5,420.00" "$5,420.00" "$2,710.00" "$2,710.00" "$4,292.64" "$5,420.00" "$4,336.00" "$2,439.00" "$1,075.73" N/A "$3,143.60" "$5,420.00" "$3,252.00" "$5,420.00" "$1,129.53" "$5,420.00" N/A N/A 6487-6-101 SUP HCPCS C1776 6487-6-101 - STEM HUMERAL 50MM 100MM BODY MRS SHOULDER BOTH IP/OP "$5,420.00" "$4,011.00" "$1,075.73" "$5,420.00" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.66" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.59" "$5,420.00" "$5,420.00" "$2,672.06" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$4,065.00" "$5,420.00" "$5,420.00" "$5,420.00" "$2,710.00" "$2,710.00" "$4,292.64" "$5,420.00" "$4,336.00" "$2,439.00" "$1,075.73" N/A "$3,143.60" "$5,420.00" "$3,252.00" "$5,420.00" "$1,129.53" "$5,420.00" N/A N/A 6487-6-115 SUP HCPCS C1776 6487-6-115 - STEM HUMERAL 9MM 115MM MRS SHOULDER BOTH IP/OP "$5,420.00" "$4,011.00" "$1,075.73" "$5,420.00" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.66" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.59" "$5,420.00" "$2,168.00" "$2,672.06" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$4,065.00" "$5,420.00" "$5,420.00" "$5,420.00" "$2,710.00" "$2,710.00" "$4,292.64" "$5,420.00" "$4,336.00" "$2,439.00" "$1,075.73" N/A "$3,143.60" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.53" "$5,420.00" N/A N/A 6487-6-126 SUP HCPCS C1776 6487-6-126 - STEM HUMERAL 125MM 50MM BODY MRS SHOULDER BOTH IP/OP "$4,054.50" "$3,000.00" $804.69 "$4,054.38" "$1,824.47" "$1,824.47" "$1,824.47" "$1,824.47" "$4,054.38" "$4,054.38" "$4,054.38" $845.03 "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" $844.98 "$4,054.38" "$4,054.38" "$1,998.81" "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" "$3,040.88" "$4,054.38" "$4,054.38" "$4,054.38" "$2,027.19" "$2,027.19" "$3,211.07" "$4,054.38" "$3,243.50" "$1,824.47" $804.69 N/A "$2,351.61" "$4,054.38" "$2,432.63" "$4,054.38" $844.93 "$4,054.38" N/A N/A 6487-7-051 SUP HCPCS C1776 6487-7-051 - STEM HUMERAL 50MM 75MM BODY MRS SHOULDER BOTH IP/OP "$4,054.50" "$3,000.00" $804.69 "$4,054.38" "$1,824.47" "$1,824.47" "$1,824.47" "$1,824.47" "$4,054.38" "$4,054.38" "$4,054.38" $845.03 "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" $844.98 "$4,054.38" "$1,621.75" "$1,998.81" "$4,054.38" "$4,054.38" "$4,054.38" "$4,054.38" "$3,040.88" "$4,054.38" "$4,054.38" "$4,054.38" "$2,027.19" "$2,027.19" "$3,211.07" "$4,054.38" "$3,243.50" "$1,824.47" $804.69 N/A "$2,351.61" "$4,054.38" "$2,432.63" "$4,054.38" $844.93 "$4,054.38" N/A N/A 6487-7-075 SUP HCPCS C1776 6487-7-075 - STEM HUMERAL 11MM 75MM MRS SHOULDER BOTH IP/OP "$5,420.00" "$4,011.00" "$1,075.73" "$5,420.00" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.66" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.59" "$5,420.00" "$2,168.00" "$2,672.06" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$4,065.00" "$5,420.00" "$5,420.00" "$5,420.00" "$2,710.00" "$2,710.00" "$4,292.64" "$5,420.00" "$4,336.00" "$2,439.00" "$1,075.73" N/A "$3,143.60" "$5,420.00" "$3,252.00" "$5,420.00" "$1,129.53" "$5,420.00" N/A N/A 6487-7-076 SUP HCPCS C1776 6487-7-076 - STEM HUMERAL 75MM 75MM BODY MRS SHOULDER BOTH IP/OP "$5,420.00" "$4,011.00" "$1,075.73" "$5,420.00" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.66" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.59" "$5,420.00" "$5,420.00" "$2,672.06" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$4,065.00" "$5,420.00" "$5,420.00" "$5,420.00" "$2,710.00" "$2,710.00" "$4,292.64" "$5,420.00" "$4,336.00" "$2,439.00" "$1,075.73" N/A "$3,143.60" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.53" "$5,420.00" N/A N/A 6487-7-101 SUP HCPCS C1776 6487-7-101 - STEM HUMERAL 100MM 75MM BODY MRS MRH SHOULDER BOTH IP/OP "$5,420.00" "$4,011.00" "$1,075.73" "$5,420.00" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.66" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.59" "$5,420.00" "$2,168.00" "$2,672.06" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$4,065.00" "$5,420.00" "$5,420.00" "$5,420.00" "$2,710.00" "$2,710.00" "$4,292.64" "$5,420.00" "$4,336.00" "$2,439.00" "$1,075.73" N/A "$3,143.60" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.53" "$5,420.00" N/A N/A 6487-7-115 SUP HCPCS C1776 6487-7-115 - STEM HUMERAL 11MM 115MM BODY MRS SHOULDER BOTH IP/OP "$5,420.00" "$4,011.00" "$1,075.73" "$5,420.00" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.66" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.59" "$5,420.00" "$5,420.00" "$2,672.06" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$4,065.00" "$5,420.00" "$5,420.00" "$5,420.00" "$2,710.00" "$2,710.00" "$4,292.64" "$5,420.00" "$4,336.00" "$2,439.00" "$1,075.73" N/A "$3,143.60" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.53" "$5,420.00" N/A N/A 6487-8-051 SUP HCPCS C1776 6487-8-051 - STEM HUMERAL 100MM 50MM BODY MRS MRH SHOULDER BOTH IP/OP "$5,420.00" "$4,011.00" "$1,075.73" "$5,420.00" "$2,439.00" "$2,439.00" "$2,439.00" "$2,439.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.66" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.59" "$5,420.00" "$2,168.00" "$2,672.06" "$5,420.00" "$5,420.00" "$5,420.00" "$5,420.00" "$4,065.00" "$5,420.00" "$5,420.00" "$5,420.00" "$2,710.00" "$2,710.00" "$4,292.64" "$5,420.00" "$4,336.00" "$2,439.00" "$1,075.73" N/A "$3,143.60" "$5,420.00" "$5,420.00" "$5,420.00" "$1,129.53" "$5,420.00" N/A N/A 6487-9-051 SUP HCPCS C1776 6487-9-051 - CAP END 50MM MRS HUMERAL PROXIMAL BOTH IP/OP "$2,635.00" "$1,950.00" $522.98 "$2,635.00" "$1,185.75" "$1,185.75" "$1,185.75" "$1,185.75" "$2,635.00" "$2,635.00" "$2,635.00" $549.20 "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" $549.16 "$2,635.00" "$2,635.00" "$1,299.06" "$2,635.00" "$2,635.00" "$2,635.00" "$2,635.00" "$1,976.25" "$2,635.00" "$2,635.00" "$2,635.00" "$1,317.50" "$1,317.50" "$2,086.92" "$2,635.00" "$2,108.00" "$1,185.75" $522.98 N/A "$1,528.30" "$2,635.00" "$2,635.00" "$2,635.00" $549.13 "$2,635.00" N/A N/A 6495-1-001 SUP HCPCS C1776 6495-1-001 - COMPONENT FEMORAL STANDARD NEUTRAL GMRS COCR HIP BOTH IP/OP "$10,355.00" "$7,663.00" "$2,055.21" "$10,355.00" "$4,659.75" "$4,659.75" "$4,659.75" "$4,659.75" "$10,355.00" "$10,355.00" "$10,355.00" "$2,158.24" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$2,158.10" "$10,355.00" "$4,142.00" "$5,105.02" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$7,766.25" "$10,355.00" "$10,355.00" "$10,355.00" "$5,177.50" "$5,177.50" "$8,201.16" "$10,355.00" "$8,284.00" "$4,659.75" "$2,055.21" N/A "$6,005.90" "$10,355.00" "$10,355.00" "$10,355.00" "$2,157.98" "$10,355.00" N/A N/A 6495-1-002 SUP HCPCS C1776 6495-1-002 - COMPONENT FEMORAL NEUTRAL GMRS HIP TROCHANTER BOTH IP/OP "$10,355.00" "$7,663.00" "$2,055.21" "$10,355.00" "$4,659.75" "$4,659.75" "$4,659.75" "$4,659.75" "$10,355.00" "$10,355.00" "$10,355.00" "$2,158.24" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$2,158.10" "$10,355.00" "$10,355.00" "$5,105.02" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$7,766.25" "$10,355.00" "$10,355.00" "$10,355.00" "$5,177.50" "$5,177.50" "$8,201.16" "$10,355.00" "$8,284.00" "$4,659.75" "$2,055.21" N/A "$6,005.90" "$10,355.00" "$6,213.00" "$10,355.00" "$2,157.98" "$10,355.00" N/A N/A 6495-1-101 SUP HCPCS C1776 6495-1-101 - COMPONENT FEMORAL 15D ANTEVERT STANDARD GMRS KNEE LEFT BOTH IP/OP "$10,355.00" "$7,663.00" "$2,055.21" "$10,355.00" "$4,659.75" "$4,659.75" "$4,659.75" "$4,659.75" "$10,355.00" "$10,355.00" "$10,355.00" "$2,158.24" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$2,158.10" "$10,355.00" "$4,142.00" "$5,105.02" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$7,766.25" "$10,355.00" "$10,355.00" "$10,355.00" "$5,177.50" "$5,177.50" "$8,201.16" "$10,355.00" "$8,284.00" "$4,659.75" "$2,055.21" N/A "$6,005.90" "$10,355.00" "$6,213.00" "$10,355.00" "$2,157.98" "$10,355.00" N/A N/A 6495-1-102 SUP HCPCS C1776 6495-1-102 - COMPONENT FEMORAL 15D ANTEVERT GMRS KNEE LEFT TROCHANTER BOTH IP/OP "$10,355.00" "$7,663.00" "$2,055.21" "$10,355.00" "$4,659.75" "$4,659.75" "$4,659.75" "$4,659.75" "$10,355.00" "$10,355.00" "$10,355.00" "$2,158.24" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$2,158.10" "$10,355.00" "$10,355.00" "$5,105.02" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$7,766.25" "$10,355.00" "$10,355.00" "$10,355.00" "$5,177.50" "$5,177.50" "$8,201.16" "$10,355.00" "$8,284.00" "$4,659.75" "$2,055.21" N/A "$6,005.90" "$10,355.00" "$10,355.00" "$10,355.00" "$2,157.98" "$10,355.00" N/A N/A 6495-1-201 SUP HCPCS C1776 6495-1-201 - COMPONENT FEMORAL 15D ANTEVERT STANDARD GMRS KNEE RIGHT BOTH IP/OP "$10,355.00" "$7,663.00" "$2,055.21" "$10,355.00" "$4,659.75" "$4,659.75" "$4,659.75" "$4,659.75" "$10,355.00" "$10,355.00" "$10,355.00" "$2,158.24" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$2,158.10" "$10,355.00" "$4,142.00" "$5,105.02" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$7,766.25" "$10,355.00" "$10,355.00" "$10,355.00" "$5,177.50" "$5,177.50" "$8,201.16" "$10,355.00" "$8,284.00" "$4,659.75" "$2,055.21" N/A "$6,005.90" "$10,355.00" "$6,213.00" "$10,355.00" "$2,157.98" "$10,355.00" N/A N/A 6495-1-202 SUP HCPCS C1776 6495-1-202 - COMPONENT FEMORAL 15D ANTEVERT GMRS KNEE RIGHT TROCHANTER BOTH IP/OP "$10,355.00" "$7,663.00" "$2,055.21" "$10,355.00" "$4,659.75" "$4,659.75" "$4,659.75" "$4,659.75" "$10,355.00" "$10,355.00" "$10,355.00" "$2,158.24" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$2,158.10" "$10,355.00" "$10,355.00" "$5,105.02" "$10,355.00" "$10,355.00" "$10,355.00" "$10,355.00" "$7,766.25" "$10,355.00" "$10,355.00" "$10,355.00" "$5,177.50" "$5,177.50" "$8,201.16" "$10,355.00" "$8,284.00" "$4,659.75" "$2,055.21" N/A "$6,005.90" "$10,355.00" "$6,213.00" "$10,355.00" "$2,157.98" "$10,355.00" N/A N/A 6495-2-010 SUP HCPCS C1776 6495-2-010 - COMPONENT FEMORAL SMALL 65MM GMRS COCR KNEE LEFT BOTH IP/OP "$14,922.50" "$11,043.00" "$2,961.74" "$14,922.50" "$6,715.13" "$6,715.13" "$6,715.13" "$6,715.13" "$14,922.50" "$14,922.50" "$14,922.50" "$3,110.22" "$14,922.50" "$14,922.50" "$14,922.50" "$14,922.50" "$14,922.50" "$3,110.01" "$14,922.50" "$14,922.50" "$7,356.79" "$14,922.50" "$14,922.50" "$14,922.50" "$14,922.50" "$11,191.88" "$14,922.50" "$14,922.50" "$14,922.50" "$7,461.25" "$7,461.25" "$11,818.62" "$14,922.50" "$11,938.00" "$6,715.13" "$2,961.74" N/A "$8,655.05" "$14,922.50" "$8,953.50" "$14,922.50" "$3,109.85" "$14,922.50" N/A N/A 6495-2-020 SUP HCPCS C1776 6495-2-020 - COMPONENT FEMORAL SMALL 65MM GMRS DISTAL RIGHT BOTH IP/OP "$14,922.50" "$11,043.00" "$2,961.74" "$14,922.50" "$6,715.13" "$6,715.13" "$6,715.13" "$6,715.13" "$14,922.50" "$14,922.50" "$14,922.50" "$3,110.22" "$14,922.50" "$14,922.50" "$14,922.50" "$14,922.50" "$14,922.50" "$3,110.01" "$14,922.50" "$14,922.50" "$7,356.79" "$14,922.50" "$14,922.50" "$14,922.50" "$14,922.50" "$11,191.88" "$14,922.50" "$14,922.50" "$14,922.50" "$7,461.25" "$7,461.25" "$11,818.62" "$14,922.50" "$11,938.00" "$6,715.13" "$2,961.74" N/A "$8,655.05" "$14,922.50" "$14,922.50" "$14,922.50" "$3,109.85" "$14,922.50" N/A N/A 6495-2-030 SUP HCPCS C1776 6495-2-030 - COMPONENT FEMORAL STANDARD 65MM GMRS COCR KNEE LEFT BOTH IP/OP "$14,787.50" "$10,943.00" "$2,934.95" "$14,787.50" "$6,654.38" "$6,654.38" "$6,654.38" "$6,654.38" "$14,787.50" "$14,787.50" "$14,787.50" "$3,082.08" "$14,787.50" "$14,787.50" "$14,787.50" "$14,787.50" "$14,787.50" "$3,081.88" "$14,787.50" "$14,787.50" "$7,290.24" "$14,787.50" "$14,787.50" "$14,787.50" "$14,787.50" "$11,090.63" "$14,787.50" "$14,787.50" "$14,787.50" "$7,393.75" "$7,393.75" "$11,711.70" "$14,787.50" "$11,830.00" "$6,654.38" "$2,934.95" N/A "$8,576.75" "$14,787.50" "$14,787.50" "$14,787.50" "$3,081.72" "$14,787.50" N/A N/A 6495-2-040 SUP HCPCS C1776 6495-2-040 - COMPONENT FEMORAL STANDARD 65MM GMRS COCR KNEE RIGHT BOTH IP/OP "$14,787.50" "$10,943.00" "$2,934.95" "$14,787.50" "$6,654.38" "$6,654.38" "$6,654.38" "$6,654.38" "$14,787.50" "$14,787.50" "$14,787.50" "$3,082.08" "$14,787.50" "$14,787.50" "$14,787.50" "$14,787.50" "$14,787.50" "$3,081.88" "$14,787.50" "$14,787.50" "$7,290.24" "$14,787.50" "$14,787.50" "$14,787.50" "$14,787.50" "$11,090.63" "$14,787.50" "$14,787.50" "$14,787.50" "$7,393.75" "$7,393.75" "$11,711.70" "$14,787.50" "$11,830.00" "$6,654.38" "$2,934.95" N/A "$8,576.75" "$14,787.50" "$14,787.50" "$14,787.50" "$3,081.72" "$14,787.50" N/A N/A 6495-2-105 SUP Custom 27803010 6495-2-105 - BUSHING FEMORAL SMALL GMRS KNEE BOTH IP/OP $640.00 $474.00 $113.92 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $113.92 $640.00 $640.00 $640.00 $640.00 $640.00 $640.00 $133.38 $640.00 $256.00 $640.00 $640.00 $640.00 $640.00 $640.00 $480.00 $640.00 $640.00 $640.00 $320.00 $320.00 $506.88 $640.00 $512.00 $288.00 $640.00 N/A $371.20 $640.00 $384.00 $640.00 $640.00 $640.00 N/A N/A 6495-2-115 SUP Custom 27803010 6495-2-115 - AXLE FEMORAL SMALL GMRS KNEE BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 6495-3-010 SUP Custom 27803010 6495-3-010 - INSERT TIBIAL SMALL 10MM GMRS PROXIMAL BOTH IP/OP "$2,367.50" "$1,752.00" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $493.41 "$2,367.50" $947.00 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$1,775.63" "$2,367.50" "$2,367.50" "$2,367.50" "$1,183.75" "$1,183.75" "$1,875.06" "$2,367.50" "$1,894.00" "$1,065.38" "$2,367.50" N/A "$1,373.15" "$2,367.50" "$1,420.50" "$2,367.50" "$2,367.50" "$2,367.50" N/A N/A 6495-3-013 SUP Custom 27803010 6495-3-013 - INSERT TIBIAL SMALL 13MM GMRS PROXIMAL BOTH IP/OP "$2,367.50" "$1,752.00" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $493.41 "$2,367.50" $947.00 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$1,775.63" "$2,367.50" "$2,367.50" "$2,367.50" "$1,183.75" "$1,183.75" "$1,875.06" "$2,367.50" "$1,894.00" "$1,065.38" "$2,367.50" N/A "$1,373.15" "$2,367.50" "$1,420.50" "$2,367.50" "$2,367.50" "$2,367.50" N/A N/A 6495-3-016 SUP Custom 27803010 6495-3-016 - INSERT TIBIAL SMALL 16MM GMRS PROXIMAL BOTH IP/OP "$2,367.50" "$1,752.00" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $493.41 "$2,367.50" $947.00 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$1,775.63" "$2,367.50" "$2,367.50" "$2,367.50" "$1,183.75" "$1,183.75" "$1,875.06" "$2,367.50" "$1,894.00" "$1,065.38" "$2,367.50" N/A "$1,373.15" "$2,367.50" "$1,420.50" "$2,367.50" "$2,367.50" "$2,367.50" N/A N/A 6495-3-020 SUP Custom 27803010 6495-3-020 - INSERT TIBIAL SMALL 20MM GMRS PROXIMAL BOTH IP/OP "$2,367.50" "$1,752.00" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $493.41 "$2,367.50" $947.00 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$1,775.63" "$2,367.50" "$2,367.50" "$2,367.50" "$1,183.75" "$1,183.75" "$1,875.06" "$2,367.50" "$1,894.00" "$1,065.38" "$2,367.50" N/A "$1,373.15" "$2,367.50" "$1,420.50" "$2,367.50" "$2,367.50" "$2,367.50" N/A N/A 6495-3-024 SUP Custom 27803010 6495-3-024 - INSERT TIBIAL SMALL 24MM GMRS PROXIMAL BOTH IP/OP "$2,367.50" "$1,752.00" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $421.42 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" $493.41 "$2,367.50" $947.00 "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$2,367.50" "$1,775.63" "$2,367.50" "$2,367.50" "$2,367.50" "$1,183.75" "$1,183.75" "$1,875.06" "$2,367.50" "$1,894.00" "$1,065.38" "$2,367.50" N/A "$1,373.15" "$2,367.50" "$1,420.50" "$2,367.50" "$2,367.50" "$2,367.50" N/A N/A 6495-3-101 SUP HCPCS C1776 6495-3-101 - COMPONENT TIBIAL SMALL GMRS PROXIMAL BOTH IP/OP "$14,895.00" "$11,022.00" "$2,956.29" "$14,895.00" "$6,702.75" "$6,702.75" "$6,702.75" "$6,702.75" "$14,895.00" "$14,895.00" "$14,895.00" "$3,104.49" "$14,895.00" "$14,895.00" "$14,895.00" "$14,895.00" "$14,895.00" "$3,104.28" "$14,895.00" "$14,895.00" "$7,343.24" "$14,895.00" "$14,895.00" "$14,895.00" "$14,895.00" "$11,171.25" "$14,895.00" "$14,895.00" "$14,895.00" "$7,447.50" "$7,447.50" "$11,796.84" "$14,895.00" "$11,916.00" "$6,702.75" "$2,956.29" N/A "$8,639.10" "$14,895.00" "$8,937.00" "$14,895.00" "$3,104.12" "$14,895.00" N/A N/A 6495-3-102 SUP HCPCS C1776 6495-3-102 - COMPONENT TIBIAL STANDARD GMRS PROXIMAL BOTH IP/OP "$14,895.00" "$11,022.00" "$2,956.29" "$14,895.00" "$6,702.75" "$6,702.75" "$6,702.75" "$6,702.75" "$14,895.00" "$14,895.00" "$14,895.00" "$3,104.49" "$14,895.00" "$14,895.00" "$14,895.00" "$14,895.00" "$14,895.00" "$3,104.28" "$14,895.00" "$14,895.00" "$7,343.24" "$14,895.00" "$14,895.00" "$14,895.00" "$14,895.00" "$11,171.25" "$14,895.00" "$14,895.00" "$14,895.00" "$7,447.50" "$7,447.50" "$11,796.84" "$14,895.00" "$11,916.00" "$6,702.75" "$2,956.29" N/A "$8,639.10" "$14,895.00" "$14,895.00" "$14,895.00" "$3,104.12" "$14,895.00" N/A N/A 6495-3-601 SUP HCPCS C1776 6495-3-601 - COMPONENT TIBIAL SMALL ROTATE GMRS TITANIUM KNEE PROXIMAL BOTH IP/OP "$6,122.50" "$4,531.00" "$1,215.16" "$6,122.50" "$2,755.13" "$2,755.13" "$2,755.13" "$2,755.13" "$6,122.50" "$6,122.50" "$6,122.50" "$1,276.08" "$6,122.50" "$6,122.50" "$6,122.50" "$6,122.50" "$6,122.50" "$1,276.00" "$6,122.50" "$6,122.50" "$3,018.39" "$6,122.50" "$6,122.50" "$6,122.50" "$6,122.50" "$4,591.88" "$6,122.50" "$6,122.50" "$6,122.50" "$3,061.25" "$3,061.25" "$4,849.02" "$6,122.50" "$4,898.00" "$2,755.13" "$1,215.16" N/A "$3,551.05" "$6,122.50" "$3,673.50" "$6,122.50" "$1,275.93" "$6,122.50" N/A N/A 6495-5-011 SUP HCPCS C1776 6495-5-011 - STEM FEMORAL STR FLUTE 11MM 125MM PRESSFIT GMRS COCR HIP BOTH IP/OP "$9,450.00" "$6,993.00" "$1,875.59" "$9,450.00" "$4,252.50" "$4,252.50" "$4,252.50" "$4,252.50" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.62" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.48" "$9,450.00" "$9,450.00" "$4,658.85" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$7,087.50" "$9,450.00" "$9,450.00" "$9,450.00" "$4,725.00" "$4,725.00" "$7,484.40" "$9,450.00" "$7,560.00" "$4,252.50" "$1,875.59" N/A "$5,481.00" "$9,450.00" "$5,670.00" "$9,450.00" "$1,969.38" "$9,450.00" N/A N/A 6495-5-012 SUP HCPCS C1776 6495-5-012 - STEM FEMORAL STR FLUTE 12MM 125MM PRESSFIT GMRS COCR HIP BOTH IP/OP "$9,450.00" "$6,993.00" "$1,875.59" "$9,450.00" "$4,252.50" "$4,252.50" "$4,252.50" "$4,252.50" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.62" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.48" "$9,450.00" "$9,450.00" "$4,658.85" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$7,087.50" "$9,450.00" "$9,450.00" "$9,450.00" "$4,725.00" "$4,725.00" "$7,484.40" "$9,450.00" "$7,560.00" "$4,252.50" "$1,875.59" N/A "$5,481.00" "$9,450.00" "$5,670.00" "$9,450.00" "$1,969.38" "$9,450.00" N/A N/A 6495-5-013 SUP HCPCS C1776 6495-5-013 - STEM FEMORAL STR FLUTE 13MM 125MM PRESSFIT GMRS COCR HIP BOTH IP/OP "$9,450.00" "$6,993.00" "$1,875.59" "$9,450.00" "$4,252.50" "$4,252.50" "$4,252.50" "$4,252.50" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.62" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.48" "$9,450.00" "$9,450.00" "$4,658.85" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$7,087.50" "$9,450.00" "$9,450.00" "$9,450.00" "$4,725.00" "$4,725.00" "$7,484.40" "$9,450.00" "$7,560.00" "$4,252.50" "$1,875.59" N/A "$5,481.00" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.38" "$9,450.00" N/A N/A 6495-5-014 SUP HCPCS C1776 6495-5-014 - STEM FEMORAL STR FLUTE 14MM 125MM PRESSFIT GMRS COCR HIP BOTH IP/OP "$9,450.00" "$6,993.00" "$1,875.59" "$9,450.00" "$4,252.50" "$4,252.50" "$4,252.50" "$4,252.50" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.62" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.48" "$9,450.00" "$9,450.00" "$4,658.85" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$7,087.50" "$9,450.00" "$9,450.00" "$9,450.00" "$4,725.00" "$4,725.00" "$7,484.40" "$9,450.00" "$7,560.00" "$4,252.50" "$1,875.59" N/A "$5,481.00" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.38" "$9,450.00" N/A N/A 6495-5-015 SUP HCPCS C1776 6495-5-015 - STEM FEMORAL STR FLUTE 15MM 125MM PRESSFIT GMRS COCR HIP BOTH IP/OP "$9,450.00" "$6,993.00" "$1,875.59" "$9,450.00" "$4,252.50" "$4,252.50" "$4,252.50" "$4,252.50" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.62" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.48" "$9,450.00" "$9,450.00" "$4,658.85" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$7,087.50" "$9,450.00" "$9,450.00" "$9,450.00" "$4,725.00" "$4,725.00" "$7,484.40" "$9,450.00" "$7,560.00" "$4,252.50" "$1,875.59" N/A "$5,481.00" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.38" "$9,450.00" N/A N/A 6495-5-016 SUP HCPCS C1776 6495-5-016 - STEM FEMORAL STR FLUTE 16MM 125MM PRESSFIT GMRS COCR HIP BOTH IP/OP "$9,450.00" "$6,993.00" "$1,875.59" "$9,450.00" "$4,252.50" "$4,252.50" "$4,252.50" "$4,252.50" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.62" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.48" "$9,450.00" "$9,450.00" "$4,658.85" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$7,087.50" "$9,450.00" "$9,450.00" "$9,450.00" "$4,725.00" "$4,725.00" "$7,484.40" "$9,450.00" "$7,560.00" "$4,252.50" "$1,875.59" N/A "$5,481.00" "$9,450.00" "$5,670.00" "$9,450.00" "$1,969.38" "$9,450.00" N/A N/A 6495-5-017 SUP HCPCS C1776 6495-5-017 - STEM FEMORAL STR FLUTE 17MM 125MM PRESSFIT GMRS COCR HIP BOTH IP/OP "$9,450.00" "$6,993.00" "$1,875.59" "$9,450.00" "$4,252.50" "$4,252.50" "$4,252.50" "$4,252.50" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.62" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.48" "$9,450.00" "$9,450.00" "$4,658.85" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$7,087.50" "$9,450.00" "$9,450.00" "$9,450.00" "$4,725.00" "$4,725.00" "$7,484.40" "$9,450.00" "$7,560.00" "$4,252.50" "$1,875.59" N/A "$5,481.00" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.38" "$9,450.00" N/A N/A 6495-5-018 SUP HCPCS C1776 6495-5-018 - STEM FEMORAL STR FLUTE 18MM 125MM PRESSFIT GMRS COCR HIP BOTH IP/OP "$9,450.00" "$6,993.00" "$1,875.59" "$9,450.00" "$4,252.50" "$4,252.50" "$4,252.50" "$4,252.50" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.62" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.48" "$9,450.00" "$9,450.00" "$4,658.85" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$7,087.50" "$9,450.00" "$9,450.00" "$9,450.00" "$4,725.00" "$4,725.00" "$7,484.40" "$9,450.00" "$7,560.00" "$4,252.50" "$1,875.59" N/A "$5,481.00" "$9,450.00" "$5,670.00" "$9,450.00" "$1,969.38" "$9,450.00" N/A N/A 6495-5-019 SUP HCPCS C1776 6495-5-019 - STEM FEMORAL STR FLUTE 19MM 125MM PRESSFIT GMRS COCR HIP BOTH IP/OP "$9,450.00" "$6,993.00" "$1,875.59" "$9,450.00" "$4,252.50" "$4,252.50" "$4,252.50" "$4,252.50" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.62" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$1,969.48" "$9,450.00" "$9,450.00" "$4,658.85" "$9,450.00" "$9,450.00" "$9,450.00" "$9,450.00" "$7,087.50" "$9,450.00" "$9,450.00" "$9,450.00" "$4,725.00" "$4,725.00" "$7,484.40" "$9,450.00" "$7,560.00" "$4,252.50" "$1,875.59" N/A "$5,481.00" "$9,450.00" "$5,670.00" "$9,450.00" "$1,969.38" "$9,450.00" N/A N/A 6495-5-111 SUP HCPCS C1776 6495-5-111 - STEM FEMORAL LONG BOW 11MM 200MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$5,977.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-112 SUP HCPCS C1776 6495-5-112 - STEM FEMORAL LONG BOW 12MM 200MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-113 SUP HCPCS C1776 6495-5-113 - STEM FEMORAL LONG BOW 13MM 200MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-114 SUP HCPCS C1776 6495-5-114 - STEM FEMORAL LONG BOW 14MM 200MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-115 SUP HCPCS C1776 6495-5-115 - STEM FEMORAL LONG BOW 15MM 200MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-116 SUP HCPCS C1776 6495-5-116 - STEM FEMORAL LONG BOW 16MM 200MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-117 SUP HCPCS C1776 6495-5-117 - STEM FEMORAL LONG BOW 17MM 200MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-118 SUP HCPCS C1776 6495-5-118 - STEM FEMORAL LONG BOW 18MM 200MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-119 SUP HCPCS C1776 6495-5-119 - STEM FEMORAL LONG BOW 19MM 200MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-211 SUP HCPCS C1776 6495-5-211 - STEM FEMORAL BOW 11MM 150MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-212 SUP HCPCS C1776 6495-5-212 - STEM FEMORAL BOW 12MM 150MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-213 SUP HCPCS C1776 6495-5-213 - STEM FEMORAL BOW 13MM 150MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-214 SUP HCPCS C1776 6495-5-214 - STEM FEMORAL BOW 14MM 150MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-215 SUP HCPCS C1776 6495-5-215 - STEM FEMORAL BOW 15MM 150MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$5,977.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-216 SUP HCPCS C1776 6495-5-216 - STEM FEMORAL BOW 16MM 150MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$5,977.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-217 SUP HCPCS C1776 6495-5-217 - STEM FEMORAL BOW 17MM 150MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$5,977.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-218 SUP HCPCS C1776 6495-5-218 - STEM FEMORAL BOW 18MM 150MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$5,977.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-5-219 SUP HCPCS C1776 6495-5-219 - STEM FEMORAL BOW 19MM 150MM PRESSFIT GMRS HIP BOTH IP/OP "$9,962.50" "$7,372.00" "$1,977.31" "$9,962.50" "$4,483.13" "$4,483.13" "$4,483.13" "$4,483.13" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.43" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$2,076.29" "$9,962.50" "$9,962.50" "$4,911.51" "$9,962.50" "$9,962.50" "$9,962.50" "$9,962.50" "$7,471.88" "$9,962.50" "$9,962.50" "$9,962.50" "$4,981.25" "$4,981.25" "$7,890.30" "$9,962.50" "$7,970.00" "$4,483.13" "$1,977.31" N/A "$5,778.25" "$9,962.50" "$5,977.50" "$9,962.50" "$2,076.19" "$9,962.50" N/A N/A 6495-6-008 SUP HCPCS C1776 6495-6-008 - COMPONENT FEMORAL 80MM CONCTR GMRS KNEE LEFT BOTH IP/OP "$9,002.50" "$6,662.00" "$1,786.77" "$9,002.50" "$4,051.13" "$4,051.13" "$4,051.13" "$4,051.13" "$9,002.50" "$9,002.50" "$9,002.50" "$1,876.35" "$9,002.50" "$9,002.50" "$9,002.50" "$9,002.50" "$9,002.50" "$1,876.22" "$9,002.50" "$9,002.50" "$4,438.23" "$9,002.50" "$9,002.50" "$9,002.50" "$9,002.50" "$6,751.88" "$9,002.50" "$9,002.50" "$9,002.50" "$4,501.25" "$4,501.25" "$7,129.98" "$9,002.50" "$7,202.00" "$4,051.13" "$1,786.77" N/A "$5,221.45" "$9,002.50" "$5,401.50" "$9,002.50" "$1,876.12" "$9,002.50" N/A N/A 6495-6-009 SUP HCPCS C1776 6495-6-009 - COMPONENT FEMORAL 90MM CONNECT PIECE GMRS KNEE LEFT BOTH IP/OP "$9,002.50" "$6,662.00" "$1,786.77" "$9,002.50" "$4,051.13" "$4,051.13" "$4,051.13" "$4,051.13" "$9,002.50" "$9,002.50" "$9,002.50" "$1,876.35" "$9,002.50" "$9,002.50" "$9,002.50" "$9,002.50" "$9,002.50" "$1,876.22" "$9,002.50" "$9,002.50" "$4,438.23" "$9,002.50" "$9,002.50" "$9,002.50" "$9,002.50" "$6,751.88" "$9,002.50" "$9,002.50" "$9,002.50" "$4,501.25" "$4,501.25" "$7,129.98" "$9,002.50" "$7,202.00" "$4,051.13" "$1,786.77" N/A "$5,221.45" "$9,002.50" "$5,401.50" "$9,002.50" "$1,876.12" "$9,002.50" N/A N/A 6495-6-018 SUP HCPCS C1776 6495-6-018 - COMPONENT FEMORAL 80MM CONNECT PIECE GMRS TITANIUM HIP RIGHT BOTH IP/OP "$9,087.50" "$6,725.00" "$1,803.64" "$9,087.50" "$4,089.38" "$4,089.38" "$4,089.38" "$4,089.38" "$9,087.50" "$9,087.50" "$9,087.50" "$1,894.06" "$9,087.50" "$9,087.50" "$9,087.50" "$9,087.50" "$9,087.50" "$1,893.93" "$9,087.50" "$9,087.50" "$4,480.14" "$9,087.50" "$9,087.50" "$9,087.50" "$9,087.50" "$6,815.63" "$9,087.50" "$9,087.50" "$9,087.50" "$4,543.75" "$4,543.75" "$7,197.30" "$9,087.50" "$7,270.00" "$4,089.38" "$1,803.64" N/A "$5,270.75" "$9,087.50" "$5,452.50" "$9,087.50" "$1,893.84" "$9,087.50" N/A N/A 6495-6-019 SUP HCPCS C1776 6495-6-019 - COMPONENT FEMORAL 90MM CONNECT PIECE GMRS KNEE RIGHT BOTH IP/OP "$9,087.50" "$6,725.00" "$1,803.64" "$9,087.50" "$4,089.38" "$4,089.38" "$4,089.38" "$4,089.38" "$9,087.50" "$9,087.50" "$9,087.50" "$1,894.06" "$9,087.50" "$9,087.50" "$9,087.50" "$9,087.50" "$9,087.50" "$1,893.93" "$9,087.50" "$9,087.50" "$4,480.14" "$9,087.50" "$9,087.50" "$9,087.50" "$9,087.50" "$6,815.63" "$9,087.50" "$9,087.50" "$9,087.50" "$4,543.75" "$4,543.75" "$7,197.30" "$9,087.50" "$7,270.00" "$4,089.38" "$1,803.64" N/A "$5,270.75" "$9,087.50" "$9,087.50" "$9,087.50" "$1,893.84" "$9,087.50" N/A N/A 6495-6-030 SUP HCPCS C1776 6495-6-030 - EXTENSION FEMORAL 30MM GMRS COCR KNEE DISTAL BOTH IP/OP "$6,257.50" "$4,631.00" "$1,241.96" "$6,257.50" "$2,815.88" "$2,815.88" "$2,815.88" "$2,815.88" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.22" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.13" "$6,257.50" "$6,257.50" "$3,084.95" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$4,693.13" "$6,257.50" "$6,257.50" "$6,257.50" "$3,128.75" "$3,128.75" "$4,955.94" "$6,257.50" "$5,006.00" "$2,815.88" "$1,241.96" N/A "$3,629.35" "$6,257.50" "$3,754.50" "$6,257.50" "$1,304.06" "$6,257.50" N/A N/A 6495-6-040 SUP HCPCS C1776 6495-6-040 - EXTENSION FEMORAL 40MM GMRS COCR KNEE DISTAL BOTH IP/OP "$6,257.50" "$4,631.00" "$1,241.96" "$6,257.50" "$2,815.88" "$2,815.88" "$2,815.88" "$2,815.88" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.22" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.13" "$6,257.50" "$6,257.50" "$3,084.95" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$4,693.13" "$6,257.50" "$6,257.50" "$6,257.50" "$3,128.75" "$3,128.75" "$4,955.94" "$6,257.50" "$5,006.00" "$2,815.88" "$1,241.96" N/A "$3,629.35" "$6,257.50" "$3,754.50" "$6,257.50" "$1,304.06" "$6,257.50" N/A N/A 6495-6-050 SUP HCPCS C1776 6495-6-050 - EXTENSION FEMORAL 50MM GMRS COCR KNEE DISTAL BOTH IP/OP "$6,257.50" "$4,631.00" "$1,241.96" "$6,257.50" "$2,815.88" "$2,815.88" "$2,815.88" "$2,815.88" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.22" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.13" "$6,257.50" "$6,257.50" "$3,084.95" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$4,693.13" "$6,257.50" "$6,257.50" "$6,257.50" "$3,128.75" "$3,128.75" "$4,955.94" "$6,257.50" "$5,006.00" "$2,815.88" "$1,241.96" N/A "$3,629.35" "$6,257.50" "$3,754.50" "$6,257.50" "$1,304.06" "$6,257.50" N/A N/A 6495-6-060 SUP HCPCS C1776 6495-6-060 - EXTENSION FEMORAL 60MM GMRS COCR KNEE DISTAL BOTH IP/OP "$6,257.50" "$4,631.00" "$1,241.96" "$6,257.50" "$2,815.88" "$2,815.88" "$2,815.88" "$2,815.88" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.22" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.13" "$6,257.50" "$6,257.50" "$3,084.95" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$4,693.13" "$6,257.50" "$6,257.50" "$6,257.50" "$3,128.75" "$3,128.75" "$4,955.94" "$6,257.50" "$5,006.00" "$2,815.88" "$1,241.96" N/A "$3,629.35" "$6,257.50" "$3,754.50" "$6,257.50" "$1,304.06" "$6,257.50" N/A N/A 6495-6-070 SUP HCPCS C1776 6495-6-070 - EXTENSION FEMORAL 70MM GMRS COCR KNEE DISTAL BOTH IP/OP "$6,257.50" "$4,631.00" "$1,241.96" "$6,257.50" "$2,815.88" "$2,815.88" "$2,815.88" "$2,815.88" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.22" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.13" "$6,257.50" "$6,257.50" "$3,084.95" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$4,693.13" "$6,257.50" "$6,257.50" "$6,257.50" "$3,128.75" "$3,128.75" "$4,955.94" "$6,257.50" "$5,006.00" "$2,815.88" "$1,241.96" N/A "$3,629.35" "$6,257.50" "$3,754.50" "$6,257.50" "$1,304.06" "$6,257.50" N/A N/A 6495-6-080 SUP HCPCS C1776 6495-6-080 - EXTENSION FEMORAL 80MM GMRS COCR KNEE DISTAL BOTH IP/OP "$6,257.50" "$4,631.00" "$1,241.96" "$6,257.50" "$2,815.88" "$2,815.88" "$2,815.88" "$2,815.88" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.22" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.13" "$6,257.50" "$6,257.50" "$3,084.95" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$4,693.13" "$6,257.50" "$6,257.50" "$6,257.50" "$3,128.75" "$3,128.75" "$4,955.94" "$6,257.50" "$5,006.00" "$2,815.88" "$1,241.96" N/A "$3,629.35" "$6,257.50" "$3,754.50" "$6,257.50" "$1,304.06" "$6,257.50" N/A N/A 6495-6-100 SUP HCPCS C1776 6495-6-100 - EXTENSION FEMORAL 100MM GMRS COCR KNEE DISTAL BOTH IP/OP "$6,257.50" "$4,631.00" "$1,241.96" "$6,257.50" "$2,815.88" "$2,815.88" "$2,815.88" "$2,815.88" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.22" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.13" "$6,257.50" "$6,257.50" "$3,084.95" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$4,693.13" "$6,257.50" "$6,257.50" "$6,257.50" "$3,128.75" "$3,128.75" "$4,955.94" "$6,257.50" "$5,006.00" "$2,815.88" "$1,241.96" N/A "$3,629.35" "$6,257.50" "$3,754.50" "$6,257.50" "$1,304.06" "$6,257.50" N/A N/A 6495-6-120 SUP HCPCS C1776 6495-6-120 - EXTENSION FEMORAL 120MM GMRS COCR KNEE DISTAL BOTH IP/OP "$6,257.50" "$4,631.00" "$1,241.96" "$6,257.50" "$2,815.88" "$2,815.88" "$2,815.88" "$2,815.88" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.22" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.13" "$6,257.50" "$6,257.50" "$3,084.95" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$4,693.13" "$6,257.50" "$6,257.50" "$6,257.50" "$3,128.75" "$3,128.75" "$4,955.94" "$6,257.50" "$5,006.00" "$2,815.88" "$1,241.96" N/A "$3,629.35" "$6,257.50" "$3,754.50" "$6,257.50" "$1,304.06" "$6,257.50" N/A N/A 6495-6-140 SUP HCPCS C1776 6495-6-140 - EXTENSION FEMORAL 140MM GMRS COCR KNEE DISTAL BOTH IP/OP "$6,257.50" "$4,631.00" "$1,241.96" "$6,257.50" "$2,815.88" "$2,815.88" "$2,815.88" "$2,815.88" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.22" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.13" "$6,257.50" "$6,257.50" "$3,084.95" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$4,693.13" "$6,257.50" "$6,257.50" "$6,257.50" "$3,128.75" "$3,128.75" "$4,955.94" "$6,257.50" "$5,006.00" "$2,815.88" "$1,241.96" N/A "$3,629.35" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.06" "$6,257.50" N/A N/A 6495-6-160 SUP HCPCS C1776 6495-6-160 - EXTENSION STEM 160MM GMRS COCR KNEE FEMUR BOTH IP/OP "$6,257.50" "$4,631.00" "$1,241.96" "$6,257.50" "$2,815.88" "$2,815.88" "$2,815.88" "$2,815.88" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.22" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.13" "$6,257.50" "$6,257.50" "$3,084.95" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$4,693.13" "$6,257.50" "$6,257.50" "$6,257.50" "$3,128.75" "$3,128.75" "$4,955.94" "$6,257.50" "$5,006.00" "$2,815.88" "$1,241.96" N/A "$3,629.35" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.06" "$6,257.50" N/A N/A 6495-6-180 SUP HCPCS C1776 6495-6-180 - EXTENSION FEMORAL 180MM GMRS COCR KNEE DISTAL BOTH IP/OP "$6,257.50" "$4,631.00" "$1,241.96" "$6,257.50" "$2,815.88" "$2,815.88" "$2,815.88" "$2,815.88" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.22" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.13" "$6,257.50" "$6,257.50" "$3,084.95" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$4,693.13" "$6,257.50" "$6,257.50" "$6,257.50" "$3,128.75" "$3,128.75" "$4,955.94" "$6,257.50" "$5,006.00" "$2,815.88" "$1,241.96" N/A "$3,629.35" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.06" "$6,257.50" N/A N/A 6495-6-200 SUP HCPCS C1776 6495-6-200 - EXTENSION FEMORAL 200MM GMRS COCR KNEE DISTAL BOTH IP/OP "$6,257.50" "$4,631.00" "$1,241.96" "$6,257.50" "$2,815.88" "$2,815.88" "$2,815.88" "$2,815.88" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.22" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.13" "$6,257.50" "$6,257.50" "$3,084.95" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$4,693.13" "$6,257.50" "$6,257.50" "$6,257.50" "$3,128.75" "$3,128.75" "$4,955.94" "$6,257.50" "$5,006.00" "$2,815.88" "$1,241.96" N/A "$3,629.35" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.06" "$6,257.50" N/A N/A 6495-6-220 SUP HCPCS C1776 6495-6-220 - EXTENSION FEMORAL 220MM GMRS COCR KNEE DISTAL BOTH IP/OP "$6,257.50" "$4,631.00" "$1,241.96" "$6,257.50" "$2,815.88" "$2,815.88" "$2,815.88" "$2,815.88" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.22" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.13" "$6,257.50" "$6,257.50" "$3,084.95" "$6,257.50" "$6,257.50" "$6,257.50" "$6,257.50" "$4,693.13" "$6,257.50" "$6,257.50" "$6,257.50" "$3,128.75" "$3,128.75" "$4,955.94" "$6,257.50" "$5,006.00" "$2,815.88" "$1,241.96" N/A "$3,629.35" "$6,257.50" "$6,257.50" "$6,257.50" "$1,304.06" "$6,257.50" N/A N/A 6500-000-009 SUP Custom 27100030 6500-000-009 - MODEL ANTM CLRVW ADLT SKL BOTH IP/OP "$11,250.00" "$8,325.00" "$2,002.50" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,002.50" "$11,250.00" "$11,250.00" "$4,181.12" "$4,181.12" "$8,671.50" "$2,060.15" "$2,344.62" "$11,250.00" "$4,500.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$7,312.50" "$11,250.00" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$11,250.00" "$11,250.00" N/A N/A 65-0003-S SUP Custom 27803010 65-0003-S - FILLER BN VOID 3ML CALLOS BOTH IP/OP "$2,962.50" "$2,192.00" $527.33 "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" $527.33 "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" $617.42 "$2,962.50" "$1,185.00" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,221.88" "$2,962.50" "$2,962.50" "$2,962.50" "$1,481.25" "$1,481.25" "$2,346.30" "$2,962.50" "$2,370.00" "$1,333.13" "$2,962.50" N/A "$1,718.25" "$2,962.50" "$1,777.50" "$2,962.50" "$2,962.50" "$2,962.50" N/A N/A 65-0005-S SUP Custom 27803010 65-0005-S - SYSTEM BN CMNT 5ML CALLOS INJ BOTH IP/OP "$3,920.00" "$2,901.00" $697.76 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $697.76 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$1,568.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" "$3,920.00" N/A "$2,273.60" "$3,920.00" "$2,352.00" "$3,920.00" "$3,920.00" "$3,920.00" N/A N/A 65-0010-S SUP Custom 27803010 65-0010-S - FILLER BN VOID 10ML CALLOS BOTH IP/OP "$7,750.00" "$5,735.00" "$1,379.50" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$1,379.50" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$1,615.19" "$7,750.00" "$3,100.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$5,812.50" "$7,750.00" "$7,750.00" "$7,750.00" "$3,875.00" "$3,875.00" "$6,138.00" "$7,750.00" "$6,200.00" "$3,487.50" "$7,750.00" N/A "$4,495.00" "$7,750.00" "$4,650.00" "$7,750.00" "$7,750.00" "$7,750.00" N/A N/A 65-0099-S SUP Custom 27203010 65-0099-S - KIT DLV INJ BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 N/A $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 650-1057 SUP HCPCS C1776 650-1057 - HEAD FEM 36MM G7 BLX D OPTN HIP BOTH IP/OP "$10,177.50" "$7,531.00" "$2,019.98" "$10,177.50" "$4,579.88" "$4,579.88" "$4,579.88" "$4,579.88" "$10,177.50" "$10,177.50" "$10,177.50" "$2,121.25" "$10,177.50" "$10,177.50" "$10,177.50" "$10,177.50" "$10,177.50" "$2,121.10" "$10,177.50" "$4,071.00" "$5,017.51" "$10,177.50" "$10,177.50" "$10,177.50" "$10,177.50" "$7,633.13" "$10,177.50" "$10,177.50" "$10,177.50" "$5,088.75" "$5,088.75" "$8,060.58" "$10,177.50" "$8,142.00" "$4,579.88" "$2,019.98" N/A "$5,902.95" "$10,177.50" "$10,177.50" "$10,177.50" "$2,120.99" "$10,177.50" N/A N/A 65-0105-S SUP Custom 27803010 65-0105-S - FILLER BN VOID 5ML CALLOS BOTH IP/OP "$3,920.00" "$2,901.00" $697.76 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $697.76 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$1,568.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" "$3,920.00" N/A "$2,273.60" "$3,920.00" "$2,352.00" "$3,920.00" "$3,920.00" "$3,920.00" N/A N/A 650-1066 SUP HCPCS C1776 650-1066 - SLEEVE FEMORAL STANDARD TAPER TYPE 1 OPTION BIOLOX DELTA BOTH IP/OP "$1,030.00" $762.00 $204.43 "$1,030.00" $463.50 $463.50 $463.50 $463.50 "$1,030.00" "$1,030.00" "$1,030.00" $214.68 "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" $214.66 "$1,030.00" $412.00 $609.25 "$1,030.00" "$1,030.00" "$1,030.00" "$1,030.00" $772.50 "$1,030.00" "$1,030.00" "$1,030.00" $515.00 $515.00 $815.76 "$1,030.00" $824.00 $463.50 $204.43 N/A $597.40 "$1,030.00" "$1,030.00" "$1,030.00" $214.65 "$1,030.00" N/A N/A 65-0110-S SUP Custom 27803010 65-0110-S - FILLER BN VOID 10ML CALLOS BOTH IP/OP "$7,750.00" "$5,735.00" "$1,379.50" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$1,379.50" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$1,615.19" "$7,750.00" "$3,100.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$5,812.50" "$7,750.00" "$7,750.00" "$7,750.00" "$3,875.00" "$3,875.00" "$6,138.00" "$7,750.00" "$6,200.00" "$3,487.50" "$7,750.00" N/A "$4,495.00" "$7,750.00" "$4,650.00" "$7,750.00" "$7,750.00" "$7,750.00" N/A N/A 65-018-E4S SUP Custom 27203010 65-018-E4S - CATHETER INFS 4 4/3FR 65CM CLARIVEIN BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 65-0199-S SUP Custom 27203010 65-0199-S - SYSTEM BONE CMNT IMPCT KIT CALLOS BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 N/A $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A 6515-0814L SUP HCPCS C1776 6515-0814L - STEM FEMORAL -5MM 14MM 205MM BOWED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-0814R SUP HCPCS C1776 6515-0814R - STEM FEMORAL -5MM 14MM 205MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-0915L SUP HCPCS C1776 6515-0915L - STEM FEMORAL -5MM 15MM 205MM BOWED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-0915R SUP HCPCS C1776 6515-0915R - STEM FEMORAL -5MM 15MM 205MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-1016L SUP HCPCS C1776 6515-1016L - STEM FEMORAL -5MM 16MM 205MM BOWED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-1016R SUP HCPCS C1776 6515-1016R - STEM FEMORAL -5MM 16MM 205MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-1117L SUP HCPCS C1776 6515-1117L - STEM FEMORAL -5MM 17MM 205MM BOWED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-1117R SUP HCPCS C1776 6515-1117R - STEM FEMORAL -5MM 17MM 205MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-1218L SUP HCPCS C1776 6515-1218L - STEM REVISION -5MM 18MM 205MM BOWED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-1218R SUP HCPCS C1776 6515-1218R - STEM FEMORAL -5MM 18MM 205MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-1319L SUP HCPCS C1776 6515-1319L - STEM FEMORAL -5MM 19MM 205MM BOWED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-1319R SUP HCPCS C1776 6515-1319R - STEM FEMORAL -5MM 19MM 205MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-1420L SUP HCPCS C1776 6515-1420L - STEM FEMORAL -5MM 20MM 205MM BOWED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-1420R SUP HCPCS C1776 6515-1420R - STEM FEMORAL -5MM 20MM 205MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-1422L SUP HCPCS C1776 6515-1422L - STEM FEMORAL -5MM 22MM 205MM BOWED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6515-1422R SUP HCPCS C1776 6515-1422R - STEM FEMORAL -5MM 22MM 205MM BOWED RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-0814L SUP HCPCS C1776 6516-0814L - STEM FEMORAL -5MM 8 14MM 14MM RED NECK RSTOR HYDRXAPT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-0814R SUP HCPCS C1776 6516-0814R - STEM FEMORAL -5MM 255MM STR RED NECK RSTOR HYDRXAPT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-0915L SUP HCPCS C1776 6516-0915L - NECK FEMORAL 15MM RED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-0915R SUP HCPCS C1776 6516-0915R - STEM FEMORAL 15MM RED NECK RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-1016L SUP HCPCS C1776 6516-1016L - STEM FEMORAL 16MM RED NECK RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-1016R SUP HCPCS C1776 6516-1016R - STEM FEMORAL 16MM REDUCE NECK RSTOR HA HIP RIGHT BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-1117L SUP HCPCS C1776 6516-1117L - STEM FEMORAL -5MM 11 17MM 17MM NO DISTAL SLOT RED NECK BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-1117R SUP HCPCS C1776 6516-1117R - STEM FEMORAL 17MM RED NECK RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-1218L SUP HCPCS C1776 6516-1218L - STEM FEMORAL 18MM RED RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-1218R SUP HCPCS C1776 6516-1218R - STEM FEMORAL -5MM 12MM 18MM 18MM RED NECK NO DISTAL SLOT BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-1319L SUP HCPCS C1776 6516-1319L - STEM FEMORAL 19MM RED NECK RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-1319R SUP HCPCS C1776 6516-1319R - STEM FEMORAL 13 19MM 19MM RED NECK NO DISTAL SLOT RSTOR BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-1420L SUP HCPCS C1776 6516-1420L - STEM FEMORAL 20MM RED NECK RSTOR HYDRXAPT LEFT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-1420R SUP HCPCS C1776 6516-1420R - STEM FEMORAL 20MM RED NECK NO DISTAL SLOT RSTOR HYDRXAPT BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$12,943.13" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-1422L SUP HCPCS C1776 6516-1422L - STEM FEMORAL -5MM 14 22MM 22MM NO DISTAL SLOT RED NECK BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6516-1422R SUP HCPCS C1776 6516-1422R - STEM FEMORAL 22MM RED NECK RSTOR HYDRXAPT RIGHT HIP BOTH IP/OP "$12,943.50" "$9,578.00" "$2,568.89" "$12,943.13" "$5,824.41" "$5,824.41" "$5,824.41" "$5,824.41" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.67" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$2,697.49" "$12,943.13" "$5,177.25" "$6,380.96" "$12,943.13" "$12,943.13" "$12,943.13" "$12,943.13" "$9,707.63" "$12,943.13" "$12,943.13" "$12,943.13" "$6,471.57" "$6,471.57" "$10,250.96" "$12,943.13" "$10,354.50" "$5,824.41" "$2,568.89" N/A "$7,507.23" "$12,943.13" "$7,765.88" "$12,943.13" "$2,697.35" "$12,943.13" N/A N/A 6519-1-028 SUP Custom 27803010 6519-1-028 - HEAD FEM +0MM UNV TPR 28MM STRL BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6519-1-032 SUP Custom 27803010 6519-1-032 - HEAD FEM +0MM UNV TPR 32MM STRL BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6519-1-036 SUP Custom 27803010 6519-1-036 - HEAD FEM +0MM UNV TPR 36MM STRL BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6519-1-040 SUP Custom 27803010 6519-1-040 - HEAD FEM +0MM UNV TPR 40MM STRL BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6519-1-044 SUP Custom 27803010 6519-1-044 - HEAD FEM +0MM UNV TPR 44MM STRL BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6519-T-025 SUP Custom 27803010 6519-T-025 - SLEEVE ADAPTER -2.5MM OFFST UNIVERSAL TAPER V40 TITANIUM HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 6519-T-100 SUP Custom 27803010 6519-T-100 - SLEEVE ADAPTER +0MM OFFST UNIVERSAL TAPER V40 TITANIUM HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 6519-T-204 SUP Custom 27803010 6519-T-204 - SLEEVE ADAPTER +4MM OFFST UNIVERSAL TAPER V40 TITANIUM HIP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A 6522-0509 SUP HCPCS C1776 6522-0509 - NECK FEMORAL 5 -5MM OFFST STR 9MM 145MM REDUCE RSTOR HA HIP BOTH IP/OP "$11,474.50" "$8,491.00" "$2,277.33" "$11,474.13" "$5,163.36" "$5,163.36" "$5,163.36" "$5,163.36" "$11,474.13" "$11,474.13" "$11,474.13" "$2,391.50" "$11,474.13" "$11,474.13" "$11,474.13" "$11,474.13" "$11,474.13" "$2,391.33" "$11,474.13" "$4,589.65" "$5,656.75" "$11,474.13" "$11,474.13" "$11,474.13" "$11,474.13" "$8,605.88" "$11,474.13" "$11,474.13" "$11,474.13" "$5,737.07" "$5,737.07" "$9,087.51" "$11,474.13" "$9,179.30" "$5,163.36" "$2,277.33" N/A "$6,655.21" "$11,474.13" "$11,474.13" "$11,474.13" "$2,391.21" "$11,474.13" N/A N/A 6522-0511 SUP HCPCS C1776 6522-0511 - NECK FEMORAL 5 -5MM STR 11MM 145MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$11,474.50" "$8,491.00" "$2,277.33" "$11,474.13" "$5,163.36" "$5,163.36" "$5,163.36" "$5,163.36" "$11,474.13" "$11,474.13" "$11,474.13" "$2,391.50" "$11,474.13" "$11,474.13" "$11,474.13" "$11,474.13" "$11,474.13" "$2,391.33" "$11,474.13" "$4,589.65" "$5,656.75" "$11,474.13" "$11,474.13" "$11,474.13" "$11,474.13" "$8,605.88" "$11,474.13" "$11,474.13" "$11,474.13" "$5,737.07" "$5,737.07" "$9,087.51" "$11,474.13" "$9,179.30" "$5,163.36" "$2,277.33" N/A "$6,655.21" "$11,474.13" "$11,474.13" "$11,474.13" "$2,391.21" "$11,474.13" N/A N/A 6522-0610 SUP HCPCS C1776 6522-0610 - NECK FEMORAL 6 -5MM OFFST STR 10MM 145MM REDUCE RSTOR HA HIP BOTH IP/OP "$11,474.50" "$8,491.00" "$2,277.33" "$11,474.13" "$5,163.36" "$5,163.36" "$5,163.36" "$5,163.36" "$11,474.13" "$11,474.13" "$11,474.13" "$2,391.50" "$11,474.13" "$11,474.13" "$11,474.13" "$11,474.13" "$11,474.13" "$2,391.33" "$11,474.13" "$4,589.65" "$5,656.75" "$11,474.13" "$11,474.13" "$11,474.13" "$11,474.13" "$8,605.88" "$11,474.13" "$11,474.13" "$11,474.13" "$5,737.07" "$5,737.07" "$9,087.51" "$11,474.13" "$9,179.30" "$5,163.36" "$2,277.33" N/A "$6,655.21" "$11,474.13" "$11,474.13" "$11,474.13" "$2,391.21" "$11,474.13" N/A N/A 6522-0612 SUP HCPCS C1776 6522-0612 - NECK FEMORAL 6 -5MM OFFST STR 12MM 145MM REDUCE RSTOR HA HIP BOTH IP/OP "$11,474.50" "$8,491.00" "$2,277.33" "$11,474.13" "$5,163.36" "$5,163.36" "$5,163.36" "$5,163.36" "$11,474.13" "$11,474.13" "$11,474.13" "$2,391.50" "$11,474.13" "$11,474.13" "$11,474.13" "$11,474.13" "$11,474.13" "$2,391.33" "$11,474.13" "$4,589.65" "$5,656.75" "$11,474.13" "$11,474.13" "$11,474.13" "$11,474.13" "$8,605.88" "$11,474.13" "$11,474.13" "$11,474.13" "$5,737.07" "$5,737.07" "$9,087.51" "$11,474.13" "$9,179.30" "$5,163.36" "$2,277.33" N/A "$6,655.21" "$11,474.13" "$11,474.13" "$11,474.13" "$2,391.21" "$11,474.13" N/A N/A 6522-0711 SUP HCPCS C1776 6522-0711 - STEM FEMORAL C TAPER 145MM RSTOR HA HIP BOTH IP/OP "$10,684.50" "$7,907.00" "$2,120.58" "$10,684.38" "$4,807.97" "$4,807.97" "$4,807.97" "$4,807.97" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.89" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.74" "$10,684.38" "$4,273.75" "$5,267.40" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$8,013.38" "$10,684.38" "$10,684.38" "$10,684.38" "$5,342.19" "$5,342.19" "$8,462.03" "$10,684.38" "$8,547.50" "$4,807.97" "$2,120.58" N/A "$6,197.01" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.62" "$10,684.38" N/A N/A 6522-0713 SUP HCPCS C1776 6522-0713 - STEM FEMORAL C TAPER 145MM RSTOR HA HIP BOTH IP/OP "$10,684.50" "$7,907.00" "$2,120.58" "$10,684.38" "$4,807.97" "$4,807.97" "$4,807.97" "$4,807.97" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.89" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.74" "$10,684.38" "$4,273.75" "$5,267.40" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$8,013.38" "$10,684.38" "$10,684.38" "$10,684.38" "$5,342.19" "$5,342.19" "$8,462.03" "$10,684.38" "$8,547.50" "$4,807.97" "$2,120.58" N/A "$6,197.01" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.62" "$10,684.38" N/A N/A 6522-0812 SUP HCPCS C1776 6522-0812 - STEM FEMORAL C TAPER 145MM RSTOR HA HIP BOTH IP/OP "$10,684.50" "$7,907.00" "$2,120.58" "$10,684.38" "$4,807.97" "$4,807.97" "$4,807.97" "$4,807.97" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.89" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.74" "$10,684.38" "$10,684.38" "$5,267.40" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$8,013.38" "$10,684.38" "$10,684.38" "$10,684.38" "$5,342.19" "$5,342.19" "$8,462.03" "$10,684.38" "$8,547.50" "$4,807.97" "$2,120.58" N/A "$6,197.01" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.62" "$10,684.38" N/A N/A 6522-0814 SUP HCPCS C1776 6522-0814 - STEM FEMORAL C TAPER 145MM RSTOR HA HIP BOTH IP/OP "$10,684.50" "$7,907.00" "$2,120.58" "$10,684.38" "$4,807.97" "$4,807.97" "$4,807.97" "$4,807.97" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.89" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.74" "$10,684.38" "$10,684.38" "$5,267.40" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$8,013.38" "$10,684.38" "$10,684.38" "$10,684.38" "$5,342.19" "$5,342.19" "$8,462.03" "$10,684.38" "$8,547.50" "$4,807.97" "$2,120.58" N/A "$6,197.01" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.62" "$10,684.38" N/A N/A 6522-0913 SUP HCPCS C1776 6522-0913 - STEM FEMORAL C TAPER 145MM RSTOR HA HIP BOTH IP/OP "$10,684.50" "$7,907.00" "$2,120.58" "$10,684.38" "$4,807.97" "$4,807.97" "$4,807.97" "$4,807.97" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.89" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.74" "$10,684.38" "$4,273.75" "$5,267.40" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$8,013.38" "$10,684.38" "$10,684.38" "$10,684.38" "$5,342.19" "$5,342.19" "$8,462.03" "$10,684.38" "$8,547.50" "$4,807.97" "$2,120.58" N/A "$6,197.01" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.62" "$10,684.38" N/A N/A 6522-0915 SUP HCPCS C1776 6522-0915 - STEM FEMORAL C TAPER 145MM RSTOR HA HIP BOTH IP/OP "$10,684.50" "$7,907.00" "$2,120.58" "$10,684.38" "$4,807.97" "$4,807.97" "$4,807.97" "$4,807.97" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.89" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.74" "$10,684.38" "$4,273.75" "$5,267.40" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$8,013.38" "$10,684.38" "$10,684.38" "$10,684.38" "$5,342.19" "$5,342.19" "$8,462.03" "$10,684.38" "$8,547.50" "$4,807.97" "$2,120.58" N/A "$6,197.01" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.62" "$10,684.38" N/A N/A 6522-1014 SUP HCPCS C1776 6522-1014 - STEM FEMORAL C TAPER 145MM RSTOR HA HIP BOTH IP/OP "$10,684.50" "$7,907.00" "$2,120.58" "$10,684.38" "$4,807.97" "$4,807.97" "$4,807.97" "$4,807.97" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.89" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.74" "$10,684.38" "$4,273.75" "$5,267.40" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$8,013.38" "$10,684.38" "$10,684.38" "$10,684.38" "$5,342.19" "$5,342.19" "$8,462.03" "$10,684.38" "$8,547.50" "$4,807.97" "$2,120.58" N/A "$6,197.01" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.62" "$10,684.38" N/A N/A 6522-1016 SUP HCPCS C1776 6522-1016 - STEM FEMORAL C TAPER 145MM RSTOR HA HIP BOTH IP/OP "$10,684.50" "$7,907.00" "$2,120.58" "$10,684.38" "$4,807.97" "$4,807.97" "$4,807.97" "$4,807.97" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.89" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.74" "$10,684.38" "$10,684.38" "$5,267.40" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$8,013.38" "$10,684.38" "$10,684.38" "$10,684.38" "$5,342.19" "$5,342.19" "$8,462.03" "$10,684.38" "$8,547.50" "$4,807.97" "$2,120.58" N/A "$6,197.01" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.62" "$10,684.38" N/A N/A 6522-1115 SUP HCPCS C1776 6522-1115 - STEM FEMORAL C TAPER 145MM RSTOR HA HIP BOTH IP/OP "$10,684.50" "$7,907.00" "$2,120.58" "$10,684.38" "$4,807.97" "$4,807.97" "$4,807.97" "$4,807.97" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.89" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.74" "$10,684.38" "$10,684.38" "$5,267.40" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$8,013.38" "$10,684.38" "$10,684.38" "$10,684.38" "$5,342.19" "$5,342.19" "$8,462.03" "$10,684.38" "$8,547.50" "$4,807.97" "$2,120.58" N/A "$6,197.01" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.62" "$10,684.38" N/A N/A 6522-1117 SUP HCPCS C1776 6522-1117 - STEM FEMORAL C TAPER 145MM RSTOR HA HIP BOTH IP/OP "$10,684.50" "$7,907.00" "$2,120.58" "$10,684.38" "$4,807.97" "$4,807.97" "$4,807.97" "$4,807.97" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.89" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.74" "$10,684.38" "$4,273.75" "$5,267.40" "$10,684.38" "$10,684.38" "$10,684.38" "$10,684.38" "$8,013.38" "$10,684.38" "$10,684.38" "$10,684.38" "$5,342.19" "$5,342.19" "$8,462.03" "$10,684.38" "$8,547.50" "$4,807.97" "$2,120.58" N/A "$6,197.01" "$10,684.38" "$10,684.38" "$10,684.38" "$2,226.62" "$10,684.38" N/A N/A 6523-0509 SUP HCPCS C1776 6523-0509 - NECK FEMORAL 5 -5MM OFFST STR 9MM 175MM REDUCE RSTOR HA HIP BOTH IP/OP "$12,150.50" "$8,991.00" "$2,411.50" "$12,150.13" "$5,467.56" "$5,467.56" "$5,467.56" "$5,467.56" "$12,150.13" "$12,150.13" "$12,150.13" "$2,532.39" "$12,150.13" "$12,150.13" "$12,150.13" "$12,150.13" "$12,150.13" "$2,532.22" "$12,150.13" "$4,860.05" "$5,990.01" "$12,150.13" "$12,150.13" "$12,150.13" "$12,150.13" "$9,112.88" "$12,150.13" "$12,150.13" "$12,150.13" "$6,075.07" "$6,075.07" "$9,622.90" "$12,150.13" "$9,720.10" "$5,467.56" "$2,411.50" N/A "$7,047.29" "$12,150.13" "$12,150.13" "$12,150.13" "$2,532.09" "$12,150.13" N/A N/A 6523-0511 SUP HCPCS C1776 6523-0511 - NECK FEMORAL 5 -5MM STR 11MM 175MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,150.50" "$8,991.00" "$2,411.50" "$12,150.13" "$5,467.56" "$5,467.56" "$5,467.56" "$5,467.56" "$12,150.13" "$12,150.13" "$12,150.13" "$2,532.39" "$12,150.13" "$12,150.13" "$12,150.13" "$12,150.13" "$12,150.13" "$2,532.22" "$12,150.13" "$4,860.05" "$5,990.01" "$12,150.13" "$12,150.13" "$12,150.13" "$12,150.13" "$9,112.88" "$12,150.13" "$12,150.13" "$12,150.13" "$6,075.07" "$6,075.07" "$9,622.90" "$12,150.13" "$9,720.10" "$5,467.56" "$2,411.50" N/A "$7,047.29" "$12,150.13" "$12,150.13" "$12,150.13" "$2,532.09" "$12,150.13" N/A N/A 6523-0610 SUP HCPCS C1776 6523-0610 - NECK FEMORAL 6 -5MM STR 10MM 175MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,150.50" "$8,991.00" "$2,411.50" "$12,150.13" "$5,467.56" "$5,467.56" "$5,467.56" "$5,467.56" "$12,150.13" "$12,150.13" "$12,150.13" "$2,532.39" "$12,150.13" "$12,150.13" "$12,150.13" "$12,150.13" "$12,150.13" "$2,532.22" "$12,150.13" "$12,150.13" "$5,990.01" "$12,150.13" "$12,150.13" "$12,150.13" "$12,150.13" "$9,112.88" "$12,150.13" "$12,150.13" "$12,150.13" "$6,075.07" "$6,075.07" "$9,622.90" "$12,150.13" "$9,720.10" "$5,467.56" "$2,411.50" N/A "$7,047.29" "$12,150.13" "$12,150.13" "$12,150.13" "$2,532.09" "$12,150.13" N/A N/A 6523-0612 SUP HCPCS C1776 6523-0612 - NECK FEMORAL 6 -5MM OFFST STR 12MM 175MM REDUCE RSTOR HA HIP BOTH IP/OP "$12,150.50" "$8,991.00" "$2,411.50" "$12,150.13" "$5,467.56" "$5,467.56" "$5,467.56" "$5,467.56" "$12,150.13" "$12,150.13" "$12,150.13" "$2,532.39" "$12,150.13" "$12,150.13" "$12,150.13" "$12,150.13" "$12,150.13" "$2,532.22" "$12,150.13" "$12,150.13" "$5,990.01" "$12,150.13" "$12,150.13" "$12,150.13" "$12,150.13" "$9,112.88" "$12,150.13" "$12,150.13" "$12,150.13" "$6,075.07" "$6,075.07" "$9,622.90" "$12,150.13" "$9,720.10" "$5,467.56" "$2,411.50" N/A "$7,047.29" "$12,150.13" "$12,150.13" "$12,150.13" "$2,532.09" "$12,150.13" N/A N/A 6523-0711 SUP HCPCS C1776 6523-0711 - STEM FEMORAL C TAPER 175MM RSTOR HA HIP BOTH IP/OP "$11,313.50" "$8,372.00" "$2,245.40" "$11,313.25" "$5,090.96" "$5,090.96" "$5,090.96" "$5,090.96" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.96" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.81" "$11,313.25" "$11,313.25" "$5,577.43" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$8,485.13" "$11,313.25" "$11,313.25" "$11,313.25" "$5,656.63" "$5,656.63" "$8,960.09" "$11,313.25" "$9,050.60" "$5,090.96" "$2,245.40" N/A "$6,561.83" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.68" "$11,313.25" N/A N/A 6523-0713 SUP HCPCS C1776 6523-0713 - STEM FEMORAL C TAPER 175MM RSTOR HA HIP BOTH IP/OP "$11,313.50" "$8,372.00" "$2,245.40" "$11,313.25" "$5,090.96" "$5,090.96" "$5,090.96" "$5,090.96" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.96" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.81" "$11,313.25" "$4,525.30" "$5,577.43" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$8,485.13" "$11,313.25" "$11,313.25" "$11,313.25" "$5,656.63" "$5,656.63" "$8,960.09" "$11,313.25" "$9,050.60" "$5,090.96" "$2,245.40" N/A "$6,561.83" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.68" "$11,313.25" N/A N/A 6523-0812 SUP HCPCS C1776 6523-0812 - STEM FEMORAL C TAPER 175MM RSTOR HA HIP BOTH IP/OP "$11,313.50" "$8,372.00" "$2,245.40" "$11,313.25" "$5,090.96" "$5,090.96" "$5,090.96" "$5,090.96" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.96" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.81" "$11,313.25" "$4,525.30" "$5,577.43" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$8,485.13" "$11,313.25" "$11,313.25" "$11,313.25" "$5,656.63" "$5,656.63" "$8,960.09" "$11,313.25" "$9,050.60" "$5,090.96" "$2,245.40" N/A "$6,561.83" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.68" "$11,313.25" N/A N/A 6523-0814 SUP HCPCS C1776 6523-0814 - STEM FEMORAL C TAPER 175MM RSTOR HA HIP BOTH IP/OP "$11,313.50" "$8,372.00" "$2,245.40" "$11,313.25" "$5,090.96" "$5,090.96" "$5,090.96" "$5,090.96" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.96" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.81" "$11,313.25" "$4,525.30" "$5,577.43" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$8,485.13" "$11,313.25" "$11,313.25" "$11,313.25" "$5,656.63" "$5,656.63" "$8,960.09" "$11,313.25" "$9,050.60" "$5,090.96" "$2,245.40" N/A "$6,561.83" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.68" "$11,313.25" N/A N/A 6523-0913 SUP HCPCS C1776 6523-0913 - STEM FEMORAL C TAPER 175MM RSTOR HA HIP BOTH IP/OP "$11,313.50" "$8,372.00" "$2,245.40" "$11,313.25" "$5,090.96" "$5,090.96" "$5,090.96" "$5,090.96" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.96" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.81" "$11,313.25" "$11,313.25" "$5,577.43" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$8,485.13" "$11,313.25" "$11,313.25" "$11,313.25" "$5,656.63" "$5,656.63" "$8,960.09" "$11,313.25" "$9,050.60" "$5,090.96" "$2,245.40" N/A "$6,561.83" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.68" "$11,313.25" N/A N/A 6523-0915 SUP HCPCS C1776 6523-0915 - STEM FEMORAL C TAPER 175MM RSTOR HA HIP BOTH IP/OP "$11,313.50" "$8,372.00" "$2,245.40" "$11,313.25" "$5,090.96" "$5,090.96" "$5,090.96" "$5,090.96" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.96" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.81" "$11,313.25" "$11,313.25" "$5,577.43" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$8,485.13" "$11,313.25" "$11,313.25" "$11,313.25" "$5,656.63" "$5,656.63" "$8,960.09" "$11,313.25" "$9,050.60" "$5,090.96" "$2,245.40" N/A "$6,561.83" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.68" "$11,313.25" N/A N/A 6523-1014 SUP HCPCS C1776 6523-1014 - STEM FEMORAL C TAPER 175MM RSTOR HA HIP BOTH IP/OP "$11,313.50" "$8,372.00" "$2,245.40" "$11,313.25" "$5,090.96" "$5,090.96" "$5,090.96" "$5,090.96" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.96" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.81" "$11,313.25" "$4,525.30" "$5,577.43" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$8,485.13" "$11,313.25" "$11,313.25" "$11,313.25" "$5,656.63" "$5,656.63" "$8,960.09" "$11,313.25" "$9,050.60" "$5,090.96" "$2,245.40" N/A "$6,561.83" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.68" "$11,313.25" N/A N/A 6523-1016 SUP HCPCS C1776 6523-1016 - STEM FEMORAL C TAPER 175MM RSTOR HA HIP BOTH IP/OP "$11,313.50" "$8,372.00" "$2,245.40" "$11,313.25" "$5,090.96" "$5,090.96" "$5,090.96" "$5,090.96" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.96" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.81" "$11,313.25" "$4,525.30" "$5,577.43" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$8,485.13" "$11,313.25" "$11,313.25" "$11,313.25" "$5,656.63" "$5,656.63" "$8,960.09" "$11,313.25" "$9,050.60" "$5,090.96" "$2,245.40" N/A "$6,561.83" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.68" "$11,313.25" N/A N/A 6523-1115 SUP HCPCS C1776 6523-1115 - STEM FEMORAL C TAPER 175MM RSTOR HA HIP BOTH IP/OP "$11,313.50" "$8,372.00" "$2,245.40" "$11,313.25" "$5,090.96" "$5,090.96" "$5,090.96" "$5,090.96" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.96" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.81" "$11,313.25" "$4,525.30" "$5,577.43" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$8,485.13" "$11,313.25" "$11,313.25" "$11,313.25" "$5,656.63" "$5,656.63" "$8,960.09" "$11,313.25" "$9,050.60" "$5,090.96" "$2,245.40" N/A "$6,561.83" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.68" "$11,313.25" N/A N/A 6523-1117 SUP HCPCS C1776 6523-1117 - STEM FEMORAL C TAPER 175MM RSTOR HA HIP BOTH IP/OP "$11,313.50" "$8,372.00" "$2,245.40" "$11,313.25" "$5,090.96" "$5,090.96" "$5,090.96" "$5,090.96" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.96" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.81" "$11,313.25" "$11,313.25" "$5,577.43" "$11,313.25" "$11,313.25" "$11,313.25" "$11,313.25" "$8,485.13" "$11,313.25" "$11,313.25" "$11,313.25" "$5,656.63" "$5,656.63" "$8,960.09" "$11,313.25" "$9,050.60" "$5,090.96" "$2,245.40" N/A "$6,561.83" "$11,313.25" "$11,313.25" "$11,313.25" "$2,357.68" "$11,313.25" N/A N/A 6524-0511L SUP HCPCS C1776 6524-0511L - STEM FEMORAL 5/11MM BOW 205MM RSTOR HA LEFT BOTH IP/OP "$11,939.00" "$8,835.00" "$2,369.57" "$11,938.88" "$5,372.50" "$5,372.50" "$5,372.50" "$5,372.50" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.36" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.19" "$11,938.88" "$11,938.88" "$5,885.87" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$8,954.25" "$11,938.88" "$11,938.88" "$11,938.88" "$5,969.44" "$5,969.44" "$9,455.59" "$11,938.88" "$9,551.10" "$5,372.50" "$2,369.57" N/A "$6,924.62" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.06" "$11,938.88" N/A N/A 6524-0511R SUP HCPCS C1776 6524-0511R - STEM FEMORAL 205MM BOWED RSTOR HYDRXAPT RIGHT BOTH IP/OP "$11,939.00" "$8,835.00" "$2,369.57" "$11,938.88" "$5,372.50" "$5,372.50" "$5,372.50" "$5,372.50" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.36" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.19" "$11,938.88" "$11,938.88" "$5,885.87" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$8,954.25" "$11,938.88" "$11,938.88" "$11,938.88" "$5,969.44" "$5,969.44" "$9,455.59" "$11,938.88" "$9,551.10" "$5,372.50" "$2,369.57" N/A "$6,924.62" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.06" "$11,938.88" N/A N/A 6524-0612L SUP HCPCS C1776 6524-0612L - STEM FEMORAL 6/12MM BOW 205MM RSTOR HA LEFT BOTH IP/OP "$11,939.00" "$8,835.00" "$2,369.57" "$11,938.88" "$5,372.50" "$5,372.50" "$5,372.50" "$5,372.50" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.36" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.19" "$11,938.88" "$4,775.55" "$5,885.87" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$8,954.25" "$11,938.88" "$11,938.88" "$11,938.88" "$5,969.44" "$5,969.44" "$9,455.59" "$11,938.88" "$9,551.10" "$5,372.50" "$2,369.57" N/A "$6,924.62" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.06" "$11,938.88" N/A N/A 6524-0612R SUP HCPCS C1776 6524-0612R - STEM FEMORAL 205MM BOWED RSTOR HYDRXAPT RIGHT BOTH IP/OP "$11,939.00" "$8,835.00" "$2,369.57" "$11,938.88" "$5,372.50" "$5,372.50" "$5,372.50" "$5,372.50" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.36" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.19" "$11,938.88" "$4,775.55" "$5,885.87" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$8,954.25" "$11,938.88" "$11,938.88" "$11,938.88" "$5,969.44" "$5,969.44" "$9,455.59" "$11,938.88" "$9,551.10" "$5,372.50" "$2,369.57" N/A "$6,924.62" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.06" "$11,938.88" N/A N/A 6524-0713L SUP HCPCS C1776 6524-0713L - STEM FEMORAL 7/13MM BOW 205MM RSTOR HA LEFT BOTH IP/OP "$12,161.50" "$9,000.00" "$2,413.75" "$12,161.50" "$5,472.68" "$5,472.68" "$5,472.68" "$5,472.68" "$12,161.50" "$12,161.50" "$12,161.50" "$2,534.76" "$12,161.50" "$12,161.50" "$12,161.50" "$12,161.50" "$12,161.50" "$2,534.59" "$12,161.50" "$4,864.60" "$5,995.62" "$12,161.50" "$12,161.50" "$12,161.50" "$12,161.50" "$9,121.13" "$12,161.50" "$12,161.50" "$12,161.50" "$6,080.75" "$6,080.75" "$9,631.91" "$12,161.50" "$9,729.20" "$5,472.68" "$2,413.75" N/A "$7,053.67" "$12,161.50" "$12,161.50" "$12,161.50" "$2,534.46" "$12,161.50" N/A N/A 6524-0713R SUP HCPCS C1776 6524-0713R - STEM FEMORAL 205MM BOWED RSTOR HYDRXAPT RIGHT BOTH IP/OP "$11,939.00" "$8,835.00" "$2,369.57" "$11,938.88" "$5,372.50" "$5,372.50" "$5,372.50" "$5,372.50" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.36" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.19" "$11,938.88" "$11,938.88" "$5,885.87" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$8,954.25" "$11,938.88" "$11,938.88" "$11,938.88" "$5,969.44" "$5,969.44" "$9,455.59" "$11,938.88" "$9,551.10" "$5,372.50" "$2,369.57" N/A "$6,924.62" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.06" "$11,938.88" N/A N/A 6524-0814L SUP HCPCS C1776 6524-0814L - STEM FEMORAL 8/14MM BOW 205MM RSTOR HA LEFT BOTH IP/OP "$11,939.00" "$8,835.00" "$2,369.57" "$11,938.88" "$5,372.50" "$5,372.50" "$5,372.50" "$5,372.50" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.36" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.19" "$11,938.88" "$4,775.55" "$5,885.87" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$8,954.25" "$11,938.88" "$11,938.88" "$11,938.88" "$5,969.44" "$5,969.44" "$9,455.59" "$11,938.88" "$9,551.10" "$5,372.50" "$2,369.57" N/A "$6,924.62" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.06" "$11,938.88" N/A N/A 6524-0814R SUP HCPCS C1776 6524-0814R - STEM FEMORAL 205MM BOWED RSTOR HYDRXAPT RIGHT BOTH IP/OP "$11,939.00" "$8,835.00" "$2,369.57" "$11,938.88" "$5,372.50" "$5,372.50" "$5,372.50" "$5,372.50" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.36" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.19" "$11,938.88" "$4,775.55" "$5,885.87" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$8,954.25" "$11,938.88" "$11,938.88" "$11,938.88" "$5,969.44" "$5,969.44" "$9,455.59" "$11,938.88" "$9,551.10" "$5,372.50" "$2,369.57" N/A "$6,924.62" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.06" "$11,938.88" N/A N/A 6524-0915L SUP HCPCS C1776 6524-0915L - STEM FEMORAL 9/15MM BOW 205MM RSTOR HA LEFT BOTH IP/OP "$11,939.00" "$8,835.00" "$2,369.57" "$11,938.88" "$5,372.50" "$5,372.50" "$5,372.50" "$5,372.50" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.36" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.19" "$11,938.88" "$4,775.55" "$5,885.87" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$8,954.25" "$11,938.88" "$11,938.88" "$11,938.88" "$5,969.44" "$5,969.44" "$9,455.59" "$11,938.88" "$9,551.10" "$5,372.50" "$2,369.57" N/A "$6,924.62" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.06" "$11,938.88" N/A N/A 6524-0915R SUP HCPCS C1776 6524-0915R - STEM FEMORAL 205MM BOWED RSTOR HYDRXAPT RIGHT BOTH IP/OP "$11,939.00" "$8,835.00" "$2,369.57" "$11,938.88" "$5,372.50" "$5,372.50" "$5,372.50" "$5,372.50" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.36" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.19" "$11,938.88" "$11,938.88" "$5,885.87" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$8,954.25" "$11,938.88" "$11,938.88" "$11,938.88" "$5,969.44" "$5,969.44" "$9,455.59" "$11,938.88" "$9,551.10" "$5,372.50" "$2,369.57" N/A "$6,924.62" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.06" "$11,938.88" N/A N/A 6524-1016L SUP HCPCS C1776 6524-1016L - STEM FEMORAL 10/16MM BOW 205MM RSTOR HA LEFT BOTH IP/OP "$11,939.00" "$8,835.00" "$2,369.57" "$11,938.88" "$5,372.50" "$5,372.50" "$5,372.50" "$5,372.50" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.36" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.19" "$11,938.88" "$11,938.88" "$5,885.87" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$8,954.25" "$11,938.88" "$11,938.88" "$11,938.88" "$5,969.44" "$5,969.44" "$9,455.59" "$11,938.88" "$9,551.10" "$5,372.50" "$2,369.57" N/A "$6,924.62" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.06" "$11,938.88" N/A N/A 6524-1016R SUP HCPCS C1776 6524-1016R - STEM FEMORAL 205MM BOWED RSTOR HYDRXAPT RIGHT BOTH IP/OP "$11,939.00" "$8,835.00" "$2,369.57" "$11,938.88" "$5,372.50" "$5,372.50" "$5,372.50" "$5,372.50" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.36" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.19" "$11,938.88" "$11,938.88" "$5,885.87" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$8,954.25" "$11,938.88" "$11,938.88" "$11,938.88" "$5,969.44" "$5,969.44" "$9,455.59" "$11,938.88" "$9,551.10" "$5,372.50" "$2,369.57" N/A "$6,924.62" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.06" "$11,938.88" N/A N/A 6524-1117L SUP HCPCS C1776 6524-1117L - STEM FEMORAL 11/17MM BOW 205MM RSTOR HA LEFT BOTH IP/OP "$11,939.00" "$8,835.00" "$2,369.57" "$11,938.88" "$5,372.50" "$5,372.50" "$5,372.50" "$5,372.50" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.36" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.19" "$11,938.88" "$4,775.55" "$5,885.87" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$8,954.25" "$11,938.88" "$11,938.88" "$11,938.88" "$5,969.44" "$5,969.44" "$9,455.59" "$11,938.88" "$9,551.10" "$5,372.50" "$2,369.57" N/A "$6,924.62" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.06" "$11,938.88" N/A N/A 6524-1117R SUP HCPCS C1776 6524-1117R - STEM FEMORAL 205MM BOWED RSTOR HYDRXAPT RIGHT BOTH IP/OP "$11,939.00" "$8,835.00" "$2,369.57" "$11,938.88" "$5,372.50" "$5,372.50" "$5,372.50" "$5,372.50" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.36" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.19" "$11,938.88" "$4,775.55" "$5,885.87" "$11,938.88" "$11,938.88" "$11,938.88" "$11,938.88" "$8,954.25" "$11,938.88" "$11,938.88" "$11,938.88" "$5,969.44" "$5,969.44" "$9,455.59" "$11,938.88" "$9,551.10" "$5,372.50" "$2,369.57" N/A "$6,924.62" "$11,938.88" "$11,938.88" "$11,938.88" "$2,488.06" "$11,938.88" N/A N/A 6528-0511 SUP HCPCS C1776 6528-0511 - STEM FEMORAL 5/11 175MM CALCAR I REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$5,075.85" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6528-0612 SUP HCPCS C1776 6528-0612 - STEM FEMORAL 6/12 175MM CALCAR I REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$12,689.63" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6528-0713 SUP HCPCS C1776 6528-0713 - STEM FEMORAL 7/13 175MM CALCAR I REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$12,689.63" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6528-0814 SUP HCPCS C1776 6528-0814 - STEM FEMORAL 8/14 175MM CALCAR I REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$12,689.63" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6528-0915 SUP HCPCS C1776 6528-0915 - STEM FEMORAL 9/15 175MM CALCAR I REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$12,689.63" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6528-1016 SUP HCPCS C1776 6528-1016 - STEM FEMORAL 10/16 175MM CALCAR I REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$12,689.63" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6528-1117 SUP HCPCS C1776 6528-1117 - STEM FEMORAL 11/17 175MM CALCAR I REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$12,689.63" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6528-1218 SUP HCPCS C1776 6528-1218 - STEM FEMORAL 12/18 175MM CALCAR I REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$12,689.63" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6529-0511 SUP HCPCS C1776 6529-0511 - STEM FEMORAL 5/11 175MM CALCAR II REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$12,689.63" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6529-0612 SUP HCPCS C1776 6529-0612 - STEM FEMORAL 6/12 175MM CALCAR II REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$12,689.63" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6529-0713 SUP HCPCS C1776 6529-0713 - STEM FEMORAL 7/13 175MM CALCAR II REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$12,689.63" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6529-0814 SUP HCPCS C1776 6529-0814 - STEM FEMORAL 8/14 175MM CALCAR II REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$12,689.63" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6529-0915 SUP HCPCS C1776 6529-0915 - STEM FEMORAL 9/15 175MM CALCAR II REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$12,689.63" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6529-1016 SUP HCPCS C1776 6529-1016 - STEM FEMORAL 10/16 175MM CALCAR II REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$12,689.63" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6529-1117 SUP HCPCS C1776 6529-1117 - STEM FEMORAL 11/17 175MM CALCAR II REDUCE NECK CEMENTED BOTH IP/OP "$12,690.00" "$9,391.00" "$2,518.57" "$12,689.63" "$5,710.33" "$5,710.33" "$5,710.33" "$5,710.33" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.84" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.66" "$12,689.63" "$12,689.63" "$6,255.99" "$12,689.63" "$12,689.63" "$12,689.63" "$12,689.63" "$9,517.50" "$12,689.63" "$12,689.63" "$12,689.63" "$6,344.82" "$6,344.82" "$10,050.19" "$12,689.63" "$10,151.70" "$5,710.33" "$2,518.57" N/A "$7,360.20" "$12,689.63" "$12,689.63" "$12,689.63" "$2,644.52" "$12,689.63" N/A N/A 6565-0-028 SUP Custom 27803010 6565-0-028 - HEAD FEMORAL -2.7MM OFFST TAPER 28MM V40 ALUM CERAMIC HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6565-0-032 SUP Custom 27803010 6565-0-032 - HEAD FEMORAL -4MM OFFST TAPER 32MM V40 ALUM CERAMIC HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6565-0-036 SUP Custom 27803010 6565-0-036 - HEAD FEMORAL -5MM OFFST TAPER 36MM V40 ALUM CERAMIC HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6565-0-128 SUP Custom 27803010 6565-0-128 - HEAD FEMORAL +0MM OFFST TAPER 28MM V40 ALUM CERAMIC HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6565-0-132 SUP Custom 27803010 6565-0-132 - HEAD FEM +0MM OFST TPR 32MM STRL V40 AL CERM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6565-0-136 SUP Custom 27803010 6565-0-136 - HEAD FEMORAL +0MM OFFST TAPER 36MM V40 ALUM CERAMIC HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6565-0-228 SUP Custom 27803010 6565-0-228 - HEAD FEMORAL +4MM OFFST TAPER 28MM V40 ALUM CERAMIC HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6565-0-232 SUP Custom 27803010 6565-0-232 - HEAD FEMORAL +4MM OFFST TAPER 32MM V40 ALUM CERAMIC HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6565-0-236 SUP Custom 27803010 6565-0-236 - HEAD FEM +5MM OFST TPR 36MM STRL V40 AL CERM HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6570-0-028 SUP Custom 27803010 6570-0-028 - HEAD FEM -4MM OFST TPR 28MM STRL V40 BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6570-0-032 SUP Custom 27803010 6570-0-032 - HEAD FEM -4MM OFST TPR 32MM STRL V40 BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6570-0-036 SUP Custom 27803010 6570-0-036 - HEAD FEM -5MM OFST TPR 36MM V40 ANTM BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6570-0-128 SUP Custom 27803010 6570-0-128 - HEAD FEMORAL 0MM OFFST TAPER 28MM V40 BIOLOX DELTA HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6570-0-132 SUP Custom 27803010 6570-0-132 - HEAD FEM +0MM OFST TPR 32MM V40 BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6570-0-136 SUP Custom 27803010 6570-0-136 - HEAD FEM +0MM OFST TPR 36MM V40 ANTM BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6570-0-228 SUP Custom 27803010 6570-0-228 - HEAD FEM +4MM OFST TPR 28MM STRL V40 BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6570-0-232 SUP Custom 27803010 6570-0-232 - HEAD FEM +4MM OFST TPR 32MM STRL V40 BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6570-0-236 SUP Custom 27803010 6570-0-236 - HEAD FEM +5MM OFST TPR 36MM V40 ANTM BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6570-0-328 SUP Custom 27803010 6570-0-328 - HEAD FEM -2.7MM OFST TPR 28MM STRL V40 BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6570-0-436 SUP Custom 27803010 6570-0-436 - HEAD FEM -2.5MM OFST TPR 36MM V40 ANTM BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6570-0-536 SUP Custom 27803010 6570-0-536 - HEAD FEM +2.5MM OFST TPR 36MM V40 ANTM BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 6570-0-736 SUP Custom 27803010 6570-0-736 - HEAD FEM +7.5MM OFST TPR 36MM STRL V40 BLX D HIP BOTH IP/OP "$1,725.00" "$1,277.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $307.05 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" $359.51 "$1,725.00" $690.00 "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" $776.25 "$1,725.00" N/A "$1,000.50" "$1,725.00" "$1,035.00" "$1,725.00" "$1,725.00" "$1,725.00" N/A N/A 65C-2240 SUP Custom 27803010 65C-2240 - CUP ACETAB 40MM 22MM 6.4MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2242 SUP Custom 27803010 65C-2242 - CUP ACETAB 42MM 22MM 7.4MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2244 SUP Custom 27803010 65C-2244 - CUP ACETAB 44MM 22MM 7.9MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2246 SUP Custom 27803010 65C-2246 - CUP ACETAB 46MM 22MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2248 SUP Custom 27803010 65C-2248 - CUP ACETAB 48MM 22MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2250 SUP Custom 27803010 65C-2250 - CUP ACETAB 50MM 22MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2252 SUP Custom 27803010 65C-2252 - CUP ACETAB 52MM 22MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2642 SUP Custom 27803010 65C-2642 - CUP ACETAB 42MM 26MM 5.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2644 SUP Custom 27803010 65C-2644 - CUP ACETAB 44MM 26MM 6.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2646 SUP Custom 27803010 65C-2646 - CUP ACETAB 46MM 26MM 7.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2648 SUP Custom 27803010 65C-2648 - CUP ACETAB 48MM 26MM 8MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2650 SUP Custom 27803010 65C-2650 - CUP ACETAB 50MM 26MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2652 SUP Custom 27803010 65C-2652 - CUP ACETAB 52MM 26MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2654 SUP Custom 27803010 65C-2654 - CUP ACETAB 54MM 26MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2844 SUP Custom 27803010 65C-2844 - CUP ACETAB 44MM 28MM 5.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2846 SUP Custom 27803010 65C-2846 - CUP ACETAB 46MM 28MM 6.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2848 SUP Custom 27803010 65C-2848 - CUP ACETAB 48MM 28MM 7.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2850 SUP Custom 27803010 65C-2850 - CUP ACETAB 50MM 28MM 8MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2852 SUP Custom 27803010 65C-2852 - CUP ACETAB 52MM 28MM 8.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2854 SUP Custom 27803010 65C-2854 - CUP ACETAB 54MM 28MM 9.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2856 SUP Custom 27803010 65C-2856 - CUP ACETAB 56MM 28MM 10.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2858 SUP Custom 27803010 65C-2858 - CUP ACETAB 58MM 28MM 11.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2860 SUP Custom 27803010 65C-2860 - CUP ACETAB 60MM 28MM 12.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2863 SUP Custom 27803010 65C-2863 - CUP ACETAB 63MM 28MM 14MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-2866 SUP Custom 27803010 65C-2866 - CUP ACETAB 66MM 28MM 15.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-3248 SUP Custom 27803010 65C-3248 - CUP ACETAB 48MM 32MM 5.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-3250 SUP Custom 27803010 65C-3250 - CUP ACETAB 50MM 32MM 6.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-3252 SUP Custom 27803010 65C-3252 - CUP ACETAB 52MM 32MM 7.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-3254 SUP Custom 27803010 65C-3254 - CUP ACETAB 54MM 32MM 8MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-3256 SUP Custom 27803010 65C-3256 - CUP ACETAB 56MM 32MM 8.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-3258 SUP Custom 27803010 65C-3258 - CUP ACETAB 58MM 32MM 9.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-3260 SUP Custom 27803010 65C-3260 - CUP ACETAB 60MM 32MM 10.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-3263 SUP Custom 27803010 65C-3263 - CUP ACETAB 63MM 32MM 12MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 65C-3266 SUP Custom 27803010 65C-3266 - CUP ACETAB 66MM 32MM 13.5MM TRIDENT XFIRE HIP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A 661-00-28B SUP Custom 27803010 661-00-28B - INSERT ACETAB 0D B ECCENTRIC 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-28C SUP Custom 27803010 661-00-28C - INSERT ACETAB 0D C ECCENTRIC 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-28D SUP Custom 27803010 661-00-28D - INSERT ACETAB 0D D ECCENTRIC 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-28E SUP Custom 27803010 661-00-28E - INSERT ACETAB 0D E ECCENTRIC 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-28F SUP Custom 27803010 661-00-28F - INSERT ACETAB 0D F ECCENTRIC 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-28G SUP Custom 27803010 661-00-28G - INSERT ACETAB 0D G ECCENTRIC 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-28H SUP Custom 27803010 661-00-28H - INSERT ACETAB 0D H ECCENTRIC 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-28I SUP Custom 27803010 661-00-28I - INSERT ACETAB 0D I ECCENTRIC 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-28J SUP Custom 27803010 661-00-28J - INSERT ACETAB 0D J ECCENTRIC 28MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-32D SUP Custom 27803010 661-00-32D - INSERT ACETAB 0D D ECCENTRIC 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-32E SUP Custom 27803010 661-00-32E - INSERT ACETAB 0D E ECCENTRIC 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-32F SUP Custom 27803010 661-00-32F - INSERT ACETAB 0D F ECCENTRIC 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-32G SUP Custom 27803010 661-00-32G - INSERT ACETAB 0D G ECCENTRIC 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-32H SUP Custom 27803010 661-00-32H - INSERT ACETAB 0D H ECCENTRIC 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-32I SUP Custom 27803010 661-00-32I - INSERT ACETAB 0D I ECCENTRIC 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-32J SUP Custom 27803010 661-00-32J - INSERT ACETAB 0D J ECCENTRIC 32MM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-36E SUP Custom 27803010 661-00-36E - INSERT ACETAB 0D E 36MM ECCENTRIC TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-36F SUP Custom 27803010 661-00-36F - INSERT ACETAB 0D F 36MM ECCENTRIC TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-36G SUP Custom 27803010 661-00-36G - INSERT ACETAB 0D G 36MM ECCENTRIC TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-36H SUP Custom 27803010 661-00-36H - INSERT ACETAB 0D H 36MM ECCENTRIC TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-36I SUP Custom 27803010 661-00-36I - INSERT ACETAB 0D I 36MM ECCENTRIC TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-00-36J SUP Custom 27803010 661-00-36J - INSERT ACETAB 0D J 36MM ECCENTRIC TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-28C SUP Custom 27803010 661-10-28C - INSERT ACETAB 10D C ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-28D SUP Custom 27803010 661-10-28D - INSERT ACETAB 10D D ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-28E SUP Custom 27803010 661-10-28E - INSERT ACETAB 10D E ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-28F SUP Custom 27803010 661-10-28F - INSERT ACETAB 10D F ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-28G SUP Custom 27803010 661-10-28G - INSERT ACETAB 10D G ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-28H SUP Custom 27803010 661-10-28H - INSERT ACETAB 10D H ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-28I SUP Custom 27803010 661-10-28I - INSERT ACETAB 10D I ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-28J SUP Custom 27803010 661-10-28J - INSERT ACETAB 10D J ECCENTRIC 28MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-32D SUP Custom 27803010 661-10-32D - INSERT ACETAB 10D D ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-32E SUP Custom 27803010 661-10-32E - INSERT ACETAB 10D E ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-32F SUP Custom 27803010 661-10-32F - INSERT ACETAB 10D F ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-32G SUP Custom 27803010 661-10-32G - INSERT ACETAB 10D G ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-32H SUP Custom 27803010 661-10-32H - INSERT ACETAB 10D H ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-32I SUP Custom 27803010 661-10-32I - INSERT ACETAB 10D I ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-32J SUP Custom 27803010 661-10-32J - INSERT ACETAB 10D J ECCENTRIC 32MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-36E SUP Custom 27803010 661-10-36E - INSERT ACETAB 10D E ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-36F SUP Custom 27803010 661-10-36F - INSERT ACETAB 10D F ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-36G SUP Custom 27803010 661-10-36G - INSERT ACETAB 10D G ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-36H SUP Custom 27803010 661-10-36H - INSERT ACETAB 10D H ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-36I SUP Custom 27803010 661-10-36I - INSERT ACETAB 10D I ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 661-10-36J SUP Custom 27803010 661-10-36J - INSERT ACETAB 10D J ECCENTRIC 36MM PRIM TRIDENT XFIRE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6630-0-010 SUP HCPCS C1776 6630-0-010 - COMPONENT FEMORAL 2XS CRUC RET BEAD DURACON KNEE LEFT BOTH IP/OP "$4,464.00" "$3,303.00" $885.99 "$4,464.00" "$2,008.80" "$2,008.80" "$2,008.80" "$2,008.80" "$4,464.00" "$4,464.00" "$4,464.00" $930.41 "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" $930.35 "$4,464.00" "$4,464.00" "$2,200.75" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$3,348.00" "$4,464.00" "$4,464.00" "$4,464.00" "$2,232.00" "$2,232.00" "$3,535.49" "$4,464.00" "$3,571.20" "$2,008.80" $885.99 N/A "$2,589.12" "$4,464.00" "$4,464.00" "$4,464.00" $930.30 "$4,464.00" N/A N/A 6630-0-015 SUP HCPCS C1776 6630-0-015 - COMPONENT FEMORAL 2XS CRUC RET NONBEAD DURACON KNEE LEFT BOTH IP/OP "$3,525.00" "$2,609.00" $699.62 "$3,525.00" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$3,525.00" "$3,525.00" "$3,525.00" $734.70 "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" $734.65 "$3,525.00" "$3,525.00" "$1,737.83" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$2,643.75" "$3,525.00" "$3,525.00" "$3,525.00" "$1,762.50" "$1,762.50" "$2,791.80" "$3,525.00" "$2,820.00" "$1,586.25" $699.62 N/A "$2,044.50" "$3,525.00" "$3,525.00" "$3,525.00" $734.61 "$3,525.00" N/A N/A 6630-0-020 SUP HCPCS C1776 6630-0-020 - COMPONENT FEMORAL 2XS CRUC RET BEAD DURACON KNEE RIGHT BOTH IP/OP "$4,464.00" "$3,303.00" $885.99 "$4,464.00" "$2,008.80" "$2,008.80" "$2,008.80" "$2,008.80" "$4,464.00" "$4,464.00" "$4,464.00" $930.41 "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" $930.35 "$4,464.00" "$4,464.00" "$2,200.75" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$3,348.00" "$4,464.00" "$4,464.00" "$4,464.00" "$2,232.00" "$2,232.00" "$3,535.49" "$4,464.00" "$3,571.20" "$2,008.80" $885.99 N/A "$2,589.12" "$4,464.00" "$4,464.00" "$4,464.00" $930.30 "$4,464.00" N/A N/A 6630-0-025 SUP HCPCS C1776 6630-0-025 - COMPONENT FEMORAL SMALL CRUC RET NONBEAD DURACON KNEE LEFT BOTH IP/OP "$3,525.00" "$2,609.00" $699.62 "$3,525.00" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$3,525.00" "$3,525.00" "$3,525.00" $734.70 "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" $734.65 "$3,525.00" "$1,410.00" "$1,737.83" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$2,643.75" "$3,525.00" "$3,525.00" "$3,525.00" "$1,762.50" "$1,762.50" "$2,791.80" "$3,525.00" "$2,820.00" "$1,586.25" $699.62 N/A "$2,044.50" "$3,525.00" "$3,525.00" "$3,525.00" $734.61 "$3,525.00" N/A N/A 6630-0-110 SUP HCPCS C1776 6630-0-110 - COMPONENT FEMORAL XS CRUC RET BEAD DURACON KNEE LEFT BOTH IP/OP "$4,464.00" "$3,303.00" $885.99 "$4,464.00" "$2,008.80" "$2,008.80" "$2,008.80" "$2,008.80" "$4,464.00" "$4,464.00" "$4,464.00" $930.41 "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" $930.35 "$4,464.00" "$1,785.60" "$2,200.75" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$3,348.00" "$4,464.00" "$4,464.00" "$4,464.00" "$2,232.00" "$2,232.00" "$3,535.49" "$4,464.00" "$3,571.20" "$2,008.80" $885.99 N/A "$2,589.12" "$4,464.00" "$4,464.00" "$4,464.00" $930.30 "$4,464.00" N/A N/A 6630-0-115 SUP HCPCS C1776 6630-0-115 - COMPONENT FEMORAL XS CRUC RET NONBEAD DURACON KNEE LEFT BOTH IP/OP "$3,525.00" "$2,609.00" $699.62 "$3,525.00" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$3,525.00" "$3,525.00" "$3,525.00" $734.70 "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" $734.65 "$3,525.00" "$3,525.00" "$1,737.83" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$2,643.75" "$3,525.00" "$3,525.00" "$3,525.00" "$1,762.50" "$1,762.50" "$2,791.80" "$3,525.00" "$2,820.00" "$1,586.25" $699.62 N/A "$2,044.50" "$3,525.00" "$3,525.00" "$3,525.00" $734.61 "$3,525.00" N/A N/A 6630-0-120 SUP HCPCS C1776 6630-0-120 - COMPONENT FEMORAL XS CRUC RET BEAD DURACON KNEE RIGHT BOTH IP/OP "$4,464.00" "$3,303.00" $885.99 "$4,464.00" "$2,008.80" "$2,008.80" "$2,008.80" "$2,008.80" "$4,464.00" "$4,464.00" "$4,464.00" $930.41 "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" $930.35 "$4,464.00" "$4,464.00" "$2,200.75" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$3,348.00" "$4,464.00" "$4,464.00" "$4,464.00" "$2,232.00" "$2,232.00" "$3,535.49" "$4,464.00" "$3,571.20" "$2,008.80" $885.99 N/A "$2,589.12" "$4,464.00" "$4,464.00" "$4,464.00" $930.30 "$4,464.00" N/A N/A 6630-0-125 SUP HCPCS C1776 6630-0-125 - COMPONENT FEMORAL XS CRUC RET NONBEAD DURACON KNEE RIGHT BOTH IP/OP "$3,525.00" "$2,609.00" $699.62 "$3,525.00" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$3,525.00" "$3,525.00" "$3,525.00" $734.70 "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" $734.65 "$3,525.00" "$1,410.00" "$1,737.83" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$2,643.75" "$3,525.00" "$3,525.00" "$3,525.00" "$1,762.50" "$1,762.50" "$2,791.80" "$3,525.00" "$2,820.00" "$1,586.25" $699.62 N/A "$2,044.50" "$3,525.00" "$3,525.00" "$3,525.00" $734.61 "$3,525.00" N/A N/A 6630-0-210 SUP HCPCS C1776 6630-0-210 - COMPONENT FEMORAL SMALL STANDARD CRUC RET BEAD DURACON KNEE BOTH IP/OP "$4,385.00" "$3,245.00" $870.31 "$4,385.00" "$1,973.25" "$1,973.25" "$1,973.25" "$1,973.25" "$4,385.00" "$4,385.00" "$4,385.00" $913.94 "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" $913.88 "$4,385.00" "$1,754.00" "$2,161.81" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$3,288.75" "$4,385.00" "$4,385.00" "$4,385.00" "$2,192.50" "$2,192.50" "$3,472.92" "$4,385.00" "$3,508.00" "$1,973.25" $870.31 N/A "$2,543.30" "$4,385.00" "$4,385.00" "$4,385.00" $913.83 "$4,385.00" N/A N/A 6630-0-215 SUP HCPCS C1776 6630-0-215 - COMPONENT FEMORAL SMALL STANDARD CRUC RET NONBEAD DURACON BOTH IP/OP "$3,464.00" "$2,563.00" $687.52 "$3,464.00" "$1,558.80" "$1,558.80" "$1,558.80" "$1,558.80" "$3,464.00" "$3,464.00" "$3,464.00" $721.98 "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" $721.94 "$3,464.00" "$1,385.60" "$1,707.75" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$2,598.00" "$3,464.00" "$3,464.00" "$3,464.00" "$1,732.00" "$1,732.00" "$2,743.49" "$3,464.00" "$2,771.20" "$1,558.80" $687.52 N/A "$2,009.12" "$3,464.00" "$3,464.00" "$3,464.00" $721.90 "$3,464.00" N/A N/A 6630-0-220 SUP HCPCS C1776 6630-0-220 - COMPONENT FEMORAL SMALL STANDARD CRUC RET BEAD DURACON KNEE BOTH IP/OP "$4,385.00" "$3,245.00" $870.31 "$4,385.00" "$1,973.25" "$1,973.25" "$1,973.25" "$1,973.25" "$4,385.00" "$4,385.00" "$4,385.00" $913.94 "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" $913.88 "$4,385.00" "$1,754.00" "$2,161.81" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$3,288.75" "$4,385.00" "$4,385.00" "$4,385.00" "$2,192.50" "$2,192.50" "$3,472.92" "$4,385.00" "$3,508.00" "$1,973.25" $870.31 N/A "$2,543.30" "$4,385.00" "$4,385.00" "$4,385.00" $913.83 "$4,385.00" N/A N/A 6630-0-225 SUP HCPCS C1776 6630-0-225 - COMPONENT FEMORAL SMALL STANDARD CRUC RET NONBEAD DURACON BOTH IP/OP "$3,464.00" "$2,563.00" $687.52 "$3,464.00" "$1,558.80" "$1,558.80" "$1,558.80" "$1,558.80" "$3,464.00" "$3,464.00" "$3,464.00" $721.98 "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" $721.94 "$3,464.00" "$1,385.60" "$1,707.75" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$2,598.00" "$3,464.00" "$3,464.00" "$3,464.00" "$1,732.00" "$1,732.00" "$2,743.49" "$3,464.00" "$2,771.20" "$1,558.80" $687.52 N/A "$2,009.12" "$3,464.00" "$3,464.00" "$3,464.00" $721.90 "$3,464.00" N/A N/A 663-00-28B SUP Custom 27803010 663-00-28B - INSERT ACETAB 0D B ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-28C SUP Custom 27803010 663-00-28C - INSERT ACETAB 0D C ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-28D SUP Custom 27803010 663-00-28D - INSERT ACETAB 0D D ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-28E SUP Custom 27803010 663-00-28E - INSERT ACETAB 0D E ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-28F SUP Custom 27803010 663-00-28F - INSERT ACETAB 0D F ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-28G SUP Custom 27803010 663-00-28G - INSERT ACETAB 0D G ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-28H SUP Custom 27803010 663-00-28H - INSERT ACETAB 0D H ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-28I SUP Custom 27803010 663-00-28I - INSERT ACETAB 0D I ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-28J SUP Custom 27803010 663-00-28J - INSERT ACETAB 0D J ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 6630-0-310 SUP HCPCS C1776 6630-0-310 - COMPONENT FEMORAL MEDIUM STANDARD CRUC RET BEAD DURACON KNEE BOTH IP/OP "$4,385.00" "$3,245.00" $870.31 "$4,385.00" "$1,973.25" "$1,973.25" "$1,973.25" "$1,973.25" "$4,385.00" "$4,385.00" "$4,385.00" $913.94 "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" $913.88 "$4,385.00" "$4,385.00" "$2,161.81" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$3,288.75" "$4,385.00" "$4,385.00" "$4,385.00" "$2,192.50" "$2,192.50" "$3,472.92" "$4,385.00" "$3,508.00" "$1,973.25" $870.31 N/A "$2,543.30" "$4,385.00" "$4,385.00" "$4,385.00" $913.83 "$4,385.00" N/A N/A 6630-0-315 SUP HCPCS C1776 6630-0-315 - COMPONENT FEMORAL MEDIUM STANDARD CRUC RET NONBEAD DURACON BOTH IP/OP "$3,464.00" "$2,563.00" $687.52 "$3,464.00" "$1,558.80" "$1,558.80" "$1,558.80" "$1,558.80" "$3,464.00" "$3,464.00" "$3,464.00" $721.98 "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" $721.94 "$3,464.00" "$1,385.60" "$1,707.75" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$2,598.00" "$3,464.00" "$3,464.00" "$3,464.00" "$1,732.00" "$1,732.00" "$2,743.49" "$3,464.00" "$2,771.20" "$1,558.80" $687.52 N/A "$2,009.12" "$3,464.00" "$3,464.00" "$3,464.00" $721.90 "$3,464.00" N/A N/A 6630-0-320 SUP HCPCS C1776 6630-0-320 - COMPONENT FEMORAL MEDIUM CRUC RET BEAD DURACON KNEE RIGHT BOTH IP/OP "$4,385.00" "$3,245.00" $870.31 "$4,385.00" "$1,973.25" "$1,973.25" "$1,973.25" "$1,973.25" "$4,385.00" "$4,385.00" "$4,385.00" $913.94 "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" $913.88 "$4,385.00" "$1,754.00" "$2,161.81" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$3,288.75" "$4,385.00" "$4,385.00" "$4,385.00" "$2,192.50" "$2,192.50" "$3,472.92" "$4,385.00" "$3,508.00" "$1,973.25" $870.31 N/A "$2,543.30" "$4,385.00" "$4,385.00" "$4,385.00" $913.83 "$4,385.00" N/A N/A 6630-0-325 SUP HCPCS C1776 6630-0-325 - COMPONENT FEMORAL MEDIUM STANDARD CRUC RET NONBEAD DURACON BOTH IP/OP "$3,464.00" "$2,563.00" $687.52 "$3,464.00" "$1,558.80" "$1,558.80" "$1,558.80" "$1,558.80" "$3,464.00" "$3,464.00" "$3,464.00" $721.98 "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" $721.94 "$3,464.00" "$3,464.00" "$1,707.75" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$2,598.00" "$3,464.00" "$3,464.00" "$3,464.00" "$1,732.00" "$1,732.00" "$2,743.49" "$3,464.00" "$2,771.20" "$1,558.80" $687.52 N/A "$2,009.12" "$3,464.00" "$3,464.00" "$3,464.00" $721.90 "$3,464.00" N/A N/A 663-00-32D SUP Custom 27803010 663-00-32D - INSERT ACETAB 0D D ECCENTRIC 32MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-32E SUP Custom 27803010 663-00-32E - INSERT ACETAB 0D E ECCENTRIC 32MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-32F SUP Custom 27803010 663-00-32F - INSERT ACETAB 0D F ECCENTRIC 32MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-32G SUP Custom 27803010 663-00-32G - INSERT ACETAB 0D G ECCENTRIC 32MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-32H SUP Custom 27803010 663-00-32H - INSERT ACETAB 0D H ECCENTRIC 32MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-32I SUP Custom 27803010 663-00-32I - INSERT ACETAB 0D I ECCENTRIC 32MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-32J SUP Custom 27803010 663-00-32J - INSERT ACETAB 0D J ECCENTRIC 32MM TRIDENT X3 HIP BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 663-00-36E SUP Custom 27803010 663-00-36E - INSERT ACETAB 0D E ECCENTRIC 36MM TRIDENT X3 HIP BOTH IP/OP "$3,830.00" "$2,834.00" $681.74 "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" $681.74 "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" $798.21 "$3,830.00" "$1,532.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$2,872.50" "$3,830.00" "$3,830.00" "$3,830.00" "$1,915.00" "$1,915.00" "$3,033.36" "$3,830.00" "$3,064.00" "$1,723.50" "$3,830.00" N/A "$2,221.40" "$3,830.00" "$2,298.00" "$3,830.00" "$3,830.00" "$3,830.00" N/A N/A 663-00-36F SUP Custom 27803010 663-00-36F - INSERT ACETAB 0D F ECCENTRIC 36MM TRIDENT X3 HIP BOTH IP/OP "$3,830.00" "$2,834.00" $681.74 "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" $681.74 "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" $798.21 "$3,830.00" "$1,532.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$2,872.50" "$3,830.00" "$3,830.00" "$3,830.00" "$1,915.00" "$1,915.00" "$3,033.36" "$3,830.00" "$3,064.00" "$1,723.50" "$3,830.00" N/A "$2,221.40" "$3,830.00" "$2,298.00" "$3,830.00" "$3,830.00" "$3,830.00" N/A N/A 663-00-36G SUP Custom 27803010 663-00-36G - INSERT ACETAB 0D G ECCENTRIC 36MM TRIDENT X3 HIP BOTH IP/OP "$3,830.00" "$2,834.00" $681.74 "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" $681.74 "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" $798.21 "$3,830.00" "$1,532.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$2,872.50" "$3,830.00" "$3,830.00" "$3,830.00" "$1,915.00" "$1,915.00" "$3,033.36" "$3,830.00" "$3,064.00" "$1,723.50" "$3,830.00" N/A "$2,221.40" "$3,830.00" "$2,298.00" "$3,830.00" "$3,830.00" "$3,830.00" N/A N/A 663-00-36H SUP Custom 27803010 663-00-36H - INSERT ACETAB 0D H ECCENTRIC 36MM TRIDENT X3 HIP BOTH IP/OP "$3,830.00" "$2,834.00" $681.74 "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" $681.74 "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" $798.21 "$3,830.00" "$1,532.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$2,872.50" "$3,830.00" "$3,830.00" "$3,830.00" "$1,915.00" "$1,915.00" "$3,033.36" "$3,830.00" "$3,064.00" "$1,723.50" "$3,830.00" N/A "$2,221.40" "$3,830.00" "$2,298.00" "$3,830.00" "$3,830.00" "$3,830.00" N/A N/A 663-00-36I SUP Custom 27803010 663-00-36I - INSERT ACETAB 0D I ECCENTRIC 36MM TRIDENT X3 HIP BOTH IP/OP "$3,830.00" "$2,834.00" $681.74 "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" $681.74 "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" $798.21 "$3,830.00" "$1,532.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$2,872.50" "$3,830.00" "$3,830.00" "$3,830.00" "$1,915.00" "$1,915.00" "$3,033.36" "$3,830.00" "$3,064.00" "$1,723.50" "$3,830.00" N/A "$2,221.40" "$3,830.00" "$2,298.00" "$3,830.00" "$3,830.00" "$3,830.00" N/A N/A 663-00-36J SUP Custom 27803010 663-00-36J - INSERT ACETAB 0D J ECCENTRIC 36MM TRIDENT X3 HIP BOTH IP/OP "$3,830.00" "$2,834.00" $681.74 "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" $681.74 "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" $798.21 "$3,830.00" "$1,532.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$3,830.00" "$2,872.50" "$3,830.00" "$3,830.00" "$3,830.00" "$1,915.00" "$1,915.00" "$3,033.36" "$3,830.00" "$3,064.00" "$1,723.50" "$3,830.00" N/A "$2,221.40" "$3,830.00" "$2,298.00" "$3,830.00" "$3,830.00" "$3,830.00" N/A N/A 6630-0-410 SUP HCPCS C1776 6630-0-410 - COMPONENT FEMORAL MEDIUM LARGE CRUC RET BEAD DURACON KNEE BOTH IP/OP "$4,385.00" "$3,245.00" $870.31 "$4,385.00" "$1,973.25" "$1,973.25" "$1,973.25" "$1,973.25" "$4,385.00" "$4,385.00" "$4,385.00" $913.94 "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" $913.88 "$4,385.00" "$1,754.00" "$2,161.81" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$3,288.75" "$4,385.00" "$4,385.00" "$4,385.00" "$2,192.50" "$2,192.50" "$3,472.92" "$4,385.00" "$3,508.00" "$1,973.25" $870.31 N/A "$2,543.30" "$4,385.00" "$2,631.00" "$4,385.00" $913.83 "$4,385.00" N/A N/A 6630-0-415 SUP HCPCS C1776 6630-0-415 - COMPONENT FEMORAL MEDIUM LARGE CRUC RET NONBEAD DURACON KNEE BOTH IP/OP "$3,464.00" "$2,563.00" $687.52 "$3,464.00" "$1,558.80" "$1,558.80" "$1,558.80" "$1,558.80" "$3,464.00" "$3,464.00" "$3,464.00" $721.98 "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" $721.94 "$3,464.00" "$1,385.60" "$1,707.75" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$2,598.00" "$3,464.00" "$3,464.00" "$3,464.00" "$1,732.00" "$1,732.00" "$2,743.49" "$3,464.00" "$2,771.20" "$1,558.80" $687.52 N/A "$2,009.12" "$3,464.00" "$2,078.40" "$3,464.00" $721.90 "$3,464.00" N/A N/A 6630-0-420 SUP HCPCS C1776 6630-0-420 - COMPONENT FEMORAL MEDIUM LARGE CRUC RET BEAD DURACON KNEE BOTH IP/OP "$4,385.00" "$3,245.00" $870.31 "$4,385.00" "$1,973.25" "$1,973.25" "$1,973.25" "$1,973.25" "$4,385.00" "$4,385.00" "$4,385.00" $913.94 "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" $913.88 "$4,385.00" "$1,754.00" "$2,161.81" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$3,288.75" "$4,385.00" "$4,385.00" "$4,385.00" "$2,192.50" "$2,192.50" "$3,472.92" "$4,385.00" "$3,508.00" "$1,973.25" $870.31 N/A "$2,543.30" "$4,385.00" "$2,631.00" "$4,385.00" $913.83 "$4,385.00" N/A N/A 6630-0-425 SUP HCPCS C1776 6630-0-425 - COMPONENT FEMORAL MEDIUM LARGE CRUC RET NONBEAD DURACON KNEE BOTH IP/OP "$3,464.00" "$2,563.00" $687.52 "$3,464.00" "$1,558.80" "$1,558.80" "$1,558.80" "$1,558.80" "$3,464.00" "$3,464.00" "$3,464.00" $721.98 "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" $721.94 "$3,464.00" "$3,464.00" "$1,707.75" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$2,598.00" "$3,464.00" "$3,464.00" "$3,464.00" "$1,732.00" "$1,732.00" "$2,743.49" "$3,464.00" "$2,771.20" "$1,558.80" $687.52 N/A "$2,009.12" "$3,464.00" "$3,464.00" "$3,464.00" $721.90 "$3,464.00" N/A N/A 6630-0-510 SUP HCPCS C1776 6630-0-510 - COMPONENT FEMORAL LARGE CRUC RET BEAD DURACON KNEE LEFT BOTH IP/OP "$4,385.00" "$3,245.00" $870.31 "$4,385.00" "$1,973.25" "$1,973.25" "$1,973.25" "$1,973.25" "$4,385.00" "$4,385.00" "$4,385.00" $913.94 "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" $913.88 "$4,385.00" "$1,754.00" "$2,161.81" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$3,288.75" "$4,385.00" "$4,385.00" "$4,385.00" "$2,192.50" "$2,192.50" "$3,472.92" "$4,385.00" "$3,508.00" "$1,973.25" $870.31 N/A "$2,543.30" "$4,385.00" "$4,385.00" "$4,385.00" $913.83 "$4,385.00" N/A N/A 6630-0-515 SUP HCPCS C1776 6630-0-515 - COMPONENT FEMORAL LARGE CRUC RET NONBEAD DURACON KNEE LEFT BOTH IP/OP "$3,464.00" "$2,563.00" $687.52 "$3,464.00" "$1,558.80" "$1,558.80" "$1,558.80" "$1,558.80" "$3,464.00" "$3,464.00" "$3,464.00" $721.98 "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" $721.94 "$3,464.00" "$3,464.00" "$1,707.75" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$2,598.00" "$3,464.00" "$3,464.00" "$3,464.00" "$1,732.00" "$1,732.00" "$2,743.49" "$3,464.00" "$2,771.20" "$1,558.80" $687.52 N/A "$2,009.12" "$3,464.00" "$3,464.00" "$3,464.00" $721.90 "$3,464.00" N/A N/A 6630-0-520 SUP HCPCS C1776 6630-0-520 - COMPONENT FEMORAL LARGE CRUC RET BEAD DURACON KNEE RIGHT BOTH IP/OP "$4,385.00" "$3,245.00" $870.31 "$4,385.00" "$1,973.25" "$1,973.25" "$1,973.25" "$1,973.25" "$4,385.00" "$4,385.00" "$4,385.00" $913.94 "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" $913.88 "$4,385.00" "$1,754.00" "$2,161.81" "$4,385.00" "$4,385.00" "$4,385.00" "$4,385.00" "$3,288.75" "$4,385.00" "$4,385.00" "$4,385.00" "$2,192.50" "$2,192.50" "$3,472.92" "$4,385.00" "$3,508.00" "$1,973.25" $870.31 N/A "$2,543.30" "$4,385.00" "$4,385.00" "$4,385.00" $913.83 "$4,385.00" N/A N/A 6630-0-525 SUP HCPCS C1776 6630-0-525 - COMPONENT FEMORAL LARGE CRUC RET NONBEAD DURACON KNEE RIGHT BOTH IP/OP "$3,464.00" "$2,563.00" $687.52 "$3,464.00" "$1,558.80" "$1,558.80" "$1,558.80" "$1,558.80" "$3,464.00" "$3,464.00" "$3,464.00" $721.98 "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" $721.94 "$3,464.00" "$1,385.60" "$1,707.75" "$3,464.00" "$3,464.00" "$3,464.00" "$3,464.00" "$2,598.00" "$3,464.00" "$3,464.00" "$3,464.00" "$1,732.00" "$1,732.00" "$2,743.49" "$3,464.00" "$2,771.20" "$1,558.80" $687.52 N/A "$2,009.12" "$3,464.00" "$3,464.00" "$3,464.00" $721.90 "$3,464.00" N/A N/A 6630-0-610 SUP HCPCS C1776 6630-0-610 - COMPONENT FEMORAL XL CRUC RET BEAD DURACON KNEE LEFT BOTH IP/OP "$4,464.00" "$3,303.00" $885.99 "$4,464.00" "$2,008.80" "$2,008.80" "$2,008.80" "$2,008.80" "$4,464.00" "$4,464.00" "$4,464.00" $930.41 "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" $930.35 "$4,464.00" "$1,785.60" "$2,200.75" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$3,348.00" "$4,464.00" "$4,464.00" "$4,464.00" "$2,232.00" "$2,232.00" "$3,535.49" "$4,464.00" "$3,571.20" "$2,008.80" $885.99 N/A "$2,589.12" "$4,464.00" "$4,464.00" "$4,464.00" $930.30 "$4,464.00" N/A N/A 6630-0-615 SUP HCPCS C1776 6630-0-615 - COMPONENT FEMORAL XL CRUC RET NONBEAD DURACON KNEE LEFT BOTH IP/OP "$3,525.00" "$2,609.00" $699.62 "$3,525.00" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$3,525.00" "$3,525.00" "$3,525.00" $734.70 "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" $734.65 "$3,525.00" "$1,410.00" "$1,737.83" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$2,643.75" "$3,525.00" "$3,525.00" "$3,525.00" "$1,762.50" "$1,762.50" "$2,791.80" "$3,525.00" "$2,820.00" "$1,586.25" $699.62 N/A "$2,044.50" "$3,525.00" "$3,525.00" "$3,525.00" $734.61 "$3,525.00" N/A N/A 6630-0-620 SUP HCPCS C1776 6630-0-620 - COMPONENT FEMORAL XL CRUC RET BEAD DURACON KNEE RIGHT BOTH IP/OP "$4,464.00" "$3,303.00" $885.99 "$4,464.00" "$2,008.80" "$2,008.80" "$2,008.80" "$2,008.80" "$4,464.00" "$4,464.00" "$4,464.00" $930.41 "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" $930.35 "$4,464.00" "$1,785.60" "$2,200.75" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$3,348.00" "$4,464.00" "$4,464.00" "$4,464.00" "$2,232.00" "$2,232.00" "$3,535.49" "$4,464.00" "$3,571.20" "$2,008.80" $885.99 N/A "$2,589.12" "$4,464.00" "$4,464.00" "$4,464.00" $930.30 "$4,464.00" N/A N/A 6630-0-625 SUP HCPCS C1776 6630-0-625 - COMPONENT FEMORAL XL CRUC RET NONBEAD DURACON KNEE RIGHT BOTH IP/OP "$3,525.00" "$2,609.00" $699.62 "$3,525.00" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$3,525.00" "$3,525.00" "$3,525.00" $734.70 "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" $734.65 "$3,525.00" "$3,525.00" "$1,737.83" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$2,643.75" "$3,525.00" "$3,525.00" "$3,525.00" "$1,762.50" "$1,762.50" "$2,791.80" "$3,525.00" "$2,820.00" "$1,586.25" $699.62 N/A "$2,044.50" "$3,525.00" "$3,525.00" "$3,525.00" $734.61 "$3,525.00" N/A N/A 6630-0-710 SUP HCPCS C1776 6630-0-710 - COMPONENT FEMORAL 2XL STANDARD CRUC RET BEAD DURACON KNEE BOTH IP/OP "$4,464.00" "$3,303.00" $885.99 "$4,464.00" "$2,008.80" "$2,008.80" "$2,008.80" "$2,008.80" "$4,464.00" "$4,464.00" "$4,464.00" $930.41 "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" $930.35 "$4,464.00" "$1,785.60" "$2,200.75" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$3,348.00" "$4,464.00" "$4,464.00" "$4,464.00" "$2,232.00" "$2,232.00" "$3,535.49" "$4,464.00" "$3,571.20" "$2,008.80" $885.99 N/A "$2,589.12" "$4,464.00" "$4,464.00" "$4,464.00" $930.30 "$4,464.00" N/A N/A 6630-0-715 SUP HCPCS C1776 6630-0-715 - COMPONENT FEMORAL 2XL CRUC RET NONBEAD DURACON KNEE LEFT BOTH IP/OP "$3,525.00" "$2,609.00" $699.62 "$3,525.00" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$3,525.00" "$3,525.00" "$3,525.00" $734.70 "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" $734.65 "$3,525.00" "$1,410.00" "$1,737.83" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$2,643.75" "$3,525.00" "$3,525.00" "$3,525.00" "$1,762.50" "$1,762.50" "$2,791.80" "$3,525.00" "$2,820.00" "$1,586.25" $699.62 N/A "$2,044.50" "$3,525.00" "$3,525.00" "$3,525.00" $734.61 "$3,525.00" N/A N/A 6630-0-720 SUP HCPCS C1776 6630-0-720 - COMPONENT FEMORAL 2XL CRUC RET BEAD DURACON KNEE RIGHT BOTH IP/OP "$4,464.00" "$3,303.00" $885.99 "$4,464.00" "$2,008.80" "$2,008.80" "$2,008.80" "$2,008.80" "$4,464.00" "$4,464.00" "$4,464.00" $930.41 "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" $930.35 "$4,464.00" "$1,785.60" "$2,200.75" "$4,464.00" "$4,464.00" "$4,464.00" "$4,464.00" "$3,348.00" "$4,464.00" "$4,464.00" "$4,464.00" "$2,232.00" "$2,232.00" "$3,535.49" "$4,464.00" "$3,571.20" "$2,008.80" $885.99 N/A "$2,589.12" "$4,464.00" "$2,678.40" "$4,464.00" $930.30 "$4,464.00" N/A N/A 6630-0-725 SUP HCPCS C1776 6630-0-725 - COMPONENT FEMORAL 2XL CRUC RET NONBEAD DURACON KNEE RIGHT BOTH IP/OP "$3,525.00" "$2,609.00" $699.62 "$3,525.00" "$1,586.25" "$1,586.25" "$1,586.25" "$1,586.25" "$3,525.00" "$3,525.00" "$3,525.00" $734.70 "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" $734.65 "$3,525.00" "$3,525.00" "$1,737.83" "$3,525.00" "$3,525.00" "$3,525.00" "$3,525.00" "$2,643.75" "$3,525.00" "$3,525.00" "$3,525.00" "$1,762.50" "$1,762.50" "$2,791.80" "$3,525.00" "$2,820.00" "$1,586.25" $699.62 N/A "$2,044.50" "$3,525.00" "$2,115.00" "$3,525.00" $734.61 "$3,525.00" N/A N/A 6630-6-105 SUP Custom 27803010 6630-6-105 - WEDGE TIBIAL S1 FLAT 5MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-110 SUP Custom 27803010 6630-6-110 - WEDGE TIBIAL S1 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-125 SUP Custom 27803010 6630-6-125 - WEDGE TIBIAL S1 FLAT 5MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-130 SUP Custom 27803010 6630-6-130 - WEDGE TIBIAL S1 FLAT 10MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-150 SUP Custom 27803010 6630-6-150 - WEDGE TIBIAL S2 HEMIFLAT 5MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-155 SUP Custom 27803010 6630-6-155 - WEDGE TIBIAL S2 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-170 SUP Custom 27803010 6630-6-170 - WEDGE TIBIAL S2 HEMIFLAT 5MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-175 SUP Custom 27803010 6630-6-175 - WEDGE TIBIAL S2 FLAT 10MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-205 SUP Custom 27803010 6630-6-205 - WEDGE TIBIAL M1 FLAT 5MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-210 SUP Custom 27803010 6630-6-210 - WEDGE TIBIAL M1 FLAT 10MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-225 SUP Custom 27803010 6630-6-225 - WEDGE TIBIAL M1 FLAT 5MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-230 SUP Custom 27803010 6630-6-230 - WEDGE TIBIAL M1 FLAT 10MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-250 SUP Custom 27803010 6630-6-250 - WEDGE TIBIAL M2 HEMIFLAT 5MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-255 SUP Custom 27803010 6630-6-255 - WEDGE TIBIAL M2 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-270 SUP Custom 27803010 6630-6-270 - WEDGE TIBIAL M2 HEMIFLAT 5MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-275 SUP Custom 27803010 6630-6-275 - WEDGE TIBIAL M2 HEMIFLAT 10MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-305 SUP Custom 27803010 6630-6-305 - WEDGE TIBIAL 1 FLAT 5MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-310 SUP Custom 27803010 6630-6-310 - WEDGE TIBIAL 1 FLAT 10MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-325 SUP Custom 27803010 6630-6-325 - WEDGE TIBIAL 1 FLAT 5MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-330 SUP Custom 27803010 6630-6-330 - WEDGE TIBIAL 1 FLAT 10MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-350 SUP Custom 27803010 6630-6-350 - WEDGE TIBIAL 2 HEMIFLAT 5MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-355 SUP Custom 27803010 6630-6-355 - WEDGE TIBIAL 2 HEMIFLAT 10MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-370 SUP Custom 27803010 6630-6-370 - WEDGE TIBIAL 2 HEMIFLAT 5MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-375 SUP Custom 27803010 6630-6-375 - WEDGE TIBIAL 2 HEMIFLAT 10MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-405 SUP Custom 27803010 6630-6-405 - WEDGE TIBIAL X1 FLAT 5MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-410 SUP Custom 27803010 6630-6-410 - WEDGE TIBIAL X1 FLAT 10MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-425 SUP Custom 27803010 6630-6-425 - WEDGE TIBIAL X1 FLAT 5MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-430 SUP Custom 27803010 6630-6-430 - WEDGE TIBIAL X1 FLAT 10MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-450 SUP Custom 27803010 6630-6-450 - WEDGE TIBIAL X2 FLAT 5MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-455 SUP Custom 27803010 6630-6-455 - WEDGE TIBIAL X2 FLAT 10MM REVISION DURACON KNEE RIGHT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-470 SUP Custom 27803010 6630-6-470 - WEDGE TIBIAL X2 FLAT 5MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-475 SUP Custom 27803010 6630-6-475 - WEDGE TIBIAL X2 FLAT 10MM REVISION DURACON KNEE LEFT BOTH IP/OP "$1,885.00" "$1,395.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $335.53 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" $392.85 "$1,885.00" $754.00 "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,885.00" "$1,413.75" "$1,885.00" "$1,885.00" "$1,885.00" $942.50 $942.50 "$1,492.92" "$1,885.00" "$1,508.00" $848.25 "$1,885.00" N/A "$1,093.30" "$1,885.00" "$1,131.00" "$1,885.00" "$1,885.00" "$1,885.00" N/A N/A 6630-6-510 SUP Custom 27803010 6630-6-510 - WEDGE TIBIAL S1 FULL FLAT 10MM REVISION DURACON KNEE BOTH IP/OP "$3,147.50" "$2,329.00" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $655.97 "$3,147.50" "$1,259.00" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$2,360.63" "$3,147.50" "$3,147.50" "$3,147.50" "$1,573.75" "$1,573.75" "$2,492.82" "$3,147.50" "$2,518.00" "$1,416.38" "$3,147.50" N/A "$1,825.55" "$3,147.50" "$1,888.50" "$3,147.50" "$3,147.50" "$3,147.50" N/A N/A 6630-6-515 SUP Custom 27803010 6630-6-515 - WEDGE TIBIAL S2 FULL 10MM REVISION DURACON KNEE BOTH IP/OP "$3,147.50" "$2,329.00" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $655.97 "$3,147.50" "$1,259.00" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$2,360.63" "$3,147.50" "$3,147.50" "$3,147.50" "$1,573.75" "$1,573.75" "$2,492.82" "$3,147.50" "$2,518.00" "$1,416.38" "$3,147.50" N/A "$1,825.55" "$3,147.50" "$1,888.50" "$3,147.50" "$3,147.50" "$3,147.50" N/A N/A 6630-6-520 SUP Custom 27803010 6630-6-520 - WEDGE TIBIAL M1 FULL 10MM REVISION DURACON KNEE BOTH IP/OP "$3,147.50" "$2,329.00" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $655.97 "$3,147.50" "$1,259.00" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$2,360.63" "$3,147.50" "$3,147.50" "$3,147.50" "$1,573.75" "$1,573.75" "$2,492.82" "$3,147.50" "$2,518.00" "$1,416.38" "$3,147.50" N/A "$1,825.55" "$3,147.50" "$1,888.50" "$3,147.50" "$3,147.50" "$3,147.50" N/A N/A 6630-6-525 SUP Custom 27803010 6630-6-525 - WEDGE TIBIAL M2 FULL FLAT 10MM REVISION DURACON KNEE BOTH IP/OP "$3,147.50" "$2,329.00" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $655.97 "$3,147.50" "$1,259.00" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$2,360.63" "$3,147.50" "$3,147.50" "$3,147.50" "$1,573.75" "$1,573.75" "$2,492.82" "$3,147.50" "$2,518.00" "$1,416.38" "$3,147.50" N/A "$1,825.55" "$3,147.50" "$1,888.50" "$3,147.50" "$3,147.50" "$3,147.50" N/A N/A 6630-6-530 SUP Custom 27803010 6630-6-530 - WEDGE TIBIAL 1 FULL FLAT 10MM REVISION DURACON KNEE BOTH IP/OP "$3,147.50" "$2,329.00" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $655.97 "$3,147.50" "$1,259.00" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$2,360.63" "$3,147.50" "$3,147.50" "$3,147.50" "$1,573.75" "$1,573.75" "$2,492.82" "$3,147.50" "$2,518.00" "$1,416.38" "$3,147.50" N/A "$1,825.55" "$3,147.50" "$1,888.50" "$3,147.50" "$3,147.50" "$3,147.50" N/A N/A 6630-6-535 SUP Custom 27803010 6630-6-535 - WEDGE TIBIAL 2 FULL FLAT 10MM REVISION DURACON KNEE BOTH IP/OP "$3,147.50" "$2,329.00" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $655.97 "$3,147.50" "$1,259.00" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$2,360.63" "$3,147.50" "$3,147.50" "$3,147.50" "$1,573.75" "$1,573.75" "$2,492.82" "$3,147.50" "$2,518.00" "$1,416.38" "$3,147.50" N/A "$1,825.55" "$3,147.50" "$1,888.50" "$3,147.50" "$3,147.50" "$3,147.50" N/A N/A 6630-6-545 SUP Custom 27803010 6630-6-545 - WEDGE TIBIAL X1 FULL 10MM REVISION DURACON KNEE BOTH IP/OP "$3,147.50" "$2,329.00" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $655.97 "$3,147.50" "$1,259.00" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$2,360.63" "$3,147.50" "$3,147.50" "$3,147.50" "$1,573.75" "$1,573.75" "$2,492.82" "$3,147.50" "$2,518.00" "$1,416.38" "$3,147.50" N/A "$1,825.55" "$3,147.50" "$1,888.50" "$3,147.50" "$3,147.50" "$3,147.50" N/A N/A 6630-6-550 SUP Custom 27803010 6630-6-550 - WEDGE TIBIAL X2 FULL 10MM REVISION DURACON KNEE BOTH IP/OP "$3,147.50" "$2,329.00" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $560.26 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $655.97 "$3,147.50" "$1,259.00" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$2,360.63" "$3,147.50" "$3,147.50" "$3,147.50" "$1,573.75" "$1,573.75" "$2,492.82" "$3,147.50" "$2,518.00" "$1,416.38" "$3,147.50" N/A "$1,825.55" "$3,147.50" "$1,888.50" "$3,147.50" "$3,147.50" "$3,147.50" N/A N/A 6630-8-005 SUP HCPCS C1776 6630-8-005 - COMPONENT FEMORAL 2XS BEAD DURACON PA KNEE LEFT BOTH IP/OP "$5,209.00" "$3,855.00" "$1,033.86" "$5,209.00" "$2,344.05" "$2,344.05" "$2,344.05" "$2,344.05" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.69" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.61" "$5,209.00" "$2,083.60" "$2,568.04" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$3,906.75" "$5,209.00" "$5,209.00" "$5,209.00" "$2,604.50" "$2,604.50" "$4,125.53" "$5,209.00" "$4,167.20" "$2,344.05" "$1,033.86" N/A "$3,021.22" "$5,209.00" "$3,125.40" "$5,209.00" "$1,085.56" "$5,209.00" N/A N/A 6630-8-010 SUP HCPCS C1776 6630-8-010 - COMPONENT FEMORAL 2XS BEAD DURACON PA KNEE RIGHT BOTH IP/OP "$5,209.00" "$3,855.00" "$1,033.86" "$5,209.00" "$2,344.05" "$2,344.05" "$2,344.05" "$2,344.05" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.69" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.61" "$5,209.00" "$5,209.00" "$2,568.04" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$3,906.75" "$5,209.00" "$5,209.00" "$5,209.00" "$2,604.50" "$2,604.50" "$4,125.53" "$5,209.00" "$4,167.20" "$2,344.05" "$1,033.86" N/A "$3,021.22" "$5,209.00" "$3,125.40" "$5,209.00" "$1,085.56" "$5,209.00" N/A N/A 6630-8-015 SUP HCPCS C1776 6630-8-015 - COMPONENT FEMORAL XS BEAD DURACON PA KNEE LEFT BOTH IP/OP "$5,209.00" "$3,855.00" "$1,033.86" "$5,209.00" "$2,344.05" "$2,344.05" "$2,344.05" "$2,344.05" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.69" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.61" "$5,209.00" "$5,209.00" "$2,568.04" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$3,906.75" "$5,209.00" "$5,209.00" "$5,209.00" "$2,604.50" "$2,604.50" "$4,125.53" "$5,209.00" "$4,167.20" "$2,344.05" "$1,033.86" N/A "$3,021.22" "$5,209.00" "$3,125.40" "$5,209.00" "$1,085.56" "$5,209.00" N/A N/A 6630-8-020 SUP HCPCS C1776 6630-8-020 - COMPONENT FEMORAL XS BEAD DURACON PA KNEE RIGHT BOTH IP/OP "$5,209.00" "$3,855.00" "$1,033.86" "$5,209.00" "$2,344.05" "$2,344.05" "$2,344.05" "$2,344.05" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.69" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.61" "$5,209.00" "$5,209.00" "$2,568.04" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$3,906.75" "$5,209.00" "$5,209.00" "$5,209.00" "$2,604.50" "$2,604.50" "$4,125.53" "$5,209.00" "$4,167.20" "$2,344.05" "$1,033.86" N/A "$3,021.22" "$5,209.00" "$3,125.40" "$5,209.00" "$1,085.56" "$5,209.00" N/A N/A 6630-8-025 SUP HCPCS C1776 6630-8-025 - COMPONENT FEMORAL SMALL BEAD DURACON PA KNEE LEFT BOTH IP/OP "$5,167.00" "$3,824.00" "$1,025.52" "$5,167.00" "$2,325.15" "$2,325.15" "$2,325.15" "$2,325.15" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.93" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.86" "$5,167.00" "$5,167.00" "$2,547.33" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$3,875.25" "$5,167.00" "$5,167.00" "$5,167.00" "$2,583.50" "$2,583.50" "$4,092.26" "$5,167.00" "$4,133.60" "$2,325.15" "$1,025.52" N/A "$2,996.86" "$5,167.00" "$3,100.20" "$5,167.00" "$1,076.80" "$5,167.00" N/A N/A 6630-8-030 SUP HCPCS C1776 6630-8-030 - COMPONENT FEMORAL SMALL BEAD DURACON PA KNEE RIGHT BOTH IP/OP "$5,167.00" "$3,824.00" "$1,025.52" "$5,167.00" "$2,325.15" "$2,325.15" "$2,325.15" "$2,325.15" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.93" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.86" "$5,167.00" "$5,167.00" "$2,547.33" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$3,875.25" "$5,167.00" "$5,167.00" "$5,167.00" "$2,583.50" "$2,583.50" "$4,092.26" "$5,167.00" "$4,133.60" "$2,325.15" "$1,025.52" N/A "$2,996.86" "$5,167.00" "$3,100.20" "$5,167.00" "$1,076.80" "$5,167.00" N/A N/A 6630-8-035 SUP HCPCS C1776 6630-8-035 - COMPONENT FEMORAL MEDIUM BEAD DURACON PA KNEE LEFT BOTH IP/OP "$5,167.00" "$3,824.00" "$1,025.52" "$5,167.00" "$2,325.15" "$2,325.15" "$2,325.15" "$2,325.15" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.93" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.86" "$5,167.00" "$5,167.00" "$2,547.33" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$3,875.25" "$5,167.00" "$5,167.00" "$5,167.00" "$2,583.50" "$2,583.50" "$4,092.26" "$5,167.00" "$4,133.60" "$2,325.15" "$1,025.52" N/A "$2,996.86" "$5,167.00" "$3,100.20" "$5,167.00" "$1,076.80" "$5,167.00" N/A N/A 6630-8-040 SUP HCPCS C1776 6630-8-040 - COMPONENT FEMORAL MEDIUM BEAD DURACON PA KNEE RIGHT BOTH IP/OP "$5,167.00" "$3,824.00" "$1,025.52" "$5,167.00" "$2,325.15" "$2,325.15" "$2,325.15" "$2,325.15" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.93" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.86" "$5,167.00" "$2,066.80" "$2,547.33" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$3,875.25" "$5,167.00" "$5,167.00" "$5,167.00" "$2,583.50" "$2,583.50" "$4,092.26" "$5,167.00" "$4,133.60" "$2,325.15" "$1,025.52" N/A "$2,996.86" "$5,167.00" "$3,100.20" "$5,167.00" "$1,076.80" "$5,167.00" N/A N/A 6630-8-045 SUP HCPCS C1776 6630-8-045 - COMPONENT FEMORAL MEDIUM LARGE BEAD DURACON PA KNEE LEFT BOTH IP/OP "$5,167.00" "$3,824.00" "$1,025.52" "$5,167.00" "$2,325.15" "$2,325.15" "$2,325.15" "$2,325.15" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.93" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.86" "$5,167.00" "$2,066.80" "$2,547.33" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$3,875.25" "$5,167.00" "$5,167.00" "$5,167.00" "$2,583.50" "$2,583.50" "$4,092.26" "$5,167.00" "$4,133.60" "$2,325.15" "$1,025.52" N/A "$2,996.86" "$5,167.00" "$3,100.20" "$5,167.00" "$1,076.80" "$5,167.00" N/A N/A 6630-8-050 SUP HCPCS C1776 6630-8-050 - COMPONENT FEMORAL MEDIUM LARGE BEAD DURACON PA KNEE RIGHT BOTH IP/OP "$5,167.00" "$3,824.00" "$1,025.52" "$5,167.00" "$2,325.15" "$2,325.15" "$2,325.15" "$2,325.15" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.93" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.86" "$5,167.00" "$2,066.80" "$2,547.33" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$3,875.25" "$5,167.00" "$5,167.00" "$5,167.00" "$2,583.50" "$2,583.50" "$4,092.26" "$5,167.00" "$4,133.60" "$2,325.15" "$1,025.52" N/A "$2,996.86" "$5,167.00" "$3,100.20" "$5,167.00" "$1,076.80" "$5,167.00" N/A N/A 6630-8-055 SUP HCPCS C1776 6630-8-055 - COMPONENT FEMORAL LARGE BEAD DURACON PA KNEE LEFT BOTH IP/OP "$5,167.00" "$3,824.00" "$1,025.52" "$5,167.00" "$2,325.15" "$2,325.15" "$2,325.15" "$2,325.15" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.93" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.86" "$5,167.00" "$2,066.80" "$2,547.33" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$3,875.25" "$5,167.00" "$5,167.00" "$5,167.00" "$2,583.50" "$2,583.50" "$4,092.26" "$5,167.00" "$4,133.60" "$2,325.15" "$1,025.52" N/A "$2,996.86" "$5,167.00" "$3,100.20" "$5,167.00" "$1,076.80" "$5,167.00" N/A N/A 6630-8-060 SUP HCPCS C1776 6630-8-060 - COMPONENT FEMORAL LARGE BEAD DURACON PA FEMUR RIGHT BOTH IP/OP "$5,167.00" "$3,824.00" "$1,025.52" "$5,167.00" "$2,325.15" "$2,325.15" "$2,325.15" "$2,325.15" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.93" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$1,076.86" "$5,167.00" "$5,167.00" "$2,547.33" "$5,167.00" "$5,167.00" "$5,167.00" "$5,167.00" "$3,875.25" "$5,167.00" "$5,167.00" "$5,167.00" "$2,583.50" "$2,583.50" "$4,092.26" "$5,167.00" "$4,133.60" "$2,325.15" "$1,025.52" N/A "$2,996.86" "$5,167.00" "$3,100.20" "$5,167.00" "$1,076.80" "$5,167.00" N/A N/A 6630-8-065 SUP HCPCS C1776 6630-8-065 - COMPONENT FEMORAL XL BEAD DURACON PA KNEE LEFT BOTH IP/OP "$5,209.00" "$3,855.00" "$1,033.86" "$5,209.00" "$2,344.05" "$2,344.05" "$2,344.05" "$2,344.05" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.69" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.61" "$5,209.00" "$2,083.60" "$2,568.04" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$3,906.75" "$5,209.00" "$5,209.00" "$5,209.00" "$2,604.50" "$2,604.50" "$4,125.53" "$5,209.00" "$4,167.20" "$2,344.05" "$1,033.86" N/A "$3,021.22" "$5,209.00" "$3,125.40" "$5,209.00" "$1,085.56" "$5,209.00" N/A N/A 6630-8-070 SUP HCPCS C1776 6630-8-070 - COMPONENT FEMORAL XL BEAD DURACON PA KNEE RIGHT BOTH IP/OP "$5,209.00" "$3,855.00" "$1,033.86" "$5,209.00" "$2,344.05" "$2,344.05" "$2,344.05" "$2,344.05" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.69" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.61" "$5,209.00" "$5,209.00" "$2,568.04" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$3,906.75" "$5,209.00" "$5,209.00" "$5,209.00" "$2,604.50" "$2,604.50" "$4,125.53" "$5,209.00" "$4,167.20" "$2,344.05" "$1,033.86" N/A "$3,021.22" "$5,209.00" "$3,125.40" "$5,209.00" "$1,085.56" "$5,209.00" N/A N/A 6630-8-075 SUP HCPCS C1776 6630-8-075 - COMPONENT FEMORAL 2XL BEAD DURACON PA KNEE LEFT BOTH IP/OP "$5,209.00" "$3,855.00" "$1,033.86" "$5,209.00" "$2,344.05" "$2,344.05" "$2,344.05" "$2,344.05" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.69" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.61" "$5,209.00" "$2,083.60" "$2,568.04" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$3,906.75" "$5,209.00" "$5,209.00" "$5,209.00" "$2,604.50" "$2,604.50" "$4,125.53" "$5,209.00" "$4,167.20" "$2,344.05" "$1,033.86" N/A "$3,021.22" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.56" "$5,209.00" N/A N/A 6630-8-080 SUP HCPCS C1776 6630-8-080 - COMPONENT FEMORAL 2XL BEAD DURACON PA KNEE RIGHT BOTH IP/OP "$5,209.00" "$3,855.00" "$1,033.86" "$5,209.00" "$2,344.05" "$2,344.05" "$2,344.05" "$2,344.05" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.69" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$1,085.61" "$5,209.00" "$5,209.00" "$2,568.04" "$5,209.00" "$5,209.00" "$5,209.00" "$5,209.00" "$3,906.75" "$5,209.00" "$5,209.00" "$5,209.00" "$2,604.50" "$2,604.50" "$4,125.53" "$5,209.00" "$4,167.20" "$2,344.05" "$1,033.86" N/A "$3,021.22" "$5,209.00" "$3,125.40" "$5,209.00" "$1,085.56" "$5,209.00" N/A N/A 663-10-28C SUP Custom 27803010 663-10-28C - INSERT ACETAB 10D C ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-28D SUP Custom 27803010 663-10-28D - INSERT ACETAB 10D D ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-28E SUP Custom 27803010 663-10-28E - INSERT ACETAB 10D E ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-28F SUP Custom 27803010 663-10-28F - INSERT ACETAB 10D F ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-28G SUP Custom 27803010 663-10-28G - INSERT ACETAB 10D G ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-28H SUP Custom 27803010 663-10-28H - INSERT ACETAB 10D H ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-28I SUP Custom 27803010 663-10-28I - INSERT ACETAB 10D I ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-28J SUP Custom 27803010 663-10-28J - INSERT ACETAB 10D J ECCENTRIC 28MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-32D SUP Custom 27803010 663-10-32D - INSERT ACETAB 10D D ECCENTRIC 32MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-32E SUP Custom 27803010 663-10-32E - INSERT ACETAB 10D E ECCENTRIC 32MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-32F SUP Custom 27803010 663-10-32F - INSERT ACETAB 10D F ECCENTRIC 32MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-32G SUP Custom 27803010 663-10-32G - INSERT ACETAB 10D G ECCENTRIC 32MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-32H SUP Custom 27803010 663-10-32H - INSERT ACETAB 10D H ECCENTRIC 32MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-32I SUP Custom 27803010 663-10-32I - INSERT ACETAB 10D I ECCENTRIC 32MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-32J SUP Custom 27803010 663-10-32J - INSERT ACETAB 10D J ECCENTRIC 32MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-36E SUP Custom 27803010 663-10-36E - INSERT ACETAB 10D E ECCENTRIC 36MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-36F SUP Custom 27803010 663-10-36F - INSERT ACETAB 10D F ECCENTRIC 36MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-36G SUP Custom 27803010 663-10-36G - INSERT ACETAB 10D G ECCENTRIC 36MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-36H SUP Custom 27803010 663-10-36H - INSERT ACETAB 10D H ECCENTRIC 36MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-36I SUP Custom 27803010 663-10-36I - INSERT ACETAB 10D I ECCENTRIC 36MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 663-10-36J SUP Custom 27803010 663-10-36J - INSERT ACETAB 10D J ECCENTRIC 36MM TRIDENT X3 HIP BOTH IP/OP "$1,440.00" "$1,066.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $256.32 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" $300.11 "$1,440.00" $576.00 "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,440.00" "$1,080.00" "$1,440.00" "$1,440.00" "$1,440.00" $720.00 $720.00 "$1,140.48" "$1,440.00" "$1,152.00" $648.00 "$1,440.00" N/A $835.20 "$1,440.00" $864.00 "$1,440.00" "$1,440.00" "$1,440.00" N/A N/A 6632-0-208 SUP Custom 27803010 6632-0-208 - STABILIZER SURG XS CEMENTED MONO DURACON FEMUR LEFT BOTH IP/OP "$5,490.00" "$4,063.00" $977.22 "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" $977.22 "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$1,144.18" "$5,490.00" "$2,196.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$4,117.50" "$5,490.00" "$5,490.00" "$5,490.00" "$2,745.00" "$2,745.00" "$4,348.08" "$5,490.00" "$4,392.00" "$2,470.50" "$5,490.00" N/A "$3,184.20" "$5,490.00" "$3,294.00" "$5,490.00" "$5,490.00" "$5,490.00" N/A N/A 6632-0-210 SUP HCPCS C1776 6632-0-210 - COMPONENT FEMORAL SMALL CRUCIATE RETAIN MODULAR DURACON KNEE BOTH IP/OP "$7,057.50" "$5,223.00" "$1,400.71" "$7,057.38" "$3,175.82" "$3,175.82" "$3,175.82" "$3,175.82" "$7,057.38" "$7,057.38" "$7,057.38" "$1,470.93" "$7,057.38" "$7,057.38" "$7,057.38" "$7,057.38" "$7,057.38" "$1,470.84" "$7,057.38" "$7,057.38" "$3,479.29" "$7,057.38" "$7,057.38" "$7,057.38" "$7,057.38" "$5,293.13" "$7,057.38" "$7,057.38" "$7,057.38" "$3,528.69" "$3,528.69" "$5,589.44" "$7,057.38" "$5,645.90" "$3,175.82" "$1,400.71" N/A "$4,093.35" "$7,057.38" "$7,057.38" "$7,057.38" "$1,470.76" "$7,057.38" N/A N/A 6632-0-215 SUP HCPCS C1776 6632-0-215 - COMPONENT FEMORAL SMALL CRUCIATE RETAIN MODULAR DURACON KNEE BOTH IP/OP "$3,437.00" "$2,543.00" $682.16 "$3,437.00" "$1,546.65" "$1,546.65" "$1,546.65" "$1,546.65" "$3,437.00" "$3,437.00" "$3,437.00" $716.36 "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" $716.31 "$3,437.00" "$1,374.80" "$1,694.44" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$2,577.75" "$3,437.00" "$3,437.00" "$3,437.00" "$1,718.50" "$1,718.50" "$2,722.10" "$3,437.00" "$2,749.60" "$1,546.65" $682.16 N/A "$1,993.46" "$3,437.00" "$3,437.00" "$3,437.00" $716.27 "$3,437.00" N/A N/A 6632-0-218 SUP HCPCS C1776 6632-0-218 - COMPONENT FEMORAL XS CRUCIATE RETAIN MODULAR DURACON KNEE BOTH IP/OP "$5,490.00" "$4,063.00" "$1,089.63" "$5,490.00" "$2,470.50" "$2,470.50" "$2,470.50" "$2,470.50" "$5,490.00" "$5,490.00" "$5,490.00" "$1,144.25" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$1,144.18" "$5,490.00" "$2,196.00" "$2,706.57" "$5,490.00" "$5,490.00" "$5,490.00" "$5,490.00" "$4,117.50" "$5,490.00" "$5,490.00" "$5,490.00" "$2,745.00" "$2,745.00" "$4,348.08" "$5,490.00" "$4,392.00" "$2,470.50" "$1,089.63" N/A "$3,184.20" "$5,490.00" "$5,490.00" "$5,490.00" "$1,144.12" "$5,490.00" N/A N/A 6632-0-220 SUP HCPCS C1776 6632-0-220 - COMPONENT FEMORAL SMALL CRUCIATE RETAIN MODULAR DURACON KNEE BOTH IP/OP "$7,057.50" "$5,223.00" "$1,400.71" "$7,057.38" "$3,175.82" "$3,175.82" "$3,175.82" "$3,175.82" "$7,057.38" "$7,057.38" "$7,057.38" "$1,470.93" "$7,057.38" "$7,057.38" "$7,057.38" "$7,057.38" "$7,057.38" "$1,470.84" "$7,057.38" "$2,822.95" "$3,479.29" "$7,057.38" "$7,057.38" "$7,057.38" "$7,057.38" "$5,293.13" "$7,057.38" "$7,057.38" "$7,057.38" "$3,528.69" "$3,528.69" "$5,589.44" "$7,057.38" "$5,645.90" "$3,175.82" "$1,400.71" N/A "$4,093.35" "$7,057.38" "$7,057.38" "$7,057.38" "$1,470.76" "$7,057.38" N/A N/A 6632-0-225 SUP HCPCS C1776 6632-0-225 - COMPONENT FEMORAL SMALL CRUCIATE RETAIN MODULAR DURACON KNEE BOTH IP/OP "$3,437.00" "$2,543.00" $682.16 "$3,437.00" "$1,546.65" "$1,546.65" "$1,546.65" "$1,546.65" "$3,437.00" "$3,437.00" "$3,437.00" $716.36 "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" $716.31 "$3,437.00" "$1,374.80" "$1,694.44" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$2,577.75" "$3,437.00" "$3,437.00" "$3,437.00" "$1,718.50" "$1,718.50" "$2,722.10" "$3,437.00" "$2,749.60" "$1,546.65" $682.16 N/A "$1,993.46" "$3,437.00" "$3,437.00" "$3,437.00" $716.27 "$3,437.00" N/A N/A 6632-0-310 SUP HCPCS C1776 6632-0-310 - COMPONENT FEMORAL MEDIUM CRUC RET MODULAR STABILIZE DURACON BOTH IP/OP "$7,057.50" "$5,223.00" "$1,400.71" "$7,057.38" "$3,175.82" "$3,175.82" "$3,175.82" "$3,175.82" "$7,057.38" "$7,057.38" "$7,057.38" "$1,470.93" "$7,057.38" "$7,057.38" "$7,057.38" "$7,057.38" "$7,057.38" "$1,470.84" "$7,057.38" "$2,822.95" "$3,479.29" "$7,057.38" "$7,057.38" "$7,057.38" "$7,057.38" "$5,293.13" "$7,057.38" "$7,057.38" "$7,057.38" "$3,528.69" "$3,528.69" "$5,589.44" "$7,057.38" "$5,645.90" "$3,175.82" "$1,400.71" N/A "$4,093.35" "$7,057.38" "$7,057.38" "$7,057.38" "$1,470.76" "$7,057.38" N/A N/A 6632-0-315 SUP HCPCS C1776 6632-0-315 - COMPONENT FEMORAL MEDIUM CRUC RET MODULAR STABILIZE DURACON BOTH IP/OP "$3,437.00" "$2,543.00" $682.16 "$3,437.00" "$1,546.65" "$1,546.65" "$1,546.65" "$1,546.65" "$3,437.00" "$3,437.00" "$3,437.00" $716.36 "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" $716.31 "$3,437.00" "$1,374.80" "$1,694.44" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$2,577.75" "$3,437.00" "$3,437.00" "$3,437.00" "$1,718.50" "$1,718.50" "$2,722.10" "$3,437.00" "$2,749.60" "$1,546.65" $682.16 N/A "$1,993.46" "$3,437.00" "$2,062.20" "$3,437.00" $716.27 "$3,437.00" N/A N/A 6632-0-317 SUP HCPCS C1776 6632-0-317 - COMPONENT FEMORAL MEDIUM NEUTRAL CRUC RET MODULAR STABILIZE BOTH IP/OP "$3,314.00" "$2,452.00" $657.75 "$3,314.00" "$1,491.30" "$1,491.30" "$1,491.30" "$1,491.30" "$3,314.00" "$3,314.00" "$3,314.00" $690.72 "$3,314.00" "$3,314.00" "$3,314.00" "$3,314.00" "$3,314.00" $690.67 "$3,314.00" "$1,325.60" "$1,633.80" "$3,314.00" "$3,314.00" "$3,314.00" "$3,314.00" "$2,485.50" "$3,314.00" "$3,314.00" "$3,314.00" "$1,657.00" "$1,657.00" "$2,624.69" "$3,314.00" "$2,651.20" "$1,491.30" $657.75 N/A "$1,922.12" "$3,314.00" "$1,988.40" "$3,314.00" $690.64 "$3,314.00" N/A N/A 6632-0-325 SUP HCPCS C1776 6632-0-325 - COMPONENT FEMORAL MEDIUM CRUC RET MODULAR STABILIZE DURACON BOTH IP/OP "$3,437.00" "$2,543.00" $682.16 "$3,437.00" "$1,546.65" "$1,546.65" "$1,546.65" "$1,546.65" "$3,437.00" "$3,437.00" "$3,437.00" $716.36 "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" $716.31 "$3,437.00" "$1,374.80" "$1,694.44" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$2,577.75" "$3,437.00" "$3,437.00" "$3,437.00" "$1,718.50" "$1,718.50" "$2,722.10" "$3,437.00" "$2,749.60" "$1,546.65" $682.16 N/A "$1,993.46" "$3,437.00" "$2,062.20" "$3,437.00" $716.27 "$3,437.00" N/A N/A 6632-0-327 SUP HCPCS C1776 6632-0-327 - COMPONENT FEMORAL MEDIUM NEUTRAL CRUC RET MODULAR STABILIZE BOTH IP/OP "$3,314.00" "$2,452.00" $657.75 "$3,314.00" "$1,491.30" "$1,491.30" "$1,491.30" "$1,491.30" "$3,314.00" "$3,314.00" "$3,314.00" $690.72 "$3,314.00" "$3,314.00" "$3,314.00" "$3,314.00" "$3,314.00" $690.67 "$3,314.00" "$1,325.60" "$1,633.80" "$3,314.00" "$3,314.00" "$3,314.00" "$3,314.00" "$2,485.50" "$3,314.00" "$3,314.00" "$3,314.00" "$1,657.00" "$1,657.00" "$2,624.69" "$3,314.00" "$2,651.20" "$1,491.30" $657.75 N/A "$1,922.12" "$3,314.00" "$1,988.40" "$3,314.00" $690.64 "$3,314.00" N/A N/A 6632-0-410 SUP HCPCS C1776 6632-0-410 - COMPONENT FEMORAL MEDIUM LARGE CRUC RET MODULAR BEAD DURACON BOTH IP/OP "$7,057.50" "$5,223.00" "$1,400.71" "$7,057.38" "$3,175.82" "$3,175.82" "$3,175.82" "$3,175.82" "$7,057.38" "$7,057.38" "$7,057.38" "$1,470.93" "$7,057.38" "$7,057.38" "$7,057.38" "$7,057.38" "$7,057.38" "$1,470.84" "$7,057.38" "$2,822.95" "$3,479.29" "$7,057.38" "$7,057.38" "$7,057.38" "$7,057.38" "$5,293.13" "$7,057.38" "$7,057.38" "$7,057.38" "$3,528.69" "$3,528.69" "$5,589.44" "$7,057.38" "$5,645.90" "$3,175.82" "$1,400.71" N/A "$4,093.35" "$7,057.38" "$7,057.38" "$7,057.38" "$1,470.76" "$7,057.38" N/A N/A 6632-0-415 SUP HCPCS C1776 6632-0-415 - COMPONENT FEMORAL MEDIUM LARGE CRUC RET MODULAR NONBEAD BOTH IP/OP "$3,437.00" "$2,543.00" $682.16 "$3,437.00" "$1,546.65" "$1,546.65" "$1,546.65" "$1,546.65" "$3,437.00" "$3,437.00" "$3,437.00" $716.36 "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" $716.31 "$3,437.00" "$3,437.00" "$1,694.44" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$2,577.75" "$3,437.00" "$3,437.00" "$3,437.00" "$1,718.50" "$1,718.50" "$2,722.10" "$3,437.00" "$2,749.60" "$1,546.65" $682.16 N/A "$1,993.46" "$3,437.00" "$2,062.20" "$3,437.00" $716.27 "$3,437.00" N/A N/A 6632-0-425 SUP HCPCS C1776 6632-0-425 - COMPONENT FEMORAL MEDIUM LARGE CRUC RET MODULAR NONBEAD BOTH IP/OP "$3,437.00" "$2,543.00" $682.16 "$3,437.00" "$1,546.65" "$1,546.65" "$1,546.65" "$1,546.65" "$3,437.00" "$3,437.00" "$3,437.00" $716.36 "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" $716.31 "$3,437.00" "$1,374.80" "$1,694.44" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$2,577.75" "$3,437.00" "$3,437.00" "$3,437.00" "$1,718.50" "$1,718.50" "$2,722.10" "$3,437.00" "$2,749.60" "$1,546.65" $682.16 N/A "$1,993.46" "$3,437.00" "$2,062.20" "$3,437.00" $716.27 "$3,437.00" N/A N/A 6632-0-515 SUP HCPCS C1776 6632-0-515 - COMPONENT FEMORAL LARGE CRUC RET MODULAR NONBEAD DURACON BOTH IP/OP "$3,437.00" "$2,543.00" $682.16 "$3,437.00" "$1,546.65" "$1,546.65" "$1,546.65" "$1,546.65" "$3,437.00" "$3,437.00" "$3,437.00" $716.36 "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" $716.31 "$3,437.00" "$1,374.80" "$1,694.44" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$2,577.75" "$3,437.00" "$3,437.00" "$3,437.00" "$1,718.50" "$1,718.50" "$2,722.10" "$3,437.00" "$2,749.60" "$1,546.65" $682.16 N/A "$1,993.46" "$3,437.00" "$2,062.20" "$3,437.00" $716.27 "$3,437.00" N/A N/A 6632-0-525 SUP HCPCS C1776 6632-0-525 - COMPONENT FEMORAL LARGE CRUC RET MODULAR BEAD DURACON KNEE BOTH IP/OP "$3,437.00" "$2,543.00" $682.16 "$3,437.00" "$1,546.65" "$1,546.65" "$1,546.65" "$1,546.65" "$3,437.00" "$3,437.00" "$3,437.00" $716.36 "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" $716.31 "$3,437.00" "$1,374.80" "$1,694.44" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$2,577.75" "$3,437.00" "$3,437.00" "$3,437.00" "$1,718.50" "$1,718.50" "$2,722.10" "$3,437.00" "$2,749.60" "$1,546.65" $682.16 N/A "$1,993.46" "$3,437.00" "$2,062.20" "$3,437.00" $716.27 "$3,437.00" N/A N/A 6632-0-610 SUP HCPCS C1776 6632-0-610 - COMPONENT FEMORAL XL CRUC RET MODULAR BEAD DURACON KNEE LEFT BOTH IP/OP "$7,192.50" "$5,322.00" "$1,427.48" "$7,192.25" "$3,236.51" "$3,236.51" "$3,236.51" "$3,236.51" "$7,192.25" "$7,192.25" "$7,192.25" "$1,499.04" "$7,192.25" "$7,192.25" "$7,192.25" "$7,192.25" "$7,192.25" "$1,498.94" "$7,192.25" "$7,192.25" "$3,545.78" "$7,192.25" "$7,192.25" "$7,192.25" "$7,192.25" "$5,394.38" "$7,192.25" "$7,192.25" "$7,192.25" "$3,596.13" "$3,596.13" "$5,696.26" "$7,192.25" "$5,753.80" "$3,236.51" "$1,427.48" N/A "$4,171.65" "$7,192.25" "$4,315.35" "$7,192.25" "$1,498.86" "$7,192.25" N/A N/A 6632-0-615 SUP HCPCS C1776 6632-0-615 - COMPONENT FEMORAL XL CRUC RET MODULAR NONBEAD DURACON KNEE BOTH IP/OP "$3,499.00" "$2,589.00" $694.46 "$3,499.00" "$1,574.55" "$1,574.55" "$1,574.55" "$1,574.55" "$3,499.00" "$3,499.00" "$3,499.00" $729.28 "$3,499.00" "$3,499.00" "$3,499.00" "$3,499.00" "$3,499.00" $729.23 "$3,499.00" "$3,499.00" "$1,725.01" "$3,499.00" "$3,499.00" "$3,499.00" "$3,499.00" "$2,624.25" "$3,499.00" "$3,499.00" "$3,499.00" "$1,749.50" "$1,749.50" "$2,771.21" "$3,499.00" "$2,799.20" "$1,574.55" $694.46 N/A "$2,029.42" "$3,499.00" "$2,099.40" "$3,499.00" $729.19 "$3,499.00" N/A N/A 6632-0-620 SUP HCPCS C1776 6632-0-620 - COMPONENT FEMORAL XL CRUC RET MODULAR BEAD DURACON KNEE BOTH IP/OP "$7,192.50" "$5,322.00" "$1,427.48" "$7,192.25" "$3,236.51" "$3,236.51" "$3,236.51" "$3,236.51" "$7,192.25" "$7,192.25" "$7,192.25" "$1,499.04" "$7,192.25" "$7,192.25" "$7,192.25" "$7,192.25" "$7,192.25" "$1,498.94" "$7,192.25" "$7,192.25" "$3,545.78" "$7,192.25" "$7,192.25" "$7,192.25" "$7,192.25" "$5,394.38" "$7,192.25" "$7,192.25" "$7,192.25" "$3,596.13" "$3,596.13" "$5,696.26" "$7,192.25" "$5,753.80" "$3,236.51" "$1,427.48" N/A "$4,171.65" "$7,192.25" "$4,315.35" "$7,192.25" "$1,498.86" "$7,192.25" N/A N/A 6632-0-625 SUP HCPCS C1776 6632-0-625 - COMPONENT FEMORAL XL CRUC RET MODULAR NONBEAD DURACON KNEE BOTH IP/OP "$3,499.00" "$2,589.00" $694.46 "$3,499.00" "$1,574.55" "$1,574.55" "$1,574.55" "$1,574.55" "$3,499.00" "$3,499.00" "$3,499.00" $729.28 "$3,499.00" "$3,499.00" "$3,499.00" "$3,499.00" "$3,499.00" $729.23 "$3,499.00" "$3,499.00" "$1,725.01" "$3,499.00" "$3,499.00" "$3,499.00" "$3,499.00" "$2,624.25" "$3,499.00" "$3,499.00" "$3,499.00" "$1,749.50" "$1,749.50" "$2,771.21" "$3,499.00" "$2,799.20" "$1,574.55" $694.46 N/A "$2,029.42" "$3,499.00" "$3,499.00" "$3,499.00" $729.19 "$3,499.00" N/A N/A 6632-0-710 SUP HCPCS C1776 6632-0-710 - COMPONENT FEMORAL 2XL CRUC RET MODULAR BEAD DURACON KNEE BOTH IP/OP "$7,192.50" "$5,322.00" "$1,427.48" "$7,192.25" "$3,236.51" "$3,236.51" "$3,236.51" "$3,236.51" "$7,192.25" "$7,192.25" "$7,192.25" "$1,499.04" "$7,192.25" "$7,192.25" "$7,192.25" "$7,192.25" "$7,192.25" "$1,498.94" "$7,192.25" "$2,876.90" "$3,545.78" "$7,192.25" "$7,192.25" "$7,192.25" "$7,192.25" "$5,394.38" "$7,192.25" "$7,192.25" "$7,192.25" "$3,596.13" "$3,596.13" "$5,696.26" "$7,192.25" "$5,753.80" "$3,236.51" "$1,427.48" N/A "$4,171.65" "$7,192.25" "$7,192.25" "$7,192.25" "$1,498.86" "$7,192.25" N/A N/A 6632-0-715 SUP HCPCS C1776 6632-0-715 - COMPONENT FEMORAL 2XL CRUC RET MODULAR NONBEAD DURACON KNEE BOTH IP/OP "$3,499.00" "$2,589.00" $694.46 "$3,499.00" "$1,574.55" "$1,574.55" "$1,574.55" "$1,574.55" "$3,499.00" "$3,499.00" "$3,499.00" $729.28 "$3,499.00" "$3,499.00" "$3,499.00" "$3,499.00" "$3,499.00" $729.23 "$3,499.00" "$1,399.60" "$1,725.01" "$3,499.00" "$3,499.00" "$3,499.00" "$3,499.00" "$2,624.25" "$3,499.00" "$3,499.00" "$3,499.00" "$1,749.50" "$1,749.50" "$2,771.21" "$3,499.00" "$2,799.20" "$1,574.55" $694.46 N/A "$2,029.42" "$3,499.00" "$3,499.00" "$3,499.00" $729.19 "$3,499.00" N/A N/A 6632-0-720 SUP HCPCS C1776 6632-0-720 - COMPONENT FEMORAL 2XL CRUC RET MODULAR BEAD DURACON KNEE BOTH IP/OP "$7,192.50" "$5,322.00" "$1,427.48" "$7,192.25" "$3,236.51" "$3,236.51" "$3,236.51" "$3,236.51" "$7,192.25" "$7,192.25" "$7,192.25" "$1,499.04" "$7,192.25" "$7,192.25" "$7,192.25" "$7,192.25" "$7,192.25" "$1,498.94" "$7,192.25" "$2,876.90" "$3,545.78" "$7,192.25" "$7,192.25" "$7,192.25" "$7,192.25" "$5,394.38" "$7,192.25" "$7,192.25" "$7,192.25" "$3,596.13" "$3,596.13" "$5,696.26" "$7,192.25" "$5,753.80" "$3,236.51" "$1,427.48" N/A "$4,171.65" "$7,192.25" "$7,192.25" "$7,192.25" "$1,498.86" "$7,192.25" N/A N/A 6632-0-725 SUP HCPCS C1776 6632-0-725 - COMPONENT FEMORAL 2XL CRUC RET MODULAR NONBEAD DURACON KNEE BOTH IP/OP "$3,499.00" "$2,589.00" $694.46 "$3,499.00" "$1,574.55" "$1,574.55" "$1,574.55" "$1,574.55" "$3,499.00" "$3,499.00" "$3,499.00" $729.28 "$3,499.00" "$3,499.00" "$3,499.00" "$3,499.00" "$3,499.00" $729.23 "$3,499.00" "$3,499.00" "$1,725.01" "$3,499.00" "$3,499.00" "$3,499.00" "$3,499.00" "$2,624.25" "$3,499.00" "$3,499.00" "$3,499.00" "$1,749.50" "$1,749.50" "$2,771.21" "$3,499.00" "$2,799.20" "$1,574.55" $694.46 N/A "$2,029.42" "$3,499.00" "$2,099.40" "$3,499.00" $729.19 "$3,499.00" N/A N/A 6632-0-750 SUP HCPCS C1713 6632-0-750 - PEG FIX MODULAR REPLACEMENT FEMUR BOTH IP/OP $524.00 $388.00 $104.00 $524.00 $235.80 $235.80 $235.80 $235.80 $524.00 $524.00 $524.00 $109.21 $524.00 $524.00 $524.00 $524.00 $524.00 $109.21 $524.00 $209.60 $309.95 $524.00 $524.00 $524.00 $524.00 $393.00 $524.00 $524.00 $524.00 $262.00 $262.00 $415.01 $524.00 $419.20 $235.80 $104.00 N/A $303.92 $524.00 $314.40 $524.00 $109.20 $524.00 N/A N/A 6632-0-810 SUP HCPCS C1776 6632-0-810 - COMPONENT FEMORAL SMALL CEMENTED MONOLITHIC STABILIZE BOTH IP/OP "$3,869.00" "$2,863.00" $767.90 "$3,869.00" "$1,741.05" "$1,741.05" "$1,741.05" "$1,741.05" "$3,869.00" "$3,869.00" "$3,869.00" $806.40 "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" $806.34 "$3,869.00" "$1,547.60" "$1,907.42" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$2,901.75" "$3,869.00" "$3,869.00" "$3,869.00" "$1,934.50" "$1,934.50" "$3,064.25" "$3,869.00" "$3,095.20" "$1,741.05" $767.90 N/A "$2,244.02" "$3,869.00" "$3,869.00" "$3,869.00" $806.30 "$3,869.00" N/A N/A 6632-0-811 SUP HCPCS C1776 6632-0-811 - COMPONENT FEMORAL SMALL CEMENTED MONOLITHIC STABILIZE BOTH IP/OP "$3,437.00" "$2,543.00" $682.16 "$3,437.00" "$1,546.65" "$1,546.65" "$1,546.65" "$1,546.65" "$3,437.00" "$3,437.00" "$3,437.00" $716.36 "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" $716.31 "$3,437.00" "$1,374.80" "$1,694.44" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$2,577.75" "$3,437.00" "$3,437.00" "$3,437.00" "$1,718.50" "$1,718.50" "$2,722.10" "$3,437.00" "$2,749.60" "$1,546.65" $682.16 N/A "$1,993.46" "$3,437.00" "$3,437.00" "$3,437.00" $716.27 "$3,437.00" N/A N/A 6632-0-815 SUP HCPCS C1776 6632-0-815 - COMPONENT FEMORAL SMALL CEMENTED MONOLITHIC STABILIZE BOTH IP/OP "$3,869.00" "$2,863.00" $767.90 "$3,869.00" "$1,741.05" "$1,741.05" "$1,741.05" "$1,741.05" "$3,869.00" "$3,869.00" "$3,869.00" $806.40 "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" $806.34 "$3,869.00" "$3,869.00" "$1,907.42" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$2,901.75" "$3,869.00" "$3,869.00" "$3,869.00" "$1,934.50" "$1,934.50" "$3,064.25" "$3,869.00" "$3,095.20" "$1,741.05" $767.90 N/A "$2,244.02" "$3,869.00" "$3,869.00" "$3,869.00" $806.30 "$3,869.00" N/A N/A 6632-0-820 SUP HCPCS C1776 6632-0-820 - COMPONENT FEMORAL MEDIUM CEMENTED MONOLITHIC STABILIZE BOTH IP/OP "$3,869.00" "$2,863.00" $767.90 "$3,869.00" "$1,741.05" "$1,741.05" "$1,741.05" "$1,741.05" "$3,869.00" "$3,869.00" "$3,869.00" $806.40 "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" $806.34 "$3,869.00" "$3,869.00" "$1,907.42" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$2,901.75" "$3,869.00" "$3,869.00" "$3,869.00" "$1,934.50" "$1,934.50" "$3,064.25" "$3,869.00" "$3,095.20" "$1,741.05" $767.90 N/A "$2,244.02" "$3,869.00" "$2,321.40" "$3,869.00" $806.30 "$3,869.00" N/A N/A 6632-0-821 SUP HCPCS C1776 6632-0-821 - COMPONENT FEMORAL MEDIUM CEMENTED MONOLITHIC STABILIZE BOTH IP/OP "$3,437.00" "$2,543.00" $682.16 "$3,437.00" "$1,546.65" "$1,546.65" "$1,546.65" "$1,546.65" "$3,437.00" "$3,437.00" "$3,437.00" $716.36 "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" $716.31 "$3,437.00" "$1,374.80" "$1,694.44" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$2,577.75" "$3,437.00" "$3,437.00" "$3,437.00" "$1,718.50" "$1,718.50" "$2,722.10" "$3,437.00" "$2,749.60" "$1,546.65" $682.16 N/A "$1,993.46" "$3,437.00" "$2,062.20" "$3,437.00" $716.27 "$3,437.00" N/A N/A 6632-0-825 SUP HCPCS C1776 6632-0-825 - COMPONENT FEM MED DRCN CMNT MNLTH STAB KN RT BOTH IP/OP "$3,869.00" "$2,863.00" $767.90 "$3,869.00" "$1,741.05" "$1,741.05" "$1,741.05" "$1,741.05" "$3,869.00" "$3,869.00" "$3,869.00" $806.40 "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" $806.34 "$3,869.00" "$1,547.60" "$1,907.42" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$2,901.75" "$3,869.00" "$3,869.00" "$3,869.00" "$1,934.50" "$1,934.50" "$3,064.25" "$3,869.00" "$3,095.20" "$1,741.05" $767.90 N/A "$2,244.02" "$3,869.00" "$2,321.40" "$3,869.00" $806.30 "$3,869.00" N/A N/A 6632-0-826 SUP HCPCS C1776 6632-0-826 - COMPONENT FEM MED DRCN CMNT MNLTH STAB KN RT BOTH IP/OP "$3,437.00" "$2,543.00" $682.16 "$3,437.00" "$1,546.65" "$1,546.65" "$1,546.65" "$1,546.65" "$3,437.00" "$3,437.00" "$3,437.00" $716.36 "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" $716.31 "$3,437.00" "$1,374.80" "$1,694.44" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$2,577.75" "$3,437.00" "$3,437.00" "$3,437.00" "$1,718.50" "$1,718.50" "$2,722.10" "$3,437.00" "$2,749.60" "$1,546.65" $682.16 N/A "$1,993.46" "$3,437.00" "$2,062.20" "$3,437.00" $716.27 "$3,437.00" N/A N/A 6632-0-830 SUP HCPCS C1776 6632-0-830 - COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN LT BOTH IP/OP "$3,869.00" "$2,863.00" $767.90 "$3,869.00" "$1,741.05" "$1,741.05" "$1,741.05" "$1,741.05" "$3,869.00" "$3,869.00" "$3,869.00" $806.40 "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" $806.34 "$3,869.00" "$1,547.60" "$1,907.42" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$2,901.75" "$3,869.00" "$3,869.00" "$3,869.00" "$1,934.50" "$1,934.50" "$3,064.25" "$3,869.00" "$3,095.20" "$1,741.05" $767.90 N/A "$2,244.02" "$3,869.00" "$2,321.40" "$3,869.00" $806.30 "$3,869.00" N/A N/A 6632-0-831 SUP HCPCS C1776 6632-0-831 - COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN LT BOTH IP/OP "$3,437.00" "$2,543.00" $682.16 "$3,437.00" "$1,546.65" "$1,546.65" "$1,546.65" "$1,546.65" "$3,437.00" "$3,437.00" "$3,437.00" $716.36 "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" $716.31 "$3,437.00" "$1,374.80" "$1,694.44" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$2,577.75" "$3,437.00" "$3,437.00" "$3,437.00" "$1,718.50" "$1,718.50" "$2,722.10" "$3,437.00" "$2,749.60" "$1,546.65" $682.16 N/A "$1,993.46" "$3,437.00" "$3,437.00" "$3,437.00" $716.27 "$3,437.00" N/A N/A 6632-0-835 SUP HCPCS C1776 6632-0-835 - COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN RT BOTH IP/OP "$3,869.00" "$2,863.00" $767.90 "$3,869.00" "$1,741.05" "$1,741.05" "$1,741.05" "$1,741.05" "$3,869.00" "$3,869.00" "$3,869.00" $806.40 "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" $806.34 "$3,869.00" "$1,547.60" "$1,907.42" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$2,901.75" "$3,869.00" "$3,869.00" "$3,869.00" "$1,934.50" "$1,934.50" "$3,064.25" "$3,869.00" "$3,095.20" "$1,741.05" $767.90 N/A "$2,244.02" "$3,869.00" "$3,869.00" "$3,869.00" $806.30 "$3,869.00" N/A N/A 6632-0-836 SUP HCPCS C1776 6632-0-836 - COMPONENT FEM MED LG DRCN CMNT MNLTH STAB KN RT BOTH IP/OP "$3,437.00" "$2,543.00" $682.16 "$3,437.00" "$1,546.65" "$1,546.65" "$1,546.65" "$1,546.65" "$3,437.00" "$3,437.00" "$3,437.00" $716.36 "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" $716.31 "$3,437.00" "$1,374.80" "$1,694.44" "$3,437.00" "$3,437.00" "$3,437.00" "$3,437.00" "$2,577.75" "$3,437.00" "$3,437.00" "$3,437.00" "$1,718.50" "$1,718.50" "$2,722.10" "$3,437.00" "$2,749.60" "$1,546.65" $682.16 N/A "$1,993.46" "$3,437.00" "$2,062.20" "$3,437.00" $716.27 "$3,437.00" N/A N/A 6632-0-840 SUP HCPCS C1776 6632-0-840 - COMPONENT FEMORAL LARGE CEMENTED MONOLITHIC STABILIZE BOTH IP/OP "$3,869.00" "$2,863.00" $767.90 "$3,869.00" "$1,741.05" "$1,741.05" "$1,741.05" "$1,741.05" "$3,869.00" "$3,869.00" "$3,869.00" $806.40 "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" $806.34 "$3,869.00" "$3,869.00" "$1,907.42" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$2,901.75" "$3,869.00" "$3,869.00" "$3,869.00" "$1,934.50" "$1,934.50" "$3,064.25" "$3,869.00" "$3,095.20" "$1,741.05" $767.90 N/A "$2,244.02" "$3,869.00" "$2,321.40" "$3,869.00" $806.30 "$3,869.00" N/A N/A 6632-0-845 SUP HCPCS C1776 6632-0-845 - COMPONENT FEMORAL LARGE CEMENTED MONOLITHIC STABILIZE BOTH IP/OP "$3,869.00" "$2,863.00" $767.90 "$3,869.00" "$1,741.05" "$1,741.05" "$1,741.05" "$1,741.05" "$3,869.00" "$3,869.00" "$3,869.00" $806.40 "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" $806.34 "$3,869.00" "$3,869.00" "$1,907.42" "$3,869.00" "$3,869.00" "$3,869.00" "$3,869.00" "$2,901.75" "$3,869.00" "$3,869.00" "$3,869.00" "$1,934.50" "$1,934.50" "$3,064.25" "$3,869.00" "$3,095.20" "$1,741.05" $767.90 N/A "$2,244.02" "$3,869.00" "$2,321.40" "$3,869.00" $806.30 "$3,869.00" N/A N/A 6632-0-855 SUP HCPCS C1776 6632-0-855 - COMPONENT FEMORAL XL CEMENTED MONOLITHIC STABILIZE DURACON BOTH IP/OP "$3,941.00" "$2,916.00" $782.19 "$3,941.00" "$1,773.45" "$1,773.45" "$1,773.45" "$1,773.45" "$3,941.00" "$3,941.00" "$3,941.00" $821.40 "$3,941.00" "$3,941.00" "$3,941.00" "$3,941.00" "$3,941.00" $821.35 "$3,941.00" "$3,941.00" "$1,942.91" "$3,941.00" "$3,941.00" "$3,941.00" "$3,941.00" "$2,955.75" "$3,941.00" "$3,941.00" "$3,941.00" "$1,970.50" "$1,970.50" "$3,121.27" "$3,941.00" "$3,152.80" "$1,773.45" $782.19 N/A "$2,285.78" "$3,941.00" "$2,364.60" "$3,941.00" $821.30 "$3,941.00" N/A N/A 6632-0-860 SUP HCPCS C1776 6632-0-860 - COMPONENT FEMORAL 2XL CEMENTED MONOLITHIC STABILIZE DURACON BOTH IP/OP "$3,941.00" "$2,916.00" $782.19 "$3,941.00" "$1,773.45" "$1,773.45" "$1,773.45" "$1,773.45" "$3,941.00" "$3,941.00" "$3,941.00" $821.40 "$3,941.00" "$3,941.00" "$3,941.00" "$3,941.00" "$3,941.00" $821.35 "$3,941.00" "$3,941.00" "$1,942.91" "$3,941.00" "$3,941.00" "$3,941.00" "$3,941.00" "$2,955.75" "$3,941.00" "$3,941.00" "$3,941.00" "$1,970.50" "$1,970.50" "$3,121.27" "$3,941.00" "$3,152.80" "$1,773.45" $782.19 N/A "$2,285.78" "$3,941.00" "$2,364.60" "$3,941.00" $821.30 "$3,941.00" N/A N/A 6632-0-865 SUP HCPCS C1776 6632-0-865 - COMPONENT FEMORAL 2XL CEMENTED MONOLITHIC STABILIZE DURACON BOTH IP/OP "$3,941.00" "$2,916.00" $782.19 "$3,941.00" "$1,773.45" "$1,773.45" "$1,773.45" "$1,773.45" "$3,941.00" "$3,941.00" "$3,941.00" $821.40 "$3,941.00" "$3,941.00" "$3,941.00" "$3,941.00" "$3,941.00" $821.35 "$3,941.00" "$3,941.00" "$1,942.91" "$3,941.00" "$3,941.00" "$3,941.00" "$3,941.00" "$2,955.75" "$3,941.00" "$3,941.00" "$3,941.00" "$1,970.50" "$1,970.50" "$3,121.27" "$3,941.00" "$3,152.80" "$1,773.45" $782.19 N/A "$2,285.78" "$3,941.00" "$2,364.60" "$3,941.00" $821.30 "$3,941.00" N/A N/A 6632-3-301 SUP HCPCS C1776 6632-3-301 - BASEPLATE TIBIAL 1 XS BEADED CRCIFRM DURACON POROUS KNEE BOTH IP/OP "$2,891.00" "$2,139.00" $573.79 "$2,891.00" "$1,300.95" "$1,300.95" "$1,300.95" "$1,300.95" "$2,891.00" "$2,891.00" "$2,891.00" $602.56 "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" $602.52 "$2,891.00" "$2,891.00" "$1,425.26" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,168.25" "$2,891.00" "$2,891.00" "$2,891.00" "$1,445.50" "$1,445.50" "$2,289.67" "$2,891.00" "$2,312.80" "$1,300.95" $573.79 N/A "$1,676.78" "$2,891.00" "$2,891.00" "$2,891.00" $602.48 "$2,891.00" N/A N/A 6632-3-303 SUP HCPCS C1776 6632-3-303 - BASEPLATE TIBIAL 2 XS BEADED CRCIFRM DURACON POROUS KNEE BOTH IP/OP "$2,891.00" "$2,139.00" $573.79 "$2,891.00" "$1,300.95" "$1,300.95" "$1,300.95" "$1,300.95" "$2,891.00" "$2,891.00" "$2,891.00" $602.56 "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" $602.52 "$2,891.00" "$2,891.00" "$1,425.26" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,168.25" "$2,891.00" "$2,891.00" "$2,891.00" "$1,445.50" "$1,445.50" "$2,289.67" "$2,891.00" "$2,312.80" "$1,300.95" $573.79 N/A "$1,676.78" "$2,891.00" "$2,891.00" "$2,891.00" $602.48 "$2,891.00" N/A N/A 6632-3-305 SUP HCPCS C1776 6632-3-305 - BASEPLATE TIBIAL 1 SMALL BEADED CRCIFRM DURACON POROUS KNEE BOTH IP/OP "$2,838.00" "$2,100.00" $563.27 "$2,838.00" "$1,277.10" "$1,277.10" "$1,277.10" "$1,277.10" "$2,838.00" "$2,838.00" "$2,838.00" $591.51 "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" $591.47 "$2,838.00" "$2,838.00" "$1,399.13" "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" "$2,128.50" "$2,838.00" "$2,838.00" "$2,838.00" "$1,419.00" "$1,419.00" "$2,247.70" "$2,838.00" "$2,270.40" "$1,277.10" $563.27 N/A "$1,646.04" "$2,838.00" "$2,838.00" "$2,838.00" $591.44 "$2,838.00" N/A N/A 6632-3-310 SUP HCPCS C1776 6632-3-310 - BASEPLATE TIBIAL 2 SMALL BEADED CRCIFRM DURACON POROUS KNEE BOTH IP/OP "$2,838.00" "$2,100.00" $563.27 "$2,838.00" "$1,277.10" "$1,277.10" "$1,277.10" "$1,277.10" "$2,838.00" "$2,838.00" "$2,838.00" $591.51 "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" $591.47 "$2,838.00" "$2,838.00" "$1,399.13" "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" "$2,128.50" "$2,838.00" "$2,838.00" "$2,838.00" "$1,419.00" "$1,419.00" "$2,247.70" "$2,838.00" "$2,270.40" "$1,277.10" $563.27 N/A "$1,646.04" "$2,838.00" "$2,838.00" "$2,838.00" $591.44 "$2,838.00" N/A N/A 6632-3-315 SUP HCPCS C1776 6632-3-315 - BASEPLATE TIBIAL 1 MEDIUM BEADED CRCIFRM DURACON POROUS KNEE BOTH IP/OP "$2,838.00" "$2,100.00" $563.27 "$2,838.00" "$1,277.10" "$1,277.10" "$1,277.10" "$1,277.10" "$2,838.00" "$2,838.00" "$2,838.00" $591.51 "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" $591.47 "$2,838.00" "$2,838.00" "$1,399.13" "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" "$2,128.50" "$2,838.00" "$2,838.00" "$2,838.00" "$1,419.00" "$1,419.00" "$2,247.70" "$2,838.00" "$2,270.40" "$1,277.10" $563.27 N/A "$1,646.04" "$2,838.00" "$2,838.00" "$2,838.00" $591.44 "$2,838.00" N/A N/A 6632-3-320 SUP HCPCS C1776 6632-3-320 - BASEPLATE TIBIAL 2 MEDIUM BEADED CRCIFRM DURACON POROUS KNEE BOTH IP/OP "$2,838.00" "$2,100.00" $563.27 "$2,838.00" "$1,277.10" "$1,277.10" "$1,277.10" "$1,277.10" "$2,838.00" "$2,838.00" "$2,838.00" $591.51 "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" $591.47 "$2,838.00" "$2,838.00" "$1,399.13" "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" "$2,128.50" "$2,838.00" "$2,838.00" "$2,838.00" "$1,419.00" "$1,419.00" "$2,247.70" "$2,838.00" "$2,270.40" "$1,277.10" $563.27 N/A "$1,646.04" "$2,838.00" "$2,838.00" "$2,838.00" $591.44 "$2,838.00" N/A N/A 6632-3-325 SUP HCPCS C1776 6632-3-325 - BASEPLATE TIBIAL 1 LARGE BEADED CRCIFRM DURACON POROUS KNEE BOTH IP/OP "$2,838.00" "$2,100.00" $563.27 "$2,838.00" "$1,277.10" "$1,277.10" "$1,277.10" "$1,277.10" "$2,838.00" "$2,838.00" "$2,838.00" $591.51 "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" $591.47 "$2,838.00" "$1,135.20" "$1,399.13" "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" "$2,128.50" "$2,838.00" "$2,838.00" "$2,838.00" "$1,419.00" "$1,419.00" "$2,247.70" "$2,838.00" "$2,270.40" "$1,277.10" $563.27 N/A "$1,646.04" "$2,838.00" "$2,838.00" "$2,838.00" $591.44 "$2,838.00" N/A N/A 6632-3-330 SUP HCPCS C1776 6632-3-330 - BASEPLATE TIBIAL 2 LARGE BEADED CRCIFRM DURACON POROUS KNEE BOTH IP/OP "$2,838.00" "$2,100.00" $563.27 "$2,838.00" "$1,277.10" "$1,277.10" "$1,277.10" "$1,277.10" "$2,838.00" "$2,838.00" "$2,838.00" $591.51 "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" $591.47 "$2,838.00" "$1,135.20" "$1,399.13" "$2,838.00" "$2,838.00" "$2,838.00" "$2,838.00" "$2,128.50" "$2,838.00" "$2,838.00" "$2,838.00" "$1,419.00" "$1,419.00" "$2,247.70" "$2,838.00" "$2,270.40" "$1,277.10" $563.27 N/A "$1,646.04" "$2,838.00" "$2,838.00" "$2,838.00" $591.44 "$2,838.00" N/A N/A 6632-3-335 SUP HCPCS C1776 6632-3-335 - BASEPLATE TIBIAL 1 XL BEADED CRCIFRM DURACON POROUS KNEE BOTH IP/OP "$2,891.00" "$2,139.00" $573.79 "$2,891.00" "$1,300.95" "$1,300.95" "$1,300.95" "$1,300.95" "$2,891.00" "$2,891.00" "$2,891.00" $602.56 "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" $602.52 "$2,891.00" "$1,156.40" "$1,425.26" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,168.25" "$2,891.00" "$2,891.00" "$2,891.00" "$1,445.50" "$1,445.50" "$2,289.67" "$2,891.00" "$2,312.80" "$1,300.95" $573.79 N/A "$1,676.78" "$2,891.00" "$2,891.00" "$2,891.00" $602.48 "$2,891.00" N/A N/A 6632-3-340 SUP HCPCS C1776 6632-3-340 - BASEPLATE TIBIAL 2 XL BEADED CRCIFRM DURACON POROUS KNEE BOTH IP/OP "$2,891.00" "$2,139.00" $573.79 "$2,891.00" "$1,300.95" "$1,300.95" "$1,300.95" "$1,300.95" "$2,891.00" "$2,891.00" "$2,891.00" $602.56 "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" $602.52 "$2,891.00" "$2,891.00" "$1,425.26" "$2,891.00" "$2,891.00" "$2,891.00" "$2,891.00" "$2,168.25" "$2,891.00" "$2,891.00" "$2,891.00" "$1,445.50" "$1,445.50" "$2,289.67" "$2,891.00" "$2,312.80" "$1,300.95" $573.79 N/A "$1,676.78" "$2,891.00" "$2,891.00" "$2,891.00" $602.48 "$2,891.00" N/A N/A 6632-3-401 SUP HCPCS C1776 6632-3-401 - BASEPLATE TIBIAL 1 XS CRCIFRM NONBEAD DURACON KNEE BOTH IP/OP "$1,918.00" "$1,419.00" $380.68 "$1,918.00" $863.10 $863.10 $863.10 $863.10 "$1,918.00" "$1,918.00" "$1,918.00" $399.76 "$1,918.00" "$1,918.00" "$1,918.00" "$1,918.00" "$1,918.00" $399.73 "$1,918.00" "$1,918.00" "$1,134.50" "$1,918.00" "$1,918.00" "$1,918.00" "$1,918.00" "$1,438.50" "$1,918.00" "$1,918.00" "$1,918.00" $959.00 $959.00 "$1,519.06" "$1,918.00" "$1,534.40" $863.10 $380.68 N/A "$1,112.44" "$1,918.00" "$1,918.00" "$1,918.00" $399.71 "$1,918.00" N/A N/A 6632-3-403 SUP HCPCS C1776 6632-3-403 - BASEPLATE TIBIAL 2 XS CRCIFRM NONBEAD DURACON KNEE BOTH IP/OP "$2,149.00" "$1,590.00" $426.52 "$2,149.00" $967.05 $967.05 $967.05 $967.05 "$2,149.00" "$2,149.00" "$2,149.00" $447.91 "$2,149.00" "$2,149.00" "$2,149.00" "$2,149.00" "$2,149.00" $447.88 "$2,149.00" "$2,149.00" "$1,271.13" "$2,149.00" "$2,149.00" "$2,149.00" "$2,149.00" "$1,611.75" "$2,149.00" "$2,149.00" "$2,149.00" "$1,074.50" "$1,074.50" "$1,702.01" "$2,149.00" "$1,719.20" $967.05 $426.52 N/A "$1,246.42" "$2,149.00" "$2,149.00" "$2,149.00" $447.85 "$2,149.00" N/A N/A 6632-3-405 SUP HCPCS C1776 6632-3-405 - BASEPLATE TIBIAL 1 SMALL CRCIFRM NONBEAD DURACON KNEE BOTH IP/OP "$2,167.00" "$1,604.00" $430.10 "$2,167.00" $975.15 $975.15 $975.15 $975.15 "$2,167.00" "$2,167.00" "$2,167.00" $451.66 "$2,167.00" "$2,167.00" "$2,167.00" "$2,167.00" "$2,167.00" $451.63 "$2,167.00" $866.80 "$1,281.78" "$2,167.00" "$2,167.00" "$2,167.00" "$2,167.00" "$1,625.25" "$2,167.00" "$2,167.00" "$2,167.00" "$1,083.50" "$1,083.50" "$1,716.26" "$2,167.00" "$1,733.60" $975.15 $430.10 N/A "$1,256.86" "$2,167.00" "$2,167.00" "$2,167.00" $451.60 "$2,167.00" N/A N/A 6632-3-410 SUP HCPCS C1776 6632-3-410 - BASEPLATE TIBIAL 2 SMALL CRCIFRM NONBEAD DURACON KNEE BOTH IP/OP "$2,167.00" "$1,604.00" $430.10 "$2,167.00" $975.15 $975.15 $975.15 $975.15 "$2,167.00" "$2,167.00" "$2,167.00" $451.66 "$2,167.00" "$2,167.00" "$2,167.00" "$2,167.00" "$2,167.00" $451.63 "$2,167.00" $866.80 "$1,281.78" "$2,167.00" "$2,167.00" "$2,167.00" "$2,167.00" "$1,625.25" "$2,167.00" "$2,167.00" "$2,167.00" "$1,083.50" "$1,083.50" "$1,716.26" "$2,167.00" "$1,733.60" $975.15 $430.10 N/A "$1,256.86" "$2,167.00" "$2,167.00" "$2,167.00" $451.60 "$2,167.00" N/A N/A 6632-3-415 SUP HCPCS C1776 6632-3-415 - BASEPLATE TIBIAL 1 MEDIUM CRCIFRM NONBEAD DURACON KNEE BOTH IP/OP "$2,131.00" "$1,577.00" $422.95 "$2,131.00" $958.95 $958.95 $958.95 $958.95 "$2,131.00" "$2,131.00" "$2,131.00" $444.15 "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" $444.12 "$2,131.00" $852.40 "$1,260.49" "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" "$1,598.25" "$2,131.00" "$2,131.00" "$2,131.00" "$1,065.50" "$1,065.50" "$1,687.75" "$2,131.00" "$1,704.80" $958.95 $422.95 N/A "$1,235.98" "$2,131.00" "$2,131.00" "$2,131.00" $444.10 "$2,131.00" N/A N/A 6632-3-420 SUP HCPCS C1776 6632-3-420 - BASEPLATE TIBIAL 2 MEDIUM CRCIFRM NONBEAD DURACON KNEE BOTH IP/OP "$2,131.00" "$1,577.00" $422.95 "$2,131.00" $958.95 $958.95 $958.95 $958.95 "$2,131.00" "$2,131.00" "$2,131.00" $444.15 "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" $444.12 "$2,131.00" "$2,131.00" "$1,260.49" "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" "$1,598.25" "$2,131.00" "$2,131.00" "$2,131.00" "$1,065.50" "$1,065.50" "$1,687.75" "$2,131.00" "$1,704.80" $958.95 $422.95 N/A "$1,235.98" "$2,131.00" "$2,131.00" "$2,131.00" $444.10 "$2,131.00" N/A N/A 6632-3-425 SUP HCPCS C1776 6632-3-425 - BASEPLATE TIBIAL 1 LARGE CRCIFRM NONBEAD DURACON KNEE BOTH IP/OP "$2,131.00" "$1,577.00" $422.95 "$2,131.00" $958.95 $958.95 $958.95 $958.95 "$2,131.00" "$2,131.00" "$2,131.00" $444.15 "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" $444.12 "$2,131.00" $852.40 "$1,260.49" "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" "$1,598.25" "$2,131.00" "$2,131.00" "$2,131.00" "$1,065.50" "$1,065.50" "$1,687.75" "$2,131.00" "$1,704.80" $958.95 $422.95 N/A "$1,235.98" "$2,131.00" "$2,131.00" "$2,131.00" $444.10 "$2,131.00" N/A N/A 6632-3-430 SUP HCPCS C1776 6632-3-430 - BASEPLATE TIBIAL 2 LARGE CRCIFRM NONBEAD DURACON KNEE BOTH IP/OP "$2,131.00" "$1,577.00" $422.95 "$2,131.00" $958.95 $958.95 $958.95 $958.95 "$2,131.00" "$2,131.00" "$2,131.00" $444.15 "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" $444.12 "$2,131.00" $852.40 "$1,260.49" "$2,131.00" "$2,131.00" "$2,131.00" "$2,131.00" "$1,598.25" "$2,131.00" "$2,131.00" "$2,131.00" "$1,065.50" "$1,065.50" "$1,687.75" "$2,131.00" "$1,704.80" $958.95 $422.95 N/A "$1,235.98" "$2,131.00" "$2,131.00" "$2,131.00" $444.10 "$2,131.00" N/A N/A 6632-3-435 SUP HCPCS C1776 6632-3-435 - BASEPLATE TIBIAL 1 XL CRCIFRM NONBEAD DURACON KNEE BOTH IP/OP "$2,167.00" "$1,604.00" $430.10 "$2,167.00" $975.15 $975.15 $975.15 $975.15 "$2,167.00" "$2,167.00" "$2,167.00" $451.66 "$2,167.00" "$2,167.00" "$2,167.00" "$2,167.00" "$2,167.00" $451.63 "$2,167.00" $866.80 "$1,281.78" "$2,167.00" "$2,167.00" "$2,167.00" "$2,167.00" "$1,625.25" "$2,167.00" "$2,167.00" "$2,167.00" "$1,083.50" "$1,083.50" "$1,716.26" "$2,167.00" "$1,733.60" $975.15 $430.10 N/A "$1,256.86" "$2,167.00" "$2,167.00" "$2,167.00" $451.60 "$2,167.00" N/A N/A 6632-3-440 SUP HCPCS C1776 6632-3-440 - BASEPLATE TIBIAL 2 XL CRCIFRM NONBEAD DURACON KNEE BOTH IP/OP "$2,167.00" "$1,604.00" $430.10 "$2,167.00" $975.15 $975.15 $975.15 $975.15 "$2,167.00" "$2,167.00" "$2,167.00" $451.66 "$2,167.00" "$2,167.00" "$2,167.00" "$2,167.00" "$2,167.00" $451.63 "$2,167.00" "$2,167.00" "$1,281.78" "$2,167.00" "$2,167.00" "$2,167.00" "$2,167.00" "$1,625.25" "$2,167.00" "$2,167.00" "$2,167.00" "$1,083.50" "$1,083.50" "$1,716.26" "$2,167.00" "$1,733.60" $975.15 $430.10 N/A "$1,256.86" "$2,167.00" "$2,167.00" "$2,167.00" $451.60 "$2,167.00" N/A N/A 6632-3-505 SUP HCPCS C1776 6632-3-505 - BASEPLATE TIBIAL 1 SMALL BEAD CRCIFRM DURACON PA KNEE BOTH IP/OP "$3,355.00" "$2,483.00" $665.88 "$3,355.00" "$1,509.75" "$1,509.75" "$1,509.75" "$1,509.75" "$3,355.00" "$3,355.00" "$3,355.00" $699.27 "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" $699.22 "$3,355.00" "$3,355.00" "$1,654.02" "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" "$2,516.25" "$3,355.00" "$3,355.00" "$3,355.00" "$1,677.50" "$1,677.50" "$2,657.16" "$3,355.00" "$2,684.00" "$1,509.75" $665.88 N/A "$1,945.90" "$3,355.00" "$3,355.00" "$3,355.00" $699.18 "$3,355.00" N/A N/A 6632-3-510 SUP HCPCS C1776 6632-3-510 - BASEPLATE TIBIAL 2 SMALL BEAD CRCIFRM DURACON PA KNEE BOTH IP/OP "$3,355.00" "$2,483.00" $665.88 "$3,355.00" "$1,509.75" "$1,509.75" "$1,509.75" "$1,509.75" "$3,355.00" "$3,355.00" "$3,355.00" $699.27 "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" $699.22 "$3,355.00" "$1,342.00" "$1,654.02" "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" "$2,516.25" "$3,355.00" "$3,355.00" "$3,355.00" "$1,677.50" "$1,677.50" "$2,657.16" "$3,355.00" "$2,684.00" "$1,509.75" $665.88 N/A "$1,945.90" "$3,355.00" "$3,355.00" "$3,355.00" $699.18 "$3,355.00" N/A N/A 6632-3-515 SUP HCPCS C1776 6632-3-515 - BASEPLATE TIBIAL 1 MEDIUM BEAD CRCIFRM DURACON PA KNEE BOTH IP/OP "$3,339.00" "$2,471.00" $662.71 "$3,339.00" "$1,502.55" "$1,502.55" "$1,502.55" "$1,502.55" "$3,339.00" "$3,339.00" "$3,339.00" $695.93 "$3,339.00" "$3,339.00" "$3,339.00" "$3,339.00" "$3,339.00" $695.88 "$3,339.00" "$3,339.00" "$1,646.13" "$3,339.00" "$3,339.00" "$3,339.00" "$3,339.00" "$2,504.25" "$3,339.00" "$3,339.00" "$3,339.00" "$1,669.50" "$1,669.50" "$2,644.49" "$3,339.00" "$2,671.20" "$1,502.55" $662.71 N/A "$1,936.62" "$3,339.00" "$3,339.00" "$3,339.00" $695.85 "$3,339.00" N/A N/A 6632-3-520 SUP HCPCS C1776 6632-3-520 - BASEPLATE TIBIAL 2 MEDIUM BEAD CRCIFRM DURACON PA KNEE BOTH IP/OP "$3,339.00" "$2,471.00" $662.71 "$3,339.00" "$1,502.55" "$1,502.55" "$1,502.55" "$1,502.55" "$3,339.00" "$3,339.00" "$3,339.00" $695.93 "$3,339.00" "$3,339.00" "$3,339.00" "$3,339.00" "$3,339.00" $695.88 "$3,339.00" "$1,335.60" "$1,646.13" "$3,339.00" "$3,339.00" "$3,339.00" "$3,339.00" "$2,504.25" "$3,339.00" "$3,339.00" "$3,339.00" "$1,669.50" "$1,669.50" "$2,644.49" "$3,339.00" "$2,671.20" "$1,502.55" $662.71 N/A "$1,936.62" "$3,339.00" "$3,339.00" "$3,339.00" $695.85 "$3,339.00" N/A N/A 6632-3-525 SUP HCPCS C1776 6632-3-525 - BASEPLATE TIBIAL 1 LARGE BEAD CRCIFRM DURACON PA KNEE BOTH IP/OP "$3,339.00" "$2,471.00" $662.71 "$3,339.00" "$1,502.55" "$1,502.55" "$1,502.55" "$1,502.55" "$3,339.00" "$3,339.00" "$3,339.00" $695.93 "$3,339.00" "$3,339.00" "$3,339.00" "$3,339.00" "$3,339.00" $695.88 "$3,339.00" "$3,339.00" "$1,646.13" "$3,339.00" "$3,339.00" "$3,339.00" "$3,339.00" "$2,504.25" "$3,339.00" "$3,339.00" "$3,339.00" "$1,669.50" "$1,669.50" "$2,644.49" "$3,339.00" "$2,671.20" "$1,502.55" $662.71 N/A "$1,936.62" "$3,339.00" "$3,339.00" "$3,339.00" $695.85 "$3,339.00" N/A N/A 6632-3-530 SUP HCPCS C1776 6632-3-530 - BASEPLATE TIBIAL 2 LARGE BEAD CRCIFRM DURACON PA KNEE BOTH IP/OP "$3,339.00" "$2,471.00" $662.71 "$3,339.00" "$1,502.55" "$1,502.55" "$1,502.55" "$1,502.55" "$3,339.00" "$3,339.00" "$3,339.00" $695.93 "$3,339.00" "$3,339.00" "$3,339.00" "$3,339.00" "$3,339.00" $695.88 "$3,339.00" "$1,335.60" "$1,646.13" "$3,339.00" "$3,339.00" "$3,339.00" "$3,339.00" "$2,504.25" "$3,339.00" "$3,339.00" "$3,339.00" "$1,669.50" "$1,669.50" "$2,644.49" "$3,339.00" "$2,671.20" "$1,502.55" $662.71 N/A "$1,936.62" "$3,339.00" "$3,339.00" "$3,339.00" $695.85 "$3,339.00" N/A N/A 6632-3-535 SUP HCPCS C1776 6632-3-535 - BASEPLATE TIBIAL 1 XL BEAD CRCIFRM DURACON PA KNEE BOTH IP/OP "$3,355.00" "$2,483.00" $665.88 "$3,355.00" "$1,509.75" "$1,509.75" "$1,509.75" "$1,509.75" "$3,355.00" "$3,355.00" "$3,355.00" $699.27 "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" $699.22 "$3,355.00" "$3,355.00" "$1,654.02" "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" "$2,516.25" "$3,355.00" "$3,355.00" "$3,355.00" "$1,677.50" "$1,677.50" "$2,657.16" "$3,355.00" "$2,684.00" "$1,509.75" $665.88 N/A "$1,945.90" "$3,355.00" "$3,355.00" "$3,355.00" $699.18 "$3,355.00" N/A N/A 6632-3-540 SUP HCPCS C1776 6632-3-540 - BASEPLATE TIBIAL 2 XL BEAD CRCIFRM DURACON PA KNEE BOTH IP/OP "$3,355.00" "$2,483.00" $665.88 "$3,355.00" "$1,509.75" "$1,509.75" "$1,509.75" "$1,509.75" "$3,355.00" "$3,355.00" "$3,355.00" $699.27 "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" $699.22 "$3,355.00" "$1,342.00" "$1,654.02" "$3,355.00" "$3,355.00" "$3,355.00" "$3,355.00" "$2,516.25" "$3,355.00" "$3,355.00" "$3,355.00" "$1,677.50" "$1,677.50" "$2,657.16" "$3,355.00" "$2,684.00" "$1,509.75" $665.88 N/A "$1,945.90" "$3,355.00" "$3,355.00" "$3,355.00" $699.18 "$3,355.00" N/A N/A 6632-3-603 SUP HCPCS C1776 6632-3-603 - BASEPLATE TIBIAL 1 MEDIUM UNIVERSAL CRCIFRM DURACON KNEE BOTH IP/OP "$2,169.00" "$1,605.00" $430.49 "$2,169.00" $976.05 $976.05 $976.05 $976.05 "$2,169.00" "$2,169.00" "$2,169.00" $452.07 "$2,169.00" "$2,169.00" "$2,169.00" "$2,169.00" "$2,169.00" $452.04 "$2,169.00" "$2,169.00" "$1,282.96" "$2,169.00" "$2,169.00" "$2,169.00" "$2,169.00" "$1,626.75" "$2,169.00" "$2,169.00" "$2,169.00" "$1,084.50" "$1,084.50" "$1,717.85" "$2,169.00" "$1,735.20" $976.05 $430.49 N/A "$1,258.02" "$2,169.00" "$2,169.00" "$2,169.00" $452.02 "$2,169.00" N/A N/A 6632-3-605 SUP HCPCS C1776 6632-3-605 - BASEPLATE TIBIAL 1 SMALL UNIVERSAL CRCIFRM DURACON KNEE BOTH IP/OP "$2,130.00" "$1,576.00" $422.75 "$2,130.00" $958.50 $958.50 $958.50 $958.50 "$2,130.00" "$2,130.00" "$2,130.00" $443.95 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$1,259.90" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 $422.75 N/A "$1,235.40" "$2,130.00" "$2,130.00" "$2,130.00" $443.89 "$2,130.00" N/A N/A 6632-3-610 SUP HCPCS C1776 6632-3-610 - BASEPLATE TIBIAL 2 SMALL UNIVERSAL CRCIFRM DURACON KNEE BOTH IP/OP "$2,130.00" "$1,576.00" $422.75 "$2,130.00" $958.50 $958.50 $958.50 $958.50 "$2,130.00" "$2,130.00" "$2,130.00" $443.95 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" "$2,130.00" "$1,259.90" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 $422.75 N/A "$1,235.40" "$2,130.00" "$2,130.00" "$2,130.00" $443.89 "$2,130.00" N/A N/A 6632-3-615 SUP HCPCS C1776 6632-3-615 - BASEPLATE TIBIAL 1 MEDIUM UNIVERSAL CRCIFRM DURACON KNEE BOTH IP/OP "$2,130.00" "$1,576.00" $422.75 "$2,130.00" $958.50 $958.50 $958.50 $958.50 "$2,130.00" "$2,130.00" "$2,130.00" $443.95 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" "$2,130.00" "$1,259.90" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 $422.75 N/A "$1,235.40" "$2,130.00" "$2,130.00" "$2,130.00" $443.89 "$2,130.00" N/A N/A 6632-3-620 SUP HCPCS C1776 6632-3-620 - BASEPLATE TIBIAL 2 MEDIUM UNIVERSAL CRCIFRM DURACON KNEE BOTH IP/OP "$2,130.00" "$1,576.00" $422.75 "$2,130.00" $958.50 $958.50 $958.50 $958.50 "$2,130.00" "$2,130.00" "$2,130.00" $443.95 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$1,259.90" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 $422.75 N/A "$1,235.40" "$2,130.00" "$2,130.00" "$2,130.00" $443.89 "$2,130.00" N/A N/A 6632-3-625 SUP HCPCS C1776 6632-3-625 - BASEPLATE TIBIAL 1 LARGE UNIVERSAL CRCIFRM DURACON KNEE BOTH IP/OP "$2,130.00" "$1,576.00" $422.75 "$2,130.00" $958.50 $958.50 $958.50 $958.50 "$2,130.00" "$2,130.00" "$2,130.00" $443.95 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" "$2,130.00" "$1,259.90" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 $422.75 N/A "$1,235.40" "$2,130.00" "$2,130.00" "$2,130.00" $443.89 "$2,130.00" N/A N/A 6632-3-630 SUP HCPCS C1776 6632-3-630 - BASEPLATE TIBIAL 2 LARGE UNIVERSAL CRCIFRM DURACON KNEE BOTH IP/OP "$2,130.00" "$1,576.00" $422.75 "$2,130.00" $958.50 $958.50 $958.50 $958.50 "$2,130.00" "$2,130.00" "$2,130.00" $443.95 "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" $443.92 "$2,130.00" $852.00 "$1,259.90" "$2,130.00" "$2,130.00" "$2,130.00" "$2,130.00" "$1,597.50" "$2,130.00" "$2,130.00" "$2,130.00" "$1,065.00" "$1,065.00" "$1,686.96" "$2,130.00" "$1,704.00" $958.50 $422.75 N/A "$1,235.40" "$2,130.00" "$2,130.00" "$2,130.00" $443.89 "$2,130.00" N/A N/A 6632-3-635 SUP HCPCS C1776 6632-3-635 - BASEPLATE TIBIAL 1 XL UNIVERSAL CRCIFRM DURACON KNEE BOTH IP/OP "$2,169.00" "$1,605.00" $430.49 "$2,169.00" $976.05 $976.05 $976.05 $976.05 "$2,169.00" "$2,169.00" "$2,169.00" $452.07 "$2,169.00" "$2,169.00" "$2,169.00" "$2,169.00" "$2,169.00" $452.04 "$2,169.00" "$2,169.00" "$1,282.96" "$2,169.00" "$2,169.00" "$2,169.00" "$2,169.00" "$1,626.75" "$2,169.00" "$2,169.00" "$2,169.00" "$1,084.50" "$1,084.50" "$1,717.85" "$2,169.00" "$1,735.20" $976.05 $430.49 N/A "$1,258.02" "$2,169.00" "$2,169.00" "$2,169.00" $452.02 "$2,169.00" N/A N/A 6632-3-640 SUP HCPCS C1776 6632-3-640 - BASEPLATE TIBIAL 2 XL UNIVERSAL CRCIFRM DURACON KNEE BOTH IP/OP "$2,169.00" "$1,605.00" $430.49 "$2,169.00" $976.05 $976.05 $976.05 $976.05 "$2,169.00" "$2,169.00" "$2,169.00" $452.07 "$2,169.00" "$2,169.00" "$2,169.00" "$2,169.00" "$2,169.00" $452.04 "$2,169.00" $867.60 "$1,282.96" "$2,169.00" "$2,169.00" "$2,169.00" "$2,169.00" "$1,626.75" "$2,169.00" "$2,169.00" "$2,169.00" "$1,084.50" "$1,084.50" "$1,717.85" "$2,169.00" "$1,735.20" $976.05 $430.49 N/A "$1,258.02" "$2,169.00" "$2,169.00" "$2,169.00" $452.02 "$2,169.00" N/A N/A 6632-3-701 SUP HCPCS C1776 6632-3-701 - BASEPLATE TIBIAL XS1 UNIVERSAL 62X37MM BEAD DURACON KNEE BOTH IP/OP "$2,919.00" "$2,160.00" $579.35 "$2,919.00" "$1,313.55" "$1,313.55" "$1,313.55" "$1,313.55" "$2,919.00" "$2,919.00" "$2,919.00" $608.39 "$2,919.00" "$2,919.00" "$2,919.00" "$2,919.00" "$2,919.00" $608.35 "$2,919.00" "$2,919.00" "$1,439.07" "$2,919.00" "$2,919.00" "$2,919.00" "$2,919.00" "$2,189.25" "$2,919.00" "$2,919.00" "$2,919.00" "$1,459.50" "$1,459.50" "$2,311.85" "$2,919.00" "$2,335.20" "$1,313.55" $579.35 N/A "$1,693.02" "$2,919.00" "$2,919.00" "$2,919.00" $608.32 "$2,919.00" N/A N/A 6632-3-703 SUP HCPCS C1776 6632-3-703 - BASEPLATE TIBIAL XS2 UNIVERSAL 64X39MM BEAD DURACON KNEE BOTH IP/OP "$2,919.00" "$2,160.00" $579.35 "$2,919.00" "$1,313.55" "$1,313.55" "$1,313.55" "$1,313.55" "$2,919.00" "$2,919.00" "$2,919.00" $608.39 "$2,919.00" "$2,919.00" "$2,919.00" "$2,919.00" "$2,919.00" $608.35 "$2,919.00" "$1,167.60" "$1,439.07" "$2,919.00" "$2,919.00" "$2,919.00" "$2,919.00" "$2,189.25" "$2,919.00" "$2,919.00" "$2,919.00" "$1,459.50" "$1,459.50" "$2,311.85" "$2,919.00" "$2,335.20" "$1,313.55" $579.35 N/A "$1,693.02" "$2,919.00" "$2,919.00" "$2,919.00" $608.32 "$2,919.00" N/A N/A 6632-3-705 SUP HCPCS C1776 6632-3-705 - BASEPLATE TIBIAL S1 UNIVERSAL 67X42MM BEAD DURACON KNEE BOTH IP/OP "$2,865.00" "$2,120.00" $568.63 "$2,865.00" "$1,289.25" "$1,289.25" "$1,289.25" "$1,289.25" "$2,865.00" "$2,865.00" "$2,865.00" $597.14 "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" $597.10 "$2,865.00" "$2,865.00" "$1,412.45" "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" "$2,148.75" "$2,865.00" "$2,865.00" "$2,865.00" "$1,432.50" "$1,432.50" "$2,269.08" "$2,865.00" "$2,292.00" "$1,289.25" $568.63 N/A "$1,661.70" "$2,865.00" "$2,865.00" "$2,865.00" $597.07 "$2,865.00" N/A N/A 6632-3-710 SUP HCPCS C1776 6632-3-710 - BASEPLATE TIBIAL S2 UNIVERSAL 69X45MM BEAD DURACON KNEE BOTH IP/OP "$2,865.00" "$2,120.00" $568.63 "$2,865.00" "$1,289.25" "$1,289.25" "$1,289.25" "$1,289.25" "$2,865.00" "$2,865.00" "$2,865.00" $597.14 "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" $597.10 "$2,865.00" "$1,146.00" "$1,412.45" "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" "$2,148.75" "$2,865.00" "$2,865.00" "$2,865.00" "$1,432.50" "$1,432.50" "$2,269.08" "$2,865.00" "$2,292.00" "$1,289.25" $568.63 N/A "$1,661.70" "$2,865.00" "$2,865.00" "$2,865.00" $597.07 "$2,865.00" N/A N/A 6632-3-715 SUP HCPCS C1776 6632-3-715 - BASEPLATE TIBIAL M1 UNIVERSAL 72X48MM BEAD DURACON KNEE BOTH IP/OP "$2,865.00" "$2,120.00" $568.63 "$2,865.00" "$1,289.25" "$1,289.25" "$1,289.25" "$1,289.25" "$2,865.00" "$2,865.00" "$2,865.00" $597.14 "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" $597.10 "$2,865.00" "$2,865.00" "$1,412.45" "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" "$2,148.75" "$2,865.00" "$2,865.00" "$2,865.00" "$1,432.50" "$1,432.50" "$2,269.08" "$2,865.00" "$2,292.00" "$1,289.25" $568.63 N/A "$1,661.70" "$2,865.00" "$2,865.00" "$2,865.00" $597.07 "$2,865.00" N/A N/A 6632-3-720 SUP HCPCS C1776 6632-3-720 - BASEPLATE TIBIAL M2 UNIVERSAL 74X50MM BEAD DURACON KNEE BOTH IP/OP "$2,865.00" "$2,120.00" $568.63 "$2,865.00" "$1,289.25" "$1,289.25" "$1,289.25" "$1,289.25" "$2,865.00" "$2,865.00" "$2,865.00" $597.14 "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" $597.10 "$2,865.00" "$1,146.00" "$1,412.45" "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" "$2,148.75" "$2,865.00" "$2,865.00" "$2,865.00" "$1,432.50" "$1,432.50" "$2,269.08" "$2,865.00" "$2,292.00" "$1,289.25" $568.63 N/A "$1,661.70" "$2,865.00" "$2,865.00" "$2,865.00" $597.07 "$2,865.00" N/A N/A 6632-3-725 SUP HCPCS C1776 6632-3-725 - BASEPLATE TIBIAL X1 UNIVERSAL 77X53MM BEAD DURACON KNEE BOTH IP/OP "$2,865.00" "$2,120.00" $568.63 "$2,865.00" "$1,289.25" "$1,289.25" "$1,289.25" "$1,289.25" "$2,865.00" "$2,865.00" "$2,865.00" $597.14 "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" $597.10 "$2,865.00" "$2,865.00" "$1,412.45" "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" "$2,148.75" "$2,865.00" "$2,865.00" "$2,865.00" "$1,432.50" "$1,432.50" "$2,269.08" "$2,865.00" "$2,292.00" "$1,289.25" $568.63 N/A "$1,661.70" "$2,865.00" "$2,865.00" "$2,865.00" $597.07 "$2,865.00" N/A N/A 6632-3-730 SUP HCPCS C1776 6632-3-730 - BASEPLATE TIBIAL X2 UNIVERSAL 79X55MM BEAD DURACON KNEE BOTH IP/OP "$2,865.00" "$2,120.00" $568.63 "$2,865.00" "$1,289.25" "$1,289.25" "$1,289.25" "$1,289.25" "$2,865.00" "$2,865.00" "$2,865.00" $597.14 "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" $597.10 "$2,865.00" "$1,146.00" "$1,412.45" "$2,865.00" "$2,865.00" "$2,865.00" "$2,865.00" "$2,148.75" "$2,865.00" "$2,865.00" "$2,865.00" "$1,432.50" "$1,432.50" "$2,269.08" "$2,865.00" "$2,292.00" "$1,289.25" $568.63 N/A "$1,661.70" "$2,865.00" "$2,865.00" "$2,865.00" $597.07 "$2,865.00" N/A N/A 6632-3-735 SUP HCPCS C1776 6632-3-735 - BASEPLATE TIBIAL X1 UNIVERSAL 82X58MM BEAD DURACON KNEE BOTH IP/OP "$2,919.00" "$2,160.00" $579.35 "$2,919.00" "$1,313.55" "$1,313.55" "$1,313.55" "$1,313.55" "$2,919.00" "$2,919.00" "$2,919.00" $608.39 "$2,919.00" "$2,919.00" "$2,919.00" "$2,919.00" "$2,919.00" $608.35 "$2,919.00" "$2,919.00" "$1,439.07" "$2,919.00" "$2,919.00" "$2,919.00" "$2,919.00" "$2,189.25" "$2,919.00" "$2,919.00" "$2,919.00" "$1,459.50" "$1,459.50" "$2,311.85" "$2,919.00" "$2,335.20" "$1,313.55" $579.35 N/A "$1,693.02" "$2,919.00" "$2,919.00" "$2,919.00" $608.32 "$2,919.00" N/A N/A 6632-3-740 SUP HCPCS C1776 6632-3-740 - BASEPLATE TIBIAL X2 UNIVERSAL 85X60MM BEAD DURACON KNEE BOTH IP/OP "$2,919.00" "$2,160.00" $579.35 "$2,919.00" "$1,313.55" "$1,313.55" "$1,313.55" "$1,313.55" "$2,919.00" "$2,919.00" "$2,919.00" $608.39 "$2,919.00" "$2,919.00" "$2,919.00" "$2,919.00" "$2,919.00" $608.35 "$2,919.00" "$1,167.60" "$1,439.07" "$2,919.00" "$2,919.00" "$2,919.00" "$2,919.00" "$2,189.25" "$2,919.00" "$2,919.00" "$2,919.00" "$1,459.50" "$1,459.50" "$2,311.85" "$2,919.00" "$2,335.20" "$1,313.55" $579.35 N/A "$1,693.02" "$2,919.00" "$2,919.00" "$2,919.00" $608.32 "$2,919.00" N/A N/A 6632-5-080 SUP Custom 27803010 6632-5-080 - SPACER FEMORAL XS 5MM DURACON KNEE LEFT MEDIAL BOTH IP/OP "$1,794.00" "$1,328.00" $319.33 "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" $319.33 "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" $373.89 "$1,794.00" $717.60 "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,345.50" "$1,794.00" "$1,794.00" "$1,794.00" $897.00 $897.00 "$1,420.85" "$1,794.00" "$1,435.20" $807.30 "$1,794.00" N/A "$1,040.52" "$1,794.00" "$1,076.40" "$1,794.00" "$1,794.00" "$1,794.00" N/A N/A 6632-5-085 SUP Custom 27803010 6632-5-085 - SPACER FEMORAL XS 5MM DURACON KNEE RIGHT MEDIAL BOTH IP/OP "$1,794.00" "$1,328.00" $319.33 "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" $319.33 "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" $373.89 "$1,794.00" $717.60 "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,794.00" "$1,345.50" "$1,794.00" "$1,794.00" "$1,794.00" $897.00 $897.00 "$1,420.85" "$1,794.00" "$1,435.20" $807.30 "$1,794.00" N/A "$1,040.52" "$1,794.00" "$1,076.40" "$1,794.00" "$1,794.00" "$1,794.00" N/A N/A 6632-5-090 SUP Custom 27803010 6632-5-090 - SPACER FEMORAL XS 5MM DURACON KNEE LEFT LATERAL BOTH IP/OP "$1,737.50" "$1,286.00" $309.21 "$1,737.13" "$1,737.13" "$1,737.13" "$1,737.13" "$1,737.13" "$1,737.13" "$1,737.13" $309.21 "$1,737.13" "$1,737.13" "$1,737.13" "$1,737.13" "$1,737.13" "$1,737.13" $362.04 "$1,737.13" $694.85 "$1,737.13" "$1,737.13" "$1,737.13" "$1,737.13" "$1,737.13" "$1,303.13" "$1,737.13" "$1,737.13" "$1,737.13" $868.57 $868.57 "$1,375.81" "$1,737.13" "$1,389.70" $781.71 "$1,737.13" N/A "$1,007.75" "$1,737.13" "$1,042.28" "$1,737.13" "$1,737.13" "$1,737.13" N/A N/A 6632-5-100 SUP Custom 27803010 6632-5-100 - SPACER FEMORAL SMALL 5MM DURACON KNEE LEFT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-105 SUP Custom 27803010 6632-5-105 - SPACER FEMORAL SMALL 5MM DURACON KNEE RIGHT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-110 SUP Custom 27803010 6632-5-110 - SPACER FEMORAL SMALL 5MM DURACON KNEE LEFT LATERAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-115 SUP Custom 27803010 6632-5-115 - SPACER FEMORAL SMALL 5MM DURACON KNEE RIGHT LAT BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-120 SUP Custom 27803010 6632-5-120 - SPACER FEMORAL MEDIUM 5MM DURACON KNEE LEFT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-125 SUP Custom 27803010 6632-5-125 - SPACER FEMORAL MEDIUM 5MM DURACON KNEE RIGHT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-130 SUP Custom 27803010 6632-5-130 - SPACER FEMORAL MEDIUM 5MM DURACON KNEE LEFT LATERAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-135 SUP Custom 27803010 6632-5-135 - SPACER FEMORAL MEDIUM 5MM DURACON KNEE RIGHT LAT BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-140 SUP Custom 27803010 6632-5-140 - SPACER FEMORAL MEDIUM LARGE 5MM DURACON KNEE LEFT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-145 SUP Custom 27803010 6632-5-145 - SPACER FEMORAL MEDIUM LARGE 5MM DURACON KNEE RIGHT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-150 SUP Custom 27803010 6632-5-150 - SPACER FEMORAL MEDIUM LARGE 5MM DURACON KNEE LEFT LATERAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-155 SUP Custom 27803010 6632-5-155 - SPACER FEMORAL MEDIUM LARGE 5MM DURACON KNEE RIGHT LAT BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-160 SUP Custom 27803010 6632-5-160 - SPACER FEMORAL LARGE 5MM DURACON KNEE LEFT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-165 SUP Custom 27803010 6632-5-165 - SPACER FEMORAL LARGE 5MM DURACON KNEE RIGHT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-170 SUP Custom 27803010 6632-5-170 - SPACER FEMORAL LARGE 5MM DURACON KNEE LEFT LATERAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-175 SUP Custom 27803010 6632-5-175 - SPACER FEMORAL LARGE 5MM DURACON KNEE RIGHT LAT BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-5-180 SUP Custom 27803010 6632-5-180 - SPACER FEMORAL XL 5MM DURACON KNEE LEFT MEDIAL BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-5-185 SUP Custom 27803010 6632-5-185 - SPACER FEMORAL XL 5MM DURACON KNEE RIGHT MEDIAL BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-5-190 SUP Custom 27803010 6632-5-190 - SPACER FEMORAL XL 5MM DURACON KNEE LEFT LATERAL BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-5-195 SUP Custom 27803010 6632-5-195 - SPACER FEMORAL XL 5MM DURACON KNEE RIGHT LAT BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-5-450 SUP Custom 27803010 6632-5-450 - STABILIZER SRG S/MED ML DRCN MDLR KN BOTH IP/OP $414.00 $306.00 $73.69 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $73.69 $414.00 $414.00 $414.00 $414.00 $414.00 $414.00 $86.28 $414.00 $165.60 $414.00 $414.00 $414.00 $414.00 $414.00 $310.50 $414.00 $414.00 $414.00 $207.00 $207.00 $327.89 $414.00 $331.20 $186.30 $414.00 N/A $240.12 $414.00 $248.40 $414.00 $414.00 $414.00 N/A N/A 6632-5-600 SUP HCPCS C1713 6632-5-600 - SCREW BONE 5MM LOCK DURACON VITALLIUM KNEE FEMUR BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $54.00 $54.00 $54.00 $54.00 $120.00 $120.00 $120.00 $25.01 $120.00 $120.00 $120.00 $120.00 $120.00 $25.01 $120.00 $48.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $54.00 $23.82 N/A $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A 6632-6-100 SUP Custom 27803010 6632-6-100 - SPACER FEM SM 10MM DRCN KN LT MDL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-105 SUP Custom 27803010 6632-6-105 - SPACER FEMORAL SMALL 10MM DURACON KNEE RIGHT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-110 SUP Custom 27803010 6632-6-110 - SPACER FEMORAL SMALL 10MM DURACON KNEE LEFT LATERAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-115 SUP Custom 27803010 6632-6-115 - SPACER FEMORAL SMALL 10MM DURACON KNEE RIGHT LAT BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-120 SUP Custom 27803010 6632-6-120 - SPACER FEMORAL MEDIUM 10MM DURACON KNEE LEFT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-125 SUP Custom 27803010 6632-6-125 - SPACER FEMORAL MEDIUM 10MM DURACON KNEE RIGHT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-130 SUP Custom 27803010 6632-6-130 - SPACER FEMORAL MEDIUM 10MM DURACON KNEE LEFT LATERAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-135 SUP Custom 27803010 6632-6-135 - SPACER FEMORAL MEDIUM 10MM DURACON KNEE RIGHT LAT BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-140 SUP Custom 27803010 6632-6-140 - SPACER FEMORAL MEDIUM LARGE 10MM DURACON KNEE LEFT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-145 SUP Custom 27803010 6632-6-145 - SPACER FEMORAL MEDIUM LARGE 10MM DURACON KNEE RIGHT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-150 SUP Custom 27803010 6632-6-150 - SPACER FEMORAL MEDIUM LARGE 10MM DURACON KNEE LEFT LATERAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-155 SUP Custom 27803010 6632-6-155 - SPACER FEMORAL MEDIUM LARGE 10MM DURACON KNEE RIGHT LAT BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-160 SUP Custom 27803010 6632-6-160 - SPACER FEMORAL LARGE 10MM DURACON KNEE LEFT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-165 SUP Custom 27803010 6632-6-165 - SPACER FEMORAL LARGE 10MM DURACON KNEE RIGHT MEDIAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-170 SUP Custom 27803010 6632-6-170 - SPACER FEMORAL LARGE 10MM DURACON KNEE LEFT LATERAL BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-175 SUP Custom 27803010 6632-6-175 - SPACER FEMORAL LARGE 10MM DURACON KNEE RIGHT LAT BOTH IP/OP "$1,865.50" "$1,380.00" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $332.06 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" $388.79 "$1,865.50" $746.20 "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,865.50" "$1,399.13" "$1,865.50" "$1,865.50" "$1,865.50" $932.75 $932.75 "$1,477.48" "$1,865.50" "$1,492.40" $839.48 "$1,865.50" N/A "$1,081.99" "$1,865.50" "$1,119.30" "$1,865.50" "$1,865.50" "$1,865.50" N/A N/A 6632-6-180 SUP Custom 27803010 6632-6-180 - SPACER FEMORAL XL 10MM DURACON KNEE LEFT MEDIAL BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-6-185 SUP Custom 27803010 6632-6-185 - SPACER FEMORAL XL 10MM DURACON KNEE RIGHT MEDIAL BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-6-190 SUP Custom 27803010 6632-6-190 - SPACER FEMORAL XL 10MM DURACON KNEE LEFT LATERAL BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-6-195 SUP Custom 27803010 6632-6-195 - SPACER FEMORAL XL 10MM DURACON KNEE RIGHT LAT BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-6-410 SUP Custom 27803010 6632-6-410 - SPACER FEMORAL SMALL 10MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-415 SUP Custom 27803010 6632-6-415 - SPACER FEMORAL SMALL 5MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-420 SUP Custom 27803010 6632-6-420 - SPACER FEMORAL MEDIUM 10MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,581.50" "$1,170.00" $281.44 "$1,581.13" "$1,581.13" "$1,581.13" "$1,581.13" "$1,581.13" "$1,581.13" "$1,581.13" $281.44 "$1,581.13" "$1,581.13" "$1,581.13" "$1,581.13" "$1,581.13" "$1,581.13" $329.52 "$1,581.13" $632.45 "$1,581.13" "$1,581.13" "$1,581.13" "$1,581.13" "$1,581.13" "$1,186.13" "$1,581.13" "$1,581.13" "$1,581.13" $790.57 $790.57 "$1,252.25" "$1,581.13" "$1,264.90" $711.51 "$1,581.13" N/A $917.27 "$1,581.13" $948.68 "$1,581.13" "$1,581.13" "$1,581.13" N/A N/A 6632-6-425 SUP Custom 27803010 6632-6-425 - SPACER FEMORAL MEDIUM 5MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-430 SUP Custom 27803010 6632-6-430 - SPACER FEMORAL MEDIUM LARGE 10MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-435 SUP Custom 27803010 6632-6-435 - SPACER FEMORAL MEDIUM LARGE 5MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-440 SUP Custom 27803010 6632-6-440 - SPACER FEMORAL LARGE 10MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-445 SUP Custom 27803010 6632-6-445 - SPACER FEMORAL LARGE 5MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-450 SUP Custom 27803010 6632-6-450 - SPACER FEMORAL XL 10MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-6-455 SUP Custom 27803010 6632-6-455 - SPACER FEMORAL XL 5MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-6-460 SUP Custom 27803010 6632-6-460 - SPACER FEMORAL 2XL FULL 10MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-6-465 SUP Custom 27803010 6632-6-465 - SPACER FEMORAL 2XL FULL 5MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-6-600 SUP HCPCS C1713 6632-6-600 - SCREW BONE 10MM LOCK DURACON KNEE FEMUR BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $54.00 $54.00 $54.00 $54.00 $120.00 $120.00 $120.00 $25.01 $120.00 $120.00 $120.00 $120.00 $120.00 $25.01 $120.00 $48.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $54.00 $23.82 N/A $69.60 $120.00 $72.00 $120.00 $25.01 $120.00 N/A N/A 6632-6-705 SUP Custom 27803010 6632-6-705 - SPACER FEMORAL XS HALF 5MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-6-710 SUP Custom 27803010 6632-6-710 - SPACER FEMORAL SMALL HALF 10MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-715 SUP Custom 27803010 6632-6-715 - SPACER FEMORAL SMALL HALF 5MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-720 SUP Custom 27803010 6632-6-720 - SPACER FEMORAL MEDIUM HALF 10MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-725 SUP Custom 27803010 6632-6-725 - SPACER FEMORAL MEDIUM HALF 5MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-730 SUP Custom 27803010 6632-6-730 - SPACER FEMORAL MEDIUM LARGE HALF 10MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-735 SUP Custom 27803010 6632-6-735 - SPACER FEMORAL MEDIUM LARGE HALF 5MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-740 SUP Custom 27803010 6632-6-740 - SPACER FEMORAL LARGE HALF 10MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-745 SUP Custom 27803010 6632-6-745 - SPACER FEMORAL LARGE HALF 5MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,869.00" "$1,383.00" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $332.64 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" $389.47 "$1,868.75" $747.50 "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,868.75" "$1,401.75" "$1,868.75" "$1,868.75" "$1,868.75" $934.38 $934.38 "$1,480.05" "$1,868.75" "$1,495.00" $840.94 "$1,868.75" N/A "$1,084.02" "$1,868.75" "$1,121.25" "$1,868.75" "$1,868.75" "$1,868.75" N/A N/A 6632-6-750 SUP Custom 27803010 6632-6-750 - SPACER FEMORAL XL HALF 10MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-6-755 SUP Custom 27803010 6632-6-755 - SPACER FEM XL HLF 5MM DRCN KN POST BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-6-760 SUP Custom 27803010 6632-6-760 - SPACER FEMORAL 2XL HALF 10MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-6-765 SUP Custom 27803010 6632-6-765 - SPACER FEMORAL XL HALF 5MM DURACON KNEE POSTERIOR BOTH IP/OP "$1,961.50" "$1,452.00" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $349.13 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" $408.77 "$1,961.38" $784.55 "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,961.38" "$1,471.13" "$1,961.38" "$1,961.38" "$1,961.38" $980.69 $980.69 "$1,553.41" "$1,961.38" "$1,569.10" $882.62 "$1,961.38" N/A "$1,137.67" "$1,961.38" "$1,176.83" "$1,961.38" "$1,961.38" "$1,961.38" N/A N/A 6632-8-800 SUP HCPCS C1776 6632-8-800 - COMPONENT FEMORAL XS TOT STABILIZE KNEE LEFT BOTH IP/OP "$10,811.50" "$8,001.00" "$2,145.74" "$10,811.13" "$4,865.01" "$4,865.01" "$4,865.01" "$4,865.01" "$10,811.13" "$10,811.13" "$10,811.13" "$2,253.31" "$10,811.13" "$10,811.13" "$10,811.13" "$10,811.13" "$10,811.13" "$2,253.16" "$10,811.13" "$10,811.13" "$5,329.89" "$10,811.13" "$10,811.13" "$10,811.13" "$10,811.13" "$8,108.63" "$10,811.13" "$10,811.13" "$10,811.13" "$5,405.57" "$5,405.57" "$8,562.41" "$10,811.13" "$8,648.90" "$4,865.01" "$2,145.74" N/A "$6,270.67" "$10,811.13" "$10,811.13" "$10,811.13" "$2,253.04" "$10,811.13" N/A N/A 6632-8-805 SUP HCPCS C1776 6632-8-805 - COMPONENT FEMORAL XS TOT STABILIZE KNEE RIGHT BOTH IP/OP "$10,811.50" "$8,001.00" "$2,145.74" "$10,811.13" "$4,865.01" "$4,865.01" "$4,865.01" "$4,865.01" "$10,811.13" "$10,811.13" "$10,811.13" "$2,253.31" "$10,811.13" "$10,811.13" "$10,811.13" "$10,811.13" "$10,811.13" "$2,253.16" "$10,811.13" "$4,324.45" "$5,329.89" "$10,811.13" "$10,811.13" "$10,811.13" "$10,811.13" "$8,108.63" "$10,811.13" "$10,811.13" "$10,811.13" "$5,405.57" "$5,405.57" "$8,562.41" "$10,811.13" "$8,648.90" "$4,865.01" "$2,145.74" N/A "$6,270.67" "$10,811.13" "$10,811.13" "$10,811.13" "$2,253.04" "$10,811.13" N/A N/A 6632-8-810 SUP HCPCS C1776 6632-8-810 - COMPONENT FEMORAL SMALL TOT STABILIZE KNEE LEFT BOTH IP/OP "$10,619.50" "$7,858.00" "$2,107.68" "$10,619.38" "$4,778.72" "$4,778.72" "$4,778.72" "$4,778.72" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.34" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.20" "$10,619.38" "$10,619.38" "$5,235.35" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$7,964.63" "$10,619.38" "$10,619.38" "$10,619.38" "$5,309.69" "$5,309.69" "$8,410.55" "$10,619.38" "$8,495.50" "$4,778.72" "$2,107.68" N/A "$6,159.31" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.08" "$10,619.38" N/A N/A 6632-8-815 SUP HCPCS C1776 6632-8-815 - COMPONENT FEMORAL SMALL TOT STABILIZE KNEE RIGHT BOTH IP/OP "$10,619.50" "$7,858.00" "$2,107.68" "$10,619.38" "$4,778.72" "$4,778.72" "$4,778.72" "$4,778.72" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.34" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.20" "$10,619.38" "$10,619.38" "$5,235.35" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$7,964.63" "$10,619.38" "$10,619.38" "$10,619.38" "$5,309.69" "$5,309.69" "$8,410.55" "$10,619.38" "$8,495.50" "$4,778.72" "$2,107.68" N/A "$6,159.31" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.08" "$10,619.38" N/A N/A 6632-8-820 SUP HCPCS C1776 6632-8-820 - COMPONENT FEMORAL MEDIUM TOT STABILIZE KNEE LEFT BOTH IP/OP "$10,619.50" "$7,858.00" "$2,107.68" "$10,619.38" "$4,778.72" "$4,778.72" "$4,778.72" "$4,778.72" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.34" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.20" "$10,619.38" "$4,247.75" "$5,235.35" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$7,964.63" "$10,619.38" "$10,619.38" "$10,619.38" "$5,309.69" "$5,309.69" "$8,410.55" "$10,619.38" "$8,495.50" "$4,778.72" "$2,107.68" N/A "$6,159.31" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.08" "$10,619.38" N/A N/A 6632-8-825 SUP HCPCS C1776 6632-8-825 - COMPONENT FEMORAL MEDIUM TOT STABILIZE KNEE RIGHT BOTH IP/OP "$10,619.50" "$7,858.00" "$2,107.68" "$10,619.38" "$4,778.72" "$4,778.72" "$4,778.72" "$4,778.72" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.34" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.20" "$10,619.38" "$10,619.38" "$5,235.35" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$7,964.63" "$10,619.38" "$10,619.38" "$10,619.38" "$5,309.69" "$5,309.69" "$8,410.55" "$10,619.38" "$8,495.50" "$4,778.72" "$2,107.68" N/A "$6,159.31" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.08" "$10,619.38" N/A N/A 6632-8-830 SUP HCPCS C1776 6632-8-830 - COMPONENT FEMORAL MEDIUM LARGE TOT STABILIZE KNEE LEFT BOTH IP/OP "$10,619.50" "$7,858.00" "$2,107.68" "$10,619.38" "$4,778.72" "$4,778.72" "$4,778.72" "$4,778.72" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.34" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.20" "$10,619.38" "$4,247.75" "$5,235.35" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$7,964.63" "$10,619.38" "$10,619.38" "$10,619.38" "$5,309.69" "$5,309.69" "$8,410.55" "$10,619.38" "$8,495.50" "$4,778.72" "$2,107.68" N/A "$6,159.31" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.08" "$10,619.38" N/A N/A 6632-8-835 SUP HCPCS C1776 6632-8-835 - COMPONENT FEMORAL MEDIUM LARGE TOT STABILIZE KNEE RIGHT BOTH IP/OP "$10,619.50" "$7,858.00" "$2,107.68" "$10,619.38" "$4,778.72" "$4,778.72" "$4,778.72" "$4,778.72" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.34" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.20" "$10,619.38" "$10,619.38" "$5,235.35" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$7,964.63" "$10,619.38" "$10,619.38" "$10,619.38" "$5,309.69" "$5,309.69" "$8,410.55" "$10,619.38" "$8,495.50" "$4,778.72" "$2,107.68" N/A "$6,159.31" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.08" "$10,619.38" N/A N/A 6632-8-840 SUP HCPCS C1776 6632-8-840 - COMPONENT FEMORAL LARGE TOT STABILIZE KNEE LEFT BOTH IP/OP "$10,619.50" "$7,858.00" "$2,107.68" "$10,619.38" "$4,778.72" "$4,778.72" "$4,778.72" "$4,778.72" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.34" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.20" "$10,619.38" "$4,247.75" "$5,235.35" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$7,964.63" "$10,619.38" "$10,619.38" "$10,619.38" "$5,309.69" "$5,309.69" "$8,410.55" "$10,619.38" "$8,495.50" "$4,778.72" "$2,107.68" N/A "$6,159.31" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.08" "$10,619.38" N/A N/A 6632-8-845 SUP HCPCS C1776 6632-8-845 - COMPONENT FEMORAL LARGE TOT STABILIZE KNEE RIGHT BOTH IP/OP "$10,619.50" "$7,858.00" "$2,107.68" "$10,619.38" "$4,778.72" "$4,778.72" "$4,778.72" "$4,778.72" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.34" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.20" "$10,619.38" "$10,619.38" "$5,235.35" "$10,619.38" "$10,619.38" "$10,619.38" "$10,619.38" "$7,964.63" "$10,619.38" "$10,619.38" "$10,619.38" "$5,309.69" "$5,309.69" "$8,410.55" "$10,619.38" "$8,495.50" "$4,778.72" "$2,107.68" N/A "$6,159.31" "$10,619.38" "$10,619.38" "$10,619.38" "$2,213.08" "$10,619.38" N/A N/A 6632-8-850 SUP HCPCS C1776 6632-8-850 - COMPONENT FEMORAL XL TOT STABILIZE KNEE LEFT BOTH IP/OP "$10,811.50" "$8,001.00" "$2,145.74" "$10,811.13" "$4,865.01" "$4,865.01" "$4,865.01" "$4,865.01" "$10,811.13" "$10,811.13" "$10,811.13" "$2,253.31" "$10,811.13" "$10,811.13" "$10,811.13" "$10,811.13" "$10,811.13" "$2,253.16" "$10,811.13" "$4,324.45" "$5,329.89" "$10,811.13" "$10,811.13" "$10,811.13" "$10,811.13" "$8,108.63" "$10,811.13" "$10,811.13" "$10,811.13" "$5,405.57" "$5,405.57" "$8,562.41" "$10,811.13" "$8,648.90" "$4,865.01" "$2,145.74" N/A "$6,270.67" "$10,811.13" "$10,811.13" "$10,811.13" "$2,253.04" "$10,811.13" N/A N/A 6632-8-855 SUP HCPCS C1776 6632-8-855 - COMPONENT FEMORAL XL TOT STABILIZE KNEE RIGHT BOTH IP/OP "$10,811.50" "$8,001.00" "$2,145.74" "$10,811.13" "$4,865.01" "$4,865.01" "$4,865.01" "$4,865.01" "$10,811.13" "$10,811.13" "$10,811.13" "$2,253.31" "$10,811.13" "$10,811.13" "$10,811.13" "$10,811.13" "$10,811.13" "$2,253.16" "$10,811.13" "$10,811.13" "$5,329.89" "$10,811.13" "$10,811.13" "$10,811.13" "$10,811.13" "$8,108.63" "$10,811.13" "$10,811.13" "$10,811.13" "$5,405.57" "$5,405.57" "$8,562.41" "$10,811.13" "$8,648.90" "$4,865.01" "$2,145.74" N/A "$6,270.67" "$10,811.13" "$10,811.13" "$10,811.13" "$2,253.04" "$10,811.13" N/A N/A 6634-0-330 SUP Custom 27803010 6634-0-330 - COMPONENT FEMORAL UNIVERSAL SMALL 57MM UNICOMP DURACON DUR BOTH IP/OP "$1,856.00" "$1,373.00" $330.37 "$1,856.00" "$1,856.00" "$1,856.00" "$1,856.00" "$1,856.00" "$1,856.00" "$1,856.00" $330.37 "$1,856.00" "$1,856.00" "$1,856.00" "$1,856.00" "$1,856.00" "$1,856.00" $386.81 "$1,856.00" $742.40 "$1,856.00" "$1,856.00" "$1,856.00" "$1,856.00" "$1,856.00" "$1,392.00" "$1,856.00" "$1,856.00" "$1,856.00" $928.00 $928.00 "$1,469.95" "$1,856.00" "$1,484.80" $835.20 "$1,856.00" N/A "$1,076.48" "$1,856.00" "$1,113.60" "$1,856.00" "$1,856.00" "$1,856.00" N/A N/A 6637-0-009 SUP HCPCS C1776 6637-0-009 - INSERT TIBIAL SMALL 9MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-011 SUP HCPCS C1776 6637-0-011 - INSERT TIBIAL SMALL 11MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-013 SUP HCPCS C1776 6637-0-013 - INSERT TIBIAL SMALL 13MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-016 SUP HCPCS C1776 6637-0-016 - INSERT TIBIAL SMALL 16MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-019 SUP HCPCS C1776 6637-0-019 - INSERT TIBIAL SMALL 19MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-022 SUP HCPCS C1776 6637-0-022 - INSERT TIBIAL SMALL 22MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-025 SUP HCPCS C1776 6637-0-025 - INSERT TIBIAL SMALL 25MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-028 SUP HCPCS C1776 6637-0-028 - INSERT TIBIAL SMALL 28MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-031 SUP HCPCS C1776 6637-0-031 - INSERT TIBIAL SMALL 31MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-109 SUP HCPCS C1776 6637-0-109 - INSERT TIBIAL MEDIUM 9MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-111 SUP HCPCS C1776 6637-0-111 - INSERT TIBIAL MEDIUM 11MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-113 SUP HCPCS C1776 6637-0-113 - INSERT TIBIAL MEDIUM 13MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-116 SUP HCPCS C1776 6637-0-116 - INSERT TIBIAL MEDIUM 16MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-119 SUP HCPCS C1776 6637-0-119 - INSERT TIBIAL MEDIUM 19MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-122 SUP HCPCS C1776 6637-0-122 - INSERT TIBIAL MEDIUM 22MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-125 SUP HCPCS C1776 6637-0-125 - INSERT TIBIAL MEDIUM 25MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-128 SUP HCPCS C1776 6637-0-128 - INSERT TIBIAL MEDIUM 28MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-131 SUP HCPCS C1776 6637-0-131 - INSERT TIBIAL MEDIUM 31MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-209 SUP HCPCS C1776 6637-0-209 - INSERT TIBIAL LARGE 9MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-211 SUP HCPCS C1776 6637-0-211 - INSERT TIBIAL LARGE 11MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-213 SUP HCPCS C1776 6637-0-213 - INSERT TIBIAL LARGE 13MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-216 SUP HCPCS C1776 6637-0-216 - INSERT TIBIAL LARGE 16MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-219 SUP HCPCS C1776 6637-0-219 - INSERT TIBIAL LARGE 19MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-222 SUP HCPCS C1776 6637-0-222 - INSERT TIBIAL LARGE 22MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-225 SUP HCPCS C1776 6637-0-225 - INSERT TIBIAL LARGE 25MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-228 SUP HCPCS C1776 6637-0-228 - INSERT TIBIAL LARGE 28MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-231 SUP HCPCS C1776 6637-0-231 - INSERT TIBIAL LARGE 31MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-309 SUP HCPCS C1776 6637-0-309 - INSERT TIBIAL XL 9MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-311 SUP HCPCS C1776 6637-0-311 - INSERT TIBIAL XL 11MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-313 SUP HCPCS C1776 6637-0-313 - INSERT TIBIAL XL 13MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-316 SUP HCPCS C1776 6637-0-316 - INSERT TIBIAL XL 16MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-319 SUP HCPCS C1776 6637-0-319 - INSERT TIBIAL XL 19MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-322 SUP HCPCS C1776 6637-0-322 - INSERT TIBIAL XL 22MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-325 SUP HCPCS C1776 6637-0-325 - INSERT TIBIAL XL 25MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-328 SUP HCPCS C1776 6637-0-328 - INSERT TIBIAL XL 28MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-331 SUP HCPCS C1776 6637-0-331 - INSERT TIBIAL XL 31MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-609 SUP HCPCS C1776 6637-0-609 - INSERT TIBIAL SMALL 9MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-611 SUP HCPCS C1776 6637-0-611 - INSERT TIBIAL SMALL 11MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-613 SUP HCPCS C1776 6637-0-613 - INSERT TIBIAL SMALL 13MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-616 SUP HCPCS C1776 6637-0-616 - INSERT TIBIAL SMALL 16MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-619 SUP HCPCS C1776 6637-0-619 - INSERT TIBIAL SMALL 19MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-622 SUP HCPCS C1776 6637-0-622 - INSERT TIBIAL SMALL 22MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-625 SUP HCPCS C1776 6637-0-625 - INSERT TIBIAL SMALL 25MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-628 SUP HCPCS C1776 6637-0-628 - INSERT TIBIAL SMALL 28MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-631 SUP HCPCS C1776 6637-0-631 - INSERT TIBIAL SMALL 31MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-709 SUP HCPCS C1776 6637-0-709 - INSERT TIBIAL MEDIUM 9MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-711 SUP HCPCS C1776 6637-0-711 - INSERT TIBIAL MEDIUM 11MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-713 SUP HCPCS C1776 6637-0-713 - INSERT TIBIAL MEDIUM 13MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-716 SUP HCPCS C1776 6637-0-716 - INSERT TIBIAL MEDIUM 16MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-719 SUP HCPCS C1776 6637-0-719 - INSERT TIBIAL MEDIUM 19MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-722 SUP HCPCS C1776 6637-0-722 - INSERT TIBIAL MEDIUM 22MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-725 SUP HCPCS C1776 6637-0-725 - INSERT TIBIAL MEDIUM 25MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-728 SUP HCPCS C1776 6637-0-728 - INSERT TIBIAL MEDIUM 28MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-731 SUP HCPCS C1776 6637-0-731 - INSERT TIBIAL MEDIUM 31MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-809 SUP HCPCS C1776 6637-0-809 - INSERT TIBIAL LARGE 9MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-811 SUP HCPCS C1776 6637-0-811 - INSERT TIBIAL LARGE 11MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-813 SUP HCPCS C1776 6637-0-813 - INSERT TIBIAL LARGE 13MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-816 SUP HCPCS C1776 6637-0-816 - INSERT TIBIAL LARGE 16MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-819 SUP HCPCS C1776 6637-0-819 - INSERT TIBIAL LARGE 16MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-822 SUP HCPCS C1776 6637-0-822 - INSERT TIBIAL LARGE 22MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-825 SUP HCPCS C1776 6637-0-825 - INSERT TIBIAL LARGE 25MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-828 SUP HCPCS C1776 6637-0-828 - INSERT TIBIAL LARGE 28MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-831 SUP HCPCS C1776 6637-0-831 - INSERT TIBIAL LARGE 31MM REVISION PCA DURACON KNEE LEFT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-909 SUP HCPCS C1776 6637-0-909 - INSERT TIBIAL XL 9MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-911 SUP HCPCS C1776 6637-0-911 - INSERT TIBIAL XL 11MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-913 SUP HCPCS C1776 6637-0-913 - INSERT TIBIAL XL 13MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-916 SUP HCPCS C1776 6637-0-916 - INSERT TIBIAL XL 16MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-919 SUP HCPCS C1776 6637-0-919 - INSERT TIBIAL XL 19MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-922 SUP HCPCS C1776 6637-0-922 - INSERT TIBIAL XL 22MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-925 SUP HCPCS C1776 6637-0-925 - INSERT TIBIAL XL 25MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-928 SUP HCPCS C1776 6637-0-928 - INSERT TIBIAL XL 28MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-0-931 SUP HCPCS C1776 6637-0-931 - INSERT TIBIAL XL 31MM REVISION PCA DURACON KNEE RIGHT BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-009 SUP HCPCS C1776 6637-4-009 - INSERT TIBIAL SMALL NEUTRAL 9MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-011 SUP HCPCS C1776 6637-4-011 - INSERT TIBIAL SMALL NEUTRAL 11MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-013 SUP HCPCS C1776 6637-4-013 - INSERT TIBIAL SMALL NEUTRAL 13MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-016 SUP HCPCS C1776 6637-4-016 - INSERT TIBIAL SMALL NEUTRAL 16MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-019 SUP HCPCS C1776 6637-4-019 - INSERT TIBIAL SMALL NEUTRAL 19MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-022 SUP HCPCS C1776 6637-4-022 - INSERT TIBIAL SMALL NEUTRAL 22MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-025 SUP HCPCS C1776 6637-4-025 - INSERT TIBIAL SMALL NEUTRAL 25MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-028 SUP HCPCS C1776 6637-4-028 - INSERT TIBIAL SMALL NEUTRAL 28MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-031 SUP HCPCS C1776 6637-4-031 - INSERT TIBIAL SMALL NEUTRAL 31MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-109 SUP HCPCS C1776 6637-4-109 - INSERT TIBIAL MEDIUM NEUTRAL 9MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-111 SUP HCPCS C1776 6637-4-111 - INSERT TIBIAL MEDIUM NEUTRAL 11MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-113 SUP HCPCS C1776 6637-4-113 - INSERT TIBIAL MEDIUM NEUTRAL 13MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-116 SUP HCPCS C1776 6637-4-116 - INSERT TIBIAL MEDIUM NEUTRAL 16MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-119 SUP HCPCS C1776 6637-4-119 - INSERT TIBIAL MEDIUM NEUTRAL 19MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-122 SUP HCPCS C1776 6637-4-122 - INSERT TIBIAL MEDIUM NEUTRAL 22MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-125 SUP HCPCS C1776 6637-4-125 - INSERT TIBIAL MEDIUM NEUTRAL 25MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-128 SUP HCPCS C1776 6637-4-128 - INSERT TIBIAL MEDIUM NEUTRAL 28MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-131 SUP HCPCS C1776 6637-4-131 - INSERT TIBIAL MEDIUM NEUTRAL 31MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-209 SUP HCPCS C1776 6637-4-209 - INSERT TIBIAL LARGE NEUTRAL 9MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-211 SUP HCPCS C1776 6637-4-211 - INSERT TIBIAL LARGE NEUTRAL 11MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-213 SUP HCPCS C1776 6637-4-213 - INSERT TIBIAL LARGE NEUTRAL 13MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-216 SUP HCPCS C1776 6637-4-216 - INSERT TIBIAL LARGE NEUTRAL 16MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-219 SUP HCPCS C1776 6637-4-219 - INSERT TIBIAL LARGE NEUTRAL 19MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-222 SUP HCPCS C1776 6637-4-222 - INSERT TIBIAL LARGE NEUTRAL 22MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-225 SUP HCPCS C1776 6637-4-225 - INSERT TIBIAL LARGE NEUTRAL 25MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-228 SUP HCPCS C1776 6637-4-228 - INSERT TIBIAL LARGE NEUTRAL 28MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-231 SUP HCPCS C1776 6637-4-231 - INSERT TIBIAL LARGE NEUTRAL 31MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-309 SUP HCPCS C1776 6637-4-309 - INSERT TIBIAL XL NEUTRAL 9MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-311 SUP HCPCS C1776 6637-4-311 - INSERT TIBIAL XL NEUTRAL 11MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$2,207.00" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-313 SUP HCPCS C1776 6637-4-313 - INSERT TIBIAL XL NEUTRAL 13MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-316 SUP HCPCS C1776 6637-4-316 - INSERT TIBIAL XL NEUTRAL 16MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-319 SUP HCPCS C1776 6637-4-319 - INSERT TIBIAL XL NEUTRAL 19MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-322 SUP HCPCS C1776 6637-4-322 - INSERT TIBIAL XL NEUTRAL 22MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-325 SUP HCPCS C1776 6637-4-325 - INSERT TIBIAL XL NEUTRAL 25MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-328 SUP HCPCS C1776 6637-4-328 - INSERT TIBIAL XL NEUTRAL 28MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6637-4-331 SUP HCPCS C1776 6637-4-331 - INSERT TIBIAL XL NEUTRAL 31MM REVISION PCA DURACON KNEE BOTH IP/OP "$5,517.50" "$4,083.00" "$1,095.09" "$5,517.50" "$2,482.88" "$2,482.88" "$2,482.88" "$2,482.88" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.98" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$1,149.91" "$5,517.50" "$5,517.50" "$2,720.13" "$5,517.50" "$5,517.50" "$5,517.50" "$5,517.50" "$4,138.13" "$5,517.50" "$5,517.50" "$5,517.50" "$2,758.75" "$2,758.75" "$4,369.86" "$5,517.50" "$4,414.00" "$2,482.88" "$1,095.09" N/A "$3,200.15" "$5,517.50" "$3,310.50" "$5,517.50" "$1,149.85" "$5,517.50" N/A N/A 6642-1-009 SUP Custom 27803010 6642-1-009 - INSERT TIBIAL XS 9MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,214.00" $898.00 $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $253.01 "$1,214.00" $485.60 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $910.50 "$1,214.00" "$1,214.00" "$1,214.00" $607.00 $607.00 $961.49 "$1,214.00" $971.20 $546.30 "$1,214.00" N/A $704.12 "$1,214.00" $728.40 "$1,214.00" "$1,214.00" "$1,214.00" N/A N/A 6642-1-011 SUP Custom 27803010 6642-1-011 - INSERT TIBIAL XS 11MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,214.00" $898.00 $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $253.01 "$1,214.00" $485.60 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $910.50 "$1,214.00" "$1,214.00" "$1,214.00" $607.00 $607.00 $961.49 "$1,214.00" $971.20 $546.30 "$1,214.00" N/A $704.12 "$1,214.00" $728.40 "$1,214.00" "$1,214.00" "$1,214.00" N/A N/A 6642-1-013 SUP Custom 27803010 6642-1-013 - INSERT TIBIAL XS 13MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,214.00" $898.00 $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $253.01 "$1,214.00" $485.60 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $910.50 "$1,214.00" "$1,214.00" "$1,214.00" $607.00 $607.00 $961.49 "$1,214.00" $971.20 $546.30 "$1,214.00" N/A $704.12 "$1,214.00" $728.40 "$1,214.00" "$1,214.00" "$1,214.00" N/A N/A 6642-1-016 SUP Custom 27803010 6642-1-016 - INSERT TIBIAL XS 16MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,214.00" $898.00 $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $253.01 "$1,214.00" $485.60 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $910.50 "$1,214.00" "$1,214.00" "$1,214.00" $607.00 $607.00 $961.49 "$1,214.00" $971.20 $546.30 "$1,214.00" N/A $704.12 "$1,214.00" $728.40 "$1,214.00" "$1,214.00" "$1,214.00" N/A N/A 6642-1-109 SUP Custom 27803010 6642-1-109 - INSERT TIBIAL SMALL 9MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-111 SUP Custom 27803010 6642-1-111 - INSERT TIBIAL SMALL 11MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-113 SUP Custom 27803010 6642-1-113 - INSERT TIBIAL SMALL 13MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-116 SUP Custom 27803010 6642-1-116 - INSERT TIBIAL SMALL 16MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-119 SUP Custom 27803010 6642-1-119 - INSERT TIBIAL SMALL 19MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-209 SUP Custom 27803010 6642-1-209 - INSERT TIBIAL MEDIUM 9MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-211 SUP Custom 27803010 6642-1-211 - INSERT TIBIAL MEDIUM 11MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-213 SUP Custom 27803010 6642-1-213 - INSERT TIBIAL MEDIUM 13MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-216 SUP Custom 27803010 6642-1-216 - INSERT TIBIAL MEDIUM 16MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-219 SUP Custom 27803010 6642-1-219 - INSERT TIBIAL MEDIUM 19MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-309 SUP Custom 27803010 6642-1-309 - INSERT TIBIAL LARGE 9MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-311 SUP Custom 27803010 6642-1-311 - INSERT TIBIAL LARGE 11MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-313 SUP Custom 27803010 6642-1-313 - INSERT TIBIAL LARGE 13MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-316 SUP Custom 27803010 6642-1-316 - INSERT TIBIAL LARGE 16MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-319 SUP Custom 27803010 6642-1-319 - INSERT TIBIAL LARGE 19MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,191.00" $881.00 $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $212.00 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $248.22 "$1,191.00" $476.40 "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" "$1,191.00" $893.25 "$1,191.00" "$1,191.00" "$1,191.00" $595.50 $595.50 $943.27 "$1,191.00" $952.80 $535.95 "$1,191.00" N/A $690.78 "$1,191.00" $714.60 "$1,191.00" "$1,191.00" "$1,191.00" N/A N/A 6642-1-409 SUP Custom 27803010 6642-1-409 - INSERT TIBIAL XL 9MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,214.00" $898.00 $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $253.01 "$1,214.00" $485.60 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $910.50 "$1,214.00" "$1,214.00" "$1,214.00" $607.00 $607.00 $961.49 "$1,214.00" $971.20 $546.30 "$1,214.00" N/A $704.12 "$1,214.00" $728.40 "$1,214.00" "$1,214.00" "$1,214.00" N/A N/A 6642-1-411 SUP Custom 27803010 6642-1-411 - INSERT TIBIAL XL 11MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,214.00" $898.00 $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $253.01 "$1,214.00" $485.60 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $910.50 "$1,214.00" "$1,214.00" "$1,214.00" $607.00 $607.00 $961.49 "$1,214.00" $971.20 $546.30 "$1,214.00" N/A $704.12 "$1,214.00" $728.40 "$1,214.00" "$1,214.00" "$1,214.00" N/A N/A 6642-1-413 SUP Custom 27803010 6642-1-413 - INSERT TIBIAL XL 13MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,214.00" $898.00 $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $253.01 "$1,214.00" $485.60 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $910.50 "$1,214.00" "$1,214.00" "$1,214.00" $607.00 $607.00 $961.49 "$1,214.00" $971.20 $546.30 "$1,214.00" N/A $704.12 "$1,214.00" $728.40 "$1,214.00" "$1,214.00" "$1,214.00" N/A N/A 6642-1-416 SUP Custom 27803010 6642-1-416 - INSERT TIBIAL XL 16MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,214.00" $898.00 $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $253.01 "$1,214.00" $485.60 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $910.50 "$1,214.00" "$1,214.00" "$1,214.00" $607.00 $607.00 $961.49 "$1,214.00" $971.20 $546.30 "$1,214.00" N/A $704.12 "$1,214.00" $728.40 "$1,214.00" "$1,214.00" "$1,214.00" N/A N/A 6642-1-419 SUP Custom 27803010 6642-1-419 - INSERT TIBIAL XL 19MM DURACON DUR KNEE CONDYLE BOTH IP/OP "$1,214.00" $898.00 $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $216.09 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $253.01 "$1,214.00" $485.60 "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" "$1,214.00" $910.50 "$1,214.00" "$1,214.00" "$1,214.00" $607.00 $607.00 $961.49 "$1,214.00" $971.20 $546.30 "$1,214.00" N/A $704.12 "$1,214.00" $728.40 "$1,214.00" "$1,214.00" "$1,214.00" N/A N/A 6642-1-509 SUP Custom 27803010 6642-1-509 - INSERT TIBIAL XS 9MM ANTERIOR/POSTERIOR LIPPED DURACON DUR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-511 SUP Custom 27803010 6642-1-511 - INSERT TIBIAL XS 11MM ANTERIOR/POSTERIOR LIPPED DURACON DUR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-513 SUP Custom 27803010 6642-1-513 - INSERT TIBIAL XS 13MM ANTERIOR/POSTERIOR LIPPED DURACON DUR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-516 SUP Custom 27803010 6642-1-516 - INSERT TIBIAL XS 16MM ANTERIOR/POSTERIOR LIPPED DURACON DUR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-609 SUP Custom 27803010 6642-1-609 - INSERT TIBIAL SMALL 9MM DURACON DUR ANTERIOR POSTERIOR KNEE BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-611 SUP Custom 27803010 6642-1-611 - INSERT TIBIAL SMALL 11MM LIPPED REVISION RECONSTRUCTION BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-613 SUP Custom 27803010 6642-1-613 - INSERT TIBIAL SMALL 13MM DURACON DUR ANTERIOR POSTERIOR KNEE BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-616 SUP Custom 27803010 6642-1-616 - INSERT TIBIAL SMALL 16MM DURACON DUR ANTERIOR POSTERIOR KNEE BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-619 SUP Custom 27803010 6642-1-619 - INSERT TIBIAL SMALL 19MM DURACON DUR KNEE ANTERIOR POSTERIOR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-622 SUP Custom 27803010 6642-1-622 - INSERT TIBIAL SMALL 22MM LIP DURACON DUR KNEE BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-625 SUP Custom 27803010 6642-1-625 - INSERT TIBIAL SMALL 25MM DURACON DUR KNEE ANTERIOR POSTERIOR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-709 SUP Custom 27803010 6642-1-709 - INSERT TIBIAL MEDIUM 9MM LIPPED DURACON DUR ANTERIOR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-711 SUP Custom 27803010 6642-1-711 - INSERT TIBIAL MEDIUM 11MM DURACON DUR ANTERIOR POSTERIOR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-713 SUP Custom 27803010 6642-1-713 - INSERT TIBIAL MEDIUM 13MM DURACON DUR ANTERIOR POSTERIOR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-716 SUP Custom 27803010 6642-1-716 - INSERT TIBIAL MEDIUM 16MM LIPPED REVISION RECONSTRUCTION BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-719 SUP Custom 27803010 6642-1-719 - INSERT TIBIAL MEDIUM 19MM DURACON DUR ANTERIOR POSTERIOR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-722 SUP Custom 27803010 6642-1-722 - INSERT TIBIAL MEDIUM 22MM DURACON DUR KNEE ANTERIOR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-725 SUP Custom 27803010 6642-1-725 - INSERT TIBIAL MEDIUM 25MM DURACON DUR KNEE ANTERIOR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-809 SUP Custom 27803010 6642-1-809 - INSERT TIBIAL LARGE 9MM DURACON DUR ANTERIOR POSTERIOR KNEE BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-811 SUP Custom 27803010 6642-1-811 - INSERT TIBIAL LARGE 11MM DURACON DUR ANTERIOR POSTERIOR KNEE BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-813 SUP Custom 27803010 6642-1-813 - INSERT TIBIAL LARGE 13MM LIPPED REVISION RECONSTRUCTION BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-816 SUP Custom 27803010 6642-1-816 - INSERT TIBIAL LARGE 16MM LIPPED REVISION RECONSTRUCTION BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-819 SUP Custom 27803010 6642-1-819 - INSERT TIBIAL LARGE 19MM DURACON DUR KNEE ANTERIOR POSTERIOR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-822 SUP Custom 27803010 6642-1-822 - INSERT TIBIAL LARGE 22MM DURACON DUR KNEE ANTERIOR POSTERIOR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-825 SUP Custom 27803010 6642-1-825 - INSERT TIBIAL LARGE 25MM DURACON DUR KNEE ANTERIOR POSTERIOR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-909 SUP Custom 27803010 6642-1-909 - INSERT TIBIAL XL 9MM LIPPED REVISION RECONSTRUCTION DURACON BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-911 SUP Custom 27803010 6642-1-911 - INSERT TIBIAL XL 11MM DURACON DUR ANTERIOR POSTERIOR KNEE BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-913 SUP Custom 27803010 6642-1-913 - INSERT TIBIAL XL 13MM DURACON DUR ANTERIOR POSTERIOR KNEE BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-916 SUP Custom 27803010 6642-1-916 - INSERT TIBIAL XL 16MM DURACON DUR ANTERIOR POSTERIOR KNEE BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-919 SUP Custom 27803010 6642-1-919 - INSERT TIBIAL XL 19MM DURACON DUR KNEE ANTERIOR POSTERIOR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-922 SUP Custom 27803010 6642-1-922 - INSERT TIBIAL XL 22MM DURACON DUR KNEE ANTERIOR POSTERIOR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-1-925 SUP Custom 27803010 6642-1-925 - INSERT TIBIAL XL 25MM DURACON DUR KNEE ANTERIOR POSTERIOR BOTH IP/OP "$1,917.50" "$1,419.00" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $341.32 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" $399.63 "$1,917.50" $767.00 "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,917.50" "$1,438.13" "$1,917.50" "$1,917.50" "$1,917.50" $958.75 $958.75 "$1,518.66" "$1,917.50" "$1,534.00" $862.88 "$1,917.50" N/A "$1,112.15" "$1,917.50" "$1,150.50" "$1,917.50" "$1,917.50" "$1,917.50" N/A N/A 6642-2-040 SUP Custom 27803010 6642-2-040 - COMPONENT PATLR XS 29MM HDPE RESIN KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-050 SUP Custom 27803010 6642-2-050 - COMPONENT PATLR SMALL 32MM HDPE RESIN KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-100 SUP Custom 27803010 6642-2-100 - COMPONENT PATLR MEDIUM 35MM HDPE RESIN KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-140 SUP Custom 27803010 6642-2-140 - COMPONENT PATLR 33MM METAL BACKED DURACON DUR BOTH IP/OP "$1,316.00" $974.00 $234.25 "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" $234.25 "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" $274.27 "$1,316.00" $526.40 "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" $987.00 "$1,316.00" "$1,316.00" "$1,316.00" $658.00 $658.00 "$1,042.27" "$1,316.00" "$1,052.80" $592.20 "$1,316.00" N/A $763.28 "$1,316.00" $789.60 "$1,316.00" "$1,316.00" "$1,316.00" N/A N/A 6642-2-145 SUP Custom 27803010 6642-2-145 - COMPONENT PATLR 33MM DURACON BOTH IP/OP "$1,571.00" "$1,163.00" $279.64 "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" $279.64 "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" $327.41 "$1,571.00" $628.40 "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,571.00" "$1,178.25" "$1,571.00" "$1,571.00" "$1,571.00" $785.50 $785.50 "$1,244.23" "$1,571.00" "$1,256.80" $706.95 "$1,571.00" N/A $911.18 "$1,571.00" $942.60 "$1,571.00" "$1,571.00" "$1,571.00" N/A N/A 6642-2-150 SUP Custom 27803010 6642-2-150 - COMPONENT PATLR LARGE 11MM DURACON DUR ALL POLY KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-200 SUP Custom 27803010 6642-2-200 - COMPONENT PATLR XL 11MM DURACON DUR ALL POLY KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-300 SUP Custom 27803010 6642-2-300 - COMPONENT PATLR SMALL METAL BACKED DURACON DUR BOTH IP/OP "$1,316.00" $974.00 $234.25 "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" $234.25 "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" $274.27 "$1,316.00" $526.40 "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" $987.00 "$1,316.00" "$1,316.00" "$1,316.00" $658.00 $658.00 "$1,042.27" "$1,316.00" "$1,052.80" $592.20 "$1,316.00" N/A $763.28 "$1,316.00" $789.60 "$1,316.00" "$1,316.00" "$1,316.00" N/A N/A 6642-2-350 SUP Custom 27803010 6642-2-350 - COMPONENT PATLR MEDIUM METAL BACKED DURACON DUR BOTH IP/OP "$1,316.00" $974.00 $234.25 "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" $234.25 "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" $274.27 "$1,316.00" $526.40 "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" $987.00 "$1,316.00" "$1,316.00" "$1,316.00" $658.00 $658.00 "$1,042.27" "$1,316.00" "$1,052.80" $592.20 "$1,316.00" N/A $763.28 "$1,316.00" $789.60 "$1,316.00" "$1,316.00" "$1,316.00" N/A N/A 6642-2-400 SUP Custom 27803010 6642-2-400 - COMPONENT PATLR LARGE ASYMMETRIC METAL BACKED DURACON DUR BOTH IP/OP "$1,316.00" $974.00 $234.25 "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" $234.25 "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" $274.27 "$1,316.00" $526.40 "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" $987.00 "$1,316.00" "$1,316.00" "$1,316.00" $658.00 $658.00 "$1,042.27" "$1,316.00" "$1,052.80" $592.20 "$1,316.00" N/A $763.28 "$1,316.00" $789.60 "$1,316.00" "$1,316.00" "$1,316.00" N/A N/A 6642-2-600 SUP Custom 27803010 6642-2-600 - INSERT TIBIAL 8MM 27MM SYMMETRIC DURACON DUR BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-610 SUP Custom 27803010 6642-2-610 - INSERT TIBIAL 8MM 29MM SYMMETRIC DURACON DUR BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-620 SUP Custom 27803010 6642-2-620 - COMPONENT PATLR 31MM 9MM SYMMETRIC DURACON DUR BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-626 SUP Custom 27203010 6642-2-626 - TRIAL SURG 25MM 10MM INSET DURACON DUR PATELLA BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $445.32 $445.32 $462.48 $312.60 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $390.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-627 SUP Custom 27803010 6642-2-627 - COMPONENT PATLR 27MM 10MM SYMMETRIC DURACON DUR KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-629 SUP Custom 27803010 6642-2-629 - COMPONENT PATLR 29MM 10MM INSET DURACON DUR BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-630 SUP Custom 27803010 6642-2-630 - INSERT TIBIAL 9MM 33MM SYMMETRIC DURACON DUR KNEE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-631 SUP Custom 27803010 6642-2-631 - COMPONENT PATLR 31MM 10MM SYMMETRIC DURACON DUR BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-633 SUP Custom 27803010 6642-2-633 - COMPONENT PATLR 33MM 10MM INSET DURACON DUR BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-640 SUP Custom 27803010 6642-2-640 - COMPONENT PATLR 36MM 10MM SYMMETRIC DURACON DUR BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-645 SUP Custom 27803010 6642-2-645 - INSERT TIBIAL 11MM 39MM SYMMETRIC DURACON DUR BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 6642-2-700 SUP Custom 27803010 6642-2-700 - COMPONENT PATLR SMALL CONVERSION DURACON DUR BOTH IP/OP "$1,634.00" "$1,209.00" $290.85 "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" $290.85 "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" $340.54 "$1,634.00" $653.60 "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,225.50" "$1,634.00" "$1,634.00" "$1,634.00" $817.00 $817.00 "$1,294.13" "$1,634.00" "$1,307.20" $735.30 "$1,634.00" N/A $947.72 "$1,634.00" $980.40 "$1,634.00" "$1,634.00" "$1,634.00" N/A N/A 6642-2-705 SUP Custom 27803010 6642-2-705 - COMPONENT PATLR MEDIUM CONVERSION DURACON DUR BOTH IP/OP "$1,634.00" "$1,209.00" $290.85 "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" $290.85 "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" $340.54 "$1,634.00" $653.60 "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,225.50" "$1,634.00" "$1,634.00" "$1,634.00" $817.00 $817.00 "$1,294.13" "$1,634.00" "$1,307.20" $735.30 "$1,634.00" N/A $947.72 "$1,634.00" $980.40 "$1,634.00" "$1,634.00" "$1,634.00" N/A N/A 6642-2-710 SUP Custom 27803010 6642-2-710 - COMPONENT PATLR LARGE CONVEX CONVEX DURACON DUR BOTH IP/OP "$1,634.00" "$1,209.00" $290.85 "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" $290.85 "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" $340.54 "$1,634.00" $653.60 "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,225.50" "$1,634.00" "$1,634.00" "$1,634.00" $817.00 $817.00 "$1,294.13" "$1,634.00" "$1,307.20" $735.30 "$1,634.00" N/A $947.72 "$1,634.00" $980.40 "$1,634.00" "$1,634.00" "$1,634.00" N/A N/A 6642-2-715 SUP Custom 27803010 6642-2-715 - COMPONENT PATLR XL CONVEX DURACON DUR UHMWPE BOTH IP/OP "$1,634.00" "$1,209.00" $290.85 "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" $290.85 "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" $340.54 "$1,634.00" $653.60 "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,634.00" "$1,225.50" "$1,634.00" "$1,634.00" "$1,634.00" $817.00 $817.00 "$1,294.13" "$1,634.00" "$1,307.20" $735.30 "$1,634.00" N/A $947.72 "$1,634.00" $980.40 "$1,634.00" "$1,634.00" "$1,634.00" N/A N/A 6642-2-720 SUP Custom 27803010 6642-2-720 - INSERT TIBIAL SMALL 7MM 20MM CONVEX DURACON DUR KNEE BOTH IP/OP $677.00 $501.00 $120.51 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $120.51 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $141.09 $677.00 $270.80 $677.00 $677.00 $677.00 $677.00 $677.00 $507.75 $677.00 $677.00 $677.00 $338.50 $338.50 $536.18 $677.00 $541.60 $304.65 $677.00 N/A $392.66 $677.00 $406.20 $677.00 $677.00 $677.00 N/A N/A 6642-2-725 SUP Custom 27803010 6642-2-725 - INSERT TIBIAL MEDIUM 7MM 25MM CONVEX DURACON DUR KNEE BOTH IP/OP $677.00 $501.00 $120.51 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $120.51 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $141.09 $677.00 $270.80 $677.00 $677.00 $677.00 $677.00 $677.00 $507.75 $677.00 $677.00 $677.00 $338.50 $338.50 $536.18 $677.00 $541.60 $304.65 $677.00 N/A $392.66 $677.00 $406.20 $677.00 $677.00 $677.00 N/A N/A 6642-2-730 SUP Custom 27803010 6642-2-730 - INSERT TIBIAL LARGE 7MM 30MM CONVEX DURACON DUR KNEE BOTH IP/OP $677.00 $501.00 $120.51 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $120.51 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $141.09 $677.00 $270.80 $677.00 $677.00 $677.00 $677.00 $677.00 $507.75 $677.00 $677.00 $677.00 $338.50 $338.50 $536.18 $677.00 $541.60 $304.65 $677.00 N/A $392.66 $677.00 $406.20 $677.00 $677.00 $677.00 N/A N/A 6642-2-735 SUP Custom 27803010 6642-2-735 - INSERT TIBIAL XL 7MM 35MM CONVEX DURACON DUR KNEE BOTH IP/OP $677.00 $501.00 $120.51 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $120.51 $677.00 $677.00 $677.00 $677.00 $677.00 $677.00 $141.09 $677.00 $270.80 $677.00 $677.00 $677.00 $677.00 $677.00 $507.75 $677.00 $677.00 $677.00 $338.50 $338.50 $536.18 $677.00 $541.60 $304.65 $677.00 N/A $392.66 $677.00 $406.20 $677.00 $677.00 $677.00 N/A N/A 6642-2-740 SUP Custom 27803010 6642-2-740 - COMPONENT PATLR SMALL DURACON BOTH IP/OP "$1,768.00" "$1,308.00" $314.70 "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" $314.70 "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" $368.47 "$1,768.00" $707.20 "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" "$1,768.00" "$1,326.00" "$1,768.00" "$1,768.00" "$1,768.00" $884.00 $884.00 "$1,400.26" "$1,768.00" "$1,414.40" $795.60 "$1,768.00" N/A "$1,025.44" "$1,768.00" "$1,060.80" "$1,768.00" "$1,768.00" "$1,768.00" N/A N/A 6642-2-745 SUP Custom 27803010 6642-2-745 - COMPONENT PATLR MEDIUM DURACON BOTH IP/OP "$1,842.00" "$1,363.00" $327.88 "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" $327.88 "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" $383.89 "$1,842.00" $736.80 "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,381.50" "$1,842.00" "$1,842.00" "$1,842.00" $921.00 $921.00 "$1,458.86" "$1,842.00" "$1,473.60" $828.90 "$1,842.00" N/A "$1,068.36" "$1,842.00" "$1,105.20" "$1,842.00" "$1,842.00" "$1,842.00" N/A N/A 6642-2-750 SUP Custom 27803010 6642-2-750 - COMPONENT PATLR ASYMMETRICAL DUR BOTH IP/OP "$1,842.00" "$1,363.00" $327.88 "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" $327.88 "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" $383.89 "$1,842.00" $736.80 "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,381.50" "$1,842.00" "$1,842.00" "$1,842.00" $921.00 $921.00 "$1,458.86" "$1,842.00" "$1,473.60" $828.90 "$1,842.00" N/A "$1,068.36" "$1,842.00" "$1,105.20" "$1,842.00" "$1,842.00" "$1,842.00" N/A N/A 6642-2-755 SUP Custom 27803010 6642-2-755 - COMPONENT PATLR XL DURACON BOTH IP/OP "$1,842.00" "$1,363.00" $327.88 "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" $327.88 "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" $383.89 "$1,842.00" $736.80 "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,842.00" "$1,381.50" "$1,842.00" "$1,842.00" "$1,842.00" $921.00 $921.00 "$1,458.86" "$1,842.00" "$1,473.60" $828.90 "$1,842.00" N/A "$1,068.36" "$1,842.00" "$1,105.20" "$1,842.00" "$1,842.00" "$1,842.00" N/A N/A 6642-5-111 SUP HCPCS C1776 6642-5-111 - INSERT TIBIAL SMALL 11MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-113 SUP HCPCS C1776 6642-5-113 - INSERT TIBIAL SMALL 13MM TOT STABILIZED DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-116 SUP HCPCS C1776 6642-5-116 - INSERT TIBIAL SMALL 16MM TOT STABILIZED DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-119 SUP HCPCS C1776 6642-5-119 - INSERT TIBIAL SMALL 19MM TOT STABILIZED DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-122 SUP HCPCS C1776 6642-5-122 - INSERT TIBIAL SMALL 22MM TOT STABILIZED DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-125 SUP HCPCS C1776 6642-5-125 - INSERT TIBIAL SMALL 25MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-128 SUP HCPCS C1776 6642-5-128 - INSERT TIBIAL SMALL 28MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-131 SUP HCPCS C1776 6642-5-131 - INSERT TIBIAL SMALL 31MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-211 SUP HCPCS C1776 6642-5-211 - INSERT TIBIAL MEDIUM 11MM TOT STABILIZED DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-213 SUP HCPCS C1776 6642-5-213 - INSERT TIBIAL MEDIUM 13MM TOT STABILIZED DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-216 SUP HCPCS C1776 6642-5-216 - INSERT TIBIAL MEDIUM 16MM TOT STABILIZED DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-219 SUP HCPCS C1776 6642-5-219 - INSERT TIBIAL MEDIUM 19MM TOT STABILIZED DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-222 SUP HCPCS C1776 6642-5-222 - INSERT TIBIAL MEDIUM 22MM TOT STABILIZED DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-225 SUP HCPCS C1776 6642-5-225 - INSERT TIBIAL MEDIUM 25MM TOT STABILIZED DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-228 SUP HCPCS C1776 6642-5-228 - INSERT TIBIAL MEDIUM 28MM TOT STABILIZED DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-231 SUP HCPCS C1776 6642-5-231 - INSERT TIBIAL MEDIUM 31MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-311 SUP HCPCS C1776 6642-5-311 - INSERT TIBIAL LARGE 11MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-313 SUP HCPCS C1776 6642-5-313 - INSERT TIBIAL LARGE 13MM TOT STABILIZED DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-316 SUP HCPCS C1776 6642-5-316 - INSERT TIBIAL LARGE 16MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-319 SUP HCPCS C1776 6642-5-319 - INSERT TIBIAL LARGE 19MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-322 SUP HCPCS C1776 6642-5-322 - INSERT TIBIAL LARGE 22MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-325 SUP HCPCS C1776 6642-5-325 - INSERT TIBIAL LARGE 25MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-328 SUP HCPCS C1776 6642-5-328 - INSERT TIBIAL LARGE 28MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-331 SUP HCPCS C1776 6642-5-331 - INSERT TIBIAL LARGE 31MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-411 SUP HCPCS C1776 6642-5-411 - INSERT TIBIAL XL 11MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-413 SUP HCPCS C1776 6642-5-413 - INSERT TIBIAL XL 13MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-416 SUP HCPCS C1776 6642-5-416 - INSERT TIBIAL XL 16MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-419 SUP HCPCS C1776 6642-5-419 - INSERT TIBIAL XL 19MM TOT STABILIZED DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-422 SUP HCPCS C1776 6642-5-422 - INSERT TIBIAL XL 22MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-425 SUP HCPCS C1776 6642-5-425 - INSERT TIBIAL XL 25MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-428 SUP HCPCS C1776 6642-5-428 - INSERT TIBIAL XL 28MM TOT STABILIZED DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-5-431 SUP HCPCS C1776 6642-5-431 - INSERT TIBIAL XL 31MM TOT STABILIZE DURACON DUR KNEE BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 6642-9-009 SUP Custom 27803010 6642-9-009 - INSERT TIBIAL XS STANDARD 9MM DURACON DUR KNEE BOTH IP/OP "$2,075.50" "$1,536.00" $369.37 "$2,075.13" "$2,075.13" "$2,075.13" "$2,075.13" "$2,075.13" "$2,075.13" "$2,075.13" $369.37 "$2,075.13" "$2,075.13" "$2,075.13" "$2,075.13" "$2,075.13" "$2,075.13" $432.48 "$2,075.13" $830.05 "$2,075.13" "$2,075.13" "$2,075.13" "$2,075.13" "$2,075.13" "$1,556.63" "$2,075.13" "$2,075.13" "$2,075.13" "$1,037.57" "$1,037.57" "$1,643.50" "$2,075.13" "$1,660.10" $933.81 "$2,075.13" N/A "$1,203.79" "$2,075.13" "$1,245.08" "$2,075.13" "$2,075.13" "$2,075.13" N/A N/A 6642-9-011 SUP HCPCS C1776 6642-9-011 - INSERT TIBIAL XS STANDARD 11MM DURACON DUR KNEE BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-013 SUP HCPCS C1776 6642-9-013 - INSERT TIBIAL XS STANDARD 13MM DURACON DUR KNEE BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-016 SUP HCPCS C1776 6642-9-016 - INSERT TIBIAL XS STANDARD 16MM DURACON DUR KNEE BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-019 SUP HCPCS C1776 6642-9-019 - INSERT TIBIAL XS STANDARD 19MM DURACON DUR KNEE BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-109 SUP HCPCS C1776 6642-9-109 - INSERT TIBIAL STANDARD SMALL 9MM TOT STABILIZED DURACON DUR BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-111 SUP HCPCS C1776 6642-9-111 - INSERT TIBIAL STANDARD SMALL 11MM TOT STABILIZED DURACON DUR BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-113 SUP HCPCS C1776 6642-9-113 - INSERT TIBIAL STANDARD SMALL 13MM TOT STABILIZED DURACON DUR BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-116 SUP HCPCS C1776 6642-9-116 - INSERT TIBIAL STANDARD SMALL 16MM TOT STABILIZED DURACON DUR BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-119 SUP HCPCS C1776 6642-9-119 - INSERT TIBIAL STANDARD SMALL 19MM TOT STABILIZED DURACON DUR BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-209 SUP HCPCS C1776 6642-9-209 - INSERT TIBIAL STANDARD MEDIUM 9MM TOT STABILIZED DURACON DUR BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-211 SUP HCPCS C1776 6642-9-211 - INSERT TIBIAL STANDARD MEDIUM 11MM 11MM TOT STABILIZED BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-213 SUP HCPCS C1776 6642-9-213 - INSERT TIBIAL STANDARD MEDIUM 13MM TOT STABILIZED DURACON BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-216 SUP HCPCS C1776 6642-9-216 - INSERT TIBIAL STANDARD MEDIUM 16MM TOT STABILIZED DURACON BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-219 SUP HCPCS C1776 6642-9-219 - INSERT TIBIAL STANDARD MEDIUM 19MM TOT STABILIZED DURACON BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-309 SUP HCPCS C1776 6642-9-309 - INSERT TIBIAL STANDARD LARGE 9MM TOT STABILIZED DURACON DUR BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-311 SUP HCPCS C1776 6642-9-311 - INSERT TIBIAL STANDARD LARGE 11MM TOT STABILIZED DURACON DUR BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-313 SUP HCPCS C1776 6642-9-313 - INSERT TIBIAL STANDARD LARGE 13MM TOT STABILIZED DURACON DUR BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-316 SUP HCPCS C1776 6642-9-316 - INSERT TIBIAL STANDARD LARGE 16MM TOT STABILIZED DURACON DUR BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-319 SUP HCPCS C1776 6642-9-319 - INSERT TIBIAL STANDARD LARGE 19MM TOT STABILIZED DURACON DUR BOTH IP/OP "$5,026.50" "$3,720.00" $997.56 "$5,026.13" "$2,261.76" "$2,261.76" "$2,261.76" "$2,261.76" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.57" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.50" "$5,026.13" "$5,026.13" "$2,477.88" "$5,026.13" "$5,026.13" "$5,026.13" "$5,026.13" "$3,769.88" "$5,026.13" "$5,026.13" "$5,026.13" "$2,513.07" "$2,513.07" "$3,980.69" "$5,026.13" "$4,020.90" "$2,261.76" $997.56 N/A "$2,915.37" "$5,026.13" "$5,026.13" "$5,026.13" "$1,047.45" "$5,026.13" N/A N/A 6642-9-609 SUP Custom 27803010 6642-9-609 - INSERT TIBIAL SMALL 9MM CONSTRAIN DURACON DUR KNEE OTHER BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-611 SUP Custom 27803010 6642-9-611 - INSERT TIBIAL SMALL 11MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-613 SUP Custom 27803010 6642-9-613 - INSERT TIBIAL SMALL 13MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-616 SUP Custom 27803010 6642-9-616 - INSERT TIBIAL SMALL 16MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-619 SUP Custom 27803010 6642-9-619 - INSERT TIBIAL SMALL 19MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-622 SUP Custom 27803010 6642-9-622 - INSERT TIBIAL SMALL 22MM CONSTRAIN DURACON DUR KNEE OTHER BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-625 SUP Custom 27803010 6642-9-625 - INSERT TIBIAL SMALL 25MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-709 SUP Custom 27803010 6642-9-709 - INSERT TIBIAL MEDIUM 9MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-711 SUP HCPCS C1776 6642-9-711 - INSERT TIBIAL MEDIUM 11MM CONSTRAIN DURACON DUR KNEE OTHER BOTH IP/OP "$5,080.00" "$3,759.00" "$1,008.25" "$5,080.00" "$2,286.00" "$2,286.00" "$2,286.00" "$2,286.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.80" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$5,080.00" "$2,504.44" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$1,008.25" N/A "$2,946.40" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.67" "$5,080.00" N/A N/A 6642-9-713 SUP Custom 27803010 6642-9-713 - INSERT TIBIAL MEDIUM 13MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-716 SUP Custom 27803010 6642-9-716 - INSERT TIBIAL MEDIUM 16MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-719 SUP Custom 27803010 6642-9-719 - INSERT TIBIAL MEDIUM 19MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-722 SUP Custom 27803010 6642-9-722 - INSERT TIBIAL MEDIUM 22MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-725 SUP Custom 27803010 6642-9-725 - INSERT TIBIAL MEDIUM 25MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-809 SUP Custom 27803010 6642-9-809 - INSERT TIBIAL LARGE 9MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-811 SUP Custom 27803010 6642-9-811 - INSERT TIBIAL LARGE 11MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-813 SUP Custom 27803010 6642-9-813 - INSERT TIBIAL LARGE 13MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-816 SUP Custom 27803010 6642-9-816 - INSERT TIBIAL LARGE 16MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-819 SUP Custom 27803010 6642-9-819 - INSERT TIBIAL LARGE 19MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-822 SUP Custom 27803010 6642-9-822 - INSERT TIBIAL LARGE 22MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6642-9-825 SUP Custom 27803010 6642-9-825 - INSERT TIBIAL LARGE 25MM CONSTRAIN DURACON DUR KNEE BOTH IP/OP "$5,080.00" "$3,759.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" $904.24 "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$1,058.73" "$5,080.00" "$2,032.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$5,080.00" "$3,810.00" "$5,080.00" "$5,080.00" "$5,080.00" "$2,540.00" "$2,540.00" "$4,023.36" "$5,080.00" "$4,064.00" "$2,286.00" "$5,080.00" N/A "$2,946.40" "$5,080.00" "$3,048.00" "$5,080.00" "$5,080.00" "$5,080.00" N/A N/A 6647-1-018 SUP HCPCS C1776 6647-1-018 - COMPONENT FEMORAL KNEE ICA BOTH IP/OP "$7,213.50" "$5,338.00" "$1,431.68" "$7,213.38" "$3,246.02" "$3,246.02" "$3,246.02" "$3,246.02" "$7,213.38" "$7,213.38" "$7,213.38" "$1,503.45" "$7,213.38" "$7,213.38" "$7,213.38" "$7,213.38" "$7,213.38" "$1,503.35" "$7,213.38" "$7,213.38" "$3,556.20" "$7,213.38" "$7,213.38" "$7,213.38" "$7,213.38" "$5,410.13" "$7,213.38" "$7,213.38" "$7,213.38" "$3,606.69" "$3,606.69" "$5,713.00" "$7,213.38" "$5,770.70" "$3,246.02" "$1,431.68" N/A "$4,183.83" "$7,213.38" "$7,213.38" "$7,213.38" "$1,503.27" "$7,213.38" N/A N/A 6647-2-012 SUP HCPCS C1713 6647-2-012 - NAIL INTRAMEDULLARY 12MM COMPRESSION FUSION WICHITA HUMERUS BOTH IP/OP "$5,000.50" "$3,700.00" $992.40 "$5,000.13" "$2,250.06" "$2,250.06" "$2,250.06" "$2,250.06" "$5,000.13" "$5,000.13" "$5,000.13" "$1,042.15" "$5,000.13" "$5,000.13" "$5,000.13" "$5,000.13" "$5,000.13" "$1,042.08" "$5,000.13" "$5,000.13" "$2,465.06" "$5,000.13" "$5,000.13" "$5,000.13" "$5,000.13" "$3,750.38" "$5,000.13" "$5,000.13" "$5,000.13" "$2,500.07" "$2,500.07" "$3,960.10" "$5,000.13" "$4,000.10" "$2,250.06" $992.40 N/A "$2,900.29" "$5,000.13" "$3,000.08" "$5,000.13" "$1,042.03" "$5,000.13" N/A N/A 6647-3-000 SUP HCPCS C1713 6647-3-000 - SCREW BONE FULTHD COMPRESSION WICHITA KNEE FUSION NAIL BOTH IP/OP "$3,520.00" "$2,605.00" $698.58 "$3,519.75" "$1,583.89" "$1,583.89" "$1,583.89" "$1,583.89" "$3,519.75" "$3,519.75" "$3,519.75" $733.60 "$3,519.75" "$3,519.75" "$3,519.75" "$3,519.75" "$3,519.75" $733.55 "$3,519.75" "$3,519.75" "$1,735.24" "$3,519.75" "$3,519.75" "$3,519.75" "$3,519.75" "$2,640.00" "$3,519.75" "$3,519.75" "$3,519.75" "$1,759.88" "$1,759.88" "$2,787.64" "$3,519.75" "$2,815.80" "$1,583.89" $698.58 N/A "$2,041.60" "$3,519.75" "$2,111.85" "$3,519.75" $733.52 "$3,519.75" N/A N/A 6647-3-125 SUP HCPCS C1713 6647-3-125 - SCREW BONE FULTHD 6MM 25MM WICHITA KNEE FUSION NAIL BOTH IP/OP $494.00 $366.00 $98.05 $494.00 $222.30 $222.30 $222.30 $222.30 $494.00 $494.00 $494.00 $102.96 $494.00 $494.00 $494.00 $494.00 $494.00 $102.96 $494.00 $494.00 $292.20 $494.00 $494.00 $494.00 $494.00 $370.50 $494.00 $494.00 $494.00 $247.00 $247.00 $391.25 $494.00 $395.20 $222.30 $98.05 N/A $286.52 $494.00 $296.40 $494.00 $102.95 $494.00 N/A N/A 6647-3-130 SUP HCPCS C1713 6647-3-130 - SCREW BONE FULTHD 6MM 30MM WICHITA KNEE FUSION NAIL BOTH IP/OP $500.50 $370.00 $99.34 $500.50 $225.23 $225.23 $225.23 $225.23 $500.50 $500.50 $500.50 $104.32 $500.50 $500.50 $500.50 $500.50 $500.50 $104.31 $500.50 $500.50 $296.05 $500.50 $500.50 $500.50 $500.50 $375.38 $500.50 $500.50 $500.50 $250.25 $250.25 $396.40 $500.50 $400.40 $225.23 $99.34 N/A $290.29 $500.50 $500.50 $500.50 $104.30 $500.50 N/A N/A 6647-3-135 SUP HCPCS C1713 6647-3-135 - SCREW BONE FULTHD 6MM 35MM WICHITA KNEE FUSION NAIL BOTH IP/OP $500.50 $370.00 $99.34 $500.50 $225.23 $225.23 $225.23 $225.23 $500.50 $500.50 $500.50 $104.32 $500.50 $500.50 $500.50 $500.50 $500.50 $104.31 $500.50 $500.50 $296.05 $500.50 $500.50 $500.50 $500.50 $375.38 $500.50 $500.50 $500.50 $250.25 $250.25 $396.40 $500.50 $400.40 $225.23 $99.34 N/A $290.29 $500.50 $300.30 $500.50 $104.30 $500.50 N/A N/A 6647-3-140 SUP HCPCS C1713 6647-3-140 - SCREW BONE FULTHD 6MM 40MM COMPRESSION WICHITA KNEE FUSION BOTH IP/OP $500.50 $370.00 $99.34 $500.50 $225.23 $225.23 $225.23 $225.23 $500.50 $500.50 $500.50 $104.32 $500.50 $500.50 $500.50 $500.50 $500.50 $104.31 $500.50 $500.50 $296.05 $500.50 $500.50 $500.50 $500.50 $375.38 $500.50 $500.50 $500.50 $250.25 $250.25 $396.40 $500.50 $400.40 $225.23 $99.34 N/A $290.29 $500.50 $300.30 $500.50 $104.30 $500.50 N/A N/A 6647-3-145 SUP HCPCS C1713 6647-3-145 - SCREW BONE FULTHD 6MM 45MM COMPRESSION WICHITA KNEE FUSION BOTH IP/OP $500.50 $370.00 $99.34 $500.50 $225.23 $225.23 $225.23 $225.23 $500.50 $500.50 $500.50 $104.32 $500.50 $500.50 $500.50 $500.50 $500.50 $104.31 $500.50 $500.50 $296.05 $500.50 $500.50 $500.50 $500.50 $375.38 $500.50 $500.50 $500.50 $250.25 $250.25 $396.40 $500.50 $400.40 $225.23 $99.34 N/A $290.29 $500.50 $300.30 $500.50 $104.30 $500.50 N/A N/A 6647-3-150 SUP HCPCS C1713 6647-3-150 - SCREW BONE FULTHD 6MM 50MM COMPRESSION WICHITA KNEE FUSION BOTH IP/OP $500.50 $370.00 $99.34 $500.50 $225.23 $225.23 $225.23 $225.23 $500.50 $500.50 $500.50 $104.32 $500.50 $500.50 $500.50 $500.50 $500.50 $104.31 $500.50 $500.50 $296.05 $500.50 $500.50 $500.50 $500.50 $375.38 $500.50 $500.50 $500.50 $250.25 $250.25 $396.40 $500.50 $400.40 $225.23 $99.34 N/A $290.29 $500.50 $300.30 $500.50 $104.30 $500.50 N/A N/A 6647-3-155 SUP HCPCS C1713 6647-3-155 - SCREW BONE FULTHD 6MM 55MM COMPRESSION WICHITA KNEE FUSION BOTH IP/OP $500.50 $370.00 $99.34 $500.50 $225.23 $225.23 $225.23 $225.23 $500.50 $500.50 $500.50 $104.32 $500.50 $500.50 $500.50 $500.50 $500.50 $104.31 $500.50 $500.50 $296.05 $500.50 $500.50 $500.50 $500.50 $375.38 $500.50 $500.50 $500.50 $250.25 $250.25 $396.40 $500.50 $400.40 $225.23 $99.34 N/A $290.29 $500.50 $300.30 $500.50 $104.30 $500.50 N/A N/A 6647-3-160 SUP HCPCS C1713 6647-3-160 - SCREW BONE FULTHD 6MM 60MM COMPRESSION WICHITA KNEE FUSION BOTH IP/OP $500.50 $370.00 $99.34 $500.50 $225.23 $225.23 $225.23 $225.23 $500.50 $500.50 $500.50 $104.32 $500.50 $500.50 $500.50 $500.50 $500.50 $104.31 $500.50 $200.20 $296.05 $500.50 $500.50 $500.50 $500.50 $375.38 $500.50 $500.50 $500.50 $250.25 $250.25 $396.40 $500.50 $400.40 $225.23 $99.34 N/A $290.29 $500.50 $300.30 $500.50 $104.30 $500.50 N/A N/A 670000B SUP HCPCS C1713 670000B - SCREW BONE 6.5MM 30MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" $622.73 $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" $934.10 "$1,556.83" $324.44 "$1,556.83" N/A N/A 670001B SUP HCPCS C1713 670001B - SCREW BONE 6.5MM 35MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" "$1,556.83" $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670002B SUP HCPCS C1713 670002B - SCREW BONE CYLINDER 6.5MM 40MM OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" "$1,556.83" $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" $934.10 "$1,556.83" $324.44 "$1,556.83" N/A N/A 670003B SUP HCPCS C1713 670003B - SCREW BONE CYLINDER 6.5MM 45MM OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" "$1,556.83" $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" $934.10 "$1,556.83" $324.44 "$1,556.83" N/A N/A 670004B SUP HCPCS C1713 670004B - SCREW BONE CYLINDER 6.5MM 50MM OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" $622.73 $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670005B SUP HCPCS C1713 670005B - SCREW BONE 7.5MM 35MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" "$1,556.83" $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" $934.10 "$1,556.83" $324.44 "$1,556.83" N/A N/A 670006B SUP HCPCS C1713 670006B - SCREW BONE 7.5MM 40MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" "$1,556.83" $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" $934.10 "$1,556.83" $324.44 "$1,556.83" N/A N/A 670007B SUP HCPCS C1713 670007B - SCREW BONE CYLINDER 7.5MM 45MM OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" "$1,556.83" $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" $934.10 "$1,556.83" $324.44 "$1,556.83" N/A N/A 670008B SUP HCPCS C1713 670008B - SCREW BONE CYLINDER 7.5MM 50MM OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" $622.73 $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" $934.10 "$1,556.83" $324.44 "$1,556.83" N/A N/A 670009B SUP HCPCS C1713 670009B - SCREW BONE 7.5MM 55MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" "$1,556.83" $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670010B SUP HCPCS C1713 670010B - SCREW BONE 7.5MM 60MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" "$1,556.83" $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670015B SUP HCPCS C1713 670015B - SCREW BONE 6.5MM 55MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" "$1,556.83" $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670016B SUP HCPCS C1713 670016B - SCREW BONE 6.5MM 60MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" $622.73 $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670017B SUP HCPCS C1713 670017B - SCREW BONE 7.5MM 30MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" "$1,556.83" $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670061B SUP HCPCS C1713 670061B - SCREW BONE LONG 5.5MM 30MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670062B SUP HCPCS C1713 670062B - SCREW BONE LONG 5.5MM 35MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670063B SUP HCPCS C1713 670063B - SCREW BONE LONG 5.5MM 40MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670070B SUP HCPCS C1713 670070B - SCREW BONE LONG 6.5MM 30MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670071B SUP HCPCS C1713 670071B - SCREW BONE LONG 6.5MM 35MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670072B SUP HCPCS C1713 670072B - SCREW BONE LONG 6.5MM 40MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670073B SUP HCPCS C1713 670073B - SCREW BONE LONG 6.5MM 45MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670074B SUP HCPCS C1713 670074B - SCREW BONE LONG 6.5MM 50MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670075B SUP HCPCS C1713 670075B - SCREW BONE LONG 6.5MM 55MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 670076B SUP HCPCS C1713 670076B - SCREW BONE LONG 6.5MM 60MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670080B SUP HCPCS C1713 670080B - SCREW BONE LONG 7.5MM 30MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A 670081B SUP HCPCS C1713 670081B - SCREW BONE LONG 7.5MM 35MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670082B SUP HCPCS C1713 670082B - SCREW BONE LONG 7.5MM 40MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670083B SUP HCPCS C1713 670083B - SCREW BONE LONG 7.5MM 45MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670084B SUP HCPCS C1713 670084B - SCREW BONE LONG 7.5MM 50MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670086B SUP HCPCS C1713 670086B - SCREW BONE LONG 7.5MM 55MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670087B SUP HCPCS C1713 670087B - SCREW BONE LONG 7.5MM 60MM HEXAGONAL CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670110B SUP HCPCS C1713 670110B - SCREW BONE 9MM 30MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" "$1,556.83" $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670111B SUP HCPCS C1713 670111B - SCREW BONE 9MM 35MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" "$1,556.83" $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670112B SUP HCPCS C1713 670112B - SCREW BONE 9MM 40MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" "$1,556.83" $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670113B SUP HCPCS C1713 670113B - SCREW BONE 9MM 45MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" $622.73 $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670114B SUP HCPCS C1713 670114B - SCREW BONE 9MM 50MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" $622.73 $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670115B SUP HCPCS C1713 670115B - SCREW BONE 9MM 55MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" $622.73 $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670116B SUP HCPCS C1713 670116B - SCREW BONE 9MM 60MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" "$1,556.83" $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670212B SUP HCPCS C1713 670212B - SCREW BONE 5.5MM 30MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" $622.73 $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670213B SUP HCPCS C1713 670213B - SCREW BONE 5.5MM 35MM CYLND OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" $622.73 $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670214B SUP HCPCS C1713 670214B - SCREW BONE CYLINDER 5.5MM 40MM OPUS SPN BOTH IP/OP "$1,557.00" "$1,152.00" $308.99 "$1,556.83" $700.57 $700.57 $700.57 $700.57 "$1,556.83" "$1,556.83" "$1,556.83" $324.48 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" $324.46 "$1,556.83" $622.73 $920.86 "$1,556.83" "$1,556.83" "$1,556.83" "$1,556.83" "$1,167.75" "$1,556.83" "$1,556.83" "$1,556.83" $778.42 $778.42 "$1,233.01" "$1,556.83" "$1,245.46" $700.57 $308.99 N/A $903.06 "$1,556.83" "$1,556.83" "$1,556.83" $324.44 "$1,556.83" N/A N/A 670215B SUP HCPCS C1713 670215B - SCREW BONE 5.5MM 45MM OPUS THORACIC SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670223C SUP HCPCS C1713 670223C - PLATE BONE SHORT 3 HOLE OPUS SPN BOTH IP/OP "$2,772.50" "$2,052.00" $550.21 "$2,772.18" "$1,247.48" "$1,247.48" "$1,247.48" "$1,247.48" "$2,772.18" "$2,772.18" "$2,772.18" $577.79 "$2,772.18" "$2,772.18" "$2,772.18" "$2,772.18" "$2,772.18" $577.75 "$2,772.18" "$2,772.18" "$1,366.68" "$2,772.18" "$2,772.18" "$2,772.18" "$2,772.18" "$2,079.38" "$2,772.18" "$2,772.18" "$2,772.18" "$1,386.09" "$1,386.09" "$2,195.57" "$2,772.18" "$2,217.74" "$1,247.48" $550.21 N/A "$1,608.05" "$2,772.18" "$2,772.18" "$2,772.18" $577.72 "$2,772.18" N/A N/A 670300B SUP HCPCS C1713 670300B - SCREW BONE 6.5MM 30MM LONG TOP CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670301B SUP HCPCS C1713 670301B - SCREW BONE 6.5MM 35MM LONG TOP CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670302B SUP HCPCS C1713 670302B - SCREW BONE 6.5MM 40MM LONG TOP CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670303B SUP HCPCS C1713 670303B - SCREW BONE 6.5MM 45MM LONG TOP CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670304B SUP HCPCS C1713 670304B - SCREW BONE 6.5MM 50MM LONG TOP CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670305B SUP HCPCS C1713 670305B - SCREW BONE 6.5MM 55MM LONG TOP CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 6703-1-018 SUP Custom 27203010 6703-1-018 - WIRE SUT .032IN VIT 6 PER TUBE BOTH IP/OP $50.50 $37.00 $8.97 $50.38 $50.38 $50.38 $50.38 $50.38 $50.38 $50.38 $8.97 $50.38 $50.38 $37.39 $37.39 $38.83 $26.25 $10.50 $50.38 $20.15 $50.38 $50.38 $50.38 $50.38 $50.38 $37.88 $50.38 $50.38 $50.38 $25.19 $25.19 $39.90 $50.38 $40.30 $32.75 $50.38 N/A $29.29 $50.38 $30.23 $50.38 $50.38 $50.38 N/A N/A 670310B SUP HCPCS C1713 670310B - SCREW BONE 7.5MM 30MM LONG TOP CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670311B SUP HCPCS C1713 670311B - SCREW BONE 7.5MM 35MM LONG TOP CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670312B SUP HCPCS C1713 670312B - SCREW BONE 7.5MM 40MM LONG TOP CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670313B SUP HCPCS C1713 670313B - SCREW BONE 7.5MM 45MM LONG TOP CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670314B SUP HCPCS C1713 670314B - SCREW BONE 7.5MM 50MM LONG TOP CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670315B SUP HCPCS C1713 670315B - SCREW BONE 7.5MM 55MM LONG TOP CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670316B SUP HCPCS C1713 670316B - SCREW BONE 7.5MM 60MM LONG TOP CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 6703-2-120 SUP Custom 27203010 6703-2-120 - WIRE SUT .032IN VIT BOTH IP/OP $218.00 $161.00 $38.76 $217.75 $217.75 $217.75 $217.75 $217.75 $217.75 $217.75 $38.76 $217.75 $217.75 $161.61 $161.61 $167.84 $113.45 $45.38 $217.75 $87.10 $217.75 $217.75 $217.75 $217.75 $217.75 $163.50 $217.75 $217.75 $217.75 $108.88 $108.88 $172.46 $217.75 $174.20 $141.54 $217.75 N/A $126.44 $217.75 $130.65 $217.75 $217.75 $217.75 N/A N/A 670370B SUP HCPCS C1713 670370B - SCREW BONE 6.5MM 30MM LONG TOP LONG HEX CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670371B SUP HCPCS C1713 670371B - SCREW BONE 6.5MM 35MM LONG TOP LONG HEX CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670372B SUP HCPCS C1713 670372B - SCREW BONE 6.5MM 40MM LONG TOP LONG HEX CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670373B SUP HCPCS C1713 670373B - SCREW BONE 6.5MM 45MM LONG TOP LONG HEX CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670374B SUP HCPCS C1713 670374B - SCREW BONE 6.5MM 50MM LONG TOP LONG HEX CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670375B SUP HCPCS C1713 670375B - SCREW BONE 6.5MM 55MM LONG TOP LONG HEX CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670376B SUP HCPCS C1713 670376B - SCREW BONE 6.5MM 60MM LONG TOP LONG HEX CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670380B SUP HCPCS C1713 670380B - SCREW BONE 7.5MM 30MM LONG TOP LONG HEX CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670381B SUP HCPCS C1713 670381B - SCREW BONE 7.5MM 35MM LONG TOP LONG HEX CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670382B SUP HCPCS C1713 670382B - SCREW BONE 7.5MM 40MM LONG TOP LONG HEX CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670383B SUP HCPCS C1713 670383B - SCREW BONE 7.5MM 45MM LONG TOP LONG HEX CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670384B SUP HCPCS C1713 670384B - SCREW BONE 7.5MM 50MM LONG TOP LONG HEX CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670385B SUP HCPCS C1713 670385B - SCREW BONE 7.5MM 55MM LONG TOP LONG HEX CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 670386B SUP HCPCS C1713 670386B - SCREW BONE 7.5MM 60MM LONG TOP LONG HEX CYLND OPUS SPN BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 6704-0-110 SUP HCPCS C1713 6704-0-110 - CABLE ORTHOPEDIC 2 1.6MM HOMOGENOUS GRIP DALL-MILES BOTH IP/OP "$2,022.50" "$1,497.00" $401.42 "$2,022.50" $910.13 $910.13 $910.13 $910.13 "$2,022.50" "$2,022.50" "$2,022.50" $421.54 "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" $421.51 "$2,022.50" $809.00 "$1,196.31" "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" "$1,516.88" "$2,022.50" "$2,022.50" "$2,022.50" "$1,011.25" "$1,011.25" "$1,601.82" "$2,022.50" "$1,618.00" $910.13 $401.42 N/A "$1,173.05" "$2,022.50" "$1,213.50" "$2,022.50" $421.49 "$2,022.50" N/A N/A 6704-0-210 SUP HCPCS C1713 6704-0-210 - CABLE ORTHOPEDIC 2 2MM HOMOGENOUS GRIP DALL-MILES VITALLIUM BOTH IP/OP "$2,022.50" "$1,497.00" $401.42 "$2,022.50" $910.13 $910.13 $910.13 $910.13 "$2,022.50" "$2,022.50" "$2,022.50" $421.54 "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" $421.51 "$2,022.50" "$2,022.50" "$1,196.31" "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" "$1,516.88" "$2,022.50" "$2,022.50" "$2,022.50" "$1,011.25" "$1,011.25" "$1,601.82" "$2,022.50" "$1,618.00" $910.13 $401.42 N/A "$1,173.05" "$2,022.50" "$1,213.50" "$2,022.50" $421.49 "$2,022.50" N/A N/A 6704-0-310 SUP HCPCS C1713 6704-0-310 - CABLE ORTHOPEDIC 2 LARGE 2MM 22MM GRIP DALL-MILES VITALLIUM BOTH IP/OP "$2,022.50" "$1,497.00" $401.42 "$2,022.50" $910.13 $910.13 $910.13 $910.13 "$2,022.50" "$2,022.50" "$2,022.50" $421.54 "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" $421.51 "$2,022.50" $809.00 "$1,196.31" "$2,022.50" "$2,022.50" "$2,022.50" "$2,022.50" "$1,516.88" "$2,022.50" "$2,022.50" "$2,022.50" "$1,011.25" "$1,011.25" "$1,601.82" "$2,022.50" "$1,618.00" $910.13 $401.42 N/A "$1,173.05" "$2,022.50" "$1,213.50" "$2,022.50" $421.49 "$2,022.50" N/A N/A 6704-0-410 SUP HCPCS C1713 6704-0-410 - CABLE ORTHOPEDIC 1.6MM SET SLEEVE DALL-MILES VITALLIUM HIP BOTH IP/OP $690.00 $511.00 $136.95 $690.00 $310.50 $310.50 $310.50 $310.50 $690.00 $690.00 $690.00 $143.81 $690.00 $690.00 $690.00 $690.00 $690.00 $143.80 $690.00 $276.00 $408.14 $690.00 $690.00 $690.00 $690.00 $517.50 $690.00 $690.00 $690.00 $345.00 $345.00 $546.48 $690.00 $552.00 $310.50 $136.95 N/A $400.20 $690.00 $414.00 $690.00 $143.80 $690.00 N/A N/A 6704-0-420 SUP HCPCS C1713 6704-0-420 - CABLE ORTHOPEDIC 1.6MM SET SLEEVE BEADED DALL-MILES BOTH IP/OP $740.00 $548.00 $146.87 $740.00 $333.00 $333.00 $333.00 $333.00 $740.00 $740.00 $740.00 $154.23 $740.00 $740.00 $740.00 $740.00 $740.00 $154.22 $740.00 $296.00 $437.71 $740.00 $740.00 $740.00 $740.00 $555.00 $740.00 $740.00 $740.00 $370.00 $370.00 $586.08 $740.00 $592.00 $333.00 $146.87 N/A $429.20 $740.00 $740.00 $740.00 $154.22 $740.00 N/A N/A 6704-0-510 SUP Custom 27803010 6704-0-510 - CABLE ORTHOPEDIC 2 2MM HOMOGENOUS DALL-MILES VITALLIUM HIP BOTH IP/OP $690.00 $511.00 $122.82 $690.00 $690.00 $690.00 $690.00 $690.00 $690.00 $690.00 $122.82 $690.00 $690.00 $690.00 $690.00 $690.00 $690.00 $143.80 $690.00 $276.00 $690.00 $690.00 $690.00 $690.00 $690.00 $517.50 $690.00 $690.00 $690.00 $345.00 $345.00 $546.48 $690.00 $552.00 $310.50 $690.00 N/A $400.20 $690.00 $414.00 $690.00 $690.00 $690.00 N/A N/A 6704-0-520 SUP HCPCS C1713 6704-0-520 - CABLE ORTHOPEDIC 2MM SET SLEEVE BEAD DALL-MILES VITALLIUM BOTH IP/OP $740.00 $548.00 $146.87 $740.00 $333.00 $333.00 $333.00 $333.00 $740.00 $740.00 $740.00 $154.23 $740.00 $740.00 $740.00 $740.00 $740.00 $154.22 $740.00 $740.00 $437.71 $740.00 $740.00 $740.00 $740.00 $555.00 $740.00 $740.00 $740.00 $370.00 $370.00 $586.08 $740.00 $592.00 $333.00 $146.87 N/A $429.20 $740.00 $740.00 $740.00 $154.22 $740.00 N/A N/A 6704-1-018 SUP Custom 27203010 6704-1-018 - WIRE SUT .04IN 18IN DLMLS VIT 6 PER TUBE BOTH IP/OP $49.00 $36.00 $8.68 $48.75 $48.75 $48.75 $48.75 $48.75 $48.75 $48.75 $8.68 $48.75 $48.75 $36.18 $36.18 $37.58 $25.40 $10.16 $48.75 $19.50 $48.75 $48.75 $48.75 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $31.69 $48.75 N/A $28.42 $48.75 $29.25 $48.75 $48.75 $48.75 N/A N/A 6704-2-120 SUP Custom 27203010 6704-2-120 - WIRE FX .04IN SUT VIT BOTH IP/OP $253.50 $188.00 $45.12 $253.50 $253.50 $253.50 $253.50 $253.50 $253.50 $253.50 $45.12 $253.50 $253.50 $188.15 $188.15 $195.40 $132.07 $52.83 $253.50 $101.40 $253.50 $253.50 $253.50 $253.50 $253.50 $190.13 $253.50 $253.50 $253.50 $126.75 $126.75 $200.77 $253.50 $202.80 $164.78 $253.50 N/A $147.03 $253.50 $152.10 $253.50 $253.50 $253.50 N/A N/A 6704-3-070 SUP HCPCS C1713 6704-3-070 - GRIP CBL 2MM SM DLMLS 2 CBL VIT HIP TROCH BOTH IP/OP "$2,552.50" "$1,889.00" $506.61 "$2,552.50" "$1,148.63" "$1,148.63" "$1,148.63" "$1,148.63" "$2,552.50" "$2,552.50" "$2,552.50" $532.00 "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" $531.97 "$2,552.50" "$1,021.00" "$1,258.38" "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" "$1,914.38" "$2,552.50" "$2,552.50" "$2,552.50" "$1,276.25" "$1,276.25" "$2,021.58" "$2,552.50" "$2,042.00" "$1,148.63" $506.61 N/A "$1,480.45" "$2,552.50" "$1,531.50" "$2,552.50" $531.94 "$2,552.50" N/A N/A 6704-3-080 SUP HCPCS C1713 6704-3-080 - GRIP CABLE 2MM MEDIUM 2MM DALL-MILES VITALLIUM HIP BOTH IP/OP "$2,552.50" "$1,889.00" $506.61 "$2,552.50" "$1,148.63" "$1,148.63" "$1,148.63" "$1,148.63" "$2,552.50" "$2,552.50" "$2,552.50" $532.00 "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" $531.97 "$2,552.50" "$1,021.00" "$1,258.38" "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" "$1,914.38" "$2,552.50" "$2,552.50" "$2,552.50" "$1,276.25" "$1,276.25" "$2,021.58" "$2,552.50" "$2,042.00" "$1,148.63" $506.61 N/A "$1,480.45" "$2,552.50" "$2,552.50" "$2,552.50" $531.94 "$2,552.50" N/A N/A 6704-3-081 SUP HCPCS C1713 6704-3-081 - PLATE BONE 2MM MEDIUM 100MM 2 CABLE GRIP DALL-MILES BOTH IP/OP "$2,552.50" "$1,889.00" $506.61 "$2,552.50" "$1,148.63" "$1,148.63" "$1,148.63" "$1,148.63" "$2,552.50" "$2,552.50" "$2,552.50" $532.00 "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" $531.97 "$2,552.50" "$2,552.50" "$1,258.38" "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" "$1,914.38" "$2,552.50" "$2,552.50" "$2,552.50" "$1,276.25" "$1,276.25" "$2,021.58" "$2,552.50" "$2,042.00" "$1,148.63" $506.61 N/A "$1,480.45" "$2,552.50" "$1,531.50" "$2,552.50" $531.94 "$2,552.50" N/A N/A 6704-3-082 SUP HCPCS C1713 6704-3-082 - PLATE BN 2MM MED 150MM DLMLS 2 CBL GRP VIT HIP TROCH BOTH IP/OP "$3,325.00" "$2,461.00" $659.93 "$3,325.00" "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$3,325.00" "$3,325.00" "$3,325.00" $693.01 "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" $692.97 "$3,325.00" "$1,330.00" "$1,639.23" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$2,493.75" "$3,325.00" "$3,325.00" "$3,325.00" "$1,662.50" "$1,662.50" "$2,633.40" "$3,325.00" "$2,660.00" "$1,496.25" $659.93 N/A "$1,928.50" "$3,325.00" "$3,325.00" "$3,325.00" $692.93 "$3,325.00" N/A N/A 6704-3-083 SUP HCPCS C1713 6704-3-083 - PLATE BN 2MM MED 200MM DLMLS 2 CBL GRP VIT HIP TROCH BOTH IP/OP "$4,115.00" "$3,045.00" $816.72 "$4,115.00" "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" "$4,115.00" "$4,115.00" "$4,115.00" $857.67 "$4,115.00" "$4,115.00" "$4,115.00" "$4,115.00" "$4,115.00" $857.61 "$4,115.00" "$1,646.00" "$2,028.70" "$4,115.00" "$4,115.00" "$4,115.00" "$4,115.00" "$3,086.25" "$4,115.00" "$4,115.00" "$4,115.00" "$2,057.50" "$2,057.50" "$3,259.08" "$4,115.00" "$3,292.00" "$1,851.75" $816.72 N/A "$2,386.70" "$4,115.00" "$4,115.00" "$4,115.00" $857.57 "$4,115.00" N/A N/A 6704-3-090 SUP HCPCS C1713 6704-3-090 - GRIP CABLE 2MM LARGE DALL-MILES VITALLIUM HIP BOTH IP/OP "$2,552.50" "$1,889.00" $506.61 "$2,552.50" "$1,148.63" "$1,148.63" "$1,148.63" "$1,148.63" "$2,552.50" "$2,552.50" "$2,552.50" $532.00 "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" $531.97 "$2,552.50" "$2,552.50" "$1,258.38" "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" "$1,914.38" "$2,552.50" "$2,552.50" "$2,552.50" "$1,276.25" "$1,276.25" "$2,021.58" "$2,552.50" "$2,042.00" "$1,148.63" $506.61 N/A "$1,480.45" "$2,552.50" "$1,531.50" "$2,552.50" $531.94 "$2,552.50" N/A N/A 6704-3-091 SUP HCPCS C1713 6704-3-091 - PLATE BN 2MM LG 110MM DLMLS 2 CBL GRP VIT HIP TROCH BOTH IP/OP "$2,552.50" "$1,889.00" $506.61 "$2,552.50" "$1,148.63" "$1,148.63" "$1,148.63" "$1,148.63" "$2,552.50" "$2,552.50" "$2,552.50" $532.00 "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" $531.97 "$2,552.50" "$2,552.50" "$1,258.38" "$2,552.50" "$2,552.50" "$2,552.50" "$2,552.50" "$1,914.38" "$2,552.50" "$2,552.50" "$2,552.50" "$1,276.25" "$1,276.25" "$2,021.58" "$2,552.50" "$2,042.00" "$1,148.63" $506.61 N/A "$1,480.45" "$2,552.50" "$1,531.50" "$2,552.50" $531.94 "$2,552.50" N/A N/A 6704-3-092 SUP HCPCS C1713 6704-3-092 - PLATE BONE 2MM LARGE 160MM 2 CABLE GRIP DALL-MILES VITALLIUM BOTH IP/OP "$3,325.00" "$2,461.00" $659.93 "$3,325.00" "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$3,325.00" "$3,325.00" "$3,325.00" $693.01 "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" $692.97 "$3,325.00" "$1,330.00" "$1,639.23" "$3,325.00" "$3,325.00" "$3,325.00" "$3,325.00" "$2,493.75" "$3,325.00" "$3,325.00" "$3,325.00" "$1,662.50" "$1,662.50" "$2,633.40" "$3,325.00" "$2,660.00" "$1,496.25" $659.93 N/A "$1,928.50" "$3,325.00" "$1,995.00" "$3,325.00" $692.93 "$3,325.00" N/A N/A 6704-3-093 SUP HCPCS C1713 6704-3-093 - PLATE BONE 2MM LARGE 210MM 2 CABLE GRIP DALL-MILES VITALLIUM BOTH IP/OP "$4,115.00" "$3,045.00" $816.72 "$4,115.00" "$1,851.75" "$1,851.75" "$1,851.75" "$1,851.75" "$4,115.00" "$4,115.00" "$4,115.00" $857.67 "$4,115.00" "$4,115.00" "$4,115.00" "$4,115.00" "$4,115.00" $857.61 "$4,115.00" "$1,646.00" "$2,028.70" "$4,115.00" "$4,115.00" "$4,115.00" "$4,115.00" "$3,086.25" "$4,115.00" "$4,115.00" "$4,115.00" "$2,057.50" "$2,057.50" "$3,259.08" "$4,115.00" "$3,292.00" "$1,851.75" $816.72 N/A "$2,386.70" "$4,115.00" "$4,115.00" "$4,115.00" $857.57 "$4,115.00" N/A N/A 6704-3-120 SUP HCPCS C1713 6704-3-120 - WIRE FX .046IN HVY GA VIT BOTH IP/OP $253.50 $188.00 $50.31 $253.50 $114.08 $114.08 $114.08 $114.08 $253.50 $253.50 $253.50 $52.84 $253.50 $253.50 $253.50 $253.50 $253.50 $52.83 $253.50 $101.40 $149.95 $253.50 $253.50 $253.50 $253.50 $190.13 $253.50 $253.50 $253.50 $126.75 $126.75 $200.77 $253.50 $202.80 $114.08 $50.31 N/A $147.03 $253.50 $253.50 $253.50 $52.83 $253.50 N/A N/A 6704-4-016 SUP HCPCS C1713 6704-4-016 - SLEEVE CABLE SMALL 1.6MM CRIMP DALL-MILES VITALLIUM HIP BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 6704-4-020 SUP HCPCS C1713 6704-4-020 - SLEEVE CABLE MEDIUM 2MM GRIP CRIMP DALL-MILES VITALLIUM HIP BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 6704-5-016 SUP HCPCS C1713 6704-5-016 - GRIP CABLE SMALL 1.6MM HOLE DALL-MILES VITALLIUM HIP STERILE BOTH IP/OP "$1,195.00" $884.00 $237.18 "$1,195.00" $537.75 $537.75 $537.75 $537.75 "$1,195.00" "$1,195.00" "$1,195.00" $249.07 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" "$1,195.00" $706.84 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 $237.18 N/A $693.10 "$1,195.00" $717.00 "$1,195.00" $249.04 "$1,195.00" N/A N/A 6704-6-020 SUP HCPCS C1713 6704-6-020 - GRIP CABLE MEDIUM 2MM HOLE DALL-MILES VITALLIUM HIP STERILE BOTH IP/OP "$1,195.00" $884.00 $237.18 "$1,195.00" $537.75 $537.75 $537.75 $537.75 "$1,195.00" "$1,195.00" "$1,195.00" $249.07 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" "$1,195.00" $706.84 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 $237.18 N/A $693.10 "$1,195.00" $717.00 "$1,195.00" $249.04 "$1,195.00" N/A N/A 6704-6-110 SUP HCPCS C1713 6704-6-110 - BUTTON FIX GROOVE LOCK DALL-MILES VITALLIUM HIP BOTH IP/OP $647.50 $479.00 $128.51 $647.50 $291.38 $291.38 $291.38 $291.38 $647.50 $647.50 $647.50 $134.96 $647.50 $647.50 $647.50 $647.50 $647.50 $134.95 $647.50 $647.50 $383.00 $647.50 $647.50 $647.50 $647.50 $485.63 $647.50 $647.50 $647.50 $323.75 $323.75 $512.82 $647.50 $518.00 $291.38 $128.51 N/A $375.55 $647.50 $647.50 $647.50 $134.94 $647.50 N/A N/A 6704-7-020 SUP Custom 27803010 6704-7-020 - GRIP CABLE LARGE 2MM DALL-MILES VITALLIUM HIP STERILE BOTH IP/OP "$1,195.00" $884.00 $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $212.71 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $249.05 "$1,195.00" $478.00 "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" "$1,195.00" $896.25 "$1,195.00" "$1,195.00" "$1,195.00" $597.50 $597.50 $946.44 "$1,195.00" $956.00 $537.75 "$1,195.00" N/A $693.10 "$1,195.00" $717.00 "$1,195.00" "$1,195.00" "$1,195.00" N/A N/A 6704-8-030 SUP HCPCS C1713 6704-8-030 - CABLE ORTHOPEDIC MINI SLEEVE DALL-MILES VITALLIUM HIP BOTH IP/OP $555.00 $411.00 $110.15 $555.00 $249.75 $249.75 $249.75 $249.75 $555.00 $555.00 $555.00 $115.68 $555.00 $555.00 $555.00 $555.00 $555.00 $115.67 $555.00 $222.00 $328.28 $555.00 $555.00 $555.00 $555.00 $416.25 $555.00 $555.00 $555.00 $277.50 $277.50 $439.56 $555.00 $444.00 $249.75 $110.15 N/A $321.90 $555.00 $555.00 $555.00 $115.66 $555.00 N/A N/A 6704-8-236 SUP HCPCS C1713 6704-8-236 - CABLE ORTHOPEDIC 1.6MM 750MM GRIP DALL-MILES VITALLIUM HIP BOTH IP/OP $622.50 $461.00 $123.55 $622.50 $280.13 $280.13 $280.13 $280.13 $622.50 $622.50 $622.50 $129.74 $622.50 $622.50 $622.50 $622.50 $622.50 $129.74 $622.50 $249.00 $368.21 $622.50 $622.50 $622.50 $622.50 $466.88 $622.50 $622.50 $622.50 $311.25 $311.25 $493.02 $622.50 $498.00 $280.13 $123.55 N/A $361.05 $622.50 $622.50 $622.50 $129.73 $622.50 N/A N/A 6704-8-240 SUP HCPCS C1713 6704-8-240 - CABLE ORTHOPEDIC 2MM 750MM GRIP DALL-MILES VITALLIUM HIP BOTH IP/OP $622.50 $461.00 $123.55 $622.50 $280.13 $280.13 $280.13 $280.13 $622.50 $622.50 $622.50 $129.74 $622.50 $622.50 $622.50 $622.50 $622.50 $129.74 $622.50 $622.50 $368.21 $622.50 $622.50 $622.50 $622.50 $466.88 $622.50 $622.50 $622.50 $311.25 $311.25 $493.02 $622.50 $498.00 $280.13 $123.55 N/A $361.05 $622.50 $622.50 $622.50 $129.73 $622.50 N/A N/A 6707920P2 SUP HCPCS C1713 6707920P2 - IMPLANT SPNL 4D 20X7X9MM LF CRNT LI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6707926P2 SUP HCPCS C1713 6707926P2 - IMPLANT SPNL 4D 26X7X9MM LF CRNT LI BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6708520P2 SUP HCPCS C1713 6708520P2 - CAGE SPNL 15D LG TPR 20X9X8MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6708820P2 SUP HCPCS C1713 6708820P2 - CAGE SPNL 8D LG TPR 20X9X8MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6708920P2 SUP HCPCS C1713 6708920P2 - CAGE SPNL 4D LG IMPCT 20X9X8MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6708926P2 SUP HCPCS C1713 6708926P2 - CAGE SPNL 4D LG IMPCT 26X9X8MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6708932P2 SUP HCPCS C1713 6708932P2 - CAGE SPNL 4D LG IMPCT 32X9X8MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6709920P2 SUP HCPCS C1713 6709920P2 - CAGE SPNL 4D LG IMPCT 20X9X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6709926P2 SUP HCPCS C1713 6709926P2 - CAGE SPNL 4D LG IMPCT 26X9X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6709932P2 SUP HCPCS C1713 6709932P2 - CAGE SPNL 4D LG IMPCT 32X9X9MM NS LF CRNT PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6710520P2 SUP HCPCS C1713 6710520P2 - CAGE SPNL 15D LG TPR 20X10X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6710820P2 SUP HCPCS C1713 6710820P2 - CAGE SPNL 8D LG TPR 20X10X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6710920P2 SUP HCPCS C1713 6710920P2 - CAGE SPNL 4D LG IMPCT 20X10X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6710926P2 SUP HCPCS C1713 6710926P2 - CAGE SPNL 4D LG IMPCT 26X10X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6710932P2 SUP HCPCS C1713 6710932P2 - CAGE SPNL 4D LG IMPCT 32X10X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6711920P2 SUP HCPCS C1713 6711920P2 - CAGE SPNL 4D LG IMPCT 20X11X9MM NS LF CRNT PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6711926P2 SUP HCPCS C1713 6711926P2 - CAGE SPNL 4D LG IMPCT 26X11X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6711932P2 SUP HCPCS C1713 6711932P2 - CAGE SPNL 4D LG IMPCT 32X11X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6712520P2 SUP HCPCS C1713 6712520P2 - CAGE SPNL 15D LG TPR 20X12X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6712820P2 SUP HCPCS C1713 6712820P2 - CAGE SPNL 8D LG TPR 20X12X9MM NS LF CRNT PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6712920P2 SUP HCPCS C1713 6712920P2 - CAGE SPNL 4D LG IMPCT 20X12X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6712926P2 SUP HCPCS C1713 6712926P2 - CAGE SPNL 4D LG IMPCT 26X12X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6712932P2 SUP HCPCS C1713 6712932P2 - CAGE SPNL 4D LG IMPCT 32X12X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6713920P2 SUP HCPCS C1713 6713920P2 - CAGE SPNL 4D LG IMPCT LRDTC 20X13X9MM NS LF CRNT PEEK BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6713926P2 SUP HCPCS C1713 6713926P2 - CAGE SPNL 4D LG IMPCT 26X13X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6713932P2 SUP HCPCS C1713 6713932P2 - CAGE SPNL 4D LG IMPCT 32X13X9MM NS LF CRNT PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6714820P2 SUP HCPCS C1713 6714820P2 - CAGE SPNL 8D LG TPR 20X14X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6714920P2 SUP HCPCS C1713 6714920P2 - CAGE SPNL 4D LG IMPCT 20X14X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6714926P2 SUP HCPCS C1713 6714926P2 - CAGE SPNL 4D LG IMPCT 26X14X9MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6714932P2 SUP HCPCS C1713 6714932P2 - CAGE SPNL 4D LG IMPCT 32X14X9MM NS LF CRNT PEEK-OPTM BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6715920P2 SUP HCPCS C1713 6715920P2 - CAGE SPNL 4D LG IMPCT 20X9X15MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6715926P2 SUP HCPCS C1713 6715926P2 - CAGE SPNL 4D LG IMPCT 26X9X15MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6716920P2 SUP HCPCS C1713 6716920P2 - CAGE SPNL 4D LG IMPCT 20X9X16MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6716926P2 SUP HCPCS C1713 6716926P2 - CAGE SPNL 4D LG IMPCT 26X9X16MM NS LF CRNT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A 6720-0027 SUP HCPCS C1776 6720-0027 - STEM FEM 132D 0 28MM STD OFST 93MM STRL ACLD II V40 PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6720-0127 SUP HCPCS C1776 6720-0127 - STEM FEM 132D 1 29MM STD OFST 96MM STRL ACLD II V40 PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6720-0230 SUP HCPCS C1776 6720-0230 - STEM FEM 132D 2 33MM STD OFST 99MM STRL ACLD II V40 PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6720-0330 SUP HCPCS C1776 6720-0330 - STEM FEM 132D 3 35MM STD OFST 102MM STRL ACLD II V40 PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6720-0435 SUP HCPCS C1776 6720-0435 - STEM FEM 132D 4 38MM STD OFST 105MM STRL ACLD II V40 PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6720-0535 SUP HCPCS C1776 6720-0535 - STEM FEM 132D 5 40MM STD OFST 108MM STRL ACLD II V40 PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6720-0635 SUP HCPCS C1776 6720-0635 - STEM FEM 132D 6 41MM STD OFST 111MM STRL ACLD II V40 PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6720-0737 SUP HCPCS C1776 6720-0737 - STEM FEM 132D 7 46MM STD OFST 114MM STRL ACLD II V40 PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6720-0837 SUP HCPCS C1776 6720-0837 - STEM FEM 132D 8 47MM STD OFST 117MM STRL ACLD II V40 PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6720-0937 SUP HCPCS C1776 6720-0937 - STEM FEM 132D 9 49MM STD OFST 120MM STRL ACLD II V40 PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6720-1040 SUP HCPCS C1776 6720-1040 - STEM FEM 132D 10 51MM STD OFST 123MM STRL ACLD II V40 PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6720-1140 SUP HCPCS C1776 6720-1140 - STEM FEM 132D 11 53MM STD OFST 126MM STRL ACLD II V40 PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6721-0027 SUP HCPCS C1776 6721-0027 - STEM FEM 127D 0 32MM HI OFST 93MM STRL ACLD II V40 PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6721-0330 SUP HCPCS C1776 6721-0330 - STEM FEM ACLD II 3 127D BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6721-0435 SUP HCPCS C1713 6721-0435 - STEM FEM ACLD II 4 127D BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$3,214.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6721-0535 SUP HCPCS C1713 6721-0535 - STEM FEM ACLD II 5 127D BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$3,214.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6721-0635 SUP HCPCS C1776 6721-0635 - STEM FEM 127D 6 TPR 111MM STRL 35MM ACLD MDLR HIP BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6721-0837 SUP HCPCS C1776 6721-0837 - STEM FEM 127D 8 TPR 117MM STRL 37MM ACLD II MDLR HIP BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$2,143.00" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6721-1140 SUP HCPCS C1776 6721-1140 - STEM FEM 127D 11 58MM HI OFST 126MM STRL ACLD II V40 PRFT BOTH IP/OP "$5,357.50" "$3,965.00" "$1,063.33" "$5,357.50" "$2,410.88" "$2,410.88" "$2,410.88" "$2,410.88" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.64" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.56" "$5,357.50" "$5,357.50" "$2,641.25" "$5,357.50" "$5,357.50" "$5,357.50" "$5,357.50" "$4,018.13" "$5,357.50" "$5,357.50" "$5,357.50" "$2,678.75" "$2,678.75" "$4,243.14" "$5,357.50" "$4,286.00" "$2,410.88" "$1,063.33" N/A "$3,107.35" "$5,357.50" "$5,357.50" "$5,357.50" "$1,116.50" "$5,357.50" N/A N/A 6728-1-609 SUP HCPCS C1776 6728-1-609 - INSERT TIBIAL SMALL 9MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-1-611 SUP HCPCS C1776 6728-1-611 - INSERT TIBIAL SMALL 11MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-1-613 SUP HCPCS C1776 6728-1-613 - INSERT TIBIAL SMALL 13MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-1-616 SUP HCPCS C1776 6728-1-616 - INSERT TIBIAL SMALL 16MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-1-619 SUP HCPCS C1776 6728-1-619 - INSERT TIBIAL SMALL 19MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-1-622 SUP HCPCS C1776 6728-1-622 - INSERT TIBIAL SMALL 22MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-1-625 SUP HCPCS C1776 6728-1-625 - INSERT TIBIAL SMALL 25MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-1-709 SUP HCPCS C1776 6728-1-709 - INSERT TIBIAL SMALL 9MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-1-711 SUP HCPCS C1776 6728-1-711 - INSERT TIBIAL SMALL 11MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-1-713 SUP HCPCS C1776 6728-1-713 - INSERT TIBIAL SMALL 13MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-1-716 SUP HCPCS C1776 6728-1-716 - INSERT TIBIAL SMALL 16MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-1-719 SUP HCPCS C1776 6728-1-719 - INSERT TIBIAL SMALL 19MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-1-722 SUP HCPCS C1776 6728-1-722 - INSERT TIBIAL SMALL 22MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-1-725 SUP HCPCS C1776 6728-1-725 - INSERT TIBIAL SMALL 25MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-1-940 SUP Custom 27803010 6728-1-940 - COMPONENT PATLR SMALL PRIM REVISION CUP PCA KNEE BOTH IP/OP "$3,630.00" "$2,686.00" $646.14 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $646.14 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $756.53 "$3,630.00" "$1,452.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$1,633.50" "$3,630.00" N/A "$2,105.40" "$3,630.00" "$2,178.00" "$3,630.00" "$3,630.00" "$3,630.00" N/A N/A 6728-2-609 SUP HCPCS C1776 6728-2-609 - INSERT TIBIAL MEDIUM 9MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-2-611 SUP HCPCS C1776 6728-2-611 - INSERT TIBIAL MEDIUM 11MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-2-613 SUP HCPCS C1776 6728-2-613 - INSERT TIBIAL MEDIUM 13MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-2-616 SUP HCPCS C1776 6728-2-616 - INSERT TIBIAL MEDIUM 16MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-2-619 SUP HCPCS C1776 6728-2-619 - INSERT TIBIAL MEDIUM 19MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-2-622 SUP HCPCS C1776 6728-2-622 - INSERT TIBIAL MEDIUM 22MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-2-625 SUP HCPCS C1776 6728-2-625 - INSERT TIBIAL MEDIUM 25MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-2-709 SUP HCPCS C1776 6728-2-709 - INSERT TIBIAL MEDIUM 9MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-2-711 SUP HCPCS C1776 6728-2-711 - INSERT TIBIAL MEDIUM 11MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-2-713 SUP HCPCS C1776 6728-2-713 - INSERT TIBIAL MEDIUM 13MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-2-716 SUP HCPCS C1776 6728-2-716 - INSERT TIBIAL MEDIUM 16MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-2-719 SUP HCPCS C1776 6728-2-719 - INSERT TIBIAL MEDIUM 19MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-2-722 SUP HCPCS C1776 6728-2-722 - INSERT TIBIAL MEDIUM 22MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-2-725 SUP HCPCS C1776 6728-2-725 - INSERT TIBIAL MEDIUM 25MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-2-940 SUP HCPCS C1776 6728-2-940 - COMPONENT PATLR MEDIUM PRIM REVISION CUP PCA KNEE BOTH IP/OP "$3,630.00" "$2,686.00" $720.46 "$3,630.00" "$1,633.50" "$1,633.50" "$1,633.50" "$1,633.50" "$3,630.00" "$3,630.00" "$3,630.00" $756.58 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $756.53 "$3,630.00" "$3,630.00" "$1,789.59" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$1,633.50" $720.46 N/A "$2,105.40" "$3,630.00" "$3,630.00" "$3,630.00" $756.49 "$3,630.00" N/A N/A 6728-4-609 SUP HCPCS C1776 6728-4-609 - INSERT TIBIAL LARGE 9MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-4-611 SUP HCPCS C1776 6728-4-611 - INSERT TIBIAL LARGE 11MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-4-613 SUP HCPCS C1776 6728-4-613 - INSERT TIBIAL LARGE 13MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-4-616 SUP HCPCS C1776 6728-4-616 - INSERT TIBIAL LARGE 16MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-4-619 SUP HCPCS C1776 6728-4-619 - INSERT TIBIAL LARGE 19MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-4-622 SUP HCPCS C1776 6728-4-622 - INSERT TIBIAL LARGE 22MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-4-625 SUP HCPCS C1776 6728-4-625 - INSERT TIBIAL LARGE 25MM REVISION PCA KNEE LEFT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-4-709 SUP HCPCS C1776 6728-4-709 - INSERT TIBIAL LARGE 9MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-4-711 SUP HCPCS C1776 6728-4-711 - INSERT TIBIAL LARGE 11MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-4-713 SUP HCPCS C1776 6728-4-713 - INSERT TIBIAL LARGE 13MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-4-716 SUP HCPCS C1776 6728-4-716 - INSERT TIBIAL LARGE 16MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-4-719 SUP HCPCS C1776 6728-4-719 - INSERT TIBIAL LARGE 19MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$5,410.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-4-722 SUP HCPCS C1776 6728-4-722 - INSERT TIBIAL LARGE 22MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-4-725 SUP HCPCS C1776 6728-4-725 - INSERT TIBIAL LARGE 25MM REVISION PCA KNEE RIGHT BOTH IP/OP "$5,410.00" "$4,003.00" "$1,073.75" "$5,410.00" "$2,434.50" "$2,434.50" "$2,434.50" "$2,434.50" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.58" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.50" "$5,410.00" "$2,164.00" "$2,667.13" "$5,410.00" "$5,410.00" "$5,410.00" "$5,410.00" "$4,057.50" "$5,410.00" "$5,410.00" "$5,410.00" "$2,705.00" "$2,705.00" "$4,284.72" "$5,410.00" "$4,328.00" "$2,434.50" "$1,073.75" N/A "$3,137.80" "$5,410.00" "$5,410.00" "$5,410.00" "$1,127.44" "$5,410.00" N/A N/A 6728-4-940 SUP Custom 27803010 6728-4-940 - COMPONENT PATLR LARGE PRIM REVISION PCA BOTH IP/OP "$3,630.00" "$2,686.00" $646.14 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $646.14 "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" $756.53 "$3,630.00" "$1,452.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$3,630.00" "$2,722.50" "$3,630.00" "$3,630.00" "$3,630.00" "$1,815.00" "$1,815.00" "$2,874.96" "$3,630.00" "$2,904.00" "$1,633.50" "$3,630.00" N/A "$2,105.40" "$3,630.00" "$2,178.00" "$3,630.00" "$3,630.00" "$3,630.00" N/A N/A 6742-1-109 SUP Custom 27803010 6742-1-109 - INSERT TIBIAL SMALL 9MM POSTERIOR STABILIZE LIP DURACON DUR BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-111 SUP Custom 27803010 6742-1-111 - INSERT TIBIAL SMALL 11MM POSTERIOR STABILIZE LIP DURACON DUR BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-113 SUP Custom 27803010 6742-1-113 - INSERT TIBIAL SMALL 13MM POSTERIOR STABILIZE LIP DURACON DUR BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-116 SUP Custom 27803010 6742-1-116 - INSERT TIBIAL SMALL 16MM POSTERIOR STABILIZE LIP DURACON DUR BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-119 SUP Custom 27803010 6742-1-119 - INSERT TIBIAL SMALL 19MM POSTERIOR STABILIZE LIP DURACON DUR BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-122 SUP Custom 27803010 6742-1-122 - INSERT TIBIAL SMALL 22MM POSTERIOR STABILIZE LIP DURACON DUR BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-125 SUP Custom 27803010 6742-1-125 - INSERT TIBIAL SMALL 25MM POSTERIOR STABILIZE LIP DURACON DUR BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-209 SUP Custom 27803010 6742-1-209 - INSERT TIBIAL MEDIUM 9MM POSTERIOR STABILIZE LIP DURACON DUR BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-211 SUP Custom 27803010 6742-1-211 - INSERT TIBIAL MEDIUM 11MM POSTERIOR STABILIZE LIP DURACON BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-213 SUP Custom 27803010 6742-1-213 - INSERT TIBIAL MEDIUM 13MM POSTERIOR STABILIZE LIP DURACON BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-216 SUP Custom 27803010 6742-1-216 - INSERT TIBIAL MEDIUM 16MM POSTERIOR STABILIZE LIP DURACON BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-219 SUP Custom 27803010 6742-1-219 - INSERT TIBIAL MEDIUM 19MM POSTERIOR STABILIZE LIP DURACON BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-222 SUP Custom 27803010 6742-1-222 - INSERT TIBIAL MEDIUM 12MM POSTERIOR STABILIZE LIP DURACON BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-225 SUP Custom 27803010 6742-1-225 - INSERT TIBIAL MEDIUM 25MM POSTERIOR STABILIZE LIP DURACON BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-309 SUP Custom 27803010 6742-1-309 - INSERT TIBIAL LARGE 9MM POSTERIOR STABILIZE LIPPED DURACON BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-311 SUP Custom 27803010 6742-1-311 - INSERT TIBIAL LARGE 11MM POSTERIOR STABILIZE LIP DURACON DUR BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-313 SUP Custom 27803010 6742-1-313 - INSERT TIBIAL LARGE 13MM POSTERIOR STABILIZE LIP DURACON DUR BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-316 SUP Custom 27803010 6742-1-316 - INSERT TIBIAL LARGE 16MM POSTERIOR STABILIZE LIP DURACON DUR BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-319 SUP Custom 27803010 6742-1-319 - INSERT TIBIAL LARGE 19MM POSTERIOR STABILIZE LIP DURACON BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-322 SUP Custom 27803010 6742-1-322 - INSERT TIBIAL LARGE 22MM POSTERIOR STABILIZE LIP DURACON BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-325 SUP Custom 27803010 6742-1-325 - INSERT TIBIAL LARGE 25MM POSTERIOR STABILIZE LIP DURACON BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-409 SUP Custom 27803010 6742-1-409 - INSERT TIBIAL XL 9MM POSTERIOR STABILIZE LIP DURACON KNEE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-411 SUP Custom 27803010 6742-1-411 - INSERT TIBIAL XL 11MM POSTERIOR STABILIZE LIP DURACON KNEE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-413 SUP Custom 27803010 6742-1-413 - INSERT TIBIAL XL 13MM POSTERIOR STABILIZE LIP DURACON KNEE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-416 SUP Custom 27803010 6742-1-416 - INSERT TIBIAL XL 16MM POSTERIOR STABILIZE LIP DURACON KNEE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-419 SUP Custom 27803010 6742-1-419 - INSERT TIBIAL XL 19MM POSTERIOR STABILIZE LIP DURACON KNEE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-422 SUP Custom 27803010 6742-1-422 - INSERT TIBIAL XL 22MM POSTERIOR STABILIZE LIP DURACON KNEE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-1-425 SUP Custom 27803010 6742-1-425 - INSERT TIBIAL XL 25MM POSTERIOR STABILIZE LIP DURACON KNEE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-4-009 SUP Custom 27803010 6742-4-009 - INSERT TIBIAL XS 9MM STABILIZE LIP DURACON DUR KNEE CONDYLE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-4-011 SUP Custom 27803010 6742-4-011 - INSERT TIBIAL XS 11MM STABILIZE LIP DURACON DUR KNEE CONDYLE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-4-013 SUP Custom 27803010 6742-4-013 - INSERT TIBIAL XS 13MM STABILIZE LIP DURACON DUR KNEE CONDYLE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-4-016 SUP Custom 27803010 6742-4-016 - INSERT TIBIAL XS 16MM STABILIZE LIP DURACON DUR KNEE CONDYLE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-4-109 SUP Custom 27803010 6742-4-109 - INSERT TIBIAL SMALL 9MM STABILIZE DURACON KNEE CONDYLE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-4-111 SUP Custom 27803010 6742-4-111 - INSERT TIBIAL SMALL 11MM STABILIZE DURACON KNEE CONDYLE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-4-113 SUP Custom 27803010 6742-4-113 - INSERT TIBIAL SMALL 13MM STABILIZE DURACON KNEE CONDYLE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-4-116 SUP Custom 27803010 6742-4-116 - INSERT TIBIAL SMALL 16MM STABILIZE DURACON KNEE CONDYLE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-4-119 SUP Custom 27803010 6742-4-119 - INSERT TIBIAL SMALL 19MM STABILIZE LIP DURACON DUR KNEE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-4-122 SUP Custom 27803010 6742-4-122 - INSERT TIBIAL SMALL 22MM STABILIZE LIP DURACON DUR KNEE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-4-125 SUP Custom 27803010 6742-4-125 - INSERT TIBIAL SMALL 25MM STABILIZE LIP DURACON DUR KNEE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-4-209 SUP Custom 27803010 6742-4-209 - INSERT TIBIAL MEDIUM 9MM STABILIZE DURACON KNEE CONDYLE BOTH IP/OP "$2,230.00" "$1,650.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $396.94 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" $464.76 "$2,230.00" $892.00 "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$2,230.00" "$1,672.50" "$2,230.00" "$2,230.00" "$2,230.00" "$1,115.00" "$1,115.00" "$1,766.16" "$2,230.00" "$1,784.00" "$1,003.50" "$2,230.00" N/A "$1,293.40" "$2,230.00" "$1,338.00" "$2,230.00" "$2,230.00" "$2,230.00" N/A N/A 6742-4-209X SUP Custom 27803010 6742-4-209X - INSERT TIBIAL MEDIUM 9MM STABILIZE DURACON X3 KNEE CONDYLE BOTH IP/OP "$5,025.00" "$3,719.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$1,047.27" "$5,025.00" "$2,010.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$3,768.75" "$5,025.00" "$5,025.00" "$5,025.00" "$2,512.50" "$2,512.50" "$3,979.80" "$5,025.00" "$4,020.00" "$2,261.25" "$5,025.00" N/A "$2,914.50" "$5,025.00" "$3,015.00" "$5,025.00" "$5,025.00" "$5,025.00" N/A N/A 6742-4-211 SUP Custom 27803010 6742-4-211 - INSERT TIBIAL MEDIUM 11MM STABILIZE DURACON KNEE CONDYLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-211X SUP Custom 27803010 6742-4-211X - INSERT TIBIAL MEDIUM 11MM STABILIZE DURACON X3 KNEE CONDYLE BOTH IP/OP "$5,025.00" "$3,719.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$1,047.27" "$5,025.00" "$2,010.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$3,768.75" "$5,025.00" "$5,025.00" "$5,025.00" "$2,512.50" "$2,512.50" "$3,979.80" "$5,025.00" "$4,020.00" "$2,261.25" "$5,025.00" N/A "$2,914.50" "$5,025.00" "$3,015.00" "$5,025.00" "$5,025.00" "$5,025.00" N/A N/A 6742-4-213 SUP Custom 27803010 6742-4-213 - INSERT TIBIAL MEDIUM 13MM STABILIZE DURACON KNEE CONDYLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-213X SUP Custom 27803010 6742-4-213X - INSERT TIBIAL MEDIUM 13MM STABILIZE DURACON X3 KNEE CONDYLE BOTH IP/OP "$5,025.00" "$3,719.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$1,047.27" "$5,025.00" "$2,010.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$3,768.75" "$5,025.00" "$5,025.00" "$5,025.00" "$2,512.50" "$2,512.50" "$3,979.80" "$5,025.00" "$4,020.00" "$2,261.25" "$5,025.00" N/A "$2,914.50" "$5,025.00" "$3,015.00" "$5,025.00" "$5,025.00" "$5,025.00" N/A N/A 6742-4-216 SUP Custom 27803010 6742-4-216 - INSERT TIBIAL MEDIUM 16MM STABILIZE DURACON DUR KNEE CONDYLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-219 SUP Custom 27803010 6742-4-219 - INSERT TIBIAL MEDIUM 19MM STABILIZE DURACON DUR KNEE CONDYLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-222 SUP Custom 27803010 6742-4-222 - INSERT TIBIAL MEDIUM 22MM STABILIZE LIP DURACON DUR KNEE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-225 SUP Custom 27803010 6742-4-225 - INSERT TIBIAL MEDIUM 25MM STABILIZE DURACON DUR KNEE CONDYLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-309 SUP Custom 27803010 6742-4-309 - INSERT TIBIAL LARGE 9MM STABILIZE DURACON DUR KNEE CONDYLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-309X SUP Custom 27803010 6742-4-309X - INSERT TIBIAL LARGE 9MM STABILIZE DURACON X3 KNEE CONDYLE BOTH IP/OP "$5,025.00" "$3,719.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$1,047.27" "$5,025.00" "$2,010.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$3,768.75" "$5,025.00" "$5,025.00" "$5,025.00" "$2,512.50" "$2,512.50" "$3,979.80" "$5,025.00" "$4,020.00" "$2,261.25" "$5,025.00" N/A "$2,914.50" "$5,025.00" "$3,015.00" "$5,025.00" "$5,025.00" "$5,025.00" N/A N/A 6742-4-311 SUP Custom 27803010 6742-4-311 - INSERT TIBIAL LARGE 11MM STABILIZE DURACON DUR KNEE CONDYLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-311X SUP Custom 27803010 6742-4-311X - INSERT TIBIAL LARGE 11MM STABILIZE DURACON X3 KNEE CONDYLE BOTH IP/OP "$5,025.00" "$3,719.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$1,047.27" "$5,025.00" "$2,010.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$3,768.75" "$5,025.00" "$5,025.00" "$5,025.00" "$2,512.50" "$2,512.50" "$3,979.80" "$5,025.00" "$4,020.00" "$2,261.25" "$5,025.00" N/A "$2,914.50" "$5,025.00" "$3,015.00" "$5,025.00" "$5,025.00" "$5,025.00" N/A N/A 6742-4-313 SUP Custom 27803010 6742-4-313 - INSERT TIBIAL LARGE 13MM STABILIZE DURACON DUR KNEE CONDYLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-313X SUP Custom 27803010 6742-4-313X - INSERT TIBIAL LARGE 13MM STABILIZE DURACON X3 KNEE CONDYLE BOTH IP/OP "$5,025.00" "$3,719.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$1,047.27" "$5,025.00" "$2,010.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$3,768.75" "$5,025.00" "$5,025.00" "$5,025.00" "$2,512.50" "$2,512.50" "$3,979.80" "$5,025.00" "$4,020.00" "$2,261.25" "$5,025.00" N/A "$2,914.50" "$5,025.00" "$3,015.00" "$5,025.00" "$5,025.00" "$5,025.00" N/A N/A 6742-4-316 SUP Custom 27803010 6742-4-316 - INSERT TIBIAL LARGE 16MM STABILIZE DURACON KNEE CONDYLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-319 SUP Custom 27803010 6742-4-319 - INSERT TIBIAL LARGE 19MM STABILIZE LIP DURACON DUR KNEE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-322 SUP Custom 27803010 6742-4-322 - INSERT TIBIAL LARGE 22MM STABILIZE LIP DURACON DUR KNEE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-325 SUP Custom 27803010 6742-4-325 - INSERT TIBIAL LARGE 25MM STABILIZE LIP DURACON DUR KNEE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-409 SUP Custom 27803010 6742-4-409 - INSERT TIBIAL XL 9MM STABILIZE DURACON KNEE CONDYLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-409X SUP Custom 27803010 6742-4-409X - INSERT TIBIAL XL 9MM STABILIZE DURACON X3 KNEE CONDYLE BOTH IP/OP "$5,025.00" "$3,719.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$1,047.27" "$5,025.00" "$2,010.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$3,768.75" "$5,025.00" "$5,025.00" "$5,025.00" "$2,512.50" "$2,512.50" "$3,979.80" "$5,025.00" "$4,020.00" "$2,261.25" "$5,025.00" N/A "$2,914.50" "$5,025.00" "$3,015.00" "$5,025.00" "$5,025.00" "$5,025.00" N/A N/A 6742-4-411 SUP Custom 27803010 6742-4-411 - INSERT TIBIAL XL 11MM STABILIZE DURACON KNEE CONDYLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-411X SUP Custom 27803010 6742-4-411X - INSERT TIBIAL XL 11MM STABILIZE DURACON X3 KNEE CONDYLE BOTH IP/OP "$5,025.00" "$3,719.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$1,047.27" "$5,025.00" "$2,010.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$3,768.75" "$5,025.00" "$5,025.00" "$5,025.00" "$2,512.50" "$2,512.50" "$3,979.80" "$5,025.00" "$4,020.00" "$2,261.25" "$5,025.00" N/A "$2,914.50" "$5,025.00" "$3,015.00" "$5,025.00" "$5,025.00" "$5,025.00" N/A N/A 6742-4-413 SUP Custom 27803010 6742-4-413 - INSERT TIBIAL XL 13MM STABILIZE DURACON KNEE CONDYLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-413X SUP Custom 27803010 6742-4-413X - INSERT TIBIAL XL 13MM STABILIZE DURACON X3 KNEE CONDYLE BOTH IP/OP "$5,025.00" "$3,719.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" $894.45 "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$1,047.27" "$5,025.00" "$2,010.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$5,025.00" "$3,768.75" "$5,025.00" "$5,025.00" "$5,025.00" "$2,512.50" "$2,512.50" "$3,979.80" "$5,025.00" "$4,020.00" "$2,261.25" "$5,025.00" N/A "$2,914.50" "$5,025.00" "$3,015.00" "$5,025.00" "$5,025.00" "$5,025.00" N/A N/A 6742-4-416 SUP Custom 27803010 6742-4-416 - INSERT TIBIAL XL 16MM CNDYLR STABILIZED DURACON RIGHT BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-419 SUP Custom 27803010 6742-4-419 - INSERT TIBIAL XL 19MM CNDYLR STABILIZED DURACON RIGHT BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-422 SUP Custom 27803010 6742-4-422 - INSERT TIBIAL XL 22MM STABILIZE LIP DURACON DUR KNEE CONDYLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6742-4-425 SUP Custom 27803010 6742-4-425 - INSERT TIBIAL XL 25MM STABILIZE LIP DURACON DUR KNEE CONDYLE BOTH IP/OP "$3,055.00" "$2,261.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $543.79 "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" $636.70 "$3,055.00" "$1,222.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$3,055.00" "$2,291.25" "$3,055.00" "$3,055.00" "$3,055.00" "$1,527.50" "$1,527.50" "$2,419.56" "$3,055.00" "$2,444.00" "$1,374.75" "$3,055.00" N/A "$1,771.90" "$3,055.00" "$1,833.00" "$3,055.00" "$3,055.00" "$3,055.00" N/A N/A 6752-5-111 SUP Custom 27803010 6752-5-111 - INSERT TIBIAL SMALL 11MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,763.00" "$1,305.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $367.43 "$1,763.00" $705.20 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,322.25" "$1,763.00" "$1,763.00" "$1,763.00" $881.50 $881.50 "$1,396.30" "$1,763.00" "$1,410.40" $793.35 "$1,763.00" N/A "$1,022.54" "$1,763.00" "$1,057.80" "$1,763.00" "$1,763.00" "$1,763.00" N/A N/A 6752-5-113 SUP Custom 27803010 6752-5-113 - INSERT TIBIAL SMALL 13MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,763.00" "$1,305.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $367.43 "$1,763.00" $705.20 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,322.25" "$1,763.00" "$1,763.00" "$1,763.00" $881.50 $881.50 "$1,396.30" "$1,763.00" "$1,410.40" $793.35 "$1,763.00" N/A "$1,022.54" "$1,763.00" "$1,057.80" "$1,763.00" "$1,763.00" "$1,763.00" N/A N/A 6752-5-116 SUP Custom 27803010 6752-5-116 - INSERT TIBIAL SMALL 16MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,763.00" "$1,305.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $367.43 "$1,763.00" $705.20 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,322.25" "$1,763.00" "$1,763.00" "$1,763.00" $881.50 $881.50 "$1,396.30" "$1,763.00" "$1,410.40" $793.35 "$1,763.00" N/A "$1,022.54" "$1,763.00" "$1,057.80" "$1,763.00" "$1,763.00" "$1,763.00" N/A N/A 6752-5-119 SUP Custom 27803010 6752-5-119 - INSERT TIBIAL SMALL 19MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,412.00" "$1,045.00" $251.34 "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" $251.34 "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" $294.28 "$1,412.00" $564.80 "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" "$1,059.00" "$1,412.00" "$1,412.00" "$1,412.00" $706.00 $706.00 "$1,118.30" "$1,412.00" "$1,129.60" $635.40 "$1,412.00" N/A $818.96 "$1,412.00" $847.20 "$1,412.00" "$1,412.00" "$1,412.00" N/A N/A 6752-5-122 SUP Custom 27803010 6752-5-122 - INSERT TIBIAL SMALL 22MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6752-5-125 SUP Custom 27803010 6752-5-125 - INSERT TIBIAL SMALL 25MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,381.00" "$1,022.00" $245.82 "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" $245.82 "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" $287.82 "$1,381.00" $552.40 "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,035.75" "$1,381.00" "$1,381.00" "$1,381.00" $690.50 $690.50 "$1,093.75" "$1,381.00" "$1,104.80" $621.45 "$1,381.00" N/A $800.98 "$1,381.00" $828.60 "$1,381.00" "$1,381.00" "$1,381.00" N/A N/A 6752-5-128 SUP Custom 27803010 6752-5-128 - INSERT TIBIAL SMALL 28MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6752-5-131 SUP Custom 27803010 6752-5-131 - INSERT TIBIAL SMALL 31MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6752-5-211 SUP Custom 27803010 6752-5-211 - INSERT TIBIAL MEDIUM 11MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,763.00" "$1,305.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $367.43 "$1,763.00" $705.20 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,322.25" "$1,763.00" "$1,763.00" "$1,763.00" $881.50 $881.50 "$1,396.30" "$1,763.00" "$1,410.40" $793.35 "$1,763.00" N/A "$1,022.54" "$1,763.00" "$1,057.80" "$1,763.00" "$1,763.00" "$1,763.00" N/A N/A 6752-5-213 SUP Custom 27803010 6752-5-213 - INSERT TIBIAL MEDIUM 13MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,763.00" "$1,305.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $367.43 "$1,763.00" $705.20 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,322.25" "$1,763.00" "$1,763.00" "$1,763.00" $881.50 $881.50 "$1,396.30" "$1,763.00" "$1,410.40" $793.35 "$1,763.00" N/A "$1,022.54" "$1,763.00" "$1,057.80" "$1,763.00" "$1,763.00" "$1,763.00" N/A N/A 6752-5-216 SUP Custom 27803010 6752-5-216 - INSERT TIBIAL MEDIUM 16MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,763.00" "$1,305.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $367.43 "$1,763.00" $705.20 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,322.25" "$1,763.00" "$1,763.00" "$1,763.00" $881.50 $881.50 "$1,396.30" "$1,763.00" "$1,410.40" $793.35 "$1,763.00" N/A "$1,022.54" "$1,763.00" "$1,057.80" "$1,763.00" "$1,763.00" "$1,763.00" N/A N/A 6752-5-219 SUP Custom 27803010 6752-5-219 - INSERT TIBIAL MEDIUM 19MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,763.00" "$1,305.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $367.43 "$1,763.00" $705.20 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,322.25" "$1,763.00" "$1,763.00" "$1,763.00" $881.50 $881.50 "$1,396.30" "$1,763.00" "$1,410.40" $793.35 "$1,763.00" N/A "$1,022.54" "$1,763.00" "$1,057.80" "$1,763.00" "$1,763.00" "$1,763.00" N/A N/A 6752-5-222 SUP Custom 27803010 6752-5-222 - INSERT TIBIAL MEDIUM 22MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6752-5-225 SUP Custom 27803010 6752-5-225 - INSERT TIBIAL MEDIUM 25MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6752-5-228 SUP Custom 27803010 6752-5-228 - INSERT TIBIAL MEDIUM 28MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6752-5-231 SUP Custom 27803010 6752-5-231 - INSERT TIBIAL MEDIUM 31MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6752-5-311 SUP Custom 27803010 6752-5-311 - INSERT TIBIAL LARGE 11MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,763.00" "$1,305.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $367.43 "$1,763.00" $705.20 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,322.25" "$1,763.00" "$1,763.00" "$1,763.00" $881.50 $881.50 "$1,396.30" "$1,763.00" "$1,410.40" $793.35 "$1,763.00" N/A "$1,022.54" "$1,763.00" "$1,057.80" "$1,763.00" "$1,763.00" "$1,763.00" N/A N/A 6752-5-313 SUP Custom 27803010 6752-5-313 - INSERT TIBIAL LARGE 13MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,763.00" "$1,305.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $367.43 "$1,763.00" $705.20 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,322.25" "$1,763.00" "$1,763.00" "$1,763.00" $881.50 $881.50 "$1,396.30" "$1,763.00" "$1,410.40" $793.35 "$1,763.00" N/A "$1,022.54" "$1,763.00" "$1,057.80" "$1,763.00" "$1,763.00" "$1,763.00" N/A N/A 6752-5-316 SUP Custom 27803010 6752-5-316 - INSERT TIBIAL LARGE 16MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,763.00" "$1,305.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $367.43 "$1,763.00" $705.20 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,322.25" "$1,763.00" "$1,763.00" "$1,763.00" $881.50 $881.50 "$1,396.30" "$1,763.00" "$1,410.40" $793.35 "$1,763.00" N/A "$1,022.54" "$1,763.00" "$1,057.80" "$1,763.00" "$1,763.00" "$1,763.00" N/A N/A 6752-5-319 SUP Custom 27803010 6752-5-319 - INSERT TIBIAL LARGE 19MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,412.00" "$1,045.00" $251.34 "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" $251.34 "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" $294.28 "$1,412.00" $564.80 "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" "$1,412.00" "$1,059.00" "$1,412.00" "$1,412.00" "$1,412.00" $706.00 $706.00 "$1,118.30" "$1,412.00" "$1,129.60" $635.40 "$1,412.00" N/A $818.96 "$1,412.00" $847.20 "$1,412.00" "$1,412.00" "$1,412.00" N/A N/A 6752-5-322 SUP Custom 27803010 6752-5-322 - INSERT TIBIAL LARGE 22MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6752-5-325 SUP Custom 27803010 6752-5-325 - INSERT TIBIAL LARGE 25MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6752-5-328 SUP Custom 27803010 6752-5-328 - INSERT TIBIAL LARGE 28MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,381.00" "$1,022.00" $245.82 "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" $245.82 "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" $287.82 "$1,381.00" $552.40 "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,035.75" "$1,381.00" "$1,381.00" "$1,381.00" $690.50 $690.50 "$1,093.75" "$1,381.00" "$1,104.80" $621.45 "$1,381.00" N/A $800.98 "$1,381.00" $828.60 "$1,381.00" "$1,381.00" "$1,381.00" N/A N/A 6752-5-331 SUP Custom 27803010 6752-5-331 - INSERT TIBIAL LARGE 31MM POSTERIOR STABILIZE CONSTRAIN MRS BOTH IP/OP "$1,381.00" "$1,022.00" $245.82 "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" $245.82 "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" $287.82 "$1,381.00" $552.40 "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,381.00" "$1,035.75" "$1,381.00" "$1,381.00" "$1,381.00" $690.50 $690.50 "$1,093.75" "$1,381.00" "$1,104.80" $621.45 "$1,381.00" N/A $800.98 "$1,381.00" $828.60 "$1,381.00" "$1,381.00" "$1,381.00" N/A N/A 6752-5-411 SUP Custom 27803010 6752-5-411 - INSERT TIBIAL XL 11MM POSTERIOR STABILIZE CONSTRAIN MRS KNEE BOTH IP/OP "$1,763.00" "$1,305.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $367.43 "$1,763.00" $705.20 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,322.25" "$1,763.00" "$1,763.00" "$1,763.00" $881.50 $881.50 "$1,396.30" "$1,763.00" "$1,410.40" $793.35 "$1,763.00" N/A "$1,022.54" "$1,763.00" "$1,057.80" "$1,763.00" "$1,763.00" "$1,763.00" N/A N/A 6752-5-413 SUP Custom 27803010 6752-5-413 - INSERT TIBIAL XL 13MM POSTERIOR STABILIZE CONSTRAIN MRS KNEE BOTH IP/OP "$1,763.00" "$1,305.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $367.43 "$1,763.00" $705.20 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,322.25" "$1,763.00" "$1,763.00" "$1,763.00" $881.50 $881.50 "$1,396.30" "$1,763.00" "$1,410.40" $793.35 "$1,763.00" N/A "$1,022.54" "$1,763.00" "$1,057.80" "$1,763.00" "$1,763.00" "$1,763.00" N/A N/A 6752-5-416 SUP Custom 27803010 6752-5-416 - INSERT TIBIAL XL 16MM POSTERIOR STABILIZE CONSTRAIN MRS KNEE BOTH IP/OP "$1,763.00" "$1,305.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $367.43 "$1,763.00" $705.20 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,322.25" "$1,763.00" "$1,763.00" "$1,763.00" $881.50 $881.50 "$1,396.30" "$1,763.00" "$1,410.40" $793.35 "$1,763.00" N/A "$1,022.54" "$1,763.00" "$1,057.80" "$1,763.00" "$1,763.00" "$1,763.00" N/A N/A 6752-5-419 SUP Custom 27803010 6752-5-419 - INSERT TIBIAL XL 19MM POSTERIOR STABILIZE CONSTRAIN MRS KNEE BOTH IP/OP "$1,763.00" "$1,305.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $313.81 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" $367.43 "$1,763.00" $705.20 "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,763.00" "$1,322.25" "$1,763.00" "$1,763.00" "$1,763.00" $881.50 $881.50 "$1,396.30" "$1,763.00" "$1,410.40" $793.35 "$1,763.00" N/A "$1,022.54" "$1,763.00" "$1,057.80" "$1,763.00" "$1,763.00" "$1,763.00" N/A N/A 6752-5-422 SUP Custom 27803010 6752-5-422 - INSERT TIBIAL XL 22MM POSTERIOR STABILIZE CONSTRAIN MRS KNEE BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 6752-5-425 SUP Custom 27803010 6752-5-425 - INSERT TIBIAL XL 25MM POSTERIOR STABILIZE CONSTRAIN MRS KNEE BOTH IP/OP "$1,439.00" "$1,065.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $256.14 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" $299.90 "$1,439.00" $575.60 "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,439.00" "$1,079.25" "$1,439.00" "$1,439.00" "$1,439.00" $719.50 $719.50 "$1,139.69" "$1,439.00" "$1,151.20" $647.55 "$1,439.00" N/A $834.62 "$1,439.00" $863.40 "$1,439.00" "$1,439.00" "$1,439.00" N/A N/A 67525P SUP HCPCS C1713 67525P - SCREW BN 6.75MM 25MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67525S SUP HCPCS C1713 67525S - SCREW BN STD 6.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67530P SUP HCPCS C1713 67530P - SCREW BN 6.75MM 30MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67530S SUP HCPCS C1713 67530S - SCREW BN STD 6.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67535P SUP HCPCS C1713 67535P - SCREW BN 6.75MM 35MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67535S SUP HCPCS C1713 67535S - SCREW BN STD 6.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67540P SUP HCPCS C1713 67540P - SCREW BN 6.75MM 40MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67540S SUP HCPCS C1713 67540S - SCREW BN STD 6.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67545P SUP HCPCS C1713 67545P - SCREW BN 6.75MM 45MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67545S SUP HCPCS C1713 67545S - SCREW BN STD 6.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67550P SUP HCPCS C1713 67550P - SCREW BN 6.75MM 50MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67550S SUP HCPCS C1713 67550S - SCREW BN STD 6.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67555P SUP HCPCS C1713 67555P - SCREW BN 6.75MM 55MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67555S SUP HCPCS C1713 67555S - SCREW BN STD 6.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67560P SUP HCPCS C1713 67560P - SCREW BN 6.75MM 60MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67560S SUP HCPCS C1713 67560S - SCREW BN STD 6.75MM 60MM SPRL R90D LCK SPNE THORLMBR BOTH IP/OP "$2,229.00" "$1,649.00" $442.31 "$2,228.53" "$1,002.84" "$1,002.84" "$1,002.84" "$1,002.84" "$2,228.53" "$2,228.53" "$2,228.53" $464.48 "$2,228.53" "$2,228.53" "$2,228.53" "$2,228.53" "$2,228.53" $464.45 "$2,228.53" "$2,228.53" "$1,318.18" "$2,228.53" "$2,228.53" "$2,228.53" "$2,228.53" "$1,671.75" "$2,228.53" "$2,228.53" "$2,228.53" "$1,114.27" "$1,114.27" "$1,765.00" "$2,228.53" "$1,782.82" "$1,002.84" $442.31 N/A "$1,292.82" "$2,228.53" "$2,228.53" "$2,228.53" $464.43 "$2,228.53" N/A N/A 67565P SUP HCPCS C1713 67565P - SCREW BN 6.75MM 65MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 67565S SUP HCPCS C1713 67565S - SCREW BN STD 6.75MM 65MM SPRL R90D LCK SPNE THORLMBR BOTH IP/OP "$1,233.50" $913.00 $244.79 "$1,233.33" $555.00 $555.00 $555.00 $555.00 "$1,233.33" "$1,233.33" "$1,233.33" $257.06 "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" $257.04 "$1,233.33" "$1,233.33" $729.51 "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" $925.13 "$1,233.33" "$1,233.33" "$1,233.33" $616.67 $616.67 $976.80 "$1,233.33" $986.66 $555.00 $244.79 N/A $715.43 "$1,233.33" "$1,233.33" "$1,233.33" $257.03 "$1,233.33" N/A N/A 690-00-22D SUP Custom 27803010 690-00-22D - INSERT ACETAB 0D D 40MM 36MM 22MM 5.6MM CONSTRAIN RING LOCK BOTH IP/OP "$6,590.00" "$4,877.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$2,636.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$6,590.00" N/A "$3,822.20" "$6,590.00" "$3,954.00" "$6,590.00" "$6,590.00" "$6,590.00" N/A N/A 690-00-22E SUP Custom 27803010 690-00-22E - INSERT ACETAB 0D E 44MM 36MM 22MM 7.5MM CONSTRAIN LOCK RING BOTH IP/OP "$6,590.00" "$4,877.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$2,636.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$6,590.00" N/A "$3,822.20" "$6,590.00" "$3,954.00" "$6,590.00" "$6,590.00" "$6,590.00" N/A N/A 690-00-28F SUP Custom 27803010 690-00-28F - INSERT ACETAB 0D F 42MM 28MM CONSTRAIN TRIDENT UHMWPE HIP BOTH IP/OP "$6,590.00" "$4,877.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$2,636.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$6,590.00" N/A "$3,822.20" "$6,590.00" "$3,954.00" "$6,590.00" "$6,590.00" "$6,590.00" N/A N/A 690-00-28G SUP Custom 27803010 690-00-28G - INSERT ACETAB 0D G 51.5MM 42MM 28MM 5.6MM CONSTRAIN LOCK BOTH IP/OP "$6,590.00" "$4,877.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$2,636.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$6,590.00" N/A "$3,822.20" "$6,590.00" "$3,954.00" "$6,590.00" "$6,590.00" "$6,590.00" N/A N/A 690-00-32H SUP Custom 27803010 690-00-32H - INSERT ACETAB 0D H 55MM 46MM 32MM 7.8MM CONSTRAIN LOCK RING BOTH IP/OP "$6,590.00" "$4,877.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$2,636.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$6,590.00" N/A "$3,822.20" "$6,590.00" "$3,954.00" "$6,590.00" "$6,590.00" "$6,590.00" N/A N/A 690-00-32I SUP Custom 27803010 690-00-32I - INSERT ACETAB 0D I 58MM 46MM 32MM CONSTRAIN BIPOL SPLIT RING BOTH IP/OP "$6,590.00" "$4,877.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$2,636.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$6,590.00" N/A "$3,822.20" "$6,590.00" "$3,954.00" "$6,590.00" "$6,590.00" "$6,590.00" N/A N/A 690-00-32J SUP Custom 27803010 690-00-32J - INSERT ACETAB 0D J 62MM 46MM 32MM CONSTRAIN BIPOL SPLIT RING BOTH IP/OP "$6,590.00" "$4,877.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$2,636.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$6,590.00" N/A "$3,822.20" "$6,590.00" "$3,954.00" "$6,590.00" "$6,590.00" "$6,590.00" N/A N/A 6900PTFX SUP Custom 27203010 6900PTFX - SIZER VLV 29MM CRP-ED PRIMNT PLUS 33MM PRICRD HRT PRICRD BOTH IP/OP "$20,695.00" "$15,314.00" "$2,060.15" "$20,695.00" "$20,695.00" "$20,695.00" "$20,695.00" "$20,695.00" "$20,695.00" "$20,695.00" "$3,683.71" "$20,695.00" "$20,695.00" "$4,181.12" "$4,181.12" "$15,951.71" "$2,060.15" "$4,313.07" "$20,695.00" "$8,278.00" "$20,695.00" "$20,695.00" "$20,695.00" "$20,695.00" "$20,695.00" "$15,521.25" "$20,695.00" "$20,695.00" "$20,695.00" "$10,347.50" "$10,347.50" "$16,390.44" "$20,695.00" "$16,556.00" "$13,451.75" "$20,695.00" N/A "$12,003.10" "$20,695.00" "$12,417.00" "$20,695.00" "$20,695.00" "$20,695.00" N/A N/A 6900PTFX 29 SUP Custom 27803010 6900PTFX 29 - VALVE MTRL 29MM C-E PRM+ BPRTH THERMAFIX TRICENTRIX HLDR BOTH IP/OP "$18,487.50" "$13,681.00" "$3,290.78" "$18,487.50" "$18,487.50" "$18,487.50" "$18,487.50" "$18,487.50" "$18,487.50" "$18,487.50" "$3,290.78" "$18,487.50" "$18,487.50" "$18,487.50" "$18,487.50" "$18,487.50" "$18,487.50" "$3,853.00" "$18,487.50" "$7,395.00" "$18,487.50" "$18,487.50" "$18,487.50" "$18,487.50" "$18,487.50" "$13,865.63" "$18,487.50" "$18,487.50" "$18,487.50" "$9,243.75" "$9,243.75" "$14,642.10" "$18,487.50" "$14,790.00" "$8,319.38" "$18,487.50" N/A "$10,722.75" "$18,487.50" "$11,092.50" "$18,487.50" "$18,487.50" "$18,487.50" N/A N/A 690-10-22E SUP Custom 27803010 690-10-22E - INSERT ACETAB 10D E 22MM CONSTRAIN TRIDENT HIP BOTH IP/OP "$6,590.00" "$4,877.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$2,636.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$6,590.00" N/A "$3,822.20" "$6,590.00" "$3,954.00" "$6,590.00" "$6,590.00" "$6,590.00" N/A N/A 690-10-22F SUP Custom 27803010 690-10-22F - INSERT ACETAB 10D H 48.4MM 36MM 22MM 9.9MM CONSTRAIN BIPOL BOTH IP/OP "$6,590.00" "$4,877.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$2,636.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$6,590.00" N/A "$3,822.20" "$6,590.00" "$3,954.00" "$6,590.00" "$6,590.00" "$6,590.00" N/A N/A 690-10-28G SUP Custom 27803010 690-10-28G - INSERT ACETAB 10D G 51.5MM 42MM 28MM 8.4MM CONSTRAIN BIPOL BOTH IP/OP "$6,590.00" "$4,877.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$2,636.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$6,590.00" N/A "$3,822.20" "$6,590.00" "$3,954.00" "$6,590.00" "$6,590.00" "$6,590.00" N/A N/A 690-10-28H SUP Custom 27803010 690-10-28H - INSERT ACETAB 10D H 55MM 42MM 28MM 10.2MM CONSTRAIN BIPOL BOTH IP/OP "$6,590.00" "$4,877.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$2,636.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$6,590.00" N/A "$3,822.20" "$6,590.00" "$3,954.00" "$6,590.00" "$6,590.00" "$6,590.00" N/A N/A 690-10-28I SUP Custom 27803010 690-10-28I - INSERT ACETAB 10D I 58MM 42MM 28MM 11.6MM CONSTRAIN RING BOTH IP/OP "$6,590.00" "$4,877.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$2,636.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$6,590.00" N/A "$3,822.20" "$6,590.00" "$3,954.00" "$6,590.00" "$6,590.00" "$6,590.00" N/A N/A 690-10-28J SUP Custom 27803010 690-10-28J - INSERT ACETAB 10D J 62MM 42MM 28MM 13.7MM CONSTRAIN RING BOTH IP/OP "$6,590.00" "$4,877.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$2,636.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$6,590.00" N/A "$3,822.20" "$6,590.00" "$3,954.00" "$6,590.00" "$6,590.00" "$6,590.00" N/A N/A 690-10-28K SUP Custom 27803010 690-10-28K - INSERT ACETAB 10D K 42MM 28MM CONSTRAIN BIPOL SPLIT RING BOTH IP/OP "$6,590.00" "$4,877.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,173.02" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$1,373.43" "$6,590.00" "$2,636.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$6,590.00" "$4,942.50" "$6,590.00" "$6,590.00" "$6,590.00" "$3,295.00" "$3,295.00" "$5,219.28" "$6,590.00" "$5,272.00" "$2,965.50" "$6,590.00" N/A "$3,822.20" "$6,590.00" "$3,954.00" "$6,590.00" "$6,590.00" "$6,590.00" N/A N/A 69-2244 SUP Custom 27803010 69-2244 - INSERT ACETAB 0D 44MM 36MM 22MM 7.3MM CONSTRAIN SPLIT RING BOTH IP/OP "$6,797.50" "$5,030.00" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,416.67" "$6,797.50" "$2,719.00" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$5,098.13" "$6,797.50" "$6,797.50" "$6,797.50" "$3,398.75" "$3,398.75" "$5,383.62" "$6,797.50" "$5,438.00" "$3,058.88" "$6,797.50" N/A "$3,942.55" "$6,797.50" "$4,078.50" "$6,797.50" "$6,797.50" "$6,797.50" N/A N/A 69-2246 SUP Custom 27803010 69-2246 - INSERT ACETAB 0D 46MM 36MM 22MM 8.3MM CONSTRAIN SPLIT RING BOTH IP/OP "$6,797.50" "$5,030.00" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,416.67" "$6,797.50" "$2,719.00" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$5,098.13" "$6,797.50" "$6,797.50" "$6,797.50" "$3,398.75" "$3,398.75" "$5,383.62" "$6,797.50" "$5,438.00" "$3,058.88" "$6,797.50" N/A "$3,942.55" "$6,797.50" "$4,078.50" "$6,797.50" "$6,797.50" "$6,797.50" N/A N/A 69-2248 SUP Custom 27803010 69-2248 - INSERT ACETAB 0D 48MM 36MM 22MM CONSTRAIN BIPOL SPLIT RING BOTH IP/OP "$6,797.50" "$5,030.00" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,416.67" "$6,797.50" "$2,719.00" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$5,098.13" "$6,797.50" "$6,797.50" "$6,797.50" "$3,398.75" "$3,398.75" "$5,383.62" "$6,797.50" "$5,438.00" "$3,058.88" "$6,797.50" N/A "$3,942.55" "$6,797.50" "$4,078.50" "$6,797.50" "$6,797.50" "$6,797.50" N/A N/A 69-2850 SUP Custom 27803010 69-2850 - INSERT ACETAB 0D 50MM 42MM 28MM 7.3MM CONSTRAIN SPLIT RING BOTH IP/OP "$6,797.50" "$5,030.00" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,416.67" "$6,797.50" "$2,719.00" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$5,098.13" "$6,797.50" "$6,797.50" "$6,797.50" "$3,398.75" "$3,398.75" "$5,383.62" "$6,797.50" "$5,438.00" "$3,058.88" "$6,797.50" N/A "$3,942.55" "$6,797.50" "$4,078.50" "$6,797.50" "$6,797.50" "$6,797.50" N/A N/A 69-2852 SUP Custom 27803010 69-2852 - INSERT ACETAB 0D 52MM 42MM 28MM 8.3MM CONSTRAIN SPLIT RING BOTH IP/OP "$6,797.50" "$5,030.00" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,416.67" "$6,797.50" "$2,719.00" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$5,098.13" "$6,797.50" "$6,797.50" "$6,797.50" "$3,398.75" "$3,398.75" "$5,383.62" "$6,797.50" "$5,438.00" "$3,058.88" "$6,797.50" N/A "$3,942.55" "$6,797.50" "$4,078.50" "$6,797.50" "$6,797.50" "$6,797.50" N/A N/A 69-2854 SUP Custom 27803010 69-2854 - INSERT ACETAB 0D 54MM 42MM 28MM 9.3MM CONSTRAIN SPLIT RING BOTH IP/OP "$6,797.50" "$5,030.00" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,416.67" "$6,797.50" "$2,719.00" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$5,098.13" "$6,797.50" "$6,797.50" "$6,797.50" "$3,398.75" "$3,398.75" "$5,383.62" "$6,797.50" "$5,438.00" "$3,058.88" "$6,797.50" N/A "$3,942.55" "$6,797.50" "$4,078.50" "$6,797.50" "$6,797.50" "$6,797.50" N/A N/A 69-3256 SUP Custom 27803010 69-3256 - INSERT ACETAB 0D 56MM 46MM 32MM 8.3MM CONSTRAIN SPLIT RING BOTH IP/OP "$6,797.50" "$5,030.00" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,416.67" "$6,797.50" "$2,719.00" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$5,098.13" "$6,797.50" "$6,797.50" "$6,797.50" "$3,398.75" "$3,398.75" "$5,383.62" "$6,797.50" "$5,438.00" "$3,058.88" "$6,797.50" N/A "$3,942.55" "$6,797.50" "$4,078.50" "$6,797.50" "$6,797.50" "$6,797.50" N/A N/A 69-3258 SUP Custom 27803010 69-3258 - INSERT ACETAB 0D 58MM 46MM 32MM 9.3MM CONSTRAIN SPLIT RING BOTH IP/OP "$6,797.50" "$5,030.00" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,416.67" "$6,797.50" "$2,719.00" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$5,098.13" "$6,797.50" "$6,797.50" "$6,797.50" "$3,398.75" "$3,398.75" "$5,383.62" "$6,797.50" "$5,438.00" "$3,058.88" "$6,797.50" N/A "$3,942.55" "$6,797.50" "$4,078.50" "$6,797.50" "$6,797.50" "$6,797.50" N/A N/A 69-3260 SUP Custom 27803010 69-3260 - INSERT ACETAB 0D 60MM 46MM 32MM CONSTRAIN BIPOL SPLIT RING BOTH IP/OP "$6,797.50" "$5,030.00" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,209.96" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$1,416.67" "$6,797.50" "$2,719.00" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$6,797.50" "$5,098.13" "$6,797.50" "$6,797.50" "$6,797.50" "$3,398.75" "$3,398.75" "$5,383.62" "$6,797.50" "$5,438.00" "$3,058.88" "$6,797.50" N/A "$3,942.55" "$6,797.50" "$4,078.50" "$6,797.50" "$6,797.50" "$6,797.50" N/A N/A 6936-0-380 SUP Custom 27803010 6936-0-380 - HEAD FEMORAL REGULAR 38MM 105MM ENDOPRSTH THOMPSON HIP FR BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-400 SUP Custom 27803010 6936-0-400 - HEAD FEMORAL REGULAR 40MM 105MM ENDOPRSTH THOMPSON HIP FR BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-410 SUP Custom 27803010 6936-0-410 - HEAD FEMORAL REGULAR 41MM 105MM ENDOPRSTH THOMPSON ZIMALOY BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-420 SUP Custom 27803010 6936-0-420 - HEAD FEMORAL REGULAR 42MM 105MM ENDOPRSTH THOMPSON HIP FR BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-430 SUP Custom 27803010 6936-0-430 - HEAD FEMORAL REGULAR 43MM 105MM ENDOPRSTH THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-440 SUP Custom 27803010 6936-0-440 - HEAD FEMORAL REGULAR 44MM 105MM ENDOPRSTH THOMPSON HIP FR BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-450 SUP Custom 27803010 6936-0-450 - HEAD FEMORAL REGULAR 45MM 105MM ENDOPRSTH THOMPSON HIP FR BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-460 SUP Custom 27803010 6936-0-460 - HEAD FEMORAL REGULAR 46MM 105MM ENDOPRSTH THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-470 SUP Custom 27803010 6936-0-470 - HEAD FEMORAL REGULAR 47MM 105MM ENDOPRSTH THOMPSON HIP FR BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-480 SUP Custom 27803010 6936-0-480 - HEAD FEMORAL REGULAR 48MM 105MM ENDOPRSTH THOMPSON HIP FRAC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-490 SUP Custom 27803010 6936-0-490 - HEAD FEMORAL REGULAR 49MM 105MM ENDOPRSTH THOMPSON HIP FR BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-500 SUP Custom 27803010 6936-0-500 - HEAD FEMORAL REGULAR 50MM 105MM ENDOPRSTH THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-510 SUP Custom 27803010 6936-0-510 - HEAD FEMORAL REGULAR 51MM 105MM ENDOPRSTH THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-520 SUP Custom 27803010 6936-0-520 - HEAD FEMORAL REGULAR 52MM 105MM ENDOPRSTH THOMPSON HIP FR BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-530 SUP Custom 27803010 6936-0-530 - HEAD FEMORAL REGULAR 53MM 105MM ENDOPRSTH THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-540 SUP Custom 27803010 6936-0-540 - HEAD FEMORAL REGULAR 54MM 105MM ENDOPRSTH THOMPSON HIP FR BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-550 SUP Custom 27803010 6936-0-550 - HEAD FEMORAL REGULAR 55MM 105MM ENDOPRSTH THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6936-0-570 SUP Custom 27803010 6936-0-570 - HEAD FEMORAL REGULAR 57MM 105MM ENDOPRSTH THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-380 SUP Custom 27803010 6939-0-380 - STEM FEMORAL 38MM 130MM CVD FENST AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-400 SUP Custom 27803010 6939-0-400 - STEM FEMORAL 40MM 130MM CVD FENST ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-410 SUP Custom 27803010 6939-0-410 - STEM FEMORAL 41MM 130MM CVD FENST ENDOPRSTH AUSTIN MOORE BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-420 SUP Custom 27803010 6939-0-420 - STEM FEMORAL 42MM 130MM CVD FENST ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-430 SUP Custom 27803010 6939-0-430 - STEM FEMORAL 43MM CVD FENST ENDOPRSTH MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-440 SUP Custom 27803010 6939-0-440 - STEM FEMORAL 44MM 130MM CVD FENST ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-450 SUP Custom 27803010 6939-0-450 - STEM FEMORAL 45MM 140MM CVD FENST ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-460 SUP Custom 27803010 6939-0-460 - STEM FEMORAL 46MM 140MM CVD FENST ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-470 SUP Custom 27803010 6939-0-470 - STEM FEMORAL 47MM 140MM CVD FENST ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-480 SUP Custom 27803010 6939-0-480 - STEM FEMORAL 48MM 140MM CVD FENST ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-490 SUP Custom 27803010 6939-0-490 - STEM FEMORAL 49MM 140MM CVD FENST ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-500 SUP Custom 27803010 6939-0-500 - STEM FEMORAL 50MM 150MM CVD FENST ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-510 SUP Custom 27803010 6939-0-510 - STEM FEMORAL 51MM 150MM CVD FENST ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-520 SUP Custom 27803010 6939-0-520 - STEM FEMORAL 52MM 150MM CVD FENST ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-530 SUP Custom 27803010 6939-0-530 - STEM FEMORAL 53MM CVD FENST ENDOPRSTH MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-540 SUP Custom 27803010 6939-0-540 - STEM FEMORAL 54MM 150MM CVD FENST AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-550 SUP Custom 27803010 6939-0-550 - HEAD FEMORAL REGULAR 55MM 150MM FENESTRATE ENDOPRSTH BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-560 SUP Custom 27803010 6939-0-560 - HEAD FEMORAL 56MM FENST CVD MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-570 SUP Custom 27803010 6939-0-570 - STEM FEMORAL 57MM 150MM CVD FENST AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-600 SUP Custom 27803010 6939-0-600 - STEM FEMORAL 60MM 60MM CVD FENST ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-0-630 SUP Custom 27803010 6939-0-630 - STEM FEMORAL 63MM 150MM CVD FENST AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-1-380 SUP Custom 27803010 6939-1-380 - STEM FEMORAL NARROW 38MM 135MM CVD FENST NARROW AUSTIN MOORE BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-1-400 SUP Custom 27803010 6939-1-400 - STEM FEMORAL NARROW 40MM 40MM CVD FENST ENDOPRSTH AUSTIN BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-1-410 SUP Custom 27803010 6939-1-410 - STEM FEMORAL NARROW 41MM 135MM CVD FENST ENDOPRSTH AUSTIN BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-1-420 SUP Custom 27803010 6939-1-420 - STEM FEMORAL NARROW 42MM 135MM CVD FENST NARROW AUSTIN MOORE BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-1-430 SUP Custom 27803010 6939-1-430 - STEM FEMORAL NARROW 43MM 135MM CVD FENST NARROW AUSTIN MOORE BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-1-440 SUP Custom 27803010 6939-1-440 - STEM FEMORAL 44MM 135MM CVD FENST NARROW AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-1-450 SUP Custom 27803010 6939-1-450 - STEM FEMORAL NARROW 45MM 135MM CVD FENST AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-1-460 SUP Custom 27803010 6939-1-460 - STEM FEMORAL NARROW 46MM 135MM CVD FENST AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-1-470 SUP Custom 27803010 6939-1-470 - STEM FEMORAL NARROW 47MM CVD FENST ENDOPRSTH MOORE BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-1-480 SUP Custom 27803010 6939-1-480 - STEM FEMORAL NARROW 48MM 135MM CVD FENST AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-1-490 SUP Custom 27803010 6939-1-490 - STEM FEMORAL NARROW 49MM 135MM CVD FENST AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-1-500 SUP Custom 27803010 6939-1-500 - STEM FEMORAL NARROW 50MM 135MM CVD FENST AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-1-510 SUP Custom 27803010 6939-1-510 - STEM FEMORAL NARROW 51MM 135MM CVD FENST AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-400 SUP Custom 27803010 6939-5-400 - STEM FEMORAL 40MM ENDOPRSTH CVD SOLID FRAC MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-410 SUP Custom 27803010 6939-5-410 - STEM FEMORAL 41MM ENDOPRSTH CVD SOLID FRAC MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-420 SUP Custom 27803010 6939-5-420 - STEM FEMORAL 42MM ENDOPRSTH CVD SOLID FRAC MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-430 SUP Custom 27803010 6939-5-430 - STEM FEMORAL 43MM SOLID CVD MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-440 SUP Custom 27803010 6939-5-440 - STEM FEMORAL 44MM SOLID CVD MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-450 SUP Custom 27803010 6939-5-450 - STEM FEMORAL 45MM SOLID CVD MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-460 SUP Custom 27803010 6939-5-460 - STEM FEMORAL 46MM CVD SOLID ENDOPRSTH MOORE BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-470 SUP Custom 27803010 6939-5-470 - STEM FEMORAL 47MM ENDOPRSTH CVD SOLID FRAC MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-480 SUP Custom 27803010 6939-5-480 - STEM FEMORAL 48MM CVD SOLID ENDOPRSTH MOORE BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-490 SUP Custom 27803010 6939-5-490 - STEM FEMORAL 49MM ENDOPRSTH CVD SOLID FRAC MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-500 SUP Custom 27803010 6939-5-500 - STEM FEMORAL 50MM CVD SOLID ENDOPRSTH MOORE BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-510 SUP Custom 27803010 6939-5-510 - STEM FEMORAL 51MM ENDOPRSTH CVD SOLID FRAC MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-520 SUP Custom 27803010 6939-5-520 - STEM FEMORAL 52MM ENDOPRSTH MODULAR CVD SOLID MOORE HIP FRAC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-530 SUP Custom 27803010 6939-5-530 - STEM FEMORAL 53MM CVD SOLID ENDOPRSTH MOORE BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-540 SUP Custom 27803010 6939-5-540 - STEM FEMORAL 54MM CVD SOLID ENDOPRSTH MOORE BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-550 SUP Custom 27803010 6939-5-550 - STEM FEMORAL 55MM SOLID CVD ENDOPRSTH MOORE BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6939-5-570 SUP Custom 27803010 6939-5-570 - STEM FEMORAL 57MM SOLID CVD MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-380 SUP Custom 27803010 6940-0-380 - STEM FEMORAL 38MM 165MM STR FENST AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-400 SUP Custom 27803010 6940-0-400 - STEM FEMORAL 40MM 165MM STR FENST AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-410 SUP Custom 27803010 6940-0-410 - HEAD FEMORAL STR 41MM 165MM FENESTRATE THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-420 SUP Custom 27803010 6940-0-420 - HEAD FEMORAL STR 42MM 165MM FENESTRATE THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-430 SUP Custom 27803010 6940-0-430 - HEAD FEMORAL STR 43MM 165MM FENESTRATE THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-440 SUP Custom 27803010 6940-0-440 - HEAD FEMORAL STR 44MM 165MM FENESTRATE ENDOPRSTH THOMPSON BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-450 SUP Custom 27803010 6940-0-450 - HEAD FEMORAL STR 45MM 165MM FENESTRATE THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-460 SUP Custom 27803010 6940-0-460 - HEAD FEMORAL STR 46MM 165MM FENESTRATE THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-470 SUP Custom 27803010 6940-0-470 - HEAD FEMORAL STR 43MM 165MM FENESTRATE THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-480 SUP Custom 27803010 6940-0-480 - HEAD FEMORAL STR 48MM 165MM FENESTRATE THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-490 SUP Custom 27803010 6940-0-490 - HEAD FEMORAL STR 49MM 165MM FENESTRATE THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-500 SUP Custom 27803010 6940-0-500 - HEAD FEMORAL STR 50MM 165MM FENESTRATE ENDOPRSTH THOMPSON BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-510 SUP Custom 27803010 6940-0-510 - STEM FEMORAL 51MM 190MM STR FENST ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-520 SUP Custom 27803010 6940-0-520 - HEAD FEMORAL STR 52MM 165MM FENESTRATE THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-530 SUP Custom 27803010 6940-0-530 - HEAD FEMORAL STR 53MM 165MM FENESTRATE THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-540 SUP Custom 27803010 6940-0-540 - HEAD FEMORAL STR 54MM 165MM FENESTRATE THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-550 SUP Custom 27803010 6940-0-550 - HEAD FEMORAL STR 55MM 165MM FENESTRATE THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-570 SUP Custom 27803010 6940-0-570 - HEAD FEMORAL STR 57MM 165MM FENESTRATE THOMPSON MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-600 SUP Custom 27803010 6940-0-600 - HEAD FEMORAL STR 60MM 165MM FENESTRATE ENDOPRSTH THOMPSON BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-0-630 SUP Custom 27803010 6940-0-630 - STEM FEMORAL 63MM 190MM STR FENST AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-1-380 SUP Custom 27803010 6940-1-380 - STEM FEMORAL NARROW 38MM STR FENST ENDOPRSTH MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-1-400 SUP Custom 27803010 6940-1-400 - STEM FEMORAL NARROW 40MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-1-410 SUP Custom 27803010 6940-1-410 - STEM FEMORAL NARROW 41MM STR FENST ENDOPRSTH MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-1-420 SUP Custom 27803010 6940-1-420 - STEM FEMORAL NARROW 42MM STR FENST ENDOPRSTH MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-1-430 SUP Custom 27803010 6940-1-430 - STEM FEMORAL NARROW 43MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-1-440 SUP Custom 27803010 6940-1-440 - STEM FEMORAL NARROW 44MM STR FENST ENDOPRSTH MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-1-450 SUP Custom 27803010 6940-1-450 - STEM FEMORAL NARROW 45MM STR FENST ENDOPRSTH MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-1-460 SUP Custom 27803010 6940-1-460 - STEM FEMORAL NARROW 46MM STR FENST ENDOPRSTH MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-1-470 SUP Custom 27803010 6940-1-470 - STEM FEMORAL NARROW 47MM STR FENST ENDOPRSTH MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-1-480 SUP Custom 27803010 6940-1-480 - STEM FEMORAL NARROW 48MM STR FENST ENDOPRSTH MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-1-490 SUP Custom 27803010 6940-1-490 - STEM FEMORAL NARROW 49MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-1-500 SUP Custom 27803010 6940-1-500 - STEM FEMORAL NARROW 50MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-1-510 SUP Custom 27803010 6940-1-510 - STEM FEMORAL NARROW 51MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-2-380 SUP Custom 27803010 6940-2-380 - STEM FEMORAL 38MM 300MM ENDOPRSTH STR FENST FRAC MOORE HIP BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-400 SUP Custom 27803010 6940-2-400 - STEM FEMORAL 40MM 300MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-410 SUP Custom 27803010 6940-2-410 - STEM FEMORAL 41MM 300MM ENDOPRSTH STR FENST FRAC MOORE HIP BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-420 SUP Custom 27803010 6940-2-420 - STEM FEMORAL 42MM 300MM STR FENST ENDOPRSTH AUSTIN MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-450 SUP Custom 27803010 6940-2-450 - STEM FEMORAL 45MM 300MM ENDOPRSTH STR FENST FRAC MOORE HIP BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-460 SUP Custom 27803010 6940-2-460 - STEM FEMORAL 46MM 300MM ENDOPRSTH STR FENST FRAC MOORE HIP BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-470 SUP Custom 27803010 6940-2-470 - STEM FEMORAL 47MM 300MM ENDOPRSTH STR FENST FRAC MOORE HIP BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-480 SUP Custom 27803010 6940-2-480 - STEM FEMORAL 48MM 300MM STR FENST ENDOPRSTH AUSTIN MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-490 SUP Custom 27803010 6940-2-490 - STEM FEMORAL 49MM 300MM STR FENST ENDOPRSTH MOORE BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-500 SUP Custom 27803010 6940-2-500 - STEM FEMORAL 50MM 300MM STR FENST ENDOPRSTH MOORE BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-510 SUP Custom 27803010 6940-2-510 - STEM FEMORAL 51MM 300MM STR FENST ENDOPRSTH MOORE HIP BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-520 SUP Custom 27803010 6940-2-520 - STEM FEMORAL 52MM 300MM ENDOPRSTH STR FENST FRAC MOORE HIP BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-540 SUP Custom 27803010 6940-2-540 - STEM FEMORAL 54MM 300MM ENDOPRSTH STR FENST FRAC MOORE HIP BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-550 SUP Custom 27803010 6940-2-550 - STEM FEMORAL 55MM 300MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-600 SUP Custom 27803010 6940-2-600 - STEM FEMORAL 60MM 300MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-2-630 SUP Custom 27803010 6940-2-630 - STEM FEMORAL 63MM 300MM ENDOPRSTH STR FENST MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-5-400 SUP Custom 27803010 6940-5-400 - HEAD FEMORAL 40MM SOLID STR MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-410 SUP Custom 27803010 6940-5-410 - HEAD FEMORAL 41MM SOLID STR MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-420 SUP Custom 27803010 6940-5-420 - HEAD FEMORAL 42MM SOLID STR MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-430 SUP Custom 27803010 6940-5-430 - HEAD FEMORAL 43MM ENDOPRSTH STR SOLID UNIPOLAR MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-440 SUP Custom 27803010 6940-5-440 - STEM FEMORAL STR 44MM SOLID ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-460 SUP Custom 27803010 6940-5-460 - STEM FEMORAL STR 46MM SOLID ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-470 SUP Custom 27803010 6940-5-470 - STEM FEMORAL 47MM SOLID ENDOPRSTH AUSTIN MOORE STERILE BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-490 SUP Custom 27803010 6940-5-490 - HEAD FEMORAL 49MM ENDOPRSTH STR SOLID UNIPOLAR MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-500 SUP Custom 27803010 6940-5-500 - HEAD FEMORAL 50MM SOLID STR MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-510 SUP Custom 27803010 6940-5-510 - HEAD FEMORAL 51MM ENDOPRSTH STR SOLID UNIPOLAR MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-520 SUP Custom 27803010 6940-5-520 - HEAD FEMORAL 52MM ENDOPRSTH STR SOLID UNIPOLAR MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-530 SUP Custom 27803010 6940-5-530 - STEM FEMORAL 53MM SOLID ENDOPRSTH AUSTIN MOORE STERILE BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-540 SUP Custom 27803010 6940-5-540 - HEAD FEMORAL 54MM SOLID STR MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-550 SUP Custom 27803010 6940-5-550 - HEAD FEMORAL 55MM SOLID STR MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-570 SUP Custom 27803010 6940-5-570 - HEAD FEMORAL 57MM SOLID STR MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-600 SUP Custom 27803010 6940-5-600 - HEAD FEMORAL 60MM ENDOPRSTH STR SOLID UNIPOLAR MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-5-630 SUP Custom 27803010 6940-5-630 - HEAD FEMORAL 63MM SOLID STR MOORE HIP BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-6-410 SUP Custom 27803010 6940-6-410 - STEM FEMORAL NARROW 41MM ENDOPRSTH STR SOLID FRAC MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-6-420 SUP Custom 27803010 6940-6-420 - STEM FEMORAL 42MM STR SOLID ENDOPRSTH MOORE BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-6-440 SUP Custom 27803010 6940-6-440 - STEM FEMORAL NARROW 44MM ENDOPRSTH STR SOLID FRAC MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-6-450 SUP Custom 27803010 6940-6-450 - STEM FEMORAL NARROW 45MM ENDOPRSTH STR SOLID FRAC MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-6-460 SUP Custom 27803010 6940-6-460 - STEM FEMORAL NARROW 46MM ENDOPRSTH STR SOLID FRAC MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-6-470 SUP Custom 27803010 6940-6-470 - STEM FEMORAL NARROW 47MM ENDOPRSTH STR SOLID FRAC MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-6-480 SUP Custom 27803010 6940-6-480 - STEM FEMORAL NARROW 48MM ENDOPRSTH STR SOLID FRAC MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-6-490 SUP Custom 27803010 6940-6-490 - STEM FEMORAL NARROW 49MM ENDOPRSTH STR SOLID FRAC MOORE ODC BOTH IP/OP "$1,257.00" $930.00 $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $223.75 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $261.97 "$1,257.00" $502.80 "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" "$1,257.00" $942.75 "$1,257.00" "$1,257.00" "$1,257.00" $628.50 $628.50 $995.54 "$1,257.00" "$1,005.60" $565.65 "$1,257.00" N/A $729.06 "$1,257.00" $754.20 "$1,257.00" "$1,257.00" "$1,257.00" N/A N/A 6940-8-380 SUP Custom 27803010 6940-8-380 - STEM FEMORAL 38MM 200MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-400 SUP Custom 27803010 6940-8-400 - STEM FEMORAL 40MM 200MM STR FENST ENDOPRSTH MOORE BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-410 SUP Custom 27803010 6940-8-410 - STEM FEMORAL 41MM 200MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-420 SUP Custom 27803010 6940-8-420 - STEM FEMORAL 42MM 200MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-430 SUP Custom 27803010 6940-8-430 - STEM FEMORAL 43MM 200MM ENDOPRSTH AUSTIN MOORE HIP BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-440 SUP Custom 27803010 6940-8-440 - STEM FEMORAL 44MM 200MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-450 SUP Custom 27803010 6940-8-450 - STEM FEMORAL 45MM 200MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-460 SUP Custom 27803010 6940-8-460 - STEM FEMORAL 46MM 200MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-470 SUP Custom 27803010 6940-8-470 - STEM FEMORAL 47MM 200MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-500 SUP Custom 27803010 6940-8-500 - STEM FEMORAL 50MM 200MM ENDOPRSTH STR FENST MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-510 SUP Custom 27803010 6940-8-510 - STEM FEMORAL 51MM 200MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-530 SUP Custom 27803010 6940-8-530 - STEM FEMORAL 53MM 200MM STR FENST AUSTIN MOORE HIP BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-540 SUP Custom 27803010 6940-8-540 - STEM FEMORAL 54MM 200MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-550 SUP Custom 27803010 6940-8-550 - STEM FEMORAL 55MM 200MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-570 SUP Custom 27803010 6940-8-570 - STEM FEMORAL 57MM 200MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-600 SUP Custom 27803010 6940-8-600 - STEM FEMORAL 60MM 200MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-8-630 SUP Custom 27803010 6940-8-630 - STEM FEMORAL 63MM 200MM ENDOPRSTH STR FENST MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-9-380 SUP Custom 27803010 6940-9-380 - STEM FEMORAL 38MM 225MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-9-410 SUP Custom 27803010 6940-9-410 - STEM FEMORAL 41MM 225MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-9-440 SUP Custom 27803010 6940-9-440 - STEM FEMORAL 44MM 225MM ENDOPRSTH STR FENST MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-9-460 SUP Custom 27803010 6940-9-460 - STEM FEMORAL 46MM 225MM STR FENST AUSTIN-MOORE HIP BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-9-480 SUP Custom 27803010 6940-9-480 - STEM FEMORAL 48MM 225MM ENDOPRSTH STR FENST MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-9-490 SUP Custom 27803010 6940-9-490 - STEM FEMORAL 49MM 225MM ENDOPRSTH STR FENST MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-9-510 SUP Custom 27803010 6940-9-510 - STEM FEMORAL 51MM 225MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-9-520 SUP Custom 27803010 6940-9-520 - STEM FEMORAL 52MM 225MM ENDOPRSTH STR FENST MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-9-530 SUP Custom 27803010 6940-9-530 - STEM FEMORAL 53MM 225MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-9-550 SUP Custom 27803010 6940-9-550 - STEM FEMORAL 55MM 225MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-9-570 SUP Custom 27803010 6940-9-570 - STEM FEMORAL 57MM 225MM ENDOPRSTH STR FENST MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6940-9-630 SUP Custom 27803010 6940-9-630 - STEM FEMORAL 63MM 225MM ENDOPRSTH STR FENST FRAC MOORE ODC BOTH IP/OP "$1,544.00" "$1,143.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $274.83 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" $321.79 "$1,544.00" $617.60 "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,544.00" "$1,158.00" "$1,544.00" "$1,544.00" "$1,544.00" $772.00 $772.00 "$1,222.85" "$1,544.00" "$1,235.20" $694.80 "$1,544.00" N/A $895.52 "$1,544.00" $926.40 "$1,544.00" "$1,544.00" "$1,544.00" N/A N/A 6942-5-038 SUP Custom 27803010 6942-5-038 - HEAD UNPLR 38MM STRL UNTRX MDLR EPRSTH HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6942-5-040 SUP Custom 27803010 6942-5-040 - HEAD UNPLR 40MM STRL UNTRX MDLR EPRSTH HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6942-5-041 SUP Custom 27803010 6942-5-041 - HEAD UNPLR 41MM STRL UNTRX MDLR EPRSTH HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6942-5-042 SUP Custom 27803010 6942-5-042 - HEAD UNIPOLAR 42MM MODULAR UNITRAX HIP FEMORAL EXETER V40 BOTH IP/OP $548.00 $406.00 $97.54 "$1,150.00" $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $97.54 $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $114.21 $548.00 $460.00 $548.00 $548.00 "$1,150.00" $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $246.60 $548.00 N/A $317.84 $548.00 $328.80 $548.00 $548.00 $548.00 N/A N/A 6942-5-043 SUP Custom 27803010 6942-5-043 - HEAD UNIPOLAR 43MM MODULAR THOMPSON MOORE ODC OMNIFIT HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6942-5-044 SUP Custom 27803010 6942-5-044 - HEAD UNPLR 44MM UNTRX HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6942-5-045 SUP Custom 27803010 6942-5-045 - HEAD UNIPOLAR 45MM MODULAR UNITRAX HIP FEMORAL EXETER V40 BOTH IP/OP "$1,050.00" $777.00 $186.90 "$1,150.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $186.90 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $218.83 "$1,050.00" $460.00 "$1,050.00" "$1,050.00" "$1,150.00" "$1,050.00" "$1,050.00" $787.50 "$1,050.00" "$1,050.00" "$1,050.00" $525.00 $525.00 $831.60 "$1,050.00" $840.00 $472.50 "$1,050.00" N/A $609.00 "$1,050.00" $630.00 "$1,050.00" "$1,050.00" "$1,050.00" N/A N/A 6942-5-046 SUP Custom 27803010 6942-5-046 - HEAD UNPLR 46MM STRL UNTRX MDLR EPRSTH HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6942-5-047 SUP Custom 27803010 6942-5-047 - HEAD UNIPOLAR 47MM MODULAR UNITRAX HIP FEMORAL EXETER V40 BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6942-5-048 SUP Custom 27803010 6942-5-048 - HEAD UNPLR 48MM STRL UNTRX MDLR EPRSTH HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6942-5-049 SUP Custom 27803010 6942-5-049 - HEAD UNPLR 49MM STRL UNTRX MDLR EPRSTH HIP BOTH IP/OP $548.00 $406.00 $97.54 "$1,150.00" $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $97.54 $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $114.21 $548.00 $460.00 $548.00 $548.00 "$1,150.00" $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $246.60 $548.00 N/A $317.84 $548.00 $328.80 $548.00 $548.00 $548.00 N/A N/A 6942-5-050 SUP Custom 27803010 6942-5-050 - HEAD UNPLR 50MM STRL UNTRX MDLR EPRSTH HIP BOTH IP/OP "$1,050.00" $777.00 $186.90 "$1,150.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $186.90 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $218.83 "$1,050.00" $460.00 "$1,050.00" "$1,050.00" "$1,150.00" "$1,050.00" "$1,050.00" $787.50 "$1,050.00" "$1,050.00" "$1,050.00" $525.00 $525.00 $831.60 "$1,050.00" $840.00 $472.50 "$1,050.00" N/A $609.00 "$1,050.00" $630.00 "$1,050.00" "$1,050.00" "$1,050.00" N/A N/A 6942-5-051 SUP Custom 27803010 6942-5-051 - HEAD UNPLR 51MM STRL UNTRX MDLR EPRSTH HIP BOTH IP/OP $548.00 $406.00 $97.54 "$1,150.00" $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $97.54 $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $114.21 $548.00 $460.00 $548.00 $548.00 "$1,150.00" $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $246.60 $548.00 N/A $317.84 $548.00 $328.80 $548.00 $548.00 $548.00 N/A N/A 6942-5-052 SUP Custom 27803010 6942-5-052 - HEAD UNPLR 52MM STRL UNTRX MDLR EPRSTH HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6942-5-053 SUP Custom 27803010 6942-5-053 - HEAD UNPLR 53MM STRL UNTRX MDLR EPRSTH HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6942-5-054 SUP Custom 27803010 6942-5-054 - HEAD UNPLR 54MM STRL UNTRX MDLR EPRSTH HIP BOTH IP/OP $548.00 $406.00 $97.54 "$1,150.00" $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $97.54 $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $114.21 $548.00 $460.00 $548.00 $548.00 "$1,150.00" $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $246.60 $548.00 N/A $317.84 $548.00 $328.80 $548.00 $548.00 $548.00 N/A N/A 6942-5-055 SUP Custom 27803010 6942-5-055 - HEAD UNPLR 55MM STRL UNTRX MDLR EPRSTH HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6942-5-056 SUP Custom 27803010 6942-5-056 - HEAD UNPLR 56MM STRL UNTRX MDLR EPRSTH HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6942-5-057 SUP Custom 27803010 6942-5-057 - HEAD UNIPOLAR 57MM MODULAR UNITRAX HIP FEMORAL EXETER V40 BOTH IP/OP $548.00 $406.00 $97.54 $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $97.54 $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $114.21 $548.00 $219.20 $548.00 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $246.60 $548.00 N/A $317.84 $548.00 $328.80 $548.00 $548.00 $548.00 N/A N/A 6942-5-058 SUP Custom 27803010 6942-5-058 - HEAD UNPLR 58MM STRL UNTRX MDLR EPRSTH HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6942-5-060 SUP Custom 27803010 6942-5-060 - HEAD UNIPOLAR 60MM MODULAR UNITRAX HIP FEMORAL EXETER V40 BOTH IP/OP $548.00 $406.00 $97.54 $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $97.54 $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $114.21 $548.00 $219.20 $548.00 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $246.60 $548.00 N/A $317.84 $548.00 $328.80 $548.00 $548.00 $548.00 N/A N/A 6942-5-061 SUP Custom 27803010 6942-5-061 - HEAD UNIPOLAR 61MM MODULAR UNITRAX HIP FEMORAL EXETER V40 BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A 6942-5-063 SUP Custom 27803010 6942-5-063 - HEAD UNIPOLAR 63MM MODULAR UNITRAX HIP FEMORAL EXETER V40 BOTH IP/OP $548.00 $406.00 $97.54 $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $97.54 $548.00 $548.00 $548.00 $548.00 $548.00 $548.00 $114.21 $548.00 $219.20 $548.00 $548.00 $548.00 $548.00 $548.00 $411.00 $548.00 $548.00 $548.00 $274.00 $274.00 $434.02 $548.00 $438.40 $246.60 $548.00 N/A $317.84 $548.00 $328.80 $548.00 $548.00 $548.00 N/A N/A 6942-6-010 SUP Custom 27803010 6942-6-010 - SLEEVE CENTERING U PCA +0MM FEM HIP BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 6942-6-020 SUP Custom 27803010 6942-6-020 - SLEEVE CENTERING +5MM UNITRAX PCA HIP FEMUR BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 6942-6-030 SUP Custom 27803010 6942-6-030 - SLEEVE CENTERING +10MM UNITRAX PCA HIP FEMUR BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 6942-6-050 SUP Custom 27803010 6942-6-050 - SLEEVE CENTERING -4MM UNITRAX PCA HIP FEMUR BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 6942-6-060 SUP Custom 27803010 6942-6-060 - SLEEVE CENTERING -4MM UNIPOLAR UNITRAX V40 HIP BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 6942-6-065 SUP Custom 27803010 6942-6-065 - SLEEVE CENTERING +0MM TAPER UNIPOLAR UNITRAX V40 EXETER HIP BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 6942-6-070 SUP Custom 27803010 6942-6-070 - SLEEVE CENTERING +4MM TAPER UNIPOLAR UNITRAX V40 EXETER HIP BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 6942-6-075 SUP Custom 27803010 6942-6-075 - SLEEVE CENTERING +8MM TAPER UNIPOLAR UNITRAX V40 EXETER HIP BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 6942-6-080 SUP Custom 27803010 6942-6-080 - SLEEVE CENTERING +12MM UNIPOLAR UNITRAX V40 HIP BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 6942-7-060 SUP Custom 27803010 6942-7-060 - SLEEVE CENTERING -3MM C TAPER UNITRAX HIP FEMUR BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 6942-7-065 SUP Custom 27803010 6942-7-065 - SLEEVE CENTERING +0MM C TAPER UNITRAX HIP FEMUR BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 6942-7-075 SUP Custom 27803010 6942-7-075 - SLEEVE CENTERING +5MM C TAPER UNITRAX HIP FEMUR BOTH IP/OP $226.00 $167.00 $40.23 $250.00 $226.00 $226.00 $226.00 $226.00 $226.00 $226.00 $40.23 $226.00 $226.00 $226.00 $226.00 $226.00 $226.00 $47.10 $226.00 $100.00 $226.00 $226.00 $250.00 $226.00 $226.00 $169.50 $226.00 $226.00 $226.00 $113.00 $113.00 $178.99 $226.00 $180.80 $101.70 $226.00 N/A $131.08 $226.00 $135.60 $226.00 $226.00 $226.00 N/A N/A 6942-7-080 SUP Custom 27803010 6942-7-080 - SLEEVE CENTERING 7.5MM C TAPER UNITRAX BOTH IP/OP $226.00 $167.00 $40.23 $226.00 $226.00 $226.00 $226.00 $226.00 $226.00 $226.00 $40.23 $226.00 $226.00 $226.00 $226.00 $226.00 $226.00 $47.10 $226.00 $90.40 $226.00 $226.00 $226.00 $226.00 $226.00 $169.50 $226.00 $226.00 $226.00 $113.00 $113.00 $178.99 $226.00 $180.80 $101.70 $226.00 N/A $131.08 $226.00 $135.60 $226.00 $226.00 $226.00 N/A N/A 6942-7-085 SUP Custom 27203010 6942-7-085 - SLEEVE CENTERING +10MM C TAPER UNITRAX HIP FEMUR BOTH IP/OP $226.00 $167.00 $40.23 $250.00 $226.00 $226.00 $226.00 $226.00 $226.00 $226.00 $40.23 $226.00 $226.00 $167.74 $167.74 $174.20 $117.75 $47.10 $226.00 $100.00 $226.00 $226.00 $250.00 $226.00 $226.00 $169.50 $226.00 $226.00 $226.00 $113.00 $113.00 $178.99 $226.00 $180.80 $146.90 $226.00 N/A $131.08 $226.00 $135.60 $226.00 $226.00 $226.00 N/A N/A 6951-0-036 SUP Custom 27803010 6951-0-036 - SHELL ACETAB 40MM PROTRUSIO HIP BOTH IP/OP "$1,326.00" $981.00 $236.03 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $236.03 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $276.35 "$1,326.00" $530.40 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $994.50 "$1,326.00" "$1,326.00" "$1,326.00" $663.00 $663.00 "$1,050.19" "$1,326.00" "$1,060.80" $596.70 "$1,326.00" N/A $769.08 "$1,326.00" $795.60 "$1,326.00" "$1,326.00" "$1,326.00" N/A N/A 6951-0-040 SUP Custom 27803010 6951-0-040 - SHELL ACETAB 48MM 44MM PROTRUSIO HIP BOTH IP/OP "$1,326.00" $981.00 $236.03 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $236.03 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $276.35 "$1,326.00" $530.40 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $994.50 "$1,326.00" "$1,326.00" "$1,326.00" $663.00 $663.00 "$1,050.19" "$1,326.00" "$1,060.80" $596.70 "$1,326.00" N/A $769.08 "$1,326.00" $795.60 "$1,326.00" "$1,326.00" "$1,326.00" N/A N/A 6951-0-045 SUP Custom 27803010 6951-0-045 - SHELL ACETAB 53MM 49MM PROTRUSIO HIP BOTH IP/OP "$1,326.00" $981.00 $236.03 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $236.03 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $276.35 "$1,326.00" $530.40 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $994.50 "$1,326.00" "$1,326.00" "$1,326.00" $663.00 $663.00 "$1,050.19" "$1,326.00" "$1,060.80" $596.70 "$1,326.00" N/A $769.08 "$1,326.00" $795.60 "$1,326.00" "$1,326.00" "$1,326.00" N/A N/A 6951-0-050 SUP Custom 27803010 6951-0-050 - SHELL ACETAB 58MM 54MM PROTRUSIO HIP BOTH IP/OP "$1,326.00" $981.00 $236.03 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $236.03 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $276.35 "$1,326.00" $530.40 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $994.50 "$1,326.00" "$1,326.00" "$1,326.00" $663.00 $663.00 "$1,050.19" "$1,326.00" "$1,060.80" $596.70 "$1,326.00" N/A $769.08 "$1,326.00" $795.60 "$1,326.00" "$1,326.00" "$1,326.00" N/A N/A 6951-0-054 SUP Custom 27803010 6951-0-054 - SHELL ACETAB 62MM 58MM PROTRUSIO HIP BOTH IP/OP "$1,326.00" $981.00 $236.03 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $236.03 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $276.35 "$1,326.00" $530.40 "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" "$1,326.00" $994.50 "$1,326.00" "$1,326.00" "$1,326.00" $663.00 $663.00 "$1,050.19" "$1,326.00" "$1,060.80" $596.70 "$1,326.00" N/A $769.08 "$1,326.00" $795.60 "$1,326.00" "$1,326.00" "$1,326.00" N/A N/A 6955975L SUP HCPCS C1713 6955975L - HOOK SPNL 4.5MM NS VRTX MX LT OFST TI LMN RECON SYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 6955975R SUP HCPCS C1713 6955975R - HOOK SPNL 4.5MM NS VRTX MX RT OFST TI LMN RECON SYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 6955977L SUP HCPCS C1713 6955977L - HOOK SPNL 6MM NS VRTX MX LT OFST TI LMN RECON SYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 6955977R SUP HCPCS C1713 6955977R - HOOK SPNL 6MM NS VRTX MX RT OFST TI LMN RECON SYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 6958718PT SUP HCPCS C1713 6958718PT - SCREW BONE PTHRD 3.5MM 18MM MULTIAX VERTEX MAX GREEN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958720PT SUP HCPCS C1713 6958720PT - SCREW BONE PTHRD 3.5MM 20MM MULTIAX VERTEX MAX GREEN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958722PT SUP HCPCS C1713 6958722PT - SCREW BONE PTHRD 3.5MM 22MM MULTIAX VERTEX MAX GREEN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958724PT SUP HCPCS C1713 6958724PT - SCREW BN P/T 3.5MM 24MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958726PT SUP HCPCS C1713 6958726PT - SCREW BN P/T 3.5MM 26MM GRN NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958728PT SUP HCPCS C1713 6958728PT - SCREW BN P/T 3.5MM 28MM GRN NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958730PT SUP HCPCS C1713 6958730PT - SCREW BN P/T 3.5MM 30MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958732PT SUP HCPCS C1713 6958732PT - SCREW BN P/T 3.5MM 32MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958734PT SUP HCPCS C1713 6958734PT - SCREW BN P/T 3.5MM 34MM GRN NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958736PT SUP HCPCS C1713 6958736PT - SCREW BN P/T 3.5MM 36MM GRN NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958738PT SUP HCPCS C1713 6958738PT - SCREW BN P/T 3.5MM 38MM GRN NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958740PT SUP HCPCS C1713 6958740PT - SCREW BN P/T 3.5MM 40MM GRN NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958742PT SUP HCPCS C1713 6958742PT - SCREW BN P/T 3.5MM 42MM VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958744PT SUP HCPCS C1713 6958744PT - SCREW BN P/T 3.5MM 44MM VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958746PT SUP HCPCS C1713 6958746PT - SCREW BN P/T 3.5MM 46MM VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958748PT SUP HCPCS C1713 6958748PT - SCREW BN P/T 3.5MM 48MM VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958750PT SUP HCPCS C1713 6958750PT - SCREW BN P/T 3.5MM 50MM VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958752PT SUP HCPCS C1713 6958752PT - SCREW BN P/T 3.5MM 52MM VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958818PT SUP HCPCS C1713 6958818PT - SCREW BN P/T 4MM 18MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958820PT SUP HCPCS C1713 6958820PT - SCREW BN P/T 4MM 20MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958822PT SUP HCPCS C1713 6958822PT - SCREW BN P/T 4MM 22MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958824PT SUP HCPCS C1713 6958824PT - SCREW BN P/T 4MM 24MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958826PT SUP HCPCS C1713 6958826PT - SCREW BN P/T 4MM 26MM AU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958828PT SUP HCPCS C1713 6958828PT - SCREW BN P/T 4MM 28MM AU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958830PT SUP HCPCS C1713 6958830PT - SCREW BN P/T 4MM 30MM AU 15MM VRTX MX TI SPNE OCPTL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958832PT SUP HCPCS C1713 6958832PT - SCREW BN P/T 4MM 32MM AU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958834PT SUP HCPCS C1713 6958834PT - SCREW BN P/T 4MM 34MM AU NS VRTX MX MA TI SPNE RECON SYS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958836PT SUP HCPCS C1713 6958836PT - SCREW BN P/T 4MM 36MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958838PT SUP HCPCS C1713 6958838PT - SCREW BN P/T 4MM 38MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958840PT SUP HCPCS C1713 6958840PT - SCREW BN P/T 4MM 40MM AU NS VRTX MX MA TI SPNE THOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958842PT SUP HCPCS C1713 6958842PT - SCREW BN P/T 4MM 42MM AU VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958844PT SUP HCPCS C1713 6958844PT - SCREW BN P/T 4MM 44MM AU VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958846PT SUP HCPCS C1713 6958846PT - SCREW BN P/T 4MM 46MM AU VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958848PT SUP HCPCS C1713 6958848PT - SCREW BN P/T 4MM 48MM AU VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958850PT SUP HCPCS C1713 6958850PT - SCREW BN P/T 4MM 50MM AU VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6958852PT SUP HCPCS C1713 6958852PT - SCREW BN P/T 4MM 52MM AU VRTX MX MA TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 6959420PT SUP HCPCS C1713 6959420PT - SCREW BN P/T 4MM 20MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959422PT SUP HCPCS C1713 6959422PT - SCREW BN P/T 4MM 22MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959424PT SUP HCPCS C1713 6959424PT - SCREW BN P/T 4MM 24MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959426PT SUP HCPCS C1713 6959426PT - SCREW BN P/T 4MM 26MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959428PT SUP HCPCS C1713 6959428PT - SCREW BN P/T 4MM 28MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959430PT SUP HCPCS C1713 6959430PT - SCREW BN P/T 4MM 30MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959432PT SUP HCPCS C1713 6959432PT - SCREW BN P/T 4MM 32MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959434PT SUP HCPCS C1713 6959434PT - SCREW BN P/T 4MM 34MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959436PT SUP HCPCS C1713 6959436PT - SCREW BN P/T 4MM 36MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959438PT SUP HCPCS C1713 6959438PT - SCREW BN P/T 4MM 38MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6959440PT SUP HCPCS C1713 6959440PT - SCREW BN P/T 4MM 40MM MA CNN TI SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 6971250CK SUP HCPCS C1713 6971250CK - DISC INTVRTB 5MM 12MM SPNE CRV BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971270CK SUP HCPCS C1713 6971270CK - DISC INTVRTB 7MM 12MM SPNE CRV BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971450CK SUP HCPCS C1713 6971450CK - DISC INTVRTB 5MM 14MM SPNE CRV BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971470CK SUP HCPCS C1713 6971470CK - DISC INTVRTB 7MM 14MM SPNE CRV BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971480CK SUP HCPCS C1713 6971480CK - DISC INTVRTB 8MM 14MM SPNE CRV BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971650CK SUP HCPCS C1713 6971650CK - DISC INTVRTB 5MM 16MM SPNE CRV BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971670CK SUP HCPCS C1713 6971670CK - DISC INTVRTB 7MM 16MM SPNE CRV BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971680CK SUP HCPCS C1713 6971680CK - DISC INTVRTB 8MM 16MM SPNE CRV BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 6971870CK SUP HCPCS C1713 6971870CK - DISC INTVRTB 7MM 18MM SPNE CRV BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$10,200.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$10,200.00" "$10,200.00" N/A N/A 6971880CK SUP HCPCS C1713 6971880CK - DISC INTVRTB 8MM 18MM SPNE CRV BOTH IP/OP "$10,200.00" "$7,548.00" "$2,024.45" "$10,200.00" "$4,590.00" "$4,590.00" "$4,590.00" "$4,590.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.94" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$2,125.79" "$10,200.00" "$4,080.00" "$5,028.60" "$10,200.00" "$10,200.00" "$10,200.00" "$10,200.00" "$7,650.00" "$10,200.00" "$10,200.00" "$10,200.00" "$5,100.00" "$5,100.00" "$8,078.40" "$10,200.00" "$8,160.00" "$4,590.00" "$2,024.45" N/A "$5,916.00" "$10,200.00" "$6,120.00" "$10,200.00" "$2,125.68" "$10,200.00" N/A N/A 698.600S SUP Custom 27803010 698.600S - MARS 3V Disposable Kit BOTH IP/OP "$7,440.00" "$5,506.00" "$1,324.32" "$7,440.00" "$7,440.00" "$7,440.00" "$7,440.00" "$7,440.00" "$7,440.00" "$7,440.00" "$1,324.32" "$7,440.00" "$7,440.00" "$7,440.00" "$7,440.00" "$7,440.00" "$7,440.00" "$1,550.58" "$7,440.00" "$2,976.00" "$7,440.00" "$7,440.00" "$7,440.00" "$7,440.00" "$7,440.00" "$5,580.00" "$7,440.00" "$7,440.00" "$7,440.00" "$3,720.00" "$3,720.00" "$5,892.48" "$7,440.00" "$5,952.00" "$3,348.00" "$7,440.00" N/A "$4,315.20" "$7,440.00" "$4,464.00" "$7,440.00" "$7,440.00" "$7,440.00" N/A N/A 6980-5-030 SUP Custom 27803010 6980-5-030 - SURFACE ARTICULAR 30MM FIRST STEP KNEE DISTAL BOTH IP/OP "$1,817.00" "$1,345.00" $323.43 "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" $323.43 "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" $378.68 "$1,817.00" $726.80 "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,362.75" "$1,817.00" "$1,817.00" "$1,817.00" $908.50 $908.50 "$1,439.06" "$1,817.00" "$1,453.60" $817.65 "$1,817.00" N/A "$1,053.86" "$1,817.00" "$1,090.20" "$1,817.00" "$1,817.00" "$1,817.00" N/A N/A 6980-5-035 SUP HCPCS C1713 6980-5-035 - STAPLE BONE 35MM FIRST STEP KNEE DISTAL BOTH IP/OP "$1,817.00" "$1,345.00" $360.63 "$1,817.00" $817.65 $817.65 $817.65 $817.65 "$1,817.00" "$1,817.00" "$1,817.00" $378.71 "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" $378.68 "$1,817.00" "$1,817.00" "$1,074.76" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,362.75" "$1,817.00" "$1,817.00" "$1,817.00" $908.50 $908.50 "$1,439.06" "$1,817.00" "$1,453.60" $817.65 $360.63 N/A "$1,053.86" "$1,817.00" "$1,817.00" "$1,817.00" $378.66 "$1,817.00" N/A N/A 6980-5-040 SUP HCPCS C1713 6980-5-040 - STAPLE BONE 40MM FIRST STEP KNEE DISTAL BOTH IP/OP "$1,817.00" "$1,345.00" $360.63 "$1,817.00" $817.65 $817.65 $817.65 $817.65 "$1,817.00" "$1,817.00" "$1,817.00" $378.71 "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" $378.68 "$1,817.00" "$1,817.00" "$1,074.76" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,362.75" "$1,817.00" "$1,817.00" "$1,817.00" $908.50 $908.50 "$1,439.06" "$1,817.00" "$1,453.60" $817.65 $360.63 N/A "$1,053.86" "$1,817.00" "$1,817.00" "$1,817.00" $378.66 "$1,817.00" N/A N/A 6980-5-045 SUP Custom 27803010 6980-5-045 - STAPLE BONE 45MM FIRST STEP KNEE DISTAL BOTH IP/OP "$1,817.00" "$1,345.00" $323.43 "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" $323.43 "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" $378.68 "$1,817.00" $726.80 "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,362.75" "$1,817.00" "$1,817.00" "$1,817.00" $908.50 $908.50 "$1,439.06" "$1,817.00" "$1,453.60" $817.65 "$1,817.00" N/A "$1,053.86" "$1,817.00" "$1,090.20" "$1,817.00" "$1,817.00" "$1,817.00" N/A N/A 6980-5-050 SUP HCPCS C1713 6980-5-050 - STAPLE BONE 50MM FIRST STEP KNEE DISTAL BOTH IP/OP "$1,817.00" "$1,345.00" $360.63 "$1,817.00" $817.65 $817.65 $817.65 $817.65 "$1,817.00" "$1,817.00" "$1,817.00" $378.71 "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" $378.68 "$1,817.00" $726.80 "$1,074.76" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,362.75" "$1,817.00" "$1,817.00" "$1,817.00" $908.50 $908.50 "$1,439.06" "$1,817.00" "$1,453.60" $817.65 $360.63 N/A "$1,053.86" "$1,817.00" "$1,817.00" "$1,817.00" $378.66 "$1,817.00" N/A N/A 6980-5-055 SUP HCPCS C1713 6980-5-055 - STAPLE BONE 55MM FIRST STEP KNEE DISTAL BOTH IP/OP "$1,817.00" "$1,345.00" $360.63 "$1,817.00" $817.65 $817.65 $817.65 $817.65 "$1,817.00" "$1,817.00" "$1,817.00" $378.71 "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" $378.68 "$1,817.00" $726.80 "$1,074.76" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,362.75" "$1,817.00" "$1,817.00" "$1,817.00" $908.50 $908.50 "$1,439.06" "$1,817.00" "$1,453.60" $817.65 $360.63 N/A "$1,053.86" "$1,817.00" "$1,817.00" "$1,817.00" $378.66 "$1,817.00" N/A N/A 6980-5-060 SUP HCPCS C1713 6980-5-060 - STAPLE BONE 60MM FIRST STEP KNEE DISTAL BOTH IP/OP "$1,817.00" "$1,345.00" $360.63 "$1,817.00" $817.65 $817.65 $817.65 $817.65 "$1,817.00" "$1,817.00" "$1,817.00" $378.71 "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" $378.68 "$1,817.00" "$1,817.00" "$1,074.76" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,362.75" "$1,817.00" "$1,817.00" "$1,817.00" $908.50 $908.50 "$1,439.06" "$1,817.00" "$1,453.60" $817.65 $360.63 N/A "$1,053.86" "$1,817.00" "$1,817.00" "$1,817.00" $378.66 "$1,817.00" N/A N/A 6980-5-065 SUP HCPCS C1713 6980-5-065 - STAPLE BONE 65MM FIRST STEP KNEE DISTAL BOTH IP/OP "$1,817.00" "$1,345.00" $360.63 "$1,817.00" $817.65 $817.65 $817.65 $817.65 "$1,817.00" "$1,817.00" "$1,817.00" $378.71 "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" $378.68 "$1,817.00" $726.80 "$1,074.76" "$1,817.00" "$1,817.00" "$1,817.00" "$1,817.00" "$1,362.75" "$1,817.00" "$1,817.00" "$1,817.00" $908.50 $908.50 "$1,439.06" "$1,817.00" "$1,453.60" $817.65 $360.63 N/A "$1,053.86" "$1,817.00" "$1,817.00" "$1,817.00" $378.66 "$1,817.00" N/A N/A 6981-5-060 SUP HCPCS C1713 6981-5-060 - STAPLE BONE 60X15MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" $454.80 $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-5-065 SUP HCPCS C1713 6981-5-065 - STAPLE BONE 65X15MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" $454.80 $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-5-070 SUP HCPCS C1713 6981-5-070 - STAPLE BONE 70X15MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" $454.80 $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-5-075 SUP HCPCS C1713 6981-5-075 - STAPLE BONE 75X15MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" $454.80 $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-5-080 SUP HCPCS C1713 6981-5-080 - STAPLE BONE 80X15MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" "$1,137.00" $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-5-085 SUP HCPCS C1713 6981-5-085 - STAPLE BONE 85X15MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" "$1,137.00" $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-5-090 SUP HCPCS C1713 6981-5-090 - STAPLE BONE 90X15MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" $454.80 $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-6-060 SUP HCPCS C1713 6981-6-060 - STAPLE BONE 60X10MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" $454.80 $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-6-065 SUP HCPCS C1713 6981-6-065 - STAPLE BONE 65X10MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" $454.80 $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-6-070 SUP HCPCS C1713 6981-6-070 - STAPLE BONE 70X10MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" "$1,137.00" $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-6-075 SUP Custom 27803010 6981-6-075 - STAPLE BONE 75X10MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $202.39 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $202.39 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" $454.80 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 "$1,137.00" N/A $659.46 "$1,137.00" $682.20 "$1,137.00" "$1,137.00" "$1,137.00" N/A N/A 6981-6-080 SUP HCPCS C1713 6981-6-080 - STAPLE BONE 80X10MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" "$1,137.00" $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-6-085 SUP HCPCS C1713 6981-6-085 - STAPLE BONE 85X10MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" "$1,137.00" $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-6-090 SUP HCPCS C1713 6981-6-090 - STAPLE BONE 90X10MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" $454.80 $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-7-060 SUP HCPCS C1713 6981-7-060 - STAPLE BONE 60MMX5MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" $454.80 $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-7-065 SUP HCPCS C1713 6981-7-065 - STAPLE BONE 65X5MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" "$1,137.00" $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-7-070 SUP HCPCS C1713 6981-7-070 - STAPLE BONE 70MMX5MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" "$1,137.00" $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-7-075 SUP HCPCS C1713 6981-7-075 - STAPLE BONE 75MMX5MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" $454.80 $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-7-080 SUP HCPCS C1713 6981-7-080 - STAPLE BONE 80MMX5MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" $454.80 $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-7-085 SUP HCPCS C1713 6981-7-085 - STAPLE BONE 85X5MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" $454.80 $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6981-7-090 SUP HCPCS C1713 6981-7-090 - STAPLE BONE 90X5MM FIRST STEP KNEE PROXIMAL BOTH IP/OP "$1,137.00" $841.00 $225.67 "$1,137.00" $511.65 $511.65 $511.65 $511.65 "$1,137.00" "$1,137.00" "$1,137.00" $236.98 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $236.96 "$1,137.00" $454.80 $672.54 "$1,137.00" "$1,137.00" "$1,137.00" "$1,137.00" $852.75 "$1,137.00" "$1,137.00" "$1,137.00" $568.50 $568.50 $900.50 "$1,137.00" $909.60 $511.65 $225.67 N/A $659.46 "$1,137.00" "$1,137.00" "$1,137.00" $236.95 "$1,137.00" N/A N/A 6CN75H SUP Custom 27203010 6CN75H - TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUF DISP INR CNN BOTH IP/OP $94.00 $70.00 $16.68 $117.10 $93.68 $93.68 $93.68 $93.68 $93.68 $93.68 $16.68 $93.68 $93.68 $69.53 $69.53 $72.21 $48.81 $19.52 $93.68 $46.84 $93.68 $93.68 $117.10 $93.68 $93.68 $70.50 $93.68 $93.68 $93.68 $46.84 $46.84 $74.19 $93.68 $74.94 $60.89 $93.68 N/A $54.52 $93.68 $56.21 $93.68 $93.68 $93.68 N/A N/A 6DCFN SUP Custom 27203010 6DCFN - TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUFLS DISP INR BOTH IP/OP $84.00 $62.00 $14.91 $83.74 $83.74 $83.74 $83.74 $83.74 $83.74 $83.74 $14.91 $83.74 $83.74 $62.15 $62.15 $64.55 $43.63 $17.45 $83.74 $33.50 $83.74 $83.74 $83.74 $83.74 $83.74 $63.00 $83.74 $83.74 $83.74 $41.87 $41.87 $66.32 $83.74 $66.99 $54.43 $83.74 N/A $48.72 $83.74 $50.24 $83.74 $83.74 $83.74 N/A N/A 6DFEN SUP Custom 27203010 6DFEN - TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUF DISP INR CNN BOTH IP/OP $99.50 $74.00 $17.70 $99.43 $99.43 $99.43 $99.43 $99.43 $99.43 $99.43 $17.70 $99.43 $99.43 $73.80 $73.80 $76.64 $51.80 $20.72 $99.43 $39.77 $99.43 $99.43 $99.43 $99.43 $99.43 $74.63 $99.43 $99.43 $99.43 $49.72 $49.72 $78.75 $99.43 $79.54 $64.63 $99.43 N/A $57.71 $99.43 $59.66 $99.43 $99.43 $99.43 N/A N/A 6LGT SUP Custom 27203010 6LGT - TUBE 50MM 11.1MM 6.4MM UNCUF LRNTMY SHLY TRCH 6 STRL LATEX BOTH IP/OP $115.00 $85.00 $20.42 $114.73 $114.73 $114.73 $114.73 $114.73 $114.73 $114.73 $20.42 $114.73 $114.73 $85.15 $85.15 $88.43 $59.77 $23.91 $114.73 $45.89 $114.73 $114.73 $114.73 $114.73 $114.73 $86.25 $114.73 $114.73 $114.73 $57.37 $57.37 $90.87 $114.73 $91.78 $74.57 $114.73 N/A $66.70 $114.73 $68.84 $114.73 $114.73 $114.73 N/A N/A 6M02A SUP Custom 27203010 6M02A - SUTURE NONABSORBABLE CV-6 TTC-9 30IN 2 ARM MONOFILAMENT BOTH IP/OP $73.50 $54.00 $13.05 $73.33 $73.33 $73.33 $73.33 $73.33 $73.33 $73.33 $13.05 $73.33 $73.33 $54.43 $54.43 $56.52 $38.20 $15.28 $73.33 $29.33 $73.33 $73.33 $73.33 $73.33 $73.33 $55.13 $73.33 $73.33 $73.33 $36.67 $36.67 $58.08 $73.33 $58.66 $47.66 $73.33 N/A $42.63 $73.33 $44.00 $73.33 $73.33 $73.33 N/A N/A 6SCT SUP Custom 27203010 6SCT - TUBE TRCH 6 8.3MM 6MM 67MM LF SHLY CUF SGL CNN RND TIP OBT BOTH IP/OP $71.50 $53.00 $12.71 $71.38 $71.38 $71.38 $71.38 $71.38 $71.38 $71.38 $12.71 $71.38 $71.38 $52.98 $52.98 $55.02 $37.19 $14.88 $71.38 $58.57 $71.38 $71.38 $71.38 $71.38 $71.38 $53.63 $71.38 $71.38 $71.38 $35.69 $35.69 $56.53 $71.38 $57.10 $46.40 $71.38 N/A $41.47 $71.38 $42.83 $71.38 $71.38 $71.38 N/A N/A 6UN75H SUP Custom 27203010 6UN75H - TUBE TRCH 6 10.8MM 6.4MM 74MM STRL LF SHLY CUFLS DISP INR BOTH IP/OP $89.00 $66.00 $15.77 $104.53 $88.58 $88.58 $88.58 $88.58 $88.58 $88.58 $15.77 $88.58 $88.58 $65.74 $65.74 $68.28 $46.15 $18.46 $88.58 $41.81 $88.58 $88.58 $104.53 $88.58 $88.58 $66.75 $88.58 $88.58 $88.58 $44.29 $44.29 $70.16 $88.58 $70.86 $57.58 $88.58 N/A $51.62 $88.58 $53.15 $88.58 $88.58 $88.58 N/A N/A 70-0007 SUP HCPCS C1713 70-0007 - PLATE BN 5 HL 1ST TARSOMETATARSAL BOTH IP/OP "$1,022.50" $757.00 $202.94 "$1,022.50" $460.13 $460.13 $460.13 $460.13 "$1,022.50" "$1,022.50" "$1,022.50" $213.11 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $213.10 "$1,022.50" "$1,022.50" $604.81 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $766.88 "$1,022.50" "$1,022.50" "$1,022.50" $511.25 $511.25 $809.82 "$1,022.50" $818.00 $460.13 $202.94 N/A $593.05 "$1,022.50" "$1,022.50" "$1,022.50" $213.09 "$1,022.50" N/A N/A 70-0008 SUP HCPCS C1713 70-0008 - PLATE BN 4 HL 1ST TARSOMETATARSAL BOTH IP/OP "$1,022.50" $757.00 $202.94 "$1,022.50" $460.13 $460.13 $460.13 $460.13 "$1,022.50" "$1,022.50" "$1,022.50" $213.11 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $213.10 "$1,022.50" "$1,022.50" $604.81 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $766.88 "$1,022.50" "$1,022.50" "$1,022.50" $511.25 $511.25 $809.82 "$1,022.50" $818.00 $460.13 $202.94 N/A $593.05 "$1,022.50" "$1,022.50" "$1,022.50" $213.09 "$1,022.50" N/A N/A 70-0009 SUP HCPCS C1713 70-0009 - PLATE BN 4 HL 2ND AND 3RD TARSOMETATARSAL BOTH IP/OP "$1,022.50" $757.00 $202.94 "$1,022.50" $460.13 $460.13 $460.13 $460.13 "$1,022.50" "$1,022.50" "$1,022.50" $213.11 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $213.10 "$1,022.50" "$1,022.50" $604.81 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $766.88 "$1,022.50" "$1,022.50" "$1,022.50" $511.25 $511.25 $809.82 "$1,022.50" $818.00 $460.13 $202.94 N/A $593.05 "$1,022.50" $613.50 "$1,022.50" $213.09 "$1,022.50" N/A N/A 70-0010 SUP HCPCS C1713 70-0010 - PLATE BN LCK LT PROX MTP BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" $768.00 "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0011 SUP HCPCS C1713 70-0011 - PLATE BN LCK RT PROX MTP BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0012 SUP HCPCS C1713 70-0012 - PLATE BN LCK FSN LT DRSL 1ST MTP BOTH IP/OP "$1,022.50" $757.00 $202.94 "$1,022.50" $460.13 $460.13 $460.13 $460.13 "$1,022.50" "$1,022.50" "$1,022.50" $213.11 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $213.10 "$1,022.50" "$1,022.50" $604.81 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $766.88 "$1,022.50" "$1,022.50" "$1,022.50" $511.25 $511.25 $809.82 "$1,022.50" $818.00 $460.13 $202.94 N/A $593.05 "$1,022.50" $613.50 "$1,022.50" $213.09 "$1,022.50" N/A N/A 70-0013 SUP HCPCS C1713 70-0013 - PLATE BN LCK FSN RT DRSL 1ST MTP BOTH IP/OP "$1,022.50" $757.00 $202.94 "$1,022.50" $460.13 $460.13 $460.13 $460.13 "$1,022.50" "$1,022.50" "$1,022.50" $213.11 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $213.10 "$1,022.50" "$1,022.50" $604.81 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $766.88 "$1,022.50" "$1,022.50" "$1,022.50" $511.25 $511.25 $809.82 "$1,022.50" $818.00 $460.13 $202.94 N/A $593.05 "$1,022.50" $613.50 "$1,022.50" $213.09 "$1,022.50" N/A N/A 70-0018 SUP HCPCS C1713 70-0018 - PLATE BN REV LCK FSN LT 1ST MTP BOTH IP/OP "$1,022.50" $757.00 $202.94 "$1,022.50" $460.13 $460.13 $460.13 $460.13 "$1,022.50" "$1,022.50" "$1,022.50" $213.11 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $213.10 "$1,022.50" "$1,022.50" $604.81 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $766.88 "$1,022.50" "$1,022.50" "$1,022.50" $511.25 $511.25 $809.82 "$1,022.50" $818.00 $460.13 $202.94 N/A $593.05 "$1,022.50" $613.50 "$1,022.50" $213.09 "$1,022.50" N/A N/A 70-0019 SUP HCPCS C1713 70-0019 - PLATE BN REV LCK FSN RT 1ST MTP BOTH IP/OP "$1,022.50" $757.00 $202.94 "$1,022.50" $460.13 $460.13 $460.13 $460.13 "$1,022.50" "$1,022.50" "$1,022.50" $213.11 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $213.10 "$1,022.50" "$1,022.50" $604.81 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $766.88 "$1,022.50" "$1,022.50" "$1,022.50" $511.25 $511.25 $809.82 "$1,022.50" $818.00 $460.13 $202.94 N/A $593.05 "$1,022.50" $613.50 "$1,022.50" $213.09 "$1,022.50" N/A N/A 70-0022 SUP HCPCS C1713 70-0022 - PLATE BONE SMALL LP 1.25IN LOCK MINI-CALC TITANIUM CALCANEUS BOTH IP/OP "$3,520.00" "$2,605.00" $698.63 "$3,520.00" "$1,584.00" "$1,584.00" "$1,584.00" "$1,584.00" "$3,520.00" "$3,520.00" "$3,520.00" $733.66 "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" $733.61 "$3,520.00" "$3,520.00" "$1,735.36" "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" "$2,640.00" "$3,520.00" "$3,520.00" "$3,520.00" "$1,760.00" "$1,760.00" "$2,787.84" "$3,520.00" "$2,816.00" "$1,584.00" $698.63 N/A "$2,041.60" "$3,520.00" "$2,112.00" "$3,520.00" $733.57 "$3,520.00" N/A N/A 70-0023 SUP HCPCS C1713 70-0023 - PLATE BONE SMALL 1.25IN LOCKING LP ACUMED RIGHT CALCANEUS BOTH IP/OP "$3,520.00" "$2,605.00" $698.63 "$3,520.00" "$1,584.00" "$1,584.00" "$1,584.00" "$1,584.00" "$3,520.00" "$3,520.00" "$3,520.00" $733.66 "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" $733.61 "$3,520.00" "$3,520.00" "$1,735.36" "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" "$2,640.00" "$3,520.00" "$3,520.00" "$3,520.00" "$1,760.00" "$1,760.00" "$2,787.84" "$3,520.00" "$2,816.00" "$1,584.00" $698.63 N/A "$2,041.60" "$3,520.00" "$2,112.00" "$3,520.00" $733.57 "$3,520.00" N/A N/A 70-0024 SUP HCPCS C1713 70-0024 - PLATE BONE MEDIUM 1.25IN LOCKING LP MINI-CALC LEFT CALCANEUS BOTH IP/OP "$3,520.00" "$2,605.00" $698.63 "$3,520.00" "$1,584.00" "$1,584.00" "$1,584.00" "$1,584.00" "$3,520.00" "$3,520.00" "$3,520.00" $733.66 "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" $733.61 "$3,520.00" "$3,520.00" "$1,735.36" "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" "$2,640.00" "$3,520.00" "$3,520.00" "$3,520.00" "$1,760.00" "$1,760.00" "$2,787.84" "$3,520.00" "$2,816.00" "$1,584.00" $698.63 N/A "$2,041.60" "$3,520.00" "$2,112.00" "$3,520.00" $733.57 "$3,520.00" N/A N/A 70-0025 SUP HCPCS C1713 70-0025 - PLATE BONE MEDIUM LP 1.25MM LOCK DESIGN MINI-CALC CALCANEUS BOTH IP/OP "$3,520.00" "$2,605.00" $698.63 "$3,520.00" "$1,584.00" "$1,584.00" "$1,584.00" "$1,584.00" "$3,520.00" "$3,520.00" "$3,520.00" $733.66 "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" $733.61 "$3,520.00" "$3,520.00" "$1,735.36" "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" "$2,640.00" "$3,520.00" "$3,520.00" "$3,520.00" "$1,760.00" "$1,760.00" "$2,787.84" "$3,520.00" "$2,816.00" "$1,584.00" $698.63 N/A "$2,041.60" "$3,520.00" "$2,112.00" "$3,520.00" $733.57 "$3,520.00" N/A N/A 70-0026 SUP HCPCS C1713 70-0026 - PLATE BONE LARGE 1.25IN LOCKING LP MINI-CALC LEFT CALCANEUS BOTH IP/OP "$3,520.00" "$2,605.00" $698.63 "$3,520.00" "$1,584.00" "$1,584.00" "$1,584.00" "$1,584.00" "$3,520.00" "$3,520.00" "$3,520.00" $733.66 "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" $733.61 "$3,520.00" "$3,520.00" "$1,735.36" "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" "$2,640.00" "$3,520.00" "$3,520.00" "$3,520.00" "$1,760.00" "$1,760.00" "$2,787.84" "$3,520.00" "$2,816.00" "$1,584.00" $698.63 N/A "$2,041.60" "$3,520.00" "$2,112.00" "$3,520.00" $733.57 "$3,520.00" N/A N/A 70-0027 SUP HCPCS C1713 70-0027 - PLATE BONE LARGE 1.25IN 7 HOLE LOCKING LP MINI-CALC RIGHT BOTH IP/OP "$3,520.00" "$2,605.00" $698.63 "$3,520.00" "$1,584.00" "$1,584.00" "$1,584.00" "$1,584.00" "$3,520.00" "$3,520.00" "$3,520.00" $733.66 "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" $733.61 "$3,520.00" "$3,520.00" "$1,735.36" "$3,520.00" "$3,520.00" "$3,520.00" "$3,520.00" "$2,640.00" "$3,520.00" "$3,520.00" "$3,520.00" "$1,760.00" "$1,760.00" "$2,787.84" "$3,520.00" "$2,816.00" "$1,584.00" $698.63 N/A "$2,041.60" "$3,520.00" "$2,112.00" "$3,520.00" $733.57 "$3,520.00" N/A N/A 70-0036 SUP HCPCS C1713 70-0036 - PLATE BN MPJ 5 HL CMB FSN LCK LT 1ST MTP BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" $768.00 "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0037 SUP HCPCS C1713 70-0037 - PLATE BONE 5 HOLE LOCK REVISION TITANIUM FRFT MIDFT RIGHT BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" $768.00 "$1,280.00" $266.75 "$1,280.00" N/A N/A 700-04-42A SUP HCPCS C1776 700-04-42A - SHELL ACTB A 42MM STRL TRDNT II SB TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 700-04-44B SUP HCPCS C1776 700-04-44B - SHELL ACTB B 44MM STRL TRDNT II SB TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 700-04-46C SUP HCPCS C1776 700-04-46C - SHELL ACTB C 46MM STRL TRDNT II SB TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 700-04-48D SUP HCPCS C1776 700-04-48D - SHELL ACTB D 48MM STRL TRDNT II SB TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 70-0045 SUP HCPCS C1713 70-0045 - PLATE BN STD NS ACLC LOPRFL LCK SHFT FX ANG SCR HL KWR HL TI BOTH IP/OP "$2,575.00" "$1,906.00" $511.07 "$2,575.00" "$1,158.75" "$1,158.75" "$1,158.75" "$1,158.75" "$2,575.00" "$2,575.00" "$2,575.00" $536.69 "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" $536.66 "$2,575.00" "$1,030.00" "$1,269.48" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$1,931.25" "$2,575.00" "$2,575.00" "$2,575.00" "$1,287.50" "$1,287.50" "$2,039.40" "$2,575.00" "$2,060.00" "$1,158.75" $511.07 N/A "$1,493.50" "$2,575.00" "$1,545.00" "$2,575.00" $536.63 "$2,575.00" N/A N/A 700-04-50D SUP HCPCS C1776 700-04-50D - SHELL ACTB D 50MM STRL TRDNT II SB TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 700-04-52E SUP HCPCS C1776 700-04-52E - SHELL ACTB E 52MM STRL TRDNT II SB TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 700-04-54E SUP HCPCS C1776 700-04-54E - SHELL ACTB E 54MM STRL TRDNT II SB TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 700-04-56F SUP HCPCS C1776 700-04-56F - SHELL ACTB F 56MM STRL TRDNT II SB TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 700-04-58F SUP HCPCS C1776 700-04-58F - SHELL ACTB F 58MM STRL TRDNT II SB TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 70-0046 SUP HCPCS C1713 70-0046 - PLATE BN STD RT DIST VOLR ULN BOTH IP/OP "$2,575.00" "$1,906.00" $511.07 "$2,575.00" "$1,158.75" "$1,158.75" "$1,158.75" "$1,158.75" "$2,575.00" "$2,575.00" "$2,575.00" $536.69 "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" $536.66 "$2,575.00" "$2,575.00" "$1,269.48" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$1,931.25" "$2,575.00" "$2,575.00" "$2,575.00" "$1,287.50" "$1,287.50" "$2,039.40" "$2,575.00" "$2,060.00" "$1,158.75" $511.07 N/A "$1,493.50" "$2,575.00" "$2,575.00" "$2,575.00" $536.63 "$2,575.00" N/A N/A 700-04-60G SUP HCPCS C1776 700-04-60G - SHELL ACTB G 60MM STRL TRDNT II SB TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 700-04-62G SUP HCPCS C1776 700-04-62G - SHELL ACTB G 62MM STRL TRDNT II SB TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 700-04-64H SUP HCPCS C1776 700-04-64H - SHELL ACTB H 64MM STRL TRDNT II SB TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 700-04-66H SUP HCPCS C1776 700-04-66H - SHELL ACTB H 66MM STRL TRDNT II SB TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 70-0047 SUP HCPCS C1713 70-0047 - PLATE BN LNG LG DIST ULN BOTH IP/OP "$2,575.00" "$1,906.00" $511.07 "$2,575.00" "$1,158.75" "$1,158.75" "$1,158.75" "$1,158.75" "$2,575.00" "$2,575.00" "$2,575.00" $536.69 "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" $536.66 "$2,575.00" "$2,575.00" "$1,269.48" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$1,931.25" "$2,575.00" "$2,575.00" "$2,575.00" "$1,287.50" "$1,287.50" "$2,039.40" "$2,575.00" "$2,060.00" "$1,158.75" $511.07 N/A "$1,493.50" "$2,575.00" "$1,545.00" "$2,575.00" $536.63 "$2,575.00" N/A N/A 70-0048 SUP HCPCS C1713 70-0048 - PLATE BN LNG NS ACLC LOPRFL LCK SHFT FX ANG SCR HL KWR HL TI BOTH IP/OP "$2,575.00" "$1,906.00" $511.07 "$2,575.00" "$1,158.75" "$1,158.75" "$1,158.75" "$1,158.75" "$2,575.00" "$2,575.00" "$2,575.00" $536.69 "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" $536.66 "$2,575.00" "$1,030.00" "$1,269.48" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$1,931.25" "$2,575.00" "$2,575.00" "$2,575.00" "$1,287.50" "$1,287.50" "$2,039.40" "$2,575.00" "$2,060.00" "$1,158.75" $511.07 N/A "$1,493.50" "$2,575.00" "$1,545.00" "$2,575.00" $536.63 "$2,575.00" N/A N/A 70-0049 SUP HCPCS C1713 70-0049 - PLATE 8 HOLE LCK BONE 1ST TARSOMETATARSAL BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" $768.00 "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-005 SUP HCPCS C1713 70-005 - PLATE BONE STANDARD ACU-LOC DORSAL DISTAL RADIAL BOTH IP/OP "$2,362.50" "$1,748.00" $468.90 "$2,362.50" "$1,063.13" "$1,063.13" "$1,063.13" "$1,063.13" "$2,362.50" "$2,362.50" "$2,362.50" $492.40 "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" $492.37 "$2,362.50" "$2,362.50" "$1,397.42" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$1,771.88" "$2,362.50" "$2,362.50" "$2,362.50" "$1,181.25" "$1,181.25" "$1,871.10" "$2,362.50" "$1,890.00" "$1,063.13" $468.90 N/A "$1,370.25" "$2,362.50" "$1,417.50" "$2,362.50" $492.35 "$2,362.50" N/A N/A 70-0050 SUP HCPCS C1713 70-0050 - PLATE 7 HOLE LCK BONE 1ST TARSOMETATARSAL BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0051 SUP HCPCS C1713 70-0051 - PLATE 7 HOLE LCK BONE SEC 3RD TARSOMETATARSAL BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0052 SUP HCPCS C1713 70-0052 - PLATE MPJ LOW PROFILE 4 DEGREE L BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0053 SUP HCPCS C1713 70-0053 - PLATE MPJ LOW PROFILE 4 DEGREE R BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0055 SUP HCPCS C1713 70-0055 - PLATE BONE STANDARD .054IN LP WIRE JOYSTICK HOLE LOCK SHAFT BOTH IP/OP "$2,575.00" "$1,906.00" $511.07 "$2,575.00" "$1,158.75" "$1,158.75" "$1,158.75" "$1,158.75" "$2,575.00" "$2,575.00" "$2,575.00" $536.69 "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" $536.66 "$2,575.00" "$2,575.00" "$1,269.48" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$1,931.25" "$2,575.00" "$2,575.00" "$2,575.00" "$1,287.50" "$1,287.50" "$2,039.40" "$2,575.00" "$2,060.00" "$1,158.75" $511.07 N/A "$1,493.50" "$2,575.00" "$2,575.00" "$2,575.00" $536.63 "$2,575.00" N/A N/A 70-0056 SUP HCPCS C1713 70-0056 - PLATE BN STD ACLC TI RT DRSL BOTH IP/OP "$2,575.00" "$1,906.00" $511.07 "$2,575.00" "$1,158.75" "$1,158.75" "$1,158.75" "$1,158.75" "$2,575.00" "$2,575.00" "$2,575.00" $536.69 "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" $536.66 "$2,575.00" "$2,575.00" "$1,269.48" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$1,931.25" "$2,575.00" "$2,575.00" "$2,575.00" "$1,287.50" "$1,287.50" "$2,039.40" "$2,575.00" "$2,060.00" "$1,158.75" $511.07 N/A "$1,493.50" "$2,575.00" "$2,575.00" "$2,575.00" $536.63 "$2,575.00" N/A N/A 70-0057 SUP HCPCS C1713 70-0057 - PLATE BN NAR NS ACLC LOPRFL LCK SHFT FX ANG SCR HL KWR HL TI BOTH IP/OP "$2,575.00" "$1,906.00" $511.07 "$2,575.00" "$1,158.75" "$1,158.75" "$1,158.75" "$1,158.75" "$2,575.00" "$2,575.00" "$2,575.00" $536.69 "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" $536.66 "$2,575.00" "$2,575.00" "$1,269.48" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$1,931.25" "$2,575.00" "$2,575.00" "$2,575.00" "$1,287.50" "$1,287.50" "$2,039.40" "$2,575.00" "$2,060.00" "$1,158.75" $511.07 N/A "$1,493.50" "$2,575.00" "$2,575.00" "$2,575.00" $536.63 "$2,575.00" N/A N/A 70-0058 SUP HCPCS C1713 70-0058 - PLATE BN NAR ACLC RT DRSL BOTH IP/OP "$2,575.00" "$1,906.00" $511.07 "$2,575.00" "$1,158.75" "$1,158.75" "$1,158.75" "$1,158.75" "$2,575.00" "$2,575.00" "$2,575.00" $536.69 "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" $536.66 "$2,575.00" "$2,575.00" "$1,269.48" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$1,931.25" "$2,575.00" "$2,575.00" "$2,575.00" "$1,287.50" "$1,287.50" "$2,039.40" "$2,575.00" "$2,060.00" "$1,158.75" $511.07 N/A "$1,493.50" "$2,575.00" "$2,575.00" "$2,575.00" $536.63 "$2,575.00" N/A N/A 70-0063 SUP HCPCS C1713 70-0063 - PLATE BN STD STRL ACLC XTD BOTH IP/OP "$2,575.00" "$1,906.00" $511.07 "$2,575.00" "$1,158.75" "$1,158.75" "$1,158.75" "$1,158.75" "$2,575.00" "$2,575.00" "$2,575.00" $536.69 "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" $536.66 "$2,575.00" "$2,575.00" "$1,269.48" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$1,931.25" "$2,575.00" "$2,575.00" "$2,575.00" "$1,287.50" "$1,287.50" "$2,039.40" "$2,575.00" "$2,060.00" "$1,158.75" $511.07 N/A "$1,493.50" "$2,575.00" "$1,545.00" "$2,575.00" $536.63 "$2,575.00" N/A N/A 70-0064 SUP HCPCS C1713 70-0064 - PLATE BONE NARROW .54IN WIRE JOYSTICK HOLE LOCK SHAFT SCREW BOTH IP/OP "$2,575.00" "$1,906.00" $511.07 "$2,575.00" "$1,158.75" "$1,158.75" "$1,158.75" "$1,158.75" "$2,575.00" "$2,575.00" "$2,575.00" $536.69 "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" $536.66 "$2,575.00" "$2,575.00" "$1,269.48" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$1,931.25" "$2,575.00" "$2,575.00" "$2,575.00" "$1,287.50" "$1,287.50" "$2,039.40" "$2,575.00" "$2,060.00" "$1,158.75" $511.07 N/A "$1,493.50" "$2,575.00" "$2,575.00" "$2,575.00" $536.63 "$2,575.00" N/A N/A 70-0066 SUP HCPCS C1713 70-0066 - PLATE BONE LP 80MM 6 HOLE MIDSHAFT LOCK ANATOMIC GOLD BOTH IP/OP "$2,315.00" "$1,713.00" $459.47 "$2,315.00" "$1,041.75" "$1,041.75" "$1,041.75" "$1,041.75" "$2,315.00" "$2,315.00" "$2,315.00" $482.50 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" "$2,315.00" "$1,369.32" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" $459.47 N/A "$1,342.70" "$2,315.00" "$2,315.00" "$2,315.00" $482.45 "$2,315.00" N/A N/A 70-0067 SUP HCPCS C1713 70-0067 - PLATE BONE LP 100MM 8 HOLE MIDSHAFT LOCK ANATOMIC GOLD BOTH IP/OP "$2,315.00" "$1,713.00" $459.47 "$2,315.00" "$1,041.75" "$1,041.75" "$1,041.75" "$1,041.75" "$2,315.00" "$2,315.00" "$2,315.00" $482.50 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$1,369.32" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" $459.47 N/A "$1,342.70" "$2,315.00" "$2,315.00" "$2,315.00" $482.45 "$2,315.00" N/A N/A 70-0068 SUP HCPCS C1713 70-0068 - PLATE BONE LP 130MM 10 HOLE MIDSHAFT LOCK ANATOMIC GOLD BOTH IP/OP "$2,315.00" "$1,713.00" $459.47 "$2,315.00" "$1,041.75" "$1,041.75" "$1,041.75" "$1,041.75" "$2,315.00" "$2,315.00" "$2,315.00" $482.50 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$1,369.32" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" $459.47 N/A "$1,342.70" "$2,315.00" "$2,315.00" "$2,315.00" $482.45 "$2,315.00" N/A N/A 70-0069 SUP HCPCS C1713 70-0069 - PLATE BONE 160MM 12 HOLE MIDSHAFT ANATOMIC TITANIUM VOLAR BOTH IP/OP "$2,315.00" "$1,713.00" $459.47 "$2,315.00" "$1,041.75" "$1,041.75" "$1,041.75" "$1,041.75" "$2,315.00" "$2,315.00" "$2,315.00" $482.50 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" "$2,315.00" "$1,369.32" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" $459.47 N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" $482.45 "$2,315.00" N/A N/A 70-0070 SUP HCPCS C1713 70-0070 - PLATE BN 80MM NS 6 HL MIDSHAFT LOPRFL ULNA BOTH IP/OP "$2,315.00" "$1,713.00" $459.47 "$2,315.00" "$1,041.75" "$1,041.75" "$1,041.75" "$1,041.75" "$2,315.00" "$2,315.00" "$2,315.00" $482.50 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$1,369.32" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" $459.47 N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" $482.45 "$2,315.00" N/A N/A 70-0071 SUP HCPCS C1713 70-0071 - PLATE BN 100MM NS 8 HL MIDSHAFT LOPRFL ULNA BOTH IP/OP "$2,315.00" "$1,713.00" $459.47 "$2,315.00" "$1,041.75" "$1,041.75" "$1,041.75" "$1,041.75" "$2,315.00" "$2,315.00" "$2,315.00" $482.50 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" "$2,315.00" "$1,369.32" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" $459.47 N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" $482.45 "$2,315.00" N/A N/A 70-0072 SUP HCPCS C1713 70-0072 - PLATE BONE 130MM 10 HOLE MIDSHAFT ANATOMIC TITANIUM ULNA BOTH IP/OP "$2,315.00" "$1,713.00" $459.47 "$2,315.00" "$1,041.75" "$1,041.75" "$1,041.75" "$1,041.75" "$2,315.00" "$2,315.00" "$2,315.00" $482.50 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" "$2,315.00" "$1,369.32" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" $459.47 N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" $482.45 "$2,315.00" N/A N/A 70-0073 SUP HCPCS C1713 70-0073 - PLATE BONE 160MM 12 HOLE MIDSHAFT ANATOMIC TITANIUM ULNA BOTH IP/OP "$2,315.00" "$1,713.00" $459.47 "$2,315.00" "$1,041.75" "$1,041.75" "$1,041.75" "$1,041.75" "$2,315.00" "$2,315.00" "$2,315.00" $482.50 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" "$2,315.00" "$1,369.32" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" $459.47 N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" $482.45 "$2,315.00" N/A N/A 70-0074 SUP HCPCS C1713 70-0074 - PLATE BONE LP 80MM 6 HOLE MIDSHAFT LOCK ANATOMIC LIGHT BLUE BOTH IP/OP "$2,315.00" "$1,713.00" $459.47 "$2,315.00" "$1,041.75" "$1,041.75" "$1,041.75" "$1,041.75" "$2,315.00" "$2,315.00" "$2,315.00" $482.50 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" "$2,315.00" "$1,369.32" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" $459.47 N/A "$1,342.70" "$2,315.00" "$1,389.00" "$2,315.00" $482.45 "$2,315.00" N/A N/A 70-0075 SUP HCPCS C1713 70-0075 - PLATE BN 100MM NS 8 HL MIDSHAFT LOPRFL RDS DORSOLATERAL BOTH IP/OP "$2,315.00" "$1,713.00" $459.47 "$2,315.00" "$1,041.75" "$1,041.75" "$1,041.75" "$1,041.75" "$2,315.00" "$2,315.00" "$2,315.00" $482.50 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" "$2,315.00" "$1,369.32" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" $459.47 N/A "$1,342.70" "$2,315.00" "$2,315.00" "$2,315.00" $482.45 "$2,315.00" N/A N/A 70-0076 SUP HCPCS C1713 70-0076 - PLATE BONE 130MM 10 HOLE MIDSHAFT TITANIUM DORSOLATERAL RAD BOTH IP/OP "$2,315.00" "$1,713.00" $459.47 "$2,315.00" "$1,041.75" "$1,041.75" "$1,041.75" "$1,041.75" "$2,315.00" "$2,315.00" "$2,315.00" $482.50 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" "$2,315.00" "$1,369.32" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" $459.47 N/A "$1,342.70" "$2,315.00" "$2,315.00" "$2,315.00" $482.45 "$2,315.00" N/A N/A 70-0077 SUP HCPCS C1713 70-0077 - PLATE BONE 160MM 12 HOLE MIDSHAFT TITANIUM DORSOLATERAL RAD BOTH IP/OP "$2,315.00" "$1,713.00" $459.47 "$2,315.00" "$1,041.75" "$1,041.75" "$1,041.75" "$1,041.75" "$2,315.00" "$2,315.00" "$2,315.00" $482.50 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" "$2,315.00" "$1,369.32" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" $459.47 N/A "$1,342.70" "$2,315.00" "$2,315.00" "$2,315.00" $482.45 "$2,315.00" N/A N/A 70-0078 SUP HCPCS C1713 70-0078 - PLATE MPJ PETIETE 4 DEGREE L BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0079 SUP HCPCS C1713 70-0079 - PLATE MPJ PETIETE 4 DEGREE R BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0097 SUP HCPCS C1713 70-0097 - PLATE BN STD CRVTR 31MM NS 3 HL LCK RADL HD BOTH IP/OP "$2,652.50" "$1,963.00" $526.45 "$2,652.50" "$1,193.63" "$1,193.63" "$1,193.63" "$1,193.63" "$2,652.50" "$2,652.50" "$2,652.50" $552.85 "$2,652.50" "$2,652.50" "$2,652.50" "$2,652.50" "$2,652.50" $552.81 "$2,652.50" "$2,652.50" "$1,307.68" "$2,652.50" "$2,652.50" "$2,652.50" "$2,652.50" "$1,989.38" "$2,652.50" "$2,652.50" "$2,652.50" "$1,326.25" "$1,326.25" "$2,100.78" "$2,652.50" "$2,122.00" "$1,193.63" $526.45 N/A "$1,538.45" "$2,652.50" "$2,652.50" "$2,652.50" $552.78 "$2,652.50" N/A N/A 70-0098 SUP HCPCS C1713 70-0098 - PLATE BN 5 HLE/HD LCK RDS BOTH IP/OP "$2,652.50" "$1,963.00" $526.45 "$2,652.50" "$1,193.63" "$1,193.63" "$1,193.63" "$1,193.63" "$2,652.50" "$2,652.50" "$2,652.50" $552.85 "$2,652.50" "$2,652.50" "$2,652.50" "$2,652.50" "$2,652.50" $552.81 "$2,652.50" "$2,652.50" "$1,307.68" "$2,652.50" "$2,652.50" "$2,652.50" "$2,652.50" "$1,989.38" "$2,652.50" "$2,652.50" "$2,652.50" "$1,326.25" "$1,326.25" "$2,100.78" "$2,652.50" "$2,122.00" "$1,193.63" $526.45 N/A "$1,538.45" "$2,652.50" "$2,652.50" "$2,652.50" $552.78 "$2,652.50" N/A N/A 70-0099 SUP HCPCS C1713 70-0099 - PLATE BN SM CRV 3 HL LCK RDS HD BOTH IP/OP "$2,652.50" "$1,963.00" $526.45 "$2,652.50" "$1,193.63" "$1,193.63" "$1,193.63" "$1,193.63" "$2,652.50" "$2,652.50" "$2,652.50" $552.85 "$2,652.50" "$2,652.50" "$2,652.50" "$2,652.50" "$2,652.50" $552.81 "$2,652.50" "$1,061.00" "$1,307.68" "$2,652.50" "$2,652.50" "$2,652.50" "$2,652.50" "$1,989.38" "$2,652.50" "$2,652.50" "$2,652.50" "$1,326.25" "$1,326.25" "$2,100.78" "$2,652.50" "$2,122.00" "$1,193.63" $526.45 N/A "$1,538.45" "$2,652.50" "$1,591.50" "$2,652.50" $552.78 "$2,652.50" N/A N/A 7000AC SUP Custom 27803010 7000AC - CLAMP SPNL SPRL R90D BOTH IP/OP "$1,615.50" "$1,195.00" $287.51 "$1,615.25" "$1,615.25" "$1,615.25" "$1,615.25" "$1,615.25" "$1,615.25" "$1,615.25" $287.51 "$1,615.25" "$1,615.25" "$1,615.25" "$1,615.25" "$1,615.25" "$1,615.25" $336.64 "$1,615.25" $646.10 "$1,615.25" "$1,615.25" "$1,615.25" "$1,615.25" "$1,615.25" "$1,211.63" "$1,615.25" "$1,615.25" "$1,615.25" $807.63 $807.63 "$1,279.28" "$1,615.25" "$1,292.20" $726.86 "$1,615.25" N/A $936.99 "$1,615.25" $969.15 "$1,615.25" "$1,615.25" "$1,615.25" N/A N/A 7000OC SUP Custom 27803010 7000OC - CLIP FX SPRL R90D OFST CRNL BOTH IP/OP "$2,148.00" "$1,590.00" $382.29 "$2,147.68" "$2,147.68" "$2,147.68" "$2,147.68" "$2,147.68" "$2,147.68" "$2,147.68" $382.29 "$2,147.68" "$2,147.68" "$2,147.68" "$2,147.68" "$2,147.68" "$2,147.68" $447.60 "$2,147.68" $859.07 "$2,147.68" "$2,147.68" "$2,147.68" "$2,147.68" "$2,147.68" "$1,611.00" "$2,147.68" "$2,147.68" "$2,147.68" "$1,073.84" "$1,073.84" "$1,700.96" "$2,147.68" "$1,718.14" $966.46 "$2,147.68" N/A "$1,245.84" "$2,147.68" "$1,288.61" "$2,147.68" "$2,147.68" "$2,147.68" N/A N/A 7000SOL SUP HCPCS C1713 7000SOL - SCREW BN LG SPRL R90D OFST TI THORLMBR SPNE BOTH IP/OP "$1,534.50" "$1,136.00" $304.54 "$1,534.38" $690.47 $690.47 $690.47 $690.47 "$1,534.38" "$1,534.38" "$1,534.38" $319.80 "$1,534.38" "$1,534.38" "$1,534.38" "$1,534.38" "$1,534.38" $319.78 "$1,534.38" $613.75 $907.59 "$1,534.38" "$1,534.38" "$1,534.38" "$1,534.38" "$1,150.88" "$1,534.38" "$1,534.38" "$1,534.38" $767.19 $767.19 "$1,215.23" "$1,534.38" "$1,227.50" $690.47 $304.54 N/A $890.01 "$1,534.38" "$1,534.38" "$1,534.38" $319.76 "$1,534.38" N/A N/A 7000SOS SUP HCPCS C1713 7000SOS - SCREW BN SHRT SPRL R90D OFST TI THORLMBR SPNE BOTH IP/OP "$1,534.50" "$1,136.00" $304.54 "$1,534.38" $690.47 $690.47 $690.47 $690.47 "$1,534.38" "$1,534.38" "$1,534.38" $319.80 "$1,534.38" "$1,534.38" "$1,534.38" "$1,534.38" "$1,534.38" $319.78 "$1,534.38" "$1,534.38" $907.59 "$1,534.38" "$1,534.38" "$1,534.38" "$1,534.38" "$1,150.88" "$1,534.38" "$1,534.38" "$1,534.38" $767.19 $767.19 "$1,215.23" "$1,534.38" "$1,227.50" $690.47 $304.54 N/A $890.01 "$1,534.38" "$1,534.38" "$1,534.38" $319.76 "$1,534.38" N/A N/A 70-0100 SUP HCPCS C1713 70-0100 - PLATE BONE SMALL CURVE 5 HOLE LOCK RADIAL HEAD STERILE BOTH IP/OP "$2,652.50" "$1,963.00" $526.45 "$2,652.50" "$1,193.63" "$1,193.63" "$1,193.63" "$1,193.63" "$2,652.50" "$2,652.50" "$2,652.50" $552.85 "$2,652.50" "$2,652.50" "$2,652.50" "$2,652.50" "$2,652.50" $552.81 "$2,652.50" "$2,652.50" "$1,307.68" "$2,652.50" "$2,652.50" "$2,652.50" "$2,652.50" "$1,989.38" "$2,652.50" "$2,652.50" "$2,652.50" "$1,326.25" "$1,326.25" "$2,100.78" "$2,652.50" "$2,122.00" "$1,193.63" $526.45 N/A "$1,538.45" "$2,652.50" "$2,652.50" "$2,652.50" $552.78 "$2,652.50" N/A N/A 70-0109 SUP HCPCS C1713 70-0109 - PLATE BONE LEFT TIB MTP BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0110 SUP HCPCS C1713 70-0110 - PLATE BONE RIGHT TIB MTP BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0111 SUP HCPCS C1713 70-0111 - PLATE BN 12 HL LCK LT DIST 3.5 MM SCR BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,057.50" "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0112 SUP HCPCS C1713 70-0112 - PLATE BN 12 HL LCK LT DIST 3.5 MM SCR BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0116 SUP HCPCS C1713 70-0116 - PLATE BN 9 HL LCK LT DIST 3.5 MM SCR BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0117 SUP HCPCS C1713 70-0117 - PLATE BN DIST CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0118 SUP HCPCS C1713 70-0118 - PLATE BN 8 HL LAT ANT BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0119 SUP HCPCS C1713 70-0119 - PLATE BN 8 HL LCK ANT MDL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,057.50" "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0120 SUP HCPCS C1713 70-0120 - PLATE BN 6 HL LCK ANT MDL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,057.50" "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0121 SUP HCPCS C1713 70-0121 - PLATE BN 10 HL ANT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,057.50" "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0122 SUP HCPCS C1713 70-0122 - PLATE BN 6 HL LCK ANT LAT BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,057.50" "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0123 SUP HCPCS C1713 70-0123 - PLATE BN 16 HL LCK RT DIST 2.3 MM SCR BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,057.50" "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0124 SUP HCPCS C1713 70-0124 - PLATE BN 101X11MM NS 16 HL LCK LOPRFL TI CLVCL LT DIST 2.3MM BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0125 SUP HCPCS C1713 70-0125 - PLATE BN 13 HL LCK RT DIST 2.3 MM SCR BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0126 SUP HCPCS C1713 70-0126 - PLATE BN 68X11MM NS 13 HL LCK LOPRFL TI CLVCL LT DIST 2.3MM BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,057.50" "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0141 SUP HCPCS C1713 70-0141 - PLATE 4D BONE LEFT MTP BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0142 SUP HCPCS C1713 70-0142 - PLATE 4D BONE RIGHT MTP BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0143 SUP HCPCS C1713 70-0143 - PLATE REV BONE LEFT MTP BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" "$1,280.00" $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0144 SUP HCPCS C1713 70-0144 - PLATE REV BONE RIGHT MTP BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" $512.00 $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0145 SUP HCPCS C1713 70-0145 - PLATE BONE LP 5 HOLE LOCK TYPE II ANODIZE FINISH ANKLE BOTH IP/OP "$3,222.50" "$2,385.00" $639.59 "$3,222.50" "$1,450.13" "$1,450.13" "$1,450.13" "$1,450.13" "$3,222.50" "$3,222.50" "$3,222.50" $671.65 "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" $671.60 "$3,222.50" "$1,289.00" "$1,588.69" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$2,416.88" "$3,222.50" "$3,222.50" "$3,222.50" "$1,611.25" "$1,611.25" "$2,552.22" "$3,222.50" "$2,578.00" "$1,450.13" $639.59 N/A "$1,869.05" "$3,222.50" "$3,222.50" "$3,222.50" $671.57 "$3,222.50" N/A N/A 70-0147 SUP HCPCS C1713 70-0147 - PLATE BONE LP 7 HOLE LOCK TYPE II ANODIZE FINISH ANKLE BOTH IP/OP "$3,222.50" "$2,385.00" $639.59 "$3,222.50" "$1,450.13" "$1,450.13" "$1,450.13" "$1,450.13" "$3,222.50" "$3,222.50" "$3,222.50" $671.65 "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" $671.60 "$3,222.50" "$1,289.00" "$1,588.69" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$2,416.88" "$3,222.50" "$3,222.50" "$3,222.50" "$1,611.25" "$1,611.25" "$2,552.22" "$3,222.50" "$2,578.00" "$1,450.13" $639.59 N/A "$1,869.05" "$3,222.50" "$3,222.50" "$3,222.50" $671.57 "$3,222.50" N/A N/A 70-0149 SUP HCPCS C1713 70-0149 - PLATE BONE LP 9 HOLE LOCK TYPE II ANODIZE FINISH ANKLE BOTH IP/OP "$3,222.50" "$2,385.00" $639.59 "$3,222.50" "$1,450.13" "$1,450.13" "$1,450.13" "$1,450.13" "$3,222.50" "$3,222.50" "$3,222.50" $671.65 "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" $671.60 "$3,222.50" "$1,289.00" "$1,588.69" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$2,416.88" "$3,222.50" "$3,222.50" "$3,222.50" "$1,611.25" "$1,611.25" "$2,552.22" "$3,222.50" "$2,578.00" "$1,450.13" $639.59 N/A "$1,869.05" "$3,222.50" "$3,222.50" "$3,222.50" $671.57 "$3,222.50" N/A N/A 70-0151 SUP HCPCS C1713 70-0151 - PLATE BONE LP 11 HOLE LOCK TYPE II ANODIZE FINISH ANKLE BOTH IP/OP "$3,222.50" "$2,385.00" $639.59 "$3,222.50" "$1,450.13" "$1,450.13" "$1,450.13" "$1,450.13" "$3,222.50" "$3,222.50" "$3,222.50" $671.65 "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" $671.60 "$3,222.50" "$3,222.50" "$1,588.69" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$2,416.88" "$3,222.50" "$3,222.50" "$3,222.50" "$1,611.25" "$1,611.25" "$2,552.22" "$3,222.50" "$2,578.00" "$1,450.13" $639.59 N/A "$1,869.05" "$3,222.50" "$1,933.50" "$3,222.50" $671.57 "$3,222.50" N/A N/A 70-0153 SUP HCPCS C1713 70-0153 - PLATE BONE LP 13 HOLE LOCK TYPE II ANODIZE FINISH ANKLE BOTH IP/OP "$3,222.50" "$2,385.00" $639.59 "$3,222.50" "$1,450.13" "$1,450.13" "$1,450.13" "$1,450.13" "$3,222.50" "$3,222.50" "$3,222.50" $671.65 "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" $671.60 "$3,222.50" "$3,222.50" "$1,588.69" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$2,416.88" "$3,222.50" "$3,222.50" "$3,222.50" "$1,611.25" "$1,611.25" "$2,552.22" "$3,222.50" "$2,578.00" "$1,450.13" $639.59 N/A "$1,869.05" "$3,222.50" "$3,222.50" "$3,222.50" $671.57 "$3,222.50" N/A N/A 70-0169 SUP HCPCS C1713 70-0169 - PLATE BN STD 9 HL LCK LAT FIB BOTH IP/OP "$3,222.50" "$2,385.00" $639.59 "$3,222.50" "$1,450.13" "$1,450.13" "$1,450.13" "$1,450.13" "$3,222.50" "$3,222.50" "$3,222.50" $671.65 "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" $671.60 "$3,222.50" "$3,222.50" "$1,588.69" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$2,416.88" "$3,222.50" "$3,222.50" "$3,222.50" "$1,611.25" "$1,611.25" "$2,552.22" "$3,222.50" "$2,578.00" "$1,450.13" $639.59 N/A "$1,869.05" "$3,222.50" "$3,222.50" "$3,222.50" $671.57 "$3,222.50" N/A N/A 70-0171 SUP HCPCS C1713 70-0171 - PLATE BONE STANDARD 11 HOLE LOCK TYPE II ANODIZE FINISH BOTH IP/OP "$3,222.50" "$2,385.00" $639.59 "$3,222.50" "$1,450.13" "$1,450.13" "$1,450.13" "$1,450.13" "$3,222.50" "$3,222.50" "$3,222.50" $671.65 "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" $671.60 "$3,222.50" "$1,289.00" "$1,588.69" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$2,416.88" "$3,222.50" "$3,222.50" "$3,222.50" "$1,611.25" "$1,611.25" "$2,552.22" "$3,222.50" "$2,578.00" "$1,450.13" $639.59 N/A "$1,869.05" "$3,222.50" "$3,222.50" "$3,222.50" $671.57 "$3,222.50" N/A N/A 70-0173 SUP HCPCS C1713 70-0173 - PLATE BONE 13 HOLE LOCK TYPE II ANODIZE FINISH ANKLE FIBULA BOTH IP/OP "$3,222.50" "$2,385.00" $639.59 "$3,222.50" "$1,450.13" "$1,450.13" "$1,450.13" "$1,450.13" "$3,222.50" "$3,222.50" "$3,222.50" $671.65 "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" $671.60 "$3,222.50" "$1,289.00" "$1,588.69" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$2,416.88" "$3,222.50" "$3,222.50" "$3,222.50" "$1,611.25" "$1,611.25" "$2,552.22" "$3,222.50" "$2,578.00" "$1,450.13" $639.59 N/A "$1,869.05" "$3,222.50" "$1,933.50" "$3,222.50" $671.57 "$3,222.50" N/A N/A 70-0227 SUP HCPCS C1713 70-0227 - PLATE BONE 7 HOLE LOCKING LP MEDIAL TIBIA ANKLE NONSTRL BOTH IP/OP "$3,222.50" "$2,385.00" $639.59 "$3,222.50" "$1,450.13" "$1,450.13" "$1,450.13" "$1,450.13" "$3,222.50" "$3,222.50" "$3,222.50" $671.65 "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" $671.60 "$3,222.50" "$1,289.00" "$1,588.69" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$2,416.88" "$3,222.50" "$3,222.50" "$3,222.50" "$1,611.25" "$1,611.25" "$2,552.22" "$3,222.50" "$2,578.00" "$1,450.13" $639.59 N/A "$1,869.05" "$3,222.50" "$1,933.50" "$3,222.50" $671.57 "$3,222.50" N/A N/A 70-0229 SUP HCPCS C1713 70-0229 - PLATE BONE 9 HOLE LOCKING LP MEDIAL TIBIA ANKLE NONSTRL BOTH IP/OP "$3,222.50" "$2,385.00" $639.59 "$3,222.50" "$1,450.13" "$1,450.13" "$1,450.13" "$1,450.13" "$3,222.50" "$3,222.50" "$3,222.50" $671.65 "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" $671.60 "$3,222.50" "$3,222.50" "$1,588.69" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$2,416.88" "$3,222.50" "$3,222.50" "$3,222.50" "$1,611.25" "$1,611.25" "$2,552.22" "$3,222.50" "$2,578.00" "$1,450.13" $639.59 N/A "$1,869.05" "$3,222.50" "$1,933.50" "$3,222.50" $671.57 "$3,222.50" N/A N/A 70-0245 SUP HCPCS C1713 70-0245 - PLATE BONE 5 HOLE LOCKING LP ANTERIOR TIBIA ANKLE NONSTRL BOTH IP/OP "$3,222.50" "$2,385.00" $639.59 "$3,222.50" "$1,450.13" "$1,450.13" "$1,450.13" "$1,450.13" "$3,222.50" "$3,222.50" "$3,222.50" $671.65 "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" $671.60 "$3,222.50" "$1,289.00" "$1,588.69" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$2,416.88" "$3,222.50" "$3,222.50" "$3,222.50" "$1,611.25" "$1,611.25" "$2,552.22" "$3,222.50" "$2,578.00" "$1,450.13" $639.59 N/A "$1,869.05" "$3,222.50" "$1,933.50" "$3,222.50" $671.57 "$3,222.50" N/A N/A 70-0247 SUP HCPCS C1713 70-0247 - PLATE BONE 7 HOLE LOCKING LP ANTERIOR TIBIA ANKLE NONSTRL BOTH IP/OP "$3,222.50" "$2,385.00" $639.59 "$3,222.50" "$1,450.13" "$1,450.13" "$1,450.13" "$1,450.13" "$3,222.50" "$3,222.50" "$3,222.50" $671.65 "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" $671.60 "$3,222.50" "$1,289.00" "$1,588.69" "$3,222.50" "$3,222.50" "$3,222.50" "$3,222.50" "$2,416.88" "$3,222.50" "$3,222.50" "$3,222.50" "$1,611.25" "$1,611.25" "$2,552.22" "$3,222.50" "$2,578.00" "$1,450.13" $639.59 N/A "$1,869.05" "$3,222.50" "$3,222.50" "$3,222.50" $671.57 "$3,222.50" N/A N/A 70-0286 SUP HCPCS C1713 70-0286 - PLATE BN 8 HL STRG LOPRFL CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,057.50" "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0287 SUP HCPCS C1713 70-0287 - PLATE BN 8 HL LOPRFL STRG RT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0288 SUP HCPCS C1713 70-0288 - PLATE BN LNG 8 HL LOPRFL LT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0289 SUP HCPCS C1713 70-0289 - PLATE BN LNG 8 HL LOPRFL RT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$1,234.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0290 SUP HCPCS C1713 70-0290 - PLATE BN 8 HL LT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,057.50" "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$1,234.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0291 SUP HCPCS C1713 70-0291 - PLATE BN MED 8 HL LOPRFL RT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,057.50" "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$1,234.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0292 SUP HCPCS C1713 70-0292 - PLATE BN SM 8 HL LOPRFL LT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$1,234.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0293 SUP HCPCS C1713 70-0293 - PLATE BN SM 8 HL LOPRFL RT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$1,234.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0294 SUP HCPCS C1713 70-0294 - PLATE BN LG 121X11MM NS 10 HL LCK MIDSHAFT LOPRFL TI CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,057.50" "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0295 SUP HCPCS C1713 70-0295 - PLATE BN 10 HL LOPRFL RT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,057.50" "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0296 SUP HCPCS C1713 70-0296 - PLATE BN 6 HL LT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,057.50" "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$1,234.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0297 SUP HCPCS C1713 70-0297 - PLATE BN NAR 6 HL LOPRFL RT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,057.50" "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$1,234.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0298 SUP HCPCS C1713 70-0298 - PLATE BN 8 HL STRG LT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$1,234.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0299 SUP HCPCS C1713 70-0299 - PLATE BN NAR 8 HL LOPRFL STRG RT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$1,234.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0300 SUP HCPCS C1713 70-0300 - PLATE BN 8 HL LT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$1,234.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0301 SUP HCPCS C1713 70-0301 - PLATE BN NAR 8 HL LOPRFL RT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0302 SUP HCPCS C1713 70-0302 - PLATE BN STD 65MM NS 3 HL LOPRFL OLCRN LT BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$1,255.00" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$1,882.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0303 SUP HCPCS C1713 70-0303 - PLATE BN STD 65MM NS 3 HL LOPRFL OLCRN RT BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$1,255.00" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$1,882.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0304 SUP HCPCS C1713 70-0304 - PLATE BN STD 90MM NS 5 HL LOPRFL OLCRN LT BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$3,137.50" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$1,882.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0305 SUP HCPCS C1713 70-0305 - PLATE BN STD 90MM NS 5 HL LOPRFL OLCRN RT BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$1,255.00" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$1,882.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0306 SUP HCPCS C1713 70-0306 - PLATE BN STD 110MM NS 7 HL LOPRFL DIST TPR LMT CNTCT OLCRN BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$1,255.00" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$1,882.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0307 SUP HCPCS C1713 70-0307 - PLATE BN STD 110MM NS 7 HL LOPRFL OLCRN RT BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$3,137.50" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$3,137.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0308 SUP HCPCS C1713 70-0308 - PLATE BN STD 150MM NS 11 HL LOPRFL OLCRN LT BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$3,137.50" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$3,137.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0309 SUP HCPCS C1713 70-0309 - PLATE BONE STANDARD 150MM 11 HOLE LP RIGHT OLECRANON ELBOW BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$3,137.50" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$1,882.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0310 SUP HCPCS C1713 70-0310 - PLATE BONE STANDARD 190MM 15 HOLE LP OPTIONAL LEFT OLECRANON BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$3,137.50" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$1,882.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0311 SUP HCPCS C1713 70-0311 - PLATE BONE STANDARD 190MM 15 HOLE PRECONTOUR LP TAP-LOC BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$3,137.50" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$3,137.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0312 SUP HCPCS C1713 70-0312 - PLATE BN 90MM NS 5 HL LOPRFL XTD OLCRN LT BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$1,255.00" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$3,137.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0313 SUP HCPCS C1713 70-0313 - PLATE BN 90MM NS 5 HL LOPRFL XTD OLCRN RT BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$3,137.50" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$1,882.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0314 SUP HCPCS C1713 70-0314 - PLATE BONE 130MM 9 HOLE LP EXTENDED LEFT OLECRANON ELBOW BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$3,137.50" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$1,882.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0315 SUP HCPCS C1713 70-0315 - PLATE BONE 130MM 9 HOLE LP EXTENDED RIGHT OLECRANON ELBOW BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$3,137.50" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$1,882.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0316 SUP HCPCS C1713 70-0316 - PLATE BONE NARROW 85MM 7 HOLE LP OPTIONAL LEFT OLECRANON BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$1,255.00" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$1,882.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0317 SUP HCPCS C1713 70-0317 - PLATE BONE NARROW 85MM 5 HOLE OPTIONAL DISTAL TAPER DESIGN BOTH IP/OP "$3,137.50" "$2,322.00" $622.72 "$3,137.50" "$1,411.88" "$1,411.88" "$1,411.88" "$1,411.88" "$3,137.50" "$3,137.50" "$3,137.50" $653.93 "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" $653.89 "$3,137.50" "$1,255.00" "$1,546.79" "$3,137.50" "$3,137.50" "$3,137.50" "$3,137.50" "$2,353.13" "$3,137.50" "$3,137.50" "$3,137.50" "$1,568.75" "$1,568.75" "$2,484.90" "$3,137.50" "$2,510.00" "$1,411.88" $622.72 N/A "$1,819.75" "$3,137.50" "$1,882.50" "$3,137.50" $653.86 "$3,137.50" N/A N/A 70-0319 SUP HCPCS C1713 70-0319 - PLATE BN J LOPRFL LT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0320 SUP HCPCS C1713 70-0320 - PLATE BN J LOPRFL RT CLVCL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 70-0323 SUP HCPCS C1713 70-0323 - PLATE EXTN OSTMY BONE LEFT BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" $512.00 $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0324 SUP HCPCS C1713 70-0324 - PLATE EXTN OSTMY BONE RIGHT BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" $512.00 $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" $768.00 "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0329 SUP HCPCS C1713 70-0329 - PLATE BN 4D PET LCK MTP LT BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" $512.00 $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" $768.00 "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0330 SUP HCPCS C1713 70-0330 - PLATE BN 4D PET MPJ LCK RT MTP BOTH IP/OP "$1,280.00" $947.00 $254.05 "$1,280.00" $576.00 $576.00 $576.00 $576.00 "$1,280.00" "$1,280.00" "$1,280.00" $266.78 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $266.77 "$1,280.00" $512.00 $757.12 "$1,280.00" "$1,280.00" "$1,280.00" "$1,280.00" $960.00 "$1,280.00" "$1,280.00" "$1,280.00" $640.00 $640.00 "$1,013.76" "$1,280.00" "$1,024.00" $576.00 $254.05 N/A $742.40 "$1,280.00" "$1,280.00" "$1,280.00" $266.75 "$1,280.00" N/A N/A 70-0331 SUP HCPCS C1713 70-0331 - PLATE BONE DIVERGENT ACU-LOC 2 RAD STYLOID NONSTRL BOTH IP/OP "$2,315.00" "$1,713.00" $459.47 "$2,315.00" "$1,041.75" "$1,041.75" "$1,041.75" "$1,041.75" "$2,315.00" "$2,315.00" "$2,315.00" $482.50 "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" $482.47 "$2,315.00" $926.00 "$1,369.32" "$2,315.00" "$2,315.00" "$2,315.00" "$2,315.00" "$1,736.25" "$2,315.00" "$2,315.00" "$2,315.00" "$1,157.50" "$1,157.50" "$1,833.48" "$2,315.00" "$1,852.00" "$1,041.75" $459.47 N/A "$1,342.70" "$2,315.00" "$2,315.00" "$2,315.00" $482.45 "$2,315.00" N/A N/A 70-0334 SUP HCPCS C1713 70-0334 - PLATE BN NS ACLC 2 SUT RDS LUNATE VOLR DIST BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,237.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0335 SUP HCPCS C1713 70-0335 - PLATE BN BTRS NS ACLC 2 RIM RDS RT DIST DRSL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,237.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0336 SUP HCPCS C1713 70-0336 - PLATE BONE BUTTRESS RIM ACU-LOC 2 LEFT DISTAL DORSAL RADIAL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0337 SUP HCPCS C1713 70-0337 - PLATE FRAC SYS BTRS RIM BONE RIGHT DISTAL DORSAL LUNATE RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0338 SUP HCPCS C1713 70-0338 - PLATE BONE ACU-LOC 2 LEFT DISTAL DORSAL VOLAR LUNATE NONSTRL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0350 SUP HCPCS C1713 70-0350 - PLATE BN STD 49X24MM NS ACLC 2 VA RDS LT VOLR DIST 2.3MM SCR BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0351 SUP HCPCS C1713 70-0351 - PLATE BN STD 49X24MM NS ACLC 2 VA RDS RT VOLR DIST 2.3MM SCR BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0352 SUP HCPCS C1713 70-0352 - PLATE LNG NAR ACLC 2 BONE PROX DISTAL VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0353 SUP HCPCS C1713 70-0353 - PLATE ACLC BONE RIGHT DISTAL VOLR PROX BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0354 SUP HCPCS C1713 70-0354 - PLATE BN ACLC 2 W LT PROX BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0355 SUP HCPCS C1713 70-0355 - PLATE BN W ACLC 2 RT PROX DIST VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0356 SUP HCPCS C1713 70-0356 - PLATE BN STD SLVR NS ACLC 2 LT DIST VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,237.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0357 SUP HCPCS C1713 70-0357 - PLATE BN STD REG ACLC 2 RT VOLR DIST RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,237.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0358 SUP HCPCS C1713 70-0358 - PLATE BN NAR STRL ACLC 2 LT DIST VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,237.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0359 SUP HCPCS C1713 70-0359 - PLATE BN NAR STRL ACLC 2 RT DIST VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,237.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0360 SUP HCPCS C1713 70-0360 - PLATE BN W STRL ACLC 2 LT DIST VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,237.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0361 SUP HCPCS C1713 70-0361 - PLATE BN W ACLC 2 RT VOLR DIST RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,237.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0364 SUP HCPCS C1713 70-0364 - PLATE NTRL ACLC 2 BONE PROX DISTAL VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0365 SUP HCPCS C1713 70-0365 - PLATE LNG EXTN ACLC 2 BONE LEFT DISTAL VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0366 SUP HCPCS C1713 70-0366 - PLATE LNG EXTN ACLC 2 BONE RIGHT DISTAL VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0368 SUP HCPCS C1713 70-0368 - PLATE BN LNG STD ACLC 2 LT DIST VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,237.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0369 SUP HCPCS C1713 70-0369 - PLATE LNG STD ACLC 2 BONE RIGHT DISTAL RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0370 SUP HCPCS C1713 70-0370 - PLATE LNG NAR ACLC 2 BONE LEFT DISTAL VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0371 SUP HCPCS C1713 70-0371 - PLATE LNG NAR 65MM OPTM DSGN ACLC 2 BONE RIGHT DISTAL VOLR BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0372 SUP HCPCS C1713 70-0372 - PLATE BN LNG STD ACLC 2 LT PROX DIST VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0373 SUP HCPCS C1713 70-0373 - PLATE BN LNG STD ACLC 2 RT PROX DIST VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0374 SUP HCPCS C1713 70-0374 - PLATE 5 HOLE BONE LEFT DISTAL POSTLAT HUM BOTH IP/OP "$3,437.50" "$2,544.00" $682.26 "$3,437.50" "$1,546.88" "$1,546.88" "$1,546.88" "$1,546.88" "$3,437.50" "$3,437.50" "$3,437.50" $716.46 "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" $716.41 "$3,437.50" "$3,437.50" "$1,694.69" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$2,578.13" "$3,437.50" "$3,437.50" "$3,437.50" "$1,718.75" "$1,718.75" "$2,722.50" "$3,437.50" "$2,750.00" "$1,546.88" $682.26 N/A "$1,993.75" "$3,437.50" "$3,437.50" "$3,437.50" $716.38 "$3,437.50" N/A N/A 70-0375 SUP HCPCS C1713 70-0375 - PLATE 78MM 5 HOLE BONE RIGHT P/L HUM BOTH IP/OP "$3,437.50" "$2,544.00" $682.26 "$3,437.50" "$1,546.88" "$1,546.88" "$1,546.88" "$1,546.88" "$3,437.50" "$3,437.50" "$3,437.50" $716.46 "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" $716.41 "$3,437.50" "$3,437.50" "$1,694.69" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$2,578.13" "$3,437.50" "$3,437.50" "$3,437.50" "$1,718.75" "$1,718.75" "$2,722.50" "$3,437.50" "$2,750.00" "$1,546.88" $682.26 N/A "$1,993.75" "$3,437.50" "$3,437.50" "$3,437.50" $716.38 "$3,437.50" N/A N/A 70-0376 SUP HCPCS C1713 70-0376 - PLATE 103MM 7 HOLE BONE LEFT DISTAL POSTLAT HUM NONSTRL BOTH IP/OP "$3,437.50" "$2,544.00" $682.26 "$3,437.50" "$1,546.88" "$1,546.88" "$1,546.88" "$1,546.88" "$3,437.50" "$3,437.50" "$3,437.50" $716.46 "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" $716.41 "$3,437.50" "$1,375.00" "$1,694.69" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$2,578.13" "$3,437.50" "$3,437.50" "$3,437.50" "$1,718.75" "$1,718.75" "$2,722.50" "$3,437.50" "$2,750.00" "$1,546.88" $682.26 N/A "$1,993.75" "$3,437.50" "$3,437.50" "$3,437.50" $716.38 "$3,437.50" N/A N/A 70-0377 SUP HCPCS C1713 70-0377 - PLATE 7 HOLE BONE RIGHT DISTAL POSTLAT HUM BOTH IP/OP "$3,437.50" "$2,544.00" $682.26 "$3,437.50" "$1,546.88" "$1,546.88" "$1,546.88" "$1,546.88" "$3,437.50" "$3,437.50" "$3,437.50" $716.46 "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" $716.41 "$3,437.50" "$1,375.00" "$1,694.69" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$2,578.13" "$3,437.50" "$3,437.50" "$3,437.50" "$1,718.75" "$1,718.75" "$2,722.50" "$3,437.50" "$2,750.00" "$1,546.88" $682.26 N/A "$1,993.75" "$3,437.50" "$3,437.50" "$3,437.50" $716.38 "$3,437.50" N/A N/A 70-0378 SUP HCPCS C1713 70-0378 - PLATE 152MM 11 HOLE BONE LEFT DISTAL POSTLAT HUM NONSTRL BOTH IP/OP "$3,437.50" "$2,544.00" $682.26 "$3,437.50" "$1,546.88" "$1,546.88" "$1,546.88" "$1,546.88" "$3,437.50" "$3,437.50" "$3,437.50" $716.46 "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" $716.41 "$3,437.50" "$3,437.50" "$1,694.69" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$2,578.13" "$3,437.50" "$3,437.50" "$3,437.50" "$1,718.75" "$1,718.75" "$2,722.50" "$3,437.50" "$2,750.00" "$1,546.88" $682.26 N/A "$1,993.75" "$3,437.50" "$3,437.50" "$3,437.50" $716.38 "$3,437.50" N/A N/A 70-0379 SUP HCPCS C1713 70-0379 - PLATE 152MM 11 HOLE BONE RIGHT DISTAL POSTLAT HUM NONSTRL BOTH IP/OP "$3,437.50" "$2,544.00" $682.26 "$3,437.50" "$1,546.88" "$1,546.88" "$1,546.88" "$1,546.88" "$3,437.50" "$3,437.50" "$3,437.50" $716.46 "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" $716.41 "$3,437.50" "$1,375.00" "$1,694.69" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$2,578.13" "$3,437.50" "$3,437.50" "$3,437.50" "$1,718.75" "$1,718.75" "$2,722.50" "$3,437.50" "$2,750.00" "$1,546.88" $682.26 N/A "$1,993.75" "$3,437.50" "$3,437.50" "$3,437.50" $716.38 "$3,437.50" N/A N/A 70-0380 SUP HCPCS C1713 70-0380 - PLATE 203MM 15 HOLE BONE LEFT DISTAL POSTLAT HUM NONSTRL BOTH IP/OP "$3,437.50" "$2,544.00" $682.26 "$3,437.50" "$1,546.88" "$1,546.88" "$1,546.88" "$1,546.88" "$3,437.50" "$3,437.50" "$3,437.50" $716.46 "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" $716.41 "$3,437.50" "$3,437.50" "$1,694.69" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$2,578.13" "$3,437.50" "$3,437.50" "$3,437.50" "$1,718.75" "$1,718.75" "$2,722.50" "$3,437.50" "$2,750.00" "$1,546.88" $682.26 N/A "$1,993.75" "$3,437.50" "$3,437.50" "$3,437.50" $716.38 "$3,437.50" N/A N/A 70-0381 SUP HCPCS C1713 70-0381 - PLATE 203MM 15 HOLE BONE RIGHT DISTAL POSTLAT HUM NONSTRL BOTH IP/OP "$3,437.50" "$2,544.00" $682.26 "$3,437.50" "$1,546.88" "$1,546.88" "$1,546.88" "$1,546.88" "$3,437.50" "$3,437.50" "$3,437.50" $716.46 "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" $716.41 "$3,437.50" "$3,437.50" "$1,694.69" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$2,578.13" "$3,437.50" "$3,437.50" "$3,437.50" "$1,718.75" "$1,718.75" "$2,722.50" "$3,437.50" "$2,750.00" "$1,546.88" $682.26 N/A "$1,993.75" "$3,437.50" "$3,437.50" "$3,437.50" $716.38 "$3,437.50" N/A N/A 70-0382 SUP HCPCS C1713 70-0382 - PLATE NAR LNG ACLC 2 BONE LEFT PROX DISTAL VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0383 SUP HCPCS C1713 70-0383 - PLATE LNG NAR ACLC 2 BONE LEFT PROX DISTAL VOLR RADL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70-0386 SUP HCPCS C1713 70-0386 - PLATE MED BONE LEFT ANT CALC BOTH IP/OP "$3,052.50" "$2,259.00" $605.84 "$3,052.50" "$1,373.63" "$1,373.63" "$1,373.63" "$1,373.63" "$3,052.50" "$3,052.50" "$3,052.50" $636.22 "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" $636.17 "$3,052.50" "$3,052.50" "$1,504.88" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$2,289.38" "$3,052.50" "$3,052.50" "$3,052.50" "$1,526.25" "$1,526.25" "$2,417.58" "$3,052.50" "$2,442.00" "$1,373.63" $605.84 N/A "$1,770.45" "$3,052.50" "$3,052.50" "$3,052.50" $636.14 "$3,052.50" N/A N/A 70-0387 SUP HCPCS C1713 70-0387 - PLATE MED BONE RIGHT ANT CALC BOTH IP/OP "$3,052.50" "$2,259.00" $605.84 "$3,052.50" "$1,373.63" "$1,373.63" "$1,373.63" "$1,373.63" "$3,052.50" "$3,052.50" "$3,052.50" $636.22 "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" $636.17 "$3,052.50" "$3,052.50" "$1,504.88" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$2,289.38" "$3,052.50" "$3,052.50" "$3,052.50" "$1,526.25" "$1,526.25" "$2,417.58" "$3,052.50" "$2,442.00" "$1,373.63" $605.84 N/A "$1,770.45" "$3,052.50" "$3,052.50" "$3,052.50" $636.14 "$3,052.50" N/A N/A 70-0388 SUP HCPCS C1713 70-0388 - PLATE BONE LEFT ANT CALC BOTH IP/OP "$3,052.50" "$2,259.00" $605.84 "$3,052.50" "$1,373.63" "$1,373.63" "$1,373.63" "$1,373.63" "$3,052.50" "$3,052.50" "$3,052.50" $636.22 "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" $636.17 "$3,052.50" "$3,052.50" "$1,504.88" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$2,289.38" "$3,052.50" "$3,052.50" "$3,052.50" "$1,526.25" "$1,526.25" "$2,417.58" "$3,052.50" "$2,442.00" "$1,373.63" $605.84 N/A "$1,770.45" "$3,052.50" "$3,052.50" "$3,052.50" $636.14 "$3,052.50" N/A N/A 70-0389 SUP HCPCS C1713 70-0389 - PLATE LG BONE RIGHT ANT CALC BOTH IP/OP "$3,052.50" "$2,259.00" $605.84 "$3,052.50" "$1,373.63" "$1,373.63" "$1,373.63" "$1,373.63" "$3,052.50" "$3,052.50" "$3,052.50" $636.22 "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" $636.17 "$3,052.50" "$3,052.50" "$1,504.88" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$2,289.38" "$3,052.50" "$3,052.50" "$3,052.50" "$1,526.25" "$1,526.25" "$2,417.58" "$3,052.50" "$2,442.00" "$1,373.63" $605.84 N/A "$1,770.45" "$3,052.50" "$3,052.50" "$3,052.50" $636.14 "$3,052.50" N/A N/A 70-0394 SUP HCPCS C1713 70-0394 - PLATE LG 5 HOLE TUBE BONE POST CALC BOTH IP/OP "$3,052.50" "$2,259.00" $605.84 "$3,052.50" "$1,373.63" "$1,373.63" "$1,373.63" "$1,373.63" "$3,052.50" "$3,052.50" "$3,052.50" $636.22 "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" $636.17 "$3,052.50" "$3,052.50" "$1,504.88" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$2,289.38" "$3,052.50" "$3,052.50" "$3,052.50" "$1,526.25" "$1,526.25" "$2,417.58" "$3,052.50" "$2,442.00" "$1,373.63" $605.84 N/A "$1,770.45" "$3,052.50" "$3,052.50" "$3,052.50" $636.14 "$3,052.50" N/A N/A 70-0395 SUP HCPCS C1713 70-0395 - PLATE 5 HOLE BONE RIGHT POST CALC BOTH IP/OP "$3,052.50" "$2,259.00" $605.84 "$3,052.50" "$1,373.63" "$1,373.63" "$1,373.63" "$1,373.63" "$3,052.50" "$3,052.50" "$3,052.50" $636.22 "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" $636.17 "$3,052.50" "$3,052.50" "$1,504.88" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$2,289.38" "$3,052.50" "$3,052.50" "$3,052.50" "$1,526.25" "$1,526.25" "$2,417.58" "$3,052.50" "$2,442.00" "$1,373.63" $605.84 N/A "$1,770.45" "$3,052.50" "$3,052.50" "$3,052.50" $636.14 "$3,052.50" N/A N/A 70-0396 SUP HCPCS C1713 70-0396 - PLATE 6 HOLE BONE LEFT POST CALC BOTH IP/OP "$3,052.50" "$2,259.00" $605.84 "$3,052.50" "$1,373.63" "$1,373.63" "$1,373.63" "$1,373.63" "$3,052.50" "$3,052.50" "$3,052.50" $636.22 "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" $636.17 "$3,052.50" "$1,221.00" "$1,504.88" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$2,289.38" "$3,052.50" "$3,052.50" "$3,052.50" "$1,526.25" "$1,526.25" "$2,417.58" "$3,052.50" "$2,442.00" "$1,373.63" $605.84 N/A "$1,770.45" "$3,052.50" "$3,052.50" "$3,052.50" $636.14 "$3,052.50" N/A N/A 70-0397 SUP HCPCS C1713 70-0397 - PLATE 6 HOLE BONE RIGHT POST CALC BOTH IP/OP "$3,052.50" "$2,259.00" $605.84 "$3,052.50" "$1,373.63" "$1,373.63" "$1,373.63" "$1,373.63" "$3,052.50" "$3,052.50" "$3,052.50" $636.22 "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" $636.17 "$3,052.50" "$1,221.00" "$1,504.88" "$3,052.50" "$3,052.50" "$3,052.50" "$3,052.50" "$2,289.38" "$3,052.50" "$3,052.50" "$3,052.50" "$1,526.25" "$1,526.25" "$2,417.58" "$3,052.50" "$2,442.00" "$1,373.63" $605.84 N/A "$1,770.45" "$3,052.50" "$3,052.50" "$3,052.50" $636.14 "$3,052.50" N/A N/A 70-0400 SUP HCPCS C1713 70-0400 - PLATE 8 HOLE BONE LEFT CALC BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 70-0401 SUP HCPCS C1713 70-0401 - PLATE MED 8 HOLE COMBO BONE RIGHT CALC BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 70-0404 SUP HCPCS C1713 70-0404 - PLATE 8 HOLE COMBO BONE LEFT CLVCL BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 70-0405 SUP HCPCS C1713 70-0405 - PLATE 8 HOLE BONE RL NONSTRL BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 70-0406 SUP HCPCS C1713 70-0406 - PLATE 4 HOLE COMBO BONE LEFT CALC BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$1,300.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 70-0407 SUP HCPCS C1713 70-0407 - PLATE LG 9 HOLE COMBO BONE RIGHT CALC BOTH IP/OP "$3,250.00" "$2,405.00" $645.04 "$3,250.00" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$3,250.00" "$3,250.00" "$3,250.00" $677.38 "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.34 "$3,250.00" "$3,250.00" "$1,602.25" "$3,250.00" "$3,250.00" "$3,250.00" "$3,250.00" "$2,437.50" "$3,250.00" "$3,250.00" "$3,250.00" "$1,625.00" "$1,625.00" "$2,574.00" "$3,250.00" "$2,600.00" "$1,462.50" $645.04 N/A "$1,885.00" "$3,250.00" "$3,250.00" "$3,250.00" $677.30 "$3,250.00" N/A N/A 7005-08003 SUP HCPCS C1713 7005-08003 - PLATE BN T .8MM NS LOPRFL TI HND BOTH IP/OP "$1,365.00" "$1,010.00" $270.92 "$1,365.00" $614.25 $614.25 $614.25 $614.25 "$1,365.00" "$1,365.00" "$1,365.00" $284.50 "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" $284.48 "$1,365.00" "$1,365.00" $807.40 "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,023.75" "$1,365.00" "$1,365.00" "$1,365.00" $682.50 $682.50 "$1,081.08" "$1,365.00" "$1,092.00" $614.25 $270.92 N/A $791.70 "$1,365.00" "$1,365.00" "$1,365.00" $284.47 "$1,365.00" N/A N/A 7005-08006 SUP HCPCS C1713 7005-08006 - PLATE BN .8MM NS 6 HL CMPR TI HND BOTH IP/OP "$1,185.00" $877.00 $235.19 "$1,185.00" $533.25 $533.25 $533.25 $533.25 "$1,185.00" "$1,185.00" "$1,185.00" $246.98 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $246.97 "$1,185.00" $474.00 $700.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $533.25 $235.19 N/A $687.30 "$1,185.00" $711.00 "$1,185.00" $246.95 "$1,185.00" N/A N/A 7005-13005 SUP HCPCS C1713 7005-13005 - PLATE BN NS ROT CRRT HND 1.3 MM SCR BOTH IP/OP $945.00 $699.00 $187.56 $945.00 $425.25 $425.25 $425.25 $425.25 $945.00 $945.00 $945.00 $196.96 $945.00 $945.00 $945.00 $945.00 $945.00 $196.95 $945.00 $378.00 $558.97 $945.00 $945.00 $945.00 $945.00 $708.75 $945.00 $945.00 $945.00 $472.50 $472.50 $748.44 $945.00 $756.00 $425.25 $187.56 N/A $548.10 $945.00 $567.00 $945.00 $196.94 $945.00 N/A N/A 7005-13006 SUP HCPCS C1713 7005-13006 - PLATE BONE 6 HOLE COMPRESSION HAND NONSTRL 1.3 MM SCREW BOTH IP/OP "$1,365.00" "$1,010.00" $270.92 "$1,365.00" $614.25 $614.25 $614.25 $614.25 "$1,365.00" "$1,365.00" "$1,365.00" $284.50 "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" $284.48 "$1,365.00" "$1,365.00" $807.40 "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,023.75" "$1,365.00" "$1,365.00" "$1,365.00" $682.50 $682.50 "$1,081.08" "$1,365.00" "$1,092.00" $614.25 $270.92 N/A $791.70 "$1,365.00" $819.00 "$1,365.00" $284.47 "$1,365.00" N/A N/A 7014-5927 SUP HCPCS L8613 7014-5927 - PISTON OSS .6MM 4.25MM SMRT RECON OVR CRMP NTNL FLRPLAS BOTH IP/OP $752.50 $557.00 $156.81 $752.40 $752.40 $752.40 $752.40 $752.40 $752.40 $752.40 $185.70 $752.40 $752.40 $752.40 $752.40 $752.40 $752.40 $156.81 $752.40 $300.96 $752.40 $752.40 $752.40 $752.40 $752.40 $564.38 $752.40 $752.40 $752.40 $376.20 $376.20 $595.90 $752.40 $601.92 $338.58 $752.40 N/A $436.45 $752.40 $451.44 $752.40 $752.40 $752.40 N/A N/A 7014-5928 SUP HCPCS L8613 7014-5928 - PISTON OSS .6MM 4.5MM SMRT NTNL FLRPLAS EAR STPS BOTH IP/OP $752.50 $557.00 $156.81 $752.40 $752.40 $752.40 $752.40 $752.40 $752.40 $752.40 $185.70 $752.40 $752.40 $752.40 $752.40 $752.40 $752.40 $156.81 $752.40 $300.96 $752.40 $752.40 $752.40 $752.40 $752.40 $564.38 $752.40 $752.40 $752.40 $376.20 $376.20 $595.90 $752.40 $601.92 $338.58 $752.40 N/A $436.45 $752.40 $451.44 $752.40 $752.40 $752.40 N/A N/A 7016RR SUP Custom 27803010 7016RR - CONNECTOR ROD 16MM SPRL R90D 2 SD TI THORLMBR SPNE BOTH IP/OP "$2,076.00" "$1,536.00" $369.49 "$2,075.80" "$2,075.80" "$2,075.80" "$2,075.80" "$2,075.80" "$2,075.80" "$2,075.80" $369.49 "$2,075.80" "$2,075.80" "$2,075.80" "$2,075.80" "$2,075.80" "$2,075.80" $432.62 "$2,075.80" $830.32 "$2,075.80" "$2,075.80" "$2,075.80" "$2,075.80" "$2,075.80" "$1,557.00" "$2,075.80" "$2,075.80" "$2,075.80" "$1,037.90" "$1,037.90" "$1,644.03" "$2,075.80" "$1,660.64" $934.11 "$2,075.80" N/A "$1,204.08" "$2,075.80" "$1,245.48" "$2,075.80" "$2,075.80" "$2,075.80" N/A N/A 702-04-42A SUP HCPCS C1776 702-04-42A - SHELL ACTB A 42MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 702-04-44B SUP HCPCS C1776 702-04-44B - SHELL ACTB B 44MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 702-04-46C SUP HCPCS C1776 702-04-46C - SHELL ACTB C 46MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 702-04-48D SUP HCPCS C1776 702-04-48D - SHELL ACTB D 48MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 702-04-50D SUP HCPCS C1776 702-04-50D - SHELL ACTB D 50MM STRL TRDNT II 3 SCR HL CLSTR TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 702-04-52E SUP HCPCS C1776 702-04-52E - SHELL ACTB E 52MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 702-04-54E SUP HCPCS C1776 702-04-54E - SHELL ACTB E 54MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 702-04-56F SUP HCPCS C1776 702-04-56F - SHELL ACTB F 56MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 702-04-58F SUP HCPCS C1776 702-04-58F - SHELL ACTB F 58MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 702-04-60G SUP HCPCS C1776 702-04-60G - SHELL ACTB G 60MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 702-04-62G SUP HCPCS C1776 702-04-62G - SHELL ACTB G 62MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 702-04-64H SUP HCPCS C1776 702-04-64H - SHELL ACTB H 64MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 702-04-66H SUP HCPCS C1776 702-04-66H - SHELL ACTB H 66MM STRL TRDNT II 5 SCR HL CLSTR TRITANIUM HIP BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" $921.00 "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A 702-11-42A SUP HCPCS C1776 702-11-42A - SHELL ACTB A 42MM TRDNT II CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 702-11-44B SUP HCPCS C1776 702-11-44B - SHELL ACTB B 44MM TRDNT II CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 702-11-46C SUP HCPCS C1776 702-11-46C - SHELL ACTB C 46MM TRDNT II CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 702-11-48D SUP HCPCS C1776 702-11-48D - SHELL ACTB D 48MM TRDNT II CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 702-11-50D SUP HCPCS C1776 702-11-50D - SHELL ACTB D 50MM TRDNT II CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 702-11-52E SUP HCPCS C1776 702-11-52E - SHELL ACTB E 52MM TRDNT II CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 702-11-54E SUP HCPCS C1776 702-11-54E - SHELL ACTB E 54MM TRDNT II CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 702-11-56F SUP HCPCS C1776 702-11-56F - SHELL ACTB F 56MM TRDNT II CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 702-11-58F SUP HCPCS C1776 702-11-58F - SHELL ACTB F 58MM STRL TRDNT II CLSTR 5 HL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 702-11-60G SUP HCPCS C1776 702-11-60G - SHELL ACTB G 60MM STRL TRDNT II CLSTR 5 HL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 702-11-62G SUP HCPCS C1776 702-11-62G - SHELL ACTB G 62MM STRL TRDNT II CLSTR 5 HL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 702-11-64H SUP HCPCS C1776 702-11-64H - SHELL ACTB H 64MM STRL TRDNT II CLSTR 5 HL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 702-11-66H SUP HCPCS C1776 702-11-66H - SHELL ACTB H 66MM STRL TRDNT II CLSTR 5 HL HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 702301-5 SUP HCPCS C1713 702301-5 - SCREW BN ALTA CNCT ORTH BOTH IP/OP $186.00 $138.00 $36.84 $185.63 $83.53 $83.53 $83.53 $83.53 $185.63 $185.63 $185.63 $38.69 $185.63 $185.63 $185.63 $185.63 $185.63 $38.69 $185.63 $74.25 $109.80 $185.63 $185.63 $185.63 $185.63 $139.50 $185.63 $185.63 $185.63 $92.82 $92.82 $147.02 $185.63 $148.50 $83.53 $36.84 N/A $107.88 $185.63 $111.38 $185.63 $38.69 $185.63 N/A N/A 702336S SUP HCPCS C1769 702336S - GUIDEWIRE ORTHOPEDIC 3MM 100MM BALL TIP STAINLESS STEEL BOTH IP/OP $260.00 $192.00 $51.58 $259.88 $141.11 $141.11 $141.11 $141.11 $259.88 $259.88 $259.88 $54.17 $259.88 $192.88 $192.88 $200.32 $135.40 $54.16 $259.88 $259.88 $153.72 $259.88 $259.88 $259.88 $259.88 $195.00 $259.88 $259.88 $259.88 $129.94 $129.94 $205.82 $259.88 $207.90 $168.92 $51.58 N/A $150.80 $259.88 $259.88 $259.88 $54.16 $259.88 N/A N/A 702341-2 SUP Custom 27203010 702341-2 - SLEEVE PROTECTION REPLACEMENT BOTH IP/OP $550.00 $407.00 $97.90 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $97.90 $550.00 $550.00 $408.21 $408.21 $423.94 $286.55 $114.63 $550.00 $220.00 $550.00 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $357.50 $550.00 N/A $319.00 $550.00 $330.00 $550.00 $550.00 $550.00 N/A N/A 702460S SUP HCPCS C1769 702460S - GUIDEWIRE ORTHOPEDIC 2MM 150MM THREAD ASNIS III FEMUR HIP BOTH IP/OP $124.50 $92.00 $24.63 $124.10 $67.39 $67.39 $67.39 $67.39 $124.10 $124.10 $124.10 $25.87 $124.10 $92.11 $92.11 $95.66 $64.66 $25.86 $124.10 $124.10 $73.41 $124.10 $124.10 $124.10 $124.10 $93.38 $124.10 $124.10 $124.10 $62.05 $62.05 $98.29 $124.10 $99.28 $80.67 $24.63 N/A $72.21 $124.10 $124.10 $124.10 $25.86 $124.10 N/A N/A 702627S SUP HCPCS C1769 702627S - GUIDEWIRE ORTHOPEDIC 3.2MM 300MM CALIBRATION FITTING STERILE BOTH IP/OP $282.00 $209.00 $55.95 $281.88 $153.06 $153.06 $153.06 $153.06 $281.88 $281.88 $281.88 $58.75 $281.88 $209.21 $209.21 $217.27 $146.86 $58.75 $281.88 $281.88 $166.73 $281.88 $281.88 $281.88 $281.88 $211.50 $281.88 $281.88 $281.88 $140.94 $140.94 $223.25 $281.88 $225.50 $183.22 $55.95 N/A $163.56 $281.88 $169.13 $281.88 $58.74 $281.88 N/A N/A 702716-2 SUP HCPCS C1713 702716-2 - SCREW BONE 4MM AXSOS HUMERAL AIMING BLOCK LOCKING PLATE BOTH IP/OP $95.00 $70.00 $18.83 $94.88 $42.70 $42.70 $42.70 $42.70 $94.88 $94.88 $94.88 $19.78 $94.88 $94.88 $94.88 $94.88 $94.88 $19.77 $94.88 $37.95 $56.12 $94.88 $94.88 $94.88 $94.88 $71.25 $94.88 $94.88 $94.88 $47.44 $47.44 $75.14 $94.88 $75.90 $42.70 $18.83 N/A $55.10 $94.88 $56.93 $94.88 $19.77 $94.88 N/A N/A 702718-2 SUP HCPCS C1713 702718-2 - SCREW BN SET SPR AIM BLCK FEM DIST BOTH IP/OP $99.00 $73.00 $19.65 $99.00 $44.55 $44.55 $44.55 $44.55 $99.00 $99.00 $99.00 $20.63 $99.00 $99.00 $99.00 $99.00 $99.00 $20.63 $99.00 $39.60 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $44.55 $19.65 N/A $57.42 $99.00 $59.40 $99.00 $20.63 $99.00 N/A N/A 702720-2 SUP HCPCS C1713 702720-2 - SCREW BONE 4MM AXSOS TIBIAL AIMING BLOCK LOCKING PLATE BOTH IP/OP $194.00 $144.00 $38.48 $193.88 $87.25 $87.25 $87.25 $87.25 $193.88 $193.88 $193.88 $40.41 $193.88 $193.88 $193.88 $193.88 $193.88 $40.41 $193.88 $77.55 $114.68 $193.88 $193.88 $193.88 $193.88 $145.50 $193.88 $193.88 $193.88 $96.94 $96.94 $153.55 $193.88 $155.10 $87.25 $38.48 N/A $112.52 $193.88 $116.33 $193.88 $40.40 $193.88 N/A N/A 702858-1 SUP Custom 27803010 702858-1 - DRIVER SRG 4MM VARIAX RING HD LCK BOTH IP/OP $571.00 $423.00 $101.57 $570.63 $570.63 $570.63 $570.63 $570.63 $570.63 $570.63 $101.57 $570.63 $570.63 $570.63 $570.63 $570.63 $570.63 $118.93 $570.63 $228.25 $570.63 $570.63 $570.63 $570.63 $570.63 $428.25 $570.63 $570.63 $570.63 $285.32 $285.32 $451.94 $570.63 $456.50 $256.78 $570.63 N/A $331.18 $570.63 $342.38 $570.63 $570.63 $570.63 N/A N/A 702970-2 SUP Custom 27803010 702970-2 - SCREW BONE SPARE SET AXSOS HUMERAL AIMING BLOCK LOCKING BOTH IP/OP $199.50 $148.00 $35.49 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $35.49 $199.38 $199.38 $199.38 $199.38 $199.38 $199.38 $41.55 $199.38 $79.75 $199.38 $199.38 $199.38 $199.38 $199.38 $149.63 $199.38 $199.38 $199.38 $99.69 $99.69 $157.91 $199.38 $159.50 $89.72 $199.38 N/A $115.71 $199.38 $119.63 $199.38 $199.38 $199.38 N/A N/A 70-3003L SUP HCPCS C1776 70-3003L - COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED POST BASIC PRIM BOTH IP/OP "$3,074.00" "$2,275.00" $610.11 "$3,074.00" "$1,383.30" "$1,383.30" "$1,383.30" "$1,383.30" "$3,074.00" "$3,074.00" "$3,074.00" $640.70 "$3,074.00" "$3,074.00" "$3,074.00" "$3,074.00" "$3,074.00" $640.66 "$3,074.00" "$1,229.60" "$1,515.48" "$3,074.00" "$3,074.00" "$3,074.00" "$3,074.00" "$2,305.50" "$3,074.00" "$3,074.00" "$3,074.00" "$1,537.00" "$1,537.00" "$2,434.61" "$3,074.00" "$2,459.20" "$1,383.30" $610.11 N/A "$1,782.92" "$3,074.00" "$3,074.00" "$3,074.00" $640.62 "$3,074.00" N/A N/A 70-3003R SUP HCPCS C1776 70-3003R - COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED POST BASIC PRIM BOTH IP/OP "$3,074.00" "$2,275.00" $610.11 "$3,074.00" "$1,383.30" "$1,383.30" "$1,383.30" "$1,383.30" "$3,074.00" "$3,074.00" "$3,074.00" $640.70 "$3,074.00" "$3,074.00" "$3,074.00" "$3,074.00" "$3,074.00" $640.66 "$3,074.00" "$1,229.60" "$1,515.48" "$3,074.00" "$3,074.00" "$3,074.00" "$3,074.00" "$2,305.50" "$3,074.00" "$3,074.00" "$3,074.00" "$1,537.00" "$1,537.00" "$2,434.61" "$3,074.00" "$2,459.20" "$1,383.30" $610.11 N/A "$1,782.92" "$3,074.00" "$3,074.00" "$3,074.00" $640.62 "$3,074.00" N/A N/A 70-3004L SUP HCPCS C1776 70-3004L - COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED POST BASIC PRIM BOTH IP/OP "$3,029.00" "$2,241.00" $601.18 "$3,029.00" "$1,363.05" "$1,363.05" "$1,363.05" "$1,363.05" "$3,029.00" "$3,029.00" "$3,029.00" $631.32 "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" $631.28 "$3,029.00" "$1,211.60" "$1,493.30" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$2,271.75" "$3,029.00" "$3,029.00" "$3,029.00" "$1,514.50" "$1,514.50" "$2,398.97" "$3,029.00" "$2,423.20" "$1,363.05" $601.18 N/A "$1,756.82" "$3,029.00" "$3,029.00" "$3,029.00" $631.24 "$3,029.00" N/A N/A 70-3004R SUP HCPCS C1776 70-3004R - COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED POST BASIC PRIM BOTH IP/OP "$3,029.00" "$2,241.00" $601.18 "$3,029.00" "$1,363.05" "$1,363.05" "$1,363.05" "$1,363.05" "$3,029.00" "$3,029.00" "$3,029.00" $631.32 "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" $631.28 "$3,029.00" "$3,029.00" "$1,493.30" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$2,271.75" "$3,029.00" "$3,029.00" "$3,029.00" "$1,514.50" "$1,514.50" "$2,398.97" "$3,029.00" "$2,423.20" "$1,363.05" $601.18 N/A "$1,756.82" "$3,029.00" "$3,029.00" "$3,029.00" $631.24 "$3,029.00" N/A N/A 70-3005L SUP HCPCS C1776 70-3005L - COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED POST BASIC PRIM BOTH IP/OP "$3,029.00" "$2,241.00" $601.18 "$3,029.00" "$1,363.05" "$1,363.05" "$1,363.05" "$1,363.05" "$3,029.00" "$3,029.00" "$3,029.00" $631.32 "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" $631.28 "$3,029.00" "$3,029.00" "$1,493.30" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$2,271.75" "$3,029.00" "$3,029.00" "$3,029.00" "$1,514.50" "$1,514.50" "$2,398.97" "$3,029.00" "$2,423.20" "$1,363.05" $601.18 N/A "$1,756.82" "$3,029.00" "$3,029.00" "$3,029.00" $631.24 "$3,029.00" N/A N/A 70-3005R SUP HCPCS C1776 70-3005R - COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED POST BASIC PRIM BOTH IP/OP "$3,029.00" "$2,241.00" $601.18 "$3,029.00" "$1,363.05" "$1,363.05" "$1,363.05" "$1,363.05" "$3,029.00" "$3,029.00" "$3,029.00" $631.32 "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" $631.28 "$3,029.00" "$3,029.00" "$1,493.30" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$2,271.75" "$3,029.00" "$3,029.00" "$3,029.00" "$1,514.50" "$1,514.50" "$2,398.97" "$3,029.00" "$2,423.20" "$1,363.05" $601.18 N/A "$1,756.82" "$3,029.00" "$3,029.00" "$3,029.00" $631.24 "$3,029.00" N/A N/A 70-3006L SUP HCPCS C1776 70-3006L - COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED POST BASIC PRIM BOTH IP/OP "$3,029.00" "$2,241.00" $601.18 "$3,029.00" "$1,363.05" "$1,363.05" "$1,363.05" "$1,363.05" "$3,029.00" "$3,029.00" "$3,029.00" $631.32 "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" $631.28 "$3,029.00" "$3,029.00" "$1,493.30" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$2,271.75" "$3,029.00" "$3,029.00" "$3,029.00" "$1,514.50" "$1,514.50" "$2,398.97" "$3,029.00" "$2,423.20" "$1,363.05" $601.18 N/A "$1,756.82" "$3,029.00" "$3,029.00" "$3,029.00" $631.24 "$3,029.00" N/A N/A 70-3006R SUP HCPCS C1776 70-3006R - COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED POST BASIC PRIM BOTH IP/OP "$3,029.00" "$2,241.00" $601.18 "$3,029.00" "$1,363.05" "$1,363.05" "$1,363.05" "$1,363.05" "$3,029.00" "$3,029.00" "$3,029.00" $631.32 "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" $631.28 "$3,029.00" "$3,029.00" "$1,493.30" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$2,271.75" "$3,029.00" "$3,029.00" "$3,029.00" "$1,514.50" "$1,514.50" "$2,398.97" "$3,029.00" "$2,423.20" "$1,363.05" $601.18 N/A "$1,756.82" "$3,029.00" "$3,029.00" "$3,029.00" $631.24 "$3,029.00" N/A N/A 70-3007L SUP HCPCS C1776 70-3007L - COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED POST BASIC PRIM BOTH IP/OP "$3,029.00" "$2,241.00" $601.18 "$3,029.00" "$1,363.05" "$1,363.05" "$1,363.05" "$1,363.05" "$3,029.00" "$3,029.00" "$3,029.00" $631.32 "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" $631.28 "$3,029.00" "$3,029.00" "$1,493.30" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$2,271.75" "$3,029.00" "$3,029.00" "$3,029.00" "$1,514.50" "$1,514.50" "$2,398.97" "$3,029.00" "$2,423.20" "$1,363.05" $601.18 N/A "$1,756.82" "$3,029.00" "$3,029.00" "$3,029.00" $631.24 "$3,029.00" N/A N/A 70-3007R SUP HCPCS C1776 70-3007R - COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED POST BASIC PRIM BOTH IP/OP "$3,029.00" "$2,241.00" $601.18 "$3,029.00" "$1,363.05" "$1,363.05" "$1,363.05" "$1,363.05" "$3,029.00" "$3,029.00" "$3,029.00" $631.32 "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" $631.28 "$3,029.00" "$3,029.00" "$1,493.30" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$2,271.75" "$3,029.00" "$3,029.00" "$3,029.00" "$1,514.50" "$1,514.50" "$2,398.97" "$3,029.00" "$2,423.20" "$1,363.05" $601.18 N/A "$1,756.82" "$3,029.00" "$3,029.00" "$3,029.00" $631.24 "$3,029.00" N/A N/A 70-3009L SUP HCPCS C1776 70-3009L - COMPONENT FEMORAL 9 CRUCIATE RETAIN CEMENTED POST BASIC PRIM BOTH IP/OP "$3,029.00" "$2,241.00" $601.18 "$3,029.00" "$1,363.05" "$1,363.05" "$1,363.05" "$1,363.05" "$3,029.00" "$3,029.00" "$3,029.00" $631.32 "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" $631.28 "$3,029.00" "$3,029.00" "$1,493.30" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$2,271.75" "$3,029.00" "$3,029.00" "$3,029.00" "$1,514.50" "$1,514.50" "$2,398.97" "$3,029.00" "$2,423.20" "$1,363.05" $601.18 N/A "$1,756.82" "$3,029.00" "$3,029.00" "$3,029.00" $631.24 "$3,029.00" N/A N/A 70-3009R SUP HCPCS C1776 70-3009R - COMPONENT FEMORAL 9 CRUCIATE RETAIN CEMENTED POST BASIC PRIM BOTH IP/OP "$3,029.00" "$2,241.00" $601.18 "$3,029.00" "$1,363.05" "$1,363.05" "$1,363.05" "$1,363.05" "$3,029.00" "$3,029.00" "$3,029.00" $631.32 "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" $631.28 "$3,029.00" "$3,029.00" "$1,493.30" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$2,271.75" "$3,029.00" "$3,029.00" "$3,029.00" "$1,514.50" "$1,514.50" "$2,398.97" "$3,029.00" "$2,423.20" "$1,363.05" $601.18 N/A "$1,756.82" "$3,029.00" "$1,817.40" "$3,029.00" $631.24 "$3,029.00" N/A N/A 70-3011L SUP HCPCS C1776 70-3011L - COMPONENT FEMORAL 11 CRUCIATE RETAIN CEMENTED POST BASIC BOTH IP/OP "$3,029.00" "$2,241.00" $601.18 "$3,029.00" "$1,363.05" "$1,363.05" "$1,363.05" "$1,363.05" "$3,029.00" "$3,029.00" "$3,029.00" $631.32 "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" $631.28 "$3,029.00" "$3,029.00" "$1,493.30" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$2,271.75" "$3,029.00" "$3,029.00" "$3,029.00" "$1,514.50" "$1,514.50" "$2,398.97" "$3,029.00" "$2,423.20" "$1,363.05" $601.18 N/A "$1,756.82" "$3,029.00" "$1,817.40" "$3,029.00" $631.24 "$3,029.00" N/A N/A 70-3011R SUP HCPCS C1776 70-3011R - COMPONENT FEMORAL 11 CRUCIATE RETAIN CEMENTED POST BASIC BOTH IP/OP "$3,029.00" "$2,241.00" $601.18 "$3,029.00" "$1,363.05" "$1,363.05" "$1,363.05" "$1,363.05" "$3,029.00" "$3,029.00" "$3,029.00" $631.32 "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" $631.28 "$3,029.00" "$1,211.60" "$1,493.30" "$3,029.00" "$3,029.00" "$3,029.00" "$3,029.00" "$2,271.75" "$3,029.00" "$3,029.00" "$3,029.00" "$1,514.50" "$1,514.50" "$2,398.97" "$3,029.00" "$2,423.20" "$1,363.05" $601.18 N/A "$1,756.82" "$3,029.00" "$1,817.40" "$3,029.00" $631.24 "$3,029.00" N/A N/A 70-3013L SUP HCPCS C1776 70-3013L - COMPONENT FEMORAL 13 CRUCIATE RETAIN CEMENTED POST BASIC BOTH IP/OP "$3,074.00" "$2,275.00" $610.11 "$3,074.00" "$1,383.30" "$1,383.30" "$1,383.30" "$1,383.30" "$3,074.00" "$3,074.00" "$3,074.00" $640.70 "$3,074.00" "$3,074.00" "$3,074.00" "$3,074.00" "$3,074.00" $640.66 "$3,074.00" "$3,074.00" "$1,515.48" "$3,074.00" "$3,074.00" "$3,074.00" "$3,074.00" "$2,305.50" "$3,074.00" "$3,074.00" "$3,074.00" "$1,537.00" "$1,537.00" "$2,434.61" "$3,074.00" "$2,459.20" "$1,383.30" $610.11 N/A "$1,782.92" "$3,074.00" "$1,844.40" "$3,074.00" $640.62 "$3,074.00" N/A N/A 70-3013R SUP HCPCS C1776 70-3013R - COMPONENT FEMORAL 13 CRUCIATE RETAIN CEMENTED POST BASIC BOTH IP/OP "$3,074.00" "$2,275.00" $610.11 "$3,074.00" "$1,383.30" "$1,383.30" "$1,383.30" "$1,383.30" "$3,074.00" "$3,074.00" "$3,074.00" $640.70 "$3,074.00" "$3,074.00" "$3,074.00" "$3,074.00" "$3,074.00" $640.66 "$3,074.00" "$1,229.60" "$1,515.48" "$3,074.00" "$3,074.00" "$3,074.00" "$3,074.00" "$2,305.50" "$3,074.00" "$3,074.00" "$3,074.00" "$1,537.00" "$1,537.00" "$2,434.61" "$3,074.00" "$2,459.20" "$1,383.30" $610.11 N/A "$1,782.92" "$3,074.00" "$1,844.40" "$3,074.00" $640.62 "$3,074.00" N/A N/A 7030-6515 SUP HCPCS C1713 7030-6515 - SCREW BN 6.5MM 15MM STRL TRDNT II LOPRFL HEX BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 7030-6520 SUP HCPCS C1713 7030-6520 - SCREW BN 6.5MM 20MM STRL TRDNT II LOPRFL HEX BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 7030-6525 SUP HCPCS C1713 7030-6525 - SCREW BN 6.5MM 25MM STRL TRDNT II LOPRFL HEX BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 7030-6530 SUP HCPCS C1713 7030-6530 - SCREW BN 6.5MM 30MM STRL TRDNT II LOPRFL HEX BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 7030-6535 SUP HCPCS C1713 7030-6535 - SCREW BN 6.5MM 35MM STRL TRDNT II LOPRFL HEX BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 7030-6540 SUP HCPCS C1713 7030-6540 - SCREW BN 6.5MM 40MM STRL TRDNT II LOPRFL HEX BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 7030-6545 SUP HCPCS C1713 7030-6545 - SCREW BN 6.5MM 45MM STRL TRDNT II LOPRFL HEX BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 7030-6550 SUP HCPCS C1713 7030-6550 - SCREW BN 6.5MM 50MM STRL TRDNT II LOPRFL HEX BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 7030-6555 SUP HCPCS C1713 7030-6555 - SCREW BN 6.5MM 55MM STRL TRDNT II LOPRFL HEX BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 7030-6560 SUP HCPCS C1713 7030-6560 - SCREW BN 6.5MM 60MM STRL TRDNT II LOPRFL HEX BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 703165-20 SUP Custom 27203010 703165-20 - SLEEVE DRILL RETAIN FEMUR ANTERIOR BOTH IP/OP $560.00 $414.00 $99.61 $559.63 $559.63 $559.63 $559.63 $559.63 $559.63 $559.63 $99.61 $559.63 $559.63 $415.36 $415.36 $431.36 $291.57 $116.63 $559.63 $223.85 $559.63 $559.63 $559.63 $559.63 $559.63 $420.00 $559.63 $559.63 $559.63 $279.82 $279.82 $443.23 $559.63 $447.70 $363.76 $559.63 N/A $324.80 $559.63 $335.78 $559.63 $559.63 $559.63 N/A N/A 704001-1 SUP Custom 27203010 704001-1 - IMPACTOR SURG HEAD OMEGA HIP BOTH IP/OP $371.50 $275.00 $66.08 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $371.25 $66.08 $371.25 $371.25 $275.54 $275.54 $286.16 $193.42 $77.37 $371.25 $148.50 $371.25 $371.25 $371.25 $371.25 $371.25 $278.63 $371.25 $371.25 $371.25 $185.63 $185.63 $294.03 $371.25 $297.00 $241.31 $371.25 N/A $215.47 $371.25 $222.75 $371.25 $371.25 $371.25 N/A N/A 704005-10 SUP Custom 27203010 704005-10 - REAMER SURG DRILL COMBO BOTH IP/OP $701.50 $519.00 $124.82 $701.25 $701.25 $701.25 $701.25 $701.25 $701.25 $701.25 $124.82 $701.25 $701.25 $520.47 $520.47 $540.52 $365.35 $146.15 $701.25 $280.50 $701.25 $701.25 $701.25 $701.25 $701.25 $526.13 $701.25 $701.25 $701.25 $350.63 $350.63 $555.39 $701.25 $561.00 $455.81 $701.25 N/A $406.87 $701.25 $420.75 $701.25 $701.25 $701.25 N/A N/A 704011S SUP HCPCS C1713 704011S - GUIDEWIRE ORTHOPEDIC 2.8MM 230MM THREADED TIP COCR HIP BOTH IP/OP $76.00 $56.00 $15.01 $75.63 $34.03 $34.03 $34.03 $34.03 $75.63 $75.63 $75.63 $15.76 $75.63 $75.63 $75.63 $75.63 $75.63 $15.76 $75.63 $75.63 $44.74 $75.63 $75.63 $75.63 $75.63 $57.00 $75.63 $75.63 $75.63 $37.82 $37.82 $59.90 $75.63 $60.50 $34.03 $15.01 N/A $44.08 $75.63 $75.63 $75.63 $15.76 $75.63 N/A N/A 704012S SUP HCPCS C1769 704012S - GUIDEWIRE ORTHOPEDIC 2.8MM 230MM THREADED TIP QUICK COUPLING BOTH IP/OP $227.00 $168.00 $45.03 $226.88 $123.20 $123.20 $123.20 $123.20 $226.88 $226.88 $226.88 $47.29 $226.88 $168.39 $168.39 $174.88 $118.20 $47.28 $226.88 $226.88 $134.20 $226.88 $226.88 $226.88 $226.88 $170.25 $226.88 $226.88 $226.88 $113.44 $113.44 $179.69 $226.88 $181.50 $147.47 $45.03 N/A $131.66 $226.88 $226.88 $226.88 $47.28 $226.88 N/A N/A 70-4103L SUP HCPCS C1776 70-4103L - COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4103R SUP HCPCS C1776 70-4103R - COMPONENT FEMORAL 3 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4104L SUP HCPCS C1776 70-4104L - COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4104R SUP HCPCS C1776 70-4104R - COMPONENT FEMORAL 4 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4105L SUP HCPCS C1776 70-4105L - COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4105R SUP HCPCS C1776 70-4105R - COMPONENT FEMORAL 5 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4106L SUP HCPCS C1776 70-4106L - COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4106R SUP HCPCS C1776 70-4106R - COMPONENT FEMORAL 6 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4107L SUP HCPCS C1776 70-4107L - COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4107R SUP HCPCS C1776 70-4107R - COMPONENT FEMORAL 7 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4109L SUP HCPCS C1776 70-4109L - COMPONENT FEMORAL 9 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4109R SUP HCPCS C1776 70-4109R - COMPONENT FEMORAL 9 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4111L SUP HCPCS C1776 70-4111L - COMPONENT FEMORAL 11 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4111R SUP HCPCS C1776 70-4111R - COMPONENT FEMORAL 11 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4113L SUP HCPCS C1776 70-4113L - COMPONENT FEMORAL 13 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-4113R SUP HCPCS C1776 70-4113R - COMPONENT FEMORAL 13 CRUCIATE RETAIN CEMENTED WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 70-5003L SUP HCPCS C1776 70-5003L - COMPONENT FEMORAL 3 MICROSTRUCTURE CRUCIATE RETAIN NONLFIT BOTH IP/OP "$4,906.00" "$3,630.00" $973.72 "$4,906.00" "$2,207.70" "$2,207.70" "$2,207.70" "$2,207.70" "$4,906.00" "$4,906.00" "$4,906.00" "$1,022.53" "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$1,022.46" "$4,906.00" "$4,906.00" "$2,418.66" "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$3,679.50" "$4,906.00" "$4,906.00" "$4,906.00" "$2,453.00" "$2,453.00" "$3,885.55" "$4,906.00" "$3,924.80" "$2,207.70" $973.72 N/A "$2,845.48" "$4,906.00" "$4,906.00" "$4,906.00" "$1,022.41" "$4,906.00" N/A N/A 70-5003R SUP HCPCS C1776 70-5003R - COMPONENT FEMORAL 3 CRUCIATE RETAIN REVISION MICROSTRUCTURE BOTH IP/OP "$4,906.00" "$3,630.00" $973.72 "$4,906.00" "$2,207.70" "$2,207.70" "$2,207.70" "$2,207.70" "$4,906.00" "$4,906.00" "$4,906.00" "$1,022.53" "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$1,022.46" "$4,906.00" "$1,962.40" "$2,418.66" "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$3,679.50" "$4,906.00" "$4,906.00" "$4,906.00" "$2,453.00" "$2,453.00" "$3,885.55" "$4,906.00" "$3,924.80" "$2,207.70" $973.72 N/A "$2,845.48" "$4,906.00" "$4,906.00" "$4,906.00" "$1,022.41" "$4,906.00" N/A N/A 70-5004L SUP HCPCS C1776 70-5004L - COMPONENT FEMORAL 4 MICROSTRUCTURE CRUCIATE RETAIN NONLFIT BOTH IP/OP "$4,777.00" "$3,535.00" $948.12 "$4,777.00" "$2,149.65" "$2,149.65" "$2,149.65" "$2,149.65" "$4,777.00" "$4,777.00" "$4,777.00" $995.65 "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" $995.58 "$4,777.00" "$4,777.00" "$2,355.06" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$3,582.75" "$4,777.00" "$4,777.00" "$4,777.00" "$2,388.50" "$2,388.50" "$3,783.38" "$4,777.00" "$3,821.60" "$2,149.65" $948.12 N/A "$2,770.66" "$4,777.00" "$2,866.20" "$4,777.00" $995.53 "$4,777.00" N/A N/A 70-5004R SUP HCPCS C1776 70-5004R - COMPONENT FEMORAL 4 CRUCIATE RETAIN REVISION MICROSTRUCTURE BOTH IP/OP "$4,777.00" "$3,535.00" $948.12 "$4,777.00" "$2,149.65" "$2,149.65" "$2,149.65" "$2,149.65" "$4,777.00" "$4,777.00" "$4,777.00" $995.65 "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" $995.58 "$4,777.00" "$1,910.80" "$2,355.06" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$3,582.75" "$4,777.00" "$4,777.00" "$4,777.00" "$2,388.50" "$2,388.50" "$3,783.38" "$4,777.00" "$3,821.60" "$2,149.65" $948.12 N/A "$2,770.66" "$4,777.00" "$2,866.20" "$4,777.00" $995.53 "$4,777.00" N/A N/A 70-5005L SUP HCPCS C1776 70-5005L - COMPONENT FEMORAL 5 MICROSTRUCTURE CRUCIATE RETAIN NONLFIT BOTH IP/OP "$4,777.00" "$3,535.00" $948.12 "$4,777.00" "$2,149.65" "$2,149.65" "$2,149.65" "$2,149.65" "$4,777.00" "$4,777.00" "$4,777.00" $995.65 "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" $995.58 "$4,777.00" "$4,777.00" "$2,355.06" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$3,582.75" "$4,777.00" "$4,777.00" "$4,777.00" "$2,388.50" "$2,388.50" "$3,783.38" "$4,777.00" "$3,821.60" "$2,149.65" $948.12 N/A "$2,770.66" "$4,777.00" "$2,866.20" "$4,777.00" $995.53 "$4,777.00" N/A N/A 70-5005R SUP HCPCS C1776 70-5005R - COMPONENT FEMORAL 5 CRUCIATE RETAIN REVISION MICROSTRUCTURE BOTH IP/OP "$4,777.00" "$3,535.00" $948.12 "$4,777.00" "$2,149.65" "$2,149.65" "$2,149.65" "$2,149.65" "$4,777.00" "$4,777.00" "$4,777.00" $995.65 "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" $995.58 "$4,777.00" "$1,910.80" "$2,355.06" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$3,582.75" "$4,777.00" "$4,777.00" "$4,777.00" "$2,388.50" "$2,388.50" "$3,783.38" "$4,777.00" "$3,821.60" "$2,149.65" $948.12 N/A "$2,770.66" "$4,777.00" "$2,866.20" "$4,777.00" $995.53 "$4,777.00" N/A N/A 70-5006L SUP HCPCS C1776 70-5006L - COMPONENT FEMORAL 6 MICROSTRUCTURE CRUCIATE RETAIN NONLFIT BOTH IP/OP "$4,777.00" "$3,535.00" $948.12 "$4,777.00" "$2,149.65" "$2,149.65" "$2,149.65" "$2,149.65" "$4,777.00" "$4,777.00" "$4,777.00" $995.65 "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" $995.58 "$4,777.00" "$1,910.80" "$2,355.06" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$3,582.75" "$4,777.00" "$4,777.00" "$4,777.00" "$2,388.50" "$2,388.50" "$3,783.38" "$4,777.00" "$3,821.60" "$2,149.65" $948.12 N/A "$2,770.66" "$4,777.00" "$2,866.20" "$4,777.00" $995.53 "$4,777.00" N/A N/A 70-5006R SUP HCPCS C1776 70-5006R - COMPONENT FEMORAL 6 CRUCIATE RETAIN REVISION MICROSTRUCTURE BOTH IP/OP "$4,777.00" "$3,535.00" $948.12 "$4,777.00" "$2,149.65" "$2,149.65" "$2,149.65" "$2,149.65" "$4,777.00" "$4,777.00" "$4,777.00" $995.65 "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" $995.58 "$4,777.00" "$4,777.00" "$2,355.06" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$3,582.75" "$4,777.00" "$4,777.00" "$4,777.00" "$2,388.50" "$2,388.50" "$3,783.38" "$4,777.00" "$3,821.60" "$2,149.65" $948.12 N/A "$2,770.66" "$4,777.00" "$2,866.20" "$4,777.00" $995.53 "$4,777.00" N/A N/A 70-5007L SUP HCPCS C1776 70-5007L - COMPONENT FEMORAL 7 MICROSTRUCTURE CRUCIATE RETAIN NONLFIT BOTH IP/OP "$4,777.00" "$3,535.00" $948.12 "$4,777.00" "$2,149.65" "$2,149.65" "$2,149.65" "$2,149.65" "$4,777.00" "$4,777.00" "$4,777.00" $995.65 "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" $995.58 "$4,777.00" "$1,910.80" "$2,355.06" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$3,582.75" "$4,777.00" "$4,777.00" "$4,777.00" "$2,388.50" "$2,388.50" "$3,783.38" "$4,777.00" "$3,821.60" "$2,149.65" $948.12 N/A "$2,770.66" "$4,777.00" "$4,777.00" "$4,777.00" $995.53 "$4,777.00" N/A N/A 70-5007R SUP HCPCS C1776 70-5007R - COMPONENT FEMORAL 7 CRUCIATE RETAIN REVISION MICROSTRUCTURE BOTH IP/OP "$4,777.00" "$3,535.00" $948.12 "$4,777.00" "$2,149.65" "$2,149.65" "$2,149.65" "$2,149.65" "$4,777.00" "$4,777.00" "$4,777.00" $995.65 "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" $995.58 "$4,777.00" "$4,777.00" "$2,355.06" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$3,582.75" "$4,777.00" "$4,777.00" "$4,777.00" "$2,388.50" "$2,388.50" "$3,783.38" "$4,777.00" "$3,821.60" "$2,149.65" $948.12 N/A "$2,770.66" "$4,777.00" "$4,777.00" "$4,777.00" $995.53 "$4,777.00" N/A N/A 70-5009L SUP HCPCS C1776 70-5009L - COMPONENT FEMORAL 9 MICROSTRUCTURE CRUCIATE RETAIN NONLFIT BOTH IP/OP "$4,777.00" "$3,535.00" $948.12 "$4,777.00" "$2,149.65" "$2,149.65" "$2,149.65" "$2,149.65" "$4,777.00" "$4,777.00" "$4,777.00" $995.65 "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" $995.58 "$4,777.00" "$1,910.80" "$2,355.06" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$3,582.75" "$4,777.00" "$4,777.00" "$4,777.00" "$2,388.50" "$2,388.50" "$3,783.38" "$4,777.00" "$3,821.60" "$2,149.65" $948.12 N/A "$2,770.66" "$4,777.00" "$4,777.00" "$4,777.00" $995.53 "$4,777.00" N/A N/A 70-5009R SUP HCPCS C1776 70-5009R - COMPONENT FEMORAL 9 CRUCIATE RETAIN REVISION MICROSTRUCTURE BOTH IP/OP "$4,777.00" "$3,535.00" $948.12 "$4,777.00" "$2,149.65" "$2,149.65" "$2,149.65" "$2,149.65" "$4,777.00" "$4,777.00" "$4,777.00" $995.65 "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" $995.58 "$4,777.00" "$1,910.80" "$2,355.06" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$3,582.75" "$4,777.00" "$4,777.00" "$4,777.00" "$2,388.50" "$2,388.50" "$3,783.38" "$4,777.00" "$3,821.60" "$2,149.65" $948.12 N/A "$2,770.66" "$4,777.00" "$4,777.00" "$4,777.00" $995.53 "$4,777.00" N/A N/A 70-5011L SUP HCPCS C1776 70-5011L - COMPONENT FEMORAL 11 MICROSTRUCTURE CRUCIATE RETAIN NONLFIT BOTH IP/OP "$4,777.00" "$3,535.00" $948.12 "$4,777.00" "$2,149.65" "$2,149.65" "$2,149.65" "$2,149.65" "$4,777.00" "$4,777.00" "$4,777.00" $995.65 "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" $995.58 "$4,777.00" "$4,777.00" "$2,355.06" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$3,582.75" "$4,777.00" "$4,777.00" "$4,777.00" "$2,388.50" "$2,388.50" "$3,783.38" "$4,777.00" "$3,821.60" "$2,149.65" $948.12 N/A "$2,770.66" "$4,777.00" "$2,866.20" "$4,777.00" $995.53 "$4,777.00" N/A N/A 70-5011R SUP HCPCS C1776 70-5011R - COMPONENT FEMORAL 11 CRUCIATE RETAIN REVISION MICROSTRUCTURE BOTH IP/OP "$4,777.00" "$3,535.00" $948.12 "$4,777.00" "$2,149.65" "$2,149.65" "$2,149.65" "$2,149.65" "$4,777.00" "$4,777.00" "$4,777.00" $995.65 "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" $995.58 "$4,777.00" "$1,910.80" "$2,355.06" "$4,777.00" "$4,777.00" "$4,777.00" "$4,777.00" "$3,582.75" "$4,777.00" "$4,777.00" "$4,777.00" "$2,388.50" "$2,388.50" "$3,783.38" "$4,777.00" "$3,821.60" "$2,149.65" $948.12 N/A "$2,770.66" "$4,777.00" "$2,866.20" "$4,777.00" $995.53 "$4,777.00" N/A N/A 70-5013L SUP HCPCS C1776 70-5013L - COMPONENT FEMORAL 13 MICROSTRUCTURE CRUCIATE RETAIN NONLFIT BOTH IP/OP "$4,906.00" "$3,630.00" $973.72 "$4,906.00" "$2,207.70" "$2,207.70" "$2,207.70" "$2,207.70" "$4,906.00" "$4,906.00" "$4,906.00" "$1,022.53" "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$1,022.46" "$4,906.00" "$4,906.00" "$2,418.66" "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$3,679.50" "$4,906.00" "$4,906.00" "$4,906.00" "$2,453.00" "$2,453.00" "$3,885.55" "$4,906.00" "$3,924.80" "$2,207.70" $973.72 N/A "$2,845.48" "$4,906.00" "$2,943.60" "$4,906.00" "$1,022.41" "$4,906.00" N/A N/A 70-5013R SUP HCPCS C1776 70-5013R - COMPONENT FEMORAL 13 CRUCIATE RETAIN REVISION MICROSTRUCTURE BOTH IP/OP "$4,906.00" "$3,630.00" $973.72 "$4,906.00" "$2,207.70" "$2,207.70" "$2,207.70" "$2,207.70" "$4,906.00" "$4,906.00" "$4,906.00" "$1,022.53" "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$1,022.46" "$4,906.00" "$1,962.40" "$2,418.66" "$4,906.00" "$4,906.00" "$4,906.00" "$4,906.00" "$3,679.50" "$4,906.00" "$4,906.00" "$4,906.00" "$2,453.00" "$2,453.00" "$3,885.55" "$4,906.00" "$3,924.80" "$2,207.70" $973.72 N/A "$2,845.48" "$4,906.00" "$2,943.60" "$4,906.00" "$1,022.41" "$4,906.00" N/A N/A 70-5103L SUP HCPCS C1776 70-5103L - COMPONENT FEMORAL 3 CRUCIATE RETAIN MICROSTRUCTURE PRIM LFIT BOTH IP/OP "$4,647.00" "$3,439.00" $922.31 "$4,647.00" "$2,091.15" "$2,091.15" "$2,091.15" "$2,091.15" "$4,647.00" "$4,647.00" "$4,647.00" $968.55 "$4,647.00" "$4,647.00" "$4,647.00" "$4,647.00" "$4,647.00" $968.49 "$4,647.00" "$4,647.00" "$2,290.97" "$4,647.00" "$4,647.00" "$4,647.00" "$4,647.00" "$3,485.25" "$4,647.00" "$4,647.00" "$4,647.00" "$2,323.50" "$2,323.50" "$3,680.42" "$4,647.00" "$3,717.60" "$2,091.15" $922.31 N/A "$2,695.26" "$4,647.00" "$2,788.20" "$4,647.00" $968.43 "$4,647.00" N/A N/A 70-5103R SUP HCPCS C1776 70-5103R - COMPONENT FEMORAL 3 CRUCIATE RETAIN MICROSTRUCTURE PRIM LFIT BOTH IP/OP "$4,647.00" "$3,439.00" $922.31 "$4,647.00" "$2,091.15" "$2,091.15" "$2,091.15" "$2,091.15" "$4,647.00" "$4,647.00" "$4,647.00" $968.55 "$4,647.00" "$4,647.00" "$4,647.00" "$4,647.00" "$4,647.00" $968.49 "$4,647.00" "$1,858.80" "$2,290.97" "$4,647.00" "$4,647.00" "$4,647.00" "$4,647.00" "$3,485.25" "$4,647.00" "$4,647.00" "$4,647.00" "$2,323.50" "$2,323.50" "$3,680.42" "$4,647.00" "$3,717.60" "$2,091.15" $922.31 N/A "$2,695.26" "$4,647.00" "$4,647.00" "$4,647.00" $968.43 "$4,647.00" N/A N/A 70-5104L SUP HCPCS C1776 70-5104L - COMPONENT FEMORAL 4 CRUCIATE RETAIN MICROSTRUCTURE PRIM LFIT BOTH IP/OP "$4,565.00" "$3,378.00" $906.04 "$4,565.00" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$4,565.00" "$4,565.00" "$4,565.00" $951.46 "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" $951.40 "$4,565.00" "$4,565.00" "$2,250.55" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$3,423.75" "$4,565.00" "$4,565.00" "$4,565.00" "$2,282.50" "$2,282.50" "$3,615.48" "$4,565.00" "$3,652.00" "$2,054.25" $906.04 N/A "$2,647.70" "$4,565.00" "$4,565.00" "$4,565.00" $951.35 "$4,565.00" N/A N/A 70-5104R SUP HCPCS C1776 70-5104R - COMPONENT FEMORAL 4 CRUCIATE RETAIN MICROSTRUCTURE PRIM LFIT BOTH IP/OP "$4,565.00" "$3,378.00" $906.04 "$4,565.00" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$4,565.00" "$4,565.00" "$4,565.00" $951.46 "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" $951.40 "$4,565.00" "$4,565.00" "$2,250.55" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$3,423.75" "$4,565.00" "$4,565.00" "$4,565.00" "$2,282.50" "$2,282.50" "$3,615.48" "$4,565.00" "$3,652.00" "$2,054.25" $906.04 N/A "$2,647.70" "$4,565.00" "$4,565.00" "$4,565.00" $951.35 "$4,565.00" N/A N/A 70-5105L SUP HCPCS C1776 70-5105L - COMPONENT FEMORAL 5 CRUCIATE RETAIN MICROSTRUCTURE PRIM LFIT BOTH IP/OP "$4,565.00" "$3,378.00" $906.04 "$4,565.00" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$4,565.00" "$4,565.00" "$4,565.00" $951.46 "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" $951.40 "$4,565.00" "$4,565.00" "$2,250.55" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$3,423.75" "$4,565.00" "$4,565.00" "$4,565.00" "$2,282.50" "$2,282.50" "$3,615.48" "$4,565.00" "$3,652.00" "$2,054.25" $906.04 N/A "$2,647.70" "$4,565.00" "$4,565.00" "$4,565.00" $951.35 "$4,565.00" N/A N/A 70-5105R SUP HCPCS C1776 70-5105R - COMPONENT FEMORAL 5 CRUCIATE RETAIN MICROSTRUCTURE PRIM LFIT BOTH IP/OP "$4,565.00" "$3,378.00" $906.04 "$4,565.00" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$4,565.00" "$4,565.00" "$4,565.00" $951.46 "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" $951.40 "$4,565.00" "$4,565.00" "$2,250.55" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$3,423.75" "$4,565.00" "$4,565.00" "$4,565.00" "$2,282.50" "$2,282.50" "$3,615.48" "$4,565.00" "$3,652.00" "$2,054.25" $906.04 N/A "$2,647.70" "$4,565.00" "$4,565.00" "$4,565.00" $951.35 "$4,565.00" N/A N/A 70-5106L SUP HCPCS C1776 70-5106L - COMPONENT FEMORAL 6 CRUCIATE RETAIN MICROSTRUCTURE PRIM LFIT BOTH IP/OP "$4,565.00" "$3,378.00" $906.04 "$4,565.00" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$4,565.00" "$4,565.00" "$4,565.00" $951.46 "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" $951.40 "$4,565.00" "$4,565.00" "$2,250.55" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$3,423.75" "$4,565.00" "$4,565.00" "$4,565.00" "$2,282.50" "$2,282.50" "$3,615.48" "$4,565.00" "$3,652.00" "$2,054.25" $906.04 N/A "$2,647.70" "$4,565.00" "$4,565.00" "$4,565.00" $951.35 "$4,565.00" N/A N/A 70-5106R SUP HCPCS C1776 70-5106R - COMPONENT FEMORAL 6 CRUCIATE RETAIN MICROSTRUCTURE PRIM LFIT BOTH IP/OP "$4,565.00" "$3,378.00" $906.04 "$4,565.00" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$4,565.00" "$4,565.00" "$4,565.00" $951.46 "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" $951.40 "$4,565.00" "$4,565.00" "$2,250.55" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$3,423.75" "$4,565.00" "$4,565.00" "$4,565.00" "$2,282.50" "$2,282.50" "$3,615.48" "$4,565.00" "$3,652.00" "$2,054.25" $906.04 N/A "$2,647.70" "$4,565.00" "$2,739.00" "$4,565.00" $951.35 "$4,565.00" N/A N/A 70-5107L SUP HCPCS C1776 70-5107L - COMPONENT FEMORAL 7 CRUCIATE RETAIN MICROSTRUCTURE PRIM LFIT BOTH IP/OP "$4,565.00" "$3,378.00" $906.04 "$4,565.00" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$4,565.00" "$4,565.00" "$4,565.00" $951.46 "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" $951.40 "$4,565.00" "$4,565.00" "$2,250.55" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$3,423.75" "$4,565.00" "$4,565.00" "$4,565.00" "$2,282.50" "$2,282.50" "$3,615.48" "$4,565.00" "$3,652.00" "$2,054.25" $906.04 N/A "$2,647.70" "$4,565.00" "$2,739.00" "$4,565.00" $951.35 "$4,565.00" N/A N/A 70-5107R SUP HCPCS C1776 70-5107R - COMPONENT FEMORAL 7 CRUCIATE RETAIN MICROSTRUCTURE PRIM LFIT BOTH IP/OP "$4,565.00" "$3,378.00" $906.04 "$4,565.00" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$4,565.00" "$4,565.00" "$4,565.00" $951.46 "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" $951.40 "$4,565.00" "$4,565.00" "$2,250.55" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$3,423.75" "$4,565.00" "$4,565.00" "$4,565.00" "$2,282.50" "$2,282.50" "$3,615.48" "$4,565.00" "$3,652.00" "$2,054.25" $906.04 N/A "$2,647.70" "$4,565.00" "$2,739.00" "$4,565.00" $951.35 "$4,565.00" N/A N/A 70-5109L SUP HCPCS C1776 70-5109L - COMPONENT FEMORAL 9 CRUCIATE RETAIN MICROSTRUCTURE PRIM LFIT BOTH IP/OP "$4,565.00" "$3,378.00" $906.04 "$4,565.00" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$4,565.00" "$4,565.00" "$4,565.00" $951.46 "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" $951.40 "$4,565.00" "$4,565.00" "$2,250.55" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$3,423.75" "$4,565.00" "$4,565.00" "$4,565.00" "$2,282.50" "$2,282.50" "$3,615.48" "$4,565.00" "$3,652.00" "$2,054.25" $906.04 N/A "$2,647.70" "$4,565.00" "$2,739.00" "$4,565.00" $951.35 "$4,565.00" N/A N/A 70-5109R SUP HCPCS C1776 70-5109R - COMPONENT FEMORAL 9 CRUCIATE RETAIN MICROSTRUCTURE PRIM LFIT BOTH IP/OP "$4,565.00" "$3,378.00" $906.04 "$4,565.00" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$4,565.00" "$4,565.00" "$4,565.00" $951.46 "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" $951.40 "$4,565.00" "$4,565.00" "$2,250.55" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$3,423.75" "$4,565.00" "$4,565.00" "$4,565.00" "$2,282.50" "$2,282.50" "$3,615.48" "$4,565.00" "$3,652.00" "$2,054.25" $906.04 N/A "$2,647.70" "$4,565.00" "$2,739.00" "$4,565.00" $951.35 "$4,565.00" N/A N/A 70-5111L SUP HCPCS C1776 70-5111L - COMPONENT FEMORAL 11 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,565.00" "$3,378.00" $906.04 "$4,565.00" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$4,565.00" "$4,565.00" "$4,565.00" $951.46 "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" $951.40 "$4,565.00" "$4,565.00" "$2,250.55" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$3,423.75" "$4,565.00" "$4,565.00" "$4,565.00" "$2,282.50" "$2,282.50" "$3,615.48" "$4,565.00" "$3,652.00" "$2,054.25" $906.04 N/A "$2,647.70" "$4,565.00" "$2,739.00" "$4,565.00" $951.35 "$4,565.00" N/A N/A 70-5111R SUP HCPCS C1776 70-5111R - COMPONENT FEMORAL 11 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,565.00" "$3,378.00" $906.04 "$4,565.00" "$2,054.25" "$2,054.25" "$2,054.25" "$2,054.25" "$4,565.00" "$4,565.00" "$4,565.00" $951.46 "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" $951.40 "$4,565.00" "$4,565.00" "$2,250.55" "$4,565.00" "$4,565.00" "$4,565.00" "$4,565.00" "$3,423.75" "$4,565.00" "$4,565.00" "$4,565.00" "$2,282.50" "$2,282.50" "$3,615.48" "$4,565.00" "$3,652.00" "$2,054.25" $906.04 N/A "$2,647.70" "$4,565.00" "$2,739.00" "$4,565.00" $951.35 "$4,565.00" N/A N/A 70-5113L SUP HCPCS C1776 70-5113L - COMPONENT FEMORAL 13 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,647.00" "$3,439.00" $922.31 "$4,647.00" "$2,091.15" "$2,091.15" "$2,091.15" "$2,091.15" "$4,647.00" "$4,647.00" "$4,647.00" $968.55 "$4,647.00" "$4,647.00" "$4,647.00" "$4,647.00" "$4,647.00" $968.49 "$4,647.00" "$4,647.00" "$2,290.97" "$4,647.00" "$4,647.00" "$4,647.00" "$4,647.00" "$3,485.25" "$4,647.00" "$4,647.00" "$4,647.00" "$2,323.50" "$2,323.50" "$3,680.42" "$4,647.00" "$3,717.60" "$2,091.15" $922.31 N/A "$2,695.26" "$4,647.00" "$4,647.00" "$4,647.00" $968.43 "$4,647.00" N/A N/A 70-5113R SUP HCPCS C1776 70-5113R - COMPONENT FEMORAL 13 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,647.00" "$3,439.00" $922.31 "$4,647.00" "$2,091.15" "$2,091.15" "$2,091.15" "$2,091.15" "$4,647.00" "$4,647.00" "$4,647.00" $968.55 "$4,647.00" "$4,647.00" "$4,647.00" "$4,647.00" "$4,647.00" $968.49 "$4,647.00" "$4,647.00" "$2,290.97" "$4,647.00" "$4,647.00" "$4,647.00" "$4,647.00" "$3,485.25" "$4,647.00" "$4,647.00" "$4,647.00" "$2,323.50" "$2,323.50" "$3,680.42" "$4,647.00" "$3,717.60" "$2,091.15" $922.31 N/A "$2,695.26" "$4,647.00" "$4,647.00" "$4,647.00" $968.43 "$4,647.00" N/A N/A 70-5203L SUP HCPCS C1776 70-5203L - COMPONENT FEMORAL 3 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 70-5203R SUP HCPCS C1776 70-5203R - COMPONENT FEMORAL 3 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 70-5205L SUP HCPCS C1776 70-5205L - COMPONENT FEMORAL 5 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 70-5205R SUP HCPCS C1776 70-5205R - COMPONENT FEMORAL 5 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$2,703.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 70-5207L SUP HCPCS C1776 70-5207L - COMPONENT FEMORAL 7 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 70-5207R SUP HCPCS C1776 70-5207R - COMPONENT FEMORAL 7 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 70-5209L SUP HCPCS C1776 70-5209L - COMPONENT FEMORAL 9 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 70-5209R SUP HCPCS C1776 70-5209R - COMPONENT FEMORAL 9 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 70-5211L SUP HCPCS C1776 70-5211L - COMPONENT FEMORAL 11 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 70-5211R SUP HCPCS C1776 70-5211R - COMPONENT FEMORAL 11 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 70-5213L SUP HCPCS C1776 70-5213L - COMPONENT FEMORAL 13 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 70-5213R SUP HCPCS C1776 70-5213R - COMPONENT FEMORAL 13 CRUCIATE RETAIN MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 7060-0000 SUP HCPCS C1713 7060-0000 - PLUG DOME HL HEX STRL LF TRDNT II DISP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A 7066-24 SUP HCPCS L1830 7066-24 - IMMOBILIZER ORTHOPEDIC UNIVERSAL 12-24IN 24IN CUTAWAY BOTH IP/OP $44.50 $33.00 $9.22 $49.68 $44.23 $44.23 $44.23 $44.23 $44.23 $44.23 $48.84 $44.23 $44.23 $44.23 $44.23 $44.23 $44.23 $9.22 $44.23 $19.87 $44.23 $44.23 $49.68 $44.23 $44.23 $33.38 $44.23 $44.23 $44.23 $22.12 $22.12 $35.03 $44.23 $35.38 $19.90 $44.23 N/A $25.81 $44.23 $26.54 $44.23 $44.23 $44.23 N/A N/A 7066-24 SUP Custom 27203010 SPLINT ORTH UNV 24IN KNEE SUP PRFR FOAM BOTH IP/OP $67.00 $50.00 $9.22 $50.25 $44.23 $44.23 $44.23 $44.23 $44.23 $44.23 $48.84 $44.23 $44.23 $44.23 $44.23 $44.23 $44.23 $9.22 $44.23 $19.87 $44.23 $44.23 $49.68 $44.23 $44.23 $50.25 $44.23 $44.23 $44.23 $22.12 $22.12 $35.03 $44.23 $35.38 $19.90 $44.23 N/A $38.86 $44.23 $26.54 $44.23 $44.23 $44.23 N/A N/A 709-04-42A SUP HCPCS C1776 709-04-42A - SHELL ACTB A 42MM STRL TRDNT II 8 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-44B SUP HCPCS C1776 709-04-44B - SHELL ACTB B 44MM STRL TRDNT II 8 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$6,782.50" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-46C SUP HCPCS C1776 709-04-46C - SHELL ACTB C 46MM STRL TRDNT II 8 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-48D SUP HCPCS C1776 709-04-48D - SHELL ACTB D 48MM STRL TRDNT II 9 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$6,782.50" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-50D SUP HCPCS C1776 709-04-50D - SHELL ACTB D 50MM STRL TRDNT II 9 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-52E SUP HCPCS C1776 709-04-52E - SHELL ACTB E 52MM STRL TRDNT II 11 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$6,782.50" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-54E SUP HCPCS C1776 709-04-54E - SHELL ACTB E 54MM STRL TRDNT II 11 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-56F SUP HCPCS C1776 709-04-56F - SHELL ACTB F 56MM STRL TRDNT II 13 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$6,782.50" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-58F SUP HCPCS C1776 709-04-58F - SHELL ACTB F 58MM STRL TRDNT II 13 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-60G SUP HCPCS C1776 709-04-60G - SHELL ACTB G 60MM STRL TRDNT II 13 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$6,782.50" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-62G SUP HCPCS C1776 709-04-62G - SHELL ACTB G 62MM STRL TRDNT II 13 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-64H SUP HCPCS C1776 709-04-64H - SHELL ACTB H 64MM STRL TRDNT II 13 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$6,782.50" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-66H SUP HCPCS C1776 709-04-66H - SHELL ACTB H 66MM STRL TRDNT II 13 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-68I SUP HCPCS C1776 709-04-68I - SHELL ACTB I 68MM STRL TRDNT II 13 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$6,782.50" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-70I SUP HCPCS C1776 709-04-70I - SHELL ACTB I 70MM STRL TRDNT II 13 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$2,713.00" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 709-04-72J SUP HCPCS C1776 709-04-72J - SHELL ACTB J 72MM STRL TRDNT II 13 HL TRITANIUM HIP BOTH IP/OP "$6,782.50" "$5,019.00" "$1,346.16" "$6,782.50" "$3,052.13" "$3,052.13" "$3,052.13" "$3,052.13" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.64" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.55" "$6,782.50" "$6,782.50" "$3,343.77" "$6,782.50" "$6,782.50" "$6,782.50" "$6,782.50" "$5,086.88" "$6,782.50" "$6,782.50" "$6,782.50" "$3,391.25" "$3,391.25" "$5,371.74" "$6,782.50" "$5,426.00" "$3,052.13" "$1,346.16" N/A "$3,933.85" "$6,782.50" "$6,782.50" "$6,782.50" "$1,413.47" "$6,782.50" N/A N/A 70-DO55 SUP HCPCS C1713 70-DO55 - PLATE BONE STANDARD LEFT DISTAL RADIAL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,237.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A 70XLTCD SUP Custom 27203010 70XLTCD - TUBE TRCH 39MM 49MM 12.3MM 7MM 100MM STRL LF 12MM SHLY XLT BOTH IP/OP $160.00 $118.00 $28.42 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $28.42 $159.65 $159.65 $118.49 $118.49 $123.06 $83.18 $33.27 $159.65 $63.86 $159.65 $159.65 $159.65 $159.65 $159.65 $120.00 $159.65 $159.65 $159.65 $79.83 $79.83 $126.44 $159.65 $127.72 $103.77 $159.65 N/A $92.80 $159.65 $95.79 $159.65 $159.65 $159.65 N/A N/A 70XLTUP SUP Custom 27203010 70XLTUP - TUBE TRCH 39MM 34MM 12.3MM 7MM 100MM STRL LF 27MM SHLY XLT BOTH IP/OP $160.00 $118.00 $28.42 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $28.42 $159.65 $159.65 $118.49 $118.49 $123.06 $83.18 $33.27 $159.65 $63.86 $159.65 $159.65 $159.65 $159.65 $159.65 $120.00 $159.65 $159.65 $159.65 $79.83 $79.83 $126.44 $159.65 $127.72 $103.77 $159.65 N/A $92.80 $159.65 $95.79 $159.65 $159.65 $159.65 N/A N/A 710.000.98S SUP HCPCS C1763 710.000.98S - SUBSTITUTE BNGFT XS VOID FILR GRANULES CHRONOS BTCP .5ML BOTH IP/OP $216.50 $160.00 $42.92 $216.25 $97.31 $97.31 $97.31 $97.31 $216.25 $216.25 $216.25 $45.07 $216.25 $216.25 $216.25 $216.25 $216.25 $45.07 $216.25 $216.25 $127.91 $216.25 $216.25 $216.25 $216.25 $162.38 $216.25 $216.25 $216.25 $108.13 $108.13 $171.27 $216.25 $173.00 $97.31 $42.92 N/A $125.57 $216.25 $216.25 $216.25 $45.07 $216.25 N/A N/A 710.001.98S SUP HCPCS C1763 710.001.98S - SUBSTITUTE BNGFT SMALL .7-1.4MM VOID FILR GRANULES CHRONOS BOTH IP/OP $216.50 $160.00 $42.92 $216.25 $97.31 $97.31 $97.31 $97.31 $216.25 $216.25 $216.25 $45.07 $216.25 $216.25 $216.25 $216.25 $216.25 $45.07 $216.25 $216.25 $127.91 $216.25 $216.25 $216.25 $216.25 $162.38 $216.25 $216.25 $216.25 $108.13 $108.13 $171.27 $216.25 $173.00 $97.31 $42.92 N/A $125.57 $216.25 $216.25 $216.25 $45.07 $216.25 N/A N/A 710.002.98S SUP HCPCS C1713 710.002.98S - CEMENT BONE .7-1.4MM/1CC GRANULES BETA-TRICALCIUM PHOSPHATE BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $180.00 $180.00 $180.00 $180.00 $400.00 $400.00 $400.00 $83.37 $400.00 $400.00 $400.00 $400.00 $400.00 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $180.00 $79.39 N/A $232.00 $400.00 $240.00 $400.00 $83.36 $400.00 N/A N/A 710.003.98S SUP HCPCS C1763 710.003.98S - SUBSTITUTE BNGFT SMALL .7-1.4MM VOID FILR GRANULES CHRONOS BOTH IP/OP $887.50 $657.00 $176.15 $887.50 $399.38 $399.38 $399.38 $399.38 $887.50 $887.50 $887.50 $184.98 $887.50 $887.50 $887.50 $887.50 $887.50 $184.96 $887.50 $887.50 $524.96 $887.50 $887.50 $887.50 $887.50 $665.63 $887.50 $887.50 $887.50 $443.75 $443.75 $702.90 $887.50 $710.00 $399.38 $176.15 N/A $514.75 $887.50 $887.50 $887.50 $184.96 $887.50 N/A N/A 710.011.98S SUP HCPCS C1763 710.011.98S - SUBSTITUTE BNGFT MEDIUM 1.4-2.8MM VOID FILR GRANULES CHRONOS BOTH IP/OP $887.50 $657.00 $176.15 $887.50 $399.38 $399.38 $399.38 $399.38 $887.50 $887.50 $887.50 $184.98 $887.50 $887.50 $887.50 $887.50 $887.50 $184.96 $887.50 $887.50 $524.96 $887.50 $887.50 $887.50 $887.50 $665.63 $887.50 $887.50 $887.50 $443.75 $443.75 $702.90 $887.50 $710.00 $399.38 $176.15 N/A $514.75 $887.50 $887.50 $887.50 $184.96 $887.50 N/A N/A 710.014.98S SUP HCPCS C1763 710.014.98S - SUBSTITUTE BNGFT MEDIUM 1.4-2.8MM VOID FILR GRANULES CHRONOS BOTH IP/OP "$1,242.50" $919.00 $246.61 "$1,242.50" $559.13 $559.13 $559.13 $559.13 "$1,242.50" "$1,242.50" "$1,242.50" $258.97 "$1,242.50" "$1,242.50" "$1,242.50" "$1,242.50" "$1,242.50" $258.95 "$1,242.50" "$1,242.50" $734.94 "$1,242.50" "$1,242.50" "$1,242.50" "$1,242.50" $931.88 "$1,242.50" "$1,242.50" "$1,242.50" $621.25 $621.25 $984.06 "$1,242.50" $994.00 $559.13 $246.61 N/A $720.65 "$1,242.50" "$1,242.50" "$1,242.50" $258.94 "$1,242.50" N/A N/A 710.019.97S SUP HCPCS C1713 710.019.97S - SUBSTITUTE BNGFT 1.4-2.8MM CHRNS MED BTCP VOID BOTH IP/OP "$1,850.00" "$1,369.00" $367.17 "$1,881.40" $832.48 $832.48 $832.48 $832.48 "$1,849.95" "$1,849.95" "$1,849.95" $385.58 "$1,849.95" "$1,849.95" "$1,849.95" "$1,849.95" "$1,849.95" $385.55 "$1,849.95" $752.56 "$1,094.25" "$1,849.95" "$1,881.40" "$1,849.95" "$1,849.95" "$1,387.50" "$1,849.95" "$1,849.95" "$1,849.95" $924.98 $924.98 "$1,465.16" "$1,849.95" "$1,479.96" $832.48 $367.17 N/A "$1,073.00" "$1,849.95" "$1,109.97" "$1,849.95" $385.53 "$1,849.95" N/A N/A 710.021.97S SUP HCPCS C1713 710.021.97S - SUBSTITUTE BNGFT 1.4-2.8MM CHRNS MED BTCP VOID BOTH IP/OP "$2,642.00" "$1,955.00" $524.30 "$2,686.55" "$1,188.74" "$1,188.74" "$1,188.74" "$1,188.74" "$2,641.65" "$2,641.65" "$2,641.65" $550.59 "$2,641.65" "$2,641.65" "$2,641.65" "$2,641.65" "$2,641.65" $550.55 "$2,641.65" "$2,686.55" "$1,302.33" "$2,641.65" "$2,686.55" "$2,641.65" "$2,641.65" "$1,981.50" "$2,641.65" "$2,641.65" "$2,641.65" "$1,320.83" "$1,320.83" "$2,092.19" "$2,641.65" "$2,113.32" "$1,188.74" $524.30 N/A "$1,532.36" "$2,641.65" "$1,584.99" "$2,641.65" $550.52 "$2,641.65" N/A N/A 710.042.98S SUP HCPCS C1763 710.042.98S - SUBSTITUTE BNGFT 10X5X5MM VOID FILR BLOCK CHRONOS BTCP BOTH IP/OP $672.50 $498.00 $133.47 $672.50 $302.63 $302.63 $302.63 $302.63 $672.50 $672.50 $672.50 $140.17 $672.50 $672.50 $672.50 $672.50 $672.50 $140.16 $672.50 $672.50 $397.78 $672.50 $672.50 $672.50 $672.50 $504.38 $672.50 $672.50 $672.50 $336.25 $336.25 $532.62 $672.50 $538.00 $302.63 $133.47 N/A $390.05 $672.50 $672.50 $672.50 $140.15 $672.50 N/A N/A 710.045.97S SUP HCPCS C1763 710.045.97S - SUBSTITUTE BNGFT 12.5X12.5X10MM VOID FILR BLOCK BOTH IP/OP $925.00 $685.00 $183.59 $940.70 $416.24 $416.24 $416.24 $416.24 $924.98 $924.98 $924.98 $192.79 $924.98 $924.98 $924.98 $924.98 $924.98 $192.78 $924.98 $940.70 $547.13 $924.98 $940.70 $924.98 $924.98 $693.75 $924.98 $924.98 $924.98 $462.49 $462.49 $732.58 $924.98 $739.98 $416.24 $183.59 N/A $536.50 $924.98 $924.98 $924.98 $192.77 $924.98 N/A N/A 710.047.97S SUP HCPCS C1763 710.047.97S - SUBSTITUTE BNGFT 20X20X10MM VOID FILR BLOCK OSTEOCONDUCTIVE BOTH IP/OP "$1,818.50" "$1,346.00" $360.85 "$1,849.03" $818.16 $818.16 $818.16 $818.16 "$1,818.13" "$1,818.13" "$1,818.13" $378.94 "$1,818.13" "$1,818.13" "$1,818.13" "$1,818.13" "$1,818.13" $378.92 "$1,818.13" "$1,849.03" "$1,075.42" "$1,818.13" "$1,849.03" "$1,818.13" "$1,818.13" "$1,363.88" "$1,818.13" "$1,818.13" "$1,818.13" $909.07 $909.07 "$1,439.96" "$1,818.13" "$1,454.50" $818.16 $360.85 N/A "$1,054.73" "$1,818.13" "$1,818.13" "$1,818.13" $378.90 "$1,818.13" N/A N/A 710.047.98S SUP HCPCS C1763 710.047.98S - SUBSTITUTE BNGFT 20X20X10MM VOID FILR BLOCK CHRONOS BETA BOTH IP/OP "$2,355.00" "$1,743.00" $467.41 "$2,355.00" "$1,059.75" "$1,059.75" "$1,059.75" "$1,059.75" "$2,355.00" "$2,355.00" "$2,355.00" $490.84 "$2,355.00" "$2,355.00" "$2,355.00" "$2,355.00" "$2,355.00" $490.81 "$2,355.00" "$2,355.00" "$1,392.98" "$2,355.00" "$2,355.00" "$2,355.00" "$2,355.00" "$1,766.25" "$2,355.00" "$2,355.00" "$2,355.00" "$1,177.50" "$1,177.50" "$1,865.16" "$2,355.00" "$1,884.00" "$1,059.75" $467.41 N/A "$1,365.90" "$2,355.00" "$2,355.00" "$2,355.00" $490.78 "$2,355.00" N/A N/A 710.050.97S SUP HCPCS C1763 710.050.97S - SUBSTITUTE BNGFT 10D RECTANGLE 25X20X6.5MM VOID FILR WEDGE BOTH IP/OP "$1,838.00" "$1,360.00" $364.80 "$1,869.25" $827.10 $827.10 $827.10 $827.10 "$1,838.00" "$1,838.00" "$1,838.00" $383.09 "$1,838.00" "$1,838.00" "$1,838.00" "$1,838.00" "$1,838.00" $383.06 "$1,838.00" "$1,869.25" "$1,087.18" "$1,838.00" "$1,869.25" "$1,838.00" "$1,838.00" "$1,378.50" "$1,838.00" "$1,838.00" "$1,838.00" $919.00 $919.00 "$1,455.70" "$1,838.00" "$1,470.40" $827.10 $364.80 N/A "$1,066.04" "$1,838.00" "$1,838.00" "$1,838.00" $383.04 "$1,838.00" N/A N/A 710.050.98S SUP HCPCS C1713 710.050.98S - SUBSTITUTE BNGFT 10D RECTANGLE 25X20MM WEDGE CHRONOS BTCP BOTH IP/OP "$2,380.00" "$1,761.00" $472.37 "$2,380.00" "$1,071.00" "$1,071.00" "$1,071.00" "$1,071.00" "$2,380.00" "$2,380.00" "$2,380.00" $496.05 "$2,380.00" "$2,380.00" "$2,380.00" "$2,380.00" "$2,380.00" $496.02 "$2,380.00" $952.00 "$1,407.77" "$2,380.00" "$2,380.00" "$2,380.00" "$2,380.00" "$1,785.00" "$2,380.00" "$2,380.00" "$2,380.00" "$1,190.00" "$1,190.00" "$1,884.96" "$2,380.00" "$1,904.00" "$1,071.00" $472.37 N/A "$1,380.40" "$2,380.00" "$1,428.00" "$2,380.00" $495.99 "$2,380.00" N/A N/A 710.051.97S SUP HCPCS C1763 710.051.97S - SUBSTITUTE BNGFT 14D RECTANGLE 25X20X8MM VOID FILR WEDGE BOTH IP/OP "$1,937.50" "$1,434.00" $384.54 "$1,970.40" $871.87 $871.87 $871.87 $871.87 "$1,937.48" "$1,937.48" "$1,937.48" $403.82 "$1,937.48" "$1,937.48" "$1,937.48" "$1,937.48" "$1,937.48" $403.79 "$1,937.48" "$1,970.40" "$1,146.02" "$1,937.48" "$1,970.40" "$1,937.48" "$1,937.48" "$1,453.13" "$1,937.48" "$1,937.48" "$1,937.48" $968.74 $968.74 "$1,534.48" "$1,937.48" "$1,549.98" $871.87 $384.54 N/A "$1,123.75" "$1,937.48" "$1,937.48" "$1,937.48" $403.77 "$1,937.48" N/A N/A 710.052.97S SUP HCPCS C1763 710.052.97S - SUBSTITUTE BNGFT 18D RECTANGULAR 25X20X10MM VOID FILR WEDGE BOTH IP/OP "$2,059.00" "$1,524.00" $408.62 "$2,093.80" $926.46 $926.46 $926.46 $926.46 "$2,058.80" "$2,058.80" "$2,058.80" $429.11 "$2,058.80" "$2,058.80" "$2,058.80" "$2,058.80" "$2,058.80" $429.08 "$2,058.80" "$2,093.80" "$1,217.78" "$2,058.80" "$2,093.80" "$2,058.80" "$2,058.80" "$1,544.25" "$2,058.80" "$2,058.80" "$2,058.80" "$1,029.40" "$1,029.40" "$1,630.57" "$2,058.80" "$1,647.04" $926.46 $408.62 N/A "$1,194.22" "$2,058.80" "$2,058.80" "$2,058.80" $429.05 "$2,058.80" N/A N/A 710.053.97S SUP HCPCS C1763 710.053.97S - SUBSTITUTE BNGFT 22D RECTANGLE 25X20X12MM VOID FILR WEDGE BOTH IP/OP "$2,170.50" "$1,606.00" $430.73 "$2,207.10" $976.59 $976.59 $976.59 $976.59 "$2,170.20" "$2,170.20" "$2,170.20" $452.32 "$2,170.20" "$2,170.20" "$2,170.20" "$2,170.20" "$2,170.20" $452.29 "$2,170.20" "$2,207.10" "$1,283.67" "$2,170.20" "$2,207.10" "$2,170.20" "$2,170.20" "$1,627.88" "$2,170.20" "$2,170.20" "$2,170.20" "$1,085.10" "$1,085.10" "$1,718.80" "$2,170.20" "$1,736.16" $976.59 $430.73 N/A "$1,258.89" "$2,170.20" "$2,170.20" "$2,170.20" $452.27 "$2,170.20" N/A N/A 710.057.97S SUP HCPCS C1763 710.057.97S - SUBSTITUTE BNGFT 7D SEMICIRCLE 35X25X7MM VOID FILR WEDGE BOTH IP/OP "$2,170.50" "$1,606.00" $430.73 "$2,207.10" $976.59 $976.59 $976.59 $976.59 "$2,170.20" "$2,170.20" "$2,170.20" $452.32 "$2,170.20" "$2,170.20" "$2,170.20" "$2,170.20" "$2,170.20" $452.29 "$2,170.20" "$2,207.10" "$1,283.67" "$2,170.20" "$2,207.10" "$2,170.20" "$2,170.20" "$1,627.88" "$2,170.20" "$2,170.20" "$2,170.20" "$1,085.10" "$1,085.10" "$1,718.80" "$2,170.20" "$1,736.16" $976.59 $430.73 N/A "$1,258.89" "$2,170.20" "$2,170.20" "$2,170.20" $452.27 "$2,170.20" N/A N/A 710.057.98S SUP HCPCS C1763 710.057.98S - SUBSTITUTE BNGFT 7D VOID FILR WEDGE SEMICIRCULAR CHRONOS BOTH IP/OP "$2,810.00" "$2,079.00" $557.71 "$2,810.00" "$1,264.50" "$1,264.50" "$1,264.50" "$1,264.50" "$2,810.00" "$2,810.00" "$2,810.00" $585.67 "$2,810.00" "$2,810.00" "$2,810.00" "$2,810.00" "$2,810.00" $585.63 "$2,810.00" "$2,810.00" "$1,385.33" "$2,810.00" "$2,810.00" "$2,810.00" "$2,810.00" "$2,107.50" "$2,810.00" "$2,810.00" "$2,810.00" "$1,405.00" "$1,405.00" "$2,225.52" "$2,810.00" "$2,248.00" "$1,264.50" $557.71 N/A "$1,629.80" "$2,810.00" "$2,810.00" "$2,810.00" $585.60 "$2,810.00" N/A N/A 710.060.97S SUP HCPCS C1763 710.060.97S - SUBSTITUTE BNGFT 10D VOID FILR WEDGE ANGLED SEMICIRCULAR BOTH IP/OP "$2,246.00" "$1,662.00" $445.74 "$2,283.98" "$1,010.61" "$1,010.61" "$1,010.61" "$1,010.61" "$2,245.80" "$2,245.80" "$2,245.80" $468.08 "$2,245.80" "$2,245.80" "$2,245.80" "$2,245.80" "$2,245.80" $468.05 "$2,245.80" "$2,283.98" "$1,328.39" "$2,245.80" "$2,283.98" "$2,245.80" "$2,245.80" "$1,684.50" "$2,245.80" "$2,245.80" "$2,245.80" "$1,122.90" "$1,122.90" "$1,778.67" "$2,245.80" "$1,796.64" "$1,010.61" $445.74 N/A "$1,302.68" "$2,245.80" "$2,245.80" "$2,245.80" $468.02 "$2,245.80" N/A N/A 710.063.97S SUP HCPCS C1763 710.063.97S - SUBSTITUTE BNGFT 13D SEMICIRCLE 35X25X13MM WEDGE BOTH IP/OP "$2,355.50" "$1,743.00" $467.45 "$2,395.25" "$1,059.84" "$1,059.84" "$1,059.84" "$1,059.84" "$2,355.20" "$2,355.20" "$2,355.20" $490.88 "$2,355.20" "$2,355.20" "$2,355.20" "$2,355.20" "$2,355.20" $490.85 "$2,355.20" "$2,395.25" "$1,393.10" "$2,355.20" "$2,395.25" "$2,355.20" "$2,355.20" "$1,766.63" "$2,355.20" "$2,355.20" "$2,355.20" "$1,177.60" "$1,177.60" "$1,865.32" "$2,355.20" "$1,884.16" "$1,059.84" $467.45 N/A "$1,366.19" "$2,355.20" "$2,355.20" "$2,355.20" $490.82 "$2,355.20" N/A N/A 71063108S SUP HCPCS C1713 71063108S - PIN HLF 3MM 10MM JTX TI NTRD BOTH IP/OP $424.00 $314.00 $84.15 $424.00 $190.80 $190.80 $190.80 $190.80 $424.00 $424.00 $424.00 $88.37 $424.00 $424.00 $424.00 $424.00 $424.00 $88.37 $424.00 $85.75 $250.80 $424.00 $214.38 $424.00 $424.00 $318.00 $424.00 $424.00 $424.00 $212.00 $212.00 $335.81 $424.00 $339.20 $190.80 $84.15 N/A $245.92 $424.00 $254.40 $424.00 $88.36 $424.00 N/A N/A 71063158S SUP HCPCS C1713 71063158S - PIN HLF 3MM 15MM JTX TI NTRD BOTH IP/OP $424.00 $314.00 $84.15 $424.00 $190.80 $190.80 $190.80 $190.80 $424.00 $424.00 $424.00 $88.37 $424.00 $424.00 $424.00 $424.00 $424.00 $88.37 $424.00 $214.38 $250.80 $424.00 $214.38 $424.00 $424.00 $318.00 $424.00 $424.00 $424.00 $212.00 $212.00 $335.81 $424.00 $339.20 $190.80 $84.15 N/A $245.92 $424.00 $254.40 $424.00 $88.36 $424.00 N/A N/A 71063208S SUP HCPCS C1713 71063208S - PIN HLF 3MM 20MM JTX TI NTRD BOTH IP/OP $424.00 $314.00 $84.15 $424.00 $190.80 $190.80 $190.80 $190.80 $424.00 $424.00 $424.00 $88.37 $424.00 $424.00 $424.00 $424.00 $424.00 $88.37 $424.00 $85.75 $250.80 $424.00 $214.38 $424.00 $424.00 $318.00 $424.00 $424.00 $424.00 $212.00 $212.00 $335.81 $424.00 $339.20 $190.80 $84.15 N/A $245.92 $424.00 $254.40 $424.00 $424.00 $424.00 N/A N/A 71063258S SUP HCPCS C1713 71063258S - PIN HLF 3MM 25MM JTX TI NTRD BOTH IP/OP $424.00 $314.00 $84.15 $424.00 $190.80 $190.80 $190.80 $190.80 $424.00 $424.00 $424.00 $88.37 $424.00 $424.00 $424.00 $424.00 $424.00 $88.37 $424.00 $85.75 $250.80 $424.00 $214.38 $424.00 $424.00 $318.00 $424.00 $424.00 $424.00 $212.00 $212.00 $335.81 $424.00 $339.20 $190.80 $84.15 N/A $245.92 $424.00 $254.40 $424.00 $424.00 $424.00 N/A N/A 71064158S SUP HCPCS C1713 71064158S - PIN HLF 4MM 15MM JTX TI NTRD BOTH IP/OP $456.00 $337.00 $90.50 $456.00 $205.20 $205.20 $205.20 $205.20 $456.00 $456.00 $456.00 $95.04 $456.00 $456.00 $456.00 $456.00 $456.00 $95.04 $456.00 $92.05 $269.72 $456.00 $230.13 $456.00 $456.00 $342.00 $456.00 $456.00 $456.00 $228.00 $228.00 $361.15 $456.00 $364.80 $205.20 $90.50 N/A $264.48 $456.00 $273.60 $456.00 $95.03 $456.00 N/A N/A 71064208S SUP HCPCS C1713 71064208S - PIN HLF 4MM 20MM JTX TI NTRD BOTH IP/OP $456.00 $337.00 $90.50 $456.00 $205.20 $205.20 $205.20 $205.20 $456.00 $456.00 $456.00 $95.04 $456.00 $456.00 $456.00 $456.00 $456.00 $95.04 $456.00 $92.05 $269.72 $456.00 $230.13 $456.00 $456.00 $342.00 $456.00 $456.00 $456.00 $228.00 $228.00 $361.15 $456.00 $364.80 $205.20 $90.50 N/A $264.48 $456.00 $456.00 $456.00 $95.03 $456.00 N/A N/A 71064258S SUP HCPCS C1713 71064258S - PIN HLF 4MM 25MM JTX TI NTRD BOTH IP/OP $456.00 $337.00 $90.50 $456.00 $205.20 $205.20 $205.20 $205.20 $456.00 $456.00 $456.00 $95.04 $456.00 $456.00 $456.00 $456.00 $456.00 $95.04 $456.00 $92.05 $269.72 $456.00 $230.13 $456.00 $456.00 $342.00 $456.00 $456.00 $456.00 $228.00 $228.00 $361.15 $456.00 $364.80 $205.20 $90.50 N/A $264.48 $456.00 $273.60 $456.00 $95.03 $456.00 N/A N/A 71064308S SUP HCPCS C1713 71064308S - PIN HLF 4MM 30MM JTX TI NTRD BOTH IP/OP $456.00 $337.00 $90.50 $456.00 $205.20 $205.20 $205.20 $205.20 $456.00 $456.00 $456.00 $95.04 $456.00 $456.00 $456.00 $456.00 $456.00 $95.04 $456.00 $92.05 $269.72 $456.00 $230.13 $456.00 $456.00 $342.00 $456.00 $456.00 $456.00 $228.00 $228.00 $361.15 $456.00 $364.80 $205.20 $90.50 N/A $264.48 $456.00 $273.60 $456.00 $95.03 $456.00 N/A N/A 71064358S SUP HCPCS C1713 71064358S - PIN HLF 4MM 35MM JTX TI NTRD BOTH IP/OP $456.00 $337.00 $90.50 $456.00 $205.20 $205.20 $205.20 $205.20 $456.00 $456.00 $456.00 $95.04 $456.00 $456.00 $456.00 $456.00 $456.00 $95.04 $456.00 $92.05 $269.72 $456.00 $230.13 $456.00 $456.00 $342.00 $456.00 $456.00 $456.00 $228.00 $228.00 $361.15 $456.00 $364.80 $205.20 $90.50 N/A $264.48 $456.00 $273.60 $456.00 $95.03 $456.00 N/A N/A 7106-5300 SUP HCPCS C1713 7106-5300 - PIN HLF SHRT 5MM 30MM ORTH BOTH IP/OP $608.00 $450.00 $120.67 $608.00 $273.60 $273.60 $273.60 $273.60 $608.00 $608.00 $608.00 $126.72 $608.00 $608.00 $608.00 $608.00 $608.00 $126.71 $608.00 $608.00 $359.63 $608.00 $608.00 $608.00 $608.00 $456.00 $608.00 $608.00 $608.00 $304.00 $304.00 $481.54 $608.00 $486.40 $273.60 $120.67 N/A $352.64 $608.00 $364.80 $608.00 $126.71 $608.00 N/A N/A 71065304S SUP HCPCS C1713 71065304S - PIN HLF XSH 5MM 30MM STRL JTX TI NTRD BOTH IP/OP $584.00 $432.00 $115.91 $584.00 $262.80 $262.80 $262.80 $262.80 $584.00 $584.00 $584.00 $121.72 $584.00 $584.00 $584.00 $584.00 $584.00 $121.71 $584.00 $117.95 $345.44 $584.00 $294.88 $584.00 $584.00 $438.00 $584.00 $584.00 $584.00 $292.00 $292.00 $462.53 $584.00 $467.20 $262.80 $115.91 N/A $338.72 $584.00 $350.40 $584.00 $121.71 $584.00 N/A N/A 71065308S SUP HCPCS C1713 71065308S - PIN HLF SHRT 5MM 30MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $312.38 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $618.00 $618.00 $128.79 $618.00 N/A N/A 71065309S SUP HCPCS C1713 71065309S - PIN HLF LNG 5MM 30MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $124.95 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $370.80 $618.00 $128.79 $618.00 N/A N/A 71065354S SUP HCPCS C1713 71065354S - PIN HLF XSH 5MM 35MM STRL JTX TI NTRD BOTH IP/OP $556.00 $411.00 $110.35 $556.00 $250.20 $250.20 $250.20 $250.20 $556.00 $556.00 $556.00 $115.88 $556.00 $556.00 $556.00 $556.00 $556.00 $115.88 $556.00 $280.88 $328.87 $556.00 $280.88 $556.00 $556.00 $417.00 $556.00 $556.00 $556.00 $278.00 $278.00 $440.35 $556.00 $444.80 $250.20 $110.35 N/A $322.48 $556.00 $556.00 $556.00 $115.87 $556.00 N/A N/A 71065358S SUP HCPCS C1713 71065358S - PIN HLF SHRT 5MM 35MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $312.38 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $370.80 $618.00 $128.79 $618.00 N/A N/A 71065359S SUP HCPCS C1713 71065359S - PIN HLF LNG 5MM 35MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $124.95 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $370.80 $618.00 $128.79 $618.00 N/A N/A 71065404S SUP HCPCS C1713 71065404S - PIN HLF XSH 5MM 40MM STRL JTX TI NTRD BOTH IP/OP $584.00 $432.00 $115.91 $584.00 $262.80 $262.80 $262.80 $262.80 $584.00 $584.00 $584.00 $121.72 $584.00 $584.00 $584.00 $584.00 $584.00 $121.71 $584.00 $117.95 $345.44 $584.00 $294.88 $584.00 $584.00 $438.00 $584.00 $584.00 $584.00 $292.00 $292.00 $462.53 $584.00 $467.20 $262.80 $115.91 N/A $338.72 $584.00 $350.40 $584.00 $121.71 $584.00 N/A N/A 71065407S SUP HCPCS C1713 71065407S - PIN HLF XSH 1.6MM 40MM STRL JTX CNN TI NTRD BOTH IP/OP $790.00 $585.00 $156.80 $790.00 $355.50 $355.50 $355.50 $355.50 $790.00 $790.00 $790.00 $164.66 $790.00 $790.00 $790.00 $790.00 $790.00 $164.64 $790.00 $398.13 $467.29 $790.00 $398.13 $790.00 $790.00 $592.50 $790.00 $790.00 $790.00 $395.00 $395.00 $625.68 $790.00 $632.00 $355.50 $156.80 N/A $458.20 $790.00 $790.00 $790.00 $164.64 $790.00 N/A N/A 71065408S SUP HCPCS C1713 71065408S - PIN HLF SHRT 5MM 40MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $124.95 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $370.80 $618.00 $128.79 $618.00 N/A N/A 71065409S SUP HCPCS C1713 71065409S - PIN HLF LNG 5MM 40MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $124.95 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $370.80 $618.00 $128.79 $618.00 N/A N/A 71065454S SUP HCPCS C1713 71065454S - PIN HLF XSH 5MM 45MM STRL JTX TI NTRD BOTH IP/OP $556.00 $411.00 $110.35 $556.00 $250.20 $250.20 $250.20 $250.20 $556.00 $556.00 $556.00 $115.88 $556.00 $556.00 $556.00 $556.00 $556.00 $115.88 $556.00 $280.88 $328.87 $556.00 $280.88 $556.00 $556.00 $417.00 $556.00 $556.00 $556.00 $278.00 $278.00 $440.35 $556.00 $444.80 $250.20 $110.35 N/A $322.48 $556.00 $333.60 $556.00 $115.87 $556.00 N/A N/A 71065458S SUP HCPCS C1713 71065458S - PIN HLF SHRT 5MM 45MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $124.95 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $618.00 $618.00 $128.79 $618.00 N/A N/A 71065459S SUP HCPCS C1713 71065459S - PIN HLF LNG 5MM 45MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $312.38 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $370.80 $618.00 $128.79 $618.00 N/A N/A 71065507S SUP HCPCS C1713 71065507S - PIN HLF 5MM 50MM STRL JTX TRC TI NTRD BOTH IP/OP "$1,132.00" $838.00 $224.67 "$1,132.00" $509.40 $509.40 $509.40 $509.40 "$1,132.00" "$1,132.00" "$1,132.00" $235.94 "$1,132.00" "$1,132.00" "$1,132.00" "$1,132.00" "$1,132.00" $235.92 "$1,132.00" $228.20 $669.58 "$1,132.00" $570.50 "$1,132.00" "$1,132.00" $849.00 "$1,132.00" "$1,132.00" "$1,132.00" $566.00 $566.00 $896.54 "$1,132.00" $905.60 $509.40 $224.67 N/A $656.56 "$1,132.00" $679.20 "$1,132.00" $235.91 "$1,132.00" N/A N/A 71065508S SUP HCPCS C1713 71065508S - PIN HLF SHRT 5MM 50MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $312.38 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $618.00 $618.00 $128.79 $618.00 N/A N/A 71065509S SUP HCPCS C1713 71065509S - PIN HLF LNG 5MM 50MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $124.95 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $370.80 $618.00 $128.79 $618.00 N/A N/A 71065558S SUP HCPCS C1713 71065558S - PIN HLF SHRT 5MM 55MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $312.38 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $370.80 $618.00 $128.79 $618.00 N/A N/A 71065559S SUP HCPCS C1713 71065559S - PIN HLF LNG 5MM 55MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $312.38 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $370.80 $618.00 $128.79 $618.00 N/A N/A 71065608S SUP HCPCS C1713 71065608S - PIN HLF SHRT 5MM 60MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $312.38 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $370.80 $618.00 $128.79 $618.00 N/A N/A 71065609S SUP HCPCS C1713 71065609S - PIN HLF LNG 5MM 60MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $312.38 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $618.00 $618.00 $128.79 $618.00 N/A N/A 71065658S SUP HCPCS C1713 71065658S - PIN HLF SHRT 5MM 65MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $312.38 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $370.80 $618.00 $128.79 $618.00 N/A N/A 71065659S SUP HCPCS C1713 71065659S - PIN HLF LNG 5MM 65MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $312.38 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $370.80 $618.00 $128.79 $618.00 N/A N/A 71065708S SUP HCPCS C1713 71065708S - PIN HLF SHRT 5MM 70MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $312.38 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $370.80 $618.00 $128.79 $618.00 N/A N/A 71065709S SUP HCPCS C1713 71065709S - PIN HLF LNG 5MM 70MM STRL JTX TI NTRD BOTH IP/OP $618.00 $457.00 $122.66 $618.00 $278.10 $278.10 $278.10 $278.10 $618.00 $618.00 $618.00 $128.81 $618.00 $618.00 $618.00 $618.00 $618.00 $128.80 $618.00 $312.38 $365.55 $618.00 $312.38 $618.00 $618.00 $463.50 $618.00 $618.00 $618.00 $309.00 $309.00 $489.46 $618.00 $494.40 $278.10 $122.66 N/A $358.44 $618.00 $618.00 $618.00 $128.79 $618.00 N/A N/A 71066409S SUP HCPCS C1713 71066409S - PIN HLF LNG 6MM 40MM STRL JTX TI NTRD BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $318.50 $372.65 $630.00 $318.50 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $630.00 $630.00 N/A N/A 71066459S SUP HCPCS C1713 71066459S - PIN HLF LNG 6MM 45MM STRL JTX TI NTRD BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $318.50 $372.65 $630.00 $318.50 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $630.00 $630.00 N/A N/A 71066509S SUP HCPCS C1713 71066509S - PIN HLF LNG 6MM 50MM STRL JTX TI NTRD BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $318.50 $372.65 $630.00 $318.50 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $131.29 $630.00 N/A N/A 71066559S SUP HCPCS C1713 71066559S - PIN HLF LNG 6MM 55MM STRL JTX TI NTRD BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $127.40 $372.65 $630.00 $318.50 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $378.00 $630.00 $630.00 $630.00 N/A N/A 71066609S SUP HCPCS C1713 71066609S - PIN HLF LNG 6MM 60MM JTX TI NTRD STERILE BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $143.33 $143.33 $143.33 $143.33 $318.50 $318.50 $318.50 $66.38 $318.50 $318.50 $318.50 $318.50 $318.50 $66.38 $318.50 $127.40 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $143.33 $63.21 N/A $184.73 $318.50 $318.50 $318.50 $66.38 $318.50 N/A N/A 71070115X SUP Custom 27011340 71070115X - RING EXFIX 180MM FULL CIR FT TLT SP BOTH IP/OP "$3,468.00" "$2,566.00" $617.30 "$3,468.00" "$3,468.00" "$3,468.00" "$3,468.00" "$3,468.00" "$3,468.00" "$3,468.00" $617.30 "$3,468.00" "$3,468.00" "$2,573.95" "$2,573.95" "$2,673.13" "$1,806.83" $722.77 "$3,468.00" "$1,387.20" "$3,468.00" "$3,468.00" "$3,468.00" "$3,468.00" "$3,468.00" "$2,601.00" "$3,468.00" "$3,468.00" "$3,468.00" "$1,734.00" "$1,734.00" "$2,746.66" "$3,468.00" "$2,774.40" "$2,254.20" "$3,468.00" N/A "$2,011.44" "$3,468.00" "$2,080.80" "$3,468.00" "$3,468.00" "$3,468.00" N/A N/A 71071306X SUP HCPCS C1713 71071306X - RING XTRNFX 2/3 155MM BOTH IP/OP "$3,315.00" "$2,453.00" $657.94 "$3,315.00" "$1,491.75" "$1,491.75" "$1,491.75" "$1,491.75" "$3,315.00" "$3,315.00" "$3,315.00" $690.93 "$3,315.00" "$3,315.00" "$3,315.00" "$3,315.00" "$3,315.00" $690.88 "$3,315.00" "$1,326.00" "$1,634.30" "$3,315.00" "$3,315.00" "$3,315.00" "$3,315.00" "$2,486.25" "$3,315.00" "$3,315.00" "$3,315.00" "$1,657.50" "$1,657.50" "$2,625.48" "$3,315.00" "$2,652.00" "$1,491.75" $657.94 N/A "$1,922.70" "$3,315.00" "$1,989.00" "$3,315.00" $690.85 "$3,315.00" N/A N/A 71101545S SUP HCPCS C1713 71101545S - WASHER ORTH 6MM STRL BOTH IP/OP $109.00 $81.00 $21.63 $109.00 $49.05 $49.05 $49.05 $49.05 $109.00 $109.00 $109.00 $22.72 $109.00 $109.00 $109.00 $109.00 $109.00 $22.72 $109.00 $78.23 $64.47 $109.00 $78.23 $109.00 $109.00 $81.75 $109.00 $109.00 $109.00 $54.50 $54.50 $86.33 $109.00 $87.20 $49.05 $21.63 N/A $63.22 $109.00 $109.00 $109.00 $22.72 $109.00 N/A N/A 71101690S SUP HCPCS C1713 71101690S - WASHER ORTH 12.7MM RND BOTH IP/OP $132.50 $98.00 $26.26 $132.30 $59.54 $59.54 $59.54 $59.54 $132.30 $132.30 $132.30 $27.57 $132.30 $132.30 $132.30 $132.30 $132.30 $27.57 $132.30 $52.92 $78.26 $132.30 $132.30 $132.30 $132.30 $99.38 $132.30 $132.30 $132.30 $66.15 $66.15 $104.78 $132.30 $105.84 $59.54 $26.26 N/A $76.85 $132.30 $132.30 $132.30 $132.30 $132.30 N/A N/A 71101693S SUP HCPCS C1713 71101693S - WASHER ORTH 21.7MM STRL BTRFLY SS LG CNN SCR SYS BOTH IP/OP $219.50 $162.00 $43.56 $219.45 $98.75 $98.75 $98.75 $98.75 $219.45 $219.45 $219.45 $45.74 $219.45 $219.45 $219.45 $219.45 $219.45 $45.74 $219.45 $87.78 $129.80 $219.45 $219.45 $219.45 $219.45 $164.63 $219.45 $219.45 $219.45 $109.73 $109.73 $173.80 $219.45 $175.56 $98.75 $43.56 N/A $127.31 $219.45 $131.67 $219.45 $219.45 $219.45 N/A N/A 71103000S SUP HCPCS C1713 71103000S - WASHER ORTH 12.7MM RND TI BOTH IP/OP $77.50 $57.00 $15.31 $77.13 $34.71 $34.71 $34.71 $34.71 $77.13 $77.13 $77.13 $16.08 $77.13 $77.13 $77.13 $77.13 $77.13 $16.07 $77.13 $30.85 $45.62 $77.13 $77.13 $77.13 $77.13 $58.13 $77.13 $77.13 $77.13 $38.57 $38.57 $61.09 $77.13 $61.70 $34.71 $15.31 N/A $44.95 $77.13 $77.13 $77.13 $16.07 $77.13 N/A N/A 71103003S SUP HCPCS C1713 71103003S - WASHER ORTH 21.7MM BTRFLY TI BOTH IP/OP $527.50 $390.00 $104.62 $527.10 $237.20 $237.20 $237.20 $237.20 $527.10 $527.10 $527.10 $109.86 $527.10 $527.10 $527.10 $527.10 $527.10 $109.85 $527.10 $527.10 $311.78 $527.10 $527.10 $527.10 $527.10 $395.63 $527.10 $527.10 $527.10 $263.55 $263.55 $417.46 $527.10 $421.68 $237.20 $104.62 N/A $305.95 $527.10 $316.26 $527.10 $109.85 $527.10 N/A N/A 71106230S SUP HCPCS C1713 71106230S - SCREW BN FT 6.5MM 30MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $174.30 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106235S SUP HCPCS C1713 71106235S - SCREW BN FT 6.5MM 35MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $174.30 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106240S SUP HCPCS C1713 71106240S - SCREW BN FT 6.5MM 40MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $174.30 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106245S SUP HCPCS C1713 71106245S - SCREW BN FT 6.5MM 45MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $174.30 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106250S SUP HCPCS C1713 71106250S - SCREW BN FT 6.5MM 50MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $174.30 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106255S SUP HCPCS C1713 71106255S - SCREW BN FT 6.5MM 55MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $174.30 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $435.75 $435.75 $90.81 $435.75 N/A N/A 71106260S SUP HCPCS C1713 71106260S - SCREW BN FT 6.5MM 60MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $174.30 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106265S SUP HCPCS C1713 71106265S - SCREW BN FT 6.5MM 65MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $174.30 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106270S SUP HCPCS C1713 71106270S - SCREW BN FT 6.5MM 70MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106275S SUP HCPCS C1713 71106275S - SCREW BN FT 6.5MM 75MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $174.30 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106280S SUP HCPCS C1713 71106280S - SCREW BN FT 6.5MM 80MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $174.30 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106285S SUP HCPCS C1713 71106285S - SCREW BN 6.5MM 85MM CNN FT SS BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $174.30 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106290S SUP HCPCS C1713 71106290S - SCREW BN FT 6.5MM 90MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $174.30 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106295S SUP HCPCS C1713 71106295S - SCREW BN FT 6.5MM 95MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106300S SUP HCPCS C1713 71106300S - SCREW BN FT 6.5MM 100MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $174.30 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106305S SUP HCPCS C1713 71106305S - SCREW BN FT 6.5MM 105MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106310S SUP HCPCS C1713 71106310S - SCREW BN FT 6.5MM 110MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106315S SUP HCPCS C1713 71106315S - SCREW BN FT 6.5MM 115MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $435.75 $435.75 $90.81 $435.75 N/A N/A 71106320S SUP HCPCS C1713 71106320S - SCREW BN FT 6.5MM 120MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106325S SUP HCPCS C1713 71106325S - SCREW BN FT 6.5MM 125MM STRL CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106330S SUP HCPCS C1713 71106330S - SCREW BN FT 6.5MM 130MM STRL CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106335S SUP HCPCS C1713 71106335S - SCREW BN FT 6.5MM 135MM STRL CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106340S SUP HCPCS C1713 71106340S - SCREW BN FT 6.5MM 140MM STRL CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $502.95 $502.95 $104.81 $502.95 N/A N/A 71106345S SUP HCPCS C1713 71106345S - SCREW BN FT 6.5MM 145MM STRL CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106350S SUP HCPCS C1713 71106350S - SCREW BN FT 6.5MM 150MM STRL CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106355S SUP HCPCS C1713 71106355S - SCREW BN FT 6.5MM 155MM STRL CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106360S SUP HCPCS C1713 71106360S - SCREW BN FT 6.5MM 160MM STRL CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106365S SUP HCPCS C1713 71106365S - SCREW BN FT 6.5MM 165MM STRL CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106370S SUP HCPCS C1713 71106370S - SCREW BN FT 6.5MM 170MM STRL CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106375S SUP HCPCS C1713 71106375S - SCREW BN FT 6.5MM 175MM STRL CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $502.95 $502.95 N/A N/A 71106380S SUP HCPCS C1713 71106380S - SCREW BN FT 6.5MM 180MM STRL CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $502.95 $502.95 N/A N/A 71106530S SUP HCPCS C1713 71106530S - SCREW BN 6.5MM 30MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106535S SUP HCPCS C1713 71106535S - SCREW BN 6.5MM 35MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $435.75 $435.75 $90.81 $435.75 N/A N/A 71106540S SUP HCPCS C1713 71106540S - SCREW BN 6.5MM 40MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106545S SUP HCPCS C1713 71106545S - SCREW BN 6.5MM 45MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106550S SUP HCPCS C1713 71106550S - SCREW BN 6.5MM 50MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106555S SUP HCPCS C1713 71106555S - SCREW BN 6.5MM 55MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106560S SUP HCPCS C1713 71106560S - SCREW BN 6.5MM 60MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106565S SUP HCPCS C1713 71106565S - SCREW BN 6.5MM 65MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106570S SUP HCPCS C1713 71106570S - SCREW BN 6.5MM 70MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106575S SUP HCPCS C1713 71106575S - SCREW BN 6.5MM 75MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $435.75 $435.75 $435.75 $435.75 N/A N/A 71106580S SUP HCPCS C1713 71106580S - SCREW BN 6.5MM 80MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $435.75 $435.75 $90.81 $435.75 N/A N/A 71106585S SUP HCPCS C1713 71106585S - SCREW BN 6.5MM 85MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106590S SUP HCPCS C1713 71106590S - SCREW BN 6.5MM 90MM STRL 22MM CNN SS ORTH BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106595S SUP HCPCS C1713 71106595S - SCREW BN 6.5MM 95MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106600S SUP HCPCS C1713 71106600S - SCREW BN 6.5MM 100MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $435.75 $435.75 $435.75 $435.75 N/A N/A 71106605S SUP HCPCS C1713 71106605S - SCREW BN 6.5MM 105MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106610S SUP HCPCS C1713 71106610S - SCREW BN 6.5MM 110MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106615S SUP HCPCS C1713 71106615S - SCREW BN 6.5MM 115MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106620S SUP HCPCS C1713 71106620S - SCREW BN 6.5MM 120MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106625S SUP HCPCS C1713 71106625S - SCREW BN 6.5MM 125MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106630S SUP HCPCS C1713 71106630S - SCREW BN 6.5MM 130MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106635S SUP HCPCS C1713 71106635S - SCREW BN 6.5MM 135MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106640S SUP HCPCS C1713 71106640S - SCREW BN 6.5MM 140MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106645S SUP HCPCS C1713 71106645S - SCREW BN 6.5MM 145MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106650S SUP HCPCS C1713 71106650S - SCREW BN 6.5MM 150MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106655S SUP HCPCS C1713 71106655S - SCREW BN 6.5MM 155MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106660S SUP HCPCS C1713 71106660S - SCREW BN 6.5MM 160MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106665S SUP HCPCS C1713 71106665S - SCREW BN 6.5MM 165MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106670S SUP HCPCS C1713 71106670S - SCREW BN 6.5MM 170MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106675S SUP HCPCS C1713 71106675S - SCREW BN 6.5MM 175MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106680S SUP HCPCS C1713 71106680S - SCREW BN 6.5MM 180MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106755S SUP HCPCS C1713 71106755S - SCREW BN 6.5MM 55MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106760S SUP HCPCS C1713 71106760S - SCREW BN 6.5MM 60MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $435.75 $435.75 $435.75 $435.75 N/A N/A 71106765S SUP HCPCS C1713 71106765S - SCREW BN 6.5MM 65MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $435.75 $435.75 $90.81 $435.75 N/A N/A 71106770S SUP HCPCS C1713 71106770S - SCREW BN 6.5MM 70MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106775S SUP HCPCS C1713 71106775S - SCREW BN 6.5MM 75MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106780S SUP HCPCS C1713 71106780S - SCREW BN 6.5MM 80MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106785S SUP HCPCS C1713 71106785S - SCREW BN 6.5MM 85MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106790S SUP HCPCS C1713 71106790S - SCREW BN 6.5MM 90MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106795S SUP HCPCS C1713 71106795S - SCREW BN 6.5MM 95MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106800S SUP HCPCS C1713 71106800S - SCREW BN 6.5MM 100MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106805S SUP HCPCS C1713 71106805S - SCREW BN 6.5MM 105MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $435.75 $435.75 $435.75 $435.75 N/A N/A 71106810S SUP HCPCS C1713 71106810S - SCREW BN 6.5MM 110MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $435.75 $435.75 $90.81 $435.75 N/A N/A 71106815S SUP HCPCS C1713 71106815S - SCREW BN 6.5MM 115MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $90.81 $435.75 N/A N/A 71106820S SUP HCPCS C1713 71106820S - SCREW BN 6.5MM 120MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106825S SUP HCPCS C1713 71106825S - SCREW BN 6.5MM 125MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $436.00 $323.00 $86.49 $435.75 $196.09 $196.09 $196.09 $196.09 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $435.75 $435.75 $435.75 $90.82 $435.75 $435.75 $257.75 $435.75 $435.75 $435.75 $435.75 $327.00 $435.75 $435.75 $435.75 $217.88 $217.88 $345.11 $435.75 $348.60 $196.09 $86.49 N/A $252.88 $435.75 $261.45 $435.75 $435.75 $435.75 N/A N/A 71106830S SUP HCPCS C1713 71106830S - SCREW BN 6.5MM 130MM STRL 40MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $502.95 $502.95 $104.81 $502.95 N/A N/A 71106835S SUP HCPCS C1713 71106835S - SCREW BN 6.5MM 135MM STRL 40MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $502.95 $502.95 $104.81 $502.95 N/A N/A 71106840S SUP HCPCS C1713 71106840S - SCREW BN 6.5MM 140MM STRL 40MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106845S SUP HCPCS C1713 71106845S - SCREW BN 6.5MM 145MM STRL 40MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $502.95 $502.95 N/A N/A 71106850S SUP HCPCS C1713 71106850S - SCREW BN 6.5MM 150MM STRL 40MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $502.95 $502.95 N/A N/A 71106855S SUP HCPCS C1713 71106855S - SCREW BN 6.5MM 155MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106860S SUP HCPCS C1713 71106860S - SCREW BN 6.5MM 160MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106865S SUP HCPCS C1713 71106865S - SCREW BN 6.5MM 165MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $502.95 $502.95 $104.81 $502.95 N/A N/A 71106870S SUP HCPCS C1713 71106870S - SCREW BN 6.5MM 170MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $502.95 $502.95 $104.81 $502.95 N/A N/A 71106875S SUP HCPCS C1713 71106875S - SCREW BN 6.5MM 175MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71106880S SUP HCPCS C1713 71106880S - SCREW BN 6.5MM 180MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $503.00 $372.00 $99.82 $502.95 $226.33 $226.33 $226.33 $226.33 $502.95 $502.95 $502.95 $104.83 $502.95 $502.95 $502.95 $502.95 $502.95 $104.82 $502.95 $502.95 $297.49 $502.95 $502.95 $502.95 $502.95 $377.25 $502.95 $502.95 $502.95 $251.48 $251.48 $398.34 $502.95 $402.36 $226.33 $99.82 N/A $291.74 $502.95 $301.77 $502.95 $104.81 $502.95 N/A N/A 71107230S SUP HCPCS C1713 71107230S - SCREW BN 6.5MM 30MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71107235S SUP HCPCS C1713 71107235S - SCREW BN 6.5MM 35MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107240S SUP HCPCS C1713 71107240S - SCREW BN 6.5MM 40MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107245S SUP HCPCS C1713 71107245S - SCREW BN 6.5MM 45MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71107250S SUP HCPCS C1713 71107250S - SCREW BN 6.5MM 50MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107255S SUP HCPCS C1713 71107255S - SCREW BN 6.5MM 55MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107260S SUP HCPCS C1713 71107260S - SCREW BN 6.5MM 60MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107265S SUP HCPCS C1713 71107265S - SCREW BN 6.5MM 65MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107270S SUP HCPCS C1713 71107270S - SCREW BN 6.5MM 70MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107275S SUP HCPCS C1713 71107275S - SCREW BN 6.5MM 75MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107280S SUP HCPCS C1713 71107280S - SCREW BN 6.5MM 80MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71107285S SUP HCPCS C1713 71107285S - SCREW BN 6.5MM 85MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71107290S SUP HCPCS C1713 71107290S - SCREW BN 6.5MM 90MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71107295S SUP HCPCS C1713 71107295S - SCREW BN 6.5MM 95MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107300S SUP HCPCS C1713 71107300S - SCREW BN 6.5MM 100MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107305S SUP HCPCS C1713 71107305S - SCREW BN 6.5MM 105MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71107310S SUP HCPCS C1713 71107310S - SCREW BN 6.5MM 110MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107315S SUP HCPCS C1713 71107315S - SCREW BN 6.5MM 115MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107320S SUP HCPCS C1713 71107320S - SCREW BN 6.5MM 120MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $540.75 $540.75 N/A N/A 71107325S SUP HCPCS C1713 71107325S - SCREW BN FT 6.5MM 125MM CNN SET TI ANKL ASCP ARTHDS BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107330S SUP HCPCS C1713 71107330S - SCREW BN 6.5MM 130MM CNN FT TI BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $295.47 $492.45 $492.45 $492.45 N/A N/A 71107335S SUP HCPCS C1713 71107335S - SCREW BN 6.5MM 135MM CNN FT TI BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $295.47 $492.45 $102.63 $492.45 N/A N/A 71107340S SUP HCPCS C1713 71107340S - SCREW BN 6.5MM 140MM CNN FT TI BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $295.47 $492.45 $102.63 $492.45 N/A N/A 71107345S SUP HCPCS C1713 71107345S - SCREW BN 6.5MM 145MM CNN FT TI BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $295.47 $492.45 $102.63 $492.45 N/A N/A 71107350S SUP HCPCS C1713 71107350S - SCREW BN 6.5MM 150MM CNN FT TI BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $295.47 $492.45 $102.63 $492.45 N/A N/A 71107355S SUP HCPCS C1713 71107355S - SCREW BN 6.5MM 155MM CNN FT TI BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $492.45 $492.45 $102.63 $492.45 N/A N/A 71107360S SUP HCPCS C1713 71107360S - SCREW BN 6.5MM 160MM CNN FT TI BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $295.47 $492.45 $102.63 $492.45 N/A N/A 71107365S SUP HCPCS C1713 71107365S - SCREW BN 6.5MM 165MM CNN FT TI BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $295.47 $492.45 $102.63 $492.45 N/A N/A 71107370S SUP HCPCS C1713 71107370S - SCREW BN 6.5MM 170MM CNN FT TI BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $295.47 $492.45 $102.63 $492.45 N/A N/A 71107375S SUP HCPCS C1713 71107375S - SCREW BN 6.5MM 175MM CNN FT TI BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $295.47 $492.45 $102.63 $492.45 N/A N/A 71107380S SUP HCPCS C1713 71107380S - SCREW BN 6.5MM 180MM CNN FT TI BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $295.47 $492.45 $102.63 $492.45 N/A N/A 71107530S SUP HCPCS C1713 71107530S - SCREW BN 6.5MM 30MM 20MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107535S SUP HCPCS C1713 71107535S - SCREW BN 6.5MM 35MM 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107540S SUP HCPCS C1713 71107540S - SCREW BN 6.5MM 40MM 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107545S SUP HCPCS C1713 71107545S - SCREW BN 6.5MM 45MM 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71107550S SUP HCPCS C1713 71107550S - SCREW BN 6.5MM 50MM 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71107555S SUP HCPCS C1713 71107555S - SCREW BN 6.5MM 55MM 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107560S SUP HCPCS C1713 71107560S - SCREW BN 6.5MM 60MM 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107565S SUP HCPCS C1713 71107565S - SCREW BN 6.5MM 65MM 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107570S SUP HCPCS C1713 71107570S - SCREW BN 6.5MM 70MM 22MM CNN P/T BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107575S SUP HCPCS C1713 71107575S - SCREW BN 6.5MM 75MM 22MM CNN P/T BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107580S SUP HCPCS C1713 71107580S - SCREW BN 6.5MM 80MM 22MM CNN P/T BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107585S SUP HCPCS C1713 71107585S - SCREW BN 6.5MM 85MM 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107590S SUP HCPCS C1713 71107590S - SCREW BN 6.5MM 90MM 22MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107595S SUP HCPCS C1713 71107595S - SCREW BN 6.5MM 95MM 22MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107600S SUP HCPCS C1713 71107600S - SCREW BN 6.5MM 100MM 22MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107605S SUP HCPCS C1713 71107605S - SCREW BN 6.5MM 105MM 22MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107610S SUP HCPCS C1713 71107610S - SCREW BN 6.5MM 110MM 22MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71107615S SUP HCPCS C1713 71107615S - SCREW BN 6.5MM 115MM 22MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71107620S SUP HCPCS C1713 71107620S - SCREW BN 6.5MM 120MM 22MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107625S SUP HCPCS C1713 71107625S - SCREW BN 6.5MM 125MM 22MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71107630S SUP HCPCS C1713 71107630S - SCREW BN 6.5MM 130MM 22MM CNN P/T BOTH IP/OP $565.00 $418.00 $112.12 $564.90 $254.21 $254.21 $254.21 $254.21 $564.90 $564.90 $564.90 $117.74 $564.90 $564.90 $564.90 $564.90 $564.90 $117.73 $564.90 $225.96 $334.14 $564.90 $564.90 $564.90 $564.90 $423.75 $564.90 $564.90 $564.90 $282.45 $282.45 $447.40 $564.90 $451.92 $254.21 $112.12 N/A $327.70 $564.90 $564.90 $564.90 $117.73 $564.90 N/A N/A 71107635S SUP HCPCS C1713 71107635S - SCREW BN 6.5MM 135MM 22MM CNN P/T BOTH IP/OP $565.00 $418.00 $112.12 $564.90 $254.21 $254.21 $254.21 $254.21 $564.90 $564.90 $564.90 $117.74 $564.90 $564.90 $564.90 $564.90 $564.90 $117.73 $564.90 $564.90 $334.14 $564.90 $564.90 $564.90 $564.90 $423.75 $564.90 $564.90 $564.90 $282.45 $282.45 $447.40 $564.90 $451.92 $254.21 $112.12 N/A $327.70 $564.90 $338.94 $564.90 $117.73 $564.90 N/A N/A 71107640S SUP HCPCS C1713 71107640S - SCREW BN 6.5MM 140MM 22MM CNN P/T BOTH IP/OP $565.00 $418.00 $112.12 $564.90 $254.21 $254.21 $254.21 $254.21 $564.90 $564.90 $564.90 $117.74 $564.90 $564.90 $564.90 $564.90 $564.90 $117.73 $564.90 $225.96 $334.14 $564.90 $564.90 $564.90 $564.90 $423.75 $564.90 $564.90 $564.90 $282.45 $282.45 $447.40 $564.90 $451.92 $254.21 $112.12 N/A $327.70 $564.90 $338.94 $564.90 $117.73 $564.90 N/A N/A 71107645S SUP HCPCS C1713 71107645S - SCREW BN 6.5MM 145MM 22MM CNN P/T BOTH IP/OP $565.00 $418.00 $112.12 $564.90 $254.21 $254.21 $254.21 $254.21 $564.90 $564.90 $564.90 $117.74 $564.90 $564.90 $564.90 $564.90 $564.90 $117.73 $564.90 $564.90 $334.14 $564.90 $564.90 $564.90 $564.90 $423.75 $564.90 $564.90 $564.90 $282.45 $282.45 $447.40 $564.90 $451.92 $254.21 $112.12 N/A $327.70 $564.90 $564.90 $564.90 $117.73 $564.90 N/A N/A 71107650S SUP HCPCS C1713 71107650S - SCREW BN 6.5MM 150MM 22MM CNN P/T BOTH IP/OP $565.00 $418.00 $112.12 $564.90 $254.21 $254.21 $254.21 $254.21 $564.90 $564.90 $564.90 $117.74 $564.90 $564.90 $564.90 $564.90 $564.90 $117.73 $564.90 $564.90 $334.14 $564.90 $564.90 $564.90 $564.90 $423.75 $564.90 $564.90 $564.90 $282.45 $282.45 $447.40 $564.90 $451.92 $254.21 $112.12 N/A $327.70 $564.90 $338.94 $564.90 $564.90 $564.90 N/A N/A 71107655S SUP HCPCS C1713 71107655S - SCREW BN 6.5MM 155MM 22MM CNN P/T BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $295.47 $492.45 $492.45 $492.45 N/A N/A 71107660S SUP HCPCS C1713 71107660S - SCREW BN 6.5MM 160MM 22MM CNN P/T BOTH IP/OP $565.00 $418.00 $112.12 $564.90 $254.21 $254.21 $254.21 $254.21 $564.90 $564.90 $564.90 $117.74 $564.90 $564.90 $564.90 $564.90 $564.90 $117.73 $564.90 $564.90 $334.14 $564.90 $564.90 $564.90 $564.90 $423.75 $564.90 $564.90 $564.90 $282.45 $282.45 $447.40 $564.90 $451.92 $254.21 $112.12 N/A $327.70 $564.90 $564.90 $564.90 $117.73 $564.90 N/A N/A 71107665S SUP HCPCS C1713 71107665S - SCREW BN 6.5MM 165MM 22MM CNN P/T BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $295.47 $492.45 $102.63 $492.45 N/A N/A 71107670S SUP HCPCS C1713 71107670S - SCREW BN 6.5MM 170MM 22MM CNN P/T BOTH IP/OP $565.00 $418.00 $112.12 $564.90 $254.21 $254.21 $254.21 $254.21 $564.90 $564.90 $564.90 $117.74 $564.90 $564.90 $564.90 $564.90 $564.90 $117.73 $564.90 $564.90 $334.14 $564.90 $564.90 $564.90 $564.90 $423.75 $564.90 $564.90 $564.90 $282.45 $282.45 $447.40 $564.90 $451.92 $254.21 $112.12 N/A $327.70 $564.90 $338.94 $564.90 $564.90 $564.90 N/A N/A 71107675S SUP HCPCS C1713 71107675S - SCREW BN 6.5MM 175MM 22MM CNN P/T BOTH IP/OP $565.00 $418.00 $112.12 $564.90 $254.21 $254.21 $254.21 $254.21 $564.90 $564.90 $564.90 $117.74 $564.90 $564.90 $564.90 $564.90 $564.90 $117.73 $564.90 $564.90 $334.14 $564.90 $564.90 $564.90 $564.90 $423.75 $564.90 $564.90 $564.90 $282.45 $282.45 $447.40 $564.90 $451.92 $254.21 $112.12 N/A $327.70 $564.90 $564.90 $564.90 $117.73 $564.90 N/A N/A 71107680S SUP HCPCS C1713 71107680S - SCREW BN 6.5MM 180MM 22MM CNN P/T BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $196.98 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $492.45 $492.45 $102.63 $492.45 N/A N/A 71107755S SUP HCPCS C1713 71107755S - SCREW BN 6.5MM 55MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $540.75 $540.75 N/A N/A 71107760S SUP HCPCS C1713 71107760S - SCREW BN 6.5MM 60MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107765S SUP HCPCS C1713 71107765S - SCREW BN 6.5MM 65MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107770S SUP HCPCS C1713 71107770S - SCREW BN 6.5MM 70MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107775S SUP HCPCS C1713 71107775S - SCREW BN 6.5MM 75MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107780S SUP HCPCS C1713 71107780S - SCREW BN 6.5MM 80MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107785S SUP HCPCS C1713 71107785S - SCREW BN 6.5MM 85MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107790S SUP HCPCS C1713 71107790S - SCREW BN 6.5MM 90MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107795S SUP HCPCS C1713 71107795S - SCREW BN 6.5MM 95MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107800S SUP HCPCS C1713 71107800S - SCREW BN 6.5MM 100MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107805S SUP HCPCS C1713 71107805S - SCREW BN 6.5MM 105MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107810S SUP HCPCS C1713 71107810S - SCREW BN 6.5MM 110MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107815S SUP HCPCS C1713 71107815S - SCREW BN 6.5MM 115MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107820S SUP HCPCS C1713 71107820S - SCREW BN 6.5MM 120MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107825S SUP HCPCS C1713 71107825S - SCREW BN 6.5MM 125MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71107830S SUP HCPCS C1713 71107830S - SCREW BN 6.5MM 130MM 46MM CNN P/T BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $492.45 $492.45 $102.63 $492.45 N/A N/A 71107835S SUP HCPCS C1713 71107835S - SCREW BN 6.5MM 135MM 46MM CNN P/T BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $492.45 $492.45 $102.63 $492.45 N/A N/A 71107840S SUP HCPCS C1713 71107840S - SCREW BN 6.5MM 140MM 46MM CNN P/T BOTH IP/OP $565.00 $418.00 $112.12 $564.90 $254.21 $254.21 $254.21 $254.21 $564.90 $564.90 $564.90 $117.74 $564.90 $564.90 $564.90 $564.90 $564.90 $117.73 $564.90 $225.96 $334.14 $564.90 $564.90 $564.90 $564.90 $423.75 $564.90 $564.90 $564.90 $282.45 $282.45 $447.40 $564.90 $451.92 $254.21 $112.12 N/A $327.70 $564.90 $564.90 $564.90 $117.73 $564.90 N/A N/A 71107845S SUP HCPCS C1713 71107845S - SCREW BN 6.5MM 145MM 46MM CNN P/T BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $492.45 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $492.45 $492.45 $102.63 $492.45 N/A N/A 71107850S SUP HCPCS C1713 71107850S - SCREW BN 6.5MM 150MM 46MM CNN P/T BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $196.98 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $492.45 $492.45 $102.63 $492.45 N/A N/A 71107855S SUP HCPCS C1713 71107855S - SCREW BN 6.5MM 155MM 46MM CNN P/T BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $196.98 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $492.45 $492.45 $102.63 $492.45 N/A N/A 71107860S SUP HCPCS C1713 71107860S - SCREW BN 6.5MM 160MM 46MM CNN P/T BOTH IP/OP $565.00 $418.00 $112.12 $564.90 $254.21 $254.21 $254.21 $254.21 $564.90 $564.90 $564.90 $117.74 $564.90 $564.90 $564.90 $564.90 $564.90 $117.73 $564.90 $225.96 $334.14 $564.90 $564.90 $564.90 $564.90 $423.75 $564.90 $564.90 $564.90 $282.45 $282.45 $447.40 $564.90 $451.92 $254.21 $112.12 N/A $327.70 $564.90 $564.90 $564.90 $117.73 $564.90 N/A N/A 71107865S SUP HCPCS C1713 71107865S - SCREW BN 6.5MM 165MM 46MM CNN P/T BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $196.98 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $492.45 $492.45 $102.63 $492.45 N/A N/A 71107870S SUP HCPCS C1713 71107870S - SCREW BN 6.5MM 170MM 46MM CNN P/T BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $196.98 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $492.45 $492.45 $102.63 $492.45 N/A N/A 71107875S SUP HCPCS C1713 71107875S - SCREW BN 6.5MM 175MM 46MM CNN P/T BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $196.98 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $492.45 $492.45 $102.63 $492.45 N/A N/A 71107880S SUP HCPCS C1713 71107880S - SCREW BN 6.5MM 180MM 46MM CNN P/T BOTH IP/OP $492.50 $364.00 $97.74 $492.45 $221.60 $221.60 $221.60 $221.60 $492.45 $492.45 $492.45 $102.64 $492.45 $492.45 $492.45 $492.45 $492.45 $102.63 $492.45 $196.98 $291.28 $492.45 $492.45 $492.45 $492.45 $369.38 $492.45 $492.45 $492.45 $246.23 $246.23 $390.02 $492.45 $393.96 $221.60 $97.74 N/A $285.65 $492.45 $492.45 $492.45 $102.63 $492.45 N/A N/A 71108240S SUP HCPCS C1713 71108240S - SCREW BN FT 8MM 40MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $444.15 $444.15 N/A N/A 71108245S SUP HCPCS C1713 71108245S - SCREW BN FT 8MM 45MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108250S SUP HCPCS C1713 71108250S - SCREW BN FT 8MM 50MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $444.15 $444.15 N/A N/A 71108255S SUP HCPCS C1713 71108255S - SCREW BN FT 8MM 55MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108260S SUP HCPCS C1713 71108260S - SCREW BN FT 8MM 60MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108265S SUP HCPCS C1713 71108265S - SCREW BN FT 8MM 65MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $177.66 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108270S SUP HCPCS C1713 71108270S - SCREW BN FT 8MM 70MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108275S SUP HCPCS C1713 71108275S - SCREW BN FT 8MM 75MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108280S SUP HCPCS C1713 71108280S - SCREW BN LG FT LOPRFL 8MM 80MM STRL CNN ST SLFDRL REVCT FLUT BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $177.66 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $444.15 $444.15 N/A N/A 71108285S SUP HCPCS C1713 71108285S - SCREW BN FT 8MM 85MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $177.66 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $444.15 $444.15 N/A N/A 71108290S SUP HCPCS C1713 71108290S - SCREW BN FT 8MM 90MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108295S SUP HCPCS C1713 71108295S - SCREW BN FT 8MM 95MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $177.66 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108300S SUP HCPCS C1713 71108300S - SCREW BN LG FT LOPRFL 8MM 100MM STRL CNN ST SLFDRL REVCT BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108305S SUP HCPCS C1713 71108305S - SCREW BN FT 8MM 105MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $177.66 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108310S SUP HCPCS C1713 71108310S - SCREW BN FT 8MM 110MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108315S SUP HCPCS C1713 71108315S - SCREW BN FT 8MM 115MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $177.66 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108320S SUP HCPCS C1713 71108320S - SCREW BN FT 8MM 120MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108325S SUP HCPCS C1713 71108325S - SCREW BN FT 8MM 125MM STRL CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $177.66 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108330S SUP HCPCS C1713 71108330S - SCREW BN FT 8MM 130MM STRL CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108335S SUP HCPCS C1713 71108335S - SCREW BN FT 8MM 135MM STRL CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $204.12 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108340S SUP HCPCS C1713 71108340S - SCREW BN FT 8MM 140MM STRL CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108345S SUP HCPCS C1713 71108345S - SCREW BN FT 8MM 145MM STRL CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $204.12 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108350S SUP HCPCS C1713 71108350S - SCREW BN FT 8MM 150MM STRL CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $510.30 $510.30 N/A N/A 71108355S SUP HCPCS C1713 71108355S - SCREW BN 8MM 155MM STRL CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $204.12 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $510.30 $510.30 N/A N/A 71108360S SUP HCPCS C1713 71108360S - SCREW BN 8MM 160MM STRL CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108365S SUP HCPCS C1713 71108365S - SCREW BN 8MM 165MM STRL CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $204.12 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108370S SUP HCPCS C1713 71108370S - SCREW BN 8MM 170MM STRL CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108375S SUP HCPCS C1713 71108375S - SCREW BN 8MM 175MM STRL CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $306.18 $510.30 $106.35 $510.30 N/A N/A 71108380S SUP HCPCS C1713 71108380S - SCREW BN 8MM 180MM STRL CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $306.18 $510.30 $106.35 $510.30 N/A N/A 71108540S SUP HCPCS C1713 71108540S - SCREW BN 8MM 40MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $92.56 $444.15 N/A N/A 71108545S SUP HCPCS C1713 71108545S - SCREW BN 8MM 45MM STRL 24MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $92.56 $444.15 N/A N/A 71108550S SUP HCPCS C1713 71108550S - SCREW BN 8MM 50MM STRL 24MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $444.15 $444.15 N/A N/A 71108555S SUP HCPCS C1713 71108555S - SCREW BN 8MM 55MM STRL 24MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $444.15 $444.15 N/A N/A 71108560S SUP HCPCS C1713 71108560S - SCREW BN 8MM 60MM STRL 24MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108565S SUP HCPCS C1713 71108565S - SCREW BN 8MM 65MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108570S SUP HCPCS C1713 71108570S - SCREW BN 8MM 70MM STRL 24MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $177.66 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $92.56 $444.15 N/A N/A 71108575S SUP HCPCS C1713 71108575S - SCREW BN 8MM 75MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $92.56 $444.15 N/A N/A 71108580S SUP HCPCS C1713 71108580S - SCREW BN 8MM 80MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $177.66 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $444.15 $444.15 N/A N/A 71108585S SUP HCPCS C1713 71108585S - SCREW BN 8MM 85MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $444.15 $444.15 N/A N/A 71108590S SUP HCPCS C1713 71108590S - SCREW BN 8MM 90MM STRL 24MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $92.56 $444.15 N/A N/A 71108595S SUP HCPCS C1713 71108595S - SCREW BN LG P/T LOPRFL 8MM 95MM STRL 22MM CNN ST SLFDRL BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $92.56 $444.15 N/A N/A 71108600S SUP HCPCS C1713 71108600S - SCREW BN LG P/T LOPRFL 8MM 100MM STRL 22MM CNN ST SLFDRL BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108605S SUP HCPCS C1713 71108605S - SCREW BN 8MM 105MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $444.15 $444.15 N/A N/A 71108610S SUP HCPCS C1713 71108610S - SCREW BN 8MM 110MM STRL 24MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $444.15 $444.15 N/A N/A 71108615S SUP HCPCS C1713 71108615S - SCREW BN 8MM 115MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $92.56 $444.15 N/A N/A 71108620S SUP HCPCS C1713 71108620S - SCREW BN 8MM 120MM STRL 24MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $444.15 $444.15 N/A N/A 71108625S SUP HCPCS C1713 71108625S - SCREW BN 8MM 125MM STRL 24MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $444.15 $444.15 N/A N/A 71108630S SUP HCPCS C1713 71108630S - SCREW BN 8MM 130MM STRL 24MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108635S SUP HCPCS C1713 71108635S - SCREW BN 8MM 135MM STRL 24MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $306.18 $510.30 $510.30 $510.30 N/A N/A 71108640S SUP HCPCS C1713 71108640S - SCREW BN 8MM 140MM STRL 24MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $306.18 $510.30 $510.30 $510.30 N/A N/A 71108645S SUP HCPCS C1713 71108645S - SCREW BN LG P/T LOPRFL 8MM 145MM STRL 22MM CNN ST SLFDRL BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $204.12 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $306.18 $510.30 $106.35 $510.30 N/A N/A 71108650S SUP HCPCS C1713 71108650S - SCREW BN 8MM 150MM STRL 24MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $204.12 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $510.30 $510.30 N/A N/A 71108655S SUP HCPCS C1713 71108655S - SCREW BN 8MM 155MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $306.18 $510.30 $510.30 $510.30 N/A N/A 71108660S SUP HCPCS C1713 71108660S - SCREW BN 8MM 160MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $306.18 $510.30 $106.35 $510.30 N/A N/A 71108665S SUP HCPCS C1713 71108665S - SCREW BN 8MM 165MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $204.12 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $510.30 $510.30 N/A N/A 71108670S SUP HCPCS C1713 71108670S - SCREW BN 8MM 170MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $306.18 $510.30 $510.30 $510.30 N/A N/A 71108675S SUP HCPCS C1713 71108675S - SCREW BN 8MM 175MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $306.18 $510.30 $510.30 $510.30 N/A N/A 71108680S SUP HCPCS C1713 71108680S - SCREW BN 8MM 180MM STRL 22MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108755S SUP HCPCS C1713 71108755S - SCREW BN LG P/T LOPRFL 8MM 55MM STRL 46MM CNN ST SLFDRL BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108760S SUP HCPCS C1713 71108760S - SCREW BN LG P/T LOPRFL 8MM 60MM STRL 46MM CNN ST SLFDRL BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $444.15 $444.15 N/A N/A 71108765S SUP HCPCS C1713 71108765S - SCREW BN 8MM 65MM STRL 40MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $444.15 $444.15 N/A N/A 71108770S SUP HCPCS C1713 71108770S - SCREW BN 8MM 70MM STRL 40MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $92.56 $444.15 N/A N/A 71108775S SUP HCPCS C1713 71108775S - SCREW BN LG P/T LOPRFL 8MM 75MM STRL 46MM CNN ST SLFDRL BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108780S SUP HCPCS C1713 71108780S - SCREW BN 8MM 80MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108785S SUP HCPCS C1713 71108785S - SCREW BN P/T 8MM 85MM CNN SS FEM TIB BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $444.15 $444.15 N/A N/A 71108790S SUP HCPCS C1713 71108790S - SCREW BN 8MM 90MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $444.15 $444.15 N/A N/A 71108795S SUP HCPCS C1713 71108795S - SCREW BN LG P/T LOPRFL 8MM 95MM STRL 46MM CNN ST SLFDRL BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $92.56 $444.15 N/A N/A 71108800S SUP HCPCS C1713 71108800S - SCREW BN 8MM 100MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $444.15 $444.15 $444.15 $444.15 N/A N/A 71108805S SUP HCPCS C1713 71108805S - SCREW BN LG P/T LOPRFL 8MM 105MM STRL 46MM CNN ST SLFDRL BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $444.15 $444.15 N/A N/A 71108810S SUP HCPCS C1713 71108810S - SCREW BN 8MM 110MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $92.56 $444.15 N/A N/A 71108815S SUP HCPCS C1713 71108815S - SCREW BN LG P/T LOPRFL 8MM 115MM STRL 46MM CNN ST SLFDRL BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $444.15 $444.15 N/A N/A 71108820S SUP HCPCS C1713 71108820S - SCREW BN LG P/T LOPRFL 8MM 120MM STRL 46MM CNN ST SLFDRL BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $92.56 $444.15 N/A N/A 71108825S SUP HCPCS C1713 71108825S - SCREW BN 8MM 125MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $444.50 $329.00 $88.15 $444.15 $199.87 $199.87 $199.87 $199.87 $444.15 $444.15 $444.15 $92.57 $444.15 $444.15 $444.15 $444.15 $444.15 $92.57 $444.15 $177.66 $262.71 $444.15 $444.15 $444.15 $444.15 $333.38 $444.15 $444.15 $444.15 $222.08 $222.08 $351.77 $444.15 $355.32 $199.87 $88.15 N/A $257.81 $444.15 $266.49 $444.15 $92.56 $444.15 N/A N/A 71108830S SUP HCPCS C1713 71108830S - SCREW BN 8MM 130MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $306.18 $510.30 $106.35 $510.30 N/A N/A 71108835S SUP HCPCS C1713 71108835S - SCREW BN 8MM 135MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $204.12 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $306.18 $510.30 $106.35 $510.30 N/A N/A 71108840S SUP HCPCS C1713 71108840S - SCREW BN 8MM 140MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $204.12 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108845S SUP HCPCS C1713 71108845S - SCREW BN 8MM 145MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108850S SUP HCPCS C1713 71108850S - SCREW BN 8MM 150MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108855S SUP HCPCS C1713 71108855S - SCREW BN 8MM 155MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $204.12 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $510.30 $510.30 N/A N/A 71108860S SUP HCPCS C1713 71108860S - SCREW BN 8MM 160MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $204.12 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $510.30 $510.30 N/A N/A 71108865S SUP HCPCS C1713 71108865S - SCREW BN 8MM 165MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108870S SUP HCPCS C1713 71108870S - SCREW BN 8MM 170MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $510.30 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108875S SUP HCPCS C1713 71108875S - SCREW BN 8MM 175MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $204.12 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $510.30 $510.30 $106.35 $510.30 N/A N/A 71108880S SUP HCPCS C1713 71108880S - SCREW BN 8MM 180MM STRL 46MM CNN SS LNG BN SM BN BOTH IP/OP $510.50 $378.00 $101.28 $510.30 $229.64 $229.64 $229.64 $229.64 $510.30 $510.30 $510.30 $106.36 $510.30 $510.30 $510.30 $510.30 $510.30 $106.35 $510.30 $204.12 $301.84 $510.30 $510.30 $510.30 $510.30 $382.88 $510.30 $510.30 $510.30 $255.15 $255.15 $404.16 $510.30 $408.24 $229.64 $101.28 N/A $296.09 $510.30 $306.18 $510.30 $106.35 $510.30 N/A N/A 71109240S SUP HCPCS C1713 71109240S - SCREW BN 8MM 40MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109245S SUP HCPCS C1713 71109245S - SCREW BN FT 8MM 45MM CNN SET TI ANKL BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109250S SUP HCPCS C1713 71109250S - SCREW BN 8MM 50MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109255S SUP HCPCS C1713 71109255S - SCREW BN 8MM 55MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71109260S SUP HCPCS C1713 71109260S - SCREW BN 8MM 60MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109265S SUP HCPCS C1713 71109265S - SCREW BN 8MM 65MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109270S SUP HCPCS C1713 71109270S - SCREW BN 8MM 70MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109275S SUP HCPCS C1713 71109275S - SCREW BN 8MM 75MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109280S SUP HCPCS C1713 71109280S - SCREW BN 8MM 80MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $540.75 $540.75 N/A N/A 71109285S SUP HCPCS C1713 71109285S - SCREW BN 8MM 85MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $540.75 $540.75 N/A N/A 71109290S SUP HCPCS C1713 71109290S - SCREW BN 8MM 90MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109295S SUP HCPCS C1713 71109295S - SCREW BN 8MM 95MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109300S SUP HCPCS C1713 71109300S - SCREW BN 8MM 100MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71109305S SUP HCPCS C1713 71109305S - SCREW BN 8MM 105MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109310S SUP HCPCS C1713 71109310S - SCREW BN 8MM 110MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109315S SUP HCPCS C1713 71109315S - SCREW BN 8MM 115MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109320S SUP HCPCS C1713 71109320S - SCREW BN 8MM 120MM FT CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109325S SUP HCPCS C1713 71109325S - SCREW BN 8MM 125MM CNN FT TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109330S SUP HCPCS C1713 71109330S - SCREW BN 8MM 130MM CNN FT TI BOTH IP/OP $513.50 $380.00 $101.91 $513.45 $231.05 $231.05 $231.05 $231.05 $513.45 $513.45 $513.45 $107.02 $513.45 $513.45 $513.45 $513.45 $513.45 $107.01 $513.45 $513.45 $303.71 $513.45 $513.45 $513.45 $513.45 $385.13 $513.45 $513.45 $513.45 $256.73 $256.73 $406.65 $513.45 $410.76 $231.05 $101.91 N/A $297.83 $513.45 $308.07 $513.45 $107.00 $513.45 N/A N/A 71109335S SUP HCPCS C1713 71109335S - SCREW BN 8MM 135MM CNN FT TI BOTH IP/OP $513.50 $380.00 $101.91 $513.45 $231.05 $231.05 $231.05 $231.05 $513.45 $513.45 $513.45 $107.02 $513.45 $513.45 $513.45 $513.45 $513.45 $107.01 $513.45 $205.38 $303.71 $513.45 $513.45 $513.45 $513.45 $385.13 $513.45 $513.45 $513.45 $256.73 $256.73 $406.65 $513.45 $410.76 $231.05 $101.91 N/A $297.83 $513.45 $308.07 $513.45 $107.00 $513.45 N/A N/A 71109340S SUP HCPCS C1713 71109340S - SCREW BN 8MM 140MM CNN FT TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71109345S SUP HCPCS C1713 71109345S - SCREW BN 8MM 145MM CNN FT TI BOTH IP/OP $513.50 $380.00 $101.91 $513.45 $231.05 $231.05 $231.05 $231.05 $513.45 $513.45 $513.45 $107.02 $513.45 $513.45 $513.45 $513.45 $513.45 $107.01 $513.45 $205.38 $303.71 $513.45 $513.45 $513.45 $513.45 $385.13 $513.45 $513.45 $513.45 $256.73 $256.73 $406.65 $513.45 $410.76 $231.05 $101.91 N/A $297.83 $513.45 $308.07 $513.45 $107.00 $513.45 N/A N/A 71109350S SUP HCPCS C1713 71109350S - SCREW BN 8MM 150MM CNN FT TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71109355S SUP HCPCS C1713 71109355S - SCREW BN 8MM 155MM CNN FT TI BOTH IP/OP $513.50 $380.00 $101.91 $513.45 $231.05 $231.05 $231.05 $231.05 $513.45 $513.45 $513.45 $107.02 $513.45 $513.45 $513.45 $513.45 $513.45 $107.01 $513.45 $205.38 $303.71 $513.45 $513.45 $513.45 $513.45 $385.13 $513.45 $513.45 $513.45 $256.73 $256.73 $406.65 $513.45 $410.76 $231.05 $101.91 N/A $297.83 $513.45 $308.07 $513.45 $107.00 $513.45 N/A N/A 71109360S SUP HCPCS C1713 71109360S - SCREW BN 8MM 160MM STRL CNN FT TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71109365S SUP HCPCS C1713 71109365S - SCREW BN 8MM 165MM STRL CNN FT TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71109370S SUP HCPCS C1713 71109370S - SCREW BN 8MM 170MM STRL CNN FT TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $591.15 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71109375S SUP HCPCS C1713 71109375S - SCREW BN 8MM 175MM STRL CNN FT TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71109380S SUP HCPCS C1713 71109380S - SCREW BN 8MM 180MM STRL CNN FT TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $591.15 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $591.15 $591.15 N/A N/A 71109540S SUP HCPCS C1713 71109540S - SCREW BN 8MM 40MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $540.75 $540.75 N/A N/A 71109545S SUP HCPCS C1713 71109545S - SCREW BN 8MM 45MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71109550S SUP HCPCS C1713 71109550S - SCREW BN 8MM 50MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109555S SUP HCPCS C1713 71109555S - SCREW BN 8MM 55MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109560S SUP HCPCS C1713 71109560S - SCREW BN 8MM 60MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109565S SUP HCPCS C1713 71109565S - SCREW BN 8MM 65MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109570S SUP HCPCS C1713 71109570S - SCREW BN 8MM 70MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109575S SUP HCPCS C1713 71109575S - SCREW BN 8MM 75MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $540.75 $540.75 N/A N/A 71109580S SUP HCPCS C1713 71109580S - SCREW BN 8MM 80MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71109585S SUP HCPCS C1713 71109585S - SCREW BN 8MM 85MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109590S SUP HCPCS C1713 71109590S - SCREW BN 8MM 90MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109595S SUP HCPCS C1713 71109595S - SCREW BN 8MM 95MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109600S SUP HCPCS C1713 71109600S - SCREW BN 8MM 100MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109605S SUP HCPCS C1713 71109605S - SCREW BN 8MM 105MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71109610S SUP HCPCS C1713 71109610S - SCREW BN P/T 8MM 110MM 22MM CNN SLFDRL ST SS HND MIDFOOT BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71109615S SUP HCPCS C1713 71109615S - SCREW BN 8MM 115MM 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71109620S SUP HCPCS C1713 71109620S - SCREW BN 8MM 120MM 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71109625S SUP HCPCS C1713 71109625S - SCREW BN 8MM 125MM STRL 22MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109630S SUP HCPCS C1713 71109630S - SCREW BN 8MM 130MM STRL 22MM CNN P/T TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $591.15 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $591.15 $591.15 N/A N/A 71109635S SUP HCPCS C1713 71109635S - SCREW BN 8MM 135MM STRL 22MM CNN P/T TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $591.15 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71109640S SUP HCPCS C1713 71109640S - SCREW BN 8MM 140MM 22MM CNN P/T TI BOTH IP/OP $513.50 $380.00 $101.91 $513.45 $231.05 $231.05 $231.05 $231.05 $513.45 $513.45 $513.45 $107.02 $513.45 $513.45 $513.45 $513.45 $513.45 $107.01 $513.45 $513.45 $303.71 $513.45 $513.45 $513.45 $513.45 $385.13 $513.45 $513.45 $513.45 $256.73 $256.73 $406.65 $513.45 $410.76 $231.05 $101.91 N/A $297.83 $513.45 $308.07 $513.45 $107.00 $513.45 N/A N/A 71109645S SUP HCPCS C1713 71109645S - SCREW BN 8MM 145MM STRL 22MM CNN P/T TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71109650S SUP HCPCS C1713 71109650S - SCREW BN 8MM 150MM STRL 22MM P/T CNN TI BOTH IP/OP $513.50 $380.00 $101.91 $513.45 $231.05 $231.05 $231.05 $231.05 $513.45 $513.45 $513.45 $107.02 $513.45 $513.45 $513.45 $513.45 $513.45 $107.01 $513.45 $513.45 $303.71 $513.45 $513.45 $513.45 $513.45 $385.13 $513.45 $513.45 $513.45 $256.73 $256.73 $406.65 $513.45 $410.76 $231.05 $101.91 N/A $297.83 $513.45 $308.07 $513.45 $513.45 $513.45 N/A N/A 71109655S SUP HCPCS C1713 71109655S - SCREW BN P/T 8MM 155MM 22MM CNN TI ANKL BOTH IP/OP $513.50 $380.00 $101.91 $513.45 $231.05 $231.05 $231.05 $231.05 $513.45 $513.45 $513.45 $107.02 $513.45 $513.45 $513.45 $513.45 $513.45 $107.01 $513.45 $513.45 $303.71 $513.45 $513.45 $513.45 $513.45 $385.13 $513.45 $513.45 $513.45 $256.73 $256.73 $406.65 $513.45 $410.76 $231.05 $101.91 N/A $297.83 $513.45 $308.07 $513.45 $513.45 $513.45 N/A N/A 71109660S SUP HCPCS C1713 71109660S - SCREW BN 8MM 160MM 22MM CNN P/T TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71109665S SUP HCPCS C1713 71109665S - SCREW BN 8MM 165MM 22MM CNN P/T TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71109670S SUP HCPCS C1713 71109670S - SCREW BN 8MM 170MM 22MM CNN P/T TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $591.15 $591.15 $123.20 $591.15 N/A N/A 71109675S SUP HCPCS C1713 71109675S - SCREW BN 8MM 175MM 22MM CNN P/T TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $591.15 $591.15 $123.20 $591.15 N/A N/A 71109680S SUP HCPCS C1713 71109680S - SCREW BN 8MM 180MM 22MM CNN P/T TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $591.15 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71109755S SUP HCPCS C1713 71109755S - SCREW BN 8MM 55MM 46MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109760S SUP HCPCS C1713 71109760S - SCREW BN 8MM 60MM 46MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109765S SUP HCPCS C1713 71109765S - SCREW BN 8MM 65MM 46MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109770S SUP HCPCS C1713 71109770S - SCREW BN 8MM 70MM 46MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71109775S SUP HCPCS C1713 71109775S - SCREW BN 8MM 75MM 46MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109780S SUP HCPCS C1713 71109780S - SCREW BN 6.5MM 80MM CNN BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109785S SUP HCPCS C1713 71109785S - SCREW BN 8MM 85MM 46MM CNN P/T TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109790S SUP HCPCS C1713 71109790S - SCREW BN 8MM 90MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109795S SUP HCPCS C1713 71109795S - SCREW BN 8MM 95MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109800S SUP HCPCS C1713 71109800S - SCREW BN 8MM 100MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $112.69 $540.75 N/A N/A 71109805S SUP HCPCS C1713 71109805S - SCREW BN 8MM 105MM 46MM P/T BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109810S SUP HCPCS C1713 71109810S - SCREW BN 8MM 110MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109815S SUP HCPCS C1713 71109815S - SCREW BN 8MM 115MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $216.30 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $540.75 $540.75 $112.69 $540.75 N/A N/A 71109820S SUP HCPCS C1713 71109820S - SCREW BN 8MM 120MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109825S SUP HCPCS C1713 71109825S - SCREW BN 8MM 125MM 46MM P/T CNN TI BOTH IP/OP $541.00 $400.00 $107.33 $540.75 $243.34 $243.34 $243.34 $243.34 $540.75 $540.75 $540.75 $112.71 $540.75 $540.75 $540.75 $540.75 $540.75 $112.70 $540.75 $540.75 $319.85 $540.75 $540.75 $540.75 $540.75 $405.75 $540.75 $540.75 $540.75 $270.38 $270.38 $428.27 $540.75 $432.60 $243.34 $107.33 N/A $313.78 $540.75 $324.45 $540.75 $540.75 $540.75 N/A N/A 71109830S SUP HCPCS C1713 71109830S - SCREW BN 8MM 130MM 46MM P/T CNN TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71109835S SUP HCPCS C1713 71109835S - SCREW BN 8MM 135MM 46MM P/T CNN TI BOTH IP/OP $513.50 $380.00 $101.91 $513.45 $231.05 $231.05 $231.05 $231.05 $513.45 $513.45 $513.45 $107.02 $513.45 $513.45 $513.45 $513.45 $513.45 $107.01 $513.45 $205.38 $303.71 $513.45 $513.45 $513.45 $513.45 $385.13 $513.45 $513.45 $513.45 $256.73 $256.73 $406.65 $513.45 $410.76 $231.05 $101.91 N/A $297.83 $513.45 $308.07 $513.45 $513.45 $513.45 N/A N/A 71109840S SUP HCPCS C1713 71109840S - SCREW BN 8MM 140MM 46MM P/T CNN TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $591.15 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71109845S SUP HCPCS C1713 71109845S - SCREW BN 8MM 145MM 46MM P/T CNN TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $591.15 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $591.15 $591.15 N/A N/A 71109850S SUP HCPCS C1713 71109850S - SCREW BN 8MM 150MM 46MM P/T CNN TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $591.15 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $591.15 $591.15 N/A N/A 71109855S SUP HCPCS C1713 71109855S - SCREW BN 8MM 155MM 46MM P/T CNN TI BOTH IP/OP $513.50 $380.00 $101.91 $513.45 $231.05 $231.05 $231.05 $231.05 $513.45 $513.45 $513.45 $107.02 $513.45 $513.45 $513.45 $513.45 $513.45 $107.01 $513.45 $205.38 $303.71 $513.45 $513.45 $513.45 $513.45 $385.13 $513.45 $513.45 $513.45 $256.73 $256.73 $406.65 $513.45 $410.76 $231.05 $101.91 N/A $297.83 $513.45 $513.45 $513.45 $513.45 $513.45 N/A N/A 71109860S SUP HCPCS C1713 71109860S - SCREW BN 8MM 160MM 46MM P/T CNN TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $591.15 $591.15 N/A N/A 71109865S SUP HCPCS C1713 71109865S - SCREW BN 8MM 165MM 46MM P/T CNN TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $591.15 $591.15 N/A N/A 71109870S SUP HCPCS C1713 71109870S - SCREW BN 8MM 170MM 46MM P/T CNN TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71109875S SUP HCPCS C1713 71109875S - SCREW BN 8MM 175MM 46MM P/T CNN TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $591.15 $591.15 $123.20 $591.15 N/A N/A 71109880S SUP HCPCS C1713 71109880S - SCREW BN 8MM 180MM 46MM P/T CNN TI BOTH IP/OP $591.50 $438.00 $117.33 $591.15 $266.02 $266.02 $266.02 $266.02 $591.15 $591.15 $591.15 $123.21 $591.15 $591.15 $591.15 $591.15 $591.15 $123.20 $591.15 $236.46 $349.67 $591.15 $591.15 $591.15 $591.15 $443.63 $591.15 $591.15 $591.15 $295.58 $295.58 $468.19 $591.15 $472.92 $266.02 $117.33 N/A $343.07 $591.15 $354.69 $591.15 $123.20 $591.15 N/A N/A 71114V SUP Custom 27203010 71114V - CLIP INTNL XLarge Clips (6 Cartridge) ( 14 Cartridges Bx)ÿ BOTH IP/OP $68.00 $50.00 $12.06 $67.77 $67.77 $67.77 $67.77 $67.77 $67.77 $67.77 $12.06 $67.77 $67.77 $50.30 $50.30 $52.24 $35.31 $14.12 $67.77 $27.11 $67.77 $67.77 $67.77 $67.77 $67.77 $51.00 $67.77 $67.77 $67.77 $33.89 $33.89 $53.67 $67.77 $54.22 $44.05 $67.77 N/A $39.44 $67.77 $40.66 $67.77 $67.77 $67.77 N/A N/A 71149308M SUP HCPCS C1713 71149308M - SCREW BN 2MM 4MM 8MM TC100 ST HEX HD SS CORT MN FRAG SYS BOTH IP/OP $107.00 $79.00 $21.20 $106.80 $48.06 $48.06 $48.06 $48.06 $106.80 $106.80 $106.80 $22.26 $106.80 $106.80 $106.80 $106.80 $106.80 $22.26 $106.80 $106.80 $63.17 $106.80 $106.80 $106.80 $106.80 $80.25 $106.80 $106.80 $106.80 $53.40 $53.40 $84.59 $106.80 $85.44 $48.06 $21.20 N/A $62.06 $106.80 $64.08 $106.80 $22.26 $106.80 N/A N/A 71149310M SUP HCPCS C1713 71149310M - SCREW BN 2MM 4MM 10MM TC100 ST HEX HD SS CORT MN FRAG SYS BOTH IP/OP $107.00 $79.00 $21.20 $106.80 $48.06 $48.06 $48.06 $48.06 $106.80 $106.80 $106.80 $22.26 $106.80 $106.80 $106.80 $106.80 $106.80 $22.26 $106.80 $42.72 $63.17 $106.80 $106.80 $106.80 $106.80 $80.25 $106.80 $106.80 $106.80 $53.40 $53.40 $84.59 $106.80 $85.44 $48.06 $21.20 N/A $62.06 $106.80 $106.80 $106.80 $22.26 $106.80 N/A N/A 71149312M SUP HCPCS C1713 71149312M - SCREW BN 2MM 12MM TC100 ST CORT BOTH IP/OP $107.00 $79.00 $21.20 $106.80 $48.06 $48.06 $48.06 $48.06 $106.80 $106.80 $106.80 $22.26 $106.80 $106.80 $106.80 $106.80 $106.80 $22.26 $106.80 $42.72 $63.17 $106.80 $106.80 $106.80 $106.80 $80.25 $106.80 $106.80 $106.80 $53.40 $53.40 $84.59 $106.80 $85.44 $48.06 $21.20 N/A $62.06 $106.80 $64.08 $106.80 $22.26 $106.80 N/A N/A 71149314M SUP HCPCS C1713 71149314M - SCREW BN 2MM 14MM TC100 ST CORT BOTH IP/OP $107.00 $79.00 $21.20 $106.80 $48.06 $48.06 $48.06 $48.06 $106.80 $106.80 $106.80 $22.26 $106.80 $106.80 $106.80 $106.80 $106.80 $22.26 $106.80 $106.80 $63.17 $106.80 $106.80 $106.80 $106.80 $80.25 $106.80 $106.80 $106.80 $53.40 $53.40 $84.59 $106.80 $85.44 $48.06 $21.20 N/A $62.06 $106.80 $64.08 $106.80 $22.26 $106.80 N/A N/A 71149316M SUP HCPCS C1713 71149316M - SCREW BN 2MM 16MM TC100 ST CORT BOTH IP/OP $107.00 $79.00 $21.20 $106.80 $48.06 $48.06 $48.06 $48.06 $106.80 $106.80 $106.80 $22.26 $106.80 $106.80 $106.80 $106.80 $106.80 $22.26 $106.80 $106.80 $63.17 $106.80 $106.80 $106.80 $106.80 $80.25 $106.80 $106.80 $106.80 $53.40 $53.40 $84.59 $106.80 $85.44 $48.06 $21.20 N/A $62.06 $106.80 $106.80 $106.80 $22.26 $106.80 N/A N/A 71149410M SUP HCPCS C1713 71149410M - SCREW BN 2.7MM 5MM 10MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $93.50 $69.00 $18.50 $93.20 $41.94 $41.94 $41.94 $41.94 $93.20 $93.20 $93.20 $19.43 $93.20 $93.20 $93.20 $93.20 $93.20 $19.42 $93.20 $93.20 $55.13 $93.20 $93.20 $93.20 $93.20 $70.13 $93.20 $93.20 $93.20 $46.60 $46.60 $73.81 $93.20 $74.56 $41.94 $18.50 N/A $54.23 $93.20 $55.92 $93.20 $19.42 $93.20 N/A N/A 71149412M SUP HCPCS C1713 71149412M - SCREW BN 2.7MM 5MM 12MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $93.50 $69.00 $18.50 $93.20 $41.94 $41.94 $41.94 $41.94 $93.20 $93.20 $93.20 $19.43 $93.20 $93.20 $93.20 $93.20 $93.20 $19.42 $93.20 $37.28 $55.13 $93.20 $93.20 $93.20 $93.20 $70.13 $93.20 $93.20 $93.20 $46.60 $46.60 $73.81 $93.20 $74.56 $41.94 $18.50 N/A $54.23 $93.20 $55.92 $93.20 $19.42 $93.20 N/A N/A 71149414M SUP HCPCS C1713 71149414M - SCREW BN 2.7MM 5MM 14MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $93.50 $69.00 $18.50 $93.20 $41.94 $41.94 $41.94 $41.94 $93.20 $93.20 $93.20 $19.43 $93.20 $93.20 $93.20 $93.20 $93.20 $19.42 $93.20 $37.28 $55.13 $93.20 $93.20 $93.20 $93.20 $70.13 $93.20 $93.20 $93.20 $46.60 $46.60 $73.81 $93.20 $74.56 $41.94 $18.50 N/A $54.23 $93.20 $93.20 $93.20 $19.42 $93.20 N/A N/A 71149418M SUP HCPCS C1713 71149418M - SCREW BN 2.7MM 5MM 18MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $93.50 $69.00 $18.50 $93.20 $41.94 $41.94 $41.94 $41.94 $93.20 $93.20 $93.20 $19.43 $93.20 $93.20 $93.20 $93.20 $93.20 $19.42 $93.20 $93.20 $55.13 $93.20 $93.20 $93.20 $93.20 $70.13 $93.20 $93.20 $93.20 $46.60 $46.60 $73.81 $93.20 $74.56 $41.94 $18.50 N/A $54.23 $93.20 $55.92 $93.20 $19.42 $93.20 N/A N/A 71149420M SUP HCPCS C1713 71149420M - SCREW BN 2.7MM 5MM 20MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $93.50 $69.00 $18.50 $93.20 $41.94 $41.94 $41.94 $41.94 $93.20 $93.20 $93.20 $19.43 $93.20 $93.20 $93.20 $93.20 $93.20 $19.42 $93.20 $37.28 $55.13 $93.20 $93.20 $93.20 $93.20 $70.13 $93.20 $93.20 $93.20 $46.60 $46.60 $73.81 $93.20 $74.56 $41.94 $18.50 N/A $54.23 $93.20 $55.92 $93.20 $19.42 $93.20 N/A N/A 71149422M SUP HCPCS C1713 71149422M - SCREW BN 2.7MM 5MM 22MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $93.50 $69.00 $18.50 $93.20 $41.94 $41.94 $41.94 $41.94 $93.20 $93.20 $93.20 $19.43 $93.20 $93.20 $93.20 $93.20 $93.20 $19.42 $93.20 $93.20 $55.13 $93.20 $93.20 $93.20 $93.20 $70.13 $93.20 $93.20 $93.20 $46.60 $46.60 $73.81 $93.20 $74.56 $41.94 $18.50 N/A $54.23 $93.20 $55.92 $93.20 $19.42 $93.20 N/A N/A 71149424M SUP HCPCS C1713 71149424M - SCREW BN 2.7MM 5MM 24MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $93.50 $69.00 $18.50 $93.20 $41.94 $41.94 $41.94 $41.94 $93.20 $93.20 $93.20 $19.43 $93.20 $93.20 $93.20 $93.20 $93.20 $19.42 $93.20 $37.28 $55.13 $93.20 $93.20 $93.20 $93.20 $70.13 $93.20 $93.20 $93.20 $46.60 $46.60 $73.81 $93.20 $74.56 $41.94 $18.50 N/A $54.23 $93.20 $55.92 $93.20 $19.42 $93.20 N/A N/A 71149510A SUP HCPCS C1713 71149510A - SCREW BN 3.5MM 6MM 10MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $51.84 $86.40 $18.01 $86.40 N/A N/A 71149510M SUP HCPCS C1713 71149510M - SCREW BN 3.5MM 6MM 10MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149512A SUP HCPCS C1713 71149512A - SCREW BN 3.5MM 6MM 12MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $51.84 $86.40 $18.01 $86.40 N/A N/A 71149514A SUP HCPCS C1713 71149514A - SCREW BN 3.5MM 6MM 14MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $51.84 $86.40 $86.40 $86.40 N/A N/A 71149516A SUP HCPCS C1713 71149516A - SCREW BN 3.5MM 6MM 16MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $51.84 $86.40 $18.01 $86.40 N/A N/A 71149518A SUP HCPCS C1713 71149518A - SCREW BN 3.5MM 6MM 18MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $51.84 $86.40 $18.01 $86.40 N/A N/A 71149520A SUP HCPCS C1713 71149520A - SCREW BN 3.5MM 6MM 20MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $51.84 $86.40 $18.01 $86.40 N/A N/A 71149520M SUP HCPCS C1713 71149520M - SCREW BN 3.5MM 6MM 20MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149522A SUP HCPCS C1713 71149522A - SCREW BN 3.5MM 6MM 22MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $51.84 $86.40 $86.40 $86.40 N/A N/A 71149522M SUP HCPCS C1713 71149522M - SCREW BN 3.5MM 22MM TC100 ST CORT BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149524A SUP HCPCS C1713 71149524A - SCREW BN 3.5MM 6MM 24MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $86.40 $86.40 $18.01 $86.40 N/A N/A 71149526A SUP HCPCS C1713 71149526A - SCREW BN 3.5MM 6MM 26MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $51.84 $86.40 $86.40 $86.40 N/A N/A 71149526M SUP HCPCS C1713 71149526M - SCREW BN 3.5MM 6MM 26MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149528A SUP HCPCS C1713 71149528A - SCREW BN 3.5MM 28MM TC100 ST CORT BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $86.40 $86.40 $18.01 $86.40 N/A N/A 71149528M SUP HCPCS C1713 71149528M - SCREW BN 3.5MM 6MM 28MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $101.20 $101.20 $21.09 $101.20 N/A N/A 71149530M SUP HCPCS C1713 71149530M - SCREW BN 3.5MM 6MM 30MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149532A SUP HCPCS C1713 71149532A - SCREW BN 3.5MM 6MM 32MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $51.84 $86.40 $86.40 $86.40 N/A N/A 71149532M SUP HCPCS C1713 71149532M - SCREW BN 3.5MM 32MM TC100 ST CORT BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $101.20 $101.20 N/A N/A 71149534A SUP HCPCS C1713 71149534A - SCREW BN 3.5MM 34MM TC100 ST CORT BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $51.84 $86.40 $18.01 $86.40 N/A N/A 71149534M SUP HCPCS C1713 71149534M - SCREW BN 3.5MM 6MM 34MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $101.20 $101.20 $101.20 $101.20 N/A N/A 71149536A SUP HCPCS C1713 71149536A - SCREW BN 3.5MM 6MM 36MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $86.40 $86.40 $18.01 $86.40 N/A N/A 71149536M SUP HCPCS C1713 71149536M - SCREW BN 3.5MM 36MM TC100 ST CORT BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149538A SUP HCPCS C1713 71149538A - SCREW BN 3.5MM 6MM 38MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $51.84 $86.40 $18.01 $86.40 N/A N/A 71149538M SUP HCPCS C1713 71149538M - SCREW BN 3.5MM 38MM TC100 ST CORT BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149540A SUP HCPCS C1713 71149540A - SCREW BN 3.5MM 6MM 40MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $51.84 $86.40 $18.01 $86.40 N/A N/A 71149540M SUP HCPCS C1713 71149540M - SCREW BN 3.5MM 40MM TC100 ST CORT BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149545A SUP HCPCS C1713 71149545A - SCREW BN 3.5MM 6MM 45MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $51.84 $86.40 $18.01 $86.40 N/A N/A 71149545M SUP HCPCS C1713 71149545M - SCREW BN 3.5MM 6MM 45MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $101.20 $101.20 N/A N/A 71149550A SUP HCPCS C1713 71149550A - SCREW BN 3.5MM 6MM 50MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $86.50 $64.00 $17.15 $86.40 $38.88 $38.88 $38.88 $38.88 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $86.40 $86.40 $86.40 $18.01 $86.40 $86.40 $51.11 $86.40 $86.40 $86.40 $86.40 $64.88 $86.40 $86.40 $86.40 $43.20 $43.20 $68.43 $86.40 $69.12 $38.88 $17.15 N/A $50.17 $86.40 $86.40 $86.40 $86.40 $86.40 N/A N/A 71149550M SUP HCPCS C1713 71149550M - SCREW BN 3.5MM 6MM 50MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $101.20 $101.20 N/A N/A 71149555M SUP HCPCS C1713 71149555M - SCREW BN 3.5MM 6MM 55MM TC100 ST HEX SCKT SS CORT SM FRAG BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $101.20 $101.20 $21.09 $101.20 N/A N/A 71149714M SUP HCPCS C1713 71149714M - SCREW BN 4.5MM 14MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149716M SUP HCPCS C1713 71149716M - SCREW BN 4.5MM 16MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149718M SUP HCPCS C1713 71149718M - SCREW BN 4.5MM 18MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $101.20 $101.20 $101.20 $101.20 N/A N/A 71149720M SUP HCPCS C1713 71149720M - SCREW BN 4.5MM 20MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $101.20 $101.20 $101.20 $101.20 N/A N/A 71149722M SUP HCPCS C1713 71149722M - SCREW BN 4.5MM 22MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $101.20 $101.20 $21.09 $101.20 N/A N/A 71149724M SUP HCPCS C1713 71149724M - SCREW BN 4.5MM 24MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $101.20 $101.20 $21.09 $101.20 N/A N/A 71149726M SUP HCPCS C1713 71149726M - SCREW BN 4.5MM 26MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $101.20 $101.20 $21.09 $101.20 N/A N/A 71149728M SUP HCPCS C1713 71149728M - SCREW BN 4.5MM 28MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $101.20 $101.20 N/A N/A 71149730M SUP HCPCS C1713 71149730M - SCREW BN 4.5MM 30MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $101.20 $101.20 N/A N/A 71149732M SUP HCPCS C1713 71149732M - SCREW BN 4.5MM 32MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149734M SUP HCPCS C1713 71149734M - SCREW BN 4.5MM 34MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $101.20 $101.20 N/A N/A 71149736M SUP HCPCS C1713 71149736M - SCREW BN 4.5MM 36MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $101.20 $101.20 N/A N/A 71149738M SUP HCPCS C1713 71149738M - SCREW BN 4.5MM 38MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149740M SUP HCPCS C1713 71149740M - SCREW BN 4.5MM 40MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $101.20 $101.20 N/A N/A 71149742M SUP HCPCS C1713 71149742M - SCREW BN 4.5MM 42MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $101.20 $101.20 N/A N/A 71149744M SUP HCPCS C1713 71149744M - SCREW BN 4.5MM 44MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $101.20 $101.20 N/A N/A 71149746M SUP HCPCS C1713 71149746M - SCREW BN 4.5MM 46MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $101.20 $101.20 $21.09 $101.20 N/A N/A 71149748M SUP HCPCS C1713 71149748M - SCREW BN 4.5MM 48MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149750M SUP HCPCS C1713 71149750M - SCREW BN 4.5MM 50MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149752M SUP HCPCS C1713 71149752M - SCREW BN 4.5MM 52MM TC100 ST CORT BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149754M SUP HCPCS C1713 71149754M - SCREW BN 4.5MM 54MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149756M SUP HCPCS C1713 71149756M - SCREW BN 4.5MM 56MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149758M SUP HCPCS C1713 71149758M - SCREW BN 4.5MM 58MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $101.20 $101.20 N/A N/A 71149760M SUP HCPCS C1713 71149760M - SCREW BN 4.5MM 60MM TC100 ST CORT BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149762M SUP HCPCS C1713 71149762M - SCREW BN 4.5MM 62MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149764M SUP HCPCS C1713 71149764M - SCREW BN 4.5MM 64MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149766M SUP HCPCS C1713 71149766M - SCREW BN 4.5MM 66MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $40.48 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149768M SUP HCPCS C1713 71149768M - SCREW BN 4.5MM 68MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149770M SUP HCPCS C1713 71149770M - SCREW BN 4.5MM 70MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $101.50 $75.00 $20.09 $101.20 $45.54 $45.54 $45.54 $45.54 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $101.20 $101.20 $101.20 $21.09 $101.20 $101.20 $59.86 $101.20 $101.20 $101.20 $101.20 $76.13 $101.20 $101.20 $101.20 $50.60 $50.60 $80.15 $101.20 $80.96 $45.54 $20.09 N/A $58.87 $101.20 $60.72 $101.20 $21.09 $101.20 N/A N/A 71149772M SUP HCPCS C1713 71149772M - SCREW BN 4.5MM 72MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $167.50 $124.00 $33.19 $167.20 $75.24 $75.24 $75.24 $75.24 $167.20 $167.20 $167.20 $34.85 $167.20 $167.20 $167.20 $167.20 $167.20 $34.85 $167.20 $66.88 $98.90 $167.20 $167.20 $167.20 $167.20 $125.63 $167.20 $167.20 $167.20 $83.60 $83.60 $132.42 $167.20 $133.76 $75.24 $33.19 N/A $97.15 $167.20 $100.32 $167.20 $167.20 $167.20 N/A N/A 71149776M SUP HCPCS C1713 71149776M - SCREW BN 4.5MM 76MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $167.50 $124.00 $33.19 $167.20 $75.24 $75.24 $75.24 $75.24 $167.20 $167.20 $167.20 $34.85 $167.20 $167.20 $167.20 $167.20 $167.20 $34.85 $167.20 $47.80 $98.90 $167.20 $119.50 $167.20 $167.20 $125.63 $167.20 $167.20 $167.20 $83.60 $83.60 $132.42 $167.20 $133.76 $75.24 $33.19 N/A $97.15 $167.20 $100.32 $167.20 $34.84 $167.20 N/A N/A 71149780M SUP HCPCS C1713 71149780M - SCREW BN 4.5MM 8MM 80MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $105.00 $78.00 $20.84 $105.00 $47.25 $47.25 $47.25 $47.25 $105.00 $105.00 $105.00 $21.88 $105.00 $105.00 $105.00 $105.00 $105.00 $21.88 $105.00 $105.00 $62.11 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $47.25 $20.84 N/A $60.90 $105.00 $63.00 $105.00 $21.88 $105.00 N/A N/A 71149785M SUP HCPCS C1713 71149785M - SCREW BN 4.5MM 85MM TC100 ST HEX SCKT SS CORT LG FRAG SYS BOTH IP/OP $167.50 $124.00 $33.19 $167.20 $75.24 $75.24 $75.24 $75.24 $167.20 $167.20 $167.20 $34.85 $167.20 $167.20 $167.20 $167.20 $167.20 $34.85 $167.20 $66.88 $98.90 $167.20 $167.20 $167.20 $167.20 $125.63 $167.20 $167.20 $167.20 $83.60 $83.60 $132.42 $167.20 $133.76 $75.24 $33.19 N/A $97.15 $167.20 $100.32 $167.20 $34.84 $167.20 N/A N/A 71149790M SUP HCPCS C1713 71149790M - SCREW BN 4.5MM 8MM 90MM TC100 ST HEX SCKT SS METACARPUS BOTH IP/OP $105.00 $78.00 $20.84 $105.00 $47.25 $47.25 $47.25 $47.25 $105.00 $105.00 $105.00 $21.88 $105.00 $105.00 $105.00 $105.00 $105.00 $21.88 $105.00 $42.00 $62.11 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $47.25 $20.84 N/A $60.90 $105.00 $63.00 $105.00 $105.00 $105.00 N/A N/A 7115-0003 SUP HCPCS C1776 7115-0003 - COMPONENT TIBIAL TRAY 3 STANDARD CEMENT SCORPIO KNEE 7000 BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" "$2,330.00" "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 7115-0004 SUP HCPCS C1776 7115-0004 - COMPONENT TIBIAL TRAY STANDARD SERIES 7000 BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" $932.00 "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 7115-0005 SUP HCPCS C1776 7115-0005 - COMPONENT TIBIAL TRAY 5 1 AXIS PRIM POSTERIOR STABILIZED BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" "$2,330.00" "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 7115-0006 SUP HCPCS C1776 7115-0006 - COMPONENT TIBIAL TRAY STANDARD 1 AXIS PRIM POSTERIOR BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" $932.00 "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 7115-0007 SUP HCPCS C1776 7115-0007 - COMPONENT TIBIAL TRAY 7 1 AXIS PRIM POSTERIOR STABILIZE BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" "$2,330.00" "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 7115-0009 SUP HCPCS C1776 7115-0009 - COMPONENT TIBIAL TRAY 9 1 AXIS PRIM POSTERIOR STABILIZED BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" $932.00 "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 7115-0011 SUP HCPCS C1776 7115-0011 - COMPONENT TIBIAL TRAY 11 1 AXIS PRIM POSTERIOR STABILIZED BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" "$2,330.00" "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 7115-0013 SUP HCPCS C1776 7115-0013 - COMPONENT TIBIAL TRAY 13 STANDARD 1 AXIS PRIM POSTERIOR BOTH IP/OP "$2,330.00" "$1,724.00" $462.45 "$2,330.00" "$1,048.50" "$1,048.50" "$1,048.50" "$1,048.50" "$2,330.00" "$2,330.00" "$2,330.00" $485.63 "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" $485.60 "$2,330.00" $932.00 "$1,378.20" "$2,330.00" "$2,330.00" "$2,330.00" "$2,330.00" "$1,747.50" "$2,330.00" "$2,330.00" "$2,330.00" "$1,165.00" "$1,165.00" "$1,845.36" "$2,330.00" "$1,864.00" "$1,048.50" $462.45 N/A "$1,351.40" "$2,330.00" "$2,330.00" "$2,330.00" $485.57 "$2,330.00" N/A N/A 7120/60 SUP HCPCS C1895 7120/60 - LEAD PCNG 7FR 60CM DURATA TRUE BP ACTFX 2 COIL STRD BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7120/65 SUP HCPCS C1895 7120/65 - LEAD PACING 7FR 65CM 2 COIL DF-4 CONCTR TRUE BIPOL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7120/75 SUP HCPCS C1895 7120/75 - LEAD PACING 7FR 75CM 60CM 2 COIL DF-4 CONCTR TRUE BIPOL BOTH IP/OP "$10,500.00" "$7,770.00" "$2,083.99" "$10,500.00" "$4,725.00" "$4,725.00" "$4,725.00" "$4,725.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.46" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.32" "$10,500.00" "$10,500.00" "$5,176.50" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$7,875.00" "$10,500.00" "$10,500.00" "$10,500.00" "$5,250.00" "$5,250.00" "$8,316.00" "$10,500.00" "$8,400.00" "$4,725.00" "$2,083.99" N/A "$6,090.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.20" "$10,500.00" N/A N/A 7120Q/52 SUP HCPCS C1895 7120Q/52 - LEAD DEFIBRILLATOR 17CM 7FR 52CM 2 COIL DF-4 CONCTR TRUE BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7120Q/58 SUP HCPCS C1895 7120Q/58 - LEAD ICD 7FR 58CM DURATA OPTIM DF4 CNCT 2 COIL BP BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7120Q/65 SUP HCPCS C1895 7120Q/65 - LEAD PACING 7FR 65CM 2 COIL DF-4 TRUE BIPOL ACTIVE FIX BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7121/60 SUP HCPCS C1895 7121/60 - LEAD DFBR 7FR 60CM 21CM DURATA 2 COIL IS-1 CNCT TRUE BP BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7121/65 SUP HCPCS C1895 7121/65 - LEAD PCNG 7FR 65CM DURATA 2 COIL ACTFX IMPL CARDVRT DFBR BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 71-2100 SUP Custom 27011340 71-2100 - ADAPTER SUCTION DISS METAL BOTH IP/OP $144.00 $107.00 $25.63 $144.00 $144.00 $144.00 $144.00 $144.00 $144.00 $144.00 $25.63 $144.00 $144.00 $106.88 $106.88 $111.00 $75.02 $30.01 $144.00 $57.60 $144.00 $144.00 $144.00 $144.00 $144.00 $108.00 $144.00 $144.00 $144.00 $72.00 $72.00 $114.05 $144.00 $115.20 $93.60 $144.00 N/A $83.52 $144.00 $86.40 $144.00 $144.00 $144.00 N/A N/A 7121Q/52 SUP HCPCS C1895 7121Q/52 - LEAD PACING 21CM SPACE 7FR 52CM 2 COIL TRUE BIPOL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7121Q/58 SUP HCPCS C1895 7121Q/58 - LEAD PACING 21CM SPACE 7FR 58CM 2 COIL TRUE BIPOL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7121Q/65 SUP HCPCS C1895 7121Q/65 - LEAD PCNG 7FR 65CM DURATA DF4 CNCT TRUE BP ACTFX IMPL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7122/60 SUP HCPCS C1895 7122/60 - LEAD DFBR 7FR 60CM DURATA 1 COIL DF1 IS-1 CNCT TRUE BP SNS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7122/65 SUP HCPCS C1895 7122/65 - LEAD PACING 7FR 65CM 1 COIL TRUE BIPOL CARDIOVERTER BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 71222010M SUP HCPCS C1713 71222010M - SCREW BN 3.5MM 6MM 10MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $76.80 $76.80 $16.01 $76.80 N/A N/A 71222012M SUP HCPCS C1713 71222012M - SCREW BN 3.5MM 6MM 12MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $76.80 $76.80 $76.80 $76.80 N/A N/A 71222016M SUP HCPCS C1713 71222016M - SCREW BN 3.5MM 6MM 16MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $76.80 $76.80 $16.01 $76.80 N/A N/A 71222018M SUP HCPCS C1713 71222018M - SCREW BN 3.5MM 6MM 18MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $76.80 $76.80 $16.01 $76.80 N/A N/A 71222020M SUP HCPCS C1713 71222020M - SCREW BN 3.5MM 6MM 20MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $76.80 $76.80 $16.01 $76.80 N/A N/A 71222022M SUP HCPCS C1713 71222022M - SCREW BN 3.5MM 6MM 22MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $16.01 $76.80 N/A N/A 71222024M SUP HCPCS C1713 71222024M - SCREW BN 3.5MM 6MM 22MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $16.01 $76.80 N/A N/A 71222026M SUP HCPCS C1713 71222026M - SCREW BN 3.5MM 6MM 26MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $16.01 $76.80 N/A N/A 71222028M SUP HCPCS C1713 71222028M - SCREW BN 3.5MM 6MM 28MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $76.80 $76.80 $16.01 $76.80 N/A N/A 71222030M SUP HCPCS C1713 71222030M - SCREW BN 3.5MM 6MM 30MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $76.80 $76.80 $16.01 $76.80 N/A N/A 71222032M SUP HCPCS C1713 71222032M - SCREW BN 3.5MM 6MM 32MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $76.80 $76.80 N/A N/A 71222034M SUP HCPCS C1713 71222034M - SCREW BN 3.5MM 6MM 34MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $16.01 $76.80 N/A N/A 71222036M SUP HCPCS C1713 71222036M - SCREW BN 3.5MM 6MM 36MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $16.01 $76.80 N/A N/A 71222038M SUP HCPCS C1713 71222038M - SCREW BN 3.5MM 6MM 38MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $76.80 $76.80 $16.01 $76.80 N/A N/A 71222040M SUP HCPCS C1713 71222040M - SCREW BN 3.5MM 6MM 40MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $16.01 $76.80 N/A N/A 71222045M SUP HCPCS C1713 71222045M - SCREW BN 3.5MM 6MM 45MM TC100 SS CORT SM FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $76.80 $76.80 N/A N/A 71223010M SUP HCPCS C1713 71223010M - SCREW BN FT 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $33.12 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $49.68 $82.80 $82.80 $82.80 N/A N/A 71223012M SUP HCPCS C1713 71223012M - SCREW BN FT 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $33.12 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $82.80 $82.80 $17.26 $82.80 N/A N/A 71223014M SUP HCPCS C1713 71223014M - SCREW BN FT 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $82.80 $82.80 $17.26 $82.80 N/A N/A 71223016M SUP HCPCS C1713 71223016M - SCREW BN FT 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $33.12 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $82.80 $82.80 $17.26 $82.80 N/A N/A 71223018M SUP HCPCS C1713 71223018M - SCREW BN FT 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $33.12 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $82.80 $82.80 $17.26 $82.80 N/A N/A 71223020M SUP HCPCS C1713 71223020M - SCREW BN FT 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $82.80 $82.80 $17.26 $82.80 N/A N/A 71223024M SUP HCPCS C1713 71223024M - SCREW BN FT 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $33.12 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $82.80 $82.80 $17.26 $82.80 N/A N/A 71223026M SUP HCPCS C1713 71223026M - SCREW BN FT 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $33.12 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $82.80 $82.80 $17.26 $82.80 N/A N/A 71223028M SUP HCPCS C1713 71223028M - SCREW BN FT 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $33.12 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $82.80 $82.80 $82.80 $82.80 N/A N/A 71223030M SUP HCPCS C1713 71223030M - SCREW BN FT 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $33.12 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $82.80 $82.80 $17.26 $82.80 N/A N/A 71223032M SUP HCPCS C1713 71223032M - SCREW BN FT 4MM 6MM 32MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $33.12 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $82.80 $82.80 $82.80 $82.80 N/A N/A 71223035M SUP HCPCS C1713 71223035M - SCREW BN SM FT 4MM 6MM 35MM TC100 SS CANC BOTH IP/OP $72.50 $54.00 $14.37 $72.40 $32.58 $32.58 $32.58 $32.58 $72.40 $72.40 $72.40 $15.09 $72.40 $72.40 $72.40 $72.40 $72.40 $15.09 $72.40 $72.40 $42.82 $72.40 $72.40 $72.40 $72.40 $54.38 $72.40 $72.40 $72.40 $36.20 $36.20 $57.34 $72.40 $57.92 $32.58 $14.37 N/A $42.05 $72.40 $72.40 $72.40 $15.09 $72.40 N/A N/A 71223036M SUP HCPCS C1713 71223036M - SCREW BN FT 4MM 6MM 36MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $82.80 $82.80 $17.26 $82.80 N/A N/A 71223040M SUP HCPCS C1713 71223040M - SCREW BN FT 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $33.12 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $82.80 $82.80 $17.26 $82.80 N/A N/A 71223045M SUP HCPCS C1713 71223045M - SCREW BN FT 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $33.12 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $49.68 $82.80 $82.80 $82.80 N/A N/A 71223050M SUP HCPCS C1713 71223050M - SCREW BN FT 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $49.68 $82.80 $82.80 $82.80 N/A N/A 71223055M SUP HCPCS C1713 71223055M - SCREW BN FT 4MM 6MM 55MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $33.12 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $82.80 $82.80 $17.26 $82.80 N/A N/A 71223060M SUP HCPCS C1713 71223060M - SCREW BN FT 4MM 6MM 60MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $83.00 $61.00 $16.43 $82.80 $37.26 $37.26 $37.26 $37.26 $82.80 $82.80 $82.80 $17.26 $82.80 $82.80 $82.80 $82.80 $82.80 $17.26 $82.80 $33.12 $48.98 $82.80 $82.80 $82.80 $82.80 $62.25 $82.80 $82.80 $82.80 $41.40 $41.40 $65.58 $82.80 $66.24 $37.26 $16.43 N/A $48.14 $82.80 $49.68 $82.80 $82.80 $82.80 N/A N/A 71223210M SUP HCPCS C1713 71223210M - SCREW BN P/T 4MM 6MM 10MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $48.48 $80.80 $80.80 $80.80 N/A N/A 71223212M SUP HCPCS C1713 71223212M - SCREW BN P/T 4MM 6MM 12MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $32.32 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $48.48 $80.80 $80.80 $80.80 N/A N/A 71223214M SUP HCPCS C1713 71223214M - SCREW BN P/T 4MM 6MM 14MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $32.32 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $48.48 $80.80 $16.84 $80.80 N/A N/A 71223216M SUP HCPCS C1713 71223216M - SCREW BN P/T 4MM 6MM 16MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $48.48 $80.80 $16.84 $80.80 N/A N/A 71223218M SUP HCPCS C1713 71223218M - SCREW BN P/T 4MM 6MM 18MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $32.32 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $48.48 $80.80 $16.84 $80.80 N/A N/A 71223220M SUP HCPCS C1713 71223220M - SCREW BN P/T 4MM 6MM 20MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $32.32 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $48.48 $80.80 $16.84 $80.80 N/A N/A 71223222M SUP HCPCS C1713 71223222M - SCREW BN P/T 4MM 6MM 22MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $32.32 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $48.48 $80.80 $16.84 $80.80 N/A N/A 71223224M SUP HCPCS C1713 71223224M - SCREW BN P/T 4MM 6MM 24MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $32.32 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $48.48 $80.80 $80.80 $80.80 N/A N/A 71223226M SUP HCPCS C1713 71223226M - SCREW BN P/T 4MM 6MM 26MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $32.32 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $48.48 $80.80 $80.80 $80.80 N/A N/A 71223228M SUP HCPCS C1713 71223228M - SCREW BN P/T 4MM 6MM 28MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $48.48 $80.80 $16.84 $80.80 N/A N/A 71223230M SUP HCPCS C1713 71223230M - SCREW BN P/T 4MM 6MM 30MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $32.32 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $80.80 $80.80 $16.84 $80.80 N/A N/A 71223235M SUP HCPCS C1713 71223235M - SCREW BN P/T 4MM 6MM 35MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $32.32 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $48.48 $80.80 $16.84 $80.80 N/A N/A 71223240M SUP HCPCS C1713 71223240M - SCREW BN P/T 4MM 6MM 40MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $32.32 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $48.48 $80.80 $80.80 $80.80 N/A N/A 71223245M SUP HCPCS C1713 71223245M - SCREW BN P/T 4MM 6MM 45MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $32.32 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $48.48 $80.80 $80.80 $80.80 N/A N/A 71223250M SUP HCPCS C1713 71223250M - SCREW BN P/T 4MM 6MM 50MM TC100 SS CANC SM FRAG SYS BOTH IP/OP $81.00 $60.00 $16.04 $80.80 $36.36 $36.36 $36.36 $36.36 $80.80 $80.80 $80.80 $16.84 $80.80 $80.80 $80.80 $80.80 $80.80 $16.84 $80.80 $32.32 $47.79 $80.80 $80.80 $80.80 $80.80 $60.75 $80.80 $80.80 $80.80 $40.40 $40.40 $63.99 $80.80 $64.64 $36.36 $16.04 N/A $46.98 $80.80 $48.48 $80.80 $16.84 $80.80 N/A N/A 71225026M SUP HCPCS C1713 71225026M - SCREW BN 4.5MM 8MM 26MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $16.01 $76.80 N/A N/A 71225028M SUP HCPCS C1713 71225028M - SCREW BN 4.5MM 8MM 28MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $76.80 $76.80 N/A N/A 71225030M SUP HCPCS C1713 71225030M - SCREW BN 4.5MM 8MM 30MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $16.01 $76.80 N/A N/A 71225032M SUP HCPCS C1713 71225032M - SCREW BN 4.5MM 8MM 32MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $76.80 $76.80 N/A N/A 71225034M SUP HCPCS C1713 71225034M - SCREW BN 4.5MM 8MM 34MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $76.80 $76.80 N/A N/A 71225036M SUP HCPCS C1713 71225036M - SCREW BN 4.5MM 8MM 36MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $76.80 $76.80 N/A N/A 71225038M SUP HCPCS C1713 71225038M - SCREW BN 4.5MM 8MM 38MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $30.72 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $16.01 $76.80 N/A N/A 71225040M SUP HCPCS C1713 71225040M - SCREW BN 4.5MM 8MM 40MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $16.01 $76.80 N/A N/A 71225042M SUP HCPCS C1713 71225042M - SCREW BN 4.5MM 8MM 42MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $76.80 $76.80 N/A N/A 71225044M SUP HCPCS C1713 71225044M - SCREW BN 4.5MM 8MM 44MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $76.80 $76.80 $76.80 $76.80 N/A N/A 71225046M SUP HCPCS C1713 71225046M - SCREW BN 4.5MM 8MM 46MM TC100 SS CORT LG FRAG SYS BOTH IP/OP $77.00 $57.00 $15.24 $76.80 $34.56 $34.56 $34.56 $34.56 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $76.80 $76.80 $76.80 $16.01 $76.80 $76.80 $45.43 $76.80 $76.80 $76.80 $76.80 $57.75 $76.80 $76.80 $76.80 $38.40 $38.40 $60.83 $76.80 $61.44 $34.56 $15.24 N/A $44.66 $76.80 $46.08 $76.80 $16.01 $76.80 N/A N/A 71226030M SUP HCPCS C1713 71226030M - SCREW BN P/T 6.5MM 8MM 30MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $165.00 $122.00 $32.71 $164.80 $74.16 $74.16 $74.16 $74.16 $164.80 $164.80 $164.80 $34.35 $164.80 $164.80 $164.80 $164.80 $164.80 $34.35 $164.80 $164.80 $97.48 $164.80 $164.80 $164.80 $164.80 $123.75 $164.80 $164.80 $164.80 $82.40 $82.40 $130.52 $164.80 $131.84 $74.16 $32.71 N/A $95.70 $164.80 $98.88 $164.80 $164.80 $164.80 N/A N/A 71226035M SUP HCPCS C1713 71226035M - SCREW BN P/T 6.5MM 8MM 35MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $165.00 $122.00 $32.71 $164.80 $74.16 $74.16 $74.16 $74.16 $164.80 $164.80 $164.80 $34.35 $164.80 $164.80 $164.80 $164.80 $164.80 $34.35 $164.80 $65.92 $97.48 $164.80 $164.80 $164.80 $164.80 $123.75 $164.80 $164.80 $164.80 $82.40 $82.40 $130.52 $164.80 $131.84 $74.16 $32.71 N/A $95.70 $164.80 $98.88 $164.80 $164.80 $164.80 N/A N/A 71226040M SUP HCPCS C1713 71226040M - SCREW BN P/T 6.5MM 8MM 40MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $165.00 $122.00 $32.71 $164.80 $74.16 $74.16 $74.16 $74.16 $164.80 $164.80 $164.80 $34.35 $164.80 $164.80 $164.80 $164.80 $164.80 $34.35 $164.80 $65.92 $97.48 $164.80 $164.80 $164.80 $164.80 $123.75 $164.80 $164.80 $164.80 $82.40 $82.40 $130.52 $164.80 $131.84 $74.16 $32.71 N/A $95.70 $164.80 $164.80 $164.80 $164.80 $164.80 N/A N/A 71226045M SUP HCPCS C1713 71226045M - SCREW BN P/T 6.5MM 8MM 45MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $165.00 $122.00 $32.71 $164.80 $74.16 $74.16 $74.16 $74.16 $164.80 $164.80 $164.80 $34.35 $164.80 $164.80 $164.80 $164.80 $164.80 $34.35 $164.80 $65.92 $97.48 $164.80 $164.80 $164.80 $164.80 $123.75 $164.80 $164.80 $164.80 $82.40 $82.40 $130.52 $164.80 $131.84 $74.16 $32.71 N/A $95.70 $164.80 $164.80 $164.80 $34.34 $164.80 N/A N/A 71226055M SUP HCPCS C1713 71226055M - SCREW BN P/T 6.5MM 8MM 55MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $165.00 $122.00 $32.71 $164.80 $74.16 $74.16 $74.16 $74.16 $164.80 $164.80 $164.80 $34.35 $164.80 $164.80 $164.80 $164.80 $164.80 $34.35 $164.80 $117.80 $97.48 $164.80 $117.80 $164.80 $164.80 $123.75 $164.80 $164.80 $164.80 $82.40 $82.40 $130.52 $164.80 $131.84 $74.16 $32.71 N/A $95.70 $164.80 $98.88 $164.80 $34.34 $164.80 N/A N/A 71226060M SUP HCPCS C1713 71226060M - SCREW BN P/T 6.5MM 8MM 60MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $165.00 $122.00 $32.71 $164.80 $74.16 $74.16 $74.16 $74.16 $164.80 $164.80 $164.80 $34.35 $164.80 $164.80 $164.80 $164.80 $164.80 $34.35 $164.80 $65.92 $97.48 $164.80 $164.80 $164.80 $164.80 $123.75 $164.80 $164.80 $164.80 $82.40 $82.40 $130.52 $164.80 $131.84 $74.16 $32.71 N/A $95.70 $164.80 $98.88 $164.80 $34.34 $164.80 N/A N/A 71226065M SUP HCPCS C1713 71226065M - SCREW BN P/T 6.5MM 8MM 65MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $165.00 $122.00 $32.71 $164.80 $74.16 $74.16 $74.16 $74.16 $164.80 $164.80 $164.80 $34.35 $164.80 $164.80 $164.80 $164.80 $164.80 $34.35 $164.80 $65.92 $97.48 $164.80 $164.80 $164.80 $164.80 $123.75 $164.80 $164.80 $164.80 $82.40 $82.40 $130.52 $164.80 $131.84 $74.16 $32.71 N/A $95.70 $164.80 $98.88 $164.80 $34.34 $164.80 N/A N/A 71226070M SUP HCPCS C1713 71226070M - SCREW BN P/T 6.5MM 8MM 70MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $165.00 $122.00 $32.71 $164.80 $74.16 $74.16 $74.16 $74.16 $164.80 $164.80 $164.80 $34.35 $164.80 $164.80 $164.80 $164.80 $164.80 $34.35 $164.80 $65.92 $97.48 $164.80 $164.80 $164.80 $164.80 $123.75 $164.80 $164.80 $164.80 $82.40 $82.40 $130.52 $164.80 $131.84 $74.16 $32.71 N/A $95.70 $164.80 $98.88 $164.80 $34.34 $164.80 N/A N/A 71226075M SUP HCPCS C1713 71226075M - SCREW BN P/T 6.5MM 8MM 75MM 16MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $165.00 $122.00 $32.71 $164.80 $74.16 $74.16 $74.16 $74.16 $164.80 $164.80 $164.80 $34.35 $164.80 $164.80 $164.80 $164.80 $164.80 $34.35 $164.80 $65.92 $97.48 $164.80 $164.80 $164.80 $164.80 $123.75 $164.80 $164.80 $164.80 $82.40 $82.40 $130.52 $164.80 $131.84 $74.16 $32.71 N/A $95.70 $164.80 $98.88 $164.80 $34.34 $164.80 N/A N/A 71226080M SUP HCPCS C1713 71226080M - SCREW BN P/T 6.5MM 80MM 16MM TC100 CANC BOTH IP/OP $165.00 $122.00 $32.71 $164.80 $74.16 $74.16 $74.16 $74.16 $164.80 $164.80 $164.80 $34.35 $164.80 $164.80 $164.80 $164.80 $164.80 $34.35 $164.80 $65.92 $97.48 $164.80 $164.80 $164.80 $164.80 $123.75 $164.80 $164.80 $164.80 $82.40 $82.40 $130.52 $164.80 $131.84 $74.16 $32.71 N/A $95.70 $164.80 $98.88 $164.80 $34.34 $164.80 N/A N/A 71229075M SUP HCPCS C1713 71229075M - SCREW BN FT 6.5MM 8MM 75MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $165.00 $122.00 $32.71 $164.80 $74.16 $74.16 $74.16 $74.16 $164.80 $164.80 $164.80 $34.35 $164.80 $164.80 $164.80 $164.80 $164.80 $34.35 $164.80 $65.92 $97.48 $164.80 $164.80 $164.80 $164.80 $123.75 $164.80 $164.80 $164.80 $82.40 $82.40 $130.52 $164.80 $131.84 $74.16 $32.71 N/A $95.70 $164.80 $164.80 $164.80 $34.34 $164.80 N/A N/A 71229080M SUP HCPCS C1713 71229080M - SCREW BN FT 6.5MM 8MM 80MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $181.00 $134.00 $35.88 $180.80 $81.36 $81.36 $81.36 $81.36 $180.80 $180.80 $180.80 $37.68 $180.80 $180.80 $180.80 $180.80 $180.80 $37.68 $180.80 $180.80 $106.94 $180.80 $180.80 $180.80 $180.80 $135.75 $180.80 $180.80 $180.80 $90.40 $90.40 $143.19 $180.80 $144.64 $81.36 $35.88 N/A $104.98 $180.80 $108.48 $180.80 $37.68 $180.80 N/A N/A 71229085M SUP HCPCS C1713 71229085M - SCREW BN FT 6.5MM 8MM 85MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $181.00 $134.00 $35.88 $180.80 $81.36 $81.36 $81.36 $81.36 $180.80 $180.80 $180.80 $37.68 $180.80 $180.80 $180.80 $180.80 $180.80 $37.68 $180.80 $180.80 $106.94 $180.80 $180.80 $180.80 $180.80 $135.75 $180.80 $180.80 $180.80 $90.40 $90.40 $143.19 $180.80 $144.64 $81.36 $35.88 N/A $104.98 $180.80 $108.48 $180.80 $180.80 $180.80 N/A N/A 71229090M SUP HCPCS C1713 71229090M - SCREW BN FT 6.5MM 8MM 90MM TC100 SS CANC LG FRAG SYS BOTH IP/OP $165.00 $122.00 $32.71 $164.80 $74.16 $74.16 $74.16 $74.16 $164.80 $164.80 $164.80 $34.35 $164.80 $164.80 $164.80 $164.80 $164.80 $34.35 $164.80 $164.80 $97.48 $164.80 $164.80 $164.80 $164.80 $123.75 $164.80 $164.80 $164.80 $82.40 $82.40 $130.52 $164.80 $131.84 $74.16 $32.71 N/A $95.70 $164.80 $164.80 $164.80 $164.80 $164.80 N/A N/A 7122Q/52 SUP HCPCS C1777 7122Q/52 - LEAD PCNG 11MM SPC 6.8FR 58CM DURATA 1 COIL TRUE BP ACTFX BOTH IP/OP "$8,775.00" "$6,494.00" "$1,741.62" "$8,775.00" "$3,948.75" "$3,948.75" "$3,948.75" "$3,948.75" "$8,775.00" "$8,775.00" "$8,775.00" "$1,828.93" "$8,775.00" "$8,775.00" "$8,775.00" "$8,775.00" "$8,775.00" "$1,828.81" "$8,775.00" "$5,250.00" "$4,326.08" "$8,775.00" "$8,775.00" "$8,775.00" "$8,775.00" "$6,581.25" "$8,775.00" "$8,775.00" "$8,775.00" "$4,387.50" "$4,387.50" "$6,949.80" "$8,775.00" "$7,020.00" "$3,948.75" "$1,741.62" N/A "$5,089.50" "$8,775.00" "$8,775.00" "$8,775.00" "$1,828.71" "$8,775.00" N/A N/A 7122Q/58 SUP HCPCS C1777 7122Q/58 - LEAD PACING 11MM SPACE 6.8FR 58CM 1 COIL TRUE BIPOL ACTIVE BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$5,250.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A 7122Q/65 SUP HCPCS C1777 7122Q/65 - LEAD PACING 11MM SPACING 6.8FR 65CM TRUE BIPOL ACTIVE FIX BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7125-0003 SUP HCPCS C1776 7125-0003 - COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED SCORPIO KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 7125-0004 SUP HCPCS C1776 7125-0004 - COMPONENT TIBIAL TRAY STANDARD 4MM MICROSTRUCTURED SERIES BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 7125-0005 SUP HCPCS C1776 7125-0005 - COMPONENT TIBIAL TRAY 5 STANDARD 66X44MM 30MM STEM WAFFLE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 7125-0006 SUP HCPCS C1776 7125-0006 - COMPONENT TIBIAL TRAY 6 STANDARD MICROSTRUCTURED CEMENTED BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 7125-0007 SUP HCPCS C1776 7125-0007 - COMPONENT TIBIAL TRAY STANDARD DELTAFIT MICROSTRUCTURE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 7125-0009 SUP HCPCS C1776 7125-0009 - COMPONENT TIBIAL TRAY STANDARD DELTAFIT MICROSTRUCTURED BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 7125-0011 SUP HCPCS C1776 7125-0011 - COMPONENT TIBIAL TRAY STANDARD DELTAFIT MICROSTRUCTURED BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 7125-0013 SUP HCPCS C1776 7125-0013 - COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED SCORPIO KNEE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 7130/60 SUP HCPCS C1895 7130/60 - LEAD DFBR 6.8FR 60CM STRL LF 17MM DURATA DISP BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7130/65 SUP HCPCS C1895 7130/65 - LEAD PACING 17MM SPACE 6.8FR 65CM 2 COIL INTEGRATE BIPOL BOTH IP/OP "$10,500.00" "$7,770.00" "$2,083.99" "$10,500.00" "$4,725.00" "$4,725.00" "$4,725.00" "$4,725.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.46" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.32" "$10,500.00" "$10,500.00" "$5,176.50" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$7,875.00" "$10,500.00" "$10,500.00" "$10,500.00" "$5,250.00" "$5,250.00" "$8,316.00" "$10,500.00" "$8,400.00" "$4,725.00" "$2,083.99" N/A "$6,090.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.20" "$10,500.00" N/A N/A 71-3003L SUP HCPCS C1776 71-3003L - COMPONENT FEMORAL 3 CEMENTED POSTERIOR STABILIZE BASIC PRIM BOTH IP/OP "$3,176.00" "$2,350.00" $630.36 "$3,176.00" "$1,429.20" "$1,429.20" "$1,429.20" "$1,429.20" "$3,176.00" "$3,176.00" "$3,176.00" $661.96 "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" $661.91 "$3,176.00" "$3,176.00" "$1,565.77" "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" "$2,382.00" "$3,176.00" "$3,176.00" "$3,176.00" "$1,588.00" "$1,588.00" "$2,515.39" "$3,176.00" "$2,540.80" "$1,429.20" $630.36 N/A "$1,842.08" "$3,176.00" "$3,176.00" "$3,176.00" $661.88 "$3,176.00" N/A N/A 71-3003R SUP HCPCS C1776 71-3003R - COMPONENT FEMORAL 3 CEMENTED POSTERIOR STABILIZE BASIC PRIM BOTH IP/OP "$3,176.00" "$2,350.00" $630.36 "$3,176.00" "$1,429.20" "$1,429.20" "$1,429.20" "$1,429.20" "$3,176.00" "$3,176.00" "$3,176.00" $661.96 "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" $661.91 "$3,176.00" "$1,270.40" "$1,565.77" "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" "$2,382.00" "$3,176.00" "$3,176.00" "$3,176.00" "$1,588.00" "$1,588.00" "$2,515.39" "$3,176.00" "$2,540.80" "$1,429.20" $630.36 N/A "$1,842.08" "$3,176.00" "$3,176.00" "$3,176.00" $661.88 "$3,176.00" N/A N/A 71-3005L SUP HCPCS C1776 71-3005L - COMPONENT FEMORAL 5 CEMENTED POSTERIOR STABILIZE BASIC PRIM BOTH IP/OP "$3,110.00" "$2,301.00" $617.26 "$3,110.00" "$1,399.50" "$1,399.50" "$1,399.50" "$1,399.50" "$3,110.00" "$3,110.00" "$3,110.00" $648.20 "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" $648.16 "$3,110.00" "$3,110.00" "$1,533.23" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$2,332.50" "$3,110.00" "$3,110.00" "$3,110.00" "$1,555.00" "$1,555.00" "$2,463.12" "$3,110.00" "$2,488.00" "$1,399.50" $617.26 N/A "$1,803.80" "$3,110.00" "$3,110.00" "$3,110.00" $648.12 "$3,110.00" N/A N/A 71-3005R SUP HCPCS C1776 71-3005R - COMPONENT FEMORAL 5 CEMENTED POSTERIOR STABILIZE BASIC PRIM BOTH IP/OP "$3,110.00" "$2,301.00" $617.26 "$3,110.00" "$1,399.50" "$1,399.50" "$1,399.50" "$1,399.50" "$3,110.00" "$3,110.00" "$3,110.00" $648.20 "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" $648.16 "$3,110.00" "$1,244.00" "$1,533.23" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$2,332.50" "$3,110.00" "$3,110.00" "$3,110.00" "$1,555.00" "$1,555.00" "$2,463.12" "$3,110.00" "$2,488.00" "$1,399.50" $617.26 N/A "$1,803.80" "$3,110.00" "$3,110.00" "$3,110.00" $648.12 "$3,110.00" N/A N/A 71-3007L SUP HCPCS C1776 71-3007L - COMPONENT FEMORAL 7 CEMENTED POSTERIOR STABILIZE BASIC PRIM BOTH IP/OP "$3,110.00" "$2,301.00" $617.26 "$3,110.00" "$1,399.50" "$1,399.50" "$1,399.50" "$1,399.50" "$3,110.00" "$3,110.00" "$3,110.00" $648.20 "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" $648.16 "$3,110.00" "$3,110.00" "$1,533.23" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$2,332.50" "$3,110.00" "$3,110.00" "$3,110.00" "$1,555.00" "$1,555.00" "$2,463.12" "$3,110.00" "$2,488.00" "$1,399.50" $617.26 N/A "$1,803.80" "$3,110.00" "$3,110.00" "$3,110.00" $648.12 "$3,110.00" N/A N/A 71-3007R SUP HCPCS C1776 71-3007R - COMPONENT FEMORAL 7 CEMENTED POSTERIOR STABILIZE BASIC PRIM BOTH IP/OP "$3,110.00" "$2,301.00" $617.26 "$3,110.00" "$1,399.50" "$1,399.50" "$1,399.50" "$1,399.50" "$3,110.00" "$3,110.00" "$3,110.00" $648.20 "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" $648.16 "$3,110.00" "$1,244.00" "$1,533.23" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$2,332.50" "$3,110.00" "$3,110.00" "$3,110.00" "$1,555.00" "$1,555.00" "$2,463.12" "$3,110.00" "$2,488.00" "$1,399.50" $617.26 N/A "$1,803.80" "$3,110.00" "$3,110.00" "$3,110.00" $648.12 "$3,110.00" N/A N/A 71-3009L SUP HCPCS C1776 71-3009L - COMPONENT FEMORAL 9 CEMENTED POSTERIOR STABILIZE BASIC PRIM BOTH IP/OP "$3,110.00" "$2,301.00" $617.26 "$3,110.00" "$1,399.50" "$1,399.50" "$1,399.50" "$1,399.50" "$3,110.00" "$3,110.00" "$3,110.00" $648.20 "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" $648.16 "$3,110.00" "$3,110.00" "$1,533.23" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$2,332.50" "$3,110.00" "$3,110.00" "$3,110.00" "$1,555.00" "$1,555.00" "$2,463.12" "$3,110.00" "$2,488.00" "$1,399.50" $617.26 N/A "$1,803.80" "$3,110.00" "$3,110.00" "$3,110.00" $648.12 "$3,110.00" N/A N/A 71-3009R SUP HCPCS C1776 71-3009R - COMPONENT FEMORAL 9 CEMENTED POSTERIOR STABILIZE BASIC PRIM BOTH IP/OP "$3,110.00" "$2,301.00" $617.26 "$3,110.00" "$1,399.50" "$1,399.50" "$1,399.50" "$1,399.50" "$3,110.00" "$3,110.00" "$3,110.00" $648.20 "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" $648.16 "$3,110.00" "$1,244.00" "$1,533.23" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$2,332.50" "$3,110.00" "$3,110.00" "$3,110.00" "$1,555.00" "$1,555.00" "$2,463.12" "$3,110.00" "$2,488.00" "$1,399.50" $617.26 N/A "$1,803.80" "$3,110.00" "$3,110.00" "$3,110.00" $648.12 "$3,110.00" N/A N/A 71-3011L SUP HCPCS C1776 71-3011L - COMPONENT FEMORAL 11 CEMENTED POSTERIOR STABILIZE BASIC PRIM BOTH IP/OP "$3,110.00" "$2,301.00" $617.26 "$3,110.00" "$1,399.50" "$1,399.50" "$1,399.50" "$1,399.50" "$3,110.00" "$3,110.00" "$3,110.00" $648.20 "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" $648.16 "$3,110.00" "$3,110.00" "$1,533.23" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$2,332.50" "$3,110.00" "$3,110.00" "$3,110.00" "$1,555.00" "$1,555.00" "$2,463.12" "$3,110.00" "$2,488.00" "$1,399.50" $617.26 N/A "$1,803.80" "$3,110.00" "$3,110.00" "$3,110.00" $648.12 "$3,110.00" N/A N/A 71-3011R SUP HCPCS C1776 71-3011R - COMPONENT FEMORAL 11 CEMENTED POSTERIOR STABILIZE BASIC PRIM BOTH IP/OP "$3,110.00" "$2,301.00" $617.26 "$3,110.00" "$1,399.50" "$1,399.50" "$1,399.50" "$1,399.50" "$3,110.00" "$3,110.00" "$3,110.00" $648.20 "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" $648.16 "$3,110.00" "$1,244.00" "$1,533.23" "$3,110.00" "$3,110.00" "$3,110.00" "$3,110.00" "$2,332.50" "$3,110.00" "$3,110.00" "$3,110.00" "$1,555.00" "$1,555.00" "$2,463.12" "$3,110.00" "$2,488.00" "$1,399.50" $617.26 N/A "$1,803.80" "$3,110.00" "$3,110.00" "$3,110.00" $648.12 "$3,110.00" N/A N/A 71-3013L SUP HCPCS C1776 71-3013L - COMPONENT FEMORAL 13 CEMENTED POSTERIOR STABILIZE BASIC PRIM BOTH IP/OP "$3,176.00" "$2,350.00" $630.36 "$3,176.00" "$1,429.20" "$1,429.20" "$1,429.20" "$1,429.20" "$3,176.00" "$3,176.00" "$3,176.00" $661.96 "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" $661.91 "$3,176.00" "$1,270.40" "$1,565.77" "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" "$2,382.00" "$3,176.00" "$3,176.00" "$3,176.00" "$1,588.00" "$1,588.00" "$2,515.39" "$3,176.00" "$2,540.80" "$1,429.20" $630.36 N/A "$1,842.08" "$3,176.00" "$3,176.00" "$3,176.00" $661.88 "$3,176.00" N/A N/A 71-3013R SUP HCPCS C1776 71-3013R - COMPONENT FEMORAL 13 CEMENTED POSTERIOR STABILIZE BASIC PRIM BOTH IP/OP "$3,176.00" "$2,350.00" $630.36 "$3,176.00" "$1,429.20" "$1,429.20" "$1,429.20" "$1,429.20" "$3,176.00" "$3,176.00" "$3,176.00" $661.96 "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" $661.91 "$3,176.00" "$3,176.00" "$1,565.77" "$3,176.00" "$3,176.00" "$3,176.00" "$3,176.00" "$2,382.00" "$3,176.00" "$3,176.00" "$3,176.00" "$1,588.00" "$1,588.00" "$2,515.39" "$3,176.00" "$2,540.80" "$1,429.20" $630.36 N/A "$1,842.08" "$3,176.00" "$3,176.00" "$3,176.00" $661.88 "$3,176.00" N/A N/A 7131/60 SUP HCPCS C1895 7131/60 - LEAD DFBR 60CM STRL LF 21CM DURATA DISP BOTH IP/OP "$10,500.00" "$7,770.00" "$2,083.99" "$10,500.00" "$4,725.00" "$4,725.00" "$4,725.00" "$4,725.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.46" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.32" "$10,500.00" "$10,500.00" "$5,176.50" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$7,875.00" "$10,500.00" "$10,500.00" "$10,500.00" "$5,250.00" "$5,250.00" "$8,316.00" "$10,500.00" "$8,400.00" "$4,725.00" "$2,083.99" N/A "$6,090.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.20" "$10,500.00" N/A N/A 7131/65 SUP HCPCS C1895 7131/65 - LEAD PACING 21MM SPACE 6.8FR 65CM 2 COIL INTEGRATE BIPOL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 71-4103L SUP HCPCS C1776 71-4103L - COMPONENT FEMORAL 3 1 AXIS POSTERIOR STABILIZE WAFFLE POST BOTH IP/OP "$3,657.00" "$2,706.00" $725.82 "$3,657.00" "$1,645.65" "$1,645.65" "$1,645.65" "$1,645.65" "$3,657.00" "$3,657.00" "$3,657.00" $762.21 "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" $762.16 "$3,657.00" "$1,462.80" "$1,802.90" "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" "$2,742.75" "$3,657.00" "$3,657.00" "$3,657.00" "$1,828.50" "$1,828.50" "$2,896.34" "$3,657.00" "$2,925.60" "$1,645.65" $725.82 N/A "$2,121.06" "$3,657.00" "$3,657.00" "$3,657.00" $762.12 "$3,657.00" N/A N/A 71-4103R SUP HCPCS C1776 71-4103R - COMPONENT FEMORAL 3 1 AXIS POSTERIOR STABILIZE WAFFLE POST BOTH IP/OP "$3,657.00" "$2,706.00" $725.82 "$3,657.00" "$1,645.65" "$1,645.65" "$1,645.65" "$1,645.65" "$3,657.00" "$3,657.00" "$3,657.00" $762.21 "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" $762.16 "$3,657.00" "$3,657.00" "$1,802.90" "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" "$2,742.75" "$3,657.00" "$3,657.00" "$3,657.00" "$1,828.50" "$1,828.50" "$2,896.34" "$3,657.00" "$2,925.60" "$1,645.65" $725.82 N/A "$2,121.06" "$3,657.00" "$3,657.00" "$3,657.00" $762.12 "$3,657.00" N/A N/A 71-4104L SUP HCPCS C1776 71-4104L - COMPONENT FEMORAL 4 1 AXIS POSTERIOR STABILIZE WAFFLE POST BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$1,450.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 71-4104R SUP HCPCS C1776 71-4104R - COMPONENT FEMORAL 4 1 AXIS POSTERIOR STABILIZE WAFFLE POST BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 71-4105L SUP HCPCS C1776 71-4105L - COMPONENT FEMORAL 5 1 AXIS POSTERIOR STABILIZE WAFFLE POST BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$1,450.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 71-4105R SUP HCPCS C1776 71-4105R - COMPONENT FEMORAL 5 1 AXIS POSTERIOR STABILIZE WAFFLE POST BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 71-4106L SUP HCPCS C1776 71-4106L - COMPONENT FEMORAL 6 1 AXIS POSTERIOR STABILIZE WAFFLE POST BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$1,450.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 71-4106R SUP HCPCS C1776 71-4106R - COMPONENT FEMORAL 6 1 AXIS POSTERIOR STABILIZE WAFFLE POST BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 71-4107L SUP HCPCS C1776 71-4107L - COMPONENT FEM 7 LFIT SCRP CMNT POST STAB WFL KN LT BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$1,450.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 71-4107R SUP HCPCS C1776 71-4107R - COMPONENT FEM 7 LFIT SCRP CMNT POST STAB WFL KN RT BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 71-4109L SUP HCPCS C1776 71-4109L - COMPONENT FEMORAL 9 71X49MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$1,450.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 71-4109R SUP HCPCS C1776 71-4109R - COMPONENT FEMORAL 9 71X49MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 71-4111L SUP HCPCS C1776 71-4111L - COMPONENT FEMORAL 11 76X53MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$1,450.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 71-4111R SUP HCPCS C1776 71-4111R - COMPONENT FEMORAL 11 76X53MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$3,625.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$3,625.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A 71-4113L SUP HCPCS C1776 71-4113L - COMPONENT FEMORAL 13 81X58MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,657.00" "$2,706.00" $725.82 "$3,657.00" "$1,645.65" "$1,645.65" "$1,645.65" "$1,645.65" "$3,657.00" "$3,657.00" "$3,657.00" $762.21 "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" $762.16 "$3,657.00" "$1,462.80" "$1,802.90" "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" "$2,742.75" "$3,657.00" "$3,657.00" "$3,657.00" "$1,828.50" "$1,828.50" "$2,896.34" "$3,657.00" "$2,925.60" "$1,645.65" $725.82 N/A "$2,121.06" "$3,657.00" "$3,657.00" "$3,657.00" $762.12 "$3,657.00" N/A N/A 71-4113R SUP HCPCS C1776 71-4113R - COMPONENT FEMORAL 13 81X58MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,657.00" "$2,706.00" $725.82 "$3,657.00" "$1,645.65" "$1,645.65" "$1,645.65" "$1,645.65" "$3,657.00" "$3,657.00" "$3,657.00" $762.21 "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" $762.16 "$3,657.00" "$1,462.80" "$1,802.90" "$3,657.00" "$3,657.00" "$3,657.00" "$3,657.00" "$2,742.75" "$3,657.00" "$3,657.00" "$3,657.00" "$1,828.50" "$1,828.50" "$2,896.34" "$3,657.00" "$2,925.60" "$1,645.65" $725.82 N/A "$2,121.06" "$3,657.00" "$3,657.00" "$3,657.00" $762.12 "$3,657.00" N/A N/A 7145-0003 SUP HCPCS C1776 7145-0003 - COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 7145-0005 SUP HCPCS C1776 7145-0005 - COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 7145-0007 SUP HCPCS C1776 7145-0007 - COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 7145-0009 SUP HCPCS C1776 7145-0009 - COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 7145-0011 SUP HCPCS C1776 7145-0011 - COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 7145-0013 SUP HCPCS C1776 7145-0013 - COMPONENT TIBIAL TRAY STANDARD MICROSTRUCTURED PERIAPT BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4503L SUP HCPCS C1776 71-4503L - COMPONENT FEMORAL 3 56X35MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4503R SUP HCPCS C1776 71-4503R - COMPONENT FEMORAL 3 56X35MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4504L SUP HCPCS C1776 71-4504L - COMPONENT FEMORAL 4 1 AXIS POSTERIOR STABILIZE WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4504R SUP HCPCS C1776 71-4504R - COMPONENT FEMORAL 4 1 AXIS POSTERIOR STABILIZE WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4505L SUP HCPCS C1776 71-4505L - COMPONENT FEMORAL 5 61X39MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4505R SUP HCPCS C1776 71-4505R - COMPONENT FEMORAL 5 61X39MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4506L SUP HCPCS C1776 71-4506L - COMPONENT FEMORAL 6 1 AXIS POSTERIOR STABILIZE WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4506R SUP HCPCS C1776 71-4506R - COMPONENT FEMORAL 6 1 AXIS POSTERIOR STABILIZE WAFFLE POST BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4507L SUP HCPCS C1776 71-4507L - COMPONENT FEMORAL 7 66X44MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4507R SUP HCPCS C1776 71-4507R - COMPONENT FEMORAL 7 66X44MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4509L SUP HCPCS C1776 71-4509L - COMPONENT FEMORAL 9 71X49MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4509R SUP HCPCS C1776 71-4509R - COMPONENT FEMORAL 9 71X49MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4511L SUP HCPCS C1776 71-4511L - COMPONENT FEMORAL 11 76X53MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4511R SUP HCPCS C1776 71-4511R - COMPONENT FEMORAL 11 76X53MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4513L SUP HCPCS C1776 71-4513L - COMPONENT FEMORAL 13 81X58MM CEMENTED POSTERIOR STABILIZE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-4513R SUP HCPCS C1776 71-4513R - COMPONENT FEMORAL 13 81X58MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 71-5003L SUP HCPCS C1776 71-5003L - COMPONENT FEMORAL 3 POSTERIOR STABILIZE MICROSTRUCTURE BOTH IP/OP "$5,199.00" "$3,847.00" "$1,031.87" "$5,199.00" "$2,339.55" "$2,339.55" "$2,339.55" "$2,339.55" "$5,199.00" "$5,199.00" "$5,199.00" "$1,083.60" "$5,199.00" "$5,199.00" "$5,199.00" "$5,199.00" "$5,199.00" "$1,083.53" "$5,199.00" "$2,079.60" "$2,563.11" "$5,199.00" "$5,199.00" "$5,199.00" "$5,199.00" "$3,899.25" "$5,199.00" "$5,199.00" "$5,199.00" "$2,599.50" "$2,599.50" "$4,117.61" "$5,199.00" "$4,159.20" "$2,339.55" "$1,031.87" N/A "$3,015.42" "$5,199.00" "$5,199.00" "$5,199.00" "$1,083.47" "$5,199.00" N/A N/A 71-5003R SUP HCPCS C1776 71-5003R - COMPONENT FEMORAL 3 1 AXIS POSTERIOR STABILIZE REVISION BOTH IP/OP "$5,199.00" "$3,847.00" "$1,031.87" "$5,199.00" "$2,339.55" "$2,339.55" "$2,339.55" "$2,339.55" "$5,199.00" "$5,199.00" "$5,199.00" "$1,083.60" "$5,199.00" "$5,199.00" "$5,199.00" "$5,199.00" "$5,199.00" "$1,083.53" "$5,199.00" "$2,079.60" "$2,563.11" "$5,199.00" "$5,199.00" "$5,199.00" "$5,199.00" "$3,899.25" "$5,199.00" "$5,199.00" "$5,199.00" "$2,599.50" "$2,599.50" "$4,117.61" "$5,199.00" "$4,159.20" "$2,339.55" "$1,031.87" N/A "$3,015.42" "$5,199.00" "$5,199.00" "$5,199.00" "$1,083.47" "$5,199.00" N/A N/A 71-5004L SUP HCPCS C1776 71-5004L - COMPONENT FEMORAL 4 POSTERIOR STABILIZE MICROSTRUCTURE BOTH IP/OP "$5,096.00" "$3,771.00" "$1,011.43" "$5,096.00" "$2,293.20" "$2,293.20" "$2,293.20" "$2,293.20" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.13" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.06" "$5,096.00" "$5,096.00" "$2,512.33" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$3,822.00" "$5,096.00" "$5,096.00" "$5,096.00" "$2,548.00" "$2,548.00" "$4,036.03" "$5,096.00" "$4,076.80" "$2,293.20" "$1,011.43" N/A "$2,955.68" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.01" "$5,096.00" N/A N/A 71-5004R SUP HCPCS C1776 71-5004R - COMPONENT FEMORAL 4 1 AXIS POSTERIOR STABILIZE REVISION BOTH IP/OP "$5,096.00" "$3,771.00" "$1,011.43" "$5,096.00" "$2,293.20" "$2,293.20" "$2,293.20" "$2,293.20" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.13" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.06" "$5,096.00" "$2,038.40" "$2,512.33" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$3,822.00" "$5,096.00" "$5,096.00" "$5,096.00" "$2,548.00" "$2,548.00" "$4,036.03" "$5,096.00" "$4,076.80" "$2,293.20" "$1,011.43" N/A "$2,955.68" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.01" "$5,096.00" N/A N/A 71-5005L SUP HCPCS C1776 71-5005L - COMPONENT FEMORAL 5 POSTERIOR STABILIZE MICROSTRUCTURE BOTH IP/OP "$5,096.00" "$3,771.00" "$1,011.43" "$5,096.00" "$2,293.20" "$2,293.20" "$2,293.20" "$2,293.20" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.13" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.06" "$5,096.00" "$2,038.40" "$2,512.33" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$3,822.00" "$5,096.00" "$5,096.00" "$5,096.00" "$2,548.00" "$2,548.00" "$4,036.03" "$5,096.00" "$4,076.80" "$2,293.20" "$1,011.43" N/A "$2,955.68" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.01" "$5,096.00" N/A N/A 71-5005R SUP HCPCS C1776 71-5005R - COMPONENT FEMORAL 5 1 AXIS POSTERIOR STABILIZE REVISION BOTH IP/OP "$5,096.00" "$3,771.00" "$1,011.43" "$5,096.00" "$2,293.20" "$2,293.20" "$2,293.20" "$2,293.20" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.13" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.06" "$5,096.00" "$2,038.40" "$2,512.33" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$3,822.00" "$5,096.00" "$5,096.00" "$5,096.00" "$2,548.00" "$2,548.00" "$4,036.03" "$5,096.00" "$4,076.80" "$2,293.20" "$1,011.43" N/A "$2,955.68" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.01" "$5,096.00" N/A N/A 71-5006L SUP HCPCS C1776 71-5006L - COMPONENT FEMORAL 6 POSTERIOR STABILIZE MICROSTRUCTURE BOTH IP/OP "$5,096.00" "$3,771.00" "$1,011.43" "$5,096.00" "$2,293.20" "$2,293.20" "$2,293.20" "$2,293.20" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.13" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.06" "$5,096.00" "$5,096.00" "$2,512.33" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$3,822.00" "$5,096.00" "$5,096.00" "$5,096.00" "$2,548.00" "$2,548.00" "$4,036.03" "$5,096.00" "$4,076.80" "$2,293.20" "$1,011.43" N/A "$2,955.68" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.01" "$5,096.00" N/A N/A 71-5006R SUP HCPCS C1776 71-5006R - COMPONENT FEMORAL 6 1 AXIS POSTERIOR STABILIZE REVISION BOTH IP/OP "$5,096.00" "$3,771.00" "$1,011.43" "$5,096.00" "$2,293.20" "$2,293.20" "$2,293.20" "$2,293.20" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.13" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.06" "$5,096.00" "$5,096.00" "$2,512.33" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$3,822.00" "$5,096.00" "$5,096.00" "$5,096.00" "$2,548.00" "$2,548.00" "$4,036.03" "$5,096.00" "$4,076.80" "$2,293.20" "$1,011.43" N/A "$2,955.68" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.01" "$5,096.00" N/A N/A 71-5007L SUP HCPCS C1776 71-5007L - COMPONENT FEMORAL 7 POSTERIOR STABILIZE MICROSTRUCTURE BOTH IP/OP "$5,096.00" "$3,771.00" "$1,011.43" "$5,096.00" "$2,293.20" "$2,293.20" "$2,293.20" "$2,293.20" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.13" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.06" "$5,096.00" "$5,096.00" "$2,512.33" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$3,822.00" "$5,096.00" "$5,096.00" "$5,096.00" "$2,548.00" "$2,548.00" "$4,036.03" "$5,096.00" "$4,076.80" "$2,293.20" "$1,011.43" N/A "$2,955.68" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.01" "$5,096.00" N/A N/A 71-5007R SUP HCPCS C1776 71-5007R - COMPONENT FEMORAL 7 1 AXIS POSTERIOR STABILIZE REVISION BOTH IP/OP "$5,096.00" "$3,771.00" "$1,011.43" "$5,096.00" "$2,293.20" "$2,293.20" "$2,293.20" "$2,293.20" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.13" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.06" "$5,096.00" "$5,096.00" "$2,512.33" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$3,822.00" "$5,096.00" "$5,096.00" "$5,096.00" "$2,548.00" "$2,548.00" "$4,036.03" "$5,096.00" "$4,076.80" "$2,293.20" "$1,011.43" N/A "$2,955.68" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.01" "$5,096.00" N/A N/A 71-5009L SUP HCPCS C1776 71-5009L - COMPONENT FEMORAL 9 POSTERIOR STABILIZE MICROSTRUCTURE BOTH IP/OP "$5,096.00" "$3,771.00" "$1,011.43" "$5,096.00" "$2,293.20" "$2,293.20" "$2,293.20" "$2,293.20" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.13" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.06" "$5,096.00" "$2,038.40" "$2,512.33" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$3,822.00" "$5,096.00" "$5,096.00" "$5,096.00" "$2,548.00" "$2,548.00" "$4,036.03" "$5,096.00" "$4,076.80" "$2,293.20" "$1,011.43" N/A "$2,955.68" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.01" "$5,096.00" N/A N/A 71-5009R SUP HCPCS C1776 71-5009R - COMPONENT FEMORAL 9 1 AXIS POSTERIOR STABILIZE REVISION BOTH IP/OP "$5,096.00" "$3,771.00" "$1,011.43" "$5,096.00" "$2,293.20" "$2,293.20" "$2,293.20" "$2,293.20" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.13" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.06" "$5,096.00" "$2,038.40" "$2,512.33" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$3,822.00" "$5,096.00" "$5,096.00" "$5,096.00" "$2,548.00" "$2,548.00" "$4,036.03" "$5,096.00" "$4,076.80" "$2,293.20" "$1,011.43" N/A "$2,955.68" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.01" "$5,096.00" N/A N/A 71-5011L SUP HCPCS C1776 71-5011L - COMPONENT FEMORAL 11 POSTERIOR STABILIZE MICROSTRUCTURE BOTH IP/OP "$5,096.00" "$3,771.00" "$1,011.43" "$5,096.00" "$2,293.20" "$2,293.20" "$2,293.20" "$2,293.20" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.13" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.06" "$5,096.00" "$2,038.40" "$2,512.33" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$3,822.00" "$5,096.00" "$5,096.00" "$5,096.00" "$2,548.00" "$2,548.00" "$4,036.03" "$5,096.00" "$4,076.80" "$2,293.20" "$1,011.43" N/A "$2,955.68" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.01" "$5,096.00" N/A N/A 71-5011R SUP HCPCS C1776 71-5011R - COMPONENT FEMORAL 11 1 AXIS POSTERIOR STABILIZE REVISION BOTH IP/OP "$5,096.00" "$3,771.00" "$1,011.43" "$5,096.00" "$2,293.20" "$2,293.20" "$2,293.20" "$2,293.20" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.13" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.06" "$5,096.00" "$5,096.00" "$2,512.33" "$5,096.00" "$5,096.00" "$5,096.00" "$5,096.00" "$3,822.00" "$5,096.00" "$5,096.00" "$5,096.00" "$2,548.00" "$2,548.00" "$4,036.03" "$5,096.00" "$4,076.80" "$2,293.20" "$1,011.43" N/A "$2,955.68" "$5,096.00" "$5,096.00" "$5,096.00" "$1,062.01" "$5,096.00" N/A N/A 71-5013L SUP HCPCS C1776 71-5013L - COMPONENT FEMORAL 13 POSTERIOR STABILIZE MICROSTRUCTURE BOTH IP/OP "$5,199.00" "$3,847.00" "$1,031.87" "$5,199.00" "$2,339.55" "$2,339.55" "$2,339.55" "$2,339.55" "$5,199.00" "$5,199.00" "$5,199.00" "$1,083.60" "$5,199.00" "$5,199.00" "$5,199.00" "$5,199.00" "$5,199.00" "$1,083.53" "$5,199.00" "$5,199.00" "$2,563.11" "$5,199.00" "$5,199.00" "$5,199.00" "$5,199.00" "$3,899.25" "$5,199.00" "$5,199.00" "$5,199.00" "$2,599.50" "$2,599.50" "$4,117.61" "$5,199.00" "$4,159.20" "$2,339.55" "$1,031.87" N/A "$3,015.42" "$5,199.00" "$5,199.00" "$5,199.00" "$1,083.47" "$5,199.00" N/A N/A 71-5013R SUP HCPCS C1776 71-5013R - COMPONENT FEMORAL 13 1 AXIS POSTERIOR STABILIZE REVISION BOTH IP/OP "$5,199.00" "$3,847.00" "$1,031.87" "$5,199.00" "$2,339.55" "$2,339.55" "$2,339.55" "$2,339.55" "$5,199.00" "$5,199.00" "$5,199.00" "$1,083.60" "$5,199.00" "$5,199.00" "$5,199.00" "$5,199.00" "$5,199.00" "$1,083.53" "$5,199.00" "$5,199.00" "$2,563.11" "$5,199.00" "$5,199.00" "$5,199.00" "$5,199.00" "$3,899.25" "$5,199.00" "$5,199.00" "$5,199.00" "$2,599.50" "$2,599.50" "$4,117.61" "$5,199.00" "$4,159.20" "$2,339.55" "$1,031.87" N/A "$3,015.42" "$5,199.00" "$5,199.00" "$5,199.00" "$1,083.47" "$5,199.00" N/A N/A 71-5103L SUP HCPCS C1776 71-5103L - COMPONENT FEMORAL 3 56X35MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,839.00" "$3,581.00" $960.42 "$4,839.00" "$2,177.55" "$2,177.55" "$2,177.55" "$2,177.55" "$4,839.00" "$4,839.00" "$4,839.00" "$1,008.57" "$4,839.00" "$4,839.00" "$4,839.00" "$4,839.00" "$4,839.00" "$1,008.50" "$4,839.00" "$4,839.00" "$2,385.63" "$4,839.00" "$4,839.00" "$4,839.00" "$4,839.00" "$3,629.25" "$4,839.00" "$4,839.00" "$4,839.00" "$2,419.50" "$2,419.50" "$3,832.49" "$4,839.00" "$3,871.20" "$2,177.55" $960.42 N/A "$2,806.62" "$4,839.00" "$4,839.00" "$4,839.00" "$1,008.45" "$4,839.00" N/A N/A 71-5103R SUP HCPCS C1776 71-5103R - COMPONENT FEMORAL 3 56X35MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,839.00" "$3,581.00" $960.42 "$4,839.00" "$2,177.55" "$2,177.55" "$2,177.55" "$2,177.55" "$4,839.00" "$4,839.00" "$4,839.00" "$1,008.57" "$4,839.00" "$4,839.00" "$4,839.00" "$4,839.00" "$4,839.00" "$1,008.50" "$4,839.00" "$4,839.00" "$2,385.63" "$4,839.00" "$4,839.00" "$4,839.00" "$4,839.00" "$3,629.25" "$4,839.00" "$4,839.00" "$4,839.00" "$2,419.50" "$2,419.50" "$3,832.49" "$4,839.00" "$3,871.20" "$2,177.55" $960.42 N/A "$2,806.62" "$4,839.00" "$4,839.00" "$4,839.00" "$1,008.45" "$4,839.00" N/A N/A 71-5104L SUP HCPCS C1776 71-5104L - COMPONENT FEMORAL 4 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,780.00" "$3,537.00" $948.71 "$4,780.00" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.27 "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.20 "$4,780.00" "$4,780.00" "$2,356.54" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$3,585.00" "$4,780.00" "$4,780.00" "$4,780.00" "$2,390.00" "$2,390.00" "$3,785.76" "$4,780.00" "$3,824.00" "$2,151.00" $948.71 N/A "$2,772.40" "$4,780.00" "$4,780.00" "$4,780.00" $996.15 "$4,780.00" N/A N/A 71-5104R SUP HCPCS C1776 71-5104R - COMPONENT FEMORAL 4 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,780.00" "$3,537.00" $948.71 "$4,780.00" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.27 "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.20 "$4,780.00" "$1,912.00" "$2,356.54" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$3,585.00" "$4,780.00" "$4,780.00" "$4,780.00" "$2,390.00" "$2,390.00" "$3,785.76" "$4,780.00" "$3,824.00" "$2,151.00" $948.71 N/A "$2,772.40" "$4,780.00" "$4,780.00" "$4,780.00" $996.15 "$4,780.00" N/A N/A 71-5105L SUP HCPCS C1776 71-5105L - COMPONENT FEMORAL 5 61X39MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,780.00" "$3,537.00" $948.71 "$4,780.00" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.27 "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.20 "$4,780.00" "$4,780.00" "$2,356.54" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$3,585.00" "$4,780.00" "$4,780.00" "$4,780.00" "$2,390.00" "$2,390.00" "$3,785.76" "$4,780.00" "$3,824.00" "$2,151.00" $948.71 N/A "$2,772.40" "$4,780.00" "$4,780.00" "$4,780.00" $996.15 "$4,780.00" N/A N/A 71-5105R SUP HCPCS C1776 71-5105R - COMPONENT FEMORAL 5 61X39MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,780.00" "$3,537.00" $948.71 "$4,780.00" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.27 "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.20 "$4,780.00" "$1,912.00" "$2,356.54" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$3,585.00" "$4,780.00" "$4,780.00" "$4,780.00" "$2,390.00" "$2,390.00" "$3,785.76" "$4,780.00" "$3,824.00" "$2,151.00" $948.71 N/A "$2,772.40" "$4,780.00" "$4,780.00" "$4,780.00" $996.15 "$4,780.00" N/A N/A 71-5106L SUP HCPCS C1776 71-5106L - COMPONENT FEMORAL 6 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,780.00" "$3,537.00" $948.71 "$4,780.00" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.27 "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.20 "$4,780.00" "$1,912.00" "$2,356.54" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$3,585.00" "$4,780.00" "$4,780.00" "$4,780.00" "$2,390.00" "$2,390.00" "$3,785.76" "$4,780.00" "$3,824.00" "$2,151.00" $948.71 N/A "$2,772.40" "$4,780.00" "$4,780.00" "$4,780.00" $996.15 "$4,780.00" N/A N/A 71-5106R SUP HCPCS C1776 71-5106R - COMPONENT FEMORAL 6 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,780.00" "$3,537.00" $948.71 "$4,780.00" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.27 "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.20 "$4,780.00" "$4,780.00" "$2,356.54" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$3,585.00" "$4,780.00" "$4,780.00" "$4,780.00" "$2,390.00" "$2,390.00" "$3,785.76" "$4,780.00" "$3,824.00" "$2,151.00" $948.71 N/A "$2,772.40" "$4,780.00" "$4,780.00" "$4,780.00" $996.15 "$4,780.00" N/A N/A 71-5107L SUP HCPCS C1776 71-5107L - COMPONENT FEMORAL 7 66X44MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,780.00" "$3,537.00" $948.71 "$4,780.00" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.27 "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.20 "$4,780.00" "$4,780.00" "$2,356.54" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$3,585.00" "$4,780.00" "$4,780.00" "$4,780.00" "$2,390.00" "$2,390.00" "$3,785.76" "$4,780.00" "$3,824.00" "$2,151.00" $948.71 N/A "$2,772.40" "$4,780.00" "$4,780.00" "$4,780.00" $996.15 "$4,780.00" N/A N/A 71-5107R SUP HCPCS C1776 71-5107R - COMPONENT FEMORAL 7 66X44MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,780.00" "$3,537.00" $948.71 "$4,780.00" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.27 "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.20 "$4,780.00" "$4,780.00" "$2,356.54" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$3,585.00" "$4,780.00" "$4,780.00" "$4,780.00" "$2,390.00" "$2,390.00" "$3,785.76" "$4,780.00" "$3,824.00" "$2,151.00" $948.71 N/A "$2,772.40" "$4,780.00" "$4,780.00" "$4,780.00" $996.15 "$4,780.00" N/A N/A 71-5109L SUP HCPCS C1776 71-5109L - COMPONENT FEMORAL 9 71X49MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,780.00" "$3,537.00" $948.71 "$4,780.00" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.27 "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.20 "$4,780.00" "$4,780.00" "$2,356.54" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$3,585.00" "$4,780.00" "$4,780.00" "$4,780.00" "$2,390.00" "$2,390.00" "$3,785.76" "$4,780.00" "$3,824.00" "$2,151.00" $948.71 N/A "$2,772.40" "$4,780.00" "$2,868.00" "$4,780.00" $996.15 "$4,780.00" N/A N/A 71-5109R SUP HCPCS C1776 71-5109R - COMPONENT FEMORAL 9 71X49MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,780.00" "$3,537.00" $948.71 "$4,780.00" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.27 "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.20 "$4,780.00" "$1,912.00" "$2,356.54" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$3,585.00" "$4,780.00" "$4,780.00" "$4,780.00" "$2,390.00" "$2,390.00" "$3,785.76" "$4,780.00" "$3,824.00" "$2,151.00" $948.71 N/A "$2,772.40" "$4,780.00" "$2,868.00" "$4,780.00" $996.15 "$4,780.00" N/A N/A 71-5111L SUP HCPCS C1776 71-5111L - COMPONENT FEMORAL 11 76X53MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,780.00" "$3,537.00" $948.71 "$4,780.00" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.27 "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.20 "$4,780.00" "$1,912.00" "$2,356.54" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$3,585.00" "$4,780.00" "$4,780.00" "$4,780.00" "$2,390.00" "$2,390.00" "$3,785.76" "$4,780.00" "$3,824.00" "$2,151.00" $948.71 N/A "$2,772.40" "$4,780.00" "$2,868.00" "$4,780.00" $996.15 "$4,780.00" N/A N/A 71-5111R SUP HCPCS C1776 71-5111R - COMPONENT FEMORAL 11 76X53MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,780.00" "$3,537.00" $948.71 "$4,780.00" "$2,151.00" "$2,151.00" "$2,151.00" "$2,151.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.27 "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" $996.20 "$4,780.00" "$1,912.00" "$2,356.54" "$4,780.00" "$4,780.00" "$4,780.00" "$4,780.00" "$3,585.00" "$4,780.00" "$4,780.00" "$4,780.00" "$2,390.00" "$2,390.00" "$3,785.76" "$4,780.00" "$3,824.00" "$2,151.00" $948.71 N/A "$2,772.40" "$4,780.00" "$4,780.00" "$4,780.00" $996.15 "$4,780.00" N/A N/A 71-5113L SUP HCPCS C1776 71-5113L - COMPONENT FEMORAL 13 81X58MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,839.00" "$3,581.00" $960.42 "$4,839.00" "$2,177.55" "$2,177.55" "$2,177.55" "$2,177.55" "$4,839.00" "$4,839.00" "$4,839.00" "$1,008.57" "$4,839.00" "$4,839.00" "$4,839.00" "$4,839.00" "$4,839.00" "$1,008.50" "$4,839.00" "$4,839.00" "$2,385.63" "$4,839.00" "$4,839.00" "$4,839.00" "$4,839.00" "$3,629.25" "$4,839.00" "$4,839.00" "$4,839.00" "$2,419.50" "$2,419.50" "$3,832.49" "$4,839.00" "$3,871.20" "$2,177.55" $960.42 N/A "$2,806.62" "$4,839.00" "$4,839.00" "$4,839.00" "$1,008.45" "$4,839.00" N/A N/A 71-5113R SUP HCPCS C1776 71-5113R - COMPONENT FEMORAL 13 81X58MM 1 AXIS POSTERIOR STABILIZE BOTH IP/OP "$4,839.00" "$3,581.00" $960.42 "$4,839.00" "$2,177.55" "$2,177.55" "$2,177.55" "$2,177.55" "$4,839.00" "$4,839.00" "$4,839.00" "$1,008.57" "$4,839.00" "$4,839.00" "$4,839.00" "$4,839.00" "$4,839.00" "$1,008.50" "$4,839.00" "$4,839.00" "$2,385.63" "$4,839.00" "$4,839.00" "$4,839.00" "$4,839.00" "$3,629.25" "$4,839.00" "$4,839.00" "$4,839.00" "$2,419.50" "$2,419.50" "$3,832.49" "$4,839.00" "$3,871.20" "$2,177.55" $960.42 N/A "$2,806.62" "$4,839.00" "$4,839.00" "$4,839.00" "$1,008.45" "$4,839.00" N/A N/A 71511V SUP Custom 27203010 71511V - CLIP INTNL Remover Med Large - Large Straight 11inÿÿ BOTH IP/OP $412.50 $305.00 $73.42 $412.48 $412.48 $412.48 $412.48 $412.48 $412.48 $412.48 $73.42 $412.48 $412.48 $306.14 $306.14 $317.94 $214.90 $85.97 $412.48 $164.99 $412.48 $412.48 $412.48 $412.48 $412.48 $309.38 $412.48 $412.48 $412.48 $206.24 $206.24 $326.68 $412.48 $329.98 $268.11 $412.48 N/A $239.25 $412.48 $247.49 $412.48 $412.48 $412.48 N/A N/A 71512V SUP Custom 27203010 71512V - Applier Med Large Curved 11inÿÿ BOTH IP/OP $379.00 $280.00 $67.41 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $67.41 $378.73 $378.73 $281.09 $281.09 $291.93 $197.32 $78.93 $378.73 $151.49 $378.73 $378.73 $378.73 $378.73 $378.73 $284.25 $378.73 $378.73 $378.73 $189.37 $189.37 $299.95 $378.73 $302.98 $246.17 $378.73 N/A $219.82 $378.73 $227.24 $378.73 $378.73 $378.73 N/A N/A 71517V SUP Custom 27203010 71517V - Applier Med Large 70 Degree 11inÿÿ BOTH IP/OP $379.00 $280.00 $67.41 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $67.41 $378.73 $378.73 $281.09 $281.09 $291.93 $197.32 $78.93 $378.73 $151.49 $378.73 $378.73 $378.73 $378.73 $378.73 $284.25 $378.73 $378.73 $378.73 $189.37 $189.37 $299.95 $378.73 $302.98 $246.17 $378.73 N/A $219.82 $378.73 $227.24 $378.73 $378.73 $378.73 N/A N/A 71-5203L SUP HCPCS C1776 71-5203L - COMPONENT FEMORAL 3 POSTERIOR STABILIZE MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 71-5203R SUP HCPCS C1776 71-5203R - COMPONENT FEMORAL 3 POSTERIOR STABILIZE MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 71-5205L SUP HCPCS C1776 71-5205L - COMPONENT FEMORAL 5 POSTERIOR STABILIZE MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 71-5205R SUP HCPCS C1776 71-5205R - COMPONENT FEMORAL 5 POSTERIOR STABILIZE MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 71-5207L SUP HCPCS C1776 71-5207L - COMPONENT FEMORAL 7 POSTERIOR STABILIZE MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$4,505.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 71-5207R SUP HCPCS C1776 71-5207R - COMPONENT FEMORAL 7 POSTERIOR STABILIZE MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 71-5209L SUP HCPCS C1776 71-5209L - COMPONENT FEMORAL 9 POSTERIOR STABILIZE MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 71-5209R SUP HCPCS C1776 71-5209R - COMPONENT FEMORAL 9 POSTERIOR STABILIZE MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 71-5211L SUP HCPCS C1776 71-5211L - COMPONENT FEMORAL 11 POSTERIOR STABILIZE MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 71-5211R SUP HCPCS C1776 71-5211R - COMPONENT FEMORAL 11 POSTERIOR STABILIZE MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 71-5213L SUP HCPCS C1776 71-5213L - COMPONENT FEMORAL 13 POSTERIOR STABILIZE MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 71-5213R SUP HCPCS C1776 71-5213R - COMPONENT FEMORAL 13 POSTERIOR STABILIZE MICROSTRUCTURE PRIM BOTH IP/OP "$4,505.00" "$3,334.00" $894.13 "$4,505.00" "$2,027.25" "$2,027.25" "$2,027.25" "$2,027.25" "$4,505.00" "$4,505.00" "$4,505.00" $938.95 "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" $938.89 "$4,505.00" "$1,802.00" "$2,220.97" "$4,505.00" "$4,505.00" "$4,505.00" "$4,505.00" "$3,378.75" "$4,505.00" "$4,505.00" "$4,505.00" "$2,252.50" "$2,252.50" "$3,567.96" "$4,505.00" "$3,604.00" "$2,027.25" $894.13 N/A "$2,612.90" "$4,505.00" "$4,505.00" "$4,505.00" $938.84 "$4,505.00" N/A N/A 71582V SUP Custom 27203010 71582V - Applier Med Large Curved 8inÿÿ BOTH IP/OP $379.00 $280.00 $67.41 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $67.41 $378.73 $378.73 $281.09 $281.09 $291.93 $197.32 $78.93 $378.73 $151.49 $378.73 $378.73 $378.73 $378.73 $378.73 $284.25 $378.73 $378.73 $378.73 $189.37 $189.37 $299.95 $378.73 $302.98 $246.17 $378.73 N/A $219.82 $378.73 $227.24 $378.73 $378.73 $378.73 N/A N/A 71587V SUP Custom 27203010 71587V - Applier Med Large 70 Degree 8inÿÿ BOTH IP/OP $379.00 $280.00 $67.41 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $67.41 $378.73 $378.73 $281.09 $281.09 $291.93 $197.32 $78.93 $378.73 $151.49 $378.73 $378.73 $378.73 $378.73 $378.73 $284.25 $378.73 $378.73 $378.73 $189.37 $189.37 $299.95 $378.73 $302.98 $246.17 $378.73 N/A $219.82 $378.73 $227.24 $378.73 $378.73 $378.73 N/A N/A 7160-20 SUP Custom 27203010 7160-20 - KIT PEG 20FR 4X4IN SPONGE FEED TUBE EXTERNAL RETENTION RING BOTH IP/OP $225.50 $167.00 $40.08 $389.05 $225.15 $225.15 $225.15 $225.15 $225.15 $225.15 $40.08 $225.15 $225.15 $167.11 $167.11 $173.55 $117.30 $46.92 $225.15 $160.28 $225.15 $225.15 $389.05 $225.15 $225.15 $169.13 $225.15 $225.15 $225.15 $112.58 $112.58 $178.32 $225.15 $180.12 $146.35 $225.15 N/A $130.79 $225.15 $135.09 $225.15 $225.15 $225.15 N/A N/A 71612V SUP Custom 27203010 71612V - Applier Large Curved 11inÿÿ BOTH IP/OP $379.00 $280.00 $67.41 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $67.41 $378.73 $378.73 $281.09 $281.09 $291.93 $197.32 $78.93 $378.73 $151.49 $378.73 $378.73 $378.73 $378.73 $378.73 $284.25 $378.73 $378.73 $378.73 $189.37 $189.37 $299.95 $378.73 $302.98 $246.17 $378.73 N/A $219.82 $378.73 $227.24 $378.73 $378.73 $378.73 N/A N/A 71617V SUP Custom 27203010 71617V - Applier Large 70 Degree 11inÿÿ BOTH IP/OP $379.00 $280.00 $67.41 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $67.41 $378.73 $378.73 $281.09 $281.09 $291.93 $197.32 $78.93 $378.73 $151.49 $378.73 $378.73 $378.73 $378.73 $378.73 $284.25 $378.73 $378.73 $378.73 $189.37 $189.37 $299.95 $378.73 $302.98 $246.17 $378.73 N/A $219.82 $378.73 $227.24 $378.73 $378.73 $378.73 N/A N/A 71682510L SUP HCPCS C1713 71682510L - NAIL IM 125D STD 10MM 19.5CM IMHS CP SS LT HIP BOTH IP/OP "$3,329.50" "$2,464.00" $660.80 "$3,329.38" "$1,498.22" "$1,498.22" "$1,498.22" "$1,498.22" "$3,329.38" "$3,329.38" "$3,329.38" $693.93 "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" $693.88 "$3,329.38" "$1,331.75" "$1,641.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$2,497.13" "$3,329.38" "$3,329.38" "$3,329.38" "$1,664.69" "$1,664.69" "$2,636.87" "$3,329.38" "$2,663.50" "$1,498.22" $660.80 N/A "$1,931.11" "$3,329.38" "$3,329.38" "$3,329.38" $693.84 "$3,329.38" N/A N/A 71682510R SUP HCPCS C1713 71682510R - NAIL IM 125D STD 10MM 19.5CM IMHS CP SS HIP RT BOTH IP/OP "$3,329.50" "$2,464.00" $660.80 "$3,329.38" "$1,498.22" "$1,498.22" "$1,498.22" "$1,498.22" "$3,329.38" "$3,329.38" "$3,329.38" $693.93 "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" $693.88 "$3,329.38" "$3,329.38" "$1,641.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$2,497.13" "$3,329.38" "$3,329.38" "$3,329.38" "$1,664.69" "$1,664.69" "$2,636.87" "$3,329.38" "$2,663.50" "$1,498.22" $660.80 N/A "$1,931.11" "$3,329.38" "$1,997.63" "$3,329.38" $693.84 "$3,329.38" N/A N/A 71682512L SUP HCPCS C1713 71682512L - NAIL IM 125D STD 12MM 19.5CM IMHS CP SS HIP LT BOTH IP/OP "$3,329.50" "$2,464.00" $660.80 "$3,329.38" "$1,498.22" "$1,498.22" "$1,498.22" "$1,498.22" "$3,329.38" "$3,329.38" "$3,329.38" $693.93 "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" $693.88 "$3,329.38" "$1,331.75" "$1,641.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$2,497.13" "$3,329.38" "$3,329.38" "$3,329.38" "$1,664.69" "$1,664.69" "$2,636.87" "$3,329.38" "$2,663.50" "$1,498.22" $660.80 N/A "$1,931.11" "$3,329.38" "$1,997.63" "$3,329.38" $693.84 "$3,329.38" N/A N/A 71682512R SUP HCPCS C1713 71682512R - NAIL IM 125D STD 12MM 19.5CM IMHS CP SS RT HIP BOTH IP/OP "$3,342.50" "$2,473.00" $663.40 "$3,342.50" "$1,504.13" "$1,504.13" "$1,504.13" "$1,504.13" "$3,342.50" "$3,342.50" "$3,342.50" $696.66 "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" $696.61 "$3,342.50" "$1,337.00" "$1,647.85" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$2,506.88" "$3,342.50" "$3,342.50" "$3,342.50" "$1,671.25" "$1,671.25" "$2,647.26" "$3,342.50" "$2,674.00" "$1,504.13" $663.40 N/A "$1,938.65" "$3,342.50" "$2,005.50" "$3,342.50" $696.58 "$3,342.50" N/A N/A 71682514L SUP HCPCS C1713 71682514L - NAIL IM 125D STD 14MM 19.5CM IMHS CP SS LT HIP BOTH IP/OP "$3,342.50" "$2,473.00" $663.40 "$3,342.50" "$1,504.13" "$1,504.13" "$1,504.13" "$1,504.13" "$3,342.50" "$3,342.50" "$3,342.50" $696.66 "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" $696.61 "$3,342.50" "$1,337.00" "$1,647.85" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$2,506.88" "$3,342.50" "$3,342.50" "$3,342.50" "$1,671.25" "$1,671.25" "$2,647.26" "$3,342.50" "$2,674.00" "$1,504.13" $663.40 N/A "$1,938.65" "$3,342.50" "$2,005.50" "$3,342.50" $696.58 "$3,342.50" N/A N/A 71682514R SUP HCPCS C1713 71682514R - NAIL IM 125D STD 14MM 19.5CM IMHS CP SS RT HIP BOTH IP/OP "$3,342.50" "$2,473.00" $663.40 "$3,342.50" "$1,504.13" "$1,504.13" "$1,504.13" "$1,504.13" "$3,342.50" "$3,342.50" "$3,342.50" $696.66 "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" $696.61 "$3,342.50" "$1,337.00" "$1,647.85" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$2,506.88" "$3,342.50" "$3,342.50" "$3,342.50" "$1,671.25" "$1,671.25" "$2,647.26" "$3,342.50" "$2,674.00" "$1,504.13" $663.40 N/A "$1,938.65" "$3,342.50" "$2,005.50" "$3,342.50" $696.58 "$3,342.50" N/A N/A 71682516L SUP HCPCS C1713 71682516L - NAIL IM 125D STD 16MM 19.5CM IMHS CP SS LT HIP BOTH IP/OP "$3,342.50" "$2,473.00" $663.40 "$3,342.50" "$1,504.13" "$1,504.13" "$1,504.13" "$1,504.13" "$3,342.50" "$3,342.50" "$3,342.50" $696.66 "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" $696.61 "$3,342.50" "$1,337.00" "$1,647.85" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$2,506.88" "$3,342.50" "$3,342.50" "$3,342.50" "$1,671.25" "$1,671.25" "$2,647.26" "$3,342.50" "$2,674.00" "$1,504.13" $663.40 N/A "$1,938.65" "$3,342.50" "$2,005.50" "$3,342.50" $696.58 "$3,342.50" N/A N/A 71682516R SUP HCPCS C1713 71682516R - NAIL IM 125D STD 16MM 19.5CM IMHS CP SS RT HIP BOTH IP/OP "$3,342.50" "$2,473.00" $663.40 "$3,342.50" "$1,504.13" "$1,504.13" "$1,504.13" "$1,504.13" "$3,342.50" "$3,342.50" "$3,342.50" $696.66 "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" $696.61 "$3,342.50" "$1,337.00" "$1,647.85" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$2,506.88" "$3,342.50" "$3,342.50" "$3,342.50" "$1,671.25" "$1,671.25" "$2,647.26" "$3,342.50" "$2,674.00" "$1,504.13" $663.40 N/A "$1,938.65" "$3,342.50" "$3,342.50" "$3,342.50" $696.58 "$3,342.50" N/A N/A 71682532L SUP HCPCS C1713 71682532L - NAIL IM 125D LNG 10MM 32CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682532R SUP HCPCS C1713 71682532R - NAIL IM 125D LNG 10MM 32CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682534L SUP HCPCS C1713 71682534L - NAIL IM 125D LNG 10MM 34CM IMHS CP SS FEM LT BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682534R SUP HCPCS C1713 71682534R - NAIL IM 125D LNG 10MM 34CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682536L SUP HCPCS C1713 71682536L - NAIL IM 125D LNG 10MM 36CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682536R SUP HCPCS C1713 71682536R - NAIL IM 125D LNG 10MM 36CM IMHS CP SS RT BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682538L SUP HCPCS C1713 71682538L - NAIL IM 125D LNG 10MM 38CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682538R SUP HCPCS C1713 71682538R - NAIL IM 125D LNG 10MM 38CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682540L SUP HCPCS C1713 71682540L - NAIL IM 125D LNG 10MM 40CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682540R SUP HCPCS C1713 71682540R - NAIL IM 125D LNG 10MM 40CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682542L SUP HCPCS C1713 71682542L - NAIL IM 125D LNG 10MM 42CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682542R SUP HCPCS C1713 71682542R - NAIL IM 125D LNG 10MM 42CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682544L SUP HCPCS C1713 71682544L - NAIL IM 125D LNG 10MM 44CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682544R SUP HCPCS C1713 71682544R - NAIL IM 125D LNG 10MM 44CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682632L SUP HCPCS C1713 71682632L - NAIL IM 125D LNG 12MM 32CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682632R SUP HCPCS C1713 71682632R - NAIL IM 125D LNG 12MM 32CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682634L SUP HCPCS C1713 71682634L - NAIL IM 125D 12MM 34CM IMHS SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682634R SUP HCPCS C1713 71682634R - NAIL IM 125D LNG 12MM 34CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682636L SUP HCPCS C1713 71682636L - NAIL IM 125D LNG 12MM 36CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682636R SUP HCPCS C1713 71682636R - NAIL IM 125D LNG 12MM 36CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682638L SUP HCPCS C1713 71682638L - NAIL IM 125D LNG 12MM 38CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682638R SUP HCPCS C1713 71682638R - NAIL IM 125D LNG 12MM 38CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682640L SUP HCPCS C1713 71682640L - NAIL IM 125D LNG 12MM 40CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682640R SUP HCPCS C1713 71682640R - NAIL IM 125D LNG 12MM 40CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682642L SUP HCPCS C1713 71682642L - NAIL IM 125D LNG 12MM 42CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682642R SUP HCPCS C1713 71682642R - NAIL IM 125D LNG 12MM 42CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682644L SUP HCPCS C1713 71682644L - NAIL IM 125D LNG 12MM 44CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682644R SUP HCPCS C1713 71682644R - NAIL IM 125D LNG 12MM 44CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682734R SUP HCPCS C1713 71682734R - NAIL IM 125D 14MM 34CM IMHS CP SS RT HIP BOTH IP/OP "$6,269.50" "$4,639.00" "$1,244.32" "$6,269.38" "$2,821.22" "$2,821.22" "$2,821.22" "$2,821.22" "$6,269.38" "$6,269.38" "$6,269.38" "$1,306.70" "$6,269.38" "$6,269.38" "$6,269.38" "$6,269.38" "$6,269.38" "$1,306.61" "$6,269.38" "$2,507.75" "$3,090.80" "$6,269.38" "$6,269.38" "$6,269.38" "$6,269.38" "$4,702.13" "$6,269.38" "$6,269.38" "$6,269.38" "$3,134.69" "$3,134.69" "$4,965.35" "$6,269.38" "$5,015.50" "$2,821.22" "$1,244.32" N/A "$3,636.31" "$6,269.38" "$3,761.63" "$6,269.38" "$1,306.54" "$6,269.38" N/A N/A 71682736L SUP HCPCS C1713 71682736L - NAIL IM 125D 14MM 36CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71682744L SUP HCPCS C1713 71682744L - NAIL IM 125D 14MM 44CM IMHS CP SS LT HIP BOTH IP/OP "$6,269.50" "$4,639.00" "$1,244.32" "$6,269.38" "$2,821.22" "$2,821.22" "$2,821.22" "$2,821.22" "$6,269.38" "$6,269.38" "$6,269.38" "$1,306.70" "$6,269.38" "$6,269.38" "$6,269.38" "$6,269.38" "$6,269.38" "$1,306.61" "$6,269.38" "$2,507.75" "$3,090.80" "$6,269.38" "$6,269.38" "$6,269.38" "$6,269.38" "$4,702.13" "$6,269.38" "$6,269.38" "$6,269.38" "$3,134.69" "$3,134.69" "$4,965.35" "$6,269.38" "$5,015.50" "$2,821.22" "$1,244.32" N/A "$3,636.31" "$6,269.38" "$6,269.38" "$6,269.38" "$1,306.54" "$6,269.38" N/A N/A 71682744R SUP HCPCS C1713 71682744R - NAIL IM 125D 14MM 44CM IMHS CP SS RT HIP BOTH IP/OP "$6,269.50" "$4,639.00" "$1,244.32" "$6,269.38" "$2,821.22" "$2,821.22" "$2,821.22" "$2,821.22" "$6,269.38" "$6,269.38" "$6,269.38" "$1,306.70" "$6,269.38" "$6,269.38" "$6,269.38" "$6,269.38" "$6,269.38" "$1,306.61" "$6,269.38" "$2,507.75" "$3,090.80" "$6,269.38" "$6,269.38" "$6,269.38" "$6,269.38" "$4,702.13" "$6,269.38" "$6,269.38" "$6,269.38" "$3,134.69" "$3,134.69" "$4,965.35" "$6,269.38" "$5,015.50" "$2,821.22" "$1,244.32" N/A "$3,636.31" "$6,269.38" "$3,761.63" "$6,269.38" "$6,269.38" "$6,269.38" N/A N/A 71682V SUP Custom 27203010 71682V - Applier Large Curved 8inÿÿ BOTH IP/OP $379.00 $280.00 $67.41 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $67.41 $378.73 $378.73 $281.09 $281.09 $291.93 $197.32 $78.93 $378.73 $151.49 $378.73 $378.73 $378.73 $378.73 $378.73 $284.25 $378.73 $378.73 $378.73 $189.37 $189.37 $299.95 $378.73 $302.98 $246.17 $378.73 N/A $219.82 $378.73 $227.24 $378.73 $378.73 $378.73 N/A N/A 71683010L SUP HCPCS C1713 71683010L - NAIL IM 130D 10MM 19.5CM IMHS CP SS HIP LT BOTH IP/OP "$3,329.50" "$2,464.00" $660.80 "$3,329.38" "$1,498.22" "$1,498.22" "$1,498.22" "$1,498.22" "$3,329.38" "$3,329.38" "$3,329.38" $693.93 "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" $693.88 "$3,329.38" "$1,331.75" "$1,641.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$2,497.13" "$3,329.38" "$3,329.38" "$3,329.38" "$1,664.69" "$1,664.69" "$2,636.87" "$3,329.38" "$2,663.50" "$1,498.22" $660.80 N/A "$1,931.11" "$3,329.38" "$1,997.63" "$3,329.38" $693.84 "$3,329.38" N/A N/A 71683012L SUP HCPCS C1713 71683012L - NAIL IM 130D 12MM 19.5CM IMHS SS LT HIP BOTH IP/OP "$3,329.50" "$2,464.00" $660.80 "$3,329.38" "$1,498.22" "$1,498.22" "$1,498.22" "$1,498.22" "$3,329.38" "$3,329.38" "$3,329.38" $693.93 "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" $693.88 "$3,329.38" "$1,331.75" "$1,641.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$2,497.13" "$3,329.38" "$3,329.38" "$3,329.38" "$1,664.69" "$1,664.69" "$2,636.87" "$3,329.38" "$2,663.50" "$1,498.22" $660.80 N/A "$1,931.11" "$3,329.38" "$1,997.63" "$3,329.38" "$3,329.38" "$3,329.38" N/A N/A 71683012R SUP HCPCS C1713 71683012R - NAIL IM 130D STD 12MM 19.5CM IMHS SS RT HIP BOTH IP/OP "$3,342.50" "$2,473.00" $663.40 "$3,342.50" "$1,504.13" "$1,504.13" "$1,504.13" "$1,504.13" "$3,342.50" "$3,342.50" "$3,342.50" $696.66 "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" $696.61 "$3,342.50" "$1,337.00" "$1,647.85" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$2,506.88" "$3,342.50" "$3,342.50" "$3,342.50" "$1,671.25" "$1,671.25" "$2,647.26" "$3,342.50" "$2,674.00" "$1,504.13" $663.40 N/A "$1,938.65" "$3,342.50" "$2,005.50" "$3,342.50" "$3,342.50" "$3,342.50" N/A N/A 71683014L SUP HCPCS C1713 71683014L - NAIL IM 130D 14MM 19.5CM IMHS SS LT HIP BOTH IP/OP "$3,329.50" "$2,464.00" $660.80 "$3,329.38" "$1,498.22" "$1,498.22" "$1,498.22" "$1,498.22" "$3,329.38" "$3,329.38" "$3,329.38" $693.93 "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" $693.88 "$3,329.38" "$1,331.75" "$1,641.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$2,497.13" "$3,329.38" "$3,329.38" "$3,329.38" "$1,664.69" "$1,664.69" "$2,636.87" "$3,329.38" "$2,663.50" "$1,498.22" $660.80 N/A "$1,931.11" "$3,329.38" "$1,997.63" "$3,329.38" "$3,329.38" "$3,329.38" N/A N/A 71683014R SUP HCPCS C1713 71683014R - NAIL IM 130D STD 14MM 19.5CM IMHS CP SS RT HIP BOTH IP/OP "$3,342.50" "$2,473.00" $663.40 "$3,342.50" "$1,504.13" "$1,504.13" "$1,504.13" "$1,504.13" "$3,342.50" "$3,342.50" "$3,342.50" $696.66 "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" $696.61 "$3,342.50" "$1,337.00" "$1,647.85" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$2,506.88" "$3,342.50" "$3,342.50" "$3,342.50" "$1,671.25" "$1,671.25" "$2,647.26" "$3,342.50" "$2,674.00" "$1,504.13" $663.40 N/A "$1,938.65" "$3,342.50" "$2,005.50" "$3,342.50" $696.58 "$3,342.50" N/A N/A 71683016L SUP HCPCS C1713 71683016L - NAIL IM 130D STD 16MM 19.5CM IMHS CP SS HIP LT BOTH IP/OP "$3,342.50" "$2,473.00" $663.40 "$3,342.50" "$1,504.13" "$1,504.13" "$1,504.13" "$1,504.13" "$3,342.50" "$3,342.50" "$3,342.50" $696.66 "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" $696.61 "$3,342.50" "$3,342.50" "$1,647.85" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$2,506.88" "$3,342.50" "$3,342.50" "$3,342.50" "$1,671.25" "$1,671.25" "$2,647.26" "$3,342.50" "$2,674.00" "$1,504.13" $663.40 N/A "$1,938.65" "$3,342.50" "$2,005.50" "$3,342.50" $696.58 "$3,342.50" N/A N/A 71683016R SUP HCPCS C1713 71683016R - NAIL IM 130D STD 16MM 19.5CM IMHS CP SS RT HIP BOTH IP/OP "$3,342.50" "$2,473.00" $663.40 "$3,342.50" "$1,504.13" "$1,504.13" "$1,504.13" "$1,504.13" "$3,342.50" "$3,342.50" "$3,342.50" $696.66 "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" $696.61 "$3,342.50" "$1,337.00" "$1,647.85" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$2,506.88" "$3,342.50" "$3,342.50" "$3,342.50" "$1,671.25" "$1,671.25" "$2,647.26" "$3,342.50" "$2,674.00" "$1,504.13" $663.40 N/A "$1,938.65" "$3,342.50" "$2,005.50" "$3,342.50" $696.58 "$3,342.50" N/A N/A 71683032L SUP HCPCS C1713 71683032L - NAIL IM 130D LNG 10MM 32CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683032R SUP HCPCS C1713 71683032R - NAIL IM 130D LNG 10MM 32CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683034L SUP HCPCS C1713 71683034L - NAIL IM 130D LNG 10MM 34CM IMHS CP SS LT BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683034R SUP HCPCS C1713 71683034R - NAIL IM 130D LNG 10MM 34CM IMHS CP SS RT BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683036L SUP HCPCS C1713 71683036L - NAIL IM 130D LNG 10MM 36CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683036R SUP HCPCS C1713 71683036R - NAIL IM 130D LNG 10MM 36CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683038L SUP HCPCS C1713 71683038L - NAIL IM 130D LNG 10MM 38CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683038R SUP HCPCS C1713 71683038R - NAIL IM 130D LNG 10MM 38CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683040L SUP HCPCS C1713 71683040L - NAIL IM 130D LNG 10MM 40CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683040R SUP HCPCS C1713 71683040R - NAIL IM 130D 10MM 40CM IMHS SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683042L SUP HCPCS C1713 71683042L - NAIL IM 130D LNG 10MM 42CM IMHS CP SS HIP LT BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683042R SUP HCPCS C1713 71683042R - NAIL IM 130D LNG 10MM 42CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683044L SUP HCPCS C1713 71683044L - NAIL IM 130D LNG 10MM 44CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683044R SUP HCPCS C1713 71683044R - NAIL IM 130D LNG 10MM 44CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683132L SUP HCPCS C1713 71683132L - NAIL IM 130D LNG 12MM 32CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683132R SUP HCPCS C1713 71683132R - NAIL IM 130D LNG 12MM 32CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683134L SUP HCPCS C1713 71683134L - NAIL IM 130D LNG 12MM 34CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683134R SUP HCPCS C1713 71683134R - NAIL IM 130D 12MM 34CM IMHS CP SS RT BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683136L SUP HCPCS C1713 71683136L - NAIL IM 130D 12MM 36CM IMHS SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683136R SUP HCPCS C1713 71683136R - NAIL IM 130D LNG 12MM 36CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683138L SUP HCPCS C1713 71683138L - NAIL IM 130D LNG 12MM 38CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683138R SUP HCPCS C1713 71683138R - NAIL IM 130D LNG 12MM 38CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$6,671.88" "$6,671.88" N/A N/A 71683140L SUP HCPCS C1713 71683140L - NAIL IM 130D LNG 12MM 40CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$6,671.88" "$6,671.88" N/A N/A 71683140R SUP HCPCS C1713 71683140R - NAIL IM 130D LNG 12MM 40CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683142L SUP HCPCS C1713 71683142L - NAIL IM 130D LNG 12MM 42CM IMHS CP SS HIP LT BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$6,671.88" "$6,671.88" N/A N/A 71683142R SUP HCPCS C1713 71683142R - NAIL IM 130D LNG 12MM 42CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$6,671.88" "$6,671.88" N/A N/A 71683144L SUP HCPCS C1713 71683144L - NAIL IM 130D LNG 12MM 44CM IMHS CP SS HIP LT BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$6,671.88" "$6,671.88" N/A N/A 71683144R SUP HCPCS C1713 71683144R - NAIL IM 130D LNG 12MM 44CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$6,671.88" "$6,671.88" N/A N/A 71683510L SUP HCPCS C1713 71683510L - NAIL IM 135D STD 10MM 19.5CM IMHS CP SS LT HIP BOTH IP/OP "$3,329.50" "$2,464.00" $660.80 "$3,329.38" "$1,498.22" "$1,498.22" "$1,498.22" "$1,498.22" "$3,329.38" "$3,329.38" "$3,329.38" $693.93 "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" $693.88 "$3,329.38" "$3,329.38" "$1,641.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$2,497.13" "$3,329.38" "$3,329.38" "$3,329.38" "$1,664.69" "$1,664.69" "$2,636.87" "$3,329.38" "$2,663.50" "$1,498.22" $660.80 N/A "$1,931.11" "$3,329.38" "$1,997.63" "$3,329.38" "$3,329.38" "$3,329.38" N/A N/A 71683510R SUP HCPCS C1713 71683510R - NAIL IM 135D STD 10MM 19.5CM IMHS CP SS RT HIP BOTH IP/OP "$3,329.50" "$2,464.00" $660.80 "$3,329.38" "$1,498.22" "$1,498.22" "$1,498.22" "$1,498.22" "$3,329.38" "$3,329.38" "$3,329.38" $693.93 "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" $693.88 "$3,329.38" "$3,329.38" "$1,641.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$2,497.13" "$3,329.38" "$3,329.38" "$3,329.38" "$1,664.69" "$1,664.69" "$2,636.87" "$3,329.38" "$2,663.50" "$1,498.22" $660.80 N/A "$1,931.11" "$3,329.38" "$1,997.63" "$3,329.38" $693.84 "$3,329.38" N/A N/A 71683512L SUP HCPCS C1713 71683512L - NAIL IM 135D STD 12MM 19.5CM IMHS CP SS LT HIP BOTH IP/OP "$3,329.50" "$2,464.00" $660.80 "$3,329.38" "$1,498.22" "$1,498.22" "$1,498.22" "$1,498.22" "$3,329.38" "$3,329.38" "$3,329.38" $693.93 "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" $693.88 "$3,329.38" "$3,329.38" "$1,641.38" "$3,329.38" "$3,329.38" "$3,329.38" "$3,329.38" "$2,497.13" "$3,329.38" "$3,329.38" "$3,329.38" "$1,664.69" "$1,664.69" "$2,636.87" "$3,329.38" "$2,663.50" "$1,498.22" $660.80 N/A "$1,931.11" "$3,329.38" "$1,997.63" "$3,329.38" "$3,329.38" "$3,329.38" N/A N/A 71683512R SUP HCPCS C1713 71683512R - NAIL IM 135D STD 12MM 19.5CM IMHS CP SS RT HIP BOTH IP/OP "$3,342.50" "$2,473.00" $663.40 "$3,342.50" "$1,504.13" "$1,504.13" "$1,504.13" "$1,504.13" "$3,342.50" "$3,342.50" "$3,342.50" $696.66 "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" $696.61 "$3,342.50" "$3,342.50" "$1,647.85" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$2,506.88" "$3,342.50" "$3,342.50" "$3,342.50" "$1,671.25" "$1,671.25" "$2,647.26" "$3,342.50" "$2,674.00" "$1,504.13" $663.40 N/A "$1,938.65" "$3,342.50" "$2,005.50" "$3,342.50" "$3,342.50" "$3,342.50" N/A N/A 71683514L SUP HCPCS C1713 71683514L - NAIL IM 135D STD 14MM 19.5CM IMHS CP SS LT HIP BOTH IP/OP "$3,342.50" "$2,473.00" $663.40 "$3,342.50" "$1,504.13" "$1,504.13" "$1,504.13" "$1,504.13" "$3,342.50" "$3,342.50" "$3,342.50" $696.66 "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" $696.61 "$3,342.50" "$3,342.50" "$1,647.85" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$2,506.88" "$3,342.50" "$3,342.50" "$3,342.50" "$1,671.25" "$1,671.25" "$2,647.26" "$3,342.50" "$2,674.00" "$1,504.13" $663.40 N/A "$1,938.65" "$3,342.50" "$2,005.50" "$3,342.50" "$3,342.50" "$3,342.50" N/A N/A 71683514R SUP HCPCS C1713 71683514R - NAIL IM 135D STD 14MM 19.5CM IMHS CP SS RT HIP BOTH IP/OP "$3,342.50" "$2,473.00" $663.40 "$3,342.50" "$1,504.13" "$1,504.13" "$1,504.13" "$1,504.13" "$3,342.50" "$3,342.50" "$3,342.50" $696.66 "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" $696.61 "$3,342.50" "$3,342.50" "$1,647.85" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$2,506.88" "$3,342.50" "$3,342.50" "$3,342.50" "$1,671.25" "$1,671.25" "$2,647.26" "$3,342.50" "$2,674.00" "$1,504.13" $663.40 N/A "$1,938.65" "$3,342.50" "$2,005.50" "$3,342.50" $696.58 "$3,342.50" N/A N/A 71683516L SUP HCPCS C1713 71683516L - NAIL IM 135D 16MM 19.5CM IMHS CP SS LT HIP BOTH IP/OP "$3,342.50" "$2,473.00" $663.40 "$3,342.50" "$1,504.13" "$1,504.13" "$1,504.13" "$1,504.13" "$3,342.50" "$3,342.50" "$3,342.50" $696.66 "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" $696.61 "$3,342.50" "$3,342.50" "$1,647.85" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$2,506.88" "$3,342.50" "$3,342.50" "$3,342.50" "$1,671.25" "$1,671.25" "$2,647.26" "$3,342.50" "$2,674.00" "$1,504.13" $663.40 N/A "$1,938.65" "$3,342.50" "$2,005.50" "$3,342.50" $696.58 "$3,342.50" N/A N/A 71683516R SUP HCPCS C1713 71683516R - NAIL IM 135D 16MM 19.5CM IMHS CP SS RT HIP BOTH IP/OP "$3,342.50" "$2,473.00" $663.40 "$3,342.50" "$1,504.13" "$1,504.13" "$1,504.13" "$1,504.13" "$3,342.50" "$3,342.50" "$3,342.50" $696.66 "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" $696.61 "$3,342.50" "$3,342.50" "$1,647.85" "$3,342.50" "$3,342.50" "$3,342.50" "$3,342.50" "$2,506.88" "$3,342.50" "$3,342.50" "$3,342.50" "$1,671.25" "$1,671.25" "$2,647.26" "$3,342.50" "$2,674.00" "$1,504.13" $663.40 N/A "$1,938.65" "$3,342.50" "$2,005.50" "$3,342.50" $696.58 "$3,342.50" N/A N/A 71683532L SUP HCPCS C1713 71683532L - NAIL IM 135D LNG 10MM 32CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683532R SUP HCPCS C1713 71683532R - NAIL IM 135D LNG 10MM 32CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683534L SUP HCPCS C1713 71683534L - NAIL IM 135D LNG 10MM 34CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$6,671.88" "$6,671.88" N/A N/A 71683534R SUP HCPCS C1713 71683534R - NAIL IM 135D LNG 10MM 34CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$6,671.88" "$6,671.88" N/A N/A 71683536L SUP HCPCS C1713 71683536L - NAIL IM 135D LNG 10MM 36CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683536R SUP HCPCS C1713 71683536R - NAIL IM 135D LNG 10MM 36CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683538L SUP HCPCS C1713 71683538L - NAIL IM 135D LNG 10MM 38CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683538R SUP HCPCS C1713 71683538R - NAIL IM 135D LNG 10MM 38CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683540L SUP HCPCS C1713 71683540L - NAIL IM 135D LNG 10MM 40CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683540R SUP HCPCS C1713 71683540R - NAIL IM 135D LNG 10MM 40CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683542L SUP HCPCS C1713 71683542L - NAIL IM 135D LNG 10MM 42CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683542R SUP HCPCS C1713 71683542R - NAIL IM 135D LNG 10MM 42CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683544L SUP HCPCS C1713 71683544L - NAIL IM 135D LNG 10MM 44CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683544R SUP HCPCS C1713 71683544R - NAIL IM 135D LNG 10MM 44CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683632L SUP HCPCS C1713 71683632L - NAIL IM 135D LNG 12MM 32CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$2,668.75" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683632R SUP HCPCS C1713 71683632R - NAIL IM 135D 12MM 32CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683634L SUP HCPCS C1713 71683634L - NAIL IM 135D LNG 12MM 34CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683634R SUP HCPCS C1713 71683634R - NAIL IM 135D LNG 12MM 34CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683636L SUP HCPCS C1713 71683636L - NAIL IM 135D LNG 12MM 36CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683636R SUP HCPCS C1713 71683636R - NAIL IM 135D LNG 12MM 36CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683638L SUP HCPCS C1713 71683638L - NAIL IM 135D LNG 12MM 38CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$6,671.88" "$6,671.88" N/A N/A 71683638R SUP HCPCS C1713 71683638R - NAIL IM 135D LNG 12MM 38CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" N/A N/A 71683640L SUP HCPCS C1713 71683640L - NAIL IM 135D LNG 12MM 40CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" N/A N/A 71683640R SUP HCPCS C1713 71683640R - NAIL IM 135D LNG 12MM 40CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683642L SUP HCPCS C1713 71683642L - NAIL IM 135D LNG 12MM 42CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$1,390.42" "$6,671.88" N/A N/A 71683642R SUP HCPCS C1713 71683642R - NAIL IM 135D LNG 12MM 42CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$6,671.88" "$6,671.88" N/A N/A 71683644L SUP HCPCS C1713 71683644L - NAIL IM 135D LNG 12MM 44CM IMHS CP SS LT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$4,003.13" "$6,671.88" "$6,671.88" "$6,671.88" N/A N/A 71683644R SUP HCPCS C1713 71683644R - NAIL IM 135D LNG 12MM 44CM IMHS CP SS RT HIP BOTH IP/OP "$6,672.00" "$4,937.00" "$1,324.20" "$6,671.88" "$3,002.35" "$3,002.35" "$3,002.35" "$3,002.35" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.59" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$1,390.49" "$6,671.88" "$6,671.88" "$3,289.24" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$5,004.00" "$6,671.88" "$6,671.88" "$6,671.88" "$3,335.94" "$3,335.94" "$5,284.13" "$6,671.88" "$5,337.50" "$3,002.35" "$1,324.20" N/A "$3,869.76" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" "$6,671.88" N/A N/A 71687V SUP Custom 27203010 71687V - Applier Large 70 Degree 8inÿÿ BOTH IP/OP $379.00 $280.00 $67.41 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $67.41 $378.73 $378.73 $281.09 $281.09 $291.93 $197.32 $78.93 $378.73 $151.49 $378.73 $378.73 $378.73 $378.73 $378.73 $284.25 $378.73 $378.73 $378.73 $189.37 $189.37 $299.95 $378.73 $302.98 $246.17 $378.73 N/A $219.82 $378.73 $227.24 $378.73 $378.73 $378.73 N/A N/A 71701016L SUP HCPCS C1713 71701016L - NAIL IM 12-10MM 16CM LIME TRGN FSN RND XSECT DC SLOT TI BOTH IP/OP "$5,614.00" "$4,154.00" "$1,114.19" "$5,613.75" "$2,526.19" "$2,526.19" "$2,526.19" "$2,526.19" "$5,613.75" "$5,613.75" "$5,613.75" "$1,170.05" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.97" "$5,613.75" "$5,613.75" "$2,767.58" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$4,210.50" "$5,613.75" "$5,613.75" "$5,613.75" "$2,806.88" "$2,806.88" "$4,446.09" "$5,613.75" "$4,491.00" "$2,526.19" "$1,114.19" N/A "$3,256.12" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" N/A N/A 71701016R SUP HCPCS C1713 71701016R - NAIL IM 10MM 16CM TRGN FSN TI RT HINDFOOT BOTH IP/OP "$5,614.00" "$4,154.00" "$1,114.19" "$5,613.75" "$2,526.19" "$2,526.19" "$2,526.19" "$2,526.19" "$5,613.75" "$5,613.75" "$5,613.75" "$1,170.05" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.97" "$5,613.75" "$2,245.50" "$2,767.58" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$4,210.50" "$5,613.75" "$5,613.75" "$5,613.75" "$2,806.88" "$2,806.88" "$4,446.09" "$5,613.75" "$4,491.00" "$2,526.19" "$1,114.19" N/A "$3,256.12" "$5,613.75" "$3,368.25" "$5,613.75" "$5,613.75" "$5,613.75" N/A N/A 71701020L SUP HCPCS C1713 71701020L - NAIL INTRAMEDULLARY 10MM 20CM FUSION TRIGEN LEFT HINDFOOT BOTH IP/OP "$5,614.00" "$4,154.00" "$1,114.19" "$5,613.75" "$2,526.19" "$2,526.19" "$2,526.19" "$2,526.19" "$5,613.75" "$5,613.75" "$5,613.75" "$1,170.05" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.97" "$5,613.75" "$2,245.50" "$2,767.58" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$4,210.50" "$5,613.75" "$5,613.75" "$5,613.75" "$2,806.88" "$2,806.88" "$4,446.09" "$5,613.75" "$4,491.00" "$2,526.19" "$1,114.19" N/A "$3,256.12" "$5,613.75" "$3,368.25" "$5,613.75" "$1,169.91" "$5,613.75" N/A N/A 71701020R SUP HCPCS C1713 71701020R - NAIL IM 12-10MM 20CM ROSE TRGN FSN RND XSECT DC SLOT TI BOTH IP/OP "$5,614.00" "$4,154.00" "$1,114.19" "$5,613.75" "$2,526.19" "$2,526.19" "$2,526.19" "$2,526.19" "$5,613.75" "$5,613.75" "$5,613.75" "$1,170.05" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.97" "$5,613.75" "$2,245.50" "$2,767.58" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$4,210.50" "$5,613.75" "$5,613.75" "$5,613.75" "$2,806.88" "$2,806.88" "$4,446.09" "$5,613.75" "$4,491.00" "$2,526.19" "$1,114.19" N/A "$3,256.12" "$5,613.75" "$3,368.25" "$5,613.75" "$5,613.75" "$5,613.75" N/A N/A 71701025L SUP HCPCS C1713 71701025L - NAIL IM 10MM 25CM TRGN TI LT HINDFOOT BOTH IP/OP "$5,614.00" "$4,154.00" "$1,114.19" "$5,613.75" "$2,526.19" "$2,526.19" "$2,526.19" "$2,526.19" "$5,613.75" "$5,613.75" "$5,613.75" "$1,170.05" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.97" "$5,613.75" "$2,245.50" "$2,767.58" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$4,210.50" "$5,613.75" "$5,613.75" "$5,613.75" "$2,806.88" "$2,806.88" "$4,446.09" "$5,613.75" "$4,491.00" "$2,526.19" "$1,114.19" N/A "$3,256.12" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.91" "$5,613.75" N/A N/A 71701025R SUP HCPCS C1713 71701025R - NAIL IM 10MM 25CM TRGN FSN TI RT HINDFOOT BOTH IP/OP "$5,614.00" "$4,154.00" "$1,114.19" "$5,613.75" "$2,526.19" "$2,526.19" "$2,526.19" "$2,526.19" "$5,613.75" "$5,613.75" "$5,613.75" "$1,170.05" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.97" "$5,613.75" "$5,613.75" "$2,767.58" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$4,210.50" "$5,613.75" "$5,613.75" "$5,613.75" "$2,806.88" "$2,806.88" "$4,446.09" "$5,613.75" "$4,491.00" "$2,526.19" "$1,114.19" N/A "$3,256.12" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.91" "$5,613.75" N/A N/A 71701116R SUP HCPCS C1713 71701116R - NAIL INTRAMEDULLARY 11.5MM 16CM FUSION TRIGEN RIGHT HINDFOOT BOTH IP/OP "$5,614.00" "$4,154.00" "$1,114.19" "$5,613.75" "$2,526.19" "$2,526.19" "$2,526.19" "$2,526.19" "$5,613.75" "$5,613.75" "$5,613.75" "$1,170.05" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.97" "$5,613.75" "$2,245.50" "$2,767.58" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$4,210.50" "$5,613.75" "$5,613.75" "$5,613.75" "$2,806.88" "$2,806.88" "$4,446.09" "$5,613.75" "$4,491.00" "$2,526.19" "$1,114.19" N/A "$3,256.12" "$5,613.75" "$3,368.25" "$5,613.75" "$1,169.91" "$5,613.75" N/A N/A 71701120L SUP HCPCS C1713 71701120L - NAIL INTRAMEDULLARY 11.5MM 20CM FUSION TRIGEN TITANIUM LEFT BOTH IP/OP "$5,614.00" "$4,154.00" "$1,114.19" "$5,613.75" "$2,526.19" "$2,526.19" "$2,526.19" "$2,526.19" "$5,613.75" "$5,613.75" "$5,613.75" "$1,170.05" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.97" "$5,613.75" "$2,245.50" "$2,767.58" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$4,210.50" "$5,613.75" "$5,613.75" "$5,613.75" "$2,806.88" "$2,806.88" "$4,446.09" "$5,613.75" "$4,491.00" "$2,526.19" "$1,114.19" N/A "$3,256.12" "$5,613.75" "$3,368.25" "$5,613.75" "$1,169.91" "$5,613.75" N/A N/A 71701120R SUP HCPCS C1713 71701120R - NAIL INTRAMEDULLARY 11.5MM 20CM FUSION TRIGEN TITANIUM RIGHT BOTH IP/OP "$5,614.00" "$4,154.00" "$1,114.19" "$5,613.75" "$2,526.19" "$2,526.19" "$2,526.19" "$2,526.19" "$5,613.75" "$5,613.75" "$5,613.75" "$1,170.05" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.97" "$5,613.75" "$2,245.50" "$2,767.58" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$4,210.50" "$5,613.75" "$5,613.75" "$5,613.75" "$2,806.88" "$2,806.88" "$4,446.09" "$5,613.75" "$4,491.00" "$2,526.19" "$1,114.19" N/A "$3,256.12" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.91" "$5,613.75" N/A N/A 71701125L SUP HCPCS C1713 71701125L - NAIL IM 11.5MM 25CM TRGN TI HINDFOOT LT BOTH IP/OP "$5,614.00" "$4,154.00" "$1,114.19" "$5,613.75" "$2,526.19" "$2,526.19" "$2,526.19" "$2,526.19" "$5,613.75" "$5,613.75" "$5,613.75" "$1,170.05" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.97" "$5,613.75" "$5,613.75" "$2,767.58" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$4,210.50" "$5,613.75" "$5,613.75" "$5,613.75" "$2,806.88" "$2,806.88" "$4,446.09" "$5,613.75" "$4,491.00" "$2,526.19" "$1,114.19" N/A "$3,256.12" "$5,613.75" "$3,368.25" "$5,613.75" "$1,169.91" "$5,613.75" N/A N/A 71701125R SUP HCPCS C1713 71701125R - TRIGIN HINDFOOT FUSION NAIL (R) 11.5x25CM BOTH IP/OP "$5,614.00" "$4,154.00" "$1,114.19" "$5,613.75" "$2,526.19" "$2,526.19" "$2,526.19" "$2,526.19" "$5,613.75" "$5,613.75" "$5,613.75" "$1,170.05" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.97" "$5,613.75" "$2,245.50" "$2,767.58" "$5,613.75" "$5,613.75" "$5,613.75" "$5,613.75" "$4,210.50" "$5,613.75" "$5,613.75" "$5,613.75" "$2,806.88" "$2,806.88" "$4,446.09" "$5,613.75" "$4,491.00" "$2,526.19" "$1,114.19" N/A "$3,256.12" "$5,613.75" "$5,613.75" "$5,613.75" "$1,169.91" "$5,613.75" N/A N/A 7170-20 SUP Custom 27203010 7170-20 - KIT PG 20FR MIC PUSH BOTH IP/OP $229.50 $170.00 $40.85 $229.50 $229.50 $229.50 $229.50 $229.50 $229.50 $229.50 $40.85 $229.50 $229.50 $170.33 $170.33 $176.90 $119.57 $47.83 $229.50 $91.80 $229.50 $229.50 $229.50 $229.50 $229.50 $172.13 $229.50 $229.50 $229.50 $114.75 $114.75 $181.76 $229.50 $183.60 $149.18 $229.50 N/A $133.11 $229.50 $137.70 $229.50 $229.50 $229.50 N/A N/A 7170-24 SUP Custom 27203010 7170-24 - KIT PG 24FR 12ML STRL LF MC SLK PUSH RADOPQ MED PORT SIL BOTH IP/OP $229.50 $170.00 $40.85 $229.50 $229.50 $229.50 $229.50 $229.50 $229.50 $229.50 $40.85 $229.50 $229.50 $170.33 $170.33 $176.90 $119.57 $47.83 $229.50 $91.80 $229.50 $229.50 $229.50 $229.50 $229.50 $172.13 $229.50 $229.50 $229.50 $114.75 $114.75 $181.76 $229.50 $183.60 $149.18 $229.50 N/A $133.11 $229.50 $137.70 $229.50 $229.50 $229.50 N/A N/A 7170Q/52 SUP HCPCS C1895 7170Q/52 - LEAD PACING 7FR 52CM 17CM TRUE BIPOL ACTIVE FIX 2 COIL BOTH IP/OP "$10,500.00" "$7,770.00" "$2,083.99" "$10,500.00" "$4,725.00" "$4,725.00" "$4,725.00" "$4,725.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.46" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.32" "$10,500.00" "$10,500.00" "$5,176.50" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$7,875.00" "$10,500.00" "$10,500.00" "$10,500.00" "$5,250.00" "$5,250.00" "$8,316.00" "$10,500.00" "$8,400.00" "$4,725.00" "$2,083.99" N/A "$6,090.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.20" "$10,500.00" N/A N/A 7170Q/58 SUP HCPCS C1895 7170Q/58 - LEAD PACING 7FR 58CM 17CM TRUE BIPOL ACTIVE FIX 2 COIL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7170Q/65 SUP HCPCS C1895 7170Q/65 - LEAD DFBR 17CM 65CM DURATA TINE FX 2 COIL DF4 CNCT TRUE BP BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 71711V SUP Custom 27203010 71711V - CLIP INTNL Remover Large - XLarge Straight 11inÿÿ BOTH IP/OP $412.50 $305.00 $73.42 $412.48 $412.48 $412.48 $412.48 $412.48 $412.48 $412.48 $73.42 $412.48 $412.48 $306.14 $306.14 $317.94 $214.90 $85.97 $412.48 $164.99 $412.48 $412.48 $412.48 $412.48 $412.48 $309.38 $412.48 $412.48 $412.48 $206.24 $206.24 $326.68 $412.48 $329.98 $268.11 $412.48 N/A $239.25 $412.48 $247.49 $412.48 $412.48 $412.48 N/A N/A 71712V SUP Custom 27203010 71712V - Applier XLarge Curved 11inÿÿ BOTH IP/OP $379.00 $280.00 $67.41 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $67.41 $378.73 $378.73 $281.09 $281.09 $291.93 $197.32 $78.93 $378.73 $151.49 $378.73 $378.73 $378.73 $378.73 $378.73 $284.25 $378.73 $378.73 $378.73 $189.37 $189.37 $299.95 $378.73 $302.98 $246.17 $378.73 N/A $219.82 $378.73 $227.24 $378.73 $378.73 $378.73 N/A N/A 71717V SUP Custom 27203010 71717V - Applier XLarge 70 Degree 11inÿÿ BOTH IP/OP $379.00 $280.00 $67.41 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $378.73 $67.41 $378.73 $378.73 $281.09 $281.09 $291.93 $197.32 $78.93 $378.73 $151.49 $378.73 $378.73 $378.73 $378.73 $378.73 $284.25 $378.73 $378.73 $378.73 $189.37 $189.37 $299.95 $378.73 $302.98 $246.17 $378.73 N/A $219.82 $378.73 $227.24 $378.73 $378.73 $378.73 N/A N/A 7171Q/52 SUP HCPCS C1895 7171Q/52 - LEAD PACING 7FR 52CM 21CM TRUE BIPOL ACTIVE FIX 2 COIL BOTH IP/OP "$10,500.00" "$7,770.00" "$2,083.99" "$10,500.00" "$4,725.00" "$4,725.00" "$4,725.00" "$4,725.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.46" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.32" "$10,500.00" "$10,500.00" "$5,176.50" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$7,875.00" "$10,500.00" "$10,500.00" "$10,500.00" "$5,250.00" "$5,250.00" "$8,316.00" "$10,500.00" "$8,400.00" "$4,725.00" "$2,083.99" N/A "$6,090.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.20" "$10,500.00" N/A N/A 7171Q/58 SUP HCPCS C1895 7171Q/58 - LEAD DFBR 7FR 58CM 21CM DURATA 2 COIL DF4 CNCT TRUE BP ACTFX BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7171Q/65 SUP HCPCS C1895 7171Q/65 - LEAD DFBR 65CM DURATA 2 COIL TRUE BP TINE FX DF4 CNCT OPTIM BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 7180025A SUP HCPCS C1713 7180025A - END CAP SPNL 18MM 20-25MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 7180027A SUP HCPCS C1713 7180027A - END CAP SPNL 18MM 21-27MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 7180033A SUP HCPCS C1713 7180033A - END CAP SPNL 18MM 24-33MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 7180041A SUP HCPCS C1713 7180041A - END CAP SPNL 18MM 28-41MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 7180055A SUP HCPCS C1713 7180055A - END CAP SPNL 18MM 35-55MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 7180067A SUP HCPCS C1713 7180067A - END CAP SPNL 18MM 41-67MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 7180079A SUP HCPCS C1713 7180079A - END CAP SPNL 18MM 47-79MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 7180-20 SUP Custom 27203010 7180-20 - KIT PG 20FR 4X4IN 12ML STRL LF SECUR-LOK MIC SPNG FDTB XTRN BOTH IP/OP $308.00 $228.00 $54.82 $307.98 $307.98 $307.98 $307.98 $307.98 $307.98 $307.98 $54.82 $307.98 $307.98 $228.58 $228.58 $237.39 $160.46 $64.19 $307.98 $97.34 $307.98 $307.98 $243.35 $307.98 $307.98 $231.00 $307.98 $307.98 $307.98 $153.99 $153.99 $243.92 $307.98 $246.38 $200.19 $307.98 N/A $178.64 $307.98 $184.79 $307.98 $307.98 $307.98 N/A N/A 7180-24 SUP Custom 27203010 7180-24 - KIT PG 24FR 12ML STRL LF MC SLK PUL RADOPQ MED PORT SIL DISP BOTH IP/OP $308.00 $228.00 $54.82 $307.98 $307.98 $307.98 $307.98 $307.98 $307.98 $307.98 $54.82 $307.98 $307.98 $228.58 $228.58 $237.39 $160.46 $64.19 $307.98 $97.34 $307.98 $307.98 $243.34 $307.98 $307.98 $231.00 $307.98 $307.98 $307.98 $153.99 $153.99 $243.92 $307.98 $246.38 $200.19 $307.98 N/A $178.64 $307.98 $184.79 $307.98 $307.98 $307.98 N/A N/A 71A003 SUP Custom 27804086 71A003 - GRAFT BONE SMALL 40-65MM CORTICAL SEGMENT BOTH IP/OP "$1,617.50" "$1,197.00" $287.92 "$1,852.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" $287.92 "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" "$1,617.50" $337.10 "$1,617.50" $741.00 "$1,617.50" "$1,617.50" "$1,852.50" "$1,617.50" "$1,617.50" "$1,213.13" "$1,617.50" "$1,617.50" "$1,617.50" $808.75 $808.75 "$1,281.06" "$1,617.50" "$1,294.00" $727.88 "$1,617.50" N/A $938.15 "$1,617.50" $970.50 "$1,617.50" "$1,617.50" "$1,617.50" N/A N/A 71A004 SUP Custom 27804086 71A004 - GRAFT BONE LARGE 66-99MM CORTICAL SEGMENT BOTH IP/OP "$1,707.50" "$1,264.00" $303.94 "$1,957.50" "$1,707.50" "$1,707.50" "$1,707.50" "$1,707.50" "$1,707.50" "$1,707.50" $303.94 "$1,707.50" "$1,707.50" "$1,707.50" "$1,707.50" "$1,707.50" "$1,707.50" $355.86 "$1,707.50" $783.00 "$1,707.50" "$1,707.50" "$1,957.50" "$1,707.50" "$1,707.50" "$1,280.63" "$1,707.50" "$1,707.50" "$1,707.50" $853.75 $853.75 "$1,352.34" "$1,707.50" "$1,366.00" $768.38 "$1,707.50" N/A $990.35 "$1,707.50" "$1,024.50" "$1,707.50" "$1,707.50" "$1,707.50" N/A N/A 720088-01 SUP HCPCS C1771 720088-01 - SLING UROLOGICAL ADVANCE MALE BOTH IP/OP "$14,150.00" "$10,471.00" "$2,808.42" "$14,150.00" "$6,367.50" "$6,367.50" "$6,367.50" "$6,367.50" "$14,150.00" "$14,150.00" "$14,150.00" "$2,949.21" "$14,150.00" "$14,150.00" "$14,150.00" "$14,150.00" "$14,150.00" "$2,949.02" "$14,150.00" "$14,150.00" "$6,975.95" "$14,150.00" "$14,150.00" "$14,150.00" "$14,150.00" "$10,612.50" "$14,150.00" "$14,150.00" "$14,150.00" "$7,075.00" "$7,075.00" "$11,206.80" "$14,150.00" "$11,320.00" "$6,367.50" "$2,808.42" N/A "$8,207.00" "$14,150.00" "$14,150.00" "$14,150.00" "$2,948.86" "$14,150.00" N/A N/A 720163-01 SUP HCPCS C1771 720163-01 - SLING URTH ADV XP KT INET XPLR M BOTH IP/OP "$17,125.00" "$12,673.00" "$3,398.88" "$17,125.00" "$7,706.25" "$7,706.25" "$7,706.25" "$7,706.25" "$17,125.00" "$17,125.00" "$17,125.00" "$3,569.28" "$17,125.00" "$17,125.00" "$17,125.00" "$17,125.00" "$17,125.00" "$3,569.04" "$17,125.00" "$17,125.00" "$8,442.63" "$17,125.00" "$17,125.00" "$17,125.00" "$17,125.00" "$12,843.75" "$17,125.00" "$17,125.00" "$17,125.00" "$8,562.50" "$8,562.50" "$13,563.00" "$17,125.00" "$13,700.00" "$7,706.25" "$3,398.88" N/A "$9,932.50" "$17,125.00" "$17,125.00" "$17,125.00" "$3,568.85" "$17,125.00" N/A N/A 720185-01 SUP HCPCS C1813 720185-01 - PROSTHESIS PENILE PRECONNECT INFLATABLE RESERVOIR AMS 700 MS BOTH IP/OP "$4,672.50" "$3,458.00" $927.37 "$4,672.50" "$2,102.63" "$2,102.63" "$2,102.63" "$2,102.63" "$4,672.50" "$4,672.50" "$4,672.50" $973.87 "$4,672.50" "$4,672.50" "$4,672.50" "$4,672.50" "$4,672.50" $973.80 "$4,672.50" "$4,672.50" "$2,303.54" "$4,672.50" "$4,672.50" "$4,672.50" "$4,672.50" "$3,504.38" "$4,672.50" "$4,672.50" "$4,672.50" "$2,336.25" "$2,336.25" "$3,700.62" "$4,672.50" "$3,738.00" "$2,102.63" $927.37 N/A "$2,710.05" "$4,672.50" "$4,672.50" "$4,672.50" $973.75 "$4,672.50" N/A N/A 72-12-0308 SUP Custom 27803010 72-12-0308 - INSERT TIBIAL 3 8MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0310 SUP Custom 27803010 72-12-0310 - INSERT TIBIAL 3 10MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0312 SUP Custom 27803010 72-12-0312 - INSERT TIBIAL 3 12MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0315 SUP Custom 27803010 72-12-0315 - INSERT TIBIAL 3 15MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0318 SUP Custom 27803010 72-12-0318 - INSERT TIBIAL 3 18MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0321 SUP Custom 27803010 72-12-0321 - INSERT TIBIAL 3 21MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0324 SUP Custom 27803010 72-12-0324 - INSERT TIBIAL 3 24MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0508 SUP Custom 27803010 72-12-0508 - INSERT TIBIAL 5 8MM CRUC RET SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0510 SUP Custom 27803010 72-12-0510 - INSERT TIBIAL 5 10MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0512 SUP Custom 27803010 72-12-0512 - INSERT TIBIAL 5 12MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0515 SUP Custom 27803010 72-12-0515 - INSERT TIBIAL 5 15MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0518 SUP Custom 27803010 72-12-0518 - INSERT TIBIAL 5 18MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0521 SUP Custom 27803010 72-12-0521 - INSERT TIBIAL 5 21MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0524 SUP Custom 27803010 72-12-0524 - INSERT TIBIAL 5 24MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0708 SUP Custom 27803010 72-12-0708 - INSERT TIBIAL 7 8MM CRUC RET SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0710 SUP Custom 27803010 72-12-0710 - INSERT TIBIAL 7 10MM CRUC RET SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0712 SUP Custom 27803010 72-12-0712 - INSERT TIBIAL 7 12MM CRUC RET SCORPIO N2/VAC KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0715 SUP Custom 27803010 72-12-0715 - INSERT TIBIAL 7 15MM CRUC RET SCORPIO N2/VAC KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0718 SUP Custom 27803010 72-12-0718 - INSERT TIBIAL 7 18MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0721 SUP Custom 27803010 72-12-0721 - INSERT TIBIAL 7 21MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0724 SUP Custom 27803010 72-12-0724 - INSERT TIBIAL 7 24MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0908 SUP Custom 27803010 72-12-0908 - INSERT TIBIAL 9 8MM CRUC RET SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0910 SUP Custom 27803010 72-12-0910 - INSERT TIBIAL 9 10MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0912 SUP Custom 27803010 72-12-0912 - INSERT TIBIAL 9 12MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0915 SUP Custom 27803010 72-12-0915 - INSERT TIBIAL 9 15MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0918 SUP Custom 27803010 72-12-0918 - INSERT TIBIAL 9 18MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0921 SUP Custom 27803010 72-12-0921 - INSERT TIBIAL 9 21MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-0924 SUP Custom 27803010 72-12-0924 - INSERT TIBIAL 9 24MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-1108 SUP Custom 27803010 72-12-1108 - INSERT TIBIAL 11 8MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-1110 SUP Custom 27803010 72-12-1110 - INSERT TIBIAL 11 10MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-1112 SUP Custom 27803010 72-12-1112 - INSERT TIBIAL 11 12MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-1115 SUP Custom 27803010 72-12-1115 - INSERT TIBIAL 11 15MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-1118 SUP Custom 27803010 72-12-1118 - INSERT TIBIAL 11 18MM CRUC RET SCORPIO POLYETHYLENE KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-1121 SUP Custom 27803010 72-12-1121 - INSERT TIBIAL 11 21MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-12-1124 SUP Custom 27803010 72-12-1124 - INSERT TIBIAL 11 24MM CRUC RET HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0308 SUP Custom 27803010 72-13-0308 - INSERT TIBIAL 3 8MM POSTERIOR STABILIZED HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0310 SUP Custom 27803010 72-13-0310 - INSERT TIBIAL 3 10MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0312 SUP Custom 27803010 72-13-0312 - INSERT TIBIAL 3 12MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0315 SUP Custom 27803010 72-13-0315 - INSERT TIBIAL 3 15MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0318 SUP Custom 27803010 72-13-0318 - INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0321 SUP Custom 27803010 72-13-0321 - INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0324 SUP Custom 27803010 72-13-0324 - INSERT TIBIAL 3 24MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0508 SUP Custom 27803010 72-13-0508 - INSERT TIBIAL 5 8MM POSTERIOR STABILIZED HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0510 SUP Custom 27803010 72-13-0510 - INSERT TIBIAL 5 10MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0512 SUP Custom 27803010 72-13-0512 - INSERT TIBIAL 5 12MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0515 SUP Custom 27803010 72-13-0515 - INSERT TIBIAL 5 15MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0518 SUP Custom 27803010 72-13-0518 - INSERT TIBIAL 5 18MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0521 SUP Custom 27803010 72-13-0521 - INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0524 SUP Custom 27803010 72-13-0524 - INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0708 SUP Custom 27803010 72-13-0708 - INSERT TIBIAL 7 8MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0710 SUP Custom 27803010 72-13-0710 - INSERT TIBIAL 7 10MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0712 SUP Custom 27803010 72-13-0712 - INSERT TIBIAL 7 12MM POSTERIOR STABILIZE SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0715 SUP Custom 27803010 72-13-0715 - INSERT TIBIAL POSTERIOR STABILIZE SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0718 SUP Custom 27803010 72-13-0718 - INSERT TIBIAL 7 18MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0721 SUP Custom 27803010 72-13-0721 - INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0724 SUP Custom 27803010 72-13-0724 - INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0908 SUP Custom 27803010 72-13-0908 - INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0910 SUP Custom 27803010 72-13-0910 - INSERT TIBIAL 9 10MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0912 SUP Custom 27803010 72-13-0912 - INSERT TIBIAL 9 12MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0915 SUP Custom 27803010 72-13-0915 - INSERT TIBIAL 9 15MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0918 SUP Custom 27803010 72-13-0918 - INSERT TIBIAL 9 18MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0921 SUP Custom 27803010 72-13-0921 - INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-0924 SUP Custom 27803010 72-13-0924 - INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-1108 SUP Custom 27803010 72-13-1108 - INSERT TIBIAL 11 8MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-1110 SUP Custom 27803010 72-13-1110 - INSERT TIBIAL 11 10MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-1112 SUP Custom 27803010 72-13-1112 - INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-1115 SUP Custom 27803010 72-13-1115 - INSERT TIBIAL 11 15MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-1118 SUP Custom 27803010 72-13-1118 - INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-1121 SUP Custom 27803010 72-13-1121 - INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-13-1124 SUP Custom 27803010 72-13-1124 - INSERT TIBIAL POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0308 SUP Custom 27803010 72-15-0308 - INSERT TIBIAL 3 8MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0310 SUP Custom 27803010 72-15-0310 - INSERT TIBIAL 3 10MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0312 SUP Custom 27803010 72-15-0312 - INSERT TIBIAL 3 12MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0315 SUP Custom 27803010 72-15-0315 - INSERT TIBIAL 3 15MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0318 SUP Custom 27803010 72-15-0318 - INSERT TIBIAL 3 18MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0321 SUP Custom 27803010 72-15-0321 - INSERT TIBIAL 3 21MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0324 SUP Custom 27803010 72-15-0324 - INSERT TIBIAL 3 24MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0508 SUP Custom 27803010 72-15-0508 - INSERT TIBIAL 5 8MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0510 SUP Custom 27803010 72-15-0510 - INSERT TIBIAL 5 10MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0512 SUP Custom 27803010 72-15-0512 - INSERT TIBIAL 5 12MM POSTERIOR STABILIZED HYPREX SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0515 SUP Custom 27803010 72-15-0515 - INSERT TIBIAL 5 15MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0518 SUP Custom 27803010 72-15-0518 - INSERT TIBIAL 5 18MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0521 SUP Custom 27803010 72-15-0521 - INSERT TIBIAL 5 21MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0524 SUP Custom 27803010 72-15-0524 - INSERT TIBIAL 5 24MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0708 SUP Custom 27803010 72-15-0708 - INSERT TIBIAL 7 8MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0710 SUP Custom 27803010 72-15-0710 - INSERT TIBIAL 7 10MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0712 SUP Custom 27803010 72-15-0712 - INSERT TIBIAL 7 12MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0715 SUP Custom 27803010 72-15-0715 - INSERT TIBIAL 7 15MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0718 SUP Custom 27803010 72-15-0718 - INSERT TIBIAL 7 18MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0721 SUP Custom 27803010 72-15-0721 - INSERT TIBIAL POSTERIOR STABILIZED HYPER EXTN SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0724 SUP Custom 27803010 72-15-0724 - INSERT TIBIAL 7 24MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0908 SUP Custom 27803010 72-15-0908 - INSERT TIBIAL 9 8MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0910 SUP Custom 27803010 72-15-0910 - INSERT TIBIAL 9 10MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0912 SUP Custom 27803010 72-15-0912 - INSERT TIBIAL 9 12MM POSTERIOR STABILIZE SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0915 SUP Custom 27803010 72-15-0915 - INSERT TIBIAL 9 15MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0918 SUP Custom 27803010 72-15-0918 - INSERT TIBIAL 9 18MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0921 SUP Custom 27803010 72-15-0921 - INSERT TIBIAL 9 21MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-0924 SUP Custom 27803010 72-15-0924 - INSERT TIBIAL 9 24MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-1108 SUP Custom 27803010 72-15-1108 - INSERT TIBIAL 11 8MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-1110 SUP Custom 27803010 72-15-1110 - INSERT TIBIAL 11 10MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-1112 SUP Custom 27803010 72-15-1112 - INSERT TIBIAL 11 12MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-1115 SUP Custom 27803010 72-15-1115 - INSERT TIBIAL 11 15MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-1118 SUP Custom 27803010 72-15-1118 - INSERT TIBIAL 11 18MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-1121 SUP Custom 27803010 72-15-1121 - INSERT TIBIAL 11 21MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-15-1124 SUP Custom 27803010 72-15-1124 - INSERT TIBIAL 11 24MM POSTERIOR STABILIZED HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0308 SUP Custom 27803010 72-16-0308 - INSERT TIBIAL CRUC RET HYPER EXTN SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0310 SUP Custom 27803010 72-16-0310 - INSERT TIBIAL CRUC RET HYPER EXTN SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0312 SUP Custom 27803010 72-16-0312 - INSERT TIBIAL CRUC RET HYPER EXTN SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0315 SUP Custom 27803010 72-16-0315 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0318 SUP Custom 27803010 72-16-0318 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0321 SUP Custom 27803010 72-16-0321 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0324 SUP Custom 27803010 72-16-0324 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0508 SUP Custom 27803010 72-16-0508 - INSERT TIBIAL 5 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0510 SUP Custom 27803010 72-16-0510 - INSERT TIBIAL 5 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0512 SUP Custom 27803010 72-16-0512 - INSERT TIBIAL 5 12MM CRUC RET SCRPFLX POLYETHYLENE KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0515 SUP Custom 27803010 72-16-0515 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0518 SUP Custom 27803010 72-16-0518 - INSERT TIBIAL 5 18MM CRUC RET SCRPFLX POLYETHYLENE KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0521 SUP Custom 27803010 72-16-0521 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0524 SUP Custom 27803010 72-16-0524 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0708 SUP Custom 27803010 72-16-0708 - INSERT TIBIAL 7 8MM CRUC RET SCORPIO KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0710 SUP Custom 27803010 72-16-0710 - INSERT TIBIAL 7 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0712 SUP Custom 27803010 72-16-0712 - INSERT TIBIAL 7 12MM CRUC RET SCRPFLX POLYETHYLENE KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0715 SUP Custom 27803010 72-16-0715 - INSERT TIBIAL 7 15MM CRUC RET SCRPFLX POLYETHYLENE KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0718 SUP Custom 27803010 72-16-0718 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0721 SUP Custom 27803010 72-16-0721 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0724 SUP Custom 27803010 72-16-0724 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0908 SUP Custom 27803010 72-16-0908 - INSERT TIBIAL 9 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0910 SUP Custom 27803010 72-16-0910 - INSERT TIBIAL 9 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0912 SUP Custom 27803010 72-16-0912 - INSERT TIBIAL 9 12MM CRUC RET SCRPFLX POLYETHYLENE KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0915 SUP Custom 27803010 72-16-0915 - INSERT TIBIAL 9 15MM CRUC RET SCRPFLX POLYETHYLENE KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0918 SUP Custom 27803010 72-16-0918 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0921 SUP Custom 27803010 72-16-0921 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0924 SUP Custom 27803010 72-16-0924 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-0924300 SUP Custom 27803010 72-16-0924300 - INSERT TIBIAL CRUCIATE RETAIN HYPER EXTN SCRPFLX BOTH IP/OP "$2,013.00" "$1,490.00" $358.31 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" $358.31 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" $419.53 "$2,013.00" $805.20 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$1,509.75" "$2,013.00" "$2,013.00" "$2,013.00" "$1,006.50" "$1,006.50" "$1,594.30" "$2,013.00" "$1,610.40" $905.85 "$2,013.00" N/A "$1,167.54" "$2,013.00" "$1,207.80" "$2,013.00" "$2,013.00" "$2,013.00" N/A N/A 72-16-1108 SUP Custom 27803010 72-16-1108 - INSERT TIBIAL 11 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-1110 SUP Custom 27803010 72-16-1110 - INSERT TIBIAL 11 10MM CRUC RET SCRPFLX POLYETHYLENE KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-1112 SUP Custom 27803010 72-16-1112 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-1115 SUP Custom 27803010 72-16-1115 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-1118 SUP Custom 27803010 72-16-1118 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-1121 SUP Custom 27803010 72-16-1121 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 72-16-1124 SUP Custom 27803010 72-16-1124 - INSERT TIBIAL CRUC RET HYPREX SCRPFLX BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 7220025A SUP HCPCS C1713 7220025A - END CAP SPNL 22MM 20-25MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 7220027A SUP HCPCS C1713 7220027A - END CAP SPNL 22MM 21-27MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 7220033A SUP HCPCS C1713 7220033A - END CAP SPNL 22MM 24-33MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$13,962.50" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 7220041A SUP HCPCS C1713 7220041A - END CAP SPNL 22MM 28-41MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$13,962.50" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 7220055A SUP HCPCS C1713 7220055A - END CAP SPNL 22MM 35-55MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 7220067A SUP HCPCS C1713 7220067A - END CAP SPNL 22MM 41-67MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$5,585.00" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 7220079A SUP HCPCS C1713 7220079A - END CAP SPNL 22MM 47-79MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$13,962.50" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 7220121A SUP HCPCS C1713 7220121A - END CAP SPNL 22MM 68-121MM NS X-COR 2 ATLCK TI BOTH IP/OP "$13,962.50" "$10,332.00" "$2,771.21" "$13,962.50" "$6,283.13" "$6,283.13" "$6,283.13" "$6,283.13" "$13,962.50" "$13,962.50" "$13,962.50" "$2,910.13" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$2,909.94" "$13,962.50" "$13,962.50" "$6,883.51" "$13,962.50" "$13,962.50" "$13,962.50" "$13,962.50" "$10,471.88" "$13,962.50" "$13,962.50" "$13,962.50" "$6,981.25" "$6,981.25" "$11,058.30" "$13,962.50" "$11,170.00" "$6,283.13" "$2,771.21" N/A "$8,098.25" "$13,962.50" "$8,377.50" "$13,962.50" "$2,909.79" "$13,962.50" N/A N/A 72-2049 SUP Custom 27203010 72-2049 - DRILL SURG 1.5MM 5MM STOP HIGH SPEED MANDIB IQ BOTH IP/OP $615.00 $455.00 $109.47 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $109.47 $615.00 $615.00 $456.45 $456.45 $474.04 $320.42 $128.17 $615.00 $246.00 $615.00 $615.00 $615.00 $615.00 $615.00 $461.25 $615.00 $615.00 $615.00 $307.50 $307.50 $487.08 $615.00 $492.00 $399.75 $615.00 N/A $356.70 $615.00 $369.00 $615.00 $615.00 $615.00 N/A N/A 72-2055 SUP Custom 27203010 72-2055 - DRILL SURG 1.5MM 22MM STOP MANDIB BOTH IP/OP $615.00 $455.00 $109.47 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $615.00 $109.47 $615.00 $615.00 $456.45 $456.45 $474.04 $320.42 $128.17 $615.00 $246.00 $615.00 $615.00 $615.00 $615.00 $615.00 $461.25 $615.00 $615.00 $615.00 $307.50 $307.50 $487.08 $615.00 $492.00 $399.75 $615.00 N/A $356.70 $615.00 $369.00 $615.00 $615.00 $615.00 N/A N/A 72-25-0308 SUP Custom 27803010 72-25-0308 - INSERT TIBIAL 3 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0310 SUP Custom 27803010 72-25-0310 - INSERT TIBIAL 3 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0312 SUP HCPCS C1776 72-25-0312 - INSERT TIB 3 12MM SCRPFLX POST STAB PE KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 72-25-0315 SUP HCPCS C1776 72-25-0315 - INSERT TIB 3 15MM SCRPFLX POST STAB X3 KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 72-25-0318 SUP HCPCS C1776 72-25-0318 - INSERT TIB 3 18MM SCRPFLX POST STAB X3 KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 72-25-0321 SUP HCPCS C1776 72-25-0321 - INSERT TIB 3 21MM SCRPFLX POST STAB X3 KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 72-25-0324 SUP HCPCS C1776 72-25-0324 - INSERT TIB 3 24MM SCRPFLX POST STAB X3 KN BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 72-25-0508 SUP Custom 27803010 72-25-0508 - INSERT TIBIAL 5 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0510 SUP Custom 27803010 72-25-0510 - INSERT TIBIAL 5 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0512 SUP Custom 27803010 72-25-0512 - INSERT TIBIAL 5 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0515 SUP Custom 27803010 72-25-0515 - INSERT TIBIAL 5 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0518 SUP HCPCS C1776 72-25-0518 - INSERT TIB SCRPFLX POST STAB X3 BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A 72-25-0521 SUP Custom 27803010 72-25-0521 - INSERT TIB 5 21MM SCRP SFLX POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0524 SUP Custom 27803010 72-25-0524 - INSERT TIB 5 24MM SCRPFLX POST STAB X3 ARTC KN BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0708 SUP Custom 27803010 72-25-0708 - INSERT TIBIAL 7 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0710 SUP Custom 27803010 72-25-0710 - INSERT TIBIAL 7 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0712 SUP Custom 27803010 72-25-0712 - INSERT TIBIAL 7 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0715 SUP Custom 27803010 72-25-0715 - INSERT TIBIAL 7 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0718 SUP Custom 27803010 72-25-0718 - INSERT TIBIAL POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0721 SUP Custom 27803010 72-25-0721 - INSERT TIB 7 21MM SCRP SFLX POST STAB KN BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0724 SUP Custom 27803010 72-25-0724 - INSERT TIB 7 24MM SCRPFLX POST STAB X3 KN BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0908 SUP Custom 27803010 72-25-0908 - INSERT TIBIAL 9 8MM POSTERIOR STABILIZE SCRPFLX X3 RIGHT BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0910 SUP Custom 27803010 72-25-0910 - INSERT TIBIAL 9 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0912 SUP Custom 27803010 72-25-0912 - INSERT TIBIAL 9 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0915 SUP Custom 27803010 72-25-0915 - INSERT TIBIAL 9 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0918 SUP Custom 27803010 72-25-0918 - INSERT TIB 9 18MM SCRPFLX POST STAB X3 ARTC BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0921 SUP Custom 27803010 72-25-0921 - INSERT TIB 9 21MM SCRPFLX POST STAB X3 ARTC KN BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-0924 SUP Custom 27803010 72-25-0924 - INSERT TIB 9 24MM STRL SCRPFLX POST STAB X3 KN BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-1108 SUP Custom 27803010 72-25-1108 - INSERT TIBIAL 11 8MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-1110 SUP Custom 27803010 72-25-1110 - INSERT TIBIAL 11 10MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-1112 SUP Custom 27803010 72-25-1112 - INSERT TIBIAL 11 12MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-1115 SUP Custom 27803010 72-25-1115 - INSERT TIBIAL 11 15MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-1118 SUP Custom 27803010 72-25-1118 - INSERT TIBIAL 11 18MM POSTERIOR STABILIZE SCRPFLX BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-1121 SUP Custom 27803010 72-25-1121 - INSERT TIBIAL 11 21MM POSTERIOR STABILIZE SCRPFLX X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-25-1124 SUP Custom 27803010 72-25-1124 - INSERT TIBIAL 11 24MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0308 SUP Custom 27803010 72-26-0308 - INSERT TIBIAL 3 8MM CRUC RET SCRPFLX POLYETHYLENE KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0310 SUP Custom 27803010 72-26-0310 - INSERT TIBIAL 3 10MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0312 SUP Custom 27803010 72-26-0312 - INSERT TIBIAL 3 12MM CRUC RET SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0315 SUP Custom 27803010 72-26-0315 - INSERT TIBIAL 3 15MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0318 SUP Custom 27803010 72-26-0318 - INSERT TIBIAL 3 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0321 SUP Custom 27803010 72-26-0321 - INSERT TIBIAL 3 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0324 SUP Custom 27803010 72-26-0324 - INSERT TIBIAL 3 24MM CRUC RET SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0508 SUP Custom 27803010 72-26-0508 - INSERT TIBIAL 5 8MM CRUC RET POSTERIOR STABILIZED SCRPFLX X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0510 SUP Custom 27803010 72-26-0510 - INSERT TIBIAL 5 10MM CRUC RET SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0512 SUP Custom 27803010 72-26-0512 - INSERT TIBIAL 5 12MM CRUC RET SCRPFLX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0515 SUP Custom 27803010 72-26-0515 - INSERT TIB 5 15MM STRL SCRPFLX CR X3 KN BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0518 SUP Custom 27803010 72-26-0518 - INSERT TIBIAL 5 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0521 SUP Custom 27803010 72-26-0521 - INSERT TIBIAL CRUC RET SCORPIO SUPERFLEX BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0524 SUP Custom 27803010 72-26-0524 - INSERT TIBIAL CRUC RET SCORPIO SUPERFLEX BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0708 SUP Custom 27803010 72-26-0708 - INSERT TIBIAL 7 8MM CRUC RET POSTERIOR STABILIZED SCRPFLX X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0710 SUP Custom 27803010 72-26-0710 - INSERT TIBIAL 7 10MM CRUC RET POSTERIOR STABILIZED SCRPFLX BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0712 SUP Custom 27803010 72-26-0712 - INSERT TIBIAL 7 12MM CRUC RET POSTERIOR STABILIZED SCRPFLX BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0715 SUP Custom 27803010 72-26-0715 - INSERT TIBIAL 7 15MM CRUC RET SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0718 SUP Custom 27803010 72-26-0718 - INSERT TIBIAL CRUC RET SCORPIO SUPERFLEX BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0721 SUP Custom 27803010 72-26-0721 - INSERT TIBIAL 7 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0724 SUP Custom 27803010 72-26-0724 - INSERT TIBIAL 7 24MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0908 SUP Custom 27803010 72-26-0908 - INSERT TIBIAL 9 8MM POSTERIOR STABILIZE SCRPFLX X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0910 SUP Custom 27803010 72-26-0910 - INSERT TIBIAL 9 10MM CRUC RET SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0912 SUP Custom 27803010 72-26-0912 - INSERT TIBIAL 9 12MM CRUC RET SCORPIO SUPERFLEX POLYETHYLENE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0915 SUP Custom 27803010 72-26-0915 - INSERT TIBIAL 9 15MM CRUC RET SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0918 SUP Custom 27803010 72-26-0918 - INSERT TIBIAL 9 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0921 SUP Custom 27803010 72-26-0921 - INSERT TIBIAL 9 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-0924 SUP Custom 27803010 72-26-0924 - INSERT TIBIAL 9 24MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-1108 SUP Custom 27803010 72-26-1108 - INSERT TIBIAL 11 8MM CRUC RET SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-1110 SUP Custom 27803010 72-26-1110 - INSERT TIB 11 10MM SCRP SFLX CRCTE RTN KN BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-1112 SUP Custom 27803010 72-26-1112 - INSERT TIBIAL 11 12MM CRUC RET SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-1115 SUP Custom 27803010 72-26-1115 - INSERT TIBIAL CRUC RET SCRPFLX BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-1118 SUP Custom 27803010 72-26-1118 - INSERT TIBIAL 11 18MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-1121 SUP Custom 27803010 72-26-1121 - INSERT TIBIAL 11 21MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72-26-1124 SUP Custom 27803010 72-26-1124 - INSERT TIBIAL 11 24MM CRUC RET SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 72402408N SUP HCPCS C1713 72402408N - SCREW BONE 2.4MM 3.8MM 8MM EVOS MINI SS CORT ST T7 BOTH IP/OP $119.00 $88.00 $23.57 $118.75 $53.44 $53.44 $53.44 $53.44 $118.75 $118.75 $118.75 $24.75 $118.75 $118.75 $118.75 $118.75 $118.75 $24.75 $118.75 $31.02 $70.24 $118.75 $118.75 $118.75 $118.75 $89.25 $118.75 $118.75 $118.75 $59.38 $59.38 $94.05 $118.75 $95.00 $53.44 $23.57 N/A $69.02 $118.75 $118.75 $118.75 $24.75 $118.75 N/A N/A 72402409N SUP HCPCS C1713 72402409N - SCREW BONE 2.4MM 3.8MM 9MM EVOS MINI SS CORT ST T7 BOTH IP/OP $119.00 $88.00 $23.57 $118.75 $53.44 $53.44 $53.44 $53.44 $118.75 $118.75 $118.75 $24.75 $118.75 $118.75 $118.75 $118.75 $118.75 $24.75 $118.75 $31.02 $70.24 $118.75 $118.75 $118.75 $118.75 $89.25 $118.75 $118.75 $118.75 $59.38 $59.38 $94.05 $118.75 $95.00 $53.44 $23.57 N/A $69.02 $118.75 $118.75 $118.75 $24.75 $118.75 N/A N/A 72402410N SUP HCPCS C1713 72402410N - SCREW BONE 2.4MM 3.8MM 10MM EVOS MINI SS CORTEX T7 BOTH IP/OP $119.00 $88.00 $23.57 $118.75 $53.44 $53.44 $53.44 $53.44 $118.75 $118.75 $118.75 $24.75 $118.75 $118.75 $118.75 $118.75 $118.75 $24.75 $118.75 $31.02 $70.24 $118.75 $118.75 $118.75 $118.75 $89.25 $118.75 $118.75 $118.75 $59.38 $59.38 $94.05 $118.75 $95.00 $53.44 $23.57 N/A $69.02 $118.75 $118.75 $118.75 $24.75 $118.75 N/A N/A 72402420N SUP HCPCS C1713 72402420N - SCREW BONE 2.4MM 3.8MM 20MM EVOS SS 1.6MM SM BONE BOTH IP/OP $119.00 $88.00 $23.57 $118.75 $53.44 $53.44 $53.44 $53.44 $118.75 $118.75 $118.75 $24.75 $118.75 $118.75 $118.75 $118.75 $118.75 $24.75 $118.75 $77.55 $70.24 $118.75 $118.75 $118.75 $118.75 $89.25 $118.75 $118.75 $118.75 $59.38 $59.38 $94.05 $118.75 $95.00 $53.44 $23.57 N/A $69.02 $118.75 $118.75 $118.75 $24.75 $118.75 N/A N/A 72-4-0310 SUP Custom 27203010 72-4-0310 - TRIAL SURG 3 10MM INSERT TOT STABILITY CONSTRAINED SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $621.67 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $621.67 "$3,492.50" "$3,492.50" "$2,592.13" "$2,592.13" "$2,692.02" "$1,819.59" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$2,270.13" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 72-4-0312 SUP Custom 27203010 72-4-0312 - TRIAL SURG 3 12MM INSERT TOT STABILITY CONSTRAINED SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $621.67 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $621.67 "$3,492.50" "$3,492.50" "$2,592.13" "$2,592.13" "$2,692.02" "$1,819.59" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$2,270.13" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 72-4-0314 SUP Custom 27203010 72-4-0314 - TRIAL SURG 3 14MM INSERT TOT STABILITY CONSTRAINED SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $621.67 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $621.67 "$3,492.50" "$3,492.50" "$2,592.13" "$2,592.13" "$2,692.02" "$1,819.59" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$2,270.13" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 72-4-0316 SUP Custom 27203010 72-4-0316 - TRIAL SURG 3 16MM INSERT TOT STABILITY CONSTRAINED SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $621.67 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $621.67 "$3,492.50" "$3,492.50" "$2,592.13" "$2,592.13" "$2,692.02" "$1,819.59" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$2,270.13" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 72-4-0318 SUP Custom 27203010 72-4-0318 - INSERT TIBIAL 3 18MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $621.67 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $621.67 "$3,492.50" "$3,492.50" "$2,592.13" "$2,592.13" "$2,692.02" "$1,819.59" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$2,270.13" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 72-4-0321 SUP Custom 27203010 72-4-0321 - TRIAL SURG 3 21MM INSERT TOT STABILITY CONSTRAINED SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $621.67 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $621.67 "$3,492.50" "$3,492.50" "$2,592.13" "$2,592.13" "$2,692.02" "$1,819.59" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$2,270.13" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 72-4-0324 SUP HCPCS C1776 72-4-0324 - INSERT TIBIAL 3 24MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0510 SUP Custom 27203010 72-4-0510 - TRIAL SURG 5 10MM INSERT TOT STABILITY CONSTRAINED SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $621.67 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $621.67 "$3,492.50" "$3,492.50" "$2,592.13" "$2,592.13" "$2,692.02" "$1,819.59" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$2,270.13" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 72-4-0512 SUP Custom 27203010 72-4-0512 - INSERT TIBIAL 5 12MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $621.67 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $621.67 "$3,492.50" "$3,492.50" "$2,592.13" "$2,592.13" "$2,692.02" "$1,819.59" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$2,270.13" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 72-4-0514 SUP HCPCS C1776 72-4-0514 - INSERT TIBIAL 5 14MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0516 SUP HCPCS C1776 72-4-0516 - INSERT TIBIAL 5 16MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0518 SUP HCPCS C1776 72-4-0518 - INSERT TIBIAL 5 18MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0521 SUP HCPCS C1776 72-4-0521 - INSERT TIBIAL 5 21MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0524 SUP Custom 27203010 72-4-0524 - TRIAL SURG 5 24MM INSERT TOT STABILITY CONSTRAINED SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $621.67 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $621.67 "$3,492.50" "$3,492.50" "$2,592.13" "$2,592.13" "$2,692.02" "$1,819.59" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$2,270.13" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 72-4-0710 SUP HCPCS C1776 72-4-0710 - INSERT TIBIAL 7 10MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0712 SUP HCPCS C1776 72-4-0712 - INSERT TIBIAL 7 12MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0714 SUP HCPCS C1776 72-4-0714 - INSERT TIBIAL 7 14MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0716 SUP HCPCS C1776 72-4-0716 - INSERT TIBIAL 7 16MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0718 SUP HCPCS C1776 72-4-0718 - INSERT TIBIAL 7 18MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0721 SUP HCPCS C1776 72-4-0721 - INSERT TIBIAL 7 21MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0724 SUP HCPCS C1776 72-4-0724 - INSERT TIBIAL 7 24MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0910 SUP Custom 27203010 72-4-0910 - TRIAL SURG 9 10MM INSERT TOT STABILITY CONSTRAINED SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $621.67 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $621.67 "$3,492.50" "$3,492.50" "$2,592.13" "$2,592.13" "$2,692.02" "$1,819.59" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$2,270.13" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 72-4-0912 SUP HCPCS C1776 72-4-0912 - INSERT TIBIAL 9 12MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0914 SUP HCPCS C1776 72-4-0914 - INSERT TIBIAL 9 14MM CONSTRAINED TOT STABILIZED SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0916 SUP HCPCS C1776 72-4-0916 - INSERT TIBIAL 9 16MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0918 SUP HCPCS C1776 72-4-0918 - INSERT TIBIAL 9 18MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0921 SUP HCPCS C1776 72-4-0921 - INSERT TIBIAL 9 21MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-0924 SUP Custom 27203010 72-4-0924 - TRIAL SURG 9 24MM INSERT TOT STABILITY CONSTRAINED SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $621.67 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $621.67 "$3,492.50" "$3,492.50" "$2,592.13" "$2,592.13" "$2,692.02" "$1,819.59" $727.88 "$3,492.50" "$1,397.00" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$2,270.13" "$3,492.50" N/A "$2,025.65" "$3,492.50" "$2,095.50" "$3,492.50" "$3,492.50" "$3,492.50" N/A N/A 72-4-1110 SUP HCPCS C1776 72-4-1110 - INSERT TIBIAL 11 10MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-1112 SUP HCPCS C1776 72-4-1112 - INSERT TIBIAL 11 12MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-1114 SUP HCPCS C1776 72-4-1114 - INSERT TIBIAL 11 14MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-1116 SUP HCPCS C1776 72-4-1116 - INSERT TIBIAL 11 16MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-1118 SUP HCPCS C1776 72-4-1118 - INSERT TIBIAL 11 18MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-1121 SUP HCPCS C1776 72-4-1121 - INSERT TIBIAL 11 21MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-1124 SUP HCPCS C1776 72-4-1124 - INSERT TIBIAL 11 24MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72412410N SUP HCPCS C1713 72412410N - SCREW BONE 2.4MM 3.8MM 10MM EVOS SS LNG BONE SM BOTH IP/OP $382.50 $283.00 $75.92 $382.50 $172.13 $172.13 $172.13 $172.13 $382.50 $382.50 $382.50 $79.72 $382.50 $382.50 $382.50 $382.50 $382.50 $79.72 $382.50 $100.65 $226.25 $382.50 $382.50 $382.50 $382.50 $286.88 $382.50 $382.50 $382.50 $191.25 $191.25 $302.94 $382.50 $306.00 $172.13 $75.92 N/A $221.85 $382.50 $229.50 $382.50 $79.71 $382.50 N/A N/A 72-4-1910 SUP HCPCS C1776 72-4-1910 - INSERT TIBIAL 19 10MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-1912 SUP HCPCS C1776 72-4-1912 - INSERT TIBIAL 19 12MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-1914 SUP HCPCS C1776 72-4-1914 - INSERT TIBIAL 19 14MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-1916 SUP HCPCS C1776 72-4-1916 - INSERT TIBIAL 19 16MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-1918 SUP HCPCS C1776 72-4-1918 - INSERT TIBIAL 19 18MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-1921 SUP HCPCS C1776 72-4-1921 - INSERT TIBIAL 19 21MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-1924 SUP HCPCS C1776 72-4-1924 - INSERT TIBIAL 19 24MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-5710 SUP HCPCS C1776 72-4-5710 - INSERT TIBIAL 7 10MM TOT STABILIZE SCORPIO POLYETHYLENE KNEE BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-5712 SUP HCPCS C1776 72-4-5712 - INSERT TIBIAL 7 12MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-5714 SUP HCPCS C1776 72-4-5714 - INSERT TIBIAL 7 14MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-5716 SUP HCPCS C1776 72-4-5716 - INSERT TIBIAL 7 16MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-5718 SUP HCPCS C1776 72-4-5718 - INSERT TIBIAL 7 18MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-5721 SUP HCPCS C1776 72-4-5721 - INSERT TIBIAL 7 21MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-5724 SUP HCPCS C1776 72-4-5724 - INSERT TIBIAL 7 24MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-7512 SUP HCPCS C1776 72-4-7512 - INSERT TIBIAL 7F/5T 12MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-7514 SUP HCPCS C1776 72-4-7514 - INSERT TIBIAL 7F/5T 14MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-7516 SUP HCPCS C1776 72-4-7516 - INSERT TIBIAL 7F/5T 16MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-7518 SUP HCPCS C1776 72-4-7518 - INSERT TIBIAL 7F/5T 18MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-7521 SUP HCPCS C1776 72-4-7521 - INSERT TIBIAL 7F/5T 21MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-7524 SUP HCPCS C1776 72-4-7524 - INSERT TIBIAL 7F/5T 24MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-9110 SUP HCPCS C1776 72-4-9110 - INSERT TIBIAL 9F/11T 10MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-9112 SUP HCPCS C1776 72-4-9112 - INSERT TIBIAL 9F/11T 12MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-9114 SUP HCPCS C1776 72-4-9114 - INSERT TIBIAL 9F/11T 14MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-9116 SUP HCPCS C1776 72-4-9116 - INSERT TIBIAL 9F/11T 16MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-9118 SUP HCPCS C1776 72-4-9118 - INSERT TIBIAL 9F/11T 18MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-9121 SUP HCPCS C1776 72-4-9121 - INSERT TIBIAL 9F/11T 21MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$3,492.50" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-4-9124 SUP HCPCS C1776 72-4-9124 - INSERT TIBIAL 9F/11T 24MM CONSTRAIN TOT STABILIZE SCORPIO BOTH IP/OP "$3,492.50" "$2,584.00" $693.17 "$3,492.50" "$1,571.63" "$1,571.63" "$1,571.63" "$1,571.63" "$3,492.50" "$3,492.50" "$3,492.50" $727.92 "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" $727.88 "$3,492.50" "$1,397.00" "$1,721.80" "$3,492.50" "$3,492.50" "$3,492.50" "$3,492.50" "$2,619.38" "$3,492.50" "$3,492.50" "$3,492.50" "$1,746.25" "$1,746.25" "$2,766.06" "$3,492.50" "$2,794.00" "$1,571.63" $693.17 N/A "$2,025.65" "$3,492.50" "$3,492.50" "$3,492.50" $727.84 "$3,492.50" N/A N/A 72-5-0508 SUP Custom 27803010 72-5-0508 - INSERT TIBIAL 5 8MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-5-0510 SUP Custom 27803010 72-5-0510 - INSERT TIBIAL 5 10MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-5-0512 SUP Custom 27803010 72-5-0512 - INSERT TIBIAL 5 12MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-5-0515 SUP Custom 27803010 72-5-0515 - INSERT TIBIAL 5 15MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-5-0518 SUP Custom 27803010 72-5-0518 - INSERT TIBIAL 5 18MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-5-0521 SUP Custom 27803010 72-5-0521 - INSERT TIBIAL 5 21MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$2,013.00" "$1,490.00" $358.31 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" $358.31 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" $419.53 "$2,013.00" $805.20 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$1,509.75" "$2,013.00" "$2,013.00" "$2,013.00" "$1,006.50" "$1,006.50" "$1,594.30" "$2,013.00" "$1,610.40" $905.85 "$2,013.00" N/A "$1,167.54" "$2,013.00" "$1,207.80" "$2,013.00" "$2,013.00" "$2,013.00" N/A N/A 72-5-0524 SUP Custom 27803010 72-5-0524 - INSERT TIB 5 44X66X24MM SCRPFLX 1 AXIS PS PE KN BOTH IP/OP "$2,013.00" "$1,490.00" $358.31 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" $358.31 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" $419.53 "$2,013.00" $805.20 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$1,509.75" "$2,013.00" "$2,013.00" "$2,013.00" "$1,006.50" "$1,006.50" "$1,594.30" "$2,013.00" "$1,610.40" $905.85 "$2,013.00" N/A "$1,167.54" "$2,013.00" "$1,207.80" "$2,013.00" "$2,013.00" "$2,013.00" N/A N/A 72-5-0708 SUP Custom 27803010 72-5-0708 - INSERT TIBIAL 7 8MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-5-0710 SUP Custom 27803010 72-5-0710 - INSERT TIBIAL 7 10MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-5-0712 SUP Custom 27803010 72-5-0712 - INSERT TIBIAL 7 12MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-5-0715 SUP Custom 27803010 72-5-0715 - INSERT TIBIAL 7 15MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-5-0718 SUP Custom 27803010 72-5-0718 - INSERT TIBIAL 7 18MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-5-0721 SUP Custom 27803010 72-5-0721 - INSERT TIB 7 21MM SCRP SFLX POST STAB KN BOTH IP/OP "$2,013.00" "$1,490.00" $358.31 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" $358.31 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" $419.53 "$2,013.00" $805.20 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$1,509.75" "$2,013.00" "$2,013.00" "$2,013.00" "$1,006.50" "$1,006.50" "$1,594.30" "$2,013.00" "$1,610.40" $905.85 "$2,013.00" N/A "$1,167.54" "$2,013.00" "$1,207.80" "$2,013.00" "$2,013.00" "$2,013.00" N/A N/A 72-5-0724 SUP Custom 27803010 72-5-0724 - INSERT TIB 7 24MM SCRPFLX POST STAB X3 KN BOTH IP/OP "$2,013.00" "$1,490.00" $358.31 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" $358.31 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" $419.53 "$2,013.00" $805.20 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$1,509.75" "$2,013.00" "$2,013.00" "$2,013.00" "$1,006.50" "$1,006.50" "$1,594.30" "$2,013.00" "$1,610.40" $905.85 "$2,013.00" N/A "$1,167.54" "$2,013.00" "$1,207.80" "$2,013.00" "$2,013.00" "$2,013.00" N/A N/A 72-5-0908 SUP HCPCS C1776 72-5-0908 - COMPONENT TIBIAL 9 8MM POSTERIOR STABILIZE SCORPIO BOTH IP/OP "$1,930.00" "$1,428.00" $383.06 "$1,930.00" $868.50 $868.50 $868.50 $868.50 "$1,930.00" "$1,930.00" "$1,930.00" $402.26 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" "$1,930.00" "$1,141.60" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 $383.06 N/A "$1,119.40" "$1,930.00" "$1,930.00" "$1,930.00" $402.21 "$1,930.00" N/A N/A 72-5-0910 SUP Custom 27803010 72-5-0910 - INSERT TIBIAL 9 10MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-5-0912 SUP Custom 27803010 72-5-0912 - INSERT TIBIAL 9 12MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-5-0915 SUP Custom 27803010 72-5-0915 - INSERT TIBIAL 9 15MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-5-0918 SUP Custom 27803010 72-5-0918 - INSERT TIB 9 18MM SCRP SFLX POST STAB ARTC KN BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-5-0921 SUP Custom 27803010 72-5-0921 - INSERT TIB 9 21MM SCRP SFLX POST STAB ARTC KN BOTH IP/OP "$2,013.00" "$1,490.00" $358.31 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" $358.31 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" $419.53 "$2,013.00" $805.20 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$1,509.75" "$2,013.00" "$2,013.00" "$2,013.00" "$1,006.50" "$1,006.50" "$1,594.30" "$2,013.00" "$1,610.40" $905.85 "$2,013.00" N/A "$1,167.54" "$2,013.00" "$1,207.80" "$2,013.00" "$2,013.00" "$2,013.00" N/A N/A 72-5-0924 SUP Custom 27803010 72-5-0924 - INSERT TIB 9 24MM SCRP SFLX POST STAB KN BOTH IP/OP "$2,013.00" "$1,490.00" $358.31 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" $358.31 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" $419.53 "$2,013.00" $805.20 "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$2,013.00" "$1,509.75" "$2,013.00" "$2,013.00" "$2,013.00" "$1,006.50" "$1,006.50" "$1,594.30" "$2,013.00" "$1,610.40" $905.85 "$2,013.00" N/A "$1,167.54" "$2,013.00" "$1,207.80" "$2,013.00" "$2,013.00" "$2,013.00" N/A N/A 72-5-1110 SUP Custom 27803010 72-5-1110 - INSERT TIBIAL 11 10MM POSTERIOR STABILIZE SCORPIO SUPERFLEX BOTH IP/OP "$1,930.00" "$1,428.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $343.54 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" $402.23 "$1,930.00" $772.00 "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,930.00" "$1,447.50" "$1,930.00" "$1,930.00" "$1,930.00" $965.00 $965.00 "$1,528.56" "$1,930.00" "$1,544.00" $868.50 "$1,930.00" N/A "$1,119.40" "$1,930.00" "$1,158.00" "$1,930.00" "$1,930.00" "$1,930.00" N/A N/A 72-6-0515 SUP Custom 27803010 72-6-0515 - INSERT TIB 5 15MM SCRP SFLX CRCTE RTN KN BOTH IP/OP "$1,922.00" "$1,422.00" $342.12 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" $342.12 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" $400.57 "$1,922.00" $768.80 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,441.50" "$1,922.00" "$1,922.00" "$1,922.00" $961.00 $961.00 "$1,522.22" "$1,922.00" "$1,537.60" $864.90 "$1,922.00" N/A "$1,114.76" "$1,922.00" "$1,153.20" "$1,922.00" "$1,922.00" "$1,922.00" N/A N/A 72-6-0708 SUP Custom 27803010 72-6-0708 - INSERT TIBIAL 7 8MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,922.00" "$1,422.00" $342.12 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" $342.12 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" $400.57 "$1,922.00" $768.80 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,441.50" "$1,922.00" "$1,922.00" "$1,922.00" $961.00 $961.00 "$1,522.22" "$1,922.00" "$1,537.60" $864.90 "$1,922.00" N/A "$1,114.76" "$1,922.00" "$1,153.20" "$1,922.00" "$1,922.00" "$1,922.00" N/A N/A 72-6-0710 SUP Custom 27803010 72-6-0710 - INSERT TIBIAL 7 10MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,922.00" "$1,422.00" $342.12 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" $342.12 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" $400.57 "$1,922.00" $768.80 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,441.50" "$1,922.00" "$1,922.00" "$1,922.00" $961.00 $961.00 "$1,522.22" "$1,922.00" "$1,537.60" $864.90 "$1,922.00" N/A "$1,114.76" "$1,922.00" "$1,153.20" "$1,922.00" "$1,922.00" "$1,922.00" N/A N/A 72-6-0908 SUP Custom 27803010 72-6-0908 - INSERT TIBIAL 9 8MM CRUCIATE RETAIN SCORPIO SUPERFLEX KNEE BOTH IP/OP "$1,922.00" "$1,422.00" $342.12 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" $342.12 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" $400.57 "$1,922.00" $768.80 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,441.50" "$1,922.00" "$1,922.00" "$1,922.00" $961.00 $961.00 "$1,522.22" "$1,922.00" "$1,537.60" $864.90 "$1,922.00" N/A "$1,114.76" "$1,922.00" "$1,153.20" "$1,922.00" "$1,922.00" "$1,922.00" N/A N/A 72-6-1110 SUP Custom 27803010 72-6-1110 - INSERT TIB 11 10MM SCRP SFLX CRCTE RTN KN BOTH IP/OP "$1,922.00" "$1,422.00" $342.12 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" $342.12 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" $400.57 "$1,922.00" $768.80 "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,922.00" "$1,441.50" "$1,922.00" "$1,922.00" "$1,922.00" $961.00 $961.00 "$1,522.22" "$1,922.00" "$1,537.60" $864.90 "$1,922.00" N/A "$1,114.76" "$1,922.00" "$1,153.20" "$1,922.00" "$1,922.00" "$1,922.00" N/A N/A 72821012S SUP HCPCS C1713 72821012S - PLATE BN 20X11MM STRL VLP LT MDL LAT TALUS 2.5MM SCR BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 72821013S SUP HCPCS C1713 72821013S - PLATE BN 20X11MM STRL VLP RT MDL LAT TALUS 2.5MM SCR BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" "$2,062.50" "$2,062.50" N/A N/A 72821014S SUP HCPCS C1713 72821014S - PLATE BN 22X16MM STRL VLP 3 HL L/L TALUS 2.5MM SCR BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 72821015S SUP HCPCS C1713 72821015S - PLATE BN 22X16MM STRL VLP 3 HL RL TALUS 2.5MM SCR BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" "$2,062.50" "$2,062.50" N/A N/A 72821016S SUP HCPCS C1713 72821016S - PLATE BN 25X16MM STRL VLP 4 HL L/L TALUS 2.5MM SCR BOTH IP/OP "$2,275.00" "$1,684.00" $451.53 "$2,275.00" "$1,023.75" "$1,023.75" "$1,023.75" "$1,023.75" "$2,275.00" "$2,275.00" "$2,275.00" $474.17 "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" $474.14 "$2,275.00" $910.00 "$1,345.66" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$1,706.25" "$2,275.00" "$2,275.00" "$2,275.00" "$1,137.50" "$1,137.50" "$1,801.80" "$2,275.00" "$1,820.00" "$1,023.75" $451.53 N/A "$1,319.50" "$2,275.00" "$2,275.00" "$2,275.00" $474.11 "$2,275.00" N/A N/A 72821017S SUP HCPCS C1713 72821017S - PLATE BN 25X16MM STRL VLP 4 HL RL TALUS FT 2.5MM SCR BOTH IP/OP "$2,275.00" "$1,684.00" $451.53 "$2,275.00" "$1,023.75" "$1,023.75" "$1,023.75" "$1,023.75" "$2,275.00" "$2,275.00" "$2,275.00" $474.17 "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" $474.14 "$2,275.00" $910.00 "$1,345.66" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$1,706.25" "$2,275.00" "$2,275.00" "$2,275.00" "$1,137.50" "$1,137.50" "$1,801.80" "$2,275.00" "$1,820.00" "$1,023.75" $451.53 N/A "$1,319.50" "$2,275.00" "$1,365.00" "$2,275.00" $474.11 "$2,275.00" N/A N/A 72821018S SUP HCPCS C1713 72821018S - PLATE BN SM 55MM STRL VLP LT CALCANEUS FT 2.7MM SCR PERC BOTH IP/OP "$2,306.50" "$1,707.00" $457.73 "$2,306.25" "$1,037.81" "$1,037.81" "$1,037.81" "$1,037.81" "$2,306.25" "$2,306.25" "$2,306.25" $480.68 "$2,306.25" "$2,306.25" "$2,306.25" "$2,306.25" "$2,306.25" $480.65 "$2,306.25" $922.50 "$1,364.15" "$2,306.25" "$2,306.25" "$2,306.25" "$2,306.25" "$1,729.88" "$2,306.25" "$2,306.25" "$2,306.25" "$1,153.13" "$1,153.13" "$1,826.55" "$2,306.25" "$1,845.00" "$1,037.81" $457.73 N/A "$1,337.77" "$2,306.25" "$1,383.75" "$2,306.25" "$2,306.25" "$2,306.25" N/A N/A 72821019S SUP HCPCS C1713 72821019S - PLATE BN SM 55MM STRL VLP RT CALCANEUS 2.7MM SCR PERC BOTH IP/OP "$2,306.50" "$1,707.00" $457.73 "$2,306.25" "$1,037.81" "$1,037.81" "$1,037.81" "$1,037.81" "$2,306.25" "$2,306.25" "$2,306.25" $480.68 "$2,306.25" "$2,306.25" "$2,306.25" "$2,306.25" "$2,306.25" $480.65 "$2,306.25" "$2,306.25" "$1,364.15" "$2,306.25" "$2,306.25" "$2,306.25" "$2,306.25" "$1,729.88" "$2,306.25" "$2,306.25" "$2,306.25" "$1,153.13" "$1,153.13" "$1,826.55" "$2,306.25" "$1,845.00" "$1,037.81" $457.73 N/A "$1,337.77" "$2,306.25" "$1,383.75" "$2,306.25" $480.62 "$2,306.25" N/A N/A 72821020S SUP HCPCS C1713 72821020S - PLATE BN LG 62 STRL VLP LT CALCANEUS FT 2.7MM SCR PERC BOTH IP/OP "$2,512.50" "$1,859.00" $498.67 "$2,512.50" "$1,130.63" "$1,130.63" "$1,130.63" "$1,130.63" "$2,512.50" "$2,512.50" "$2,512.50" $523.67 "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" $523.63 "$2,512.50" "$2,512.50" "$1,238.66" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$1,884.38" "$2,512.50" "$2,512.50" "$2,512.50" "$1,256.25" "$1,256.25" "$1,989.90" "$2,512.50" "$2,010.00" "$1,130.63" $498.67 N/A "$1,457.25" "$2,512.50" "$1,507.50" "$2,512.50" "$2,512.50" "$2,512.50" N/A N/A 72821021S SUP HCPCS C1713 72821021S - PLATE BN LG 62 STRL VLP RT CALCANEUS FT 2.7MM SCR PERC BOTH IP/OP "$2,512.50" "$1,859.00" $498.67 "$2,512.50" "$1,130.63" "$1,130.63" "$1,130.63" "$1,130.63" "$2,512.50" "$2,512.50" "$2,512.50" $523.67 "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" $523.63 "$2,512.50" "$1,005.00" "$1,238.66" "$2,512.50" "$2,512.50" "$2,512.50" "$2,512.50" "$1,884.38" "$2,512.50" "$2,512.50" "$2,512.50" "$1,256.25" "$1,256.25" "$1,989.90" "$2,512.50" "$2,010.00" "$1,130.63" $498.67 N/A "$1,457.25" "$2,512.50" "$1,507.50" "$2,512.50" $523.61 "$2,512.50" N/A N/A 72821022S SUP HCPCS C1713 72821022S - PLATE BN 67MM STRL 3 HL FSN PRM RT ANT ANKL 3.5MM SCR BOTH IP/OP "$2,375.00" "$1,758.00" $471.38 "$2,375.00" "$1,068.75" "$1,068.75" "$1,068.75" "$1,068.75" "$2,375.00" "$2,375.00" "$2,375.00" $495.01 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" "$2,375.00" "$1,404.81" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" $471.38 N/A "$1,377.50" "$2,375.00" "$2,375.00" "$2,375.00" $494.95 "$2,375.00" N/A N/A 72821023S SUP HCPCS C1713 72821023S - PLATE BN 67MM STRL 3 HL FSN PRM LT ANT ANKL 3.5MM SCR BOTH IP/OP "$2,375.00" "$1,758.00" $471.38 "$2,375.00" "$1,068.75" "$1,068.75" "$1,068.75" "$1,068.75" "$2,375.00" "$2,375.00" "$2,375.00" $495.01 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" "$2,375.00" "$1,404.81" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" $471.38 N/A "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" $494.95 "$2,375.00" N/A N/A 72821024S SUP HCPCS C1713 72821024S - PLATE BN 92MM STRL 5 HL FSN PRM RT ANT ANKL 3.5MM SCR BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$1,462.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A 72821025S SUP HCPCS C1713 72821025S - PLATE BN 92MM STRL 5 HL FSN PRM LT ANT ANKL 3.5MM SCR BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$1,462.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A 72821026S SUP HCPCS C1713 72821026S - PLATE BN 79MM STRL 3 HL FSN UTL RT ANKL HINDFOOT 3.5MM SCR BOTH IP/OP "$2,575.00" "$1,906.00" $511.07 "$2,575.00" "$1,158.75" "$1,158.75" "$1,158.75" "$1,158.75" "$2,575.00" "$2,575.00" "$2,575.00" $536.69 "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" $536.66 "$2,575.00" "$2,575.00" "$1,269.48" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$1,931.25" "$2,575.00" "$2,575.00" "$2,575.00" "$1,287.50" "$1,287.50" "$2,039.40" "$2,575.00" "$2,060.00" "$1,158.75" $511.07 N/A "$1,493.50" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" N/A N/A 72821027S SUP HCPCS C1713 72821027S - PLATE BN 79MM STRL 3 HL FSN UTL LT ANKL HINDFOOT 3.5MM SCR BOTH IP/OP "$2,575.00" "$1,906.00" $511.07 "$2,575.00" "$1,158.75" "$1,158.75" "$1,158.75" "$1,158.75" "$2,575.00" "$2,575.00" "$2,575.00" $536.69 "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" $536.66 "$2,575.00" "$2,575.00" "$1,269.48" "$2,575.00" "$2,575.00" "$2,575.00" "$2,575.00" "$1,931.25" "$2,575.00" "$2,575.00" "$2,575.00" "$1,287.50" "$1,287.50" "$2,039.40" "$2,575.00" "$2,060.00" "$1,158.75" $511.07 N/A "$1,493.50" "$2,575.00" "$1,545.00" "$2,575.00" "$2,575.00" "$2,575.00" N/A N/A 72821028S SUP HCPCS C1713 72821028S - PLATE BN 5 FSN UTL RT ANKL HINDFOOT 3.5MM SCR BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 72821029S SUP HCPCS C1713 72821029S - PLATE BN 79MM STRL 5 HL FSN UTL LT ANKL HINDFOOT 3.5MM SCR BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 72821030S SUP HCPCS C1713 72821030S - PLATE BN 120MM STRL PRLC FSN RL TIB TALOCALCANEUS ANKL 4.5MM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" $975.00 "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A 72821031S SUP HCPCS C1713 72821031S - PLATE BN 120MM STRL PRLC FSN L/L TIB TALOCALCANEUS ANKL 4.5 BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" $975.00 "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A 72821034S SUP HCPCS C1713 72821034S - PLATE BN 80MMX3.8-5.3MM STRL PRLC FSN RT POST ANKL 3.5MM SCR BOTH IP/OP "$2,375.00" "$1,758.00" $471.38 "$2,375.00" "$1,068.75" "$1,068.75" "$1,068.75" "$1,068.75" "$2,375.00" "$2,375.00" "$2,375.00" $495.01 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" $950.00 "$1,404.81" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" $471.38 N/A "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" $494.95 "$2,375.00" N/A N/A 72821035S SUP HCPCS C1713 72821035S - PLATE BN 80MM STRL PRLC FSN LT POST ANKL 3.5MM SCR SM FRAG BOTH IP/OP "$2,375.00" "$1,758.00" $471.38 "$2,375.00" "$1,068.75" "$1,068.75" "$1,068.75" "$1,068.75" "$2,375.00" "$2,375.00" "$2,375.00" $495.01 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" "$2,375.00" "$1,404.81" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" $471.38 N/A "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" $494.95 "$2,375.00" N/A N/A 72821036S SUP HCPCS C1713 72821036S - PLATE BONE MEDIUM 58MM VLP LEFT CALCANEUS FT STERILE 2.7MM BOTH IP/OP "$2,400.00" "$1,776.00" $476.34 "$2,400.00" "$1,080.00" "$1,080.00" "$1,080.00" "$1,080.00" "$2,400.00" "$2,400.00" "$2,400.00" $500.22 "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" $500.19 "$2,400.00" "$2,400.00" "$1,419.60" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$1,800.00" "$2,400.00" "$2,400.00" "$2,400.00" "$1,200.00" "$1,200.00" "$1,900.80" "$2,400.00" "$1,920.00" "$1,080.00" $476.34 N/A "$1,392.00" "$2,400.00" "$1,440.00" "$2,400.00" $500.16 "$2,400.00" N/A N/A 72821037S SUP HCPCS C1713 72821037S - PLATE BN MED 58MM STRL VLP RT CALCANEUS FT 2.7MM SCR PERC BOTH IP/OP "$2,400.00" "$1,776.00" $476.34 "$2,400.00" "$1,080.00" "$1,080.00" "$1,080.00" "$1,080.00" "$2,400.00" "$2,400.00" "$2,400.00" $500.22 "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" $500.19 "$2,400.00" $960.00 "$1,419.60" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$1,800.00" "$2,400.00" "$2,400.00" "$2,400.00" "$1,200.00" "$1,200.00" "$1,900.80" "$2,400.00" "$1,920.00" "$1,080.00" $476.34 N/A "$1,392.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" "$2,400.00" N/A N/A 72821040S SUP HCPCS C1713 72821040S - PLATE BN 20X17MM STRL VLP LT MDL LAT TALUS TIB 2.5MM SCR BOTH IP/OP "$2,275.00" "$1,684.00" $451.53 "$2,275.00" "$1,023.75" "$1,023.75" "$1,023.75" "$1,023.75" "$2,275.00" "$2,275.00" "$2,275.00" $474.17 "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" $474.14 "$2,275.00" $910.00 "$1,345.66" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$1,706.25" "$2,275.00" "$2,275.00" "$2,275.00" "$1,137.50" "$1,137.50" "$1,801.80" "$2,275.00" "$1,820.00" "$1,023.75" $451.53 N/A "$1,319.50" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" N/A N/A 72821041S SUP HCPCS C1713 72821041S - PLATE BN 20X17MM STRL VLP RT DIST MDL TALUS 2.5MM SCR BOTH IP/OP "$2,275.00" "$1,684.00" $451.53 "$2,275.00" "$1,023.75" "$1,023.75" "$1,023.75" "$1,023.75" "$2,275.00" "$2,275.00" "$2,275.00" $474.17 "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" $474.14 "$2,275.00" $910.00 "$1,345.66" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$1,706.25" "$2,275.00" "$2,275.00" "$2,275.00" "$1,137.50" "$1,137.50" "$1,801.80" "$2,275.00" "$1,820.00" "$1,023.75" $451.53 N/A "$1,319.50" "$2,275.00" "$1,365.00" "$2,275.00" "$2,275.00" "$2,275.00" N/A N/A 72821042S SUP HCPCS C1713 72821042S - PLATE BN 67MM STRL PRLC 3 HL FSN PRM CMPR SLOT ANKL RT ANT BOTH IP/OP "$2,375.00" "$1,758.00" $471.38 "$2,375.00" "$1,068.75" "$1,068.75" "$1,068.75" "$1,068.75" "$2,375.00" "$2,375.00" "$2,375.00" $495.01 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" "$2,375.00" "$1,404.81" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" $471.38 N/A "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" $494.95 "$2,375.00" N/A N/A 72821043S SUP HCPCS C1713 72821043S - PLATE BN 67MM STRL PRLC 3 HL FSN PRM CMPR SLOT ANKL LT ANT BOTH IP/OP "$2,375.00" "$1,758.00" $471.38 "$2,375.00" "$1,068.75" "$1,068.75" "$1,068.75" "$1,068.75" "$2,375.00" "$2,375.00" "$2,375.00" $495.01 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" "$2,375.00" "$1,404.81" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" $471.38 N/A "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" "$2,375.00" "$2,375.00" N/A N/A 72821044S SUP HCPCS C1713 72821044S - PLATE BN 92MM STRL ANCHORAGE 5 HL PRM FSN CMPR RT ANT BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" N/A N/A 72821045S SUP HCPCS C1713 72821045S - PLATE BN 92MM STRL PRLC 5 HL FSN PRM CMPR SLOT ANKL LT 3.5MM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$1,462.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A 72821046S SUP HCPCS C1713 72821046S - PLATE BN 5 FSN UTL CMPR RT ANKL HINDFOOT 3.5MM SCR BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 72821047S SUP HCPCS C1713 72821047S - PLATE BN 104MM STRL PER-LOC 5 HL FSN UTL CMPR SLOT LT BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A 72821048S SUP HCPCS C1713 72821048S - PLATE BN XL 68X33.5X1.27MM STRL VLP VA FT LT CALCANEUS PERC BOTH IP/OP "$2,606.50" "$1,929.00" $517.28 "$2,606.25" "$1,172.81" "$1,172.81" "$1,172.81" "$1,172.81" "$2,606.25" "$2,606.25" "$2,606.25" $543.21 "$2,606.25" "$2,606.25" "$2,606.25" "$2,606.25" "$2,606.25" $543.17 "$2,606.25" "$1,042.50" "$1,284.88" "$2,606.25" "$2,606.25" "$2,606.25" "$2,606.25" "$1,954.88" "$2,606.25" "$2,606.25" "$2,606.25" "$1,303.13" "$1,303.13" "$2,064.15" "$2,606.25" "$2,085.00" "$1,172.81" $517.28 N/A "$1,511.77" "$2,606.25" "$1,563.75" "$2,606.25" "$2,606.25" "$2,606.25" N/A N/A 72821049S SUP HCPCS C1713 72821049S - PLATE BN XL 68MM VLP RT CALCANEUS FT 2.7MM SCR PERC BOTH IP/OP "$2,606.50" "$1,929.00" $517.28 "$2,606.25" "$1,172.81" "$1,172.81" "$1,172.81" "$1,172.81" "$2,606.25" "$2,606.25" "$2,606.25" $543.21 "$2,606.25" "$2,606.25" "$2,606.25" "$2,606.25" "$2,606.25" $543.17 "$2,606.25" "$1,042.50" "$1,284.88" "$2,606.25" "$2,606.25" "$2,606.25" "$2,606.25" "$1,954.88" "$2,606.25" "$2,606.25" "$2,606.25" "$1,303.13" "$1,303.13" "$2,064.15" "$2,606.25" "$2,085.00" "$1,172.81" $517.28 N/A "$1,511.77" "$2,606.25" "$2,606.25" "$2,606.25" "$2,606.25" "$2,606.25" N/A N/A 72822206S SUP HCPCS C1713 72822206S - SCREW BN 2.5MM 6MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $171.75 $286.25 $59.65 $286.25 N/A N/A 72822208S SUP HCPCS C1713 72822208S - SCREW BN 2.5MM 8MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72822210S SUP HCPCS C1713 72822210S - SCREW BN 2.5MM 10MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $171.75 $286.25 $59.65 $286.25 N/A N/A 72822212S SUP HCPCS C1713 72822212S - SCREW BN 2.5MM 12MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $171.75 $286.25 $59.65 $286.25 N/A N/A 72822214S SUP HCPCS C1713 72822214S - SCREW BN 2.5MM 14MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $171.75 $286.25 $59.65 $286.25 N/A N/A 72822216S SUP HCPCS C1713 72822216S - SCREW BN 2.5MM 16MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72822218S SUP HCPCS C1713 72822218S - SCREW BN 2.5MM 18MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72822220S SUP HCPCS C1713 72822220S - SCREW BN 2.5MM 20MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72822222S SUP HCPCS C1713 72822222S - SCREW BN 2.5MM 22MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72822224S SUP HCPCS C1713 72822224S - SCREW BN 2.5MM 24MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72822226S SUP HCPCS C1713 72822226S - SCREW BN 2.5MM 26MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72822228S SUP HCPCS C1713 72822228S - SCREW BN 2.5MM 28MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72822230S SUP HCPCS C1713 72822230S - SCREW BN 2.5MM 30MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72822232S SUP HCPCS C1713 72822232S - SCREW BN 2.5MM 32MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $171.75 $286.25 $59.65 $286.25 N/A N/A 72822234S SUP HCPCS C1713 72822234S - SCREW BN 2.5MM 34MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $171.75 $286.25 $59.65 $286.25 N/A N/A 72822236S SUP HCPCS C1713 72822236S - SCREW BN 2.5MM 36MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $171.75 $286.25 $59.65 $286.25 N/A N/A 72822238S SUP HCPCS C1713 72822238S - SCREW BN 2.5MM 38MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72822240S SUP HCPCS C1713 72822240S - SCREW BN 2.5MM 40MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72822245S SUP HCPCS C1713 72822245S - SCREW BN 2.5MM 45MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72822250S SUP HCPCS C1713 72822250S - SCREW BN 2.5MM 50MM STRL VLP ST T7 STRDR RCS FT BOTH IP/OP $286.50 $212.00 $56.81 $286.25 $128.81 $128.81 $128.81 $128.81 $286.25 $286.25 $286.25 $59.66 $286.25 $286.25 $286.25 $286.25 $286.25 $59.66 $286.25 $114.50 $169.32 $286.25 $286.25 $286.25 $286.25 $214.88 $286.25 $286.25 $286.25 $143.13 $143.13 $226.71 $286.25 $229.00 $128.81 $56.81 N/A $166.17 $286.25 $286.25 $286.25 $59.65 $286.25 N/A N/A 72823003S SUP HCPCS C1713 72823003S - PLATE BN STRL PRLC VLP 3 HL 1/3 TBLR 3.5 MM SCR BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $227.25 $227.25 $227.25 $227.25 $505.00 $505.00 $505.00 $105.25 $505.00 $505.00 $505.00 $505.00 $505.00 $105.25 $505.00 $202.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $227.25 $100.23 N/A $292.90 $505.00 $303.00 $505.00 $105.24 $505.00 N/A N/A 72823004S SUP HCPCS C1713 72823004S - PLATE BN 1/3 TBLR STRL PRLC VLP 4 HL 3.5MM SCR BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $227.25 $227.25 $227.25 $227.25 $505.00 $505.00 $505.00 $105.25 $505.00 $505.00 $505.00 $505.00 $505.00 $105.25 $505.00 $202.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $227.25 $100.23 N/A $292.90 $505.00 $303.00 $505.00 $105.24 $505.00 N/A N/A 72823106S SUP HCPCS C1713 72823106S - SCREW BN ST 2.7MM 6MM STRL VLP LCK CORT FT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823108S SUP HCPCS C1713 72823108S - SCREW BN ST 2.7MM 8MM STRL VLP ST LCK FT CORT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $297.50 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823110S SUP HCPCS C1713 72823110S - SCREW BN 5MM 38MM VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823112S SUP HCPCS C1713 72823112S - SCREW BN 2.7MM 12MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $297.50 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823114S SUP HCPCS C1713 72823114S - SCREW BN 2.7MM 14MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $297.50 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823116S SUP HCPCS C1713 72823116S - SCREW BN 2.7MM 16MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823118S SUP HCPCS C1713 72823118S - SCREW BN 2.7MM 18MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $297.50 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823120S SUP HCPCS C1713 72823120S - SCREW BN 2.7MM 20MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823122S SUP HCPCS C1713 72823122S - SCREW BN 2.7MM 22MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $297.50 $297.50 N/A N/A 72823124S SUP HCPCS C1713 72823124S - SCREW BN 2.7MM 24MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $297.50 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823126S SUP HCPCS C1713 72823126S - SCREW BN 2.7MM 26MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823128S SUP HCPCS C1713 72823128S - SCREW BN 2.7MM 28MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $297.50 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823130S SUP HCPCS C1713 72823130S - SCREW BN 2.7MM 30MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $297.50 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823132S SUP HCPCS C1713 72823132S - SCREW BN 2.7MM 32MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $297.50 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $297.50 $297.50 N/A N/A 72823134S SUP HCPCS C1713 72823134S - SCREW BN 2.7MM 34MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823136S SUP HCPCS C1713 72823136S - SCREW BN 2.7MM 36MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $297.50 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823138S SUP HCPCS C1713 72823138S - SCREW BN 2.7MM 38MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823140S SUP HCPCS C1713 72823140S - SCREW BN 2.7MM 40MM STRL VLP ST LCK CORT FOREFOOT MIDFOOT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $297.50 $297.50 N/A N/A 72823142S SUP HCPCS C1713 72823142S - SCREW BN 3 FLUT 2.7MM 4.9MM 42MM STRL VLP ST LCK CORT FT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $297.50 $297.50 N/A N/A 72823144S SUP HCPCS C1713 72823144S - SCREW BN 3 FLUT LOPRFL 2.7MM 4.9MM 44MM STRL VLP ST LCK CORT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $297.50 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823146S SUP HCPCS C1713 72823146S - SCREW BN 3 FLUT LOPRFL 2.7MM 4.9MM 46MM STRL VLP ST LCK CORT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823148S SUP HCPCS C1713 72823148S - SCREW BN 3 FLUT LOPRFL 2.7MM 4.9MM 48MM STRL VLP ST LCK CORT BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $297.50 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823150S SUP HCPCS C1713 72823150S - SCREW BN 2.7MM 4.9MM 50MM STRL VLP 3 FLT ST LCK FT CORT PERC BOTH IP/OP $297.50 $220.00 $59.05 $297.50 $133.88 $133.88 $133.88 $133.88 $297.50 $297.50 $297.50 $62.01 $297.50 $297.50 $297.50 $297.50 $297.50 $62.00 $297.50 $119.00 $175.97 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $133.88 $59.05 N/A $172.55 $297.50 $297.50 $297.50 $62.00 $297.50 N/A N/A 72823206S SUP HCPCS C1713 72823206S - SCREW BN FT 4MM 6MM STRL VLP FT OSTEOPENIA BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $60.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 72823208S SUP HCPCS C1713 72823208S - SCREW BN FT 4MM 8MM STRL VLP FT OSTEOPENIA BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $60.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A 72823210S SUP HCPCS C1713 72823210S - SCREW BN 4MM 10MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823212S SUP HCPCS C1713 72823212S - SCREW BN 4MM 12MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823214S SUP HCPCS C1713 72823214S - SCREW BN 4MM 14MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823216S SUP HCPCS C1713 72823216S - SCREW BN 4MM 16MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823218S SUP HCPCS C1713 72823218S - SCREW BN 4MM 18MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823220S SUP HCPCS C1713 72823220S - SCREW BN 4MM 20MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823222S SUP HCPCS C1713 72823222S - SCREW BN 4MM 22MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823224S SUP HCPCS C1713 72823224S - SCREW BN 4MM 24MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823226S SUP HCPCS C1713 72823226S - SCREW BN 4MM 26MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823228S SUP HCPCS C1713 72823228S - SCREW BN 4MM 28MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823230S SUP HCPCS C1713 72823230S - SCREW BN 4MM 30MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $91.50 $152.50 $31.78 $152.50 N/A N/A 72823232S SUP HCPCS C1713 72823232S - SCREW BN 4MM 32MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $91.50 $152.50 $31.78 $152.50 N/A N/A 72823234S SUP HCPCS C1713 72823234S - SCREW BN 4MM 34MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $91.50 $152.50 $31.78 $152.50 N/A N/A 72823236S SUP HCPCS C1713 72823236S - SCREW BN 4MM 36MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $91.50 $152.50 $31.78 $152.50 N/A N/A 72823238S SUP HCPCS C1713 72823238S - SCREW BN FT 4MM 38MM STRL VLP FT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $91.50 $152.50 $31.78 $152.50 N/A N/A 72823240S SUP HCPCS C1713 72823240S - SCREW BN 4MM 40MM STRL VLP FT FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $91.50 $152.50 $31.78 $152.50 N/A N/A 72823242S SUP HCPCS C1713 72823242S - SCREW BN FT 4MM 5MM 42MM STRL VLP FT OSTEOPENIA PERC BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $91.50 $152.50 $31.78 $152.50 N/A N/A 72823244S SUP HCPCS C1713 72823244S - SCREW BN FT 4MM 5MM 44MM STRL VLP FT OSTEOPENIA PERC BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823246S SUP HCPCS C1713 72823246S - SCREW BN FT LOPRFL 4MM 5MM 46MM STRL VLP FT OSTEOPENIA PERC BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823248S SUP HCPCS C1713 72823248S - SCREW BN FT LOPRFL 4MM 5MM 48MM STRL VLP FT OSTEOPENIA PERC BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823250S SUP HCPCS C1713 72823250S - SCREW BN FT LOPRFL 4MM 5MM 50MM STRL VLP FT OSTEOPENIA PERC BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823326S SUP HCPCS C1713 72823326S - SCREW BN 4MM 26MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823328S SUP HCPCS C1713 72823328S - SCREW BN 4MM 28MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823330S SUP HCPCS C1713 72823330S - SCREW BN 4MM 30MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823332S SUP HCPCS C1713 72823332S - SCREW BN 4MM 32MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823334S SUP HCPCS C1713 72823334S - SCREW BN 4MM 34MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823336S SUP HCPCS C1713 72823336S - SCREW BN 4MM 36MM STRL VLP P/T FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823338S SUP HCPCS C1713 72823338S - SCREW BN P/T 4MM 5MM 38MMX2.5MM STRL 14MM VLP FOREFOOT BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823340S SUP HCPCS C1713 72823340S - SCREW BN P/T 4MM 5MM 40MMX2.5MM STRL 14MM VLP FOREFOOT BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823342S SUP HCPCS C1713 72823342S - SCREW BN P/T LOPRFL 4MM 5MM 42MM STRL VLP FT OSTEOPENIA PERC BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823344S SUP HCPCS C1713 72823344S - SCREW BN P/T LOPRFL 4MM 5MM 44MM STRL VLP FT OSTEOPENIA PERC BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823346S SUP HCPCS C1713 72823346S - SCREW BN P/T LOPRFL 4MM 5MM 46MM STRL VLP FT OSTEOPENIA PERC BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823348S SUP HCPCS C1713 72823348S - SCREW BN P/T LOPRFL 4MM 5MM 48MM STRL VLP FT OSTEOPENIA PERC BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $91.50 $152.50 $31.78 $152.50 N/A N/A 72823350S SUP HCPCS C1713 72823350S - SCREW BN P/T LOPRFL 4MM 5MM 50MM STRL VLP FT OSTEOPENIA PERC BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 72823406S SUP HCPCS C1713 72823406S - SCREW BN 4MM 6MM STRL VLP LCK FT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823408S SUP HCPCS C1713 72823408S - SCREW BN 4MM 8MM STRL VLP LCK FT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823410S SUP HCPCS C1713 72823410S - SCREW BN 4MM 10MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823412S SUP HCPCS C1713 72823412S - SCREW BN 4MM 12MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $425.00 $425.00 N/A N/A 72823414S SUP HCPCS C1713 72823414S - SCREW BN 4MM 14MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 72823416S SUP HCPCS C1713 72823416S - SCREW BN 4MM 16MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823418S SUP HCPCS C1713 72823418S - SCREW BN 4MM 18MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $425.00 $425.00 N/A N/A 72823420S SUP HCPCS C1713 72823420S - SCREW BN 4MM 20MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 72823422S SUP HCPCS C1713 72823422S - SCREW BN 4MM 22MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823424S SUP HCPCS C1713 72823424S - SCREW BN 4MM 24MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $425.00 $425.00 N/A N/A 72823426S SUP HCPCS C1713 72823426S - SCREW BN 4MM 26MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823428S SUP HCPCS C1713 72823428S - SCREW BN 4MM 28MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $425.00 $425.00 N/A N/A 72823430S SUP HCPCS C1713 72823430S - SCREW BN 4MM 30MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 72823432S SUP HCPCS C1713 72823432S - SCREW BN 4MM 32MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823434S SUP HCPCS C1713 72823434S - SCREW BN 4MM 34MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823436S SUP HCPCS C1713 72823436S - SCREW BN 4MM 36MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823438S SUP HCPCS C1713 72823438S - SCREW BN 4MM 38MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823440S SUP HCPCS C1713 72823440S - SCREW BN 4MM 40MM STRL VLP LCK FOREFOOT MIDFOOT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823442S SUP HCPCS C1713 72823442S - SCREW BN 4MM 4.9MM 42MM STRL VLP LCK FT OSTEOPENIA PERC BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $425.00 $425.00 N/A N/A 72823444S SUP HCPCS C1713 72823444S - SCREW BN LOPRFL 4MM 4.9MM 44MM STRL VLP LCK FT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $425.00 $425.00 N/A N/A 72823446S SUP HCPCS C1713 72823446S - SCREW BN LOPRFL 4MM 4.9MM 46MM STRL VLP LCK FT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 72823448S SUP HCPCS C1713 72823448S - SCREW BN LOPRFL 4MM 4.9MM 48MM STRL VLP LCK FT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823450S SUP HCPCS C1713 72823450S - SCREW BN LOPRFL 4MM 4.9MM 50MM STRL VLP LCK FT OSTEOPENIA BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 72823510S SUP HCPCS C1713 72823510S - SCREW BN 15D 2.5MM 5MM 5.4MM 10MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823512S SUP HCPCS C1713 72823512S - SCREW BN 15D 2.5MM 5MM 5.4MM 12MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823514S SUP HCPCS C1713 72823514S - SCREW BN 15D 2.5MM 5MM 5.4MM 14MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823516S SUP HCPCS C1713 72823516S - SCREW BN 15D 2.5MM 5MM 5.4MM 16MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 72823518S SUP HCPCS C1713 72823518S - SCREW BN 15D 2.5MM 5MM 5.4MM 18MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823520S SUP HCPCS C1713 72823520S - SCREW BN 15D 2.5MM 5MM 5.4MM 20MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823522S SUP HCPCS C1713 72823522S - SCREW BN 15D 2.5MM 5MM 5.4MM 22MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823524S SUP HCPCS C1713 72823524S - SCREW BN 15D 2.5MM 5MM 5.4MM 24MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823526S SUP HCPCS C1713 72823526S - SCREW BN 15D 2.5MM 5MM 5.4MM 26MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823528S SUP HCPCS C1713 72823528S - SCREW BN 15D 2.5MM 5MM 5.4MM 28MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823530S SUP HCPCS C1713 72823530S - SCREW BN 15D 2.5MM 5MM 5.4MM 30MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823532S SUP HCPCS C1713 72823532S - SCREW BN 15D 2.5MM 5MM 5.4MM 32MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823534S SUP HCPCS C1713 72823534S - SCREW BN 15D 2.5MM 5MM 5.4MM 34MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823536S SUP HCPCS C1713 72823536S - SCREW BN 15D 2.5MM 5MM 5.4MM 36MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823538S SUP HCPCS C1713 72823538S - SCREW BN 15D 2.5MM 5MM 5.4MM 38MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A 72823540S SUP HCPCS C1713 72823540S - SCREW BN 15D 2.5MM 5MM 5.4MM 40MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823542S SUP HCPCS C1713 72823542S - SCREW BN 15D 2.5MM 5MM 5.4MM 42MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823544S SUP HCPCS C1713 72823544S - SCREW BN 15D 2.5MM 5MM 5.4MM 44MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823546S SUP HCPCS C1713 72823546S - SCREW BN 15D 2.5MM 5MM 5.4MM 46MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A 72823548S SUP HCPCS C1713 72823548S - SCREW BN 15D 2.5MM 5MM 5.4MM 48MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $425.00 $425.00 N/A N/A 72823550S SUP HCPCS C1713 72823550S - SCREW BN 15D 2.5MM 5MM 5.4MM 50MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A 72823555S SUP HCPCS C1713 72823555S - SCREW BN 15D 2.5MM 5MM 5.4MM 55MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $425.00 $425.00 N/A N/A 72823560S SUP HCPCS C1713 72823560S - SCREW BN 15D 2.5MM 5MM 5.4MM 60MMX3.3MM STRL VLP LCK LOPRFL BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $425.00 $425.00 N/A N/A 72824001S SUP HCPCS C1713 72824001S - PLATE BN T STRL VLP LCK VA FT 2.7MM SCR BOTH IP/OP "$1,262.50" $934.00 $250.57 "$1,262.50" $568.13 $568.13 $568.13 $568.13 "$1,262.50" "$1,262.50" "$1,262.50" $263.14 "$1,262.50" "$1,262.50" "$1,262.50" "$1,262.50" "$1,262.50" $263.12 "$1,262.50" $505.00 $746.77 "$1,262.50" "$1,262.50" "$1,262.50" "$1,262.50" $946.88 "$1,262.50" "$1,262.50" "$1,262.50" $631.25 $631.25 $999.90 "$1,262.50" "$1,010.00" $568.13 $250.57 N/A $732.25 "$1,262.50" $757.50 "$1,262.50" $263.11 "$1,262.50" N/A N/A 72824002S SUP HCPCS C1713 72824002S - PLATE BN L STRL PRLC VLP SS LT MTP FOREFOOT MIDFOOT 2.7MM BOTH IP/OP "$1,021.50" $756.00 $202.69 "$1,021.25" $459.56 $459.56 $459.56 $459.56 "$1,021.25" "$1,021.25" "$1,021.25" $212.85 "$1,021.25" "$1,021.25" "$1,021.25" "$1,021.25" "$1,021.25" $212.84 "$1,021.25" $408.50 $604.07 "$1,021.25" "$1,021.25" "$1,021.25" "$1,021.25" $766.13 "$1,021.25" "$1,021.25" "$1,021.25" $510.63 $510.63 $808.83 "$1,021.25" $817.00 $459.56 $202.69 N/A $592.47 "$1,021.25" $612.75 "$1,021.25" "$1,021.25" "$1,021.25" N/A N/A 72824003S SUP HCPCS C1713 72824003S - PLATE BN L STRL PRLC VLP SS RT MTP FOREFOOT MIDFOOT 2.7MM BOTH IP/OP "$1,021.50" $756.00 $202.69 "$1,021.25" $459.56 $459.56 $459.56 $459.56 "$1,021.25" "$1,021.25" "$1,021.25" $212.85 "$1,021.25" "$1,021.25" "$1,021.25" "$1,021.25" "$1,021.25" $212.84 "$1,021.25" $408.50 $604.07 "$1,021.25" "$1,021.25" "$1,021.25" "$1,021.25" $766.13 "$1,021.25" "$1,021.25" "$1,021.25" $510.63 $510.63 $808.83 "$1,021.25" $817.00 $459.56 $202.69 N/A $592.47 "$1,021.25" $612.75 "$1,021.25" "$1,021.25" "$1,021.25" N/A N/A 72824004S SUP HCPCS C1713 72824004S - PLATE BN H STRL PRLC VLP 5 HL SS FOREFOOT MIDFOOT 2.7MM SCR BOTH IP/OP "$1,775.00" "$1,314.00" $352.29 "$1,775.00" $798.75 $798.75 $798.75 $798.75 "$1,775.00" "$1,775.00" "$1,775.00" $369.95 "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" $369.93 "$1,775.00" $710.00 "$1,049.91" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,331.25" "$1,775.00" "$1,775.00" "$1,775.00" $887.50 $887.50 "$1,405.80" "$1,775.00" "$1,420.00" $798.75 $352.29 N/A "$1,029.50" "$1,775.00" "$1,065.00" "$1,775.00" $369.91 "$1,775.00" N/A N/A 72824005S SUP HCPCS C1713 72824005S - PLATE BN STRL PRLC VLP H 8 HL 2.7 MM SCR BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 72824006S SUP HCPCS C1713 72824006S - PLATE BN .25 TBLR STRL PRLC VLP 3 HL SS FOREFOOT MIDFOOT 2.7 BOTH IP/OP $969.00 $717.00 $192.27 $968.75 $435.94 $435.94 $435.94 $435.94 $968.75 $968.75 $968.75 $201.91 $968.75 $968.75 $968.75 $968.75 $968.75 $201.90 $968.75 $387.50 $573.02 $968.75 $968.75 $968.75 $968.75 $726.75 $968.75 $968.75 $968.75 $484.38 $484.38 $767.25 $968.75 $775.00 $435.94 $192.27 N/A $562.02 $968.75 $581.25 $968.75 $201.89 $968.75 N/A N/A 72824007S SUP HCPCS C1713 72824007S - PLATE BN STRL PRLC VLP 4 HL QT TBLR MTP 2.7 MM SCR BOTH IP/OP $969.00 $717.00 $192.27 $968.75 $435.94 $435.94 $435.94 $435.94 $968.75 $968.75 $968.75 $201.91 $968.75 $968.75 $968.75 $968.75 $968.75 $201.90 $968.75 $387.50 $573.02 $968.75 $968.75 $968.75 $968.75 $726.75 $968.75 $968.75 $968.75 $484.38 $484.38 $767.25 $968.75 $775.00 $435.94 $192.27 N/A $562.02 $968.75 $581.25 $968.75 $201.89 $968.75 N/A N/A 72824008S SUP HCPCS C1713 72824008S - PLATE BN .25 TBLR 39.8X8X1.5MM STRL VLP 5 HL FOREFOOT BOTH IP/OP $969.00 $717.00 $192.27 $968.75 $435.94 $435.94 $435.94 $435.94 $968.75 $968.75 $968.75 $201.91 $968.75 $968.75 $968.75 $968.75 $968.75 $201.90 $968.75 $387.50 $573.02 $968.75 $968.75 $968.75 $968.75 $726.75 $968.75 $968.75 $968.75 $484.38 $484.38 $767.25 $968.75 $775.00 $435.94 $192.27 N/A $562.02 $968.75 $581.25 $968.75 $201.89 $968.75 N/A N/A 72824009S SUP HCPCS C1713 72824009S - PLATE BN STRL PRLC VLP 6 HL QT TBLR MTP 2.7 MM SCR BOTH IP/OP $969.00 $717.00 $192.27 $968.75 $435.94 $435.94 $435.94 $435.94 $968.75 $968.75 $968.75 $201.91 $968.75 $968.75 $968.75 $968.75 $968.75 $201.90 $968.75 $968.75 $573.02 $968.75 $968.75 $968.75 $968.75 $726.75 $968.75 $968.75 $968.75 $484.38 $484.38 $767.25 $968.75 $775.00 $435.94 $192.27 N/A $562.02 $968.75 $581.25 $968.75 $201.89 $968.75 N/A N/A 72824010S SUP HCPCS C1713 72824010S - PLATE BN STRL PRLC VLP 7 HL QT TBLR MTP 2.7 MM SCR BOTH IP/OP $969.00 $717.00 $192.27 $968.75 $435.94 $435.94 $435.94 $435.94 $968.75 $968.75 $968.75 $201.91 $968.75 $968.75 $968.75 $968.75 $968.75 $201.90 $968.75 $387.50 $573.02 $968.75 $968.75 $968.75 $968.75 $726.75 $968.75 $968.75 $968.75 $484.38 $484.38 $767.25 $968.75 $775.00 $435.94 $192.27 N/A $562.02 $968.75 $581.25 $968.75 $201.89 $968.75 N/A N/A 72824011S SUP HCPCS C1713 72824011S - PLATE BN .25 TBLR STRL PRLC VLP 8 HL SS FOREFOOT MIDFOOT 2.7 BOTH IP/OP $969.00 $717.00 $192.27 $968.75 $435.94 $435.94 $435.94 $435.94 $968.75 $968.75 $968.75 $201.91 $968.75 $968.75 $968.75 $968.75 $968.75 $201.90 $968.75 $387.50 $573.02 $968.75 $968.75 $968.75 $968.75 $726.75 $968.75 $968.75 $968.75 $484.38 $484.38 $767.25 $968.75 $775.00 $435.94 $192.27 N/A $562.02 $968.75 $581.25 $968.75 $968.75 $968.75 N/A N/A 72824012S SUP HCPCS C1713 72824012S - PLATE BN .25 TBLR STRL PRLC VLP 3 HL CMPR SS FOREFOOT BOTH IP/OP "$1,519.00" "$1,124.00" $301.43 "$1,518.75" $683.44 $683.44 $683.44 $683.44 "$1,518.75" "$1,518.75" "$1,518.75" $316.55 "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" $316.52 "$1,518.75" "$1,518.75" $898.34 "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,139.25" "$1,518.75" "$1,518.75" "$1,518.75" $759.38 $759.38 "$1,202.85" "$1,518.75" "$1,215.00" $683.44 $301.43 N/A $881.02 "$1,518.75" $911.25 "$1,518.75" "$1,518.75" "$1,518.75" N/A N/A 72824013S SUP HCPCS C1713 72824013S - PLATE BN STRL PRLC VLP 5 HL QT TBLR CMPR 2.7 MM SCR BOTH IP/OP "$1,687.50" "$1,249.00" $334.93 "$1,687.50" $759.38 $759.38 $759.38 $759.38 "$1,687.50" "$1,687.50" "$1,687.50" $351.72 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" $351.69 "$1,687.50" "$1,687.50" $998.16 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" $759.38 $334.93 N/A $978.75 "$1,687.50" "$1,012.50" "$1,687.50" $351.68 "$1,687.50" N/A N/A 72824014S SUP HCPCS C1713 72824014S - PLATE BN .25 TBLR STRL PRLC VLP 7 HL CMPR SS FOREFOOT BOTH IP/OP "$1,775.00" "$1,314.00" $352.29 "$1,775.00" $798.75 $798.75 $798.75 $798.75 "$1,775.00" "$1,775.00" "$1,775.00" $369.95 "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" $369.93 "$1,775.00" "$1,775.00" "$1,049.91" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,331.25" "$1,775.00" "$1,775.00" "$1,775.00" $887.50 $887.50 "$1,405.80" "$1,775.00" "$1,420.00" $798.75 $352.29 N/A "$1,029.50" "$1,775.00" "$1,065.00" "$1,775.00" "$1,775.00" "$1,775.00" N/A N/A 72824015S SUP HCPCS C1713 72824015S - PLATE BN STRL PRLC VLP PRM SS LT MTP FOREFOOT MIDFOOT 2.7 MM BOTH IP/OP "$1,775.00" "$1,314.00" $352.29 "$1,775.00" $798.75 $798.75 $798.75 $798.75 "$1,775.00" "$1,775.00" "$1,775.00" $369.95 "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" $369.93 "$1,775.00" $710.00 "$1,049.91" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,331.25" "$1,775.00" "$1,775.00" "$1,775.00" $887.50 $887.50 "$1,405.80" "$1,775.00" "$1,420.00" $798.75 $352.29 N/A "$1,029.50" "$1,775.00" "$1,065.00" "$1,775.00" $369.91 "$1,775.00" N/A N/A 72824016S SUP HCPCS C1713 72824016S - PLATE BN 53.1MMX1.27MM STRL 11MM VLP PRM RT MTP FOREFOOT BOTH IP/OP "$1,775.00" "$1,314.00" $352.29 "$1,775.00" $798.75 $798.75 $798.75 $798.75 "$1,775.00" "$1,775.00" "$1,775.00" $369.95 "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" $369.93 "$1,775.00" $710.00 "$1,049.91" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,331.25" "$1,775.00" "$1,775.00" "$1,775.00" $887.50 $887.50 "$1,405.80" "$1,775.00" "$1,420.00" $798.75 $352.29 N/A "$1,029.50" "$1,775.00" "$1,775.00" "$1,775.00" $369.91 "$1,775.00" N/A N/A 72824017S SUP HCPCS C1713 72824017S - PLATE BN STRL PRLC VLP REV LT MTP 2.7 MM SCR BOTH IP/OP "$2,262.50" "$1,674.00" $449.05 "$2,262.50" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$2,262.50" "$2,262.50" "$2,262.50" $471.56 "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" $471.53 "$2,262.50" "$2,262.50" "$1,338.27" "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" "$1,696.88" "$2,262.50" "$2,262.50" "$2,262.50" "$1,131.25" "$1,131.25" "$1,791.90" "$2,262.50" "$1,810.00" "$1,018.13" $449.05 N/A "$1,312.25" "$2,262.50" "$2,262.50" "$2,262.50" $471.51 "$2,262.50" N/A N/A 72824018S SUP HCPCS C1713 72824018S - PLATE BN STRL PRLC VLP REV SS RT MTP FOREFOOT MIDFOOT 2.7 MM BOTH IP/OP "$2,262.50" "$1,674.00" $449.05 "$2,262.50" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$2,262.50" "$2,262.50" "$2,262.50" $471.56 "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" $471.53 "$2,262.50" "$2,262.50" "$1,338.27" "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" "$1,696.88" "$2,262.50" "$2,262.50" "$2,262.50" "$1,131.25" "$1,131.25" "$1,791.90" "$2,262.50" "$1,810.00" "$1,018.13" $449.05 N/A "$1,312.25" "$2,262.50" "$2,262.50" "$2,262.50" $471.51 "$2,262.50" N/A N/A 72824019S SUP HCPCS C1713 72824019S - PLATE BN SHRT STRL VLP FSN LCK VA TARSOMETATARSAL FT 2.7MM BOTH IP/OP "$1,775.00" "$1,314.00" $352.29 "$1,775.00" $798.75 $798.75 $798.75 $798.75 "$1,775.00" "$1,775.00" "$1,775.00" $369.95 "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" $369.93 "$1,775.00" "$1,775.00" "$1,049.91" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,331.25" "$1,775.00" "$1,775.00" "$1,775.00" $887.50 $887.50 "$1,405.80" "$1,775.00" "$1,420.00" $798.75 $352.29 N/A "$1,029.50" "$1,775.00" "$1,775.00" "$1,775.00" $369.91 "$1,775.00" N/A N/A 72824020S SUP HCPCS C1713 72824020S - PLATE BN LNG STRL PRLC VLP FSN TARSOMETATARSAL 2.7MM SCR BOTH IP/OP "$2,144.00" "$1,587.00" $425.48 "$2,143.75" $964.69 $964.69 $964.69 $964.69 "$2,143.75" "$2,143.75" "$2,143.75" $446.81 "$2,143.75" "$2,143.75" "$2,143.75" "$2,143.75" "$2,143.75" $446.78 "$2,143.75" "$2,143.75" "$1,268.03" "$2,143.75" "$2,143.75" "$2,143.75" "$2,143.75" "$1,608.00" "$2,143.75" "$2,143.75" "$2,143.75" "$1,071.88" "$1,071.88" "$1,697.85" "$2,143.75" "$1,715.00" $964.69 $425.48 N/A "$1,243.52" "$2,143.75" "$2,143.75" "$2,143.75" $446.76 "$2,143.75" N/A N/A 72824021S SUP HCPCS C1713 72824021S - PLATE BN 18.1X7.1X1.5MM STRL VLP BRBL FOREFOOT MIDFOOT 2.7MM BOTH IP/OP "$1,194.00" $884.00 $236.93 "$1,193.75" $537.19 $537.19 $537.19 $537.19 "$1,193.75" "$1,193.75" "$1,193.75" $248.81 "$1,193.75" "$1,193.75" "$1,193.75" "$1,193.75" "$1,193.75" $248.79 "$1,193.75" "$1,193.75" $706.10 "$1,193.75" "$1,193.75" "$1,193.75" "$1,193.75" $895.50 "$1,193.75" "$1,193.75" "$1,193.75" $596.88 $596.88 $945.45 "$1,193.75" $955.00 $537.19 $236.93 N/A $692.52 "$1,193.75" "$1,193.75" "$1,193.75" $248.78 "$1,193.75" N/A N/A 72824022S SUP HCPCS C1713 72824022S - PLATE BN SM 24X18X1.5MM STRL VLP UTL FOREFOOT MIDFOOT 2.7MM BOTH IP/OP "$2,012.50" "$1,489.00" $399.43 "$2,012.50" $905.63 $905.63 $905.63 $905.63 "$2,012.50" "$2,012.50" "$2,012.50" $419.46 "$2,012.50" "$2,012.50" "$2,012.50" "$2,012.50" "$2,012.50" $419.43 "$2,012.50" "$2,012.50" "$1,190.39" "$2,012.50" "$2,012.50" "$2,012.50" "$2,012.50" "$1,509.38" "$2,012.50" "$2,012.50" "$2,012.50" "$1,006.25" "$1,006.25" "$1,593.90" "$2,012.50" "$1,610.00" $905.63 $399.43 N/A "$1,167.25" "$2,012.50" "$2,012.50" "$2,012.50" "$2,012.50" "$2,012.50" N/A N/A 72824023S SUP HCPCS C1713 72824023S - PLATE BN MED STRL PRLC VLP UTL MTP 2.7MM SCR BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 72824024S SUP HCPCS C1713 72824024S - PLATE BN LG STRL PRLC VLP UTL SS FOREFOOT MIDFOOT 2.7MM SCR BOTH IP/OP "$2,262.50" "$1,674.00" $449.05 "$2,262.50" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$2,262.50" "$2,262.50" "$2,262.50" $471.56 "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" $471.53 "$2,262.50" $905.00 "$1,338.27" "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" "$1,696.88" "$2,262.50" "$2,262.50" "$2,262.50" "$1,131.25" "$1,131.25" "$1,791.90" "$2,262.50" "$1,810.00" "$1,018.13" $449.05 N/A "$1,312.25" "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" N/A N/A 72824025S SUP HCPCS C1713 72824025S - PLATE BN STRL PRLC VLP 3 HL 1/3 TBLR CMPR MTP 3.5 MM SCR BOTH IP/OP "$1,519.00" "$1,124.00" $301.43 "$1,518.75" $683.44 $683.44 $683.44 $683.44 "$1,518.75" "$1,518.75" "$1,518.75" $316.55 "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" $316.52 "$1,518.75" $607.50 $898.34 "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,139.25" "$1,518.75" "$1,518.75" "$1,518.75" $759.38 $759.38 "$1,202.85" "$1,518.75" "$1,215.00" $683.44 $301.43 N/A $881.02 "$1,518.75" $911.25 "$1,518.75" "$1,518.75" "$1,518.75" N/A N/A 72824026S SUP HCPCS C1713 72824026S - PLATE BN STRL PRLC VLP 5 HL 1/3 TBLR CMPR 3.5 MM SCR BOTH IP/OP "$1,687.50" "$1,249.00" $334.93 "$1,687.50" $759.38 $759.38 $759.38 $759.38 "$1,687.50" "$1,687.50" "$1,687.50" $351.72 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" $351.69 "$1,687.50" $675.00 $998.16 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" $759.38 $334.93 N/A $978.75 "$1,687.50" "$1,012.50" "$1,687.50" "$1,687.50" "$1,687.50" N/A N/A 72824027S SUP HCPCS C1713 72824027S - PLATE BN STRL PRLC VLP 7 HL 1/3 TBLR CMPR 3.5 MM SCR BOTH IP/OP "$1,775.00" "$1,314.00" $352.29 "$1,775.00" $798.75 $798.75 $798.75 $798.75 "$1,775.00" "$1,775.00" "$1,775.00" $369.95 "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" $369.93 "$1,775.00" "$1,775.00" "$1,049.91" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,331.25" "$1,775.00" "$1,775.00" "$1,775.00" $887.50 $887.50 "$1,405.80" "$1,775.00" "$1,420.00" $798.75 $352.29 N/A "$1,029.50" "$1,775.00" "$1,065.00" "$1,775.00" $369.91 "$1,775.00" N/A N/A 72824028S SUP HCPCS C1713 72824028S - PLATE BN SM STRL PRLC VLP LT CALCANEUS 3.5MM SCR BOTH IP/OP "$2,019.00" "$1,494.00" $400.67 "$2,018.75" $908.44 $908.44 $908.44 $908.44 "$2,018.75" "$2,018.75" "$2,018.75" $420.76 "$2,018.75" "$2,018.75" "$2,018.75" "$2,018.75" "$2,018.75" $420.73 "$2,018.75" "$2,018.75" "$1,194.09" "$2,018.75" "$2,018.75" "$2,018.75" "$2,018.75" "$1,514.25" "$2,018.75" "$2,018.75" "$2,018.75" "$1,009.38" "$1,009.38" "$1,598.85" "$2,018.75" "$1,615.00" $908.44 $400.67 N/A "$1,171.02" "$2,018.75" "$1,211.25" "$2,018.75" $420.71 "$2,018.75" N/A N/A 72824029S SUP HCPCS C1713 72824029S - PLATE BN SM STRL PRLC VLP VA LCK RT CALCANEUS 3.5MM SCR BOTH IP/OP "$2,019.00" "$1,494.00" $400.67 "$2,018.75" $908.44 $908.44 $908.44 $908.44 "$2,018.75" "$2,018.75" "$2,018.75" $420.76 "$2,018.75" "$2,018.75" "$2,018.75" "$2,018.75" "$2,018.75" $420.73 "$2,018.75" $807.50 "$1,194.09" "$2,018.75" "$2,018.75" "$2,018.75" "$2,018.75" "$1,514.25" "$2,018.75" "$2,018.75" "$2,018.75" "$1,009.38" "$1,009.38" "$1,598.85" "$2,018.75" "$1,615.00" $908.44 $400.67 N/A "$1,171.02" "$2,018.75" "$1,211.25" "$2,018.75" "$2,018.75" "$2,018.75" N/A N/A 72824030S SUP HCPCS C1713 72824030S - PLATE BN LG STRL PRLC VLP LT CALCANEUS MIDFOOT HINDFOOT 3.5 BOTH IP/OP "$2,087.50" "$1,545.00" $414.32 "$2,087.50" $939.38 $939.38 $939.38 $939.38 "$2,087.50" "$2,087.50" "$2,087.50" $435.09 "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" $435.06 "$2,087.50" $835.00 "$1,234.76" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$1,565.63" "$2,087.50" "$2,087.50" "$2,087.50" "$1,043.75" "$1,043.75" "$1,653.30" "$2,087.50" "$1,670.00" $939.38 $414.32 N/A "$1,210.75" "$2,087.50" "$1,252.50" "$2,087.50" $435.04 "$2,087.50" N/A N/A 72824031S SUP HCPCS C1713 72824031S - PLATE BN LG STRL PRLC VLP VA LCK SS RT CALCANEUS 3.5MM SCR BOTH IP/OP "$2,087.50" "$1,545.00" $414.32 "$2,087.50" $939.38 $939.38 $939.38 $939.38 "$2,087.50" "$2,087.50" "$2,087.50" $435.09 "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" $435.06 "$2,087.50" $835.00 "$1,234.76" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$1,565.63" "$2,087.50" "$2,087.50" "$2,087.50" "$1,043.75" "$1,043.75" "$1,653.30" "$2,087.50" "$1,670.00" $939.38 $414.32 N/A "$1,210.75" "$2,087.50" "$1,252.50" "$2,087.50" $435.04 "$2,087.50" N/A N/A 72824032S SUP HCPCS C1713 72824032S - PLATE BN STRL PRLC VLP FSN MTP 3.5 MM SCR BOTH IP/OP "$2,012.50" "$1,489.00" $399.43 "$2,012.50" $905.63 $905.63 $905.63 $905.63 "$2,012.50" "$2,012.50" "$2,012.50" $419.46 "$2,012.50" "$2,012.50" "$2,012.50" "$2,012.50" "$2,012.50" $419.43 "$2,012.50" $805.00 "$1,190.39" "$2,012.50" "$2,012.50" "$2,012.50" "$2,012.50" "$1,509.38" "$2,012.50" "$2,012.50" "$2,012.50" "$1,006.25" "$1,006.25" "$1,593.90" "$2,012.50" "$1,610.00" $905.63 $399.43 N/A "$1,167.25" "$2,012.50" "$1,207.50" "$2,012.50" $419.41 "$2,012.50" N/A N/A 72824033S SUP HCPCS C1713 72824033S - PLATE BN LNG STRL PRLC VLP FSN 3.5MM SCR BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 72824034S SUP HCPCS C1713 72824034S - PLATE BN STRL PRLC VLP CLMN FSN 3.5 MM SCR BOTH IP/OP "$2,994.00" "$2,216.00" $594.18 "$2,993.75" "$1,347.19" "$1,347.19" "$1,347.19" "$1,347.19" "$2,993.75" "$2,993.75" "$2,993.75" $623.97 "$2,993.75" "$2,993.75" "$2,993.75" "$2,993.75" "$2,993.75" $623.93 "$2,993.75" "$2,993.75" "$1,475.92" "$2,993.75" "$2,993.75" "$2,993.75" "$2,993.75" "$2,245.50" "$2,993.75" "$2,993.75" "$2,993.75" "$1,496.88" "$1,496.88" "$2,371.05" "$2,993.75" "$2,395.00" "$1,347.19" $594.18 N/A "$1,736.52" "$2,993.75" "$1,796.25" "$2,993.75" "$2,993.75" "$2,993.75" N/A N/A 72824035S SUP HCPCS C1713 72824035S - PLATE BN STRL VLP 6 HL MLT FRAG MIDFOOT HINDFOOT 3.5 MM SCR BOTH IP/OP "$1,775.00" "$1,314.00" $352.29 "$1,775.00" $798.75 $798.75 $798.75 $798.75 "$1,775.00" "$1,775.00" "$1,775.00" $369.95 "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" $369.93 "$1,775.00" $710.00 "$1,049.91" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,331.25" "$1,775.00" "$1,775.00" "$1,775.00" $887.50 $887.50 "$1,405.80" "$1,775.00" "$1,420.00" $798.75 $352.29 N/A "$1,029.50" "$1,775.00" "$1,065.00" "$1,775.00" $369.91 "$1,775.00" N/A N/A 72824036S SUP HCPCS C1713 72824036S - PLATE BN STRL PRLC VLP 10 HL MLT FRAG MTP 3.5 MM SCR BOTH IP/OP "$2,444.00" "$1,809.00" $485.02 "$2,443.75" "$1,099.69" "$1,099.69" "$1,099.69" "$1,099.69" "$2,443.75" "$2,443.75" "$2,443.75" $509.34 "$2,443.75" "$2,443.75" "$2,443.75" "$2,443.75" "$2,443.75" $509.30 "$2,443.75" "$2,443.75" "$1,445.48" "$2,443.75" "$2,443.75" "$2,443.75" "$2,443.75" "$1,833.00" "$2,443.75" "$2,443.75" "$2,443.75" "$1,221.88" "$1,221.88" "$1,935.45" "$2,443.75" "$1,955.00" "$1,099.69" $485.02 N/A "$1,417.52" "$2,443.75" "$1,466.25" "$2,443.75" $509.28 "$2,443.75" N/A N/A 72824037S SUP HCPCS C1713 72824037S - PLATE BN STRL PRLC VLP 14 HL MLT FRAG VARAIBLE ANG MIDFOOT BOTH IP/OP "$2,925.00" "$2,165.00" $580.54 "$2,925.00" "$1,316.25" "$1,316.25" "$1,316.25" "$1,316.25" "$2,925.00" "$2,925.00" "$2,925.00" $609.64 "$2,925.00" "$2,925.00" "$2,925.00" "$2,925.00" "$2,925.00" $609.60 "$2,925.00" "$1,170.00" "$1,442.03" "$2,925.00" "$2,925.00" "$2,925.00" "$2,925.00" "$2,193.75" "$2,925.00" "$2,925.00" "$2,925.00" "$1,462.50" "$1,462.50" "$2,316.60" "$2,925.00" "$2,340.00" "$1,316.25" $580.54 N/A "$1,696.50" "$2,925.00" "$1,755.00" "$2,925.00" "$2,925.00" "$2,925.00" N/A N/A 72824038S SUP HCPCS C1713 72824038S - PLATE BN VLP 4 HL MULTIFRAGMENT MIDFOOT HINDFOOT 3.5 MM SCR BOTH IP/OP "$1,687.50" "$1,249.00" $334.93 "$1,687.50" $759.38 $759.38 $759.38 $759.38 "$1,687.50" "$1,687.50" "$1,687.50" $351.72 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" $351.69 "$1,687.50" "$1,687.50" $998.16 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" $759.38 $334.93 N/A $978.75 "$1,687.50" "$1,687.50" "$1,687.50" $351.68 "$1,687.50" N/A N/A 72824039S SUP HCPCS C1713 72824039S - PLATE BN MED STRL VLP LT CALCANEUS MIDFOOT HINDFOOT 3.5MM BOTH IP/OP "$2,225.00" "$1,647.00" $441.61 "$2,225.00" "$1,001.25" "$1,001.25" "$1,001.25" "$1,001.25" "$2,225.00" "$2,225.00" "$2,225.00" $463.75 "$2,225.00" "$2,225.00" "$2,225.00" "$2,225.00" "$2,225.00" $463.71 "$2,225.00" "$2,225.00" "$1,316.09" "$2,225.00" "$2,225.00" "$2,225.00" "$2,225.00" "$1,668.75" "$2,225.00" "$2,225.00" "$2,225.00" "$1,112.50" "$1,112.50" "$1,762.20" "$2,225.00" "$1,780.00" "$1,001.25" $441.61 N/A "$1,290.50" "$2,225.00" "$2,225.00" "$2,225.00" $463.69 "$2,225.00" N/A N/A 72824040S SUP HCPCS C1713 72824040S - PLATE BN MED STRL VLP RT CALCANEUS MIDFOOT HINDFOOT 3.5MM BOTH IP/OP "$2,225.00" "$1,647.00" $441.61 "$2,225.00" "$1,001.25" "$1,001.25" "$1,001.25" "$1,001.25" "$2,225.00" "$2,225.00" "$2,225.00" $463.75 "$2,225.00" "$2,225.00" "$2,225.00" "$2,225.00" "$2,225.00" $463.71 "$2,225.00" $890.00 "$1,316.09" "$2,225.00" "$2,225.00" "$2,225.00" "$2,225.00" "$1,668.75" "$2,225.00" "$2,225.00" "$2,225.00" "$1,112.50" "$1,112.50" "$1,762.20" "$2,225.00" "$1,780.00" "$1,001.25" $441.61 N/A "$1,290.50" "$2,225.00" "$2,225.00" "$2,225.00" "$2,225.00" "$2,225.00" N/A N/A 72824041S SUP HCPCS C1713 72824041S - PLATE BN XL STRL VLP LT CALCANEUS MIDFOOT HINDFOOT 3.5MM SCR BOTH IP/OP "$2,331.50" "$1,725.00" $462.69 "$2,331.25" "$1,049.06" "$1,049.06" "$1,049.06" "$1,049.06" "$2,331.25" "$2,331.25" "$2,331.25" $485.89 "$2,331.25" "$2,331.25" "$2,331.25" "$2,331.25" "$2,331.25" $485.86 "$2,331.25" "$2,331.25" "$1,378.93" "$2,331.25" "$2,331.25" "$2,331.25" "$2,331.25" "$1,748.63" "$2,331.25" "$2,331.25" "$2,331.25" "$1,165.63" "$1,165.63" "$1,846.35" "$2,331.25" "$1,865.00" "$1,049.06" $462.69 N/A "$1,352.27" "$2,331.25" "$2,331.25" "$2,331.25" $485.83 "$2,331.25" N/A N/A 72824042S SUP HCPCS C1713 72824042S - PLATE BN XL RT CALC 3.5MM SCR BOTH IP/OP "$2,331.50" "$1,725.00" $462.69 "$2,331.25" "$1,049.06" "$1,049.06" "$1,049.06" "$1,049.06" "$2,331.25" "$2,331.25" "$2,331.25" $485.89 "$2,331.25" "$2,331.25" "$2,331.25" "$2,331.25" "$2,331.25" $485.86 "$2,331.25" $932.50 "$1,378.93" "$2,331.25" "$2,331.25" "$2,331.25" "$2,331.25" "$1,748.63" "$2,331.25" "$2,331.25" "$2,331.25" "$1,165.63" "$1,165.63" "$1,846.35" "$2,331.25" "$1,865.00" "$1,049.06" $462.69 N/A "$1,352.27" "$2,331.25" "$2,331.25" "$2,331.25" "$2,331.25" "$2,331.25" N/A N/A 7291-0108 SUP Custom 27803010 7291-0108 - INSERT TIBIAL 1 8MM POSTERIOR STABILIZE BEARING SCORPIO KNEE BOTH IP/OP "$1,299.00" $961.00 $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $270.73 "$1,299.00" $519.60 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $974.25 "$1,299.00" "$1,299.00" "$1,299.00" $649.50 $649.50 "$1,028.81" "$1,299.00" "$1,039.20" $584.55 "$1,299.00" N/A $753.42 "$1,299.00" $779.40 "$1,299.00" "$1,299.00" "$1,299.00" N/A N/A 7291-0110 SUP Custom 27803010 7291-0110 - INSERT TIBIAL 1 10MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,298.00" $961.00 $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $270.52 "$1,298.00" $519.20 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $973.50 "$1,298.00" "$1,298.00" "$1,298.00" $649.00 $649.00 "$1,028.02" "$1,298.00" "$1,038.40" $584.10 "$1,298.00" N/A $752.84 "$1,298.00" $778.80 "$1,298.00" "$1,298.00" "$1,298.00" N/A N/A 7291-0115 SUP Custom 27803010 7291-0115 - INSERT TIBIAL 1 15MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,299.00" $961.00 $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $270.73 "$1,299.00" $519.60 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $974.25 "$1,299.00" "$1,299.00" "$1,299.00" $649.50 $649.50 "$1,028.81" "$1,299.00" "$1,039.20" $584.55 "$1,299.00" N/A $753.42 "$1,299.00" $779.40 "$1,299.00" "$1,299.00" "$1,299.00" N/A N/A 7291-0118 SUP Custom 27803010 7291-0118 - INSERT TIBIAL 1 18MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,298.00" $961.00 $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $270.52 "$1,298.00" $519.20 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $973.50 "$1,298.00" "$1,298.00" "$1,298.00" $649.00 $649.00 "$1,028.02" "$1,298.00" "$1,038.40" $584.10 "$1,298.00" N/A $752.84 "$1,298.00" $778.80 "$1,298.00" "$1,298.00" "$1,298.00" N/A N/A 7291-0121 SUP Custom 27803010 7291-0121 - INSERT TIBIAL 1 21MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,246.00" $922.00 $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $259.68 "$1,246.00" $498.40 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $934.50 "$1,246.00" "$1,246.00" "$1,246.00" $623.00 $623.00 $986.83 "$1,246.00" $996.80 $560.70 "$1,246.00" N/A $722.68 "$1,246.00" $747.60 "$1,246.00" "$1,246.00" "$1,246.00" N/A N/A 7291-0124 SUP Custom 27803010 7291-0124 - INSERT TIBIAL 1 24MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,246.00" $922.00 $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $259.68 "$1,246.00" $498.40 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $934.50 "$1,246.00" "$1,246.00" "$1,246.00" $623.00 $623.00 $986.83 "$1,246.00" $996.80 $560.70 "$1,246.00" N/A $722.68 "$1,246.00" $747.60 "$1,246.00" "$1,246.00" "$1,246.00" N/A N/A 7291-0308 SUP Custom 27803010 7291-0308 - INSERT TIBIAL 3 8MM POSTERIOR STABILIZE BEARING SCORPIO KNEE BOTH IP/OP "$1,246.00" $922.00 $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $259.68 "$1,246.00" $498.40 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $934.50 "$1,246.00" "$1,246.00" "$1,246.00" $623.00 $623.00 $986.83 "$1,246.00" $996.80 $560.70 "$1,246.00" N/A $722.68 "$1,246.00" $747.60 "$1,246.00" "$1,246.00" "$1,246.00" N/A N/A 7291-0310 SUP Custom 27803010 7291-0310 - INSERT TIBIAL 3 10MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,246.00" $922.00 $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $259.68 "$1,246.00" $498.40 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $934.50 "$1,246.00" "$1,246.00" "$1,246.00" $623.00 $623.00 $986.83 "$1,246.00" $996.80 $560.70 "$1,246.00" N/A $722.68 "$1,246.00" $747.60 "$1,246.00" "$1,246.00" "$1,246.00" N/A N/A 7291-0312 SUP Custom 27803010 7291-0312 - INSERT TIBIAL 3 12MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,246.00" $922.00 $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $259.68 "$1,246.00" $498.40 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $934.50 "$1,246.00" "$1,246.00" "$1,246.00" $623.00 $623.00 $986.83 "$1,246.00" $996.80 $560.70 "$1,246.00" N/A $722.68 "$1,246.00" $747.60 "$1,246.00" "$1,246.00" "$1,246.00" N/A N/A 7291-0315 SUP Custom 27803010 7291-0315 - INSERT TIBIAL 3 15MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,246.00" $922.00 $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $259.68 "$1,246.00" $498.40 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $934.50 "$1,246.00" "$1,246.00" "$1,246.00" $623.00 $623.00 $986.83 "$1,246.00" $996.80 $560.70 "$1,246.00" N/A $722.68 "$1,246.00" $747.60 "$1,246.00" "$1,246.00" "$1,246.00" N/A N/A 7291-0318 SUP Custom 27803010 7291-0318 - INSERT TIBIAL 3 18MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,246.00" $922.00 $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $259.68 "$1,246.00" $498.40 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $934.50 "$1,246.00" "$1,246.00" "$1,246.00" $623.00 $623.00 $986.83 "$1,246.00" $996.80 $560.70 "$1,246.00" N/A $722.68 "$1,246.00" $747.60 "$1,246.00" "$1,246.00" "$1,246.00" N/A N/A 7291-0321 SUP Custom 27803010 7291-0321 - INSERT TIBIAL 3 21MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,298.00" $961.00 $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $270.52 "$1,298.00" $519.20 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $973.50 "$1,298.00" "$1,298.00" "$1,298.00" $649.00 $649.00 "$1,028.02" "$1,298.00" "$1,038.40" $584.10 "$1,298.00" N/A $752.84 "$1,298.00" $778.80 "$1,298.00" "$1,298.00" "$1,298.00" N/A N/A 7291-0324 SUP Custom 27803010 7291-0324 - INSERT TIBIAL 3 24MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,246.00" $922.00 $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $259.68 "$1,246.00" $498.40 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $934.50 "$1,246.00" "$1,246.00" "$1,246.00" $623.00 $623.00 $986.83 "$1,246.00" $996.80 $560.70 "$1,246.00" N/A $722.68 "$1,246.00" $747.60 "$1,246.00" "$1,246.00" "$1,246.00" N/A N/A 7291-0512 SUP Custom 27803010 7291-0512 - INSERT TIBIAL 5 12MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,246.00" $922.00 $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $259.68 "$1,246.00" $498.40 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $934.50 "$1,246.00" "$1,246.00" "$1,246.00" $623.00 $623.00 $986.83 "$1,246.00" $996.80 $560.70 "$1,246.00" N/A $722.68 "$1,246.00" $747.60 "$1,246.00" "$1,246.00" "$1,246.00" N/A N/A 7291-0515 SUP Custom 27803010 7291-0515 - INSERT TIBIAL 5 15MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,299.00" $961.00 $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $270.73 "$1,299.00" $519.60 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $974.25 "$1,299.00" "$1,299.00" "$1,299.00" $649.50 $649.50 "$1,028.81" "$1,299.00" "$1,039.20" $584.55 "$1,299.00" N/A $753.42 "$1,299.00" $779.40 "$1,299.00" "$1,299.00" "$1,299.00" N/A N/A 7291-0518 SUP Custom 27803010 7291-0518 - INSERT TIBIAL 5 18MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,299.00" $961.00 $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $270.73 "$1,299.00" $519.60 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $974.25 "$1,299.00" "$1,299.00" "$1,299.00" $649.50 $649.50 "$1,028.81" "$1,299.00" "$1,039.20" $584.55 "$1,299.00" N/A $753.42 "$1,299.00" $779.40 "$1,299.00" "$1,299.00" "$1,299.00" N/A N/A 7291-0521 SUP Custom 27803010 7291-0521 - INSERT TIBIAL 5 21MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,298.00" $961.00 $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $270.52 "$1,298.00" $519.20 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $973.50 "$1,298.00" "$1,298.00" "$1,298.00" $649.00 $649.00 "$1,028.02" "$1,298.00" "$1,038.40" $584.10 "$1,298.00" N/A $752.84 "$1,298.00" $778.80 "$1,298.00" "$1,298.00" "$1,298.00" N/A N/A 7291-0524 SUP Custom 27803010 7291-0524 - INSERT TIBIAL 5 24MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,246.00" $922.00 $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $259.68 "$1,246.00" $498.40 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $934.50 "$1,246.00" "$1,246.00" "$1,246.00" $623.00 $623.00 $986.83 "$1,246.00" $996.80 $560.70 "$1,246.00" N/A $722.68 "$1,246.00" $747.60 "$1,246.00" "$1,246.00" "$1,246.00" N/A N/A 7291-0708 SUP Custom 27803010 7291-0708 - INSERT TIBIAL 7 8MM POSTERIOR STABILIZE BEARING SCORPIO KNEE BOTH IP/OP "$1,299.00" $961.00 $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $270.73 "$1,299.00" $519.60 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $974.25 "$1,299.00" "$1,299.00" "$1,299.00" $649.50 $649.50 "$1,028.81" "$1,299.00" "$1,039.20" $584.55 "$1,299.00" N/A $753.42 "$1,299.00" $779.40 "$1,299.00" "$1,299.00" "$1,299.00" N/A N/A 7291-0710 SUP Custom 27803010 7291-0710 - INSERT TIBIAL 7 10MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,298.00" $961.00 $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $270.52 "$1,298.00" $519.20 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $973.50 "$1,298.00" "$1,298.00" "$1,298.00" $649.00 $649.00 "$1,028.02" "$1,298.00" "$1,038.40" $584.10 "$1,298.00" N/A $752.84 "$1,298.00" $778.80 "$1,298.00" "$1,298.00" "$1,298.00" N/A N/A 7291-0712 SUP Custom 27803010 7291-0712 - INSERT TIBIAL 7 12MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,298.00" $961.00 $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $270.52 "$1,298.00" $519.20 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $973.50 "$1,298.00" "$1,298.00" "$1,298.00" $649.00 $649.00 "$1,028.02" "$1,298.00" "$1,038.40" $584.10 "$1,298.00" N/A $752.84 "$1,298.00" $778.80 "$1,298.00" "$1,298.00" "$1,298.00" N/A N/A 7291-0718 SUP Custom 27803010 7291-0718 - INSERT TIBIAL 7 18MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,298.00" $961.00 $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $270.52 "$1,298.00" $519.20 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $973.50 "$1,298.00" "$1,298.00" "$1,298.00" $649.00 $649.00 "$1,028.02" "$1,298.00" "$1,038.40" $584.10 "$1,298.00" N/A $752.84 "$1,298.00" $778.80 "$1,298.00" "$1,298.00" "$1,298.00" N/A N/A 7291-0721 SUP Custom 27803010 7291-0721 - INSERT TIBIAL 1 24MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,246.00" $922.00 $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $259.68 "$1,246.00" $498.40 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $934.50 "$1,246.00" "$1,246.00" "$1,246.00" $623.00 $623.00 $986.83 "$1,246.00" $996.80 $560.70 "$1,246.00" N/A $722.68 "$1,246.00" $747.60 "$1,246.00" "$1,246.00" "$1,246.00" N/A N/A 7291-0724 SUP Custom 27803010 7291-0724 - INSERT TIBIAL 7 24MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,246.00" $922.00 $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $259.68 "$1,246.00" $498.40 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $934.50 "$1,246.00" "$1,246.00" "$1,246.00" $623.00 $623.00 $986.83 "$1,246.00" $996.80 $560.70 "$1,246.00" N/A $722.68 "$1,246.00" $747.60 "$1,246.00" "$1,246.00" "$1,246.00" N/A N/A 7291-0908 SUP Custom 27803010 7291-0908 - INSERT TIBIAL 9 8MM POSTERIOR STABILIZE BEARING SCORPIO KNEE BOTH IP/OP "$1,298.00" $961.00 $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $231.04 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $270.52 "$1,298.00" $519.20 "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" "$1,298.00" $973.50 "$1,298.00" "$1,298.00" "$1,298.00" $649.00 $649.00 "$1,028.02" "$1,298.00" "$1,038.40" $584.10 "$1,298.00" N/A $752.84 "$1,298.00" $778.80 "$1,298.00" "$1,298.00" "$1,298.00" N/A N/A 7291-0910 SUP Custom 27803010 7291-0910 - INSERT TIBIAL 9 10MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,299.00" $961.00 $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $270.73 "$1,299.00" $519.60 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $974.25 "$1,299.00" "$1,299.00" "$1,299.00" $649.50 $649.50 "$1,028.81" "$1,299.00" "$1,039.20" $584.55 "$1,299.00" N/A $753.42 "$1,299.00" $779.40 "$1,299.00" "$1,299.00" "$1,299.00" N/A N/A 7291-0915 SUP Custom 27803010 7291-0915 - INSERT TIBIAL 9 15MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,299.00" $961.00 $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $270.73 "$1,299.00" $519.60 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $974.25 "$1,299.00" "$1,299.00" "$1,299.00" $649.50 $649.50 "$1,028.81" "$1,299.00" "$1,039.20" $584.55 "$1,299.00" N/A $753.42 "$1,299.00" $779.40 "$1,299.00" "$1,299.00" "$1,299.00" N/A N/A 7291-0918 SUP Custom 27803010 7291-0918 - INSERT TIBIAL 9 18MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,246.00" $922.00 $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $259.68 "$1,246.00" $498.40 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $934.50 "$1,246.00" "$1,246.00" "$1,246.00" $623.00 $623.00 $986.83 "$1,246.00" $996.80 $560.70 "$1,246.00" N/A $722.68 "$1,246.00" $747.60 "$1,246.00" "$1,246.00" "$1,246.00" N/A N/A 7291-0921 SUP Custom 27803010 7291-0921 - INSERT TIBIAL 9 21MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,299.00" $961.00 $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $231.22 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $270.73 "$1,299.00" $519.60 "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" "$1,299.00" $974.25 "$1,299.00" "$1,299.00" "$1,299.00" $649.50 $649.50 "$1,028.81" "$1,299.00" "$1,039.20" $584.55 "$1,299.00" N/A $753.42 "$1,299.00" $779.40 "$1,299.00" "$1,299.00" "$1,299.00" N/A N/A 7291-0924 SUP Custom 27803010 7291-0924 - INSERT TIBIAL 9 24MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,246.00" $922.00 $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $221.79 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $259.68 "$1,246.00" $498.40 "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" $934.50 "$1,246.00" "$1,246.00" "$1,246.00" $623.00 $623.00 $986.83 "$1,246.00" $996.80 $560.70 "$1,246.00" N/A $722.68 "$1,246.00" $747.60 "$1,246.00" "$1,246.00" "$1,246.00" N/A N/A 72A002 SUP Custom 27804086 72A002 - GRAFT BONE SMALL 100-125MM FREEZE DRIED SHAFT CORTICAL BOTH IP/OP "$1,760.00" "$1,302.00" $313.28 "$2,015.00" "$1,760.00" "$1,760.00" "$1,760.00" "$1,760.00" "$1,760.00" "$1,760.00" $313.28 "$1,760.00" "$1,760.00" "$1,760.00" "$1,760.00" "$1,760.00" "$1,760.00" $366.80 "$1,760.00" $806.00 "$1,760.00" "$1,760.00" "$2,015.00" "$1,760.00" "$1,760.00" "$1,320.00" "$1,760.00" "$1,760.00" "$1,760.00" $880.00 $880.00 "$1,393.92" "$1,760.00" "$1,408.00" $792.00 "$1,760.00" N/A "$1,020.80" "$1,760.00" "$1,056.00" "$1,760.00" "$1,760.00" "$1,760.00" N/A N/A 72B006 SUP HCPCS C1762 72B006 - GRAFT BONE LARGE 126MM FROZEN SHAFT CORTICAL BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,357.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" "$2,357.50" "$1,217.01" "$2,057.50" "$2,357.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A 730032ADP SUP Custom 27803010 730032ADP - GRAFT CV 42MM 32MM 15CM 32MM GLWV VSLV WVN GELTN AOR ROOT BOTH IP/OP "$6,437.50" "$4,764.00" "$1,145.88" "$6,437.50" "$6,437.50" "$6,437.50" "$6,437.50" "$6,437.50" "$6,437.50" "$6,437.50" "$1,145.88" "$6,437.50" "$6,437.50" "$6,437.50" "$6,437.50" "$6,437.50" "$6,437.50" "$1,341.65" "$6,437.50" "$2,575.00" "$6,437.50" "$6,437.50" "$6,437.50" "$6,437.50" "$6,437.50" "$4,828.13" "$6,437.50" "$6,437.50" "$6,437.50" "$3,218.75" "$3,218.75" "$5,098.50" "$6,437.50" "$5,150.00" "$2,896.88" "$6,437.50" N/A "$3,733.75" "$6,437.50" "$3,862.50" "$6,437.50" "$6,437.50" "$6,437.50" N/A N/A 7300TFX25MM SUP Custom 27803010 7300TFX25MM - VALVE MTRL 25MM CRP-ED PRIMNT MAGNA BPRTH EASE HRT BOTH IP/OP "$22,275.00" "$16,484.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$4,642.36" "$22,275.00" "$8,910.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$16,706.25" "$22,275.00" "$22,275.00" "$22,275.00" "$11,137.50" "$11,137.50" "$17,641.80" "$22,275.00" "$17,820.00" "$10,023.75" "$22,275.00" N/A "$12,919.50" "$22,275.00" "$13,365.00" "$22,275.00" "$22,275.00" "$22,275.00" N/A N/A 7300TFX29MM SUP Custom 27803010 7300TFX29MM - VALVE MTRL 29MM CRP-ED PRIMNT MG HRT PRICRD EASE BOTH IP/OP "$22,275.00" "$16,484.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$4,642.36" "$22,275.00" "$8,910.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$16,706.25" "$22,275.00" "$22,275.00" "$22,275.00" "$11,137.50" "$11,137.50" "$17,641.80" "$22,275.00" "$17,820.00" "$10,023.75" "$22,275.00" N/A "$12,919.50" "$22,275.00" "$13,365.00" "$22,275.00" "$22,275.00" "$22,275.00" N/A N/A 7300TFX31MM SUP Custom 27803010 7300TFX31MM - VALVE MITRAL 31MM BIOPROSTHESIS EASE CARPENTIER-EDWARDS BOTH IP/OP "$22,275.00" "$16,484.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$4,642.36" "$22,275.00" "$8,910.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$16,706.25" "$22,275.00" "$22,275.00" "$22,275.00" "$11,137.50" "$11,137.50" "$17,641.80" "$22,275.00" "$17,820.00" "$10,023.75" "$22,275.00" N/A "$12,919.50" "$22,275.00" "$13,365.00" "$22,275.00" "$22,275.00" "$22,275.00" N/A N/A 7300TFX33MM SUP Custom 27803010 7300TFX33MM - VALVE MTRL 33MM CRP-ED PRIMNT MAGNA BPRTH EASE HRT BOTH IP/OP "$22,275.00" "$16,484.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$3,964.95" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$4,642.36" "$22,275.00" "$8,910.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$22,275.00" "$16,706.25" "$22,275.00" "$22,275.00" "$22,275.00" "$11,137.50" "$11,137.50" "$17,641.80" "$22,275.00" "$17,820.00" "$10,023.75" "$22,275.00" N/A "$12,919.50" "$22,275.00" "$13,365.00" "$22,275.00" "$22,275.00" "$22,275.00" N/A N/A 73-0110 SUP Custom 27803010 73-0110 - COMPONENT PATLR 11 10MM MEDIALIZED DOME SCORPIO N2/VAC BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 73-020S SUP HCPCS C1713 73-020S - SCREW CANNULATED FULLY THREADED 7.3MM X 20MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-025S SUP HCPCS C1713 73-025S - SCREW CANNULATED FULLY THREADED 7.3MM X 25MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-030S SUP HCPCS C1713 73-030S - SCREW CANNULATED FULLY THREADED 7.3MM X 30MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-035S SUP HCPCS C1713 73-035S - SCREW CANNULATED FULLY THREADED 7.3MM X 35MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-040S SUP HCPCS C1713 73-040S - SCREW CANNULATED FULLY THREADED 7.3MM X 40MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-045S SUP HCPCS C1713 73-045S - SCREW CANNULATED FULLY THREADED 7.3MM X 45MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-050S SUP HCPCS C1713 73-050S - SCREW CANNULATED FULLY THREADED 7.3MM X 50MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-0510 SUP Custom 27803010 73-0510 - COMPONENT PATLR 5 1.5MM OFFST 32/35MM 5MM 5MMX10MM MEDIALIZE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 73-055S SUP HCPCS C1713 73-055S - SCREW CANNULATED FULLY THREADED 7.3MM X 55MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-060S SUP HCPCS C1713 73-060S - SCREW CANNULATED FULLY THREADED 7.3MM X 60MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-065S SUP HCPCS C1713 73-065S - SCREW CANNULATED FULLY THREADED 7.3MM X 65MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-070S SUP HCPCS C1713 73-070S - SCREW CANNULATED FULLY THREADED 7.3MM X 70MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-0710 SUP Custom 27803010 73-0710 - COMPONENT PATLR 7 1.5MM OFFST 34/38MM 5MM 5MMX10MM MEDIALIZE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 73-075S SUP HCPCS C1713 73-075S - SCREW CANNULATED FULLY THREADED 7.3MM X 75MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-080S SUP HCPCS C1713 73-080S - SCREW CANNULATED FULLY THREADED 7.3MM X 80MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-085S SUP HCPCS C1713 73-085S - SCREW CANNULATED FULLY THREADED 7.3MM X 85MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-090S SUP HCPCS C1713 73-090S - SCREW CANNULATED FULLY THREADED 7.3MM X 90MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-0910 SUP Custom 27803010 73-0910 - COMPONENT PATLR 7 1.5MM OFFST 36/41MM 5MM 5MMX10MM MEDIALIZE BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 73-095S SUP HCPCS C1713 73-095S - SCREW CANNULATED FULLY THREADED 7.3MM X 95MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-100S SUP HCPCS C1713 73-100S - SCREW CANNULATED FULLY THREADED 7.3MM X 100MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-105S SUP HCPCS C1713 73-105S - SCREW CANNULATED FULLY THREADED 7.3MM X 105MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-110S SUP HCPCS C1713 73-110S - SCREW CANNULATED FULLY THREADED 7.3MM X 110MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-115S SUP HCPCS C1713 73-115S - SCREW CANNULATED FULLY THREADED 7.3MM X 115MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-120S SUP HCPCS C1713 73-120S - SCREW CANNULATED FULLY THREADED 7.3MM X 120MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-125S SUP HCPCS C1713 73-125S - SCREW CANNULATED FULLY THREADED 7.3MM X 125MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-130S SUP HCPCS C1713 73-130S - SCREW CANNULATED FULLY THREADED 7.3MM X 130MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-16030S SUP HCPCS C1713 73-16030S - SCREW 7.3MM X 30MM CANNULATED SCREW 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16035S SUP HCPCS C1713 73-16035S - SCREW 7.3MM X 35MM CANNULATED SCREW 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16040S SUP HCPCS C1713 73-16040S - SCREW CANNULATED 7.3MM X 40MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-16045S SUP HCPCS C1713 73-16045S - SCREW CANNULATED 7.3MM X 45MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-16050S SUP HCPCS C1713 73-16050S - SCREW CANNULATED 7.3MM X 50MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-16055S SUP HCPCS C1713 73-16055S - SCREW CANNULATED 7.3MM X 55MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16060S SUP HCPCS C1713 73-16060S - SCREW CANNULATED 7.3MM X 60MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-16065S SUP HCPCS C1713 73-16065S - SCREW CANNULATED 7.3MM X 65MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16070S SUP HCPCS C1713 73-16070S - SCREW CANNULATED 7.3MM X 70MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16075S SUP HCPCS C1713 73-16075S - SCREW CANNULATED 7.3MM X 75MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16080S SUP HCPCS C1713 73-16080S - SCREW CANNULATED 7.3MM X 80MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16085S SUP HCPCS C1713 73-16085S - SCREW CANNULATED 7.3MM X 85MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16090S SUP HCPCS C1713 73-16090S - SCREW CANNULATED 7.3MM X 90MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16095S SUP HCPCS C1713 73-16095S - SCREW CANNULATED 7.3MM X 95MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16100S SUP HCPCS C1713 73-16100S - SCREW CANNULATED 7.3MM X 100MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16105S SUP HCPCS C1713 73-16105S - SCREW CANNULATED 7.3MM X 105MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16110S SUP HCPCS C1713 73-16110S - SCREW CANNULATED 7.3MM X 110MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16115S SUP HCPCS C1713 73-16115S - SCREW CANNULATED 7.3MM X 115MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16120S SUP HCPCS C1713 73-16120S - SCREW CANNULATED 7.3MM X 120MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-16125S SUP HCPCS C1713 73-16125S - SCREW CANNULATED 7.3MM X 125MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-16130S SUP HCPCS C1713 73-16130S - SCREW CANNULATED 7.3MM X 130MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-16135S SUP HCPCS C1713 73-16135S - SCREW CANNULATED 7.3MM X 135MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-16140S SUP HCPCS C1713 73-16140S - SCREW CANNULATED 7.3MM X 140MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-16145S SUP HCPCS C1713 73-16145S - SCREW CANNULATED 7.3MM X 145MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-16150S SUP HCPCS C1713 73-16150S - SCREW CANNULATED 7.3MM X 150MM 16MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-1952 SUP HCPCS C1713 73-1952 - PLATE BN STERNALOCK BLU 8 HL STRG STRNM BOTH IP/OP "$2,562.50" "$1,896.00" $508.59 "$2,847.50" "$1,153.13" "$1,153.13" "$1,153.13" "$1,153.13" "$2,562.50" "$2,562.50" "$2,562.50" $534.09 "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" $534.05 "$2,562.50" "$2,847.50" "$1,263.31" "$2,562.50" "$2,847.50" "$2,562.50" "$2,562.50" "$1,921.88" "$2,562.50" "$2,562.50" "$2,562.50" "$1,281.25" "$1,281.25" "$2,029.50" "$2,562.50" "$2,050.00" "$1,153.13" $508.59 N/A "$1,486.25" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" N/A N/A 73-20-0110 SUP Custom 27803010 73-20-0110 - COMPONENT PATLR 1 10MM MEDIALIZED DOME SCORPIO X3 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 73-20-0510 SUP Custom 27803010 73-20-0510 - COMPONENT PATLR 5 10MM MEDIALIZED DOME SCORPIO X3 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 73-20-0710 SUP Custom 27803010 73-20-0710 - COMPONENT PATLR 7 MEDIALIZE DOME SCORPIO X3 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 73-20-0910 SUP Custom 27803010 73-20-0910 - COMPONENT PATLR 9 10MM MEDIALIZED DOME SCORPIO X3 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 73-20-2110 SUP Custom 27803010 73-20-2110 - COMPONENT PATLR 11 10MM CONCENTRIC DOME SCORPIO X3 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 73-20-2510 SUP Custom 27803010 73-20-2510 - COMPONENT PATLR 5 10MM CONCENTRIC DOME SCORPIO X3 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 73-20-2710 SUP Custom 27803010 73-20-2710 - COMPONENT PATLR 7 10MM CONCENTRIC DOME SCORPIO X3 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 73-20-2910 SUP Custom 27803010 73-20-2910 - COMPONENT PATLR 9 10MM CONCENTRIC DOME SCORPIO X3 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 73-20-3110 SUP Custom 27803010 73-20-3110 - COMPONENT PATLR 11 10MM UNIVERSAL DOME SCORPIO X3 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 73-20-3308 SUP Custom 27803010 73-20-3308 - COMPONENT PATLR UNIVERSAL DOME SCORPIO X3 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 73-20-3508 SUP Custom 27803010 73-20-3508 - COMPONENT PATLR 5 8MM UNIVERSAL DOME SCORPIO X3 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 73-20-3708 SUP Custom 27803010 73-20-3708 - COMPONENT PATLR 7 8MM UNIVERSAL DOME SCORPIO X3 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 73-20-3710 SUP Custom 27803010 73-20-3710 - COMPONENT PTLR 7 UNV DOME 34MM 10MM STRL SCRP X3 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 73-20-3910 SUP Custom 27803010 73-20-3910 - COMPONENT PTLR 9 UNV DOME 36MM 10MM STRL SCRP X3 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A 73-20-4026 SUP Custom 27803010 73-20-4026 - COMPONENT PATLR 26MM RECESSED SCORPIO X3 BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 73-20-4028 SUP Custom 27803010 73-20-4028 - COMPONENT PATLR 28MM SCORPIO X3 BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 73-20-4030 SUP Custom 27803010 73-20-4030 - COMPONENT PATLR 30MM RECESSED SCORPIO X3 BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 73-20-4032 SUP Custom 27803010 73-20-4032 - COMPONENT PATLR 32MM RECESSED SCORPIO X3 BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A 73-20-5030 SUP Custom 27803010 73-20-5030 - COMPONENT PATLR 30MM INSERT SCORPIO X3 BOTH IP/OP "$1,205.00" $892.00 $214.49 "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" $214.49 "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" $251.14 "$1,205.00" $482.00 "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" $903.75 "$1,205.00" "$1,205.00" "$1,205.00" $602.50 $602.50 $954.36 "$1,205.00" $964.00 $542.25 "$1,205.00" N/A $698.90 "$1,205.00" $723.00 "$1,205.00" "$1,205.00" "$1,205.00" N/A N/A 73-20-5032 SUP Custom 27803010 73-20-5032 - COMPONENT PATLR 32MM INSERT SCORPIO X3 BOTH IP/OP "$1,205.00" $892.00 $214.49 "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" $214.49 "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" $251.14 "$1,205.00" $482.00 "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" "$1,205.00" $903.75 "$1,205.00" "$1,205.00" "$1,205.00" $602.50 $602.50 $954.36 "$1,205.00" $964.00 $542.25 "$1,205.00" N/A $698.90 "$1,205.00" $723.00 "$1,205.00" "$1,205.00" "$1,205.00" N/A N/A 73-2110 SUP Custom 27803010 73-2110 - COMPONENT PATLR 11 10MM CONCENTRIC DOME SCORPIO N2/VAC BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 73-2408 SUP HCPCS C1713 73-2408 - SCREW BN 2.4MM 8MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC BOTH IP/OP $237.50 $176.00 $47.14 $275.00 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $110.00 $140.48 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 73-2410 SUP HCPCS C1713 73-2410 - SCREW BN 2.4MM 10MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC BOTH IP/OP $237.50 $176.00 $47.14 $275.00 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $275.00 $140.48 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 73-2412 SUP HCPCS C1713 73-2412 - SCREW BN 2.4MM 12MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC BOTH IP/OP $237.50 $176.00 $47.14 $275.00 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $275.00 $140.48 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $237.50 $237.50 N/A N/A 73-2414 SUP HCPCS C1713 73-2414 - SCREW BN 2.4MM 14MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC BOTH IP/OP $237.50 $176.00 $47.14 $275.00 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $275.00 $140.48 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A 73-2416 SUP HCPCS C1713 73-2416 - SCREW BN 2.4MM 16MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC BOTH IP/OP $237.50 $176.00 $47.14 $275.00 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $275.00 $140.48 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 73-2418 SUP HCPCS C1713 73-2418 - SCREW BN 2.4MM 18MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC BOTH IP/OP $237.50 $176.00 $47.14 $275.00 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $275.00 $140.48 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A 73-2420 SUP HCPCS C1713 73-2420 - SCREW BN 2.4MM 20MM AU STERNALOCK BLU SLF DRL LCK STRNM CANC BOTH IP/OP $237.50 $176.00 $47.14 $275.00 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $275.00 $140.48 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 73-2510 SUP Custom 27803010 73-2510 - COMPONENT PATLR 5 10MM CONCENTRIC DOME SCORPIO N2/VAC BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 73-2610 SUP Custom 27803010 73-2610 - INSERT TIBIAL 6 26MM 10MM INSET SCORPIO N2 VAC PATELLA BOTH IP/OP $851.00 $630.00 $151.48 $851.00 $851.00 $851.00 $851.00 $851.00 $851.00 $851.00 $151.48 $851.00 $851.00 $851.00 $851.00 $851.00 $851.00 $177.36 $851.00 $340.40 $851.00 $851.00 $851.00 $851.00 $851.00 $638.25 $851.00 $851.00 $851.00 $425.50 $425.50 $673.99 $851.00 $680.80 $382.95 $851.00 N/A $493.58 $851.00 $510.60 $851.00 $851.00 $851.00 N/A N/A 73-2622 SUP HCPCS C1713 73-2622 - PLATE BN SQ STERNALOCK BLU 4 HL STRNM BOTH IP/OP "$1,537.50" "$1,138.00" $305.16 "$1,707.50" $691.88 $691.88 $691.88 $691.88 "$1,537.50" "$1,537.50" "$1,537.50" $320.45 "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" $320.43 "$1,537.50" "$1,707.50" $909.43 "$1,537.50" "$1,707.50" "$1,537.50" "$1,537.50" "$1,153.13" "$1,537.50" "$1,537.50" "$1,537.50" $768.75 $768.75 "$1,217.70" "$1,537.50" "$1,230.00" $691.88 $305.16 N/A $891.75 "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" N/A N/A 73-2623 SUP HCPCS C1713 73-2623 - PLATE BN STERNALOCK BLU 8 HL STRNM BOTH IP/OP "$2,077.50" "$1,537.00" $412.33 "$2,307.50" $934.88 $934.88 $934.88 $934.88 "$2,077.50" "$2,077.50" "$2,077.50" $433.00 "$2,077.50" "$2,077.50" "$2,077.50" "$2,077.50" "$2,077.50" $432.97 "$2,077.50" "$2,307.50" "$1,228.84" "$2,077.50" "$2,307.50" "$2,077.50" "$2,077.50" "$1,558.13" "$2,077.50" "$2,077.50" "$2,077.50" "$1,038.75" "$1,038.75" "$1,645.38" "$2,077.50" "$1,662.00" $934.88 $412.33 N/A "$1,204.95" "$2,077.50" "$1,246.50" "$2,077.50" $432.95 "$2,077.50" N/A N/A 73-2632 SUP HCPCS C1713 73-2632 - PLATE BN NAR STERNALOCK BLU 12 HL STRNM 2.4MM SCR BOTH IP/OP "$2,175.00" "$1,610.00" $431.68 "$2,417.50" $978.75 $978.75 $978.75 $978.75 "$2,175.00" "$2,175.00" "$2,175.00" $453.32 "$2,175.00" "$2,175.00" "$2,175.00" "$2,175.00" "$2,175.00" $453.29 "$2,175.00" "$2,417.50" "$1,286.51" "$2,175.00" "$2,417.50" "$2,175.00" "$2,175.00" "$1,631.25" "$2,175.00" "$2,175.00" "$2,175.00" "$1,087.50" "$1,087.50" "$1,722.60" "$2,175.00" "$1,740.00" $978.75 $431.68 N/A "$1,261.50" "$2,175.00" "$2,175.00" "$2,175.00" $453.27 "$2,175.00" N/A N/A 73-2634 SUP HCPCS C1713 73-2634 - PLATE BN W STERNALOCK BLU 12 HL STRNM 2.4MM SCR BOTH IP/OP "$2,175.00" "$1,610.00" $431.68 "$2,417.50" $978.75 $978.75 $978.75 $978.75 "$2,175.00" "$2,175.00" "$2,175.00" $453.32 "$2,175.00" "$2,175.00" "$2,175.00" "$2,175.00" "$2,175.00" $453.29 "$2,175.00" "$2,417.50" "$1,286.51" "$2,175.00" "$2,417.50" "$2,175.00" "$2,175.00" "$1,631.25" "$2,175.00" "$2,175.00" "$2,175.00" "$1,087.50" "$1,087.50" "$1,722.60" "$2,175.00" "$1,740.00" $978.75 $431.68 N/A "$1,261.50" "$2,175.00" "$2,175.00" "$2,175.00" $453.27 "$2,175.00" N/A N/A 73-2636 SUP HCPCS C1713 73-2636 - PLATE BN STRG STERNALOCK BLU 4 HL STRNM 2.4MM SCR BOTH IP/OP "$1,537.50" "$1,138.00" $305.16 "$1,707.50" $691.88 $691.88 $691.88 $691.88 "$1,537.50" "$1,537.50" "$1,537.50" $320.45 "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" $320.43 "$1,537.50" "$1,707.50" $909.43 "$1,537.50" "$1,707.50" "$1,537.50" "$1,537.50" "$1,153.13" "$1,537.50" "$1,537.50" "$1,537.50" $768.75 $768.75 "$1,217.70" "$1,537.50" "$1,230.00" $691.88 $305.16 N/A $891.75 "$1,537.50" "$1,537.50" "$1,537.50" $320.42 "$1,537.50" N/A N/A 73-2643 SUP HCPCS C1713 73-2643 - PLATE BN 100D L STERNALOCK BLU 4 HL STRNM BOTH IP/OP "$1,537.50" "$1,138.00" $305.16 "$1,707.50" $691.88 $691.88 $691.88 $691.88 "$1,537.50" "$1,537.50" "$1,537.50" $320.45 "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" "$1,537.50" $320.43 "$1,537.50" $683.00 $909.43 "$1,537.50" "$1,707.50" "$1,537.50" "$1,537.50" "$1,153.13" "$1,537.50" "$1,537.50" "$1,537.50" $768.75 $768.75 "$1,217.70" "$1,537.50" "$1,230.00" $691.88 $305.16 N/A $891.75 "$1,537.50" "$1,537.50" "$1,537.50" $320.42 "$1,537.50" N/A N/A 73-2645 SUP HCPCS C1713 73-2645 - PLATE BN JL STERNALOCK BLU 8 HL STRNM PRM CLSR SYS BOTH IP/OP "$1,945.00" "$1,439.00" $386.03 "$2,160.00" $875.25 $875.25 $875.25 $875.25 "$1,945.00" "$1,945.00" "$1,945.00" $405.39 "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" $405.36 "$1,945.00" "$2,160.00" "$1,150.47" "$1,945.00" "$2,160.00" "$1,945.00" "$1,945.00" "$1,458.75" "$1,945.00" "$1,945.00" "$1,945.00" $972.50 $972.50 "$1,540.44" "$1,945.00" "$1,556.00" $875.25 $386.03 N/A "$1,128.10" "$1,945.00" "$1,945.00" "$1,945.00" $405.34 "$1,945.00" N/A N/A 73-2708 SUP HCPCS C1713 73-2708 - SCREW BN 2.7MM 8MM MAG STERNALOCK BLU SLF DRL LCK STRNM CANC BOTH IP/OP $237.50 $176.00 $47.14 $275.00 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $110.00 $140.48 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 73-2710 SUP HCPCS C1713 73-2710 - COMPONENT PTLR 7 CONC DOME 34/38MM 10MM SCRP N2/VAC BOTH IP/OP $237.50 $176.00 $47.14 $275.00 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $110.00 $140.48 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A 73-2712 SUP HCPCS C1713 73-2712 - SCREW BN 2.7MM 12MM MAG STERNALOCK BLU SLF DRL LCK STRNM BOTH IP/OP $237.50 $176.00 $47.14 $275.00 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $275.00 $140.48 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $237.50 $237.50 N/A N/A 73-2714 SUP HCPCS C1713 73-2714 - SCREW BN 2.7MM 14MM MAG STERNALOCK BLU SLF DRL LCK STRNM BOTH IP/OP $237.50 $176.00 $47.14 $275.00 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $275.00 $140.48 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A 73-2716 SUP HCPCS C1713 73-2716 - SCREW BN 2.7MM 16MM MAG STERNALOCK BLU SLF DRL LCK STRNM BOTH IP/OP $237.50 $176.00 $47.14 $275.00 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $275.00 $140.48 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $237.50 $237.50 N/A N/A 73-2718 SUP HCPCS C1713 73-2718 - SCREW BN 2.7MM 18MM MAG STERNALOCK BLU SLF DRL LCK STRNM BOTH IP/OP $237.50 $176.00 $47.14 $275.00 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $110.00 $140.48 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $237.50 $237.50 N/A N/A 73-2720 SUP HCPCS C1713 73-2720 - SCREW BN 2.7MM 20MM MAG STERNALOCK BLU SLF DRL LCK STRNM BOTH IP/OP $237.50 $176.00 $47.14 $275.00 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $110.00 $140.48 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 73-2810 SUP Custom 27803010 73-2810 - COMPONENT PATLR 8 28MM 10MM INSET SCORPIO BOTH IP/OP $851.00 $630.00 $151.48 $851.00 $851.00 $851.00 $851.00 $851.00 $851.00 $851.00 $151.48 $851.00 $851.00 $851.00 $851.00 $851.00 $851.00 $177.36 $851.00 $340.40 $851.00 $851.00 $851.00 $851.00 $851.00 $638.25 $851.00 $851.00 $851.00 $425.50 $425.50 $673.99 $851.00 $680.80 $382.95 $851.00 N/A $493.58 $851.00 $510.60 $851.00 $851.00 $851.00 N/A N/A 73281488/8ARM SUP HCPCS C1768 73281488/8ARM - GRAFT CARDIOVASCULAR PLEXUS 28MM 14x8x8 BOTH IP/OP "$6,612.50" "$4,893.00" "$1,312.42" "$6,612.50" "$2,975.63" "$2,975.63" "$2,975.63" "$2,975.63" "$6,612.50" "$6,612.50" "$6,612.50" "$1,378.21" "$6,612.50" "$6,612.50" "$6,612.50" "$6,612.50" "$6,612.50" "$1,378.12" "$6,612.50" "$6,612.50" "$3,259.96" "$6,612.50" "$6,612.50" "$6,612.50" "$6,612.50" "$4,959.38" "$6,612.50" "$6,612.50" "$6,612.50" "$3,306.25" "$3,306.25" "$5,237.10" "$6,612.50" "$5,290.00" "$2,975.63" "$1,312.42" N/A "$3,835.25" "$6,612.50" "$6,612.50" "$6,612.50" "$1,378.05" "$6,612.50" N/A N/A 73-2910 SUP Custom 27803010 73-2910 - COMPONENT PATLR 9 CONCENTRIC DOME 10MM SCORPIO N2/VAC BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 73-3010 SUP Custom 27803010 73-3010 - COMPONENT PATLR INSET SCORPIO BOTH IP/OP $851.00 $630.00 $151.48 $851.00 $851.00 $851.00 $851.00 $851.00 $851.00 $851.00 $151.48 $851.00 $851.00 $851.00 $851.00 $851.00 $851.00 $177.36 $851.00 $340.40 $851.00 $851.00 $851.00 $851.00 $851.00 $638.25 $851.00 $851.00 $851.00 $425.50 $425.50 $673.99 $851.00 $680.80 $382.95 $851.00 N/A $493.58 $851.00 $510.60 $851.00 $851.00 $851.00 N/A N/A 73301488/8ARM SUP HCPCS C1768 73301488/8ARM - 4 BRANCH TOTAL ARC GRAFT 30mm BOTH IP/OP "$6,612.50" "$4,893.00" "$1,312.42" "$6,612.50" "$2,975.63" "$2,975.63" "$2,975.63" "$2,975.63" "$6,612.50" "$6,612.50" "$6,612.50" "$1,378.21" "$6,612.50" "$6,612.50" "$6,612.50" "$6,612.50" "$6,612.50" "$1,378.12" "$6,612.50" "$6,612.50" "$3,259.96" "$6,612.50" "$6,612.50" "$6,612.50" "$6,612.50" "$4,959.38" "$6,612.50" "$6,612.50" "$6,612.50" "$3,306.25" "$3,306.25" "$5,237.10" "$6,612.50" "$5,290.00" "$2,975.63" "$1,312.42" N/A "$3,835.25" "$6,612.50" "$6,612.50" "$6,612.50" "$1,378.05" "$6,612.50" N/A N/A 73-3110 SUP Custom 27803010 73-3110 - COMPONENT PATLR 11MM 10MM UNIVERSAL DOME SCORPIO N2/VAC BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 73-32045S SUP HCPCS C1713 73-32045S - SCREW CANNULATED 7.3MM X 45MM 32MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32050S SUP HCPCS C1713 73-32050S - SCREW CANNULATED 7.3MM X 50MM 32MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32055S SUP HCPCS C1713 73-32055S - SCREW CANNULATED 7.3MM X 55MM 32MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32060S SUP HCPCS C1713 73-32060S - SCREW CANNULATED 7.3MM X 60MM 32MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32065S SUP HCPCS C1713 73-32065S - SCREW CANNULATED 7.3MM X 65MM 32MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32070S SUP HCPCS C1713 73-32070S - SCREW CANNULATED 7.3MM X 70MM 32MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32075S SUP HCPCS C1713 73-32075S - SCREW CANNULATED 7.3MM X 75MM 32MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-32080S SUP HCPCS C1713 73-32080S - SCREW CANNULATED 7.3MM X 80MM 32MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32085S SUP HCPCS C1713 73-32085S - SCREW CANNULATED 7.3MM X 85MM 32MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32090S SUP HCPCS C1713 73-32090S - SCREW CANNULATED 7.3MM X 90MM 32MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32095S SUP HCPCS C1713 73-32095S - SCREW CANNULATED 7.3MM X 95MM 32MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-3210 SUP Custom 27803010 73-3210 - COMPONENT PATLR 2 32MM 10MM INSET SCORPIO BOTH IP/OP $851.00 $630.00 $151.48 $851.00 $851.00 $851.00 $851.00 $851.00 $851.00 $851.00 $151.48 $851.00 $851.00 $851.00 $851.00 $851.00 $851.00 $177.36 $851.00 $340.40 $851.00 $851.00 $851.00 $851.00 $851.00 $638.25 $851.00 $851.00 $851.00 $425.50 $425.50 $673.99 $851.00 $680.80 $382.95 $851.00 N/A $493.58 $851.00 $510.60 $851.00 $851.00 $851.00 N/A N/A 73-32100S SUP HCPCS C1713 73-32100S - SCREW CANNULATED 7.3MM X 100MM 32MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32105S SUP HCPCS C1713 73-32105S - SCREW CANNULATED 7.3MM X 105MM 32MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32110S SUP HCPCS C1713 73-32110S - SCREW CANNULATED 7.3MM X 110MM 32MM THREAD BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32115S SUP HCPCS C1713 73-32115S - SCREW CANNULATED 32MM THREAD 7.3MM X 115MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32120S SUP HCPCS C1713 73-32120S - SCREW CANNULATED 32MM THREAD 7.3MM X 120MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-32125S SUP HCPCS C1713 73-32125S - SCREW CANNULATED 32MM THREAD 7.3MM X 125MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $94.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $235.00 $235.00 $48.97 $235.00 N/A N/A 73-32130S SUP HCPCS C1713 73-32130S - SCREW CANNULATED 32MM THREAD 7.3MM X 130MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32135S SUP HCPCS C1713 73-32135S - SCREW CANNULATED 32MM THREAD 7.3MM X 135MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32140S SUP HCPCS C1713 73-32140S - SCREW CANNULATED 32MM THREAD 7.3MM X 140MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32145S SUP HCPCS C1713 73-32145S - SCREW CANNULATED 32MM THREAD 7.3MM X 145MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-32150S SUP HCPCS C1713 73-32150S - SCREW CANNULATED 32MM THREAD 7.3MM X 150MM BOTH IP/OP $235.00 $174.00 $46.64 $235.00 $105.75 $105.75 $105.75 $105.75 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $235.00 $235.00 $235.00 $48.98 $235.00 $235.00 $139.00 $235.00 $235.00 $235.00 $235.00 $176.25 $235.00 $235.00 $235.00 $117.50 $117.50 $186.12 $235.00 $188.00 $105.75 $46.64 N/A $136.30 $235.00 $141.00 $235.00 $48.97 $235.00 N/A N/A 73-3308 SUP Custom 27803010 73-3308 - COMPONENT PATLR 3 8MM UNIVERSAL DOME SCORPIO N2/VAC BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 73-3508 SUP Custom 27803010 73-3508 - COMPONENT PATLR 5 32MM 5MM 8MM 4MM UNIVERSAL DOME PEGGED BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 73-3708 SUP Custom 27803010 73-3708 - COMPONENT PATLR 7 8MM 8MM UNIVERSAL DOME SCORPIO N2/VAC BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 73-3710 SUP Custom 27803010 73-3710 - COMPONENT PTLR 7 UNV DOME 34MM 10MM SCRP PG N2/VAC 1 AXIS KN BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 73-3910 SUP Custom 27803010 73-3910 - COMPONENT PTLR 5 UNV DOME 36MM 10MM SCRP PG N2/VAC 1 AXIS KN BOTH IP/OP $600.00 $444.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $106.80 $600.00 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $240.00 $600.00 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $600.00 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A 734024/8 SUP HCPCS C1768 734024/8 - GRAFT CARDIO 8MM 24MM 8MM 40CM 15CM ANTE-FLO VASCUTEK BOTH IP/OP "$3,225.00" "$2,387.00" $640.08 "$3,225.00" "$1,451.25" "$1,451.25" "$1,451.25" "$1,451.25" "$3,225.00" "$3,225.00" "$3,225.00" $672.17 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$3,225.00" "$1,589.93" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" $640.08 N/A "$1,870.50" "$3,225.00" "$3,225.00" "$3,225.00" $672.09 "$3,225.00" N/A N/A 734026/8 SUP HCPCS C1768 734026/8 - GRAFT CARDIO 8MM 26MM 8MM 40CM 15CM PERFUSION SIDE BRANCH BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 734028/8 SUP Custom 27803010 734028/8 - GRAFT CARDIO 8MM 28MM 8MM 40CM 15CM ANTE-FLO VASCUTEK BOTH IP/OP "$3,862.50" "$2,858.00" $687.53 "$3,862.50" "$3,862.50" "$3,862.50" "$3,862.50" "$3,862.50" "$3,862.50" "$3,862.50" $687.53 "$3,862.50" "$3,862.50" "$3,862.50" "$3,862.50" "$3,862.50" "$3,862.50" $804.99 "$3,862.50" "$1,545.00" "$3,862.50" "$3,862.50" "$3,862.50" "$3,862.50" "$3,862.50" "$2,896.88" "$3,862.50" "$3,862.50" "$3,862.50" "$1,931.25" "$1,931.25" "$3,059.10" "$3,862.50" "$3,090.00" "$1,738.13" "$3,862.50" N/A "$2,240.25" "$3,862.50" "$2,317.50" "$3,862.50" "$3,862.50" "$3,862.50" N/A N/A 734030/8 SUP HCPCS C1768 734030/8 - GRAFT CARDIO 30MM 8MM 40CM 15CM ANTEFLO PERFUSION SIDE BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 734032/8 SUP HCPCS C1768 734032/8 - GRAFT CARDIO 32MM 8MM 40CM 15CM PERFUSION SIDE BRANCH GRAFT BOTH IP/OP "$4,050.00" "$2,997.00" $803.82 "$4,050.00" "$1,822.50" "$1,822.50" "$1,822.50" "$1,822.50" "$4,050.00" "$4,050.00" "$4,050.00" $844.12 "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.06 "$4,050.00" "$4,050.00" "$1,996.65" "$4,050.00" "$4,050.00" "$4,050.00" "$4,050.00" "$3,037.50" "$4,050.00" "$4,050.00" "$4,050.00" "$2,025.00" "$2,025.00" "$3,207.60" "$4,050.00" "$3,240.00" "$1,822.50" $803.82 N/A "$2,349.00" "$4,050.00" "$4,050.00" "$4,050.00" $844.02 "$4,050.00" N/A N/A 734034/8 SUP HCPCS C1768 734034/8 - GRAFT CARDIO 34MM 8MM 40CM 15CM ANTEFLO PERFUSION SIDE BOTH IP/OP "$3,387.50" "$2,507.00" $672.33 "$3,387.50" "$1,524.38" "$1,524.38" "$1,524.38" "$1,524.38" "$3,387.50" "$3,387.50" "$3,387.50" $706.04 "$3,387.50" "$3,387.50" "$3,387.50" "$3,387.50" "$3,387.50" $705.99 "$3,387.50" "$3,387.50" "$1,670.04" "$3,387.50" "$3,387.50" "$3,387.50" "$3,387.50" "$2,540.63" "$3,387.50" "$3,387.50" "$3,387.50" "$1,693.75" "$1,693.75" "$2,682.90" "$3,387.50" "$2,710.00" "$1,524.38" $672.33 N/A "$1,964.75" "$3,387.50" "$3,387.50" "$3,387.50" $705.96 "$3,387.50" N/A N/A 74-2-0510 SUP Custom 27803010 74-2-0510 - INSERT TIBIAL 5 10MM CRUC RET SCORPIO ALL POLY KNEE BOTH IP/OP "$1,431.00" "$1,059.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $298.24 "$1,431.00" $572.40 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,073.25" "$1,431.00" "$1,431.00" "$1,431.00" $715.50 $715.50 "$1,133.35" "$1,431.00" "$1,144.80" $643.95 "$1,431.00" N/A $829.98 "$1,431.00" $858.60 "$1,431.00" "$1,431.00" "$1,431.00" N/A N/A 74-2-0512 SUP Custom 27803010 74-2-0512 - INSERT TIBIAL 5 12MM CRUC RET SCORPIO ALL POLY N2 VAC KNEE BOTH IP/OP "$1,431.00" "$1,059.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $298.24 "$1,431.00" $572.40 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,073.25" "$1,431.00" "$1,431.00" "$1,431.00" $715.50 $715.50 "$1,133.35" "$1,431.00" "$1,144.80" $643.95 "$1,431.00" N/A $829.98 "$1,431.00" $858.60 "$1,431.00" "$1,431.00" "$1,431.00" N/A N/A 74-2-0515 SUP HCPCS C1776 74-2-0515 - COMPONENT TIBIAL 5 15MM CRUC RET SCORPIO ALL POLY KNEE BOTH IP/OP "$1,431.00" "$1,059.00" $284.02 "$1,431.00" $643.95 $643.95 $643.95 $643.95 "$1,431.00" "$1,431.00" "$1,431.00" $298.26 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $298.24 "$1,431.00" "$1,431.00" $846.44 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,073.25" "$1,431.00" "$1,431.00" "$1,431.00" $715.50 $715.50 "$1,133.35" "$1,431.00" "$1,144.80" $643.95 $284.02 N/A $829.98 "$1,431.00" "$1,431.00" "$1,431.00" $298.22 "$1,431.00" N/A N/A 74-2-0710 SUP Custom 27803010 74-2-0710 - INSERT TIBIAL 7 10MM CRUC RET STYLE SCORPIO POLYETHYLENE N2 BOTH IP/OP "$1,431.00" "$1,059.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $298.24 "$1,431.00" $572.40 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,073.25" "$1,431.00" "$1,431.00" "$1,431.00" $715.50 $715.50 "$1,133.35" "$1,431.00" "$1,144.80" $643.95 "$1,431.00" N/A $829.98 "$1,431.00" $858.60 "$1,431.00" "$1,431.00" "$1,431.00" N/A N/A 74-2-0712 SUP Custom 27803010 74-2-0712 - INSERT TIBIAL 7 12MM CRUC RET SCORPIO ALL POLY N2 VAC KNEE BOTH IP/OP "$1,431.00" "$1,059.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $298.24 "$1,431.00" $572.40 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,073.25" "$1,431.00" "$1,431.00" "$1,431.00" $715.50 $715.50 "$1,133.35" "$1,431.00" "$1,144.80" $643.95 "$1,431.00" N/A $829.98 "$1,431.00" $858.60 "$1,431.00" "$1,431.00" "$1,431.00" N/A N/A 74-2-0715 SUP Custom 27803010 74-2-0715 - INSERT TIBIAL 7 15MM CRUC RET SCORPIO ALL POLY N2 VAC KNEE BOTH IP/OP "$1,431.00" "$1,059.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $298.24 "$1,431.00" $572.40 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,073.25" "$1,431.00" "$1,431.00" "$1,431.00" $715.50 $715.50 "$1,133.35" "$1,431.00" "$1,144.80" $643.95 "$1,431.00" N/A $829.98 "$1,431.00" $858.60 "$1,431.00" "$1,431.00" "$1,431.00" N/A N/A 74-2-0910 SUP HCPCS C1776 74-2-0910 - COMPONENT TIBIAL 9 10MM CRUC RET SCORPIO ALL POLY KNEE BOTH IP/OP "$1,431.00" "$1,059.00" $284.02 "$1,431.00" $643.95 $643.95 $643.95 $643.95 "$1,431.00" "$1,431.00" "$1,431.00" $298.26 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $298.24 "$1,431.00" "$1,431.00" $846.44 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,073.25" "$1,431.00" "$1,431.00" "$1,431.00" $715.50 $715.50 "$1,133.35" "$1,431.00" "$1,144.80" $643.95 $284.02 N/A $829.98 "$1,431.00" "$1,431.00" "$1,431.00" $298.22 "$1,431.00" N/A N/A 74-2-0912 SUP Custom 27803010 74-2-0912 - INSERT TIBIAL 9 12MM CRUC RET SCORPIO ALL POLY N2 VAC KNEE BOTH IP/OP "$1,431.00" "$1,059.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $298.24 "$1,431.00" $572.40 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,073.25" "$1,431.00" "$1,431.00" "$1,431.00" $715.50 $715.50 "$1,133.35" "$1,431.00" "$1,144.80" $643.95 "$1,431.00" N/A $829.98 "$1,431.00" $858.60 "$1,431.00" "$1,431.00" "$1,431.00" N/A N/A 74-2-0915 SUP Custom 27803010 74-2-0915 - INSERT TIBIAL 9 15MM CRUC RET SCORPIO ALL POLY N2 VAC KNEE BOTH IP/OP "$1,431.00" "$1,059.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $298.24 "$1,431.00" $572.40 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,073.25" "$1,431.00" "$1,431.00" "$1,431.00" $715.50 $715.50 "$1,133.35" "$1,431.00" "$1,144.80" $643.95 "$1,431.00" N/A $829.98 "$1,431.00" $858.60 "$1,431.00" "$1,431.00" "$1,431.00" N/A N/A 74-2-1110 SUP Custom 27803010 74-2-1110 - INSERT TIBIAL 11 10MM CRUC RET SCORPIO ALL POLY N2 VAC KNEE BOTH IP/OP "$1,431.00" "$1,059.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $298.24 "$1,431.00" $572.40 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,073.25" "$1,431.00" "$1,431.00" "$1,431.00" $715.50 $715.50 "$1,133.35" "$1,431.00" "$1,144.80" $643.95 "$1,431.00" N/A $829.98 "$1,431.00" $858.60 "$1,431.00" "$1,431.00" "$1,431.00" N/A N/A 74-2-1112 SUP Custom 27803010 74-2-1112 - INSERT TIBIAL 11 12MM CRUC RET SCORPIO ALL POLY N2 VAC KNEE BOTH IP/OP "$1,431.00" "$1,059.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $298.24 "$1,431.00" $572.40 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,073.25" "$1,431.00" "$1,431.00" "$1,431.00" $715.50 $715.50 "$1,133.35" "$1,431.00" "$1,144.80" $643.95 "$1,431.00" N/A $829.98 "$1,431.00" $858.60 "$1,431.00" "$1,431.00" "$1,431.00" N/A N/A 74-2-1115 SUP Custom 27803010 74-2-1115 - INSERT TIBIAL 11 15MM CRUC RET SCORPIO ALL POLY N2 VAC KNEE BOTH IP/OP "$1,431.00" "$1,059.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $254.72 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" $298.24 "$1,431.00" $572.40 "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,431.00" "$1,073.25" "$1,431.00" "$1,431.00" "$1,431.00" $715.50 $715.50 "$1,133.35" "$1,431.00" "$1,144.80" $643.95 "$1,431.00" N/A $829.98 "$1,431.00" $858.60 "$1,431.00" "$1,431.00" "$1,431.00" N/A N/A 742-11-42A SUP HCPCS C1776 742-11-42A - SHELL ACTB A 42MM STRL TRDNT II PSL 3 HL CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 742-11-44B SUP HCPCS C1776 742-11-44B - SHELL ACTB B 44MM STRL TRDNT II PSL 3 HL CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 742-11-46C SUP HCPCS C1776 742-11-46C - SHELL ACTB C 46MM STRL TRDNT II PSL 3 HL CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 742-11-48D SUP HCPCS C1776 742-11-48D - SHELL ACTB D 48MM STRL TRDNT II PSL CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 742-11-50D SUP HCPCS C1776 742-11-50D - SHELL ACTB D 50MM STRL TRDNT II PSL CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 742-11-52E SUP HCPCS C1776 742-11-52E - SHELL ACTB E 52MM STRL TRDNT II PSL CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 742-11-54E SUP HCPCS C1776 742-11-54E - SHELL ACTB E 54MM STRL TRDNT II PSL CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 742-11-56F SUP HCPCS C1776 742-11-56F - SHELL ACTB F 56MM STRL TRDNT II PSL CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 742-11-58F SUP HCPCS C1776 742-11-58F - SHELL ACTB F 58MM STRL TRDNT II PSL CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 742-11-60G SUP HCPCS C1776 742-11-60G - SHELL ACTB G 60MM STRL TRDNT II PSL CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 742-11-62G SUP HCPCS C1776 742-11-62G - SHELL ACTB G 62MM STRL TRDNT II PSL CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" $880.00 "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 742-11-64H SUP HCPCS C1776 742-11-64H - SHELL ACTB H 64MM STRL TRDNT II PSL CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 742-11-66H SUP HCPCS C1776 742-11-66H - SHELL ACTB H 66MM STRL TRDNT II PSL CH HA HIP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A 74-3-0510 SUP HCPCS C1776 74-3-0510 - COMPONENT TIBIAL 5 10MM POSTERIOR STABILIZE ALL POLY KNEE BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $661.50 $661.50 $661.50 $661.50 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" $306.36 "$1,470.00" $588.00 $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $661.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A 74-3-0512 SUP HCPCS C1776 74-3-0512 - COMPONENT TIBIAL 5 12MM POSTERIOR STABILIZE ALL POLY KNEE BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $661.50 $661.50 $661.50 $661.50 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" $306.36 "$1,470.00" "$1,470.00" $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $661.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A 74-3-0515 SUP HCPCS C1776 74-3-0515 - COMPONENT TIBIAL 5 15MM POSTERIOR STABILIZE SCORPIO ALL POLY BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $661.50 $661.50 $661.50 $661.50 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" $306.36 "$1,470.00" "$1,470.00" $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $661.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A 74-3-0710 SUP HCPCS C1776 74-3-0710 - COMPONENT TIBIAL 7 10MM POSTERIOR STABILIZED STYLE ALL POLY BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $661.50 $661.50 $661.50 $661.50 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" $306.36 "$1,470.00" $588.00 $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $661.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A 74-3-0712 SUP HCPCS C1776 74-3-0712 - COMPONENT TIBIAL 7 12MM POSTERIOR STABILIZE ALL POLY KNEE BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $661.50 $661.50 $661.50 $661.50 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" $306.36 "$1,470.00" $588.00 $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $661.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A 74-3-0715 SUP HCPCS C1776 74-3-0715 - COMPONENT TIBIAL 7 15MM POSTERIOR STABILIZE ALL POLY KNEE BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $661.50 $661.50 $661.50 $661.50 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" $306.36 "$1,470.00" $588.00 $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $661.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A 74-3-0910 SUP HCPCS C1776 74-3-0910 - COMPONENT TIBIAL 9 10MM POSTERIOR STABILIZE ALL POLY KNEE BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $661.50 $661.50 $661.50 $661.50 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" $306.36 "$1,470.00" "$1,470.00" $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $661.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A 74-3-0912 SUP HCPCS C1776 74-3-0912 - COMPONENT TIBIAL 9 12MM POSTERIOR STABILIZE ALL POLY KNEE BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $661.50 $661.50 $661.50 $661.50 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" $306.36 "$1,470.00" "$1,470.00" $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $661.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A 74-3-0915 SUP HCPCS C1776 74-3-0915 - COMPONENT TIBIAL 9 15MM POSTERIOR STABILIZE ALL POLY KNEE BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $661.50 $661.50 $661.50 $661.50 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" $306.36 "$1,470.00" "$1,470.00" $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $661.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A 74-3-1110 SUP HCPCS C1776 74-3-1110 - COMPONENT TIBIAL 11 10MM POSTERIOR STABILIZE ALL POLY KNEE BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $661.50 $661.50 $661.50 $661.50 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" $306.36 "$1,470.00" $588.00 $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $661.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A 74-3-1112 SUP HCPCS C1776 74-3-1112 - COMPONENT TIBIAL 11 12MM POSTERIOR STABILIZE ALL POLY KNEE BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $661.50 $661.50 $661.50 $661.50 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" $306.36 "$1,470.00" $588.00 $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $661.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A 74-3-1115 SUP HCPCS C1776 74-3-1115 - COMPONENT TIBIAL 11 15MM POSTERIOR STABILIZE ALL POLY KNEE BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $661.50 $661.50 $661.50 $661.50 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" $306.36 "$1,470.00" $588.00 $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $661.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A 74402006N SUP HCPCS C1713 74402006N - SCREW BN T6 2MM 1.4MM 6MM NS VLP MN-MOD ST TI OSTEOPENIA BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402007N SUP HCPCS C1713 74402007N - SCREW BN T6 2MM 1.4MM 7MM NS VLP MN-MOD ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402008N SUP HCPCS C1713 74402008N - SCREW BN T6 2MM 1.4MM 8MM NS VLP MN-MOD ST DRV MECH TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402009N SUP HCPCS C1713 74402009N - SCREW BN T6 2MM 1.4MM 9MM NS VLP MN-MOD ST TI OSTEOPENIA BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402010N SUP HCPCS C1713 74402010N - SCREW BN T6 2MM 1.4MM 10MM NS VLP MN-MOD ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402011N SUP HCPCS C1713 74402011N - SCREW BN T6 2MM 1.4MM 11MM NS VLP MN-MOD ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402012N SUP HCPCS C1713 74402012N - SCREW BN 2MM 1.4MM 12MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402013N SUP HCPCS C1713 74402013N - SCREW BN T6 2MM 1.4MM 13MM NS VLP MN-MOD ST TI OSTEOPENIA BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402014N SUP HCPCS C1713 74402014N - SCREW BN 2MM 1.4MM 14MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402016N SUP HCPCS C1713 74402016N - SCREW BN 2MM 1.4MM 16MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402018N SUP HCPCS C1713 74402018N - SCREW BN 2MM 1.4MM 18MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402020N SUP HCPCS C1713 74402020N - SCREW BN 2MM 1.4MM 20MM PUR NS VLP MN-MOD T6 DRVR ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402022N SUP HCPCS C1713 74402022N - SCREW BN T6 2MM 1.4MM 22MM NS VLP MN-MOD ST TI OSTEOPENIA BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402024N SUP HCPCS C1713 74402024N - SCREW BN T6 2MM 1.4MM 24MM NS VLP MN-MOD ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402026N SUP HCPCS C1713 74402026N - SCREW BN T6 2MM 1.4MM 26MM NS VLP MN-MOD ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402028N SUP HCPCS C1713 74402028N - SCREW BN T6 2MM 1.4MM 28MM NS VLP MN-MOD ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $112.48 $112.48 N/A N/A 74402030N SUP HCPCS C1713 74402030N - SCREW BN T6 2MM 1.4MM 30MM NS VLP MN-MOD ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $112.48 $112.48 N/A N/A 74402032N SUP HCPCS C1713 74402032N - SCREW BN T6 2MM 1.4MM 32MM NS VLP MN-MOD ST TI OSTEOPENIA BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402034N SUP HCPCS C1713 74402034N - SCREW BN T6 2MM 1.4MM 34MM NS VLP MN-MOD ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402036N SUP HCPCS C1713 74402036N - SCREW BN T6 2MM 1.4MM 36MM NS VLP MN-MOD ST TI OSTEOPENIA BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402406N SUP HCPCS C1713 74402406N - SCREW BN T7 2.4MM 1.7MM 6MM NS VLP MN-MOD ST TI OSTEOPENIA BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402407N SUP HCPCS C1713 74402407N - SCREW BN T7 2.4MM 1.7MM 7MM NS VLP MN-MOD ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402409N SUP HCPCS C1713 74402409N - SCREW BN T7 2.4MM 1.7MM 9MM GRN NS VLP ST LO HD PRFL TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402410N SUP HCPCS C1713 74402410N - SCREW BN T7 2.4MM 1.7MM 10MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402411N SUP HCPCS C1713 74402411N - SCREW BN T7 2.4MM 1.7MM 11MM NS VLP MN-MOD ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402412N SUP HCPCS C1713 74402412N - SCREW BN 2.4MM 1.7MM 12MM GRN NS VLP MN-MOD T7 DRVR ST TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $112.48 $112.48 N/A N/A 74402413N SUP HCPCS C1713 74402413N - SCREW BN T7 2.4MM 1.7MM 13MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402414N SUP HCPCS C1713 74402414N - SCREW BN 2.4MM 1.7MM 14MM GRN NS VLP MN-MOD T7 DRVR ST TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402415N SUP HCPCS C1713 74402415N - SCREW BN 2.4MM 1.7MM 15MM GRN NS VLP MN-MOD T7 DRVR ST TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $112.48 $112.48 N/A N/A 74402416N SUP HCPCS C1713 74402416N - SCREW BN T7 2.4MM 1.7MM 16MM GRN NS VLP ST LOPRFL HD TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402418N SUP HCPCS C1713 74402418N - SCREW BN T7 2.4MM 1.7MM 18MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402420N SUP HCPCS C1713 74402420N - SCREW BN T7 2.4MM 1.7MM 20MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402422N SUP HCPCS C1713 74402422N - SCREW BN T7 2.4MM 1.7MM 22MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402424N SUP HCPCS C1713 74402424N - SCREW BN T7 2.4MM 1.7MM 24MM GRN NS VLP ST LOPRFL HD TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402426N SUP HCPCS C1713 74402426N - SCREW BN T7 2.4MM 26MM NS VLP MN-MOD ST TI CORT BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402428N SUP HCPCS C1713 74402428N - SCREW BN T7 2.4MM 1.7MM 28MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402430N SUP HCPCS C1713 74402430N - SCREW BN T7 2.4MM 1.7MM 30MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402432N SUP HCPCS C1713 74402432N - SCREW BN T7 2.4MM 1.7MM 32MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402434N SUP HCPCS C1713 74402434N - SCREW BN T7 2.4MM 1.7MM 34MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402436N SUP HCPCS C1713 74402436N - SCREW BN T7 2.4MM 1.7MM 36MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402438N SUP HCPCS C1713 74402438N - SCREW BN T7 2.4MM 1.7MM 38MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402440N SUP HCPCS C1713 74402440N - SCREW BN T7 2.4MM 1.7MM 40MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74402442N SUP HCPCS C1713 74402442N - SCREW BN T7 2.4MM 1.7MM 42MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $112.48 $112.48 N/A N/A 74402444N SUP HCPCS C1713 74402444N - SCREW BN T7 2.4MM 1.7MM 44MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $112.48 $112.48 $23.44 $112.48 N/A N/A 74402446N SUP HCPCS C1713 74402446N - SCREW BN T7 2.4MM 1.7MM 46MM GRN NS VLP ST LO HD PRFL TI BOTH IP/OP $112.50 $83.00 $22.32 $112.48 $50.62 $50.62 $50.62 $50.62 $112.48 $112.48 $112.48 $23.44 $112.48 $112.48 $112.48 $112.48 $112.48 $23.44 $112.48 $44.99 $66.53 $112.48 $112.48 $112.48 $112.48 $84.38 $112.48 $112.48 $112.48 $56.24 $56.24 $89.08 $112.48 $89.98 $50.62 $22.32 N/A $65.25 $112.48 $67.49 $112.48 $23.44 $112.48 N/A N/A 74412006N SUP HCPCS C1713 74412006N - SCREW BN T6 2MM 1.4MM 6MM PUR NS VLP LCK ST LOPRFL HD TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412007N SUP HCPCS C1713 74412007N - SCREW BN T6 2MM 1.4MM 7MM PUR NS VLP LCK ST LOPRFL HD TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412008N SUP HCPCS C1713 74412008N - SCREW BN 2MM 8MM NS VLP LCK ST T6 DRVR TI SM BN BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412009N SUP HCPCS C1713 74412009N - SCREW BN T6 2MM 1.4MM 9MM PUR NS VLP LCK ST LOPRFL HD TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412010N SUP HCPCS C1713 74412010N - SCREW BN 2MM 10MM NS VLP LCK ST T6 DRVR TI SM BN BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412011N SUP HCPCS C1713 74412011N - SCREW BN 2MM 1.4MM 11MM PUR NS VLP MN-MOD T6 DRVR ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412012N SUP HCPCS C1713 74412012N - SCREW BN 2MM 1.4MM 12MM PUR NS VLP MN-MOD T6 DRVR ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412013N SUP HCPCS C1713 74412013N - SCREW BN T6 2MM 1.4MM 13MM PUR NS VLP LCK ST LOPRFL HD TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412014N SUP HCPCS C1713 74412014N - SCREW BN 2MM 14MM NS VLP LCK ST T6 DRVR TI SM BN BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412016N SUP HCPCS C1713 74412016N - SCREW BN T6 2MM 1.4MM 16MM PUR NS VLP LCK ST LOPRFL HD TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412018N SUP HCPCS C1713 74412018N - SCREW BN T6 2MM 1.4MM 18MM PUR NS VLP LCK ST LOPRFL HD TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $237.88 $237.88 N/A N/A 74412020N SUP HCPCS C1713 74412020N - SCREW BN T6 2MM 1.4MM 20MM PUR NS VLP LCK ST LOPRFL HD TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412022N SUP HCPCS C1713 74412022N - SCREW BN T6 2MM 1.4MM 22MM PUR NS VLP LCK ST LOPRFL HD TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412024N SUP HCPCS C1713 74412024N - SCREW BN T6 2MM 1.4MM 24MM PUR NS VLP LCK ST LOPRFL HD TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412026N SUP HCPCS C1713 74412026N - SCREW BN T6 2MM 1.4MM 26MM PUR NS VLP LCK ST LO HD PRFL TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412028N SUP HCPCS C1713 74412028N - SCREW BN T6 2MM 1.4MM 28MM PUR NS VLP LCK ST LOPRFL HD TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412030N SUP HCPCS C1713 74412030N - SCREW BN T6 2MM 1.4MM 30MM PUR NS VLP LCK ST LOPRFL HD TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412032N SUP HCPCS C1713 74412032N - SCREW BN T6 2MM 1.4MM 32MM PUR NS VLP LCK ST LO HD PRFL TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412034N SUP HCPCS C1713 74412034N - SCREW BN T6 2MM 1.4MM 34MM PUR NS VLP LCK ST LOPRFL HD TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412036N SUP HCPCS C1713 74412036N - SCREW BN T6 2MM 1.4MM 36MM PUR NS VLP LCK ST LOPRFL HD TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412406N SUP HCPCS C1713 74412406N - SCREW BN T7 2.4MM 1.7MM 6MM NS VLP MN-MOD ST LCK TI CORT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412407N SUP HCPCS C1713 74412407N - SCREW BN T7 2.4MM 1.7MM 7MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412408N SUP HCPCS C1713 74412408N - SCREW BN T7 2.4MM 8MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412409N SUP HCPCS C1713 74412409N - SCREW BN T7 2.4MM 1.7MM 9MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412410N SUP HCPCS C1713 74412410N - SCREW BN T7 2.4MM 10MM NS VLP MN-MOD ST LCK LOPRFL HD TI FT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412411N SUP HCPCS C1713 74412411N - SCREW BN T7 2.4MM 1.7MM 11MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412412N SUP HCPCS C1713 74412412N - SCREW BN T7 2.4MM 1.7MM 12MM NS VLP ST LCK TI CORT MN-MOD SM BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412413N SUP HCPCS C1713 74412413N - SCREW BN T7 2.4MM 1.7MM 13MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412414N SUP HCPCS C1713 74412414N - SCREW BN T7 2.4MM 1.7MM 14MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412415N SUP HCPCS C1713 74412415N - SCREW BN T7 2.4MM 1.7MM 15MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412416N SUP HCPCS C1713 74412416N - SCREW BN 2.4MM 1.7MM 16MM GRN NS VLP MN-MOD T7 DRVR ST LCK BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412418N SUP HCPCS C1713 74412418N - SCREW BN T7 2.4MM 18MM NS VLP ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412420N SUP HCPCS C1713 74412420N - SCREW BN T7 2.4MM 1.7MM 20MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412422N SUP HCPCS C1713 74412422N - SCREW BN T7 2.4MM 22MM GRN NS VLP ST DRVR TI FT SM BN PLT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412424N SUP HCPCS C1713 74412424N - SCREW BN T7 2.4MM 24MM GRN NS VLP ST DRVR TI FT SM BN PLT BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $237.88 $237.88 N/A N/A 74412426N SUP HCPCS C1713 74412426N - SCREW BN T7 2.4MM 1.7MM 26MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412428N SUP HCPCS C1713 74412428N - SCREW BN T7 2.4MM 1.7MM 28MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412430N SUP HCPCS C1713 74412430N - SCREW BN T7 2.4MM 1.7MM 30MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412432N SUP HCPCS C1713 74412432N - SCREW BN T7 2.4MM 1.7MM 32MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $237.88 $237.88 N/A N/A 74412434N SUP HCPCS C1713 74412434N - SCREW BN T7 2.4MM 1.7MM 34MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $237.88 $237.88 $49.57 $237.88 N/A N/A 74412436N SUP HCPCS C1713 74412436N - SCREW BN T7 2.4MM 1.7MM 36MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412438N SUP HCPCS C1713 74412438N - SCREW BN T7 2.4MM 1.7MM 38MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412440N SUP HCPCS C1713 74412440N - SCREW BN T7 2.4MM 1.7MM 40MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $49.57 $237.88 N/A N/A 74412442N SUP HCPCS C1713 74412442N - SCREW BN T7 2.4MM 1.7MM 42MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $237.88 $237.88 N/A N/A 74412444N SUP HCPCS C1713 74412444N - SCREW BN T7 2.4MM 1.7MM 44MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $237.88 $237.88 N/A N/A 74412446N SUP HCPCS C1713 74412446N - SCREW BN T7 2.4MM 1.7MM 46MM NS VLP MN-MOD ST LCK TI BOTH IP/OP $238.00 $176.00 $47.21 $237.88 $107.05 $107.05 $107.05 $107.05 $237.88 $237.88 $237.88 $49.58 $237.88 $237.88 $237.88 $237.88 $237.88 $49.58 $237.88 $95.15 $140.71 $237.88 $237.88 $237.88 $237.88 $178.50 $237.88 $237.88 $237.88 $118.94 $118.94 $188.40 $237.88 $190.30 $107.05 $47.21 N/A $138.04 $237.88 $142.73 $237.88 $237.88 $237.88 N/A N/A 746F8 SUP HCPCS C1751 746F8 - CATHETER PA STD 8FR 110CM SG C VIP TD BOTH IP/OP "$1,007.00" $745.00 $199.80 "$1,006.70" $453.02 $453.02 $453.02 $453.02 "$1,006.70" "$1,006.70" "$1,006.70" $209.82 "$1,006.70" "$1,006.70" "$1,006.70" "$1,006.70" "$1,006.70" $209.81 "$1,006.70" "$1,006.70" $595.46 "$1,006.70" "$1,006.70" "$1,006.70" "$1,006.70" $755.25 "$1,006.70" "$1,006.70" "$1,006.70" $503.35 $503.35 $797.31 "$1,006.70" $805.36 $453.02 $199.80 N/A $584.06 "$1,006.70" "$1,006.70" "$1,006.70" $209.80 "$1,006.70" N/A N/A 746HF8 SUP Custom 27203010 746HF8 - CATHETER ART LN 8FR 110CM SG C VIP 7 LUM CCO AMC THRMBSH BOTH IP/OP $537.50 $398.00 $95.68 $537.50 $537.50 $537.50 $537.50 $537.50 $537.50 $537.50 $95.68 $537.50 $537.50 $398.93 $398.93 $414.31 $280.04 $112.02 $537.50 $215.00 $537.50 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $349.38 $537.50 N/A $311.75 $537.50 $322.50 $537.50 $537.50 $537.50 N/A N/A 74703-02 SUP Custom 27203010 74703-02 - TUBING PACK BOTH IP/OP $636.50 $471.00 $113.25 $636.25 $636.25 $636.25 $636.25 $636.25 $636.25 $636.25 $113.25 $636.25 $636.25 $472.22 $472.22 $490.42 $331.49 $132.60 $636.25 $254.50 $636.25 $636.25 $636.25 $636.25 $636.25 $477.38 $636.25 $636.25 $636.25 $318.13 $318.13 $503.91 $636.25 $509.00 $413.56 $636.25 N/A $369.17 $636.25 $381.75 $636.25 $636.25 $636.25 N/A N/A 7492-0108 SUP Custom 27803010 7492-0108 - INSERT TIBIAL 1 8MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0110 SUP Custom 27803010 7492-0110 - INSERT TIBIAL 1 10MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0112 SUP Custom 27803010 7492-0112 - INSERT TIBIAL 1 12MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0115 SUP Custom 27803010 7492-0115 - INSERT TIBIAL 1 15MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0118 SUP Custom 27803010 7492-0118 - INSERT TIBIAL 1 18MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0121 SUP Custom 27803010 7492-0121 - INSERT TIBIAL 1 21MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0124 SUP Custom 27803010 7492-0124 - INSERT TIBIAL 1 24MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,347.00" $997.00 $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $280.73 "$1,347.00" $538.80 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,010.25" "$1,347.00" "$1,347.00" "$1,347.00" $673.50 $673.50 "$1,066.82" "$1,347.00" "$1,077.60" $606.15 "$1,347.00" N/A $781.26 "$1,347.00" $808.20 "$1,347.00" "$1,347.00" "$1,347.00" N/A N/A 7492-0308 SUP Custom 27803010 7492-0308 - INSERT TIBIAL 3 8MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0310 SUP Custom 27803010 7492-0310 - INSERT TIBIAL 3 10MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0312 SUP Custom 27803010 7492-0312 - INSERT TIBIAL 3 12MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0315 SUP Custom 27803010 7492-0315 - INSERT TIBIAL 3 15MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0318 SUP Custom 27803010 7492-0318 - INSERT TIBIAL 3 18MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0321 SUP Custom 27803010 7492-0321 - INSERT TIBIAL 3 21MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0324 SUP Custom 27803010 7492-0324 - INSERT TIBIAL 3 24MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0508 SUP Custom 27803010 7492-0508 - INSERT TIBIAL 5 8MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0510 SUP Custom 27803010 7492-0510 - INSERT TIBIAL 5 10MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0512 SUP Custom 27803010 7492-0512 - INSERT TIBIAL 5 12MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0515 SUP Custom 27803010 7492-0515 - INSERT TIBIAL 5 15MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,347.00" $997.00 $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $280.73 "$1,347.00" $538.80 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,010.25" "$1,347.00" "$1,347.00" "$1,347.00" $673.50 $673.50 "$1,066.82" "$1,347.00" "$1,077.60" $606.15 "$1,347.00" N/A $781.26 "$1,347.00" $808.20 "$1,347.00" "$1,347.00" "$1,347.00" N/A N/A 7492-0518 SUP Custom 27803010 7492-0518 - INSERT TIBIAL 5 18MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,347.00" $997.00 $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $280.73 "$1,347.00" $538.80 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,010.25" "$1,347.00" "$1,347.00" "$1,347.00" $673.50 $673.50 "$1,066.82" "$1,347.00" "$1,077.60" $606.15 "$1,347.00" N/A $781.26 "$1,347.00" $808.20 "$1,347.00" "$1,347.00" "$1,347.00" N/A N/A 7492-0521 SUP Custom 27803010 7492-0521 - INSERT TIBIAL 5 21MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0524 SUP Custom 27803010 7492-0524 - INSERT TIBIAL 5 24MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0708 SUP Custom 27803010 7492-0708 - INSERT TIBIAL 7 8MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0710 SUP Custom 27803010 7492-0710 - INSERT TIBIAL 7 10MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,347.00" $997.00 $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $280.73 "$1,347.00" $538.80 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,010.25" "$1,347.00" "$1,347.00" "$1,347.00" $673.50 $673.50 "$1,066.82" "$1,347.00" "$1,077.60" $606.15 "$1,347.00" N/A $781.26 "$1,347.00" $808.20 "$1,347.00" "$1,347.00" "$1,347.00" N/A N/A 7492-0712 SUP Custom 27803010 7492-0712 - INSERT TIBIAL 7 12MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,347.00" $997.00 $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $280.73 "$1,347.00" $538.80 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,010.25" "$1,347.00" "$1,347.00" "$1,347.00" $673.50 $673.50 "$1,066.82" "$1,347.00" "$1,077.60" $606.15 "$1,347.00" N/A $781.26 "$1,347.00" $808.20 "$1,347.00" "$1,347.00" "$1,347.00" N/A N/A 7492-0715 SUP Custom 27803010 7492-0715 - INSERT TIBIAL 7 15MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,347.00" $997.00 $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $280.73 "$1,347.00" $538.80 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,010.25" "$1,347.00" "$1,347.00" "$1,347.00" $673.50 $673.50 "$1,066.82" "$1,347.00" "$1,077.60" $606.15 "$1,347.00" N/A $781.26 "$1,347.00" $808.20 "$1,347.00" "$1,347.00" "$1,347.00" N/A N/A 7492-0718 SUP Custom 27803010 7492-0718 - INSERT TIBIAL 7 18MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,347.00" $997.00 $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $280.73 "$1,347.00" $538.80 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,010.25" "$1,347.00" "$1,347.00" "$1,347.00" $673.50 $673.50 "$1,066.82" "$1,347.00" "$1,077.60" $606.15 "$1,347.00" N/A $781.26 "$1,347.00" $808.20 "$1,347.00" "$1,347.00" "$1,347.00" N/A N/A 7492-0721 SUP Custom 27803010 7492-0721 - INSERT TIBIAL 7 21MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,347.00" $997.00 $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $280.73 "$1,347.00" $538.80 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,010.25" "$1,347.00" "$1,347.00" "$1,347.00" $673.50 $673.50 "$1,066.82" "$1,347.00" "$1,077.60" $606.15 "$1,347.00" N/A $781.26 "$1,347.00" $808.20 "$1,347.00" "$1,347.00" "$1,347.00" N/A N/A 7492-0724 SUP Custom 27803010 7492-0724 - INSERT TIBIAL 7 24MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0908 SUP Custom 27803010 7492-0908 - INSERT TIBIAL 9 8MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,347.00" $997.00 $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $239.77 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" $280.73 "$1,347.00" $538.80 "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,347.00" "$1,010.25" "$1,347.00" "$1,347.00" "$1,347.00" $673.50 $673.50 "$1,066.82" "$1,347.00" "$1,077.60" $606.15 "$1,347.00" N/A $781.26 "$1,347.00" $808.20 "$1,347.00" "$1,347.00" "$1,347.00" N/A N/A 7492-0910 SUP Custom 27803010 7492-0910 - INSERT TIBIAL 9 10MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0912 SUP Custom 27803010 7492-0912 - INSERT TIBIAL 9 12MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0915 SUP Custom 27803010 7492-0915 - INSERT TIBIAL 9 15MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0918 SUP Custom 27803010 7492-0918 - INSERT TIBIAL 9 18MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0921 SUP Custom 27803010 7492-0921 - INSERT TIBIAL 9 21MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7492-0924 SUP Custom 27803010 7492-0924 - INSERT TIBIAL 9 24MM POSTERIOR STABILIZE II BEARING KNEE BOTH IP/OP "$1,293.00" $957.00 $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $230.15 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $269.48 "$1,293.00" $517.20 "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" "$1,293.00" $969.75 "$1,293.00" "$1,293.00" "$1,293.00" $646.50 $646.50 "$1,024.06" "$1,293.00" "$1,034.40" $581.85 "$1,293.00" N/A $749.94 "$1,293.00" $775.80 "$1,293.00" "$1,293.00" "$1,293.00" N/A N/A 7493-0108 SUP Custom 27803010 7493-0108 - INSERT TIBIAL 1 8MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0110 SUP Custom 27803010 7493-0110 - INSERT TIBIAL 1 10MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0112 SUP Custom 27803010 7493-0112 - INSERT TIBIAL 1 12MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0115 SUP Custom 27803010 7493-0115 - INSERT TIBIAL 1 15MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0118 SUP Custom 27803010 7493-0118 - INSERT TIBIAL 1 18MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0121 SUP Custom 27803010 7493-0121 - INSERT TIBIAL 1 21MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0124 SUP Custom 27803010 7493-0124 - INSERT TIBIAL 1 24MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0308 SUP Custom 27803010 7493-0308 - INSERT TIBIAL 3 8MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0310 SUP Custom 27803010 7493-0310 - INSERT TIBIAL 3 10MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0312 SUP Custom 27803010 7493-0312 - INSERT TIBIAL 3 12MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0315 SUP Custom 27803010 7493-0315 - INSERT TIBIAL 3 15MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0318 SUP Custom 27803010 7493-0318 - INSERT TIBIAL 3 18MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0321 SUP Custom 27803010 7493-0321 - INSERT TIBIAL 3 21MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0324 SUP Custom 27803010 7493-0324 - INSERT TIBIAL 3 24MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0508 SUP Custom 27803010 7493-0508 - INSERT TIBIAL 5 8MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0510 SUP Custom 27803010 7493-0510 - INSERT TIBIAL 5 10MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0512 SUP Custom 27803010 7493-0512 - INSERT TIBIAL 5 12MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0515 SUP Custom 27803010 7493-0515 - INSERT TIBIAL 5 15MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0518 SUP Custom 27803010 7493-0518 - INSERT TIBIAL 5 18MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0521 SUP Custom 27803010 7493-0521 - INSERT TIBIAL 5 21MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0524 SUP Custom 27803010 7493-0524 - INSERT TIBIAL 5 24MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0708 SUP Custom 27803010 7493-0708 - INSERT TIBIAL 7 8MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0710 SUP Custom 27803010 7493-0710 - INSERT TIBIAL 7 10MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0712 SUP Custom 27803010 7493-0712 - INSERT TIBIAL 7 12MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0715 SUP Custom 27803010 7493-0715 - INSERT TIBIAL 7 15MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0718 SUP Custom 27803010 7493-0718 - INSERT TIBIAL 7 18MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0721 SUP Custom 27803010 7493-0721 - INSERT TIBIAL 7 21MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0724 SUP Custom 27803010 7493-0724 - INSERT TIBIAL 7 24MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0908 SUP Custom 27803010 7493-0908 - INSERT TIBIAL 9 8MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0910 SUP Custom 27803010 7493-0910 - INSERT TIBIAL 9 10MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0912 SUP Custom 27803010 7493-0912 - INSERT TIBIAL 9 12MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0915 SUP Custom 27803010 7493-0915 - INSERT TIBIAL 9 15MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0918 SUP Custom 27803010 7493-0918 - INSERT TIBIAL 9 18MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0921 SUP Custom 27803010 7493-0921 - INSERT TIBIAL 9 21MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 7493-0924 SUP Custom 27803010 7493-0924 - INSERT TIBIAL 9 24MM POSTERIOR STABILIZE BEARING KNEE S7000 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" $940.00 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A 75-1-0305 SUP Custom 27803010 75-1-0305 - BLOCK AUGMENTATION 3 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0310 SUP Custom 27803010 75-1-0310 - BLOCK AUGMENTATION 3 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0315 SUP Custom 27803010 75-1-0315 - BLOCK AUGMENTATION 3 15MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0405 SUP Custom 27803010 75-1-0405 - BLOCK AUGMENTATION 4 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0410 SUP Custom 27803010 75-1-0410 - BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0415 SUP Custom 27803010 75-1-0415 - BLOCK AUGMENTATION 4 15MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0505 SUP Custom 27803010 75-1-0505 - BLOCK AUGMENTATION 5 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0510 SUP Custom 27803010 75-1-0510 - BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0515 SUP Custom 27803010 75-1-0515 - BLOCK AUGMENTATION 5 15MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0605 SUP Custom 27803010 75-1-0605 - BLOCK AUGMENTATION 6 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0610 SUP Custom 27803010 75-1-0610 - BLOCK AUGMENTATION 6 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0615 SUP Custom 27803010 75-1-0615 - BLOCK AUGMENTATION 6 15MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0705 SUP Custom 27803010 75-1-0705 - BLOCK AUGMENTATION 7 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0710 SUP Custom 27803010 75-1-0710 - BLOCK AUGMENTATION 7 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0715 SUP Custom 27803010 75-1-0715 - BLOCK AUGMENTATION 7 15MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0905 SUP Custom 27803010 75-1-0905 - BLOCK AUGMENTATION 9 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0910 SUP Custom 27803010 75-1-0910 - BLOCK AUGMENTATION 9 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-0915 SUP Custom 27803010 75-1-0915 - BLOCK AUGMENTATION 9 15MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-1105 SUP Custom 27803010 75-1-1105 - BLOCK AUGMENTATION 11 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-1110 SUP Custom 27803010 75-1-1110 - BLOCK AUGMENTATION 11 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-1115 SUP Custom 27803010 75-1-1115 - BLOCK AUGMENTATION 11 15MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-1305 SUP Custom 27803010 75-1-1305 - BLOCK AUGMENTATION 13 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-1310 SUP Custom 27803010 75-1-1310 - BLOCK AUGMENTATION 13 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-1-1315 SUP Custom 27803010 75-1-1315 - BLOCK AUGMENTATION 13 15MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-0305 SUP Custom 27803010 75-2-0305 - BLOCK AUGMENTATION 3 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-0310 SUP Custom 27803010 75-2-0310 - BLOCK AUGMENTATION 3 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-0405 SUP Custom 27803010 75-2-0405 - BLOCK AUGMENTATION 4 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-0410 SUP Custom 27803010 75-2-0410 - BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-0505 SUP Custom 27803010 75-2-0505 - BLOCK AUGMENTATION 5 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-0510 SUP Custom 27803010 75-2-0510 - BLOCK AUGMENTATION 4 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-0605 SUP Custom 27803010 75-2-0605 - BLOCK AUGMENTATION 9 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-0610 SUP Custom 27803010 75-2-0610 - BLOCK AUGMENTATION 6 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-0705 SUP Custom 27803010 75-2-0705 - BLOCK AUGMENTATION 7 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-0710 SUP Custom 27803010 75-2-0710 - BLOCK AUGMENTATION 7 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-0905 SUP Custom 27803010 75-2-0905 - BLOCK AUGMENTATION 9 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-0910 SUP Custom 27803010 75-2-0910 - BLOCK AUGMENTATION 9 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-1105 SUP Custom 27803010 75-2-1105 - BLOCK AUGMENTATION 11 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-1110 SUP Custom 27803010 75-2-1110 - BLOCK AUGMENTATION 11 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-1305 SUP Custom 27803010 75-2-1305 - BLOCK AUGMENTATION 13 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-2-1310 SUP Custom 27803010 75-2-1310 - BLOCK AUGMENTATION 13 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,292.50" "$1,696.00" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $408.07 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" $477.78 "$2,292.50" $917.00 "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$2,292.50" "$1,719.38" "$2,292.50" "$2,292.50" "$2,292.50" "$1,146.25" "$1,146.25" "$1,815.66" "$2,292.50" "$1,834.00" "$1,031.63" "$2,292.50" N/A "$1,329.65" "$2,292.50" "$1,375.50" "$2,292.50" "$2,292.50" "$2,292.50" N/A N/A 75-3-0305 SUP Custom 27803010 75-3-0305 - BLOCK AUGMENTATION 3 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,112.63" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-0310 SUP Custom 27803010 75-3-0310 - BLOCK AUGMENTATION 3 HALF 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,112.63" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-0405 SUP Custom 27203010 75-3-0405 - TRIAL KN 4 5MM SCRP AUG HLF BLCK TIB LT BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$1,835.09" "$1,835.09" "$1,905.80" "$1,288.17" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,607.13" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-0410 SUP Custom 27203010 75-3-0410 - TRIAL KN 4 10MM SCRP AUG HLF BLCK TIB LT BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$1,835.09" "$1,835.09" "$1,905.80" "$1,288.17" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,607.13" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-0505 SUP Custom 27803010 75-3-0505 - BLOCK AUGMENTATION 5 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,112.63" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-0510 SUP Custom 27203010 75-3-0510 - BLOCK AUGMENTATION 5 HALF 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$1,835.09" "$1,835.09" "$1,905.80" "$1,288.17" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,607.13" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-0605 SUP Custom 27803010 75-3-0605 - BLOCK AUGMENTATION 6 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,112.63" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-0610 SUP Custom 27203010 75-3-0610 - TRIAL KN 6 10MM SCRP AUG HLF BLCK TIB LT BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$1,835.09" "$1,835.09" "$1,905.80" "$1,288.17" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,607.13" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-0705 SUP Custom 27803010 75-3-0705 - BLOCK AUGMENTATION 7 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,112.63" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-0710 SUP Custom 27203010 75-3-0710 - BLOCK AUGMENTATION 7 10MM TOT STABILIZED HALF SCORPIO KNEE BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$1,835.09" "$1,835.09" "$1,905.80" "$1,288.17" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,607.13" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-0905 SUP Custom 27803010 75-3-0905 - BLOCK AUGMENTATION 9 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,112.63" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-0910 SUP Custom 27803010 75-3-0910 - BLOCK AUGMENTATION 9 HALF 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,112.63" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-1105 SUP Custom 27803010 75-3-1105 - BLOCK AUGMENTATION 11 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,112.63" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-1110 SUP Custom 27203010 75-3-1110 - BLOCK AUGMENTATION 11 HALF 10MM 1 AXIS CRUC RET POSTERIOR BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$1,835.09" "$1,835.09" "$1,905.80" "$1,288.17" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,607.13" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-1305 SUP Custom 27803010 75-3-1305 - BLOCK AUGMENTATION 13 HALF 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,112.63" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-3-1310 SUP Custom 27803010 75-3-1310 - BLOCK AUGMENTATION 13 HALF 10MM 1 AXIS CRUC RET POSTERIOR BOTH IP/OP "$2,472.50" "$1,830.00" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $440.11 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" $515.30 "$2,472.50" $989.00 "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,112.63" "$2,472.50" N/A "$1,434.05" "$2,472.50" "$1,483.50" "$2,472.50" "$2,472.50" "$2,472.50" N/A N/A 75-4-0310 SUP Custom 27803010 75-4-0310 - BLOCK AUGMENTATION 3 FULL 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 75-4-0410 SUP Custom 27803010 75-4-0410 - BLOCK AUGMENTATION 4 10MM FULL SCORPIO TIBIA BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 75-4-0510 SUP Custom 27803010 75-4-0510 - BLOCK AUGMENTATION 5 FULL 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 75-4-0610 SUP Custom 27803010 75-4-0610 - BLOCK AUGMENTATION 6 10MM FULL SCORPIO TIBIA BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 75-4-0710 SUP Custom 27803010 75-4-0710 - BLOCK AUGMENTATION 7 FULL 10MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 75-4-0910 SUP Custom 27803010 75-4-0910 - BLOCK AUGMENTATION 9 FULL 5MM 1 AXIS CRUC RET POSTERIOR TOT BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 75-4-1110 SUP Custom 27803010 75-4-1110 - BLOCK AUGMENTATION 11 10MM FULL TOT STABILIZED SCORPIO FEMUR BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 75-4-1310 SUP Custom 27803010 75-4-1310 - BLOCK AUGMENTATION 13 10MM FULL TOT STABILIZED SCORPIO FEMUR BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 75-5-0305 SUP Custom 27803010 75-5-0305 - BLOCK AUGMENTATION 5D FULL WEDGE 3MM CRUCIATE RETAIN TOT BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 75-5-0405 SUP Custom 27803010 75-5-0405 - TRIAL SURG 4.5D FULL WEDGE BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 75-5-0505 SUP Custom 27803010 75-5-0505 - WEDGE TIBIAL 5D FULL 5 TOT STABILIZE SCORPIO KNEE BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 75-5-0605 SUP Custom 27203010 75-5-0605 - TRIAL SURG FULL WEDGE 6.5D BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$2,660.79" "$2,660.79" "$2,763.32" "$1,867.79" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$2,330.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 75-5-0705 SUP Custom 27803010 75-5-0705 - WEDGE TIBIAL 5D FULL 7 10MM TOT STABILIZE SCORPIO KNEE BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 75-5-0905 SUP Custom 27803010 75-5-0905 - BLOCK AUGMENTATION 5D FULL WEDGE 9MM CRUCIATE RETAIN TOT BOTH IP/OP "$3,585.00" "$2,653.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $638.13 "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" $747.15 "$3,585.00" "$1,434.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$3,585.00" "$2,688.75" "$3,585.00" "$3,585.00" "$3,585.00" "$1,792.50" "$1,792.50" "$2,839.32" "$3,585.00" "$2,868.00" "$1,613.25" "$3,585.00" N/A "$2,079.30" "$3,585.00" "$2,151.00" "$3,585.00" "$3,585.00" "$3,585.00" N/A N/A 75-5-1105 SUP Custom 27803010 75-5-1105 - WEDGE TIBIAL AUGMENTATION 5D 11 ANGLE FULL CRUCIATE RETAIN BOTH IP/OP "$3,445.00" "$2,549.00" $613.21 "$3,445.00" "$3,445.00" "$3,445.00" "$3,445.00" "$3,445.00" "$3,445.00" "$3,445.00" $613.21 "$3,445.00" "$3,445.00" "$3,445.00" "$3,445.00" "$3,445.00" "$3,445.00" $717.98 "$3,445.00" "$1,378.00" "$3,445.00" "$3,445.00" "$3,445.00" "$3,445.00" "$3,445.00" "$2,583.75" "$3,445.00" "$3,445.00" "$3,445.00" "$1,722.50" "$1,722.50" "$2,728.44" "$3,445.00" "$2,756.00" "$1,550.25" "$3,445.00" N/A "$1,998.10" "$3,445.00" "$2,067.00" "$3,445.00" "$3,445.00" "$3,445.00" N/A N/A 75-5-1305 SUP Custom 27803010 75-5-1305 - WEDGE TIBIAL AUGMENTATION 5D 13 ANGLE FULL CRUCIATE RETAIN BOTH IP/OP "$3,616.00" "$2,676.00" $643.58 "$3,615.63" "$3,615.63" "$3,615.63" "$3,615.63" "$3,615.63" "$3,615.63" "$3,615.63" $643.58 "$3,615.63" "$3,615.63" "$3,615.63" "$3,615.63" "$3,615.63" "$3,615.63" $753.54 "$3,615.63" "$1,446.25" "$3,615.63" "$3,615.63" "$3,615.63" "$3,615.63" "$3,615.63" "$2,712.00" "$3,615.63" "$3,615.63" "$3,615.63" "$1,807.82" "$1,807.82" "$2,863.58" "$3,615.63" "$2,892.50" "$1,627.03" "$3,615.63" N/A "$2,097.28" "$3,615.63" "$2,169.38" "$3,615.63" "$3,615.63" "$3,615.63" N/A N/A 75AC50 SUP Custom 27203010 75AC50 - PLATE 18MM TI BONE SPNL BOTH IP/OP $304.00 $225.00 $54.09 $303.88 $303.88 $303.88 $303.88 $303.88 $303.88 $303.88 $54.09 $303.88 $303.88 $225.54 $225.54 $234.23 $158.32 $63.33 $303.88 $121.55 $303.88 $303.88 $303.88 $303.88 $303.88 $228.00 $303.88 $303.88 $303.88 $151.94 $151.94 $240.67 $303.88 $243.10 $197.52 $303.88 N/A $176.32 $303.88 $182.33 $303.88 $303.88 $303.88 N/A N/A 75AC60 SUP Custom 27203010 75AC60 - SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT BOTH IP/OP $304.00 $225.00 $54.09 $303.88 $303.88 $303.88 $303.88 $303.88 $303.88 $303.88 $54.09 $303.88 $303.88 $225.54 $225.54 $234.23 $158.32 $63.33 $303.88 $121.55 $303.88 $303.88 $303.88 $303.88 $303.88 $228.00 $303.88 $303.88 $303.88 $151.94 $151.94 $240.67 $303.88 $243.10 $197.52 $303.88 N/A $176.32 $303.88 $182.33 $303.88 $303.88 $303.88 N/A N/A 75BA05 SUP Custom 27203010 75BA05 - BURR SURG .5MM 7.5CM BALL HEAD FLUTED LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA05L SUP Custom 27203010 75BA05L - BURR SURG LONG .5MM 7.5CM FLUTED BALL HEAD LEGEND MIDAS REX BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA06DL SUP Custom 27203010 75BA06DL - BURR SURG LONG .6MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA08DL SUP Custom 27203010 75BA08DL - TOOL DISSECTING LONG BALL DIAMOND .8MM 7.5CM MIDAS REX BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA10 SUP Custom 27203010 75BA10 - TOOL DISSECTING BALL FLUTE 1MM 7.5CM MIDAS REX LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA10D SUP Custom 27203010 75BA10D - BURR SURG BALL 1MM 7.5CM LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA10DC SUP Custom 27203010 75BA10DC - BURR SURG COARSE 1MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA10DCL SUP Custom 27203010 75BA10DCL - BURR SURG LONG BALL COARSE 1MM 7.5CM LEGEND DIAMOND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA10DL SUP Custom 27203010 75BA10DL - BURR SURG LONG BALL DIAMOND 1MM 7.5CM LEGEND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA10DLF SUP Custom 27203010 75BA10DLF - BURR SURG LONG FINE BALL 1MM 7.5CM LEGEND DIAMOND STERILE BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA10L SUP Custom 27203010 75BA10L - TOOL DISSECTING LONG BALL FLUTE 1MM 7.5CM MIDAS REX LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA12DL SUP Custom 27203010 75BA12DL - BURR SURG LONG 1.2MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA15 SUP Custom 27203010 75BA15 - TOOL DISSECTING BALL FLUTE 1.5MM 7.5CM MIDAS REX LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA15D SUP Custom 27203010 75BA15D - BURR SURG 1.5MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA15DC SUP Custom 27203010 75BA15DC - BURR SURG COARSE 1.5MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA15DCL SUP Custom 27203010 75BA15DCL - BURR SURG COARSE 1.5MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA15DL SUP Custom 27203010 75BA15DL - BURR SURG LONG 1.5MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA15DLF SUP Custom 27203010 75BA15DLF - TOOL DISSECTING LONG FINE BALL DIAMOND 1.5MM 7.5CM MIDAS REX BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA15L SUP Custom 27203010 75BA15L - TOOL DISSECTING LONG BALL FLUTE 1.5MM 7.5CM MIDAS REX LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA20 SUP Custom 27203010 75BA20 - BURR SURG FLUTE 2MM 7.5CM BALL HEAD LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA20D SUP Custom 27203010 75BA20D - BURR SURG BALL 2MM 7.5CM LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA20DC SUP Custom 27203010 75BA20DC - TOOL DISSECTING COARSE BALL DIAMOND 2MM 7.5CM MIDAS REX BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA20DCL SUP Custom 27203010 75BA20DCL - TOOL DISSECTING LONG COARSE BALL 2MM 7.5CM LEGEND DIAMOND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA20DF SUP Custom 27203010 75BA20DF - BURR SURG DIAMOND BALL FINE 2MM 7.5CM LEGEND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA20DL SUP Custom 27203010 75BA20DL - BURR SURG LONG 2MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA20DLF SUP Custom 27203010 75BA20DLF - BURR SURG LONG FINE 2MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA20F SUP Custom 27203010 75BA20F - TOOL DISSECTING FINE BALL FLUTE 2MM 7.5CM LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA20L SUP Custom 27203010 75BA20L - BURR SURG FLUTE LONG 2MM 7.5CM BALL HEAD LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA20LF SUP Custom 27203010 75BA20LF - TOOL DISSECTING LONG BALL FLUTE 2MM 7.5CM LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA25 SUP Custom 27203010 75BA25 - TOOL DISSECTING BALL FLUTE 2.5MM 7.5CM MIDAS REX LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA25D SUP Custom 27203010 75BA25D - TOOL DISSECTING BALL DIAMOND 2.5MM 7.5CM MIDAS REX LEGEND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA25DC SUP Custom 27203010 75BA25DC - BURR SURG COARSE 2.5MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA25DCL SUP Custom 27203010 75BA25DCL - BURR SURG LONG COARSE 2.5MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA25DL SUP Custom 27203010 75BA25DL - TOOL DISSECTING LONG BALL 2.5MM 7.5CM LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA25DLF SUP Custom 27203010 75BA25DLF - TOOL DISSECTING LONG FINE BALL 2.5MM 7.5CM LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA25F SUP Custom 27203010 75BA25F - BURR SURG 2.5MM 7.5CM BALL HEAD FLUTED LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA25L SUP Custom 27203010 75BA25L - BURR SURG LONG 2.5MM 7.5CM FLUTED BALL HEAD LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA25LF SUP Custom 27203010 75BA25LF - BURR SURG BALL FLUTE 2.5MM 7.5CM LATEX FREE LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA30 SUP Custom 27203010 75BA30 - BURR SURG FLUTE 3MM 7.5CM BALL HEAD LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA30D SUP Custom 27203010 75BA30D - BURR SURG 3MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA30DC SUP Custom 27203010 75BA30DC - TOOL DISSECTING COARSE BALL DIAMOND 3MM 7.5CM MIDAS REX BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA30DCL SUP Custom 27203010 75BA30DCL - BURR SURG LONG COARSE 3MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA30DF SUP Custom 27203010 75BA30DF - TOOL DISSECTING FINE BALL DIAMOND 3MM 7.5CM MIDAS REX LEGEND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA30DL SUP Custom 27203010 75BA30DL - BURR SURG LONG 3MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA30DLF SUP Custom 27203010 75BA30DLF - TOOL DISSECTING LONG FINE BALL DIAMOND 3MM 7.5CM MIDAS REX BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA30F SUP Custom 27203010 75BA30F - BURR SURG FINE 3MM 7.5CM BALL FLUTED LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA30L SUP Custom 27203010 75BA30L - BURR SURG FLUTE LONG 3MM 7.5CM BALL HEAD LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA30LF SUP Custom 27203010 75BA30LF - BURR SURG FLUTE LONG 3MM 7.5CM BALL HEAD LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA35 SUP Custom 27203010 75BA35 - BURR SURG 3.5MM 7.5CM BALL HEAD FLUTED LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA35D SUP Custom 27203010 75BA35D - BURR SURG 3.5MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA35DCL SUP Custom 27203010 75BA35DCL - BURR SURG LONG COARSE 3.5MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA35DL SUP Custom 27203010 75BA35DL - TOOL DISSECTING LONG BALL DIAMOND 3.5MM 7.5CM MIDAS REX BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA35F SUP Custom 27203010 75BA35F - TOOL DISSECTING FINE BALL FLUTE 3.5MM 7.5CM MIDAS REX LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA35L SUP Custom 27203010 75BA35L - BURR SURG LONG 3.5MM 7.5CM BALL HEAD FLUTED LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA35LF SUP Custom 27203010 75BA35LF - BURR SURG 3.5MM 7.5CM BALL HEAD FLUTED LATEX FREE LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA40 SUP Custom 27203010 75BA40 - BURR SURG ROUND 4MM 7.5CM BALL FLUTED LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA40D SUP Custom 27203010 75BA40D - BURR SURG BALL 4MM 7.5CM LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA40DC SUP Custom 27203010 75BA40DC - BURR SURG COARSE 4MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA40DF SUP Custom 27203010 75BA40DF - TOOL DISSECTING FINE BALL DIAMOND 4MM 7.5CM MIDAS REX LEGEND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA40DL SUP Custom 27203010 75BA40DL - BURR SURG BALL LONG 4MM 7.5CM LATEX FREE LEGEND DIAMOND BOTH IP/OP $321.00 $238.00 $57.12 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $57.12 $320.88 $320.88 $238.16 $238.16 $247.33 $167.18 $66.87 $320.88 $128.35 $320.88 $320.88 $320.88 $320.88 $320.88 $240.75 $320.88 $320.88 $320.88 $160.44 $160.44 $254.14 $320.88 $256.70 $208.57 $320.88 N/A $186.18 $320.88 $192.53 $320.88 $320.88 $320.88 N/A N/A 75BA40DX SUP Custom 27203010 75BA40DX - BURR SURG XCOARSE 4MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA40F SUP Custom 27203010 75BA40F - BURR SURG FINE 4MM 7.5CM BALL FLUTED LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA40L SUP Custom 27203010 75BA40L - TOOL DISSECTING LONG BALL FLUTE 4MM 7.5CM LEGEND BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 75BA50 SUP Custom 27203010 75BA50 - BURR SURG BALL FLUTE 5MM 7.5CM LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA50D SUP Custom 27203010 75BA50D - BURR SURG 5MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA50DC SUP Custom 27203010 75BA50DC - BURR SURG COARSE 5MM 7.5CM DIAMOND BALL TIP LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA50DF SUP Custom 27203010 75BA50DF - BURR SURG FINE COARSE 5MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA50DX SUP Custom 27203010 75BA50DX - BURR SURG XCOARSE 5MM 7.5CM DIAMOND BALL TIP LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA50F SUP Custom 27203010 75BA50F - BURR SURG FINE 5MM 7.5CM BALL FLUTED LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA60 SUP Custom 27203010 75BA60 - BURR SURG BALL FLUTE 6MM 7.5CM LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA60D SUP Custom 27203010 75BA60D - BURR SURG BALL 6MM 7.5CM LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA60DC SUP Custom 27203010 75BA60DC - TOOL DISSECTING COARSE BALL 6MM 7.5CM LEGEND DIAMOND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA60DX SUP Custom 27203010 75BA60DX - BURR SURG XCOARSE 6MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75BA60F SUP Custom 27203010 75BA60F - TOOL DISSECTING FINE BALL FLUTE 6MM 7.5CM LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA70 SUP Custom 27203010 75BA70 - BURR SURG 7MM 7.5CM BALL FLUTED LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA80 SUP Custom 27203010 75BA80 - BURR SURG FLUTE 8MM 7.5CM BALL HEAD LEGEND BOTH IP/OP $293.50 $217.00 $52.20 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $293.25 $52.20 $293.25 $293.25 $217.65 $217.65 $226.04 $152.78 $61.12 $293.25 $117.30 $293.25 $293.25 $293.25 $293.25 $293.25 $220.13 $293.25 $293.25 $293.25 $146.63 $146.63 $232.25 $293.25 $234.60 $190.61 $293.25 N/A $170.23 $293.25 $175.95 $293.25 $293.25 $293.25 N/A N/A 75BA80D SUP Custom 27203010 75BA80D - BURR SURG 8MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $317.00 $235.00 $56.36 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $316.63 $56.36 $316.63 $316.63 $235.00 $235.00 $244.06 $164.96 $65.99 $316.63 $126.65 $316.63 $316.63 $316.63 $316.63 $316.63 $237.75 $316.63 $316.63 $316.63 $158.32 $158.32 $250.77 $316.63 $253.30 $205.81 $316.63 N/A $183.86 $316.63 $189.98 $316.63 $316.63 $316.63 N/A N/A 75BA80DC SUP Custom 27203010 75BA80DC - BURR SURG COARSE 8MM 7.5CM BALL HEAD LEGEND DIAMOND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 75CY65DX SUP Custom 27203010 75CY65DX - PLATE 18MM TI BONE SPNL BOTH IP/OP $325.50 $241.00 $57.87 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $57.87 $325.13 $325.13 $241.31 $241.31 $250.61 $169.39 $67.76 $325.13 $130.05 $325.13 $325.13 $325.13 $325.13 $325.13 $244.13 $325.13 $325.13 $325.13 $162.57 $162.57 $257.50 $325.13 $260.10 $211.33 $325.13 N/A $188.79 $325.13 $195.08 $325.13 $325.13 $325.13 N/A N/A 75MH22 SUP Custom 27203010 75MH22 - SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT BOTH IP/OP $304.00 $225.00 $54.09 $303.88 $303.88 $303.88 $303.88 $303.88 $303.88 $303.88 $54.09 $303.88 $303.88 $225.54 $225.54 $234.23 $158.32 $63.33 $303.88 $121.55 $303.88 $303.88 $303.88 $303.88 $303.88 $228.00 $303.88 $303.88 $303.88 $151.94 $151.94 $240.67 $303.88 $243.10 $197.52 $303.88 N/A $176.32 $303.88 $182.33 $303.88 $303.88 $303.88 N/A N/A 75MH22D SUP Custom 27203010 75MH22D - PLATE 18MM TI BONE SPNL BOTH IP/OP $325.50 $241.00 $57.87 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $57.87 $325.13 $325.13 $241.31 $241.31 $250.61 $169.39 $67.76 $325.13 $130.05 $325.13 $325.13 $325.13 $325.13 $325.13 $244.13 $325.13 $325.13 $325.13 $162.57 $162.57 $257.50 $325.13 $260.10 $211.33 $325.13 N/A $188.79 $325.13 $195.08 $325.13 $325.13 $325.13 N/A N/A 75MH30 SUP Custom 27203010 75MH30 - TOOL DISSECTING 3MM 7.5CM MATCH HEAD LEGEND STERILE B3 BOTH IP/OP $304.00 $225.00 $54.09 $303.88 $303.88 $303.88 $303.88 $303.88 $303.88 $303.88 $54.09 $303.88 $303.88 $225.54 $225.54 $234.23 $158.32 $63.33 $303.88 $121.55 $303.88 $303.88 $303.88 $303.88 $303.88 $228.00 $303.88 $303.88 $303.88 $151.94 $151.94 $240.67 $303.88 $243.10 $197.52 $303.88 N/A $176.32 $303.88 $182.33 $303.88 $303.88 $303.88 N/A N/A 75MH30D SUP Custom 27203010 75MH30D - PLATE 18MM TI BONE SPNL BOTH IP/OP $325.50 $241.00 $57.87 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $57.87 $325.13 $325.13 $241.31 $241.31 $250.61 $169.39 $67.76 $325.13 $130.05 $325.13 $325.13 $325.13 $325.13 $325.13 $244.13 $325.13 $325.13 $325.13 $162.57 $162.57 $257.50 $325.13 $260.10 $211.33 $325.13 N/A $188.79 $325.13 $195.08 $325.13 $325.13 $325.13 N/A N/A 75OV40 SUP Custom 27203010 75OV40 - SOURCE LGHT 18MM RDN X QDRNT ILUM MTRX X-TUBE RTRCT BOTH IP/OP $304.00 $225.00 $54.09 $303.88 $303.88 $303.88 $303.88 $303.88 $303.88 $303.88 $54.09 $303.88 $303.88 $225.54 $225.54 $234.23 $158.32 $63.33 $303.88 $121.55 $303.88 $303.88 $303.88 $303.88 $303.88 $228.00 $303.88 $303.88 $303.88 $151.94 $151.94 $240.67 $303.88 $243.10 $197.52 $303.88 N/A $176.32 $303.88 $182.33 $303.88 $303.88 $303.88 N/A N/A 76-0007 SUP HCPCS C1713 76-0007 - SCREW BN 2.4MM 10MM RIBFIX BLU LCK TI STRNM BOTH IP/OP $615.00 $455.00 $122.06 $772.50 $276.75 $276.75 $276.75 $276.75 $615.00 $615.00 $615.00 $128.18 $615.00 $615.00 $615.00 $615.00 $615.00 $128.17 $615.00 $772.50 $363.77 $615.00 $772.50 $615.00 $615.00 $461.25 $615.00 $615.00 $615.00 $307.50 $307.50 $487.08 $615.00 $492.00 $276.75 $122.06 N/A $356.70 $615.00 $615.00 $615.00 $615.00 $615.00 N/A N/A 76-0010 SUP HCPCS C1713 76-0010 - SCREW BN 2.4MM 12MM RIBFIX BLU DRL LCK STRNM SCAPULA BOTH IP/OP $605.00 $448.00 $120.08 $605.00 $272.25 $272.25 $272.25 $272.25 $605.00 $605.00 $605.00 $126.10 $605.00 $605.00 $605.00 $605.00 $605.00 $126.09 $605.00 $242.00 $357.86 $605.00 $605.00 $605.00 $605.00 $453.75 $605.00 $605.00 $605.00 $302.50 $302.50 $479.16 $605.00 $484.00 $272.25 $120.08 N/A $350.90 $605.00 $605.00 $605.00 $605.00 $605.00 N/A N/A 7602-20M SUP HCPCS C1725 7602-20M - CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR .052IN 100CM SIZING BOTH IP/OP $226.50 $168.00 $44.91 $226.28 $122.87 $122.87 $122.87 $122.87 $226.28 $226.28 $226.28 $47.16 $226.28 $167.95 $167.95 $174.42 $117.89 $47.16 $226.28 $90.51 $133.84 $226.28 $226.28 $226.28 $226.28 $169.88 $226.28 $226.28 $226.28 $113.14 $113.14 $179.21 $226.28 $181.02 $147.08 $44.91 N/A $131.37 $226.28 $226.28 $226.28 $47.16 $226.28 N/A N/A 7602-2M65 SUP HCPCS C1725 7602-2M65 - CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR .052IN 65CM SIZING BOTH IP/OP $69.50 $51.00 $13.72 $69.13 $37.54 $37.54 $37.54 $37.54 $69.13 $69.13 $69.13 $14.41 $69.13 $51.31 $51.31 $53.29 $36.02 $14.41 $69.13 $69.13 $40.89 $69.13 $69.13 $69.13 $69.13 $52.13 $69.13 $69.13 $69.13 $34.57 $34.57 $54.75 $69.13 $55.30 $44.93 $13.72 N/A $40.31 $69.13 $69.13 $69.13 $14.41 $69.13 N/A N/A 7602-51 SUP HCPCS C1725 7602-51 - CATHETER ANGIO PGTL CRV 5FR 90CM STRL PRFM 10 SH RADOPQ BRD BOTH IP/OP $30.00 $22.00 $5.88 $29.65 $16.10 $16.10 $16.10 $16.10 $29.65 $29.65 $29.65 $6.18 $29.65 $22.01 $22.01 $22.85 $15.45 $6.18 $29.65 $29.65 $17.54 $29.65 $29.65 $29.65 $29.65 $22.50 $29.65 $29.65 $29.65 $14.83 $14.83 $23.48 $29.65 $23.72 $19.27 $5.88 N/A $17.40 $29.65 $29.65 $29.65 $6.18 $29.65 N/A N/A 76-2001 SUP HCPCS C1713 76-2001 - SCREW BN 2.4MM 34MM X DRV BOTH IP/OP "$1,127.50" $834.00 $223.78 "$1,127.50" $507.38 $507.38 $507.38 $507.38 "$1,127.50" "$1,127.50" "$1,127.50" $235.00 "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" $234.98 "$1,127.50" $451.00 $666.92 "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" $845.63 "$1,127.50" "$1,127.50" "$1,127.50" $563.75 $563.75 $892.98 "$1,127.50" $902.00 $507.38 $223.78 N/A $653.95 "$1,127.50" "$1,127.50" "$1,127.50" $234.97 "$1,127.50" N/A N/A 76-2408 SUP HCPCS C1713 76-2408 - SCREW BN 2.4MM 8MM RIBFIX BLU SLF DRL LCK RB BOTH IP/OP $367.50 $272.00 $72.94 $492.50 $165.38 $165.38 $165.38 $165.38 $367.50 $367.50 $367.50 $76.60 $367.50 $367.50 $367.50 $367.50 $367.50 $76.59 $367.50 $197.00 $217.38 $367.50 $492.50 $367.50 $367.50 $275.63 $367.50 $367.50 $367.50 $183.75 $183.75 $291.06 $367.50 $294.00 $165.38 $72.94 N/A $213.15 $367.50 $367.50 $367.50 $76.59 $367.50 N/A N/A 76-2410 SUP HCPCS C1713 76-2410 - SCREW BN 2.4MM 10MM RIBFIX BLU ST LCK BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $197.00 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $492.50 $492.50 $102.64 $492.50 N/A N/A 76-2412 SUP HCPCS C1713 76-2412 - Screw S/d-lk 2.4x12mm BOTH IP/OP $367.50 $272.00 $72.94 $492.50 $165.38 $165.38 $165.38 $165.38 $367.50 $367.50 $367.50 $76.60 $367.50 $367.50 $367.50 $367.50 $367.50 $76.59 $367.50 $197.00 $217.38 $367.50 $492.50 $367.50 $367.50 $275.63 $367.50 $367.50 $367.50 $183.75 $183.75 $291.06 $367.50 $294.00 $165.38 $72.94 N/A $213.15 $367.50 $367.50 $367.50 $76.59 $367.50 N/A N/A 76-2414 SUP HCPCS C1713 76-2414 - SCREW BN 2.4MM 14MM RIBFIX BLU ST LCK TI THOR BOTH IP/OP $367.50 $272.00 $72.94 $492.50 $165.38 $165.38 $165.38 $165.38 $367.50 $367.50 $367.50 $76.60 $367.50 $367.50 $367.50 $367.50 $367.50 $76.59 $367.50 $492.50 $217.38 $367.50 $492.50 $367.50 $367.50 $275.63 $367.50 $367.50 $367.50 $183.75 $183.75 $291.06 $367.50 $294.00 $165.38 $72.94 N/A $213.15 $367.50 $367.50 $367.50 $367.50 $367.50 N/A N/A 76-2416 SUP HCPCS C1713 76-2416 - SCREW BN 2.4MM 16MM RIBFIX BLU SLF DRL LCK RB BOTH IP/OP $367.50 $272.00 $72.94 $492.50 $165.38 $165.38 $165.38 $165.38 $367.50 $367.50 $367.50 $76.60 $367.50 $367.50 $367.50 $367.50 $367.50 $76.59 $367.50 $197.00 $217.38 $367.50 $492.50 $367.50 $367.50 $275.63 $367.50 $367.50 $367.50 $183.75 $183.75 $291.06 $367.50 $294.00 $165.38 $72.94 N/A $213.15 $367.50 $367.50 $367.50 $367.50 $367.50 N/A N/A 76-2601 SUP HCPCS C1713 76-2601 - PLATE BN STRG NS RIBFIX BLU 8 HL TI RB BOTH IP/OP "$2,497.50" "$1,848.00" $495.69 "$3,222.50" "$1,123.88" "$1,123.88" "$1,123.88" "$1,123.88" "$2,497.50" "$2,497.50" "$2,497.50" $520.54 "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" "$2,497.50" $520.51 "$2,497.50" "$3,222.50" "$1,477.27" "$2,497.50" "$3,222.50" "$2,497.50" "$2,497.50" "$1,873.13" "$2,497.50" "$2,497.50" "$2,497.50" "$1,248.75" "$1,248.75" "$1,978.02" "$2,497.50" "$1,998.00" "$1,123.88" $495.69 N/A "$1,448.55" "$2,497.50" "$2,497.50" "$2,497.50" $520.48 "$2,497.50" N/A N/A 76-2602 SUP HCPCS C1713 76-2602 - SCREW BN PREBNT 2.4MM 14MM SLF DRL LCK TI RB BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$4,227.50" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,691.00" "$1,540.63" "$3,125.00" "$4,227.50" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A 76-2603 SUP HCPCS C1713 76-2603 - PLATE BN PREBNT NS RIBFIX BLU 16 HL TI RB BOTH IP/OP "$3,747.50" "$2,773.00" $743.79 "$5,992.50" "$1,686.38" "$1,686.38" "$1,686.38" "$1,686.38" "$3,747.50" "$3,747.50" "$3,747.50" $781.07 "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" $781.02 "$3,747.50" "$2,397.00" "$1,847.52" "$3,747.50" "$5,992.50" "$3,747.50" "$3,747.50" "$2,810.63" "$3,747.50" "$3,747.50" "$3,747.50" "$1,873.75" "$1,873.75" "$2,968.02" "$3,747.50" "$2,998.00" "$1,686.38" $743.79 N/A "$2,173.55" "$3,747.50" "$3,747.50" "$3,747.50" $780.98 "$3,747.50" N/A N/A 76-2708 SUP HCPCS C1713 76-2708 - SCREW BN 2.7MM 8MM ER TI RB BOTH IP/OP $367.50 $272.00 $72.94 $492.50 $165.38 $165.38 $165.38 $165.38 $367.50 $367.50 $367.50 $76.60 $367.50 $367.50 $367.50 $367.50 $367.50 $76.59 $367.50 $197.00 $217.38 $367.50 $492.50 $367.50 $367.50 $275.63 $367.50 $367.50 $367.50 $183.75 $183.75 $291.06 $367.50 $294.00 $165.38 $72.94 N/A $213.15 $367.50 $367.50 $367.50 $76.59 $367.50 N/A N/A 76-2710 SUP HCPCS C1713 76-2710 - SCREW BN 2.7MM 10MM ER TI RB BOTH IP/OP $367.50 $272.00 $72.94 $492.50 $165.38 $165.38 $165.38 $165.38 $367.50 $367.50 $367.50 $76.60 $367.50 $367.50 $367.50 $367.50 $367.50 $76.59 $367.50 $492.50 $217.38 $367.50 $492.50 $367.50 $367.50 $275.63 $367.50 $367.50 $367.50 $183.75 $183.75 $291.06 $367.50 $294.00 $165.38 $72.94 N/A $213.15 $367.50 $367.50 $367.50 $76.59 $367.50 N/A N/A 76-2712 SUP HCPCS C1713 76-2712 - SCREW BN 2.7MM 12MM ER RB BOTH IP/OP $367.50 $272.00 $72.94 $492.50 $165.38 $165.38 $165.38 $165.38 $367.50 $367.50 $367.50 $76.60 $367.50 $367.50 $367.50 $367.50 $367.50 $76.59 $367.50 $197.00 $217.38 $367.50 $492.50 $367.50 $367.50 $275.63 $367.50 $367.50 $367.50 $183.75 $183.75 $291.06 $367.50 $294.00 $165.38 $72.94 N/A $213.15 $367.50 $367.50 $367.50 $367.50 $367.50 N/A N/A 76-2714 SUP HCPCS C1713 76-2714 - SCREW BN 2.7MM 14MM ER RB BOTH IP/OP $367.50 $272.00 $72.94 $492.50 $165.38 $165.38 $165.38 $165.38 $367.50 $367.50 $367.50 $76.60 $367.50 $367.50 $367.50 $367.50 $367.50 $76.59 $367.50 $197.00 $217.38 $367.50 $492.50 $367.50 $367.50 $275.63 $367.50 $367.50 $367.50 $183.75 $183.75 $291.06 $367.50 $294.00 $165.38 $72.94 N/A $213.15 $367.50 $367.50 $367.50 $367.50 $367.50 N/A N/A 76-4003L SUP HCPCS C1776 76-4003L - COMPONENT FEMORAL 3 TOT STABILIZE REVISION SCORPIO COCR KNEE BOTH IP/OP "$10,226.50" "$7,568.00" "$2,029.63" "$10,226.13" "$4,601.76" "$4,601.76" "$4,601.76" "$4,601.76" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.38" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.24" "$10,226.13" "$10,226.13" "$5,041.48" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$7,669.88" "$10,226.13" "$10,226.13" "$10,226.13" "$5,113.07" "$5,113.07" "$8,099.09" "$10,226.13" "$8,180.90" "$4,601.76" "$2,029.63" N/A "$5,931.37" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" N/A N/A 76-4003R SUP HCPCS C1776 76-4003R - COMPONENT FEMORAL 3 TOT STABILIZE REVISION SCORPIO COCR KNEE BOTH IP/OP "$10,226.50" "$7,568.00" "$2,029.63" "$10,226.13" "$4,601.76" "$4,601.76" "$4,601.76" "$4,601.76" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.38" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.24" "$10,226.13" "$10,226.13" "$5,041.48" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$7,669.88" "$10,226.13" "$10,226.13" "$10,226.13" "$5,113.07" "$5,113.07" "$8,099.09" "$10,226.13" "$8,180.90" "$4,601.76" "$2,029.63" N/A "$5,931.37" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.13" "$10,226.13" N/A N/A 76-4004L SUP HCPCS C1776 76-4004L - COMPONENT FEMORAL 4 TOT STABILIZE REVISION SCORPIO COCR KNEE BOTH IP/OP "$10,226.50" "$7,568.00" "$2,029.63" "$10,226.13" "$4,601.76" "$4,601.76" "$4,601.76" "$4,601.76" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.38" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.24" "$10,226.13" "$4,090.45" "$5,041.48" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$7,669.88" "$10,226.13" "$10,226.13" "$10,226.13" "$5,113.07" "$5,113.07" "$8,099.09" "$10,226.13" "$8,180.90" "$4,601.76" "$2,029.63" N/A "$5,931.37" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.13" "$10,226.13" N/A N/A 76-4004R SUP HCPCS C1776 76-4004R - COMPONENT FEMORAL 4 TOT STABILIZE REVISION SCORPIO COCR KNEE BOTH IP/OP "$10,226.50" "$7,568.00" "$2,029.63" "$10,226.13" "$4,601.76" "$4,601.76" "$4,601.76" "$4,601.76" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.38" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.24" "$10,226.13" "$4,090.45" "$5,041.48" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$7,669.88" "$10,226.13" "$10,226.13" "$10,226.13" "$5,113.07" "$5,113.07" "$8,099.09" "$10,226.13" "$8,180.90" "$4,601.76" "$2,029.63" N/A "$5,931.37" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.13" "$10,226.13" N/A N/A 76-4005L SUP HCPCS C1776 76-4005L - COMPONENT FEMORAL 5 TOT STABILIZE REVISION SCORPIO COCR KNEE BOTH IP/OP "$9,995.50" "$7,397.00" "$1,983.83" "$9,995.38" "$4,497.92" "$4,497.92" "$4,497.92" "$4,497.92" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.29" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.15" "$9,995.38" "$3,998.15" "$4,927.72" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$7,496.63" "$9,995.38" "$9,995.38" "$9,995.38" "$4,997.69" "$4,997.69" "$7,916.34" "$9,995.38" "$7,996.30" "$4,497.92" "$1,983.83" N/A "$5,797.39" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.04" "$9,995.38" N/A N/A 76-4005R SUP HCPCS C1776 76-4005R - COMPONENT FEMORAL 5 TOT STABILIZE REVISION SCORPIO COCR KNEE BOTH IP/OP "$9,995.50" "$7,397.00" "$1,983.83" "$9,995.38" "$4,497.92" "$4,497.92" "$4,497.92" "$4,497.92" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.29" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.15" "$9,995.38" "$3,998.15" "$4,927.72" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$7,496.63" "$9,995.38" "$9,995.38" "$9,995.38" "$4,997.69" "$4,997.69" "$7,916.34" "$9,995.38" "$7,996.30" "$4,497.92" "$1,983.83" N/A "$5,797.39" "$9,995.38" "$5,997.23" "$9,995.38" "$2,083.04" "$9,995.38" N/A N/A 76-4006L SUP HCPCS C1776 76-4006L - COMPONENT FEMORAL 6 TOT STABILIZE REVISION SCORPIO COCR KNEE BOTH IP/OP "$10,226.50" "$7,568.00" "$2,029.63" "$10,226.13" "$4,601.76" "$4,601.76" "$4,601.76" "$4,601.76" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.38" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.24" "$10,226.13" "$4,090.45" "$5,041.48" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$7,669.88" "$10,226.13" "$10,226.13" "$10,226.13" "$5,113.07" "$5,113.07" "$8,099.09" "$10,226.13" "$8,180.90" "$4,601.76" "$2,029.63" N/A "$5,931.37" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.13" "$10,226.13" N/A N/A 76-4006R SUP HCPCS C1776 76-4006R - COMPONENT FEMORAL 6 TOT STABILIZE REVISION SCORPIO COCR KNEE BOTH IP/OP "$10,226.50" "$7,568.00" "$2,029.63" "$10,226.13" "$4,601.76" "$4,601.76" "$4,601.76" "$4,601.76" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.38" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.24" "$10,226.13" "$10,226.13" "$5,041.48" "$10,226.13" "$10,226.13" "$10,226.13" "$10,226.13" "$7,669.88" "$10,226.13" "$10,226.13" "$10,226.13" "$5,113.07" "$5,113.07" "$8,099.09" "$10,226.13" "$8,180.90" "$4,601.76" "$2,029.63" N/A "$5,931.37" "$10,226.13" "$10,226.13" "$10,226.13" "$2,131.13" "$10,226.13" N/A N/A 76-4007L SUP HCPCS C1776 76-4007L - COMPONENT FEMORAL 7 TOT STABILIZE REVISION SCORPIO COCR KNEE BOTH IP/OP "$9,995.50" "$7,397.00" "$1,983.83" "$9,995.38" "$4,497.92" "$4,497.92" "$4,497.92" "$4,497.92" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.29" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.15" "$9,995.38" "$9,995.38" "$4,927.72" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$7,496.63" "$9,995.38" "$9,995.38" "$9,995.38" "$4,997.69" "$4,997.69" "$7,916.34" "$9,995.38" "$7,996.30" "$4,497.92" "$1,983.83" N/A "$5,797.39" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.04" "$9,995.38" N/A N/A 76-4007R SUP HCPCS C1776 76-4007R - COMPONENT FEMORAL 7 TOT STABILIZE REVISION SCORPIO COCR KNEE BOTH IP/OP "$9,995.50" "$7,397.00" "$1,983.83" "$9,995.38" "$4,497.92" "$4,497.92" "$4,497.92" "$4,497.92" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.29" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.15" "$9,995.38" "$9,995.38" "$4,927.72" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$7,496.63" "$9,995.38" "$9,995.38" "$9,995.38" "$4,997.69" "$4,997.69" "$7,916.34" "$9,995.38" "$7,996.30" "$4,497.92" "$1,983.83" N/A "$5,797.39" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.04" "$9,995.38" N/A N/A 76-4009L SUP HCPCS C1776 76-4009L - COMPONENT FEMORAL 9 TOT STABILIZE REVISION SCORPIO COCR KNEE BOTH IP/OP "$9,995.50" "$7,397.00" "$1,983.83" "$9,995.38" "$4,497.92" "$4,497.92" "$4,497.92" "$4,497.92" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.29" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.15" "$9,995.38" "$9,995.38" "$4,927.72" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$7,496.63" "$9,995.38" "$9,995.38" "$9,995.38" "$4,997.69" "$4,997.69" "$7,916.34" "$9,995.38" "$7,996.30" "$4,497.92" "$1,983.83" N/A "$5,797.39" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.04" "$9,995.38" N/A N/A 76-4009R SUP HCPCS C1776 76-4009R - COMPONENT FEMORAL 9 TOT STABILIZE REVISION SCORPIO COCR KNEE BOTH IP/OP "$9,995.50" "$7,397.00" "$1,983.83" "$9,995.38" "$4,497.92" "$4,497.92" "$4,497.92" "$4,497.92" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.29" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.15" "$9,995.38" "$3,998.15" "$4,927.72" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$7,496.63" "$9,995.38" "$9,995.38" "$9,995.38" "$4,997.69" "$4,997.69" "$7,916.34" "$9,995.38" "$7,996.30" "$4,497.92" "$1,983.83" N/A "$5,797.39" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.04" "$9,995.38" N/A N/A 76-4011L SUP HCPCS C1776 76-4011L - COMPONENT FEMORAL 11 TOT STABILIZE REVISION SCORPIO COCR BOTH IP/OP "$9,995.50" "$7,397.00" "$1,983.83" "$9,995.38" "$4,497.92" "$4,497.92" "$4,497.92" "$4,497.92" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.29" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.15" "$9,995.38" "$9,995.38" "$4,927.72" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$7,496.63" "$9,995.38" "$9,995.38" "$9,995.38" "$4,997.69" "$4,997.69" "$7,916.34" "$9,995.38" "$7,996.30" "$4,497.92" "$1,983.83" N/A "$5,797.39" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.04" "$9,995.38" N/A N/A 76-4011R SUP HCPCS C1776 76-4011R - COMPONENT FEMORAL 11 TOT STABILIZE REVISION SCORPIO COCR BOTH IP/OP "$9,995.50" "$7,397.00" "$1,983.83" "$9,995.38" "$4,497.92" "$4,497.92" "$4,497.92" "$4,497.92" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.29" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.15" "$9,995.38" "$9,995.38" "$4,927.72" "$9,995.38" "$9,995.38" "$9,995.38" "$9,995.38" "$7,496.63" "$9,995.38" "$9,995.38" "$9,995.38" "$4,997.69" "$4,997.69" "$7,916.34" "$9,995.38" "$7,996.30" "$4,497.92" "$1,983.83" N/A "$5,797.39" "$9,995.38" "$9,995.38" "$9,995.38" "$2,083.04" "$9,995.38" N/A N/A 76-4013L SUP HCPCS C1776 76-4013L - COMPONENT FEMORAL 13 TOT STABILIZE REVISION SCORPIO COCR BOTH IP/OP "$8,567.00" "$6,340.00" "$1,700.34" "$8,567.00" "$3,855.15" "$3,855.15" "$3,855.15" "$3,855.15" "$8,567.00" "$8,567.00" "$8,567.00" "$1,785.58" "$8,567.00" "$8,567.00" "$8,567.00" "$8,567.00" "$8,567.00" "$1,785.46" "$8,567.00" "$3,426.80" "$4,223.53" "$8,567.00" "$8,567.00" "$8,567.00" "$8,567.00" "$6,425.25" "$8,567.00" "$8,567.00" "$8,567.00" "$4,283.50" "$4,283.50" "$6,785.06" "$8,567.00" "$6,853.60" "$3,855.15" "$1,700.34" N/A "$4,968.86" "$8,567.00" "$8,567.00" "$8,567.00" "$8,567.00" "$8,567.00" N/A N/A 76-4013R SUP HCPCS C1776 76-4013R - COMPONENT FEMORAL 13 TOT STABILIZE REVISION SCORPIO COCR BOTH IP/OP "$8,567.00" "$6,340.00" "$1,700.34" "$8,567.00" "$3,855.15" "$3,855.15" "$3,855.15" "$3,855.15" "$8,567.00" "$8,567.00" "$8,567.00" "$1,785.58" "$8,567.00" "$8,567.00" "$8,567.00" "$8,567.00" "$8,567.00" "$1,785.46" "$8,567.00" "$3,426.80" "$4,223.53" "$8,567.00" "$8,567.00" "$8,567.00" "$8,567.00" "$6,425.25" "$8,567.00" "$8,567.00" "$8,567.00" "$4,283.50" "$4,283.50" "$6,785.06" "$8,567.00" "$6,853.60" "$3,855.15" "$1,700.34" N/A "$4,968.86" "$8,567.00" "$8,567.00" "$8,567.00" "$8,567.00" "$8,567.00" N/A N/A 76-4103L SUP HCPCS C1776 76-4103L - COMPONENT FEMORAL 3 56X35MM MODULAR TOT STABILIZE REVISION BOTH IP/OP "$12,130.00" "$8,976.00" "$2,407.50" "$12,130.00" "$5,458.50" "$5,458.50" "$5,458.50" "$5,458.50" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.20" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.03" "$12,130.00" "$4,852.00" "$5,980.09" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$9,097.50" "$12,130.00" "$12,130.00" "$12,130.00" "$6,065.00" "$6,065.00" "$9,606.96" "$12,130.00" "$9,704.00" "$5,458.50" "$2,407.50" N/A "$7,035.40" "$12,130.00" "$12,130.00" "$12,130.00" "$2,527.89" "$12,130.00" N/A N/A 76-4103R SUP HCPCS C1776 76-4103R - COMPONENT FEMORAL 3 56X35MM MODULAR TOT STABILIZE REVISION BOTH IP/OP "$12,130.00" "$8,976.00" "$2,407.50" "$12,130.00" "$5,458.50" "$5,458.50" "$5,458.50" "$5,458.50" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.20" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.03" "$12,130.00" "$4,852.00" "$5,980.09" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$9,097.50" "$12,130.00" "$12,130.00" "$12,130.00" "$6,065.00" "$6,065.00" "$9,606.96" "$12,130.00" "$9,704.00" "$5,458.50" "$2,407.50" N/A "$7,035.40" "$12,130.00" "$12,130.00" "$12,130.00" "$2,527.89" "$12,130.00" N/A N/A 76-4105L SUP HCPCS C1776 76-4105L - COMPONENT FEMORAL 5 61X39MM MODULAR TOT STABILIZE REVISION BOTH IP/OP "$12,130.00" "$8,976.00" "$2,407.50" "$12,130.00" "$5,458.50" "$5,458.50" "$5,458.50" "$5,458.50" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.20" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.03" "$12,130.00" "$12,130.00" "$5,980.09" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$9,097.50" "$12,130.00" "$12,130.00" "$12,130.00" "$6,065.00" "$6,065.00" "$9,606.96" "$12,130.00" "$9,704.00" "$5,458.50" "$2,407.50" N/A "$7,035.40" "$12,130.00" "$12,130.00" "$12,130.00" "$2,527.89" "$12,130.00" N/A N/A 76-4105R SUP HCPCS C1776 76-4105R - COMPONENT FEMORAL 5 61X39MM MODULAR TOT STABILIZE REVISION BOTH IP/OP "$12,130.00" "$8,976.00" "$2,407.50" "$12,130.00" "$5,458.50" "$5,458.50" "$5,458.50" "$5,458.50" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.20" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.03" "$12,130.00" "$4,852.00" "$5,980.09" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$9,097.50" "$12,130.00" "$12,130.00" "$12,130.00" "$6,065.00" "$6,065.00" "$9,606.96" "$12,130.00" "$9,704.00" "$5,458.50" "$2,407.50" N/A "$7,035.40" "$12,130.00" "$12,130.00" "$12,130.00" "$2,527.89" "$12,130.00" N/A N/A 76-4107L SUP HCPCS C1776 76-4107L - COMPONENT FEMORAL 7 66X44MM MODULAR TOT STABILIZE REVISION BOTH IP/OP "$12,130.00" "$8,976.00" "$2,407.50" "$12,130.00" "$5,458.50" "$5,458.50" "$5,458.50" "$5,458.50" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.20" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.03" "$12,130.00" "$12,130.00" "$5,980.09" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$9,097.50" "$12,130.00" "$12,130.00" "$12,130.00" "$6,065.00" "$6,065.00" "$9,606.96" "$12,130.00" "$9,704.00" "$5,458.50" "$2,407.50" N/A "$7,035.40" "$12,130.00" "$12,130.00" "$12,130.00" "$2,527.89" "$12,130.00" N/A N/A 76-4107R SUP HCPCS C1776 76-4107R - COMPONENT FEMORAL 7 66X44MM MODULAR TOT STABILIZE REVISION BOTH IP/OP "$12,130.00" "$8,976.00" "$2,407.50" "$12,130.00" "$5,458.50" "$5,458.50" "$5,458.50" "$5,458.50" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.20" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.03" "$12,130.00" "$4,852.00" "$5,980.09" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$9,097.50" "$12,130.00" "$12,130.00" "$12,130.00" "$6,065.00" "$6,065.00" "$9,606.96" "$12,130.00" "$9,704.00" "$5,458.50" "$2,407.50" N/A "$7,035.40" "$12,130.00" "$12,130.00" "$12,130.00" "$2,527.89" "$12,130.00" N/A N/A 76-4109L SUP HCPCS C1776 76-4109L - COMPONENT FEMORAL 9 71X49MM MODULAR TOT STABILIZE REVISION BOTH IP/OP "$12,130.00" "$8,976.00" "$2,407.50" "$12,130.00" "$5,458.50" "$5,458.50" "$5,458.50" "$5,458.50" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.20" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.03" "$12,130.00" "$12,130.00" "$5,980.09" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$9,097.50" "$12,130.00" "$12,130.00" "$12,130.00" "$6,065.00" "$6,065.00" "$9,606.96" "$12,130.00" "$9,704.00" "$5,458.50" "$2,407.50" N/A "$7,035.40" "$12,130.00" "$12,130.00" "$12,130.00" "$2,527.89" "$12,130.00" N/A N/A 76-4109R SUP HCPCS C1776 76-4109R - COMPONENT FEMORAL 9 71X49MM MODULAR TOT STABILIZE REVISION BOTH IP/OP "$12,130.00" "$8,976.00" "$2,407.50" "$12,130.00" "$5,458.50" "$5,458.50" "$5,458.50" "$5,458.50" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.20" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.03" "$12,130.00" "$4,852.00" "$5,980.09" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$9,097.50" "$12,130.00" "$12,130.00" "$12,130.00" "$6,065.00" "$6,065.00" "$9,606.96" "$12,130.00" "$9,704.00" "$5,458.50" "$2,407.50" N/A "$7,035.40" "$12,130.00" "$12,130.00" "$12,130.00" "$2,527.89" "$12,130.00" N/A N/A 76-4111L SUP HCPCS C1776 76-4111L - COMPONENT FEMORAL 11 76X53MM MODULAR TOT STABILIZE REVISION BOTH IP/OP "$12,130.00" "$8,976.00" "$2,407.50" "$12,130.00" "$5,458.50" "$5,458.50" "$5,458.50" "$5,458.50" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.20" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.03" "$12,130.00" "$12,130.00" "$5,980.09" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$9,097.50" "$12,130.00" "$12,130.00" "$12,130.00" "$6,065.00" "$6,065.00" "$9,606.96" "$12,130.00" "$9,704.00" "$5,458.50" "$2,407.50" N/A "$7,035.40" "$12,130.00" "$12,130.00" "$12,130.00" "$2,527.89" "$12,130.00" N/A N/A 76-4111R SUP HCPCS C1776 76-4111R - COMPONENT FEMORAL 11 76X53MM MODULAR TOT STABILIZE REVISION BOTH IP/OP "$12,130.00" "$8,976.00" "$2,407.50" "$12,130.00" "$5,458.50" "$5,458.50" "$5,458.50" "$5,458.50" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.20" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.03" "$12,130.00" "$12,130.00" "$5,980.09" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$9,097.50" "$12,130.00" "$12,130.00" "$12,130.00" "$6,065.00" "$6,065.00" "$9,606.96" "$12,130.00" "$9,704.00" "$5,458.50" "$2,407.50" N/A "$7,035.40" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" N/A N/A 76-4113L SUP HCPCS C1776 76-4113L - COMPONENT FEMORAL 13 81X58MM MODULAR TOT STABILIZE REVISION BOTH IP/OP "$12,130.00" "$8,976.00" "$2,407.50" "$12,130.00" "$5,458.50" "$5,458.50" "$5,458.50" "$5,458.50" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.20" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.03" "$12,130.00" "$4,852.00" "$5,980.09" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$9,097.50" "$12,130.00" "$12,130.00" "$12,130.00" "$6,065.00" "$6,065.00" "$9,606.96" "$12,130.00" "$9,704.00" "$5,458.50" "$2,407.50" N/A "$7,035.40" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" N/A N/A 76-4113R SUP HCPCS C1776 76-4113R - COMPONENT FEMORAL 13 81X58MM MODULAR TOT STABILIZE REVISION BOTH IP/OP "$12,130.00" "$8,976.00" "$2,407.50" "$12,130.00" "$5,458.50" "$5,458.50" "$5,458.50" "$5,458.50" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.20" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$2,528.03" "$12,130.00" "$12,130.00" "$5,980.09" "$12,130.00" "$12,130.00" "$12,130.00" "$12,130.00" "$9,097.50" "$12,130.00" "$12,130.00" "$12,130.00" "$6,065.00" "$6,065.00" "$9,606.96" "$12,130.00" "$9,704.00" "$5,458.50" "$2,407.50" N/A "$7,035.40" "$12,130.00" "$7,278.00" "$12,130.00" "$12,130.00" "$12,130.00" N/A N/A 7650-2038A SUP Custom 27203010 7650-2038A - PIN FIX FLUTE SQUARE 1/8IN 3.5IN STAINLESS STEEL KNEE BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A 7679922P SUP Custom 27203010 7679922P - REAMER SRG 3.15MM STRL PCM MRC SPNE BOTH IP/OP $960.00 $710.00 $170.88 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $170.88 $960.00 $960.00 $712.51 $712.51 $739.97 $500.16 $200.07 $960.00 $384.00 $960.00 $960.00 $960.00 $960.00 $960.00 $720.00 $960.00 $960.00 $960.00 $480.00 $480.00 $760.32 $960.00 $768.00 $624.00 $960.00 N/A $556.80 $960.00 $576.00 $960.00 $960.00 $960.00 N/A N/A 7679925P SUP Custom 27203010 7679925P - REAMER SRG 3.5MM STRL PCM ANS SPNE BOTH IP/OP $960.00 $710.00 $170.88 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $170.88 $960.00 $960.00 $712.51 $712.51 $739.97 $500.16 $200.07 $960.00 $384.00 $960.00 $960.00 $960.00 $960.00 $960.00 $720.00 $960.00 $960.00 $960.00 $480.00 $480.00 $760.32 $960.00 $768.00 $624.00 $960.00 N/A $556.80 $960.00 $576.00 $960.00 $960.00 $960.00 N/A N/A 7679926P SUP Custom 27203010 7679926P - REAMER SRG 3.5MM STRL PCM MRL SPNE BOTH IP/OP $960.00 $710.00 $170.88 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $170.88 $960.00 $960.00 $712.51 $712.51 $739.97 $500.16 $200.07 $960.00 $384.00 $960.00 $960.00 $960.00 $960.00 $960.00 $720.00 $960.00 $960.00 $960.00 $480.00 $480.00 $760.32 $960.00 $768.00 $624.00 $960.00 N/A $556.80 $960.00 $576.00 $960.00 $960.00 $960.00 N/A N/A 7679927P SUP Custom 27203010 7679927P - REAMER SRG 3.5MM STRL PCM HXL SPNE BOTH IP/OP $960.00 $710.00 $170.88 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $170.88 $960.00 $960.00 $712.51 $712.51 $739.97 $500.16 $200.07 $960.00 $384.00 $960.00 $960.00 $960.00 $960.00 $960.00 $720.00 $960.00 $960.00 $960.00 $480.00 $480.00 $760.32 $960.00 $768.00 $624.00 $960.00 N/A $556.80 $960.00 $576.00 $960.00 $960.00 $960.00 N/A N/A 7679930P SUP Custom 27203010 7679930P - REAMER SRG 3.5MM STRL PCM JC SPNE BOTH IP/OP $960.00 $710.00 $170.88 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $170.88 $960.00 $960.00 $712.51 $712.51 $739.97 $500.16 $200.07 $960.00 $384.00 $960.00 $960.00 $960.00 $960.00 $960.00 $720.00 $960.00 $960.00 $960.00 $480.00 $480.00 $760.32 $960.00 $768.00 $624.00 $960.00 N/A $556.80 $960.00 $576.00 $960.00 $960.00 $960.00 N/A N/A 7679934P SUP Custom 27203010 7679934P - REAMER SRG 3.5MM STRL PCM TSPE SPNE BOTH IP/OP $960.00 $710.00 $170.88 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $960.00 $170.88 $960.00 $960.00 $712.51 $712.51 $739.97 $500.16 $200.07 $960.00 $384.00 $960.00 $960.00 $960.00 $960.00 $960.00 $720.00 $960.00 $960.00 $960.00 $480.00 $480.00 $760.32 $960.00 $768.00 $624.00 $960.00 N/A $556.80 $960.00 $576.00 $960.00 $960.00 $960.00 N/A N/A 768G SUP Custom 27203010 768G - SUTURE NONABSORBABLE 7-0 G-6 18IN 2 ARM BRAID NEEDLE BOTH IP/OP $33.00 $24.00 $5.81 $33.58 $32.63 $32.63 $32.63 $32.63 $32.63 $32.63 $5.81 $32.63 $32.63 $24.22 $24.22 $25.15 $17.00 $6.80 $32.63 $13.43 $32.63 $32.63 $33.58 $32.63 $32.63 $24.75 $32.63 $32.63 $32.63 $16.32 $16.32 $25.84 $32.63 $26.10 $21.21 $32.63 N/A $19.14 $32.63 $19.58 $32.63 $32.63 $32.63 N/A N/A 76-9102 SUP HCPCS C1713 76-9102 - SCREW BN 2.7MM 8MM ER LCK RB BOTH IP/OP $185.00 $137.00 $36.72 $232.50 $83.25 $83.25 $83.25 $83.25 $185.00 $185.00 $185.00 $38.56 $185.00 $185.00 $185.00 $185.00 $185.00 $38.56 $185.00 $93.00 $109.43 $185.00 $232.50 $185.00 $185.00 $138.75 $185.00 $185.00 $185.00 $92.50 $92.50 $146.52 $185.00 $148.00 $83.25 $36.72 N/A $107.30 $185.00 $185.00 $185.00 $185.00 $185.00 N/A N/A 76-9103 SUP HCPCS C1713 76-9103 - PLATE BN 16 HL TMPLT RB BOTH IP/OP $185.00 $137.00 $36.72 $232.50 $83.25 $83.25 $83.25 $83.25 $185.00 $185.00 $185.00 $38.56 $185.00 $185.00 $185.00 $185.00 $185.00 $38.56 $185.00 $93.00 $109.43 $185.00 $232.50 $185.00 $185.00 $138.75 $185.00 $185.00 $185.00 $92.50 $92.50 $146.52 $185.00 $148.00 $83.25 $36.72 N/A $107.30 $185.00 $185.00 $185.00 $38.55 $185.00 N/A N/A 76-9104 SUP HCPCS C1713 76-9104 - TEMPLATE SZ 16 HL PLT BOTH IP/OP $185.00 $137.00 $36.72 $232.50 $83.25 $83.25 $83.25 $83.25 $185.00 $185.00 $185.00 $38.56 $185.00 $185.00 $185.00 $185.00 $185.00 $38.56 $185.00 $93.00 $109.43 $185.00 $232.50 $185.00 $185.00 $138.75 $185.00 $185.00 $185.00 $92.50 $92.50 $146.52 $185.00 $148.00 $83.25 $36.72 N/A $107.30 $185.00 $185.00 $185.00 $185.00 $185.00 N/A N/A 769G SUP Custom 27203010 769G - SUTURE NABSB 6-0 G-6 18IN BLK PRMHND MICROPOINT 2 ARM BRD BOTH IP/OP $32.50 $24.00 $5.77 $33.33 $32.39 $32.39 $32.39 $32.39 $32.39 $32.39 $5.77 $32.39 $32.39 $24.04 $24.04 $24.97 $16.88 $6.75 $32.39 $13.33 $32.39 $32.39 $33.33 $32.39 $32.39 $24.38 $32.39 $32.39 $32.39 $16.20 $16.20 $25.65 $32.39 $25.91 $21.05 $32.39 N/A $18.85 $32.39 $19.43 $32.39 $32.39 $32.39 N/A N/A 77-1003 SUP HCPCS C1776 77-1003 - TRAY TIBIAL 3MM LP SCORPIO KNEE BOTH IP/OP "$2,308.00" "$1,708.00" $458.08 "$2,308.00" "$1,038.60" "$1,038.60" "$1,038.60" "$1,038.60" "$2,308.00" "$2,308.00" "$2,308.00" $481.04 "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" $481.01 "$2,308.00" $923.20 "$1,365.18" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$1,731.00" "$2,308.00" "$2,308.00" "$2,308.00" "$1,154.00" "$1,154.00" "$1,827.94" "$2,308.00" "$1,846.40" "$1,038.60" $458.08 N/A "$1,338.64" "$2,308.00" "$1,384.80" "$2,308.00" $480.99 "$2,308.00" N/A N/A 77-1004 SUP HCPCS C1776 77-1004 - TRAY TIBIAL 4MM LP SCORPIO KNEE BOTH IP/OP "$2,308.00" "$1,708.00" $458.08 "$2,308.00" "$1,038.60" "$1,038.60" "$1,038.60" "$1,038.60" "$2,308.00" "$2,308.00" "$2,308.00" $481.04 "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" $481.01 "$2,308.00" "$2,308.00" "$1,365.18" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$1,731.00" "$2,308.00" "$2,308.00" "$2,308.00" "$1,154.00" "$1,154.00" "$1,827.94" "$2,308.00" "$1,846.40" "$1,038.60" $458.08 N/A "$1,338.64" "$2,308.00" "$1,384.80" "$2,308.00" "$2,308.00" "$2,308.00" N/A N/A 77-1006 SUP HCPCS C1776 77-1006 - TRAY TIBIAL 6MM LP SCORPIO KNEE BOTH IP/OP "$2,308.00" "$1,708.00" $458.08 "$2,308.00" "$1,038.60" "$1,038.60" "$1,038.60" "$1,038.60" "$2,308.00" "$2,308.00" "$2,308.00" $481.04 "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" $481.01 "$2,308.00" $923.20 "$1,365.18" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$1,731.00" "$2,308.00" "$2,308.00" "$2,308.00" "$1,154.00" "$1,154.00" "$1,827.94" "$2,308.00" "$1,846.40" "$1,038.60" $458.08 N/A "$1,338.64" "$2,308.00" "$1,384.80" "$2,308.00" "$2,308.00" "$2,308.00" N/A N/A 77-1007 SUP HCPCS C1776 77-1007 - TRAY TIBIAL 7MM LP SCORPIO KNEE BOTH IP/OP "$2,308.00" "$1,708.00" $458.08 "$2,308.00" "$1,038.60" "$1,038.60" "$1,038.60" "$1,038.60" "$2,308.00" "$2,308.00" "$2,308.00" $481.04 "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" $481.01 "$2,308.00" "$2,308.00" "$1,365.18" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$1,731.00" "$2,308.00" "$2,308.00" "$2,308.00" "$1,154.00" "$1,154.00" "$1,827.94" "$2,308.00" "$1,846.40" "$1,038.60" $458.08 N/A "$1,338.64" "$2,308.00" "$1,384.80" "$2,308.00" $480.99 "$2,308.00" N/A N/A 77-1009 SUP HCPCS C1776 77-1009 - TRAY TIBIAL 9MM LP SCORPIO KNEE BOTH IP/OP "$2,308.00" "$1,708.00" $458.08 "$2,308.00" "$1,038.60" "$1,038.60" "$1,038.60" "$1,038.60" "$2,308.00" "$2,308.00" "$2,308.00" $481.04 "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" $481.01 "$2,308.00" $923.20 "$1,365.18" "$2,308.00" "$2,308.00" "$2,308.00" "$2,308.00" "$1,731.00" "$2,308.00" "$2,308.00" "$2,308.00" "$1,154.00" "$1,154.00" "$1,827.94" "$2,308.00" "$1,846.40" "$1,038.60" $458.08 N/A "$1,338.64" "$2,308.00" "$2,308.00" "$2,308.00" $480.99 "$2,308.00" N/A N/A 7717G SUP Custom 27203010 7717G - SUTURE NONABSORBABLE 9-0 TG140-8 12IN 2 ARM MONOFILAMENT BOTH IP/OP $34.00 $25.00 $6.01 $34.75 $33.76 $33.76 $33.76 $33.76 $33.76 $33.76 $6.01 $33.76 $33.76 $25.06 $25.06 $26.02 $17.59 $7.04 $33.76 $13.90 $33.76 $33.76 $34.75 $33.76 $33.76 $25.50 $33.76 $33.76 $33.76 $16.88 $16.88 $26.74 $33.76 $27.01 $21.94 $33.76 N/A $19.72 $33.76 $20.26 $33.76 $33.76 $33.76 N/A N/A 7731G SUP Custom 27203010 7731G - SUTURE NABSB 5-0 S-24 18IN BLK ETH SBLC 2 ARM MFL BOTH IP/OP $34.00 $25.00 $6.05 $34.96 $33.98 $33.98 $33.98 $33.98 $33.98 $33.98 $6.05 $33.98 $33.98 $25.22 $25.22 $26.19 $17.70 $7.08 $33.98 $13.98 $33.98 $33.98 $34.96 $33.98 $33.98 $25.50 $33.98 $33.98 $33.98 $16.99 $16.99 $26.91 $33.98 $27.18 $22.09 $33.98 N/A $19.72 $33.98 $20.39 $33.98 $33.98 $33.98 N/A N/A 77-4003 SUP HCPCS C1776 77-4003 - TRAY TIBIAL 3 40/61MM 35MM 1 AXIS TOT STABILIZE STEM END CAP BOTH IP/OP "$5,837.50" "$4,320.00" "$1,158.60" "$5,837.50" "$2,626.88" "$2,626.88" "$2,626.88" "$2,626.88" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.68" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.60" "$5,837.50" "$5,837.50" "$2,877.89" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$4,378.13" "$5,837.50" "$5,837.50" "$5,837.50" "$2,918.75" "$2,918.75" "$4,623.30" "$5,837.50" "$4,670.00" "$2,626.88" "$1,158.60" N/A "$3,385.75" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.54" "$5,837.50" N/A N/A 77-4004 SUP HCPCS C1776 77-4004 - TRAY TIBIAL 4 TOT STABILIZE MODULAR SCORPIO KNEE BOTH IP/OP "$5,837.50" "$4,320.00" "$1,158.60" "$5,837.50" "$2,626.88" "$2,626.88" "$2,626.88" "$2,626.88" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.68" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.60" "$5,837.50" "$2,335.00" "$2,877.89" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$4,378.13" "$5,837.50" "$5,837.50" "$5,837.50" "$2,918.75" "$2,918.75" "$4,623.30" "$5,837.50" "$4,670.00" "$2,626.88" "$1,158.60" N/A "$3,385.75" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" N/A N/A 77-4005 SUP HCPCS C1776 77-4005 - TRAY TIBIAL 5 44/66MM 35MM 1 AXIS TOT STABILIZE STEM END CAP BOTH IP/OP "$5,837.50" "$4,320.00" "$1,158.60" "$5,837.50" "$2,626.88" "$2,626.88" "$2,626.88" "$2,626.88" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.68" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.60" "$5,837.50" "$5,837.50" "$2,877.89" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$4,378.13" "$5,837.50" "$5,837.50" "$5,837.50" "$2,918.75" "$2,918.75" "$4,623.30" "$5,837.50" "$4,670.00" "$2,626.88" "$1,158.60" N/A "$3,385.75" "$5,837.50" "$3,502.50" "$5,837.50" "$5,837.50" "$5,837.50" N/A N/A 77-4006 SUP HCPCS C1776 77-4006 - TRAY TIBIAL 6 TOT STABILIZE MODULAR SCORPIO KNEE BOTH IP/OP "$5,837.50" "$4,320.00" "$1,158.60" "$5,837.50" "$2,626.88" "$2,626.88" "$2,626.88" "$2,626.88" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.68" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.60" "$5,837.50" "$2,335.00" "$2,877.89" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$4,378.13" "$5,837.50" "$5,837.50" "$5,837.50" "$2,918.75" "$2,918.75" "$4,623.30" "$5,837.50" "$4,670.00" "$2,626.88" "$1,158.60" N/A "$3,385.75" "$5,837.50" "$3,502.50" "$5,837.50" "$1,216.54" "$5,837.50" N/A N/A 77-4007 SUP HCPCS C1776 77-4007 - TRAY TIBIAL 7 47/71MM 37MM 1 AXIS TOT STABILIZE STEM END CAP BOTH IP/OP "$5,837.50" "$4,320.00" "$1,158.60" "$5,837.50" "$2,626.88" "$2,626.88" "$2,626.88" "$2,626.88" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.68" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.60" "$5,837.50" "$5,837.50" "$2,877.89" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$4,378.13" "$5,837.50" "$5,837.50" "$5,837.50" "$2,918.75" "$2,918.75" "$4,623.30" "$5,837.50" "$4,670.00" "$2,626.88" "$1,158.60" N/A "$3,385.75" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.54" "$5,837.50" N/A N/A 77-4009 SUP HCPCS C1776 77-4009 - TRAY TIBIAL 9 51/77MM 37MM 1 AXIS TOT STABILIZE STEM END CAP BOTH IP/OP "$5,837.50" "$4,320.00" "$1,158.60" "$5,837.50" "$2,626.88" "$2,626.88" "$2,626.88" "$2,626.88" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.68" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.60" "$5,837.50" "$2,335.00" "$2,877.89" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$4,378.13" "$5,837.50" "$5,837.50" "$5,837.50" "$2,918.75" "$2,918.75" "$4,623.30" "$5,837.50" "$4,670.00" "$2,626.88" "$1,158.60" N/A "$3,385.75" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.54" "$5,837.50" N/A N/A 77-4011 SUP HCPCS C1776 77-4011 - TRAY TIBIAL 11 54/82MM 43MM 1 AXIS TOT STABILIZE STEM END BOTH IP/OP "$5,837.50" "$4,320.00" "$1,158.60" "$5,837.50" "$2,626.88" "$2,626.88" "$2,626.88" "$2,626.88" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.68" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.60" "$5,837.50" "$5,837.50" "$2,877.89" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$4,378.13" "$5,837.50" "$5,837.50" "$5,837.50" "$2,918.75" "$2,918.75" "$4,623.30" "$5,837.50" "$4,670.00" "$2,626.88" "$1,158.60" N/A "$3,385.75" "$5,837.50" "$3,502.50" "$5,837.50" "$1,216.54" "$5,837.50" N/A N/A 77-4013 SUP HCPCS C1776 77-4013 - TRAY TIBIAL 13 58/88MM 43MM 1 AXIS TOT STABILIZE STEM END BOTH IP/OP "$5,837.50" "$4,320.00" "$1,158.60" "$5,837.50" "$2,626.88" "$2,626.88" "$2,626.88" "$2,626.88" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.68" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$1,216.60" "$5,837.50" "$2,335.00" "$2,877.89" "$5,837.50" "$5,837.50" "$5,837.50" "$5,837.50" "$4,378.13" "$5,837.50" "$5,837.50" "$5,837.50" "$2,918.75" "$2,918.75" "$4,623.30" "$5,837.50" "$4,670.00" "$2,626.88" "$1,158.60" N/A "$3,385.75" "$5,837.50" "$3,502.50" "$5,837.50" "$1,216.54" "$5,837.50" N/A N/A 7751710EP SUP HCPCS C1713 7751710EP - SCREW BONE 3.5MM 10MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751712EP SUP HCPCS C1713 7751712EP - SCREW BONE 3.5MM 10MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751714EP SUP HCPCS C1713 7751714EP - SCREW BONE 3.5MM 14MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751716EP SUP HCPCS C1713 7751716EP - SCREW BONE 3.5MM 16MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751718EP SUP HCPCS C1713 7751718EP - SCREW BONE 3.5MM 18MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751720EP SUP HCPCS C1713 7751720EP - SCREW BONE 3.5MM 20MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751722EP SUP HCPCS C1713 7751722EP - SCREW BONE 3.5MM 22MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751724EP SUP HCPCS C1713 7751724EP - SCREW BONE 3.5MM 24MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751724PT SUP HCPCS C1713 7751724PT - SCREW BONE PTHRD 3.5MM 24MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751726PT SUP HCPCS C1713 7751726PT - SCREW BONE PTHRD 3.5MM 26MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $983.68 $983.68 N/A N/A 7751728PT SUP HCPCS C1713 7751728PT - SCREW BONE PTHRD 3.5MM 28MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751730PT SUP HCPCS C1713 7751730PT - SCREW BONE PTHRD 3.5MM 30MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751732PT SUP HCPCS C1713 7751732PT - SCREW BONE PTHRD 3.5MM 32MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $983.68 $983.68 N/A N/A 7751734PT SUP HCPCS C1713 7751734PT - SCREW BONE PTHRD 3.5MM 34MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $205.00 $983.68 N/A N/A 7751810EP SUP HCPCS C1713 7751810EP - SCREW BONE 4MM 10MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751812EP SUP HCPCS C1713 7751812EP - SCREW BONE 4MM 12MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751814EP SUP HCPCS C1713 7751814EP - SCREW BONE 4MM 14MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751816EP SUP HCPCS C1713 7751816EP - SCREW BONE 4MM 16MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751818EP SUP HCPCS C1713 7751818EP - SCREW BONE 4MM 18MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $983.68 $983.68 N/A N/A 7751820EP SUP HCPCS C1713 7751820EP - SCREW BONE 4MM 20MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $983.68 $983.68 N/A N/A 7751822EP SUP HCPCS C1713 7751822EP - SCREW BONE 4MM 22MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751824EP SUP HCPCS C1713 7751824EP - SCREW BONE 4MM 24MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751824PT SUP HCPCS C1713 7751824PT - SCREW BONE PTHRD 4MM 24MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751826EP SUP HCPCS C1713 7751826EP - SCREW BONE 4MM 26MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751826PT SUP HCPCS C1713 7751826PT - SCREW BONE PTHRD 4MM 26MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751828EP SUP HCPCS C1713 7751828EP - SCREW BONE 4MM 28MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $983.68 $983.68 N/A N/A 7751828PT SUP HCPCS C1713 7751828PT - SCREW BONE PTHRD 4MM 28MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $983.68 $983.68 N/A N/A 7751830EP SUP HCPCS C1713 7751830EP - SCREW BONE 4MM 30MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751830PT SUP HCPCS C1713 7751830PT - SCREW BONE PTHRD 4MM 30MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751832EP SUP HCPCS C1713 7751832EP - SCREW BONE 4MM 32MM EXTENDED POST SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $983.68 $983.68 N/A N/A 7751832PT SUP HCPCS C1713 7751832PT - SCREW BONE PTHRD 4MM 32MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $983.68 $983.68 N/A N/A 7751834EP SUP HCPCS C1713 7751834EP - SCREW BONE 4MM 34MM EXTENDED POST VERTEX TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $983.68 $983.68 $983.68 $983.68 N/A N/A 7751834PT SUP HCPCS C1713 7751834PT - SCREW BONE PTHRD 4MM 34MM POSTED SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751924EP SUP HCPCS C1713 7751924EP - SCREW BONE 4.5MM 24MM EXTENDED POST VERTEX TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $983.68 $983.68 N/A N/A 7751926EP SUP HCPCS C1713 7751926EP - SCREW BONE 4.5MM 26MM EXTENDED POST VERTEX TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $983.68 $983.68 N/A N/A 7751928EP SUP HCPCS C1713 7751928EP - SCREW BONE 4.5MM 28MM EXTENDED POST VERTEX TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751930EP SUP HCPCS C1713 7751930EP - SCREW BONE 4.5MM 30MM EXTENDED POST VERTEX TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751932EP SUP HCPCS C1713 7751932EP - SCREW BONE 4.5MM 32MM EXTENDED POST VERTEX TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $983.68 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $205.00 $983.68 N/A N/A 7751934EP SUP HCPCS C1713 7751934EP - SCREW BONE 4.5MM 34MM EXTENDED POST VERTEX TITANIUM SPN BOTH IP/OP $984.00 $728.00 $195.24 $983.68 $442.66 $442.66 $442.66 $442.66 $983.68 $983.68 $983.68 $205.02 $983.68 $983.68 $983.68 $983.68 $983.68 $205.01 $983.68 $393.47 $581.85 $983.68 $983.68 $983.68 $983.68 $738.00 $983.68 $983.68 $983.68 $491.84 $491.84 $779.07 $983.68 $786.94 $442.66 $195.24 N/A $570.72 $983.68 $590.21 $983.68 $983.68 $983.68 N/A N/A 77525P SUP HCPCS C1713 77525P - SCREW BN 7.75MM 25MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77525S SUP HCPCS C1713 77525S - SCREW BN STD 7.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77530P SUP HCPCS C1713 77530P - SCREW BN 7.75MM 30MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77530S SUP HCPCS C1713 77530S - SCREW BN STD 7.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77535P SUP HCPCS C1713 77535P - SCREW BN 7.75MM 35MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77535S SUP HCPCS C1713 77535S - SCREW BN STD 7.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77540P SUP HCPCS C1713 77540P - SCREW BN 7.75MM 40MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77540S SUP HCPCS C1713 77540S - SCREW BN STD 7.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77545P SUP HCPCS C1713 77545P - SCREW BN 7.75MM 45MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77545S SUP HCPCS C1713 77545S - SCREW BN STD 7.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77550P SUP HCPCS C1713 77550P - SCREW BN 7.75MM 50MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77550S SUP HCPCS C1713 77550S - SCREW BN STD 7.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77555P SUP HCPCS C1713 77555P - SCREW BN 7.75MM 55MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77555S SUP HCPCS C1713 77555S - SCREW BN STD 7.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 7756073L SUP HCPCS C1713 7756073L - HOOK SPINAL 4.5MM LEFT OFFST LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 7756073R SUP HCPCS C1713 7756073R - HOOK SPINAL 4.5MM OFFST RIGHT LMNR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A 7756074L SUP HCPCS C1713 7756074L - HOOK SPINAL OFFST 6MM LAMINA LEFT BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 7756074R SUP HCPCS C1713 7756074R - HOOK SPINAL OFFST 6MM LAMINA RIGHT BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 77560P SUP HCPCS C1713 77560P - SCREW BN 7.75MM 60MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77560S SUP HCPCS C1713 77560S - SCREW BN STD 7.75MM 60MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77565P SUP HCPCS C1713 77565P - SCREW BN 7.75MM 65MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$1,622.00" "$1,200.00" $321.92 "$1,621.98" $729.89 $729.89 $729.89 $729.89 "$1,621.98" "$1,621.98" "$1,621.98" $338.06 "$1,621.98" "$1,621.98" "$1,621.98" "$1,621.98" "$1,621.98" $338.04 "$1,621.98" "$1,621.98" $959.40 "$1,621.98" "$1,621.98" "$1,621.98" "$1,621.98" "$1,216.50" "$1,621.98" "$1,621.98" "$1,621.98" $810.99 $810.99 "$1,284.61" "$1,621.98" "$1,297.58" $729.89 $321.92 N/A $940.76 "$1,621.98" "$1,621.98" "$1,621.98" $338.02 "$1,621.98" N/A N/A 77565S SUP HCPCS C1713 77565S - SCREW BN STD 7.75MM 65MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$1,233.50" $913.00 $244.79 "$1,233.33" $555.00 $555.00 $555.00 $555.00 "$1,233.33" "$1,233.33" "$1,233.33" $257.06 "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" $257.04 "$1,233.33" $493.33 $729.51 "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" $925.13 "$1,233.33" "$1,233.33" "$1,233.33" $616.67 $616.67 $976.80 "$1,233.33" $986.66 $555.00 $244.79 N/A $715.43 "$1,233.33" "$1,233.33" "$1,233.33" $257.03 "$1,233.33" N/A N/A 77570P SUP HCPCS C1713 77570P - SCREW BN 7.75MM 70MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77580P SUP HCPCS C1713 77580P - SCREW BN 7.75MM 80MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 77590P SUP HCPCS C1713 77590P - SCREW BN 7.75MM 90MM SPRL R90D MULTIANGLE TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 78-10030 SUP HCPCS C1713 78-10030 - IMPLANT CRNL LG KT CSTM BOTH IP/OP "$30,104.50" "$22,277.00" "$5,974.96" "$30,104.35" "$13,546.96" "$13,546.96" "$13,546.96" "$13,546.96" "$30,104.35" "$30,104.35" "$30,104.35" "$6,274.50" "$30,104.35" "$30,104.35" "$30,104.35" "$30,104.35" "$30,104.35" "$6,274.08" "$30,104.35" "$30,104.35" "$14,841.44" "$30,104.35" "$30,104.35" "$30,104.35" "$30,104.35" "$22,578.38" "$30,104.35" "$30,104.35" "$30,104.35" "$15,052.18" "$15,052.18" "$23,842.65" "$30,104.35" "$24,083.48" "$13,546.96" "$5,974.96" N/A "$17,460.61" "$30,104.35" "$30,104.35" "$30,104.35" "$6,273.75" "$30,104.35" N/A N/A 7850-1-000 SUP HCPCS C1776 7850-1-000 - STEM FEMORAL 135D 0 HIPSTAR HIP BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$6,665.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$3,999.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 7850-1-001 SUP HCPCS C1776 7850-1-001 - STEM FEMORAL 135D 1 HIPSTAR HIP BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$2,666.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$3,999.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 7850-1-002 SUP HCPCS C1776 7850-1-002 - STEM FEMORAL 135D 2 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-1-003 SUP HCPCS C1776 7850-1-003 - STEM FEMORAL 135D 3 HIPSTAR TMZF HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-1-004 SUP HCPCS C1776 7850-1-004 - STEM FEMORAL HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-1-005 SUP HCPCS C1776 7850-1-005 - STEM FEMORAL 135D 5 HIPSTAR TMZF HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-1-006 SUP HCPCS C1776 7850-1-006 - STEM FEMORAL 135D 6 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-1-007 SUP HCPCS C1776 7850-1-007 - STEM FEMORAL 135D 7 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-1-008 SUP HCPCS C1776 7850-1-008 - STEM FEMORAL 135D 8 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-1-009 SUP HCPCS C1776 7850-1-009 - STEM FEMORAL 135D 9 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-1-010 SUP HCPCS C1776 7850-1-010 - STEM FEMORAL 135D 10 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-1-011 SUP HCPCS C1776 7850-1-011 - STEM FEMORAL 135D 11 HIPSTAR HIP BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$2,666.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$3,999.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 7850-1-012 SUP HCPCS C1776 7850-1-012 - STEM FEMORAL 135D 12 HIPSTAR HIP BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$6,665.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$6,665.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 7850-5-000 SUP HCPCS C1776 7850-5-000 - STEM FEMORAL 127D 0 HIPSTAR HIP BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$6,665.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$3,999.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 7850-5-001 SUP HCPCS C1776 7850-5-001 - STEM FEMORAL 127D 1 HIPSTAR HIP BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$2,666.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$3,999.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 7850-5-002 SUP HCPCS C1776 7850-5-002 - STEM FEMORAL 127D 2 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-5-003 SUP HCPCS C1776 7850-5-003 - STEM FEMORAL 127D 3 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-5-004 SUP HCPCS C1776 7850-5-004 - STEM FEMORAL 127D 4 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-5-005 SUP HCPCS C1776 7850-5-005 - STEM FEMORAL 127D 5 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$6,328.00" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-5-006 SUP HCPCS C1776 7850-5-006 - STEM FEMORAL 127D 6 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-5-007 SUP HCPCS C1776 7850-5-007 - STEM FEMORAL 127D 7 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-5-008 SUP HCPCS C1776 7850-5-008 - STEM FEMORAL 127D 8 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-5-009 SUP HCPCS C1776 7850-5-009 - STEM FEMORAL 127D 9 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-5-010 SUP HCPCS C1776 7850-5-010 - STEM FEMORAL 127D 10 HIPSTAR HIP BOTH IP/OP "$6,328.00" "$4,683.00" "$1,255.95" "$6,328.00" "$2,847.60" "$2,847.60" "$2,847.60" "$2,847.60" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.91" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$1,318.82" "$6,328.00" "$2,531.20" "$3,119.70" "$6,328.00" "$6,328.00" "$6,328.00" "$6,328.00" "$4,746.00" "$6,328.00" "$6,328.00" "$6,328.00" "$3,164.00" "$3,164.00" "$5,011.78" "$6,328.00" "$5,062.40" "$2,847.60" "$1,255.95" N/A "$3,670.24" "$6,328.00" "$3,796.80" "$6,328.00" "$1,318.76" "$6,328.00" N/A N/A 7850-5-011 SUP HCPCS C1776 7850-5-011 - STEM FEMORAL 127D 11 HIPSTAR HIP BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$2,666.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$3,999.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 7850-5-012 SUP HCPCS C1776 7850-5-012 - STEM FEMORAL 127D 12 HIPSTAR HIP BOTH IP/OP "$6,665.00" "$4,932.00" "$1,322.84" "$6,665.00" "$2,999.25" "$2,999.25" "$2,999.25" "$2,999.25" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.15" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$1,389.06" "$6,665.00" "$2,666.00" "$3,285.85" "$6,665.00" "$6,665.00" "$6,665.00" "$6,665.00" "$4,998.75" "$6,665.00" "$6,665.00" "$6,665.00" "$3,332.50" "$3,332.50" "$5,278.68" "$6,665.00" "$5,332.00" "$2,999.25" "$1,322.84" N/A "$3,865.70" "$6,665.00" "$6,665.00" "$6,665.00" "$1,388.99" "$6,665.00" N/A N/A 7925011S SUP HCPCS C1713 7925011S - CABLE SPINAL 2 LOOP 2 CRIMP TITANIUM STERILE BOTH IP/OP "$2,325.00" "$1,721.00" $461.45 "$2,325.00" "$1,046.25" "$1,046.25" "$1,046.25" "$1,046.25" "$2,325.00" "$2,325.00" "$2,325.00" $484.59 "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" $484.56 "$2,325.00" "$2,325.00" "$1,375.24" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$1,743.75" "$2,325.00" "$2,325.00" "$2,325.00" "$1,162.50" "$1,162.50" "$1,841.40" "$2,325.00" "$1,860.00" "$1,046.25" $461.45 N/A "$1,348.50" "$2,325.00" "$1,395.00" "$2,325.00" $484.53 "$2,325.00" N/A N/A 79-43903 SUP HCPCS C1713 79-43903 - CEMENT BONE INJECTABLE BIOCOMPATIBLE OSTEOCONDUCTIVE BOTH IP/OP "$2,315.00" "$1,713.00" $459.43 "$2,314.78" "$1,041.65" "$1,041.65" "$1,041.65" "$1,041.65" "$2,314.78" "$2,314.78" "$2,314.78" $482.46 "$2,314.78" "$2,314.78" "$2,314.78" "$2,314.78" "$2,314.78" $482.43 "$2,314.78" $925.91 "$1,369.19" "$2,314.78" "$2,314.78" "$2,314.78" "$2,314.78" "$1,736.25" "$2,314.78" "$2,314.78" "$2,314.78" "$1,157.39" "$1,157.39" "$1,833.31" "$2,314.78" "$1,851.82" "$1,041.65" $459.43 N/A "$1,342.70" "$2,314.78" "$2,314.78" "$2,314.78" $482.40 "$2,314.78" N/A N/A 79-43905 SUP HCPCS C1713 79-43905 - CEMENT BONE INJECTABLE BIOCOMPATIBLE OSTEOCONDUCTIVE BOTH IP/OP "$3,817.50" "$2,825.00" $757.62 "$3,817.23" "$1,717.75" "$1,717.75" "$1,717.75" "$1,717.75" "$3,817.23" "$3,817.23" "$3,817.23" $795.61 "$3,817.23" "$3,817.23" "$3,817.23" "$3,817.23" "$3,817.23" $795.55 "$3,817.23" "$3,817.23" "$1,881.89" "$3,817.23" "$3,817.23" "$3,817.23" "$3,817.23" "$2,863.13" "$3,817.23" "$3,817.23" "$3,817.23" "$1,908.62" "$1,908.62" "$3,023.25" "$3,817.23" "$3,053.78" "$1,717.75" $757.62 N/A "$2,214.15" "$3,817.23" "$3,817.23" "$3,817.23" $795.51 "$3,817.23" N/A N/A 79-43910 SUP HCPCS C1713 79-43910 - CEMENT BN 10CC STRL LF HYDROSET INJ OSTCNDC CA PHOS VOID FIL BOTH IP/OP "$7,335.50" "$5,428.00" "$1,455.84" "$7,335.12" "$3,300.80" "$3,300.80" "$3,300.80" "$3,300.80" "$7,335.12" "$7,335.12" "$7,335.12" "$1,528.82" "$7,335.12" "$7,335.12" "$7,335.12" "$7,335.12" "$7,335.12" "$1,528.72" "$7,335.12" "$7,335.12" "$3,616.21" "$7,335.12" "$7,335.12" "$7,335.12" "$7,335.12" "$5,501.63" "$7,335.12" "$7,335.12" "$7,335.12" "$3,667.56" "$3,667.56" "$5,809.42" "$7,335.12" "$5,868.10" "$3,300.80" "$1,455.84" N/A "$4,254.59" "$7,335.12" "$7,335.12" "$7,335.12" "$1,528.64" "$7,335.12" N/A N/A 79-45903 SUP HCPCS C1713 79-45903 - DIRECT INJECT 3CC BOTH IP/OP "$3,840.00" "$2,842.00" $762.14 "$3,840.00" "$1,728.00" "$1,728.00" "$1,728.00" "$1,728.00" "$3,840.00" "$3,840.00" "$3,840.00" $800.35 "$3,840.00" "$3,840.00" "$3,840.00" "$3,840.00" "$3,840.00" $800.30 "$3,840.00" "$3,840.00" "$1,893.12" "$3,840.00" "$3,840.00" "$3,840.00" "$3,840.00" "$2,880.00" "$3,840.00" "$3,840.00" "$3,840.00" "$1,920.00" "$1,920.00" "$3,041.28" "$3,840.00" "$3,072.00" "$1,728.00" $762.14 N/A "$2,227.20" "$3,840.00" "$2,304.00" "$3,840.00" $800.26 "$3,840.00" N/A N/A 79-45905 SUP HCPCS C1713 79-45905 - DIRECT INJECT 5CC BOTH IP/OP "$6,010.00" "$4,447.00" "$1,192.83" "$6,010.00" "$2,704.50" "$2,704.50" "$2,704.50" "$2,704.50" "$6,010.00" "$6,010.00" "$6,010.00" "$1,252.63" "$6,010.00" "$6,010.00" "$6,010.00" "$6,010.00" "$6,010.00" "$1,252.55" "$6,010.00" "$6,010.00" "$2,962.93" "$6,010.00" "$6,010.00" "$6,010.00" "$6,010.00" "$4,507.50" "$6,010.00" "$6,010.00" "$6,010.00" "$3,005.00" "$3,005.00" "$4,759.92" "$6,010.00" "$4,808.00" "$2,704.50" "$1,192.83" N/A "$3,485.80" "$6,010.00" "$3,606.00" "$6,010.00" "$1,252.48" "$6,010.00" N/A N/A 79-45910 SUP HCPCS C1713 79-45910 - DIRECT INJECT 10CC BOTH IP/OP "$9,278.00" "$6,866.00" "$1,841.40" "$9,277.75" "$4,174.99" "$4,174.99" "$4,174.99" "$4,174.99" "$9,277.75" "$9,277.75" "$9,277.75" "$1,933.72" "$9,277.75" "$9,277.75" "$9,277.75" "$9,277.75" "$9,277.75" "$1,933.59" "$9,277.75" "$9,277.75" "$4,573.93" "$9,277.75" "$9,277.75" "$9,277.75" "$9,277.75" "$6,958.50" "$9,277.75" "$9,277.75" "$9,277.75" "$4,638.88" "$4,638.88" "$7,347.98" "$9,277.75" "$7,422.20" "$4,174.99" "$1,841.40" N/A "$5,381.24" "$9,277.75" "$5,566.65" "$9,277.75" "$1,933.48" "$9,277.75" N/A N/A 794G SUP Custom 27203010 794G - SUTURE ABSORBABLE 6-0 G-6 18IN 2 ARM MONOFILAMENT CHROMIC BOTH IP/OP $43.50 $32.00 $7.74 $44.76 $43.50 $43.50 $43.50 $43.50 $43.50 $43.50 $7.74 $43.50 $43.50 $32.29 $32.29 $33.53 $22.66 $9.07 $43.50 $17.90 $43.50 $43.50 $44.76 $43.50 $43.50 $32.63 $43.50 $43.50 $43.50 $21.75 $21.75 $34.45 $43.50 $34.80 $28.28 $43.50 N/A $25.23 $43.50 $26.10 $43.50 $43.50 $43.50 N/A N/A 79-83203 SUP HCPCS L0172 79-83203 - COLLAR CERV SMALL 10-20IN 2IN CHIN REST COMFORT PAD BOTH IP/OP $102.00 $75.00 $21.23 $112.86 $45.85 $45.85 $45.85 $45.85 $101.88 $101.88 $86.19 $112.86 $101.88 $101.88 $101.88 $101.88 $101.88 $21.23 $101.88 $34.66 $60.26 $101.88 $86.65 $101.88 $101.88 $76.50 $101.88 $101.88 $101.88 $50.94 $50.94 $80.69 $101.88 $81.50 $45.85 $101.88 N/A $59.16 $101.88 $61.13 $101.88 $109.67 $101.88 N/A N/A 79-83205 SUP HCPCS L0172 79-83205 - COLLAR CERV MEDIUM 10-20IN 2.5IN CHIN REST PAD TRACHEAL OPEN BOTH IP/OP $102.00 $75.00 $21.23 $112.86 $45.85 $45.85 $45.85 $45.85 $101.88 $101.88 $86.19 $112.86 $101.88 $101.88 $101.88 $101.88 $101.88 $21.23 $101.88 $40.75 $60.26 $101.88 $101.88 $101.88 $101.88 $76.50 $101.88 $101.88 $101.88 $50.94 $50.94 $80.69 $101.88 $81.50 $45.85 $101.88 N/A $59.16 $101.88 $61.13 $101.88 $109.67 $101.88 N/A N/A 79-83207 SUP HCPCS L0172 79-83207 - COLLAR CERV LARGE 10-20IN 3IN CHIN REST PAD TRACHEAL OPEN BOTH IP/OP $102.00 $75.00 $21.23 $112.86 $45.85 $45.85 $45.85 $45.85 $101.88 $101.88 $86.19 $112.86 $101.88 $101.88 $101.88 $101.88 $101.88 $21.23 $101.88 $40.75 $60.26 $101.88 $101.88 $101.88 $101.88 $76.50 $101.88 $101.88 $101.88 $50.94 $50.94 $80.69 $101.88 $81.50 $45.85 $101.88 N/A $59.16 $101.88 $61.13 $101.88 $109.67 $101.88 N/A N/A 79-94001 SUP Custom 27203010 BRACE ORTH LG UNV PS FOAM KNEERANGER BOTH IP/OP $140.00 $104.00 $24.86 $139.65 $139.65 $139.65 $139.65 $139.65 $139.65 $139.65 $24.86 $139.65 $139.65 $103.65 $103.65 $107.64 $72.76 $29.10 $139.65 $55.86 $139.65 $139.65 $139.65 $139.65 $139.65 $105.00 $139.65 $139.65 $139.65 $69.83 $69.83 $110.60 $139.65 $111.72 $90.77 $139.65 N/A $81.20 $139.65 $83.79 $139.65 $139.65 $139.65 N/A N/A 79-94001 SUP HCPCS L1832 79-94001 - BRACE ORTHOPEDIC LARGE LONG 32+ IN HINGE BAR POSTOPERATIVE BOTH IP/OP $145.50 $108.00 $24.86 $139.65 $139.65 $139.65 $139.65 $139.65 $139.65 $139.65 $24.86 $139.65 $139.65 $103.65 $103.65 $107.64 $72.76 $29.10 $139.65 $55.86 $139.65 $139.65 $139.65 $139.65 $139.65 $109.13 $139.65 $139.65 $139.65 $69.83 $69.83 $110.60 $139.65 $111.72 $90.77 $139.65 N/A $84.39 $139.65 $83.79 $139.65 $139.65 $139.65 N/A N/A 79-96018 SUP HCPCS L1830 79-96018 - SPLINT ORTHOPEDIC UNIVERSAL 2 CNTOUR 29- IN 18IN 3IN BASIC BOTH IP/OP $35.00 $26.00 $7.29 $48.84 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $48.84 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $15.75 $35.00 N/A $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A 79-97955 SUP HCPCS L3980 79-97955 - BRACE ORTHOPEDIC 2 THICK MEDIUM 10-13IN 10.25IN STOCKINETTE BOTH IP/OP $147.50 $109.00 $30.70 $223.26 $66.28 $66.28 $66.28 $66.28 $147.29 $147.29 $205.02 $223.26 $147.29 $147.29 $147.29 $147.29 $147.29 $30.70 $147.29 $58.92 $87.12 $147.29 $147.29 $147.29 $147.29 $110.63 $147.29 $147.29 $147.29 $73.65 $73.65 $116.65 $147.29 $117.83 $66.28 $147.29 N/A $85.55 $147.29 $88.37 $147.29 $216.95 $147.29 N/A N/A 7AC60-MN SUP Custom 27203010 7AC60-MN - TOOL DISSECTING 6MM 7CM ACORN FLUTED MIDAS REX LEGEND BOTH IP/OP $312.50 $231.00 $55.60 $312.38 $312.38 $312.38 $312.38 $312.38 $312.38 $312.38 $55.60 $312.38 $312.38 $231.85 $231.85 $240.78 $162.75 $65.10 $312.38 $124.95 $312.38 $312.38 $312.38 $312.38 $312.38 $234.38 $312.38 $312.38 $312.38 $156.19 $156.19 $247.40 $312.38 $249.90 $203.05 $312.38 N/A $181.25 $312.38 $187.43 $312.38 $312.38 $312.38 N/A N/A 7BA05 SUP Custom 27203010 7BA05 - TOOL DISSECTING .5MM 7CM BALL FLUTED MIDAS REX LEGEND BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA05L-MN SUP Custom 27203010 7BA05L-MN - TOOL DISSECTING LONG BALL .5MM 7CM SMALL BORE FLUTED MIDAS BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA05-MN SUP Custom 27203010 7BA05-MN - TOOL DISSECTING BALL .5MM 7CM FLUTED MIDAS REX LEGEND BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA06DL-MN SUP Custom 27203010 7BA06DL-MN - TOOL DISSECTING LONG .6MM 7CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA06D-MN SUP Custom 27203010 7BA06D-MN - TOOL DISSECTING .6MM 7CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA10 SUP Custom 27203010 7BA10 - TOOL DISSECTING 1MM 7CM BALL FLUTED MIDAS REX LEGEND STERILE BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA10C-MN SUP Custom 27203010 7BA10C-MN - TOOL DISSECTING 1MM 7CM BALL FLUTED MIDAS REX LEGEND MEDNEXT BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 7BA10D SUP Custom 27203010 7BA10D - TOOL DISSECTING 1MM 7CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA10-MN SUP Custom 27203010 7BA10-MN - TOOL DISSECTING 1MM 7CM BALL FLUTED MIDAS REX LEGEND MEDNEXT BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA15 SUP Custom 27203010 7BA15 - TOOL DISSECTING 1.5MM 7CM BALL FLUTED MIDAS REX LEGEND BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA15D SUP Custom 27203010 7BA15D - TOOL DISSECTING 1.5MM 7CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA15DL-MN SUP Custom 27203010 7BA15DL-MN - TOOL DISSECTING LONG 1.5MM 7CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA15D-MN SUP Custom 27203010 7BA15D-MN - TOOL DISSECTING 1.5MM 7CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA15-MN SUP Custom 27203010 7BA15-MN - TOOL DISSECTING 1.5MM 7CM BALL FLUTED MIDAS REX LEGEND BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA20 SUP Custom 27203010 7BA20 - TOOL DISSECTING 2MM 7CM BALL FLUTED MIDAS REX LEGEND STERILE BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA20C-MN SUP Custom 27203010 7BA20C-MN - TOOL DISSECTING 2MM 7CM BALL FLUTED MIDAS REX LEGEND MEDNEXT BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 7BA20D SUP Custom 27203010 7BA20D - TOOL DISSECTING BALL 2MM 7CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA20DC-MN SUP Custom 27203010 7BA20DC-MN - TOOL DISSECTING 2MM 7CM BALL DIAMOND COARSE MIDAS REX LEGEND BOTH IP/OP $325.50 $241.00 $57.87 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $57.87 $325.13 $325.13 $241.31 $241.31 $250.61 $169.39 $67.76 $325.13 $130.05 $325.13 $325.13 $325.13 $325.13 $325.13 $244.13 $325.13 $325.13 $325.13 $162.57 $162.57 $257.50 $325.13 $260.10 $211.33 $325.13 N/A $188.79 $325.13 $195.08 $325.13 $325.13 $325.13 N/A N/A 7BA20DL-MN SUP Custom 27203010 7BA20DL-MN - TOOL DISSECTING LONG 2MM 7CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA20-MN SUP Custom 27203010 7BA20-MN - BURR SURG 2MM 7CM BALL HEAD LEGEND MEDNEXT BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA25 SUP Custom 27203010 7BA25 - TOOL DISSECTING 2.5MM 7CM BALL FLUTED MIDAS REX LEGEND BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA25D SUP Custom 27203010 7BA25D - TOOL DISSECTING 2.5MM 7CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA25D-MN SUP Custom 27203010 7BA25D-MN - TOOL DISSECTING 2.5MM 7CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA25-MN SUP Custom 27203010 7BA25-MN - TOOL DISSECTING 2.5MM 7CM BALL FLUTED MIDAS REX LEGEND BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA30 SUP Custom 27203010 7BA30 - TOOL DISSECTING BALL 3MM 7CM FLUTED MIDAS REX LEGEND STERILE BOTH IP/OP $300.00 $222.00 $53.33 $299.63 $299.63 $299.63 $299.63 $299.63 $299.63 $299.63 $53.33 $299.63 $299.63 $222.39 $222.39 $230.95 $156.11 $62.45 $299.63 $119.85 $299.63 $299.63 $299.63 $299.63 $299.63 $225.00 $299.63 $299.63 $299.63 $149.82 $149.82 $237.31 $299.63 $239.70 $194.76 $299.63 N/A $174.00 $299.63 $179.78 $299.63 $299.63 $299.63 N/A N/A 7BA30C-MN SUP Custom 27203010 7BA30C-MN - TOOL DISSECTING BALL 3MM 7CM FLUTED MIDAS REX LEGEND MEDNEXT BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 7BA30D SUP Custom 27203010 7BA30D - TOOL DISSECTING 3MM 7CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA30DC-MN SUP Custom 27203010 7BA30DC-MN - TOOL DISSECTING BALL COARSE 3MM 7CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $325.50 $241.00 $57.87 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $57.87 $325.13 $325.13 $241.31 $241.31 $250.61 $169.39 $67.76 $325.13 $130.05 $325.13 $325.13 $325.13 $325.13 $325.13 $244.13 $325.13 $325.13 $325.13 $162.57 $162.57 $257.50 $325.13 $260.10 $211.33 $325.13 N/A $188.79 $325.13 $195.08 $325.13 $325.13 $325.13 N/A N/A 7BA30DL-MN SUP Custom 27203010 7BA30DL-MN - TOOL DISSECTING BALL LONG 3MM 7CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA30L-MN SUP Custom 27203010 7BA30L-MN - TOOL DISSECTING LONG 3MM 7CM BALL FLUTED MIDAS REX LEGEND BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA30-MN SUP Custom 27203010 7BA30-MN - TOOL DISSECTING BALL 3MM 7CM FLUTED MIDAS REX LEGEND MEDNEXT BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA40C-MN SUP Custom 27203010 7BA40C-MN - TOOL DISSECTING 4MM 7CM BALL FLUTED MIDAS REX LEGEND MEDNEXT BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 7BA40D SUP Custom 27203010 7BA40D - TOOL DISSECTING BALL 4MM 7CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $325.50 $241.00 $57.87 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $57.87 $325.13 $325.13 $241.31 $241.31 $250.61 $169.39 $67.76 $325.13 $130.05 $325.13 $325.13 $325.13 $325.13 $325.13 $244.13 $325.13 $325.13 $325.13 $162.57 $162.57 $257.50 $325.13 $260.10 $211.33 $325.13 N/A $188.79 $325.13 $195.08 $325.13 $325.13 $325.13 N/A N/A 7BA40DC-MN SUP Custom 27203010 7BA40DC-MN - TOOL DISSECTING BALL COARSE 4MM 7CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $325.50 $241.00 $57.87 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $57.87 $325.13 $325.13 $241.31 $241.31 $250.61 $169.39 $67.76 $325.13 $130.05 $325.13 $325.13 $325.13 $325.13 $325.13 $244.13 $325.13 $325.13 $325.13 $162.57 $162.57 $257.50 $325.13 $260.10 $211.33 $325.13 N/A $188.79 $325.13 $195.08 $325.13 $325.13 $325.13 N/A N/A 7BA40F-MN SUP Custom 27203010 7BA40F-MN - TOOL DISSECTING BALL FINE 4MM 7CM MIDAS REX LEGEND MEDNEXT BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA40-MN SUP Custom 27203010 7BA40-MN - TOOL DISSECTING 4MM 7CM BALL LEGEND MN BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA50C-MN SUP Custom 27203010 7BA50C-MN - TOOL DISSECTING BALL 5MM 7CM FLUTED MIDAS REX LEGEND MEDNEXT BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 7BA50DC-MN SUP Custom 27203010 7BA50DC-MN - TOOL DISSECTING BALL COARSE 5MM 7CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $325.50 $241.00 $57.87 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $57.87 $325.13 $325.13 $241.31 $241.31 $250.61 $169.39 $67.76 $325.13 $130.05 $325.13 $325.13 $325.13 $325.13 $325.13 $244.13 $325.13 $325.13 $325.13 $162.57 $162.57 $257.50 $325.13 $260.10 $211.33 $325.13 N/A $188.79 $325.13 $195.08 $325.13 $325.13 $325.13 N/A N/A 7BA50F-MN SUP Custom 27203010 7BA50F-MN - TOOL DISSECTING BALL FINE 5MM 7CM MIDAS REX LEGEND MEDNEXT BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA50-MN SUP Custom 27203010 7BA50-MN - TOOL DISSECTING BALL 5MM 7CM FLUTED MIDAS REX LEGEND MEDNEXT BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA60C-MN SUP Custom 27203010 7BA60C-MN - TOOL DISSECTING BALL 6MM 7CM FLUTED MIDAS REX LEGEND MEDNEXT BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 7BA60D SUP Custom 27203010 7BA60D - TOOL DISSECTING 6MM 7CM BALL MIDAS REX LEGEND DIAMOND BOTH IP/OP $325.50 $241.00 $57.87 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $57.87 $325.13 $325.13 $241.31 $241.31 $250.61 $169.39 $67.76 $325.13 $130.05 $325.13 $325.13 $325.13 $325.13 $325.13 $244.13 $325.13 $325.13 $325.13 $162.57 $162.57 $257.50 $325.13 $260.10 $211.33 $325.13 N/A $188.79 $325.13 $195.08 $325.13 $325.13 $325.13 N/A N/A 7BA60DC-MN SUP Custom 27203010 7BA60DC-MN - TOOL DISSECTING BALL COARSE 6MM 7CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $325.50 $241.00 $57.87 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $325.13 $57.87 $325.13 $325.13 $241.31 $241.31 $250.61 $169.39 $67.76 $325.13 $130.05 $325.13 $325.13 $325.13 $325.13 $325.13 $244.13 $325.13 $325.13 $325.13 $162.57 $162.57 $257.50 $325.13 $260.10 $211.33 $325.13 N/A $188.79 $325.13 $195.08 $325.13 $325.13 $325.13 N/A N/A 7BA60D-MN SUP Custom 27203010 7BA60D-MN - TOOL DISSECTING BALL 6MM 7CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA60F-MN SUP Custom 27203010 7BA60F-MN - TOOL DISSECTING BALL FINE 6MM 7CM MIDAS REX LEGEND MEDNEXT BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA60-MN SUP Custom 27203010 7BA60-MN - TOOL DISSECTING BALL 6MM 7CM FLUTED MIDAS REX LEGEND MEDNEXT BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7BA70C-MN SUP Custom 27203010 7BA70C-MN - TOOL DISSECTING BALL 7MM 7CM FLUTED MIDAS REX LEGEND MEDNEXT BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 7BA70D-MN SUP Custom 27203010 7BA70D-MN - TOOL DISSECTING BALL 7MM 7CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA70-MN SUP Custom 27203010 7BA70-MN - TOOL DISSECTING BALL 7MM 7CM FLUTED MIDAS REX LEGEND MEDNEXT BOTH IP/OP $300.00 $222.00 $53.33 $299.63 $299.63 $299.63 $299.63 $299.63 $299.63 $299.63 $53.33 $299.63 $299.63 $222.39 $222.39 $230.95 $156.11 $62.45 $299.63 $119.85 $299.63 $299.63 $299.63 $299.63 $299.63 $225.00 $299.63 $299.63 $299.63 $149.82 $149.82 $237.31 $299.63 $239.70 $194.76 $299.63 N/A $174.00 $299.63 $179.78 $299.63 $299.63 $299.63 N/A N/A 7BA80C-MN SUP Custom 27203010 7BA80C-MN - TOOL DISSECTING BALL 8MM 7CM FLUTED MIDAS REX LEGEND MEDNEXT BOTH IP/OP $306.00 $226.00 $54.47 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $306.00 $54.47 $306.00 $306.00 $227.11 $227.11 $235.86 $159.43 $63.77 $306.00 $122.40 $306.00 $306.00 $306.00 $306.00 $306.00 $229.50 $306.00 $306.00 $306.00 $153.00 $153.00 $242.35 $306.00 $244.80 $198.90 $306.00 N/A $177.48 $306.00 $183.60 $306.00 $306.00 $306.00 N/A N/A 7BA80D-MN SUP Custom 27203010 7BA80D-MN - TOOL DISSECTING BALL 8MM 7CM DIAMOND MIDAS REX LEGEND BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 7BA80-MN SUP Custom 27203010 7BA80-MN - TOOL DISSECTING 8MM 7CM BALL FLUTED MIDAS REX LEGEND MEDNEXT BOTH IP/OP $297.50 $220.00 $52.96 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $297.50 $52.96 $297.50 $297.50 $220.80 $220.80 $229.31 $155.00 $62.00 $297.50 $119.00 $297.50 $297.50 $297.50 $297.50 $297.50 $223.13 $297.50 $297.50 $297.50 $148.75 $148.75 $235.62 $297.50 $238.00 $193.38 $297.50 N/A $172.55 $297.50 $178.50 $297.50 $297.50 $297.50 N/A N/A 7SCT SUP Custom 27203010 7SCT - TUBE TRACHEOSTOMY 9.6MM 7MM 80MM 1 CANNU CUFF LOW PRESSURE BOTH IP/OP $71.50 $53.00 $12.71 $71.38 $71.38 $71.38 $71.38 $71.38 $71.38 $71.38 $12.71 $71.38 $71.38 $52.98 $52.98 $55.02 $37.19 $14.88 $71.38 $70.97 $71.38 $71.38 $71.38 $71.38 $71.38 $53.63 $71.38 $71.38 $71.38 $35.69 $35.69 $56.53 $71.38 $57.10 $46.40 $71.38 N/A $41.47 $71.38 $42.83 $71.38 $71.38 $71.38 N/A N/A 800.604.02S SUP HCPCS C1713 800.604.02S - SCREW BONE 1.5MM 4MM RESORB CORTICAL CRANIOMAXILLOFACIAL BOTH IP/OP $373.50 $276.00 $74.13 $373.50 $168.08 $168.08 $168.08 $168.08 $373.50 $373.50 $373.50 $77.85 $373.50 $373.50 $373.50 $373.50 $373.50 $77.84 $373.50 $149.40 $220.93 $373.50 $373.50 $373.50 $373.50 $280.13 $373.50 $373.50 $373.50 $186.75 $186.75 $295.81 $373.50 $298.80 $168.08 $74.13 N/A $216.63 $373.50 $373.50 $373.50 $373.50 $373.50 N/A N/A 80-0055 SUP Custom 27203010 80-0055 - DRILL SURG CANN BOTH IP/OP $730.00 $540.00 $129.94 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $129.94 $730.00 $730.00 $541.81 $541.81 $562.68 $380.33 $152.14 $730.00 $292.00 $730.00 $730.00 $730.00 $730.00 $730.00 $547.50 $730.00 $730.00 $730.00 $365.00 $365.00 $578.16 $730.00 $584.00 $474.50 $730.00 N/A $423.40 $730.00 $438.00 $730.00 $730.00 $730.00 N/A N/A 80-0056 SUP Custom 27203010 80-0056 - BIT DRL 5.5MM ACTRK2 BOTH IP/OP $730.00 $540.00 $129.94 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $129.94 $730.00 $730.00 $541.81 $541.81 $562.68 $380.33 $152.14 $730.00 $292.00 $730.00 $730.00 $730.00 $730.00 $730.00 $547.50 $730.00 $730.00 $730.00 $365.00 $365.00 $578.16 $730.00 $584.00 $474.50 $730.00 N/A $423.40 $730.00 $438.00 $730.00 $730.00 $730.00 N/A N/A 80-0100 SUP Custom 27203010 80-0100 - DRILL SRG MIC LNG ACTRK2 BOTH IP/OP $730.00 $540.00 $129.94 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $129.94 $730.00 $730.00 $541.81 $541.81 $562.68 $380.33 $152.14 $730.00 $292.00 $730.00 $730.00 $730.00 $730.00 $730.00 $547.50 $730.00 $730.00 $730.00 $365.00 $365.00 $578.16 $730.00 $584.00 $474.50 $730.00 N/A $423.40 $730.00 $438.00 $730.00 $730.00 $730.00 N/A N/A 800-1003A SUP Custom 27203010 800-1003A - KIT CNTRF 30ML GPS III 1 PLTL CONC DISP BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$1,669.95" "$1,669.95" "$1,734.30" "$1,172.25" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,462.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 8001021-3 SUP HCPCS C1781 8001021-3 - PLATE BONE MEDIUM THIN RIGID FLEXIBLE FLEXMESH TITANIUM BOTH IP/OP "$2,962.50" "$2,192.00" $587.93 "$2,962.25" "$1,333.01" "$1,333.01" "$1,333.01" "$1,333.01" "$2,962.25" "$2,962.25" "$2,962.25" $617.41 "$2,962.25" "$2,962.25" "$2,962.25" "$2,962.25" "$2,962.25" $617.37 "$2,962.25" "$2,962.25" "$1,460.39" "$2,962.25" "$2,962.25" "$2,962.25" "$2,962.25" "$2,221.88" "$2,962.25" "$2,962.25" "$2,962.25" "$1,481.13" "$1,481.13" "$2,346.10" "$2,962.25" "$2,369.80" "$1,333.01" $587.93 N/A "$1,718.25" "$2,962.25" "$2,962.25" "$2,962.25" $617.33 "$2,962.25" N/A N/A 8001021-6 SUP HCPCS C1781 8001021-6 - PLATE BONE MEDIUM STANDARD RIGID FLEXIBLE FLEXMESH TITANIUM BOTH IP/OP "$2,962.50" "$2,192.00" $587.93 "$2,962.25" "$1,333.01" "$1,333.01" "$1,333.01" "$1,333.01" "$2,962.25" "$2,962.25" "$2,962.25" $617.41 "$2,962.25" "$2,962.25" "$2,962.25" "$2,962.25" "$2,962.25" $617.37 "$2,962.25" "$2,962.25" "$1,460.39" "$2,962.25" "$2,962.25" "$2,962.25" "$2,962.25" "$2,221.88" "$2,962.25" "$2,962.25" "$2,962.25" "$1,481.13" "$1,481.13" "$2,346.10" "$2,962.25" "$2,369.80" "$1,333.01" $587.93 N/A "$1,718.25" "$2,962.25" "$2,962.25" "$2,962.25" $617.33 "$2,962.25" N/A N/A 80-0148 SUP HCPCS C1713 80-0148 - SCREW BN 3MM 2 TRK TAP DRL CLVCL BOTH IP/OP $427.50 $316.00 $84.85 $427.50 $192.38 $192.38 $192.38 $192.38 $427.50 $427.50 $427.50 $89.10 $427.50 $427.50 $427.50 $427.50 $427.50 $89.10 $427.50 $171.00 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $192.38 $84.85 N/A $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A 80-0149 SUP Custom 27203010 80-0149 - SCREW BN 3.8MM 2 TRK TAP DRL CLVCL BOTH IP/OP $427.50 $316.00 $76.10 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $427.50 $76.10 $427.50 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $171.00 $427.50 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $427.50 N/A $247.95 $427.50 $256.50 $427.50 $427.50 $427.50 N/A N/A 80-0150 SUP HCPCS C1769 80-0150 - GUIDE SURG STANDARD T ACU-LOC DORSAL LEFT BOTH IP/OP "$2,960.00" "$2,190.00" $587.49 "$2,960.00" "$1,607.28" "$1,607.28" "$1,607.28" "$1,607.28" "$2,960.00" "$2,960.00" "$2,960.00" $616.94 "$2,960.00" "$2,196.91" "$2,196.91" "$2,281.57" "$1,542.16" $616.90 "$2,960.00" "$2,960.00" "$1,750.84" "$2,960.00" "$2,960.00" "$2,960.00" "$2,960.00" "$2,220.00" "$2,960.00" "$2,960.00" "$2,960.00" "$1,480.00" "$1,480.00" "$2,344.32" "$2,960.00" "$2,368.00" "$1,924.00" $587.49 N/A "$1,716.80" "$2,960.00" "$2,960.00" "$2,960.00" $616.86 "$2,960.00" N/A N/A 8001511-3 SUP HCPCS C1781 8001511-3 - PLATE BONE SMALL THIN 56X50X.3MM RIGID FLEXMESH TITANIUM BOTH IP/OP "$2,189.00" "$1,620.00" $434.41 "$2,188.75" $984.94 $984.94 $984.94 $984.94 "$2,188.75" "$2,188.75" "$2,188.75" $456.19 "$2,188.75" "$2,188.75" "$2,188.75" "$2,188.75" "$2,188.75" $456.16 "$2,188.75" "$2,188.75" "$1,294.65" "$2,188.75" "$2,188.75" "$2,188.75" "$2,188.75" "$1,641.75" "$2,188.75" "$2,188.75" "$2,188.75" "$1,094.38" "$1,094.38" "$1,733.49" "$2,188.75" "$1,751.00" $984.94 $434.41 N/A "$1,269.62" "$2,188.75" "$2,188.75" "$2,188.75" $456.14 "$2,188.75" N/A N/A 8001511-6 SUP HCPCS C1781 8001511-6 - PLATE BONE STANDARD 56X50X.6MM RIGID FLEXMESH TITANIUM SKULL BOTH IP/OP "$2,189.00" "$1,620.00" $434.41 "$2,188.75" $984.94 $984.94 $984.94 $984.94 "$2,188.75" "$2,188.75" "$2,188.75" $456.19 "$2,188.75" "$2,188.75" "$2,188.75" "$2,188.75" "$2,188.75" $456.16 "$2,188.75" "$2,188.75" "$1,294.65" "$2,188.75" "$2,188.75" "$2,188.75" "$2,188.75" "$1,641.75" "$2,188.75" "$2,188.75" "$2,188.75" "$1,094.38" "$1,094.38" "$1,733.49" "$2,188.75" "$1,751.00" $984.94 $434.41 N/A "$1,269.62" "$2,188.75" "$2,188.75" "$2,188.75" $456.14 "$2,188.75" N/A N/A 8001521-3 SUP HCPCS C1781 8001521-3 - PLATE BONE MEDIUM THIN 113X77X.3MM RIGID FLEXMESH TITANIUM BOTH IP/OP "$2,769.00" "$2,049.00" $549.55 "$2,768.88" "$1,246.00" "$1,246.00" "$1,246.00" "$1,246.00" "$2,768.88" "$2,768.88" "$2,768.88" $577.10 "$2,768.88" "$2,768.88" "$2,768.88" "$2,768.88" "$2,768.88" $577.07 "$2,768.88" "$2,768.88" "$1,365.06" "$2,768.88" "$2,768.88" "$2,768.88" "$2,768.88" "$2,076.75" "$2,768.88" "$2,768.88" "$2,768.88" "$1,384.44" "$1,384.44" "$2,192.95" "$2,768.88" "$2,215.10" "$1,246.00" $549.55 N/A "$1,606.02" "$2,768.88" "$2,768.88" "$2,768.88" $577.03 "$2,768.88" N/A N/A 8001521-6 SUP HCPCS C1781 8001521-6 - PLATE BONE STANDARD 113X77X.6MM RIGID FLEXMESH TITANIUM BOTH IP/OP "$2,881.50" "$2,132.00" $571.91 "$2,881.50" "$1,296.68" "$1,296.68" "$1,296.68" "$1,296.68" "$2,881.50" "$2,881.50" "$2,881.50" $600.58 "$2,881.50" "$2,881.50" "$2,881.50" "$2,881.50" "$2,881.50" $600.54 "$2,881.50" "$2,881.50" "$1,420.58" "$2,881.50" "$2,881.50" "$2,881.50" "$2,881.50" "$2,161.13" "$2,881.50" "$2,881.50" "$2,881.50" "$1,440.75" "$1,440.75" "$2,282.15" "$2,881.50" "$2,305.20" "$1,296.68" $571.91 N/A "$1,671.27" "$2,881.50" "$2,881.50" "$2,881.50" $600.50 "$2,881.50" N/A N/A 8001523-6 SUP HCPCS C1781 8001523-6 - PLATE BONE MEDIUM 113X77X.6MM RIGID FLEXMESH TITANIUM SKULL BOTH IP/OP "$2,881.50" "$2,132.00" $571.91 "$2,881.50" "$1,296.68" "$1,296.68" "$1,296.68" "$1,296.68" "$2,881.50" "$2,881.50" "$2,881.50" $600.58 "$2,881.50" "$2,881.50" "$2,881.50" "$2,881.50" "$2,881.50" $600.54 "$2,881.50" "$2,881.50" "$1,420.58" "$2,881.50" "$2,881.50" "$2,881.50" "$2,881.50" "$2,161.13" "$2,881.50" "$2,881.50" "$2,881.50" "$1,440.75" "$1,440.75" "$2,282.15" "$2,881.50" "$2,305.20" "$1,296.68" $571.91 N/A "$1,671.27" "$2,881.50" "$2,881.50" "$2,881.50" $600.50 "$2,881.50" N/A N/A 8001531-6 SUP HCPCS C1781 8001531-6 - PLATE BONE LARGE STANDARD 148X148X.6MM RIGID FLEXIBLE BOTH IP/OP "$4,741.00" "$3,508.00" $940.95 "$4,740.88" "$2,133.40" "$2,133.40" "$2,133.40" "$2,133.40" "$4,740.88" "$4,740.88" "$4,740.88" $988.12 "$4,740.88" "$4,740.88" "$4,740.88" "$4,740.88" "$4,740.88" $988.05 "$4,740.88" "$4,740.88" "$2,337.25" "$4,740.88" "$4,740.88" "$4,740.88" "$4,740.88" "$3,555.75" "$4,740.88" "$4,740.88" "$4,740.88" "$2,370.44" "$2,370.44" "$3,754.78" "$4,740.88" "$3,792.70" "$2,133.40" $940.95 N/A "$2,749.78" "$4,740.88" "$4,740.88" "$4,740.88" $988.00 "$4,740.88" N/A N/A 8001533-6 SUP HCPCS C1781 8001533-6 - PLATE BONE LARGE RIGID FLEXIBLE FLEXMESH TITANIUM SKULL 1.5 BOTH IP/OP "$4,836.50" "$3,579.00" $959.92 "$4,836.50" "$2,176.43" "$2,176.43" "$2,176.43" "$2,176.43" "$4,836.50" "$4,836.50" "$4,836.50" "$1,008.05" "$4,836.50" "$4,836.50" "$4,836.50" "$4,836.50" "$4,836.50" "$1,007.98" "$4,836.50" "$4,836.50" "$2,384.39" "$4,836.50" "$4,836.50" "$4,836.50" "$4,836.50" "$3,627.38" "$4,836.50" "$4,836.50" "$4,836.50" "$2,418.25" "$2,418.25" "$3,830.51" "$4,836.50" "$3,869.20" "$2,176.43" $959.92 N/A "$2,805.17" "$4,836.50" "$4,836.50" "$4,836.50" "$1,007.93" "$4,836.50" N/A N/A 80-018 SUP Custom 27203010 80-018 - BIT DRILL 2MM HEAD BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A 80-0180 SUP Custom 27203010 80-0180 - TIP SCRDRVR 1.5MM SLD HEX AO CONNECT DRVR NONSTRL BOTH IP/OP $470.00 $348.00 $83.66 $470.00 $470.00 $470.00 $470.00 $470.00 $470.00 $470.00 $83.66 $470.00 $470.00 $348.83 $348.83 $362.28 $244.87 $97.95 $470.00 $188.00 $470.00 $470.00 $470.00 $470.00 $470.00 $352.50 $470.00 $470.00 $470.00 $235.00 $235.00 $372.24 $470.00 $376.00 $305.50 $470.00 N/A $272.60 $470.00 $282.00 $470.00 $470.00 $470.00 N/A N/A 80-0205 SUP Custom 27203010 80-0205 - TRPHN ACTRK6/7 SURG BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A 80-0206 SUP Custom 27203010 80-0206 - TRPHN ACTRK+ SURG BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A 80-0207 SUP Custom 27203010 80-0207 - TRPHN ACTRK 4/5 SURG BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A 80-0208 SUP Custom 27203010 80-0208 - TRPHN 20+ MM STD ACTRK SURG BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A 80-0209 SUP Custom 27203010 80-0209 - TRPHN 0-20MM STD ACTRK SURG BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A 80-0210 SUP Custom 27203010 80-0210 - TRPHN MINI ACTRK SURG BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A 80-0211 SUP Custom 27203010 80-0211 - TRPHN STD ACTRK2 SURG BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A 80-0212 SUP Custom 27203010 80-0212 - TRPHN MINI ACTRK2 SURG BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A 80-0213 SUP Custom 27203010 80-0213 - TRPHN MIC ACTRK2 SURG BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A 80-0214 SUP Custom 27203010 80-0214 - TRPHN ACTRK2 SURG 5.5 MM SCR BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A 80-0216 SUP Custom 27203010 80-0216 - TRPHN ACTRK2 BRKN SURG 3.5 MM CMPR SCR BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A 80-0217 SUP Custom 27203010 80-0217 - TRPHN ACTRK2 BRKN SURG 2.7 MM CMPR SCR BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A 8002221-6 SUP HCPCS C1781 8002221-6 - COIL EMBOLIZATION 2.2IN MEDIUM WEIGHT STANDARD FLEXMESH BOTH IP/OP "$2,828.50" "$2,093.00" $561.36 "$2,828.38" "$1,272.77" "$1,272.77" "$1,272.77" "$1,272.77" "$2,828.38" "$2,828.38" "$2,828.38" $589.51 "$2,828.38" "$2,828.38" "$2,828.38" "$2,828.38" "$2,828.38" $589.47 "$2,828.38" "$2,828.38" "$1,394.39" "$2,828.38" "$2,828.38" "$2,828.38" "$2,828.38" "$2,121.38" "$2,828.38" "$2,828.38" "$2,828.38" "$1,414.19" "$1,414.19" "$2,240.08" "$2,828.38" "$2,262.70" "$1,272.77" $561.36 N/A "$1,640.53" "$2,828.38" "$2,828.38" "$2,828.38" $589.43 "$2,828.38" N/A N/A 8002231-6 SUP HCPCS C1781 8002231-6 - PLATE BONE STANDARD LARGE 154X154X.6MM TIMESH FLEXMESH BOTH IP/OP "$4,798.50" "$3,551.00" $952.33 "$4,798.25" "$2,159.21" "$2,159.21" "$2,159.21" "$2,159.21" "$4,798.25" "$4,798.25" "$4,798.25" "$1,000.08" "$4,798.25" "$4,798.25" "$4,798.25" "$4,798.25" "$4,798.25" "$1,000.01" "$4,798.25" "$4,798.25" "$2,365.54" "$4,798.25" "$4,798.25" "$4,798.25" "$4,798.25" "$3,598.88" "$4,798.25" "$4,798.25" "$4,798.25" "$2,399.13" "$2,399.13" "$3,800.21" "$4,798.25" "$3,838.60" "$2,159.21" $952.33 N/A "$2,783.13" "$4,798.25" "$4,798.25" "$4,798.25" $999.96 "$4,798.25" N/A N/A 8002233-6 SUP HCPCS C1781 8002233-6 - PLATE BONE LARGE 154X154X.6MM RIGID TIMESH FLEXMESH TITANIUM BOTH IP/OP "$4,798.50" "$3,551.00" $952.33 "$4,798.25" "$2,159.21" "$2,159.21" "$2,159.21" "$2,159.21" "$4,798.25" "$4,798.25" "$4,798.25" "$1,000.08" "$4,798.25" "$4,798.25" "$4,798.25" "$4,798.25" "$4,798.25" "$1,000.01" "$4,798.25" "$4,798.25" "$2,365.54" "$4,798.25" "$4,798.25" "$4,798.25" "$4,798.25" "$3,598.88" "$4,798.25" "$4,798.25" "$4,798.25" "$2,399.13" "$2,399.13" "$3,800.21" "$4,798.25" "$3,838.60" "$2,159.21" $952.33 N/A "$2,783.13" "$4,798.25" "$4,798.25" "$4,798.25" $999.96 "$4,798.25" N/A N/A 80-0248 SUP HCPCS C1713 80-0248 - PLATE SM TACK BONE BOTH IP/OP $137.50 $102.00 $27.29 $137.50 $61.88 $61.88 $61.88 $61.88 $137.50 $137.50 $137.50 $28.66 $137.50 $137.50 $137.50 $137.50 $137.50 $28.66 $137.50 $55.00 $81.33 $137.50 $137.50 $137.50 $137.50 $103.13 $137.50 $137.50 $137.50 $68.75 $68.75 $108.90 $137.50 $110.00 $61.88 $27.29 N/A $79.75 $137.50 $137.50 $137.50 $28.66 $137.50 N/A N/A 80-0297 SUP Custom 27203010 80-0297 - BIT DRILL 4.6MM 3.1MM ACTRK DNS BOTH IP/OP $805.00 $596.00 $143.29 $805.00 $805.00 $805.00 $805.00 $805.00 $805.00 $805.00 $143.29 $805.00 $805.00 $597.47 $597.47 $620.49 $419.41 $167.77 $805.00 $322.00 $805.00 $805.00 $805.00 $805.00 $805.00 $603.75 $805.00 $805.00 $805.00 $402.50 $402.50 $637.56 $805.00 $644.00 $523.25 $805.00 N/A $466.90 $805.00 $483.00 $805.00 $805.00 $805.00 N/A N/A 80-0298 SUP Custom 27203010 80-0298 - DRILL SURG ACTRK+ CANN DNS QRLSE BOTH IP/OP $805.00 $596.00 $143.29 $805.00 $805.00 $805.00 $805.00 $805.00 $805.00 $805.00 $143.29 $805.00 $805.00 $597.47 $597.47 $620.49 $419.41 $167.77 $805.00 $322.00 $805.00 $805.00 $805.00 $805.00 $805.00 $603.75 $805.00 $805.00 $805.00 $402.50 $402.50 $637.56 $805.00 $644.00 $523.25 $805.00 N/A $466.90 $805.00 $483.00 $805.00 $805.00 $805.00 N/A N/A 80-0302 SUP Custom 27203010 80-0302 - BIT DRILL 2.5MM HEX TIP FLXB BOTH IP/OP "$1,152.50" $853.00 $205.15 "$1,152.50" "$1,152.50" "$1,152.50" "$1,152.50" "$1,152.50" "$1,152.50" "$1,152.50" $205.15 "$1,152.50" "$1,152.50" $855.39 $855.39 $888.35 $600.45 $240.19 "$1,152.50" $461.00 "$1,152.50" "$1,152.50" "$1,152.50" "$1,152.50" "$1,152.50" $864.38 "$1,152.50" "$1,152.50" "$1,152.50" $576.25 $576.25 $912.78 "$1,152.50" $922.00 $749.13 "$1,152.50" N/A $668.45 "$1,152.50" $691.50 "$1,152.50" "$1,152.50" "$1,152.50" N/A N/A 80-0318 SUP Custom 27203010 80-0318 - BIT DRL 2MM NS ACLC 2 SURGIBIT QRLSE 2.7MM SCR BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A 80-0362 SUP Custom 27203010 80-0362 - TAP BN 2.3MM BOTH IP/OP $285.00 $211.00 $50.73 $285.00 $285.00 $285.00 $285.00 $285.00 $285.00 $285.00 $50.73 $285.00 $285.00 $211.53 $211.53 $219.68 $148.49 $59.40 $285.00 $114.00 $285.00 $285.00 $285.00 $285.00 $285.00 $213.75 $285.00 $285.00 $285.00 $142.50 $142.50 $225.72 $285.00 $228.00 $185.25 $285.00 N/A $165.30 $285.00 $171.00 $285.00 $285.00 $285.00 N/A N/A 80-0386 SUP Custom 27203010 80-0386 - DRILL SURG QRLSE 2MM BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A 80-0387 SUP Custom 27203010 80-0387 - DRILL SRG 2.8MM QRLSE 3.5MM SCR BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A 80-0399 SUP Custom 27203010 80-0399 - DRILL SURG 1.5MM ACTRK LEFT HND BOTH IP/OP $460.00 $340.00 $81.88 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $81.88 $460.00 $460.00 $341.41 $341.41 $354.57 $239.66 $95.87 $460.00 $184.00 $460.00 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $299.00 $460.00 N/A $266.80 $460.00 $276.00 $460.00 $460.00 $460.00 N/A N/A 80-0400 SUP Custom 27203010 80-0400 - DRILL SURG 2MM ACTRK LEFT HND SCR REM BOTH IP/OP $460.00 $340.00 $81.88 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $81.88 $460.00 $460.00 $341.41 $341.41 $354.57 $239.66 $95.87 $460.00 $184.00 $460.00 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $299.00 $460.00 N/A $266.80 $460.00 $276.00 $460.00 $460.00 $460.00 N/A N/A 80-0401 SUP Custom 27203010 80-0401 - DRILL SURG 2.5MM ACTRK LEFT HND SCR REM BOTH IP/OP $460.00 $340.00 $81.88 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $81.88 $460.00 $460.00 $341.41 $341.41 $354.57 $239.66 $95.87 $460.00 $184.00 $460.00 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $299.00 $460.00 N/A $266.80 $460.00 $276.00 $460.00 $460.00 $460.00 N/A N/A 80-0402 SUP Custom 27203010 80-0402 - DRILL SURG 3MM ACTRK LEFT HND SCR REM BOTH IP/OP $460.00 $340.00 $81.88 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $81.88 $460.00 $460.00 $341.41 $341.41 $354.57 $239.66 $95.87 $460.00 $184.00 $460.00 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $299.00 $460.00 N/A $266.80 $460.00 $276.00 $460.00 $460.00 $460.00 N/A N/A 80-0403 SUP Custom 27203010 80-0403 - DRILL SURG 3.5MM ACTRK LEFT HND SCR REM BOTH IP/OP $460.00 $340.00 $81.88 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $81.88 $460.00 $460.00 $341.41 $341.41 $354.57 $239.66 $95.87 $460.00 $184.00 $460.00 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $299.00 $460.00 N/A $266.80 $460.00 $276.00 $460.00 $460.00 $460.00 N/A N/A 80-0404 SUP Custom 27203010 80-0404 - DRILL SURG 4MM ACTRK LEFT HND SCR REM BOTH IP/OP $460.00 $340.00 $81.88 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $81.88 $460.00 $460.00 $341.41 $341.41 $354.57 $239.66 $95.87 $460.00 $184.00 $460.00 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $299.00 $460.00 N/A $266.80 $460.00 $276.00 $460.00 $460.00 $460.00 N/A N/A 80-0411 SUP Custom 27803010 80-0411 - PIN TNSNBND SNAPPER BOTH IP/OP $212.50 $157.00 $37.83 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $37.83 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $212.50 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $212.50 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A 80-0413 SUP HCPCS C1769 80-0413 - WIRE FX .062IN KRSH BOTH IP/OP $37.50 $28.00 $7.44 $37.50 $20.36 $20.36 $20.36 $20.36 $37.50 $37.50 $37.50 $7.82 $37.50 $27.83 $27.83 $28.91 $19.54 $7.82 $37.50 $37.50 $22.18 $37.50 $37.50 $37.50 $37.50 $28.13 $37.50 $37.50 $37.50 $18.75 $18.75 $29.70 $37.50 $30.00 $24.38 $7.44 N/A $21.75 $37.50 $37.50 $37.50 $7.82 $37.50 N/A N/A 80-0465 SUP Custom 27203010 80-0465 - DRILL SRG CNN OLCRN BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A 80-0477 SUP Custom 27203010 80-0477 - DRILL SURG 40-65MM ACTRK6/7 CANN QRLSE DNS BOTH IP/OP $805.00 $596.00 $143.29 $805.00 $805.00 $805.00 $805.00 $805.00 $805.00 $805.00 $143.29 $805.00 $805.00 $597.47 $597.47 $620.49 $419.41 $167.77 $805.00 $322.00 $805.00 $805.00 $805.00 $805.00 $805.00 $603.75 $805.00 $805.00 $805.00 $402.50 $402.50 $637.56 $805.00 $644.00 $523.25 $805.00 N/A $466.90 $805.00 $483.00 $805.00 $805.00 $805.00 N/A N/A 80-0478 SUP Custom 27203010 80-0478 - DRILL SURG 70-85MM ACTRK6/7 CANN QRLSE DNS BOTH IP/OP $902.50 $668.00 $160.65 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $902.50 $160.65 $902.50 $902.50 $669.84 $669.84 $695.65 $470.20 $188.09 $902.50 $361.00 $902.50 $902.50 $902.50 $902.50 $902.50 $676.88 $902.50 $902.50 $902.50 $451.25 $451.25 $714.78 $902.50 $722.00 $586.63 $902.50 N/A $523.45 $902.50 $541.50 $902.50 $902.50 $902.50 N/A N/A 80-0479 SUP Custom 27203010 80-0479 - DRILL SURG 90-120MM ACTRK6/7 CANN QRLSE DNS BOTH IP/OP "$1,127.50" $834.00 $200.70 "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" $200.70 "$1,127.50" "$1,127.50" $836.83 $836.83 $869.08 $587.43 $234.98 "$1,127.50" $451.00 "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" $845.63 "$1,127.50" "$1,127.50" "$1,127.50" $563.75 $563.75 $892.98 "$1,127.50" $902.00 $732.88 "$1,127.50" N/A $653.95 "$1,127.50" $676.50 "$1,127.50" "$1,127.50" "$1,127.50" N/A N/A 80-0569 SUP Custom 27203010 80-0569 - REAMER SURG 16MM CNCV MTP FRFT MIDFT PLT SYS NONSTRL BOTH IP/OP "$1,360.00" "$1,006.00" $242.08 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" $242.08 "$1,360.00" "$1,360.00" "$1,009.39" "$1,009.39" "$1,048.29" $708.56 $283.44 "$1,360.00" $544.00 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,020.00" "$1,360.00" "$1,360.00" "$1,360.00" $680.00 $680.00 "$1,077.12" "$1,360.00" "$1,088.00" $884.00 "$1,360.00" N/A $788.80 "$1,360.00" $816.00 "$1,360.00" "$1,360.00" "$1,360.00" N/A N/A 80-0570 SUP Custom 27203010 80-0570 - REAMER SURG 16MM CNVX MTP FRFT MIDFT PLT SYS NONSTRL BOTH IP/OP "$1,360.00" "$1,006.00" $242.08 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" $242.08 "$1,360.00" "$1,360.00" "$1,009.39" "$1,009.39" "$1,048.29" $708.56 $283.44 "$1,360.00" $544.00 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,020.00" "$1,360.00" "$1,360.00" "$1,360.00" $680.00 $680.00 "$1,077.12" "$1,360.00" "$1,088.00" $884.00 "$1,360.00" N/A $788.80 "$1,360.00" $816.00 "$1,360.00" "$1,360.00" "$1,360.00" N/A N/A 80-0571 SUP Custom 27203010 80-0571 - REAMER SURG 18MM MALE SET FT BOTH IP/OP "$1,360.00" "$1,006.00" $242.08 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" $242.08 "$1,360.00" "$1,360.00" "$1,009.39" "$1,009.39" "$1,048.29" $708.56 $283.44 "$1,360.00" $544.00 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,020.00" "$1,360.00" "$1,360.00" "$1,360.00" $680.00 $680.00 "$1,077.12" "$1,360.00" "$1,088.00" $884.00 "$1,360.00" N/A $788.80 "$1,360.00" $816.00 "$1,360.00" "$1,360.00" "$1,360.00" N/A N/A 80-0572 SUP Custom 27203010 80-0572 - REAMER SURG 18MM FMALE SET FT BOTH IP/OP "$1,360.00" "$1,006.00" $242.08 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" $242.08 "$1,360.00" "$1,360.00" "$1,009.39" "$1,009.39" "$1,048.29" $708.56 $283.44 "$1,360.00" $544.00 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,020.00" "$1,360.00" "$1,360.00" "$1,360.00" $680.00 $680.00 "$1,077.12" "$1,360.00" "$1,088.00" $884.00 "$1,360.00" N/A $788.80 "$1,360.00" $816.00 "$1,360.00" "$1,360.00" "$1,360.00" N/A N/A 80-0573 SUP Custom 27203010 80-0573 - REAMER SURG 20MM CNCV MTP FRFT MIDFT PLT SYS NONSTRL BOTH IP/OP "$1,360.00" "$1,006.00" $242.08 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" $242.08 "$1,360.00" "$1,360.00" "$1,009.39" "$1,009.39" "$1,048.29" $708.56 $283.44 "$1,360.00" $544.00 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,020.00" "$1,360.00" "$1,360.00" "$1,360.00" $680.00 $680.00 "$1,077.12" "$1,360.00" "$1,088.00" $884.00 "$1,360.00" N/A $788.80 "$1,360.00" $816.00 "$1,360.00" "$1,360.00" "$1,360.00" N/A N/A 80-0574 SUP Custom 27203010 80-0574 - REAMER SURG 74MM STNLS STELL CNCV SM BONE BOTH IP/OP "$1,360.00" "$1,006.00" $242.08 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" $242.08 "$1,360.00" "$1,360.00" "$1,009.39" "$1,009.39" "$1,048.29" $708.56 $283.44 "$1,360.00" $544.00 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,020.00" "$1,360.00" "$1,360.00" "$1,360.00" $680.00 $680.00 "$1,077.12" "$1,360.00" "$1,088.00" $884.00 "$1,360.00" N/A $788.80 "$1,360.00" $816.00 "$1,360.00" "$1,360.00" "$1,360.00" N/A N/A 80-0575 SUP Custom 27203010 80-0575 - REAMER SURG 76MM SS CNVX SM BONE BOTH IP/OP "$1,360.00" "$1,006.00" $242.08 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" $242.08 "$1,360.00" "$1,360.00" "$1,009.39" "$1,009.39" "$1,048.29" $708.56 $283.44 "$1,360.00" $544.00 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,020.00" "$1,360.00" "$1,360.00" "$1,360.00" $680.00 $680.00 "$1,077.12" "$1,360.00" "$1,088.00" $884.00 "$1,360.00" N/A $788.80 "$1,360.00" $816.00 "$1,360.00" "$1,360.00" "$1,360.00" N/A N/A 80-0576 SUP Custom 27203010 80-0576 - REAMER SURG 75MM SS CNCV SM BONE BOTH IP/OP "$1,360.00" "$1,006.00" $242.08 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" $242.08 "$1,360.00" "$1,360.00" "$1,009.39" "$1,009.39" "$1,048.29" $708.56 $283.44 "$1,360.00" $544.00 "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,360.00" "$1,020.00" "$1,360.00" "$1,360.00" "$1,360.00" $680.00 $680.00 "$1,077.12" "$1,360.00" "$1,088.00" $884.00 "$1,360.00" N/A $788.80 "$1,360.00" $816.00 "$1,360.00" "$1,360.00" "$1,360.00" N/A N/A 80-0583 SUP Custom 27203010 80-0583 - DRIVER 1.5MM ACTRK QRLSE SLD HEX TIP SURG BOTH IP/OP $382.50 $283.00 $68.09 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $68.09 $382.50 $382.50 $283.89 $283.89 $294.83 $199.28 $79.72 $382.50 $153.00 $382.50 $382.50 $382.50 $382.50 $382.50 $286.88 $382.50 $382.50 $382.50 $191.25 $191.25 $302.94 $382.50 $306.00 $248.63 $382.50 N/A $221.85 $382.50 $229.50 $382.50 $382.50 $382.50 N/A N/A 80-0598 SUP Custom 27203010 80-0598 - XTRT SURG EZOUT QRLSE 1.5MM BOTH IP/OP $307.50 $228.00 $54.74 $307.50 $307.50 $307.50 $307.50 $307.50 $307.50 $307.50 $54.74 $307.50 $307.50 $228.23 $228.23 $237.02 $160.21 $64.09 $307.50 $123.00 $307.50 $307.50 $307.50 $307.50 $307.50 $230.63 $307.50 $307.50 $307.50 $153.75 $153.75 $243.54 $307.50 $246.00 $199.88 $307.50 N/A $178.35 $307.50 $184.50 $307.50 $307.50 $307.50 N/A N/A 80-0599 SUP Custom 27203010 80-0599 - XTRT SURG ACTRK QRLSE EZOUT 2MM BOTH IP/OP $307.50 $228.00 $54.74 $307.50 $307.50 $307.50 $307.50 $307.50 $307.50 $307.50 $54.74 $307.50 $307.50 $228.23 $228.23 $237.02 $160.21 $64.09 $307.50 $123.00 $307.50 $307.50 $307.50 $307.50 $307.50 $230.63 $307.50 $307.50 $307.50 $153.75 $153.75 $243.54 $307.50 $246.00 $199.88 $307.50 N/A $178.35 $307.50 $184.50 $307.50 $307.50 $307.50 N/A N/A 80-0600 SUP Custom 27203010 80-0600 - XTRT SURG EZOUT QRLSE 2.5MM BOTH IP/OP $325.00 $241.00 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 N/A $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A 80-0601 SUP Custom 27203010 80-0601 - TOOL REM 3MM ACTRK SCR EASYOUT BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A 80-0602 SUP Custom 27203010 80-0602 - TOOL REM 3.5MM ACTRK SCR EASYOUT BOTH IP/OP $430.00 $318.00 $76.54 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $76.54 $430.00 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $172.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $430.00 N/A $249.40 $430.00 $258.00 $430.00 $430.00 $430.00 N/A N/A 80-0603 SUP Custom 27203010 80-0603 - TOOL REM 4MM ACTRK SCR EASYOUT BOTH IP/OP $490.00 $363.00 $87.22 $490.00 $490.00 $490.00 $490.00 $490.00 $490.00 $490.00 $87.22 $490.00 $490.00 $363.68 $363.68 $377.69 $255.29 $102.12 $490.00 $196.00 $490.00 $490.00 $490.00 $490.00 $490.00 $367.50 $490.00 $490.00 $490.00 $245.00 $245.00 $388.08 $490.00 $392.00 $318.50 $490.00 N/A $284.20 $490.00 $294.00 $490.00 $490.00 $490.00 N/A N/A 80-0605 SUP Custom 27203010 80-0605 - DRIVER ACTRK HEX TIP IMPCT XTRT 3MM SURG BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A 80-0606 SUP Custom 27203010 80-0606 - DRIVER ACTRK HEX TIP IMPCT SCR XTRT 4MM SURG BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A 80-0610 SUP Custom 27203010 80-0610 - TIP SCRDRVR ACTRK REM SHFT QRLSE BOTH IP/OP $612.50 $453.00 $109.03 $612.50 $612.50 $612.50 $612.50 $612.50 $612.50 $612.50 $109.03 $612.50 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $245.00 $612.50 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $612.50 N/A $355.25 $612.50 $367.50 $612.50 $612.50 $612.50 N/A N/A 80-0611 SUP Custom 27203010 80-0611 - WRENCH SURG SCR REM TIP ACTRK BOTH IP/OP "$1,837.50" "$1,360.00" $327.08 "$1,837.50" "$1,837.50" "$1,837.50" "$1,837.50" "$1,837.50" "$1,837.50" "$1,837.50" $327.08 "$1,837.50" "$1,837.50" "$1,363.79" "$1,363.79" "$1,416.35" $957.34 $382.96 "$1,837.50" $735.00 "$1,837.50" "$1,837.50" "$1,837.50" "$1,837.50" "$1,837.50" "$1,378.13" "$1,837.50" "$1,837.50" "$1,837.50" $918.75 $918.75 "$1,455.30" "$1,837.50" "$1,470.00" "$1,194.38" "$1,837.50" N/A "$1,065.75" "$1,837.50" "$1,102.50" "$1,837.50" "$1,837.50" "$1,837.50" N/A N/A 80-0612 SUP Custom 27203010 80-0612 - TIP SCRDRVR ACTRK MIC REM BOTH IP/OP "$1,225.00" $907.00 $218.05 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $218.05 "$1,225.00" "$1,225.00" $909.20 $909.20 $944.23 $638.23 $255.30 "$1,225.00" $490.00 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $796.25 "$1,225.00" N/A $710.50 "$1,225.00" $735.00 "$1,225.00" "$1,225.00" "$1,225.00" N/A N/A 80-0613 SUP Custom 27203010 80-0613 - TOOL REM ACTRK MINI TIP BOTH IP/OP "$1,225.00" $907.00 $218.05 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $218.05 "$1,225.00" "$1,225.00" $909.20 $909.20 $944.23 $638.23 $255.30 "$1,225.00" $490.00 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $796.25 "$1,225.00" N/A $710.50 "$1,225.00" $735.00 "$1,225.00" "$1,225.00" "$1,225.00" N/A N/A 80-0614 SUP Custom 27203010 80-0614 - TOOL REM ACTRK STD TIP BOTH IP/OP "$1,225.00" $907.00 $218.05 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $218.05 "$1,225.00" "$1,225.00" $909.20 $909.20 $944.23 $638.23 $255.30 "$1,225.00" $490.00 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $796.25 "$1,225.00" N/A $710.50 "$1,225.00" $735.00 "$1,225.00" "$1,225.00" "$1,225.00" N/A N/A 80-0615 SUP Custom 27203010 80-0615 - TOOL REM ACTRK LG TIP BOTH IP/OP "$1,225.00" $907.00 $218.05 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $218.05 "$1,225.00" "$1,225.00" $909.20 $909.20 $944.23 $638.23 $255.30 "$1,225.00" $490.00 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $796.25 "$1,225.00" N/A $710.50 "$1,225.00" $735.00 "$1,225.00" "$1,225.00" "$1,225.00" N/A N/A 80-0616 SUP Custom 27203010 80-0616 - TOOL REM ACTRK XL TIP BOTH IP/OP "$1,225.00" $907.00 $218.05 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $218.05 "$1,225.00" "$1,225.00" $909.20 $909.20 $944.23 $638.23 $255.30 "$1,225.00" $490.00 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $796.25 "$1,225.00" N/A $710.50 "$1,225.00" $735.00 "$1,225.00" "$1,225.00" "$1,225.00" N/A N/A 80-0625 SUP Custom 27203010 80-0625 - TAP BONE 2.7MM HEXALOBE SCR BOTH IP/OP $307.50 $228.00 $54.74 $307.50 $307.50 $307.50 $307.50 $307.50 $307.50 $307.50 $54.74 $307.50 $307.50 $228.23 $228.23 $237.02 $160.21 $64.09 $307.50 $123.00 $307.50 $307.50 $307.50 $307.50 $307.50 $230.63 $307.50 $307.50 $307.50 $153.75 $153.75 $243.54 $307.50 $246.00 $199.88 $307.50 N/A $178.35 $307.50 $184.50 $307.50 $307.50 $307.50 N/A N/A 80-0626 SUP Custom 27203010 80-0626 - TAP BN INS CORONOID DISP 3MM NLCKG SCR BOTH IP/OP $315.00 $233.00 $56.07 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $315.00 $56.07 $315.00 $315.00 $233.79 $233.79 $242.80 $164.12 $65.65 $315.00 $126.00 $315.00 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $204.75 $315.00 N/A $182.70 $315.00 $189.00 $315.00 $315.00 $315.00 N/A N/A 80-0627 SUP Custom 27203010 80-0627 - DRILL SURG 2.3MM 5IN QUICK RELEASE BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 80-0628 SUP Custom 27203010 80-0628 - GUIDE DRILL 2MM 2.3MM NAR BOTH IP/OP $730.00 $540.00 $129.94 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $129.94 $730.00 $730.00 $541.81 $541.81 $562.68 $380.33 $152.14 $730.00 $292.00 $730.00 $730.00 $730.00 $730.00 $730.00 $547.50 $730.00 $730.00 $730.00 $365.00 $365.00 $578.16 $730.00 $584.00 $474.50 $730.00 N/A $423.40 $730.00 $438.00 $730.00 $730.00 $730.00 N/A N/A 80-0632 SUP Custom 27203010 80-0632 - DRIVER 2MM QRLSE SLD HEX TIP SURG BOTH IP/OP $460.00 $340.00 $81.88 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $81.88 $460.00 $460.00 $341.41 $341.41 $354.57 $239.66 $95.87 $460.00 $184.00 $460.00 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $299.00 $460.00 N/A $266.80 $460.00 $276.00 $460.00 $460.00 $460.00 N/A N/A 80-0633 SUP Custom 27203010 80-0633 - DRIVER 3MM ACTRK QRLSE SLD HEX TIP SURG BOTH IP/OP $535.00 $396.00 $95.23 $535.00 $535.00 $535.00 $535.00 $535.00 $535.00 $535.00 $95.23 $535.00 $535.00 $397.08 $397.08 $412.38 $278.74 $111.50 $535.00 $214.00 $535.00 $535.00 $535.00 $535.00 $535.00 $401.25 $535.00 $535.00 $535.00 $267.50 $267.50 $423.72 $535.00 $428.00 $347.75 $535.00 N/A $310.30 $535.00 $321.00 $535.00 $535.00 $535.00 N/A N/A 80-0634 SUP Custom 27203010 80-0634 - DRIVER 3.5MM ACTRK QRLSE SLD HEX TIP SURG BOTH IP/OP $597.50 $442.00 $106.36 $597.50 $597.50 $597.50 $597.50 $597.50 $597.50 $597.50 $106.36 $597.50 $597.50 $443.46 $443.46 $460.55 $311.30 $124.53 $597.50 $239.00 $597.50 $597.50 $597.50 $597.50 $597.50 $448.13 $597.50 $597.50 $597.50 $298.75 $298.75 $473.22 $597.50 $478.00 $388.38 $597.50 N/A $346.55 $597.50 $358.50 $597.50 $597.50 $597.50 N/A N/A 80-0635 SUP Custom 27203010 80-0635 - DRIVER 4MM ACTRK QRLSE SLD HEX TIP SURG BOTH IP/OP $657.50 $487.00 $117.04 $657.50 $657.50 $657.50 $657.50 $657.50 $657.50 $657.50 $117.04 $657.50 $657.50 $488.00 $488.00 $506.80 $342.56 $137.03 $657.50 $263.00 $657.50 $657.50 $657.50 $657.50 $657.50 $493.13 $657.50 $657.50 $657.50 $328.75 $328.75 $520.74 $657.50 $526.00 $427.38 $657.50 N/A $381.35 $657.50 $394.50 $657.50 $657.50 $657.50 N/A N/A 80-0636 SUP Custom 27203010 80-0636 - DRIVER ACTRK QRLSE CRCIFRM TIP SURG BOTH IP/OP $767.50 $568.00 $136.62 $767.50 $767.50 $767.50 $767.50 $767.50 $767.50 $767.50 $136.62 $767.50 $767.50 $569.64 $569.64 $591.59 $399.87 $159.96 $767.50 $307.00 $767.50 $767.50 $767.50 $767.50 $767.50 $575.63 $767.50 $767.50 $767.50 $383.75 $383.75 $607.86 $767.50 $614.00 $498.88 $767.50 N/A $445.15 $767.50 $460.50 $767.50 $767.50 $767.50 N/A N/A 80-0642 SUP Custom 27203010 80-0642 - ROD XTRNFX 2.8IN DRL FIB BOTH IP/OP $302.50 $224.00 $53.85 $302.50 $302.50 $302.50 $302.50 $302.50 $302.50 $302.50 $53.85 $302.50 $302.50 $224.52 $224.52 $233.17 $157.60 $63.04 $302.50 $121.00 $302.50 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $196.63 $302.50 N/A $175.45 $302.50 $181.50 $302.50 $302.50 $302.50 N/A N/A 80-0659 SUP Custom 27203010 80-0659 - TAP SRG DIST ELB 3 MM SCR BOTH IP/OP $730.00 $540.00 $129.94 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $129.94 $730.00 $730.00 $541.81 $541.81 $562.68 $380.33 $152.14 $730.00 $292.00 $730.00 $730.00 $730.00 $730.00 $730.00 $547.50 $730.00 $730.00 $730.00 $365.00 $365.00 $578.16 $730.00 $584.00 $474.50 $730.00 N/A $423.40 $730.00 $438.00 $730.00 $730.00 $730.00 N/A N/A 80-0661 SUP Custom 27203010 80-0661 - TAP SRG NS HUM DIST 3.5 MM SCR BOTH IP/OP $730.00 $540.00 $129.94 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $129.94 $730.00 $730.00 $541.81 $541.81 $562.68 $380.33 $152.14 $730.00 $292.00 $730.00 $730.00 $730.00 $730.00 $730.00 $547.50 $730.00 $730.00 $730.00 $365.00 $365.00 $578.16 $730.00 $584.00 $474.50 $730.00 N/A $423.40 $730.00 $438.00 $730.00 $730.00 $730.00 N/A N/A 80-0663 SUP Custom 27203010 80-0663 - HANDLE DRVR MED RCHT BOTH IP/OP "$2,275.00" "$1,684.00" $404.95 "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" $404.95 "$2,275.00" "$2,275.00" "$1,688.51" "$1,688.51" "$1,753.57" "$1,185.28" $474.14 "$2,275.00" $910.00 "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$2,275.00" "$1,706.25" "$2,275.00" "$2,275.00" "$2,275.00" "$1,137.50" "$1,137.50" "$1,801.80" "$2,275.00" "$1,820.00" "$1,478.75" "$2,275.00" N/A "$1,319.50" "$2,275.00" "$1,365.00" "$2,275.00" "$2,275.00" "$2,275.00" N/A N/A 80-0664 SUP Custom 27203010 80-0664 - PROBE SURG 2.3MM DEPTH BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A 80-0688 SUP Custom 27203010 80-0688 - WIRE FIX .054IN KWIRE GUIDE REUSE BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A 80-0724 SUP Custom 27203010 80-0724 - BIT DRILL 2.5MM FRAG-LOC SURG BOTH IP/OP $535.00 $396.00 $95.23 $535.00 $535.00 $535.00 $535.00 $535.00 $535.00 $535.00 $95.23 $535.00 $535.00 $397.08 $397.08 $412.38 $278.74 $111.50 $535.00 $214.00 $535.00 $535.00 $535.00 $535.00 $535.00 $401.25 $535.00 $535.00 $535.00 $267.50 $267.50 $423.72 $535.00 $428.00 $347.75 $535.00 N/A $310.30 $535.00 $321.00 $535.00 $535.00 $535.00 N/A N/A 80-0728 SUP Custom 27203010 80-0728 - DRIVER 1.5MM HEX TIP LCK GRV 2.3MM SURG BOTH IP/OP $535.00 $396.00 $95.23 $535.00 $535.00 $535.00 $535.00 $535.00 $535.00 $535.00 $95.23 $535.00 $535.00 $397.08 $397.08 $412.38 $278.74 $111.50 $535.00 $214.00 $535.00 $535.00 $535.00 $535.00 $535.00 $401.25 $535.00 $535.00 $535.00 $267.50 $267.50 $423.72 $535.00 $428.00 $347.75 $535.00 N/A $310.30 $535.00 $321.00 $535.00 $535.00 $535.00 N/A N/A 80-0758 SUP Custom 27203010 80-0758 - GUIDEWIRE ORTHOPEDIC 24IN THREADED INSTR UCSS BOTH IP/OP $805.00 $596.00 $143.29 $805.00 $805.00 $805.00 $805.00 $805.00 $805.00 $805.00 $143.29 $805.00 $805.00 $597.47 $597.47 $620.49 $419.41 $167.77 $805.00 $322.00 $805.00 $805.00 $805.00 $805.00 $805.00 $603.75 $805.00 $805.00 $805.00 $402.50 $402.50 $637.56 $805.00 $644.00 $523.25 $805.00 N/A $466.90 $805.00 $483.00 $805.00 $805.00 $805.00 N/A N/A 80-0759 SUP Custom 27203010 80-0759 - DRIVER SRG T8 MN STICKFIT HEXALOBE QC DRL REUSE BOTH IP/OP $707.50 $524.00 $125.94 $707.50 $707.50 $707.50 $707.50 $707.50 $707.50 $707.50 $125.94 $707.50 $707.50 $525.11 $525.11 $545.34 $368.61 $147.45 $707.50 $283.00 $707.50 $707.50 $707.50 $707.50 $707.50 $530.63 $707.50 $707.50 $707.50 $353.75 $353.75 $560.34 $707.50 $566.00 $459.88 $707.50 N/A $410.35 $707.50 $424.50 $707.50 $707.50 $707.50 N/A N/A 80-0760 SUP Custom 27203010 80-0760 - DRIVER SRG T15 HEXALOBE SCR STK FIR BOTH IP/OP $707.50 $524.00 $125.94 $707.50 $707.50 $707.50 $707.50 $707.50 $707.50 $707.50 $125.94 $707.50 $707.50 $525.11 $525.11 $545.34 $368.61 $147.45 $707.50 $283.00 $707.50 $707.50 $707.50 $707.50 $707.50 $530.63 $707.50 $707.50 $707.50 $353.75 $353.75 $560.34 $707.50 $566.00 $459.88 $707.50 N/A $410.35 $707.50 $424.50 $707.50 $707.50 $707.50 N/A N/A 80-0772 SUP HCPCS C1713 80-0772 - SCREW BN 3MM 2 TRK STP DRL CLVCL BOTH IP/OP $547.50 $405.00 $108.67 $547.50 $246.38 $246.38 $246.38 $246.38 $547.50 $547.50 $547.50 $114.11 $547.50 $547.50 $547.50 $547.50 $547.50 $114.11 $547.50 $219.00 $323.85 $547.50 $547.50 $547.50 $547.50 $410.63 $547.50 $547.50 $547.50 $273.75 $273.75 $433.62 $547.50 $438.00 $246.38 $108.67 N/A $317.55 $547.50 $328.50 $547.50 $114.10 $547.50 N/A N/A 80-0773 SUP Custom 27203010 80-0773 - SCREW BN 3.8MM 2 TRK STP DRL CLVCL BOTH IP/OP $547.50 $405.00 $97.46 $547.50 $547.50 $547.50 $547.50 $547.50 $547.50 $547.50 $97.46 $547.50 $547.50 $406.35 $406.35 $422.01 $285.25 $114.11 $547.50 $219.00 $547.50 $547.50 $547.50 $547.50 $547.50 $410.63 $547.50 $547.50 $547.50 $273.75 $273.75 $433.62 $547.50 $438.00 $355.88 $547.50 N/A $317.55 $547.50 $328.50 $547.50 $547.50 $547.50 N/A N/A 80-0774 SUP Custom 27203010 80-0774 - REAMER SURG 3MM THDL BOTH IP/OP "$1,287.50" $953.00 $229.18 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $229.18 "$1,287.50" "$1,287.50" $955.58 $955.58 $992.41 $670.79 $268.33 "$1,287.50" $515.00 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $965.63 "$1,287.50" "$1,287.50" "$1,287.50" $643.75 $643.75 "$1,019.70" "$1,287.50" "$1,030.00" $836.88 "$1,287.50" N/A $746.75 "$1,287.50" $772.50 "$1,287.50" "$1,287.50" "$1,287.50" N/A N/A 80-0775 SUP Custom 27203010 80-0775 - REAMER SURG 3.8MM THDL DL TRK CLVCL SCR SYS BOTH IP/OP "$1,287.50" $953.00 $229.18 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $229.18 "$1,287.50" "$1,287.50" $955.58 $955.58 $992.41 $670.79 $268.33 "$1,287.50" $515.00 "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" "$1,287.50" $965.63 "$1,287.50" "$1,287.50" "$1,287.50" $643.75 $643.75 "$1,019.70" "$1,287.50" "$1,030.00" $836.88 "$1,287.50" N/A $746.75 "$1,287.50" $772.50 "$1,287.50" "$1,287.50" "$1,287.50" N/A N/A 80-0783 SUP Custom 27203010 80-0783 - SCREW BN 3MM 2 TRK TAP CLVCL BOTH IP/OP $420.00 $311.00 $74.76 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $74.76 $420.00 $420.00 $311.72 $311.72 $323.74 $218.82 $87.53 $420.00 $168.00 $420.00 $420.00 $420.00 $420.00 $420.00 $315.00 $420.00 $420.00 $420.00 $210.00 $210.00 $332.64 $420.00 $336.00 $273.00 $420.00 N/A $243.60 $420.00 $252.00 $420.00 $420.00 $420.00 N/A N/A 80-0838 SUP HCPCS C1713 80-0838 - SCREW BONE .75IN 3/32IN BLNK BOTH IP/OP $15.00 $11.00 $2.98 $15.00 $6.75 $6.75 $6.75 $6.75 $15.00 $15.00 $15.00 $3.13 $15.00 $15.00 $15.00 $15.00 $15.00 $3.13 $15.00 $6.00 $8.87 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $6.75 $2.98 N/A $8.70 $15.00 $15.00 $15.00 $3.13 $15.00 N/A N/A 80129-201 SUP HCPCS C1874 80129-201 - STENT ESPH 16FR 18MM 67CM 70MM ALIMAXX-ES FULL CVR PROX SUT BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-202 SUP HCPCS C1874 80129-202 - STENT ESPH 18MM 22FR 100CM ALIMAXX-E REM COVERED RADOPQ MTL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-203 SUP HCPCS C1874 80129-203 - STENT ESPH 22FR 18MM 120CM ALIMAXX-E REM COVERED MTL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-204 SUP HCPCS C1874 80129-204 - STENT ESPH 22MM 22FR 70CM ALIMAXX-E REM COVERED RADOPQ MTL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-205 SUP HCPCS C1874 80129-205 - STENT ESPH 22FR 100CM ALIMAXX-E SYS MTL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-206 SUP HCPCS C1874 80129-206 - STENT ESPH 22FR 120CM ALIMAXX-E SLF XPD MTL DISP BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-207 SUP HCPCS C1874 80129-207 - STENT ESPH 12MM 70CM ALIMAXX-ES FLLY COVERED BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-208 SUP HCPCS C1874 80129-208 - STENT ESPH 22MM 100CM ALIMAXX-ES PU CVR ANTIMIGRATION STRUT BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-209 SUP HCPCS C1874 80129-209 - STENT ESPH GMTR 12MM 16FR 120MM NS 62CM ALIMAXX-ES FLLY BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-210 SUP HCPCS C1874 80129-210 - STENT ESPH 14MM 70CM ALIMAXX-ES FLLY COVERED BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-211 SUP HCPCS C1874 80129-211 - STENT ESPH 14MM 16FR 100MM 64CM ALIMAXX-ES FLLY COVERED SMTH BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-212 SUP HCPCS C1874 80129-212 - STENT ESPH 14MM 16FR 62CM 120MM ALIMAXX-ES FLLY COVERED GMTR BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-213 SUP HCPCS C1874 80129-213 - STENT ESPH GMTR 16MM 70CM ALIMAXX-ES FLLY COVERED PU CVR BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-214 SUP HCPCS C1874 80129-214 - STENT ESPH 16MM 16FR 100MM 64CM ALIMAXX-ES FLLY COVERED SMTH BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-215 SUP HCPCS C1874 80129-215 - STENT ESPH 16MM 62CM 120MM ALIMAXX-ES FLLY COVERED GMTR PU BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$6,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$6,250.00" "$2,588.25" "$5,250.00" "$6,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 80129-406 SUP HCPCS C1769 80129-406 - GUIDEWIRE ENDSCP STR .035IN 260CM SUPER STIFF FLEXIBILITY BOTH IP/OP $500.00 $370.00 $99.24 $750.00 $271.50 $271.50 $271.50 $271.50 $500.00 $500.00 $500.00 $104.21 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $750.00 $295.75 $500.00 $750.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 80-1759 SUP HCPCS C1713 80-1759 - TACK FX .04IN PLT BOTH IP/OP $322.50 $239.00 $64.01 $322.50 $145.13 $145.13 $145.13 $145.13 $322.50 $322.50 $322.50 $67.22 $322.50 $322.50 $322.50 $322.50 $322.50 $67.21 $322.50 $129.00 $190.76 $322.50 $322.50 $322.50 $322.50 $241.88 $322.50 $322.50 $322.50 $161.25 $161.25 $255.42 $322.50 $258.00 $145.13 $64.01 N/A $187.05 $322.50 $193.50 $322.50 $67.21 $322.50 N/A N/A 80-1794 SUP Custom 27203010 80-1794 - DRILL SRG 1.1MM 3.5IN QRLSE STD AO 1.5MM SCR BOTH IP/OP $742.50 $549.00 $132.17 $742.50 $742.50 $742.50 $742.50 $742.50 $742.50 $742.50 $132.17 $742.50 $742.50 $551.08 $551.08 $572.32 $386.84 $154.75 $742.50 $297.00 $742.50 $742.50 $742.50 $742.50 $742.50 $556.88 $742.50 $742.50 $742.50 $371.25 $371.25 $588.06 $742.50 $594.00 $482.63 $742.50 N/A $430.65 $742.50 $445.50 $742.50 $742.50 $742.50 N/A N/A 80-1796 SUP Custom 27203010 80-1796 - DRILL SURG 2MM 3.5IN QUICK RELEASE STANDARD AO SURGIBIT BOTH IP/OP $742.50 $549.00 $132.17 $742.50 $742.50 $742.50 $742.50 $742.50 $742.50 $742.50 $132.17 $742.50 $742.50 $551.08 $551.08 $572.32 $386.84 $154.75 $742.50 $297.00 $742.50 $742.50 $742.50 $742.50 $742.50 $556.88 $742.50 $742.50 $742.50 $371.25 $371.25 $588.06 $742.50 $594.00 $482.63 $742.50 N/A $430.65 $742.50 $445.50 $742.50 $742.50 $742.50 N/A N/A 80-1797 SUP Custom 27203010 80-1797 - DRILL SURG MINI 2IN 3.5IN CUT INSERTION SURGIBIT REUSABLE BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A 8023 A SUP Custom 27803010 8023 A - SET TRAUMA FIX SMALL 2.1MM TAB BOTH IP/OP $214.00 $158.00 $38.05 $213.75 $213.75 $213.75 $213.75 $213.75 $213.75 $213.75 $38.05 $213.75 $213.75 $213.75 $213.75 $213.75 $213.75 $44.55 $213.75 $85.50 $213.75 $213.75 $213.75 $213.75 $213.75 $160.50 $213.75 $213.75 $213.75 $106.88 $106.88 $169.29 $213.75 $171.00 $96.19 $213.75 N/A $124.12 $213.75 $128.25 $213.75 $213.75 $213.75 N/A N/A 8023 B SUP Custom 27803010 8023 B - SET TRAUMA FIX STANDARD 2.5MM TAB BOTH IP/OP $214.00 $158.00 $38.05 $213.75 $213.75 $213.75 $213.75 $213.75 $213.75 $213.75 $38.05 $213.75 $213.75 $213.75 $213.75 $213.75 $213.75 $44.55 $213.75 $85.50 $213.75 $213.75 $213.75 $213.75 $213.75 $160.50 $213.75 $213.75 $213.75 $106.88 $106.88 $169.29 $213.75 $171.00 $96.19 $213.75 N/A $124.12 $213.75 $128.25 $213.75 $213.75 $213.75 N/A N/A 803.605.02S SUP HCPCS C1713 803.605.02S - SCREW BONE 1.5MM 5MM RESORB CORTICAL STERILE BOTH IP/OP $361.50 $268.00 $71.66 $361.03 $162.46 $162.46 $162.46 $162.46 $361.03 $361.03 $361.03 $75.25 $361.03 $361.03 $361.03 $361.03 $361.03 $75.24 $361.03 $78.90 $213.55 $361.03 $197.25 $361.03 $361.03 $271.13 $361.03 $361.03 $361.03 $180.52 $180.52 $285.94 $361.03 $288.82 $162.46 $71.66 N/A $209.67 $361.03 $216.62 $361.03 $361.03 $361.03 N/A N/A 804.006.02S SUP HCPCS C1713 804.006.02S - SCREW BONE 2MM 6MM RESORB MESH CORTICAL STERILE BOTH IP/OP $361.50 $268.00 $71.66 $361.03 $162.46 $162.46 $162.46 $162.46 $361.03 $361.03 $361.03 $75.25 $361.03 $361.03 $361.03 $361.03 $361.03 $75.24 $361.03 $197.25 $213.55 $361.03 $197.25 $361.03 $361.03 $271.13 $361.03 $361.03 $361.03 $180.52 $180.52 $285.94 $361.03 $288.82 $162.46 $71.66 N/A $209.67 $361.03 $361.03 $361.03 $75.24 $361.03 N/A N/A 80-4403L SUP HCPCS C1776 80-4403L - COMPONENT FEMORAL 3 57X51MM CRUCIATE RETAIN POST PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4403R SUP HCPCS C1776 80-4403R - COMPONENT FEMORAL 3 57X51MM CRUCIATE RETAIN PRIM LUG SCORPIO BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4404L SUP HCPCS C1776 80-4404L - COMPONENT FEMORAL 4 60X53MM CRUCIATE RETAIN PRIM LUG SCORPIO BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4404R SUP HCPCS C1776 80-4404R - COMPONENT FEMORAL 4 60X53MM CRUCIATE RETAIN PRIM LUG SCORPIO BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4405L SUP HCPCS C1776 80-4405L - COMPONENT FEMORAL 5 62X55MM CRUCIATE RETAIN PRIM LUG SCORPIO BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4405R SUP HCPCS C1776 80-4405R - COMPONENT FEMORAL 5 62X55MM CRUCIATE RETAIN PRIM LUG SCORPIO BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4406L SUP HCPCS C1776 80-4406L - COMPONENT FEMORAL 6 65X57MM CRUCIATE RETAIN PRIM LUG SCORPIO BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4406R SUP HCPCS C1776 80-4406R - COMPONENT FEMORAL 6 65X57MM CRUCIATE RETAIN PRIM LUG SCORPIO BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4407L SUP HCPCS C1776 80-4407L - COMPONENT FEMORAL 7 67X60MM CRUCIATE RETAIN PRIM LUG SCORPIO BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4407R SUP HCPCS C1776 80-4407R - COMPONENT FEMORAL 7 67X60MM CRUCIATE RETAIN PRIM LUG SCORPIO BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4408L SUP HCPCS C1776 80-4408L - COMPONENT FEMORAL 8 70X62MM CRUCIATE RETAIN PRIM LUG SCORPIO BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4408R SUP HCPCS C1776 80-4408R - COMPONENT FEMORAL 8 70X62MM CRUCIATE RETAIN PRIM LUG SCORPIO BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4409L SUP HCPCS C1776 80-4409L - COMPONENT FEMORAL 9 72X64MM CRUCIATE RETAIN PRIM LUG SCORPIO BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4409R SUP HCPCS C1776 80-4409R - COMPONENT FEMORAL 9 72X64MM CRUCIATE RETAIN PRIM LUG SCORPIO BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4411L SUP HCPCS C1776 80-4411L - COMPONENT FEMORAL 11 77X69MM CRUCIATE RETAIN PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4411R SUP HCPCS C1776 80-4411R - COMPONENT FEMORAL 11 77X69MM CRUCIATE RETAIN PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4413L SUP HCPCS C1776 80-4413L - COMPONENT FEMORAL 13 82X74MM CRUCIATE RETAIN PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 80-4413R SUP HCPCS C1776 80-4413R - COMPONENT FEMORAL 13 82X74MM CRUCIATE RETAIN PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 805.603.02S SUP HCPCS C1713 805.603.02S - SCREW BN 1.5MM 3MM STRL CRNMXF CORT 2 PK BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $157.50 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $236.25 $393.75 $393.75 $393.75 N/A N/A 805.604.02S SUP HCPCS C1713 805.604.02S - SCREW BONE 1.5MM 4MM RAPID RESORB CORTICAL BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $393.75 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $236.25 $393.75 $82.06 $393.75 N/A N/A 805.605.02S SUP HCPCS C1713 805.605.02S - SCREW BN 1.5MM 5MM STRL CRNMXF CORT 2 PK BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $157.50 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $236.25 $393.75 $82.06 $393.75 N/A N/A 805.606.02S SUP HCPCS C1713 805.606.02S - SCREW BN 1.5MM 6MM STRL CRNMXF CORT 2 PK BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $157.50 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $393.75 $393.75 $82.06 $393.75 N/A N/A 805.608.02S SUP HCPCS C1713 805.608.02S - SCREW BONE 1.5MM 8MM RAPID RESORB CORTICAL BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $157.50 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $393.75 $393.75 $82.06 $393.75 N/A N/A 805.614.02S SUP HCPCS C1713 805.614.02S - TACK FX 1.5MM 4MM STRL RAPIDSORB RSRB CRNMXF BOTH IP/OP $373.50 $276.00 $74.13 $373.50 $168.08 $168.08 $168.08 $168.08 $373.50 $373.50 $373.50 $77.85 $373.50 $373.50 $373.50 $373.50 $373.50 $77.84 $373.50 $373.50 $220.93 $373.50 $373.50 $373.50 $373.50 $280.13 $373.50 $373.50 $373.50 $186.75 $186.75 $295.81 $373.50 $298.80 $168.08 $74.13 N/A $216.63 $373.50 $224.10 $373.50 $77.84 $373.50 N/A N/A 806.004.02S SUP HCPCS C1713 806.004.02S - SCREW BONE 2MM 4MM RAPID RESORB CORTICAL CRANIOMAXILLOFACIAL BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $393.75 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $236.25 $393.75 $82.06 $393.75 N/A N/A 806.006.02S SUP HCPCS C1713 806.006.02S - SCREW BN 2MM 6MM STRL CRNMXF CORT 2 PK BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $393.75 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $236.25 $393.75 $82.06 $393.75 N/A N/A 806.008.02S SUP HCPCS C1713 806.008.02S - SCREW BN 2MM 8MM STRL CRNMXF CORT 2 PK BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $393.75 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $393.75 $393.75 $82.06 $393.75 N/A N/A 806.044.02S SUP HCPCS C1713 806.044.02S - SCREW BONE 2.5MM 4MM RAPID RESORB EMERGENCY CORTICAL BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $393.75 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $393.75 $393.75 $82.06 $393.75 N/A N/A 806.046.02S SUP HCPCS C1713 806.046.02S - SCREW BONE 2.5MM 6MM RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $393.75 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $236.25 $393.75 $393.75 $393.75 N/A N/A 806.048.02S SUP HCPCS C1713 806.048.02S - SCREW BONE 2.5MM 8MM RAPID RESORB EMERGENCY CORTICAL BOTH IP/OP $394.00 $292.00 $78.15 $393.75 $177.19 $177.19 $177.19 $177.19 $393.75 $393.75 $393.75 $82.07 $393.75 $393.75 $393.75 $393.75 $393.75 $82.06 $393.75 $393.75 $232.90 $393.75 $393.75 $393.75 $393.75 $295.50 $393.75 $393.75 $393.75 $196.88 $196.88 $311.85 $393.75 $315.00 $177.19 $78.15 N/A $228.52 $393.75 $236.25 $393.75 $82.06 $393.75 N/A N/A 808-002 SUP HCPCS C1713 808-002 - ROD SPINAL 3/16IN THREADED STR STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 808-083 SUP HCPCS C1713 808-083 - ROD SPINAL HEXAGON 6.35MM 20IN FLEXIBLE TSRH STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 808-105 SUP HCPCS C1713 808-105 - SCREW SET BREAKOFF TSRH STAINLESS STEEL SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 808-190 SUP HCPCS C1713 808-190 - SCREW SET LOCKING BOLT TOP TSRH SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 808-524 SUP HCPCS C1713 808-524 - HOLDER IMPLANT .25IN ROD BOTH IP/OP "$2,670.00" "$1,976.00" $529.93 "$2,670.00" "$1,201.50" "$1,201.50" "$1,201.50" "$1,201.50" "$2,670.00" "$2,670.00" "$2,670.00" $556.49 "$2,670.00" "$2,670.00" "$2,670.00" "$2,670.00" "$2,670.00" $556.46 "$2,670.00" "$1,068.00" "$1,316.31" "$2,670.00" "$2,670.00" "$2,670.00" "$2,670.00" "$2,002.50" "$2,670.00" "$2,670.00" "$2,670.00" "$1,335.00" "$1,335.00" "$2,114.64" "$2,670.00" "$2,136.00" "$1,201.50" $529.93 N/A "$1,548.60" "$2,670.00" "$2,670.00" "$2,670.00" $556.43 "$2,670.00" N/A N/A 809-DBL SUP HCPCS C1713 809-DBL - SCREW BONE 2.2MM 9MM 2 CROSS DRIVE TITANIUM SPN BOTH IP/OP $97.50 $72.00 $19.26 $97.05 $43.67 $43.67 $43.67 $43.67 $97.05 $97.05 $97.05 $20.23 $97.05 $97.05 $97.05 $97.05 $97.05 $20.23 $97.05 $38.82 $57.41 $97.05 $97.05 $97.05 $97.05 $73.13 $97.05 $97.05 $97.05 $48.53 $48.53 $76.86 $97.05 $77.64 $43.67 $19.26 N/A $56.55 $97.05 $58.23 $97.05 $20.23 $97.05 N/A N/A 80XLTCD SUP Custom 27203010 80XLTCD - TUBE TRCH 40MM 50MM 13.3MM 8MM 105MM STRL LF 15MM SHLY XLT BOTH IP/OP $160.00 $118.00 $28.42 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $28.42 $159.65 $159.65 $118.49 $118.49 $123.06 $83.18 $33.27 $159.65 $63.86 $159.65 $159.65 $159.65 $159.65 $159.65 $120.00 $159.65 $159.65 $159.65 $79.83 $79.83 $126.44 $159.65 $127.72 $103.77 $159.65 N/A $92.80 $159.65 $95.79 $159.65 $159.65 $159.65 N/A N/A 80XLTCP SUP Custom 27203010 80XLTCP - TUBE TRCH 40MM 35MM 13.3MM 8MM 105MM STRL LF 30MM SHLY XLT BOTH IP/OP $160.00 $118.00 $28.42 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $159.65 $28.42 $159.65 $159.65 $118.49 $118.49 $123.06 $83.18 $33.27 $159.65 $63.86 $159.65 $159.65 $159.65 $159.65 $159.65 $120.00 $159.65 $159.65 $159.65 $79.83 $79.83 $126.44 $159.65 $127.72 $103.77 $159.65 N/A $92.80 $159.65 $95.79 $159.65 $159.65 $159.65 N/A N/A 810041B SUP HCPCS C1781 810041B - MESH TRANSVAGINAL 45X1.1CM TAPE TVT PROLENE BLUE BOTH IP/OP "$1,955.50" "$1,447.00" $388.04 "$1,955.10" $879.80 $879.80 $879.80 $879.80 "$1,955.10" "$1,955.10" "$1,955.10" $407.49 "$1,955.10" "$1,955.10" "$1,955.10" "$1,955.10" "$1,955.10" $407.46 "$1,955.10" "$1,955.10" "$1,156.44" "$1,955.10" "$1,955.10" "$1,955.10" "$1,955.10" "$1,466.63" "$1,955.10" "$1,955.10" "$1,955.10" $977.55 $977.55 "$1,548.44" "$1,955.10" "$1,564.08" $879.80 $388.04 N/A "$1,134.19" "$1,955.10" "$1,955.10" "$1,955.10" $407.44 "$1,955.10" N/A N/A 810-200 SUP HCPCS C1713 810-200 - PLATE BONE LP .375IN MULTI-SPAN CROSSLINK STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-201 SUP HCPCS C1713 810-201 - PLATE BONE LP .675IN MULTI-SPAN CROSSLINK STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-202 SUP HCPCS C1713 810-202 - PLATE BONE LP .75IN MULTI-SPAN CROSSLINK STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-203 SUP HCPCS C1713 810-203 - PLATE BONE LP .875IN MULTI-SPAN CROSSLINK STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-205 SUP HCPCS C1713 810-205 - PLATE BONE LP 1.125IN MULTI-SPAN CROSSLINK STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-206 SUP HCPCS C1713 810-206 - PLATE BONE LP 1.25IN MULTI-SPAN CROSSLINK STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-207 SUP HCPCS C1713 810-207 - PLATE BONE LP 1.375IN MULTI-SPAN CROSSLINK STAINLESS STEEL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-208 SUP HCPCS C1713 810-208 - PLATE BONE LP 1.5IN MULTI-SPAN CROSSLINK STAINLESS STEEL SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-221 SUP HCPCS C1713 810-221 - PLATE BONE LP 1.55-1.75IN MULTI-SPAN CROSSLINK STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-222 SUP HCPCS C1713 810-222 - PLATE BONE LP 1.75-2.15IN MULTI-SPAN CROSSLINK STAINLESS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8103.0201S SUP HCPCS C1713 8103.0201S - SUBSTITUTE BNGFT PLUS XEMPLIFI DEMINERALIZE BONE MATRIX 1ML BOTH IP/OP $570.00 $422.00 $113.13 $570.00 $256.50 $256.50 $256.50 $256.50 $570.00 $570.00 $570.00 $118.80 $570.00 $570.00 $570.00 $570.00 $570.00 $118.79 $570.00 $228.00 $337.16 $570.00 $570.00 $570.00 $570.00 $427.50 $570.00 $570.00 $570.00 $285.00 $285.00 $451.44 $570.00 $456.00 $256.50 $113.13 N/A $330.60 $570.00 $342.00 $570.00 $118.79 $570.00 N/A N/A 8103.0203S SUP HCPCS C1713 8103.0203S - SUBSTITUTE BNGFT PLUS XEMPLIFI DEMINERALIZE BONE MATRIX 3ML BOTH IP/OP "$1,485.00" "$1,099.00" $294.74 "$1,485.00" $668.25 $668.25 $668.25 $668.25 "$1,485.00" "$1,485.00" "$1,485.00" $309.51 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" $309.49 "$1,485.00" $594.00 $878.38 "$1,485.00" "$1,485.00" "$1,485.00" "$1,485.00" "$1,113.75" "$1,485.00" "$1,485.00" "$1,485.00" $742.50 $742.50 "$1,176.12" "$1,485.00" "$1,188.00" $668.25 $294.74 N/A $861.30 "$1,485.00" $891.00 "$1,485.00" $309.47 "$1,485.00" N/A N/A 810-300 SUP HCPCS C1713 810-300 - PLATE BONE OFFST LP .375IN MULTI-SPAN CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-301 SUP HCPCS C1713 810-301 - PLATE BONE LP .625IN BAR FIX MULTI-SPAN CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-302 SUP HCPCS C1713 810-302 - PLATE BONE LP .75IN BAR FIX MULTI-SPAN CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-303 SUP HCPCS C1713 810-303 - PLATE BONE LP .875IN BAR FIX MULTI-SPAN CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-304 SUP HCPCS C1713 810-304 - PLATE BONE LP 1IN BAR FIX MULTI-SPAN CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-305 SUP HCPCS C1713 810-305 - PLATE BONE LP 1.125IN BAR FIX MULTI-SPAN CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-306 SUP HCPCS C1713 810-306 - PLATE BONE LP 1.25IN BAR FIX MULTI-SPAN CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-307 SUP HCPCS C1713 810-307 - PLATE BONE LP 1.375IN BAR FIX MULTI-SPAN CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-308 SUP HCPCS C1713 810-308 - PLATE BONE LP 1.5IN BAR FIX MULTI-SPAN CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-321 SUP HCPCS C1713 810-321 - PLATE BONE LP 1.55-1.75IN BAR FIX MULTI-SPAN CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-322 SUP HCPCS C1713 810-322 - PLATE BONE LP 1.75-2.15IN BAR FIX MULTI-SPAN CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-323 SUP HCPCS C1713 810-323 - PLATE BONE LP 2.15-2.95IN BAR FIX MULTI-SPAN CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-400 SUP HCPCS C1713 810-400 - PLATE BONE STANDARD OFFST LP .375IN BAR FIX MULTI-SPAN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-401 SUP HCPCS C1713 810-401 - PLATE BONE LP .625IN BAR FIX MULTI-SPAN CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-402 SUP HCPCS C1713 810-402 - PLATE BONE LP .75IN BAR FIX MULTI-SPAN CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-403 SUP HCPCS C1713 810-403 - PLATE BONE STANDARD LP .875IN BAR FIX MULTI-SPAN CROSSLINK BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-404 SUP HCPCS C1713 810-404 - PLATE BONE LP 1IN BAR FIX MULTI-SPAN CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-405 SUP HCPCS C1713 810-405 - PLATE BONE LP 1.125IN BAR FIX MULTI-SPAN CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-406 SUP HCPCS C1713 810-406 - PLATE BONE LP 1.25IN BAR FIX MULTI-SPAN CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 810-407 SUP HCPCS C1713 810-407 - PLATE BONE LP 1.375IN BAR FIX MULTI-SPAN CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-408 SUP HCPCS C1713 810-408 - PLATE BONE STANDARD LP 1.5IN BAR FIX MULTI-SPAN CROSSLINK CD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-421 SUP HCPCS C1713 810-421 - PLATE BONE STANDARD LP 1.55-1.75IN BAR FIX MULTI-SPAN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 810-422 SUP HCPCS C1713 810-422 - PLATE BONE STANDARD LP 1.75-2.15IN BAR FIX MULTI-SPAN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 810-423 SUP HCPCS C1713 810-423 - PLATE BONE STANDARD LP 2.15-2.95IN BAR FIX MULTI-SPAN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 810-450 SUP HCPCS C1713 810-450 - SCREW SET NONBREAKOFF LP PLATE CROSSLINK TSRH STAINLESS BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $250.00 $250.00 N/A N/A 810-451 SUP HCPCS C1713 810-451 - SCREW SET LP OFFST PLATE CROSSLINK STAINLESS STEEL SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 8104528M SUP HCPCS C1713 8104528M - PLATE BONE 28MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8104530M SUP HCPCS C1713 8104530M - PLATE BN 30-34MM X10 XLNK TI SPNE 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8104534M SUP HCPCS C1713 8104534M - PLATE BONE 42MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8104541M SUP HCPCS C1713 8104541M - PLATE BONE 56MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8104555M SUP HCPCS C1713 8104555M - PLATE BONE 55MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-300 SUP HCPCS C1713 811-300 - PLATE BONE OFFST LP .375IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-301 SUP HCPCS C1713 811-301 - PLATE BONE LP .625IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 811-302 SUP HCPCS C1713 811-302 - PLATE BONE LP .75IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 811-303 SUP HCPCS C1713 811-303 - PLATE BONE LP .875IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-304 SUP HCPCS C1713 811-304 - PLATE BONE LP 1IN CROSSLINK CD HORIZON TITANIUM SPN STERILE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-305 SUP HCPCS C1713 811-305 - PLATE BONE LP 1.125IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-306 SUP HCPCS C1713 811-306 - PLATE BONE LP 1.25IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-307 SUP HCPCS C1713 811-307 - PLATE BONE LP 1.375IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-308 SUP HCPCS C1713 811-308 - PLATE BN 1.5IN STRL XLNK CD HZN LOPRFL TI SPNE 5.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-313 SUP Custom 27803010 811-313 - PLATE BONE LP .5IN X10 CROSSLINK TITANIUM SPN STERILE 5.5MM BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 811-321 SUP HCPCS C1713 811-321 - PLATE BN 1.55-1.75IN STRL MLSPN XLNK CD HZN LOPRFL TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-322 SUP HCPCS C1713 811-322 - PLATE BN 1.75-2.15IN STRL MLSPN XLNK CD HZN LOPRFL TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-323 SUP HCPCS C1713 811-323 - PLATE BN 2.15-2.95IN STRL MLSPN XLNK CD HZN LOPRFL TI SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-324 SUP HCPCS C1713 811-324 - PLATE BONE LP 2.953IN X10 CROSSLINK TITANIUM SPN STERILE 5.5 BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 811-400 SUP HCPCS C1713 811-400 - PLATE BONE OFFST LP .375IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-401 SUP HCPCS C1713 811-401 - PLATE BONE LP .625IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A 811-402 SUP HCPCS C1713 811-402 - PLATE BONE LP .75IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-403 SUP HCPCS C1713 811-403 - PLATE BONE LP .875IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-404 SUP HCPCS C1713 811-404 - PLATE BONE LP 1IN CROSSLINK CD HORIZON TITANIUM SPINAL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-405 SUP HCPCS C1713 811-405 - PLATE BONE LP 1.125IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-406 SUP HCPCS C1713 811-406 - PLATE BONE LP 1.25IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-407 SUP HCPCS C1713 811-407 - PLATE BONE LP 1.375IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-408 SUP HCPCS C1713 811-408 - PLATE BONE LP 1.5IN CROSSLINK CD HORIZON TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-421 SUP HCPCS C1713 811-421 - PLATE BONE LP 1.55-1.75IN MULTI-SPAN CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-422 SUP HCPCS C1713 811-422 - PLATE BONE LP 1.75-2.15IN MULTI-SPAN CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-423 SUP HCPCS C1713 811-423 - PLATE BONE LP 2.15-2.95IN MULTI-SPAN CROSSLINK CD HORIZON BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-450 SUP HCPCS C1713 811-450 - SCREW SET NONBREAKOFF LP PLATE CROSSLINK TITANIUM SPN 6.35 BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 811-451 SUP HCPCS C1713 811-451 - SCREW SET LP OFFST PLATE CROSSLINK TITANIUM SPN 6.35MM ROD BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 8114528M SUP HCPCS C1713 8114528M - PLATE BONE 30MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8114530M SUP HCPCS C1713 8114530M - PLATE BONE 34MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8114534M SUP HCPCS C1713 8114534M - PLATE BONE 42MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8114541M SUP HCPCS C1713 8114541M - PLATE BONE 56MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 8114555M SUP HCPCS C1713 8114555M - PLATE BONE 84MM X10 CROSSLINK TITANIUM SPN 4.5MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-500 SUP HCPCS C1713 811-500 - PLATE BONE LP .375IN CROSSLINK TITANIUM SPN 6MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-501 SUP HCPCS C1713 811-501 - PLATE BONE LP .625IN CROSSLINK TITANIUM SPN 6MM ROD BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 811-DBL SUP HCPCS C1713 811-DBL - SCREW BONE 2.2MM 11MM 2 CROSS DRIVE TIMESH TITANIUM CRANIUM BOTH IP/OP $98.00 $73.00 $19.40 $97.75 $43.99 $43.99 $43.99 $43.99 $97.75 $97.75 $97.75 $20.37 $97.75 $97.75 $97.75 $97.75 $97.75 $20.37 $97.75 $97.75 $57.82 $97.75 $97.75 $97.75 $97.75 $73.50 $97.75 $97.75 $97.75 $48.88 $48.88 $77.42 $97.75 $78.20 $43.99 $19.40 N/A $56.84 $97.75 $97.75 $97.75 $20.37 $97.75 N/A N/A 813-DBL SUP HCPCS C1713 813-DBL - SCREW BONE 2.2MM 13MM 2 CROSS DRIVE TIMESH TITANIUM CRANIUM BOTH IP/OP $98.00 $73.00 $19.40 $97.75 $43.99 $43.99 $43.99 $43.99 $97.75 $97.75 $97.75 $20.37 $97.75 $97.75 $97.75 $97.75 $97.75 $20.37 $97.75 $39.10 $57.82 $97.75 $97.75 $97.75 $97.75 $73.50 $97.75 $97.75 $97.75 $48.88 $48.88 $77.42 $97.75 $78.20 $43.99 $19.40 N/A $56.84 $97.75 $97.75 $97.75 $20.37 $97.75 N/A N/A 81-4403L SUP HCPCS C1776 81-4403L - COMPONENT FEMORAL 3 57X51MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4403R SUP HCPCS C1776 81-4403R - COMPONENT FEMORAL 3 57X51MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4404L SUP HCPCS C1776 81-4404L - COMPONENT FEMORAL 4 60X54MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4404R SUP HCPCS C1776 81-4404R - COMPONENT FEMORAL 4 60X54MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4405L SUP HCPCS C1776 81-4405L - COMPONENT FEMORAL 5 62X56MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4405R SUP HCPCS C1776 81-4405R - COMPONENT FEMORAL 5 62X56MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4406L SUP HCPCS C1776 81-4406L - COMPONENT FEMORAL 6 65X58MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4406R SUP HCPCS C1776 81-4406R - COMPONENT FEMORAL 6 65X58MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4407L SUP HCPCS C1776 81-4407L - COMPONENT FEMORAL 7 67X61MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4407R SUP HCPCS C1776 81-4407R - COMPONENT FEMORAL 7 67X61MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4408L SUP HCPCS C1776 81-4408L - COMPONENT FEMORAL 8 70X63MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4408R SUP HCPCS C1776 81-4408R - COMPONENT FEMORAL 8 70X63MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4409L SUP HCPCS C1776 81-4409L - COMPONENT FEMORAL 9 72X65MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4409R SUP HCPCS C1776 81-4409R - COMPONENT FEMORAL 9 72X65MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4411L SUP HCPCS C1776 81-4411L - COMPONENT FEMORAL 11 77X70MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4411R SUP HCPCS C1776 81-4411R - COMPONENT FEMORAL 11 77X70MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$1,201.00" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4413L SUP HCPCS C1776 81-4413L - COMPONENT FEMORAL 13 82X75MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81-4413R SUP HCPCS C1776 81-4413R - COMPONENT FEMORAL 13 82X75MM POSTERIOR STABILIZE PRIM LUG BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$1,801.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A 81500V SUP Custom 27203010 81500V - APPLIER ENDOSCOPIC Med Large Straight 13inÿÿ BOTH IP/OP "$2,374.00" "$1,757.00" $422.52 "$2,373.73" "$2,373.73" "$2,373.73" "$2,373.73" "$2,373.73" "$2,373.73" "$2,373.73" $422.52 "$2,373.73" "$2,373.73" "$1,761.78" "$1,761.78" "$1,829.67" "$1,236.71" $494.71 "$2,373.73" $949.49 "$2,373.73" "$2,373.73" "$2,373.73" "$2,373.73" "$2,373.73" "$1,780.50" "$2,373.73" "$2,373.73" "$2,373.73" "$1,186.87" "$1,186.87" "$1,879.99" "$2,373.73" "$1,898.98" "$1,542.92" "$2,373.73" N/A "$1,376.92" "$2,373.73" "$1,424.24" "$2,373.73" "$2,373.73" "$2,373.73" N/A N/A 815-013 SUP HCPCS C1713 815-013 - STAPLE BONE 13MM CD HORIZON STAINLESS STEEL SPN BOTH IP/OP $475.50 $352.00 $94.37 $475.50 $213.98 $213.98 $213.98 $213.98 $475.50 $475.50 $475.50 $99.11 $475.50 $475.50 $475.50 $475.50 $475.50 $99.10 $475.50 $190.20 $281.26 $475.50 $475.50 $475.50 $475.50 $356.63 $475.50 $475.50 $475.50 $237.75 $237.75 $376.60 $475.50 $380.40 $213.98 $94.37 N/A $275.79 $475.50 $475.50 $475.50 $99.09 $475.50 N/A N/A 815-015 SUP HCPCS C1713 815-015 - STAPLE BONE 15MM CD HORIZON STAINLESS STEEL SPN BOTH IP/OP $475.50 $352.00 $94.37 $475.50 $213.98 $213.98 $213.98 $213.98 $475.50 $475.50 $475.50 $99.11 $475.50 $475.50 $475.50 $475.50 $475.50 $99.10 $475.50 $190.20 $281.26 $475.50 $475.50 $475.50 $475.50 $356.63 $475.50 $475.50 $475.50 $237.75 $237.75 $376.60 $475.50 $380.40 $213.98 $94.37 N/A $275.79 $475.50 $475.50 $475.50 $99.09 $475.50 N/A N/A 815-017 SUP HCPCS C1713 815-017 - STAPLE BONE 17MM CD HORIZON STAINLESS STEEL SPN BOTH IP/OP $475.50 $352.00 $94.37 $475.50 $213.98 $213.98 $213.98 $213.98 $475.50 $475.50 $475.50 $99.11 $475.50 $475.50 $475.50 $475.50 $475.50 $99.10 $475.50 $475.50 $281.26 $475.50 $475.50 $475.50 $475.50 $356.63 $475.50 $475.50 $475.50 $237.75 $237.75 $376.60 $475.50 $380.40 $213.98 $94.37 N/A $275.79 $475.50 $475.50 $475.50 $99.09 $475.50 N/A N/A 81501V SUP Custom 27203010 81501V - CLIP INTNL Endo Remover Med Large - Large Straight 13inÿÿ BOTH IP/OP "$2,165.00" "$1,602.00" $385.37 "$2,164.98" "$2,164.98" "$2,164.98" "$2,164.98" "$2,164.98" "$2,164.98" "$2,164.98" $385.37 "$2,164.98" "$2,164.98" "$1,606.85" "$1,606.85" "$1,668.77" "$1,127.95" $451.21 "$2,164.98" $865.99 "$2,164.98" "$2,164.98" "$2,164.98" "$2,164.98" "$2,164.98" "$1,623.75" "$2,164.98" "$2,164.98" "$2,164.98" "$1,082.49" "$1,082.49" "$1,714.66" "$2,164.98" "$1,731.98" "$1,407.24" "$2,164.98" N/A "$1,255.70" "$2,164.98" "$1,298.99" "$2,164.98" "$2,164.98" "$2,164.98" N/A N/A 816-013 SUP HCPCS C1713 816-013 - STAPLE BONE 13MM 1 HOLE CD HORIZON TITANIUM ANTERIOR SPN BOTH IP/OP $549.00 $406.00 $108.96 $549.00 $247.05 $247.05 $247.05 $247.05 $549.00 $549.00 $549.00 $114.43 $549.00 $549.00 $549.00 $549.00 $549.00 $114.42 $549.00 $219.60 $324.73 $549.00 $549.00 $549.00 $549.00 $411.75 $549.00 $549.00 $549.00 $274.50 $274.50 $434.81 $549.00 $439.20 $247.05 $108.96 N/A $318.42 $549.00 $549.00 $549.00 $114.41 $549.00 N/A N/A 816-015 SUP HCPCS C1713 816-015 - STAPLE BONE 15MM 1 HOLE CD HORIZON TITANIUM ANTERIOR SPN BOTH IP/OP $549.00 $406.00 $108.96 $549.00 $247.05 $247.05 $247.05 $247.05 $549.00 $549.00 $549.00 $114.43 $549.00 $549.00 $549.00 $549.00 $549.00 $114.42 $549.00 $219.60 $324.73 $549.00 $549.00 $549.00 $549.00 $411.75 $549.00 $549.00 $549.00 $274.50 $274.50 $434.81 $549.00 $439.20 $247.05 $108.96 N/A $318.42 $549.00 $549.00 $549.00 $114.41 $549.00 N/A N/A 816-017 SUP HCPCS C1713 816-017 - STAPLE BONE 17MM 1 HOLE CD HORIZON TITANIUM ANTERIOR SPN BOTH IP/OP $549.00 $406.00 $108.96 $549.00 $247.05 $247.05 $247.05 $247.05 $549.00 $549.00 $549.00 $114.43 $549.00 $549.00 $549.00 $549.00 $549.00 $114.42 $549.00 $549.00 $324.73 $549.00 $549.00 $549.00 $549.00 $411.75 $549.00 $549.00 $549.00 $274.50 $274.50 $434.81 $549.00 $439.20 $247.05 $108.96 N/A $318.42 $549.00 $549.00 $549.00 $114.41 $549.00 N/A N/A 81602V SUP Custom 27203010 81602V - APPLIER ENDOSCOPIC Large Curved 13inÿÿ BOTH IP/OP "$2,374.00" "$1,757.00" $422.52 "$2,373.73" "$2,373.73" "$2,373.73" "$2,373.73" "$2,373.73" "$2,373.73" "$2,373.73" $422.52 "$2,373.73" "$2,373.73" "$1,761.78" "$1,761.78" "$1,829.67" "$1,236.71" $494.71 "$2,373.73" $949.49 "$2,373.73" "$2,373.73" "$2,373.73" "$2,373.73" "$2,373.73" "$1,780.50" "$2,373.73" "$2,373.73" "$2,373.73" "$1,186.87" "$1,186.87" "$1,879.99" "$2,373.73" "$1,898.98" "$1,542.92" "$2,373.73" N/A "$1,376.92" "$2,373.73" "$1,424.24" "$2,373.73" "$2,373.73" "$2,373.73" N/A N/A 8161-35-026 SUP HCPCS C1713 8161-35-026 - SCREW 3.5X26MM CORTICAL LOCKING BOTH IP/OP $402.50 $298.00 $79.89 $402.50 $181.13 $181.13 $181.13 $181.13 $402.50 $402.50 $402.50 $83.89 $402.50 $402.50 $402.50 $402.50 $402.50 $83.89 $402.50 $402.50 $238.08 $402.50 $402.50 $402.50 $402.50 $301.88 $402.50 $402.50 $402.50 $201.25 $201.25 $318.78 $402.50 $322.00 $181.13 $79.89 N/A $233.45 $402.50 $402.50 $402.50 $83.88 $402.50 N/A N/A 81701V SUP Custom 27203010 81701V - CLIP INTNL Endo RemoverÿLarge - XLarge Straight 13inÿÿ BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,249.98" "$2,249.98" "$2,249.98" "$2,249.98" "$2,249.98" "$2,249.98" "$2,249.98" $400.50 "$2,249.98" "$2,249.98" "$1,669.94" "$1,669.94" "$1,734.28" "$1,172.24" $468.92 "$2,249.98" $899.99 "$2,249.98" "$2,249.98" "$2,249.98" "$2,249.98" "$2,249.98" "$1,687.50" "$2,249.98" "$2,249.98" "$2,249.98" "$1,124.99" "$1,124.99" "$1,781.98" "$2,249.98" "$1,799.98" "$1,462.49" "$2,249.98" N/A "$1,305.00" "$2,249.98" "$1,349.99" "$2,249.98" "$2,249.98" "$2,249.98" N/A N/A 81702V SUP Custom 27203010 81702V - APPLIER ENDOSCOPIC XLarge Curved 13inÿÿ BOTH IP/OP "$2,549.00" "$1,886.00" $453.67 "$2,548.73" "$2,548.73" "$2,548.73" "$2,548.73" "$2,548.73" "$2,548.73" "$2,548.73" $453.67 "$2,548.73" "$2,548.73" "$1,891.67" "$1,891.67" "$1,964.56" "$1,327.89" $531.18 "$2,548.73" "$1,019.49" "$2,548.73" "$2,548.73" "$2,548.73" "$2,548.73" "$2,548.73" "$1,911.75" "$2,548.73" "$2,548.73" "$2,548.73" "$1,274.37" "$1,274.37" "$2,018.59" "$2,548.73" "$2,038.98" "$1,656.67" "$2,548.73" N/A "$1,478.42" "$2,548.73" "$1,529.24" "$2,548.73" "$2,548.73" "$2,548.73" N/A N/A 81B001 SUP HCPCS C1776 81B001 - GRAFT SFT TIS FRZDR ANT TIB TNDN BOTH IP/OP "$5,032.50" "$3,724.00" $998.83 "$5,767.50" "$2,264.63" "$2,264.63" "$2,264.63" "$2,264.63" "$5,032.50" "$5,032.50" "$5,032.50" "$1,048.90" "$5,032.50" "$5,032.50" "$5,032.50" "$5,032.50" "$5,032.50" "$1,048.83" "$5,032.50" "$5,767.50" "$2,481.02" "$5,032.50" "$5,767.50" "$5,032.50" "$5,032.50" "$3,774.38" "$5,032.50" "$5,032.50" "$5,032.50" "$2,516.25" "$2,516.25" "$3,985.74" "$5,032.50" "$4,026.00" "$2,264.63" $998.83 N/A "$2,918.85" "$5,032.50" "$5,032.50" "$5,032.50" "$1,048.77" "$5,032.50" N/A N/A 81B005 SUP HCPCS C1776 81B005 - GRAFT BN GRCLS SEMITENDINOSUS BOTH IP/OP "$5,045.00" "$3,733.00" "$1,001.31" "$5,780.00" "$2,270.25" "$2,270.25" "$2,270.25" "$2,270.25" "$5,045.00" "$5,045.00" "$5,045.00" "$1,051.50" "$5,045.00" "$5,045.00" "$5,045.00" "$5,045.00" "$5,045.00" "$1,051.43" "$5,045.00" "$2,312.00" "$2,487.19" "$5,045.00" "$5,780.00" "$5,045.00" "$5,045.00" "$3,783.75" "$5,045.00" "$5,045.00" "$5,045.00" "$2,522.50" "$2,522.50" "$3,995.64" "$5,045.00" "$4,036.00" "$2,270.25" "$1,001.31" N/A "$2,926.10" "$5,045.00" "$5,045.00" "$5,045.00" "$1,051.38" "$5,045.00" N/A N/A 820-050 SUP HCPCS C1713 820-050 - EYEBOLT SPINAL ASMBLY LOCK NUT BONE SCREW BOTH IP/OP $553.50 $410.00 $109.86 $553.50 $249.08 $249.08 $249.08 $249.08 $553.50 $553.50 $553.50 $115.36 $553.50 $553.50 $553.50 $553.50 $553.50 $115.36 $553.50 $221.40 $327.40 $553.50 $553.50 $553.50 $553.50 $415.13 $553.50 $553.50 $553.50 $276.75 $276.75 $438.37 $553.50 $442.80 $249.08 $109.86 N/A $321.03 $553.50 $332.10 $553.50 $115.35 $553.50 N/A N/A 82091-01 SUP HCPCS C1876 82091-01 - STENT VASCULAR TAPER 8-6MM 30MM SELF EXPANDABLE ERGONOMIC BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,125.00" "$1,856.25" "$1,856.25" "$1,856.25" "$1,856.25" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$4,125.00" "$2,033.63" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" $818.71 N/A "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A 82-2-0308 SUP Custom 27803010 82-2-0308 - INSERT TIBIAL 3 8MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0310 SUP Custom 27803010 82-2-0310 - INSERT TIBIAL 3 10MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0312 SUP Custom 27803010 82-2-0312 - INSERT TIBIAL 3 12MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0315 SUP Custom 27803010 82-2-0315 - INSERT TIBIAL 3 15MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0318 SUP Custom 27803010 82-2-0318 - INSERT TIBIAL 3 18MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0321 SUP Custom 27803010 82-2-0321 - INSERT TIBIAL 3 21MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0324 SUP Custom 27803010 82-2-0324 - INSERT TIBIAL 3 24MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0508 SUP Custom 27803010 82-2-0508 - INSERT TIBIAL 5 8MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0510 SUP Custom 27803010 82-2-0510 - INSERT TIBIAL 5 10MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0512 SUP Custom 27803010 82-2-0512 - INSERT TIBIAL 5 12MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0515 SUP Custom 27803010 82-2-0515 - INSERT TIBIAL 5 15MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0518 SUP Custom 27803010 82-2-0518 - INSERT TIBIAL 5 18MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0521 SUP Custom 27803010 82-2-0521 - INSERT TIBIAL 5 21MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0524 SUP Custom 27803010 82-2-0524 - INSERT TIBIAL 5 24MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0708 SUP Custom 27803010 82-2-0708 - INSERT TIBIAL 7 BEARING NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0710 SUP Custom 27803010 82-2-0710 - INSERT TIBIAL 7 10MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0712 SUP Custom 27803010 82-2-0712 - INSERT TIBIAL 7 12MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0715 SUP Custom 27803010 82-2-0715 - INSERT TIBIAL 7 15MM SCORPIO NRG CR ANKLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0718 SUP Custom 27803010 82-2-0718 - INSERT TIBIAL 7 18MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0721 SUP Custom 27803010 82-2-0721 - INSERT TIBIAL 7 21MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0724 SUP Custom 27803010 82-2-0724 - INSERT TIBIAL 7 24MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0908 SUP Custom 27803010 82-2-0908 - INSERT TIBIAL 9 8MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0910 SUP Custom 27803010 82-2-0910 - INSERT TIBIAL 9 10MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0912 SUP Custom 27803010 82-2-0912 - INSERT TIBIAL 9 12MM SCORPIO NRG CR ANKLE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0915 SUP Custom 27803010 82-2-0915 - INSERT TIBIAL 9 15MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0918 SUP Custom 27803010 82-2-0918 - INSERT TIBIAL 9 18MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0921 SUP Custom 27803010 82-2-0921 - INSERT TIBIAL 9 21MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-0924 SUP Custom 27803010 82-2-0924 - INSERT TIBIAL 9 24MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-1108 SUP Custom 27803010 82-2-1108 - INSERT TIBIAL 11 8MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-1110 SUP Custom 27803010 82-2-1110 - INSERT TIBIAL 11 10MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-1112 SUP Custom 27803010 82-2-1112 - INSERT TIBIAL 11 12MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-1115 SUP Custom 27803010 82-2-1115 - INSERT TIBIAL 11 15MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-1118 SUP Custom 27803010 82-2-1118 - INSERT TIBIAL 11 18MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-1121 SUP Custom 27803010 82-2-1121 - INSERT TIBIAL 11 21MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-2-1124 SUP Custom 27803010 82-2-1124 - INSERT TIBIAL 11 24MM CRUC RET BEARING SCORPIO NRG KNEE BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 822-230 SUP HCPCS C1713 822-230 - SCREW BONE LP 6.5MM 30MM ZPLATE II TITANIUM SPN THORACIC BOTH IP/OP "$1,209.00" $895.00 $239.96 "$1,209.00" $544.05 $544.05 $544.05 $544.05 "$1,209.00" "$1,209.00" "$1,209.00" $251.99 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $251.97 "$1,209.00" $483.60 $715.12 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $906.75 "$1,209.00" "$1,209.00" "$1,209.00" $604.50 $604.50 $957.53 "$1,209.00" $967.20 $544.05 $239.96 N/A $701.22 "$1,209.00" $725.40 "$1,209.00" $251.96 "$1,209.00" N/A N/A 822-235 SUP HCPCS C1713 822-235 - SCREW BONE LP 6.5MM 35MM ZPLATE II TITANIUM SPN THORACIC BOTH IP/OP "$1,209.00" $895.00 $239.96 "$1,209.00" $544.05 $544.05 $544.05 $544.05 "$1,209.00" "$1,209.00" "$1,209.00" $251.99 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $251.97 "$1,209.00" $483.60 $715.12 "$1,209.00" "$1,209.00" "$1,209.00" "$1,209.00" $906.75 "$1,209.00" "$1,209.00" "$1,209.00" $604.50 $604.50 $957.53 "$1,209.00" $967.20 $544.05 $239.96 N/A $701.22 "$1,209.00" $725.40 "$1,209.00" $251.96 "$1,209.00" N/A N/A 82-3-0308 SUP Custom 27803010 82-3-0308 - INSERT TIBIAL 3 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0310 SUP Custom 27803010 82-3-0310 - INSERT TIBIAL 3 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0312 SUP Custom 27803010 82-3-0312 - INSERT TIBIAL 3 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0315 SUP Custom 27803010 82-3-0315 - INSERT TIBIAL 3 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0318 SUP Custom 27803010 82-3-0318 - INSERT TIBIAL 3 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0321 SUP Custom 27803010 82-3-0321 - INSERT TIBIAL 3 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0324 SUP Custom 27803010 82-3-0324 - INSERT TIBIAL 3 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0508 SUP Custom 27803010 82-3-0508 - INSERT TIBIAL 5 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0510 SUP Custom 27803010 82-3-0510 - INSERT TIBIAL 5 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0512 SUP Custom 27803010 82-3-0512 - INSERT TIBIAL 5 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0515 SUP Custom 27803010 82-3-0515 - INSERT TIBIAL 5 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0518 SUP Custom 27803010 82-3-0518 - INSERT TIBIAL 5 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0521 SUP Custom 27803010 82-3-0521 - INSERT TIBIAL 5 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0524 SUP Custom 27803010 82-3-0524 - INSERT TIBIAL 5 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0708 SUP Custom 27803010 82-3-0708 - INSERT TIBIAL 7 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0710 SUP Custom 27803010 82-3-0710 - INSERT TIBIAL 7 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0712 SUP Custom 27803010 82-3-0712 - INSERT TIBIAL 7 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0715 SUP Custom 27803010 82-3-0715 - INSERT TIBIAL 7 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0718 SUP Custom 27803010 82-3-0718 - INSERT TIBIAL 7 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0721 SUP Custom 27803010 82-3-0721 - INSERT TIBIAL 7 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0724 SUP Custom 27803010 82-3-0724 - INSERT TIBIAL 7 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0908 SUP Custom 27803010 82-3-0908 - INSERT TIBIAL 9 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0910 SUP Custom 27803010 82-3-0910 - INSERT TIBIAL 9 10MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0912 SUP Custom 27803010 82-3-0912 - INSERT TIBIAL 9 12MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0915 SUP Custom 27803010 82-3-0915 - INSERT TIBIAL 9 15MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0918 SUP Custom 27803010 82-3-0918 - INSERT TIBIAL 9 18MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0921 SUP Custom 27803010 82-3-0921 - INSERT TIBIAL 9 21MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-0924 SUP Custom 27803010 82-3-0924 - INSERT TIBIAL 9 24MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-1108 SUP Custom 27803010 82-3-1108 - INSERT TIBIAL 11 8MM POSTERIOR STABILIZE BEARING SCORPIO NRG BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-1110 SUP Custom 27803010 82-3-1110 - INSERT TIBIAL 11 10MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-1112 SUP Custom 27803010 82-3-1112 - INSERT TIBIAL 11 12MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-1115 SUP Custom 27803010 82-3-1115 - INSERT TIBIAL 11 15MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-1118 SUP Custom 27803010 82-3-1118 - INSERT TIBIAL 11 18MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-1121 SUP Custom 27803010 82-3-1121 - INSERT TIBIAL 11 21MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3-1124 SUP Custom 27803010 82-3-1124 - INSERT TIBIAL 11 24MM POSTERIOR STABILIZE BEARING SCORPIO BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $250.09 "$1,200.00" $480.00 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $540.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A 82-3164 SUP Custom 27803010 82-3164 - VALVE SHNT REG STRL STRT2 CSF PRGM FLW CNTRL BALL SPRG MECH BOTH IP/OP "$9,839.50" "$7,281.00" "$1,751.42" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$1,751.42" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$2,050.65" "$9,839.45" "$3,935.78" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$9,839.45" "$7,379.63" "$9,839.45" "$9,839.45" "$9,839.45" "$4,919.73" "$4,919.73" "$7,792.84" "$9,839.45" "$7,871.56" "$4,427.75" "$9,839.45" N/A "$5,706.91" "$9,839.45" "$5,903.67" "$9,839.45" "$9,839.45" "$9,839.45" N/A N/A 824-005 SUP HCPCS C1713 824-005 - NUT LOCK .5IN CROSSLINK TSRH TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 824-007 SUP Custom 27803010 824-007 - EYEBOLT SPINAL .25IN CROSSLINK TSRH TITANIUM BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A 824-027 SUP HCPCS C1713 824-027 - PLATE BONE 1.25IN MULTI-SPAN CROSSLINK TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 824-028 SUP HCPCS C1713 824-028 - PLATE BONE 1.75IN MULTI-SPAN CROSSLINK TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 824-040 SUP HCPCS C1713 824-040 - PLATE BONE .875IN MULTI-SPAN CROSSLINK TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 824-041 SUP HCPCS C1713 824-041 - PLATE BONE 1IN MULTI-SPAN CROSSLINK TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 824-042 SUP HCPCS C1713 824-042 - PLATE BONE 1.25IN MULTI-SPAN CROSSLINK TITANIUM SPN BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 82-5472 SUP Custom 27803010 82-5472 - VALVE SHNT REG STRL DLT CSF 1 LVL BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 82-5474 SUP Custom 27803010 82-5474 - VALVE SHNT REG 40X16.5MM STRL LF 13MM DLT PS MDCL CSF PRFRM BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,686.00" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 82-5475 SUP Custom 27803010 82-5475 - VALVE SHNT REG STRL DLT CSF 2 LVL BOTH IP/OP "$3,617.50" "$2,677.00" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $643.85 "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" $753.85 "$3,617.13" "$1,446.85" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$3,617.13" "$2,713.13" "$3,617.13" "$3,617.13" "$3,617.13" "$1,808.57" "$1,808.57" "$2,864.77" "$3,617.13" "$2,893.70" "$1,627.71" "$3,617.13" N/A "$2,098.15" "$3,617.13" "$2,170.28" "$3,617.13" "$3,617.13" "$3,617.13" N/A N/A 826-011 SUP Custom 27203010 826-011 - CABLE SPINAL 2 INTEGRAL CRIMP ATLAS STAINLESS STEEL BOTH IP/OP $828.50 $613.00 $147.47 $828.50 $828.50 $828.50 $828.50 $828.50 $828.50 $828.50 $147.47 $828.50 $828.50 $614.91 $614.91 $638.61 $431.65 $172.67 $828.50 $331.40 $828.50 $828.50 $828.50 $828.50 $828.50 $621.38 $828.50 $828.50 $828.50 $414.25 $414.25 $656.17 $828.50 $662.80 $538.53 $828.50 N/A $480.53 $828.50 $497.10 $828.50 $828.50 $828.50 N/A N/A 826-012 SUP Custom 27203010 826-012 - CABLE SPINAL 2 INTEGRAL CRIMP ATLAS STAINLESS STEEL BOTH IP/OP $828.50 $613.00 $147.47 $828.50 $828.50 $828.50 $828.50 $828.50 $828.50 $828.50 $147.47 $828.50 $828.50 $614.91 $614.91 $638.61 $431.65 $172.67 $828.50 $331.40 $828.50 $828.50 $828.50 $828.50 $828.50 $621.38 $828.50 $828.50 $828.50 $414.25 $414.25 $656.17 $828.50 $662.80 $538.53 $828.50 N/A $480.53 $828.50 $497.10 $828.50 $828.50 $828.50 N/A N/A 826-013 SUP Custom 27203010 826-013 - CABLE SPINAL 1 INTEGRAL CRIMP ATLAS STAINLESS STEEL BOTH IP/OP $828.50 $613.00 $147.47 $828.50 $828.50 $828.50 $828.50 $828.50 $828.50 $828.50 $147.47 $828.50 $828.50 $614.91 $614.91 $638.61 $431.65 $172.67 $828.50 $331.40 $828.50 $828.50 $828.50 $828.50 $828.50 $621.38 $828.50 $828.50 $828.50 $414.25 $414.25 $656.17 $828.50 $662.80 $538.53 $828.50 N/A $480.53 $828.50 $497.10 $828.50 $828.50 $828.50 N/A N/A 826-016 SUP Custom 27803010 826-016 - CRIMP BAR INTEGRAL ATLAS STAINLESS STEEL BOTH IP/OP $388.50 $287.00 $69.15 $388.50 $388.50 $388.50 $388.50 $388.50 $388.50 $388.50 $69.15 $388.50 $388.50 $388.50 $388.50 $388.50 $388.50 $80.97 $388.50 $155.40 $388.50 $388.50 $388.50 $388.50 $388.50 $291.38 $388.50 $388.50 $388.50 $194.25 $194.25 $307.69 $388.50 $310.80 $174.83 $388.50 N/A $225.33 $388.50 $233.10 $388.50 $388.50 $388.50 N/A N/A 82-6-0308 SUP Custom 27803010 82-6-0308 - INSERT TIBIAL 3 8MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0310 SUP Custom 27803010 82-6-0310 - INSERT TIBIAL 3 10MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0312 SUP Custom 27803010 82-6-0312 - INSERT TIBIAL 3 12MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0314 SUP Custom 27803010 82-6-0314 - INSERT TIBIAL 3 14MM CRUC RET SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0315 SUP Custom 27803010 82-6-0315 - INSERT TIBIAL 3 15MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0318 SUP Custom 27803010 82-6-0318 - INSERT TIBIAL 3 18MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0321 SUP Custom 27803010 82-6-0321 - INSERT TIBIAL 3 21MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0324 SUP Custom 27803010 82-6-0324 - INSERT TIBIAL 3 24MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0508 SUP Custom 27803010 82-6-0508 - INSERT TIBIAL 5 8MM KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0510 SUP Custom 27803010 82-6-0510 - INSERT TIBIAL 5 10MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0512 SUP Custom 27803010 82-6-0512 - INSERT TIBIAL 5 12MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0515 SUP Custom 27803010 82-6-0515 - INSERT TIBIAL 5 15MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0518 SUP Custom 27803010 82-6-0518 - INSERT TIBIAL 5 18MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0521 SUP Custom 27803010 82-6-0521 - INSERT TIBIAL 5 21MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0524 SUP Custom 27803010 82-6-0524 - INSERT TIBIAL 5 24MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0708 SUP Custom 27803010 82-6-0708 - INSERT TIBIAL 7 8MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0710 SUP Custom 27803010 82-6-0710 - INSERT TIBIAL 7 10MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0712 SUP Custom 27803010 82-6-0712 - INSERT TIBIAL X3 POLYETHYLENE KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0715 SUP Custom 27803010 82-6-0715 - INSERT TIBIAL 7 15MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0718 SUP Custom 27803010 82-6-0718 - INSERT TIBIAL 7 18MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0721 SUP Custom 27803010 82-6-0721 - INSERT TIBIAL 7 21MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0724 SUP Custom 27803010 82-6-0724 - INSERT TIBIAL 7 24MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0908 SUP Custom 27803010 82-6-0908 - INSERT TIBIAL 9 8MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0910 SUP Custom 27803010 82-6-0910 - INSERT TIBIAL 9 10MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0912 SUP Custom 27803010 82-6-0912 - INSERT TIBIAL 9 12MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0914 SUP Custom 27803010 82-6-0914 - INSERT TIBIAL 9 14MM CRUC RET SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0915 SUP Custom 27803010 82-6-0915 - INSERT TIBIAL 9 15MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0916 SUP Custom 27803010 82-6-0916 - INSERT TIBIAL 9 16MM CRUC RET SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0918 SUP Custom 27803010 82-6-0918 - INSERT TIBIAL 9 18MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0921 SUP Custom 27803010 82-6-0921 - INSERT TIBIAL 9 21MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-0924 SUP Custom 27803010 82-6-0924 - INSERT TIBIAL 9 24MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-1108 SUP Custom 27803010 82-6-1108 - INSERT TIBIAL 11 8MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-1110 SUP Custom 27803010 82-6-1110 - INSERT TIBIAL 11 10MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-1112 SUP Custom 27803010 82-6-1112 - INSERT TIBIAL 11 12MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-1114 SUP Custom 27803010 82-6-1114 - INSERT TIBIAL 11 14MM CRUC RET SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-1115 SUP Custom 27803010 82-6-1115 - INSERT TIBIAL 11 15MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-1116 SUP Custom 27803010 82-6-1116 - INSERT TIBIAL 11 16MM CRUC RET SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-1118 SUP Custom 27803010 82-6-1118 - INSERT TIBIAL CRUC RET SCORPIO X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-1121 SUP Custom 27803010 82-6-1121 - INSERT TIBIAL 11 21MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-6-1124 SUP Custom 27803010 82-6-1124 - INSERT TIBIAL 11 24MM CRUC RET SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 826-212 SUP Custom 27203010 826-212 - CABLE SPINAL 2 INTEGRAL CRIMP ATLAS TITANIUM BOTH IP/OP "$1,005.00" $744.00 $178.85 "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" $178.85 "$1,004.75" "$1,004.75" $745.73 $745.73 $774.46 $523.47 $209.40 "$1,004.75" $401.90 "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" $753.75 "$1,004.75" "$1,004.75" "$1,004.75" $502.38 $502.38 $795.76 "$1,004.75" $803.80 $653.09 "$1,004.75" N/A $582.90 "$1,004.75" $602.85 "$1,004.75" "$1,004.75" "$1,004.75" N/A N/A 826-213 SUP Custom 27203010 826-213 - CABLE SPINAL 1 INTEGRAL CRIMP ATLAS SONGER TITANIUM BOTH IP/OP "$1,005.00" $744.00 $178.85 "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" $178.85 "$1,004.75" "$1,004.75" $745.73 $745.73 $774.46 $523.47 $209.40 "$1,004.75" $401.90 "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" $753.75 "$1,004.75" "$1,004.75" "$1,004.75" $502.38 $502.38 $795.76 "$1,004.75" $803.80 $653.09 "$1,004.75" N/A $582.90 "$1,004.75" $602.85 "$1,004.75" "$1,004.75" "$1,004.75" N/A N/A 826-216 SUP Custom 27803010 826-216 - CABLE SPINAL INTEGRAL BAR CRIMP ATLAS TITANIUM BOTH IP/OP $495.00 $366.00 $88.11 $495.00 $495.00 $495.00 $495.00 $495.00 $495.00 $495.00 $88.11 $495.00 $495.00 $495.00 $495.00 $495.00 $495.00 $103.16 $495.00 $198.00 $495.00 $495.00 $495.00 $495.00 $495.00 $371.25 $495.00 $495.00 $495.00 $247.50 $247.50 $392.04 $495.00 $396.00 $222.75 $495.00 N/A $287.10 $495.00 $297.00 $495.00 $495.00 $495.00 N/A N/A 826-217 SUP HCPCS C1713 826-217 - BAR SPINAL FLAT FLAT ATLAS TITANIUM BOTH IP/OP $178.50 $132.00 $35.43 $178.50 $80.33 $80.33 $80.33 $80.33 $178.50 $178.50 $178.50 $37.20 $178.50 $178.50 $178.50 $178.50 $178.50 $37.20 $178.50 $71.40 $105.58 $178.50 $178.50 $178.50 $178.50 $133.88 $178.50 $178.50 $178.50 $89.25 $89.25 $141.37 $178.50 $142.80 $80.33 $35.43 N/A $103.53 $178.50 $178.50 $178.50 $37.20 $178.50 N/A N/A 826-219 SUP Custom 27203010 826-219 - CABLE SPINAL 2 LEADER ATLAS TITANIUM BOTH IP/OP "$1,005.00" $744.00 $178.85 "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" $178.85 "$1,004.75" "$1,004.75" $745.73 $745.73 $774.46 $523.47 $209.40 "$1,004.75" $401.90 "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" $753.75 "$1,004.75" "$1,004.75" "$1,004.75" $502.38 $502.38 $795.76 "$1,004.75" $803.80 $653.09 "$1,004.75" N/A $582.90 "$1,004.75" $602.85 "$1,004.75" "$1,004.75" "$1,004.75" N/A N/A 826-320 SUP Custom 27203010 826-320 - CABLE SPINAL 2 INTEGRAL CRIMP TITANIUM NONSTRL BOTH IP/OP "$1,005.00" $744.00 $178.85 "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" $178.85 "$1,004.75" "$1,004.75" $745.73 $745.73 $774.46 $523.47 $209.40 "$1,004.75" $401.90 "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" "$1,004.75" $753.75 "$1,004.75" "$1,004.75" "$1,004.75" $502.38 $502.38 $795.76 "$1,004.75" $803.80 $653.09 "$1,004.75" N/A $582.90 "$1,004.75" $602.85 "$1,004.75" "$1,004.75" "$1,004.75" N/A N/A 82-6638 SUP Custom 27803010 82-6638 - KIT PRESSURE MONITR .7MM SKULL BOLT MICROSENSOR SUBDURAL BOTH IP/OP "$1,947.50" "$1,441.00" $346.66 "$1,947.50" "$1,947.50" "$1,947.50" "$1,947.50" "$1,947.50" "$1,947.50" "$1,947.50" $346.66 "$1,947.50" "$1,947.50" "$1,947.50" "$1,947.50" "$1,947.50" "$1,947.50" $405.88 "$1,947.50" $779.00 "$1,947.50" "$1,947.50" "$1,947.50" "$1,947.50" "$1,947.50" "$1,460.63" "$1,947.50" "$1,947.50" "$1,947.50" $973.75 $973.75 "$1,542.42" "$1,947.50" "$1,558.00" $876.38 "$1,947.50" N/A "$1,129.55" "$1,947.50" "$1,168.50" "$1,947.50" "$1,947.50" "$1,947.50" N/A N/A 82-7-0308 SUP Custom 27803010 82-7-0308 - INSERT TIBIAL 3 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0310 SUP Custom 27803010 82-7-0310 - INSERT TIBIAL 3 10MM BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0312 SUP Custom 27803010 82-7-0312 - INSERT TIBIAL 3 12MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0314 SUP Custom 27803010 82-7-0314 - INSERT TIBIAL 3 14MM POSTERIOR STABILIZING SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0315 SUP Custom 27803010 82-7-0315 - INSERT TIBIAL 3 15MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0316 SUP Custom 27803010 82-7-0316 - INSERT TIBIAL 3 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0318 SUP Custom 27803010 82-7-0318 - INSERT TIBIAL 3 18MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0321 SUP Custom 27803010 82-7-0321 - INSERT TIBIAL 3 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0324 SUP Custom 27803010 82-7-0324 - INSERT TIBIAL 3 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0508 SUP Custom 27803010 82-7-0508 - INSERT TIBIAL 5 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0510 SUP Custom 27803010 82-7-0510 - INSERT TIBIAL 5 10MM BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0512 SUP Custom 27803010 82-7-0512 - INSERT TIBIAL 5 12MM BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0514 SUP Custom 27803010 82-7-0514 - INSERT TIBIAL 5 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0515 SUP Custom 27803010 82-7-0515 - INSERT TIBIAL 5 15MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0516 SUP Custom 27803010 82-7-0516 - INSERT TIBIAL 5 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0518 SUP Custom 27803010 82-7-0518 - INSERT TIBIAL 3 18MM BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0521 SUP Custom 27803010 82-7-0521 - INSERT TIBIAL 5 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0524 SUP Custom 27803010 82-7-0524 - INSERT TIBIAL 5 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0708 SUP Custom 27803010 82-7-0708 - INSERT TIBIAL 7 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0710 SUP Custom 27803010 82-7-0710 - INSERT TIBIAL 7 10MM BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0712 SUP Custom 27803010 82-7-0712 - INSERT TIBIAL 7 12MM SCORPIO KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0714 SUP Custom 27803010 82-7-0714 - INSERT TIBIAL 7 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0715 SUP Custom 27803010 82-7-0715 - INSERT TIBIAL 7 15MM SCORPIO KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0716 SUP Custom 27803010 82-7-0716 - INSERT TIBIAL 7 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0718 SUP Custom 27803010 82-7-0718 - INSERT TIBIAL 7 18MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0721 SUP Custom 27803010 82-7-0721 - INSERT TIBIAL 7 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0724 SUP Custom 27803010 82-7-0724 - INSERT TIBIAL 7 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0908 SUP Custom 27803010 82-7-0908 - INSERT TIBIAL 9 8MM KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0910 SUP Custom 27803010 82-7-0910 - INSERT TIBIAL 10MM KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0912 SUP Custom 27803010 82-7-0912 - INSERT TIBIAL 9 12MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0914 SUP Custom 27803010 82-7-0914 - INSERT TIBIAL 9 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0915 SUP Custom 27803010 82-7-0915 - INSERT TIBIAL 9 15MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0916 SUP Custom 27803010 82-7-0916 - INSERT TIBIAL 9 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0918 SUP Custom 27803010 82-7-0918 - INSERT TIBIAL 9 18MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0921 SUP Custom 27803010 82-7-0921 - INSERT TIBIAL 9 21MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-0924 SUP Custom 27803010 82-7-0924 - INSERT TIBIAL 9 24MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-1108 SUP Custom 27803010 82-7-1108 - INSERT TIBIAL 11 8MM POSTERIOR STABILIZE SCORPIO NRG X3 KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-1110 SUP Custom 27803010 82-7-1110 - INSERT TIBIAL 11 10MM POSTERIOR STABILIZE SCORPIO NRG X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-1112 SUP Custom 27803010 82-7-1112 - INSERT TIBIAL 11 12MM POSTERIOR STABILIZE SCORPIO NRG X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-1114 SUP Custom 27803010 82-7-1114 - INSERT TIBIAL 11 14MM POSTERIOR STABILIZE SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-1115 SUP Custom 27803010 82-7-1115 - INSERT TIBIAL 11 15MM POSTERIOR STABILIZE SCORPIO NRG X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-1116 SUP Custom 27803010 82-7-1116 - INSERT TIBIAL 11 16MM POSTERIOR STABILIZE SCORPIO NRG KNEE BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-1118 SUP Custom 27803010 82-7-1118 - INSERT TIBIAL 11 18MM POSTERIOR STABILIZE SCORPIO NRG X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-1121 SUP Custom 27803010 82-7-1121 - INSERT TIBIAL 11 21MM POSTERIOR STABILIZE SCORPIO NRG X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 82-7-1124 SUP Custom 27803010 82-7-1124 - INSERT TIBIAL 11 24MM POSTERIOR STABILIZE SCORPIO NRG X3 BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A 827-160 SUP HCPCS C1713 827-160 - SCREW BONE MULTIAX SPACER WASHER TITANIUM SPN BOTH IP/OP $129.00 $95.00 $25.60 $129.00 $58.05 $58.05 $58.05 $58.05 $129.00 $129.00 $129.00 $26.89 $129.00 $129.00 $129.00 $129.00 $129.00 $26.89 $129.00 $51.60 $76.30 $129.00 $129.00 $129.00 $129.00 $96.75 $129.00 $129.00 $129.00 $64.50 $64.50 $102.17 $129.00 $103.20 $58.05 $25.60 N/A $74.82 $129.00 $77.40 $129.00 $26.88 $129.00 N/A N/A 828-083 SUP HCPCS C1713 828-083 - ROD SPINAL STR 6.35MM 20IN FLEXIBLE HEXAGONAL END PRECUT BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 828-090 SUP HCPCS C1713 828-090 - ROD SPINAL STR PRECUT 6.35MM 20IN PURE TSRH TITANIUM SPN BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 828-105 SUP HCPCS C1713 828-105 - SCREW BONE 2 HEXAGONAL LOCK TSRH TITANIUM SPN STERILE 6.35 BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 828-107 SUP HCPCS C1713 828-107 - HOOK SPINAL LARGE CENTRL POST TSRH TITANIUM LAMINA BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 828-135C SUP Custom 27803010 828-135C - CONNECTOR ROD SMALL 5.5MM VAR ANG TOP TIGHTEN BOLT TITANIUM BOTH IP/OP "$1,314.50" $973.00 $233.95 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $233.95 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $273.91 "$1,314.30" $525.72 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $985.88 "$1,314.30" "$1,314.30" "$1,314.30" $657.15 $657.15 "$1,040.93" "$1,314.30" "$1,051.44" $591.44 "$1,314.30" N/A $762.41 "$1,314.30" $788.58 "$1,314.30" "$1,314.30" "$1,314.30" N/A N/A 828-136C SUP Custom 27803010 828-136C - CONNECTOR ROD MEDIUM 5.5MM VAR ANG TOP TIGHTEN BOLT TITANIUM BOTH IP/OP "$1,314.50" $973.00 $233.95 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $233.95 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $273.91 "$1,314.30" $525.72 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $985.88 "$1,314.30" "$1,314.30" "$1,314.30" $657.15 $657.15 "$1,040.93" "$1,314.30" "$1,051.44" $591.44 "$1,314.30" N/A $762.41 "$1,314.30" $788.58 "$1,314.30" "$1,314.30" "$1,314.30" N/A N/A 828-137C SUP Custom 27803010 828-137C - CONNECTOR ROD LARGE 5.5MM VAR ANG TOP TIGHTEN BOLT TITANIUM BOTH IP/OP "$1,314.50" $973.00 $233.95 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $233.95 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $273.91 "$1,314.30" $525.72 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $985.88 "$1,314.30" "$1,314.30" "$1,314.30" $657.15 $657.15 "$1,040.93" "$1,314.30" "$1,051.44" $591.44 "$1,314.30" N/A $762.41 "$1,314.30" $788.58 "$1,314.30" "$1,314.30" "$1,314.30" N/A N/A 828-145 SUP HCPCS C1713 828-145 - SCREW BONE TSRH TI SPNL LCK FLSH BRK 6.35 MM ROD BOTH IP/OP $483.00 $357.00 $95.79 $482.65 $217.19 $217.19 $217.19 $217.19 $482.65 $482.65 $482.65 $100.60 $482.65 $482.65 $482.65 $482.65 $482.65 $100.59 $482.65 $482.65 $285.49 $482.65 $482.65 $482.65 $482.65 $362.25 $482.65 $482.65 $482.65 $241.33 $241.33 $382.26 $482.65 $386.12 $217.19 $95.79 N/A $280.14 $482.65 $289.59 $482.65 $100.58 $482.65 N/A N/A 828-190 SUP HCPCS C1713 828-190 - SCREW BONE 90MM LOCK TOP TIGHTEN TSRH TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 828-191C SUP Custom 27803010 828-191C - CONNECTOR ROD .25MM VAR ANG TOP TIGHTEN BOLT TITANIUM SPN BOTH IP/OP "$1,314.50" $973.00 $233.95 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $233.95 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $273.91 "$1,314.30" $525.72 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $985.88 "$1,314.30" "$1,314.30" "$1,314.30" $657.15 $657.15 "$1,040.93" "$1,314.30" "$1,051.44" $591.44 "$1,314.30" N/A $762.41 "$1,314.30" $788.58 "$1,314.30" "$1,314.30" "$1,314.30" N/A N/A 828-193 SUP Custom 27803010 828-193 - BOLT SPNL 6.35MM TSRH SM TI T TOP TGHT VA BOTH IP/OP "$2,362.00" "$1,748.00" $420.40 "$2,361.80" "$2,361.80" "$2,361.80" "$2,361.80" "$2,361.80" "$2,361.80" "$2,361.80" $420.40 "$2,361.80" "$2,361.80" "$2,361.80" "$2,361.80" "$2,361.80" "$2,361.80" $492.23 "$2,361.80" $944.72 "$2,361.80" "$2,361.80" "$2,361.80" "$2,361.80" "$2,361.80" "$1,771.50" "$2,361.80" "$2,361.80" "$2,361.80" "$1,180.90" "$1,180.90" "$1,870.55" "$2,361.80" "$1,889.44" "$1,062.81" "$2,361.80" N/A "$1,369.96" "$2,361.80" "$1,417.08" "$2,361.80" "$2,361.80" "$2,361.80" N/A N/A 828-193C SUP HCPCS C1713 828-193C - BOLT SPINAL SMALL 6.35MM T TOP TIGHTENING CONCTR TSRH BOTH IP/OP "$1,314.50" $973.00 $260.86 "$1,314.30" $591.44 $591.44 $591.44 $591.44 "$1,314.30" "$1,314.30" "$1,314.30" $273.93 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $273.91 "$1,314.30" $525.72 $777.41 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $985.88 "$1,314.30" "$1,314.30" "$1,314.30" $657.15 $657.15 "$1,040.93" "$1,314.30" "$1,051.44" $591.44 $260.86 N/A $762.41 "$1,314.30" $788.58 "$1,314.30" $273.90 "$1,314.30" N/A N/A 828-349C SUP Custom 27803010 828-349C - BOLT SPINAL 5.5MM T TOP TIGHTENING CONCTR TSRH TITANIUM BOTH IP/OP "$1,314.50" $973.00 $233.95 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $233.95 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $273.91 "$1,314.30" $525.72 "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" "$1,314.30" $985.88 "$1,314.30" "$1,314.30" "$1,314.30" $657.15 $657.15 "$1,040.93" "$1,314.30" "$1,051.44" $591.44 "$1,314.30" N/A $762.41 "$1,314.30" $788.58 "$1,314.30" "$1,314.30" "$1,314.30" N/A N/A 828-780 SUP HCPCS C1713 828-780 - SCREW BONE 5.5MM 30MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" $877.80 "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$2,194.50" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828-785 SUP HCPCS C1713 828-785 - SCREW BONE 5.5MM 35MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" $877.80 "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$2,194.50" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828-790 SUP HCPCS C1713 828-790 - SCREW BONE 5.5MM 40MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" $877.80 "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$1,316.70" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828-795 SUP HCPCS C1713 828-795 - SCREW BONE 5.5MM 45MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" $877.80 "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$1,316.70" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828800PL SUP Custom 27803010 828800PL - VALVE SHUNT INLINE CERTAS BOTH IP/OP "$11,723.00" "$8,675.00" "$2,086.66" "$11,722.83" "$11,722.83" "$11,722.83" "$11,722.83" "$11,722.83" "$11,722.83" "$11,722.83" "$2,086.66" "$11,722.83" "$11,722.83" "$11,722.83" "$11,722.83" "$11,722.83" "$11,722.83" "$2,443.17" "$11,722.83" "$4,689.13" "$11,722.83" "$11,722.83" "$11,722.83" "$11,722.83" "$11,722.83" "$8,792.25" "$11,722.83" "$11,722.83" "$11,722.83" "$5,861.42" "$5,861.42" "$9,284.48" "$11,722.83" "$9,378.26" "$5,275.27" "$11,722.83" N/A "$6,799.34" "$11,722.83" "$7,033.70" "$11,722.83" "$11,722.83" "$11,722.83" N/A N/A 828-830 SUP HCPCS C1713 828-830 - SCREW BONE 6.5MM 30MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" $877.80 "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$1,316.70" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828-835 SUP HCPCS C1713 828-835 - SCREW BONE 6.5MM 35MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" $877.80 "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$1,316.70" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828-840 SUP HCPCS C1713 828-840 - SCREW BONE 6.5MM 40MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" "$2,194.50" "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$2,194.50" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828-845 SUP HCPCS C1713 828-845 - SCREW BONE 6.5MM 45MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" "$2,194.50" "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$1,316.70" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828-850 SUP HCPCS C1713 828-850 - SCREW BONE 6.5MM 50MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" $877.80 "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$1,316.70" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828-855 SUP HCPCS C1713 828-855 - SCREW BONE 6.5MM 55MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" "$2,194.50" "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$1,316.70" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828-860 SUP HCPCS C1713 828-860 - SCREW BONE 6.5MM 60MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" "$2,194.50" "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$1,316.70" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828-930 SUP HCPCS C1713 828-930 - SCREW BONE 7.5MM 30MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" "$2,194.50" "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$1,316.70" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828-935 SUP HCPCS C1713 828-935 - SCREW BONE 7.5MM 35MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" "$2,194.50" "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$1,316.70" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828-940 SUP HCPCS C1713 828-940 - SCREW BONE 7.5MM 40MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" "$2,194.50" "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$1,316.70" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828-945 SUP HCPCS C1713 828-945 - SCREW BONE 7.5MM 45MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" "$2,194.50" "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$1,316.70" "$2,194.50" $457.33 "$2,194.50" N/A N/A 828-950 SUP HCPCS C1713 828-950 - SCREW BONE 7.5MM 50MM VAR ANG TSRH TITANIUM SPN PEDICLE BOTH IP/OP "$2,194.50" "$1,624.00" $435.55 "$2,194.50" $987.53 $987.53 $987.53 $987.53 "$2,194.50" "$2,194.50" "$2,194.50" $457.39 "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" $457.36 "$2,194.50" "$2,194.50" "$1,298.05" "$2,194.50" "$2,194.50" "$2,194.50" "$2,194.50" "$1,645.88" "$2,194.50" "$2,194.50" "$2,194.50" "$1,097.25" "$1,097.25" "$1,738.04" "$2,194.50" "$1,755.60" $987.53 $435.55 N/A "$1,272.81" "$2,194.50" "$1,316.70" "$2,194.50" $457.33 "$2,194.50" N/A N/A 830-031 SUP HCPCS C1713 830-031 - ROD SPINAL 6.35MM 31CM UNIT TSRH STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 830-033 SUP HCPCS C1713 830-033 - ROD SPINAL 6.35MM 33CM UNIT TSRH STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 830-035 SUP HCPCS C1713 830-035 - ROD SPINAL 6.35MM 35CM STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 830-037 SUP HCPCS C1713 830-037 - ROD SPINAL 6.35MM 37CM STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 830-039 SUP HCPCS C1713 830-039 - ROD SPINAL 6.35MM 39CM UNIT TSRH STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 830-041 SUP HCPCS C1713 830-041 - ROD SPINAL 6.35MM 41CM STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 830-043 SUP HCPCS C1713 830-043 - ROD SPINAL 6.35MM 43CM STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 830-045 SUP HCPCS C1713 830-045 - ROD SPINAL 6.35MM 45CM STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 830-050 SUP HCPCS C1713 830-050 - ROD SPINAL 6.35MM 51CM STAINLESS STEEL LEFT BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 830-051 SUP HCPCS C1713 830-051 - ROD SPINAL 6.35MM 51CM STAINLESS STEEL RIGHT BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 8300KITB19A SUP Custom 27803010 8300KITB19A - VALVE AOR 19MM STRL LF EDWRD INTUITY ELT BOTH IP/OP "$30,000.00" "$22,200.00" "$5,340.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$5,340.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$12,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$30,000.00" N/A "$17,400.00" "$30,000.00" "$18,000.00" "$30,000.00" "$30,000.00" "$30,000.00" N/A N/A 8300KITB21A SUP Custom 27803010 8300KITB21A - VALVE AOR 21MM STRL LF EDWRD INTUITY ELT BOTH IP/OP "$30,000.00" "$22,200.00" "$5,340.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$5,340.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$12,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$30,000.00" N/A "$17,400.00" "$30,000.00" "$18,000.00" "$30,000.00" "$30,000.00" "$30,000.00" N/A N/A 8300KITB23A SUP Custom 27803010 8300KITB23A - VALVE AOR 23MM STRL LF EDWRD INTUITY ELT BOTH IP/OP "$30,000.00" "$22,200.00" "$5,340.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$5,340.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$12,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$30,000.00" N/A "$17,400.00" "$30,000.00" "$18,000.00" "$30,000.00" "$30,000.00" "$30,000.00" N/A N/A 8300KITB25A SUP Custom 27803010 8300KITB25A - VALVE AOR 25MM STRL LF EDWRD INTUITY ELT BOTH IP/OP "$30,000.00" "$22,200.00" "$5,340.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$5,340.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$12,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$30,000.00" N/A "$17,400.00" "$30,000.00" "$18,000.00" "$30,000.00" "$30,000.00" "$30,000.00" N/A N/A 8300KITB27A SUP Custom 27803010 8300KITB27A - VALVE AOR 27MM STRL LF EDWRD INTUITY ELT BOTH IP/OP "$30,000.00" "$22,200.00" "$5,340.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$5,340.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$6,252.33" "$30,000.00" "$12,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$30,000.00" "$22,500.00" "$30,000.00" "$30,000.00" "$30,000.00" "$15,000.00" "$15,000.00" "$23,760.00" "$30,000.00" "$24,000.00" "$13,500.00" "$30,000.00" N/A "$17,400.00" "$30,000.00" "$18,000.00" "$30,000.00" "$30,000.00" "$30,000.00" N/A N/A 8304H SUP Custom 27203010 8304H - SUTURE NABSB 7-0 BV-1 24IN BLU PR VSBLCK 2 ARM MFL BOTH IP/OP $47.00 $35.00 $8.32 $48.12 $46.76 $46.76 $46.76 $46.76 $46.76 $46.76 $8.32 $46.76 $46.76 $34.71 $34.71 $36.04 $24.36 $9.75 $46.76 $19.25 $46.76 $46.76 $48.12 $46.76 $46.76 $35.25 $46.76 $46.76 $46.76 $23.38 $23.38 $37.03 $46.76 $37.41 $30.39 $46.76 N/A $27.26 $46.76 $28.06 $46.76 $46.76 $46.76 N/A N/A 830-529 SUP HCPCS C1713 830-529 - ROD SPINAL 5.5MM 29CM TSRH STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 830-531 SUP HCPCS C1713 830-531 - ROD SPINAL 5.5MM 31CM UNIT TSRH STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 830-533 SUP HCPCS C1713 830-533 - ROD SPINAL 5.5MM 33CM UNIT TSRH STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 830-535 SUP HCPCS C1713 830-535 - ROD SPINAL 5.5MM 35CM UNIT TSRH STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 830-537 SUP HCPCS C1713 830-537 - ROD SPINAL 5.5MM 37CM STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 830-539 SUP HCPCS C1713 830-539 - ROD SPINAL 5.5MM 39CM STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 830-541 SUP HCPCS C1713 830-541 - ROD SPINAL 5.5MM 41CM STAINLESS STEEL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A 830-550 SUP HCPCS C1713 830-550 - ROD SPINAL 5.5MM STAINLESS STEEL LEFT BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $300.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 830-551 SUP HCPCS C1713 830-551 - ROD SPINAL 5.5MM STAINLESS STEEL RIGHT BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A 8305H SUP Custom 27203010 8305H - SUTURE NONABSORBABLE 6-0 BV-1 24IN 2 ARM MONOFILAMENT FIRM BOTH IP/OP $47.00 $35.00 $8.31 $48.01 $46.66 $46.66 $46.66 $46.66 $46.66 $46.66 $8.31 $46.66 $46.66 $34.63 $34.63 $35.97 $24.31 $9.72 $46.66 $19.20 $46.66 $46.66 $48.01 $46.66 $46.66 $35.25 $46.66 $46.66 $46.66 $23.33 $23.33 $36.95 $46.66 $37.33 $30.33 $46.66 N/A $27.26 $46.66 $28.00 $46.66 $46.66 $46.66 N/A N/A 83545309H SUP HCPCS C1713 83545309H - SCREW BN OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83545359H SUP HCPCS C1713 83545359H - SCREW BN OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83545409H SUP HCPCS C1713 83545409H - SCREW BN 4.5MM 40MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83545459H SUP HCPCS C1713 83545459H - SCREW BN 4.5MM 45MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83545509H SUP HCPCS C1713 83545509H - SCREW BN 4.5MM 50MM TSRH OSTEOGRIP THNLN TI SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83545559H SUP HCPCS C1713 83545559H - SCREW BN 4.5MM 55MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83545609H SUP HCPCS C1713 83545609H - SCREW BN 4.5MM 60MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83555309H SUP HCPCS C1713 83555309H - SCREW BN 5.5MM 30MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83555359H SUP HCPCS C1713 83555359H - SCREW BONE 5.5MM 35MM TSRH OSTEOGRIP THINLINE TITANIUM SPN BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83555409H SUP HCPCS C1713 83555409H - SCREW BN 5.5MM 40MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83555459H SUP HCPCS C1713 83555459H - SCREW BN 5.5MM 45MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83555509H SUP HCPCS C1713 83555509H - SCREW BN 5.5MM 50MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83555559H SUP HCPCS C1713 83555559H - SCREW BN 5.5MM 55MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83555609H SUP HCPCS C1713 83555609H - SCREW BN 5.5MM 60MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83565309H SUP HCPCS C1713 83565309H - SCREW BONE 6.5MM 30MM TSRH OSTEOGRIP THINLINE HA SPN BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83565359H SUP HCPCS C1713 83565359H - SCREW BONE 6.5MM 35MM TSRH OSTEOGRIP THINLINE HA SPN BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83565409H SUP HCPCS C1713 83565409H - SCREW BN 5.5MM 40MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83565459H SUP HCPCS C1713 83565459H - SCREW BN 5.5MM 45MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83565509H SUP HCPCS C1713 83565509H - SCREW BONE 6.5MM 50MM TSRH OSTEOGRIP THINLINE HA SPN BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83565559H SUP HCPCS C1713 83565559H - SCREW BONE 6.5MM 55MM TSRH OSTEOGRIP THINLINE HA SPN BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83565609H SUP HCPCS C1713 83565609H - SCREW BONE 6.5MM 60MM TSRH OSTEOGRIP THINLINE HA SPN BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83575309H SUP HCPCS C1713 83575309H - SCREW BN 7.5MM 30MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83575359H SUP HCPCS C1713 83575359H - SCREW BN 7.5MM 35MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83575409H SUP HCPCS C1713 83575409H - SCREW BN 7.5MM 40MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83575459H SUP HCPCS C1713 83575459H - SCREW BN 7.5MM 45MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83575509H SUP HCPCS C1713 83575509H - SCREW BN 7.5MM 50MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83575559H SUP HCPCS C1713 83575559H - SCREW BN 7.5MM 55MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83575609H SUP HCPCS C1713 83575609H - SCREW BN 7.5MM 60MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83585309H SUP HCPCS C1713 83585309H - SCREW BN 8.5MM 30MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83585359H SUP HCPCS C1713 83585359H - SCREW BN 8.5MM 35MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83585409H SUP HCPCS C1713 83585409H - SCREW BN 8.5MM 40MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83585459H SUP HCPCS C1713 83585459H - SCREW BN 8.5MM 45MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83585509H SUP HCPCS C1713 83585509H - SCREW BN 8.5MM 50MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83585559H SUP HCPCS C1713 83585559H - SCREW BN 8.5MM 55MM OSTEOGRIP TSRH HA SPNE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $825.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 83585609H SUP HCPCS C1713 83585609H - SCREW BONE 8.5MM 60MM TSRH OSTEOGRIP THINLINE TITANIUM SPN BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A 837-125 SUP HCPCS C1713 837-125 - ROD SPINAL STANDARD 5.5MM 25CM PRECUT TSRH SILO TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 837-135 SUP HCPCS C1713 837-135 - ROD SPINAL 6.35MM 25CM PRECUT TSRH-3D TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 837-230 SUP HCPCS C1713 837-230 - SCREW BONE 5.5MM 30MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-235 SUP HCPCS C1713 837-235 - SCREW BONE 5.5MM 35MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-240 SUP HCPCS C1713 837-240 - SCREW BONE 5.5MM 40MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" $652.50 "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-245 SUP HCPCS C1713 837-245 - SCREW BONE 5.5MM 45MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-250 SUP HCPCS C1713 837-250 - SCREW BONE 5.5MM 50MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-330 SUP HCPCS C1713 837-330 - SCREW BONE 6.5MM 30MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-335 SUP HCPCS C1713 837-335 - SCREW BONE 6.5MM 35MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-340 SUP HCPCS C1713 837-340 - SCREW BONE 6.5MM 40MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-345 SUP HCPCS C1713 837-345 - SCREW BONE 6.5MM 45MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-350 SUP HCPCS C1713 837-350 - SCREW BONE 6.5MM 50MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-355 SUP HCPCS C1713 837-355 - SCREW BONE 6.5MM 55MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-430 SUP HCPCS C1713 837-430 - SCREW BONE 7.5MM 30MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-435 SUP HCPCS C1713 837-435 - SCREW BONE 7.5MM 35MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-440 SUP HCPCS C1713 837-440 - SCREW BONE 7.5MM 40MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-445 SUP HCPCS C1713 837-445 - SCREW BONE 7.5MM 45MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-450 SUP HCPCS C1713 837-450 - SCREW BONE 7.5MM 50MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-455 SUP HCPCS C1713 837-455 - SCREW BONE 7.5MM 55MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" $652.50 "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-460 SUP HCPCS C1713 837-460 - SCREW BONE 7.5MM 60MM EXTEND POST TSRH-3D TITANIUM SPN BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" $652.50 "$1,087.50" $226.64 "$1,087.50" N/A N/A 837-530 SUP HCPCS C1713 837-530 - SCREW BONE 5.5MM 30MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 837-535 SUP HCPCS C1713 837-535 - SCREW BONE 5.5MM 35MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 837-540 SUP HCPCS C1713 837-540 - SCREW BONE 5.5MM 40MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 837-545 SUP HCPCS C1713 837-545 - SCREW BONE 5.5MM 45MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $984.00 $984.00 $205.07 $984.00 N/A N/A 837-550 SUP HCPCS C1713 837-550 - SCREW BONE 5.5MM 50MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 837-630 SUP HCPCS C1713 837-630 - SCREW BONE 6.5MM 30MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 837-635 SUP HCPCS C1713 837-635 - SCREW BONE 6.5MM 35MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $984.00 $984.00 $205.07 $984.00 N/A N/A 837-640 SUP HCPCS C1713 837-640 - SCREW BONE 6.5MM 40MM TSRH-3D TITANIUM SPINAL PEDICLE BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 837-645 SUP HCPCS C1713 837-645 - SCREW BONE 6.5MM 45MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 837-650 SUP HCPCS C1713 837-650 - SCREW BONE 6.5MM 50MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $984.00 $984.00 $205.07 $984.00 N/A N/A 837-655 SUP HCPCS C1713 837-655 - SCREW BONE 6.5MM 55MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $984.00 $984.00 $205.07 $984.00 N/A N/A 837-730 SUP HCPCS C1713 837-730 - SCREW BONE 7.5MM 30MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 837-735 SUP HCPCS C1713 837-735 - SCREW BONE 7.5MM 35MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 837-740 SUP HCPCS C1713 837-740 - SCREW BONE 7.5MM 40MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 837-745 SUP HCPCS C1713 837-745 - SCREW BONE 7.5MM 45MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $984.00 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 837-750 SUP HCPCS C1713 837-750 - SCREW BONE 7.5MM 50MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 837-755 SUP HCPCS C1713 837-755 - SCREW BONE 7.5MM 55MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $984.00 $984.00 $205.07 $984.00 N/A N/A 837-760 SUP HCPCS C1713 837-760 - SCREW BONE 7.5MM 60MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 837-835 SUP HCPCS C1713 837-835 - SCREW BONE 8.5MM 35MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 837-845 SUP HCPCS C1713 837-845 - SCREW BONE 8.5MM 45MM TSRH-3D TITANIUM SPN PEDICLE POSTERIOR BOTH IP/OP $984.00 $728.00 $195.30 $984.00 $442.80 $442.80 $442.80 $442.80 $984.00 $984.00 $984.00 $205.09 $984.00 $984.00 $984.00 $984.00 $984.00 $205.08 $984.00 $393.60 $582.04 $984.00 $984.00 $984.00 $984.00 $738.00 $984.00 $984.00 $984.00 $492.00 $492.00 $779.33 $984.00 $787.20 $442.80 $195.30 N/A $570.72 $984.00 $590.40 $984.00 $205.07 $984.00 N/A N/A 8379120C SUP Custom 27803010 8379120C - CONNECTOR ROD 3MM OFFST 5.5MM TSRH-3D TITANIUM SPN PEDICLE BOTH IP/OP "$2,166.00" "$1,603.00" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $451.35 "$2,165.65" $866.26 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$1,624.50" "$2,165.65" "$2,165.65" "$2,165.65" "$1,082.83" "$1,082.83" "$1,715.19" "$2,165.65" "$1,732.52" $974.54 "$2,165.65" N/A "$1,256.28" "$2,165.65" "$1,299.39" "$2,165.65" "$2,165.65" "$2,165.65" N/A N/A 8379121C SUP Custom 27803010 8379121C - CONNECTOR ROD MEDIUM 5.5MM OFFST CNTOUR TSRH-3D TITANIUM SPN BOTH IP/OP "$2,166.00" "$1,603.00" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $385.49 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" $451.35 "$2,165.65" $866.26 "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$2,165.65" "$1,624.50" "$2,165.65" "$2,165.65" "$2,165.65" "$1,082.83" "$1,082.83" "$1,715.19" "$2,165.65" "$1,732.52" $974.54 "$2,165.65" N/A "$1,256.28" "$2,165.65" "$1,299.39" "$2,165.65" "$2,165.65" "$2,165.65" N/A N/A 838-012 SUP HCPCS C1713 838-012 - ROD SPINAL 4.5MM 20IN 2 SURG TECHNIQUE LEGACY CD HORIZON BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 838-855 SUP HCPCS C1713 838-855 - SCREW BONE 55MM ECLIPSE CD HORIZON M8 STAINLESS STEEL SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 8400-0611 SUP HCPCS Q4107 8400-0611 - GRAFT SYNTH TISSUE RESORB MINI BEAD KIT OSTEOSET CALCIUM BOTH IP/OP "$1,637.50" "$1,212.00" $80.90 "$1,637.50" "$1,637.50" "$1,637.50" "$1,637.50" "$1,637.50" "$1,637.50" "$1,637.50" $80.90 "$1,637.50" "$1,637.50" "$1,637.50" "$1,637.50" "$1,637.50" "$1,637.50" $341.27 "$1,637.50" $655.00 "$1,637.50" "$1,637.50" "$1,637.50" "$1,637.50" "$1,637.50" "$1,228.13" "$1,637.50" "$1,637.50" "$1,637.50" $818.75 $818.75 "$1,296.90" "$1,637.50" "$1,310.00" $736.88 "$1,637.50" N/A $949.75 "$1,637.50" $982.50 "$1,637.50" "$1,637.50" "$1,637.50" N/A N/A 84133HT SUP HCPCS C1713 84133HT - HOOK SPINAL LORDOTIC NARROW BLADE RAMPED BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 84154T SUP Custom 27803010 84154T - CONNECTOR ROD CD HORIZON TITANIUM SPN HOOK SCREW BOTH IP/OP "$2,200.50" "$1,628.00" $391.69 "$2,200.50" "$2,200.50" "$2,200.50" "$2,200.50" "$2,200.50" "$2,200.50" "$2,200.50" $391.69 "$2,200.50" "$2,200.50" "$2,200.50" "$2,200.50" "$2,200.50" "$2,200.50" $458.61 "$2,200.50" $880.20 "$2,200.50" "$2,200.50" "$2,200.50" "$2,200.50" "$2,200.50" "$1,650.38" "$2,200.50" "$2,200.50" "$2,200.50" "$1,100.25" "$1,100.25" "$1,742.80" "$2,200.50" "$1,760.40" $990.23 "$2,200.50" N/A "$1,276.29" "$2,200.50" "$1,320.30" "$2,200.50" "$2,200.50" "$2,200.50" N/A N/A 84161HT SUP HCPCS C1713 84161HT - SCREW SET BREAKOFF CD HORIZON TITANIUM SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A 84181H SUP Custom 27803010 84181H - SET SPINAL CD HORIZON ILIOSACRAL BOTH IP/OP "$1,991.50" "$1,474.00" $354.44 "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" $354.44 "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" $415.00 "$1,991.25" $796.50 "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" "$1,991.25" "$1,493.63" "$1,991.25" "$1,991.25" "$1,991.25" $995.63 $995.63 "$1,577.07" "$1,991.25" "$1,593.00" $896.06 "$1,991.25" N/A "$1,155.07" "$1,991.25" "$1,194.75" "$1,991.25" "$1,991.25" "$1,991.25" N/A N/A 84193H SUP HCPCS C1713 84193H - HOOK SPINAL MEDIAN CD HORIZON STAINLESS STEEL 5.5 MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 84193HT SUP HCPCS C1713 84193HT - HOOK SPINAL MEDIAN CD HORIZON TITANIUM 5.5 MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 8450107030D SUP Custom 27203010 8450107030D - BIT DRILL 3MM 13CM MATCH HEAD DIAMOND BOTH IP/OP $466.50 $345.00 $83.01 $466.35 $466.35 $466.35 $466.35 $466.35 $466.35 $466.35 $83.01 $466.35 $466.35 $346.12 $346.12 $359.46 $242.97 $97.19 $466.35 $186.54 $466.35 $466.35 $466.35 $466.35 $466.35 $349.88 $466.35 $466.35 $466.35 $233.18 $233.18 $369.35 $466.35 $373.08 $303.13 $466.35 N/A $270.57 $466.35 $279.81 $466.35 $466.35 $466.35 N/A N/A 845-011 SUP HCPCS C1713 845-011 - ROD SPINAL HEXAGON 5.5MM 20IN CD HORIZON STAINLESS STEEL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 84505H SUP Custom 27803010 84505H - CONNECTOR ROD 5.5/5.5MM DMN SPNE BOTH IP/OP "$1,797.00" "$1,330.00" $319.79 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" $319.79 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" $374.43 "$1,796.58" $718.63 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,347.75" "$1,796.58" "$1,796.58" "$1,796.58" $898.29 $898.29 "$1,422.89" "$1,796.58" "$1,437.26" $808.46 "$1,796.58" N/A "$1,042.26" "$1,796.58" "$1,077.95" "$1,796.58" "$1,796.58" "$1,796.58" N/A N/A 84505HT SUP Custom 27803010 84505HT - CONNECTOR ROD 5.5MM DOMINO CD HORIZON DOMINO TITANIUM SPN BOTH IP/OP "$1,831.50" "$1,355.00" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $381.64 "$1,831.18" $732.47 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,373.63" "$1,831.18" "$1,831.18" "$1,831.18" $915.59 $915.59 "$1,450.29" "$1,831.18" "$1,464.94" $824.03 "$1,831.18" N/A "$1,062.27" "$1,831.18" "$1,098.71" "$1,831.18" "$1,831.18" "$1,831.18" N/A N/A 84505LH SUP Custom 27803010 84505LH - CONNECTOR ROD 5.5/5.5MM DOMINO BOTH IP/OP "$1,797.00" "$1,330.00" $319.79 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" $319.79 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" $374.43 "$1,796.58" $718.63 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,347.75" "$1,796.58" "$1,796.58" "$1,796.58" $898.29 $898.29 "$1,422.89" "$1,796.58" "$1,437.26" $808.46 "$1,796.58" N/A "$1,042.26" "$1,796.58" "$1,077.95" "$1,796.58" "$1,796.58" "$1,796.58" N/A N/A 84505QH SUP Custom 27803010 84505QH - CONNECTOR ROD 5.5/5.5MM OPEN SIDE CD HORIZON DOMINO SPN BOTH IP/OP "$1,831.50" "$1,355.00" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $381.64 "$1,831.18" $732.47 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,373.63" "$1,831.18" "$1,831.18" "$1,831.18" $915.59 $915.59 "$1,450.29" "$1,831.18" "$1,464.94" $824.03 "$1,831.18" N/A "$1,062.27" "$1,831.18" "$1,098.71" "$1,831.18" "$1,831.18" "$1,831.18" N/A N/A 84506H SUP Custom 27803010 84506H - CONNECTOR ROD 5.5/6.35MM CD HZN DMN SS SPNE BOTH IP/OP "$1,797.00" "$1,330.00" $319.79 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" $319.79 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" $374.43 "$1,796.58" $718.63 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,347.75" "$1,796.58" "$1,796.58" "$1,796.58" $898.29 $898.29 "$1,422.89" "$1,796.58" "$1,437.26" $808.46 "$1,796.58" N/A "$1,042.26" "$1,796.58" "$1,077.95" "$1,796.58" "$1,796.58" "$1,796.58" N/A N/A 84506HT SUP Custom 27803010 84506HT - CONNECTOR ROD 5.5MM 6.35MM DOMINO TITANIUM SPN BOTH IP/OP "$1,831.50" "$1,355.00" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $381.64 "$1,831.18" $732.47 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,373.63" "$1,831.18" "$1,831.18" "$1,831.18" $915.59 $915.59 "$1,450.29" "$1,831.18" "$1,464.94" $824.03 "$1,831.18" N/A "$1,062.27" "$1,831.18" "$1,098.71" "$1,831.18" "$1,831.18" "$1,831.18" N/A N/A 84507H SUP Custom 27803010 84507H - CONNECTOR ROD 5.5/7MM DOMINO SPN BOTH IP/OP "$2,053.00" "$1,519.00" $365.39 "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" $365.39 "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" $427.82 "$2,052.75" $821.10 "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$2,052.75" "$1,539.75" "$2,052.75" "$2,052.75" "$2,052.75" "$1,026.38" "$1,026.38" "$1,625.78" "$2,052.75" "$1,642.20" $923.74 "$2,052.75" N/A "$1,190.74" "$2,052.75" "$1,231.65" "$2,052.75" "$2,052.75" "$2,052.75" N/A N/A 84507HT SUP Custom 27803010 84507HT - CONNECTOR ROD 5.5MM CD HORIZON DOMINO SPN BOTH IP/OP "$1,831.50" "$1,355.00" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $381.64 "$1,831.18" $732.47 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,373.63" "$1,831.18" "$1,831.18" "$1,831.18" $915.59 $915.59 "$1,450.29" "$1,831.18" "$1,464.94" $824.03 "$1,831.18" N/A "$1,062.27" "$1,831.18" "$1,098.71" "$1,831.18" "$1,831.18" "$1,831.18" N/A N/A 84509H SUP Custom 27803010 84509H - CONNECTOR ROD 5.5/5.5MM AXIAL TITANIUM SPN BOTH IP/OP "$2,118.50" "$1,568.00" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $441.51 "$2,118.45" $847.38 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$1,588.88" "$2,118.45" "$2,118.45" "$2,118.45" "$1,059.23" "$1,059.23" "$1,677.81" "$2,118.45" "$1,694.76" $953.30 "$2,118.45" N/A "$1,228.73" "$2,118.45" "$1,271.07" "$2,118.45" "$2,118.45" "$2,118.45" N/A N/A 84509HT SUP Custom 27803010 84509HT - CONNECTOR ROD 5.5MM AXIAL CD HORIZON DOMINO TITANIUM SPN BOTH IP/OP "$2,346.50" "$1,736.00" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $938.44 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" "$2,346.10" N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 84510H SUP Custom 27803010 84510H - CONNECTOR ROD 5.5-6.35MM AXIAL LEGACY CD HORIZON STAINLESS BOTH IP/OP "$2,118.50" "$1,568.00" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $441.51 "$2,118.45" $847.38 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$1,588.88" "$2,118.45" "$2,118.45" "$2,118.45" "$1,059.23" "$1,059.23" "$1,677.81" "$2,118.45" "$1,694.76" $953.30 "$2,118.45" N/A "$1,228.73" "$2,118.45" "$1,271.07" "$2,118.45" "$2,118.45" "$2,118.45" N/A N/A 84510HT SUP Custom 27803010 84510HT - CONNECTOR ROD 5.5/6.35MM AXIAL CD HORIZON DOMINO TITANIUM BOTH IP/OP "$2,346.50" "$1,736.00" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $938.44 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" "$2,346.10" N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 84511H SUP Custom 27803010 84511H - CONNECTOR ROD AXIAL CD HORIZON DOMINO STAINLESS STEEL SPN BOTH IP/OP "$2,118.50" "$1,568.00" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $441.51 "$2,118.45" $847.38 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$1,588.88" "$2,118.45" "$2,118.45" "$2,118.45" "$1,059.23" "$1,059.23" "$1,677.81" "$2,118.45" "$1,694.76" $953.30 "$2,118.45" N/A "$1,228.73" "$2,118.45" "$1,271.07" "$2,118.45" "$2,118.45" "$2,118.45" N/A N/A 848-011 SUP HCPCS C1713 848-011 - ROD SPINAL STANDARD 4.5MM HEXAGONAL END CD HORIZON ECLIPSE BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 848-012 SUP HCPCS C1713 848-012 - ROD SPINAL STANDARD 4.5MM 20IN STR CD HORIZON ECLIPSE BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 848-520 SUP HCPCS C1713 848-520 - SCREW BONE 5.5MM 20MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-523 SUP HCPCS C1713 848-523 - SCREW BONE 5.5MM 22.5MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-525 SUP HCPCS C1713 848-525 - SCREW BONE 5.5MM 25MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$2,352.00" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-528 SUP HCPCS C1713 848-528 - SCREW BONE 5.5MM 27.5MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$2,352.00" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-530 SUP HCPCS C1713 848-530 - SCREW BONE 5.5MM 30MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$2,352.00" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-533 SUP HCPCS C1713 848-533 - SCREW BONE 5.5MM 32.5MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$2,352.00" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-535 SUP HCPCS C1713 848-535 - SCREW BONE 5.5MM 35MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$2,352.00" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-538 SUP HCPCS C1713 848-538 - SCREW BONE 5.5MM 37.5MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-540 SUP HCPCS C1713 848-540 - SCREW BONE 5.5MM 40MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$2,352.00" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-543 SUP HCPCS C1713 848-543 - SCREW BONE 5.5MM 42.5MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-545 SUP HCPCS C1713 848-545 - SCREW BONE 5.5MM 45MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-548 SUP HCPCS C1713 848-548 - SCREW BONE 5.5MM 47.5MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$2,352.00" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-550 SUP HCPCS C1713 848-550 - SCREW BONE 5.5MM 50MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-553 SUP HCPCS C1713 848-553 - SCREW BONE 5.5MM 52.5MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-555 SUP HCPCS C1713 848-555 - SCREW BONE 5.5MM 55MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$2,352.00" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-625 SUP HCPCS C1713 848-625 - SCREW BONE 6.5MM 25MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-630 SUP HCPCS C1713 848-630 - SCREW BONE 6.5MM 30MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-635 SUP HCPCS C1713 848-635 - SCREW BONE 6.5MM 35MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-640 SUP HCPCS C1713 848-640 - SCREW BONE 6.5MM 40MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-645 SUP HCPCS C1713 848-645 - SCREW BONE 6.5MM 45MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$2,352.00" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-725 SUP HCPCS C1713 848-725 - SCREW BONE 7.5MM 25MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-730 SUP HCPCS C1713 848-730 - SCREW BONE 7.5MM 30MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-735 SUP HCPCS C1713 848-735 - SCREW BONE 7.5MM 35MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-740 SUP HCPCS C1713 848-740 - SCREW BONE 7.5MM 40MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" $940.80 "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$2,352.00" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-745 SUP HCPCS C1713 848-745 - SCREW BONE 7.5MM 45MM CANN ECLIPSE CD HORIZON TITANIUM SPN BOTH IP/OP "$2,352.00" "$1,740.00" $466.81 "$2,352.00" "$1,058.40" "$1,058.40" "$1,058.40" "$1,058.40" "$2,352.00" "$2,352.00" "$2,352.00" $490.22 "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" $490.18 "$2,352.00" "$2,352.00" "$1,391.21" "$2,352.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,764.00" "$2,352.00" "$2,352.00" "$2,352.00" "$1,176.00" "$1,176.00" "$1,862.78" "$2,352.00" "$1,881.60" "$1,058.40" $466.81 N/A "$1,364.16" "$2,352.00" "$1,411.20" "$2,352.00" $490.16 "$2,352.00" N/A N/A 848-855 SUP HCPCS C1713 848-855 - SCREW SET NONBREAKOFF CD HORIZON M8 STAINLESS STEEL SPN BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 851.002.01S SUP HCPCS C1713 851.002.01S - PLATE BONE STR 2 HOLE RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP $315.00 $233.00 $62.52 $315.00 $141.75 $141.75 $141.75 $141.75 $315.00 $315.00 $315.00 $65.65 $315.00 $315.00 $315.00 $315.00 $315.00 $65.65 $315.00 $315.00 $186.32 $315.00 $315.00 $315.00 $315.00 $236.25 $315.00 $315.00 $315.00 $157.50 $157.50 $249.48 $315.00 $252.00 $141.75 $62.52 N/A $182.70 $315.00 $189.00 $315.00 $65.65 $315.00 N/A N/A 851.004.01S SUP HCPCS C1713 851.004.01S - PLATE BONE STR 4 HOLE RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP $461.50 $342.00 $91.55 $461.25 $207.56 $207.56 $207.56 $207.56 $461.25 $461.25 $461.25 $96.14 $461.25 $461.25 $461.25 $461.25 $461.25 $96.13 $461.25 $461.25 $272.83 $461.25 $461.25 $461.25 $461.25 $346.13 $461.25 $461.25 $461.25 $230.63 $230.63 $365.31 $461.25 $369.00 $207.56 $91.55 N/A $267.67 $461.25 $461.25 $461.25 $96.12 $461.25 N/A N/A 851.008.01S SUP HCPCS C1713 851.008.01S - PLATE BONE 8 HOLE ADAPTION RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP $517.50 $383.00 $102.71 $517.50 $232.88 $232.88 $232.88 $232.88 $517.50 $517.50 $517.50 $107.86 $517.50 $517.50 $517.50 $517.50 $517.50 $107.85 $517.50 $517.50 $306.10 $517.50 $517.50 $517.50 $517.50 $388.13 $517.50 $517.50 $517.50 $258.75 $258.75 $409.86 $517.50 $414.00 $232.88 $102.71 N/A $300.15 $517.50 $517.50 $517.50 $107.85 $517.50 N/A N/A 851.009.01S SUP HCPCS C1713 851.009.01S - PLATE BONE 8 HOLE SCALLOPED ADAPTATION SCALLOPED RAPID BOTH IP/OP $517.50 $383.00 $102.71 $517.50 $232.88 $232.88 $232.88 $232.88 $517.50 $517.50 $517.50 $107.86 $517.50 $517.50 $517.50 $517.50 $517.50 $107.85 $517.50 $517.50 $306.10 $517.50 $517.50 $517.50 $517.50 $388.13 $517.50 $517.50 $517.50 $258.75 $258.75 $409.86 $517.50 $414.00 $232.88 $102.71 N/A $300.15 $517.50 $517.50 $517.50 $517.50 $517.50 N/A N/A 851.020.01S SUP HCPCS C1713 851.020.01S - PLATE BONE 20 HOLE ADAPTION RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP $754.00 $558.00 $149.60 $753.75 $339.19 $339.19 $339.19 $339.19 $753.75 $753.75 $753.75 $157.10 $753.75 $753.75 $753.75 $753.75 $753.75 $157.09 $753.75 $753.75 $445.84 $753.75 $753.75 $753.75 $753.75 $565.50 $753.75 $753.75 $753.75 $376.88 $376.88 $596.97 $753.75 $603.00 $339.19 $149.60 N/A $437.32 $753.75 $452.25 $753.75 $157.08 $753.75 N/A N/A 851.021.01S SUP HCPCS C1713 851.021.01S - PLATE BONE 20 HOLE SCALLOPED ADAPTATION SCALLOPED RAPID BOTH IP/OP $754.00 $558.00 $149.60 $753.75 $339.19 $339.19 $339.19 $339.19 $753.75 $753.75 $753.75 $157.10 $753.75 $753.75 $753.75 $753.75 $753.75 $157.09 $753.75 $753.75 $445.84 $753.75 $753.75 $753.75 $753.75 $565.50 $753.75 $753.75 $753.75 $376.88 $376.88 $596.97 $753.75 $603.00 $339.19 $149.60 N/A $437.32 $753.75 $452.25 $753.75 $157.08 $753.75 N/A N/A 851.110.01S SUP HCPCS C1713 851.110.01S - PLATE BONE 10 HOLE RAPID RESORB ORBTL RIM STERILE 1.5 MM BOTH IP/OP $697.50 $516.00 $138.44 $697.50 $313.88 $313.88 $313.88 $313.88 $697.50 $697.50 $697.50 $145.38 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $697.50 $412.57 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $138.44 N/A $404.55 $697.50 $418.50 $697.50 $145.36 $697.50 N/A N/A 851.320.01S SUP HCPCS C1713 851.320.01S - PLATE BONE 10 HOLE 2 Y RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP $697.50 $516.00 $138.44 $697.50 $313.88 $313.88 $313.88 $313.88 $697.50 $697.50 $697.50 $145.38 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $697.50 $412.57 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $138.44 N/A $404.55 $697.50 $418.50 $697.50 $145.36 $697.50 N/A N/A 851.343.01S SUP HCPCS C1713 851.343.01S - PLATE BONE 4X3 X 3 HOLE Y RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP $697.50 $516.00 $138.44 $697.50 $313.88 $313.88 $313.88 $313.88 $697.50 $697.50 $697.50 $145.38 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $697.50 $412.57 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $138.44 N/A $404.55 $697.50 $697.50 $697.50 $145.36 $697.50 N/A N/A 851.344.01S SUP HCPCS C1713 851.344.01S - PLATE BONE T 18X14X.8MM 2X3 HOLE RAPID RESORB FIX CRANFCL BOTH IP/OP $697.50 $516.00 $138.44 $697.50 $313.88 $313.88 $313.88 $313.88 $697.50 $697.50 $697.50 $145.38 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $697.50 $412.57 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $138.44 N/A $404.55 $697.50 $418.50 $697.50 $145.36 $697.50 N/A N/A 851.420.01S SUP HCPCS C1713 851.420.01S - PLATE BONE 2X10 HOLE STRUT RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP "$1,226.50" $908.00 $243.38 "$1,226.25" $551.81 $551.81 $551.81 $551.81 "$1,226.25" "$1,226.25" "$1,226.25" $255.58 "$1,226.25" "$1,226.25" "$1,226.25" "$1,226.25" "$1,226.25" $255.56 "$1,226.25" "$1,226.25" $725.33 "$1,226.25" "$1,226.25" "$1,226.25" "$1,226.25" $919.88 "$1,226.25" "$1,226.25" "$1,226.25" $613.13 $613.13 $971.19 "$1,226.25" $981.00 $551.81 $243.38 N/A $711.37 "$1,226.25" "$1,226.25" "$1,226.25" $255.55 "$1,226.25" N/A N/A 851.421.01S SUP HCPCS C1713 851.421.01S - PLATE BONE 2X18 HOLE STRUT RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP "$1,519.00" "$1,124.00" $301.43 "$1,518.75" $683.44 $683.44 $683.44 $683.44 "$1,518.75" "$1,518.75" "$1,518.75" $316.55 "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" $316.52 "$1,518.75" "$1,518.75" $898.34 "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,139.25" "$1,518.75" "$1,518.75" "$1,518.75" $759.38 $759.38 "$1,202.85" "$1,518.75" "$1,215.00" $683.44 $301.43 N/A $881.02 "$1,518.75" "$1,518.75" "$1,518.75" $316.51 "$1,518.75" N/A N/A 851.424.01S SUP HCPCS C1713 851.424.01S - PLATE BONE 2X10 HOLE STRUT SCALLOPED RAPID RESORB BOTH IP/OP "$1,228.50" $909.00 $243.83 "$1,228.50" $552.83 $552.83 $552.83 $552.83 "$1,228.50" "$1,228.50" "$1,228.50" $256.05 "$1,228.50" "$1,228.50" "$1,228.50" "$1,228.50" "$1,228.50" $256.03 "$1,228.50" $491.40 $726.66 "$1,228.50" "$1,228.50" "$1,228.50" "$1,228.50" $921.38 "$1,228.50" "$1,228.50" "$1,228.50" $614.25 $614.25 $972.97 "$1,228.50" $982.80 $552.83 $243.83 N/A $712.53 "$1,228.50" "$1,228.50" "$1,228.50" $256.02 "$1,228.50" N/A N/A 851.425.01S SUP HCPCS C1713 851.425.01S - PLATE BONE 2X18 HOLE STRUT SCALLOPED RAPID RESORB BOTH IP/OP "$1,519.00" "$1,124.00" $301.43 "$1,518.75" $683.44 $683.44 $683.44 $683.44 "$1,518.75" "$1,518.75" "$1,518.75" $316.55 "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" $316.52 "$1,518.75" "$1,518.75" $898.34 "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$1,139.25" "$1,518.75" "$1,518.75" "$1,518.75" $759.38 $759.38 "$1,202.85" "$1,518.75" "$1,215.00" $683.44 $301.43 N/A $881.02 "$1,518.75" $911.25 "$1,518.75" $316.51 "$1,518.75" N/A N/A 851.436.01S SUP HCPCS C1713 851.436.01S - PLATE BONE 2X36 HOLE STRUT SCALLOPED RAPID RESORB STERILE BOTH IP/OP "$3,026.50" "$2,240.00" $600.63 "$3,026.25" "$1,361.81" "$1,361.81" "$1,361.81" "$1,361.81" "$3,026.25" "$3,026.25" "$3,026.25" $630.75 "$3,026.25" "$3,026.25" "$3,026.25" "$3,026.25" "$3,026.25" $630.70 "$3,026.25" "$1,210.50" "$1,491.94" "$3,026.25" "$3,026.25" "$3,026.25" "$3,026.25" "$2,269.88" "$3,026.25" "$3,026.25" "$3,026.25" "$1,513.13" "$1,513.13" "$2,396.79" "$3,026.25" "$2,421.00" "$1,361.81" $600.63 N/A "$1,755.37" "$3,026.25" "$1,815.75" "$3,026.25" $630.67 "$3,026.25" N/A N/A 851.500.01S SUP HCPCS C1713 851.500.01S - PLATE BONE 4 HOLE RAPID RESORB BOX STERILE 1.5 MM SCREW BOTH IP/OP $697.50 $516.00 $138.44 $697.50 $313.88 $313.88 $313.88 $313.88 $697.50 $697.50 $697.50 $145.38 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $697.50 $412.57 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $138.44 N/A $404.55 $697.50 $418.50 $697.50 $145.36 $697.50 N/A N/A 851.506.01S SUP Custom 27803010 851.506.01S - COVER BURR HOLE 8 HOLE RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP $641.50 $475.00 $114.14 $641.25 $641.25 $641.25 $641.25 $641.25 $641.25 $641.25 $114.14 $641.25 $641.25 $641.25 $641.25 $641.25 $641.25 $133.64 $641.25 $256.50 $641.25 $641.25 $641.25 $641.25 $641.25 $481.13 $641.25 $641.25 $641.25 $320.63 $320.63 $507.87 $641.25 $513.00 $288.56 $641.25 N/A $372.07 $641.25 $384.75 $641.25 $641.25 $641.25 N/A N/A 851.508.01S SUP Custom 27803010 851.508.01S - COVER BURR HOLE 10 HOLE RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP $641.50 $475.00 $114.14 $641.25 $641.25 $641.25 $641.25 $641.25 $641.25 $641.25 $114.14 $641.25 $641.25 $641.25 $641.25 $641.25 $641.25 $133.64 $641.25 $256.50 $641.25 $641.25 $641.25 $641.25 $641.25 $481.13 $641.25 $641.25 $641.25 $320.63 $320.63 $507.87 $641.25 $513.00 $288.56 $641.25 N/A $372.07 $641.25 $384.75 $641.25 $641.25 $641.25 N/A N/A 851.510.01S SUP HCPCS C1713 851.510.01S - PLATE BONE 50X50X.5MM MESH RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP "$3,060.00" "$2,264.00" $607.33 "$3,060.00" "$1,377.00" "$1,377.00" "$1,377.00" "$1,377.00" "$3,060.00" "$3,060.00" "$3,060.00" $637.78 "$3,060.00" "$3,060.00" "$3,060.00" "$3,060.00" "$3,060.00" $637.74 "$3,060.00" "$1,224.00" "$1,508.58" "$3,060.00" "$3,060.00" "$3,060.00" "$3,060.00" "$2,295.00" "$3,060.00" "$3,060.00" "$3,060.00" "$1,530.00" "$1,530.00" "$2,423.52" "$3,060.00" "$2,448.00" "$1,377.00" $607.33 N/A "$1,774.80" "$3,060.00" "$1,836.00" "$3,060.00" $637.70 "$3,060.00" N/A N/A 851.512.01S SUP HCPCS C1713 851.512.01S - PLATE BONE 100X100X.5MM MESH RAPID RESORB BOTH IP/OP "$6,525.00" "$4,829.00" "$1,295.05" "$6,525.00" "$2,936.25" "$2,936.25" "$2,936.25" "$2,936.25" "$6,525.00" "$6,525.00" "$6,525.00" "$1,359.97" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$1,359.88" "$6,525.00" "$2,610.00" "$3,216.83" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$4,893.75" "$6,525.00" "$6,525.00" "$6,525.00" "$3,262.50" "$3,262.50" "$5,167.80" "$6,525.00" "$5,220.00" "$2,936.25" "$1,295.05" N/A "$3,784.50" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" N/A N/A 851.520.01S SUP HCPCS C1713 851.520.01S - PLATE BONE 50X50X.8MM MESH RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP "$3,195.00" "$2,364.00" $634.13 "$3,195.00" "$1,437.75" "$1,437.75" "$1,437.75" "$1,437.75" "$3,195.00" "$3,195.00" "$3,195.00" $665.92 "$3,195.00" "$3,195.00" "$3,195.00" "$3,195.00" "$3,195.00" $665.87 "$3,195.00" "$1,278.00" "$1,575.14" "$3,195.00" "$3,195.00" "$3,195.00" "$3,195.00" "$2,396.25" "$3,195.00" "$3,195.00" "$3,195.00" "$1,597.50" "$1,597.50" "$2,530.44" "$3,195.00" "$2,556.00" "$1,437.75" $634.13 N/A "$1,853.10" "$3,195.00" "$3,195.00" "$3,195.00" "$3,195.00" "$3,195.00" N/A N/A 851.521.01S SUP HCPCS C1713 851.521.01S - PLATE BONE 100X100X.8MM MESH RAPID RESORB BOTH IP/OP "$7,279.00" "$5,386.00" "$1,444.65" "$7,278.75" "$3,275.44" "$3,275.44" "$3,275.44" "$3,275.44" "$7,278.75" "$7,278.75" "$7,278.75" "$1,517.07" "$7,278.75" "$7,278.75" "$7,278.75" "$7,278.75" "$7,278.75" "$1,516.97" "$7,278.75" "$2,911.50" "$3,588.42" "$7,278.75" "$7,278.75" "$7,278.75" "$7,278.75" "$5,459.25" "$7,278.75" "$7,278.75" "$7,278.75" "$3,639.38" "$3,639.38" "$5,764.77" "$7,278.75" "$5,823.00" "$3,275.44" "$1,444.65" N/A "$4,221.82" "$7,278.75" "$7,278.75" "$7,278.75" "$1,516.89" "$7,278.75" N/A N/A 851.532.01S SUP HCPCS C1713 851.532.01S - PLATE BONE 50X50X.5MM SHEET RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP "$2,257.00" "$1,670.00" $447.91 "$2,256.75" "$1,015.54" "$1,015.54" "$1,015.54" "$1,015.54" "$2,256.75" "$2,256.75" "$2,256.75" $470.36 "$2,256.75" "$2,256.75" "$2,256.75" "$2,256.75" "$2,256.75" $470.33 "$2,256.75" $902.70 "$1,334.87" "$2,256.75" "$2,256.75" "$2,256.75" "$2,256.75" "$1,692.75" "$2,256.75" "$2,256.75" "$2,256.75" "$1,128.38" "$1,128.38" "$1,787.35" "$2,256.75" "$1,805.40" "$1,015.54" $447.91 N/A "$1,309.06" "$2,256.75" "$1,354.05" "$2,256.75" "$2,256.75" "$2,256.75" N/A N/A 851.534.01S SUP HCPCS C1713 851.534.01S - PLATE BONE 50X50X.8MM SHEET RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP "$2,351.50" "$1,740.00" $466.66 "$2,351.25" "$1,058.06" "$1,058.06" "$1,058.06" "$1,058.06" "$2,351.25" "$2,351.25" "$2,351.25" $490.06 "$2,351.25" "$2,351.25" "$2,351.25" "$2,351.25" "$2,351.25" $490.03 "$2,351.25" "$2,351.25" "$1,390.76" "$2,351.25" "$2,351.25" "$2,351.25" "$2,351.25" "$1,763.63" "$2,351.25" "$2,351.25" "$2,351.25" "$1,175.63" "$1,175.63" "$1,862.19" "$2,351.25" "$1,881.00" "$1,058.06" $466.66 N/A "$1,363.87" "$2,351.25" "$1,410.75" "$2,351.25" $490.00 "$2,351.25" N/A N/A 851.540.01S SUP HCPCS C1713 851.540.01S - PLATE BONE 24X24X.5MM RAPID REABSORBABLE TRANSPARENT ORBTL BOTH IP/OP "$1,890.00" "$1,399.00" $375.12 "$1,890.00" $850.50 $850.50 $850.50 $850.50 "$1,890.00" "$1,890.00" "$1,890.00" $393.92 "$1,890.00" "$1,890.00" "$1,890.00" "$1,890.00" "$1,890.00" $393.90 "$1,890.00" $756.00 "$1,117.94" "$1,890.00" "$1,890.00" "$1,890.00" "$1,890.00" "$1,417.50" "$1,890.00" "$1,890.00" "$1,890.00" $945.00 $945.00 "$1,496.88" "$1,890.00" "$1,512.00" $850.50 $375.12 N/A "$1,096.20" "$1,890.00" "$1,134.00" "$1,890.00" $393.88 "$1,890.00" N/A N/A 851.541.01S SUP HCPCS C1713 851.541.01S - PLATE BONE MEDIUM 30MM RAPID RESORB ORBTL FLOOR STERILE 1.5 BOTH IP/OP "$1,969.00" "$1,457.00" $390.75 "$1,968.75" $885.94 $885.94 $885.94 $885.94 "$1,968.75" "$1,968.75" "$1,968.75" $410.34 "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" $410.31 "$1,968.75" $787.50 "$1,164.52" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$1,476.75" "$1,968.75" "$1,968.75" "$1,968.75" $984.38 $984.38 "$1,559.25" "$1,968.75" "$1,575.00" $885.94 $390.75 N/A "$1,142.02" "$1,968.75" "$1,968.75" "$1,968.75" $410.29 "$1,968.75" N/A N/A 851.542.01S SUP HCPCS C1713 851.542.01S - PLATE BONE LARGE 35X35X.5MM RAPID RESORB RADIOLUCENT BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" $819.00 "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" N/A N/A 851.604.01S SUP HCPCS C1713 851.604.01S - PLATE BONE 4 HOLE X RAPID RESORB CRANIOMAXILLOFACIAL STERILE BOTH IP/OP $664.00 $491.00 $131.74 $663.75 $298.69 $298.69 $298.69 $298.69 $663.75 $663.75 $663.75 $138.34 $663.75 $663.75 $663.75 $663.75 $663.75 $138.33 $663.75 $265.50 $392.61 $663.75 $663.75 $663.75 $663.75 $498.00 $663.75 $663.75 $663.75 $331.88 $331.88 $525.69 $663.75 $531.00 $298.69 $131.74 N/A $385.12 $663.75 $663.75 $663.75 $663.75 $663.75 N/A N/A 851.605.01S SUP HCPCS C1713 851.605.01S - PLATE BONE X 19X24X.8MM 8 HOLE RAPID RESORB FIX CRANFCL BOTH IP/OP $664.00 $491.00 $131.74 $663.75 $298.69 $298.69 $298.69 $298.69 $663.75 $663.75 $663.75 $138.34 $663.75 $663.75 $663.75 $663.75 $663.75 $138.33 $663.75 $663.75 $392.61 $663.75 $663.75 $663.75 $663.75 $498.00 $663.75 $663.75 $663.75 $331.88 $331.88 $525.69 $663.75 $531.00 $298.69 $131.74 N/A $385.12 $663.75 $663.75 $663.75 $138.33 $663.75 N/A N/A 851.611.01S SUP HCPCS C1713 851.611.01S - PLATE BONE 50X50X.25MM RAPID RESORB CONTUR MESH FIX CRANFCL BOTH IP/OP "$3,352.50" "$2,481.00" $665.39 "$3,352.50" "$1,508.63" "$1,508.63" "$1,508.63" "$1,508.63" "$3,352.50" "$3,352.50" "$3,352.50" $698.74 "$3,352.50" "$3,352.50" "$3,352.50" "$3,352.50" "$3,352.50" $698.70 "$3,352.50" "$1,341.00" "$1,652.78" "$3,352.50" "$3,352.50" "$3,352.50" "$3,352.50" "$2,514.38" "$3,352.50" "$3,352.50" "$3,352.50" "$1,676.25" "$1,676.25" "$2,655.18" "$3,352.50" "$2,682.00" "$1,508.63" $665.39 N/A "$1,944.45" "$3,352.50" "$3,352.50" "$3,352.50" "$3,352.50" "$3,352.50" N/A N/A 851.612.01S SUP HCPCS C1713 851.612.01S - MESH CRNL 100X100X.25MM STRL RAPIDSORB CNTR RSRB RPD 1.5MM BOTH IP/OP "$7,222.50" "$5,345.00" "$1,433.49" "$7,222.50" "$3,250.13" "$3,250.13" "$3,250.13" "$3,250.13" "$7,222.50" "$7,222.50" "$7,222.50" "$1,505.35" "$7,222.50" "$7,222.50" "$7,222.50" "$7,222.50" "$7,222.50" "$1,505.25" "$7,222.50" "$2,889.00" "$3,560.69" "$7,222.50" "$7,222.50" "$7,222.50" "$7,222.50" "$5,416.88" "$7,222.50" "$7,222.50" "$7,222.50" "$3,611.25" "$3,611.25" "$5,720.22" "$7,222.50" "$5,778.00" "$3,250.13" "$1,433.49" N/A "$4,189.05" "$7,222.50" "$7,222.50" "$7,222.50" "$7,222.50" "$7,222.50" N/A N/A 851.621.01S SUP HCPCS C1713 851.621.01S - PLATE BONE 50X50X.5MM RAPID RESORB CONTUR MESH FIX CRANFCL BOTH IP/OP "$3,352.50" "$2,481.00" $665.39 "$3,352.50" "$1,508.63" "$1,508.63" "$1,508.63" "$1,508.63" "$3,352.50" "$3,352.50" "$3,352.50" $698.74 "$3,352.50" "$3,352.50" "$3,352.50" "$3,352.50" "$3,352.50" $698.70 "$3,352.50" "$3,352.50" "$1,652.78" "$3,352.50" "$3,352.50" "$3,352.50" "$3,352.50" "$2,514.38" "$3,352.50" "$3,352.50" "$3,352.50" "$1,676.25" "$1,676.25" "$2,655.18" "$3,352.50" "$2,682.00" "$1,508.63" $665.39 N/A "$1,944.45" "$3,352.50" "$3,352.50" "$3,352.50" $698.66 "$3,352.50" N/A N/A 851.622.01S SUP HCPCS C1713 851.622.01S - PLATE BONE 100X100X.50MM CONTUR MESH RAPID RESORB STERILE BOTH IP/OP "$7,222.50" "$5,345.00" "$1,433.49" "$7,222.50" "$3,250.13" "$3,250.13" "$3,250.13" "$3,250.13" "$7,222.50" "$7,222.50" "$7,222.50" "$1,505.35" "$7,222.50" "$7,222.50" "$7,222.50" "$7,222.50" "$7,222.50" "$1,505.25" "$7,222.50" "$7,222.50" "$3,560.69" "$7,222.50" "$7,222.50" "$7,222.50" "$7,222.50" "$5,416.88" "$7,222.50" "$7,222.50" "$7,222.50" "$3,611.25" "$3,611.25" "$5,720.22" "$7,222.50" "$5,778.00" "$3,250.13" "$1,433.49" N/A "$4,189.05" "$7,222.50" "$7,222.50" "$7,222.50" "$7,222.50" "$7,222.50" N/A N/A 851.623.01S SUP HCPCS C1713 851.623.01S - PLATE BONE 150X150X.5MM CONTUR MESH RAPID RESORB STERILE 1.5 BOTH IP/OP "$12,172.50" "$9,008.00" "$2,415.94" "$12,172.50" "$5,477.63" "$5,477.63" "$5,477.63" "$5,477.63" "$12,172.50" "$12,172.50" "$12,172.50" "$2,537.05" "$12,172.50" "$12,172.50" "$12,172.50" "$12,172.50" "$12,172.50" "$2,536.88" "$12,172.50" "$12,172.50" "$6,001.04" "$12,172.50" "$12,172.50" "$12,172.50" "$12,172.50" "$9,129.38" "$12,172.50" "$12,172.50" "$12,172.50" "$6,086.25" "$6,086.25" "$9,640.62" "$12,172.50" "$9,738.00" "$5,477.63" "$2,415.94" N/A "$7,060.05" "$12,172.50" "$12,172.50" "$12,172.50" "$2,536.75" "$12,172.50" N/A N/A 851.633.01S SUP HCPCS C1713 851.633.01S - PLATE BONE 150X150X.8MM RAPID RESORB CONTUR MESH FIX CRANFCL BOTH IP/OP "$12,375.00" "$9,158.00" "$2,456.13" "$12,375.00" "$5,568.75" "$5,568.75" "$5,568.75" "$5,568.75" "$12,375.00" "$12,375.00" "$12,375.00" "$2,579.26" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$2,579.09" "$12,375.00" "$12,375.00" "$6,100.88" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$9,281.25" "$12,375.00" "$12,375.00" "$12,375.00" "$6,187.50" "$6,187.50" "$9,801.00" "$12,375.00" "$9,900.00" "$5,568.75" "$2,456.13" N/A "$7,177.50" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" N/A N/A 851.651.01S SUP HCPCS C1713 851.651.01S - PLATE BONE 50MM .5MM CONTUR MESH RAPID RESORB BOTH IP/OP "$3,352.50" "$2,481.00" $665.39 "$3,352.50" "$1,508.63" "$1,508.63" "$1,508.63" "$1,508.63" "$3,352.50" "$3,352.50" "$3,352.50" $698.74 "$3,352.50" "$3,352.50" "$3,352.50" "$3,352.50" "$3,352.50" $698.70 "$3,352.50" "$3,352.50" "$1,652.78" "$3,352.50" "$3,352.50" "$3,352.50" "$3,352.50" "$2,514.38" "$3,352.50" "$3,352.50" "$3,352.50" "$1,676.25" "$1,676.25" "$2,655.18" "$3,352.50" "$2,682.00" "$1,508.63" $665.39 N/A "$1,944.45" "$3,352.50" "$3,352.50" "$3,352.50" "$3,352.50" "$3,352.50" N/A N/A 851.652.01S SUP HCPCS C1713 851.652.01S - PLATE BONE 100MM .5MM CONTUR MESH RAPID RESORB BOTH IP/OP "$7,222.50" "$5,345.00" "$1,433.49" "$7,222.50" "$3,250.13" "$3,250.13" "$3,250.13" "$3,250.13" "$7,222.50" "$7,222.50" "$7,222.50" "$1,505.35" "$7,222.50" "$7,222.50" "$7,222.50" "$7,222.50" "$7,222.50" "$1,505.25" "$7,222.50" "$7,222.50" "$3,560.69" "$7,222.50" "$7,222.50" "$7,222.50" "$7,222.50" "$5,416.88" "$7,222.50" "$7,222.50" "$7,222.50" "$3,611.25" "$3,611.25" "$5,720.22" "$7,222.50" "$5,778.00" "$3,250.13" "$1,433.49" N/A "$4,189.05" "$7,222.50" "$7,222.50" "$7,222.50" "$1,505.17" "$7,222.50" N/A N/A 851.661.01S SUP HCPCS C1713 851.661.01S - PLATE BONE 50MM .8MM CONTUR MESH RAPID RESORB BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$3,487.50" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$3,487.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A 851.662.01S SUP HCPCS C1713 851.662.01S - PLATE BONE CNTOUR 100MM .8MM MESH RAPIDSORB BOTH IP/OP "$7,605.00" "$5,628.00" "$1,509.40" "$7,605.00" "$3,422.25" "$3,422.25" "$3,422.25" "$3,422.25" "$7,605.00" "$7,605.00" "$7,605.00" "$1,585.07" "$7,605.00" "$7,605.00" "$7,605.00" "$7,605.00" "$7,605.00" "$1,584.97" "$7,605.00" "$3,042.00" "$3,749.27" "$7,605.00" "$7,605.00" "$7,605.00" "$7,605.00" "$5,703.75" "$7,605.00" "$7,605.00" "$7,605.00" "$3,802.50" "$3,802.50" "$6,023.16" "$7,605.00" "$6,084.00" "$3,422.25" "$1,509.40" N/A "$4,410.90" "$7,605.00" "$7,605.00" "$7,605.00" "$1,584.88" "$7,605.00" N/A N/A 851.680.01S SUP HCPCS C1713 851.680.01S - PLATE BONE 25X7X.5MM RAPID RESORB SELLAR FLOOR BOTH IP/OP $641.50 $475.00 $127.27 $641.25 $288.56 $288.56 $288.56 $288.56 $641.25 $641.25 $641.25 $133.65 $641.25 $641.25 $641.25 $641.25 $641.25 $133.64 $641.25 $256.50 $379.30 $641.25 $641.25 $641.25 $641.25 $481.13 $641.25 $641.25 $641.25 $320.63 $320.63 $507.87 $641.25 $513.00 $288.56 $127.27 N/A $372.07 $641.25 $641.25 $641.25 $133.64 $641.25 N/A N/A 851.681.01S SUP HCPCS C1713 851.681.01S - PLATE BONE 7X25X.8MM RAPID RESORB SELLAR FLOOR FIX CRANFCL BOTH IP/OP $641.50 $475.00 $127.27 $641.25 $288.56 $288.56 $288.56 $288.56 $641.25 $641.25 $641.25 $133.65 $641.25 $641.25 $641.25 $641.25 $641.25 $133.64 $641.25 $256.50 $379.30 $641.25 $641.25 $641.25 $641.25 $481.13 $641.25 $641.25 $641.25 $320.63 $320.63 $507.87 $641.25 $513.00 $288.56 $127.27 N/A $372.07 $641.25 $641.25 $641.25 $133.64 $641.25 N/A N/A 851.689.01S SUP HCPCS C1713 851.689.01S - PLATE BONE 24MM RAPID RESORB BENDING TEMPLATE ORBTL FLOOR BOTH IP/OP "$1,901.50" "$1,407.00" $377.35 "$1,901.25" $855.56 $855.56 $855.56 $855.56 "$1,901.25" "$1,901.25" "$1,901.25" $396.27 "$1,901.25" "$1,901.25" "$1,901.25" "$1,901.25" "$1,901.25" $396.24 "$1,901.25" $760.50 "$1,124.59" "$1,901.25" "$1,901.25" "$1,901.25" "$1,901.25" "$1,426.13" "$1,901.25" "$1,901.25" "$1,901.25" $950.63 $950.63 "$1,505.79" "$1,901.25" "$1,521.00" $855.56 $377.35 N/A "$1,102.87" "$1,901.25" "$1,901.25" "$1,901.25" $396.22 "$1,901.25" N/A N/A 851.690.01S SUP HCPCS C1713 851.690.01S - PLATE BONE 30X30MM RAPID RESORB BENDING TEMPLATE ORBTL FLOOR BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" $891.00 $891.00 $891.00 $891.00 "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" $412.65 "$1,980.00" $792.00 "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" $891.00 $392.98 N/A "$1,148.40" "$1,980.00" "$1,980.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A 851.691.01S SUP HCPCS C1713 851.691.01S - PLATE BONE 35X35MM BENDING TEMPLATE RAPID RESORB ORBTL FLOOR BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" $819.00 "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$2,047.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A 851.711.01S SUP HCPCS C1713 851.711.01S - PLATE BONE 50X50X.5MM STR ROW MESH RAPID RESORB BOTH IP/OP "$3,060.00" "$2,264.00" $607.33 "$3,060.00" "$1,377.00" "$1,377.00" "$1,377.00" "$1,377.00" "$3,060.00" "$3,060.00" "$3,060.00" $637.78 "$3,060.00" "$3,060.00" "$3,060.00" "$3,060.00" "$3,060.00" $637.74 "$3,060.00" "$1,224.00" "$1,508.58" "$3,060.00" "$3,060.00" "$3,060.00" "$3,060.00" "$2,295.00" "$3,060.00" "$3,060.00" "$3,060.00" "$1,530.00" "$1,530.00" "$2,423.52" "$3,060.00" "$2,448.00" "$1,377.00" $607.33 N/A "$1,774.80" "$3,060.00" "$3,060.00" "$3,060.00" $637.70 "$3,060.00" N/A N/A 851.711.97S SUP HCPCS C1713 851.711.97S - PLATE BONE 50X50X.5MM STR ROW MESH RAPID RESORB POLY BOTH IP/OP "$2,847.00" "$2,107.00" $564.97 "$2,894.93" "$1,280.94" "$1,280.94" "$1,280.94" "$1,280.94" "$2,846.53" "$2,846.53" "$2,846.53" $593.29 "$2,846.53" "$2,846.53" "$2,846.53" "$2,846.53" "$2,846.53" $593.25 "$2,846.53" "$1,157.97" "$1,403.34" "$2,846.53" "$2,894.93" "$2,846.53" "$2,846.53" "$2,135.25" "$2,846.53" "$2,846.53" "$2,846.53" "$1,423.27" "$1,423.27" "$2,254.45" "$2,846.53" "$2,277.22" "$1,280.94" $564.97 N/A "$1,651.26" "$2,846.53" "$2,846.53" "$2,846.53" $593.22 "$2,846.53" N/A N/A 851.712.01S SUP HCPCS C1713 851.712.01S - PLATE BONE 100X100X.5MM STR ROW MESH RAPID RESORB BOTH IP/OP "$6,525.00" "$4,829.00" "$1,295.05" "$6,525.00" "$2,936.25" "$2,936.25" "$2,936.25" "$2,936.25" "$6,525.00" "$6,525.00" "$6,525.00" "$1,359.97" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$1,359.88" "$6,525.00" "$2,610.00" "$3,216.83" "$6,525.00" "$6,525.00" "$6,525.00" "$6,525.00" "$4,893.75" "$6,525.00" "$6,525.00" "$6,525.00" "$3,262.50" "$3,262.50" "$5,167.80" "$6,525.00" "$5,220.00" "$2,936.25" "$1,295.05" N/A "$3,784.50" "$6,525.00" "$6,525.00" "$6,525.00" "$1,359.81" "$6,525.00" N/A N/A 851.712.97S SUP HCPCS C1713 851.712.97S - PLATE BONE 100MM RESORB STR ROW MESH ORTHOPEDIC NONSTRL 1MM BOTH IP/OP "$6,071.00" "$4,493.00" "$1,204.94" "$6,174.20" "$2,731.95" "$2,731.95" "$2,731.95" "$2,731.95" "$6,071.00" "$6,071.00" "$6,071.00" "$1,265.35" "$6,071.00" "$6,071.00" "$6,071.00" "$6,071.00" "$6,071.00" "$1,265.26" "$6,071.00" "$2,469.68" "$2,993.00" "$6,071.00" "$6,174.20" "$6,071.00" "$6,071.00" "$4,553.25" "$6,071.00" "$6,071.00" "$6,071.00" "$3,035.50" "$3,035.50" "$4,808.23" "$6,071.00" "$4,856.80" "$2,731.95" "$1,204.94" N/A "$3,521.18" "$6,071.00" "$3,642.60" "$6,071.00" "$1,265.20" "$6,071.00" N/A N/A 851.721.01S SUP HCPCS C1713 851.721.01S - PLATE BONE 50X50X.8MM STR ROW MESH RAPID RESORB BOTH IP/OP "$3,240.00" "$2,398.00" $643.06 "$3,240.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$3,240.00" "$3,240.00" "$3,240.00" $675.30 "$3,240.00" "$3,240.00" "$3,240.00" "$3,240.00" "$3,240.00" $675.25 "$3,240.00" "$1,296.00" "$1,597.32" "$3,240.00" "$3,240.00" "$3,240.00" "$3,240.00" "$2,430.00" "$3,240.00" "$3,240.00" "$3,240.00" "$1,620.00" "$1,620.00" "$2,566.08" "$3,240.00" "$2,592.00" "$1,458.00" $643.06 N/A "$1,879.20" "$3,240.00" "$3,240.00" "$3,240.00" "$3,240.00" "$3,240.00" N/A N/A 851.722.01S SUP HCPCS C1713 851.722.01S - PLATE BONE 100X100X.8MM STR ROW MESH RAPID RESORB BOTH IP/OP "$7,200.00" "$5,328.00" "$1,429.02" "$7,200.00" "$3,240.00" "$3,240.00" "$3,240.00" "$3,240.00" "$7,200.00" "$7,200.00" "$7,200.00" "$1,500.66" "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" "$1,500.56" "$7,200.00" "$7,200.00" "$3,549.60" "$7,200.00" "$7,200.00" "$7,200.00" "$7,200.00" "$5,400.00" "$7,200.00" "$7,200.00" "$7,200.00" "$3,600.00" "$3,600.00" "$5,702.40" "$7,200.00" "$5,760.00" "$3,240.00" "$1,429.02" N/A "$4,176.00" "$7,200.00" "$7,200.00" "$7,200.00" "$1,500.48" "$7,200.00" N/A N/A 851.724.01S SUP HCPCS C1713 851.724.01S - PLATE BONE 75X75X.8MM RAPID RESORB STR ROW MESH FIX CRANFCL BOTH IP/OP "$4,657.50" "$3,447.00" $924.40 "$4,657.50" "$2,095.88" "$2,095.88" "$2,095.88" "$2,095.88" "$4,657.50" "$4,657.50" "$4,657.50" $970.74 "$4,657.50" "$4,657.50" "$4,657.50" "$4,657.50" "$4,657.50" $970.67 "$4,657.50" "$1,863.00" "$2,296.15" "$4,657.50" "$4,657.50" "$4,657.50" "$4,657.50" "$3,493.13" "$4,657.50" "$4,657.50" "$4,657.50" "$2,328.75" "$2,328.75" "$3,688.74" "$4,657.50" "$3,726.00" "$2,095.88" $924.40 N/A "$2,701.35" "$4,657.50" "$4,657.50" "$4,657.50" "$4,657.50" "$4,657.50" N/A N/A 851.801.01S SUP Custom 27803010 851.801.01S - CLAMP TUBE 18MM RAPID RESORB CRANIAL FLAP STERILE BOTH IP/OP $787.50 $583.00 $140.18 $787.50 $787.50 $787.50 $787.50 $787.50 $787.50 $787.50 $140.18 $787.50 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $315.00 $787.50 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $787.50 N/A $456.75 $787.50 $472.50 $787.50 $787.50 $787.50 N/A N/A 852.002.01S SUP HCPCS C1713 852.002.01S - PLATE BONE 2 HOLE STR RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP $326.50 $242.00 $64.75 $326.25 $146.81 $146.81 $146.81 $146.81 $326.25 $326.25 $326.25 $68.00 $326.25 $326.25 $326.25 $326.25 $326.25 $67.99 $326.25 $130.50 $192.98 $326.25 $326.25 $326.25 $326.25 $244.88 $326.25 $326.25 $326.25 $163.13 $163.13 $258.39 $326.25 $261.00 $146.81 $64.75 N/A $189.37 $326.25 $326.25 $326.25 $326.25 $326.25 N/A N/A 852.004.01S SUP HCPCS C1713 852.004.01S - PLATE BONE 4 HOLE STR RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP $484.00 $358.00 $96.01 $483.75 $217.69 $217.69 $217.69 $217.69 $483.75 $483.75 $483.75 $100.83 $483.75 $483.75 $483.75 $483.75 $483.75 $100.82 $483.75 $483.75 $286.14 $483.75 $483.75 $483.75 $483.75 $363.00 $483.75 $483.75 $483.75 $241.88 $241.88 $383.13 $483.75 $387.00 $217.69 $96.01 N/A $280.72 $483.75 $290.25 $483.75 $100.81 $483.75 N/A N/A 852.008.01S SUP HCPCS C1713 852.008.01S - PLATE BONE 8 HOLE ADAPTION RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP $540.00 $400.00 $107.18 $540.00 $243.00 $243.00 $243.00 $243.00 $540.00 $540.00 $540.00 $112.55 $540.00 $540.00 $540.00 $540.00 $540.00 $112.54 $540.00 $540.00 $319.41 $540.00 $540.00 $540.00 $540.00 $405.00 $540.00 $540.00 $540.00 $270.00 $270.00 $427.68 $540.00 $432.00 $243.00 $107.18 N/A $313.20 $540.00 $324.00 $540.00 $540.00 $540.00 N/A N/A 852.020.01S SUP HCPCS C1713 852.020.01S - PLATE BONE 102X7X1.2MM 20 HOLE ADAPTION RAPIDSORB BOTH IP/OP $787.50 $583.00 $156.30 $787.50 $354.38 $354.38 $354.38 $354.38 $787.50 $787.50 $787.50 $164.13 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $315.00 $465.81 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $156.30 N/A $456.75 $787.50 $472.50 $787.50 $787.50 $787.50 N/A N/A 852.110.01S SUP HCPCS C1713 852.110.01S - PLATE BONE 10 HOLE RAPID RESORB ORBTL RIM STERILE 2 MM BOTH IP/OP $697.50 $516.00 $138.44 $697.50 $313.88 $313.88 $313.88 $313.88 $697.50 $697.50 $697.50 $145.38 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $279.00 $412.57 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $138.44 N/A $404.55 $697.50 $418.50 $697.50 $145.36 $697.50 N/A N/A 852.263.01S SUP HCPCS C1713 852.263.01S - PLATE BONE 6X4 HOLE L LEFT OBLIQUE RAPID RESORB BOTH IP/OP $697.50 $516.00 $138.44 $697.50 $313.88 $313.88 $313.88 $313.88 $697.50 $697.50 $697.50 $145.38 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $279.00 $412.57 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $138.44 N/A $404.55 $697.50 $418.50 $697.50 $145.36 $697.50 N/A N/A 852.264.01S SUP HCPCS C1713 852.264.01S - PLATE BONE 6X4 HOLE L RIGHT OBLIQUE RAPID RESORB BOTH IP/OP $697.50 $516.00 $138.44 $697.50 $313.88 $313.88 $313.88 $313.88 $697.50 $697.50 $697.50 $145.38 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $279.00 $412.57 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $138.44 N/A $404.55 $697.50 $418.50 $697.50 $145.36 $697.50 N/A N/A 852.343.01S SUP HCPCS C1713 852.343.01S - PLATE BONE 4X3 X 3 HOLE RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP $697.50 $516.00 $138.44 $697.50 $313.88 $313.88 $313.88 $313.88 $697.50 $697.50 $697.50 $145.38 $697.50 $697.50 $697.50 $697.50 $697.50 $145.37 $697.50 $279.00 $412.57 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $313.88 $138.44 N/A $404.55 $697.50 $418.50 $697.50 $145.36 $697.50 N/A N/A 852.420.01S SUP HCPCS C1713 852.420.01S - PLATE BONE 2X10 HOLE STRUT RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP "$1,294.00" $958.00 $256.78 "$1,293.75" $582.19 $582.19 $582.19 $582.19 "$1,293.75" "$1,293.75" "$1,293.75" $269.65 "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" $269.63 "$1,293.75" $517.50 $765.25 "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" $970.50 "$1,293.75" "$1,293.75" "$1,293.75" $646.88 $646.88 "$1,024.65" "$1,293.75" "$1,035.00" $582.19 $256.78 N/A $750.52 "$1,293.75" $776.25 "$1,293.75" $269.62 "$1,293.75" N/A N/A 852.421.01S SUP HCPCS C1713 852.421.01S - PLATE BONE 2X18 HOLE STRUT RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP "$1,597.50" "$1,182.00" $317.06 "$1,597.50" $718.88 $718.88 $718.88 $718.88 "$1,597.50" "$1,597.50" "$1,597.50" $332.96 "$1,597.50" "$1,597.50" "$1,597.50" "$1,597.50" "$1,597.50" $332.94 "$1,597.50" $639.00 $944.92 "$1,597.50" "$1,597.50" "$1,597.50" "$1,597.50" "$1,198.13" "$1,597.50" "$1,597.50" "$1,597.50" $798.75 $798.75 "$1,265.22" "$1,597.50" "$1,278.00" $718.88 $317.06 N/A $926.55 "$1,597.50" $958.50 "$1,597.50" $332.92 "$1,597.50" N/A N/A 852.520.01S SUP HCPCS C1713 852.520.01S - PLATE BONE 48X48X1.2MM MESH RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$1,395.00" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A 852.521.01S SUP HCPCS C1713 852.521.01S - PLATE BONE 78X78X1.2MM MESH RAPID RESORB CRANIOMAXILLOFACIAL BOTH IP/OP "$5,445.00" "$4,029.00" "$1,080.70" "$5,445.00" "$2,450.25" "$2,450.25" "$2,450.25" "$2,450.25" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.87" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$1,134.80" "$5,445.00" "$2,178.00" "$2,684.39" "$5,445.00" "$5,445.00" "$5,445.00" "$5,445.00" "$4,083.75" "$5,445.00" "$5,445.00" "$5,445.00" "$2,722.50" "$2,722.50" "$4,312.44" "$5,445.00" "$4,356.00" "$2,450.25" "$1,080.70" N/A "$3,158.10" "$5,445.00" "$3,267.00" "$5,445.00" "$1,134.74" "$5,445.00" N/A N/A 852.641.01S SUP HCPCS C1713 852.641.01S - PLATE BONE 50MM 1.2MM CONTUR MESH RAPID RESORB BOTH IP/OP "$3,802.50" "$2,814.00" $754.70 "$3,802.50" "$1,711.13" "$1,711.13" "$1,711.13" "$1,711.13" "$3,802.50" "$3,802.50" "$3,802.50" $792.54 "$3,802.50" "$3,802.50" "$3,802.50" "$3,802.50" "$3,802.50" $792.48 "$3,802.50" "$1,521.00" "$1,874.63" "$3,802.50" "$3,802.50" "$3,802.50" "$3,802.50" "$2,851.88" "$3,802.50" "$3,802.50" "$3,802.50" "$1,901.25" "$1,901.25" "$3,011.58" "$3,802.50" "$3,042.00" "$1,711.13" $754.70 N/A "$2,205.45" "$3,802.50" "$2,281.50" "$3,802.50" $792.44 "$3,802.50" N/A N/A 853008LH SUP HCPCS C1713 853008LH - PLATE BONE 8MM LATERAL HOLE OPEN DOOR COLOR CODED BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" "$1,093.50" "$1,093.50" $227.89 "$1,093.50" N/A N/A 853008LW SUP HCPCS C1713 853008LW - PLATE BONE 8MM TIMESH TITANIUM CRANIUM BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853008WM SUP HCPCS C1713 853008WM - PLATE BONE WIDE MOUTH 8MM OPEN DOOR COLOR CODED CENTERPIECE BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" "$1,093.50" $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853-010 SUP HCPCS C1713 853-010 - PLATE BONE PRECONTOUR 10MM MULTIPLE HOLE OPEN DOOR PRECUT BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" "$1,093.50" "$1,093.50" $227.89 "$1,093.50" N/A N/A 853010LH SUP HCPCS C1713 853010LH - PLATE BONE LORDOTIC 10MM LATERAL HOLE OPEN DOOR COLOR CODED BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" "$1,093.50" $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853010LW SUP HCPCS C1713 853010LW - PLATE BN W MTH 10MM CENTERPIECE LAT HL OPN DOOR CLR CD TI BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" "$1,093.50" $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" "$1,093.50" "$1,093.50" N/A N/A 853010WM SUP HCPCS C1713 853010WM - PLATE BONE WIDE MOUTH 10MM OPEN DOOR COLOR CODED CENTERPIECE BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" "$1,093.50" $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" "$1,093.50" "$1,093.50" $227.89 "$1,093.50" N/A N/A 853-012 SUP HCPCS C1713 853-012 - PLATE BONE PRECONTOUR 12MM MULTIPLE HOLE OPEN DOOR PRECUT BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" "$1,093.50" $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853012LH SUP HCPCS C1713 853012LH - PLATE BONE 12MM LATERAL HOLE OPEN DOOR COLOR CODED BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853012WM SUP HCPCS C1713 853012WM - PLATE BONE WIDE MOUTH 12MM OPEN DOOR COLOR CODED CENTERPIECE BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853-014 SUP HCPCS C1713 853-014 - PLATE BONE PRECONTOUR 14MM MULTIPLE HOLE OPEN DOOR PRECUT BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853014LH SUP HCPCS C1713 853014LH - PLATE BONE LORDOTIC 14MM LATERAL HOLE OPEN DOOR COLOR CODED BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" "$1,093.50" $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853014LW SUP HCPCS C1713 853014LW - PLATE BONE 14MM WIDE MOUTH TIMESH TITANIUM CRANIUM BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" "$1,093.50" $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853014WM SUP HCPCS C1713 853014WM - PLATE BONE WIDE MOUTH 14MM OPEN DOOR CENTERPIECE TITANIUM BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" "$1,093.50" "$1,093.50" $227.89 "$1,093.50" N/A N/A 853-016 SUP HCPCS C1713 853-016 - PLATE BONE 16MM LP STR TIMESH TITANIUM CRANIAL BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853016LH SUP HCPCS C1713 853016LH - PLATE BONE LORDOTIC 16MM LATERAL HOLE OPEN DOOR COLOR CODED BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853016LW SUP HCPCS C1713 853016LW - PLATE BONE 16MM WIDE MOUTH TIMESH TITANIUM CRANIUM BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853016WM SUP HCPCS C1713 853016WM - PLATE BONE LORDOTIC WIDE MOUTH 16MM OPEN DOOR COLOR CODED BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" "$1,093.50" "$1,093.50" $227.89 "$1,093.50" N/A N/A 853-018 SUP HCPCS C1713 853-018 - PLATE BONE PRECONTOUR 18MM MULTIPLE HOLE OPEN DOOR PRECUT BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853018LH SUP HCPCS C1713 853018LH - PLATE BONE 18MM LATERAL HOLE OPEN DOOR COLOR CODED BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853018LW SUP HCPCS C1713 853018LW - PLATE BONE 18MM WIDE MOUTH TIMESH TITANIUM CRANIUM BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853018WM SUP HCPCS C1713 853018WM - PLATE BONE WIDE MOUTH 18MM OPEN DOOR COLOR CODED CENTERPIECE BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" "$1,093.50" "$1,093.50" $227.89 "$1,093.50" N/A N/A 853-107 SUP HCPCS C1713 853-107 - PLATE 7MM TI BONE SPNL BOTH IP/OP "$1,657.50" "$1,227.00" $328.97 "$1,657.50" $745.88 $745.88 $745.88 $745.88 "$1,657.50" "$1,657.50" "$1,657.50" $345.46 "$1,657.50" "$1,657.50" "$1,657.50" "$1,657.50" "$1,657.50" $345.44 "$1,657.50" "$1,657.50" $980.41 "$1,657.50" "$1,657.50" "$1,657.50" "$1,657.50" "$1,243.13" "$1,657.50" "$1,657.50" "$1,657.50" $828.75 $828.75 "$1,312.74" "$1,657.50" "$1,326.00" $745.88 $328.97 N/A $961.35 "$1,657.50" "$1,657.50" "$1,657.50" $345.42 "$1,657.50" N/A N/A 853408LH SUP HCPCS C1713 853408LH - PLATE BONE 8MM LATERAL HOLE GRAFT COLOR CODED CENTERPIECE BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853-410 SUP HCPCS C1713 853-410 - PLATE BN 10MM NS CENTERPIECE GFT SPNE BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853410LH SUP HCPCS C1713 853410LH - PLATE BONE 10MM LATERAL HOLE GRAFT COLOR CODED CENTERPIECE BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853-412 SUP HCPCS C1713 853-412 - PLATE BN 12MM NS CENTERPIECE GFT SPNE BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" "$1,093.50" $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853412LH SUP HCPCS C1713 853412LH - PLATE BONE 12MM LATERAL HOLE GRAFT COLOR CODED CENTERPIECE BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" "$1,093.50" $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853-414 SUP HCPCS C1713 853-414 - PLATE BONE PRECONTOUR 14MM GRAFT PRECUT COLOR CODED BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853414LH SUP HCPCS C1713 853414LH - PLATE BONE 14MM LATERAL HOLE GRAFT COLOR CODED CENTERPIECE BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" "$1,093.50" "$1,093.50" $227.89 "$1,093.50" N/A N/A 853-416 SUP HCPCS C1713 853-416 - PLATE BONE PRECONTOUR 16MM GRAFT PRECUT COLOR CODED BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853416LH SUP HCPCS C1713 853416LH - PLATE BONE 16MM LATERAL HOLE GRAFT COLOR CODED CENTERPIECE BOTH IP/OP "$1,093.50" $809.00 $217.03 "$1,093.50" $492.08 $492.08 $492.08 $492.08 "$1,093.50" "$1,093.50" "$1,093.50" $227.91 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 $646.81 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 $217.03 N/A $634.23 "$1,093.50" $656.10 "$1,093.50" $227.89 "$1,093.50" N/A N/A 853-418 SUP Custom 27803010 853-418 - PLATE BONE PRECONTOUR 18MM GRAFT PRECUT COLOR CODED BOTH IP/OP "$1,093.50" $809.00 $194.64 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $194.64 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $227.90 "$1,093.50" $437.40 "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" "$1,093.50" $820.13 "$1,093.50" "$1,093.50" "$1,093.50" $546.75 $546.75 $866.05 "$1,093.50" $874.80 $492.08 "$1,093.50" N/A $634.23 "$1,093.50" $656.10 "$1,093.50" "$1,093.50" "$1,093.50" N/A N/A 853-465 SUP HCPCS C1713 853-465 - SCREW BONE 2.6MM 5MM SELF TAP STAB GRAB COLOR CODED BOTH IP/OP $171.00 $127.00 $33.94 $171.00 $76.95 $76.95 $76.95 $76.95 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $101.15 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $76.95 $33.94 N/A $99.18 $171.00 $171.00 $171.00 $35.64 $171.00 N/A N/A 853-467 SUP HCPCS C1713 853-467 - SCREW BONE 2.6MM 7MM SELF TAP STAB GRAB COLOR CODED BOTH IP/OP $171.00 $127.00 $33.94 $171.00 $76.95 $76.95 $76.95 $76.95 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $171.00 $171.00 $171.00 $35.64 $171.00 $68.40 $101.15 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $76.95 $33.94 N/A $99.18 $171.00 $102.60 $171.00 $35.64 $171.00 N/A N/A 853-469 SUP HCPCS C1713 853-469 - SCREW BONE 2.6MM 9MM SELF TAP STAB GRAB COLOR CODED BOTH IP/OP $171.00 $127.00 $33.94 $171.00 $76.95 $76.95 $76.95 $76.95 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $101.15 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $76.95 $33.94 N/A $99.18 $171.00 $171.00 $171.00 $35.64 $171.00 N/A N/A 853-471 SUP HCPCS C1713 853-471 - SCREW BONE 2.6MM 11MM SELF TAP STAB GRAB COLOR CODED BOTH IP/OP $171.00 $127.00 $33.94 $171.00 $76.95 $76.95 $76.95 $76.95 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $171.00 $171.00 $171.00 $35.64 $171.00 $68.40 $101.15 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $76.95 $33.94 N/A $99.18 $171.00 $102.60 $171.00 $35.64 $171.00 N/A N/A 853-505 SUP HCPCS C1713 853-505 - SCREW BONE 3MM 5MM SELF TAP STAB GRAB COLOR CODED BOTH IP/OP $171.00 $127.00 $33.94 $171.00 $76.95 $76.95 $76.95 $76.95 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $101.15 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $76.95 $33.94 N/A $99.18 $171.00 $171.00 $171.00 $35.64 $171.00 N/A N/A 853-507 SUP HCPCS C1713 853-507 - SCREW BONE 3MM 7MM SELF TAP STAB GRAB COLOR CODED BOTH IP/OP $171.00 $127.00 $33.94 $171.00 $76.95 $76.95 $76.95 $76.95 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $171.00 $171.00 $171.00 $35.64 $171.00 $68.40 $101.15 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $76.95 $33.94 N/A $99.18 $171.00 $102.60 $171.00 $35.64 $171.00 N/A N/A 853-509 SUP HCPCS C1713 853-509 - SCREW BONE 3MM 9MM SELF TAP STAB GRAB COLOR CODED BOTH IP/OP $171.00 $127.00 $33.94 $171.00 $76.95 $76.95 $76.95 $76.95 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $171.00 $171.00 $171.00 $35.64 $171.00 $68.40 $101.15 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $76.95 $33.94 N/A $99.18 $171.00 $102.60 $171.00 $35.64 $171.00 N/A N/A 853-511 SUP HCPCS C1713 853-511 - SCREW BONE 3MM 11MM SELF TAP STAB GRAB COLOR CODED BOTH IP/OP $171.00 $127.00 $33.94 $171.00 $76.95 $76.95 $76.95 $76.95 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $171.00 $171.00 $171.00 $35.64 $171.00 $171.00 $101.15 $171.00 $171.00 $171.00 $171.00 $128.25 $171.00 $171.00 $171.00 $85.50 $85.50 $135.43 $171.00 $136.80 $76.95 $33.94 N/A $99.18 $171.00 $102.60 $171.00 $35.64 $171.00 N/A N/A 853-602 SUP Custom 27203010 853-602 - BIT DRILL 5MM TRI FLAT STAINLESS STEEL BOTH IP/OP $225.00 $167.00 $40.05 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $40.05 $225.00 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $90.00 $225.00 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $225.00 N/A $130.50 $225.00 $135.00 $225.00 $225.00 $225.00 N/A N/A 8550012L SUP HCPCS C1713 8550012L - ROD SPINAL 5.5MM HEXAGONAL END LINED CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 855-011 SUP HCPCS C1713 855-011 - ROD SPINAL HEXAGON 5.5MM 20MM CD HORIZON TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 855011L100 SUP HCPCS C1713 855011L100 - ROD SPINAL 5.5MM 100MM PRECUT TSRH TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 855-012 SUP HCPCS C1713 855-012 - ROD SPINAL HEXAGON 5.5MM 510MM CD HORIZON TITANIUM STERILE BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 85-62010 SUP Custom 27203010 85-62010 - STM HNDHLD LCTR VRSTIM3 NRV STD SBDRM BOTH IP/OP $113.00 $84.00 $20.11 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $113.00 $20.11 $113.00 $113.00 $83.87 $83.87 $87.10 $58.87 $23.55 $113.00 $45.20 $113.00 $113.00 $113.00 $113.00 $113.00 $84.75 $113.00 $113.00 $113.00 $56.50 $56.50 $89.50 $113.00 $90.40 $73.45 $113.00 N/A $65.54 $113.00 $67.80 $113.00 $113.00 $113.00 N/A N/A 858-002 SUP HCPCS C1713 858-002 - HOOK SPINAL SMALL CD HORIZON M8 STAINLESS STEEL PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-010 SUP HCPCS C1713 858-010 - HOOK SPINAL SMALL WIDE BLADE CD HORIZON M8 STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-020 SUP HCPCS C1713 858-020 - HOOK SPINAL SMALL NARROW BLADE CD HORIZON M8 STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-024 SUP HCPCS C1713 858-024 - HOOK SPINAL SMALL ANGLED BLADE CD HORIZON M8 STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-030 SUP HCPCS C1713 858-030 - HOOK SPINAL SMALL EXTENDED BODY CD HORIZON M8 STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-052 SUP HCPCS C1713 858-052 - HOOK SPINAL SMALL NARROW BLADE RAMPED CD HORIZON M8 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-102 SUP HCPCS C1713 858-102 - HOOK SPINAL CD HORIZON M8 STAINLESS STEEL PEDICLE 5.5/6.35 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-110 SUP HCPCS C1713 858-110 - HOOK SPINAL WIDE BLADE CD HORIZON M8 STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-112 SUP HCPCS C1713 858-112 - HOOK SPINAL SMALL WIDE GROOVE BLADE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-120 SUP HCPCS C1713 858-120 - HOOK SPINAL NARROW BLADE CD HORIZON M8 STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-122 SUP HCPCS C1713 858-122 - HOOK SPINAL SMALL GROOVE NARROW BLADE CD HORIZON M8 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-124 SUP HCPCS C1713 858-124 - HOOK SPINAL ANGLED BLADE CD HORIZON M8 STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-130 SUP HCPCS C1713 858-130 - HOOK SPINAL EXTENDED BODY CD HORIZON M8 STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-140 SUP HCPCS C1713 858-140 - HOOK SPINAL RIGHT OFFST CD HORIZON M8 STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-142 SUP HCPCS C1713 858-142 - HOOK SPINAL LEFT OFFST CD HORIZON M8 STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-150 SUP HCPCS C1713 858-150 - HOOK SPINAL STANDARD BLADE RAMP CD HORIZON M8 STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-152 SUP HCPCS C1713 858-152 - HOOK SPINAL RAMPED NARROW BLADE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-160 SUP HCPCS C1713 858-160 - HOOK SPINAL RIGHT ANG RIGHT ANG CD HORIZON M8 STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-162 SUP HCPCS C1713 858-162 - HOOK SPINAL LEFT ANGLE LEFT ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-202 SUP HCPCS C1713 858-202 - HOOK SPINAL LARGE CD HORIZON M8 STAINLESS STEEL PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-218 SUP HCPCS C1713 858-218 - HOOK SPINAL LARGE GROOVE WIDE BLADE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-220 SUP HCPCS C1713 858-220 - HOOK SPINAL LARGE GROOVE CD HORIZON M8 STAINLESS STEEL BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-230 SUP HCPCS C1713 858-230 - HOOK SPINAL LARGE GROOVE EXTENDED BODY CD HORIZON M8 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 858-425 SUP HCPCS C1713 858-425 - SCREW BONE 4.5MM 25MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" "$1,659.00" $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-430 SUP HCPCS C1713 858-430 - SCREW BONE 4.5MM 30MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-435 SUP HCPCS C1713 858-435 - SCREW BONE 4.5MM 35MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-440 SUP HCPCS C1713 858-440 - SCREW BONE 4.5MM 40MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-525 SUP HCPCS C1713 858-525 - SCREW BONE 5.5MM 25MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" "$1,659.00" $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-530 SUP HCPCS C1713 858-530 - SCREW BONE 5.5MM 30MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-535 SUP HCPCS C1713 858-535 - SCREW BONE 5.5MM 35MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-540 SUP HCPCS C1713 858-540 - SCREW BONE 5.5MM 40MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" "$1,659.00" $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-545 SUP HCPCS C1713 858-545 - SCREW BONE 5.5MM 45MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" "$1,659.00" $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-550 SUP HCPCS C1713 858-550 - SCREW BONE 5.5MM 50MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-555 SUP HCPCS C1713 858-555 - SCREW BONE 5.5MM 55MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-630 SUP HCPCS C1713 858-630 - SCREW BONE 6.5MM 30MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-635 SUP HCPCS C1713 858-635 - SCREW BONE 6.5MM 35MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-640 SUP HCPCS C1713 858-640 - SCREW BONE 6.5MM 40MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-645 SUP HCPCS C1713 858-645 - SCREW BONE 6.5MM 45MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" "$1,659.00" $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-650 SUP HCPCS C1713 858-650 - SCREW BONE 6.5MM 50MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" "$1,659.00" $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-655 SUP HCPCS C1713 858-655 - SCREW BONE 6.5MM 55MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-730 SUP HCPCS C1713 858-730 - SCREW BONE 7.5MM 30MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-735 SUP HCPCS C1713 858-735 - SCREW BONE 7.5MM 35MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-740 SUP HCPCS C1713 858-740 - SCREW BONE 7.5MM 40MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-745 SUP HCPCS C1713 858-745 - SCREW BONE 7.5MM 45MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-750 SUP HCPCS C1713 858-750 - SCREW BONE 7.5MM 50MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" $995.40 "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-755 SUP HCPCS C1713 858-755 - SCREW BONE 7.5MM 55MM FIX ANGLE CD HORIZON M8 STAINLESS BOTH IP/OP "$1,659.00" "$1,228.00" $329.27 "$1,659.00" $746.55 $746.55 $746.55 $746.55 "$1,659.00" "$1,659.00" "$1,659.00" $345.78 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" $345.75 "$1,659.00" $663.60 $981.30 "$1,659.00" "$1,659.00" "$1,659.00" "$1,659.00" "$1,244.25" "$1,659.00" "$1,659.00" "$1,659.00" $829.50 $829.50 "$1,313.93" "$1,659.00" "$1,327.20" $746.55 $329.27 N/A $962.22 "$1,659.00" "$1,659.00" "$1,659.00" $345.74 "$1,659.00" N/A N/A 858-855 SUP HCPCS C1713 858-855 - SCREW SET 8.5MM 55MM HZNM8 BRK OFF SS SPNE 5.5MM ROD BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 859-002 SUP HCPCS C1713 859-002 - HOOK SPINAL SMALL SMALL GROOVE CD HORIZON M8 SEXTANT BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 85900P SUP HCPCS C1725 85900P - CATHETER ULTRASOUND 20MHZ STANDARD TAPER 5FR 20MM 150CM BOTH IP/OP "$1,812.50" "$1,341.00" $359.74 "$1,812.50" $984.19 $984.19 $984.19 $984.19 "$1,812.50" "$1,812.50" "$1,812.50" $377.77 "$1,812.50" "$1,345.24" "$1,345.24" "$1,397.08" $944.31 $377.74 "$1,812.50" "$1,812.50" "$1,072.09" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,359.38" "$1,812.50" "$1,812.50" "$1,812.50" $906.25 $906.25 "$1,435.50" "$1,812.50" "$1,450.00" "$1,178.13" $359.74 N/A "$1,051.25" "$1,812.50" "$1,812.50" "$1,812.50" $377.73 "$1,812.50" N/A N/A 859-010 SUP HCPCS C1713 859-010 - HOOK SPINAL SMALL WIDE BLADE TITANIUM PEDICLE 5.5MM ROD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-012 SUP HCPCS C1713 859-012 - HOOK SPINAL SMALL GROOVE WIDE BLADE CD HORIZON M8 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-020 SUP HCPCS C1713 859-020 - HOOK SPINAL SMALL NARROW BLADE CD HORIZON M8 SEXTANT BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-024 SUP HCPCS C1713 859-024 - HOOK SPINAL SMALL ANGLED BLADE NONREDUCTION CD HORIZON M8 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-030 SUP HCPCS C1713 859-030 - HOOK SPINAL SMALL 5.5MM EXTEND BODY CD HORIZON M8 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-052 SUP HCPCS C1713 859-052 - HOOK SPINAL SMALL NARROW BLADE RAMPED CD HORIZON M8 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-102 SUP HCPCS C1713 859-102 - HOOK SPINAL BLADE NONREDUCTION CD HORIZON M8 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-110 SUP HCPCS C1713 859-110 - HOOK SPINAL WIDE BLADE CD HORIZON M8 TITANIUM PEDIATRIC BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-112 SUP HCPCS C1713 859-112 - HOOK SPINAL SMALL STANDARD WIDE GROOVE 5.5MM BLADE THROAT BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-120 SUP HCPCS C1713 859-120 - HOOK SPINAL NARROW BLADE SEXTANT CD HORIZON TITANIUM PEDICLE BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-122 SUP HCPCS C1713 859-122 - HOOK SPINAL NARROW BLADE SMALL GROOVE SAW CD HORIZON M8 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-124 SUP HCPCS C1713 859-124 - HOOK SPINAL 5.5MM ANGLED BLADE CD HORIZON M8 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-130 SUP HCPCS C1713 859-130 - HOOK SPINAL EXTENDED BODY STANDARD BLADE NONREDUCTION CD BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-140 SUP HCPCS C1713 859-140 - HOOK SPINAL RIGHT OFFST CD HORIZON M8 TITANIUM PEDICLE 5.5MM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-142 SUP HCPCS C1713 859-142 - HOOK SPINAL LEFT OFFST CD HORIZON M8 TITANIUM PEDICLE 5.5MM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-150 SUP HCPCS C1713 859-150 - HOOK SPINAL STANDARD BLADE RAMP CD HORIZON M8 TITANIUM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-152 SUP HCPCS C1713 859-152 - HOOK SPINAL NARROW BLADE NONREDUCTION RAMPED CD HORIZON M8 BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-160 SUP HCPCS C1713 859-160 - PASSER SURG 60CM CATHETER BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-162 SUP HCPCS C1713 859-162 - HOOK SPINAL LEFT ANGLE CD HORIZON M8 TITANIUM PEDICLE 5.5 MM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A 859-425 SUP HCPCS C1713 859-425 - SCREW BONE 4.5MM 25MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-430 SUP HCPCS C1713 859-430 - SCREW BONE 4.5MM 30MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-435 SUP HCPCS C1713 859-435 - SCREW BONE 4.5MM 35MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" "$1,893.00" "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-440 SUP HCPCS C1713 859-440 - SCREW BONE 4.5MM 40MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-445 SUP HCPCS C1713 859-445 - SCREW BONE 4.5MM 45MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,135.80" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-450 SUP HCPCS C1713 859-450 - SCREW BONE 4.5MM 50MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-525 SUP HCPCS C1713 859-525 - SCREW BONE 5.5MM 25MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-530 SUP HCPCS C1713 859-530 - SCREW BONE 5.5MM 30MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-535 SUP HCPCS C1713 859-535 - SCREW BONE 5.5MM 35MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" "$1,893.00" "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-540 SUP HCPCS C1713 859-540 - SCREW BONE 5.5MM 40MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" "$1,893.00" "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-545 SUP HCPCS C1713 859-545 - SCREW BONE 5.5MM 45MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-550 SUP HCPCS C1713 859-550 - SCREW BONE 5.5MM 50MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-555 SUP HCPCS C1713 859-555 - SCREW BONE 5.5MM 55MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-630 SUP HCPCS C1713 859-630 - SCREW BONE 6.5MM 30MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-635 SUP HCPCS C1713 859-635 - SCREW BONE 6.5MM 35MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-640 SUP HCPCS C1713 859-640 - SCREW BONE 6.5MM 40MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-645 SUP HCPCS C1713 859-645 - SCREW BONE 6.5MM 45MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-650 SUP HCPCS C1713 859-650 - SCREW BONE 6.5MM 50MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-655 SUP HCPCS C1713 859-655 - SCREW BONE 6.5MM 55MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-730 SUP HCPCS C1713 859-730 - SCREW BONE 7.5MM 30MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" "$1,893.00" "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-735 SUP HCPCS C1713 859-735 - SCREW BONE 7.5MM 35MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" "$1,893.00" "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-740 SUP HCPCS C1713 859-740 - SCREW BONE 7.5MM 40MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-745 SUP HCPCS C1713 859-745 - SCREW BONE 7.5MM 45MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-750 SUP HCPCS C1713 859-750 - SCREW BONE 7.5MM 50MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,135.80" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-755 SUP HCPCS C1713 859-755 - SCREW BONE 7.5MM 55MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" "$1,893.00" "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,893.00" "$1,893.00" $394.50 "$1,893.00" N/A N/A 859-760 SUP HCPCS C1713 859-760 - SCREW BONE 7.5MM 60MM FIX ANGLE CD HORIZON M8 TITANIUM SPN BOTH IP/OP "$1,893.00" "$1,401.00" $375.71 "$1,893.00" $851.85 $851.85 $851.85 $851.85 "$1,893.00" "$1,893.00" "$1,893.00" $394.55 "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" $394.52 "$1,893.00" $757.20 "$1,119.71" "$1,893.00" "$1,893.00" "$1,893.00" "$1,893.00" "$1,419.75" "$1,893.00" "$1,893.00" "$1,893.00" $946.50 $946.50 "$1,499.26" "$1,893.00" "$1,514.40" $851.85 $375.71 N/A "$1,097.94" "$1,893.00" "$1,135.80" "$1,893.00" $394.50 "$1,893.00" N/A N/A 86-100 SUP HCPCS C1713 86-100 - PLATE BN V NS LF TRITIUM STRNL DISP BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" "$1,237.50" $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" $257.90 "$1,237.50" N/A N/A 86-200 SUP HCPCS C1713 86-200 - PLATE BN TRITIUM 8 HL 1 CBL STRNL BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" "$1,737.50" "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,737.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A 86-27-08 SUP HCPCS C1713 86-27-08 - SCREW BN 2.7MM 8MM NS TRITIUM STRNL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 86-27-10 SUP HCPCS C1713 86-27-10 - SCREW BN 2.7MM 10MM NS TRITIUM STRNL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 86-27-12 SUP HCPCS C1713 86-27-12 - SCREW BN 12MM NS LF TRITIUM STRNL CBL PLT SYS BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 86-27-14 SUP HCPCS C1713 86-27-14 - SCREW BN 14MM NS LF TRITIUM STRNL CBL PLT SYS BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 86-27-16 SUP HCPCS C1713 86-27-16 - SCREW BN 16MM NS TRITIUM STRNL CBL PLT SYS BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 86-300 SUP HCPCS C1713 86-300 - PLATE BN NS TRITIUM 2 CBL STRNL BOTH IP/OP "$1,845.00" "$1,365.00" $366.19 "$1,845.00" $830.25 $830.25 $830.25 $830.25 "$1,845.00" "$1,845.00" "$1,845.00" $384.54 "$1,845.00" "$1,845.00" "$1,845.00" "$1,845.00" "$1,845.00" $384.52 "$1,845.00" "$1,845.00" "$1,091.32" "$1,845.00" "$1,845.00" "$1,845.00" "$1,845.00" "$1,383.75" "$1,845.00" "$1,845.00" "$1,845.00" $922.50 $922.50 "$1,461.24" "$1,845.00" "$1,476.00" $830.25 $366.19 N/A "$1,070.10" "$1,845.00" "$1,845.00" "$1,845.00" $384.50 "$1,845.00" N/A N/A 86-30-08 SUP HCPCS C1713 86-30-08 - SCREW BN NS TRITIUM RSC STRNL CBL PLT SYS BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A 86-30-10 SUP HCPCS C1713 86-30-10 - SCREW BN 3MM 10MM NS LF RSC TRITIUM STRNL CBL PLT SYS BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A 86-30-12 SUP HCPCS C1713 86-30-12 - SCREW BN 3MM 12MM NS LF RSC TRITIUM STRNL CBL PLT SYS BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 86-30-14 SUP HCPCS C1713 86-30-14 - SCREW BN 3MM 14MM NS LF RSC TRITIUM STRNL CBL PLT SYS BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 86-30-16 SUP HCPCS C1713 86-30-16 - SCREW BN NS TRITIUM RSC STRNL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A 86-350-S SUP HCPCS C1713 86-350-S - DEVICE FX STRL LF TRITIUM 4 HL 2 CBL PLT SHRP NDL STRNL BOTH IP/OP "$1,882.50" "$1,393.00" $373.63 "$1,882.50" $847.13 $847.13 $847.13 $847.13 "$1,882.50" "$1,882.50" "$1,882.50" $392.36 "$1,882.50" "$1,882.50" "$1,882.50" "$1,882.50" "$1,882.50" $392.33 "$1,882.50" "$1,882.50" "$1,113.50" "$1,882.50" "$1,882.50" "$1,882.50" "$1,882.50" "$1,411.88" "$1,882.50" "$1,882.50" "$1,882.50" $941.25 $941.25 "$1,490.94" "$1,882.50" "$1,506.00" $847.13 $373.63 N/A "$1,091.85" "$1,882.50" "$1,882.50" "$1,882.50" $392.31 "$1,882.50" N/A N/A 86-400 SUP HCPCS C1713 86-400 - PLATE BN TRITIUM 5 HL 1 CBL STRNL BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" "$1,487.50" $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A 86-500 SUP HCPCS C1713 86-500 - PLATE BN TRITIUM 4 HL 1 CBL STRNL BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $595.00 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A 86-600 SUP HCPCS C1713 86-600 - PLATE BN NS TRITIUM CBL STRNL RB BOTH IP/OP "$1,790.00" "$1,325.00" $355.27 "$1,790.00" $805.50 $805.50 $805.50 $805.50 "$1,790.00" "$1,790.00" "$1,790.00" $373.08 "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" $373.06 "$1,790.00" $716.00 "$1,058.79" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,342.50" "$1,790.00" "$1,790.00" "$1,790.00" $895.00 $895.00 "$1,417.68" "$1,790.00" "$1,432.00" $805.50 $355.27 N/A "$1,038.20" "$1,790.00" "$1,790.00" "$1,790.00" $373.04 "$1,790.00" N/A N/A 86-700 SUP HCPCS C1713 86-700 - PLATE LADDER TRITIUM SCP 14 HL PRECONTOUR STRNM STRNL CBL BOTH IP/OP "$1,797.50" "$1,330.00" $356.76 "$1,797.50" $808.88 $808.88 $808.88 $808.88 "$1,797.50" "$1,797.50" "$1,797.50" $374.64 "$1,797.50" "$1,797.50" "$1,797.50" "$1,797.50" "$1,797.50" $374.62 "$1,797.50" $719.00 "$1,063.22" "$1,797.50" "$1,797.50" "$1,797.50" "$1,797.50" "$1,348.13" "$1,797.50" "$1,797.50" "$1,797.50" $898.75 $898.75 "$1,423.62" "$1,797.50" "$1,438.00" $808.88 $356.76 N/A "$1,042.55" "$1,797.50" "$1,797.50" "$1,797.50" $374.60 "$1,797.50" N/A N/A 868-011 SUP HCPCS C1713 868-011 - ROD SPINAL 5.5MM 500MM HEXAGONAL END LINED CD HORIZON LEGACY BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 868-021 SUP HCPCS C1713 868-021 - ROD SPINAL 5.5MM 50CM HEXAGONAL END LINED CD HORIZON LEGACY BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 869-011 SUP HCPCS C1713 869-011 - ROD SPINAL PREBENT 5.5MM 110MM HEXAGONAL END CENTRL POST CD BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 869-012 SUP HCPCS C1713 869-012 - ROD SPINAL PREBENT 5.5MM 350MM HEXAGONAL END CENTRL POST CD BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 869-013 SUP HCPCS C1713 869-013 - ROD SPINAL STANDARD 5.5MM 500MM HEXAGONAL END CD HORIZON BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 869-014 SUP HCPCS C1713 869-014 - ROD SPINAL 5.5MM 500MM CD HORIZON LEGACY CP 2 BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 869-021 SUP HCPCS C1713 869-021 - ROD SPINAL 5.5MM 210MM MULTIAX CD HORIZON LEGACY TITANIUM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 869-022 SUP HCPCS C1713 869-022 - ROD SPINAL LONG 5.5MM 50CM HEXAGONAL END LINED CD HORIZON BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8696G SUP Custom 27203010 8696G - SUTURE NABSB 7-0 P1 18IN BLU PRLN MFL BOTH IP/OP $17.00 $13.00 $2.96 $16.63 $16.63 $16.63 $16.63 $16.63 $16.63 $16.63 $2.96 $16.63 $16.63 $12.34 $12.34 $12.82 $8.66 $3.47 $16.63 $6.65 $16.63 $16.63 $16.63 $16.63 $16.63 $12.75 $16.63 $16.63 $16.63 $8.32 $8.32 $13.17 $16.63 $13.30 $10.81 $16.63 N/A $9.86 $16.63 $9.98 $16.63 $16.63 $16.63 N/A N/A 8700-000865-01 SUP Custom 27203010 8700-000865-01 - PACK SRG 6FT IVTM COOL LINE SRT UP DISP BOTH IP/OP "$6,725.50" "$4,977.00" "$1,197.07" "$6,725.10" "$6,725.10" "$6,725.10" "$6,725.10" "$6,725.10" "$6,725.10" "$6,725.10" "$1,197.07" "$6,725.10" "$6,725.10" "$4,181.12" "$4,181.12" "$5,183.71" "$2,060.15" "$1,401.58" "$6,725.10" "$2,690.04" "$6,725.10" "$6,725.10" "$6,725.10" "$6,725.10" "$6,725.10" "$5,044.13" "$6,725.10" "$6,725.10" "$6,725.10" "$3,362.55" "$3,362.55" "$5,326.28" "$6,725.10" "$5,380.08" "$4,371.32" "$6,725.10" N/A "$3,900.79" "$6,725.10" "$4,035.06" "$6,725.10" "$6,725.10" "$6,725.10" N/A N/A 8700-000866-01 SUP Custom 27203010 8700-000866-01 - PACK SRG 6FT IVTM ICY SRT UP DISP BOTH IP/OP "$9,640.00" "$7,134.00" "$1,715.85" "$9,639.60" "$9,639.60" "$9,639.60" "$9,639.60" "$9,639.60" "$9,639.60" "$9,639.60" "$1,715.85" "$9,639.60" "$9,639.60" "$4,181.12" "$4,181.12" "$7,430.20" "$2,060.15" "$2,009.00" "$9,639.60" "$3,855.84" "$9,639.60" "$9,639.60" "$9,639.60" "$9,639.60" "$9,639.60" "$7,230.00" "$9,639.60" "$9,639.60" "$9,639.60" "$4,819.80" "$4,819.80" "$7,634.56" "$9,639.60" "$7,711.68" "$6,265.74" "$9,639.60" N/A "$5,591.20" "$9,639.60" "$5,783.76" "$9,639.60" "$9,639.60" "$9,639.60" N/A N/A 8700-000867-01 SUP Custom 27203010 8700-000867-01 - PACK SRG 6FT IVTM QUATTRO SRT UP DISP BOTH IP/OP "$10,579.50" "$7,829.00" "$1,883.10" "$10,579.20" "$10,579.20" "$10,579.20" "$10,579.20" "$10,579.20" "$10,579.20" "$10,579.20" "$1,883.10" "$10,579.20" "$10,579.20" "$4,181.12" "$4,181.12" "$8,154.45" "$2,060.15" "$2,204.82" "$10,579.20" "$4,231.68" "$10,579.20" "$10,579.20" "$10,579.20" "$10,579.20" "$10,579.20" "$7,934.63" "$10,579.20" "$10,579.20" "$10,579.20" "$5,289.60" "$5,289.60" "$8,378.73" "$10,579.20" "$8,463.36" "$6,876.48" "$10,579.20" N/A "$6,136.11" "$10,579.20" "$6,347.52" "$10,579.20" "$10,579.20" "$10,579.20" N/A N/A 8700-0654-01 SUP HCPCS C1751 8700-0654-01 - CATHETER CEN VEN 9.3FR 22CM 58MM ODS BOTH IP/OP "$1,227.00" $908.00 $243.47 "$1,226.70" $552.02 $552.02 $552.02 $552.02 "$1,226.70" "$1,226.70" "$1,226.70" $255.67 "$1,226.70" "$1,226.70" "$1,226.70" "$1,226.70" "$1,226.70" $255.66 "$1,226.70" "$1,226.70" $725.59 "$1,226.70" "$1,226.70" "$1,226.70" "$1,226.70" $920.25 "$1,226.70" "$1,226.70" "$1,226.70" $613.35 $613.35 $971.55 "$1,226.70" $981.36 $552.02 $243.47 N/A $711.66 "$1,226.70" "$1,226.70" "$1,226.70" $255.64 "$1,226.70" N/A N/A 8700-0657-01 SUP HCPCS C1751 8700-0657-01 - CATHETER CEN VEN .032IN 9.3FR 38CM 75CM 3 INFUS LUMEN EXTN BOTH IP/OP "$1,955.50" "$1,447.00" $388.08 "$1,955.33" $879.90 $879.90 $879.90 $879.90 "$1,955.33" "$1,955.33" "$1,955.33" $407.54 "$1,955.33" "$1,955.33" "$1,955.33" "$1,955.33" "$1,955.33" $407.51 "$1,955.33" "$1,955.33" "$1,156.58" "$1,955.33" "$1,955.33" "$1,955.33" "$1,955.33" "$1,466.63" "$1,955.33" "$1,955.33" "$1,955.33" $977.67 $977.67 "$1,548.62" "$1,955.33" "$1,564.26" $879.90 $388.08 N/A "$1,134.19" "$1,955.33" "$1,955.33" "$1,955.33" $407.49 "$1,955.33" N/A N/A 8700-0660-01 SUP HCPCS C1752 8700-0660-01 - KIT CATHETER 9.3FR 45CM TRIP QUATRO BOTH IP/OP "$2,190.50" "$1,621.00" $456.47 "$2,190.23" "$2,190.23" "$2,190.23" "$2,190.23" "$2,190.23" "$2,190.23" "$2,190.23" "$2,190.23" "$2,190.23" "$2,190.23" "$2,190.23" "$2,190.23" "$2,190.23" "$2,190.23" $456.47 "$2,190.23" $876.09 "$2,190.23" "$2,190.23" "$2,190.23" "$2,190.23" "$2,190.23" "$1,642.88" "$2,190.23" "$2,190.23" "$2,190.23" "$1,095.12" "$1,095.12" "$1,734.66" "$2,190.23" "$1,752.18" $985.60 "$2,190.23" N/A "$1,270.49" "$2,190.23" "$1,314.14" "$2,190.23" "$2,190.23" "$2,190.23" N/A N/A 8700-0781-01 SUP Custom 27203010 8700-0781-01 - CATHETER CV 9.3FR 22CM STRL LF CL LN HEAT EXCH KT BOTH IP/OP "$1,288.00" $953.00 $229.19 "$1,287.60" "$1,287.60" "$1,287.60" "$1,287.60" "$1,287.60" "$1,287.60" "$1,287.60" $229.19 "$1,287.60" "$1,287.60" $955.66 $955.66 $992.48 $670.84 $268.35 "$1,287.60" $515.04 "$1,287.60" "$1,287.60" "$1,287.60" "$1,287.60" "$1,287.60" $966.00 "$1,287.60" "$1,287.60" "$1,287.60" $643.80 $643.80 "$1,019.78" "$1,287.60" "$1,030.08" $836.94 "$1,287.60" N/A $747.04 "$1,287.60" $772.56 "$1,287.60" "$1,287.60" "$1,287.60" N/A N/A 8700-0782-01 SUP Custom 27203010 8700-0782-01 - KIT CATH 9.3FR 38CM ICY CV BOTH IP/OP "$2,053.50" "$1,520.00" $365.47 "$2,053.20" "$2,053.20" "$2,053.20" "$2,053.20" "$2,053.20" "$2,053.20" "$2,053.20" $365.47 "$2,053.20" "$2,053.20" "$1,523.89" "$1,523.89" "$1,582.61" "$1,069.72" $427.91 "$2,053.20" $821.28 "$2,053.20" "$2,053.20" "$2,053.20" "$2,053.20" "$2,053.20" "$1,540.13" "$2,053.20" "$2,053.20" "$2,053.20" "$1,026.60" "$1,026.60" "$1,626.13" "$2,053.20" "$1,642.56" "$1,334.58" "$2,053.20" N/A "$1,191.03" "$2,053.20" "$1,231.92" "$2,053.20" "$2,053.20" "$2,053.20" N/A N/A 8700-0783-01 SUP Custom 27203010 8700-0783-01 - KIT CATH 9.3FR 45CM QUATTRO HEAT EXCH 3 LUM LL APPLAUSE HEP BOTH IP/OP "$2,299.00" "$1,701.00" $409.22 "$2,298.98" "$2,298.98" "$2,298.98" "$2,298.98" "$2,298.98" "$2,298.98" "$2,298.98" $409.22 "$2,298.98" "$2,298.98" "$1,706.30" "$1,706.30" "$1,772.05" "$1,197.77" $479.13 "$2,298.98" $919.59 "$2,298.98" "$2,298.98" "$2,298.98" "$2,298.98" "$2,298.98" "$1,724.25" "$2,298.98" "$2,298.98" "$2,298.98" "$1,149.49" "$1,149.49" "$1,820.79" "$2,298.98" "$1,839.18" "$1,494.34" "$2,298.98" N/A "$1,333.42" "$2,298.98" "$1,379.39" "$2,298.98" "$2,298.98" "$2,298.98" N/A N/A 8700-0784-01 SUP Custom 27203010 8700-0784-01 - KIT IV CLGRD 3K SRT BOTH IP/OP $455.00 $337.00 $80.92 $454.58 $454.58 $454.58 $454.58 $454.58 $454.58 $454.58 $80.92 $454.58 $454.58 $337.39 $337.39 $350.39 $236.84 $94.74 $454.58 $181.83 $454.58 $454.58 $454.58 $454.58 $454.58 $341.25 $454.58 $454.58 $454.58 $227.29 $227.29 $360.03 $454.58 $363.66 $295.48 $454.58 N/A $263.90 $454.58 $272.75 $454.58 $454.58 $454.58 N/A N/A 8700-0785-01 SUP Custom 27203010 8700-0785-01 - TUBING XTN 9FT BOTH IP/OP $511.50 $379.00 $90.98 $511.13 $511.13 $511.13 $511.13 $511.13 $511.13 $511.13 $90.98 $511.13 $511.13 $379.36 $379.36 $393.98 $266.30 $106.53 $511.13 $204.45 $511.13 $511.13 $511.13 $511.13 $511.13 $383.63 $511.13 $511.13 $511.13 $255.57 $255.57 $404.81 $511.13 $408.90 $332.23 $511.13 N/A $296.67 $511.13 $306.68 $511.13 $511.13 $511.13 N/A N/A 8709H SUP Custom 27203010 8709H - SUTURE NONABSORBABLE 6-0 BV-1 30IN 2 ARM MONOFILAMENT BOTH IP/OP $34.50 $26.00 $6.07 $34.09 $34.09 $34.09 $34.09 $34.09 $34.09 $34.09 $6.07 $34.09 $34.09 $25.30 $25.30 $26.28 $17.76 $7.10 $34.09 $13.64 $34.09 $34.09 $34.09 $34.09 $34.09 $25.88 $34.09 $34.09 $34.09 $17.05 $17.05 $27.00 $34.09 $27.27 $22.16 $34.09 N/A $20.01 $34.09 $20.45 $34.09 $34.09 $34.09 N/A N/A 8711H SUP Custom 27203010 8711H - SUTURE NABSB 6-0 RB-2 30IN BLU PRLN 2 ARM MFL BOTH IP/OP $578.50 $428.00 $102.90 $594.90 $578.10 $578.10 $578.10 $578.10 $578.10 $578.10 $102.90 $578.10 $578.10 $429.07 $429.07 $445.60 $301.19 $120.48 $578.10 $237.96 $578.10 $578.10 $594.90 $578.10 $578.10 $433.88 $578.10 $578.10 $578.10 $289.05 $289.05 $457.86 $578.10 $462.48 $375.77 $578.10 N/A $335.53 $578.10 $346.86 $578.10 $578.10 $578.10 N/A N/A 873-004 SUP HCPCS C1769 873-004 - GUIDEWIRE ORTHOPEDIC 24IN THREAD UCSS BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 873-011 SUP HCPCS C1769 873-011 - GUIDEWIRE ORTHOPEDIC 24IN UCSS DISPOSABLE BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A 873-030 SUP HCPCS C1713 873-030 - SCREW BONE 4MM 30MM CANN UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" $552.60 $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" "$1,381.50" "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-032 SUP HCPCS C1713 873-032 - SCREW BONE 4MM 32MM CANN UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" $552.60 $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" "$1,381.50" "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-034 SUP HCPCS C1713 873-034 - SCREW BONE 4MM 34MM CANN UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" $552.60 $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" $828.90 "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-036 SUP HCPCS C1713 873-036 - SCREW BONE 4MM 36MM CANN UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" "$1,381.50" $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" "$1,381.50" "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-038 SUP HCPCS C1713 873-038 - SCREW BONE 4MM 38MM CANN UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" $552.60 $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" "$1,381.50" "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-040 SUP HCPCS C1713 873-040 - SCREW BONE 4MM 40MM CANN UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" "$1,381.50" $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" "$1,381.50" "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-042 SUP HCPCS C1713 873-042 - SCREW BONE 4MM 42MM CANN UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" "$1,381.50" $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" "$1,381.50" "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-044 SUP HCPCS C1713 873-044 - SCREW BONE 4MM 44MM CANN UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" $552.60 $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" "$1,381.50" "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-046 SUP HCPCS C1713 873-046 - SCREW BONE 4MM 46MM CANN UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" $552.60 $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" "$1,381.50" "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-048 SUP HCPCS C1713 873-048 - SCREW BONE 4MM 48MM CANN UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" $552.60 $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" $828.90 "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-050 SUP HCPCS C1713 873-050 - SCREW BONE 4MM 50MM CANN UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" $552.60 $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" $828.90 "$1,381.50" $287.90 "$1,381.50" N/A N/A 8730H SUP Custom 27203010 8730H - SUTURE NONABSORBABLE 8-0 BV130-5 18IN 2 ARM MONOFILAMENT BOTH IP/OP $203.00 $150.00 $36.05 $208.43 $202.54 $202.54 $202.54 $202.54 $202.54 $202.54 $36.05 $202.54 $202.54 $150.33 $150.33 $156.12 $105.52 $42.21 $202.54 $83.37 $202.54 $202.54 $208.43 $202.54 $202.54 $152.25 $202.54 $202.54 $202.54 $101.27 $101.27 $160.41 $202.54 $162.03 $131.65 $202.54 N/A $117.74 $202.54 $121.52 $202.54 $202.54 $202.54 N/A N/A 873-136 SUP HCPCS C1713 873-136 - SCREW BN P/T 4MM 36MM UCSS LG CNN TI SPNE CORT BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" "$1,381.50" $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" "$1,381.50" "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-138 SUP HCPCS C1713 873-138 - SCREW BONE 4MM 38MM CANN LAG UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" "$1,381.50" $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" $828.90 "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-140 SUP HCPCS C1713 873-140 - SCREW BONE 4MM 40MM CANN LAG UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" "$1,381.50" $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" $828.90 "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-142 SUP HCPCS C1713 873-142 - SCREW BONE 4MM 42MM CANN LAG UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" $552.60 $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" "$1,381.50" "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-144 SUP HCPCS C1713 873-144 - SCREW BONE 4MM 44MM CANN LAG UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" $552.60 $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" "$1,381.50" "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-146 SUP HCPCS C1713 873-146 - SCREW BONE 4MM 46MM CANN LAG UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" $552.60 $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" $828.90 "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-148 SUP HCPCS C1713 873-148 - SCREW BONE 4MM 48MM LAG CANN UCSS TITANIUM CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" "$1,381.50" $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" $828.90 "$1,381.50" $287.90 "$1,381.50" N/A N/A 873-150 SUP HCPCS C1713 873-150 - SCREW BONE 4MM 50MM CANN LAG UCSS TITANIUM SPN CORTICAL BOTH IP/OP "$1,381.50" "$1,022.00" $274.19 "$1,381.50" $621.68 $621.68 $621.68 $621.68 "$1,381.50" "$1,381.50" "$1,381.50" $287.94 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" $287.92 "$1,381.50" "$1,381.50" $817.16 "$1,381.50" "$1,381.50" "$1,381.50" "$1,381.50" "$1,036.13" "$1,381.50" "$1,381.50" "$1,381.50" $690.75 $690.75 "$1,094.15" "$1,381.50" "$1,105.20" $621.68 $274.19 N/A $801.27 "$1,381.50" $828.90 "$1,381.50" $287.90 "$1,381.50" N/A N/A 8747H SUP Custom 27203010 8747H - SUTURE NONABSORBABLE 7-0 BV175-8 24IN 2 ARM MONOFILAMENT BOTH IP/OP $72.50 $54.00 $12.88 $72.38 $72.38 $72.38 $72.38 $72.38 $72.38 $72.38 $12.88 $72.38 $72.38 $53.72 $53.72 $55.79 $37.71 $15.08 $72.38 $28.95 $72.38 $72.38 $72.38 $72.38 $72.38 $54.38 $72.38 $72.38 $72.38 $36.19 $36.19 $57.32 $72.38 $57.90 $47.05 $72.38 N/A $42.05 $72.38 $43.43 $72.38 $72.38 $72.38 N/A N/A 87525S SUP HCPCS C1713 87525S - SCREW BN STD 8.75MM 25MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$1,233.50" $913.00 $244.79 "$1,233.33" $555.00 $555.00 $555.00 $555.00 "$1,233.33" "$1,233.33" "$1,233.33" $257.06 "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" $257.04 "$1,233.33" $493.33 $729.51 "$1,233.33" "$1,233.33" "$1,233.33" "$1,233.33" $925.13 "$1,233.33" "$1,233.33" "$1,233.33" $616.67 $616.67 $976.80 "$1,233.33" $986.66 $555.00 $244.79 N/A $715.43 "$1,233.33" "$1,233.33" "$1,233.33" $257.03 "$1,233.33" N/A N/A 87530S SUP HCPCS C1713 87530S - SCREW BN STD 8.75MM 30MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 87535S SUP HCPCS C1713 87535S - SCREW BN STD 8.75MM 35MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 87540S SUP HCPCS C1713 87540S - SCREW BN STD 8.75MM 40MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 87545S SUP HCPCS C1713 87545S - SCREW BN STD 8.75MM 45MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 87550S SUP HCPCS C1713 87550S - SCREW BN STD 8.75MM 50MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 87555S SUP HCPCS C1713 87555S - SCREW BN STD 8.75MM 55MM SPRL R90D LCK TI SPNE THORLMBR BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,125.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A 876-010 SUP HCPCS C1713 876-010 - SCREW BONE 4MM 10MM FIX ANGLE ATLANTIS GRAY TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-011 SUP HCPCS C1713 876-011 - SCREW BONE 4MM 11MM FIX ANGLE ATLANTIS GRAY TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-012 SUP HCPCS C1713 876-012 - SCREW BN 4MM 12MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-013 SUP HCPCS C1713 876-013 - SCREW BN 4MM 13MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-014 SUP HCPCS C1713 876-014 - SCREW BN 4MM 14MM GRY STRL ATLNTS FX ANG TI SPNE CANC CRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-015 SUP HCPCS C1713 876-015 - SCREW BN 4MM 15MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-016 SUP HCPCS C1713 876-016 - SCREW BN 4MM 16MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-017 SUP HCPCS C1713 876-017 - SCREW BN 4MM 17MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-018 SUP HCPCS C1713 876-018 - SCREW BN 4MM 18MM GRY STRL ATLNTS FX ANG TI SPNE CRV CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-019 SUP HCPCS C1713 876-019 - SCREW BONE 4MM 19MM FIX ANGLE ATLANTIS GRAY TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-020 SUP HCPCS C1713 876-020 - SCREW BONE 4MM 20MM FIX ANGLE ATLANTIS GRAY TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-021 SUP HCPCS C1713 876-021 - SCREW BONE 4MM 21MM FIX ANGLE ATLANTIS GRAY TITANIUM SPN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-053 SUP HCPCS C1713 876-053 - SCREW BN 4.5MM 13MM BLU STRL ATLNTS FX ANG TI SPNE CRV CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-055 SUP HCPCS C1713 876-055 - SCREW BN 4.5MM 15MM BLU STRL ATLNTS FX ANG TI SPNE CRV CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-057 SUP HCPCS C1713 876-057 - SCREW BN 4.5MM 17MM BLU STRL ATLNTS FX ANG TI SPNE CRV CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-119 SUP HCPCS C1713 876-119 - PLATE BONE LP 19MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 876-121 SUP HCPCS C1713 876-121 - PLATE BONE LP 21MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 876-123 SUP HCPCS C1713 876-123 - PLATE BONE LP 23MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 876-125 SUP HCPCS C1713 876-125 - PLATE BONE LP 25MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 876-127 SUP HCPCS C1713 876-127 - PLATE BONE LP 27.5MM LOCK ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 876-130 SUP HCPCS C1713 876-130 - PLATE BONE LP 30MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 876-132 SUP HCPCS C1713 876-132 - PLATE BONE LP 32.5MM LOCK ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 876-135 SUP HCPCS C1713 876-135 - PLATE BONE LP 35MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 876-137 SUP HCPCS C1713 876-137 - PLATE BONE LP 37.5MM LOCK ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 876-140 SUP HCPCS C1713 876-140 - PLATE BONE LP 40MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 876-142 SUP HCPCS C1713 876-142 - PLATE BN 42.5MM STRL ATLNTS LCK LOPRFL TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 876-145 SUP HCPCS C1713 876-145 - PLATE BONE LP 45MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 876-147 SUP HCPCS C1713 876-147 - PLATE BONE LP 47.5MM LOCK ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 876-150 SUP HCPCS C1713 876-150 - PLATE BONE 50MM LOCK LP ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 876-152 SUP HCPCS C1713 876-152 - PLATE BONE LP 52.5MM LOCK ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 876-155 SUP HCPCS C1713 876-155 - PLATE BONE LP 32.5MM LOCK ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 876-157 SUP HCPCS C1713 876-157 - PLATE BONE LP 57.5MM LOCK ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 876-160 SUP HCPCS C1713 876-160 - PLATE BONE LP 60MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 876-162 SUP HCPCS C1713 876-162 - PLATE BONE LP 62.5MM LOCK ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 876-165 SUP HCPCS C1713 876-165 - PLATE BONE LP 65MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 876-167 SUP HCPCS C1713 876-167 - PLATE BONE LP 67.5MM LOCK ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 876-170 SUP HCPCS C1713 876-170 - PLATE BONE LP 70MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 876-172 SUP HCPCS C1713 876-172 - PLATE BONE LP 72.5MM LOCK ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 876-175 SUP HCPCS C1713 876-175 - PLATE BONE LP 75MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 876-177 SUP HCPCS C1713 876-177 - PLATE BONE LP 77.5MM LOCK ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 876-180 SUP HCPCS C1713 876-180 - PLATE BONE LP 80MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 876-182 SUP HCPCS C1713 876-182 - PLATE BONE LP 82.5MM LOCK ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 876-185 SUP HCPCS C1713 876-185 - PLATE BONE LP 85MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 876-187 SUP HCPCS C1713 876-187 - PLATE BONE LP 87.5MM LOCK ATLANTIS TITANIUM SPN CERV BOTH IP/OP "$4,135.50" "$3,060.00" $820.79 "$4,135.50" "$1,860.98" "$1,860.98" "$1,860.98" "$1,860.98" "$4,135.50" "$4,135.50" "$4,135.50" $861.94 "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" $861.88 "$4,135.50" "$4,135.50" "$2,038.80" "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" "$3,101.63" "$4,135.50" "$4,135.50" "$4,135.50" "$2,067.75" "$2,067.75" "$3,275.32" "$4,135.50" "$3,308.40" "$1,860.98" $820.79 N/A "$2,398.59" "$4,135.50" "$2,481.30" "$4,135.50" $861.84 "$4,135.50" N/A N/A 876-190 SUP HCPCS C1713 876-190 - PLATE BONE LP 90MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$4,135.50" "$3,060.00" $820.79 "$4,135.50" "$1,860.98" "$1,860.98" "$1,860.98" "$1,860.98" "$4,135.50" "$4,135.50" "$4,135.50" $861.94 "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" $861.88 "$4,135.50" "$1,654.20" "$2,038.80" "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" "$3,101.63" "$4,135.50" "$4,135.50" "$4,135.50" "$2,067.75" "$2,067.75" "$3,275.32" "$4,135.50" "$3,308.40" "$1,860.98" $820.79 N/A "$2,398.59" "$4,135.50" "$2,481.30" "$4,135.50" $861.84 "$4,135.50" N/A N/A 876-195 SUP HCPCS C1713 876-195 - PLATE BONE LP 95MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$4,135.50" "$3,060.00" $820.79 "$4,135.50" "$1,860.98" "$1,860.98" "$1,860.98" "$1,860.98" "$4,135.50" "$4,135.50" "$4,135.50" $861.94 "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" $861.88 "$4,135.50" "$1,654.20" "$2,038.80" "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" "$3,101.63" "$4,135.50" "$4,135.50" "$4,135.50" "$2,067.75" "$2,067.75" "$3,275.32" "$4,135.50" "$3,308.40" "$1,860.98" $820.79 N/A "$2,398.59" "$4,135.50" "$2,481.30" "$4,135.50" $861.84 "$4,135.50" N/A N/A 876-200 SUP HCPCS C1713 876-200 - PLATE BONE LP 100MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$4,135.50" "$3,060.00" $820.79 "$4,135.50" "$1,860.98" "$1,860.98" "$1,860.98" "$1,860.98" "$4,135.50" "$4,135.50" "$4,135.50" $861.94 "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" $861.88 "$4,135.50" "$4,135.50" "$2,038.80" "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" "$3,101.63" "$4,135.50" "$4,135.50" "$4,135.50" "$2,067.75" "$2,067.75" "$3,275.32" "$4,135.50" "$3,308.40" "$1,860.98" $820.79 N/A "$2,398.59" "$4,135.50" "$2,481.30" "$4,135.50" $861.84 "$4,135.50" N/A N/A 876-205 SUP HCPCS C1713 876-205 - PLATE BONE LP 105MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$4,135.50" "$3,060.00" $820.79 "$4,135.50" "$1,860.98" "$1,860.98" "$1,860.98" "$1,860.98" "$4,135.50" "$4,135.50" "$4,135.50" $861.94 "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" $861.88 "$4,135.50" "$1,654.20" "$2,038.80" "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" "$3,101.63" "$4,135.50" "$4,135.50" "$4,135.50" "$2,067.75" "$2,067.75" "$3,275.32" "$4,135.50" "$3,308.40" "$1,860.98" $820.79 N/A "$2,398.59" "$4,135.50" "$4,135.50" "$4,135.50" $861.84 "$4,135.50" N/A N/A 876-210 SUP HCPCS C1713 876-210 - PLATE BONE LP 110MM LOCK ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP "$4,135.50" "$3,060.00" $820.79 "$4,135.50" "$1,860.98" "$1,860.98" "$1,860.98" "$1,860.98" "$4,135.50" "$4,135.50" "$4,135.50" $861.94 "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" $861.88 "$4,135.50" "$4,135.50" "$2,038.80" "$4,135.50" "$4,135.50" "$4,135.50" "$4,135.50" "$3,101.63" "$4,135.50" "$4,135.50" "$4,135.50" "$2,067.75" "$2,067.75" "$3,275.32" "$4,135.50" "$3,308.40" "$1,860.98" $820.79 N/A "$2,398.59" "$4,135.50" "$2,481.30" "$4,135.50" $861.84 "$4,135.50" N/A N/A 8762H SUP Custom 27203010 8762H - SUTURE NABSB 3-0 SH-1 30IN BLU PRLN 2 ARM MFL BOTH IP/OP $554.50 $410.00 $98.69 $554.42 $554.42 $554.42 $554.42 $554.42 $554.42 $554.42 $98.69 $554.42 $554.42 $411.49 $411.49 $427.35 $288.85 $115.55 $554.42 $221.77 $554.42 $554.42 $554.42 $554.42 $554.42 $415.88 $554.42 $554.42 $554.42 $277.21 $277.21 $439.10 $554.42 $443.54 $360.37 $554.42 N/A $321.61 $554.42 $332.65 $554.42 $554.42 $554.42 N/A N/A 876-310 SUP HCPCS C1713 876-310 - SCREW BONE 4MM 10MM VAR ANG SELF DRILL ATLANTIS GREEN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-311 SUP HCPCS C1713 876-311 - SCREW BONE 4MM 11MM VAR ANG SELF DRILL ATLANTIS GREEN BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-312 SUP HCPCS C1713 876-312 - SCREW BN 4MM 12MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-313 SUP HCPCS C1713 876-313 - SCREW BN 4MM 13MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-314 SUP HCPCS C1713 876-314 - SCREW BN 4MM 14MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-315 SUP HCPCS C1713 876-315 - SCREW BN 4MM 15MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-316 SUP HCPCS C1713 876-316 - SCREW BN 4MM 16MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-317 SUP HCPCS C1713 876-317 - SCREW BN 4MM 17MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-318 SUP HCPCS C1713 876-318 - SCREW BN 4MM 18MM GRN STRL ATLNTS VA TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-319 SUP HCPCS C1713 876-319 - SCREW BONE 4MM 19MM VAR ANG ATLANTIS GREEN TITANIUM SPN CERV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-320 SUP HCPCS C1713 876-320 - SCREW BONE 4MM 20MM VAR ANG ATLANTIS GREEN TITANIUM SPN CERV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-321 SUP HCPCS C1713 876-321 - SCREW BONE 4MM 21MM VAR ANG ATLANTIS GREEN TITANIUM SPN CERV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-353 SUP HCPCS C1713 876-353 - SCREW BN 4.5MM 13MM MAG STRL ATLNTS VA TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-355 SUP HCPCS C1713 876-355 - SCREW BN 4.5MM 15MM MAG STRL ATLNTS VA TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-357 SUP HCPCS C1713 876-357 - SCREW BN 4.5MM 17MM MAG STRL ATLNTS VA TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-404 SUP HCPCS C1713 876-404 - PIN HOLDING PLATE ATLANTIS TITANIUM SPN CERV ANTERIOR BOTH IP/OP $219.00 $162.00 $43.47 $219.00 $98.55 $98.55 $98.55 $98.55 $219.00 $219.00 $219.00 $45.65 $219.00 $219.00 $219.00 $219.00 $219.00 $45.64 $219.00 $219.00 $129.54 $219.00 $219.00 $219.00 $219.00 $164.25 $219.00 $219.00 $219.00 $109.50 $109.50 $173.45 $219.00 $175.20 $98.55 $43.47 N/A $127.02 $219.00 $131.40 $219.00 $45.64 $219.00 N/A N/A 876-443 SUP Custom 27203010 876-443 - BIT DRL 3 FLT 13MM STRL ATLNTS DISP BOTH IP/OP $760.00 $562.00 $135.28 $760.00 $760.00 $760.00 $760.00 $760.00 $760.00 $760.00 $135.28 $760.00 $760.00 $564.07 $564.07 $585.81 $395.96 $158.39 $760.00 $304.00 $760.00 $760.00 $760.00 $760.00 $760.00 $570.00 $760.00 $760.00 $760.00 $380.00 $380.00 $601.92 $760.00 $608.00 $494.00 $760.00 N/A $440.80 $760.00 $456.00 $760.00 $760.00 $760.00 N/A N/A 876-455 SUP Custom 27203010 876-455 - BIT DRILL 5MM TRIFLAT ADJUSTABLE ATLANTIS ANTERIOR CERV SPN BOTH IP/OP $501.00 $371.00 $89.18 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $89.18 $501.00 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $200.40 $501.00 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $501.00 N/A $290.58 $501.00 $300.60 $501.00 $501.00 $501.00 N/A N/A 876-612 SUP HCPCS C1713 876-612 - SCREW BN 4MM 12MM STRL ATLNTS VA SLF DRL TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-613 SUP HCPCS C1713 876-613 - SCREW BN 4MM 13MM GRN STRL ATLNTS VA SLF DRL TI SPNE CRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-614 SUP HCPCS C1713 876-614 - SCREW BN 4MM 14MM STRL ATLNTS VA SLF DRL NTNL SPNL CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-615 SUP HCPCS C1713 876-615 - SCREW BN 4MM 15MM GRN STRL ATLNTS VA SLF DRL TI SPNE CRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-643 SUP HCPCS C1713 876-643 - SCREW BN 4.5MM 13MM MAG STRL ATLNTS VA SLF DRL TI SPNE CRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-644 SUP HCPCS C1713 876-644 - SCREW BN 4.5MM 14MM STRL ATLNTS VA SLF DRL NTNL SPNL CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-645 SUP HCPCS C1713 876-645 - SCREW BN 4.5MM 15MM MAG STRL ATLNTS VA SLF DRL TI SPNE CRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-710 SUP HCPCS C1713 876-710 - SCREW BONE 4MM 10MM FIX ANGLE SELF TAP ATLANTIS GRAY BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-711 SUP HCPCS C1713 876-711 - SCREW BONE 4MM 11MM FIX ANGLE SELF TAP ATLANTIS GRAY BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-712 SUP HCPCS C1713 876-712 - SCREW BN 4MM 12MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-713 SUP HCPCS C1713 876-713 - SCREW BN 4MM 13MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-714 SUP HCPCS C1713 876-714 - SCREW BONE 4MM 14MM FIX ANGLE SELF TAP ATLANTIS GRAY BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-715 SUP HCPCS C1713 876-715 - SCREW BN 4MM 15MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-716 SUP HCPCS C1713 876-716 - SCREW BONE 4MM 16MM FIX ANGLE SELF TAP ATLANTIS GRAY BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-717 SUP HCPCS C1713 876-717 - SCREW BONE 4MM 17MM FIX ANGLE SELF TAP ATLANTIS GRAY BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-718 SUP HCPCS C1713 876-718 - SCREW BN 4MM 18MM GRY STRL ATLNTS FX ANG ST TI SPNE CRV CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-753 SUP HCPCS C1713 876-753 - SCREW BN 4.5MM 13MM BLU STRL ATLNTS FX ANG ST TI SPNE CRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-755 SUP HCPCS C1713 876-755 - SCREW BN 4.5MM 15MM BLU STRL ATLNTS FX ANG ST TI SPNE CRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-757 SUP HCPCS C1713 876-757 - SCREW BONE 4.5MM 17MM FIX ANGLE SELF TAP ATLANTIS BLUE BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-810 SUP HCPCS C1713 876-810 - SCREW BONE 4MM 10MM VAR ANG SELF TAP ATLANTIS GREEN TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-811 SUP HCPCS C1713 876-811 - SCREW BONE 4MM 11MM VAR ANG SELF TAP ATLANTIS GREEN TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-812 SUP HCPCS C1713 876-812 - SCREW BN 4MM 12MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-813 SUP HCPCS C1713 876-813 - SCREW BN 4MM 13MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-814 SUP HCPCS C1713 876-814 - SCREW BONE 4MM 14MM VAR ANG SELF TAP ATLANTIS GREEN TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-815 SUP HCPCS C1713 876-815 - SCREW BN 4MM 15MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-816 SUP HCPCS C1713 876-816 - SCREW BONE 4MM 16MM VAR ANG SELF TAP ATLANTIS GREEN TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-817 SUP HCPCS C1713 876-817 - SCREW BONE 4MM 17MM VAR ANG SELF TAP ATLANTIS GREEN TITANIUM BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-818 SUP HCPCS C1713 876-818 - SCREW BN 4MM 18MM GRN STRL ATLNTS VA ST TI SPNE CRV CANC ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 876-853 SUP HCPCS C1713 876-853 - SCREW BONE 4.5MM 13MM VAR ANG SELF TAP ATLANTIS MAGENTA BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-855 SUP HCPCS C1713 876-855 - SCREW BN 4.5MM 15MM MAG STRL ATLNTS VA ST TI SPNE CRV CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-857 SUP HCPCS C1713 876-857 - SCREW BONE 4.5MM 17MM VAR ANG SELF TAP ATLANTIS MAGENTA BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 876-943 SUP Custom 27203010 876-943 - BIT DRILL 13MM ATLANTIS NONSTRL BOTH IP/OP $501.00 $371.00 $89.18 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $89.18 $501.00 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $200.40 $501.00 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $501.00 N/A $290.58 $501.00 $300.60 $501.00 $501.00 $501.00 N/A N/A 876-955 SUP Custom 27203010 876-955 - BIT DRILL ADJUSTABLE ATLANTIS NONSTRL BOTH IP/OP $501.00 $371.00 $89.18 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $501.00 $89.18 $501.00 $501.00 $371.84 $371.84 $386.17 $261.02 $104.41 $501.00 $200.40 $501.00 $501.00 $501.00 $501.00 $501.00 $375.75 $501.00 $501.00 $501.00 $250.50 $250.50 $396.79 $501.00 $400.80 $325.65 $501.00 N/A $290.58 $501.00 $300.60 $501.00 $501.00 $501.00 N/A N/A 8800500A SUP HCPCS C1713 8800500A - SCREW BN 10.5MM 100MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8800510A SUP HCPCS C1713 8800510A - SCREW BN 10.5MM 110MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8800520A SUP HCPCS C1713 8800520A - SCREW BN 10.5MM 120MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8800525A SUP HCPCS C1713 8800525A - SCREW BN 10.5MM 25MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8800530A SUP HCPCS C1713 8800530A - SCREW BN 10.5MM 30MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8800535A SUP HCPCS C1713 8800535A - SCREW BN 10.5MM 35MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8800540A SUP HCPCS C1713 8800540A - SCREW BN 10.5MM 40MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8800545A SUP HCPCS C1713 8800545A - SCREW BN 10.5MM 45MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8800550A SUP HCPCS C1713 8800550A - SCREW BN 10.5MM 50MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8800555A SUP HCPCS C1713 8800555A - SCREW BN 10.5MM 55MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8800560A SUP HCPCS C1713 8800560A - SCREW BN 10.5MM 60MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8800570A SUP HCPCS C1713 8800570A - SCREW BN 10.5MM 70MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8800580A SUP HCPCS C1713 8800580A - SCREW BN 10.5MM 80MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8800590A SUP HCPCS C1713 8800590A - SCREW BN 10.5MM 90MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8804525A SUP HCPCS C1713 8804525A - SCREW BN 4.5MM 25MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 8804530A SUP HCPCS C1713 8804530A - SCREW BN 4.5MM 30MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A 8804535A SUP HCPCS C1713 8804535A - SCREW BN 4.5MM 35MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8804540A SUP HCPCS C1713 8804540A - SCREW BN 4.5MM 40MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8804545A SUP HCPCS C1713 8804545A - SCREW BN 4.5MM 45MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8804550A SUP HCPCS C1713 8804550A - SCREW BN 4.5MM 50MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8804555A SUP HCPCS C1713 8804555A - SCREW BN 4.5MM 55MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8804560A SUP HCPCS C1713 8804560A - SCREW BN 4.5MM 60MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805025A SUP HCPCS C1713 8805025A - SCREW BN 5MM 25MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805030A SUP HCPCS C1713 8805030A - SCREW BN 5MM 30MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805035A SUP HCPCS C1713 8805035A - SCREW BN 5MM 35MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805040A SUP HCPCS C1713 8805040A - SCREW BN 5MM 40MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805045A SUP HCPCS C1713 8805045A - SCREW BN 5MM 45MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805050A SUP HCPCS C1713 8805050A - SCREW BN 5MM 50MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805055A SUP HCPCS C1713 8805055A - SCREW BN 5MM 55MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805060A SUP HCPCS C1713 8805060A - SCREW BN 5MM 60MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805525A SUP HCPCS C1713 8805525A - SCREW BN 5.5MM 25MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805530A SUP HCPCS C1713 8805530A - SCREW BN 5.5MM 30MM NS PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805535A SUP HCPCS C1713 8805535A - SCREW BN 5.5MM 35MM NS PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805540A SUP HCPCS C1713 8805540A - SCREW BONE 40MM POLYAX PRECEPT 5.5MM SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805545A SUP HCPCS C1713 8805545A - SCREW BONE 5.5MM 45MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805550A SUP HCPCS C1713 8805550A - SCREW BONE 5.5MM 50MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805555A SUP HCPCS C1713 8805555A - SCREW BN 5.5MM 55MM NS PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8805560A SUP HCPCS C1713 8805560A - SCREW BN 5.5MM 60MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806025A SUP HCPCS C1713 8806025A - SCREW BN 6MM 25MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806030A SUP HCPCS C1713 8806030A - SCREW BN 6MM 30MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806035A SUP HCPCS C1713 8806035A - SCREW BN 6MM 35MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806040A SUP HCPCS C1713 8806040A - SCREW BN 6MM 40MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806045A SUP HCPCS C1713 8806045A - SCREW BN 6MM 45MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806050A SUP HCPCS C1713 8806050A - SCREW BN 6MM 50MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806055A SUP HCPCS C1713 8806055A - SCREW BN 6MM 55MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806060A SUP HCPCS C1713 8806060A - SCREW BN 6MM 60MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806500A SUP HCPCS C1713 8806500A - SCREW BN 6.5MM 100MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806510A SUP HCPCS C1713 8806510A - SCREW BN 6.5MM 110MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806520A SUP HCPCS C1713 8806520A - SCREW BN 6.5MM 120MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806525A SUP HCPCS C1713 8806525A - SCREW BN 6.5MM 25MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806530A SUP HCPCS C1713 8806530A - SCREW BN 6.5MM 30MM NS PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806535A SUP HCPCS C1713 8806535A - SCREW BN 6.5MM 35MM NS PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806540A SUP HCPCS C1713 8806540A - SCREW BN 6.5MM 40MM NS PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806545A SUP HCPCS C1713 8806545A - SCREW BONE 6.5MM 45MM POLYAX PRECEPT SPN BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806550A SUP HCPCS C1713 8806550A - SCREW BONE 50MM 6.5MM SPN MAS BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806555A SUP HCPCS C1713 8806555A - SCREW BN 6.5MM 55MM NS PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806560A SUP HCPCS C1713 8806560A - SCREW BN 6.5MM 60MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806570A SUP HCPCS C1713 8806570A - SCREW BN 6.5MM 70MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806580A SUP HCPCS C1713 8806580A - SCREW BN 6.5MM 80MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8806590A SUP HCPCS C1713 8806590A - SCREW BN 6.5MM 90MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807000A SUP HCPCS C1713 8807000A - SCREW BN 7MM 100MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807010A SUP HCPCS C1713 8807010A - SCREW BN 7MM 110MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807020A SUP HCPCS C1713 8807020A - SCREW BN 7MM 120MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807025A SUP HCPCS C1713 8807025A - SCREW BN 7MM 25MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807030A SUP HCPCS C1713 8807030A - SCREW BN 7MM 30MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807035A SUP HCPCS C1713 8807035A - SCREW BN 7MM 35MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807040A SUP HCPCS C1713 8807040A - SCREW BN 7MM 40MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807045A SUP HCPCS C1713 8807045A - SCREW BN 7MM 45MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807050A SUP HCPCS C1713 8807050A - SCREW BN 7MM 50MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807060A SUP HCPCS C1713 8807060A - SCREW BN 7MM 60MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807070A SUP HCPCS C1713 8807070A - SCREW BN 7MM 70MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807080A SUP HCPCS C1713 8807080A - SCREW BN 7MM 80MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807090A SUP HCPCS C1713 8807090A - SCREW BN 7MM 90MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807500A SUP HCPCS C1713 8807500A - SCREW BN 7.5MM 100MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807510A SUP HCPCS C1713 8807510A - SCREW BN 7.5MM 110MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807520A SUP HCPCS C1713 8807520A - SCREW BN 7.5MM 120MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807525A SUP HCPCS C1713 8807525A - SCREW BN 7.5MM 25MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807530A SUP HCPCS C1713 8807530A - SCREW BN 7.5MM 30MM NS PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807535A SUP HCPCS C1713 8807535A - SCREW BN 7.5MM 35MM NS PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807540A SUP HCPCS C1713 8807540A - SCREW BN 7.5MM 40MM NS PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807545A SUP HCPCS C1713 8807545A - SCREW BN 7.5MM 45MM NS PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807550A SUP HCPCS C1713 8807550A - SCREW BN 7.5MM 50MM NS PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807555A SUP HCPCS C1713 8807555A - SCREW BN 7.5MM 55MM NS PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807560A SUP HCPCS C1713 8807560A - SCREW BN 7.5MM 60MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807570A SUP HCPCS C1713 8807570A - SCREW BN 7.5MM 70MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807580A SUP HCPCS C1713 8807580A - SCREW BN 7.5MM 80MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8807590A SUP HCPCS C1713 8807590A - SCREW BN 7.5MM 90MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808500A SUP HCPCS C1713 8808500A - SCREW BN 8.5MM 100MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808510A SUP HCPCS C1713 8808510A - SCREW BN 8.5MM 110MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808520A SUP HCPCS C1713 8808520A - SCREW BN 8.5MM 120MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808525A SUP HCPCS C1713 8808525A - SCREW BN 8.5MM 25MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808530A SUP HCPCS C1713 8808530A - SCREW BN 8.5MM 30MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808535A SUP HCPCS C1713 8808535A - SCREW BN 8.5MM 35MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808540A SUP HCPCS C1713 8808540A - SCREW BN 8.5MM 40MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808545A SUP HCPCS C1713 8808545A - SCREW BN 8.5MM 45MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808550A SUP HCPCS C1713 8808550A - SCREW BN 8.5MM 50MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808555A SUP HCPCS C1713 8808555A - SCREW BN 8.5MM 55MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808560A SUP HCPCS C1713 8808560A - SCREW BN 8.5MM 60MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808570A SUP HCPCS C1713 8808570A - SCREW BN 8.5MM 70MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808580A SUP HCPCS C1713 8808580A - SCREW BN 8.5MM 80MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8808590A SUP HCPCS C1713 8808590A - SCREW BN 8.5MM 90MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8809500A SUP HCPCS C1713 8809500A - SCREW BN 9.5MM 100MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8809510A SUP HCPCS C1713 8809510A - SCREW BN 9.5MM 110MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8809520A SUP HCPCS C1713 8809520A - SCREW BN 9.5MM 120MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8809525A SUP HCPCS C1713 8809525A - SCREW BN 9.5MM 25MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8809530A SUP HCPCS C1713 8809530A - SCREW BN 9.5MM 30MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8809535A SUP HCPCS C1713 8809535A - SCREW BN 9.5MM 35MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8809540A SUP HCPCS C1713 8809540A - SCREW BN 9.5MM 40MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8809545A SUP HCPCS C1713 8809545A - SCREW BN 9.5MM 45MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8809550A SUP HCPCS C1713 8809550A - SCREW BN 9.5MM 50MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8809555A SUP HCPCS C1713 8809555A - SCREW BN 9.5MM 55MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8809560A SUP HCPCS C1713 8809560A - SCREW BN 9.5MM 60MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8809570A SUP HCPCS C1713 8809570A - SCREW BN 9.5MM 70MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8809580A SUP HCPCS C1713 8809580A - SCREW BN 9.5MM 80MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8809590A SUP HCPCS C1713 8809590A - SCREW BN 9.5MM 90MM PRCPT PA SPNE BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 8829-01 SUP Custom 27203010 8829-01 - PADDING CAST 36X21X.25IN ORTHOPEDIC LATEX FREE WHITE FELT BOTH IP/OP $17.50 $13.00 $3.11 $24.00 $17.45 $17.45 $17.45 $17.45 $17.45 $17.45 $3.11 $17.45 $17.45 $12.95 $12.95 $13.45 $9.09 $3.64 $17.45 $9.60 $17.45 $17.45 $24.00 $17.45 $17.45 $13.13 $17.45 $17.45 $17.45 $8.73 $8.73 $13.82 $17.45 $13.96 $11.34 $17.45 N/A $10.15 $17.45 $10.47 $17.45 $17.45 $17.45 N/A N/A 8872H SUP Custom 27203010 8872H - SUTURE NONABSORBABLE 3-0 RB-1 30IN MONOFILAMENT PROLENE BLUE BOTH IP/OP $338.00 $250.00 $60.10 $347.40 $337.65 $337.65 $337.65 $337.65 $337.65 $337.65 $60.10 $337.65 $337.65 $250.60 $250.60 $260.26 $175.92 $70.37 $337.65 $138.96 $337.65 $337.65 $347.40 $337.65 $337.65 $253.50 $337.65 $337.65 $337.65 $168.83 $168.83 $267.42 $337.65 $270.12 $219.47 $337.65 N/A $196.04 $337.65 $202.59 $337.65 $337.65 $337.65 N/A N/A 8888146044P SUP HCPCS C1750 8888146044P - KIT CATHETER 61CM 44CM SYMMETRICAL TIP PALINDROME PRECISION BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A 8900-4003 SUP Custom 27203010 8900-4003 - ELECTRODE DEFIBRILLATOR RECTANGULAR 24IN MULTIFUNCTION CLOSE BOTH IP/OP $73.00 $54.00 $12.97 $72.85 $72.85 $72.85 $72.85 $72.85 $72.85 $72.85 $12.97 $72.85 $72.85 $54.07 $54.07 $56.15 $37.95 $15.18 $72.85 $29.14 $72.85 $72.85 $72.85 $72.85 $72.85 $54.75 $72.85 $72.85 $72.85 $36.43 $36.43 $57.70 $72.85 $58.28 $47.35 $72.85 N/A $42.34 $72.85 $43.71 $72.85 $72.85 $72.85 N/A N/A 890-120 SUP Custom 27803010 890-120 - CAGE SPNL 20MMX12MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-125 SUP Custom 27803010 890-125 - CAGE SPNL 25MMX12MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-140 SUP Custom 27803010 890-140 - CAGE SPNL 20MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-143 SUP Custom 27803010 890-143 - CAGE SPNL 23MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-146 SUP Custom 27803010 890-146 - CAGE SPNL 26MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-149 SUP Custom 27803010 890-149 - CAGE SPNL 29MMX14MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-160 SUP Custom 27803010 890-160 - CAGE SPNL 20MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-163 SUP Custom 27803010 890-163 - CAGE SPNL 23MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-166 SUP Custom 27803010 890-166 - CAGE SPNL 26MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-169 SUP Custom 27803010 890-169 - CAGE SPNL 29MMX16MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-180 SUP Custom 27803010 890-180 - CAGE SPNL 20MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-183 SUP Custom 27803010 890-183 - CAGE SPNL 23MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-186 SUP Custom 27803010 890-186 - CAGE SPNL 26MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-189 SUP Custom 27803010 890-189 - CAGE SPNL 29MMX18MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-200 SUP Custom 27803010 890-200 - CAGE SPNL 20MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-203 SUP Custom 27803010 890-203 - CAGE SPNL 23MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-206 SUP Custom 27803010 890-206 - CAGE SPNL 26MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-209 SUP Custom 27803010 890-209 - CAGE SPNL 29MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-220 SUP Custom 27803010 890-220 - CAGE SPNL 20MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-223 SUP Custom 27803010 890-223 - CAGE SPNL 23MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-226 SUP Custom 27803010 890-226 - CAGE SPNL 26MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-229 SUP Custom 27803010 890-229 - CAGE SPNL 29MMX22MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-240 SUP Custom 27803010 890-240 - CAGE SPNL 24MMX20MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-243 SUP Custom 27803010 890-243 - CAGE SPNL 24MMX23MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-244 SUP HCPCS C1713 890-244 - PLUG SPINAL 12MM PRESS BOTH IP/OP $541.50 $401.00 $107.47 $541.50 $243.68 $243.68 $243.68 $243.68 $541.50 $541.50 $541.50 $112.86 $541.50 $541.50 $541.50 $541.50 $541.50 $112.85 $541.50 $216.60 $320.30 $541.50 $541.50 $541.50 $541.50 $406.13 $541.50 $541.50 $541.50 $270.75 $270.75 $428.87 $541.50 $433.20 $243.68 $107.47 N/A $314.07 $541.50 $541.50 $541.50 $112.85 $541.50 N/A N/A 890-246 SUP Custom 27803010 890-246 - CAGE SPNL 26MMX24MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-249 SUP Custom 27803010 890-249 - CAGE SPNL 29MMX24MM LF INTRFX L-CG THRD CNCT TI LMBR INTRBD BOTH IP/OP "$7,500.00" "$5,550.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,335.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A 890-444 SUP HCPCS C1713 890-444 - PRESS SURG 14MM PLUG BONE REUSABLE BOTH IP/OP $541.50 $401.00 $107.47 $541.50 $243.68 $243.68 $243.68 $243.68 $541.50 $541.50 $541.50 $112.86 $541.50 $541.50 $541.50 $541.50 $541.50 $112.85 $541.50 $216.60 $320.30 $541.50 $541.50 $541.50 $541.50 $406.13 $541.50 $541.50 $541.50 $270.75 $270.75 $428.87 $541.50 $433.20 $243.68 $107.47 N/A $314.07 $541.50 $324.90 $541.50 $112.85 $541.50 N/A N/A 890-999 SUP HCPCS C1713 890-999 - SCREW BONE 4.5MM 19MM LATERAL EXTENDED SPN REPLACEMENT BOTH IP/OP $42.00 $31.00 $8.34 $42.00 $18.90 $18.90 $18.90 $18.90 $42.00 $42.00 $42.00 $8.75 $42.00 $42.00 $42.00 $42.00 $42.00 $8.75 $42.00 $42.00 $24.84 $42.00 $42.00 $42.00 $42.00 $31.50 $42.00 $42.00 $42.00 $21.00 $21.00 $33.26 $42.00 $33.60 $18.90 $8.34 N/A $24.36 $42.00 $25.20 $42.00 $8.75 $42.00 N/A N/A 89104EH SUP HCPCS C1713 89104EH - SCREW SET BREAKOFF CD HORIZON M10 SPN T25 BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 89104EHT SUP HCPCS C1713 89104EHT - SET SCR CD HZN M10 BRKOF TI SPNE PDCL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A 89-2505 SUP Custom 27203010 89-2505 - KIT SRG OB EMS BOTH IP/OP $19.50 $14.00 $3.41 $19.18 $19.18 $19.18 $19.18 $19.18 $19.18 $19.18 $3.41 $19.18 $19.18 $14.24 $14.24 $14.78 $9.99 $4.00 $19.18 $7.67 $19.18 $19.18 $19.18 $19.18 $19.18 $14.63 $19.18 $19.18 $19.18 $9.59 $9.59 $15.19 $19.18 $15.34 $12.47 $19.18 N/A $11.31 $19.18 $11.51 $19.18 $19.18 $19.18 N/A N/A 8941420P SUP Custom 27803010 8941420P - CAGE SPNL 14MM 20X17MM LTCG TI LMBR TPR FSN DEV BOTH IP/OP "$7,865.00" "$5,820.00" "$1,399.97" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$1,399.97" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$1,639.15" "$7,865.00" "$3,146.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$5,898.75" "$7,865.00" "$7,865.00" "$7,865.00" "$3,932.50" "$3,932.50" "$6,229.08" "$7,865.00" "$6,292.00" "$3,539.25" "$7,865.00" N/A "$4,561.70" "$7,865.00" "$4,719.00" "$7,865.00" "$7,865.00" "$7,865.00" N/A N/A 8941423P SUP Custom 27803010 8941423P - CAGE SPNL 14MM 23X17.5MM LTCG PEEK-OPTM LMBR TPR FSN DEV BOTH IP/OP "$7,865.00" "$5,820.00" "$1,399.97" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$1,399.97" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$1,639.15" "$7,865.00" "$3,146.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$5,898.75" "$7,865.00" "$7,865.00" "$7,865.00" "$3,932.50" "$3,932.50" "$6,229.08" "$7,865.00" "$6,292.00" "$3,539.25" "$7,865.00" N/A "$4,561.70" "$7,865.00" "$4,719.00" "$7,865.00" "$7,865.00" "$7,865.00" N/A N/A 8941620P SUP Custom 27803010 8941620P - CAGE SPNL 16MM 20X19MM LTCG PEEK-OPTM LMBR TPR FSN DEV BOTH IP/OP "$7,865.00" "$5,820.00" "$1,399.97" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$1,399.97" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$1,639.15" "$7,865.00" "$3,146.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$5,898.75" "$7,865.00" "$7,865.00" "$7,865.00" "$3,932.50" "$3,932.50" "$6,229.08" "$7,865.00" "$6,292.00" "$3,539.25" "$7,865.00" N/A "$4,561.70" "$7,865.00" "$4,719.00" "$7,865.00" "$7,865.00" "$7,865.00" N/A N/A 8941623P SUP Custom 27803010 8941623P - CAGE SPNL 16MM 23X19MM LTCG TI LMBR TPR FSN DEV BOTH IP/OP "$7,865.00" "$5,820.00" "$1,399.97" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$1,399.97" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$1,639.15" "$7,865.00" "$3,146.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$5,898.75" "$7,865.00" "$7,865.00" "$7,865.00" "$3,932.50" "$3,932.50" "$6,229.08" "$7,865.00" "$6,292.00" "$3,539.25" "$7,865.00" N/A "$4,561.70" "$7,865.00" "$4,719.00" "$7,865.00" "$7,865.00" "$7,865.00" N/A N/A 8941626P SUP Custom 27803010 8941626P - CAGE SPNL 16MM 26X20MM LTCG PEEK-OPTM LMBR TPR FSN DEV BOTH IP/OP "$7,865.00" "$5,820.00" "$1,399.97" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$1,399.97" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$1,639.15" "$7,865.00" "$3,146.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$5,898.75" "$7,865.00" "$7,865.00" "$7,865.00" "$3,932.50" "$3,932.50" "$6,229.08" "$7,865.00" "$6,292.00" "$3,539.25" "$7,865.00" N/A "$4,561.70" "$7,865.00" "$4,719.00" "$7,865.00" "$7,865.00" "$7,865.00" N/A N/A 8941823P SUP Custom 27803010 8941823P - CAGE SPNL 18MM 23X21.5MM LTCG PEEK-OPTM LMBR TPR FSN DEV BOTH IP/OP "$7,865.00" "$5,820.00" "$1,399.97" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$1,399.97" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$1,639.15" "$7,865.00" "$3,146.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$5,898.75" "$7,865.00" "$7,865.00" "$7,865.00" "$3,932.50" "$3,932.50" "$6,229.08" "$7,865.00" "$6,292.00" "$3,539.25" "$7,865.00" N/A "$4,561.70" "$7,865.00" "$4,719.00" "$7,865.00" "$7,865.00" "$7,865.00" N/A N/A 8941826P SUP Custom 27803010 8941826P - CAGE SPNL 18MM 26X22MM LTCG PEEK-OPTM LMBR TPR FSN DEV BOTH IP/OP "$7,865.00" "$5,820.00" "$1,399.97" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$1,399.97" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$1,639.15" "$7,865.00" "$3,146.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$7,865.00" "$5,898.75" "$7,865.00" "$7,865.00" "$7,865.00" "$3,932.50" "$3,932.50" "$6,229.08" "$7,865.00" "$6,292.00" "$3,539.25" "$7,865.00" N/A "$4,561.70" "$7,865.00" "$4,719.00" "$7,865.00" "$7,865.00" "$7,865.00" N/A N/A 89690E SUP Custom 27203010 89690E - HOLDER IMPLANT CURVE RED BOTH IP/OP "$2,295.00" "$1,698.00" $408.51 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" $408.51 "$2,295.00" "$2,295.00" "$1,703.35" "$1,703.35" "$1,768.99" "$1,195.70" $478.30 "$2,295.00" $918.00 "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$2,295.00" "$1,721.25" "$2,295.00" "$2,295.00" "$2,295.00" "$1,147.50" "$1,147.50" "$1,817.64" "$2,295.00" "$1,836.00" "$1,491.75" "$2,295.00" N/A "$1,331.10" "$2,295.00" "$1,377.00" "$2,295.00" "$2,295.00" "$2,295.00" N/A N/A 8AC50 SUP Custom 27203010 8AC50 - TOOL DISSECTING ACORN 5MM 8CM FLUTED MIDAS REX LEGEND BOTH IP/OP $321.00 $238.00 $57.12 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $57.12 $320.88 $320.88 $238.16 $238.16 $247.33 $167.18 $66.87 $320.88 $128.35 $320.88 $320.88 $320.88 $320.88 $320.88 $240.75 $320.88 $320.88 $320.88 $160.44 $160.44 $254.14 $320.88 $256.70 $208.57 $320.88 N/A $186.18 $320.88 $192.53 $320.88 $320.88 $320.88 N/A N/A 8AC60 SUP Custom 27203010 8AC60 - TOOL DISSECTING ACORN 6MM 8CM FLUTED MIDAS REX LEGEND BOTH IP/OP $321.00 $238.00 $57.12 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $57.12 $320.88 $320.88 $238.16 $238.16 $247.33 $167.18 $66.87 $320.88 $128.35 $320.88 $320.88 $320.88 $320.88 $320.88 $240.75 $320.88 $320.88 $320.88 $160.44 $160.44 $254.14 $320.88 $256.70 $208.57 $320.88 N/A $186.18 $320.88 $192.53 $320.88 $320.88 $320.88 N/A N/A 8CN85H SUP Custom 27203010 8CN85H - TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUF DISP INR CNN BOTH IP/OP $94.00 $70.00 $16.68 $117.10 $93.68 $93.68 $93.68 $93.68 $93.68 $93.68 $16.68 $93.68 $93.68 $69.53 $69.53 $72.21 $48.81 $19.52 $93.68 $46.84 $93.68 $93.68 $117.10 $93.68 $93.68 $70.50 $93.68 $93.68 $93.68 $46.84 $46.84 $74.19 $93.68 $74.94 $60.89 $93.68 N/A $54.52 $93.68 $56.21 $93.68 $93.68 $93.68 N/A N/A 8DCFN SUP Custom 27203010 8DCFN - TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUFLS DISP INR BOTH IP/OP $84.00 $62.00 $14.91 $83.74 $83.74 $83.74 $83.74 $83.74 $83.74 $83.74 $14.91 $83.74 $83.74 $62.15 $62.15 $64.55 $43.63 $17.45 $83.74 $33.50 $83.74 $83.74 $83.74 $83.74 $83.74 $63.00 $83.74 $83.74 $83.74 $41.87 $41.87 $66.32 $83.74 $66.99 $54.43 $83.74 N/A $48.72 $83.74 $50.24 $83.74 $83.74 $83.74 N/A N/A 8DCFS SUP Custom 27203010 8DCFS - TUBE TRCH 8 12.2MM 79MM SHLY UNCUF DISP INR CNN BVL TIP BOTH IP/OP $89.00 $66.00 $15.77 $88.58 $88.58 $88.58 $88.58 $88.58 $88.58 $88.58 $15.77 $88.58 $88.58 $65.74 $65.74 $68.28 $46.15 $18.46 $88.58 $35.43 $88.58 $88.58 $88.58 $88.58 $88.58 $66.75 $88.58 $88.58 $88.58 $44.29 $44.29 $70.16 $88.58 $70.86 $57.58 $88.58 N/A $51.62 $88.58 $53.15 $88.58 $88.58 $88.58 N/A N/A 8DFEN SUP Custom 27203010 8DFEN - TUBE TRCH 8 12.2MM 7.6MM 79MM STRL LF SHLY CUF DISP INR CNN BOTH IP/OP $99.50 $74.00 $17.70 $99.43 $99.43 $99.43 $99.43 $99.43 $99.43 $99.43 $17.70 $99.43 $99.43 $73.80 $73.80 $76.64 $51.80 $20.72 $99.43 $39.77 $99.43 $99.43 $99.43 $99.43 $99.43 $74.63 $99.43 $99.43 $99.43 $49.72 $49.72 $78.75 $99.43 $79.54 $64.63 $99.43 N/A $57.71 $99.43 $59.66 $99.43 $99.43 $99.43 N/A N/A 8LGT SUP Custom 27203010 8LGT - TUBE TRACHEOSTOMY 8 12.6MM 15MM 7.6MM 50MM CUFFLESS BOTH IP/OP $115.00 $85.00 $20.42 $114.73 $114.73 $114.73 $114.73 $114.73 $114.73 $114.73 $20.42 $114.73 $114.73 $85.15 $85.15 $88.43 $59.77 $23.91 $114.73 $45.89 $114.73 $114.73 $114.73 $114.73 $114.73 $86.25 $114.73 $114.73 $114.73 $57.37 $57.37 $90.87 $114.73 $91.78 $74.57 $114.73 N/A $66.70 $114.73 $68.84 $114.73 $114.73 $114.73 N/A N/A 8MH22D SUP Custom 27203010 8MH22D - TOOL DISSECTING MATCH HEAD 2.2MM 8CM DIAMOND MIDAS REX BOTH IP/OP $295.50 $219.00 $52.58 $295.38 $295.38 $295.38 $295.38 $295.38 $295.38 $295.38 $52.58 $295.38 $295.38 $219.23 $219.23 $227.68 $153.89 $61.56 $295.38 $118.15 $295.38 $295.38 $295.38 $295.38 $295.38 $221.63 $295.38 $295.38 $295.38 $147.69 $147.69 $233.94 $295.38 $236.30 $192.00 $295.38 N/A $171.39 $295.38 $177.23 $295.38 $295.38 $295.38 N/A N/A 8SCT SUP Custom 27203010 8SCT - TUBE TRACHEOSTOMY 8 10.9MM 8MM 89MM 1 CANNU CUFF SMOOTH BOTH IP/OP $71.50 $53.00 $12.71 $71.38 $71.38 $71.38 $71.38 $71.38 $71.38 $71.38 $12.71 $71.38 $71.38 $52.98 $52.98 $55.02 $37.19 $14.88 $71.38 $70.99 $71.38 $71.38 $71.38 $71.38 $71.38 $53.63 $71.38 $71.38 $71.38 $35.69 $35.69 $56.53 $71.38 $57.10 $46.40 $71.38 N/A $41.47 $71.38 $42.83 $71.38 $71.38 $71.38 N/A N/A 8TA17 SUP Custom 27203010 8TA17 - TOOL DISSECTING TAPER 1.7MM 8CM MIDAS REX LEGEND STERILE BOTH IP/OP $266.00 $197.00 $47.28 $265.63 $265.63 $265.63 $265.63 $265.63 $265.63 $265.63 $47.28 $265.63 $265.63 $197.15 $197.15 $204.75 $138.39 $55.36 $265.63 $106.25 $265.63 $265.63 $265.63 $265.63 $265.63 $199.50 $265.63 $265.63 $265.63 $132.82 $132.82 $210.38 $265.63 $212.50 $172.66 $265.63 N/A $154.28 $265.63 $159.38 $265.63 $265.63 $265.63 N/A N/A 8TD084 SUP Custom 27203010 8TD084 - DRILL TWIST .8MM 8CM 4MM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $389.00 $288.00 $69.22 $388.88 $388.88 $388.88 $388.88 $388.88 $388.88 $388.88 $69.22 $388.88 $388.88 $288.63 $288.63 $299.75 $202.61 $81.05 $388.88 $155.55 $388.88 $388.88 $388.88 $388.88 $388.88 $291.75 $388.88 $388.88 $388.88 $194.44 $194.44 $307.99 $388.88 $311.10 $252.77 $388.88 N/A $225.62 $388.88 $233.33 $388.88 $388.88 $388.88 N/A N/A 8TD104 SUP Custom 27203010 8TD104 - DRILL TWIST 1MM 8CM 4MM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD114 SUP Custom 27203010 8TD114 - DRILL TWIST 1.1MM 8CM 4MM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD116 SUP Custom 27203010 8TD116 - DRILL TWIST 6MM 1.1MM 8CM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD124 SUP Custom 27203010 8TD124 - DRILL TWIST 1.2MM 8CM 6MM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD126 SUP Custom 27203010 8TD126 - DRILL TWIST 1.2MM 8CM 6MM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD134 SUP Custom 27203010 8TD134 - DRILL TWIST 4MM 1.3MM 8CM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD136 SUP Custom 27203010 8TD136 - DRILL TWIST 6MM 1.3MM 8CM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD154 SUP Custom 27203010 8TD154 - DRILL TWIST 4MM 1.5MM 8CM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD156 SUP Custom 27203010 8TD156 - DRILL TWIST 1.5MM 8CM 6MM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD158 SUP Custom 27203010 8TD158 - DRILL TWIST 1.5MM 8CM 8MM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD174 SUP Custom 27203010 8TD174 - DRILL TWIST 1.7MM 8CM 4MM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD176 SUP Custom 27203010 8TD176 - DRILL TWIST 1.7MM 8CM 6MM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD178 SUP Custom 27203010 8TD178 - DRILL TWIST 1.7MM 8CM 8MM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD204 SUP Custom 27203010 8TD204 - DRILL TWIST 2MM 8CM 4MM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD206 SUP Custom 27203010 8TD206 - DRILL TWIST 2MM 8CM 6MM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 8TD208 SUP Custom 27203010 8TD208 - DRILL TWIST 2MM 8CM 8MM STOP MIDAS REX LEGEND STERILE BOTH IP/OP $240.50 $178.00 $42.74 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $240.13 $42.74 $240.13 $240.13 $178.22 $178.22 $185.09 $125.11 $50.05 $240.13 $96.05 $240.13 $240.13 $240.13 $240.13 $240.13 $180.38 $240.13 $240.13 $240.13 $120.07 $120.07 $190.18 $240.13 $192.10 $156.08 $240.13 N/A $139.49 $240.13 $144.08 $240.13 $240.13 $240.13 N/A N/A 9001C0212 SUP Custom 27203010 9001C0212 - GUIDE NEEDLE 18GA 1.5-2.5CM KIT GEL 2 BAND PREFOLDED SHEATH BOTH IP/OP $6.50 $5.00 $1.08 $6.09 $6.09 $6.09 $6.09 $6.09 $6.09 $6.09 $1.08 $6.09 $6.09 $4.52 $4.52 $4.69 $3.17 $1.27 $6.09 $2.44 $6.09 $6.09 $6.09 $6.09 $6.09 $4.88 $6.09 $6.09 $6.09 $3.05 $3.05 $4.82 $6.09 $4.87 $3.96 $6.09 N/A $3.77 $6.09 $3.65 $6.09 $6.09 $6.09 N/A N/A 9001C0212 SUP Custom 27203010 9001C0212 - KIT NDL GD 18GA 48IN STRL LF DISP STRT US SYS BOTH IP/OP $61.00 $45.00 $1.08 $45.75 $6.09 $6.09 $6.09 $6.09 $6.09 $6.09 $1.08 $6.09 $6.09 $4.52 $4.52 $4.69 $3.17 $1.27 $6.09 $2.44 $6.09 $6.09 $6.09 $6.09 $6.09 $45.75 $6.09 $6.09 $6.09 $3.05 $3.05 $4.82 $6.09 $4.87 $3.96 $6.09 N/A $35.38 $6.09 $3.65 $6.09 $6.09 $6.09 N/A N/A 9001G SUP Custom 27203010 9001G - SUTURE NONABSORBABLE 10-0 CS160-6 6IN 2 ARM MONOFILAMENT BOTH IP/OP $49.00 $36.00 $8.66 $48.64 $48.64 $48.64 $48.64 $48.64 $48.64 $48.64 $8.66 $48.64 $48.64 $36.10 $36.10 $37.49 $25.34 $10.14 $48.64 $19.46 $48.64 $48.64 $48.64 $48.64 $48.64 $36.75 $48.64 $48.64 $48.64 $24.32 $24.32 $38.52 $48.64 $38.91 $31.62 $48.64 N/A $28.42 $48.64 $29.18 $48.64 $48.64 $48.64 N/A N/A 9001-VC-005 SUP Custom 27203010 9001-VC-005 - NEEDLE IO OD 15GA 25MM STRL LF EZIO EZ-CNCT WRST BAND STD LL BOTH IP/OP $275.00 $204.00 $48.95 $341.50 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $48.95 $275.00 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $136.60 $275.00 $275.00 $341.50 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $275.00 N/A $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A 9003 B SUP Custom 27803010 9003 B - KIT SHUNT SMALL MEDIUM INTEGRAL CNTOUR BOTH IP/OP $860.00 $636.00 $153.04 $859.75 $859.75 $859.75 $859.75 $859.75 $859.75 $859.75 $153.04 $859.75 $859.75 $859.75 $859.75 $859.75 $859.75 $179.18 $859.75 $343.90 $859.75 $859.75 $859.75 $859.75 $859.75 $645.00 $859.75 $859.75 $859.75 $429.88 $429.88 $680.92 $859.75 $687.80 $386.89 $859.75 N/A $498.80 $859.75 $515.85 $859.75 $859.75 $859.75 N/A N/A 900-601 SUP HCPCS C1769 900-601 - GWIRE ORTH 150MM 1.6MM DRILL TIP NONSTRL BOTH IP/OP $109.00 $81.00 $21.56 $108.65 $59.00 $59.00 $59.00 $59.00 $108.65 $108.65 $108.65 $22.65 $108.65 $80.64 $80.64 $83.75 $56.61 $22.64 $108.65 $108.65 $64.27 $108.65 $108.65 $108.65 $108.65 $81.75 $108.65 $108.65 $108.65 $54.33 $54.33 $86.05 $108.65 $86.92 $70.62 $21.56 N/A $63.22 $108.65 $108.65 $108.65 $22.64 $108.65 N/A N/A 9007 H SUP Custom 27803010 9007 H - CATHETER DRAIN STANDARD HIGH CLOSURE PRESSURE CSF CARDIAC BOTH IP/OP $606.00 $448.00 $107.80 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $107.80 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $126.22 $605.63 $242.25 $605.63 $605.63 $605.63 $605.63 $605.63 $454.50 $605.63 $605.63 $605.63 $302.82 $302.82 $479.66 $605.63 $484.50 $272.53 $605.63 N/A $351.48 $605.63 $363.38 $605.63 $605.63 $605.63 N/A N/A 9007 L SUP Custom 27803010 9007 L - CATHETER DRAIN STANDARD LOW CLOSURE PRESSURE CSF CARDIAC BOTH IP/OP $606.00 $448.00 $107.80 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $107.80 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $126.22 $605.63 $242.25 $605.63 $605.63 $605.63 $605.63 $605.63 $454.50 $605.63 $605.63 $605.63 $302.82 $302.82 $479.66 $605.63 $484.50 $272.53 $605.63 N/A $351.48 $605.63 $363.38 $605.63 $605.63 $605.63 N/A N/A 9007 M SUP Custom 27803010 9007 M - CATHETER DRAIN STANDARD MEDIUM CLOSURE PRESSURE CSF CARDIAC BOTH IP/OP $606.00 $448.00 $107.80 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $107.80 $605.63 $605.63 $605.63 $605.63 $605.63 $605.63 $126.22 $605.63 $242.25 $605.63 $605.63 $605.63 $605.63 $605.63 $454.50 $605.63 $605.63 $605.63 $302.82 $302.82 $479.66 $605.63 $484.50 $272.53 $605.63 N/A $351.48 $605.63 $363.38 $605.63 $605.63 $605.63 N/A N/A 9009 B-H SUP Custom 27803010 9009 B-H - SHUNT NEUROSURGICAL SMALL 90CM HIGH PRESSURE CNTOUR INTEGRAL BOTH IP/OP "$2,658.00" "$1,967.00" $473.06 "$2,657.63" "$2,657.63" "$2,657.63" "$2,657.63" "$2,657.63" "$2,657.63" "$2,657.63" $473.06 "$2,657.63" "$2,657.63" "$2,657.63" "$2,657.63" "$2,657.63" "$2,657.63" $553.88 "$2,657.63" "$1,063.05" "$2,657.63" "$2,657.63" "$2,657.63" "$2,657.63" "$2,657.63" "$1,993.50" "$2,657.63" "$2,657.63" "$2,657.63" "$1,328.82" "$1,328.82" "$2,104.84" "$2,657.63" "$2,126.10" "$1,195.93" "$2,657.63" N/A "$1,541.64" "$2,657.63" "$1,594.58" "$2,657.63" "$2,657.63" "$2,657.63" N/A N/A 9009 B-L SUP Custom 27803010 9009 B-L - SHUNT NEUROSURGICAL SMALL 90CM LOW PRESSURE CNTOUR INTEGRAL BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 9009 B-M SUP Custom 27803010 9009 B-M - SHUNT NEUROSURGICAL SMALL 90CM MEDIUM PRESSURE CNTOUR BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 901-118 SUP Custom 27803010 901-118 - SHUNT NS INTRO PRTNL BOTH IP/OP $127.00 $94.00 $22.61 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $22.61 $127.00 $127.00 $127.00 $127.00 $127.00 $127.00 $26.47 $127.00 $50.80 $127.00 $127.00 $127.00 $127.00 $127.00 $95.25 $127.00 $127.00 $127.00 $63.50 $63.50 $100.58 $127.00 $101.60 $57.15 $127.00 N/A $73.66 $127.00 $76.20 $127.00 $127.00 $127.00 N/A N/A 90129-203 SUP HCPCS C1874 90129-203 - STENT TRCHBR LOPRFL 18MM 22FR 56MM NS AERO OTW FULL CVR FLXB BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 90129-204 SUP HCPCS C1874 90129-204 - STENT TRCHBR GMTR 16MM 22FR 40MM NS 61CM AERO OTW FLLY CVR BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 90129-206 SUP HCPCS C1874 90129-206 - STENT TRCHBR LOPRFL 16MM 22FR 56MM NS AERO OTW FULL CVR FLXB BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 90129-207 SUP HCPCS C1874 90129-207 - STENT TRCHBR GMTR 10MM 16FR 20MM NS 63CM AERO OTW FLLY CVR BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 90129-209 SUP HCPCS C1874 90129-209 - STENT TRCHBR GMTR 10MM 16FR 40MM NS 61CM AERO OTW FLLY CVR BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 90129-210 SUP HCPCS C1874 90129-210 - STENT TRCHBR 12MM 16FR 20MM 63CM AERO FLLY CVR ANTIMIGRATION BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 90129-211 SUP HCPCS C1874 90129-211 - STENT TRCHBR GMTR 12MM 16FR 30MM NS 62CM AERO OTW FLLY CVR BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 90129-213 SUP HCPCS C1874 90129-213 - STENT TRCHBR GMTR 14MM 16FR 20MM NS 63CM AERO OTW FLLY CVR BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 90129-214 SUP HCPCS C1874 90129-214 - STENT TRCHBR GMTR 14MM 16FR 30MM NS 62CM AERO OTW FLLY CVR BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 90129-215 SUP HCPCS C1874 90129-215 - STENT TRCHBR GMTR 14MM 16FR 40MM NS 61CM AERO OTW FLLY CVR BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 90129-216 SUP HCPCS C1874 90129-216 - STENT TRCHBR GMTR 20MM 22FR 40MM NS 61CM AERO OTW FLLY CVR BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 90129-217 SUP HCPCS C1874 90129-217 - STENT TRCHBR 20MM 60MM AERO OTW FLLY COVERED BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 90129-218 SUP HCPCS C1874 90129-218 - STENT TRCH 20MM 80MM AERO FLLY COVERED BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$5,750.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$5,750.00" "$2,834.75" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A 90129-301 SUP HCPCS C1874 90129-301 - STENT TRCHBR 18MM 40MM AERO DV FLLY COVERED DRCT VIS SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,750.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,750.00" "$2,588.25" "$5,250.00" "$5,750.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-302 SUP HCPCS C1874 90129-302 - STENT TRCHBR 18MM 60MM AERO DV FLLY COVERED DRCT VIS SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,750.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,750.00" "$2,588.25" "$5,250.00" "$5,750.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-303 SUP HCPCS C1874 90129-303 - STENT TRCHBR 18MM 80MM AERO DV FLLY COVERED DRCT VSN DLV SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,750.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,750.00" "$2,588.25" "$5,250.00" "$5,750.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-304 SUP HCPCS C1874 90129-304 - STENT TRCHBR 16MM 30MM 40MM 39MM AERO OTW DRCT VIS NOVEL BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,750.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,750.00" "$2,588.25" "$5,250.00" "$5,750.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-305 SUP HCPCS C1874 90129-305 - STENT TRCHBR 16MM 60MM AERO FLLY COVERED PURSE STNG DRCT VIS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-306 SUP HCPCS C1874 90129-306 - STENT TRCHBR 16MM 80MM AERO DV FLLY COVERED DRCT VSN DLV SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,750.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,750.00" "$2,588.25" "$5,250.00" "$5,750.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-310 SUP HCPCS C1874 90129-310 - STENT TRCHBR 12MM 20MM AERO DV FLLY COVERED DRCT VSN DLV SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,750.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,750.00" "$2,588.25" "$5,250.00" "$5,750.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-311 SUP HCPCS C1874 90129-311 - STENT TRCHBR GMTR LOPRFL 12MM 28FR 30MM 40CM AERO FULL CVR BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,750.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,750.00" "$2,588.25" "$5,250.00" "$5,750.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-312 SUP HCPCS C1874 90129-312 - STENT TRCHBR GMTR LOPRFL 28FR 12MM 40MM 39CM AERO FULL CVR BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,750.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,750.00" "$2,588.25" "$5,250.00" "$5,750.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-313 SUP HCPCS C1874 90129-313 - STENT TRCHBR 14MM 20MM AERO DV FLLY COVERED DRCT VSN DLV SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,750.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,750.00" "$2,588.25" "$5,250.00" "$5,750.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-314 SUP HCPCS C1874 90129-314 - STENT TRCHBR 14MM 30MM AERO DV FLLY COVERED DRCT VIS SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,750.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,750.00" "$2,588.25" "$5,250.00" "$5,750.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-315 SUP HCPCS C1874 90129-315 - STENT TRCHBR 14MM 40MM AERO FLLY COVERED PURSE STNG DRCT VIS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,750.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,750.00" "$2,588.25" "$5,250.00" "$5,750.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-316 SUP HCPCS C1874 90129-316 - STENT TRCHBR 20MM 40MM AERO DV FLLY COVERED DRCT VIS SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,750.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,750.00" "$2,588.25" "$5,250.00" "$5,750.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-317 SUP HCPCS C1874 90129-317 - STENT TRCHBR 20MM 60MM AERO DV FLLY COVERED DRCT VIS SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,750.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,750.00" "$2,588.25" "$5,250.00" "$5,750.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-318 SUP HCPCS C1874 90129-318 - STENT TRCHBR 20MM 80MM AERO DV FLLY COVERED DRCT VIS SYS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,750.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,750.00" "$2,588.25" "$5,250.00" "$5,750.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A 90129-501 SUP HCPCS C1874 90129-501 - SIZER SRG AEROSIZER STNT MSR DEV BOTH IP/OP $375.00 $278.00 $74.43 $437.50 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $437.50 $221.81 $375.00 $437.50 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 9013 A SUP Custom 27803010 9013 A - RESERVOIR DRAIN 50X12MM BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 9013 B SUP Custom 27803010 9013 B - RESERVOIR DRAIN 12MM 2.5MM 1.3MM 60MM 32 HOLE RIGHT ANG BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 9013 F SUP Custom 27803010 9013 F - RESERVOIR DRAIN 70X12MM BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 9013 G SUP Custom 27803010 9013 G - RESERVOIR DRAIN 12MM VENT BOTH IP/OP "$1,047.50" $775.00 $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $186.43 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $218.29 "$1,047.38" $418.95 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $471.32 "$1,047.38" N/A $607.55 "$1,047.38" $628.43 "$1,047.38" "$1,047.38" "$1,047.38" N/A N/A 903016A SUP HCPCS C1729 903016A - TRAY CATH BDX IC CMP CR 16FR 350ML FOLEY URMTR ANTIINFECTIVE BOTH IP/OP $25.00 $19.00 $4.95 $24.95 $13.55 $13.55 $13.55 $13.55 $24.95 $24.95 $24.95 $5.20 $24.95 $18.52 $18.52 $19.23 $13.00 $5.20 $24.95 $24.95 $14.76 $24.95 $24.95 $24.95 $24.95 $18.75 $24.95 $24.95 $24.95 $12.48 $12.48 $19.76 $24.95 $19.96 $16.22 $4.95 N/A $14.50 $24.95 $24.95 $24.95 $5.20 $24.95 N/A N/A 903018A SUP HCPCS C1729 903018A - TRAY CATHETERIZATION 18FR URINE METER FOLEY ANTIINFECTIVE BOTH IP/OP $39.00 $29.00 $8.23 $41.48 $22.52 $22.52 $22.52 $22.52 $41.48 $41.48 $41.48 $8.65 $41.48 $30.79 $30.79 $31.97 $21.61 $8.64 $41.48 $41.48 $24.54 $41.48 $41.48 $41.48 $41.48 $29.25 $41.48 $41.48 $41.48 $20.74 $20.74 $32.85 $41.48 $33.18 $26.96 $8.23 N/A $22.62 $41.48 $41.48 $41.48 $8.64 $41.48 N/A N/A 903018A SUP HCPCS C1729 TRAY CATH LBRCTH 18FR 350ML FOLEY URMTR BOTH IP/OP $41.50 $31.00 $8.23 $41.48 $22.52 $22.52 $22.52 $22.52 $41.48 $41.48 $41.48 $8.65 $41.48 $30.79 $30.79 $31.97 $21.61 $8.64 $41.48 $41.48 $24.54 $41.48 $41.48 $41.48 $41.48 $31.13 $41.48 $41.48 $41.48 $20.74 $20.74 $32.85 $41.48 $33.18 $26.96 $8.23 N/A $24.07 $41.48 $41.48 $41.48 $8.64 $41.48 N/A N/A 9032G SUP Custom 27203010 9032G - SUTURE NONABSORBABLE 10-0 CS175-8 12IN 2 ARM MONOFILAMENT BOTH IP/OP $43.00 $32.00 $7.65 $44.22 $42.97 $42.97 $42.97 $42.97 $42.97 $42.97 $7.65 $42.97 $42.97 $31.89 $31.89 $33.12 $22.39 $8.96 $42.97 $17.69 $42.97 $42.97 $44.22 $42.97 $42.97 $32.25 $42.97 $42.97 $42.97 $21.49 $21.49 $34.03 $42.97 $34.38 $27.93 $42.97 N/A $24.94 $42.97 $25.78 $42.97 $42.97 $42.97 N/A N/A 9040 R SUP Custom 27803010 9040 R - SHUNT NEUROSURGICAL SMALL MEDIUM PRESSURE CSF DELTA STERILE BOTH IP/OP $860.00 $636.00 $153.04 $859.75 $859.75 $859.75 $859.75 $859.75 $859.75 $859.75 $153.04 $859.75 $859.75 $859.75 $859.75 $859.75 $859.75 $179.18 $859.75 $343.90 $859.75 $859.75 $859.75 $859.75 $859.75 $645.00 $859.75 $859.75 $859.75 $429.88 $429.88 $680.92 $859.75 $687.80 $386.89 $859.75 N/A $498.80 $859.75 $515.85 $859.75 $859.75 $859.75 N/A N/A 9042 A SUP HCPCS C1894 9042 A - RESERVOIR DRAIN SMALL ANGLE RIGHT 12MM 5CM CSF VENTRICULAR BOTH IP/OP "$1,223.50" $905.00 $242.76 "$1,223.13" $664.16 $664.16 $664.16 $664.16 "$1,223.13" "$1,223.13" "$1,223.13" $254.93 "$1,223.13" $907.81 $907.81 $942.79 $637.25 $254.91 "$1,223.13" "$1,223.13" $723.48 "$1,223.13" "$1,223.13" "$1,223.13" "$1,223.13" $917.63 "$1,223.13" "$1,223.13" "$1,223.13" $611.57 $611.57 $968.72 "$1,223.13" $978.50 $795.03 $242.76 N/A $709.63 "$1,223.13" "$1,223.13" "$1,223.13" $254.90 "$1,223.13" N/A N/A 9042 B SUP HCPCS C1894 9042 B - RESERVOIR DRAIN SMALL ANGLE RIGHT 12MM 6CM CSF VENTRICULAR BOTH IP/OP "$1,223.50" $905.00 $242.76 "$1,223.13" $664.16 $664.16 $664.16 $664.16 "$1,223.13" "$1,223.13" "$1,223.13" $254.93 "$1,223.13" $907.81 $907.81 $942.79 $637.25 $254.91 "$1,223.13" "$1,223.13" $723.48 "$1,223.13" "$1,223.13" "$1,223.13" "$1,223.13" $917.63 "$1,223.13" "$1,223.13" "$1,223.13" $611.57 $611.57 $968.72 "$1,223.13" $978.50 $795.03 $242.76 N/A $709.63 "$1,223.13" "$1,223.13" "$1,223.13" $254.90 "$1,223.13" N/A N/A 9042 D SUP HCPCS C1894 9042 D - RESERVOIR DRAIN SMALL ANGLE RIGHT 12MM 4CM CSF VENTRICULAR BOTH IP/OP "$1,047.50" $775.00 $207.88 "$1,047.38" $568.73 $568.73 $568.73 $568.73 "$1,047.38" "$1,047.38" "$1,047.38" $218.30 "$1,047.38" $777.37 $777.37 $807.32 $545.68 $218.29 "$1,047.38" "$1,047.38" $619.53 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $680.80 $207.88 N/A $607.55 "$1,047.38" "$1,047.38" "$1,047.38" $218.27 "$1,047.38" N/A N/A 9042 G SUP HCPCS C1894 9042 G - RESERVOIR DRAIN SMALL RIGHT ANG 12MM 3.5CM CSF VENTRICULAR BOTH IP/OP "$1,047.50" $775.00 $207.88 "$1,047.38" $568.73 $568.73 $568.73 $568.73 "$1,047.38" "$1,047.38" "$1,047.38" $218.30 "$1,047.38" $777.37 $777.37 $807.32 $545.68 $218.29 "$1,047.38" "$1,047.38" $619.53 "$1,047.38" "$1,047.38" "$1,047.38" "$1,047.38" $785.63 "$1,047.38" "$1,047.38" "$1,047.38" $523.69 $523.69 $829.52 "$1,047.38" $837.90 $680.80 $207.88 N/A $607.55 "$1,047.38" "$1,047.38" "$1,047.38" $218.27 "$1,047.38" N/A N/A 9046 B-H SUP Custom 27803010 9046 B-H - SHUNT NEUROSURGICAL REGULAR 90CM CSF HIGH PRESSURE ASMBLY BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 9046 B-L SUP Custom 27803010 9046 B-L - SHUNT NEUROSURGICAL REGULAR 90CM LOW PRESSURE CNTOUR BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 9046 B-M SUP Custom 27803010 9046 B-M - SHUNT NEUROSURGICAL REGULAR 90CM CSF ASMBLY MEDIUM PRESSURE BOTH IP/OP "$2,498.50" "$1,849.00" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $444.73 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" $520.71 "$2,498.50" $999.40 "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$2,498.50" "$1,873.88" "$2,498.50" "$2,498.50" "$2,498.50" "$1,249.25" "$1,249.25" "$1,978.81" "$2,498.50" "$1,998.80" "$1,124.33" "$2,498.50" N/A "$1,449.13" "$2,498.50" "$1,499.10" "$2,498.50" "$2,498.50" "$2,498.50" N/A N/A 905-101 SUP HCPCS C1781 905-101 - MESH SURG 10MM 100MM ROUND PYRAMESH TITANIUM BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 905-103 SUP HCPCS C1781 905-103 - CAGE SPNL RND 10MM 30MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-107 SUP HCPCS C1781 905-107 - MESH SURG ROUND 70MMX10MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 905-108 SUP HCPCS C1781 905-108 - CAGE SPNL RND 10MM 8MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-110 SUP HCPCS C1781 905-110 - CAGE SPNL RND 10MM 10MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-112 SUP HCPCS C1781 905-112 - CAGE SPNL RND 10MM 12MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-115 SUP HCPCS C1781 905-115 - CAGE SPNL RND 10MM 15MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-133 SUP HCPCS C1781 905-133 - CAGE SPNL RND 13MM 30MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-137 SUP HCPCS C1781 905-137 - MESH SURG ROUND 13MM 70MM ROUND PYRAMESH TITANIUM BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 905-139 SUP HCPCS C1781 905-139 - CAGE SPNL RND 13MM 9MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-161 SUP HCPCS C1781 905-161 - CAGE SPNL RND 16MM 10MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-163 SUP HCPCS C1781 905-163 - CAGE SPNL RND 16MM 30MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-166 SUP HCPCS C1781 905-166 - MESH SURG ROUND 16MM 60MM PYRAMESH TITANIUM BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 905-194 SUP Custom 27803010 905-194 - CAGE SPNL RND 19MM 40MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$12,605.00" "$9,328.00" "$2,243.62" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,243.62" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$5,041.83" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$12,604.58" N/A "$7,310.90" "$12,604.58" "$7,562.75" "$12,604.58" "$12,604.58" "$12,604.58" N/A N/A 905-199 SUP HCPCS C1781 905-199 - CAGE SPNL RND 19MM 90MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 905-251 SUP HCPCS C1781 905-251 - MESH SURG ROUND 100MMX25MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 905-255 SUP HCPCS C1781 905-255 - MESH SURG ANGLE ROUND 25X15X10MM CAGE PYRAMESH TITANIUM BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-256 SUP Custom 27803010 905-256 - MESH SURG ROUND 60MMX25MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$12,605.00" "$9,328.00" "$2,243.62" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,243.62" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$5,041.83" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$12,604.58" N/A "$7,310.90" "$12,604.58" "$7,562.75" "$12,604.58" "$12,604.58" "$12,604.58" N/A N/A 905-299 SUP HCPCS C1781 905-299 - ENDCAP SPINAL ROUND 19MM PYRAMESH TITANIUM LUMBAR INTERBODY BOTH IP/OP $858.00 $635.00 $170.29 $858.00 $386.10 $386.10 $386.10 $386.10 $858.00 $858.00 $858.00 $178.83 $858.00 $858.00 $858.00 $858.00 $858.00 $178.82 $858.00 $858.00 $507.51 $858.00 $858.00 $858.00 $858.00 $643.50 $858.00 $858.00 $858.00 $429.00 $429.00 $679.54 $858.00 $686.40 $386.10 $170.29 N/A $497.64 $858.00 $858.00 $858.00 $178.81 $858.00 N/A N/A 905-308 SUP HCPCS C1781 905-308 - CAGE SPNL RND 13MM 8MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-309 SUP HCPCS C1781 905-309 - MESH SURG ROUND 100MMX25MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 905-310 SUP HCPCS C1781 905-310 - CAGE SPNL RND 13MM 10MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-311 SUP HCPCS C1781 905-311 - MESH SURG ROUND 13MMX11MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-312 SUP HCPCS C1781 905-312 - MESH SURG ROUND 13MMX12MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-313 SUP HCPCS C1781 905-313 - MESH SURG ROUND 13MMX13MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-320 SUP HCPCS C1781 905-320 - MESH SURG ROUND 20MMX13MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-399 SUP HCPCS C1781 905-399 - ENDCAP SPINAL ROUND 25MM PYRAMESH TITANIUM LUMBAR INTERBODY BOTH IP/OP $858.00 $635.00 $170.29 $858.00 $386.10 $386.10 $386.10 $386.10 $858.00 $858.00 $858.00 $178.83 $858.00 $858.00 $858.00 $858.00 $858.00 $178.82 $858.00 $858.00 $507.51 $858.00 $858.00 $858.00 $858.00 $643.50 $858.00 $858.00 $858.00 $429.00 $429.00 $679.54 $858.00 $686.40 $386.10 $170.29 N/A $497.64 $858.00 $858.00 $858.00 $178.81 $858.00 N/A N/A 905-401 SUP HCPCS C1781 905-401 - MESH SRG OVOID 14X10X10MM PRMSH BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-403 SUP HCPCS C1781 905-403 - CAGE SPNL OVOID 14X10X30MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-407 SUP HCPCS C1781 905-407 - MESH SURG OVOID 70X14X10MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$12,605.00" "$9,328.00" "$2,501.69" "$12,604.58" "$5,672.06" "$5,672.06" "$5,672.06" "$5,672.06" "$12,604.58" "$12,604.58" "$12,604.58" "$2,627.11" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.93" "$12,604.58" "$12,604.58" "$6,214.06" "$12,604.58" "$12,604.58" "$12,604.58" "$12,604.58" "$9,453.75" "$12,604.58" "$12,604.58" "$12,604.58" "$6,302.29" "$6,302.29" "$9,982.83" "$12,604.58" "$10,083.66" "$5,672.06" "$2,501.69" N/A "$7,310.90" "$12,604.58" "$12,604.58" "$12,604.58" "$2,626.79" "$12,604.58" N/A N/A 905-408 SUP HCPCS C1781 905-408 - CAGE SPNL OVOID 14X10X8MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-409 SUP HCPCS C1781 905-409 - MESH SURG OVOID 14X10X9MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-411 SUP HCPCS C1781 905-411 - MESH SURG OVOID 14X10X11MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-412 SUP HCPCS C1781 905-412 - MESH SURG OVOID 14X10X12MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-415 SUP HCPCS C1781 905-415 - MESH SURG OVOID 15X14X10MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-501 SUP HCPCS C1781 905-501 - MESH SURG OVOID 17X13X10MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-508 SUP HCPCS C1781 905-508 - MESH SURG OVOID 17X13X8MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-509 SUP HCPCS C1781 905-509 - MESH SURG OVOID 17X13X9MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-511 SUP HCPCS C1781 905-511 - MESH SURG OVOID 17X13X11MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-512 SUP HCPCS C1781 905-512 - MESH SURG OVOID 17X13X12MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-515 SUP HCPCS C1781 905-515 - MESH SURG OVOID 17X13X15MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-520 SUP HCPCS C1781 905-520 - MESH SURG OVOID 17X13X20MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$7,139.00" "$5,283.00" "$1,416.83" "$7,138.60" "$3,212.37" "$3,212.37" "$3,212.37" "$3,212.37" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.86" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.76" "$7,138.60" "$7,138.60" "$3,519.33" "$7,138.60" "$7,138.60" "$7,138.60" "$7,138.60" "$5,354.25" "$7,138.60" "$7,138.60" "$7,138.60" "$3,569.30" "$3,569.30" "$5,653.77" "$7,138.60" "$5,710.88" "$3,212.37" "$1,416.83" N/A "$4,140.62" "$7,138.60" "$7,138.60" "$7,138.60" "$1,487.68" "$7,138.60" N/A N/A 905-608 SUP HCPCS C1781 905-608 - MESH SURG ROUND 16MMX8MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-609 SUP HCPCS C1781 905-609 - MESH SURG ROUND 16MMX9MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-611 SUP HCPCS C1781 905-611 - MESH SURG ROUND 16MMX11MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-612 SUP HCPCS C1781 905-612 - MESH SURG ROUND 16MMX12MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-615 SUP HCPCS C1781 905-615 - MESH SURG ROUND 16MMX15MM CAGE PYRAMESH TITANIUM LUMBAR BOTH IP/OP "$3,514.00" "$2,600.00" $697.41 "$3,513.85" "$1,581.23" "$1,581.23" "$1,581.23" "$1,581.23" "$3,513.85" "$3,513.85" "$3,513.85" $732.37 "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" $732.32 "$3,513.85" "$3,513.85" "$1,732.33" "$3,513.85" "$3,513.85" "$3,513.85" "$3,513.85" "$2,635.50" "$3,513.85" "$3,513.85" "$3,513.85" "$1,756.93" "$1,756.93" "$2,782.97" "$3,513.85" "$2,811.08" "$1,581.23" $697.41 N/A "$2,038.12" "$3,513.85" "$3,513.85" "$3,513.85" $732.29 "$3,513.85" N/A N/A 905-800 SUP HCPCS C1781 905-800 - SCREW SET END RING PYRAMESH C TITANIUM SPN BOTH IP/OP $81.50 $60.00 $16.13 $81.25 $36.56 $36.56 $36.56 $36.56 $81.25 $81.25 $81.25 $16.93 $81.25 $81.25 $81.25 $81.25 $81.25 $16.93 $81.25 $81.25 $48.06 $81.25 $81.25 $81.25 $81.25 $61.13 $81.25 $81.25 $81.25 $40.63 $40.63 $64.35 $81.25 $65.00 $36.56 $16.13 N/A $47.27 $81.25 $81.25 $81.25 $16.93 $81.25 N/A N/A 905-810 SUP Custom 27203010 905-810 - HOLDER IMPLANT STR MESH BOTH IP/OP "$1,486.50" "$1,100.00" $264.60 "$1,486.50" "$1,486.50" "$1,486.50" "$1,486.50" "$1,486.50" "$1,486.50" "$1,486.50" $264.60 "$1,486.50" "$1,486.50" "$1,103.28" "$1,103.28" "$1,145.79" $774.47 $309.80 "$1,486.50" $594.60 "$1,486.50" "$1,486.50" "$1,486.50" "$1,486.50" "$1,486.50" "$1,114.88" "$1,486.50" "$1,486.50" "$1,486.50" $743.25 $743.25 "$1,177.31" "$1,486.50" "$1,189.20" $966.23 "$1,486.50" N/A $862.17 "$1,486.50" $891.90 "$1,486.50" "$1,486.50" "$1,486.50" N/A N/A 905-815 SUP Custom 27203010 905-815 - HOLDER IMPLANT SMALL MESH BOTH IP/OP "$1,486.50" "$1,100.00" $264.60 "$1,486.50" "$1,486.50" "$1,486.50" "$1,486.50" "$1,486.50" "$1,486.50" "$1,486.50" $264.60 "$1,486.50" "$1,486.50" "$1,103.28" "$1,103.28" "$1,145.79" $774.47 $309.80 "$1,486.50" $594.60 "$1,486.50" "$1,486.50" "$1,486.50" "$1,486.50" "$1,486.50" "$1,114.88" "$1,486.50" "$1,486.50" "$1,486.50" $743.25 $743.25 "$1,177.31" "$1,486.50" "$1,189.20" $966.23 "$1,486.50" N/A $862.17 "$1,486.50" $891.90 "$1,486.50" "$1,486.50" "$1,486.50" N/A N/A 905-820 SUP Custom 27203010 905-820 - IMPACTOR IMPLANT STR MESH PYRAMESH TITANIUM SPN BOTH IP/OP "$1,461.00" "$1,081.00" $260.06 "$1,461.00" "$1,461.00" "$1,461.00" "$1,461.00" "$1,461.00" "$1,461.00" "$1,461.00" $260.06 "$1,461.00" "$1,461.00" "$1,084.35" "$1,084.35" "$1,126.14" $761.18 $304.49 "$1,461.00" $584.40 "$1,461.00" "$1,461.00" "$1,461.00" "$1,461.00" "$1,461.00" "$1,095.75" "$1,461.00" "$1,461.00" "$1,461.00" $730.50 $730.50 "$1,157.11" "$1,461.00" "$1,168.80" $949.65 "$1,461.00" N/A $847.38 "$1,461.00" $876.60 "$1,461.00" "$1,461.00" "$1,461.00" N/A N/A 905-825 SUP Custom 27203010 905-825 - IMPACTOR IMPLANT ANGLE MESH PYRAMESH TITANIUM SPN BOTH IP/OP "$1,461.00" "$1,081.00" $260.06 "$1,461.00" "$1,461.00" "$1,461.00" "$1,461.00" "$1,461.00" "$1,461.00" "$1,461.00" $260.06 "$1,461.00" "$1,461.00" "$1,084.35" "$1,084.35" "$1,126.14" $761.18 $304.49 "$1,461.00" $584.40 "$1,461.00" "$1,461.00" "$1,461.00" "$1,461.00" "$1,461.00" "$1,095.75" "$1,461.00" "$1,461.00" "$1,461.00" $730.50 $730.50 "$1,157.11" "$1,461.00" "$1,168.80" $949.65 "$1,461.00" N/A $847.38 "$1,461.00" $876.60 "$1,461.00" "$1,461.00" "$1,461.00" N/A N/A 905-830 SUP Custom 27203010 905-830 - TRIMMER STATION MESH PYRAMESH TITANIUM SPN BOTH IP/OP "$2,518.50" "$1,864.00" $448.29 "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" $448.29 "$2,518.50" "$2,518.50" "$1,869.23" "$1,869.23" "$1,941.26" "$1,312.14" $524.88 "$2,518.50" "$1,007.40" "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" "$2,518.50" "$1,888.88" "$2,518.50" "$2,518.50" "$2,518.50" "$1,259.25" "$1,259.25" "$1,994.65" "$2,518.50" "$2,014.80" "$1,637.03" "$2,518.50" N/A "$1,460.73" "$2,518.50" "$1,511.10" "$2,518.50" "$2,518.50" "$2,518.50" N/A N/A 905-880 SUP Custom 27203010 905-880 - SCREWDRIVER SURG END-RING PYRAMESH BOTH IP/OP $937.50 $694.00 $166.88 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $166.88 $937.50 $937.50 $695.81 $695.81 $722.63 $488.44 $195.39 $937.50 $375.00 $937.50 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $609.38 $937.50 N/A $543.75 $937.50 $562.50 $937.50 $937.50 $937.50 N/A N/A 905-901 SUP HCPCS C1781 905-901 - MESH SURG CURVE 130MMX13MM CAGE PYRAMESH TITANIUM BOTH IP/OP "$16,828.00" "$12,453.00" "$3,339.86" "$16,827.60" "$7,572.42" "$7,572.42" "$7,572.42" "$7,572.42" "$16,827.60" "$16,827.60" "$16,827.60" "$3,507.29" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$3,507.06" "$16,827.60" "$16,827.60" "$8,296.01" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$12,621.00" "$16,827.60" "$16,827.60" "$16,827.60" "$8,413.80" "$8,413.80" "$13,327.46" "$16,827.60" "$13,462.08" "$7,572.42" "$3,339.86" N/A "$9,760.24" "$16,827.60" "$16,827.60" "$16,827.60" "$3,506.87" "$16,827.60" N/A N/A 905-902 SUP HCPCS C1781 905-902 - MESH SURG CURVE OVOID 10MM 14MMX130MM PYRAMESH TITANIUM BOTH IP/OP "$16,828.00" "$12,453.00" "$3,339.86" "$16,827.60" "$7,572.42" "$7,572.42" "$7,572.42" "$7,572.42" "$16,827.60" "$16,827.60" "$16,827.60" "$3,507.29" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$3,507.06" "$16,827.60" "$16,827.60" "$8,296.01" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$12,621.00" "$16,827.60" "$16,827.60" "$16,827.60" "$8,413.80" "$8,413.80" "$13,327.46" "$16,827.60" "$13,462.08" "$7,572.42" "$3,339.86" N/A "$9,760.24" "$16,827.60" "$16,827.60" "$16,827.60" "$3,506.87" "$16,827.60" N/A N/A 905-903 SUP HCPCS C1781 905-903 - CAGE SPNL ANG 19MM 150MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$16,828.00" "$12,453.00" "$3,339.86" "$16,827.60" "$7,572.42" "$7,572.42" "$7,572.42" "$7,572.42" "$16,827.60" "$16,827.60" "$16,827.60" "$3,507.29" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$3,507.06" "$16,827.60" "$16,827.60" "$8,296.01" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$12,621.00" "$16,827.60" "$16,827.60" "$16,827.60" "$8,413.80" "$8,413.80" "$13,327.46" "$16,827.60" "$13,462.08" "$7,572.42" "$3,339.86" N/A "$9,760.24" "$16,827.60" "$16,827.60" "$16,827.60" "$3,506.87" "$16,827.60" N/A N/A 905-904 SUP HCPCS C1781 905-904 - CAGE SPNL ANG 25MM 150MM PRMSH MESH TI LMBR INTRBD FS BOTH IP/OP "$16,828.00" "$12,453.00" "$3,339.86" "$16,827.60" "$7,572.42" "$7,572.42" "$7,572.42" "$7,572.42" "$16,827.60" "$16,827.60" "$16,827.60" "$3,507.29" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$3,507.06" "$16,827.60" "$16,827.60" "$8,296.01" "$16,827.60" "$16,827.60" "$16,827.60" "$16,827.60" "$12,621.00" "$16,827.60" "$16,827.60" "$16,827.60" "$8,413.80" "$8,413.80" "$13,327.46" "$16,827.60" "$13,462.08" "$7,572.42" "$3,339.86" N/A "$9,760.24" "$16,827.60" "$16,827.60" "$16,827.60" "$3,506.87" "$16,827.60" N/A N/A 909-145 SUP Custom 27203010 909-145 - PIN 14MM DSTRCT BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $90.00 N/A $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A 9091G SUP Custom 27203010 9091G - SUTURE NABSB 10-0 CTC-6L 4IN BLU PRLN HMSL ULT 2 ARM MFL BOTH IP/OP $73.50 $54.00 $13.07 $75.58 $73.45 $73.45 $73.45 $73.45 $73.45 $73.45 $13.07 $73.45 $73.45 $54.51 $54.51 $56.62 $38.27 $15.31 $73.45 $30.23 $73.45 $73.45 $75.58 $73.45 $73.45 $55.13 $73.45 $73.45 $73.45 $36.73 $36.73 $58.17 $73.45 $58.76 $47.74 $73.45 N/A $42.63 $73.45 $44.07 $73.45 $73.45 $73.45 N/A N/A 91-1504 SUP HCPCS C1713 91-1504 - SCREW BONE 1.5MM 4MM SLFTAP HIGH TORQUE CROSS DRIVE GOLD BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 91-1505 SUP HCPCS C1713 91-1505 - SCREW BONE 1.5MM 5MM SLFTAP HIGH TORQUE CROSS DRIVE GOLD BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 91-1506 SUP HCPCS C1713 91-1506 - SCREW BONE 1.5MM 6MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 91-1507 SUP HCPCS C1713 91-1507 - SCREW BONE 1.5MM 7MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 91-1508 SUP HCPCS C1713 91-1508 - SCREW BONE 1.5MM 8MM CROSS DRIVE HIGH TORQUE CENTRE DRIVE BOTH IP/OP $140.00 $104.00 $27.79 $140.00 $63.00 $63.00 $63.00 $63.00 $140.00 $140.00 $140.00 $29.18 $140.00 $140.00 $140.00 $140.00 $140.00 $29.18 $140.00 $140.00 $82.81 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $63.00 $27.79 N/A $81.20 $140.00 $140.00 $140.00 $29.18 $140.00 N/A N/A 91-1509 SUP HCPCS C1713 91-1509 - SCREW BONE 1.5MM 9MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 91-1511 SUP HCPCS C1713 91-1511 - SCREW BONE 1.5MM 11MM HIGH TORQUE CROSS DRIVE TITANIUM BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 91-1513 SUP HCPCS C1713 91-1513 - SCREW BONE 1.5MM 13MM HIGH TORQUE CROSS DRIVE CENTRE DRIVE BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 91-1515 SUP HCPCS C1713 91-1515 - SCREW BONE 1.5MM 15MM HIGH TORQUE CROSS DRIVE TITANIUM BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A 91-1805 SUP HCPCS C1713 91-1805 - SCREW BONE 1.8MM 5MM EMERGENCY SELF TAP HIGH TORQUE CROSS BOTH IP/OP $245.00 $181.00 $48.63 $245.00 $110.25 $110.25 $110.25 $110.25 $245.00 $245.00 $245.00 $51.06 $245.00 $245.00 $245.00 $245.00 $245.00 $51.06 $245.00 $245.00 $144.92 $245.00 $245.00 $245.00 $245.00 $183.75 $245.00 $245.00 $245.00 $122.50 $122.50 $194.04 $245.00 $196.00 $110.25 $48.63 N/A $142.10 $245.00 $245.00 $245.00 $51.06 $245.00 N/A N/A 91-1807 SUP HCPCS C1713 91-1807 - SCREW BONE 1.8MM 7MM EMERGENCY HIGH TORQUE CROSS DRIVE BOTH IP/OP $245.00 $181.00 $48.63 $245.00 $110.25 $110.25 $110.25 $110.25 $245.00 $245.00 $245.00 $51.06 $245.00 $245.00 $245.00 $245.00 $245.00 $51.06 $245.00 $98.00 $144.92 $245.00 $245.00 $245.00 $245.00 $183.75 $245.00 $245.00 $245.00 $122.50 $122.50 $194.04 $245.00 $196.00 $110.25 $48.63 N/A $142.10 $245.00 $245.00 $245.00 $51.06 $245.00 N/A N/A 91-1809 SUP HCPCS C1713 91-1809 - SCREW BONE 1.8MM 9MM EMERGENCY CROSS DRIVE HIGH TORQUE BOTH IP/OP $140.00 $104.00 $27.79 $140.00 $63.00 $63.00 $63.00 $63.00 $140.00 $140.00 $140.00 $29.18 $140.00 $140.00 $140.00 $140.00 $140.00 $29.18 $140.00 $56.00 $82.81 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $63.00 $27.79 N/A $81.20 $140.00 $140.00 $140.00 $29.18 $140.00 N/A N/A 91500V SUP Custom 27203010 91500V - APPLIER ENDOSCOPIC Med Large Straight 18inÿÿ BOTH IP/OP "$2,774.00" "$2,053.00" $493.72 "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" $493.72 "$2,773.73" "$2,773.73" "$2,058.66" "$2,058.66" "$2,137.99" "$1,445.11" $578.08 "$2,773.73" "$1,109.49" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,080.50" "$2,773.73" "$2,773.73" "$2,773.73" "$1,386.87" "$1,386.87" "$2,196.79" "$2,773.73" "$2,218.98" "$1,802.92" "$2,773.73" N/A "$1,608.92" "$2,773.73" "$1,664.24" "$2,773.73" "$2,773.73" "$2,773.73" N/A N/A 91501V SUP Custom 27203010 91501V - CLIP INTNL Endo Remover Med Large - Large Straight 18inÿÿ BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,249.98" "$2,249.98" "$2,249.98" "$2,249.98" "$2,249.98" "$2,249.98" "$2,249.98" $400.50 "$2,249.98" "$2,249.98" "$1,669.94" "$1,669.94" "$1,734.28" "$1,172.24" $468.92 "$2,249.98" $899.99 "$2,249.98" "$2,249.98" "$2,249.98" "$2,249.98" "$2,249.98" "$1,687.50" "$2,249.98" "$2,249.98" "$2,249.98" "$1,124.99" "$1,124.99" "$1,781.98" "$2,249.98" "$1,799.98" "$1,462.49" "$2,249.98" N/A "$1,305.00" "$2,249.98" "$1,349.99" "$2,249.98" "$2,249.98" "$2,249.98" N/A N/A 915-3100 SUP Custom 27803010 915-3100 - PIN FIX HEAT CONTOURING PEN LACTOSORB STERILE BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A 91-5607 SUP HCPCS C1713 91-5607 - SCREW BONE 2MM 7MM SELF DRILL TRAUMAONE LORENZ BLUE MANDIB BOTH IP/OP $435.00 $322.00 $86.34 $435.00 $195.75 $195.75 $195.75 $195.75 $435.00 $435.00 $435.00 $90.66 $435.00 $435.00 $435.00 $435.00 $435.00 $90.66 $435.00 $435.00 $257.30 $435.00 $435.00 $435.00 $435.00 $326.25 $435.00 $435.00 $435.00 $217.50 $217.50 $344.52 $435.00 $348.00 $195.75 $86.34 N/A $252.30 $435.00 $435.00 $435.00 $90.65 $435.00 N/A N/A 91-5609 SUP HCPCS C1713 91-5609 - SCREW BONE 2MM 9MM SLFDRILL LORENZ TRAUMAONE BLUE MANDIB BOTH IP/OP $435.00 $322.00 $86.34 $435.00 $195.75 $195.75 $195.75 $195.75 $435.00 $435.00 $435.00 $90.66 $435.00 $435.00 $435.00 $435.00 $435.00 $90.66 $435.00 $174.00 $257.30 $435.00 $435.00 $435.00 $435.00 $326.25 $435.00 $435.00 $435.00 $217.50 $217.50 $344.52 $435.00 $348.00 $195.75 $86.34 N/A $252.30 $435.00 $261.00 $435.00 $90.65 $435.00 N/A N/A 91-5611 SUP HCPCS C1713 91-5611 - SCREW BONE 2MM 11MM SLFDRILL LORENZ TRAUMAONE BLUE MANDIB BOTH IP/OP $435.00 $322.00 $86.34 $435.00 $195.75 $195.75 $195.75 $195.75 $435.00 $435.00 $435.00 $90.66 $435.00 $435.00 $435.00 $435.00 $435.00 $90.66 $435.00 $435.00 $257.30 $435.00 $435.00 $435.00 $435.00 $326.25 $435.00 $435.00 $435.00 $217.50 $217.50 $344.52 $435.00 $348.00 $195.75 $86.34 N/A $252.30 $435.00 $435.00 $435.00 $90.65 $435.00 N/A N/A 91-5707 SUP HCPCS C1713 91-5707 - SCREW BONE 2MM 7MM SELF DRILL TEMPORARY ANCHOR CROSS DRIVE BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $195.00 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A 91602V SUP Custom 27203010 91602V - APPLIER ENDOSCOPIC Large Curved 18inÿÿ BOTH IP/OP "$2,774.00" "$2,053.00" $493.72 "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" $493.72 "$2,773.73" "$2,773.73" "$2,058.66" "$2,058.66" "$2,137.99" "$1,445.11" $578.08 "$2,773.73" "$1,109.49" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,080.50" "$2,773.73" "$2,773.73" "$2,773.73" "$1,386.87" "$1,386.87" "$2,196.79" "$2,773.73" "$2,218.98" "$1,802.92" "$2,773.73" N/A "$1,608.92" "$2,773.73" "$1,664.24" "$2,773.73" "$2,773.73" "$2,773.73" N/A N/A 91-6103 SUP HCPCS C1713 91-6103 - SCREW BONE 1.5MM 3.5MM SELF DRILL HIGH TORQUE CROSS DRIVE BOTH IP/OP $245.00 $181.00 $48.63 $245.00 $110.25 $110.25 $110.25 $110.25 $245.00 $245.00 $245.00 $51.06 $245.00 $245.00 $245.00 $245.00 $245.00 $51.06 $245.00 $98.00 $144.92 $245.00 $245.00 $245.00 $245.00 $183.75 $245.00 $245.00 $245.00 $122.50 $122.50 $194.04 $245.00 $196.00 $110.25 $48.63 N/A $142.10 $245.00 $147.00 $245.00 $51.06 $245.00 N/A N/A 91-6104 SUP HCPCS C1713 91-6104 - SCREW BONE 1.5MM 4MM SELF DRILL HIGH TORQUE CROSS DRIVE BOTH IP/OP $245.00 $181.00 $48.63 $245.00 $110.25 $110.25 $110.25 $110.25 $245.00 $245.00 $245.00 $51.06 $245.00 $245.00 $245.00 $245.00 $245.00 $51.06 $245.00 $245.00 $144.92 $245.00 $245.00 $245.00 $245.00 $183.75 $245.00 $245.00 $245.00 $122.50 $122.50 $194.04 $245.00 $196.00 $110.25 $48.63 N/A $142.10 $245.00 $245.00 $245.00 $51.06 $245.00 N/A N/A 91-6105 SUP HCPCS C1713 91-6105 - SCREW BONE 1.5MM 5MM SELF DRILL HIGH TORQUE CROSS DRIVE BOTH IP/OP $245.00 $181.00 $48.63 $245.00 $110.25 $110.25 $110.25 $110.25 $245.00 $245.00 $245.00 $51.06 $245.00 $245.00 $245.00 $245.00 $245.00 $51.06 $245.00 $98.00 $144.92 $245.00 $245.00 $245.00 $245.00 $183.75 $245.00 $245.00 $245.00 $122.50 $122.50 $194.04 $245.00 $196.00 $110.25 $48.63 N/A $142.10 $245.00 $245.00 $245.00 $51.06 $245.00 N/A N/A 91-6106 SUP HCPCS C1713 91-6106 - SCREW BN 1.5MM 6MM GRN SLF DRL XDR TI MDFC LORENZ TRAUMAONE BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 91-6107 SUP HCPCS C1713 91-6107 - SCREW BN 1.5MM 7MM GRN SLF DRL XDR TI MDFC LORENZ TRAUMAONE BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $68.63 $68.63 $68.63 $68.63 $152.50 $152.50 $152.50 $31.78 $152.50 $152.50 $152.50 $152.50 $152.50 $31.78 $152.50 $61.00 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $68.63 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A 91-6703 SUP HCPCS C1713 91-6703 - SCREW BONE 1.5MM 3.5MM SELF DRILL CROSS DRIVE THINFLAP BOTH IP/OP $260.00 $192.00 $51.60 $260.00 $117.00 $117.00 $117.00 $117.00 $260.00 $260.00 $260.00 $54.19 $260.00 $260.00 $260.00 $260.00 $260.00 $54.19 $260.00 $104.00 $153.79 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $117.00 $51.60 N/A $150.80 $260.00 $156.00 $260.00 $54.18 $260.00 N/A N/A 91-6704 SUP HCPCS C1713 91-6704 - SCREW BONE 1.5MM 4MM SELF DRILL CROSS DRIVE THINFLAP BOTH IP/OP $260.00 $192.00 $51.60 $260.00 $117.00 $117.00 $117.00 $117.00 $260.00 $260.00 $260.00 $54.19 $260.00 $260.00 $260.00 $260.00 $260.00 $54.19 $260.00 $260.00 $153.79 $260.00 $260.00 $260.00 $260.00 $195.00 $260.00 $260.00 $260.00 $130.00 $130.00 $205.92 $260.00 $208.00 $117.00 $51.60 N/A $150.80 $260.00 $156.00 $260.00 $54.18 $260.00 N/A N/A 91701V SUP Custom 27203010 91701V - CLIP INTNL Endo Remover Large - XLarge Straight 18inÿÿ BOTH IP/OP "$2,365.00" "$1,750.00" $420.97 "$2,364.98" "$2,364.98" "$2,364.98" "$2,364.98" "$2,364.98" "$2,364.98" "$2,364.98" $420.97 "$2,364.98" "$2,364.98" "$1,755.29" "$1,755.29" "$1,822.93" "$1,232.15" $492.89 "$2,364.98" $945.99 "$2,364.98" "$2,364.98" "$2,364.98" "$2,364.98" "$2,364.98" "$1,773.75" "$2,364.98" "$2,364.98" "$2,364.98" "$1,182.49" "$1,182.49" "$1,873.06" "$2,364.98" "$1,891.98" "$1,537.24" "$2,364.98" N/A "$1,371.70" "$2,364.98" "$1,418.99" "$2,364.98" "$2,364.98" "$2,364.98" N/A N/A 91702V SUP Custom 27203010 91702V - APPLIER ENDOSCOPIC XLarge Curved 18inÿÿ BOTH IP/OP "$2,774.00" "$2,053.00" $493.72 "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" $493.72 "$2,773.73" "$2,773.73" "$2,058.66" "$2,058.66" "$2,137.99" "$1,445.11" $578.08 "$2,773.73" "$1,109.49" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,773.73" "$2,080.50" "$2,773.73" "$2,773.73" "$2,773.73" "$1,386.87" "$1,386.87" "$2,196.79" "$2,773.73" "$2,218.98" "$1,802.92" "$2,773.73" N/A "$1,608.92" "$2,773.73" "$1,664.24" "$2,773.73" "$2,773.73" "$2,773.73" N/A N/A 92-00646 SUP HCPCS C1713 92-00646 - PLATE BONE 90X90MM MESH PREFORMED TITANIUM BOTH IP/OP "$17,717.00" "$13,111.00" "$3,516.36" "$17,716.88" "$7,972.60" "$7,972.60" "$7,972.60" "$7,972.60" "$17,716.88" "$17,716.88" "$17,716.88" "$3,692.64" "$17,716.88" "$17,716.88" "$17,716.88" "$17,716.88" "$17,716.88" "$3,692.39" "$17,716.88" "$7,086.75" "$8,734.42" "$17,716.88" "$17,716.88" "$17,716.88" "$17,716.88" "$13,287.75" "$17,716.88" "$17,716.88" "$17,716.88" "$8,858.44" "$8,858.44" "$14,031.77" "$17,716.88" "$14,173.50" "$7,972.60" "$3,516.36" N/A "$10,275.86" "$17,716.88" "$10,630.13" "$17,716.88" "$3,692.20" "$17,716.88" N/A N/A 92-00647 SUP HCPCS C1713 92-00647 - PLATE BONE 190X140MM MESH PREFORMED TITANIUM BOTH IP/OP "$68,617.50" "$50,777.00" "$7,712.84" "$68,617.50" "$30,877.88" "$30,877.88" "$30,877.88" "$30,877.88" "$68,617.50" "$68,617.50" "$68,617.50" "$9,417.94" "$68,617.50" "$68,617.50" "$68,617.50" "$68,617.50" "$68,617.50" "$14,300.64" "$68,617.50" "$68,617.50" "$33,828.43" "$68,617.50" "$68,617.50" "$68,617.50" "$68,617.50" "$51,463.13" "$68,617.50" "$68,617.50" "$68,617.50" "$34,308.75" "$34,308.75" "$54,345.06" "$68,617.50" "$54,894.00" "$30,877.88" "$7,712.84" N/A "$39,798.15" "$68,617.50" "$41,170.50" "$68,617.50" "$8,098.48" "$68,617.50" N/A N/A 92-03210 SUP HCPCS C1713 92-03210 - PLATE BN NS UNV NEURO II 2 HL LOPRFL TAB BOTH IP/OP $227.50 $168.00 $45.15 $227.50 $102.38 $102.38 $102.38 $102.38 $227.50 $227.50 $227.50 $47.42 $227.50 $227.50 $227.50 $227.50 $227.50 $47.41 $227.50 $91.00 $134.57 $227.50 $227.50 $227.50 $227.50 $170.63 $227.50 $227.50 $227.50 $113.75 $113.75 $180.18 $227.50 $182.00 $102.38 $45.15 N/A $131.95 $227.50 $136.50 $227.50 $47.41 $227.50 N/A N/A 92-03510 SUP Custom 27803010 92-03510 - COVER BURR HOLE 10MM LP CRANIUM 3MM SCREW BOTH IP/OP $461.50 $342.00 $82.10 $461.25 $461.25 $461.25 $461.25 $461.25 $461.25 $461.25 $82.10 $461.25 $461.25 $461.25 $461.25 $461.25 $461.25 $96.13 $461.25 $184.50 $461.25 $461.25 $461.25 $461.25 $461.25 $346.13 $461.25 $461.25 $461.25 $230.63 $230.63 $365.31 $461.25 $369.00 $207.56 $461.25 N/A $267.67 $461.25 $276.75 $461.25 $461.25 $461.25 N/A N/A 92-03514 SUP Custom 27803010 92-03514 - COVER BURR HOLE LP 14MM CRANIUM 3MM SCREW BOTH IP/OP $461.50 $342.00 $82.10 $461.25 $461.25 $461.25 $461.25 $461.25 $461.25 $461.25 $82.10 $461.25 $461.25 $461.25 $461.25 $461.25 $461.25 $96.13 $461.25 $184.50 $461.25 $461.25 $461.25 $461.25 $461.25 $346.13 $461.25 $461.25 $461.25 $230.63 $230.63 $365.31 $461.25 $369.00 $207.56 $461.25 N/A $267.67 $461.25 $276.75 $461.25 $461.25 $461.25 N/A N/A 92-03608 SUP HCPCS C1713 92-03608 - PLATE BONE 2Y MICRO LP 8MM 6 HOLE BAR CRANIUM BOTH IP/OP $639.00 $473.00 $126.83 $639.00 $287.55 $287.55 $287.55 $287.55 $639.00 $639.00 $639.00 $133.18 $639.00 $639.00 $639.00 $639.00 $639.00 $133.17 $639.00 $255.60 $377.97 $639.00 $639.00 $639.00 $639.00 $479.25 $639.00 $639.00 $639.00 $319.50 $319.50 $506.09 $639.00 $511.20 $287.55 $126.83 N/A $370.62 $639.00 $383.40 $639.00 $133.17 $639.00 N/A N/A 92-05228 SUP HCPCS C1713 92-05228 - PLATE BONE LARGE LP BOX TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $498.50 $369.00 $98.88 $498.18 $224.18 $224.18 $224.18 $224.18 $498.18 $498.18 $498.18 $103.83 $498.18 $498.18 $498.18 $498.18 $498.18 $103.83 $498.18 $498.18 $294.67 $498.18 $498.18 $498.18 $498.18 $373.88 $498.18 $498.18 $498.18 $249.09 $249.09 $394.56 $498.18 $398.54 $224.18 $98.88 N/A $289.13 $498.18 $298.91 $498.18 $103.82 $498.18 N/A N/A 92-07211 SUP Custom 27203010 92-07211 - SLEEVE LAPSCP TWN FX BLDE BOTH IP/OP $525.50 $389.00 $93.49 $525.25 $525.25 $525.25 $525.25 $525.25 $525.25 $525.25 $93.49 $525.25 $525.25 $389.84 $389.84 $404.86 $273.66 $109.47 $525.25 $210.10 $525.25 $525.25 $525.25 $525.25 $525.25 $394.13 $525.25 $525.25 $525.25 $262.63 $262.63 $416.00 $525.25 $420.20 $341.41 $525.25 N/A $304.79 $525.25 $315.15 $525.25 $525.25 $525.25 N/A N/A 92-07230 SUP Custom 27203010 92-07230 - BIT DRILL 3.4MM 200MM CANN BOTH IP/OP $463.50 $343.00 $82.46 $463.25 $463.25 $463.25 $463.25 $463.25 $463.25 $463.25 $82.46 $463.25 $463.25 $343.82 $343.82 $357.07 $241.35 $96.55 $463.25 $185.30 $463.25 $463.25 $463.25 $463.25 $463.25 $347.63 $463.25 $463.25 $463.25 $231.63 $231.63 $366.89 $463.25 $370.60 $301.11 $463.25 N/A $268.83 $463.25 $277.95 $463.25 $463.25 $463.25 N/A N/A 92-10504 SUP HCPCS C1713 92-10504 - PLATE BN MN 4 HL TI 1.25MM BOTH IP/OP "$1,857.50" "$1,375.00" $368.67 "$1,857.50" $835.88 $835.88 $835.88 $835.88 "$1,857.50" "$1,857.50" "$1,857.50" $387.15 "$1,857.50" "$1,857.50" "$1,857.50" "$1,857.50" "$1,857.50" $387.12 "$1,857.50" $743.00 "$1,098.71" "$1,857.50" "$1,857.50" "$1,857.50" "$1,857.50" "$1,393.13" "$1,857.50" "$1,857.50" "$1,857.50" $928.75 $928.75 "$1,471.14" "$1,857.50" "$1,486.00" $835.88 $368.67 N/A "$1,077.35" "$1,857.50" "$1,114.50" "$1,857.50" $387.10 "$1,857.50" N/A N/A 92-10505 SUP HCPCS C1713 92-10505 - PLATE BONE MINI 1.5MM 4 HOLE BAR TITANIUM MAXFACL BOTH IP/OP "$1,374.50" "$1,017.00" $272.75 "$1,374.23" $618.40 $618.40 $618.40 $618.40 "$1,374.23" "$1,374.23" "$1,374.23" $286.42 "$1,374.23" "$1,374.23" "$1,374.23" "$1,374.23" "$1,374.23" $286.40 "$1,374.23" "$1,374.23" $812.86 "$1,374.23" "$1,374.23" "$1,374.23" "$1,374.23" "$1,030.88" "$1,374.23" "$1,374.23" "$1,374.23" $687.12 $687.12 "$1,088.39" "$1,374.23" "$1,099.38" $618.40 $272.75 N/A $797.21 "$1,374.23" $824.54 "$1,374.23" $286.39 "$1,374.23" N/A N/A 92-10506 SUP HCPCS C1713 92-10506 - PLATE BONE MINI 6 HOLE CUSTOM MAXFACL BOTH IP/OP "$2,555.00" "$1,891.00" $507.10 "$2,555.00" "$1,149.75" "$1,149.75" "$1,149.75" "$1,149.75" "$2,555.00" "$2,555.00" "$2,555.00" $532.53 "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" $532.49 "$2,555.00" "$2,555.00" "$1,259.62" "$2,555.00" "$2,555.00" "$2,555.00" "$2,555.00" "$1,916.25" "$2,555.00" "$2,555.00" "$2,555.00" "$1,277.50" "$1,277.50" "$2,023.56" "$2,555.00" "$2,044.00" "$1,149.75" $507.10 N/A "$1,481.90" "$2,555.00" "$1,533.00" "$2,555.00" $532.46 "$2,555.00" N/A N/A 92-10507 SUP HCPCS C1713 92-10507 - PLATE BONE 2MM 6 HOLE BARMAND LOCK CRANIOMAXILLOFACIAL BOTH IP/OP "$1,703.00" "$1,260.00" $337.95 "$1,702.73" $766.23 $766.23 $766.23 $766.23 "$1,702.73" "$1,702.73" "$1,702.73" $354.89 "$1,702.73" "$1,702.73" "$1,702.73" "$1,702.73" "$1,702.73" $354.87 "$1,702.73" "$1,702.73" "$1,007.16" "$1,702.73" "$1,702.73" "$1,702.73" "$1,702.73" "$1,277.25" "$1,702.73" "$1,702.73" "$1,702.73" $851.37 $851.37 "$1,348.56" "$1,702.73" "$1,362.18" $766.23 $337.95 N/A $987.74 "$1,702.73" "$1,021.64" "$1,702.73" $354.85 "$1,702.73" N/A N/A 92-10516 SUP HCPCS C1713 92-10516 - PLATE BN 1.5MM MN 16 HL MXLFCL BOTH IP/OP "$2,850.00" "$2,109.00" $565.65 "$2,850.00" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$2,850.00" "$2,850.00" "$2,850.00" $594.01 "$2,850.00" "$2,850.00" "$2,850.00" "$2,850.00" "$2,850.00" $593.97 "$2,850.00" "$2,850.00" "$1,405.05" "$2,850.00" "$2,850.00" "$2,850.00" "$2,850.00" "$2,137.50" "$2,850.00" "$2,850.00" "$2,850.00" "$1,425.00" "$1,425.00" "$2,257.20" "$2,850.00" "$2,280.00" "$1,282.50" $565.65 N/A "$1,653.00" "$2,850.00" "$1,710.00" "$2,850.00" $593.94 "$2,850.00" N/A N/A 92-10562 SUP HCPCS C1713 92-10562 - PLATE BN STRUT TROCH BOTH IP/OP "$2,850.00" "$2,109.00" $565.65 "$2,850.00" "$1,282.50" "$1,282.50" "$1,282.50" "$1,282.50" "$2,850.00" "$2,850.00" "$2,850.00" $594.01 "$2,850.00" "$2,850.00" "$2,850.00" "$2,850.00" "$2,850.00" $593.97 "$2,850.00" "$2,850.00" "$1,405.05" "$2,850.00" "$2,850.00" "$2,850.00" "$2,850.00" "$2,137.50" "$2,850.00" "$2,850.00" "$2,850.00" "$1,425.00" "$1,425.00" "$2,257.20" "$2,850.00" "$2,280.00" "$1,282.50" $565.65 N/A "$1,653.00" "$2,850.00" "$1,710.00" "$2,850.00" $593.94 "$2,850.00" N/A N/A 92-15514 SUP HCPCS C1713 92-15514 - PLATE BONE 2MM STR FRAC BOTH IP/OP "$3,907.50" "$2,892.00" $775.54 "$3,907.50" "$1,758.38" "$1,758.38" "$1,758.38" "$1,758.38" "$3,907.50" "$3,907.50" "$3,907.50" $814.42 "$3,907.50" "$3,907.50" "$3,907.50" "$3,907.50" "$3,907.50" $814.37 "$3,907.50" "$3,907.50" "$1,926.40" "$3,907.50" "$3,907.50" "$3,907.50" "$3,907.50" "$2,930.63" "$3,907.50" "$3,907.50" "$3,907.50" "$1,953.75" "$1,953.75" "$3,094.74" "$3,907.50" "$3,126.00" "$1,758.38" $775.54 N/A "$2,266.35" "$3,907.50" "$2,344.50" "$3,907.50" $814.32 "$3,907.50" N/A N/A 92-15904 SUP HCPCS C1713 92-15904 - SCREW BONE 1.5MM 4MM SELF DRILL TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $101.00 $75.00 $20.04 $100.95 $45.43 $45.43 $45.43 $45.43 $100.95 $100.95 $100.95 $21.04 $100.95 $100.95 $100.95 $100.95 $100.95 $21.04 $100.95 $100.95 $59.71 $100.95 $100.95 $100.95 $100.95 $75.75 $100.95 $100.95 $100.95 $50.48 $50.48 $79.95 $100.95 $80.76 $45.43 $20.04 N/A $58.58 $100.95 $60.57 $100.95 $21.04 $100.95 N/A N/A 92-15905 SUP HCPCS C1713 92-15905 - SCREW BONE 1.5MM 5MM SELF DRILL TITANIUM CRANIOMAXILLOFACIAL BOTH IP/OP $101.00 $75.00 $20.04 $100.95 $45.43 $45.43 $45.43 $45.43 $100.95 $100.95 $100.95 $21.04 $100.95 $100.95 $100.95 $100.95 $100.95 $21.04 $100.95 $100.95 $59.71 $100.95 $100.95 $100.95 $100.95 $75.75 $100.95 $100.95 $100.95 $50.48 $50.48 $79.95 $100.95 $80.76 $45.43 $20.04 N/A $58.58 $100.95 $100.95 $100.95 $21.04 $100.95 N/A N/A 92-15920 SUP HCPCS C1713 92-15920 - PLATE BONE 20MM HEMI RECONSTRUCTION TITANIUM MANDIB BOTH IP/OP "$10,292.50" "$7,616.00" "$2,042.80" "$10,292.50" "$4,631.63" "$4,631.63" "$4,631.63" "$4,631.63" "$10,292.50" "$10,292.50" "$10,292.50" "$2,145.21" "$10,292.50" "$10,292.50" "$10,292.50" "$10,292.50" "$10,292.50" "$2,145.07" "$10,292.50" "$10,292.50" "$5,074.20" "$10,292.50" "$10,292.50" "$10,292.50" "$10,292.50" "$7,719.38" "$10,292.50" "$10,292.50" "$10,292.50" "$5,146.25" "$5,146.25" "$8,151.66" "$10,292.50" "$8,234.00" "$4,631.63" "$2,042.80" N/A "$5,969.65" "$10,292.50" "$6,175.50" "$10,292.50" "$2,144.96" "$10,292.50" N/A N/A 92-15922 SUP HCPCS C1713 92-15922 - PLATE BONE 22MM HEMI RECONSTRUCTION TITANIUM MANDIB BOTH IP/OP "$10,292.50" "$7,616.00" "$2,042.80" "$10,292.50" "$4,631.63" "$4,631.63" "$4,631.63" "$4,631.63" "$10,292.50" "$10,292.50" "$10,292.50" "$2,145.21" "$10,292.50" "$10,292.50" "$10,292.50" "$10,292.50" "$10,292.50" "$2,145.07" "$10,292.50" "$10,292.50" "$5,074.20" "$10,292.50" "$10,292.50" "$10,292.50" "$10,292.50" "$7,719.38" "$10,292.50" "$10,292.50" "$10,292.50" "$5,146.25" "$5,146.25" "$8,151.66" "$10,292.50" "$8,234.00" "$4,631.63" "$2,042.80" N/A "$5,969.65" "$10,292.50" "$10,292.50" "$10,292.50" "$2,144.96" "$10,292.50" N/A N/A 92-16035 SUP Custom 27100030 92-16035 - BIT DRILL 1.6MM 35MM 7MM TWIST STOP BOTH IP/OP $469.00 $347.00 $83.41 $468.58 $468.58 $468.58 $468.58 $468.58 $468.58 $468.58 $83.41 $468.58 $468.58 $347.78 $347.78 $361.18 $244.13 $97.66 $468.58 $187.43 $468.58 $468.58 $468.58 $468.58 $468.58 $351.75 $468.58 $468.58 $468.58 $234.29 $234.29 $371.12 $468.58 $374.86 $304.58 $468.58 N/A $272.02 $468.58 $281.15 $468.58 $468.58 $468.58 N/A N/A 92-16135 SUP Custom 27203010 92-16135 - DRILL SRG 1.6MM 115MM NS LF 35MM CLR CD DISP BOTH IP/OP $990.00 $733.00 $176.22 $990.00 $990.00 $990.00 $990.00 $990.00 $990.00 $990.00 $176.22 $990.00 $990.00 $734.78 $734.78 $763.09 $515.79 $206.33 $990.00 $396.00 $990.00 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $643.50 $990.00 N/A $574.20 $990.00 $594.00 $990.00 $990.00 $990.00 N/A N/A 92-17126 SUP Custom 27203010 92-17126 - BIT DRL TWST BOTH IP/OP $161.00 $119.00 $28.60 $160.65 $160.65 $160.65 $160.65 $160.65 $160.65 $160.65 $28.60 $160.65 $160.65 $119.23 $119.23 $123.83 $83.70 $33.48 $160.65 $64.26 $160.65 $160.65 $160.65 $160.65 $160.65 $120.75 $160.65 $160.65 $160.65 $80.33 $80.33 $127.23 $160.65 $128.52 $104.42 $160.65 N/A $93.38 $160.65 $96.39 $160.65 $160.65 $160.65 N/A N/A 92-19035 SUP Custom 27100030 92-19035 - BIT DRILL 1.9MM 35MM TWIST BOTH IP/OP $737.00 $545.00 $131.16 $736.88 $736.88 $736.88 $736.88 $736.88 $736.88 $736.88 $131.16 $736.88 $736.88 $546.91 $546.91 $567.99 $383.91 $153.57 $736.88 $294.75 $736.88 $736.88 $736.88 $736.88 $736.88 $552.75 $736.88 $736.88 $736.88 $368.44 $368.44 $583.61 $736.88 $589.50 $478.97 $736.88 N/A $427.46 $736.88 $442.13 $736.88 $736.88 $736.88 N/A N/A 92-23126 SUP Custom 27203010 92-23126 - BIT DRL 23MM BOTH IP/OP $161.00 $119.00 $28.60 $160.65 $160.65 $160.65 $160.65 $160.65 $160.65 $160.65 $28.60 $160.65 $160.65 $119.23 $119.23 $123.83 $83.70 $33.48 $160.65 $64.26 $160.65 $160.65 $160.65 $160.65 $160.65 $120.75 $160.65 $160.65 $160.65 $80.33 $80.33 $127.23 $160.65 $128.52 $104.42 $160.65 N/A $93.38 $160.65 $96.39 $160.65 $160.65 $160.65 N/A N/A 92-25290 SUP HCPCS C1713 92-25290 - PLATE BONE STANDARD LONG RIGHT DORSAL RADIAL BOTH IP/OP $894.00 $662.00 $177.39 $893.75 $402.19 $402.19 $402.19 $402.19 $893.75 $893.75 $893.75 $186.28 $893.75 $893.75 $893.75 $893.75 $893.75 $186.27 $893.75 $893.75 $528.65 $893.75 $893.75 $893.75 $893.75 $670.50 $893.75 $893.75 $893.75 $446.88 $446.88 $707.85 $893.75 $715.00 $402.19 $177.39 N/A $518.52 $893.75 $536.25 $893.75 $186.26 $893.75 N/A N/A 92-25291 SUP HCPCS C1713 92-25291 - PLATE BONE STANDARD LONG LEFT DORSAL RADIAL BOTH IP/OP $894.00 $662.00 $177.39 $893.75 $402.19 $402.19 $402.19 $402.19 $893.75 $893.75 $893.75 $186.28 $893.75 $893.75 $893.75 $893.75 $893.75 $186.27 $893.75 $893.75 $528.65 $893.75 $893.75 $893.75 $893.75 $670.50 $893.75 $893.75 $893.75 $446.88 $446.88 $707.85 $893.75 $715.00 $402.19 $177.39 N/A $518.52 $893.75 $536.25 $893.75 $186.26 $893.75 N/A N/A 92-25292 SUP HCPCS C1713 92-25292 - PLATE BONE LONG WIDE RIGHT DORSAL RADIAL BOTH IP/OP $894.00 $662.00 $177.39 $893.75 $402.19 $402.19 $402.19 $402.19 $893.75 $893.75 $893.75 $186.28 $893.75 $893.75 $893.75 $893.75 $893.75 $186.27 $893.75 $357.50 $528.65 $893.75 $893.75 $893.75 $893.75 $670.50 $893.75 $893.75 $893.75 $446.88 $446.88 $707.85 $893.75 $715.00 $402.19 $177.39 N/A $518.52 $893.75 $536.25 $893.75 $186.26 $893.75 N/A N/A 92-25293 SUP HCPCS C1713 92-25293 - PLATE BONE LONG WIDE LEFT DORSAL RADIAL BOTH IP/OP $894.00 $662.00 $177.39 $893.75 $402.19 $402.19 $402.19 $402.19 $893.75 $893.75 $893.75 $186.28 $893.75 $893.75 $893.75 $893.75 $893.75 $186.27 $893.75 $357.50 $528.65 $893.75 $893.75 $893.75 $893.75 $670.50 $893.75 $893.75 $893.75 $446.88 $446.88 $707.85 $893.75 $715.00 $402.19 $177.39 N/A $518.52 $893.75 $536.25 $893.75 $186.26 $893.75 N/A N/A 92-25395 SUP HCPCS C1713 92-25395 - PLATE BONE NARROW XLONG VOLAR RADIAL BOTH IP/OP "$1,217.00" $901.00 $241.52 "$1,216.88" $547.60 $547.60 $547.60 $547.60 "$1,216.88" "$1,216.88" "$1,216.88" $253.63 "$1,216.88" "$1,216.88" "$1,216.88" "$1,216.88" "$1,216.88" $253.61 "$1,216.88" $486.75 $719.78 "$1,216.88" "$1,216.88" "$1,216.88" "$1,216.88" $912.75 "$1,216.88" "$1,216.88" "$1,216.88" $608.44 $608.44 $963.77 "$1,216.88" $973.50 $547.60 $241.52 N/A $705.86 "$1,216.88" $730.13 "$1,216.88" $253.60 "$1,216.88" N/A N/A 92-25397 SUP HCPCS C1713 92-25397 - PLATE BONE STANDARD XLONG VOLAR RADIAL BOTH IP/OP "$1,217.00" $901.00 $241.52 "$1,216.88" $547.60 $547.60 $547.60 $547.60 "$1,216.88" "$1,216.88" "$1,216.88" $253.63 "$1,216.88" "$1,216.88" "$1,216.88" "$1,216.88" "$1,216.88" $253.61 "$1,216.88" $486.75 $719.78 "$1,216.88" "$1,216.88" "$1,216.88" "$1,216.88" $912.75 "$1,216.88" "$1,216.88" "$1,216.88" $608.44 $608.44 $963.77 "$1,216.88" $973.50 $547.60 $241.52 N/A $705.86 "$1,216.88" $730.13 "$1,216.88" $253.60 "$1,216.88" N/A N/A 92-25399 SUP HCPCS C1713 92-25399 - PLATE BONE WIDE XLONG VOLAR RADIAL BOTH IP/OP "$1,217.00" $901.00 $241.52 "$1,216.88" $547.60 $547.60 $547.60 $547.60 "$1,216.88" "$1,216.88" "$1,216.88" $253.63 "$1,216.88" "$1,216.88" "$1,216.88" "$1,216.88" "$1,216.88" $253.61 "$1,216.88" $486.75 $719.78 "$1,216.88" "$1,216.88" "$1,216.88" "$1,216.88" $912.75 "$1,216.88" "$1,216.88" "$1,216.88" $608.44 $608.44 $963.77 "$1,216.88" $973.50 $547.60 $241.52 N/A $705.86 "$1,216.88" "$1,216.88" "$1,216.88" $253.60 "$1,216.88" N/A N/A 92-25403 SUP HCPCS C1713 92-25403 - PLATE BN SHRT T BOTH IP/OP "$1,271.00" $941.00 $252.26 "$1,271.00" $571.95 $571.95 $571.95 $571.95 "$1,271.00" "$1,271.00" "$1,271.00" $264.91 "$1,271.00" "$1,271.00" "$1,271.00" "$1,271.00" "$1,271.00" $264.89 "$1,271.00" $508.40 $751.80 "$1,271.00" "$1,271.00" "$1,271.00" "$1,271.00" $953.25 "$1,271.00" "$1,271.00" "$1,271.00" $635.50 $635.50 "$1,006.63" "$1,271.00" "$1,016.80" $571.95 $252.26 N/A $737.18 "$1,271.00" $762.60 "$1,271.00" $264.88 "$1,271.00" N/A N/A 92-25405 SUP HCPCS C1713 92-25405 - PLATE BONE LONG 7 HOLE T COLUMN ULNA BOTH IP/OP "$1,271.00" $941.00 $252.26 "$1,271.00" $571.95 $571.95 $571.95 $571.95 "$1,271.00" "$1,271.00" "$1,271.00" $264.91 "$1,271.00" "$1,271.00" "$1,271.00" "$1,271.00" "$1,271.00" $264.89 "$1,271.00" $508.40 $751.80 "$1,271.00" "$1,271.00" "$1,271.00" "$1,271.00" $953.25 "$1,271.00" "$1,271.00" "$1,271.00" $635.50 $635.50 "$1,006.63" "$1,271.00" "$1,016.80" $571.95 $252.26 N/A $737.18 "$1,271.00" $762.60 "$1,271.00" $264.88 "$1,271.00" N/A N/A 92-27007 SUP Custom 27203010 92-27007 - HOLDER INSTR SHAFT PLATE BOTH IP/OP $434.50 $322.00 $77.34 $434.50 $434.50 $434.50 $434.50 $434.50 $434.50 $434.50 $77.34 $434.50 $434.50 $322.49 $322.49 $334.91 $226.37 $90.55 $434.50 $173.80 $434.50 $434.50 $434.50 $434.50 $434.50 $325.88 $434.50 $434.50 $434.50 $217.25 $217.25 $344.12 $434.50 $347.60 $282.43 $434.50 N/A $252.01 $434.50 $260.70 $434.50 $434.50 $434.50 N/A N/A 92-40281 SUP HCPCS C1713 92-40281 - WIRE FX 1.4MM 160MM KRSH STP BOTH IP/OP $41.50 $31.00 $8.19 $41.25 $18.56 $18.56 $18.56 $18.56 $41.25 $41.25 $41.25 $8.60 $41.25 $41.25 $41.25 $41.25 $41.25 $8.60 $41.25 $41.25 $24.40 $41.25 $41.25 $41.25 $41.25 $31.13 $41.25 $41.25 $41.25 $20.63 $20.63 $32.67 $41.25 $33.00 $18.56 $8.19 N/A $24.07 $41.25 $24.75 $41.25 $8.60 $41.25 N/A N/A 92-40283 SUP HCPCS C1713 92-40283 - WIRE FX .062IN 160MM KRSH BOTH IP/OP $48.50 $36.00 $9.55 $48.13 $21.66 $21.66 $21.66 $21.66 $48.13 $48.13 $48.13 $10.03 $48.13 $48.13 $48.13 $48.13 $48.13 $10.03 $48.13 $48.13 $28.47 $48.13 $48.13 $48.13 $48.13 $36.38 $48.13 $48.13 $48.13 $24.07 $24.07 $38.12 $48.13 $38.50 $21.66 $9.55 N/A $28.13 $48.13 $48.13 $48.13 $10.03 $48.13 N/A N/A 92-53514 SUP Custom 27803010 92-53514 - COVER BURR HOLE 14MM LP BOTH IP/OP $520.50 $385.00 $92.57 $520.05 $520.05 $520.05 $520.05 $520.05 $520.05 $520.05 $92.57 $520.05 $520.05 $520.05 $520.05 $520.05 $520.05 $108.38 $520.05 $208.02 $520.05 $520.05 $520.05 $520.05 $520.05 $390.38 $520.05 $520.05 $520.05 $260.03 $260.03 $411.88 $520.05 $416.04 $234.02 $520.05 N/A $301.89 $520.05 $312.03 $520.05 $520.05 $520.05 N/A N/A 92-55005 SUP HCPCS C1713 92-55005 - PLATE BONE SHORT 4 HOLE PREBENT CRANIOMAXILLOFACIAL LEFT BOTH IP/OP "$1,222.50" $905.00 $242.64 "$1,222.50" $550.13 $550.13 $550.13 $550.13 "$1,222.50" "$1,222.50" "$1,222.50" $254.80 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $254.78 "$1,222.50" $489.00 $723.11 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $916.88 "$1,222.50" "$1,222.50" "$1,222.50" $611.25 $611.25 $968.22 "$1,222.50" $978.00 $550.13 $242.64 N/A $709.05 "$1,222.50" $733.50 "$1,222.50" $254.77 "$1,222.50" N/A N/A 92-55007 SUP HCPCS C1713 92-55007 - PLATE BONE SHORT 4 HOLE PREBENT CRANIOMAXILLOFACIAL RIGHT BOTH IP/OP "$1,222.50" $905.00 $242.64 "$1,222.50" $550.13 $550.13 $550.13 $550.13 "$1,222.50" "$1,222.50" "$1,222.50" $254.80 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $254.78 "$1,222.50" $489.00 $723.11 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $916.88 "$1,222.50" "$1,222.50" "$1,222.50" $611.25 $611.25 $968.22 "$1,222.50" $978.00 $550.13 $242.64 N/A $709.05 "$1,222.50" "$1,222.50" "$1,222.50" $254.77 "$1,222.50" N/A N/A 92-55011 SUP HCPCS C1713 92-55011 - PLATE BN 2.5MM 11 HL MNDB BOTH IP/OP "$7,835.00" "$5,798.00" "$1,555.05" "$7,835.00" "$3,525.75" "$3,525.75" "$3,525.75" "$3,525.75" "$7,835.00" "$7,835.00" "$7,835.00" "$1,633.01" "$7,835.00" "$7,835.00" "$7,835.00" "$7,835.00" "$7,835.00" "$1,632.90" "$7,835.00" "$7,835.00" "$3,862.66" "$7,835.00" "$7,835.00" "$7,835.00" "$7,835.00" "$5,876.25" "$7,835.00" "$7,835.00" "$7,835.00" "$3,917.50" "$3,917.50" "$6,205.32" "$7,835.00" "$6,268.00" "$3,525.75" "$1,555.05" N/A "$4,544.30" "$7,835.00" "$4,701.00" "$7,835.00" "$7,835.00" "$7,835.00" N/A N/A 92-55066 SUP HCPCS C1713 92-55066 - PLATE BONE 100D L BAR CRANIOMAXILLOFACIAL RIGHT BOTH IP/OP "$1,150.00" $851.00 $228.25 "$1,150.00" $517.50 $517.50 $517.50 $517.50 "$1,150.00" "$1,150.00" "$1,150.00" $239.69 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 $680.23 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 $228.25 N/A $667.00 "$1,150.00" "$1,150.00" "$1,150.00" $239.66 "$1,150.00" N/A N/A 92-55067 SUP HCPCS C1713 92-55067 - PLATE BONE 100D L BAR CRANIOMAXILLOFACIAL LEFT BOTH IP/OP "$1,150.00" $851.00 $228.25 "$1,150.00" $517.50 $517.50 $517.50 $517.50 "$1,150.00" "$1,150.00" "$1,150.00" $239.69 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 $680.23 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 $228.25 N/A $667.00 "$1,150.00" "$1,150.00" "$1,150.00" $239.66 "$1,150.00" N/A N/A 92-55159 SUP HCPCS C1713 92-55159 - PLATE BN 2MM 11 HL CRNMXF BOTH IP/OP "$6,960.00" "$5,150.00" "$1,381.39" "$6,960.00" "$3,132.00" "$3,132.00" "$3,132.00" "$3,132.00" "$6,960.00" "$6,960.00" "$6,960.00" "$1,450.64" "$6,960.00" "$6,960.00" "$6,960.00" "$6,960.00" "$6,960.00" "$1,450.54" "$6,960.00" "$2,784.00" "$3,431.28" "$6,960.00" "$6,960.00" "$6,960.00" "$6,960.00" "$5,220.00" "$6,960.00" "$6,960.00" "$6,960.00" "$3,480.00" "$3,480.00" "$5,512.32" "$6,960.00" "$5,568.00" "$3,132.00" "$1,381.39" N/A "$4,036.80" "$6,960.00" "$6,960.00" "$6,960.00" "$1,450.46" "$6,960.00" N/A N/A 92-55161 SUP HCPCS C1713 92-55161 - PLATE BONE 2MM 17 HOLE PRIM RECONSTRUCTION TEMPLATE MANDIB BOTH IP/OP "$8,477.50" "$6,273.00" "$1,682.57" "$8,477.50" "$3,814.88" "$3,814.88" "$3,814.88" "$3,814.88" "$8,477.50" "$8,477.50" "$8,477.50" "$1,766.92" "$8,477.50" "$8,477.50" "$8,477.50" "$8,477.50" "$8,477.50" "$1,766.80" "$8,477.50" "$3,391.00" "$4,179.41" "$8,477.50" "$8,477.50" "$8,477.50" "$8,477.50" "$6,358.13" "$8,477.50" "$8,477.50" "$8,477.50" "$4,238.75" "$4,238.75" "$6,714.18" "$8,477.50" "$6,782.00" "$3,814.88" "$1,682.57" N/A "$4,916.95" "$8,477.50" "$5,086.50" "$8,477.50" "$1,766.71" "$8,477.50" N/A N/A 92-55506 SUP HCPCS C1713 92-55506 - PLATE BONE 4 HOLE PREBENT TITANIUM LEFT MAXFACL BOTH IP/OP "$1,082.50" $801.00 $214.85 "$1,082.50" $487.13 $487.13 $487.13 $487.13 "$1,082.50" "$1,082.50" "$1,082.50" $225.62 "$1,082.50" "$1,082.50" "$1,082.50" "$1,082.50" "$1,082.50" $225.60 "$1,082.50" "$1,082.50" $640.30 "$1,082.50" "$1,082.50" "$1,082.50" "$1,082.50" $811.88 "$1,082.50" "$1,082.50" "$1,082.50" $541.25 $541.25 $857.34 "$1,082.50" $866.00 $487.13 $214.85 N/A $627.85 "$1,082.50" $649.50 "$1,082.50" $225.59 "$1,082.50" N/A N/A 92-55922 SUP HCPCS C1713 92-55922 - PLATE BN 2MM HEMI PRM LT 2 BOTH IP/OP "$6,475.00" "$4,792.00" "$1,285.13" "$6,475.00" "$2,913.75" "$2,913.75" "$2,913.75" "$2,913.75" "$6,475.00" "$6,475.00" "$6,475.00" "$1,349.55" "$6,475.00" "$6,475.00" "$6,475.00" "$6,475.00" "$6,475.00" "$1,349.46" "$6,475.00" "$2,590.00" "$3,192.18" "$6,475.00" "$6,475.00" "$6,475.00" "$6,475.00" "$4,856.25" "$6,475.00" "$6,475.00" "$6,475.00" "$3,237.50" "$3,237.50" "$5,128.20" "$6,475.00" "$5,180.00" "$2,913.75" "$1,285.13" N/A "$3,755.50" "$6,475.00" "$3,885.00" "$6,475.00" "$1,349.39" "$6,475.00" N/A N/A 92-57262 SUP HCPCS C1713 92-57262 - PLATE BN FX 1.7 MM SCR BOTH IP/OP $584.50 $433.00 $115.98 $584.38 $262.97 $262.97 $262.97 $262.97 $584.38 $584.38 $584.38 $121.80 $584.38 $584.38 $584.38 $584.38 $584.38 $121.79 $584.38 $233.75 $345.66 $584.38 $584.38 $584.38 $584.38 $438.38 $584.38 $584.38 $584.38 $292.19 $292.19 $462.83 $584.38 $467.50 $262.97 $115.98 N/A $339.01 $584.38 $350.63 $584.38 $121.78 $584.38 N/A N/A 92-60090 SUP Custom 27203010 92-60090 - TWIST DRILL DIA.0.9X66MM TWIST LENGTH 22MM AO SHAFT BOTH IP/OP $165.00 $122.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $165.00 N/A $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A 92-60130 SUP Custom 27203010 92-60130 - TWIST DRILL DIA.1.3X66MM TWIST LENGTH 22MM AO SHAFT BOTH IP/OP $165.00 $122.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $165.00 N/A $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A 92-60165 SUP Custom 27100030 92-60165 - BIT DRILL 35MM COLOR CODED BOTH IP/OP $407.00 $301.00 $72.39 $406.70 $406.70 $406.70 $406.70 $406.70 $406.70 $406.70 $72.39 $406.70 $406.70 $301.85 $301.85 $313.48 $211.89 $84.76 $406.70 $162.68 $406.70 $406.70 $406.70 $406.70 $406.70 $305.25 $406.70 $406.70 $406.70 $203.35 $203.35 $322.11 $406.70 $325.36 $264.36 $406.70 N/A $236.06 $406.70 $244.02 $406.70 $406.70 $406.70 N/A N/A 92-60170 SUP Custom 27203010 92-60170 - DRILL TWST 1.7MM 66MM BOTH IP/OP $165.00 $122.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $165.00 N/A $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A 92-60190 SUP Custom 27203010 92-60190 - TWIST DRILL DIA.1.9X82MM TWIST LENGTH 39MM AO SHAFT BOTH IP/OP $165.00 $122.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $165.00 N/A $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A 92-60199 SUP Custom 27100030 92-60199 - DRILL TWIST 1.9MM STOP 35MM 115MM BOTH IP/OP $491.50 $364.00 $87.43 $491.18 $491.18 $491.18 $491.18 $491.18 $491.18 $491.18 $87.43 $491.18 $491.18 $364.55 $364.55 $378.60 $255.90 $102.37 $491.18 $196.47 $491.18 $491.18 $491.18 $491.18 $491.18 $368.63 $491.18 $491.18 $491.18 $245.59 $245.59 $389.01 $491.18 $392.94 $319.27 $491.18 N/A $285.07 $491.18 $294.71 $491.18 $491.18 $491.18 N/A N/A 92-60230 SUP Custom 27203010 92-60230 - DRILL TWST 2.3MM 82MM BOTH IP/OP $165.00 $122.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $165.00 N/A $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A 92-62254 SUP Custom 27203010 92-62254 - GUIDE DRL 1.2MM 1.7MM FUSED BOTH IP/OP "$1,176.00" $870.00 $209.26 "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" $209.26 "$1,175.63" "$1,175.63" $872.55 $872.55 $906.18 $612.50 $245.01 "$1,175.63" $470.25 "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" $882.00 "$1,175.63" "$1,175.63" "$1,175.63" $587.82 $587.82 $931.10 "$1,175.63" $940.50 $764.16 "$1,175.63" N/A $682.08 "$1,175.63" $705.38 "$1,175.63" "$1,175.63" "$1,175.63" N/A N/A 92-62255 SUP Custom 27203010 92-62255 - GUIDE DRL 2.3MM LG FUSED CMPR BOTH IP/OP "$1,118.00" $827.00 $198.98 "$1,117.88" "$1,117.88" "$1,117.88" "$1,117.88" "$1,117.88" "$1,117.88" "$1,117.88" $198.98 "$1,117.88" "$1,117.88" $829.69 $829.69 $861.66 $582.42 $232.98 "$1,117.88" $447.15 "$1,117.88" "$1,117.88" "$1,117.88" "$1,117.88" "$1,117.88" $838.50 "$1,117.88" "$1,117.88" "$1,117.88" $558.94 $558.94 $885.36 "$1,117.88" $894.30 $726.62 "$1,117.88" N/A $648.44 "$1,117.88" $670.73 "$1,117.88" "$1,117.88" "$1,117.88" N/A N/A 92-62256 SUP Custom 27203010 92-62256 - GUIDE DRL 2.3MM 2.5MM FUSED CENTRIC BOTH IP/OP "$1,228.00" $909.00 $218.56 "$1,227.88" "$1,227.88" "$1,227.88" "$1,227.88" "$1,227.88" "$1,227.88" "$1,227.88" $218.56 "$1,227.88" "$1,227.88" $911.33 $911.33 $946.45 $639.73 $255.90 "$1,227.88" $491.15 "$1,227.88" "$1,227.88" "$1,227.88" "$1,227.88" "$1,227.88" $921.00 "$1,227.88" "$1,227.88" "$1,227.88" $613.94 $613.94 $972.48 "$1,227.88" $982.30 $798.12 "$1,227.88" N/A $712.24 "$1,227.88" $736.73 "$1,227.88" "$1,227.88" "$1,227.88" N/A N/A 92-62270 SUP Custom 27803010 92-62270 - TAP FOR 2.7MM SCREW BOTH IP/OP $571.00 $423.00 $101.57 $570.63 $570.63 $570.63 $570.63 $570.63 $570.63 $570.63 $101.57 $570.63 $570.63 $570.63 $570.63 $570.63 $570.63 $118.93 $570.63 $228.25 $570.63 $570.63 $570.63 $570.63 $570.63 $428.25 $570.63 $570.63 $570.63 $285.32 $285.32 $451.94 $570.63 $456.50 $256.78 $570.63 N/A $331.18 $570.63 $342.38 $570.63 $570.63 $570.63 N/A N/A 93-9268 SUP HCPCS C1762 93-9268 - GRAFT SKIN 8X6CM DEHYDRATED GAMA IRRADIATED AXIS TUTOPLAST BOTH IP/OP "$3,847.50" "$2,847.00" $763.63 "$3,847.50" "$1,731.38" "$1,731.38" "$1,731.38" "$1,731.38" "$3,847.50" "$3,847.50" "$3,847.50" $801.92 "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" $801.86 "$3,847.50" "$3,847.50" "$1,896.82" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$2,885.63" "$3,847.50" "$3,847.50" "$3,847.50" "$1,923.75" "$1,923.75" "$3,047.22" "$3,847.50" "$3,078.00" "$1,731.38" $763.63 N/A "$2,231.55" "$3,847.50" "$3,847.50" "$3,847.50" $801.82 "$3,847.50" N/A N/A 94107CE SUP HCPCS C1713 94107CE - COMPRESSOR SURG 60MM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 94107DE SUP HCPCS C1713 94107DE - DISTRACTOR SURG 60MM TRNSVRS TRACTION DEVICE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 9450002E SUP Custom 27203010 9450002E - STIMULATOR NERVE ELECTRODE LOW IMPEDANCE NIM BOTH IP/OP $669.00 $495.00 $119.08 $669.00 $669.00 $669.00 $669.00 $669.00 $669.00 $669.00 $119.08 $669.00 $669.00 $496.53 $496.53 $515.67 $348.55 $139.43 $669.00 $267.60 $669.00 $669.00 $669.00 $669.00 $669.00 $501.75 $669.00 $669.00 $669.00 $334.50 $334.50 $529.85 $669.00 $535.20 $434.85 $669.00 N/A $388.02 $669.00 $401.40 $669.00 $669.00 $669.00 N/A N/A 945DMA1002 SUP Custom 27203010 945DMA1002 - ELECTRODE EMG GOLD FOIL EAR CANAL ADULT BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 N/A $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 945DMA1004 SUP Custom 27203010 945DMA1004 - ELECTRODE EMG GOLD FOIL EAR CANAL PEDIATRIC BOTH IP/OP $9.00 $7.00 $1.60 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $9.00 $1.60 $9.00 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $3.60 $9.00 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $9.00 N/A $5.22 $9.00 $5.40 $9.00 $9.00 $9.00 N/A N/A 945DME1001 SUP Custom 27203010 945DME1001 - ELECTRODE EEG 1.2MR CORK SCREW BOTH IP/OP $82.50 $61.00 $14.69 $82.50 $82.50 $82.50 $82.50 $82.50 $82.50 $82.50 $14.69 $82.50 $82.50 $61.23 $61.23 $63.59 $42.98 $17.19 $82.50 $33.00 $82.50 $82.50 $82.50 $82.50 $82.50 $61.88 $82.50 $82.50 $82.50 $41.25 $41.25 $65.34 $82.50 $66.00 $53.63 $82.50 N/A $47.85 $82.50 $49.50 $82.50 $82.50 $82.50 N/A N/A 945DME1004 SUP Custom 27203010 945DME1004 - ELECTRODE EMG 5X3.5CM 1 GROUNDING GREEN DISPOSABLE BOTH IP/OP $25.50 $19.00 $4.54 $25.50 $25.50 $25.50 $25.50 $25.50 $25.50 $25.50 $4.54 $25.50 $25.50 $18.93 $18.93 $19.66 $13.29 $5.31 $25.50 $10.20 $25.50 $25.50 $25.50 $25.50 $25.50 $19.13 $25.50 $25.50 $25.50 $12.75 $12.75 $20.20 $25.50 $20.40 $16.58 $25.50 N/A $14.79 $25.50 $15.30 $25.50 $25.50 $25.50 N/A N/A 945DME2002 SUP Custom 27203010 945DME2002 - ELECTRODE EEG 1.2MR CORK SCREW DISPOSABLE BOTH IP/OP $165.00 $122.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $165.00 N/A $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A 945DSE1115 SUP Custom 27203010 945DSE1115 - ELECTRODE EMG 1.5CM 2CM 1.5MR 1 BOTH IP/OP $12.00 $9.00 $2.14 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $2.14 $12.00 $12.00 $8.91 $8.91 $9.25 $6.25 $2.50 $12.00 $4.80 $12.00 $12.00 $12.00 $12.00 $12.00 $9.00 $12.00 $12.00 $12.00 $6.00 $6.00 $9.50 $12.00 $9.60 $7.80 $12.00 N/A $6.96 $12.00 $7.20 $12.00 $12.00 $12.00 N/A N/A 945DSE1125 SUP Custom 27203010 945DSE1125 - ELECTRODE EMG 1.5CM 2CM 2.5MR 1 BOTH IP/OP $18.00 $13.00 $3.20 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $18.00 $3.20 $18.00 $18.00 $13.36 $13.36 $13.87 $9.38 $3.75 $18.00 $7.20 $18.00 $18.00 $18.00 $18.00 $18.00 $13.50 $18.00 $18.00 $18.00 $9.00 $9.00 $14.26 $18.00 $14.40 $11.70 $18.00 N/A $10.44 $18.00 $10.80 $18.00 $18.00 $18.00 N/A N/A 945DSE2115 SUP Custom 27203010 945DSE2115 - ELECTRODE EMG 2CM 2.7CM 1.5MR 1 BOTH IP/OP $12.00 $9.00 $2.14 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $2.14 $12.00 $12.00 $8.91 $8.91 $9.25 $6.25 $2.50 $12.00 $4.80 $12.00 $12.00 $12.00 $12.00 $12.00 $9.00 $12.00 $12.00 $12.00 $6.00 $6.00 $9.50 $12.00 $9.60 $7.80 $12.00 N/A $6.96 $12.00 $7.20 $12.00 $12.00 $12.00 N/A N/A 945DSE2125 SUP Custom 27203010 945DSE2125 - ELECTRODE EMG 2 2.7CM 2.5MR BOTH IP/OP $15.00 $11.00 $2.67 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $15.00 $2.67 $15.00 $15.00 $11.13 $11.13 $11.56 $7.82 $3.13 $15.00 $6.00 $15.00 $15.00 $15.00 $15.00 $15.00 $11.25 $15.00 $15.00 $15.00 $7.50 $7.50 $11.88 $15.00 $12.00 $9.75 $15.00 N/A $8.70 $15.00 $9.00 $15.00 $15.00 $15.00 N/A N/A 945DSE3115 SUP Custom 27203010 945DSE3115 - ELECTRODE EMG 1.5CM 2CM 1.5MR 2 GEL NIM BOTH IP/OP $43.50 $32.00 $7.74 $43.50 $43.50 $43.50 $43.50 $43.50 $43.50 $43.50 $7.74 $43.50 $43.50 $32.29 $32.29 $33.53 $22.66 $9.07 $43.50 $17.40 $43.50 $43.50 $43.50 $43.50 $43.50 $32.63 $43.50 $43.50 $43.50 $21.75 $21.75 $34.45 $43.50 $34.80 $28.28 $43.50 N/A $25.23 $43.50 $26.10 $43.50 $43.50 $43.50 N/A N/A 945DSE3125 SUP Custom 27203010 945DSE3125 - ELECTRODE EMG 1.5CM 2CM 2.5MR 2 NIM BOTH IP/OP $63.00 $47.00 $11.21 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $11.21 $63.00 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $25.20 $63.00 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $31.50 $31.50 $49.90 $63.00 $50.40 $40.95 $63.00 N/A $36.54 $63.00 $37.80 $63.00 $63.00 $63.00 N/A N/A 945DSE4115 SUP Custom 27203010 945DSE4115 - ELECTRODE EMG 2CM 2.7CM 1.5MR 2 BOTH IP/OP $43.50 $32.00 $7.74 $43.50 $43.50 $43.50 $43.50 $43.50 $43.50 $43.50 $7.74 $43.50 $43.50 $32.29 $32.29 $33.53 $22.66 $9.07 $43.50 $17.40 $43.50 $43.50 $43.50 $43.50 $43.50 $32.63 $43.50 $43.50 $43.50 $21.75 $21.75 $34.45 $43.50 $34.80 $28.28 $43.50 N/A $25.23 $43.50 $26.10 $43.50 $43.50 $43.50 N/A N/A 945DSE4125 SUP Custom 27203010 945DSE4125 - ELECTRODE EMG 2CM 2.7CM 2.5MR 2 BOTH IP/OP $63.00 $47.00 $11.21 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $63.00 $11.21 $63.00 $63.00 $46.76 $46.76 $48.56 $32.82 $13.13 $63.00 $25.20 $63.00 $63.00 $63.00 $63.00 $63.00 $47.25 $63.00 $63.00 $63.00 $31.50 $31.50 $49.90 $63.00 $50.40 $40.95 $63.00 N/A $36.54 $63.00 $37.80 $63.00 $63.00 $63.00 N/A N/A 945DSN1260 SUP Custom 27203010 945DSN1260 - ELECTRODE EMG 27GA 13MM SUNSPOTS SUBDERMAL AST BOTH IP/OP $22.50 $17.00 $4.01 $22.50 $22.50 $22.50 $22.50 $22.50 $22.50 $22.50 $4.01 $22.50 $22.50 $16.70 $16.70 $17.34 $11.72 $4.69 $22.50 $9.00 $22.50 $22.50 $22.50 $22.50 $22.50 $16.88 $22.50 $22.50 $22.50 $11.25 $11.25 $17.82 $22.50 $18.00 $14.63 $22.50 N/A $13.05 $22.50 $13.50 $22.50 $22.50 $22.50 N/A N/A 945DSN1299 SUP Custom 27203010 945DSN1299 - ELECTRODE EMG 27GA 13MM 2.5MR BOTH IP/OP $22.50 $17.00 $4.01 $22.50 $22.50 $22.50 $22.50 $22.50 $22.50 $22.50 $4.01 $22.50 $22.50 $16.70 $16.70 $17.34 $11.72 $4.69 $22.50 $9.00 $22.50 $22.50 $22.50 $22.50 $22.50 $16.88 $22.50 $22.50 $22.50 $11.25 $11.25 $17.82 $22.50 $18.00 $14.63 $22.50 N/A $13.05 $22.50 $13.50 $22.50 $22.50 $22.50 N/A N/A 945DSN2260 SUP Custom 27203010 945DSN2260 - ELECTRODE EEG 1.5MM 27GA 60IN MONITR NEEDLE TWISTED BOTH IP/OP $52.50 $39.00 $9.35 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $9.35 $52.50 $52.50 $38.97 $38.97 $40.47 $27.35 $10.94 $52.50 $21.00 $52.50 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $34.13 $52.50 N/A $30.45 $52.50 $31.50 $52.50 $52.50 $52.50 N/A N/A 945DSN2280 SUP Custom 27203010 945DSN2280 - ELECTRODE EMG 27GA 13MM 2MR 2 BOTH IP/OP $52.50 $39.00 $9.35 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $9.35 $52.50 $52.50 $38.97 $38.97 $40.47 $27.35 $10.94 $52.50 $21.00 $52.50 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $34.13 $52.50 N/A $30.45 $52.50 $31.50 $52.50 $52.50 $52.50 N/A N/A 945DSN2299 SUP Custom 27203010 945DSN2299 - ELECTRODE EMG 2 TWISTED BOTH IP/OP $61.50 $46.00 $10.95 $61.50 $61.50 $61.50 $61.50 $61.50 $61.50 $61.50 $10.95 $61.50 $61.50 $45.65 $45.65 $47.40 $32.04 $12.82 $61.50 $24.60 $61.50 $61.50 $61.50 $61.50 $61.50 $46.13 $61.50 $61.50 $61.50 $30.75 $30.75 $48.71 $61.50 $49.20 $39.98 $61.50 N/A $35.67 $61.50 $36.90 $61.50 $61.50 $61.50 N/A N/A 945DTE0001 SUP HCPCS C1898 945DTE0001 - LEADWIRE EMG .6MR CLIP RED DISPOSABLE BOTH IP/OP $45.00 $33.00 $9.38 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $20.25 $45.00 N/A $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 945DTE0002 SUP HCPCS C1898 945DTE0002 - LEADWIRE EMG .6MR CLIP GREEN DISPOSABLE BOTH IP/OP $45.00 $33.00 $9.38 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $20.25 $45.00 N/A $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 945DTE0003 SUP HCPCS C1898 945DTE0003 - LEADWIRE EMG .6MR CLIP BLACK DISPOSABLE BOTH IP/OP $45.00 $33.00 $9.38 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $20.25 $45.00 N/A $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A 945DTE1002 SUP Custom 27203010 945DTE1002 - ELECTRODE EMG 1.9CM 1.27CM PREGEL TAB BOTH IP/OP $33.00 $24.00 $5.87 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $5.87 $33.00 $33.00 $24.49 $24.49 $25.44 $17.19 $6.88 $33.00 $13.20 $33.00 $33.00 $33.00 $33.00 $33.00 $24.75 $33.00 $33.00 $33.00 $16.50 $16.50 $26.14 $33.00 $26.40 $21.45 $33.00 N/A $19.14 $33.00 $19.80 $33.00 $33.00 $33.00 N/A N/A 945DTE1003 SUP Custom 27203010 945DTE1003 - ELECTRODE EMG 2.54CM 2.54CM PREGEL TAB BOTH IP/OP $33.00 $24.00 $5.87 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $5.87 $33.00 $33.00 $24.49 $24.49 $25.44 $17.19 $6.88 $33.00 $13.20 $33.00 $33.00 $33.00 $33.00 $33.00 $24.75 $33.00 $33.00 $33.00 $16.50 $16.50 $26.14 $33.00 $26.40 $21.45 $33.00 N/A $19.14 $33.00 $19.80 $33.00 $33.00 $33.00 N/A N/A 945MEP1001 SUP Custom 27203010 945MEP1001 - ELECTRODE NEUROSTIMULATOR CORKSCREW BOTH IP/OP $624.00 $462.00 $111.07 $624.00 $624.00 $624.00 $624.00 $624.00 $624.00 $624.00 $111.07 $624.00 $624.00 $463.13 $463.13 $480.98 $325.10 $130.05 $624.00 $249.60 $624.00 $624.00 $624.00 $624.00 $624.00 $468.00 $624.00 $624.00 $624.00 $312.00 $312.00 $494.21 $624.00 $499.20 $405.60 $624.00 N/A $361.92 $624.00 $374.40 $624.00 $624.00 $624.00 N/A N/A 945NRE1003 SUP Custom 27203010 945NRE1003 - ELECTRODE EMG NEEDLE NIM SUBDERMAL BOTH IP/OP $891.00 $659.00 $158.60 $891.00 $891.00 $891.00 $891.00 $891.00 $891.00 $891.00 $158.60 $891.00 $891.00 $661.30 $661.30 $686.78 $464.21 $185.69 $891.00 $356.40 $891.00 $891.00 $891.00 $891.00 $891.00 $668.25 $891.00 $891.00 $891.00 $445.50 $445.50 $705.67 $891.00 $712.80 $579.15 $891.00 N/A $516.78 $891.00 $534.60 $891.00 $891.00 $891.00 N/A N/A 945NRE1004 SUP Custom 27203010 945NRE1004 - ELECTRODE EMG NEEDLE RING BOTH IP/OP "$1,320.00" $977.00 $234.96 "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" $234.96 "$1,320.00" "$1,320.00" $979.70 $979.70 "$1,017.46" $687.72 $275.10 "$1,320.00" $528.00 "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" "$1,320.00" $990.00 "$1,320.00" "$1,320.00" "$1,320.00" $660.00 $660.00 "$1,045.44" "$1,320.00" "$1,056.00" $858.00 "$1,320.00" N/A $765.60 "$1,320.00" $792.00 "$1,320.00" "$1,320.00" "$1,320.00" N/A N/A 945POC1002 SUP HCPCS C1713 945POC1002 - CLIP SENSOR PULSE OXIMETER DISPOSABLE BOTH IP/OP $223.50 $165.00 $44.36 $223.50 $100.58 $100.58 $100.58 $100.58 $223.50 $223.50 $223.50 $46.58 $223.50 $223.50 $223.50 $223.50 $223.50 $46.58 $223.50 $223.50 $132.20 $223.50 $223.50 $223.50 $223.50 $167.63 $223.50 $223.50 $223.50 $111.75 $111.75 $177.01 $223.50 $178.80 $100.58 $44.36 N/A $129.63 $223.50 $134.10 $223.50 $46.58 $223.50 N/A N/A 945PXC2002 SUP HCPCS C1713 945PXC2002 - CLIP SENSOR 1MM LEAD FINGER TOE BOTH IP/OP $82.50 $61.00 $16.37 $82.50 $37.13 $37.13 $37.13 $37.13 $82.50 $82.50 $82.50 $17.20 $82.50 $82.50 $82.50 $82.50 $82.50 $17.19 $82.50 $33.00 $48.80 $82.50 $82.50 $82.50 $82.50 $61.88 $82.50 $82.50 $82.50 $41.25 $41.25 $65.34 $82.50 $66.00 $37.13 $16.37 N/A $47.85 $82.50 $49.50 $82.50 $17.19 $82.50 N/A N/A 945RMA1016 SUP Custom 27203010 945RMA1016 - TUBE SUCTION EMG REPLACEMENT DISPOSABLE BOTH IP/OP $22.50 $17.00 $4.01 $22.50 $22.50 $22.50 $22.50 $22.50 $22.50 $22.50 $4.01 $22.50 $22.50 $16.70 $16.70 $17.34 $11.72 $4.69 $22.50 $9.00 $22.50 $22.50 $22.50 $22.50 $22.50 $16.88 $22.50 $22.50 $22.50 $11.25 $11.25 $17.82 $22.50 $18.00 $14.63 $22.50 N/A $13.05 $22.50 $13.50 $22.50 $22.50 $22.50 N/A N/A 945RMA1019 SUP Custom 27203010 945RMA1019 - ELECTRODE EMG STANDARD SURFACE LARYNGEAL BOTH IP/OP $289.50 $214.00 $51.53 $289.50 $289.50 $289.50 $289.50 $289.50 $289.50 $289.50 $51.53 $289.50 $289.50 $214.87 $214.87 $223.15 $150.83 $60.33 $289.50 $115.80 $289.50 $289.50 $289.50 $289.50 $289.50 $217.13 $289.50 $289.50 $289.50 $144.75 $144.75 $229.28 $289.50 $231.60 $188.18 $289.50 N/A $167.91 $289.50 $173.70 $289.50 $289.50 $289.50 N/A N/A 945RMA1019S SUP Custom 27203010 945RMA1019S - ELECTRODE EMG SMALL SURFACE LARYNGEAL BOTH IP/OP $289.50 $214.00 $51.53 $289.50 $289.50 $289.50 $289.50 $289.50 $289.50 $289.50 $51.53 $289.50 $289.50 $214.87 $214.87 $223.15 $150.83 $60.33 $289.50 $115.80 $289.50 $289.50 $289.50 $289.50 $289.50 $217.13 $289.50 $289.50 $289.50 $144.75 $144.75 $229.28 $289.50 $231.60 $188.18 $289.50 N/A $167.91 $289.50 $173.70 $289.50 $289.50 $289.50 N/A N/A 945RMA1019SP SUP Custom 27203010 945RMA1019SP - ELECTRODE EMG 5-5.2MM LARYNX DISPOSABLE BOTH IP/OP $289.50 $214.00 $51.53 $289.50 $289.50 $289.50 $289.50 $289.50 $289.50 $289.50 $51.53 $289.50 $289.50 $214.87 $214.87 $223.15 $150.83 $60.33 $289.50 $115.80 $289.50 $289.50 $289.50 $289.50 $289.50 $217.13 $289.50 $289.50 $289.50 $144.75 $144.75 $229.28 $289.50 $231.60 $188.18 $289.50 N/A $167.91 $289.50 $173.70 $289.50 $289.50 $289.50 N/A N/A 945RMA2029 SUP Custom 27203010 945RMA2029 - ELECTRODE EMG LARGE LARYNGEAL BOTH IP/OP $330.00 $244.00 $58.74 $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $58.74 $330.00 $330.00 $244.93 $244.93 $254.36 $171.93 $68.78 $330.00 $132.00 $330.00 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $214.50 $330.00 N/A $191.40 $330.00 $198.00 $330.00 $330.00 $330.00 N/A N/A 945RMA2029SP SUP Custom 27203010 945RMA2029SP - ELECTRODE EMG MEDIUM LARYNGEAL BOTH IP/OP $330.00 $244.00 $58.74 $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $330.00 $58.74 $330.00 $330.00 $244.93 $244.93 $254.36 $171.93 $68.78 $330.00 $132.00 $330.00 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $214.50 $330.00 N/A $191.40 $330.00 $198.00 $330.00 $330.00 $330.00 N/A N/A 945SRE1002 SUP Custom 27203010 945SRE1002 - ELECTRODE EMG SURFACE RECORDING BOTH IP/OP $891.00 $659.00 $158.60 $891.00 $891.00 $891.00 $891.00 $891.00 $891.00 $891.00 $158.60 $891.00 $891.00 $661.30 $661.30 $686.78 $464.21 $185.69 $891.00 $356.40 $891.00 $891.00 $891.00 $891.00 $891.00 $668.25 $891.00 $891.00 $891.00 $445.50 $445.50 $705.67 $891.00 $712.80 $579.15 $891.00 N/A $516.78 $891.00 $534.60 $891.00 $891.00 $891.00 N/A N/A 95-363 SUP Custom 27203010 95-363 - PAD OR TBL 3 PC FULL SET PD SRG 1 FIT ALL SEG SRG BOTH IP/OP "$2,525.00" "$1,869.00" $449.45 "$2,525.00" "$2,525.00" "$2,525.00" "$2,525.00" "$2,525.00" "$2,525.00" "$2,525.00" $449.45 "$2,525.00" "$2,525.00" "$1,874.06" "$1,874.06" "$1,946.27" "$1,315.53" $526.24 "$2,525.00" "$1,010.00" "$2,525.00" "$2,525.00" "$2,525.00" "$2,525.00" "$2,525.00" "$1,893.75" "$2,525.00" "$2,525.00" "$2,525.00" "$1,262.50" "$1,262.50" "$1,999.80" "$2,525.00" "$2,020.00" "$1,641.25" "$2,525.00" N/A "$1,464.50" "$2,525.00" "$1,515.00" "$2,525.00" "$2,525.00" "$2,525.00" N/A N/A 96505H SUP Custom 27803010 96505H - CONNECTOR ROD 6.35/6.35MM DMN SPNE BOTH IP/OP "$1,797.00" "$1,330.00" $319.79 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" $319.79 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" $374.43 "$1,796.58" $718.63 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,347.75" "$1,796.58" "$1,796.58" "$1,796.58" $898.29 $898.29 "$1,422.89" "$1,796.58" "$1,437.26" $808.46 "$1,796.58" N/A "$1,042.26" "$1,796.58" "$1,077.95" "$1,796.58" "$1,796.58" "$1,796.58" N/A N/A 96505HT SUP Custom 27803010 96505HT - CONNECTOR ROD 6.35/6.35MM DOMINO TITANIUM SPN BOTH IP/OP "$1,831.50" "$1,355.00" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $325.95 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" $381.64 "$1,831.18" $732.47 "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,831.18" "$1,373.63" "$1,831.18" "$1,831.18" "$1,831.18" $915.59 $915.59 "$1,450.29" "$1,831.18" "$1,464.94" $824.03 "$1,831.18" N/A "$1,062.27" "$1,831.18" "$1,098.71" "$1,831.18" "$1,831.18" "$1,831.18" N/A N/A 96507H SUP Custom 27803010 96507H - CONNECTOR ROD 6.35/7MM CD HORIZON DOMINO TITANIUM SPN BOTH IP/OP "$1,797.00" "$1,330.00" $319.79 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" $319.79 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" $374.43 "$1,796.58" $718.63 "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,796.58" "$1,347.75" "$1,796.58" "$1,796.58" "$1,796.58" $898.29 $898.29 "$1,422.89" "$1,796.58" "$1,437.26" $808.46 "$1,796.58" N/A "$1,042.26" "$1,796.58" "$1,077.95" "$1,796.58" "$1,796.58" "$1,796.58" N/A N/A 96509H SUP Custom 27803010 96509H - CONNECTOR ROD 6.35MM AXIAL LEGACY CD HORIZON STAINLESS STEEL BOTH IP/OP "$2,118.50" "$1,568.00" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $377.08 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" $441.51 "$2,118.45" $847.38 "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$2,118.45" "$1,588.88" "$2,118.45" "$2,118.45" "$2,118.45" "$1,059.23" "$1,059.23" "$1,677.81" "$2,118.45" "$1,694.76" $953.30 "$2,118.45" N/A "$1,228.73" "$2,118.45" "$1,271.07" "$2,118.45" "$2,118.45" "$2,118.45" N/A N/A 96509HT SUP Custom 27803010 96509HT - CONNECTOR ROD 6.35MM AXIAL CD HORIZON DOMINO TITANIUM SPN BOTH IP/OP "$2,346.50" "$1,736.00" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $417.61 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" $488.95 "$2,346.10" $938.44 "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$2,346.10" "$1,759.88" "$2,346.10" "$2,346.10" "$2,346.10" "$1,173.05" "$1,173.05" "$1,858.11" "$2,346.10" "$1,876.88" "$1,055.75" "$2,346.10" N/A "$1,360.97" "$2,346.10" "$1,407.66" "$2,346.10" "$2,346.10" "$2,346.10" N/A N/A 968-021 SUP HCPCS C1713 968-021 - ROD SPINAL 6.35MM 500MM HEXAGONAL END LINED PREBENT CD BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 96880-021 SUP Custom 27803010 96880-021 - CANNULA PRFSN 60CM 21FR FEM PERC VN ADLT 3/8IN 1 BOTH IP/OP "$1,060.00" $784.00 $188.68 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $188.68 "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" "$1,060.00" $220.92 "$1,060.00" $394.74 "$1,060.00" "$1,060.00" $986.86 "$1,060.00" "$1,060.00" $795.00 "$1,060.00" "$1,060.00" "$1,060.00" $530.00 $530.00 $839.52 "$1,060.00" $848.00 $477.00 "$1,060.00" N/A $614.80 "$1,060.00" $636.00 "$1,060.00" "$1,060.00" "$1,060.00" N/A N/A 96880-025 SUP Custom 27203010 96880-025 - CANNULA PERFUSION 3/8IN 25FR 60CM 1 PIECE KINK RESISTANT BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $394.74 "$1,000.00" "$1,000.00" $986.86 "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A 969-012 SUP HCPCS C1713 969-012 - ROD SPINAL SEA GREEN TITANIUM THORAX LUMBAR CP BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 969-022 SUP HCPCS C1713 969-022 - ROD SPINAL 6.35MM 500MM HEXAGONAL END LINED LEGACY SEAFOAM BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A 976-119 SUP HCPCS C1713 976-119 - PLATE BN 19MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 976-121 SUP HCPCS C1713 976-121 - PLATE BONE 21MM LOCK ATLANTIS VISION TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 976-123 SUP HCPCS C1713 976-123 - PLATE BONE 23MM LOCK ATLANTIS VISION TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 976-125 SUP HCPCS C1713 976-125 - PLATE BONE 25MM LOCK ATLANTIS VISION TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 976-127 SUP HCPCS C1713 976-127 - PLATE BONE 27.5MM LOCK ATLANTIS VISION TITANIUM SPN CERV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 976-130 SUP HCPCS C1713 976-130 - PLATE BN 30MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A 976-132 SUP HCPCS C1713 976-132 - PLATE BN 32.5MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 976-135 SUP HCPCS C1713 976-135 - PLATE BN 35MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 976-137 SUP HCPCS C1713 976-137 - PLATE BN 37.5MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 976-140 SUP HCPCS C1713 976-140 - PLATE BN 40MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 976-142 SUP HCPCS C1713 976-142 - PLATE BONE 42.5MM LOCK ATLANTIS VISION TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 976-145 SUP HCPCS C1713 976-145 - PLATE BONE 45MM LOCK ATLANTIS VISION TITANIUM SPN CERV BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 976-147 SUP HCPCS C1713 976-147 - PLATE BN 47.5MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 976-150 SUP HCPCS C1713 976-150 - PLATE BN 50MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A 976-152 SUP HCPCS C1713 976-152 - PLATE BN 52.5MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 976-155 SUP HCPCS C1713 976-155 - PLATE BN 55MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 976-157 SUP HCPCS C1713 976-157 - PLATE BN 57.5MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 976-160 SUP HCPCS C1713 976-160 - PLATE BN 60MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 976-162 SUP HCPCS C1713 976-162 - PLATE BN 62.5MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 976-165 SUP HCPCS C1713 976-165 - PLATE BN 65MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 976-167 SUP HCPCS C1713 976-167 - PLATE BN 67.5MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 976-170 SUP HCPCS C1713 976-170 - PLATE BN 70MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 976-172 SUP HCPCS C1713 976-172 - PLATE BN 72.5MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A 976-175 SUP HCPCS C1713 976-175 - PLATE BN 75MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 976-177 SUP HCPCS C1713 976-177 - PLATE BN 77.5MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 976-180 SUP HCPCS C1713 976-180 - PLATE BN 80MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 976-182 SUP HCPCS C1713 976-182 - PLATE BN 82.5MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 976-185 SUP HCPCS C1713 976-185 - PLATE BN 85MM STRL ATL VS LCK TI SPNE CRV ANT BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A 976-187 SUP HCPCS C1713 976-187 - PLATE BONE 87.5MM LOCK ATLANTIS VISION TITANIUM SPN CERV BOTH IP/OP "$4,278.00" "$3,166.00" $849.08 "$4,278.00" "$1,925.10" "$1,925.10" "$1,925.10" "$1,925.10" "$4,278.00" "$4,278.00" "$4,278.00" $891.64 "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" $891.58 "$4,278.00" "$1,711.20" "$2,109.05" "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" "$3,208.50" "$4,278.00" "$4,278.00" "$4,278.00" "$2,139.00" "$2,139.00" "$3,388.18" "$4,278.00" "$3,422.40" "$1,925.10" $849.08 N/A "$2,481.24" "$4,278.00" "$2,566.80" "$4,278.00" $891.54 "$4,278.00" N/A N/A 976-190 SUP HCPCS C1713 976-190 - PLATE BONE 90MM LOCK ATLANTIS VISION TITANIUM SPN CERV BOTH IP/OP "$4,278.00" "$3,166.00" $849.08 "$4,278.00" "$1,925.10" "$1,925.10" "$1,925.10" "$1,925.10" "$4,278.00" "$4,278.00" "$4,278.00" $891.64 "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" $891.58 "$4,278.00" "$1,711.20" "$2,109.05" "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" "$3,208.50" "$4,278.00" "$4,278.00" "$4,278.00" "$2,139.00" "$2,139.00" "$3,388.18" "$4,278.00" "$3,422.40" "$1,925.10" $849.08 N/A "$2,481.24" "$4,278.00" "$2,566.80" "$4,278.00" $891.54 "$4,278.00" N/A N/A 976-195 SUP HCPCS C1713 976-195 - PLATE BONE 95MM LOCK ATLANTIS VISION TITANIUM SPN CERV BOTH IP/OP "$4,278.00" "$3,166.00" $849.08 "$4,278.00" "$1,925.10" "$1,925.10" "$1,925.10" "$1,925.10" "$4,278.00" "$4,278.00" "$4,278.00" $891.64 "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" $891.58 "$4,278.00" "$1,711.20" "$2,109.05" "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" "$3,208.50" "$4,278.00" "$4,278.00" "$4,278.00" "$2,139.00" "$2,139.00" "$3,388.18" "$4,278.00" "$3,422.40" "$1,925.10" $849.08 N/A "$2,481.24" "$4,278.00" "$2,566.80" "$4,278.00" $891.54 "$4,278.00" N/A N/A 976-200 SUP HCPCS C1713 976-200 - PLATE BONE 100MM LOCK ATLANTIS VISION TITANIUM SPN CERV BOTH IP/OP "$4,278.00" "$3,166.00" $849.08 "$4,278.00" "$1,925.10" "$1,925.10" "$1,925.10" "$1,925.10" "$4,278.00" "$4,278.00" "$4,278.00" $891.64 "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" $891.58 "$4,278.00" "$1,711.20" "$2,109.05" "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" "$3,208.50" "$4,278.00" "$4,278.00" "$4,278.00" "$2,139.00" "$2,139.00" "$3,388.18" "$4,278.00" "$3,422.40" "$1,925.10" $849.08 N/A "$2,481.24" "$4,278.00" "$2,566.80" "$4,278.00" $891.54 "$4,278.00" N/A N/A 976-205 SUP HCPCS C1713 976-205 - PLATE BONE 105MM LOCK ATLANTIS VISION TITANIUM SPN CERV BOTH IP/OP "$4,278.00" "$3,166.00" $849.08 "$4,278.00" "$1,925.10" "$1,925.10" "$1,925.10" "$1,925.10" "$4,278.00" "$4,278.00" "$4,278.00" $891.64 "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" $891.58 "$4,278.00" "$4,278.00" "$2,109.05" "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" "$3,208.50" "$4,278.00" "$4,278.00" "$4,278.00" "$2,139.00" "$2,139.00" "$3,388.18" "$4,278.00" "$3,422.40" "$1,925.10" $849.08 N/A "$2,481.24" "$4,278.00" "$2,566.80" "$4,278.00" $891.54 "$4,278.00" N/A N/A 976-210 SUP HCPCS C1713 976-210 - PLATE BONE 110MM LOCK ATLANTIS VISION TITANIUM SPN CERV BOTH IP/OP "$4,278.00" "$3,166.00" $849.08 "$4,278.00" "$1,925.10" "$1,925.10" "$1,925.10" "$1,925.10" "$4,278.00" "$4,278.00" "$4,278.00" $891.64 "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" $891.58 "$4,278.00" "$1,711.20" "$2,109.05" "$4,278.00" "$4,278.00" "$4,278.00" "$4,278.00" "$3,208.50" "$4,278.00" "$4,278.00" "$4,278.00" "$2,139.00" "$2,139.00" "$3,388.18" "$4,278.00" "$3,422.40" "$1,925.10" $849.08 N/A "$2,481.24" "$4,278.00" "$2,566.80" "$4,278.00" $891.54 "$4,278.00" N/A N/A 976-612 SUP HCPCS C1713 976-612 - SCREW BN 4MM 12MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 976-613 SUP HCPCS C1713 976-613 - SCREW BN 4MM 13MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 976-614 SUP HCPCS C1713 976-614 - SCREW BN 4MM 14MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 976-615 SUP HCPCS C1713 976-615 - SCREW BN 4MM 15MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV ANT BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A 976-643 SUP HCPCS C1713 976-643 - SCREW BN 4.5MM 13MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 976-644 SUP HCPCS C1713 976-644 - SCREW BN 4.5MM 14MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 976-645 SUP HCPCS C1713 976-645 - SCREW BN 4.5MM 15MM STRL ATL VS FX ANG SLF DRL TI SPNE CRV BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A 995FR19 SUP Custom 27803010 995FR19 - FREESTYLE ROOT VALVE 19 MM BOTH IP/OP "$15,330.00" "$11,344.00" "$2,728.74" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$2,728.74" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$3,194.94" "$15,330.00" "$6,132.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$11,497.50" "$15,330.00" "$15,330.00" "$15,330.00" "$7,665.00" "$7,665.00" "$12,141.36" "$15,330.00" "$12,264.00" "$6,898.50" "$15,330.00" N/A "$8,891.40" "$15,330.00" "$9,198.00" "$15,330.00" "$15,330.00" "$15,330.00" N/A N/A 995FR21 SUP Custom 27803010 995FR21 - FREESTYLE ROOT VALVE 21 MM BOTH IP/OP "$15,330.00" "$11,344.00" "$2,728.74" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$2,728.74" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$3,194.94" "$15,330.00" "$6,132.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$11,497.50" "$15,330.00" "$15,330.00" "$15,330.00" "$7,665.00" "$7,665.00" "$12,141.36" "$15,330.00" "$12,264.00" "$6,898.50" "$15,330.00" N/A "$8,891.40" "$15,330.00" "$9,198.00" "$15,330.00" "$15,330.00" "$15,330.00" N/A N/A 995FR23 SUP Custom 27803010 995FR23 - FREESTYLE ROOT VALVE 23 MM BOTH IP/OP "$15,330.00" "$11,344.00" "$2,728.74" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$2,728.74" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$3,194.94" "$15,330.00" "$6,132.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$11,497.50" "$15,330.00" "$15,330.00" "$15,330.00" "$7,665.00" "$7,665.00" "$12,141.36" "$15,330.00" "$12,264.00" "$6,898.50" "$15,330.00" N/A "$8,891.40" "$15,330.00" "$9,198.00" "$15,330.00" "$15,330.00" "$15,330.00" N/A N/A 995FR25 SUP Custom 27803010 995FR25 - FREESTYLE ROOT VALVE 25 MM BOTH IP/OP "$15,330.00" "$11,344.00" "$2,728.74" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$2,728.74" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$3,194.94" "$15,330.00" "$6,132.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$11,497.50" "$15,330.00" "$15,330.00" "$15,330.00" "$7,665.00" "$7,665.00" "$12,141.36" "$15,330.00" "$12,264.00" "$6,898.50" "$15,330.00" N/A "$8,891.40" "$15,330.00" "$9,198.00" "$15,330.00" "$15,330.00" "$15,330.00" N/A N/A 99-7284 SUP HCPCS C1713 99-7284 - SCREW BONE 1.5MM 4MM SELF DRILL CENTRE-DRIVE TITANIUM MANDIB BOTH IP/OP $140.00 $104.00 $27.79 $140.00 $63.00 $63.00 $63.00 $63.00 $140.00 $140.00 $140.00 $29.18 $140.00 $140.00 $140.00 $140.00 $140.00 $29.18 $140.00 $56.00 $82.81 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $63.00 $27.79 N/A $81.20 $140.00 $84.00 $140.00 $29.18 $140.00 N/A N/A 999-LG SUP HCPCS L3702 999-LG - SPLINT ORTH LG BCKL VLCR CLSR PVC KODEL POST ELB BOTH IP/OP $66.50 $49.00 $13.76 $208.54 $29.71 $29.71 $29.71 $29.71 $66.03 $66.03 $170.29 $208.54 $66.03 $66.03 $66.03 $66.03 $66.03 $13.76 $66.03 $26.41 $39.06 $66.03 $66.03 $66.03 $66.03 $49.88 $66.03 $66.03 $66.03 $33.02 $33.02 $52.30 $66.03 $52.82 $29.71 $66.03 N/A $38.57 $66.03 $39.62 $66.03 $202.65 $66.03 N/A N/A 999-MED SUP HCPCS L3702 999-MED - SPLINT ORTH MED BCKL VLCR CLSR PVC KODEL POST ELB BOTH IP/OP $66.50 $49.00 $13.76 $208.54 $29.71 $29.71 $29.71 $29.71 $66.03 $66.03 $170.29 $208.54 $66.03 $66.03 $66.03 $66.03 $66.03 $13.76 $66.03 $26.41 $39.06 $66.03 $66.03 $66.03 $66.03 $49.88 $66.03 $66.03 $66.03 $33.02 $33.02 $52.30 $66.03 $52.82 $29.71 $66.03 N/A $38.57 $66.03 $39.62 $66.03 $202.65 $66.03 N/A N/A 9AC50 SUP Custom 27203010 9AC50 - TOOL DISSECTING 5MM 9CM ACORN MIDAS REX LEGEND STERILE BOTH IP/OP $321.00 $238.00 $57.12 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $57.12 $320.88 $320.88 $238.16 $238.16 $247.33 $167.18 $66.87 $320.88 $128.35 $320.88 $320.88 $320.88 $320.88 $320.88 $240.75 $320.88 $320.88 $320.88 $160.44 $160.44 $254.14 $320.88 $256.70 $208.57 $320.88 N/A $186.18 $320.88 $192.53 $320.88 $320.88 $320.88 N/A N/A 9AC60 SUP Custom 27203010 9AC60 - TOOL DISSECTING ACORN FLUTE 6MM 9CM MIDAS REX LEGEND STERILE BOTH IP/OP $321.00 $238.00 $57.12 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $57.12 $320.88 $320.88 $238.16 $238.16 $247.33 $167.18 $66.87 $320.88 $128.35 $320.88 $320.88 $320.88 $320.88 $320.88 $240.75 $320.88 $320.88 $320.88 $160.44 $160.44 $254.14 $320.88 $256.70 $208.57 $320.88 N/A $186.18 $320.88 $192.53 $320.88 $320.88 $320.88 N/A N/A 9AC75 SUP Custom 27203010 9AC75 - TOOL DISSECTING 7.5MM 9CM ACORN LEGEND STERILE BOTH IP/OP $321.00 $238.00 $57.12 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $57.12 $320.88 $320.88 $238.16 $238.16 $247.33 $167.18 $66.87 $320.88 $128.35 $320.88 $320.88 $320.88 $320.88 $320.88 $240.75 $320.88 $320.88 $320.88 $160.44 $160.44 $254.14 $320.88 $256.70 $208.57 $320.88 N/A $186.18 $320.88 $192.53 $320.88 $320.88 $320.88 N/A N/A 9AC90 SUP Custom 27203010 9AC90 - TOOL DISSECTING 9MM 90MM ACORN MIDAS REX LEGEND STERILE BOTH IP/OP $321.00 $238.00 $57.12 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $57.12 $320.88 $320.88 $238.16 $238.16 $247.33 $167.18 $66.87 $320.88 $128.35 $320.88 $320.88 $320.88 $320.88 $320.88 $240.75 $320.88 $320.88 $320.88 $160.44 $160.44 $254.14 $320.88 $256.70 $208.57 $320.88 N/A $186.18 $320.88 $192.53 $320.88 $320.88 $320.88 N/A N/A 9BA30 SUP Custom 27203010 9BA30 - TOOL DISSECTING 3MM 9CM BALL FLUTED LEGEND STERILE BOTH IP/OP $334.00 $247.00 $59.39 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $59.39 $333.63 $333.63 $247.62 $247.62 $257.16 $173.82 $69.53 $333.63 $133.45 $333.63 $333.63 $333.63 $333.63 $333.63 $250.50 $333.63 $333.63 $333.63 $166.82 $166.82 $264.23 $333.63 $266.90 $216.86 $333.63 N/A $193.72 $333.63 $200.18 $333.63 $333.63 $333.63 N/A N/A 9BA30D SUP Custom 27203010 9BA30D - TOOL DISSECTING 3MM 9CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $380.50 $282.00 $67.71 $380.38 $380.38 $380.38 $380.38 $380.38 $380.38 $380.38 $67.71 $380.38 $380.38 $282.32 $282.32 $293.20 $198.18 $79.28 $380.38 $152.15 $380.38 $380.38 $380.38 $380.38 $380.38 $285.38 $380.38 $380.38 $380.38 $190.19 $190.19 $301.26 $380.38 $304.30 $247.25 $380.38 N/A $220.69 $380.38 $228.23 $380.38 $380.38 $380.38 N/A N/A 9BA30DC SUP Custom 27203010 9BA30DC - TOOL DISSECTING 3MM 9CM BALL DIAMOND COARSE MIDAS REX LEGEND BOTH IP/OP $382.50 $283.00 $68.09 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $68.09 $382.50 $382.50 $283.89 $283.89 $294.83 $199.28 $79.72 $382.50 $153.00 $382.50 $382.50 $382.50 $382.50 $382.50 $286.88 $382.50 $382.50 $382.50 $191.25 $191.25 $302.94 $382.50 $306.00 $248.63 $382.50 N/A $221.85 $382.50 $229.50 $382.50 $382.50 $382.50 N/A N/A 9BA40 SUP Custom 27203010 9BA40 - TOOL DISSECTING 4MM 9CM BALL FLUTED MIDAS REX LEGEND STERILE BOTH IP/OP $334.00 $247.00 $59.39 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $59.39 $333.63 $333.63 $247.62 $247.62 $257.16 $173.82 $69.53 $333.63 $133.45 $333.63 $333.63 $333.63 $333.63 $333.63 $250.50 $333.63 $333.63 $333.63 $166.82 $166.82 $264.23 $333.63 $266.90 $216.86 $333.63 N/A $193.72 $333.63 $200.18 $333.63 $333.63 $333.63 N/A N/A 9BA40D SUP Custom 27203010 9BA40D - TOOL DISSECTING 4MM 9CM BALL DIAMOND MIDAS REX LEGEND BOTH IP/OP $380.50 $282.00 $67.71 $380.38 $380.38 $380.38 $380.38 $380.38 $380.38 $380.38 $67.71 $380.38 $380.38 $282.32 $282.32 $293.20 $198.18 $79.28 $380.38 $152.15 $380.38 $380.38 $380.38 $380.38 $380.38 $285.38 $380.38 $380.38 $380.38 $190.19 $190.19 $301.26 $380.38 $304.30 $247.25 $380.38 N/A $220.69 $380.38 $228.23 $380.38 $380.38 $380.38 N/A N/A 9BA40DC SUP Custom 27203010 9BA40DC - TOOL DISSECTING 4MM 9CM BALL DIAMOND COARSE MIDAS REX LEGEND BOTH IP/OP $382.50 $283.00 $68.09 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $68.09 $382.50 $382.50 $283.89 $283.89 $294.83 $199.28 $79.72 $382.50 $153.00 $382.50 $382.50 $382.50 $382.50 $382.50 $286.88 $382.50 $382.50 $382.50 $191.25 $191.25 $302.94 $382.50 $306.00 $248.63 $382.50 N/A $221.85 $382.50 $229.50 $382.50 $382.50 $382.50 N/A N/A 9BA40DX SUP Custom 27203010 9BA40DX - TOOL DISSECTING 4MM 9CM BALL DIAMOND XCOARSE MIDAS REX BOTH IP/OP $378.50 $280.00 $67.33 $378.25 $378.25 $378.25 $378.25 $378.25 $378.25 $378.25 $67.33 $378.25 $378.25 $280.74 $280.74 $291.56 $197.07 $78.83 $378.25 $151.30 $378.25 $378.25 $378.25 $378.25 $378.25 $283.88 $378.25 $378.25 $378.25 $189.13 $189.13 $299.57 $378.25 $302.60 $245.86 $378.25 N/A $219.53 $378.25 $226.95 $378.25 $378.25 $378.25 N/A N/A 9BA50DC SUP Custom 27203010 9BA50DC - TOOL DISSECTING 5MM 9CM BALL DIAMOND COARSE MIDAS REX LEGEND BOTH IP/OP $382.50 $283.00 $68.09 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $68.09 $382.50 $382.50 $283.89 $283.89 $294.83 $199.28 $79.72 $382.50 $153.00 $382.50 $382.50 $382.50 $382.50 $382.50 $286.88 $382.50 $382.50 $382.50 $191.25 $191.25 $302.94 $382.50 $306.00 $248.63 $382.50 N/A $221.85 $382.50 $229.50 $382.50 $382.50 $382.50 N/A N/A 9BA50DX SUP Custom 27203010 9BA50DX - TOOL DISSECTING 5MM 9CM BALL DIAMOND XCOARSE MIDAS REX BOTH IP/OP $378.50 $280.00 $67.33 $378.25 $378.25 $378.25 $378.25 $378.25 $378.25 $378.25 $67.33 $378.25 $378.25 $280.74 $280.74 $291.56 $197.07 $78.83 $378.25 $151.30 $378.25 $378.25 $378.25 $378.25 $378.25 $283.88 $378.25 $378.25 $378.25 $189.13 $189.13 $299.57 $378.25 $302.60 $245.86 $378.25 N/A $219.53 $378.25 $226.95 $378.25 $378.25 $378.25 N/A N/A 9BA60DC SUP Custom 27203010 9BA60DC - TOOL DISSECTING 6MM 9CM BALL DIAMOND COARSE MIDAS REX LEGEND BOTH IP/OP $382.50 $283.00 $68.09 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $382.50 $68.09 $382.50 $382.50 $283.89 $283.89 $294.83 $199.28 $79.72 $382.50 $153.00 $382.50 $382.50 $382.50 $382.50 $382.50 $286.88 $382.50 $382.50 $382.50 $191.25 $191.25 $302.94 $382.50 $306.00 $248.63 $382.50 N/A $221.85 $382.50 $229.50 $382.50 $382.50 $382.50 N/A N/A 9BA60DX SUP Custom 27203010 9BA60DX - TOOL DISSECTING 6MM 9CM BALL DIAMOND XCOARSE MIDAS REX BOTH IP/OP $378.50 $280.00 $67.33 $378.25 $378.25 $378.25 $378.25 $378.25 $378.25 $378.25 $67.33 $378.25 $378.25 $280.74 $280.74 $291.56 $197.07 $78.83 $378.25 $151.30 $378.25 $378.25 $378.25 $378.25 $378.25 $283.88 $378.25 $378.25 $378.25 $189.13 $189.13 $299.57 $378.25 $302.60 $245.86 $378.25 N/A $219.53 $378.25 $226.95 $378.25 $378.25 $378.25 N/A N/A 9BA75D SUP Custom 27203010 9BA75D - TOOL DISSECTING 7.5MM 9CM BALL DIAMOND LEGEND STERILE BOTH IP/OP $380.50 $282.00 $67.71 $380.38 $380.38 $380.38 $380.38 $380.38 $380.38 $380.38 $67.71 $380.38 $380.38 $282.32 $282.32 $293.20 $198.18 $79.28 $380.38 $152.15 $380.38 $380.38 $380.38 $380.38 $380.38 $285.38 $380.38 $380.38 $380.38 $190.19 $190.19 $301.26 $380.38 $304.30 $247.25 $380.38 N/A $220.69 $380.38 $228.23 $380.38 $380.38 $380.38 N/A N/A 9BA90 SUP Custom 27203010 9BA90 - TOOL DISSECTING 9MM 9CM BALL LEGEND STERILE BOTH IP/OP $334.00 $247.00 $59.39 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $59.39 $333.63 $333.63 $247.62 $247.62 $257.16 $173.82 $69.53 $333.63 $133.45 $333.63 $333.63 $333.63 $333.63 $333.63 $250.50 $333.63 $333.63 $333.63 $166.82 $166.82 $264.23 $333.63 $266.90 $216.86 $333.63 N/A $193.72 $333.63 $200.18 $333.63 $333.63 $333.63 N/A N/A 9CY50 SUP Custom 27203010 9CY50 - TOOL DISSECTING 5MM 9CM CYLND MIDAS REX LEGEND STERILE BOTH IP/OP $308.50 $228.00 $54.85 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $54.85 $308.13 $308.13 $228.69 $228.69 $237.51 $160.54 $64.22 $308.13 $123.25 $308.13 $308.13 $308.13 $308.13 $308.13 $231.38 $308.13 $308.13 $308.13 $154.07 $154.07 $244.04 $308.13 $246.50 $200.28 $308.13 N/A $178.93 $308.13 $184.88 $308.13 $308.13 $308.13 N/A N/A 9CY60 SUP Custom 27203010 9CY60 - TOOL DISSECTING 6MM 9CM CYLINDER MIDAS REX LEGEND STERILE BOTH IP/OP $308.50 $228.00 $54.85 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $54.85 $308.13 $308.13 $228.69 $228.69 $237.51 $160.54 $64.22 $308.13 $123.25 $308.13 $308.13 $308.13 $308.13 $308.13 $231.38 $308.13 $308.13 $308.13 $154.07 $154.07 $244.04 $308.13 $246.50 $200.28 $308.13 N/A $178.93 $308.13 $184.88 $308.13 $308.13 $308.13 N/A N/A 9CY75 SUP Custom 27203010 9CY75 - TOOL DISSECTING 7.5MM 9CM CYLINDER MIDAS REX LEGEND STERILE BOTH IP/OP $308.50 $228.00 $54.85 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $54.85 $308.13 $308.13 $228.69 $228.69 $237.51 $160.54 $64.22 $308.13 $123.25 $308.13 $308.13 $308.13 $308.13 $308.13 $231.38 $308.13 $308.13 $308.13 $154.07 $154.07 $244.04 $308.13 $246.50 $200.28 $308.13 N/A $178.93 $308.13 $184.88 $308.13 $308.13 $308.13 N/A N/A 9HM100 SUP Custom 27203010 9HM100 - TOOL DISSECTING 10MM 9CM HOLE MAKER LEGEND STERILE BOTH IP/OP $412.50 $305.00 $73.38 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $73.38 $412.25 $412.25 $305.97 $305.97 $317.76 $214.78 $85.92 $412.25 $164.90 $412.25 $412.25 $412.25 $412.25 $412.25 $309.38 $412.25 $412.25 $412.25 $206.13 $206.13 $326.50 $412.25 $329.80 $267.96 $412.25 N/A $239.25 $412.25 $247.35 $412.25 $412.25 $412.25 N/A N/A 9HM126 SUP Custom 27203010 9HM126 - TOOL DISSECTING 12.6MM 9CM HOLE MAKER MIDAS REX LEGEND BOTH IP/OP $412.50 $305.00 $73.38 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $73.38 $412.25 $412.25 $305.97 $305.97 $317.76 $214.78 $85.92 $412.25 $164.90 $412.25 $412.25 $412.25 $412.25 $412.25 $309.38 $412.25 $412.25 $412.25 $206.13 $206.13 $326.50 $412.25 $329.80 $267.96 $412.25 N/A $239.25 $412.25 $247.35 $412.25 $412.25 $412.25 N/A N/A 9HM95 SUP Custom 27203010 9HM95 - TOOL DISSECTING 9.5MM 9CM HOLE MAKER MIDAS REX LEGEND BOTH IP/OP $412.50 $305.00 $73.38 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $73.38 $412.25 $412.25 $305.97 $305.97 $317.76 $214.78 $85.92 $412.25 $164.90 $412.25 $412.25 $412.25 $412.25 $412.25 $309.38 $412.25 $412.25 $412.25 $206.13 $206.13 $326.50 $412.25 $329.80 $267.96 $412.25 N/A $239.25 $412.25 $247.35 $412.25 $412.25 $412.25 N/A N/A 9HS108 SUP Custom 27203010 9HS108 - TOOL DISSECTING 10.8MM 9CM HOLE SAW MIDAS REX LEGEND STERILE BOTH IP/OP $467.50 $346.00 $83.22 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $83.22 $467.50 $467.50 $346.98 $346.98 $360.35 $243.57 $97.43 $467.50 $187.00 $467.50 $467.50 $467.50 $467.50 $467.50 $350.63 $467.50 $467.50 $467.50 $233.75 $233.75 $370.26 $467.50 $374.00 $303.88 $467.50 N/A $271.15 $467.50 $280.50 $467.50 $467.50 $467.50 N/A N/A 9HS135 SUP Custom 27203010 9HS135 - TOOL DISSECTING 13.5MM 9CM HOLE SAW LEGEND STERILE BOTH IP/OP $467.50 $346.00 $83.22 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $467.50 $83.22 $467.50 $467.50 $346.98 $346.98 $360.35 $243.57 $97.43 $467.50 $187.00 $467.50 $467.50 $467.50 $467.50 $467.50 $350.63 $467.50 $467.50 $467.50 $233.75 $233.75 $370.26 $467.50 $374.00 $303.88 $467.50 N/A $271.15 $467.50 $280.50 $467.50 $467.50 $467.50 N/A N/A 9MH30DC SUP Custom 27203010 9MH30DC - TOOL DISSECTING 3MM 9CM DIAMOND MATCH HEAD COARSE MIDAS REX BOTH IP/OP $368.00 $272.00 $65.44 $367.63 $367.63 $367.63 $367.63 $367.63 $367.63 $367.63 $65.44 $367.63 $367.63 $272.85 $272.85 $283.37 $191.54 $76.62 $367.63 $147.05 $367.63 $367.63 $367.63 $367.63 $367.63 $276.00 $367.63 $367.63 $367.63 $183.82 $183.82 $291.16 $367.63 $294.10 $238.96 $367.63 N/A $213.44 $367.63 $220.58 $367.63 $367.63 $367.63 N/A N/A 9OV55 SUP Custom 27203010 9OV55 - TOOL DISSECTING 5.5MM 9CM OVAL MIDAS REX LEGEND STERILE BOTH IP/OP $323.00 $239.00 $57.49 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $323.00 $57.49 $323.00 $323.00 $239.73 $239.73 $248.97 $168.28 $67.32 $323.00 $129.20 $323.00 $323.00 $323.00 $323.00 $323.00 $242.25 $323.00 $323.00 $323.00 $161.50 $161.50 $255.82 $323.00 $258.40 $209.95 $323.00 N/A $187.34 $323.00 $193.80 $323.00 $323.00 $323.00 N/A N/A 9SCT SUP Custom 27203010 9SCT - TUBE TRACHEOSTOMY 12.1MM 9MM 99MM 1 CANNU CUFF LATEX FREE BOTH IP/OP $71.50 $53.00 $12.71 $71.38 $71.38 $71.38 $71.38 $71.38 $71.38 $71.38 $12.71 $71.38 $71.38 $52.98 $52.98 $55.02 $37.19 $14.88 $71.38 $71.07 $71.38 $71.38 $71.38 $71.38 $71.38 $53.63 $71.38 $71.38 $71.38 $35.69 $35.69 $56.53 $71.38 $57.10 $46.40 $71.38 N/A $41.47 $71.38 $42.83 $71.38 $71.38 $71.38 N/A N/A 9TA30 SUP Custom 27203010 9TA30 - TOOL DISSECTING 3MM 9CM TAPERED MIDAS REX LEGEND STERILE BOTH IP/OP $338.00 $250.00 $60.14 $337.88 $337.88 $337.88 $337.88 $337.88 $337.88 $337.88 $60.14 $337.88 $337.88 $250.77 $250.77 $260.44 $176.04 $70.42 $337.88 $135.15 $337.88 $337.88 $337.88 $337.88 $337.88 $253.50 $337.88 $337.88 $337.88 $168.94 $168.94 $267.60 $337.88 $270.30 $219.62 $337.88 N/A $196.04 $337.88 $202.73 $337.88 $337.88 $337.88 N/A N/A A1-0014 SUP HCPCS C1713 A1-0014 - SCREW BONE 14MM COMPRESSION ACUTWIST ACUTRAK HAND FT STERILE BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $148.49 $712.50 N/A N/A A1-0016 SUP HCPCS C1713 A1-0016 - SCREW BONE FULTHD TAPER 16MM COMPRESSION ACUTWIST ACUTRAK BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $148.49 $712.50 N/A N/A A1-0020 SUP HCPCS C1713 A1-0020 - SCREW BONE 20MM ACUTWIST BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A A1-0022 SUP HCPCS C1713 A1-0022 - SCREW BONE 22MM ACUTWIST BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A A10230592 SUP Custom 27803010 A10230592 - VALVE AORTIC 21MM EP SUP THV BOTH IP/OP "$23,350.00" "$17,279.00" "$4,156.30" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$4,156.30" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$4,866.40" "$23,350.00" "$9,340.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$17,512.50" "$23,350.00" "$23,350.00" "$23,350.00" "$11,675.00" "$11,675.00" "$18,493.20" "$23,350.00" "$18,680.00" "$10,507.50" "$23,350.00" N/A "$13,543.00" "$23,350.00" "$14,010.00" "$23,350.00" "$23,350.00" "$23,350.00" N/A N/A A10235766 SUP Custom 27803010 A10235766 - VALVE MTRL 25MM 23MM EP 3 PIG LEAFLETS STNT LINX AC TCH LP BOTH IP/OP "$23,350.00" "$17,279.00" "$4,156.30" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$4,156.30" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$4,866.40" "$23,350.00" "$9,340.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$17,512.50" "$23,350.00" "$23,350.00" "$23,350.00" "$11,675.00" "$11,675.00" "$18,493.20" "$23,350.00" "$18,680.00" "$10,507.50" "$23,350.00" N/A "$13,543.00" "$23,350.00" "$14,010.00" "$23,350.00" "$23,350.00" "$23,350.00" N/A N/A A1072 SUP Custom 27203010 A1072 - PIN SKL STRL MYFLD WNG GRV PLS ADLT CRNM DISP BOTH IP/OP $27.50 $20.00 $4.85 $27.27 $27.27 $27.27 $27.27 $27.27 $27.27 $27.27 $4.85 $27.27 $27.27 $20.24 $20.24 $21.02 $14.21 $5.68 $27.27 $10.91 $27.27 $27.27 $27.27 $27.27 $27.27 $20.63 $27.27 $27.27 $27.27 $13.64 $13.64 $21.60 $27.27 $21.82 $17.73 $27.27 N/A $15.95 $27.27 $16.36 $27.27 $27.27 $27.27 N/A N/A A-1083 SUP HCPCS C1713 A-1083 - PIN SKULL 13MM RED O RING SECURE FIT RIGID FIX MAYFIELD BOTH IP/OP $102.50 $76.00 $20.34 $102.50 $46.13 $46.13 $46.13 $46.13 $102.50 $102.50 $102.50 $21.36 $102.50 $102.50 $102.50 $102.50 $102.50 $21.36 $102.50 $102.50 $60.63 $102.50 $102.50 $102.50 $102.50 $76.88 $102.50 $102.50 $102.50 $51.25 $51.25 $81.18 $102.50 $82.00 $46.13 $20.34 N/A $59.45 $102.50 $61.50 $102.50 $21.36 $102.50 N/A N/A A1815 SUP Custom 27203010 A1815 - NEEDLE BIOP 18GA 15CM COAXIAL AUTOMATED PROGRAMMABLE ACHIEVE BOTH IP/OP $92.50 $68.00 $16.47 $92.50 $92.50 $92.50 $92.50 $92.50 $92.50 $92.50 $16.47 $92.50 $92.50 $68.65 $68.65 $71.30 $48.19 $19.28 $92.50 $37.00 $92.50 $92.50 $92.50 $92.50 $92.50 $69.38 $92.50 $92.50 $92.50 $46.25 $46.25 $73.26 $92.50 $74.00 $60.13 $92.50 N/A $53.65 $92.50 $55.50 $92.50 $92.50 $92.50 N/A N/A A1815 SUP Custom 27203010 NEEDLE BIOP 18GA 15CM ACHV COAX AUTO PRGM SFT TIS DISP BOTH IP/OP $108.00 $80.00 $16.47 $92.50 $92.50 $92.50 $92.50 $92.50 $92.50 $92.50 $16.47 $92.50 $92.50 $68.65 $68.65 $71.30 $48.19 $19.28 $92.50 $37.00 $92.50 $92.50 $92.50 $92.50 $92.50 $81.00 $92.50 $92.50 $92.50 $46.25 $46.25 $73.26 $92.50 $74.00 $60.13 $92.50 N/A $62.64 $92.50 $55.50 $92.50 $92.50 $92.50 N/A N/A A2015-020 SUP HCPCS C1725 A2015-020 - CATHETER BLNDIL 1.5MM 150CM 20MM ARMADA FLXB MRKR STREAMLINE BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $115.39 $115.39 $115.39 $115.39 $212.50 $212.50 $212.50 $44.29 $212.50 $157.72 $157.72 $163.80 $110.71 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $138.13 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A A2020-200 SUP HCPCS C1725 A2020-200 - CATHETER BLNDIL 2MM 150CM 200MM ARMADA FLXB MRKR STREAMLINE BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $115.39 $115.39 $115.39 $115.39 $212.50 $212.50 $212.50 $44.29 $212.50 $157.72 $157.72 $163.80 $110.71 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $138.13 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A A2030-080 SUP HCPCS C1725 A2030-080 - CATHETER BLNDIL 3MM 150CM 80MM ARMADA FLXB MRKR STREAMLINE BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $115.39 $115.39 $115.39 $115.39 $212.50 $212.50 $212.50 $44.29 $212.50 $157.72 $157.72 $163.80 $110.71 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $138.13 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A A-3434 SUP Custom 27203010 A-3434 - BIT DRILL 1.6MM 86MM 30MM AO SHAFT TWIST STOP 2MM SCREW BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A A368LL SUP HCPCS L1930 A368LL - SPLINT ORTHOPEDIC 9-10.5 LARGE 20.5IN 7.75IN POSTERIOR LEAF BOTH IP/OP $75.00 $56.00 $15.63 $160.36 $74.98 $74.98 $74.98 $74.98 $74.98 $74.98 $160.36 $74.98 $74.98 $74.98 $74.98 $74.98 $74.98 $15.63 $74.98 $29.99 $74.98 $74.98 $74.98 $74.98 $74.98 $56.25 $74.98 $74.98 $74.98 $37.49 $37.49 $59.38 $74.98 $59.98 $33.74 $74.98 N/A $43.50 $74.98 $44.99 $74.98 $74.98 $74.98 N/A N/A A368LM SUP HCPCS L1930 A368LM - SPLINT ORTHOPEDIC 7-9 MEDIUM 19.5IN 7IN POSTERIOR LEAF BOTH IP/OP $75.00 $56.00 $15.63 $160.36 $74.98 $74.98 $74.98 $74.98 $74.98 $74.98 $160.36 $74.98 $74.98 $74.98 $74.98 $74.98 $74.98 $15.63 $74.98 $29.99 $74.98 $74.98 $74.98 $74.98 $74.98 $56.25 $74.98 $74.98 $74.98 $37.49 $37.49 $59.38 $74.98 $59.98 $33.74 $74.98 N/A $43.50 $74.98 $44.99 $74.98 $74.98 $74.98 N/A N/A A368LX SUP HCPCS L1930 A368LX - SPLINT ORTHOPEDIC 11-12.5 XL 21.5IN 8.5IN POSTERIOR LEAF BOTH IP/OP $81.00 $60.00 $16.79 $160.36 $80.58 $80.58 $80.58 $80.58 $80.58 $80.58 $160.36 $80.58 $80.58 $80.58 $80.58 $80.58 $80.58 $16.79 $80.58 $32.23 $80.58 $80.58 $80.58 $80.58 $80.58 $60.75 $80.58 $80.58 $80.58 $40.29 $40.29 $63.82 $80.58 $64.46 $36.26 $80.58 N/A $46.98 $80.58 $48.35 $80.58 $80.58 $80.58 N/A N/A A368RL SUP HCPCS L1930 A368RL - SPLINT ORTHOPEDIC 9-11 LARGE 20.5IN 7.75IN POSTERIOR LEAF BOTH IP/OP $75.00 $56.00 $15.63 $160.36 $74.98 $74.98 $74.98 $74.98 $74.98 $74.98 $160.36 $74.98 $74.98 $74.98 $74.98 $74.98 $74.98 $15.63 $74.98 $29.99 $74.98 $74.98 $74.98 $74.98 $74.98 $56.25 $74.98 $74.98 $74.98 $37.49 $37.49 $59.38 $74.98 $59.98 $33.74 $74.98 N/A $43.50 $74.98 $44.99 $74.98 $74.98 $74.98 N/A N/A A368RM SUP HCPCS L1930 A368RM - SPLINT ORTHOPEDIC 7-9 MEDIUM 19.5IN 7IN POSTERIOR LEAF BOTH IP/OP $75.00 $56.00 $15.63 $160.36 $74.98 $74.98 $74.98 $74.98 $74.98 $74.98 $160.36 $74.98 $74.98 $74.98 $74.98 $74.98 $74.98 $15.63 $74.98 $29.99 $74.98 $74.98 $74.98 $74.98 $74.98 $56.25 $74.98 $74.98 $74.98 $37.49 $37.49 $59.38 $74.98 $59.98 $33.74 $74.98 N/A $43.50 $74.98 $44.99 $74.98 $74.98 $74.98 N/A N/A A368RX SUP HCPCS L1930 A368RX - SPLINT ORTHOPEDIC 11-12.5 XL 21.5IN 8.5IN POSTERIOR LEAF BOTH IP/OP $81.00 $60.00 $16.79 $160.36 $80.58 $80.58 $80.58 $80.58 $80.58 $80.58 $160.36 $80.58 $80.58 $80.58 $80.58 $80.58 $80.58 $16.79 $80.58 $32.23 $80.58 $80.58 $80.58 $80.58 $80.58 $60.75 $80.58 $80.58 $80.58 $40.29 $40.29 $63.82 $80.58 $64.46 $36.26 $80.58 N/A $46.98 $80.58 $48.35 $80.58 $80.58 $80.58 N/A N/A A390014 SUP HCPCS C1713 A390014 - WASHER ORTH 8MM 4MM BOTH IP/OP $36.00 $27.00 $7.09 $35.70 $16.07 $16.07 $16.07 $16.07 $35.70 $35.70 $35.70 $7.44 $35.70 $35.70 $35.70 $35.70 $35.70 $7.44 $35.70 $10.29 $21.12 $35.70 $25.73 $35.70 $35.70 $27.00 $35.70 $35.70 $35.70 $17.85 $17.85 $28.27 $35.70 $28.56 $16.07 $7.09 N/A $20.88 $35.70 $21.42 $35.70 $35.70 $35.70 N/A N/A A3SR01 SUP HCPCS C1786 A3SR01 - PACEMAKER CRD ADVISA SR MR SURESCAN 1 CHMBR UNPLR BOTH IP/OP "$7,595.00" "$5,620.00" "$1,507.42" "$7,595.00" "$3,417.75" "$3,417.75" "$3,417.75" "$3,417.75" "$7,595.00" "$7,595.00" "$7,595.00" "$1,582.99" "$7,595.00" "$7,595.00" "$7,595.00" "$7,595.00" "$7,595.00" "$1,582.88" "$7,595.00" "$7,595.00" "$3,744.34" "$7,595.00" "$7,595.00" "$7,595.00" "$7,595.00" "$5,696.25" "$7,595.00" "$7,595.00" "$7,595.00" "$3,797.50" "$3,797.50" "$6,015.24" "$7,595.00" "$6,076.00" "$3,417.75" "$1,507.42" N/A "$4,405.10" "$7,595.00" "$7,595.00" "$7,595.00" "$1,582.80" "$7,595.00" N/A N/A A-4300.01 SUP HCPCS C1713 A-4300.01 - PLATE BN STRG 18MMX.6MM APTUS 4 HL FX TI HND 1.2/1.5MM SCR BOTH IP/OP $580.50 $430.00 $115.14 $580.13 $261.06 $261.06 $261.06 $261.06 $580.13 $580.13 $580.13 $120.91 $580.13 $580.13 $580.13 $580.13 $580.13 $120.91 $580.13 $232.05 $343.15 $580.13 $580.13 $580.13 $580.13 $435.38 $580.13 $580.13 $580.13 $290.07 $290.07 $459.46 $580.13 $464.10 $261.06 $115.14 N/A $336.69 $580.13 $348.08 $580.13 $120.90 $580.13 N/A N/A A-4300.03 SUP HCPCS C1713 A-4300.03 - PLATE 6 HOLE BONE BOTH IP/OP $580.50 $430.00 $115.14 $580.13 $261.06 $261.06 $261.06 $261.06 $580.13 $580.13 $580.13 $120.91 $580.13 $580.13 $580.13 $580.13 $580.13 $120.91 $580.13 $232.05 $343.15 $580.13 $580.13 $580.13 $580.13 $435.38 $580.13 $580.13 $580.13 $290.07 $290.07 $459.46 $580.13 $464.10 $261.06 $115.14 N/A $336.69 $580.13 $580.13 $580.13 $120.90 $580.13 N/A N/A A-4300.04 SUP HCPCS C1713 A-4300.04 - PLATE 1.5MM 16 HOLE STR BONE 1.2MM BOTH IP/OP $785.00 $581.00 $155.78 $784.88 $353.20 $353.20 $353.20 $353.20 $784.88 $784.88 $784.88 $163.59 $784.88 $784.88 $784.88 $784.88 $784.88 $163.58 $784.88 $313.95 $464.26 $784.88 $784.88 $784.88 $784.88 $588.75 $784.88 $784.88 $784.88 $392.44 $392.44 $621.62 $784.88 $627.90 $353.20 $155.78 N/A $455.30 $784.88 $784.88 $784.88 $163.57 $784.88 N/A N/A A-4300.05 SUP HCPCS C1713 A-4300.05 - PLATE BN CRV 69MMX.6MM APTUS 16 HL FX TI HND 1.2/1.5MM SCR BOTH IP/OP $785.00 $581.00 $155.78 $784.88 $353.20 $353.20 $353.20 $353.20 $784.88 $784.88 $784.88 $163.59 $784.88 $784.88 $784.88 $784.88 $784.88 $163.58 $784.88 $313.95 $464.26 $784.88 $784.88 $784.88 $784.88 $588.75 $784.88 $784.88 $784.88 $392.44 $392.44 $621.62 $784.88 $627.90 $353.20 $155.78 N/A $455.30 $784.88 $784.88 $784.88 $163.57 $784.88 N/A N/A A-4300.06 SUP HCPCS C1713 A-4300.06 - PLATE BN OFST 51MMX.6MM APTUS 16 HL FX TI HND 1.2/1.5MM SCR BOTH IP/OP $785.00 $581.00 $155.78 $784.88 $353.20 $353.20 $353.20 $353.20 $784.88 $784.88 $784.88 $163.59 $784.88 $784.88 $784.88 $784.88 $784.88 $163.58 $784.88 $313.95 $464.26 $784.88 $784.88 $784.88 $784.88 $588.75 $784.88 $784.88 $784.88 $392.44 $392.44 $621.62 $784.88 $627.90 $353.20 $155.78 N/A $455.30 $784.88 $784.88 $784.88 $163.57 $784.88 N/A N/A A-4300.10 SUP HCPCS C1713 A-4300.10 - PLATE BN T 27MMX.6MM APTUS 2X5 HL FX TI HND 1.2/1.5MM SCR BOTH IP/OP $690.50 $511.00 $137.02 $690.38 $310.67 $310.67 $310.67 $310.67 $690.38 $690.38 $690.38 $143.89 $690.38 $690.38 $690.38 $690.38 $690.38 $143.88 $690.38 $690.38 $408.36 $690.38 $690.38 $690.38 $690.38 $517.88 $690.38 $690.38 $690.38 $345.19 $345.19 $546.78 $690.38 $552.30 $310.67 $137.02 N/A $400.49 $690.38 $690.38 $690.38 $143.88 $690.38 N/A N/A A-4300.11 SUP HCPCS C1713 A-4300.11 - PLATE BONE T 27X10X.6MM 3X5 HOLE FIX APTUS TITANIUM HAND BOTH IP/OP $690.50 $511.00 $137.02 $690.38 $310.67 $310.67 $310.67 $310.67 $690.38 $690.38 $690.38 $143.89 $690.38 $690.38 $690.38 $690.38 $690.38 $143.88 $690.38 $276.15 $408.36 $690.38 $690.38 $690.38 $690.38 $517.88 $690.38 $690.38 $690.38 $345.19 $345.19 $546.78 $690.38 $552.30 $310.67 $137.02 N/A $400.49 $690.38 $690.38 $690.38 $143.88 $690.38 N/A N/A A-4300.13 SUP HCPCS C1713 A-4300.13 - PLATE BN 1.2MM 1.5MM Y 2.4 HL BOTH IP/OP $690.50 $511.00 $137.02 $690.38 $310.67 $310.67 $310.67 $310.67 $690.38 $690.38 $690.38 $143.89 $690.38 $690.38 $690.38 $690.38 $690.38 $143.88 $690.38 $690.38 $408.36 $690.38 $690.38 $690.38 $690.38 $517.88 $690.38 $690.38 $690.38 $345.19 $345.19 $546.78 $690.38 $552.30 $310.67 $137.02 N/A $400.49 $690.38 $690.38 $690.38 $143.88 $690.38 N/A N/A A-4300.20 SUP HCPCS C1713 A-4300.20 - PLATE BN 1.2MM 1.5MM L 2-3 HL LT BOTH IP/OP $690.50 $511.00 $137.02 $690.38 $310.67 $310.67 $310.67 $310.67 $690.38 $690.38 $690.38 $143.89 $690.38 $690.38 $690.38 $690.38 $690.38 $143.88 $690.38 $276.15 $408.36 $690.38 $690.38 $690.38 $690.38 $517.88 $690.38 $690.38 $690.38 $345.19 $345.19 $546.78 $690.38 $552.30 $310.67 $137.02 N/A $400.49 $690.38 $690.38 $690.38 $143.88 $690.38 N/A N/A A-4300.21 SUP HCPCS C1713 A-4300.21 - PLATE BN L RT 18MMX.6MM APTUS 2X3 HL FX TI HND 1.2/1.5MM SCR BOTH IP/OP $690.50 $511.00 $137.02 $690.38 $310.67 $310.67 $310.67 $310.67 $690.38 $690.38 $690.38 $143.89 $690.38 $690.38 $690.38 $690.38 $690.38 $143.88 $690.38 $690.38 $408.36 $690.38 $690.38 $690.38 $690.38 $517.88 $690.38 $690.38 $690.38 $345.19 $345.19 $546.78 $690.38 $552.30 $310.67 $137.02 N/A $400.49 $690.38 $690.38 $690.38 $143.88 $690.38 N/A N/A A-4300.50 SUP HCPCS C1713 A-4300.50 - PLATE BN RECT 9MMX.6MM APTUS 2X2 HL GRID FX TI HND 1.2/1.5MM BOTH IP/OP $711.50 $527.00 $141.19 $711.38 $320.12 $320.12 $320.12 $320.12 $711.38 $711.38 $711.38 $148.27 $711.38 $711.38 $711.38 $711.38 $711.38 $148.26 $711.38 $284.55 $420.78 $711.38 $711.38 $711.38 $711.38 $533.63 $711.38 $711.38 $711.38 $355.69 $355.69 $563.41 $711.38 $569.10 $320.12 $141.19 N/A $412.67 $711.38 $711.38 $711.38 $148.25 $711.38 N/A N/A A-4300.51 SUP HCPCS C1713 A-4300.51 - PLATE 1.2 MM 1.5 MM SCR LEAN MESH BONE BOTH IP/OP $711.50 $527.00 $141.19 $711.38 $320.12 $320.12 $320.12 $320.12 $711.38 $711.38 $711.38 $148.27 $711.38 $711.38 $711.38 $711.38 $711.38 $148.26 $711.38 $711.38 $420.78 $711.38 $711.38 $711.38 $711.38 $533.63 $711.38 $711.38 $711.38 $355.69 $355.69 $563.41 $711.38 $569.10 $320.12 $141.19 N/A $412.67 $711.38 $711.38 $711.38 $148.25 $711.38 N/A N/A A-4300.54 SUP HCPCS C1713 A-4300.54 - PLATE 1.2-1.5 MM SCR MESH TRP 2X2 HOLE BONE BOTH IP/OP $711.50 $527.00 $141.19 $711.38 $320.12 $320.12 $320.12 $320.12 $711.38 $711.38 $711.38 $148.27 $711.38 $711.38 $711.38 $711.38 $711.38 $148.26 $711.38 $284.55 $420.78 $711.38 $711.38 $711.38 $711.38 $533.63 $711.38 $711.38 $711.38 $355.69 $355.69 $563.41 $711.38 $569.10 $320.12 $141.19 N/A $412.67 $711.38 $711.38 $711.38 $148.25 $711.38 N/A N/A A-4300.55 SUP HCPCS C1713 A-4300.55 - PLATE BN RECT 15MMX.6MM APTUS 3X2 HL GRID FX TI HND 1.2/1.5 BOTH IP/OP $772.00 $571.00 $153.17 $771.75 $347.29 $347.29 $347.29 $347.29 $771.75 $771.75 $771.75 $160.85 $771.75 $771.75 $771.75 $771.75 $771.75 $160.84 $771.75 $771.75 $456.49 $771.75 $771.75 $771.75 $771.75 $579.00 $771.75 $771.75 $771.75 $385.88 $385.88 $611.23 $771.75 $617.40 $347.29 $153.17 N/A $447.76 $771.75 $771.75 $771.75 $160.83 $771.75 N/A N/A A-4300.56 SUP HCPCS C1713 A-4300.56 - PLATE BN TRPZD BOTH IP/OP $772.00 $571.00 $153.17 $771.75 $347.29 $347.29 $347.29 $347.29 $771.75 $771.75 $771.75 $160.85 $771.75 $771.75 $771.75 $771.75 $771.75 $160.84 $771.75 $771.75 $456.49 $771.75 $771.75 $771.75 $771.75 $579.00 $771.75 $771.75 $771.75 $385.88 $385.88 $611.23 $771.75 $617.40 $347.29 $153.17 N/A $447.76 $771.75 $771.75 $771.75 $160.83 $771.75 N/A N/A A-4300.58 SUP HCPCS C1713 A-4300.58 - PLATE 1.2-1.5 MM SCR MESH TRP 3X2 HOLE BONE LEFT BOTH IP/OP $772.00 $571.00 $153.17 $771.75 $347.29 $347.29 $347.29 $347.29 $771.75 $771.75 $771.75 $160.85 $771.75 $771.75 $771.75 $771.75 $771.75 $160.84 $771.75 $308.70 $456.49 $771.75 $771.75 $771.75 $771.75 $579.00 $771.75 $771.75 $771.75 $385.88 $385.88 $611.23 $771.75 $617.40 $347.29 $153.17 N/A $447.76 $771.75 $771.75 $771.75 $160.83 $771.75 N/A N/A A-4300.59 SUP HCPCS C1713 A-4300.59 - PLATE BN TRPZD RT 17MMX.6MM APTUS 3X2 HL GRID FX TI HND BOTH IP/OP $772.00 $571.00 $153.17 $771.75 $347.29 $347.29 $347.29 $347.29 $771.75 $771.75 $771.75 $160.85 $771.75 $771.75 $771.75 $771.75 $771.75 $160.84 $771.75 $308.70 $456.49 $771.75 $771.75 $771.75 $771.75 $579.00 $771.75 $771.75 $771.75 $385.88 $385.88 $611.23 $771.75 $617.40 $347.29 $153.17 N/A $447.76 $771.75 $771.75 $771.75 $771.75 $771.75 N/A N/A A-4300.60 SUP HCPCS C1713 A-4300.60 - PLATE BN ANG LT 17MMX.6MM APTUS 3X3 HL GRID FX TI HND BOTH IP/OP $801.00 $593.00 $158.91 $800.63 $360.28 $360.28 $360.28 $360.28 $800.63 $800.63 $800.63 $166.87 $800.63 $800.63 $800.63 $800.63 $800.63 $166.86 $800.63 $320.25 $473.57 $800.63 $800.63 $800.63 $800.63 $600.75 $800.63 $800.63 $800.63 $400.32 $400.32 $634.10 $800.63 $640.50 $360.28 $158.91 N/A $464.58 $800.63 $800.63 $800.63 $166.85 $800.63 N/A N/A A-4300.61 SUP HCPCS C1713 A-4300.61 - PLATE BN ANG RT 17MMX.6MM APTUS 3X3 HL GRID FX TI HND BOTH IP/OP $801.00 $593.00 $158.91 $800.63 $360.28 $360.28 $360.28 $360.28 $800.63 $800.63 $800.63 $166.87 $800.63 $800.63 $800.63 $800.63 $800.63 $166.86 $800.63 $800.63 $473.57 $800.63 $800.63 $800.63 $800.63 $600.75 $800.63 $800.63 $800.63 $400.32 $400.32 $634.10 $800.63 $640.50 $360.28 $158.91 N/A $464.58 $800.63 $800.63 $800.63 $166.85 $800.63 N/A N/A A-4300.62 SUP HCPCS C1713 A-4300.62 - PLATE BN TRPZD 21MMX.6MM APTUS 4X2 HL GRID FX TI HND 1.2/1.5 BOTH IP/OP $808.50 $598.00 $160.47 $808.50 $363.83 $363.83 $363.83 $363.83 $808.50 $808.50 $808.50 $168.51 $808.50 $808.50 $808.50 $808.50 $808.50 $168.50 $808.50 $323.40 $478.23 $808.50 $808.50 $808.50 $808.50 $606.38 $808.50 $808.50 $808.50 $404.25 $404.25 $640.33 $808.50 $646.80 $363.83 $160.47 N/A $468.93 $808.50 $808.50 $808.50 $168.49 $808.50 N/A N/A A-4300.64 SUP HCPCS C1713 A-4300.64 - PLATE BN ANG LT 20MMX.6MM APTUS 4X2 HL GRID FX TI HND BOTH IP/OP $808.50 $598.00 $160.47 $808.50 $363.83 $363.83 $363.83 $363.83 $808.50 $808.50 $808.50 $168.51 $808.50 $808.50 $808.50 $808.50 $808.50 $168.50 $808.50 $323.40 $478.23 $808.50 $808.50 $808.50 $808.50 $606.38 $808.50 $808.50 $808.50 $404.25 $404.25 $640.33 $808.50 $646.80 $363.83 $160.47 N/A $468.93 $808.50 $808.50 $808.50 $168.49 $808.50 N/A N/A A-4300.65 SUP HCPCS C1713 A-4300.65 - PLATE BN ANG RT 20MMX.6MM APTUS 4X2 HL GRID FX TI HND BOTH IP/OP $808.50 $598.00 $160.47 $808.50 $363.83 $363.83 $363.83 $363.83 $808.50 $808.50 $808.50 $168.51 $808.50 $808.50 $808.50 $808.50 $808.50 $168.50 $808.50 $323.40 $478.23 $808.50 $808.50 $808.50 $808.50 $606.38 $808.50 $808.50 $808.50 $404.25 $404.25 $640.33 $808.50 $646.80 $363.83 $160.47 N/A $468.93 $808.50 $808.50 $808.50 $168.49 $808.50 N/A N/A A-4300.66 SUP HCPCS C1713 A-4300.66 - PLATE BN ANG LT 27MMX.6MM APTUS 5X2 HL GRID FX TI HND BOTH IP/OP $808.50 $598.00 $160.47 $808.50 $363.83 $363.83 $363.83 $363.83 $808.50 $808.50 $808.50 $168.51 $808.50 $808.50 $808.50 $808.50 $808.50 $168.50 $808.50 $808.50 $478.23 $808.50 $808.50 $808.50 $808.50 $606.38 $808.50 $808.50 $808.50 $404.25 $404.25 $640.33 $808.50 $646.80 $363.83 $160.47 N/A $468.93 $808.50 $808.50 $808.50 $168.49 $808.50 N/A N/A A-4300.67 SUP HCPCS C1713 A-4300.67 - PLATE BN TRPZD 33MMX.6MM APTUS 6X2 HL GRID FX TI HND 1.2/1.5 BOTH IP/OP $808.50 $598.00 $160.47 $808.50 $363.83 $363.83 $363.83 $363.83 $808.50 $808.50 $808.50 $168.51 $808.50 $808.50 $808.50 $808.50 $808.50 $168.50 $808.50 $808.50 $478.23 $808.50 $808.50 $808.50 $808.50 $606.38 $808.50 $808.50 $808.50 $404.25 $404.25 $640.33 $808.50 $646.80 $363.83 $160.47 N/A $468.93 $808.50 $808.50 $808.50 $168.49 $808.50 N/A N/A A43102 SUP Custom 27804086 A43102 - FILLER BN VOID 1ML GRFTN ALGRF PTTY JR DBM BOTH IP/OP $540.00 $400.00 $96.12 $540.00 $540.00 $540.00 $540.00 $540.00 $540.00 $540.00 $96.12 $540.00 $540.00 $540.00 $540.00 $540.00 $540.00 $112.54 $540.00 $216.00 $540.00 $540.00 $540.00 $540.00 $540.00 $405.00 $540.00 $540.00 $540.00 $270.00 $270.00 $427.68 $540.00 $432.00 $243.00 $540.00 N/A $313.20 $540.00 $324.00 $540.00 $540.00 $540.00 N/A N/A A43103 SUP Custom 27804086 A43103 - GRAFT BN 2.5ML GRFTN PTTY JR DBM BOTH IP/OP "$1,190.00" $881.00 $211.82 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $211.82 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $248.01 "$1,190.00" $476.00 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $892.50 "$1,190.00" "$1,190.00" "$1,190.00" $595.00 $595.00 $942.48 "$1,190.00" $952.00 $535.50 "$1,190.00" N/A $690.20 "$1,190.00" $714.00 "$1,190.00" "$1,190.00" "$1,190.00" N/A N/A A-4340.11 SUP HCPCS C1713 A-4340.11 - PLATE BN T OFST 35X10X.6MM APTUS 3X8 HL 2 HK CMPR TI HND BOTH IP/OP $879.50 $651.00 $174.53 $879.38 $395.72 $395.72 $395.72 $395.72 $879.38 $879.38 $879.38 $183.28 $879.38 $879.38 $879.38 $879.38 $879.38 $183.27 $879.38 $879.38 $520.15 $879.38 $879.38 $879.38 $879.38 $659.63 $879.38 $879.38 $879.38 $439.69 $439.69 $696.47 $879.38 $703.50 $395.72 $174.53 N/A $510.11 $879.38 $879.38 $879.38 $183.26 $879.38 N/A N/A A-4340.12 SUP HCPCS C1713 A-4340.12 - PLATE BN T OFST 35X13X.6MM APTUS 4X8 HL CMPR TI HND 1.2/1.5 BOTH IP/OP $879.50 $651.00 $174.53 $879.38 $395.72 $395.72 $395.72 $395.72 $879.38 $879.38 $879.38 $183.28 $879.38 $879.38 $879.38 $879.38 $879.38 $183.27 $879.38 $879.38 $520.15 $879.38 $879.38 $879.38 $879.38 $659.63 $879.38 $879.38 $879.38 $439.69 $439.69 $696.47 $879.38 $703.50 $395.72 $174.53 N/A $510.11 $879.38 $879.38 $879.38 $183.26 $879.38 N/A N/A A-4340.30 SUP HCPCS C1713 A-4340.30 - PLATE BONE 30MM 4X8 HOLE GRID ANGLED COMPRESSION TRAPEZOID BOTH IP/OP $950.50 $703.00 $188.60 $950.25 $427.61 $427.61 $427.61 $427.61 $950.25 $950.25 $950.25 $198.06 $950.25 $950.25 $950.25 $950.25 $950.25 $198.04 $950.25 $950.25 $562.07 $950.25 $950.25 $950.25 $950.25 $712.88 $950.25 $950.25 $950.25 $475.13 $475.13 $752.60 $950.25 $760.20 $427.61 $188.60 N/A $551.29 $950.25 $950.25 $950.25 $198.03 $950.25 N/A N/A A-4340.31 SUP HCPCS C1713 A-4340.31 - PLATE 5 HOLE CMPR PIN BONE RIGHT BOTH IP/OP $950.50 $703.00 $188.60 $950.25 $427.61 $427.61 $427.61 $427.61 $950.25 $950.25 $950.25 $198.06 $950.25 $950.25 $950.25 $950.25 $950.25 $198.04 $950.25 $380.10 $562.07 $950.25 $950.25 $950.25 $950.25 $712.88 $950.25 $950.25 $950.25 $475.13 $475.13 $752.60 $950.25 $760.20 $427.61 $188.60 N/A $551.29 $950.25 $950.25 $950.25 $198.03 $950.25 N/A N/A A-4340.32 SUP HCPCS C1713 A-4340.32 - PLATE BN .6MM APTUS 1 HL 2 HK CMPR TI HND 1.2/1.5MM SCR BOTH IP/OP $879.50 $651.00 $174.53 $879.38 $395.72 $395.72 $395.72 $395.72 $879.38 $879.38 $879.38 $183.28 $879.38 $879.38 $879.38 $879.38 $879.38 $183.27 $879.38 $351.75 $520.15 $879.38 $879.38 $879.38 $879.38 $659.63 $879.38 $879.38 $879.38 $439.69 $439.69 $696.47 $879.38 $703.50 $395.72 $174.53 N/A $510.11 $879.38 $879.38 $879.38 $183.26 $879.38 N/A N/A A-4350.01 SUP HCPCS C1713 A-4350.01 - PLATE BONE STR 19MMX.8MM 4 HOLE APTUS TRILOCK TITANIUM BOTH IP/OP "$1,142.00" $845.00 $226.63 "$1,141.88" $513.85 $513.85 $513.85 $513.85 "$1,141.88" "$1,141.88" "$1,141.88" $238.00 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $237.98 "$1,141.88" $456.75 $675.42 "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" $856.50 "$1,141.88" "$1,141.88" "$1,141.88" $570.94 $570.94 $904.37 "$1,141.88" $913.50 $513.85 $226.63 N/A $662.36 "$1,141.88" "$1,141.88" "$1,141.88" $237.97 "$1,141.88" N/A N/A A-4350.14 SUP HCPCS C1713 A-4350.14 - PLATE BONE T 25X11X.8MM 8 HOLE APTUS TRILOCK TITANIUM BOTH IP/OP "$1,218.00" $901.00 $241.74 "$1,218.00" $548.10 $548.10 $548.10 $548.10 "$1,218.00" "$1,218.00" "$1,218.00" $253.86 "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" $253.84 "$1,218.00" "$1,218.00" $720.45 "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" $913.50 "$1,218.00" "$1,218.00" "$1,218.00" $609.00 $609.00 $964.66 "$1,218.00" $974.40 $548.10 $241.74 N/A $706.44 "$1,218.00" "$1,218.00" "$1,218.00" $253.83 "$1,218.00" N/A N/A A-4350.23 SUP HCPCS C1713 A-4350.23 - PLATE BONE 23X9X.8MM 6 HOLE ROTATION APTUS TRILOCK TITANIUM BOTH IP/OP "$1,242.00" $919.00 $246.43 "$1,241.63" $558.73 $558.73 $558.73 $558.73 "$1,241.63" "$1,241.63" "$1,241.63" $258.79 "$1,241.63" "$1,241.63" "$1,241.63" "$1,241.63" "$1,241.63" $258.77 "$1,241.63" "$1,241.63" $734.42 "$1,241.63" "$1,241.63" "$1,241.63" "$1,241.63" $931.50 "$1,241.63" "$1,241.63" "$1,241.63" $620.82 $620.82 $983.37 "$1,241.63" $993.30 $558.73 $246.43 N/A $720.36 "$1,241.63" $744.98 "$1,241.63" $258.76 "$1,241.63" N/A N/A A-4350.41 SUP HCPCS C1713 A-4350.41 - PLATE BONE T 24X11X.8MM 9 HOLE 2 ROW APTUS TRILOCK TITANIUM BOTH IP/OP "$1,263.00" $935.00 $250.60 "$1,262.63" $568.18 $568.18 $568.18 $568.18 "$1,262.63" "$1,262.63" "$1,262.63" $263.16 "$1,262.63" "$1,262.63" "$1,262.63" "$1,262.63" "$1,262.63" $263.15 "$1,262.63" "$1,262.63" $746.85 "$1,262.63" "$1,262.63" "$1,262.63" "$1,262.63" $947.25 "$1,262.63" "$1,262.63" "$1,262.63" $631.32 $631.32 "$1,000.00" "$1,262.63" "$1,010.10" $568.18 $250.60 N/A $732.54 "$1,262.63" "$1,262.63" "$1,262.63" $263.13 "$1,262.63" N/A N/A A-4350.50 SUP HCPCS C1713 A-4350.50 - PLATE BONE RECTANGLE 9MMX.8MM 4 HOLE GRID APTUS TRILOCK BOTH IP/OP "$1,373.00" "$1,016.00" $272.48 "$1,372.88" $617.80 $617.80 $617.80 $617.80 "$1,372.88" "$1,372.88" "$1,372.88" $286.14 "$1,372.88" "$1,372.88" "$1,372.88" "$1,372.88" "$1,372.88" $286.12 "$1,372.88" $549.15 $812.06 "$1,372.88" "$1,372.88" "$1,372.88" "$1,372.88" "$1,029.75" "$1,372.88" "$1,372.88" "$1,372.88" $686.44 $686.44 "$1,087.32" "$1,372.88" "$1,098.30" $617.80 $272.48 N/A $796.34 "$1,372.88" $823.73 "$1,372.88" $286.11 "$1,372.88" N/A N/A A-4350.56 SUP HCPCS C1713 A-4350.56 - PLATE BONE TRAPEZOID 15MMX.8MM 6X2 HOLE GRID APTUS TRILOCK BOTH IP/OP "$1,420.50" "$1,051.00" $281.86 "$1,420.13" $639.06 $639.06 $639.06 $639.06 "$1,420.13" "$1,420.13" "$1,420.13" $295.99 "$1,420.13" "$1,420.13" "$1,420.13" "$1,420.13" "$1,420.13" $295.97 "$1,420.13" $568.05 $840.01 "$1,420.13" "$1,420.13" "$1,420.13" "$1,420.13" "$1,065.38" "$1,420.13" "$1,420.13" "$1,420.13" $710.07 $710.07 "$1,124.74" "$1,420.13" "$1,136.10" $639.06 $281.86 N/A $823.89 "$1,420.13" $852.08 "$1,420.13" $295.96 "$1,420.13" N/A N/A A-4350.62 SUP HCPCS C1713 A-4350.62 - PLATE BONE TRAPEZOID 21MMX.8MM 4X2 HOLE GRID APTUS TRILOCK BOTH IP/OP "$1,496.50" "$1,107.00" $296.97 "$1,496.25" $673.31 $673.31 $673.31 $673.31 "$1,496.25" "$1,496.25" "$1,496.25" $311.86 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" $311.83 "$1,496.25" $598.50 $885.03 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,122.38" "$1,496.25" "$1,496.25" "$1,496.25" $748.13 $748.13 "$1,185.03" "$1,496.25" "$1,197.00" $673.31 $296.97 N/A $867.97 "$1,496.25" $897.75 "$1,496.25" $311.82 "$1,496.25" N/A N/A A-4350.66 SUP HCPCS C1713 A-4350.66 - PLATE BONE TRAPEZOID 27MMX.8MM 5X2 HOLE GRID APTUS TRILOCK BOTH IP/OP "$1,530.50" "$1,133.00" $303.74 "$1,530.38" $688.67 $688.67 $688.67 $688.67 "$1,530.38" "$1,530.38" "$1,530.38" $318.97 "$1,530.38" "$1,530.38" "$1,530.38" "$1,530.38" "$1,530.38" $318.95 "$1,530.38" "$1,530.38" $905.22 "$1,530.38" "$1,530.38" "$1,530.38" "$1,530.38" "$1,147.88" "$1,530.38" "$1,530.38" "$1,530.38" $765.19 $765.19 "$1,212.06" "$1,530.38" "$1,224.30" $688.67 $303.74 N/A $887.69 "$1,530.38" $918.23 "$1,530.38" $318.93 "$1,530.38" N/A N/A A-4350.80 SUP HCPCS C1713 A-4350.80 - PLATE BONE SCAPHOID 17MMX.8MM 6 HOLE APTUS TRILOCK TITANIUM BOTH IP/OP "$1,496.50" "$1,107.00" $296.97 "$1,496.25" $673.31 $673.31 $673.31 $673.31 "$1,496.25" "$1,496.25" "$1,496.25" $311.86 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" $311.83 "$1,496.25" $598.50 $885.03 "$1,496.25" "$1,496.25" "$1,496.25" "$1,496.25" "$1,122.38" "$1,496.25" "$1,496.25" "$1,496.25" $748.13 $748.13 "$1,185.03" "$1,496.25" "$1,197.00" $673.31 $296.97 N/A $867.97 "$1,496.25" $897.75 "$1,496.25" $311.82 "$1,496.25" N/A N/A A45-10020 SUP HCPCS C1713 A45-10020 - SCREW BN 4.5/3.5MM 100MM 20MM DNFX TPR SS CORT BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $134.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $201.00 $335.00 $69.81 $335.00 N/A N/A A-4645.01 SUP HCPCS C1713 A-4645.01 - PLATE BN STRG 29MMX1.3MM APTUS 4 HL CMPR TI MTCRPL 2/2.3MM BOTH IP/OP $816.50 $604.00 $162.03 $816.38 $367.37 $367.37 $367.37 $367.37 $816.38 $816.38 $816.38 $170.15 $816.38 $816.38 $816.38 $816.38 $816.38 $170.14 $816.38 $326.55 $482.89 $816.38 $816.38 $816.38 $816.38 $612.38 $816.38 $816.38 $816.38 $408.19 $408.19 $646.57 $816.38 $653.10 $367.37 $162.03 N/A $473.57 $816.38 $489.83 $816.38 $170.13 $816.38 N/A N/A A-4645.02 SUP HCPCS C1713 A-4645.02 - PLATE BN STRG 36MMX1.3MM APTUS 5 HL CMPR TI MTCRPL 2/2.3MM BOTH IP/OP $816.50 $604.00 $162.03 $816.38 $367.37 $367.37 $367.37 $367.37 $816.38 $816.38 $816.38 $170.15 $816.38 $816.38 $816.38 $816.38 $816.38 $170.14 $816.38 $326.55 $482.89 $816.38 $816.38 $816.38 $816.38 $612.38 $816.38 $816.38 $816.38 $408.19 $408.19 $646.57 $816.38 $653.10 $367.37 $162.03 N/A $473.57 $816.38 $489.83 $816.38 $170.13 $816.38 N/A N/A A-4645.03 SUP HCPCS C1713 A-4645.03 - PLATE BN STRG 42MMX1.3MM APTUS 6 HL CMPR TI MTCRPL 2/2.3MM BOTH IP/OP $816.50 $604.00 $162.03 $816.38 $367.37 $367.37 $367.37 $367.37 $816.38 $816.38 $816.38 $170.15 $816.38 $816.38 $816.38 $816.38 $816.38 $170.14 $816.38 $326.55 $482.89 $816.38 $816.38 $816.38 $816.38 $612.38 $816.38 $816.38 $816.38 $408.19 $408.19 $646.57 $816.38 $653.10 $367.37 $162.03 N/A $473.57 $816.38 $816.38 $816.38 $170.13 $816.38 N/A N/A A-4645.08 SUP HCPCS C1713 A-4645.08 - PLATE BONE STR 8 HOLE 4 CORNER FUSION COMPRESSION APTUS BOTH IP/OP $919.00 $680.00 $182.35 $918.75 $413.44 $413.44 $413.44 $413.44 $918.75 $918.75 $918.75 $191.49 $918.75 $918.75 $918.75 $918.75 $918.75 $191.48 $918.75 $367.50 $543.44 $918.75 $918.75 $918.75 $918.75 $689.25 $918.75 $918.75 $918.75 $459.38 $459.38 $727.65 $918.75 $735.00 $413.44 $182.35 N/A $533.02 $918.75 $918.75 $918.75 $191.47 $918.75 N/A N/A A-4645.10 SUP HCPCS C1713 A-4645.10 - PLATE BN T 35MMX1.3MM APTUS 2X4 HL CMPR TI MTCRPL 2/2.3MM BOTH IP/OP $738.00 $546.00 $146.40 $737.63 $331.93 $331.93 $331.93 $331.93 $737.63 $737.63 $737.63 $153.74 $737.63 $737.63 $737.63 $737.63 $737.63 $153.73 $737.63 $295.05 $436.31 $737.63 $737.63 $737.63 $737.63 $553.50 $737.63 $737.63 $737.63 $368.82 $368.82 $584.20 $737.63 $590.10 $331.93 $146.40 N/A $428.04 $737.63 $737.63 $737.63 $153.72 $737.63 N/A N/A A-4645.16 SUP HCPCS C1713 A-4645.16 - PLATE BN T 60MMX1.3MM APTUS 2X8 HL CMPR TI MTCRPL 2/2.3MM BOTH IP/OP $997.50 $738.00 $197.98 $997.50 $448.88 $448.88 $448.88 $448.88 $997.50 $997.50 $997.50 $207.90 $997.50 $997.50 $997.50 $997.50 $997.50 $207.89 $997.50 $997.50 $590.02 $997.50 $997.50 $997.50 $997.50 $748.13 $997.50 $997.50 $997.50 $498.75 $498.75 $790.02 $997.50 $798.00 $448.88 $197.98 N/A $578.55 $997.50 $997.50 $997.50 $207.88 $997.50 N/A N/A A-4645.20 SUP HCPCS C1713 A-4645.20 - PLATE BN L LT 37MMX1.3MM APTUS 2X4 HL CMPR TI MTCRPL 2/2.3MM BOTH IP/OP $738.00 $546.00 $146.40 $737.63 $331.93 $331.93 $331.93 $331.93 $737.63 $737.63 $737.63 $153.74 $737.63 $737.63 $737.63 $737.63 $737.63 $153.73 $737.63 $737.63 $436.31 $737.63 $737.63 $737.63 $737.63 $553.50 $737.63 $737.63 $737.63 $368.82 $368.82 $584.20 $737.63 $590.10 $331.93 $146.40 N/A $428.04 $737.63 $737.63 $737.63 $153.72 $737.63 N/A N/A A-4645.21 SUP HCPCS C1713 A-4645.21 - PLATE BN L RT 37MMX1.3MM APTUS 2X4 HL CMPR TI MTCRPL 2/2.3MM BOTH IP/OP $738.00 $546.00 $146.40 $737.63 $331.93 $331.93 $331.93 $331.93 $737.63 $737.63 $737.63 $153.74 $737.63 $737.63 $737.63 $737.63 $737.63 $153.73 $737.63 $295.05 $436.31 $737.63 $737.63 $737.63 $737.63 $553.50 $737.63 $737.63 $737.63 $368.82 $368.82 $584.20 $737.63 $590.10 $331.93 $146.40 N/A $428.04 $737.63 $737.63 $737.63 $153.72 $737.63 N/A N/A A-4645.22 SUP HCPCS C1713 A-4645.22 - PLATE BN L LT 63MMX1.3MM APTUS 2X8 HL CMPR TI MTCRPL 2/2.3MM BOTH IP/OP $997.50 $738.00 $197.98 $997.50 $448.88 $448.88 $448.88 $448.88 $997.50 $997.50 $997.50 $207.90 $997.50 $997.50 $997.50 $997.50 $997.50 $207.89 $997.50 $399.00 $590.02 $997.50 $997.50 $997.50 $997.50 $748.13 $997.50 $997.50 $997.50 $498.75 $498.75 $790.02 $997.50 $798.00 $448.88 $197.98 N/A $578.55 $997.50 $997.50 $997.50 $207.88 $997.50 N/A N/A A-4645.23 SUP HCPCS C1713 A-4645.23 - PLATE BONE RIGHT ANG 63MMX1.3MM 2X8 HOLE COMPRESSION BAR BOTH IP/OP $997.50 $738.00 $197.98 $997.50 $448.88 $448.88 $448.88 $448.88 $997.50 $997.50 $997.50 $207.90 $997.50 $997.50 $997.50 $997.50 $997.50 $207.89 $997.50 $399.00 $590.02 $997.50 $997.50 $997.50 $997.50 $748.13 $997.50 $997.50 $997.50 $498.75 $498.75 $790.02 $997.50 $798.00 $448.88 $197.98 N/A $578.55 $997.50 $598.50 $997.50 $207.88 $997.50 N/A N/A A-4650.03 SUP HCPCS C1713 A-4650.03 - PLATE BN STRG 33MMX1MM APTUS TRLK 6 HL TI HND 2/2.3MM SCR BOTH IP/OP "$1,186.50" $878.00 $235.49 "$1,186.50" $533.93 $533.93 $533.93 $533.93 "$1,186.50" "$1,186.50" "$1,186.50" $247.30 "$1,186.50" "$1,186.50" "$1,186.50" "$1,186.50" "$1,186.50" $247.28 "$1,186.50" $474.60 $701.81 "$1,186.50" "$1,186.50" "$1,186.50" "$1,186.50" $889.88 "$1,186.50" "$1,186.50" "$1,186.50" $593.25 $593.25 $939.71 "$1,186.50" $949.20 $533.93 $235.49 N/A $688.17 "$1,186.50" $711.90 "$1,186.50" $247.27 "$1,186.50" N/A N/A A-4650.10 SUP HCPCS C1713 A-4650.10 - PLATE BN T 29MMX1MM APTUS TRLK 2X4 HL TI HND 2/2.3MM SCR BOTH IP/OP "$1,228.50" $909.00 $243.83 "$1,228.50" $552.83 $552.83 $552.83 $552.83 "$1,228.50" "$1,228.50" "$1,228.50" $256.05 "$1,228.50" "$1,228.50" "$1,228.50" "$1,228.50" "$1,228.50" $256.03 "$1,228.50" $491.40 $726.66 "$1,228.50" "$1,228.50" "$1,228.50" "$1,228.50" $921.38 "$1,228.50" "$1,228.50" "$1,228.50" $614.25 $614.25 $972.97 "$1,228.50" $982.80 $552.83 $243.83 N/A $712.53 "$1,228.50" $737.10 "$1,228.50" $256.02 "$1,228.50" N/A N/A A-4650.11 SUP HCPCS C1713 A-4650.11 - PLATE BN T 29X13X1MM APTUS TRLK 3X4 HL TI HND 2/2.3MM SCR BOTH IP/OP "$1,286.50" $952.00 $255.29 "$1,286.25" $578.81 $578.81 $578.81 $578.81 "$1,286.25" "$1,286.25" "$1,286.25" $268.09 "$1,286.25" "$1,286.25" "$1,286.25" "$1,286.25" "$1,286.25" $268.07 "$1,286.25" $514.50 $760.82 "$1,286.25" "$1,286.25" "$1,286.25" "$1,286.25" $964.88 "$1,286.25" "$1,286.25" "$1,286.25" $643.13 $643.13 "$1,018.71" "$1,286.25" "$1,029.00" $578.81 $255.29 N/A $746.17 "$1,286.25" "$1,286.25" "$1,286.25" $268.05 "$1,286.25" N/A N/A A-4650.13 SUP HCPCS C1713 A-4650.13 - PLATE BN Y 35MMX1MM APTUS TRLK 2X5 HL TI HND 2/2.3MM SCR BOTH IP/OP "$1,265.50" $936.00 $251.12 "$1,265.25" $569.36 $569.36 $569.36 $569.36 "$1,265.25" "$1,265.25" "$1,265.25" $263.71 "$1,265.25" "$1,265.25" "$1,265.25" "$1,265.25" "$1,265.25" $263.69 "$1,265.25" "$1,265.25" $748.40 "$1,265.25" "$1,265.25" "$1,265.25" "$1,265.25" $949.13 "$1,265.25" "$1,265.25" "$1,265.25" $632.63 $632.63 "$1,002.08" "$1,265.25" "$1,012.20" $569.36 $251.12 N/A $733.99 "$1,265.25" $759.15 "$1,265.25" $263.68 "$1,265.25" N/A N/A A-4650.20 SUP HCPCS C1713 A-4650.20 - PLATE BONE 20MM 4 HOLE L LOCKING GRID COMPRESSION TRAPEZOID BOTH IP/OP "$1,218.00" $901.00 $241.74 "$1,218.00" $548.10 $548.10 $548.10 $548.10 "$1,218.00" "$1,218.00" "$1,218.00" $253.86 "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" $253.84 "$1,218.00" "$1,218.00" $720.45 "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" $913.50 "$1,218.00" "$1,218.00" "$1,218.00" $609.00 $609.00 $964.66 "$1,218.00" $974.40 $548.10 $241.74 N/A $706.44 "$1,218.00" $730.80 "$1,218.00" $253.83 "$1,218.00" N/A N/A A-4650.21 SUP HCPCS C1713 A-4650.21 - PLATE BN L RT 32MMX1MM APTUS TRLK 2X4 HL TI HND 2/2.3MM SCR BOTH IP/OP "$1,218.00" $901.00 $241.74 "$1,218.00" $548.10 $548.10 $548.10 $548.10 "$1,218.00" "$1,218.00" "$1,218.00" $253.86 "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" $253.84 "$1,218.00" "$1,218.00" $720.45 "$1,218.00" "$1,218.00" "$1,218.00" "$1,218.00" $913.50 "$1,218.00" "$1,218.00" "$1,218.00" $609.00 $609.00 $964.66 "$1,218.00" $974.40 $548.10 $241.74 N/A $706.44 "$1,218.00" $730.80 "$1,218.00" $253.83 "$1,218.00" N/A N/A A-4650.51 SUP HCPCS C1713 A-4650.51 - PLATE BN RECT 13MMX1MM APTUS TRLK 2X2 HL GRID TI HND 2/2.3MM BOTH IP/OP "$1,428.00" "$1,057.00" $283.42 "$1,428.00" $642.60 $642.60 $642.60 $642.60 "$1,428.00" "$1,428.00" "$1,428.00" $297.63 "$1,428.00" "$1,428.00" "$1,428.00" "$1,428.00" "$1,428.00" $297.61 "$1,428.00" "$1,428.00" $844.66 "$1,428.00" "$1,428.00" "$1,428.00" "$1,428.00" "$1,071.00" "$1,428.00" "$1,428.00" "$1,428.00" $714.00 $714.00 "$1,130.98" "$1,428.00" "$1,142.40" $642.60 $283.42 N/A $828.24 "$1,428.00" $856.80 "$1,428.00" $297.60 "$1,428.00" N/A N/A A-4650.56 SUP HCPCS C1713 A-4650.56 - PLATE BONE 56MM 6 HOLE LOCKING GRID COMPRESSION TRAPEZOID 2 BOTH IP/OP "$1,475.50" "$1,092.00" $292.80 "$1,475.25" $663.86 $663.86 $663.86 $663.86 "$1,475.25" "$1,475.25" "$1,475.25" $307.48 "$1,475.25" "$1,475.25" "$1,475.25" "$1,475.25" "$1,475.25" $307.46 "$1,475.25" "$1,475.25" $872.61 "$1,475.25" "$1,475.25" "$1,475.25" "$1,475.25" "$1,106.63" "$1,475.25" "$1,475.25" "$1,475.25" $737.63 $737.63 "$1,168.40" "$1,475.25" "$1,180.20" $663.86 $292.80 N/A $855.79 "$1,475.25" $885.15 "$1,475.25" $307.44 "$1,475.25" N/A N/A A-4650.58 SUP HCPCS C1713 A-4650.58 - PLATE BONE 3X2 HOLE LOCKING GRID TRAPEZOID LEFT 2 MM 2.3 MM BOTH IP/OP "$1,557.00" "$1,152.00" $308.95 "$1,556.63" $700.48 $700.48 $700.48 $700.48 "$1,556.63" "$1,556.63" "$1,556.63" $324.44 "$1,556.63" "$1,556.63" "$1,556.63" "$1,556.63" "$1,556.63" $324.42 "$1,556.63" "$1,556.63" $920.75 "$1,556.63" "$1,556.63" "$1,556.63" "$1,556.63" "$1,167.75" "$1,556.63" "$1,556.63" "$1,556.63" $778.32 $778.32 "$1,232.85" "$1,556.63" "$1,245.30" $700.48 $308.95 N/A $903.06 "$1,556.63" $933.98 "$1,556.63" $324.40 "$1,556.63" N/A N/A A-4650.59 SUP HCPCS C1713 A-4650.59 - PLATE BN TRPZD RT 23MMX1MM APTUS TRLK 3X2 HL GRID TI HND BOTH IP/OP "$1,557.00" "$1,152.00" $308.95 "$1,556.63" $700.48 $700.48 $700.48 $700.48 "$1,556.63" "$1,556.63" "$1,556.63" $324.44 "$1,556.63" "$1,556.63" "$1,556.63" "$1,556.63" "$1,556.63" $324.42 "$1,556.63" "$1,556.63" $920.75 "$1,556.63" "$1,556.63" "$1,556.63" "$1,556.63" "$1,167.75" "$1,556.63" "$1,556.63" "$1,556.63" $778.32 $778.32 "$1,232.85" "$1,556.63" "$1,245.30" $700.48 $308.95 N/A $903.06 "$1,556.63" $933.98 "$1,556.63" $324.40 "$1,556.63" N/A N/A A-4650.62 SUP HCPCS C1713 A-4650.62 - PLATE BN TRPZD 29MMX1MM APTUS TRLK 4X2 HL GRID TI HND 2/2.3 BOTH IP/OP "$1,557.00" "$1,152.00" $308.95 "$1,556.63" $700.48 $700.48 $700.48 $700.48 "$1,556.63" "$1,556.63" "$1,556.63" $324.44 "$1,556.63" "$1,556.63" "$1,556.63" "$1,556.63" "$1,556.63" $324.42 "$1,556.63" "$1,556.63" $920.75 "$1,556.63" "$1,556.63" "$1,556.63" "$1,556.63" "$1,167.75" "$1,556.63" "$1,556.63" "$1,556.63" $778.32 $778.32 "$1,232.85" "$1,556.63" "$1,245.30" $700.48 $308.95 N/A $903.06 "$1,556.63" "$1,556.63" "$1,556.63" $324.40 "$1,556.63" N/A N/A A-4650.67 SUP HCPCS C1713 A-4650.67 - PLATE BN TRPZD 45MMX1MM APTUS TRLK 6X2 HL GRID TI HND 2/2.3 BOTH IP/OP "$1,622.50" "$1,201.00" $321.98 "$1,622.25" $730.01 $730.01 $730.01 $730.01 "$1,622.25" "$1,622.25" "$1,622.25" $338.12 "$1,622.25" "$1,622.25" "$1,622.25" "$1,622.25" "$1,622.25" $338.09 "$1,622.25" "$1,622.25" $959.56 "$1,622.25" "$1,622.25" "$1,622.25" "$1,622.25" "$1,216.88" "$1,622.25" "$1,622.25" "$1,622.25" $811.13 $811.13 "$1,284.82" "$1,622.25" "$1,297.80" $730.01 $321.98 N/A $941.05 "$1,622.25" "$1,622.25" "$1,622.25" $338.08 "$1,622.25" N/A N/A A-4655.01 SUP HCPCS C1713 A-4655.01 - PLATE BONE STR 27MMX1.3MM 4 HOLE LOCK GRID APTUS TRILOCK BOTH IP/OP "$1,572.50" "$1,164.00" $312.10 "$1,572.50" $707.63 $707.63 $707.63 $707.63 "$1,572.50" "$1,572.50" "$1,572.50" $327.75 "$1,572.50" "$1,572.50" "$1,572.50" "$1,572.50" "$1,572.50" $327.73 "$1,572.50" $629.00 $930.13 "$1,572.50" "$1,572.50" "$1,572.50" "$1,572.50" "$1,179.38" "$1,572.50" "$1,572.50" "$1,572.50" $786.25 $786.25 "$1,245.42" "$1,572.50" "$1,258.00" $707.63 $312.10 N/A $912.05 "$1,572.50" $943.50 "$1,572.50" $327.71 "$1,572.50" N/A N/A A-4655.02 SUP HCPCS C1713 A-4655.02 - PLATE BONE STR 32MMX1.3MM 5 HOLE LOCKING GRID APTUS TRILOCK BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A A-4655.03 SUP HCPCS C1713 A-4655.03 - PLATE BONE STR 38MMX1.3MM 6 HOLE LOCKING GRID APTUS TRILOCK BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A A-4655.08 SUP HCPCS C1713 A-4655.08 - PLATE BONE 1.3MM 8 HOLE LOCKING CVD TRAPEZOID 2MM 2.3MM BOTH IP/OP "$1,922.50" "$1,423.00" $381.57 "$1,922.50" $865.13 $865.13 $865.13 $865.13 "$1,922.50" "$1,922.50" "$1,922.50" $400.70 "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" $400.67 "$1,922.50" $769.00 "$1,137.16" "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" "$1,441.88" "$1,922.50" "$1,922.50" "$1,922.50" $961.25 $961.25 "$1,522.62" "$1,922.50" "$1,538.00" $865.13 $381.57 N/A "$1,115.05" "$1,922.50" "$1,922.50" "$1,922.50" $400.65 "$1,922.50" N/A N/A A-4655.10 SUP HCPCS C1713 A-4655.10 - PLATE BONE 1.3MM 2/4 HOLE T LOCKING TRAPEZOID 2MM 2.3MM BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A A-4655.16 SUP HCPCS C1713 A-4655.16 - PLATE BONE T 56MMX1.3MM 2X8 HOLE LOCKING GRID APTUS TRILOCK BOTH IP/OP "$1,922.50" "$1,423.00" $381.57 "$1,922.50" $865.13 $865.13 $865.13 $865.13 "$1,922.50" "$1,922.50" "$1,922.50" $400.70 "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" $400.67 "$1,922.50" $769.00 "$1,137.16" "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" "$1,441.88" "$1,922.50" "$1,922.50" "$1,922.50" $961.25 $961.25 "$1,522.62" "$1,922.50" "$1,538.00" $865.13 $381.57 N/A "$1,115.05" "$1,922.50" "$1,922.50" "$1,922.50" $400.65 "$1,922.50" N/A N/A A-4655.20 SUP HCPCS C1713 A-4655.20 - PLATE BONE L LEFT ANGLE 35MMX1.3MM 2X6 HOLE LOCKING GRID BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,090.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A A-4655.21 SUP HCPCS C1713 A-4655.21 - PLATE BONE L RIGHT ANG 35MMX1.3MM 4 HOLE LOCKING GRID APTUS BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,817.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A A-4655.22 SUP HCPCS C1713 A-4655.22 - PLATE BONE L LEFT ANGLE 58MMX1.3MM 2X8 HOLE LOCKING GRID BOTH IP/OP "$1,922.50" "$1,423.00" $381.57 "$1,922.50" $865.13 $865.13 $865.13 $865.13 "$1,922.50" "$1,922.50" "$1,922.50" $400.70 "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" $400.67 "$1,922.50" "$1,922.50" "$1,137.16" "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" "$1,441.88" "$1,922.50" "$1,922.50" "$1,922.50" $961.25 $961.25 "$1,522.62" "$1,922.50" "$1,538.00" $865.13 $381.57 N/A "$1,115.05" "$1,922.50" "$1,922.50" "$1,922.50" $400.65 "$1,922.50" N/A N/A A-4655.23 SUP HCPCS C1713 A-4655.23 - PLATE BONE L RIGHT ANG 58MMX1.3MM 10 HOLE LOCKING GRID APTUS BOTH IP/OP "$1,922.50" "$1,423.00" $381.57 "$1,922.50" $865.13 $865.13 $865.13 $865.13 "$1,922.50" "$1,922.50" "$1,922.50" $400.70 "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" $400.67 "$1,922.50" $769.00 "$1,137.16" "$1,922.50" "$1,922.50" "$1,922.50" "$1,922.50" "$1,441.88" "$1,922.50" "$1,922.50" "$1,922.50" $961.25 $961.25 "$1,522.62" "$1,922.50" "$1,538.00" $865.13 $381.57 N/A "$1,115.05" "$1,922.50" "$1,153.50" "$1,922.50" "$1,922.50" "$1,922.50" N/A N/A A-4655.51 SUP HCPCS C1713 A-4655.51 - PLATE BONE 1.3MM 2X2 HOLE LOCKING GRID SQUARE TRAPEZOID 2MM BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" $727.00 "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,090.50" "$1,817.50" "$1,817.50" "$1,817.50" N/A N/A A-4655.56 SUP HCPCS C1713 A-4655.56 - PLATE 3X2 HOLE MESH LCK TRP BONE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A A-4655.62 SUP HCPCS C1713 A-4655.62 - PLATE BONE 1.3MM 4X2 HOLE T LOCKING GRID TRAPEZOID RIGHT 2MM BOTH IP/OP "$1,970.00" "$1,458.00" $391.00 "$1,970.00" $886.50 $886.50 $886.50 $886.50 "$1,970.00" "$1,970.00" "$1,970.00" $410.60 "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" $410.57 "$1,970.00" $788.00 "$1,165.26" "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" "$1,477.50" "$1,970.00" "$1,970.00" "$1,970.00" $985.00 $985.00 "$1,560.24" "$1,970.00" "$1,576.00" $886.50 $391.00 N/A "$1,142.60" "$1,970.00" "$1,182.00" "$1,970.00" $410.55 "$1,970.00" N/A N/A A-4655.66 SUP HCPCS C1713 A-4655.66 - PLATE BONE TRAPEZOID 42MMX1.3MM 5X2 HOLE LOCKING GRID APTUS BOTH IP/OP "$2,057.50" "$1,523.00" $408.36 "$2,057.50" $925.88 $925.88 $925.88 $925.88 "$2,057.50" "$2,057.50" "$2,057.50" $428.83 "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" $428.81 "$2,057.50" $823.00 "$1,217.01" "$2,057.50" "$2,057.50" "$2,057.50" "$2,057.50" "$1,543.13" "$2,057.50" "$2,057.50" "$2,057.50" "$1,028.75" "$1,028.75" "$1,629.54" "$2,057.50" "$1,646.00" $925.88 $408.36 N/A "$1,193.35" "$2,057.50" "$2,057.50" "$2,057.50" $428.78 "$2,057.50" N/A N/A A-5040.21/1 SUP Custom 27203010 A-5040.21/1 - WIRE FX 1.2MM 150MM NS KRSH APTUS TROC TIP SS BOTH IP/OP $75.00 $56.00 $13.35 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $13.35 $75.00 $75.00 $55.67 $55.67 $57.81 $39.08 $15.63 $75.00 $30.00 $75.00 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $48.75 $75.00 N/A $43.50 $75.00 $45.00 $75.00 $75.00 $75.00 N/A N/A A-5100.04/1 SUP HCPCS C1713 A-5100.04/1 - SCREW BONE 4MM HEAD 1.2MM 4MM CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $210.00 $210.00 N/A N/A A-5100.05/1 SUP HCPCS C1713 A-5100.05/1 - SCREW BONE 1.2MM 5MM 4 HANDLE CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5100.06/1 SUP HCPCS C1713 A-5100.06/1 - SCREW BONE 1.2MM 6MM CORT 4 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $210.00 $210.00 N/A N/A A-5100.07/1 SUP HCPCS C1713 A-5100.07/1 - SCREW BONE 4MM HEAD 1.2MM 7MM HEXADRIVE 4 APTUS TITANIUM BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5100.08/1 SUP HCPCS C1713 A-5100.08/1 - SCREW BONE 4MM HEAD 1.2MM 8MM HEXADRIVE 4 APTUS TITANIUM BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5100.09/1 SUP HCPCS C1713 A-5100.09/1 - SCREW BONE 1.2MM 9MM HEXADRIVE 4 APTUS TITANIUM HAND BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5100.10/1 SUP HCPCS C1713 A-5100.10/1 - SCREW BONE 1.2MM 10MM HEXADRIVE 4 APTUS TITANIUM HAND BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5100.12/1 SUP HCPCS C1713 A-5100.12/1 - SCREW BONE 1.2MM 12MM HEXADRIVE 4 APTUS TITANIUM HAND BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5100.14/1 SUP HCPCS C1713 A-5100.14/1 - SCREW BONE 1.2MM 14MM CORT 4 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5100.16/1 SUP HCPCS C1713 A-5100.16/1 - SCREW BONE 1.2MM 16MM CORT 4 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.04/1 SUP HCPCS C1713 A-5200.04/1 - SCREW BONE 1.5MM 4MM CORT 4 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.05/1 SUP HCPCS C1713 A-5200.05/1 - SCREW BONE 1.5MM 5MM CORT 4 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.06 SUP HCPCS C1713 A-5200.06 - SCREW BONE 1.5MM 6MM CORTICAL BOTH IP/OP $218.50 $162.00 $43.37 $218.50 $98.33 $98.33 $98.33 $98.33 $218.50 $218.50 $218.50 $45.54 $218.50 $218.50 $218.50 $218.50 $218.50 $45.54 $218.50 $218.50 $129.24 $218.50 $218.50 $218.50 $218.50 $163.88 $218.50 $218.50 $218.50 $109.25 $109.25 $173.05 $218.50 $174.80 $98.33 $43.37 N/A $126.73 $218.50 $218.50 $218.50 $45.54 $218.50 N/A N/A A-5200.06/1 SUP HCPCS C1713 A-5200.06/1 - SCREW BONE 1.5MM 6MM HEXADRIVE 4 APTUS TITANIUM HAND BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.07/1 SUP HCPCS C1713 A-5200.07/1 - SCREW BONE 1.5MM 7MM HEXADRIVE 4 APTUS TITANIUM HAND BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.08 SUP HCPCS C1713 A-5200.08 - SCREW BONE 1.5MM 8MM HEXADRIVE 4 APTUS TITANIUM CORTICAL BOTH IP/OP $218.50 $162.00 $43.37 $218.50 $98.33 $98.33 $98.33 $98.33 $218.50 $218.50 $218.50 $45.54 $218.50 $218.50 $218.50 $218.50 $218.50 $45.54 $218.50 $87.40 $129.24 $218.50 $218.50 $218.50 $218.50 $163.88 $218.50 $218.50 $218.50 $109.25 $109.25 $173.05 $218.50 $174.80 $98.33 $43.37 N/A $126.73 $218.50 $218.50 $218.50 $45.54 $218.50 N/A N/A A-5200.08/1 SUP HCPCS C1713 A-5200.08/1 - SCREW BONE HEXADRIVE 4 1.5MM 8MM APTUS GREEN TITANIUM HAND BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.09/1 SUP HCPCS C1713 A-5200.09/1 - SCREW BONE HEXADRIVE 4 1.5MM 9MM APTUS GREEN TITANIUM HAND BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.10 SUP HCPCS C1713 A-5200.10 - SCREW BONE 1.5MM 10MM WASHER TWIST DRILL HEXADRIVE 4 APTUS BOTH IP/OP $218.50 $162.00 $43.37 $218.50 $98.33 $98.33 $98.33 $98.33 $218.50 $218.50 $218.50 $45.54 $218.50 $218.50 $218.50 $218.50 $218.50 $45.54 $218.50 $87.40 $129.24 $218.50 $218.50 $218.50 $218.50 $163.88 $218.50 $218.50 $218.50 $109.25 $109.25 $173.05 $218.50 $174.80 $98.33 $43.37 N/A $126.73 $218.50 $218.50 $218.50 $45.54 $218.50 N/A N/A A-5200.10/1 SUP HCPCS C1713 A-5200.10/1 - SCREW BONE 1.5MM 10MM HEXADRIVE 4 APTUS TITANIUM HAND BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.11/1 SUP HCPCS C1713 A-5200.11/1 - SCREW BONE 4MM HEAD 1.5MM 11MM HEXADRIVE 4 APTUS GREEN BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.12/1 SUP HCPCS C1713 A-5200.12/1 - SCREW BONE 4MM HEAD 1.5MM 12MM 4 HEXADRIVE APTUS GREEN BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.13/1 SUP HCPCS C1713 A-5200.13/1 - SCREW BONE 4MM HEAD 1.5MM 13MM HEXADRIVE 4 APTUS GREEN BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.14/1 SUP HCPCS C1713 A-5200.14/1 - SCREW BONE 1.5MM 14MM HEXADRIVE 4 APTUS TITANIUM HAND BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.15/1 SUP HCPCS C1713 A-5200.15/1 - SCREW BONE 1.5MM 15MM HEXADRIVE 4 APTUS TITANIUM HAND BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.16/1 SUP HCPCS C1713 A-5200.16/1 - SCREW BN 1.5MM 16MM 4 HNDL CORT BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.17/1 SUP HCPCS C1713 A-5200.17/1 - SCREW BN 1.5MM 17MM 4 HNDL CORT BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.18/1 SUP HCPCS C1713 A-5200.18/1 - SCREW BONE 1.5MM 18MM CORT 4 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.19/1 SUP HCPCS C1713 A-5200.19/1 - SCREW BONE 1.5MM 19MM APTUS CORT BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.20/1 SUP HCPCS C1713 A-5200.20/1 - SCREW BONE 1.5MM 20MM CORT 4 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.21/1 SUP HCPCS C1713 A-5200.21/1 - SCREW BONE 1.5MM 21MM CORT 4 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.22/1 SUP HCPCS C1713 A-5200.22/1 - SCREW BONE 1.5MM 22MM APTUS CORT BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.23/1 SUP HCPCS C1713 A-5200.23/1 - SCREW BN 1.5MM 23MM APTUS CORT BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5200.24/1 SUP HCPCS C1713 A-5200.24/1 - SCREW BONE 1.5MM 24MM HEXADRIVE 4 APTUS TITANIUM HAND BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5250.04/1 SUP HCPCS C1713 A-5250.04/1 - SCREW BONE 1.5MM 4MM HEXADRIVE 4 APTUS TRILOCK TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $337.50 $337.50 $70.34 $337.50 N/A N/A A-5250.05/1 SUP HCPCS C1713 A-5250.05/1 - SCREW BONE 1.5MM 5MM HEXADRIVE 4 APTUS TRILOCK TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $337.50 $337.50 $70.34 $337.50 N/A N/A A-5250.06/1 SUP HCPCS C1713 A-5250.06/1 - SCREW BONE 1.5MM 6MM HEXADRIVE 4 APTUS TRILOCK TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5250.07 SUP HCPCS C1713 A-5250.07 - SCREW BONE 1.5MM 7MM 2 THREADED HEXADRIVE 4 OPTIMAL SELF BOTH IP/OP $218.50 $162.00 $43.37 $218.50 $98.33 $98.33 $98.33 $98.33 $218.50 $218.50 $218.50 $45.54 $218.50 $218.50 $218.50 $218.50 $218.50 $45.54 $218.50 $87.40 $129.24 $218.50 $218.50 $218.50 $218.50 $163.88 $218.50 $218.50 $218.50 $109.25 $109.25 $173.05 $218.50 $174.80 $98.33 $43.37 N/A $126.73 $218.50 $131.10 $218.50 $45.54 $218.50 N/A N/A A-5250.07/1 SUP HCPCS C1713 A-5250.07/1 - SCREW BONE 1.5MM 7MM HEXADRIVE 4 APTUS TRILOCK TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $337.50 $337.50 $70.34 $337.50 N/A N/A A-5250.08 SUP HCPCS C1713 A-5250.08 - SCREW BONE 1.5MM 8MM 2 THREAD HEXADRIVE 4 ATRAUMATIC TIP BOTH IP/OP $305.00 $226.00 $60.53 $305.00 $137.25 $137.25 $137.25 $137.25 $305.00 $305.00 $305.00 $63.57 $305.00 $305.00 $305.00 $305.00 $305.00 $63.57 $305.00 $122.00 $180.41 $305.00 $305.00 $305.00 $305.00 $228.75 $305.00 $305.00 $305.00 $152.50 $152.50 $241.56 $305.00 $244.00 $137.25 $60.53 N/A $176.90 $305.00 $183.00 $305.00 $63.56 $305.00 N/A N/A A-5250.08/1 SUP HCPCS C1713 A-5250.08/1 - SCREW BONE 1.5MM 8MM HEXADRIVE 4 APTUS TRILOCK TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5250.09/1 SUP HCPCS C1713 A-5250.09/1 - SCREW BONE 1.5MM 9MM HEXADRIVE 4 APTUS TRILOCK TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5250.10/1 SUP HCPCS C1713 A-5250.10/1 - SCREW BONE 1.5MM 10MM HEXADRIVE 4 APTUS TRILOCK TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $337.50 $337.50 $70.34 $337.50 N/A N/A A-5250.11/1 SUP HCPCS C1713 A-5250.11/1 - SCREW BONE 1.5MM 11MM HEXADRIVE 4 APTUS TRILOCK TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $337.50 $337.50 $70.34 $337.50 N/A N/A A-5250.12/1 SUP HCPCS C1713 A-5250.12/1 - SCREW BONE 1.5MM 12MM HEXADRIVE 4 APTUS TRILOCK TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $337.50 $337.50 $70.34 $337.50 N/A N/A A-5250.13/1 SUP HCPCS C1713 A-5250.13/1 - SCREW BONE 1.5MM 13MM HEXADRIVE 4 APTUS TRILOCK TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5250-11 SUP HCPCS C1713 A-5250-11 - SCREW BONE 1.5MM 11MM LOCK CORTICAL BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $73.98 $355.00 N/A N/A A-5300.06/1 SUP HCPCS C1713 A-5300.06/1 - SCREW BONE 1.8MM 6MM CORT 4 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5300.10/1 SUP HCPCS C1713 A-5300.10/1 - SCREW BONE 4MM HEAD 1.8MM 10MM EMERGENCY HEXADRIVE 4 APTUS BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.04/1 SUP HCPCS C1713 A-5400.04/1 - SCREW BONE 2MM 4MM HEXADRIVE 6 APTUS TITANIUM HAND CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.05 SUP HCPCS C1713 A-5400.05 - SCREW BONE 6MM HEAD 2MM 5MM CORTICAL BOTH IP/OP $437.00 $323.00 $86.73 $437.00 $196.65 $196.65 $196.65 $196.65 $437.00 $437.00 $437.00 $91.08 $437.00 $437.00 $437.00 $437.00 $437.00 $91.08 $437.00 $437.00 $258.49 $437.00 $437.00 $437.00 $437.00 $327.75 $437.00 $437.00 $437.00 $218.50 $218.50 $346.10 $437.00 $349.60 $196.65 $86.73 N/A $253.46 $437.00 $262.20 $437.00 $91.07 $437.00 N/A N/A A-5400.05/1 SUP HCPCS C1713 A-5400.05/1 - SCREW BONE 2MM 5MM HEXADRIVE 6 APTUS TITANIUM HAND CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5400.06/1 SUP HCPCS C1713 A-5400.06/1 - SCREW BONE 2MM 6MM HEXADRIVE 6 APTUS TITANIUM HAND CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5400.07/1 SUP HCPCS C1713 A-5400.07/1 - SCREW BONE TAPER 2MM 7MM 2 THREAD HEXADRIVE 6 SELF TAP BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.08 SUP HCPCS C1713 A-5400.08 - SCREW BONE 2 THREAD TAPER 2MM 8MM SLFTAP SELF RETAINING BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.08/1 SUP HCPCS C1713 A-5400.08/1 - SCREW BONE TAPER 2MM 8MM 2 THREAD HEXADRIVE 6 SELF TAP BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5400.09/1 SUP HCPCS C1713 A-5400.09/1 - SCREW BONE 6MM HEAD 2MM 9MM LOCK APTUS BLUE TITANIUM HAND BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5400.10/1 SUP HCPCS C1713 A-5400.10/1 - SCREW BONE HEXADRIVE 6 TAPER 2MM 10MM 2 THREAD SELF TAP BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5400.11 SUP HCPCS C1713 A-5400.11 - SCREW BONE 2 THREAD TAPER 2MM 11MM SLFTAP SELF RETAINING BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.11/1 SUP HCPCS C1713 A-5400.11/1 - SCREW BONE 2MM 11MM 2 THREADED HEXADRIVE 6 SLFTAP TAPERED BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.12 SUP HCPCS C1713 A-5400.12 - SCREW BONE 6MM HEAD 2MM 12MM CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.12/1 SUP HCPCS C1713 A-5400.12/1 - SCREW BONE TAPER 2MM 12MM 2 THREAD HEXADRIVE 6 SELF TAP BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.13 SUP HCPCS C1713 A-5400.13 - SCREW BONE 2MM 13MM CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.13/1 SUP HCPCS C1713 A-5400.13/1 - SCREW BONE TAPER 2MM 13MM 2 THREAD HEXADRIVE 6 SELF TAP BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.14 SUP HCPCS C1713 A-5400.14 - SCREW BONE 2 THREAD TAPER 2MM 14MM SLFTAP SELF RETAINING BOTH IP/OP $218.50 $162.00 $43.37 $218.50 $98.33 $98.33 $98.33 $98.33 $218.50 $218.50 $218.50 $45.54 $218.50 $218.50 $218.50 $218.50 $218.50 $45.54 $218.50 $218.50 $129.24 $218.50 $218.50 $218.50 $218.50 $163.88 $218.50 $218.50 $218.50 $109.25 $109.25 $173.05 $218.50 $174.80 $98.33 $43.37 N/A $126.73 $218.50 $131.10 $218.50 $45.54 $218.50 N/A N/A A-5400.14/1 SUP HCPCS C1713 A-5400.14/1 - SCREW BONE 2MM 14MM HEXADRIVE 6 APTUS TITANIUM HAND CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.15/1 SUP HCPCS C1713 A-5400.15/1 - SCREW BONE 2MM 15MM APTUS BLUE TITANIUM HAND CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.16/1 SUP HCPCS C1713 A-5400.16/1 - SCREW BONE 2MM 16MM CORT 6 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.17 SUP HCPCS C1713 A-5400.17 - SCREW BONE 2MM 17MM APTUS BLUE TITANIUM HAND CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.17/1 SUP HCPCS C1713 A-5400.17/1 - SCREW BONE 2MM 17MM APTUS BLUE TITANIUM HAND CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.18/1 SUP HCPCS C1713 A-5400.18/1 - SCREW BONE 2MM 18MM CORT 6 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5400.19/1 SUP HCPCS C1713 A-5400.19/1 - SCREW BONE 2MM 19MM CORT 6 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.20 SUP HCPCS C1713 A-5400.20 - SCREW BONE 6MM HEAD 2MM 20MM CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.20/1 SUP HCPCS C1713 A-5400.20/1 - SCREW BONE 2MM 20MM HEXADRIVE 6 APTUS TRILOCK TITANIUM MIDFT BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.21/1 SUP HCPCS C1713 A-5400.21/1 - SCREW BONE 2MM 21MM HEXADRIVE 6 APTUS TITANIUM CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.22/1 SUP HCPCS C1713 A-5400.22/1 - SCREW BONE 2MM 22MM HEXADRIVE 6 APTUS TITANIUM CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5400.23/1 SUP HCPCS C1713 A-5400.23/1 - SCREW BONE 2MM 23MM CORT 6 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5400.24/1 SUP HCPCS C1713 A-5400.24/1 - SCREW BONE 2MM 24MM CORT 6 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5450.06/1 SUP HCPCS C1713 A-5450.06/1 - SCREW BONE 2MM 6MM HEXADRIVE 6 LOCK APTUS TRI-LOCK TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $337.50 $337.50 $70.34 $337.50 N/A N/A A-5450.07/1 SUP HCPCS C1713 A-5450.07/1 - SCREW BONE HEXADRIVE 6 TAPER 2MM 7MM 2 THREAD SELF TAP BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5450.08/1 SUP HCPCS C1713 A-5450.08/1 - SCREW BONE HEXADRIVE 6 TAPER 2MM 8MM 2 THREAD SELF TAP BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5450.09 SUP HCPCS C1713 A-5450.09 - SCREW BONE 2MM 9MM LOCK APTUS BLUE TITANIUM HAND CORTICAL BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5450.09/1 SUP HCPCS C1713 A-5450.09/1 - SCREW BONE 6MM 2MM 9MM 2 THREADED TRILOCK HEXADRIVE SLFTAP BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5450.10 SUP HCPCS C1713 A-5450.10 - SCREW BONE 2 THREAD TAPER SPHERE 2MM 10MM TRILOCK LOCKING BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5450.10/1 SUP HCPCS C1713 A-5450.10/1 - SCREW BONE HEXADRIVE 6 TAPER 2MM 10MM 2 THREAD SELF TAP BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5450.11 SUP HCPCS C1713 A-5450.11 - SCREW BONE 2MM 11MM LOCKING HEXADRIVE 6 APTUS TRILOCK BLUE BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5450.11/1 SUP HCPCS C1713 A-5450.11/1 - SCREW BONE 2MM 11MM HEXADRIVE 6 LOCK APTUS TRI-LOCK TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $337.50 $337.50 $70.34 $337.50 N/A N/A A-5450.12 SUP HCPCS C1713 A-5450.12 - SCREW BONE 2 THREAD TAPER SPHERE 2MM 12MM TRILOCK LOCKING BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $337.50 $337.50 $70.34 $337.50 N/A N/A A-5450.12/1 SUP HCPCS C1713 A-5450.12/1 - SCREW BONE 2MM 12MM LOCKING HEXADRIVE 6 APTUS TRILOCK BLUE BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5450.13/1 SUP HCPCS C1713 A-5450.13/1 - SCREW BONE 6MM HEAD 2MM 13MM HEXADRIVE 6 APTUS BLUE TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5450.14/1 SUP HCPCS C1713 A-5450.14/1 - SCREW BONE 6MM HEAD 2MM 14MM LOCK APTUS BLUE TITANIUM HAND BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5450.16 SUP HCPCS C1713 A-5450.16 - SCREW BONE 2MM 16MM LOCKING HEXAGONAL DRIVE BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $73.98 $355.00 N/A N/A A-5450.16/1 SUP HCPCS C1713 A-5450.16/1 - SCREW BONE 2MM 16MM HEXADRIVE 6 APTUS TRILOCK TITANIUM MIDFT BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5450.18/1 SUP HCPCS C1713 A-5450.18/1 - SCREW BONE 2MM 18MM HEXADRIVE 6 LOCK APTUS TRI-LOCK TITANIUM BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $337.50 $337.50 $70.34 $337.50 N/A N/A A-5450.20/1 SUP HCPCS C1713 A-5450.20/1 - SCREW BONE 6MM HEAD 2MM 20MM 2 THREADED LOCKING HEXADRIVE 6 BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $151.88 $151.88 $151.88 $151.88 $337.50 $337.50 $337.50 $70.34 $337.50 $337.50 $337.50 $337.50 $337.50 $70.34 $337.50 $135.00 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $151.88 $66.99 N/A $195.75 $337.50 $202.50 $337.50 $70.34 $337.50 N/A N/A A-5500.05/1 SUP HCPCS C1713 A-5500.05/1 - SCREW BONE 6MM HEAD 2.3MM 5MM CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.06/1 SUP HCPCS C1713 A-5500.06/1 - SCREW BONE 2.3MM 6MM CORT 6 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.07/1 SUP HCPCS C1713 A-5500.07/1 - SCREW BONE 2.3MM 7MM CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.08/1 SUP HCPCS C1713 A-5500.08/1 - SCREW BONE TAPER ATRAUMATIC 2.3MM 8MM 2 THREADED TENSILE BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.09/1 SUP HCPCS C1713 A-5500.09/1 - SCREW BONE TAPER 2.3MM 9MM 2 THREAD HEXADRIVE 6 SELF TAP BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.10/1 SUP HCPCS C1713 A-5500.10/1 - SCREW BONE TAPER 2.3MM 10MM 2 THREAD LOCK HEXADRIVE 6 CORE BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.11/1 SUP HCPCS C1713 A-5500.11/1 - SCREW BONE 2.3MM 11MM APTUS BROWN TITANIUM HAND CORTICAL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.12/1 SUP HCPCS C1713 A-5500.12/1 - SCREW BONE TAPER ATRAUMATIC 2.3MM 12MM 2 THREADED TENSILE BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.13/1 SUP HCPCS C1713 A-5500.13/1 - SCREW BONE TAPER 2.3MM 13MM 2 THREAD HEXADRIVE 6 SELF TAP BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5500.14/1 SUP HCPCS C1713 A-5500.14/1 - SCREW BONE TAPER ATRAUMATIC 2.3MM 14MM 2 THREADED TENSILE BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.15/1 SUP HCPCS C1713 A-5500.15/1 - SCREW BONE TAPER 2.3MM 15MM 2 THREAD HEXADRIVE 6 SELF TAP BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.16/1 SUP HCPCS C1713 A-5500.16/1 - SCREW BONE TAPER 2.3MM 16MM 2 THREAD HEXADRIVE 6 SELF TAP BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $84.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5500.17/1 SUP HCPCS C1713 A-5500.17/1 - SCREW BONE 2.3MM 17MM CORT 6 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.18/1 SUP HCPCS C1713 A-5500.18/1 - SCREW BONE TAPER 2.3MM 18MM 2 THREAD HEXADRIVE 6 SELF TAP BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5500.19/1 SUP HCPCS C1713 A-5500.19/1 - SCREW BONE 2.3MM 19MM CORT 6 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.20/1 SUP HCPCS C1713 A-5500.20/1 - SCREW BONE TAPER 2.3MM 20MM 2 THREAD HEXADRIVE 6 SELF TAP BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.21/1 SUP HCPCS C1713 A-5500.21/1 - SCREW BONE 2.3MM 21MM CORT 6 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.22/1 SUP HCPCS C1713 A-5500.22/1 - SCREW BONE 2.3MM 22MM CORT 6 HNDL BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $210.00 $210.00 $43.76 $210.00 N/A N/A A-5500.23/1 SUP HCPCS C1713 A-5500.23/1 - SCREW BONE 2.3MM 23MM APTUS BROWN TITANIUM CORTICAL HAND BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A-5500.24/1 SUP HCPCS C1713 A-5500.24/1 - SCREW BONE TAPER 2.3MM 24MM 2 THREAD HEXADRIVE 6 SELF TAP BOTH IP/OP $210.00 $155.00 $41.68 $210.00 $94.50 $94.50 $94.50 $94.50 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $210.00 $210.00 $210.00 $43.77 $210.00 $210.00 $124.22 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $94.50 $41.68 N/A $121.80 $210.00 $126.00 $210.00 $43.76 $210.00 N/A N/A A60-15030 SUP HCPCS C1713 A60-15030 - SCREW XTRNFX 6MM 6-5MM 150MM NS 30MM DFS SHNK CORT 4.8MM DRL BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $134.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $201.00 $335.00 $69.81 $335.00 N/A N/A ABS-1000 SUP Custom 27203010 ABS-1000 - SYSTEM BN CMNT 3ML DLV MX ABS BOTH IP/OP $472.50 $350.00 $84.11 $472.50 $472.50 $472.50 $472.50 $472.50 $472.50 $472.50 $84.11 $472.50 $472.50 $350.69 $350.69 $364.20 $246.17 $98.47 $472.50 $189.00 $472.50 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $307.13 $472.50 N/A $274.05 $472.50 $283.50 $472.50 $472.50 $472.50 N/A N/A ABS-1000-L SUP Custom 27203010 ABS-1000-L - SYSTEM BN CMNT LG MX DLV APL BOTH IP/OP $612.50 $453.00 $109.03 $612.50 $612.50 $612.50 $612.50 $612.50 $612.50 $612.50 $109.03 $612.50 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $264.60 $612.50 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $612.50 N/A $355.25 $612.50 $367.50 $612.50 $612.50 $612.50 N/A N/A ABS-1000-S SUP Custom 27203010 ABS-1000-S - SYSTEM BN CMNT STRL ARTHX DLV MX SM APL BOTH IP/OP $612.50 $453.00 $109.03 $612.50 $612.50 $612.50 $612.50 $612.50 $612.50 $612.50 $109.03 $612.50 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $264.60 $612.50 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $612.50 N/A $355.25 $612.50 $367.50 $612.50 $612.50 $612.50 N/A N/A ABS-1001 SUP Custom 27203010 ABS-1001 - NEEDLE EPDRL TUO OBT BOTH IP/OP $140.00 $104.00 $24.92 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $24.92 $140.00 $140.00 $103.91 $103.91 $107.91 $72.94 $29.18 $140.00 $60.48 $140.00 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $91.00 $140.00 N/A $81.20 $140.00 $84.00 $140.00 $140.00 $140.00 N/A N/A ABS-1002 SUP Custom 27203010 ABS-1002 - NEEDLE EPDRL STRG TUO OBT BOTH IP/OP $140.00 $104.00 $24.92 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $24.92 $140.00 $140.00 $103.91 $103.91 $107.91 $72.94 $29.18 $140.00 $60.48 $140.00 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $91.00 $140.00 N/A $81.20 $140.00 $84.00 $140.00 $140.00 $140.00 N/A N/A ABS-10020 SUP Custom 27203010 ABS-10020 - CENTRIFUGE BNCHTP 110V ACP HETTICH ROTOFIX 32 SWNG OUT RTR BOTH IP/OP "$10,750.00" "$7,955.00" "$1,913.50" "$10,750.00" "$10,750.00" "$10,750.00" "$10,750.00" "$10,750.00" "$10,750.00" "$10,750.00" "$1,913.50" "$10,750.00" "$10,750.00" "$4,181.12" "$4,181.12" "$8,286.10" "$2,060.15" "$2,240.42" "$10,750.00" "$4,300.00" "$10,750.00" "$10,750.00" "$10,750.00" "$10,750.00" "$10,750.00" "$8,062.50" "$10,750.00" "$10,750.00" "$10,750.00" "$5,375.00" "$5,375.00" "$8,514.00" "$10,750.00" "$8,600.00" "$6,987.50" "$10,750.00" N/A "$6,235.00" "$10,750.00" "$6,450.00" "$10,750.00" "$10,750.00" "$10,750.00" N/A N/A ABS-10023 SUP HCPCS C1713 ABS-10023 - CAP CNTRF ACP HETTICH REPL BCKT ABS-10023 BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A ABS-1003 SUP Custom 27203010 ABS-1003 - SYSTEM BN CMNT FNL BOTH IP/OP $70.00 $52.00 $12.46 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $12.46 $70.00 $70.00 $51.95 $51.95 $53.96 $36.47 $14.59 $70.00 $30.24 $70.00 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $45.50 $70.00 N/A $40.60 $70.00 $42.00 $70.00 $70.00 $70.00 N/A N/A ABS-10050 SUP Custom 27203010 ABS-10050 - APPLICATOR SRG XLNG BLNT BVL 10CM VISCOGEL EZ TO FIL HVISC BOTH IP/OP $687.50 $509.00 $122.38 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $122.38 $687.50 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $275.00 $687.50 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $687.50 N/A $398.75 $687.50 $412.50 $687.50 $687.50 $687.50 N/A N/A ABS-10051 SUP Custom 27203010 ABS-10051 - APPLICATOR SRG XLNG BLNT BVL 3CM VSC SPRY EZ TO FIL LVISC MX BOTH IP/OP $687.50 $509.00 $122.38 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $122.38 $687.50 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $275.00 $687.50 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $687.50 N/A $398.75 $687.50 $412.50 $687.50 $687.50 $687.50 N/A N/A ABS10055 SUP Custom 27203010 ABS10055 - KIT SRG STRL TULIP GEMS CELLFRIENDLY SUPERLUERLOK ADIPOSE BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A ABS-1007-BC SUP HCPCS C1762 ABS-1007-BC - MATRIX TISS .75CC BIOCARTILAGE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$2,025.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$2,025.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A ABS-1010-BC SUP HCPCS C1762 ABS-1010-BC - FILLER BN VOID 1CC BIOCARTILAGE BOTH IP/OP "$2,450.00" "$1,813.00" $486.26 "$2,646.00" "$1,102.50" "$1,102.50" "$1,102.50" "$1,102.50" "$2,450.00" "$2,450.00" "$2,450.00" $510.64 "$2,450.00" "$2,450.00" "$2,450.00" "$2,450.00" "$2,450.00" $510.61 "$2,450.00" "$2,646.00" "$1,449.18" "$2,450.00" "$2,450.00" "$2,450.00" "$2,450.00" "$1,837.50" "$2,450.00" "$2,450.00" "$2,450.00" "$1,225.00" "$1,225.00" "$1,940.40" "$2,450.00" "$1,960.00" "$1,102.50" $486.26 N/A "$1,421.00" "$2,450.00" "$2,450.00" "$2,450.00" $510.58 "$2,450.00" N/A N/A ABS-1102-19 SUP HCPCS L8699 ABS-1102-19 - GRAFT BN 19X12MM CARTIFORM BOTH IP/OP "$15,625.00" "$11,563.00" "$3,256.42" "$15,625.00" "$15,625.00" "$15,625.00" "$15,625.00" "$15,625.00" "$15,625.00" "$15,625.00" "$15,625.00" "$15,625.00" "$15,625.00" "$15,625.00" "$15,625.00" "$15,625.00" "$15,625.00" "$3,256.42" "$15,625.00" "$6,750.00" "$15,625.00" "$15,625.00" "$15,625.00" "$15,625.00" "$15,625.00" "$11,718.75" "$15,625.00" "$15,625.00" "$15,625.00" "$7,812.50" "$7,812.50" "$12,375.00" "$15,625.00" "$12,500.00" "$7,031.25" "$15,625.00" N/A "$9,062.50" "$15,625.00" "$9,375.00" "$15,625.00" "$15,625.00" "$15,625.00" N/A N/A ABS-1102-25 SUP HCPCS L8699 ABS-1102-25 - GRAFT BN 25X20MM CARTIFORM BOTH IP/OP "$27,500.00" "$20,350.00" "$5,731.30" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$11,880.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$27,500.00" N/A "$15,950.00" "$27,500.00" "$16,500.00" "$27,500.00" "$27,500.00" "$27,500.00" N/A N/A ABS-20000 SUP Custom 27203010 ABS-20000 - NEEDLE SPNL 17GA 14.63CM 1.27CM 8 HL FENESTRATE HUB BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A ABS-2001-01 SUP HCPCS C1713 ABS-2001-01 - FILLER BN VOID 1CC STIMUBLAST PTTY BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A ABS-2001-02 SUP HCPCS C1713 ABS-2001-02 - FILLER BN VOID 2.5CC STIMUBLAST PTTY BOTH IP/OP "$1,100.00" $814.00 $218.32 "$1,100.00" $495.00 $495.00 $495.00 $495.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.27 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $229.25 "$1,100.00" $440.00 $650.65 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $495.00 $218.32 N/A $638.00 "$1,100.00" "$1,100.00" "$1,100.00" $229.24 "$1,100.00" N/A N/A ABS-2001-05 SUP HCPCS C1713 ABS-2001-05 - FILLER BN VOID 5ML STIMUBLAST PTTY RVRS PHS MED DBM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A ABS-2002-05 SUP HCPCS C1713 ABS-2002-05 - FILLER BN VOID 5CC NS STIMUBLAST ARTHX GEL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A ABS-2002-10 SUP HCPCS C1713 ABS-2002-10 - FILLER BN VOID 10ML STIMUBLAST GEL RVRS PHS MED DBM BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,000.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A ABS-2003-05 SUP HCPCS C1713 ABS-2003-05 - FILLER BN VOID 5ML STIMUBLAST PTTY RVRS PHS MED CANC DBM BOTH IP/OP "$2,050.00" "$1,517.00" $406.87 "$2,050.00" $922.50 $922.50 $922.50 $922.50 "$2,050.00" "$2,050.00" "$2,050.00" $427.27 "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" $427.24 "$2,050.00" "$2,050.00" "$1,212.58" "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" "$1,537.50" "$2,050.00" "$2,050.00" "$2,050.00" "$1,025.00" "$1,025.00" "$1,623.60" "$2,050.00" "$1,640.00" $922.50 $406.87 N/A "$1,189.00" "$2,050.00" "$1,230.00" "$2,050.00" "$2,050.00" "$2,050.00" N/A N/A ABS-2003-10 SUP HCPCS C1713 ABS-2003-10 - FILLER BN VOID 10ML STIMUBLAST PTTY RVRS PHS MED CANC DBM BOTH IP/OP "$3,237.50" "$2,396.00" $642.56 "$3,237.50" "$1,456.88" "$1,456.88" "$1,456.88" "$1,456.88" "$3,237.50" "$3,237.50" "$3,237.50" $674.78 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $674.73 "$3,237.50" "$3,237.50" "$1,596.09" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$1,456.88" $642.56 N/A "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" $674.70 "$3,237.50" N/A N/A ABS-2004-01 SUP HCPCS C1713 ABS-2004-01 - FILLER BN VOID 1ML STIMUBLAST PTTY RVRS PHS MED CANC DBM BOTH IP/OP $525.00 $389.00 $104.20 $525.00 $236.25 $236.25 $236.25 $236.25 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $310.54 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $236.25 $104.20 N/A $304.50 $525.00 $525.00 $525.00 $109.41 $525.00 N/A N/A ABS-2004-03 SUP HCPCS C1713 ABS-2004-03 - FILLER BN VOID 3ML STIMUBLAST PST RVRS PHS MED CANC DBM BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" $260.50 "$1,250.00" N/A N/A ABS-2004-08 SUP HCPCS C1713 ABS-2004-08 - FILLER BN VOID 8ML STIMUBLAST PST RVRS PHS MED CANC DBM BOTH IP/OP "$2,487.50" "$1,841.00" $493.71 "$2,487.50" "$1,119.38" "$1,119.38" "$1,119.38" "$1,119.38" "$2,487.50" "$2,487.50" "$2,487.50" $518.46 "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" $518.42 "$2,487.50" "$2,487.50" "$1,471.36" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$1,865.63" "$2,487.50" "$2,487.50" "$2,487.50" "$1,243.75" "$1,243.75" "$1,970.10" "$2,487.50" "$1,990.00" "$1,119.38" $493.71 N/A "$1,442.75" "$2,487.50" "$1,492.50" "$2,487.50" "$2,487.50" "$2,487.50" N/A N/A ABS-2009-02 SUP HCPCS L8699 ABS-2009-02 - GRAFT BN 2.5CC ARTHROCELL BOTH IP/OP "$4,750.00" "$3,515.00" $989.95 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$2,052.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A ABS-2009-05 SUP HCPCS L8699 ABS-2009-05 - GRAFT BN 5CC ARTHROCELL BOTH IP/OP "$8,750.00" "$6,475.00" "$1,823.60" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,780.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A ABS-21000 SUP Custom 27203010 ABS-21000 - NEEDLE EPDRL 17GA 6IN TUO DLV BOTH IP/OP $62.50 $46.00 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A ABS-30001S SUP HCPCS L8699 ABS-30001S - GRAFT SFT TIS THK 5X5CM STRL HDRT RTU REINF DRML XCLR MTRX BOTH IP/OP "$4,125.00" "$3,053.00" $859.70 "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" $859.70 "$4,125.00" "$1,650.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$1,856.25" "$4,125.00" N/A "$2,392.50" "$4,125.00" "$2,475.00" "$4,125.00" "$4,125.00" "$4,125.00" N/A N/A ABS-30002S SUP HCPCS L8699 ABS-30002S - GRAFT SFT TIS THK 8X6CM STRL HDRT RTU REINF DRML XCLR MTRX BOTH IP/OP "$4,500.00" "$3,330.00" $937.85 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,025.00" "$4,500.00" N/A "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A ABS-4003 SUP Custom 27203010 ABS-4003 - DRESSING WND 3X3IN JUMPSTART ANMC BOTH IP/OP $35.00 $26.00 $6.23 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $35.00 $6.23 $35.00 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $14.00 $35.00 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $35.00 N/A $20.30 $35.00 $21.00 $35.00 $35.00 $35.00 N/A N/A ABS-4004 SUP Custom 27203010 ABS-4004 - DRESSING WND 4X4IN JUMPSTART ANMC BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A ABS-4005 SUP Custom 27203010 ABS-4005 - DRESSING WND 1.5IN 8IN JUMPSTART ANMC BOTH IP/OP $475.00 $352.00 $84.55 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $84.55 $475.00 $475.00 $352.55 $352.55 $366.13 $247.48 $99.00 $475.00 $190.00 $475.00 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $308.75 $475.00 N/A $275.50 $475.00 $285.00 $475.00 $475.00 $475.00 N/A N/A ABS-4008 SUP Custom 27203010 ABS-4008 - DRESSING WND 8X8IN JUMPSTART ANMC BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $129.60 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A ABS-4012 SUP Custom 27203010 ABS-4012 - DRESSING WND 12X12IN JUMPSTART 1 LYR DOT MTRX PTRN ANMC LSR BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $243.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A ABS-4025 SUP Custom 27203010 ABS-4025 - DRESSING WND 2X5IN JUMPSTART ANMC BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A ABS-4053 SUP Custom 27203010 ABS-4053 - DRESSING WND 4X4IN 2X2IN JUMPSTART COMP ADH BRDR PD ANMC BOTH IP/OP $82.50 $61.00 $14.69 $82.50 $82.50 $82.50 $82.50 $82.50 $82.50 $82.50 $14.69 $82.50 $82.50 $61.23 $61.23 $63.59 $42.98 $17.19 $82.50 $33.00 $82.50 $82.50 $82.50 $82.50 $82.50 $61.88 $82.50 $82.50 $82.50 $41.25 $41.25 $65.34 $82.50 $66.00 $53.63 $82.50 N/A $47.85 $82.50 $49.50 $82.50 $82.50 $82.50 N/A N/A ABS-4054 SUP Custom 27203010 ABS-4054 - DRESSING WND 2.5IN 1IN JUMPSTART COMP ADH BRDR PD ANMC BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A ABS-4056 SUP Custom 27203010 ABS-4056 - DRESSING WND 4IN 2IN JUMPSTART COMP ADH BRDR PD ANMC BOTH IP/OP $32.50 $24.00 $5.79 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $5.79 $32.50 $32.50 $24.12 $24.12 $25.05 $16.93 $6.77 $32.50 $13.00 $32.50 $32.50 $32.50 $32.50 $32.50 $24.38 $32.50 $32.50 $32.50 $16.25 $16.25 $25.74 $32.50 $26.00 $21.13 $32.50 N/A $18.85 $32.50 $19.50 $32.50 $32.50 $32.50 N/A N/A ABS-4100-022 SUP HCPCS L8699 ABS-4100-022 - MATRIX TISS THN 2X2CM ARTHX AMNION BOTH IP/OP "$2,375.00" "$1,758.00" $494.98 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" "$1,026.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" "$2,375.00" N/A "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" "$2,375.00" "$2,375.00" N/A N/A ABS-4100-023 SUP HCPCS L8699 ABS-4100-023 - MATRIX TISS THN 3X2CM ARTHX AMNION BOTH IP/OP "$2,875.00" "$2,128.00" $599.18 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$1,242.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" "$2,875.00" N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" "$2,875.00" "$2,875.00" N/A N/A ABS-4100-033 SUP HCPCS L8699 ABS-4100-033 - MATRIX TISS THN 3X3CM AMNION BOTH IP/OP "$3,937.50" "$2,914.00" $820.62 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$1,701.00" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" "$3,937.50" N/A "$2,283.75" "$3,937.50" "$2,362.50" "$3,937.50" "$3,937.50" "$3,937.50" N/A N/A ABS-4100-044 SUP HCPCS L8699 ABS-4100-044 - MATRIX TISS THN 4X4CM ARTHX AMNION BOTH IP/OP "$5,562.50" "$4,116.00" "$1,159.29" "$5,562.50" "$5,562.50" "$5,562.50" "$5,562.50" "$5,562.50" "$5,562.50" "$5,562.50" "$5,562.50" "$5,562.50" "$5,562.50" "$5,562.50" "$5,562.50" "$5,562.50" "$5,562.50" "$1,159.29" "$5,562.50" "$2,403.00" "$5,562.50" "$5,562.50" "$5,562.50" "$5,562.50" "$5,562.50" "$4,171.88" "$5,562.50" "$5,562.50" "$5,562.50" "$2,781.25" "$2,781.25" "$4,405.50" "$5,562.50" "$4,450.00" "$2,503.13" "$5,562.50" N/A "$3,226.25" "$5,562.50" "$3,337.50" "$5,562.50" "$5,562.50" "$5,562.50" N/A N/A ABS-4100-046 SUP HCPCS L8699 ABS-4100-046 - MATRIX TISS THN 6X4CM ALGRF AMNION BOTH IP/OP "$7,562.50" "$5,596.00" "$1,576.11" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$1,576.11" "$7,562.50" "$3,267.00" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$5,671.88" "$7,562.50" "$7,562.50" "$7,562.50" "$3,781.25" "$3,781.25" "$5,989.50" "$7,562.50" "$6,050.00" "$3,403.13" "$7,562.50" N/A "$4,386.25" "$7,562.50" "$4,537.50" "$7,562.50" "$7,562.50" "$7,562.50" N/A N/A ABS-4100-048 SUP HCPCS L8699 ABS-4100-048 - MATRIX TISS THN 8X4CM ARTHX AMNION BOTH IP/OP "$9,312.50" "$6,891.00" "$1,940.83" "$9,312.50" "$9,312.50" "$9,312.50" "$9,312.50" "$9,312.50" "$9,312.50" "$9,312.50" "$9,312.50" "$9,312.50" "$9,312.50" "$9,312.50" "$9,312.50" "$9,312.50" "$9,312.50" "$1,940.83" "$9,312.50" "$4,023.00" "$9,312.50" "$9,312.50" "$9,312.50" "$9,312.50" "$9,312.50" "$6,984.38" "$9,312.50" "$9,312.50" "$9,312.50" "$4,656.25" "$4,656.25" "$7,375.50" "$9,312.50" "$7,450.00" "$4,190.63" "$9,312.50" N/A "$5,401.25" "$9,312.50" "$5,587.50" "$9,312.50" "$9,312.50" "$9,312.50" N/A N/A ABS-4100-077 SUP HCPCS L8699 ABS-4100-077 - MATRIX TISS THN 7X7CM ARTHX AMNION BOTH IP/OP "$12,312.50" "$9,111.00" "$2,566.06" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$2,566.06" "$12,312.50" "$5,319.00" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$9,234.38" "$12,312.50" "$12,312.50" "$12,312.50" "$6,156.25" "$6,156.25" "$9,751.50" "$12,312.50" "$9,850.00" "$5,540.63" "$12,312.50" N/A "$7,141.25" "$12,312.50" "$7,387.50" "$12,312.50" "$12,312.50" "$12,312.50" N/A N/A ABS-4100-212 SUP HCPCS L8699 ABS-4100-212 - MATRIX TISS THN 12X2CM ARTHX AMNION BOTH IP/OP "$7,562.50" "$5,596.00" "$1,576.11" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$1,576.11" "$7,562.50" "$3,267.00" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$7,562.50" "$5,671.88" "$7,562.50" "$7,562.50" "$7,562.50" "$3,781.25" "$3,781.25" "$5,989.50" "$7,562.50" "$6,050.00" "$3,403.13" "$7,562.50" N/A "$4,386.25" "$7,562.50" "$4,537.50" "$7,562.50" "$7,562.50" "$7,562.50" N/A N/A ABS-4200-022 SUP HCPCS L8699 ABS-4200-022 - MATRIX TISS THK 2X2CM ALGRF AMNION BOTH IP/OP "$2,956.50" "$2,188.00" $616.12 "$2,956.25" "$2,956.25" "$2,956.25" "$2,956.25" "$2,956.25" "$2,956.25" "$2,956.25" "$2,956.25" "$2,956.25" "$2,956.25" "$2,956.25" "$2,956.25" "$2,956.25" "$2,956.25" $616.12 "$2,956.25" "$1,277.10" "$2,956.25" "$2,956.25" "$2,956.25" "$2,956.25" "$2,956.25" "$2,217.38" "$2,956.25" "$2,956.25" "$2,956.25" "$1,478.13" "$1,478.13" "$2,341.35" "$2,956.25" "$2,365.00" "$1,330.31" "$2,956.25" N/A "$1,714.77" "$2,956.25" "$1,773.75" "$2,956.25" "$2,956.25" "$2,956.25" N/A N/A ABS-4200-023 SUP HCPCS L8699 ABS-4200-023 - MATRIX TISS THK 8X3CM ARTHX AMNION BOTH IP/OP "$4,250.00" "$3,145.00" $885.75 "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" $885.75 "$4,250.00" "$1,836.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$4,250.00" "$3,187.50" "$4,250.00" "$4,250.00" "$4,250.00" "$2,125.00" "$2,125.00" "$3,366.00" "$4,250.00" "$3,400.00" "$1,912.50" "$4,250.00" N/A "$2,465.00" "$4,250.00" "$2,550.00" "$4,250.00" "$4,250.00" "$4,250.00" N/A N/A ABS-4200-033 SUP HCPCS L8699 ABS-4200-033 - MATRIX TISS THK 3X3CM ALGRF AMNION BOTH IP/OP "$6,125.00" "$4,533.00" "$1,276.52" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$1,276.52" "$6,125.00" "$2,646.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$6,125.00" "$4,593.75" "$6,125.00" "$6,125.00" "$6,125.00" "$3,062.50" "$3,062.50" "$4,851.00" "$6,125.00" "$4,900.00" "$2,756.25" "$6,125.00" N/A "$3,552.50" "$6,125.00" "$3,675.00" "$6,125.00" "$6,125.00" "$6,125.00" N/A N/A ABS-4200-034 SUP HCPCS L8699 ABS-4200-034 - MATRIX TISS THK 4X3CM ARTHX AMNION BOTH IP/OP "$7,000.00" "$5,180.00" "$1,458.88" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$1,458.88" "$7,000.00" "$3,024.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$7,000.00" "$5,250.00" "$7,000.00" "$7,000.00" "$7,000.00" "$3,500.00" "$3,500.00" "$5,544.00" "$7,000.00" "$5,600.00" "$3,150.00" "$7,000.00" N/A "$4,060.00" "$7,000.00" "$4,200.00" "$7,000.00" "$7,000.00" "$7,000.00" N/A N/A ABS-4200-036 SUP HCPCS L8699 ABS-4200-036 - MATRIX TISS THK 4X3CM AMNION BOTH IP/OP "$9,250.00" "$6,845.00" "$1,927.80" "$9,250.00" "$9,250.00" "$9,250.00" "$9,250.00" "$9,250.00" "$9,250.00" "$9,250.00" "$9,250.00" "$9,250.00" "$9,250.00" "$9,250.00" "$9,250.00" "$9,250.00" "$9,250.00" "$1,927.80" "$9,250.00" "$3,996.00" "$9,250.00" "$9,250.00" "$9,250.00" "$9,250.00" "$9,250.00" "$6,937.50" "$9,250.00" "$9,250.00" "$9,250.00" "$4,625.00" "$4,625.00" "$7,326.00" "$9,250.00" "$7,400.00" "$4,162.50" "$9,250.00" N/A "$5,365.00" "$9,250.00" "$5,550.00" "$9,250.00" "$9,250.00" "$9,250.00" N/A N/A ABS-4200-038 SUP HCPCS L8699 ABS-4200-038 - MATRIX TISS THK 8X3CM ARTHX AMNION BOTH IP/OP "$11,000.00" "$8,140.00" "$2,292.52" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.52" "$11,000.00" "$4,752.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$8,250.00" "$11,000.00" "$11,000.00" "$11,000.00" "$5,500.00" "$5,500.00" "$8,712.00" "$11,000.00" "$8,800.00" "$4,950.00" "$11,000.00" N/A "$6,380.00" "$11,000.00" "$6,600.00" "$11,000.00" "$11,000.00" "$11,000.00" N/A N/A ABS-4300-050 SUP HCPCS L8699 ABS-4300-050 - MATRIX TISS .5CC ARTHX ALGRF FLW AMNION BOTH IP/OP "$2,000.00" "$1,480.00" $416.82 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A ABS-4300-100 SUP HCPCS L8699 ABS-4300-100 - MATRIX TISS 1CC ARTHX AMNION FLW BOTH IP/OP "$2,750.00" "$2,035.00" $573.13 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A ABS-4300-200 SUP HCPCS L8699 ABS-4300-200 - MATRIX TISS 2CC ARTHX AMNION FLW BOTH IP/OP "$4,500.00" "$3,330.00" $937.85 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,025.00" "$4,500.00" N/A "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A ABSTACK15 SUP Custom 27203010 ABSTACK15 - DEVICE FIX 5MM 15 TACK RATCHET HANDLE PISTOL GRIP NO SHARP BOTH IP/OP $627.50 $464.00 $111.61 $627.03 $627.03 $627.03 $627.03 $627.03 $627.03 $627.03 $111.61 $627.03 $627.03 $465.38 $465.38 $483.31 $326.68 $130.68 $627.03 $250.81 $627.03 $627.03 $627.03 $627.03 $627.03 $470.63 $627.03 $627.03 $627.03 $313.52 $313.52 $496.61 $627.03 $501.62 $407.57 $627.03 N/A $363.95 $627.03 $376.22 $627.03 $627.03 $627.03 N/A N/A ABSTACK30 SUP Custom 27203010 ABSTACK30 - DEVICE FIX 5MM 30 TACK RATCHET HANDLE PISTOL GRIP NO SHARP BOTH IP/OP "$1,160.00" $858.00 $206.48 "$2,209.57" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $206.48 "$1,160.00" "$1,160.00" $860.95 $860.95 $894.13 $604.36 $241.76 "$1,160.00" $883.83 "$1,160.00" "$1,160.00" "$2,209.57" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $754.00 "$1,160.00" N/A $672.80 "$1,160.00" $696.00 "$1,160.00" "$1,160.00" "$1,160.00" N/A N/A AC003 SUP Custom 27203010 AC003 - SET SPINAL ADAPTER BREMER HALO MAYFIELD BOTH IP/OP "$2,078.00" "$1,538.00" $369.84 "$2,077.78" "$2,077.78" "$2,077.78" "$2,077.78" "$2,077.78" "$2,077.78" "$2,077.78" $369.84 "$2,077.78" "$2,077.78" "$1,542.13" "$1,542.13" "$1,601.55" "$1,082.52" $433.03 "$2,077.78" $831.11 "$2,077.78" "$2,077.78" "$2,077.78" "$2,077.78" "$2,077.78" "$1,558.50" "$2,077.78" "$2,077.78" "$2,077.78" "$1,038.89" "$1,038.89" "$1,645.60" "$2,077.78" "$1,662.22" "$1,350.56" "$2,077.78" N/A "$1,205.24" "$2,077.78" "$1,246.67" "$2,077.78" "$2,077.78" "$2,077.78" N/A N/A AC018 SUP HCPCS C1713 AC018 - PIN SKULL BREMER HALO STERILE BOTH IP/OP $116.50 $86.00 $23.07 $116.25 $52.31 $52.31 $52.31 $52.31 $116.25 $116.25 $116.25 $24.23 $116.25 $116.25 $116.25 $116.25 $116.25 $24.23 $116.25 $46.50 $68.76 $116.25 $116.25 $116.25 $116.25 $87.38 $116.25 $116.25 $116.25 $58.13 $58.13 $92.07 $116.25 $93.00 $52.31 $23.07 N/A $67.57 $116.25 $116.25 $116.25 $24.23 $116.25 N/A N/A AC020 SUP HCPCS C1713 AC020 - PIN SKULL BREMER HALO STERILE BOTH IP/OP $100.50 $74.00 $19.95 $100.50 $45.23 $45.23 $45.23 $45.23 $100.50 $100.50 $100.50 $20.95 $100.50 $100.50 $100.50 $100.50 $100.50 $20.95 $100.50 $40.20 $59.45 $100.50 $100.50 $100.50 $100.50 $75.38 $100.50 $100.50 $100.50 $50.25 $50.25 $79.60 $100.50 $80.40 $45.23 $19.95 N/A $58.29 $100.50 $100.50 $100.50 $20.94 $100.50 N/A N/A AC3930A SUP Custom 27203010 AC3930A - CATHETER ANGEL BOTH IP/OP "$5,625.00" "$4,163.00" "$1,001.25" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,001.25" "$5,625.00" "$5,625.00" "$4,174.88" "$4,174.88" "$4,335.75" "$2,060.15" "$1,172.31" "$5,625.00" "$2,250.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$3,656.25" "$5,625.00" N/A "$3,262.50" "$5,625.00" "$3,375.00" "$5,625.00" "$5,625.00" "$5,625.00" N/A N/A ACH140 SUP HCPCS C1760 ACH140 - DEVICE CLOSURE STANDARD 40MM EXCLUSION SYSTEM ATRICLIP BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,750.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A ACTR10 SUP Custom 27803010 ACTR10 - RING CPSLR TNSN THK.15MM 10-12.3MM STRL REFORM PMMA BOTH IP/OP $493.00 $365.00 $87.67 $492.53 $492.53 $492.53 $492.53 $492.53 $492.53 $492.53 $87.67 $492.53 $492.53 $492.53 $492.53 $492.53 $492.53 $102.65 $492.53 $197.01 $492.53 $492.53 $492.53 $492.53 $492.53 $369.75 $492.53 $492.53 $492.53 $246.27 $246.27 $390.08 $492.53 $394.02 $221.64 $492.53 N/A $285.94 $492.53 $295.52 $492.53 $492.53 $492.53 N/A N/A ACTR11 SUP Custom 27803010 ACTR11 - RING CPSLR FX THK.17MM 11-13MM STRL REFORM PMMA BOTH IP/OP $493.00 $365.00 $87.67 $492.53 $492.53 $492.53 $492.53 $492.53 $492.53 $492.53 $87.67 $492.53 $492.53 $492.53 $492.53 $492.53 $492.53 $102.65 $492.53 $197.01 $492.53 $492.53 $492.53 $492.53 $492.53 $369.75 $492.53 $492.53 $492.53 $246.27 $246.27 $390.08 $492.53 $394.02 $221.64 $492.53 N/A $285.94 $492.53 $295.52 $492.53 $492.53 $492.53 N/A N/A ACTR12 SUP Custom 27803010 ACTR12 - RING CPSLR TNSN THK.2MM 12-14.5MM STRL REFORM PMMA BOTH IP/OP $493.00 $365.00 $87.67 $492.53 $492.53 $492.53 $492.53 $492.53 $492.53 $492.53 $87.67 $492.53 $492.53 $492.53 $492.53 $492.53 $492.53 $102.65 $492.53 $197.01 $492.53 $492.53 $492.53 $492.53 $492.53 $369.75 $492.53 $492.53 $492.53 $246.27 $246.27 $390.08 $492.53 $394.02 $221.64 $492.53 N/A $285.94 $492.53 $295.52 $492.53 $492.53 $492.53 N/A N/A ACU0T0.300 SUP HCPCS V2632 ACU0T0.300 - LENS IOL +30 DIOP STRL LF ACRSF ULTRASERT 1 PC FLD UV BLU BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A AD03 SUP Custom 27203010 AD03 - CHUCK DRL 1000 RPM MDSRX LGN JCB PRFR DRVR BOTH IP/OP "$7,528.50" "$5,571.00" "$1,340.00" "$7,528.10" "$7,528.10" "$7,528.10" "$7,528.10" "$7,528.10" "$7,528.10" "$7,528.10" "$1,340.00" "$7,528.10" "$7,528.10" "$4,181.12" "$4,181.12" "$5,802.66" "$2,060.15" "$1,568.94" "$7,528.10" "$3,011.24" "$7,528.10" "$7,528.10" "$7,528.10" "$7,528.10" "$7,528.10" "$5,646.38" "$7,528.10" "$7,528.10" "$7,528.10" "$3,764.05" "$3,764.05" "$5,962.26" "$7,528.10" "$6,022.48" "$4,893.27" "$7,528.10" N/A "$4,366.53" "$7,528.10" "$4,516.86" "$7,528.10" "$7,528.10" "$7,528.10" N/A N/A AD-5230 SUP HCPCS V2790 AD-5230 - GRAFT SFT TIS 3X2CM AMBIO2 DEHYDRATE ALGRF AMNIO MEMBR BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,562.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" "$1,562.50" $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A ADAPTADRK2 SUP HCPCS C2619 ADAPTADRK2 - PACEMAKER CARDIAC THK7.5MM 47.9X44.7MM IMPLTABLE 2 CHAMBER BOTH IP/OP "$8,355.00" "$6,183.00" "$1,741.27" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$1,741.27" "$8,355.00" "$3,342.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$6,266.25" "$8,355.00" "$8,355.00" "$8,355.00" "$4,177.50" "$4,177.50" "$6,617.16" "$8,355.00" "$6,684.00" "$3,759.75" "$8,355.00" N/A "$4,845.90" "$8,355.00" "$5,013.00" "$8,355.00" "$8,355.00" "$8,355.00" N/A N/A ADAPTALGDRK2 SUP HCPCS C2619 ADAPTALGDRK2 - KIT PCMKR LG ADAPTA 2 CHMBR 2 LD BOTH IP/OP "$8,355.00" "$6,183.00" "$1,741.27" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$1,741.27" "$8,355.00" "$3,342.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$8,355.00" "$6,266.25" "$8,355.00" "$8,355.00" "$8,355.00" "$4,177.50" "$4,177.50" "$6,617.16" "$8,355.00" "$6,684.00" "$3,759.75" "$8,355.00" N/A "$4,845.90" "$8,355.00" "$5,013.00" "$8,355.00" "$8,355.00" "$8,355.00" N/A N/A ADAPTASRK2 SUP HCPCS C2619 ADAPTASRK2 - PACEMAKER CARDIAC IMPLTABLE 1 CHAMBER RATE RESPONSIVE BOTH IP/OP "$6,382.50" "$4,723.00" "$1,330.18" "$6,382.50" "$6,382.50" "$6,382.50" "$6,382.50" "$6,382.50" "$6,382.50" "$6,382.50" "$6,382.50" "$6,382.50" "$6,382.50" "$6,382.50" "$6,382.50" "$6,382.50" "$6,382.50" "$1,330.18" "$6,382.50" "$2,553.00" "$6,382.50" "$6,382.50" "$6,382.50" "$6,382.50" "$6,382.50" "$4,786.88" "$6,382.50" "$6,382.50" "$6,382.50" "$3,191.25" "$3,191.25" "$5,054.94" "$6,382.50" "$5,106.00" "$2,872.13" "$6,382.50" N/A "$3,701.85" "$6,382.50" "$3,829.50" "$6,382.50" "$6,382.50" "$6,382.50" N/A N/A ADDR01 SUP HCPCS C1785 ADDR01 - PACEMAKER CRD 12.1CC ADAPTA DR 2 CHMBR IS-1 CNCT GNTR 27.1GM BOTH IP/OP "$6,370.00" "$4,714.00" "$1,264.29" "$6,370.00" "$2,866.50" "$2,866.50" "$2,866.50" "$2,866.50" "$6,370.00" "$6,370.00" "$6,370.00" "$1,327.67" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$1,327.58" "$6,370.00" "$6,370.00" "$3,140.41" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$4,777.50" "$6,370.00" "$6,370.00" "$6,370.00" "$3,185.00" "$3,185.00" "$5,045.04" "$6,370.00" "$5,096.00" "$2,866.50" "$1,264.29" N/A "$3,694.60" "$6,370.00" "$6,370.00" "$6,370.00" "$1,327.51" "$6,370.00" N/A N/A ADDRL1 SUP HCPCS C2619 ADDRL1 - PACEMAKER CARDIAC THK7.5MM 45.4X52.3MM 2 CHAMBER UNIPOLAR BOTH IP/OP "$6,370.00" "$4,714.00" "$1,327.58" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$1,327.58" "$6,370.00" "$2,548.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$4,777.50" "$6,370.00" "$6,370.00" "$6,370.00" "$3,185.00" "$3,185.00" "$5,045.04" "$6,370.00" "$5,096.00" "$2,866.50" "$6,370.00" N/A "$3,694.60" "$6,370.00" "$3,822.00" "$6,370.00" "$6,370.00" "$6,370.00" N/A N/A ADDRS1 SUP Custom 27203010 ADDRS1 - PACEMAKER CARDIAC THK7.5MM 42.9X44.7MM 2 CHAMBER UNIPOLAR BOTH IP/OP "$6,370.00" "$4,714.00" "$1,133.86" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$1,133.86" "$6,370.00" "$6,370.00" "$4,181.12" "$4,181.12" "$4,910.00" "$2,060.15" "$1,327.58" "$6,370.00" "$2,548.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$6,370.00" "$4,777.50" "$6,370.00" "$6,370.00" "$6,370.00" "$3,185.00" "$3,185.00" "$5,045.04" "$6,370.00" "$5,096.00" "$4,140.50" "$6,370.00" N/A "$3,694.60" "$6,370.00" "$3,822.00" "$6,370.00" "$6,370.00" "$6,370.00" N/A N/A ADP215790C SUP Custom 27011340 ADP215790C - KIT SURG PED BOTH IP/OP $30.00 $22.00 $5.29 $29.73 $29.73 $29.73 $29.73 $29.73 $29.73 $29.73 $5.29 $29.73 $29.73 $22.07 $22.07 $22.92 $15.49 $6.20 $29.73 $11.89 $29.73 $29.73 $29.73 $29.73 $29.73 $22.50 $29.73 $29.73 $29.73 $14.87 $14.87 $23.55 $29.73 $23.78 $19.32 $29.73 N/A $17.40 $29.73 $17.84 $29.73 $29.73 $29.73 N/A N/A ADS201844 SUP Custom 27203010 ADS201844 - SEALANT HEMOSTATIC NEEDLE FREE ADAPTER FLOSEAL MATRIX 5ML BOTH IP/OP $339.50 $251.00 $60.38 $339.22 $339.22 $339.22 $339.22 $339.22 $339.22 $339.22 $60.38 $339.22 $339.22 $251.77 $251.77 $261.47 $176.73 $70.70 $339.22 $135.69 $339.22 $339.22 $339.22 $339.22 $339.22 $254.63 $339.22 $339.22 $339.22 $169.61 $169.61 $268.66 $339.22 $271.38 $220.49 $339.22 N/A $196.91 $339.22 $203.53 $339.22 $339.22 $339.22 N/A N/A ADS201845 SUP Custom 27203010 ADS201845 - SEALANT HEMOSTATIC NEEDLE FREE ADAPTER FLOSEAL MATRIX 10ML BOTH IP/OP $621.00 $460.00 $110.47 $620.62 $620.62 $620.62 $620.62 $620.62 $620.62 $620.62 $110.47 $620.62 $620.62 $460.62 $460.62 $478.37 $323.34 $129.34 $620.62 $248.25 $620.62 $620.62 $620.62 $620.62 $620.62 $465.75 $620.62 $620.62 $620.62 $310.31 $310.31 $491.53 $620.62 $496.50 $403.40 $620.62 N/A $360.18 $620.62 $372.37 $620.62 $620.62 $620.62 N/A N/A AF02 SUP Custom 27203010 AF02 - ATTCH TL FT MDSRX LGN 2.4MM F2 BOTH IP/OP "$2,133.50" "$1,579.00" $379.69 "$2,133.10" "$2,133.10" "$2,133.10" "$2,133.10" "$2,133.10" "$2,133.10" "$2,133.10" $379.69 "$2,133.10" "$2,133.10" "$1,583.19" "$1,583.19" "$1,644.19" "$1,111.35" $444.56 "$2,133.10" $853.24 "$2,133.10" "$2,133.10" "$2,133.10" "$2,133.10" "$2,133.10" "$1,600.13" "$2,133.10" "$2,133.10" "$2,133.10" "$1,066.55" "$1,066.55" "$1,689.42" "$2,133.10" "$1,706.48" "$1,386.52" "$2,133.10" N/A "$1,237.43" "$2,133.10" "$1,279.86" "$2,133.10" "$2,133.10" "$2,133.10" N/A N/A AF101 SUP Custom 27011340 AF101 - HALTER TRACTION SHORT 28-38IN VEST SYSTEM EXFIX HALO AIRFLO BOTH IP/OP "$2,812.50" "$2,081.00" $500.63 "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" $500.63 "$2,812.50" "$2,812.50" "$2,087.44" "$2,087.44" "$2,167.88" "$1,465.31" $586.16 "$2,812.50" "$1,125.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,109.38" "$2,812.50" "$2,812.50" "$2,812.50" "$1,406.25" "$1,406.25" "$2,227.50" "$2,812.50" "$2,250.00" "$1,828.13" "$2,812.50" N/A "$1,631.25" "$2,812.50" "$1,687.50" "$2,812.50" "$2,812.50" "$2,812.50" N/A N/A AF-101 SUP Custom 27203010 AF-101 - HALTER TRC 28-38IN HALO AIRFLO SHRT HDNK VST SYS EXFIX BOTH IP/OP "$3,002.50" "$2,222.00" $534.38 "$3,002.13" "$3,002.13" "$3,002.13" "$3,002.13" "$3,002.13" "$3,002.13" "$3,002.13" $534.38 "$3,002.13" "$3,002.13" "$2,228.18" "$2,228.18" "$2,314.04" "$1,564.11" $625.68 "$3,002.13" "$1,200.85" "$3,002.13" "$3,002.13" "$3,002.13" "$3,002.13" "$3,002.13" "$2,251.88" "$3,002.13" "$3,002.13" "$3,002.13" "$1,501.07" "$1,501.07" "$2,377.69" "$3,002.13" "$2,401.70" "$1,951.38" "$3,002.13" N/A "$1,741.45" "$3,002.13" "$1,801.28" "$3,002.13" "$3,002.13" "$3,002.13" N/A N/A AF102 SUP Custom 27011340 AF102 - HALTER TRACTION LARGE 30-44IN VEST HALO BREMER AIRFLO HEAD BOTH IP/OP "$2,812.50" "$2,081.00" $500.63 "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" $500.63 "$2,812.50" "$2,812.50" "$2,087.44" "$2,087.44" "$2,167.88" "$1,465.31" $586.16 "$2,812.50" "$1,125.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,109.38" "$2,812.50" "$2,812.50" "$2,812.50" "$1,406.25" "$1,406.25" "$2,227.50" "$2,812.50" "$2,250.00" "$1,828.13" "$2,812.50" N/A "$1,631.25" "$2,812.50" "$1,687.50" "$2,812.50" "$2,812.50" "$2,812.50" N/A N/A AF-1230 SUP HCPCS V2790 AF-1230 - GRAFT SFT TIS THN 3X2CM OPQ AMBIODRY5 LTWT AMNIO MEMBR BOTH IP/OP "$1,687.50" "$1,249.00" $334.93 "$1,687.50" $759.38 $759.38 $759.38 $759.38 "$1,687.50" "$1,687.50" "$1,687.50" $351.72 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" $351.69 "$1,687.50" "$1,687.50" $998.16 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" $759.38 $334.93 N/A $978.75 "$1,687.50" "$1,687.50" "$1,687.50" $351.68 "$1,687.50" N/A N/A AFLEX100 SUP HCPCS Q4125 AFLEX100 - GRAFT SFT TIS THK1.5MM 35X35MM STRL ARTHROFLEX FLEXIGRAFT BOTH IP/OP "$5,942.50" "$4,397.00" "$1,238.48" "$5,942.50" "$5,942.50" "$5,942.50" "$5,942.50" "$5,942.50" "$5,942.50" "$5,942.50" "$5,942.50" "$5,942.50" "$5,942.50" "$5,942.50" "$5,942.50" "$5,942.50" "$5,942.50" "$1,238.48" "$5,942.50" "$2,619.00" "$5,942.50" "$5,942.50" "$5,942.50" "$5,942.50" "$5,942.50" "$4,456.88" "$5,942.50" "$5,942.50" "$5,942.50" "$2,971.25" "$2,971.25" "$4,706.46" "$5,942.50" "$4,754.00" "$2,674.13" "$5,942.50" N/A "$3,446.65" "$5,942.50" "$3,565.50" "$5,942.50" "$5,942.50" "$5,942.50" N/A N/A AFLEX101 SUP HCPCS Q4125 AFLEX101 - GRAFT SFT TIS THK1.5MM 40X70MM STRL MATRACELL ARTHROFLEX BOTH IP/OP "$7,065.00" "$5,228.00" "$1,472.42" "$7,065.00" "$7,065.00" "$7,065.00" "$7,065.00" "$7,065.00" "$7,065.00" "$7,065.00" "$7,065.00" "$7,065.00" "$7,065.00" "$7,065.00" "$7,065.00" "$7,065.00" "$7,065.00" "$1,472.42" "$7,065.00" "$3,113.64" "$7,065.00" "$7,065.00" "$7,065.00" "$7,065.00" "$7,065.00" "$5,298.75" "$7,065.00" "$7,065.00" "$7,065.00" "$3,532.50" "$3,532.50" "$5,595.48" "$7,065.00" "$5,652.00" "$3,179.25" "$7,065.00" N/A "$4,097.70" "$7,065.00" "$4,239.00" "$7,065.00" "$7,065.00" "$7,065.00" N/A N/A AFLEX103 SUP HCPCS Q4125 AFLEX103 - GRAFT SFT TIS THK1.5MM 90X50MM STRL MATRACELL ARTHROFLEX BOTH IP/OP "$9,502.50" "$7,032.00" "$1,980.43" "$9,502.50" "$9,502.50" "$9,502.50" "$9,502.50" "$9,502.50" "$9,502.50" "$9,502.50" "$9,502.50" "$9,502.50" "$9,502.50" "$9,502.50" "$9,502.50" "$9,502.50" "$9,502.50" "$1,980.43" "$9,502.50" "$4,187.16" "$9,502.50" "$9,502.50" "$9,502.50" "$9,502.50" "$9,502.50" "$7,126.88" "$9,502.50" "$9,502.50" "$9,502.50" "$4,751.25" "$4,751.25" "$7,525.98" "$9,502.50" "$7,602.00" "$4,276.13" "$9,502.50" N/A "$5,511.45" "$9,502.50" "$5,701.50" "$9,502.50" "$9,502.50" "$9,502.50" N/A N/A AFLEX150 SUP HCPCS Q4125 AFLEX150 - GRAFT SFT TIS THK1.5MM 140X15MM STRL MATRACELL ARTHROFLEX BOTH IP/OP "$5,360.00" "$3,966.00" "$1,117.08" "$5,360.00" "$5,360.00" "$5,360.00" "$5,360.00" "$5,360.00" "$5,360.00" "$5,360.00" "$5,360.00" "$5,360.00" "$5,360.00" "$5,360.00" "$5,360.00" "$5,360.00" "$5,360.00" "$1,117.08" "$5,360.00" "$2,361.96" "$5,360.00" "$5,360.00" "$5,360.00" "$5,360.00" "$5,360.00" "$4,020.00" "$5,360.00" "$5,360.00" "$5,360.00" "$2,680.00" "$2,680.00" "$4,245.12" "$5,360.00" "$4,288.00" "$2,412.00" "$5,360.00" N/A "$3,108.80" "$5,360.00" "$3,216.00" "$5,360.00" "$5,360.00" "$5,360.00" N/A N/A AFLEX200 SUP HCPCS Q4125 AFLEX200 - GRAFT SFT TIS THK2MM 35X35MM STRL MATRACELL ARTHROFLEX BOTH IP/OP "$7,932.50" "$5,870.00" "$1,653.22" "$7,932.50" "$7,932.50" "$7,932.50" "$7,932.50" "$7,932.50" "$7,932.50" "$7,932.50" "$7,932.50" "$7,932.50" "$7,932.50" "$7,932.50" "$7,932.50" "$7,932.50" "$7,932.50" "$1,653.22" "$7,932.50" "$3,426.84" "$7,932.50" "$7,932.50" "$7,932.50" "$7,932.50" "$7,932.50" "$5,949.38" "$7,932.50" "$7,932.50" "$7,932.50" "$3,966.25" "$3,966.25" "$6,282.54" "$7,932.50" "$6,346.00" "$3,569.63" "$7,932.50" N/A "$4,600.85" "$7,932.50" "$4,759.50" "$7,932.50" "$7,932.50" "$7,932.50" N/A N/A AFLEX201 SUP HCPCS Q4125 AFLEX201 - GRAFT SFT TIS THK2MM 70X40MM STRL MATRACELL ARTHROFLEX BOTH IP/OP "$9,505.00" "$7,034.00" "$1,980.95" "$9,505.00" "$9,505.00" "$9,505.00" "$9,505.00" "$9,505.00" "$9,505.00" "$9,505.00" "$9,505.00" "$9,505.00" "$9,505.00" "$9,505.00" "$9,505.00" "$9,505.00" "$9,505.00" "$1,980.95" "$9,505.00" "$4,106.16" "$9,505.00" "$9,505.00" "$9,505.00" "$9,505.00" "$9,505.00" "$7,128.75" "$9,505.00" "$9,505.00" "$9,505.00" "$4,752.50" "$4,752.50" "$7,527.96" "$9,505.00" "$7,604.00" "$4,277.25" "$9,505.00" N/A "$5,512.90" "$9,505.00" "$5,703.00" "$9,505.00" "$9,505.00" "$9,505.00" N/A N/A AFLEX301 SUP HCPCS Q4125 AFLEX301 - GRAFT SFT TIS THK3MM 70X40MM DECELLULARIZE DERM BOTH IP/OP "$9,965.00" "$7,374.00" "$2,076.82" "$9,965.00" "$9,965.00" "$9,965.00" "$9,965.00" "$9,965.00" "$9,965.00" "$9,965.00" "$9,965.00" "$9,965.00" "$9,965.00" "$9,965.00" "$9,965.00" "$9,965.00" "$9,965.00" "$2,076.82" "$9,965.00" "$4,304.88" "$9,965.00" "$9,965.00" "$9,965.00" "$9,965.00" "$9,965.00" "$7,473.75" "$9,965.00" "$9,965.00" "$9,965.00" "$4,982.50" "$4,982.50" "$7,892.28" "$9,965.00" "$7,972.00" "$4,484.25" "$9,965.00" N/A "$5,779.70" "$9,965.00" "$5,979.00" "$9,965.00" "$9,965.00" "$9,965.00" N/A N/A AFLEX400 SUP HCPCS Q4125 AFLEX400 - GRAFT SFT TIS 40X40X1MM DECELLUARIZE DERM BOTH IP/OP "$5,495.00" "$4,066.00" "$1,145.22" "$5,495.00" "$5,495.00" "$5,495.00" "$5,495.00" "$5,495.00" "$5,495.00" "$5,495.00" "$5,495.00" "$5,495.00" "$5,495.00" "$5,495.00" "$5,495.00" "$5,495.00" "$5,495.00" "$1,145.22" "$5,495.00" "$2,421.36" "$5,495.00" "$5,495.00" "$5,495.00" "$5,495.00" "$5,495.00" "$4,121.25" "$5,495.00" "$5,495.00" "$5,495.00" "$2,747.50" "$2,747.50" "$4,352.04" "$5,495.00" "$4,396.00" "$2,472.75" "$5,495.00" N/A "$3,187.10" "$5,495.00" "$3,297.00" "$5,495.00" "$5,495.00" "$5,495.00" N/A N/A AFLEX401 SUP HCPCS Q4125 AFLEX401 - GRAFT SFT TIS 70X40X1MM DECELLULARIZE DERM BOTH IP/OP "$6,700.00" "$4,958.00" "$1,396.35" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$1,396.35" "$6,700.00" "$2,952.72" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$5,025.00" "$6,700.00" "$6,700.00" "$6,700.00" "$3,350.00" "$3,350.00" "$5,306.40" "$6,700.00" "$5,360.00" "$3,015.00" "$6,700.00" N/A "$3,886.00" "$6,700.00" "$4,020.00" "$6,700.00" "$6,700.00" "$6,700.00" N/A N/A AFLEX500 SUP HCPCS Q4125 AFLEX500 - GRAFT SFT TIS THK.5MM 40X30MM DECELLULARIZE DERM BOTH IP/OP "$3,107.50" "$2,300.00" $647.64 "$3,107.50" "$3,107.50" "$3,107.50" "$3,107.50" "$3,107.50" "$3,107.50" "$3,107.50" "$3,107.50" "$3,107.50" "$3,107.50" "$3,107.50" "$3,107.50" "$3,107.50" "$3,107.50" $647.64 "$3,107.50" "$1,369.44" "$3,107.50" "$3,107.50" "$3,107.50" "$3,107.50" "$3,107.50" "$2,330.63" "$3,107.50" "$3,107.50" "$3,107.50" "$1,553.75" "$1,553.75" "$2,461.14" "$3,107.50" "$2,486.00" "$1,398.38" "$3,107.50" N/A "$1,802.35" "$3,107.50" "$1,864.50" "$3,107.50" "$3,107.50" "$3,107.50" N/A N/A AG0340 SUP HCPCS C1763 AG0340 - PROTECTOR NERVE 3.5MM 40MM REINFORCED WRAP AXOGUARD PIG BOTH IP/OP "$5,787.50" "$4,283.00" "$1,148.67" "$6,200.00" "$2,604.38" "$2,604.38" "$2,604.38" "$2,604.38" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.26" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.18" "$5,787.50" "$6,200.00" "$2,853.24" "$5,787.50" "$6,020.00" "$5,787.50" "$5,787.50" "$4,340.63" "$5,787.50" "$5,787.50" "$5,787.50" "$2,893.75" "$2,893.75" "$4,583.70" "$5,787.50" "$4,630.00" "$2,604.38" "$1,148.67" N/A "$3,356.75" "$5,787.50" "$5,787.50" "$5,787.50" "$1,206.12" "$5,787.50" N/A N/A AG0740 SUP HCPCS C1763 AG0740 - PROTECTOR TISSUE 7MM 40MM AXOGUARD PIG EXTRACELLULAR MATRIX BOTH IP/OP "$5,935.00" "$4,392.00" "$1,177.95" "$6,357.50" "$2,670.75" "$2,670.75" "$2,670.75" "$2,670.75" "$5,935.00" "$5,935.00" "$5,935.00" "$1,237.00" "$5,935.00" "$5,935.00" "$5,935.00" "$5,935.00" "$5,935.00" "$1,236.92" "$5,935.00" "$6,357.50" "$2,925.96" "$5,935.00" "$6,172.50" "$5,935.00" "$5,935.00" "$4,451.25" "$5,935.00" "$5,935.00" "$5,935.00" "$2,967.50" "$2,967.50" "$4,700.52" "$5,935.00" "$4,748.00" "$2,670.75" "$1,177.95" N/A "$3,442.30" "$5,935.00" "$5,935.00" "$5,935.00" "$1,236.85" "$5,935.00" N/A N/A AG1040 SUP HCPCS C1763 AG1040 - PROTECTOR NERVE 10MM 40MM MULTILAMINAR AXOGUARD BOTH IP/OP "$5,935.00" "$4,392.00" "$1,177.95" "$6,357.50" "$2,670.75" "$2,670.75" "$2,670.75" "$2,670.75" "$5,935.00" "$5,935.00" "$5,935.00" "$1,237.00" "$5,935.00" "$5,935.00" "$5,935.00" "$5,935.00" "$5,935.00" "$1,236.92" "$5,935.00" "$6,357.50" "$2,925.96" "$5,935.00" "$6,172.50" "$5,935.00" "$5,935.00" "$4,451.25" "$5,935.00" "$5,935.00" "$5,935.00" "$2,967.50" "$2,967.50" "$4,700.52" "$5,935.00" "$4,748.00" "$2,670.75" "$1,177.95" N/A "$3,442.30" "$5,935.00" "$5,935.00" "$5,935.00" "$1,236.85" "$5,935.00" N/A N/A AG-2015 SUP HCPCS V2790 AG-2015 - GRAFT SOFT TISSUE B THK50-100UM 2X1.5IN ALLOGRAFT BOTH IP/OP "$1,722.50" "$1,275.00" $341.87 "$1,722.50" $775.13 $775.13 $775.13 $775.13 "$1,722.50" "$1,722.50" "$1,722.50" $359.01 "$1,722.50" "$1,722.50" "$1,722.50" "$1,722.50" "$1,722.50" $358.99 "$1,722.50" "$1,722.50" "$1,018.86" "$1,722.50" "$1,722.50" "$1,722.50" "$1,722.50" "$1,291.88" "$1,722.50" "$1,722.50" "$1,722.50" $861.25 $861.25 "$1,364.22" "$1,722.50" "$1,378.00" $775.13 $341.87 N/A $999.05 "$1,722.50" "$1,722.50" "$1,722.50" $358.97 "$1,722.50" N/A N/A AGX215 SUP HCPCS C1763 AGX215 - CONNECTOR NERVE 2MM 15MM COAPTATION AID AXOGUARD PIG BOTH IP/OP "$3,730.00" "$2,760.00" $740.31 "$4,035.00" "$1,678.50" "$1,678.50" "$1,678.50" "$1,678.50" "$3,730.00" "$3,730.00" "$3,730.00" $777.43 "$3,730.00" "$3,730.00" "$3,730.00" "$3,730.00" "$3,730.00" $777.37 "$3,730.00" "$4,035.00" "$1,838.89" "$3,730.00" "$3,880.00" "$3,730.00" "$3,730.00" "$2,797.50" "$3,730.00" "$3,730.00" "$3,730.00" "$1,865.00" "$1,865.00" "$2,954.16" "$3,730.00" "$2,984.00" "$1,678.50" $740.31 N/A "$2,163.40" "$3,730.00" "$3,730.00" "$3,730.00" $777.33 "$3,730.00" N/A N/A AGX310 SUP HCPCS C1763 AGX310 - CONNECTOR NERVE 3MM 10MM COAPTATION AID AXOGUARD PIG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,760.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,760.00" "$1,478.75" "$2,500.00" "$2,680.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AGX415 SUP HCPCS C1763 AGX415 - CONNECTOR NERVE 4MM 15MM COAPTATION AID AXOGUARD PIG BOTH IP/OP "$3,587.50" "$2,655.00" $712.03 "$4,035.00" "$1,614.38" "$1,614.38" "$1,614.38" "$1,614.38" "$3,587.50" "$3,587.50" "$3,587.50" $747.72 "$3,587.50" "$3,587.50" "$3,587.50" "$3,587.50" "$3,587.50" $747.67 "$3,587.50" "$4,035.00" "$1,768.64" "$3,587.50" "$3,880.00" "$3,587.50" "$3,587.50" "$2,690.63" "$3,587.50" "$3,587.50" "$3,587.50" "$1,793.75" "$1,793.75" "$2,841.30" "$3,587.50" "$2,870.00" "$1,614.38" $712.03 N/A "$2,080.75" "$3,587.50" "$3,587.50" "$3,587.50" $747.64 "$3,587.50" N/A N/A AGX515 SUP HCPCS C1763 AGX515 - CONNECTOR NERVE 5MM 15MM COAPTATION AID AXOGUARD PIG BOTH IP/OP "$3,730.00" "$2,760.00" $740.31 "$4,035.00" "$1,678.50" "$1,678.50" "$1,678.50" "$1,678.50" "$3,730.00" "$3,730.00" "$3,730.00" $777.43 "$3,730.00" "$3,730.00" "$3,730.00" "$3,730.00" "$3,730.00" $777.37 "$3,730.00" "$4,035.00" "$1,838.89" "$3,730.00" "$3,880.00" "$3,730.00" "$3,730.00" "$2,797.50" "$3,730.00" "$3,730.00" "$3,730.00" "$1,865.00" "$1,865.00" "$2,954.16" "$3,730.00" "$2,984.00" "$1,678.50" $740.31 N/A "$2,163.40" "$3,730.00" "$3,730.00" "$3,730.00" $777.33 "$3,730.00" N/A N/A AGX615 SUP HCPCS C1763 AGX615 - CONNECTOR NRV 6MM 15MM STRL AXOGUARD COAPTATION AID PRCN BOTH IP/OP "$3,730.00" "$2,760.00" $740.31 "$4,035.00" "$1,678.50" "$1,678.50" "$1,678.50" "$1,678.50" "$3,730.00" "$3,730.00" "$3,730.00" $777.43 "$3,730.00" "$3,730.00" "$3,730.00" "$3,730.00" "$3,730.00" $777.37 "$3,730.00" "$4,035.00" "$1,838.89" "$3,730.00" "$3,880.00" "$3,730.00" "$3,730.00" "$2,797.50" "$3,730.00" "$3,730.00" "$3,730.00" "$1,865.00" "$1,865.00" "$2,954.16" "$3,730.00" "$2,984.00" "$1,678.50" $740.31 N/A "$2,163.40" "$3,730.00" "$3,730.00" "$3,730.00" $777.33 "$3,730.00" N/A N/A AGX715 SUP HCPCS C1763 AGX715 - CONNECTOR NRV 7MM 15MM STRL AXOGUARD COAPTATION AID PRCN BOTH IP/OP "$3,450.00" "$2,553.00" $684.74 "$4,035.00" "$1,552.50" "$1,552.50" "$1,552.50" "$1,552.50" "$3,450.00" "$3,450.00" "$3,450.00" $719.07 "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" "$3,450.00" $719.02 "$3,450.00" "$4,035.00" "$1,700.85" "$3,450.00" "$3,880.00" "$3,450.00" "$3,450.00" "$2,587.50" "$3,450.00" "$3,450.00" "$3,450.00" "$1,725.00" "$1,725.00" "$2,732.40" "$3,450.00" "$2,760.00" "$1,552.50" $684.74 N/A "$2,001.00" "$3,450.00" "$3,450.00" "$3,450.00" $718.98 "$3,450.00" N/A N/A AI-0010-S SUP HCPCS C1713 AI-0010-S - SCREW BONE 10MM COMPRESSION ACUTWIST ACUTRAK CALCANEAL BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AI-0012-S SUP HCPCS C1713 AI-0012-S - SCREW BONE 12MM COMPRESSION VARIABLE THREAD PITCH BREAK OFF BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AI-0014-S SUP HCPCS C1713 AI-0014-S - SCREW BONE FULTHD TAPER 14MM COMPRESSION ACUTWIST ACUTRAK BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $148.49 $712.50 N/A N/A AI-0016 SUP HCPCS C1713 AI-0016 - SCREW BONE 16MM ACUTWIST TI ORTH CMPR NONSTRL BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AI-0016-S SUP HCPCS C1713 AI-0016-S - SCREW BONE FULTHD TAPER 16MM COMPRESSION ACUTWIST ACUTRAK BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $148.49 $712.50 N/A N/A AI-0018-S SUP HCPCS C1713 AI-0018-S - SCREW BONE FULTHD TAPER 18MM COMPRESSION ACUTWIST ACUTRAK BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $148.49 $712.50 N/A N/A AI-0020 SUP HCPCS C1713 AI-0020 - SCREW BONE FULTHD TAPER 20MM COMPRESSION ACUTWIST ACUTRAK BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $148.49 $712.50 N/A N/A AI-0020-S SUP HCPCS C1713 AI-0020-S - SCREW BONE FULTHD TAPER 20MM COMPRESSION ACUTWIST ACUTRAK BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $148.49 $712.50 N/A N/A AI-0022-S SUP HCPCS C1713 AI-0022-S - SCREW BONE FULTHD TAPER 22MM COMPRESSION ACUTWIST ACUTRAK BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $148.49 $712.50 N/A N/A AI-0024 SUP HCPCS C1713 AI-0024 - SCREW BONE 24MM ACUTWIST TI ORTH NONSTRL BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AI-0024-S SUP HCPCS C1713 AI-0024-S - SCREW BONE FULTHD TAPER 24MM COMPRESSION ACUTWIST ACUTRAK BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $148.49 $712.50 N/A N/A AI-0026 SUP HCPCS C1713 AI-0026 - SCREW BONE 26MM ACTRK ACUTWIST CMPR NONSTRL BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AI-0026-S SUP HCPCS C1713 AI-0026-S - SCREW BONE FULTHD TAPER 26MM COMPRESSION ACUTWIST ACUTRAK BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $712.50 $712.50 N/A N/A AI-0028-S SUP HCPCS C1713 AI-0028-S - SCREW BONE FULTHD TAPER 28MM COMPRESSION ACUTWIST ACUTRAK BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $148.49 $712.50 N/A N/A AI-0030-S SUP HCPCS C1713 AI-0030-S - SCREW BONE FULTHD TAPER 30MM COMPRESSION ACUTWIST ACUTRAK BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $712.50 $712.50 N/A N/A AI-EX20 SUP HCPCS C1713 AI-EX20 - EXTRACTOR SURG TOOL ACUTRAK BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AI-NG30 SUP HCPCS C1713 AI-NG30 - TAP BONE ACUTWIST ACUTRAK BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $217.50 $217.50 $45.33 $217.50 N/A N/A AK-01000 SUP Custom 27203010 AK-01000 - KIT THORACENTESIS 8FR 22GA 7.5IN 1.5IN 3 WAY STOPCOCK BOTH IP/OP $140.00 $104.00 $24.92 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $140.00 $24.92 $140.00 $140.00 $103.91 $103.91 $107.91 $72.94 $29.18 $140.00 $56.00 $140.00 $140.00 $140.00 $140.00 $140.00 $105.00 $140.00 $140.00 $140.00 $70.00 $70.00 $110.88 $140.00 $112.00 $91.00 $140.00 N/A $81.20 $140.00 $84.00 $140.00 $140.00 $140.00 N/A N/A AK-04212 SUP HCPCS C1751 AK-04212 - KIT CATHETER .032IN 16GA 18GA 20CM 2.5IN CATHETER GWIRE BOTH IP/OP $42.00 $31.00 $8.28 $41.70 $22.64 $22.64 $22.64 $22.64 $41.70 $41.70 $41.70 $8.69 $41.70 $30.95 $30.95 $32.14 $21.73 $8.69 $41.70 $41.70 $24.67 $41.70 $41.70 $41.70 $41.70 $31.50 $41.70 $41.70 $41.70 $20.85 $20.85 $33.03 $41.70 $33.36 $27.11 $8.28 N/A $24.36 $41.70 $41.70 $41.70 $8.69 $41.70 N/A N/A AK-09000 SUP HCPCS C1729 AK-09000 - KIT PERITONEAL LAVAGE .035IN 8FR 18GA 9.25IN 17.75IN BOTH IP/OP $58.50 $43.00 $11.52 $58.50 $31.50 $31.50 $31.50 $31.50 $58.02 $58.02 $58.02 $12.09 $58.02 $43.06 $43.06 $44.72 $30.23 $12.09 $58.02 $58.50 $34.32 $58.02 $58.50 $58.02 $58.02 $43.88 $58.02 $58.02 $58.02 $29.01 $29.01 $45.95 $58.02 $46.42 $37.71 $11.52 N/A $33.93 $58.02 $58.02 $58.02 $12.09 $58.02 N/A N/A AK-15703-ASP SUP Custom 27203010 TRAY CATH 7FR 8IN CEN VEN A-H BL FLX 3 LUM RADIOPQ SPRG BOTH IP/OP $131.50 $97.00 $23.33 $131.08 $131.08 $131.08 $131.08 $131.08 $131.08 $131.08 $23.33 $131.08 $131.08 $97.29 $97.29 $101.04 $68.29 $27.32 $131.08 $52.43 $131.08 $131.08 $131.08 $131.08 $131.08 $98.63 $131.08 $131.08 $131.08 $65.54 $65.54 $103.82 $131.08 $104.86 $85.20 $131.08 N/A $76.27 $131.08 $78.65 $131.08 $131.08 $131.08 N/A N/A AK-16553 SUP HCPCS C1769 KIT PED 5 1/8IN 5.5FR .018IN 3 LUM RADIOPQ SPRG GUIDEWIRE BOTH IP/OP $127.00 $94.00 $25.18 $126.85 $68.88 $68.88 $68.88 $68.88 $126.85 $126.85 $126.85 $26.44 $126.85 $94.15 $94.15 $97.78 $66.09 $26.44 $126.85 $126.85 $75.03 $126.85 $126.85 $126.85 $126.85 $95.25 $126.85 $126.85 $126.85 $63.43 $63.43 $100.47 $126.85 $101.48 $82.45 $25.18 N/A $73.66 $126.85 $126.85 $126.85 $26.44 $126.85 N/A N/A AK-24703-A SUP HCPCS C1729 CATHETER KIT CENTRAL VENOUS ARROWGUARD 7FR X 12IN MULTI LUM BOTH IP/OP $960.00 $710.00 $190.54 $960.00 $521.28 $521.28 $521.28 $521.28 $960.00 $960.00 $960.00 $200.09 $960.00 $712.51 $712.51 $739.97 $500.16 $200.07 $960.00 $960.00 $567.84 $960.00 $960.00 $960.00 $960.00 $720.00 $960.00 $960.00 $960.00 $480.00 $480.00 $760.32 $960.00 $768.00 $624.00 $190.54 N/A $556.80 $960.00 $960.00 $960.00 $200.06 $960.00 N/A N/A AM-0025-S SUP HCPCS C1713 AM-0025-S - SCREW BONE FULTHD TAPER 4-5MM 25MM SELF TAP CANN VARIABLE BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AM-0030-S SUP HCPCS C1713 AM-0030-S - SCREW BONE FULTHD TAPER 4-5MM 30MM SELF TAP CANN VARIABLE BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AM-0035-S SUP HCPCS C1713 AM-0035-S - SCREW BONE FULTHD TAPER 4-5MM 35MM SELF TAP CANN VARIABLE BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $376.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AM-0040-S SUP HCPCS C1713 AM-0040-S - SCREW BONE FULTHD TAPER 4-5MM 40MM SELF TAP CANN VARIABLE BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $376.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AM-0045-S SUP HCPCS C1713 AM-0045-S - SCREW BN FT 4-5MM 45MM STRL ACTRK ST CNN CMPR HDLS TPR TI BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $376.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AM-0050-S SUP HCPCS C1713 AM-0050-S - SCREW BONE FULTHD TAPER 4-5MM 50MM SELF TAP CANN VARIABLE BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AM-5010 SUP Custom 27203010 AM-5010 - DRILL SURG STANDARD 4/5MM CANN ACUTRAK NONSTRL BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A AM-5014 SUP Custom 27203010 AM-5014 - DRILL SRG 4/5MM ACTRK DNS CNN BN BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A AMP225210152 SUP HCPCS C1725 AMP225210152 - CATHETER BLNDIL 2-2.5MM 150CM 210MM AM DP OTW LOPRFL TPR BRD BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $536.21 $536.21 $536.21 $536.21 $987.50 $987.50 $987.50 $205.82 $987.50 $732.92 $732.92 $761.17 $514.49 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $641.88 $195.99 N/A $572.75 $987.50 $987.50 $987.50 $205.80 $987.50 N/A N/A AM-TA25 SUP HCPCS C1713 AM-TA25 - SCREW BONE 25MM ACTRK 4/5 FT ANKL TPR NONSTRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $140.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A AN-11 SUP Custom 27203010 AN-11 - TUBE NASOGASTRIC 10FR 1.22MR 24 PORT VENTED VINYL PEDIATRIC BOTH IP/OP $41.00 $30.00 $7.22 $40.58 $40.58 $40.58 $40.58 $40.58 $40.58 $40.58 $7.22 $40.58 $40.58 $30.12 $30.12 $31.28 $21.14 $8.46 $40.58 $16.23 $40.58 $40.58 $40.58 $40.58 $40.58 $30.75 $40.58 $40.58 $40.58 $20.29 $20.29 $32.14 $40.58 $32.46 $26.38 $40.58 N/A $23.78 $40.58 $24.35 $40.58 $40.58 $40.58 N/A N/A AP-0035-S SUP HCPCS C1713 AP-0035-S - SCREW BONE FULTHD HEXAGON 5/6.5MM 35MM SELF TAP CANN FIX BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AP-0040-S SUP HCPCS C1713 AP-0040-S - SCREW BONE FULTHD HEXAGON 5/6.5MM 40MM SELF TAP CANN FIX BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AP-0045-S SUP HCPCS C1713 AP-0045-S - SCREW BONE FULTHD 45MM SLFTAP CANN FIX TAPERED ACUTRAK PLUS BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $376.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-0050-S SUP HCPCS C1713 AP-0050-S - SCREW BONE FULTHD HEXAGON 5/6.5MM 50MM SELF TAP CANN FIX BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-0055-S SUP HCPCS C1713 AP-0055-S - SCREW BONE FULTHD HEXAGON 5/6.5MM 55MM SELF TAP CANN FIX BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-0060-S SUP HCPCS C1713 AP-0060-S - SCREW BONE FULTHD HEXAGON 5/6.5MM 60MM SELF TAP CANN FIX BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AP-0065-S SUP HCPCS C1713 AP-0065-S - SCREW BONE 65MM CANN ACUTRAK PLUS TITANIUM CORTICAL STERILE BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $376.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-0070-S SUP HCPCS C1713 AP-0070-S - SCREW BONE FULTHD HEXAGON 5/6.5MM 70MM SELF TAP CANN FIX BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AP-0075-S SUP HCPCS C1713 AP-0075-S - SCREW BONE FULTHD HEXAGON 5/6.5MM 75MM SELF TAP CANN FIX BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-0080-S SUP HCPCS C1713 AP-0080-S - SCREW BONE 80MM CANN ACUTRAK PLUS TITANIUM CORTICAL STERILE BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AP-010 SUP Custom 27203010 AP-010 - BIT DRILL CANN BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AP-0100 SUP Custom 27203010 AP-0100 - DRILL SURG TAPER CANN ACUTRAK PLUS TITANIUM BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A AP-0104 SUP Custom 27203010 AP-0104 - DRILL SRG ACTRK+ DNS BN BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A AP-0110 SUP Custom 27203010 AP-0110 - BIT DRL NS ACTRK+ CNN GRV SPNE BOTH IP/OP $785.00 $581.00 $139.73 $785.00 $785.00 $785.00 $785.00 $785.00 $785.00 $785.00 $139.73 $785.00 $785.00 $582.63 $582.63 $605.08 $408.99 $163.60 $785.00 $314.00 $785.00 $785.00 $785.00 $785.00 $785.00 $588.75 $785.00 $785.00 $785.00 $392.50 $392.50 $621.72 $785.00 $628.00 $510.25 $785.00 N/A $455.30 $785.00 $471.00 $785.00 $785.00 $785.00 N/A N/A AP-67008 SUP Custom 27203010 AP-67008 - DEVICE REM 4MM SCR BOTH IP/OP $747.50 $553.00 $133.06 $747.50 $747.50 $747.50 $747.50 $747.50 $747.50 $747.50 $133.06 $747.50 $747.50 $554.79 $554.79 $576.17 $389.45 $155.79 $747.50 $299.00 $747.50 $747.50 $747.50 $747.50 $747.50 $560.63 $747.50 $747.50 $747.50 $373.75 $373.75 $592.02 $747.50 $598.00 $485.88 $747.50 N/A $433.55 $747.50 $448.50 $747.50 $747.50 $747.50 N/A N/A AP-67011 SUP Custom 27203010 AP-67011 - DRILL SURG SMALL 6-7MM 40-120MM CANN ACUTRAK TITANIUM BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A AP-67012 SUP Custom 27203010 AP-67012 - DRILL SURG MEDIUM 70-85MM 70-85MM CANN ACUTRAK TITANIUM BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A AP-67013 SUP Custom 27203010 AP-67013 - DRILL SURG LARGE 90-120MM 90-120MM CANN ACUTRAK TITANIUM 6/7 BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A AP-67014 SUP Custom 27203010 AP-67014 - BIT DRILL SMALL 6MM 7MM 40-65MM CANN DENSE ACUTRAK STERILE BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A AP-67015 SUP Custom 27203010 AP-67015 - DRILL SURG MEDIUM 70-85MM 70-85MM CANN DENSE ACUTRAK BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A AP-67016 SUP Custom 27203010 AP-67016 - DRILL SURG LONG 90-120MM 40-120MM CANN DENSE ACUTRAK BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A AP-67100-S SUP HCPCS C1713 AP-67100-S - SCREW BONE .094IN 6/7MM 4MM 100MM FIX ACUTRAK TITANIUM FEMUR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $376.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-67105-S SUP HCPCS C1713 AP-67105-S - SCREW BONE .094IN 6/7MM 4MM 105MM FIX ACUTRAK TITANIUM FEMUR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $376.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-67110-S SUP HCPCS C1713 AP-67110-S - SCREW BONE .094IN 6/7MM 4MM 110MM FIX ACUTRAK TITANIUM FEMUR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AP-67115-S SUP HCPCS C1713 AP-67115-S - SCREW BONE STANDARD FULTHD TAPER 6-7MM 4MM 115MM FIX ACUTRAK BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AP-67120-S SUP HCPCS C1713 AP-67120-S - SCREW BONE STANDARD FULTHD TAPER 6-7MM 4MM 120MM FIX ACUTRAK BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AP-6740-S SUP HCPCS C1713 AP-6740-S - SCREW BONE .094IN 6/7MM 4MM 40MM FIX ACUTRAK TITANIUM FEMUR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-6745-S SUP HCPCS C1713 AP-6745-S - SCREW BONE .094IN 6/7MM 45MM FIX ACUTRAK TITANIUM FEMUR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-6750-S SUP HCPCS C1713 AP-6750-S - SCREW BONE .094IN 6/7MM 4MM 50MM FIX ACUTRAK TITANIUM FEMUR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AP-6755-S SUP HCPCS C1713 AP-6755-S - SCREW BONE .094IN 6/7MM 4MM 55MM FIX ACUTRAK TITANIUM FEMUR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AP-6760-S SUP HCPCS C1713 AP-6760-S - SCREW BONE .094IN 6/7MM 4MM 60MM FIX ACUTRAK TITANIUM FEMUR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-6765-S SUP HCPCS C1713 AP-6765-S - SCREW BONE 6/7MM 65MM FIX ACUTRAK TITANIUM ORTHOPEDIC BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-6770-S SUP HCPCS C1713 AP-6770-S - SCREW BONE .094IN 6/7MM 4MM 70MM FIX ACUTRAK TITANIUM FEMUR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AP-6775-S SUP HCPCS C1713 AP-6775-S - SCREW BONE .094IN 6/7MM 4MM 75MM FIX ACUTRAK TITANIUM FEMUR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-6780-S SUP HCPCS C1713 AP-6780-S - SCREW BN .094IN 6/7MM 4MM 80MM STRL ACTRK FX TI BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-6785-S SUP HCPCS C1713 AP-6785-S - SCREW BONE .094IN 6/7MM 4MM 85MM FIX ACUTRAK TITANIUM FEMUR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-6790-S SUP HCPCS C1713 AP-6790-S - SCREW BONE .094IN 6/7MM 4MM 90MM FIX ACUTRAK TITANIUM FEMUR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AP-6795-S SUP HCPCS C1713 AP-6795-S - SCREW BONE .094IN 6/7MM 4MM 95MM FIX ACUTRAK TITANIUM FEMUR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AQL-110 SUP Custom 27203010 AQL-110 - SET TBG AQUILEX FL CNTRL INFL BOTH IP/OP $397.50 $294.00 $70.76 $397.50 $397.50 $397.50 $397.50 $397.50 $397.50 $397.50 $70.76 $397.50 $397.50 $295.02 $295.02 $306.39 $207.10 $82.84 $397.50 $159.00 $397.50 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $258.38 $397.50 N/A $230.55 $397.50 $238.50 $397.50 $397.50 $397.50 N/A N/A AQL-111 SUP Custom 27203010 AQL-111 - SET TBG AQUILEX FL CNTRL OFLW BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $231.94 $231.94 $240.88 $162.81 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $203.13 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A AR-005-AC00 SUP Custom 27203010 AR-005-AC00 - CLAMP XTRNFX IBALANCE ANKL UNCNDL KN ARTHOPLASTY BOTH IP/OP "$1,700.00" "$1,258.00" $302.60 "$1,700.00" "$1,700.00" "$1,700.00" "$1,700.00" "$1,700.00" "$1,700.00" "$1,700.00" $302.60 "$1,700.00" "$1,700.00" "$1,261.74" "$1,261.74" "$1,310.36" $885.70 $354.30 "$1,700.00" $680.00 "$1,700.00" "$1,700.00" "$1,700.00" "$1,700.00" "$1,700.00" "$1,275.00" "$1,700.00" "$1,700.00" "$1,700.00" $850.00 $850.00 "$1,346.40" "$1,700.00" "$1,360.00" "$1,105.00" "$1,700.00" N/A $986.00 "$1,700.00" "$1,020.00" "$1,700.00" "$1,700.00" "$1,700.00" N/A N/A AR-1000 SUP Custom 27203010 AR-1000 - PASSER SUT TRANSOSSEOUS BOTH IP/OP $162.50 $120.00 $28.93 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $28.93 $162.50 $162.50 $120.61 $120.61 $125.26 $84.66 $33.87 $162.50 $65.00 $162.50 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $105.63 $162.50 N/A $94.25 $162.50 $97.50 $162.50 $162.50 $162.50 N/A N/A AR-1006 SUP HCPCS C1713 AR-1006 - STAPLE BN SPK 20X6MM STRL COCR ACL PCL BOTH IP/OP $197.50 $146.00 $39.20 $197.50 $88.88 $88.88 $88.88 $88.88 $197.50 $197.50 $197.50 $41.16 $197.50 $197.50 $197.50 $197.50 $197.50 $41.16 $197.50 $197.50 $116.82 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $88.88 $39.20 N/A $114.55 $197.50 $118.50 $197.50 $41.16 $197.50 N/A N/A AR-1006M SUP HCPCS C1713 AR-1006M - STAPLE BN 20X6MM STRL COCR ACL PCL BOTH IP/OP $197.50 $146.00 $39.20 $197.50 $88.88 $88.88 $88.88 $88.88 $197.50 $197.50 $197.50 $41.16 $197.50 $197.50 $197.50 $197.50 $197.50 $41.16 $197.50 $197.50 $116.82 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $88.88 $39.20 N/A $114.55 $197.50 $118.50 $197.50 $41.16 $197.50 N/A N/A AR-1006MNS SUP Custom 27803010 AR-1006MNS - STAPLE BN 20X6MM NS COCR ACL PCL BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $41.16 $197.50 $79.00 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $88.88 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-1006NS SUP Custom 27803010 AR-1006NS - STAPLE BN SPK 20X6MM NS COCR ACL PCL BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $41.16 $197.50 $79.00 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $88.88 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-1008 SUP HCPCS C1713 AR-1008 - STAPLE BN SPK 20X8MM STRL LOPRFL LGMNT COCR ACL PCL BOTH IP/OP $197.50 $146.00 $39.20 $197.50 $88.88 $88.88 $88.88 $88.88 $197.50 $197.50 $197.50 $41.16 $197.50 $197.50 $197.50 $197.50 $197.50 $41.16 $197.50 $197.50 $116.82 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $88.88 $39.20 N/A $114.55 $197.50 $118.50 $197.50 $41.16 $197.50 N/A N/A AR-1008NS SUP Custom 27803010 AR-1008NS - STAPLE BN SPK 20X8MM NS COCR ACL PCL BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $41.16 $197.50 $79.00 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $88.88 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-1011 SUP HCPCS C1713 AR-1011 - STAPLE BN SPK 20X11MM STRL COCR ACL PCL BOTH IP/OP $197.50 $146.00 $39.20 $197.50 $88.88 $88.88 $88.88 $88.88 $197.50 $197.50 $197.50 $41.16 $197.50 $197.50 $197.50 $197.50 $197.50 $41.16 $197.50 $197.50 $116.82 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $88.88 $39.20 N/A $114.55 $197.50 $118.50 $197.50 $41.16 $197.50 N/A N/A AR-1011NS SUP Custom 27803010 AR-1011NS - STAPLE BN SPK LOPRFL 20X11MM NS COCR ACL PCL BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $41.16 $197.50 $79.00 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $88.88 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-1016 SUP HCPCS C1713 AR-1016 - STAPLE BN SPK 20X16MM STRL COCR ACL PCL BOTH IP/OP $197.50 $146.00 $39.20 $197.50 $88.88 $88.88 $88.88 $88.88 $197.50 $197.50 $197.50 $41.16 $197.50 $197.50 $197.50 $197.50 $197.50 $41.16 $197.50 $197.50 $116.82 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $88.88 $39.20 N/A $114.55 $197.50 $118.50 $197.50 $41.16 $197.50 N/A N/A AR-1016NS SUP Custom 27803010 AR-1016NS - STAPLE BN SPK LOPRFL 20X16MM NS COCR ACL PCL BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $41.16 $197.50 $79.00 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $88.88 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-1201.7D SUP Custom 27203010 AR-1201.7D - BIT DRL SM LOPRFL 1.7MM 20X25IN AMERPAK FRM 100 AO CNCT PLT BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $146.58 $146.58 $152.23 $102.90 $41.16 $197.50 $85.32 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $128.38 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-1201-7DC SUP Custom 27203010 AR-1201-7DC - BIT DRL 1.7MM CNN AO CNCT BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-1202-3D SUP Custom 27203010 AR-1202-3D - BIT DRL 2.3MM SM FRAG SCR BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $81.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A AR-12040 SUP Custom 27203010 AR-12040 - PUNCH ARTHRO 3.5MM STR SER 1 DSGN WIDEBITER 3.4MM BOTH IP/OP "$2,487.50" "$1,841.00" $442.78 "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" $442.78 "$2,487.50" "$2,487.50" "$1,846.22" "$1,846.22" "$1,917.37" "$1,295.99" $518.42 "$2,487.50" "$1,074.60" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$1,865.63" "$2,487.50" "$2,487.50" "$2,487.50" "$1,243.75" "$1,243.75" "$1,970.10" "$2,487.50" "$1,990.00" "$1,616.88" "$2,487.50" N/A "$1,442.75" "$2,487.50" "$1,492.50" "$2,487.50" "$2,487.50" "$2,487.50" N/A N/A AR-1204AF-100 SUP Custom 27203010 AR-1204AF-100 - CUTTER ASCP 10MM BLU STRL LF FLIPCUTTER II DRL PIN FEM SCKT BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-105 SUP Custom 27203010 AR-1204AF-105 - CUTTER ARTHRO RTRGRD LP 10.5MM DRILL PIN FEMORAL SOCKET BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $351.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-110 SUP Custom 27203010 AR-1204AF-110 - CUTTER ARTHRO RTRGRD LP 11MM DRILL PIN FEMORAL SOCKET BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $351.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-115 SUP Custom 27203010 AR-1204AF-115 - CUTTER ASCP 11.5MM FLIPCUTTER II RETROCONSTRUCTION DRL PIN BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-120 SUP Custom 27203010 AR-1204AF-120 - CUTTER ASCP 12MM FLIPCUTTER II RETROCONSTRUCTION DRL PIN RMR BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-125 SUP Custom 27203010 AR-1204AF-125 - CUTTER ASCP RTRGD LOPRFL 12.5MM BLU STRL LF FLIPCUTTER II BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-130 SUP Custom 27203010 AR-1204AF-130 - CUTTER ASCP RTRGD LOPRFL 13MM BLU STRL LF FLIPCUTTER II DRL BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-50 SUP Custom 27203010 AR-1204AF-50 - CUTTER ASCP RTRGD LOPRFL 5MM BLU STRL LF FLIPCUTTER II DRL BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-55 SUP Custom 27203010 AR-1204AF-55 - CUTTER ASCP 5MM FLIPCUTTER II BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-60 SUP Custom 27203010 AR-1204AF-60 - CUTTER ASCP RTRGD LOPRFL 6MM BLU STRL LF FLIPCUTTER II DRL BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-65 SUP Custom 27203010 AR-1204AF-65 - CUTTER ASCP RTRGD LOPRFL 6.5MM BLU STRL LF FLIPCUTTER II DRL BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-70 SUP Custom 27203010 AR-1204AF-70 - CUTTER ASCP RTRGD LOPRFL 7MM BLU STRL LF FLIPCUTTER II DRL BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-75 SUP Custom 27203010 AR-1204AF-75 - CUTTER ASCP RTRGD 7.5MM BLU STRL LF FLIPCUTTER II DRL PIN BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-80 SUP Custom 27203010 AR-1204AF-80 - CUTTER ASCP 8MM BLU STRL LF FLIPCUTTER II DRL PIN FEM SCKT BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-85 SUP Custom 27203010 AR-1204AF-85 - CUTTER ASCP 8.5MM BLU STRL LF FLIPCUTTER II DRL PIN FEM SCKT BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-90 SUP Custom 27203010 AR-1204AF-90 - CUTTER ASCP RTRGD 9MM BLU STRL LF FLIPCUTTER II DRL PIN FEM BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AF-95 SUP Custom 27203010 AR-1204AF-95 - CUTTER ASCP RTRGD LOPRFL 9.5MM BLU STRL LF FLIPCUTTER II DRL BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AS-105 SUP Custom 27203010 AR-1204AS-105 - CUTTER ASCP SHRT 10.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AS-110 SUP Custom 27203010 AR-1204AS-110 - CUTTER ASCP SHRT 11MM FLIPCUTTER II ANTM SCKT KN 3.5MM BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AS-120 SUP Custom 27203010 AR-1204AS-120 - CUTTER ASCP SHRT 12MM FLIPCUTTER II ANTM SCKT KN 3.5MM BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AS-50 SUP Custom 27203010 AR-1204AS-50 - CUTTER ASCP SHRT 5MM FLIPCUTTER II ANTM SCKT KN 3.5MM BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AS-55 SUP Custom 27203010 AR-1204AS-55 - CUTTER ASCP SHRT 5.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AS-60 SUP Custom 27203010 AR-1204AS-60 - CUTTER ASCP SHRT 6MM FLIPCUTTER II ANTM SCKT KN 3.5MM BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AS-65 SUP Custom 27203010 AR-1204AS-65 - CUTTER ASCP SHRT 6.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AS-70 SUP Custom 27203010 AR-1204AS-70 - CUTTER ASCP SHRT 7MM FLIPCUTTER II ANTM SCKT KN 3.5MM BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AS-75 SUP Custom 27203010 AR-1204AS-75 - CUTTER ASCP SHRT 7.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AS-80 SUP Custom 27203010 AR-1204AS-80 - CUTTER ASCP SHRT 8MM FLIPCUTTER II ANTM SCKT KN 3.5MM BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AS-85 SUP Custom 27203010 AR-1204AS-85 - CUTTER ASCP SHRT 8.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $351.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AS-90 SUP Custom 27203010 AR-1204AS-90 - CUTTER ARTHRO ANTM SCKT FLIPCUTTER II SHRT KNEE 9 BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $351.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204AS-95 SUP Custom 27203010 AR-1204AS-95 - CUTTER ASCP SHRT 9.5MM FLIPCUTTER II ANTM SCKT KN 3.5MM BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1204D SUP Custom 27203010 AR-1204D - DRILL SURG 4MM BIT SCREW BIO-TENODESIS BOTH IP/OP $287.50 $213.00 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $51.18 $287.50 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $124.20 $287.50 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $287.50 N/A $166.75 $287.50 $172.50 $287.50 $287.50 $287.50 N/A N/A AR-1204R-055S SUP Custom 27203010 AR-1204R-055S - CUTTER ASCP 5.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1204R-05S SUP Custom 27203010 AR-1204R-05S - CUTTER ASCP 5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1204R-065S SUP Custom 27203010 AR-1204R-065S - CUTTER ASCP 6.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1204R-06S SUP Custom 27203010 AR-1204R-06S - CUTTER ASCP 6MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1204R-075S SUP Custom 27203010 AR-1204R-075S - CUTTER ASCP 7.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1204R-07S SUP Custom 27203010 AR-1204R-07S - CUTTER ASCP 7MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1204R-08S SUP Custom 27203010 AR-1204R-08S - CUTTER ASCP 8MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1204R-095S SUP Custom 27203010 AR-1204R-095S - CUTTER ASCP 9.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1204R-09S SUP Custom 27203010 AR-1204R-09S - CUTTER ASCP 9MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1204R-105S SUP Custom 27203010 AR-1204R-105S - CUTTER ASCP 10.5MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1204R-12S SUP Custom 27203010 AR-1204R-12S - CUTTER ASCP 12MM STRL RETROCUTTER ANTM SCKT FLXB TNL FEM TIB BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-100 SUP Custom 27203010 AR-1218-100 - DRILL SURG FULL THICK 10MM CALIBRATE DEPTH MARK CANN ACL BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-105 SUP Custom 27203010 AR-1218-105 - DRILL SRG 10.5MM STRL CNN BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-115 SUP Custom 27203010 AR-1218-115 - DRILL SRG 11.5MM STRL CNN BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-120 SUP Custom 27203010 AR-1218-120 - DRILL SRG 12MM STRL CNN BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-150 SUP Custom 27203010 AR-1218-150 - DRILL SRG 15MM STRL CNN BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-40 SUP Custom 27203010 AR-1218-40 - DRILL SRG FULL THK 4MM STRL CLBRT D MRK CNN ACL DISP BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-50 SUP Custom 27203010 AR-1218-50 - DRILL SRG FULL THK 5MM STRL CLBRT D MRK CNN ACL DISP BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-55 SUP Custom 27203010 AR-1218-55 - DRILL SRG CNN 5.5 MM SCR BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-60 SUP Custom 27203010 AR-1218-60 - DRILL SRG FULL THK 6MM STRL CLBRT D MRK CNN ACL HAZ BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-65 SUP Custom 27203010 AR-1218-65 - DRILL SRG 6.5MM STRL CNN BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-70 SUP Custom 27203010 AR-1218-70 - DRILL SRG 7MM STRL CNN BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-75 SUP Custom 27203010 AR-1218-75 - DRILL SURG 7.5MM CANN STERILE BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-80 SUP Custom 27203010 AR-1218-80 - DRILL SRG FULL THK 8MM STRL CLBRT D MRK CNN ACL DISP BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-90 SUP Custom 27203010 AR-1218-90 - DRILL SURG FULL THICK 9MM CALIBRATE DEPTH MARK CANN ACL BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1218-95 SUP Custom 27203010 AR-1218-95 - DRILL SURG FULL THK CLBRT DEPTH MARK CANN ACL 9.5 BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1220S SUP Custom 27203010 AR-1220S - REAMER SRG 7MM STRL CNN COLR PIN SET COR DISP BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1222S SUP Custom 27203010 AR-1222S - REAMER SRG 8MM STRL CNN COLR PIN SET COR DISP BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1223S SUP Custom 27203010 AR-1223S - REAMER SRG 9MM STRL CNN COLR PIN SET COR DISP BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1224S SUP Custom 27203010 AR-1224S - REAMER SRG 10MM STRL CNN COLR PIN SET COR DISP BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1226S SUP Custom 27203010 AR-1226S - REAMER SRG 11MM STRL CNN COLR PIN SET COR DISP BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1227S SUP Custom 27203010 AR-1227S - REAMER SRG 12MM STRL CNN COLR PIN SET COR DISP BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1229S SUP Custom 27203010 AR-1229S - REAMER SRG 13MM STRL CNN COLR PIN SET COR DISP BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1231S SUP Custom 27203010 AR-1231S - REAMER SRG 14MM STRL CNN COLR PIN SET COR DISP BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1246-1 SUP Custom 27203010 AR-1246-1 - GUIDE DRL OFST 3MM BOTH IP/OP $780.00 $577.00 $138.84 $780.00 $780.00 $780.00 $780.00 $780.00 $780.00 $780.00 $138.84 $780.00 $780.00 $578.92 $578.92 $601.22 $406.38 $162.56 $780.00 $336.96 $780.00 $780.00 $780.00 $780.00 $780.00 $585.00 $780.00 $780.00 $780.00 $390.00 $390.00 $617.76 $780.00 $624.00 $507.00 $780.00 N/A $452.40 $780.00 $468.00 $780.00 $780.00 $780.00 N/A N/A AR-1250 SUP Custom 27203010 AR-1250 - DRILL SRG 25-30MM 2MM 12IN STRL SEMIFIX D MRK NTNL TIB DISP BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-1250F SUP Custom 27203010 AR-1250F - GUIDE PIN ORTH 3.5MM 30CM STRL PREDRILL ACL DISP FLIPCUTTER BOTH IP/OP $110.00 $81.00 $19.58 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $19.58 $110.00 $110.00 $81.64 $81.64 $84.79 $57.31 $22.93 $110.00 $44.00 $110.00 $110.00 $110.00 $110.00 $110.00 $82.50 $110.00 $110.00 $110.00 $55.00 $55.00 $87.12 $110.00 $88.00 $71.50 $110.00 N/A $63.80 $110.00 $66.00 $110.00 $110.00 $110.00 N/A N/A AR-1250L SUP Custom 27203010 AR-1250L - GUIDE PIN ORTH 2.4MM 30CM STRL PREDRILL ACL DISP BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-1250LT SUP Custom 27203010 AR-1250LT - DRILL SRG 2.4MM STP 3MM SUT TK BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 N/A $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A AR-1250LTC SUP Custom 27203010 AR-1250LTC - DRILL SRG 3MM STP 3MM SUT TK HRD BN BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 N/A $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A AR-1252 SUP Custom 27203010 AR-1252 - DRILL SRG THK SPD 3MM SUT TK BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $146.58 $146.58 $152.23 $102.90 $41.16 $197.50 $79.00 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $128.38 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-1254 SUP Custom 27203010 AR-1254 - GUIDE PIN ORTH 25/30MM 2MM STRL D MRK NTNL 6MM SCR BOTH IP/OP $52.50 $39.00 $9.35 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $9.35 $52.50 $52.50 $38.97 $38.97 $40.47 $27.35 $10.94 $52.50 $21.00 $52.50 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $34.13 $52.50 N/A $30.45 $52.50 $31.50 $52.50 $52.50 $52.50 N/A N/A AR-1256 SUP Custom 27203010 AR-1256 - DRILL SRG SHRT SPD STRL BSUT TK NDL DISP SUT TK BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $146.58 $146.58 $152.23 $102.90 $41.16 $197.50 $79.00 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $128.38 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-1257 SUP Custom 27203010 AR-1257 - DRILL SRG SPD STRL BSUT TK DISP 3MM SUT TK BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $146.58 $146.58 $152.23 $102.90 $41.16 $197.50 $79.00 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $128.38 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-1259 SUP Custom 27203010 AR-1259 - PASSER SUT RETROPASSER NTNL ASCP BOTH IP/OP $310.00 $229.00 $55.18 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $310.00 $55.18 $310.00 $310.00 $230.08 $230.08 $238.95 $161.51 $64.61 $310.00 $124.00 $310.00 $310.00 $310.00 $310.00 $310.00 $232.50 $310.00 $310.00 $310.00 $155.00 $155.00 $245.52 $310.00 $248.00 $201.50 $310.00 N/A $179.80 $310.00 $186.00 $310.00 $310.00 $310.00 N/A N/A AR-1267 SUP HCPCS C1713 AR-1267 - CAP PCTV POPLITEUM PCL BOTH IP/OP $840.00 $622.00 $166.72 $840.00 $378.00 $378.00 $378.00 $378.00 $840.00 $840.00 $840.00 $175.08 $840.00 $840.00 $840.00 $840.00 $840.00 $175.07 $840.00 $362.88 $496.86 $840.00 $840.00 $840.00 $840.00 $630.00 $840.00 $840.00 $840.00 $420.00 $420.00 $665.28 $840.00 $672.00 $378.00 $166.72 N/A $487.20 $840.00 $504.00 $840.00 $175.06 $840.00 N/A N/A AR-1270 SUP Custom 27203010 AR-1270 - GUIDE DRL LNG NS RETROBUTTON D BOTH IP/OP $872.50 $646.00 $155.31 $872.50 $872.50 $872.50 $872.50 $872.50 $872.50 $872.50 $155.31 $872.50 $872.50 $647.57 $647.57 $672.52 $454.57 $181.84 $872.50 $376.92 $872.50 $872.50 $872.50 $872.50 $872.50 $654.38 $872.50 $872.50 $872.50 $436.25 $436.25 $691.02 $872.50 $698.00 $567.13 $872.50 N/A $506.05 $872.50 $523.50 $872.50 $872.50 $872.50 N/A N/A AR-1288-100 SUP HCPCS C1713 AR-1288-100 - SYSTEM FX SHRT 10MM TGHTRP RT FLIPCUTTER II 2 LD BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-1288-105 SUP HCPCS C1713 AR-1288-105 - SYSTEM FX SHRT 10.5MM TGHTRP RT FLIPCUTTER II 2 LD BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,876.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" "$1,876.50" "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,737.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-1288-110 SUP HCPCS C1713 AR-1288-110 - SYSTEM FX 11MM TGHTRP RT SHRT FLIPCUTTER II 2 LD BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" "$1,737.50" "$1,737.50" N/A N/A AR-1288-70 SUP HCPCS C1713 AR-1288-70 - SYSTEM FX SHRT 7MM TGHTRP RT FLIPCUTTER II 2 LD BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-1288-75 SUP HCPCS C1713 AR-1288-75 - SYSTEM FX SHRT 7.5MM TGHTRP RT FLIPCUTTER II 2 LD BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,876.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" "$1,876.50" "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" "$1,737.50" "$1,737.50" N/A N/A AR-1288-80 SUP HCPCS C1713 AR-1288-80 - SYSTEM FX SHRT 8MM TGHTRP RT FLIPCUTTER II 2 LD BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,876.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" "$1,876.50" "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" N/A N/A AR-1288-85 SUP HCPCS C1713 AR-1288-85 - SYSTEM FX SHRT 8.5MM TGHTRP RT FLIPCUTTER II 2 LD BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,876.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" "$1,876.50" "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,737.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-1288-90 SUP HCPCS C1713 AR-1288-90 - SYSTEM FX SHRT 9MM TGHTRP RT FLIPCUTTER II 2 LD BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,876.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" "$1,876.50" "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" N/A N/A AR-1288-95 SUP HCPCS C1713 AR-1288-95 - SYSTEM FX SHRT 9.5MM TGHTRP RT FLIPCUTTER II 2 LD BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,876.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" "$1,876.50" "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" N/A N/A AR-1288BTB-100 SUP HCPCS C1713 AR-1288BTB-100 - KIT FX 10MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN BOTH IP/OP "$1,925.00" "$1,425.00" $382.06 "$1,925.00" $866.25 $866.25 $866.25 $866.25 "$1,925.00" "$1,925.00" "$1,925.00" $401.22 "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" $401.19 "$1,925.00" $831.60 "$1,138.64" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,443.75" "$1,925.00" "$1,925.00" "$1,925.00" $962.50 $962.50 "$1,524.60" "$1,925.00" "$1,540.00" $866.25 $382.06 N/A "$1,116.50" "$1,925.00" "$1,155.00" "$1,925.00" $401.17 "$1,925.00" N/A N/A AR-1288BTB-110 SUP HCPCS C1713 AR-1288BTB-110 - KIT FX 11MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN BOTH IP/OP "$1,925.00" "$1,425.00" $382.06 "$2,079.00" $866.25 $866.25 $866.25 $866.25 "$1,925.00" "$1,925.00" "$1,925.00" $401.22 "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" $401.19 "$1,925.00" "$2,079.00" "$1,138.64" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,443.75" "$1,925.00" "$1,925.00" "$1,925.00" $962.50 $962.50 "$1,524.60" "$1,925.00" "$1,540.00" $866.25 $382.06 N/A "$1,116.50" "$1,925.00" "$1,155.00" "$1,925.00" $401.17 "$1,925.00" N/A N/A AR-1288BTB-70 SUP HCPCS C1713 AR-1288BTB-70 - KIT FX 7MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN BOTH IP/OP "$1,925.00" "$1,425.00" $382.06 "$1,925.00" $866.25 $866.25 $866.25 $866.25 "$1,925.00" "$1,925.00" "$1,925.00" $401.22 "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" $401.19 "$1,925.00" $770.00 "$1,138.64" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,443.75" "$1,925.00" "$1,925.00" "$1,925.00" $962.50 $962.50 "$1,524.60" "$1,925.00" "$1,540.00" $866.25 $382.06 N/A "$1,116.50" "$1,925.00" "$1,155.00" "$1,925.00" $401.17 "$1,925.00" N/A N/A AR-1288BTB-75 SUP HCPCS C1713 AR-1288BTB-75 - KIT FX 7.5MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN BOTH IP/OP "$1,925.00" "$1,425.00" $382.06 "$1,925.00" $866.25 $866.25 $866.25 $866.25 "$1,925.00" "$1,925.00" "$1,925.00" $401.22 "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" $401.19 "$1,925.00" $770.00 "$1,138.64" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,443.75" "$1,925.00" "$1,925.00" "$1,925.00" $962.50 $962.50 "$1,524.60" "$1,925.00" "$1,540.00" $866.25 $382.06 N/A "$1,116.50" "$1,925.00" "$1,155.00" "$1,925.00" $401.17 "$1,925.00" N/A N/A AR-1288BTB-80 SUP HCPCS C1713 AR-1288BTB-80 - KIT FX 8MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN BOTH IP/OP "$1,925.00" "$1,425.00" $382.06 "$1,925.00" $866.25 $866.25 $866.25 $866.25 "$1,925.00" "$1,925.00" "$1,925.00" $401.22 "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" $401.19 "$1,925.00" $770.00 "$1,138.64" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,443.75" "$1,925.00" "$1,925.00" "$1,925.00" $962.50 $962.50 "$1,524.60" "$1,925.00" "$1,540.00" $866.25 $382.06 N/A "$1,116.50" "$1,925.00" "$1,925.00" "$1,925.00" $401.17 "$1,925.00" N/A N/A AR-1288BTB-85 SUP HCPCS C1713 AR-1288BTB-85 - KIT FX 8.5MM SHRT TGHTRP FLIPCUTTER 2 LD BN TNDN BN BOTH IP/OP "$1,925.00" "$1,425.00" $382.06 "$1,925.00" $866.25 $866.25 $866.25 $866.25 "$1,925.00" "$1,925.00" "$1,925.00" $401.22 "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" $401.19 "$1,925.00" $831.60 "$1,138.64" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,443.75" "$1,925.00" "$1,925.00" "$1,925.00" $962.50 $962.50 "$1,524.60" "$1,925.00" "$1,540.00" $866.25 $382.06 N/A "$1,116.50" "$1,925.00" "$1,155.00" "$1,925.00" $401.17 "$1,925.00" N/A N/A AR-1288BTB-90 SUP HCPCS C1713 AR-1288BTB-90 - SYSTEM FX 9MM STRL LF ARTHX TGHTRP BTB J DISP FLPCTR IIS BOTH IP/OP "$1,925.00" "$1,425.00" $382.06 "$1,925.00" $866.25 $866.25 $866.25 $866.25 "$1,925.00" "$1,925.00" "$1,925.00" $401.22 "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" $401.19 "$1,925.00" $831.60 "$1,138.64" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,443.75" "$1,925.00" "$1,925.00" "$1,925.00" $962.50 $962.50 "$1,524.60" "$1,925.00" "$1,540.00" $866.25 $382.06 N/A "$1,116.50" "$1,925.00" "$1,155.00" "$1,925.00" "$1,925.00" "$1,925.00" N/A N/A AR-1288BTB-95 SUP HCPCS C1713 AR-1288BTB-95 - SYSTEM FX 9.5MM STRL LF ARTHX TGHTRP BTB J DISP FLPCTR IIS BOTH IP/OP "$1,925.00" "$1,425.00" $382.06 "$1,925.00" $866.25 $866.25 $866.25 $866.25 "$1,925.00" "$1,925.00" "$1,925.00" $401.22 "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" $401.19 "$1,925.00" $831.60 "$1,138.64" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,443.75" "$1,925.00" "$1,925.00" "$1,925.00" $962.50 $962.50 "$1,524.60" "$1,925.00" "$1,540.00" $866.25 $382.06 N/A "$1,116.50" "$1,925.00" "$1,155.00" "$1,925.00" $401.17 "$1,925.00" N/A N/A AR-1291-4 SUP Custom 27203010 AR-1291-4 - NEEDLE SUT STRL GFT PREP DISP BOTH IP/OP $925.00 $685.00 $164.65 $925.00 $925.00 $925.00 $925.00 $925.00 $925.00 $925.00 $164.65 $925.00 $925.00 $686.54 $686.54 $712.99 $481.93 $192.78 $925.00 $370.00 $925.00 $925.00 $925.00 $925.00 $925.00 $693.75 $925.00 $925.00 $925.00 $462.50 $462.50 $732.60 $925.00 $740.00 $601.25 $925.00 N/A $536.50 $925.00 $555.00 $925.00 $925.00 $925.00 N/A N/A AR-1297 SUP Custom 27203010 AR-1297 - GUIDE PIN ORTH BALL 1.7MM ACL BOTH IP/OP $170.00 $126.00 $30.26 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $30.26 $170.00 $170.00 $126.17 $126.17 $131.04 $88.57 $35.43 $170.00 $68.00 $170.00 $170.00 $170.00 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $110.50 $170.00 N/A $98.60 $170.00 $102.00 $170.00 $170.00 $170.00 N/A N/A AR-1297L SUP Custom 27203010 AR-1297L - GUIDE PIN ORTH 2.4MM 50CM STRL SUT EYE ACL DISP PCL REPR BOTH IP/OP $170.00 $126.00 $30.26 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $30.26 $170.00 $170.00 $126.17 $126.17 $131.04 $88.57 $35.43 $170.00 $68.00 $170.00 $170.00 $170.00 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $110.50 $170.00 N/A $98.60 $170.00 $102.00 $170.00 $170.00 $170.00 N/A N/A AR-12990N SUP Custom 27203010 AR-12990N - NEEDLE SUT SCRPN KN BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-13100-05.0 SUP HCPCS C1713 AR-13100-05.0 - PLATE BN 5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,825.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13100-07.5 SUP HCPCS C1713 AR-13100-07.5 - PLATE BN 7.5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13100-09.0 SUP HCPCS C1713 AR-13100-09.0 - PLATE BN 9MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13100-10.0 SUP HCPCS C1713 AR-13100-10.0 - PLATE BN 10MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" "$1,825.00" "$1,825.00" N/A N/A AR-13100-11.0 SUP HCPCS C1713 AR-13100-11.0 - PLATE BN 11MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" "$1,825.00" "$1,825.00" N/A N/A AR-13100-12.5 SUP HCPCS C1713 AR-13100-12.5 - PLATE BN 12.5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13100-15.0 SUP HCPCS C1713 AR-13100-15.0 - PLATE BN 15MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" N/A N/A AR-13100-17.5 SUP HCPCS C1713 AR-13100-17.5 - PLATE BN 17.5MM STRL SS KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13100T-05.0 SUP HCPCS C1713 AR-13100T-05.0 - PLATE BN 5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-13100T-07.5 SUP HCPCS C1713 AR-13100T-07.5 - PLATE BN 7.5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-13100T-09.0 SUP HCPCS C1713 AR-13100T-09.0 - PLATE BN 9MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-13100T-10.0 SUP HCPCS C1713 AR-13100T-10.0 - PLATE BN 10MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,237.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-13100T-11.0 SUP HCPCS C1713 AR-13100T-11.0 - PLATE BN 11MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-13100T-12.5 SUP HCPCS C1713 AR-13100T-12.5 - PLATE BN 12.5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-13100T-15.0 SUP HCPCS C1713 AR-13100T-15.0 - PLATE BN 15MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-13100T-17.5 SUP HCPCS C1713 AR-13100T-17.5 - PLATE BN 17.5MM STRL TI KN FEM 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,237.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-13120G-2 SUP Custom 27203010 AR-13120G-2 - GUIDE DRL MN LOPRFL D 2.4MM SCR BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" $486.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A AR-13120T-10 SUP HCPCS C1713 AR-13120T-10 - SCREW BN 1.5MM FT HEX 2.3MM 10MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-10C SUP HCPCS C1713 AR-13120T-10C - SCREW BN 1.5MM P/T HEX 2.3MM 10MM STRL LOPRFL SCR LG CNN ST BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-13120T-10S SUP HCPCS C1713 AR-13120T-10S - SCREW BN 2.3MM 10MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-11 SUP HCPCS C1713 AR-13120T-11 - SCREW BN 1.5MM HEX FT 2.3MM 11MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-11S SUP HCPCS C1713 AR-13120T-11S - SCREW BN 2.3MM 11MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-12 SUP HCPCS C1713 AR-13120T-12 - SCREW BN 1.5MM FT HEX 2.3MM 12MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-12C SUP HCPCS C1713 AR-13120T-12C - SCREW BN 1.5MM P/T HEX 2.3MM 12MM STRL LOPRFL SCR LG CNN ST BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-13120T-12S SUP HCPCS C1713 AR-13120T-12S - SCREW BN 2.3MM 12MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-13 SUP HCPCS C1713 AR-13120T-13 - SCREW BN 1.5MM HEX FT 2.3MM 13MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-13S SUP HCPCS C1713 AR-13120T-13S - SCREW BN 2.3MM 13MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-14 SUP HCPCS C1713 AR-13120T-14 - SCREW BN 1.5MM FT HEX 2.3MM 14MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-14C SUP HCPCS C1713 AR-13120T-14C - SCREW BN 1.5MM P/T HEX 2.3MM 14MM STRL LOPRFL SCR LG CNN ST BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-13120T-14S SUP HCPCS C1713 AR-13120T-14S - SCREW BN 2.3MM 14MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-15 SUP HCPCS C1713 AR-13120T-15 - SCREW BN 1.5MM HEX FT 2.3MM 15MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-15S SUP HCPCS C1713 AR-13120T-15S - SCREW BN 2.3MM 15MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-16 SUP HCPCS C1713 AR-13120T-16 - SCREW BN 1.5MM FT HEX 2.3MM 16MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-16C SUP HCPCS C1713 AR-13120T-16C - SCREW BN 1.5MM P/T HEX 2.3MM 16MM STRL LOPRFL SCR LG CNN ST BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-13120T-16S SUP HCPCS C1713 AR-13120T-16S - SCREW BN 2.3MM 16MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $237.50 $237.50 N/A N/A AR-13120T-17 SUP HCPCS C1713 AR-13120T-17 - SCREW BN 1.5MM HEX FT 2.3MM 17MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-17S SUP HCPCS C1713 AR-13120T-17S - SCREW BN 2.3MM 17MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-13120T-18 SUP HCPCS C1713 AR-13120T-18 - SCREW BN 1.5MM FT HEX 2.3MM 18MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-18C SUP HCPCS C1713 AR-13120T-18C - SCREW BN 1.5MM P/T HEX 2.3MM 18MM STRL LOPRFL SCR LG CNN ST BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-13120T-18S SUP HCPCS C1713 AR-13120T-18S - SCREW BN 2.3MM 18MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-13120T-19 SUP HCPCS C1713 AR-13120T-19 - SCREW BN 1.5MM HEX FT 2.3MM 19MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-19S SUP HCPCS C1713 AR-13120T-19S - SCREW BN 2.3MM 19MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-13120T-20 SUP HCPCS C1713 AR-13120T-20 - SCREW BN 1.5MM FT HEX 2.3MM 20MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-20C SUP HCPCS C1713 AR-13120T-20C - SCREW BN 1.5MM P/T HEX 2.3MM 20MM STRL LOPRFL SCR LG CNN ST BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-13120T-20S SUP HCPCS C1713 AR-13120T-20S - SCREW BN 2.3MM 20MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $237.50 $237.50 N/A N/A AR-13120T-21 SUP HCPCS C1713 AR-13120T-21 - SCREW BN 1.5MM HEX FT 2.3MM 21MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-21S SUP HCPCS C1713 AR-13120T-21S - SCREW BN 2.3MM 21MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-22 SUP HCPCS C1713 AR-13120T-22 - SCREW BN 1.5MM FT HEX 2.3MM 22MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-22C SUP HCPCS C1713 AR-13120T-22C - SCREW BN 1.5MM P/T HEX 2.3MM 22MM STRL LOPRFL SCR LG CNN ST BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-13120T-22S SUP HCPCS C1713 AR-13120T-22S - SCREW BN 2.3MM 22MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-13120T-23 SUP HCPCS C1713 AR-13120T-23 - SCREW BN 1.5MM HEX FT 2.3MM 23MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-23S SUP HCPCS C1713 AR-13120T-23S - SCREW BN 2.3MM 23MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-13120T-24 SUP HCPCS C1713 AR-13120T-24 - SCREW BN 1.5MM FT HEX 2.3MM 24MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-24C SUP HCPCS C1713 AR-13120T-24C - SCREW BN 1.5MM P/T HEX 2.3MM 24MM STRL LOPRFL SCR LG CNN ST BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-13120T-24S SUP HCPCS C1713 AR-13120T-24S - SCREW BN 2.3MM 24MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-25 SUP HCPCS C1713 AR-13120T-25 - SCREW BN 1.5MM HEX FT 2.3MM 25MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-25S SUP HCPCS C1713 AR-13120T-25S - SCREW BN 2.3MM 25MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $237.50 $237.50 N/A N/A AR-13120T-26 SUP HCPCS C1713 AR-13120T-26 - SCREW BN 1.5MM FT HEX 2.3MM 26MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-26C SUP HCPCS C1713 AR-13120T-26C - SCREW BN 1.5MM P/T HEX 2.3MM 26MM STRL LOPRFL SCR LG CNN ST BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-13120T-26S SUP HCPCS C1713 AR-13120T-26S - SCREW BN 2.3MM 26MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $237.50 $237.50 N/A N/A AR-13120T-27 SUP HCPCS C1713 AR-13120T-27 - SCREW BN 1.5MM HEX FT 2.3MM 27MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-27S SUP HCPCS C1713 AR-13120T-27S - SCREW BN 2.3MM 27MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-28 SUP HCPCS C1713 AR-13120T-28 - SCREW BN 1.5MM FT HEX 2.3MM 28MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-28C SUP HCPCS C1713 AR-13120T-28C - SCREW BN 1.5MM P/T HEX 2.3MM 28MM STRL LOPRFL SCR LG CNN ST BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $287.50 $287.50 N/A N/A AR-13120T-28S SUP HCPCS C1713 AR-13120T-28S - SCREW BN 2.3MM 28MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-29 SUP HCPCS C1713 AR-13120T-29 - SCREW BN 1.5MM HEX FT 2.3MM 29MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-29S SUP HCPCS C1713 AR-13120T-29S - SCREW BN 2.3MM 29MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-30 SUP HCPCS C1713 AR-13120T-30 - SCREW BN 1.5MM FT HEX 2.3MM 30MM STRL LOPRFL SCR SLF DRL ST BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13120T-30C SUP HCPCS C1713 AR-13120T-30C - SCREW BN 1.5MM P/T HEX 2.3MM 30MM STRL LOPRFL SCR LG CNN ST BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $287.50 $287.50 N/A N/A AR-13120T-30S SUP HCPCS C1713 AR-13120T-30S - SCREW BN 2.3MM 30MM STRL ARTHX LOPRFL CORT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13123-08 SUP HCPCS C1713 AR-13123-08 - SCREW BN 2.3MM 8MM SS CORT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $70.20 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A AR-13123-10 SUP HCPCS C1713 AR-13123-10 - SCREW BN 2.3MM 10MM STRL LOPRFL SCR SLD SS SM BN CORT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $70.20 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $162.50 $162.50 N/A N/A AR-13123-12 SUP HCPCS C1713 AR-13123-12 - SCREW BN 2.3MM 12MM STRL LOPRFL SCR SLD SS SM BN CORT BOTH IP/OP $162.50 $120.00 $32.25 $175.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $175.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $162.50 $162.50 N/A N/A AR-13123-14 SUP HCPCS C1713 AR-13123-14 - SCREW BN 2.3MM 14MM STRL LOPRFL SCR SLD SS SM BN CORT BOTH IP/OP $162.50 $120.00 $32.25 $175.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $175.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A AR-13123-16 SUP HCPCS C1713 AR-13123-16 - SCREW BN 2.3MM 16MM STRL LOPRFL SCR SLD SS SM BN CORT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $70.20 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $162.50 $162.50 N/A N/A AR-13123-18 SUP HCPCS C1713 AR-13123-18 - SCREW BN 2.3MM 18MM STRL LOPRFL SCR SLD SS SM BN CORT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $70.20 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $162.50 $162.50 N/A N/A AR-13123-20 SUP HCPCS C1713 AR-13123-20 - SCREW BN 2.3MM 20MM STRL LOPRFL SCR SLD SS SM BN CORT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $70.20 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A AR-13123-22 SUP HCPCS C1713 AR-13123-22 - SCREW BN 2.3MM 22MM STRL LOPRFL SCR SLD SS SM BN CORT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $70.20 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A AR-13123-24 SUP HCPCS C1713 AR-13123-24 - SCREW BN 2.3MM 24MM SS CORT BOTH IP/OP $162.50 $120.00 $32.25 $175.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $175.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A AR-1318FT SUP HCPCS C1713 AR-1318FT - ANCHOR SUTURE 2-0 3/8 CIR MICRO FULTHD TAPER 2.2MM 4MM 17.9 BOTH IP/OP $712.50 $527.00 $141.41 "$1,539.00" $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 "$1,539.00" $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AR-1318FT-40 SUP HCPCS C1713 AR-1318FT-40 - ANCHOR SUTURE 4-0 3/8 CIR MICRO FULTHD TAPER 2.2MM 4MM 12.3 BOTH IP/OP $712.50 $527.00 $141.41 "$1,539.00" $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 "$1,539.00" $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AR-1319FT SUP HCPCS C1713 AR-1319FT - ANCHOR SUTURE 2-0 3/8 CIR MINI FULTHD TAPER 2.7MM 7MM 17.9MM BOTH IP/OP $712.50 $527.00 $141.41 "$3,847.50" $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 "$3,847.50" $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $148.49 $712.50 N/A N/A AR-13200-03.0 SUP HCPCS C1713 AR-13200-03.0 - PLATE BN 3MM STRL SS TIB OPN WDG OSTM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200-03.0S SUP HCPCS C1713 AR-13200-03.0S - PLATE BN 3MM STRL ARTHX TIB OPN WDG OSTM BOTH IP/OP $345.00 $255.00 $68.47 $345.00 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $345.00 $71.91 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $138.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $68.47 N/A $200.10 $345.00 $207.00 $345.00 $345.00 $345.00 N/A N/A AR-13200-05.0 SUP HCPCS C1713 AR-13200-05.0 - PLATE BN 5MM STRL SS TIB OPN WDG OSTM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" "$1,300.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200-05.0S SUP HCPCS C1713 AR-13200-05.0S - PLATE BN 5MM STRL ARTHX TIB OPN WDG OSTM BOTH IP/OP $345.00 $255.00 $68.47 $345.00 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $345.00 $71.91 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $138.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $68.47 N/A $200.10 $345.00 $207.00 $345.00 $345.00 $345.00 N/A N/A AR-13200-06.0 SUP HCPCS C1713 AR-13200-06.0 - PLATE BN 6MM STRL SS TIB OPN WDG OSTM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200-06.0S SUP HCPCS C1713 AR-13200-06.0S - PLATE BN 6MM STRL ARTHX TIB OPN WDG OSTM BOTH IP/OP $345.00 $255.00 $68.47 $345.00 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $345.00 $71.91 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $68.47 N/A $200.10 $345.00 $207.00 $345.00 $345.00 $345.00 N/A N/A AR-13200-07.5 SUP HCPCS C1713 AR-13200-07.5 - PLATE BN 7.5MM STRL SS TIB OPN WDG OSTM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200-07.5S SUP HCPCS C1713 AR-13200-07.5S - PLATE BN 7.5MM STRL ARTHX TIB OPN WDG OSTM BOTH IP/OP $345.00 $255.00 $68.47 $345.00 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $345.00 $71.91 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $138.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $68.47 N/A $200.10 $345.00 $345.00 $345.00 $345.00 $345.00 N/A N/A AR-13200-09.0 SUP HCPCS C1713 AR-13200-09.0 - PLATE BN 9MM STRL SS TIB OPN WDG OSTM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" "$1,300.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200-09.0S SUP HCPCS C1713 AR-13200-09.0S - PLATE BN 9MM STRL ARTHX TIB OPN WDG OSTM BOTH IP/OP $345.00 $255.00 $68.47 $345.00 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $345.00 $71.91 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $138.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $68.47 N/A $200.10 $345.00 $207.00 $345.00 $345.00 $345.00 N/A N/A AR-13200-10.0 SUP HCPCS C1713 AR-13200-10.0 - PLATE BN 10MM STRL SS TIB OPN WDG OSTM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200-10.0S SUP HCPCS C1713 AR-13200-10.0S - PLATE BN 10MM STRL ARTHX TIB OPN WDG OSTM BOTH IP/OP $345.00 $255.00 $68.47 $345.00 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $345.00 $71.91 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $68.47 N/A $200.10 $345.00 $345.00 $345.00 $71.90 $345.00 N/A N/A AR-13200-11.0 SUP HCPCS C1713 AR-13200-11.0 - PLATE BN 11MM STRL SS TIB OPN WDG OSTM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" "$1,300.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A AR-13200-11.0S SUP HCPCS C1713 AR-13200-11.0S - PLATE BN 11MM STRL ARTHX TIB OPN WDG OSTM BOTH IP/OP $345.00 $255.00 $68.47 $345.00 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $345.00 $71.91 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $68.47 N/A $200.10 $345.00 $207.00 $345.00 $71.90 $345.00 N/A N/A AR-13200-12.5 SUP HCPCS C1713 AR-13200-12.5 - PLATE BN 12.5MM STRL SS TIB OPN WDG OSTM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200-12.5S SUP HCPCS C1713 AR-13200-12.5S - PLATE BN 12.5MM STRL ARTHX TIB OPN WDG OSTM BOTH IP/OP $345.00 $255.00 $68.47 $345.00 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $345.00 $71.91 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $138.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $68.47 N/A $200.10 $345.00 $207.00 $345.00 $345.00 $345.00 N/A N/A AR-13200-13.5 SUP HCPCS C1713 AR-13200-13.5 - PLATE BN 13.5MM STRL SS TIB OPN WDG OSTM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200-13.5S SUP HCPCS C1713 AR-13200-13.5S - PLATE BN 13.5MM STRL ARTHX TIB OPN WDG OSTM BOTH IP/OP $345.00 $255.00 $68.47 $345.00 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $345.00 $71.91 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $138.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $68.47 N/A $200.10 $345.00 $207.00 $345.00 $71.90 $345.00 N/A N/A AR-13200-15.0 SUP HCPCS C1713 AR-13200-15.0 - PLATE BN 15MM STRL SS TIB OPN WDG OSTM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A AR-13200-15.0S SUP HCPCS C1713 AR-13200-15.0S - PLATE BN 15MM STRL ARTHX TIB OPN WDG OSTM BOTH IP/OP $345.00 $255.00 $68.47 $345.00 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $345.00 $71.91 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $68.47 N/A $200.10 $345.00 $207.00 $345.00 $345.00 $345.00 N/A N/A AR-13200-16.0 SUP HCPCS C1713 AR-13200-16.0 - PLATE BN 16MM STRL SS TIB OPN WDG OSTM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A AR-13200-16.0S SUP HCPCS C1713 AR-13200-16.0S - PLATE BN 16MM STRL ARTHX TIB OPN WDG OSTM BOTH IP/OP $345.00 $255.00 $68.47 $345.00 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $345.00 $71.91 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $138.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $68.47 N/A $200.10 $345.00 $207.00 $345.00 $345.00 $345.00 N/A N/A AR-13200-17.5 SUP HCPCS C1713 AR-13200-17.5 - PLATE BN 17.5MM STRL SS TIB OPN WDG OSTM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200-17.5S SUP HCPCS C1713 AR-13200-17.5S - PLATE BN 17.5MM STRL ARTHX TIB OPN WDG OSTM BOTH IP/OP $345.00 $255.00 $68.47 $345.00 $155.25 $155.25 $155.25 $155.25 $345.00 $345.00 $345.00 $71.91 $345.00 $345.00 $345.00 $345.00 $345.00 $71.90 $345.00 $138.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $155.25 $68.47 N/A $200.10 $345.00 $207.00 $345.00 $71.90 $345.00 N/A N/A AR-13200D-05 SUP HCPCS C1713 AR-13200D-05 - PLATE BN LOPRFL 5MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $561.60 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200D-06 SUP HCPCS C1713 AR-13200D-06 - PLATE BN LOPRFL 6MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $561.60 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200D-07 SUP HCPCS C1713 AR-13200D-07 - PLATE BN LOPRFL 7MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,404.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" "$1,404.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200D-08 SUP HCPCS C1713 AR-13200D-08 - PLATE BN LOPRFL 8MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,404.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" "$1,404.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200D-09 SUP HCPCS C1713 AR-13200D-09 - PLATE BN LOPRFL 9MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $561.60 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200D-10 SUP HCPCS C1713 AR-13200D-10 - PLATE BN LOPRFL 10MM STRL SS TIB DIST 3.5-4MM SCR OPN WDG BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $561.60 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200DC SUP HCPCS C1713 AR-13200DC - PLATE BN LOPRFL SS TIB DIST 3.5/4MM SCR CLS WDG OSTM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $561.60 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200M SUP HCPCS C1713 AR-13200M - PLATE BN L FLT TI METATARSUS 2.4MM SCR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-025L SUP HCPCS C1713 AR-13200M-025L - PLATE BN L LOPRFL 2.5MM TI METATARSUS LT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-025R SUP HCPCS C1713 AR-13200M-025R - PLATE BN L LOPRFL 2.5MM TI METATARSUS RT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-02L SUP HCPCS C1713 AR-13200M-02L - PLATE BN L LOPRFL 2MM TI METATARSUS LT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-02R SUP HCPCS C1713 AR-13200M-02R - PLATE BN L LOPRFL 2MM TI METATARSUS RT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-035L SUP HCPCS C1713 AR-13200M-035L - PLATE BN L LOPRFL 3.5MM TI METATARSUS LT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-035R SUP HCPCS C1713 AR-13200M-035R - PLATE BN L LOPRFL 3.5MM TI METATARSUS RT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-03L SUP HCPCS C1713 AR-13200M-03L - PLATE BN L LOPRFL 3MM TI METATARSUS LT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-03R SUP HCPCS C1713 AR-13200M-03R - PLATE BN L LOPRFL 3MM TI METATARSUS RT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-045L SUP HCPCS C1713 AR-13200M-045L - PLATE BN L LOPRFL 4.5MM TI METATARSUS LT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-045R SUP HCPCS C1713 AR-13200M-045R - PLATE BN L LOPRFL 4.5MM TI METATARSUS RT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-04L SUP HCPCS C1713 AR-13200M-04L - PLATE BN L LOPRFL 4MM TI METATARSUS LT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-04R SUP HCPCS C1713 AR-13200M-04R - PLATE BN L LOPRFL 4MM TI METATARSUS RT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-055L SUP HCPCS C1713 AR-13200M-055L - PLATE BN L LOPRFL 5.5MM TI METATARSUS LT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-055R SUP HCPCS C1713 AR-13200M-055R - PLATE BN L LOPRFL 5.5MM TI METATARSUS RT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-05L SUP HCPCS C1713 AR-13200M-05L - PLATE BN L LOPRFL 5MM TI METATARSUS LT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-05R SUP HCPCS C1713 AR-13200M-05R - PLATE BN L LOPRFL 5MM TI METATARSUS RT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-065L SUP HCPCS C1713 AR-13200M-065L - PLATE BN L LOPRFL 6.5MM TI METATARSUS LT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-065R SUP HCPCS C1713 AR-13200M-065R - PLATE BN L LOPRFL 6.5MM TI METATARSUS RT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-06L SUP HCPCS C1713 AR-13200M-06L - PLATE BN L LOPRFL 6MM TI METATARSUS LT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-06R SUP HCPCS C1713 AR-13200M-06R - PLATE BN L LOPRFL 6MM TI METATARSUS RT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-075L SUP HCPCS C1713 AR-13200M-075L - PLATE BN 32219095 7.5MM NS ARTHX LOPRFL OPN WDG TI BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" "$1,237.50" $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A AR-13200M-075R SUP HCPCS C1713 AR-13200M-075R - PLATE BN 7.5MM NS ARTHX LOPRFL OPN WDG TI METATARSUS RT BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A AR-13200M-07L SUP HCPCS C1713 AR-13200M-07L - PLATE BN L LOPRFL 7MM TI METATARSUS LT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200M-07R SUP HCPCS C1713 AR-13200M-07R - PLATE BN L LOPRFL 7MM TI METATARSUS RT 2.4MM SCR OPN WDG BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-13200PA-05.0 SUP HCPCS C1713 AR-13200PA-05.0 - PLATE BN 5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200PA-06.0 SUP HCPCS C1713 AR-13200PA-06.0 - PLATE BN 6MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200PA-07.5 SUP HCPCS C1713 AR-13200PA-07.5 - PLATE BN 7.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200PA-09.0 SUP HCPCS C1713 AR-13200PA-09.0 - PLATE BN 9MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" "$1,300.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200PA-10.0 SUP HCPCS C1713 AR-13200PA-10.0 - PLATE BN 10MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200PA-11.0 SUP HCPCS C1713 AR-13200PA-11.0 - PLATE BN 11MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" "$1,300.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200PA-12.5 SUP HCPCS C1713 AR-13200PA-12.5 - PLATE BN 12.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200PA-13.5 SUP HCPCS C1713 AR-13200PA-13.5 - PLATE BN 13.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200PA-15.0 SUP HCPCS C1713 AR-13200PA-15.0 - PLATE BN 15MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A AR-13200PA-16.0 SUP HCPCS C1713 AR-13200PA-16.0 - PLATE BN 16MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A AR-13200PA-17.5 SUP HCPCS C1713 AR-13200PA-17.5 - PLATE BN 17.5MM ANTEROPOSTERIOR SLOP SS TIB 6.5MM CANC 4.5MM BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" $520.00 $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-13200ST-05.0 SUP HCPCS C1713 AR-13200ST-05.0 - PLATE BN LOPRFL 5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200ST-07.5 SUP HCPCS C1713 AR-13200ST-07.5 - PLATE BN LOPRFL 7.5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200ST-09.0 SUP HCPCS C1713 AR-13200ST-09.0 - PLATE BN LOPRFL 9MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" "$1,825.00" "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200ST-10.0 SUP HCPCS C1713 AR-13200ST-10.0 - PLATE BN LOPRFL 10MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" "$1,825.00" "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200ST-11.0 SUP HCPCS C1713 AR-13200ST-11.0 - PLATE BN LOPRFL 11MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200ST-12.5 SUP HCPCS C1713 AR-13200ST-12.5 - PLATE BN LOPRFL 12.5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200ST-15.0 SUP HCPCS C1713 AR-13200ST-15.0 - PLATE BN LOPRFL 15MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM CANC BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" "$1,825.00" "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200ST-17.5 SUP HCPCS C1713 AR-13200ST-17.5 - PLATE BN LOPRFL 17.5MM ANTEROPOSTERIOR SLOP TI TIB 6.5MM BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200T-05.0 SUP HCPCS C1713 AR-13200T-05.0 - PLATE BN LOPRFL 5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN WDG BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200T-07.5 SUP HCPCS C1713 AR-13200T-07.5 - PLATE BN LOPRFL 7.5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200T-09.0 SUP HCPCS C1713 AR-13200T-09.0 - PLATE BN LOPRFL 9MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN WDG BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" "$1,825.00" "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200T-10.0 SUP HCPCS C1713 AR-13200T-10.0 - PLATE BN 10MM LOPRFL TI TIB 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" "$1,825.00" "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200T-11.0 SUP HCPCS C1713 AR-13200T-11.0 - PLATE BN LOPRFL 11MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" "$1,825.00" "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200T-12.5 SUP HCPCS C1713 AR-13200T-12.5 - PLATE BN LOPRFL 12.5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200T-15.0 SUP HCPCS C1713 AR-13200T-15.0 - PLATE BN LOPRFL 15MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" "$1,825.00" "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-13200T-17.5 SUP HCPCS C1713 AR-13200T-17.5 - PLATE BN LOPRFL 17.5MM TI TIB 6.5MM CANC 4.5MM CORT SCR OPN BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A AR-1320BCNF SUP HCPCS C1713 AR-1320BCNF - ANCHOR SUT MIC NS DISP BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-1320BCNF-40 SUP HCPCS C1713 AR-1320BCNF-40 - ANCHOR SUT 4-0 MIC 2 TPR 2.4MM 6.5MM NS SUT TK FBRWR BCMPS BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-1320DSC SUP Custom 27203010 AR-1320DSC - KIT INST MIC 1.8MM 2MM STRL SUT TK BIT DRL GD PNCH SHLDR BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-13215 SUP HCPCS C1713 AR-13215 - PLATE BN 30MM STRL 2 HL SPRT KN OSTM BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $600.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A AR-13217 SUP Custom 27203010 AR-13217 - KIT INST CUT BLCK PIN DISP T3 AMZ BOTH IP/OP "$1,247.50" $923.00 $222.06 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $222.06 "$1,247.50" "$1,247.50" $925.89 $925.89 $961.57 $649.95 $259.99 "$1,247.50" $499.00 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $810.88 "$1,247.50" N/A $723.55 "$1,247.50" $748.50 "$1,247.50" "$1,247.50" "$1,247.50" N/A N/A AR-13220 SUP Custom 27203010 AR-13220 - DRILL BIT CNTRSNK 2.3MM AO CNCT BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $54.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-13220C SUP Custom 27203010 AR-13220C - DRILL BIT CNTRSNK 2.3MM AO CNCT CNN BOTH IP/OP $375.00 $278.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $66.75 $375.00 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $162.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $375.00 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A AR-13220DG SUP Custom 27203010 AR-13220DG - GUIDE DRL LOPRFL PLT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $226.80 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1322-752SF SUP HCPCS C1713 AR-1322-752SF - ANCHOR SUT 2-0 SM 2.4MM 7.5MM STRL FSTK2 FWR BABSR HNDL BOTH IP/OP $462.50 $342.00 $91.79 $462.50 $208.13 $208.13 $208.13 $208.13 $462.50 $462.50 $462.50 $96.40 $462.50 $462.50 $462.50 $462.50 $462.50 $96.39 $462.50 $462.50 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $208.13 $91.79 N/A $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A AR-1322BCNF SUP HCPCS C1713 AR-1322BCNF - ANCHOR SUT 2-0 MIC STRG FWD TPR 2.4MM 8.5MM LF BSUT TK FBRWR BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-1322D-18 SUP Custom 27203010 AR-1322D-18 - DRILL SRG MN 1.8MM SUT TK BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1322D-20 SUP Custom 27203010 AR-1322D-20 - DRILL SRG MN 2MM SUT TK BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1322DSC SUP Custom 27203010 AR-1322DSC - KIT ESCP INST 2-0 MN 2.4MM 8.5MM STRL LF BSUT TK ANCH DRLBT BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-1322SXF SUP HCPCS C1713 AR-1322SXF - ANCHOR SUT 2 2.4MM 11.7MM STRL FSTK FWR BRD CNN INSRTR ST TI BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $165.00 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-1324B SUP HCPCS C1713 AR-1324B - ANCHOR SUT 2 3MM 14MM STRL BFSTK TVDK BRD EYLT HNDL INSRTR BOTH IP/OP $562.50 $416.00 $111.64 $562.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $562.50 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $337.50 $562.50 $117.23 $562.50 N/A N/A AR-1324BF SUP HCPCS C1713 AR-1324BF - ANCHOR SUT 2 3MM 14MM STRL BFSTK FWR BRD EYLT HNDL INSRTR BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $275.63 $275.63 $275.63 $275.63 $612.50 $612.50 $612.50 $127.66 $612.50 $612.50 $612.50 $612.50 $612.50 $127.65 $612.50 $245.00 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $275.63 $121.57 N/A $355.25 $612.50 $367.50 $612.50 $127.65 $612.50 N/A N/A AR-1324BF-2 SUP HCPCS C1713 AR-1324BF-2 - ANCHOR SUT 2 3MM 11MM STRL BFSTK FWR BRD EYLT HNDL INSRTR BOTH IP/OP $650.00 $481.00 $129.01 $650.00 $292.50 $292.50 $292.50 $292.50 $650.00 $650.00 $650.00 $135.48 $650.00 $650.00 $650.00 $650.00 $650.00 $135.47 $650.00 $260.00 $384.48 $650.00 $650.00 $650.00 $650.00 $487.50 $650.00 $650.00 $650.00 $325.00 $325.00 $514.80 $650.00 $520.00 $292.50 $129.01 N/A $377.00 $650.00 $390.00 $650.00 $135.46 $650.00 N/A N/A AR-1324D SUP Custom 27203010 AR-1324D - DRILL SRG SPR 2.8MM FSTK II CNN TI SHLDR BOTH IP/OP $225.00 $167.00 $40.05 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $40.05 $225.00 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $90.00 $225.00 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $225.00 N/A $130.50 $225.00 $135.00 $225.00 $225.00 $225.00 N/A N/A AR-1324HF SUP HCPCS C1713 AR-1324HF - ANCHOR SUT 2 2.8MM 11.7MM STRL FSTK2 FWR HNDL TI KN BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $202.50 $202.50 $202.50 $202.50 $450.00 $450.00 $450.00 $93.79 $450.00 $450.00 $450.00 $450.00 $450.00 $93.78 $450.00 $180.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $202.50 $89.31 N/A $261.00 $450.00 $270.00 $450.00 $93.78 $450.00 N/A N/A AR-1324SF SUP HCPCS C1713 AR-1324SF - ANCHOR SUT 2 2.8MM 11.7MM STRL FSTK2 FWR CNN INSRTR TI BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $165.00 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-13280-35 SUP HCPCS C1713 AR-13280-35 - SCREW BN 6.5MM 35MM TI TIB CANC OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A AR-13280-40 SUP HCPCS C1713 AR-13280-40 - SCREW BN 6.5MM 40MM TI TIB CANC OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A AR-13280-45 SUP HCPCS C1713 AR-13280-45 - SCREW BN 6.5MM 45MM TI TIB CANC OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A AR-13280-50 SUP HCPCS C1713 AR-13280-50 - SCREW BN 6.5MM 50MM TI TIB CANC OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A AR-13280-55 SUP HCPCS C1713 AR-13280-55 - SCREW BN 6.5MM 55MM TI TIB CANC OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A AR-13280-60 SUP HCPCS C1713 AR-13280-60 - SCREW BN 6.5MM 60MM TI TIB CANC OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A AR-13280-65 SUP HCPCS C1713 AR-13280-65 - SCREW BN 6.5MM 65MM TI TIB CANC OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A AR-13280-70 SUP HCPCS C1713 AR-13280-70 - SCREW BN 6.5MM 70MM TI TIB CANC OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A AR-13303-2.4 SUP Custom 27203010 AR-13303-2.4 - GUIDE PIN ORTH 2.4MM BRKWY FEM OSTM BOTH IP/OP $92.50 $68.00 $16.47 $92.50 $92.50 $92.50 $92.50 $92.50 $92.50 $92.50 $16.47 $92.50 $92.50 $68.65 $68.65 $71.30 $48.19 $19.28 $92.50 $37.00 $92.50 $92.50 $92.50 $92.50 $92.50 $69.38 $92.50 $92.50 $92.50 $46.25 $46.25 $73.26 $92.50 $74.00 $60.13 $92.50 N/A $53.65 $92.50 $55.50 $92.50 $92.50 $92.50 N/A N/A AR-13303-3.0 SUP Custom 27203010 AR-13303-3.0 - GUIDE PIN ORTH 3MM BRKWY FEM OSTM BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-13319 SUP Custom 27203010 AR-13319 - DRILL SRG HTO TI SCR BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A AR-13320 SUP Custom 27203010 AR-13320 - GUIDE DRL OPN WDG OSTM HTO PLT BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $221.40 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-13321 SUP Custom 27203010 AR-13321 - GUIDE DRL OPN WDG OSTM HTO TI PLT BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $77.76 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A AR-13370-2 SUP HCPCS C1713 AR-13370-2 - FILLER BN VOID 30X10MM STRL OPTM PORE DIA RGD FX DEV TRM WDG BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" $257.90 "$1,237.50" N/A N/A AR-13370-3 SUP HCPCS C1713 AR-13370-3 - FILLER BN VOID 35X12MM STRL OPTM PORE DIA RGD FX DEV TRM WDG BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" "$1,237.50" $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" $257.90 "$1,237.50" N/A N/A AR-13370-4 SUP HCPCS C1713 AR-13370-4 - FILLER BN VOID 35X15MM STRL OPTM PORE DIA RGD FX DEV TRM WDG BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" $257.90 "$1,237.50" N/A N/A AR-13372-1 SUP HCPCS C1713 AR-13372-1 - FILLER BN VOID 75D THK7MM TRPZD 25X8MM OSFERION BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-13372-2 SUP HCPCS C1713 AR-13372-2 - FILLER BN VOID 75D THK7MM TRPZD 25X9MM OSFERION BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-13372-3 SUP HCPCS C1713 AR-13372-3 - FILLER BN VOID 75D THK7MM TRPZD 25X10MM OSFERION BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-13380-26 SUP HCPCS C1713 AR-13380-26 - SCREW BN 4.5MM 26MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A AR-13380-28 SUP HCPCS C1713 AR-13380-28 - SCREW BN 4.5MM 28MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A AR-13380-30 SUP HCPCS C1713 AR-13380-30 - SCREW BN 4.5MM 30MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A AR-13380-32 SUP HCPCS C1713 AR-13380-32 - SCREW BN 4.5MM 32MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A AR-13380-34 SUP HCPCS C1713 AR-13380-34 - SCREW BN 4.5MM 34MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A AR-13380-36 SUP HCPCS C1713 AR-13380-36 - SCREW BN 4.5MM 36MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A AR-13380-38 SUP HCPCS C1713 AR-13380-38 - SCREW BN 4.5MM 38MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A AR-13380-40 SUP HCPCS C1713 AR-13380-40 - SCREW BN 4.5MM 40MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A AR-13380-42 SUP HCPCS C1713 AR-13380-42 - SCREW BN 4.5MM 42MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A AR-13380-44 SUP HCPCS C1713 AR-13380-44 - SCREW BN 4.5MM 44MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A AR-13380-46 SUP HCPCS C1713 AR-13380-46 - SCREW BN 4.5MM 46MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A AR-13380-48 SUP HCPCS C1713 AR-13380-48 - SCREW BN 4.5MM 48MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A AR-13380-50 SUP HCPCS C1713 AR-13380-50 - SCREW BN 4.5MM 50MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A AR-13380-52 SUP HCPCS C1713 AR-13380-52 - SCREW BN 4.5MM 52MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A AR-13380-54 SUP HCPCS C1713 AR-13380-54 - SCREW BN 4.5MM 54MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A AR-13380-56 SUP HCPCS C1713 AR-13380-56 - SCREW BN 4.5MM 56MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A AR-13380-58 SUP HCPCS C1713 AR-13380-58 - SCREW BN 4.5MM 58MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A AR-13380-60 SUP HCPCS C1713 AR-13380-60 - SCREW BN 4.5MM 60MM TI TIB CORT OPN WDG OSTM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A AR-13400L-05 SUP Custom 27803010 AR-13400L-05 - WEDGE TIB 5D LG IBALANCE HTO BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400L-06 SUP Custom 27803010 AR-13400L-06 - WEDGE TIB 6D 7D LG XL IBALANCE HTO BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400L-07 SUP Custom 27803010 AR-13400L-07 - WEDGE TIB 6D 7D LG XL IBALANCE PEEK KN HTO BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400L-08 SUP Custom 27803010 AR-13400L-08 - WEDGE TIB 7D 8D LG XL IBALANCE KN HTO BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400L-09 SUP Custom 27803010 AR-13400L-09 - WEDGE TIB 8D 9D LG XL IBALANCE PEEK KN HTO PLT BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400L-10 SUP Custom 27803010 AR-13400L-10 - WEDGE TIB 9D 10D LG XL IBALANCE PEEK KN HTO PLT BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400L-11 SUP Custom 27803010 AR-13400L-11 - WEDGE TIB 10D 11D LG XL IBALANCE PEEK KN HTO PLT BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400L-12 SUP Custom 27803010 AR-13400L-12 - WEDGE TIB 11D 12D LG XL IBALANCE PEEK KN HTO PLT BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400L-13 SUP Custom 27803010 AR-13400L-13 - WEDGE TIB 12D 13D LG XL IBALANCE HTO BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400L-14 SUP Custom 27803010 AR-13400L-14 - WEDGE TIB 13D 14D LG XL IBALANCE PEEK HTO BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400L-15 SUP Custom 27803010 AR-13400L-15 - WEDGE TIB 15D LG IBALANCE HTO BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400M-05 SUP Custom 27803010 AR-13400M-05 - WEDGE TIB 5D 6D S/MED IBALANCE HTO BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400M-06 SUP Custom 27803010 AR-13400M-06 - WEDGE TIB 6D MED IBALANCE HTO BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400M-07 SUP Custom 27803010 AR-13400M-07 - WEDGE TIB 7D 8D S/MED IBALANCE PEEK KN HTO PLT BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400M-08 SUP Custom 27803010 AR-13400M-08 - WEDGE TIB 8D 9D S/MED IBALANCE PEEK KN HTO PLT BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400M-09 SUP Custom 27803010 AR-13400M-09 - WEDGE TIB 9D 10D S/MED IBALANCE PEEK KN HTO PLT BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400M-10 SUP Custom 27803010 AR-13400M-10 - WEDGE TIB 10D 11D S/MED IBALANCE PEEK KN HTO PLT BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400M-11 SUP Custom 27803010 AR-13400M-11 - WEDGE TIB 13D 11D S/MED IBALANCE HTO BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400M-12 SUP Custom 27803010 AR-13400M-12 - WEDGE TIB 12D 14D S/MED IBALANCE PEEK KN HTO PLT BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400M-13 SUP Custom 27803010 AR-13400M-13 - WEDGE TIB 15D 13D S/MED IBALANCE KN HTO BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400M-14 SUP Custom 27803010 AR-13400M-14 - WEDGE TIB 14D MED IBALANCE HTO BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400M-15 SUP Custom 27803010 AR-13400M-15 - WEDGE TIB 15D MED IBALANCE HTO BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13400S-12 SUP Custom 27803010 AR-13400S-12 - WEDGE TIB 12D SM IBALANCE PEEK KN HTO PLT BOTH IP/OP "$4,750.00" "$3,515.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $845.50 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A AR-13401-20 SUP HCPCS C1713 AR-13401-20 - ANCHOR SUT 6.5MM 20MM IBALANCE CANC HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-13401-22 SUP HCPCS C1713 AR-13401-22 - ANCHOR SUT 6.5MM 22MM IBALANCE CANC HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-13401-24 SUP HCPCS C1713 AR-13401-24 - ANCHOR SUT 6.5MM 24MM IBALANCE CANC HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-13401-26 SUP HCPCS C1713 AR-13401-26 - ANCHOR SUT 6.5MM 26MM IBALANCE CANC HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-13401-28 SUP HCPCS C1713 AR-13401-28 - ANCHOR SUT 6.5MM 28MM IBALANCE CANC HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-13401-30 SUP HCPCS C1713 AR-13401-30 - ANCHOR SUT 6.5MM 30MM IBALANCE CANC HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-13401-32 SUP HCPCS C1713 AR-13401-32 - ANCHOR SUT 6.5MM 32MM IBALANCE CANC HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-13402-24 SUP HCPCS C1713 AR-13402-24 - ANCHOR SUT 4.5MM 24MM IBALANCE CORT HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-13402-26 SUP HCPCS C1713 AR-13402-26 - ANCHOR SUT 4.5MM 26MM IBALANCE CORT HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-13402-28 SUP HCPCS C1713 AR-13402-28 - ANCHOR SUT 4.5MM 28MM IBALANCE CORT HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-13402-30 SUP HCPCS C1713 AR-13402-30 - ANCHOR SUT 4.5MM 30MM IBALANCE CORT HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-13402-32 SUP HCPCS C1713 AR-13402-32 - ANCHOR SUT 4.5MM 32MM IBALANCE CORT HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-13402-34 SUP HCPCS C1713 AR-13402-34 - ANCHOR SUT 4.5MM 34MM IBALANCE CORT HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-13402-36 SUP HCPCS C1713 AR-13402-36 - ANCHOR SUT 4.5MM 36MM IBALANCE CORT HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-13402-38 SUP HCPCS C1713 AR-13402-38 - ANCHOR SUT 4.5MM 38MM IBALANCE CORT HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-13402-40 SUP HCPCS C1713 AR-13402-40 - ANCHOR SUT 4.5MM 40MM IBALANCE CORT HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-13402-42 SUP HCPCS C1713 AR-13402-42 - ANCHOR SUT 4.5MM 42MM IBALANCE CORT HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $250.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-13402-44 SUP HCPCS C1713 AR-13402-44 - ANCHOR SUT 4.5MM 44MM IBALANCE CORT HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-13402-46 SUP HCPCS C1713 AR-13402-46 - ANCHOR SUT 4.5MM 46MM IBALANCE CORT HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-13402-48 SUP HCPCS C1713 AR-13402-48 - ANCHOR SUT 4.5MM 48MM IBALANCE CORT HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-13402-50 SUP HCPCS C1713 AR-13402-50 - ANCHOR SUT 4.5MM 50MM IBALANCE CORT HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-13402-52 SUP HCPCS C1713 AR-13402-52 - ANCHOR SUT 4.5MM 52MM IBALANCE HTO BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-13413 SUP HCPCS C1713 AR-13413 - WASHER ORTH FSTN LCK BOTH IP/OP $177.50 $131.00 $35.22 $191.65 $79.85 $79.85 $79.85 $79.85 $177.45 $177.45 $177.45 $36.99 $177.45 $177.45 $177.45 $177.45 $177.45 $36.98 $177.45 $191.65 $104.96 $177.45 $177.45 $177.45 $177.45 $133.13 $177.45 $177.45 $177.45 $88.73 $88.73 $140.54 $177.45 $141.96 $79.85 $35.22 N/A $102.95 $177.45 $177.45 $177.45 $177.45 $177.45 N/A N/A AR-13417L SUP Custom 27203010 AR-13417L - GUIDE DRL LG FREECUT KYHL HTO IBALANCE BOTH IP/OP "$2,697.50" "$1,996.00" $480.16 "$2,697.50" "$2,697.50" "$2,697.50" "$2,697.50" "$2,697.50" "$2,697.50" "$2,697.50" $480.16 "$2,697.50" "$2,697.50" "$2,002.08" "$2,002.08" "$2,079.23" "$1,405.40" $562.19 "$2,697.50" "$1,165.32" "$2,697.50" "$2,697.50" "$2,697.50" "$2,697.50" "$2,697.50" "$2,023.13" "$2,697.50" "$2,697.50" "$2,697.50" "$1,348.75" "$1,348.75" "$2,136.42" "$2,697.50" "$2,158.00" "$1,753.38" "$2,697.50" N/A "$1,564.55" "$2,697.50" "$1,618.50" "$2,697.50" "$2,697.50" "$2,697.50" N/A N/A AR-13417M SUP Custom 27203010 AR-13417M - GUIDE DRL MED FREECUT KYHL HTO IBALANCE BOTH IP/OP "$2,697.50" "$1,996.00" $480.16 "$2,697.50" "$2,697.50" "$2,697.50" "$2,697.50" "$2,697.50" "$2,697.50" "$2,697.50" $480.16 "$2,697.50" "$2,697.50" "$2,002.08" "$2,002.08" "$2,079.23" "$1,405.40" $562.19 "$2,697.50" "$1,165.32" "$2,697.50" "$2,697.50" "$2,697.50" "$2,697.50" "$2,697.50" "$2,023.13" "$2,697.50" "$2,697.50" "$2,697.50" "$1,348.75" "$1,348.75" "$2,136.42" "$2,697.50" "$2,158.00" "$1,753.38" "$2,697.50" N/A "$1,564.55" "$2,697.50" "$1,618.50" "$2,697.50" "$2,697.50" "$2,697.50" N/A N/A AR-13433 SUP Custom 27203010 AR-13433 - GUIDE DRL IBALANCE ANCH HTO BOTH IP/OP $632.50 $468.00 $112.57 $632.40 $632.40 $632.40 $632.40 $632.40 $632.40 $632.40 $112.57 $632.40 $632.40 $469.37 $469.37 $487.45 $329.48 $131.80 $632.40 $273.20 $632.40 $632.40 $632.40 $632.40 $632.40 $474.38 $632.40 $632.40 $632.40 $316.20 $316.20 $500.86 $632.40 $505.92 $411.06 $632.40 N/A $366.85 $632.40 $379.44 $632.40 $632.40 $632.40 N/A N/A AR-1349 SUP Custom 27803010 AR-1349 - WASHER 14MM SPK LP ORTH TI CANC SCR STRL BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $108.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1349L SUP Custom 27803010 AR-1349L - WASHER ORTH 18MM STRL SPK LOPRFL TI CANC SCR BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1349LM SUP Custom 27803010 AR-1349LM - WASHER ORTH 18MM STRL SUT TI ACL DISP CANC SCR BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1349LMNS SUP Custom 27803010 AR-1349LMNS - WASHER ORTH LOPRFL 18MM NS SUT TI ACL PCL CANC SCR BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1349LNS SUP Custom 27803010 AR-1349LNS - WASHER 18MM ACL PCL SPK LP ORTH TI CANC SCR BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $108.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1349M SUP Custom 27803010 AR-1349M - WASHER ORTH 14MM STRL TI CANC SCR BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1349MNS SUP Custom 27803010 AR-1349MNS - WASHER 14MM ACL PCL SUTURE LP ORTH TI CANC SCR BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $108.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1349NS SUP Custom 27803010 AR-1349NS - WASHER ORTH SPK LOPRFL 14MM NS TI ACL PCL CANC SCR BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1351 SUP HCPCS C1713 AR-1351 - PIN FX 3MM 40MM STRL TRNFX SLF CUT ST TI ACL BOTH IP/OP $395.00 $292.00 $78.40 $395.00 $177.75 $177.75 $177.75 $177.75 $395.00 $395.00 $395.00 $82.33 $395.00 $395.00 $395.00 $395.00 $395.00 $82.32 $395.00 $170.64 $233.64 $395.00 $395.00 $395.00 $395.00 $296.25 $395.00 $395.00 $395.00 $197.50 $197.50 $312.84 $395.00 $316.00 $177.75 $78.40 N/A $229.10 $395.00 $395.00 $395.00 $82.32 $395.00 N/A N/A AR-1351B SUP HCPCS C1713 AR-1351B - IMPLANT FX 5MM 40MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT BOTH IP/OP $722.50 $535.00 $143.40 $722.50 $325.13 $325.13 $325.13 $325.13 $722.50 $722.50 $722.50 $150.59 $722.50 $722.50 $722.50 $722.50 $722.50 $150.58 $722.50 $312.12 $427.36 $722.50 $722.50 $722.50 $722.50 $541.88 $722.50 $722.50 $722.50 $361.25 $361.25 $572.22 $722.50 $578.00 $325.13 $143.40 N/A $419.05 $722.50 $433.50 $722.50 $150.57 $722.50 N/A N/A AR-1351BK-CP SUP HCPCS C1713 AR-1351BK-CP - SET IMPL 40MM BTRNSF PK ACL BOTH IP/OP "$1,102.50" $816.00 $218.82 "$1,102.50" $496.13 $496.13 $496.13 $496.13 "$1,102.50" "$1,102.50" "$1,102.50" $229.79 "$1,102.50" "$1,102.50" "$1,102.50" "$1,102.50" "$1,102.50" $229.77 "$1,102.50" $476.28 $652.13 "$1,102.50" "$1,102.50" "$1,102.50" "$1,102.50" $826.88 "$1,102.50" "$1,102.50" "$1,102.50" $551.25 $551.25 $873.18 "$1,102.50" $882.00 $496.13 $218.82 N/A $639.45 "$1,102.50" $661.50 "$1,102.50" $229.76 "$1,102.50" N/A N/A AR-1351BT SUP HCPCS C1713 AR-1351BT - IMPLANT FX 3MM 40MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT BOTH IP/OP $722.50 $535.00 $143.40 $722.50 $325.13 $325.13 $325.13 $325.13 $722.50 $722.50 $722.50 $150.59 $722.50 $722.50 $722.50 $722.50 $722.50 $150.58 $722.50 $289.00 $427.36 $722.50 $722.50 $722.50 $722.50 $541.88 $722.50 $722.50 $722.50 $361.25 $361.25 $572.22 $722.50 $578.00 $325.13 $143.40 N/A $419.05 $722.50 $722.50 $722.50 $150.57 $722.50 N/A N/A AR-1351C-01 SUP HCPCS C1713 AR-1351C-01 - SCREW INTFR 5MM 40MM STRL TRNFX STRNG BCMPS KN BOTH IP/OP $997.50 $738.00 $197.98 $997.50 $448.88 $448.88 $448.88 $448.88 $997.50 $997.50 $997.50 $207.90 $997.50 $997.50 $997.50 $997.50 $997.50 $207.89 $997.50 $430.92 $590.02 $997.50 $997.50 $997.50 $997.50 $748.13 $997.50 $997.50 $997.50 $498.75 $498.75 $790.02 $997.50 $798.00 $448.88 $197.98 N/A $578.55 $997.50 $598.50 $997.50 $207.88 $997.50 N/A N/A AR-1351C-02 SUP HCPCS C1713 AR-1351C-02 - SCREW INTFR 5MM 50MM STRL TRNFX STRNG BCMPS KN BOTH IP/OP $997.50 $738.00 $197.98 $997.50 $448.88 $448.88 $448.88 $448.88 $997.50 $997.50 $997.50 $207.90 $997.50 $997.50 $997.50 $997.50 $997.50 $207.89 $997.50 $430.92 $590.02 $997.50 $997.50 $997.50 $997.50 $748.13 $997.50 $997.50 $997.50 $498.75 $498.75 $790.02 $997.50 $798.00 $448.88 $197.98 N/A $578.55 $997.50 $997.50 $997.50 $207.88 $997.50 N/A N/A AR-1351K-CP SUP HCPCS C1713 AR-1351K-CP - SET IMPL 40MM TRNFX2 PK ACL BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $334.80 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $465.00 $775.00 $161.51 $775.00 N/A N/A AR-1351L SUP HCPCS C1713 AR-1351L - IMPLANT FX 3MM 50MM STRL TRNFX SLF CUT ST TI ACL BOTH IP/OP $395.00 $292.00 $78.40 $395.00 $177.75 $177.75 $177.75 $177.75 $395.00 $395.00 $395.00 $82.33 $395.00 $395.00 $395.00 $395.00 $395.00 $82.32 $395.00 $170.64 $233.64 $395.00 $395.00 $395.00 $395.00 $296.25 $395.00 $395.00 $395.00 $197.50 $197.50 $312.84 $395.00 $316.00 $177.75 $78.40 N/A $229.10 $395.00 $395.00 $395.00 $82.32 $395.00 N/A N/A AR-1351LB SUP HCPCS C1713 AR-1351LB - IMPLANT FX 5MM 50MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT BOTH IP/OP $722.50 $535.00 $143.40 $722.50 $325.13 $325.13 $325.13 $325.13 $722.50 $722.50 $722.50 $150.59 $722.50 $722.50 $722.50 $722.50 $722.50 $150.58 $722.50 $312.12 $427.36 $722.50 $722.50 $722.50 $722.50 $541.88 $722.50 $722.50 $722.50 $361.25 $361.25 $572.22 $722.50 $578.00 $325.13 $143.40 N/A $419.05 $722.50 $433.50 $722.50 $150.57 $722.50 N/A N/A AR-1351LBK-CP SUP HCPCS C1713 AR-1351LBK-CP - SET IMPL 50MM BTRNSF PK ACL BOTH IP/OP "$1,102.50" $816.00 $218.82 "$1,102.50" $496.13 $496.13 $496.13 $496.13 "$1,102.50" "$1,102.50" "$1,102.50" $229.79 "$1,102.50" "$1,102.50" "$1,102.50" "$1,102.50" "$1,102.50" $229.77 "$1,102.50" $476.28 $652.13 "$1,102.50" "$1,102.50" "$1,102.50" "$1,102.50" $826.88 "$1,102.50" "$1,102.50" "$1,102.50" $551.25 $551.25 $873.18 "$1,102.50" $882.00 $496.13 $218.82 N/A $639.45 "$1,102.50" $661.50 "$1,102.50" $229.76 "$1,102.50" N/A N/A AR-1351LBT SUP HCPCS C1713 AR-1351LBT - IMPLANT FX 3MM 50MM STRL BTRNSF 1 XPN AMRPH BABSR PUL OUT BOTH IP/OP $722.50 $535.00 $143.40 $722.50 $325.13 $325.13 $325.13 $325.13 $722.50 $722.50 $722.50 $150.59 $722.50 $722.50 $722.50 $722.50 $722.50 $150.58 $722.50 $289.00 $427.36 $722.50 $722.50 $722.50 $722.50 $541.88 $722.50 $722.50 $722.50 $361.25 $361.25 $572.22 $722.50 $578.00 $325.13 $143.40 N/A $419.05 $722.50 $433.50 $722.50 $150.57 $722.50 N/A N/A AR-1351LK-CP SUP HCPCS C1713 AR-1351LK-CP - SET IMPL 50MM TRNFX PK ACL BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $334.80 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $465.00 $775.00 $161.51 $775.00 N/A N/A AR-1355 SUP HCPCS C1713 AR-1355 - SCREW BONE GROOVE LP 6.5MM 25MM DEPTH MARK STEP DRILL BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $96.12 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $222.50 $222.50 $46.37 $222.50 N/A N/A AR-1355D SUP Custom 27203010 AR-1355D - DRILL SRG 25MM LSR D MRK STP KN LOPRFL CANC SCR BOTH IP/OP $205.00 $152.00 $36.49 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $36.49 $205.00 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $82.00 $205.00 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $205.00 N/A $118.90 $205.00 $123.00 $205.00 $205.00 $205.00 N/A N/A AR-1355NS SUP HCPCS C1713 AR-1355NS - SCREW BN LOPRFL 6.5MM 25MM NS SMTH SHNK TI ACL PCL CANC BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $89.00 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $133.50 $222.50 $46.37 $222.50 N/A N/A AR-1356 SUP HCPCS C1713 AR-1356 - SCREW BN GRV LOPRFL 6.5MM 30MM STRL D MRK STP DRL TI ACL/PCL BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $89.00 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $133.50 $222.50 $46.37 $222.50 N/A N/A AR-1356NS SUP HCPCS C1713 AR-1356NS - SCREW BN LOPRFL 6.5MM 30MM NS SMTH SHNK TI ACL PCL CANC BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $89.00 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $133.50 $222.50 $46.37 $222.50 N/A N/A AR-1357 SUP HCPCS C1713 AR-1357 - SCREW BN GRV LOPRFL 6.5MM 35MM STRL D MRK STP DRL TI ACL/PCL BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $133.50 $222.50 $46.37 $222.50 N/A N/A AR-1357B SUP HCPCS C1713 AR-1357B - POST FX 6.25MM 35MM STRL BPST WSHR POLY L LAC ACD ACL DISP BOTH IP/OP $675.00 $500.00 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $270.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 N/A $391.50 $675.00 $405.00 $675.00 $140.67 $675.00 N/A N/A AR-1357NS SUP HCPCS C1713 AR-1357NS - SCREW BN LOPRFL 6.5MM 35MM NS SMTH SHNK TI ACL PCL CANC BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $222.50 $222.50 $46.37 $222.50 N/A N/A AR-1358 SUP HCPCS C1713 AR-1358 - SCREW BN GRV LOPRFL 6.5MM 40MM STRL D MRK STP DRL TI ACL/PCL BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $89.00 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $222.50 $222.50 $46.37 $222.50 N/A N/A AR-1358NS SUP HCPCS C1713 AR-1358NS - SCREW BN LOPRFL 6.5MM 40MM NS SMTH SHNK TI ACL PCL CANC BOTH IP/OP $222.50 $165.00 $44.16 $222.50 $100.13 $100.13 $100.13 $100.13 $222.50 $222.50 $222.50 $46.37 $222.50 $222.50 $222.50 $222.50 $222.50 $46.37 $222.50 $89.00 $131.61 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $100.13 $44.16 N/A $129.05 $222.50 $133.50 $222.50 $46.37 $222.50 N/A N/A AR-1360B SUP HCPCS C1713 AR-1360B - SCREW INTFR 6MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $142.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $355.00 $355.00 N/A N/A AR-1360C SUP HCPCS C1713 AR-1360C - SCREW INTFR 6MM 23MM STRL CNN RDC HD BCMPS ACL PCL BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $122.44 $587.50 N/A N/A AR-1360C-CP SUP HCPCS C1713 AR-1360C-CP - SET IMPL 4.5MM 6MM CNN DRL GDPN INTFR SCR RMR TMPLT MPFL PK BOTH IP/OP "$3,717.50" "$2,751.00" $737.83 "$3,717.50" "$1,672.88" "$1,672.88" "$1,672.88" "$1,672.88" "$3,717.50" "$3,717.50" "$3,717.50" $774.82 "$3,717.50" "$3,717.50" "$3,717.50" "$3,717.50" "$3,717.50" $774.77 "$3,717.50" "$3,717.50" "$1,832.73" "$3,717.50" "$3,717.50" "$3,717.50" "$3,717.50" "$2,788.13" "$3,717.50" "$3,717.50" "$3,717.50" "$1,858.75" "$1,858.75" "$2,944.26" "$3,717.50" "$2,974.00" "$1,672.88" $737.83 N/A "$2,156.15" "$3,717.50" "$3,717.50" "$3,717.50" $774.73 "$3,717.50" N/A N/A AR-1360CST-CP SUP HCPCS C1713 AR-1360CST-CP - SET IMPL 1.1MM 3.5IN CNN CLS EYLT DRL PIN RMR TMPLT MPFL PK BOTH IP/OP "$4,217.50" "$3,121.00" $837.07 "$4,217.50" "$1,897.88" "$1,897.88" "$1,897.88" "$1,897.88" "$4,217.50" "$4,217.50" "$4,217.50" $879.03 "$4,217.50" "$4,217.50" "$4,217.50" "$4,217.50" "$4,217.50" $878.97 "$4,217.50" "$4,217.50" "$2,079.23" "$4,217.50" "$4,217.50" "$4,217.50" "$4,217.50" "$3,163.13" "$4,217.50" "$4,217.50" "$4,217.50" "$2,108.75" "$2,108.75" "$3,340.26" "$4,217.50" "$3,374.00" "$1,897.88" $837.07 N/A "$2,446.15" "$4,217.50" "$2,530.50" "$4,217.50" "$4,217.50" "$4,217.50" N/A N/A AR-1360E SUP HCPCS C1713 AR-1360E - SCREW INTFR 6MM 20MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $115.00 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-1360P SUP HCPCS C1713 AR-1360P - SCREW INTFR 6MM 23MM STRL THRD PTRN PEEK-OPTM ACL PCL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-1363 SUP HCPCS C1713 AR-1363 - SCREW INTFR 3MM 40MM STRL TRNFX SLF CUT ST TI ACL BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $198.72 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A AR-1363L SUP HCPCS C1713 AR-1363L - SCREW INTFR 3MM 50MM STRL TRNFX SLF CUT ST TI ACL BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $198.72 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $276.00 $460.00 $95.86 $460.00 N/A N/A AR-1365-25 SUP HCPCS C1713 AR-1365-25 - POST FIX LP 4.5MM 25MM SELF TAP THREAD TITANIUM KNEE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $108.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A AR-1365-275 SUP Custom 27203010 AR-1365-275 - POST FX LOPRFL 4.5MM 27.5MM STRL ST THRD TI KN BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365-30 SUP Custom 27203010 AR-1365-30 - POST FX LOPRFL 4.5MM 30MM STRL ST THRD TI KN BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365-325 SUP Custom 27203010 AR-1365-325 - POST FX LOPRFL 4.5MM 32.5MM ST THRD TI KN BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365-375 SUP Custom 27203010 AR-1365-375 - POST FX LOPRFL 4.5MM 37.5MM STRL ST THRD TI KN BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365-40 SUP Custom 27203010 AR-1365-40 - POST FX LOPRFL 4.5MM 40MM STRL ST THRD TI KN BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365-425 SUP Custom 27203010 AR-1365-425 - POST FX LOPRFL 4.5MM 42.5MM STRL ST THRD TI KN BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365-45 SUP Custom 27203010 AR-1365-45 - POST FX LOPRFL 4.5MM 45MM STRL ST THRD TI KN BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365-475 SUP Custom 27203010 AR-1365-475 - POST FX LOPRFL 4.5MM 47.5MM STRL ST THRD TI KN BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365-50 SUP Custom 27203010 AR-1365-50 - POST FX LOPRFL 4.5MM 50MM STRL ST THRD TI KN BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365-525 SUP Custom 27203010 AR-1365-525 - POST FX LOPRFL 4.5MM 52.5MM STRL ST THRD TI KN BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365-55 SUP Custom 27203010 AR-1365-55 - POST FX LOPRFL 4.5MM 55MM STRL ST THRD TI KN BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365-575 SUP Custom 27203010 AR-1365-575 - POST FX LOPRFL 4.5MM 57.5MM STRL ST THRD TI KN BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365-60 SUP Custom 27203010 AR-1365-60 - POST FX LOPRFL 4.5MM 60MM STRL ST THRD TI KN BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-25 SUP Custom 27203010 AR-1365NS-25 - POST FX LOPRFL 4.5MM 25MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-275 SUP Custom 27203010 AR-1365NS-275 - POST FX LOPRFL 4.5MM 27.5MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-30 SUP Custom 27203010 AR-1365NS-30 - POST FX LOPRFL 4.5MM 30MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-325 SUP Custom 27203010 AR-1365NS-325 - POST FX LOPRFL 4.5MM 32.5MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-35 SUP Custom 27203010 AR-1365NS-35 - POST FX LOPRFL 4.5MM 35MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-375 SUP Custom 27203010 AR-1365NS-375 - POST FX LOPRFL 4.5MM 37.5MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-40 SUP Custom 27203010 AR-1365NS-40 - POST FX LOPRFL 4.5MM 40MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-425 SUP Custom 27203010 AR-1365NS-425 - POST FX LOPRFL 4.5MM 42.5MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-45 SUP Custom 27203010 AR-1365NS-45 - POST FX LOPRFL 4.5MM 45MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-475 SUP Custom 27203010 AR-1365NS-475 - POST FX LOPRFL 4.5MM 47.5MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-50 SUP Custom 27203010 AR-1365NS-50 - POST FX LOPRFL 4.5MM 50MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-525 SUP Custom 27203010 AR-1365NS-525 - POST FX LOPRFL 4.5MM 52.5MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-55 SUP Custom 27203010 AR-1365NS-55 - POST FX LOPRFL 4.5MM 55MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-575 SUP Custom 27203010 AR-1365NS-575 - POST FX LOPRFL 4.5MM 57.5MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1365NS-60 SUP Custom 27203010 AR-1365NS-60 - POST FX LOPRFL 4.5MM 60MM NS TI ACL PCL BCORT BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1366-30 SUP Custom 27203010 AR-1366-30 - POST FX LOPRFL 6.5MM 30MM STRL ST THRD TI KN BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366-32 SUP Custom 27203010 AR-1366-32 - POST FX LOPRFL 6.5MM 32MM STRL ST THRD TI KN BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366-34 SUP Custom 27203010 AR-1366-34 - POST FX LOPRFL 6.5MM 34MM STRL ST THRD TI KN BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366-36 SUP Custom 27203010 AR-1366-36 - POST FX LOPRFL 6.5MM 36MM STRL ST THRD TI KN BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366-38 SUP Custom 27203010 AR-1366-38 - POST FX LOPRFL 6.5MM 38MM STRL ST THRD TI KN BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366-40 SUP Custom 27203010 AR-1366-40 - POST FX LOPRFL 6.5MM 40MM STRL ST THRD TI KN BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366-42 SUP Custom 27203010 AR-1366-42 - POST FX LOPRFL 6.5MM 42MM STRL ST THRD TI KN BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366-44 SUP Custom 27203010 AR-1366-44 - POST FX LOPRFL 6.5MM 44MM ST THRD TI KN BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366-46 SUP Custom 27203010 AR-1366-46 - POST FX LOPRFL 6.5MM 46MM STRL ST THRD TI KN BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366-48 SUP Custom 27203010 AR-1366-48 - POST FX LOPRFL 6.5MM 48MM STRL ST THRD TI KN BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366-50 SUP Custom 27203010 AR-1366-50 - POST FX LOPRFL 6.5MM 50MM ST THRD TI KN BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366-52 SUP Custom 27203010 AR-1366-52 - POST FX LOPRFL 6.5MM 52MM STRL ST THRD TI KN BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366NS-30 SUP Custom 27203010 AR-1366NS-30 - POST FX LOPRFL 6.5MM 30MM NS TI ACL PCL BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366NS-32 SUP Custom 27203010 AR-1366NS-32 - POST FX LOPRFL 6.5MM 32MM NS TI ACL PCL BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366NS-34 SUP Custom 27203010 AR-1366NS-34 - POST FX LOPRFL 6.5MM 34MM NS TI ACL PCL BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366NS-36 SUP Custom 27203010 AR-1366NS-36 - POST FX LOPRFL 6.5MM 36MM NS TI ACL PCL BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366NS-38 SUP Custom 27203010 AR-1366NS-38 - POST FX LOPRFL 6.5MM 38MM NS TI ACL PCL BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366NS-40 SUP Custom 27203010 AR-1366NS-40 - POST FX LOPRFL 6.5MM 40MM NS TI ACL PCL BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366NS-42 SUP Custom 27203010 AR-1366NS-42 - POST FX LOPRFL 6.5MM 42MM NS TI ACL PCL BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366NS-44 SUP Custom 27203010 AR-1366NS-44 - POST FX LOPRFL 6.5MM 44MM NS TI ACL PCL BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366NS-46 SUP Custom 27203010 AR-1366NS-46 - POST FX LOPRFL 6.5MM 46MM NS TI ACL PCL BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366NS-48 SUP Custom 27203010 AR-1366NS-48 - POST FX LOPRFL 6.5MM 48MM NS TI ACL PCL BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1366NS-50 SUP Custom 27203010 AR-1366NS-50 - POST FX LOPRFL 6.5MM 50MM NS TI ACL PCL BCORT BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1367D SUP Custom 27203010 AR-1367D - BIT DRL 4.8MM 6.5MM POST BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $221.40 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1370 SUP HCPCS C1713 "AR-1370 - SCREW, CANNULATED INTERFERENCE" BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-1370B SUP HCPCS C1713 AR-1370B - SCREW INTFR 7MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $355.00 $355.00 N/A N/A AR-1370C SUP HCPCS C1713 AR-1370C - SCREW INTERFERENCE 7MM 23MM CANN REDUCE HEAD BIOCOMPOSITE BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $253.80 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $122.44 $587.50 N/A N/A AR-1370E SUP HCPCS C1713 AR-1370E - SCREW INTFR 7MM 20MM STRL CNN DISP SHTH TI ACL PCL ACPT 2MM BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $115.00 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-1370H-25 SUP HCPCS C1713 AR-1370H-25 - SCREW INTFR BLNT RND 7MM 25MM STRL CNN SFT TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-1370H-30 SUP HCPCS C1713 AR-1370H-30 - SCREW INTFR BLNT RND 7MM 30MM STRL CNN SFT TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1370P SUP HCPCS C1713 AR-1370P - SCREW INTFR 7MM 23MM STRL PEEK-OPTM BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-1370T SUP HCPCS C1713 AR-1370T - SCREW INTFR FT RND 7MM 20MM STRL CNN RECON TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $237.50 $237.50 N/A N/A AR-1370TB SUP HCPCS C1713 AR-1370TB - SCREW INTFR FT 7MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $355.00 $355.00 N/A N/A AR-1370TC SUP HCPCS C1713 AR-1370TC - SCREW INTFR FT STP TPR 7MM 28MM STRL CNN FULL SEAT RDC HD BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $122.44 $587.50 N/A N/A AR-1371 SUP HCPCS C1713 AR-1371 - SCREW INTFR 7MM 25MM STRL CNN TI ACL PCL BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-13710-03.0 SUP HCPCS C1713 AR-13710-03.0 - PLATE BN STRG 3MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13710-05.0 SUP HCPCS C1713 AR-13710-05.0 - PLATE BN STRG 5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13710-07.5 SUP HCPCS C1713 AR-13710-07.5 - PLATE BN STRG 7.5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13710-09.0 SUP HCPCS C1713 AR-13710-09.0 - PLATE BN STRG 9MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13710-10.0 SUP HCPCS C1713 AR-13710-10.0 - PLATE BN STRG 10MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13710-11.0 SUP HCPCS C1713 AR-13710-11.0 - PLATE BN STRG 11MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13710-12.5 SUP HCPCS C1713 AR-13710-12.5 - PLATE BN STRG 12.5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13710-15.0 SUP HCPCS C1713 AR-13710-15.0 - PLATE BN STRG 15MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A AR-13710-17.5 SUP HCPCS C1713 AR-13710-17.5 - PLATE BN STRG 17.5MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13715-03.0 SUP HCPCS C1713 AR-13715-03.0 - PLATE BN STRG 3MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13715-05.0 SUP HCPCS C1713 AR-13715-05.0 - PLATE BN STRG 5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13715-07.5 SUP HCPCS C1713 AR-13715-07.5 - PLATE BN STRG 7.5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13715-09.0 SUP HCPCS C1713 AR-13715-09.0 - PLATE BN STRG 9MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13715-10.0 SUP HCPCS C1713 AR-13715-10.0 - PLATE BN STRG 10MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13715-11.0 SUP HCPCS C1713 AR-13715-11.0 - PLATE BN STRG 11MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13715-12.5 SUP HCPCS C1713 AR-13715-12.5 - PLATE BN STRG 12.5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13715-15.0 SUP HCPCS C1713 AR-13715-15.0 - PLATE BN STRG 15MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13715-17.5 SUP HCPCS C1713 AR-13715-17.5 - PLATE BN STRG 17.5MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A AR-1371E SUP HCPCS C1713 AR-1371E - SCREW INTFR 7MM 25MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-1371T SUP HCPCS C1713 AR-1371T - SCREW INTFR FT RND 7MM 25MM STRL CNN RECON TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-1372 SUP HCPCS C1713 AR-1372 - SCREW INTFR 7MM 30MM STRL BIOINTF CNN TI ACL PCL BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13720-05.0 SUP HCPCS C1713 AR-13720-05.0 - PLATE BN 5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13720-07.5 SUP HCPCS C1713 AR-13720-07.5 - PLATE BN 7.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A AR-13720-09.0 SUP HCPCS C1713 AR-13720-09.0 - PLATE BN 9MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13720-10.0 SUP HCPCS C1713 AR-13720-10.0 - PLATE BN 10MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13720-11.0 SUP HCPCS C1713 AR-13720-11.0 - PLATE BN 11MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A AR-13720-12.5 SUP HCPCS C1713 AR-13720-12.5 - PLATE BN 12.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13720-15.0 SUP HCPCS C1713 AR-13720-15.0 - PLATE BN 15MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13720-17.5 SUP HCPCS C1713 AR-13720-17.5 - PLATE BN 17.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A AR-13725-05.0 SUP HCPCS C1713 AR-13725-05.0 - PLATE BN 5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A AR-13725-07.5 SUP HCPCS C1713 AR-13725-07.5 - PLATE BN 7.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13725-09.0 SUP HCPCS C1713 AR-13725-09.0 - PLATE BN 9MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13725-10.0 SUP HCPCS C1713 AR-13725-10.0 - PLATE BN 10MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13725-11.0 SUP HCPCS C1713 AR-13725-11.0 - PLATE BN 11MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A AR-13725-12.5 SUP HCPCS C1713 AR-13725-12.5 - PLATE BN 12.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13725-15.0 SUP HCPCS C1713 AR-13725-15.0 - PLATE BN 15MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR SLOP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13725-17.5 SUP HCPCS C1713 AR-13725-17.5 - PLATE BN 17.5MM STRL CONTOURLOCK HTO PLT ANTEROPOSTERIOR BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A AR-1372E SUP HCPCS C1713 AR-1372E - SCREW INTFR 7MM 30MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $115.00 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-1372T SUP HCPCS C1713 AR-1372T - SCREW INTFR FT RND 7MM 30MM STRL CNN RECON TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-13730-01 SUP HCPCS C1713 AR-13730-01 - PLATE BN FLT 67MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A AR-13730-02 SUP HCPCS C1713 AR-13730-02 - PLATE BN FLT 71MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13730-03 SUP HCPCS C1713 AR-13730-03 - PLATE BN FLT 84MM STRL CONTOURLOCK HTO PLT TIB LT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A AR-13735-01 SUP HCPCS C1713 AR-13735-01 - PLATE BN FLT 67MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-13735-02 SUP HCPCS C1713 AR-13735-02 - PLATE BN FLT 71MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A AR-13735-03 SUP HCPCS C1713 AR-13735-03 - PLATE BN FLT 84MM STRL CONTOURLOCK HTO PLT TIB RT OPN WDG BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A AR-1375E SUP HCPCS C1713 AR-1375E - SCREW INTFR 7MM 15MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $115.00 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-1380 SUP HCPCS C1713 AR-1380 - SCREW INTFR 8MM 20MM STRL BIOINTF CNN TI ACL PCL BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-1380B SUP HCPCS C1713 AR-1380B - SCREW INTFR 8MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $73.98 $355.00 N/A N/A AR-1380E SUP HCPCS C1713 AR-1380E - SCREW INTERFERENCE 8MM 20MM CANN SHEATH TITANIUM ACL PCL BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $115.00 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-1380H-25 SUP HCPCS C1713 AR-1380H-25 - SCREW INTFR BLNT RND 8MM 25MM STRL CNN SFT TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-1380H-30 SUP HCPCS C1713 AR-1380H-30 - SCREW INTFR BLNT RND 8MM 30MM STRL CNN SFT TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-1380H-35 SUP HCPCS C1713 AR-1380H-35 - SCREW INTFR BLNT RND 8MM 35MM STRL CNN SFT TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1380HLU-25 SUP HCPCS C1713 AR-1380HLU-25 - SCREW SOFT CANN LFT HAND THD 8X25MM TI BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-1380P SUP HCPCS C1713 AR-1380P - SCREW INTFR 8MM 23MM STRL PEEK-OPTM BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-1380T SUP HCPCS C1713 AR-1380T - SCREW INTFR FT RND 8MM 20MM STRL CNN RECON TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1380TB SUP HCPCS C1713 AR-1380TB - SCREW INTFR FT 8MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $73.98 $355.00 N/A N/A AR-1380TC SUP HCPCS C1713 AR-1380TC - SCREW INTFR BLNT FT STP TPR 8MM 28MM STRL CNN FULL SEAT RDC BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $235.00 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $587.50 $587.50 N/A N/A AR-1381 SUP HCPCS C1713 AR-1381 - SCREW INTFR 8MM 25MM STRL BIOINTF CNN TI ACL PCL BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-1381T SUP HCPCS C1713 AR-1381T - SCREW INTFR FT RND 8MM 25MM STRL CNN RECON TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1382 SUP HCPCS C1713 AR-1382 - SCREW INTFR 8MM 30MM STRL BIOINTF CNN TI ACL PCL BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-1382T SUP HCPCS C1713 AR-1382T - SCREW INTFR FT RND 8MM 30MM STRL CNN RECON TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $237.50 $237.50 N/A N/A AR-1390 SUP HCPCS C1713 AR-1390 - SCREW INTFR 9MM 20MM STRL BIOINTF CNN TI ACL PCL BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-1390B SUP HCPCS C1713 AR-1390B - SCREW INTFR 9MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $73.98 $355.00 N/A N/A AR-1390E SUP HCPCS C1713 AR-1390E - SCREW INTERFERENCE 9MM 20MM CANN SHEATH TITANIUM ACL PCL BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-1390H-35 SUP HCPCS C1713 AR-1390H-35 - SCREW INTFR BLNT RND 9MM 35MM STRL CNN SFT TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1390P SUP HCPCS C1713 AR-1390P - SCREW INTFR 9MM 23MM STRL PEEK-OPTM BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-1390T SUP HCPCS C1713 AR-1390T - SCREW INTFR FT RND 9MM 20MM STRL CNN RECON TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-1390TB SUP HCPCS C1713 AR-1390TB - SCREW INTFR FT 9MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $142.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $355.00 $355.00 $73.98 $355.00 N/A N/A AR-1390TC SUP HCPCS C1713 AR-1390TC - SCREW INTERFERENCE BLUNT FULTHD STEP TAPER 9MM 28MM CANN BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $253.80 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $122.44 $587.50 N/A N/A AR-1391 SUP HCPCS C1713 AR-1391 - SCREW INTFR 9MM 25MM STRL BIOINTF CNN TI ACL PCL BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-1391E SUP HCPCS C1713 AR-1391E - SCREW INTFR 9MM 25MM STRL CNN DISP SHTH TI ACL PCL ACPT 2MM BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $115.00 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-1391T SUP HCPCS C1713 AR-1391T - SCREW INTFR FT RND 9MM 25MM STRL CNN RECON TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-1392 SUP HCPCS C1713 AR-1392 - SCREW INTFR RND 9MM 30MM STRL CNN TI ACL PCL BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-1392E SUP HCPCS C1713 AR-1392E - SCREW INTFR 9MM 30MM STRL CNN SHTH TI ACL PCL ACPT 2MM NTNL BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-1392T SUP HCPCS C1713 AR-1392T - SCREW INTFR FT RND 9MM 30MM STRL CNN RECON TI ACL PCL ACPT 2 BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-13991N SUP Custom 27203010 AR-13991N - NEEDLE SUTURE SCORPION SUREFIRE ROTATOR CUFF BOTH IP/OP $350.00 $259.00 $62.30 $756.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $756.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-13995N SUP Custom 27203010 AR-13995N - NEEDLE SUT MF SCRPN BOTH IP/OP $425.00 $315.00 $75.65 $918.00 $425.00 $425.00 $425.00 $425.00 $425.00 $425.00 $75.65 $425.00 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $918.00 $425.00 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $425.00 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A AR-1400 SUP HCPCS C1713 AR-1400 - SCREW INTFR 10MM 20MM STRL BIOINTF CNN TI ACL PCL BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-14003 SUP HCPCS C1713 AR-14003 - PLATE BN STRL SUTUREPLATE 3 HL HUM BOTH IP/OP "$3,737.50" "$2,766.00" $741.80 "$3,737.50" "$1,681.88" "$1,681.88" "$1,681.88" "$1,681.88" "$3,737.50" "$3,737.50" "$3,737.50" $778.99 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$1,614.60" "$1,842.59" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" $741.80 N/A "$2,167.75" "$3,737.50" "$2,242.50" "$3,737.50" "$3,737.50" "$3,737.50" N/A N/A AR-14005 SUP HCPCS C1713 AR-14005 - PLATE BN STRL SUTUREPLATE 5 HL HUM BOTH IP/OP "$3,987.50" "$2,951.00" $791.42 "$3,987.50" "$1,794.38" "$1,794.38" "$1,794.38" "$1,794.38" "$3,987.50" "$3,987.50" "$3,987.50" $831.09 "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" $831.04 "$3,987.50" "$1,722.60" "$1,965.84" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$2,990.63" "$3,987.50" "$3,987.50" "$3,987.50" "$1,993.75" "$1,993.75" "$3,158.10" "$3,987.50" "$3,190.00" "$1,794.38" $791.42 N/A "$2,312.75" "$3,987.50" "$3,987.50" "$3,987.50" $831.00 "$3,987.50" N/A N/A AR-1400B SUP HCPCS C1713 AR-1400B - SCREW INTFR 10MM 23MM STRL BIOINTF CNN SHTH POLY L LAC ACD BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $142.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $73.98 $355.00 N/A N/A AR-1400H-25 SUP HCPCS C1713 AR-1400H-25 - SCREW INTFR BLNT RND 10MM 25MM STRL CNN SFT TI ACL PCL ACPT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $237.50 $237.50 N/A N/A AR-1400H-30 SUP HCPCS C1713 AR-1400H-30 - SCREW INTFR BLNT RND 10MM 30MM STRL CNN SFT TI ACL PCL ACPT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1400H-35 SUP HCPCS C1713 AR-1400H-35 - SCREW INTFR BLNT RND 10MM 35MM STRL CNN SFT TI ACL PCL ACPT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-1400P SUP HCPCS C1713 AR-1400P - SCREW INTFR 10MM 23MM STRL PEEK-OPTM BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-1400T SUP HCPCS C1713 AR-1400T - SCREW INTFR FT RND 10MM 28MM STRL CNN RECON TI ACL PCL ACPT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1400TB SUP HCPCS C1713 AR-1400TB - SCREW INTFR FT 10MM 28MM STRL BIOINTF CNN POLY L LAC ACD ACL BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $142.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $73.98 $355.00 N/A N/A AR-1400TC SUP HCPCS C1713 AR-1400TC - SCREW INTFR BLNT FT STP TPR 10MM 28MM STRL CNN FULL SEAT RDC BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $235.00 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $122.44 $587.50 N/A N/A AR-1401 SUP HCPCS C1713 AR-1401 - SCREW INTFR 10MM 25MM STRL CNN TI ACL PCL DISP BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-14012 SUP Custom 27203010 AR-14012 - GUIDE DRL 2.5MM SUTUREPLATE THRD BOTH IP/OP "$1,062.50" $786.00 $189.13 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $189.13 "$1,062.50" "$1,062.50" $788.59 $788.59 $818.98 $553.56 $221.44 "$1,062.50" $459.00 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $690.63 "$1,062.50" N/A $616.25 "$1,062.50" $637.50 "$1,062.50" "$1,062.50" "$1,062.50" N/A N/A AR-1401T SUP HCPCS C1713 AR-1401T - SCREW INTFR FT RND 10MM 25MM STRL CNN RECON TI ACL PCL ACPT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-1402 SUP HCPCS C1713 AR-1402 - SCREW INTFR 10MM 30MM STRL BIOINTF CNN TI ACL PCL BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A AR-14029 SUP Custom 27203010 AR-14029 - GUIDE DRL 2.5MM BOTH IP/OP $662.50 $490.00 $117.93 $662.50 $662.50 $662.50 $662.50 $662.50 $662.50 $662.50 $117.93 $662.50 $662.50 $491.71 $491.71 $510.66 $345.16 $138.07 $662.50 $286.20 $662.50 $662.50 $662.50 $662.50 $662.50 $496.88 $662.50 $662.50 $662.50 $331.25 $331.25 $524.70 $662.50 $530.00 $430.63 $662.50 N/A $384.25 $662.50 $397.50 $662.50 $662.50 $662.50 N/A N/A AR-1402T SUP HCPCS C1713 AR-1402T - SCREW INTFR FT RND 10MM 30MM STRL CNN RECON TI ACL PCL ACPT BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1403TB SUP HCPCS C1713 AR-1403TB - SCREW INTFR FT 11MM 28MM STRL BIOINTF CNN BLNT POLY L LAC BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $142.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $355.00 $355.00 N/A N/A AR-1403TC SUP HCPCS C1713 AR-1403TC - SCREW INTFR FT STP TPR 11MM 28MM STRL CNN SEAT RDC HD BLNT BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1404TB SUP HCPCS C1713 AR-1404TB - SCREW INTFR FT 12MM 28MM STRL BIOINTF CNN BLNT POLY L LAC BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $142.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $73.98 $355.00 N/A N/A AR-1405LP SUP Custom 27203010 AR-1405LP - REAMER SRG LOPRFL 5MM STRL CNN ACL DISP BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1405LP-50 SUP Custom 27203010 AR-1405LP-50 - REAMER SURG LP 5.5MM CANN ACL STERILE DISPOSABLE BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1406LP SUP Custom 27203010 AR-1406LP - REAMER SRG LOPRFL 6MM STRL CNN ACL DISP BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1406LP-50 SUP Custom 27203010 AR-1406LP-50 - REAMER SRG LOPRFL 6.5MM STRL CNN ACL DISP BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1407LP SUP Custom 27203010 AR-1407LP - REAMER SURG LP 7MM CANN ACL STERILE DISPOSABLE BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1407LP-50 SUP Custom 27203010 AR-1407LP-50 - REAMER SURG LP 7.5MM CANN ACL STERILE DISPOSABLE BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1408LP SUP Custom 27203010 AR-1408LP - REAMER SURG LP 8MM CANN ACL STERILE DISPOSABLE BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1408LP-50 SUP Custom 27203010 AR-1408LP-50 - REAMER SURG LP 8.5MM CANN ACL STERILE DISPOSABLE BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1408LPF SUP Custom 27203010 AR-1408LPF - REAMER SRG LOPRFL 8MM LOW PROFILE BOTH IP/OP $712.50 $527.00 $126.83 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $126.83 $712.50 $712.50 $528.82 $528.82 $549.20 $371.21 $148.49 $712.50 $285.00 $712.50 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $463.13 $712.50 N/A $413.25 $712.50 $427.50 $712.50 $712.50 $712.50 N/A N/A AR-1408LPF-50 SUP Custom 27203010 AR-1408LPF-50 - REAMER SRG LOPRFL 8.5MM LOW PROFILE BOTH IP/OP $712.50 $527.00 $126.83 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $126.83 $712.50 $712.50 $528.82 $528.82 $549.20 $371.21 $148.49 $712.50 $285.00 $712.50 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $463.13 $712.50 N/A $413.25 $712.50 $427.50 $712.50 $712.50 $712.50 N/A N/A AR-1409LP SUP Custom 27203010 AR-1409LP - REAMER SURG LP 9MM CANN ACL STERILE DISPOSABLE BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1409LP-50 SUP Custom 27203010 AR-1409LP-50 - REAMER SURG LP 9.5MM CANN ACL STERILE DISPOSABLE BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1409LPF SUP Custom 27203010 AR-1409LPF - REAMER SRG LOPRFL 9MM LOW PROFILE BOTH IP/OP $712.50 $527.00 $126.83 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $126.83 $712.50 $712.50 $528.82 $528.82 $549.20 $371.21 $148.49 $712.50 $285.00 $712.50 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $463.13 $712.50 N/A $413.25 $712.50 $427.50 $712.50 $712.50 $712.50 N/A N/A AR-1409LPF-50 SUP Custom 27203010 AR-1409LPF-50 - REAMER SRG LOPRFL 9.5MM LOW PROFILE BOTH IP/OP $712.50 $527.00 $126.83 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $126.83 $712.50 $712.50 $528.82 $528.82 $549.20 $371.21 $148.49 $712.50 $285.00 $712.50 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $463.13 $712.50 N/A $413.25 $712.50 $427.50 $712.50 $712.50 $712.50 N/A N/A AR-1410LP SUP Custom 27203010 AR-1410LP - REAMER SURG LP 10MM CANN ACL STERILE DISPOSABLE BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1410LP-50 SUP Custom 27203010 AR-1410LP-50 - REAMER SURG LP 10.5MM CANN ACL STERILE DISPOSABLE BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1410LPF SUP Custom 27203010 AR-1410LPF - REAMER SRG LOPRFL 10MM LOW PROFILE BOTH IP/OP $712.50 $527.00 $126.83 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $126.83 $712.50 $712.50 $528.82 $528.82 $549.20 $371.21 $148.49 $712.50 $285.00 $712.50 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $463.13 $712.50 N/A $413.25 $712.50 $427.50 $712.50 $712.50 $712.50 N/A N/A AR-1410LPF-50 SUP Custom 27203010 AR-1410LPF-50 - REAMER SRG LOPRFL 10.5MM LOW PROFILE BOTH IP/OP $712.50 $527.00 $126.83 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $126.83 $712.50 $712.50 $528.82 $528.82 $549.20 $371.21 $148.49 $712.50 $285.00 $712.50 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $463.13 $712.50 N/A $413.25 $712.50 $427.50 $712.50 $712.50 $712.50 N/A N/A AR-14116 SUP HCPCS C1713 AR-14116 - SCREW BN LOPRFL 3.5MM 16MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14116NL SUP HCPCS C1713 AR-14116NL - SCREW BN LOPRFL 3.5MM 16MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $48.60 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-14118 SUP HCPCS C1713 AR-14118 - SCREW BN LOPRFL 3.5MM 18MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14118NL SUP HCPCS C1713 AR-14118NL - SCREW BN LOPRFL 3.5MM 18MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $48.60 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-1411LP SUP Custom 27203010 AR-1411LP - REAMER SURG LP 11MM CANN ACL STERILE DISPOSABLE BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1411LP-50 SUP Custom 27203010 AR-1411LP-50 - REAMER SRG LOPRFL 11.5MM STRL CNN ACL DISP BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1411LPF SUP Custom 27203010 AR-1411LPF - REAMER SRG LOPRFL 11MM LOW PROFILE BOTH IP/OP $712.50 $527.00 $126.83 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $126.83 $712.50 $712.50 $528.82 $528.82 $549.20 $371.21 $148.49 $712.50 $285.00 $712.50 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $463.13 $712.50 N/A $413.25 $712.50 $427.50 $712.50 $712.50 $712.50 N/A N/A AR-14120 SUP HCPCS C1713 AR-14120 - SCREW BN LOPRFL 3.5MM 20MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14120NL SUP HCPCS C1713 AR-14120NL - SCREW BN LOPRFL 3.5MM 20MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-14122 SUP HCPCS C1713 AR-14122 - SCREW BN LOPRFL 3.5MM 22MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14122NL SUP HCPCS C1713 AR-14122NL - SCREW BN LOPRFL 3.5MM 22MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-14124 SUP HCPCS C1713 AR-14124 - SCREW BN LOPRFL 3.5MM 24MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14124NL SUP HCPCS C1713 AR-14124NL - SCREW BN LOPRFL 3.5MM 24MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $112.50 $112.50 N/A N/A AR-14126 SUP HCPCS C1713 AR-14126 - SCREW BN LOPRFL 3.5MM 26MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14126NL SUP HCPCS C1713 AR-14126NL - SCREW BN LOPRFL 3.5MM 26MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $112.50 $112.50 N/A N/A AR-14128 SUP HCPCS C1713 AR-14128 - SCREW BN LOPRFL 3.5MM 28MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14128NL SUP HCPCS C1713 AR-14128NL - SCREW BN LOPRFL 3.5MM 28MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-1412LP SUP Custom 27203010 AR-1412LP - REAMER SRG LOPRFL 12MM STRL CNN ACL DISP BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1412LP-50 SUP Custom 27203010 AR-1412LP-50 - REAMER SRG LOPRFL 12.5MM STRL CNN ACL DISP BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-14130 SUP HCPCS C1713 AR-14130 - SCREW BN LOPRFL 3.5MM 30MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14130NL SUP HCPCS C1713 AR-14130NL - SCREW BN LOPRFL 3.5MM 30MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $112.50 $112.50 N/A N/A AR-14132 SUP HCPCS C1713 AR-14132 - SCREW BN LOPRFL 3.5MM 32MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14132NL SUP HCPCS C1713 AR-14132NL - SCREW BN LOPRFL 3.5MM 32MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $112.50 $112.50 N/A N/A AR-14134 SUP HCPCS C1713 AR-14134 - SCREW BN LOPRFL 3.5MM 34MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14134NL SUP HCPCS C1713 AR-14134NL - SCREW BN LOPRFL 3.5MM 34MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $48.60 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $112.50 $112.50 N/A N/A AR-14136 SUP HCPCS C1713 AR-14136 - SCREW BN LOPRFL 3.5MM 36MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14136NL SUP HCPCS C1713 AR-14136NL - SCREW BN LOPRFL 3.5MM 36MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $48.60 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-14138 SUP HCPCS C1713 AR-14138 - SCREW BN LOPRFL 3.5MM 38MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14138NL SUP HCPCS C1713 AR-14138NL - SCREW BN LOPRFL 3.5MM 38MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-1413LP SUP Custom 27203010 AR-1413LP - REAMER SRG LOPRFL 13MM STRL CNN ACL DISP BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-14140 SUP HCPCS C1713 AR-14140 - SCREW BN LOPRFL 3.5MM 40MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14140NL SUP HCPCS C1713 AR-14140NL - SCREW BN LOPRFL 3.5MM 40MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $112.50 $112.50 N/A N/A AR-14145 SUP HCPCS C1713 AR-14145 - SCREW BN LOPRFL 3.5MM 45MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14145NL SUP HCPCS C1713 AR-14145NL - SCREW BN LOPRFL 3.5MM 45MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $112.50 $112.50 N/A N/A AR-14150 SUP HCPCS C1713 AR-14150 - SCREW BN LOPRFL 3.5MM 50MM SUTUREPLATE LCK TI SHLDR CORT BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14150NL SUP HCPCS C1713 AR-14150NL - SCREW BN LOPRFL 3.5MM 50MM SUTUREPLATE TI SHLDR CORT ARTHPL BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-14224 SUP HCPCS C1713 AR-14224 - SCREW BN LOPRFL 4MM 24MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14226 SUP HCPCS C1713 AR-14226 - SCREW BN LOPRFL 4MM 26MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14228 SUP HCPCS C1713 AR-14228 - SCREW BN LOPRFL 4MM 28MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14230 SUP HCPCS C1713 AR-14230 - SCREW BN LOPRFL 4MM 30MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14232 SUP HCPCS C1713 AR-14232 - SCREW BN LOPRFL 4MM 32MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14234 SUP HCPCS C1713 AR-14234 - SCREW BN LOPRFL 4MM 34MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $280.00 $280.00 N/A N/A AR-14236 SUP HCPCS C1713 AR-14236 - SCREW BN LOPRFL 4MM 36MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $168.00 $280.00 $280.00 $280.00 N/A N/A AR-14238 SUP HCPCS C1713 AR-14238 - SCREW BN LOPRFL 4MM 38MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $168.00 $280.00 $280.00 $280.00 N/A N/A AR-14240 SUP HCPCS C1713 AR-14240 - SCREW BN LOPRFL 4MM 40MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $168.00 $280.00 $58.35 $280.00 N/A N/A AR-14242 SUP HCPCS C1713 AR-14242 - SCREW BN LOPRFL 4MM 42MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $168.00 $280.00 $280.00 $280.00 N/A N/A AR-14244 SUP HCPCS C1713 AR-14244 - SCREW BN LOPRFL 4MM 44MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $168.00 $280.00 $280.00 $280.00 N/A N/A AR-14246 SUP HCPCS C1713 AR-14246 - SCREW BN LOPRFL 4MM 46MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $168.00 $280.00 $58.35 $280.00 N/A N/A AR-14248 SUP HCPCS C1713 AR-14248 - SCREW BN LOPRFL 4MM 48MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $168.00 $280.00 $58.35 $280.00 N/A N/A AR-14250 SUP HCPCS C1713 AR-14250 - SCREW BN 4MM 50MM SUTUREPLATE LCK HUM CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14252 SUP HCPCS C1713 AR-14252 - SCREW BN LOPRFL 4MM 52MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14254 SUP HCPCS C1713 AR-14254 - SCREW BN LOPRFL 4MM 54MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-14256 SUP HCPCS C1713 AR-14256 - SCREW BN LOPRFL 4MM 56MM SUTUREPLATE LCK TI SHLDR CANC BOTH IP/OP $280.00 $207.00 $55.57 $302.40 $126.00 $126.00 $126.00 $126.00 $280.00 $280.00 $280.00 $58.36 $280.00 $280.00 $280.00 $280.00 $280.00 $58.36 $280.00 $302.40 $165.62 $280.00 $280.00 $280.00 $280.00 $210.00 $280.00 $280.00 $280.00 $140.00 $140.00 $221.76 $280.00 $224.00 $126.00 $55.57 N/A $162.40 $280.00 $280.00 $280.00 $58.35 $280.00 N/A N/A AR-1450 SUP Custom 27203010 AR-1450 - REAMER SRG 6MM STRL PILT HD BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1451 SUP Custom 27203010 AR-1451 - REAMER SURG 6.5MM PILOT HEAD STERILE BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $221.40 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1452 SUP Custom 27203010 AR-1452 - REAMER SRG 7MM STRL PILT HD BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1453 SUP Custom 27203010 AR-1453 - REAMER SRG 7.5MM STRL PILT HD BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1454 SUP Custom 27203010 AR-1454 - REAMER SRG 8MM STRL PILT HD BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1455 SUP Custom 27203010 AR-1455 - REAMER SRG 8.5MM STRL PILT HD BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1456 SUP Custom 27203010 AR-1456 - REAMER SRG 9MM STRL PILT HD BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1457 SUP Custom 27203010 AR-1457 - REAMER SRG 9.5MM STRL PILT HD BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1458 SUP Custom 27203010 AR-1458 - REAMER SRG 10MM STRL PILT HD BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1502 SUP Custom 27203010 AR-1502 - INSERT PSTN CSHN FM LG HLDR BOTH IP/OP $662.50 $490.00 $117.93 $662.50 $662.50 $662.50 $662.50 $662.50 $662.50 $662.50 $117.93 $662.50 $662.50 $491.71 $491.71 $510.66 $345.16 $138.07 $662.50 $265.00 $662.50 $662.50 $662.50 $662.50 $662.50 $496.88 $662.50 $662.50 $662.50 $331.25 $331.25 $524.70 $662.50 $530.00 $430.63 $662.50 N/A $384.25 $662.50 $397.50 $662.50 $662.50 $662.50 N/A N/A AR-1510FL SUP Custom 27203010 AR-1510FL - GUIDE DRL RETROCONSTRUCTION SET ADJ C RING FTPRNT SLV FEM LT BOTH IP/OP "$1,365.00" "$1,010.00" $242.97 "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" $242.97 "$1,365.00" "$1,365.00" "$1,013.10" "$1,013.10" "$1,052.14" $711.17 $284.48 "$1,365.00" $589.68 "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,023.75" "$1,365.00" "$1,365.00" "$1,365.00" $682.50 $682.50 "$1,081.08" "$1,365.00" "$1,092.00" $887.25 "$1,365.00" N/A $791.70 "$1,365.00" $819.00 "$1,365.00" "$1,365.00" "$1,365.00" N/A N/A AR-1510FLS SUP Custom 27203010 AR-1510FLS - GUIDE DRL ANG SM RETROCONSTRUCTION FTPRNT FEM LT ACL BOTH IP/OP "$2,434.00" "$1,801.00" $433.21 "$2,433.75" "$2,433.75" "$2,433.75" "$2,433.75" "$2,433.75" "$2,433.75" "$2,433.75" $433.21 "$2,433.75" "$2,433.75" "$1,806.33" "$1,806.33" "$1,875.93" "$1,267.98" $507.22 "$2,433.75" "$1,051.38" "$2,433.75" "$2,433.75" "$2,433.75" "$2,433.75" "$2,433.75" "$1,825.50" "$2,433.75" "$2,433.75" "$2,433.75" "$1,216.88" "$1,216.88" "$1,927.53" "$2,433.75" "$1,947.00" "$1,581.94" "$2,433.75" N/A "$1,411.72" "$2,433.75" "$1,460.25" "$2,433.75" "$2,433.75" "$2,433.75" N/A N/A AR-1510FPL SUP Custom 27203010 AR-1510FPL - GUIDE DRL 7MM OFST RETROCONSTRUCTION FTPRNT FEM LT ACL BOTH IP/OP "$1,365.00" "$1,010.00" $242.97 "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" $242.97 "$1,365.00" "$1,365.00" "$1,013.10" "$1,013.10" "$1,052.14" $711.17 $284.48 "$1,365.00" $589.68 "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,023.75" "$1,365.00" "$1,365.00" "$1,365.00" $682.50 $682.50 "$1,081.08" "$1,365.00" "$1,092.00" $887.25 "$1,365.00" N/A $791.70 "$1,365.00" $819.00 "$1,365.00" "$1,365.00" "$1,365.00" N/A N/A AR-1510FPR SUP Custom 27203010 AR-1510FPR - GUIDE DRL 7MM OFST RETROCONSTRUCTION FTPRNT FEM RT ACL BOTH IP/OP "$1,365.00" "$1,010.00" $242.97 "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" $242.97 "$1,365.00" "$1,365.00" "$1,013.10" "$1,013.10" "$1,052.14" $711.17 $284.48 "$1,365.00" $589.68 "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,023.75" "$1,365.00" "$1,365.00" "$1,365.00" $682.50 $682.50 "$1,081.08" "$1,365.00" "$1,092.00" $887.25 "$1,365.00" N/A $791.70 "$1,365.00" $819.00 "$1,365.00" "$1,365.00" "$1,365.00" N/A N/A AR-1510FR SUP Custom 27203010 AR-1510FR - GUIDE DRL RETROCONSTRUCTION SET ADJ C RING FTPRNT SLV FEM RT BOTH IP/OP "$1,365.00" "$1,010.00" $242.97 "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" $242.97 "$1,365.00" "$1,365.00" "$1,013.10" "$1,013.10" "$1,052.14" $711.17 $284.48 "$1,365.00" $589.68 "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,365.00" "$1,023.75" "$1,365.00" "$1,365.00" "$1,365.00" $682.50 $682.50 "$1,081.08" "$1,365.00" "$1,092.00" $887.25 "$1,365.00" N/A $791.70 "$1,365.00" $819.00 "$1,365.00" "$1,365.00" "$1,365.00" N/A N/A AR-1510FRS SUP Custom 27203010 AR-1510FRS - GUIDE DRL ANG SM RETROCONSTRUCTION FTPRNT FEM RT ACL BOTH IP/OP "$2,434.00" "$1,801.00" $433.21 "$2,433.75" "$2,433.75" "$2,433.75" "$2,433.75" "$2,433.75" "$2,433.75" "$2,433.75" $433.21 "$2,433.75" "$2,433.75" "$1,806.33" "$1,806.33" "$1,875.93" "$1,267.98" $507.22 "$2,433.75" "$1,051.38" "$2,433.75" "$2,433.75" "$2,433.75" "$2,433.75" "$2,433.75" "$1,825.50" "$2,433.75" "$2,433.75" "$2,433.75" "$1,216.88" "$1,216.88" "$1,927.53" "$2,433.75" "$1,947.00" "$1,581.94" "$2,433.75" N/A "$1,411.72" "$2,433.75" "$1,460.25" "$2,433.75" "$2,433.75" "$2,433.75" N/A N/A AR-1530BC SUP HCPCS C1713 AR-1530BC - SCREW INTFR 3MM 8MM STRL TENODESIS HNDL INSRTR BCMPS SFT TIS BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $562.50 $937.50 $195.38 $937.50 N/A N/A AR-1530C-25 SUP Custom 27203010 AR-1530C-25 - BIT DRL 2.5MM CNN BOTH IP/OP $412.50 $305.00 $73.43 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $73.43 $412.50 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $178.20 $412.50 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $412.50 N/A $239.25 $412.50 $247.50 $412.50 $412.50 $412.50 N/A N/A AR-1530DS SUP Custom 27203010 AR-1530DS - KIT INST 2-0 .041IN 2.5MM BTNDS FWR NDL CNN DRL SUT PASS WRE BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A AR-1530P-CP SUP HCPCS C1713 AR-1530P-CP - SYSTEM IMPL STRL INTERNALBRACE PEEK FOREFOOT BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,569.38" "$1,569.38" "$1,569.38" "$1,569.38" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$1,506.60" "$1,719.34" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" $692.18 N/A "$2,022.75" "$3,487.50" "$3,487.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A AR-1530PS SUP HCPCS C1713 AR-1530PS - SCREW INTFR 3MM 8MM STRL TENODESIS HNDL INSRTR VNT PEEK-OPTM BOTH IP/OP $912.50 $675.00 $181.11 $912.50 $410.63 $410.63 $410.63 $410.63 $912.50 $912.50 $912.50 $190.19 $912.50 $912.50 $912.50 $912.50 $912.50 $190.18 $912.50 $365.00 $539.74 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $410.63 $181.11 N/A $529.25 $912.50 $547.50 $912.50 $190.17 $912.50 N/A N/A AR-1540B SUP HCPCS C1713 AR-1540B - SCREW INTFR 4MM 10MM STRL BTNDS RECON POLY L LAC ACD ACL PCL BOTH IP/OP $787.50 $583.00 $156.30 $787.50 $354.38 $354.38 $354.38 $354.38 $787.50 $787.50 $787.50 $164.13 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $340.20 $465.81 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $156.30 N/A $456.75 $787.50 $472.50 $787.50 $787.50 $787.50 N/A N/A AR-1540BC SUP HCPCS C1713 AR-1540BC - SCREW INTFR 4MM 10MM STRL TENODESIS BCMPS ACL BOTH IP/OP $862.50 $638.00 $171.18 $862.50 $388.13 $388.13 $388.13 $388.13 $862.50 $862.50 $862.50 $179.77 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $510.17 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $171.18 N/A $500.25 $862.50 $517.50 $862.50 $179.75 $862.50 N/A N/A AR-1540CDS SUP HCPCS C1713 AR-1540CDS - SCREW INTFR 4MM 10MM TENODESIS SCR DISP DRVR PK BCMPS BOTH IP/OP "$4,812.50" "$3,561.00" $955.16 "$4,812.50" "$2,165.63" "$2,165.63" "$2,165.63" "$2,165.63" "$4,812.50" "$4,812.50" "$4,812.50" "$1,003.05" "$4,812.50" "$4,812.50" "$4,812.50" "$4,812.50" "$4,812.50" "$1,002.98" "$4,812.50" "$4,812.50" "$2,372.56" "$4,812.50" "$4,812.50" "$4,812.50" "$4,812.50" "$3,609.38" "$4,812.50" "$4,812.50" "$4,812.50" "$2,406.25" "$2,406.25" "$3,811.50" "$4,812.50" "$3,850.00" "$2,165.63" $955.16 N/A "$2,791.25" "$4,812.50" "$2,887.50" "$4,812.50" "$1,002.93" "$4,812.50" N/A N/A AR-1540PS SUP HCPCS C1713 AR-1540PS - SCREW INTFR 4MM 10MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL BOTH IP/OP $787.50 $583.00 $156.30 $787.50 $354.38 $354.38 $354.38 $354.38 $787.50 $787.50 $787.50 $164.13 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $315.00 $465.81 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $156.30 N/A $456.75 $787.50 $787.50 $787.50 $787.50 $787.50 N/A N/A AR-1547BC SUP HCPCS C1713 AR-1547BC - SCREW INTFR 4.75MM 15MM STRL TENODESIS BCMPS ACL BOTH IP/OP $862.50 $638.00 $171.18 $862.50 $388.13 $388.13 $388.13 $388.13 $862.50 $862.50 $862.50 $179.77 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $510.17 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $171.18 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A AR-1547CDS SUP HCPCS C1713 AR-1547CDS - SCREW INTFR 4.75MM 15MM TENODESIS SCR DISP DRVR PK BCMPS BOTH IP/OP "$4,812.50" "$3,561.00" $955.16 "$4,812.50" "$2,165.63" "$2,165.63" "$2,165.63" "$2,165.63" "$4,812.50" "$4,812.50" "$4,812.50" "$1,003.05" "$4,812.50" "$4,812.50" "$4,812.50" "$4,812.50" "$4,812.50" "$1,002.98" "$4,812.50" "$1,925.00" "$2,372.56" "$4,812.50" "$4,812.50" "$4,812.50" "$4,812.50" "$3,609.38" "$4,812.50" "$4,812.50" "$4,812.50" "$2,406.25" "$2,406.25" "$3,811.50" "$4,812.50" "$3,850.00" "$2,165.63" $955.16 N/A "$2,791.25" "$4,812.50" "$4,812.50" "$4,812.50" "$4,812.50" "$4,812.50" N/A N/A AR-1547PS SUP HCPCS C1713 AR-1547PS - SCREW INTFR 4.75MM 15MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL BOTH IP/OP $787.50 $583.00 $156.30 $787.50 $354.38 $354.38 $354.38 $354.38 $787.50 $787.50 $787.50 $164.13 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $315.00 $465.81 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $156.30 N/A $456.75 $787.50 $472.50 $787.50 $787.50 $787.50 N/A N/A AR-1555BC SUP HCPCS C1713 AR-1555BC - SCREW INTFR 5.5MM 15MM STRL TENODESIS BCMPS ACL BOTH IP/OP $862.50 $638.00 $171.18 $862.50 $388.13 $388.13 $388.13 $388.13 $862.50 $862.50 $862.50 $179.77 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $862.50 $510.17 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $171.18 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A AR-1555CDS-1 SUP HCPCS C1713 AR-1555CDS-1 - SCREW BN 5.5MM 15MM STRL ARTHX DISP DRVR BCMPS TENODESIS BOTH IP/OP $962.50 $712.00 $191.03 $962.50 $433.13 $433.13 $433.13 $433.13 $962.50 $962.50 $962.50 $200.61 $962.50 $962.50 $962.50 $962.50 $962.50 $200.60 $962.50 $385.00 $569.32 $962.50 $962.50 $962.50 $962.50 $721.88 $962.50 $962.50 $962.50 $481.25 $481.25 $762.30 $962.50 $770.00 $433.13 $191.03 N/A $558.25 $962.50 $577.50 $962.50 $962.50 $962.50 N/A N/A AR-1555PS SUP HCPCS C1713 AR-1555PS - SCREW INTFR 5.5MM 15MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL BOTH IP/OP $787.50 $583.00 $156.30 $850.50 $354.38 $354.38 $354.38 $354.38 $787.50 $787.50 $787.50 $164.13 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $850.50 $465.81 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $156.30 N/A $456.75 $787.50 $472.50 $787.50 $164.12 $787.50 N/A N/A AR-1562BC SUP HCPCS C1713 AR-1562BC - SCREW INTFR 6.25MM 15MM STRL TENODESIS BCMPS ACL BOTH IP/OP $862.50 $638.00 $171.18 $862.50 $388.13 $388.13 $388.13 $388.13 $862.50 $862.50 $862.50 $179.77 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $862.50 $510.17 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $171.18 N/A $500.25 $862.50 $862.50 $862.50 $179.75 $862.50 N/A N/A AR-1562CDS SUP HCPCS C1713 AR-1562CDS - SCREW INTFR 6.25MM 15MM TENODESIS SCR DISP DRVR PK BCMPS BOTH IP/OP "$4,812.50" "$3,561.00" $955.16 "$4,812.50" "$2,165.63" "$2,165.63" "$2,165.63" "$2,165.63" "$4,812.50" "$4,812.50" "$4,812.50" "$1,003.05" "$4,812.50" "$4,812.50" "$4,812.50" "$4,812.50" "$4,812.50" "$1,002.98" "$4,812.50" "$1,925.00" "$2,372.56" "$4,812.50" "$4,812.50" "$4,812.50" "$4,812.50" "$3,609.38" "$4,812.50" "$4,812.50" "$4,812.50" "$2,406.25" "$2,406.25" "$3,811.50" "$4,812.50" "$3,850.00" "$2,165.63" $955.16 N/A "$2,791.25" "$4,812.50" "$2,887.50" "$4,812.50" "$1,002.93" "$4,812.50" N/A N/A AR-1562PS SUP HCPCS C1713 AR-1562PS - SCREW INTFR 6.25MM 15MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL BOTH IP/OP $787.50 $583.00 $156.30 $850.50 $354.38 $354.38 $354.38 $354.38 $787.50 $787.50 $787.50 $164.13 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $850.50 $465.81 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $156.30 N/A $456.75 $787.50 $472.50 $787.50 $164.12 $787.50 N/A N/A AR-1570BC SUP HCPCS C1713 AR-1570BC - SCREW INTFR 7MM 23MM STRL TENODESIS BCMPS ACL BOTH IP/OP $862.50 $638.00 $171.18 $862.50 $388.13 $388.13 $388.13 $388.13 $862.50 $862.50 $862.50 $179.77 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $510.17 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $171.18 N/A $500.25 $862.50 $517.50 $862.50 $179.75 $862.50 N/A N/A AR-1570PS SUP HCPCS C1713 AR-1570PS - SCREW INTFR 7MM 23MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL BOTH IP/OP $787.50 $583.00 $156.30 $787.50 $354.38 $354.38 $354.38 $354.38 $787.50 $787.50 $787.50 $164.13 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $315.00 $465.81 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $156.30 N/A $456.75 $787.50 $472.50 $787.50 $164.12 $787.50 N/A N/A AR-1580BC SUP HCPCS C1713 AR-1580BC - SCREW INTFR 8MM 23MM STRL TENODESIS BCMPS ACL BOTH IP/OP $862.50 $638.00 $171.18 $862.50 $388.13 $388.13 $388.13 $388.13 $862.50 $862.50 $862.50 $179.77 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $510.17 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $171.18 N/A $500.25 $862.50 $517.50 $862.50 $179.75 $862.50 N/A N/A AR-1580PS SUP HCPCS C1713 AR-1580PS - SCREW INTFR 8MM 23MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL BOTH IP/OP $787.50 $583.00 $156.30 $787.50 $354.38 $354.38 $354.38 $354.38 $787.50 $787.50 $787.50 $164.13 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $315.00 $465.81 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $156.30 N/A $456.75 $787.50 $787.50 $787.50 $164.12 $787.50 N/A N/A AR-1586FR-07 SUP HCPCS C1713 AR-1586FR-07 - SCREW INTFR 7MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A AR-1586FR-08 SUP HCPCS C1713 AR-1586FR-08 - SCREW INTFR 8MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-1586FR-09 SUP HCPCS C1713 AR-1586FR-09 - SCREW INTFR 9MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A AR-1586FR-10 SUP HCPCS C1713 AR-1586FR-10 - SCREW INTFR 10MM 20MM STRL RETROSCREW 2 BNDL RECON RVRS THRD BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A AR-1586FRB-07 SUP HCPCS C1713 AR-1586FRB-07 - SCREW INTFR 7MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $485.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-1586FRB-08 SUP HCPCS C1713 AR-1586FRB-08 - SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-1586FRB-09 SUP HCPCS C1713 AR-1586FRB-09 - SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $485.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $485.00 $485.00 N/A N/A AR-1586FRB-10 SUP HCPCS C1713 AR-1586FRB-10 - SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $485.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-1586LB-08 SUP HCPCS C1713 AR-1586LB-08 - SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-1586LB-09 SUP HCPCS C1713 AR-1586LB-09 - SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $485.00 $485.00 $485.00 $485.00 N/A N/A AR-1586LB-10 SUP HCPCS C1713 AR-1586LB-10 - SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-1586R-08 SUP HCPCS C1713 AR-1586R-08 - SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN TI BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-1586R-09 SUP HCPCS C1713 AR-1586R-09 - SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN TI BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-1586R-10 SUP HCPCS C1713 AR-1586R-10 - SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A AR-1586RB-06 SUP HCPCS C1713 AR-1586RB-06 - SCREW INTFR 6MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-1586RB-07 SUP HCPCS C1713 AR-1586RB-07 - SCREW INTFR 7MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $485.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-1586RB-08 SUP HCPCS C1713 AR-1586RB-08 - SCREW INTFR 8MM 20MM STRL RETROSCREW RECON RVRS THRD POLY L BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $485.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-1586RB-09 SUP HCPCS C1713 AR-1586RB-09 - SCREW INTFR 9MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $485.00 $485.00 $101.07 $485.00 N/A N/A AR-1586RB-10 SUP HCPCS C1713 AR-1586RB-10 - SCREW INTFR 10MM 20MM STRL RETROSCREW RECON RVRS THRD DSGN BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-1586RC-07 SUP HCPCS C1713 AR-1586RC-07 - SCREW INTFR 20MM 7MM STRL RETROSCREW RVRS THRD DSGN BCMPS BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1586RC-08 SUP HCPCS C1713 AR-1586RC-08 - SCREW INTFR 20MM 8MM STRL RETROSCREW RVRS THRD DSGN BCMPS BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $122.44 $587.50 N/A N/A AR-1586RC-09 SUP HCPCS C1713 AR-1586RC-09 - SCREW INTFR 20MM 9MM STRL RETROSCREW RVRS THRD DSGN BCMPS BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $122.44 $587.50 N/A N/A AR-1586RC-10 SUP HCPCS C1713 AR-1586RC-10 - SCREW INTFR 10MM 20MM STRL RETROSCREW ACL RVRS THRD DSGN BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $122.44 $587.50 N/A N/A AR-1587S SUP Custom 27203010 AR-1587S - KIT INST STRL ALL INSD ACL DISP BOTH IP/OP "$1,182.50" $875.00 $210.49 "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" $210.49 "$1,182.50" "$1,182.50" $877.65 $877.65 $911.47 $616.08 $246.45 "$1,182.50" $473.00 "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" "$1,182.50" $886.88 "$1,182.50" "$1,182.50" "$1,182.50" $591.25 $591.25 $936.54 "$1,182.50" $946.00 $768.63 "$1,182.50" N/A $685.85 "$1,182.50" $709.50 "$1,182.50" "$1,182.50" "$1,182.50" N/A N/A AR-1588-15 SUP HCPCS C1763 AR-1588-15 - BUTTON FX 12MM STRL 15MM RETROBUTTON LOOP SLF FLP TI UHMWPE BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1588-25 SUP HCPCS C1763 AR-1588-25 - BUTTON FX 12MM STRL 25MM RETROBUTTON LOOP SLF FLP TI UHMWPE BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1588-25BT SUP HCPCS C1763 AR-1588-25BT - BUTTON FX 12MM STRL 25MM RETROBUTTON LOOP SLF FLP TI UHMWPE BOTH IP/OP $762.50 $564.00 $151.34 $762.50 $343.13 $343.13 $343.13 $343.13 $762.50 $762.50 $762.50 $158.92 $762.50 $762.50 $762.50 $762.50 $762.50 $158.91 $762.50 $762.50 $451.02 $762.50 $762.50 $762.50 $762.50 $571.88 $762.50 $762.50 $762.50 $381.25 $381.25 $603.90 $762.50 $610.00 $343.13 $151.34 N/A $442.25 $762.50 $762.50 $762.50 $158.91 $762.50 N/A N/A AR-1588-30BT SUP HCPCS C1763 AR-1588-30BT - BUTTON FX 12MM STRL 30MM RETROBUTTON LOOP SLF FLP TI UHMWPE BOTH IP/OP $762.50 $564.00 $151.34 $762.50 $343.13 $343.13 $343.13 $343.13 $762.50 $762.50 $762.50 $158.92 $762.50 $762.50 $762.50 $762.50 $762.50 $158.91 $762.50 $762.50 $451.02 $762.50 $762.50 $762.50 $762.50 $571.88 $762.50 $762.50 $762.50 $381.25 $381.25 $603.90 $762.50 $610.00 $343.13 $151.34 N/A $442.25 $762.50 $762.50 $762.50 $158.91 $762.50 N/A N/A AR-1588-35 SUP HCPCS C1763 AR-1588-35 - BUTTON FX 12MM STRL 35MM RETROBUTTON LOOP SLF FLP TI UHMWPE BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1588-35BT SUP HCPCS C1763 AR-1588-35BT - BUTTON FX 12MM STRL 35MM RETROBUTTON LOOP SLF FLP TI UHMWPE BOTH IP/OP $762.50 $564.00 $151.34 $762.50 $343.13 $343.13 $343.13 $343.13 $762.50 $762.50 $762.50 $158.92 $762.50 $762.50 $762.50 $762.50 $762.50 $158.91 $762.50 $762.50 $451.02 $762.50 $762.50 $762.50 $762.50 $571.88 $762.50 $762.50 $762.50 $381.25 $381.25 $603.90 $762.50 $610.00 $343.13 $151.34 N/A $442.25 $762.50 $762.50 $762.50 $158.91 $762.50 N/A N/A AR-1588-40 SUP HCPCS C1763 AR-1588-40 - BUTTON FX 12MM STRL 40MM RETROBUTTON LOOP SLF FLP TI UHMWPE BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1588-45 SUP HCPCS C1763 AR-1588-45 - BUTTON FX 12MM STRL 45MM RETROBUTTON LOOP SLF FLP TI UHMWPE BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1588-50 SUP HCPCS C1763 AR-1588-50 - BUTTON FX 12MM STRL 50MM RETROBUTTON LOOP SLF FLP TI UHMWPE BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1588-55 SUP HCPCS C1763 AR-1588-55 - BUTTON FX 12MM STRL 55MM RETROBUTTON LOOP SLF FLP TI UHMWPE BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1588-55BT SUP HCPCS C1763 "AR-1588-55BT - BUTTON BTB RETROBUTTON, 12MM X 55MM LOOP" BOTH IP/OP $762.50 $564.00 $151.34 $762.50 $343.13 $343.13 $343.13 $343.13 $762.50 $762.50 $762.50 $158.92 $762.50 $762.50 $762.50 $762.50 $762.50 $158.91 $762.50 $762.50 $451.02 $762.50 $762.50 $762.50 $762.50 $571.88 $762.50 $762.50 $762.50 $381.25 $381.25 $603.90 $762.50 $610.00 $343.13 $151.34 N/A $442.25 $762.50 $762.50 $762.50 $158.91 $762.50 N/A N/A AR-1588-60 SUP HCPCS C1763 AR-1588-60 - BUTTON FX 12MM STRL 60MM RETROBUTTON LOOP SLF FLP TI UHMWPE BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1588-60BT SUP HCPCS C1763 "AR-1588-60BT - BUTTON BTB 12MM RETROBUTTON, 60MM LOOP" BOTH IP/OP $762.50 $564.00 $151.34 $762.50 $343.13 $343.13 $343.13 $343.13 $762.50 $762.50 $762.50 $158.92 $762.50 $762.50 $762.50 $762.50 $762.50 $158.91 $762.50 $762.50 $451.02 $762.50 $762.50 $762.50 $762.50 $571.88 $762.50 $762.50 $762.50 $381.25 $381.25 $603.90 $762.50 $610.00 $343.13 $151.34 N/A $442.25 $762.50 $762.50 $762.50 $158.91 $762.50 N/A N/A AR-1588BTB SUP HCPCS C1713 AR-1588BTB - DEVICE FIX SMALL 10MM 4 POINT LOCK ADJUSTABLE LOOP DRILL BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,147.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,147.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A AR-1588BTB-J SUP HCPCS C1713 AR-1588BTB-J - DEVICE FX TGHTRP DEPLOYING SUT BOTH IP/OP "$1,112.50" $823.00 $220.80 "$1,112.50" $500.63 $500.63 $500.63 $500.63 "$1,112.50" "$1,112.50" "$1,112.50" $231.87 "$1,112.50" "$1,112.50" "$1,112.50" "$1,112.50" "$1,112.50" $231.86 "$1,112.50" $445.00 $658.04 "$1,112.50" "$1,112.50" "$1,112.50" "$1,112.50" $834.38 "$1,112.50" "$1,112.50" "$1,112.50" $556.25 $556.25 $881.10 "$1,112.50" $890.00 $500.63 $220.80 N/A $645.25 "$1,112.50" "$1,112.50" "$1,112.50" $231.85 "$1,112.50" N/A N/A AR-1588RT SUP HCPCS C1713 AR-1588RT - KIT ENDSCP INSTR LATEX FREE TIGHTROPE TITANIUM UHMWPE ACL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $378.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A AR-1588RT-07 SUP Custom 27203010 AR-1588RT-07 - KIT ASCP FX 8MM LF TGHTRP FLIPCUTTER II TIB RT ACL BOTH IP/OP "$1,687.50" "$1,249.00" $300.38 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" $300.38 "$1,687.50" "$1,687.50" "$1,252.46" "$1,252.46" "$1,300.73" $879.19 $351.69 "$1,687.50" $675.00 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" "$1,096.88" "$1,687.50" N/A $978.75 "$1,687.50" "$1,012.50" "$1,687.50" "$1,687.50" "$1,687.50" N/A N/A AR-1588RT-13 SUP Custom 27203010 AR-1588RT-13 - KIT ASCP FX 11MM LF TGHTRP FLIPCUTTER II TIB RT ACL BOTH IP/OP "$1,687.50" "$1,249.00" $300.38 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" $300.38 "$1,687.50" "$1,687.50" "$1,252.46" "$1,252.46" "$1,300.73" $879.19 $351.69 "$1,687.50" $675.00 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" "$1,096.88" "$1,687.50" N/A $978.75 "$1,687.50" "$1,012.50" "$1,687.50" "$1,687.50" "$1,687.50" N/A N/A AR-1588RT-18 SUP Custom 27203010 AR-1588RT-18 - KIT ASCP FX 9MM LF TGHTRP FLIPCUTTER II TIB RT ACL BOTH IP/OP "$1,687.50" "$1,249.00" $300.38 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" $300.38 "$1,687.50" "$1,687.50" "$1,252.46" "$1,252.46" "$1,300.73" $879.19 $351.69 "$1,687.50" $675.00 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" "$1,096.88" "$1,687.50" N/A $978.75 "$1,687.50" "$1,012.50" "$1,687.50" "$1,687.50" "$1,687.50" N/A N/A AR-1588RT-J SUP HCPCS C1713 AR-1588RT-J - DEVICE FX TGHTRP 2 LD PASS SUT ACL RT BOTH IP/OP $925.00 $685.00 $183.59 $925.00 $416.25 $416.25 $416.25 $416.25 $925.00 $925.00 $925.00 $192.79 $925.00 $925.00 $925.00 $925.00 $925.00 $192.78 $925.00 $925.00 $547.14 $925.00 $925.00 $925.00 $925.00 $693.75 $925.00 $925.00 $925.00 $462.50 $462.50 $732.60 $925.00 $740.00 $416.25 $183.59 N/A $536.50 $925.00 $925.00 $925.00 $192.77 $925.00 N/A N/A AR-1588RTS SUP HCPCS C1713 AR-1588RTS - KIT ARTHRO FIX DELIVERY SYSTEM DRILL PIN TIGHTROPE ACL RIGHT BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $506.25 $506.25 $506.25 $506.25 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $486.00 $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 $223.28 N/A $652.50 "$1,125.00" $675.00 "$1,125.00" $234.45 "$1,125.00" N/A N/A AR-1588T SUP Custom 27203010 AR-1588T - KIT ASCP FX STRL TGHTRP REPR ACL BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A AR-1588TB SUP HCPCS C1763 AR-1588TB - BUTTON FX 12MM 8MM TGHTRP ATCH SLOT ACL BOTH IP/OP $357.50 $265.00 $70.95 $357.50 $160.88 $160.88 $160.88 $160.88 $357.50 $357.50 $357.50 $74.51 $357.50 $357.50 $357.50 $357.50 $357.50 $74.51 $357.50 $357.50 $211.46 $357.50 $357.50 $357.50 $357.50 $268.13 $357.50 $357.50 $357.50 $178.75 $178.75 $283.14 $357.50 $286.00 $160.88 $70.95 N/A $207.35 $357.50 $357.50 $357.50 $74.50 $357.50 N/A N/A AR-1588TB-1 SUP HCPCS C1763 AR-1588TB-1 - BUTTON FIXATION TIGHTROPE ROUND OD14 MM ACL ATTACHABLE BOTH IP/OP $535.00 $396.00 $106.18 $577.80 $240.75 $240.75 $240.75 $240.75 $535.00 $535.00 $535.00 $111.51 $535.00 $535.00 $535.00 $535.00 $535.00 $111.50 $535.00 $577.80 $316.45 $535.00 $535.00 $535.00 $535.00 $401.25 $535.00 $535.00 $535.00 $267.50 $267.50 $423.72 $535.00 $428.00 $240.75 $106.18 N/A $310.30 $535.00 $535.00 $535.00 $111.49 $535.00 N/A N/A AR-1588TB-2 SUP HCPCS C1763 AR-1588TB-2 - BUTTON FX OBLNG 13MMXW 3.4MM TGHTRP ATCH SLOT ACL BOTH IP/OP $502.50 $372.00 $99.73 $502.50 $226.13 $226.13 $226.13 $226.13 $502.50 $502.50 $502.50 $104.73 $502.50 $502.50 $502.50 $502.50 $502.50 $104.73 $502.50 $502.50 $297.23 $502.50 $502.50 $502.50 $502.50 $376.88 $502.50 $502.50 $502.50 $251.25 $251.25 $397.98 $502.50 $402.00 $226.13 $99.73 N/A $291.45 $502.50 $502.50 $502.50 $104.72 $502.50 N/A N/A AR-1588TB-3 SUP HCPCS C1763 AR-1588TB-3 - BUTTON FX RND CNCV 11MM TGHTRP ATCH BOTH IP/OP $560.00 $414.00 $111.15 $560.00 $252.00 $252.00 $252.00 $252.00 $560.00 $560.00 $560.00 $116.72 $560.00 $560.00 $560.00 $560.00 $560.00 $116.71 $560.00 $560.00 $331.24 $560.00 $560.00 $560.00 $560.00 $420.00 $560.00 $560.00 $560.00 $280.00 $280.00 $443.52 $560.00 $448.00 $252.00 $111.15 N/A $324.80 $560.00 $560.00 $560.00 $116.70 $560.00 N/A N/A AR-1588TB-4 SUP HCPCS C1763 AR-1588TB-4 - BUTTON FX RND CNCV 14MM TGHTRP ATCH BOTH IP/OP $560.00 $414.00 $111.15 $560.00 $252.00 $252.00 $252.00 $252.00 $560.00 $560.00 $560.00 $116.72 $560.00 $560.00 $560.00 $560.00 $560.00 $116.71 $560.00 $560.00 $331.24 $560.00 $560.00 $560.00 $560.00 $420.00 $560.00 $560.00 $560.00 $280.00 $280.00 $443.52 $560.00 $448.00 $252.00 $111.15 N/A $324.80 $560.00 $560.00 $560.00 $116.70 $560.00 N/A N/A AR-1588TB-5 SUP HCPCS C1763 AR-1588TB-5 - BUTTON FX RND 20MM 9MM TGHTRP COLR ABS BOTH IP/OP $560.00 $414.00 $111.15 $560.00 $252.00 $252.00 $252.00 $252.00 $560.00 $560.00 $560.00 $116.72 $560.00 $560.00 $560.00 $560.00 $560.00 $116.71 $560.00 $560.00 $331.24 $560.00 $560.00 $560.00 $560.00 $420.00 $560.00 $560.00 $560.00 $280.00 $280.00 $443.52 $560.00 $448.00 $252.00 $111.15 N/A $324.80 $560.00 $560.00 $560.00 $116.70 $560.00 N/A N/A AR-1588TDB-7 SUP HCPCS C1713 AR-1588TDB-7 - DEVICE FX 7MM TGHTRP DLV SYS ACL DISP BOTH IP/OP "$1,162.50" $860.00 $230.73 "$1,162.50" $523.13 $523.13 $523.13 $523.13 "$1,162.50" "$1,162.50" "$1,162.50" $242.29 "$1,162.50" "$1,162.50" "$1,162.50" "$1,162.50" "$1,162.50" $242.28 "$1,162.50" $465.00 $687.62 "$1,162.50" "$1,162.50" "$1,162.50" "$1,162.50" $871.88 "$1,162.50" "$1,162.50" "$1,162.50" $581.25 $581.25 $920.70 "$1,162.50" $930.00 $523.13 $230.73 N/A $674.25 "$1,162.50" "$1,162.50" "$1,162.50" $242.27 "$1,162.50" N/A N/A AR-1588TDB-7S SUP HCPCS C1713 AR-1588TDB-7S - DEVICE FX TGHTRP DLV SYS ACL BOTH IP/OP "$1,475.00" "$1,092.00" $292.75 "$1,475.00" $663.75 $663.75 $663.75 $663.75 "$1,475.00" "$1,475.00" "$1,475.00" $307.43 "$1,475.00" "$1,475.00" "$1,475.00" "$1,475.00" "$1,475.00" $307.41 "$1,475.00" $590.00 $872.46 "$1,475.00" "$1,475.00" "$1,475.00" "$1,475.00" "$1,106.25" "$1,475.00" "$1,475.00" "$1,475.00" $737.50 $737.50 "$1,168.20" "$1,475.00" "$1,180.00" $663.75 $292.75 N/A $855.50 "$1,475.00" "$1,475.00" "$1,475.00" $307.39 "$1,475.00" N/A N/A AR-1588TN SUP HCPCS C1713 AR-1588TN - DEVICE TGHTRP ACL UHMWPE ATCH BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $198.72 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A AR-1588TN-1 SUP HCPCS C1713 AR-1588TN-1 - DEVICE FX TGHTRP ATCH OPN UHMWPE ACL BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $485.00 $485.00 $101.07 $485.00 N/A N/A AR-1588TP SUP Custom 27203010 AR-1588TP - KIT ASCP FX TGHTRP PCL BOTH IP/OP $872.50 $646.00 $155.31 $872.50 $872.50 $872.50 $872.50 $872.50 $872.50 $872.50 $155.31 $872.50 $872.50 $647.57 $647.57 $672.52 $454.57 $181.84 $872.50 $349.00 $872.50 $872.50 $872.50 $872.50 $872.50 $654.38 $872.50 $872.50 $872.50 $436.25 $436.25 $691.02 $872.50 $698.00 $567.13 $872.50 N/A $506.05 $872.50 $523.50 $872.50 $872.50 $872.50 N/A N/A AR-1589-15 SUP HCPCS C1763 AR-1589-15 - BUTTON FX LNG 15MM STRL 15MM RETROBUTTON LOOP SLF FLP TI BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1589-20 SUP HCPCS C1763 AR-1589-20 - BUTTON FX LNG 15MM STRL 20MM RETROBUTTON LOOP SLF FLP TI BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1589-25 SUP HCPCS C1763 AR-1589-25 - BUTTON FX LNG 15MM STRL 25MM RETROBUTTON LOOP SLF FLP TI BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1589-30 SUP HCPCS C1763 AR-1589-30 - BUTTON FX LNG 15MM STRL 30MM RETROBUTTON LOOP SLF FLP TI BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1589-35 SUP HCPCS C1763 AR-1589-35 - BUTTON FX LNG 15MM STRL 35MM RETROBUTTON LOOP SLF FLP TI BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1589-40 SUP HCPCS C1763 AR-1589-40 - BUTTON FX LNG 15MM STRL 40MM RETROBUTTON LOOP SLF FLP TI BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-1589RT SUP HCPCS C1763 AR-1589RT - BUTTON SUT LG 20X5MM TGHTRP XTD FTPRNT BOTH IP/OP $562.50 $416.00 $111.64 $562.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $562.50 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $562.50 $562.50 $117.23 $562.50 N/A N/A AR-1590BC SUP HCPCS C1713 AR-1590BC - SCREW INTFR 9MM 23MM STRL TENODESIS BCMPS ACL BOTH IP/OP $862.50 $638.00 $171.18 $862.50 $388.13 $388.13 $388.13 $388.13 $862.50 $862.50 $862.50 $179.77 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $510.17 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $171.18 N/A $500.25 $862.50 $517.50 $862.50 $179.75 $862.50 N/A N/A AR-1590PS SUP HCPCS C1713 AR-1590PS - SCREW INTFR 9MM 23MM STRL TENODESIS VNT PEEK-OPTM FT/ANKL BOTH IP/OP $787.50 $583.00 $156.30 $787.50 $354.38 $354.38 $354.38 $354.38 $787.50 $787.50 $787.50 $164.13 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $315.00 $465.81 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $156.30 N/A $456.75 $787.50 $472.50 $787.50 $164.12 $787.50 N/A N/A AR-1592 SUP HCPCS C1763 AR-1592 - BUTTON FX XL 11MM 20MM STRL RETROBUTTON ASYM LOOP RECON STF BOTH IP/OP $662.50 $490.00 $131.49 $662.50 $298.13 $298.13 $298.13 $298.13 $662.50 $662.50 $662.50 $138.08 $662.50 $662.50 $662.50 $662.50 $662.50 $138.07 $662.50 $662.50 $391.87 $662.50 $662.50 $662.50 $662.50 $496.88 $662.50 $662.50 $662.50 $331.25 $331.25 $524.70 $662.50 $530.00 $298.13 $131.49 N/A $384.25 $662.50 $662.50 $662.50 $138.07 $662.50 N/A N/A AR-1593 SUP Custom 27203010 AR-1593 - SYSTEM FX ACL BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $648.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A AR-1595 SUP HCPCS C1763 AR-1595 - PIN DRILL RETROBUTTON KNEE ACL STERILE DISPOSABLE BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-1595TC SUP HCPCS C1763 AR-1595TC - PIN DRL 4MM STRL RETROBUTTON TGHTRP CLS EYLT KN ACL DISP BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-1605S SUP HCPCS C1713 AR-1605S - HOOK SCR STOR WLMNT 2 HK 2 BOLT DRL BOTH IP/OP $47.50 $35.00 $9.43 $47.50 $21.38 $21.38 $21.38 $21.38 $47.50 $47.50 $47.50 $9.90 $47.50 $47.50 $47.50 $47.50 $47.50 $9.90 $47.50 $20.52 $28.10 $47.50 $47.50 $47.50 $47.50 $35.63 $47.50 $47.50 $47.50 $23.75 $23.75 $37.62 $47.50 $38.00 $21.38 $9.43 N/A $27.55 $47.50 $47.50 $47.50 $9.90 $47.50 N/A N/A AR-1606 SUP Custom 27203010 AR-1606 - DEVICE PSTN STRL CBN STAR SLV LAT TRC ROT STRAP FM FRARM BOTH IP/OP $175.00 $130.00 $31.15 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $31.15 $175.00 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $70.00 $175.00 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $175.00 N/A $101.50 $175.00 $105.00 $175.00 $175.00 $175.00 N/A N/A AR-1606C SUP Custom 27203010 AR-1606C - DEVICE PSTN STRL CBN STAR SLV CMPCT LAT TRC ROT STRAP SFT FM BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 N/A $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A AR-1606LV SUP Custom 27203010 AR-1606LV - DEVICE PSTN XLNG STRL STAR SLV VLCR FM ARM DISP BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1606SV SUP Custom 27203010 AR-1606SV - DEVICE PSTN SM STRL STAR SLV VLCR LMB DISP BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-1606V SUP Custom 27203010 AR-1606V - DEVICE POSITIONING TRACTION SLING STAR SLEEVE VELCRO FOAM BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A AR-1627-06 SUP Custom 27203010 AR-1627-06 - KIT POSITIONING UNIVERSAL HEAD STERILE DISPOSABLE BOTH IP/OP $50.00 $37.00 $8.86 $214.90 $49.75 $49.75 $49.75 $49.75 $49.75 $49.75 $8.86 $49.75 $49.75 $36.92 $36.92 $38.35 $25.92 $10.37 $49.75 $214.90 $49.75 $49.75 $49.75 $49.75 $49.75 $37.50 $49.75 $49.75 $49.75 $24.88 $24.88 $39.40 $49.75 $39.80 $32.34 $49.75 N/A $29.00 $49.75 $29.85 $49.75 $49.75 $49.75 N/A N/A AR-1627-11 SUP Custom 27203010 AR-1627-11 - CLAMP OP TBL CLRK RAIL BOTH IP/OP $937.50 $694.00 $166.88 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $166.88 $937.50 $937.50 $695.81 $695.81 $722.63 $488.44 $195.39 $937.50 $405.00 $937.50 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $609.38 $937.50 N/A $543.75 $937.50 $562.50 $937.50 $937.50 $937.50 N/A N/A AR-1644 SUP Custom 27203010 AR-1644 - KIT POSITIONING BEACH CHAIR DRAPE HOLDER LIGHTWEIGHT TRIMANO BOTH IP/OP $187.50 $139.00 $33.38 $486.00 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $486.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A AR-1648 SUP Custom 27203010 AR-1648 - COVER PSTN STRL TRIMANO DRP BOTH IP/OP $45.00 $33.00 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 N/A $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A AR-1650-07 SUP Custom 27203010 AR-1650-07 - CLAMP OP TBL CLRK RAIL SHLDR SPNS SYS BOTH IP/OP "$2,000.00" "$1,480.00" $356.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $356.00 "$2,000.00" "$2,000.00" "$1,484.40" "$1,484.40" "$1,541.60" "$1,042.00" $416.82 "$2,000.00" $864.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" "$1,300.00" "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-1655PS SUP HCPCS C1713 AR-1655PS - SCREW INTFR 5.5MM 8MM STRL BTNDS RECON PEEK-OPTM ACL BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AR-1655PS-10 SUP HCPCS C1713 AR-1655PS-10 - SCREW INTFR 5.5MM 10MM STRL BTNDS RECON PEEK-OPTM ACL BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AR-1655PS-12 SUP HCPCS C1713 AR-1655PS-12 - SCREW INTFR 5.5MM 12MM STRL BTNDS RECON PEEK-OPTM ACL BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AR-1662B SUP HCPCS C1713 AR-1662B - ANCHOR SUT 6.25MM 19.1MM SWIVELOCK BICEPS TENODESIS SYS BOTH IP/OP $950.00 $703.00 $188.55 $950.00 $427.50 $427.50 $427.50 $427.50 $950.00 $950.00 $950.00 $198.00 $950.00 $950.00 $950.00 $950.00 $950.00 $197.99 $950.00 $380.00 $561.93 $950.00 $950.00 $950.00 $950.00 $712.50 $950.00 $950.00 $950.00 $475.00 $475.00 $752.40 $950.00 $760.00 $427.50 $188.55 N/A $551.00 $950.00 $570.00 $950.00 $950.00 $950.00 N/A N/A AR-1662BC SUP HCPCS C1713 AR-1662BC - ANCHOR SUT 6.25MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT BOTH IP/OP "$1,025.00" $759.00 $203.44 "$1,025.00" $461.25 $461.25 $461.25 $461.25 "$1,025.00" "$1,025.00" "$1,025.00" $213.64 "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" $213.62 "$1,025.00" $410.00 $606.29 "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" $768.75 "$1,025.00" "$1,025.00" "$1,025.00" $512.50 $512.50 $811.80 "$1,025.00" $820.00 $461.25 $203.44 N/A $594.50 "$1,025.00" $615.00 "$1,025.00" $213.61 "$1,025.00" N/A N/A AR-1662BC-7 SUP HCPCS C1713 AR-1662BC-7 - ANCHOR SUT SWVLK TENO BIO-COMP 7X 19.5MM BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A AR-1662BC-8 SUP HCPCS C1713 AR-1662BC-8 - ANCHOR SUTURE 8MM 19.5MM FORK EYELET SWIVELOCK TENODESIS BOTH IP/OP "$1,087.50" $805.00 $215.84 "$2,349.00" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$2,349.00" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" $652.50 "$1,087.50" $226.64 "$1,087.50" N/A N/A AR-1662BC-9 SUP HCPCS C1713 AR-1662BC-9 - ANCHOR SUT 9MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" $652.50 "$1,087.50" $226.64 "$1,087.50" N/A N/A AR-1662BCC-7 SUP HCPCS C1713 AR-1662BCC-7 - ANCHOR SUT 7MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A AR-1662BCC-8 SUP HCPCS C1713 AR-1662BCC-8 - ANCHOR SUT 8MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" $652.50 "$1,087.50" $226.64 "$1,087.50" N/A N/A AR-1662BCC-9 SUP HCPCS C1713 AR-1662BCC-9 - ANCHOR SUT 9MM 19.1MM STRL SWIVELOCK TENODESIS CLS EYLT BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" $652.50 "$1,087.50" $226.64 "$1,087.50" N/A N/A AR-1662PSL-7 SUP HCPCS C1713 AR-1662PSL-7 - ANCHOR SUT 7MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT PEEK BOTH IP/OP "$1,012.50" $749.00 $200.96 "$1,012.50" $455.63 $455.63 $455.63 $455.63 "$1,012.50" "$1,012.50" "$1,012.50" $211.03 "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" $211.02 "$1,012.50" "$1,012.50" $598.89 "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" $759.38 "$1,012.50" "$1,012.50" "$1,012.50" $506.25 $506.25 $801.90 "$1,012.50" $810.00 $455.63 $200.96 N/A $587.25 "$1,012.50" "$1,012.50" "$1,012.50" $211.01 "$1,012.50" N/A N/A AR-1662PSL-8 SUP HCPCS C1713 AR-1662PSL-8 - ANCHOR SUT 8MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT PEEK BOTH IP/OP "$1,012.50" $749.00 $200.96 "$2,187.00" $455.63 $455.63 $455.63 $455.63 "$1,012.50" "$1,012.50" "$1,012.50" $211.03 "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" $211.02 "$1,012.50" "$2,187.00" $598.89 "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" $759.38 "$1,012.50" "$1,012.50" "$1,012.50" $506.25 $506.25 $801.90 "$1,012.50" $810.00 $455.63 $200.96 N/A $587.25 "$1,012.50" $607.50 "$1,012.50" $211.01 "$1,012.50" N/A N/A AR-1662PSL-9 SUP HCPCS C1713 AR-1662PSL-9 - ANCHOR SUT 9MM 19.5MM STRL SWIVELOCK TENODESIS FRK EYLT PEEK BOTH IP/OP "$1,012.50" $749.00 $200.96 "$1,012.50" $455.63 $455.63 $455.63 $455.63 "$1,012.50" "$1,012.50" "$1,012.50" $211.03 "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" $211.02 "$1,012.50" "$1,012.50" $598.89 "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" $759.38 "$1,012.50" "$1,012.50" "$1,012.50" $506.25 $506.25 $801.90 "$1,012.50" $810.00 $455.63 $200.96 N/A $587.25 "$1,012.50" $607.50 "$1,012.50" $211.01 "$1,012.50" N/A N/A AR-1670BC SUP HCPCS C1713 AR-1670BC - SCREW INTFR 7MM 10MM STRL TENODESIS BCMPS ACL BOTH IP/OP $862.50 $638.00 $171.18 $862.50 $388.13 $388.13 $388.13 $388.13 $862.50 $862.50 $862.50 $179.77 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $510.17 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $171.18 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A AR-1670PS SUP HCPCS C1713 AR-1670PS - SCREW INTFR 7MM 10MM STRL TENODESIS PEEK-OPTM ACL BOTH IP/OP $787.50 $583.00 $156.30 $850.50 $354.38 $354.38 $354.38 $354.38 $787.50 $787.50 $787.50 $164.13 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $850.50 $465.81 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $156.30 N/A $456.75 $787.50 $787.50 $787.50 $164.12 $787.50 N/A N/A AR-1675BC-CP SUP HCPCS C1713 AR-1675BC-CP - SET IMPL BCMPS SCRDRVR RECON SYS BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$2,625.00" "$4,375.00" "$4,375.00" "$4,375.00" N/A N/A AR-1676DS SUP Custom 27203010 AR-1676DS - KIT INSTR BIOABSORBABLE BIO-TENODESIS STERILE DISPOSABLE BOTH IP/OP $487.50 $361.00 $86.78 "$1,053.00" $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 "$1,053.00" $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1677BC-CP SUP HCPCS C1713 AR-1677BC-CP - SET IMPL 4MM CNN DRL GDPN RLR SCR TNDN SHTL CMC LGMNT RECON BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" "$1,487.50" $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" $892.50 "$1,487.50" $310.00 "$1,487.50" N/A N/A AR-1678-01 SUP Custom 27203010 AR-1678-01 - GUIDE DRL LF TTH FT BOTH IP/OP "$1,737.50" "$1,286.00" $309.28 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $309.28 "$1,737.50" "$1,737.50" "$1,289.57" "$1,289.57" "$1,339.27" $905.24 $362.11 "$1,737.50" $750.60 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" "$1,129.38" "$1,737.50" N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" "$1,737.50" "$1,737.50" N/A N/A AR-1678-02 SUP Custom 27203010 AR-1678-02 - BIT DRL 3.5MM SWIVELOCK BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $231.94 $231.94 $240.88 $162.81 $65.13 $312.50 $135.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $203.13 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A AR-1678-05 SUP Custom 27203010 AR-1678-05 - BIT DRL 3.5MM SWIVELOCK BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $231.94 $231.94 $240.88 $162.81 $65.13 $312.50 $135.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $203.13 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A AR-1678-CP SUP HCPCS C1713 AR-1678-CP - SET IMPL 3.5MM INTERNALBRACE SWIVELOCK FIBERTAPE 2 2 NDL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" N/A N/A AR-1680B SUP HCPCS C1713 AR-1680B - SCREW INTERFERENCE 8MM 12MM RECONSTRUCTION BIO-TENODESIS BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AR-1680PS SUP HCPCS C1713 AR-1680PS - TENODESIS SCREW 8x12MM BOTH IP/OP $787.50 $583.00 $156.30 $787.50 $354.38 $354.38 $354.38 $354.38 $787.50 $787.50 $787.50 $164.13 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $340.20 $465.81 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $156.30 N/A $456.75 $787.50 $472.50 $787.50 $164.12 $787.50 N/A N/A AR-1688-CP SUP Custom 27203010 AR-1688-CP - KIT ASCP FX INTERNALBRACE FIBERTAPE CLGN LGMNT AUG REPR BOTH IP/OP "$2,687.50" "$1,989.00" $478.38 "$2,687.50" "$2,687.50" "$2,687.50" "$2,687.50" "$2,687.50" "$2,687.50" "$2,687.50" $478.38 "$2,687.50" "$2,687.50" "$1,994.66" "$1,994.66" "$2,071.53" "$1,400.19" $560.10 "$2,687.50" "$1,075.00" "$2,687.50" "$2,687.50" "$2,687.50" "$2,687.50" "$2,687.50" "$2,015.63" "$2,687.50" "$2,687.50" "$2,687.50" "$1,343.75" "$1,343.75" "$2,128.50" "$2,687.50" "$2,150.00" "$1,746.88" "$2,687.50" N/A "$1,558.75" "$2,687.50" "$1,612.50" "$2,687.50" "$2,687.50" "$2,687.50" N/A N/A AR-16991N SUP Custom 27203010 AR-16991N - NEEDLE SUT RND GRV LOPRFL SCRPN FBRWR 1 PRTL SMTH JAW MN BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-16992N SUP Custom 27203010 AR-16992N - NEEDLE SUT SCRPN CAPSULECLOSE BOTH IP/OP $612.50 $453.00 $109.03 $612.50 $612.50 $612.50 $612.50 $612.50 $612.50 $612.50 $109.03 $612.50 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $245.00 $612.50 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $612.50 N/A $355.25 $612.50 $367.50 $612.50 $612.50 $612.50 N/A N/A AR-1713-03 SUP Custom 27203010 AR-1713-03 - CLAMP BDRL DSTRCT SET STRL ANKL BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$1,669.95" "$1,669.95" "$1,734.30" "$1,172.25" $468.92 "$2,250.00" $972.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,462.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A AR-1801 SUP Custom 27203010 AR-1801 - GUIDE DRL OFST 7MM AU FEM ACL TRNTB DISP 7-8MM HL BOTH IP/OP "$2,087.50" "$1,545.00" $371.58 "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" $371.58 "$2,087.50" "$2,087.50" "$1,549.34" "$1,549.34" "$1,609.05" "$1,087.59" $435.06 "$2,087.50" $901.80 "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$1,565.63" "$2,087.50" "$2,087.50" "$2,087.50" "$1,043.75" "$1,043.75" "$1,653.30" "$2,087.50" "$1,670.00" "$1,356.88" "$2,087.50" N/A "$1,210.75" "$2,087.50" "$1,252.50" "$2,087.50" "$2,087.50" "$2,087.50" N/A N/A AR-1802D SUP Custom 27203010 AR-1802D - CANNULA ASCP 9-12MM STRL TNL SIL TIB DISP BOTH IP/OP $475.00 $352.00 $84.55 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $84.55 $475.00 $475.00 $352.55 $352.55 $366.13 $247.48 $99.00 $475.00 $190.00 $475.00 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $308.75 $475.00 N/A $275.50 $475.00 $285.00 $475.00 $475.00 $475.00 N/A N/A AR-1803 SUP Custom 27203010 AR-1803 - GUIDE DRL OFST 5MM RD FEM ACL TRNTB DISP 7-8MM HL BOTH IP/OP "$2,087.50" "$1,545.00" $371.58 "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" $371.58 "$2,087.50" "$2,087.50" "$1,549.34" "$1,549.34" "$1,609.05" "$1,087.59" $435.06 "$2,087.50" $901.80 "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$1,565.63" "$2,087.50" "$2,087.50" "$2,087.50" "$1,043.75" "$1,043.75" "$1,653.30" "$2,087.50" "$1,670.00" "$1,356.88" "$2,087.50" N/A "$1,210.75" "$2,087.50" "$1,252.50" "$2,087.50" "$2,087.50" "$2,087.50" N/A N/A AR-1804 SUP Custom 27203010 AR-1804 - GUIDE DRL OFST 6MM GRN FEM ACL TRNTB DISP 8-9MM HL BOTH IP/OP "$2,087.50" "$1,545.00" $371.58 "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" $371.58 "$2,087.50" "$2,087.50" "$1,549.34" "$1,549.34" "$1,609.05" "$1,087.59" $435.06 "$2,087.50" $901.80 "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$1,565.63" "$2,087.50" "$2,087.50" "$2,087.50" "$1,043.75" "$1,043.75" "$1,653.30" "$2,087.50" "$1,670.00" "$1,356.88" "$2,087.50" N/A "$1,210.75" "$2,087.50" "$1,252.50" "$2,087.50" "$2,087.50" "$2,087.50" N/A N/A AR-1805 SUP Custom 27203010 AR-1805 - GUIDE DRL OFST 8MM BLU FEM ACL TRNTB DISP 12-13MM HL BOTH IP/OP "$2,087.50" "$1,545.00" $371.58 "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" $371.58 "$2,087.50" "$2,087.50" "$1,549.34" "$1,549.34" "$1,609.05" "$1,087.59" $435.06 "$2,087.50" $901.80 "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$1,565.63" "$2,087.50" "$2,087.50" "$2,087.50" "$1,043.75" "$1,043.75" "$1,653.30" "$2,087.50" "$1,670.00" "$1,356.88" "$2,087.50" N/A "$1,210.75" "$2,087.50" "$1,252.50" "$2,087.50" "$2,087.50" "$2,087.50" N/A N/A AR-1806 SUP Custom 27203010 AR-1806 - GUIDE DRL OFST 4MM PUR FEM ACL TRNTB DISP 6-7MM HL BOTH IP/OP "$2,087.50" "$1,545.00" $371.58 "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" $371.58 "$2,087.50" "$2,087.50" "$1,549.34" "$1,549.34" "$1,609.05" "$1,087.59" $435.06 "$2,087.50" $901.80 "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$2,087.50" "$1,565.63" "$2,087.50" "$2,087.50" "$2,087.50" "$1,043.75" "$1,043.75" "$1,653.30" "$2,087.50" "$1,670.00" "$1,356.88" "$2,087.50" N/A "$1,210.75" "$2,087.50" "$1,252.50" "$2,087.50" "$2,087.50" "$2,087.50" N/A N/A AR-1822 SUP Custom 27203010 AR-1822 - BIT DRL LNG 2MM STRL D STP GFT HRVT BOTH IP/OP $62.50 $46.00 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $27.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-1861 SUP Custom 27203010 AR-1861 - CANNULA ASCP 11MM GFT PASS BOTH IP/OP $732.50 $542.00 $130.39 $732.50 $732.50 $732.50 $732.50 $732.50 $732.50 $732.50 $130.39 $732.50 $732.50 $543.66 $543.66 $564.61 $381.63 $152.66 $732.50 $293.00 $732.50 $732.50 $732.50 $732.50 $732.50 $549.38 $732.50 $732.50 $732.50 $366.25 $366.25 $580.14 $732.50 $586.00 $476.13 $732.50 N/A $424.85 $732.50 $439.50 $732.50 $732.50 $732.50 N/A N/A AR-1875 SUP Custom 27203010 AR-1875 - GUIDE DRL ADAPTEUR C RING ACL BOTH IP/OP "$3,545.00" "$2,623.00" $631.01 "$3,545.00" "$3,545.00" "$3,545.00" "$3,545.00" "$3,545.00" "$3,545.00" "$3,545.00" $631.01 "$3,545.00" "$3,545.00" "$2,631.10" "$2,631.10" "$2,732.49" "$1,846.95" $738.82 "$3,545.00" "$1,418.00" "$3,545.00" "$3,545.00" "$3,545.00" "$3,545.00" "$3,545.00" "$2,658.75" "$3,545.00" "$3,545.00" "$3,545.00" "$1,772.50" "$1,772.50" "$2,807.64" "$3,545.00" "$2,836.00" "$2,304.25" "$3,545.00" N/A "$2,056.10" "$3,545.00" "$2,127.00" "$3,545.00" "$3,545.00" "$3,545.00" N/A N/A AR-1897S SUP Custom 27203010 AR-1897S - KIT INST HALL SW BLDE ACL DISP TRNTB BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A AR-18985 SUP HCPCS C1713 AR-18985 - KIT INST ACL TRNTB DISP BOTH IP/OP $520.00 $385.00 $103.21 $520.00 $234.00 $234.00 $234.00 $234.00 $520.00 $520.00 $520.00 $108.38 $520.00 $520.00 $520.00 $520.00 $520.00 $108.37 $520.00 $208.00 $307.58 $520.00 $520.00 $520.00 $520.00 $390.00 $520.00 $520.00 $520.00 $260.00 $260.00 $411.84 $520.00 $416.00 $234.00 $103.21 N/A $301.60 $520.00 $312.00 $520.00 $108.37 $520.00 N/A N/A AR-1902SF SUP HCPCS C1713 AR-1902SF - ANCHOR SUT 2 5MM 15.5MM STRL CSCR2 FWR 2 EYLT ST TI ROTR CUF BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $241.88 $241.88 $241.88 $241.88 $537.50 $537.50 $537.50 $112.03 $537.50 $537.50 $537.50 $537.50 $537.50 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $241.88 $106.68 N/A $311.75 $537.50 $322.50 $537.50 $112.02 $537.50 N/A N/A AR-1907H-3.5 SUP Custom 27203010 AR-1907H-3.5 - GUIDE DRL 3.5MM ANCH CNN TROC SDL HIP BOTH IP/OP "$1,247.50" $923.00 $222.06 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $222.06 "$1,247.50" "$1,247.50" $925.89 $925.89 $961.57 $649.95 $259.99 "$1,247.50" $499.00 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $810.88 "$1,247.50" N/A $723.55 "$1,247.50" $748.50 "$1,247.50" "$1,247.50" "$1,247.50" N/A N/A AR-1911 SUP Custom 27203010 AR-1911 - DRILL SRG SPD 1 STP 3.5MM PUSHLOCK BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1912 SUP Custom 27203010 AR-1912 - DRILL SRG LG 1 STP 3.5MM PUSHLOCK BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1913 SUP Custom 27203010 AR-1913 - BIT DRL 3.5MM BCMPS PUSHLOCK BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1915FT-2 SUP HCPCS C1713 AR-1915FT-2 - ANCHOR SUT 1 2.3MM .5 CRC 2 DMD PT FT 3.5MM 2.5MM 26.5MM BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $285.00 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AR-1915S SUP HCPCS C1713 AR-1915S - ANCHOR SUT 2 3.5MM 12MM STRL CRKSCR BABSR ST TI ROTR CUF BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $202.50 $202.50 $202.50 $202.50 $450.00 $450.00 $450.00 $93.79 $450.00 $450.00 $450.00 $450.00 $450.00 $93.78 $450.00 $180.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $202.50 $89.31 N/A $261.00 $450.00 $270.00 $450.00 $93.78 $450.00 N/A N/A AR-1915SF SUP HCPCS C1713 AR-1915SF - ANCHOR SUT 2 3.5MM 12MM STRL CSCR FWR ST SUT EYLT TI ROTR BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $195.00 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $101.60 $487.50 N/A N/A AR-1915SNF SUP HCPCS C1713 AR-1915SNF - ANCHOR SUTURE 2.3MM 0 SHORT .5 CIR 2 DIAMOND POINT 3.5MM BOTH IP/OP $525.00 $389.00 $104.20 "$2,835.00" $236.25 $236.25 $236.25 $236.25 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $525.00 $525.00 $525.00 $109.42 $525.00 "$2,835.00" $310.54 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $236.25 $104.20 N/A $304.50 $525.00 $525.00 $525.00 $109.41 $525.00 N/A N/A AR-1920BF SUP HCPCS C1713 AR-1920BF - BIOCRKSCRW SUTR ANCH 5MM W/2 #2 FW BOTH IP/OP $650.00 $481.00 $129.01 $650.00 $292.50 $292.50 $292.50 $292.50 $650.00 $650.00 $650.00 $135.48 $650.00 $650.00 $650.00 $650.00 $650.00 $135.47 $650.00 $260.00 $384.48 $650.00 $650.00 $650.00 $650.00 $487.50 $650.00 $650.00 $650.00 $325.00 $325.00 $514.80 $650.00 $520.00 $292.50 $129.01 N/A $377.00 $650.00 $390.00 $650.00 $135.46 $650.00 N/A N/A AR-1920BFT SUP HCPCS C1713 AR-1920BFT - ANCHOR SUT 2 5MM 17.9MM STRL BCSCR TGRL BABSR BRD HNDL BOTH IP/OP $700.00 $518.00 $138.93 $700.00 $315.00 $315.00 $315.00 $315.00 $700.00 $700.00 $700.00 $145.90 $700.00 $700.00 $700.00 $700.00 $700.00 $145.89 $700.00 $280.00 $414.05 $700.00 $700.00 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $350.00 $350.00 $554.40 $700.00 $560.00 $315.00 $138.93 N/A $406.00 $700.00 $420.00 $700.00 $145.88 $700.00 N/A N/A AR-1920BNF SUP HCPCS C1713 AR-1920BNF - ANCHOR SUT 2 3/8 CRC 5MM 26MM STRL 17.9MM BCSCR FWR BABSR BOTH IP/OP $675.00 $500.00 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $270.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 N/A $391.50 $675.00 $405.00 $675.00 $140.67 $675.00 N/A N/A AR-1920NSF SUP HCPCS C1713 AR-1920NSF - ANCHOR SUT 2 5MM 15.5MM STRL CSCR FWR BRD NDL ROTR CUF DISP BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $241.88 $241.88 $241.88 $241.88 $537.50 $537.50 $537.50 $112.03 $537.50 $537.50 $537.50 $537.50 $537.50 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $241.88 $106.68 N/A $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A AR-1920S SUP HCPCS C1713 AR-1920S - ANCHOR SUT 2 5MM 15.5MM STRL CRKSCR BRD HNDL INSRTR TI ROTR BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $202.50 $202.50 $202.50 $202.50 $450.00 $450.00 $450.00 $93.79 $450.00 $450.00 $450.00 $450.00 $450.00 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $202.50 $89.31 N/A $261.00 $450.00 $270.00 $450.00 $93.78 $450.00 N/A N/A AR-1920SF SUP HCPCS C1713 AR-1920SF - ANCHOR SUT 2 5MM 15.5MM STRL CSCR FWR HNDL INSRTR TI ROTR BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $487.50 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $101.60 $487.50 N/A N/A AR-1920SNF SUP HCPCS C1713 AR-1920SNF - ANCHOR SUT 2 5MM 15MM STRL CSCR FWR BABSR HNDL INSRTR NDL BOTH IP/OP $525.00 $389.00 $104.20 $525.00 $236.25 $236.25 $236.25 $236.25 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $310.54 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $236.25 $104.20 N/A $304.50 $525.00 $315.00 $525.00 $109.41 $525.00 N/A N/A AR-1922BC SUP HCPCS C1713 AR-1922BC - ANCHOR SUT 4.5MM 24MM STRL PUSHLOCK BCMPS DISP BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" $400.00 $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.40 "$1,000.00" N/A N/A AR-1922BCM SUP HCPCS C1713 AR-1922BCM - ANCHOR SUT 4.5MM 28MM STRL PUSHLOCK SLF PNCH BCMPS DISP BOTH IP/OP "$1,037.50" $768.00 $205.92 "$1,037.50" $466.88 $466.88 $466.88 $466.88 "$1,037.50" "$1,037.50" "$1,037.50" $216.24 "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" $216.23 "$1,037.50" $415.00 $613.68 "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" $778.13 "$1,037.50" "$1,037.50" "$1,037.50" $518.75 $518.75 $821.70 "$1,037.50" $830.00 $466.88 $205.92 N/A $601.75 "$1,037.50" $622.50 "$1,037.50" "$1,037.50" "$1,037.50" N/A N/A AR-1922BM SUP HCPCS C1713 AR-1922BM - ANCHOR SUT 4.5MM 28MM STRL BIO-PUSHLOCK SLF PNCH DISP BOTH IP/OP $975.00 $722.00 $193.51 $975.00 $438.75 $438.75 $438.75 $438.75 $975.00 $975.00 $975.00 $203.21 $975.00 $975.00 $975.00 $975.00 $975.00 $203.20 $975.00 $390.00 $576.71 $975.00 $975.00 $975.00 $975.00 $731.25 $975.00 $975.00 $975.00 $487.50 $487.50 $772.20 $975.00 $780.00 $438.75 $193.51 N/A $565.50 $975.00 $585.00 $975.00 $203.19 $975.00 N/A N/A AR-1922PS SUP HCPCS C1713 AR-1922PS - ANCHOR SUT 4.5MM 24MM STRL PUSHLOCK PEEK SHLDR DISP BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $405.00 $405.00 $405.00 $405.00 $900.00 $900.00 $900.00 $187.58 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $360.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $178.63 N/A $522.00 $900.00 $540.00 $900.00 $187.56 $900.00 N/A N/A AR-1922PSM SUP HCPCS C1713 AR-1922PSM - ANCHOR SUT 4.5MM 28MM STRL PUSHLOCK SLF PNCH PEEK DISP BOTH IP/OP $975.00 $722.00 $193.51 $975.00 $438.75 $438.75 $438.75 $438.75 $975.00 $975.00 $975.00 $203.21 $975.00 $975.00 $975.00 $975.00 $975.00 $203.20 $975.00 $390.00 $576.71 $975.00 $975.00 $975.00 $975.00 $731.25 $975.00 $975.00 $975.00 $487.50 $487.50 $772.20 $975.00 $780.00 $438.75 $193.51 N/A $565.50 $975.00 $975.00 $975.00 $203.19 $975.00 N/A N/A AR-1923BC SUP HCPCS C1713 AR-1923BC - ANCHOR SUTURE 2.9MM 15.5MM PUSHLOCK BIOCOMPOSITE STERILE BOTH IP/OP "$1,000.00" $740.00 $198.48 "$2,160.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" "$2,160.00" $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" $600.00 "$1,000.00" $208.40 "$1,000.00" N/A N/A AR-1923BCH SUP HCPCS C1713 AR-1923BCH - ANCHOR SUT PUSHLOCK BCMPS HIP BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" "$1,000.00" $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.40 "$1,000.00" N/A N/A AR-1923BNF SUP HCPCS C1713 AR-1923BNF - ANCHOR SUT 3/8 CRC DMD 3.7MM 17.9MM STRL 22.2MM BCSCR FWR BOTH IP/OP $650.00 $481.00 $129.01 $650.00 $292.50 $292.50 $292.50 $292.50 $650.00 $650.00 $650.00 $135.48 $650.00 $650.00 $650.00 $650.00 $650.00 $135.47 $650.00 $650.00 $384.48 $650.00 $650.00 $650.00 $650.00 $487.50 $650.00 $650.00 $650.00 $325.00 $325.00 $514.80 $650.00 $520.00 $292.50 $129.01 N/A $377.00 $650.00 $390.00 $650.00 $135.46 $650.00 N/A N/A AR-1923D SUP Custom 27203010 AR-1923D - DRILL SRG 2.9 MM PUSHLOCK HRD BN BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1923DH SUP Custom 27203010 AR-1923DH - DRILL SRG HIP 2.9 MM PUSHLOCK BOTH IP/OP $362.50 $268.00 $64.53 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $145.00 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 N/A $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A AR-1923DHS SUP Custom 27203010 AR-1923DHS - KIT INST 2.9MM DISP 2.9MM PUSHLOCK BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-1923DHT SUP Custom 27203010 AR-1923DHT - DRILL SRG HIP HRD BN 2.9 MM PUSHLOCK BOTH IP/OP $362.50 $268.00 $64.53 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $145.00 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 N/A $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A AR-1923DS SUP HCPCS C1713 AR-1923DS - KIT INSTR 2.9MM DRILL SPEAR METAL STERILE DISPOSABLE 2.9MM BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-1923D-ST SUP Custom 27203010 AR-1923D-ST - DRILL SRG STRL 2.9 MM PUSHLOCK BOTH IP/OP $262.50 $194.00 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $46.73 $262.50 $262.50 $194.83 $194.83 $202.34 $136.76 $54.71 $262.50 $105.00 $262.50 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $170.63 $262.50 N/A $152.25 $262.50 $157.50 $262.50 $262.50 $262.50 N/A N/A AR-1923DT SUP Custom 27203010 AR-1923DT - DRILL SRG 2.9 MM SHRT PUSHLOCK HRD BN BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-1923DT-ST SUP Custom 27203010 AR-1923DT-ST - DRILL SRG STRL 2.9 MM PUSHLOCK BOTH IP/OP $262.50 $194.00 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $46.73 $262.50 $262.50 $194.83 $194.83 $202.34 $136.76 $54.71 $262.50 $105.00 $262.50 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $170.63 $262.50 N/A $152.25 $262.50 $157.50 $262.50 $262.50 $262.50 N/A N/A AR-1923MC SUP Custom 27203010 AR-1923MC - CANNULA ASCP FT 2.9MM 4.5MM PUSHLOCK CRKSCR MTL REUSE BOTH IP/OP $850.00 $629.00 $151.30 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $151.30 $850.00 $850.00 $630.87 $630.87 $655.18 $442.85 $177.15 $850.00 $367.20 $850.00 $850.00 $850.00 $850.00 $850.00 $637.50 $850.00 $850.00 $850.00 $425.00 $425.00 $673.20 $850.00 $680.00 $552.50 $850.00 N/A $493.00 $850.00 $510.00 $850.00 $850.00 $850.00 N/A N/A AR-1923MCS SUP Custom 27203010 AR-1923MCS - CANNULA ASCP 2.9MM 4.5MM PUSHLOCK CRKSCR SET MTL REUSE BOTH IP/OP "$1,412.50" "$1,045.00" $251.43 "$1,412.50" "$1,412.50" "$1,412.50" "$1,412.50" "$1,412.50" "$1,412.50" "$1,412.50" $251.43 "$1,412.50" "$1,412.50" "$1,048.36" "$1,048.36" "$1,088.76" $735.91 $294.38 "$1,412.50" $610.20 "$1,412.50" "$1,412.50" "$1,412.50" "$1,412.50" "$1,412.50" "$1,059.38" "$1,412.50" "$1,412.50" "$1,412.50" $706.25 $706.25 "$1,118.70" "$1,412.50" "$1,130.00" $918.13 "$1,412.50" N/A $819.25 "$1,412.50" $847.50 "$1,412.50" "$1,412.50" "$1,412.50" N/A N/A AR-1923PHS SUP HCPCS C1713 AR-1923PHS - ANCHOR SUT 2.9MM 15.5MM STRL PUSHLOCK PEEK HIP DISP BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $405.00 $405.00 $405.00 $405.00 $900.00 $900.00 $900.00 $187.58 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $360.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $178.63 N/A $522.00 $900.00 $540.00 $900.00 $187.56 $900.00 N/A N/A AR-1923PK SUP Custom 27203010 AR-1923PK - KIT ENDSCP INSTR 1.1MM 17GA 2.9MM CANNU DRILL NEEDLE PORTAL BOTH IP/OP $550.00 $407.00 $97.90 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $97.90 $550.00 $550.00 $408.21 $408.21 $423.94 $286.55 $114.63 $550.00 $237.60 $550.00 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $357.50 $550.00 N/A $319.00 $550.00 $330.00 $550.00 $550.00 $550.00 N/A N/A AR-1923SD SUP Custom 27203010 AR-1923SD - DRILL SRG SPD STRL 2.9MM PUSHLOCK BOTH IP/OP $275.00 $204.00 $48.95 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $48.95 $275.00 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $110.00 $275.00 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $275.00 N/A $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A AR-1925BF SUP HCPCS C1713 AR-1925BF - ANCHOR SUT 2 FT 6.5MM 17.9MM STRL BCSCR 2 BABSR ROTR CUF BOTH IP/OP $650.00 $481.00 $129.01 $650.00 $292.50 $292.50 $292.50 $292.50 $650.00 $650.00 $650.00 $135.48 $650.00 $650.00 $650.00 $650.00 $650.00 $135.47 $650.00 $650.00 $384.48 $650.00 $650.00 $650.00 $650.00 $487.50 $650.00 $650.00 $650.00 $325.00 $325.00 $514.80 $650.00 $520.00 $292.50 $129.01 N/A $377.00 $650.00 $390.00 $650.00 $135.46 $650.00 N/A N/A AR-1925BNF SUP HCPCS C1713 AR-1925BNF - ANCHOR SUT 2 6.5MM 17.9MM STRL BCSCR FWR 2 BRD BABSR MLD BOTH IP/OP $675.00 $500.00 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $270.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 N/A $391.50 $675.00 $405.00 $675.00 $140.67 $675.00 N/A N/A AR-1925SF SUP HCPCS C1713 AR-1925SF - ANCHOR SUT 2 6.5MM 15.5MM STRL CSCR FWR 2 BABSR HNDL INSRTR BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $195.00 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $101.60 $487.50 N/A N/A AR-1926BC SUP HCPCS C1713 AR-1926BC - ANCHOR SUT 3.5MM 19.5MM STRL PUSHLOCK BCMPS DISP BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" $400.00 $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-1926BH SUP HCPCS C1713 AR-1926BH - ANCHOR SUT 3.5MM 19.5MM STRL BIO-PUSHLOCK HIP DISP BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $405.00 $405.00 $405.00 $405.00 $900.00 $900.00 $900.00 $187.58 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $360.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $178.63 N/A $522.00 $900.00 $540.00 $900.00 $187.56 $900.00 N/A N/A AR-1926DHS SUP Custom 27203010 AR-1926DHS - KIT INST DISP 3.5MM PUSHLOCK BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-1926DS-2 SUP Custom 27203010 AR-1926DS-2 - KIT INST OFST DRL GD 3.5MM PUSHLOCK BOTH IP/OP $525.00 $389.00 $93.45 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $525.00 $93.45 $525.00 $525.00 $389.66 $389.66 $404.67 $273.53 $109.42 $525.00 $210.00 $525.00 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $341.25 $525.00 N/A $304.50 $525.00 $315.00 $525.00 $525.00 $525.00 N/A N/A AR-1926MC SUP Custom 27203010 AR-1926MC - CANNULA ASCP PUSHLOCK MTL BOTH IP/OP $650.00 $481.00 $115.70 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $115.70 $650.00 $650.00 $482.43 $482.43 $501.02 $338.65 $135.47 $650.00 $260.00 $650.00 $650.00 $650.00 $650.00 $650.00 $487.50 $650.00 $650.00 $650.00 $325.00 $325.00 $514.80 $650.00 $520.00 $422.50 $650.00 N/A $377.00 $650.00 $390.00 $650.00 $650.00 $650.00 N/A N/A AR-1926PHS SUP HCPCS C1713 AR-1926PHS - ANCHOR SUT 3.5MM 19.5MM STRL BIO-PUSHLOCK HIP DISP BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $405.00 $405.00 $405.00 $405.00 $900.00 $900.00 $900.00 $187.58 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $360.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $178.63 N/A $522.00 $900.00 $540.00 $900.00 $187.56 $900.00 N/A N/A AR-1926PS SUP HCPCS C1713 AR-1926PS - ANCHOR SUT 3.5MM 19.5MM STRL PUSHLOCK PEEK ROTR CUF DISP BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $405.00 $405.00 $405.00 $405.00 $900.00 $900.00 $900.00 $187.58 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $360.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $178.63 N/A $522.00 $900.00 $540.00 $900.00 $187.56 $900.00 N/A N/A AR-1927BCF SUP HCPCS C1713 AR-1927BCF - ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR TIGERWIRE 2 DRV BOTH IP/OP "$4,062.50" "$3,006.00" $806.30 "$4,062.50" "$1,828.13" "$1,828.13" "$1,828.13" "$1,828.13" "$4,062.50" "$4,062.50" "$4,062.50" $846.73 "$4,062.50" "$4,062.50" "$4,062.50" "$4,062.50" "$4,062.50" $846.67 "$4,062.50" "$4,062.50" "$2,002.81" "$4,062.50" "$4,062.50" "$4,062.50" "$4,062.50" "$3,046.88" "$4,062.50" "$4,062.50" "$4,062.50" "$2,031.25" "$2,031.25" "$3,217.50" "$4,062.50" "$3,250.00" "$1,828.13" $806.30 N/A "$2,356.25" "$4,062.50" "$4,062.50" "$4,062.50" $846.63 "$4,062.50" N/A N/A AR-1927BCF-3 SUP HCPCS C1713 AR-1927BCF-3 - ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 3 BCMPS DISP BOTH IP/OP $850.00 $629.00 $168.70 $850.00 $382.50 $382.50 $382.50 $382.50 $850.00 $850.00 $850.00 $177.16 $850.00 $850.00 $850.00 $850.00 $850.00 $177.15 $850.00 $850.00 $502.78 $850.00 $850.00 $850.00 $850.00 $637.50 $850.00 $850.00 $850.00 $425.00 $425.00 $673.20 $850.00 $680.00 $382.50 $168.70 N/A $493.00 $850.00 $510.00 $850.00 $177.14 $850.00 N/A N/A AR-1927BCF-45 SUP HCPCS C1713 AR-1927BCF-45 - ANCHOR SUT 2 FT 4.5MM 14MM STRL CSCR FWR 2 BCMPS DISP BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-1927BCF-65 SUP HCPCS C1713 AR-1927BCF-65 - ANCHOR SUT 2 FT 6.5MM 14.7MM STRL CSCR FWR 2 VNT BCMPS DISP BOTH IP/OP $837.50 $620.00 $166.22 $837.50 $376.88 $376.88 $376.88 $376.88 $837.50 $837.50 $837.50 $174.56 $837.50 $837.50 $837.50 $837.50 $837.50 $174.54 $837.50 $837.50 $495.38 $837.50 $837.50 $837.50 $837.50 $628.13 $837.50 $837.50 $837.50 $418.75 $418.75 $663.30 $837.50 $670.00 $376.88 $166.22 N/A $485.75 $837.50 $502.50 $837.50 $174.54 $837.50 N/A N/A AR-1927BCFT SUP HCPCS C1713 AR-1927BCFT - ANCHOR SUTURE 2 SQUARE FULTHD 5.5MM 14.7MM DRIVE MECHANISM BOTH IP/OP $862.50 $638.00 $171.18 "$1,863.00" $388.13 $388.13 $388.13 $388.13 $862.50 $862.50 $862.50 $179.77 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 "$1,863.00" $510.17 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $171.18 N/A $500.25 $862.50 $517.50 $862.50 $179.75 $862.50 N/A N/A AR-1927BCFT-45 SUP HCPCS C1713 AR-1927BCFT-45 - ANCHOR SUT 2 SQ FT 4.5MM 14.7MM STRL CRKSCR TGTL DRV MECH BOTH IP/OP $862.50 $638.00 $171.18 $862.50 $388.13 $388.13 $388.13 $388.13 $862.50 $862.50 $862.50 $179.77 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $862.50 $510.17 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $171.18 N/A $500.25 $862.50 $517.50 $862.50 $179.75 $862.50 N/A N/A AR-1927BCNF SUP HCPCS C1713 AR-1927BCNF - ANCHOR SUTURE 2 FULTHD 5.5MM 14.7MM 2 4 NEEDLE CORKSCREW BOTH IP/OP $837.50 $620.00 $166.22 "$1,809.00" $376.88 $376.88 $376.88 $376.88 $837.50 $837.50 $837.50 $174.56 $837.50 $837.50 $837.50 $837.50 $837.50 $174.54 $837.50 "$1,809.00" $495.38 $837.50 $837.50 $837.50 $837.50 $628.13 $837.50 $837.50 $837.50 $418.75 $418.75 $663.30 $837.50 $670.00 $376.88 $166.22 N/A $485.75 $837.50 $502.50 $837.50 $174.54 $837.50 N/A N/A AR-1927BCNF-45 SUP HCPCS C1713 AR-1927BCNF-45 - ANCHOR SUT 4.5MM BCMPS CRKSCR FT NDL BOTH IP/OP $837.50 $620.00 $166.22 $837.50 $376.88 $376.88 $376.88 $376.88 $837.50 $837.50 $837.50 $174.56 $837.50 $837.50 $837.50 $837.50 $837.50 $174.54 $837.50 $837.50 $495.38 $837.50 $837.50 $837.50 $837.50 $628.13 $837.50 $837.50 $837.50 $418.75 $418.75 $663.30 $837.50 $670.00 $376.88 $166.22 N/A $485.75 $837.50 $837.50 $837.50 $174.54 $837.50 N/A N/A AR-1927BCT SUP HCPCS C1713 AR-1927BCT - ANCHOR SUT FT 1.3MM 5.5MM 14.7MM BLK BLU WHT CRKSCR BOTH IP/OP "$4,437.50" "$3,284.00" $880.73 "$4,437.50" "$1,996.88" "$1,996.88" "$1,996.88" "$1,996.88" "$4,437.50" "$4,437.50" "$4,437.50" $924.89 "$4,437.50" "$4,437.50" "$4,437.50" "$4,437.50" "$4,437.50" $924.82 "$4,437.50" "$1,775.00" "$2,187.69" "$4,437.50" "$4,437.50" "$4,437.50" "$4,437.50" "$3,328.13" "$4,437.50" "$4,437.50" "$4,437.50" "$2,218.75" "$2,218.75" "$3,514.50" "$4,437.50" "$3,550.00" "$1,996.88" $880.73 N/A "$2,573.75" "$4,437.50" "$4,437.50" "$4,437.50" $924.78 "$4,437.50" N/A N/A AR-1927BF SUP HCPCS C1713 AR-1927BF - ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR FWR 2 POLY L LACTD BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AR-1927BF-3 SUP HCPCS C1713 AR-1927BF-3 - ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR FWR 3 PLAY BABSR VNT BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A AR-1927BF-45 SUP HCPCS C1713 AR-1927BF-45 - ANCHOR SUT 2 FT 4.5MM 14MM STRL BCSCR FWR 2 POLY L LACTD CO BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AR-1927BF-65 SUP HCPCS C1713 AR-1927BF-65 - ANCHOR SUT 2 FT 6.5MM 14.7MM STRL BCSCR FWR 2 POLY L LACTD BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-1927BFC SUP HCPCS C1713 AR-1927BFC - ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR FWR FIBERCHAIN BABSR BOTH IP/OP $787.50 $583.00 $156.30 $787.50 $354.38 $354.38 $354.38 $354.38 $787.50 $787.50 $787.50 $164.13 $787.50 $787.50 $787.50 $787.50 $787.50 $164.12 $787.50 $787.50 $465.81 $787.50 $787.50 $787.50 $787.50 $590.63 $787.50 $787.50 $787.50 $393.75 $393.75 $623.70 $787.50 $630.00 $354.38 $156.30 N/A $456.75 $787.50 $472.50 $787.50 $164.12 $787.50 N/A N/A AR-1927BFS SUP HCPCS C1713 AR-1927BFS - ANCHOR SUT 2 FT 5.5MM 14.7MM STRL BCSCR SCRPN BABSR NDL DISP BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,062.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A AR-1927BFT-45 SUP HCPCS C1713 AR-1927BFT-45 - ANCHOR SUT 2 FT 4.5MM 14MM STRL BCSCR TGRL POLY L LACTD CO D BOTH IP/OP $762.50 $564.00 $151.34 $762.50 $343.13 $343.13 $343.13 $343.13 $762.50 $762.50 $762.50 $158.92 $762.50 $762.50 $762.50 $762.50 $762.50 $158.91 $762.50 $762.50 $451.02 $762.50 $762.50 $762.50 $762.50 $571.88 $762.50 $762.50 $762.50 $381.25 $381.25 $603.90 $762.50 $610.00 $343.13 $151.34 N/A $442.25 $762.50 $457.50 $762.50 $158.91 $762.50 N/A N/A AR-1927BNF SUP HCPCS C1713 AR-1927BNF - ANCHOR SUT 2 .5 CRC FT 5.5MM 14.7MM STRL 26MM BCSCR FWR 2 4 BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-1927BNF-45 SUP HCPCS C1713 AR-1927BNF-45 - ANCHOR SUT 2 .5 CRC FT 4.5MM 14MM STRL 26MM BCSCR FWR 2 4 BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-1927PBS SUP HCPCS C1713 AR-1927PBS - PUNCH ARTHRO STERILE DISPOSABLE 5.5 CORKSCREW FULTHD BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-1927PNF SUP HCPCS C1713 AR-1927PNF - ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 2 BRD 4 NDL PEEK BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-1927PNF-45 SUP HCPCS C1713 AR-1927PNF-45 - ANCHOR SUT 2 FT 4.5MM 14MM BLU W/B STRL CSCR FWR 2 BRD 4 NDL BOTH IP/OP $737.50 $546.00 $146.38 "$1,593.00" $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 "$1,593.00" $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-1927PSF SUP HCPCS C1713 AR-1927PSF - ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 2 PEEK DISP BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AR-1927PSF-3 SUP HCPCS C1713 AR-1927PSF-3 - ANCHOR SUT 2 FT 5.5MM 14.7MM STRL CSCR FWR 3 PEEK SHLDR DISP BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A AR-1927PSF-45 SUP HCPCS C1713 AR-1927PSF-45 - ANCHOR SUT 2 FT 4.5MM 14MM BLK BLU WHT STRL CSCR FWR 2 PEEK BOTH IP/OP $712.50 $527.00 $141.41 "$1,539.00" $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 "$1,539.00" $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AR-1927PSF-65 SUP HCPCS C1713 AR-1927PSF-65 - ANCHOR SUT 2 FT 6.5MM STRL CSCR FWR 2 PEEK DISP BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-1928SF SUP HCPCS C1713 AR-1928SF - ANCHOR SUT 2 FT 5.5MM 15MM STRL CSCR2 FWR BOTH IP/OP $575.00 $426.00 $114.12 $575.00 $258.75 $258.75 $258.75 $258.75 $575.00 $575.00 $575.00 $119.84 $575.00 $575.00 $575.00 $575.00 $575.00 $119.84 $575.00 $575.00 $340.11 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $258.75 $114.12 N/A $333.50 $575.00 $345.00 $575.00 $119.83 $575.00 N/A N/A AR-1928SF-2 SUP HCPCS C1713 AR-1928SF-2 - ANCHOR SUT 2 FT 5.5MM 16.3MM STRL CSCR2 FWR TI DISP BOTH IP/OP $575.00 $426.00 $114.12 $575.00 $258.75 $258.75 $258.75 $258.75 $575.00 $575.00 $575.00 $119.84 $575.00 $575.00 $575.00 $575.00 $575.00 $119.84 $575.00 $575.00 $340.11 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $258.75 $114.12 N/A $333.50 $575.00 $345.00 $575.00 $119.83 $575.00 N/A N/A AR-1928SF-3 SUP HCPCS C1713 AR-1928SF-3 - ANCHOR SUT 2 FT 5.5MM 16.3MM STRL CSCR2 FWR 3 TI DISP BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $275.63 $275.63 $275.63 $275.63 $612.50 $612.50 $612.50 $127.66 $612.50 $612.50 $612.50 $612.50 $612.50 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $275.63 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A AR-1928SF-45 SUP HCPCS C1713 AR-1928SF-45 - ANCHOR SUT 2 FT 4.5MM 14MM STRL CSCR2 FWR 2 TI DISP BOTH IP/OP $575.00 $426.00 $114.12 $575.00 $258.75 $258.75 $258.75 $258.75 $575.00 $575.00 $575.00 $119.84 $575.00 $575.00 $575.00 $575.00 $575.00 $119.84 $575.00 $575.00 $340.11 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $258.75 $114.12 N/A $333.50 $575.00 $575.00 $575.00 $119.83 $575.00 N/A N/A AR-1928SFT-2 SUP HCPCS C1713 AR-1928SFT-2 - ANCHOR SUT 2 FT 5.5MM 16.3MM STRL CRKSCR II TGTL TI BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-1928SNF SUP HCPCS C1713 AR-1928SNF - ANCHOR SUT 2 5.5MM 26MM STRL CSCR FWR TI ROTR CUF DISP BOTH IP/OP $637.50 $472.00 $126.53 $637.50 $286.88 $286.88 $286.88 $286.88 $637.50 $637.50 $637.50 $132.87 $637.50 $637.50 $637.50 $637.50 $637.50 $132.86 $637.50 $637.50 $377.08 $637.50 $637.50 $637.50 $637.50 $478.13 $637.50 $637.50 $637.50 $318.75 $318.75 $504.90 $637.50 $510.00 $286.88 $126.53 N/A $369.75 $637.50 $382.50 $637.50 $132.86 $637.50 N/A N/A AR-1928SNF-2 SUP HCPCS C1713 AR-1928SNF-2 - ANCHOR SUTURE 2 .5 CIR FULTHD DIAMOND 5.5MM 16MM 26MM 2 KNOT BOTH IP/OP $637.50 $472.00 $126.53 $637.50 $286.88 $286.88 $286.88 $286.88 $637.50 $637.50 $637.50 $132.87 $637.50 $637.50 $637.50 $637.50 $637.50 $132.86 $637.50 $255.00 $377.08 $637.50 $637.50 $637.50 $637.50 $478.13 $637.50 $637.50 $637.50 $318.75 $318.75 $504.90 $637.50 $510.00 $286.88 $126.53 N/A $369.75 $637.50 $637.50 $637.50 $132.86 $637.50 N/A N/A AR-1928SNF-2 SUP HCPCS C1713 AR-1928SNF-2 - ANCHOR SUTURE 2 .5 CIR FULTHD DIAMOND 5.5MM 16MM 26MM 2 KNOT BOTH IP/OP $637.50 $472.00 $126.53 $637.50 $286.88 $286.88 $286.88 $286.88 $637.50 $637.50 $637.50 $132.87 $637.50 $637.50 $637.50 $637.50 $637.50 $132.86 $637.50 $255.00 $377.08 $637.50 $637.50 $637.50 $637.50 $478.13 $637.50 $637.50 $637.50 $318.75 $318.75 $504.90 $637.50 $510.00 $286.88 $126.53 N/A $369.75 $637.50 $637.50 $637.50 $132.86 $637.50 N/A N/A AR-1929SF-3 SUP HCPCS C1713 "AR-1929SF-3 - SUTURE ANCHOR, CORKSCREW FT III" BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $275.63 $275.63 $275.63 $275.63 $612.50 $612.50 $612.50 $127.66 $612.50 $612.50 $612.50 $612.50 $612.50 $127.65 $612.50 $245.00 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $275.63 $121.57 N/A $355.25 $612.50 $367.50 $612.50 $127.65 $612.50 N/A N/A AR-1931S SUP Custom 27203010 AR-1931S - REAMER SRG 14MM STRL CNN COLR PIN SET COR DISP BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 N/A $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A AR-1934-20DS SUP Custom 27203010 AR-1934-20DS - KIT INST 2MM SUT TK ANCH DRL SPR TROC DISP BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-1934-24DS SUP Custom 27203010 AR-1934-24DS - KIT ESCP INST 2.4MM BSUT TK ANCH SPR STP DRL DISP ASCP BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-1934BCF SUP HCPCS C1713 AR-1934BCF - ANCHOR SUT 2 3MM 14.5MM STRL SUT TK FBRWR BCMPS DISP BOTH IP/OP $762.50 $564.00 $151.34 $762.50 $343.13 $343.13 $343.13 $343.13 $762.50 $762.50 $762.50 $158.92 $762.50 $762.50 $762.50 $762.50 $762.50 $158.91 $762.50 $762.50 $451.02 $762.50 $762.50 $762.50 $762.50 $571.88 $762.50 $762.50 $762.50 $381.25 $381.25 $603.90 $762.50 $610.00 $343.13 $151.34 N/A $442.25 $762.50 $457.50 $762.50 $158.91 $762.50 N/A N/A AR-1934BCF-2 SUP HCPCS C1713 AR-1934BCF-2 - ANCHOR SUT 2 3MM 14.5MM STRL SUT TK TIGERWIRE FBRWR BCMPS BOTH IP/OP $800.00 $592.00 $158.78 $800.00 $360.00 $360.00 $360.00 $360.00 $800.00 $800.00 $800.00 $166.74 $800.00 $800.00 $800.00 $800.00 $800.00 $166.73 $800.00 $320.00 $473.20 $800.00 $800.00 $800.00 $800.00 $600.00 $800.00 $800.00 $800.00 $400.00 $400.00 $633.60 $800.00 $640.00 $360.00 $158.78 N/A $464.00 $800.00 $800.00 $800.00 $166.72 $800.00 N/A N/A AR-1934BCF-20 SUP HCPCS C1713 AR-1934BCF-20 - ANCHOR SUT 1 MN 2MM 12MM STRL SUT TK FBRWR BCMPS BOTH IP/OP $762.50 $564.00 $151.34 $762.50 $343.13 $343.13 $343.13 $343.13 $762.50 $762.50 $762.50 $158.92 $762.50 $762.50 $762.50 $762.50 $762.50 $158.91 $762.50 $305.00 $451.02 $762.50 $762.50 $762.50 $762.50 $571.88 $762.50 $762.50 $762.50 $381.25 $381.25 $603.90 $762.50 $610.00 $343.13 $151.34 N/A $442.25 $762.50 $457.50 $762.50 $158.91 $762.50 N/A N/A AR-1934BCF-24 SUP HCPCS C1713 AR-1934BCF-24 - ANCHOR SUT 2 2.4MM 12MM STRL SUT TK FBRWR BCMPS DISP BOTH IP/OP $762.50 $564.00 $151.34 "$4,117.50" $343.13 $343.13 $343.13 $343.13 $762.50 $762.50 $762.50 $158.92 $762.50 $762.50 $762.50 $762.50 $762.50 $158.91 $762.50 "$4,117.50" $451.02 $762.50 $762.50 $762.50 $762.50 $571.88 $762.50 $762.50 $762.50 $381.25 $381.25 $603.90 $762.50 $610.00 $343.13 $151.34 N/A $442.25 $762.50 $457.50 $762.50 $158.91 $762.50 N/A N/A AR-1934BCF-24-2 SUP HCPCS C1713 AR-1934BCF-24-2 - ANCHOR SUT 2 2.4MM 12MM STRL SUT TK FBRWR BCMPS DISP BOTH IP/OP $800.00 $592.00 $158.78 $800.00 $360.00 $360.00 $360.00 $360.00 $800.00 $800.00 $800.00 $166.74 $800.00 $800.00 $800.00 $800.00 $800.00 $166.73 $800.00 $800.00 $473.20 $800.00 $800.00 $800.00 $800.00 $600.00 $800.00 $800.00 $800.00 $400.00 $400.00 $633.60 $800.00 $640.00 $360.00 $158.78 N/A $464.00 $800.00 $480.00 $800.00 $166.72 $800.00 N/A N/A AR-1934BCFT SUP HCPCS C1713 AR-1934BCFT - ANCHOR SUTURE 2 3MM 14.5MM SUTURETAK TIGERTAIL BIOCOMPOSITE BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-1934BCFT-2 SUP HCPCS C1713 AR-1934BCFT-2 - ANCHOR SUT 2 3MM 14.5MM STRL SUT TK TGTL BCMPS DISP BOTH IP/OP $850.00 $629.00 $168.70 $850.00 $382.50 $382.50 $382.50 $382.50 $850.00 $850.00 $850.00 $177.16 $850.00 $850.00 $850.00 $850.00 $850.00 $177.15 $850.00 $340.00 $502.78 $850.00 $850.00 $850.00 $850.00 $637.50 $850.00 $850.00 $850.00 $425.00 $425.00 $673.20 $850.00 $680.00 $382.50 $168.70 N/A $493.00 $850.00 $510.00 $850.00 $177.14 $850.00 N/A N/A AR-1934BF SUP HCPCS C1713 AR-1934BF - ANCHOR SUT 2 3MM 14.5MM STRL BSUT TK FBRWR BABSR PUSH IN BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $275.63 $275.63 $275.63 $275.63 $612.50 $612.50 $612.50 $127.66 $612.50 $612.50 $612.50 $612.50 $612.50 $127.65 $612.50 $245.00 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $275.63 $121.57 N/A $355.25 $612.50 $367.50 $612.50 $127.65 $612.50 N/A N/A AR-1934BFT SUP HCPCS C1713 AR-1934BFT - ANCHOR SUTURE 2 3MM 14.5MM BIOABSORBABLE BIO-SUTURETAK BOTH IP/OP $662.50 $490.00 $131.49 $662.50 $298.13 $298.13 $298.13 $298.13 $662.50 $662.50 $662.50 $138.08 $662.50 $662.50 $662.50 $662.50 $662.50 $138.07 $662.50 $265.00 $391.87 $662.50 $662.50 $662.50 $662.50 $496.88 $662.50 $662.50 $662.50 $331.25 $331.25 $524.70 $662.50 $530.00 $298.13 $131.49 N/A $384.25 $662.50 $397.50 $662.50 $138.07 $662.50 N/A N/A AR-1934D-20 SUP Custom 27203010 AR-1934D-20 - DRILL SRG 2 MM SUT TK BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 N/A $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A AR-1934D-20-1 SUP Custom 27203010 AR-1934D-20-1 - DRILL SRG 2 MM SUT TK HRD BN BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 N/A $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A AR-1934D-24 SUP Custom 27203010 AR-1934D-24 - DRILL SRG STP DISP 2.4MM SUT TK BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 N/A $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A AR-1934D-24-1 SUP Custom 27203010 AR-1934D-24-1 - DRILL SRG 2.6MM 2.4MM SUT TK BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 N/A $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A AR-1934D-24-2 SUP Custom 27203010 AR-1934D-24-2 - DRILL SRG 2.6MM 2.4MM SUT TK BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 N/A $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A AR-1934DHS-2 SUP Custom 27203010 AR-1934DHS-2 - KIT INST HIP DISP 3MM SUT TK BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-1934DS-2 SUP Custom 27203010 AR-1934DS-2 - KIT INST STRL GD SPR STP DRL TROC DISP 3MM SUT TK BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-1934PF-20 SUP HCPCS C1713 AR-1934PF-20 - ANCHOR SUT 1 2MM 12MM STRL SUT TK FBRWR PEEK BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-1934PF-24 SUP HCPCS C1713 AR-1934PF-24 - ANCHOR SUT 2 2.4MM 12MM STRL SUT TK FBRWR PEEK BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-1934PI SUP Custom 27203010 AR-1934PI - KIT INS 1.1MM 17GA 2.4MM BSUT TK DRL NDL PERC INS PRTL DIL BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1934PI-20 SUP Custom 27203010 AR-1934PI-20 - KIT INS 1.1MM 17GA 2MM SUT TK DRL PRTL DIL SPR SPNL NDL WRE BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1934PI-30 SUP Custom 27203010 AR-1934PI-30 - KIT INSERTION 1.1MM 17GA 3MM STEP DRILL PORTAL DILAT SPEAR BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-1934PRK SUP Custom 27203010 AR-1934PRK - KIT ASCP FX 2.4MM 4.5MM SUT TK SWIVELOCK SPR NDL GW DIL BOTH IP/OP "$2,962.50" "$2,192.00" $527.33 "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" $527.33 "$2,962.50" "$2,962.50" "$2,198.77" "$2,198.77" "$2,283.50" "$1,543.46" $617.42 "$2,962.50" "$1,185.00" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,221.88" "$2,962.50" "$2,962.50" "$2,962.50" "$1,481.25" "$1,481.25" "$2,346.30" "$2,962.50" "$2,370.00" "$1,925.63" "$2,962.50" N/A "$1,718.25" "$2,962.50" "$1,777.50" "$2,962.50" "$2,962.50" "$2,962.50" N/A N/A AR-1934PS SUP HCPCS C1713 AR-1934PS - ANCHOR SUT 2 3MM 12.4MM BSUT TK FBRWR PEEK BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $600.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A AR-1934PS-2 SUP HCPCS C1713 AR-1934PS-2 - ANCHOR SUT 2 3MM 12.2MM SUT TK FBRWR PEEK ROTR CUF BOTH IP/OP $637.50 $472.00 $126.53 $637.50 $286.88 $286.88 $286.88 $286.88 $637.50 $637.50 $637.50 $132.87 $637.50 $637.50 $637.50 $637.50 $637.50 $132.86 $637.50 $637.50 $377.08 $637.50 $637.50 $637.50 $637.50 $478.13 $637.50 $637.50 $637.50 $318.75 $318.75 $504.90 $637.50 $510.00 $286.88 $126.53 N/A $369.75 $637.50 $382.50 $637.50 $132.86 $637.50 N/A N/A AR-1938BC SUP HCPCS C1713 AR-1938BC - ANCHOR SUT 2 3MM 12.7MM SUT TK FBRWR KNTLS BCMPS BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $425.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" "$1,062.50" "$1,062.50" $221.43 "$1,062.50" N/A N/A AR-1938D SUP Custom 27203010 AR-1938D - DRILL SRG 2.6MM 3MM SUT TK BOTH IP/OP $262.50 $194.00 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $46.73 $262.50 $262.50 $194.83 $194.83 $202.34 $136.76 $54.71 $262.50 $105.00 $262.50 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $170.63 $262.50 N/A $152.25 $262.50 $157.50 $262.50 $262.50 $262.50 N/A N/A AR-1938PS SUP HCPCS C1713 AR-1938PS - ANCHOR SUT 2 3MM 12.7MM KNTLS SUT TK FBRWR PEEK BOTH IP/OP $962.50 $712.00 $191.03 $962.50 $433.13 $433.13 $433.13 $433.13 $962.50 $962.50 $962.50 $200.61 $962.50 $962.50 $962.50 $962.50 $962.50 $200.60 $962.50 $385.00 $569.32 $962.50 $962.50 $962.50 $962.50 $721.88 $962.50 $962.50 $962.50 $481.25 $481.25 $762.30 $962.50 $770.00 $433.13 $191.03 N/A $558.25 $962.50 $577.50 $962.50 $200.59 $962.50 N/A N/A AR-1938PS-PL SUP HCPCS C1713 AR-1938PS-PL - SUTRE ANCH PEEK S-TAK KNOTLESS 3X12.7M BOTH IP/OP $962.50 $712.00 $191.03 $962.50 $433.13 $433.13 $433.13 $433.13 $962.50 $962.50 $962.50 $200.61 $962.50 $962.50 $962.50 $962.50 $962.50 $200.60 $962.50 $385.00 $569.32 $962.50 $962.50 $962.50 $962.50 $721.88 $962.50 $962.50 $962.50 $481.25 $481.25 $762.30 $962.50 $770.00 $433.13 $191.03 N/A $558.25 $962.50 $577.50 $962.50 $200.59 $962.50 N/A N/A AR-1949H-2.4 SUP Custom 27203010 AR-1949H-2.4 - GUIDE DRL 2.4MM ANCH CNN SDL TROC HIP BOTH IP/OP "$1,247.50" $923.00 $222.06 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $222.06 "$1,247.50" "$1,247.50" $925.89 $925.89 $961.57 $649.95 $259.99 "$1,247.50" $538.92 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $810.88 "$1,247.50" N/A $723.55 "$1,247.50" $748.50 "$1,247.50" "$1,247.50" "$1,247.50" N/A N/A AR-1949H-3.0 SUP Custom 27203010 AR-1949H-3.0 - GUIDE DRL 3MM ANCH CNN SDL TROC HIP BOTH IP/OP "$1,247.50" $923.00 $222.06 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $222.06 "$1,247.50" "$1,247.50" $925.89 $925.89 $961.57 $649.95 $259.99 "$1,247.50" $538.92 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $810.88 "$1,247.50" N/A $723.55 "$1,247.50" $748.50 "$1,247.50" "$1,247.50" "$1,247.50" N/A N/A AR-1965 SUP Custom 27203010 AR-1965 - GUIDE DRL ALGTR MNSCL ALGRF BOTH IP/OP "$5,120.00" "$3,789.00" $911.36 "$5,120.00" "$5,120.00" "$5,120.00" "$5,120.00" "$5,120.00" "$5,120.00" "$5,120.00" $911.36 "$5,120.00" "$5,120.00" "$3,800.06" "$3,800.06" "$3,946.50" "$2,060.15" "$1,067.06" "$5,120.00" "$2,048.00" "$5,120.00" "$5,120.00" "$5,120.00" "$5,120.00" "$5,120.00" "$3,840.00" "$5,120.00" "$5,120.00" "$5,120.00" "$2,560.00" "$2,560.00" "$4,055.04" "$5,120.00" "$4,096.00" "$3,328.00" "$5,120.00" N/A "$2,969.60" "$5,120.00" "$3,072.00" "$5,120.00" "$5,120.00" "$5,120.00" N/A N/A AR-1965G SUP Custom 27203010 AR-1965G - GUIDE DRL DVTL TIB BOTH IP/OP "$7,250.00" "$5,365.00" "$1,290.50" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$1,290.50" "$7,250.00" "$7,250.00" "$4,181.12" "$4,181.12" "$5,588.30" "$2,060.15" "$1,510.98" "$7,250.00" "$3,132.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$7,250.00" "$5,437.50" "$7,250.00" "$7,250.00" "$7,250.00" "$3,625.00" "$3,625.00" "$5,742.00" "$7,250.00" "$5,800.00" "$4,712.50" "$7,250.00" N/A "$4,205.00" "$7,250.00" "$4,350.00" "$7,250.00" "$7,250.00" "$7,250.00" N/A N/A AR-1966DS SUP Custom 27203010 AR-1966DS - KIT INST ALGRF DISP BOTH IP/OP "$1,825.00" "$1,351.00" $324.85 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $324.85 "$1,825.00" "$1,825.00" "$1,354.52" "$1,354.52" "$1,406.71" $950.83 $380.35 "$1,825.00" $730.00 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" "$1,186.25" "$1,825.00" N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" "$1,825.00" "$1,825.00" N/A N/A AR-1967A SUP Custom 27203010 AR-1967A - CLAMP SRG ADJ SFT TIS BOTH IP/OP "$1,510.00" "$1,117.00" $268.78 "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" $268.78 "$1,510.00" "$1,510.00" "$1,120.72" "$1,120.72" "$1,163.91" $786.71 $314.70 "$1,510.00" $652.32 "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" "$1,132.50" "$1,510.00" "$1,510.00" "$1,510.00" $755.00 $755.00 "$1,195.92" "$1,510.00" "$1,208.00" $981.50 "$1,510.00" N/A $875.80 "$1,510.00" $906.00 "$1,510.00" "$1,510.00" "$1,510.00" N/A N/A AR-1967F SUP Custom 27203010 AR-1967F - CLAMP SRG FX SFT TIS BOTH IP/OP "$1,510.00" "$1,117.00" $268.78 "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" $268.78 "$1,510.00" "$1,510.00" "$1,120.72" "$1,120.72" "$1,163.91" $786.71 $314.70 "$1,510.00" $604.00 "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" "$1,510.00" "$1,132.50" "$1,510.00" "$1,510.00" "$1,510.00" $755.00 $755.00 "$1,195.92" "$1,510.00" "$1,208.00" $981.50 "$1,510.00" N/A $875.80 "$1,510.00" $906.00 "$1,510.00" "$1,510.00" "$1,510.00" N/A N/A AR-1974 SUP Custom 27203010 AR-1974 - DRILL SRG 5MM ACL 3MM PIN TRNFX BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-1974L SUP Custom 27203010 AR-1974L - DRILL SRG LNG 5MM STRL 2MM GDPN TRNFX2 BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-1975 SUP Custom 27203010 AR-1975 - GUIDE DRL ACL RECON TIB TRNFX2 BOTH IP/OP "$2,350.00" "$1,739.00" $418.30 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $418.30 "$2,350.00" "$2,350.00" "$1,744.17" "$1,744.17" "$1,811.38" "$1,224.35" $489.77 "$2,350.00" "$1,015.20" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,527.50" "$2,350.00" N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" "$2,350.00" "$2,350.00" N/A N/A AR-1980-05S SUP Custom 27203010 AR-1980-05S - SET GFT HRVT 6MM 5MM STRL OATS COLR PIN TUBE ACL DISP BOTH IP/OP "$1,247.50" $923.00 $222.06 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $222.06 "$1,247.50" "$1,247.50" $925.89 $925.89 $961.57 $649.95 $259.99 "$1,247.50" $499.00 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $810.88 "$1,247.50" N/A $723.55 "$1,247.50" $748.50 "$1,247.50" "$1,247.50" "$1,247.50" N/A N/A AR-1980-06S SUP Custom 27203010 AR-1980-06S - SET GFT HRVT 7MM 6MM STRL OATS COLR PIN TUBE ACL DISP BOTH IP/OP "$1,247.50" $923.00 $222.06 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $222.06 "$1,247.50" "$1,247.50" $925.89 $925.89 $961.57 $649.95 $259.99 "$1,247.50" $499.00 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $810.88 "$1,247.50" N/A $723.55 "$1,247.50" $748.50 "$1,247.50" "$1,247.50" "$1,247.50" N/A N/A AR-1980-07S SUP Custom 27203010 AR-1980-07S - SET GFT HRVT 8MM 7MM STRL OATS COLR PIN TUBE ACL DISP BOTH IP/OP "$1,247.50" $923.00 $222.06 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $222.06 "$1,247.50" "$1,247.50" $925.89 $925.89 $961.57 $649.95 $259.99 "$1,247.50" $499.00 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $810.88 "$1,247.50" N/A $723.55 "$1,247.50" $748.50 "$1,247.50" "$1,247.50" "$1,247.50" N/A N/A AR-1980-08S SUP Custom 27203010 AR-1980-08S - SET GFT HRVT 9MM 8MM STRL OATS COLR PIN TUBE ACL DISP BOTH IP/OP "$1,247.50" $923.00 $222.06 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $222.06 "$1,247.50" "$1,247.50" $925.89 $925.89 $961.57 $649.95 $259.99 "$1,247.50" $499.00 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $810.88 "$1,247.50" N/A $723.55 "$1,247.50" $748.50 "$1,247.50" "$1,247.50" "$1,247.50" N/A N/A AR-1980-09S SUP Custom 27203010 AR-1980-09S - SET GFT HRVT 10MM 9MM STRL OATS COLR PIN TUBE ACL DISP BOTH IP/OP "$1,247.50" $923.00 $222.06 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $222.06 "$1,247.50" "$1,247.50" $925.89 $925.89 $961.57 $649.95 $259.99 "$1,247.50" $499.00 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $810.88 "$1,247.50" N/A $723.55 "$1,247.50" $748.50 "$1,247.50" "$1,247.50" "$1,247.50" N/A N/A AR-1980-10S SUP Custom 27203010 AR-1980-10S - SET GFT HRVT 11MM 10MM STRL OATS COLR PIN TUBE ACL DISP BOTH IP/OP "$1,247.50" $923.00 $222.06 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $222.06 "$1,247.50" "$1,247.50" $925.89 $925.89 $961.57 $649.95 $259.99 "$1,247.50" $499.00 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $810.88 "$1,247.50" N/A $723.55 "$1,247.50" $748.50 "$1,247.50" "$1,247.50" "$1,247.50" N/A N/A AR-1980-12SU SUP Custom 27203010 AR-1980-12SU - SET GFT HRVT 12MM 11MM STRL OATS COLR PIN TUBE ACL DISP BOTH IP/OP "$1,247.50" $923.00 $222.06 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $222.06 "$1,247.50" "$1,247.50" $925.89 $925.89 $961.57 $649.95 $259.99 "$1,247.50" $499.00 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $810.88 "$1,247.50" N/A $723.55 "$1,247.50" $748.50 "$1,247.50" "$1,247.50" "$1,247.50" N/A N/A AR-1981-04S SUP Custom 27203010 AR-1981-04S - SET GFT HRVT 4.75MM STRL OATS ALGN ROD COR XTRDR DLV TUBE BOTH IP/OP "$1,300.00" $962.00 $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $231.40 "$1,300.00" "$1,300.00" $964.86 $964.86 "$1,002.04" $677.30 $270.93 "$1,300.00" $520.00 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $845.00 "$1,300.00" N/A $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A AR-1981-06H SUP Custom 27203010 AR-1981-06H - SET GFT HRVT 6MM STRL OATS ALGN ROD COR XTRDR DLV TUBE TAMP BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-1981-06S SUP Custom 27203010 AR-1981-06S - SET GFT HRVT 7MM 6MM STRL OATS ALGN ROD COR XTRDR DLV TUBE BOTH IP/OP "$1,300.00" $962.00 $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $231.40 "$1,300.00" "$1,300.00" $964.86 $964.86 "$1,002.04" $677.30 $270.93 "$1,300.00" $520.00 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $845.00 "$1,300.00" N/A $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A AR-1981-08H SUP Custom 27203010 AR-1981-08H - SET GFT HRVT 8MM STRL OATS ALGN ROD COR XTRDR DLV TUBE TAMP BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-1981-08S SUP Custom 27203010 AR-1981-08S - SET GFT HRVT 9MM 8MM STRL OATS ALGN ROD COR XTRDR DLV TUBE BOTH IP/OP "$1,300.00" $962.00 $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $231.40 "$1,300.00" "$1,300.00" $964.86 $964.86 "$1,002.04" $677.30 $270.93 "$1,300.00" $520.00 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $845.00 "$1,300.00" N/A $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A AR-1981-10H SUP Custom 27203010 AR-1981-10H - SET GFT HRVT 10MM STRL OATS ALGN ROD COR XTRDR DLV TUBE TAMP BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-1982-08S SUP Custom 27203010 AR-1982-08S - SET GFT HRVT RTRGD 8MM STRL OATS DISP BOTH IP/OP "$1,825.00" "$1,351.00" $324.85 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $324.85 "$1,825.00" "$1,825.00" "$1,354.52" "$1,354.52" "$1,406.71" $950.83 $380.35 "$1,825.00" $730.00 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" "$1,186.25" "$1,825.00" N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" "$1,825.00" "$1,825.00" N/A N/A AR-1982-10S SUP Custom 27203010 AR-1982-10S - SET GFT HRVT RTRGD 10MM STRL OATS DISP BOTH IP/OP "$1,825.00" "$1,351.00" $324.85 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $324.85 "$1,825.00" "$1,825.00" "$1,354.52" "$1,354.52" "$1,406.71" $950.83 $380.35 "$1,825.00" $730.00 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" "$1,186.25" "$1,825.00" N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" "$1,825.00" "$1,825.00" N/A N/A AR-1983 SUP HCPCS C1713 AR-1983 - CAP PCTV OATS CRTLG ACL BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $334.80 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $465.00 $775.00 $775.00 $775.00 N/A N/A AR-1991 SUP HCPCS C1713 AR-1991 - CALIBRATOR PIN OATS BOTH IP/OP $327.50 $242.00 $65.00 $327.50 $147.38 $147.38 $147.38 $147.38 $327.50 $327.50 $327.50 $68.26 $327.50 $327.50 $327.50 $327.50 $327.50 $68.25 $327.50 $131.00 $193.72 $327.50 $327.50 $327.50 $327.50 $245.63 $327.50 $327.50 $327.50 $163.75 $163.75 $259.38 $327.50 $262.00 $147.38 $65.00 N/A $189.95 $327.50 $327.50 $327.50 $68.25 $327.50 N/A N/A AR-2236B SUP HCPCS C1763 AR-2236B - BUTTON FX 6.5MM 1MM TISSUEBUTTON HNDL INSRTR PRELD POLY L BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A AR-2238B SUP HCPCS C1763 AR-2238B - BUTTON FX 8MM 1MM STRL TISSUEBUTTON BABSR POLY L LAC ACD SFT BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A AR-2240B SUP HCPCS C1763 AR-2240B - BUTTON FX 5MM 10MM STRL TISSUEBUTTON POLY L LAC ACD ROTR CUF BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A AR-2253L SUP Custom 27203010 AR-2253L - GUIDE DRL ARM LT ACJT ACJT RECON SYS BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $351.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-2253R SUP Custom 27203010 AR-2253R - GUIDE DRL ARM RT ACJT ACJT RECON SYS BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $351.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-2255CG SUP Custom 27203010 AR-2255CG - GUIDE DRL CNST ACJT BOTH IP/OP "$4,912.50" "$3,635.00" $874.43 "$4,912.50" "$4,912.50" "$4,912.50" "$4,912.50" "$4,912.50" "$4,912.50" "$4,912.50" $874.43 "$4,912.50" "$4,912.50" "$3,646.06" "$3,646.06" "$3,786.56" "$2,060.15" "$1,023.82" "$4,912.50" "$2,122.20" "$4,912.50" "$4,912.50" "$4,912.50" "$4,912.50" "$4,912.50" "$3,684.38" "$4,912.50" "$4,912.50" "$4,912.50" "$2,456.25" "$2,456.25" "$3,890.70" "$4,912.50" "$3,930.00" "$3,193.13" "$4,912.50" N/A "$2,849.25" "$4,912.50" "$2,947.50" "$4,912.50" "$4,912.50" "$4,912.50" N/A N/A AR-2257-01 SUP HCPCS C1763 AR-2257-01 - BUTTON FX CLVCL BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A AR-2257-02 SUP HCPCS C1763 AR-2257-02 - BUTTON FX CORACOID BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A AR-2257D-24 SUP Custom 27203010 AR-2257D-24 - DRILL SRG 2.4MM CNN ACML REPR BOTH IP/OP $687.50 $509.00 $122.38 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $122.38 $687.50 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $275.00 $687.50 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $687.50 N/A $398.75 $687.50 $412.50 $687.50 $687.50 $687.50 N/A N/A AR-2257D-30 SUP Custom 27203010 AR-2257D-30 - DRILL SRG 3MM CNN AC REPR BOTH IP/OP $687.50 $509.00 $122.38 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $122.38 $687.50 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $275.00 $687.50 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $687.50 N/A $398.75 $687.50 $412.50 $687.50 $687.50 $687.50 N/A N/A AR-2258-03 SUP Custom 27803010 AR-2258-03 - WASHER ORTH CLVCL BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A AR-2260 SUP Custom 27203010 AR-2260 - KIT ASCP FX STRL BTN DRL PIN INSRTR SCR BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$1,577.18" "$1,577.18" "$1,637.95" "$1,107.13" $442.87 "$2,125.00" $918.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" "$1,381.25" "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A AR-2261 SUP HCPCS C1763 AR-2261 - BUTTON SUT 12MM STRL BICEPS BOTH IP/OP $737.50 $546.00 $146.38 $796.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $796.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-2263 SUP HCPCS C1763 AR-2263 - PIN DRL 3.2MM STRL BISCEPSBUTTON DIST DISP BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-2264 SUP HCPCS C1713 AR-2264 - DEVICE FX STRL TGHTRP TWN TAIL ACJT BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $575.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-2266 SUP HCPCS C1763 AR-2266 - BUTTON FX 2.6MM 10.9MM TI SHLDR PECTORALIS MN OPN REPR BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-2267 SUP HCPCS C1763 AR-2267 - BUTTON FX LF INSRTR LG EYLT PECTORALIS BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A AR-2270 SUP HCPCS C1763 AR-2270 - BUTTON FX DOG BN BOTH IP/OP $875.00 $648.00 $173.67 $875.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $875.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $875.00 $875.00 $182.35 $875.00 N/A N/A AR-2271 SUP Custom 27203010 AR-2271 - KIT ASCP FX 2MM 3MM TIGERTAPE SUTLSO 2 DOG BN BTN CNN DRL BOTH IP/OP "$2,812.50" "$2,081.00" $500.63 "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" $500.63 "$2,812.50" "$2,812.50" "$2,087.44" "$2,087.44" "$2,167.88" "$1,465.31" $586.16 "$2,812.50" "$1,125.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$2,109.38" "$2,812.50" "$2,812.50" "$2,812.50" "$1,406.25" "$1,406.25" "$2,227.50" "$2,812.50" "$2,250.00" "$1,828.13" "$2,812.50" N/A "$1,631.25" "$2,812.50" "$1,687.50" "$2,812.50" "$2,812.50" "$2,812.50" N/A N/A AR-2273 SUP Custom 27203010 AR-2273 - GUIDE DRL ACJT ACJT RECON SYS BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $351.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-2274 SUP Custom 27203010 AR-2274 - CANNULA ESCP 4.7MM SLOT BOTH IP/OP $987.50 $731.00 $175.78 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $175.78 $987.50 $987.50 $732.92 $732.92 $761.17 $514.49 $205.81 $987.50 $395.00 $987.50 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $641.88 $987.50 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A AR-2280 SUP HCPCS C1763 AR-2280 - BUTTON INSERTER/SUTURE KIT BOTH IP/OP "$1,975.00" "$1,462.00" $391.99 "$1,975.00" $888.75 $888.75 $888.75 $888.75 "$1,975.00" "$1,975.00" "$1,975.00" $411.64 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" "$1,975.00" "$1,168.21" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 $391.99 N/A "$1,145.50" "$1,975.00" "$1,975.00" "$1,975.00" $411.59 "$1,975.00" N/A N/A AR-2281 SUP HCPCS C1763 AR-2281 - 12MM BUTTON/SUTURE CONSTRUCT BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $987.50 $987.50 $205.80 $987.50 N/A N/A AR-2290 SUP HCPCS C1713 AR-2290 - SET IMPLANT 3.2MM PROXIMAL TENODESIS BUTTON FIBERLOOP DRILL BOTH IP/OP "$1,687.50" "$1,249.00" $334.93 "$1,687.50" $759.38 $759.38 $759.38 $759.38 "$1,687.50" "$1,687.50" "$1,687.50" $351.72 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" $351.69 "$1,687.50" $729.00 $998.16 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" $759.38 $334.93 N/A $978.75 "$1,687.50" "$1,012.50" "$1,687.50" $351.68 "$1,687.50" N/A N/A AR-2291 SUP HCPCS C1763 AR-2291 - BUTTON FX 0 BICEPS PROX TENODESIS BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" "$1,087.50" $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" "$1,087.50" "$1,087.50" $226.64 "$1,087.50" N/A N/A AR-2323BCC SUP HCPCS C1713 AR-2323BCC - ANCHOR SUTURE 5.5MM 19.1MM CLOSE EYELET VENT SWIVELOCK C BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" $432.00 $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" $600.00 "$1,000.00" $208.40 "$1,000.00" N/A N/A AR-2323BCM SUP HCPCS C1713 AR-2323BCM - ANCHOR SUT 5.5MM 24.5MM STRL SWIVELOCK SP SLF PNCH VNT BCMPS BOTH IP/OP "$1,050.00" $777.00 $208.40 "$1,050.00" $472.50 $472.50 $472.50 $472.50 "$1,050.00" "$1,050.00" "$1,050.00" $218.85 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $218.83 "$1,050.00" "$1,050.00" $621.08 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $787.50 "$1,050.00" "$1,050.00" "$1,050.00" $525.00 $525.00 $831.60 "$1,050.00" $840.00 $472.50 $208.40 N/A $609.00 "$1,050.00" $630.00 "$1,050.00" $218.82 "$1,050.00" N/A N/A AR-2323BCT-2 SUP HCPCS C1713 AR-2323BCT-2 - ANCHOR SUT 2 5.5MM 22MM BLK BLU WHT FIBERTAK SWIVELOCK C BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $425.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" "$1,062.50" "$1,062.50" N/A N/A AR-2323BSL SUP HCPCS C1713 AR-2323BSL - ANCHOR SUT 5.5MM 20MM STRL BIO-SWIVELOCK SLF PNCH VNT DISP BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $937.50 $937.50 $195.38 $937.50 N/A N/A AR-2323BSLC SUP HCPCS C1713 AR-2323BSLC - ANCHOR SUT 5.5MM 19.1MM STRL BIO-SWIVELOCK C CLS EYLT VNT BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $562.50 $937.50 $195.38 $937.50 N/A N/A AR-2323BSLM SUP HCPCS C1713 AR-2323BSLM - ANCHOR SUT 5.5MM 24.5MM STRL BIO-SWIVELOCK SLF PNCH VNT DISP BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" "$1,000.00" $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.40 "$1,000.00" N/A N/A AR-2323PSL SUP HCPCS C1713 AR-2323PSL - ANCHOR SUT 5.5MM 20MM SWIVELOCK PEEK BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $375.00 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $937.50 $937.50 $195.38 $937.50 N/A N/A AR-2323PSLC SUP HCPCS C1713 AR-2323PSLC - ANCHOR SUTURE 5.5MM 19.1MM CLOSE EYELET SWIVELOCK C BOTH IP/OP $937.50 $694.00 $186.07 "$2,025.00" $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 "$2,025.00" $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $562.50 $937.50 $195.38 $937.50 N/A N/A AR-2323PSLC-2 SUP HCPCS C1713 AR-2323PSLC-2 - ANCHOR SUT 5.5MM STRL LF ARTHX SWIVELOCK 2 LD PEEK BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $395.00 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $987.50 $987.50 $205.80 $987.50 N/A N/A AR-2323PSLM SUP HCPCS C1713 AR-2323PSLM - ANCHOR SUT 5.5MM 24.5MM STRL BIO-SWIVELOCK SLF PNCH DISP BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" "$1,000.00" $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" $600.00 "$1,000.00" $208.40 "$1,000.00" N/A N/A AR-2323SLM SUP HCPCS C1713 AR-2323SLM - ANCHOR SUT 5.5MM 24.5MM STRL SWIVELOCK SLF PNCH DISP BOTH IP/OP $800.00 $592.00 $158.78 $800.00 $360.00 $360.00 $360.00 $360.00 $800.00 $800.00 $800.00 $166.74 $800.00 $800.00 $800.00 $800.00 $800.00 $166.73 $800.00 $800.00 $473.20 $800.00 $800.00 $800.00 $800.00 $600.00 $800.00 $800.00 $800.00 $400.00 $400.00 $633.60 $800.00 $640.00 $360.00 $158.78 N/A $464.00 $800.00 $480.00 $800.00 $166.72 $800.00 N/A N/A AR-2324BCC SUP HCPCS C1713 AR-2324BCC - ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET VENT SWIVELOCK C BOTH IP/OP "$1,000.00" $740.00 $198.48 "$2,160.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" "$2,160.00" $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" $600.00 "$1,000.00" $208.40 "$1,000.00" N/A N/A AR-2324BCC-2 SUP HCPCS C1713 AR-2324BCC-2 - ANCHOR SUT 4.75MM STRL SWIVELOCK TIGERWIRE ARTHX 2 LD 2 TIP BOTH IP/OP "$1,042.50" $771.00 $206.91 "$1,042.50" $469.13 $469.13 $469.13 $469.13 "$1,042.50" "$1,042.50" "$1,042.50" $217.28 "$1,042.50" "$1,042.50" "$1,042.50" "$1,042.50" "$1,042.50" $217.27 "$1,042.50" "$1,042.50" $616.64 "$1,042.50" "$1,042.50" "$1,042.50" "$1,042.50" $781.88 "$1,042.50" "$1,042.50" "$1,042.50" $521.25 $521.25 $825.66 "$1,042.50" $834.00 $469.13 $206.91 N/A $604.65 "$1,042.50" $625.50 "$1,042.50" $217.26 "$1,042.50" N/A N/A AR-2324BCC-CP SUP HCPCS C1713 AR-2324BCC-CP - SET IMPL FULL 4.75MM 19.1MM SWIVELOCK C CLS EYLT VNT KN BOTH IP/OP "$2,562.50" "$1,896.00" $508.59 "$2,562.50" "$1,153.13" "$1,153.13" "$1,153.13" "$1,153.13" "$2,562.50" "$2,562.50" "$2,562.50" $534.09 "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" $534.05 "$2,562.50" "$2,562.50" "$1,263.31" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$1,921.88" "$2,562.50" "$2,562.50" "$2,562.50" "$1,281.25" "$1,281.25" "$2,029.50" "$2,562.50" "$2,050.00" "$1,153.13" $508.59 N/A "$1,486.25" "$2,562.50" "$1,537.50" "$2,562.50" "$2,562.50" "$2,562.50" N/A N/A AR-2324BCCS SUP HCPCS C1713 AR-2324BCCS - SYSTEM ENDSCP FIX 4.75MM NEEDLE MULTIFIRE SCORPION SWIVELOCK BOTH IP/OP "$1,600.00" "$1,184.00" $317.56 "$1,600.00" $720.00 $720.00 $720.00 $720.00 "$1,600.00" "$1,600.00" "$1,600.00" $333.48 "$1,600.00" "$1,600.00" "$1,600.00" "$1,600.00" "$1,600.00" $333.46 "$1,600.00" $691.20 $946.40 "$1,600.00" "$1,600.00" "$1,600.00" "$1,600.00" "$1,200.00" "$1,600.00" "$1,600.00" "$1,600.00" $800.00 $800.00 "$1,267.20" "$1,600.00" "$1,280.00" $720.00 $317.56 N/A $928.00 "$1,600.00" "$1,600.00" "$1,600.00" $333.44 "$1,600.00" N/A N/A AR-2324BCCT SUP HCPCS C1713 AR-2324BCCT - ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET TAPE LOOP VENT BOTH IP/OP "$1,175.00" $870.00 $233.21 "$2,538.00" $528.75 $528.75 $528.75 $528.75 "$1,175.00" "$1,175.00" "$1,175.00" $244.90 "$1,175.00" "$1,175.00" "$1,175.00" "$1,175.00" "$1,175.00" $244.88 "$1,175.00" "$2,538.00" $695.01 "$1,175.00" "$1,175.00" "$1,175.00" "$1,175.00" $881.25 "$1,175.00" "$1,175.00" "$1,175.00" $587.50 $587.50 $930.60 "$1,175.00" $940.00 $528.75 $233.21 N/A $681.50 "$1,175.00" $705.00 "$1,175.00" $244.87 "$1,175.00" N/A N/A AR-2324BCCTT SUP HCPCS C1713 AR-2324BCCTT - ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET VENT SWIVELOCK C BOTH IP/OP "$1,175.00" $870.00 $233.21 "$6,345.00" $528.75 $528.75 $528.75 $528.75 "$1,175.00" "$1,175.00" "$1,175.00" $244.90 "$1,175.00" "$1,175.00" "$1,175.00" "$1,175.00" "$1,175.00" $244.88 "$1,175.00" "$6,345.00" $695.01 "$1,175.00" "$1,175.00" "$1,175.00" "$1,175.00" $881.25 "$1,175.00" "$1,175.00" "$1,175.00" $587.50 $587.50 $930.60 "$1,175.00" $940.00 $528.75 $233.21 N/A $681.50 "$1,175.00" $705.00 "$1,175.00" $244.87 "$1,175.00" N/A N/A AR-2324BCM SUP HCPCS C1713 AR-2324BCM - ANCHOR SUTURE 4.75MM 24.5MM SELF PUNCH VENT SWIVELOCK BOTH IP/OP "$1,050.00" $777.00 $208.40 "$2,268.00" $472.50 $472.50 $472.50 $472.50 "$1,050.00" "$1,050.00" "$1,050.00" $218.85 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $218.83 "$1,050.00" "$2,268.00" $621.08 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $787.50 "$1,050.00" "$1,050.00" "$1,050.00" $525.00 $525.00 $831.60 "$1,050.00" $840.00 $472.50 $208.40 N/A $609.00 "$1,050.00" $630.00 "$1,050.00" $218.82 "$1,050.00" N/A N/A AR-2324BCT-2 SUP HCPCS C1713 AR-2324BCT-2 - ANCHOR SUT 2 4.75MM 22MM BLK BLU WHT SWIVELOCK C FIBERTAK BOTH IP/OP "$5,312.50" "$3,931.00" "$1,054.40" "$5,312.50" "$2,390.63" "$2,390.63" "$2,390.63" "$2,390.63" "$5,312.50" "$5,312.50" "$5,312.50" "$1,107.26" "$5,312.50" "$5,312.50" "$5,312.50" "$5,312.50" "$5,312.50" "$1,107.18" "$5,312.50" "$5,312.50" "$2,619.06" "$5,312.50" "$5,312.50" "$5,312.50" "$5,312.50" "$3,984.38" "$5,312.50" "$5,312.50" "$5,312.50" "$2,656.25" "$2,656.25" "$4,207.50" "$5,312.50" "$4,250.00" "$2,390.63" "$1,054.40" N/A "$3,081.25" "$5,312.50" "$3,187.50" "$5,312.50" "$1,107.13" "$5,312.50" N/A N/A AR-2324BSL SUP HCPCS C1713 AR-2324BSL - ANCHOR SUT 4.75MM 20MM STRL BIO-SWIVELOCK DISP BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $562.50 $937.50 $195.38 $937.50 N/A N/A AR-2324BSLC SUP HCPCS C1713 AR-2324BSLC - ANCHOR SUT 4.75MM 19.1MM STRL BIO-SWIVELOCK C CLS EYLT VNT BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $562.50 $937.50 $195.38 $937.50 N/A N/A AR-2324PCT SUP HCPCS C1713 AR-2324PCT - ANCHOR SUT 4.75MM 19.1MM BLU STRL SWIVELOCK C FIBERTAPE CLS BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $425.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" N/A N/A AR-2324PCTT SUP HCPCS C1713 AR-2324PCTT - ANCHOR SUT 4.75MM 19.1MM B/W STRL SWIVELOCK C TIGERTAPE CLS BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $425.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" N/A N/A AR-2324PSLC SUP HCPCS C1713 AR-2324PSLC - ANCHOR SUTURE 4.75MM 19.1MM CLOSE EYELET VENT SWIVELOCK PEEK BOTH IP/OP $937.50 $694.00 $186.07 "$2,025.00" $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 "$2,025.00" $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $562.50 $937.50 $195.38 $937.50 N/A N/A AR-2324PSLC-2 SUP HCPCS C1713 AR-2324PSLC-2 - ANCHOR SUT 4.75MM STRL LF ARTHX SWIVELOCK 2 LD PEEK BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $987.50 $987.50 $205.80 $987.50 N/A N/A AR-2324PSLM SUP HCPCS C1713 AR-2324PSLM - ANCHOR SUT 4.75MM 24.5MM STRL SWIVELOCK SLF PNCH VNT PEEK BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" $400.00 $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" $600.00 "$1,000.00" $208.40 "$1,000.00" N/A N/A AR-2324SLM SUP HCPCS C1713 AR-2324SLM - ANCHOR SUT 4.75MM 24.5MM STRL SWIVELOCK SLF PNCH VNT TI DISP BOTH IP/OP $800.00 $592.00 $158.78 $800.00 $360.00 $360.00 $360.00 $360.00 $800.00 $800.00 $800.00 $166.74 $800.00 $800.00 $800.00 $800.00 $800.00 $166.73 $800.00 $800.00 $473.20 $800.00 $800.00 $800.00 $800.00 $600.00 $800.00 $800.00 $800.00 $400.00 $400.00 $633.60 $800.00 $640.00 $360.00 $158.78 N/A $464.00 $800.00 $480.00 $800.00 $166.72 $800.00 N/A N/A AR-2325BCC SUP HCPCS C1713 AR-2325BCC - BIO-COMP SWVLK 3.5X 15.8MM BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" "$1,000.00" $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" $600.00 "$1,000.00" $208.40 "$1,000.00" N/A N/A AR-2325D SUP Custom 27203010 AR-2325D - DRILL SRG 3.5 MM SWIVELLOCK BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-2325D-ST SUP Custom 27203010 AR-2325D-ST - DRILL SRG STRL 3.5 MM LABRAL SWIVELOCK BOTH IP/OP $262.50 $194.00 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $46.73 $262.50 $262.50 $194.83 $194.83 $202.34 $136.76 $54.71 $262.50 $105.00 $262.50 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $170.63 $262.50 N/A $152.25 $262.50 $157.50 $262.50 $262.50 $262.50 N/A N/A AR-2325PSLC SUP HCPCS C1713 AR-2325PSLC - ANCHOR SUT 3.5MM 14.8MM SWIVELOCK VNT PEEK-OPTM BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $937.50 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $562.50 $937.50 $195.38 $937.50 N/A N/A AR-2374 SUP Custom 27203010 AR-2374 - 5.1MM CANNULATED REAMER WITH STOP BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A AR-2511 SUP Custom 27203010 AR-2511 - GUIDE DRL SHLDR PERC REUSE PNG SYS BOTH IP/OP "$1,937.50" "$1,434.00" $344.88 "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" $344.88 "$1,937.50" "$1,937.50" "$1,438.01" "$1,438.01" "$1,493.43" "$1,009.44" $403.80 "$1,937.50" $837.00 "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,453.13" "$1,937.50" "$1,937.50" "$1,937.50" $968.75 $968.75 "$1,534.50" "$1,937.50" "$1,550.00" "$1,259.38" "$1,937.50" N/A "$1,123.75" "$1,937.50" "$1,162.50" "$1,937.50" "$1,937.50" "$1,937.50" N/A N/A AR-2512 SUP Custom 27203010 AR-2512 - GUIDE DRL PRLL SHLDR PERC REUSE PNG SYS BOTH IP/OP "$2,487.50" "$1,841.00" $442.78 "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" $442.78 "$2,487.50" "$2,487.50" "$1,846.22" "$1,846.22" "$1,917.37" "$1,295.99" $518.42 "$2,487.50" "$1,074.60" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$1,865.63" "$2,487.50" "$2,487.50" "$2,487.50" "$1,243.75" "$1,243.75" "$1,970.10" "$2,487.50" "$1,990.00" "$1,616.88" "$2,487.50" N/A "$1,442.75" "$2,487.50" "$1,492.50" "$2,487.50" "$2,487.50" "$2,487.50" N/A N/A AR-2528 SUP Custom 27203010 AR-2528 - DRILL SRG 3.2MM CNN SHLDR PERC DISP PNG SYS BOTH IP/OP $712.50 $527.00 $126.83 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $126.83 $712.50 $712.50 $528.82 $528.82 $549.20 $371.21 $148.49 $712.50 $285.00 $712.50 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $463.13 $712.50 N/A $413.25 $712.50 $427.50 $712.50 $712.50 $712.50 N/A N/A AR-2600SBS-6 SUP HCPCS C1713 AR-2600SBS-6 - SYSTEM FX 4.75MM BLK BLU WHT SPEEDBRIDGE SWIVELOCK FIBERTAPE BOTH IP/OP "$4,000.00" "$2,960.00" $793.90 "$4,000.00" "$1,800.00" "$1,800.00" "$1,800.00" "$1,800.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.70 "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" $833.64 "$4,000.00" "$1,728.00" "$1,972.00" "$4,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$3,000.00" "$4,000.00" "$4,000.00" "$4,000.00" "$2,000.00" "$2,000.00" "$3,168.00" "$4,000.00" "$3,200.00" "$1,800.00" $793.90 N/A "$2,320.00" "$4,000.00" "$2,400.00" "$4,000.00" "$4,000.00" "$4,000.00" N/A N/A AR-2622DL SUP HCPCS C1713 AR-2622DL - PLATE BN 22MM CLVCL LT DIST BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2622DR SUP HCPCS C1713 AR-2622DR - PLATE BN 22D STRL ARTHX CLVCL RT DIST BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2650CL SUP HCPCS C1713 AR-2650CL - PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A AR-2650CR SUP HCPCS C1713 AR-2650CR - PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2651CL SUP HCPCS C1713 AR-2651CL - PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,295.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,295.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2651CR SUP HCPCS C1713 AR-2651CR - PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2652CL SUP HCPCS C1713 AR-2652CL - PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2652CR SUP HCPCS C1713 AR-2652CR - PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2653CL SUP HCPCS C1713 AR-2653CL - PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2653CR SUP HCPCS C1713 AR-2653CR - PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2654CL SUP HCPCS C1713 AR-2654CL - PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2654CR SUP HCPCS C1713 AR-2654CR - PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2655CL SUP HCPCS C1713 AR-2655CL - PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2655CR SUP HCPCS C1713 AR-2655CR - PLATE BN PRECONTOUR STRL CNTR 3RD CMPR SLOT LCK HL SS CLVCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2656DL SUP HCPCS C1713 AR-2656DL - PLATE BN SHRT PRECONTOUR STRL CHMFR SUT EYLT CMPR SLOT THRD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2656DR SUP HCPCS C1713 AR-2656DR - PLATE BN SHRT PRECONTOUR LOPRFL LCK CMPR HL SS CLVCL RT DIST BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2657DL SUP HCPCS C1713 AR-2657DL - PLATE BN SHRT PRECONTOUR STRL CHMFR SUT EYLT CMPR SLOT THRD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,295.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,295.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2657DR SUP HCPCS C1713 AR-2657DR - PLATE BN SHRT PRECONTOUR STRL CHMFR SUT EYLT CMPR SLOT THRD BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,295.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" "$2,295.00" "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2658 SUP HCPCS C1713 AR-2658 - BUTTON FX CMPR SLOT PLT SEAT FLSH SS CLVCL DIST BOTH IP/OP $875.00 $648.00 $173.67 $945.00 $393.75 $393.75 $393.75 $393.75 $875.00 $875.00 $875.00 $182.37 $875.00 $875.00 $875.00 $875.00 $875.00 $182.36 $875.00 $945.00 $517.56 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $393.75 $173.67 N/A $507.50 $875.00 $525.00 $875.00 $182.35 $875.00 N/A N/A AR-2664L SUP Custom 27203010 AR-2664L - GUIDE DRL PLT SCR CLVCL LT DIST BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" $881.36 $881.36 $915.33 $618.69 $247.49 "$1,187.50" $513.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $771.88 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A AR-2664R SUP Custom 27203010 AR-2664R - GUIDE DRL PLT SCR CLVCL RT DIST BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" $881.36 $881.36 $915.33 $618.69 $247.49 "$1,187.50" $513.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $771.88 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A AR-2665-10H SUP HCPCS C1713 AR-2665-10H - SCREW BN HEXALOBE 2.5MM 10MM HRBRT 2 PTCH SS ELB SHLDR SM BOTH IP/OP $562.50 $416.00 $111.64 $562.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $243.00 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $337.50 $562.50 $117.23 $562.50 N/A N/A AR-2665-12H SUP HCPCS C1713 AR-2665-12H - SCREW BN HEXALOBE 2.5MM 12MM HRBRT 2 PTCH SS ELB SHLDR SM BOTH IP/OP $562.50 $416.00 $111.64 $607.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $607.50 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $337.50 $562.50 $117.23 $562.50 N/A N/A AR-2665-14H SUP HCPCS C1713 AR-2665-14H - SCREW BN HEXALOBE 2.5MM 14MM HRBRT 2 PTCH SS ELB SHLDR SM BOTH IP/OP $562.50 $416.00 $111.64 $607.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $607.50 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $562.50 $562.50 $117.23 $562.50 N/A N/A AR-2665-16H SUP HCPCS C1713 AR-2665-16H - SCREW BN HEXALOBE 2.5MM 16MM HRBRT 2 PTCH SS ELB SHLDR SM BOTH IP/OP $562.50 $416.00 $111.64 $562.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $243.00 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $337.50 $562.50 $117.23 $562.50 N/A N/A AR-2665-18H SUP HCPCS C1713 AR-2665-18H - SCREW BN HEXALOBE 2.5MM 18MM HRBRT 2 PTCH SS ELB SHLDR SM BOTH IP/OP $562.50 $416.00 $111.64 $607.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $607.50 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $337.50 $562.50 $117.23 $562.50 N/A N/A AR-2665-20H SUP HCPCS C1713 AR-2665-20H - SCREW BN HEXALOBE 2.5MM 20MM HRBRT 2 PTCH SS ELB SHLDR SM BOTH IP/OP $562.50 $416.00 $111.64 $562.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $243.00 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $337.50 $562.50 $117.23 $562.50 N/A N/A AR-2665-22H SUP HCPCS C1713 AR-2665-22H - SCREW BN HEXALOBE 2.5MM 22MM HRBRT 2 PTCH SS ELB SHLDR SM BOTH IP/OP $562.50 $416.00 $111.64 $562.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $243.00 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $337.50 $562.50 $117.23 $562.50 N/A N/A AR-2665-24H SUP HCPCS C1713 AR-2665-24H - SCREW BN HEXALOBE 2.5MM 24MM HRBRT 2 PTCH SS ELB SHLDR SM BOTH IP/OP $562.50 $416.00 $111.64 $562.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $243.00 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $337.50 $562.50 $117.23 $562.50 N/A N/A AR-2668 SUP Custom 27203010 AR-2668 - GUIDE DRL LCK SLV 2.7 MM SCR BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $81.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A AR-2669 SUP Custom 27203010 AR-2669 - GUIDE DRL LCK DIST 2.7 MM SCR BOTH IP/OP $262.50 $194.00 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $46.73 $262.50 $262.50 $194.83 $194.83 $202.34 $136.76 $54.71 $262.50 $113.40 $262.50 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $170.63 $262.50 N/A $152.25 $262.50 $157.50 $262.50 $262.50 $262.50 N/A N/A AR-2680ST SUP HCPCS C1713 AR-2680ST - PLATE BN PRECONTOUR FX 7 HL SS CLVCL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2685DR-10 SUP HCPCS C1713 AR-2685DR-10 - PLATE BN 10 HL LOPRFL PRECONTOUR CMPR SLOT SS CLVCL RT DIST BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-2810-20 SUP Custom 27203010 AR-2810-20 - PARTIAL ECLIPSE HUMERAL REAMER BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,020.53" "$1,020.53" "$1,059.85" $716.38 $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $893.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A AR-2810-25 SUP Custom 27203010 AR-2810-25 - PARTIAL ECLIPSE HUMERAL REAMER BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,020.53" "$1,020.53" "$1,059.85" $716.38 $286.57 "$1,375.00" $550.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $893.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A AR-2810F-18-5 SUP Custom 27203010 AR-2810F-18-5 - PARTIAL ECLIPSE GLENOID REAMER BOTH IP/OP "$1,625.00" "$1,203.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $289.25 "$1,625.00" "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" $650.00 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" "$1,625.00" N/A $942.50 "$1,625.00" $975.00 "$1,625.00" "$1,625.00" "$1,625.00" N/A N/A AR-2810F-20-5 SUP Custom 27203010 AR-2810F-20-5 - PARTIAL ECLIPSE GLENOID REAMER BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A AR-2810F-22-5 SUP Custom 27203010 AR-2810F-22-5 - PARTIAL ECLIPSE GLENOID REAMER BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A AR-2810R-20-5 SUP Custom 27203010 AR-2810R-20-5 - ALLOGRAFT PARTIAL ECLIPSE HUMERAL REAMER BOTH IP/OP "$1,625.00" "$1,203.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $289.25 "$1,625.00" "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" $650.00 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" "$1,625.00" N/A $942.50 "$1,625.00" $975.00 "$1,625.00" "$1,625.00" "$1,625.00" N/A N/A AR-2810R-25-5 SUP Custom 27203010 AR-2810R-25-5 - ALLOGRAFT PARTIAL ECLIPSE HUMERAL REAMER BOTH IP/OP "$1,625.00" "$1,203.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $289.25 "$1,625.00" "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" $650.00 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" "$1,625.00" N/A $942.50 "$1,625.00" $975.00 "$1,625.00" "$1,625.00" "$1,625.00" N/A N/A AR-2810R-30-5 SUP Custom 27203010 AR-2810R-30-5 - ALLOGRAFT PARTIAL ECLIPSE HUMERAL REAMER BOTH IP/OP "$1,625.00" "$1,203.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $289.25 "$1,625.00" "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" $650.00 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" "$1,625.00" N/A $942.50 "$1,625.00" $975.00 "$1,625.00" "$1,625.00" "$1,625.00" N/A N/A AR-2820 SUP Custom 27203010 AR-2820 - GUIDE DRL PRT ECLPS STEMLESS SHLDR ARTHPL BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A AR-2922BC SUP HCPCS C1713 AR-2922BC - ANCHOR SUT 2.4MM 11.3MM PUSHLOCK BCMPS 1 FBRWR 2 FIBERLINK BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" $400.00 $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-2922D-24-1 SUP Custom 27203010 AR-2922D-24-1 - DRILL SRG 2.4 MM PUSHLOCK BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-2922PS SUP HCPCS C1713 AR-2922PS - ANCHOR SUT 2.4MM 14MM STRL PUSHLOCK CNN EYLT HNDL INSRTR BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $405.00 $405.00 $405.00 $405.00 $900.00 $900.00 $900.00 $187.58 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $360.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $178.63 N/A $522.00 $900.00 $540.00 $900.00 $900.00 $900.00 N/A N/A AR-2923BC SUP HCPCS C1713 AR-2923BC - ANCHOR SUTURE SHORT 2.9MM 12.5MM CANN EYELET HANDLE INSERTER BOTH IP/OP "$1,000.00" $740.00 $198.48 "$2,160.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" "$2,160.00" $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" $600.00 "$1,000.00" $208.40 "$1,000.00" N/A N/A AR-2923BCH SUP HCPCS C1713 AR-2923BCH - SUTR ANCH HIP BIO-COMP P-LCK 2.9X12.5MM BOTH IP/OP "$1,050.00" $777.00 $208.40 "$1,050.00" $472.50 $472.50 $472.50 $472.50 "$1,050.00" "$1,050.00" "$1,050.00" $218.85 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $218.83 "$1,050.00" "$1,050.00" $621.08 "$1,050.00" "$1,050.00" "$1,050.00" "$1,050.00" $787.50 "$1,050.00" "$1,050.00" "$1,050.00" $525.00 $525.00 $831.60 "$1,050.00" $840.00 $472.50 $208.40 N/A $609.00 "$1,050.00" $630.00 "$1,050.00" $218.82 "$1,050.00" N/A N/A AR-2923D SUP Custom 27203010 AR-2923D - DRILL SRG BCMPS 2.9 MM SHRT PUSHLOCK BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-2923DHT SUP Custom 27203010 AR-2923DHT - DRILL SRG HIP SHRT 2.9 MM PUSHLOCK HRD BN BOTH IP/OP $362.50 $268.00 $64.53 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $145.00 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 N/A $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A AR-2923D-ST SUP Custom 27203010 AR-2923D-ST - DRILL SRG STRL ELB SHLDR 2.9 MM SHRT PUSHLOCK BOTH IP/OP $262.50 $194.00 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $46.73 $262.50 $262.50 $194.83 $194.83 $202.34 $136.76 $54.71 $262.50 $105.00 $262.50 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $170.63 $262.50 N/A $152.25 $262.50 $157.50 $262.50 $262.50 $262.50 N/A N/A AR-2923DT SUP Custom 27203010 AR-2923DT - DRILL SRG 2.9 MM SHRT PUSHLOCK HRD BN BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-2923DT-ST SUP Custom 27203010 AR-2923DT-ST - DRILL SRG STRL 2.9 MM SHRT PUSHLOCK HRD BN BOTH IP/OP $262.50 $194.00 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $46.73 $262.50 $262.50 $194.83 $194.83 $202.34 $136.76 $54.71 $262.50 $105.00 $262.50 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $170.63 $262.50 N/A $152.25 $262.50 $157.50 $262.50 $262.50 $262.50 N/A N/A AR-2923PHS SUP HCPCS C1713 AR-2923PHS - ANCHOR SUT SHRT 2.9MM 12.5MM PUSHLOCK PEEK HIP BOTH IP/OP $950.00 $703.00 $188.55 $950.00 $427.50 $427.50 $427.50 $427.50 $950.00 $950.00 $950.00 $198.00 $950.00 $950.00 $950.00 $950.00 $950.00 $197.99 $950.00 $950.00 $561.93 $950.00 $950.00 $950.00 $950.00 $712.50 $950.00 $950.00 $950.00 $475.00 $475.00 $752.40 $950.00 $760.00 $427.50 $188.55 N/A $551.00 $950.00 $570.00 $950.00 $950.00 $950.00 N/A N/A AR-2923PS SUP HCPCS C1713 AR-2923PS - ANCHOR SUT SHRT 2.9MM 12.5MM STRL PUSHLOCK CNN PEEK BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $405.00 $405.00 $405.00 $405.00 $900.00 $900.00 $900.00 $187.58 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $360.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $178.63 N/A $522.00 $900.00 $540.00 $900.00 $187.56 $900.00 N/A N/A AR-2950SC SUP Custom 27203010 AR-2950SC - CLAMP SRG GRAFTPRO SFT TIS BOTH IP/OP "$1,492.50" "$1,104.00" $265.67 "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" $265.67 "$1,492.50" "$1,492.50" "$1,107.73" "$1,107.73" "$1,150.42" $777.59 $311.05 "$1,492.50" $644.76 "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,119.38" "$1,492.50" "$1,492.50" "$1,492.50" $746.25 $746.25 "$1,182.06" "$1,492.50" "$1,194.00" $970.13 "$1,492.50" N/A $865.65 "$1,492.50" $895.50 "$1,492.50" "$1,492.50" "$1,492.50" N/A N/A AR-2962 SUP Custom 27203010 AR-2962 - GUIDE DRL DVTL ALGRF MNSCS BOTH IP/OP "$1,825.00" "$1,351.00" $324.85 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $324.85 "$1,825.00" "$1,825.00" "$1,354.52" "$1,354.52" "$1,406.71" $950.83 $380.35 "$1,825.00" $788.40 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" "$1,186.25" "$1,825.00" N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" "$1,825.00" "$1,825.00" N/A N/A AR-3400H-4.5 SUP Custom 27203010 AR-3400H-4.5 - CANNULA ASCP HIP LGTH TPR 4.5MM BLNT FENESTRATE QCK CNCT LCK BOTH IP/OP $870.00 $644.00 $154.78 $869.55 $869.55 $869.55 $869.55 $869.55 $869.55 $869.55 $154.78 $869.55 $869.55 $645.38 $645.38 $670.25 $453.04 $181.22 $869.55 $375.65 $869.55 $869.55 $869.55 $869.55 $869.55 $652.50 $869.55 $869.55 $869.55 $434.78 $434.78 $688.68 $869.55 $695.64 $565.21 $869.55 N/A $504.60 $869.55 $521.73 $869.55 $869.55 $869.55 N/A N/A AR-3400H-5.0 SUP Custom 27203010 AR-3400H-5.0 - CANNULA ASCP HIP LGTH TPR 5MM BLNT FENESTRATE QCK CNCT LCK BOTH IP/OP $870.00 $644.00 $154.78 $869.55 $869.55 $869.55 $869.55 $869.55 $869.55 $869.55 $154.78 $869.55 $869.55 $645.38 $645.38 $670.25 $453.04 $181.22 $869.55 $375.65 $869.55 $869.55 $869.55 $869.55 $869.55 $652.50 $869.55 $869.55 $869.55 $434.78 $434.78 $688.68 $869.55 $695.64 $565.21 $869.55 N/A $504.60 $869.55 $521.73 $869.55 $869.55 $869.55 N/A N/A AR-3400H-5.5 SUP Custom 27203010 AR-3400H-5.5 - CANNULA ASCP HIP LGTH TPR 5.5MM BLNT FENESTRATE QCK CNCT LCK BOTH IP/OP $870.00 $644.00 $154.78 $869.55 $869.55 $869.55 $869.55 $869.55 $869.55 $869.55 $154.78 $869.55 $869.55 $645.38 $645.38 $670.25 $453.04 $181.22 $869.55 $375.65 $869.55 $869.55 $869.55 $869.55 $869.55 $652.50 $869.55 $869.55 $869.55 $434.78 $434.78 $688.68 $869.55 $695.64 $565.21 $869.55 N/A $504.60 $869.55 $521.73 $869.55 $869.55 $869.55 N/A N/A AR-3400H-6.5 SUP Custom 27203010 AR-3400H-6.5 - CANNULA ASCP HIP LGTH TPR 6.5MM BLNT FENESTRATE QCK CNCT LCK BOTH IP/OP $870.00 $644.00 $154.78 $869.55 $869.55 $869.55 $869.55 $869.55 $869.55 $869.55 $154.78 $869.55 $869.55 $645.38 $645.38 $670.25 $453.04 $181.22 $869.55 $375.65 $869.55 $869.55 $869.55 $869.55 $869.55 $652.50 $869.55 $869.55 $869.55 $434.78 $434.78 $688.68 $869.55 $695.64 $565.21 $869.55 N/A $504.60 $869.55 $521.73 $869.55 $869.55 $869.55 N/A N/A AR-3490HQC SUP Custom 27203010 AR-3490HQC - CANNULA ASCP STD HIP LGTH HUB QCK CNCT BOTH IP/OP $671.00 $497.00 $119.39 $670.73 $670.73 $670.73 $670.73 $670.73 $670.73 $670.73 $119.39 $670.73 $670.73 $497.82 $497.82 $517.00 $349.45 $139.79 $670.73 $268.29 $670.73 $670.73 $670.73 $670.73 $670.73 $503.25 $670.73 $670.73 $670.73 $335.37 $335.37 $531.22 $670.73 $536.58 $435.97 $670.73 N/A $389.18 $670.73 $402.44 $670.73 $670.73 $670.73 N/A N/A AR-3600-2 SUP HCPCS C1713 AR-3600-2 - ANCHOR SUT 2 FIBERTAK FBRWR CLS EYLT BOTH IP/OP $850.00 $629.00 $168.70 $850.00 $382.50 $382.50 $382.50 $382.50 $850.00 $850.00 $850.00 $177.16 $850.00 $850.00 $850.00 $850.00 $850.00 $177.15 $850.00 $850.00 $502.78 $850.00 $850.00 $850.00 $850.00 $637.50 $850.00 $850.00 $850.00 $425.00 $425.00 $673.20 $850.00 $680.00 $382.50 $168.70 N/A $493.00 $850.00 $510.00 $850.00 $177.14 $850.00 N/A N/A AR-3600D-1 SUP Custom 27203010 AR-3600D-1 - DRILL SRG 1.6MM FIBERTAK BOTH IP/OP $262.50 $194.00 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $46.73 $262.50 $262.50 $194.83 $194.83 $202.34 $136.76 $54.71 $262.50 $105.00 $262.50 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $170.63 $262.50 N/A $152.25 $262.50 $157.50 $262.50 $262.50 $262.50 N/A N/A AR-3600DS SUP HCPCS C1713 AR-3600DS - ANCHOR SUT STRL LF ARTHX FIBERTAK DRL SPR OBT DISP BOTH IP/OP "$1,300.00" $962.00 $258.02 "$1,300.00" $585.00 $585.00 $585.00 $585.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $270.93 "$1,300.00" "$1,300.00" $768.95 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $585.00 $258.02 N/A $754.00 "$1,300.00" "$1,300.00" "$1,300.00" $270.92 "$1,300.00" N/A N/A AR-3600ND-3 SUP Custom 27203010 AR-3600ND-3 - DRILL SRG 1.7MM FLXB FIBERTAK BOTH IP/OP $262.50 $194.00 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $46.73 $262.50 $262.50 $194.83 $194.83 $202.34 $136.76 $54.71 $262.50 $105.00 $262.50 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $170.63 $262.50 N/A $152.25 $262.50 $157.50 $262.50 $262.50 $262.50 N/A N/A AR-3601 SUP HCPCS C1713 "AR-3601 - KNOTLESS FIBERTAK SUTURE ANCHOR, 1.5MM" BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $395.00 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $592.50 $987.50 $205.80 $987.50 N/A N/A AR-3602-2 SUP HCPCS C1713 AR-3602-2 - ANCHOR SUT 1.3MM BLU WHT FIBERTAK SUTURETAPE 2 LD BOTH IP/OP $925.00 $685.00 $183.59 $925.00 $416.25 $416.25 $416.25 $416.25 $925.00 $925.00 $925.00 $192.79 $925.00 $925.00 $925.00 $925.00 $925.00 $192.78 $925.00 $925.00 $547.14 $925.00 $925.00 $925.00 $925.00 $693.75 $925.00 $925.00 $925.00 $462.50 $462.50 $732.60 $925.00 $740.00 $416.25 $183.59 N/A $536.50 $925.00 $555.00 $925.00 $192.77 $925.00 N/A N/A AR-3603-2 SUP HCPCS C1713 AR-3603-2 - ANCHOR SUT 2 FIBERTAK TGTL 2 LD BOTH IP/OP $850.00 $629.00 $168.70 $850.00 $382.50 $382.50 $382.50 $382.50 $850.00 $850.00 $850.00 $177.16 $850.00 $850.00 $850.00 $850.00 $850.00 $177.15 $850.00 $850.00 $502.78 $850.00 $850.00 $850.00 $850.00 $637.50 $850.00 $850.00 $850.00 $425.00 $425.00 $673.20 $850.00 $680.00 $382.50 $168.70 N/A $493.00 $850.00 $510.00 $850.00 $177.14 $850.00 N/A N/A AR-3651T SUP HCPCS C1713 AR-3651T - ANCHOR SUT 2 BLK GRN/WHT FIBERTAK TGTL LABRALTAPE 2 ROW BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $506.25 $506.25 $506.25 $506.25 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 $223.28 N/A $652.50 "$1,125.00" $675.00 "$1,125.00" $234.45 "$1,125.00" N/A N/A AR-3651TT SUP HCPCS C1713 AR-3651TT - ANCHOR SUT 2 BLK BLU WHT FIBERTAK TGTL LABRALTAPE 2 ROW BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $506.25 $506.25 $506.25 $506.25 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 $223.28 N/A $652.50 "$1,125.00" "$1,125.00" "$1,125.00" $234.45 "$1,125.00" N/A N/A AR-4007JS SUP Custom 27203010 AR-4007JS - SET GFT PREP MNS DRT JSTK BOTH IP/OP "$1,300.00" $962.00 $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $231.40 "$1,300.00" "$1,300.00" $964.86 $964.86 "$1,002.04" $677.30 $270.93 "$1,300.00" $520.00 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $845.00 "$1,300.00" N/A $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A AR-4008 SUP Custom 27203010 AR-4008 - PROBE ASCP STRL MNS DRT MSR DISP BOTH IP/OP $117.50 $87.00 $20.92 $117.50 $117.50 $117.50 $117.50 $117.50 $117.50 $117.50 $20.92 $117.50 $117.50 $87.21 $87.21 $90.57 $61.22 $24.49 $117.50 $47.00 $117.50 $117.50 $117.50 $117.50 $117.50 $88.13 $117.50 $117.50 $117.50 $58.75 $58.75 $93.06 $117.50 $94.00 $76.38 $117.50 N/A $68.15 $117.50 $70.50 $117.50 $117.50 $117.50 N/A N/A AR-4045 SUP Custom 27203010 AR-4045 - CANNULA ASCP STRL MNS DRT OBT DISP BOTH IP/OP $60.00 $44.00 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 N/A $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A AR-4065-45L SUP Custom 27203010 AR-4065-45L - PASSER SUT 45D CRV LT STRL CRKSCR SUTLSO DISP ASCP BOTH IP/OP $325.00 $241.00 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 N/A $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A AR-4065-45R SUP Custom 27203010 AR-4065-45R - PASSER SUT 45D RT CRV STRL CRKSCR SUTLSO DISP ASCP BOTH IP/OP $325.00 $241.00 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 N/A $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A AR-4065-90S SUP Custom 27203010 AR-4065-90S - PASSER SUT 90D 2.3MM STRL SUTLSO NTNL ELB SHLDR DISP ASCP BOTH IP/OP $287.50 $213.00 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $51.18 $287.50 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $115.00 $287.50 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $287.50 N/A $166.75 $287.50 $172.50 $287.50 $287.50 $287.50 N/A N/A AR-4065-90W SUP Custom 27203010 AR-4065-90W - PASSER SUT 90D 2.3MM STRL SUTLSO WRE LOOP NTNL ELB SHLDR BOTH IP/OP $325.00 $241.00 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 N/A $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A AR-4065B SUP Custom 27203010 AR-4065B - PASSER SUT UNV BNA 2.3MM STRL SUTLSO ROTR CUF NTNL DISP ASCP BOTH IP/OP $325.00 $241.00 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 N/A $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A AR-4065H SUP HCPCS C1713 AR-4065H - ANCHOR SUT 45D LASSO HIP BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-4065S SUP Custom 27203010 AR-4065S - PASSER SUT 45D CRV STRL SUTLSO NTNL DISP ASCP BOTH IP/OP $287.50 $213.00 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $51.18 $287.50 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $115.00 $287.50 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $287.50 N/A $166.75 $287.50 $172.50 $287.50 $287.50 $287.50 N/A N/A AR-4065W SUP Custom 27203010 AR-4065W - PASSER SUT 45D 2.3MM STRL SUTLSO WRE LOOP NTNL DISP ASCP BOTH IP/OP $325.00 $241.00 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 N/A $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A AR-4068-05SD SUP Custom 27203010 AR-4068-05SD - PASSER SUT 1.8MM 3.8MM STRL SUTLSO SD WIRELOOP NTNL ASCP BOTH IP/OP $70.00 $52.00 $12.46 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $12.46 $70.00 $70.00 $51.95 $51.95 $53.96 $36.47 $14.59 $70.00 $28.00 $70.00 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $45.50 $70.00 N/A $40.60 $70.00 $42.00 $70.00 $70.00 $70.00 N/A N/A AR-4068-25TL SUP Custom 27203010 AR-4068-25TL - PASSER SUTURE 25D TIGHT LEFT CURVE 1.8MM 3.8MM SUTURELASSO BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $151.20 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-4068-25TLF SUP Custom 27203010 AR-4068-25TLF - PASSER SUT 25D TIGHT LT CRV 1.8MM 3.8MM STRL SUTLSO SD BOTH IP/OP $445.00 $329.00 $79.21 $445.00 $445.00 $445.00 $445.00 $445.00 $445.00 $445.00 $79.21 $445.00 $445.00 $330.28 $330.28 $343.01 $231.85 $92.74 $445.00 $178.00 $445.00 $445.00 $445.00 $445.00 $445.00 $333.75 $445.00 $445.00 $445.00 $222.50 $222.50 $352.44 $445.00 $356.00 $289.25 $445.00 N/A $258.10 $445.00 $267.00 $445.00 $445.00 $445.00 N/A N/A AR-4068-25TR SUP Custom 27203010 AR-4068-25TR - PASSER SUT 25D TIGHT RT CRV 1.8MM 3.8MM STRL SUTLSO SD THB BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-4068-25TRF SUP Custom 27203010 AR-4068-25TRF - PASSER SUT 25D TIGHT RT CRV 1.8MM 3.8MM STRL SUTLSO SD BOTH IP/OP $445.00 $329.00 $79.21 $445.00 $445.00 $445.00 $445.00 $445.00 $445.00 $445.00 $79.21 $445.00 $445.00 $330.28 $330.28 $343.01 $231.85 $92.74 $445.00 $178.00 $445.00 $445.00 $445.00 $445.00 $445.00 $333.75 $445.00 $445.00 $445.00 $222.50 $222.50 $352.44 $445.00 $356.00 $289.25 $445.00 N/A $258.10 $445.00 $267.00 $445.00 $445.00 $445.00 N/A N/A AR-4068-30 SUP Custom 27203010 AR-4068-30 - PASSER SUT 30D STRG 1.8MM 3.8MM STRL SUTLSO SD THB PD NTNL BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-4068-45LH SUP Custom 27203010 AR-4068-45LH - PASSER SUT 45D LT CRV STRL SUTLSO DISP HIP ASCP BOTH IP/OP $412.50 $305.00 $73.43 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $73.43 $412.50 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $165.00 $412.50 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $412.50 N/A $239.25 $412.50 $247.50 $412.50 $412.50 $412.50 N/A N/A AR-4068-45R SUP Custom 27203010 AR-4068-45R - PASSER SUTURE 45D RIGHT CURVE 1.8MM 3.8MM THUMB PAD BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $151.20 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-4068-45RH SUP Custom 27203010 AR-4068-45RH - PASSER SUT 45D RT CRV STRL SUTLSO DISP HIP ASCP BOTH IP/OP $412.50 $305.00 $73.43 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $73.43 $412.50 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $165.00 $412.50 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $412.50 N/A $239.25 $412.50 $247.50 $412.50 $412.50 $412.50 N/A N/A AR-4068-90 SUP Custom 27203010 AR-4068-90 - PASSER SUTURE 90D UP STR 1.8MM 3.8MM THUMB PAD SUTURELASSO BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $151.20 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-4068-90H SUP Custom 27203010 AR-4068-90H - PASSER SUT 90D STRG STRL SUTLSO DISP HIP ASCP BOTH IP/OP $412.50 $305.00 $73.43 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $73.43 $412.50 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $165.00 $412.50 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $412.50 N/A $239.25 $412.50 $247.50 $412.50 $412.50 $412.50 N/A N/A AR-4068-90L SUP Custom 27203010 AR-4068-90L - PASSER SUTURE 90D LEFT CURVE 1.8MM 3.8MM THUMB PAD BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $151.20 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-4068-90R SUP Custom 27203010 AR-4068-90R - PASSER SUTURE 90D RIGHT CURVE 1.8MM 3.8MM THUMB PAD BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $151.20 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-4068C SUP Custom 27203010 AR-4068C - PASSER SUTURE SMALL CRESCENT 1.8MM 3.8MM THUMB PAD BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $151.20 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-4068CH SUP Custom 27203010 AR-4068CH - PASSER SUT CRSNT STRL SUTLSO DISP HIP ASCP BOTH IP/OP $412.50 $305.00 $73.43 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $73.43 $412.50 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $165.00 $412.50 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $412.50 N/A $239.25 $412.50 $247.50 $412.50 $412.50 $412.50 N/A N/A AR-4070-01 SUP Custom 27203010 AR-4070-01 - PROBE ASCP 60D 220MM MSR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A AR-4070-70S SUP Custom 27203010 AR-4070-70S - PROBE ASCP 70D STRL MSR MP KN DISP BOTH IP/OP $395.00 $292.00 $70.31 $395.00 $395.00 $395.00 $395.00 $395.00 $395.00 $395.00 $70.31 $395.00 $395.00 $293.17 $293.17 $304.47 $205.80 $82.32 $395.00 $158.00 $395.00 $395.00 $395.00 $395.00 $395.00 $296.25 $395.00 $395.00 $395.00 $197.50 $197.50 $312.84 $395.00 $316.00 $256.75 $395.00 N/A $229.10 $395.00 $237.00 $395.00 $395.00 $395.00 N/A N/A AR-4151B SUP HCPCS C1713 AR-4151B - PIN DRL 1.5MM 100MM STRL TRMIT DISP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A AR-4151DS SUP HCPCS C1713 AR-4151DS - KIT INST 1.5MM 100MM STRL TRMIT DRL PIN KRSH BN TAMP GD SLV BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-4152B SUP HCPCS C1713 AR-4152B - PIN DRL 2MM 100MM STRL TRMIT DISP BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$1,000.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$1,500.00" "$2,500.00" "$2,500.00" "$2,500.00" N/A N/A AR-4152DS SUP HCPCS C1713 AR-4152DS - KIT INST 2MM 100MM STRL TRMIT DRL PIN KRSH BN TAMP GD SLV BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-4152MS SUP HCPCS C1713 AR-4152MS - PIN DRL 2MM 100MM STRL TRMIT BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A AR-4154P-3010 SUP HCPCS C1713 AR-4154P-3010 - KIT TRMA FX 10D 2.5MM 30MM STRL PIP DART RDLCNT INSRTR DRL BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" "$1,487.50" $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A AR-4154PS-3000 SUP HCPCS C1713 AR-4154PS-3000 - KIT TRMA FX STRG 2.5MM 30MM STRL PIP DART INSRTR DRL GW TROC BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $642.60 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" $892.50 "$1,487.50" $310.00 "$1,487.50" N/A N/A AR-4154PS-3010 SUP HCPCS C1713 AR-4154PS-3010 - KIT TRMA FX 10D 2.5MM 30MM STRL PIP DART INSRTR DRL GW BRB BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,606.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" "$1,606.50" $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A AR-4155P-3010 SUP HCPCS C1713 AR-4155P-3010 - KIT TRMA FX 10D 3MM 30MM STRL PIP DART RDLCNT INSRTR DRL GW BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" "$1,487.50" $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A AR-4155PS-3010 SUP HCPCS C1713 AR-4155PS-3010 - KIT TRMA FX 10D 3MM 30MM STRL PIP DART INSRTR DRL GW TROC BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $642.60 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A AR-4156DS SUP HCPCS C1713 AR-4156DS - KIT INST 2MM 100MM STRL TRMIT DRL PIN KRSH BN TAMP GD SLV BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,000.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$1,200.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A AR-4160-20 SUP Custom 27203010 AR-4160-20 - BIT DRL 2MM TRMIT BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $146.58 $146.58 $152.23 $102.90 $41.16 $197.50 $85.32 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $128.38 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-4160-24 SUP Custom 27203010 AR-4160-24 - BIT DRL 2.4MM TRMIT BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-4160-25 SUP Custom 27203010 AR-4160-25 - BIT DRL 2.5MM TRMIT BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $146.58 $146.58 $152.23 $102.90 $41.16 $197.50 $85.32 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $128.38 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-4160-26 SUP Custom 27203010 AR-4160-26 - BIT DRL 2.6MM TRMIT BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $146.58 $146.58 $152.23 $102.90 $41.16 $197.50 $85.32 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $128.38 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-4160-27 SUP Custom 27203010 AR-4160-27 - BIT DRL 2.7MM TRMIT BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $146.58 $146.58 $152.23 $102.90 $41.16 $197.50 $85.32 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $128.38 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-4160-34 SUP Custom 27203010 AR-4160-34 - BIT DRL 3.4MM TRMIT BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-4160-35 SUP Custom 27203010 AR-4160-35 - BIT DRL 3.5MM TRMIT BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $146.58 $146.58 $152.23 $102.90 $41.16 $197.50 $85.32 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $128.38 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-4160-40 SUP Custom 27203010 AR-4160-40 - BIT DRL 4MM TRMIT BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $231.94 $231.94 $240.88 $162.81 $65.13 $312.50 $135.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $203.13 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A AR-4160-45 SUP Custom 27203010 AR-4160-45 - BIT DRL 4.5MM TRMIT BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $231.94 $231.94 $240.88 $162.81 $65.13 $312.50 $135.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $203.13 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A AR-4161 SUP Custom 27203010 AR-4161 - DRILL BIT CNTRSNK 2.7MM TRMIT BOTH IP/OP $362.50 $268.00 $64.53 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $145.00 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 N/A $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A AR-4161B SUP HCPCS C1713 AR-4161B - SCREW INTFR HEX 2.7MM 30MM STRL TRMIT CNN POLY L LAC ACD ACL BOTH IP/OP $482.50 $357.00 $95.76 $482.50 $217.13 $217.13 $217.13 $217.13 $482.50 $482.50 $482.50 $100.57 $482.50 $482.50 $482.50 $482.50 $482.50 $100.56 $482.50 $193.00 $285.40 $482.50 $482.50 $482.50 $482.50 $361.88 $482.50 $482.50 $482.50 $241.25 $241.25 $382.14 $482.50 $386.00 $217.13 $95.76 N/A $279.85 $482.50 $289.50 $482.50 $100.55 $482.50 N/A N/A AR-4161G SUP Custom 27203010 AR-4161G - GUIDE DRL 2MM 2.7MM TRMIT BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-4162B SUP HCPCS C1713 AR-4162B - SCREW INTFR HEX 3.5MM 40MM STRL TRMIT CNN POLY L LAC ACD ACL BOTH IP/OP $525.00 $389.00 $104.20 $525.00 $236.25 $236.25 $236.25 $236.25 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $525.00 $525.00 $525.00 $109.42 $525.00 $210.00 $310.54 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $236.25 $104.20 N/A $304.50 $525.00 $315.00 $525.00 $109.41 $525.00 N/A N/A AR-4163 SUP Custom 27203010 AR-4163 - DRILL BIT CNTRSNK 4MM BOTH IP/OP $362.50 $268.00 $64.53 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $145.00 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 N/A $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A AR-4163B SUP HCPCS C1713 AR-4163B - SCREW INTFR HEX 4MM 50MM STRL TRMIT CNN POLY L LAC ACD ACL BOTH IP/OP $525.00 $389.00 $104.20 $525.00 $236.25 $236.25 $236.25 $236.25 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $525.00 $525.00 $525.00 $109.42 $525.00 $525.00 $310.54 $525.00 $525.00 $525.00 $525.00 $393.75 $525.00 $525.00 $525.00 $262.50 $262.50 $415.80 $525.00 $420.00 $236.25 $104.20 N/A $304.50 $525.00 $315.00 $525.00 $109.41 $525.00 N/A N/A AR-4163G SUP Custom 27203010 AR-4163G - GUIDE DRL 2.4MM 4MM TRMIT BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $172.80 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-4164 SUP Custom 27203010 AR-4164 - DRILL BIT CNTRSNK 4.5MM BOTH IP/OP $362.50 $268.00 $64.53 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $145.00 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 N/A $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A AR-4164B SUP HCPCS C1713 AR-4164B - SCREW INTFR FT HEX 4.5MM 60MM STRL TRMIT CNN POLY L LAC ACD BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $310.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $465.00 $775.00 $775.00 $775.00 N/A N/A AR-4164G SUP Custom 27203010 AR-4164G - GUIDE DRL 3.4MM 4.5MM TRMIT BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $432.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-4207-12 SUP Custom 27203010 AR-4207-12 - COMPONENT SUBTALAR CNCV 7MM 12MM STRL PROSTOP BABSR TI POLY BOTH IP/OP "$3,737.50" "$2,766.00" $665.28 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $665.28 "$3,737.50" "$3,737.50" "$2,773.97" "$2,773.97" "$2,880.87" "$1,947.24" $778.94 "$3,737.50" "$1,614.60" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$2,429.38" "$3,737.50" N/A "$2,167.75" "$3,737.50" "$2,242.50" "$3,737.50" "$3,737.50" "$3,737.50" N/A N/A AR-4208-14 SUP Custom 27203010 AR-4208-14 - COMPONENT SUBTALAR CNCV 8MM 14MM STRL PROSTOP BABSR TI POLY BOTH IP/OP "$3,737.50" "$2,766.00" $665.28 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $665.28 "$3,737.50" "$3,737.50" "$2,773.97" "$2,773.97" "$2,880.87" "$1,947.24" $778.94 "$3,737.50" "$1,614.60" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$2,429.38" "$3,737.50" N/A "$2,167.75" "$3,737.50" "$2,242.50" "$3,737.50" "$3,737.50" "$3,737.50" N/A N/A AR-4208B-14 SUP Custom 27203010 AR-4208B-14 - COMPONENT SUBTALAR CNCV 8MM 14MM STRL PROSTOP + BABSR TI BOTH IP/OP "$3,237.50" "$2,396.00" $576.28 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $576.28 "$3,237.50" "$3,237.50" "$2,402.87" "$2,402.87" "$2,495.47" "$1,686.74" $674.73 "$3,237.50" "$1,295.00" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$2,104.38" "$3,237.50" N/A "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" "$3,237.50" "$3,237.50" N/A N/A AR-4209-14 SUP Custom 27203010 AR-4209-14 - COMPONENT SUBTALAR CNCV 9MM 14MM STRL PROSTOP BABSR TI POLY BOTH IP/OP "$3,737.50" "$2,766.00" $665.28 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $665.28 "$3,737.50" "$3,737.50" "$2,773.97" "$2,773.97" "$2,880.87" "$1,947.24" $778.94 "$3,737.50" "$1,614.60" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$2,429.38" "$3,737.50" N/A "$2,167.75" "$3,737.50" "$2,242.50" "$3,737.50" "$3,737.50" "$3,737.50" N/A N/A AR-4209B-14 SUP Custom 27203010 AR-4209B-14 - COMPONENT SUBTALAR CNCV 9MM 14MM STRL PROSTOP + BABSR TI BOTH IP/OP "$3,237.50" "$2,396.00" $576.28 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $576.28 "$3,237.50" "$3,237.50" "$2,402.87" "$2,402.87" "$2,495.47" "$1,686.74" $674.73 "$3,237.50" "$1,295.00" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$2,104.38" "$3,237.50" N/A "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" "$3,237.50" "$3,237.50" N/A N/A AR-4210-14 SUP Custom 27203010 AR-4210-14 - COMPONENT SUBTALAR CNCV 10MM 14MM STRL PROSTOP BABSR TI POLY BOTH IP/OP "$3,737.50" "$2,766.00" $665.28 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $665.28 "$3,737.50" "$3,737.50" "$2,773.97" "$2,773.97" "$2,880.87" "$1,947.24" $778.94 "$3,737.50" "$1,614.60" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$2,429.38" "$3,737.50" N/A "$2,167.75" "$3,737.50" "$2,242.50" "$3,737.50" "$3,737.50" "$3,737.50" N/A N/A AR-4210B-14 SUP Custom 27203010 AR-4210B-14 - COMPONENT SUBTALAR CNCV 10MM 14MM STRL PROSTOP + BABSR TI BOTH IP/OP "$3,237.50" "$2,396.00" $576.28 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $576.28 "$3,237.50" "$3,237.50" "$2,402.87" "$2,402.87" "$2,495.47" "$1,686.74" $674.73 "$3,237.50" "$1,295.00" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$2,104.38" "$3,237.50" N/A "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" "$3,237.50" "$3,237.50" N/A N/A AR-4211-16 SUP Custom 27203010 AR-4211-16 - COMPONENT SUBTALAR CNCV 11MM 16MM STRL PROSTOP BABSR TI POLY BOTH IP/OP "$3,737.50" "$2,766.00" $665.28 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $665.28 "$3,737.50" "$3,737.50" "$2,773.97" "$2,773.97" "$2,880.87" "$1,947.24" $778.94 "$3,737.50" "$1,614.60" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$2,429.38" "$3,737.50" N/A "$2,167.75" "$3,737.50" "$2,242.50" "$3,737.50" "$3,737.50" "$3,737.50" N/A N/A AR-4211B-16 SUP Custom 27203010 AR-4211B-16 - COMPONENT SUBTALAR CNCV 11MM 16MM STRL PROSTOP + BABSR TI BOTH IP/OP "$3,237.50" "$2,396.00" $576.28 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $576.28 "$3,237.50" "$3,237.50" "$2,402.87" "$2,402.87" "$2,495.47" "$1,686.74" $674.73 "$3,237.50" "$1,295.00" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$2,104.38" "$3,237.50" N/A "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" "$3,237.50" "$3,237.50" N/A N/A AR-4212-16 SUP Custom 27203010 AR-4212-16 - COMPONENT SUBTALAR CNCV 12MM 16MM STRL PROSTOP BABSR TI POLY BOTH IP/OP "$3,737.50" "$2,766.00" $665.28 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $665.28 "$3,737.50" "$3,737.50" "$2,773.97" "$2,773.97" "$2,880.87" "$1,947.24" $778.94 "$3,737.50" "$1,614.60" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$2,429.38" "$3,737.50" N/A "$2,167.75" "$3,737.50" "$2,242.50" "$3,737.50" "$3,737.50" "$3,737.50" N/A N/A AR-4212B-16 SUP Custom 27203010 AR-4212B-16 - COMPONENT SUBTALAR CNCV 12MM 16MM STRL PROSTOP + BABSR TI BOTH IP/OP "$3,237.50" "$2,396.00" $576.28 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $576.28 "$3,237.50" "$3,237.50" "$2,402.87" "$2,402.87" "$2,495.47" "$1,686.74" $674.73 "$3,237.50" "$1,295.00" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$2,104.38" "$3,237.50" N/A "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" "$3,237.50" "$3,237.50" N/A N/A AR-4502 SUP HCPCS C1713 AR-4502 - NEEDLE SUT 2-0 CRV SPEEDCINCH FBRWR PEEK BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $426.60 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $592.50 $987.50 $205.80 $987.50 N/A N/A AR-4515 SUP Custom 27203010 AR-4515 - CUTTER SUTURE REMOVAL KNOT PUSHER MENISCAL CINCH STERILE BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $231.94 $231.94 $240.88 $162.81 $65.13 $312.50 $135.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $203.13 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A AR-4520 SUP Custom 27203010 AR-4520 - CUTTER SUT REM TGHTRP RECON SUT ACL ASCP BOTH IP/OP $395.00 $292.00 $70.31 $395.00 $395.00 $395.00 $395.00 $395.00 $395.00 $395.00 $70.31 $395.00 $395.00 $293.17 $293.17 $304.47 $205.80 $82.32 $395.00 $158.00 $395.00 $395.00 $395.00 $395.00 $395.00 $296.25 $395.00 $395.00 $395.00 $197.50 $197.50 $312.84 $395.00 $316.00 $256.75 $395.00 N/A $229.10 $395.00 $237.00 $395.00 $395.00 $395.00 N/A N/A AR-5010AB SUP HCPCS C1713 AR-5010AB - SCREW INTFR 50D 10MM 17MM STRL BCRTCL BCK END FLSH POLY L BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $73.98 $355.00 N/A N/A AR-5010BB SUP HCPCS C1713 AR-5010BB - SCREW INTFR 10MM 20MM STRL BCRTCL BCK END FLSH POLY L LAC BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $355.00 $355.00 N/A N/A AR-5011AB SUP HCPCS C1713 AR-5011AB - SCREW INTFR 50D 11MM 17MM STRL BCRTCL BCK END FLSH POLY L BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $73.98 $355.00 N/A N/A AR-501-TBA0 SUP HCPCS C1713 AR-501-TBA0 - BEARING TIB 1 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBA1 SUP HCPCS C1713 AR-501-TBA1 - BEARING TIB 1 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBA2 SUP HCPCS C1713 AR-501-TBA2 - BEARING TIB 1 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBA4 SUP HCPCS C1713 AR-501-TBA4 - BEARING TIB 1 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBA8 SUP HCPCS C1713 AR-501-TBA8 - BEARING TIB 1 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBA9 SUP HCPCS C1713 AR-501-TBA9 - BEARING TIB 1 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBB0 SUP HCPCS C1713 AR-501-TBB0 - BEARING TIB 2 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBB1 SUP HCPCS C1713 AR-501-TBB1 - BEARING TIB 2 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBB2 SUP HCPCS C1713 AR-501-TBB2 - BEARING TIB 2 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBB4 SUP HCPCS C1713 AR-501-TBB4 - BEARING TIB 2 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBB8 SUP HCPCS C1713 AR-501-TBB8 - BEARING TIB 2 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBB9 SUP HCPCS C1713 AR-501-TBB9 - BEARING TIB 2 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-501-TBC0 SUP HCPCS C1713 AR-501-TBC0 - BEARING TIB 3 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBC1 SUP HCPCS C1713 AR-501-TBC1 - BEARING TIB 3 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBC2 SUP HCPCS C1713 AR-501-TBC2 - BEARING TIB 3 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBC4 SUP HCPCS C1713 AR-501-TBC4 - BEARING TIB 3 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBC8 SUP HCPCS C1713 AR-501-TBC8 - BEARING TIB 3 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-501-TBC9 SUP HCPCS C1713 AR-501-TBC9 - BEARING TIB 3 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-501-TBD0 SUP HCPCS C1713 AR-501-TBD0 - BEARING TIB 4 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBD1 SUP HCPCS C1713 AR-501-TBD1 - BEARING TIB 4 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBD2 SUP HCPCS C1713 AR-501-TBD2 - BEARING TIB 4 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-501-TBD4 SUP HCPCS C1713 AR-501-TBD4 - BEARING TIB 4 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBD8 SUP HCPCS C1713 AR-501-TBD8 - BEARING TIB 4 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBD9 SUP HCPCS C1713 AR-501-TBD9 - BEARING TIB D 9MM UNCMP BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBE0 SUP HCPCS C1713 AR-501-TBE0 - BEARING TIB 5 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBE1 SUP HCPCS C1713 AR-501-TBE1 - BEARING TIB 5 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-501-TBE2 SUP HCPCS C1713 AR-501-TBE2 - BEARING TIB 5 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-501-TBE4 SUP HCPCS C1713 AR-501-TBE4 - BEARING TIB 5 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBE8 SUP HCPCS C1713 AR-501-TBE8 - BEARING TIB 5 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-501-TBE9 SUP HCPCS C1713 AR-501-TBE9 - BEARING TIB 5 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-501-TBF0 SUP HCPCS C1713 AR-501-TBF0 - BEARING TIB 6 10MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBF1 SUP HCPCS C1713 AR-501-TBF1 - BEARING TIB 6 11MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBF2 SUP HCPCS C1713 AR-501-TBF2 - BEARING TIB 6 12MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBF4 SUP HCPCS C1713 AR-501-TBF4 - BEARING TIB 6 14MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBF8 SUP HCPCS C1713 AR-501-TBF8 - BEARING TIB 6 8MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TBF9 SUP HCPCS C1713 AR-501-TBF9 - BEARING TIB 6 9MM IBALANCE ANTM DSGN RSRFC PE KN UNCNDL BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-501-TTLA SUP Custom 27203010 AR-501-TTLA - TRAY TIB 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL BOTH IP/OP "$4,500.00" "$3,330.00" $801.00 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $801.00 "$4,500.00" "$4,500.00" "$3,339.90" "$3,339.90" "$3,468.60" "$2,060.15" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,925.00" "$4,500.00" N/A "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A AR-501-TTLB SUP Custom 27203010 AR-501-TTLB - TRAY TIB 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL BOTH IP/OP "$4,500.00" "$3,330.00" $801.00 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $801.00 "$4,500.00" "$4,500.00" "$3,339.90" "$3,339.90" "$3,468.60" "$2,060.15" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,925.00" "$4,500.00" N/A "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A AR-501-TTLC SUP Custom 27203010 AR-501-TTLC - TRAY TIB 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL BOTH IP/OP "$4,500.00" "$3,330.00" $801.00 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $801.00 "$4,500.00" "$4,500.00" "$3,339.90" "$3,339.90" "$3,468.60" "$2,060.15" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,925.00" "$4,500.00" N/A "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A AR-501-TTLD SUP HCPCS C1776 AR-501-TTLD - COMPONENT TIBTRY D UNCMP LT BOTH IP/OP "$4,500.00" "$3,330.00" $893.14 "$4,500.00" "$2,025.00" "$2,025.00" "$2,025.00" "$2,025.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.91 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 "$4,500.00" "$4,500.00" "$2,218.50" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,025.00" $893.14 N/A "$2,610.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.80 "$4,500.00" N/A N/A AR-501-TTLE SUP Custom 27203010 AR-501-TTLE - TRAY TIB 5 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL BOTH IP/OP "$4,500.00" "$3,330.00" $801.00 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $801.00 "$4,500.00" "$4,500.00" "$3,339.90" "$3,339.90" "$3,468.60" "$2,060.15" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,925.00" "$4,500.00" N/A "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A AR-501-TTLF SUP Custom 27203010 AR-501-TTLF - TRAY TIB 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT MDL BOTH IP/OP "$4,500.00" "$3,330.00" $801.00 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $801.00 "$4,500.00" "$4,500.00" "$3,339.90" "$3,339.90" "$3,468.60" "$2,060.15" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,925.00" "$4,500.00" N/A "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A AR-501-TTRA SUP Custom 27203010 AR-501-TTRA - TRAY TIB 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL BOTH IP/OP "$4,500.00" "$3,330.00" $801.00 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $801.00 "$4,500.00" "$4,500.00" "$3,339.90" "$3,339.90" "$3,468.60" "$2,060.15" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,925.00" "$4,500.00" N/A "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A AR-501-TTRB SUP Custom 27203010 AR-501-TTRB - TRAY TIB 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL BOTH IP/OP "$4,500.00" "$3,330.00" $801.00 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $801.00 "$4,500.00" "$4,500.00" "$3,339.90" "$3,339.90" "$3,468.60" "$2,060.15" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,925.00" "$4,500.00" N/A "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A AR-501-TTRC SUP Custom 27203010 AR-501-TTRC - TRAY TIB 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL BOTH IP/OP "$4,500.00" "$3,330.00" $801.00 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $801.00 "$4,500.00" "$4,500.00" "$3,339.90" "$3,339.90" "$3,468.60" "$2,060.15" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,925.00" "$4,500.00" N/A "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A AR-501-TTRD SUP Custom 27203010 AR-501-TTRD - TRAY TIB 4 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL BOTH IP/OP "$4,500.00" "$3,330.00" $801.00 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $801.00 "$4,500.00" "$4,500.00" "$3,339.90" "$3,339.90" "$3,468.60" "$2,060.15" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,925.00" "$4,500.00" N/A "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A AR-501-TTRE SUP Custom 27203010 AR-501-TTRE - TRAY TIB 5 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL BOTH IP/OP "$4,500.00" "$3,330.00" $801.00 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $801.00 "$4,500.00" "$4,500.00" "$3,339.90" "$3,339.90" "$3,468.60" "$2,060.15" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,925.00" "$4,500.00" N/A "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A AR-501-TTRF SUP Custom 27203010 AR-501-TTRF - TRAY TIB 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT MDL BOTH IP/OP "$4,500.00" "$3,330.00" $801.00 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $801.00 "$4,500.00" "$4,500.00" "$3,339.90" "$3,339.90" "$3,468.60" "$2,060.15" $937.85 "$4,500.00" "$1,800.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,925.00" "$4,500.00" N/A "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" "$4,500.00" "$4,500.00" N/A N/A AR-501-UFLA SUP HCPCS C1776 AR-501-UFLA - COMPONENT FEM 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A AR-501-UFLB SUP HCPCS C1776 AR-501-UFLB - COMPONENT FEM 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A AR-501-UFLC SUP HCPCS C1776 AR-501-UFLC - COMPONENT FEM 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A AR-501-UFLD SUP HCPCS C1776 AR-501-UFLD - COMPONENT FEM 4 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A AR-501-UFLE SUP HCPCS C1776 AR-501-UFLE - COMPONENT FEM E KN LT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A AR-501-UFLF SUP HCPCS C1776 AR-501-UFLF - COMPONENT FEM 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL LT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A AR-501-UFRA SUP HCPCS C1776 AR-501-UFRA - COMPONENT FEM 1 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A AR-501-UFRB SUP HCPCS C1776 AR-501-UFRB - COMPONENT FEM 2 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A AR-501-UFRC SUP HCPCS C1776 AR-501-UFRC - COMPONENT FEM 3 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A AR-501-UFRD SUP HCPCS C1776 AR-501-UFRD - COMPONENT FEM 4 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A AR-501-UFRE SUP HCPCS C1776 AR-501-UFRE - COMPONENT FEM 5 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A AR-501-UFRF SUP HCPCS C1776 AR-501-UFRF - COMPONENT FEM 6 IBALANCE ANTM DSGN CMNT RSRFC KN UNCNDL RT BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A AR-502-1L SUP HCPCS C1776 AR-502-1L - COMPONENT FEM 1 IBALANCE PTLFEM LT BOTH IP/OP "$11,900.00" "$8,806.00" "$2,361.85" "$11,900.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.26" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.09" "$11,900.00" "$11,900.00" "$5,866.70" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$8,925.00" "$11,900.00" "$11,900.00" "$11,900.00" "$5,950.00" "$5,950.00" "$9,424.80" "$11,900.00" "$9,520.00" "$5,355.00" "$2,361.85" N/A "$6,902.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,479.96" "$11,900.00" N/A N/A AR-502-1R SUP HCPCS C1776 AR-502-1R - COMPONENT FEM 1 IBALANCE PTLFEM RT BOTH IP/OP "$11,900.00" "$8,806.00" "$2,361.85" "$11,900.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.26" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.09" "$11,900.00" "$11,900.00" "$5,866.70" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$8,925.00" "$11,900.00" "$11,900.00" "$11,900.00" "$5,950.00" "$5,950.00" "$9,424.80" "$11,900.00" "$9,520.00" "$5,355.00" "$2,361.85" N/A "$6,902.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,479.96" "$11,900.00" N/A N/A AR-502-2L SUP HCPCS C1776 AR-502-2L - COMPONENT FEM 2 IBALANCE PTLFEM LT BOTH IP/OP "$11,900.00" "$8,806.00" "$2,361.85" "$11,900.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.26" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.09" "$11,900.00" "$11,900.00" "$5,866.70" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$8,925.00" "$11,900.00" "$11,900.00" "$11,900.00" "$5,950.00" "$5,950.00" "$9,424.80" "$11,900.00" "$9,520.00" "$5,355.00" "$2,361.85" N/A "$6,902.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,479.96" "$11,900.00" N/A N/A AR-502-2R SUP HCPCS C1776 AR-502-2R - COMPONENT FEM 2 IBALANCE PTLFEM RT BOTH IP/OP "$11,900.00" "$8,806.00" "$2,361.85" "$11,900.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.26" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.09" "$11,900.00" "$4,760.00" "$5,866.70" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$8,925.00" "$11,900.00" "$11,900.00" "$11,900.00" "$5,950.00" "$5,950.00" "$9,424.80" "$11,900.00" "$9,520.00" "$5,355.00" "$2,361.85" N/A "$6,902.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,479.96" "$11,900.00" N/A N/A AR-502-3L SUP HCPCS C1776 AR-502-3L - COMPONENT FEM 3 IBALANCE PTLFEM LT BOTH IP/OP "$11,900.00" "$8,806.00" "$2,361.85" "$11,900.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.26" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.09" "$11,900.00" "$4,760.00" "$5,866.70" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$8,925.00" "$11,900.00" "$11,900.00" "$11,900.00" "$5,950.00" "$5,950.00" "$9,424.80" "$11,900.00" "$9,520.00" "$5,355.00" "$2,361.85" N/A "$6,902.00" "$11,900.00" "$7,140.00" "$11,900.00" "$2,479.96" "$11,900.00" N/A N/A AR-502-3R SUP HCPCS C1776 AR-502-3R - COMPONENT FEM 3 IBALANCE PTLFEM RT BOTH IP/OP "$11,900.00" "$8,806.00" "$2,361.85" "$11,900.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.26" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.09" "$11,900.00" "$4,760.00" "$5,866.70" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$8,925.00" "$11,900.00" "$11,900.00" "$11,900.00" "$5,950.00" "$5,950.00" "$9,424.80" "$11,900.00" "$9,520.00" "$5,355.00" "$2,361.85" N/A "$6,902.00" "$11,900.00" "$7,140.00" "$11,900.00" "$2,479.96" "$11,900.00" N/A N/A AR-502-4L SUP HCPCS C1776 AR-502-4L - COMPONENT FEM 4 IBALANCE PTLFEM LT BOTH IP/OP "$11,900.00" "$8,806.00" "$2,361.85" "$11,900.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.26" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.09" "$11,900.00" "$11,900.00" "$5,866.70" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$8,925.00" "$11,900.00" "$11,900.00" "$11,900.00" "$5,950.00" "$5,950.00" "$9,424.80" "$11,900.00" "$9,520.00" "$5,355.00" "$2,361.85" N/A "$6,902.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,479.96" "$11,900.00" N/A N/A AR-502-4R SUP HCPCS C1776 AR-502-4R - COMPONENT FEM 4 IBALANCE PTLFEM RT BOTH IP/OP "$11,900.00" "$8,806.00" "$2,361.85" "$11,900.00" "$5,355.00" "$5,355.00" "$5,355.00" "$5,355.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.26" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,480.09" "$11,900.00" "$11,900.00" "$5,866.70" "$11,900.00" "$11,900.00" "$11,900.00" "$11,900.00" "$8,925.00" "$11,900.00" "$11,900.00" "$11,900.00" "$5,950.00" "$5,950.00" "$9,424.80" "$11,900.00" "$9,520.00" "$5,355.00" "$2,361.85" N/A "$6,902.00" "$11,900.00" "$11,900.00" "$11,900.00" "$2,479.96" "$11,900.00" N/A N/A AR-5024TDA SUP Custom 27203010 AR-5024TDA - BIT DRL CMPR SCR TPR ASCP BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A AR-5024TDP SUP Custom 27203010 AR-5024TDP - BIT DRL CMPR SCR TPR PERC BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A AR-5025B-16 SUP HCPCS C1713 AR-5025B-16 - SCREW INTFR TPR 3-3.7MM 16MM STRL BIO-CMPR SCR CNN SLF CMPR BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $592.50 $987.50 $205.80 $987.50 N/A N/A AR-5025B-18 SUP HCPCS C1713 AR-5025B-18 - SCREW INTFR TPR 3-3.7MM 18MM STRL BIO-CMPR SCR CNN SLF CMPR BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $987.50 $987.50 $987.50 $987.50 N/A N/A AR-5025B-20 SUP HCPCS C1713 AR-5025B-20 - SCREW INTFR TPR 2.7-3.7MM 20MM STRL BIO-CMPR SCR CNN SLF BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $592.50 $987.50 $205.80 $987.50 N/A N/A AR-5025B-22 SUP HCPCS C1713 AR-5025B-22 - SCREW INTFR TPR 3-3.7MM 22MM STRL BIO-CMPR SCR CNN SLF CMPR BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $592.50 $987.50 $205.80 $987.50 N/A N/A AR-5025B-24 SUP HCPCS C1713 AR-5025B-24 - SCREW INTFR TPR 3-3.7MM 24MM STRL BIO-CMPR SCR CNN SLF CMPR BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $592.50 $987.50 $205.80 $987.50 N/A N/A AR-5025B-26 SUP HCPCS C1713 AR-5025B-26 - SCREW INTFR TPR 3-3.7MM 26MM STRL BIO-CMPR SCR CNN SLF CMPR BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $987.50 $987.50 $205.80 $987.50 N/A N/A AR-5025ETDC-26 SUP Custom 27203010 AR-5025ETDC-26 - BIT DRL 26MM CNN BIO-CMPR SCR BOTH IP/OP $450.00 $333.00 $80.10 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $450.00 $80.10 $450.00 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $194.40 $450.00 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $450.00 N/A $261.00 $450.00 $270.00 $450.00 $450.00 $450.00 N/A N/A AR-5025TD SUP Custom 27203010 AR-5025TD - BIT DRL 2.7MM 20MM CNN BIO-CMPR SCR BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-5025TDC SUP Custom 27203010 AR-5025TDC - BIT DRL CNN BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5025TDC-16 SUP Custom 27203010 AR-5025TDC-16 - BIT DRL 16MM CNN BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5025TDC-18 SUP Custom 27203010 AR-5025TDC-18 - BIT DRL 18MM CNN BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5025TDC-22 SUP Custom 27203010 AR-5025TDC-22 - BIT DRL 22MM CNN BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5025TDC-24 SUP Custom 27203010 AR-5025TDC-24 - BIT DRL 24MM CNN BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5025TDC-26 SUP Custom 27203010 AR-5025TDC-26 - BIT DRL 26MM CNN BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5026B-16 SUP HCPCS C1713 AR-5026B-16 - SCREW INTFR TPR 3.5-4.4MM 16MM BIO-CMPR SCR CNN SLF CMPR STP BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $987.50 $987.50 $205.80 $987.50 N/A N/A AR-5026B-18 SUP HCPCS C1713 AR-5026B-18 - SCREW INTFR TPR 3.5-4.5MM 18MM BIO-CMPR SCR CNN SLF CMPR STP BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $592.50 $987.50 $205.80 $987.50 N/A N/A AR-5026B-20 SUP HCPCS C1713 AR-5026B-20 - SCREW INTFR TPR 3.5-4.6MM 20MM BIO-CMPR SCR CNN SLF CMPR STP BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $592.50 $987.50 $205.80 $987.50 N/A N/A AR-5026B-22 SUP HCPCS C1713 AR-5026B-22 - SCREW INTFR TPR 3.5-4.7MM 22MM BIO-CMPR SCR CNN SLF CMPR STP BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A AR-5026B-24 SUP HCPCS C1713 AR-5026B-24 - SCREW INTFR TPR 3.5-4.8MM 24MM BIO-CMPR SCR CNN SLF CMPR STP BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A AR-5026B-26 SUP HCPCS C1713 AR-5026B-26 - SCREW INTFR TPR 3.5-4.9MM 26MM BIO-CMPR SCR CNN SLF CMPR STP BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $592.50 $987.50 $205.80 $987.50 N/A N/A AR-5026B-28 SUP HCPCS C1713 AR-5026B-28 - SCREW INTFR TPR 3.5-5-5MM 28MM BIO-CMPR SCR CNN SLF CMPR STP BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A AR-5026B-30 SUP HCPCS C1713 AR-5026B-30 - SCREW INTFR TPR 3.5-5.1MM 30MM BIO-CMPR SCR CNN SLF CMPR STP BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A AR-5026B-32 SUP HCPCS C1713 AR-5026B-32 - SCREW INTFR TPR 3.5-3.5MM 32MM BIO-CMPR SCR CNN SLF CMPR STP BOTH IP/OP $987.50 $731.00 $195.99 $987.50 $444.38 $444.38 $444.38 $444.38 $987.50 $987.50 $987.50 $205.82 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $987.50 $584.11 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $195.99 N/A $572.75 $987.50 $592.50 $987.50 $205.80 $987.50 N/A N/A AR-5026G SUP Custom 27203010 AR-5026G - GUIDE DRL 20MM C RING DRVR BIO-CMPR SCR BOTH IP/OP "$1,900.00" "$1,406.00" $338.20 "$1,900.00" "$1,900.00" "$1,900.00" "$1,900.00" "$1,900.00" "$1,900.00" "$1,900.00" $338.20 "$1,900.00" "$1,900.00" "$1,410.18" "$1,410.18" "$1,464.52" $989.90 $395.98 "$1,900.00" $820.80 "$1,900.00" "$1,900.00" "$1,900.00" "$1,900.00" "$1,900.00" "$1,425.00" "$1,900.00" "$1,900.00" "$1,900.00" $950.00 $950.00 "$1,504.80" "$1,900.00" "$1,520.00" "$1,235.00" "$1,900.00" N/A "$1,102.00" "$1,900.00" "$1,140.00" "$1,900.00" "$1,900.00" "$1,900.00" N/A N/A AR-5026TDC-16 SUP Custom 27203010 AR-5026TDC-16 - BIT DRL TPR 3.5MM 16MM BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5026TDC-18 SUP Custom 27203010 AR-5026TDC-18 - BIT DRL TPR 3.5MM 18MM BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5026TDC-20 SUP Custom 27203010 AR-5026TDC-20 - BIT DRL TPR 3.5MM 20MM BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5026TDC-22 SUP Custom 27203010 AR-5026TDC-22 - BIT DRL TPR 3.5MM 22MM BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5026TDC-24 SUP Custom 27203010 AR-5026TDC-24 - BIT DRL TPR 3.5MM 24MM BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5026TDC-26 SUP Custom 27203010 AR-5026TDC-26 - BIT DRL TPR 3.5MM 26MM BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5026TDC-28 SUP Custom 27203010 AR-5026TDC-28 - BIT DRL TPR 3.5MM 28MM BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5026TDC-30 SUP Custom 27203010 AR-5026TDC-30 - BIT DRL TPR 3.5MM 30MM BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5026TDC-32 SUP Custom 27203010 AR-5026TDC-32 - BIT DRL TPR 3.5MM 32MM BIO-CMPR SCR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-5028B-08 SUP HCPCS C1713 AR-5028B-08 - SCREW INTFR DLT TPR 8MM 28MM STRL 6.5MM BIOINTF POLY L LAC BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-5028B-09 SUP HCPCS C1713 AR-5028B-09 - SCREW INTFR DLT TPR 9MM 28MM STRL 7.5MM BIOINTF POLY L LAC BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-5028B-10 SUP HCPCS C1713 AR-5028B-10 - SCREW INTFR DLT TPR 10MM 28MM STRL 8.5MM BIOINTF POLY L LAC BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-5028B-11 SUP HCPCS C1713 AR-5028B-11 - SCREW INTFR DLT TPR 11MM 28MM STRL 9.5MM BIOINTF POLY L LAC BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-5028C-08 SUP HCPCS C1713 AR-5028C-08 - SCREW INTFR DLT TPR 8MM 28MM STRL BCMPS SHLDR BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $122.44 $587.50 N/A N/A AR-5028C-10 SUP HCPCS C1713 AR-5028C-10 - SCREW INTERFERENCE DELTA TAPER 10MM 28MM BIOCOMPOSITE BOTH IP/OP $587.50 $435.00 $116.60 $634.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $634.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A AR-5028C-11 SUP HCPCS C1713 AR-5028C-11 - SCREW INTERFERENCE DELTA TAPER 11MM 28MM BIOCOMPOSITE BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $253.80 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $122.44 $587.50 N/A N/A AR-5028P-07 SUP HCPCS C1713 AR-5028P-07 - SCREW INTFR DLT TPR 7MM 28MM STRL RECON SHTH THRD PTRN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-5028P-08 SUP HCPCS C1713 AR-5028P-08 - ROUND DELTA TAPERED INTERFERENCE SCREW BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-5028P-09 SUP HCPCS C1713 AR-5028P-09 - SCREW INTFR DLT TPR 9MM 28MM STRL RECON SHTH THRD PTRN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-5028P-10 SUP HCPCS C1713 AR-5028P-10 - SCREW INTFR DLT TPR 10MM 28MM STRL RECON SHTH THRD PTRN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-5028P-11 SUP HCPCS C1713 AR-5028P-11 - SCREW INTFR DLT TPR 11MM 28MM STRL RECON SHTH THRD PTRN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-5028P-12 SUP HCPCS C1713 AR-5028P-12 - SCREW INTFR DLT TPR 12MM 28MM STRL RECON SHTH THRD PTRN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-5035P-09 SUP HCPCS C1713 AR-5035P-09 - SCREW INTFR DLT TPR 9MM 35MM STRL CNN DRVR RECON PEEK-OPTM BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-5035P-10 SUP HCPCS C1713 AR-5035P-10 - SCREW INTFR DLT TPR 10MM 35MM STRL CNN DRVR RECON PEEK-OPTM BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-5035P-11 SUP HCPCS C1713 AR-5035P-11 - SCREW INTFR DLT TPR 11MM 35MM STRL CNN DRVR RECON PEEK-OPTM BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-5035P-12 SUP HCPCS C1713 AR-5035P-12 - SCREW INTFR DLT TPR 12MM 35MM STRL CNN DRVR RECON PEEK-OPTM BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-5035TB-09 SUP HCPCS C1713 AR-5035TB-09 - SCREW INTFR DLT TPR 7.5-9MM 35MM STRL BIOINTF CNN POLY L LAC BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-5035TB-10 SUP HCPCS C1713 AR-5035TB-10 - SCREW INTFR DLT TPR 8.5-10MM 35MM STRL BIOINTF CNN POLY L BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-5035TB-11 SUP HCPCS C1713 AR-5035TB-11 - SCREW INTFR DLT TPR 9.5-11MM 35MM STRL BIOINTF CNN POLY L BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $485.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-5035TB-12 SUP HCPCS C1713 AR-5035TB-12 - SCREW INTFR DLT TPR 10.5-12MM 35MM STRL BIOINTF CNN POLY L BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $194.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $291.00 $485.00 $101.07 $485.00 N/A N/A AR-5035TC-09 SUP HCPCS C1713 AR-5035TC-09 - SCREW INTFR DLT 9MM 35MM STRL CNN BCMPS ACL BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $587.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $122.44 $587.50 N/A N/A AR-5035TC-10 SUP HCPCS C1713 AR-5035TC-10 - SCREW INTFR DLT 10MM 35MM STRL CNN BCMPS ACL BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $235.00 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $587.50 $587.50 N/A N/A AR-5035TC-12 SUP HCPCS C1713 AR-5035TC-12 - SCREW INTFR BCMPS 35MM 12MM DLT ACL CANN STRL BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $253.80 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $122.44 $587.50 N/A N/A AR-503-A1008 SUP HCPCS C1776 "AR-503-A1008 - CR PLUS TIBIAL BEARING, SIZE 10, 8MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A1009 SUP HCPCS C1776 "AR-503-A1009 - CR PLUS TIBIAL BEARING, SIZE 10, 9MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A1010 SUP HCPCS C1776 "AR-503-A1010 - CR PLUS TIBIAL BEARING, SIZE 10, 10MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A1011 SUP HCPCS C1776 "AR-503-A1011 - CR PLUS TIBIAL BEARING, SIZE 10, 11MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A1012 SUP HCPCS C1776 "AR-503-A1012 - CR PLUS TIBIAL BEARING, SIZE 10, 12MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A1013 SUP HCPCS C1776 "AR-503-A1013 - CR PLUS TIBIAL BEARING, SIZE 10, 13MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A1014 SUP HCPCS C1776 "AR-503-A1014 - CR PLUS TIBIAL BEARING, SIZE 10, 14MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A1016 SUP HCPCS C1776 "AR-503-A1016 - CR PLUS TIBIAL BEARING, SIZE 10, 16MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A1018 SUP HCPCS C1776 "AR-503-A1018 - CR PLUS TIBIAL BEARING, SIZE 10, 18MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A908 SUP HCPCS C1776 "AR-503-A908 - CR PLUS TIBIAL BEARING, SIZE 9, 8MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A909 SUP HCPCS C1776 "AR-503-A909 - CR PLUS TIBIAL BEARING, SIZE 9, 9MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A910 SUP HCPCS C1776 "AR-503-A910 - CR PLUS TIBIAL BEARING, SIZE 9, 10MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A911 SUP HCPCS C1776 "AR-503-A911 - CR PLUS TIBIAL BEARING, SIZE 9, 11MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A912 SUP HCPCS C1776 "AR-503-A912 - CR PLUS TIBIAL BEARING, SIZE 9, 12MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A913 SUP HCPCS C1776 "AR-503-A913 - CR PLUS TIBIAL BEARING, SIZE 9, 13MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A914 SUP HCPCS C1776 "AR-503-A914 - CR PLUS TIBIAL BEARING, SIZE 9, 14MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A916 SUP HCPCS C1776 "AR-503-A916 - CR PLUS TIBIAL BEARING, SIZE 9, 16MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-A918 SUP HCPCS C1776 "AR-503-A918 - CR PLUS TIBIAL BEARING, SIZE 9, 18MM" BOTH IP/OP "$3,750.00" "$2,775.00" $744.28 "$3,750.00" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$3,750.00" "$3,750.00" "$3,750.00" $781.59 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$3,750.00" "$1,848.75" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" $744.28 N/A "$2,175.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.50 "$3,750.00" N/A N/A AR-503-PSRA SUP HCPCS C1776 AR-503-PSRA - COMPONENT FEM IBALANCE CMNT POST STAB KN RT BOTH IP/OP "$7,750.00" "$5,735.00" "$1,538.18" "$7,750.00" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$7,750.00" "$7,750.00" "$7,750.00" "$1,615.29" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$1,615.19" "$7,750.00" "$3,100.00" "$3,820.75" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$5,812.50" "$7,750.00" "$7,750.00" "$7,750.00" "$3,875.00" "$3,875.00" "$6,138.00" "$7,750.00" "$6,200.00" "$3,487.50" "$1,538.18" N/A "$4,495.00" "$7,750.00" "$4,650.00" "$7,750.00" "$1,615.10" "$7,750.00" N/A N/A AR-504-PSA8 SUP HCPCS C1776 AR-504-PSA8 - COMPONENT PTLR DOME 27MM 8MM IBALANCE BOTH IP/OP "$2,187.50" "$1,619.00" $434.16 "$2,187.50" $984.38 $984.38 $984.38 $984.38 "$2,187.50" "$2,187.50" "$2,187.50" $455.93 "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" $455.90 "$2,187.50" "$2,187.50" "$1,293.91" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$1,640.63" "$2,187.50" "$2,187.50" "$2,187.50" "$1,093.75" "$1,093.75" "$1,732.50" "$2,187.50" "$1,750.00" $984.38 $434.16 N/A "$1,268.75" "$2,187.50" "$2,187.50" "$2,187.50" $455.88 "$2,187.50" N/A N/A AR-504-PSB8 SUP HCPCS C1776 AR-504-PSB8 - COMPONENT PTLR DOME 30MM 8MM IBALANCE BOTH IP/OP "$2,187.50" "$1,619.00" $434.16 "$2,187.50" $984.38 $984.38 $984.38 $984.38 "$2,187.50" "$2,187.50" "$2,187.50" $455.93 "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" $455.90 "$2,187.50" "$2,187.50" "$1,293.91" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$1,640.63" "$2,187.50" "$2,187.50" "$2,187.50" "$1,093.75" "$1,093.75" "$1,732.50" "$2,187.50" "$1,750.00" $984.38 $434.16 N/A "$1,268.75" "$2,187.50" "$2,187.50" "$2,187.50" $455.88 "$2,187.50" N/A N/A AR-504-PSE0 SUP HCPCS C1776 AR-504-PSE0 - COMPONENT PTLR THK10MM 3 DOME 40MM IBALANCE 3 PG BOTH IP/OP "$2,187.50" "$1,619.00" $434.16 "$2,187.50" $984.38 $984.38 $984.38 $984.38 "$2,187.50" "$2,187.50" "$2,187.50" $455.93 "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" $455.90 "$2,187.50" "$2,187.50" "$1,293.91" "$2,187.50" "$2,187.50" "$2,187.50" "$2,187.50" "$1,640.63" "$2,187.50" "$2,187.50" "$2,187.50" "$1,093.75" "$1,093.75" "$1,732.50" "$2,187.50" "$1,750.00" $984.38 $434.16 N/A "$1,268.75" "$2,187.50" "$2,187.50" "$2,187.50" $455.88 "$2,187.50" N/A N/A AR-5050-05 SUP Custom 27203010 AR-5050-05 - CLAMP SRG 2X SM WEBER LNG THROW PTLR FX SYS BOTH IP/OP $442.50 $327.00 $78.77 $442.50 $442.50 $442.50 $442.50 $442.50 $442.50 $442.50 $78.77 $442.50 $442.50 $328.42 $328.42 $341.08 $230.54 $92.22 $442.50 $191.16 $442.50 $442.50 $442.50 $442.50 $442.50 $331.88 $442.50 $442.50 $442.50 $221.25 $221.25 $350.46 $442.50 $354.00 $287.63 $442.50 N/A $256.65 $442.50 $265.50 $442.50 $442.50 $442.50 N/A N/A AR-5050-07 SUP Custom 27203010 AR-5050-07 - GUIDE DRL 2MM 1.6MM BOTH IP/OP "$1,117.50" $827.00 $198.92 "$1,117.50" "$1,117.50" "$1,117.50" "$1,117.50" "$1,117.50" "$1,117.50" "$1,117.50" $198.92 "$1,117.50" "$1,117.50" $829.41 $829.41 $861.37 $582.22 $232.90 "$1,117.50" $482.76 "$1,117.50" "$1,117.50" "$1,117.50" "$1,117.50" "$1,117.50" $838.13 "$1,117.50" "$1,117.50" "$1,117.50" $558.75 $558.75 $885.06 "$1,117.50" $894.00 $726.38 "$1,117.50" N/A $648.15 "$1,117.50" $670.50 "$1,117.50" "$1,117.50" "$1,117.50" N/A N/A AR-5050-11 SUP Custom 27203010 AR-5050-11 - GUIDE DRL PRLL PTLR FX BOTH IP/OP "$1,402.50" "$1,038.00" $249.65 "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" $249.65 "$1,402.50" "$1,402.50" "$1,040.94" "$1,040.94" "$1,081.05" $730.70 $292.30 "$1,402.50" $605.88 "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" "$1,402.50" "$1,051.88" "$1,402.50" "$1,402.50" "$1,402.50" $701.25 $701.25 "$1,110.78" "$1,402.50" "$1,122.00" $911.63 "$1,402.50" N/A $813.45 "$1,402.50" $841.50 "$1,402.50" "$1,402.50" "$1,402.50" N/A N/A AR-5050K-2 SUP Custom 27203010 AR-5050K-2 - CANNULA ASCP 7MM 7CM STRL OBT THRD SHLDR DISP BOTH IP/OP $97.50 $72.00 $17.36 $97.50 $97.50 $97.50 $97.50 $97.50 $97.50 $97.50 $17.36 $97.50 $97.50 $72.36 $72.36 $75.15 $50.80 $20.32 $97.50 $39.00 $97.50 $97.50 $97.50 $97.50 $97.50 $73.13 $97.50 $97.50 $97.50 $48.75 $48.75 $77.22 $97.50 $78.00 $63.38 $97.50 N/A $56.55 $97.50 $58.50 $97.50 $97.50 $97.50 N/A N/A AR-5051-24 SUP HCPCS C1713 AR-5051-24 - SCREW BN 4MM 24MM CNN BLNT TIP LOPRFL BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-26 SUP HCPCS C1713 AR-5051-26 - SCREW BN 4MM 26MM CNN BLNT TIP LOPRFL BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-28 SUP HCPCS C1713 AR-5051-28 - SCREW BN 4MM 28MM CNN BLNT TIP LOPRFL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-30 SUP HCPCS C1713 AR-5051-30 - SCREW BN 4MM 30MM CNN BLNT TIP LOPRFL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-32 SUP HCPCS C1713 AR-5051-32 - SCREW BN 4MM 32MM BLNT TIP CNN LG BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-34 SUP HCPCS C1713 AR-5051-34 - SCREW BN 4MM 34MM BLNT TIP CNN LG BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-36 SUP HCPCS C1713 AR-5051-36 - SCREW BN 4MM 36MM CNN BLNT TIP LOPRFL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-38 SUP HCPCS C1713 AR-5051-38 - SCREW BN 4MM 38MM CNN BLNT TIP LOPRFL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-40 SUP HCPCS C1713 AR-5051-40 - SCREW BN 4MM 40MM BLNT TIP CNN LG BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-42 SUP HCPCS C1713 AR-5051-42 - SCREW BN 4MM 42MM BLNT TIP CNN LG BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-44 SUP HCPCS C1713 AR-5051-44 - SCREW BN 4MM 44MM CNN BLNT LOPRFL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-46 SUP HCPCS C1713 AR-5051-46 - SCREW BN 4MM 46MM CNN BLNT LOPRFL BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-48 SUP HCPCS C1713 AR-5051-48 - SCREW BN 4MM 48MM CNN BLNT TIP LOPRFL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-50 SUP HCPCS C1713 AR-5051-50 - SCREW BN 4MM 50MM CNN LOPRFL BLNT TIP BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-55 SUP HCPCS C1713 AR-5051-55 - SCREW BN 4MM 55MM CNN BLNT LOPRFL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-5051-60 SUP HCPCS C1713 AR-5051-60 - SCREW BN 4MM 60MM CNN BLNT LOPRFL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-5068-25TL SUP Custom 27203010 AR-5068-25TL - PASSER SUT 25D SUTLSO SD CRV LT SHFT TIGHT BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-5068-25TR SUP Custom 27203010 AR-5068-25TR - PASSER SUT 25D SUTLSO SD CRV RT SHFT TIGHT BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-5068-30 SUP Custom 27203010 AR-5068-30 - PASSER SUT 30D SUTLSO SD STRG SHFT BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-5068-45L SUP Custom 27203010 AR-5068-45L - PASSER SUT 45D SUTLSO SD CRV LT SHFT BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-5068-45R SUP Custom 27203010 AR-5068-45R - PASSER SUT 45D SUTLSO SD CRV RT SHFT BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-5068-90 SUP Custom 27203010 AR-5068-90 - PASSER SUT 90D SUTLSO SD STRG SHFT BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-5068-90L SUP Custom 27203010 AR-5068-90L - PASSER SUT 90D SUTLSO SD CRV LT SHFT BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-5068-90R SUP Custom 27203010 AR-5068-90R - PASSER SUT 90D SUTLSO SD CRV RT SHFT BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-5068-90T SUP Custom 27203010 AR-5068-90T - PASSER SUT 90D 2 SUTLSO SD SHFT STRG RT BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-5068C SUP Custom 27203010 AR-5068C - PASSER SUT SUTLSO SD CRSNT SHFT BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-5068H SUP Custom 27203010 AR-5068H - PASSER SUT SUTLSO HNDL BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$1,577.18" "$1,577.18" "$1,637.95" "$1,107.13" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" "$1,381.25" "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A AR-5080AB SUP HCPCS C1713 AR-5080AB - SCREW INTFR 50D 8MM 17MM STRL BCRTCL BCK END FLSH POLY L LAC BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $355.00 $355.00 $73.98 $355.00 N/A N/A AR-5080BB SUP HCPCS C1713 AR-5080BB - SCREW INTFR 8MM 20MM STRL BCRTCL BCK END FLSH POLY L LAC ACD BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $142.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $73.98 $355.00 N/A N/A AR-5090AB SUP HCPCS C1713 AR-5090AB - SCREW INTFR 50D 9MM 17MM STRL BCRTCL BCK END FLSH POLY L LAC BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $355.00 $355.00 $355.00 $355.00 N/A N/A AR-5090BB SUP HCPCS C1713 AR-5090BB - SCREW INTFR 9MM 20MM STRL BCRTCL BCK END FLSH POLY L LAC ACD BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $142.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $73.98 $355.00 N/A N/A AR-513-10100 SUP HCPCS C1776 AR-513-10100 - EXTENSION STM 10MM 100MM IBALANCE SCR TIB BOTH IP/OP "$2,875.00" "$2,128.00" $570.62 "$2,875.00" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$2,875.00" "$2,875.00" "$2,875.00" $599.22 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$2,875.00" "$1,417.38" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" $570.62 N/A "$1,667.50" "$2,875.00" "$2,875.00" "$2,875.00" $599.15 "$2,875.00" N/A N/A AR-513-1050 SUP HCPCS C1776 AR-513-1050 - STEM XTN 10MM 50MM IBALANCE TKA SCR TIB BOTH IP/OP "$2,875.00" "$2,128.00" $570.62 "$2,875.00" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$2,875.00" "$2,875.00" "$2,875.00" $599.22 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$2,875.00" "$1,417.38" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" $570.62 N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" $599.15 "$2,875.00" N/A N/A AR-513-12100 SUP HCPCS C1776 AR-513-12100 - EXTENSION STM 12MM 100MM IBALANCE SCR TIB BOTH IP/OP "$2,875.00" "$2,128.00" $570.62 "$2,875.00" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$2,875.00" "$2,875.00" "$2,875.00" $599.22 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$2,875.00" "$1,417.38" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" $570.62 N/A "$1,667.50" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" N/A N/A AR-513-1250 SUP HCPCS C1776 AR-513-1250 - COMPONENT FEM 12MM 50MM STRL IBALANCE ARTHX STM XTN CMNT T/K BOTH IP/OP "$2,875.00" "$2,128.00" $570.62 "$2,875.00" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$2,875.00" "$2,875.00" "$2,875.00" $599.22 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$1,150.00" "$1,417.38" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" $570.62 N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" $599.15 "$2,875.00" N/A N/A AR-513-14100 SUP HCPCS C1776 AR-513-14100 - EXTENSION STM 14MM 100MM IBALANCE SCR TIB BOTH IP/OP "$2,875.00" "$2,128.00" $570.62 "$2,875.00" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$2,875.00" "$2,875.00" "$2,875.00" $599.22 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$1,150.00" "$1,417.38" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" $570.62 N/A "$1,667.50" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" N/A N/A AR-513-1450 SUP HCPCS C1776 AR-513-1450 - COMPONENT FEM 14MM 50MM STRL IBALANCE ARTHX STM XTN CMNT T/K BOTH IP/OP "$2,875.00" "$2,128.00" $570.62 "$2,875.00" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$2,875.00" "$2,875.00" "$2,875.00" $599.22 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$1,150.00" "$1,417.38" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" $570.62 N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" $599.15 "$2,875.00" N/A N/A AR-513-RL1010 SUP HCPCS C1713 AR-513-RL1010 - AUGMENT TIB 10 10MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL105 SUP HCPCS C1713 AR-513-RL105 - AUGMENT TIB 10 5MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL110 SUP HCPCS C1713 AR-513-RL110 - AUGMENT TIB 1 10MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL15 SUP HCPCS C1713 AR-513-RL15 - AUGMENT TIB 1 5MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL210 SUP HCPCS C1713 AR-513-RL210 - AUGMENT TIB 2 10MM IBALANCE SCR LT MDL RL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL25 SUP HCPCS C1713 AR-513-RL25 - AUGMENT TIB 2 5MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL310 SUP HCPCS C1713 AR-513-RL310 - AUGMENT TIB 3 10MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL35 SUP HCPCS C1713 AR-513-RL35 - AUGMENT TIB 3 5MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL410 SUP HCPCS C1713 AR-513-RL410 - AUGMENT TIB 4 10MM IBALANCE SCR LT MDL RL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL45 SUP HCPCS C1713 AR-513-RL45 - AUGMENT TIB 4 5MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL510 SUP HCPCS C1713 AR-513-RL510 - AUGMENT TIB 5 10MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL55 SUP HCPCS C1713 AR-513-RL55 - AUGMENT TIB 5 5MM IBALANCE SCR LT MDL RL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL610 SUP HCPCS C1713 AR-513-RL610 - AUGMENT TIB 6 10MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL65 SUP HCPCS C1713 AR-513-RL65 - AUGMENT TIB 5 5MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL710 SUP HCPCS C1713 AR-513-RL710 - AUGMENT TIB 7 10MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL75 SUP HCPCS C1713 AR-513-RL75 - AUGMENT TIB 7 5MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL810 SUP HCPCS C1713 AR-513-RL810 - AUGMENT TIB 8 10MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL85 SUP HCPCS C1713 AR-513-RL85 - AUGMENT TIB 8 5MM IBALANCE SCR LT MDL RL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL910 SUP HCPCS C1713 AR-513-RL910 - AUGMENT TIB 9 10MM IBALANCE SCR LT MDL RL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RL95 SUP HCPCS C1713 AR-513-RL95 - AUGMENT TIB 9 5MM IBALANCE SCR RL/LM TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" N/A N/A AR-513-RM1010 SUP HCPCS C1713 AR-513-RM1010 - AUGMENT TIB 10 10MM IBALANCE SCR LT MDL RL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" N/A N/A AR-513-RM105 SUP HCPCS C1713 AR-513-RM105 - AUGMENT TIB 10 5MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" N/A N/A AR-513-RM110 SUP HCPCS C1713 AR-513-RM110 - AUGMENT TIB 1 10MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM15 SUP HCPCS C1713 AR-513-RM15 - AUGMENT TIB 1 5MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" "$2,625.00" "$2,625.00" N/A N/A AR-513-RM210 SUP HCPCS C1713 AR-513-RM210 - AUGMENT TIB 2 10MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM25 SUP HCPCS C1713 AR-513-RM25 - AUGMENT TIB 2 5MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM310 SUP HCPCS C1713 AR-513-RM310 - AUGMENT TIB 3 10MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM35 SUP HCPCS C1713 AR-513-RM35 - AUGMENT TIB 3 5MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM410 SUP HCPCS C1713 AR-513-RM410 - AUGMENT TIB 4 10MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM45 SUP HCPCS C1713 AR-513-RM45 - AUGMENT TIB 4 5MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM510 SUP HCPCS C1713 AR-513-RM510 - AUGMENT TIB 5 10MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM55 SUP HCPCS C1713 AR-513-RM55 - AUGMENT TIB 5 5MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM610 SUP HCPCS C1713 AR-513-RM610 - AUGMENT TIB 6 10MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM65 SUP HCPCS C1713 AR-513-RM65 - AUGMENT TIB 6 5MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM710 SUP HCPCS C1713 AR-513-RM710 - AUGMENT TIB 7 10MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM75 SUP HCPCS C1713 AR-513-RM75 - AUGMENT TIB 7 5MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM810 SUP HCPCS C1713 AR-513-RM810 - AUGMENT TIB 8 10MM IBALANCE SCR LT MDL RL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM85 SUP HCPCS C1713 AR-513-RM85 - AUGMENT TIB 8 5MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM910 SUP HCPCS C1713 AR-513-RM910 - AUGMENT TIB 9 10MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-RM95 SUP HCPCS C1713 AR-513-RM95 - AUGMENT TIB 9 5MM IBALANCE SCR RMLL TKA BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A AR-513-T1 SUP HCPCS C1713 AR-513-T1 - COMPONENT TIBTRY 1 STRL IBALANCE ARTHX MDLR T/K ARTHPL BOTH IP/OP "$6,175.00" "$4,570.00" "$1,225.58" "$6,175.00" "$2,778.75" "$2,778.75" "$2,778.75" "$2,778.75" "$6,175.00" "$6,175.00" "$6,175.00" "$1,287.02" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$1,286.94" "$6,175.00" "$2,470.00" "$3,044.28" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$4,631.25" "$6,175.00" "$6,175.00" "$6,175.00" "$3,087.50" "$3,087.50" "$4,890.60" "$6,175.00" "$4,940.00" "$2,778.75" "$1,225.58" N/A "$3,581.50" "$6,175.00" "$3,705.00" "$6,175.00" "$1,286.87" "$6,175.00" N/A N/A AR-513-T2 SUP HCPCS C1713 AR-513-T2 - COMPONENT TIBTRY 2 STRL IBALANCE ARTHX MDLR T/K ARTHPL BOTH IP/OP "$6,175.00" "$4,570.00" "$1,225.58" "$6,175.00" "$2,778.75" "$2,778.75" "$2,778.75" "$2,778.75" "$6,175.00" "$6,175.00" "$6,175.00" "$1,287.02" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$1,286.94" "$6,175.00" "$6,175.00" "$3,044.28" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$4,631.25" "$6,175.00" "$6,175.00" "$6,175.00" "$3,087.50" "$3,087.50" "$4,890.60" "$6,175.00" "$4,940.00" "$2,778.75" "$1,225.58" N/A "$3,581.50" "$6,175.00" "$3,705.00" "$6,175.00" "$1,286.87" "$6,175.00" N/A N/A AR-513-T5 SUP HCPCS C1713 AR-513-T5 - COMPONENT TIBTRY 5 STRL IBALANCE ARTHX MDLR T/K ARTHPL BOTH IP/OP "$6,175.00" "$4,570.00" "$1,225.58" "$6,175.00" "$2,778.75" "$2,778.75" "$2,778.75" "$2,778.75" "$6,175.00" "$6,175.00" "$6,175.00" "$1,287.02" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$1,286.94" "$6,175.00" "$2,470.00" "$3,044.28" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$4,631.25" "$6,175.00" "$6,175.00" "$6,175.00" "$3,087.50" "$3,087.50" "$4,890.60" "$6,175.00" "$4,940.00" "$2,778.75" "$1,225.58" N/A "$3,581.50" "$6,175.00" "$3,705.00" "$6,175.00" "$1,286.87" "$6,175.00" N/A N/A AR-513-T7 SUP HCPCS C1713 AR-513-T7 - COMPONENT TIBTRY 7 STRL IBALANCE ARTHX MDLR T/K ARTHPL BOTH IP/OP "$6,175.00" "$4,570.00" "$1,225.58" "$6,175.00" "$2,778.75" "$2,778.75" "$2,778.75" "$2,778.75" "$6,175.00" "$6,175.00" "$6,175.00" "$1,287.02" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$1,286.94" "$6,175.00" "$2,470.00" "$3,044.28" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$4,631.25" "$6,175.00" "$6,175.00" "$6,175.00" "$3,087.50" "$3,087.50" "$4,890.60" "$6,175.00" "$4,940.00" "$2,778.75" "$1,225.58" N/A "$3,581.50" "$6,175.00" "$3,705.00" "$6,175.00" "$1,286.87" "$6,175.00" N/A N/A AR-513-T8 SUP HCPCS C1713 AR-513-T8 - COMPONENT TIBTRY 8 STRL IBALANCE ARTHX MDLR T/K ARTHPL BOTH IP/OP "$6,175.00" "$4,570.00" "$1,225.58" "$6,175.00" "$2,778.75" "$2,778.75" "$2,778.75" "$2,778.75" "$6,175.00" "$6,175.00" "$6,175.00" "$1,287.02" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$1,286.94" "$6,175.00" "$6,175.00" "$3,044.28" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$4,631.25" "$6,175.00" "$6,175.00" "$6,175.00" "$3,087.50" "$3,087.50" "$4,890.60" "$6,175.00" "$4,940.00" "$2,778.75" "$1,225.58" N/A "$3,581.50" "$6,175.00" "$3,705.00" "$6,175.00" "$6,175.00" "$6,175.00" N/A N/A AR-513-T9 SUP HCPCS C1713 AR-513-T9 - COMPONENT TIBTRY 9 STRL IBALANCE ARTHX MDLR T/K ARTHPL BOTH IP/OP "$6,175.00" "$4,570.00" "$1,225.58" "$6,175.00" "$2,778.75" "$2,778.75" "$2,778.75" "$2,778.75" "$6,175.00" "$6,175.00" "$6,175.00" "$1,287.02" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$1,286.94" "$6,175.00" "$2,470.00" "$3,044.28" "$6,175.00" "$6,175.00" "$6,175.00" "$6,175.00" "$4,631.25" "$6,175.00" "$6,175.00" "$6,175.00" "$3,087.50" "$3,087.50" "$4,890.60" "$6,175.00" "$4,940.00" "$2,778.75" "$1,225.58" N/A "$3,581.50" "$6,175.00" "$3,705.00" "$6,175.00" "$6,175.00" "$6,175.00" N/A N/A AR-513-TL10 SUP HCPCS C1713 AR-513-TL10 - AUGMENT TIB 10MM LCK SCR BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $100.50 $167.50 $34.91 $167.50 N/A N/A AR-513-TL5 SUP HCPCS C1713 AR-513-TL5 - AUGMENT TIB 5MM LCK SCR KN BOTH IP/OP $167.50 $124.00 $33.24 $167.50 $75.38 $75.38 $75.38 $75.38 $167.50 $167.50 $167.50 $34.91 $167.50 $167.50 $167.50 $167.50 $167.50 $34.91 $167.50 $67.00 $99.08 $167.50 $167.50 $167.50 $167.50 $125.63 $167.50 $167.50 $167.50 $83.75 $83.75 $132.66 $167.50 $134.00 $75.38 $33.24 N/A $97.15 $167.50 $100.50 $167.50 $34.91 $167.50 N/A N/A AR-516-5R SUP HCPCS C1776 AR-516-5R - COMPONENT FEM 5 IBALANCE CMNT POST STAB KN RT T/K ARTHPL BOTH IP/OP "$7,750.00" "$5,735.00" "$1,538.18" "$7,750.00" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$7,750.00" "$7,750.00" "$7,750.00" "$1,615.29" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$1,615.19" "$7,750.00" "$3,100.00" "$3,820.75" "$7,750.00" "$7,750.00" "$7,750.00" "$7,750.00" "$5,812.50" "$7,750.00" "$7,750.00" "$7,750.00" "$3,875.00" "$3,875.00" "$6,138.00" "$7,750.00" "$6,200.00" "$3,487.50" "$1,538.18" N/A "$4,495.00" "$7,750.00" "$4,650.00" "$7,750.00" "$1,615.10" "$7,750.00" N/A N/A AR-523-B1008 SUP HCPCS C1776 "AR-523-B1008 - PS TIBIAL BEARING, SIZE 10, 8MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B1009 SUP HCPCS C1776 "AR-523-B1009 - PS TIBIAL BEARING, SIZE 10, 9MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B1010 SUP HCPCS C1776 "AR-523-B1010 - PS TIBIAL BEARING, SIZE 10, 10MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B1011 SUP HCPCS C1776 "AR-523-B1011 - PS TIBIAL BEARING, SIZE 10, 11MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B1012 SUP HCPCS C1776 "AR-523-B1012 - PS TIBIAL BEARING, SIZE 10, 12MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B1013 SUP HCPCS C1776 "AR-523-B1013 - PS TIBIAL BEARING, SIZE 10, 13MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B1014 SUP HCPCS C1776 "AR-523-B1014 - PS TIBIAL BEARING, SIZE 10, 14MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B1016 SUP HCPCS C1776 "AR-523-B1016 - PS TIBIAL BEARING, SIZE 10, 16MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B1018 SUP HCPCS C1776 "AR-523-B1018 - PS TIBIAL BEARING, SIZE 10, 18MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B1020 SUP HCPCS C1776 "AR-523-B1020 - PS TIBIAL BEARING, SIZE 10, 20MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B108 SUP HCPCS C1776 "AR-523-B108 - PS TIBIAL BEARING, SIZE 1, 8MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B109 SUP HCPCS C1776 "AR-523-B109 - PS TIBIAL BEARING, SIZE 1, 9MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B110 SUP HCPCS C1776 "AR-523-B110 - PS TIBIAL BEARING, SIZE 1, 10MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B111 SUP HCPCS C1776 "AR-523-B111 - PS TIBIAL BEARING, SIZE 1, 11MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B112 SUP HCPCS C1776 "AR-523-B112 - PS TIBIAL BEARING, SIZE 1, 12MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B113 SUP HCPCS C1776 "AR-523-B113 - PS TIBIAL BEARING, SIZE 1, 13MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B114 SUP HCPCS C1776 "AR-523-B114 - PS TIBIAL BEARING, SIZE 1, 14MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B116 SUP HCPCS C1776 "AR-523-B116 - PS TIBIAL BEARING, SIZE 1, 16MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B118 SUP HCPCS C1776 "AR-523-B118 - PS TIBIAL BEARING, SIZE 1, 18MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B120 SUP HCPCS C1776 "AR-523-B120 - PS TIBIAL BEARING, SIZE 1, 20MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B208 SUP HCPCS C1776 "AR-523-B208 - PS TIBIAL BEARING, SIZE 2, 8MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B209 SUP HCPCS C1776 "AR-523-B209 - PS TIBIAL BEARING, SIZE 2, 9MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B210 SUP HCPCS C1776 "AR-523-B210 - PS TIBIAL BEARING, SIZE 2, 10MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B211 SUP HCPCS C1776 "AR-523-B211 - PS TIBIAL BEARING, SIZE 2, 11MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B212 SUP HCPCS C1776 "AR-523-B212 - PS TIBIAL BEARING, SIZE 2, 12MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B213 SUP HCPCS C1776 "AR-523-B213 - PS TIBIAL BEARING, SIZE 2, 13MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B214 SUP HCPCS C1776 "AR-523-B214 - PS TIBIAL BEARING, SIZE 2, 14MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B216 SUP HCPCS C1776 "AR-523-B216 - PS TIBIAL BEARING, SIZE 2, 16MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B218 SUP HCPCS C1776 "AR-523-B218 - PS TIBIAL BEARING, SIZE 2, 18MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B220 SUP HCPCS C1776 "AR-523-B220 - PS TIBIAL BEARING, SIZE 2, 20MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B308 SUP HCPCS C1776 "AR-523-B308 - PS TIBIAL BEARING, SIZE 3, 8MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B309 SUP HCPCS C1776 "AR-523-B309 - PS TIBIAL BEARING, SIZE 3, 9MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B310 SUP HCPCS C1776 "AR-523-B310 - PS TIBIAL BEARING, SIZE 3, 10MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B311 SUP HCPCS C1776 "AR-523-B311 - PS TIBIAL BEARING, SIZE 3, 11MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B312 SUP HCPCS C1776 "AR-523-B312 - PS TIBIAL BEARING, SIZE 3, 12MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B313 SUP HCPCS C1776 "AR-523-B313 - PS TIBIAL BEARING, SIZE 3, 13MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B314 SUP HCPCS C1776 "AR-523-B314 - PS TIBIAL BEARING, SIZE 3, 14MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B316 SUP HCPCS C1776 "AR-523-B316 - PS TIBIAL BEARING, SIZE 3, 16MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B318 SUP HCPCS C1776 "AR-523-B318 - PS TIBIAL BEARING, SIZE 3, 18MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B320 SUP HCPCS C1776 "AR-523-B320 - PS TIBIAL BEARING, SIZE 3, 20MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B408 SUP HCPCS C1776 "AR-523-B408 - PS TIBIAL BEARING, SIZE 4, 8MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B409 SUP HCPCS C1776 "AR-523-B409 - PS TIBIAL BEARING, SIZE 4, 9MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B410 SUP HCPCS C1776 "AR-523-B410 - PS TIBIAL BEARING, SIZE 4, 10MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B411 SUP HCPCS C1776 "AR-523-B411 - PS TIBIAL BEARING, SIZE 4, 11MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B412 SUP HCPCS C1776 "AR-523-B412 - PS TIBIAL BEARING, SIZE 4, 12MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B413 SUP HCPCS C1776 "AR-523-B413 - PS TIBIAL BEARING, SIZE 4, 13MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B414 SUP HCPCS C1776 "AR-523-B414 - PS TIBIAL BEARING, SIZE 4, 14MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B416 SUP HCPCS C1776 "AR-523-B416 - PS TIBIAL BEARING, SIZE 4, 16MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B418 SUP HCPCS C1776 "AR-523-B418 - PS TIBIAL BEARING, SIZE 4, 18MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B420 SUP HCPCS C1776 "AR-523-B420 - PS TIBIAL BEARING, SIZE 4, 20MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B508 SUP HCPCS C1776 "AR-523-B508 - PS TIBIAL BEARING, SIZE 5, 8MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B509 SUP HCPCS C1776 "AR-523-B509 - PS TIBIAL BEARING, SIZE 5, 9MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B510 SUP HCPCS C1776 "AR-523-B510 - PS TIBIAL BEARING, SIZE 5, 10MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B511 SUP HCPCS C1776 "AR-523-B511 - PS TIBIAL BEARING, SIZE 5, 11MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B512 SUP HCPCS C1776 "AR-523-B512 - PS TIBIAL BEARING, SIZE 5, 12MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B513 SUP HCPCS C1776 "AR-523-B513 - PS TIBIAL BEARING, SIZE 5, 13MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B514 SUP HCPCS C1776 "AR-523-B514 - PS TIBIAL BEARING, SIZE 5, 14MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B516 SUP HCPCS C1776 "AR-523-B516 - PS TIBIAL BEARING, SIZE 5, 16MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B518 SUP HCPCS C1776 "AR-523-B518 - PS TIBIAL BEARING, SIZE 5, 18MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B520 SUP HCPCS C1776 "AR-523-B520 - PS TIBIAL BEARING, SIZE 5, 20MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B608 SUP HCPCS C1776 "AR-523-B608 - PS TIBIAL BEARING, SIZE 6, 8MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B609 SUP HCPCS C1776 "AR-523-B609 - PS TIBIAL BEARING, SIZE 6, 9MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B610 SUP HCPCS C1776 "AR-523-B610 - PS TIBIAL BEARING, SIZE 6, 10MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B611 SUP HCPCS C1776 "AR-523-B611 - PS TIBIAL BEARING, SIZE 6, 11MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B612 SUP HCPCS C1776 "AR-523-B612 - PS TIBIAL BEARING, SIZE 6, 12MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B613 SUP HCPCS C1776 "AR-523-B613 - PS TIBIAL BEARING, SIZE 6, 13MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B614 SUP HCPCS C1776 "AR-523-B614 - PS TIBIAL BEARING, SIZE 6, 14MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B616 SUP HCPCS C1776 "AR-523-B616 - PS TIBIAL BEARING, SIZE 6, 16MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B618 SUP HCPCS C1776 "AR-523-B618 - PS TIBIAL BEARING, SIZE 6, 18MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B620 SUP HCPCS C1776 "AR-523-B620 - PS TIBIAL BEARING, SIZE 6, 20MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B708 SUP HCPCS C1776 "AR-523-B708 - PS TIBIAL BEARING, SIZE 7, 8MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B709 SUP HCPCS C1776 "AR-523-B709 - PS TIBIAL BEARING, SIZE 7, 9MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B710 SUP HCPCS C1776 "AR-523-B710 - PS TIBIAL BEARING, SIZE 7, 10MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B711 SUP HCPCS C1776 "AR-523-B711 - PS TIBIAL BEARING, SIZE 7, 11MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B712 SUP HCPCS C1776 "AR-523-B712 - PS TIBIAL BEARING, SIZE 7, 12MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B713 SUP HCPCS C1776 "AR-523-B713 - PS TIBIAL BEARING, SIZE 7, 13MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B714 SUP HCPCS C1776 "AR-523-B714 - PS TIBIAL BEARING, SIZE 7, 14MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B716 SUP HCPCS C1776 "AR-523-B716 - PS TIBIAL BEARING, SIZE 7, 16MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B718 SUP HCPCS C1776 "AR-523-B718 - PS TIBIAL BEARING, SIZE 7, 18MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B720 SUP HCPCS C1776 "AR-523-B720 - PS TIBIAL BEARING, SIZE 7, 20MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B808 SUP HCPCS C1776 "AR-523-B808 - PS TIBIAL BEARING, SIZE 8, 8MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B809 SUP HCPCS C1776 "AR-523-B809 - PS TIBIAL BEARING, SIZE 8, 9MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B810 SUP HCPCS C1776 "AR-523-B810 - PS TIBIAL BEARING, SIZE 8, 10MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B811 SUP HCPCS C1776 "AR-523-B811 - PS TIBIAL BEARING, SIZE 8, 11MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B812 SUP HCPCS C1776 "AR-523-B812 - PS TIBIAL BEARING, SIZE 8, 12MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B813 SUP HCPCS C1776 "AR-523-B813 - PS TIBIAL BEARING, SIZE 8, 13MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B814 SUP HCPCS C1776 "AR-523-B814 - PS TIBIAL BEARING, SIZE 8, 14MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B816 SUP HCPCS C1776 "AR-523-B816 - PS TIBIAL BEARING, SIZE 8, 16MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B818 SUP HCPCS C1776 "AR-523-B818 - PS TIBIAL BEARING, SIZE 8, 18MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B820 SUP HCPCS C1776 "AR-523-B820 - PS TIBIAL BEARING, SIZE 8, 20MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B908 SUP HCPCS C1776 "AR-523-B908 - PS TIBIAL BEARING, SIZE 9, 8MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$2,034.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B909 SUP HCPCS C1776 "AR-523-B909 - PS TIBIAL BEARING, SIZE 9, 9MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B910 SUP HCPCS C1776 "AR-523-B910 - PS TIBIAL BEARING, SIZE 9, 10MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B911 SUP HCPCS C1776 "AR-523-B911 - PS TIBIAL BEARING, SIZE 9, 11MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B912 SUP HCPCS C1776 "AR-523-B912 - PS TIBIAL BEARING, SIZE 9, 12MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B913 SUP HCPCS C1776 "AR-523-B913 - PS TIBIAL BEARING, SIZE 9, 13MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B914 SUP HCPCS C1776 "AR-523-B914 - PS TIBIAL BEARING, SIZE 9, 14MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B916 SUP HCPCS C1776 "AR-523-B916 - PS TIBIAL BEARING, SIZE 9, 16MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B918 SUP HCPCS C1776 "AR-523-B918 - PS TIBIAL BEARING, SIZE 9, 18MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-523-B920 SUP HCPCS C1776 "AR-523-B920 - PS TIBIAL BEARING, SIZE 9, 20MM, VIT E" BOTH IP/OP "$5,085.00" "$3,763.00" "$1,009.25" "$5,085.00" "$2,288.25" "$2,288.25" "$2,288.25" "$2,288.25" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.84" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.77" "$5,085.00" "$5,085.00" "$2,506.91" "$5,085.00" "$5,085.00" "$5,085.00" "$5,085.00" "$3,813.75" "$5,085.00" "$5,085.00" "$5,085.00" "$2,542.50" "$2,542.50" "$4,027.32" "$5,085.00" "$4,068.00" "$2,288.25" "$1,009.25" N/A "$2,949.30" "$5,085.00" "$5,085.00" "$5,085.00" "$1,059.71" "$5,085.00" N/A N/A AR-524-PS328 SUP HCPCS C1713 AR-524-PS328 - DOME PTLR 32MM 8MM STRL LF ARTHX VIT E KN BOTH IP/OP "$2,967.50" "$2,196.00" $588.97 "$2,967.50" "$1,335.38" "$1,335.38" "$1,335.38" "$1,335.38" "$2,967.50" "$2,967.50" "$2,967.50" $618.50 "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" $618.46 "$2,967.50" "$2,967.50" "$1,462.98" "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" "$2,225.63" "$2,967.50" "$2,967.50" "$2,967.50" "$1,483.75" "$1,483.75" "$2,350.26" "$2,967.50" "$2,374.00" "$1,335.38" $588.97 N/A "$1,721.15" "$2,967.50" "$2,967.50" "$2,967.50" $618.43 "$2,967.50" N/A N/A AR-524-PSA8 SUP HCPCS C1713 AR-524-PSA8 - DOME PTLR 27MM 8MM STRL LF ARTHX VIT E KN BOTH IP/OP "$2,967.50" "$2,196.00" $588.97 "$2,967.50" "$1,335.38" "$1,335.38" "$1,335.38" "$1,335.38" "$2,967.50" "$2,967.50" "$2,967.50" $618.50 "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" $618.46 "$2,967.50" "$1,187.00" "$1,462.98" "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" "$2,225.63" "$2,967.50" "$2,967.50" "$2,967.50" "$1,483.75" "$1,483.75" "$2,350.26" "$2,967.50" "$2,374.00" "$1,335.38" $588.97 N/A "$1,721.15" "$2,967.50" "$2,967.50" "$2,967.50" $618.43 "$2,967.50" N/A N/A AR-524-PSB8 SUP HCPCS C1713 AR-524-PSB8 - DOME PTLR 30MM 8MM STRL LF ARTHX VIT E KN BOTH IP/OP "$2,967.50" "$2,196.00" $588.97 "$2,967.50" "$1,335.38" "$1,335.38" "$1,335.38" "$1,335.38" "$2,967.50" "$2,967.50" "$2,967.50" $618.50 "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" $618.46 "$2,967.50" "$1,187.00" "$1,462.98" "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" "$2,225.63" "$2,967.50" "$2,967.50" "$2,967.50" "$1,483.75" "$1,483.75" "$2,350.26" "$2,967.50" "$2,374.00" "$1,335.38" $588.97 N/A "$1,721.15" "$2,967.50" "$1,780.50" "$2,967.50" $618.43 "$2,967.50" N/A N/A AR-524-PSC9 SUP HCPCS C1713 AR-524-PSC9 - DOME PTLR 34MM 9MM STRL LF ARTHX VIT E BOTH IP/OP "$2,967.50" "$2,196.00" $588.97 "$2,967.50" "$1,335.38" "$1,335.38" "$1,335.38" "$1,335.38" "$2,967.50" "$2,967.50" "$2,967.50" $618.50 "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" $618.46 "$2,967.50" "$1,187.00" "$1,462.98" "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" "$2,225.63" "$2,967.50" "$2,967.50" "$2,967.50" "$1,483.75" "$1,483.75" "$2,350.26" "$2,967.50" "$2,374.00" "$1,335.38" $588.97 N/A "$1,721.15" "$2,967.50" "$1,780.50" "$2,967.50" $618.43 "$2,967.50" N/A N/A AR-524-PSD0 SUP HCPCS C1713 AR-524-PSD0 - DOME PTLR 37MM 10MM STRL LF ARTHX VIT E BOTH IP/OP "$2,967.50" "$2,196.00" $588.97 "$2,967.50" "$1,335.38" "$1,335.38" "$1,335.38" "$1,335.38" "$2,967.50" "$2,967.50" "$2,967.50" $618.50 "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" $618.46 "$2,967.50" "$1,187.00" "$1,462.98" "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" "$2,225.63" "$2,967.50" "$2,967.50" "$2,967.50" "$1,483.75" "$1,483.75" "$2,350.26" "$2,967.50" "$2,374.00" "$1,335.38" $588.97 N/A "$1,721.15" "$2,967.50" "$1,780.50" "$2,967.50" $618.43 "$2,967.50" N/A N/A AR-524-PSE0 SUP HCPCS C1713 AR-524-PSE0 - DOME PTLR 40MM 10MM STRL LF ARTHX VIT E KN BOTH IP/OP "$2,967.50" "$2,196.00" $588.97 "$2,967.50" "$1,335.38" "$1,335.38" "$1,335.38" "$1,335.38" "$2,967.50" "$2,967.50" "$2,967.50" $618.50 "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" $618.46 "$2,967.50" "$1,187.00" "$1,462.98" "$2,967.50" "$2,967.50" "$2,967.50" "$2,967.50" "$2,225.63" "$2,967.50" "$2,967.50" "$2,967.50" "$1,483.75" "$1,483.75" "$2,350.26" "$2,967.50" "$2,374.00" "$1,335.38" $588.97 N/A "$1,721.15" "$2,967.50" "$1,780.50" "$2,967.50" $618.43 "$2,967.50" N/A N/A AR-5503 SUP Custom 27203010 AR-5503 - GUIDE DRL PIN PRLL BOTH IP/OP "$1,390.50" "$1,029.00" $247.47 "$1,390.30" "$1,390.30" "$1,390.30" "$1,390.30" "$1,390.30" "$1,390.30" "$1,390.30" $247.47 "$1,390.30" "$1,390.30" "$1,031.88" "$1,031.88" "$1,071.64" $724.35 $289.75 "$1,390.30" $600.61 "$1,390.30" "$1,390.30" "$1,390.30" "$1,390.30" "$1,390.30" "$1,042.88" "$1,390.30" "$1,390.30" "$1,390.30" $695.15 $695.15 "$1,101.12" "$1,390.30" "$1,112.24" $903.70 "$1,390.30" N/A $806.49 "$1,390.30" $834.18 "$1,390.30" "$1,390.30" "$1,390.30" N/A N/A AR-5511-CP SUP HCPCS C1713 AR-5511-CP - KIT ARTHRO FIX INTERNALBRACE FIBERTAPE SWIVELOCK BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$1,290.60" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$1,792.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A AR-5600-01 SUP Custom 27203010 AR-5600-01 - GUIDE DRL OFST CRDL FISH MTH 4MM CHONDROGUARD NOVEL TIP XTN BOTH IP/OP "$1,497.50" "$1,108.00" $266.56 "$1,497.50" "$1,497.50" "$1,497.50" "$1,497.50" "$1,497.50" "$1,497.50" "$1,497.50" $266.56 "$1,497.50" "$1,497.50" "$1,111.44" "$1,111.44" "$1,154.27" $780.20 $312.10 "$1,497.50" $599.00 "$1,497.50" "$1,497.50" "$1,497.50" "$1,497.50" "$1,497.50" "$1,123.13" "$1,497.50" "$1,497.50" "$1,497.50" $748.75 $748.75 "$1,186.02" "$1,497.50" "$1,198.00" $973.38 "$1,497.50" N/A $868.55 "$1,497.50" $898.50 "$1,497.50" "$1,497.50" "$1,497.50" N/A N/A AR-5600-02 SUP Custom 27203010 AR-5600-02 - GUIDE DRL OFST CRDL FISH MTH 6MM CHONDROGUARD NOVEL TIP XTN BOTH IP/OP "$1,497.50" "$1,108.00" $266.56 "$1,497.50" "$1,497.50" "$1,497.50" "$1,497.50" "$1,497.50" "$1,497.50" "$1,497.50" $266.56 "$1,497.50" "$1,497.50" "$1,111.44" "$1,111.44" "$1,154.27" $780.20 $312.10 "$1,497.50" $599.00 "$1,497.50" "$1,497.50" "$1,497.50" "$1,497.50" "$1,497.50" "$1,123.13" "$1,497.50" "$1,497.50" "$1,497.50" $748.75 $748.75 "$1,186.02" "$1,497.50" "$1,198.00" $973.38 "$1,497.50" N/A $868.55 "$1,497.50" $898.50 "$1,497.50" "$1,497.50" "$1,497.50" N/A N/A AR-601-BBS0 SUP Custom 27203010 AR-601-BBS0 - BIT DRL 2.7MM TRMIT CNN SLF CMPR THRD PTCH BOTH IP/OP $850.00 $629.00 $151.30 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $151.30 $850.00 $850.00 $630.87 $630.87 $655.18 $442.85 $177.15 $850.00 $340.00 $850.00 $850.00 $850.00 $850.00 $850.00 $637.50 $850.00 $850.00 $850.00 $425.00 $425.00 $673.20 $850.00 $680.00 $552.50 $850.00 N/A $493.00 $850.00 $510.00 $850.00 $850.00 $850.00 N/A N/A AR-601-SB06 SUP Custom 27203010 AR-601-SB06 - INSERT TIB 6MM IBALANCE SPCR BLCK KN UNCNDL BOTH IP/OP $160.00 $118.00 $28.48 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $28.48 $160.00 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $64.00 $160.00 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $160.00 N/A $92.80 $160.00 $96.00 $160.00 $160.00 $160.00 N/A N/A AR-601-SB07 SUP Custom 27203010 AR-601-SB07 - INSERT TIB 7MM IBALANCE SPCR BLCK KN UNCNDL BOTH IP/OP $160.00 $118.00 $28.48 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $28.48 $160.00 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $64.00 $160.00 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $160.00 N/A $92.80 $160.00 $96.00 $160.00 $160.00 $160.00 N/A N/A AR-601-SB08 SUP Custom 27203010 AR-601-SB08 - INSERT TIB 8MM IBALANCE SPCR BLCK KN UNCNDL BOTH IP/OP $160.00 $118.00 $28.48 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $28.48 $160.00 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $64.00 $160.00 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $160.00 N/A $92.80 $160.00 $96.00 $160.00 $160.00 $160.00 N/A N/A AR-601-SB09 SUP Custom 27203010 AR-601-SB09 - INSERT TIB 9MM IBALANCE SPCR BLCK KN UNCNDL BOTH IP/OP $160.00 $118.00 $28.48 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $28.48 $160.00 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $64.00 $160.00 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $160.00 N/A $92.80 $160.00 $96.00 $160.00 $160.00 $160.00 N/A N/A AR-601-SB10 SUP Custom 27203010 AR-601-SB10 - INSERT TIB 10MM IBALANCE SPCR BLCK KN UNCNDL BOTH IP/OP $160.00 $118.00 $28.48 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $28.48 $160.00 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $64.00 $160.00 $160.00 $160.00 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $160.00 N/A $92.80 $160.00 $96.00 $160.00 $160.00 $160.00 N/A N/A AR-602-44 SUP Custom 27203010 AR-602-44 - GUIDE DRL 27MM IBALANCE PTLR BOTH IP/OP $617.50 $457.00 $109.92 $617.50 $617.50 $617.50 $617.50 $617.50 $617.50 $617.50 $109.92 $617.50 $617.50 $458.31 $458.31 $475.97 $321.72 $128.69 $617.50 $247.00 $617.50 $617.50 $617.50 $617.50 $617.50 $463.13 $617.50 $617.50 $617.50 $308.75 $308.75 $489.06 $617.50 $494.00 $401.38 $617.50 N/A $358.15 $617.50 $370.50 $617.50 $617.50 $617.50 N/A N/A AR-602-45 SUP Custom 27203010 AR-602-45 - GUIDE DRL 30MM IBALANCE PTLR BOTH IP/OP $617.50 $457.00 $109.92 $617.50 $617.50 $617.50 $617.50 $617.50 $617.50 $617.50 $109.92 $617.50 $617.50 $458.31 $458.31 $475.97 $321.72 $128.69 $617.50 $247.00 $617.50 $617.50 $617.50 $617.50 $617.50 $463.13 $617.50 $617.50 $617.50 $308.75 $308.75 $489.06 $617.50 $494.00 $401.38 $617.50 N/A $358.15 $617.50 $370.50 $617.50 $617.50 $617.50 N/A N/A AR-602-46 SUP Custom 27203010 AR-602-46 - GUIDE DRL 34MM IBALANCE PTLR BOTH IP/OP $617.50 $457.00 $109.92 $617.50 $617.50 $617.50 $617.50 $617.50 $617.50 $617.50 $109.92 $617.50 $617.50 $458.31 $458.31 $475.97 $321.72 $128.69 $617.50 $247.00 $617.50 $617.50 $617.50 $617.50 $617.50 $463.13 $617.50 $617.50 $617.50 $308.75 $308.75 $489.06 $617.50 $494.00 $401.38 $617.50 N/A $358.15 $617.50 $370.50 $617.50 $617.50 $617.50 N/A N/A AR-602-47 SUP Custom 27203010 AR-602-47 - GUIDE DRL 37MM IBALANCE PTLR BOTH IP/OP $617.50 $457.00 $109.92 $617.50 $617.50 $617.50 $617.50 $617.50 $617.50 $617.50 $109.92 $617.50 $617.50 $458.31 $458.31 $475.97 $321.72 $128.69 $617.50 $247.00 $617.50 $617.50 $617.50 $617.50 $617.50 $463.13 $617.50 $617.50 $617.50 $308.75 $308.75 $489.06 $617.50 $494.00 $401.38 $617.50 N/A $358.15 $617.50 $370.50 $617.50 $617.50 $617.50 N/A N/A AR-602-49 SUP Custom 27203010 AR-602-49 - GUIDE DRL IBALANCE CMBN PTLR BOTH IP/OP $915.00 $677.00 $162.87 $915.00 $915.00 $915.00 $915.00 $915.00 $915.00 $915.00 $162.87 $915.00 $915.00 $679.11 $679.11 $705.28 $476.72 $190.70 $915.00 $366.00 $915.00 $915.00 $915.00 $915.00 $915.00 $686.25 $915.00 $915.00 $915.00 $457.50 $457.50 $724.68 $915.00 $732.00 $594.75 $915.00 N/A $530.70 $915.00 $549.00 $915.00 $915.00 $915.00 N/A N/A AR-603-85 SUP Custom 27203010 AR-603-85 - CLAMP SRG IBALANCE CMNT TMPLT PTLR BOTH IP/OP "$3,712.50" "$2,747.00" $660.83 "$3,712.50" "$3,712.50" "$3,712.50" "$3,712.50" "$3,712.50" "$3,712.50" "$3,712.50" $660.83 "$3,712.50" "$3,712.50" "$2,755.42" "$2,755.42" "$2,861.60" "$1,934.21" $773.73 "$3,712.50" "$1,485.00" "$3,712.50" "$3,712.50" "$3,712.50" "$3,712.50" "$3,712.50" "$2,784.38" "$3,712.50" "$3,712.50" "$3,712.50" "$1,856.25" "$1,856.25" "$2,940.30" "$3,712.50" "$2,970.00" "$2,413.13" "$3,712.50" N/A "$2,153.25" "$3,712.50" "$2,227.50" "$3,712.50" "$3,712.50" "$3,712.50" N/A N/A AR-6068-25TL SUP Custom 27203010 AR-6068-25TL - PASSER SUTURE 25D SMALL TIGHT LEFT CURVE 8.25MM CANNU BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $172.80 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6068-25TR SUP Custom 27203010 AR-6068-25TR - PASSER SUT 25D SM TIGHT RT CRV 8.25MM STRL QUICKPASS SUTLSO BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6068-30 SUP Custom 27203010 AR-6068-30 - PASSER SUT 30D SM STRG 7MM STRL QUICKPASS SUTLSO CNN ERG BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6068-45L SUP Custom 27203010 AR-6068-45L - PASSER SUT 45D SM LT CRV 7MM STRL QUICKPASS SUTLSO CNN ERG BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6068-45R SUP Custom 27203010 AR-6068-45R - PASSER SUT 45D CRV QUICKPASS SUTLSO RT BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6068-90 SUP Custom 27203010 AR-6068-90 - PASSER SUTURE 90D SMALL STR 7MM CANNU ERGONOMIC HANDLE BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $172.80 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6068-90L SUP Custom 27203010 AR-6068-90L - PASSER SUT 90D SM LT CRV 8.25MM STRL QUICKPASS SUTLSO CNN BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6068-90R SUP Custom 27203010 AR-6068-90R - PASSER SUT 90D SM RT CRV 8.25MM STRL QUICKPASS SUTLSO CNN BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6068-90T SUP Custom 27203010 AR-6068-90T - PASSER SUT 90D SM TC 7MM STRL QUICKPASS SUTLSO CNN ERG HNDL BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6069-45L SUP Custom 27203010 AR-6069-45L - PASSER SUT 45D 1 LT CRV 1.5MM 10YD BLU SUTLSO ERG HNDL BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6069-45R SUP Custom 27203010 AR-6069-45R - PASSER SUT 45D 1 RT CRV 1.5MM 10YD BLU SUTLSO ERG HNDL BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6069-90 SUP Custom 27203010 AR-6069-90 - PASSER SUT 90D STRG CRV SUTLSO REELPASS BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6506 SUP Custom 27203010 AR-6506 - CANNULA ASCP OPN BOTH IP/OP $987.50 $731.00 $175.78 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $175.78 $987.50 $987.50 $732.92 $732.92 $761.17 $514.49 $205.81 $987.50 $395.00 $987.50 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $641.88 $987.50 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A AR-6507 SUP Custom 27203010 AR-6507 - CANNULA ASCP BLNT OPN BOTH IP/OP $987.50 $731.00 $175.78 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $175.78 $987.50 $987.50 $732.92 $732.92 $761.17 $514.49 $205.81 $987.50 $395.00 $987.50 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $641.88 $987.50 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A AR-6507-01 SUP Custom 27203010 AR-6507-01 - CANNULA ASCP TPR OPN SHRP PLYCRB BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 N/A $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A AR-6507-02 SUP Custom 27203010 AR-6507-02 - CANNULA ASCP BLNT OPN SHRP PLYCRB BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 N/A $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A AR-6507-03 SUP Custom 27203010 AR-6507-03 - CANNULA ASCP TPR DTCH HNDL OPN MTL BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-6507-04 SUP Custom 27203010 AR-6507-04 - CANNULA ASCP BLNT DTCH HNDL OPN MTL BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-6520-15 SUP Custom 27203010 AR-6520-15 - STICK SWH LNG ACR CNN DTCH HNDL HIP BOTH IP/OP $475.00 $352.00 $84.55 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $84.55 $475.00 $475.00 $352.55 $352.55 $366.13 $247.48 $99.00 $475.00 $205.20 $475.00 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $308.75 $475.00 N/A $275.50 $475.00 $285.00 $475.00 $475.00 $475.00 N/A N/A AR-6520-16 SUP Custom 27203010 AR-6520-16 - STICK SWH LNG 3.5MM 15IN CNN BOTH IP/OP $662.50 $490.00 $117.93 $662.50 $662.50 $662.50 $662.50 $662.50 $662.50 $662.50 $117.93 $662.50 $662.50 $491.71 $491.71 $510.66 $345.16 $138.07 $662.50 $286.20 $662.50 $662.50 $662.50 $662.50 $662.50 $496.88 $662.50 $662.50 $662.50 $331.25 $331.25 $524.70 $662.50 $530.00 $430.63 $662.50 N/A $384.25 $662.50 $397.50 $662.50 $662.50 $662.50 N/A N/A AR-6521 SUP Custom 27203010 AR-6521 - NEEDLE ESCP STRL PIN REPL DISP PRTL DILATION SET ASCP BOTH IP/OP $162.50 $120.00 $28.93 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $28.93 $162.50 $162.50 $120.61 $120.61 $125.26 $84.66 $33.87 $162.50 $65.00 $162.50 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $105.63 $162.50 N/A $94.25 $162.50 $97.50 $162.50 $162.50 $162.50 N/A N/A AR-6523 SUP Custom 27203010 AR-6523 - NEEDLE ESCP BLNT STRL DISP PRTL DILATION SET ASCP BOTH IP/OP $162.50 $120.00 $28.93 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $28.93 $162.50 $162.50 $120.61 $120.61 $125.26 $84.66 $33.87 $162.50 $65.00 $162.50 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $105.63 $162.50 N/A $94.25 $162.50 $97.50 $162.50 $162.50 $162.50 N/A N/A AR-6526S SUP Custom 27203010 AR-6526S - KIT ENDSCP INSTR MSTR 1.5MM 14GA GWIRE KNF BLADE BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" $486.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A AR-6527S SUP Custom 27203010 AR-6527S - KIT ESCP INST CRV BNA 14GA 1.5MM 35ML BLDE KNF PIN SYR NTNL BOTH IP/OP $937.50 $694.00 $166.88 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $166.88 $937.50 $937.50 $695.81 $695.81 $722.63 $488.44 $195.39 $937.50 $375.00 $937.50 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $609.38 $937.50 N/A $543.75 $937.50 $562.50 $937.50 $937.50 $937.50 N/A N/A AR-6528-07 SUP Custom 27203010 AR-6528-07 - PROBE ASCP 220MM NAV-X RND ABLT MNPLR STRBL COAG HIP BOTH IP/OP "$1,237.50" $916.00 $220.28 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $220.28 "$1,237.50" "$1,237.50" $918.47 $918.47 $953.87 $644.74 $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $804.38 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A AR-6529-07 SUP Custom 27203010 AR-6529-07 - POST OP TBL PERI HDS BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A AR-6530 SUP Custom 27203010 AR-6530 - CANNULA ARTHRO 8.25MM 7CM OBTURATOR THREAD TWIST-IN BOTH IP/OP $62.50 $46.00 $11.13 $135.00 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $135.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6530N SUP Custom 27203010 AR-6530N - CANNULA ARTHRO 8.25MM 7CM NOTCHED TWIST IN STERILE BOTH IP/OP $62.50 $46.00 $11.13 $135.00 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $135.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6530TD SUP Custom 27203010 AR-6530TD - CANNULA ARTHROSCOPIC TWIST-IN L7 CM ID8.25 MM 3 DAM TRANSLUC BOTH IP/OP $80.00 $59.00 $14.24 $172.80 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $172.80 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-6532 SUP Custom 27203010 AR-6532 - CANNULA ASCP 5.5MM 9CM STRL OBT THRD SHLDR DISP BOTH IP/OP $62.50 $46.00 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6535 SUP Custom 27203010 AR-6535 - CANNULA ARTHRO 6MM 7CM OBTURATOR THREAD TWIST-IN TRANSLUCENT BOTH IP/OP $62.50 $46.00 $11.13 $135.00 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $135.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6535TD SUP Custom 27203010 AR-6535TD - CANNULA ASCP 6MM 7CM TWST-IN 3 DAM SDPRT LL CNCT VLV SWH BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6545 SUP Custom 27203010 AR-6545 - CANNULA ASCP 6MM 9CM TRNLU STRL TWST-IN OBT THRD SHLDR DISP BOTH IP/OP $62.50 $46.00 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6548 SUP Custom 27203010 AR-6548 - CANNULA ARTHRO LP OBTURATOR THREAD PUSHLOCK SHOULDER STERILE BOTH IP/OP $62.50 $46.00 $11.13 $135.00 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $135.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6550TD SUP Custom 27203010 AR-6550TD - CANNULA ASCP 7MM 7CM TWST-IN 3 DAM SDPRT LL CNCT VLV SWH BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6551L SUP Custom 27203010 AR-6551L - CANNULA ASCP SM 6MM 7.75CM BOTH IP/OP $325.00 $241.00 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 N/A $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A AR-6560 SUP Custom 27203010 AR-6560 - CANNULA ASCP BRL 5.75MM 7CM TRNLU STRL CRYS DIST RING RTNT BOTH IP/OP $62.50 $46.00 $11.13 $135.00 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $135.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6560F SUP Custom 27203010 AR-6560F - CANNULA ASCP BRL 5.75MM 7CM TRNLU STRL CRYS DIST RING FLXB BOTH IP/OP $70.00 $52.00 $12.46 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $12.46 $70.00 $70.00 $51.95 $51.95 $53.96 $36.47 $14.59 $70.00 $28.00 $70.00 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $45.50 $70.00 N/A $40.60 $70.00 $42.00 $70.00 $70.00 $70.00 N/A N/A AR-6562 SUP Custom 27203010 AR-6562 - CANNULA ASCP BRL 5.75MM 7CM TRNLU STRL CRYS RTNT BWL SMTH BOTH IP/OP $62.50 $46.00 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6564 SUP Custom 27203010 AR-6564 - CANNULA ASCP P/T BRL 5.75MM 7CM TRNLU STRL CRYS RTNT BWL BOTH IP/OP $62.50 $46.00 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6565 SUP Custom 27203010 AR-6565 - CANNULA ASCP 6MM 9CM STRL SHOHN LNGTDNL SLOT OBT SHLDR DISP BOTH IP/OP $62.50 $46.00 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6566 SUP Custom 27203010 AR-6566 - CANNULA ASCP P/T 8.25MM 7CM TRNLU STRL FLXB OBT THRD ROTR BOTH IP/OP $62.50 $46.00 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6568 SUP Custom 27203010 AR-6568 - CANNULA ASCP SHRT P/T 5.75MM 5CM TRNLU CRYS BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $231.94 $231.94 $240.88 $162.81 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $203.13 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A AR-6570 SUP Custom 27203010 AR-6570 - CANNULA ARTHRO 7MM 7CM OBTURATOR TWIST-IN TRANSLUCENT BOTH IP/OP $62.50 $46.00 $11.13 $135.00 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $135.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6570F SUP Custom 27203010 AR-6570F - CANNULA ASCP 7MM 7CM TRNLU STRL TWST-IN FLXB OBT SHLDR DISP BOTH IP/OP $70.00 $52.00 $12.46 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $12.46 $70.00 $70.00 $51.95 $51.95 $53.96 $36.47 $14.59 $70.00 $28.00 $70.00 $70.00 $70.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $45.50 $70.00 N/A $40.60 $70.00 $42.00 $70.00 $70.00 $70.00 N/A N/A AR-6570TD SUP Custom 27203010 AR-6570TD - CANNULA ASCP 7MM 7CM TWST-IN 3 DAM SDPRT LL CNCT VLV SWH BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6570TDNV SUP Custom 27203010 AR-6570TDNV - CANNULA ASCP 6MM 7CM TWST-IN 3 DAM SDPRT LL CNCT NO VLV BOTH IP/OP $400.00 $296.00 $71.20 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $400.00 $71.20 $400.00 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $400.00 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $400.00 N/A $232.00 $400.00 $240.00 $400.00 $400.00 $400.00 N/A N/A AR-6572 SUP Custom 27203010 AR-6572 - CANNULA ARTHRO LP 8.25MM 9CM SELF RETAINING SYSTEM GEMINI SR BOTH IP/OP $80.00 $59.00 $14.24 $172.80 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $172.80 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-6575-09 SUP Custom 27203010 AR-6575-09 - CANNULA ASCP P/T 8.25MM 9CM TRNLU STRL OBT DISP BOTH IP/OP $62.50 $46.00 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6575-11 SUP Custom 27203010 AR-6575-11 - CANNULA ASCP P/T 8.25MM 11CM TRNLU STRL OBT DISP BOTH IP/OP $62.50 $46.00 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6576S-C SUP Custom 27203010 AR-6576S-C - SYSTEM ESCP XL ASCP C MNT HIP BOTH IP/OP "$69,755.00" "$51,619.00" "$2,060.15" "$69,755.00" "$69,755.00" "$69,755.00" "$69,755.00" "$69,755.00" "$69,755.00" "$69,755.00" "$12,416.39" "$69,755.00" "$69,755.00" "$4,181.12" "$4,181.12" "$53,767.15" "$2,060.15" "$14,537.71" "$69,755.00" "$30,134.16" "$69,755.00" "$69,755.00" "$69,755.00" "$69,755.00" "$69,755.00" "$52,316.25" "$69,755.00" "$69,755.00" "$69,755.00" "$34,877.50" "$34,877.50" "$55,245.96" "$69,755.00" "$55,804.00" "$45,340.75" "$69,755.00" N/A "$40,457.90" "$69,755.00" "$41,853.00" "$69,755.00" "$69,755.00" "$69,755.00" N/A N/A AR-6576S-E SUP Custom 27203010 AR-6576S-E - SYSTEM ESCP XL ASCP EYE PC HIP BOTH IP/OP "$62,280.00" "$46,087.00" "$2,060.15" "$62,280.00" "$62,280.00" "$62,280.00" "$62,280.00" "$62,280.00" "$62,280.00" "$62,280.00" "$11,085.84" "$62,280.00" "$62,280.00" "$4,181.12" "$4,181.12" "$48,005.42" "$2,060.15" "$12,979.84" "$62,280.00" "$26,904.96" "$62,280.00" "$62,280.00" "$62,280.00" "$62,280.00" "$62,280.00" "$46,710.00" "$62,280.00" "$62,280.00" "$62,280.00" "$31,140.00" "$31,140.00" "$49,325.76" "$62,280.00" "$49,824.00" "$40,482.00" "$62,280.00" N/A "$36,122.40" "$62,280.00" "$37,368.00" "$62,280.00" "$62,280.00" "$62,280.00" N/A N/A AR-6577-09 SUP Custom 27203010 AR-6577-09 - CANNULA ARTHRO PTHRD 7MM 9CM HIP STERILE BOTH IP/OP $62.50 $46.00 $11.13 $135.00 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $135.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6577-11 SUP Custom 27203010 AR-6577-11 - CANNULA ASCP P/T 7MM 11CM STRL HIP BOTH IP/OP $62.50 $46.00 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-6580 SUP Custom 27203010 AR-6580 - CANNULA ASCP 3.75MM 3 DAM BOTH IP/OP $344.00 $255.00 $61.19 $343.75 $343.75 $343.75 $343.75 $343.75 $343.75 $343.75 $61.19 $343.75 $343.75 $255.13 $255.13 $264.96 $179.09 $71.64 $343.75 $137.50 $343.75 $343.75 $343.75 $343.75 $343.75 $258.00 $343.75 $343.75 $343.75 $171.88 $171.88 $272.25 $343.75 $275.00 $223.44 $343.75 N/A $199.52 $343.75 $206.25 $343.75 $343.75 $343.75 N/A N/A AR-6590 SUP Custom 27203010 AR-6590 - CANNULA ASCP TRMIT CSTM HIP BOTH IP/OP $162.50 $120.00 $28.93 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $28.93 $162.50 $162.50 $120.61 $120.61 $125.26 $84.66 $33.87 $162.50 $65.00 $162.50 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $105.63 $162.50 N/A $94.25 $162.50 $97.50 $162.50 $162.50 $162.50 N/A N/A AR-6590DT SUP Custom 27203010 AR-6590DT - CANNULA ASCP TRMIT DTCH OBT BOTH IP/OP $650.00 $481.00 $115.70 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $115.70 $650.00 $650.00 $482.43 $482.43 $501.02 $338.65 $135.47 $650.00 $280.80 $650.00 $650.00 $650.00 $650.00 $650.00 $487.50 $650.00 $650.00 $650.00 $325.00 $325.00 $514.80 $650.00 $520.00 $422.50 $650.00 N/A $377.00 $650.00 $390.00 $650.00 $650.00 $650.00 N/A N/A AR-6590ST SUP Custom 27203010 AR-6590ST - STICK SWH 4MM TRMIT CNN CNN BOTH IP/OP $687.50 $509.00 $122.38 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $122.38 $687.50 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $297.00 $687.50 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $687.50 N/A $398.75 $687.50 $412.50 $687.50 $687.50 $687.50 N/A N/A AR-6592 SUP Custom 27203010 AR-6592 - CANNULA BTN CRV LOPRFL STRL LF PSPRT 1 PC MLD 2 DAM DSGN 2 BOTH IP/OP $362.50 $268.00 $64.53 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $156.60 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 N/A $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A AR-6592-06-20 SUP Custom 27203010 AR-6592-06-20 - CANNULA BTN CRV LOPRFL 6MM 2CM STRL LF PSPRT 1 PC MLD 2 DAM BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-6592-06-30 SUP Custom 27203010 AR-6592-06-30 - CANNULA BTN CRV LOPRFL 6MM 3CM STRL LF PSPRT 1 PC MLD 2 DAM BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-6592-06-40 SUP Custom 27203010 AR-6592-06-40 - CANNULA BTN CRV LOPRFL 6MM 4CM STRL LF PSPRT 1 PC MLD 2 DAM BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-6592-06-50 SUP Custom 27203010 AR-6592-06-50 - CANNULA BTN CRV LOPRFL 6MM 5CM STRL LF PSPRT 1 PC MLD 2 DAM BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-6592-08-20 SUP Custom 27203010 AR-6592-08-20 - CANNULA BTN CRV LOPRFL 8MM 2CM STRL LF PSPRT 1 PC MLD 2 DAM BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-6592-08-40 SUP Custom 27203010 AR-6592-08-40 - CANNULA BTN CRV LOPRFL 8MM 4CM STRL LF PSPRT 1 PC MLD 2 DAM BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-6592-08-50 SUP Custom 27203010 AR-6592-08-50 - CANNULA BTN CRV LOPRFL 8MM 5CM STRL LF PSPRT 1 PC MLD 2 DAM BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-6592-08-60 SUP Custom 27203010 AR-6592-08-60 - CANNULA BTN CRV LOPRFL 8MM 6CM STRL LF PSPRT 1 PC MLD 2 DAM BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-6592-08-90 SUP Custom 27203010 AR-6592-08-90 - CANNULA BTN CRV LOPRFL 9MM 9CM STRL LF PSPRT 1 PC MLD 2 DAM BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 N/A $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A AR-6592-10-20 SUP Custom 27203010 AR-6592-10-20 - CANNULA BTN CRV LOPRFL 10MM 2CM STRL LF PSPRT 1 PC MLD 2 DAM BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-6592-10-30 SUP Custom 27203010 AR-6592-10-30 - CANNULA BUTTON CURVE LP 10MM 3CM 1 PIECE MOLD 2 DAM DESIGN 2 BOTH IP/OP $80.00 $59.00 $14.24 $172.80 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $172.80 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-6592-10-40 SUP Custom 27203010 AR-6592-10-40 - CANNULA BUTTON CURVE LP 10MM 4CM 1 PIECE MOLD 2 DAM DESIGN 2 BOTH IP/OP $80.00 $59.00 $14.24 $172.80 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $172.80 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-6592-10-50 SUP Custom 27203010 AR-6592-10-50 - CANNULA BUTTON CURVE LP 10MM 5CM 1 PIECE MOLD 2 DAM DESIGN 2 BOTH IP/OP $80.00 $59.00 $14.24 $172.80 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $172.80 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-6955 SUP HCPCS C1713 AR-6955 - SET IMPL 2.7MM TRMIT TNL INSTRUMENTATION SET BOTH IP/OP "$4,917.50" "$3,639.00" $976.00 "$4,917.50" "$2,212.88" "$2,212.88" "$2,212.88" "$2,212.88" "$4,917.50" "$4,917.50" "$4,917.50" "$1,024.93" "$4,917.50" "$4,917.50" "$4,917.50" "$4,917.50" "$4,917.50" "$1,024.86" "$4,917.50" "$1,967.00" "$2,424.33" "$4,917.50" "$4,917.50" "$4,917.50" "$4,917.50" "$3,688.13" "$4,917.50" "$4,917.50" "$4,917.50" "$2,458.75" "$2,458.75" "$3,894.66" "$4,917.50" "$3,934.00" "$2,212.88" $976.00 N/A "$2,852.15" "$4,917.50" "$2,950.50" "$4,917.50" "$1,024.81" "$4,917.50" N/A N/A AR-7000-03 SUP Custom 27203010 AR-7000-03 - GUIDE DRL 4MM PRLL BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" $486.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A AR-7000-04 SUP Custom 27203010 AR-7000-04 - GUIDE DRL 6MM PRLL BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" $486.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A AR-7000-05 SUP Custom 27203010 AR-7000-05 - GUIDE DRL 8MM PRLL BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" $486.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A AR-7000-07 SUP Custom 27203010 AR-7000-07 - GUIDE DRL CORACOID BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$1,577.18" "$1,577.18" "$1,637.95" "$1,107.13" $442.87 "$2,125.00" $918.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" "$1,381.25" "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A AR-7000-14 SUP Custom 27203010 AR-7000-14 - DRILL SURG MINI .066IN 2.75MM CANN OPEN REPAIR BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $378.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A AR-7000-15 SUP Custom 27803010 AR-7000-15 - WASHER ORTHOPEDIC CANN SELF COMPRESS THREAD PITCH TITANIUM BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $54.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7000-16 SUP Custom 27203010 AR-7000-16 - GUIDE DRL PRLL BOTH IP/OP "$1,062.50" $786.00 $189.13 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $189.13 "$1,062.50" "$1,062.50" $788.59 $788.59 $818.98 $553.56 $221.44 "$1,062.50" $459.00 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $690.63 "$1,062.50" N/A $616.25 "$1,062.50" $637.50 "$1,062.50" "$1,062.50" "$1,062.50" N/A N/A AR-7000-17 SUP Custom 27203010 AR-7000-17 - GUIDE DRL SHLW CORACOID BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$1,577.18" "$1,577.18" "$1,637.95" "$1,107.13" $442.87 "$2,125.00" $918.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" "$1,381.25" "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A AR-7000-18T SUP Custom 27803010 AR-7000-18T - WASHER ESCP 2 CRV FBRWR NDL SUT TI ASCP BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A AR-7000-26 SUP HCPCS C1713 AR-7000-26 - SCREW BN P/T 3.75MM 26MM SLF DRL ST CNN TI SHLDR GLND BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-26FT SUP HCPCS C1713 AR-7000-26FT - SCREW BN FT 3.75MM 26MM SLF DRL ST CNN TI SHLDR GLND BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A AR-7000-28 SUP HCPCS C1713 AR-7000-28 - SCREW BN P/T 3.75MM 28MM SLF DRL ST CNN TI SHLDR GLND BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-28FT SUP HCPCS C1713 AR-7000-28FT - SCREW BN FT 3.75MM 28MM SLF DRL ST CNN TI SHLDR GLND BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A AR-7000-30 SUP HCPCS C1713 AR-7000-30 - SCREW BN P/T 3.75MM 30MM SLF DRL ST CNN TI SHLDR GLND BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-30FT SUP HCPCS C1713 AR-7000-30FT - SCREW BN FT 3.75MM 30MM SLF DRL ST CNN TI SHLDR GLND BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-32 SUP HCPCS C1713 AR-7000-32 - SCREW BONE PTHRD 3.75MM 32MM SELF DRILL SELF TAP CANN BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $216.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-32FT SUP HCPCS C1713 AR-7000-32FT - SCREW BN FT 3.75MM 32MM SLF DRL ST CNN TI SHLDR GLND BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-34 SUP HCPCS C1713 AR-7000-34 - SCREW BN P/T 3.75MM 34MM SLF DRL ST CNN TI SHLDR GLND BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-34FT SUP HCPCS C1713 AR-7000-34FT - SCREW BONE 3.75MM 34MM TI FULTHD SHLDR GLND SLF BOTH IP/OP $500.00 $370.00 $99.24 $540.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $540.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-36 SUP HCPCS C1713 AR-7000-36 - SCREW BONE PTHRD 3.75MM 36MM SELF DRILL SELF TAP CANN BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $216.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-36FT SUP HCPCS C1713 AR-7000-36FT - SCREW BN FT 3.75MM 36MM SLF DRL ST CNN TI SHLDR GLND BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-38 SUP HCPCS C1713 AR-7000-38 - SCREW BN P/T 3.75MM 38MM SLF DRL ST CNN TI SHLDR GLND BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-38FT SUP HCPCS C1713 AR-7000-38FT - SCREW BN FT 3.75MM 38MM SLF DRL ST CNN TI SHLDR GLND BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-40 SUP HCPCS C1713 AR-7000-40 - SCREW BONE PTHRD 3.75MM 40MM SELF DRILL SELF TAP CANN BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $216.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-40FT SUP HCPCS C1713 AR-7000-40FT - SCREW BN FT 3.75MM 40MM SLF DRL ST CNN TI SHLDR GLND BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-42 SUP HCPCS C1713 AR-7000-42 - SCREW BONE PTHRD 3.75MM 42MM SELF DRILL SELF TAP CANN BOTH IP/OP $500.00 $370.00 $99.24 $540.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $540.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A AR-7000-42FT SUP HCPCS C1713 AR-7000-42FT - SCREW BN FT 3.75MM 42MM SLF DRL ST CNN TI SHLDR GLND BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $200.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A AR-7199 SUP Custom 27203010 AR-7199 - DEVICE PSTN BLU WHT FINGERSHIELD LT OPN TIP MRKR PCTV RADOPQ BOTH IP/OP $87.50 $65.00 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $35.00 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $87.50 N/A $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A AR-7200 SUP Custom 27803010 AR-7200 - SUTURE NABSB 2 T-5 38IN BLU FBRWR MS LWR KNT PRFL BOTH IP/OP $55.00 $41.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $11.46 $55.00 $22.00 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $24.75 $55.00 N/A $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A AR-7200B SUP Custom 27803010 AR-7200B - SUTURE NABSB 2 TPR 38IN FBRWR BRD TIE MS LWR KNT PRFL NDL BOTH IP/OP $97.50 $72.00 $17.36 $97.50 $97.50 $97.50 $97.50 $97.50 $97.50 $97.50 $17.36 $97.50 $97.50 $97.50 $97.50 $97.50 $97.50 $20.32 $97.50 $39.00 $97.50 $97.50 $97.50 $97.50 $97.50 $73.13 $97.50 $97.50 $97.50 $48.75 $48.75 $77.22 $97.50 $78.00 $43.88 $97.50 N/A $56.55 $97.50 $58.50 $97.50 $97.50 $97.50 N/A N/A AR-7201 SUP Custom 27803010 AR-7201 - SUTURE NABSB 2 .5 CRC STRG DMD PT RVRS CUT 38IN BLK BLU WHT BOTH IP/OP $87.50 $65.00 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $87.50 N/A $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A AR-7202 SUP Custom 27803010 AR-7202 - SUTURE NABSB 2 C-13 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL BOTH IP/OP $55.00 $41.00 $9.79 $285.12 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $11.46 $55.00 $285.12 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $24.75 $55.00 N/A $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A AR-7203 SUP Custom 27203010 AR-7203 - SUTURE NABSB 2 38IN B/W TIGERWIRE BRD BOTH IP/OP $57.50 $43.00 $10.24 $57.50 $57.50 $57.50 $57.50 $57.50 $57.50 $57.50 $10.24 $57.50 $57.50 $42.68 $42.68 $44.32 $29.96 $11.98 $57.50 $23.00 $57.50 $57.50 $57.50 $57.50 $57.50 $43.13 $57.50 $57.50 $57.50 $28.75 $28.75 $45.54 $57.50 $46.00 $37.38 $57.50 N/A $33.35 $57.50 $34.50 $57.50 $57.50 $57.50 N/A N/A AR-7204 SUP Custom 27803010 AR-7204 - SUTURE NABSB 2 STRG 26IN GRN 10MM FBRWR BRD MS CLS LOOP LWR BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $150.00 N/A $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A AR-7205 SUP Custom 27803010 AR-7205 - SUTURE NABSB 2 T-5 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A AR-7205T SUP Custom 27203010 AR-7205T - SUTURE NABSB 2 T-5 38IN B/W FVR TGRWR 2 ARM BRD TIE MS LWR BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A AR-7206 SUP Custom 27803010 AR-7206 - SUTURE NABSB 2 T-8 38IN BLU FBRWR 2 ARM BRD MS LWR KNT PRFL BOTH IP/OP $55.00 $41.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $11.46 $55.00 $22.00 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $24.75 $55.00 N/A $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A AR-7207 SUP Custom 27803010 AR-7207 - SUTURE NABSB 2 38IN BLU 10MM FBRWR BRD TIE MS LWR KNT PRFL BOTH IP/OP $100.00 $74.00 $17.80 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $17.80 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $20.84 $100.00 $40.00 $100.00 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $45.00 $100.00 N/A $58.00 $100.00 $60.00 $100.00 $100.00 $100.00 N/A N/A AR-7208 SUP Custom 27803010 AR-7208 - SUTURE NABSB 2 T-5 38IN BLK BLU WHT FBRWR BRD TIE MS LWR KNT BOTH IP/OP $120.00 $89.00 $21.36 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $21.36 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $25.01 $120.00 $48.00 $120.00 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $54.00 $120.00 N/A $69.60 $120.00 $72.00 $120.00 $120.00 $120.00 N/A N/A AR-7209 SUP Custom 27803010 AR-7209 - SUTURE NABSB 2 50IN 12IN FBSTK FBRWR 1 END STIFFEN BOTH IP/OP $125.00 $93.00 $22.25 $270.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $270.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7209T SUP HCPCS C1713 AR-7209T - SUTURE NONABSORBABLE 2 50IN 12IN 1 END STIFFEN MONOFILAMENT BOTH IP/OP $125.00 $93.00 $24.81 $675.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $675.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A AR-7210 SUP Custom 27803010 AR-7210 - SUTURE NABSB 5 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL BOTH IP/OP $95.00 $70.00 $16.91 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $16.91 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $19.80 $95.00 $38.00 $95.00 $95.00 $95.00 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $42.75 $95.00 N/A $55.10 $95.00 $57.00 $95.00 $95.00 $95.00 N/A N/A AR-7211 SUP Custom 27203010 AR-7211 - SUTURE NABSB 5 CCS-1 38IN BLU FBRWR MS LWR KNT PRFL BOTH IP/OP $100.00 $74.00 $17.80 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $17.80 $100.00 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $40.00 $100.00 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $100.00 N/A $58.00 $100.00 $60.00 $100.00 $100.00 $100.00 N/A N/A AR-7212 SUP Custom 27803010 AR-7212 - SUTURE NABSB 5 .5 CRC 38IN BLK BLU WHT 48MM FBRWR CNV CUT BOTH IP/OP $262.50 $194.00 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $262.50 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $262.50 N/A $152.25 $262.50 $157.50 $262.50 $262.50 $262.50 N/A N/A AR-7213 SUP Custom 27803010 AR-7213 - SUTURE NONABSORBABLE 5 T-5 CCS-1 38IN 48MM BRAID TIES BOTH IP/OP $100.00 $74.00 $17.80 $518.40 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $17.80 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $20.84 $100.00 $518.40 $100.00 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $45.00 $100.00 N/A $58.00 $100.00 $60.00 $100.00 $100.00 $100.00 N/A N/A AR-7216 SUP Custom 27803010 AR-7216 - SUTURE NABSB 1 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL BOTH IP/OP $52.50 $39.00 $9.35 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $9.35 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $10.94 $52.50 $21.00 $52.50 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $23.63 $52.50 N/A $30.45 $52.50 $31.50 $52.50 $52.50 $52.50 N/A N/A AR-7217 SUP Custom 27803010 AR-7217 - SUTURE NABSB 2 .5 CRC RVRS CUT 38IN BLK BLU WHT 36.6MM FBRWR BOTH IP/OP $120.00 $89.00 $21.36 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $21.36 $120.00 $120.00 $120.00 $120.00 $120.00 $120.00 $25.01 $120.00 $48.00 $120.00 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $54.00 $120.00 N/A $69.60 $120.00 $72.00 $120.00 $120.00 $120.00 N/A N/A AR-7220 SUP Custom 27203010 AR-7220 - SUTURE NABSB 2-0 T-13 18IN BLU FBRWR MS LWR KNT PRFL BOTH IP/OP $55.00 $41.00 $9.79 $285.12 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $40.82 $40.82 $42.39 $28.66 $11.46 $55.00 $285.12 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $35.75 $55.00 N/A $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A AR-7221 SUP Custom 27803010 "AR-7221 - FIBERWIRE, BRAIDED PB 2-0 SUTURE, BLUE" BOTH IP/OP $52.50 $39.00 $9.35 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $9.35 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $10.94 $52.50 $21.00 $52.50 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $23.63 $52.50 N/A $30.45 $52.50 $31.50 $52.50 $52.50 $52.50 N/A N/A AR-7222 SUP Custom 27803010 AR-7222 - SUTURE NABSB 2-0 50IN BLU 12IN FBRWR FBSTK 1 END STIFFEN BRD BOTH IP/OP $105.00 $78.00 $18.69 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $18.69 $105.00 $105.00 $105.00 $105.00 $105.00 $105.00 $21.88 $105.00 $42.00 $105.00 $105.00 $105.00 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $47.25 $105.00 N/A $60.90 $105.00 $63.00 $105.00 $105.00 $105.00 N/A N/A AR-7223SM SUP Custom 27803010 AR-7223SM - SUTURE NABSB 2-0 SM STRL FBRWR BRD SWEDGE LO KNT PRFL MNSCS BOTH IP/OP $180.00 $133.00 $32.04 $777.60 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $777.60 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A AR-7227-01 SUP Custom 27803010 AR-7227-01 - SUTURE NABSB 3-0 T-43 18IN BLU FBRWR BRD TIE MS LWR KNT PRFL BOTH IP/OP $55.00 $41.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $11.46 $55.00 $22.00 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $24.75 $55.00 N/A $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A AR-7227-02 SUP Custom 27803010 AR-7227-02 - SUTURE NABSB 3-0 C-22 18IN BLU FBRWR BRD TIE MS LWR KNT PRFL BOTH IP/OP $55.00 $41.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $11.46 $55.00 $22.00 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $24.75 $55.00 N/A $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A AR-7228 SUP Custom 27803010 AR-7228 - SUTURE NABSB 4-0 DE-10 18IN BLU FBRWR BRD TIE MS LWR KNT BOTH IP/OP $55.00 $41.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $11.46 $55.00 $22.00 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $24.75 $55.00 N/A $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A AR-7229-12 SUP Custom 27203010 AR-7229-12 - SUTURE NABSB 4-0 T-13 12IN BLU FIBERLOOP MS BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7229-20 SUP Custom 27203010 AR-7229-20 - SUTURE NABSB 4-0 3/8 CRC 10IN BLU 17.9MM FIBERLOOP TPR NDL BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7230-01 SUP Custom 27803010 AR-7230-01 - SUTURE NABSB 4-0 T-12 18IN BLU FBRWR MS LWR KNT PRFL BOTH IP/OP $55.00 $41.00 $9.79 $285.12 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $11.46 $55.00 $285.12 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $24.75 $55.00 N/A $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A AR-7230-02 SUP Custom 27803010 AR-7230-02 - SUTURE NABSB 4-0 C-17 18IN BLU FBRWR BRD TIE MS LWR KNT PRFL BOTH IP/OP $55.00 $41.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $11.46 $55.00 $22.00 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $24.75 $55.00 N/A $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A AR-7232-01 SUP Custom 27203010 AR-7232-01 - SUTURE NABSB 2-0 D-17 60IN BLU FIBERLOOP 2 ARM MS BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7232-02 SUP Custom 27203010 AR-7232-02 - SUTURE NABSB 2-0 D-14 24IN BLU FIBERLOOP 2 ARM MS BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7232-03 SUP Custom 27203010 AR-7232-03 - SUTURE NABSB 2-0 SD-2 13IN BLU FIBERLOOP 2 ARM MS BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7232-05 SUP Custom 27203010 AR-7232-05 - SUTURE NABSB 2-0 3/8 CRC TPR PNT 14IN 17.9MM FIBERLOOP LOOP BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A AR-7233 SUP Custom 27803010 AR-7233 - SUTURE NABSB 2 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL BOTH IP/OP $52.50 $39.00 $9.35 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $9.35 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $10.94 $52.50 $21.00 $52.50 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $23.63 $52.50 N/A $30.45 $52.50 $31.50 $52.50 $52.50 $52.50 N/A N/A AR-7234 SUP Custom 27203010 AR-7234 - SUTURE NONABSORBABLE 2 7MM STR 20IN 76MM BRAID MULTISTRAND BOTH IP/OP $125.00 $93.00 $22.25 $648.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $648.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7234-01 SUP Custom 27203010 AR-7234-01 - SUTURE NABSB 2 7MM STRG 20IN WHT 76MM FIBERLOOP BRD MS NDL BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7234B SUP Custom 27203010 AR-7234B - SUTURE NABSB 2 STRG 20IN BLU 76MM FIBERLOOP BRD MS NDL BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A AR-7234C SUP Custom 27203010 AR-7234C - SUTURE NONABSORBABLE 2 .5 CIR CURVE 20IN BRAID MULTISTRAND BOTH IP/OP $125.00 $93.00 $22.25 $648.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $648.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7234T SUP Custom 27203010 AR-7234T - SUTURE NONABSORBABLE 2 STR 20IN 3IN BRAID MULTISTRAND NEEDLE BOTH IP/OP $125.00 $93.00 $22.25 $648.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $648.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7235 SUP Custom 27203010 AR-7235 - SUTURE NONABSORBABLE 2 26IN 1.5IN BRAID TIES MULTISTRAND BOTH IP/OP $137.50 $102.00 $24.48 $712.80 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $24.48 $137.50 $137.50 $102.05 $102.05 $105.99 $71.64 $28.66 $137.50 $712.80 $137.50 $137.50 $137.50 $137.50 $137.50 $103.13 $137.50 $137.50 $137.50 $68.75 $68.75 $108.90 $137.50 $110.00 $89.38 $137.50 N/A $79.75 $137.50 $82.50 $137.50 $137.50 $137.50 N/A N/A AR-7235T SUP Custom 27203010 AR-7235T - SUTURE NABSB 2 26IN B/W TIGERLINK FBRWR CLS LOOP BOTH IP/OP $137.50 $102.00 $24.48 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $137.50 $24.48 $137.50 $137.50 $102.05 $102.05 $105.99 $71.64 $28.66 $137.50 $55.00 $137.50 $137.50 $137.50 $137.50 $137.50 $103.13 $137.50 $137.50 $137.50 $68.75 $68.75 $108.90 $137.50 $110.00 $89.38 $137.50 N/A $79.75 $137.50 $82.50 $137.50 $137.50 $137.50 N/A N/A AR-7237 SUP Custom 27803010 AR-7237 - SUTURE NABSB 2 TPR 54IN BLU 36INX2MM FIBERTAPE FBRWR BRD BOTH IP/OP $262.50 $194.00 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $46.73 $262.50 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $262.50 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $262.50 N/A $152.25 $262.50 $157.50 $262.50 $262.50 $262.50 N/A N/A AR-7237-17LN SUP Custom 27803010 AR-7237-17LN - SUTURE NABSB 2MM STRG 17IN BLU FIBERTAPE BRD BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7237-17N SUP Custom 27803010 AR-7237-17N - SUTURE NABSB 2 .5 CRC TPR 17IN BLU 26.5MM FIBERTAPE FBRWR BOTH IP/OP $190.00 $141.00 $33.82 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $33.82 $190.00 $190.00 $190.00 $190.00 $190.00 $190.00 $39.60 $190.00 $76.00 $190.00 $190.00 $190.00 $190.00 $190.00 $142.50 $190.00 $190.00 $190.00 $95.00 $95.00 $150.48 $190.00 $152.00 $85.50 $190.00 N/A $110.20 $190.00 $114.00 $190.00 $190.00 $190.00 N/A N/A AR-7237-7 SUP Custom 27803010 AR-7237-7 - SUTURE NONABSORBABLE 2 TAPER 7INX2MM BRAID FIBERTAPE BOTH IP/OP $125.00 $93.00 $22.25 $324.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $324.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7237-7T SUP Custom 27203010 AR-7237-7T - SUTURE NABSB 2 TPR 7INX2MM B/W TIGERTAPE TIGERWIRE BRD BOTH IP/OP $125.00 $93.00 $22.25 $324.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $324.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7240 SUP Custom 27803010 AR-7240 - SUTURE NONABSORBABLE 2 38IN BRAID 2 STRAND LOWER KNOT BOTH IP/OP $87.50 $65.00 $15.58 $453.60 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $453.60 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $87.50 N/A $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A AR-7242 SUP Custom 27203010 AR-7242 - SUTURE NABSB 2-0 T-5 18IN BLU TIGERTAPE FBRWR BRD TIE MS BOTH IP/OP $55.00 $41.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $40.82 $40.82 $42.39 $28.66 $11.46 $55.00 $22.00 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $35.75 $55.00 N/A $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A AR-7246 SUP Custom 27803010 AR-7246 - SUTURE NABSB 2 STRG DMD 38IN BLU 26.5MM FBRWR 1 END NDL BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $36.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A AR-7246-02 SUP Custom 27803010 AR-7246-02 - SUTURE NABSB 2 STRG DMD 38IN BLU 64MM FBRWR 1 END 2 NDL BOTH IP/OP $110.00 $81.00 $19.58 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $19.58 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $22.93 $110.00 $44.00 $110.00 $110.00 $110.00 $110.00 $110.00 $82.50 $110.00 $110.00 $110.00 $55.00 $55.00 $87.12 $110.00 $88.00 $49.50 $110.00 N/A $63.80 $110.00 $66.00 $110.00 $110.00 $110.00 N/A N/A AR-7248 SUP Custom 27803010 AR-7248 - SUTURE NABSB 4-0 T-22 18IN WHT FBRWR BRD TIE MS LWR KNT PRFL BOTH IP/OP $55.00 $41.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $11.46 $55.00 $22.00 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $24.75 $55.00 N/A $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A AR-7249-12 SUP Custom 27203010 AR-7249-12 - SUTURE NABSB 4-0 T-22 6IN WHT FIBERLOOP MS BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7249-20 SUP Custom 27203010 AR-7249-20 - SUTURE NABSB 4-0 T-22 10IN WHT FIBERLOOP MS BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7250 SUP Custom 27803010 AR-7250 - SUTURE NABSB 0 T-4 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL BOTH IP/OP $55.00 $41.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $11.46 $55.00 $22.00 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $24.75 $55.00 N/A $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A AR-7251 SUP Custom 27803010 AR-7251 - SUTURE NABSB 0 D-10 38IN BLU FBRWR BRD TIE MS LWR KNT PRFL BOTH IP/OP $55.00 $41.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $11.46 $55.00 $22.00 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $24.75 $55.00 N/A $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A AR-7253 SUP Custom 27203010 AR-7253 - SUTURE NABSB 0 7MM STRG 13IN BLU 76MM FIBERLOOP BRD MS BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7253T SUP Custom 27203010 AR-7253T - SUTURE NABSB 0 7MM STRG 13IN B/W 76MM FIBERLOOP TIGERLOOP BOTH IP/OP $125.00 $93.00 $22.25 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $125.00 $22.25 $125.00 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $50.00 $125.00 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $125.00 N/A $72.50 $125.00 $75.00 $125.00 $125.00 $125.00 N/A N/A AR-7254 SUP Custom 27803010 AR-7254 - SUTURE NABSB 0 FBRWR BOTH IP/OP $52.50 $39.00 $9.35 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $9.35 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $10.94 $52.50 $21.00 $52.50 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $23.63 $52.50 N/A $30.45 $52.50 $31.50 $52.50 $52.50 $52.50 N/A N/A AR-7255 SUP Custom 27803010 AR-7255 - SUTURE NABSB 0 38IN WHT FBRWR LWR KNT PRFL SMTH TIE ABL SUP BOTH IP/OP $62.50 $46.00 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $11.13 $62.50 $62.50 $62.50 $62.50 $62.50 $62.50 $13.03 $62.50 $25.00 $62.50 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $28.13 $62.50 N/A $36.25 $62.50 $37.50 $62.50 $62.50 $62.50 N/A N/A AR-7258 SUP Custom 27203010 AR-7258 - SUTURE NABSB 0 36IN BLU 1.5IN FIBERLINK LOOP BOTH IP/OP "$1,950.00" "$1,443.00" $347.10 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" $347.10 "$1,950.00" "$1,950.00" "$1,447.29" "$1,447.29" "$1,503.06" "$1,015.95" $406.40 "$1,950.00" $780.00 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,462.50" "$1,950.00" "$1,950.00" "$1,950.00" $975.00 $975.00 "$1,544.40" "$1,950.00" "$1,560.00" "$1,267.50" "$1,950.00" N/A "$1,131.00" "$1,950.00" "$1,170.00" "$1,950.00" "$1,950.00" "$1,950.00" N/A N/A AR-7258T SUP Custom 27203010 AR-7258T - SUTURE NABSB 0 36IN 1.5IN TIGERLINK LOOP BOTH IP/OP "$1,950.00" "$1,443.00" $347.10 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" $347.10 "$1,950.00" "$1,950.00" "$1,447.29" "$1,447.29" "$1,503.06" "$1,015.95" $406.40 "$1,950.00" $780.00 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,462.50" "$1,950.00" "$1,950.00" "$1,950.00" $975.00 $975.00 "$1,544.40" "$1,950.00" "$1,560.00" "$1,267.50" "$1,950.00" N/A "$1,131.00" "$1,950.00" "$1,170.00" "$1,950.00" "$1,950.00" "$1,950.00" N/A N/A AR-7264 SUP Custom 27803010 AR-7264 - SUTURE NABSB 2 FIBERTAG SPEEDWHIP FIBERLOOP BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A AR-7270 SUP Custom 27803010 AR-7270 - SUTURE NABSB 2 10 LNG LOOP 7MM FBRWR FIBERCHAIN BRD BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A AR-7272 SUP Custom 27803010 AR-7272 - FIBERWIRE CL WHITE BLUE 38IN BOTH IP/OP $52.50 $39.00 $9.35 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $9.35 $52.50 $52.50 $52.50 $52.50 $52.50 $52.50 $10.94 $52.50 $21.00 $52.50 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $23.63 $52.50 N/A $30.45 $52.50 $31.50 $52.50 $52.50 $52.50 N/A N/A AR-7272T SUP Custom 27203010 AR-7272T - TIGERWIRE CL WHITE BLACK 38IN W NDL BOTH IP/OP $55.00 $41.00 $9.79 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $55.00 $9.79 $55.00 $55.00 $40.82 $40.82 $42.39 $28.66 $11.46 $55.00 $22.00 $55.00 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $35.75 $55.00 N/A $31.90 $55.00 $33.00 $55.00 $55.00 $55.00 N/A N/A AR-7275 SUP Custom 27803010 AR-7275 - SUTURE NONABSORBABLE 2 2MM 8IN 24IN FIBERTAPE FIBERWIRE BLUE BOTH IP/OP $175.00 $130.00 $31.15 $453.60 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $31.15 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $453.60 $175.00 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $175.00 N/A $101.50 $175.00 $105.00 $175.00 $175.00 $175.00 N/A N/A AR-7275T SUP Custom 27203010 AR-7275T - SUTURE NONABSORBABLE 2 2MM 8IN 24IN TIGERTAPE TIGERWIRE BLUE BOTH IP/OP $175.00 $130.00 $31.15 $453.60 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $31.15 $175.00 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $453.60 $175.00 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $175.00 N/A $101.50 $175.00 $105.00 $175.00 $175.00 $175.00 N/A N/A AR-7276 SUP Custom 27203010 AR-7276 - SUTURE NABSB 1.5MM 36IN WHT LABRALTAPE BOTH IP/OP $175.00 $130.00 $31.15 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $31.15 $175.00 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $70.00 $175.00 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $175.00 N/A $101.50 $175.00 $105.00 $175.00 $175.00 $175.00 N/A N/A AR-7276T SUP Custom 27203010 AR-7276T - SUTURE NONABSORBABLE 1.5MM 36IN LABRALTAPE BLACK WHITE BOTH IP/OP $175.00 $130.00 $31.15 $907.20 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $31.15 $175.00 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $907.20 $175.00 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $175.00 N/A $101.50 $175.00 $105.00 $175.00 $175.00 $175.00 N/A N/A AR-7280 SUP Custom 27203010 AR-7280 - NEEDLE SUT C-13 .5 CRC RVRS CUT 36.6MM LOOP NTNL BOTH IP/OP $47.50 $35.00 $8.46 $47.50 $47.50 $47.50 $47.50 $47.50 $47.50 $47.50 $8.46 $47.50 $47.50 $35.25 $35.25 $36.61 $24.75 $9.90 $47.50 $19.00 $47.50 $47.50 $47.50 $47.50 $47.50 $35.63 $47.50 $47.50 $47.50 $23.75 $23.75 $37.62 $47.50 $38.00 $30.88 $47.50 N/A $27.55 $47.50 $28.50 $47.50 $47.50 $47.50 N/A N/A AR-7281 SUP Custom 27203010 AR-7281 - NEEDLE SUT T-5 .5 CRC TPR 26.5MM BTNDS LOOP NTNL DISP BOTH IP/OP $47.50 $35.00 $8.46 $47.50 $47.50 $47.50 $47.50 $47.50 $47.50 $47.50 $8.46 $47.50 $47.50 $35.25 $35.25 $36.61 $24.75 $9.90 $47.50 $19.00 $47.50 $47.50 $47.50 $47.50 $47.50 $35.63 $47.50 $47.50 $47.50 $23.75 $23.75 $37.62 $47.50 $38.00 $30.88 $47.50 N/A $27.55 $47.50 $28.50 $47.50 $47.50 $47.50 N/A N/A AR-7282 SUP Custom 27203010 AR-7282 - PASSER SUT 1 FBRWR LOOP BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A AR-7284 SUP Custom 27203010 AR-7284 - SUTURE NABSB 2 FIBERLOOP SWAGE STRG NDL BOTH IP/OP "$1,950.00" "$1,443.00" $347.10 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" $347.10 "$1,950.00" "$1,950.00" "$1,447.29" "$1,447.29" "$1,503.06" "$1,015.95" $406.40 "$1,950.00" $780.00 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,462.50" "$1,950.00" "$1,950.00" "$1,950.00" $975.00 $975.00 "$1,544.40" "$1,950.00" "$1,560.00" "$1,267.50" "$1,950.00" N/A "$1,131.00" "$1,950.00" "$1,170.00" "$1,950.00" "$1,950.00" "$1,950.00" N/A N/A AR-7300DS SUP Custom 27203010 AR-7300DS - BLADE SHVR 3MM 7CM STRL COOLCUT ASCP DSCT S JNT DISP BOTH IP/OP $165.00 $122.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $165.00 N/A $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A AR-7300OBT SUP Custom 27203010 AR-7300OBT - BURR SHVR 10 FLUT OVL3MM S JNT BOTH IP/OP $165.00 $122.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $165.00 N/A $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A AR-7324PSL SUP HCPCS C1713 AR-7324PSL - ANCHOR SUT SWIVELOCK TENODESIS PEEK BOTH IP/OP "$1,087.50" $805.00 $215.84 "$1,087.50" $489.38 $489.38 $489.38 $489.38 "$1,087.50" "$1,087.50" "$1,087.50" $226.66 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $226.65 "$1,087.50" $435.00 $643.26 "$1,087.50" "$1,087.50" "$1,087.50" "$1,087.50" $815.63 "$1,087.50" "$1,087.50" "$1,087.50" $543.75 $543.75 $861.30 "$1,087.50" $870.00 $489.38 $215.84 N/A $630.75 "$1,087.50" $652.50 "$1,087.50" $226.64 "$1,087.50" N/A N/A AR-7400TD SUP Custom 27203010 AR-7400TD - BLADE SHVR 4MM 7CM TORPEDO COOLCUT OVIOD OUTR WDW SMTH CUT BOTH IP/OP $252.50 $187.00 $44.95 $252.50 $252.50 $252.50 $252.50 $252.50 $252.50 $252.50 $44.95 $252.50 $252.50 $187.41 $187.41 $194.63 $131.55 $52.62 $252.50 $101.00 $252.50 $252.50 $252.50 $252.50 $252.50 $189.38 $252.50 $252.50 $252.50 $126.25 $126.25 $199.98 $252.50 $202.00 $164.13 $252.50 N/A $146.45 $252.50 $151.50 $252.50 $252.50 $252.50 N/A N/A AR-7500 SUP Custom 27203010 AR-7500 - SUTURE NABSB 1.3MM 36IN WHT BLU STRL SUTURETAPE .5 CRC TPR BOTH IP/OP $87.50 $65.00 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $35.00 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $87.50 N/A $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A AR-7710 SUP Custom 27203010 AR-7710 - BIT DRL 5MM 15MM SCKT HUM TNL ULN COLLATERAL LGMNT BOTH IP/OP $987.50 $731.00 $175.78 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $175.78 $987.50 $987.50 $732.92 $732.92 $761.17 $514.49 $205.81 $987.50 $395.00 $987.50 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $641.88 $987.50 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A AR-7710-4.5 SUP Custom 27203010 AR-7710-4.5 - BIT DRL 4.5MM HUM TNL ULN COLLATERAL LGMNT BOTH IP/OP $337.50 $250.00 $60.08 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $60.08 $337.50 $337.50 $250.49 $250.49 $260.15 $175.84 $70.34 $337.50 $135.00 $337.50 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $219.38 $337.50 N/A $195.75 $337.50 $202.50 $337.50 $337.50 $337.50 N/A N/A AR-7710-5.0 SUP Custom 27203010 AR-7710-5.0 - BIT DRL 5MM HUM TNL ULN COLLATERAL LGMNT BOTH IP/OP $337.50 $250.00 $60.08 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $60.08 $337.50 $337.50 $250.49 $250.49 $260.15 $175.84 $70.34 $337.50 $135.00 $337.50 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $219.38 $337.50 N/A $195.75 $337.50 $202.50 $337.50 $337.50 $337.50 N/A N/A AR-7711 SUP Custom 27203010 AR-7711 - BIT DRL 4.5MM 15MM SCKT HUM TNL ULN COLLATERAL LGMNT BOTH IP/OP $987.50 $731.00 $175.78 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $175.78 $987.50 $987.50 $732.92 $732.92 $761.17 $514.49 $205.81 $987.50 $395.00 $987.50 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $641.88 $987.50 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A AR-7715-4.5 SUP Custom 27203010 AR-7715-4.5 - KIT INST 2 MIC CRV 6IN STRL TIGERLOOP FIBERLOOP SUTLSO NDL BOTH IP/OP "$1,737.50" "$1,286.00" $309.28 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $309.28 "$1,737.50" "$1,737.50" "$1,289.57" "$1,289.57" "$1,339.27" $905.24 $362.11 "$1,737.50" $695.00 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" "$1,129.38" "$1,737.50" N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" "$1,737.50" "$1,737.50" N/A N/A AR-7720-2.0 SUP Custom 27203010 AR-7720-2.0 - DRILL SRG 2MM RECON ELB HUM ULN COLLATERAL LGMNT BOTH IP/OP $337.50 $250.00 $60.08 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $60.08 $337.50 $337.50 $250.49 $250.49 $260.15 $175.84 $70.34 $337.50 $135.00 $337.50 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $219.38 $337.50 N/A $195.75 $337.50 $202.50 $337.50 $337.50 $337.50 N/A N/A AR-7720-2.7 SUP Custom 27203010 AR-7720-2.7 - DRILL SRG 2.7MM HUM BOTH IP/OP $337.50 $250.00 $60.08 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $60.08 $337.50 $337.50 $250.49 $250.49 $260.15 $175.84 $70.34 $337.50 $135.00 $337.50 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $219.38 $337.50 N/A $195.75 $337.50 $202.50 $337.50 $337.50 $337.50 N/A N/A AR-7720-3.2 SUP Custom 27203010 AR-7720-3.2 - DRILL SRG 3.2MM HUM BOTH IP/OP $337.50 $250.00 $60.08 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $60.08 $337.50 $337.50 $250.49 $250.49 $260.15 $175.84 $70.34 $337.50 $135.00 $337.50 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $219.38 $337.50 N/A $195.75 $337.50 $202.50 $337.50 $337.50 $337.50 N/A N/A AR-7720-3.5 SUP Custom 27203010 AR-7720-3.5 - DRILL SRG 3.5MM RECON ELB HUM ULN COLLATERAL LGMNT BOTH IP/OP $337.50 $250.00 $60.08 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $60.08 $337.50 $337.50 $250.49 $250.49 $260.15 $175.84 $70.34 $337.50 $135.00 $337.50 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $219.38 $337.50 N/A $195.75 $337.50 $202.50 $337.50 $337.50 $337.50 N/A N/A AR-7720-4.0 SUP Custom 27203010 AR-7720-4.0 - DRILL SRG 4MM RECON ELB HUM ULN COLLATERAL LGMNT BOTH IP/OP $337.50 $250.00 $60.08 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $60.08 $337.50 $337.50 $250.49 $250.49 $260.15 $175.84 $70.34 $337.50 $135.00 $337.50 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $219.38 $337.50 N/A $195.75 $337.50 $202.50 $337.50 $337.50 $337.50 N/A N/A AR-7750-3.5 SUP Custom 27203010 AR-7750-3.5 - GUIDE DRL V 3.5MM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $231.94 $231.94 $240.88 $162.81 $65.13 $312.50 $135.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $203.13 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A AR-7750-55 SUP Custom 27203010 AR-7750-55 - GUIDE DRL 55D V ULNA BOTH IP/OP "$1,487.50" "$1,101.00" $264.78 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $264.78 "$1,487.50" "$1,487.50" "$1,104.02" "$1,104.02" "$1,146.57" $774.99 $310.01 "$1,487.50" $642.60 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $966.88 "$1,487.50" N/A $862.75 "$1,487.50" $892.50 "$1,487.50" "$1,487.50" "$1,487.50" N/A N/A AR-7750-55M SUP Custom 27203010 AR-7750-55M - GUIDE DRL 55D V PRT ULNA BOTH IP/OP "$1,487.50" "$1,101.00" $264.78 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $264.78 "$1,487.50" "$1,487.50" "$1,104.02" "$1,104.02" "$1,146.57" $774.99 $310.01 "$1,487.50" $642.60 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $966.88 "$1,487.50" N/A $862.75 "$1,487.50" $892.50 "$1,487.50" "$1,487.50" "$1,487.50" N/A N/A AR-7752 SUP Custom 27203010 AR-7752 - GUIDE DRL 3.5MM BOTH IP/OP $987.50 $731.00 $175.78 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $175.78 $987.50 $987.50 $732.92 $732.92 $761.17 $514.49 $205.81 $987.50 $426.60 $987.50 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $641.88 $987.50 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A AR-7755 SUP Custom 27203010 AR-7755 - GUIDE DRL OFST 7MM ULNA BOTH IP/OP "$1,487.50" "$1,101.00" $264.78 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $264.78 "$1,487.50" "$1,487.50" "$1,104.02" "$1,104.02" "$1,146.57" $774.99 $310.01 "$1,487.50" $642.60 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $966.88 "$1,487.50" N/A $862.75 "$1,487.50" $892.50 "$1,487.50" "$1,487.50" "$1,487.50" N/A N/A AR-8003-10 SUP HCPCS C1713 AR-8003-10 - STAPLE BN 10X10MM CMPR SS BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $459.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A AR-8003-15 SUP HCPCS C1713 AR-8003-15 - STAPLE BN 15X10MM CMPR SS BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $459.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A AR-8004-10 SUP HCPCS C1713 AR-8004-10 - STAPLE BN 10X15MM CMPR SS BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $459.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A AR-8004-15 SUP HCPCS C1713 AR-8004-15 - STAPLE BN 15X15MM CMPR SS DISP BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,147.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,147.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" "$1,062.50" "$1,062.50" $221.43 "$1,062.50" N/A N/A AR-8005-20 SUP HCPCS C1713 AR-8005-20 - STAPLE BN 20X20MM CMPR SS DISP BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,147.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,147.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A AR-8005D-20 SUP Custom 27203010 AR-8005D-20 - BIT DRL 2MM 120MM CNN BOTH IP/OP $347.50 $257.00 $61.86 $347.50 $347.50 $347.50 $347.50 $347.50 $347.50 $347.50 $61.86 $347.50 $347.50 $257.91 $257.91 $267.85 $181.05 $72.42 $347.50 $150.12 $347.50 $347.50 $347.50 $347.50 $347.50 $260.63 $347.50 $347.50 $347.50 $173.75 $173.75 $275.22 $347.50 $278.00 $225.88 $347.50 N/A $201.55 $347.50 $208.50 $347.50 $347.50 $347.50 N/A N/A AR-8005D-30 SUP Custom 27203010 AR-8005D-30 - BIT DRL 3MM 120MM CNN BOTH IP/OP $347.50 $257.00 $61.86 $347.50 $347.50 $347.50 $347.50 $347.50 $347.50 $347.50 $61.86 $347.50 $347.50 $257.91 $257.91 $267.85 $181.05 $72.42 $347.50 $139.00 $347.50 $347.50 $347.50 $347.50 $347.50 $260.63 $347.50 $347.50 $347.50 $173.75 $173.75 $275.22 $347.50 $278.00 $225.88 $347.50 N/A $201.55 $347.50 $208.50 $347.50 $347.50 $347.50 N/A N/A AR-8006-20 SUP HCPCS C1713 AR-8006-20 - PLATE BN 20MM 2 CMPR 2 HL SS FT/ANKL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8006-25 SUP HCPCS C1713 AR-8006-25 - PLATE BN 25MM 2 CMPR 2 HL SS FT/ANKL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,416.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,416.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8006-30 SUP HCPCS C1713 AR-8006-30 - PLATE BN 30MM 2 CMPR 2 HL SS FT/ANKL BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A AR-8006C SUP Custom 27203010 AR-8006C - BIT DRL 2.4MM TRMIT CNN SLF CMPR THRD PTCH BOTH IP/OP "$3,625.00" "$2,683.00" $645.25 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $645.25 "$3,625.00" "$3,625.00" "$2,690.48" "$2,690.48" "$2,794.15" "$1,888.63" $755.49 "$3,625.00" "$1,566.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$2,356.25" "$3,625.00" N/A "$2,102.50" "$3,625.00" "$2,175.00" "$3,625.00" "$3,625.00" "$3,625.00" N/A N/A AR-8006S SUP Custom 27203010 AR-8006S - BIT DRL 2.5MM LAPIDUS CNN SLF CMPR THRD PTCH MIDFOOT BOTH IP/OP "$10,000.00" "$7,400.00" "$1,780.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$1,780.00" "$10,000.00" "$10,000.00" "$4,181.12" "$4,181.12" "$7,708.00" "$2,060.15" "$2,084.11" "$10,000.00" "$4,320.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$6,500.00" "$10,000.00" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A AR-8006T SUP HCPCS C1713 AR-8006T - PLATE BN TRL 2 HL 2 CMPR BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,336.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" "$1,336.50" $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" $742.50 "$1,237.50" $257.90 "$1,237.50" N/A N/A AR-8007-20 SUP HCPCS C1713 AR-8007-20 - PLATE BN 20MM 2 CMPR 3 HL SS FT/ANKL BOTH IP/OP "$2,487.50" "$1,841.00" $493.71 "$2,487.50" "$1,119.38" "$1,119.38" "$1,119.38" "$1,119.38" "$2,487.50" "$2,487.50" "$2,487.50" $518.46 "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" $518.42 "$2,487.50" "$1,074.60" "$1,471.36" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$1,865.63" "$2,487.50" "$2,487.50" "$2,487.50" "$1,243.75" "$1,243.75" "$1,970.10" "$2,487.50" "$1,990.00" "$1,119.38" $493.71 N/A "$1,442.75" "$2,487.50" "$1,492.50" "$2,487.50" "$2,487.50" "$2,487.50" N/A N/A AR-8007-25 SUP HCPCS C1713 AR-8007-25 - PLATE BN 25MM 2 CMPR 3 HL SS FT/ANKL BOTH IP/OP "$2,487.50" "$1,841.00" $493.71 "$2,686.50" "$1,119.38" "$1,119.38" "$1,119.38" "$1,119.38" "$2,487.50" "$2,487.50" "$2,487.50" $518.46 "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" $518.42 "$2,487.50" "$2,686.50" "$1,471.36" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$1,865.63" "$2,487.50" "$2,487.50" "$2,487.50" "$1,243.75" "$1,243.75" "$1,970.10" "$2,487.50" "$1,990.00" "$1,119.38" $493.71 N/A "$1,442.75" "$2,487.50" "$1,492.50" "$2,487.50" $518.40 "$2,487.50" N/A N/A AR-8007-30 SUP HCPCS C1713 AR-8007-30 - PLATE BN 30MM 2 CMPR 3 HL SS FT/ANKL BOTH IP/OP "$2,487.50" "$1,841.00" $493.71 "$2,686.50" "$1,119.38" "$1,119.38" "$1,119.38" "$1,119.38" "$2,487.50" "$2,487.50" "$2,487.50" $518.46 "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" $518.42 "$2,487.50" "$2,686.50" "$1,471.36" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$1,865.63" "$2,487.50" "$2,487.50" "$2,487.50" "$1,243.75" "$1,243.75" "$1,970.10" "$2,487.50" "$1,990.00" "$1,119.38" $493.71 N/A "$1,442.75" "$2,487.50" "$1,492.50" "$2,487.50" "$2,487.50" "$2,487.50" N/A N/A AR-8007C-1 SUP HCPCS C1713 AR-8007C-1 - CASE INST 2 CMPR BOTH IP/OP "$4,737.50" "$3,506.00" $940.28 "$4,737.50" "$2,131.88" "$2,131.88" "$2,131.88" "$2,131.88" "$4,737.50" "$4,737.50" "$4,737.50" $987.41 "$4,737.50" "$4,737.50" "$4,737.50" "$4,737.50" "$4,737.50" $987.35 "$4,737.50" "$2,046.60" "$2,335.59" "$4,737.50" "$4,737.50" "$4,737.50" "$4,737.50" "$3,553.13" "$4,737.50" "$4,737.50" "$4,737.50" "$2,368.75" "$2,368.75" "$3,752.10" "$4,737.50" "$3,790.00" "$2,131.88" $940.28 N/A "$2,747.75" "$4,737.50" "$4,737.50" "$4,737.50" $987.30 "$4,737.50" N/A N/A AR-8007T SUP HCPCS C1713 AR-8007T - TRIAL TRMA 3 HL 2 CMPR PLT BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $534.60 $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" $257.90 "$1,237.50" N/A N/A AR-8008-20 SUP HCPCS C1713 AR-8008-20 - PLATE BN STRG 20MM 2 CMPR 4 HL SS FT/ANKL BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$3,226.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$3,226.50" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$1,792.50" "$2,987.50" "$2,987.50" "$2,987.50" N/A N/A AR-8008-25 SUP HCPCS C1713 AR-8008-25 - PLATE BN STRG 25MM 2 CMPR 4 HL SS FT/ANKL BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$3,226.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$3,226.50" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$1,792.50" "$2,987.50" "$2,987.50" "$2,987.50" N/A N/A AR-8008-30 SUP HCPCS C1713 AR-8008-30 - PLATE BN STRG 30MM 2 CMPR 4 HL SS FT/ANKL BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$1,290.60" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$2,987.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A AR-8009-20 SUP HCPCS C1713 AR-8009-20 - PLATE BN SQ 20MM 2 CMPR 4 HL SS FT/ANKL BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$1,290.60" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$2,987.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A AR-8009-25 SUP HCPCS C1713 AR-8009-25 - PLATE BN SQ 25MM 2 CMPR 4 HL SS FT/ANKL BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$3,226.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$3,226.50" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$1,792.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A AR-8009-30 SUP HCPCS C1713 AR-8009-30 - PLATE BN SQ 30MM 2 CMPR 4 HL SS FT/ANKL BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$1,290.60" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$1,792.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A AR-8400CSS SUP Custom 27203010 AR-8400CSS - BURR SHVR 6 FLUT 4MM 13CM STRL CLRCT COOLCUT SLAP BOTH IP/OP $165.00 $122.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $165.00 N/A $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A AR-8400EX SUP Custom 27203010 AR-8400EX - BLADE SHVR 4MM 13CM STRL EXCLBR COOLCUT DISP BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A AR-8400OBE SUP Custom 27203010 AR-8400OBE - BURR SHVR 8 FLUT OVL 4MM 13CM STRL COOLCUT DISP BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A AR-8400TD SUP Custom 27203010 AR-8400TD - BLADE SHVR TORPEDO 4MM 13CM COOLCUT 2 INR CUT BOTH IP/OP "$1,262.50" $934.00 $224.73 "$1,262.50" "$1,262.50" "$1,262.50" "$1,262.50" "$1,262.50" "$1,262.50" "$1,262.50" $224.73 "$1,262.50" "$1,262.50" $937.03 $937.03 $973.14 $657.76 $263.12 "$1,262.50" $505.00 "$1,262.50" "$1,262.50" "$1,262.50" "$1,262.50" "$1,262.50" $946.88 "$1,262.50" "$1,262.50" "$1,262.50" $631.25 $631.25 $999.90 "$1,262.50" "$1,010.00" $820.63 "$1,262.50" N/A $732.25 "$1,262.50" $757.50 "$1,262.50" "$1,262.50" "$1,262.50" N/A N/A AR-8500BC SUP Custom 27203010 AR-8500BC - CUTTER BN CUT 5MM 13CM STRL COOLCUT DISP BOTH IP/OP $165.00 $122.00 $29.37 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $165.00 $29.37 $165.00 $165.00 $122.46 $122.46 $127.18 $85.97 $34.39 $165.00 $66.00 $165.00 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $107.25 $165.00 N/A $95.70 $165.00 $99.00 $165.00 $165.00 $165.00 N/A N/A AR-8500EX SUP Custom 27203010 AR-8500EX - BLADE SHVR 5MM 13CM STRL EXCLBR COOLCUT DISP BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A AR-8500OBE SUP Custom 27203010 AR-8500OBE - BURR SHVR 8 FLUT OVL 5MM 13CM STRL COOLCUT DISP BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A AR-8545-16 SUP HCPCS C1713 AR-8545-16 - SCREW BN LOPRFL 4.5MM 16MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-18 SUP HCPCS C1713 AR-8545-18 - SCREW BN LOPRFL 4.5MM 18MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $187.50 $187.50 N/A N/A AR-8545-20 SUP HCPCS C1713 AR-8545-20 - SCREW BN LOPRFL 4.5MM 20MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-22 SUP HCPCS C1713 AR-8545-22 - SCREW BN LOPRFL 4.5MM 22MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $202.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-24 SUP HCPCS C1713 AR-8545-24 - SCREW BN LOPRFL 4.5MM 24MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $202.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-26 SUP HCPCS C1713 AR-8545-26 - SCREW BN LOPRFL 4.5MM 26MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $187.50 $187.50 N/A N/A AR-8545-28 SUP HCPCS C1713 AR-8545-28 - SCREW BN LOPRFL 4.5MM 28MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $202.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-30 SUP HCPCS C1713 AR-8545-30 - SCREW BN LOPRFL 4.5MM 30MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $202.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $187.50 $187.50 N/A N/A AR-8545-32 SUP HCPCS C1713 AR-8545-32 - SCREW BN LOPRFL 4.5MM 32MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-34 SUP HCPCS C1713 AR-8545-34 - SCREW BN LOPRFL 4.5MM 34MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A AR-8545-36 SUP HCPCS C1713 AR-8545-36 - SCREW BN LOPRFL 4.5MM 36MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $202.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-38 SUP HCPCS C1713 AR-8545-38 - SCREW BN LOPRFL 4.5MM 38MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-40 SUP HCPCS C1713 AR-8545-40 - SCREW BN LOPRFL 4.5MM 40MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-42 SUP HCPCS C1713 AR-8545-42 - SCREW BN 4.5MM 42MM NS ARTHX LOPRFL TI BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-45 SUP HCPCS C1713 AR-8545-45 - SCREW BN LOPRFL 4.5MM 45MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-48 SUP HCPCS C1713 AR-8545-48 - SCREW BN 4.5MM 48MM LOPRFL TI BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-50 SUP HCPCS C1713 AR-8545-50 - SCREW BN LOPRFL 4.5MM 50MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $202.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-55 SUP HCPCS C1713 AR-8545-55 - SCREW BN LOPRFL 4.5MM 55MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $202.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-60 SUP HCPCS C1713 AR-8545-60 - SCREW BN LOPRFL 4.5MM 60MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $202.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A AR-8545-65 SUP HCPCS C1713 AR-8545-65 - SCREW BN LOPRFL 4.5MM 65MM ANKL BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $202.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A AR-8545L-16 SUP HCPCS C1713 AR-8545L-16 - SCREW BN LOPRFL 4.5MM 16MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-8545L-18 SUP HCPCS C1713 AR-8545L-18 - SCREW BN LOPRFL 4.5MM 18MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-20 SUP HCPCS C1713 AR-8545L-20 - SCREW BN LOPRFL 4.5MM 20MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $487.50 $487.50 N/A N/A AR-8545L-22 SUP HCPCS C1713 AR-8545L-22 - SCREW BN LOPRFL 4.5MM 22MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $487.50 $487.50 N/A N/A AR-8545L-24 SUP HCPCS C1713 AR-8545L-24 - SCREW BN LOPRFL 4.5MM 24MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $526.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $526.50 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-26 SUP HCPCS C1713 AR-8545L-26 - SCREW BN LOPRFL 4.5MM 26MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-28 SUP HCPCS C1713 AR-8545L-28 - SCREW BN LOPRFL 4.5MM 28MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-30 SUP HCPCS C1713 AR-8545L-30 - SCREW BN LOPRFL 4.5MM 30MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-32 SUP HCPCS C1713 AR-8545L-32 - SCREW BN LOPRFL 4.5MM 32MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-34 SUP HCPCS C1713 AR-8545L-34 - SCREW BN LOPRFL 4.5MM 34MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-36 SUP HCPCS C1713 AR-8545L-36 - SCREW BN LOPRFL 4.5MM 36MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $526.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $526.50 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-38 SUP HCPCS C1713 AR-8545L-38 - SCREW BN LOPRFL 4.5MM 38MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-40 SUP HCPCS C1713 AR-8545L-40 - SCREW BN LOPRFL 4.5MM 40MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-44 SUP HCPCS C1713 AR-8545L-44 - SCREW BN 4.5MM 44MM NS ARTHX LCK LOPRFL TI BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-50 SUP HCPCS C1713 AR-8545L-50 - SCREW BN LOPRFL 4.5MM 50MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-50S SUP HCPCS C1713 AR-8545L-50S - SCREW BN 4.5MM 50MM STRL ARTHX LOPRFL LCK BOTH IP/OP $487.50 $361.00 $96.76 $526.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $526.50 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-52 SUP HCPCS C1713 AR-8545L-52 - SCREW BN 4.5MM 52MM LOPRFL LCK BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-8545L-54 SUP HCPCS C1713 AR-8545L-54 - SCREW BN 4.5MM 54MM LOPRFL LCK BOTH IP/OP $487.50 $361.00 $96.76 $526.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $526.50 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $487.50 $487.50 N/A N/A AR-8545L-55 SUP HCPCS C1713 AR-8545L-55 - SCREW BN LOPRFL 4.5MM 55MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $526.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $526.50 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-8545L-56 SUP HCPCS C1713 AR-8545L-56 - SCREW BN 4.5MM 56MM LOPRFL LCK BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-58 SUP HCPCS C1713 AR-8545L-58 - SCREW BN 4.5MM 58MM LOPRFL LCK BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $487.50 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-60 SUP HCPCS C1713 AR-8545L-60 - SCREW BN LOPRFL 4.5MM 60MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A AR-8545L-65 SUP HCPCS C1713 AR-8545L-65 - SCREW BN LOPRFL 4.5MM 65MM LCK ANKL BOTH IP/OP $487.50 $361.00 $96.76 $487.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $210.60 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $292.50 $487.50 $101.60 $487.50 N/A N/A AR-8555-20 SUP HCPCS C1713 AR-8555-20 - SCREW BN LOPRFL 5.5MM 20MM ANKL CANC BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $202.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8555-25 SUP HCPCS C1713 AR-8555-25 - SCREW BN LOPRFL 5.5MM 25MM ANKL CANC BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $202.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8555-30 SUP HCPCS C1713 AR-8555-30 - SCREW BN LOPRFL 5.5MM 30MM ANKL CANC BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $202.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8555-35 SUP HCPCS C1713 AR-8555-35 - SCREW BN LOPRFL 5.5MM 35MM ANKL CANC BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $202.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8555-40 SUP HCPCS C1713 AR-8555-40 - SCREW BN LOPRFL 5.5MM 40MM ANKL CANC BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8555-45 SUP HCPCS C1713 AR-8555-45 - SCREW BN LOPRFL 5.5MM 45MM ANKL CANC BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8555-50 SUP HCPCS C1713 AR-8555-50 - SCREW BN LOPRFL 5.5MM 50MM ANKL CANC BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $202.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8555-55 SUP HCPCS C1713 AR-8555-55 - SCREW BN LOPRFL 5.5MM 55MM ANKL CANC BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $187.50 $187.50 N/A N/A AR-8555-60 SUP HCPCS C1713 AR-8555-60 - SCREW BN LOPRFL 5.5MM 60MM ANKL CANC BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $187.50 $187.50 N/A N/A AR-8555-65 SUP HCPCS C1713 AR-8555-65 - SCREW BN LOPRFL 5.5MM 65MM ANKL CANC BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8555-70 SUP HCPCS C1713 AR-8555-70 - SCREW BN LOPRFL 5.5MM 70MM ANKL CANC BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8555-75 SUP HCPCS C1713 AR-8555-75 - SCREW BN LOPRFL 5.5MM 75MM ANKL CANC BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $81.00 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A AR-8610DB-25 SUP Custom 27203010 "AR-8610DB-25 - DRILL BIT, CANNULATED, 1.7MM" BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8610DB-25C SUP Custom 27203010 AR-8610DB-25C - BIT DRL 1.7MM CNN BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8610DB-30 SUP Custom 27203010 "AR-8610DB-30 - DRILL BIT, CANNULATED, 2.0MM" BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8610DB-30C SUP Custom 27203010 AR-8610DB-30C - BIT DRL 2MM CNN VTRN BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8610DB-43 SUP Custom 27203010 "AR-8610DB-43 - DRILL BIT, CANNULATED, 3.0MM" BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8610DB-43C SUP Custom 27203010 AR-8610DB-43C - BIT DRL 3MM CNN DISP 4.3MM HDLS CMPR SCR BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8610DB-65 SUP Custom 27203010 "AR-8610DB-65 - DRILL BIT, CANNULATED, 4.3MM" BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8610DB-65C SUP Custom 27203010 AR-8610DB-65C - BIT DRL 4.3MM CNN DISP 6.5MM HDLS CMPR P/T SCR BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8610S-01 SUP HCPCS C1713 AR-8610S-01 - HEADLESS COMPRESSION SCREW SYSTEM2.5/3.0 BOTH IP/OP "$34,412.50" "$25,465.00" "$6,830.02" "$34,412.50" "$15,485.63" "$15,485.63" "$15,485.63" "$15,485.63" "$34,412.50" "$34,412.50" "$34,412.50" "$7,172.43" "$34,412.50" "$34,412.50" "$34,412.50" "$34,412.50" "$34,412.50" "$7,171.94" "$34,412.50" "$13,765.00" "$16,965.36" "$34,412.50" "$34,412.50" "$34,412.50" "$34,412.50" "$25,809.38" "$34,412.50" "$34,412.50" "$34,412.50" "$17,206.25" "$17,206.25" "$27,254.70" "$34,412.50" "$27,530.00" "$15,485.63" "$6,830.02" N/A "$19,959.25" "$34,412.50" "$20,647.50" "$34,412.50" "$34,412.50" "$34,412.50" N/A N/A AR-8610S-02 SUP HCPCS C1713 AR-8610S-02 - HEADLESS COMPRESSION SCREW SYSTEM4.3/6.5 BOTH IP/OP "$29,750.00" "$22,015.00" "$5,904.63" "$29,750.00" "$13,387.50" "$13,387.50" "$13,387.50" "$13,387.50" "$29,750.00" "$29,750.00" "$29,750.00" "$6,200.64" "$29,750.00" "$29,750.00" "$29,750.00" "$29,750.00" "$29,750.00" "$6,200.23" "$29,750.00" "$11,900.00" "$14,666.75" "$29,750.00" "$29,750.00" "$29,750.00" "$29,750.00" "$22,312.50" "$29,750.00" "$29,750.00" "$29,750.00" "$14,875.00" "$14,875.00" "$23,562.00" "$29,750.00" "$23,800.00" "$13,387.50" "$5,904.63" N/A "$17,255.00" "$29,750.00" "$17,850.00" "$29,750.00" "$6,199.90" "$29,750.00" N/A N/A AR-8625-08 SUP HCPCS C1713 AR-8625-08 - HEADLESS COMPR SCRW 2.5X 8 MMCANN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8625-10 SUP HCPCS C1713 AR-8625-10 - HEADLESS COMPR SCRW 2.5X 10 MMCANN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8625-12 SUP HCPCS C1713 AR-8625-12 - HEADLESS COMPR SCRW 2.5X 12 MMCANN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8625-14 SUP HCPCS C1713 AR-8625-14 - HEADLESS COMPR SCRW 2.5X 14 MMCANN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8625-16 SUP HCPCS C1713 AR-8625-16 - HEADLESS COMPR SCRW 2.5X 16 MMCANN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8625-18 SUP HCPCS C1713 AR-8625-18 - HEADLESS COMPR SCRW 2.5X 18 MMCANN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8625-20 SUP HCPCS C1713 AR-8625-20 - SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A AR-8625-22 SUP HCPCS C1713 AR-8625-22 - HEADLESS COMPR SCRW 2.5X 22 MMCANN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8625-24 SUP HCPCS C1713 AR-8625-24 - HEADLESS COMPR SCRW 2.5X 24 MMCANN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8625-26 SUP HCPCS C1713 AR-8625-26 - HEADLESS COMPR SCRW 2.5X 26 MMCANN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8625-28 SUP HCPCS C1713 AR-8625-28 - HEADLESS COMPR SCRW 2.5X 28 MMCANN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8625-30 SUP HCPCS C1713 AR-8625-30 - HEADLESS COMPR SCRW 2.5X 30 MMCANN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8625-32 SUP HCPCS C1713 AR-8625-32 - HEADLESS COMPR SCRW 2.5X 32 MMCANN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A AR-8625-34 SUP HCPCS C1713 AR-8625-34 - HEADLESS COMPR SCRW 2.5X 34 MMCANN BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8630-10 SUP HCPCS C1713 "AR-8630-10 - HEDLESS COMPR SCRW,3.0X 10 MMCANN" BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8630-12 SUP HCPCS C1713 "AR-8630-12 - HEDLESS COMPR SCRW,3.0X 12 MMCANN" BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8630-14 SUP HCPCS C1713 "AR-8630-14 - HEDLESS COMPR SCRW,3.0X 14 MMCANN" BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A AR-8630-16 SUP HCPCS C1713 "AR-8630-16 - HEDLESS COMPR SCRW,3.0X 16 MMCANN" BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $687.50 $687.50 N/A N/A AR-8630-18 SUP HCPCS C1713 "AR-8630-18 - HEDLESS COMPR SCRW,3.0X 18 MMCANN" BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8630-20 SUP HCPCS C1713 "AR-8630-20 - HEDLESS COMPR SCRW,3.0X 20 MMCANN" BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8630-22 SUP HCPCS C1713 "AR-8630-22 - HEDLESS COMPR SCRW,3.0X 22 MMCANN" BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A AR-8630-24 SUP HCPCS C1713 AR-8630-24 - SCREW BN 3MM 24MM NS ARTHX CMPR CNN HDLS BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A AR-8630-26 SUP HCPCS C1713 "AR-8630-26 - HEDLESS COMPR SCRW,3.0X 26 MMCANN" BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8630-28 SUP HCPCS C1713 "AR-8630-28 - HEDLESS COMPR SCRW,3.0X 28 MMCANN" BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8630-30 SUP HCPCS C1713 "AR-8630-30 - HEDLESS COMPR SCRW,3.0X 30 MMCANN" BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8630-32 SUP HCPCS C1713 "AR-8630-32 - HEDLESS COMPR SCRW,3.0X 32 MMCANN" BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8630-34 SUP HCPCS C1713 "AR-8630-34 - HEDLESS COMPR SCRW,3.0X 34 MMCANN" BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A AR-8630-36 SUP HCPCS C1713 "AR-8630-36 - HEDLESS COMPR SCRW,3.0X 36 MMCANN" BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8643-14 SUP HCPCS C1713 "AR-8643-14 - HEDLESS COMPR SCRW,4.3X 14 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-16 SUP HCPCS C1713 "AR-8643-16 - HEDLESS COMPR SCRW,4.3X 16 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-18 SUP HCPCS C1713 "AR-8643-18 - HEDLESS COMPR SCRW,4.3X 18 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-20 SUP HCPCS C1713 "AR-8643-20 - HEDLESS COMPR SCRW,4.3X 20 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-22 SUP HCPCS C1713 "AR-8643-22 - HEDLESS COMPR SCRW,4.3X 22 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-24 SUP HCPCS C1713 "AR-8643-24 - HEDLESS COMPR SCRW,4.3X 24 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-26 SUP HCPCS C1713 "AR-8643-26 - HEDLESS COMPR SCRW,4.3X 26 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-28 SUP HCPCS C1713 "AR-8643-28 - HEDLESS COMPR SCRW,4.3X 28 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-30 SUP HCPCS C1713 "AR-8643-30 - HEDLESS COMPR SCRW,4.3X 30 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-32 SUP HCPCS C1713 "AR-8643-32 - HEDLESS COMPR SCRW,4.3X 32 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-34 SUP HCPCS C1713 "AR-8643-34 - HEDLESS COMPR SCRW,4.3X 34 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-8643-36 SUP HCPCS C1713 "AR-8643-36 - HEDLESS COMPR SCRW,4.3X 36 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $812.50 $812.50 N/A N/A AR-8643-38 SUP HCPCS C1713 "AR-8643-38 - HEDLESS COMPR SCRW,4.3X 38 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-40 SUP HCPCS C1713 "AR-8643-40 - HEDLESS COMPR SCRW,4.3X 40 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-42 SUP HCPCS C1713 "AR-8643-42 - HEDLESS COMPR SCRW,4.3X 42 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-44 SUP HCPCS C1713 "AR-8643-44 - HEDLESS COMPR SCRW,4.3X 44 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $812.50 $812.50 N/A N/A AR-8643-46 SUP HCPCS C1713 "AR-8643-46 - HEDLESS COMPR SCRW,4.3X 46 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-48 SUP HCPCS C1713 "AR-8643-48 - HEDLESS COMPR SCRW,4.3X 48 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-50 SUP HCPCS C1713 "AR-8643-50 - HEDLESS COMPR SCRW,4.3X 50 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-55 SUP HCPCS C1713 "AR-8643-55 - HEDLESS COMPR SCRW,4.3X 55 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-60 SUP HCPCS C1713 "AR-8643-60 - HEDLESS COMPR SCRW,4.3X 60 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-65 SUP HCPCS C1713 "AR-8643-65 - HEDLESS COMPR SCRW,4.3X 65 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-70 SUP HCPCS C1713 "AR-8643-70 - HEDLESS COMPR SCRW,4.3X 70 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-8643-75 SUP HCPCS C1713 "AR-8643-75 - HEDLESS COMPR SCRW,4.3X 75 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8643-80 SUP HCPCS C1713 "AR-8643-80 - HEDLESS COMPR SCRW,4.3X 80 MMCANN" BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $812.50 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-8655-13 SUP Custom 27203010 AR-8655-13 - GUIDE DRL ANKL BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $378.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A AR-8656G SUP Custom 27203010 AR-8656G - GUIDE DRL GPS TRGT BOTH IP/OP "$4,987.50" "$3,691.00" $887.78 "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" $887.78 "$4,987.50" "$4,987.50" "$3,701.72" "$3,701.72" "$3,844.37" "$2,060.15" "$1,039.45" "$4,987.50" "$2,154.60" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$3,740.63" "$4,987.50" "$4,987.50" "$4,987.50" "$2,493.75" "$2,493.75" "$3,950.10" "$4,987.50" "$3,990.00" "$3,241.88" "$4,987.50" N/A "$2,892.75" "$4,987.50" "$2,992.50" "$4,987.50" "$4,987.50" "$4,987.50" N/A N/A AR-8656G-04 SUP Custom 27203010 AR-8656G-04 - CANNULA ASCP GPS 1.1/1.6/2.4 MM BOTH IP/OP "$1,125.00" $833.00 $200.25 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $200.25 "$1,125.00" "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" $486.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A AR-8665-100 SUP HCPCS C1713 AR-8665-100 - HEDLESS COMPR SCRW 6.5X 100 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" "$1,312.50" "$1,312.50" N/A N/A AR-8665-105 SUP HCPCS C1713 AR-8665-105 - HEDLESS COMPR SCRW 6.5X 105 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8665-110 SUP HCPCS C1713 AR-8665-110 - HEDLESS COMPR SCRW 6.5X 110MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" "$1,312.50" "$1,312.50" N/A N/A AR-8665-115 SUP HCPCS C1713 AR-8665-115 - HEDLESS COMPR SCRW 6.5X 115 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8665-120 SUP HCPCS C1713 AR-8665-120 - HEDLESS COMPR SCRW 6.5X 120 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8665-18100 SUP HCPCS C1713 AR-8665-18100 - SCREW BN ST 6.5MM 100MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-18105 SUP HCPCS C1713 AR-8665-18105 - SCREW BN ST 6.5MM 105MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,552.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" "$1,552.50" $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-18110 SUP HCPCS C1713 AR-8665-18110 - SCREW BN ST 6.5MM 110MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,552.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" "$1,552.50" $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-18115 SUP HCPCS C1713 AR-8665-18115 - SCREW BN ST 6.5MM 115MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" $862.50 "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-18120 SUP HCPCS C1713 AR-8665-18120 - SCREW BN ST 6.5MM 120MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" $862.50 "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-1830 SUP HCPCS C1713 AR-8665-1830 - SCREW BN ST 6.5MM 30MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,552.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" "$1,552.50" $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" $862.50 "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-1835 SUP HCPCS C1713 AR-8665-1835 - SCREW BN ST 6.5MM 35MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" $862.50 "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-1850 SUP HCPCS C1713 AR-8665-1850 - SCREW BN P/T 6.5MM 50MM CMPR HDLS BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-1855 SUP HCPCS C1713 AR-8665-1855 - SCREW BN ST 6.5MM 55MM CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" $862.50 "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-1860 SUP HCPCS C1713 AR-8665-1860 - SCREW BN ST 6.5MM 60MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" $862.50 "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-1865 SUP HCPCS C1713 AR-8665-1865 - SCREW BN ST 6.5MM 65MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" $862.50 "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-1880 SUP HCPCS C1713 AR-8665-1880 - SCREW BN P/T 6.5MM 80MM CMPR HDLS BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" $862.50 "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-1885 SUP HCPCS C1713 AR-8665-1885 - SCREW BN P/T 6.5MM 85MM CMPR HDLS BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,552.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" "$1,552.50" $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" $862.50 "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-1890 SUP HCPCS C1713 AR-8665-1890 - SCREW BN ST 6.5MM 90MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" $862.50 "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-1895 SUP HCPCS C1713 AR-8665-1895 - SCREW BN ST 6.5MM 95MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,552.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" "$1,552.50" $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-28100 SUP HCPCS C1713 AR-8665-28100 - SCREW BN L/T 6.5MM 100MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-28105 SUP HCPCS C1713 AR-8665-28105 - SCREW BN L/T 6.5MM 105MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" $862.50 "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-28110 SUP HCPCS C1713 AR-8665-28110 - SCREW BN L/T 6.5MM 110MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" $862.50 "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-28115 SUP HCPCS C1713 AR-8665-28115 - SCREW BN L/T 6.5MM 115MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" $862.50 "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-28120 SUP HCPCS C1713 AR-8665-28120 - SCREW BN L/T 6.5MM 120MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" $862.50 "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-2860 SUP HCPCS C1713 AR-8665-2860 - SCREW BN L/T 6.5MM 60MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,552.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" "$1,552.50" $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-2865 SUP HCPCS C1713 AR-8665-2865 - SCREW BN L/T 6.5MM 65MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,552.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" "$1,552.50" $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-2870 SUP HCPCS C1713 AR-8665-2870 - SCREW BN L/T 6.5MM 70MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-2875 SUP HCPCS C1713 AR-8665-2875 - SCREW BN L/T 6.5MM 75MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-2880 SUP HCPCS C1713 AR-8665-2880 - SCREW BN L/T 6.5MM 80MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,552.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" "$1,552.50" $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" N/A N/A AR-8665-2885 SUP HCPCS C1713 AR-8665-2885 - SCREW BN L/T 6.5MM 85MM NS ARTHX CMPR HDLS BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,552.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" "$1,552.50" $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" N/A N/A AR-8665-2890 SUP HCPCS C1713 AR-8665-2890 - SCREW BN L/T 6.5MM 90MM CMPR CNN HDLS VTRN BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A AR-8665-2895 SUP HCPCS C1713 AR-8665-2895 - SCREW BN L/T 6.5MM 95MM NS ARTHX CMPR HDLS BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" $621.00 $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" N/A N/A AR-8665-30 SUP HCPCS C1713 AR-8665-30 - HEDLESS COMPR SCRW 6.5X 30 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8665-35 SUP HCPCS C1713 AR-8665-35 - HEDLESS COMPR SCRW 6.5X 35 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" "$1,312.50" "$1,312.50" N/A N/A AR-8665-40 SUP HCPCS C1713 AR-8665-40 - HEDLESS COMPR SCRW 6.5X 40 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8665-45 SUP HCPCS C1713 AR-8665-45 - HEDLESS COMPR SCRW 6.5X 45 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" "$1,312.50" "$1,312.50" N/A N/A AR-8665-50 SUP HCPCS C1713 AR-8665-50 - HEDLESS COMPR SCRW 6.5X 50 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8665-55 SUP HCPCS C1713 AR-8665-55 - HEDLESS COMPR SCRW 6.5X 55 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8665-60 SUP HCPCS C1713 AR-8665-60 - HEDLESS COMPR SCRW 6.5X 60 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8665-65 SUP HCPCS C1713 AR-8665-65 - HEDLESS COMPR SCRW 6.5X 65 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8665-70 SUP HCPCS C1713 AR-8665-70 - HEDLESS COMPR SCRW 6.5X 70 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8665-75 SUP HCPCS C1713 AR-8665-75 - HEDLESS COMPR SCRW 6.5X 75 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8665-80 SUP HCPCS C1713 AR-8665-80 - SCREW BN 6.5MM 80MM NS ARTHX CMPR CNN HDLS BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8665-85 SUP HCPCS C1713 AR-8665-85 - HEDLESS COMPR SCRW 6.5X 85 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $525.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8665-90 SUP HCPCS C1713 AR-8665-90 - SCREW BN 6.5MM 90MM NS ARTHX CMPR CNN HDLS BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8665-95 SUP HCPCS C1713 AR-8665-95 - HEDLESS COMPR SCRW 6.5X 95 MMCANN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8690DS SUP HCPCS C1713 AR-8690DS - SYSTEM FX CPR MN SCRPN DX BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,737.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$1,182.60" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8692DS SUP Custom 27203010 AR-8692DS - SYSTEM FX CPR VPR BOTH IP/OP "$2,737.50" "$2,026.00" $487.28 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $487.28 "$2,737.50" "$2,737.50" "$2,031.77" "$2,031.77" "$2,110.07" "$1,426.24" $570.53 "$2,737.50" "$1,182.60" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,779.38" "$2,737.50" N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" "$2,737.50" "$2,737.50" N/A N/A AR-8701 SUP Custom 27203010 AR-8701 - PASSER SUTURE MICRO SMALL CURVE BENT 1.25MM 6IN BRAID EASIER BOTH IP/OP $350.00 $259.00 $62.30 $756.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $756.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-8703 SUP Custom 27203010 AR-8703 - PASSER SUTLSO MIC STR SUTURE STRL DISP BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A AR-8704 SUP Custom 27203010 AR-8704 - PASSER SUT 70D MIC SHRT BNT 3ANG STRL SUTLSO FIBROCARTILAGE BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A AR-8708 SUP HCPCS C1713 AR-8708 - STAPLE BN SM 8MM SUT SS BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8708S SUP HCPCS C1713 AR-8708S - STAPLE BN SM QFIX BOTH IP/OP "$5,625.00" "$4,163.00" "$1,116.42" "$5,625.00" "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.39" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$2,250.00" "$2,773.13" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$1,116.42" N/A "$3,262.50" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.25" "$5,625.00" N/A N/A AR-8710 SUP HCPCS C1713 AR-8710 - STAPLE BN SM 10MM QFIX SS BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8714 SUP HCPCS C1713 AR-8714 - PLATE BN LOPRFL 12MM PLAPLE SS DIAPHYSIS BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,147.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,147.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" "$1,062.50" "$1,062.50" $221.43 "$1,062.50" N/A N/A AR-8715 SUP HCPCS C1713 AR-8715 - PLATE BN LOPRFL 15MM PLAPLE SS SM BN 2.3MM CORT SCR BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,147.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,147.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A AR-8716 SUP HCPCS C1713 AR-8716 - PLATE BN LOPRFL 20MM PLAPLE SS SM BN 2.3MM CORT SCR BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,147.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,147.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" $637.50 "$1,062.50" $221.43 "$1,062.50" N/A N/A AR-8720-08PT SUP HCPCS C1713 AR-8720-08PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 8MM QFIX SLF DRL ST CNN BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A AR-8720-10PT SUP HCPCS C1713 AR-8720-10PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 10MM QFIX SLF DRL ST CNN BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8720-12PT SUP HCPCS C1713 AR-8720-12PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 12MM QFIX SLF DRL ST CNN BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8720-14PT SUP HCPCS C1713 AR-8720-14PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 14MM QFIX SLF DRL ST CNN BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8720-16PT SUP HCPCS C1713 AR-8720-16PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 16MM QFIX SLF DRL ST CNN BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8720-18PT SUP HCPCS C1713 AR-8720-18PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 18MM QFIX SLF DRL ST CNN BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8720-20PT SUP HCPCS C1713 AR-8720-20PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 20MM QFIX SLF DRL ST CNN BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8720-22PT SUP HCPCS C1713 AR-8720-22PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 22MM QFIX SLF DRL ST CNN BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8720-24PT SUP HCPCS C1713 AR-8720-24PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 24MM QFIX SLF DRL ST CNN BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8720-26PT SUP HCPCS C1713 AR-8720-26PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 26MM QFIX SLF DRL ST CNN BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8720-28PT SUP HCPCS C1713 AR-8720-28PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2MM 28MM QFIX SLF DRL ST CNN BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8720-30PT SUP HCPCS C1713 AR-8720-30PT - SCREW BN P/T 2MM 30MM QFIX CNN TI BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8724-08 SUP HCPCS C1713 AR-8724-08 - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 8MM QFIX SLF DRL ST BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8724-08PT SUP HCPCS C1713 AR-8724-08PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 8MM QFIX SLF DRL ST BOTH IP/OP $362.50 $268.00 $71.95 $391.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $391.50 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $362.50 $362.50 N/A N/A AR-8724-10 SUP HCPCS C1713 AR-8724-10 - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 10MM QFIX SLF DRL ST BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8724-10PT SUP HCPCS C1713 AR-8724-10PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 10MM QFIX SLF DRL ST BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $156.60 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $362.50 $362.50 N/A N/A AR-8724-12 SUP HCPCS C1713 AR-8724-12 - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 12MM QFIX SLF DRL ST BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $275.00 $275.00 N/A N/A AR-8724-12PT SUP HCPCS C1713 AR-8724-12PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 12MM QFIX SLF DRL ST BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $156.60 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $75.55 $362.50 N/A N/A AR-8724-14 SUP HCPCS C1713 AR-8724-14 - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 14MM QFIX SLF DRL ST BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $275.00 $275.00 N/A N/A AR-8724-14PT SUP HCPCS C1713 AR-8724-14PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 14MM QFIX SLF DRL ST BOTH IP/OP $362.50 $268.00 $71.95 $391.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $391.50 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $75.55 $362.50 N/A N/A AR-8724-16 SUP HCPCS C1713 AR-8724-16 - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 16MM QFIX SLF DRL ST BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $275.00 $275.00 N/A N/A AR-8724-16PT SUP HCPCS C1713 AR-8724-16PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 16MM QFIX SLF DRL ST BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $156.60 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $75.55 $362.50 N/A N/A AR-8724-18PT SUP HCPCS C1713 AR-8724-18PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 18MM QFIX SLF DRL ST BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $156.60 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $217.50 $362.50 $75.55 $362.50 N/A N/A AR-8724-20 SUP HCPCS C1713 AR-8724-20 - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 20MM QFIX SLF DRL ST BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8724-20PT SUP HCPCS C1713 AR-8724-20PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 20MM QFIX SLF DRL ST BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $156.60 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $217.50 $362.50 $75.55 $362.50 N/A N/A AR-8724-22 SUP HCPCS C1713 AR-8724-22 - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 22MM QFIX SLF DRL ST BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8724-22PT SUP HCPCS C1713 AR-8724-22PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 22MM QFIX SLF DRL ST BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $156.60 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $217.50 $362.50 $75.55 $362.50 N/A N/A AR-8724-24PT SUP HCPCS C1713 AR-8724-24PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 24MM QFIX SLF DRL ST BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $156.60 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $217.50 $362.50 $75.55 $362.50 N/A N/A AR-8724-26PT SUP HCPCS C1713 AR-8724-26PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 26MM QFIX SLF DRL ST BOTH IP/OP $362.50 $268.00 $71.95 $391.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $391.50 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A AR-8724-28 SUP HCPCS C1713 AR-8724-28 - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 28MM QFIX SLF DRL ST BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8724-28PT SUP HCPCS C1713 AR-8724-28PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 28MM QFIX SLF DRL ST BOTH IP/OP $362.50 $268.00 $71.95 $391.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $391.50 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A AR-8724-30 SUP HCPCS C1713 AR-8724-30 - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 30MM QFIX SLF DRL ST BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8724-30PT SUP HCPCS C1713 AR-8724-30PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 30MM QFIX SLF DRL ST BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $156.60 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $217.50 $362.50 $75.55 $362.50 N/A N/A AR-8724-32 SUP HCPCS C1713 AR-8724-32 - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 32MM QFIX SLF DRL ST BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8724-32PT SUP HCPCS C1713 AR-8724-32PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 32MM QFIX SLF DRL ST BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $156.60 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $75.55 $362.50 N/A N/A AR-8724-34 SUP HCPCS C1713 AR-8724-34 - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 34MM QFIX SLF DRL ST BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8724-34PT SUP HCPCS C1713 AR-8724-34PT - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 34MM QFIX SLF DRL ST BOTH IP/OP $362.50 $268.00 $71.95 $391.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $391.50 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $75.55 $362.50 N/A N/A AR-8724-36 SUP HCPCS C1713 AR-8724-36 - SCREW BN T8 P/T HEXALOBE LOPRFL 2.4MM 36MM QFIX SLF DRL ST BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8724-36PT SUP HCPCS C1713 AR-8724-36PT - SCREW BN P/T 2.4MM 36MM QFIX CNN TI BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $163.13 $163.13 $163.13 $163.13 $362.50 $362.50 $362.50 $75.55 $362.50 $362.50 $362.50 $362.50 $362.50 $75.55 $362.50 $156.60 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $163.13 $71.95 N/A $210.25 $362.50 $217.50 $362.50 $75.55 $362.50 N/A N/A AR-8724-38 SUP HCPCS C1713 AR-8724-38 - SCREW BN 2.4MM 38MM LOPRFL TI FT/ANKL CORT BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8724-40 SUP HCPCS C1713 AR-8724-40 - SCREW BN 2.4MM 40MM LOPRFL TI FT/ANKL CORT BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8724GV SUP Custom 27203010 AR-8724GV - GUIDE DRL 2.4MM VA BOTH IP/OP "$1,187.50" $879.00 $211.38 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $211.38 "$1,187.50" "$1,187.50" $881.36 $881.36 $915.33 $618.69 $247.49 "$1,187.50" $513.00 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $771.88 "$1,187.50" N/A $688.75 "$1,187.50" $712.50 "$1,187.50" "$1,187.50" "$1,187.50" N/A N/A AR-8724L-08 SUP HCPCS C1713 AR-8724L-08 - SCREW BN 2.4MM 8MM LCK LOPRFL BOTH IP/OP $312.50 $231.00 $62.02 $337.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $337.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-10 SUP HCPCS C1713 AR-8724L-10 - SCREW BN T8 FT HEXALOBE 2.4MM 10MM SLF DRL SLD LCK TI SM BN BOTH IP/OP $312.50 $231.00 $62.02 $337.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $337.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-12 SUP HCPCS C1713 AR-8724L-12 - SCREW BN T8 FT HEXALOBE 2.4MM 12MM SLF DRL SLD LCK TI SM BN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $135.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-14 SUP HCPCS C1713 AR-8724L-14 - SCREW BN T8 FT HEXALOBE 2.4MM 14MM SLF DRL SLD LCK TI SM BN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $135.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-16 SUP HCPCS C1713 AR-8724L-16 - SCREW BN T8 FT HEXALOBE 2.4MM 16MM SLF DRL SLD LCK TI SM BN BOTH IP/OP $312.50 $231.00 $62.02 $337.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $337.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-18 SUP HCPCS C1713 AR-8724L-18 - SCREW BN T8 FT HEXALOBE 2.4MM 18MM SLF DRL SLD LCK TI SM BN BOTH IP/OP $312.50 $231.00 $62.02 $337.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $337.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-20 SUP HCPCS C1713 AR-8724L-20 - SCREW BN T8 FT HEXALOBE 2.4MM 20MM SLF DRL SLD LCK TI SM BN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $135.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-22 SUP HCPCS C1713 AR-8724L-22 - SCREW BN LOPRFL 2.4MM 22MM LCK ST SLD TI FT BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $135.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-24 SUP HCPCS C1713 AR-8724L-24 - SCREW BN LOPRFL 2.4MM 24MM LCK ST SLD TI FT BOTH IP/OP $312.50 $231.00 $62.02 $337.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $337.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-26 SUP HCPCS C1713 AR-8724L-26 - SCREW BN 2.4MM 26MM LCK LOPRFL TI FT/ANKL BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $135.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-28 SUP HCPCS C1713 AR-8724L-28 - SCREW BN 2.4MM 28MM LOPRFL LCK TI BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $135.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-30 SUP HCPCS C1713 AR-8724L-30 - SCREW BN 2.4MM 30MM LCK LOPRFL TI FT/ANKL BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $135.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-32 SUP HCPCS C1713 AR-8724L-32 - SCREW BN 2.4MM 32MM LCK LOPRFL TI FT/ANKL BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $135.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-34 SUP HCPCS C1713 AR-8724L-34 - SCREW BN T8 FT HEXALOBE 2.4MM 34MM LCK SLF DRL SLD TI SM BN BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $135.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-36 SUP HCPCS C1713 AR-8724L-36 - SCREW BN T8 FT HEXALOBE 2.4MM 36MM LCK SLF DRL SLD TI SM BN BOTH IP/OP $312.50 $231.00 $62.02 $337.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $337.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-38 SUP HCPCS C1713 AR-8724L-38 - SCREW BN 2.4MM 38MM LCK LOPRFL TI FT/ANKL BOTH IP/OP $312.50 $231.00 $62.02 $337.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $337.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-8724L-40 SUP HCPCS C1713 AR-8724L-40 - SCREW BN 2.4MM 40MM LCK LOPRFL TI FT/ANKL BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $135.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-8724V-08 SUP HCPCS C1713 AR-8724V-08 - SCREW BN LOPRFL 2.4MM 8MM VA ST SLD LCK TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-10 SUP HCPCS C1713 AR-8724V-10 - SCREW BN LOPRFL 2.4MM 10MM VA ST SLD LCK TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-12 SUP HCPCS C1713 AR-8724V-12 - SCREW BN LOPRFL 2.4MM 12MM VA ST SLD LCK TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-14 SUP HCPCS C1713 AR-8724V-14 - SCREW BN LOPRFL 2.4MM 14MM VA ST SLD LCK TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-16 SUP HCPCS C1713 AR-8724V-16 - SCREW BN LOPRFL 2.4MM 16MM VA ST SLD LCK TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-18 SUP HCPCS C1713 AR-8724V-18 - SCREW BN LOPRFL 2.4MM 18MM VA ST SLD LCK TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-20 SUP HCPCS C1713 AR-8724V-20 - SCREW BN LOPRFL 2.4MM 20MM VA ST SLD LCK TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-22 SUP HCPCS C1713 AR-8724V-22 - SCREW BN LOPRFL 2.4MM 22MM VA ST SLD LCK TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-24 SUP HCPCS C1713 AR-8724V-24 - SCREW BN LOPRFL 2.4MM 24MM VA ST SLD LCK TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-26 SUP HCPCS C1713 AR-8724V-26 - SCREW BN LOPRFL 2.4MM 26MM VA ST SLD LCK TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-28 SUP HCPCS C1713 AR-8724V-28 - SCREW BN LOPRFL 2.4MM 28MM VA ST SLD LCK TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-30 SUP HCPCS C1713 AR-8724V-30 - SCREW BN LOPRFL 2.4MM 30MM VA ST SLD LCK TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-32 SUP HCPCS C1713 AR-8724V-32 - SCREW BN LOPRFL 2.4MM 32MM LCK ST SLD VA TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-34 SUP HCPCS C1713 AR-8724V-34 - SCREW BN LOPRFL 2.4MM 34MM LCK ST SLD VA TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-36 SUP HCPCS C1713 AR-8724V-36 - SCREW BN LOPRFL 2.4MM 32MM LCK ST SLD VA TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-38 SUP HCPCS C1713 AR-8724V-38 - SCREW BN LOPRFL 2.4MM 38MM LCK ST SLD VA TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8724V-40 SUP HCPCS C1713 AR-8724V-40 - SCREW BN LOPRFL 2.4MM 40MM LCK ST SLD VA TI FT HND ANKL WRST BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8724W SUP HCPCS C1713 AR-8724W - WASHER ORTH 6MM TI 2/2.4MM QFIX SCR BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8725-08H SUP HCPCS C1713 AR-8725-08H - SCREW BN 1.5MM MIC FT HEX 2.5MM 8MM QFIX SLF DRL ST CNN CMPR BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8725-09H SUP HCPCS C1713 AR-8725-09H - SCREW BN 1.5MM MIC FT HEX 2.5MM 9MM QFIX SLF DRL ST CNN CMPR BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8725-10H SUP HCPCS C1713 AR-8725-10H - SCREW BN 1.5MM MIC FT HEX 2.5MM 10MM QFIX SLF DRL ST CNN BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8725-11H SUP HCPCS C1713 AR-8725-11H - SCREW BN 1.5MM MIC FT HEX 2.5MM 11MM QFIX SLF DRL ST CNN BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8725-12H SUP HCPCS C1713 AR-8725-12H - SCREW BN 1.5MM MIC FT HEX 2.5MM 12MM QFIX SLF DRL ST CNN BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8725-13H SUP HCPCS C1713 AR-8725-13H - SCREW BN 1.5MM MIC FT HEX 2.5MM 13MM QFIX SLF DRL ST CNN BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8725-14H SUP HCPCS C1713 AR-8725-14H - SCREW BN 1.5MM MIC FT 2.5MM 14MM QFIX SLF DRL ST CNN CMPR TI BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8725-16H SUP HCPCS C1713 AR-8725-16H - SCREW BN 1.5MM MIC FT HEX 2.5MM 16MM QFIX SLF DRL ST CNN BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8725-18H SUP HCPCS C1713 AR-8725-18H - SCREW BN 1.5MM MIC FT HEX 2.5MM 18MM QFIX SLF DRL ST CNN BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8725-20H SUP HCPCS C1713 AR-8725-20H - SCREW BN 1.5MM MIC FT HEX 2.5MM 20MM QFIX SLF DRL ST CNN BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8725-22H SUP HCPCS C1713 AR-8725-22H - SCREW BN 1.5MM MIC FT HEX 2.5MM 22MM QFIX SLF DRL ST CNN BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8725-24H SUP HCPCS C1713 AR-8725-24H - SCREW BN 1.5MM MIC FT HEX 2.5MM 24MM QFIX SLF DRL ST CNN BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $737.50 $737.50 N/A N/A AR-8725-26H SUP HCPCS C1713 AR-8725-26H - SCREW BN 1.5MM MIC FT HEX 2.5MM 26MM QFIX SLF DRL ST CNN BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8725-28H SUP HCPCS C1713 AR-8725-28H - SCREW BN 1.5MM MIC FT HEX 2.5MM 28MM QFIX SLF DRL ST CNN BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8725-30H SUP HCPCS C1713 AR-8725-30H - SCREW BN 1.5MM MIC FT HEX 2.5MM 30MM QFIX SLF DRL ST CNN BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8730-10PT SUP HCPCS C1713 AR-8730-10PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 10MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8730-12H SUP HCPCS C1713 AR-8730-12H - SCREW BN MN FT 3.6MM 12MM QFIX CNN CMPR TI FT/ANKL BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8730-12PT SUP HCPCS C1713 AR-8730-12PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 12MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8730-14H SUP HCPCS C1713 AR-8730-14H - SCREW BN MN FT 3.6MM 14MM QFIX CNN CMPR TI FT/ANKL BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8730-14PT SUP HCPCS C1713 AR-8730-14PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 14MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A AR-8730-16H SUP HCPCS C1713 AR-8730-16H - SCREW BN MN FT 3.6MM 16MM QFIX CNN CMPR TI FT/ANKL BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8730-16PT SUP HCPCS C1713 AR-8730-16PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 16MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A AR-8730-18H SUP HCPCS C1713 AR-8730-18H - SCREW BN MN FT 3.6MM 18MM QFIX CNN CMPR TI FT/ANKL BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8730-18PT SUP HCPCS C1713 AR-8730-18PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 18MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A AR-8730-20H SUP HCPCS C1713 AR-8730-20H - SCREW BN MN FT 3.6MM 20MM QFIX CNN CMPR TI FT/ANKL BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8730-20PT SUP HCPCS C1713 AR-8730-20PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 20MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A AR-8730-22H SUP HCPCS C1713 AR-8730-22H - SCREW BN MN FT 3.5MM 22MM QFIX CMPR TI FT/ANKL BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8730-22PT SUP HCPCS C1713 AR-8730-22PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 22MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A AR-8730-24H SUP HCPCS C1713 AR-8730-24H - SCREW BN MN FT 3.6MM 24MM QFIX CNN CMPR TI FT/ANKL BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8730-24PT SUP HCPCS C1713 AR-8730-24PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 24MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A AR-8730-26H SUP HCPCS C1713 AR-8730-26H - SCREW BN MN FT 3.6MM 26MM QFIX CNN CMPR TI FT/ANKL BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8730-26PT SUP HCPCS C1713 AR-8730-26PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 26MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8730-28H SUP HCPCS C1713 AR-8730-28H - SCREW BN MN FT 3.6MM 28MM QFIX CNN CMPR TI FT/ANKL BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8730-28PT SUP HCPCS C1713 AR-8730-28PT - SCREW BN P/T 3MM 28MM QFIX TI CANC BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8730-30H SUP HCPCS C1713 AR-8730-30H - SCREW BN MN FT 3.6MM 30MM QFIX CNN CMPR TI FT/ANKL BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8730-30PT SUP HCPCS C1713 AR-8730-30PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 30MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8730-32H SUP HCPCS C1713 AR-8730-32H - SCREW BN MN FT 3.6MM 32MM QFIX CNN CMPR TI FT/ANKL BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8730-32PT SUP HCPCS C1713 AR-8730-32PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 32MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A AR-8730-34H SUP HCPCS C1713 AR-8730-34H - SCREW BN MN FT 3.6MM 34MM QFIX CNN CMPR TI FT/ANKL BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8730-34PT SUP HCPCS C1713 AR-8730-34PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 34MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A AR-8730-36PT SUP HCPCS C1713 AR-8730-36PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 36MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8730-38PT SUP HCPCS C1713 AR-8730-38PT - SCREW BN P/T 3MM 38MM QFIX TI CANC BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A AR-8730-40PT SUP HCPCS C1713 AR-8730-40PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 40MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A AR-8730-42PT SUP HCPCS C1713 AR-8730-42PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 42MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A AR-8730-44PT SUP HCPCS C1713 AR-8730-44PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 44MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8730-46PT SUP HCPCS C1713 AR-8730-46PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 46MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A AR-8730-48PT SUP HCPCS C1713 AR-8730-48PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 48MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A AR-8730-50PT SUP HCPCS C1713 AR-8730-50PT - SCREW BN T10 P/T HEXALOBE LOPRFL 3MM 50MM QFIX SLF DRL ST BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A AR-8730W SUP HCPCS C1713 AR-8730W - WASHER ORTH 6.5MM TI 3MM QFIX SCR BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8737-03 SUP Custom 27203010 AR-8737-03 - GUIDE DRL .86MM 1.7MM BOTH IP/OP $850.00 $629.00 $151.30 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $151.30 $850.00 $850.00 $630.87 $630.87 $655.18 $442.85 $177.15 $850.00 $367.20 $850.00 $850.00 $850.00 $850.00 $850.00 $637.50 $850.00 $850.00 $850.00 $425.00 $425.00 $673.20 $850.00 $680.00 $552.50 $850.00 N/A $493.00 $850.00 $510.00 $850.00 $850.00 $850.00 N/A N/A AR-8737-06 SUP Custom 27203010 AR-8737-06 - GUIDE DRL 3MM 4MM BOTH IP/OP $850.00 $629.00 $151.30 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $850.00 $151.30 $850.00 $850.00 $630.87 $630.87 $655.18 $442.85 $177.15 $850.00 $367.20 $850.00 $850.00 $850.00 $850.00 $850.00 $637.50 $850.00 $850.00 $850.00 $425.00 $425.00 $673.20 $850.00 $680.00 $552.50 $850.00 N/A $493.00 $850.00 $510.00 $850.00 $850.00 $850.00 N/A N/A AR-8737-09 SUP Custom 27203010 AR-8737-09 - BIT DRL 2.5MM QFIX CNN BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8737-11 SUP Custom 27203010 AR-8737-11 - BIT DRL 4MM QFIX CNN BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8737-17 SUP Custom 27203010 AR-8737-17 - BIT DRL 1.7MM QFIX CNN BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8737-23 SUP Custom 27203010 AR-8737-23 - DRILL BIT CNTRSNK 2-2.4MM QFIX CNN BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8737-24 SUP Custom 27203010 AR-8737-24 - DRILL BIT CNTRSNK 3MM QFIX CNN BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8737-34 SUP Custom 27203010 AR-8737-34 - BIT DRL STRG 2MM CNN DISP MIC CMPR FT SCR BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-8737-35 SUP Custom 27203010 AR-8737-35 - BIT DRL STRG 2.7MM CNN 3.5MM MN CMPR FT SCR BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-8737-43 SUP Custom 27203010 AR-8737-43 - GUIDE DRL PERC CMPR FT SCR SYS SET BOTH IP/OP "$1,737.50" "$1,286.00" $309.28 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $309.28 "$1,737.50" "$1,737.50" "$1,289.57" "$1,289.57" "$1,339.27" $905.24 $362.11 "$1,737.50" $750.60 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" "$1,129.38" "$1,737.50" N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" "$1,737.50" "$1,737.50" N/A N/A AR-8737-48 SUP Custom 27203010 AR-8737-48 - GUIDE DRL PRLL MIC CMPR FT SCR BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,020.53" "$1,020.53" "$1,059.85" $716.38 $286.57 "$1,375.00" $594.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $893.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A AR-8737-49 SUP Custom 27203010 AR-8737-49 - GUIDE DRL PRLL MN CMPR FT SCR BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,020.53" "$1,020.53" "$1,059.85" $716.38 $286.57 "$1,375.00" $594.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $893.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A AR-8737-50 SUP Custom 27203010 AR-8737-50 - BIT DRL STRG 2.7MM CLBRT CNN STD CMPR FT 4MM SCR BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-8737-55 SUP Custom 27203010 AR-8737-55 - GUIDE DRL PRLL 4 MM STD CMPR FT SCR BOTH IP/OP "$1,375.00" "$1,018.00" $244.75 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $244.75 "$1,375.00" "$1,375.00" "$1,020.53" "$1,020.53" "$1,059.85" $716.38 $286.57 "$1,375.00" $594.00 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $893.75 "$1,375.00" N/A $797.50 "$1,375.00" $825.00 "$1,375.00" "$1,375.00" "$1,375.00" N/A N/A AR-8737-57 SUP Custom 27203010 AR-8737-57 - CLAMP XTRNFX PIN PERC CMPR FT SCR SYS SET BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" $540.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A AR-8737-58 SUP Custom 27203010 AR-8737-58 - BIT DRL STRG 2.2MM CNN 2.5MM CMPR FT SCR BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-8737C-SC-01 SUP HCPCS C1713 AR-8737C-SC-01 - PLATE STRL QFIX CADDY TOP CNN SCR SYS BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A AR-8737H-2 SUP HCPCS C1713 AR-8737H-2 - SET TRMA FX UPGRD CMPR FT SCR BOTH IP/OP "$15,587.50" "$11,535.00" "$3,093.73" "$15,587.50" "$7,014.38" "$7,014.38" "$7,014.38" "$7,014.38" "$15,587.50" "$15,587.50" "$15,587.50" "$3,248.82" "$15,587.50" "$15,587.50" "$15,587.50" "$15,587.50" "$15,587.50" "$3,248.61" "$15,587.50" "$6,733.80" "$7,684.64" "$15,587.50" "$15,587.50" "$15,587.50" "$15,587.50" "$11,690.63" "$15,587.50" "$15,587.50" "$15,587.50" "$7,793.75" "$7,793.75" "$12,345.30" "$15,587.50" "$12,470.00" "$7,014.38" "$3,093.73" N/A "$9,040.75" "$15,587.50" "$15,587.50" "$15,587.50" "$3,248.44" "$15,587.50" N/A N/A AR-8740-14PTS SUP HCPCS C1713 AR-8740-14PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 14MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-16H SUP HCPCS C1713 AR-8740-16H - SCREW BN STD FT 4.6MM 16MM CNN CMPR VAR STP PTCH TI FT HND BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8740-16PTS SUP HCPCS C1713 AR-8740-16PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 16MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-18H SUP HCPCS C1713 AR-8740-18H - SCREW BN STD FT 4.6MM 18MM QFIX CNN CMPR TI ANKL/FT BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8740-18PTS SUP HCPCS C1713 AR-8740-18PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 18MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-20H SUP HCPCS C1713 AR-8740-20H - SCREW BN STD FT 4.6MM 20MM CNN CMPR VAR STP PTCH TI FT HND BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8740-20PTS SUP HCPCS C1713 AR-8740-20PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 20MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-22H SUP HCPCS C1713 AR-8740-22H - SCREW BN STD FT 4MM 22MM CNN CMPR VAR STP PTCH TI FT HND BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8740-22PTS SUP HCPCS C1713 AR-8740-22PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 22MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $412.50 $412.50 N/A N/A AR-8740-24H SUP HCPCS C1713 AR-8740-24H - SCREW BN STD FT 4.6MM 24MM CNN CMPR VAR STP PTCH TI FT HND BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8740-24PTS SUP HCPCS C1713 AR-8740-24PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 24MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-26H SUP HCPCS C1713 AR-8740-26H - SCREW BN STD FT 4.6MM 26MM CNN CMPR VAR STP PTCH TI FT HND BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8740-26PTS SUP HCPCS C1713 AR-8740-26PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 26MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $412.50 $412.50 N/A N/A AR-8740-28H SUP HCPCS C1713 AR-8740-28H - SCREW BN STD FT 4.6MM 28MM QFIX CNN CMPR TI ANKL/FT BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8740-28PTS SUP HCPCS C1713 AR-8740-28PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 28MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-30H SUP HCPCS C1713 AR-8740-30H - SCREW BN STD FT 4MM 30MM CNN CMPR VAR STP PTCH TI FT HND BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8740-30PTL SUP HCPCS C1713 AR-8740-30PTL - SCREW BN LNG P/T LOPRFL 4MM 30MM SLF DRL ST CNN TI SHLDR BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-30PTS SUP HCPCS C1713 AR-8740-30PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 30MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-32H SUP HCPCS C1713 AR-8740-32H - SCREW BN STD FT 4.6MM 32MM QFIX CNN CMPR TI ANKL/FT BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-8740-32PTL SUP HCPCS C1713 AR-8740-32PTL - SCREW BN LNG P/T LOPRFL 4MM 32MM SLF DRL ST CNN TI SHLDR BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-32PTS SUP HCPCS C1713 AR-8740-32PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 32MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-34H SUP HCPCS C1713 AR-8740-34H - SCREW BN STD FT 4MM 34MM CNN CMPR VAR STP PTCH TI FT HND BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8740-34PTL SUP HCPCS C1713 AR-8740-34PTL - SCREW BN LNG P/T LOPRFL 4MM 34MM SLF DRL ST CNN TI SHLDR BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-34PTS SUP HCPCS C1713 AR-8740-34PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 34MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-36H SUP HCPCS C1713 AR-8740-36H - SCREW BN STD FT 4MM 36MM CNN CMPR VAR STP PTCH TI FT/ANKL BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-8740-36PTL SUP HCPCS C1713 AR-8740-36PTL - SCREW BN LNG P/T LOPRFL 4MM 36MM SLF DRL ST CNN TI SHLDR BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $412.50 $412.50 N/A N/A AR-8740-36PTS SUP HCPCS C1713 AR-8740-36PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 36MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-38H SUP HCPCS C1713 AR-8740-38H - SCREW BN STD FT 4MM 38MM CNN CMPR VAR STP PTCH TI FT HND BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A AR-8740-38PTL SUP HCPCS C1713 AR-8740-38PTL - SCREW BN LNG P/T LOPRFL 4MM 38MM SLF DRL ST CNN TI SHLDR BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-38PTS SUP HCPCS C1713 AR-8740-38PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 38MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-40H SUP HCPCS C1713 AR-8740-40H - SCREW BN STD FT 4MM 40MM CNN CMPR VAR STP PTCH TI FT HND BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $153.70 $737.50 N/A N/A AR-8740-40PTS SUP HCPCS C1713 AR-8740-40PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 40MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-42H SUP HCPCS C1713 AR-8740-42H - SCREW BN STD FT 4.6MM 42MM CNN CMPR VAR STP PTCH TI FT HND BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8740-42PTS SUP HCPCS C1713 AR-8740-42PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 42MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-44H SUP HCPCS C1713 AR-8740-44H - SCREW BN STD FT 4.6MM 44MM CNN CMPR VAR STP PTCH TI FT HND BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8740-44PTS SUP HCPCS C1713 AR-8740-44PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 44MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-46H SUP HCPCS C1713 AR-8740-46H - SCREW BN STD FT 4.6MM 46MM CNN CMPR VAR STP PTCH TI FT HND BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8740-46PTS SUP HCPCS C1713 AR-8740-46PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 46MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-48H SUP HCPCS C1713 AR-8740-48H - SCREW BN STD FT 4.6MM 48MM CNN CMPR VAR STP PTCH TI FT HND BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $737.50 $737.50 $737.50 $737.50 N/A N/A AR-8740-48PTS SUP HCPCS C1713 AR-8740-48PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 48MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-50H SUP HCPCS C1713 AR-8740-50H - SCREW BN STD FT 4.6MM 50MM CNN CMPR VAR STP PTCH TI FT HND BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8740-50PTS SUP HCPCS C1713 AR-8740-50PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 50MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-52PTLS SUP HCPCS C1713 AR-8740-52PTLS - SCREW BN P/T 4MM 52MM STRL ARTHX LOPRFL BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-52PTS SUP HCPCS C1713 AR-8740-52PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 52MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-54PTS SUP HCPCS C1713 AR-8740-54PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 54MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-56PTS SUP HCPCS C1713 AR-8740-56PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 56MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-58PTS SUP HCPCS C1713 AR-8740-58PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 58MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8740-60PTS SUP HCPCS C1713 AR-8740-60PTS - SCREW BN SHRT P/T T15 HEXALOBE LOPRFL 4MM 60MM QFIX BCMPT BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8740W SUP HCPCS C1713 AR-8740W - WASHER ORTH 7MM TI 4MM QFIX SCR BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8801 SUP Custom 27203010 AR-8801 - SHEATH ASCP GD SLOT BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $648.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A AR-8825B SUP HCPCS C1713 AR-8825B - ANCHOR SUT MN 2.5MM 8MM STRL BIO-PUSHLOCK BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $405.00 $405.00 $405.00 $405.00 $900.00 $900.00 $900.00 $187.58 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $900.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $178.63 N/A $522.00 $900.00 $540.00 $900.00 $187.56 $900.00 N/A N/A AR-8825CP SUP Custom 27203010 AR-8825CP - KIT INST 3ANG FIBROCARTILAGE CMPLX DISP BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A AR-8825P SUP HCPCS C1713 AR-8825P - ANCHOR SUT MN 2.5MM 8MM STRL PUSHLOCK PEEK BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $405.00 $405.00 $405.00 $405.00 $900.00 $900.00 $900.00 $187.58 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $360.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $178.63 N/A $522.00 $900.00 $540.00 $900.00 $187.56 $900.00 N/A N/A AR-8826G SUP Custom 27203010 AR-8826G - GUIDE DRL C RING GFT ANCH BOTH IP/OP "$7,187.50" "$5,319.00" "$1,279.38" "$7,187.50" "$7,187.50" "$7,187.50" "$7,187.50" "$7,187.50" "$7,187.50" "$7,187.50" "$1,279.38" "$7,187.50" "$7,187.50" "$4,181.12" "$4,181.12" "$5,540.13" "$2,060.15" "$1,497.95" "$7,187.50" "$2,875.00" "$7,187.50" "$7,187.50" "$7,187.50" "$7,187.50" "$7,187.50" "$5,390.63" "$7,187.50" "$7,187.50" "$7,187.50" "$3,593.75" "$3,593.75" "$5,692.50" "$7,187.50" "$5,750.00" "$4,671.88" "$7,187.50" N/A "$4,168.75" "$7,187.50" "$4,312.50" "$7,187.50" "$7,187.50" "$7,187.50" N/A N/A AR-8827-10 SUP HCPCS C1713 AR-8827-10 - SCREW BN 2.7MM 10MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-12 SUP HCPCS C1713 AR-8827-12 - SCREW BN 2.7MM 12MM LOPRFL SCR NONLOCK SS CORT ANKL FX MGMT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-14 SUP HCPCS C1713 AR-8827-14 - SCREW BN 2.7MM 14MM LOPRFL SCR NONLOCK SS CORT ANKL FX MGMT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-16 SUP HCPCS C1713 AR-8827-16 - SCREW BN 2.7MM 16MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-18 SUP HCPCS C1713 AR-8827-18 - SCREW BN 2.7MM 18MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-20 SUP HCPCS C1713 AR-8827-20 - SCREW BN 2.7MM 20MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-22 SUP HCPCS C1713 AR-8827-22 - SCREW BN 2.7MM 22MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-24 SUP HCPCS C1713 AR-8827-24 - SCREW BN 2.7MM 24MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-26 SUP HCPCS C1713 AR-8827-26 - SCREW BN 2.7MM 26MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $48.60 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-28 SUP HCPCS C1713 AR-8827-28 - SCREW BN 2.7MM 28MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-30 SUP HCPCS C1713 AR-8827-30 - SCREW BN 2.7MM 30MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-32 SUP HCPCS C1713 AR-8827-32 - SCREW BN 2.7MM 32MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $48.60 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-34 SUP HCPCS C1713 AR-8827-34 - SCREW BN 2.7MM 34MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-36 SUP HCPCS C1713 AR-8827-36 - SCREW BN 2.7MM 36MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-38 SUP HCPCS C1713 AR-8827-38 - SCREW BN 2.7MM 38MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-40 SUP HCPCS C1713 AR-8827-40 - SCREW BN 2.7MM 40MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-42 SUP HCPCS C1713 AR-8827-42 - SCREW BN 2.7MM 42MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-44 SUP HCPCS C1713 AR-8827-44 - SCREW BN 2.7MM 44MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-46 SUP HCPCS C1713 AR-8827-46 - SCREW BN 2.7MM 46MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-48 SUP HCPCS C1713 AR-8827-48 - SCREW BN 2.7MM 48MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-50 SUP HCPCS C1713 AR-8827-50 - SCREW BN 2.7MM 50MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $48.60 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-52 SUP HCPCS C1713 AR-8827-52 - SCREW BN 2.7MM 52MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-54 SUP HCPCS C1713 AR-8827-54 - SCREW BN 2.7MM 54MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $121.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $121.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-56 SUP HCPCS C1713 AR-8827-56 - SCREW BN 2.7MM 56MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $48.60 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-58 SUP HCPCS C1713 AR-8827-58 - SCREW BN 2.7MM 56MM NONLOCK LOPRFL ANKL CORT FX MGMT SYS BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $48.60 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827-60 SUP HCPCS C1713 AR-8827-60 - SCREW BN 2.7MM 60MM LOPRFL SCR SLD SHFT SS FT/ANKL CORT BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $48.60 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A AR-8827D-01 SUP Custom 27203010 AR-8827D-01 - BIT DRL 2.7MM 2.7/3MM SCR ANKL FX MGMT SYS BOTH IP/OP $212.50 $157.00 $37.83 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $37.83 $212.50 $212.50 $157.72 $157.72 $163.80 $110.71 $44.29 $212.50 $91.80 $212.50 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $138.13 $212.50 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A AR-8827D-02 SUP Custom 27203010 AR-8827D-02 - GUIDE DRL 2.7MM 2MM BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $432.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-8827L-08 SUP HCPCS C1713 AR-8827L-08 - SCREW BN T10 HEXALOBE FT 2.7MM 8MM LOPRFL SCR LCK MDLR SLF BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-10 SUP HCPCS C1713 AR-8827L-10 - SCREW BN FT T10 HEXALOBE 2.7MM 10MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-12 SUP HCPCS C1713 AR-8827L-12 - SCREW BN FT T10 HEXALOBE 2.7MM 12MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-14 SUP HCPCS C1713 AR-8827L-14 - SCREW BN FT T10 HEXALOBE 2.7MM 14MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $124.20 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-16 SUP HCPCS C1713 AR-8827L-16 - SCREW BN FT T10 HEXALOBE 2.7MM 16MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-18 SUP HCPCS C1713 AR-8827L-18 - SCREW BN FT T10 HEXALOBE 2.7MM 18MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $124.20 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-20 SUP HCPCS C1713 AR-8827L-20 - SCREW BN FT T10 HEXALOBE 2.7MM 20MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-22 SUP HCPCS C1713 AR-8827L-22 - SCREW BN FT T10 HEXALOBE 2.7MM 22MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $124.20 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-24 SUP HCPCS C1713 AR-8827L-24 - SCREW BN FT T10 HEXALOBE 2.7MM 24MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-26 SUP HCPCS C1713 AR-8827L-26 - SCREW BN FT T10 HEXALOBE 2.7MM 26MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-28 SUP HCPCS C1713 AR-8827L-28 - SCREW BN T10 HEXALOBE FT 2.7MM 28MM LOPRFL SCR LCK MDLR SLF BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-30 SUP HCPCS C1713 AR-8827L-30 - SCREW BN 2.7MM 30MM LOPRFL LCK ANKL BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-34 SUP HCPCS C1713 AR-8827L-34 - SCREW BN 2.7MM 34MM NS LF LPR ARTHX LCK SS BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-36 SUP HCPCS C1713 AR-8827L-36 - SCREW BN 2.7MM 36MM NS LF LPR ARTHX LCK SS BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-38 SUP HCPCS C1713 AR-8827L-38 - SCREW BN 2.7MM 38MM NS LF LPR ARTHX LCK SS BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-40 SUP HCPCS C1713 AR-8827L-40 - SCREW BN 2.7MM 40MM NS LF LPR ARTHX LCK SS BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-42 SUP HCPCS C1713 AR-8827L-42 - SCREW BN 2.7MM 42MM STRL LOPRFL SCR LCK ANKL BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-44 SUP HCPCS C1713 AR-8827L-44 - SCREW BN 2.7MM 44MM LOPRFL SCR LCK BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-46 SUP HCPCS C1713 AR-8827L-46 - SCREW BN 2.7MM 46MM STRL LOPRFL SCR LCK ANKL BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-48 SUP HCPCS C1713 AR-8827L-48 - SCREW BN 2.7MM 48MM STRL LOPRFL SCR LCK BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-50 SUP HCPCS C1713 AR-8827L-50 - SCREW BN 2.7MM 50MM LOPRFL SCR LCK ANKL BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $287.50 $287.50 N/A N/A AR-8827L-52 SUP HCPCS C1713 AR-8827L-52 - SCREW BN 2.7MM 52MM LOPRFL SCR LCK ANKL BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $124.20 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $287.50 $287.50 N/A N/A AR-8827L-54 SUP HCPCS C1713 AR-8827L-54 - SCREW BN 2.7MM 54MM ARTHX LOPRFL SCR LCK BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $124.20 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-56 SUP HCPCS C1713 AR-8827L-56 - SCREW BN 2.7MM 56MM LOPRFL SCR LCK ANKL BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-58 SUP HCPCS C1713 AR-8827L-58 - SCREW BN 2.7MM 58MM ARTHX LOPRFL SCR LCK BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $124.20 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8827L-60 SUP HCPCS C1713 AR-8827L-60 - SCREW BN 2.7MM 60MM LOPRFL SCR LCK ANKL BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $124.20 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8830-10 SUP HCPCS C1713 AR-8830-10 - SCREW BN FT T10 HEXALOBE 3MM 10MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8830-12 SUP HCPCS C1713 AR-8830-12 - SCREW BN FT T10 HEXALOBE 3MM 12MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8830-14 SUP HCPCS C1713 AR-8830-14 - SCREW BN FT T10 HEXALOBE 3MM 14MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8830-16 SUP HCPCS C1713 AR-8830-16 - SCREW BN FT T10 HEXALOBE 3MM 16MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8830-18 SUP HCPCS C1713 AR-8830-18 - SCREW BN FT T10 HEXALOBE 3MM 18MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8830-20 SUP HCPCS C1713 AR-8830-20 - SCREW BN FT T10 HEXALOBE 3MM 20MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8830-22 SUP HCPCS C1713 AR-8830-22 - SCREW BN FT T10 HEXALOBE 3MM 22MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8830-24 SUP HCPCS C1713 AR-8830-24 - SCREW BN FT T10 HEXALOBE 3MM 24MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8830-26 SUP HCPCS C1713 AR-8830-26 - SCREW BN FT T10 HEXALOBE 3MM 26MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8830-28 SUP HCPCS C1713 AR-8830-28 - SCREW BN FT T10 HEXALOBE 3MM 28MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8830-30 SUP HCPCS C1713 AR-8830-30 - SCREW BN FT T10 HEXALOBE 3MM 30MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-08 SUP HCPCS C1713 AR-8835-08 - SCREW BN T15 HEXALOBE FT 3.5MM 8MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-08S SUP HCPCS C1713 AR-8835-08S - SCREW BN 3.5MM 8MM STRL ARTHX LOPRFL CORT BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-10 SUP HCPCS C1713 AR-8835-10 - SCREW BN T15 FT HEXALOBE 3.5MM 10MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-12 SUP HCPCS C1713 AR-8835-12 - SCREW BN T15 FT HEXALOBE 3.5MM 12MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-14 SUP HCPCS C1713 AR-8835-14 - SCREW BN T15 FT HEXALOBE 3.5MM 14MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-16 SUP HCPCS C1713 AR-8835-16 - SCREW BN T15 FT HEXALOBE 3.5MM 16MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-18 SUP HCPCS C1713 AR-8835-18 - SCREW BN T15 FT HEXALOBE 3.5MM 18MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-20 SUP HCPCS C1713 AR-8835-20 - SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-22 SUP HCPCS C1713 AR-8835-22 - SCREW BN T15 FT HEXALOBE 3.5MM 22MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-24 SUP HCPCS C1713 AR-8835-24 - SCREW BN T15 FT HEXALOBE 3.5MM 24MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-26 SUP HCPCS C1713 AR-8835-26 - SCREW BN T15 FT HEXALOBE 3.5MM 26MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-28 SUP HCPCS C1713 AR-8835-28 - SCREW BN T15 FT HEXALOBE 3.5MM 28MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-30 SUP HCPCS C1713 AR-8835-30 - SCREW BN T15 HEXALOBE FT 3.5MM 30MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-32 SUP HCPCS C1713 AR-8835-32 - SCREW BN T15 HEXALOBE FT 3.5MM 32MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-34 SUP HCPCS C1713 AR-8835-34 - SCREW BN T15 HEXALOBE FT 3.5MM 34MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-35 SUP HCPCS C1713 AR-8835-35 - SCREW BN T15 FT HEXALOBE 3.5MM 35MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-36 SUP HCPCS C1713 AR-8835-36 - SCREW BN T15 HEXALOBE FT 3.5MM 36MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-38 SUP HCPCS C1713 AR-8835-38 - SCREW BN T15 HEXALOBE FT 3.5MM 38MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-40 SUP HCPCS C1713 AR-8835-40 - SCREW BN T15 FT HEXALOBE 3.5MM 40MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-42 SUP HCPCS C1713 AR-8835-42 - SCREW BN T15 HEXALOBE FT 3.5MM 42MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-44 SUP HCPCS C1713 AR-8835-44 - SCREW BN T15 FT HEXALOBE 3.5MM 44MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-45 SUP HCPCS C1713 AR-8835-45 - SCREW BN T15 FT HEXALOBE 3.5MM 45MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-46 SUP HCPCS C1713 AR-8835-46 - SCREW BN T15 HEXALOBE FT 3.5MM 46MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-48 SUP HCPCS C1713 AR-8835-48 - SCREW BN T15 HEXALOBE FT 3.5MM 48MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-50 SUP HCPCS C1713 AR-8835-50 - SCREW BN T15 FT HEXALOBE 3.5MM 50MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-55 SUP HCPCS C1713 AR-8835-55 - SCREW BN T15 FT HEXALOBE 3.5MM 55MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-60 SUP HCPCS C1713 AR-8835-60 - SCREW BN T15 FT HEXALOBE 3.5MM 60MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-65 SUP HCPCS C1713 AR-8835-65 - SCREW BN HEXALOBE FT 3.5MM 65MM LOPRFL SCR T15 SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-70 SUP HCPCS C1713 AR-8835-70 - SCREW BN HEXALOBE FT 3.5MM 70MM LOPRFL SCR T15 SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-75 SUP HCPCS C1713 AR-8835-75 - SCREW BN HEXALOBE FT 3.5MM 75MM LOPRFL SCR T15 SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8835-80 SUP HCPCS C1713 AR-8835-80 - SCREW BN 3.5MM 80MM ARTHX LOPRFL SCR CORT BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8835L-08 SUP HCPCS C1713 AR-8835L-08 - SCREW BN T15 HEXALOBE FT 3.5MM 8MM LOPRFL SCR LCK MDLR SLF BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-10 SUP HCPCS C1713 AR-8835L-10 - SCREW BN T15 FT HEXALOBE 3.5MM 10MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-12 SUP HCPCS C1713 AR-8835L-12 - SCREW BN T15 FT HEXALOBE 3.5MM 12MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $124.20 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-14 SUP HCPCS C1713 AR-8835L-14 - SCREW BN T15 FT HEXALOBE 3.5MM 14MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-16 SUP HCPCS C1713 AR-8835L-16 - SCREW BN T15 FT HEXALOBE 3.5MM 16MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $124.20 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-18 SUP HCPCS C1713 AR-8835L-18 - SCREW BN T15 FT HEXALOBE 3.5MM 18MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-20 SUP HCPCS C1713 AR-8835L-20 - SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-22 SUP HCPCS C1713 AR-8835L-22 - SCREW BN T15 FT HEXALOBE 3.5MM 22MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $124.20 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-24 SUP HCPCS C1713 AR-8835L-24 - SCREW BN T15 HEXALOBE FT 3.5MM 24MM LOPRFL SCR LCK MDLR SLF BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $287.50 $287.50 N/A N/A AR-8835L-26 SUP HCPCS C1713 AR-8835L-26 - SCREW BN T15 HEXALOBE FT 3.5MM 26MM LOPRFL SCR LCK MDLR SLF BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $124.20 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $287.50 $287.50 N/A N/A AR-8835L-28 SUP HCPCS C1713 AR-8835L-28 - SCREW BN T15 HEXALOBE FT 3.5MM 28MM LOPRFL SCR LCK MDLR SLF BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $287.50 $287.50 N/A N/A AR-8835L-30 SUP HCPCS C1713 AR-8835L-30 - SCREW BN T15 FT HEXALOBE 3.5MM 30MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-32 SUP HCPCS C1713 AR-8835L-32 - SCREW BN T15 HEXALOBE FT 3.5MM 32MM LOPRFL SCR LCK MDLR SLF BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $124.20 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-34 SUP HCPCS C1713 AR-8835L-34 - SCREW BN T15 HEXALOBE FT 3.5MM 34MM LOPRFL SCR LCK MDLR SLF BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-36 SUP HCPCS C1713 AR-8835L-36 - SCREW BN T15 HEXALOBE FT 3.5MM 36MM LOPRFL SCR LCK MDLR SLF BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $124.20 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-38 SUP HCPCS C1713 AR-8835L-38 - SCREW BN T15 HEXALOBE FT 3.5MM 38MM LOPRFL SCR LCK MDLR SLF BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-40 SUP HCPCS C1713 AR-8835L-40 - SCREW BN T15 FT HEXALOBE 3.5MM 40MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $287.50 $287.50 N/A N/A AR-8835L-42 SUP HCPCS C1713 AR-8835L-42 - SCREW BN T15 FT HEXALOBE 3.5MM 42MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $287.50 $287.50 N/A N/A AR-8835L-44 SUP HCPCS C1713 AR-8835L-44 - SCREW BN T15 FT HEXALOBE 3.5MM 44MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-45 SUP HCPCS C1713 AR-8835L-45 - SCREW BN T15 FT HEXALOBE 3.5MM 45MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-46 SUP HCPCS C1713 AR-8835L-46 - SCREW BN T15 FT HEXALOBE 3.5MM 46MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-48 SUP HCPCS C1713 AR-8835L-48 - SCREW BN T15 FT HEXALOBE 3.5MM 48MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-8835L-50 SUP HCPCS C1713 AR-8835L-50 - SCREW BN T15 HEXALOBE FT 3.5MM 50MM LOPRFL SCR LCK MDLR SLF BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-8840-10 SUP HCPCS C1713 AR-8840-10 - SCREW BN T15 FT HEXALOBE 4MM 10MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-10S SUP HCPCS C1713 AR-8840-10S - SCREW BN 4MM 10MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-12 SUP HCPCS C1713 AR-8840-12 - SCREW BN T15 FT HEXALOBE 4MM 12MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-12S SUP HCPCS C1713 AR-8840-12S - SCREW BN 4MM 12MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-14 SUP HCPCS C1713 AR-8840-14 - SCREW BN T15 FT HEXALOBE 4MM 14MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-16 SUP HCPCS C1713 AR-8840-16 - SCREW BN T15 FT HEXALOBE 4MM 16MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-16S SUP HCPCS C1713 AR-8840-16S - SCREW BN 4MM 16MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-18 SUP HCPCS C1713 AR-8840-18 - SCREW BN T15 FT HEXALOBE 4MM 18MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-18S SUP HCPCS C1713 AR-8840-18S - SCREW BN 4MM 18MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-20 SUP HCPCS C1713 AR-8840-20 - SCREW BN T15 FT HEXALOBE 4MM 20MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-20S SUP HCPCS C1713 AR-8840-20S - SCREW BN 4MM 20MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-22 SUP HCPCS C1713 AR-8840-22 - SCREW BN T15 FT HEXALOBE 4MM 22MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-22S SUP HCPCS C1713 AR-8840-22S - SCREW BN 4MM 22MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-24 SUP HCPCS C1713 AR-8840-24 - SCREW BN T15 FT HEXALOBE 4MM 24MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-26 SUP HCPCS C1713 AR-8840-26 - SCREW BN T15 FT HEXALOBE 4MM 26MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-26S SUP HCPCS C1713 AR-8840-26S - SCREW BN 4MM 26MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-28 SUP HCPCS C1713 AR-8840-28 - SCREW BN T15 FT HEXALOBE 4MM 28MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-28S SUP HCPCS C1713 AR-8840-28S - SCREW BN 4MM 28MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-30 SUP HCPCS C1713 AR-8840-30 - SCREW BN T15 FT HEXALOBE 4MM 30MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-32 SUP HCPCS C1713 AR-8840-32 - SCREW BN T15 FT HEXALOBE 4MM 32MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-32S SUP HCPCS C1713 AR-8840-32S - SCREW BN 4MM 32MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-34 SUP HCPCS C1713 AR-8840-34 - SCREW BN T15 FT HEXALOBE 4MM 34MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-34S SUP HCPCS C1713 AR-8840-34S - SCREW BN 4MM 34MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-36 SUP HCPCS C1713 AR-8840-36 - SCREW BN T15 HEXALOBE FT 4MM 36MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-36S SUP HCPCS C1713 AR-8840-36S - SCREW BN 4MM 36MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-38 SUP HCPCS C1713 AR-8840-38 - SCREW BN T15 FT HEXALOBE 4MM 38MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-38S SUP HCPCS C1713 AR-8840-38S - SCREW BN 4MM 38MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-40 SUP HCPCS C1713 AR-8840-40 - SCREW BN T15 FT HEXALOBE 4MM 40MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-40S SUP HCPCS C1713 AR-8840-40S - SCREW BN 4MM 40MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-42 SUP HCPCS C1713 AR-8840-42 - SCREW BN T15 FT HEXALOBE 4MM 42MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-44 SUP HCPCS C1713 AR-8840-44 - SCREW BN T15 HEXALOBE FT 4MM 44MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-45 SUP HCPCS C1713 AR-8840-45 - SCREW BN T15 FT HEXALOBE 4MM 45MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-46 SUP HCPCS C1713 AR-8840-46 - SCREW BN T15 HEXALOBE FT 4MM 46MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-48 SUP HCPCS C1713 AR-8840-48 - SCREW BN T15 HEXALOBE FT 4MM 48MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-50 SUP HCPCS C1713 AR-8840-50 - SCREW BN T15 HEXALOBE FT 4MM 50MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-50S SUP HCPCS C1713 AR-8840-50S - SCREW BN 4MM 50MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-55 SUP HCPCS C1713 AR-8840-55 - SCREW BN T15 FT HEXALOBE 4MM 55MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-55S SUP HCPCS C1713 AR-8840-55S - SCREW BN 4MM 55MM STRL ARTHX LOPRFL CANC BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8840-60 SUP HCPCS C1713 AR-8840-60 - SCREW BN T15 HEXALOBE FT 4MM 60MM LOPRFL SCR MDLR SLF DRL BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840C-30 SUP HCPCS C1713 AR-8840C-30 - SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 30MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840C-32 SUP HCPCS C1713 AR-8840C-32 - SCREW BN ST 4MM 32MM LOPRFL SCR CNN SS ANKL FX MGMT SYS BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8840C-34 SUP HCPCS C1713 AR-8840C-34 - SCREW BN ST 4MM 34MM LOPRFL SCR CNN SS ANKL FX MGMT SYS BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840C-35 SUP HCPCS C1713 AR-8840C-35 - SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 35MM LOPRFL SCR MDLR BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8840C-36 SUP HCPCS C1713 AR-8840C-36 - SCREW BN ST 4MM 36MM LOPRFL SCR CNN SS ANKL FX MGMT SYS BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8840C-38 SUP HCPCS C1713 AR-8840C-38 - SCREW BN ST 4MM 38MM LOPRFL SCR CNN SS ANKL FX MGMT SYS BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840C-40 SUP HCPCS C1713 AR-8840C-40 - SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 40MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840C-42 SUP HCPCS C1713 AR-8840C-42 - SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 42MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840C-44 SUP HCPCS C1713 AR-8840C-44 - SCREW BN ST 4MM 44MM LOPRFL SCR CNN SS ANKL FX MGMT SYS BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840C-45 SUP HCPCS C1713 AR-8840C-45 - SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 45MM LOPRFL SCR MDLR BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840C-46 SUP HCPCS C1713 AR-8840C-46 - SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 46MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840C-48 SUP HCPCS C1713 AR-8840C-48 - SCREW BN ST 4MM 48MM LOPRFL SCR CNN SS ANKL FX MGMT SYS BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840C-50 SUP HCPCS C1713 AR-8840C-50 - SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 50MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840C-55 SUP HCPCS C1713 AR-8840C-55 - SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 55MM LOPRFL SCR MDLR BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840C-60 SUP HCPCS C1713 AR-8840C-60 - SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 60MM LOPRFL SCR MDLR BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8840CL-30 SUP HCPCS C1713 AR-8840CL-30 - SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 30MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8840CL-32 SUP HCPCS C1713 AR-8840CL-32 - SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 32MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $412.50 $412.50 N/A N/A AR-8840CL-34 SUP HCPCS C1713 AR-8840CL-34 - SCREW BN L/T 4MM 34MM LOPRFL SCR CNN SS ANKL FX MGMT SYS BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $412.50 $412.50 N/A N/A AR-8840CL-35 SUP HCPCS C1713 AR-8840CL-35 - SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 35MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8840CL-36 SUP HCPCS C1713 AR-8840CL-36 - SCREW BN L/T 4MM 36MM LOPRFL SCR CNN SS ANKL FX MGMT SYS BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $412.50 $412.50 N/A N/A AR-8840CL-38 SUP HCPCS C1713 AR-8840CL-38 - SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 38MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $412.50 $412.50 N/A N/A AR-8840CL-40 SUP HCPCS C1713 AR-8840CL-40 - SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 40MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840CL-42 SUP HCPCS C1713 AR-8840CL-42 - SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 42MM LOPRFL SCR MDLR BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840CL-44 SUP HCPCS C1713 AR-8840CL-44 - SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 44MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840CL-45 SUP HCPCS C1713 AR-8840CL-45 - SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 45MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840CL-46 SUP HCPCS C1713 AR-8840CL-46 - SCREW BN L/T 4MM 46MM LOPRFL SCR CNN SS ANKL FX MGMT SYS BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840CL-48 SUP HCPCS C1713 AR-8840CL-48 - SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 48MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $412.50 $412.50 N/A N/A AR-8840CL-50 SUP HCPCS C1713 AR-8840CL-50 - SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 50MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $178.20 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8840CL-55 SUP HCPCS C1713 AR-8840CL-55 - SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 55MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A AR-8840CL-60 SUP HCPCS C1713 AR-8840CL-60 - SCREW BN LNG .5 LGTH T15 HEXALOBE 4MM 60MM LOPRFL SCR SLF BOTH IP/OP $412.50 $305.00 $81.87 $445.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $445.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A AR-8840P-30 SUP HCPCS C1713 AR-8840P-30 - SCREW BN ST 4MM 30MM LOPRFL SCR SS ANKL FX MGMT SYS BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840P-32 SUP HCPCS C1713 AR-8840P-32 - SCREW BN ST 4MM 32MM LOPRFL SCR SS ANKL FX MGMT SYS BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840P-34 SUP HCPCS C1713 AR-8840P-34 - SCREW BN ST 4MM 34MM LOPRFL SCR SS ANKL FX MGMT SYS BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840P-36 SUP HCPCS C1713 AR-8840P-36 - SCREW BN ST 4MM 36MM LOPRFL SCR SS ANKL FX MGMT SYS BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840P-38 SUP HCPCS C1713 AR-8840P-38 - SCREW BN ST 4MM 38MM LOPRFL SCR SS ANKL FX MGMT SYS BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840P-40 SUP HCPCS C1713 AR-8840P-40 - SCREW BN SHRT 1/3 LGTH T15 HEXALOBE 4MM 40MM LOPRFL SCR SLF BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840P-42 SUP HCPCS C1713 AR-8840P-42 - SCREW BN ST 4MM 42MM LOPRFL SCR SS ANKL FX MGMT SYS BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8840P-44 SUP HCPCS C1713 AR-8840P-44 - SCREW BN ST 4MM 44MM LOPRFL SCR SS ANKL FX MGMT SYS BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8840P-46 SUP HCPCS C1713 AR-8840P-46 - SCREW BN ST 4MM 46MM LOPRFL SS BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840P-48 SUP HCPCS C1713 AR-8840P-48 - SCREW BN ST 4MM 48MM LOPRFL SCR SS ANKL FX MGMT SYS BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840P-50 SUP HCPCS C1713 AR-8840P-50 - SCREW BN ST 4MM 50MM LOPRFL SS BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840P-55 SUP HCPCS C1713 AR-8840P-55 - SCREW BN ST 4MM 55MM LOPRFL SCR SS ANKL FX MGMT SYS BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840P-60 SUP HCPCS C1713 AR-8840P-60 - SCREW BN ST 4MM 60MM LOPRFL SS BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840PL-30 SUP HCPCS C1713 AR-8840PL-30 - SCREW BN L/T 4MM 30MM LOPRFL SS BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840PL-32 SUP HCPCS C1713 AR-8840PL-32 - SCREW BN L/T 4MM 32MM LOPRFL SS BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840PL-34 SUP HCPCS C1713 AR-8840PL-34 - SCREW BN L/T 4MM 34MM LOPRFL SS BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840PL-36 SUP HCPCS C1713 AR-8840PL-36 - SCREW BN L/T 4MM 36MM LOPRFL SS BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840PL-38 SUP HCPCS C1713 AR-8840PL-38 - SCREW BN LNG 1/3 LGTH T15 HEXALOBE 4MM 38MM LOPRFL SCR MDLR BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840PL-40 SUP HCPCS C1713 AR-8840PL-40 - SCREW BN L/T 4MM 40MM LOPRFL SS BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840PL-42 SUP HCPCS C1713 AR-8840PL-42 - SCREW BN L/T 4MM 42MM LOPRFL SS BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840PL-44 SUP HCPCS C1713 AR-8840PL-44 - SCREW BN L/T 4MM 44MM LOPRFL SS BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840PL-46 SUP HCPCS C1713 AR-8840PL-46 - SCREW BN LNG 1/3 LGTH T15 HEXALOBE 4MM 46MM LOPRFL SCR MDLR BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840PL-48 SUP HCPCS C1713 AR-8840PL-48 - SCREW BN LNG 1/3 LGTH T15 HEXALOBE 4MM 48MM LOPRFL SCR MDLR BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840PL-50 SUP HCPCS C1713 AR-8840PL-50 - SCREW BN L/T 4MM 50MM LOPRFL SS BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840PL-55 SUP HCPCS C1713 AR-8840PL-55 - SCREW BN L/T 4MM 55MM LOPRFL SCR SS ANKL FX MGMT SYS BOTH IP/OP $87.50 $65.00 $17.37 $94.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $94.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8840PL-60 SUP HCPCS C1713 AR-8840PL-60 - SCREW BN L/T 4MM 60MM LOPRFL SCR SS ANKL FX MGMT SYS BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $37.80 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A AR-8870W SUP HCPCS C1713 AR-8870W - WASHER ORTH 7MM BOTH IP/OP $80.50 $60.00 $15.93 $86.68 $36.11 $36.11 $36.11 $36.11 $80.25 $80.25 $80.25 $16.73 $80.25 $80.25 $80.25 $80.25 $80.25 $16.72 $80.25 $86.68 $47.47 $80.25 $80.25 $80.25 $80.25 $60.38 $80.25 $80.25 $80.25 $40.13 $40.13 $63.56 $80.25 $64.20 $36.11 $15.93 N/A $46.69 $80.25 $80.25 $80.25 $16.72 $80.25 N/A N/A AR-8911DC SUP Custom 27203010 AR-8911DC - BIT DRL CNN MN TGHTRP BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8911DS SUP HCPCS C1713 AR-8911DS - KIT ESCP INST .45IN MN RND 2.7MM 1.6MM STRL TGHTRP BTN CNN BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,417.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" "$1,417.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8911G-05 SUP Custom 27203010 AR-8911G-05 - GUIDE DRL KRSH WRE MN TGHTRP BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $432.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-8912DS SUP HCPCS C1713 AR-8912DS - KIT ESCP INST MN FT STRL TGHTRP BCSCR CNN DRLBT CUP BTN DRVR BOTH IP/OP "$1,700.00" "$1,258.00" $337.41 "$1,836.00" $765.00 $765.00 $765.00 $765.00 "$1,700.00" "$1,700.00" "$1,700.00" $354.32 "$1,700.00" "$1,700.00" "$1,700.00" "$1,700.00" "$1,700.00" $354.30 "$1,700.00" "$1,836.00" "$1,005.55" "$1,700.00" "$1,700.00" "$1,700.00" "$1,700.00" "$1,275.00" "$1,700.00" "$1,700.00" "$1,700.00" $850.00 $850.00 "$1,346.40" "$1,700.00" "$1,360.00" $765.00 $337.41 N/A $986.00 "$1,700.00" "$1,700.00" "$1,700.00" $354.28 "$1,700.00" N/A N/A AR-8913DS SUP HCPCS C1713 AR-8913DS - BUTTON FX MN TGHTRP INSRTR BOTH IP/OP "$1,512.50" "$1,119.00" $300.19 "$1,512.50" $680.63 $680.63 $680.63 $680.63 "$1,512.50" "$1,512.50" "$1,512.50" $315.24 "$1,512.50" "$1,512.50" "$1,512.50" "$1,512.50" "$1,512.50" $315.22 "$1,512.50" $653.40 $894.64 "$1,512.50" "$1,512.50" "$1,512.50" "$1,512.50" "$1,134.38" "$1,512.50" "$1,512.50" "$1,512.50" $756.25 $756.25 "$1,197.90" "$1,512.50" "$1,210.00" $680.63 $300.19 N/A $877.25 "$1,512.50" $907.50 "$1,512.50" $315.21 "$1,512.50" N/A N/A AR-8914P SUP HCPCS C1713 AR-8914P - PLATE BN MN TGHTRP BTRS BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A AR-8916-05 SUP Custom 27203010 AR-8916-05 - GUIDE DRL 1.7MM 2.5MM BOTH IP/OP $937.50 $694.00 $166.88 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $166.88 $937.50 $937.50 $695.81 $695.81 $722.63 $488.44 $195.39 $937.50 $405.00 $937.50 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $609.38 $937.50 N/A $543.75 $937.50 $562.50 $937.50 $937.50 $937.50 N/A N/A AR-8916-06 SUP Custom 27203010 AR-8916-06 - BIT DRL 2.5MM CLBRT GRAD 3.5MM LCK CORT SCR BOTH IP/OP $170.00 $126.00 $30.26 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $170.00 $30.26 $170.00 $170.00 $126.17 $126.17 $131.04 $88.57 $35.43 $170.00 $73.44 $170.00 $170.00 $170.00 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $110.50 $170.00 N/A $98.60 $170.00 $102.00 $170.00 $170.00 $170.00 N/A N/A AR-8916-07 SUP Custom 27203010 AR-8916-07 - GUIDE DRL 3.5MM 30MM THRD WRST PLT SYS BOTH IP/OP $720.00 $533.00 $128.16 $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $720.00 $128.16 $720.00 $720.00 $534.38 $534.38 $554.98 $375.12 $150.06 $720.00 $311.04 $720.00 $720.00 $720.00 $720.00 $720.00 $540.00 $720.00 $720.00 $720.00 $360.00 $360.00 $570.24 $720.00 $576.00 $468.00 $720.00 N/A $417.60 $720.00 $432.00 $720.00 $720.00 $720.00 N/A N/A AR-8916-09 SUP Custom 27203010 AR-8916-09 - GUIDE DRL 2.4MM AIM WRST PLT SYS BOTH IP/OP $790.00 $585.00 $140.62 $790.00 $790.00 $790.00 $790.00 $790.00 $790.00 $790.00 $140.62 $790.00 $790.00 $586.34 $586.34 $608.93 $411.59 $164.64 $790.00 $341.28 $790.00 $790.00 $790.00 $790.00 $790.00 $592.50 $790.00 $790.00 $790.00 $395.00 $395.00 $625.68 $790.00 $632.00 $513.50 $790.00 N/A $458.20 $790.00 $474.00 $790.00 $790.00 $790.00 N/A N/A AR-8916-16 SUP HCPCS C1713 AR-8916-16 - SCREW BN ATCH RDS RT DIST VOLR BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-8916-17 SUP HCPCS C1713 AR-8916-17 - SCREW BN ATCH RDS LT DIST VOLR BOTH IP/OP $237.50 $176.00 $47.14 $256.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $256.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-8916-21 SUP Custom 27203010 AR-8916-21 - GUIDE DRL 2.4MM VAL DRP WRST PLT SYS BOTH IP/OP $610.00 $451.00 $108.58 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $610.00 $108.58 $610.00 $610.00 $452.74 $452.74 $470.19 $317.81 $127.13 $610.00 $263.52 $610.00 $610.00 $610.00 $610.00 $610.00 $457.50 $610.00 $610.00 $610.00 $305.00 $305.00 $483.12 $610.00 $488.00 $396.50 $610.00 N/A $353.80 $610.00 $366.00 $610.00 $610.00 $610.00 N/A N/A AR-8916-23 SUP Custom 27203010 AR-8916-23 - GUIDE DRL 2.5MM 1.7MM BOTH IP/OP "$1,035.00" $766.00 $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $184.23 "$1,035.00" "$1,035.00" $768.18 $768.18 $797.78 $539.24 $215.71 "$1,035.00" $447.12 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $776.25 "$1,035.00" "$1,035.00" "$1,035.00" $517.50 $517.50 $819.72 "$1,035.00" $828.00 $672.75 "$1,035.00" N/A $600.30 "$1,035.00" $621.00 "$1,035.00" "$1,035.00" "$1,035.00" N/A N/A AR-8916-26 SUP Custom 27203010 AR-8916-26 - GUIDE DRL PRLL Y 1.7MM PLT PERIPROSTHETIC BOTH IP/OP $950.00 $703.00 $169.10 $950.00 $950.00 $950.00 $950.00 $950.00 $950.00 $950.00 $169.10 $950.00 $950.00 $705.09 $705.09 $732.26 $494.95 $197.99 $950.00 $410.40 $950.00 $950.00 $950.00 $950.00 $950.00 $712.50 $950.00 $950.00 $950.00 $475.00 $475.00 $752.40 $950.00 $760.00 $617.50 $950.00 N/A $551.00 $950.00 $570.00 $950.00 $950.00 $950.00 N/A N/A AR-8916-28 SUP Custom 27203010 AR-8916-28 - BIT DRL SHRT 1.7MM GRAD 2.4MM VA LCK CORT SCR BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $146.58 $146.58 $152.23 $102.90 $41.16 $197.50 $85.32 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $128.38 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-8916CX24-18 SUP HCPCS C1713 AR-8916CX24-18 - SCREW BN 2.4MM CORT BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8916DNL-04 SUP HCPCS C1713 AR-8916DNL-04 - PLATE BN NAR 4 HL RDS LT DIST DRSL BOTH IP/OP "$3,237.50" "$2,396.00" $642.56 "$3,237.50" "$1,456.88" "$1,456.88" "$1,456.88" "$1,456.88" "$3,237.50" "$3,237.50" "$3,237.50" $674.78 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $674.73 "$3,237.50" "$1,398.60" "$1,596.09" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$1,456.88" $642.56 N/A "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" $674.70 "$3,237.50" N/A N/A AR-8916DNR-04 SUP HCPCS C1713 AR-8916DNR-04 - PLATE BN NAR 4 HL RDS RT DIST DRSL BOTH IP/OP "$3,237.50" "$2,396.00" $642.56 "$3,237.50" "$1,456.88" "$1,456.88" "$1,456.88" "$1,456.88" "$3,237.50" "$3,237.50" "$3,237.50" $674.78 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $674.73 "$3,237.50" "$1,398.60" "$1,596.09" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$1,456.88" $642.56 N/A "$1,877.75" "$3,237.50" "$3,237.50" "$3,237.50" $674.70 "$3,237.50" N/A N/A AR-8916DSL-04 SUP HCPCS C1713 AR-8916DSL-04 - PLATE BN 4 HL RDS LT DIST DRSL BOTH IP/OP "$3,237.50" "$2,396.00" $642.56 "$3,496.50" "$1,456.88" "$1,456.88" "$1,456.88" "$1,456.88" "$3,237.50" "$3,237.50" "$3,237.50" $674.78 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $674.73 "$3,237.50" "$3,496.50" "$1,596.09" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$1,456.88" $642.56 N/A "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" $674.70 "$3,237.50" N/A N/A AR-8916DSR-04 SUP HCPCS C1713 AR-8916DSR-04 - PLATE BN STD 4 HL RDS RT DRSL DIST BOTH IP/OP "$3,237.50" "$2,396.00" $642.56 "$3,496.50" "$1,456.88" "$1,456.88" "$1,456.88" "$1,456.88" "$3,237.50" "$3,237.50" "$3,237.50" $674.78 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $674.73 "$3,237.50" "$3,496.50" "$1,596.09" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$1,456.88" $642.56 N/A "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" $674.70 "$3,237.50" N/A N/A AR-8916FS SUP HCPCS C1713 AR-8916FS - MODULE INST FRAG SPC SYS BOTH IP/OP "$5,662.50" "$4,190.00" "$1,123.86" "$6,115.50" "$2,548.13" "$2,548.13" "$2,548.13" "$2,548.13" "$5,662.50" "$5,662.50" "$5,662.50" "$1,180.21" "$5,662.50" "$5,662.50" "$5,662.50" "$5,662.50" "$5,662.50" "$1,180.13" "$5,662.50" "$6,115.50" "$2,791.61" "$5,662.50" "$5,662.50" "$5,662.50" "$5,662.50" "$4,246.88" "$5,662.50" "$5,662.50" "$5,662.50" "$2,831.25" "$2,831.25" "$4,484.70" "$5,662.50" "$4,530.00" "$2,548.13" "$1,123.86" N/A "$3,284.25" "$5,662.50" "$5,662.50" "$5,662.50" "$1,180.07" "$5,662.50" N/A N/A AR-8916RSTY-05 SUP HCPCS C1713 AR-8916RSTY-05 - PLATE BN 5 HL WRST RDS 2.4 MM SCR STYLOID BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8916SPN SUP HCPCS C1713 AR-8916SPN - PLATE BN 9 HL SPAN TI WRST BOTH IP/OP "$4,487.50" "$3,321.00" $890.66 "$4,487.50" "$2,019.38" "$2,019.38" "$2,019.38" "$2,019.38" "$4,487.50" "$4,487.50" "$4,487.50" $935.31 "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" $935.24 "$4,487.50" "$1,938.60" "$2,212.34" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$3,365.63" "$4,487.50" "$4,487.50" "$4,487.50" "$2,243.75" "$2,243.75" "$3,554.10" "$4,487.50" "$3,590.00" "$2,019.38" $890.66 N/A "$2,602.75" "$4,487.50" "$4,487.50" "$4,487.50" $935.20 "$4,487.50" N/A N/A AR-8916VH-04 SUP HCPCS C1713 AR-8916VH-04 - PLATE BN 4 HL HK RDS VOLR BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8916VH-06 SUP HCPCS C1713 AR-8916VH-06 - PLATE BN 6 HL HK TI WRST VOLR BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A AR-8916VNC-08 SUP HCPCS C1713 AR-8916VNC-08 - SCREW BN P/T LOPRFL 2.4MM 8MM AU LCK SMTH VA TI RDS CORT BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8916VNC-10 SUP HCPCS C1713 AR-8916VNC-10 - SCREW BN P/T LOPRFL 2.4MM 10MM AU LCK SMTH VA TI RDS CORT BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $350.00 $350.00 N/A N/A AR-8916VNC-12 SUP HCPCS C1713 AR-8916VNC-12 - SCREW BN P/T LOPRFL 2.4MM 12MM AU LCK SMTH VA TI RDS CORT BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $350.00 $350.00 N/A N/A AR-8916VNC-14 SUP HCPCS C1713 AR-8916VNC-14 - SCREW BN P/T LOPRFL 2.4MM 14MM AU VA LCK SMTH TI RDS CORT BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8916VNC-16 SUP HCPCS C1713 AR-8916VNC-16 - SCREW BN P/T LOPRFL 2.4MM 16MM AU VA LCK SMTH TI RDS CORT BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $350.00 $350.00 N/A N/A AR-8916VNC-18 SUP HCPCS C1713 AR-8916VNC-18 - SCREW BN P/T LOPRFL 2.4MM 18MM AU VA LCK SMTH TI RDS CORT BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $350.00 $350.00 N/A N/A AR-8916VNC-20 SUP HCPCS C1713 AR-8916VNC-20 - SCREW BN P/T LOPRFL 2.4MM 20MM AU VA LCK SMTH TI RDS CORT BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8916VNC-22 SUP HCPCS C1713 AR-8916VNC-22 - SCREW BN P/T LOPRFL 2.4MM 22MM AU VA LCK SMTH TI RDS CORT BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8916VNC-24 SUP HCPCS C1713 AR-8916VNC-24 - SCREW BN P/T LOPRFL 2.4MM 24MM AU VA LCK SMTH TI RDS CORT BOTH IP/OP $350.00 $259.00 $69.47 $378.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $378.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8916VNC-26 SUP HCPCS C1713 AR-8916VNC-26 - SCREW BN P/T LOPRFL 2.4MM 26MM AU LCK SMTH VA TI RDS CORT BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8916VNC-28 SUP HCPCS C1713 AR-8916VNC-28 - SCREW BN P/T LOPRFL 2.4MM 28MM AU LCK SMTH VA TI RDS CORT BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8916VNC-30 SUP HCPCS C1713 AR-8916VNC-30 - SCREW BN P/T LOPRFL 2.4MM 30MM AU LCK SMTH VA TI RDS CORT BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8916VNC-32 SUP HCPCS C1713 AR-8916VNC-32 - SCREW BN P/T LOPRFL 2.4MM 32MM AU LCK SMTH VA TI RDS CORT BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8916VNC-34 SUP HCPCS C1713 AR-8916VNC-34 - SCREW BN P/T LOPRFL 2.4MM 34MM AU LCK SMTH VA TI RDS CORT BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $151.20 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A AR-8916VNL-03 SUP HCPCS C1713 AR-8916VNL-03 - PLATE BN NAR CNTR 3 HL ANTM GFT WDW TI RDS LT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VNL-05 SUP HCPCS C1713 AR-8916VNL-05 - PLATE BN NAR CNTR 5 HL ANTM GFT WDW TI RDS LT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VNL-07 SUP HCPCS C1713 AR-8916VNL-07 - PLATE BN NAR CNTR 7 HL ANTM GFT WDW TI RDS LT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VNR-03 SUP HCPCS C1713 AR-8916VNR-03 - PLATE BN NAR CNTR 3 HL ANTM GFT WDW TI RDS RT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VNR-05 SUP HCPCS C1713 AR-8916VNR-05 - PLATE BN NAR CNTR 5 HL ANTM GFT WDW TI RDS RT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VNR-07 SUP HCPCS C1713 AR-8916VNR-07 - PLATE BN NAR CNTR 7 HL ANTM GFT WDW TI RDS RT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VSL-03 SUP HCPCS C1713 AR-8916VSL-03 - PLATE BN STD CNTR 3 HL ANTM GFT WDW TI RDS LT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VSL-05 SUP HCPCS C1713 AR-8916VSL-05 - PLATE BN STD CNTR 5 HL ANTM GFT WDW TI RDS LT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VSL-07 SUP HCPCS C1713 AR-8916VSL-07 - PLATE BN STD CNTR 7 HL ANTM GFT WDW TI RDS LT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VSL-09 SUP HCPCS C1713 AR-8916VSL-09 - PLATE BN STD CNTR 9 HL ANTM GFT WDW TI RDS LT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VSR-03 SUP HCPCS C1713 AR-8916VSR-03 - PLATE BN STD CNTR 3 HL ANTM GFT WDW TI RDS RT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VSR-05 SUP HCPCS C1713 AR-8916VSR-05 - PLATE BN STD CNTR 5 HL ANTM GFT WDW TI RDS RT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VSR-07 SUP HCPCS C1713 AR-8916VSR-07 - PLATE BN STD CNTR 7 HL ANTM GFT WDW TI RDS RT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VSR-09 SUP HCPCS C1713 AR-8916VSR-09 - PLATE BN STD CNTR 9 HL ANTM GFT WDW TI RDS RT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VWL-03 SUP HCPCS C1713 AR-8916VWL-03 - PLATE BN W CNTR 3 HL ANTM GFT WDW TI RDS LT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VWL-05 SUP HCPCS C1713 AR-8916VWL-05 - PLATE BN W CNTR 5 HL ANTM GFT WDW TI RDS LT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VWL-07 SUP HCPCS C1713 AR-8916VWL-07 - PLATE BN W CNTR 7 HL ANTM GFT WDW TI RDS LT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" "$1,987.50" "$1,987.50" N/A N/A AR-8916VWL-09 SUP HCPCS C1713 AR-8916VWL-09 - PLATE BN W CNTR 9 HL ANTM GFT WDW TI RDS LT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $795.00 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" "$1,987.50" "$1,987.50" N/A N/A AR-8916VWR-03 SUP HCPCS C1713 AR-8916VWR-03 - PLATE BN W CNTR 3 HL ANTM GFT WDW TI RDS RT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8916VWR-05 SUP HCPCS C1713 AR-8916VWR-05 - PLATE BN W CNTR 5 HL ANTM GFT WDW TI RDS RT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" "$1,987.50" "$1,987.50" N/A N/A AR-8916VWR-07 SUP HCPCS C1713 AR-8916VWR-07 - PLATE BN W CNTR 7 HL ANTM GFT WDW TI RDS RT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" "$1,987.50" "$1,987.50" N/A N/A AR-8916VWR-09 SUP HCPCS C1713 AR-8916VWR-09 - PLATE BN W CNTR 9 HL ANTM GFT WDW TI RDS RT WRST VOLR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" "$1,987.50" "$1,987.50" N/A N/A AR-8917DS SUP HCPCS C1713 AR-8917DS - KIT ESCP INST MN FT 3.5MM STRL TGHTRP DRL GW HNDL INSRTR BOTH IP/OP "$1,575.00" "$1,166.00" $312.60 "$1,575.00" $708.75 $708.75 $708.75 $708.75 "$1,575.00" "$1,575.00" "$1,575.00" $328.27 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" $328.25 "$1,575.00" $680.40 $931.61 "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,181.25" "$1,575.00" "$1,575.00" "$1,575.00" $787.50 $787.50 "$1,247.40" "$1,575.00" "$1,260.00" $708.75 $312.60 N/A $913.50 "$1,575.00" $945.00 "$1,575.00" $328.23 "$1,575.00" N/A N/A AR-8919DS SUP Custom 27203010 AR-8919DS - KIT ASCP FX MN 1.1MM TGHTRP KRSH BTN ANCH SUT CMC BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$1,660.67" "$1,660.67" "$1,724.67" "$1,165.74" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,454.38" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A AR-8920 SUP HCPCS C1763 AR-8920 - BUTTON SUT 3.5MM STRL BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A AR-8920CDS SUP Custom 27203010 AR-8920CDS - KIT ESCP INST STRL TGHTRP CNN FLXB TI DISP SYNDESMOSIS REPR BOTH IP/OP "$1,312.50" $971.00 $233.63 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $233.63 "$1,312.50" "$1,312.50" $974.14 $974.14 "$1,011.68" $683.81 $273.54 "$1,312.50" $525.00 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $853.13 "$1,312.50" N/A $761.25 "$1,312.50" $787.50 "$1,312.50" "$1,312.50" "$1,312.50" N/A N/A AR-8920DC SUP Custom 27203010 AR-8920DC - BIT DRL 3.5MM CNN BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8921CDS SUP HCPCS C1769 AR-8921CDS - TIGHTROPE AR-8921CDS BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $712.69 $712.69 $712.69 $712.69 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" $974.14 $974.14 "$1,011.68" $683.81 $273.54 "$1,312.50" "$1,312.50" $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $853.13 $260.50 N/A $761.25 "$1,312.50" "$1,312.50" "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8922 SUP HCPCS C1763 AR-8922 - BUTTON SUT 12MM STRL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A AR-8923BC SUP HCPCS C1713 AR-8923BC - ANCHOR SUT SHRT MED 2.9MM 2.3MM 12.5MM STRL PUSHLOCK BCMPS BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" $400.00 $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" $600.00 "$1,000.00" $208.40 "$1,000.00" N/A N/A AR-8923DSC SUP Custom 27203010 AR-8923DSC - KIT INST SHRT DRLBT DRL GD DISP 2.9/12.5MM BCMPS PUSHLOCK BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8926SS SUP Custom 27203010 AR-8926SS - KIT ESCP INST STRL TGHTRP CNN SS SYNDESMOSIS REPR ASCP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$1,632.84" "$1,632.84" "$1,695.76" "$1,146.20" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" "$1,430.00" "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A AR-8926T SUP Custom 27203010 AR-8926T - KIT ESCP INST STRL TGHTRP SUT TI DESMOSIS REPR ASCP BOTH IP/OP "$2,200.00" "$1,628.00" $391.60 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $391.60 "$2,200.00" "$2,200.00" "$1,632.84" "$1,632.84" "$1,695.76" "$1,146.20" $458.50 "$2,200.00" $880.00 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" "$1,430.00" "$2,200.00" N/A "$1,276.00" "$2,200.00" "$1,320.00" "$2,200.00" "$2,200.00" "$2,200.00" N/A N/A AR-8927BC SUP HCPCS C1713 AR-8927BC - ANCHOR SUT 1 LG FT TPR 3.4MM 15MM CSCR FWR TIGERWIRE BRD NDL BOTH IP/OP $812.50 $601.00 $161.26 $812.50 $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 $325.00 $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $487.50 $812.50 $169.33 $812.50 N/A N/A AR-8927BCNF-CP SUP HCPCS C1713 AR-8927BCNF-CP - SET IMPL STRL LF ARTHX SUTUREBRIDGE BCMPS DISP AHLS PK BOTH IP/OP "$3,987.50" "$2,951.00" $791.42 "$3,987.50" "$1,794.38" "$1,794.38" "$1,794.38" "$1,794.38" "$3,987.50" "$3,987.50" "$3,987.50" $831.09 "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" $831.04 "$3,987.50" "$1,595.00" "$1,965.84" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$2,990.63" "$3,987.50" "$3,987.50" "$3,987.50" "$1,993.75" "$1,993.75" "$3,158.10" "$3,987.50" "$3,190.00" "$1,794.38" $791.42 N/A "$2,312.75" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" N/A N/A AR-8927BNF SUP HCPCS C1713 AR-8927BNF - ANCHOR SUT 1 LG FT TPR 5.5MM 15MM BCSCR FWR BRD NDL POLY L BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8927BNF-CP SUP HCPCS C1713 AR-8927BNF-CP - SET IMPL LG TPR SUTUREBRIDGE ANCH DRL GD NDL PNCH TAP AHLS BOTH IP/OP "$3,100.00" "$2,294.00" $615.27 "$3,100.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$3,100.00" "$3,100.00" "$3,100.00" $646.12 "$3,100.00" "$3,100.00" "$3,100.00" "$3,100.00" "$3,100.00" $646.07 "$3,100.00" "$3,100.00" "$1,528.30" "$3,100.00" "$3,100.00" "$3,100.00" "$3,100.00" "$2,325.00" "$3,100.00" "$3,100.00" "$3,100.00" "$1,550.00" "$1,550.00" "$2,455.20" "$3,100.00" "$2,480.00" "$1,395.00" $615.27 N/A "$1,798.00" "$3,100.00" "$3,100.00" "$3,100.00" "$3,100.00" "$3,100.00" N/A N/A AR-8927DSC SUP Custom 27203010 AR-8927DSC - KIT INST DISP 4.5/14MM BCMPS CRKSCR BOTH IP/OP $437.50 $324.00 $77.88 $945.00 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $945.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8927P-CP SUP HCPCS C1713 AR-8927P-CP - SET IMPL SUTUREBRIDGE DRL GD PNCH PUSHLOCK TAP PEEK AHLS PK BOTH IP/OP "$3,100.00" "$2,294.00" $615.27 "$3,100.00" "$1,395.00" "$1,395.00" "$1,395.00" "$1,395.00" "$3,100.00" "$3,100.00" "$3,100.00" $646.12 "$3,100.00" "$3,100.00" "$3,100.00" "$3,100.00" "$3,100.00" $646.07 "$3,100.00" "$1,240.00" "$1,528.30" "$3,100.00" "$3,100.00" "$3,100.00" "$3,100.00" "$2,325.00" "$3,100.00" "$3,100.00" "$3,100.00" "$1,550.00" "$1,550.00" "$2,455.20" "$3,100.00" "$2,480.00" "$1,395.00" $615.27 N/A "$1,798.00" "$3,100.00" "$1,860.00" "$3,100.00" $646.04 "$3,100.00" N/A N/A AR-8928BC-CP SUP HCPCS C1713 AR-8928BC-CP - SET IMPL SUTUREBRIDGE ANCH DRILL GUIDE PNCH TAP BOTH IP/OP "$4,350.00" "$3,219.00" $863.37 "$4,350.00" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$4,350.00" "$4,350.00" "$4,350.00" $906.65 "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" $906.59 "$4,350.00" "$1,879.20" "$2,144.55" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$3,262.50" "$4,350.00" "$4,350.00" "$4,350.00" "$2,175.00" "$2,175.00" "$3,445.20" "$4,350.00" "$3,480.00" "$1,957.50" $863.37 N/A "$2,523.00" "$4,350.00" "$2,610.00" "$4,350.00" $906.54 "$4,350.00" N/A N/A AR-8928BCJ-CP SUP HCPCS C1713 AR-8928BCJ-CP - SYSTEM FX STRL SPEEDBRIDGE JUMPSTART BCMPS AHLS BOTH IP/OP "$4,987.50" "$3,691.00" $989.89 "$5,386.50" "$2,244.38" "$2,244.38" "$2,244.38" "$2,244.38" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.52" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.45" "$4,987.50" "$5,386.50" "$2,458.84" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$3,740.63" "$4,987.50" "$4,987.50" "$4,987.50" "$2,493.75" "$2,493.75" "$3,950.10" "$4,987.50" "$3,990.00" "$2,244.38" $989.89 N/A "$2,892.75" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.40" "$4,987.50" N/A N/A AR-8928P-CP SUP HCPCS C1713 AR-8928P-CP - SET IMPL SUTUREBRIDGE ANCH DRL GD PNCH TAP PEEK AHLS PK BOTH IP/OP "$4,350.00" "$3,219.00" $863.37 "$4,350.00" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$4,350.00" "$4,350.00" "$4,350.00" $906.65 "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" $906.59 "$4,350.00" "$4,350.00" "$2,144.55" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$3,262.50" "$4,350.00" "$4,350.00" "$4,350.00" "$2,175.00" "$2,175.00" "$3,445.20" "$4,350.00" "$3,480.00" "$1,957.50" $863.37 N/A "$2,523.00" "$4,350.00" "$4,350.00" "$4,350.00" $906.54 "$4,350.00" N/A N/A AR-8928PJ-CP SUP HCPCS C1713 AR-8928PJ-CP - SYSTEM IMPL STRL ARTHX SPEEDBRIDGE JUMPSTART AHLS BOTH IP/OP "$4,987.50" "$3,691.00" $989.89 "$5,386.50" "$2,244.38" "$2,244.38" "$2,244.38" "$2,244.38" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.52" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.45" "$4,987.50" "$5,386.50" "$2,458.84" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$3,740.63" "$4,987.50" "$4,987.50" "$4,987.50" "$2,493.75" "$2,493.75" "$3,950.10" "$4,987.50" "$3,990.00" "$2,244.38" $989.89 N/A "$2,892.75" "$4,987.50" "$2,992.50" "$4,987.50" "$1,039.40" "$4,987.50" N/A N/A AR-8930-10 SUP HCPCS C1713 AR-8930-10 - SCREW BN FT 2MM 10MM SLVR QFIX 3 PR SLF DRL ST SNPOF SLD TI BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $259.20 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A AR-8930-11 SUP HCPCS C1713 AR-8930-11 - SCREW BN FT 2MM 11MM MAG QFIX 3 PR SLF DRL ST SNPOF SLD TI BOTH IP/OP $600.00 $444.00 $119.09 $648.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $648.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A AR-8930-12 SUP HCPCS C1713 AR-8930-12 - SCREW BN FT 2MM 12MM BLU QFIX 3 PR SLF DRL ST SNPOF SLD TI BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $259.20 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A AR-8930-13 SUP HCPCS C1713 AR-8930-13 - SCREW BN FT 2MM 13MM GRN QFIX 3 PR SLF DRL ST SNPOF SLD TI BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $259.20 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A AR-8930-14 SUP HCPCS C1713 AR-8930-14 - SCREW BN FT 2MM 14MM PUR QFIX 3 PR SLF DRL ST SNPOF SLD TI BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $259.20 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A AR-8930D-13 SUP Custom 27203010 AR-8930D-13 - BIT DRL 1.3MM 2MM QFIX SCR BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8930MC SUP Custom 27203010 AR-8930MC - CLAMP SRG QFIX WEIL OSTM BOTH IP/OP "$3,987.50" "$2,951.00" $709.78 "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" $709.78 "$3,987.50" "$3,987.50" "$2,959.52" "$2,959.52" "$3,073.57" "$2,060.15" $831.04 "$3,987.50" "$1,722.60" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$3,987.50" "$2,990.63" "$3,987.50" "$3,987.50" "$3,987.50" "$1,993.75" "$1,993.75" "$3,158.10" "$3,987.50" "$3,190.00" "$2,591.88" "$3,987.50" N/A "$2,312.75" "$3,987.50" "$2,392.50" "$3,987.50" "$3,987.50" "$3,987.50" N/A N/A AR-8930MCS SUP Custom 27203010 AR-8930MCS - CLAMP SRG QFIX INST SET BOTH IP/OP "$4,737.50" "$3,506.00" $843.28 "$4,737.50" "$4,737.50" "$4,737.50" "$4,737.50" "$4,737.50" "$4,737.50" "$4,737.50" $843.28 "$4,737.50" "$4,737.50" "$3,516.17" "$3,516.17" "$3,651.67" "$2,060.15" $987.35 "$4,737.50" "$1,895.00" "$4,737.50" "$4,737.50" "$4,737.50" "$4,737.50" "$4,737.50" "$3,553.13" "$4,737.50" "$4,737.50" "$4,737.50" "$2,368.75" "$2,368.75" "$3,752.10" "$4,737.50" "$3,790.00" "$3,079.38" "$4,737.50" N/A "$2,747.75" "$4,737.50" "$2,842.50" "$4,737.50" "$4,737.50" "$4,737.50" N/A N/A AR-8931-13 SUP HCPCS C1713 AR-8931-13 - SCREW BN FT 3MM 13MM YLW QFIX 3 PR SLF DRL SNPOF TI FT HND BOTH IP/OP $600.00 $444.00 $119.09 $648.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $648.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $600.00 $600.00 $125.04 $600.00 N/A N/A AR-8931-15 SUP HCPCS C1713 AR-8931-15 - SCREW BN FT 3MM 15MM LGHT BLU QFIX 3 PR SLF DRL SNPOF TI FT BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $259.20 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $600.00 $600.00 $125.04 $600.00 N/A N/A AR-8931-17 SUP HCPCS C1713 AR-8931-17 - SCREW BN FT 3MM 17MM AQ QFIX 3 PR SLF DRL SNPOF TI FT HND BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $259.20 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A AR-8931-17S SUP HCPCS C1713 AR-8931-17S - SCREW BN 3MM 17MM STRL ARTHX QFIX BOTH IP/OP $600.00 $444.00 $119.09 $648.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $648.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $600.00 $600.00 $125.04 $600.00 N/A N/A AR-8931-19 SUP HCPCS C1713 AR-8931-19 - SCREW BN FT 3MM 19MM BRNZ QFIX 3 PR SLF DRL SNPOF TI FT HND BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $259.20 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A AR-8933-10 SUP HCPCS C1713 AR-8933-10 - SCREW BN FT T10 HEXALOBE 3MM 10MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8933-10PT SUP HCPCS C1713 AR-8933-10PT - SCREW BN 2.5MM HEX P/T 3MM 10MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $324.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $324.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8933-12 SUP HCPCS C1713 AR-8933-12 - SCREW BN FT T10 HEXALOBE 3MM 12MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8933-12PT SUP HCPCS C1713 AR-8933-12PT - SCREW BN 2.5MM P/T HEX 3MM 12MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $324.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $324.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8933-14 SUP HCPCS C1713 AR-8933-14 - SCREW BN FT T10 HEXALOBE 3MM 14MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8933-14PT SUP HCPCS C1713 AR-8933-14PT - SCREW BN 2.5MM P/T HEX 3MM 14MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $324.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $324.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8933-16 SUP HCPCS C1713 AR-8933-16 - SCREW BN FT T10 HEXALOBE 3MM 16MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8933-16PT SUP HCPCS C1713 AR-8933-16PT - SCREW BN 2.5MM P/T HEX 3MM 16MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $324.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $324.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8933-18 SUP HCPCS C1713 AR-8933-18 - SCREW BN T10 HEXALOBE FT 3MM 18MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8933-18PT SUP HCPCS C1713 AR-8933-18PT - SCREW BN 2.5MM P/T HEX 3MM 18MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $324.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $324.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A AR-8933-18PTS SUP HCPCS C1713 AR-8933-18PTS - SCREW BN P/T 3MM 18MM STRL ARTHX LOPRFL SCR CNN TI BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8933-20 SUP HCPCS C1713 AR-8933-20 - SCREW BN FT T10 HEXALOBE 3MM 20MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8933-20C SUP Custom 27203010 AR-8933-20C - BIT DRL 2MM CNN AO BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8933-20PT SUP HCPCS C1713 AR-8933-20PT - SCREW BN 2.5MM P/T HEX 3MM 20MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $129.60 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A AR-8933-20PTS SUP HCPCS C1713 AR-8933-20PTS - SCREW BN P/T 3MM 20MM STRL ARTHX LOPRFL SCR CNN TI BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $18.24 $87.50 N/A N/A AR-8933-22 SUP HCPCS C1713 AR-8933-22 - SCREW BN FT T10 HEXALOBE 3MM 22MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8933-22PT SUP HCPCS C1713 AR-8933-22PT - SCREW BN 2.5MM P/T HEX 3MM 22MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $129.60 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A AR-8933-24 SUP HCPCS C1713 AR-8933-24 - SCREW BN FT T10 HEXALOBE 3MM 24MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8933-24PT SUP HCPCS C1713 AR-8933-24PT - SCREW BN 2.5MM P/T HEX 3MM 24MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $324.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $324.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A AR-8933-26 SUP HCPCS C1713 AR-8933-26 - SCREW BN T10 HEXALOBE FT 3MM 26MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8933-26PT SUP HCPCS C1713 AR-8933-26PT - SCREW BN 2.5MM P/T HEX 3MM 26MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $129.60 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A AR-8933-28 SUP HCPCS C1713 AR-8933-28 - SCREW BN FT T10 HEXALOBE 3MM 28MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8933-28PT SUP HCPCS C1713 AR-8933-28PT - SCREW BN 2.5MM P/T HEX 3MM 28MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $129.60 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A AR-8933-30 SUP HCPCS C1713 AR-8933-30 - SCREW BN T10 HEXALOBE FT 3MM 30MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $275.00 $275.00 N/A N/A AR-8933-30C SUP Custom 27203010 AR-8933-30C - BIT DRL 3MM CNN BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8933-30PT SUP HCPCS C1713 AR-8933-30PT - SCREW BN 2.5MM P/T HEX 3MM 30MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $324.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $324.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8933-30PTS SUP HCPCS C1713 AR-8933-30PTS - SCREW BN P/T 3MM 30MM STRL ARTHX LOPRFL SCR CNN TI BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $39.38 $39.38 $39.38 $39.38 $87.50 $87.50 $87.50 $18.24 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $17.37 N/A $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A AR-8933-32PT SUP HCPCS C1713 AR-8933-32PT - SCREW BN 2.5MM P/T HEX 3MM 32MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $324.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $324.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8933-34 SUP HCPCS C1713 AR-8933-34 - SCREW BN T10 HEXALOBE FT 3MM 34MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8933-34PT SUP HCPCS C1713 AR-8933-34PT - SCREW BN 2.5MM HEX P/T 3MM 34MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $129.60 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8933-36 SUP HCPCS C1713 AR-8933-36 - SCREW BN T10 HEXALOBE FT 3MM 36MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8933-36PT SUP HCPCS C1713 AR-8933-36PT - SCREW BN 2.5MM P/T HEX 3MM 36MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $129.60 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8933-38 SUP HCPCS C1713 AR-8933-38 - SCREW BN T10 HEXALOBE FT 3MM 38MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8933-38PT SUP HCPCS C1713 AR-8933-38PT - SCREW BN 2.5MM P/T HEX 3MM 38MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $129.60 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8933-40 SUP HCPCS C1713 AR-8933-40 - SCREW BN T10 HEXALOBE FT 3MM 40MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $275.00 $204.00 $54.58 $297.00 $123.75 $123.75 $123.75 $123.75 $275.00 $275.00 $275.00 $57.32 $275.00 $275.00 $275.00 $275.00 $275.00 $57.31 $275.00 $297.00 $162.66 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $123.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A AR-8933-40PT SUP HCPCS C1713 AR-8933-40PT - SCREW BN 2.5MM P/T HEX 3MM 40MM LOPRFL SCR SLF DRL ST CNN TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $129.60 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A AR-8933G SUP Custom 27203010 AR-8933G - GUIDE DRL LOPRFL 1.1-2MM BOTH IP/OP $712.50 $527.00 $126.83 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $712.50 $126.83 $712.50 $712.50 $528.82 $528.82 $549.20 $371.21 $148.49 $712.50 $307.80 $712.50 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $463.13 $712.50 N/A $413.25 $712.50 $427.50 $712.50 $712.50 $712.50 N/A N/A AR-8933GV SUP Custom 27203010 AR-8933GV - GUIDE DRL 3MM VA BOTH IP/OP "$1,037.50" $768.00 $184.68 "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" $184.68 "$1,037.50" "$1,037.50" $770.03 $770.03 $799.71 $540.54 $216.23 "$1,037.50" $448.20 "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" $778.13 "$1,037.50" "$1,037.50" "$1,037.50" $518.75 $518.75 $821.70 "$1,037.50" $830.00 $674.38 "$1,037.50" N/A $601.75 "$1,037.50" $622.50 "$1,037.50" "$1,037.50" "$1,037.50" N/A N/A AR-8933L-10 SUP HCPCS C1713 AR-8933L-10 - SCREW BN FT T10 HEXALOBE 3MM 10MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8933L-12 SUP HCPCS C1713 AR-8933L-12 - SCREW BN FT T10 HEXALOBE 3MM 12MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8933L-14 SUP HCPCS C1713 AR-8933L-14 - SCREW BN FT T10 HEXALOBE 3MM 14MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8933L-16 SUP HCPCS C1713 AR-8933L-16 - SCREW BN FT T10 HEXALOBE 3MM 16MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8933L-18 SUP HCPCS C1713 AR-8933L-18 - SCREW BN T10 HEXALOBE FT 3MM 18MM SLF DRL SLD LCK LOPRFL TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8933L-20 SUP HCPCS C1713 AR-8933L-20 - SCREW BN FT T10 3MM 20MM SLF DRL SLD LCK LOPRFL TI FOREFOOT BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8933L-22 SUP HCPCS C1713 AR-8933L-22 - SCREW BN FT T10 HEXALOBE 3MM 22MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8933L-24 SUP HCPCS C1713 AR-8933L-24 - SCREW BN FT T10 HEXALOBE 3MM 24MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8933L-26 SUP HCPCS C1713 AR-8933L-26 - SCREW BN T10 HEXALOBE FT 3MM 26MM LCK SLF DRL SLD TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8933L-28 SUP HCPCS C1713 AR-8933L-28 - SCREW BN 3MM 28MM LCK LOPRFL TI FT HND ANKL WRST BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A AR-8933L-30 SUP HCPCS C1713 AR-8933L-30 - SCREW BN 3MM 30MM LCK LOPRFL TI FT HND ANKL WRST BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A AR-8933L-32 SUP HCPCS C1713 AR-8933L-32 - SCREW BN 3MM 32MM LCK TI FT/ANKL BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8933L-36 SUP HCPCS C1713 AR-8933L-36 - SCREW BN 3MM 36MM LOPRFL LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8933L-38 SUP HCPCS C1713 AR-8933L-38 - SCREW BN 3MM 38MM LCK TI FT/ANKL BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8933L-40 SUP HCPCS C1713 AR-8933L-40 - SCREW BN 3MM 40MM LCK TI FT/ANKL BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8933V-10 SUP HCPCS C1713 AR-8933V-10 - SCREW BN 3MM 10MM LCK VA TI FT BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $437.50 $437.50 N/A N/A AR-8933V-12 SUP HCPCS C1713 AR-8933V-12 - SCREW BN 3MM 12MM LCK VA TI FT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $437.50 $437.50 N/A N/A AR-8933V-14 SUP HCPCS C1713 AR-8933V-14 - SCREW BN 3MM 14MM LCK VA TI FT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8933V-16 SUP HCPCS C1713 AR-8933V-16 - SCREW BN 3MM 16MM VA LCK TI FT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8933V-18 SUP HCPCS C1713 AR-8933V-18 - SCREW BN 3MM 18MM LCK VA TI FT BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $437.50 $437.50 N/A N/A AR-8933V-20 SUP HCPCS C1713 AR-8933V-20 - SCREW BN 3MM 20MM VA LCK TI FT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $437.50 $437.50 N/A N/A AR-8933V-22 SUP HCPCS C1713 AR-8933V-22 - SCREW BN 3MM 22MM VA LCK TI FT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8933V-24 SUP HCPCS C1713 AR-8933V-24 - SCREW BN 3MM 24MM LCK VA TI FT BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8933V-26 SUP HCPCS C1713 AR-8933V-26 - SCREW BN 3MM 26MM LCK VA TI FT BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8933V-28 SUP HCPCS C1713 AR-8933V-28 - SCREW BN 3MM 28MM LCK VA TI FT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8933V-30 SUP HCPCS C1713 AR-8933V-30 - SCREW BN 3MM 30MM LCK VA TI FT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $437.50 $437.50 N/A N/A AR-8933V-32 SUP HCPCS C1713 AR-8933V-32 - SCREW BN 3MM 32MM LCK VA TI FT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $437.50 $437.50 N/A N/A AR-8933V-34 SUP HCPCS C1713 AR-8933V-34 - SCREW BN 3MM 34MM LCK VA TI FT BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8933V-36 SUP HCPCS C1713 AR-8933V-36 - SCREW BN 3MM 36MM LCK VA TI FT BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8933V-38 SUP HCPCS C1713 AR-8933V-38 - SCREW BN 3MM 38MM LCK VA TI FT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8933V-40 SUP HCPCS C1713 AR-8933V-40 - SCREW BN 3MM 40MM LCK VA TI FT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $437.50 $437.50 N/A N/A AR-8934BCNF SUP HCPCS C1713 AR-8934BCNF - ANCHOR SUTURE 1 .5 CIR 2 DIAMOND 26.2MM NEEDLE SUTURETAK BOTH IP/OP $812.50 $601.00 $161.26 "$1,755.00" $365.63 $365.63 $365.63 $365.63 $812.50 $812.50 $812.50 $169.35 $812.50 $812.50 $812.50 $812.50 $812.50 $169.33 $812.50 "$1,755.00" $480.59 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $365.63 $161.26 N/A $471.25 $812.50 $812.50 $812.50 $169.33 $812.50 N/A N/A AR-8934BCNF-00 SUP HCPCS C1713 AR-8934BCNF-00 - ANCHOR SUT 0 .5 CRC 4 DMD 22.2MM SUT TK FBRWR NDL BCMPS S BOTH IP/OP "$4,062.50" "$3,006.00" $806.30 "$4,062.50" "$1,828.13" "$1,828.13" "$1,828.13" "$1,828.13" "$4,062.50" "$4,062.50" "$4,062.50" $846.73 "$4,062.50" "$4,062.50" "$4,062.50" "$4,062.50" "$4,062.50" $846.67 "$4,062.50" "$1,625.00" "$2,002.81" "$4,062.50" "$4,062.50" "$4,062.50" "$4,062.50" "$3,046.88" "$4,062.50" "$4,062.50" "$4,062.50" "$2,031.25" "$2,031.25" "$3,217.50" "$4,062.50" "$3,250.00" "$1,828.13" $806.30 N/A "$2,356.25" "$4,062.50" "$4,062.50" "$4,062.50" $846.63 "$4,062.50" N/A N/A AR-8934DSC SUP Custom 27203010 AR-8934DSC - KIT INSTR 2.4MM DRILL GUIDE STEP DRILL DISPOSABLE SMALL BOTH IP/OP $362.50 $268.00 $64.53 $783.00 $362.50 $362.50 $362.50 $362.50 $362.50 $362.50 $64.53 $362.50 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $783.00 $362.50 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $362.50 N/A $210.25 $362.50 $217.50 $362.50 $362.50 $362.50 N/A N/A AR-8935-10 SUP HCPCS C1713 AR-8935-10 - SCREW BN T15 HEXALOBE FT 3.5MM 10MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $90.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-11 SUP HCPCS C1713 AR-8935-11 - SCREW BN T15 HEXALOBE FT 3.5MM 11MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-12 SUP HCPCS C1713 AR-8935-12 - SCREW BN T15 FT HEXALOBE 3.5MM 12MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-13 SUP HCPCS C1713 AR-8935-13 - SCREW BN T15 FT HEXALOBE 3.5MM 13MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-14 SUP HCPCS C1713 AR-8935-14 - SCREW BN T15 FT HEXALOBE 3.5MM 14MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-16 SUP HCPCS C1713 AR-8935-16 - SCREW BN T15 FT HEXALOBE 3.5MM 16MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-18 SUP HCPCS C1713 AR-8935-18 - SCREW BN T15 FT HEXALOBE 3.5MM 18MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-20 SUP HCPCS C1713 AR-8935-20 - SCREW BN T15 FT HEXALOBE 3.5MM 20MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-22 SUP HCPCS C1713 AR-8935-22 - SCREW BN T15 FT HEXALOBE 3.5MM 22MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-28 SUP HCPCS C1713 AR-8935-28 - SCREW BN T15 FT HEXALOBE 3.5MM 28MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-30 SUP HCPCS C1713 AR-8935-30 - SCREW BN T15 FT HEXALOBE 3.5MM 30MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $150.00 $150.00 N/A N/A AR-8935-34 SUP HCPCS C1713 AR-8935-34 - SCREW BN T15 FT HEXALOBE 3.5MM 34MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-36 SUP HCPCS C1713 AR-8935-36 - SCREW BN T15 FT HEXALOBE 3.5MM 36MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $150.00 $150.00 N/A N/A AR-8935-38 SUP HCPCS C1713 AR-8935-38 - SCREW BN T15 FT HEXALOBE 3.5MM 38MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-40 SUP HCPCS C1713 AR-8935-40 - SCREW BN T15 FT HEXALOBE 3.5MM 40MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-42 SUP HCPCS C1713 AR-8935-42 - SCREW BN T15 FT HEXALOBE 3.5MM 42MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $150.00 $150.00 N/A N/A AR-8935-44 SUP HCPCS C1713 AR-8935-44 - SCREW BN T15 FT HEXALOBE 3.5MM 44MM LOPRFL SCR SLF DRL SLD BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-46 SUP HCPCS C1713 AR-8935-46 - SCREW BN 3.5MM 46MM LOPRFL TI FT/ANKL CORT BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-48 SUP HCPCS C1713 AR-8935-48 - SCREW BN 3.5MM 48MM LOPRFL TI CORT BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-50 SUP HCPCS C1713 AR-8935-50 - SCREW BN 3.5MM 50MM LOPRFL TI FT/ANKL CORT BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-52 SUP HCPCS C1713 AR-8935-52 - SCREW BN 3.5MM 52MM LOPRFL TI CORT BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-54 SUP HCPCS C1713 AR-8935-54 - SCREW BN 3.5MM 54MM LOPRFL TI FT/ANKL CORT BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-56 SUP HCPCS C1713 AR-8935-56 - SCREW BN 3.5MM 56MM LOPRFL TI FT/ANKL CORT BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-58 SUP HCPCS C1713 AR-8935-58 - SCREW BN 3.5MM 58MM LOPRFL TI FT/ANKL CORT BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935-60 SUP HCPCS C1713 AR-8935-60 - SCREW BN 3.5MM 60MM LOPRFL TI FT/ANKL CORT BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8935G SUP Custom 27203010 AR-8935G - GUIDE DRL 3.5MM 4MM BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $216.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A AR-8935GV SUP Custom 27203010 AR-8935GV - GUIDE DRL 3.5MM VA BOTH IP/OP "$1,037.50" $768.00 $184.68 "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" $184.68 "$1,037.50" "$1,037.50" $770.03 $770.03 $799.71 $540.54 $216.23 "$1,037.50" $448.20 "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" "$1,037.50" $778.13 "$1,037.50" "$1,037.50" "$1,037.50" $518.75 $518.75 $821.70 "$1,037.50" $830.00 $674.38 "$1,037.50" N/A $601.75 "$1,037.50" $622.50 "$1,037.50" "$1,037.50" "$1,037.50" N/A N/A AR-8935GVN SUP Custom 27203010 AR-8935GVN - GUIDE DRL 3.5MM LCK VA BOTH IP/OP $337.50 $250.00 $60.08 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $60.08 $337.50 $337.50 $250.49 $250.49 $260.15 $175.84 $70.34 $337.50 $145.80 $337.50 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $219.38 $337.50 N/A $195.75 $337.50 $202.50 $337.50 $337.50 $337.50 N/A N/A AR-8935L-10 SUP HCPCS C1713 AR-8935L-10 - SCREW BN 3.5MM 10MM LOPRFL LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-12 SUP HCPCS C1713 AR-8935L-12 - SCREW BN 3.5MM 12MM LCK LOPRFL TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-14 SUP HCPCS C1713 AR-8935L-14 - SCREW BN T15 FT HEXALOBE 3.5MM 14MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-16 SUP HCPCS C1713 AR-8935L-16 - SCREW BN 3.5MM 16MM LCK TI MIDFOOT CORT BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-20 SUP HCPCS C1713 AR-8935L-20 - SCREW BN T15 FT HEXALOBE 3.5MM 20MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-22 SUP HCPCS C1713 AR-8935L-22 - SCREW BN T15 FT HEXALOBE 3.5MM 22MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-24 SUP HCPCS C1713 AR-8935L-24 - SCREW BN T15 FT HEXALOBE 3.5MM 24MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-26 SUP HCPCS C1713 AR-8935L-26 - SCREW BN T15 FT HEXALOBE 3.5MM 26MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-28 SUP HCPCS C1713 AR-8935L-28 - SCREW BN T15 FT HEXALOBE 3.5MM 28MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-30 SUP HCPCS C1713 AR-8935L-30 - SCREW BN T15 FT HEXALOBE 3.5MM 30MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-32 SUP HCPCS C1713 AR-8935L-32 - SCREW BN T15 FT HEXALOBE 3.5MM 32MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A AR-8935L-34 SUP HCPCS C1713 AR-8935L-34 - SCREW BN T15 FT HEXALOBE 3.5MM 34MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $375.00 $375.00 N/A N/A AR-8935L-36 SUP HCPCS C1713 AR-8935L-36 - SCREW BN T15 FT HEXALOBE 3.5MM 36MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-38 SUP HCPCS C1713 AR-8935L-38 - SCREW BN T15 FT HEXALOBE 3.5MM 38MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-40 SUP HCPCS C1713 AR-8935L-40 - SCREW BN T15 FT HEXALOBE 3.5MM 40MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-42 SUP HCPCS C1713 AR-8935L-42 - SCREW BN T15 FT HEXALOBE 3.5MM 42MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-44 SUP HCPCS C1713 AR-8935L-44 - SCREW BN T15 FT HEXALOBE 3.5MM 44MM SLF DRL SLD LCK TI BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-46 SUP HCPCS C1713 AR-8935L-46 - SCREW BN 3.5MM 46MM LCK LOPRFL TI HND ANKL LNG BN BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-48 SUP HCPCS C1713 AR-8935L-48 - SCREW BN 3.5MM 48MM LCK LOPRFL TI FT/ANKL BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-50 SUP HCPCS C1713 AR-8935L-50 - SCREW BN 3.5MM 50MM LCK LOPRFL TI FT/ANKL BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-52 SUP HCPCS C1713 AR-8935L-52 - SCREW BN 3.5MM 52MM LCK LOPRFL TI FT/ANKL BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $162.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-54 SUP HCPCS C1713 AR-8935L-54 - SCREW BN 3.5MM 54MM LCK LOPRFL TI FT/ANKL BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-56 SUP HCPCS C1713 AR-8935L-56 - SCREW BN 3.5MM 56MM LCK LOPRFL TI FT/ANKL BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-58 SUP HCPCS C1713 AR-8935L-58 - SCREW BN 3.5MM 58MM LCK LOPRFL TI FT/ANKL BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8935L-60 SUP HCPCS C1713 AR-8935L-60 - SCREW BN 3.5MM 60MM LCK LOPRFL TI FT/ANKL BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8936BC-CP SUP HCPCS C1713 AR-8936BC-CP - KIT ESCP INST CNN STP DRL DRL GD OBT BROSTROM ASCP BOTH IP/OP "$3,625.00" "$2,683.00" $719.47 "$3,625.00" "$1,631.25" "$1,631.25" "$1,631.25" "$1,631.25" "$3,625.00" "$3,625.00" "$3,625.00" $755.54 "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" $755.49 "$3,625.00" "$1,566.00" "$1,787.13" "$3,625.00" "$3,625.00" "$3,625.00" "$3,625.00" "$2,718.75" "$3,625.00" "$3,625.00" "$3,625.00" "$1,812.50" "$1,812.50" "$2,871.00" "$3,625.00" "$2,900.00" "$1,631.25" $719.47 N/A "$2,102.50" "$3,625.00" "$2,175.00" "$3,625.00" $755.45 "$3,625.00" N/A N/A AR-8938P SUP HCPCS C1713 AR-8938P - KIT INST RD YLW 2 EYLT CNVR LCK DRVR SMPL SNP SUT LDR PEEK BOTH IP/OP $487.50 $361.00 $96.76 $526.50 $219.38 $219.38 $219.38 $219.38 $487.50 $487.50 $487.50 $101.61 $487.50 $487.50 $487.50 $487.50 $487.50 $101.60 $487.50 $526.50 $288.36 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $219.38 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A AR-8940-14 SUP HCPCS C1713 AR-8940-14 - SCREW BN T15 FT HEXALOBE 4MM 14MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-16 SUP HCPCS C1713 AR-8940-16 - SCREW BN T15 FT HEXALOBE 4MM 16MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-16S SUP HCPCS C1713 AR-8940-16S - SCREW BN 4MM 16MM STRL ARTHX LOPRFL SCR TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $300.00 $300.00 $300.00 $300.00 N/A N/A AR-8940-18 SUP HCPCS C1713 AR-8940-18 - SCREW BN T15 FT HEXALOBE 4MM 18MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-18S SUP HCPCS C1713 AR-8940-18S - SCREW BN 4MM 18MM STRL ARTHX LOPRFL SCR TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8940-20 SUP HCPCS C1713 AR-8940-20 - SCREW BN T15 FT HEXALOBE 4MM 20MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-20S SUP HCPCS C1713 AR-8940-20S - SCREW BN 4MM 20MM STRL ARTHX LOPRFL SCR TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8940-22 SUP HCPCS C1713 AR-8940-22 - SCREW BN T15 FT HEXALOBE 4MM 22MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-22S SUP HCPCS C1713 AR-8940-22S - SCREW BN 4MM 22MM STRL ARTHX LOPRFL SCR TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A AR-8940-24 SUP HCPCS C1713 AR-8940-24 - SCREW BN T15 FT HEXALOBE 4MM 24MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-26 SUP HCPCS C1713 AR-8940-26 - SCREW BN T15 FT HEXALOBE 4MM 26MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-28 SUP HCPCS C1713 AR-8940-28 - SCREW BN T15 FT HEXALOBE 4MM 28MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-28S SUP HCPCS C1713 AR-8940-28S - SCREW BN 4MM 28MM STRL ARTHX LOPRFL SCR TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8940-30 SUP HCPCS C1713 AR-8940-30 - SCREW BN T15 FT HEXALOBE 4MM 30MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-30S SUP HCPCS C1713 AR-8940-30S - SCREW BN 4MM 30MM STRL ARTHX LOPRFL SCR TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $300.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8940-32 SUP HCPCS C1713 AR-8940-32 - SCREW BN T15 FT HEXALOBE 4MM 32MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $150.00 $150.00 N/A N/A AR-8940-32S SUP HCPCS C1713 AR-8940-32S - SCREW BN 4MM 32MM STRL ARTHX LOPRFL SCR TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8940-34 SUP HCPCS C1713 AR-8940-34 - SCREW BN T15 FT HEXALOBE 4MM 34MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $150.00 $150.00 N/A N/A AR-8940-36 SUP HCPCS C1713 AR-8940-36 - SCREW BN T15 FT HEXALOBE 4MM 36MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-38 SUP HCPCS C1713 AR-8940-38 - SCREW BN T15 FT HEXALOBE 4MM 38MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-40 SUP HCPCS C1713 AR-8940-40 - SCREW BN T15 FT HEXALOBE 4MM 40MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-40S SUP HCPCS C1713 AR-8940-40S - SCREW BN 4MM 40MM STRL ARTHX LOPRFL SCR TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8940-42 SUP HCPCS C1713 AR-8940-42 - SCREW BN T15 FT HEXALOBE 4MM 42MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-42S SUP HCPCS C1713 AR-8940-42S - SCREW BN 4MM 42MM STRL ARTHX LOPRFL SCR TI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-8940-44 SUP HCPCS C1713 AR-8940-44 - SCREW BN T15 FT HEXALOBE 4MM 44MM LOPRFL SCR SLF DRL SLD TI BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-46 SUP HCPCS C1713 AR-8940-46 - SCREW BN 4MM 46MM LOPRFL TI FT/ANKL CANC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-48 SUP HCPCS C1713 AR-8940-48 - SCREW BN 4MM 48MM LOPRFL TI FT/ANKL CANC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-50 SUP HCPCS C1713 AR-8940-50 - SCREW BN 4MM 50MM LOPRFL TI HND ANKL LNG BN BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-52 SUP HCPCS C1713 AR-8940-52 - SCREW BN 4MM 52MM LOPRFL TI FT/ANKL CANC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-54 SUP HCPCS C1713 AR-8940-54 - SCREW BN 4MM 54MM LOPRFL TI FT/ANKL CANC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-56 SUP HCPCS C1713 AR-8940-56 - SCREW BN 4MM 56MM LOPRFL TI FT/ANKL CANC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-58 SUP HCPCS C1713 AR-8940-58 - SCREW BN 4MM 58MM LOPRFL TI FT/ANKL CANC BOTH IP/OP $150.00 $111.00 $29.77 $162.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $162.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8940-60 SUP HCPCS C1713 AR-8940-60 - SCREW BN 4MM 60MM LOPRFL TI FT/ANKL CANC BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-8941-6 SUP HCPCS C1769 AR-8941-6 - WIRE FIX .062IN .062IN 6IN KWIRE BOTH IP/OP $100.00 $74.00 $19.85 $108.00 $54.30 $54.30 $54.30 $54.30 $100.00 $100.00 $100.00 $20.84 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $108.00 $59.15 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $19.85 N/A $58.00 $100.00 $100.00 $100.00 $20.84 $100.00 N/A N/A AR-8941-7 SUP HCPCS C1769 AR-8941-7 - WIRE FIX .062IN .062IN 7IN KWIRE BOTH IP/OP $100.00 $74.00 $19.85 $108.00 $54.30 $54.30 $54.30 $54.30 $100.00 $100.00 $100.00 $20.84 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $108.00 $59.15 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $19.85 N/A $58.00 $100.00 $100.00 $100.00 $20.84 $100.00 N/A N/A AR-8941G SUP Custom 27203010 AR-8941G - GUIDE DRL 3.5/4 MM MTL SCR BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $216.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A AR-8941GL SUP Custom 27203010 AR-8941GL - GUIDE DRL D LCK BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $243.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A AR-8941L SUP HCPCS C1713 AR-8941L - PLATE BN LNG LOPRFL FT/ANKL LAPIDUS LISFRANC BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8941PLS SUP HCPCS C1713 AR-8941PLS - PLATE BN SHRT LOPRFL PRECONTOUR TI PLNTR LT LAPIDUS BOTH IP/OP "$3,737.50" "$2,766.00" $741.80 "$3,737.50" "$1,681.88" "$1,681.88" "$1,681.88" "$1,681.88" "$3,737.50" "$3,737.50" "$3,737.50" $778.99 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$1,614.60" "$1,842.59" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" $741.80 N/A "$2,167.75" "$3,737.50" "$3,737.50" "$3,737.50" $778.90 "$3,737.50" N/A N/A AR-8941PR SUP HCPCS C1713 AR-8941PR - PLATE BN PLNTR RT LAPIDUS BOTH IP/OP "$3,737.50" "$2,766.00" $741.80 "$4,036.50" "$1,681.88" "$1,681.88" "$1,681.88" "$1,681.88" "$3,737.50" "$3,737.50" "$3,737.50" $778.99 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$4,036.50" "$1,842.59" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" $741.80 N/A "$2,167.75" "$3,737.50" "$3,737.50" "$3,737.50" $778.90 "$3,737.50" N/A N/A AR-8941PRS SUP HCPCS C1713 AR-8941PRS - PLATE BN SHRT PLNTR RT LAPIDUS BOTH IP/OP "$3,737.50" "$2,766.00" $741.80 "$3,737.50" "$1,681.88" "$1,681.88" "$1,681.88" "$1,681.88" "$3,737.50" "$3,737.50" "$3,737.50" $778.99 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$1,614.60" "$1,842.59" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" $741.80 N/A "$2,167.75" "$3,737.50" "$2,242.50" "$3,737.50" $778.90 "$3,737.50" N/A N/A AR-8942-02 SUP Custom 27203010 AR-8942-02 - BIT DRL WDG 1.7MM EVANS DISP BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $129.60 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A AR-8942-03 SUP Custom 27203010 AR-8942-03 - GUIDE DRL 1.7MM EVANS WDG BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $270.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-8942L-06 SUP HCPCS C1713 AR-8942L-06 - PLATE BN H WDG LOPRFL 34X16X6MM TI MIDFOOT LT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,416.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,416.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8942L-08 SUP HCPCS C1713 AR-8942L-08 - PLATE BN H WDG LOPRFL 36X16X8MM TI MIDFOOT LT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8942L-10 SUP HCPCS C1713 AR-8942L-10 - PLATE BN H WDG LOPRFL 36X16X10MM TI MIDFOOT LT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8942L-L SUP HCPCS C1713 AR-8942L-L - PLATE BN LG H FLT LOPRFL 38X16MM TI MIDFOOT LT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8942L-M SUP HCPCS C1713 AR-8942L-M - PLATE BN MED H FLT LOPRFL 34X16MM TI MIDFOOT LT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8942L-S SUP HCPCS C1713 AR-8942L-S - PLATE BN SM H FLT LOPRFL 28X16MM TI MIDFOOT LT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,416.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,416.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8942R-06 SUP HCPCS C1713 AR-8942R-06 - PLATE BN H WDG LOPRFL 34X16X6MM TI MIDFOOT RT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,416.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,416.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8942R-08 SUP HCPCS C1713 AR-8942R-08 - PLATE BN H WDG LOPRFL 34X16X8MM TI MIDFOOT RT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,416.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,416.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8942R-10 SUP HCPCS C1713 AR-8942R-10 - PLATE BN H WDG LOPRFL 36X16X10MM TI MIDFOOT RT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8942R-L SUP HCPCS C1713 AR-8942R-L - PLATE BN LG H FLT LOPRFL 38X16MM TI MIDFOOT RT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,416.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,416.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8942R-M SUP HCPCS C1713 AR-8942R-M - PLATE BN MED H FLT LOPRFL 34X16MM TI MIDFOOT RT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8942R-S SUP HCPCS C1713 AR-8942R-S - PLATE BN SM H FLT LOPRFL 28X16MM TI MIDFOOT RT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8943-02 SUP Custom 27203010 AR-8943-02 - BIT DRL 2.6MM 160MM CNN 4MM LPS P/T SCR BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8943-03 SUP Custom 27203010 AR-8943-03 - GUIDE DRL 1.35-2.6MM 4MM LPS P/T SCR BOTH IP/OP $937.50 $694.00 $166.88 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $166.88 $937.50 $937.50 $695.81 $695.81 $722.63 $488.44 $195.39 $937.50 $405.00 $937.50 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $609.38 $937.50 N/A $543.75 $937.50 $562.50 $937.50 $937.50 $937.50 N/A N/A AR-8943-05 SUP Custom 27203010 AR-8943-05 - DRILL BIT CNTRSNK 4MM QFIX CNN 4MM LPS P/T SCR BOTH IP/OP $375.00 $278.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $66.75 $375.00 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $162.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $375.00 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A AR-8943-13 SUP Custom 27203010 AR-8943-13 - BIT DRL 2.5MM CLBRT GRAD BOTH IP/OP $212.50 $157.00 $37.83 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $37.83 $212.50 $212.50 $157.72 $157.72 $163.80 $110.71 $44.29 $212.50 $91.80 $212.50 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $138.13 $212.50 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A AR-8943-14 SUP Custom 27203010 AR-8943-14 - GUIDE DRL 3.5MM 2.5MM 3.5MM CORT 4MM CANC SCR LCK BOTH IP/OP "$1,687.50" "$1,249.00" $300.38 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" $300.38 "$1,687.50" "$1,687.50" "$1,252.46" "$1,252.46" "$1,300.73" $879.19 $351.69 "$1,687.50" $729.00 "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,687.50" "$1,265.63" "$1,687.50" "$1,687.50" "$1,687.50" $843.75 $843.75 "$1,336.50" "$1,687.50" "$1,350.00" "$1,096.88" "$1,687.50" N/A $978.75 "$1,687.50" "$1,012.50" "$1,687.50" "$1,687.50" "$1,687.50" N/A N/A AR-8943-16 SUP Custom 27203010 AR-8943-16 - BIT DRL 2MM CLBRT GRAD 2.7/3MM SCR BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $102.60 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-8943-17 SUP Custom 27203010 AR-8943-17 - GUIDE DRL LOPRFL 2.7MM THRD 2.7/3MM SCR BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $432.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-8943-24 SUP Custom 27203010 AR-8943-24 - CLAMP SRG WEBER BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $243.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A AR-8943-26 SUP Custom 27203010 AR-8943-26 - GUIDE DRL LOPRFL 3.5MM THRD BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $432.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-8943-30 SUP Custom 27203010 AR-8943-30 - BIT DRL 2.5MM 110MM ANKL 3.5MM CORT 4MM CANC SCR LCK BOTH IP/OP $212.50 $157.00 $37.83 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $37.83 $212.50 $212.50 $157.72 $157.72 $163.80 $110.71 $44.29 $212.50 $91.80 $212.50 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $138.13 $212.50 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A AR-8943-31 SUP Custom 27203010 AR-8943-31 - GUIDE DRL 3MM 2MM ANKL 2.7/3MM SCR BOTH IP/OP "$1,062.50" $786.00 $189.13 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $189.13 "$1,062.50" "$1,062.50" $788.59 $788.59 $818.98 $553.56 $221.44 "$1,062.50" $459.00 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $690.63 "$1,062.50" N/A $616.25 "$1,062.50" $637.50 "$1,062.50" "$1,062.50" "$1,062.50" N/A N/A AR-8943-36 SUP Custom 27203010 AR-8943-36 - BIT DRL 3MM ANKL 2.7/3MM SCR BOTH IP/OP $287.50 $213.00 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $51.18 $287.50 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $124.20 $287.50 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $287.50 N/A $166.75 $287.50 $172.50 $287.50 $287.50 $287.50 N/A N/A AR-8943-37 SUP HCPCS C1713 AR-8943-37 - SCREW BN REPL ATCH ANKL FX MGMT BOTH IP/OP $287.50 $213.00 $57.06 $310.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $310.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $172.50 $287.50 $59.92 $287.50 N/A N/A AR-8943-40 SUP Custom 27203010 AR-8943-40 - BIT DRL 2MM CNN BOTH IP/OP $687.50 $509.00 $122.38 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $122.38 $687.50 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $275.00 $687.50 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $687.50 N/A $398.75 $687.50 $412.50 $687.50 $687.50 $687.50 N/A N/A AR-8943-41 SUP Custom 27203010 AR-8943-41 - GUIDE DRL 2.6MM 1.35MM PRLL 4MM LPS P/T SCR BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $432.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-8943-43 SUP Custom 27203010 AR-8943-43 - GUIDE DRL 3.5MM BIT FX LCK VA FT/ANKL 3.5MM CORT 4MM CANC BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $432.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-8943-44 SUP Custom 27203010 AR-8943-44 - CLAMP SRG SYNDESMOSIS BOTH IP/OP "$8,750.00" "$6,475.00" "$1,557.50" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,557.50" "$8,750.00" "$8,750.00" "$4,181.12" "$4,181.12" "$6,744.50" "$2,060.15" "$1,823.60" "$8,750.00" "$3,780.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$5,687.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A AR-8943BL-04 SUP HCPCS C1713 AR-8943BL-04 - PLATE BN LOPRFL 4 HL LCK MDLR SS FIB LT DIST BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,485.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,485.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A AR-8943BL-05 SUP HCPCS C1713 AR-8943BL-05 - PLATE BN LOPRFL 5 HL LCK MDLR SS FIB LT DIST BOTH IP/OP "$1,625.00" "$1,203.00" $322.52 "$1,625.00" $731.25 $731.25 $731.25 $731.25 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" $702.00 $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 $322.52 N/A $942.50 "$1,625.00" $975.00 "$1,625.00" $338.65 "$1,625.00" N/A N/A AR-8943BL-06 SUP HCPCS C1713 AR-8943BL-06 - PLATE BN LOPRFL 6 HL LCK MDLR SS FIB LT DIST BOTH IP/OP "$1,812.50" "$1,341.00" $359.74 "$1,812.50" $815.63 $815.63 $815.63 $815.63 "$1,812.50" "$1,812.50" "$1,812.50" $377.77 "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" $377.74 "$1,812.50" $783.00 "$1,072.09" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,359.38" "$1,812.50" "$1,812.50" "$1,812.50" $906.25 $906.25 "$1,435.50" "$1,812.50" "$1,450.00" $815.63 $359.74 N/A "$1,051.25" "$1,812.50" "$1,087.50" "$1,812.50" $377.73 "$1,812.50" N/A N/A AR-8943BL-08 SUP HCPCS C1713 AR-8943BL-08 - PLATE BN LOPRFL 8 HL LCK MDLR SS FIB LT DIST BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8943BLS-10 SUP HCPCS C1713 AR-8943BLS-10 - PLATE BN STRL 10 HL LCK FIB LT DIST BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-8943BLS-12 SUP HCPCS C1713 AR-8943BLS-12 - PLATE BN STRL 12 HL LCK FIB LT DIST BOTH IP/OP "$2,150.00" "$1,591.00" $426.72 "$2,150.00" $967.50 $967.50 $967.50 $967.50 "$2,150.00" "$2,150.00" "$2,150.00" $448.11 "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" $448.08 "$2,150.00" $928.80 "$1,271.73" "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" "$1,612.50" "$2,150.00" "$2,150.00" "$2,150.00" "$1,075.00" "$1,075.00" "$1,702.80" "$2,150.00" "$1,720.00" $967.50 $426.72 N/A "$1,247.00" "$2,150.00" "$1,290.00" "$2,150.00" $448.06 "$2,150.00" N/A N/A AR-8943BLS-14 SUP HCPCS C1713 AR-8943BLS-14 - PLATE BN STRL 14 HL LCK FIB LT DIST BOTH IP/OP "$2,175.00" "$1,610.00" $431.68 "$2,349.00" $978.75 $978.75 $978.75 $978.75 "$2,175.00" "$2,175.00" "$2,175.00" $453.32 "$2,175.00" "$2,175.00" "$2,175.00" "$2,175.00" "$2,175.00" $453.29 "$2,175.00" "$2,349.00" "$1,286.51" "$2,175.00" "$2,175.00" "$2,175.00" "$2,175.00" "$1,631.25" "$2,175.00" "$2,175.00" "$2,175.00" "$1,087.50" "$1,087.50" "$1,722.60" "$2,175.00" "$1,740.00" $978.75 $431.68 N/A "$1,261.50" "$2,175.00" "$1,305.00" "$2,175.00" $453.27 "$2,175.00" N/A N/A AR-8943BR-04 SUP HCPCS C1713 AR-8943BR-04 - PLATE BN LOPRFL 4 HL LCK MDLR SS ANKL RT FIB BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $594.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A AR-8943BR-05 SUP HCPCS C1713 AR-8943BR-05 - PLATE BN LOPRFL 5 HL LCK MDLR SS ANKL RT FIB BOTH IP/OP "$1,625.00" "$1,203.00" $322.52 "$1,625.00" $731.25 $731.25 $731.25 $731.25 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" $702.00 $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 $322.52 N/A $942.50 "$1,625.00" $975.00 "$1,625.00" $338.65 "$1,625.00" N/A N/A AR-8943BR-06 SUP HCPCS C1713 AR-8943BR-06 - PLATE BN LOPRFL 6 HL LCK MDLR SS ANKL RT FIB BOTH IP/OP "$1,812.50" "$1,341.00" $359.74 "$1,812.50" $815.63 $815.63 $815.63 $815.63 "$1,812.50" "$1,812.50" "$1,812.50" $377.77 "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" $377.74 "$1,812.50" $783.00 "$1,072.09" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,359.38" "$1,812.50" "$1,812.50" "$1,812.50" $906.25 $906.25 "$1,435.50" "$1,812.50" "$1,450.00" $815.63 $359.74 N/A "$1,051.25" "$1,812.50" "$1,087.50" "$1,812.50" $377.73 "$1,812.50" N/A N/A AR-8943BR-08 SUP HCPCS C1713 AR-8943BR-08 - PLATE BN LOPRFL 8 HL LCK MDLR SS ANKL RT FIB BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8943BRS-10 SUP HCPCS C1713 AR-8943BRS-10 - PLATE BN STRL 10 HL LCK FIB RT DIST BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-8943BRS-12 SUP HCPCS C1713 AR-8943BRS-12 - PLATE BN STRL 12 HL LCK FIB RT DIST BOTH IP/OP "$2,150.00" "$1,591.00" $426.72 "$2,150.00" $967.50 $967.50 $967.50 $967.50 "$2,150.00" "$2,150.00" "$2,150.00" $448.11 "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" $448.08 "$2,150.00" $928.80 "$1,271.73" "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" "$1,612.50" "$2,150.00" "$2,150.00" "$2,150.00" "$1,075.00" "$1,075.00" "$1,702.80" "$2,150.00" "$1,720.00" $967.50 $426.72 N/A "$1,247.00" "$2,150.00" "$1,290.00" "$2,150.00" $448.06 "$2,150.00" N/A N/A AR-8943BRS-14 SUP HCPCS C1713 AR-8943BRS-14 - PLATE BN STRL 12 HL LCK FIB RT DIST BOTH IP/OP "$2,175.00" "$1,610.00" $431.68 "$2,175.00" $978.75 $978.75 $978.75 $978.75 "$2,175.00" "$2,175.00" "$2,175.00" $453.32 "$2,175.00" "$2,175.00" "$2,175.00" "$2,175.00" "$2,175.00" $453.29 "$2,175.00" $939.60 "$1,286.51" "$2,175.00" "$2,175.00" "$2,175.00" "$2,175.00" "$1,631.25" "$2,175.00" "$2,175.00" "$2,175.00" "$1,087.50" "$1,087.50" "$1,722.60" "$2,175.00" "$1,740.00" $978.75 $431.68 N/A "$1,261.50" "$2,175.00" "$1,305.00" "$2,175.00" $453.27 "$2,175.00" N/A N/A AR-8943C-04 SUP HCPCS C1713 AR-8943C-04 - PLATE BN STRG 55MM 4 HL LCK SS ANKL BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $506.25 $506.25 $506.25 $506.25 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $486.00 $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 $223.28 N/A $652.50 "$1,125.00" $675.00 "$1,125.00" $234.45 "$1,125.00" N/A N/A AR-8943C-06 SUP HCPCS C1713 AR-8943C-06 - PLATE BN STRG 80MM 6 HL LCK SS ANKL BOTH IP/OP "$1,187.50" $879.00 $235.69 "$1,187.50" $534.38 $534.38 $534.38 $534.38 "$1,187.50" "$1,187.50" "$1,187.50" $247.50 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $513.00 $702.41 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 $235.69 N/A $688.75 "$1,187.50" "$1,187.50" "$1,187.50" $247.48 "$1,187.50" N/A N/A AR-8943C-07 SUP HCPCS C1713 AR-8943C-07 - PLATE BN STRG 93MM 7 HL LCK SS ANKL BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $567.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-8943C-08 SUP HCPCS C1713 AR-8943C-08 - PLATE BN STRG 106MM 8 HL LCK SS ANKL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $594.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A AR-8943C-10 SUP HCPCS C1713 AR-8943C-10 - PLATE BN STRG 131MM 10 HL LCK SS ANKL BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $642.60 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" $892.50 "$1,487.50" $310.00 "$1,487.50" N/A N/A AR-8943C-12 SUP HCPCS C1713 AR-8943C-12 - PLATE BN STRG 156MM 12 HL LCK SS ANKL BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-8943H-03 SUP HCPCS C1713 AR-8943H-03 - PLATE BN 61MM 3 HL HK LCK SS ANKL MLLE MDL BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $891.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A AR-8943H-05 SUP HCPCS C1713 AR-8943H-05 - PLATE BN 79MM 5 HL HK LCK SS FT/ANKL MDL BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" $891.00 "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A AR-8943H-07 SUP HCPCS C1713 AR-8943H-07 - PLATE BN 97MM 7 HL HK LCK SS FT/ANKL MDL BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $972.00 "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A AR-8943I SUP HCPCS C1713 AR-8943I - SET IMPL ANKL FX SYS BOTH IP/OP "$112,500.00" "$83,250.00" "$7,712.84" "$112,500.00" "$50,625.00" "$50,625.00" "$50,625.00" "$50,625.00" "$112,500.00" "$112,500.00" "$112,500.00" "$9,417.94" "$112,500.00" "$112,500.00" "$112,500.00" "$112,500.00" "$112,500.00" "$23,446.24" "$112,500.00" "$112,500.00" "$55,462.50" "$112,500.00" "$112,500.00" "$112,500.00" "$112,500.00" "$84,375.00" "$112,500.00" "$112,500.00" "$112,500.00" "$56,250.00" "$56,250.00" "$89,100.00" "$112,500.00" "$90,000.00" "$50,625.00" "$7,712.84" N/A "$65,250.00" "$112,500.00" "$67,500.00" "$112,500.00" "$112,500.00" "$112,500.00" N/A N/A AR-8943T-04 SUP HCPCS C1713 AR-8943T-04 - PLATE BN 1/3 TUBE 47MM 4 HL LCK SS ANKL BOTH IP/OP $562.50 $416.00 $111.64 $562.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $243.00 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A AR-8943T-05 SUP HCPCS C1713 AR-8943T-05 - PLATE BN 1/3 TUBE 59MM 5 HL LCK SS ANKL BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $253.80 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $122.44 $587.50 N/A N/A AR-8943T-06 SUP HCPCS C1713 AR-8943T-06 - PLATE BN 1/3 TUBE 72MM 6 HL LCK SS ANKL BOTH IP/OP $600.00 $444.00 $119.09 $648.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $648.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $125.04 $600.00 N/A N/A AR-8943T-07 SUP HCPCS C1713 AR-8943T-07 - PLATE BN 1/3 TUBE 85MM 7 HL LCK SS ANKL BOTH IP/OP $637.50 $472.00 $126.53 $637.50 $286.88 $286.88 $286.88 $286.88 $637.50 $637.50 $637.50 $132.87 $637.50 $637.50 $637.50 $637.50 $637.50 $132.86 $637.50 $275.40 $377.08 $637.50 $637.50 $637.50 $637.50 $478.13 $637.50 $637.50 $637.50 $318.75 $318.75 $504.90 $637.50 $510.00 $286.88 $126.53 N/A $369.75 $637.50 $382.50 $637.50 $132.86 $637.50 N/A N/A AR-8943T-08 SUP HCPCS C1713 AR-8943T-08 - PLATE BN 1/3 TUBE 98MM 8 HL LCK SS ANKL BOTH IP/OP $662.50 $490.00 $131.49 $715.50 $298.13 $298.13 $298.13 $298.13 $662.50 $662.50 $662.50 $138.08 $662.50 $662.50 $662.50 $662.50 $662.50 $138.07 $662.50 $715.50 $391.87 $662.50 $662.50 $662.50 $662.50 $496.88 $662.50 $662.50 $662.50 $331.25 $331.25 $524.70 $662.50 $530.00 $298.13 $131.49 N/A $384.25 $662.50 $397.50 $662.50 $662.50 $662.50 N/A N/A AR-8943T-10 SUP HCPCS C1713 AR-8943T-10 - PLATE BN 1/3 TUBE 123MM 10 HL LCK SS ANKL BOTH IP/OP $700.00 $518.00 $138.93 $700.00 $315.00 $315.00 $315.00 $315.00 $700.00 $700.00 $700.00 $145.90 $700.00 $700.00 $700.00 $700.00 $700.00 $145.89 $700.00 $302.40 $414.05 $700.00 $700.00 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $350.00 $350.00 $554.40 $700.00 $560.00 $315.00 $138.93 N/A $406.00 $700.00 $420.00 $700.00 $145.88 $700.00 N/A N/A AR-8943T-12 SUP HCPCS C1713 AR-8943T-12 - PLATE BN 1/3 TUBE 148MM 12 HL LCK SS ANKL BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $324.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A AR-8943TH-03 SUP HCPCS C1713 AR-8943TH-03 - PLATE BN 72MM 3 HL AVULSION HK LCK SS ANKL LAT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $756.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A AR-8943TH-05 SUP HCPCS C1713 AR-8943TH-05 - PLATE BN 98MM 5 HL AVULSION HK LCK SS ANKL LAT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $756.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A AR-8943TH-07 SUP HCPCS C1713 AR-8943TH-07 - PLATE BN 123MM 7 HL AVULSION HK LCK SS ANKL LAT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $756.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A AR-8944-10S SUP HCPCS C1713 AR-8944-10S - PLATE BN 10D STD LOPRFL MTP VLGS BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,737.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$1,182.60" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8944-22 SUP Custom 27203010 AR-8944-22 - BIT DRL 2MM AO CNCT LCK 3MM SCR BOTH IP/OP $212.50 $157.00 $37.83 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $37.83 $212.50 $212.50 $157.72 $157.72 $163.80 $110.71 $44.29 $212.50 $91.80 $212.50 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $138.13 $212.50 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A AR-8944C-10S SUP HCPCS C1713 AR-8944C-10S - PLATE BN 10D STD DFLXN MTP VLGS BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,956.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$2,956.50" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8944CL-L SUP HCPCS C1713 AR-8944CL-L - PLATE BN LNG CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT LT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8944CL-P SUP HCPCS C1713 AR-8944CL-P - PLATE BN SHRT CNTR FSN MOD TI FOREFOOT 1ST MTP LT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,416.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,416.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A AR-8944CL-S SUP HCPCS C1713 AR-8944CL-S - PLATE BN STD CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT LT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A AR-8944CR-L SUP HCPCS C1713 AR-8944CR-L - PLATE BN LNG CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT RT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A AR-8944CR-P SUP HCPCS C1713 AR-8944CR-P - PLATE BN SHRT CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT RT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,416.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,416.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8944CR-S SUP HCPCS C1713 AR-8944CR-S - PLATE BN STD CNTR LOPRFL MTP PLT FSN MOD TI FOREFOOT RT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8944-L SUP HCPCS C1713 AR-8944-L - PLATE BN LNG STRG LOPRFL MTP PLT FSN MOD TI FOREFOOT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A AR-8944-P SUP HCPCS C1713 AR-8944-P - PLATE BN SHRT STRG LOPRFL MTP PLT FSN MOD TI FOREFOOT BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8945-20FT SUP HCPCS C1713 AR-8945-20FT - SCREW BN .062IN 3.5MM FT HEX LOPRFL 4.5MM 20MM SLF DRL ST BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-20PT SUP HCPCS C1713 AR-8945-20PT - SCREW BN .062IN 3.5MM 1/3 FT HEX LOPRFL 4.5MM 20MM SLF DRL BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-22FT SUP HCPCS C1713 AR-8945-22FT - SCREW BN FT HEX 4.5MM 22MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-22PT SUP HCPCS C1713 AR-8945-22PT - SCREW BN P/T LOPRFL 4.5MM 22MM CNN TI MLR CORT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-24FT SUP HCPCS C1713 AR-8945-24FT - SCREW BN FT HEX 4.5MM 24MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-24PT SUP HCPCS C1713 AR-8945-24PT - SCREW BN P/T HEX 4.5MM 24MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-26FT SUP HCPCS C1713 AR-8945-26FT - SCREW BN FT HEX 4.5MM 26MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-26PT SUP HCPCS C1713 AR-8945-26PT - SCREW BN P/T LOPRFL 4.5MM 26MM CNN TI MLR CORT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-28FT SUP HCPCS C1713 AR-8945-28FT - SCREW BN FT HEX 4.5MM 28MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-28PT SUP HCPCS C1713 AR-8945-28PT - SCREW BN P/T HEX 4.5MM 28MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-30C SUP Custom 27203010 AR-8945-30C - BIT DRL MN 3MM 120MM CNN 4.5MM SCR BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8945-30FT SUP HCPCS C1713 AR-8945-30FT - SCREW BN FT HEX 4.5MM 30MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-30PT SUP HCPCS C1713 AR-8945-30PT - SCREW BN P/T HEX 4.5MM 30MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-32FT SUP HCPCS C1713 AR-8945-32FT - SCREW BN FT HEX 4.5MM 32MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-32PT SUP HCPCS C1713 AR-8945-32PT - SCREW BN P/T HEX 4.5MM 32MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-34FT SUP HCPCS C1713 AR-8945-34FT - SCREW BN FT HEX 4.5MM 34MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-34PT SUP HCPCS C1713 AR-8945-34PT - SCREW BN P/T HEX 4.5MM 34MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-35FT SUP HCPCS C1713 AR-8945-35FT - SCREW BN FT HEX 4.5MM 35MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-35PT SUP HCPCS C1713 AR-8945-35PT - SCREW BN P/T HEX 4.5MM 35MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-36FT SUP HCPCS C1713 AR-8945-36FT - SCREW BN FT HEX 4.5MM 36MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-36PT SUP HCPCS C1713 AR-8945-36PT - SCREW BN P/T HEX 4.5MM 36MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-38FT SUP HCPCS C1713 AR-8945-38FT - SCREW BN FT HEX 4.5MM 38MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-38PT SUP HCPCS C1713 AR-8945-38PT - SCREW BN P/T HEX 4.5MM 38MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-40FT SUP HCPCS C1713 AR-8945-40FT - SCREW BN FT HEX 4.5MM 40MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-40PT SUP HCPCS C1713 AR-8945-40PT - SCREW BN P/T HEX 4.5MM 40MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-45C SUP Custom 27203010 AR-8945-45C - BIT DRL 4.5MM HDSN CNN BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-8945-45FT SUP HCPCS C1713 AR-8945-45FT - SCREW BN FT HEX 4.5MM 45MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-45PT SUP HCPCS C1713 AR-8945-45PT - SCREW BN P/T HEX 4.5MM 45MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-50FT SUP HCPCS C1713 AR-8945-50FT - SCREW BN FT HEX 4.5MM 50MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-50PT SUP HCPCS C1713 AR-8945-50PT - SCREW BN P/T HEX 4.5MM 50MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-55FT SUP HCPCS C1713 AR-8945-55FT - SCREW BN FT HEX 4.5MM 55MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-55PT SUP HCPCS C1713 AR-8945-55PT - SCREW BN P/T HEX 4.5MM 55MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-60FT SUP HCPCS C1713 AR-8945-60FT - SCREW BN FT HEX 4.5MM 60MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-60PT SUP HCPCS C1713 AR-8945-60PT - SCREW BN P/T HEX 4.5MM 60MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-65FT SUP HCPCS C1713 AR-8945-65FT - SCREW BN FT HEX 4.5MM 65MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-65PT SUP HCPCS C1713 AR-8945-65PT - SCREW BN P/T HEX 4.5MM 65MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-70FT SUP HCPCS C1713 AR-8945-70FT - SCREW BN FT HEX 4.5MM 70MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-70PT SUP HCPCS C1713 AR-8945-70PT - SCREW BN P/T HEX 4.5MM 70MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-75FT SUP HCPCS C1713 AR-8945-75FT - SCREW BN FT HEX 4.5MM 75MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-75PT SUP HCPCS C1713 AR-8945-75PT - SCREW BN P/T HEX 4.5MM 75MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-80FT SUP HCPCS C1713 AR-8945-80FT - SCREW BN FT HEX 4.5MM 80MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8945-80PT SUP HCPCS C1713 AR-8945-80PT - SCREW BN P/T HEX 4.5MM 80MM LOPRFL SCR SLF DRL ST CNN LG TI BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $189.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8945CS SUP Custom 27203010 AR-8945CS - DRILL BIT CNTRSNK CNN FX HNDL 4.5/6 MM BOTH IP/OP $550.00 $407.00 $97.90 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $550.00 $97.90 $550.00 $550.00 $408.21 $408.21 $423.94 $286.55 $114.63 $550.00 $237.60 $550.00 $550.00 $550.00 $550.00 $550.00 $412.50 $550.00 $550.00 $550.00 $275.00 $275.00 $435.60 $550.00 $440.00 $357.50 $550.00 N/A $319.00 $550.00 $330.00 $550.00 $550.00 $550.00 N/A N/A AR-8945CSF SUP Custom 27203010 AR-8945CSF - COUNTERSINK DRL CNN 4.5 MM SCR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $324.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A AR-8945W SUP HCPCS C1713 AR-8945W - WASHER ORTH 10MM CNN TI BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $90.00 $90.00 $90.00 $90.00 $200.00 $200.00 $200.00 $41.69 $200.00 $200.00 $200.00 $200.00 $200.00 $41.68 $200.00 $86.40 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $90.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $200.00 $200.00 N/A N/A AR-8947DS SUP HCPCS C1713 AR-8947DS - PLATE BN BTRS TGHTRP IMPL DLV ANKL SYNDESMOSIS BOTH IP/OP "$2,562.50" "$1,896.00" $508.59 "$2,562.50" "$1,153.13" "$1,153.13" "$1,153.13" "$1,153.13" "$2,562.50" "$2,562.50" "$2,562.50" $534.09 "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" $534.05 "$2,562.50" "$1,107.00" "$1,263.31" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$1,921.88" "$2,562.50" "$2,562.50" "$2,562.50" "$1,281.25" "$1,281.25" "$2,029.50" "$2,562.50" "$2,050.00" "$1,153.13" $508.59 N/A "$1,486.25" "$2,562.50" "$2,562.50" "$2,562.50" $534.03 "$2,562.50" N/A N/A AR-8948-00 SUP HCPCS C1713 AR-8948-00 - PLATE BN FLT LOPRFL TI CTTN FT/ANKL 2.4MM SCR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8948-02 SUP HCPCS C1713 AR-8948-02 - PLATE BN LOPRFL 2MM TI CTTN FT/ANKL 2.4MM SCR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-8948-06 SUP HCPCS C1713 AR-8948-06 - PLATE BN LOPRFL 6MM TI CTTN FT/ANKL 2.4MM SCR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" N/A N/A AR-8948-08 SUP HCPCS C1713 AR-8948-08 - PLATE BN LOPRFL 8MM TI CTTN FT/ANKL 2.4MM SCR BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" N/A N/A AR-8949-050 SUP HCPCS C1713 AR-8949-050 - PLATE BN 5MM STP CALCANEUS BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,956.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$2,956.50" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" N/A N/A AR-8949-075 SUP HCPCS C1713 AR-8949-075 - PLATE BN 7.5MM STP CALCANEUS BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,956.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$2,956.50" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8949-100 SUP HCPCS C1713 AR-8949-100 - PLATE BN 10MM STP CALCANEUS BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,737.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$1,182.60" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" "$2,737.50" "$2,737.50" N/A N/A AR-8949DG SUP Custom 27203010 AR-8949DG - GUIDE DRL CMPR HL BOTH IP/OP "$1,200.00" $888.00 $213.60 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $213.60 "$1,200.00" "$1,200.00" $890.64 $890.64 $924.96 $625.20 $250.09 "$1,200.00" $518.40 "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" "$1,200.00" $900.00 "$1,200.00" "$1,200.00" "$1,200.00" $600.00 $600.00 $950.40 "$1,200.00" $960.00 $780.00 "$1,200.00" N/A $696.00 "$1,200.00" $720.00 "$1,200.00" "$1,200.00" "$1,200.00" N/A N/A AR-8949S SUP HCPCS C1713 AR-8949S - PLATE BN 5MM 7.5MM 10MM STP CALCANEUS BOTH IP/OP "$5,625.00" "$4,163.00" "$1,116.42" "$5,625.00" "$2,531.25" "$2,531.25" "$2,531.25" "$2,531.25" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.39" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.31" "$5,625.00" "$2,430.00" "$2,773.13" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$4,218.75" "$5,625.00" "$5,625.00" "$5,625.00" "$2,812.50" "$2,812.50" "$4,455.00" "$5,625.00" "$4,500.00" "$2,531.25" "$1,116.42" N/A "$3,262.50" "$5,625.00" "$5,625.00" "$5,625.00" "$1,172.25" "$5,625.00" N/A N/A AR-8950-01 SUP Custom 27203010 AR-8950-01 - COUNTERSINK DRL 2.4MM BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $189.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-8950-02 SUP Custom 27203010 AR-8950-02 - COUNTERSINK DRL 3MM BOTH IP/OP $375.00 $278.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $66.75 $375.00 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $162.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $375.00 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A AR-8950-03 SUP Custom 27203010 AR-8950-03 - COUNTERSINK DRL 3.5 4 MM SCR BOTH IP/OP $375.00 $278.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $66.75 $375.00 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $162.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $375.00 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A AR-8950-05 SUP Custom 27203010 AR-8950-05 - BIT DRL 3MM BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $146.58 $146.58 $152.23 $102.90 $41.16 $197.50 $85.32 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $128.38 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-8950-08 SUP Custom 27203010 AR-8950-08 - GUIDE DRL BNT 2.4MM LCK BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $129.60 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A AR-8950-09 SUP Custom 27203010 AR-8950-09 - GUIDE DRL BNT 3MM LCK BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $129.60 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A AR-8950C-14 SUP Custom 27203010 AR-8950C-14 - INSERT TRY CMPRH FT SYS BOTH IP/OP "$3,737.50" "$2,766.00" $665.28 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $665.28 "$3,737.50" "$3,737.50" "$2,773.97" "$2,773.97" "$2,880.87" "$1,947.24" $778.94 "$3,737.50" "$1,614.60" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$2,429.38" "$3,737.50" N/A "$2,167.75" "$3,737.50" "$2,242.50" "$3,737.50" "$3,737.50" "$3,737.50" N/A N/A AR-8950JD-1 SUP HCPCS C1713 AR-8950JD-1 - DISTRACTOR SRG MN 16MM TRC SCR BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8950JD-2 SUP HCPCS C1713 AR-8950JD-2 - SCREW DSTRCT 20MM MN JNT BOTH IP/OP $437.50 $324.00 $86.83 $472.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $472.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $262.50 $437.50 $91.18 $437.50 N/A N/A AR-8950S-V1 SUP HCPCS C1713 AR-8950S-V1 - SET SCR VA CMPRH FT SYS BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A AR-8951LL SUP HCPCS C1713 AR-8951LL - PLATE BN LG CNTR LOPRFL 1.4MM TI LISFRANC LT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $864.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-8951LR SUP HCPCS C1713 AR-8951LR - PLATE BN LG CNTR LOPRFL 1.4MM TI LISFRANC RT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $864.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-8951ML SUP HCPCS C1713 AR-8951ML - PLATE BN MED CNTR LOPRFL 1.4MM TI LISFRANC LT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $864.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-8951MR SUP HCPCS C1713 AR-8951MR - PLATE BN MED CNTR LOPRFL 1.4MM TI LISFRANC RT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,160.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,160.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-8951SL SUP HCPCS C1713 AR-8951SL - PLATE BN SM CNTR LOPRFL 1.4MM TI LISFRANC LT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $864.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-8951SR SUP HCPCS C1713 AR-8951SR - PLATE BN SM CNTR LOPRFL 1.4MM TI LISFRANC RT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $864.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-8952MC-LL SUP HCPCS C1713 AR-8952MC-LL - PLATE BN LG LOPRFL CLMN FT LT MDL 3.5MM SCR BOTH IP/OP "$3,737.50" "$2,766.00" $741.80 "$3,737.50" "$1,681.88" "$1,681.88" "$1,681.88" "$1,681.88" "$3,737.50" "$3,737.50" "$3,737.50" $778.99 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$1,614.60" "$1,842.59" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" $741.80 N/A "$2,167.75" "$3,737.50" "$2,242.50" "$3,737.50" $778.90 "$3,737.50" N/A N/A AR-8952MC-LR SUP HCPCS C1713 AR-8952MC-LR - PLATE BN LG LOPRFL CLMN FT RT MDL 3.5MM SCR BOTH IP/OP "$3,737.50" "$2,766.00" $741.80 "$3,737.50" "$1,681.88" "$1,681.88" "$1,681.88" "$1,681.88" "$3,737.50" "$3,737.50" "$3,737.50" $778.99 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$1,614.60" "$1,842.59" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" $741.80 N/A "$2,167.75" "$3,737.50" "$3,737.50" "$3,737.50" $778.90 "$3,737.50" N/A N/A AR-8952MC-ML SUP HCPCS C1713 AR-8952MC-ML - PLATE BN MED LOPRFL CLMN FT LT MDL 3.5MM SCR BOTH IP/OP "$3,737.50" "$2,766.00" $741.80 "$3,737.50" "$1,681.88" "$1,681.88" "$1,681.88" "$1,681.88" "$3,737.50" "$3,737.50" "$3,737.50" $778.99 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$1,614.60" "$1,842.59" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" $741.80 N/A "$2,167.75" "$3,737.50" "$2,242.50" "$3,737.50" $778.90 "$3,737.50" N/A N/A AR-8952MC-MR SUP HCPCS C1713 AR-8952MC-MR - PLATE BN MED LOPRFL CLMN FT RT MDL 3.5MM SCR BOTH IP/OP "$3,737.50" "$2,766.00" $741.80 "$4,036.50" "$1,681.88" "$1,681.88" "$1,681.88" "$1,681.88" "$3,737.50" "$3,737.50" "$3,737.50" $778.99 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$4,036.50" "$1,842.59" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" $741.80 N/A "$2,167.75" "$3,737.50" "$2,242.50" "$3,737.50" $778.90 "$3,737.50" N/A N/A AR-8952MC-SL SUP HCPCS C1713 AR-8952MC-SL - PLATE BN SM LOPRFL CLMN FT LT MDL 3.5MM SCR BOTH IP/OP "$3,737.50" "$2,766.00" $741.80 "$3,737.50" "$1,681.88" "$1,681.88" "$1,681.88" "$1,681.88" "$3,737.50" "$3,737.50" "$3,737.50" $778.99 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$1,614.60" "$1,842.59" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" $741.80 N/A "$2,167.75" "$3,737.50" "$2,242.50" "$3,737.50" $778.90 "$3,737.50" N/A N/A AR-8952MC-SR SUP HCPCS C1713 AR-8952MC-SR - PLATE BN SM LOPRFL CLMN FT RT MDL 3.5MM SCR BOTH IP/OP "$3,737.50" "$2,766.00" $741.80 "$3,737.50" "$1,681.88" "$1,681.88" "$1,681.88" "$1,681.88" "$3,737.50" "$3,737.50" "$3,737.50" $778.99 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$1,614.60" "$1,842.59" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" $741.80 N/A "$2,167.75" "$3,737.50" "$3,737.50" "$3,737.50" $778.90 "$3,737.50" N/A N/A AR-8952ML-05L SUP HCPCS C1713 AR-8952ML-05L - PLATE BN 5 HL TI WRST LT 2.4 MM SCR BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8952ML-05R SUP HCPCS C1713 AR-8952ML-05R - PLATE BN L 2 HLE/HD 5 HL SHFT TI RT 2.4MM SCR BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,416.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,416.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8952MS-04 SUP HCPCS C1713 AR-8952MS-04 - PLATE BN STRG LOPRFL 2.4MM 4 HL FT BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,737.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-8952MS-05 SUP HCPCS C1713 AR-8952MS-05 - PLATE BN STRG LOPRFL 2.4MM 5 HL FT BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-8952MS-06 SUP HCPCS C1713 AR-8952MS-06 - PLATE BN STRG LOPRFL 2.4MM 6 HL FT BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,876.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" "$1,876.50" "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-8952MS-07 SUP HCPCS C1713 AR-8952MS-07 - PLATE BN STRG LOPRFL 2.4MM 7 HL FT BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,737.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-8952MS-08 SUP HCPCS C1713 AR-8952MS-08 - PLATE BN STRG 8 HL LOPRFL 2.4MM SCR BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-8952MT-03 SUP HCPCS C1713 AR-8952MT-03 - PLATE BN T 3 HL LOPRFL 2.4MM SCR BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,876.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" "$1,876.50" "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-8952MT-04 SUP HCPCS C1713 AR-8952MT-04 - PLATE BN T LOPRFL 4 HL FT 2.4MM SCR BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,876.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" "$1,876.50" "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-8952MT-05 SUP HCPCS C1713 AR-8952MT-05 - PLATE BN T LOPRFL 2.4MM 5 HL FT BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-8952MT-06 SUP HCPCS C1713 AR-8952MT-06 - PLATE BN T LOPRFL 2.4MM 6 HL FT BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,737.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-8952MT-07 SUP HCPCS C1713 AR-8952MT-07 - PLATE BN T 2.4MM 7 HL LOPRFL BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,876.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" "$1,876.50" "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-8952MT-08 SUP HCPCS C1713 AR-8952MT-08 - PLATE BN T 8 HL LOPRFL 2.4MM SCR BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-8952MT-09 SUP HCPCS C1713 AR-8952MT-09 - PLATE BN T LOPRFL 9 HL 2.4MM SCR BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-8952TS-02 SUP HCPCS C1713 AR-8952TS-02 - PLATE BN STRG LOPRFL 2 HL TI FT 3MM SCR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $864.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-8952TS-04 SUP HCPCS C1713 AR-8952TS-04 - PLATE BN STRG 3MM LOPRFL 4 HL TI BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $864.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-8952TS-05 SUP HCPCS C1713 AR-8952TS-05 - PLATE BN STRG 5 HL LOPRFL TI 3MM SCR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $864.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-8952TT-03 SUP HCPCS C1713 AR-8952TT-03 - PLATE BN T LOPRFL 3MM 3 HL TI FT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $864.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-8952TT-04 SUP HCPCS C1713 AR-8952TT-04 - PLATE BN T 4 HL LOPRFL TI 3MM SCR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $864.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-8952XL SUP HCPCS C1713 AR-8952XL - PLATE BN LG X 2 HL TI FT 3MM SCR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $864.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-8952XM SUP HCPCS C1713 AR-8952XM - PLATE BN MED X TI 3MM SCR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,160.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,160.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-8952XP SUP HCPCS C1713 AR-8952XP - PLATE BN SM X TI 2.4MM SCR BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,737.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-8953-00 SUP HCPCS C1713 AR-8953-00 - PLATE BN FLT LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG OSTM BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8953-02 SUP HCPCS C1713 AR-8953-02 - PLATE BN LOPRFL 2MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8953-025 SUP HCPCS C1713 AR-8953-025 - PLATE BN LOPRFL 2.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,416.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,416.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8953-03 SUP HCPCS C1713 AR-8953-03 - PLATE BN LOPRFL 3MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,416.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,416.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8953-035 SUP HCPCS C1713 AR-8953-035 - PLATE BN LOPRFL 3.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8953-04 SUP HCPCS C1713 AR-8953-04 - PLATE BN 4MM LCK POW LOPRFL TI FT/ANKL PROX 3MM SCR OPN WDG BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8953-045 SUP HCPCS C1713 AR-8953-045 - PLATE BN LOPRFL 4.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,416.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,416.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8953-05 SUP HCPCS C1713 AR-8953-05 - PLATE BN LOPRFL 5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8953-055 SUP HCPCS C1713 AR-8953-055 - PLATE BN LOPRFL 5.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8953-06 SUP HCPCS C1713 AR-8953-06 - PLATE BN LOPRFL 6MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8953-065 SUP HCPCS C1713 AR-8953-065 - PLATE BN LOPRFL 6.5MM LCK POW TI FT/ANKL PROX 3MM SCR OPN BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8953-07 SUP HCPCS C1713 AR-8953-07 - PLATE BN LOPRFL 7MM LCK POW TI FT/ANKL PROX 3MM SCR OPN WDG BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $966.60 "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A AR-8954-07 SUP Custom 27203010 AR-8954-07 - GUIDE DRL BNT 3.5MM LCK BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $129.60 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A AR-8954ML-L SUP HCPCS C1713 AR-8954ML-L - PLATE BN LNG LOPRFL TPR LCK CALCANEUS LT ANT ATCH GD PERC BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,737.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$1,182.60" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8954ML-S SUP HCPCS C1713 AR-8954ML-S - PLATE BN STD LOPRFL TPR LCK CALCANEUS LT ANT ATCH GD PERC BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,737.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$1,182.60" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8954MR-L SUP HCPCS C1713 AR-8954MR-L - PLATE BN LNG LOPRFL TPR LCK CALCANEUS RT ANT ATCH GD PERC BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,956.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$2,956.50" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" N/A N/A AR-8954MR-S SUP HCPCS C1713 AR-8954MR-S - PLATE BN STD LOPRFL TPR LCK CALCANEUS RT ANT ATCH GD PERC BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,956.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$2,956.50" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$2,737.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8954MT SUP HCPCS C1713 AR-8954MT - PLATE BN T LOPRFL 4 HL FT 3.5MM SCR BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,956.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$2,956.50" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8954PL-L SUP HCPCS C1713 AR-8954PL-L - PLATE BN LG PRIMTR CALC FX LT BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,737.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$1,182.60" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8954PL-M SUP HCPCS C1713 AR-8954PL-M - PLATE BN MED LOPRFL LCK PRIMTR TI CALCANEUS LT 3.5/4MM SCR BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,737.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$1,182.60" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8954PL-S SUP HCPCS C1713 AR-8954PL-S - PLATE BN SM LOPRFL LCK PRIMTR TI CALCANEUS LT 3.5/4MM SCR BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,956.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$2,956.50" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8954PL-XS SUP HCPCS C1713 AR-8954PL-XS - PLATE BN XS LOPRFL LCK PRIMTR TI CALCANEUS LT 3.5/4MM SCR BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,956.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$2,956.50" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8954PR-L SUP HCPCS C1713 AR-8954PR-L - PLATE BN LG LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,956.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$2,956.50" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8954PR-M SUP HCPCS C1713 AR-8954PR-M - PLATE BN MED LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,737.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$1,182.60" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$2,737.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8954PR-S SUP HCPCS C1713 AR-8954PR-S - PLATE BN SM LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,737.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$1,182.60" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$2,737.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8954PR-XS SUP HCPCS C1713 AR-8954PR-XS - PLATE BN XS LOPRFL LCK PRIMTR TI CALCANEUS RT 3.5/4MM SCR BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,956.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$2,956.50" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8954YL-L SUP HCPCS C1713 AR-8954YL-L - PLATE BN LNG LOPRFL TPR LCK CALCANEUS LT ANT POST ATCH GD BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,956.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$2,956.50" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8954YL-S SUP HCPCS C1713 AR-8954YL-S - PLATE BN STD LOPRFL TPR LCK CALCANEUS LT ANT POST ATCH GD BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,737.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$1,182.60" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" $570.50 "$2,737.50" N/A N/A AR-8954YR-L SUP HCPCS C1713 AR-8954YR-L - PLATE BN LNG LOPRFL TPR LCK CALCANEUS RT ANT POST ATCH GD BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,737.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$1,182.60" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$1,642.50" "$2,737.50" "$2,737.50" "$2,737.50" N/A N/A AR-8954YR-S SUP HCPCS C1713 AR-8954YR-S - PLATE BN STD LOPRFL TPR LCK CALCANEUS RT ANT POST ATCH GD BOTH IP/OP "$2,737.50" "$2,026.00" $543.33 "$2,956.50" "$1,231.88" "$1,231.88" "$1,231.88" "$1,231.88" "$2,737.50" "$2,737.50" "$2,737.50" $570.56 "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" $570.53 "$2,737.50" "$2,956.50" "$1,349.59" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,053.13" "$2,737.50" "$2,737.50" "$2,737.50" "$1,368.75" "$1,368.75" "$2,168.10" "$2,737.50" "$2,190.00" "$1,231.88" $543.33 N/A "$1,587.75" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" "$2,737.50" N/A N/A AR-8955-60PT SUP HCPCS C1713 AR-8955-60PT - SCREW BN 3.5MM P/T HEX 5.5MM 60MM LOPRFL SCR SLF DRL SLD LG BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $324.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A AR-8955-65PT SUP HCPCS C1713 AR-8955-65PT - SCREW BN 3.5MM P/T HEX 5.5MM 65MM LOPRFL SCR SLF DRL SLD LG BOTH IP/OP $750.00 $555.00 $148.86 $810.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $810.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $450.00 $750.00 $156.30 $750.00 N/A N/A AR-8955G SUP Custom 27203010 AR-8955G - GUIDE DRL LOPRFL 4MM 1.6MM 4.5MM SCR BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $432.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-8955T SUP HCPCS C1713 AR-8955T - SCREW BN LOPRFL 5.5MM TAP JNS FX BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $175.00 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A AR-8956-01 SUP HCPCS C1713 AR-8956-01 - PLATE BN UNV HK METATARSUS FIFTH MTRSL FX SYS BOTH IP/OP "$2,312.50" "$1,711.00" $458.97 "$2,497.50" "$1,040.63" "$1,040.63" "$1,040.63" "$1,040.63" "$2,312.50" "$2,312.50" "$2,312.50" $481.98 "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" $481.95 "$2,312.50" "$2,497.50" "$1,367.84" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$1,734.38" "$2,312.50" "$2,312.50" "$2,312.50" "$1,156.25" "$1,156.25" "$1,831.50" "$2,312.50" "$1,850.00" "$1,040.63" $458.97 N/A "$1,341.25" "$2,312.50" "$1,387.50" "$2,312.50" $481.93 "$2,312.50" N/A N/A AR-8956-08 SUP HCPCS C1713 AR-8956-08 - PLATE BN HK TAMP METATARSUS FIFTH MTRSL FX SYS BOTH IP/OP $375.00 $278.00 $74.43 $405.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $405.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A AR-8956L-02 SUP HCPCS C1713 AR-8956L-02 - PLATE BN LNG HK METATARSUS LT FIFTH MTRSL FX SYS BOTH IP/OP "$3,187.50" "$2,359.00" $632.64 "$3,442.50" "$1,434.38" "$1,434.38" "$1,434.38" "$1,434.38" "$3,187.50" "$3,187.50" "$3,187.50" $664.35 "$3,187.50" "$3,187.50" "$3,187.50" "$3,187.50" "$3,187.50" $664.31 "$3,187.50" "$3,442.50" "$1,571.44" "$3,187.50" "$3,187.50" "$3,187.50" "$3,187.50" "$2,390.63" "$3,187.50" "$3,187.50" "$3,187.50" "$1,593.75" "$1,593.75" "$2,524.50" "$3,187.50" "$2,550.00" "$1,434.38" $632.64 N/A "$1,848.75" "$3,187.50" "$1,912.50" "$3,187.50" $664.28 "$3,187.50" N/A N/A AR-8956R-03 SUP HCPCS C1713 AR-8956R-03 - PLATE BN LNG 7 HL HK LOPRFL 5TH MTRSL RT 2.4MM SCR BOTH IP/OP "$3,187.50" "$2,359.00" $632.64 "$3,187.50" "$1,434.38" "$1,434.38" "$1,434.38" "$1,434.38" "$3,187.50" "$3,187.50" "$3,187.50" $664.35 "$3,187.50" "$3,187.50" "$3,187.50" "$3,187.50" "$3,187.50" $664.31 "$3,187.50" "$1,377.00" "$1,571.44" "$3,187.50" "$3,187.50" "$3,187.50" "$3,187.50" "$2,390.63" "$3,187.50" "$3,187.50" "$3,187.50" "$1,593.75" "$1,593.75" "$2,524.50" "$3,187.50" "$2,550.00" "$1,434.38" $632.64 N/A "$1,848.75" "$3,187.50" "$1,912.50" "$3,187.50" $664.28 "$3,187.50" N/A N/A AR-8958-01 SUP HCPCS C1713 AR-8958-01 - PLATE BN TGHTRP 2 HL SS SYNDESMOSIS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $864.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A AR-8958-01S SUP HCPCS C1713 AR-8958-01S - PLATE BN STRL TGHTRP 2 HL SS SYNDESMOSIS BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-8958-02 SUP HCPCS C1713 AR-8958-02 - PLATE BN TGHTRP 2 HL TI SYNDESMOSIS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $864.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-8958-02S SUP HCPCS C1713 AR-8958-02S - PLATE BN STRL TGHTRP 2 HL TI SYNDESMOSIS BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $918.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A AR-8958TDS SUP HCPCS C1713 AR-8958TDS - SYSTEM FX TGHTRP BB-TAK 2 BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,538.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$3,525.00" "$5,875.00" "$5,875.00" "$5,875.00" N/A N/A AR-8963-05 SUP Custom 27203010 AR-8963-05 - BIT DRL LNG 2MM CLBRT TIB DIST BOTH IP/OP $275.00 $204.00 $48.95 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $48.95 $275.00 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $118.80 $275.00 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $275.00 N/A $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A AR-8963-08 SUP Custom 27203010 AR-8963-08 - GUIDE DRL 2.7MM 10-60MM THRD BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $432.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-8963A-03 SUP HCPCS C1713 AR-8963A-03 - PLATE BN 62MM 3 HL 2 ROW CONSTRUCT TPR TIP TIB DIST ANT 2.7 BOTH IP/OP "$2,312.50" "$1,711.00" $458.97 "$2,312.50" "$1,040.63" "$1,040.63" "$1,040.63" "$1,040.63" "$2,312.50" "$2,312.50" "$2,312.50" $481.98 "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" $481.95 "$2,312.50" $999.00 "$1,367.84" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$1,734.38" "$2,312.50" "$2,312.50" "$2,312.50" "$1,156.25" "$1,156.25" "$1,831.50" "$2,312.50" "$1,850.00" "$1,040.63" $458.97 N/A "$1,341.25" "$2,312.50" "$1,387.50" "$2,312.50" $481.93 "$2,312.50" N/A N/A AR-8963A-05 SUP HCPCS C1713 AR-8963A-05 - PLATE BN 84MM 5 HL TIB DIST ANT BOTH IP/OP "$2,375.00" "$1,758.00" $471.38 "$2,565.00" "$1,068.75" "$1,068.75" "$1,068.75" "$1,068.75" "$2,375.00" "$2,375.00" "$2,375.00" $495.01 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" "$2,565.00" "$1,404.81" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" $471.38 N/A "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" $494.95 "$2,375.00" N/A N/A AR-8963A-07 SUP HCPCS C1713 AR-8963A-07 - PLATE BN 107MM 7 HL 2 ROW CONSTRUCT TPR TIP TIB DIST ANT 2.7 BOTH IP/OP "$2,450.00" "$1,813.00" $486.26 "$2,450.00" "$1,102.50" "$1,102.50" "$1,102.50" "$1,102.50" "$2,450.00" "$2,450.00" "$2,450.00" $510.64 "$2,450.00" "$2,450.00" "$2,450.00" "$2,450.00" "$2,450.00" $510.61 "$2,450.00" "$1,058.40" "$1,449.18" "$2,450.00" "$2,450.00" "$2,450.00" "$2,450.00" "$1,837.50" "$2,450.00" "$2,450.00" "$2,450.00" "$1,225.00" "$1,225.00" "$1,940.40" "$2,450.00" "$1,960.00" "$1,102.50" $486.26 N/A "$1,421.00" "$2,450.00" "$1,470.00" "$2,450.00" $510.58 "$2,450.00" N/A N/A AR-8963A-09 SUP HCPCS C1713 AR-8963A-09 - PLATE BN 130MM 9 HL 2 ROW CONSTRUCT TPR TIP TIB DIST ANT 2.7 BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,375.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$3,375.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A AR-8963AL-04 SUP HCPCS C1713 AR-8963AL-04 - PLATE BN CNTR 66MM 4 HL TPR TIP LOPRFL TIB LT DIST ALAT 2.7 BOTH IP/OP "$4,550.00" "$3,367.00" $903.06 "$4,550.00" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$4,550.00" "$4,550.00" "$4,550.00" $948.33 "$4,550.00" "$4,550.00" "$4,550.00" "$4,550.00" "$4,550.00" $948.27 "$4,550.00" "$1,965.60" "$2,243.15" "$4,550.00" "$4,550.00" "$4,550.00" "$4,550.00" "$3,412.50" "$4,550.00" "$4,550.00" "$4,550.00" "$2,275.00" "$2,275.00" "$3,603.60" "$4,550.00" "$3,640.00" "$2,047.50" $903.06 N/A "$2,639.00" "$4,550.00" "$2,730.00" "$4,550.00" $948.22 "$4,550.00" N/A N/A AR-8963AL-06 SUP HCPCS C1713 AR-8963AL-06 - PLATE BN OBLNG 91MM 6 HL TPR TIP LOPRFL TIB LT DIST ALAT BOTH IP/OP "$4,600.00" "$3,404.00" $912.99 "$4,600.00" "$2,070.00" "$2,070.00" "$2,070.00" "$2,070.00" "$4,600.00" "$4,600.00" "$4,600.00" $958.76 "$4,600.00" "$4,600.00" "$4,600.00" "$4,600.00" "$4,600.00" $958.69 "$4,600.00" "$1,987.20" "$2,267.80" "$4,600.00" "$4,600.00" "$4,600.00" "$4,600.00" "$3,450.00" "$4,600.00" "$4,600.00" "$4,600.00" "$2,300.00" "$2,300.00" "$3,643.20" "$4,600.00" "$3,680.00" "$2,070.00" $912.99 N/A "$2,668.00" "$4,600.00" "$2,760.00" "$4,600.00" $958.64 "$4,600.00" N/A N/A AR-8963AL-08 SUP HCPCS C1713 AR-8963AL-08 - PLATE BN 117MM 8 HL TIB LT DIST ALAT BOTH IP/OP "$4,650.00" "$3,441.00" $922.91 "$5,022.00" "$2,092.50" "$2,092.50" "$2,092.50" "$2,092.50" "$4,650.00" "$4,650.00" "$4,650.00" $969.18 "$4,650.00" "$4,650.00" "$4,650.00" "$4,650.00" "$4,650.00" $969.11 "$4,650.00" "$5,022.00" "$2,292.45" "$4,650.00" "$4,650.00" "$4,650.00" "$4,650.00" "$3,487.50" "$4,650.00" "$4,650.00" "$4,650.00" "$2,325.00" "$2,325.00" "$3,682.80" "$4,650.00" "$3,720.00" "$2,092.50" $922.91 N/A "$2,697.00" "$4,650.00" "$4,650.00" "$4,650.00" $969.06 "$4,650.00" N/A N/A AR-8963AL-10 SUP HCPCS C1713 AR-8963AL-10 - PLATE BN 142MM 10 HL TIB LT DIST ALAT BOTH IP/OP "$4,700.00" "$3,478.00" $932.83 "$5,076.00" "$2,115.00" "$2,115.00" "$2,115.00" "$2,115.00" "$4,700.00" "$4,700.00" "$4,700.00" $979.60 "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" $979.53 "$4,700.00" "$5,076.00" "$2,317.10" "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" "$3,525.00" "$4,700.00" "$4,700.00" "$4,700.00" "$2,350.00" "$2,350.00" "$3,722.40" "$4,700.00" "$3,760.00" "$2,115.00" $932.83 N/A "$2,726.00" "$4,700.00" "$4,700.00" "$4,700.00" $979.48 "$4,700.00" N/A N/A AR-8963AL-12 SUP HCPCS C1713 AR-8963AL-12 - PLATE BN 168MM 12 HL TIB LT DIST ALAT BOTH IP/OP "$4,750.00" "$3,515.00" $942.76 "$5,130.00" "$2,137.50" "$2,137.50" "$2,137.50" "$2,137.50" "$4,750.00" "$4,750.00" "$4,750.00" $990.02 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$5,130.00" "$2,341.75" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" $942.76 N/A "$2,755.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.90 "$4,750.00" N/A N/A AR-8963AL-14 SUP HCPCS C1713 AR-8963AL-14 - PLATE BN 193MM 14 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST BOTH IP/OP "$4,800.00" "$3,552.00" $952.68 "$4,800.00" "$2,160.00" "$2,160.00" "$2,160.00" "$2,160.00" "$4,800.00" "$4,800.00" "$4,800.00" "$1,000.44" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$1,000.37" "$4,800.00" "$2,073.60" "$2,366.40" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$3,600.00" "$4,800.00" "$4,800.00" "$4,800.00" "$2,400.00" "$2,400.00" "$3,801.60" "$4,800.00" "$3,840.00" "$2,160.00" $952.68 N/A "$2,784.00" "$4,800.00" "$4,800.00" "$4,800.00" "$1,000.32" "$4,800.00" N/A N/A AR-8963AL-16 SUP HCPCS C1713 AR-8963AL-16 - PLATE BN 218MM 16 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST BOTH IP/OP "$4,850.00" "$3,589.00" $962.60 "$4,850.00" "$2,182.50" "$2,182.50" "$2,182.50" "$2,182.50" "$4,850.00" "$4,850.00" "$4,850.00" "$1,010.86" "$4,850.00" "$4,850.00" "$4,850.00" "$4,850.00" "$4,850.00" "$1,010.79" "$4,850.00" "$2,095.20" "$2,391.05" "$4,850.00" "$4,850.00" "$4,850.00" "$4,850.00" "$3,637.50" "$4,850.00" "$4,850.00" "$4,850.00" "$2,425.00" "$2,425.00" "$3,841.20" "$4,850.00" "$3,880.00" "$2,182.50" $962.60 N/A "$2,813.00" "$4,850.00" "$4,850.00" "$4,850.00" "$1,010.74" "$4,850.00" N/A N/A AR-8963AL-18 SUP HCPCS C1713 AR-8963AL-18 - PLATE BN BTRS 244MM 18 HL OBLNG HL TPR TIP LOPRFL TIB LT BOTH IP/OP "$4,900.00" "$3,626.00" $972.53 "$4,900.00" "$2,205.00" "$2,205.00" "$2,205.00" "$2,205.00" "$4,900.00" "$4,900.00" "$4,900.00" "$1,021.28" "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" "$1,021.21" "$4,900.00" "$2,116.80" "$2,415.70" "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" "$3,675.00" "$4,900.00" "$4,900.00" "$4,900.00" "$2,450.00" "$2,450.00" "$3,880.80" "$4,900.00" "$3,920.00" "$2,205.00" $972.53 N/A "$2,842.00" "$4,900.00" "$4,900.00" "$4,900.00" "$1,021.16" "$4,900.00" N/A N/A AR-8963APLL-04 SUP HCPCS C1713 AR-8963APLL-04 - PLATE BN 75MM 4 HL TPR TIP LOPRFL FIB LT DIST P/L 2.7MM LCK BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,188.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A AR-8963APLL-06 SUP HCPCS C1713 AR-8963APLL-06 - PLATE BN 126MM ANTM 6 HL SS FIB LT DIST P/L BOTH IP/OP "$2,875.00" "$2,128.00" $570.62 "$2,875.00" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$2,875.00" "$2,875.00" "$2,875.00" $599.22 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$1,242.00" "$1,417.38" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" $570.62 N/A "$1,667.50" "$2,875.00" "$2,875.00" "$2,875.00" $599.15 "$2,875.00" N/A N/A AR-8963APLL-08 SUP HCPCS C1713 AR-8963APLL-08 - PLATE BN 151MM 8 HL ANTM TPR TIP CUT OUT FIB LT DIST P/L BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,240.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,240.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A AR-8963APLL-10 SUP HCPCS C1713 AR-8963APLL-10 - PLATE BN 10 HL ANTM TPR TIP CUT OUT FIB LT DIST P/L BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,350.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A AR-8963APLR-04 SUP HCPCS C1713 AR-8963APLR-04 - PLATE BN 75MM JUMPSTART 4 HL FIB RT DIST P/L BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,750.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,188.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.10 "$2,750.00" N/A N/A AR-8963APLR-06 SUP HCPCS C1713 AR-8963APLR-06 - PLATE BN LOPRFL SS FIB RT P/L DIST BOTH IP/OP "$2,875.00" "$2,128.00" $570.62 "$2,875.00" "$1,293.75" "$1,293.75" "$1,293.75" "$1,293.75" "$2,875.00" "$2,875.00" "$2,875.00" $599.22 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $599.18 "$2,875.00" "$1,242.00" "$1,417.38" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,293.75" $570.62 N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" $599.15 "$2,875.00" N/A N/A AR-8963APLR-08 SUP HCPCS C1713 AR-8963APLR-08 - PLATE BN 151MM 8 HL FIB RT DIST P/L BOTH IP/OP "$3,000.00" "$2,220.00" $595.43 "$3,240.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.28 "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" $625.23 "$3,000.00" "$3,240.00" "$1,479.00" "$3,000.00" "$3,000.00" "$3,000.00" "$3,000.00" "$2,250.00" "$3,000.00" "$3,000.00" "$3,000.00" "$1,500.00" "$1,500.00" "$2,376.00" "$3,000.00" "$2,400.00" "$1,350.00" $595.43 N/A "$1,740.00" "$3,000.00" "$1,800.00" "$3,000.00" $625.20 "$3,000.00" N/A N/A AR-8963APLR-10 SUP HCPCS C1713 AR-8963APLR-10 - PLATE BN 10 HL FIB RT DIST P/L BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,350.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A AR-8963AR-04 SUP HCPCS C1713 AR-8963AR-04 - PLATE BN BTRS 66MM 4 HL OBLNG HL TPR TIP LOPRFL TIB RT DIST BOTH IP/OP "$4,550.00" "$3,367.00" $903.06 "$4,550.00" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$4,550.00" "$4,550.00" "$4,550.00" $948.33 "$4,550.00" "$4,550.00" "$4,550.00" "$4,550.00" "$4,550.00" $948.27 "$4,550.00" "$1,965.60" "$2,243.15" "$4,550.00" "$4,550.00" "$4,550.00" "$4,550.00" "$3,412.50" "$4,550.00" "$4,550.00" "$4,550.00" "$2,275.00" "$2,275.00" "$3,603.60" "$4,550.00" "$3,640.00" "$2,047.50" $903.06 N/A "$2,639.00" "$4,550.00" "$4,550.00" "$4,550.00" $948.22 "$4,550.00" N/A N/A AR-8963AR-06 SUP HCPCS C1713 AR-8963AR-06 - PLATE BN BTRS 91MM 6 HL OBLNG HL TPR TIP LOPRFL TIB RT DIST BOTH IP/OP "$4,600.00" "$3,404.00" $912.99 "$4,600.00" "$2,070.00" "$2,070.00" "$2,070.00" "$2,070.00" "$4,600.00" "$4,600.00" "$4,600.00" $958.76 "$4,600.00" "$4,600.00" "$4,600.00" "$4,600.00" "$4,600.00" $958.69 "$4,600.00" "$1,987.20" "$2,267.80" "$4,600.00" "$4,600.00" "$4,600.00" "$4,600.00" "$3,450.00" "$4,600.00" "$4,600.00" "$4,600.00" "$2,300.00" "$2,300.00" "$3,643.20" "$4,600.00" "$3,680.00" "$2,070.00" $912.99 N/A "$2,668.00" "$4,600.00" "$4,600.00" "$4,600.00" $958.64 "$4,600.00" N/A N/A AR-8963AR-08 SUP HCPCS C1713 AR-8963AR-08 - PLATE BN 117MM 8 HL TIB RT DIST ALAT BOTH IP/OP "$4,650.00" "$3,441.00" $922.91 "$4,650.00" "$2,092.50" "$2,092.50" "$2,092.50" "$2,092.50" "$4,650.00" "$4,650.00" "$4,650.00" $969.18 "$4,650.00" "$4,650.00" "$4,650.00" "$4,650.00" "$4,650.00" $969.11 "$4,650.00" "$2,008.80" "$2,292.45" "$4,650.00" "$4,650.00" "$4,650.00" "$4,650.00" "$3,487.50" "$4,650.00" "$4,650.00" "$4,650.00" "$2,325.00" "$2,325.00" "$3,682.80" "$4,650.00" "$3,720.00" "$2,092.50" $922.91 N/A "$2,697.00" "$4,650.00" "$2,790.00" "$4,650.00" $969.06 "$4,650.00" N/A N/A AR-8963AR-10 SUP HCPCS C1713 AR-8963AR-10 - PLATE BN 142MM 10 HL TIB RT DIST ALAT BOTH IP/OP "$4,700.00" "$3,478.00" $932.83 "$4,700.00" "$2,115.00" "$2,115.00" "$2,115.00" "$2,115.00" "$4,700.00" "$4,700.00" "$4,700.00" $979.60 "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" $979.53 "$4,700.00" "$2,030.40" "$2,317.10" "$4,700.00" "$4,700.00" "$4,700.00" "$4,700.00" "$3,525.00" "$4,700.00" "$4,700.00" "$4,700.00" "$2,350.00" "$2,350.00" "$3,722.40" "$4,700.00" "$3,760.00" "$2,115.00" $932.83 N/A "$2,726.00" "$4,700.00" "$2,820.00" "$4,700.00" $979.48 "$4,700.00" N/A N/A AR-8963AR-14 SUP HCPCS C1713 AR-8963AR-14 - PLATE BN 193MM 14 HL TIB RT DIST ALAT BOTH IP/OP "$4,800.00" "$3,552.00" $952.68 "$5,184.00" "$2,160.00" "$2,160.00" "$2,160.00" "$2,160.00" "$4,800.00" "$4,800.00" "$4,800.00" "$1,000.44" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$1,000.37" "$4,800.00" "$5,184.00" "$2,366.40" "$4,800.00" "$4,800.00" "$4,800.00" "$4,800.00" "$3,600.00" "$4,800.00" "$4,800.00" "$4,800.00" "$2,400.00" "$2,400.00" "$3,801.60" "$4,800.00" "$3,840.00" "$2,160.00" $952.68 N/A "$2,784.00" "$4,800.00" "$2,880.00" "$4,800.00" "$1,000.32" "$4,800.00" N/A N/A AR-8963AR-16 SUP HCPCS C1713 AR-8963AR-16 - PLATE BN 218MM 16 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST BOTH IP/OP "$4,850.00" "$3,589.00" $962.60 "$4,850.00" "$2,182.50" "$2,182.50" "$2,182.50" "$2,182.50" "$4,850.00" "$4,850.00" "$4,850.00" "$1,010.86" "$4,850.00" "$4,850.00" "$4,850.00" "$4,850.00" "$4,850.00" "$1,010.79" "$4,850.00" "$2,095.20" "$2,391.05" "$4,850.00" "$4,850.00" "$4,850.00" "$4,850.00" "$3,637.50" "$4,850.00" "$4,850.00" "$4,850.00" "$2,425.00" "$2,425.00" "$3,841.20" "$4,850.00" "$3,880.00" "$2,182.50" $962.60 N/A "$2,813.00" "$4,850.00" "$2,910.00" "$4,850.00" "$1,010.74" "$4,850.00" N/A N/A AR-8963AR-18 SUP HCPCS C1713 AR-8963AR-18 - PLATE BN BTRS 244MM 18 HL OBLNG HL TPR TIP LOPRFL TIB RT BOTH IP/OP "$4,900.00" "$3,626.00" $972.53 "$5,292.00" "$2,205.00" "$2,205.00" "$2,205.00" "$2,205.00" "$4,900.00" "$4,900.00" "$4,900.00" "$1,021.28" "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" "$1,021.21" "$4,900.00" "$5,292.00" "$2,415.70" "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" "$3,675.00" "$4,900.00" "$4,900.00" "$4,900.00" "$2,450.00" "$2,450.00" "$3,880.80" "$4,900.00" "$3,920.00" "$2,205.00" $972.53 N/A "$2,842.00" "$4,900.00" "$4,900.00" "$4,900.00" "$1,021.16" "$4,900.00" N/A N/A AR-8963ML-04 SUP HCPCS C1713 AR-8963ML-04 - PLATE BN 103MM 4 HL TIB LT DIST MDL BOTH IP/OP "$4,300.00" "$3,182.00" $853.44 "$4,300.00" "$1,935.00" "$1,935.00" "$1,935.00" "$1,935.00" "$4,300.00" "$4,300.00" "$4,300.00" $896.23 "$4,300.00" "$4,300.00" "$4,300.00" "$4,300.00" "$4,300.00" $896.17 "$4,300.00" "$1,857.60" "$2,119.90" "$4,300.00" "$4,300.00" "$4,300.00" "$4,300.00" "$3,225.00" "$4,300.00" "$4,300.00" "$4,300.00" "$2,150.00" "$2,150.00" "$3,405.60" "$4,300.00" "$3,440.00" "$1,935.00" $853.44 N/A "$2,494.00" "$4,300.00" "$2,580.00" "$4,300.00" $896.12 "$4,300.00" N/A N/A AR-8963ML-06 SUP HCPCS C1713 AR-8963ML-06 - PLATE BN 128MM 6 HL TIB LT DIST MDL BOTH IP/OP "$4,350.00" "$3,219.00" $863.37 "$4,698.00" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$4,350.00" "$4,350.00" "$4,350.00" $906.65 "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" $906.59 "$4,350.00" "$4,698.00" "$2,144.55" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$3,262.50" "$4,350.00" "$4,350.00" "$4,350.00" "$2,175.00" "$2,175.00" "$3,445.20" "$4,350.00" "$3,480.00" "$1,957.50" $863.37 N/A "$2,523.00" "$4,350.00" "$4,350.00" "$4,350.00" $906.54 "$4,350.00" N/A N/A AR-8963ML-10 SUP HCPCS C1713 AR-8963ML-10 - PLATE BN 179MM 10 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST MDL BOTH IP/OP "$4,450.00" "$3,293.00" $883.21 "$4,450.00" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$4,450.00" "$4,450.00" "$4,450.00" $927.49 "$4,450.00" "$4,450.00" "$4,450.00" "$4,450.00" "$4,450.00" $927.43 "$4,450.00" "$1,922.40" "$2,193.85" "$4,450.00" "$4,450.00" "$4,450.00" "$4,450.00" "$3,337.50" "$4,450.00" "$4,450.00" "$4,450.00" "$2,225.00" "$2,225.00" "$3,524.40" "$4,450.00" "$3,560.00" "$2,002.50" $883.21 N/A "$2,581.00" "$4,450.00" "$4,450.00" "$4,450.00" $927.38 "$4,450.00" N/A N/A AR-8963ML-14 SUP HCPCS C1713 AR-8963ML-14 - PLATE BN 230MM 14 HL TIB LT DIST MDL BOTH IP/OP "$4,550.00" "$3,367.00" $903.06 "$4,550.00" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$4,550.00" "$4,550.00" "$4,550.00" $948.33 "$4,550.00" "$4,550.00" "$4,550.00" "$4,550.00" "$4,550.00" $948.27 "$4,550.00" "$1,965.60" "$2,243.15" "$4,550.00" "$4,550.00" "$4,550.00" "$4,550.00" "$3,412.50" "$4,550.00" "$4,550.00" "$4,550.00" "$2,275.00" "$2,275.00" "$3,603.60" "$4,550.00" "$3,640.00" "$2,047.50" $903.06 N/A "$2,639.00" "$4,550.00" "$2,730.00" "$4,550.00" $948.22 "$4,550.00" N/A N/A AR-8963ML-16 SUP HCPCS C1713 AR-8963ML-16 - PLATE BN 278MM 16 HL TPR TIP OBLNG HL LOPRFL TIB LT DIST MDL BOTH IP/OP "$4,600.00" "$3,404.00" $912.99 "$4,600.00" "$2,070.00" "$2,070.00" "$2,070.00" "$2,070.00" "$4,600.00" "$4,600.00" "$4,600.00" $958.76 "$4,600.00" "$4,600.00" "$4,600.00" "$4,600.00" "$4,600.00" $958.69 "$4,600.00" "$1,987.20" "$2,267.80" "$4,600.00" "$4,600.00" "$4,600.00" "$4,600.00" "$3,450.00" "$4,600.00" "$4,600.00" "$4,600.00" "$2,300.00" "$2,300.00" "$3,643.20" "$4,600.00" "$3,680.00" "$2,070.00" $912.99 N/A "$2,668.00" "$4,600.00" "$2,760.00" "$4,600.00" $958.64 "$4,600.00" N/A N/A AR-8963MR-04 SUP HCPCS C1713 AR-8963MR-04 - PLATE BN 4 HL LOPRFL SS TIB RT DIST MDL 2.7 MM SCR BOTH IP/OP "$4,300.00" "$3,182.00" $853.44 "$4,300.00" "$1,935.00" "$1,935.00" "$1,935.00" "$1,935.00" "$4,300.00" "$4,300.00" "$4,300.00" $896.23 "$4,300.00" "$4,300.00" "$4,300.00" "$4,300.00" "$4,300.00" $896.17 "$4,300.00" "$1,857.60" "$2,119.90" "$4,300.00" "$4,300.00" "$4,300.00" "$4,300.00" "$3,225.00" "$4,300.00" "$4,300.00" "$4,300.00" "$2,150.00" "$2,150.00" "$3,405.60" "$4,300.00" "$3,440.00" "$1,935.00" $853.44 N/A "$2,494.00" "$4,300.00" "$4,300.00" "$4,300.00" $896.12 "$4,300.00" N/A N/A AR-8963MR-06 SUP HCPCS C1713 AR-8963MR-06 - PLATE BN CNTR 128MM 6 HL TPR TIP LOPRFL TIB RT DIST MDL 2.7 BOTH IP/OP "$4,350.00" "$3,219.00" $863.37 "$4,698.00" "$1,957.50" "$1,957.50" "$1,957.50" "$1,957.50" "$4,350.00" "$4,350.00" "$4,350.00" $906.65 "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" $906.59 "$4,350.00" "$4,698.00" "$2,144.55" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$3,262.50" "$4,350.00" "$4,350.00" "$4,350.00" "$2,175.00" "$2,175.00" "$3,445.20" "$4,350.00" "$3,480.00" "$1,957.50" $863.37 N/A "$2,523.00" "$4,350.00" "$2,610.00" "$4,350.00" $906.54 "$4,350.00" N/A N/A AR-8963MR-08 SUP HCPCS C1713 AR-8963MR-08 - PLATE BN 154MM 8 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL BOTH IP/OP "$4,400.00" "$3,256.00" $873.29 "$4,400.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$4,400.00" "$4,400.00" "$4,400.00" $917.07 "$4,400.00" "$4,400.00" "$4,400.00" "$4,400.00" "$4,400.00" $917.01 "$4,400.00" "$1,900.80" "$2,169.20" "$4,400.00" "$4,400.00" "$4,400.00" "$4,400.00" "$3,300.00" "$4,400.00" "$4,400.00" "$4,400.00" "$2,200.00" "$2,200.00" "$3,484.80" "$4,400.00" "$3,520.00" "$1,980.00" $873.29 N/A "$2,552.00" "$4,400.00" "$2,640.00" "$4,400.00" $916.96 "$4,400.00" N/A N/A AR-8963MR-10 SUP HCPCS C1713 AR-8963MR-10 - PLATE BN CNTR 179MM 10 HL LOPRFL TPR TIP TIB RT DIST MDL BOTH IP/OP "$4,450.00" "$3,293.00" $883.21 "$4,450.00" "$2,002.50" "$2,002.50" "$2,002.50" "$2,002.50" "$4,450.00" "$4,450.00" "$4,450.00" $927.49 "$4,450.00" "$4,450.00" "$4,450.00" "$4,450.00" "$4,450.00" $927.43 "$4,450.00" "$1,922.40" "$2,193.85" "$4,450.00" "$4,450.00" "$4,450.00" "$4,450.00" "$3,337.50" "$4,450.00" "$4,450.00" "$4,450.00" "$2,225.00" "$2,225.00" "$3,524.40" "$4,450.00" "$3,560.00" "$2,002.50" $883.21 N/A "$2,581.00" "$4,450.00" "$4,450.00" "$4,450.00" $927.38 "$4,450.00" N/A N/A AR-8963MR-12 SUP HCPCS C1713 AR-8963MR-12 - PLATE BN 204MM 12 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL BOTH IP/OP "$4,500.00" "$3,330.00" $893.14 "$4,500.00" "$2,025.00" "$2,025.00" "$2,025.00" "$2,025.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.91 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 "$4,500.00" "$1,944.00" "$2,218.50" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,025.00" $893.14 N/A "$2,610.00" "$4,500.00" "$2,700.00" "$4,500.00" $937.80 "$4,500.00" N/A N/A AR-8963MR-14 SUP HCPCS C1713 AR-8963MR-14 - PLATE BN 230MM 14 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL BOTH IP/OP "$4,550.00" "$3,367.00" $903.06 "$4,550.00" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$4,550.00" "$4,550.00" "$4,550.00" $948.33 "$4,550.00" "$4,550.00" "$4,550.00" "$4,550.00" "$4,550.00" $948.27 "$4,550.00" "$1,965.60" "$2,243.15" "$4,550.00" "$4,550.00" "$4,550.00" "$4,550.00" "$3,412.50" "$4,550.00" "$4,550.00" "$4,550.00" "$2,275.00" "$2,275.00" "$3,603.60" "$4,550.00" "$3,640.00" "$2,047.50" $903.06 N/A "$2,639.00" "$4,550.00" "$4,550.00" "$4,550.00" $948.22 "$4,550.00" N/A N/A AR-8963MR-16 SUP HCPCS C1713 AR-8963MR-16 - PLATE BN 278MM 16 HL TPR TIP OBLNG HL LOPRFL TIB RT DIST MDL BOTH IP/OP "$4,600.00" "$3,404.00" $912.99 "$4,600.00" "$2,070.00" "$2,070.00" "$2,070.00" "$2,070.00" "$4,600.00" "$4,600.00" "$4,600.00" $958.76 "$4,600.00" "$4,600.00" "$4,600.00" "$4,600.00" "$4,600.00" $958.69 "$4,600.00" "$1,987.20" "$2,267.80" "$4,600.00" "$4,600.00" "$4,600.00" "$4,600.00" "$3,450.00" "$4,600.00" "$4,600.00" "$4,600.00" "$2,300.00" "$2,300.00" "$3,643.20" "$4,600.00" "$3,680.00" "$2,070.00" $912.99 N/A "$2,668.00" "$4,600.00" "$2,760.00" "$4,600.00" $958.64 "$4,600.00" N/A N/A AR-8963P-03 SUP HCPCS C1713 AR-8963P-03 - PLATE BN 57MM ARTHX 3 HL TIB DP BOTH IP/OP "$2,487.50" "$1,841.00" $493.71 "$2,686.50" "$1,119.38" "$1,119.38" "$1,119.38" "$1,119.38" "$2,487.50" "$2,487.50" "$2,487.50" $518.46 "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" $518.42 "$2,487.50" "$2,686.50" "$1,471.36" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$1,865.63" "$2,487.50" "$2,487.50" "$2,487.50" "$1,243.75" "$1,243.75" "$1,970.10" "$2,487.50" "$1,990.00" "$1,119.38" $493.71 N/A "$1,442.75" "$2,487.50" "$1,492.50" "$2,487.50" "$2,487.50" "$2,487.50" N/A N/A AR-8963P-05 SUP HCPCS C1713 AR-8963P-05 - PLATE BN 77MM 5 HL TIB DP BOTH IP/OP "$2,487.50" "$1,841.00" $493.71 "$2,487.50" "$1,119.38" "$1,119.38" "$1,119.38" "$1,119.38" "$2,487.50" "$2,487.50" "$2,487.50" $518.46 "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" $518.42 "$2,487.50" "$1,074.60" "$1,471.36" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$1,865.63" "$2,487.50" "$2,487.50" "$2,487.50" "$1,243.75" "$1,243.75" "$1,970.10" "$2,487.50" "$1,990.00" "$1,119.38" $493.71 N/A "$1,442.75" "$2,487.50" "$1,492.50" "$2,487.50" $518.40 "$2,487.50" N/A N/A AR-8963P-07 SUP HCPCS C1713 AR-8963P-07 - PLATE BN 7 HL TIB DP BOTH IP/OP "$2,750.00" "$2,035.00" $545.81 "$2,970.00" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$2,750.00" "$2,750.00" "$2,750.00" $573.17 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$2,970.00" "$1,355.75" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" $545.81 N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A AR-8963P-09 SUP HCPCS C1713 AR-8963P-09 - PLATE BN 118MM 9 HL TIB DP BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$1,350.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A AR-8963PLL-04 SUP HCPCS C1713 AR-8963PLL-04 - PLATE BN 75MM 4 HL FIB DIST P/L BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $864.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A AR-8963PLL-05 SUP HCPCS C1713 AR-8963PLL-05 - PLATE BN STD 88MM 5 HL TPR TIP FIB DIST P/L 2.7MM LCK BOTH IP/OP "$2,050.00" "$1,517.00" $406.87 "$2,214.00" $922.50 $922.50 $922.50 $922.50 "$2,050.00" "$2,050.00" "$2,050.00" $427.27 "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" $427.24 "$2,050.00" "$2,214.00" "$1,212.58" "$2,050.00" "$2,050.00" "$2,050.00" "$2,050.00" "$1,537.50" "$2,050.00" "$2,050.00" "$2,050.00" "$1,025.00" "$1,025.00" "$1,623.60" "$2,050.00" "$1,640.00" $922.50 $406.87 N/A "$1,189.00" "$2,050.00" "$2,050.00" "$2,050.00" $427.22 "$2,050.00" N/A N/A AR-8963PLL-06 SUP HCPCS C1713 AR-8963PLL-06 - PLATE BN 100MM 6 HL TPR TIP CUT OUT SCLP FIB DIST P/L BOTH IP/OP "$2,100.00" "$1,554.00" $416.80 "$2,100.00" $945.00 $945.00 $945.00 $945.00 "$2,100.00" "$2,100.00" "$2,100.00" $437.69 "$2,100.00" "$2,100.00" "$2,100.00" "$2,100.00" "$2,100.00" $437.66 "$2,100.00" $907.20 "$1,242.15" "$2,100.00" "$2,100.00" "$2,100.00" "$2,100.00" "$1,575.00" "$2,100.00" "$2,100.00" "$2,100.00" "$1,050.00" "$1,050.00" "$1,663.20" "$2,100.00" "$1,680.00" $945.00 $416.80 N/A "$1,218.00" "$2,100.00" "$1,260.00" "$2,100.00" $437.64 "$2,100.00" N/A N/A AR-8963PLL-08 SUP HCPCS C1713 AR-8963PLL-08 - PLATE BN STD 126MM 8 HL TPR TIP FIB DIST P/L 2.7MM LCK BOTH IP/OP "$2,150.00" "$1,591.00" $426.72 "$2,322.00" $967.50 $967.50 $967.50 $967.50 "$2,150.00" "$2,150.00" "$2,150.00" $448.11 "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" $448.08 "$2,150.00" "$2,322.00" "$1,271.73" "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" "$1,612.50" "$2,150.00" "$2,150.00" "$2,150.00" "$1,075.00" "$1,075.00" "$1,702.80" "$2,150.00" "$1,720.00" $967.50 $426.72 N/A "$1,247.00" "$2,150.00" "$1,290.00" "$2,150.00" $448.06 "$2,150.00" N/A N/A AR-8963RM-02 SUP HCPCS C1713 AR-8963RM-02 - PLATE BN STRG 16MM 2 HL OBLNG HL TPR TIP LOPRFL 2.7MM SCR BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-8963RM-03 SUP HCPCS C1713 AR-8963RM-03 - PLATE BN STRG 16MM 3 HL OBLNG HL TPR TIP LOPRFL 2.7MM SCR BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $297.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $412.50 $687.50 $143.28 $687.50 N/A N/A AR-8963RM-04 SUP HCPCS C1713 AR-8963RM-04 - PLATE BN STRG 16MM 4 HL OBLNG HL TPR TIP LOPRFL 2.7MM SCR BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $320.63 $320.63 $320.63 $320.63 $712.50 $712.50 $712.50 $148.50 $712.50 $712.50 $712.50 $712.50 $712.50 $148.49 $712.50 $307.80 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $320.63 $141.41 N/A $413.25 $712.50 $427.50 $712.50 $148.49 $712.50 N/A N/A AR-8963RM-05 SUP HCPCS C1713 AR-8963RM-05 - PLATE BN STRG 40MM 5 HL 2.7MM SCR BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $318.60 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A AR-8964-01 SUP HCPCS C1713 AR-8964-01 - SCREW BN 4MM 125MM SCHNZ BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $135.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-8964-02 SUP HCPCS C1713 AR-8964-02 - SCREW BN 4MM 125MM SCHNZ BOTH IP/OP $312.50 $231.00 $62.02 $337.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $337.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-8964-03 SUP HCPCS C1713 AR-8964-03 - SCREW BN 5MM 175MM SCHNZ BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $135.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A AR-8964-04 SUP HCPCS C1713 AR-8964-04 - SCREW BN 5MM 200MM SCHNZ BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $135.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $187.50 $312.50 $65.13 $312.50 N/A N/A AR-8964-05 SUP HCPCS C1713 AR-8964-05 - PIN FX 6MM 225MM TRNFX BOTH IP/OP $225.00 $167.00 $44.66 $243.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $243.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A AR-8964-06 SUP HCPCS C1713 AR-8964-06 - PIN FX 6MM 300MM TRNFX BOTH IP/OP $225.00 $167.00 $44.66 $243.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $243.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A AR-8964-07 SUP Custom 27203010 AR-8964-07 - CLAMP XTRNFX LG CMBN BOTH IP/OP "$1,240.00" $918.00 $220.72 "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" $220.72 "$1,240.00" "$1,240.00" $920.33 $920.33 $955.79 $646.04 $258.43 "$1,240.00" $535.68 "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" $930.00 "$1,240.00" "$1,240.00" "$1,240.00" $620.00 $620.00 $982.08 "$1,240.00" $992.00 $806.00 "$1,240.00" N/A $719.20 "$1,240.00" $744.00 "$1,240.00" "$1,240.00" "$1,240.00" N/A N/A AR-8964-08 SUP Custom 27203010 AR-8964-08 - CLAMP XTRNFX LG MLPN BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $432.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-8964-09 SUP Custom 27203010 AR-8964-09 - CLAMP XTRNFX LG MLPN ROD ATCH BOTH IP/OP $937.50 $694.00 $166.88 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $937.50 $166.88 $937.50 $937.50 $695.81 $695.81 $722.63 $488.44 $195.39 $937.50 $405.00 $937.50 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $609.38 $937.50 N/A $543.75 $937.50 $562.50 $937.50 $937.50 $937.50 N/A N/A AR-8964-10 SUP Custom 27203010 AR-8964-10 - BIT DRL 3.5MM 195MM BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $102.60 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A AR-8964-22 SUP HCPCS C1713 AR-8964-22 - CAP END NS LF ARTHX SCR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A AR-8964-24 SUP HCPCS C1713 AR-8964-24 - SCREW BN 5MM 250MM SCHNZ BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $140.63 $140.63 $140.63 $140.63 $312.50 $312.50 $312.50 $65.13 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $135.00 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A AR-8964R-100 SUP HCPCS C1713 AR-8964R-100 - ROD XTRNFX 11MM 100MM ARTHROFX RDLCNT LTWT CFBR BOTH IP/OP $422.50 $313.00 $83.86 $456.30 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $456.30 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $422.50 $422.50 $88.05 $422.50 N/A N/A AR-8964R-150 SUP HCPCS C1713 AR-8964R-150 - ROD XTRNFX 11MM 150MM CFBR BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $182.52 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $422.50 $422.50 $422.50 $422.50 N/A N/A AR-8964R-200 SUP HCPCS C1713 AR-8964R-200 - ROD XTRNFX 11MM 200MM ARTHROFX CFBR BOTH IP/OP $422.50 $313.00 $83.86 $422.50 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $182.52 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $422.50 $422.50 $88.05 $422.50 N/A N/A AR-8964R-250 SUP HCPCS C1713 AR-8964R-250 - ROD XTRNFX 11MM 250MM CFBR BOTH IP/OP $422.50 $313.00 $83.86 $456.30 $190.13 $190.13 $190.13 $190.13 $422.50 $422.50 $422.50 $88.06 $422.50 $422.50 $422.50 $422.50 $422.50 $88.05 $422.50 $456.30 $249.91 $422.50 $422.50 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $190.13 $83.86 N/A $245.05 $422.50 $422.50 $422.50 $422.50 $422.50 N/A N/A AR-8964R-300 SUP HCPCS C1713 AR-8964R-300 - ROD XTRNFX 11MM 300MM CFBR BOTH IP/OP $475.00 $352.00 $94.28 $513.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $513.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A AR-8964R-350 SUP HCPCS C1713 AR-8964R-350 - ROD XTRNFX 11MM 350MM CFBR BOTH IP/OP $475.00 $352.00 $94.28 $513.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $513.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A AR-8964R-400 SUP HCPCS C1713 AR-8964R-400 - ROD XTRNFX 11MM 400MM CFBR BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $216.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $500.00 $500.00 N/A N/A AR-8964R-450 SUP HCPCS C1713 AR-8964R-450 - ROD XTRNFX 11MM 450MM CFBR BOTH IP/OP $500.00 $370.00 $99.24 $540.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $540.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A AR-8964R-500 SUP HCPCS C1713 AR-8964R-500 - ROD XTRNFX 11MM 500MM ARTHROFX RDLCNT LTWT CFBR BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8964S SUP Custom 27203010 AR-8964S - SYSTEM XTRNFX ARTHROFX BOTH IP/OP "$35,000.00" "$25,900.00" "$2,060.15" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$6,230.00" "$35,000.00" "$35,000.00" "$4,181.12" "$4,181.12" "$26,978.00" "$2,060.15" "$7,294.39" "$35,000.00" "$15,120.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$35,000.00" "$26,250.00" "$35,000.00" "$35,000.00" "$35,000.00" "$17,500.00" "$17,500.00" "$27,720.00" "$35,000.00" "$28,000.00" "$22,750.00" "$35,000.00" N/A "$20,300.00" "$35,000.00" "$21,000.00" "$35,000.00" "$35,000.00" "$35,000.00" N/A N/A AR-8967-100FT SUP HCPCS C1713 AR-8967-100FT - SCREW BN FT 6.7MM 100MM LOPRFL SCR SLF DRL ST CNN MTL BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-105FT SUP HCPCS C1713 ar-8967-105FT - SCREW BN FT 6.7MM 105MM LOPRFL SCR SLF DRL ST CNN MTL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $625.00 $625.00 N/A N/A AR-8967-110FT SUP HCPCS C1713 AR-8967-110FT - SCREW BN FT 6.7MM 110MM LOPRFL SCR SLF DRL ST CNN MTL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-115FT SUP HCPCS C1713 AR-8967-115FT - SCREW BN FT 6.7MM 115MM LOPRFL SCR SLF DRL ST CNN MTL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-8967-120FT SUP HCPCS C1713 AR-8967-120FT - SCREW BN FT 6.7MM 120MM LOPRFL SCR SLF DRL ST CNN MTL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-8967-18100 SUP HCPCS C1713 AR-8967-18100 - SCREW BN LOPRFL 6.7MM 100MM 18MM CNN TI FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-18105 SUP HCPCS C1713 AR-8967-18105 - SCREW BN LOPRFL 6.7MM 105MM 18MM CNN TI FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-18110 SUP HCPCS C1713 AR-8967-18110 - SCREW BN LOPRFL 6.7MM 110MM 18MM CNN TI FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-18115 SUP HCPCS C1713 AR-8967-18115 - SCREW BN LOPRFL 6.7MM 115MM 18MM CNN TI FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-18120 SUP HCPCS C1713 AR-8967-18120 - SCREW BN LOPRFL 6.7MM 120MM 18MM CNN TI FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-1840 SUP HCPCS C1713 AR-8967-1840 - SCREW BN 3.5MM HEX 6.7MM 40MM 18MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-1845 SUP HCPCS C1713 AR-8967-1845 - SCREW BN 3.5MM HEX 6.7MM 45MM 18MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-1850 SUP HCPCS C1713 AR-8967-1850 - SCREW BN 3.5MM HEX 6.7MM 50MM 18MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-1855 SUP HCPCS C1713 AR-8967-1855 - SCREW BN 3.5MM HEX 6.7MM 55MM 18MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-1860 SUP HCPCS C1713 AR-8967-1860 - SCREW BN 3.5MM HEX 6.7MM 60MM 18MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-1865 SUP HCPCS C1713 AR-8967-1865 - SCREW BN 3.5MM HEX 6.7MM 65MM 18MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-1865S SUP HCPCS C1713 AR-8967-1865S - SCREW BN P/T 6.7MM 65MM STRL ARTHX LOPRFL SCR CNN TI BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-1870 SUP HCPCS C1713 AR-8967-1870 - SCREW BN 3.5MM HEX 6.7MM 70MM 18MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-1875 SUP HCPCS C1713 AR-8967-1875 - SCREW BN 3.5MM HEX 6.7MM 75MM 18MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-1880 SUP HCPCS C1713 AR-8967-1880 - SCREW BN 3.5MM HEX 6.7MM 80MM 18MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-8967-1880S SUP HCPCS C1713 AR-8967-1880S - SCREW BN P/T 6.7MM 80MM STRL ARTHX LOPRFL SCR CNN TI BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-1885 SUP HCPCS C1713 AR-8967-1885 - SCREW BN 3.5MM HEX 6.7MM 85MM 18MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-8967-1890 SUP HCPCS C1713 AR-8967-1890 - SCREW BN 3.5MM HEX 6.7MM 90MM 18MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-1890S SUP HCPCS C1713 AR-8967-1890S - SCREW BN P/T 6.7MM 90MM STRL ARTHX LOPRFL SCR CNN TI BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $625.00 $625.00 N/A N/A AR-8967-1895 SUP HCPCS C1713 AR-8967-1895 - SCREW BN 3.5MM HEX 6.7MM 95MM 18MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-8967-28100 SUP HCPCS C1713 AR-8967-28100 - SCREW BN 3.5MM HEX 6.7MM 100MM 18MM LOPRFL SCR SLF DRL ST BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-8967-28105 SUP HCPCS C1713 AR-8967-28105 - SCREW BN 3.5MM HEX 6.7MM 105MM 18MM LOPRFL SCR SLF DRL ST BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-28110 SUP HCPCS C1713 AR-8967-28110 - SCREW BN 3.5MM HEX 6.7MM 110MM 18MM LOPRFL SCR SLF DRL ST BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-28115 SUP HCPCS C1713 AR-8967-28115 - SCREW BN 3.5MM HEX 6.7MM 115MM 18MM LOPRFL SCR SLF DRL ST BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-8967-28120 SUP HCPCS C1713 AR-8967-28120 - SCREW BN 3.5MM HEX 6.7MM 120MM 18MM LOPRFL SCR SLF DRL ST BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-8967-2840 SUP HCPCS C1713 AR-8967-2840 - SCREW BN 3.5MM HEX 6.7MM 40MM 28MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-2845 SUP HCPCS C1713 AR-8967-2845 - SCREW BN 3.5MM HEX 6.7MM 45MM 28MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-2850 SUP HCPCS C1713 AR-8967-2850 - SCREW BN 3.5MM HEX 6.7MM 50MM 28MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-2855 SUP HCPCS C1713 AR-8967-2855 - SCREW BN 3.5MM HEX 6.7MM 55MM 28MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-2860 SUP HCPCS C1713 AR-8967-2860 - SCREW BN 3.5MM HEX 6.7MM 60MM 28MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-2865 SUP HCPCS C1713 AR-8967-2865 - SCREW BN 3.5MM HEX 6.7MM 65MM 28MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-2870 SUP HCPCS C1713 AR-8967-2870 - SCREW BN 3.5MM HEX 6.7MM 70MM 28MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-2875 SUP HCPCS C1713 AR-8967-2875 - SCREW BN 3.5MM HEX 6.7MM 75MM 28MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-2880 SUP HCPCS C1713 AR-8967-2880 - SCREW BN 3.5MM HEX 6.7MM 80MM 28MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-2885 SUP HCPCS C1713 AR-8967-2885 - SCREW BN 3.5MM HEX 6.7MM 85MM 28MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-2890 SUP HCPCS C1713 AR-8967-2890 - SCREW BN 3.5MM HEX 6.7MM 90MM 28MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-2895 SUP HCPCS C1713 AR-8967-2895 - SCREW BN 3.5MM HEX 6.7MM 95MM 28MM LOPRFL SCR SLF DRL ST CNN BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-40C SUP Custom 27203010 AR-8967-40C - BIT DRL 4MM 120MM CNN 6.7MM SCR BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-8967-40FT SUP HCPCS C1713 AR-8967-40FT - SCREW BN FT 6.7MM 40MM LOPRFL SCR CNN MTL FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-45FT SUP HCPCS C1713 AR-8967-45FT - SCREW BN FT 6.7MM 45MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-50FT SUP HCPCS C1713 AR-8967-50FT - SCREW BN FT 6.7MM 50MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-55FT SUP HCPCS C1713 AR-8967-55FT - SCREW BN FT 6.7MM 55MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-60FT SUP HCPCS C1713 AR-8967-60FT - SCREW BN FT 6.7MM 60MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $675.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $675.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-65FT SUP HCPCS C1713 AR-8967-65FT - SCREW BN FT 6.7MM 65MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-67C SUP Custom 27203010 AR-8967-67C - BIT DRL MN 6.7MM HDSN CNN BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-8967-70FT SUP HCPCS C1713 AR-8967-70FT - SCREW BN FT 6.7MM 70MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-75FT SUP HCPCS C1713 AR-8967-75FT - SCREW BN FT 6.7MM 75MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-80FT SUP HCPCS C1713 AR-8967-80FT - SCREW BN FT 6.7MM 80MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-85FT SUP HCPCS C1713 AR-8967-85FT - SCREW BN FT 6.7MM 85MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-90FT SUP HCPCS C1713 AR-8967-90FT - SCREW BN FT 6.7MM 90MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $130.25 $625.00 N/A N/A AR-8967-95FT SUP HCPCS C1713 AR-8967-95FT - SCREW BN FT 6.7MM 95MM LOPRFL SCR SLF DRL ST CNN MTL FT/ANKL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $270.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-8967C SUP HCPCS C1713 AR-8967C - SCREW BN LOPRFL 7MM PLT INS SM BN BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" $400.00 $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" $600.00 "$1,000.00" $208.40 "$1,000.00" N/A N/A AR-8967CSF SUP Custom 27203010 AR-8967CSF - COUNTERSINK DRL CNN 6.7 MM SCR BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $324.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A AR-8967G SUP Custom 27203010 AR-8967G - GUIDE DRL 6.7MM 4MM CNN BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $432.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-8967S SUP HCPCS C1713 AR-8967S - MODULE INST 6.7 MM TENODESIS LOPRFL SCR BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A AR-8967W SUP HCPCS C1713 AR-8967W - WASHER ORTH 13MM TI BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $90.00 $90.00 $90.00 $90.00 $200.00 $200.00 $200.00 $41.69 $200.00 $200.00 $200.00 $200.00 $200.00 $41.68 $200.00 $86.40 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $90.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $200.00 $200.00 N/A N/A AR-8970-01 SUP Custom 27203010 AR-8970-01 - GUIDE DRL 4.5 MM LCK SCR BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $432.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-8970-02 SUP Custom 27203010 AR-8970-02 - GUIDE DRL 3 4.5 MM SCR BOTH IP/OP "$1,000.00" $740.00 $178.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $178.00 "$1,000.00" "$1,000.00" $742.20 $742.20 $770.80 $521.00 $208.41 "$1,000.00" $432.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $650.00 "$1,000.00" N/A $580.00 "$1,000.00" $600.00 "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A AR-8970-30 SUP Custom 27203010 AR-8970-30 - BIT DRL 3MM CLBRT BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-8970-30C SUP Custom 27203010 AR-8970-30C - BIT DRL 3MM CNN BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-8970-40C SUP Custom 27203010 AR-8970-40C - BIT DRL 4MM CNN BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $210.60 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A AR-8970-45 SUP Custom 27203010 AR-8970-45 - BIT DRL 4.5MM BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $146.58 $146.58 $152.23 $102.90 $41.16 $197.50 $85.32 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $128.38 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-8970-55 SUP Custom 27203010 AR-8970-55 - BIT DRL 5.5MM BOTH IP/OP $197.50 $146.00 $35.16 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $197.50 $35.16 $197.50 $197.50 $146.58 $146.58 $152.23 $102.90 $41.16 $197.50 $85.32 $197.50 $197.50 $197.50 $197.50 $197.50 $148.13 $197.50 $197.50 $197.50 $98.75 $98.75 $156.42 $197.50 $158.00 $128.38 $197.50 N/A $114.55 $197.50 $118.50 $197.50 $197.50 $197.50 N/A N/A AR-8970AL SUP HCPCS C1713 AR-8970AL - PLATE BN ANKL LT ANT BOTH IP/OP "$5,187.50" "$3,839.00" "$1,029.59" "$5,187.50" "$2,334.38" "$2,334.38" "$2,334.38" "$2,334.38" "$5,187.50" "$5,187.50" "$5,187.50" "$1,081.20" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$1,081.13" "$5,187.50" "$2,241.00" "$2,557.44" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$3,890.63" "$5,187.50" "$5,187.50" "$5,187.50" "$2,593.75" "$2,593.75" "$4,108.50" "$5,187.50" "$4,150.00" "$2,334.38" "$1,029.59" N/A "$3,008.75" "$5,187.50" "$5,187.50" "$5,187.50" "$1,081.08" "$5,187.50" N/A N/A AR-8970AR SUP HCPCS C1713 AR-8970AR - PLATE BN ANKL RT ANT BOTH IP/OP "$5,187.50" "$3,839.00" "$1,029.59" "$5,187.50" "$2,334.38" "$2,334.38" "$2,334.38" "$2,334.38" "$5,187.50" "$5,187.50" "$5,187.50" "$1,081.20" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$1,081.13" "$5,187.50" "$2,241.00" "$2,557.44" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$3,890.63" "$5,187.50" "$5,187.50" "$5,187.50" "$2,593.75" "$2,593.75" "$4,108.50" "$5,187.50" "$4,150.00" "$2,334.38" "$1,029.59" N/A "$3,008.75" "$5,187.50" "$5,187.50" "$5,187.50" "$1,081.08" "$5,187.50" N/A N/A AR-8970PL SUP HCPCS C1713 AR-8970PL - PLATE BN ANKL LT TIBIOTALOCALCANEAL POST BOTH IP/OP "$5,687.50" "$4,209.00" "$1,128.83" "$6,142.50" "$2,559.38" "$2,559.38" "$2,559.38" "$2,559.38" "$5,687.50" "$5,687.50" "$5,687.50" "$1,185.42" "$5,687.50" "$5,687.50" "$5,687.50" "$5,687.50" "$5,687.50" "$1,185.34" "$5,687.50" "$6,142.50" "$2,803.94" "$5,687.50" "$5,687.50" "$5,687.50" "$5,687.50" "$4,265.63" "$5,687.50" "$5,687.50" "$5,687.50" "$2,843.75" "$2,843.75" "$4,504.50" "$5,687.50" "$4,550.00" "$2,559.38" "$1,128.83" N/A "$3,298.75" "$5,687.50" "$5,687.50" "$5,687.50" "$5,687.50" "$5,687.50" N/A N/A AR-8970PR SUP HCPCS C1713 AR-8970PR - PLATE BN ANKL RT POST TIBIOTALOCALCANEAL BOTH IP/OP "$5,687.50" "$4,209.00" "$1,128.83" "$5,687.50" "$2,559.38" "$2,559.38" "$2,559.38" "$2,559.38" "$5,687.50" "$5,687.50" "$5,687.50" "$1,185.42" "$5,687.50" "$5,687.50" "$5,687.50" "$5,687.50" "$5,687.50" "$1,185.34" "$5,687.50" "$2,457.00" "$2,803.94" "$5,687.50" "$5,687.50" "$5,687.50" "$5,687.50" "$4,265.63" "$5,687.50" "$5,687.50" "$5,687.50" "$2,843.75" "$2,843.75" "$4,504.50" "$5,687.50" "$4,550.00" "$2,559.38" "$1,128.83" N/A "$3,298.75" "$5,687.50" "$5,687.50" "$5,687.50" "$1,185.28" "$5,687.50" N/A N/A AR-8970S SUP HCPCS C1713 AR-8970S - SCREW BN ANKL FSN PLT SYS BOTH IP/OP "$36,250.00" "$26,825.00" "$7,194.72" "$36,250.00" "$16,312.50" "$16,312.50" "$16,312.50" "$16,312.50" "$36,250.00" "$36,250.00" "$36,250.00" "$7,555.41" "$36,250.00" "$36,250.00" "$36,250.00" "$36,250.00" "$36,250.00" "$7,554.90" "$36,250.00" "$15,660.00" "$17,871.25" "$36,250.00" "$36,250.00" "$36,250.00" "$36,250.00" "$27,187.50" "$36,250.00" "$36,250.00" "$36,250.00" "$18,125.00" "$18,125.00" "$28,710.00" "$36,250.00" "$29,000.00" "$16,312.50" "$7,194.72" N/A "$21,025.00" "$36,250.00" "$21,750.00" "$36,250.00" "$7,554.50" "$36,250.00" N/A N/A AR-8970TT SUP HCPCS C1713 AR-8970TT - PLATE BN FSN ANKL TIBIOTALAR LAT BOTH IP/OP "$5,187.50" "$3,839.00" "$1,029.59" "$5,187.50" "$2,334.38" "$2,334.38" "$2,334.38" "$2,334.38" "$5,187.50" "$5,187.50" "$5,187.50" "$1,081.20" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$1,081.13" "$5,187.50" "$2,241.00" "$2,557.44" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$3,890.63" "$5,187.50" "$5,187.50" "$5,187.50" "$2,593.75" "$2,593.75" "$4,108.50" "$5,187.50" "$4,150.00" "$2,334.38" "$1,029.59" N/A "$3,008.75" "$5,187.50" "$3,112.50" "$5,187.50" "$1,081.08" "$5,187.50" N/A N/A AR-8970TTC SUP HCPCS C1713 AR-8970TTC - PLATE BN FSN ANKL LAT TIBIOTALOCALCANEAL BOTH IP/OP "$5,437.50" "$4,024.00" "$1,079.21" "$5,437.50" "$2,446.88" "$2,446.88" "$2,446.88" "$2,446.88" "$5,437.50" "$5,437.50" "$5,437.50" "$1,133.31" "$5,437.50" "$5,437.50" "$5,437.50" "$5,437.50" "$5,437.50" "$1,133.23" "$5,437.50" "$2,349.00" "$2,680.69" "$5,437.50" "$5,437.50" "$5,437.50" "$5,437.50" "$4,078.13" "$5,437.50" "$5,437.50" "$5,437.50" "$2,718.75" "$2,718.75" "$4,306.50" "$5,437.50" "$4,350.00" "$2,446.88" "$1,079.21" N/A "$3,153.75" "$5,437.50" "$3,262.50" "$5,437.50" "$1,133.18" "$5,437.50" N/A N/A AR-8978DS SUP Custom 27203010 AR-8978DS - KIT ASCP FX 3.5MM 8.5MM STRL ARTHX DX SWIVELOCK SL BOTH IP/OP $687.50 $509.00 $122.38 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $687.50 $122.38 $687.50 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $275.00 $687.50 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $687.50 N/A $398.75 $687.50 $412.50 $687.50 $687.50 $687.50 N/A N/A AR-8978P SUP HCPCS C1713 AR-8978P - ANCHOR SUT 3.5MM STRL DX SWIVELOCK SL8.5MM FRK EYLT BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" $425.00 $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" "$1,062.50" "$1,062.50" $221.43 "$1,062.50" N/A N/A AR-8981-06S SUP Custom 27203010 AR-8981-06S - SET GFT HRVT 6MM STRL OATS DISP S JNT BOTH IP/OP "$1,237.50" $916.00 $220.28 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $220.28 "$1,237.50" "$1,237.50" $918.47 $918.47 $953.87 $644.74 $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $804.38 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A AR-8981-08S SUP Custom 27203010 AR-8981-08S - SET GFT HRVT 8MM STRL OATS DISP S JNT BOTH IP/OP "$1,237.50" $916.00 $220.28 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $220.28 "$1,237.50" "$1,237.50" $918.47 $918.47 $953.87 $644.74 $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $804.38 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A AR-8981-10S SUP Custom 27203010 AR-8981-10S - SET GFT HRVT 10MM STRL OATS DISP S JNT BOTH IP/OP "$1,237.50" $916.00 $220.28 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $220.28 "$1,237.50" "$1,237.50" $918.47 $918.47 $953.87 $644.74 $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $804.38 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A AR-8999N SUP Custom 27203010 AR-8999N - NEEDLE SUT MN SCRPN DX BOTH IP/OP "$4,937.50" "$3,654.00" $878.88 "$4,937.50" "$4,937.50" "$4,937.50" "$4,937.50" "$4,937.50" "$4,937.50" "$4,937.50" $878.88 "$4,937.50" "$4,937.50" "$3,664.61" "$3,664.61" "$3,805.83" "$2,060.15" "$1,029.03" "$4,937.50" "$1,975.00" "$4,937.50" "$4,937.50" "$4,937.50" "$4,937.50" "$4,937.50" "$3,703.13" "$4,937.50" "$4,937.50" "$4,937.50" "$2,468.75" "$2,468.75" "$3,910.50" "$4,937.50" "$3,950.00" "$3,209.38" "$4,937.50" N/A "$2,863.75" "$4,937.50" "$2,962.50" "$4,937.50" "$4,937.50" "$4,937.50" N/A N/A AR-9045-40PT SUP HCPCS C1713 AR-9045-40PT - SCREW BN P/T LOPRFL 4.5MM 40MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-9045-45PT SUP HCPCS C1713 AR-9045-45PT - SCREW BN P/T 4.5MM 45MM LOPRFL HD ST TI METATARSUS BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" "$1,987.50" "$1,987.50" N/A N/A AR-9045-50PT SUP HCPCS C1713 AR-9045-50PT - SCREW BN P/T LOPRFL 4.5MM 50MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-9045-55PT SUP HCPCS C1713 AR-9045-55PT - SCREW BN P/T LOPRFL 4.5MM 55MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-9045-60PT SUP HCPCS C1713 AR-9045-60PT - SCREW BN P/T LOPRFL 4.5MM 60MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-9045-65PT SUP HCPCS C1713 AR-9045-65PT - SCREW BN P/T LOPRFL 4.5MM 65MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-9055-40PT SUP HCPCS C1713 AR-9055-40PT - SCREW BN P/T LOPRFL 5.5MM 40MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-9055-45PT SUP HCPCS C1713 AR-9055-45PT - SCREW BN P/T 5.5MM 45MM SOLINULLD LOPRFL ST TI METATARSUS BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-9055-50PT SUP HCPCS C1713 AR-9055-50PT - SCREW BN P/T LOPRFL 5.5MM 50MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-9055-55PT SUP HCPCS C1713 AR-9055-55PT - SCREW BN P/T 5.5MM 55MM LOPRFL HD ST TI METATARSUS BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-9055-60PT SUP HCPCS C1713 AR-9055-60PT - SCREW BN P/T LOPRFL 5.5MM 60MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-9055-65PT SUP HCPCS C1713 AR-9055-65PT - SCREW BN P/T LOPRFL 5.5MM 65MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-9060-40PT SUP HCPCS C1713 AR-9060-40PT - SCREW BN P/T LOPRFL 6MM 40MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-9060-45PT SUP HCPCS C1713 AR-9060-45PT - SCREW BN P/T LOPRFL 6MM 45MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" N/A N/A AR-9060-50PT SUP HCPCS C1713 AR-9060-50PT - SCREW BN P/T LOPRFL 6MM 50MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" "$1,987.50" "$1,987.50" N/A N/A AR-9060-55PT SUP HCPCS C1713 AR-9060-55PT - SCREW BN P/T LOPRFL 6MM 55MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A AR-9060-60PT SUP HCPCS C1713 AR-9060-60PT - SCREW BN P/T LOPRFL 6MM 60MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$2,146.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$2,146.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" "$1,987.50" "$1,987.50" N/A N/A AR-9060-65PT SUP HCPCS C1713 AR-9060-65PT - SCREW BN P/T LOPRFL 6MM 65MM SLD TI METATARSUS JNS FX BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $858.60 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" "$1,987.50" "$1,987.50" N/A N/A AR-9100-05P SUP HCPCS C1776 AR-9100-05P - STEM HUM 5MM 105MM STRL BOTH IP/OP "$9,187.50" "$6,799.00" "$1,823.49" "$9,187.50" "$4,134.38" "$4,134.38" "$4,134.38" "$4,134.38" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.90" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.78" "$9,187.50" "$3,675.00" "$4,529.44" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$6,890.63" "$9,187.50" "$9,187.50" "$9,187.50" "$4,593.75" "$4,593.75" "$7,276.50" "$9,187.50" "$7,350.00" "$4,134.38" "$1,823.49" N/A "$5,328.75" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.68" "$9,187.50" N/A N/A AR-9100-05S SUP HCPCS C1776 AR-9100-05S - STEM HUM 132.5D 5MM 60MM UNIVERS APX BOTH IP/OP "$10,437.50" "$7,724.00" "$2,071.58" "$10,437.50" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.44" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.29" "$10,437.50" "$10,437.50" "$5,145.69" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$7,828.13" "$10,437.50" "$10,437.50" "$10,437.50" "$5,218.75" "$5,218.75" "$8,266.50" "$10,437.50" "$8,350.00" "$4,696.88" "$2,071.58" N/A "$6,053.75" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.18" "$10,437.50" N/A N/A AR-9100-06P SUP HCPCS C1776 AR-9100-06P - STEM HUM 6MM 115MM STRL UNIVERS II SHLDR BOTH IP/OP "$9,187.50" "$6,799.00" "$1,823.49" "$9,187.50" "$4,134.38" "$4,134.38" "$4,134.38" "$4,134.38" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.90" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.78" "$9,187.50" "$9,187.50" "$4,529.44" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$6,890.63" "$9,187.50" "$9,187.50" "$9,187.50" "$4,593.75" "$4,593.75" "$7,276.50" "$9,187.50" "$7,350.00" "$4,134.38" "$1,823.49" N/A "$5,328.75" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.68" "$9,187.50" N/A N/A AR-9100-06S SUP HCPCS C1776 AR-9100-06S - STEM HUM RECT 6MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL BOTH IP/OP "$10,437.50" "$7,724.00" "$2,071.58" "$10,437.50" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.44" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.29" "$10,437.50" "$10,437.50" "$5,145.69" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$7,828.13" "$10,437.50" "$10,437.50" "$10,437.50" "$5,218.75" "$5,218.75" "$8,266.50" "$10,437.50" "$8,350.00" "$4,696.88" "$2,071.58" N/A "$6,053.75" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.18" "$10,437.50" N/A N/A AR-9100-07 SUP HCPCS C1776 AR-9100-07 - STEM HUM 7MM UNIVERS SHLDR BOTH IP/OP "$5,987.50" "$4,431.00" "$1,188.37" "$5,987.50" "$2,694.38" "$2,694.38" "$2,694.38" "$2,694.38" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.94" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.86" "$5,987.50" "$2,395.00" "$2,951.84" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$4,490.63" "$5,987.50" "$5,987.50" "$5,987.50" "$2,993.75" "$2,993.75" "$4,742.10" "$5,987.50" "$4,790.00" "$2,694.38" "$1,188.37" N/A "$3,472.75" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.80" "$5,987.50" N/A N/A AR-9100-07P SUP HCPCS C1776 AR-9100-07P - STEM HUM 7MM 140MM STRL UNIVERS II SHLDR BOTH IP/OP "$9,187.50" "$6,799.00" "$1,823.49" "$9,187.50" "$4,134.38" "$4,134.38" "$4,134.38" "$4,134.38" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.90" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.78" "$9,187.50" "$9,187.50" "$4,529.44" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$6,890.63" "$9,187.50" "$9,187.50" "$9,187.50" "$4,593.75" "$4,593.75" "$7,276.50" "$9,187.50" "$7,350.00" "$4,134.38" "$1,823.49" N/A "$5,328.75" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.68" "$9,187.50" N/A N/A AR-9100-07S SUP HCPCS C1776 AR-9100-07S - STEM HUM RECT 7MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL BOTH IP/OP "$10,437.50" "$7,724.00" "$2,071.58" "$10,437.50" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.44" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.29" "$10,437.50" "$10,437.50" "$5,145.69" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$7,828.13" "$10,437.50" "$10,437.50" "$10,437.50" "$5,218.75" "$5,218.75" "$8,266.50" "$10,437.50" "$8,350.00" "$4,696.88" "$2,071.58" N/A "$6,053.75" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.18" "$10,437.50" N/A N/A AR-9100-08 SUP HCPCS C1776 AR-9100-08 - STEM HUM 8MM UNIVERS SHLDR BOTH IP/OP "$5,987.50" "$4,431.00" "$1,188.37" "$5,987.50" "$2,694.38" "$2,694.38" "$2,694.38" "$2,694.38" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.94" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.86" "$5,987.50" "$2,395.00" "$2,951.84" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$4,490.63" "$5,987.50" "$5,987.50" "$5,987.50" "$2,993.75" "$2,993.75" "$4,742.10" "$5,987.50" "$4,790.00" "$2,694.38" "$1,188.37" N/A "$3,472.75" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.80" "$5,987.50" N/A N/A AR-9100-08F SUP HCPCS C1776 AR-9100-08F - STEM HUM 8MM 158MM STRL UNIVERS ADJ HT SHLDR BOTH IP/OP "$6,812.50" "$5,041.00" "$1,352.11" "$6,812.50" "$3,065.63" "$3,065.63" "$3,065.63" "$3,065.63" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.90" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.80" "$6,812.50" "$6,812.50" "$3,358.56" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$5,109.38" "$6,812.50" "$6,812.50" "$6,812.50" "$3,406.25" "$3,406.25" "$5,395.50" "$6,812.50" "$5,450.00" "$3,065.63" "$1,352.11" N/A "$3,951.25" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.73" "$6,812.50" N/A N/A AR-9100-08P SUP HCPCS C1776 AR-9100-08P - STEM HUM 8MM 143MM STRL UNIVERS II SHLDR BOTH IP/OP "$9,187.50" "$6,799.00" "$1,823.49" "$9,187.50" "$4,134.38" "$4,134.38" "$4,134.38" "$4,134.38" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.90" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.78" "$9,187.50" "$9,187.50" "$4,529.44" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$6,890.63" "$9,187.50" "$9,187.50" "$9,187.50" "$4,593.75" "$4,593.75" "$7,276.50" "$9,187.50" "$7,350.00" "$4,134.38" "$1,823.49" N/A "$5,328.75" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.68" "$9,187.50" N/A N/A AR-9100-08S SUP HCPCS C1776 AR-9100-08S - STEM HUM RECT 8MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL BOTH IP/OP "$10,437.50" "$7,724.00" "$2,071.58" "$10,437.50" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.44" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.29" "$10,437.50" "$4,175.00" "$5,145.69" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$7,828.13" "$10,437.50" "$10,437.50" "$10,437.50" "$5,218.75" "$5,218.75" "$8,266.50" "$10,437.50" "$8,350.00" "$4,696.88" "$2,071.58" N/A "$6,053.75" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.18" "$10,437.50" N/A N/A AR-9100-09 SUP HCPCS C1776 AR-9100-09 - STEM HUM 9MM UNIVERS SHLDR BOTH IP/OP "$5,987.50" "$4,431.00" "$1,188.37" "$5,987.50" "$2,694.38" "$2,694.38" "$2,694.38" "$2,694.38" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.94" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.86" "$5,987.50" "$2,395.00" "$2,951.84" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$4,490.63" "$5,987.50" "$5,987.50" "$5,987.50" "$2,993.75" "$2,993.75" "$4,742.10" "$5,987.50" "$4,790.00" "$2,694.38" "$1,188.37" N/A "$3,472.75" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.80" "$5,987.50" N/A N/A AR-9100-09F SUP HCPCS C1776 AR-9100-09F - STEM HUM 9MM 173MM STRL UNIVERS ADJ HT SHLDR BOTH IP/OP "$6,812.50" "$5,041.00" "$1,352.11" "$6,812.50" "$3,065.63" "$3,065.63" "$3,065.63" "$3,065.63" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.90" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.80" "$6,812.50" "$2,725.00" "$3,358.56" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$5,109.38" "$6,812.50" "$6,812.50" "$6,812.50" "$3,406.25" "$3,406.25" "$5,395.50" "$6,812.50" "$5,450.00" "$3,065.63" "$1,352.11" N/A "$3,951.25" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.73" "$6,812.50" N/A N/A AR-9100-09P SUP HCPCS C1776 AR-9100-09P - STEM HUM 9MM 146MM STRL UNIVERS II SHLDR BOTH IP/OP "$9,187.50" "$6,799.00" "$1,823.49" "$9,187.50" "$4,134.38" "$4,134.38" "$4,134.38" "$4,134.38" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.90" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.78" "$9,187.50" "$9,187.50" "$4,529.44" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$6,890.63" "$9,187.50" "$9,187.50" "$9,187.50" "$4,593.75" "$4,593.75" "$7,276.50" "$9,187.50" "$7,350.00" "$4,134.38" "$1,823.49" N/A "$5,328.75" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.68" "$9,187.50" N/A N/A AR-9100-09S SUP HCPCS C1776 AR-9100-09S - STEM HUM RECT 9MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL BOTH IP/OP "$10,437.50" "$7,724.00" "$2,071.58" "$10,437.50" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.44" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.29" "$10,437.50" "$4,175.00" "$5,145.69" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$7,828.13" "$10,437.50" "$10,437.50" "$10,437.50" "$5,218.75" "$5,218.75" "$8,266.50" "$10,437.50" "$8,350.00" "$4,696.88" "$2,071.58" N/A "$6,053.75" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.18" "$10,437.50" N/A N/A AR-9100-10F SUP HCPCS C1776 AR-9100-10F - STEM HUM 10MM 180MM STRL UNIVERS ADJ HT FX SHLDR BOTH IP/OP "$6,812.50" "$5,041.00" "$1,352.11" "$6,812.50" "$3,065.63" "$3,065.63" "$3,065.63" "$3,065.63" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.90" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.80" "$6,812.50" "$2,725.00" "$3,358.56" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$5,109.38" "$6,812.50" "$6,812.50" "$6,812.50" "$3,406.25" "$3,406.25" "$5,395.50" "$6,812.50" "$5,450.00" "$3,065.63" "$1,352.11" N/A "$3,951.25" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.73" "$6,812.50" N/A N/A AR-9100-10P SUP HCPCS C1776 AR-9100-10P - STEM HUM 10MM 148MM STRL UNIVERS II SHLDR BOTH IP/OP "$9,187.50" "$6,799.00" "$1,823.49" "$9,187.50" "$4,134.38" "$4,134.38" "$4,134.38" "$4,134.38" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.90" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.78" "$9,187.50" "$9,187.50" "$4,529.44" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$6,890.63" "$9,187.50" "$9,187.50" "$9,187.50" "$4,593.75" "$4,593.75" "$7,276.50" "$9,187.50" "$7,350.00" "$4,134.38" "$1,823.49" N/A "$5,328.75" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.68" "$9,187.50" N/A N/A AR-9100-10S SUP HCPCS C1776 AR-9100-10S - STEM HUM RECT 10MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL BOTH IP/OP "$10,437.50" "$7,724.00" "$2,071.58" "$10,437.50" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.44" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.29" "$10,437.50" "$4,175.00" "$5,145.69" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$7,828.13" "$10,437.50" "$10,437.50" "$10,437.50" "$5,218.75" "$5,218.75" "$8,266.50" "$10,437.50" "$8,350.00" "$4,696.88" "$2,071.58" N/A "$6,053.75" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.18" "$10,437.50" N/A N/A AR-9100-11 SUP HCPCS C1776 AR-9100-11 - STEM HUM 11MM UNIVERS SHLDR BOTH IP/OP "$5,987.50" "$4,431.00" "$1,188.37" "$5,987.50" "$2,694.38" "$2,694.38" "$2,694.38" "$2,694.38" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.94" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.86" "$5,987.50" "$5,987.50" "$2,951.84" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$4,490.63" "$5,987.50" "$5,987.50" "$5,987.50" "$2,993.75" "$2,993.75" "$4,742.10" "$5,987.50" "$4,790.00" "$2,694.38" "$1,188.37" N/A "$3,472.75" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.80" "$5,987.50" N/A N/A AR-9100-11F SUP HCPCS C1776 AR-9100-11F - STEM HUM 11MM 187MM STRL UNIVERS ADJ HT SHLDR BOTH IP/OP "$6,812.50" "$5,041.00" "$1,352.11" "$6,812.50" "$3,065.63" "$3,065.63" "$3,065.63" "$3,065.63" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.90" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.80" "$6,812.50" "$2,725.00" "$3,358.56" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$5,109.38" "$6,812.50" "$6,812.50" "$6,812.50" "$3,406.25" "$3,406.25" "$5,395.50" "$6,812.50" "$5,450.00" "$3,065.63" "$1,352.11" N/A "$3,951.25" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.73" "$6,812.50" N/A N/A AR-9100-11P SUP HCPCS C1776 AR-9100-11P - STEM HUM 11MM 151MM STRL UNIVERS II SHLDR BOTH IP/OP "$9,187.50" "$6,799.00" "$1,823.49" "$9,187.50" "$4,134.38" "$4,134.38" "$4,134.38" "$4,134.38" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.90" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.78" "$9,187.50" "$3,675.00" "$4,529.44" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$6,890.63" "$9,187.50" "$9,187.50" "$9,187.50" "$4,593.75" "$4,593.75" "$7,276.50" "$9,187.50" "$7,350.00" "$4,134.38" "$1,823.49" N/A "$5,328.75" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.68" "$9,187.50" N/A N/A AR-9100-11S SUP HCPCS C1776 AR-9100-11S - STEM HUM RECT 11MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL BOTH IP/OP "$10,437.50" "$7,724.00" "$2,071.58" "$10,437.50" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.44" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.29" "$10,437.50" "$4,175.00" "$5,145.69" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$7,828.13" "$10,437.50" "$10,437.50" "$10,437.50" "$5,218.75" "$5,218.75" "$8,266.50" "$10,437.50" "$8,350.00" "$4,696.88" "$2,071.58" N/A "$6,053.75" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.18" "$10,437.50" N/A N/A AR-9100-12 SUP HCPCS C1776 AR-9100-12 - STEM HUM 12MM UNIVERS SHLDR BOTH IP/OP "$5,987.50" "$4,431.00" "$1,188.37" "$5,987.50" "$2,694.38" "$2,694.38" "$2,694.38" "$2,694.38" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.94" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.86" "$5,987.50" "$2,395.00" "$2,951.84" "$5,987.50" "$5,987.50" "$5,987.50" "$5,987.50" "$4,490.63" "$5,987.50" "$5,987.50" "$5,987.50" "$2,993.75" "$2,993.75" "$4,742.10" "$5,987.50" "$4,790.00" "$2,694.38" "$1,188.37" N/A "$3,472.75" "$5,987.50" "$5,987.50" "$5,987.50" "$1,247.80" "$5,987.50" N/A N/A AR-9100-12F SUP HCPCS C1776 AR-9100-12F - STEM HUM 12MM 195MM STRL UNIVERS ADJ HT SHLDR BOTH IP/OP "$6,812.50" "$5,041.00" "$1,352.11" "$6,812.50" "$3,065.63" "$3,065.63" "$3,065.63" "$3,065.63" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.90" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.80" "$6,812.50" "$2,725.00" "$3,358.56" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$5,109.38" "$6,812.50" "$6,812.50" "$6,812.50" "$3,406.25" "$3,406.25" "$5,395.50" "$6,812.50" "$5,450.00" "$3,065.63" "$1,352.11" N/A "$3,951.25" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.73" "$6,812.50" N/A N/A AR-9100-12P SUP HCPCS C1776 AR-9100-12P - STEM HUM 12MM 151MM STRL UNIVERS II SHLDR BOTH IP/OP "$9,187.50" "$6,799.00" "$1,823.49" "$9,187.50" "$4,134.38" "$4,134.38" "$4,134.38" "$4,134.38" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.90" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.78" "$9,187.50" "$3,675.00" "$4,529.44" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$6,890.63" "$9,187.50" "$9,187.50" "$9,187.50" "$4,593.75" "$4,593.75" "$7,276.50" "$9,187.50" "$7,350.00" "$4,134.38" "$1,823.49" N/A "$5,328.75" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.68" "$9,187.50" N/A N/A AR-9100-12S SUP HCPCS C1776 AR-9100-12S - STEM HUM RECT 12MM 60MM UNIVERS APX PRFT REM TRUNION SUT HL BOTH IP/OP "$10,437.50" "$7,724.00" "$2,071.58" "$10,437.50" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.44" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.29" "$10,437.50" "$4,175.00" "$5,145.69" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$7,828.13" "$10,437.50" "$10,437.50" "$10,437.50" "$5,218.75" "$5,218.75" "$8,266.50" "$10,437.50" "$8,350.00" "$4,696.88" "$2,071.58" N/A "$6,053.75" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.18" "$10,437.50" N/A N/A AR-9100-13F SUP HCPCS C1776 AR-9100-13F - STEM HUM 13MM 204MM STRL UNIVERS ADJ HT SHLDR FX BOTH IP/OP "$6,812.50" "$5,041.00" "$1,352.11" "$6,812.50" "$3,065.63" "$3,065.63" "$3,065.63" "$3,065.63" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.90" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.80" "$6,812.50" "$2,725.00" "$3,358.56" "$6,812.50" "$6,812.50" "$6,812.50" "$6,812.50" "$5,109.38" "$6,812.50" "$6,812.50" "$6,812.50" "$3,406.25" "$3,406.25" "$5,395.50" "$6,812.50" "$5,450.00" "$3,065.63" "$1,352.11" N/A "$3,951.25" "$6,812.50" "$6,812.50" "$6,812.50" "$1,419.73" "$6,812.50" N/A N/A AR-9100-13P SUP HCPCS C1776 AR-9100-13P - STEM HUM 13MM UNIVERS SHLDR BOTH IP/OP "$9,187.50" "$6,799.00" "$1,823.49" "$9,187.50" "$4,134.38" "$4,134.38" "$4,134.38" "$4,134.38" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.90" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.78" "$9,187.50" "$3,675.00" "$4,529.44" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$6,890.63" "$9,187.50" "$9,187.50" "$9,187.50" "$4,593.75" "$4,593.75" "$7,276.50" "$9,187.50" "$7,350.00" "$4,134.38" "$1,823.49" N/A "$5,328.75" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.68" "$9,187.50" N/A N/A AR-9100-13S SUP HCPCS C1776 AR-9100-13S - STEM HUM RECT 13MM 65MM UNIVERS APX PRFT REM TRUNION SUT HL BOTH IP/OP "$10,437.50" "$7,724.00" "$2,071.58" "$10,437.50" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.44" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.29" "$10,437.50" "$4,175.00" "$5,145.69" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$7,828.13" "$10,437.50" "$10,437.50" "$10,437.50" "$5,218.75" "$5,218.75" "$8,266.50" "$10,437.50" "$8,350.00" "$4,696.88" "$2,071.58" N/A "$6,053.75" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.18" "$10,437.50" N/A N/A AR-9100-14P SUP HCPCS C1776 AR-9100-14P - STEM HUM 14MM 151MM STRL UNIVERS II SHLDR BOTH IP/OP "$9,187.50" "$6,799.00" "$1,823.49" "$9,187.50" "$4,134.38" "$4,134.38" "$4,134.38" "$4,134.38" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.90" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.78" "$9,187.50" "$3,675.00" "$4,529.44" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$6,890.63" "$9,187.50" "$9,187.50" "$9,187.50" "$4,593.75" "$4,593.75" "$7,276.50" "$9,187.50" "$7,350.00" "$4,134.38" "$1,823.49" N/A "$5,328.75" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.68" "$9,187.50" N/A N/A AR-9100-14S SUP HCPCS C1776 AR-9100-14S - STEM HUM RECT 14MM 65MM UNIVERS APX PRFT REM TRUNION SUT HL BOTH IP/OP "$10,437.50" "$7,724.00" "$2,071.58" "$10,437.50" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.44" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.29" "$10,437.50" "$10,437.50" "$5,145.69" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$7,828.13" "$10,437.50" "$10,437.50" "$10,437.50" "$5,218.75" "$5,218.75" "$8,266.50" "$10,437.50" "$8,350.00" "$4,696.88" "$2,071.58" N/A "$6,053.75" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.18" "$10,437.50" N/A N/A AR-9100-15P SUP HCPCS C1776 AR-9100-15P - STEM HUM 15MM 151MM STRL UNIVERS II SHLDR BOTH IP/OP "$9,187.50" "$6,799.00" "$1,823.49" "$9,187.50" "$4,134.38" "$4,134.38" "$4,134.38" "$4,134.38" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.90" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.78" "$9,187.50" "$9,187.50" "$4,529.44" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$6,890.63" "$9,187.50" "$9,187.50" "$9,187.50" "$4,593.75" "$4,593.75" "$7,276.50" "$9,187.50" "$7,350.00" "$4,134.38" "$1,823.49" N/A "$5,328.75" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.68" "$9,187.50" N/A N/A AR-9100-15S SUP HCPCS C1776 AR-9100-15S - STEM HUM RECT 15MM 65MM UNIVERS APX PRFT REM TRUNION SUT HL BOTH IP/OP "$10,437.50" "$7,724.00" "$2,071.58" "$10,437.50" "$4,696.88" "$4,696.88" "$4,696.88" "$4,696.88" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.44" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.29" "$10,437.50" "$10,437.50" "$5,145.69" "$10,437.50" "$10,437.50" "$10,437.50" "$10,437.50" "$7,828.13" "$10,437.50" "$10,437.50" "$10,437.50" "$5,218.75" "$5,218.75" "$8,266.50" "$10,437.50" "$8,350.00" "$4,696.88" "$2,071.58" N/A "$6,053.75" "$10,437.50" "$10,437.50" "$10,437.50" "$2,175.18" "$10,437.50" N/A N/A AR-9100-21 SUP Custom 27203010 AR-9100-21 - KIT ASCP FX UNV TRUNNION BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $250.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-9100-22 SUP HCPCS C1776 AR-9100-22 - COMPONENT GLND 3 USP UNIVERS REPL TRUNION KT BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-9100-24 SUP HCPCS C1776 AR-9100-24 - COMPONENT GLND 5 USP UNIVERS REPL TRUNION KT BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A AR-9104-01 SUP HCPCS C1776 AR-9104-01 - COMPONENT GLND SM STRL UNIVERS II CMNT KEEL PE SHLDR BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$1,575.00" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$3,937.50" "$3,937.50" $820.58 "$3,937.50" N/A N/A AR-9104-02 SUP HCPCS C1776 AR-9104-02 - COMPONENT GLND MED STRL UNIVERS II CMNT KEEL PE SHLDR BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$3,937.50" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$3,937.50" "$3,937.50" $820.58 "$3,937.50" N/A N/A AR-9104-03 SUP HCPCS C1776 AR-9104-03 - COMPONENT GLND LG STRL UNIVERS II CMNT KEEL PE SHLDR BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$1,575.00" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$3,937.50" "$3,937.50" $820.58 "$3,937.50" N/A N/A AR-9104-04 SUP HCPCS C1776 AR-9104-04 - COMPONENT GLND XL STRL UNIVERS II CMNT KEEL PE SHLDR BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$1,575.00" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$3,937.50" "$3,937.50" $820.58 "$3,937.50" N/A N/A AR-9105-01 SUP HCPCS C1776 AR-9105-01 - COMPONENT GLND SM STRL UNIVERS II CMNT PG PE SHLDR BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$1,575.00" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$3,937.50" "$3,937.50" $820.58 "$3,937.50" N/A N/A AR-9105-02 SUP HCPCS C1776 AR-9105-02 - COMPONENT GLND MED STRL UNIVERS II CMNT PG PE SHLDR BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$1,575.00" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$3,937.50" "$3,937.50" $820.58 "$3,937.50" N/A N/A AR-9105-03 SUP HCPCS C1776 AR-9105-03 - COMPONENT GLND LG STRL UNIVERS II CMNT PG PE SHLDR BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$3,937.50" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$3,937.50" "$3,937.50" $820.58 "$3,937.50" N/A N/A AR-9105-04 SUP HCPCS C1776 AR-9105-04 - COMPONENT GLND XL STRL UNIVERS II CMNT PG PE SHLDR BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$1,575.00" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$3,937.50" "$3,937.50" $820.58 "$3,937.50" N/A N/A AR-9106-01 SUP HCPCS C1713 AR-9106-01 - COMPONENT GLND SM STRL LF UNIVERS VAULTLOCK DISP BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$1,575.00" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$3,937.50" "$3,937.50" $820.58 "$3,937.50" N/A N/A AR-9106-02 SUP HCPCS C1776 AR-9106-02 - COMPONENT GLND MED STRL ARTHX UNIVERS VAULTLOCK BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$1,575.00" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$3,937.50" "$3,937.50" $820.58 "$3,937.50" N/A N/A AR-9106-04 SUP HCPCS C1776 AR-9106-04 - COMPONENT GLND XL STRL ARTHX UNIVERS VAULTLOCK BOTH IP/OP "$3,937.50" "$2,914.00" $781.50 "$3,937.50" "$1,771.88" "$1,771.88" "$1,771.88" "$1,771.88" "$3,937.50" "$3,937.50" "$3,937.50" $820.67 "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" $820.62 "$3,937.50" "$1,575.00" "$1,941.19" "$3,937.50" "$3,937.50" "$3,937.50" "$3,937.50" "$2,953.13" "$3,937.50" "$3,937.50" "$3,937.50" "$1,968.75" "$1,968.75" "$3,118.50" "$3,937.50" "$3,150.00" "$1,771.88" $781.50 N/A "$2,283.75" "$3,937.50" "$2,362.50" "$3,937.50" $820.58 "$3,937.50" N/A N/A AR-9120-01 SUP HCPCS C1713 AR-9120-01 - BASEPLATE GLND SM UNV SHLDR BOTH IP/OP "$4,287.50" "$3,173.00" $850.96 "$4,287.50" "$1,929.38" "$1,929.38" "$1,929.38" "$1,929.38" "$4,287.50" "$4,287.50" "$4,287.50" $893.62 "$4,287.50" "$4,287.50" "$4,287.50" "$4,287.50" "$4,287.50" $893.56 "$4,287.50" "$1,715.00" "$2,113.74" "$4,287.50" "$4,287.50" "$4,287.50" "$4,287.50" "$3,215.63" "$4,287.50" "$4,287.50" "$4,287.50" "$2,143.75" "$2,143.75" "$3,395.70" "$4,287.50" "$3,430.00" "$1,929.38" $850.96 N/A "$2,486.75" "$4,287.50" "$2,572.50" "$4,287.50" $893.52 "$4,287.50" N/A N/A AR-9125-1 SUP Custom 27203010 AR-9125-1 - GUIDE DRL -10D 5D SM GLND BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A AR-9125-10 SUP Custom 27203010 AR-9125-10 - GUIDE DRL -20D 15D 0D SM GLND BOTH IP/OP "$1,787.50" "$1,323.00" $318.18 "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" $318.18 "$1,787.50" "$1,787.50" "$1,326.68" "$1,326.68" "$1,377.81" $931.29 $372.53 "$1,787.50" $715.00 "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,340.63" "$1,787.50" "$1,787.50" "$1,787.50" $893.75 $893.75 "$1,415.70" "$1,787.50" "$1,430.00" "$1,161.88" "$1,787.50" N/A "$1,036.75" "$1,787.50" "$1,072.50" "$1,787.50" "$1,787.50" "$1,787.50" N/A N/A AR-9125-2 SUP Custom 27203010 AR-9125-2 - GUIDE DRL -10D 5D MED GLND BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A AR-9125-20 SUP Custom 27203010 AR-9125-20 - GUIDE DRL -20D 15D 0D MED GLND BOTH IP/OP "$1,787.50" "$1,323.00" $318.18 "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" $318.18 "$1,787.50" "$1,787.50" "$1,326.68" "$1,326.68" "$1,377.81" $931.29 $372.53 "$1,787.50" $715.00 "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,340.63" "$1,787.50" "$1,787.50" "$1,787.50" $893.75 $893.75 "$1,415.70" "$1,787.50" "$1,430.00" "$1,161.88" "$1,787.50" N/A "$1,036.75" "$1,787.50" "$1,072.50" "$1,787.50" "$1,787.50" "$1,787.50" N/A N/A AR-9125-3 SUP Custom 27203010 AR-9125-3 - GUIDE DRL -10D 5D LG GLND BOTH IP/OP "$1,750.00" "$1,295.00" $311.50 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $311.50 "$1,750.00" "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" $700.00 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" "$1,750.00" N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" "$1,750.00" "$1,750.00" N/A N/A AR-9125-30 SUP Custom 27203010 AR-9125-30 - GUIDE DRL -20D 15D 0D LG GLND BOTH IP/OP "$1,787.50" "$1,323.00" $318.18 "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" $318.18 "$1,787.50" "$1,787.50" "$1,326.68" "$1,326.68" "$1,377.81" $931.29 $372.53 "$1,787.50" $715.00 "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,340.63" "$1,787.50" "$1,787.50" "$1,787.50" $893.75 $893.75 "$1,415.70" "$1,787.50" "$1,430.00" "$1,161.88" "$1,787.50" N/A "$1,036.75" "$1,787.50" "$1,072.50" "$1,787.50" "$1,787.50" "$1,787.50" N/A N/A AR-9140-14 SUP HCPCS C1776 AR-9140-14 - HEAD HUM 40MM 14MM UNIVERS 3D MTL SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9140-17P SUP HCPCS C1776 AR-9140-17P - HEAD HUM 40MM 17MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9142-17CA SUP HCPCS C1776 "AR-9142-17CA - UNIVERS CA HUMERAL HEAD, 42/17" BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9142-17P SUP HCPCS C1776 AR-9142-17P - HEAD HUM 42MM 17MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9143-15 SUP HCPCS C1776 AR-9143-15 - HEAD HUM 43MM 15MM SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9143-15F SUP HCPCS C1776 AR-9143-15F - HEAD HUM 43MM 15MM SHLDR BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$3,125.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A AR-9144-17CA SUP HCPCS C1776 "AR-9144-17CA - UNIVERS CA HUMERAL HEAD, 44/17" BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9144-17P SUP HCPCS C1776 AR-9144-17P - HEAD HUM 44MM 17MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$1,750.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9144-19CA SUP HCPCS C1776 "AR-9144-19CA - UNIVERS CA HUMERAL HEAD, 44/19" BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9144-19P SUP HCPCS C1776 AR-9144-19P - HEAD HUM 44MM 19MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$1,750.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9145-15 SUP HCPCS C1776 AR-9145-15 - HEAD HUM 45MM 15MM MTL SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$1,750.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9145-24 SUP HCPCS C1713 AR-9145-24 - SCREW BN 18D 4.5MM 24MM UNIVERS REVERS LCK VA SHLDR GLND BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-9145-24NL SUP HCPCS C1713 AR-9145-24NL - SCREW BN 4.5MM 24MM UNIVERS REVERS NONLOCK PERI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A AR-9145-30 SUP HCPCS C1713 AR-9145-30 - SCREW BONE 4.5MM 30MM UNIVERS REVERS 18D SHLDR BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-9145-30NL SUP HCPCS C1713 "AR-9145-30NL - PERIPHERAL SCREW, NL, UNI REV, 4.5x30mm" BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-9145-36 SUP HCPCS C1713 AR-9145-36 - SCREW BONE 4.5MM 36MM UNIVERS REVERS 18D SHLDR BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-9145-36NL SUP HCPCS C1713 AR-9145-36NL - SCREW BN 4.5MM 36MM UNIVERS REVERS NONLOCK PERI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-9145-42 SUP HCPCS C1713 AR-9145-42 - SCREW BN 18D 4.5MM 42MM UNIVERS REVERS LCK VA SHLDR GLND BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A AR-9145-42NL SUP HCPCS C1713 AR-9145-42NL - SCREW BN 4.5MM 42MM UNIVERS REVERS NONLOCK PERI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-9145-48 SUP HCPCS C1713 AR-9145-48 - SCREW BN 18D 4.5MM 48MM UNIVERS REVERS LCK VA SHLDR GLND BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $300.00 $300.00 $62.52 $300.00 N/A N/A AR-9145-48NL SUP HCPCS C1713 AR-9145-48NL - SCREW BN 4.5MM 48MM UNIVERS REVERS NONLOCK PERI BOTH IP/OP $300.00 $222.00 $59.54 $300.00 $135.00 $135.00 $135.00 $135.00 $300.00 $300.00 $300.00 $62.53 $300.00 $300.00 $300.00 $300.00 $300.00 $62.52 $300.00 $120.00 $177.45 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $135.00 $59.54 N/A $174.00 $300.00 $180.00 $300.00 $62.52 $300.00 N/A N/A AR-9145DG SUP Custom 27203010 AR-9145DG - GUIDE DRL 45MM UNIVERS REVERS GLND BOTH IP/OP "$1,825.00" "$1,351.00" $324.85 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $324.85 "$1,825.00" "$1,825.00" "$1,354.52" "$1,354.52" "$1,406.71" $950.83 $380.35 "$1,825.00" $730.00 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" "$1,186.25" "$1,825.00" N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" "$1,825.00" "$1,825.00" N/A N/A AR-9146-17 SUP HCPCS C1776 AR-9146-17 - HEAD HUM 46MM 17MM STRL UNIVERS ADJ HT ANTM REFIXATION BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9146-17F SUP HCPCS C1776 AR-9146-17F - HEAD HUM 46MM 17MM STRL UNIVERS ADJ HT ANTM REFIXATION BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$3,125.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A AR-9146-18CA SUP HCPCS C1776 "AR-9146-18CA - UNIVERS CA HUMERAL HEAD, 46/18" BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$5,875.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9146-18P SUP HCPCS C1776 AR-9146-18P - HEAD HUM 46MM 18MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$1,750.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9146-20CA SUP HCPCS C1776 "AR-9146-20CA - UNIVERS CA HUMERAL HEAD, 46/20" BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9146-20P SUP HCPCS C1776 AR-9146-20P - HEAD HUM 46MM 20MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9148-17 SUP HCPCS C1776 AR-9148-17 - HEAD HUM 48MM 17MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9148-17F SUP HCPCS C1776 AR-9148-17F - HEAD HUM 48MM 17MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$3,125.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A AR-9148-18 SUP HCPCS C1776 AR-9148-18 - HEAD HUM 3D BOTH IP/OP "$2,987.50" "$2,211.00" $592.94 "$2,987.50" "$1,344.38" "$1,344.38" "$1,344.38" "$1,344.38" "$2,987.50" "$2,987.50" "$2,987.50" $622.67 "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" $622.63 "$2,987.50" "$1,195.00" "$1,472.84" "$2,987.50" "$2,987.50" "$2,987.50" "$2,987.50" "$2,240.63" "$2,987.50" "$2,987.50" "$2,987.50" "$1,493.75" "$1,493.75" "$2,366.10" "$2,987.50" "$2,390.00" "$1,344.38" $592.94 N/A "$1,732.75" "$2,987.50" "$2,987.50" "$2,987.50" $622.60 "$2,987.50" N/A N/A AR-9148-19CA SUP HCPCS C1776 "AR-9148-19CA - UNIVERS CA HUMERAL HEAD, 48/19" BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9148-19P SUP HCPCS C1776 AR-9148-19P - HEAD HUM 48MM 19MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$1,750.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9148-21CA SUP HCPCS C1776 "AR-9148-21CA - UNIVERS CA HUMERAL HEAD, 48/21" BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9148-21P SUP HCPCS C1776 AR-9148-21P - HEAD HUM 48MM 21MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9150-19 SUP HCPCS C1776 AR-9150-19 - HEAD HUM 50MM 19MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9150-19CA SUP HCPCS C1776 "AR-9150-19CA - UNIVERS CA HUMERAL HEAD, 50/19" BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9150-19F SUP HCPCS C1776 AR-9150-19F - HEAD HUM 50MM 19MM STRL UNIVERS ADJ HT ANTM REFIXATION BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$3,125.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A AR-9150-19P SUP HCPCS C1776 AR-9150-19P - HEAD HUM 50MM 19MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9150-21CA SUP HCPCS C1776 "AR-9150-21CA - UNIVERS CA HUMERAL HEAD, 50/21" BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9150-21P SUP HCPCS C1776 AR-9150-21P - HEAD HUM 50MM 21MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9151-22 SUP HCPCS C1776 AR-9151-22 - HEAD HUM 51MM 22MM STRL UNIVERS ADJ HT ECNTRC SET MTL SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9151-22F SUP HCPCS C1776 AR-9151-22F - HEAD HUM 51MM 22MM STRL UNIVERS ADJ HT ANTM REFIXATION BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$3,125.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A AR-9152-20CA SUP HCPCS C1776 "AR-9152-20CA - UNIVERS CA HUMERAL HEAD, 52/20" BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9152-20P SUP HCPCS C1776 AR-9152-20P - HEAD HUM 52MM 20MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9152-22CA SUP HCPCS C1776 "AR-9152-22CA - UNIVERS CA HUMERAL HEAD, 52/22" BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9152-22P SUP HCPCS C1776 AR-9152-22P - HEAD HUM 52MM 22MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$1,750.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9153-19 SUP HCPCS C1776 AR-9153-19 - HEAD HUM 53MM 19MM UNIVERS 3D SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$1,750.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9153-19F SUP HCPCS C1776 AR-9153-19F - HEAD HUM 53MM 19MM STRL UNIVERS ADJ HT ANTM REFIXATION BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$3,125.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A AR-9153-23 SUP HCPCS C1776 AR-9153-23 - HEAD HUM 53MM 23MM UNIVERS 3D SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$1,750.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9154-21CA SUP HCPCS C1776 "AR-9154-21CA - UNIVERS CA HUMERAL HEAD, 54/21" BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$5,875.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9154-21P SUP HCPCS C1776 AR-9154-21P - HEAD HUM 54MM 21MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9154-23CA SUP HCPCS C1776 "AR-9154-23CA - UNIVERS CA HUMERAL HEAD, 54/23" BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9154-23P SUP HCPCS C1776 AR-9154-23P - HEAD HUM 54MM 23MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$1,750.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9156-22CA SUP HCPCS C1776 AR-9156-22CA - HEAD HUM 56MM 22MM UNIVERS CA BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9156-22P SUP HCPCS C1776 AR-9156-22P - HEAD HUM 56MM 22MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$1,750.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9156-24CA SUP HCPCS C1776 AR-9156-24CA - HEAD HUM 56MM 24MM UNIVERS CA BOTH IP/OP "$5,875.00" "$4,348.00" "$1,166.04" "$5,875.00" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.50" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.41" "$5,875.00" "$2,350.00" "$2,896.38" "$5,875.00" "$5,875.00" "$5,875.00" "$5,875.00" "$4,406.25" "$5,875.00" "$5,875.00" "$5,875.00" "$2,937.50" "$2,937.50" "$4,653.00" "$5,875.00" "$4,700.00" "$2,643.75" "$1,166.04" N/A "$3,407.50" "$5,875.00" "$5,875.00" "$5,875.00" "$1,224.35" "$5,875.00" N/A N/A AR-9156-24P SUP HCPCS C1776 AR-9156-24P - HEAD HUM 56MM 24MM STRL UNIVERS II ANTM RSTR VAR ADJ SHLDR BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$4,375.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A AR-9165-15 SUP HCPCS C1713 AR-9165-15 - SCREW BN 6.5MM 15MM UNIVERS REVERS VA SHLDR GLND CNTR BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A AR-9165-15NL SUP HCPCS C1713 AR-9165-15NL - SCREW BN 6.5MM 15MM UNIVERS REVERS VA SHLDR GLND CNTR NONLOC BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A AR-9165-20 SUP HCPCS C1713 AR-9165-20 - SCREW BN 6.5MM 20MM UNIVERS REVERS VA SHLDR GLND CNTR BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $425.00 $425.00 N/A N/A AR-9165-20NL SUP HCPCS C1713 AR-9165-20NL - SCREW BONE 6.5MM 20MM UNIVERS REVERS BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A AR-9165-25 SUP HCPCS C1713 AR-9165-25 - SCREW BN 6.5MM 25MM UNIVERS REVERS VA SHLDR GLND CNTR BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A AR-9165-25NL SUP HCPCS C1713 AR-9165-25NL - SCREW BN 6.5MM 25MM UNIVERS REVERS CNTR NONLOCK BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A AR-9165-30NL SUP HCPCS C1713 AR-9165-30NL - SCREW BN 6.5MM 30MM UNIVERS REVERS CNTR NONLOCK BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A AR-9165-35NL SUP HCPCS C1713 AR-9165-35NL - SCREW BN 6.5MM 35MM UNIVERS REVERS CNTR NONLOCK BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $191.25 $191.25 $191.25 $191.25 $425.00 $425.00 $425.00 $88.58 $425.00 $425.00 $425.00 $425.00 $425.00 $88.57 $425.00 $170.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $191.25 $84.35 N/A $246.50 $425.00 $255.00 $425.00 $88.57 $425.00 N/A N/A AR-9165DDG SUP HCPCS C1713 AR-9165DDG - SCREW BN UNIVERS REVERS CNTR UNV BSPLT IMPCTR BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $300.00 $500.00 $104.20 $500.00 N/A N/A AR-9202-16 SUP HCPCS C1776 AR-9202-16 - CONNECTOR XTRNFX UNIVERS 3D TRL HD BOTH IP/OP $575.00 $426.00 $114.12 $575.00 $258.75 $258.75 $258.75 $258.75 $575.00 $575.00 $575.00 $119.84 $575.00 $575.00 $575.00 $575.00 $575.00 $119.84 $575.00 $230.00 $340.11 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $258.75 $114.12 N/A $333.50 $575.00 $575.00 $575.00 $119.83 $575.00 N/A N/A AR-9204-02 SUP HCPCS C1776 AR-9204-02 - STEM HUM UNIVERS XTRT SHLDR SHLDR FX BOTH IP/OP "$2,100.00" "$1,554.00" $416.80 "$2,100.00" $945.00 $945.00 $945.00 $945.00 "$2,100.00" "$2,100.00" "$2,100.00" $437.69 "$2,100.00" "$2,100.00" "$2,100.00" "$2,100.00" "$2,100.00" $437.66 "$2,100.00" $840.00 "$1,242.15" "$2,100.00" "$2,100.00" "$2,100.00" "$2,100.00" "$1,575.00" "$2,100.00" "$2,100.00" "$2,100.00" "$1,050.00" "$1,050.00" "$1,663.20" "$2,100.00" "$1,680.00" $945.00 $416.80 N/A "$1,218.00" "$2,100.00" "$2,100.00" "$2,100.00" "$2,100.00" "$2,100.00" N/A N/A AR-9207S SUP HCPCS C1776 AR-9207S - SET SPNL UNIVERS II STRL BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $275.00 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A AR-9215-1-01 SUP Custom 27203010 AR-9215-1-01 - GUIDE DRL 6.5IN HNDL BOTH IP/OP $625.00 $463.00 $111.25 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $625.00 $111.25 $625.00 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $270.00 $625.00 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $625.00 N/A $362.50 $625.00 $375.00 $625.00 $625.00 $625.00 N/A N/A AR-9215-1-02 SUP Custom 27203010 AR-9215-1-02 - GUIDE DRL LNG UNIVERS II HNDL GLND BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A AR-9215-2 SUP Custom 27203010 AR-9215-2 - GUIDE DRL 1 SM GLND BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A AR-9215-3 SUP Custom 27203010 AR-9215-3 - GUIDE DRL 2 SM KEEL GLND BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A AR-9215-4 SUP Custom 27203010 AR-9215-4 - GUIDE DRL 1 MED KEEL GLND BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A AR-9215-5 SUP Custom 27203010 AR-9215-5 - GUIDE DRL 2 MED KEEL GLND BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A AR-9215-6 SUP Custom 27203010 AR-9215-6 - GUIDE DRL 1 LG KEEL GLND BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A AR-9215-7 SUP Custom 27203010 AR-9215-7 - GUIDE DRL 2 LG KEEL GLND BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A AR-9215-8 SUP Custom 27203010 AR-9215-8 - GUIDE DRL 1 XL GLND BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A AR-9215-9 SUP Custom 27203010 AR-9215-9 - GUIDE DRL 2 XL KEEL GLND BOTH IP/OP $875.00 $648.00 $155.75 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $875.00 $155.75 $875.00 $875.00 $649.43 $649.43 $674.45 $455.88 $182.36 $875.00 $350.00 $875.00 $875.00 $875.00 $875.00 $875.00 $656.25 $875.00 $875.00 $875.00 $437.50 $437.50 $693.00 $875.00 $700.00 $568.75 $875.00 N/A $507.50 $875.00 $525.00 $875.00 $875.00 $875.00 N/A N/A AR-9216-1 SUP Custom 27203010 AR-9216-1 - GUIDE DRL 6MM UNIVERS II GLND BOTH IP/OP $812.50 $601.00 $144.63 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $325.00 $812.50 $812.50 $812.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A AR-9216-2 SUP Custom 27203010 AR-9216-2 - GUIDE DRL UNIVERS II GLV PRTC GLND BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A AR-9216-4 SUP Custom 27203010 AR-9216-4 - GUIDE DRL UNIVERS II GLV PRTC GLND BOTH IP/OP $420.00 $311.00 $74.76 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $74.76 $420.00 $420.00 $311.72 $311.72 $323.74 $218.82 $87.53 $420.00 $168.00 $420.00 $420.00 $420.00 $420.00 $420.00 $315.00 $420.00 $420.00 $420.00 $210.00 $210.00 $332.64 $420.00 $336.00 $273.00 $420.00 N/A $243.60 $420.00 $252.00 $420.00 $420.00 $420.00 N/A N/A AR-9231-01 SUP Custom 27203010 AR-9231-01 - GUIDE DRL 2 SM UNIVERS II PG GLND BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A AR-9231-01PP SUP Custom 27203010 AR-9231-01PP - GUIDE DRL SM UNIVERS VAULTLOCK GLND BOTH IP/OP "$1,625.00" "$1,203.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $289.25 "$1,625.00" "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" $650.00 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" "$1,625.00" N/A $942.50 "$1,625.00" $975.00 "$1,625.00" "$1,625.00" "$1,625.00" N/A N/A AR-9231-02 SUP Custom 27203010 AR-9231-02 - GUIDE DRL 2 MED UNIVERS II PG GLND BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A AR-9231-02PP SUP Custom 27203010 AR-9231-02PP - GUIDE DRL MED UNIVERS VAULTLOCK GLND BOTH IP/OP "$1,625.00" "$1,203.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $289.25 "$1,625.00" "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" $650.00 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" "$1,625.00" N/A $942.50 "$1,625.00" $975.00 "$1,625.00" "$1,625.00" "$1,625.00" N/A N/A AR-9231-03 SUP Custom 27203010 AR-9231-03 - GUIDE DRL 2 LG UNIVERS II PG GLND BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A AR-9231-03PP SUP Custom 27203010 AR-9231-03PP - GUIDE DRL LG UNIVERS VAULTLOCK GLND BOTH IP/OP "$1,625.00" "$1,203.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $289.25 "$1,625.00" "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" $650.00 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" "$1,625.00" N/A $942.50 "$1,625.00" $975.00 "$1,625.00" "$1,625.00" "$1,625.00" N/A N/A AR-9231-04 SUP Custom 27203010 AR-9231-04 - GUIDE DRL 2 XL UNIVERS II PG GLND BOTH IP/OP "$1,250.00" $925.00 $222.50 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $222.50 "$1,250.00" "$1,250.00" $927.75 $927.75 $963.50 $651.25 $260.51 "$1,250.00" $500.00 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $812.50 "$1,250.00" N/A $725.00 "$1,250.00" $750.00 "$1,250.00" "$1,250.00" "$1,250.00" N/A N/A AR-9231-04PP SUP Custom 27203010 AR-9231-04PP - GUIDE DRL XL UNIVERS VAULTLOCK GLND BOTH IP/OP "$1,625.00" "$1,203.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $289.25 "$1,625.00" "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" $650.00 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" "$1,625.00" N/A $942.50 "$1,625.00" $975.00 "$1,625.00" "$1,625.00" "$1,625.00" N/A N/A AR-9500-170 SUP HCPCS C1776 AR-9500-170 - JOINT TOE 17MM STRL ANATOEMIC PILT PNCH COCR PHALANX BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,737.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-9500-185 SUP HCPCS C1776 AR-9500-185 - JOINT TOE 18.5MM STRL ANATOEMIC PILT PNCH COCR PHALANX BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-9500-200 SUP HCPCS C1776 AR-9500-200 - JOINT TOE 20MM STRL ANATOEMIC PILT PNCH COCR PHALANX BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,876.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" "$1,876.50" "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-9500-215 SUP HCPCS C1776 AR-9500-215 - JOINT TOE 21.5MM STRL ANATOEMIC PILT PNCH COCR PHALANX BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-9500-230 SUP HCPCS C1776 AR-9500-230 - JOINT TOE 23MM STRL ANATOEMIC PILT PNCH COCR PHALANX BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,737.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $750.60 "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,737.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-9500T-170 SUP HCPCS C1776 AR-9500T-170 - TRIAL ANKL 17MM ANATOEMIC PHALANX BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $60.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-9500T-185 SUP HCPCS C1776 AR-9500T-185 - TRIAL ANKL 18.5MM ANATOEMIC PHALANX BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $64.80 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-9500T-200 SUP HCPCS C1776 AR-9500T-200 - TRIAL ANKL 20MM ANATOEMIC PHALANX BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $60.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-9500T-215 SUP HCPCS C1776 AR-9500T-215 - TRIAL ANKL 21.5MM ANATOEMIC PHALANX BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $60.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-9500T-230 SUP HCPCS C1776 AR-9500T-230 - TRIAL ANKL 23MM ANATOEMIC PHALANX BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $60.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A AR-9501-05-135CPC SUP HCPCS C1776 AR-9501-05-135CPC - STEM HUM 135D 5 95MM STRL UNIVERS REVERS SET SPL MNBLCK PROX BOTH IP/OP "$9,187.50" "$6,799.00" "$1,823.49" "$9,187.50" "$4,134.38" "$4,134.38" "$4,134.38" "$4,134.38" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.90" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.78" "$9,187.50" "$3,675.00" "$4,529.44" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$6,890.63" "$9,187.50" "$9,187.50" "$9,187.50" "$4,593.75" "$4,593.75" "$7,276.50" "$9,187.50" "$7,350.00" "$4,134.38" "$1,823.49" N/A "$5,328.75" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.68" "$9,187.50" N/A N/A AR-9501-05-155CPC SUP HCPCS C1776 AR-9501-05-155CPC - STEM HUM 155D 5 95MM STRL UNIVERS REVERS SET SPL MNBLCK PROX BOTH IP/OP "$9,187.50" "$6,799.00" "$1,823.49" "$9,187.50" "$4,134.38" "$4,134.38" "$4,134.38" "$4,134.38" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.90" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.78" "$9,187.50" "$3,675.00" "$4,529.44" "$9,187.50" "$9,187.50" "$9,187.50" "$9,187.50" "$6,890.63" "$9,187.50" "$9,187.50" "$9,187.50" "$4,593.75" "$4,593.75" "$7,276.50" "$9,187.50" "$7,350.00" "$4,134.38" "$1,823.49" N/A "$5,328.75" "$9,187.50" "$9,187.50" "$9,187.50" "$1,914.68" "$9,187.50" N/A N/A AR-9501-06CPC SUP HCPCS C1776 AR-9501-06CPC - STEM HUM 6 111MM STRL UNIVERS REVERS COR SET PROX FIL CA BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A AR-9501-06RCPC SUP HCPCS C1776 AR-9501-06RCPC - STEM HUM 6 LNG 150MM STRL UNIVERS REVERS PROX FIL REV CA BOTH IP/OP "$7,437.50" "$5,504.00" "$1,476.16" "$7,437.50" "$3,346.88" "$3,346.88" "$3,346.88" "$3,346.88" "$7,437.50" "$7,437.50" "$7,437.50" "$1,550.16" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$1,550.06" "$7,437.50" "$2,975.00" "$3,666.69" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$5,578.13" "$7,437.50" "$7,437.50" "$7,437.50" "$3,718.75" "$3,718.75" "$5,890.50" "$7,437.50" "$5,950.00" "$3,346.88" "$1,476.16" N/A "$4,313.75" "$7,437.50" "$7,437.50" "$7,437.50" "$1,549.98" "$7,437.50" N/A N/A AR-9501-07CPC SUP HCPCS C1776 AR-9501-07CPC - STEM HUM 115MM CORE SET PROX FIL UNIVERS REVERS BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A AR-9501-08CPC SUP HCPCS C1776 AR-9501-08CPC - STEM HUM 8 119MM STRL UNIVERS REVERS COR SET PROX FIL CA BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A AR-9501-09CPC SUP HCPCS C1776 AR-9501-09CPC - STEM HUM 9 123MM STRL UNIVERS REVERS COR SET PROX FIL CA BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A AR-9501-09RCPC SUP HCPCS C1776 AR-9501-09RCPC - STEM HUM 9 LNG 180MM STRL UNIVERS REVERS PROX FIL REV CA BOTH IP/OP "$7,437.50" "$5,504.00" "$1,476.16" "$7,437.50" "$3,346.88" "$3,346.88" "$3,346.88" "$3,346.88" "$7,437.50" "$7,437.50" "$7,437.50" "$1,550.16" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$1,550.06" "$7,437.50" "$2,975.00" "$3,666.69" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$5,578.13" "$7,437.50" "$7,437.50" "$7,437.50" "$3,718.75" "$3,718.75" "$5,890.50" "$7,437.50" "$5,950.00" "$3,346.88" "$1,476.16" N/A "$4,313.75" "$7,437.50" "$7,437.50" "$7,437.50" "$1,549.98" "$7,437.50" N/A N/A AR-9501-10CPC SUP HCPCS C1776 AR-9501-10CPC - STEM HUM 10 127MM STRL UNIVERS REVERS COR SET PROX FIL CA BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A AR-9501-11CPC SUP HCPCS C1776 AR-9501-11CPC - STEM HUM 11 131MM STRL UNIVERS REVERS COR SET PROX FIL CA BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A AR-9501-12CPC SUP HCPCS C1776 AR-9501-12CPC - STEM HUM 12 135MM STRL UNIVERS REVERS COR SET PROX FIL CA BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$6,212.50" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A AR-9501-12RCPC SUP HCPCS C1776 AR-9501-12RCPC - STEM HUM 12 LNG 180MM STRL UNIVERS REVERS PROX FIL REV CA BOTH IP/OP "$7,437.50" "$5,504.00" "$1,476.16" "$7,437.50" "$3,346.88" "$3,346.88" "$3,346.88" "$3,346.88" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$1,550.06" "$7,437.50" "$2,975.00" "$3,666.69" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$5,578.13" "$7,437.50" "$7,437.50" "$7,437.50" "$3,718.75" "$3,718.75" "$5,890.50" "$7,437.50" "$5,950.00" "$3,346.88" "$1,476.16" N/A "$4,313.75" "$7,437.50" "$7,437.50" "$7,437.50" "$1,549.98" "$7,437.50" N/A N/A AR-9501-13CPC SUP HCPCS C1776 AR-9501-13CPC - STEM HUM 13 139MM STRL UNIVERS REVERS SET SPL PROX FIL CA BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A AR-9501-14CPC SUP HCPCS C1776 AR-9501-14CPC - STEM HUM 14 143MM STRL UNIVERS REVERS SET SPL PROX FIL CA BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A AR-9501-15CPC SUP HCPCS C1776 AR-9501-15CPC - STEM HUM 15 146MM STRL UNIVERS REVERS SET SPL PROX FIL CA BOTH IP/OP "$6,212.50" "$4,597.00" "$1,233.03" "$6,212.50" "$2,795.63" "$2,795.63" "$2,795.63" "$2,795.63" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.84" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.75" "$6,212.50" "$2,485.00" "$3,062.76" "$6,212.50" "$6,212.50" "$6,212.50" "$6,212.50" "$4,659.38" "$6,212.50" "$6,212.50" "$6,212.50" "$3,106.25" "$3,106.25" "$4,920.30" "$6,212.50" "$4,970.00" "$2,795.63" "$1,233.03" N/A "$3,603.25" "$6,212.50" "$6,212.50" "$6,212.50" "$1,294.69" "$6,212.50" N/A N/A AR-9502-36ARCA SUP HCPCS C1776 AR-9502-36ARCA - ADAPTER HD 36MM STRL ARTHX RVRS CUF ARTHROPATHY BOTH IP/OP "$5,375.00" "$3,978.00" "$1,066.80" "$5,375.00" "$2,418.75" "$2,418.75" "$2,418.75" "$2,418.75" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.28" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.21" "$5,375.00" "$2,150.00" "$2,649.88" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$4,031.25" "$5,375.00" "$5,375.00" "$5,375.00" "$2,687.50" "$2,687.50" "$4,257.00" "$5,375.00" "$4,300.00" "$2,418.75" "$1,066.80" N/A "$3,117.50" "$5,375.00" "$3,225.00" "$5,375.00" "$1,120.15" "$5,375.00" N/A N/A AR-9502-36CPC SUP Custom 27803010 AR-9502-36CPC - CUP HUM NTRL 36MM STRL UNIVERS REVERS CA PHOS SHLDR ARTHPL BOTH IP/OP "$4,462.50" "$3,302.00" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" "$4,462.50" N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" "$4,462.50" "$4,462.50" N/A N/A AR-9502-36LCPC SUP Custom 27803010 AR-9502-36LCPC - CUP HUM +2MM OFST 36MM STRL UNIVERS REVERS CA PHOS SHLDR LT BOTH IP/OP "$4,462.50" "$3,302.00" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" "$4,462.50" N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" "$4,462.50" "$4,462.50" N/A N/A AR-9502-36RCPC SUP Custom 27803010 AR-9502-36RCPC - CUP HUM +2MM OFST 36MM STRL UNIVERS REVERS CA PHOS SHLDR RT BOTH IP/OP "$4,462.50" "$3,302.00" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" "$4,462.50" N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" "$4,462.50" "$4,462.50" N/A N/A AR-9502-39ARCA SUP HCPCS C1776 AR-9502-39ARCA - ADAPTER HD 39MM STRL ARTHX RVRS BOTH IP/OP "$5,375.00" "$3,978.00" "$1,066.80" "$5,375.00" "$2,418.75" "$2,418.75" "$2,418.75" "$2,418.75" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.28" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.21" "$5,375.00" "$2,150.00" "$2,649.88" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$4,031.25" "$5,375.00" "$5,375.00" "$5,375.00" "$2,687.50" "$2,687.50" "$4,257.00" "$5,375.00" "$4,300.00" "$2,418.75" "$1,066.80" N/A "$3,117.50" "$5,375.00" "$3,225.00" "$5,375.00" "$1,120.15" "$5,375.00" N/A N/A AR-9502-39CPC SUP Custom 27803010 AR-9502-39CPC - CUP HUM NTRL 39MM STRL UNIVERS REVERS CA PHOS SHLDR ARTHPL BOTH IP/OP "$4,462.50" "$3,302.00" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" "$4,462.50" N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" "$4,462.50" "$4,462.50" N/A N/A AR-9502-39LCPC SUP Custom 27803010 AR-9502-39LCPC - CUP HUM +2MM OFST 39MM STRL UNIVERS REVERS CA PHOS SHLDR LT BOTH IP/OP "$4,462.50" "$3,302.00" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" "$4,462.50" N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" "$4,462.50" "$4,462.50" N/A N/A AR-9502-39RCPC SUP Custom 27803010 AR-9502-39RCPC - CUP HUM +2MM OFST 39MM STRL UNIVERS REVERS CA PHOS SHLDR RT BOTH IP/OP "$4,462.50" "$3,302.00" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" "$4,462.50" N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" "$4,462.50" "$4,462.50" N/A N/A AR-9502-42ARCA SUP HCPCS C1776 AR-9502-42ARCA - ADAPTER HD 42MM STRL ARTHX RVRS BOTH IP/OP "$5,375.00" "$3,978.00" "$1,066.80" "$5,375.00" "$2,418.75" "$2,418.75" "$2,418.75" "$2,418.75" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.28" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$1,120.21" "$5,375.00" "$2,150.00" "$2,649.88" "$5,375.00" "$5,375.00" "$5,375.00" "$5,375.00" "$4,031.25" "$5,375.00" "$5,375.00" "$5,375.00" "$2,687.50" "$2,687.50" "$4,257.00" "$5,375.00" "$4,300.00" "$2,418.75" "$1,066.80" N/A "$3,117.50" "$5,375.00" "$3,225.00" "$5,375.00" "$1,120.15" "$5,375.00" N/A N/A AR-9502-42CPC SUP Custom 27803010 AR-9502-42CPC - CUP HUM NTRL 42MM STRL UNIVERS REVERS CA PHOS SHLDR ARTHPL BOTH IP/OP "$4,462.50" "$3,302.00" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" "$4,462.50" N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" "$4,462.50" "$4,462.50" N/A N/A AR-9502-42LCPC SUP Custom 27803010 AR-9502-42LCPC - CUP HUM +2MM OFST 42MM STRL UNIVERS REVERS CA PHOS SHLDR LT BOTH IP/OP "$4,462.50" "$3,302.00" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" "$4,462.50" N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" "$4,462.50" "$4,462.50" N/A N/A AR-9502-42RCPC SUP Custom 27803010 AR-9502-42RCPC - CUP HUM +2MM OFST 42MM STRL UNIVERS REVERS CA PHOS SHLDR RT BOTH IP/OP "$4,462.50" "$3,302.00" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" "$4,462.50" N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" "$4,462.50" "$4,462.50" N/A N/A AR-9502F-36CPC SUP HCPCS C1776 AR-9502F-36CPC - CUP HUM 36MM STRL LF ARTHX UNIVERS REVERS SUT BOTH IP/OP "$4,462.50" "$3,302.00" $885.69 "$4,462.50" "$2,008.13" "$2,008.13" "$2,008.13" "$2,008.13" "$4,462.50" "$4,462.50" "$4,462.50" $930.10 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$4,462.50" "$2,200.01" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" $885.69 N/A "$2,588.25" "$4,462.50" "$4,462.50" "$4,462.50" $929.99 "$4,462.50" N/A N/A AR-9502F-36LCPC SUP Custom 27803010 AR-9502F-36LCPC - CUP HUM +2 36MM UNIVERS REVERS SUT SHLDR LT BOTH IP/OP "$4,462.50" "$3,302.00" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" "$4,462.50" N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" "$4,462.50" "$4,462.50" N/A N/A AR-9502F-36RCPC SUP Custom 27803010 AR-9502F-36RCPC - CUP HUM +2 36MM UNIVERS REVERS SUT SHLDR RT BOTH IP/OP "$4,462.50" "$3,302.00" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" "$4,462.50" N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" "$4,462.50" "$4,462.50" N/A N/A AR-9502F-39LCPC SUP Custom 27803010 AR-9502F-39LCPC - CUP HUM +2 39MM UNIVERS REVERS SUT SHLDR LT BOTH IP/OP "$4,462.50" "$3,302.00" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" "$4,462.50" N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" "$4,462.50" "$4,462.50" N/A N/A AR-9502F-39RCPC SUP Custom 27803010 AR-9502F-39RCPC - CUP HUM +2 39MM UNIVERS REVERS SUT SHLDR RT BOTH IP/OP "$4,462.50" "$3,302.00" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" "$4,462.50" N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" "$4,462.50" "$4,462.50" N/A N/A AR-9502F-42RCPC SUP Custom 27803010 AR-9502F-42RCPC - CUP HUM +2 42MM UNIVERS REVERS SUT SHLDR RT BOTH IP/OP "$4,462.50" "$3,302.00" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $794.33 "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" $930.03 "$4,462.50" "$1,785.00" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$4,462.50" "$3,346.88" "$4,462.50" "$4,462.50" "$4,462.50" "$2,231.25" "$2,231.25" "$3,534.30" "$4,462.50" "$3,570.00" "$2,008.13" "$4,462.50" N/A "$2,588.25" "$4,462.50" "$2,677.50" "$4,462.50" "$4,462.50" "$4,462.50" N/A N/A AR-9503L-03 SUP HCPCS C1776 AR-9503L-03 - INSERT HUM +3MM LG 42MM STRL UNIVERS REVERS SHLDR ARTHPL BOTH IP/OP "$2,537.50" "$1,878.00" $503.63 "$2,537.50" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$2,537.50" "$2,537.50" "$2,537.50" $528.88 "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" $528.84 "$2,537.50" "$2,537.50" "$1,250.99" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$1,903.13" "$2,537.50" "$2,537.50" "$2,537.50" "$1,268.75" "$1,268.75" "$2,009.70" "$2,537.50" "$2,030.00" "$1,141.88" $503.63 N/A "$1,471.75" "$2,537.50" "$2,537.50" "$2,537.50" $528.82 "$2,537.50" N/A N/A AR-9503L-03C SUP HCPCS C1776 AR-9503L-03C - INSERT HUM +3MM LG 42MM STRL UNIVERS REVERS CNSTRN SHLDR BOTH IP/OP "$2,537.50" "$1,878.00" $503.63 "$2,537.50" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" $528.84 "$2,537.50" "$2,537.50" "$1,250.99" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$1,903.13" "$2,537.50" "$2,537.50" "$2,537.50" "$1,268.75" "$1,268.75" "$2,009.70" "$2,537.50" "$2,030.00" "$1,141.88" $503.63 N/A "$1,471.75" "$2,537.50" "$2,537.50" "$2,537.50" $528.82 "$2,537.50" N/A N/A AR-9503L-06 SUP HCPCS C1776 AR-9503L-06 - INSERT HUM +6MM LG 42MM STRL UNIVERS REVERS SHLDR ARTHPL BOTH IP/OP "$2,537.50" "$1,878.00" $503.63 "$2,537.50" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$2,537.50" "$2,537.50" "$2,537.50" $528.88 "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" $528.84 "$2,537.50" "$1,015.00" "$1,250.99" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$1,903.13" "$2,537.50" "$2,537.50" "$2,537.50" "$1,268.75" "$1,268.75" "$2,009.70" "$2,537.50" "$2,030.00" "$1,141.88" $503.63 N/A "$1,471.75" "$2,537.50" "$2,537.50" "$2,537.50" $528.82 "$2,537.50" N/A N/A AR-9503L-06C SUP HCPCS C1776 AR-9503L-06C - INSERT HUM +6MM LG 42MM STRL UNIVERS REVERS CNSTRN SHLDR BOTH IP/OP "$2,537.50" "$1,878.00" $503.63 "$2,537.50" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$2,537.50" "$2,537.50" "$2,537.50" $528.88 "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" $528.84 "$2,537.50" "$2,537.50" "$1,250.99" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$1,903.13" "$2,537.50" "$2,537.50" "$2,537.50" "$1,268.75" "$1,268.75" "$2,009.70" "$2,537.50" "$2,030.00" "$1,141.88" $503.63 N/A "$1,471.75" "$2,537.50" "$2,537.50" "$2,537.50" $528.82 "$2,537.50" N/A N/A AR-9503M-03 SUP HCPCS C1776 AR-9503M-03 - INSERT HUM +3MM MED 39MM STRL UNIVERS REVERS SHLDR ARTHPL BOTH IP/OP "$2,537.50" "$1,878.00" $503.63 "$2,537.50" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$2,537.50" "$2,537.50" "$2,537.50" $528.88 "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" $528.84 "$2,537.50" "$2,537.50" "$1,250.99" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$1,903.13" "$2,537.50" "$2,537.50" "$2,537.50" "$1,268.75" "$1,268.75" "$2,009.70" "$2,537.50" "$2,030.00" "$1,141.88" $503.63 N/A "$1,471.75" "$2,537.50" "$2,537.50" "$2,537.50" $528.82 "$2,537.50" N/A N/A AR-9503M-03C SUP HCPCS C1776 AR-9503M-03C - INSERT HUM +3MM MED 39MM STRL UNIVERS REVERS CNSTRN SHLDR BOTH IP/OP "$2,537.50" "$1,878.00" $503.63 "$2,537.50" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$2,537.50" "$2,537.50" "$2,537.50" $528.88 "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" $528.84 "$2,537.50" "$2,537.50" "$1,250.99" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$1,903.13" "$2,537.50" "$2,537.50" "$2,537.50" "$1,268.75" "$1,268.75" "$2,009.70" "$2,537.50" "$2,030.00" "$1,141.88" $503.63 N/A "$1,471.75" "$2,537.50" "$2,537.50" "$2,537.50" $528.82 "$2,537.50" N/A N/A AR-9503M-06 SUP HCPCS C1776 AR-9503M-06 - INSERT HUM +6MM MED 39MM STRL UNIVERS REVERS SHLDR ARTHPL BOTH IP/OP "$2,537.50" "$1,878.00" $503.63 "$2,537.50" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" $528.84 "$2,537.50" "$1,015.00" "$1,250.99" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$1,903.13" "$2,537.50" "$2,537.50" "$2,537.50" "$1,268.75" "$1,268.75" "$2,009.70" "$2,537.50" "$2,030.00" "$1,141.88" $503.63 N/A "$1,471.75" "$2,537.50" "$2,537.50" "$2,537.50" $528.82 "$2,537.50" N/A N/A AR-9503M-06C SUP HCPCS C1776 AR-9503M-06C - INSERT HUM +6MM MED 39MM STRL UNIVERS REVERS CNSTRN SHLDR BOTH IP/OP "$2,537.50" "$1,878.00" $503.63 "$2,537.50" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$2,537.50" "$2,537.50" "$2,537.50" $528.88 "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" $528.84 "$2,537.50" "$1,015.00" "$1,250.99" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$1,903.13" "$2,537.50" "$2,537.50" "$2,537.50" "$1,268.75" "$1,268.75" "$2,009.70" "$2,537.50" "$2,030.00" "$1,141.88" $503.63 N/A "$1,471.75" "$2,537.50" "$2,537.50" "$2,537.50" $528.82 "$2,537.50" N/A N/A AR-9503S-03 SUP HCPCS C1776 AR-9503S-03 - INSERT HUM 36MM UNIVERS REVERS +3MM SM SHLDR BOTH IP/OP "$2,537.50" "$1,878.00" $503.63 "$2,537.50" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$2,537.50" "$2,537.50" "$2,537.50" $528.88 "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" $528.84 "$2,537.50" "$1,015.00" "$1,250.99" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$1,903.13" "$2,537.50" "$2,537.50" "$2,537.50" "$1,268.75" "$1,268.75" "$2,009.70" "$2,537.50" "$2,030.00" "$1,141.88" $503.63 N/A "$1,471.75" "$2,537.50" "$2,537.50" "$2,537.50" $528.82 "$2,537.50" N/A N/A AR-9503S-03C SUP HCPCS C1776 AR-9503S-03C - INSERT HUM +3MM SM 36MM STRL UNIVERS REVERS CNSTRN SHLDR BOTH IP/OP "$2,537.50" "$1,878.00" $503.63 "$2,537.50" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$2,537.50" "$2,537.50" "$2,537.50" $528.88 "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" $528.84 "$2,537.50" "$2,537.50" "$1,250.99" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$1,903.13" "$2,537.50" "$2,537.50" "$2,537.50" "$1,268.75" "$1,268.75" "$2,009.70" "$2,537.50" "$2,030.00" "$1,141.88" $503.63 N/A "$1,471.75" "$2,537.50" "$2,537.50" "$2,537.50" $528.82 "$2,537.50" N/A N/A AR-9503S-06 SUP HCPCS C1776 AR-9503S-06 - INSERT HUM +6MM SM 36MM STRL UNIVERS REVERS SHLDR ARTHPL BOTH IP/OP "$2,537.50" "$1,878.00" $503.63 "$2,537.50" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" $528.84 "$2,537.50" "$1,015.00" "$1,250.99" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$1,903.13" "$2,537.50" "$2,537.50" "$2,537.50" "$1,268.75" "$1,268.75" "$2,009.70" "$2,537.50" "$2,030.00" "$1,141.88" $503.63 N/A "$1,471.75" "$2,537.50" "$2,537.50" "$2,537.50" $528.82 "$2,537.50" N/A N/A AR-9503S-06C SUP HCPCS C1776 AR-9503S-06C - INSERT HUM +6MM SM 36MM STRL UNIVERS REVERS CNSTRN SHLDR BOTH IP/OP "$2,537.50" "$1,878.00" $503.63 "$2,537.50" "$1,141.88" "$1,141.88" "$1,141.88" "$1,141.88" "$2,537.50" "$2,537.50" "$2,537.50" $528.88 "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" $528.84 "$2,537.50" "$1,015.00" "$1,250.99" "$2,537.50" "$2,537.50" "$2,537.50" "$2,537.50" "$1,903.13" "$2,537.50" "$2,537.50" "$2,537.50" "$1,268.75" "$1,268.75" "$2,009.70" "$2,537.50" "$2,030.00" "$1,141.88" $503.63 N/A "$1,471.75" "$2,537.50" "$2,537.50" "$2,537.50" $528.82 "$2,537.50" N/A N/A AR-9504L SUP HCPCS C1776 AR-9504L - HEAD GLND LG UNV 42MM STRL UNIVERS REVERS GLENOSPHERE VA CA BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A AR-9504L-04 SUP HCPCS C1776 AR-9504L-04 - HEAD GLND +4MM LG UNV LAT OFST 42MM STRL UNIVERS REVERS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A AR-9504M SUP HCPCS C1776 AR-9504M - HEAD GLND MED UNV 39MM STRL UNIVERS REVERS GLENOSPHERE VA CA BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$2,100.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A AR-9504M-02 SUP HCPCS C1776 AR-9504M-02 - HEAD GLND +2.5MM MED UNV INFR OFST 42MM STRL UNIVERS REVERS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$2,100.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A AR-9504M-04 SUP HCPCS C1776 AR-9504M-04 - HEAD GLND +4MM MED UNV LAT OFST 39MM STRL UNIVERS REVERS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A AR-9504S SUP HCPCS C1776 AR-9504S - HEAD GLND SM UNV 36MM STRL UNIVERS REVERS GLENOSPHERE VA CA BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$2,100.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A AR-9504S-02 SUP HCPCS C1776 AR-9504S-02 - HEAD GLND +2.5MM SM UNV INFR OFST 36MM STRL UNIVERS REVERS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$2,100.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A AR-9504S-04 SUP HCPCS C1776 AR-9504S-04 - HEAD GLND 36MM UNIVERS REVERS +4MM SM UNV LAT BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$2,100.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A AR-9504S-INF SUP HCPCS C1776 AR-9504S-INF - HEAD GLND +2.5MM INFR OFST 36MM STRL UNIVERS REVERS BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$2,100.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A AR-9505-06 SUP HCPCS C1776 AR-9505-06 - SPACER HUM +6MM 39MM STRL UNIVERS REVERS TI SHLDR ARTHPL BOTH IP/OP "$1,225.00" $907.00 $243.13 "$1,225.00" $551.25 $551.25 $551.25 $551.25 "$1,225.00" "$1,225.00" "$1,225.00" $255.32 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $255.30 "$1,225.00" "$1,225.00" $724.59 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $551.25 $243.13 N/A $710.50 "$1,225.00" "$1,225.00" "$1,225.00" $255.29 "$1,225.00" N/A N/A AR-9505-09 SUP HCPCS C1776 AR-9505-09 - SPACER HUM +9MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL BOTH IP/OP "$1,225.00" $907.00 $243.13 "$1,225.00" $551.25 $551.25 $551.25 $551.25 "$1,225.00" "$1,225.00" "$1,225.00" $255.32 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $255.30 "$1,225.00" $490.00 $724.59 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $551.25 $243.13 N/A $710.50 "$1,225.00" "$1,225.00" "$1,225.00" $255.29 "$1,225.00" N/A N/A AR-9505-12 SUP HCPCS C1776 AR-9505-12 - SPACER HUM +12MM 39MM STRL UNIVERS REVERS TI SHLDR ARTHPL BOTH IP/OP "$1,225.00" $907.00 $243.13 "$1,225.00" $551.25 $551.25 $551.25 $551.25 "$1,225.00" "$1,225.00" "$1,225.00" $255.32 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $255.30 "$1,225.00" $490.00 $724.59 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $551.25 $243.13 N/A $710.50 "$1,225.00" "$1,225.00" "$1,225.00" $255.29 "$1,225.00" N/A N/A AR-9505-15 SUP HCPCS C1776 AR-9505-15 - SPACER HUM +15MM 39MM STRL UNIVERS REVERS TI SHLDR ARTHPL BOTH IP/OP "$1,225.00" $907.00 $243.13 "$1,225.00" $551.25 $551.25 $551.25 $551.25 "$1,225.00" "$1,225.00" "$1,225.00" $255.32 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $255.30 "$1,225.00" "$1,225.00" $724.59 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $551.25 $243.13 N/A $710.50 "$1,225.00" "$1,225.00" "$1,225.00" $255.29 "$1,225.00" N/A N/A AR-9510-06 SUP HCPCS C1776 AR-9510-06 - RASP SRG 6 UNIVERS REVERS STM TRL SHLDR ARTHPL BOTH IP/OP "$3,262.50" "$2,414.00" $647.52 "$3,262.50" "$1,468.13" "$1,468.13" "$1,468.13" "$1,468.13" "$3,262.50" "$3,262.50" "$3,262.50" $679.99 "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" $679.94 "$3,262.50" "$3,262.50" "$1,608.41" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$2,446.88" "$3,262.50" "$3,262.50" "$3,262.50" "$1,631.25" "$1,631.25" "$2,583.90" "$3,262.50" "$2,610.00" "$1,468.13" $647.52 N/A "$1,892.25" "$3,262.50" "$1,957.50" "$3,262.50" $679.91 "$3,262.50" N/A N/A AR-9510-07 SUP HCPCS C1776 AR-9510-07 - RASP SRG 7 UNIVERS REVERS STM TRL SHLDR ARTHPL BOTH IP/OP "$3,262.50" "$2,414.00" $647.52 "$3,262.50" "$1,468.13" "$1,468.13" "$1,468.13" "$1,468.13" "$3,262.50" "$3,262.50" "$3,262.50" $679.99 "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" $679.94 "$3,262.50" "$1,305.00" "$1,608.41" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$2,446.88" "$3,262.50" "$3,262.50" "$3,262.50" "$1,631.25" "$1,631.25" "$2,583.90" "$3,262.50" "$2,610.00" "$1,468.13" $647.52 N/A "$1,892.25" "$3,262.50" "$1,957.50" "$3,262.50" $679.91 "$3,262.50" N/A N/A AR-9510-08 SUP HCPCS C1776 AR-9510-08 - RASP SRG 8 UNIVERS REVERS STM TRL SHLDR ARTHPL BOTH IP/OP "$3,262.50" "$2,414.00" $647.52 "$3,262.50" "$1,468.13" "$1,468.13" "$1,468.13" "$1,468.13" "$3,262.50" "$3,262.50" "$3,262.50" $679.99 "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" $679.94 "$3,262.50" "$1,305.00" "$1,608.41" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$2,446.88" "$3,262.50" "$3,262.50" "$3,262.50" "$1,631.25" "$1,631.25" "$2,583.90" "$3,262.50" "$2,610.00" "$1,468.13" $647.52 N/A "$1,892.25" "$3,262.50" "$1,957.50" "$3,262.50" $679.91 "$3,262.50" N/A N/A AR-9510-09 SUP HCPCS C1776 AR-9510-09 - RASP SRG 9 UNIVERS REVERS STM TRL SHLDR ARTHPL BOTH IP/OP "$3,262.50" "$2,414.00" $647.52 "$3,262.50" "$1,468.13" "$1,468.13" "$1,468.13" "$1,468.13" "$3,262.50" "$3,262.50" "$3,262.50" $679.99 "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" $679.94 "$3,262.50" "$1,305.00" "$1,608.41" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$2,446.88" "$3,262.50" "$3,262.50" "$3,262.50" "$1,631.25" "$1,631.25" "$2,583.90" "$3,262.50" "$2,610.00" "$1,468.13" $647.52 N/A "$1,892.25" "$3,262.50" "$1,957.50" "$3,262.50" $679.91 "$3,262.50" N/A N/A AR-9510-09R SUP HCPCS C1776 AR-9510-09R - RASP SRG 9 LNG 180MM UNIVERS REVERS REV STM TRL SHLDR ARTHPL BOTH IP/OP "$3,612.50" "$2,673.00" $716.99 "$3,612.50" "$1,625.63" "$1,625.63" "$1,625.63" "$1,625.63" "$3,612.50" "$3,612.50" "$3,612.50" $752.94 "$3,612.50" "$3,612.50" "$3,612.50" "$3,612.50" "$3,612.50" $752.88 "$3,612.50" "$1,445.00" "$1,780.96" "$3,612.50" "$3,612.50" "$3,612.50" "$3,612.50" "$2,709.38" "$3,612.50" "$3,612.50" "$3,612.50" "$1,806.25" "$1,806.25" "$2,861.10" "$3,612.50" "$2,890.00" "$1,625.63" $716.99 N/A "$2,095.25" "$3,612.50" "$2,167.50" "$3,612.50" $752.85 "$3,612.50" N/A N/A AR-9510-10 SUP HCPCS C1776 AR-9510-10 - RASP SRG 10 UNIVERS REVERS STM TRL SHLDR ARTHPL BOTH IP/OP "$3,262.50" "$2,414.00" $647.52 "$3,262.50" "$1,468.13" "$1,468.13" "$1,468.13" "$1,468.13" "$3,262.50" "$3,262.50" "$3,262.50" $679.99 "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" $679.94 "$3,262.50" "$1,305.00" "$1,608.41" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$2,446.88" "$3,262.50" "$3,262.50" "$3,262.50" "$1,631.25" "$1,631.25" "$2,583.90" "$3,262.50" "$2,610.00" "$1,468.13" $647.52 N/A "$1,892.25" "$3,262.50" "$3,262.50" "$3,262.50" $679.91 "$3,262.50" N/A N/A AR-9510-11 SUP HCPCS C1776 AR-9510-11 - RASP SRG 11 UNIVERS REVERS STM TRL SHLDR ARTHPL BOTH IP/OP "$3,262.50" "$2,414.00" $647.52 "$3,262.50" "$1,468.13" "$1,468.13" "$1,468.13" "$1,468.13" "$3,262.50" "$3,262.50" "$3,262.50" $679.99 "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" $679.94 "$3,262.50" "$3,262.50" "$1,608.41" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$2,446.88" "$3,262.50" "$3,262.50" "$3,262.50" "$1,631.25" "$1,631.25" "$2,583.90" "$3,262.50" "$2,610.00" "$1,468.13" $647.52 N/A "$1,892.25" "$3,262.50" "$3,262.50" "$3,262.50" $679.91 "$3,262.50" N/A N/A AR-9510-12 SUP HCPCS C1776 AR-9510-12 - RASP SRG 12 UNIVERS REVERS STM TRL SHLDR ARTHPL BOTH IP/OP "$3,262.50" "$2,414.00" $647.52 "$3,262.50" "$1,468.13" "$1,468.13" "$1,468.13" "$1,468.13" "$3,262.50" "$3,262.50" "$3,262.50" $679.99 "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" $679.94 "$3,262.50" "$1,305.00" "$1,608.41" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$2,446.88" "$3,262.50" "$3,262.50" "$3,262.50" "$1,631.25" "$1,631.25" "$2,583.90" "$3,262.50" "$2,610.00" "$1,468.13" $647.52 N/A "$1,892.25" "$3,262.50" "$3,262.50" "$3,262.50" $679.91 "$3,262.50" N/A N/A AR-9510-12R SUP HCPCS C1776 AR-9510-12R - RASP SRG 12 LNG 180MM UNIVERS REVERS REV STM TRL SHLDR BOTH IP/OP "$3,612.50" "$2,673.00" $716.99 "$3,612.50" "$1,625.63" "$1,625.63" "$1,625.63" "$1,625.63" "$3,612.50" "$3,612.50" "$3,612.50" $752.94 "$3,612.50" "$3,612.50" "$3,612.50" "$3,612.50" "$3,612.50" $752.88 "$3,612.50" "$1,445.00" "$1,780.96" "$3,612.50" "$3,612.50" "$3,612.50" "$3,612.50" "$2,709.38" "$3,612.50" "$3,612.50" "$3,612.50" "$1,806.25" "$1,806.25" "$2,861.10" "$3,612.50" "$2,890.00" "$1,625.63" $716.99 N/A "$2,095.25" "$3,612.50" "$2,167.50" "$3,612.50" $752.85 "$3,612.50" N/A N/A AR-9510-13 SUP HCPCS C1776 AR-9510-13 - RASP SRG 13 UNIVERS REVERS STM TRL SHLDR ARTHPL BOTH IP/OP "$3,262.50" "$2,414.00" $647.52 "$3,262.50" "$1,468.13" "$1,468.13" "$1,468.13" "$1,468.13" "$3,262.50" "$3,262.50" "$3,262.50" $679.99 "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" $679.94 "$3,262.50" "$1,305.00" "$1,608.41" "$3,262.50" "$3,262.50" "$3,262.50" "$3,262.50" "$2,446.88" "$3,262.50" "$3,262.50" "$3,262.50" "$1,631.25" "$1,631.25" "$2,583.90" "$3,262.50" "$2,610.00" "$1,468.13" $647.52 N/A "$1,892.25" "$3,262.50" "$1,957.50" "$3,262.50" $679.91 "$3,262.50" N/A N/A AR-9510-14 SUP HCPCS C1776 AR-9510-14 - RASP SRG 14 UNIVERS REVERS STM TRL SHLDR ARTHPL BOTH IP/OP "$3,412.50" "$2,525.00" $677.30 "$3,412.50" "$1,535.63" "$1,535.63" "$1,535.63" "$1,535.63" "$3,412.50" "$3,412.50" "$3,412.50" $711.25 "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" $711.20 "$3,412.50" "$1,365.00" "$1,682.36" "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" "$2,559.38" "$3,412.50" "$3,412.50" "$3,412.50" "$1,706.25" "$1,706.25" "$2,702.70" "$3,412.50" "$2,730.00" "$1,535.63" $677.30 N/A "$1,979.25" "$3,412.50" "$2,047.50" "$3,412.50" $711.17 "$3,412.50" N/A N/A AR-9510-15 SUP HCPCS C1776 AR-9510-15 - RASP SRG 15 UNIVERS REVERS STM TRL SHLDR ARTHPL BOTH IP/OP "$3,412.50" "$2,525.00" $677.30 "$3,412.50" "$1,535.63" "$1,535.63" "$1,535.63" "$1,535.63" "$3,412.50" "$3,412.50" "$3,412.50" $711.25 "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" $711.20 "$3,412.50" "$1,365.00" "$1,682.36" "$3,412.50" "$3,412.50" "$3,412.50" "$3,412.50" "$2,559.38" "$3,412.50" "$3,412.50" "$3,412.50" "$1,706.25" "$1,706.25" "$2,702.70" "$3,412.50" "$2,730.00" "$1,535.63" $677.30 N/A "$1,979.25" "$3,412.50" "$2,047.50" "$3,412.50" $711.17 "$3,412.50" N/A N/A AR-9550-06 SUP HCPCS C1776 AR-9550-06 - SPACER HUM +6MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL BOTH IP/OP "$1,225.00" $907.00 $243.13 "$1,225.00" $551.25 $551.25 $551.25 $551.25 "$1,225.00" "$1,225.00" "$1,225.00" $255.32 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $255.30 "$1,225.00" $490.00 $724.59 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $551.25 $243.13 N/A $710.50 "$1,225.00" "$1,225.00" "$1,225.00" $255.29 "$1,225.00" N/A N/A AR-9550-09 SUP HCPCS C1776 AR-9550-09 - SPACER HUM +9MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL BOTH IP/OP "$1,225.00" $907.00 $243.13 "$1,225.00" $551.25 $551.25 $551.25 $551.25 "$1,225.00" "$1,225.00" "$1,225.00" $255.32 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $255.30 "$1,225.00" $490.00 $724.59 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $551.25 $243.13 N/A $710.50 "$1,225.00" "$1,225.00" "$1,225.00" $255.29 "$1,225.00" N/A N/A AR-9550-12 SUP HCPCS C1776 AR-9550-12 - SPACER HUM +12MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL BOTH IP/OP "$1,225.00" $907.00 $243.13 "$1,225.00" $551.25 $551.25 $551.25 $551.25 "$1,225.00" "$1,225.00" "$1,225.00" $255.32 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $255.30 "$1,225.00" $490.00 $724.59 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $551.25 $243.13 N/A $710.50 "$1,225.00" "$1,225.00" "$1,225.00" $255.29 "$1,225.00" N/A N/A AR-9550-15 SUP HCPCS C1776 AR-9550-15 - SPACER HUM +15MM 42MM STRL UNIVERS REVERS TI SHLDR ARTHPL BOTH IP/OP "$1,225.00" $907.00 $243.13 "$1,225.00" $551.25 $551.25 $551.25 $551.25 "$1,225.00" "$1,225.00" "$1,225.00" $255.32 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $255.30 "$1,225.00" "$1,225.00" $724.59 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $551.25 $243.13 N/A $710.50 "$1,225.00" "$1,225.00" "$1,225.00" $255.29 "$1,225.00" N/A N/A AR-9555-06 SUP HCPCS C1776 AR-9555-06 - SPACER HUM 36MM UNIVERS REVERS +6MM SHLDR TI BOTH IP/OP "$1,225.00" $907.00 $243.13 "$1,225.00" $551.25 $551.25 $551.25 $551.25 "$1,225.00" "$1,225.00" "$1,225.00" $255.32 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $255.30 "$1,225.00" $490.00 $724.59 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $551.25 $243.13 N/A $710.50 "$1,225.00" "$1,225.00" "$1,225.00" $255.29 "$1,225.00" N/A N/A AR-9555-09 SUP HCPCS C1776 AR-9555-09 - SPACER HUM +9MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL BOTH IP/OP "$1,225.00" $907.00 $243.13 "$1,225.00" $551.25 $551.25 $551.25 $551.25 "$1,225.00" "$1,225.00" "$1,225.00" $255.32 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $255.30 "$1,225.00" $490.00 $724.59 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $551.25 $243.13 N/A $710.50 "$1,225.00" "$1,225.00" "$1,225.00" $255.29 "$1,225.00" N/A N/A AR-9555-12 SUP HCPCS C1776 AR-9555-12 - SPACER HUM +12MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL BOTH IP/OP "$1,225.00" $907.00 $243.13 "$1,225.00" $551.25 $551.25 $551.25 $551.25 "$1,225.00" "$1,225.00" "$1,225.00" $255.32 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $255.30 "$1,225.00" $490.00 $724.59 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $551.25 $243.13 N/A $710.50 "$1,225.00" "$1,225.00" "$1,225.00" $255.29 "$1,225.00" N/A N/A AR-9555-15 SUP HCPCS C1776 AR-9555-15 - SPACER HUM +15MM 36MM STRL UNIVERS REVERS TI SHLDR ARTHPL BOTH IP/OP "$1,225.00" $907.00 $243.13 "$1,225.00" $551.25 $551.25 $551.25 $551.25 "$1,225.00" "$1,225.00" "$1,225.00" $255.32 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $255.30 "$1,225.00" "$1,225.00" $724.59 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $551.25 $243.13 N/A $710.50 "$1,225.00" "$1,225.00" "$1,225.00" $255.29 "$1,225.00" N/A N/A AR-9703A-90 SUP Custom 27203010 AR-9703A-90 - PROBE ESURG 90D LOPRFL 3MM STRL OPES ASPIRATE ABLT DISP BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-9704A-90 SUP Custom 27203010 AR-9704A-90 - PROBE ESURG 90D LOPRFL 4MM STRL OPES ASPIRATE ABLT DISP BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-9705-90 SUP Custom 27203010 AR-9705-90 - PROBE ESURG 90D LOPRFL STRL OPES ABLT TTHBRSH DISP BOTH IP/OP $337.50 $250.00 $60.08 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $337.50 $60.08 $337.50 $337.50 $250.49 $250.49 $260.15 $175.84 $70.34 $337.50 $135.00 $337.50 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $219.38 $337.50 N/A $195.75 $337.50 $202.50 $337.50 $337.50 $337.50 N/A N/A AR-9705A-90 SUP Custom 27203010 AR-9705A-90 - PROBE ESURG 90D LOPRFL STRL OPES ASPIRATE ABLT TTHBRSH DISP BOTH IP/OP $462.50 $342.00 $82.33 $462.50 $462.50 $462.50 $462.50 $462.50 $462.50 $462.50 $82.33 $462.50 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $185.00 $462.50 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $462.50 N/A $268.25 $462.50 $277.50 $462.50 $462.50 $462.50 N/A N/A AR-9802M-45 SUP Custom 27203010 AR-9802M-45 - ELECTRODE ESURG 45D STRL COOLCUT ABLATOR MNSCTM BOTH IP/OP $287.50 $213.00 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $51.18 $287.50 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $115.00 $287.50 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $287.50 N/A $166.75 $287.50 $172.50 $287.50 $287.50 $287.50 N/A N/A AR-9802M-90 SUP Custom 27203010 AR-9802M-90 - ELECTRODE ESURG 90D COOLCUT ABLATOR MNSCTM BOTH IP/OP $287.50 $213.00 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $51.18 $287.50 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $115.00 $287.50 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $287.50 N/A $166.75 $287.50 $172.50 $287.50 $287.50 $287.50 N/A N/A AR-9803-30 SUP Custom 27203010 AR-9803-30 - PROBE ESURG 30D 3MM STRL COOLCUT ABLT RF WND BOTH IP/OP $325.00 $241.00 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 N/A $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A AR-9803-50 SUP Custom 27203010 AR-9803-50 - ELECTRODE ESURG 50D 3MM COOLCUT 50 ABLATOR 50NA BOTH IP/OP $325.00 $241.00 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 N/A $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A AR-9803-90 SUP Custom 27203010 AR-9803-90 - PROBE ESURG 90D 3MM STRL COOLCUT ABLT RF WND BOTH IP/OP $325.00 $241.00 $57.85 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $325.00 $57.85 $325.00 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $130.00 $325.00 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $325.00 N/A $188.50 $325.00 $195.00 $325.00 $325.00 $325.00 N/A N/A AR-9803A-30 SUP Custom 27203010 AR-9803A-30 - PROBE ESURG 30D 3MM STRL COOLCUT ASPIRATE ABLT RF WND BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-9803A-50 SUP Custom 27203010 AR-9803A-50 - PROBE ESURG 50D 3MM STRL COOLCUT ASPIRATE ABLT RF WND BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-9803A-90 SUP Custom 27203010 AR-9803A-90 - PROBE ESURG 3MM COOLCUT 90D ASPIRATE ABLT RF WND BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AR-9808 SUP Custom 27203010 AR-9808 - ELECTRODE ESURG BALL STRL COOLCUT ABLT RF WND S JNT BOTH IP/OP $287.50 $213.00 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $51.18 $287.50 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $115.00 $287.50 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $287.50 N/A $166.75 $287.50 $172.50 $287.50 $287.50 $287.50 N/A N/A AR-9808-45 SUP Custom 27203010 AR-9808-45 - ELECTRODE ESURG 45D COOLCUT BALL ASCP BOTH IP/OP $287.50 $213.00 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $51.18 $287.50 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $115.00 $287.50 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $287.50 N/A $166.75 $287.50 $172.50 $287.50 $287.50 $287.50 N/A N/A AR-9808SJ SUP Custom 27203010 AR-9808SJ - ELECTRODE ESURG BALL STRL COOLCUT ABLT RF WND S JNT BOTH IP/OP $287.50 $213.00 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $51.18 $287.50 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $115.00 $287.50 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $287.50 N/A $166.75 $287.50 $172.50 $287.50 $287.50 $287.50 N/A N/A AR-9808SJ-45 SUP Custom 27203010 AR-9808SJ-45 - ELECTRODE ESURG 45D BALL STRL COOLCUT ABLT RF WND S JNT BOTH IP/OP $287.50 $213.00 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $51.18 $287.50 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $115.00 $287.50 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $287.50 N/A $166.75 $287.50 $172.50 $287.50 $287.50 $287.50 N/A N/A AR-9809SJ-45 SUP Custom 27203010 AR-9809SJ-45 - ELECTRODE ESURG 45D BALL STRL COOLCUT ABLT RF WND S JNT BOTH IP/OP $287.50 $213.00 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $51.18 $287.50 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $115.00 $287.50 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $287.50 N/A $166.75 $287.50 $172.50 $287.50 $287.50 $287.50 N/A N/A AR-9809SJ-90 SUP Custom 27203010 AR-9809SJ-90 - ELECTRODE ESURG 90D BALL STRL COOLCUT ABLT RF WND S JNT BOTH IP/OP $287.50 $213.00 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $51.18 $287.50 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $115.00 $287.50 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $287.50 N/A $166.75 $287.50 $172.50 $287.50 $287.50 $287.50 N/A N/A AR-9811 SUP Custom 27203010 AR-9811 - PROBE ESURG 90D APLO RF ML PRT BOTH IP/OP $475.00 $352.00 $84.55 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $475.00 $84.55 $475.00 $475.00 $352.55 $352.55 $366.13 $247.48 $99.00 $475.00 $190.00 $475.00 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $308.75 $475.00 N/A $275.50 $475.00 $285.00 $475.00 $475.00 $475.00 N/A N/A AR-992 SUP Custom 27203010 AR-992 - CASE INSTR OATS BOTH IP/OP $750.00 $555.00 $133.50 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $750.00 $133.50 $750.00 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $300.00 $750.00 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $750.00 N/A $435.00 $750.00 $450.00 $750.00 $750.00 $750.00 N/A N/A AR-9943BL-04 SUP HCPCS C1713 AR-9943BL-04 - PLATE BN 4 HL LCK TI FIB LT DIST BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $648.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A AR-9943BL-05 SUP HCPCS C1713 AR-9943BL-05 - PLATE BN 5 HL LCK TI FIB LT DIST BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" $756.00 "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A AR-9943BL-06 SUP HCPCS C1713 AR-9943BL-06 - PLATE BN 6 HL LCK TI FIB LT DIST BOTH IP/OP "$1,937.50" "$1,434.00" $384.55 "$2,092.50" $871.88 $871.88 $871.88 $871.88 "$1,937.50" "$1,937.50" "$1,937.50" $403.82 "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" $403.80 "$1,937.50" "$2,092.50" "$1,146.03" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,453.13" "$1,937.50" "$1,937.50" "$1,937.50" $968.75 $968.75 "$1,534.50" "$1,937.50" "$1,550.00" $871.88 $384.55 N/A "$1,123.75" "$1,937.50" "$1,162.50" "$1,937.50" $403.78 "$1,937.50" N/A N/A AR-9943BL-08 SUP HCPCS C1713 AR-9943BL-08 - PLATE BN ARTHX 8 HL LCK TI FIB LT DIST BOTH IP/OP "$2,112.50" "$1,563.00" $419.28 "$2,281.50" $950.63 $950.63 $950.63 $950.63 "$2,112.50" "$2,112.50" "$2,112.50" $440.30 "$2,112.50" "$2,112.50" "$2,112.50" "$2,112.50" "$2,112.50" $440.27 "$2,112.50" "$2,281.50" "$1,249.54" "$2,112.50" "$2,112.50" "$2,112.50" "$2,112.50" "$1,584.38" "$2,112.50" "$2,112.50" "$2,112.50" "$1,056.25" "$1,056.25" "$1,673.10" "$2,112.50" "$1,690.00" $950.63 $419.28 N/A "$1,225.25" "$2,112.50" "$2,112.50" "$2,112.50" $440.25 "$2,112.50" N/A N/A AR-9943BL-10 SUP HCPCS C1713 AR-9943BL-10 - PLATE BN ARTHX 10 HL LCK TI FIB LT DIST BOTH IP/OP "$2,325.00" "$1,721.00" $461.45 "$2,511.00" "$1,046.25" "$1,046.25" "$1,046.25" "$1,046.25" "$2,325.00" "$2,325.00" "$2,325.00" $484.59 "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" $484.56 "$2,325.00" "$2,511.00" "$1,375.24" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$1,743.75" "$2,325.00" "$2,325.00" "$2,325.00" "$1,162.50" "$1,162.50" "$1,841.40" "$2,325.00" "$1,860.00" "$1,046.25" $461.45 N/A "$1,348.50" "$2,325.00" "$1,395.00" "$2,325.00" $484.53 "$2,325.00" N/A N/A AR-9943BL-12 SUP HCPCS C1713 AR-9943BL-12 - PLATE BN ARTHX 12 HL LCK TI FIB LT DIST BOTH IP/OP "$2,350.00" "$1,739.00" $466.42 "$2,350.00" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$2,350.00" "$2,350.00" "$2,350.00" $489.80 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" "$1,015.20" "$1,390.03" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" $466.42 N/A "$1,363.00" "$2,350.00" "$1,410.00" "$2,350.00" $489.74 "$2,350.00" N/A N/A AR-9943BL-14 SUP HCPCS C1713 AR-9943BL-14 - PLATE BN ARTHX 14 HL LCK TI FIB LT DIST BOTH IP/OP "$2,375.00" "$1,758.00" $471.38 "$2,565.00" "$1,068.75" "$1,068.75" "$1,068.75" "$1,068.75" "$2,375.00" "$2,375.00" "$2,375.00" $495.01 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" "$2,565.00" "$1,404.81" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" $471.38 N/A "$1,377.50" "$2,375.00" "$1,425.00" "$2,375.00" $494.95 "$2,375.00" N/A N/A AR-9943BR-04 SUP HCPCS C1713 AR-9943BR-04 - PLATE BN 4 HL LCK TI FIB DIST BOTH IP/OP "$1,500.00" "$1,110.00" $297.71 "$1,500.00" $675.00 $675.00 $675.00 $675.00 "$1,500.00" "$1,500.00" "$1,500.00" $312.64 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $312.62 "$1,500.00" $648.00 $887.25 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $675.00 $297.71 N/A $870.00 "$1,500.00" $900.00 "$1,500.00" $312.60 "$1,500.00" N/A N/A AR-9943BR-06 SUP HCPCS C1713 AR-9943BR-06 - PLATE BN 6 HL LCK TI FIB RT DIST BOTH IP/OP "$1,937.50" "$1,434.00" $384.55 "$1,937.50" $871.88 $871.88 $871.88 $871.88 "$1,937.50" "$1,937.50" "$1,937.50" $403.82 "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" $403.80 "$1,937.50" $837.00 "$1,146.03" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,453.13" "$1,937.50" "$1,937.50" "$1,937.50" $968.75 $968.75 "$1,534.50" "$1,937.50" "$1,550.00" $871.88 $384.55 N/A "$1,123.75" "$1,937.50" "$1,162.50" "$1,937.50" $403.78 "$1,937.50" N/A N/A AR-9943BR-08 SUP HCPCS C1713 AR-9943BR-08 - PLATE BN ARTHX 8 HL LCK TI FIB RT DIST BOTH IP/OP "$2,112.50" "$1,563.00" $419.28 "$2,281.50" $950.63 $950.63 $950.63 $950.63 "$2,112.50" "$2,112.50" "$2,112.50" $440.30 "$2,112.50" "$2,112.50" "$2,112.50" "$2,112.50" "$2,112.50" $440.27 "$2,112.50" "$2,281.50" "$1,249.54" "$2,112.50" "$2,112.50" "$2,112.50" "$2,112.50" "$1,584.38" "$2,112.50" "$2,112.50" "$2,112.50" "$1,056.25" "$1,056.25" "$1,673.10" "$2,112.50" "$1,690.00" $950.63 $419.28 N/A "$1,225.25" "$2,112.50" "$1,267.50" "$2,112.50" $440.25 "$2,112.50" N/A N/A AR-9943BR-10 SUP HCPCS C1713 AR-9943BR-10 - PLATE BN ARTHX 10 HL LCK TI FIB RT DIST BOTH IP/OP "$2,325.00" "$1,721.00" $461.45 "$2,325.00" "$1,046.25" "$1,046.25" "$1,046.25" "$1,046.25" "$2,325.00" "$2,325.00" "$2,325.00" $484.59 "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" $484.56 "$2,325.00" "$1,004.40" "$1,375.24" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$1,743.75" "$2,325.00" "$2,325.00" "$2,325.00" "$1,162.50" "$1,162.50" "$1,841.40" "$2,325.00" "$1,860.00" "$1,046.25" $461.45 N/A "$1,348.50" "$2,325.00" "$2,325.00" "$2,325.00" $484.53 "$2,325.00" N/A N/A AR-9943BR-12 SUP HCPCS C1713 AR-9943BR-12 - PLATE BN NS ARTHX 12 HL LCK TI FIB RT DIST BOTH IP/OP "$2,350.00" "$1,739.00" $466.42 "$2,538.00" "$1,057.50" "$1,057.50" "$1,057.50" "$1,057.50" "$2,350.00" "$2,350.00" "$2,350.00" $489.80 "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.77 "$2,350.00" "$2,538.00" "$1,390.03" "$2,350.00" "$2,350.00" "$2,350.00" "$2,350.00" "$1,762.50" "$2,350.00" "$2,350.00" "$2,350.00" "$1,175.00" "$1,175.00" "$1,861.20" "$2,350.00" "$1,880.00" "$1,057.50" $466.42 N/A "$1,363.00" "$2,350.00" "$2,350.00" "$2,350.00" $489.74 "$2,350.00" N/A N/A AR-9943BR-14 SUP HCPCS C1713 AR-9943BR-14 - PLATE BN ARTHX 14 HL LCK TI FIB RT DIST BOTH IP/OP "$2,375.00" "$1,758.00" $471.38 "$2,375.00" "$1,068.75" "$1,068.75" "$1,068.75" "$1,068.75" "$2,375.00" "$2,375.00" "$2,375.00" $495.01 "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" $494.98 "$2,375.00" "$1,026.00" "$1,404.81" "$2,375.00" "$2,375.00" "$2,375.00" "$2,375.00" "$1,781.25" "$2,375.00" "$2,375.00" "$2,375.00" "$1,187.50" "$1,187.50" "$1,881.00" "$2,375.00" "$1,900.00" "$1,068.75" $471.38 N/A "$1,377.50" "$2,375.00" "$2,375.00" "$2,375.00" $494.95 "$2,375.00" N/A N/A AR-9943C-04 SUP HCPCS C1713 AR-9943C-04 - PLATE BN STRG 4 HL LCK TI BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $506.25 $506.25 $506.25 $506.25 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $486.00 $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 $223.28 N/A $652.50 "$1,125.00" "$1,125.00" "$1,125.00" $234.45 "$1,125.00" N/A N/A AR-9943C-06 SUP HCPCS C1713 AR-9943C-06 - PLATE BN STRG 6 HL LCK TI BOTH IP/OP "$1,187.50" $879.00 $235.69 "$1,187.50" $534.38 $534.38 $534.38 $534.38 "$1,187.50" "$1,187.50" "$1,187.50" $247.50 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $247.49 "$1,187.50" $513.00 $702.41 "$1,187.50" "$1,187.50" "$1,187.50" "$1,187.50" $890.63 "$1,187.50" "$1,187.50" "$1,187.50" $593.75 $593.75 $940.50 "$1,187.50" $950.00 $534.38 $235.69 N/A $688.75 "$1,187.50" "$1,187.50" "$1,187.50" $247.48 "$1,187.50" N/A N/A AR-9943C-07 SUP HCPCS C1713 AR-9943C-07 - PLATE BN STRG 7 HL LCK TI BOTH IP/OP "$1,312.50" $971.00 $260.50 "$1,312.50" $590.63 $590.63 $590.63 $590.63 "$1,312.50" "$1,312.50" "$1,312.50" $273.56 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $273.54 "$1,312.50" $567.00 $776.34 "$1,312.50" "$1,312.50" "$1,312.50" "$1,312.50" $984.38 "$1,312.50" "$1,312.50" "$1,312.50" $656.25 $656.25 "$1,039.50" "$1,312.50" "$1,050.00" $590.63 $260.50 N/A $761.25 "$1,312.50" $787.50 "$1,312.50" $273.53 "$1,312.50" N/A N/A AR-9943C-08 SUP HCPCS C1713 AR-9943C-08 - PLATE BN STRG 8 HL LCK TI ANKL BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" $594.00 $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" $825.00 "$1,375.00" $286.55 "$1,375.00" N/A N/A AR-9943C-10 SUP HCPCS C1713 AR-9943C-10 - PLATE BN STRG 10 HL LCK TI BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" $642.60 $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" $892.50 "$1,487.50" $310.00 "$1,487.50" N/A N/A AR-9943C-12 SUP HCPCS C1713 AR-9943C-12 - PLATE BN STRG 12 HL LCK TI BOTH IP/OP "$1,737.50" "$1,286.00" $344.85 "$1,876.50" $781.88 $781.88 $781.88 $781.88 "$1,737.50" "$1,737.50" "$1,737.50" $362.14 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" "$1,876.50" "$1,027.73" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 $344.85 N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" $362.10 "$1,737.50" N/A N/A AR-9943T-04 SUP HCPCS C1713 AR-9943T-04 - PLATE BN 1/3 TBLR 4 HL LCK TI BOTH IP/OP $562.50 $416.00 $111.64 $607.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $607.50 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $337.50 $562.50 $117.23 $562.50 N/A N/A AR-9943T-05 SUP HCPCS C1713 AR-9943T-05 - PLATE BN 1/3 TBLR 5 HL LCK TI BOTH IP/OP $587.50 $435.00 $116.60 $634.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $634.50 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $352.50 $587.50 $122.44 $587.50 N/A N/A AR-9943T-06 SUP HCPCS C1713 AR-9943T-06 - PLATE BN 1/3 TUBE 6 HL LCK TI BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $270.00 $270.00 $270.00 $270.00 $600.00 $600.00 $600.00 $125.06 $600.00 $600.00 $600.00 $600.00 $600.00 $125.05 $600.00 $259.20 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $270.00 $119.09 N/A $348.00 $600.00 $360.00 $600.00 $600.00 $600.00 N/A N/A AR-9943T-07 SUP HCPCS C1713 AR-9943T-07 - PLATE BN 3 TBLR 7 HL LCK TI BOTH IP/OP $637.50 $472.00 $126.53 $688.50 $286.88 $286.88 $286.88 $286.88 $637.50 $637.50 $637.50 $132.87 $637.50 $637.50 $637.50 $637.50 $637.50 $132.86 $637.50 $688.50 $377.08 $637.50 $637.50 $637.50 $637.50 $478.13 $637.50 $637.50 $637.50 $318.75 $318.75 $504.90 $637.50 $510.00 $286.88 $126.53 N/A $369.75 $637.50 $637.50 $637.50 $132.86 $637.50 N/A N/A AR-9943T-08 SUP HCPCS C1713 AR-9943T-08 - PLATE BN 1/3 TBLR 8 HL LCK TI BOTH IP/OP $662.50 $490.00 $131.49 $662.50 $298.13 $298.13 $298.13 $298.13 $662.50 $662.50 $662.50 $138.08 $662.50 $662.50 $662.50 $662.50 $662.50 $138.07 $662.50 $286.20 $391.87 $662.50 $662.50 $662.50 $662.50 $496.88 $662.50 $662.50 $662.50 $331.25 $331.25 $524.70 $662.50 $530.00 $298.13 $131.49 N/A $384.25 $662.50 $397.50 $662.50 $138.07 $662.50 N/A N/A AR-9943T-10 SUP HCPCS C1713 AR-9943T-10 - PLATE BN 1/3 TBLR 10 HL LCK TI ANKL BOTH IP/OP $700.00 $518.00 $138.93 $700.00 $315.00 $315.00 $315.00 $315.00 $700.00 $700.00 $700.00 $145.90 $700.00 $700.00 $700.00 $700.00 $700.00 $145.89 $700.00 $302.40 $414.05 $700.00 $700.00 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $350.00 $350.00 $554.40 $700.00 $560.00 $315.00 $138.93 N/A $406.00 $700.00 $420.00 $700.00 $145.88 $700.00 N/A N/A AR-9943T-12 SUP HCPCS C1713 AR-9943T-12 - PLATE BN 1/3 TBLR 12 HL LCK TI BOTH IP/OP $750.00 $555.00 $148.86 $810.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $810.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A AS09 SUP Custom 27203010 AS09 - ATTACHMENT TL STRG 3.2MM 9CM MDSRX LGN LG BORE BOTH IP/OP "$2,133.50" "$1,579.00" $379.69 "$2,133.10" "$2,133.10" "$2,133.10" "$2,133.10" "$2,133.10" "$2,133.10" "$2,133.10" $379.69 "$2,133.10" "$2,133.10" "$1,583.19" "$1,583.19" "$1,644.19" "$1,111.35" $444.56 "$2,133.10" $853.24 "$2,133.10" "$2,133.10" "$2,133.10" "$2,133.10" "$2,133.10" "$1,600.13" "$2,133.10" "$2,133.10" "$2,133.10" "$1,066.55" "$1,066.55" "$1,689.42" "$2,133.10" "$1,706.48" "$1,386.52" "$2,133.10" N/A "$1,237.43" "$2,133.10" "$1,279.86" "$2,133.10" "$2,133.10" "$2,133.10" N/A N/A AS10 SUP Custom 27203010 AS10 - ATTCH TL 10CM STR SM BORE MDSRX LGN 2.4MM BOTH IP/OP "$1,824.00" "$1,350.00" $324.66 "$1,823.93" "$1,823.93" "$1,823.93" "$1,823.93" "$1,823.93" "$1,823.93" "$1,823.93" $324.66 "$1,823.93" "$1,823.93" "$1,353.72" "$1,353.72" "$1,405.89" $950.27 $380.13 "$1,823.93" $729.57 "$1,823.93" "$1,823.93" "$1,823.93" "$1,823.93" "$1,823.93" "$1,368.00" "$1,823.93" "$1,823.93" "$1,823.93" $911.97 $911.97 "$1,444.55" "$1,823.93" "$1,459.14" "$1,185.55" "$1,823.93" N/A "$1,057.92" "$1,823.93" "$1,094.36" "$1,823.93" "$1,823.93" "$1,823.93" N/A N/A AS74180-06 SUP Custom 27203010 AS74180-06 - PACK VITRECTOMY 23GA BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 N/A $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A AT-0225-S SUP HCPCS C1713 AT-0225-S - SCREW BONE STANDARD 22.5MM ACUTRAK BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $310.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $465.00 $775.00 $161.51 $775.00 N/A N/A AT-1032 SUP Custom 27203010 AT-1032 - BIT DRILL CANN ACUTRAK BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A AT-1125-S SUP HCPCS C1713 AT-1125-S - SCREW BONE STANDARD FULTHD TAPER 3.3-4.6MM 12.5MM SELF TAP BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AT-1150-S SUP HCPCS C1713 AT-1150-S - SCREW BN STD 15MM BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AT-1175-S SUP HCPCS C1713 AT-1175-S - SCREW BN STD 3.3-4.6MM 17.5MM STRL ACTRK SLF CUT CNN VAR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AT-1200-S SUP HCPCS C1713 AT-1200-S - SCREW BN STD 3.3-4.6MM 20MM STRL ACTRK SLF CUT CNN VAR PTCH BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AT-1225-S SUP HCPCS C1713 AT-1225-S - SCREW BN STD 3.3-4.6MM 22.5MM STRL ACTRK SLF CUT CNN VAR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AT-1250-S SUP HCPCS C1713 AT-1250-S - SCREW BN STD 3.3-4.6MM 25MM STRL ACTRK SLF CUT CNN VAR PTCH BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A AT-1275-S SUP HCPCS C1713 AT-1275-S - SCREW BN STD 3.3-4.6MM 27.5MM STRL ACTRK SLF CUT CNN VAR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AT-1300-S SUP HCPCS C1713 AT-1300-S - SCREW BN STD 3.3-4.6MM 30MM STRL ACTRK SLF CUT CNN VAR PTCH BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AT2-1509 SUP Custom 27203010 AT2-1509 - BIT DRL 2 MIC ACUTRAL BOTH IP/OP $567.50 $420.00 $101.02 $567.50 $567.50 $567.50 $567.50 $567.50 $567.50 $567.50 $101.02 $567.50 $567.50 $421.20 $421.20 $437.43 $295.67 $118.27 $567.50 $227.00 $567.50 $567.50 $567.50 $567.50 $567.50 $425.63 $567.50 $567.50 $567.50 $283.75 $283.75 $449.46 $567.50 $454.00 $368.88 $567.50 N/A $329.15 $567.50 $340.50 $567.50 $567.50 $567.50 N/A N/A AT2-2515 SUP Custom 27203010 AT2-2515 - BIT DRL STD ACTRK2 BOTH IP/OP $567.50 $420.00 $101.02 $567.50 $567.50 $567.50 $567.50 $567.50 $567.50 $567.50 $101.02 $567.50 $567.50 $421.20 $421.20 $437.43 $295.67 $118.27 $567.50 $227.00 $567.50 $567.50 $567.50 $567.50 $567.50 $425.63 $567.50 $567.50 $567.50 $283.75 $283.75 $449.46 $567.50 $454.00 $368.88 $567.50 N/A $329.15 $567.50 $340.50 $567.50 $567.50 $567.50 N/A N/A AT2-3500 SUP HCPCS C1769 AT2-3500 - GUIDEWIRE ORTH .035IN PRLL BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $325.80 $325.80 $325.80 $325.80 $600.00 $600.00 $600.00 $125.06 $600.00 $445.32 $445.32 $462.48 $312.60 $125.05 $600.00 $600.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $390.00 $119.09 N/A $348.00 $600.00 $600.00 $600.00 $125.04 $600.00 N/A N/A AT2-4500 SUP HCPCS C1769 AT2-4500 - GWIRE ORTH .045IN PRLL BOTH IP/OP $560.00 $414.00 $111.15 $560.00 $304.08 $304.08 $304.08 $304.08 $560.00 $560.00 $560.00 $116.72 $560.00 $415.63 $415.63 $431.65 $291.76 $116.71 $560.00 $560.00 $331.24 $560.00 $560.00 $560.00 $560.00 $420.00 $560.00 $560.00 $560.00 $280.00 $280.00 $443.52 $560.00 $448.00 $364.00 $111.15 N/A $324.80 $560.00 $560.00 $560.00 $116.70 $560.00 N/A N/A AT2-520-S SUP HCPCS C1713 AT2-520-S - SCREW BONE STANDARD HEXAGON 20MM CANN SELF CUT COMPRESSION BOTH IP/OP "$1,062.50" $786.00 $210.88 "$1,062.50" $478.13 $478.13 $478.13 $478.13 "$1,062.50" "$1,062.50" "$1,062.50" $221.45 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $221.44 "$1,062.50" "$1,062.50" $628.47 "$1,062.50" "$1,062.50" "$1,062.50" "$1,062.50" $796.88 "$1,062.50" "$1,062.50" "$1,062.50" $531.25 $531.25 $841.50 "$1,062.50" $850.00 $478.13 $210.88 N/A $616.25 "$1,062.50" "$1,062.50" "$1,062.50" $221.43 "$1,062.50" N/A N/A AT2-5400 SUP HCPCS C1769 AT2-5400 - GWIRE ORTH .054IN PRLL BOTH IP/OP $560.00 $414.00 $111.15 $560.00 $304.08 $304.08 $304.08 $304.08 $560.00 $560.00 $560.00 $116.72 $560.00 $415.63 $415.63 $431.65 $291.76 $116.71 $560.00 $560.00 $331.24 $560.00 $560.00 $560.00 $560.00 $420.00 $560.00 $560.00 $560.00 $280.00 $280.00 $443.52 $560.00 $448.00 $364.00 $111.15 N/A $324.80 $560.00 $560.00 $560.00 $116.70 $560.00 N/A N/A AT2-C08-S SUP HCPCS C1713 AT2-C08-S - SCREW BN MIC 8MM FUSHIA BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" $696.00 "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-C09-S SUP HCPCS C1713 AT2-C09-S - SCREW BN MIC 9MM FUSHIA BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" $696.00 "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-C10-S SUP HCPCS C1713 AT2-C10-S - SCREW BN MIC 10MM FUSHIA BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" $696.00 "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-C11-S SUP HCPCS C1713 AT2-C11-S - SCREW BONE 2MM 11MM ACTRK TI MIC FULTHD ORTH SLFTAP CANN BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" $696.00 "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-C12-S SUP HCPCS C1713 AT2-C12-S - SCREW BN MIC 12MM FUSHIA BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" $696.00 "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-C13-S SUP HCPCS C1713 AT2-C13-S - SCREW BONE 2MM 13MM ACTRK2 TI MIC FULTHD ORTH SLFTAP CANN BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-C14-S SUP HCPCS C1713 AT2-C14-S - SCREW BN MIC 14MM FUSHIA BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-C16-S SUP HCPCS C1713 AT2-C16-S - SCREW BN MIC 16MM FUSHIA BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-C18-S SUP HCPCS C1713 AT2-C18-S - SCREW BN MIC 18MM FUSHIA BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-C20-S SUP HCPCS C1713 AT2-C20-S - SCREW BN MIC FT 2.5-2.8MM 20MM STRL ACTRK2 SLF CUT CNN VAR BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2L1813 SUP Custom 27203010 AT2L1813 - BIT DRILL ACTRK2 MINI BOTH IP/OP $567.50 $420.00 $101.02 $567.50 $567.50 $567.50 $567.50 $567.50 $567.50 $567.50 $101.02 $567.50 $567.50 $421.20 $421.20 $437.43 $295.67 $118.27 $567.50 $227.00 $567.50 $567.50 $567.50 $567.50 $567.50 $425.63 $567.50 $567.50 $567.50 $283.75 $283.75 $449.46 $567.50 $454.00 $368.88 $567.50 N/A $329.15 $567.50 $340.50 $567.50 $567.50 $567.50 N/A N/A AT2-L2515 SUP HCPCS C1713 AT2-L2515 - BIT DRL LNG ACTRK2 BOTH IP/OP $567.50 $420.00 $112.63 $567.50 $255.38 $255.38 $255.38 $255.38 $567.50 $567.50 $567.50 $118.28 $567.50 $567.50 $567.50 $567.50 $567.50 $118.27 $567.50 $227.00 $335.68 $567.50 $567.50 $567.50 $567.50 $425.63 $567.50 $567.50 $567.50 $283.75 $283.75 $449.46 $567.50 $454.00 $255.38 $112.63 N/A $329.15 $567.50 $567.50 $567.50 $118.27 $567.50 N/A N/A AT2-M16-S SUP HCPCS C1713 AT2-M16-S - SCREW BN MN FT 3.5-3.6MM 16MM STRL ACTRK2 SLF CUT CNN VAR BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" $696.00 "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2M-1813 SUP Custom 27203010 AT2M-1813 - DRILL SURG MINI PROFILE ACUTRAK 2 NONSTRL 3.5-4MM SCREW BOTH IP/OP $567.50 $420.00 $101.02 $567.50 $567.50 $567.50 $567.50 $567.50 $567.50 $567.50 $101.02 $567.50 $567.50 $421.20 $421.20 $437.43 $295.67 $118.27 $567.50 $227.00 $567.50 $567.50 $567.50 $567.50 $567.50 $425.63 $567.50 $567.50 $567.50 $283.75 $283.75 $449.46 $567.50 $454.00 $368.88 $567.50 N/A $329.15 $567.50 $340.50 $567.50 $567.50 $567.50 N/A N/A AT2-M20-S SUP HCPCS C1713 AT2-M20-S - SCREW BN MN 20MM STRL ACTRK2 TI ORTH BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-M22-S SUP HCPCS C1713 AT2-M22-S - SCREW BN MN FT 3.5-3.6MM 22MM STRL ACTRK2 SLF CUT CNN VAR BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-M24-S SUP HCPCS C1713 AT2-M24-S - SCREW BN MN 24MM STRL ACTRK2 TI ORTH BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-M26-S SUP HCPCS C1713 AT2-M26-S - SCREW BN MN FT 3.5-3.6MM 26MM STRL ACTRK2 SLF CUT CNN VAR BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-M28-S SUP HCPCS C1713 AT2-M28-S - SCREW BN MN FT 3.5-3.6MM 28MM STRL ACTRK2 SLF CUT CNN VAR BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" N/A N/A AT2-M30-S SUP HCPCS C1713 AT2-M30-S - SCREW 30.0MM MINI ACUTRAK 2 BONE BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" $464.00 $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" $696.00 "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2M-L1813 SUP Custom 27203010 AT2M-L1813 - BIT DRL MN BOTH IP/OP $567.50 $420.00 $101.02 $567.50 $567.50 $567.50 $567.50 $567.50 $567.50 $567.50 $101.02 $567.50 $567.50 $421.20 $421.20 $437.43 $295.67 $118.27 $567.50 $227.00 $567.50 $567.50 $567.50 $567.50 $567.50 $425.63 $567.50 $567.50 $567.50 $283.75 $283.75 $449.46 $567.50 $454.00 $368.88 $567.50 N/A $329.15 $567.50 $340.50 $567.50 $567.50 $567.50 N/A N/A AT2ML1816 SUP Custom 27203010 AT2ML1816 - BIT DRILL BOTH IP/OP $567.50 $420.00 $101.02 $567.50 $567.50 $567.50 $567.50 $567.50 $567.50 $567.50 $101.02 $567.50 $567.50 $421.20 $421.20 $437.43 $295.67 $118.27 $567.50 $227.00 $567.50 $567.50 $567.50 $567.50 $567.50 $425.63 $567.50 $567.50 $567.50 $283.75 $283.75 $449.46 $567.50 $454.00 $368.88 $567.50 N/A $329.15 $567.50 $340.50 $567.50 $567.50 $567.50 N/A N/A AT2-S16-S SUP HCPCS C1713 AT2-S16-S - SCREW BN STD 2MM 16MM ACTRK2 BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-S18-S SUP HCPCS C1713 AT2-S18-S - SCREW BN STD FT 4-4.1MM 18MM STRL ACTRK2 SLF CUT CNN VAR BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-S20-S SUP HCPCS C1713 AT2-S20-S - SCREW BN STD FT 4-4.1MM 20MM STRL ACTRK2 SLF CUT CNN VAR BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-S22-S SUP HCPCS C1713 AT2-S22-S - SCREW BN STD FT 4-4.1MM 22MM STRL ACTRK2 SLF CUT CNN VAR BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-S24-S SUP HCPCS C1713 AT2-S24-S - SCREW BN 24MM STRL BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-S26-S SUP HCPCS C1713 AT2-S26-S - SCREW BN STD FT 4-4.1MM 26MM STRL ACTRK2 SLFCT CNN CMPR HEX BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-S28-S SUP HCPCS C1713 AT2-S28-S - SCREW BN STD 2MM 28MM ACTRK2 BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-S30-S SUP HCPCS C1713 AT2-S30-S - SCREW BONE 2MM 30MM ACTRK2 TI STD HINDFOOT ANKL SLFTAP CANN BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-S32-S SUP HCPCS C1713 AT2-S32-S - SCREW BONE STANDARD 2MM 32MM ACUTRAK 2 FT HAND BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT2-S34-S SUP HCPCS C1713 AT2-S34-S - SCREW BONE STANDARD 2MM 34MM ACUTRAK 2 FT HAND BOTH IP/OP "$1,160.00" $858.00 $230.23 "$1,160.00" $522.00 $522.00 $522.00 $522.00 "$1,160.00" "$1,160.00" "$1,160.00" $241.77 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $241.76 "$1,160.00" "$1,160.00" $686.14 "$1,160.00" "$1,160.00" "$1,160.00" "$1,160.00" $870.00 "$1,160.00" "$1,160.00" "$1,160.00" $580.00 $580.00 $918.72 "$1,160.00" $928.00 $522.00 $230.23 N/A $672.80 "$1,160.00" "$1,160.00" "$1,160.00" $241.74 "$1,160.00" N/A N/A AT-7032 SUP Custom 27203010 AT-7032 - BIT DRL STD TPR 2.5MM 4.7MM STRL ACTRK CNN TI BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A AT-7044 SUP Custom 27203010 AT-7044 - DRILL SURG STANDARD CANN DENSE ACUTRAK STERILE BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A ATF-024 SUP Custom 27203010 ATF-024 - DRILL SRG 24MM ACTRK FSN BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A ATF-032 SUP Custom 27203010 ATF-032 - DRILL SURG 2MM FUSION ACUTRAK 27MM SCREW BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A ATF-037 SUP Custom 27203010 ATF-037 - DRILL SURG 2.4MM 37MM FUSION ACUTRAK 37MM SCREW BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A ATF-140-S SUP HCPCS C1713 ATF-140-S - SCREW BN 14MM ACTRK FSN BOTH IP/OP $810.00 $599.00 $160.76 $810.00 $364.50 $364.50 $364.50 $364.50 $810.00 $810.00 $810.00 $168.82 $810.00 $810.00 $810.00 $810.00 $810.00 $168.81 $810.00 $810.00 $479.12 $810.00 $810.00 $810.00 $810.00 $607.50 $810.00 $810.00 $810.00 $405.00 $405.00 $641.52 $810.00 $648.00 $364.50 $160.76 N/A $469.80 $810.00 $810.00 $810.00 $168.80 $810.00 N/A N/A ATF-160-S SUP HCPCS C1713 ATF-160-S - SCREW BN 16MM ACTRK FSN BOTH IP/OP $810.00 $599.00 $160.76 $810.00 $364.50 $364.50 $364.50 $364.50 $810.00 $810.00 $810.00 $168.82 $810.00 $810.00 $810.00 $810.00 $810.00 $168.81 $810.00 $810.00 $479.12 $810.00 $810.00 $810.00 $810.00 $607.50 $810.00 $810.00 $810.00 $405.00 $405.00 $641.52 $810.00 $648.00 $364.50 $160.76 N/A $469.80 $810.00 $810.00 $810.00 $168.80 $810.00 N/A N/A ATF-180-S SUP HCPCS C1713 ATF-180-S - SCREW BN 18MM ACTRK FSN BOTH IP/OP $810.00 $599.00 $160.76 $810.00 $364.50 $364.50 $364.50 $364.50 $810.00 $810.00 $810.00 $168.82 $810.00 $810.00 $810.00 $810.00 $810.00 $168.81 $810.00 $810.00 $479.12 $810.00 $810.00 $810.00 $810.00 $607.50 $810.00 $810.00 $810.00 $405.00 $405.00 $641.52 $810.00 $648.00 $364.50 $160.76 N/A $469.80 $810.00 $810.00 $810.00 $168.80 $810.00 N/A N/A ATF-200-S SUP HCPCS C1713 ATF-200-S - SCREW BN 20MM ACTRK FSN BOTH IP/OP $810.00 $599.00 $160.76 $810.00 $364.50 $364.50 $364.50 $364.50 $810.00 $810.00 $810.00 $168.82 $810.00 $810.00 $810.00 $810.00 $810.00 $168.81 $810.00 $810.00 $479.12 $810.00 $810.00 $810.00 $810.00 $607.50 $810.00 $810.00 $810.00 $405.00 $405.00 $641.52 $810.00 $648.00 $364.50 $160.76 N/A $469.80 $810.00 $810.00 $810.00 $168.80 $810.00 N/A N/A ATF-220-S SUP HCPCS C1713 ATF-220-S - SCREW BN 22MM ACTRK FSN BOTH IP/OP $810.00 $599.00 $160.76 $810.00 $364.50 $364.50 $364.50 $364.50 $810.00 $810.00 $810.00 $168.82 $810.00 $810.00 $810.00 $810.00 $810.00 $168.81 $810.00 $810.00 $479.12 $810.00 $810.00 $810.00 $810.00 $607.50 $810.00 $810.00 $810.00 $405.00 $405.00 $641.52 $810.00 $648.00 $364.50 $160.76 N/A $469.80 $810.00 $810.00 $810.00 $168.80 $810.00 N/A N/A ATF-240-S SUP HCPCS C1713 ATF-240-S - SCREW BN FT 2-2.5MM 24MM STRL ACTRK SLF CUT CNN FSN HDLS TI BOTH IP/OP $810.00 $599.00 $160.76 $810.00 $364.50 $364.50 $364.50 $364.50 $810.00 $810.00 $810.00 $168.82 $810.00 $810.00 $810.00 $810.00 $810.00 $168.81 $810.00 $324.00 $479.12 $810.00 $810.00 $810.00 $810.00 $607.50 $810.00 $810.00 $810.00 $405.00 $405.00 $641.52 $810.00 $648.00 $364.50 $160.76 N/A $469.80 $810.00 $810.00 $810.00 $168.80 $810.00 N/A N/A ATF-270-S SUP HCPCS C1713 ATF-270-S - SCREW BN FT 2.8-3.5MM 27MM STRL ACTRK SLF CUT CNN FSN HDLS BOTH IP/OP $810.00 $599.00 $160.76 $810.00 $364.50 $364.50 $364.50 $364.50 $810.00 $810.00 $810.00 $168.82 $810.00 $810.00 $810.00 $810.00 $810.00 $168.81 $810.00 $324.00 $479.12 $810.00 $810.00 $810.00 $810.00 $607.50 $810.00 $810.00 $810.00 $405.00 $405.00 $641.52 $810.00 $648.00 $364.50 $160.76 N/A $469.80 $810.00 $810.00 $810.00 $168.80 $810.00 N/A N/A ATF-320-S SUP HCPCS C1713 ATF-320-S - SCREW BONE FULTHD TAPER 2.8-3.5MM 32MM SELF TAP CANN BOTH IP/OP $810.00 $599.00 $160.76 $810.00 $364.50 $364.50 $364.50 $364.50 $810.00 $810.00 $810.00 $168.82 $810.00 $810.00 $810.00 $810.00 $810.00 $168.81 $810.00 $810.00 $479.12 $810.00 $810.00 $810.00 $810.00 $607.50 $810.00 $810.00 $810.00 $405.00 $405.00 $641.52 $810.00 $648.00 $364.50 $160.76 N/A $469.80 $810.00 $810.00 $810.00 $168.80 $810.00 N/A N/A ATF-370-S SUP Custom 27803010 ATF-370-S - SCREW BONE FULTHD TAPER 3.3-4MM 37MM SELF TAP CANN VARIABLE BOTH IP/OP $810.00 $599.00 $144.18 $810.00 $810.00 $810.00 $810.00 $810.00 $810.00 $810.00 $144.18 $810.00 $810.00 $810.00 $810.00 $810.00 $810.00 $168.81 $810.00 $324.00 $810.00 $810.00 $810.00 $810.00 $810.00 $607.50 $810.00 $810.00 $810.00 $405.00 $405.00 $641.52 $810.00 $648.00 $364.50 $810.00 N/A $469.80 $810.00 $486.00 $810.00 $810.00 $810.00 N/A N/A ATG80144 SUP HCPCS C1725 ATG80144 - CATHETER BLNDIL LG DIA 14MM 80CM 4CM ATLS AU SHRT SHLDR ACPT BOTH IP/OP $700.00 $518.00 $138.93 $712.50 $380.10 $380.10 $380.10 $380.10 $700.00 $700.00 $700.00 $145.90 $700.00 $519.54 $519.54 $539.56 $364.70 $145.89 $700.00 $712.50 $414.05 $700.00 $712.50 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $350.00 $350.00 $554.40 $700.00 $560.00 $455.00 $138.93 N/A $406.00 $700.00 $700.00 $700.00 $145.88 $700.00 N/A N/A ATG80164 SUP HCPCS C1725 ATG80164 - CATHETER BLNDIL LG DIA 16MM 80CM 4CM ATLS AU SHRT SHLDR ACPT BOTH IP/OP $700.00 $518.00 $138.93 $712.50 $380.10 $380.10 $380.10 $380.10 $700.00 $700.00 $700.00 $145.90 $700.00 $519.54 $519.54 $539.56 $364.70 $145.89 $700.00 $712.50 $414.05 $700.00 $712.50 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $350.00 $350.00 $554.40 $700.00 $560.00 $455.00 $138.93 N/A $406.00 $700.00 $700.00 $700.00 $145.88 $700.00 N/A N/A ATM-008-S SUP HCPCS C1713 ATM-008-S - SCREW BN 8MM ACTRK BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A ATM-078 SUP Custom 27203010 ATM-078 - DRILL SURG MINI SHORT TAPER 2.3MM CANN ACUTRAK STERILE BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A ATM-099 SUP Custom 27203010 ATM-099 - DRILL SURG MINI LONG TAPER CANN ACUTRAK STERILE BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A ATM-100-S SUP HCPCS C1713 ATM-100-S - SCREW BN MN 10MM ACTRK FX BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A ATM-120-S SUP HCPCS C1713 ATM-120-S - SCREW BN MN FT 2.8-3.6MM 12MM STRL ACTRK SLF CUT CNN VAR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A ATM-140-S SUP HCPCS C1713 ATM-140-S - SCREW BN MN FT 2.8-3.6MM 14MM STRL ACTRK SLF CUT CNN VAR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A ATM-160-S SUP HCPCS C1713 ATM-160-S - SCREW BN MN FT 2.8-3.6MM 16MM STRL ACTRK SLF CUT CNN VAR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A ATM-180-S SUP HCPCS C1713 ATM-180-S - SCREW BN MN FT 2.8-3.6MM 18MM STRL ACTRK SLF CUT CNN VAR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A ATM-200-S SUP HCPCS C1713 ATM-200-S - SCREW BN MN FT 2.8-3.6MM 20MM STRL ACTRK SLF CUT CNN VAR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A ATM-220-S SUP HCPCS C1713 ATM-220-S - SCREW BN MN FT 2.8-3.6MM 22MM STRL ACTRK SLF CUT CNN VAR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $940.00 $940.00 $195.90 $940.00 N/A N/A ATM-240-S SUP HCPCS C1713 ATM-240-S - SCREW BN MN 24MM ACTRK FX BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A ATM-260-S SUP HCPCS C1713 ATM-260-S - SCREW BN MN FT 2.8-3.6MM 26MM STRL ACTRK SLF CUT CNN VAR BOTH IP/OP $940.00 $696.00 $186.57 $940.00 $423.00 $423.00 $423.00 $423.00 $940.00 $940.00 $940.00 $195.92 $940.00 $940.00 $940.00 $940.00 $940.00 $195.91 $940.00 $940.00 $556.01 $940.00 $940.00 $940.00 $940.00 $705.00 $940.00 $940.00 $940.00 $470.00 $470.00 $744.48 $940.00 $752.00 $423.00 $186.57 N/A $545.20 $940.00 $564.00 $940.00 $195.90 $940.00 N/A N/A AU00T0 SUP HCPCS V2632 AU00T0 - LENS IOL 0D PLANAR 6MM 30MM ACRSF IQ STABLEFORCE ULTRASERT BOTH IP/OP $537.50 $398.00 $106.68 $537.50 $241.88 $241.88 $241.88 $241.88 $537.50 $537.50 $537.50 $112.03 $537.50 $537.50 $537.50 $537.50 $537.50 $112.02 $537.50 $537.50 $317.93 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $241.88 $106.68 N/A $311.75 $537.50 $537.50 $537.50 $112.02 $537.50 N/A N/A AVM851 SUP Custom 27803010 AVM851 - CLIP INTNL SM STRL LF FLSH SFLN UPR JAW SIL TI FLLPN TUBE BOTH IP/OP $224.00 $166.00 $39.86 $223.95 $223.95 $223.95 $223.95 $223.95 $223.95 $223.95 $39.86 $223.95 $223.95 $223.95 $223.95 $223.95 $223.95 $46.67 $223.95 $89.58 $223.95 $223.95 $223.95 $223.95 $223.95 $168.00 $223.95 $223.95 $223.95 $111.98 $111.98 $177.37 $223.95 $179.16 $100.78 $223.95 N/A $129.92 $223.95 $134.37 $223.95 $223.95 $223.95 N/A N/A AVRL0101 SUP HCPCS Q4100 AVRL0101 - DEVICE CELL HRVT RECELL ATLGS BOTH IP/OP "$16,687.50" "$12,349.00" "$3,312.05" "$17,187.50" "$7,509.38" "$7,509.38" "$7,509.38" "$7,509.38" "$16,687.50" "$16,687.50" "$16,687.50" "$3,478.09" "$16,687.50" "$16,687.50" "$16,687.50" "$16,687.50" "$16,687.50" "$3,477.86" "$16,687.50" "$17,187.50" "$8,226.94" "$16,687.50" "$16,687.50" "$16,687.50" "$16,687.50" "$12,515.63" "$16,687.50" "$16,687.50" "$16,687.50" "$8,343.75" "$8,343.75" "$13,216.50" "$16,687.50" "$13,350.00" "$7,509.38" "$3,312.05" N/A "$9,678.75" "$16,687.50" "$16,687.50" "$16,687.50" "$3,477.68" "$16,687.50" N/A N/A AVSM10060 SUP HCPCS C2625 AVSM10060 - STENT VASCULAR COVERA COVERED 10MM X 60MM 80CM DELIVERY STR BOTH IP/OP "$3,883.50" "$2,874.00" $770.72 "$6,750.00" "$1,747.44" "$1,747.44" "$1,747.44" "$1,747.44" "$3,883.20" "$3,883.20" "$3,883.20" $809.36 "$3,883.20" "$3,883.20" "$3,883.20" "$3,883.20" "$3,883.20" $809.30 "$3,883.20" "$6,750.00" "$1,914.42" "$3,883.20" "$3,883.20" "$3,883.20" "$3,883.20" "$2,912.63" "$3,883.20" "$3,883.20" "$3,883.20" "$1,941.60" "$1,941.60" "$3,075.49" "$3,883.20" "$3,106.56" "$1,747.44" $770.72 N/A "$2,252.43" "$3,883.20" "$3,883.20" "$3,883.20" $809.26 "$3,883.20" N/A N/A AW-14735 SUP HCPCS C1769 GUIDEWIRE VASC .35IN 65CM SPRG JTP 2 END STRG ARW ADV SS BOTH IP/OP $24.00 $18.00 $7.97 $40.15 $21.80 $21.80 $21.80 $21.80 $40.15 $40.15 $40.15 $8.37 $40.15 $29.80 $29.80 $30.95 $20.92 $8.37 $40.15 $24.40 $23.75 $40.15 $24.40 $40.15 $40.15 $18.00 $40.15 $40.15 $40.15 $20.08 $20.08 $31.80 $40.15 $32.12 $26.10 $7.97 N/A $13.92 $40.15 $40.15 $40.15 $8.37 $40.15 N/A N/A AW-14735 SUP HCPCS C1769 AW-14735 - GUIDEWIRE VASCULAR .035IN 26 13/16IN 1 END MARK SPRING STR BOTH IP/OP $40.50 $30.00 $7.97 $40.15 $21.80 $21.80 $21.80 $21.80 $40.15 $40.15 $40.15 $8.37 $40.15 $29.80 $29.80 $30.95 $20.92 $8.37 $40.15 $24.40 $23.75 $40.15 $24.40 $40.15 $40.15 $30.38 $40.15 $40.15 $40.15 $20.08 $20.08 $31.80 $40.15 $32.12 $26.10 $7.97 N/A $23.49 $40.15 $40.15 $40.15 $8.37 $40.15 N/A N/A B000-0185 SUP HCPCS C1713 B000-0185 - RESTRICTOR CEMENT SMALL UNIVERSAL 18.5MM REVISION PLUG HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A B000-0200 SUP HCPCS C1713 B000-0200 - PLUG BONE CEMENT MEDIUM UNIVERSAL 20MM BOTH IP/OP $188.00 $139.00 $37.31 $188.00 $84.60 $84.60 $84.60 $84.60 $188.00 $188.00 $188.00 $39.18 $188.00 $188.00 $188.00 $188.00 $188.00 $39.18 $188.00 $188.00 $111.20 $188.00 $188.00 $188.00 $188.00 $141.00 $188.00 $188.00 $188.00 $94.00 $94.00 $148.90 $188.00 $150.40 $84.60 $37.31 N/A $109.04 $188.00 $112.80 $188.00 $39.18 $188.00 N/A N/A B000-0240 SUP HCPCS C1713 B000-0240 - RESTRICTOR CEMENT MEDIUM UNIVERSAL 24MM REVISION PLUG HIP BOTH IP/OP $183.00 $135.00 $36.32 $183.00 $82.35 $82.35 $82.35 $82.35 $183.00 $183.00 $183.00 $38.14 $183.00 $183.00 $183.00 $183.00 $183.00 $38.14 $183.00 $112.50 $108.24 $183.00 $112.50 $183.00 $183.00 $137.25 $183.00 $183.00 $183.00 $91.50 $91.50 $144.94 $183.00 $146.40 $82.35 $36.32 N/A $106.14 $183.00 $109.80 $183.00 $38.14 $183.00 N/A N/A B000-0300 SUP HCPCS C1713 B000-0300 - RESTRICTOR CEMENT XL UNIVERSAL 30MM REVISION HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $45.00 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A B000-1185 SUP HCPCS C1713 B000-1185 - RESTRICTOR CEMENT SMALL UNIVERSAL DISPOSABLE INSERTER DISTAL BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A B000-1240 SUP HCPCS C1713 B000-1240 - RESTRICTOR CEMENT MEDIUM UNIVERSAL DISPOSABLE INSERTER BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A B000-1300 SUP HCPCS C1713 B000-1300 - RESTRICTOR CEMENT UNIVERSAL DISPOSABLE INSERTER BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A B001-0110 SUP HCPCS C1713 B001-0110 - PLUG BONE CEMENT 1 11MM UHMWPE HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A B002-0125 SUP HCPCS C1713 B002-0125 - PLUG BONE CEMENT 2 12.5MM UHMWPE HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A B003-0140 SUP HCPCS C1713 B003-0140 - PLUG BONE CEMENT 3 17.5MM UHMWPE HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A B004-0155 SUP HCPCS C1713 B004-0155 - PLUG BONE CEMENT 4 23MM UHMWPE HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A B005-0170 SUP HCPCS C1713 B005-0170 - PLUG BONE CEMENT 5 17MM UHMWPE HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A B006-0185 SUP HCPCS C1713 B006-0185 - PLUG BONE CEMENT 6 18MM UHMWPE HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A B007-0200 SUP HCPCS C1713 B007-0200 - PLUG BONE CEMENT 7 20MM UHMWPE HIP BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A B008-0215 SUP HCPCS C1713 B008-0215 - PLUG BONE CEMENT 8 21.5MM UHMWPE BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $50.63 $50.63 $50.63 $50.63 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $112.50 $112.50 $112.50 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $50.63 $22.33 N/A $65.25 $112.50 $67.50 $112.50 $23.45 $112.50 N/A N/A B10-27A-00 SUP Custom 27803010 B10-27A-00 - VALVE AORTIC LP 27MM 17MM BIOPROSTHESIS STENT RADIOPQ BIOCOR BOTH IP/OP "$19,200.00" "$14,208.00" "$3,417.60" "$19,200.00" "$19,200.00" "$19,200.00" "$19,200.00" "$19,200.00" "$19,200.00" "$19,200.00" "$3,417.60" "$19,200.00" "$19,200.00" "$19,200.00" "$19,200.00" "$19,200.00" "$19,200.00" "$4,001.49" "$19,200.00" "$7,680.00" "$19,200.00" "$19,200.00" "$19,200.00" "$19,200.00" "$19,200.00" "$14,400.00" "$19,200.00" "$19,200.00" "$19,200.00" "$9,600.00" "$9,600.00" "$15,206.40" "$19,200.00" "$15,360.00" "$8,640.00" "$19,200.00" N/A "$11,136.00" "$19,200.00" "$11,520.00" "$19,200.00" "$19,200.00" "$19,200.00" N/A N/A B12LGS SUP Custom 27203010 B12LGS - TROCAR LAPSCP LNG 12MM 150MM STRL LF VERSAONE SMTH CNN BLDE BOTH IP/OP $85.00 $63.00 $15.13 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $85.00 $15.13 $85.00 $85.00 $63.09 $63.09 $65.52 $44.29 $17.71 $85.00 $32.87 $85.00 $85.00 $82.18 $85.00 $85.00 $63.75 $85.00 $85.00 $85.00 $42.50 $42.50 $67.32 $85.00 $68.00 $55.25 $85.00 N/A $49.30 $85.00 $51.00 $85.00 $85.00 $85.00 N/A N/A B12LT SUP Custom 27203010 B12LT - TROCAR LAPSCOP 12MM 100MM STABILITY SLEEVE OPTICAL TIP BOTH IP/OP $475.50 $352.00 $84.63 $475.45 $475.45 $475.45 $475.45 $475.45 $475.45 $475.45 $84.63 $475.45 $475.45 $352.88 $352.88 $366.48 $247.71 $99.09 $475.45 $190.18 $475.45 $475.45 $475.45 $475.45 $475.45 $356.63 $475.45 $475.45 $475.45 $237.73 $237.73 $376.56 $475.45 $380.36 $309.04 $475.45 N/A $275.79 $475.45 $285.27 $475.45 $475.45 $475.45 N/A N/A B12STF SUP Custom 27203010 B12STF - TROCAR LAPSCP 12MM VERSAONE FX CNN BLDE BOTH IP/OP $82.50 $61.00 $14.63 $82.18 $82.18 $82.18 $82.18 $82.18 $82.18 $82.18 $14.63 $82.18 $82.18 $60.99 $60.99 $63.34 $42.82 $17.13 $82.18 $32.87 $82.18 $82.18 $82.18 $82.18 $82.18 $61.88 $82.18 $82.18 $82.18 $41.09 $41.09 $65.09 $82.18 $65.74 $53.42 $82.18 N/A $47.85 $82.18 $49.31 $82.18 $82.18 $82.18 N/A N/A B12XT SUP Custom 27203010 B12XT - TROCAR LAPSCOP 12MM 150MM STABILITY SLEEVE OPTICAL OBTURATOR BOTH IP/OP $537.00 $397.00 $95.57 $536.91 $536.91 $536.91 $536.91 $536.91 $536.91 $536.91 $95.57 $536.91 $536.91 $398.49 $398.49 $413.85 $279.73 $111.90 $536.91 $214.76 $536.91 $536.91 $536.91 $536.91 $536.91 $402.75 $536.91 $536.91 $536.91 $268.46 $268.46 $425.23 $536.91 $429.53 $348.99 $536.91 N/A $311.46 $536.91 $322.15 $536.91 $536.91 $536.91 N/A N/A B500-5016 SUP HCPCS C1713 B500-5016 - SCREW BONE 5MM 16MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $53.63 $89.38 $18.63 $89.38 N/A N/A B500-5020 SUP HCPCS C1713 B500-5020 - SCREW BONE 5MM 20MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $89.38 $89.38 $18.63 $89.38 N/A N/A B500-5024 SUP HCPCS C1713 B500-5024 - SCREW BONE 5MM 24MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $53.63 $89.38 $18.63 $89.38 N/A N/A B500-5028 SUP HCPCS C1713 B500-5028 - SCREW BONE 5MM 28MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $53.63 $89.38 $18.63 $89.38 N/A N/A B500-5032 SUP HCPCS C1713 B500-5032 - SCREW BONE 5MM 32MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $53.63 $89.38 $18.63 $89.38 N/A N/A B500-5034 SUP HCPCS C1713 B500-5034 - SCREW BONE 5MM 34MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $89.38 $89.38 $18.63 $89.38 N/A N/A B500-5036 SUP HCPCS C1713 B500-5036 - SCREW BONE 5MM 36MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $89.38 $89.38 $18.63 $89.38 N/A N/A B500-5038 SUP HCPCS C1713 B500-5038 - SCREW BONE 5MM 38MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $35.75 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $89.38 $89.38 $18.63 $89.38 N/A N/A B500-5040 SUP HCPCS C1713 B500-5040 - SCREW BONE 5MM 40MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $53.63 $89.38 $18.63 $89.38 N/A N/A B500-5042 SUP HCPCS C1713 B500-5042 - SCREW BONE 5MM 42MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $35.75 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $53.63 $89.38 $18.63 $89.38 N/A N/A B500-5044 SUP HCPCS C1713 B500-5044 - SCREW BONE 5MM 44MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $35.75 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $53.63 $89.38 $18.63 $89.38 N/A N/A B500-5046 SUP HCPCS C1713 B500-5046 - SCREW BONE 5MM 46MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $35.75 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $89.38 $89.38 $18.63 $89.38 N/A N/A B500-5048 SUP HCPCS C1713 B500-5048 - SCREW BONE 5MM 48MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $89.38 $89.38 $18.63 $89.38 N/A N/A B500-5050 SUP HCPCS C1713 B500-5050 - SCREW BONE 5MM 50MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $35.75 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $89.38 $89.38 $18.63 $89.38 N/A N/A B500-5052 SUP HCPCS C1713 B500-5052 - SCREW BONE 5MM 52MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $35.75 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $89.38 $89.38 $18.63 $89.38 N/A N/A B500-5054 SUP HCPCS C1713 B500-5054 - SCREW BONE 5MM 54MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $35.75 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $89.38 $89.38 $18.63 $89.38 N/A N/A B500-5056 SUP HCPCS C1713 B500-5056 - SCREW BONE 5MM 56MM CORTICAL BOTH IP/OP $89.50 $66.00 $17.74 $89.38 $40.22 $40.22 $40.22 $40.22 $89.38 $89.38 $89.38 $18.63 $89.38 $89.38 $89.38 $89.38 $89.38 $18.63 $89.38 $35.75 $52.87 $89.38 $89.38 $89.38 $89.38 $67.13 $89.38 $89.38 $89.38 $44.69 $44.69 $70.79 $89.38 $71.50 $40.22 $17.74 N/A $51.91 $89.38 $53.63 $89.38 $18.63 $89.38 N/A N/A B5LT SUP Custom 27203010 B5LT - TROCAR LAPSCOP 5MM 100MM STABILITY SLEEVE CANNU XCEL BOTH IP/OP $350.00 $259.00 $62.26 $349.76 $349.76 $349.76 $349.76 $349.76 $349.76 $349.76 $62.26 $349.76 $349.76 $259.59 $259.59 $269.60 $182.22 $72.89 $349.76 $139.90 $349.76 $349.76 $349.76 $349.76 $349.76 $262.50 $349.76 $349.76 $349.76 $174.88 $174.88 $277.01 $349.76 $279.81 $227.34 $349.76 N/A $203.00 $349.76 $209.86 $349.76 $349.76 $349.76 N/A N/A B5STF SUP Custom 27203010 B5STF - TROCAR LAPSCP STD 5MM STRL LF VERSAONE FX CNN BLDE DISP BOTH IP/OP $73.00 $54.00 $12.97 $72.88 $72.88 $72.88 $72.88 $72.88 $72.88 $72.88 $12.97 $72.88 $72.88 $54.09 $54.09 $56.18 $37.97 $15.19 $72.88 $15.12 $72.88 $72.88 $37.80 $72.88 $72.88 $54.75 $72.88 $72.88 $72.88 $36.44 $36.44 $57.72 $72.88 $58.30 $47.37 $72.88 N/A $42.34 $72.88 $43.73 $72.88 $72.88 $72.88 N/A N/A B5XT SUP Custom 27203010 B5XT - TROCAR LAPSCOP 5MM 100MM STABILITY SLEEVE XCEL ENDOPATH BOTH IP/OP $406.00 $300.00 $72.22 $405.73 $405.73 $405.73 $405.73 $405.73 $405.73 $405.73 $72.22 $405.73 $405.73 $301.13 $301.13 $312.74 $211.39 $84.56 $405.73 $162.29 $405.73 $405.73 $405.73 $405.73 $405.73 $304.50 $405.73 $405.73 $405.73 $202.87 $202.87 $321.34 $405.73 $324.58 $263.72 $405.73 N/A $235.48 $405.73 $243.44 $405.73 $405.73 $405.73 N/A N/A BA22-40/I13-40 SUP Custom 27803010 BA22-40/I13-40 - GRAFT STNT 2 BRCH 22MM 13MM 40MM STRL LF 40MM AFX STRATA BOTH IP/OP "$28,950.00" "$21,423.00" "$5,153.10" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$5,153.10" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$6,033.50" "$28,950.00" "$11,580.00" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$21,712.50" "$28,950.00" "$28,950.00" "$28,950.00" "$14,475.00" "$14,475.00" "$22,928.40" "$28,950.00" "$23,160.00" "$13,027.50" "$28,950.00" N/A "$16,791.00" "$28,950.00" "$17,370.00" "$28,950.00" "$28,950.00" "$28,950.00" N/A N/A BA22-60/I13-40 SUP Custom 27803010 BA22-60/I13-40 - GRAFT STNT BFUR 22-13MM 17FR 60MM 40MM AFX ACTIVESEAL STRATA BOTH IP/OP "$28,025.00" "$20,739.00" "$4,988.45" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$4,988.45" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$5,840.72" "$28,025.00" "$11,210.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$21,018.75" "$28,025.00" "$28,025.00" "$28,025.00" "$14,012.50" "$14,012.50" "$22,195.80" "$28,025.00" "$22,420.00" "$12,611.25" "$28,025.00" N/A "$16,254.50" "$28,025.00" "$16,815.00" "$28,025.00" "$28,025.00" "$28,025.00" N/A N/A BA22-70/I16-30 SUP Custom 27803010 BA22-70/I16-30 - GRAFT STNT 2 BRCH 22MM 16MM 70MM STRL 30MM AFX LMB XTN PTFE BOTH IP/OP "$28,950.00" "$21,423.00" "$5,153.10" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$5,153.10" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$6,033.50" "$28,950.00" "$11,580.00" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$28,950.00" "$21,712.50" "$28,950.00" "$28,950.00" "$28,950.00" "$14,475.00" "$14,475.00" "$22,928.40" "$28,950.00" "$23,160.00" "$13,027.50" "$28,950.00" N/A "$16,791.00" "$28,950.00" "$17,370.00" "$28,950.00" "$28,950.00" "$28,950.00" N/A N/A BA25-70/I16-30 SUP Custom 27803010 BA25-70/I16-30 - GRAFT STENT 2 BRANCH THIN WALL 16-25MM 70MM 30MM SELF BOTH IP/OP "$28,025.00" "$20,739.00" "$4,988.45" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$4,988.45" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$5,840.72" "$28,025.00" "$11,210.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$21,018.75" "$28,025.00" "$28,025.00" "$28,025.00" "$14,012.50" "$14,012.50" "$22,195.80" "$28,025.00" "$22,420.00" "$12,611.25" "$28,025.00" N/A "$16,254.50" "$28,025.00" "$16,815.00" "$28,025.00" "$28,025.00" "$28,025.00" N/A N/A BA25-80/I16-40 SUP Custom 27803010 BA25-80/I16-40 - GRAFT STENT 2 BRANCH 25-16MM 17FR 80MM 40MM SELF EXPAND MAIN BOTH IP/OP "$28,025.00" "$20,739.00" "$4,988.45" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$4,988.45" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$5,840.72" "$28,025.00" "$11,210.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$28,025.00" "$21,018.75" "$28,025.00" "$28,025.00" "$28,025.00" "$14,012.50" "$14,012.50" "$22,195.80" "$28,025.00" "$22,420.00" "$12,611.25" "$28,025.00" N/A "$16,254.50" "$28,025.00" "$16,815.00" "$28,025.00" "$28,025.00" "$28,025.00" N/A N/A BA28-70/I16-30 SUP Custom 27803010 BA28-70/I16-30 - GRAFT STNT BFUR 28-16MM 17FR 70MM 30MM AFX ACTIVESEAL STRATA BOTH IP/OP "$28,237.50" "$20,896.00" "$5,026.28" "$28,237.50" "$28,237.50" "$28,237.50" "$28,237.50" "$28,237.50" "$28,237.50" "$28,237.50" "$5,026.28" "$28,237.50" "$28,237.50" "$28,237.50" "$28,237.50" "$28,237.50" "$28,237.50" "$5,885.01" "$28,237.50" "$11,295.00" "$28,237.50" "$28,237.50" "$28,237.50" "$28,237.50" "$28,237.50" "$21,178.13" "$28,237.50" "$28,237.50" "$28,237.50" "$14,118.75" "$14,118.75" "$22,364.10" "$28,237.50" "$22,590.00" "$12,706.88" "$28,237.50" N/A "$16,377.75" "$28,237.50" "$16,942.50" "$28,237.50" "$28,237.50" "$28,237.50" N/A N/A BCK9015 SUP Custom 27804086 BCK9015 - NEEDLE BIOP 11GA 15CM VIPER BEVELED TROCAR BLUNT TIP BOTH IP/OP $537.50 $398.00 $95.68 $537.50 $537.50 $537.50 $537.50 $537.50 $537.50 $537.50 $95.68 $537.50 $537.50 $537.50 $537.50 $537.50 $537.50 $112.02 $537.50 $215.00 $537.50 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $241.88 $537.50 N/A $311.75 $537.50 $322.50 $537.50 $537.50 $537.50 N/A N/A BE1234 SUP HCPCS C1713 "BE1234 - ROD, PEEK, 200MM" BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A BE6055 SUP HCPCS L8613 BE6055 - SET ET 14GA 26IN STRL 24IN BLM-SNG INTRO NDL SHTH CATH PNCT BOTH IP/OP $589.50 $436.00 $122.86 $589.50 $589.50 $589.50 $589.50 $589.50 $589.50 $589.50 $185.70 $589.50 $589.50 $589.50 $589.50 $589.50 $589.50 $122.86 $589.50 $235.80 $589.50 $589.50 $589.50 $589.50 $589.50 $442.13 $589.50 $589.50 $589.50 $294.75 $294.75 $466.88 $589.50 $471.60 $265.28 $589.50 N/A $341.91 $589.50 $353.70 $589.50 $589.50 $589.50 N/A N/A BEA22-70/I16-30 SUP Custom 27803010 BEA22-70/I16-30 - GRAFT STNT 2 BRCH 22MM 16MM 70MM STRL LF 30MM AFX2 MAIN BD BOTH IP/OP "$34,997.50" "$25,898.00" "$6,229.56" "$34,997.50" "$34,997.50" "$34,997.50" "$34,997.50" "$34,997.50" "$34,997.50" "$34,997.50" "$6,229.56" "$34,997.50" "$34,997.50" "$34,997.50" "$34,997.50" "$34,997.50" "$34,997.50" "$7,293.86" "$34,997.50" "$13,999.00" "$34,997.50" "$34,997.50" "$34,997.50" "$34,997.50" "$34,997.50" "$26,248.13" "$34,997.50" "$34,997.50" "$34,997.50" "$17,498.75" "$17,498.75" "$27,718.02" "$34,997.50" "$27,998.00" "$15,748.88" "$34,997.50" N/A "$20,298.55" "$34,997.50" "$20,998.50" "$34,997.50" "$34,997.50" "$34,997.50" N/A N/A BG3510-5-US SUP HCPCS A4364 BG3510-5-US - ADHESIVE SURG PREFILLED SYRINGE LATEX FREE BIOGLUE BOVINE BOTH IP/OP "$1,725.00" "$1,277.00" $342.37 "$1,725.00" $936.68 $936.68 $936.68 $936.68 "$1,725.00" "$1,725.00" "$1,725.00" $359.53 "$1,725.00" "$1,280.30" "$1,280.30" "$1,329.63" $898.73 $359.51 "$1,725.00" "$1,725.00" "$1,020.34" "$1,725.00" "$1,725.00" "$1,725.00" "$1,725.00" "$1,293.75" "$1,725.00" "$1,725.00" "$1,725.00" $862.50 $862.50 "$1,366.20" "$1,725.00" "$1,380.00" "$1,121.25" $342.37 N/A "$1,000.50" "$1,725.00" "$1,725.00" "$1,725.00" $359.49 "$1,725.00" N/A N/A BG-8006-S SUP Custom 27203010 BG-8006-S - DRILL SURG 6MM BNGFT STERILE BOTH IP/OP $965.00 $714.00 $171.77 $965.00 $965.00 $965.00 $965.00 $965.00 $965.00 $965.00 $171.77 $965.00 $965.00 $716.22 $716.22 $743.82 $502.77 $201.12 $965.00 $386.00 $965.00 $965.00 $965.00 $965.00 $965.00 $723.75 $965.00 $965.00 $965.00 $482.50 $482.50 $764.28 $965.00 $772.00 $627.25 $965.00 N/A $559.70 $965.00 $579.00 $965.00 $965.00 $965.00 N/A N/A BG-8010-S SUP Custom 27203010 BG-8010-S - DRILL SURG 8MM BNGFT STERILE BOTH IP/OP $965.00 $714.00 $171.77 $965.00 $965.00 $965.00 $965.00 $965.00 $965.00 $965.00 $171.77 $965.00 $965.00 $716.22 $716.22 $743.82 $502.77 $201.12 $965.00 $386.00 $965.00 $965.00 $965.00 $965.00 $965.00 $723.75 $965.00 $965.00 $965.00 $482.50 $482.50 $764.28 $965.00 $772.00 $627.25 $965.00 N/A $559.70 $965.00 $579.00 $965.00 $965.00 $965.00 N/A N/A BG-8020-S SUP Custom 27203010 BG-8020-S - DRILL SURG 10MM BNGFT STERILE BOTH IP/OP $965.00 $714.00 $171.77 $965.00 $965.00 $965.00 $965.00 $965.00 $965.00 $965.00 $171.77 $965.00 $965.00 $716.22 $716.22 $743.82 $502.77 $201.12 $965.00 $386.00 $965.00 $965.00 $965.00 $965.00 $965.00 $723.75 $965.00 $965.00 $965.00 $482.50 $482.50 $764.28 $965.00 $772.00 $627.25 $965.00 N/A $559.70 $965.00 $579.00 $965.00 $965.00 $965.00 N/A N/A BG-8030-S SUP Custom 27203010 BG-8030-S - DRILL SURG 12MM BNGFT STERILE BOTH IP/OP $965.00 $714.00 $171.77 $965.00 $965.00 $965.00 $965.00 $965.00 $965.00 $965.00 $171.77 $965.00 $965.00 $716.22 $716.22 $743.82 $502.77 $201.12 $965.00 $386.00 $965.00 $965.00 $965.00 $965.00 $965.00 $723.75 $965.00 $965.00 $965.00 $482.50 $482.50 $764.28 $965.00 $772.00 $627.25 $965.00 N/A $559.70 $965.00 $579.00 $965.00 $965.00 $965.00 N/A N/A BG-8040 SUP Custom 27203010 BG-8040 - ADPR TBG HDSN FIT BOTH IP/OP $510.00 $377.00 $90.78 $510.00 $510.00 $510.00 $510.00 $510.00 $510.00 $510.00 $90.78 $510.00 $510.00 $378.52 $378.52 $393.11 $265.71 $106.29 $510.00 $204.00 $510.00 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $331.50 $510.00 N/A $295.80 $510.00 $306.00 $510.00 $510.00 $510.00 N/A N/A BG-8043 SUP Custom 27203010 BG-8043 - HANDLE RCHT T BNGFT BOTH IP/OP "$2,287.50" "$1,693.00" $407.18 "$2,287.50" "$2,287.50" "$2,287.50" "$2,287.50" "$2,287.50" "$2,287.50" "$2,287.50" $407.18 "$2,287.50" "$2,287.50" "$1,697.78" "$1,697.78" "$1,763.21" "$1,191.79" $476.74 "$2,287.50" $915.00 "$2,287.50" "$2,287.50" "$2,287.50" "$2,287.50" "$2,287.50" "$1,715.63" "$2,287.50" "$2,287.50" "$2,287.50" "$1,143.75" "$1,143.75" "$1,811.70" "$2,287.50" "$1,830.00" "$1,486.88" "$2,287.50" N/A "$1,326.75" "$2,287.50" "$1,372.50" "$2,287.50" "$2,287.50" "$2,287.50" N/A N/A BG-8044 SUP Custom 27203010 BG-8044 - ADPR CHK JCB BOTH IP/OP $572.50 $424.00 $101.91 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $572.50 $101.91 $572.50 $572.50 $424.91 $424.91 $441.28 $298.27 $119.32 $572.50 $229.00 $572.50 $572.50 $572.50 $572.50 $572.50 $429.38 $572.50 $572.50 $572.50 $286.25 $286.25 $453.42 $572.50 $458.00 $372.13 $572.50 N/A $332.05 $572.50 $343.50 $572.50 $572.50 $572.50 N/A N/A BG-8060 SUP Custom 27203010 BG-8060 - EXTRACTOR SRG G S GFT BOTH IP/OP $162.50 $120.00 $28.93 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $28.93 $162.50 $162.50 $120.61 $120.61 $125.26 $84.66 $33.87 $162.50 $65.00 $162.50 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $105.63 $162.50 N/A $94.25 $162.50 $97.50 $162.50 $162.50 $162.50 N/A N/A BG-8064 SUP Custom 27203010 BG-8064 - EXTRACTOR SRG 6MM G S BOTH IP/OP $162.50 $120.00 $28.93 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $28.93 $162.50 $162.50 $120.61 $120.61 $125.26 $84.66 $33.87 $162.50 $65.00 $162.50 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $105.63 $162.50 N/A $94.25 $162.50 $97.50 $162.50 $162.50 $162.50 N/A N/A BG-8080 SUP Custom 27203010 BG-8080 - PUNCH SRG GFT TROC BOTH IP/OP $205.00 $152.00 $36.49 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $36.49 $205.00 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $82.00 $205.00 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $205.00 N/A $118.90 $205.00 $123.00 $205.00 $205.00 $205.00 N/A N/A BI-2030 SUP Custom 27203010 BI-2030 - CIRCUIT BREATHING 9X8X3IN TRANSPORT TEST CAP PORTABLE BOTH IP/OP $74.00 $55.00 $13.10 $73.61 $73.61 $73.61 $73.61 $73.61 $73.61 $73.61 $13.10 $73.61 $73.61 $54.63 $54.63 $56.74 $38.35 $15.34 $73.61 $29.44 $73.61 $73.61 $73.61 $73.61 $73.61 $55.50 $73.61 $73.61 $73.61 $36.81 $36.81 $58.30 $73.61 $58.89 $47.85 $73.61 N/A $42.92 $73.61 $44.17 $73.61 $73.61 $73.61 N/A N/A BK406 SUP Custom 27203010 BK406 - PROTECTOR STUMP ROOKE BKA BOTH IP/OP $622.50 $461.00 $110.81 $622.50 $622.50 $622.50 $622.50 $622.50 $622.50 $622.50 $110.81 $622.50 $622.50 $462.02 $462.02 $479.82 $324.32 $129.74 $622.50 $249.00 $622.50 $622.50 $622.50 $622.50 $622.50 $466.88 $622.50 $622.50 $622.50 $311.25 $311.25 $493.02 $622.50 $498.00 $404.63 $622.50 N/A $361.05 $622.50 $373.50 $622.50 $622.50 $622.50 N/A N/A BL-1600-001 SUP HCPCS C1713 BL-1600-001 - GRAFT BN SM 1CC VIVIGEN FRMBL CLLR BN MTRX BOTH IP/OP "$1,375.00" "$1,018.00" $272.90 "$1,375.00" $618.75 $618.75 $618.75 $618.75 "$1,375.00" "$1,375.00" "$1,375.00" $286.58 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" $286.57 "$1,375.00" "$1,375.00" $813.31 "$1,375.00" "$1,375.00" "$1,375.00" "$1,375.00" "$1,031.25" "$1,375.00" "$1,375.00" "$1,375.00" $687.50 $687.50 "$1,089.00" "$1,375.00" "$1,100.00" $618.75 $272.90 N/A $797.50 "$1,375.00" "$1,375.00" "$1,375.00" $286.55 "$1,375.00" N/A N/A BL-1600-002 SUP HCPCS C1713 BL-1600-002 - GRAFT BN MED 5CC VIVIGEN FRMBL CLLR BN MTRX BOTH IP/OP "$6,120.00" "$4,529.00" "$1,214.67" "$6,120.00" "$2,754.00" "$2,754.00" "$2,754.00" "$2,754.00" "$6,120.00" "$6,120.00" "$6,120.00" "$1,275.56" "$6,120.00" "$6,120.00" "$6,120.00" "$6,120.00" "$6,120.00" "$1,275.48" "$6,120.00" "$6,120.00" "$3,017.16" "$6,120.00" "$6,120.00" "$6,120.00" "$6,120.00" "$4,590.00" "$6,120.00" "$6,120.00" "$6,120.00" "$3,060.00" "$3,060.00" "$4,847.04" "$6,120.00" "$4,896.00" "$2,754.00" "$1,214.67" N/A "$3,549.60" "$6,120.00" "$6,120.00" "$6,120.00" "$1,275.41" "$6,120.00" N/A N/A BL-1600-003 SUP HCPCS C1713 BL-1600-003 - GRAFT BN LG 10CC VIVIGEN FRMBL CLLR BN MTRX BOTH IP/OP "$10,920.00" "$8,081.00" "$2,167.35" "$10,920.00" "$4,914.00" "$4,914.00" "$4,914.00" "$4,914.00" "$10,920.00" "$10,920.00" "$10,920.00" "$2,276.00" "$10,920.00" "$10,920.00" "$10,920.00" "$10,920.00" "$10,920.00" "$2,275.85" "$10,920.00" "$10,920.00" "$5,383.56" "$10,920.00" "$10,920.00" "$10,920.00" "$10,920.00" "$8,190.00" "$10,920.00" "$10,920.00" "$10,920.00" "$5,460.00" "$5,460.00" "$8,648.64" "$10,920.00" "$8,736.00" "$4,914.00" "$2,167.35" N/A "$6,333.60" "$10,920.00" "$10,920.00" "$10,920.00" "$2,275.73" "$10,920.00" N/A N/A BL-1600-004 SUP HCPCS C1713 BL-1600-004 - GRAFT BN XL VIVIGEN FRMBL ALGRF CLLR DEMINERALIZE FBR BOTH IP/OP "$13,590.00" "$10,057.00" "$2,697.28" "$13,590.00" "$6,115.50" "$6,115.50" "$6,115.50" "$6,115.50" "$13,590.00" "$13,590.00" "$13,590.00" "$2,832.50" "$13,590.00" "$13,590.00" "$13,590.00" "$13,590.00" "$13,590.00" "$2,832.31" "$13,590.00" "$13,590.00" "$6,699.87" "$13,590.00" "$13,590.00" "$13,590.00" "$13,590.00" "$10,192.50" "$13,590.00" "$13,590.00" "$13,590.00" "$6,795.00" "$6,795.00" "$10,763.28" "$13,590.00" "$10,872.00" "$6,115.50" "$2,697.28" N/A "$7,882.20" "$13,590.00" "$13,590.00" "$13,590.00" "$2,832.16" "$13,590.00" N/A N/A BL5115-2 SUP Custom 27203010 BL5115-2 - PACK SRG STD NS LF ADP FLUIDICS DISP BOTH IP/OP $160.00 $118.00 $28.48 $243.43 $160.00 $160.00 $160.00 $160.00 $160.00 $160.00 $28.48 $160.00 $160.00 $118.75 $118.75 $123.33 $83.36 $33.35 $160.00 $97.37 $160.00 $160.00 $243.43 $160.00 $160.00 $120.00 $160.00 $160.00 $160.00 $80.00 $80.00 $126.72 $160.00 $128.00 $104.00 $160.00 N/A $92.80 $160.00 $96.00 $160.00 $160.00 $160.00 N/A N/A BM200 SUP Custom 27203010 BM200 - MILL BONE SPATULA LEGEND DISPOSABLE BOTH IP/OP $628.00 $465.00 $111.74 $627.75 $627.75 $627.75 $627.75 $627.75 $627.75 $627.75 $111.74 $627.75 $627.75 $465.92 $465.92 $483.87 $327.06 $130.83 $627.75 $251.10 $627.75 $627.75 $627.75 $627.75 $627.75 $471.00 $627.75 $627.75 $627.75 $313.88 $313.88 $497.18 $627.75 $502.20 $408.04 $627.75 N/A $364.24 $627.75 $376.65 $627.75 $627.75 $627.75 N/A N/A BMW2021 SUP HCPCS Q4108 BMW2021 - DRESSING BIO 2X2IN STRL LF INTGR BL MX BVN CLGN GAG BOTH IP/OP "$5,172.00" "$3,827.00" "$1,026.51" "$5,171.98" "$2,327.39" "$2,327.39" "$2,327.39" "$2,327.39" "$5,171.98" "$5,171.98" "$5,171.98" "$1,077.97" "$5,171.98" "$5,171.98" "$5,171.98" "$5,171.98" "$5,171.98" "$1,077.90" "$5,171.98" "$5,171.98" "$2,549.79" "$5,171.98" "$5,171.98" "$5,171.98" "$5,171.98" "$3,879.00" "$5,171.98" "$5,171.98" "$5,171.98" "$2,585.99" "$2,585.99" "$4,096.21" "$5,171.98" "$4,137.58" "$2,327.39" "$1,026.51" N/A "$2,999.76" "$5,171.98" "$5,171.98" "$5,171.98" "$1,077.84" "$5,171.98" N/A N/A BMW8101 SUP HCPCS Q4104 BMW8101 - DRESSING BIOLOGICAL 10X8IN ADHERENT BILAYER MATRIX FLEXIBLE BOTH IP/OP "$23,893.50" "$17,681.00" "$4,742.20" "$23,893.18" "$10,751.93" "$10,751.93" "$10,751.93" "$10,751.93" "$23,893.18" "$23,893.18" "$23,893.18" "$4,979.94" "$23,893.18" "$23,893.18" "$23,893.18" "$23,893.18" "$23,893.18" "$4,979.60" "$23,893.18" "$23,893.18" "$11,779.34" "$23,893.18" "$23,893.18" "$23,893.18" "$23,893.18" "$17,920.13" "$23,893.18" "$23,893.18" "$23,893.18" "$11,946.59" "$11,946.59" "$18,923.40" "$23,893.18" "$19,114.54" "$10,751.93" "$4,742.20" N/A "$13,858.23" "$23,893.18" "$23,893.18" "$23,893.18" "$4,979.34" "$23,893.18" N/A N/A BP10405 SUP Custom 27803010 BP10405 - BP SUTURABLE GRAFT 4CM x 5CM BOTH IP/OP $850.50 $629.00 $151.35 $850.28 $850.28 $850.28 $850.28 $850.28 $850.28 $850.28 $151.35 $850.28 $850.28 $850.28 $850.28 $850.28 $850.28 $177.21 $850.28 $340.11 $850.28 $850.28 $850.28 $850.28 $850.28 $637.88 $850.28 $850.28 $850.28 $425.14 $425.14 $673.42 $850.28 $680.22 $382.63 $850.28 N/A $493.29 $850.28 $510.17 $850.28 $850.28 $850.28 N/A N/A BP10608 SUP Custom 27803010 BP10608 - BP SUTURABLE GRAFT 6CM x 8CM BOTH IP/OP "$1,098.00" $813.00 $195.44 "$1,097.98" "$1,097.98" "$1,097.98" "$1,097.98" "$1,097.98" "$1,097.98" "$1,097.98" $195.44 "$1,097.98" "$1,097.98" "$1,097.98" "$1,097.98" "$1,097.98" "$1,097.98" $228.83 "$1,097.98" $439.19 "$1,097.98" "$1,097.98" "$1,097.98" "$1,097.98" "$1,097.98" $823.50 "$1,097.98" "$1,097.98" "$1,097.98" $548.99 $548.99 $869.60 "$1,097.98" $878.38 $494.09 "$1,097.98" N/A $636.84 "$1,097.98" $658.79 "$1,097.98" "$1,097.98" "$1,097.98" N/A N/A BP10812 SUP Custom 27803010 BP10812 - BP SUTURABLE GRAFT 8CM x 12CM BOTH IP/OP "$1,811.00" "$1,340.00" $322.36 "$1,811.00" "$1,811.00" "$1,811.00" "$1,811.00" "$1,811.00" "$1,811.00" "$1,811.00" $322.36 "$1,811.00" "$1,811.00" "$1,811.00" "$1,811.00" "$1,811.00" "$1,811.00" $377.43 "$1,811.00" $724.40 "$1,811.00" "$1,811.00" "$1,811.00" "$1,811.00" "$1,811.00" "$1,358.25" "$1,811.00" "$1,811.00" "$1,811.00" $905.50 $905.50 "$1,434.31" "$1,811.00" "$1,448.80" $814.95 "$1,811.00" N/A "$1,050.38" "$1,811.00" "$1,086.60" "$1,811.00" "$1,811.00" "$1,811.00" N/A N/A BP11216 SUP Custom 27803010 BP11216 - GRAFT SFT TIS 12X16CM STRL TTPLST RSRB SUTURABLE BOTH IP/OP "$3,614.00" "$2,674.00" $643.23 "$3,613.63" "$3,613.63" "$3,613.63" "$3,613.63" "$3,613.63" "$3,613.63" "$3,613.63" $643.23 "$3,613.63" "$3,613.63" "$3,613.63" "$3,613.63" "$3,613.63" "$3,613.63" $753.12 "$3,613.63" "$1,445.45" "$3,613.63" "$3,613.63" "$3,613.63" "$3,613.63" "$3,613.63" "$2,710.50" "$3,613.63" "$3,613.63" "$3,613.63" "$1,806.82" "$1,806.82" "$2,861.99" "$3,613.63" "$2,890.90" "$1,626.13" "$3,613.63" N/A "$2,096.12" "$3,613.63" "$2,168.18" "$3,613.63" "$3,613.63" "$3,613.63" N/A N/A BPT12STS SUP Custom 27203010 BPT12STS - TROCAR LAPSCP 5-12MM AU STRL BLNTPRT + RDLCNT SLV THRD ANCH BOTH IP/OP $82.50 $61.00 $14.63 $82.18 $82.18 $82.18 $82.18 $82.18 $82.18 $82.18 $14.63 $82.18 $82.18 $60.99 $60.99 $63.34 $42.82 $17.13 $82.18 $20.82 $82.18 $82.18 $52.05 $82.18 $82.18 $61.88 $82.18 $82.18 $82.18 $41.09 $41.09 $65.09 $82.18 $65.74 $53.42 $82.18 N/A $47.85 $82.18 $49.31 $82.18 $82.18 $82.18 N/A N/A BRC000410-00 SUP HCPCS C1725 BRC000410-00 - CATHETER BLNOCC 4MM 10MM ASCNT CMPT SYS MCIOL NRVSC ANRSM BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,582.85" "$1,582.85" "$1,582.85" "$1,582.85" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,163.51" "$2,163.51" "$2,246.88" "$1,518.72" $607.52 "$2,915.00" "$2,915.00" "$1,724.22" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,894.75" $578.55 N/A "$1,690.70" "$2,915.00" "$2,915.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A BRC000415-00 SUP HCPCS C1725 BRC000415-00 - CATHETER BLNOCC 4MM 15MM ASCNT REMODEL BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,582.85" "$1,582.85" "$1,582.85" "$1,582.85" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,163.51" "$2,163.51" "$2,246.88" "$1,518.72" $607.52 "$2,915.00" "$1,166.00" "$1,724.22" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,894.75" $578.55 N/A "$1,690.70" "$2,915.00" "$2,915.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A BRS000609-00 SUP HCPCS C1725 BRS000609-00 - CATHETER BLNOCC 6MM 9MM ASCNT REMODEL BOTH IP/OP "$2,915.00" "$2,157.00" $578.55 "$2,915.00" "$1,582.85" "$1,582.85" "$1,582.85" "$1,582.85" "$2,915.00" "$2,915.00" "$2,915.00" $607.56 "$2,915.00" "$2,163.51" "$2,163.51" "$2,246.88" "$1,518.72" $607.52 "$2,915.00" "$2,915.00" "$1,724.22" "$2,915.00" "$2,915.00" "$2,915.00" "$2,915.00" "$2,186.25" "$2,915.00" "$2,915.00" "$2,915.00" "$1,457.50" "$1,457.50" "$2,308.68" "$2,915.00" "$2,332.00" "$1,894.75" $578.55 N/A "$1,690.70" "$2,915.00" "$2,915.00" "$2,915.00" $607.49 "$2,915.00" N/A N/A BSCLX351304100 SUP Custom 27203010 BSCLX351304100 - CATHETER BLNDIL 4MM 130CM LF 100MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX351304120 SUP Custom 27203010 BSCLX351304120 - CATHETER BLNDIL 4MM 130CM LF 120MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX351304150 SUP Custom 27203010 BSCLX351304150 - CATHETER BLNDIL 4MM 130CM LF 150MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX35130440 SUP Custom 27203010 BSCLX35130440 - CATHETER BLNDIL 4MM 130CM LF 40MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX35130460 SUP Custom 27203010 BSCLX35130460 - CATHETER BLNDIL 4MM 130CM LF 60MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX35130480 SUP Custom 27203010 BSCLX35130480 - CATHETER BLNDIL 4MM 130CM LF 80MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX351305100 SUP Custom 27203010 BSCLX351305100 - CATHETER BLNDIL 5MM 130CM LF 100MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX351305120 SUP Custom 27203010 BSCLX351305120 - CATHETER BLNDIL 5MM 130CM LF 120MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX351305150 SUP Custom 27203010 BSCLX351305150 - CATHETER BLNDIL 5MM 130CM LF 150MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX35130540 SUP Custom 27203010 BSCLX35130540 - CATHETER BLNDIL 5MM 130CM LF 40MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX35130560 SUP Custom 27203010 BSCLX35130560 - CATHETER BLNDIL 5MM 130CM LF 60MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX35130580 SUP Custom 27203010 BSCLX35130580 - CATHETER BLNDIL 5MM 130CM LF 80MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX351306100 SUP Custom 27203010 BSCLX351306100 - CATHETER BLNDIL 6MM 130CM LF 100MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX351306120 SUP Custom 27203010 BSCLX351306120 - CATHETER BALDILAT 6FR 6MM 130CM 120MM PCLTXL BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX351306150 SUP Custom 27203010 BSCLX351306150 - CATHETER BLNDIL 6MM 130CM LF 150MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX35130640 SUP Custom 27203010 BSCLX35130640 - CATHETER BLNDIL 6MM 130CM LF 40MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX35130660 SUP Custom 27203010 BSCLX35130660 - CATHETER BLNDIL 6MM 130CM LF 60MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BSCLX35130680 SUP Custom 27203010 BSCLX35130680 - CATHETER BLNDIL 6MM 130CM LF 80MM LUTONIX 035 PCLTXL ACPT BOTH IP/OP "$3,500.00" "$2,590.00" $623.00 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $623.00 "$3,500.00" "$3,500.00" "$2,597.70" "$2,597.70" "$2,697.80" "$1,823.50" $729.44 "$3,500.00" "$1,400.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$2,275.00" "$3,500.00" N/A "$2,030.00" "$3,500.00" "$2,100.00" "$3,500.00" "$3,500.00" "$3,500.00" N/A N/A BTC-100 SUP HCPCS C1758 CATHETER URET BT-CATH TEMPONADE BOTH IP/OP $267.00 $198.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $200.25 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 N/A $154.86 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A BTC-100 SUP Custom 27203010 BTC-100 - CATHETER UTERINE 2 SYRINGE 1 BAG SPIKE TAMPONADE BALLOON BOTH IP/OP $290.00 $215.00 $51.62 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $290.00 $51.62 $290.00 $290.00 $215.24 $215.24 $223.53 $151.09 $60.44 $290.00 $116.00 $290.00 $290.00 $290.00 $290.00 $290.00 $217.50 $290.00 $290.00 $290.00 $145.00 $145.00 $229.68 $290.00 $232.00 $188.50 $290.00 N/A $168.20 $290.00 $174.00 $290.00 $290.00 $290.00 N/A N/A BTE1000 SUP Custom 27803010 BTE1000 - EXPANDER TISSUE P8-10.2CM RECTANGLE 17X8CM REMOTE PORT BOTH IP/OP "$1,337.50" $990.00 $238.08 "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" $238.08 "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" $278.75 "$1,337.50" $535.00 "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,003.13" "$1,337.50" "$1,337.50" "$1,337.50" $668.75 $668.75 "$1,059.30" "$1,337.50" "$1,070.00" $601.88 "$1,337.50" N/A $775.75 "$1,337.50" $802.50 "$1,337.50" "$1,337.50" "$1,337.50" N/A N/A BTE750 SUP Custom 27803010 BTE750 - EXPANDER TISSUE P7-9CM RECTANGLE 15X7.5CM REMOTE PORT SMOOTH BOTH IP/OP "$1,337.50" $990.00 $238.08 "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" $238.08 "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" $278.75 "$1,337.50" $535.00 "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,003.13" "$1,337.50" "$1,337.50" "$1,337.50" $668.75 $668.75 "$1,059.30" "$1,337.50" "$1,070.00" $601.88 "$1,337.50" N/A $775.75 "$1,337.50" $802.50 "$1,337.50" "$1,337.50" "$1,337.50" N/A N/A BW012 SUP Custom 27803010 BW012 - WAX BN STRL LF OSTENE HMST AGNT ALK OXD 2.5GM DISP BOTH IP/OP $192.50 $142.00 $34.18 $192.05 $192.05 $192.05 $192.05 $192.05 $192.05 $192.05 $34.18 $192.05 $192.05 $192.05 $192.05 $192.05 $192.05 $40.03 $192.05 $76.82 $192.05 $192.05 $192.05 $192.05 $192.05 $144.38 $192.05 $192.05 $192.05 $96.03 $96.03 $152.10 $192.05 $153.64 $86.42 $192.05 N/A $111.65 $192.05 $115.23 $192.05 $192.05 $192.05 N/A N/A BX00711052 SUP Custom 27203010 BX00711052 - NET SPECIMEN RETRIEVAL STANDARD 2.5MM 230CM 6X3CM STRONG BOTH IP/OP $222.50 $165.00 $39.61 $222.50 $222.50 $222.50 $222.50 $222.50 $222.50 $222.50 $39.61 $222.50 $222.50 $165.14 $165.14 $171.50 $115.92 $46.37 $222.50 $89.00 $222.50 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $144.63 $222.50 N/A $129.05 $222.50 $133.50 $222.50 $222.50 $222.50 N/A N/A BX-1000 SUP Custom 27203010 BX-1000 - KIT ASCP ARTHROBOX BOTH IP/OP $987.50 $731.00 $175.78 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $175.78 $987.50 $987.50 $732.92 $732.92 $761.17 $514.49 $205.81 $987.50 $395.00 $987.50 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $641.88 $987.50 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A BXA073901A SUP HCPCS C1874 BXA073901A - STENT EPRSTH .035IN 7MM 11MM 7FR 39MM 80CM GORE VBHN BLN BOTH IP/OP "$8,935.00" "$6,612.00" "$1,773.37" "$9,292.50" "$4,020.75" "$4,020.75" "$4,020.75" "$4,020.75" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.28" "$8,935.00" "$8,935.00" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.15" "$8,935.00" "$9,292.50" "$4,404.96" "$8,935.00" "$9,292.50" "$8,935.00" "$8,935.00" "$6,701.25" "$8,935.00" "$8,935.00" "$8,935.00" "$4,467.50" "$4,467.50" "$7,076.52" "$8,935.00" "$7,148.00" "$4,020.75" "$1,773.37" N/A "$5,182.30" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.05" "$8,935.00" N/A N/A BXA075901A SUP HCPCS C1874 BXA075901A - STENT EPRSTH .035IN 7MM 11MM 7FR 59MM 80CM GORE VBHN BLN BOTH IP/OP "$8,935.00" "$6,612.00" "$1,773.37" "$9,292.50" "$4,020.75" "$4,020.75" "$4,020.75" "$4,020.75" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.28" "$8,935.00" "$8,935.00" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.15" "$8,935.00" "$9,292.50" "$4,404.96" "$8,935.00" "$9,292.50" "$8,935.00" "$8,935.00" "$6,701.25" "$8,935.00" "$8,935.00" "$8,935.00" "$4,467.50" "$4,467.50" "$7,076.52" "$8,935.00" "$7,148.00" "$4,020.75" "$1,773.37" N/A "$5,182.30" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.05" "$8,935.00" N/A N/A BXA082901A SUP HCPCS C1874 BXA082901A - STENT EPRSTH .035IN 8MM 11MM 7FR 29MM 80CM GORE VBHN BLN BOTH IP/OP "$8,935.00" "$6,612.00" "$1,773.37" "$9,292.50" "$4,020.75" "$4,020.75" "$4,020.75" "$4,020.75" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.28" "$8,935.00" "$8,935.00" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.15" "$8,935.00" "$9,292.50" "$4,404.96" "$8,935.00" "$9,292.50" "$8,935.00" "$8,935.00" "$6,701.25" "$8,935.00" "$8,935.00" "$8,935.00" "$4,467.50" "$4,467.50" "$7,076.52" "$8,935.00" "$7,148.00" "$4,020.75" "$1,773.37" N/A "$5,182.30" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.05" "$8,935.00" N/A N/A BXA083901A SUP HCPCS C1874 BXA083901A - STENT EPRSTH .035IN 8MM 11MM 7FR 39MM 80CM GORE VBHN BLN BOTH IP/OP "$8,935.00" "$6,612.00" "$1,773.37" "$9,292.50" "$4,020.75" "$4,020.75" "$4,020.75" "$4,020.75" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.28" "$8,935.00" "$8,935.00" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.15" "$8,935.00" "$9,292.50" "$4,404.96" "$8,935.00" "$9,292.50" "$8,935.00" "$8,935.00" "$6,701.25" "$8,935.00" "$8,935.00" "$8,935.00" "$4,467.50" "$4,467.50" "$7,076.52" "$8,935.00" "$7,148.00" "$4,020.75" "$1,773.37" N/A "$5,182.30" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.05" "$8,935.00" N/A N/A BXA085901A SUP HCPCS C1874 BXA085901A - STENT EPRSTH .035IN 8MM 11MM 7FR 59MM 80CM GORE VBHN BLN BOTH IP/OP "$8,935.00" "$6,612.00" "$1,773.37" "$9,292.50" "$4,020.75" "$4,020.75" "$4,020.75" "$4,020.75" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.28" "$8,935.00" "$8,935.00" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.15" "$8,935.00" "$9,292.50" "$4,404.96" "$8,935.00" "$9,292.50" "$8,935.00" "$8,935.00" "$6,701.25" "$8,935.00" "$8,935.00" "$8,935.00" "$4,467.50" "$4,467.50" "$7,076.52" "$8,935.00" "$7,148.00" "$4,020.75" "$1,773.37" N/A "$5,182.30" "$8,935.00" "$8,935.00" "$8,935.00" "$1,862.05" "$8,935.00" N/A N/A BXA092902A SUP HCPCS C1874 BXA092902A - STENT EPRSTH .035IN 9MM 13MM 8FR 29MM 135CM GORE VBHN BLN BOTH IP/OP "$9,292.50" "$6,876.00" "$1,844.33" "$9,292.50" "$4,181.63" "$4,181.63" "$4,181.63" "$4,181.63" "$9,292.50" "$9,292.50" "$9,292.50" "$1,936.79" "$9,292.50" "$9,292.50" "$9,292.50" "$9,292.50" "$9,292.50" "$1,936.66" "$9,292.50" "$9,292.50" "$4,581.20" "$9,292.50" "$9,292.50" "$9,292.50" "$9,292.50" "$6,969.38" "$9,292.50" "$9,292.50" "$9,292.50" "$4,646.25" "$4,646.25" "$7,359.66" "$9,292.50" "$7,434.00" "$4,181.63" "$1,844.33" N/A "$5,389.65" "$9,292.50" "$9,292.50" "$9,292.50" "$1,936.56" "$9,292.50" N/A N/A BXA093901A SUP HCPCS C1874 BXA093901A - STENT EPRSTH .035IN 9MM 13MM 8FR 39MM 80CM GORE VBHN BLN BOTH IP/OP "$9,292.50" "$6,876.00" "$1,844.33" "$9,292.50" "$4,181.63" "$4,181.63" "$4,181.63" "$4,181.63" "$9,292.50" "$9,292.50" "$9,292.50" "$1,936.79" "$9,292.50" "$9,292.50" "$9,292.50" "$9,292.50" "$9,292.50" "$1,936.66" "$9,292.50" "$9,292.50" "$4,581.20" "$9,292.50" "$9,292.50" "$9,292.50" "$9,292.50" "$6,969.38" "$9,292.50" "$9,292.50" "$9,292.50" "$4,646.25" "$4,646.25" "$7,359.66" "$9,292.50" "$7,434.00" "$4,181.63" "$1,844.33" N/A "$5,389.65" "$9,292.50" "$9,292.50" "$9,292.50" "$1,936.56" "$9,292.50" N/A N/A C021D SUP Custom 27203010 C021D - SUTURE NONABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8 BOTH IP/OP $285.50 $211.00 $50.82 $293.80 $285.50 $285.50 $285.50 $285.50 $285.50 $285.50 $50.82 $285.50 $285.50 $211.90 $211.90 $220.06 $148.75 $59.50 $285.50 $117.52 $285.50 $285.50 $293.80 $285.50 $285.50 $214.13 $285.50 $285.50 $285.50 $142.75 $142.75 $226.12 $285.50 $228.40 $185.58 $285.50 N/A $165.59 $285.50 $171.30 $285.50 $285.50 $285.50 N/A N/A C-028 SUP HCPCS C1713 C-028 - GUARD PIN .028IN .028IN POST SURG K WIRE STEINMANN PIN BOTH IP/OP $5.00 $4.00 $0.91 $4.58 $2.06 $2.06 $2.06 $2.06 $4.58 $4.58 $4.58 $0.95 $4.58 $4.58 $4.58 $4.58 $4.58 $0.95 $4.58 $1.83 $2.71 $4.58 $4.58 $4.58 $4.58 $3.75 $4.58 $4.58 $4.58 $2.29 $2.29 $3.63 $4.58 $3.66 $2.06 $0.91 N/A $2.90 $4.58 $4.58 $4.58 $0.95 $4.58 N/A N/A C-045 SUP HCPCS C1713 C-045 - COVER PIN .045IN SHEATH WIRE LATEX FREE KWIRE STEINMANN BOTH IP/OP $5.00 $4.00 $0.91 $4.58 $2.06 $2.06 $2.06 $2.06 $4.58 $4.58 $4.58 $0.95 $4.58 $4.58 $4.58 $4.58 $4.58 $0.95 $4.58 $1.83 $2.71 $4.58 $4.58 $4.58 $4.58 $3.75 $4.58 $4.58 $4.58 $2.29 $2.29 $3.63 $4.58 $3.66 $2.06 $0.91 N/A $2.90 $4.58 $4.58 $4.58 $0.95 $4.58 N/A N/A C-062 SUP HCPCS C1713 C-062 - COVER PIN .062IN SHEATH WIRE LATEX FREE KWIRE GREEN PLST BOTH IP/OP $3.00 $2.00 $0.55 $2.75 $1.24 $1.24 $1.24 $1.24 $2.75 $2.75 $2.75 $0.57 $2.75 $2.75 $2.75 $2.75 $2.75 $0.57 $2.75 $1.10 $1.63 $2.75 $2.75 $2.75 $2.75 $2.25 $2.75 $2.75 $2.75 $1.38 $1.38 $2.18 $2.75 $2.20 $1.24 $0.55 N/A $1.74 $2.75 $2.75 $2.75 $0.57 $2.75 N/A N/A C-078 SUP HCPCS C1713 C-078 - GUARD PIN .035IN .078IN K WIRE STEINMANN PINK STERILE BOTH IP/OP $5.00 $4.00 $0.99 $5.00 $2.25 $2.25 $2.25 $2.25 $5.00 $5.00 $5.00 $1.04 $5.00 $5.00 $5.00 $5.00 $5.00 $1.04 $5.00 $2.00 $2.96 $5.00 $5.00 $5.00 $5.00 $3.75 $5.00 $5.00 $5.00 $2.50 $2.50 $3.96 $5.00 $4.00 $2.25 $0.99 N/A $2.90 $5.00 $5.00 $5.00 $1.04 $5.00 N/A N/A C0L-3140 SUP HCPCS C1713 C0L-3140 - SCREW BONE 3.5MM 14MM ACUMED ACLC CORT ORTH LCK STRL BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A C0L-3160 SUP HCPCS C1713 C0L-3160 - SCREW BONE 3.5MM 16MM TI DISTAL RADL CORT CLVCL WR HND LCK BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A C141 SUP HCPCS C1713 C141 - COVER PIN .141IN K WIRE BOTH IP/OP $5.00 $4.00 $0.99 $5.00 $2.25 $2.25 $2.25 $2.25 $5.00 $5.00 $5.00 $1.04 $5.00 $5.00 $5.00 $5.00 $5.00 $1.04 $5.00 $2.00 $2.96 $5.00 $5.00 $5.00 $5.00 $3.75 $5.00 $5.00 $5.00 $2.50 $2.50 $3.96 $5.00 $4.00 $2.25 $0.99 N/A $2.90 $5.00 $5.00 $5.00 $1.04 $5.00 N/A N/A C156 SUP HCPCS C1713 C156 - COVER PIN .156IN K WIRE BOTH IP/OP $5.00 $4.00 $0.99 $5.00 $2.25 $2.25 $2.25 $2.25 $5.00 $5.00 $5.00 $1.04 $5.00 $5.00 $5.00 $5.00 $5.00 $1.04 $5.00 $5.00 $2.96 $5.00 $5.00 $5.00 $5.00 $3.75 $5.00 $5.00 $5.00 $2.50 $2.50 $3.96 $5.00 $4.00 $2.25 $0.99 N/A $2.90 $5.00 $5.00 $5.00 $1.04 $5.00 N/A N/A C1712 SUP HCPCS C1713 C1712 - SCREW BONE 1.7MM 12MM CANN LBLU BOTH IP/OP $825.00 $611.00 $163.74 $825.00 $371.25 $371.25 $371.25 $371.25 $825.00 $825.00 $825.00 $171.95 $825.00 $825.00 $825.00 $825.00 $825.00 $171.94 $825.00 $330.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $371.25 $163.74 N/A $478.50 $825.00 $495.00 $825.00 $171.93 $825.00 N/A N/A C1713 SUP HCPCS C1713 C1713 - SCREW BONE 1.7MM 13MM CANN LIGHT BLUE BOTH IP/OP $825.00 $611.00 $163.74 $825.00 $371.25 $371.25 $371.25 $371.25 $825.00 $825.00 $825.00 $171.95 $825.00 $825.00 $825.00 $825.00 $825.00 $171.94 $825.00 $330.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $371.25 $163.74 N/A $478.50 $825.00 $825.00 $825.00 $171.93 $825.00 N/A N/A C1714 SUP HCPCS C1713 C1714 - SCREW BONE 1.7MM 9MM CANN COMPRESSION LIGHT BLUE ORTHOPEDIC BOTH IP/OP $825.00 $611.00 $163.74 $825.00 $371.25 $371.25 $371.25 $371.25 $825.00 $825.00 $825.00 $171.95 $825.00 $825.00 $825.00 $825.00 $825.00 $171.94 $825.00 $330.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $371.25 $163.74 N/A $478.50 $825.00 $825.00 $825.00 $171.93 $825.00 N/A N/A C2314 SUP HCPCS C1713 C2314 - SCREW BONE L14 MM OD2.3 MM ORTHOPEDIC LOCK BLUE BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $310.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $465.00 $775.00 $161.51 $775.00 N/A N/A C2316 SUP HCPCS C1713 C2316 - SCREW BN 2.3MM 16MM BLU CNN CMPR BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $310.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $465.00 $775.00 $161.51 $775.00 N/A N/A C2318 SUP HCPCS C1713 "C2318 - CANNULATED SCREW 2.3MM, 18MM" BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $310.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A C2320 SUP HCPCS C1713 C2320 - SCREW BONE 2.3MM 20MM LOCK BLUE ORTHOPEDIC BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $310.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A C2322 SUP HCPCS C1713 C2322 - SCREW BONE 2.3MM 22MM CANN COMPRESSION BLUE BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $310.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A C2324 SUP HCPCS C1713 C2324 - SCREW BN 2.3MM 24MM BLU CNN CMPR BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $310.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A C2326 SUP HCPCS C1713 C2326 - SCREW BONE 2.3MM 26MM CANN COMPRESSION BLUE BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $310.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A C2328 SUP HCPCS C1713 C2328 - SCREW BONE 2.3MM 28MM CANN COMPRESSION BLUE BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $310.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A C2TR01 SUP HCPCS C2621 C2TR01 - PACEMAKER CARDIAC THK6MM 57X59MM 2 CHAMBER RATE RESPONSIVE BOTH IP/OP "$14,700.00" "$10,878.00" "$2,917.58" "$14,700.00" "$6,615.00" "$6,615.00" "$6,615.00" "$6,615.00" "$14,700.00" "$14,700.00" "$14,700.00" "$3,063.85" "$14,700.00" "$14,700.00" "$14,700.00" "$14,700.00" "$14,700.00" "$3,063.64" "$14,700.00" "$14,700.00" "$7,247.10" "$14,700.00" "$14,700.00" "$14,700.00" "$14,700.00" "$11,025.00" "$14,700.00" "$14,700.00" "$14,700.00" "$7,350.00" "$7,350.00" "$11,642.40" "$14,700.00" "$11,760.00" "$6,615.00" "$2,917.58" N/A "$8,526.00" "$14,700.00" "$14,700.00" "$14,700.00" "$3,063.48" "$14,700.00" N/A N/A C3.5-20 SUP HCPCS C1713 C3.5-20 - SCREW BONE 3.5MM 20MM CANN ORANGE ORTHOPEDIC BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $737.50 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A C3018 SUP HCPCS C1713 C3018 - SCREW BONE 3MM 18MM CANN COMPRESSION YELLOW BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $775.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A C3020 SUP HCPCS C1713 C3020 - SCREW BONE 3MM 20MM CANN COMPRESSION YELLOW BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $775.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A C3022 SUP HCPCS C1713 C3022 - SCREW BONE 3MM 22MM CANN YELLOW BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $775.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $775.00 $775.00 $161.51 $775.00 N/A N/A C3024 SUP HCPCS C1713 C3024 - SCREW BONE 3MM 24MM COMPRESSION BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $775.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $465.00 $775.00 $161.51 $775.00 N/A N/A C3026 SUP HCPCS C1713 C3026 - SCREW BONE 3MM 26MM CANN COMPRESSION YELLOW BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $310.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $465.00 $775.00 $161.51 $775.00 N/A N/A C3524 SUP HCPCS C1713 C3524 - SCREW BONE 3.5MM 24MM CANN COMPRESSION ORANGE ORTHOPEDIC BOTH IP/OP $775.00 $574.00 $153.82 $775.00 $348.75 $348.75 $348.75 $348.75 $775.00 $775.00 $775.00 $161.53 $775.00 $775.00 $775.00 $775.00 $775.00 $161.52 $775.00 $310.00 $458.41 $775.00 $775.00 $775.00 $775.00 $581.25 $775.00 $775.00 $775.00 $387.50 $387.50 $613.80 $775.00 $620.00 $348.75 $153.82 N/A $449.50 $775.00 $465.00 $775.00 $161.51 $775.00 N/A N/A C4120 SUP Custom 27203010 C4120 - CARTRIDGE GRSPR 5MM 38CM STRL 20MM D DR ATRM DISP BOTH IP/OP $175.00 $130.00 $31.15 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $31.15 $175.00 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $70.00 $175.00 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $175.00 N/A $101.50 $175.00 $105.00 $175.00 $175.00 $175.00 N/A N/A C46145 SUP Custom 27203010 C46145 - CUSA CURVED EXTENDED STD TIPS 8/BX BOTH IP/OP "$1,219.50" $902.00 $217.05 "$1,219.38" "$1,219.38" "$1,219.38" "$1,219.38" "$1,219.38" "$1,219.38" "$1,219.38" $217.05 "$1,219.38" "$1,219.38" $905.02 $905.02 $939.90 $635.30 $254.13 "$1,219.38" $487.75 "$1,219.38" "$1,219.38" "$1,219.38" "$1,219.38" "$1,219.38" $914.63 "$1,219.38" "$1,219.38" "$1,219.38" $609.69 $609.69 $965.75 "$1,219.38" $975.50 $792.60 "$1,219.38" N/A $707.31 "$1,219.38" $731.63 "$1,219.38" "$1,219.38" "$1,219.38" N/A N/A C514D SUP Custom 27203010 C514D - SUTURE NONABSORBABLE 4-0 SH 18IN CONTROL RELEASE BRAID 8 BOTH IP/OP $30.50 $23.00 $5.36 $30.13 $30.13 $30.13 $30.13 $30.13 $30.13 $30.13 $5.36 $30.13 $30.13 $22.36 $22.36 $23.22 $15.70 $6.28 $30.13 $12.05 $30.13 $30.13 $30.13 $30.13 $30.13 $22.88 $30.13 $30.13 $30.13 $15.07 $15.07 $23.86 $30.13 $24.10 $19.58 $30.13 N/A $17.69 $30.13 $18.08 $30.13 $30.13 $30.13 N/A N/A C554D SUP Custom 27203010 C554D - SUTURE NRLN 4-0 RB1 18IN BRAID CR MPK BLK NABSB BOTH IP/OP $35.50 $26.00 $6.29 $35.34 $35.34 $35.34 $35.34 $35.34 $35.34 $35.34 $6.29 $35.34 $35.34 $26.23 $26.23 $27.24 $18.41 $7.37 $35.34 $14.14 $35.34 $35.34 $35.34 $35.34 $35.34 $26.63 $35.34 $35.34 $35.34 $17.67 $17.67 $27.99 $35.34 $28.27 $22.97 $35.34 N/A $20.59 $35.34 $21.20 $35.34 $35.34 $35.34 N/A N/A C5601 SUP Custom 27203010 C5601 - WRENCH SURG 23 KHZ TORQUE CUSA EXCEL STERILE DISPOSABLE CUSA BOTH IP/OP $182.50 $135.00 $32.49 $182.50 $182.50 $182.50 $182.50 $182.50 $182.50 $182.50 $32.49 $182.50 $182.50 $135.45 $135.45 $140.67 $95.08 $38.04 $182.50 $73.00 $182.50 $182.50 $182.50 $182.50 $182.50 $136.88 $182.50 $182.50 $182.50 $91.25 $91.25 $144.54 $182.50 $146.00 $118.63 $182.50 N/A $105.85 $182.50 $109.50 $182.50 $182.50 $182.50 N/A N/A C5602 SUP Custom 27203010 C5602 - WRENCH SURG 36KHZ TORQUE LATEX FREE CUSA EXCEL STERILE BOTH IP/OP $192.00 $142.00 $34.12 $191.67 $191.67 $191.67 $191.67 $191.67 $191.67 $191.67 $34.12 $191.67 $191.67 $142.26 $142.26 $147.74 $99.86 $39.95 $191.67 $76.67 $191.67 $191.67 $191.67 $191.67 $191.67 $144.00 $191.67 $191.67 $191.67 $95.84 $95.84 $151.80 $191.67 $153.34 $124.59 $191.67 N/A $111.36 $191.67 $115.00 $191.67 $191.67 $191.67 N/A N/A C584D SUP Custom 27203010 C584D - SUTURE NABSB 4-0 TF 18IN BLK NRLN CR BRD 8 STRN NYL 6 6 BOTH IP/OP $40.00 $30.00 $7.10 $41.02 $39.86 $39.86 $39.86 $39.86 $39.86 $39.86 $7.10 $39.86 $39.86 $29.58 $29.58 $30.72 $20.77 $8.31 $39.86 $16.41 $39.86 $39.86 $41.02 $39.86 $39.86 $30.00 $39.86 $39.86 $39.86 $19.93 $19.93 $31.57 $39.86 $31.89 $25.91 $39.86 N/A $23.20 $39.86 $23.92 $39.86 $39.86 $39.86 N/A N/A C8402 SUP Custom 27203010 C8402 - RETRACTOR SURG MEDIUM RING ATRAUMATIC SELF RETAIN WOUND BOTH IP/OP $135.00 $100.00 $24.03 $155.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $62.00 $135.00 $135.00 $155.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 N/A $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A C8403 SUP Custom 27203010 C8403 - RETRACTOR SURG LARGE RIGID RETRACTION RING ALEXIS O 9-14CM BOTH IP/OP $187.50 $139.00 $33.38 $215.00 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $86.00 $187.50 $187.50 $215.00 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A C8404 SUP Custom 27203010 C8404 - RETRACTOR SURG XL 11-17CM WOUND LATEX FREE ALEXIS 11-17CM BOTH IP/OP $237.50 $176.00 $42.28 $275.00 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $110.00 $237.50 $237.50 $275.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A C8584 SUP Custom 27203010 C8584 - BIT DRILL 9.5MM 9IN TAPERED HEAD TUNNEL DEPTH ECCENTRIC BOTH IP/OP "$1,751.00" "$1,296.00" $311.68 "$1,751.00" "$1,751.00" "$1,751.00" "$1,751.00" "$1,751.00" "$1,751.00" "$1,751.00" $311.68 "$1,751.00" "$1,751.00" "$1,299.59" "$1,299.59" "$1,349.67" $912.27 $364.93 "$1,751.00" $700.40 "$1,751.00" "$1,751.00" "$1,751.00" "$1,751.00" "$1,751.00" "$1,313.25" "$1,751.00" "$1,751.00" "$1,751.00" $875.50 $875.50 "$1,386.79" "$1,751.00" "$1,400.80" "$1,138.15" "$1,751.00" N/A "$1,015.58" "$1,751.00" "$1,050.60" "$1,751.00" "$1,751.00" "$1,751.00" N/A N/A C8XX2 SUP Custom 27203010 C8XX2 - PORT HND ACC 120MM LF ALEXIS GLPRT WND RTRCTR LAPSCP MRK PEN BOTH IP/OP "$1,625.00" "$1,203.00" $289.25 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $289.25 "$1,625.00" "$1,625.00" "$1,206.08" "$1,206.08" "$1,252.55" $846.63 $338.67 "$1,625.00" $650.00 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" "$1,056.25" "$1,625.00" N/A $942.50 "$1,625.00" $975.00 "$1,625.00" "$1,625.00" "$1,625.00" N/A N/A CA0304 SUP Custom 27803010 CA0304 - GRAFT SFT TISSUE AVIVE HUMAN UMBILICAL CORD MEMBRANE 3CMx4CM BOTH IP/OP "$6,000.00" "$4,440.00" "$1,068.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,068.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.47" "$6,000.00" "$2,450.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$4,500.00" "$6,000.00" "$6,000.00" "$6,000.00" "$3,000.00" "$3,000.00" "$4,752.00" "$6,000.00" "$4,800.00" "$2,700.00" "$6,000.00" N/A "$3,480.00" "$6,000.00" "$3,600.00" "$6,000.00" "$6,000.00" "$6,000.00" N/A N/A CA-4120 SUP HCPCS C1713 CA-4120 - SCREW BN 4MM 12MM NS HEX TI CANC BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CA-4140 SUP HCPCS C1713 CA-4140 - SCREW BN 4MM 14MM NS HEX TI CANC BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CA-4160 SUP HCPCS C1713 CA-4160 - SCREW BN 4MM 16MM NS HEX TI CANC BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CA-4180 SUP HCPCS C1713 CA-4180 - SCREW BN 4MM 18MM NS HEX TI CANC BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CA-4200 SUP HCPCS C1713 CA-4200 - SCREW BN 4MM 20MM NS HEX TI CANC BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CA-4220 SUP HCPCS C1713 CA-4220 - SCREW BN 4MM 22MM NS HEX TI CANC BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CA-4225 SUP HCPCS C1713 CA-4225 - SCREW BONE 4MM 22.5MM CANCELLOUS NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CA-4240 SUP HCPCS C1713 CA-4240 - SCREW BN 4MM 24MM NS HEX TI CANC BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CA-4250 SUP HCPCS C1713 CA-4250 - SCREW BONE 4MM 25MM TAP-LOC TITANIUM ELBOW CANCELLOUS BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CA-4260 SUP HCPCS C1713 CA-4260 - SCREW BN 4MM 26MM NS HEX TI CANC BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CA-4275 SUP HCPCS C1713 CA-4275 - SCREW BONE 4MM 27.5MM CANCELLOUS NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CA-4280 SUP HCPCS C1713 CA-4280 - SCREW BN 4MM 28MM CNN BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CA-4300 SUP HCPCS C1713 CA-4300 - SCREW BN 4MM 30MM NS HEX TI CANC BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CA-4340 SUP HCPCS C1713 CA-4340 - SCREW BONE 4MM 34MM TAP-LOC TITANIUM ELBOW CANCELLOUS BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CA-4350 SUP HCPCS C1713 CA-4350 - SCREW BONE 4MM 35MM TAP-LOC TITANIUM ELBOW CANCELLOUS BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CA-4400 SUP HCPCS C1713 CA-4400 - SCREW BONE 4MM 40MM TAP-LOC TITANIUM ELBOW CANCELLOUS BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CA-4450 SUP HCPCS C1713 CA-4450 - SCREW BONE 4MM 45MM TAP-LOC TITANIUM ELBOW CANCELLOUS BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CA-4500 SUP HCPCS C1713 CA-4500 - SCREW BONE 4MM 50MM TAP-LOC TITANIUM ELBOW CANCELLOUS BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CA-4550 SUP HCPCS C1713 CA-4550 - SCREW BN 4MM 55MM CNN BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CA-4600 SUP HCPCS C1713 CA-4600 - SCREW BN 4MM 60MM NS HEX TI CANC BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CAB3.8-12 SUP HCPCS C1713 CAB3.8-12 - SCREW BONE 3.8MM 12MM CANCELLOUS BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A CAB3.8-16 SUP HCPCS C1713 CAB3.8-16 - SCREW BONE 3.8MM 16MM CANCELLOUS BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A CAB3.8-20 SUP HCPCS C1713 CAB3.8-20 - SCREW BONE 3.8MM 20MM CANCELLOUS ANKLE FIX SYSTEM BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A CAB3.8-24 SUP HCPCS C1713 CAB3.8-24 - SCREW BN 3.8MM 24MM CANC ANKL FX SYS BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A CAB3.8-26 SUP HCPCS C1713 CAB3.8-26 - SCREW BONE 3.8MM 26MM CANCELLOUS ANKLE FIX SYSTEM BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A CA-PHB25 SUP HCPCS C1713 CA-PHB25 - SCREW BONE BUTTRESS 4.5MM 25MM LOCK POLARUS TITANIUM HUMERUS BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $180.00 $180.00 $180.00 $180.00 $400.00 $400.00 $400.00 $83.37 $400.00 $400.00 $400.00 $400.00 $400.00 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $180.00 $79.39 N/A $232.00 $400.00 $240.00 $400.00 $83.36 $400.00 N/A N/A CA-PHB275 SUP HCPCS C1713 CA-PHB275 - SCREW BONE BUTTRESS 4.5MM 27.5MM LOCK POLARUS TITANIUM BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $180.00 $180.00 $180.00 $180.00 $400.00 $400.00 $400.00 $83.37 $400.00 $400.00 $400.00 $400.00 $400.00 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $180.00 $79.39 N/A $232.00 $400.00 $240.00 $400.00 $83.36 $400.00 N/A N/A CA-PHB30 SUP HCPCS C1713 CA-PHB30 - SCREW BONE BUTTRESS 4.5MM 30MM LOCK POLARUS TITANIUM HUMERUS BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $180.00 $180.00 $180.00 $180.00 $400.00 $400.00 $400.00 $83.37 $400.00 $400.00 $400.00 $400.00 $400.00 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $180.00 $79.39 N/A $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A CA-PHB325 SUP HCPCS C1713 CA-PHB325 - SCREW BONE BUTTRESS 4.5MM 32.5MM LOCK POLARUS TITANIUM BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $180.00 $180.00 $180.00 $180.00 $400.00 $400.00 $400.00 $83.37 $400.00 $400.00 $400.00 $400.00 $400.00 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $180.00 $79.39 N/A $232.00 $400.00 $240.00 $400.00 $83.36 $400.00 N/A N/A CA-PHB35 SUP HCPCS C1713 CA-PHB35 - SCREW BONE 4.5MM 35MM LOCKING BUTTRESS POLARUS TITANIUM BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $180.00 $180.00 $180.00 $180.00 $400.00 $400.00 $400.00 $83.37 $400.00 $400.00 $400.00 $400.00 $400.00 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $180.00 $79.39 N/A $232.00 $400.00 $240.00 $400.00 $83.36 $400.00 N/A N/A CA-PHB375 SUP HCPCS C1713 CA-PHB375 - SCREW BONE 4.5MM 37.5MM TI CANC LCK BTRS NONSTRL BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $180.00 $180.00 $180.00 $180.00 $400.00 $400.00 $400.00 $83.37 $400.00 $400.00 $400.00 $400.00 $400.00 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $180.00 $79.39 N/A $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A CA-PHB40 SUP HCPCS C1713 CA-PHB40 - SCREW BN 4.5MM 40MM NS CORT BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $180.00 $180.00 $180.00 $180.00 $400.00 $400.00 $400.00 $83.37 $400.00 $400.00 $400.00 $400.00 $400.00 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $180.00 $79.39 N/A $232.00 $400.00 $240.00 $400.00 $83.36 $400.00 N/A N/A CA-PHB45 SUP HCPCS C1713 CA-PHB45 - SCREW BN 4.5MM 45MM LCK BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $180.00 $180.00 $180.00 $180.00 $400.00 $400.00 $400.00 $83.37 $400.00 $400.00 $400.00 $400.00 $400.00 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $180.00 $79.39 N/A $232.00 $400.00 $240.00 $400.00 $83.36 $400.00 N/A N/A CA-PHB50 SUP HCPCS C1713 CA-PHB50 - SCREW BONE BUTTRESS 4.5MM 50MM LOCK POLARUS TITANIUM HUMERUS BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $180.00 $180.00 $180.00 $180.00 $400.00 $400.00 $400.00 $83.37 $400.00 $400.00 $400.00 $400.00 $400.00 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $180.00 $79.39 N/A $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A CA-PHB55 SUP HCPCS C1713 CA-PHB55 - SCREW BONE 4.5MM 55MM LOCKING BUTTRESS POLARUS TITANIUM BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $180.00 $180.00 $180.00 $180.00 $400.00 $400.00 $400.00 $83.37 $400.00 $400.00 $400.00 $400.00 $400.00 $83.36 $400.00 $400.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $180.00 $79.39 N/A $232.00 $400.00 $240.00 $400.00 $83.36 $400.00 N/A N/A CAT00241 SUP Custom 27203010 CAT00241 - KIT ARTHRO 17GA HIP NTNL PRTL ENTRY 2 SPNL NDL SYR BOTH IP/OP $822.50 $609.00 $146.41 $822.50 $822.50 $822.50 $822.50 $822.50 $822.50 $822.50 $146.41 $822.50 $822.50 $610.46 $610.46 $633.98 $428.52 $171.42 $822.50 $329.00 $822.50 $822.50 $822.50 $822.50 $822.50 $616.88 $822.50 $822.50 $822.50 $411.25 $411.25 $651.42 $822.50 $658.00 $534.63 $822.50 N/A $477.05 $822.50 $493.50 $822.50 $822.50 $822.50 N/A N/A CAT02438 SUP Custom 27203010 CAT02438 - CANNULA ARTHRO 165MM OBT RADIOPQ FLOWPORT II STRYK BOTH IP/OP $987.50 $731.00 $175.78 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $175.78 $987.50 $987.50 $732.92 $732.92 $761.17 $514.49 $205.81 $987.50 $395.00 $987.50 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $641.88 $987.50 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A CAT02590 SUP Custom 27203010 CAT02590 - DEVICE SUT 70D UP 1 PORT BRD VAR TIP SLNGSHT BOTH IP/OP $872.50 $646.00 $155.31 $872.50 $872.50 $872.50 $872.50 $872.50 $872.50 $872.50 $155.31 $872.50 $872.50 $647.57 $647.57 $672.52 $454.57 $181.84 $872.50 $349.00 $872.50 $872.50 $872.50 $872.50 $872.50 $654.38 $872.50 $872.50 $872.50 $436.25 $436.25 $691.02 $872.50 $698.00 $567.13 $872.50 N/A $506.05 $872.50 $523.50 $872.50 $872.50 $872.50 N/A N/A CAT6KIT SUP HCPCS C1757 CAT6KIT - CATHETER THRMB 6FR 135CM LF INDG ASP DYNMC TBG SEPRTR 6 BOTH IP/OP "$5,637.50" "$4,172.00" "$1,118.90" "$5,637.50" "$3,061.16" "$3,061.16" "$3,061.16" "$3,061.16" "$5,637.50" "$5,637.50" "$5,637.50" "$1,175.00" "$5,637.50" "$4,181.12" "$4,181.12" "$4,345.39" "$2,060.15" "$1,174.92" "$5,637.50" "$5,637.50" "$3,094.73" "$5,637.50" "$5,637.50" "$5,637.50" "$5,637.50" "$4,228.13" "$5,637.50" "$5,637.50" "$5,637.50" "$2,818.75" "$2,818.75" "$4,464.90" "$5,637.50" "$4,510.00" "$3,664.38" "$1,118.90" N/A "$3,269.75" "$5,637.50" "$5,637.50" "$5,637.50" "$1,174.86" "$5,637.50" N/A N/A CAT8TORQ85 SUP HCPCS C1757 CAT8TORQ85 - CATHETER THRMB 85CM 8FR INDG ASPIRAT TRQ TIP LATEX BOTH IP/OP "$7,225.00" "$5,347.00" "$1,433.98" "$7,225.00" "$3,923.18" "$3,923.18" "$3,923.18" "$3,923.18" "$7,225.00" "$7,225.00" "$7,225.00" "$1,505.87" "$7,225.00" "$4,181.12" "$4,181.12" "$5,569.03" "$2,060.15" "$1,505.77" "$7,225.00" "$7,225.00" "$3,094.73" "$7,225.00" "$7,225.00" "$7,225.00" "$7,225.00" "$5,418.75" "$7,225.00" "$7,225.00" "$7,225.00" "$3,612.50" "$3,612.50" "$5,722.20" "$7,225.00" "$5,780.00" "$4,696.25" "$1,433.98" N/A "$4,190.50" "$7,225.00" "$7,225.00" "$7,225.00" "$1,505.69" "$7,225.00" N/A N/A CAT8XTORQ115 SUP HCPCS C1757 "CAT8XTORQ115 - INDIGO CATHETER 8, XTORQ TIP 115CM" BOTH IP/OP "$7,225.00" "$5,347.00" "$1,433.98" "$7,225.00" "$3,923.18" "$3,923.18" "$3,923.18" "$3,923.18" "$7,225.00" "$7,225.00" "$7,225.00" "$1,505.87" "$7,225.00" "$4,181.12" "$4,181.12" "$5,569.03" "$2,060.15" "$1,505.77" "$7,225.00" "$7,225.00" "$3,094.73" "$7,225.00" "$7,225.00" "$7,225.00" "$7,225.00" "$5,418.75" "$7,225.00" "$7,225.00" "$7,225.00" "$3,612.50" "$3,612.50" "$5,722.20" "$7,225.00" "$5,780.00" "$4,696.25" "$1,433.98" N/A "$4,190.50" "$7,225.00" "$7,225.00" "$7,225.00" "$1,505.69" "$7,225.00" N/A N/A CB09BA10 SUP Custom 27203010 CB09BA10 - BURR SURG BALL CVD 1MM 9CM MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB09BA10D SUP Custom 27203010 CB09BA10D - BURR SURG BALL CVD 1MM 9CM DIAMOND MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB09BA20 SUP Custom 27203010 CB09BA20 - BURR SURG BALL CVD 2MM 9CM MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB09BA20D SUP Custom 27203010 CB09BA20D - BURR SURG BALL CVD 2MM 9CM DIAMOND MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB09BA30 SUP Custom 27203010 CB09BA30 - BURR SURG BALL CVD 3MM 9CM MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB09BA30D SUP Custom 27203010 CB09BA30D - BURR SURG BALL CVD 3MM 9CM DIAMOND MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB09BA40 SUP Custom 27203010 CB09BA40 - BURR SURG BALL CVD 4MM 9CM MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB09BA40D SUP Custom 27203010 CB09BA40D - BURR SURG BALL CVD 4MM 9CM DIAMOND MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB11BA10 SUP Custom 27203010 CB11BA10 - BURR SURG BALL CVD 1MM 11CM MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB11BA10D SUP Custom 27203010 CB11BA10D - BURR SURG BALL CVD 1MM 11CM DIAMOND MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB11BA20 SUP Custom 27203010 CB11BA20 - BURR SURG BALL CVD 2MM 11CM MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB11BA20D SUP Custom 27203010 CB11BA20D - BURR SURG BALL CVD 2MM 11CM DIAMOND MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB11BA30 SUP Custom 27203010 CB11BA30 - BURR SURG BALL CVD 3MM 11CM MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB11BA30D SUP Custom 27203010 CB11BA30D - BURR SURG BALL CVD 3MM 11CM DIAMOND MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB11BA40 SUP Custom 27203010 CB11BA40 - BURR SURG BALL CVD 4MM 11CM MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CB11BA40D SUP Custom 27203010 CB11BA40D - BURR SURG BALL CVD 4MM 11CM DIAMOND MIDAS REX LEGEND STERILE BOTH IP/OP $711.00 $526.00 $126.56 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $711.00 $126.56 $711.00 $711.00 $527.70 $527.70 $548.04 $370.43 $148.18 $711.00 $284.40 $711.00 $711.00 $711.00 $711.00 $711.00 $533.25 $711.00 $711.00 $711.00 $355.50 $355.50 $563.11 $711.00 $568.80 $462.15 $711.00 N/A $412.38 $711.00 $426.60 $711.00 $711.00 $711.00 N/A N/A CBO33010 SUP HCPCS C1726 CBO33010 - CATHETER BLNDIL 3MM 10MM ANGPLSTY BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $373.31 $373.31 $373.31 $373.31 $687.50 $687.50 $687.50 $143.29 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A CC-2300 SUP Custom 27203010 CC-2300 - CONNECTOR DIALYSIS TITANIUM 2 PART FLEX-NECK CATHETER STERIL BOTH IP/OP $377.50 $279.00 $67.20 $377.50 $377.50 $377.50 $377.50 $377.50 $377.50 $377.50 $67.20 $377.50 $377.50 $280.18 $280.18 $290.98 $196.68 $78.68 $377.50 $151.00 $377.50 $377.50 $377.50 $377.50 $377.50 $283.13 $377.50 $377.50 $377.50 $188.75 $188.75 $298.98 $377.50 $302.00 $245.38 $377.50 N/A $218.95 $377.50 $226.50 $377.50 $377.50 $377.50 N/A N/A CC2A SUP HCPCS C1713 CC2A - CEMENT BN 3 KYPHON XPEDE KYPHON MUL-TAP MXR PK ADPR BOTH IP/OP $675.00 $500.00 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $675.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 N/A $391.50 $675.00 $675.00 $675.00 $140.67 $675.00 N/A N/A CD1231-40 SUP HCPCS C1722 CD1231-40 - DEFIBRILLATOR CARDIAC THK14MM 40J 40X73MM 1 CHAMBER IS-1 BOTH IP/OP "$32,250.00" "$23,865.00" "$6,400.82" "$32,250.00" "$14,512.50" "$14,512.50" "$14,512.50" "$14,512.50" "$32,250.00" "$32,250.00" "$32,250.00" "$6,721.71" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$6,721.25" "$32,250.00" "$32,250.00" "$15,899.25" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$24,187.50" "$32,250.00" "$32,250.00" "$32,250.00" "$16,125.00" "$16,125.00" "$25,542.00" "$32,250.00" "$25,800.00" "$14,512.50" "$6,400.82" N/A "$18,705.00" "$32,250.00" "$32,250.00" "$32,250.00" "$6,720.90" "$32,250.00" N/A N/A CD1231-40Q SUP HCPCS C1722 CD1231-40Q - DEFIBRILLATOR CARDIAC THK14MM 40J 40X71MM 1 CHAMBER DF-4 RF BOTH IP/OP "$32,250.00" "$23,865.00" "$6,400.82" "$32,250.00" "$14,512.50" "$14,512.50" "$14,512.50" "$14,512.50" "$32,250.00" "$32,250.00" "$32,250.00" "$6,721.71" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$6,721.25" "$32,250.00" "$32,250.00" "$15,899.25" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$24,187.50" "$32,250.00" "$32,250.00" "$32,250.00" "$16,125.00" "$16,125.00" "$25,542.00" "$32,250.00" "$25,800.00" "$14,512.50" "$6,400.82" N/A "$18,705.00" "$32,250.00" "$32,250.00" "$32,250.00" "$6,720.90" "$32,250.00" N/A N/A CD1257-40 SUP HCPCS C1722 CD1257-40 - DEFIBRILLATOR CARDIAC THK14MM 40J 40X73MM 1 CHAMBER 1IS-1 1 BOTH IP/OP "$32,250.00" "$23,865.00" "$6,400.82" "$32,250.00" "$14,512.50" "$14,512.50" "$14,512.50" "$14,512.50" "$32,250.00" "$32,250.00" "$32,250.00" "$6,721.71" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$6,721.25" "$32,250.00" "$32,250.00" "$15,899.25" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$24,187.50" "$32,250.00" "$32,250.00" "$32,250.00" "$16,125.00" "$16,125.00" "$25,542.00" "$32,250.00" "$25,800.00" "$14,512.50" "$6,400.82" N/A "$18,705.00" "$32,250.00" "$32,250.00" "$32,250.00" "$6,720.90" "$32,250.00" N/A N/A CD1257-40Q SUP HCPCS C1722 CD1257-40Q - DEFIBRILLATOR CARDIAC THK14MM 40J NARROW 40X71MM 1 CHAMBER BOTH IP/OP "$32,250.00" "$23,865.00" "$6,400.82" "$32,250.00" "$14,512.50" "$14,512.50" "$14,512.50" "$14,512.50" "$32,250.00" "$32,250.00" "$32,250.00" "$6,721.71" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$6,721.25" "$32,250.00" "$32,250.00" "$15,899.25" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$24,187.50" "$32,250.00" "$32,250.00" "$32,250.00" "$16,125.00" "$16,125.00" "$25,542.00" "$32,250.00" "$25,800.00" "$14,512.50" "$6,400.82" N/A "$18,705.00" "$32,250.00" "$32,250.00" "$32,250.00" "$6,720.90" "$32,250.00" N/A N/A CD1311-36 SUP HCPCS C1722 CD1311-36 - DEFIBRILLATOR CARDIAC THK12MM 36J 51X68MM 1 CHAMBER 1IS-1 1 BOTH IP/OP "$32,250.00" "$23,865.00" "$6,400.82" "$32,250.00" "$14,512.50" "$14,512.50" "$14,512.50" "$14,512.50" "$32,250.00" "$32,250.00" "$32,250.00" "$6,721.71" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$6,721.25" "$32,250.00" "$32,250.00" "$15,899.25" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$24,187.50" "$32,250.00" "$32,250.00" "$32,250.00" "$16,125.00" "$16,125.00" "$25,542.00" "$32,250.00" "$25,800.00" "$14,512.50" "$6,400.82" N/A "$18,705.00" "$32,250.00" "$32,250.00" "$32,250.00" "$6,720.90" "$32,250.00" N/A N/A CD1311-36Q SUP HCPCS C1722 CD1311-36Q - DEFIBRILLATOR CARDIAC THK12MM 36J 66X51MM 2 CHAMBER 2DF-4 BOTH IP/OP "$32,250.00" "$23,865.00" "$6,400.82" "$32,250.00" "$14,512.50" "$14,512.50" "$14,512.50" "$14,512.50" "$32,250.00" "$32,250.00" "$32,250.00" "$6,721.71" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$6,721.25" "$32,250.00" "$32,250.00" "$15,899.25" "$32,250.00" "$32,250.00" "$32,250.00" "$32,250.00" "$24,187.50" "$32,250.00" "$32,250.00" "$32,250.00" "$16,125.00" "$16,125.00" "$25,542.00" "$32,250.00" "$25,800.00" "$14,512.50" "$6,400.82" N/A "$18,705.00" "$32,250.00" "$32,250.00" "$32,250.00" "$6,720.90" "$32,250.00" N/A N/A CD2231-40 SUP HCPCS C1721 CD2231-40 - DEFIBRILLATOR CARDIAC THK14MM 40J 40X74MM 2 CHAMBER 2DF-1 BOTH IP/OP "$33,075.00" "$24,476.00" "$6,893.19" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$6,893.19" "$33,075.00" "$13,230.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$24,806.25" "$33,075.00" "$33,075.00" "$33,075.00" "$16,537.50" "$16,537.50" "$26,195.40" "$33,075.00" "$26,460.00" "$14,883.75" "$33,075.00" N/A "$19,183.50" "$33,075.00" "$19,845.00" "$33,075.00" "$33,075.00" "$33,075.00" N/A N/A CD2231-40Q SUP HCPCS C1721 CD2231-40Q - DEFIBRILLATOR CARDIAC THK14MM 40J 40X71MM 2 CHAMBER 2DF-4 BOTH IP/OP "$33,075.00" "$24,476.00" "$6,893.19" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$6,893.19" "$33,075.00" "$13,230.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$24,806.25" "$33,075.00" "$33,075.00" "$33,075.00" "$16,537.50" "$16,537.50" "$26,195.40" "$33,075.00" "$26,460.00" "$14,883.75" "$33,075.00" N/A "$19,183.50" "$33,075.00" "$19,845.00" "$33,075.00" "$33,075.00" "$33,075.00" N/A N/A CD2257-40 SUP HCPCS C1721 CD2257-40 - DEFIBRILLATOR CARDIAC THK14MM 40J 40X74MM 2 CHAMBER 2DF-1 BOTH IP/OP "$33,075.00" "$24,476.00" "$6,893.19" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$6,893.19" "$33,075.00" "$13,230.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$24,806.25" "$33,075.00" "$33,075.00" "$33,075.00" "$16,537.50" "$16,537.50" "$26,195.40" "$33,075.00" "$26,460.00" "$14,883.75" "$33,075.00" N/A "$19,183.50" "$33,075.00" "$19,845.00" "$33,075.00" "$33,075.00" "$33,075.00" N/A N/A CD2257-40Q SUP HCPCS C1721 CD2257-40Q - DEFIBRILLATOR CRD THK14MM 40J 40X71MM 35CC STRL LF FORTIFY BOTH IP/OP "$33,075.00" "$24,476.00" "$6,893.19" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$6,893.19" "$33,075.00" "$13,230.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$24,806.25" "$33,075.00" "$33,075.00" "$33,075.00" "$16,537.50" "$16,537.50" "$26,195.40" "$33,075.00" "$26,460.00" "$14,883.75" "$33,075.00" N/A "$19,183.50" "$33,075.00" "$19,845.00" "$33,075.00" "$33,075.00" "$33,075.00" N/A N/A CD2311-36 SUP HCPCS C1721 CD2311-36 - DEFIBRILLATOR CARDIAC THK12MM 36J 51X69MM 1 CHAMBER 1IS-1 1 BOTH IP/OP "$33,075.00" "$24,476.00" "$6,893.19" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$6,893.19" "$33,075.00" "$13,230.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$24,806.25" "$33,075.00" "$33,075.00" "$33,075.00" "$16,537.50" "$16,537.50" "$26,195.40" "$33,075.00" "$26,460.00" "$14,883.75" "$33,075.00" N/A "$19,183.50" "$33,075.00" "$19,845.00" "$33,075.00" "$33,075.00" "$33,075.00" N/A N/A CD2311-36Q SUP HCPCS C1721 CD2311-36Q - DEFIBRILLATOR CRD THK12MM 36J 51X70MM 31ML ELLIPSE 2 CHMBR 1 BOTH IP/OP "$33,075.00" "$24,476.00" "$6,893.19" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$6,893.19" "$33,075.00" "$13,230.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$33,075.00" "$24,806.25" "$33,075.00" "$33,075.00" "$33,075.00" "$16,537.50" "$16,537.50" "$26,195.40" "$33,075.00" "$26,460.00" "$14,883.75" "$33,075.00" N/A "$19,183.50" "$33,075.00" "$19,845.00" "$33,075.00" "$33,075.00" "$33,075.00" N/A N/A CD3231-40 SUP HCPCS C1721 CD3231-40 - DEFIBRILLATOR CRD THK14MM 2.5V 40X79MM 36ML UNIFY CRT-D QHR BOTH IP/OP "$45,500.00" "$33,670.00" "$9,482.70" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$9,482.70" "$45,500.00" "$18,200.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$34,125.00" "$45,500.00" "$45,500.00" "$45,500.00" "$22,750.00" "$22,750.00" "$36,036.00" "$45,500.00" "$36,400.00" "$20,475.00" "$45,500.00" N/A "$26,390.00" "$45,500.00" "$27,300.00" "$45,500.00" "$45,500.00" "$45,500.00" N/A N/A CD3231-40Q SUP HCPCS C1721 CD3231-40Q - DEFIBRILLATOR CARDIAC THK14MM 2.5V 500OHM 60 PPM 40X73MM 2 BOTH IP/OP "$39,825.00" "$29,471.00" "$8,299.97" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$8,299.97" "$39,825.00" "$15,930.00" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$29,868.75" "$39,825.00" "$39,825.00" "$39,825.00" "$19,912.50" "$19,912.50" "$31,541.40" "$39,825.00" "$31,860.00" "$17,921.25" "$39,825.00" N/A "$23,098.50" "$39,825.00" "$23,895.00" "$39,825.00" "$39,825.00" "$39,825.00" N/A N/A CD3257-40 SUP HCPCS C1882 CD3257-40 - DEFIBRILLATOR CRD THK14MM 40J 40X79MM 36CC UNIFY ASR CRT-D 2 BOTH IP/OP "$39,825.00" "$29,471.00" "$7,712.84" "$39,825.00" "$17,921.25" "$17,921.25" "$17,921.25" "$17,921.25" "$39,825.00" "$39,825.00" "$39,825.00" "$8,300.53" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$8,299.97" "$39,825.00" "$39,825.00" "$19,633.73" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$29,868.75" "$39,825.00" "$39,825.00" "$39,825.00" "$19,912.50" "$19,912.50" "$31,541.40" "$39,825.00" "$31,860.00" "$17,921.25" "$7,712.84" N/A "$23,098.50" "$39,825.00" "$39,825.00" "$39,825.00" "$8,098.48" "$39,825.00" N/A N/A CD3257-40Q SUP HCPCS C1882 CD3257-40Q - DEFIBRILLATOR CRD THK14MM 40J 40X73MM 36CC UNIFY ASR BOTH IP/OP "$39,825.00" "$29,471.00" "$7,712.84" "$39,825.00" "$17,921.25" "$17,921.25" "$17,921.25" "$17,921.25" "$39,825.00" "$39,825.00" "$39,825.00" "$8,300.53" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$8,299.97" "$39,825.00" "$39,825.00" "$19,633.73" "$39,825.00" "$39,825.00" "$39,825.00" "$39,825.00" "$29,868.75" "$39,825.00" "$39,825.00" "$39,825.00" "$19,912.50" "$19,912.50" "$31,541.40" "$39,825.00" "$31,860.00" "$17,921.25" "$7,712.84" N/A "$23,098.50" "$39,825.00" "$39,825.00" "$39,825.00" "$8,098.48" "$39,825.00" N/A N/A CD3265-40 SUP HCPCS C1882 CD3265-40 - DEFIBRILLATOR CARDIAC THK14MM 40J 41X83MM 2 CHAMBER 1IS-1 1 BOTH IP/OP "$42,750.00" "$31,635.00" "$7,712.84" "$42,750.00" "$19,237.50" "$19,237.50" "$19,237.50" "$19,237.50" "$42,750.00" "$42,750.00" "$42,750.00" "$8,910.17" "$42,750.00" "$42,750.00" "$42,750.00" "$42,750.00" "$42,750.00" "$8,909.57" "$42,750.00" "$42,750.00" "$21,075.75" "$42,750.00" "$42,750.00" "$42,750.00" "$42,750.00" "$32,062.50" "$42,750.00" "$42,750.00" "$42,750.00" "$21,375.00" "$21,375.00" "$33,858.00" "$42,750.00" "$34,200.00" "$19,237.50" "$7,712.84" N/A "$24,795.00" "$42,750.00" "$42,750.00" "$42,750.00" "$8,098.48" "$42,750.00" N/A N/A CD3265-40Q SUP HCPCS C1882 CD3265-40Q - DEFIBRILLATOR CRD THK14MM 40J 41X76MM 38CC QD ASR BOTH IP/OP "$42,750.00" "$31,635.00" "$7,712.84" "$42,750.00" "$19,237.50" "$19,237.50" "$19,237.50" "$19,237.50" "$42,750.00" "$42,750.00" "$42,750.00" "$8,910.17" "$42,750.00" "$42,750.00" "$42,750.00" "$42,750.00" "$42,750.00" "$8,909.57" "$42,750.00" "$42,750.00" "$21,075.75" "$42,750.00" "$42,750.00" "$42,750.00" "$42,750.00" "$32,062.50" "$42,750.00" "$42,750.00" "$42,750.00" "$21,375.00" "$21,375.00" "$33,858.00" "$42,750.00" "$34,200.00" "$19,237.50" "$7,712.84" N/A "$24,795.00" "$42,750.00" "$42,750.00" "$42,750.00" "$8,098.48" "$42,750.00" N/A N/A CDSLM57 SUP Custom 27803010 CDSLM57 - PATCH DURAL 7X5IN LATEX FREE DURAMATRIX-ONLAY BOTH IP/OP "$4,337.50" "$3,210.00" $771.99 "$4,337.03" "$4,337.03" "$4,337.03" "$4,337.03" "$4,337.03" "$4,337.03" "$4,337.03" $771.99 "$4,337.03" "$4,337.03" "$4,337.03" "$4,337.03" "$4,337.03" "$4,337.03" $903.88 "$4,337.03" "$1,734.81" "$4,337.03" "$4,337.03" "$4,337.03" "$4,337.03" "$4,337.03" "$3,253.13" "$4,337.03" "$4,337.03" "$4,337.03" "$2,168.52" "$2,168.52" "$3,434.93" "$4,337.03" "$3,469.62" "$1,951.66" "$4,337.03" N/A "$2,515.75" "$4,337.03" "$2,602.22" "$4,337.03" "$4,337.03" "$4,337.03" N/A N/A CDSM33 SUP Custom 27803010 CDSM33 - PATCH DURA 3X3IN DRMTRX IMPL FLXB STRNG CLGN MTRX BOTH IP/OP "$1,731.00" "$1,281.00" $308.12 "$1,731.00" "$1,731.00" "$1,731.00" "$1,731.00" "$1,731.00" "$1,731.00" "$1,731.00" $308.12 "$1,731.00" "$1,731.00" "$1,731.00" "$1,731.00" "$1,731.00" "$1,731.00" $360.76 "$1,731.00" $692.40 "$1,731.00" "$1,731.00" "$1,731.00" "$1,731.00" "$1,731.00" "$1,298.25" "$1,731.00" "$1,731.00" "$1,731.00" $865.50 $865.50 "$1,370.95" "$1,731.00" "$1,384.80" $778.95 "$1,731.00" N/A "$1,003.98" "$1,731.00" "$1,038.60" "$1,731.00" "$1,731.00" "$1,731.00" N/A N/A CEK-1866-20 SUP Custom 27203010 CEK-1866-20 - BRUSH ENDSCP CLEAN KIT 2 END HEDGEHOG BOTH IP/OP $35.50 $26.00 $6.25 $35.13 $35.13 $35.13 $35.13 $35.13 $35.13 $35.13 $6.25 $35.13 $35.13 $26.07 $26.07 $27.08 $18.30 $7.32 $35.13 $24.50 $35.13 $35.13 $35.13 $35.13 $35.13 $26.63 $35.13 $35.13 $35.13 $17.57 $17.57 $27.82 $35.13 $28.10 $22.83 $35.13 N/A $20.59 $35.13 $21.08 $35.13 $35.13 $35.13 N/A N/A CF-5260 SUP HCPCS C1750 CF-5260 - CATHETER DIALYSIS STANDARD 5.3MM 4.5MM 3.5MM 62CM STR INTER BOTH IP/OP $435.00 $322.00 $86.34 $435.00 $195.75 $195.75 $195.75 $195.75 $435.00 $435.00 $435.00 $90.66 $435.00 $435.00 $435.00 $435.00 $435.00 $90.66 $435.00 $435.00 $257.30 $435.00 $435.00 $435.00 $435.00 $326.25 $435.00 $435.00 $435.00 $217.50 $217.50 $344.52 $435.00 $348.00 $195.75 $86.34 N/A $252.30 $435.00 $435.00 $435.00 $90.65 $435.00 N/A N/A CF7-3-60 SUP HCPCS C1888 CF7-3-60 - CATHETER INTERVENTIONAL .025IN 7FR 60CM 3CM RADIOFREQUENCY BOTH IP/OP "$5,250.00" "$3,885.00" "$1,094.16" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,896.55" "$3,896.55" "$4,046.70" "$2,060.15" "$1,094.16" "$5,250.00" "$2,100.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$3,412.50" "$5,250.00" N/A "$3,045.00" "$5,250.00" "$3,150.00" "$5,250.00" "$5,250.00" "$5,250.00" N/A N/A CFF03 SUP Custom 27203010 CFF03 - TROCAR LAPSCP 5MM 100MM LF KII FIOS ADV FX SLV RPD INSFL 1ST BOTH IP/OP $225.00 $167.00 $40.05 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $40.05 $225.00 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $90.00 $225.00 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $225.00 N/A $130.50 $225.00 $135.00 $225.00 $225.00 $225.00 N/A N/A CFF71 SUP Custom 27203010 CFF71 - TROCAR LAPSCP 12MM 150MM LF KII FIOS ADV FX SLV RPD INSFL 1 BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A CFF73 SUP Custom 27203010 CFF73 - TROCAR LAPSCP 12MM 100MM KII FIOS ADV FX SLV 1ST ENTRY BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $185.55 $185.55 $192.70 $130.25 $52.10 $250.00 $100.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $162.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A CG409 SUP HCPCS C1725 CG409 - CATHETER ANGIO CBR 2 CRV 4FR .041IN 65CM 15CM GLDCATH GLD BOTH IP/OP $121.50 $90.00 $24.09 $132.95 $65.91 $65.91 $65.91 $65.91 $121.38 $121.38 $121.38 $25.30 $121.38 $90.09 $90.09 $93.56 $63.24 $25.30 $121.38 $132.95 $71.80 $121.38 $132.95 $121.38 $121.38 $91.13 $121.38 $121.38 $121.38 $60.69 $60.69 $96.13 $121.38 $97.10 $78.90 $24.09 N/A $70.47 $121.38 $121.38 $121.38 $25.30 $121.38 N/A N/A CG415 SUP HCPCS C1725 CG415 - CATHETER ANGIOGRAPHIC ANGLE 4FR .041IN 65CM 15CM 2 BRAID BOTH IP/OP $121.50 $90.00 $24.09 $132.95 $65.91 $65.91 $65.91 $65.91 $121.38 $121.38 $121.38 $25.30 $121.38 $90.09 $90.09 $93.56 $63.24 $25.30 $121.38 $132.95 $71.80 $121.38 $132.95 $121.38 $121.38 $91.13 $121.38 $121.38 $121.38 $60.69 $60.69 $96.13 $121.38 $97.10 $78.90 $24.09 N/A $70.47 $121.38 $121.38 $121.38 $25.30 $121.38 N/A N/A CG416 SUP HCPCS C1887 CG416 - CATHETER ANGIOGRAPHIC ANGLE 4FR .041IN 100CM 15CM 2 BRAID BOTH IP/OP $121.50 $90.00 $24.09 $132.95 $65.91 $65.91 $65.91 $65.91 $121.38 $121.38 $121.38 $25.30 $121.38 $90.09 $90.09 $93.56 $63.24 $25.30 $121.38 $132.95 $71.80 $121.38 $132.95 $121.38 $121.38 $91.13 $121.38 $121.38 $121.38 $60.69 $60.69 $96.13 $121.38 $97.10 $78.90 $24.09 N/A $70.47 $121.38 $121.38 $121.38 $25.30 $121.38 N/A N/A CG502 SUP HCPCS C1725 CG502 - CATHETER ANGIO CBR 2 CRV 5FR .047IN 65CM 25CM GLDCATH GLD BOTH IP/OP $121.50 $90.00 $26.39 $132.95 $72.19 $72.19 $72.19 $72.19 $132.95 $132.95 $132.95 $27.71 $132.95 $98.68 $98.68 $102.48 $69.27 $27.71 $132.95 $132.95 $78.64 $132.95 $132.95 $132.95 $132.95 $91.13 $132.95 $132.95 $132.95 $66.48 $66.48 $105.30 $132.95 $106.36 $86.42 $26.39 N/A $70.47 $132.95 $132.95 $132.95 $27.71 $132.95 N/A N/A CG502 SUP HCPCS C1725 CG502 - CATHETER ANGIO C2 CRV 5FR 65CM STRL LF GLDCATH RADIFOCUS BRD BOTH IP/OP $133.00 $98.00 $26.39 $132.95 $72.19 $72.19 $72.19 $72.19 $132.95 $132.95 $132.95 $27.71 $132.95 $98.68 $98.68 $102.48 $69.27 $27.71 $132.95 $132.95 $78.64 $132.95 $132.95 $132.95 $132.95 $99.75 $132.95 $132.95 $132.95 $66.48 $66.48 $105.30 $132.95 $106.36 $86.42 $26.39 N/A $77.14 $132.95 $132.95 $132.95 $27.71 $132.95 N/A N/A CG506 SUP HCPCS C1725 CG506 - CATHETER ANGIO STRG TPR 5FR .047IN 100CM GLDCATH GLD TCH BRD BOTH IP/OP $121.50 $90.00 $26.39 $132.95 $72.19 $72.19 $72.19 $72.19 $132.95 $132.95 $132.95 $27.71 $132.95 $98.68 $98.68 $102.48 $69.27 $27.71 $132.95 $132.95 $78.64 $132.95 $132.95 $132.95 $132.95 $91.13 $132.95 $132.95 $132.95 $66.48 $66.48 $105.30 $132.95 $106.36 $86.42 $26.39 N/A $70.47 $132.95 $132.95 $132.95 $27.71 $132.95 N/A N/A CG506 SUP HCPCS C1725 CG506 - CATHETER ANGIO STRG TPR 5FR 100CM STRL LF GLDCATH RADIFOCUS BOTH IP/OP $133.00 $98.00 $26.39 $132.95 $72.19 $72.19 $72.19 $72.19 $132.95 $132.95 $132.95 $27.71 $132.95 $98.68 $98.68 $102.48 $69.27 $27.71 $132.95 $132.95 $78.64 $132.95 $132.95 $132.95 $132.95 $99.75 $132.95 $132.95 $132.95 $66.48 $66.48 $105.30 $132.95 $106.36 $86.42 $26.39 N/A $77.14 $132.95 $132.95 $132.95 $27.71 $132.95 N/A N/A CG507 SUP HCPCS C1725 CG507 - CATHETER ANGIOGRAPHIC ANGLE 5FR .047IN 65CM 25CM 1 BRAID BOTH IP/OP $121.50 $90.00 $24.09 $132.95 $65.91 $65.91 $65.91 $65.91 $121.38 $121.38 $121.38 $25.30 $121.38 $90.09 $90.09 $93.56 $63.24 $25.30 $121.38 $132.95 $71.80 $121.38 $132.95 $121.38 $121.38 $91.13 $121.38 $121.38 $121.38 $60.69 $60.69 $96.13 $121.38 $97.10 $78.90 $24.09 N/A $70.47 $121.38 $121.38 $121.38 $25.30 $121.38 N/A N/A CG508 SUP HCPCS C1725 CG508 - CATHETER ANGIOGRAPHIC ANGLE 5FR .047IN 100CM 25CM 1 BRAID BOTH IP/OP $121.50 $90.00 $24.09 $132.95 $65.91 $65.91 $65.91 $65.91 $121.38 $121.38 $121.38 $25.30 $121.38 $90.09 $90.09 $93.56 $63.24 $25.30 $121.38 $132.95 $71.80 $121.38 $132.95 $121.38 $121.38 $91.13 $121.38 $121.38 $121.38 $60.69 $60.69 $96.13 $121.38 $97.10 $78.90 $24.09 N/A $70.47 $121.38 $121.38 $121.38 $25.30 $121.38 N/A N/A CG511 SUP HCPCS C1725 CG511 - CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 5FR .047IN 100CM 1 BOTH IP/OP $121.50 $90.00 $24.09 $132.95 $65.91 $65.91 $65.91 $65.91 $121.38 $121.38 $121.38 $25.30 $121.38 $90.09 $90.09 $93.56 $63.24 $25.30 $121.38 $132.95 $71.80 $121.38 $132.95 $121.38 $121.38 $91.13 $121.38 $121.38 $121.38 $60.69 $60.69 $96.13 $121.38 $97.10 $78.90 $24.09 N/A $70.47 $121.38 $121.38 $121.38 $25.30 $121.38 N/A N/A CG511 SUP HCPCS C1725 CG511 - CATHETER ANGIO SIM2 CRV 5FR 100CM GLDCATH BRD SS HDRPH CRBRL BOTH IP/OP $133.00 $98.00 $24.09 $132.95 $65.91 $65.91 $65.91 $65.91 $121.38 $121.38 $121.38 $25.30 $121.38 $90.09 $90.09 $93.56 $63.24 $25.30 $121.38 $132.95 $71.80 $121.38 $132.95 $121.38 $121.38 $99.75 $121.38 $121.38 $121.38 $60.69 $60.69 $96.13 $121.38 $97.10 $78.90 $24.09 N/A $77.14 $121.38 $121.38 $121.38 $25.30 $121.38 N/A N/A CG513 SUP HCPCS C1725 CG513 - CATHETER ANGIO HDHNTR 1 CRV 5FR .047IN 100CM 25CM GLDCATH BOTH IP/OP $121.50 $90.00 $26.39 $132.95 $72.19 $72.19 $72.19 $72.19 $132.95 $132.95 $132.95 $27.71 $132.95 $98.68 $98.68 $102.48 $69.27 $27.71 $132.95 $132.95 $78.64 $132.95 $132.95 $132.95 $132.95 $91.13 $132.95 $132.95 $132.95 $66.48 $66.48 $105.30 $132.95 $106.36 $86.42 $26.39 N/A $70.47 $132.95 $132.95 $132.95 $27.71 $132.95 N/A N/A CG513 SUP HCPCS C1725 CG513 - CATHETER ANGIO 1 CRV 5FR 100CM STRL LF GLDCATH RADIFOCUS BRD BOTH IP/OP $133.00 $98.00 $26.39 $132.95 $72.19 $72.19 $72.19 $72.19 $132.95 $132.95 $132.95 $27.71 $132.95 $98.68 $98.68 $102.48 $69.27 $27.71 $132.95 $132.95 $78.64 $132.95 $132.95 $132.95 $132.95 $99.75 $132.95 $132.95 $132.95 $66.48 $66.48 $105.30 $132.95 $106.36 $86.42 $26.39 N/A $77.14 $132.95 $132.95 $132.95 $27.71 $132.95 N/A N/A CG514 SUP HCPCS C1725 CG514 - CATHETER ANGIO BNTSN 1 CRV 5FR .047IN 100CM 25CM GLDCATH GLD BOTH IP/OP $121.50 $90.00 $24.09 $132.95 $65.91 $65.91 $65.91 $65.91 $121.38 $121.38 $121.38 $25.30 $121.38 $90.09 $90.09 $93.56 $63.24 $25.30 $121.38 $132.95 $71.80 $121.38 $132.95 $121.38 $121.38 $91.13 $121.38 $121.38 $121.38 $60.69 $60.69 $96.13 $121.38 $97.10 $78.90 $24.09 N/A $70.47 $121.38 $121.38 $121.38 $25.30 $121.38 N/A N/A CM1518 SUP HCPCS Q4116 CM1518 - MATRIX TISS THK1.2-2MM MED CNTR 19.3X9.6CM ALDRM SLCT ALGRF BOTH IP/OP "$9,007.50" "$6,666.00" "$1,787.76" "$9,007.50" "$4,053.38" "$4,053.38" "$4,053.38" "$4,053.38" "$9,007.50" "$9,007.50" "$9,007.50" "$1,877.39" "$9,007.50" "$9,007.50" "$9,007.50" "$9,007.50" "$9,007.50" "$1,877.26" "$9,007.50" "$9,007.50" "$4,440.70" "$9,007.50" "$9,007.50" "$9,007.50" "$9,007.50" "$6,755.63" "$9,007.50" "$9,007.50" "$9,007.50" "$4,503.75" "$4,503.75" "$7,133.94" "$9,007.50" "$7,206.00" "$4,053.38" "$1,787.76" N/A "$5,224.35" "$9,007.50" "$9,007.50" "$9,007.50" "$1,877.16" "$9,007.50" N/A N/A CM1520 SUP HCPCS Q4116 CM1520 - MATRIX TISS THK.4-1.6MM MED CNTR 19.3X9.6CM ALDRM SLCT ALGRF BOTH IP/OP "$13,972.50" "$10,340.00" "$2,773.19" "$13,972.50" "$6,287.63" "$6,287.63" "$6,287.63" "$6,287.63" "$13,972.50" "$13,972.50" "$13,972.50" "$2,912.22" "$13,972.50" "$13,972.50" "$13,972.50" "$13,972.50" "$13,972.50" "$2,912.02" "$13,972.50" "$9,007.50" "$6,888.44" "$13,972.50" "$9,007.50" "$13,972.50" "$13,972.50" "$10,479.38" "$13,972.50" "$13,972.50" "$13,972.50" "$6,986.25" "$6,986.25" "$11,066.22" "$13,972.50" "$11,178.00" "$6,287.63" "$2,773.19" N/A "$8,104.05" "$13,972.50" "$13,972.50" "$13,972.50" "$2,911.87" "$13,972.50" N/A N/A CM630147S SUP HCPCS C1713 CM630147S - NAIL INTRAMEDULLARY 130D LONG 11MM 32CM GAMMA3 HIP RIGHT BOTH IP/OP "$1,947.00" "$1,441.00" $386.43 "$1,947.00" $876.15 $876.15 $876.15 $876.15 "$1,947.00" "$1,947.00" "$1,947.00" $405.80 "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" $405.78 "$1,947.00" $778.80 "$1,151.65" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,460.25" "$1,947.00" "$1,947.00" "$1,947.00" $973.50 $973.50 "$1,542.02" "$1,947.00" "$1,557.60" $876.15 $386.43 N/A "$1,129.26" "$1,947.00" "$1,168.20" "$1,947.00" $405.75 "$1,947.00" N/A N/A CM640047S SUP HCPCS C1713 CM640047S - NAIL INTRAMEDULLARY 130D LONG 11MM 32CM GAMA HIP LEFT BOTH IP/OP "$1,947.00" "$1,441.00" $386.43 "$1,947.00" $876.15 $876.15 $876.15 $876.15 "$1,947.00" "$1,947.00" "$1,947.00" $405.80 "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" $405.78 "$1,947.00" $778.80 "$1,151.65" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,460.25" "$1,947.00" "$1,947.00" "$1,947.00" $973.50 $973.50 "$1,542.02" "$1,947.00" "$1,557.60" $876.15 $386.43 N/A "$1,129.26" "$1,947.00" "$1,168.20" "$1,947.00" $405.75 "$1,947.00" N/A N/A CM640048S SUP HCPCS C1713 CM640048S - NAIL INTRAMEDULLARY 130D LONG 11MM 28CM GAMA HIP LEFT BOTH IP/OP "$1,947.00" "$1,441.00" $386.43 "$1,947.00" $876.15 $876.15 $876.15 $876.15 "$1,947.00" "$1,947.00" "$1,947.00" $405.80 "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" $405.78 "$1,947.00" "$1,947.00" "$1,151.65" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,460.25" "$1,947.00" "$1,947.00" "$1,947.00" $973.50 $973.50 "$1,542.02" "$1,947.00" "$1,557.60" $876.15 $386.43 N/A "$1,129.26" "$1,947.00" "$1,168.20" "$1,947.00" $405.75 "$1,947.00" N/A N/A CM640060S SUP HCPCS C1713 CM640060S - NAIL INTRAMEDULLARY 135D LONG 11MM 300MM GAMMA3 HIP LEFT BOTH IP/OP "$1,947.00" "$1,441.00" $386.43 "$1,947.00" $876.15 $876.15 $876.15 $876.15 "$1,947.00" "$1,947.00" "$1,947.00" $405.80 "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" $405.78 "$1,947.00" $778.80 "$1,151.65" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,460.25" "$1,947.00" "$1,947.00" "$1,947.00" $973.50 $973.50 "$1,542.02" "$1,947.00" "$1,557.60" $876.15 $386.43 N/A "$1,129.26" "$1,947.00" "$1,168.20" "$1,947.00" $405.75 "$1,947.00" N/A N/A CM640106S SUP HCPCS C1713 CM640106S - NAIL INTRAMEDULLARY 135D LONG 11MM 32CM GAMA HIP LEFT BOTH IP/OP "$1,947.00" "$1,441.00" $386.43 "$1,947.00" $876.15 $876.15 $876.15 $876.15 "$1,947.00" "$1,947.00" "$1,947.00" $405.80 "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" $405.78 "$1,947.00" $778.80 "$1,151.65" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,460.25" "$1,947.00" "$1,947.00" "$1,947.00" $973.50 $973.50 "$1,542.02" "$1,947.00" "$1,557.60" $876.15 $386.43 N/A "$1,129.26" "$1,947.00" "$1,168.20" "$1,947.00" $405.75 "$1,947.00" N/A N/A CM640113S SUP HCPCS C1713 CM640113S - NAIL INTRAMEDULLARY 130D LONG 11MM 30CM GAMMA3 TITANIUM HIP BOTH IP/OP "$1,947.00" "$1,441.00" $386.43 "$1,947.00" $876.15 $876.15 $876.15 $876.15 "$1,947.00" "$1,947.00" "$1,947.00" $405.80 "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" $405.78 "$1,947.00" $778.80 "$1,151.65" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,460.25" "$1,947.00" "$1,947.00" "$1,947.00" $973.50 $973.50 "$1,542.02" "$1,947.00" "$1,557.60" $876.15 $386.43 N/A "$1,129.26" "$1,947.00" "$1,168.20" "$1,947.00" $405.75 "$1,947.00" N/A N/A CM644004S SUP HCPCS C1713 CM644004S - NAIL INTRAMEDULLARY 135D LONG 11MM 28CM GAMA HIP LEFT BOTH IP/OP "$1,947.00" "$1,441.00" $386.43 "$1,947.00" $876.15 $876.15 $876.15 $876.15 "$1,947.00" "$1,947.00" "$1,947.00" $405.80 "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" $405.78 "$1,947.00" "$1,947.00" "$1,151.65" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,460.25" "$1,947.00" "$1,947.00" "$1,947.00" $973.50 $973.50 "$1,542.02" "$1,947.00" "$1,557.60" $876.15 $386.43 N/A "$1,129.26" "$1,947.00" "$1,168.20" "$1,947.00" $405.75 "$1,947.00" N/A N/A CM645050S SUP HCPCS C1713 CM645050S - NAIL INTRAMEDULLARY LONG GAMA HIP RIGHT BOTH IP/OP "$1,947.00" "$1,441.00" $386.43 "$1,947.00" $876.15 $876.15 $876.15 $876.15 "$1,947.00" "$1,947.00" "$1,947.00" $405.80 "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" $405.78 "$1,947.00" $778.80 "$1,151.65" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,460.25" "$1,947.00" "$1,947.00" "$1,947.00" $973.50 $973.50 "$1,542.02" "$1,947.00" "$1,557.60" $876.15 $386.43 N/A "$1,129.26" "$1,947.00" "$1,947.00" "$1,947.00" $405.75 "$1,947.00" N/A N/A CM645051S SUP HCPCS C1713 CM645051S - NAIL INTRAMEDULLARY 135D LONG 11MM 280MM GAMMA3 HIP RIGHT BOTH IP/OP "$1,947.00" "$1,441.00" $386.43 "$1,947.00" $876.15 $876.15 $876.15 $876.15 "$1,947.00" "$1,947.00" "$1,947.00" $405.80 "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" $405.78 "$1,947.00" $778.80 "$1,151.65" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,460.25" "$1,947.00" "$1,947.00" "$1,947.00" $973.50 $973.50 "$1,542.02" "$1,947.00" "$1,557.60" $876.15 $386.43 N/A "$1,129.26" "$1,947.00" "$1,947.00" "$1,947.00" $405.75 "$1,947.00" N/A N/A CM645059S SUP HCPCS C1713 CM645059S - NAIL INTRAMEDULLARY 135D LONG 11MM 30CM GAMA HIP RIGHT BOTH IP/OP "$1,947.00" "$1,441.00" $386.43 "$1,947.00" $876.15 $876.15 $876.15 $876.15 "$1,947.00" "$1,947.00" "$1,947.00" $405.80 "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" $405.78 "$1,947.00" "$1,947.00" "$1,151.65" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,460.25" "$1,947.00" "$1,947.00" "$1,947.00" $973.50 $973.50 "$1,542.02" "$1,947.00" "$1,557.60" $876.15 $386.43 N/A "$1,129.26" "$1,947.00" "$1,168.20" "$1,947.00" $405.75 "$1,947.00" N/A N/A CM645092S SUP HCPCS C1713 CM645092S - NAIL INTRAMEDULLARY 135D LONG 11MM 320MM GAMA HIP RIGHT BOTH IP/OP "$1,947.00" "$1,441.00" $386.43 "$1,947.00" $876.15 $876.15 $876.15 $876.15 "$1,947.00" "$1,947.00" "$1,947.00" $405.80 "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" $405.78 "$1,947.00" "$1,947.00" "$1,151.65" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,460.25" "$1,947.00" "$1,947.00" "$1,947.00" $973.50 $973.50 "$1,542.02" "$1,947.00" "$1,557.60" $876.15 $386.43 N/A "$1,129.26" "$1,947.00" "$1,168.20" "$1,947.00" $405.75 "$1,947.00" N/A N/A CM645107S SUP HCPCS C1713 CM645107S - NAIL INTRAMEDULLARY 130D LONG 11MM 30CM GAMMA3 TITANIUM HIP BOTH IP/OP "$1,947.00" "$1,441.00" $386.43 "$1,947.00" $876.15 $876.15 $876.15 $876.15 "$1,947.00" "$1,947.00" "$1,947.00" $405.80 "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" $405.78 "$1,947.00" "$1,947.00" "$1,151.65" "$1,947.00" "$1,947.00" "$1,947.00" "$1,947.00" "$1,460.25" "$1,947.00" "$1,947.00" "$1,947.00" $973.50 $973.50 "$1,542.02" "$1,947.00" "$1,557.60" $876.15 $386.43 N/A "$1,129.26" "$1,947.00" "$1,168.20" "$1,947.00" $405.75 "$1,947.00" N/A N/A CMRM6122 SUP Custom 27503206 CMRM6122 - ENVELOPE DFBR MED 2.5X2.75IN AIGISRX PCMKR ANBCTRL KNTD DISP BOTH IP/OP "$1,737.50" "$1,286.00" $309.28 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $309.28 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" $362.11 "$1,737.50" $895.00 "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,737.50" "$1,303.13" "$1,737.50" "$1,737.50" "$1,737.50" $868.75 $868.75 "$1,376.10" "$1,737.50" "$1,390.00" $781.88 "$1,737.50" N/A "$1,007.75" "$1,737.50" "$1,042.50" "$1,737.50" "$1,737.50" "$1,737.50" N/A N/A CMRM6133 SUP Custom 27503206 CMRM6133 - ENVELOPE DFBR 3.35X3IN AIGISRX RSRB MINOCYCLINE RFMPN PP BOTH IP/OP "$2,237.50" "$1,656.00" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $398.28 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $895.00 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" "$2,237.50" N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" "$2,237.50" "$2,237.50" N/A N/A CO-2324 SUP HCPCS C1713 CO-2324 - SCREW BONE 2.3MM 24MM TITANIUM CORTICAL NONSTRL BOTH IP/OP $165.00 $122.00 $32.75 $165.00 $74.25 $74.25 $74.25 $74.25 $165.00 $165.00 $165.00 $34.39 $165.00 $165.00 $165.00 $165.00 $165.00 $34.39 $165.00 $165.00 $97.60 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $74.25 $32.75 N/A $95.70 $165.00 $99.00 $165.00 $34.39 $165.00 N/A N/A CO-2326 SUP HCPCS C1713 CO-2326 - SCREW BONE 2.3MM 26MM TITANIUM CORTICAL NONSTRL BOTH IP/OP $165.00 $122.00 $32.75 $165.00 $74.25 $74.25 $74.25 $74.25 $165.00 $165.00 $165.00 $34.39 $165.00 $165.00 $165.00 $165.00 $165.00 $34.39 $165.00 $165.00 $97.60 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $74.25 $32.75 N/A $95.70 $165.00 $165.00 $165.00 $34.39 $165.00 N/A N/A CO261230 SUP Custom 27203010 CO261230 - KIT CRANIOTOMY BOTH IP/OP "$1,025.00" $759.00 $182.45 "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" $182.45 "$1,025.00" "$1,025.00" $760.76 $760.76 $790.07 $534.03 $213.62 "$1,025.00" $410.00 "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" "$1,025.00" $768.75 "$1,025.00" "$1,025.00" "$1,025.00" $512.50 $512.50 $811.80 "$1,025.00" $820.00 $666.25 "$1,025.00" N/A $594.50 "$1,025.00" $615.00 "$1,025.00" "$1,025.00" "$1,025.00" N/A N/A CO-2706 SUP HCPCS C1713 CO-2706 - SCREW BONE 2.7MM 6MM POLARUS TITANIUM HUMERUS CORTICAL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-2708 SUP HCPCS C1713 CO-2708 - SCREW BN 2.7MM 8MM CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-2710 SUP HCPCS C1713 CO-2710 - SCREW BN 2.7MM 10MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-2712 SUP HCPCS C1713 CO-2712 - SCREW BN 2.7MM 12MM NS CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $180.00 $180.00 N/A N/A CO-2714 SUP HCPCS C1713 CO-2714 - SCREW BN 2.7MM 14MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-2716 SUP HCPCS C1713 CO-2716 - SCREW BN 2.7MM 16MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-2718 SUP HCPCS C1713 CO-2718 - SCREW BN 2.7MM 18MM NS CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-2720 SUP HCPCS C1713 CO-2720 - SCREW BN 2.7MM 20MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-2722 SUP HCPCS C1713 CO-2722 - SCREW BN 2.7MM 22MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-27225 SUP HCPCS C1713 CO-27225 - SCREW BONE 2.7MM 22.5MM POLARUS TITANIUM HUMERUS CORTICAL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-2724 SUP HCPCS C1713 CO-2724 - SCREW BN 2.7MM 24MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-2725 SUP HCPCS C1713 CO-2725 - SCREW BN 2.7MM 25MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-2726 SUP HCPCS C1713 CO-2726 - SCREW BN 2.7MM 26MM CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-27275 SUP HCPCS C1713 CO-27275 - SCREW BONE 2.7MM 27.5MM POLARUS TITANIUM HUMERUS CORTICAL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-2728 SUP HCPCS C1713 CO-2728 - SCREW BN 2.7MM 28MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-2730 SUP HCPCS C1713 CO-2730 - SCREW BN 2.7MM 30MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-2732 SUP HCPCS C1713 CO-2732 - SCREW BN 2.7MM 32MM CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-2734 SUP HCPCS C1713 CO-2734 - SCREW BN 2.7MM 34MM CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-2735 SUP HCPCS C1713 CO-2735 - SCREW BONE 2.7MM 35MM POLARUS TITANIUM HUMERUS CORTICAL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-2736 SUP HCPCS C1713 CO-2736 - SCREW BN 2.7MM 36MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-27375 SUP HCPCS C1713 CO-27375 - SCREW BONE 2.7MM 37.5MM POLARUS TITANIUM SHOULDER CORTICAL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-2738 SUP HCPCS C1713 CO-2738 - SCREW BN 2.7MM 38MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-2740 SUP HCPCS C1713 CO-2740 - SCREW BN 2.7MM 40MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-2745 SUP HCPCS C1713 CO-2745 - SCREW BONE 2.7MM 45MM TITANIUM ELBOW CLAVICLE SCAPULA BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-2750 SUP HCPCS C1713 CO-2750 - SCREW BN 2.7MM 50MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-2755 SUP HCPCS C1713 CO-2755 - SCREW BN 2.7MM 55MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-2760 SUP HCPCS C1713 CO-2760 - SCREW BN 2.7MM 60MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-2765 SUP HCPCS C1713 CO-2765 - SCREW BONE 2.7MM 65MM TITANIUM ELBOW CLAVICLE SCAPULA BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3060 SUP HCPCS C1713 CO-3060 - SCREW BONE 3.5MM 6MM CORT NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3080 SUP HCPCS C1713 CO-3080 - SCREW BN 3.5MM 8MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3100 SUP HCPCS C1713 CO-3100 - SCREW BN 3.5MM 10MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3110 SUP HCPCS C1713 CO-3110 - SCREW BN 3.5MM 10MM NS NLCKG CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-3120 SUP HCPCS C1713 CO-3120 - SCREW BN 3.5MM 12MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3140 SUP HCPCS C1713 CO-3140 - SCREW BN 3.5MM 14MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3150-S SUP HCPCS C1713 CO-3150-S - SCREW BONE 3.5MM 15MM TITANIUM HAND WRIST CORTICAL STERILE BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $112.50 $187.50 $39.08 $187.50 N/A N/A CO-3160 SUP HCPCS C1713 CO-3160 - SCREW BN 3.5MM 16MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3175-S SUP HCPCS C1713 CO-3175-S - SCREW BONE 3.5MM 17.5MM TITANIUM HAND WRIST CORTICAL STERILE BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A CO-3180 SUP HCPCS C1713 CO-3180 - SCREW BN 3.5MM 18MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3200 SUP HCPCS C1713 CO-3200 - SCREW BN 3.5MM 20MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-3200-S SUP HCPCS C1713 CO-3200-S - SCREW BONE 3.5MM 20MM TITANIUM HAND WRIST CORTICAL STERILE BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A CO-3220 SUP HCPCS C1713 CO-3220 - SCREW BN 3.5MM 22MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-3225 SUP HCPCS C1713 CO-3225 - SCREW BN 3.5MM 22.5MM CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3240 SUP HCPCS C1713 CO-3240 - SCREW BN 3.5MM 24MM CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-3250 SUP HCPCS C1713 CO-3250 - SCREW BONE 3.5MM 25MM POLARUS TITANIUM HUMERUS CORTICAL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3250-S SUP HCPCS C1713 CO-3250-S - SCREW BONE L25 MM OD3.5 MM CORTICAL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3260 SUP HCPCS C1713 CO-3260 - SCREW BN 3.5MM 26MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-3275 SUP HCPCS C1713 CO-3275 - SCREW BONE 3.5MM 27.5MM LOCK TITANIUM ANKLE ELBOW SHOULDER BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3280 SUP HCPCS C1713 CO-3280 - SCREW BN 3.5MM 28MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $180.00 $180.00 N/A N/A CO3300 SUP HCPCS C1713 CO3300 - SCREW BONE 3.5MM 30MM TI CORT ORTH STRL BOTH IP/OP $136.00 $101.00 $26.96 $135.85 $61.13 $61.13 $61.13 $61.13 $135.85 $135.85 $135.85 $28.31 $135.85 $135.85 $135.85 $135.85 $135.85 $28.31 $135.85 $135.85 $80.36 $135.85 $135.85 $135.85 $135.85 $102.00 $135.85 $135.85 $135.85 $67.93 $67.93 $107.59 $135.85 $108.68 $61.13 $26.96 N/A $78.88 $135.85 $135.85 $135.85 $28.31 $135.85 N/A N/A CO-3300 SUP HCPCS C1713 CO-3300 - SCREW BN 3.5MM 30MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $180.00 $180.00 N/A N/A CO-3300-S SUP HCPCS C1713 CO-3300-S - SCREW BONE 3.5MM 30MM TITANIUM HAND WRIST CORTICAL STERILE BOTH IP/OP $165.00 $122.00 $32.75 $165.00 $74.25 $74.25 $74.25 $74.25 $165.00 $165.00 $165.00 $34.39 $165.00 $165.00 $165.00 $165.00 $165.00 $34.39 $165.00 $165.00 $97.60 $165.00 $165.00 $165.00 $165.00 $123.75 $165.00 $165.00 $165.00 $82.50 $82.50 $130.68 $165.00 $132.00 $74.25 $32.75 N/A $95.70 $165.00 $165.00 $165.00 $34.39 $165.00 N/A N/A CO-3320 SUP HCPCS C1713 CO-3320 - SCREW BN 3.5MM 32MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-3325 SUP HCPCS C1713 CO-3325 - SCREW BN 3.5MM 32.5MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3340 SUP HCPCS C1713 CO-3340 - SCREW BONE 3.5MM 34MM POLARUS TITANIUM HUMERUS CORTICAL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $180.00 $180.00 N/A N/A CO-3350 SUP HCPCS C1713 CO-3350 - SCREW BONE 3.5MM 35MM POLARUS TITANIUM HUMERUS CORTICAL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-3360 SUP HCPCS C1713 CO-3360 - SCREW BN 3.5MM 36MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-3375 SUP HCPCS C1713 CO-3375 - SCREW BONE 3.5MM 37.5MM POLARUS TITANIUM HUMERUS CORTICAL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3380 SUP HCPCS C1713 CO-3380 - SCREW BN 3.5MM 38MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-3400 SUP HCPCS C1713 CO-3400 - SCREW BN 3.5MM 40MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3450 SUP HCPCS C1713 CO-3450 - SCREW BN 3.5MM 45MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-3500 SUP HCPCS C1713 CO-3500 - SCREW BONE 3.5MM 50MM POLARUS TITANIUM HUMERUS CORTICAL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-3550 SUP HCPCS C1713 CO-3550 - SCREW BN 3.5MM 55MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3600 SUP HCPCS C1713 CO-3600 - SCREW BN 3.5MM 60MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-3650 SUP HCPCS C1713 CO-3650 - SCREW BN 3.5MM 65MM NS TI CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO431022 SUP HCPCS C1713 CO431022 - PLATE BONE 150X150MM MESH TITANIUM CRANFCL BOTH IP/OP "$2,950.00" "$2,183.00" $585.50 "$2,950.00" "$1,327.50" "$1,327.50" "$1,327.50" "$1,327.50" "$2,950.00" "$2,950.00" "$2,950.00" $614.85 "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" $614.81 "$2,950.00" "$2,950.00" "$1,454.35" "$2,950.00" "$2,950.00" "$2,950.00" "$2,950.00" "$2,212.50" "$2,950.00" "$2,950.00" "$2,950.00" "$1,475.00" "$1,475.00" "$2,336.40" "$2,950.00" "$2,360.00" "$1,327.50" $585.50 N/A "$1,711.00" "$2,950.00" "$1,770.00" "$2,950.00" $614.78 "$2,950.00" N/A N/A CO-F2106 SUP HCPCS C1713 CO-F2106 - SCREW BONE 2.1MM 6MM CRCIFRM MODULAR TITANIUM HAND NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-F2108 SUP HCPCS C1713 CO-F2108 - SCREW BN 2.1MM 8MM NLCKG TI BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-F2110 SUP HCPCS C1713 CO-F2110 - SCREW BN 2.1MM 10MM NLCKG TI BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-F2112 SUP HCPCS C1713 CO-F2112 - SCREW BN 2.1MM 12MM NLCKG TI BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-F2114 SUP HCPCS C1713 CO-F2114 - SCREW BONE CRCIFRM 2.1MM 14MM MODULAR TITANIUM HAND NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-F2116 SUP HCPCS C1713 CO-F2116 - SCREW BN 2.1MM 16MM NLCKG TI BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-F2118 SUP HCPCS C1713 CO-F2118 - SCREW BONE CRCIFRM 2.1MM 18MM MODULAR TITANIUM HAND NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-F2120 SUP HCPCS C1713 CO-F2120 - SCREW BONE CRCIFRM 2.1MM 20MM MODULAR TITANIUM HAND NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-F2122 SUP HCPCS C1713 CO-F2122 - SCREW BONE CRCIFRM 2.1MM 22MM MODULAR TITANIUM HAND NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-F2124 SUP HCPCS C1713 CO-F2124 - SCREW BONE CRCIFRM 2.1MM 24MM MODULAR TITANIUM HAND NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-F2126 SUP HCPCS C1713 CO-F2126 - SCREW BONE 2.1MM 26MM CRCIFRM MODULAR TITANIUM HAND NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-F2128 SUP HCPCS C1713 CO-F2128 - SCREW BONE CRCIFRM 2.1MM 28MM MODULAR TITANIUM HAND NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-F2706 SUP HCPCS C1713 CO-F2706 - SCREW BN 2.7MM 6MM NS CRFRM TI CORT MDLR HND SYS BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-F2708 SUP HCPCS C1713 CO-F2708 - SCREW BN 2.7MM 8MM NS CRFRM TI CORT MDLR HND SYS BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-F2710 SUP HCPCS C1713 CO-F2710 - SCREW BN 2.7MM 10MM NS CRFRM TI CORT MDLR HND SYS BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-F2712 SUP HCPCS C1713 CO-F2712 - SCREW BN 2.7MM 12MM NS CRFRM TI CORT MDLR HND SYS BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-F2714 SUP HCPCS C1713 CO-F2714 - SCREW BN 2.7MM 14MM CRFRM CORT BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-F2716 SUP HCPCS C1713 CO-F2716 - SCREW BONE CRCIFRM 2.7MM 16MM MODULAR TITANIUM HAND WRIST BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-F2718 SUP HCPCS C1713 CO-F2718 - SCREW BONE 2.7MM 18MM LOCK TITANIUM CORTICAL NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-F2720 SUP HCPCS C1713 CO-F2720 - SCREW BONE 2.7MM 20MM LOCK TITANIUM CORTICAL NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-F2722 SUP HCPCS C1713 CO-F2722 - SCREW BONE 2.7MM 22MM LOCK TITANIUM CORTICAL NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-F2724 SUP HCPCS C1713 CO-F2724 - SCREW BONE 2.7MM 24MM LOCK TITANIUM CORTICAL NONSTRL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-F2726 SUP HCPCS C1713 CO-F2726 - SCREW BONE CRCIFRM 2.7MM 26MM TITANIUM ELBOW RAD STERILE BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A CO-F2728 SUP HCPCS C1713 CO-F2728 - SCREW BONE CRCIFRM 2.7MM 28MM MODULAR TITANIUM HAND CORTICAL BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $81.00 $81.00 $81.00 $81.00 $180.00 $180.00 $180.00 $37.52 $180.00 $180.00 $180.00 $180.00 $180.00 $37.51 $180.00 $72.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $81.00 $35.73 N/A $104.40 $180.00 $108.00 $180.00 $37.51 $180.00 N/A N/A CO-FA2736 SUP HCPCS C1713 CO-FA2736 - SCREW BONE 2.7MM 36MM TAP-LOC ACUMED CORTICAL ELBOW STERILE BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A CO-FA3545 SUP HCPCS C1713 CO-FA3545 - SCREW BONE 3.5MM 45MM TAP-LOC ACUMED ELBOW STERILE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A CO-FA3555 SUP HCPCS C1713 CO-FA3555 - SCREW BONE 3.5MM 55MM TAP-LOC ACUMED ELBOW STERILE BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A COL-2080 SUP HCPCS C1713 COL-2080 - SCREW BN 2.7MM 8MM LCK CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2100 SUP HCPCS C1713 COL-2100 - SCREW BONE 2.7MM 10MM LOCK TITANIUM ELBOW CLAVICLE SCAPULA BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2120 SUP HCPCS C1713 COL-2120 - SCREW BN 2.7MM 12MM LCK CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2140 SUP HCPCS C1713 COL-2140 - SCREW BN 2.7MM 14MM NS LCK HEX TI CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2160 SUP HCPCS C1713 COL-2160 - SCREW BN 2.7MM 16MM NS LCK HEX TI CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-2180 SUP HCPCS C1713 COL-2180 - SCREW BN 2.7MM 18MM NS LCK HEX TI CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2200 SUP HCPCS C1713 COL-2200 - SCREW BN 2.7MM 20MM LCK CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-2220 SUP HCPCS C1713 COL-2220 - SCREW BN 2.7MM 22MM NS LCK HEX TI CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-2240 SUP HCPCS C1713 COL-2240 - SCREW BONE 2.7MM 24MM LOCK TITANIUM ELBOW CLAVICLE SCAPULA BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2250 SUP HCPCS C1713 COL-2250 - SCREW BONE 2.7MM 25MM LOCK CORTICAL NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2260 SUP HCPCS C1713 COL-2260 - SCREW BONE 2.7MM 26MM LOCK TITANIUM ELBOW CLAVICLE SCAPULA BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2280 SUP HCPCS C1713 COL-2280 - SCREW BONE 2.7MM 28MM LOCK TITANIUM ELBOW CLAVICLE SCAPULA BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-2300 SUP HCPCS C1713 COL-2300 - SCREW BONE 2.7MM 30MM LOCK TITANIUM CORTICAL NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2320 SUP HCPCS C1713 COL-2320 - SCREW BONE 2.7MM 32MM LOCK TITANIUM ELBOW CLAVICLE SCAPULA BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2340 SUP HCPCS C1713 COL-2340 - SCREW BONE 2.7MM 34MM LOCK TITANIUM ELBOW CLAVICLE SCAPULA BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2360 SUP HCPCS C1713 COL-2360 - SCREW BONE 2.7MM 36MM LOCK TITANIUM ELBOW CLAVICLE SCAPULA BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-2380 SUP HCPCS C1713 COL-2380 - SCREW BONE 2.7MM 38MM LOCK TITANIUM ELBOW CLAVICLE SCAPULA BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2400 SUP HCPCS C1713 COL-2400 - SCREW BONE 2.7MM 40MM LOCK TITANIUM ELBOW CLAVICLE SCAPULA BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2450 SUP HCPCS C1713 COL-2450 - SCREW BONE 2.7MM 45MM LOCK TITANIUM ELBOW CLAVICLE SCAPULA BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-2500 SUP HCPCS C1713 COL-2500 - SCREW BONE 2.7MM 50MM LOCK TITANIUM ELBOW CLAVICLE SCAPULA BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-2550 SUP HCPCS C1713 COL-2550 - SCREW BONE 2.7MM 55MM LOCK TITANIUM ELBOW CLAVICLE SCAPULA BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-2600 SUP HCPCS C1713 COL-2600 - SCREW BN 2.7MM 60MM NS LCK HEX TI CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-2650 SUP HCPCS C1713 COL-2650 - SCREW BONE 2.7MM 65MM LOCK CORTICAL NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2718 SUP HCPCS C1713 COL-2718 - SCREW BONE 2.7MM 18MM LOCK CORTICAL NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2720 SUP HCPCS C1713 COL-2720 - SCREW BONE 2.7MM 20MM CORTICAL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-2722 SUP HCPCS C1713 COL-2722 - SCREW BONE 2.7MM 22MM LOCK TITANIUM CORTICAL NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-3060 SUP HCPCS C1713 COL-3060 - SCREW BONE 3.5MM 6MM CORT LCK NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-3080 SUP HCPCS C1713 COL-3080 - SCREW BONE 3.5MM 8MM LOCK RAD CORTICAL DISTAL VOLAR NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-3100 SUP HCPCS C1713 COL-3100 - SCREW BONE 3.5MM 10MM LOCK RAD CORTICAL DISTAL VOLAR NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-3120 SUP HCPCS C1713 COL-3120 - SCREW BONE 3.5MM 12MM LOCK RAD CORTICAL DISTAL VOLAR NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-3140 SUP HCPCS C1713 COL-3140 - SCREW BONE 3.5MM 14MM LOCK RAD CORTICAL DISTAL VOLAR NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-3160 SUP HCPCS C1713 COL-3160 - SCREW BONE 3.5MM 16MM LOCK RAD CORTICAL DISTAL VOLAR NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-3180 SUP HCPCS C1713 COL-3180 - SCREW BONE 3.5MM 18MM LOCK RAD CORTICAL DISTAL VOLAR NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $232.50 $232.50 N/A N/A COL-3200 SUP HCPCS C1713 COL-3200 - SCREW BONE 3.5MM 20MM LOCK ACU-LOC TITANIUM HAND WRIST BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-3220 SUP HCPCS C1713 COL-3220 - SCREW BONE 3.5MM 22MM LOCK ACU-LOC TITANIUM HAND WRIST BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-3225 SUP HCPCS C1713 COL-3225 - SCREW BONE 3.5MM 22.5MM LOCK TITANIUM CORTICAL NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-3240 SUP HCPCS C1713 COL-3240 - SCREW BONE 3.5MM 24MM LOCK ACU-LOC TITANIUM HAND WRIST BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-3250 SUP HCPCS C1713 COL-3250 - SCREW BONE 3.5MM 25MM LOCK TITANIUM CORTICAL NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-3260 SUP HCPCS C1713 COL-3260 - SCREW BONE 3.5MM 26MM LOCK ACU-LOC TITANIUM HAND WRIST BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-3275 SUP HCPCS C1713 COL-3275 - SCREW BONE 3.5MM 27.5MM LOCK ACU-LOC TITANIUM HAND WRIST BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-3280 SUP HCPCS C1713 COL-3280 - SCREW BONE 3.5MM 28MM LOCK ACU-LOC TITANIUM HAND WRIST BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-3300 SUP HCPCS C1713 COL-3300 - SCREW BN 3.5MM 30MM NS TI CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-3320 SUP HCPCS C1713 COL-3320 - SCREW BN 3.5MM 32MM NS LCK TI CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-3340 SUP HCPCS C1713 COL-3340 - SCREW BONE 3.5MM 34MM LOCK ACU-LOC TITANIUM HAND WRIST BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $232.50 $232.50 N/A N/A COL-3360 SUP HCPCS C1713 COL-3360 - SCREW BN 3.5MM 36MM NS LCK TI CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $232.50 $232.50 N/A N/A COL-3380 SUP HCPCS C1713 COL-3380 - SCREW BN 3.5MM 38MM LCK CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-3400 SUP HCPCS C1713 COL-3400 - SCREW BN 3.5MM 40MM NS LCK TI CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-3450 SUP HCPCS C1713 COL-3450 - SCREW BN 3.5MM 45MM NS LCK TI CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-3500 SUP HCPCS C1713 COL-3500 - SCREW BN 3.5MM 50MM NS LCK TI CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COL-3550 SUP HCPCS C1713 COL-3550 - SCREW BN 3.5MM 55MM LCK CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-3600 SUP HCPCS C1713 COL-3600 - SCREW BN 3.5MM 60MM LCK CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A COL-3650 SUP HCPCS C1713 COL-3650 - SCREW BN 3.5MM 65MM LCK CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A COLS-35080-TS SUP HCPCS C1713 COLS-35080-TS - SCREW BN 3.5MM 8MM LCK TI RDS CORT DIST BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A COLS-35090-TS SUP HCPCS C1713 COLS-35090-TS - SCREW BN 3.5MM 9MM LCK TI RDS CORT DIST BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A COLS-35100-TS SUP HCPCS C1713 COLS-35100-TS - SCREW BN 3.5MM 10MM NS GEMINUS LCK TI DIST CORT VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A COLS-35110-TS SUP HCPCS C1713 COLS-35110-TS - SCREW BN 3.5MM 11MM BRNZ NS GEMINUS LCK TI CORT VOLR DIST BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $87.00 $146.40 $247.50 $217.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A COLS-35120-TS SUP HCPCS C1713 COLS-35120-TS - SCREW BN 3.5MM 12MM NS GEMINUS LCK TI DIST CORT VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A COLS-35130-TS SUP HCPCS C1713 COLS-35130-TS - SCREW BN 3.5MM 13MM NS GEMINUS LCK TI DIST CORT VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A COLS-35140-TS SUP HCPCS C1713 COLS-35140-TS - SCREW BN 3.5MM 14MM NS GEMINUS LCK TI DIST CORT VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $217.50 $217.50 $45.33 $217.50 N/A N/A COLS-35150-TS SUP HCPCS C1713 COLS-35150-TS - SCREW BN 3.5MM 15MM NS GEMINUS LCK TI DIST CORT VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A COLS-35160-TS SUP HCPCS C1713 COLS-35160-TS - SCREW BN 3.5MM 16MM NS GEMINUS LCK TI DIST CORT VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A COLS-35180-TS SUP HCPCS C1713 COLS-35180-TS - SCREW BN 3.5MM 18MM NS GEMINUS LCK TI DIST CORT VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A CO-N2308 SUP HCPCS C1713 CO-N2308 - SCREW BN 2.3MM 8MM NONTOGGLING BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-N2310 SUP HCPCS C1713 CO-N2310 - SCREW BN 2.3MM 10MM NONTOGGLING CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-N2312 SUP HCPCS C1713 CO-N2312 - SCREW BN 2.3MM 12MM NLCKG BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-N2314 SUP HCPCS C1713 CO-N2314 - SCREW BN 2.3MM 14MM SLVR NS NONTOGGLE HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-N2316 SUP HCPCS C1713 CO-N2316 - SCREW BN 2.3MM 16MM SLVR NS NONTOGGLE HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-N2318 SUP HCPCS C1713 CO-N2318 - SCREW BN 2.3MM 18MM SLVR NS NONTOGGLE HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-N2320 SUP HCPCS C1713 CO-N2320 - SCREW BN 2.3MM 20MM SLVR NS NONTOGGLE HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-N2322 SUP HCPCS C1713 CO-N2322 - SCREW BN 2.3MM 22MM SLVR NS NONTOGGLE HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-N2324 SUP HCPCS C1713 CO-N2324 - SCREW BONE 2.3MM 24MM ACU-LOC 2 TITANIUM HAND WRIST RAD BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-N2326 SUP HCPCS C1713 CO-N2326 - SCREW BONE 2.3MM 26MM ACU-LOC 2 TITANIUM HAND WRIST RAD BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-N2328 SUP HCPCS C1713 CO-N2328 - SCREW 2.3MM X 28MM NON-TOGGLING CORTICAL BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-N2330 SUP HCPCS C1713 CO-N2330 - SCREW BONE 2.3MM 30MM ACU-LOC 2 SILVER TITANIUM HAND WRIST BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-N2332 SUP HCPCS C1713 CO-N2332 - SCREW BN 2.3MM 32MM STRL NONTOGGLING CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-N2334 SUP HCPCS C1713 CO-N2334 - SCREW BONE 2.3MM 34MM NONTOGGLING ACU-LOC 2 SILVER DISTAL BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-N2336 SUP HCPCS C1713 CO-N2336 - SCREW BONE 2.3MM 36MM ACU-LOC 2 SILVER TITANIUM HAND WRIST BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-N2338 SUP HCPCS C1713 CO-N2338 - SCREW BONE 2.3MM 38MM NONTOGGLING ACU-LOC 2 SILVER DISTAL BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-N2340 SUP HCPCS C1713 CO-N2340 - SCREW BONE 2.3MM 40MM ACU-LOC 2 SILVER TITANIUM HAND WRIST BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-N2342 SUP HCPCS C1713 CO-N2342 - SCREW BONE 2.3MM 42MM NONTOGGLING ACU-LOC 2 SILVER DISTAL BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-N2344 SUP HCPCS C1713 CO-N2344 - SCREW BONE 2.3MM 44MM ACU-LOC 2 SILVER TITANIUM HAND WRIST BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-N2346 SUP HCPCS C1713 CO-N2346 - SCREW BONE 2.3MM 46MM NONTOGGLING ACU-LOC 2 SILVER DISTAL BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CONSULTAMMAM SUP HCPCS C2621 CONSULTAMMAM - DEFIBRILLATOR CARDIAC DEVICE ATTAIN ABILITY CONSULTA BOTH IP/OP "$60,500.00" "$44,770.00" "$7,712.84" "$60,500.00" "$27,225.00" "$27,225.00" "$27,225.00" "$27,225.00" "$60,500.00" "$60,500.00" "$60,500.00" "$9,417.94" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$12,608.87" "$60,500.00" "$60,500.00" "$29,826.50" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$45,375.00" "$60,500.00" "$60,500.00" "$60,500.00" "$30,250.00" "$30,250.00" "$47,916.00" "$60,500.00" "$48,400.00" "$27,225.00" "$7,712.84" N/A "$35,090.00" "$60,500.00" "$60,500.00" "$60,500.00" "$8,098.48" "$60,500.00" N/A N/A CO-S2112 SUP HCPCS C1713 CO-S2112 - SCREW BONE 2.1MM 12MM LP CORTICAL STERILE BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $232.50 $232.50 N/A N/A CO-S2114 SUP HCPCS C1713 CO-S2114 - SCREW BONE 2.1MM 14MM LP CORTICAL STERILE BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $87.00 $145.00 $30.22 $145.00 N/A N/A CO-S2308 SUP Custom 27803010 CO-S2308 - PEG FIX 2.3MM 8MM LOCK SMOOTH ACU-LOC TITANIUM HAND WRIST BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A CO-S2310 SUP HCPCS C1713 CO-S2310 - PEG FX 2.3MM 10MM LCK SMTH BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-S2312 SUP Custom 27203010 CO-S2312 - PEG FIX 2.3MM 12MM LOCK ACU-LOC 2 TITANIUM CORTICAL STERILE BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A CO-S2314 SUP Custom 27803010 CO-S2314 - PEG FIX 2.3MM 14MM LOCK SMOOTH ACU-LOC TITANIUM HAND WRIST BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A CO-S2316 SUP Custom 27803010 CO-S2316 - PEG FX 2.3MM 16MM SMTH LCK CORT BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A CO-S2318 SUP Custom 27803010 CO-S2318 - PEG FIX 2.3MM 18MM LOCK SMOOTH ACU-LOC TITANIUM HAND WRIST BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A CO-S2320 SUP Custom 27803010 CO-S2320 - PEG FIX 2.3MM 20MM LOCK SMOOTH ACU-LOC TITANIUM HAND WRIST BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A CO-S2322 SUP Custom 27803010 CO-S2322 - PEG FIX 2.3MM 22MM LOCK SMOOTH ACU-LOC TITANIUM HAND WRIST BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A CO-S2324 SUP Custom 27803010 CO-S2324 - PEG FIX 2.3MM 24MM LOCK SMOOTH ACU-LOC TITANIUM HAND WRIST BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A CO-S2326 SUP Custom 27803010 CO-S2326 - PEG FIX 2.3MM 26MM LOCK SMOOTH ACU-LOC TITANIUM HAND WRIST BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A CO-S2328 SUP HCPCS C1713 CO-S2328 - PEG FX 2.3MM 28MM SMTH LCK CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-S2714 SUP HCPCS C1713 CO-S2714 - SCREW BONE 2.7MM 14MM LP CORTICAL STERILE BOTH IP/OP $145.00 $107.00 $28.78 $145.00 $65.25 $65.25 $65.25 $65.25 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $145.00 $145.00 $145.00 $30.22 $145.00 $145.00 $85.77 $145.00 $145.00 $145.00 $145.00 $108.75 $145.00 $145.00 $145.00 $72.50 $72.50 $114.84 $145.00 $116.00 $65.25 $28.78 N/A $84.10 $145.00 $145.00 $145.00 $30.22 $145.00 N/A N/A CO-T2308 SUP HCPCS C1713 CO-T2308 - SCREW BN FT 2.3MM 8MM AU NS LCK HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-T2310 SUP HCPCS C1713 CO-T2310 - SCREW BN FT 2.3MM 10MM AU NS LCK HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $220.00 $220.00 N/A N/A CO-T2312 SUP HCPCS C1713 CO-T2312 - SCREW BN FT 2.3MM 12MM AU NS LCK HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $220.00 $220.00 N/A N/A CO-T2314 SUP HCPCS C1713 CO-T2314 - SCREW BN FT 2.3MM 14MM AU NS LCK HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-T2316 SUP HCPCS C1713 CO-T2316 - SCREW BN FT 2.3MM 16MM AU NS LCK HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-T2318 SUP HCPCS C1713 CO-T2318 - SCREW BN FT 2.3MM 18MM AU NS LCK HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-T2320 SUP HCPCS C1713 CO-T2320 - SCREW BN FT 2.3MM 20MM AU NS LCK HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $88.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-T2322 SUP HCPCS C1713 CO-T2322 - SCREW BN FT 2.3MM 22MM AU NS LCK HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-T2324 SUP HCPCS C1713 CO-T2324 - SCREW BN FT 2.3MM 24MM AU NS LCK HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-T2326 SUP HCPCS C1713 CO-T2326 - SCREW BN FT 2.3MM 26MM AU NS LCK HEX TI CORT BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-T2328 SUP HCPCS C1713 CO-T2328 - SCREW BONE FULTHD 2.3MM 28MM LOCK ACU-LOC 2 GOLD TITANIUM BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $220.00 $220.00 N/A N/A CO-T2330 SUP HCPCS C1713 CO-T2330 - SCREW BONE 2.3MM 30MM LOCK ACU-LOC 2 DISTAL VOLAR CORTEX RAD BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-T2332 SUP HCPCS C1713 CO-T2332 - SCREW BONE FULTHD 2.3MM 32MM LOCK ACU-LOC 2 GOLD TITANIUM BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-T2334 SUP HCPCS C1713 CO-T2334 - SCREW BONE 2.3MM 34MM LOCK ACU-LOC 2 DISTAL VOLAR CORTEX RAD BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CO-T2336 SUP HCPCS C1713 CO-T2336 - SCREW BONE FULTHD 2.3MM 36MM LOCK ACU-LOC 2 GOLD TITANIUM BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-T2338 SUP HCPCS C1713 CO-T2338 - SCREW BONE FULTHD 2.3MM 38MM LOCK ACU-LOC 2 GOLD TITANIUM BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-T2340 SUP HCPCS C1713 CO-T2340 - SCREW BONE FULTHD 2.3MM 40MM LOCK ACU-LOC 2 TITANIUM HAND BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-T2342 SUP HCPCS C1713 CO-T2342 - SCREW BONE FULTHD 2.3MM 42MM LOCK ACU-LOC 2 GOLD TITANIUM BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-T2344 SUP HCPCS C1713 CO-T2344 - SCREW BONE FULTHD 2.3MM 44MM LOCK ACU-LOC 2 TITANIUM HAND BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $132.00 $220.00 $45.85 $220.00 N/A N/A CO-T2346 SUP HCPCS C1713 CO-T2346 - SCREW BONE FULTHD 2.3MM 46MM LOCK ACU-LOC 2 GOLD TITANIUM BOTH IP/OP $220.00 $163.00 $43.66 $220.00 $99.00 $99.00 $99.00 $99.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $220.00 $220.00 $220.00 $45.85 $220.00 $220.00 $130.13 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $99.00 $43.66 N/A $127.60 $220.00 $220.00 $220.00 $45.85 $220.00 N/A N/A CP320340 SUP HCPCS C1713 CP320340 - CUSTOM KNEE ARTHRODESIS NAIL 11.5X880MM BOTH IP/OP "$16,225.00" "$12,007.00" "$3,220.26" "$16,225.00" "$7,301.25" "$7,301.25" "$7,301.25" "$7,301.25" "$16,225.00" "$16,225.00" "$16,225.00" "$3,381.70" "$16,225.00" "$16,225.00" "$16,225.00" "$16,225.00" "$16,225.00" "$3,381.47" "$16,225.00" "$6,490.00" "$7,998.93" "$16,225.00" "$16,225.00" "$16,225.00" "$16,225.00" "$12,168.75" "$16,225.00" "$16,225.00" "$16,225.00" "$8,112.50" "$8,112.50" "$12,850.20" "$16,225.00" "$12,980.00" "$7,301.25" "$3,220.26" N/A "$9,410.50" "$16,225.00" "$16,225.00" "$16,225.00" "$3,381.29" "$16,225.00" N/A N/A CP326963 SUP HCPCS C1713 CP326963 - ASNIS SCREW 8.0 X 160mm BOTH IP/OP "$1,097.50" $812.00 $217.78 "$1,097.25" $493.76 $493.76 $493.76 $493.76 "$1,097.25" "$1,097.25" "$1,097.25" $228.69 "$1,097.25" "$1,097.25" "$1,097.25" "$1,097.25" "$1,097.25" $228.68 "$1,097.25" "$1,097.25" $649.02 "$1,097.25" "$1,097.25" "$1,097.25" "$1,097.25" $823.13 "$1,097.25" "$1,097.25" "$1,097.25" $548.63 $548.63 $869.02 "$1,097.25" $877.80 $493.76 $217.78 N/A $636.55 "$1,097.25" $658.35 "$1,097.25" $228.67 "$1,097.25" N/A N/A CP326981 SUP HCPCS C1713 CP326981 - ASNIS SCREW 8.0 X 180mm BOTH IP/OP "$1,097.50" $812.00 $217.78 "$1,097.25" $493.76 $493.76 $493.76 $493.76 "$1,097.25" "$1,097.25" "$1,097.25" $228.69 "$1,097.25" "$1,097.25" "$1,097.25" "$1,097.25" "$1,097.25" $228.68 "$1,097.25" $438.90 $649.02 "$1,097.25" "$1,097.25" "$1,097.25" "$1,097.25" $823.13 "$1,097.25" "$1,097.25" "$1,097.25" $548.63 $548.63 $869.02 "$1,097.25" $877.80 $493.76 $217.78 N/A $636.55 "$1,097.25" $658.35 "$1,097.25" $228.67 "$1,097.25" N/A N/A CP390009 SUP HCPCS C1713 CP390009 - WASHER 26mm BOTH IP/OP $140.50 $104.00 $27.84 $140.25 $63.11 $63.11 $63.11 $63.11 $140.25 $140.25 $140.25 $29.23 $140.25 $140.25 $140.25 $140.25 $140.25 $29.23 $140.25 $56.10 $82.96 $140.25 $140.25 $140.25 $140.25 $105.38 $140.25 $140.25 $140.25 $70.13 $70.13 $111.08 $140.25 $112.20 $63.11 $27.84 N/A $81.49 $140.25 $84.15 $140.25 $29.23 $140.25 N/A N/A CP425737 SUP HCPCS C1713 CP425737 - CUSTOM CLAVICLE PLATE BOTH IP/OP "$4,400.00" "$3,256.00" $873.29 "$4,400.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$4,400.00" "$4,400.00" "$4,400.00" $917.07 "$4,400.00" "$4,400.00" "$4,400.00" "$4,400.00" "$4,400.00" $917.01 "$4,400.00" "$4,400.00" "$2,169.20" "$4,400.00" "$4,400.00" "$4,400.00" "$4,400.00" "$3,300.00" "$4,400.00" "$4,400.00" "$4,400.00" "$2,200.00" "$2,200.00" "$3,484.80" "$4,400.00" "$3,520.00" "$1,980.00" $873.29 N/A "$2,552.00" "$4,400.00" "$2,640.00" "$4,400.00" $916.96 "$4,400.00" N/A N/A CP427181 SUP HCPCS C1713 CP427181 - AXSOS CUSTOM-MADE DEVICE_ HUMERUS PLATE 8-HOLES BOTH IP/OP "$4,812.50" "$3,561.00" $955.16 "$4,812.50" "$2,165.63" "$2,165.63" "$2,165.63" "$2,165.63" "$4,812.50" "$4,812.50" "$4,812.50" "$1,003.05" "$4,812.50" "$4,812.50" "$4,812.50" "$4,812.50" "$4,812.50" "$1,002.98" "$4,812.50" "$4,812.50" "$2,372.56" "$4,812.50" "$4,812.50" "$4,812.50" "$4,812.50" "$3,609.38" "$4,812.50" "$4,812.50" "$4,812.50" "$2,406.25" "$2,406.25" "$3,811.50" "$4,812.50" "$3,850.00" "$2,165.63" $955.16 N/A "$2,791.25" "$4,812.50" "$4,812.50" "$4,812.50" "$1,002.93" "$4,812.50" N/A N/A CP427182 SUP HCPCS C1713 CP427182 - AXSOS CUSTOM-MADE DEVICE - HUMERUS PLATE 6 HOLES BOTH IP/OP "$9,625.00" "$7,123.00" "$1,910.32" "$9,625.00" "$4,331.25" "$4,331.25" "$4,331.25" "$4,331.25" "$9,625.00" "$9,625.00" "$9,625.00" "$2,006.09" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$2,005.96" "$9,625.00" "$3,850.00" "$4,745.13" "$9,625.00" "$9,625.00" "$9,625.00" "$9,625.00" "$7,218.75" "$9,625.00" "$9,625.00" "$9,625.00" "$4,812.50" "$4,812.50" "$7,623.00" "$9,625.00" "$7,700.00" "$4,331.25" "$1,910.32" N/A "$5,582.50" "$9,625.00" "$5,775.00" "$9,625.00" "$2,005.85" "$9,625.00" N/A N/A CP461006 SUP Custom 27803010 CP461006 - TRIAL SURG 4CM OSS DPHSL IMPL BOTH IP/OP "$2,500,000.00" "$1,850,000.00" "$445,000.00" "$2,500,000.00" "$2,500,000.00" "$2,500,000.00" "$2,500,000.00" "$2,500,000.00" "$2,500,000.00" "$2,500,000.00" "$445,000.00" "$2,500,000.00" "$2,500,000.00" "$2,500,000.00" "$2,500,000.00" "$2,500,000.00" "$2,500,000.00" "$521,027.50" "$2,500,000.00" "$1,000,000.00" "$2,500,000.00" "$2,500,000.00" "$2,500,000.00" "$2,500,000.00" "$2,500,000.00" "$1,875,000.00" "$2,500,000.00" "$2,500,000.00" "$2,500,000.00" "$1,250,000.00" "$1,250,000.00" "$1,980,000.00" "$2,500,000.00" "$2,000,000.00" "$1,125,000.00" "$2,500,000.00" N/A "$1,450,000.00" "$2,500,000.00" "$1,500,000.00" "$2,500,000.00" "$2,500,000.00" "$2,500,000.00" N/A N/A CP5080-2-112 SUP Custom 27203010 CP5080-2-112 - APEX PIN DIA 2MM_ LENGTH 100MM_ THREAD LENGTH 12MM BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A CP5080-2-120 SUP Custom 27203010 CP5080-2-120 - APEX PIN DIA 2MM_ LENGTH 100MM_ THREAD LENGTH 20MM BOTH IP/OP $220.00 $163.00 $39.16 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $220.00 $39.16 $220.00 $220.00 $163.28 $163.28 $169.58 $114.62 $45.85 $220.00 $88.00 $220.00 $220.00 $220.00 $220.00 $220.00 $165.00 $220.00 $220.00 $220.00 $110.00 $110.00 $174.24 $220.00 $176.00 $143.00 $220.00 N/A $127.60 $220.00 $132.00 $220.00 $220.00 $220.00 N/A N/A CP5080-2-212 SUP Custom 27203010 CP5080-2-212 - CUSTOM-MADE DEVICE APEX DIA 2MM 100 x 12MM BOTH IP/OP $364.50 $270.00 $64.86 $364.38 $364.38 $364.38 $364.38 $364.38 $364.38 $364.38 $64.86 $364.38 $364.38 $270.44 $270.44 $280.86 $189.84 $75.94 $364.38 $145.75 $364.38 $364.38 $364.38 $364.38 $364.38 $273.38 $364.38 $364.38 $364.38 $182.19 $182.19 $288.59 $364.38 $291.50 $236.85 $364.38 N/A $211.41 $364.38 $218.63 $364.38 $364.38 $364.38 N/A N/A CP5080-2-220 SUP Custom 27203010 CP5080-2-220 - CUSTOM-MADE DEVICE APEX DIA 2MM 100 x 20MM BOTH IP/OP $364.50 $270.00 $64.86 $364.38 $364.38 $364.38 $364.38 $364.38 $364.38 $364.38 $64.86 $364.38 $364.38 $270.44 $270.44 $280.86 $189.84 $75.94 $364.38 $145.75 $364.38 $364.38 $364.38 $364.38 $364.38 $273.38 $364.38 $364.38 $364.38 $182.19 $182.19 $288.59 $364.38 $291.50 $236.85 $364.38 N/A $211.41 $364.38 $218.63 $364.38 $364.38 $364.38 N/A N/A CP5150-2-864 SUP Custom 27803010 CP5150-2-864 - MONOTUBE TRIAX DIA 20 X 640MM BOTH IP/OP "$3,118.50" "$2,308.00" $555.09 "$3,118.50" "$3,118.50" "$3,118.50" "$3,118.50" "$3,118.50" "$3,118.50" "$3,118.50" $555.09 "$3,118.50" "$3,118.50" "$3,118.50" "$3,118.50" "$3,118.50" "$3,118.50" $649.93 "$3,118.50" "$1,247.40" "$3,118.50" "$3,118.50" "$3,118.50" "$3,118.50" "$3,118.50" "$2,338.88" "$3,118.50" "$3,118.50" "$3,118.50" "$1,559.25" "$1,559.25" "$2,469.85" "$3,118.50" "$2,494.80" "$1,403.33" "$3,118.50" N/A "$1,808.73" "$3,118.50" "$1,871.10" "$3,118.50" "$3,118.50" "$3,118.50" N/A N/A CP606155 SUP Custom 27803010 CP606155 - ASNIS III DIA 6.5 X 155MM - CUSTOM MADE DEVICE BOTH IP/OP "$1,081.00" $800.00 $192.37 "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" $192.37 "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" $225.24 "$1,080.75" $432.30 "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" $810.75 "$1,080.75" "$1,080.75" "$1,080.75" $540.38 $540.38 $855.95 "$1,080.75" $864.60 $486.34 "$1,080.75" N/A $626.98 "$1,080.75" $648.45 "$1,080.75" "$1,080.75" "$1,080.75" N/A N/A CP606160 SUP Custom 27803010 CP606160 - ASNIS III DIA 6.5 X 160MM - CUSTOM MADE DEVICE BOTH IP/OP "$1,081.00" $800.00 $192.37 "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" $192.37 "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" $225.24 "$1,080.75" $432.30 "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" "$1,080.75" $810.75 "$1,080.75" "$1,080.75" "$1,080.75" $540.38 $540.38 $855.95 "$1,080.75" $864.60 $486.34 "$1,080.75" N/A $626.98 "$1,080.75" $648.45 "$1,080.75" "$1,080.75" "$1,080.75" N/A N/A CP910 SUP HCPCS L8614 CP910 - PROCESSOR SOUND MEDIUM STANDARD EARHOOK INDICATOR LIGHT BOTH IP/OP "$23,250.00" "$17,205.00" "$4,845.56" "$23,250.00" "$23,250.00" "$23,250.00" "$23,250.00" "$23,250.00" "$23,250.00" "$23,250.00" "$12,551.80" "$23,250.00" "$23,250.00" "$23,250.00" "$23,250.00" "$23,250.00" "$23,250.00" "$4,845.56" "$23,250.00" "$9,300.00" "$23,250.00" "$23,250.00" "$23,250.00" "$23,250.00" "$23,250.00" "$17,437.50" "$23,250.00" "$23,250.00" "$23,250.00" "$11,625.00" "$11,625.00" "$18,414.00" "$23,250.00" "$18,600.00" "$10,462.50" "$23,250.00" N/A "$13,485.00" "$23,250.00" "$13,950.00" "$23,250.00" "$23,250.00" "$23,250.00" N/A N/A CPO-6 SUP Custom 27011340 CPO-6 - CATHETER SURG 6FR PNEUMO COLPOTOMY LATEX FREE COLPO-PNEUMO BOTH IP/OP $110.00 $81.00 $19.52 $377.13 $109.68 $109.68 $109.68 $109.68 $109.68 $109.68 $19.52 $109.68 $109.68 $81.40 $81.40 $84.54 $57.14 $22.86 $109.68 $150.85 $109.68 $109.68 $377.13 $109.68 $109.68 $82.50 $109.68 $109.68 $109.68 $54.84 $54.84 $86.87 $109.68 $87.74 $71.29 $109.68 N/A $63.80 $109.68 $65.81 $109.68 $109.68 $109.68 N/A N/A C-PTISY-100-HC-PERC8 SUP HCPCS C1769 C-PTISY-100-HC-PERC8 - INTROD TUBE 24-28FR CGL BRHN 8 PERC HYDPHI INTROD SHLY DILAT BOTH IP/OP $905.50 $670.00 $179.63 $905.05 $491.44 $491.44 $491.44 $491.44 $905.05 $905.05 $905.05 $188.64 $905.05 $671.73 $671.73 $697.61 $471.53 $188.62 $905.05 $905.05 $535.34 $905.05 $905.05 $905.05 $905.05 $679.13 $905.05 $905.05 $905.05 $452.53 $452.53 $716.80 $905.05 $724.04 $588.28 $179.63 N/A $525.19 $905.05 $905.05 $905.05 $188.61 $905.05 N/A N/A CQ75102 SUP HCPCS C1725 CQ75102 - CATHETER BLNDIL 10MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS BOTH IP/OP $662.50 $490.00 $131.49 $662.50 $359.74 $359.74 $359.74 $359.74 $662.50 $662.50 $662.50 $138.08 $662.50 $491.71 $491.71 $510.66 $345.16 $138.07 $662.50 $337.50 $391.87 $662.50 $337.50 $662.50 $662.50 $496.88 $662.50 $662.50 $662.50 $331.25 $331.25 $524.70 $662.50 $530.00 $430.63 $131.49 N/A $384.25 $662.50 $662.50 $662.50 $138.07 $662.50 N/A N/A CQ75104 SUP HCPCS C1725 CQ75104 - CATHETER BLNDIL 10MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS BOTH IP/OP $462.50 $342.00 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $337.50 $273.57 $462.50 $337.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 N/A $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A CQ75122 SUP HCPCS C1725 CQ75122 - CATHETER BLNDIL 12MM 75CM LF 2CM CONQ RPD INFL SHTHLS ENTRY BOTH IP/OP $462.50 $342.00 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $337.50 $273.57 $462.50 $337.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 N/A $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A CQ75124 SUP HCPCS C1725 CQ75124 - CATHETER BLNDIL 12MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS BOTH IP/OP $462.50 $342.00 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $337.50 $273.57 $462.50 $337.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 N/A $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A CQ7552 SUP HCPCS C1725 CQ7552 - CATHETER BLNDIL 5MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS BOTH IP/OP $462.50 $342.00 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $337.50 $273.57 $462.50 $337.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 N/A $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A CQ7554 SUP HCPCS C1725 CQ7554 - CATHETER BLNDIL 5MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS BOTH IP/OP $462.50 $342.00 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $337.50 $273.57 $462.50 $337.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 N/A $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A CQ7562 SUP HCPCS C1725 CQ7562 - CATHETER BLNDIL 6MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS BOTH IP/OP $662.50 $490.00 $131.49 $662.50 $359.74 $359.74 $359.74 $359.74 $662.50 $662.50 $662.50 $138.08 $662.50 $491.71 $491.71 $510.66 $345.16 $138.07 $662.50 $337.50 $391.87 $662.50 $337.50 $662.50 $662.50 $496.88 $662.50 $662.50 $662.50 $331.25 $331.25 $524.70 $662.50 $530.00 $430.63 $131.49 N/A $384.25 $662.50 $662.50 $662.50 $138.07 $662.50 N/A N/A CQ7564 SUP HCPCS C1725 CQ7564 - CATHETER BLNDIL 6MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS BOTH IP/OP $462.50 $342.00 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $337.50 $273.57 $462.50 $337.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 N/A $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A CQ7572 SUP HCPCS C1725 CQ7572 - CATHETER BLNDIL 7MM 75CM 2CM CONQ RADOPQ RPD INFL SHTHLS BOTH IP/OP $662.50 $490.00 $131.49 $662.50 $359.74 $359.74 $359.74 $359.74 $662.50 $662.50 $662.50 $138.08 $662.50 $491.71 $491.71 $510.66 $345.16 $138.07 $662.50 $337.50 $391.87 $662.50 $337.50 $662.50 $662.50 $496.88 $662.50 $662.50 $662.50 $331.25 $331.25 $524.70 $662.50 $530.00 $430.63 $131.49 N/A $384.25 $662.50 $662.50 $662.50 $138.07 $662.50 N/A N/A CQ7574 SUP HCPCS C1725 CQ7574 - CATHETER BLNDIL 7MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS BOTH IP/OP $662.50 $490.00 $131.49 $662.50 $359.74 $359.74 $359.74 $359.74 $662.50 $662.50 $662.50 $138.08 $662.50 $491.71 $491.71 $510.66 $345.16 $138.07 $662.50 $337.50 $391.87 $662.50 $337.50 $662.50 $662.50 $496.88 $662.50 $662.50 $662.50 $331.25 $331.25 $524.70 $662.50 $530.00 $430.63 $131.49 N/A $384.25 $662.50 $662.50 $662.50 $138.07 $662.50 N/A N/A CQ7582 SUP HCPCS C1725 CQ7582 - CATHETER BLNDIL 8MM 75CM LF 2CM CONQ RPD INFL SHTHLS ENTRY BOTH IP/OP $462.50 $342.00 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $337.50 $273.57 $462.50 $337.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 N/A $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A CQ7584 SUP HCPCS C1725 CQ7584 - CATHETER BLNDIL 8MM 75CM 4CM CONQ RADOPQ RPD INFL SHTHLS BOTH IP/OP $462.50 $342.00 $91.79 $462.50 $251.14 $251.14 $251.14 $251.14 $462.50 $462.50 $462.50 $96.40 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $337.50 $273.57 $462.50 $337.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $91.79 N/A $268.25 $462.50 $462.50 $462.50 $96.39 $462.50 N/A N/A CR40G SUP Custom 27203010 CR40G - RELOAD STPLR 40MMX4.7MM GRN STRL LF 2MM CNTR 4 ROW CRV CTR BOTH IP/OP $633.00 $468.00 $112.63 $632.76 $632.76 $632.76 $632.76 $632.76 $632.76 $632.76 $112.63 $632.76 $632.76 $469.63 $469.63 $487.73 $329.67 $131.87 $632.76 $253.10 $632.76 $632.76 $632.76 $632.76 $632.76 $474.75 $632.76 $632.76 $632.76 $316.38 $316.38 $501.15 $632.76 $506.21 $411.29 $632.76 N/A $367.14 $632.76 $379.66 $632.76 $632.76 $632.76 N/A N/A CR5BU0.100 SUP HCPCS V2632 CR5BU0.100 - LENS IOL 10 D +10 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.105 SUP HCPCS V2632 CR5BU0.105 - LENS IOL 10 D +10.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.110 SUP HCPCS V2632 CR5BU0.110 - LENS IOL 10 D +11 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.115 SUP HCPCS V2632 CR5BU0.115 - LENS IOL 10 D +11.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.120 SUP HCPCS V2632 CR5BU0.120 - LENS IOL 10 D +12 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.125 SUP HCPCS V2632 CR5BU0.125 - LENS IOL 10 D +12.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.130 SUP HCPCS V2632 CR5BU0.130 - LENS IOL 10 D +13 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.135 SUP HCPCS V2632 CR5BU0.135 - LENS IOL 10 D +13.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.140 SUP HCPCS V2632 CR5BU0.140 - LENS IOL 10 D +14 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.145 SUP HCPCS V2632 CR5BU0.145 - LENS IOL 10 D +14.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.150 SUP HCPCS V2632 CR5BU0.150 - LENS IOL 10 D +15 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.155 SUP HCPCS V2632 CR5BU0.155 - LENS IOL 10 D +15.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.160 SUP HCPCS V2632 CR5BU0.160 - LENS IOL 10 D +16 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.165 SUP HCPCS V2632 CR5BU0.165 - LENS IOL 10 D +16.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.170 SUP HCPCS V2632 CR5BU0.170 - LENS IOL 10 D +17 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.175 SUP HCPCS V2632 CR5BU0.175 - LENS IOL 10 D +17.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.180 SUP HCPCS V2632 CR5BU0.180 - LENS IOL 10 D +18 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.185 SUP HCPCS V2632 CR5BU0.185 - LENS IOL 10 D +18.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.190 SUP HCPCS V2632 CR5BU0.190 - LENS IOL 10 D +19 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.195 SUP HCPCS V2632 CR5BU0.195 - LENS IOL 10 D +19.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.200 SUP HCPCS V2632 CR5BU0.200 - LENS IOL 10 D +20 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.205 SUP HCPCS V2632 CR5BU0.205 - LENS IOL 10 D +20.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.210 SUP HCPCS V2632 CR5BU0.210 - LENS IOL 10 D +21 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.215 SUP HCPCS V2632 CR5BU0.215 - LENS IOL 10 D +21.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.220 SUP HCPCS V2632 CR5BU0.220 - LENS IOL 10 D +22 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.225 SUP HCPCS V2632 CR5BU0.225 - LENS IOL 10 D +22.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.230 SUP HCPCS V2632 CR5BU0.230 - LENS IOL 10 D +23 DIOPTER BICNVX 7MM 13.5MM 1 PIECE PMMA BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.235 SUP HCPCS V2632 CR5BU0.235 - LENS IOL 10 D +23.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.240 SUP HCPCS V2632 CR5BU0.240 - LENS IOL 10 D +24 DIOPTER BICNVX 7MM 13.5MM 1 PIECE PMMA BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.245 SUP HCPCS V2632 CR5BU0.245 - LENS IOL 10 D +24.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.250 SUP HCPCS V2632 CR5BU0.250 - LENS IOL 10 D +25 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.255 SUP HCPCS V2632 CR5BU0.255 - LENS IOL 10 D +25.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.260 SUP HCPCS V2632 CR5BU0.260 - LENS IOL +26 DIOPTER 7MM 13.5MM BICNVX 1 PIECE PMMA PSTCHBR BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.265 SUP HCPCS V2632 CR5BU0.265 - LENS IOL 10 D +26.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.270 SUP HCPCS V2632 CR5BU0.270 - LENS IOL 10 D +27 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.275 SUP HCPCS V2632 CR5BU0.275 - LENS IOL 10 D +27.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.280 SUP HCPCS V2632 CR5BU0.280 - LENS IOL 10 D +28 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.285 SUP HCPCS V2632 CR5BU0.285 - LENS IOL 10 D +28.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.290 SUP HCPCS V2632 CR5BU0.290 - LENS IOL 10 D +29 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.295 SUP HCPCS V2632 CR5BU0.295 - LENS IOL 10 D +29.5 DIOPTER BICNVX 7MM 13.5MM 1 PIECE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR5BU0.300 SUP HCPCS V2632 CR5BU0.300 - LENS IOL 10 D +30 DIOPTER BICNVX 7MM 13.5MM 1 PIECE FOLDABLE BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.040 SUP HCPCS V2632 CR70BU.040 - LENS IOL 10 D +4 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.045 SUP HCPCS V2632 CR70BU.045 - LENS IOL 10 D +4.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.050 SUP HCPCS V2632 CR70BU.050 - LENS IOL 10 D +5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.055 SUP HCPCS V2632 CR70BU.055 - LENS IOL 10 D +5.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.060 SUP HCPCS V2632 CR70BU.060 - LENS IOL 10 D +6 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.065 SUP HCPCS V2632 CR70BU.065 - LENS IOL 10 D +6.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.070 SUP HCPCS V2632 CR70BU.070 - LENS IOL 10 D +7 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.075 SUP HCPCS V2632 CR70BU.075 - LENS IOL 10 D +7.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.080 SUP HCPCS V2632 CR70BU.080 - LENS IOL 10 D +8 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.085 SUP HCPCS V2632 CR70BU.085 - LENS IOL 10 D +8.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.090 SUP HCPCS V2632 CR70BU.090 - LENS IOL 10 D +9 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV ABS BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.095 SUP HCPCS V2632 CR70BU.095 - LENS IOL 10 D +9.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.100 SUP HCPCS V2632 CR70BU.100 - LENS IOL 10 D +10 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.105 SUP HCPCS V2632 CR70BU.105 - LENS IOL 10 D +10.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.110 SUP HCPCS V2632 CR70BU.110 - LENS IOL 10 D +11 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.115 SUP HCPCS V2632 CR70BU.115 - LENS IOL 10 D +11.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.120 SUP HCPCS V2632 CR70BU.120 - LENS IOL 10 D +12 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.125 SUP HCPCS V2632 CR70BU.125 - LENS IOL 10 D +12.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.130 SUP HCPCS V2632 CR70BU.130 - LENS IOL 10 D +13 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.135 SUP HCPCS V2632 CR70BU.135 - LENS IOL 10 D +13.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.140 SUP HCPCS V2632 CR70BU.140 - LENS IOL 10 D +14 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.145 SUP HCPCS V2632 CR70BU.145 - LENS IOL 10 D +14.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.150 SUP HCPCS V2632 CR70BU.150 - LENS IOL 10 D +15 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.155 SUP HCPCS V2632 CR70BU.155 - LENS IOL 10 D +15.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.160 SUP HCPCS V2632 CR70BU.160 - LENS IOL 10 D +16 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.165 SUP HCPCS V2632 CR70BU.165 - LENS IOL 10 D +16.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.170 SUP HCPCS V2632 CR70BU.170 - LENS IOL 10 D +17 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.175 SUP HCPCS V2632 CR70BU.175 - LENS IOL 10 D +17.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.180 SUP HCPCS V2632 CR70BU.180 - LENS IOL 10 D +18 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.185 SUP HCPCS V2632 CR70BU.185 - LENS IOL 10 D +18.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.190 SUP HCPCS V2632 CR70BU.190 - LENS IOL 10 D +19 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.195 SUP HCPCS V2632 CR70BU.195 - LENS IOL 10 D +19.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.200 SUP HCPCS V2632 CR70BU.200 - LENS IOL 10 D +20 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.205 SUP HCPCS V2632 CR70BU.205 - LENS IOL 10 D +20.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.210 SUP HCPCS V2632 CR70BU.210 - LENS IOL 10 D +21 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.215 SUP HCPCS V2632 CR70BU.215 - LENS IOL 10 D +21.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.220 SUP HCPCS V2632 CR70BU.220 - LENS IOL 10 D +22 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.225 SUP HCPCS V2632 CR70BU.225 - LENS IOL 10 D +22.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.230 SUP HCPCS V2632 CR70BU.230 - LENS IOL 10 D +23 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.235 SUP HCPCS V2632 CR70BU.235 - LENS IOL 10 D +23.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.240 SUP HCPCS V2632 CR70BU.240 - LENS IOL 10 D +24 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.245 SUP HCPCS V2632 CR70BU.245 - LENS IOL 10 D +24.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.250 SUP HCPCS V2632 CR70BU.250 - LENS IOL 10 D +25 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.255 SUP HCPCS V2632 CR70BU.255 - LENS IOL 10 D +25.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.260 SUP HCPCS V2632 CR70BU.260 - LENS IOL 10 D +26 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.265 SUP HCPCS V2632 CR70BU.265 - LENS IOL 10 D +26.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.270 SUP HCPCS V2632 CR70BU.270 - LENS IOL 10 D +27 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.275 SUP HCPCS V2632 CR70BU.275 - LENS IOL 10 D +27.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.280 SUP HCPCS V2632 CR70BU.280 - LENS IOL 10 D +28 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.285 SUP HCPCS V2632 CR70BU.285 - LENS IOL 10 D +28.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.290 SUP HCPCS V2632 CR70BU.290 - LENS IOL 10 D +29 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.295 SUP HCPCS V2632 CR70BU.295 - LENS IOL 10 D +29.5 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CR70BU.300 SUP HCPCS V2632 CR70BU.300 - LENS IOL 10 D +30 DIOP BCNVX 7MM 13.5MM ACRSF 1 PC FLD UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CS-01701 SUP HCPCS C1726 CS-01701 - KIT CHLGM 4FR 10FR 60CM 1.25ML 21.4CM 2 LUM 3W STPCK CATH BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $195.00 $325.00 $67.73 $325.00 N/A N/A CS-12 SUP HCPCS C1713 CS-12 - SCREW BONE 3.5MM 12MM DVR TI DISTAL RADL VOLR CORT BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $105.00 $175.00 $36.47 $175.00 N/A N/A CS-16 SUP HCPCS C1713 CS-16 - SCREW BONE 3.5MM 16MM DVR TI DISTAL RADL VOLR CORT BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $105.00 $175.00 $36.47 $175.00 N/A N/A CS-18 SUP HCPCS C1713 CS-18 - SCREW BONE 3.5MM 18MM DVR TI DISTAL RADL VOLR CORT BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $105.00 $175.00 $36.47 $175.00 N/A N/A CS220-ICC SUP Custom 27203010 DRESSING NADH VAC GFM FOAM ABD BOTH IP/OP $801.50 $593.00 $142.60 $801.14 $801.14 $801.14 $801.14 $801.14 $801.14 $801.14 $142.60 $801.14 $801.14 $594.61 $594.61 $617.52 $417.39 $166.97 $801.14 $320.46 $801.14 $801.14 $801.14 $801.14 $801.14 $601.13 $801.14 $801.14 $801.14 $400.57 $400.57 $634.50 $801.14 $640.91 $520.74 $801.14 N/A $464.87 $801.14 $480.68 $801.14 $801.14 $801.14 N/A N/A CS-362 SUP Custom 27203010 CS-362 - CATHETER DIALYSIS FLEX-NECK ADULT SMALL L62 CM W6-14 CM OD5. BOTH IP/OP $222.50 $165.00 $39.61 $222.50 $222.50 $222.50 $222.50 $222.50 $222.50 $222.50 $39.61 $222.50 $222.50 $165.14 $165.14 $171.50 $115.92 $46.37 $222.50 $89.00 $222.50 $222.50 $222.50 $222.50 $222.50 $166.88 $222.50 $222.50 $222.50 $111.25 $111.25 $176.22 $222.50 $178.00 $144.63 $222.50 N/A $129.05 $222.50 $133.50 $222.50 $222.50 $222.50 N/A N/A CS40G SUP Custom 27203010 CS40G - STAPLER INTERNAL CURVE 40MMX4.7MM 2MM 6 FIRING 4 ROW LINEAR BOTH IP/OP "$1,626.00" "$1,203.00" $289.34 "$1,625.51" "$1,625.51" "$1,625.51" "$1,625.51" "$1,625.51" "$1,625.51" "$1,625.51" $289.34 "$1,625.51" "$1,625.51" "$1,206.45" "$1,206.45" "$1,252.94" $846.89 $338.77 "$1,625.51" $650.20 "$1,625.51" "$1,625.51" "$1,625.51" "$1,625.51" "$1,625.51" "$1,219.50" "$1,625.51" "$1,625.51" "$1,625.51" $812.76 $812.76 "$1,287.40" "$1,625.51" "$1,300.41" "$1,056.58" "$1,625.51" N/A $943.08 "$1,625.51" $975.31 "$1,625.51" "$1,625.51" "$1,625.51" N/A N/A CSOFT6 SUP Custom 27203010 CSOFT6 - CLIP SRG 6MM FGRTY 2 SFJW SPRG ATRM OCL DISP BOTH IP/OP $33.50 $25.00 $5.91 $43.25 $33.23 $33.23 $33.23 $33.23 $33.23 $33.23 $5.91 $33.23 $33.23 $24.66 $24.66 $25.61 $17.31 $6.93 $33.23 $21.80 $33.23 $33.23 $43.25 $33.23 $33.23 $25.13 $33.23 $33.23 $33.23 $16.62 $16.62 $26.32 $33.23 $26.58 $21.60 $33.23 N/A $19.43 $33.23 $19.94 $33.23 $33.23 $33.23 N/A N/A CTI-512N SUP Custom 27203010 CTI-512N - DEVICE CLOSURE 5MM 10/12MM SUTURE PASSER CARTER-THOMASON BOTH IP/OP $278.50 $206.00 $49.50 $278.10 $278.10 $278.10 $278.10 $278.10 $278.10 $278.10 $49.50 $278.10 $278.10 $206.41 $206.41 $214.36 $144.89 $57.96 $278.10 $111.24 $278.10 $278.10 $278.10 $278.10 $278.10 $208.88 $278.10 $278.10 $278.10 $139.05 $139.05 $220.26 $278.10 $222.48 $180.77 $278.10 N/A $161.53 $278.10 $166.86 $278.10 $278.10 $278.10 N/A N/A C-TP-1507 SUP Custom 27803010 C-TP-1507 - DEVICE CLSR ANG TIGERPAW SYS II 7 CNCT UNQ FSTNR ZERO BLD BOTH IP/OP "$3,375.00" "$2,498.00" $600.75 "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" $600.75 "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" $703.39 "$3,375.00" "$1,350.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$2,531.25" "$3,375.00" "$3,375.00" "$3,375.00" "$1,687.50" "$1,687.50" "$2,673.00" "$3,375.00" "$2,700.00" "$1,518.75" "$3,375.00" N/A "$1,957.50" "$3,375.00" "$2,025.00" "$3,375.00" "$3,375.00" "$3,375.00" N/A N/A C-TP-1509 SUP Custom 27803010 C-TP-1509 - DEVICE CLSR ANG TIGERPAW SYS II 9 CNCT UNQ FSTNR ZERO BLD BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A CTR11R SUP Custom 27803010 CTR11R - RING TENSION FORTIFEYE PMMA 13 MM 11 MM CAPSULAR RIGHT PRELO BOTH IP/OP $250.00 $185.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $44.50 $250.00 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $150.00 $250.00 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $250.00 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A CUSTOM IMPLANT SUP HCPCS C1763 CUSTOM IMPLANT - TISSUE SYNTH PE POR MEDPOR IMPL CSTM CRANIAL BOTH IP/OP "$12,000.00" "$8,880.00" "$2,381.70" "$12,000.00" "$5,400.00" "$5,400.00" "$5,400.00" "$5,400.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,501.10" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,500.93" "$12,000.00" "$12,000.00" "$5,916.00" "$12,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$9,000.00" "$12,000.00" "$12,000.00" "$12,000.00" "$6,000.00" "$6,000.00" "$9,504.00" "$12,000.00" "$9,600.00" "$5,400.00" "$2,381.70" N/A "$6,960.00" "$12,000.00" "$12,000.00" "$12,000.00" "$2,500.80" "$12,000.00" N/A N/A CX01B SUP HCPCS C1713 CX01B - CEMENT BONE KYPHON XPEDE SPNL MXR BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A CX01B-MT2 SUP HCPCS C1713 CX01B-MT2 - Xpede Cement and Mixer with Size 2 Multi-Tap BOTH IP/OP $675.00 $500.00 $133.97 $675.00 $303.75 $303.75 $303.75 $303.75 $675.00 $675.00 $675.00 $140.69 $675.00 $675.00 $675.00 $675.00 $675.00 $140.68 $675.00 $675.00 $399.26 $675.00 $675.00 $675.00 $675.00 $506.25 $675.00 $675.00 $675.00 $337.50 $337.50 $534.60 $675.00 $540.00 $303.75 $133.97 N/A $391.50 $675.00 $675.00 $675.00 $140.67 $675.00 N/A N/A CX30D SUP Custom 27203010 CX30D - SUTURE NABSB 1 CTX 18IN GRN EBND CR BRD 8 STRN BOTH IP/OP $355.50 $263.00 $63.24 $365.60 $355.28 $355.28 $355.28 $355.28 $355.28 $355.28 $63.24 $355.28 $355.28 $263.69 $263.69 $273.85 $185.10 $74.04 $355.28 $146.24 $355.28 $355.28 $365.60 $355.28 $355.28 $266.63 $355.28 $355.28 $355.28 $177.64 $177.64 $281.38 $355.28 $284.22 $230.93 $355.28 N/A $206.19 $355.28 $213.17 $355.28 $355.28 $355.28 N/A N/A CX41D SUP Custom 27203010 CX41D - SUTURE NONABSORBABLE 0 MO-7 18IN CONTROL RELEASE BRAID 8 BOTH IP/OP $35.50 $26.00 $6.28 $36.32 $35.29 $35.29 $35.29 $35.29 $35.29 $35.29 $6.28 $35.29 $35.29 $26.19 $26.19 $27.20 $18.39 $7.35 $35.29 $14.53 $35.29 $35.29 $36.32 $35.29 $35.29 $26.63 $35.29 $35.29 $35.29 $17.65 $17.65 $27.95 $35.29 $28.23 $22.94 $35.29 N/A $20.59 $35.29 $21.17 $35.29 $35.29 $35.29 N/A N/A CXS08300 SUP HCPCS C1874 CXS08300 - STENT CORON 3MM 8MM 137CM .014IN OTW SLF XPD RAPEX RAPTORAIL BOTH IP/OP "$6,500.00" "$4,810.00" "$1,290.09" "$6,500.00" "$2,925.00" "$2,925.00" "$2,925.00" "$2,925.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.76" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.67" "$6,500.00" "$6,500.00" "$3,204.50" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$4,875.00" "$6,500.00" "$6,500.00" "$6,500.00" "$3,250.00" "$3,250.00" "$5,148.00" "$6,500.00" "$5,200.00" "$2,925.00" "$1,290.09" N/A "$3,770.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.60" "$6,500.00" N/A N/A CZ70BD.100 SUP HCPCS V2632 CZ70BD.100 - LENS IOL 5 D +10 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.105 SUP HCPCS V2632 CZ70BD.105 - LENS IOL 5 D +10.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.110 SUP HCPCS V2632 CZ70BD.110 - LENS IOL 5 D +11 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.115 SUP HCPCS V2632 CZ70BD.115 - LENS IOL 5 D +11.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.120 SUP HCPCS V2632 CZ70BD.120 - LENS IOL 5 D +12 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.125 SUP HCPCS V2632 CZ70BD.125 - LENS IOL 5 D +12.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.130 SUP HCPCS V2632 CZ70BD.130 - LENS IOL 5 D +13 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.135 SUP HCPCS V2632 CZ70BD.135 - LENS IOL 5 D +13.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.140 SUP HCPCS V2632 CZ70BD.140 - LENS IOL 5 D +14 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.145 SUP HCPCS V2632 CZ70BD.145 - LENS IOL 5 D +14.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.150 SUP HCPCS V2632 CZ70BD.150 - LENS IOL 5 D +15 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.155 SUP HCPCS V2632 CZ70BD.155 - LENS IOL 5 D +15.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.160 SUP HCPCS V2632 CZ70BD.160 - LENS IOL 5 D +16 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.165 SUP HCPCS V2632 CZ70BD.165 - LENS IOL 5 D +16.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.170 SUP HCPCS V2632 CZ70BD.170 - LENS IOL 5 D +17 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.175 SUP HCPCS V2632 CZ70BD.175 - LENS IOL 5 D +17.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.180 SUP HCPCS V2632 CZ70BD.180 - LENS IOL 5 D +18 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.185 SUP HCPCS V2632 CZ70BD.185 - LENS IOL 5 D +18.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.190 SUP HCPCS V2632 CZ70BD.190 - LENS IOL 5 D +19 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.195 SUP HCPCS V2632 CZ70BD.195 - LENS IOL 5 D +19.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE EYELET BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.200 SUP HCPCS V2632 CZ70BD.200 - LENS IOL 5 D +20 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $56.25 $56.25 $56.25 $56.25 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $125.00 $125.00 $125.00 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $56.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A CZ70BD.205 SUP HCPCS V2632 CZ70BD.205 - LENS IOL 5 D +20.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.210 SUP HCPCS V2632 CZ70BD.210 - LENS IOL 5 D +21 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.215 SUP HCPCS V2632 CZ70BD.215 - LENS IOL 5 D +21.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.220 SUP HCPCS V2632 CZ70BD.220 - LENS IOL 5 D +22 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.225 SUP HCPCS V2632 CZ70BD.225 - LENS IOL 5 D +22.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE EYELET BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.230 SUP HCPCS V2632 CZ70BD.230 - LENS IOL 5 D +23 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.235 SUP HCPCS V2632 CZ70BD.235 - LENS IOL +23.5 DIOPTER 5 D BICNVX 7MM 12.5MM 1 PIECE EYELET BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.240 SUP HCPCS V2632 CZ70BD.240 - LENS IOL 5 D +24 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.245 SUP HCPCS V2632 CZ70BD.245 - LENS IOL 5 D +24.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.250 SUP HCPCS V2632 CZ70BD.250 - LENS IOL 5 D +25 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.255 SUP HCPCS V2632 CZ70BD.255 - LENS IOL 5 D +25.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.260 SUP HCPCS V2632 CZ70BD.260 - LENS IOL 5 D +26 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.265 SUP HCPCS V2632 CZ70BD.265 - LENS IOL 5 D +26.5 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.270 SUP HCPCS V2632 CZ70BD.270 - LENS IOL 5 D +27 DIOPTER BICNVX 7MM 12.5MM 1 PIECE UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.275 SUP HCPCS V2632 CZ70BD.275 - LENS IOL 5 D +27.5 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.280 SUP HCPCS V2632 CZ70BD.280 - LENS IOL 5 D +28 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.285 SUP HCPCS V2632 CZ70BD.285 - LENS IOL 5 D +28.5 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.290 SUP HCPCS V2632 CZ70BD.290 - LENS IOL 5 D +29 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.295 SUP HCPCS V2632 CZ70BD.295 - LENS IOL 5 D +29.5 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A CZ70BD.300 SUP HCPCS V2632 CZ70BD.300 - LENS IOL 5 D +30 DIOP MOD C BCNVX 7MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A D204DRM SUP HCPCS C1721 D204DRM - DEFIBRILLATOR CARDIAC THK15MM 51X66MM 1 CHAMBER 1IS-1 1DF-4 BOTH IP/OP "$38,750.00" "$28,675.00" "$8,075.93" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$8,075.93" "$38,750.00" "$15,500.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$29,062.50" "$38,750.00" "$38,750.00" "$38,750.00" "$19,375.00" "$19,375.00" "$30,690.00" "$38,750.00" "$31,000.00" "$17,437.50" "$38,750.00" N/A "$22,475.00" "$38,750.00" "$23,250.00" "$38,750.00" "$38,750.00" "$38,750.00" N/A N/A D204TRM SUP HCPCS C2621 D204TRM - DEFIBRILLATOR CARDIAC THK15MM 51X66MM 2 CHAMBER 2IS-1 1DF-4 BOTH IP/OP "$69,920.00" "$51,741.00" "$7,712.84" "$69,920.00" "$31,464.00" "$31,464.00" "$31,464.00" "$31,464.00" "$69,920.00" "$69,920.00" "$69,920.00" "$9,417.94" "$69,920.00" "$69,920.00" "$69,920.00" "$69,920.00" "$69,920.00" "$14,572.10" "$69,920.00" "$69,920.00" "$34,470.56" "$69,920.00" "$69,920.00" "$69,920.00" "$69,920.00" "$52,440.00" "$69,920.00" "$69,920.00" "$69,920.00" "$34,960.00" "$34,960.00" "$55,376.64" "$69,920.00" "$55,936.00" "$31,464.00" "$7,712.84" N/A "$40,553.60" "$69,920.00" "$69,920.00" "$69,920.00" "$8,098.48" "$69,920.00" N/A N/A D204VRM SUP HCPCS C1721 D204VRM - DEFIBRILLATOR CARDIAC THK15MM 51X64MM 1 CHAMBER 1DF-4 BOTH IP/OP "$33,750.00" "$24,975.00" "$7,033.87" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$7,033.87" "$33,750.00" "$13,500.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$25,312.50" "$33,750.00" "$33,750.00" "$33,750.00" "$16,875.00" "$16,875.00" "$26,730.00" "$33,750.00" "$27,000.00" "$15,187.50" "$33,750.00" N/A "$19,575.00" "$33,750.00" "$20,250.00" "$33,750.00" "$33,750.00" "$33,750.00" N/A N/A D224DRG SUP HCPCS C1721 D224DRG - DEFIBRILLATOR CARDIAC THK15MM 51X64MM 2 CHAMBER 2IS-1 2DF-1 BOTH IP/OP "$38,750.00" "$28,675.00" "$8,075.93" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$8,075.93" "$38,750.00" "$15,500.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$29,062.50" "$38,750.00" "$38,750.00" "$38,750.00" "$19,375.00" "$19,375.00" "$30,690.00" "$38,750.00" "$31,000.00" "$17,437.50" "$38,750.00" N/A "$22,475.00" "$38,750.00" "$23,250.00" "$38,750.00" "$38,750.00" "$38,750.00" N/A N/A D224TRK SUP HCPCS C1882 D224TRK - DEFIBRILLATOR CARDIAC THK.59IN 2.01X2.72IN IMPLTABLE BOTH IP/OP "$69,920.00" "$51,741.00" "$7,712.84" "$69,920.00" "$31,464.00" "$31,464.00" "$31,464.00" "$31,464.00" "$69,920.00" "$69,920.00" "$69,920.00" "$9,417.94" "$69,920.00" "$69,920.00" "$69,920.00" "$69,920.00" "$69,920.00" "$14,572.10" "$69,920.00" "$69,920.00" "$34,470.56" "$69,920.00" "$69,920.00" "$69,920.00" "$69,920.00" "$52,440.00" "$69,920.00" "$69,920.00" "$69,920.00" "$34,960.00" "$34,960.00" "$55,376.64" "$69,920.00" "$55,936.00" "$31,464.00" "$7,712.84" N/A "$40,553.60" "$69,920.00" "$69,920.00" "$69,920.00" "$8,098.48" "$69,920.00" N/A N/A D334DRG SUP HCPCS C1721 D334DRG - DEFIBRILLATOR CARDIAC THK15MM 51X64MM 2 CHAMBER 2IS-1 2DF-1 BOTH IP/OP "$38,750.00" "$28,675.00" "$8,075.93" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$8,075.93" "$38,750.00" "$15,500.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$29,062.50" "$38,750.00" "$38,750.00" "$38,750.00" "$19,375.00" "$19,375.00" "$30,690.00" "$38,750.00" "$31,000.00" "$17,437.50" "$38,750.00" N/A "$22,475.00" "$38,750.00" "$23,250.00" "$38,750.00" "$38,750.00" "$38,750.00" N/A N/A D334DRM SUP HCPCS C1721 D334DRM - DEFIBRILLATOR CARDIAC 2 CHAMBER CARDIOVERTER PACEMAKER BOTH IP/OP "$38,750.00" "$28,675.00" "$8,075.93" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$8,075.93" "$38,750.00" "$15,500.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$29,062.50" "$38,750.00" "$38,750.00" "$38,750.00" "$19,375.00" "$19,375.00" "$30,690.00" "$38,750.00" "$31,000.00" "$17,437.50" "$38,750.00" N/A "$22,475.00" "$38,750.00" "$23,250.00" "$38,750.00" "$38,750.00" "$38,750.00" N/A N/A D334TRG SUP HCPCS C1721 D334TRG - DEFIBRILLATOR CARDIAC THK15MM 51X69MM 2 CHAMBER 2IS-1 2DF-1 BOTH IP/OP "$45,500.00" "$33,670.00" "$9,482.70" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$9,482.70" "$45,500.00" "$18,200.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$34,125.00" "$45,500.00" "$45,500.00" "$45,500.00" "$22,750.00" "$22,750.00" "$36,036.00" "$45,500.00" "$36,400.00" "$20,475.00" "$45,500.00" N/A "$26,390.00" "$45,500.00" "$27,300.00" "$45,500.00" "$45,500.00" "$45,500.00" N/A N/A D334TRM SUP HCPCS C1721 D334TRM - DEFIBRILLATOR CARDIAC RESYNCHRONIZATION THERAPY PROTECTA BOTH IP/OP "$45,500.00" "$33,670.00" "$9,482.70" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$9,482.70" "$45,500.00" "$18,200.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$34,125.00" "$45,500.00" "$45,500.00" "$45,500.00" "$22,750.00" "$22,750.00" "$36,036.00" "$45,500.00" "$36,400.00" "$20,475.00" "$45,500.00" N/A "$26,390.00" "$45,500.00" "$27,300.00" "$45,500.00" "$45,500.00" "$45,500.00" N/A N/A D4295 SUP Custom 27203010 D4295 - SUTURE PRLN 4-0 TF 36IN MFL CSTM BLUE NABSB BOTH IP/OP $120.50 $89.00 $21.37 $120.03 $120.03 $120.03 $120.03 $120.03 $120.03 $120.03 $21.37 $120.03 $120.03 $89.09 $89.09 $92.52 $62.54 $25.02 $120.03 $48.01 $120.03 $120.03 $120.03 $120.03 $120.03 $90.38 $120.03 $120.03 $120.03 $60.02 $60.02 $95.06 $120.03 $96.02 $78.02 $120.03 N/A $69.89 $120.03 $72.02 $120.03 $120.03 $120.03 N/A N/A D5961 SUP Custom 27203010 D5961 - SUTURE ABSORBABLE 2 BP-1 27IN BRAID COATED CUSTOM VICRYL BOTH IP/OP $376.00 $278.00 $66.89 $392.71 $375.79 $375.79 $375.79 $375.79 $375.79 $375.79 $66.89 $375.79 $375.79 $278.91 $278.91 $289.66 $195.79 $78.32 $375.79 $197.53 $375.79 $375.79 $392.71 $375.79 $375.79 $282.00 $375.79 $375.79 $375.79 $187.90 $187.90 $297.63 $375.79 $300.63 $244.26 $375.79 N/A $218.08 $375.79 $225.47 $375.79 $375.79 $375.79 N/A N/A D7933 SUP Custom 27203010 D7933 - SUTURE ABS 4-0 SH 36IN VIOL PDS2 2 ARM MFL BOTH IP/OP $98.00 $73.00 $17.44 $106.47 $97.96 $97.96 $97.96 $97.96 $97.96 $97.96 $17.44 $97.96 $97.96 $72.71 $72.71 $75.51 $51.04 $20.42 $97.96 $42.59 $97.96 $97.96 $106.47 $97.96 $97.96 $73.50 $97.96 $97.96 $97.96 $48.98 $48.98 $77.58 $97.96 $78.37 $63.67 $97.96 N/A $56.84 $97.96 $58.78 $97.96 $97.96 $97.96 N/A N/A D900VP8HS SUP Custom 27203010 PROBE DPLR 2.9X5.5IN MN DPL 8 MHZ MINI BOTH IP/OP "$1,281.00" $948.00 $328.64 "$1,846.28" "$1,846.28" "$1,846.28" "$1,846.28" "$1,846.28" "$1,846.28" "$1,846.28" $328.64 "$1,846.28" "$1,846.28" "$1,370.31" "$1,370.31" "$1,423.11" $961.91 $384.79 "$1,846.28" $738.51 "$1,846.28" "$1,846.28" "$1,846.28" "$1,846.28" "$1,846.28" $960.75 "$1,846.28" "$1,846.28" "$1,846.28" $923.14 $923.14 "$1,462.25" "$1,846.28" "$1,477.02" "$1,200.08" "$1,846.28" N/A $742.98 "$1,846.28" "$1,107.77" "$1,846.28" "$1,846.28" "$1,846.28" N/A N/A D900VP8HS SUP Custom 27203010 D900VP8HS - PROBE DOPPLER 8 MHZ MINI 2.9X5.5IN MINI DOPPLEX BOTH IP/OP "$1,846.50" "$1,366.00" $328.64 "$1,846.28" "$1,846.28" "$1,846.28" "$1,846.28" "$1,846.28" "$1,846.28" "$1,846.28" $328.64 "$1,846.28" "$1,846.28" "$1,370.31" "$1,370.31" "$1,423.11" $961.91 $384.79 "$1,846.28" $738.51 "$1,846.28" "$1,846.28" "$1,846.28" "$1,846.28" "$1,846.28" "$1,384.88" "$1,846.28" "$1,846.28" "$1,846.28" $923.14 $923.14 "$1,462.25" "$1,846.28" "$1,477.02" "$1,200.08" "$1,846.28" N/A "$1,070.97" "$1,846.28" "$1,107.77" "$1,846.28" "$1,846.28" "$1,846.28" N/A N/A D9311 SUP Custom 27203010 D9311 - SUTURE NABSB 3-0 27IN WHT EBND EXC D SPCL CSTM BOTH IP/OP $179.50 $133.00 $31.89 $179.13 $179.13 $179.13 $179.13 $179.13 $179.13 $179.13 $31.89 $179.13 $179.13 $132.95 $132.95 $138.07 $93.33 $37.33 $179.13 $71.65 $179.13 $179.13 $179.13 $179.13 $179.13 $134.63 $179.13 $179.13 $179.13 $89.57 $89.57 $141.87 $179.13 $143.30 $116.43 $179.13 N/A $104.11 $179.13 $107.48 $179.13 $179.13 $179.13 N/A N/A DB-2.5 SUP Custom 27203010 DB-2.5 - BIT DRILL 2.5MM STRL DISP BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 N/A $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A DCE-110 SUP Custom 27203010 DCE-110 - ELECTRODE ELECTROSURGICAL LARGE 15MM 23MM CONIZATION C-LETZ BOTH IP/OP $52.50 $39.00 $9.30 $52.25 $52.25 $52.25 $52.25 $52.25 $52.25 $52.25 $9.30 $52.25 $52.25 $38.78 $38.78 $40.27 $27.22 $10.89 $52.25 $20.90 $52.25 $52.25 $52.25 $52.25 $52.25 $39.38 $52.25 $52.25 $52.25 $26.13 $26.13 $41.38 $52.25 $41.80 $33.96 $52.25 N/A $30.45 $52.25 $31.35 $52.25 $52.25 $52.25 N/A N/A DCE-115 SUP Custom 27203010 DCE-115 - ELECTRODE ELECTROSURGICAL MEDIUM 11MM 18MM CONIZATION CNTOUR BOTH IP/OP $52.50 $39.00 $9.30 $52.25 $52.25 $52.25 $52.25 $52.25 $52.25 $52.25 $9.30 $52.25 $52.25 $38.78 $38.78 $40.27 $27.22 $10.89 $52.25 $20.90 $52.25 $52.25 $52.25 $52.25 $52.25 $39.38 $52.25 $52.25 $52.25 $26.13 $26.13 $41.38 $52.25 $41.80 $33.96 $52.25 N/A $30.45 $52.25 $31.35 $52.25 $52.25 $52.25 N/A N/A DCE-125 SUP Custom 27203010 DCE-125 - ELECTRODE ELECTROSURGICAL SMALL 9MM 13MM CNTOUR CONIZATION BOTH IP/OP $52.50 $39.00 $9.30 $52.25 $52.25 $52.25 $52.25 $52.25 $52.25 $52.25 $9.30 $52.25 $52.25 $38.78 $38.78 $40.27 $27.22 $10.89 $52.25 $20.90 $52.25 $52.25 $52.25 $52.25 $52.25 $39.38 $52.25 $52.25 $52.25 $26.13 $26.13 $41.38 $52.25 $41.80 $33.96 $52.25 N/A $30.45 $52.25 $31.35 $52.25 $52.25 $52.25 N/A N/A DC-PY1506UA1 SUP HCPCS C1725 DC-PY1506UA1 - CATHETER BLNDIL 1.5MM 6MM TAKERU OTW PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-PY1512UA1 SUP HCPCS C1725 DC-PY1512UA1 - CATHETER BLNDIL 1.5MM 12MM TAKERU OTW PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-PY1515UA1 SUP HCPCS C1725 DC-PY1515UA1 - CATHETER BLNDIL 1.5MM 15MM TAKERU OTW PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-PY2008UA2 SUP HCPCS C1725 DC-PY2008UA2 - CATHETER BLNDIL 2MM 8MM TAKERU OTW PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-PY2012UA2 SUP HCPCS C1725 DC-PY2012UA2 - CATHETER BLNDIL 2MM 12MM TAKERU OTW PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-PY2015UA2 SUP HCPCS C1725 DC-PY2015UA2 - CATHETER BLNDIL 2MM 15MM TAKERU OTW PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-PY2020UA2 SUP HCPCS C1725 DC-PY2020UA2 - CATHETER BLNDIL 2MM 20MM TAKERU OTW PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-PY2212UA2 SUP HCPCS C1725 DC-PY2212UA2 - CATHETER BLNDIL 2.25MM 12MM TAKERU OTW PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-PY2215UA2 SUP HCPCS C1725 DC-PY2215UA2 - CATHETER BLNDIL 2.25MM 15MM TAKERU OTW PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-PY2220UA2 SUP HCPCS C1725 DC-PY2220UA2 - CATHETER BLNDIL 2.25MM 20MM TAKERU OTW PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-PY2508UA2 SUP HCPCS C1725 DC-PY2508UA2 - CATHETER BLNDIL 2.5MM 8MM TAKERU OTW PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-PY2512UA2 SUP HCPCS C1725 DC-PY2512UA2 - CATHETER BLNDIL 2.5MM 12MM TAKERU OTW PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-PY2515UA2 SUP HCPCS C1725 DC-PY2515UA2 - CATHETER BLNDIL 2.5MM 15MM TAKERU OTW PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-PY2520UA2 SUP HCPCS C1725 DC-PY2520UA2 - CATHETER BLNDIL 2.5MM 20MM TAKERU OTW PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RY1506UA1 SUP HCPCS C1725 DC-RY1506UA1 - CATHETER BLNDIL 1.5MM 6MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RY1512UA1 SUP HCPCS C1725 DC-RY1512UA1 - CATHETER BLNDIL 1.5MM 12MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RY1515UA1 SUP HCPCS C1725 DC-RY1515UA1 - CATHETER BLNDIL 1.5MM 15MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RY2008UA2 SUP HCPCS C1725 DC-RY2008UA2 - CATHETER BLNDIL 2MM 8MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RY2012UA2 SUP HCPCS C1725 DC-RY2012UA2 - CATHETER BLNDIL 2MM 12MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RY2015UA2 SUP HCPCS C1725 DC-RY2015UA2 - CATHETER BLNDIL 2MM 15MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RY2020UA2 SUP HCPCS C1725 DC-RY2020UA2 - CATHETER BLNDIL 2MM 20MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RY2212UA2 SUP HCPCS C1725 DC-RY2212UA2 - CATHETER BLNDIL 2.25MM 12MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RY2215UA2 SUP HCPCS C1725 DC-RY2215UA2 - CATHETER BLNDIL 2.25MM 15MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RY2220UA2 SUP HCPCS C1725 DC-RY2220UA2 - CATHETER BLNDIL 2.25MM 20MM TAKERU RX SMCPNT PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RY2508UA2 SUP HCPCS C1725 DC-RY2508UA2 - CATHETER BLNDIL 2.25MM 8MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RY2512UA2 SUP HCPCS C1725 DC-RY2512UA2 - CATHETER BLNDIL 2.5MM 12MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RY2515UA2 SUP HCPCS C1725 DC-RY2515UA2 - CATHETER BLNDIL 2.5MM 15MM RX TAKERU LO ENTRY PRFL PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RY2520UA2 SUP HCPCS C1725 DC-RY2520UA2 - CATHETER BLNDIL 2.5MM 20MM TAKERU RX SMCPNT PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2008UA2 SUP HCPCS C1725 DC-RZ2008UA2 - CATHETER BLNDIL 2MM 8MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2012UA2 SUP HCPCS C1725 DC-RZ2012UA2 - CATHETER BLNDIL 2MM 12MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2015UA2 SUP HCPCS C1725 DC-RZ2015UA2 - CATHETER BLNDIL 2MM 15MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2021UA2 SUP HCPCS C1725 DC-RZ2021UA2 - CATHETER BLNDIL 2MM 21MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2208UA2 SUP HCPCS C1725 DC-RZ2208UA2 - CATHETER BLNDIL 2.25MM 8MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2212UA2 SUP HCPCS C1725 DC-RZ2212UA2 - CATHETER BLNDIL 2.25MM 12MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2215UA2 SUP HCPCS C1725 DC-RZ2215UA2 - CATHETER BLNDIL 2.25MM 15MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2221UA2 SUP HCPCS C1725 DC-RZ2221UA2 - CATHETER BLNDIL 2.25MM 21MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2508UA2 SUP HCPCS C1725 DC-RZ2508UA2 - CATHETER BLNDIL 2.5MM 8MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2512UA2 SUP HCPCS C1725 DC-RZ2512UA2 - CATHETER BLNDIL 2.5MM 12MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2515UA2 SUP HCPCS C1725 DC-RZ2515UA2 - CATHETER BLNDIL 2.5MM 15MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2521UA2 SUP HCPCS C1725 DC-RZ2521UA2 - CATHETER BLNDIL 2.5MM 21MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2708UA2 SUP HCPCS C1725 DC-RZ2708UA2 - CATHETER BLNDIL 2.75MM 8MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2712UA2 SUP HCPCS C1725 DC-RZ2712UA2 - CATHETER BLNDIL 2.75MM 12MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2715UA2 SUP HCPCS C1725 DC-RZ2715UA2 - CATHETER BLNDIL 2.75MM 15MM TAKERU RX PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ2721UA2 SUP HCPCS C1725 DC-RZ2721UA2 - CATHETER BLNDIL 2.75MM 21MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ3008UA2 SUP HCPCS C1725 DC-RZ3008UA2 - CATHETER BLNDIL 3MM 8MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ3012UA2 SUP HCPCS C1725 DC-RZ3012UA2 - CATHETER BLNDIL 3MM 12MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ3015UA2 SUP HCPCS C1725 DC-RZ3015UA2 - CATHETER BLNDIL 3MM 15MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ3021UA2 SUP HCPCS C1725 DC-RZ3021UA2 - CATHETER BLNDIL 3MM 21MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ3208UA2 SUP HCPCS C1725 DC-RZ3208UA2 - CATHETER BLNDIL 3.25MM 8MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ3212UA2 SUP HCPCS C1725 DC-RZ3212UA2 - CATHETER BLNDIL 3.25MM 12MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ3215UA2 SUP HCPCS C1725 DC-RZ3215UA2 - CATHETER BLNDIL 3.25MM 15MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ3221UA2 SUP HCPCS C1725 DC-RZ3221UA2 - CATHETER BLNDIL 3.25MM 21MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ3508UA2 SUP HCPCS C1725 DC-RZ3508UA2 - CATHETER BLNDIL 3.5MM 8MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ3512UA2 SUP HCPCS C1725 DC-RZ3512UA2 - CATHETER BLNDIL 3.5MM 12MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ3515UA2 SUP HCPCS C1725 DC-RZ3515UA2 - CATHETER BLNDIL 3.5MM 15MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ3521UA2 SUP HCPCS C1725 DC-RZ3521UA2 - CATHETER BLNDIL 3.5MM 21MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ4008UA2 SUP HCPCS C1725 DC-RZ4008UA2 - CATHETER BLNDIL 4MM 8MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ4012UA2 SUP HCPCS C1725 DC-RZ4012UA2 - CATHETER BLNDIL 4MM 12MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ4015UA2 SUP HCPCS C1725 DC-RZ4015UA2 - CATHETER BLNDIL 4MM 15MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DC-RZ4021UA2 SUP HCPCS C1725 DC-RZ4021UA2 - CATHETER BLNDIL 4MM 21MM TAKERU PTCA BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $156.11 $156.11 $156.11 $156.11 $287.50 $287.50 $287.50 $59.92 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A DFS100210-20 SUP Custom 27803010 DFS100210-20 - COIL EMBL 2MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH BOTH IP/OP "$2,294.50" "$1,698.00" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $478.15 "$2,294.25" $917.70 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$1,720.88" "$2,294.25" "$2,294.25" "$2,294.25" "$1,147.13" "$1,147.13" "$1,817.05" "$2,294.25" "$1,835.40" "$1,032.41" "$2,294.25" N/A "$1,330.81" "$2,294.25" "$1,376.55" "$2,294.25" "$2,294.25" "$2,294.25" N/A N/A DFS100250-20 SUP Custom 27803010 DFS100250-20 - COIL EMBL 2.5MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS BOTH IP/OP "$2,294.50" "$1,698.00" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $478.15 "$2,294.25" $917.70 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$1,720.88" "$2,294.25" "$2,294.25" "$2,294.25" "$1,147.13" "$1,147.13" "$1,817.05" "$2,294.25" "$1,835.40" "$1,032.41" "$2,294.25" N/A "$1,330.81" "$2,294.25" "$1,376.55" "$2,294.25" "$2,294.25" "$2,294.25" N/A N/A DFS100310-20 SUP Custom 27803010 DFS100310-20 - COIL EMBOLIZATION 3MM 10CM 10 MICROCOIL STRETCH RESISTANT BOTH IP/OP "$2,294.50" "$1,698.00" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $478.15 "$2,294.25" $917.70 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$1,720.88" "$2,294.25" "$2,294.25" "$2,294.25" "$1,147.13" "$1,147.13" "$1,817.05" "$2,294.25" "$1,835.40" "$1,032.41" "$2,294.25" N/A "$1,330.81" "$2,294.25" "$1,376.55" "$2,294.25" "$2,294.25" "$2,294.25" N/A N/A DFS100406-20 SUP Custom 27803010 DFS100406-20 - COIL EMBL 4MM 6CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH BOTH IP/OP "$2,294.50" "$1,698.00" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $478.15 "$2,294.25" $917.70 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$1,720.88" "$2,294.25" "$2,294.25" "$2,294.25" "$1,147.13" "$1,147.13" "$1,817.05" "$2,294.25" "$1,835.40" "$1,032.41" "$2,294.25" N/A "$1,330.81" "$2,294.25" "$1,376.55" "$2,294.25" "$2,294.25" "$2,294.25" N/A N/A DFS100408-20 SUP Custom 27803010 DFS100408-20 - COIL EMBL 4MM 8CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH BOTH IP/OP "$2,294.50" "$1,698.00" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $478.15 "$2,294.25" $917.70 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$1,720.88" "$2,294.25" "$2,294.25" "$2,294.25" "$1,147.13" "$1,147.13" "$1,817.05" "$2,294.25" "$1,835.40" "$1,032.41" "$2,294.25" N/A "$1,330.81" "$2,294.25" "$1,376.55" "$2,294.25" "$2,294.25" "$2,294.25" N/A N/A DFS100410-20 SUP Custom 27803010 DFS100410-20 - COIL EMBL 4MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH BOTH IP/OP "$2,294.50" "$1,698.00" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $478.15 "$2,294.25" $917.70 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$1,720.88" "$2,294.25" "$2,294.25" "$2,294.25" "$1,147.13" "$1,147.13" "$1,817.05" "$2,294.25" "$1,835.40" "$1,032.41" "$2,294.25" N/A "$1,330.81" "$2,294.25" "$1,376.55" "$2,294.25" "$2,294.25" "$2,294.25" N/A N/A DFS100510-20 SUP Custom 27803010 DFS100510-20 - COIL EMBL 5MM 10CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH BOTH IP/OP "$2,294.50" "$1,698.00" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $478.15 "$2,294.25" $917.70 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$1,720.88" "$2,294.25" "$2,294.25" "$2,294.25" "$1,147.13" "$1,147.13" "$1,817.05" "$2,294.25" "$1,835.40" "$1,032.41" "$2,294.25" N/A "$1,330.81" "$2,294.25" "$1,376.55" "$2,294.25" "$2,294.25" "$2,294.25" N/A N/A DFS100515-20 SUP Custom 27803010 DFS100515-20 - COIL EMBL 5MM 15CM DELTAPAQ DELTAWIND 10 MCIOL STRCH RS DTCH BOTH IP/OP "$2,294.50" "$1,698.00" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $408.38 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" $478.15 "$2,294.25" $917.70 "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$2,294.25" "$1,720.88" "$2,294.25" "$2,294.25" "$2,294.25" "$1,147.13" "$1,147.13" "$1,817.05" "$2,294.25" "$1,835.40" "$1,032.41" "$2,294.25" N/A "$1,330.81" "$2,294.25" "$1,376.55" "$2,294.25" "$2,294.25" "$2,294.25" N/A N/A DH1 SUP Custom 27203010 DH1 - HANDLE INST LF DTCH PENUMBRA COIL 400 BOTH IP/OP $595.00 $440.00 $105.91 $595.00 $595.00 $595.00 $595.00 $595.00 $595.00 $595.00 $105.91 $595.00 $595.00 $441.61 $441.61 $458.63 $310.00 $124.00 $595.00 $238.00 $595.00 $595.00 $595.00 $595.00 $595.00 $446.25 $595.00 $595.00 $595.00 $297.50 $297.50 $471.24 $595.00 $476.00 $386.75 $595.00 N/A $345.10 $595.00 $357.00 $595.00 $595.00 $595.00 N/A N/A DJ4008X SUP Custom 27203010 DJ4008X - NEEDLE BIOP STANDARD TAPER 8GA 4IN LIGHTWEIGHT HANDLE DISTAL BOTH IP/OP $55.50 $41.00 $9.81 $55.13 $55.13 $55.13 $55.13 $55.13 $55.13 $55.13 $9.81 $55.13 $55.13 $40.92 $40.92 $42.49 $28.72 $11.49 $55.13 $22.05 $55.13 $55.13 $55.13 $55.13 $55.13 $41.63 $55.13 $55.13 $55.13 $27.57 $27.57 $43.66 $55.13 $44.10 $35.83 $55.13 N/A $32.19 $55.13 $33.08 $55.13 $55.13 $55.13 N/A N/A DJ4011X SUP Custom 27203010 DJ4011X - NEEDLE BIOP 11GA 4IN TAPER DISTAL SHARP BEVEL TIP ADAPTER BOTH IP/OP $51.00 $38.00 $9.08 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $9.08 $51.00 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $20.40 $51.00 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $51.00 N/A $29.58 $51.00 $30.60 $51.00 $51.00 $51.00 N/A N/A DJ4011X SUP Custom 27203010 NEEDLE BIOP 11GA 4IN JMSHD STD HNDL TPR DISTAL TIP BN MRW BOTH IP/OP $54.00 $40.00 $9.08 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $51.00 $9.08 $51.00 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $20.40 $51.00 $51.00 $51.00 $51.00 $51.00 $40.50 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $51.00 N/A $31.32 $51.00 $30.60 $51.00 $51.00 $51.00 N/A N/A DJ6011X SUP Custom 27203010 DJ6011X - NEEDLE BIOP 11GA 6IN TAPER DISTAL SHARP BEVEL TIP ADAPTER BOTH IP/OP $39.50 $29.00 $7.01 $39.36 $39.36 $39.36 $39.36 $39.36 $39.36 $39.36 $7.01 $39.36 $39.36 $29.21 $29.21 $30.34 $20.51 $8.20 $39.36 $15.74 $39.36 $39.36 $39.36 $39.36 $39.36 $29.63 $39.36 $39.36 $39.36 $19.68 $19.68 $31.17 $39.36 $31.49 $25.58 $39.36 N/A $22.91 $39.36 $23.62 $39.36 $39.36 $39.36 N/A N/A DL900F SUP HCPCS C1880 DL900F - FILTER EMBOLIZATION DELIVERY KIT DENALI NITINOL FEMORAL VENA BOTH IP/OP "$3,750.00" "$2,775.00" $781.54 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$1,687.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A DLS-7083-01S SUP Custom 27203010 DLS-7083-01S - NEEDLE BN CMNT 8GA 10CM STRL DLV BOTH IP/OP $151.50 $112.00 $26.91 $153.75 $151.18 $151.18 $151.18 $151.18 $151.18 $151.18 $26.91 $151.18 $151.18 $112.21 $112.21 $116.53 $78.76 $31.51 $151.18 $61.50 $151.18 $151.18 $153.75 $151.18 $151.18 $113.63 $151.18 $151.18 $151.18 $75.59 $75.59 $119.73 $151.18 $120.94 $98.27 $151.18 N/A $87.87 $151.18 $90.71 $151.18 $151.18 $151.18 N/A N/A DLS-7083-05S SUP Custom 27203010 DLS-7083-05S - NEEDLE BONE CEMENT 8GA 10CM DELIVERY NORIAN SRS STERILE BOTH IP/OP $114.50 $85.00 $20.36 $617.03 $114.38 $114.38 $114.38 $114.38 $114.38 $114.38 $20.36 $114.38 $114.38 $84.89 $84.89 $88.16 $59.59 $23.84 $114.38 $246.81 $114.38 $114.38 $617.03 $114.38 $114.38 $85.88 $114.38 $114.38 $114.38 $57.19 $57.19 $90.59 $114.38 $91.50 $74.35 $114.38 N/A $66.41 $114.38 $68.63 $114.38 $114.38 $114.38 N/A N/A DLS-7103-01S SUP Custom 27804086 DLS-7103-01S - SYSTEM BONE CEMENT 10GA 10CM DELIVERY NEEDLE NORIAN SRS BOTH IP/OP $151.50 $112.00 $26.91 $153.75 $151.18 $151.18 $151.18 $151.18 $151.18 $151.18 $26.91 $151.18 $151.18 $151.18 $151.18 $151.18 $151.18 $31.51 $151.18 $61.50 $151.18 $151.18 $153.75 $151.18 $151.18 $113.63 $151.18 $151.18 $151.18 $75.59 $75.59 $119.73 $151.18 $120.94 $68.03 $151.18 N/A $87.87 $151.18 $90.71 $151.18 $151.18 $151.18 N/A N/A DLS-7103-05S SUP Custom 27203010 DLS-7103-05S - NEEDLE BONE CEMENT 10GA 10CM NORIAN SRS STERILE DISPOSABLE BOTH IP/OP $607.00 $449.00 $107.99 $617.03 $606.70 $606.70 $606.70 $606.70 $606.70 $606.70 $107.99 $606.70 $606.70 $450.29 $450.29 $467.64 $316.09 $126.44 $606.70 $246.81 $606.70 $606.70 $617.03 $606.70 $606.70 $455.25 $606.70 $606.70 $606.70 $303.35 $303.35 $480.51 $606.70 $485.36 $394.36 $606.70 N/A $352.06 $606.70 $364.02 $606.70 $606.70 $606.70 N/A N/A DNX12 SUP HCPCS A4364 DNX12 - ADH SKNCLS 2 OCTYL CYNCRLT DRMBND ADV EZ TO USE APL TOP .7ML BOTH IP/OP $50.00 $37.00 $9.92 $49.98 $27.14 $27.14 $27.14 $27.14 $49.98 $49.98 $49.98 $10.42 $49.98 $37.10 $37.10 $38.52 $26.04 $10.42 $49.98 $49.98 $29.56 $49.98 $49.98 $49.98 $49.98 $37.50 $49.98 $49.98 $49.98 $24.99 $24.99 $39.58 $49.98 $39.98 $32.49 $9.92 N/A $29.00 $49.98 $49.98 $49.98 $10.42 $49.98 N/A N/A DPL 100151-20 SUP Custom 27803010 DPL 100151-20 - COIL EMBL 1MM 1.5CM DELTAPLUSH PLTN BOTH IP/OP "$2,545.00" "$1,883.00" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $530.32 "$2,544.60" "$1,017.84" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$1,908.75" "$2,544.60" "$2,544.60" "$2,544.60" "$1,272.30" "$1,272.30" "$2,015.32" "$2,544.60" "$2,035.68" "$1,145.07" "$2,544.60" N/A "$1,476.10" "$2,544.60" "$1,526.76" "$2,544.60" "$2,544.60" "$2,544.60" N/A N/A DPL 100152-20 SUP Custom 27803010 DPL 100152-20 - COIL EMBL 1.5MM 2CM DELTAPLUSH PLTN BOTH IP/OP "$2,545.00" "$1,883.00" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $530.32 "$2,544.60" "$1,017.84" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$1,908.75" "$2,544.60" "$2,544.60" "$2,544.60" "$1,272.30" "$1,272.30" "$2,015.32" "$2,544.60" "$2,035.68" "$1,145.07" "$2,544.60" N/A "$1,476.10" "$2,544.60" "$1,526.76" "$2,544.60" "$2,544.60" "$2,544.60" N/A N/A DPL 100153-20 SUP Custom 27803010 DPL 100153-20 - COIL EMBL MIC 1.5MM 3CM DELTAPLUSH BOTH IP/OP "$2,545.00" "$1,883.00" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $530.32 "$2,544.60" "$1,017.84" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$1,908.75" "$2,544.60" "$2,544.60" "$2,544.60" "$1,272.30" "$1,272.30" "$2,015.32" "$2,544.60" "$2,035.68" "$1,145.07" "$2,544.60" N/A "$1,476.10" "$2,544.60" "$1,526.76" "$2,544.60" "$2,544.60" "$2,544.60" N/A N/A DPL 100202-20 SUP Custom 27803010 DPL 100202-20 - COIL EMBL 2MM 2CM DELTAPLUSH PLTN BOTH IP/OP "$2,545.00" "$1,883.00" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $530.32 "$2,544.60" "$1,017.84" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$1,908.75" "$2,544.60" "$2,544.60" "$2,544.60" "$1,272.30" "$1,272.30" "$2,015.32" "$2,544.60" "$2,035.68" "$1,145.07" "$2,544.60" N/A "$1,476.10" "$2,544.60" "$1,526.76" "$2,544.60" "$2,544.60" "$2,544.60" N/A N/A DPL 100203-20 SUP Custom 27803010 DPL 100203-20 - COIL EMBL 2MM 3CM DELTAPLUSH PLTN BOTH IP/OP "$2,545.00" "$1,883.00" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $530.32 "$2,544.60" "$1,017.84" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$1,908.75" "$2,544.60" "$2,544.60" "$2,544.60" "$1,272.30" "$1,272.30" "$2,015.32" "$2,544.60" "$2,035.68" "$1,145.07" "$2,544.60" N/A "$1,476.10" "$2,544.60" "$1,526.76" "$2,544.60" "$2,544.60" "$2,544.60" N/A N/A DPL 100204-20 SUP Custom 27803010 DPL 100204-20 - COIL EMBL 2MM 4CM DELTAPLUSH PLTN BOTH IP/OP "$2,545.00" "$1,883.00" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $530.32 "$2,544.60" "$1,017.84" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$1,908.75" "$2,544.60" "$2,544.60" "$2,544.60" "$1,272.30" "$1,272.30" "$2,015.32" "$2,544.60" "$2,035.68" "$1,145.07" "$2,544.60" N/A "$1,476.10" "$2,544.60" "$1,526.76" "$2,544.60" "$2,544.60" "$2,544.60" N/A N/A DPL 100206-20 SUP Custom 27803010 DPL 100206-20 - COIL EMBL 2MM 6CM DELTAPLUSH PLTN BOTH IP/OP "$2,545.00" "$1,883.00" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $530.32 "$2,544.60" "$1,017.84" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$1,908.75" "$2,544.60" "$2,544.60" "$2,544.60" "$1,272.30" "$1,272.30" "$2,015.32" "$2,544.60" "$2,035.68" "$1,145.07" "$2,544.60" N/A "$1,476.10" "$2,544.60" "$1,526.76" "$2,544.60" "$2,544.60" "$2,544.60" N/A N/A DPL10020120 SUP Custom 27803010 DPL10020120 - COIL EMBL 2MM 1CM DELTAPLUSH PLTN BOTH IP/OP "$2,545.00" "$1,883.00" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $452.94 "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" $530.32 "$2,544.60" "$1,017.84" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$2,544.60" "$1,908.75" "$2,544.60" "$2,544.60" "$2,544.60" "$1,272.30" "$1,272.30" "$2,015.32" "$2,544.60" "$2,035.68" "$1,145.07" "$2,544.60" N/A "$1,476.10" "$2,544.60" "$1,526.76" "$2,544.60" "$2,544.60" "$2,544.60" N/A N/A DRB1015 SUP Custom 27203010 DRB1015 - BIT DRILL 10MM BUD NONSTRL BOTH IP/OP $757.50 $561.00 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $134.84 $757.50 $757.50 $562.22 $562.22 $583.88 $394.66 $157.87 $757.50 $303.00 $757.50 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $492.38 $757.50 N/A $439.35 $757.50 $454.50 $757.50 $757.50 $757.50 N/A N/A DRB1115 SUP Custom 27203010 DRB1115 - DRILL SURG 50-60MM 11MM BUD FIX CANN POLARUS C-REAMER BOTH IP/OP $757.50 $561.00 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $134.84 $757.50 $757.50 $562.22 $562.22 $583.88 $394.66 $157.87 $757.50 $303.00 $757.50 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $492.38 $757.50 N/A $439.35 $757.50 $454.50 $757.50 $757.50 $757.50 N/A N/A DRILL BIT SUP HCPCS C1713 DRILL BIT - DRILL BIT 2.4MM QUICK COUPLING W/65MM STOP BOTH IP/OP $462.50 $342.00 $91.79 $462.50 $208.13 $208.13 $208.13 $208.13 $462.50 $462.50 $462.50 $96.40 $462.50 $462.50 $462.50 $462.50 $462.50 $96.39 $462.50 $185.00 $273.57 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $208.13 $91.79 N/A $268.25 $462.50 $277.50 $462.50 $96.39 $462.50 N/A N/A DRILL-1.6CL SUP Custom 27203010 DRILL-1.6CL - BIT DRILL 1.6MM TWISTED BOTH IP/OP $387.50 $287.00 $68.98 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $68.98 $387.50 $387.50 $287.60 $287.60 $298.69 $201.89 $80.76 $387.50 $155.00 $387.50 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $251.88 $387.50 N/A $224.75 $387.50 $232.50 $387.50 $387.50 $387.50 N/A N/A DRILL-1.75L SUP Custom 27203010 DRILL-1.75L - BIT DRL 1.75IN TWST BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A DRILL-2.00 SUP Custom 27203010 DRILL-2.00 - DRILL TWIST REGULAR 2MM BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A DRILL-2.00CL SUP Custom 27203010 DRILL-2.00CL - BIT DRILL LONG 3.2MM 2MM CANN TWIST BOTH IP/OP $387.50 $287.00 $68.98 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $68.98 $387.50 $387.50 $287.60 $287.60 $298.69 $201.89 $80.76 $387.50 $155.00 $387.50 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $251.88 $387.50 N/A $224.75 $387.50 $232.50 $387.50 $387.50 $387.50 N/A N/A DRILL-2.00L SUP Custom 27203010 DRILL-2.00L - DRILL TWIST LONG 2MM BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A DRILL-2.1/110C SUP Custom 27203010 DRILL-2.1/110C - DRILL SRG 2.1MM 110MM CNN TI BOTH IP/OP $412.50 $305.00 $73.43 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $73.43 $412.50 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $165.00 $412.50 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $412.50 N/A $239.25 $412.50 $247.50 $412.50 $412.50 $412.50 N/A N/A DRILL-2.1CL SUP Custom 27203010 DRILL-2.1CL - BIT DRILL 2.1MM SMALL HEADLESS SCREWS BOTH IP/OP $387.50 $287.00 $68.98 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $68.98 $387.50 $387.50 $287.60 $287.60 $298.69 $201.89 $80.76 $387.50 $155.00 $387.50 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $251.88 $387.50 N/A $224.75 $387.50 $232.50 $387.50 $387.50 $387.50 N/A N/A DRILL-2.3 SUP Custom 27203010 DRILL-2.3 - BIT DRL 2.3MM STRL BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A DRILL-2.3/080 SUP Custom 27203010 DRILL-2.3/080 - DRILL SRG 2.3MM 80MM NS LF REUSE BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $231.94 $231.94 $240.88 $162.81 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $203.13 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A DRILL-2.30 SUP Custom 27203010 DRILL-2.30 - BIT DRILL TWIST 2.3MM BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A DRILL-2.30L SUP Custom 27203010 DRILL-2.30L - BIT DRILL LONG TWIST 2.3MM BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A DRILL-2.4CL SUP Custom 27203010 DRILL-2.4CL - BIT DRILL 2.4MM GS BOTH IP/OP $387.50 $287.00 $68.98 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $68.98 $387.50 $387.50 $287.60 $287.60 $298.69 $201.89 $80.76 $387.50 $155.00 $387.50 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $251.88 $387.50 N/A $224.75 $387.50 $232.50 $387.50 $387.50 $387.50 N/A N/A DRILL-3.20L SUP Custom 27203010 DRILL-3.20L - DRILL TWIST 3.2MM NONCANNULATED BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A DRLL-PLS-20 SUP HCPCS C1713 DRLL-PLS-20 - DRILL SRG 2MM 40MM GEMINUS CNN PA LCK SCR BOTH IP/OP $250.00 $185.00 $49.62 $255.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $102.00 $147.88 $250.00 $255.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A DRLL-SSC-20040 SUP Custom 27203010 DRLL-SSC-20040 - DRILL SURG 2MM 40MM SOLID SIDE CUT GEMINUS NONSTRL BOTH IP/OP $275.00 $204.00 $48.95 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $48.95 $275.00 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $102.00 $275.00 $275.00 $255.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $275.00 N/A $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A DRLL-SSC-23040 SUP Custom 27203010 "DRLL-SSC-23040 - DRILL, 2.3MM x 40MM" BOTH IP/OP "$2,755.00" "$2,039.00" $102.00 "$2,755.00" "$2,755.00" "$2,755.00" "$2,755.00" "$2,755.00" "$2,755.00" "$2,755.00" $490.39 "$2,755.00" "$2,755.00" "$2,044.76" "$2,044.76" "$2,123.55" "$1,435.36" $574.17 "$2,755.00" $102.00 "$2,755.00" "$2,755.00" $255.00 "$2,755.00" "$2,755.00" "$2,066.25" "$2,755.00" "$2,755.00" "$2,755.00" "$1,377.50" "$1,377.50" "$2,181.96" "$2,755.00" "$2,204.00" "$1,790.75" "$2,755.00" N/A "$1,597.90" "$2,755.00" "$1,653.00" "$2,755.00" "$2,755.00" "$2,755.00" N/A N/A DRLL-SSC-25040 SUP Custom 27203010 DRLL-SSC-25040 - DRILL SURG 2.5MM 40MM SOLID SIDE CUT GEMINUS NONSTRL BOTH IP/OP $275.00 $204.00 $48.95 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $48.95 $275.00 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $102.00 $275.00 $275.00 $255.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $275.00 N/A $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A DRVR-AOS-PLS SUP Custom 27203010 DRVR-AOS-PLS - DRIVER SRG GEMINUS PA LCK SCR AO CNCT DISP BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 N/A $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A DRVR-AOS-S20 SUP Custom 27203010 DRVR-AOS-S20 - DRIVER SRG 2MM NS GEMINUS SQ TIP AO CNCT DISP BOTH IP/OP $207.50 $154.00 $36.94 $255.00 $207.50 $207.50 $207.50 $207.50 $207.50 $207.50 $36.94 $207.50 $207.50 $154.01 $154.01 $159.94 $108.11 $43.25 $207.50 $102.00 $207.50 $207.50 $255.00 $207.50 $207.50 $155.63 $207.50 $207.50 $207.50 $103.75 $103.75 $164.34 $207.50 $166.00 $134.88 $207.50 N/A $120.35 $207.50 $124.50 $207.50 $207.50 $207.50 N/A N/A DRVR-UQC-T10 SUP Custom 27203010 DRVR-UQC-T10 - DRIVER SRG 2MM NS GEMINUS T10 UNV QCK CNCT DISP BOTH IP/OP $237.50 $176.00 $42.28 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $237.50 $42.28 $237.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $95.00 $237.50 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $237.50 N/A $137.75 $237.50 $142.50 $237.50 $237.50 $237.50 N/A N/A DS2A003 SUP Custom 27203010 DS2A003 - SLITTER CATH UNV CPS ERG DSGN ACPT 4-6FR LD BOTH IP/OP $80.00 $59.00 $14.24 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $80.00 $14.24 $80.00 $80.00 $59.38 $59.38 $61.66 $41.68 $16.67 $80.00 $32.00 $80.00 $80.00 $80.00 $80.00 $80.00 $60.00 $80.00 $80.00 $80.00 $40.00 $40.00 $63.36 $80.00 $64.00 $52.00 $80.00 N/A $46.40 $80.00 $48.00 $80.00 $80.00 $80.00 N/A N/A DS2C002 SUP HCPCS C1893 DS2C002 - CATHETER GD 115D 9FR 47CM CPS DRCT SL II DRCT-TO-TRGT BRD BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 N/A $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A DS2N021/59 SUP HCPCS C1893 DS2N021/59 - CATHETER GD ACUTE CRV 7FR 59CM CPS AIM SL DRCT-TO-TRGT BOTH IP/OP $427.50 $316.00 $84.85 $427.50 $232.13 $232.13 $232.13 $232.13 $427.50 $427.50 $427.50 $89.10 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $427.50 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $84.85 N/A $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A DS2N021/65 SUP HCPCS C1887 DS2N021/65 - CATHETER GD ACUTE CRV 7FR 65CM CPS AIM SL DRCT-TO-TRGT BOTH IP/OP $427.50 $316.00 $84.85 $427.50 $232.13 $232.13 $232.13 $232.13 $427.50 $427.50 $427.50 $89.10 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $427.50 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $84.85 N/A $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A DS2N022/59 SUP HCPCS C1887 DS2N022/59 - CATHETER GUID 90D 7FR 5FR 59CM SLITTABLE INTEGRATED VALVE BOTH IP/OP $427.50 $316.00 $84.85 $427.50 $232.13 $232.13 $232.13 $232.13 $427.50 $427.50 $427.50 $89.10 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $427.50 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $84.85 N/A $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A DS2N022/65 SUP HCPCS C1887 DS2N022/65 - CATHETER GD 90D 7FR 65CM CPS AIM SL DRCT-TO-TRGT SLITTABLE BOTH IP/OP $427.50 $316.00 $84.85 $427.50 $232.13 $232.13 $232.13 $232.13 $427.50 $427.50 $427.50 $89.10 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $427.50 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $84.85 N/A $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A DS2N023/59 SUP HCPCS C1887 DS2N023/59 - CATHETER GD OBTUSE CRV 7FR 59CM CPS AIM SL DRCT-TO-TRGT BOTH IP/OP $427.50 $316.00 $84.85 $427.50 $232.13 $232.13 $232.13 $232.13 $427.50 $427.50 $427.50 $89.10 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $427.50 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $84.85 N/A $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A DS2N023/65 SUP HCPCS C1887 DS2N023/65 - CATHETER GUID OBTUSE CURVE 7FR 5FR 65CM SLITTABLE INTEGRATED BOTH IP/OP $427.50 $316.00 $84.85 $427.50 $232.13 $232.13 $232.13 $232.13 $427.50 $427.50 $427.50 $89.10 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $427.50 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $84.85 N/A $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A DS2N024/65 SUP HCPCS C1887 DS2N024/65 - CATHETER GD CSL CRV 7FR 65CM CPS AIM SL DRCT-TO-TRGT BOTH IP/OP $427.50 $316.00 $84.85 $427.50 $232.13 $232.13 $232.13 $232.13 $427.50 $427.50 $427.50 $89.10 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $427.50 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $84.85 N/A $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A DS2N025/65 SUP HCPCS C1887 DS2N025/65 - CATHETER GD ASII CRV 7FR 65CM CPS AIM SL DRCT-TO-TRGT BOTH IP/OP $427.50 $316.00 $84.85 $427.50 $232.13 $232.13 $232.13 $232.13 $427.50 $427.50 $427.50 $89.10 $427.50 $317.29 $317.29 $329.52 $222.73 $89.10 $427.50 $427.50 $252.87 $427.50 $427.50 $427.50 $427.50 $320.63 $427.50 $427.50 $427.50 $213.75 $213.75 $338.58 $427.50 $342.00 $277.88 $84.85 N/A $247.95 $427.50 $427.50 $427.50 $89.09 $427.50 N/A N/A DSF1833 SUP HCPCS C1894 DSF1833 - SHEATH INTRO 18FR 6.7MM 6MM 33CM GORE DRYSEAL FLX HDRPH BOTH IP/OP "$1,657.50" "$1,227.00" $328.97 "$1,740.00" $900.02 $900.02 $900.02 $900.02 "$1,657.50" "$1,657.50" "$1,657.50" $345.46 "$1,657.50" "$1,230.20" "$1,230.20" "$1,277.60" $863.56 $345.44 "$1,657.50" "$1,740.00" $980.41 "$1,657.50" "$1,740.00" "$1,657.50" "$1,657.50" "$1,243.13" "$1,657.50" "$1,657.50" "$1,657.50" $828.75 $828.75 "$1,312.74" "$1,657.50" "$1,326.00" "$1,077.38" $328.97 N/A $961.35 "$1,657.50" "$1,657.50" "$1,657.50" $345.42 "$1,657.50" N/A N/A DSF2433 SUP HCPCS C1894 DSF2433 - SHEATH INTRO 8.8MM 24FR 33CM GORE DRYSEAL FLX HDRPH BOTH IP/OP "$1,657.50" "$1,227.00" $328.97 "$1,740.00" $900.02 $900.02 $900.02 $900.02 "$1,657.50" "$1,657.50" "$1,657.50" $345.46 "$1,657.50" "$1,230.20" "$1,230.20" "$1,277.60" $863.56 $345.44 "$1,657.50" "$1,740.00" $980.41 "$1,657.50" "$1,740.00" "$1,657.50" "$1,657.50" "$1,243.13" "$1,657.50" "$1,657.50" "$1,657.50" $828.75 $828.75 "$1,312.74" "$1,657.50" "$1,326.00" "$1,077.38" $328.97 N/A $961.35 "$1,657.50" "$1,657.50" "$1,657.50" $345.42 "$1,657.50" N/A N/A DSL1228 SUP HCPCS C1894 DSL1228 - SHEATH INTRO 12FR 5MM 4.1MM 28CM DRYSEAL DIL VLV INFL SYR BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $373.31 $373.31 $373.31 $373.31 $687.50 $687.50 $687.50 $143.29 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A DSL1628 SUP HCPCS C1894 DSL1628 - SHEATH INTRO 16FR 6.2MM 5.3MM 28CM DRYSEAL DIL VLV INFL SYR BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $373.31 $373.31 $373.31 $373.31 $687.50 $687.50 $687.50 $143.29 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A DSL2628 SUP HCPCS C1894 DSL2628 - SHEATH INTROD 26FR 9.8MM 8.6MM 28CM DRYSEAL DILAT VALVE BOTH IP/OP $862.50 $638.00 $171.18 $862.50 $468.34 $468.34 $468.34 $468.34 $862.50 $862.50 $862.50 $179.77 $862.50 $640.15 $640.15 $664.82 $449.36 $179.75 $862.50 $862.50 $510.17 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $560.63 $171.18 N/A $500.25 $862.50 $862.50 $862.50 $179.75 $862.50 N/A N/A DTPC2D1 SUP HCPCS C1882 DTPC2D1 - DEFIBRILLATOR CRD CROME DF1 MR CONDITIONAL BOTH IP/OP "$42,385.00" "$31,365.00" "$7,712.84" "$42,385.00" "$19,073.25" "$19,073.25" "$19,073.25" "$19,073.25" "$42,385.00" "$42,385.00" "$42,385.00" "$8,834.09" "$42,385.00" "$42,385.00" "$42,385.00" "$42,385.00" "$42,385.00" "$8,833.50" "$42,385.00" "$33,750.00" "$20,895.81" "$42,385.00" "$33,750.00" "$42,385.00" "$42,385.00" "$31,788.75" "$42,385.00" "$42,385.00" "$42,385.00" "$21,192.50" "$21,192.50" "$33,568.92" "$42,385.00" "$33,908.00" "$19,073.25" "$7,712.84" N/A "$24,583.30" "$42,385.00" "$42,385.00" "$42,385.00" "$8,098.48" "$42,385.00" N/A N/A DUET4535A SUP Custom 27203010 DUET4535A - RELOAD STPLR 45MMX3.5MM STRL LF 1.5MM DUET TRS ARTC TISS BOTH IP/OP "$1,718.50" "$1,272.00" $305.84 "$1,718.23" "$1,718.23" "$1,718.23" "$1,718.23" "$1,718.23" "$1,718.23" "$1,718.23" $305.84 "$1,718.23" "$1,718.23" "$1,275.27" "$1,275.27" "$1,324.41" $895.20 $358.10 "$1,718.23" $687.29 "$1,718.23" "$1,718.23" "$1,718.23" "$1,718.23" "$1,718.23" "$1,288.88" "$1,718.23" "$1,718.23" "$1,718.23" $859.12 $859.12 "$1,360.84" "$1,718.23" "$1,374.58" "$1,116.85" "$1,718.23" N/A $996.73 "$1,718.23" "$1,030.94" "$1,718.23" "$1,718.23" "$1,718.23" N/A N/A DUET4548A SUP Custom 27203010 DUET4548A - RELOAD STPLR 45MMX4.8MM STRL LF 2MM DUET TRS ARTC TISS DISP BOTH IP/OP "$1,909.50" "$1,413.00" $339.83 "$1,909.14" "$1,909.14" "$1,909.14" "$1,909.14" "$1,909.14" "$1,909.14" "$1,909.14" $339.83 "$1,909.14" "$1,909.14" "$1,416.96" "$1,416.96" "$1,471.57" $994.66 $397.89 "$1,909.14" $763.66 "$1,909.14" "$1,909.14" "$1,909.14" "$1,909.14" "$1,909.14" "$1,432.13" "$1,909.14" "$1,909.14" "$1,909.14" $954.57 $954.57 "$1,512.04" "$1,909.14" "$1,527.31" "$1,240.94" "$1,909.14" N/A "$1,107.51" "$1,909.14" "$1,145.48" "$1,909.14" "$1,909.14" "$1,909.14" N/A N/A DUET6035A SUP Custom 27203010 DUET6035A - RELOAD STPLR 60MMX3.5MM STRL LF 1.5MM DUET TRS ARTC TISS BOTH IP/OP "$1,868.00" "$1,382.00" $332.43 "$1,867.59" "$1,867.59" "$1,867.59" "$1,867.59" "$1,867.59" "$1,867.59" "$1,867.59" $332.43 "$1,867.59" "$1,867.59" "$1,386.13" "$1,386.13" "$1,439.54" $973.01 $389.23 "$1,867.59" $747.04 "$1,867.59" "$1,867.59" "$1,867.59" "$1,867.59" "$1,867.59" "$1,401.00" "$1,867.59" "$1,867.59" "$1,867.59" $933.80 $933.80 "$1,479.13" "$1,867.59" "$1,494.07" "$1,213.93" "$1,867.59" N/A "$1,083.44" "$1,867.59" "$1,120.55" "$1,867.59" "$1,867.59" "$1,867.59" N/A N/A DUET6048A SUP Custom 27203010 DUET6048A - RELOAD STPLR 60MMX4.8MM STRL LF 2MM DUET TRS ARTC TISS DISP BOTH IP/OP "$11,206.00" "$8,292.00" "$1,994.59" "$11,205.54" "$11,205.54" "$11,205.54" "$11,205.54" "$11,205.54" "$11,205.54" "$11,205.54" "$1,994.59" "$11,205.54" "$11,205.54" "$4,181.12" "$4,181.12" "$8,637.23" "$2,060.15" "$2,335.36" "$11,205.54" "$4,482.22" "$11,205.54" "$11,205.54" "$11,205.54" "$11,205.54" "$11,205.54" "$8,404.50" "$11,205.54" "$11,205.54" "$11,205.54" "$5,602.77" "$5,602.77" "$8,874.79" "$11,205.54" "$8,964.43" "$7,283.60" "$11,205.54" N/A "$6,499.48" "$11,205.54" "$6,723.32" "$11,205.54" "$11,205.54" "$11,205.54" N/A N/A DUR1000D SUP Custom 27011340 DUR1000D - FIBER LASER 1000UM HOLMIUM DISPOSABLE BOTH IP/OP "$2,794.50" "$2,068.00" $497.38 "$2,794.28" "$2,794.28" "$2,794.28" "$2,794.28" "$2,794.28" "$2,794.28" "$2,794.28" $497.38 "$2,794.28" "$2,794.28" "$2,073.91" "$2,073.91" "$2,153.83" "$1,455.82" $582.36 "$2,794.28" "$1,117.71" "$2,794.28" "$2,794.28" "$2,794.28" "$2,794.28" "$2,794.28" "$2,095.88" "$2,794.28" "$2,794.28" "$2,794.28" "$1,397.14" "$1,397.14" "$2,213.07" "$2,794.28" "$2,235.42" "$1,816.28" "$2,794.28" N/A "$1,620.81" "$2,794.28" "$1,676.57" "$2,794.28" "$2,794.28" "$2,794.28" N/A N/A DUR270D SUP Custom 27011340 DUR270D - LASER FIBER_ 270 MICRON BOTH IP/OP "$1,267.00" $938.00 $225.47 "$1,266.67" "$1,266.67" "$1,266.67" "$1,266.67" "$1,266.67" "$1,266.67" "$1,266.67" $225.47 "$1,266.67" "$1,266.67" $940.12 $940.12 $976.35 $659.94 $263.99 "$1,266.67" $506.67 "$1,266.67" "$1,266.67" "$1,266.67" "$1,266.67" "$1,266.67" $950.25 "$1,266.67" "$1,266.67" "$1,266.67" $633.34 $633.34 "$1,003.20" "$1,266.67" "$1,013.34" $823.34 "$1,266.67" N/A $734.86 "$1,266.67" $760.00 "$1,266.67" "$1,266.67" "$1,266.67" N/A N/A DUR400D SUP Custom 27011340 DUR400D - LASER FIBER_ 400 MICRON BOTH IP/OP "$1,267.00" $938.00 $225.47 "$1,266.67" "$1,266.67" "$1,266.67" "$1,266.67" "$1,266.67" "$1,266.67" "$1,266.67" $225.47 "$1,266.67" "$1,266.67" $940.12 $940.12 $976.35 $659.94 $263.99 "$1,266.67" $506.67 "$1,266.67" "$1,266.67" "$1,266.67" "$1,266.67" "$1,266.67" $950.25 "$1,266.67" "$1,266.67" "$1,266.67" $633.34 $633.34 "$1,003.20" "$1,266.67" "$1,013.34" $823.34 "$1,266.67" N/A $734.86 "$1,266.67" $760.00 "$1,266.67" "$1,266.67" "$1,266.67" N/A N/A DUR400DBX SUP Custom 27011340 DUR400DBX - FIBER LSR 400UM STRL DUR HO DISP LTHTRP BOTH IP/OP "$1,074.50" $795.00 $191.22 "$1,074.28" "$1,074.28" "$1,074.28" "$1,074.28" "$1,074.28" "$1,074.28" "$1,074.28" $191.22 "$1,074.28" "$1,074.28" $797.33 $797.33 $828.06 $559.70 $223.89 "$1,074.28" $429.71 "$1,074.28" "$1,074.28" "$1,074.28" "$1,074.28" "$1,074.28" $805.88 "$1,074.28" "$1,074.28" "$1,074.28" $537.14 $537.14 $850.83 "$1,074.28" $859.42 $698.28 "$1,074.28" N/A $623.21 "$1,074.28" $644.57 "$1,074.28" "$1,074.28" "$1,074.28" N/A N/A DUR600D SUP Custom 27011340 DUR600D - LASER FIBER_ 600 MICRON BOTH IP/OP "$1,475.00" "$1,092.00" $262.55 "$1,475.00" "$1,475.00" "$1,475.00" "$1,475.00" "$1,475.00" "$1,475.00" "$1,475.00" $262.55 "$1,475.00" "$1,475.00" "$1,094.75" "$1,094.75" "$1,136.93" $768.48 $307.41 "$1,475.00" $590.00 "$1,475.00" "$1,475.00" "$1,475.00" "$1,475.00" "$1,475.00" "$1,106.25" "$1,475.00" "$1,475.00" "$1,475.00" $737.50 $737.50 "$1,168.20" "$1,475.00" "$1,180.00" $958.75 "$1,475.00" N/A $855.50 "$1,475.00" $885.00 "$1,475.00" "$1,475.00" "$1,475.00" N/A N/A DUR600DBX SUP Custom 27011340 DUR600DBX - FIBER LSR 600UM STRL DUR HO DISP LTHTRP BOTH IP/OP "$1,254.50" $928.00 $223.24 "$1,254.17" "$1,254.17" "$1,254.17" "$1,254.17" "$1,254.17" "$1,254.17" "$1,254.17" $223.24 "$1,254.17" "$1,254.17" $930.84 $930.84 $966.71 $653.42 $261.38 "$1,254.17" $501.67 "$1,254.17" "$1,254.17" "$1,254.17" "$1,254.17" "$1,254.17" $940.88 "$1,254.17" "$1,254.17" "$1,254.17" $627.09 $627.09 $993.30 "$1,254.17" "$1,003.34" $815.21 "$1,254.17" N/A $727.61 "$1,254.17" $752.50 "$1,254.17" "$1,254.17" "$1,254.17" N/A N/A DURS3391 SUP Custom 27803010 DURS3391 - GRAFT SOFT TISSUE 3X3IN PATCH RESORB SUTURABLE DURAGEN BOTH IP/OP "$2,685.00" "$1,987.00" $477.88 "$2,684.70" "$2,684.70" "$2,684.70" "$2,684.70" "$2,684.70" "$2,684.70" "$2,684.70" $477.88 "$2,684.70" "$2,684.70" "$2,684.70" "$2,684.70" "$2,684.70" "$2,684.70" $559.52 "$2,684.70" "$1,073.88" "$2,684.70" "$2,684.70" "$2,684.70" "$2,684.70" "$2,684.70" "$2,013.75" "$2,684.70" "$2,684.70" "$2,684.70" "$1,342.35" "$1,342.35" "$2,126.28" "$2,684.70" "$2,147.76" "$1,208.12" "$2,684.70" N/A "$1,557.30" "$2,684.70" "$1,610.82" "$2,684.70" "$2,684.70" "$2,684.70" N/A N/A DVPB3D4 SUP HCPCS C1722 DVPB3D4 - DEFIBRILLATOR CRD CBLT VR DF4 MR CONDITIONAL BOTH IP/OP "$27,685.00" "$20,487.00" "$5,494.78" "$27,685.00" "$12,458.25" "$12,458.25" "$12,458.25" "$12,458.25" "$27,685.00" "$27,685.00" "$27,685.00" "$5,770.25" "$27,685.00" "$27,685.00" "$27,685.00" "$27,685.00" "$27,685.00" "$5,769.86" "$27,685.00" "$22,000.00" "$13,648.71" "$27,685.00" "$22,000.00" "$27,685.00" "$27,685.00" "$20,763.75" "$27,685.00" "$27,685.00" "$27,685.00" "$13,842.50" "$13,842.50" "$21,926.52" "$27,685.00" "$22,148.00" "$12,458.25" "$5,494.78" N/A "$16,057.30" "$27,685.00" "$27,685.00" "$27,685.00" "$5,769.55" "$27,685.00" N/A N/A DVR-AXXL SUP HCPCS C1713 DVR-AXXL - PLATE X XTD DVR BONE LEFT DISTAL VOLR RADL STRL BOTH IP/OP "$3,865.00" "$2,860.00" $767.11 "$3,865.00" "$1,739.25" "$1,739.25" "$1,739.25" "$1,739.25" "$3,865.00" "$3,865.00" "$3,865.00" $805.56 "$3,865.00" "$3,865.00" "$3,865.00" "$3,865.00" "$3,865.00" $805.51 "$3,865.00" "$1,546.00" "$1,905.45" "$3,865.00" "$3,865.00" "$3,865.00" "$3,865.00" "$2,898.75" "$3,865.00" "$3,865.00" "$3,865.00" "$1,932.50" "$1,932.50" "$3,061.08" "$3,865.00" "$3,092.00" "$1,739.25" $767.11 N/A "$2,241.70" "$3,865.00" "$2,319.00" "$3,865.00" $805.47 "$3,865.00" N/A N/A DWB172 SUP HCPCS C1776 DWB172 - STEM HUMERAL 25IN 9MM 130MM BONE GROWTH AEQUALIS CEMENTED BOTH IP/OP "$10,685.00" "$7,907.00" "$2,120.71" "$10,685.00" "$4,808.25" "$4,808.25" "$4,808.25" "$4,808.25" "$10,685.00" "$10,685.00" "$10,685.00" "$2,227.02" "$10,685.00" "$10,685.00" "$10,685.00" "$10,685.00" "$10,685.00" "$2,226.87" "$10,685.00" "$10,685.00" "$5,267.71" "$10,685.00" "$10,685.00" "$10,685.00" "$10,685.00" "$8,013.75" "$10,685.00" "$10,685.00" "$10,685.00" "$5,342.50" "$5,342.50" "$8,462.52" "$10,685.00" "$8,548.00" "$4,808.25" "$2,120.71" N/A "$6,197.30" "$10,685.00" "$10,685.00" "$10,685.00" "$2,226.75" "$10,685.00" N/A N/A DWB173 SUP HCPCS C1776 DWB173 - STEM HUMERAL 130D 12MM 130MM MONOBLOCK CEMENT AEQUALIS BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$1,686.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$4,215.00" "$4,215.00" $878.41 "$4,215.00" N/A N/A DWB243 SUP HCPCS C1776 DWB243 - HEAD HUMERAL CALOTTE HUMERALE BOTH IP/OP "$4,215.00" "$3,119.00" $836.57 "$4,215.00" "$1,896.75" "$1,896.75" "$1,896.75" "$1,896.75" "$4,215.00" "$4,215.00" "$4,215.00" $878.51 "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" $878.45 "$4,215.00" "$4,215.00" "$2,078.00" "$4,215.00" "$4,215.00" "$4,215.00" "$4,215.00" "$3,161.25" "$4,215.00" "$4,215.00" "$4,215.00" "$2,107.50" "$2,107.50" "$3,338.28" "$4,215.00" "$3,372.00" "$1,896.75" $836.57 N/A "$2,444.70" "$4,215.00" "$4,215.00" "$4,215.00" $878.41 "$4,215.00" N/A N/A DWB252 SUP HCPCS C1776 DWB252 - HEAD HUM 52MM 19MM AQLS CMNT PVRS TI SHLDR BOTH IP/OP "$17,125.00" "$12,673.00" "$3,398.88" "$17,125.00" "$7,706.25" "$7,706.25" "$7,706.25" "$7,706.25" "$17,125.00" "$17,125.00" "$17,125.00" "$3,569.28" "$17,125.00" "$17,125.00" "$17,125.00" "$17,125.00" "$17,125.00" "$3,569.04" "$17,125.00" "$6,850.00" "$8,442.63" "$17,125.00" "$17,125.00" "$17,125.00" "$17,125.00" "$12,843.75" "$17,125.00" "$17,125.00" "$17,125.00" "$8,562.50" "$8,562.50" "$13,563.00" "$17,125.00" "$13,700.00" "$7,706.25" "$3,398.88" N/A "$9,932.50" "$17,125.00" "$17,125.00" "$17,125.00" "$3,568.85" "$17,125.00" N/A N/A DWB253 SUP HCPCS C1776 DWB253 - HEAD HUMERAL 52MM 23MM CEMENTED REVERSED AEQUALIS TITANIUM BOTH IP/OP "$10,685.00" "$7,907.00" "$2,120.71" "$10,685.00" "$4,808.25" "$4,808.25" "$4,808.25" "$4,808.25" "$10,685.00" "$10,685.00" "$10,685.00" "$2,227.02" "$10,685.00" "$10,685.00" "$10,685.00" "$10,685.00" "$10,685.00" "$2,226.87" "$10,685.00" "$4,274.00" "$5,267.71" "$10,685.00" "$10,685.00" "$10,685.00" "$10,685.00" "$8,013.75" "$10,685.00" "$10,685.00" "$10,685.00" "$5,342.50" "$5,342.50" "$8,462.52" "$10,685.00" "$8,548.00" "$4,808.25" "$2,120.71" N/A "$6,197.30" "$10,685.00" "$10,685.00" "$10,685.00" "$2,226.75" "$10,685.00" N/A N/A DWD020 SUP HCPCS C1713 DWD020 - SCREW BSPLT 20MM 4.5MM AQLS GLND TI LOCK MLDIR ST BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $165.00 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A DWD023 SUP HCPCS C1713 DWD023 - SCREW BSPLT 23MM 4.5MM AQLS GLND TI LOCK MLDIR ST BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $165.00 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $247.50 $412.50 $85.97 $412.50 N/A N/A DWD029 SUP HCPCS C1713 DWD029 - SCREW BSPLT 29MM 4.5MM AQLS GLND TI LOCK MLDIR ST BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $165.00 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A DWD055 SUP Custom 27203010 DWD055 - BIT DRL 3MM STRL DISP BOTH IP/OP $342.50 $253.00 $60.97 $342.50 $342.50 $342.50 $342.50 $342.50 $342.50 $342.50 $60.97 $342.50 $342.50 $254.20 $254.20 $264.00 $178.44 $71.38 $342.50 $137.00 $342.50 $342.50 $342.50 $342.50 $342.50 $256.88 $342.50 $342.50 $342.50 $171.25 $171.25 $271.26 $342.50 $274.00 $222.63 $342.50 N/A $198.65 $342.50 $205.50 $342.50 $342.50 $342.50 N/A N/A DWD180 SUP HCPCS C1776 DWD180 - SPHERE GLND 36MM AQLS CRCO RVRS CNTR 25MM BSPLT BOTH IP/OP "$8,312.50" "$6,151.00" "$1,649.82" "$8,312.50" "$3,740.63" "$3,740.63" "$3,740.63" "$3,740.63" "$8,312.50" "$8,312.50" "$8,312.50" "$1,732.53" "$8,312.50" "$8,312.50" "$8,312.50" "$8,312.50" "$8,312.50" "$1,732.42" "$8,312.50" "$3,325.00" "$4,098.06" "$8,312.50" "$8,312.50" "$8,312.50" "$8,312.50" "$6,234.38" "$8,312.50" "$8,312.50" "$8,312.50" "$4,156.25" "$4,156.25" "$6,583.50" "$8,312.50" "$6,650.00" "$3,740.63" "$1,649.82" N/A "$4,821.25" "$8,312.50" "$8,312.50" "$8,312.50" "$1,732.33" "$8,312.50" N/A N/A DWD860 SUP HCPCS C1776 DWD860 - INSERT HUM 36MM AQLS 6MM SHLDR LAT PVRS ADPR FRAC BOTH IP/OP "$4,507.50" "$3,336.00" $894.63 "$4,507.50" "$2,028.38" "$2,028.38" "$2,028.38" "$2,028.38" "$4,507.50" "$4,507.50" "$4,507.50" $939.48 "$4,507.50" "$4,507.50" "$4,507.50" "$4,507.50" "$4,507.50" $939.41 "$4,507.50" "$1,803.00" "$2,222.20" "$4,507.50" "$4,507.50" "$4,507.50" "$4,507.50" "$3,380.63" "$4,507.50" "$4,507.50" "$4,507.50" "$2,253.75" "$2,253.75" "$3,569.94" "$4,507.50" "$3,606.00" "$2,028.38" $894.63 N/A "$2,614.35" "$4,507.50" "$4,507.50" "$4,507.50" $939.36 "$4,507.50" N/A N/A DWD861 SUP HCPCS C1776 DWD861 - INSERT HUM 36MM AQLS +9MM LAT RVRS ADPR FRAC PRIM BOTH IP/OP "$4,507.50" "$3,336.00" $894.63 "$4,507.50" "$2,028.38" "$2,028.38" "$2,028.38" "$2,028.38" "$4,507.50" "$4,507.50" "$4,507.50" $939.48 "$4,507.50" "$4,507.50" "$4,507.50" "$4,507.50" "$4,507.50" $939.41 "$4,507.50" "$4,507.50" "$2,222.20" "$4,507.50" "$4,507.50" "$4,507.50" "$4,507.50" "$3,380.63" "$4,507.50" "$4,507.50" "$4,507.50" "$2,253.75" "$2,253.75" "$3,569.94" "$4,507.50" "$3,606.00" "$2,028.38" $894.63 N/A "$2,614.35" "$4,507.50" "$4,507.50" "$4,507.50" $939.36 "$4,507.50" N/A N/A DWD901 SUP HCPCS C1776 DWD901 - STEM HUM 130MM 7MM PVRS FRAC AQLS SHLDR BOTH IP/OP "$13,975.00" "$10,342.00" "$2,773.69" "$13,975.00" "$6,288.75" "$6,288.75" "$6,288.75" "$6,288.75" "$13,975.00" "$13,975.00" "$13,975.00" "$2,912.74" "$13,975.00" "$13,975.00" "$13,975.00" "$13,975.00" "$13,975.00" "$2,912.54" "$13,975.00" "$13,975.00" "$6,889.68" "$13,975.00" "$13,975.00" "$13,975.00" "$13,975.00" "$10,481.25" "$13,975.00" "$13,975.00" "$13,975.00" "$6,987.50" "$6,987.50" "$11,068.20" "$13,975.00" "$11,180.00" "$6,288.75" "$2,773.69" N/A "$8,105.50" "$13,975.00" "$13,975.00" "$13,975.00" "$2,912.39" "$13,975.00" N/A N/A DX-22-100 SUP Custom 27203010 DX-22-100 - SYSTEM SPNL FX DTRAX BOTH IP/OP "$2,125.00" "$1,573.00" $378.25 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $378.25 "$2,125.00" "$2,125.00" "$1,577.18" "$1,577.18" "$1,637.95" "$1,107.13" $442.87 "$2,125.00" $850.00 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" "$1,381.25" "$2,125.00" N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" "$2,125.00" "$2,125.00" N/A N/A DYND11216 SUP HCPCS A4344 DYND11216 - CATHETER URETHRAL 16FR FOLEY 2 WAY MEDIUM OLIVE COUDE TIP 1 BOTH IP/OP $11.50 $9.00 $2.21 $11.16 $6.06 $6.06 $6.06 $6.06 $11.16 $11.16 $11.16 $2.33 $11.16 $8.28 $8.28 $8.60 $5.81 $2.33 $11.16 $8.91 $6.60 $11.16 $8.91 $11.16 $11.16 $8.63 $11.16 $11.16 $11.16 $5.58 $5.58 $8.84 $11.16 $8.93 $7.25 $2.21 N/A $6.67 $11.16 $11.16 $11.16 $2.33 $11.16 N/A N/A DYND11501 SUP Custom 27203010 DYND11501 - CATHETER URTH 14FR 10ML BLU STRP CLR STRL LF DOV FL 2W LG BOTH IP/OP $10.00 $7.00 $1.78 $11.03 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.41 $10.00 $10.00 $11.03 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 N/A $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A DYND11502 SUP HCPCS A4344 DYND11502 - CATHETER URTH 16FR 10ML BLU STRP CLR STRL LF DOV FL 2W LG BOTH IP/OP $10.00 $7.00 $1.98 $11.03 $5.43 $5.43 $5.43 $5.43 $10.00 $10.00 $10.00 $2.08 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $11.03 $5.92 $10.00 $11.03 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $1.98 N/A $5.80 $10.00 $10.00 $10.00 $2.08 $10.00 N/A N/A DYND11503 SUP Custom 27203010 DYND11503 - CATHETER URTH 18FR 10ML BLU STRP CLR STRL LF DOV FL 2W LG BOTH IP/OP $10.00 $7.00 $1.78 $11.03 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.41 $10.00 $10.00 $11.03 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 N/A $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A DYND11505 SUP Custom 27203010 DYND11505 - CATHETER URTH 22FR 10ML BLU STRP CLR STRL LF DOV FL 2W LG BOTH IP/OP $10.00 $7.00 $1.78 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $1.78 $10.00 $10.00 $7.42 $7.42 $7.71 $5.21 $2.08 $10.00 $4.00 $10.00 $10.00 $10.00 $10.00 $10.00 $7.50 $10.00 $10.00 $10.00 $5.00 $5.00 $7.92 $10.00 $8.00 $6.50 $10.00 N/A $5.80 $10.00 $6.00 $10.00 $10.00 $10.00 N/A N/A DYND11532 SUP Custom 27203010 DYND11532 - CATHETER URTH 16FR 30ML BLU STRP CLR STRL LF DOV FL 2W LG BOTH IP/OP $11.00 $8.00 $1.91 $11.84 $10.75 $10.75 $10.75 $10.75 $10.75 $10.75 $1.91 $10.75 $10.75 $7.98 $7.98 $8.29 $5.60 $2.24 $10.75 $4.74 $10.75 $10.75 $11.84 $10.75 $10.75 $8.25 $10.75 $10.75 $10.75 $5.38 $5.38 $8.51 $10.75 $8.60 $6.99 $10.75 N/A $6.38 $10.75 $6.45 $10.75 $10.75 $10.75 N/A N/A DYND11534 SUP Custom 27203010 DYND11534 - CATHETER URTH 20FR 30ML BLU STRP CLR STRL LF DOV FL 2W LG BOTH IP/OP $11.00 $8.00 $1.91 $10.75 $10.75 $10.75 $10.75 $10.75 $10.75 $10.75 $1.91 $10.75 $10.75 $7.98 $7.98 $8.29 $5.60 $2.24 $10.75 $4.30 $10.75 $10.75 $10.75 $10.75 $10.75 $8.25 $10.75 $10.75 $10.75 $5.38 $5.38 $8.51 $10.75 $8.60 $6.99 $10.75 N/A $6.38 $10.75 $6.45 $10.75 $10.75 $10.75 N/A N/A DYND11535 SUP Custom 27203010 DYND11535 - CATHETER URTH 22FR 30ML BLU STRP CLR STRL LF DOV FL 2W LG BOTH IP/OP $11.00 $8.00 $1.91 $10.75 $10.75 $10.75 $10.75 $10.75 $10.75 $10.75 $1.91 $10.75 $10.75 $7.98 $7.98 $8.29 $5.60 $2.24 $10.75 $4.30 $10.75 $10.75 $10.75 $10.75 $10.75 $8.25 $10.75 $10.75 $10.75 $5.38 $5.38 $8.51 $10.75 $8.60 $6.99 $10.75 N/A $6.38 $10.75 $6.45 $10.75 $10.75 $10.75 N/A N/A DYND11554 SUP Custom 27203010 DYND11554 - CATHETER URTH 10FR 3ML LF FL 2W LG SMTH DRN EYE FIRM TIP SIL BOTH IP/OP $13.50 $10.00 $2.36 $13.28 $13.28 $13.28 $13.28 $13.28 $13.28 $13.28 $2.36 $13.28 $13.28 $9.86 $9.86 $10.24 $6.92 $2.77 $13.28 $5.31 $13.28 $13.28 $13.28 $13.28 $13.28 $10.13 $13.28 $13.28 $13.28 $6.64 $6.64 $10.52 $13.28 $10.62 $8.63 $13.28 N/A $7.83 $13.28 $7.97 $13.28 $13.28 $13.28 N/A N/A DYND13522 SUP HCPCS A4351 DYND13522 - CATHETER URETHRAL 22FR 16IN 2 OVAL EYE INTERMITTENT RADIOPQ BOTH IP/OP $2.00 $1.00 $0.33 $1.65 $0.90 $0.90 $0.90 $0.90 $1.65 $1.65 $1.65 $0.34 $1.65 $1.22 $1.22 $1.27 $0.86 $0.34 $1.65 $1.65 $0.98 $1.65 $1.65 $1.65 $1.65 $1.50 $1.65 $1.65 $1.65 $0.83 $0.83 $1.31 $1.65 $1.32 $1.07 $0.33 N/A $1.16 $1.65 $1.65 $1.65 $0.34 $1.65 N/A N/A DYNJ69767 SUP Custom 27203010 DYNJ69767 - OPEN HEART PACK BOTH IP/OP "$2,416.00" "$1,788.00" $429.99 "$2,415.65" "$2,415.65" "$2,415.65" "$2,415.65" "$2,415.65" "$2,415.65" "$2,415.65" $429.99 "$2,415.65" "$2,415.65" "$1,792.90" "$1,792.90" "$1,861.98" "$1,258.55" $503.45 "$2,415.65" $501.90 "$2,415.65" "$2,415.65" "$1,246.03" "$2,415.65" "$2,415.65" "$1,812.00" "$2,415.65" "$2,415.65" "$2,415.65" "$1,207.83" "$1,207.83" "$1,913.19" "$2,415.65" "$1,932.52" "$1,570.17" "$2,415.65" N/A "$1,401.28" "$2,415.65" "$1,449.39" "$2,415.65" "$2,415.65" "$2,415.65" N/A N/A E05021 SUP Custom 27203010 E05021 - ADAPTER ESURG UNV STRL VLAB MNPLR FTSWTCH DISP ACPT 3.2- MM BOTH IP/OP $98.00 $73.00 $17.41 $97.83 $97.83 $97.83 $97.83 $97.83 $97.83 $97.83 $17.41 $97.83 $97.83 $72.61 $72.61 $75.41 $50.97 $20.39 $97.83 $39.13 $97.83 $97.83 $97.83 $97.83 $97.83 $73.50 $97.83 $97.83 $97.83 $48.92 $48.92 $77.48 $97.83 $78.26 $63.59 $97.83 N/A $56.84 $97.83 $58.70 $97.83 $97.83 $97.83 N/A N/A E100-21A-00 SUP Custom 27803010 E100-21A-00 - VALVE AORTIC 21MM 19MM 14MM BIOPROSTHESIS STENTED SEWING BOTH IP/OP "$15,000.00" "$11,100.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$15,000.00" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$15,000.00" "$15,000.00" N/A N/A E100-23A-00 SUP Custom 27803010 E100-23A-00 - VALVE AOR 23MM 21MM 15MM EP LINX BPRTH STNT SW CUF PLSTR SUP BOTH IP/OP "$15,000.00" "$11,100.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$15,000.00" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$15,000.00" "$15,000.00" N/A N/A E100-25A-00 SUP Custom 27803010 E100-25A-00 - VALVE AORTIC 25MM 23MM 16MM BIOPROSTHESIS STENTED SEWING BOTH IP/OP "$15,000.00" "$11,100.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$15,000.00" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$15,000.00" "$15,000.00" N/A N/A E100-25M-00 SUP Custom 27803010 E100-25M-00 - VALVE MTRL 25MM 23MM 16MM EP FLEXFIT BPRTH STNT HLDR LOPRFL BOTH IP/OP "$23,350.00" "$17,279.00" "$4,156.30" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$4,156.30" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$4,866.40" "$23,350.00" "$9,340.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$23,350.00" "$17,512.50" "$23,350.00" "$23,350.00" "$23,350.00" "$11,675.00" "$11,675.00" "$18,493.20" "$23,350.00" "$18,680.00" "$10,507.50" "$23,350.00" N/A "$13,543.00" "$23,350.00" "$14,010.00" "$23,350.00" "$23,350.00" "$23,350.00" N/A N/A E100-27A-00 SUP Custom 27803010 E100-27A-00 - VALVE AOR 27MM 25MM 17MM EP LINX BPRTH STNT SW CUF PLSTR SUP BOTH IP/OP "$15,000.00" "$11,100.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$15,000.00" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$15,000.00" "$15,000.00" N/A N/A E100-27M-00 SUP Custom 27803010 E100-27M-00 - VALVE MTRL LOPRFL 25MM 23MM 16MM EP FLEXFIT BPRTH STNT HLDR BOTH IP/OP "$15,500.00" "$11,470.00" "$2,759.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$2,759.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$3,230.37" "$15,500.00" "$6,200.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$11,625.00" "$15,500.00" "$15,500.00" "$15,500.00" "$7,750.00" "$7,750.00" "$12,276.00" "$15,500.00" "$12,400.00" "$6,975.00" "$15,500.00" N/A "$8,990.00" "$15,500.00" "$9,300.00" "$15,500.00" "$15,500.00" "$15,500.00" N/A N/A E100-29A-00 SUP Custom 27803010 E100-29A-00 - VALVE AORTIC LP 29MM 27MM 19MM BIOPROSTHESIS STENT SEWING BOTH IP/OP "$15,000.00" "$11,100.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$15,000.00" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$15,000.00" "$15,000.00" N/A N/A E100-29M-00 SUP Custom 27803010 E100-29M-00 - VALVE MTRL 29MM 27MM 19MM LF 10MM EP LINX BIOCOR FLEXFIT BOTH IP/OP "$15,500.00" "$11,470.00" "$2,759.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$2,759.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$3,230.37" "$15,500.00" "$6,200.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$11,625.00" "$15,500.00" "$15,500.00" "$15,500.00" "$7,750.00" "$7,750.00" "$12,276.00" "$15,500.00" "$12,400.00" "$6,975.00" "$15,500.00" N/A "$8,990.00" "$15,500.00" "$9,300.00" "$15,500.00" "$15,500.00" "$15,500.00" N/A N/A E100-31M-00 SUP Custom 27803010 E100-31M-00 - VALVE MTRL 31MM 29MM 20MM STRL LF EP FLEXFIT BPRTH STNT HLDR BOTH IP/OP "$15,500.00" "$11,470.00" "$2,759.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$2,759.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$3,230.37" "$15,500.00" "$6,200.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$11,625.00" "$15,500.00" "$15,500.00" "$15,500.00" "$7,750.00" "$7,750.00" "$12,276.00" "$15,500.00" "$12,400.00" "$6,975.00" "$15,500.00" N/A "$8,990.00" "$15,500.00" "$9,300.00" "$15,500.00" "$15,500.00" "$15,500.00" N/A N/A E100-33M-00 SUP Custom 27803010 E100-33M-00 - VALVE MTRL 33MM 41MM 31MM 20MM STRL EP FLEXFIT BPRTH STNT BOTH IP/OP "$15,500.00" "$11,470.00" "$2,759.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$2,759.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$3,230.37" "$15,500.00" "$6,200.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$15,500.00" "$11,625.00" "$15,500.00" "$15,500.00" "$15,500.00" "$7,750.00" "$7,750.00" "$12,276.00" "$15,500.00" "$12,400.00" "$6,975.00" "$15,500.00" N/A "$8,990.00" "$15,500.00" "$9,300.00" "$15,500.00" "$15,500.00" "$15,500.00" N/A N/A E1457 SUP Custom 27203010 E1457 - ELECTRODE ELECTROSURGICAL 45D 178MM NEEDLE SLEEVE BOTH IP/OP $282.50 $209.00 $50.29 $282.50 $282.50 $282.50 $282.50 $282.50 $282.50 $282.50 $50.29 $282.50 $282.50 $209.67 $209.67 $217.75 $147.18 $58.88 $282.50 $113.00 $282.50 $282.50 $282.50 $282.50 $282.50 $211.88 $282.50 $282.50 $282.50 $141.25 $141.25 $223.74 $282.50 $226.00 $183.63 $282.50 N/A $163.85 $282.50 $169.50 $282.50 $282.50 $282.50 N/A N/A E2530-6 SUP Custom 27203010 E2530-6 - ELECTRODE ELECTROSURGICAL 6IN HANDSET COAGULATION FLEXIBLE BOTH IP/OP $649.00 $480.00 $115.52 $649.00 $649.00 $649.00 $649.00 $649.00 $649.00 $649.00 $115.52 $649.00 $649.00 $481.69 $481.69 $500.25 $338.13 $135.26 $649.00 $259.60 $649.00 $649.00 $649.00 $649.00 $649.00 $486.75 $649.00 $649.00 $649.00 $324.50 $324.50 $514.01 $649.00 $519.20 $421.85 $649.00 N/A $376.42 $649.00 $389.40 $649.00 $649.00 $649.00 N/A N/A E3635 SUP Custom 27203010 E3635 - TUBING SMKEVC 7/8IN 1 1/3IN 10FT STRL OPTM 2 PREFLT SPNG GRD BOTH IP/OP $32.00 $24.00 $5.64 $31.70 $31.70 $31.70 $31.70 $31.70 $31.70 $31.70 $5.64 $31.70 $31.70 $23.53 $23.53 $24.43 $16.52 $6.61 $31.70 $12.68 $31.70 $31.70 $31.70 $31.70 $31.70 $24.00 $31.70 $31.70 $31.70 $15.85 $15.85 $25.11 $31.70 $25.36 $20.61 $31.70 N/A $18.56 $31.70 $19.02 $31.70 $31.70 $31.70 N/A N/A E5211-6K SUP Custom 27203010 E5211-6K - BIT DRILL 7.4MM 150MM BOTH IP/OP $291.50 $216.00 $51.89 $291.50 $291.50 $291.50 $291.50 $291.50 $291.50 $291.50 $51.89 $291.50 $291.50 $216.35 $216.35 $224.69 $151.87 $60.75 $291.50 $116.60 $291.50 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $189.48 $291.50 N/A $169.07 $291.50 $174.90 $291.50 $291.50 $291.50 N/A N/A E5211-6L SUP Custom 27203010 E5211-6L - BIT DRILL 7.4MM 200MM BOTH IP/OP $291.50 $216.00 $51.89 $291.50 $291.50 $291.50 $291.50 $291.50 $291.50 $291.50 $51.89 $291.50 $291.50 $216.35 $216.35 $224.69 $151.87 $60.75 $291.50 $116.60 $291.50 $291.50 $291.50 $291.50 $291.50 $218.63 $291.50 $291.50 $291.50 $145.75 $145.75 $230.87 $291.50 $233.20 $189.48 $291.50 N/A $169.07 $291.50 $174.90 $291.50 $291.50 $291.50 N/A N/A E-70-0045 SUP HCPCS C1713 E-70-0045 - PLATE BONE ACUMED LEFT DISTAL ULNAR BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,237.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$1,342.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A EA100 SUP Custom 27203010 EA100 - CASE INSTR MIDAS REX LEGEND EHS BOTH IP/OP "$1,258.00" $931.00 $223.92 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $223.92 "$1,258.00" "$1,258.00" $933.69 $933.69 $969.67 $655.42 $262.18 "$1,258.00" $503.20 "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" "$1,258.00" $943.50 "$1,258.00" "$1,258.00" "$1,258.00" $629.00 $629.00 $996.34 "$1,258.00" "$1,006.40" $817.70 "$1,258.00" N/A $729.64 "$1,258.00" $754.80 "$1,258.00" "$1,258.00" "$1,258.00" N/A N/A EASYCAPII SUP Custom 27203010 EASYCAPII - DETECTOR CO2 22MM 15MM 15MM 13MM LF NLCR CLRMTR ADLT DISP ET BOTH IP/OP $317.50 $235.00 $184.15 $238.13 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $238.13 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $184.15 N/A N/A N/A N/A N/A N/A N/A EB0101 SUP Custom 27203010 EB0101 - RESTRICTOR CEMENT 8-15MM LATITUDE ELBOW BOTH IP/OP $420.00 $311.00 $74.76 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $420.00 $74.76 $420.00 $420.00 $311.72 $311.72 $323.74 $218.82 $87.53 $420.00 $168.00 $420.00 $420.00 $420.00 $420.00 $420.00 $315.00 $420.00 $420.00 $420.00 $210.00 $210.00 $332.64 $420.00 $336.00 $273.00 $420.00 N/A $243.60 $420.00 $252.00 $420.00 $420.00 $420.00 N/A N/A EB2S103 SUP HCPCS C1884 EB2S103 - PARTICLES EMBL 100-300UM 2ML YLW BDBL MCSPH CMPR PVA BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $437.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A EB2S305 SUP Custom 27803010 EB2S305 - PARTICLES EMBL 300-500UM 2ML BLU BDBL CMPR MCSPH PVA BOTH IP/OP $460.00 $340.00 $81.88 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $81.88 $460.00 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $460.00 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $460.00 N/A $266.80 $460.00 $276.00 $460.00 $460.00 $460.00 N/A N/A EB2S507 SUP HCPCS C1884 EB2S507 - PARTICLES EMBL 500-700UM 2ML RD BDBL CMPR PRECISELY CLBRT BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $460.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A EB2S709 SUP HCPCS C1884 EB2S709 - PARTICLES EMBL 700-900UM 2ML GRN BDBL CMPR PRECISELY CLBRT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $437.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A EB2S912 SUP HCPCS C1884 EB2S912 - PARTICLES EMBL 900-1200UM 2ML PUR BDBL CMPR PRECISELY CLBRT BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $437.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A ECATCH15 SUP Custom 27203010 ECATCH15 - POUCH SPEC RTRVL 15MM 34.5CM LF 29.5CM E-CTCH II FLXB ERG BOTH IP/OP $284.00 $210.00 $50.53 $283.90 $283.90 $283.90 $283.90 $283.90 $283.90 $283.90 $50.53 $283.90 $283.90 $210.71 $210.71 $218.83 $147.91 $59.17 $283.90 $113.56 $283.90 $283.90 $283.90 $283.90 $283.90 $213.00 $283.90 $283.90 $283.90 $141.95 $141.95 $224.85 $283.90 $227.12 $184.54 $283.90 N/A $164.72 $283.90 $170.34 $283.90 $283.90 $283.90 N/A N/A ECH060040A SUP HCPCS C1768 ECH060040A - GRAFT VASCULAR 6CM 40CM 3 LAYER ACUSEAL PTFE BOTH IP/OP "$3,225.00" "$2,387.00" $640.08 "$3,225.00" "$1,451.25" "$1,451.25" "$1,451.25" "$1,451.25" "$3,225.00" "$3,225.00" "$3,225.00" $672.17 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$3,225.00" "$1,589.93" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" $640.08 N/A "$1,870.50" "$3,225.00" "$3,225.00" "$3,225.00" $672.09 "$3,225.00" N/A N/A ECH470045A SUP HCPCS C1768 ECH470045A - GRAFT VASCULAR 4-7MM 45CM TAPER GORE ACUSEAL STERILE BOTH IP/OP "$3,700.00" "$2,738.00" $734.36 "$3,700.00" "$1,665.00" "$1,665.00" "$1,665.00" "$1,665.00" "$3,700.00" "$3,700.00" "$3,700.00" $771.17 "$3,700.00" "$3,700.00" "$3,700.00" "$3,700.00" "$3,700.00" $771.12 "$3,700.00" "$3,700.00" "$1,824.10" "$3,700.00" "$3,700.00" "$3,700.00" "$3,700.00" "$2,775.00" "$3,700.00" "$3,700.00" "$3,700.00" "$1,850.00" "$1,850.00" "$2,930.40" "$3,700.00" "$2,960.00" "$1,665.00" $734.36 N/A "$2,146.00" "$3,700.00" "$3,700.00" "$3,700.00" $771.08 "$3,700.00" N/A N/A EEA2835 SUP Custom 27203010 EEA2835 - STAPLER INTERNAL 3.5MM CIRCULAR 28MM 22CM SHAFT LARGE BOTH IP/OP $747.00 $553.00 $132.92 $746.73 $746.73 $746.73 $746.73 $746.73 $746.73 $746.73 $132.92 $746.73 $746.73 $554.22 $554.22 $575.58 $389.05 $155.63 $746.73 $298.69 $746.73 $746.73 $746.73 $746.73 $746.73 $560.25 $746.73 $746.73 $746.73 $373.37 $373.37 $591.41 $746.73 $597.38 $485.37 $746.73 N/A $433.26 $746.73 $448.04 $746.73 $746.73 $746.73 N/A N/A EGIA45AMT SUP Custom 27203010 EGIA45AMT - RELOAD STPLR 3MM 3.5MM 4MM 45MM PUR STRL LF EGIA ARTC KNF BOTH IP/OP $440.00 $326.00 $78.28 $439.78 $439.78 $439.78 $439.78 $439.78 $439.78 $439.78 $78.28 $439.78 $439.78 $326.40 $326.40 $338.98 $229.13 $91.65 $439.78 $146.58 $439.78 $439.78 $366.45 $439.78 $439.78 $330.00 $439.78 $439.78 $439.78 $219.89 $219.89 $348.31 $439.78 $351.82 $285.86 $439.78 N/A $255.20 $439.78 $263.87 $439.78 $439.78 $439.78 N/A N/A EGIA45AV SUP Custom 27203010 EGIA45AV - RELOAD STPLR 2MM 45MM GRY STRL LF EGIA ARTC KNF BLDE LGR BOTH IP/OP $507.00 $375.00 $90.18 $506.63 $506.63 $506.63 $506.63 $506.63 $506.63 $506.63 $90.18 $506.63 $506.63 $376.02 $376.02 $390.51 $263.95 $105.59 $506.63 $202.65 $506.63 $506.63 $506.63 $506.63 $506.63 $380.25 $506.63 $506.63 $506.63 $253.32 $253.32 $401.25 $506.63 $405.30 $329.31 $506.63 N/A $294.06 $506.63 $303.98 $506.63 $506.63 $506.63 N/A N/A EGIA45AVM SUP Custom 27203010 EGIA45AVM - RELOAD STPLR 2MM 2.5MM 3MM 45MM TN STRL LF EGIA ARTC KNF BOTH IP/OP $424.00 $314.00 $75.40 $423.60 $423.60 $423.60 $423.60 $423.60 $423.60 $423.60 $75.40 $423.60 $423.60 $314.40 $314.40 $326.51 $220.70 $88.28 $423.60 $169.44 $423.60 $423.60 $423.60 $423.60 $423.60 $318.00 $423.60 $423.60 $423.60 $211.80 $211.80 $335.49 $423.60 $338.88 $275.34 $423.60 N/A $245.92 $423.60 $254.16 $423.60 $423.60 $423.60 N/A N/A EGIA60AMT SUP Custom 27203010 EGIA60AMT - RELOAD STPLR 3MM 3.5MM 4MM 60MM PUR STRL LF EGIA ARTC KNF BOTH IP/OP $579.00 $428.00 $103.00 $578.63 $578.63 $578.63 $578.63 $578.63 $578.63 $578.63 $103.00 $578.63 $578.63 $429.46 $429.46 $446.01 $301.47 $120.59 $578.63 $175.01 $578.63 $578.63 $437.53 $578.63 $578.63 $434.25 $578.63 $578.63 $578.63 $289.32 $289.32 $458.27 $578.63 $462.90 $376.11 $578.63 N/A $335.82 $578.63 $347.18 $578.63 $578.63 $578.63 N/A N/A EGIA60AVM SUP Custom 27203010 EGIA60AVM - RELOAD STPLR 2MM 2.5MM 3MM 60MM TN STRL LF EGIA ARTC KNF BOTH IP/OP $554.50 $410.00 $98.62 $554.03 $554.03 $554.03 $554.03 $554.03 $554.03 $554.03 $98.62 $554.03 $554.03 $411.20 $411.20 $427.05 $288.65 $115.47 $554.03 $175.01 $554.03 $554.03 $437.53 $554.03 $554.03 $415.88 $554.03 $554.03 $554.03 $277.02 $277.02 $438.79 $554.03 $443.22 $360.12 $554.03 N/A $321.61 $554.03 $332.42 $554.03 $554.03 $554.03 N/A N/A EGIARADMT SUP Custom 27203010 EGIARADMT - RELOAD STPLR 3MM 3.5MM 4MM PUR STRL LF EGIA ARTC KNF BLDE FX BOTH IP/OP "$1,017.50" $753.00 $181.11 "$1,017.45" "$1,017.45" "$1,017.45" "$1,017.45" "$1,017.45" "$1,017.45" "$1,017.45" $181.11 "$1,017.45" "$1,017.45" $755.15 $755.15 $784.25 $530.09 $212.05 "$1,017.45" $406.98 "$1,017.45" "$1,017.45" "$1,017.45" "$1,017.45" "$1,017.45" $763.13 "$1,017.45" "$1,017.45" "$1,017.45" $508.73 $508.73 $805.82 "$1,017.45" $813.96 $661.34 "$1,017.45" N/A $590.15 "$1,017.45" $610.47 "$1,017.45" "$1,017.45" "$1,017.45" N/A N/A EGIARADXT SUP Custom 27203010 EGIARADXT - RELOAD STPLR 15MM BLK STRL LF EGIA RADL TI X THKTIS DISP BOTH IP/OP "$6,412.00" "$4,745.00" "$1,141.29" "$6,411.75" "$6,411.75" "$6,411.75" "$6,411.75" "$6,411.75" "$6,411.75" "$6,411.75" "$1,141.29" "$6,411.75" "$6,411.75" "$4,181.12" "$4,181.12" "$4,942.18" "$2,060.15" "$1,336.28" "$6,411.75" "$2,564.70" "$6,411.75" "$6,411.75" "$6,411.75" "$6,411.75" "$6,411.75" "$4,809.00" "$6,411.75" "$6,411.75" "$6,411.75" "$3,205.88" "$3,205.88" "$5,078.11" "$6,411.75" "$5,129.40" "$4,167.64" "$6,411.75" N/A "$3,718.96" "$6,411.75" "$3,847.05" "$6,411.75" "$6,411.75" "$6,411.75" N/A N/A EGIAUSHORT SUP Custom 27203010 EGIAUSHORT - STAPLER INTERNAL SHORT UNIVERSAL 6CM ARTICULATING LOADING BOTH IP/OP $722.50 $535.00 $128.52 $722.03 $722.03 $722.03 $722.03 $722.03 $722.03 $722.03 $128.52 $722.03 $722.03 $535.89 $535.89 $556.54 $376.18 $150.48 $722.03 $288.81 $722.03 $722.03 $722.03 $722.03 $722.03 $541.88 $722.03 $722.03 $722.03 $361.02 $361.02 $571.85 $722.03 $577.62 $469.32 $722.03 N/A $419.05 $722.03 $433.22 $722.03 $722.03 $722.03 N/A N/A EICA587401 SUP Custom 27203010 EICA587401 - WAND ELECTROSURGICAL 70D PLASMA INTEGRATED CABLE SUCTION BOTH IP/OP $578.00 $428.00 $102.83 $577.70 $577.70 $577.70 $577.70 $577.70 $577.70 $577.70 $102.83 $577.70 $577.70 $428.77 $428.77 $445.29 $300.98 $120.40 $577.70 $231.08 $577.70 $577.70 $577.70 $577.70 $577.70 $433.50 $577.70 $577.70 $577.70 $288.85 $288.85 $457.54 $577.70 $462.16 $375.51 $577.70 N/A $335.24 $577.70 $346.62 $577.70 $577.70 $577.70 N/A N/A EL-21-L SUP Custom 27203010 EL-21-L - SUTURE ABSORBABLE 0 3.9MM 21IN BRAID COATED LIGATE LOOP BOTH IP/OP $54.50 $40.00 $9.66 $54.25 $54.25 $54.25 $54.25 $54.25 $54.25 $54.25 $9.66 $54.25 $54.25 $40.26 $40.26 $41.82 $28.26 $11.31 $54.25 $17.78 $54.25 $54.25 $44.45 $54.25 $54.25 $40.88 $54.25 $54.25 $54.25 $27.13 $27.13 $42.97 $54.25 $43.40 $35.26 $54.25 N/A $31.61 $54.25 $32.55 $54.25 $54.25 $54.25 N/A N/A ELAFIXP2P744 SUP HCPCS C1893 ELAFIXP2P744 - LEAD PCNG ELAPASS PSV FX ART VNTRC BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $610.88 $610.88 $610.88 $610.88 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 $223.28 N/A $652.50 "$1,125.00" "$1,125.00" "$1,125.00" $234.45 "$1,125.00" N/A N/A ELAFIXP2P752 SUP HCPCS C1893 ELAFIXP2P752 - LEAD PCNG 52CM SCR IN BP ATRERY BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $610.88 $610.88 $610.88 $610.88 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 $223.28 N/A $652.50 "$1,125.00" "$1,125.00" "$1,125.00" $234.45 "$1,125.00" N/A N/A ELAFIXP2P758 SUP HCPCS C1893 ELAFIXP2P758 - LEAD SRG 10MM 7FR 58CM SCR IN IS 1 BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $610.88 $610.88 $610.88 $610.88 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" $834.98 $834.98 $867.15 $586.13 $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $731.25 $223.28 N/A $652.50 "$1,125.00" "$1,125.00" "$1,125.00" $234.45 "$1,125.00" N/A N/A ELAFIXS2J748 SUP HCPCS C1898 ELAFIXS2J748 - LEAD PCNG JTP ATR BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A ELAFIXS2J752 SUP HCPCS C1898 ELAFIXS2J752 - LEAD PCNG JTP ATR BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A ELAPASSP752 SUP HCPCS C1898 ELAPASSP752 - LEAD PCNG ELAPASS TN VNTRC BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A ELAPASSP758 SUP HCPCS C1898 ELAPASSP758 - LEAD PCNG 58CM BP STRG VNTRC BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A ELAPASSPJ744 SUP HCPCS C1898 ELAPASSPJ744 - LEAD PCNG 7FR 44CM ELAPASS P BP ATR BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A ELAPASSPJ752 SUP HCPCS C1898 ELAPASSPJ752 - LEAD PACING J 52CM BIPOL PREFORMED TINED LOW VOLTAGE ELAPASS BOTH IP/OP "$1,125.00" $833.00 $234.46 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" $450.00 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 "$1,125.00" N/A $652.50 "$1,125.00" $675.00 "$1,125.00" "$1,125.00" "$1,125.00" N/A N/A EMP-FBX1000HS SUP Custom 27203010 EMP-FBX1000HS - LASER SURGICAL 1000 MH FIBER SINGLE USE BOTH IP/OP "$1,937.50" "$1,434.00" $344.88 "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" $344.88 "$1,937.50" "$1,937.50" "$1,438.01" "$1,438.01" "$1,493.43" "$1,009.44" $403.80 "$1,937.50" $775.00 "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,453.13" "$1,937.50" "$1,937.50" "$1,937.50" $968.75 $968.75 "$1,534.50" "$1,937.50" "$1,550.00" "$1,259.38" "$1,937.50" N/A "$1,123.75" "$1,937.50" "$1,162.50" "$1,937.50" "$1,937.50" "$1,937.50" N/A N/A EMP-FBX272HS-C SUP Custom 27203010 "EMP-FBX272HS-C - LASER SURGICAL 272 MH FIBER SINGLE USE, COMPATIBLE" BOTH IP/OP $726.00 $537.00 $129.22 $725.95 $725.95 $725.95 $725.95 $725.95 $725.95 $725.95 $129.22 $725.95 $725.95 $538.80 $538.80 $559.56 $378.22 $151.30 $725.95 $290.38 $725.95 $725.95 $725.95 $725.95 $725.95 $544.50 $725.95 $725.95 $725.95 $362.98 $362.98 $574.95 $725.95 $580.76 $471.87 $725.95 N/A $421.08 $725.95 $435.57 $725.95 $725.95 $725.95 N/A N/A EMP-FBX365HS SUP Custom 27203010 EMP-FBX365HS - LASER SURGICAL 365 MH FIBER SINGLE USE BOTH IP/OP $875.00 $648.00 $155.71 $874.75 $874.75 $874.75 $874.75 $874.75 $874.75 $874.75 $155.71 $874.75 $874.75 $649.24 $649.24 $674.26 $455.74 $182.31 $874.75 $349.90 $874.75 $874.75 $874.75 $874.75 $874.75 $656.25 $874.75 $874.75 $874.75 $437.38 $437.38 $692.80 $874.75 $699.80 $568.59 $874.75 N/A $507.50 $874.75 $524.85 $874.75 $874.75 $874.75 N/A N/A EMP-FBX550HS SUP Custom 27203010 EMP-FBX550HS - LASER SURGICAL 550 MH FIBER SINGLE USE BOTH IP/OP "$1,070.50" $792.00 $190.55 "$1,070.50" "$1,070.50" "$1,070.50" "$1,070.50" "$1,070.50" "$1,070.50" "$1,070.50" $190.55 "$1,070.50" "$1,070.50" $794.53 $794.53 $825.14 $557.73 $223.10 "$1,070.50" $428.20 "$1,070.50" "$1,070.50" "$1,070.50" "$1,070.50" "$1,070.50" $802.88 "$1,070.50" "$1,070.50" "$1,070.50" $535.25 $535.25 $847.84 "$1,070.50" $856.40 $695.83 "$1,070.50" N/A $620.89 "$1,070.50" $642.30 "$1,070.50" "$1,070.50" "$1,070.50" N/A N/A EN2006015-C SUP HCPCS C1757 EN2006015-C - SNARE VASC STD 9-15MM 6FR 120CM 100CM ENSNR 3 PREFRM LOOP BOTH IP/OP $827.50 $612.00 $164.24 $827.50 $449.33 $449.33 $449.33 $449.33 $827.50 $827.50 $827.50 $172.47 $827.50 $614.17 $614.17 $637.84 $431.13 $172.46 $827.50 $827.50 $489.47 $827.50 $827.50 $827.50 $827.50 $620.63 $827.50 $827.50 $827.50 $413.75 $413.75 $655.38 $827.50 $662.00 $537.88 $164.24 N/A $479.95 $827.50 $827.50 $827.50 $172.45 $827.50 N/A N/A EN2007030 SUP Custom 27203010 EN2007030 - SNARE VASC STD 18-30MM 7FR 120CM 100CM ENSNR 3 INTERLACE BOTH IP/OP $827.50 $612.00 $147.30 $827.50 $827.50 $827.50 $827.50 $827.50 $827.50 $827.50 $147.30 $827.50 $827.50 $614.17 $614.17 $637.84 $431.13 $172.46 $827.50 $331.00 $827.50 $827.50 $827.50 $827.50 $827.50 $620.63 $827.50 $827.50 $827.50 $413.75 $413.75 $655.38 $827.50 $662.00 $537.88 $827.50 N/A $479.95 $827.50 $496.50 $827.50 $827.50 $827.50 N/A N/A EN2007045 SUP Custom 27203010 EN2007045 - SNARE VASCULAR STANDARD 27-45MM 7FR 120CM 100CM 3 PREFORM BOTH IP/OP "$1,100.00" $814.00 $195.80 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $195.80 "$1,100.00" "$1,100.00" $816.42 $816.42 $847.88 $573.10 $229.25 "$1,100.00" $440.00 "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" "$1,100.00" $825.00 "$1,100.00" "$1,100.00" "$1,100.00" $550.00 $550.00 $871.20 "$1,100.00" $880.00 $715.00 "$1,100.00" N/A $638.00 "$1,100.00" $660.00 "$1,100.00" "$1,100.00" "$1,100.00" N/A N/A ENDO-014 SUP HCPCS C1769 ENDO-014 - GUIDEWIRE ENDOVASCULAR L260 CM OD.014 IN ANCILLARY BOTH IP/OP $450.00 $333.00 $89.31 $450.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $450.00 $266.18 $450.00 $450.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 N/A $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A ENF402300 SUP HCPCS C1874 ENF402300 - STENT VASCULAR 4.5MM 22MM W/O DISTAL TIP ENTERPRISE NITINOL BOTH IP/OP "$14,899.50" "$11,026.00" "$2,957.12" "$14,899.20" "$6,704.64" "$6,704.64" "$6,704.64" "$6,704.64" "$14,899.20" "$14,899.20" "$14,899.20" "$3,105.37" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$3,105.16" "$14,899.20" "$14,899.20" "$7,345.31" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$11,174.63" "$14,899.20" "$14,899.20" "$14,899.20" "$7,449.60" "$7,449.60" "$11,800.17" "$14,899.20" "$11,919.36" "$6,704.64" "$2,957.12" N/A "$8,641.71" "$14,899.20" "$14,899.20" "$14,899.20" "$3,104.99" "$14,899.20" N/A N/A ENF402312 SUP HCPCS C1874 ENF402312 - STENT VASC 4.5MM 22MM ENTRP RECON DEV SLF EXPANDABLE DLV SYS BOTH IP/OP "$14,899.50" "$11,026.00" "$2,957.12" "$14,899.20" "$6,704.64" "$6,704.64" "$6,704.64" "$6,704.64" "$14,899.20" "$14,899.20" "$14,899.20" "$3,105.37" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$3,105.16" "$14,899.20" "$14,899.20" "$7,345.31" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$11,174.63" "$14,899.20" "$14,899.20" "$14,899.20" "$7,449.60" "$7,449.60" "$11,800.17" "$14,899.20" "$11,919.36" "$6,704.64" "$2,957.12" N/A "$8,641.71" "$14,899.20" "$14,899.20" "$14,899.20" "$3,104.99" "$14,899.20" N/A N/A ENF403000 SUP HCPCS C1874 ENF403000 - STENT VASCULAR 4.5MM 28MM W/O DISTAL TIP ENTERPRISE NITINOL BOTH IP/OP "$14,899.50" "$11,026.00" "$2,957.12" "$14,899.20" "$6,704.64" "$6,704.64" "$6,704.64" "$6,704.64" "$14,899.20" "$14,899.20" "$14,899.20" "$3,105.37" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$3,105.16" "$14,899.20" "$14,899.20" "$7,345.31" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$11,174.63" "$14,899.20" "$14,899.20" "$14,899.20" "$7,449.60" "$7,449.60" "$11,800.17" "$14,899.20" "$11,919.36" "$6,704.64" "$2,957.12" N/A "$8,641.71" "$14,899.20" "$14,899.20" "$14,899.20" "$3,104.99" "$14,899.20" N/A N/A ENF403012 SUP HCPCS C1874 ENF403012 - STENT VASC 4.5MM 28MM ENTRP RECON DEV SLF EXPANDABLE DLV SYS BOTH IP/OP "$14,899.50" "$11,026.00" "$2,957.12" "$14,899.20" "$6,704.64" "$6,704.64" "$6,704.64" "$6,704.64" "$14,899.20" "$14,899.20" "$14,899.20" "$3,105.37" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$3,105.16" "$14,899.20" "$14,899.20" "$7,345.31" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$11,174.63" "$14,899.20" "$14,899.20" "$14,899.20" "$7,449.60" "$7,449.60" "$11,800.17" "$14,899.20" "$11,919.36" "$6,704.64" "$2,957.12" N/A "$8,641.71" "$14,899.20" "$14,899.20" "$14,899.20" "$3,104.99" "$14,899.20" N/A N/A ENF403900 SUP HCPCS C1874 ENF403900 - STENT VASCULAR 4.5MM 37MM W/O DISTAL TIP ENTERPRISE NITINOL BOTH IP/OP "$14,899.50" "$11,026.00" "$2,957.12" "$14,899.20" "$6,704.64" "$6,704.64" "$6,704.64" "$6,704.64" "$14,899.20" "$14,899.20" "$14,899.20" "$3,105.37" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$3,105.16" "$14,899.20" "$14,899.20" "$7,345.31" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$11,174.63" "$14,899.20" "$14,899.20" "$14,899.20" "$7,449.60" "$7,449.60" "$11,800.17" "$14,899.20" "$11,919.36" "$6,704.64" "$2,957.12" N/A "$8,641.71" "$14,899.20" "$14,899.20" "$14,899.20" "$3,104.99" "$14,899.20" N/A N/A ENF403912 SUP HCPCS C1874 ENF403912 - STENT VASC 4.5MM 37MM ENTRP RECON DEV SLF EXPANDABLE DLV SYS BOTH IP/OP "$14,899.50" "$11,026.00" "$2,957.12" "$14,899.20" "$6,704.64" "$6,704.64" "$6,704.64" "$6,704.64" "$14,899.20" "$14,899.20" "$14,899.20" "$3,105.37" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$3,105.16" "$14,899.20" "$14,899.20" "$7,345.31" "$14,899.20" "$14,899.20" "$14,899.20" "$14,899.20" "$11,174.63" "$14,899.20" "$14,899.20" "$14,899.20" "$7,449.60" "$7,449.60" "$11,800.17" "$14,899.20" "$11,919.36" "$6,704.64" "$2,957.12" N/A "$8,641.71" "$14,899.20" "$8,939.52" "$14,899.20" "$3,104.99" "$14,899.20" N/A N/A ER7232A SUP HCPCS C2628 ER7232A - ER-REBOA CATHETER BOTH IP/OP "$5,437.50" "$4,024.00" "$1,079.21" "$5,437.50" "$2,952.56" "$2,952.56" "$2,952.56" "$2,952.56" "$5,437.50" "$5,437.50" "$5,437.50" "$1,133.31" "$5,437.50" "$4,035.71" "$4,035.71" "$4,191.23" "$2,060.15" "$1,133.23" "$5,437.50" "$5,437.50" "$3,094.73" "$5,437.50" "$5,437.50" "$5,437.50" "$5,437.50" "$4,078.13" "$5,437.50" "$5,437.50" "$5,437.50" "$2,718.75" "$2,718.75" "$4,306.50" "$5,437.50" "$4,350.00" "$3,534.38" "$1,079.21" N/A "$3,153.75" "$5,437.50" "$5,437.50" "$5,437.50" "$1,133.18" "$5,437.50" N/A N/A ESCDH33 SUP Custom 27203010 ESCDH33 - STAPLER INTNL CRV CRC 33MM 5.5MM STRL LF 1-2.5MM PRX LNR CTR BOTH IP/OP "$3,588.50" "$2,655.00" $638.75 "$3,588.47" "$3,588.47" "$3,588.47" "$3,588.47" "$3,588.47" "$3,588.47" "$3,588.47" $638.75 "$3,588.47" "$3,588.47" "$2,663.36" "$2,663.36" "$2,765.99" "$1,869.59" $747.88 "$3,588.47" "$1,435.39" "$3,588.47" "$3,588.47" "$3,588.47" "$3,588.47" "$3,588.47" "$2,691.38" "$3,588.47" "$3,588.47" "$3,588.47" "$1,794.24" "$1,794.24" "$2,842.07" "$3,588.47" "$2,870.78" "$2,332.51" "$3,588.47" N/A "$2,081.33" "$3,588.47" "$2,153.08" "$3,588.47" "$3,588.47" "$3,588.47" N/A N/A ESEJ10G SUP Custom 27203010 ESEJ10G - SUTURE ABSORBABLE 0 18IN BRAID TIES COATED VICRYL ENDOLOOP BOTH IP/OP $376.50 $279.00 $66.96 $376.17 $376.17 $376.17 $376.17 $376.17 $376.17 $376.17 $66.96 $376.17 $376.17 $279.19 $279.19 $289.95 $195.98 $78.40 $376.17 $150.47 $376.17 $376.17 $376.17 $376.17 $376.17 $282.38 $376.17 $376.17 $376.17 $188.09 $188.09 $297.93 $376.17 $300.94 $244.51 $376.17 N/A $218.37 $376.17 $225.70 $376.17 $376.17 $376.17 N/A N/A ESP100-21-00 SUP Custom 27803010 ESP100-21-00 - VALVE AORTIC LP 21MM 15MM BIOPROSTHESIS STENT SCALLOP INFLOW BOTH IP/OP "$15,000.00" "$11,100.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$15,000.00" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$15,000.00" "$15,000.00" N/A N/A ESP100-23-00 SUP Custom 27803010 ESP100-23-00 - VALVE AOR 23MM 16MM EP FLEXFIT BPRTH STNT SCLP INFL EDG HLDR BOTH IP/OP "$15,000.00" "$11,100.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$15,000.00" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$15,000.00" "$15,000.00" N/A N/A ESP100-25-00 SUP Custom 27803010 ESP100-25-00 - VALVE AORTIC LP 25MM 17MM BIOPROSTHESIS STENT SCALLOP INFLOW BOTH IP/OP "$19,700.00" "$14,578.00" "$3,506.60" "$19,700.00" "$19,700.00" "$19,700.00" "$19,700.00" "$19,700.00" "$19,700.00" "$19,700.00" "$3,506.60" "$19,700.00" "$19,700.00" "$19,700.00" "$19,700.00" "$19,700.00" "$19,700.00" "$4,105.70" "$19,700.00" "$7,880.00" "$19,700.00" "$19,700.00" "$19,700.00" "$19,700.00" "$19,700.00" "$14,775.00" "$19,700.00" "$19,700.00" "$19,700.00" "$9,850.00" "$9,850.00" "$15,602.40" "$19,700.00" "$15,760.00" "$8,865.00" "$19,700.00" N/A "$11,426.00" "$19,700.00" "$11,820.00" "$19,700.00" "$19,700.00" "$19,700.00" N/A N/A ESP100-27-00 SUP Custom 27803010 ESP100-27-00 - VALVE AORTIC LP 27MM 19MM BIOPROSTHESIS STENT SCALLOP INFLOW BOTH IP/OP "$15,000.00" "$11,100.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$15,000.00" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$15,000.00" "$15,000.00" N/A N/A ESP1955 SUP Custom 27011340 ESP1955 - SPLINTS YELLOW JACKET BOTH IP/OP $66.00 $49.00 $11.68 $65.63 $65.63 $65.63 $65.63 $65.63 $65.63 $65.63 $11.68 $65.63 $65.63 $48.71 $48.71 $50.59 $34.19 $13.68 $65.63 $26.25 $65.63 $65.63 $65.63 $65.63 $65.63 $49.50 $65.63 $65.63 $65.63 $32.82 $32.82 $51.98 $65.63 $52.50 $42.66 $65.63 N/A $38.28 $65.63 $39.38 $65.63 $65.63 $65.63 N/A N/A ESP3075 SUP Custom 27203010 ESP3075 - KIT SPLINT NEOPRENE DURABLE NONABSORBENT EASY FRACTURE MANAG BOTH IP/OP $437.50 $324.00 $77.85 $437.38 $437.38 $437.38 $437.38 $437.38 $437.38 $437.38 $77.85 $437.38 $437.38 $324.62 $324.62 $337.13 $227.87 $91.15 $437.38 $174.95 $437.38 $437.38 $437.38 $437.38 $437.38 $328.13 $437.38 $437.38 $437.38 $218.69 $218.69 $346.40 $437.38 $349.90 $284.30 $437.38 N/A $253.75 $437.38 $262.43 $437.38 $437.38 $437.38 N/A N/A ETBF3216C166E SUP Custom 27803010 ETBF3216C166E - GRAFT STNT 2 BRCH 32-16MM 20FR 166MM ENDURANT II DLV SYS C BOTH IP/OP "$24,937.50" "$18,454.00" "$4,438.88" "$24,937.50" "$24,937.50" "$24,937.50" "$24,937.50" "$24,937.50" "$24,937.50" "$24,937.50" "$4,438.88" "$24,937.50" "$24,937.50" "$24,937.50" "$24,937.50" "$24,937.50" "$24,937.50" "$5,197.25" "$24,937.50" "$9,975.00" "$24,937.50" "$24,937.50" "$24,937.50" "$24,937.50" "$24,937.50" "$18,703.13" "$24,937.50" "$24,937.50" "$24,937.50" "$12,468.75" "$12,468.75" "$19,750.50" "$24,937.50" "$19,950.00" "$11,221.88" "$24,937.50" N/A "$14,463.75" "$24,937.50" "$14,962.50" "$24,937.50" "$24,937.50" "$24,937.50" N/A N/A ETDPP6 SUP Custom 27203010 ETDPP6 - ADHESIVE SKNCLS 2 OCTYL CYNCRLT DRMBND VL TOP LQ HVISC PRPN BOTH IP/OP $64.50 $48.00 $11.47 $64.42 $64.42 $64.42 $64.42 $64.42 $64.42 $64.42 $11.47 $64.42 $64.42 $47.81 $47.81 $49.65 $33.56 $13.43 $64.42 $25.77 $64.42 $64.42 $64.42 $64.42 $64.42 $48.38 $64.42 $64.42 $64.42 $32.21 $32.21 $51.02 $64.42 $51.54 $41.87 $64.42 N/A $37.41 $64.42 $38.65 $64.42 $64.42 $64.42 N/A N/A ETLW1616C82E SUP Custom 27803010 ETLW1616C82E - GRAFT STNT 16-16MM 14FR 82MM ENDURANT II DLV SYS C DIST BOTH IP/OP "$11,187.50" "$8,279.00" "$1,991.38" "$11,187.50" "$11,187.50" "$11,187.50" "$11,187.50" "$11,187.50" "$11,187.50" "$11,187.50" "$1,991.38" "$11,187.50" "$11,187.50" "$11,187.50" "$11,187.50" "$11,187.50" "$11,187.50" "$2,331.60" "$11,187.50" "$4,475.00" "$11,187.50" "$11,187.50" "$11,187.50" "$11,187.50" "$11,187.50" "$8,390.63" "$11,187.50" "$11,187.50" "$11,187.50" "$5,593.75" "$5,593.75" "$8,860.50" "$11,187.50" "$8,950.00" "$5,034.38" "$11,187.50" N/A "$6,488.75" "$11,187.50" "$6,712.50" "$11,187.50" "$11,187.50" "$11,187.50" N/A N/A ETLW1620C156E SUP Custom 27803010 ETLW1620C156E - GRAFT STNT 16-20MM 16FR 156MM ENDURANT II DLV SYS C DIST BOTH IP/OP "$16,000.00" "$11,840.00" "$2,848.00" "$16,000.00" "$16,000.00" "$16,000.00" "$16,000.00" "$16,000.00" "$16,000.00" "$16,000.00" "$2,848.00" "$16,000.00" "$16,000.00" "$16,000.00" "$16,000.00" "$16,000.00" "$16,000.00" "$3,334.58" "$16,000.00" "$6,400.00" "$16,000.00" "$16,000.00" "$16,000.00" "$16,000.00" "$16,000.00" "$12,000.00" "$16,000.00" "$16,000.00" "$16,000.00" "$8,000.00" "$8,000.00" "$12,672.00" "$16,000.00" "$12,800.00" "$7,200.00" "$16,000.00" N/A "$9,280.00" "$16,000.00" "$9,600.00" "$16,000.00" "$16,000.00" "$16,000.00" N/A N/A ETLW1628C93E SUP HCPCS C2625 ETLW1628C93E - GRAFT STNT 16-28MM 16FR 93MM ENDURANT II DLV SYS C DIST BOTH IP/OP "$12,312.50" "$9,111.00" "$2,443.72" "$12,312.50" "$5,540.63" "$5,540.63" "$5,540.63" "$5,540.63" "$12,312.50" "$12,312.50" "$12,312.50" "$2,566.23" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$2,566.06" "$12,312.50" "$12,312.50" "$6,070.06" "$12,312.50" "$12,312.50" "$12,312.50" "$12,312.50" "$9,234.38" "$12,312.50" "$12,312.50" "$12,312.50" "$6,156.25" "$6,156.25" "$9,751.50" "$12,312.50" "$9,850.00" "$5,540.63" "$2,443.72" N/A "$7,141.25" "$12,312.50" "$12,312.50" "$12,312.50" "$2,565.93" "$12,312.50" N/A N/A EUSCFS-070026-14-13 SUP HCPCS C1768 EUSCFS-070026-14-13 - SET STENT 26CM 7-14FR CFLX URET EURTM RELS SLV PSTNR 13CM BOTH IP/OP $297.50 $220.00 $58.96 $297.06 $133.68 $133.68 $133.68 $133.68 $297.06 $297.06 $297.06 $61.91 $297.06 $297.06 $297.06 $297.06 $297.06 $61.91 $297.06 $297.06 $175.71 $297.06 $297.06 $297.06 $297.06 $223.13 $297.06 $297.06 $297.06 $148.53 $148.53 $235.27 $297.06 $237.65 $133.68 $58.96 N/A $172.55 $297.06 $297.06 $297.06 $61.91 $297.06 N/A N/A EX70410 SUP HCPCS A4364 EX70410 - ADHESIVE SKNCLS 1ML EXOFIN BOTH IP/OP $25.00 $19.00 $4.96 $59.63 $13.58 $13.58 $13.58 $13.58 $25.00 $25.00 $25.00 $5.21 $25.00 $18.56 $18.56 $19.27 $13.03 $5.21 $25.00 $27.50 $14.79 $25.00 $59.63 $25.00 $25.00 $18.75 $25.00 $25.00 $25.00 $12.50 $12.50 $19.80 $25.00 $20.00 $16.25 $4.96 N/A $14.50 $25.00 $25.00 $25.00 $5.21 $25.00 N/A N/A EXPORTAP SUP HCPCS C1757 EXPORTAP - CATHETER THROMBECTOMY FULL WALL 6FR .07IN 140CM BRAID BOTH IP/OP "$1,425.00" "$1,055.00" $282.83 "$1,425.00" $773.78 $773.78 $773.78 $773.78 "$1,425.00" "$1,425.00" "$1,425.00" $297.01 "$1,425.00" "$1,057.64" "$1,057.64" "$1,098.39" $742.43 $296.99 "$1,425.00" "$1,425.00" $842.89 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,068.75" "$1,425.00" "$1,425.00" "$1,425.00" $712.50 $712.50 "$1,128.60" "$1,425.00" "$1,140.00" $926.25 $282.83 N/A $826.50 "$1,425.00" "$1,425.00" "$1,425.00" $296.97 "$1,425.00" N/A N/A EZ15-15-15 SUP HCPCS C1713 EZ15-15-15 - STAPLE BONE 2MM 15X15X1.8-1.3MM MONOCORTICAL SUPERELASTIC LP BOTH IP/OP "$3,208.50" "$2,374.00" $636.81 "$3,208.50" "$1,443.83" "$1,443.83" "$1,443.83" "$1,443.83" "$3,208.50" "$3,208.50" "$3,208.50" $668.73 "$3,208.50" "$3,208.50" "$3,208.50" "$3,208.50" "$3,208.50" $668.69 "$3,208.50" "$1,283.40" "$1,581.79" "$3,208.50" "$3,208.50" "$3,208.50" "$3,208.50" "$2,406.38" "$3,208.50" "$3,208.50" "$3,208.50" "$1,604.25" "$1,604.25" "$2,541.13" "$3,208.50" "$2,566.80" "$1,443.83" $636.81 N/A "$1,860.93" "$3,208.50" "$1,925.10" "$3,208.50" $668.65 "$3,208.50" N/A N/A EZF21TA SUP Custom 27203010 EZF21TA - CANNULA PERFUSION 3/8IN 21FR 14.8IN CURVE TIP SUTURE FLANGE BOTH IP/OP $111.00 $82.00 $19.70 $110.68 $110.68 $110.68 $110.68 $110.68 $110.68 $110.68 $19.70 $110.68 $110.68 $82.15 $82.15 $85.31 $57.66 $23.07 $110.68 $44.27 $110.68 $110.68 $110.68 $110.68 $110.68 $83.25 $110.68 $110.68 $110.68 $55.34 $55.34 $87.66 $110.68 $88.54 $71.94 $110.68 N/A $64.38 $110.68 $66.41 $110.68 $110.68 $110.68 N/A N/A EZS24TA SUP Custom 27203010 EZS24TA - CANNULA PERFUSION 3/8IN STR 24FR 14IN AUTO DILATE TIP SUTURE BOTH IP/OP $93.50 $69.00 $16.61 $93.30 $93.30 $93.30 $93.30 $93.30 $93.30 $93.30 $16.61 $93.30 $93.30 $69.25 $69.25 $71.92 $48.61 $19.44 $93.30 $37.32 $93.30 $93.30 $93.30 $93.30 $93.30 $70.13 $93.30 $93.30 $93.30 $46.65 $46.65 $73.89 $93.30 $74.64 $60.65 $93.30 N/A $54.23 $93.30 $55.98 $93.30 $93.30 $93.30 N/A N/A F1/8TA15S SUP Custom 27203010 F1/8TA15S - TOOL DISSECTING 1.5MM 8CM TAPERED SPIRAL LEGEND STERILE BOTH IP/OP $270.00 $200.00 $48.04 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $48.04 $269.88 $269.88 $200.30 $200.30 $208.02 $140.61 $56.25 $269.88 $107.95 $269.88 $269.88 $269.88 $269.88 $269.88 $202.50 $269.88 $269.88 $269.88 $134.94 $134.94 $213.74 $269.88 $215.90 $175.42 $269.88 N/A $156.60 $269.88 $161.93 $269.88 $269.88 $269.88 N/A N/A F1006 SUP HCPCS C1768 F1006 - GRAFT VASCULAR 6MM 10CM FLEX IMPRA CARBOFLO PTFE PERIPHERAL BOTH IP/OP $891.50 $660.00 $176.94 $891.48 $401.17 $401.17 $401.17 $401.17 $891.48 $891.48 $891.48 $185.81 $891.48 $891.48 $891.48 $891.48 $891.48 $185.79 $891.48 $891.48 $527.31 $891.48 $891.48 $891.48 $891.48 $668.63 $891.48 $891.48 $891.48 $445.74 $445.74 $706.05 $891.48 $713.18 $401.17 $176.94 N/A $517.07 $891.48 $891.48 $891.48 $185.78 $891.48 N/A N/A F1010 SUP HCPCS C1768 F1010 - GRAFT VASCULAR 10MM 10CM FLEX IMPRA CARBOFLO PTFE PERIPHERAL BOTH IP/OP $891.50 $660.00 $176.94 $891.48 $401.17 $401.17 $401.17 $401.17 $891.48 $891.48 $891.48 $185.81 $891.48 $891.48 $891.48 $891.48 $891.48 $185.79 $891.48 $891.48 $527.31 $891.48 $891.48 $891.48 $891.48 $668.63 $891.48 $891.48 $891.48 $445.74 $445.74 $706.05 $891.48 $713.18 $401.17 $176.94 N/A $517.07 $891.48 $891.48 $891.48 $185.78 $891.48 N/A N/A F2/8TA23S SUP Custom 27203010 F2/8TA23S - TOOL DISSECTING SPIRAL 2.3MM 8CM TAPER LEGEND BOTH IP/OP $270.00 $200.00 $48.04 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $269.88 $48.04 $269.88 $269.88 $200.30 $200.30 $208.02 $140.61 $56.25 $269.88 $107.95 $269.88 $269.88 $269.88 $269.88 $269.88 $202.50 $269.88 $269.88 $269.88 $134.94 $134.94 $213.74 $269.88 $215.90 $175.42 $269.88 N/A $156.60 $269.88 $161.93 $269.88 $269.88 $269.88 N/A N/A F6008 SUP HCPCS C1768 F6008 - GRAFT VASCULAR 8MM 60CM PERIPHERAL BYPASS FLEX IMPRA BOTH IP/OP "$2,161.00" "$1,599.00" $428.88 "$2,160.88" $972.40 $972.40 $972.40 $972.40 "$2,160.88" "$2,160.88" "$2,160.88" $450.38 "$2,160.88" "$2,160.88" "$2,160.88" "$2,160.88" "$2,160.88" $450.35 "$2,160.88" "$2,160.88" "$1,278.16" "$2,160.88" "$2,160.88" "$2,160.88" "$2,160.88" "$1,620.75" "$2,160.88" "$2,160.88" "$2,160.88" "$1,080.44" "$1,080.44" "$1,711.42" "$2,160.88" "$1,728.70" $972.40 $428.88 N/A "$1,253.38" "$2,160.88" "$2,160.88" "$2,160.88" $450.33 "$2,160.88" N/A N/A F7006 SUP HCPCS C1768 F7006 - GRAFT VASCULAR STR 6MM 70CM FLEX IMPRA CARBOFLO PTFE BOTH IP/OP "$2,570.50" "$1,902.00" $510.14 "$2,570.28" "$1,156.63" "$1,156.63" "$1,156.63" "$1,156.63" "$2,570.28" "$2,570.28" "$2,570.28" $535.71 "$2,570.28" "$2,570.28" "$2,570.28" "$2,570.28" "$2,570.28" $535.67 "$2,570.28" "$2,570.28" "$1,267.15" "$2,570.28" "$2,570.28" "$2,570.28" "$2,570.28" "$1,927.88" "$2,570.28" "$2,570.28" "$2,570.28" "$1,285.14" "$1,285.14" "$2,035.66" "$2,570.28" "$2,056.22" "$1,156.63" $510.14 N/A "$1,490.89" "$2,570.28" "$2,570.28" "$2,570.28" $535.65 "$2,570.28" N/A N/A F7008 SUP HCPCS C1768 F7008 - GRAFT VASC STRG 8MM 70CM IMPRA FLX SM BEAD EPTFE BOTH IP/OP "$2,570.50" "$1,902.00" $510.14 "$2,570.28" "$1,156.63" "$1,156.63" "$1,156.63" "$1,156.63" "$2,570.28" "$2,570.28" "$2,570.28" $535.71 "$2,570.28" "$2,570.28" "$2,570.28" "$2,570.28" "$2,570.28" $535.67 "$2,570.28" "$2,570.28" "$1,267.15" "$2,570.28" "$2,570.28" "$2,570.28" "$2,570.28" "$1,927.88" "$2,570.28" "$2,570.28" "$2,570.28" "$1,285.14" "$1,285.14" "$2,035.66" "$2,570.28" "$2,056.22" "$1,156.63" $510.14 N/A "$1,490.89" "$2,570.28" "$2,570.28" "$2,570.28" $535.65 "$2,570.28" N/A N/A FA-0140 SUP HCPCS C1713 FA-0140 - SCREW BN 3.5MM 14MM CNN XTRMT BOTH IP/OP $562.50 $416.00 $111.64 $562.50 $253.13 $253.13 $253.13 $253.13 $562.50 $562.50 $562.50 $117.24 $562.50 $562.50 $562.50 $562.50 $562.50 $117.23 $562.50 $562.50 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $253.13 $111.64 N/A $326.25 $562.50 $337.50 $562.50 $117.23 $562.50 N/A N/A FA-0160 SUP HCPCS C1713 FA-0160 - SCREW BN 3.5MM 16MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-0180 SUP HCPCS C1713 FA-0180 - SCREW BN 3.5MM 18MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-0200 SUP HCPCS C1713 FA-0200 - SCREW BN 3.5MM 20MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-0220 SUP HCPCS C1713 FA-0220 - SCREW BN 3.5MM 22MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-0240 SUP HCPCS C1713 FA-0240 - SCREW BN 3.5MM 24MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-0260 SUP HCPCS C1713 FA-0260 - SCREW BN 3.5MM 26MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-0280 SUP HCPCS C1713 FA-0280 - SCREW BN 3.5MM 28MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $492.50 $492.50 $102.64 $492.50 N/A N/A FA-0300 SUP HCPCS C1713 FA-0300 - SCREW BN 3.5MM 30MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-0320 SUP HCPCS C1713 FA-0320 - SCREW BN 3.5MM 32MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-0340 SUP HCPCS C1713 FA-0340 - SCREW BN 3.5MM 34MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $492.50 $492.50 $102.64 $492.50 N/A N/A FA-0360 SUP HCPCS C1713 FA-0360 - SCREW BN 3.5MM 36MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $197.00 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-0380 SUP HCPCS C1713 FA-0380 - SCREW BN 3.5MM 38MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-0400 SUP HCPCS C1713 FA-0400 - SCREW BN 3.5MM 40MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $492.50 $492.50 $102.64 $492.50 N/A N/A FA-04020 SUP Custom 27203010 FA-04020 - KIT ARTERIAL LINE .018IN 20GA 22GA 1.75IN CATHETER RADIOPQ BOTH IP/OP $34.50 $26.00 $6.12 $34.40 $34.40 $34.40 $34.40 $34.40 $34.40 $34.40 $6.12 $34.40 $34.40 $25.53 $25.53 $26.52 $17.92 $7.17 $34.40 $13.76 $34.40 $34.40 $34.40 $34.40 $34.40 $25.88 $34.40 $34.40 $34.40 $17.20 $17.20 $27.24 $34.40 $27.52 $22.36 $34.40 N/A $20.01 $34.40 $20.64 $34.40 $34.40 $34.40 N/A N/A FA-0420 SUP HCPCS C1713 FA-0420 - SCREW BN 3.5MM 42MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-4014 SUP HCPCS C1713 FA-4014 - SCREW BN 4MM 14MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-4016 SUP HCPCS C1713 FA-4016 - SCREW BN 4MM 16MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $197.00 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-4018 SUP HCPCS C1713 FA-4018 - SCREW BN 4MM 18MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-4020 SUP HCPCS C1713 FA-4020 - SCREW BN 4MM 20MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-4022 SUP HCPCS C1713 FA-4022 - SCREW BN 4MM 22MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-4024 SUP HCPCS C1713 FA-4024 - SCREW BN 4MM 24MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-4026 SUP HCPCS C1713 FA-4026 - SCREW BN 4MM 26MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $197.00 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-4028 SUP HCPCS C1713 FA-4028 - SCREW BN 4MM 28MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-4030 SUP HCPCS C1713 FA-4030 - SCREW BN 4MM 30MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-4032 SUP HCPCS C1713 FA-4032 - SCREW BN 4MM 32MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-4034 SUP HCPCS C1713 FA-4034 - SCREW BN 4MM 34MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-4036 SUP HCPCS C1713 FA-4036 - SCREW BN 4MM 36MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-4038 SUP HCPCS C1713 FA-4038 - SCREW BN 4MM 38MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $492.50 $492.50 $102.64 $492.50 N/A N/A FA-4040 SUP HCPCS C1713 FA-4040 - SCREW BN 4MM 40MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-4042 SUP HCPCS C1713 FA-4042 - SCREW BN 4MM 42MM CNN XTRMT BOTH IP/OP $492.50 $364.00 $97.75 $492.50 $221.63 $221.63 $221.63 $221.63 $492.50 $492.50 $492.50 $102.65 $492.50 $492.50 $492.50 $492.50 $492.50 $102.64 $492.50 $492.50 $291.31 $492.50 $492.50 $492.50 $492.50 $369.38 $492.50 $492.50 $492.50 $246.25 $246.25 $390.06 $492.50 $394.00 $221.63 $97.75 N/A $285.65 $492.50 $295.50 $492.50 $102.64 $492.50 N/A N/A FA-55150-1030 SUP HCPCS C1876 FA-55150-1030 - CATHETER INFS MIC 2.8-3.2FR .027IN 150CM 10CM MARKSMAN 1 LUM BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A FA-88810-20 SUP Custom 27803010 FA-88810-20 - DEVICE SPEC RTRVL 2IN ALGTR ATRM TIP FLXB MIC MOV CNTRL 4 BOTH IP/OP "$6,562.50" "$4,856.00" "$1,168.13" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$1,168.13" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$1,367.70" "$6,562.50" "$2,625.00" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$4,921.88" "$6,562.50" "$6,562.50" "$6,562.50" "$3,281.25" "$3,281.25" "$5,197.50" "$6,562.50" "$5,250.00" "$2,953.13" "$6,562.50" N/A "$3,806.25" "$6,562.50" "$3,937.50" "$6,562.50" "$6,562.50" "$6,562.50" N/A N/A FA-88810-30 SUP HCPCS C1751 FA-88810-30 - DEVICE SPEC RTRVL 3MM ALGTR ATRM TIP FLXB MIC MOV CNTRL 4 BOTH IP/OP "$6,562.50" "$4,856.00" "$1,302.49" "$6,562.50" "$3,563.44" "$3,563.44" "$3,563.44" "$3,563.44" "$6,562.50" "$6,562.50" "$6,562.50" "$1,367.79" "$6,562.50" "$4,181.12" "$4,181.12" "$5,058.38" "$2,060.15" "$1,367.70" "$6,562.50" "$6,562.50" "$3,094.73" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$4,921.88" "$6,562.50" "$6,562.50" "$6,562.50" "$3,281.25" "$3,281.25" "$5,197.50" "$6,562.50" "$5,250.00" "$4,265.63" "$1,302.49" N/A "$3,806.25" "$6,562.50" "$6,562.50" "$6,562.50" "$1,367.63" "$6,562.50" N/A N/A FA-88810-40 SUP Custom 27803010 FA-88810-40 - DEVICE SPEC RTRVL 4MM ALGTR ATRM TIP FLXB MIC MOV CNTRL 4 BOTH IP/OP "$6,562.50" "$4,856.00" "$1,168.13" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$1,168.13" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$1,367.70" "$6,562.50" "$2,625.00" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$4,921.88" "$6,562.50" "$6,562.50" "$6,562.50" "$3,281.25" "$3,281.25" "$5,197.50" "$6,562.50" "$5,250.00" "$2,953.13" "$6,562.50" N/A "$3,806.25" "$6,562.50" "$3,937.50" "$6,562.50" "$6,562.50" "$6,562.50" N/A N/A FA-88810-50 SUP Custom 27803010 FA-88810-50 - DEVICE SPEC RTRVL 5MM ALGTR ATRM TIP FLXB MIC MOV CNTRL 4 BOTH IP/OP "$6,562.50" "$4,856.00" "$1,168.13" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$1,168.13" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$1,367.70" "$6,562.50" "$2,625.00" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$6,562.50" "$4,921.88" "$6,562.50" "$6,562.50" "$6,562.50" "$3,281.25" "$3,281.25" "$5,197.50" "$6,562.50" "$5,250.00" "$2,953.13" "$6,562.50" N/A "$3,806.25" "$6,562.50" "$3,937.50" "$6,562.50" "$6,562.50" "$6,562.50" N/A N/A FA-9020 SUP HCPCS C1713 FA-9020 - DRILL SRG XTRMT 3.5 MM SCR BOTH IP/OP $355.00 $263.00 $70.46 $355.00 $159.75 $159.75 $159.75 $159.75 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $355.00 $355.00 $355.00 $73.99 $355.00 $355.00 $209.98 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $159.75 $70.46 N/A $205.90 $355.00 $213.00 $355.00 $73.98 $355.00 N/A N/A FA-CO2736 SUP HCPCS C1713 FA-CO2736 - SCREW BONE 2.7MM 36MM TAP-LOC TITANIUM ELBOW NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $232.50 $232.50 N/A N/A FA-CO2738 SUP HCPCS C1713 FA-CO2738 - SCREW BONE 2.7MM 38MM TAP-LOC TITANIUM ELBOW NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A FA-CO2740 SUP HCPCS C1713 FA-CO2740 - SCREW BONE 2.7MM 40MM TAP-LOC CORTICAL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A FA-CO2745 SUP HCPCS C1713 FA-CO2745 - SCREW BONE 2.7MM 45MM LOCK TAP TAP-LOC TITANIUM ELBOW BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A FA-CO2750 SUP HCPCS C1713 FA-CO2750 - SCREW BONE 2.7MM 50MM SLFTAP LOCKING TAP-LOC TITANIUM BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A FA-CO2755 SUP HCPCS C1713 FA-CO2755 - SCREW BONE 2.7MM 55MM LOCK TAP TAP-LOC TITANIUM ELBOW BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A FA-CO2760 SUP HCPCS C1713 FA-CO2760 - SCREW BONE 2.7MM 60MM LOCK TAP TAP-LOC TITANIUM ELBOW BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A FA-CO3536 SUP HCPCS C1713 FA-CO3536 - SCREW BONE 3.5MM 36MM TAP-LOC TITANIUM ELBOW NONSTRL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A FA-CO3538 SUP HCPCS C1713 FA-CO3538 - SCREW BN 3.5MM 38MM TAP LCK BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A FA-CO3540 SUP HCPCS C1713 FA-CO3540 - SCREW BONE 3.5MM 40MM LOCK TAP TAP-LOC TITANIUM ELBOW BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A FA-CO3545 SUP HCPCS C1713 FA-CO3545 - SCREW BONE 3.5MM 45MM TAP-LOC TITANIUM ELBOW CORTICAL BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A FA-CO3550 SUP HCPCS C1713 FA-CO3550 - SCREW BN 3.5MM 50MM NS TPRLK CORT BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $139.50 $232.50 $48.45 $232.50 N/A N/A FA-CO3555 SUP HCPCS C1713 FA-CO3555 - SCREW BN 3.5MM 55MM NS LCK TAP TI ELB PLT SYS BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $93.00 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A FA-CO3560 SUP HCPCS C1713 FA-CO3560 - SCREW BN 3.5MM 60MM NS LCK TAP TI ELB PLT SYS BOTH IP/OP $232.50 $172.00 $46.15 $232.50 $104.63 $104.63 $104.63 $104.63 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $232.50 $232.50 $232.50 $48.46 $232.50 $232.50 $137.52 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $104.63 $46.15 N/A $134.85 $232.50 $232.50 $232.50 $48.45 $232.50 N/A N/A FBRC SUP HCPCS C1884 FBRC - SYSTEM REM .035IN 10FR 75CM RCVR CN WRE BSKT RADOPQ PEBAX BOTH IP/OP "$1,593.50" "$1,179.00" $316.26 "$1,593.45" $717.05 $717.05 $717.05 $717.05 "$1,593.45" "$1,593.45" "$1,593.45" $332.11 "$1,593.45" "$1,593.45" "$1,593.45" "$1,593.45" "$1,593.45" $332.09 "$1,593.45" "$1,593.45" $942.53 "$1,593.45" "$1,593.45" "$1,593.45" "$1,593.45" "$1,195.13" "$1,593.45" "$1,593.45" "$1,593.45" $796.73 $796.73 "$1,262.01" "$1,593.45" "$1,274.76" $717.05 $316.26 N/A $924.23 "$1,593.45" "$1,593.45" "$1,593.45" $332.07 "$1,593.45" N/A N/A FC-10-30-3D SUP Custom 27203010 FC-10-30-3D - COIL EMBL 3D 10MM 30CM AXIUM FRM V01 BOTH IP/OP "$5,237.50" "$3,876.00" $932.28 "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" $932.28 "$5,237.50" "$5,237.50" "$3,887.27" "$3,887.27" "$4,037.07" "$2,060.15" "$1,091.55" "$5,237.50" "$2,095.00" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$3,928.13" "$5,237.50" "$5,237.50" "$5,237.50" "$2,618.75" "$2,618.75" "$4,148.10" "$5,237.50" "$4,190.00" "$3,404.38" "$5,237.50" N/A "$3,037.75" "$5,237.50" "$3,142.50" "$5,237.50" "$5,237.50" "$5,237.50" N/A N/A FC-10-40-3D SUP Custom 27203010 FC-10-40-3D - COIL EMBL 3D 10MM 40CM AXIUM FRM NRVSC V01 BOTH IP/OP "$5,237.50" "$3,876.00" $932.28 "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" $932.28 "$5,237.50" "$5,237.50" "$3,887.27" "$3,887.27" "$4,037.07" "$2,060.15" "$1,091.55" "$5,237.50" "$2,095.00" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$3,928.13" "$5,237.50" "$5,237.50" "$5,237.50" "$2,618.75" "$2,618.75" "$4,148.10" "$5,237.50" "$4,190.00" "$3,404.38" "$5,237.50" N/A "$3,037.75" "$5,237.50" "$3,142.50" "$5,237.50" "$5,237.50" "$5,237.50" N/A N/A FC-14-50-3D SUP Custom 27203010 FC-14-50-3D - COIL EMBL 3D 14MM 50CM AXIUM FRM NRVSC V01 BOTH IP/OP "$5,237.50" "$3,876.00" $932.28 "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" $932.28 "$5,237.50" "$5,237.50" "$3,887.27" "$3,887.27" "$4,037.07" "$2,060.15" "$1,091.55" "$5,237.50" "$2,095.00" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$3,928.13" "$5,237.50" "$5,237.50" "$5,237.50" "$2,618.75" "$2,618.75" "$4,148.10" "$5,237.50" "$4,190.00" "$3,404.38" "$5,237.50" N/A "$3,037.75" "$5,237.50" "$3,142.50" "$5,237.50" "$5,237.50" "$5,237.50" N/A N/A FC-16-50-3D SUP Custom 27203010 FC-16-50-3D - COIL EMBL 3D 16MM 50CM AXIUM FRM NRVSC V01 BOTH IP/OP "$5,237.50" "$3,876.00" $932.28 "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" $932.28 "$5,237.50" "$5,237.50" "$3,887.27" "$3,887.27" "$4,037.07" "$2,060.15" "$1,091.55" "$5,237.50" "$2,095.00" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$3,928.13" "$5,237.50" "$5,237.50" "$5,237.50" "$2,618.75" "$2,618.75" "$4,148.10" "$5,237.50" "$4,190.00" "$3,404.38" "$5,237.50" N/A "$3,037.75" "$5,237.50" "$3,142.50" "$5,237.50" "$5,237.50" "$5,237.50" N/A N/A FC-18-50-3D SUP Custom 27203010 FC-18-50-3D - COIL EMBL 3D 18MM 50CM AXIUM FRM NRVSC V01 BOTH IP/OP "$5,237.50" "$3,876.00" $932.28 "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" $932.28 "$5,237.50" "$5,237.50" "$3,887.27" "$3,887.27" "$4,037.07" "$2,060.15" "$1,091.55" "$5,237.50" "$2,095.00" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$3,928.13" "$5,237.50" "$5,237.50" "$5,237.50" "$2,618.75" "$2,618.75" "$4,148.10" "$5,237.50" "$4,190.00" "$3,404.38" "$5,237.50" N/A "$3,037.75" "$5,237.50" "$3,142.50" "$5,237.50" "$5,237.50" "$5,237.50" N/A N/A FC-22-50-3D SUP Custom 27203010 FC-22-50-3D - COIL EMBL 3D 22MM 50CM AXIUM FRM V01 BOTH IP/OP "$5,237.50" "$3,876.00" $932.28 "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" $932.28 "$5,237.50" "$5,237.50" "$3,887.27" "$3,887.27" "$4,037.07" "$2,060.15" "$1,091.55" "$5,237.50" "$2,095.00" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$3,928.13" "$5,237.50" "$5,237.50" "$5,237.50" "$2,618.75" "$2,618.75" "$4,148.10" "$5,237.50" "$4,190.00" "$3,404.38" "$5,237.50" N/A "$3,037.75" "$5,237.50" "$3,142.50" "$5,237.50" "$5,237.50" "$5,237.50" N/A N/A FC-7-30-3D SUP Custom 27203010 FC-7-30-3D - COIL EMBL 3D 7MM 30CM AXIUM FRM V01 BOTH IP/OP "$4,487.50" "$3,321.00" $798.78 "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" $798.78 "$4,487.50" "$4,487.50" "$3,330.62" "$3,330.62" "$3,458.97" "$2,060.15" $935.24 "$4,487.50" "$1,795.00" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$3,365.63" "$4,487.50" "$4,487.50" "$4,487.50" "$2,243.75" "$2,243.75" "$3,554.10" "$4,487.50" "$3,590.00" "$2,916.88" "$4,487.50" N/A "$2,602.75" "$4,487.50" "$2,692.50" "$4,487.50" "$4,487.50" "$4,487.50" N/A N/A FC-8-30-3D SUP Custom 27203010 FC-8-30-3D - COIL EMBL 3D 8MM 30CM AXIUM FRM V01 BOTH IP/OP "$5,237.50" "$3,876.00" $932.28 "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" $932.28 "$5,237.50" "$5,237.50" "$3,887.27" "$3,887.27" "$4,037.07" "$2,060.15" "$1,091.55" "$5,237.50" "$2,095.00" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$3,928.13" "$5,237.50" "$5,237.50" "$5,237.50" "$2,618.75" "$2,618.75" "$4,148.10" "$5,237.50" "$4,190.00" "$3,404.38" "$5,237.50" N/A "$3,037.75" "$5,237.50" "$3,142.50" "$5,237.50" "$5,237.50" "$5,237.50" N/A N/A FD-410LR SUP Custom 27203010 FD-410LR - FORCEPS MNPLR 2.75MM 2.8MM 165X5MM STRL COAGRASPER HMSTS BOTH IP/OP $464.00 $343.00 $82.51 $463.53 $463.53 $463.53 $463.53 $463.53 $463.53 $463.53 $82.51 $463.53 $463.53 $344.03 $344.03 $357.29 $241.50 $96.60 $463.53 $185.41 $463.53 $463.53 $463.53 $463.53 $463.53 $348.00 $463.53 $463.53 $463.53 $231.77 $231.77 $367.12 $463.53 $370.82 $301.29 $463.53 N/A $269.12 $463.53 $278.12 $463.53 $463.53 $463.53 N/A N/A FD-411UR SUP Custom 27203010 FD-411UR - FORCEPS MNPLR 2.75MM 3.2MM 230X4MM STRL COAGRASPER HMSTS BOTH IP/OP $589.00 $436.00 $104.82 $588.85 $588.85 $588.85 $588.85 $588.85 $588.85 $588.85 $104.82 $588.85 $588.85 $437.04 $437.04 $453.89 $306.79 $122.72 $588.85 $235.54 $588.85 $588.85 $588.85 $588.85 $588.85 $441.75 $588.85 $588.85 $588.85 $294.43 $294.43 $466.37 $588.85 $471.08 $382.75 $588.85 N/A $341.62 $588.85 $353.31 $588.85 $588.85 $588.85 N/A N/A FD-412LR SUP Custom 27203010 FD-412LR - FORCEPS ESCP 2.8MM 2.75MM 165CM COAGRASPER HMST GRSPR MNPLR BOTH IP/OP $464.00 $343.00 $82.51 $463.53 $463.53 $463.53 $463.53 $463.53 $463.53 $463.53 $82.51 $463.53 $463.53 $344.03 $344.03 $357.29 $241.50 $96.60 $463.53 $185.41 $463.53 $463.53 $463.53 $463.53 $463.53 $348.00 $463.53 $463.53 $463.53 $231.77 $231.77 $367.12 $463.53 $370.82 $301.29 $463.53 N/A $269.12 $463.53 $278.12 $463.53 $463.53 $463.53 N/A N/A FE660K SUP Custom 27803010 FE660K - CLIP ANEURYSM STANDARD 10.3MM OPENING 5MM 12MM STR FENST BOTH IP/OP "$1,014.00" $750.00 $180.42 "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" $180.42 "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" $211.24 "$1,013.59" $405.44 "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" $760.50 "$1,013.59" "$1,013.59" "$1,013.59" $506.80 $506.80 $802.76 "$1,013.59" $810.87 $456.12 "$1,013.59" N/A $588.12 "$1,013.59" $608.15 "$1,013.59" "$1,013.59" "$1,013.59" N/A N/A FE664K SUP Custom 27803010 FE664K - CLIP ANEURYSM 5.5MM OPEN STANDARD 5MM 10/6.4MM PERMANENT BOTH IP/OP "$1,014.00" $750.00 $180.42 "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" $180.42 "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" $211.24 "$1,013.59" $405.44 "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" $760.50 "$1,013.59" "$1,013.59" "$1,013.59" $506.80 $506.80 $802.76 "$1,013.59" $810.87 $456.12 "$1,013.59" N/A $588.12 "$1,013.59" $608.15 "$1,013.59" "$1,013.59" "$1,013.59" N/A N/A FE776K SUP Custom 27803010 FE776K - CLIP ANEURYSM STANDARD 5MM OPENING 5MM 10MM CVD DOWN FENST BOTH IP/OP "$1,014.00" $750.00 $180.42 "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" $180.42 "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" $211.24 "$1,013.59" $405.44 "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" $760.50 "$1,013.59" "$1,013.59" "$1,013.59" $506.80 $506.80 $802.76 "$1,013.59" $810.87 $456.12 "$1,013.59" N/A $588.12 "$1,013.59" $608.15 "$1,013.59" "$1,013.59" "$1,013.59" N/A N/A FE779K SUP Custom 27803010 FE779K - CLIP ANEURYSM STANDARD 5MM OPENING 5MM 10MM CVD UP FENST BOTH IP/OP "$1,014.00" $750.00 $180.42 "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" $180.42 "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" $211.24 "$1,013.59" $405.44 "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" "$1,013.59" $760.50 "$1,013.59" "$1,013.59" "$1,013.59" $506.80 $506.80 $802.76 "$1,013.59" $810.87 $456.12 "$1,013.59" N/A $588.12 "$1,013.59" $608.15 "$1,013.59" "$1,013.59" "$1,013.59" N/A N/A FEM08040 SUP HCPCS C1876 FEM08040 - GRAFT STNT 8MM 9FR 40MM 80CM FLN + 2 LYR KINK RST INR CATH BOTH IP/OP "$7,857.50" "$5,815.00" "$1,559.52" "$7,857.50" "$3,535.88" "$3,535.88" "$3,535.88" "$3,535.88" "$7,857.50" "$7,857.50" "$7,857.50" "$1,637.70" "$7,857.50" "$7,857.50" "$7,857.50" "$7,857.50" "$7,857.50" "$1,637.59" "$7,857.50" "$7,857.50" "$3,873.75" "$7,857.50" "$7,857.50" "$7,857.50" "$7,857.50" "$5,893.13" "$7,857.50" "$7,857.50" "$7,857.50" "$3,928.75" "$3,928.75" "$6,223.14" "$7,857.50" "$6,286.00" "$3,535.88" "$1,559.52" N/A "$4,557.35" "$7,857.50" "$7,857.50" "$7,857.50" "$1,637.50" "$7,857.50" N/A N/A FEMII016AS SUP Custom 27203010 FEMII016AS - CANNULA PERFUSION 3/8IN ULTRA THIN WALL TAPER 16FR 9.5IN 6IN BOTH IP/OP $592.50 $438.00 $105.43 $592.30 $592.30 $592.30 $592.30 $592.30 $592.30 $592.30 $105.43 $592.30 $592.30 $439.61 $439.61 $456.54 $308.59 $123.44 $592.30 $236.92 $592.30 $592.30 $592.30 $592.30 $592.30 $444.38 $592.30 $592.30 $592.30 $296.15 $296.15 $469.10 $592.30 $473.84 $385.00 $592.30 N/A $343.65 $592.30 $355.38 $592.30 $592.30 $592.30 N/A N/A FEMII018AS SUP Custom 27203010 FEMII018AS - CANNULA PERFUSION 3/8IN ULTRA-THIN WALL TAPER 18FR 9.5IN 6IN BOTH IP/OP $592.50 $438.00 $105.43 $592.30 $592.30 $592.30 $592.30 $592.30 $592.30 $592.30 $105.43 $592.30 $592.30 $439.61 $439.61 $456.54 $308.59 $123.44 $592.30 $236.92 $592.30 $592.30 $592.30 $592.30 $592.30 $444.38 $592.30 $592.30 $592.30 $296.15 $296.15 $469.10 $592.30 $473.84 $385.00 $592.30 N/A $343.65 $592.30 $355.38 $592.30 $592.30 $592.30 N/A N/A FEMII020AS SUP Custom 27203010 FEMII020AS - CANNULA PERFUSION 3/8IN ULTRA THIN WALL TAPER 20FR 9.5IN 6IN BOTH IP/OP $592.50 $438.00 $105.43 $592.30 $592.30 $592.30 $592.30 $592.30 $592.30 $592.30 $105.43 $592.30 $592.30 $439.61 $439.61 $456.54 $308.59 $123.44 $592.30 $236.92 $592.30 $592.30 $592.30 $592.30 $592.30 $444.38 $592.30 $592.30 $592.30 $296.15 $296.15 $469.10 $592.30 $473.84 $385.00 $592.30 N/A $343.65 $592.30 $355.38 $592.30 $592.30 $592.30 N/A N/A FG-0201 SUP Custom 27203010 FG-0201 - DEVICE TISS REM 3.6MM SYMPHION RESCT BOTH IP/OP "$4,120.00" "$3,049.00" $733.36 "$4,120.00" "$4,120.00" "$4,120.00" "$4,120.00" "$4,120.00" "$4,120.00" "$4,120.00" $733.36 "$4,120.00" "$4,120.00" "$3,057.86" "$3,057.86" "$3,175.70" "$2,060.15" $858.65 "$4,120.00" "$1,648.00" "$4,120.00" "$4,120.00" "$4,120.00" "$4,120.00" "$4,120.00" "$3,090.00" "$4,120.00" "$4,120.00" "$4,120.00" "$2,060.00" "$2,060.00" "$3,263.04" "$4,120.00" "$3,296.00" "$2,678.00" "$4,120.00" N/A "$2,389.60" "$4,120.00" "$2,472.00" "$4,120.00" "$4,120.00" "$4,120.00" N/A N/A FG-0202 SUP Custom 27203010 FG-0202 - TISSUE REMOVAL SYSTEM FLUID MANAGEMENT ACCESSORIES BOTH IP/OP "$1,285.00" $951.00 $228.72 "$1,284.93" "$1,284.93" "$1,284.93" "$1,284.93" "$1,284.93" "$1,284.93" "$1,284.93" $228.72 "$1,284.93" "$1,284.93" $953.68 $953.68 $990.42 $669.45 $267.79 "$1,284.93" $513.97 "$1,284.93" "$1,284.93" "$1,284.93" "$1,284.93" "$1,284.93" $963.75 "$1,284.93" "$1,284.93" "$1,284.93" $642.47 $642.47 "$1,017.66" "$1,284.93" "$1,027.94" $835.20 "$1,284.93" N/A $745.30 "$1,284.93" $770.96 "$1,284.93" "$1,284.93" "$1,284.93" N/A N/A FG-44NR-1 SUP Custom 27203010 FG-44NR-1 - FORCEP SPEC RTRVL 180CM 2.8MM BRNCHL FB ROT ALGTR JAW RAT BOTH IP/OP "$1,164.00" $861.00 $207.12 "$1,163.58" "$1,163.58" "$1,163.58" "$1,163.58" "$1,163.58" "$1,163.58" "$1,163.58" $207.12 "$1,163.58" "$1,163.58" $863.61 $863.61 $896.89 $606.23 $242.50 "$1,163.58" $465.43 "$1,163.58" "$1,163.58" "$1,163.58" "$1,163.58" "$1,163.58" $873.00 "$1,163.58" "$1,163.58" "$1,163.58" $581.79 $581.79 $921.56 "$1,163.58" $930.86 $756.33 "$1,163.58" N/A $675.12 "$1,163.58" $698.15 "$1,163.58" "$1,163.58" "$1,163.58" N/A N/A FGL07560 SUP HCPCS L8699 FGL07560 - GRAFT SFT TIS 7.5MM 60MM FLEXIGRAFT GRAFTLINK ALGRF FRZN BOTH IP/OP "$6,160.00" "$4,558.00" "$1,283.81" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$1,283.81" "$6,160.00" "$2,661.12" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$6,160.00" "$4,620.00" "$6,160.00" "$6,160.00" "$6,160.00" "$3,080.00" "$3,080.00" "$4,878.72" "$6,160.00" "$4,928.00" "$2,772.00" "$6,160.00" N/A "$3,572.80" "$6,160.00" "$3,696.00" "$6,160.00" "$6,160.00" "$6,160.00" N/A N/A FP-07.24.0 SUP HCPCS C1713 FP-07.24.0 - CAGE SPNL 24MMX7MM FUSE 0D PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A FP-08.24.0 SUP HCPCS C1713 FP-08.24.0 - CAGE SPNL 24MMX8MM FUSE 0D PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A FP-09.24.4 SUP HCPCS C1713 FP-09.24.4 - CAGE SPNL 24MMX9MM FUSE 4D PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A FP-09.24.8 SUP HCPCS C1713 FP-09.24.8 - CAGE SPNL 24MMX9MM FUSE 8D PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A FP-10.24.4 SUP HCPCS C1713 FP-10.24.4 - CAGE SPNL 24MMX10MM FUSE 4D PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A FP-10.24.8 SUP HCPCS C1713 FP-10.24.8 - CAGE SPNL 24MMX10MM FUSE 8D PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A FP-11.24.4 SUP HCPCS C1713 FP-11.24.4 - CAGE SPNL 24MMX11MM FUSE 4D PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A FP-11.24.8 SUP HCPCS C1713 FP-11.24.8 - CAGE SPNL 24MMX11MM FUSE 8D PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A FP-12.24.4 SUP HCPCS C1713 FP-12.24.4 - CAGE SPNL 24MMX12MM FUSE 4D PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A FP-12.24.8 SUP HCPCS C1713 FP-12.24.8 - CAGE SPNL 24MMX12MM FUSE 8D PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A FP-13.24.4 SUP HCPCS C1713 FP-13.24.4 - CAGE SPNL 24MMX13MM FUSE 4D PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A FP-13.24.8 SUP HCPCS C1713 FP-13.24.8 - CAGE SPNL 24MMX13MM FUSE 8D PLIF BOTH IP/OP "$7,500.00" "$5,550.00" "$1,488.56" "$7,500.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.19" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$7,500.00" "$3,697.50" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$1,488.56" N/A "$4,350.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.00" "$7,500.00" N/A N/A FP-14 SUP HCPCS C1713 FP-14 - PEG FIX 2.5MM 14MM FULTHD BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A FP-16 SUP HCPCS C1713 FP-16 - PEG FIX 2.5MM 16MM FULTHD BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $105.00 $175.00 $36.47 $175.00 N/A N/A FP-20 SUP HCPCS C1713 FP-20 - PEG FIX 2.5MM 20MM FULTHD BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $105.00 $175.00 $36.47 $175.00 N/A N/A FP-26 SUP HCPCS C1713 FP-26 - PEG FIX 2.5MM 26MM FULTHD BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $105.00 $175.00 $36.47 $175.00 N/A N/A FP-7 SUP HCPCS C1783 FP-7 - DRAIN GLAUCOMA THK.9MM BLUNT TAPER .635MM .305MM 16X13MM 25 BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$2,500.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$2,500.00" "$1,035.13" "$1,750.00" "$2,500.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A FR995-27 SUP Custom 27803010 FR995-27 - VALVE AOR 27MM 34MM STRL 3MM FRSTL BPRTH PRCN ROOT BOTH IP/OP "$23,125.00" "$17,113.00" "$4,116.25" "$23,125.00" "$23,125.00" "$23,125.00" "$23,125.00" "$23,125.00" "$23,125.00" "$23,125.00" "$4,116.25" "$23,125.00" "$23,125.00" "$23,125.00" "$23,125.00" "$23,125.00" "$23,125.00" "$4,819.50" "$23,125.00" "$9,250.00" "$23,125.00" "$23,125.00" "$23,125.00" "$23,125.00" "$23,125.00" "$17,343.75" "$23,125.00" "$23,125.00" "$23,125.00" "$11,562.50" "$11,562.50" "$18,315.00" "$23,125.00" "$18,500.00" "$10,406.25" "$23,125.00" N/A "$13,412.50" "$23,125.00" "$13,875.00" "$23,125.00" "$23,125.00" "$23,125.00" N/A N/A FR995-29 SUP Custom 27803010 FR995-29 - FREESTYLE ROOT VALVE 29 MM BOTH IP/OP "$15,330.00" "$11,344.00" "$2,728.74" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$2,728.74" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$3,194.94" "$15,330.00" "$6,132.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$15,330.00" "$11,497.50" "$15,330.00" "$15,330.00" "$15,330.00" "$7,665.00" "$7,665.00" "$12,141.36" "$15,330.00" "$12,264.00" "$6,898.50" "$15,330.00" N/A "$8,891.40" "$15,330.00" "$9,198.00" "$15,330.00" "$15,330.00" "$15,330.00" N/A N/A FS0808 SUP HCPCS C1781 FS0808 - GRAFT SNTH TISS 8X8CM BIO-A BABSR REINF SCFLD TISS BOTH IP/OP "$1,022.50" $757.00 $202.94 "$1,022.50" $460.13 $460.13 $460.13 $460.13 "$1,022.50" "$1,022.50" "$1,022.50" $213.11 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $213.10 "$1,022.50" "$1,022.50" $604.81 "$1,022.50" "$1,022.50" "$1,022.50" "$1,022.50" $766.88 "$1,022.50" "$1,022.50" "$1,022.50" $511.25 $511.25 $809.82 "$1,022.50" $818.00 $460.13 $202.94 N/A $593.05 "$1,022.50" "$1,022.50" "$1,022.50" $213.09 "$1,022.50" N/A N/A FS0915 SUP HCPCS C1781 FS0915 - GRAFT SNTH TISS 15X9CM GORE BIO-A BABSR SCFLD BOTH IP/OP "$1,825.00" "$1,351.00" $362.22 "$1,825.00" $821.25 $821.25 $821.25 $821.25 "$1,825.00" "$1,825.00" "$1,825.00" $380.38 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" "$1,825.00" "$1,079.49" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 $362.22 N/A "$1,058.50" "$1,825.00" "$1,825.00" "$1,825.00" $380.33 "$1,825.00" N/A N/A FS1030 SUP HCPCS C1781 FS1030 - MESH SRG 30X10CM BIO-ASNTH BABSR REINF SCFLD TRM TISS BOTH IP/OP "$5,027.50" "$3,720.00" $997.83 "$5,027.50" "$2,262.38" "$2,262.38" "$2,262.38" "$2,262.38" "$5,027.50" "$5,027.50" "$5,027.50" "$1,047.86" "$5,027.50" "$5,027.50" "$5,027.50" "$5,027.50" "$5,027.50" "$1,047.79" "$5,027.50" "$5,027.50" "$2,478.56" "$5,027.50" "$5,027.50" "$5,027.50" "$5,027.50" "$3,770.63" "$5,027.50" "$5,027.50" "$5,027.50" "$2,513.75" "$2,513.75" "$3,981.78" "$5,027.50" "$4,022.00" "$2,262.38" $997.83 N/A "$2,915.95" "$5,027.50" "$5,027.50" "$5,027.50" "$1,047.73" "$5,027.50" N/A N/A FS2020 SUP HCPCS C1781 FS2020 - GRAFT SNTH TISS 20X20CM BIO-A BABSR REINF SCFLD TISS BOTH IP/OP "$6,712.50" "$4,967.00" "$1,332.26" "$6,712.50" "$3,020.63" "$3,020.63" "$3,020.63" "$3,020.63" "$6,712.50" "$6,712.50" "$6,712.50" "$1,399.05" "$6,712.50" "$6,712.50" "$6,712.50" "$6,712.50" "$6,712.50" "$1,398.96" "$6,712.50" "$6,712.50" "$3,309.26" "$6,712.50" "$6,712.50" "$6,712.50" "$6,712.50" "$5,034.38" "$6,712.50" "$6,712.50" "$6,712.50" "$3,356.25" "$3,356.25" "$5,316.30" "$6,712.50" "$5,370.00" "$3,020.63" "$1,332.26" N/A "$3,893.25" "$6,712.50" "$6,712.50" "$6,712.50" "$1,398.89" "$6,712.50" N/A N/A FS2030 SUP HCPCS C1781 FS2030 - MESH SRG 30X20CM BIO-A BABSR REINF SCFLD TISS BOTH IP/OP "$10,080.00" "$7,459.00" "$2,000.63" "$10,080.00" "$4,536.00" "$4,536.00" "$4,536.00" "$4,536.00" "$10,080.00" "$10,080.00" "$10,080.00" "$2,100.92" "$10,080.00" "$10,080.00" "$10,080.00" "$10,080.00" "$10,080.00" "$2,100.78" "$10,080.00" "$10,080.00" "$4,969.44" "$10,080.00" "$10,080.00" "$10,080.00" "$10,080.00" "$7,560.00" "$10,080.00" "$10,080.00" "$10,080.00" "$5,040.00" "$5,040.00" "$7,983.36" "$10,080.00" "$8,064.00" "$4,536.00" "$2,000.63" N/A "$5,846.40" "$10,080.00" "$10,080.00" "$10,080.00" "$2,100.67" "$10,080.00" N/A N/A FSR100201-20 SUP Custom 27803010 FSR100201-20 - COIL EMBL HLCL 2MM 1CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH BOTH IP/OP "$2,166.00" "$1,603.00" $385.54 "$2,165.95" "$2,165.95" "$2,165.95" "$2,165.95" "$2,165.95" "$2,165.95" "$2,165.95" $385.54 "$2,165.95" "$2,165.95" "$2,165.95" "$2,165.95" "$2,165.95" "$2,165.95" $451.41 "$2,165.95" $866.38 "$2,165.95" "$2,165.95" "$2,165.95" "$2,165.95" "$2,165.95" "$1,624.50" "$2,165.95" "$2,165.95" "$2,165.95" "$1,082.98" "$1,082.98" "$1,715.43" "$2,165.95" "$1,732.76" $974.68 "$2,165.95" N/A "$1,256.28" "$2,165.95" "$1,299.57" "$2,165.95" "$2,165.95" "$2,165.95" N/A N/A FSR100202-20 SUP Custom 27803010 FSR100202-20 - COIL EMBL HLCL 2MM 2CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH BOTH IP/OP "$2,195.50" "$1,625.00" $390.75 "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" $390.75 "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" $457.51 "$2,195.23" $878.09 "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" "$1,646.63" "$2,195.23" "$2,195.23" "$2,195.23" "$1,097.62" "$1,097.62" "$1,738.62" "$2,195.23" "$1,756.18" $987.85 "$2,195.23" N/A "$1,273.39" "$2,195.23" "$1,317.14" "$2,195.23" "$2,195.23" "$2,195.23" N/A N/A FSR100203-20 SUP Custom 27803010 FSR100203-20 - COIL EMBL HLCL 2MM 3CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH BOTH IP/OP "$2,224.50" "$1,646.00" $395.96 "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" $395.96 "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" $463.61 "$2,224.50" $889.80 "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$1,668.38" "$2,224.50" "$2,224.50" "$2,224.50" "$1,112.25" "$1,112.25" "$1,761.80" "$2,224.50" "$1,779.60" "$1,001.03" "$2,224.50" N/A "$1,290.21" "$2,224.50" "$1,334.70" "$2,224.50" "$2,224.50" "$2,224.50" N/A N/A FSR100204-20 SUP Custom 27803010 FSR100204-20 - COIL EMBL HLCL 2MM 4CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH BOTH IP/OP "$2,224.50" "$1,646.00" $395.96 "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" $395.96 "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" $463.61 "$2,224.50" $889.80 "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$1,668.38" "$2,224.50" "$2,224.50" "$2,224.50" "$1,112.25" "$1,112.25" "$1,761.80" "$2,224.50" "$1,779.60" "$1,001.03" "$2,224.50" N/A "$1,290.21" "$2,224.50" "$1,334.70" "$2,224.50" "$2,224.50" "$2,224.50" N/A N/A FSR100206-20 SUP Custom 27803010 FSR100206-20 - COIL EMBL HLCL 2MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH BOTH IP/OP "$2,254.00" "$1,668.00" $401.17 "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" $401.17 "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" $469.71 "$2,253.78" $901.51 "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$1,690.50" "$2,253.78" "$2,253.78" "$2,253.78" "$1,126.89" "$1,126.89" "$1,784.99" "$2,253.78" "$1,803.02" "$1,014.20" "$2,253.78" N/A "$1,307.32" "$2,253.78" "$1,352.27" "$2,253.78" "$2,253.78" "$2,253.78" N/A N/A FSR100208-20 SUP Custom 27803010 FSR100208-20 - COIL EMBL HLX 2MM 8CM ULTIPAQ 10 MCIOL STRCH RS HLCL LOOP BOTH IP/OP "$2,283.50" "$1,690.00" $406.38 "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" $406.38 "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" $475.81 "$2,283.05" $913.22 "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$1,712.63" "$2,283.05" "$2,283.05" "$2,283.05" "$1,141.53" "$1,141.53" "$1,808.18" "$2,283.05" "$1,826.44" "$1,027.37" "$2,283.05" N/A "$1,324.43" "$2,283.05" "$1,369.83" "$2,283.05" "$2,283.05" "$2,283.05" N/A N/A FSR100252-20 SUP Custom 27803010 FSR100252-20 - COIL EMBL HLX 2.5MM 2CM ULTIPAQ 10 MCIOL STRCH RS HLCL LOOP BOTH IP/OP "$2,195.50" "$1,625.00" $390.75 "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" $390.75 "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" $457.51 "$2,195.23" $878.09 "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" "$2,195.23" "$1,646.63" "$2,195.23" "$2,195.23" "$2,195.23" "$1,097.62" "$1,097.62" "$1,738.62" "$2,195.23" "$1,756.18" $987.85 "$2,195.23" N/A "$1,273.39" "$2,195.23" "$1,317.14" "$2,195.23" "$2,195.23" "$2,195.23" N/A N/A FSR100254-20 SUP Custom 27803010 FSR100254-20 - COIL EMBL HLCL 2.5MM 4CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH BOTH IP/OP "$2,224.50" "$1,646.00" $395.96 "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" $395.96 "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" $463.61 "$2,224.50" $889.80 "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$2,224.50" "$1,668.38" "$2,224.50" "$2,224.50" "$2,224.50" "$1,112.25" "$1,112.25" "$1,761.80" "$2,224.50" "$1,779.60" "$1,001.03" "$2,224.50" N/A "$1,290.21" "$2,224.50" "$1,334.70" "$2,224.50" "$2,224.50" "$2,224.50" N/A N/A FSR100256-20 SUP Custom 27803010 FSR100256-20 - COIL EMBL HLCL 2.5MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH BOTH IP/OP "$2,254.00" "$1,668.00" $401.17 "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" $401.17 "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" $469.71 "$2,253.78" $901.51 "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$1,690.50" "$2,253.78" "$2,253.78" "$2,253.78" "$1,126.89" "$1,126.89" "$1,784.99" "$2,253.78" "$1,803.02" "$1,014.20" "$2,253.78" N/A "$1,307.32" "$2,253.78" "$1,352.27" "$2,253.78" "$2,253.78" "$2,253.78" N/A N/A FSR100258-20 SUP Custom 27803010 FSR100258-20 - COIL EMBL 2.5MM 8CM ULTIPAQ 10 MCIOL STRCH RS HLCL LOOP DTCH BOTH IP/OP "$2,283.50" "$1,690.00" $406.38 "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" $406.38 "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" $475.81 "$2,283.05" $913.22 "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$1,712.63" "$2,283.05" "$2,283.05" "$2,283.05" "$1,141.53" "$1,141.53" "$1,808.18" "$2,283.05" "$1,826.44" "$1,027.37" "$2,283.05" N/A "$1,324.43" "$2,283.05" "$1,369.83" "$2,283.05" "$2,283.05" "$2,283.05" N/A N/A FSR100306-20 SUP Custom 27803010 FSR100306-20 - COIL EMBL HLCL 3MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH BOTH IP/OP "$2,254.00" "$1,668.00" $401.17 "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" $401.17 "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" $469.71 "$2,253.78" $901.51 "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$1,690.50" "$2,253.78" "$2,253.78" "$2,253.78" "$1,126.89" "$1,126.89" "$1,784.99" "$2,253.78" "$1,803.02" "$1,014.20" "$2,253.78" N/A "$1,307.32" "$2,253.78" "$1,352.27" "$2,253.78" "$2,253.78" "$2,253.78" N/A N/A FSR100308-20 SUP Custom 27803010 FSR100308-20 - COIL EMBL 3MM 8CM ULTIPAQ 10 MCIOL HLCL LOOP DTCH SFT STRCH BOTH IP/OP "$2,283.50" "$1,690.00" $406.38 "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" $406.38 "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" $475.81 "$2,283.05" $913.22 "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$1,712.63" "$2,283.05" "$2,283.05" "$2,283.05" "$1,141.53" "$1,141.53" "$1,808.18" "$2,283.05" "$1,826.44" "$1,027.37" "$2,283.05" N/A "$1,324.43" "$2,283.05" "$1,369.83" "$2,283.05" "$2,283.05" "$2,283.05" N/A N/A FSR100406-20 SUP Custom 27803010 FSR100406-20 - COIL EMBL HLCL 4MM 6CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH BOTH IP/OP "$2,254.00" "$1,668.00" $401.17 "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" $401.17 "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" $469.71 "$2,253.78" $901.51 "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$2,253.78" "$1,690.50" "$2,253.78" "$2,253.78" "$2,253.78" "$1,126.89" "$1,126.89" "$1,784.99" "$2,253.78" "$1,803.02" "$1,014.20" "$2,253.78" N/A "$1,307.32" "$2,253.78" "$1,352.27" "$2,253.78" "$2,253.78" "$2,253.78" N/A N/A FSR100408-20 SUP Custom 27803010 FSR100408-20 - COIL EMBL HLCL 4MM 8CM ULTIPAQ 10 MCIOL STRCH RS LOOP DTCH BOTH IP/OP "$2,283.50" "$1,690.00" $406.38 "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" $406.38 "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" $475.81 "$2,283.05" $913.22 "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$2,283.05" "$1,712.63" "$2,283.05" "$2,283.05" "$2,283.05" "$1,141.53" "$1,141.53" "$1,808.18" "$2,283.05" "$1,826.44" "$1,027.37" "$2,283.05" N/A "$1,324.43" "$2,283.05" "$1,369.83" "$2,283.05" "$2,283.05" "$2,283.05" N/A N/A FT-1100 SUP Custom 27203010 FT-1100 - TROCAR SURGICAL FALLER DIALYSIS CATHETER BOTH IP/OP $187.50 $139.00 $33.38 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $187.50 $33.38 $187.50 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $75.00 $187.50 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $187.50 N/A $108.75 $187.50 $112.50 $187.50 $187.50 $187.50 N/A N/A FT-12100 SUP Custom 27803010 FT-12100 - SHUNT CARDIO 1MM 18MM GLOBAL FLO-THRU SILICONE INTRALUMINAL BOTH IP/OP $174.00 $129.00 $30.97 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $30.97 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $36.26 $174.00 $69.60 $174.00 $174.00 $174.00 $174.00 $174.00 $130.50 $174.00 $174.00 $174.00 $87.00 $87.00 $137.81 $174.00 $139.20 $78.30 $174.00 N/A $100.92 $174.00 $104.40 $174.00 $174.00 $174.00 N/A N/A FT12125 SUP Custom 27803010 FT12125 - SHUNT CARDIO BULB TAPER 1.25MM 18MM RADIOPQ FLEXIBLE BOTH IP/OP $174.00 $129.00 $30.97 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $30.97 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $36.26 $174.00 $69.60 $174.00 $174.00 $174.00 $174.00 $174.00 $130.50 $174.00 $174.00 $174.00 $87.00 $87.00 $137.81 $174.00 $139.20 $78.30 $174.00 N/A $100.92 $174.00 $104.40 $174.00 $174.00 $174.00 N/A N/A FT-12150 SUP Custom 27803010 FT-12150 - SHUNT CARDIO TAPER 1.5MM 18MM 1 PIECE RADIOPQ TUBE FLEXIBLE BOTH IP/OP $174.00 $129.00 $30.97 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $30.97 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $36.26 $174.00 $69.60 $174.00 $174.00 $174.00 $174.00 $174.00 $130.50 $174.00 $174.00 $174.00 $87.00 $87.00 $137.81 $174.00 $139.20 $78.30 $174.00 N/A $100.92 $174.00 $104.40 $174.00 $174.00 $174.00 N/A N/A FT-12175 SUP Custom 27803010 FT-12175 - CORONARY SHUNT 1.75 MM BOTH IP/OP $174.00 $129.00 $30.97 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $30.97 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $36.26 $174.00 $69.60 $174.00 $174.00 $174.00 $174.00 $174.00 $130.50 $174.00 $174.00 $174.00 $87.00 $87.00 $137.81 $174.00 $139.20 $78.30 $174.00 N/A $100.92 $174.00 $104.40 $174.00 $174.00 $174.00 N/A N/A FT-12200 SUP Custom 27803010 FT-12200 - CORONARY SHUNT 2.00 MM BOTH IP/OP $185.00 $137.00 $32.86 $184.60 $184.60 $184.60 $184.60 $184.60 $184.60 $184.60 $32.86 $184.60 $184.60 $184.60 $184.60 $184.60 $184.60 $38.47 $184.60 $73.84 $184.60 $184.60 $184.60 $184.60 $184.60 $138.75 $184.60 $184.60 $184.60 $92.30 $92.30 $146.20 $184.60 $147.68 $83.07 $184.60 N/A $107.30 $184.60 $110.76 $184.60 $184.60 $184.60 N/A N/A FT-12225 SUP Custom 27803010 FT-12225 - SHUNT CARDIO TAPER 2.25MM 18MM 1 PIECE RADIOPQ TUBE FLEXIBLE BOTH IP/OP $174.00 $129.00 $30.97 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $30.97 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $36.26 $174.00 $69.60 $174.00 $174.00 $174.00 $174.00 $174.00 $130.50 $174.00 $174.00 $174.00 $87.00 $87.00 $137.81 $174.00 $139.20 $78.30 $174.00 N/A $100.92 $174.00 $104.40 $174.00 $174.00 $174.00 N/A N/A FT12250 SUP Custom 27803010 FT12250 - SHUNT CARDIO 2.5MM 18MM FLO-THRU INTRALUMINAL BOTH IP/OP $174.00 $129.00 $30.97 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $30.97 $174.00 $174.00 $174.00 $174.00 $174.00 $174.00 $36.26 $174.00 $69.60 $174.00 $174.00 $174.00 $174.00 $174.00 $130.50 $174.00 $174.00 $174.00 $87.00 $87.00 $137.81 $174.00 $139.20 $78.30 $174.00 N/A $100.92 $174.00 $104.40 $174.00 $174.00 $174.00 N/A N/A FT180T SUP Custom 27803010 FT180T - CLIP ANEURYSM MINI 3.3MM OPENING 3MM STR TEMPORARY NARROW BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT190T SUP Custom 27803010 FT190T - CLIP ANEURYSM MINI 4MM OPENING 5MM STR NARROW TEMPORARY BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT220T SUP Custom 27803010 FT220T - CLIP ANEURYSM MINI 4.6MM OPENING 7MM STR TEMPORARY LATEX BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT222T SUP Custom 27803010 FT222T - CLIP ANEURYSM MINI 4.4MM OPENING 6.6MM CVD SLIGHTLY BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT224T SUP Custom 27803010 FT224T - CLIP ANEURYSM MINI 4MM OPENING 5MM CVD TEMPORARY LATEX FREE BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT250T SUP Custom 27803010 FT250T - CLIP ANEURYSM 7MM OPEN STANDARD 9MM TEMPORARY SPRING BOTH IP/OP $975.50 $722.00 $173.59 $975.25 $975.25 $975.25 $975.25 $975.25 $975.25 $975.25 $173.59 $975.25 $975.25 $975.25 $975.25 $975.25 $975.25 $203.25 $975.25 $390.10 $975.25 $975.25 $975.25 $975.25 $975.25 $731.63 $975.25 $975.25 $975.25 $487.63 $487.63 $772.40 $975.25 $780.20 $438.86 $975.25 N/A $565.79 $975.25 $585.15 $975.25 $975.25 $975.25 N/A N/A FT252T SUP Custom 27803010 FT252T - CLIP ANEURYSM STANDARD 6.8MM OPENING 8.3MM CVD SLIGHTLY BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT254T SUP Custom 27803010 FT254T - CLIP ANEURYSM STANDARD 6.1MM OPENING 6.4MM CVD TEMPORARY BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT280T SUP Custom 27803010 FT280T - CLIP ANEURYSM 9.2MM OPENING STANDARD 15MM TEMPORARY MRI BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT290T SUP Custom 27803010 FT290T - CLIP ANEURYSM STANDARD 11.4MM OPENING 20MM STR TEMPORARY BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT620T SUP Custom 27803010 FT620T - CLIP ANEURYSM STANDARD 9.6MM OPENING 3.5MM 12MM STR FENST BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT623T SUP Custom 27803010 FT623T - CLIP ANEURYSM 7.8MM OPENING STANDARD 10.6MM PERMANENT MRI BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT640T SUP Custom 27803010 FT640T - CLIP ANEURYSM STANDARD 7.9MM OPENING 5MM 6MM STR FENST BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT680T SUP Custom 27803010 FT680T - CLIP ANEURYSM MINI 3.3MM OPENING 3MM STR NARROW PERMANENT BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT690T SUP Custom 27803010 FT690T - CLIP ANEURYSM MINI 4MM OPENING 5MM STR NARROW PERMANENT BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT700T SUP Custom 27803010 FT700T - CLIP ANEURYSM MINI 3.5MM OPENING 3MM SLIGHTLY CVD PERMANENT BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT710T SUP Custom 27803010 FT710T - CLIP ANEURYSM MINI 4MM OPENING 5MM STR PERMANENT LATEX FREE BOTH IP/OP $975.50 $722.00 $173.59 $975.25 $975.25 $975.25 $975.25 $975.25 $975.25 $975.25 $173.59 $975.25 $975.25 $975.25 $975.25 $975.25 $975.25 $203.25 $975.25 $390.10 $975.25 $975.25 $975.25 $975.25 $975.25 $731.63 $975.25 $975.25 $975.25 $487.63 $487.63 $772.40 $975.25 $780.20 $438.86 $975.25 N/A $565.79 $975.25 $585.15 $975.25 $975.25 $975.25 N/A N/A FT712T SUP Custom 27803010 FT712T - CLIP ANEURYSM MINI 3.8MM OPENING 4.7MM CVD SLIGHTLY BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT714T SUP Custom 27803010 FT714T - CLIP ANEURYSM MINI 3.5MM OPENING 3.9MM SLIGHTLY CVD BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT720T SUP Custom 27803010 FT720T - CLIP ANEURYSM MINI 4.6MM OPENING 7MM STR PERMANENT LATEX BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT722T SUP Custom 27803010 FT722T - CLIP ANEURYSM MINI 4.4MM OPENING 6.6MM CVD SLIGHTLY BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT724T SUP Custom 27803010 FT724T - CLIP ANEURYSM MINI 4MM OPENING 5MM CVD PERMANENT LATEX FREE BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT726T SUP Custom 27803010 FT726T - CLIP ANEURYSM MINI 4MM OPENING 5.2MM SLIGHTLY CVD PERMANENT BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT727T SUP Custom 27803010 FT727T - CLIP ANEURYSM MINI 7MM OPENING 4MM BAYONET PERMANENT LATEX BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT728D SUP Custom 27803010 FT728D - CLIP ANEURYSM MINI 5.7MM OPENING 7MM BAYONET PERMANENT LATEX BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT740T SUP Custom 27803010 FT740T - CLIP ANEURYSM 6.2MM OPENING STANDARD 7MM PERMANENT MRI BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT742T SUP Custom 27803010 FT742T - CLIP ANEURYSM STANDARD 6MM OPENING 6.5MM SLIGHTLY CVD BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT744T SUP Custom 27803010 FT744T - CLIP ANEURYSM STANDARD 5.5MM OPENING 5.4MM CVD PERMANENT BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT746T SUP Custom 27803010 FT746T - CLIP ANEURYSM STANDARD 5.7MM OPENING 7MM LATERAL ANGLED BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT747T SUP Custom 27803010 FT747T - CLIP ANEURYSM 7MM OPENING STANDARD 8.6MM PERMANENT MRI BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT750T SUP Custom 27803010 FT750T - CLIP ANEURYSM STANDARD 7MM OPENING 9MM STR PERMANENT LATEX BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT752T SUP Custom 27803010 FT752T - CLIP ANEURYSM STANDARD 6.8MM OPENING 8.3MM SLIGHTLY CVD BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT754T SUP Custom 27803010 FT754T - CLIP ANEURYSM STANDARD 6.1MM OPENING 6.4MM CVD PERMANENT BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT760T SUP Custom 27803010 FT760T - CLIP ANEURYSM STANDARD 7.8MM OPENING 11MM STR PERMANENT BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT762T SUP Custom 27803010 FT762T - CLIP ANEURYSM 7.5MM OPENING STANDARD 10.2MM PERMANENT MRI BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT780D SUP Custom 27803010 FT780D - CLIP ANEURYSM 9.2MM OPENING STANDARD 15MM PERMANENT MRI BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT782T SUP Custom 27803010 FT782T - CLIP ANEURYSM STANDARD 8.7MM OPENING 13.7MM PERMANENT CVD BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT786T SUP Custom 27803010 FT786T - CLIP ANEURYSM STANDARD 9.8MM OPENING 15.3MM CVD SLIGHTLY BOTH IP/OP $975.50 $722.00 $173.59 $975.25 $975.25 $975.25 $975.25 $975.25 $975.25 $975.25 $173.59 $975.25 $975.25 $975.25 $975.25 $975.25 $975.25 $203.25 $975.25 $390.10 $975.25 $975.25 $975.25 $975.25 $975.25 $731.63 $975.25 $975.25 $975.25 $487.63 $487.63 $772.40 $975.25 $780.20 $438.86 $975.25 N/A $565.79 $975.25 $585.15 $975.25 $975.25 $975.25 N/A N/A FT790D SUP Custom 27803010 FT790D - CLIP ANEURYSM STANDARD 11.4MM OPENING 20MM STR PERMANENT BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT806T SUP Custom 27803010 FT806T - CLIP ANEURYSM MINI 4.5MM OPENING 7MM ANGLED FORWARD BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT810T SUP Custom 27803010 FT810T - CLIP ANEURYSM STANDARD 6.5MM OPENING 9MM ANGLED FORWARD BOTH IP/OP "$1,084.50" $803.00 $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $192.99 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $225.97 "$1,084.23" $433.69 "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" "$1,084.23" $813.38 "$1,084.23" "$1,084.23" "$1,084.23" $542.12 $542.12 $858.71 "$1,084.23" $867.38 $487.90 "$1,084.23" N/A $629.01 "$1,084.23" $650.54 "$1,084.23" "$1,084.23" "$1,084.23" N/A N/A FT820T SUP Custom 27803010 FT820T - CLIP ANEURYSM STANDARD 4.5MM OPENING 7MM ANGLED RIGHT BOTH IP/OP $975.50 $722.00 $173.59 $975.25 $975.25 $975.25 $975.25 $975.25 $975.25 $975.25 $173.59 $975.25 $975.25 $975.25 $975.25 $975.25 $975.25 $203.25 $975.25 $390.10 $975.25 $975.25 $975.25 $975.25 $975.25 $731.63 $975.25 $975.25 $975.25 $487.63 $487.63 $772.40 $975.25 $780.20 $438.86 $975.25 N/A $565.79 $975.25 $585.15 $975.25 $975.25 $975.25 N/A N/A FTL10040 SUP HCPCS C1876 FTL10040 - STENT TRCHBR 10MM 9FR 40MM STRL 117CM FLN + PUZZLE GFT BOTH IP/OP "$7,482.50" "$5,537.00" "$1,485.09" "$7,482.50" "$3,367.13" "$3,367.13" "$3,367.13" "$3,367.13" "$7,482.50" "$7,482.50" "$7,482.50" "$1,559.54" "$7,482.50" "$7,482.50" "$7,482.50" "$7,482.50" "$7,482.50" "$1,559.44" "$7,482.50" "$7,482.50" "$3,688.87" "$7,482.50" "$7,482.50" "$7,482.50" "$7,482.50" "$5,611.88" "$7,482.50" "$7,482.50" "$7,482.50" "$3,741.25" "$3,741.25" "$5,926.14" "$7,482.50" "$5,986.00" "$3,367.13" "$1,485.09" N/A "$4,339.85" "$7,482.50" "$7,482.50" "$7,482.50" "$1,559.35" "$7,482.50" N/A N/A FTM06040 SUP HCPCS C1876 FTM06040 - STENT TRACHEOBRONCHIAL 6MM 8FR 40MM 80CM GRAFT FLUENCY PLUS BOTH IP/OP "$7,482.50" "$5,537.00" "$1,485.09" "$7,482.50" "$3,367.13" "$3,367.13" "$3,367.13" "$3,367.13" "$7,482.50" "$7,482.50" "$7,482.50" "$1,559.54" "$7,482.50" "$7,482.50" "$7,482.50" "$7,482.50" "$7,482.50" "$1,559.44" "$7,482.50" "$7,482.50" "$3,688.87" "$7,482.50" "$7,482.50" "$7,482.50" "$7,482.50" "$5,611.88" "$7,482.50" "$7,482.50" "$7,482.50" "$3,741.25" "$3,741.25" "$5,926.14" "$7,482.50" "$5,986.00" "$3,367.13" "$1,485.09" N/A "$4,339.85" "$7,482.50" "$7,482.50" "$7,482.50" "$1,559.35" "$7,482.50" N/A N/A FWD301 SUP HCPCS Q4114 FWD301 - DRSG FLW MTRX WND 3ML BOTH IP/OP "$3,231.00" "$2,391.00" $673.35 "$3,230.88" "$3,230.88" "$3,230.88" "$3,230.88" "$3,230.88" "$3,230.88" "$3,230.88" "$1,725.02" "$3,230.88" "$3,230.88" "$3,230.88" "$3,230.88" "$3,230.88" "$3,230.88" $673.35 "$3,230.88" "$1,292.35" "$3,230.88" "$3,230.88" "$3,230.88" "$3,230.88" "$3,230.88" "$2,423.25" "$3,230.88" "$3,230.88" "$3,230.88" "$1,615.44" "$1,615.44" "$2,558.86" "$3,230.88" "$2,584.70" "$1,453.90" "$3,230.88" N/A "$1,873.98" "$3,230.88" "$1,938.53" "$3,230.88" "$3,230.88" "$3,230.88" N/A N/A FX-4001-S SUP Custom 27203010 FX-4001-S - KIT XTRNFX STRL STABLELOC LTWT RDLCNT WRST BOTH IP/OP "$3,462.50" "$2,562.00" $616.33 "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" $616.33 "$3,462.50" "$3,462.50" "$2,569.87" "$2,569.87" "$2,668.90" "$1,803.96" $721.62 "$3,462.50" "$1,385.00" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$2,596.88" "$3,462.50" "$3,462.50" "$3,462.50" "$1,731.25" "$1,731.25" "$2,742.30" "$3,462.50" "$2,770.00" "$2,250.63" "$3,462.50" N/A "$2,008.25" "$3,462.50" "$2,077.50" "$3,462.50" "$3,462.50" "$3,462.50" N/A N/A FX-4004-S SUP Custom 27203010 FX-4004-S - PIN FIX 3.2MM 30MM SLFDRILL STABLELOC ORTHOPEDIC STERILE BOTH IP/OP $707.50 $524.00 $125.94 $707.50 $707.50 $707.50 $707.50 $707.50 $707.50 $707.50 $125.94 $707.50 $707.50 $525.11 $525.11 $545.34 $368.61 $147.45 $707.50 $283.00 $707.50 $707.50 $707.50 $707.50 $707.50 $530.63 $707.50 $707.50 $707.50 $353.75 $353.75 $560.34 $707.50 $566.00 $459.88 $707.50 N/A $410.35 $707.50 $424.50 $707.50 $707.50 $707.50 N/A N/A FX-4054-S SUP Custom 27203010 FX-4054-S - PIN FIX 2.7MM 25MM SLFDRILL STABLELOC STERILE BOTH IP/OP $707.50 $524.00 $125.94 $707.50 $707.50 $707.50 $707.50 $707.50 $707.50 $707.50 $125.94 $707.50 $707.50 $525.11 $525.11 $545.34 $368.61 $147.45 $707.50 $283.00 $707.50 $707.50 $707.50 $707.50 $707.50 $530.63 $707.50 $707.50 $707.50 $353.75 $353.75 $560.34 $707.50 $566.00 $459.88 $707.50 N/A $410.35 $707.50 $424.50 $707.50 $707.50 $707.50 N/A N/A G00012 SUP Custom 27203010 G00012 - NEEDLE BIOP 22GA 15CM ASPIRAT CHIBA STERILE DISPOSABLE BOTH IP/OP $27.00 $20.00 $4.73 $26.58 $26.58 $26.58 $26.58 $26.58 $26.58 $26.58 $4.73 $26.58 $26.58 $19.73 $19.73 $20.49 $13.85 $5.54 $26.58 $10.63 $26.58 $26.58 $26.58 $26.58 $26.58 $20.25 $26.58 $26.58 $26.58 $13.29 $13.29 $21.05 $26.58 $21.26 $17.28 $26.58 N/A $15.66 $26.58 $15.95 $26.58 $26.58 $26.58 N/A N/A G00130 SUP HCPCS C1725 G00130 - CATHETER ANGIOGRAPHIC STR 5FR 65CM FLEXIBLE POLYETHYLENE BOTH IP/OP $55.00 $41.00 $10.92 $65.00 $29.87 $29.87 $29.87 $29.87 $55.00 $55.00 $55.00 $11.46 $55.00 $40.82 $40.82 $42.39 $28.66 $11.46 $55.00 $65.00 $32.53 $55.00 $65.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $35.75 $10.92 N/A $31.90 $55.00 $55.00 $55.00 $11.46 $55.00 N/A N/A G00164 SUP Custom 27203010 G00164 - STOPCOCK IV .95IN CLR STRL 1 WY F TO M LL ROT ADPR LP PLS BOTH IP/OP $14.50 $11.00 $2.56 $14.38 $14.38 $14.38 $14.38 $14.38 $14.38 $14.38 $2.56 $14.38 $14.38 $10.67 $10.67 $11.08 $7.49 $3.00 $14.38 $5.75 $14.38 $14.38 $14.38 $14.38 $14.38 $10.88 $14.38 $14.38 $14.38 $7.19 $7.19 $11.39 $14.38 $11.50 $9.35 $14.38 N/A $8.41 $14.38 $8.63 $14.38 $14.38 $14.38 N/A N/A G00165 SUP HCPCS C1770 G00165 - COIL EMBOLIZATION .035IN 5MM 5CM 3.2 LOOP OCCLUDE SPRING BOTH IP/OP $66.00 $49.00 $13.73 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $13.73 $65.89 $26.36 $65.89 $65.89 $65.89 $65.89 $65.89 $49.50 $65.89 $65.89 $65.89 $32.95 $32.95 $52.18 $65.89 $52.71 $29.65 $65.89 N/A $38.28 $65.89 $39.53 $65.89 $65.89 $65.89 N/A N/A G00314 SUP HCPCS C1769 G00314 - GUIDEWIRE VASC 3MM .038IN 100CM STRL SFTJ JTP HVYDTY CRV BOTH IP/OP $25.50 $19.00 $5.06 $25.50 $13.85 $13.85 $13.85 $13.85 $25.50 $25.50 $25.50 $5.31 $25.50 $18.93 $18.93 $19.66 $13.29 $5.31 $25.50 $25.50 $15.08 $25.50 $25.50 $25.50 $25.50 $19.13 $25.50 $25.50 $25.50 $12.75 $12.75 $20.20 $25.50 $20.40 $16.58 $5.06 N/A $14.79 $25.50 $25.50 $25.50 $5.31 $25.50 N/A N/A G00321 SUP HCPCS C1769 G00321 - GUIDEWIRE VASC STRG .038IN 145CM LNDRQS RING TRQ SS PTFE BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $15.00 $15.00 $15.00 $15.00 $27.63 $27.63 $27.63 $5.76 $27.63 $20.51 $20.51 $21.30 $14.40 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $17.96 $5.48 N/A $16.24 $27.63 $27.63 $27.63 $5.76 $27.63 N/A N/A G00331 SUP HCPCS C1769 G00331 - SET STNT .035IN 2 PGTL CRV 4.7FR 28CM STRL PSTNR GW SFLX BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $15.00 $15.00 $15.00 $15.00 $27.63 $27.63 $27.63 $5.76 $27.63 $20.51 $20.51 $21.30 $14.40 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $17.96 $5.48 N/A $16.24 $27.63 $27.63 $27.63 $5.76 $27.63 N/A N/A G00511 SUP HCPCS C1769 G00511 - GUIDEWIRE VASCULAR CURVE TAPER .035IN 145CM 3CM FLEXIBLE TIP BOTH IP/OP $36.00 $27.00 $7.07 $36.87 $19.35 $19.35 $19.35 $19.35 $35.63 $35.63 $35.63 $7.43 $35.63 $26.44 $26.44 $27.46 $18.56 $7.43 $35.63 $36.87 $21.08 $35.63 $36.87 $35.63 $35.63 $27.00 $35.63 $35.63 $35.63 $17.82 $17.82 $28.22 $35.63 $28.50 $23.16 $7.07 N/A $20.88 $35.63 $35.63 $35.63 $7.43 $35.63 N/A N/A G00529 SUP HCPCS C1769 G00529 - GUIDEWIRE VASCULAR CURVE TAPER .035IN 80CM 3CM FLEXIBLE TIP BOTH IP/OP $32.00 $24.00 $6.35 $33.10 $17.37 $17.37 $17.37 $17.37 $31.98 $31.98 $31.98 $6.67 $31.98 $23.74 $23.74 $24.65 $16.66 $6.66 $31.98 $33.10 $18.92 $31.98 $33.10 $31.98 $31.98 $24.00 $31.98 $31.98 $31.98 $15.99 $15.99 $25.33 $31.98 $25.58 $20.79 $6.35 N/A $18.56 $31.98 $31.98 $31.98 $6.66 $31.98 N/A N/A G00593 SUP HCPCS C1769 G00593 - GUIDEWIRE VASCULAR STR TAPER .018IN 50CM FLEXIBLE TIP FIX BOTH IP/OP $31.00 $23.00 $6.14 $32.03 $16.81 $16.81 $16.81 $16.81 $30.95 $30.95 $30.95 $6.45 $30.95 $22.97 $22.97 $23.86 $16.12 $6.45 $30.95 $32.03 $18.31 $30.95 $32.03 $30.95 $30.95 $23.25 $30.95 $30.95 $30.95 $15.48 $15.48 $24.51 $30.95 $24.76 $20.12 $6.14 N/A $17.98 $30.95 $30.95 $30.95 $6.45 $30.95 N/A N/A G00631 SUP HCPCS C1769 G00631 - GUIDEWIRE VASC STRG .038IN 145CM FX COR SS BOTH IP/OP $46.00 $34.00 $9.07 $45.70 $24.82 $24.82 $24.82 $24.82 $45.70 $45.70 $45.70 $9.53 $45.70 $33.92 $33.92 $35.23 $23.81 $9.52 $45.70 $45.70 $27.03 $45.70 $45.70 $45.70 $45.70 $34.50 $45.70 $45.70 $45.70 $22.85 $22.85 $36.19 $45.70 $36.56 $29.71 $9.07 N/A $26.68 $45.70 $45.70 $45.70 $9.52 $45.70 N/A N/A G00666 SUP HCPCS C1769 G00666 - GUIDEWIRE VASC .035IN 145CM 8CM AMPTZ 2 FLX TP XSTIF SS BOTH IP/OP $53.00 $39.00 $10.43 $52.55 $28.53 $28.53 $28.53 $28.53 $52.55 $52.55 $52.55 $10.95 $52.55 $39.00 $39.00 $40.51 $27.38 $10.95 $52.55 $52.55 $31.08 $52.55 $52.55 $52.55 $52.55 $39.75 $52.55 $52.55 $52.55 $26.28 $26.28 $41.62 $52.55 $42.04 $34.16 $10.43 N/A $30.74 $52.55 $31.53 $52.55 $10.95 $52.55 N/A N/A G00683 SUP HCPCS C1769 G00683 - GUIDEWIRE VASC STRG TPR .028IN 145CM STRL FX COR SS PTFE BOTH IP/OP $43.50 $32.00 $8.61 $43.38 $23.56 $23.56 $23.56 $23.56 $43.38 $43.38 $43.38 $9.04 $43.38 $32.20 $32.20 $33.44 $22.60 $9.04 $43.38 $43.38 $25.66 $43.38 $43.38 $43.38 $43.38 $32.63 $43.38 $43.38 $43.38 $21.69 $21.69 $34.36 $43.38 $34.70 $28.20 $8.61 N/A $25.23 $43.38 $43.38 $43.38 $9.04 $43.38 N/A N/A G00691 SUP HCPCS C1769 G00691 - GUIDEWIRE VASCULAR 6CM STANDARD STR .035IN 145CM 15CM FLOPPY BOTH IP/OP $49.00 $36.00 $9.68 $49.97 $26.47 $26.47 $26.47 $26.47 $48.75 $48.75 $48.75 $10.16 $48.75 $36.18 $36.18 $37.58 $25.40 $10.16 $48.75 $49.97 $28.84 $48.75 $49.97 $48.75 $48.75 $36.75 $48.75 $48.75 $48.75 $24.38 $24.38 $38.61 $48.75 $39.00 $31.69 $9.68 N/A $28.42 $48.75 $48.75 $48.75 $10.16 $48.75 N/A N/A G00693 SUP HCPCS C1769 G00693 - GUIDEWIRE VASCULAR STR BENTSON CURVE .038IN 145CM 20CM BOTH IP/OP $62.00 $46.00 $12.28 $61.88 $33.60 $33.60 $33.60 $33.60 $61.88 $61.88 $61.88 $12.90 $61.88 $45.93 $45.93 $47.70 $32.24 $12.90 $61.88 $61.88 $36.60 $61.88 $61.88 $61.88 $61.88 $46.50 $61.88 $61.88 $61.88 $30.94 $30.94 $49.01 $61.88 $49.50 $40.22 $12.28 N/A $35.96 $61.88 $61.88 $61.88 $12.90 $61.88 N/A N/A G00785 SUP HCPCS C1769 G00785 - GUIDEWIRE VASC .045IN 145CM STRL STRG TPR FXCR SS PTFE DISP BOTH IP/OP $44.50 $33.00 $8.75 $44.10 $23.95 $23.95 $23.95 $23.95 $44.10 $44.10 $44.10 $9.19 $44.10 $32.73 $32.73 $33.99 $22.98 $9.19 $44.10 $44.10 $26.09 $44.10 $44.10 $44.10 $44.10 $33.38 $44.10 $44.10 $44.10 $22.05 $22.05 $34.93 $44.10 $35.28 $28.67 $8.75 N/A $25.81 $44.10 $44.10 $44.10 $9.19 $44.10 N/A N/A G00852 SUP Custom 27203010 G00852 - NEEDLE BIOP 22GA 10CM CHIBA STERILE DISPOSABLE ASPIRAT BOTH IP/OP $27.00 $20.00 $4.73 $26.58 $26.58 $26.58 $26.58 $26.58 $26.58 $26.58 $4.73 $26.58 $26.58 $19.73 $19.73 $20.49 $13.85 $5.54 $26.58 $10.63 $26.58 $26.58 $26.58 $26.58 $26.58 $20.25 $26.58 $26.58 $26.58 $13.29 $13.29 $21.05 $26.58 $21.26 $17.28 $26.58 N/A $15.66 $26.58 $15.95 $26.58 $26.58 $26.58 N/A N/A G00973 SUP Custom 27203010 G00973 - DILATOR VASCULAR STANDARD 7FR 20CM RADIOPQ VESSEL BOTH IP/OP $18.50 $14.00 $3.27 $19.91 $18.35 $18.35 $18.35 $18.35 $18.35 $18.35 $3.27 $18.35 $18.35 $13.62 $13.62 $14.14 $9.56 $3.82 $18.35 $7.96 $18.35 $18.35 $19.91 $18.35 $18.35 $13.88 $18.35 $18.35 $18.35 $9.18 $9.18 $14.53 $18.35 $14.68 $11.93 $18.35 N/A $10.73 $18.35 $11.01 $18.35 $18.35 $18.35 N/A N/A G00980 SUP Custom 27203010 G00980 - DILATOR VASCULAR STANDARD 8FR 20CM 15.5CM RADIOPQ VESSEL BOTH IP/OP $18.50 $14.00 $3.27 $19.91 $18.35 $18.35 $18.35 $18.35 $18.35 $18.35 $3.27 $18.35 $18.35 $13.62 $13.62 $14.14 $9.56 $3.82 $18.35 $7.96 $18.35 $18.35 $19.91 $18.35 $18.35 $13.88 $18.35 $18.35 $18.35 $9.18 $9.18 $14.53 $18.35 $14.68 $11.93 $18.35 N/A $10.73 $18.35 $11.01 $18.35 $18.35 $18.35 N/A N/A G00983 SUP Custom 27203010 G00983 - DILATOR VASCULAR .038IN STANDARD 5FR 20CM RADIOPQ GWIRE BOTH IP/OP $18.50 $14.00 $3.27 $19.91 $18.35 $18.35 $18.35 $18.35 $18.35 $18.35 $3.27 $18.35 $18.35 $13.62 $13.62 $14.14 $9.56 $3.82 $18.35 $7.96 $18.35 $18.35 $19.91 $18.35 $18.35 $13.88 $18.35 $18.35 $18.35 $9.18 $9.18 $14.53 $18.35 $14.68 $11.93 $18.35 N/A $10.73 $18.35 $11.01 $18.35 $18.35 $18.35 N/A N/A G00992 SUP Custom 27203010 G00992 - DILATOR VASCULAR STANDARD 9FR 20CM RADIOPQ VESSEL STERILE BOTH IP/OP $18.50 $14.00 $3.27 $19.91 $18.35 $18.35 $18.35 $18.35 $18.35 $18.35 $3.27 $18.35 $18.35 $13.62 $13.62 $14.14 $9.56 $3.82 $18.35 $7.96 $18.35 $18.35 $19.91 $18.35 $18.35 $13.88 $18.35 $18.35 $18.35 $9.18 $9.18 $14.53 $18.35 $14.68 $11.93 $18.35 N/A $10.73 $18.35 $11.01 $18.35 $18.35 $18.35 N/A N/A G01062 SUP HCPCS C1769 G01062 - GWIRE VASC 6CM .035IN 260CM 20CM BNTSN STR EXCH DISTAL FLPY BOTH IP/OP $56.00 $41.00 $11.04 $55.63 $30.21 $30.21 $30.21 $30.21 $55.63 $55.63 $55.63 $11.59 $55.63 $41.29 $41.29 $42.88 $28.98 $11.59 $55.63 $55.63 $32.91 $55.63 $55.63 $55.63 $55.63 $42.00 $55.63 $55.63 $55.63 $27.82 $27.82 $44.06 $55.63 $44.50 $36.16 $11.04 N/A $32.48 $55.63 $55.63 $55.63 $11.59 $55.63 N/A N/A G01095 SUP HCPCS C1769 G01095 - GUIDEWIRE VASCULAR STR .035IN 200CM BENTSON ATRAUMATIC EXTRA BOTH IP/OP $51.50 $38.00 $10.17 $52.53 $27.83 $27.83 $27.83 $27.83 $51.25 $51.25 $51.25 $10.68 $51.25 $38.04 $38.04 $39.50 $26.70 $10.68 $51.25 $52.53 $30.31 $51.25 $52.53 $51.25 $51.25 $38.63 $51.25 $51.25 $51.25 $25.63 $25.63 $40.59 $51.25 $41.00 $33.31 $10.17 N/A $29.87 $51.25 $51.25 $51.25 $10.68 $51.25 N/A N/A G01185 SUP HCPCS C1770 G01185 - COIL EMBL .038IN 5MM 5CM STRL 3.2 LOOP SS VASC BOTH IP/OP $66.00 $49.00 $13.73 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $13.73 $65.89 $26.36 $65.89 $65.89 $65.89 $65.89 $65.89 $49.50 $65.89 $65.89 $65.89 $32.95 $32.95 $52.18 $65.89 $52.71 $29.65 $65.89 N/A $38.28 $65.89 $39.53 $65.89 $65.89 $65.89 N/A N/A G01212 SUP HCPCS C1892 G01212 - DILATOR SURG STANDARD 16FR 20CM RADIOPQ VESSEL STERILE BOTH IP/OP $18.50 $14.00 $3.64 $19.91 $9.96 $9.96 $9.96 $9.96 $18.35 $18.35 $18.35 $3.82 $18.35 $13.62 $13.62 $14.14 $9.56 $3.82 $18.35 $19.91 $10.85 $18.35 $19.91 $18.35 $18.35 $13.88 $18.35 $18.35 $18.35 $9.18 $9.18 $14.53 $18.35 $14.68 $11.93 $3.64 N/A $10.73 $18.35 $18.35 $18.35 $3.82 $18.35 N/A N/A G01232 SUP HCPCS C1770 G01232 - COIL EMBOLIZATION 15MM 8CM 1.7 LOOP LOAD CARTRIDGE STAINLESS BOTH IP/OP $66.00 $49.00 $13.73 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $13.73 $65.89 $26.36 $65.89 $65.89 $65.89 $65.89 $65.89 $49.50 $65.89 $65.89 $65.89 $32.95 $32.95 $52.18 $65.89 $52.71 $29.65 $65.89 N/A $38.28 $65.89 $39.53 $65.89 $65.89 $65.89 N/A N/A G01253 SUP HCPCS C1769 G01253 - GUIDEWIRE VASCULAR J ROSEN CURVE .035IN 260CM 1.5CM HEAVY BOTH IP/OP $74.00 $55.00 $14.64 $77.81 $40.05 $40.05 $40.05 $40.05 $73.75 $73.75 $73.75 $15.37 $73.75 $54.74 $54.74 $56.85 $38.42 $15.37 $73.75 $77.81 $43.62 $73.75 $77.81 $73.75 $73.75 $55.50 $73.75 $73.75 $73.75 $36.88 $36.88 $58.41 $73.75 $59.00 $47.94 $14.64 N/A $42.92 $73.75 $73.75 $73.75 $15.37 $73.75 N/A N/A G01261 SUP HCPCS C1769 G01261 - GUIDEWIRE VASCULAR J ROSEN CURVE .035IN 145CM 1.5CM HEAVY BOTH IP/OP $35.00 $26.00 $6.95 $36.93 $19.01 $19.01 $19.01 $19.01 $35.00 $35.00 $35.00 $7.29 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $36.93 $20.70 $35.00 $36.93 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $6.95 N/A $20.30 $35.00 $35.00 $35.00 $7.29 $35.00 N/A N/A G01264 SUP HCPCS C1769 G01264 - GUIDEWIRE VASC 1.5CM J RSN CRV TPR .035IN 180CM 4.5CM HIWIRE BOTH IP/OP $35.00 $26.00 $6.95 $36.93 $19.01 $19.01 $19.01 $19.01 $35.00 $35.00 $35.00 $7.29 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $36.93 $20.70 $35.00 $36.93 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $6.95 N/A $20.30 $35.00 $35.00 $35.00 $7.29 $35.00 N/A N/A G01292 SUP HCPCS C1770 G01292 - COIL EMBL .038IN 10MM 5CM STRL 1.6 LOOP SS VASC BOTH IP/OP $66.00 $49.00 $13.73 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $13.73 $65.89 $26.36 $65.89 $65.89 $65.89 $65.89 $65.89 $49.50 $65.89 $65.89 $65.89 $32.95 $32.95 $52.18 $65.89 $52.71 $29.65 $65.89 N/A $38.28 $65.89 $39.53 $65.89 $65.89 $65.89 N/A N/A G01371 SUP HCPCS C1769 G01371 - GUIDEWIRE VASC .038IN 145CM AMPTZ MOV COR TPR STRG PTFE BOTH IP/OP $46.00 $34.00 $9.07 $45.70 $24.82 $24.82 $24.82 $24.82 $45.70 $45.70 $45.70 $9.53 $45.70 $33.92 $33.92 $35.23 $23.81 $9.52 $45.70 $45.70 $27.03 $45.70 $45.70 $45.70 $45.70 $34.50 $45.70 $45.70 $45.70 $22.85 $22.85 $36.19 $45.70 $36.56 $29.71 $9.07 N/A $26.68 $45.70 $45.70 $45.70 $9.52 $45.70 N/A N/A G01384 SUP HCPCS C1725 G01384 - CATHETER BLNDIL 80CM 4.5CM V ANDL TPR TIP ILC FEM POPLT ART BOTH IP/OP $37.50 $28.00 $7.44 $60.00 $20.36 $20.36 $20.36 $20.36 $37.50 $37.50 $37.50 $7.82 $37.50 $27.83 $27.83 $28.91 $19.54 $7.82 $37.50 $60.00 $22.18 $37.50 $37.50 $37.50 $37.50 $28.13 $37.50 $37.50 $37.50 $18.75 $18.75 $29.70 $37.50 $30.00 $24.38 $7.44 N/A $21.75 $37.50 $37.50 $37.50 $7.82 $37.50 N/A N/A G01428 SUP HCPCS C1769 G01428 - GUIDEWIRE VASCULAR 1.5MM ROSEN CURVE .035IN 180CM 1.5MM BOTH IP/OP $42.50 $31.00 $8.44 $42.50 $23.08 $23.08 $23.08 $23.08 $42.50 $42.50 $42.50 $8.86 $42.50 $31.54 $31.54 $32.76 $22.14 $8.86 $42.50 $42.50 $25.14 $42.50 $42.50 $42.50 $42.50 $31.88 $42.50 $42.50 $42.50 $21.25 $21.25 $33.66 $42.50 $34.00 $27.63 $8.44 N/A $24.65 $42.50 $42.50 $42.50 $8.86 $42.50 N/A N/A G01471 SUP Custom 27203010 G01471 - DILATOR VASCULAR STANDARD 20FR 20CM RADIOPQ STERILE BOTH IP/OP $34.50 $26.00 $6.06 $36.95 $34.05 $34.05 $34.05 $34.05 $34.05 $34.05 $6.06 $34.05 $34.05 $25.27 $25.27 $26.25 $17.74 $7.10 $34.05 $14.78 $34.05 $34.05 $36.95 $34.05 $34.05 $25.88 $34.05 $34.05 $34.05 $17.03 $17.03 $26.97 $34.05 $27.24 $22.13 $34.05 N/A $20.01 $34.05 $20.43 $34.05 $34.05 $34.05 N/A N/A G01472 SUP Custom 27203010 G01472 - DILATOR VASCULAR .038IN 22FR 20CM RADIOPQ GWIRE STERILE BOTH IP/OP $34.50 $26.00 $6.06 $36.95 $34.05 $34.05 $34.05 $34.05 $34.05 $34.05 $6.06 $34.05 $34.05 $25.27 $25.27 $26.25 $17.74 $7.10 $34.05 $14.78 $34.05 $34.05 $36.95 $34.05 $34.05 $25.88 $34.05 $34.05 $34.05 $17.03 $17.03 $26.97 $34.05 $27.24 $22.13 $34.05 N/A $20.01 $34.05 $20.43 $34.05 $34.05 $34.05 N/A N/A G01616 SUP HCPCS C1769 G01616 - GUIDEWIRE VASC .038IN 260CM BNTSN STRG FXCR SS PTFE CRBRL BOTH IP/OP $121.50 $90.00 $24.07 $121.25 $65.84 $65.84 $65.84 $65.84 $121.25 $121.25 $121.25 $25.27 $121.25 $89.99 $89.99 $93.46 $63.17 $25.27 $121.25 $121.25 $71.72 $121.25 $121.25 $121.25 $121.25 $91.13 $121.25 $121.25 $121.25 $60.63 $60.63 $96.03 $121.25 $97.00 $78.81 $24.07 N/A $70.47 $121.25 $121.25 $121.25 $25.27 $121.25 N/A N/A G01729 SUP HCPCS C1769 G01729 - GUIDEWIRE VASC STD STRG .035IN 145CM 3CM 2 FLXB SS PTFE BOTH IP/OP $39.50 $29.00 $7.81 $39.33 $21.36 $21.36 $21.36 $21.36 $39.33 $39.33 $39.33 $8.20 $39.33 $29.19 $29.19 $30.32 $20.49 $8.20 $39.33 $39.33 $23.26 $39.33 $39.33 $39.33 $39.33 $29.63 $39.33 $39.33 $39.33 $19.67 $19.67 $31.15 $39.33 $31.46 $25.56 $7.81 N/A $22.91 $39.33 $39.33 $39.33 $8.20 $39.33 N/A N/A G01884 SUP Custom 27203010 G01884 - DILATOR VASCULAR .038IN STANDARD 24FR 20CM STANDARD RADIOPQ BOTH IP/OP $34.50 $26.00 $6.06 $36.95 $34.05 $34.05 $34.05 $34.05 $34.05 $34.05 $6.06 $34.05 $34.05 $25.27 $25.27 $26.25 $17.74 $7.10 $34.05 $14.78 $34.05 $34.05 $36.95 $34.05 $34.05 $25.88 $34.05 $34.05 $34.05 $17.03 $17.03 $26.97 $34.05 $27.24 $22.13 $34.05 N/A $20.01 $34.05 $20.43 $34.05 $34.05 $34.05 N/A N/A G02295 SUP HCPCS C1769 G02295 - CATHETER URET UNV 4FR 70CM RTNR WDG BOTH IP/OP $4.50 $3.00 $0.85 $4.30 $2.33 $2.33 $2.33 $2.33 $4.30 $4.30 $4.30 $0.90 $4.30 $3.19 $3.19 $3.31 $2.24 $0.90 $4.30 $4.30 $2.54 $4.30 $4.30 $4.30 $4.30 $3.38 $4.30 $4.30 $4.30 $2.15 $2.15 $3.41 $4.30 $3.44 $2.80 $0.85 N/A $2.61 $4.30 $4.30 $4.30 $0.90 $4.30 N/A N/A G02760 SUP HCPCS C1770 G02760 - COIL EMBOLIZATION .035IN 3MM 4CM 4.3 LOOP STAINLESS STEEL BOTH IP/OP $66.00 $49.00 $13.73 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $13.73 $65.89 $26.36 $65.89 $65.89 $65.89 $65.89 $65.89 $49.50 $65.89 $65.89 $65.89 $32.95 $32.95 $52.18 $65.89 $52.71 $29.65 $65.89 N/A $38.28 $65.89 $39.53 $65.89 $65.89 $65.89 N/A N/A G03031 SUP HCPCS C1769 G03031 - GUIDEWIRE VASCULAR STR FLOPPY TAPER .038IN 145CM FLEXIBLE BOTH IP/OP $65.00 $48.00 $12.82 $64.58 $35.07 $35.07 $35.07 $35.07 $64.58 $64.58 $64.58 $13.46 $64.58 $47.93 $47.93 $49.78 $33.65 $13.46 $64.58 $64.58 $38.20 $64.58 $64.58 $64.58 $64.58 $48.75 $64.58 $64.58 $64.58 $32.29 $32.29 $51.15 $64.58 $51.66 $41.98 $12.82 N/A $37.70 $64.58 $64.58 $64.58 $13.46 $64.58 N/A N/A G03037 SUP HCPCS C1769 G03037 - GUIDEWIRE VASC .038IN 100CM STRL STRG TPR FXCR SS PTFE DISP BOTH IP/OP $55.00 $41.00 $10.92 $55.00 $29.87 $29.87 $29.87 $29.87 $55.00 $55.00 $55.00 $11.46 $55.00 $40.82 $40.82 $42.39 $28.66 $11.46 $55.00 $55.00 $32.53 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $35.75 $10.92 N/A $31.90 $55.00 $33.00 $55.00 $11.46 $55.00 N/A N/A G03095 SUP HCPCS C1769 G03095 - GUIDEWIRE VASCULAR 3CM STR TAPER .035IN 145CM 7CM FLEXIBLE BOTH IP/OP $65.00 $48.00 $12.82 $67.16 $35.07 $35.07 $35.07 $35.07 $64.58 $64.58 $64.58 $13.46 $64.58 $47.93 $47.93 $49.78 $33.65 $13.46 $64.58 $67.16 $38.20 $64.58 $67.16 $64.58 $64.58 $48.75 $64.58 $64.58 $64.58 $32.29 $32.29 $51.15 $64.58 $51.66 $41.98 $12.82 N/A $37.70 $64.58 $64.58 $64.58 $13.46 $64.58 N/A N/A G03211 SUP HCPCS C1769 G03211 - GUIDEWIRE VASC .038IN 145CM STRL STRG MOV COR SS PTFE DISP BOTH IP/OP $52.00 $38.00 $10.31 $51.93 $28.20 $28.20 $28.20 $28.20 $51.93 $51.93 $51.93 $10.82 $51.93 $38.54 $38.54 $40.03 $27.06 $10.82 $51.93 $51.93 $30.72 $51.93 $51.93 $51.93 $51.93 $39.00 $51.93 $51.93 $51.93 $25.97 $25.97 $41.13 $51.93 $41.54 $33.75 $10.31 N/A $30.16 $51.93 $51.93 $51.93 $10.82 $51.93 N/A N/A G03301 SUP HCPCS C1729 G03301 - SET DRAIN STANDARD 9FR 18GA 29CM 20CM 1 WAY STOPCOCK BOTH IP/OP $459.00 $340.00 $91.04 $458.70 $249.07 $249.07 $249.07 $249.07 $458.70 $458.70 $458.70 $95.60 $458.70 $340.45 $340.45 $353.57 $238.98 $95.60 $458.70 $458.70 $271.32 $458.70 $458.70 $458.70 $458.70 $344.25 $458.70 $458.70 $458.70 $229.35 $229.35 $363.29 $458.70 $366.96 $298.16 $91.04 N/A $266.22 $458.70 $458.70 $458.70 $95.59 $458.70 N/A N/A G03445 SUP HCPCS C1769 G03445 - GUIDEWIRE URO STD STRG .038IN 145CM STRL 3CM 2 FLX TP FXCR BOTH IP/OP $55.00 $41.00 $10.92 $55.00 $29.87 $29.87 $29.87 $29.87 $55.00 $55.00 $55.00 $11.46 $55.00 $40.82 $40.82 $42.39 $28.66 $11.46 $55.00 $55.00 $32.53 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $35.75 $10.92 N/A $31.90 $55.00 $55.00 $55.00 $11.46 $55.00 N/A N/A G03522 SUP HCPCS C1769 G03522 - GUIDEWIRE VASC STRG TPR .035IN 145CM STRL AMPTZ MOV COR SS BOTH IP/OP $50.50 $37.00 $9.94 $50.10 $27.20 $27.20 $27.20 $27.20 $50.10 $50.10 $50.10 $10.44 $50.10 $37.18 $37.18 $38.62 $26.10 $10.44 $50.10 $50.10 $29.63 $50.10 $50.10 $50.10 $50.10 $37.88 $50.10 $50.10 $50.10 $25.05 $25.05 $39.68 $50.10 $40.08 $32.57 $9.94 N/A $29.29 $50.10 $50.10 $50.10 $10.44 $50.10 N/A N/A G03562 SUP HCPCS C1769 G03562 - GUIDEWIRE VASCULAR STR .035IN 260CM EXTRA STIFF SHAFT COIL BOTH IP/OP $67.50 $50.00 $13.40 $70.20 $36.65 $36.65 $36.65 $36.65 $67.50 $67.50 $67.50 $14.07 $67.50 $50.10 $50.10 $52.03 $35.17 $14.07 $67.50 $70.20 $39.93 $67.50 $70.20 $67.50 $67.50 $50.63 $67.50 $67.50 $67.50 $33.75 $33.75 $53.46 $67.50 $54.00 $43.88 $13.40 N/A $39.15 $67.50 $40.50 $67.50 $14.07 $67.50 N/A N/A G03579 SUP HCPCS C1769 G03579 - GUIDEWIRE VASCULAR STR .038IN 300CM EXTRA STIFF SHAFT BOTH IP/OP $67.50 $50.00 $13.40 $67.50 $36.65 $36.65 $36.65 $36.65 $67.50 $67.50 $67.50 $14.07 $67.50 $50.10 $50.10 $52.03 $35.17 $14.07 $67.50 $67.50 $39.93 $67.50 $67.50 $67.50 $67.50 $50.63 $67.50 $67.50 $67.50 $33.75 $33.75 $53.46 $67.50 $54.00 $43.88 $13.40 N/A $39.15 $67.50 $40.50 $67.50 $14.07 $67.50 N/A N/A G03831 SUP HCPCS C2628 G03831 - CATHETER BLNDIL 32MM 120CM CODA PU ACPT .035IN GW 12FR INTRO BOTH IP/OP "$1,042.50" $771.00 $206.91 "$1,042.50" $566.08 $566.08 $566.08 $566.08 "$1,042.50" "$1,042.50" "$1,042.50" $217.28 "$1,042.50" $773.74 $773.74 $803.56 $543.14 $217.27 "$1,042.50" "$1,042.50" $616.64 "$1,042.50" "$1,042.50" "$1,042.50" "$1,042.50" $781.88 "$1,042.50" "$1,042.50" "$1,042.50" $521.25 $521.25 $825.66 "$1,042.50" $834.00 $677.63 $206.91 N/A $604.65 "$1,042.50" "$1,042.50" "$1,042.50" $217.26 "$1,042.50" N/A N/A G04001 SUP HCPCS C1769 G04001 - GUIDEWIRE VASCULAR STR .035IN 300CM FLEXIBLE TIP EXTRA STIFF BOTH IP/OP $101.50 $75.00 $20.10 $105.30 $54.98 $54.98 $54.98 $54.98 $101.25 $101.25 $101.25 $21.10 $101.25 $75.15 $75.15 $78.04 $52.75 $21.10 $101.25 $105.30 $59.89 $101.25 $105.30 $101.25 $101.25 $76.13 $101.25 $101.25 $101.25 $50.63 $50.63 $80.19 $101.25 $81.00 $65.81 $20.10 N/A $58.87 $101.25 $60.75 $101.25 $21.10 $101.25 N/A N/A G04044 SUP HCPCS C1770 G04044 - COIL EMBOLIZATION .035IN 3MM 2CM 2.1 LOOP STAINLESS STEEL BOTH IP/OP $66.00 $49.00 $13.73 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $65.89 $13.73 $65.89 $26.36 $65.89 $65.89 $65.89 $65.89 $65.89 $49.50 $65.89 $65.89 $65.89 $32.95 $32.95 $52.18 $65.89 $52.71 $29.65 $65.89 N/A $38.28 $65.89 $39.53 $65.89 $65.89 $65.89 N/A N/A G04096 SUP HCPCS C1892 G04096 - INTRODUCER SHEATH LARGE 22FR 13CM 20CM GWIRE DILAT PEEL-AWAY BOTH IP/OP $113.50 $84.00 $22.46 $114.85 $61.44 $61.44 $61.44 $61.44 $113.15 $113.15 $113.15 $23.58 $113.15 $83.98 $83.98 $87.22 $58.95 $23.58 $113.15 $114.85 $66.93 $113.15 $114.85 $113.15 $113.15 $85.13 $113.15 $113.15 $113.15 $56.58 $56.58 $89.61 $113.15 $90.52 $73.55 $22.46 N/A $65.83 $113.15 $113.15 $113.15 $23.58 $113.15 N/A N/A G04267 SUP HCPCS C1894 G04267 - SET ACC NEFF PERC BOTH IP/OP $205.00 $152.00 $40.65 $208.90 $111.21 $111.21 $111.21 $111.21 $204.80 $204.80 $204.80 $42.69 $204.80 $152.00 $152.00 $157.86 $106.70 $42.68 $204.80 $208.90 $121.14 $204.80 $208.90 $204.80 $204.80 $153.75 $204.80 $204.80 $204.80 $102.40 $102.40 $162.20 $204.80 $163.84 $133.12 $40.65 N/A $118.90 $204.80 $204.80 $204.80 $42.68 $204.80 N/A N/A G04636 SUP HCPCS C1894 G04636 - INTRODUCER SHEATH .018IN 4FR 40CM 10CM COAXIAL CATHETER BOTH IP/OP $69.00 $51.00 $13.69 $69.00 $37.47 $37.47 $37.47 $37.47 $69.00 $69.00 $69.00 $14.38 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $69.00 $40.81 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $13.69 N/A $40.02 $69.00 $69.00 $69.00 $14.38 $69.00 N/A N/A G04812 SUP HCPCS C1887 G04812 - CATHETER ANGIOGRAPHIC PIGTAIL CURVE 7FR 100CM 12 SIDEPORT BOTH IP/OP $55.00 $41.00 $10.92 $55.00 $29.87 $29.87 $29.87 $29.87 $55.00 $55.00 $55.00 $11.46 $55.00 $40.82 $40.82 $42.39 $28.66 $11.46 $55.00 $55.00 $32.53 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $35.75 $10.92 N/A $31.90 $55.00 $55.00 $55.00 $11.46 $55.00 N/A N/A G05060 SUP HCPCS C1725 G05060 - CATHETER ANGIOGRAPHIC STANDARD PIGTAIL CURVE 4FR 70CM 10 BOTH IP/OP $32.50 $24.00 $6.45 $32.50 $17.65 $17.65 $17.65 $17.65 $32.50 $32.50 $32.50 $6.77 $32.50 $24.12 $24.12 $25.05 $16.93 $6.77 $32.50 $32.50 $19.22 $32.50 $32.50 $32.50 $32.50 $24.38 $32.50 $32.50 $32.50 $16.25 $16.25 $25.74 $32.50 $26.00 $21.13 $6.45 N/A $18.85 $32.50 $32.50 $32.50 $6.77 $32.50 N/A N/A G05183 SUP HCPCS C1769 G05183 - GUIDEWIRE VASCULAR ANGLED .018IN 60CM 7CM SOFT COPE MANDRIL BOTH IP/OP $95.00 $70.00 $18.76 $97.83 $51.33 $51.33 $51.33 $51.33 $94.53 $94.53 $94.53 $19.70 $94.53 $70.16 $70.16 $72.86 $49.25 $19.70 $94.53 $97.83 $55.91 $94.53 $97.83 $94.53 $94.53 $71.25 $94.53 $94.53 $94.53 $47.27 $47.27 $74.87 $94.53 $75.62 $61.44 $18.76 N/A $55.10 $94.53 $94.53 $94.53 $19.70 $94.53 N/A N/A G05189 SUP HCPCS C1725 G05189 - CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 70CM SIZING 10 BOTH IP/OP $55.00 $41.00 $10.92 $55.00 $29.87 $29.87 $29.87 $29.87 $55.00 $55.00 $55.00 $11.46 $55.00 $40.82 $40.82 $42.39 $28.66 $11.46 $55.00 $55.00 $32.53 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $35.75 $10.92 N/A $31.90 $55.00 $55.00 $55.00 $11.46 $55.00 N/A N/A G05641 SUP Custom 27203010 G05641 - ADAPTER TUBING MALE LUER LOCK LOCK TO TUOHY BORST STOPCOCK BOTH IP/OP $25.50 $19.00 $4.49 $25.20 $25.20 $25.20 $25.20 $25.20 $25.20 $25.20 $4.49 $25.20 $25.20 $18.70 $18.70 $19.42 $13.13 $5.25 $25.20 $10.08 $25.20 $25.20 $25.20 $25.20 $25.20 $19.13 $25.20 $25.20 $25.20 $12.60 $12.60 $19.96 $25.20 $20.16 $16.38 $25.20 N/A $14.79 $25.20 $15.12 $25.20 $25.20 $25.20 N/A N/A G05839 SUP Custom 27203010 G05839 - SET JEJUNOSTOMY 16.5FR 24FR 80CM 2 LUMEN 2 CATHETER SIDEPORT BOTH IP/OP $826.00 $611.00 $146.99 $825.80 $825.80 $825.80 $825.80 $825.80 $825.80 $825.80 $146.99 $825.80 $825.80 $612.91 $612.91 $636.53 $430.24 $172.11 $825.80 $330.32 $825.80 $825.80 $825.80 $825.80 $825.80 $619.50 $825.80 $825.80 $825.80 $412.90 $412.90 $654.03 $825.80 $660.64 $536.77 $825.80 N/A $479.08 $825.80 $495.48 $825.80 $825.80 $825.80 N/A N/A G06299 SUP Custom 27203010 G06299 - ADAPTER CATHETER 9FR LARGE BORE SIDE ARM ROTATING MALE INFUS BOTH IP/OP $50.00 $37.00 $8.90 $53.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $8.90 $50.00 $50.00 $37.11 $37.11 $38.54 $26.05 $10.42 $50.00 $21.20 $50.00 $50.00 $53.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $32.50 $50.00 N/A $29.00 $50.00 $30.00 $50.00 $50.00 $50.00 N/A N/A G06444 SUP HCPCS C1892 G06444 - SET INTROD 18FR 15.5CM PEEL-AWAY PERCUTANEOUS STERILE BOTH IP/OP $113.50 $84.00 $22.46 $114.85 $61.44 $61.44 $61.44 $61.44 $113.15 $113.15 $113.15 $23.58 $113.15 $83.98 $83.98 $87.22 $58.95 $23.58 $113.15 $114.85 $66.93 $113.15 $114.85 $113.15 $113.15 $85.13 $113.15 $113.15 $113.15 $56.58 $56.58 $89.61 $113.15 $90.52 $73.55 $22.46 N/A $65.83 $113.15 $113.15 $113.15 $23.58 $113.15 N/A N/A G06445 SUP HCPCS C1892 G06445 - INTRODUCER SHEATH LARGE 20FR 13CM 20CM PEEL-AWAY BOTH IP/OP $113.50 $84.00 $22.46 $114.85 $61.44 $61.44 $61.44 $61.44 $113.15 $113.15 $113.15 $23.58 $113.15 $83.98 $83.98 $87.22 $58.95 $23.58 $113.15 $114.85 $66.93 $113.15 $114.85 $113.15 $113.15 $85.13 $113.15 $113.15 $113.15 $56.58 $56.58 $89.61 $113.15 $90.52 $73.55 $22.46 N/A $65.83 $113.15 $113.15 $113.15 $23.58 $113.15 N/A N/A G06446 SUP HCPCS C1892 G06446 - INTRODUCER SHEATH .038IN LARGE 24FR 13CM 20CM PEEL-AWAY BOTH IP/OP $113.50 $84.00 $22.46 $114.85 $61.44 $61.44 $61.44 $61.44 $113.15 $113.15 $113.15 $23.58 $113.15 $83.98 $83.98 $87.22 $58.95 $23.58 $113.15 $114.85 $66.93 $113.15 $114.85 $113.15 $113.15 $85.13 $113.15 $113.15 $113.15 $56.58 $56.58 $89.61 $113.15 $90.52 $73.55 $22.46 N/A $65.83 $113.15 $113.15 $113.15 $23.58 $113.15 N/A N/A G06447 SUP HCPCS C1892 G06447 - INTRODUCER SHEATH .038IN LARGE 26FR 13CM 20CM W/O GWIRE BOTH IP/OP $113.50 $84.00 $22.46 $114.85 $61.44 $61.44 $61.44 $61.44 $113.15 $113.15 $113.15 $23.58 $113.15 $83.98 $83.98 $87.22 $58.95 $23.58 $113.15 $114.85 $66.93 $113.15 $114.85 $113.15 $113.15 $85.13 $113.15 $113.15 $113.15 $56.58 $56.58 $89.61 $113.15 $90.52 $73.55 $22.46 N/A $65.83 $113.15 $113.15 $113.15 $23.58 $113.15 N/A N/A G06451 SUP HCPCS C1880 G06451 - SYSTEM EMBOLIZATION .038IN 11FR 12FR 40CM EMERGENCY CHRONIC BOTH IP/OP "$3,487.50" "$2,581.00" $726.83 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$1,295.00" "$3,487.50" "$3,487.50" "$3,237.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" "$3,487.50" N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" "$3,487.50" "$3,487.50" N/A N/A G06452 SUP HCPCS C1880 G06452 - FILTER EMBOLIZATION .038IN 40MM 11FR 75CM CATHETER GWIRE BOTH IP/OP "$3,487.50" "$2,581.00" $726.83 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$1,295.00" "$3,487.50" "$3,487.50" "$3,237.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" "$3,487.50" N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" "$3,487.50" "$3,487.50" N/A N/A G06491 SUP HCPCS C1892 G06491 - SET INTROD .038IN 11FR 15.5CM PEEL-AWAY PERCUTANEOUS STERILE BOTH IP/OP $113.50 $84.00 $22.46 $114.85 $61.44 $61.44 $61.44 $61.44 $113.15 $113.15 $113.15 $23.58 $113.15 $83.98 $83.98 $87.22 $58.95 $23.58 $113.15 $114.85 $66.93 $113.15 $114.85 $113.15 $113.15 $85.13 $113.15 $113.15 $113.15 $56.58 $56.58 $89.61 $113.15 $90.52 $73.55 $22.46 N/A $65.83 $113.15 $113.15 $113.15 $23.58 $113.15 N/A N/A G06492 SUP HCPCS C1892 G06492 - SET INTROD .038IN 12FR 15.5CM PEEL-AWAY PERCUTANEOUS STERILE BOTH IP/OP $113.50 $84.00 $22.46 $114.85 $61.44 $61.44 $61.44 $61.44 $113.15 $113.15 $113.15 $23.58 $113.15 $83.98 $83.98 $87.22 $58.95 $23.58 $113.15 $114.85 $66.93 $113.15 $114.85 $113.15 $113.15 $85.13 $113.15 $113.15 $113.15 $56.58 $56.58 $89.61 $113.15 $90.52 $73.55 $22.46 N/A $65.83 $113.15 $113.15 $113.15 $23.58 $113.15 N/A N/A G06496 SUP HCPCS C1892 G06496 - SET INTROD .038IN 14FR 15.5CM PEEL-AWAY PERCUTANEOUS STERILE BOTH IP/OP $104.50 $77.00 $20.72 $114.85 $56.69 $56.69 $56.69 $56.69 $104.40 $104.40 $104.40 $21.76 $104.40 $77.49 $77.49 $80.47 $54.39 $21.76 $104.40 $114.85 $61.75 $104.40 $114.85 $104.40 $104.40 $78.38 $104.40 $104.40 $104.40 $52.20 $52.20 $82.68 $104.40 $83.52 $67.86 $20.72 N/A $60.61 $104.40 $104.40 $104.40 $21.76 $104.40 N/A N/A G06541 SUP HCPCS C1894 G06541 - SET INTERVENTIONAL 9FR 16GA 38.5CM 50.5CM INTROD SHEATH BOTH IP/OP "$1,215.50" $899.00 $241.20 "$1,215.25" $659.88 $659.88 $659.88 $659.88 "$1,215.25" "$1,215.25" "$1,215.25" $253.29 "$1,215.25" $901.96 $901.96 $936.71 $633.15 $253.27 "$1,215.25" "$1,215.25" $718.82 "$1,215.25" "$1,215.25" "$1,215.25" "$1,215.25" $911.63 "$1,215.25" "$1,215.25" "$1,215.25" $607.63 $607.63 $962.48 "$1,215.25" $972.20 $789.91 $241.20 N/A $704.99 "$1,215.25" "$1,215.25" "$1,215.25" $253.26 "$1,215.25" N/A N/A G06929 SUP Custom 27203010 G06929 - SET INTERVENTIONAL .038IN 10FR 40CM 62.5CM CATHETER CANNU BOTH IP/OP "$1,101.50" $815.00 $196.03 "$1,101.30" "$1,101.30" "$1,101.30" "$1,101.30" "$1,101.30" "$1,101.30" "$1,101.30" $196.03 "$1,101.30" "$1,101.30" $817.38 $817.38 $848.88 $573.78 $229.52 "$1,101.30" $440.52 "$1,101.30" "$1,101.30" "$1,101.30" "$1,101.30" "$1,101.30" $826.13 "$1,101.30" "$1,101.30" "$1,101.30" $550.65 $550.65 $872.23 "$1,101.30" $881.04 $715.85 "$1,101.30" N/A $638.87 "$1,101.30" $660.78 "$1,101.30" "$1,101.30" "$1,101.30" N/A N/A G07090 SUP HCPCS C1729 G07090 - TRAY DRAIN 14FR 41CM 4 SIDEPORT RADIOPQ ENTRY NEEDLE SCALPEL BOTH IP/OP $425.00 $315.00 $84.33 $424.90 $230.72 $230.72 $230.72 $230.72 $424.90 $424.90 $424.90 $88.56 $424.90 $315.36 $315.36 $327.51 $221.37 $88.55 $424.90 $424.90 $251.33 $424.90 $424.90 $424.90 $424.90 $318.75 $424.90 $424.90 $424.90 $212.45 $212.45 $336.52 $424.90 $339.92 $276.19 $84.33 N/A $246.50 $424.90 $424.90 $424.90 $88.55 $424.90 N/A N/A G07427 SUP HCPCS C1894 G07427 - INTRODUCER CATHETER 5FR 1.7MM 13CM 20CM SIDEARM FIT SIDE BOTH IP/OP $47.50 $35.00 $9.36 $81.75 $25.60 $25.60 $25.60 $25.60 $47.15 $47.15 $47.15 $9.83 $47.15 $34.99 $34.99 $36.34 $24.57 $9.83 $47.15 $81.75 $27.89 $47.15 $81.75 $47.15 $47.15 $35.63 $47.15 $47.15 $47.15 $23.58 $23.58 $37.34 $47.15 $37.72 $30.65 $9.36 N/A $27.55 $47.15 $47.15 $47.15 $9.83 $47.15 N/A N/A G07465 SUP HCPCS C1894 G07465 - INTRODUCER SHEATH 9FR 30CM SMALL VALVE ASMBLY RADIOPQ BAND BOTH IP/OP $175.00 $130.00 $34.73 $177.63 $95.03 $95.03 $95.03 $95.03 $175.00 $175.00 $175.00 $36.47 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $177.63 $103.51 $175.00 $177.63 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A G07914 SUP HCPCS C1769 G07914 - GUIDEWIRE VASCULAR TAPER .035IN 145CM RADIOPQ FLOPPY TIP BOTH IP/OP $94.00 $70.00 $18.61 $97.50 $50.91 $50.91 $50.91 $50.91 $93.75 $93.75 $93.75 $19.54 $93.75 $69.58 $69.58 $72.26 $48.84 $19.54 $93.75 $97.50 $55.45 $93.75 $97.50 $93.75 $93.75 $70.50 $93.75 $93.75 $93.75 $46.88 $46.88 $74.25 $93.75 $75.00 $60.94 $18.61 N/A $54.52 $93.75 $93.75 $93.75 $19.54 $93.75 N/A N/A G07937 SUP HCPCS C1769 G07937 - GUIDEWIRE VASCULAR ANGLE TAPER .035IN 180CM 9CM RADIOPQ BOTH IP/OP $94.00 $70.00 $18.61 $97.50 $50.91 $50.91 $50.91 $50.91 $93.75 $93.75 $93.75 $19.54 $93.75 $69.58 $69.58 $72.26 $48.84 $19.54 $93.75 $97.50 $55.45 $93.75 $97.50 $93.75 $93.75 $70.50 $93.75 $93.75 $93.75 $46.88 $46.88 $74.25 $93.75 $75.00 $60.94 $18.61 N/A $54.52 $93.75 $93.75 $93.75 $19.54 $93.75 N/A N/A G08113 SUP Custom 27203010 G08113 - CATHETER ANGIOGRAPHIC 18FR SLIP-CATH BEACON TIP HYDPHI BOTH IP/OP $313.50 $232.00 $55.75 $313.20 $313.20 $313.20 $313.20 $313.20 $313.20 $313.20 $55.75 $313.20 $313.20 $232.46 $232.46 $241.41 $163.18 $65.27 $313.20 $125.28 $313.20 $313.20 $313.20 $313.20 $313.20 $235.13 $313.20 $313.20 $313.20 $156.60 $156.60 $248.05 $313.20 $250.56 $203.58 $313.20 N/A $181.83 $313.20 $187.92 $313.20 $313.20 $313.20 N/A N/A G08259 SUP Custom 27203010 G08259 - COIL EMBOLIZATION .018IN 6-2MM 7CM SOFT MICROCOIL TORNADO BOTH IP/OP $275.50 $204.00 $49.01 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $49.01 $275.33 $275.33 $204.35 $204.35 $212.22 $143.45 $57.38 $275.33 $110.13 $275.33 $275.33 $275.33 $275.33 $275.33 $206.63 $275.33 $275.33 $275.33 $137.67 $137.67 $218.06 $275.33 $220.26 $178.96 $275.33 N/A $159.79 $275.33 $165.20 $275.33 $275.33 $275.33 N/A N/A G08261 SUP Custom 27803010 G08261 - COIL EMBL 3-2MM 2CM STRL TRND MCL PLTN ACPT .081IN CATH AVM BOTH IP/OP $275.50 $204.00 $49.01 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $49.01 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $57.38 $275.33 $110.13 $275.33 $275.33 $275.33 $275.33 $275.33 $206.63 $275.33 $275.33 $275.33 $137.67 $137.67 $218.06 $275.33 $220.26 $123.90 $275.33 N/A $159.79 $275.33 $165.20 $275.33 $275.33 $275.33 N/A N/A G08283 SUP Custom 27203010 G08283 - SET BIOP 18GA 7FR 60CM 20MM HEAVY DUTY FIRING SPRING ACCES BOTH IP/OP "$1,075.00" $796.00 $191.35 "$1,075.00" "$1,075.00" "$1,075.00" "$1,075.00" "$1,075.00" "$1,075.00" "$1,075.00" $191.35 "$1,075.00" "$1,075.00" $797.87 $797.87 $828.61 $560.08 $224.04 "$1,075.00" $430.00 "$1,075.00" "$1,075.00" "$1,075.00" "$1,075.00" "$1,075.00" $806.25 "$1,075.00" "$1,075.00" "$1,075.00" $537.50 $537.50 $851.40 "$1,075.00" $860.00 $698.75 "$1,075.00" N/A $623.50 "$1,075.00" $645.00 "$1,075.00" "$1,075.00" "$1,075.00" N/A N/A G08417 SUP HCPCS C1729 G08417 - SET GASTROSTOMY 14FR 30CM 1 LUMEN 6 SIDEPORT CATHETER DILAT BOTH IP/OP $302.00 $223.00 $59.87 $301.63 $163.79 $163.79 $163.79 $163.79 $301.63 $301.63 $301.63 $62.87 $301.63 $223.87 $223.87 $232.50 $157.15 $62.86 $301.63 $301.63 $178.41 $301.63 $301.63 $301.63 $301.63 $226.50 $301.63 $301.63 $301.63 $150.82 $150.82 $238.89 $301.63 $241.30 $196.06 $59.87 N/A $175.16 $301.63 $301.63 $301.63 $62.86 $301.63 N/A N/A G08421 SUP HCPCS C1725 G08421 - CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 5FR 100CM TORCON NB BOTH IP/OP $62.50 $46.00 $12.40 $65.00 $33.94 $33.94 $33.94 $33.94 $62.50 $62.50 $62.50 $13.03 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $65.00 $36.97 $62.50 $65.00 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $12.40 N/A $36.25 $62.50 $62.50 $62.50 $13.03 $62.50 N/A N/A G08422 SUP HCPCS C1725 G08422 - CATHETER ANGIOGRAPHIC ANGLE SIMMONS 2 CURVE 5FR 100CM BOTH IP/OP $62.50 $46.00 $12.40 $65.00 $33.94 $33.94 $33.94 $33.94 $62.50 $62.50 $62.50 $13.03 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $65.00 $36.97 $62.50 $65.00 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $12.40 N/A $36.25 $62.50 $62.50 $62.50 $13.03 $62.50 N/A N/A G08427 SUP HCPCS C1769 G08427 - GUIDEWIRE VASCULAR ANGLE TAPER .018IN 60CM SOFT TIP COPE BOTH IP/OP $115.50 $85.00 $22.88 $119.34 $62.61 $62.61 $62.61 $62.61 $115.30 $115.30 $115.30 $24.03 $115.30 $85.58 $85.58 $88.87 $60.07 $24.03 $115.30 $119.34 $68.20 $115.30 $119.34 $115.30 $115.30 $86.63 $115.30 $115.30 $115.30 $57.65 $57.65 $91.32 $115.30 $92.24 $74.95 $22.88 N/A $66.99 $115.30 $115.30 $115.30 $24.03 $115.30 N/A N/A G08441 SUP HCPCS C1725 G08441 - CATHETER ANGIOGRAPHIC C1 CURVE ANGLE 5FR 65CM MULTPUR TORCON BOTH IP/OP $62.50 $46.00 $12.40 $65.00 $33.94 $33.94 $33.94 $33.94 $62.50 $62.50 $62.50 $13.03 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $65.00 $36.97 $62.50 $65.00 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $12.40 N/A $36.25 $62.50 $62.50 $62.50 $13.03 $62.50 N/A N/A G08442 SUP HCPCS C1725 G08442 - CATHETER ANGIOGRAPHIC C2 CURVE ANGLE 5FR 65CM MULTPUR TORCON BOTH IP/OP $32.50 $24.00 $6.45 $32.50 $17.65 $17.65 $17.65 $17.65 $32.50 $32.50 $32.50 $6.77 $32.50 $24.12 $24.12 $25.05 $16.93 $6.77 $32.50 $32.50 $19.22 $32.50 $32.50 $32.50 $32.50 $24.38 $32.50 $32.50 $32.50 $16.25 $16.25 $25.74 $32.50 $26.00 $21.13 $6.45 N/A $18.85 $32.50 $32.50 $32.50 $6.77 $32.50 N/A N/A G08471 SUP HCPCS C1725 G08471 - CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 100CM TORCON NB BOTH IP/OP $62.50 $46.00 $12.40 $65.00 $33.94 $33.94 $33.94 $33.94 $62.50 $62.50 $62.50 $13.03 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $65.00 $36.97 $62.50 $65.00 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $12.40 N/A $36.25 $62.50 $62.50 $62.50 $13.03 $62.50 N/A N/A G08515 SUP HCPCS C1725 G08515 - CATHETER ANGIOGRAPHIC .035IN NEFF CURVE 5FR 80CM 8 SIDEPORT BOTH IP/OP $41.00 $30.00 $8.05 $40.55 $22.02 $22.02 $22.02 $22.02 $40.55 $40.55 $40.55 $8.45 $40.55 $30.10 $30.10 $31.26 $21.13 $8.45 $40.55 $40.55 $23.99 $40.55 $40.55 $40.55 $40.55 $30.75 $40.55 $40.55 $40.55 $20.28 $20.28 $32.12 $40.55 $32.44 $26.36 $8.05 N/A $23.78 $40.55 $40.55 $40.55 $8.45 $40.55 N/A N/A G08552 SUP HCPCS C1877 G08552 - STENT TRACHEOBRONCHIAL 15MM 14FR 5CM INTROD SELF EXPANDING BOTH IP/OP "$2,559.50" "$1,894.00" $507.97 "$2,943.28" "$1,151.72" "$1,151.72" "$1,151.72" "$1,151.72" "$2,559.38" "$2,559.38" "$2,559.38" $533.44 "$2,559.38" "$2,559.38" "$2,559.38" "$2,559.38" "$2,559.38" $533.40 "$2,559.38" "$2,943.28" "$1,261.77" "$2,559.38" "$2,943.28" "$2,559.38" "$2,559.38" "$1,919.63" "$2,559.38" "$2,559.38" "$2,559.38" "$1,279.69" "$1,279.69" "$2,027.03" "$2,559.38" "$2,047.50" "$1,151.72" $507.97 N/A "$1,484.51" "$2,559.38" "$2,559.38" "$2,559.38" $533.37 "$2,559.38" N/A N/A G08553 SUP HCPCS C1877 G08553 - STENT TRACHEOBRONCHIAL 20MM 16FR 5CM INTROD SELF EXPANDING BOTH IP/OP "$2,559.50" "$1,894.00" $507.97 "$2,943.28" "$1,151.72" "$1,151.72" "$1,151.72" "$1,151.72" "$2,559.38" "$2,559.38" "$2,559.38" $533.44 "$2,559.38" "$2,559.38" "$2,559.38" "$2,559.38" "$2,559.38" $533.40 "$2,559.38" "$2,943.28" "$1,261.77" "$2,559.38" "$2,943.28" "$2,559.38" "$2,559.38" "$1,919.63" "$2,559.38" "$2,559.38" "$2,559.38" "$1,279.69" "$1,279.69" "$2,027.03" "$2,559.38" "$2,047.50" "$1,151.72" $507.97 N/A "$1,484.51" "$2,559.38" "$2,559.38" "$2,559.38" $533.37 "$2,559.38" N/A N/A G08554 SUP HCPCS C1877 G08554 - STENT TRACHEOBRONCHIAL 25MM 16FR 5CM INTROD SELF EXPAND BOTH IP/OP "$2,559.50" "$1,894.00" $507.97 "$2,943.28" "$1,151.72" "$1,151.72" "$1,151.72" "$1,151.72" "$2,559.38" "$2,559.38" "$2,559.38" $533.44 "$2,559.38" "$2,559.38" "$2,559.38" "$2,559.38" "$2,559.38" $533.40 "$2,559.38" "$2,943.28" "$1,261.77" "$2,559.38" "$2,943.28" "$2,559.38" "$2,559.38" "$1,919.63" "$2,559.38" "$2,559.38" "$2,559.38" "$1,279.69" "$1,279.69" "$2,027.03" "$2,559.38" "$2,047.50" "$1,151.72" $507.97 N/A "$1,484.51" "$2,559.38" "$2,559.38" "$2,559.38" $533.37 "$2,559.38" N/A N/A G08555 SUP HCPCS C1877 G08555 - STENT TRACHEOBRONCHIAL 30MM 16FR 5CM INTROD SELF EXPANDING BOTH IP/OP "$2,559.50" "$1,894.00" $507.97 "$2,943.28" "$1,151.72" "$1,151.72" "$1,151.72" "$1,151.72" "$2,559.38" "$2,559.38" "$2,559.38" $533.44 "$2,559.38" "$2,559.38" "$2,559.38" "$2,559.38" "$2,559.38" $533.40 "$2,559.38" "$2,943.28" "$1,261.77" "$2,559.38" "$2,943.28" "$2,559.38" "$2,559.38" "$1,919.63" "$2,559.38" "$2,559.38" "$2,559.38" "$1,279.69" "$1,279.69" "$2,027.03" "$2,559.38" "$2,047.50" "$1,151.72" $507.97 N/A "$1,484.51" "$2,559.38" "$2,559.38" "$2,559.38" $533.37 "$2,559.38" N/A N/A G08556 SUP HCPCS C1877 G08556 - STENT TRACHEOBRONCHIAL 35MM 16FR 5CM INTROD SELF EXPANDING BOTH IP/OP "$2,559.50" "$1,894.00" $507.97 "$2,943.28" "$1,151.72" "$1,151.72" "$1,151.72" "$1,151.72" "$2,559.38" "$2,559.38" "$2,559.38" $533.44 "$2,559.38" "$2,559.38" "$2,559.38" "$2,559.38" "$2,559.38" $533.40 "$2,559.38" "$2,943.28" "$1,261.77" "$2,559.38" "$2,943.28" "$2,559.38" "$2,559.38" "$1,919.63" "$2,559.38" "$2,559.38" "$2,559.38" "$1,279.69" "$1,279.69" "$2,027.03" "$2,559.38" "$2,047.50" "$1,151.72" $507.97 N/A "$1,484.51" "$2,559.38" "$2,559.38" "$2,559.38" $533.37 "$2,559.38" N/A N/A G08581 SUP HCPCS C1884 G08581 - CATHETER ANGIOGRAPHIC DAV CURVE ANGLE 5FR 100CM MULTPUR BOTH IP/OP $62.50 $46.00 $12.40 $65.00 $28.13 $28.13 $28.13 $28.13 $62.50 $62.50 $62.50 $13.03 $62.50 $62.50 $62.50 $62.50 $62.50 $13.03 $62.50 $65.00 $36.97 $62.50 $65.00 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $28.13 $12.40 N/A $36.25 $62.50 $62.50 $62.50 $13.03 $62.50 N/A N/A G08586 SUP HCPCS C1887 G08586 - CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 80CM TORCON NB BOTH IP/OP $62.50 $46.00 $12.40 $65.00 $33.94 $33.94 $33.94 $33.94 $62.50 $62.50 $62.50 $13.03 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $65.00 $36.97 $62.50 $65.00 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $12.40 N/A $36.25 $62.50 $62.50 $62.50 $13.03 $62.50 N/A N/A G08597 SUP HCPCS C1725 G08597 - CATHETER ANGIOGRAPHIC SIMMONS 3 CURVE 5FR 100CM TORCON NB BOTH IP/OP $62.50 $46.00 $12.40 $65.00 $33.94 $33.94 $33.94 $33.94 $62.50 $62.50 $62.50 $13.03 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $65.00 $36.97 $62.50 $65.00 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $12.40 N/A $36.25 $62.50 $62.50 $62.50 $13.03 $62.50 N/A N/A G08682 SUP HCPCS C1894 G08682 - SET INTROD 14FR 15MM 70CM GIANTURCO ROSCH DESIGN RADIOPQ BOTH IP/OP $580.00 $429.00 $115.12 $667.00 $314.94 $314.94 $314.94 $314.94 $580.00 $580.00 $580.00 $120.89 $580.00 $430.48 $430.48 $447.06 $302.18 $120.88 $580.00 $667.00 $343.07 $580.00 $667.00 $580.00 $580.00 $435.00 $580.00 $580.00 $580.00 $290.00 $290.00 $459.36 $580.00 $464.00 $377.00 $115.12 N/A $336.40 $580.00 $580.00 $580.00 $120.87 $580.00 N/A N/A G08686 SUP HCPCS C1894 G08686 - SET INTRO 10FR 3.3MM 30CM STRL 41CM CKFL DISP ACPT .038IN GW BOTH IP/OP $107.50 $80.00 $21.34 $111.80 $58.37 $58.37 $58.37 $58.37 $107.50 $107.50 $107.50 $22.41 $107.50 $79.79 $79.79 $82.86 $56.01 $22.40 $107.50 $111.80 $63.59 $107.50 $111.80 $107.50 $107.50 $80.63 $107.50 $107.50 $107.50 $53.75 $53.75 $85.14 $107.50 $86.00 $69.88 $21.34 N/A $62.35 $107.50 $107.50 $107.50 $22.40 $107.50 N/A N/A G08699 SUP Custom 27203010 G08699 - CATHETER ANGIOGRAPHIC DAV CURVE ANGLE 5FR 100CM MULTPUR BOTH IP/OP $312.50 $231.00 $55.63 $325.00 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $231.94 $231.94 $240.88 $162.81 $65.13 $312.50 $130.00 $312.50 $312.50 $325.00 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $203.13 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A G08777 SUP HCPCS C1769 G08777 - GUIDEWIRE VASCULAR ANGLE SPRING COIL .014IN 180CM HEAVY DUTY BOTH IP/OP $278.50 $206.00 $55.20 $282.30 $151.02 $151.02 $151.02 $151.02 $278.13 $278.13 $278.13 $57.97 $278.13 $206.43 $206.43 $214.38 $144.91 $57.97 $278.13 $282.30 $164.51 $278.13 $282.30 $278.13 $278.13 $208.88 $278.13 $278.13 $278.13 $139.07 $139.07 $220.28 $278.13 $222.50 $180.78 $55.20 N/A $161.53 $278.13 $166.88 $278.13 $57.96 $278.13 N/A N/A G08801 SUP HCPCS C1769 G08801 - GUIDEWIRE VASCULAR TAPER FLOPPY ANGLE SPRING COIL .014IN 300 BOTH IP/OP $306.50 $227.00 $60.78 $310.85 $166.29 $166.29 $166.29 $166.29 $306.25 $306.25 $306.25 $63.83 $306.25 $227.30 $227.30 $236.06 $159.56 $63.83 $306.25 $310.85 $181.15 $306.25 $310.85 $306.25 $306.25 $229.88 $306.25 $306.25 $306.25 $153.13 $153.13 $242.55 $306.25 $245.00 $199.06 $60.78 N/A $177.77 $306.25 $306.25 $306.25 $63.82 $306.25 N/A N/A G08943 SUP HCPCS C1725 G08943 - CATHETER ANGIOGRAPHIC .038IN SHORT MONT-1 CURVE 7FR 100CM 4 BOTH IP/OP $32.50 $24.00 $6.45 $32.50 $17.65 $17.65 $17.65 $17.65 $32.50 $32.50 $32.50 $6.77 $32.50 $24.12 $24.12 $25.05 $16.93 $6.77 $32.50 $32.50 $19.22 $32.50 $32.50 $32.50 $32.50 $24.38 $32.50 $32.50 $32.50 $16.25 $16.25 $25.74 $32.50 $26.00 $21.13 $6.45 N/A $18.85 $32.50 $32.50 $32.50 $6.77 $32.50 N/A N/A G08957 SUP HCPCS C1894 G08957 - SET INTROD .038IN 14FR 30CM 41CM RADIOPQ DILAT SIDEARM FIT BOTH IP/OP $317.50 $235.00 $63.02 $330.20 $172.40 $172.40 $172.40 $172.40 $317.50 $317.50 $317.50 $66.17 $317.50 $235.65 $235.65 $244.73 $165.42 $66.17 $317.50 $330.20 $187.80 $317.50 $330.20 $317.50 $317.50 $238.13 $317.50 $317.50 $317.50 $158.75 $158.75 $251.46 $317.50 $254.00 $206.38 $63.02 N/A $184.15 $317.50 $317.50 $317.50 $66.17 $317.50 N/A N/A G09105 SUP HCPCS C1769 G09105 - GUIDEWIRE VASCULAR ANGLE TAPER .035IN 260CM RADIOPQ STIFF BOTH IP/OP $81.50 $60.00 $16.16 $136.50 $44.20 $44.20 $44.20 $44.20 $81.40 $81.40 $81.40 $16.97 $81.40 $60.42 $60.42 $62.74 $42.41 $16.96 $81.40 $136.50 $48.15 $81.40 $136.50 $81.40 $81.40 $61.13 $81.40 $81.40 $81.40 $40.70 $40.70 $64.47 $81.40 $65.12 $52.91 $16.16 N/A $47.27 $81.40 $81.40 $81.40 $16.96 $81.40 N/A N/A G09215 SUP HCPCS C1770 G09215 - COIL EMBOLIZATION .018IN 8-4MM 9.5CM MICROCOIL SOFT SPACED BOTH IP/OP $275.50 $204.00 $57.38 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $57.38 $275.33 $110.13 $275.33 $275.33 $275.33 $275.33 $275.33 $206.63 $275.33 $275.33 $275.33 $137.67 $137.67 $218.06 $275.33 $220.26 $123.90 $275.33 N/A $159.79 $275.33 $165.20 $275.33 $275.33 $275.33 N/A N/A G09217 SUP Custom 27803010 G09217 - COIL EMBL 14.2CM 10-4MM TRND MCIOL SFT SPC PUSH BOTH IP/OP $275.50 $204.00 $49.01 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $49.01 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $57.38 $275.33 $110.13 $275.33 $275.33 $275.33 $275.33 $275.33 $206.63 $275.33 $275.33 $275.33 $137.67 $137.67 $218.06 $275.33 $220.26 $123.90 $275.33 N/A $159.79 $275.33 $165.20 $275.33 $275.33 $275.33 N/A N/A G09411 SUP HCPCS C1725 G09411 - CATHETER ANGIOGRAPHIC STR CURVE 5FR 70CM 10 SIDEPORT HIGH BOTH IP/OP $32.50 $24.00 $6.45 $32.50 $17.65 $17.65 $17.65 $17.65 $32.50 $32.50 $32.50 $6.77 $32.50 $24.12 $24.12 $25.05 $16.93 $6.77 $32.50 $32.50 $19.22 $32.50 $32.50 $32.50 $32.50 $24.38 $32.50 $32.50 $32.50 $16.25 $16.25 $25.74 $32.50 $26.00 $21.13 $6.45 N/A $18.85 $32.50 $32.50 $32.50 $6.77 $32.50 N/A N/A G09469 SUP HCPCS C1725 G09469 - CATHETER ANGIOGRAPHIC ANGLE KMP CURVE TAPER 5FR 65CM LP BOTH IP/OP $62.50 $46.00 $12.40 $65.00 $33.94 $33.94 $33.94 $33.94 $62.50 $62.50 $62.50 $13.03 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $65.00 $36.97 $62.50 $65.00 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $12.40 N/A $36.25 $62.50 $62.50 $62.50 $13.03 $62.50 N/A N/A G09479 SUP HCPCS C1894 G09479 - INTRODUCER CATHETER .038IN 7FR 40CM BALKIN UP AND OVER BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A G09497 SUP HCPCS C1729 G09497 - CATHETER DRAIN 8.5FR 40CM 32 SIDEPORT RADIOPQ BAND MAC-LOC BOTH IP/OP $250.00 $185.00 $49.60 $253.65 $135.70 $135.70 $135.70 $135.70 $249.90 $249.90 $249.90 $52.09 $249.90 $185.48 $185.48 $192.62 $130.20 $52.08 $249.90 $253.65 $147.82 $249.90 $253.65 $249.90 $249.90 $187.50 $249.90 $249.90 $249.90 $124.95 $124.95 $197.92 $249.90 $199.92 $162.44 $49.60 N/A $145.00 $249.90 $249.90 $249.90 $52.08 $249.90 N/A N/A G09498 SUP HCPCS C1729 G09498 - CATHETER DRAIN 10.2FR 40CM 32 SIDEPORT RADIOPQ BAND MAC-LOC BOTH IP/OP $250.00 $185.00 $49.60 $253.65 $135.70 $135.70 $135.70 $135.70 $249.90 $249.90 $249.90 $52.09 $249.90 $185.48 $185.48 $192.62 $130.20 $52.08 $249.90 $253.65 $147.82 $249.90 $253.65 $249.90 $249.90 $187.50 $249.90 $249.90 $249.90 $124.95 $124.95 $197.92 $249.90 $199.92 $162.44 $49.60 N/A $145.00 $249.90 $249.90 $249.90 $52.08 $249.90 N/A N/A G09499 SUP HCPCS C1729 G09499 - CATHETER DRAIN 12FR 40CM 32 SIDEPORT RADIOPQ BAND MAC-LOC BOTH IP/OP $250.00 $185.00 $49.60 $253.65 $135.70 $135.70 $135.70 $135.70 $249.90 $249.90 $249.90 $52.09 $249.90 $185.48 $185.48 $192.62 $130.20 $52.08 $249.90 $253.65 $147.82 $249.90 $253.65 $249.90 $249.90 $187.50 $249.90 $249.90 $249.90 $124.95 $124.95 $197.92 $249.90 $199.92 $162.44 $49.60 N/A $145.00 $249.90 $249.90 $249.90 $52.08 $249.90 N/A N/A G09500 SUP HCPCS C1729 G09500 - CATHETER DRAIN 14FR 40CM 8CM 32 SIDEPORT LOCK MECHANISM BOTH IP/OP $250.00 $185.00 $49.60 $253.65 $135.70 $135.70 $135.70 $135.70 $249.90 $249.90 $249.90 $52.09 $249.90 $185.48 $185.48 $192.62 $130.20 $52.08 $249.90 $253.65 $147.82 $249.90 $253.65 $249.90 $249.90 $187.50 $249.90 $249.90 $249.90 $124.95 $124.95 $197.92 $249.90 $199.92 $162.44 $49.60 N/A $145.00 $249.90 $249.90 $249.90 $52.08 $249.90 N/A N/A G09501 SUP HCPCS C1729 G09501 - CATHETER DRAIN 8.5FR 25CM 6 SIDEPORT TROCAR MULTPUR RADIOPQ BOTH IP/OP $250.00 $185.00 $49.60 $254.90 $135.70 $135.70 $135.70 $135.70 $249.90 $249.90 $249.90 $52.09 $249.90 $185.48 $185.48 $192.62 $130.20 $52.08 $249.90 $254.90 $147.82 $249.90 $254.90 $249.90 $249.90 $187.50 $249.90 $249.90 $249.90 $124.95 $124.95 $197.92 $249.90 $199.92 $162.44 $49.60 N/A $145.00 $249.90 $249.90 $249.90 $52.08 $249.90 N/A N/A G09502 SUP HCPCS C1729 G09502 - CATHETER DRAIN 10.2FR 25CM 6 SIDEPORT LOCK LOOP RADIOPQ BAND BOTH IP/OP $250.00 $185.00 $49.60 $254.90 $135.70 $135.70 $135.70 $135.70 $249.90 $249.90 $249.90 $52.09 $249.90 $185.48 $185.48 $192.62 $130.20 $52.08 $249.90 $254.90 $147.82 $249.90 $254.90 $249.90 $249.90 $187.50 $249.90 $249.90 $249.90 $124.95 $124.95 $197.92 $249.90 $199.92 $162.44 $49.60 N/A $145.00 $249.90 $249.90 $249.90 $52.08 $249.90 N/A N/A G09503 SUP HCPCS C1729 G09503 - CATHETER DRAIN .038IN 12FR 25CM 6 SIDEPORT MAC LOC LOCKING BOTH IP/OP $250.00 $185.00 $49.60 $254.90 $135.70 $135.70 $135.70 $135.70 $249.90 $249.90 $249.90 $52.09 $249.90 $185.48 $185.48 $192.62 $130.20 $52.08 $249.90 $254.90 $147.82 $249.90 $254.90 $249.90 $249.90 $187.50 $249.90 $249.90 $249.90 $124.95 $124.95 $197.92 $249.90 $199.92 $162.44 $49.60 N/A $145.00 $249.90 $249.90 $249.90 $52.08 $249.90 N/A N/A G09504 SUP HCPCS C1729 G09504 - CATHETER DRAIN .038IN 14FR 25CM 6 SIDEPORT MAC-LOC LOCKING BOTH IP/OP $250.00 $185.00 $49.60 $254.90 $135.70 $135.70 $135.70 $135.70 $249.90 $249.90 $249.90 $52.09 $249.90 $185.48 $185.48 $192.62 $130.20 $52.08 $249.90 $254.90 $147.82 $249.90 $254.90 $249.90 $249.90 $187.50 $249.90 $249.90 $249.90 $124.95 $124.95 $197.92 $249.90 $199.92 $162.44 $49.60 N/A $145.00 $249.90 $249.90 $249.90 $52.08 $249.90 N/A N/A G09607 SUP HCPCS C1769 G09607 - GUIDEWIRE VASCULAR .035IN 145CM ANGLE SHORT TAPER FLEXIBLE BOTH IP/OP $94.00 $70.00 $18.61 $97.50 $50.91 $50.91 $50.91 $50.91 $93.75 $93.75 $93.75 $19.54 $93.75 $69.58 $69.58 $72.26 $48.84 $19.54 $93.75 $97.50 $55.45 $93.75 $97.50 $93.75 $93.75 $70.50 $93.75 $93.75 $93.75 $46.88 $46.88 $74.25 $93.75 $75.00 $60.94 $18.61 N/A $54.52 $93.75 $56.25 $93.75 $19.54 $93.75 N/A N/A G09691 SUP HCPCS C1892 G09691 - INTRODUCER SHEATH .038IN LARGE 16FR 30CM 42CM RADIOPQ BAND BOTH IP/OP $317.50 $235.00 $63.02 $328.61 $172.40 $172.40 $172.40 $172.40 $317.50 $317.50 $317.50 $66.17 $317.50 $235.65 $235.65 $244.73 $165.42 $66.17 $317.50 $328.61 $187.80 $317.50 $328.61 $317.50 $317.50 $238.13 $317.50 $317.50 $317.50 $158.75 $158.75 $251.46 $317.50 $254.00 $206.38 $63.02 N/A $184.15 $317.50 $317.50 $317.50 $66.17 $317.50 N/A N/A G09751 SUP HCPCS C1725 G09751 - CATHETER ANGIOGRAPHIC KMP CURVE 5FR 40CM TORCON NB ADVANTAGE BOTH IP/OP $62.50 $46.00 $12.40 $65.00 $33.94 $33.94 $33.94 $33.94 $62.50 $62.50 $62.50 $13.03 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $65.00 $36.97 $62.50 $65.00 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $12.40 N/A $36.25 $62.50 $62.50 $62.50 $13.03 $62.50 N/A N/A G09954 SUP HCPCS C1769 G09954 - GUIDEWIRE VASCULAR STR .035IN 145CM FLEXIBLE TIP ULTRA-STIFF BOTH IP/OP $59.50 $44.00 $11.80 $67.16 $32.28 $32.28 $32.28 $32.28 $59.45 $59.45 $59.45 $12.39 $59.45 $44.12 $44.12 $45.82 $30.97 $12.39 $59.45 $67.16 $35.16 $59.45 $67.16 $59.45 $59.45 $44.63 $59.45 $59.45 $59.45 $29.73 $29.73 $47.08 $59.45 $47.56 $38.64 $11.80 N/A $34.51 $59.45 $59.45 $59.45 $12.39 $59.45 N/A N/A G09956 SUP HCPCS C1769 G09956 - GUIDEWIRE VASCULAR STR .035IN 180CM FLEXIBLE TIP ULTRA-STIFF BOTH IP/OP $86.50 $64.00 $17.12 $89.70 $46.83 $46.83 $46.83 $46.83 $86.25 $86.25 $86.25 $17.98 $86.25 $64.01 $64.01 $66.48 $44.94 $17.98 $86.25 $89.70 $51.02 $86.25 $89.70 $86.25 $86.25 $64.88 $86.25 $86.25 $86.25 $43.13 $43.13 $68.31 $86.25 $69.00 $56.06 $17.12 N/A $50.17 $86.25 $86.25 $86.25 $17.97 $86.25 N/A N/A G10082 SUP HCPCS C1725 G10082 - CATHETER ANGIO ROSCH INFR MESENTRIC CRV TPR 5FR 65CM STRL 41 BOTH IP/OP $312.50 $231.00 $62.02 $325.00 $169.69 $169.69 $169.69 $169.69 $312.50 $312.50 $312.50 $65.13 $312.50 $231.94 $231.94 $240.88 $162.81 $65.13 $312.50 $325.00 $184.84 $312.50 $325.00 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $203.13 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A G10205 SUP HCPCS C1726 G10205 - DILATOR VASCULAR .025IN 4FR 20CM DECREASED FRICTION RADIOPQ BOTH IP/OP $26.50 $20.00 $5.21 $26.25 $14.25 $14.25 $14.25 $14.25 $26.25 $26.25 $26.25 $5.47 $26.25 $19.48 $19.48 $20.23 $13.68 $5.47 $26.25 $10.70 $15.53 $26.25 $26.25 $26.25 $26.25 $19.88 $26.25 $26.25 $26.25 $13.13 $13.13 $20.79 $26.25 $21.00 $17.06 $5.21 N/A $15.37 $26.25 $26.25 $26.25 $5.47 $26.25 N/A N/A G10210 SUP Custom 27203010 G10210 - TRAY PERICARDIOCENTESIS PIGTAIL CURVE 8.3FR 18GA 40CM 15CM 6 BOTH IP/OP $474.00 $351.00 $84.33 $531.38 $473.75 $473.75 $473.75 $473.75 $473.75 $473.75 $84.33 $473.75 $473.75 $351.62 $351.62 $365.17 $246.82 $98.73 $473.75 $212.55 $473.75 $473.75 $531.38 $473.75 $473.75 $355.50 $473.75 $473.75 $473.75 $236.88 $236.88 $375.21 $473.75 $379.00 $307.94 $473.75 N/A $274.92 $473.75 $284.25 $473.75 $473.75 $473.75 N/A N/A G10292 SUP HCPCS C1758 G10292 - DILATOR VASCULAR 12FR 20CM RADIOPQ HYDPHI STERILE DISPOSABLE BOTH IP/OP $27.00 $20.00 $5.31 $29.03 $14.53 $14.53 $14.53 $14.53 $26.75 $26.75 $26.75 $5.58 $26.75 $19.85 $19.85 $20.62 $13.94 $5.57 $26.75 $29.03 $15.82 $26.75 $29.03 $26.75 $26.75 $20.25 $26.75 $26.75 $26.75 $13.38 $13.38 $21.19 $26.75 $21.40 $17.39 $5.31 N/A $15.66 $26.75 $26.75 $26.75 $5.57 $26.75 N/A N/A G10383 SUP HCPCS C1894 G10383 - INTRODUCER SHEATH 6FR 40CM OVER CONTRALATERAL RADIOPQ BAND BOTH IP/OP $187.50 $139.00 $37.21 $194.06 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $194.06 $110.91 $187.50 $194.06 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G10405 SUP HCPCS C1894 G10405 - INTRODUCER SHEATH .035IN 7FR 40CM BALKIN UP AND OVER BOTH IP/OP $155.00 $115.00 $30.70 $154.70 $84.00 $84.00 $84.00 $84.00 $154.70 $154.70 $154.70 $32.24 $154.70 $114.82 $114.82 $119.24 $80.60 $32.24 $154.70 $154.70 $91.51 $154.70 $154.70 $154.70 $154.70 $116.25 $154.70 $154.70 $154.70 $77.35 $77.35 $122.52 $154.70 $123.76 $100.56 $30.70 N/A $89.90 $154.70 $154.70 $154.70 $32.24 $154.70 N/A N/A G10414 SUP HCPCS C1770 G10414 - COIL EMBOLIZATION .035IN STANDARD SMALL 4-3MM 2.6CM TORNADO BOTH IP/OP $275.50 $204.00 $57.38 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $57.38 $275.33 $110.13 $275.33 $275.33 $275.33 $275.33 $275.33 $206.63 $275.33 $275.33 $275.33 $137.67 $137.67 $218.06 $275.33 $220.26 $123.90 $275.33 N/A $159.79 $275.33 $165.20 $275.33 $275.33 $275.33 N/A N/A G10415 SUP HCPCS C1770 G10415 - COIL EMBOLIZATION .035IN STANDARD SMALL 5-3MM 4.1CM SOFT BOTH IP/OP $275.50 $204.00 $57.38 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $57.38 $275.33 $110.13 $275.33 $275.33 $275.33 $275.33 $275.33 $206.63 $275.33 $275.33 $275.33 $137.67 $137.67 $218.06 $275.33 $220.26 $123.90 $275.33 N/A $159.79 $275.33 $165.20 $275.33 $275.33 $275.33 N/A N/A G10417 SUP HCPCS C1770 G10417 - COIL EMBOLIZATION 7-3MM 8CM TORNADO PLATINUM ARTERIOVENOUS BOTH IP/OP $275.50 $204.00 $57.38 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $57.38 $275.33 $110.13 $275.33 $275.33 $275.33 $275.33 $275.33 $206.63 $275.33 $275.33 $275.33 $137.67 $137.67 $218.06 $275.33 $220.26 $123.90 $275.33 N/A $159.79 $275.33 $165.20 $275.33 $275.33 $275.33 N/A N/A G10455 SUP HCPCS C1725 G10455 - CATHETER ANGIOGRAPHIC MPA CURVE 5FR 65CM TORCON NB ADVANTAGE BOTH IP/OP $55.00 $41.00 $10.92 $55.00 $29.87 $29.87 $29.87 $29.87 $55.00 $55.00 $55.00 $11.46 $55.00 $40.82 $40.82 $42.39 $28.66 $11.46 $55.00 $55.00 $32.53 $55.00 $55.00 $55.00 $55.00 $41.25 $55.00 $55.00 $55.00 $27.50 $27.50 $43.56 $55.00 $44.00 $35.75 $10.92 N/A $31.90 $55.00 $55.00 $55.00 $11.46 $55.00 N/A N/A G10460 SUP HCPCS C1894 G10460 - SET ACCES 6FR 22GA 4FR 15CM 20CM CHIBA TIP NEEDLE SHEATH BOTH IP/OP $249.50 $185.00 $49.50 $249.38 $135.41 $135.41 $135.41 $135.41 $249.38 $249.38 $249.38 $51.98 $249.38 $185.09 $185.09 $192.22 $129.93 $51.97 $249.38 $249.38 $147.51 $249.38 $249.38 $249.38 $249.38 $187.13 $249.38 $249.38 $249.38 $124.69 $124.69 $197.51 $249.38 $199.50 $162.10 $49.50 N/A $144.71 $249.38 $249.38 $249.38 $51.97 $249.38 N/A N/A G10554 SUP Custom 27203010 G10554 - SET INTUBATION .038IN 3MM 14FR 70CM 110CM RTRGRD RADIOPQ BOTH IP/OP $383.50 $284.00 $68.23 $383.33 $383.33 $383.33 $383.33 $383.33 $383.33 $383.33 $68.23 $383.33 $383.33 $284.51 $284.51 $295.47 $199.71 $79.89 $383.33 $153.33 $383.33 $383.33 $383.33 $383.33 $383.33 $287.63 $383.33 $383.33 $383.33 $191.67 $191.67 $303.60 $383.33 $306.66 $249.16 $383.33 N/A $222.43 $383.33 $230.00 $383.33 $383.33 $383.33 N/A N/A G10722 SUP Custom 27203010 G10722 - NEEDLE INTRAOSSEOUS 15.5GA 3CM 2 OPPOSE SIDEPORT INFUS BOTH IP/OP $111.50 $83.00 $19.80 $111.25 $111.25 $111.25 $111.25 $111.25 $111.25 $111.25 $19.80 $111.25 $111.25 $82.57 $82.57 $85.75 $57.96 $23.19 $111.25 $44.50 $111.25 $111.25 $111.25 $111.25 $111.25 $83.63 $111.25 $111.25 $111.25 $55.63 $55.63 $88.11 $111.25 $89.00 $72.31 $111.25 N/A $64.67 $111.25 $66.75 $111.25 $111.25 $111.25 N/A N/A G11017 SUP HCPCS C1894 G11017 - INTRODUCER CATHETER 8FR 40CM CONTRALATERAL RADIOPQ BAND BOTH IP/OP $337.50 $250.00 $66.99 $337.50 $183.26 $183.26 $183.26 $183.26 $337.50 $337.50 $337.50 $70.34 $337.50 $250.49 $250.49 $260.15 $175.84 $70.34 $337.50 $337.50 $199.63 $337.50 $337.50 $337.50 $337.50 $253.13 $337.50 $337.50 $337.50 $168.75 $168.75 $267.30 $337.50 $270.00 $219.38 $66.99 N/A $195.75 $337.50 $337.50 $337.50 $70.34 $337.50 N/A N/A G11189 SUP HCPCS C1892 G11189 - CATHETER ANGIOGRAPHIC VISCERAL 1 CURVE 5FR 80CM TORCON NB BOTH IP/OP $47.00 $35.00 $9.30 $65.00 $25.46 $25.46 $25.46 $25.46 $46.88 $46.88 $46.88 $9.77 $46.88 $34.79 $34.79 $36.14 $24.42 $9.77 $46.88 $65.00 $27.73 $46.88 $65.00 $46.88 $46.88 $35.25 $46.88 $46.88 $46.88 $23.44 $23.44 $37.13 $46.88 $37.50 $30.47 $9.30 N/A $27.26 $46.88 $46.88 $46.88 $9.77 $46.88 N/A N/A G11240 SUP HCPCS C1894 G11240 - SET INTROD .038IN 11FR 70CM RADIOPQ BAND CHK-FLO PERFORMER BOTH IP/OP $237.50 $176.00 $47.14 $247.00 $128.96 $128.96 $128.96 $128.96 $237.50 $237.50 $237.50 $49.50 $237.50 $176.27 $176.27 $183.07 $123.74 $49.50 $237.50 $247.00 $140.48 $237.50 $247.00 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $154.38 $47.14 N/A $137.75 $237.50 $237.50 $237.50 $49.50 $237.50 N/A N/A G11667 SUP HCPCS C1769 G11667 - GUIDEWIRE VASC CRV .035IN 260CM STRL 2MM RDRR PC THE FIRM BOTH IP/OP $94.00 $70.00 $18.61 $122.50 $50.91 $50.91 $50.91 $50.91 $93.75 $93.75 $93.75 $19.54 $93.75 $69.58 $69.58 $72.26 $48.84 $19.54 $93.75 $122.50 $55.45 $93.75 $122.50 $93.75 $93.75 $70.50 $93.75 $93.75 $93.75 $46.88 $46.88 $74.25 $93.75 $75.00 $60.94 $18.61 N/A $54.52 $93.75 $93.75 $93.75 $19.54 $93.75 N/A N/A G11672 SUP HCPCS C1894 G11672 - INTRODUCER SHEATH .038IN LARGE 18FR 30CM 42CM RADIOPQ BAND BOTH IP/OP $317.50 $235.00 $63.02 $328.61 $172.40 $172.40 $172.40 $172.40 $317.50 $317.50 $317.50 $66.17 $317.50 $235.65 $235.65 $244.73 $165.42 $66.17 $317.50 $328.61 $187.80 $317.50 $328.61 $317.50 $317.50 $238.13 $317.50 $317.50 $317.50 $158.75 $158.75 $251.46 $317.50 $254.00 $206.38 $63.02 N/A $184.15 $317.50 $317.50 $317.50 $66.17 $317.50 N/A N/A G11916 SUP HCPCS C1884 G11916 - CATHETER ANGIO PGTL CRV 5FR 100CM AUROUS 10 SDPRT RADOPQ SZ BOTH IP/OP $343.50 $254.00 $68.10 $343.13 $154.41 $154.41 $154.41 $154.41 $343.13 $343.13 $343.13 $71.52 $343.13 $343.13 $343.13 $343.13 $343.13 $71.51 $343.13 $343.13 $202.96 $343.13 $343.13 $343.13 $343.13 $257.63 $343.13 $343.13 $343.13 $171.57 $171.57 $271.76 $343.13 $274.50 $154.41 $68.10 N/A $199.23 $343.13 $343.13 $343.13 $71.51 $343.13 N/A N/A G12016 SUP HCPCS C1769 G12016 - GUIDEWIRE VASC .018IN 8FR 6.5FR 20CM STRL 15CM JEFFREY SET BOTH IP/OP $318.00 $235.00 $63.11 $324.31 $172.65 $172.65 $172.65 $172.65 $317.95 $317.95 $317.95 $66.27 $317.95 $235.98 $235.98 $245.08 $165.65 $66.26 $317.95 $324.31 $188.07 $317.95 $324.31 $317.95 $317.95 $238.50 $317.95 $317.95 $317.95 $158.98 $158.98 $251.82 $317.95 $254.36 $206.67 $63.11 N/A $184.44 $317.95 $317.95 $317.95 $66.26 $317.95 N/A N/A G12082 SUP HCPCS C1884 G12082 - CATHETER ANGIO VTK CRBRL CRV 5FR 125CM SCTH BTP BRD RADOPQ BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $122.50 $122.50 $25.53 $122.50 N/A N/A G12168 SUP HCPCS C1884 G12168 - CATHETER ANGIOGRAPHIC ANGLE VERTEBRAL CURVE 5FR 125CM BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $55.13 $55.13 $55.13 $55.13 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $24.31 N/A $71.05 $122.50 $122.50 $122.50 $25.53 $122.50 N/A N/A G12170 SUP HCPCS C1725 G12170 - CATHETER ANGIOGRAPHIC .038IN VERT CURVE 5FR 125CM LP RADIOPQ BOTH IP/OP $62.50 $46.00 $12.40 $65.00 $33.94 $33.94 $33.94 $33.94 $62.50 $62.50 $62.50 $13.03 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $65.00 $36.97 $62.50 $65.00 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $12.40 N/A $36.25 $62.50 $62.50 $62.50 $13.03 $62.50 N/A N/A G12179 SUP Custom 27203010 G12179 - CATHETER ANGIOGRAPHIC .038IN TEGT CURVE 5FR 65CM SLIP-CATH BOTH IP/OP $122.50 $91.00 $21.81 $122.50 $122.50 $122.50 $122.50 $122.50 $122.50 $122.50 $21.81 $122.50 $122.50 $90.92 $90.92 $94.42 $63.82 $25.53 $122.50 $49.00 $122.50 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $79.63 $122.50 N/A $71.05 $122.50 $73.50 $122.50 $122.50 $122.50 N/A N/A G12266 SUP HCPCS C1894 G12266 - SHEATH GUID 6FR 2.2MM 90CM CHK-FLO VALVE SOFT TIP RADIOPQ BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G12423 SUP HCPCS C1894 G12423 - SET INTROD .018IN 6FR 20CM 13CM ACCES NEEDLE PLATINUM TIP BOTH IP/OP $95.00 $70.00 $18.86 $104.50 $51.59 $51.59 $51.59 $51.59 $95.00 $95.00 $95.00 $19.80 $95.00 $70.51 $70.51 $73.23 $49.50 $19.80 $95.00 $104.50 $56.19 $95.00 $104.50 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $61.75 $18.86 N/A $55.10 $95.00 $95.00 $95.00 $19.80 $95.00 N/A N/A G12513 SUP Custom 27203010 G12513 - TRAY TRACHEOSTOMY STANDARD 24-28FR 2 CANNU DILAT CUFF TUBE BOTH IP/OP $800.00 $592.00 $142.40 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $142.40 $800.00 $800.00 $593.76 $593.76 $616.64 $416.80 $166.73 $800.00 $320.00 $800.00 $800.00 $800.00 $800.00 $800.00 $600.00 $800.00 $800.00 $800.00 $400.00 $400.00 $633.60 $800.00 $640.00 $520.00 $800.00 N/A $464.00 $800.00 $480.00 $800.00 $800.00 $800.00 N/A N/A G12560 SUP HCPCS C1894 G12560 - SET INTROD .018IN 4FR 10CM 40CM GWIRE CATHETER MICROPUNCTURE BOTH IP/OP $123.00 $91.00 $24.40 $122.93 $66.75 $66.75 $66.75 $66.75 $122.93 $122.93 $122.93 $25.62 $122.93 $91.24 $91.24 $94.75 $64.05 $25.62 $122.93 $122.93 $72.71 $122.93 $122.93 $122.93 $122.93 $92.25 $122.93 $122.93 $122.93 $61.47 $61.47 $97.36 $122.93 $98.34 $79.90 $24.40 N/A $71.34 $122.93 $122.93 $122.93 $25.62 $122.93 N/A N/A G12565 SUP HCPCS C1894 G12565 - TRAY TRCH 8.5FR SHLY BLU RHINO FLXB ADLT PERC BOTH IP/OP "$1,631.50" "$1,207.00" $323.79 "$1,631.40" $885.85 $885.85 $885.85 $885.85 "$1,631.40" "$1,631.40" "$1,631.40" $340.02 "$1,631.40" "$1,210.83" "$1,210.83" "$1,257.48" $849.96 $340.00 "$1,631.40" "$1,096.10" $964.97 "$1,631.40" "$1,096.10" "$1,631.40" "$1,631.40" "$1,223.63" "$1,631.40" "$1,631.40" "$1,631.40" $815.70 $815.70 "$1,292.07" "$1,631.40" "$1,305.12" "$1,060.41" $323.79 N/A $946.27 "$1,631.40" "$1,631.40" "$1,631.40" $339.98 "$1,631.40" N/A N/A G12580 SUP HCPCS C1763 G12580 - GRAFT SOFT TISSUE 10X7CM 4 LAYER MESH SURGISIS BIODESIGN PIG BOTH IP/OP "$2,262.50" "$1,674.00" $449.05 "$2,262.50" "$1,018.13" "$1,018.13" "$1,018.13" "$1,018.13" "$2,262.50" "$2,262.50" "$2,262.50" $471.56 "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" $471.53 "$2,262.50" "$2,262.50" "$1,338.27" "$2,262.50" "$2,262.50" "$2,262.50" "$2,262.50" "$1,696.88" "$2,262.50" "$2,262.50" "$2,262.50" "$1,131.25" "$1,131.25" "$1,791.90" "$2,262.50" "$1,810.00" "$1,018.13" $449.05 N/A "$1,312.25" "$2,262.50" "$2,262.50" "$2,262.50" $471.51 "$2,262.50" N/A N/A G12831 SUP HCPCS C1894 G12831 - INTRODUCER SHEATH XL 22FR 25CM 41CM DILAT NONTAPER CLOSE BOTH IP/OP $847.50 $627.00 $168.21 $847.50 $460.19 $460.19 $460.19 $460.19 $847.50 $847.50 $847.50 $176.64 $847.50 $629.01 $629.01 $653.25 $441.55 $176.63 $847.50 $847.50 $501.30 $847.50 $847.50 $847.50 $847.50 $635.63 $847.50 $847.50 $847.50 $423.75 $423.75 $671.22 $847.50 $678.00 $550.88 $168.21 N/A $491.55 $847.50 $847.50 $847.50 $176.62 $847.50 N/A N/A G12835 SUP HCPCS C1894 G12835 - INTRODUCER CATHETER 7FR 2.5MM 90CM TUOHY BORST SIDEARM DILAT BOTH IP/OP $377.50 $279.00 $74.92 $390.71 $204.98 $204.98 $204.98 $204.98 $377.50 $377.50 $377.50 $78.68 $377.50 $280.18 $280.18 $290.98 $196.68 $78.68 $377.50 $390.71 $223.29 $377.50 $390.71 $377.50 $377.50 $283.13 $377.50 $377.50 $377.50 $188.75 $188.75 $298.98 $377.50 $302.00 $245.38 $74.92 N/A $218.95 $377.50 $377.50 $377.50 $78.67 $377.50 N/A N/A G12847 SUP HCPCS C1763 G12847 - GUIDEWIRE ESCP STRG .038IN 145CM 2 FLX TP BOTH IP/OP $873.00 $646.00 $173.23 $872.83 $392.77 $392.77 $392.77 $392.77 $872.83 $872.83 $872.83 $181.92 $872.83 $872.83 $872.83 $872.83 $872.83 $181.91 $872.83 $872.83 $516.28 $872.83 $872.83 $872.83 $872.83 $654.75 $872.83 $872.83 $872.83 $436.42 $436.42 $691.28 $872.83 $698.26 $392.77 $173.23 N/A $506.34 $872.83 $872.83 $872.83 $181.90 $872.83 N/A N/A G12848 SUP HCPCS C1763 G12848 - GRAFT SFT TIS 10X7CM SURGISIS 1 LYR SHT PEEL OPN DRY PRCN BOTH IP/OP "$2,391.50" "$1,770.00" $474.65 "$2,391.50" "$1,076.18" "$1,076.18" "$1,076.18" "$1,076.18" "$2,391.50" "$2,391.50" "$2,391.50" $498.45 "$2,391.50" "$2,391.50" "$2,391.50" "$2,391.50" "$2,391.50" $498.41 "$2,391.50" "$2,391.50" "$1,414.57" "$2,391.50" "$2,391.50" "$2,391.50" "$2,391.50" "$1,793.63" "$2,391.50" "$2,391.50" "$2,391.50" "$1,195.75" "$1,195.75" "$1,894.07" "$2,391.50" "$1,913.20" "$1,076.18" $474.65 N/A "$1,387.07" "$2,391.50" "$2,391.50" "$2,391.50" $498.39 "$2,391.50" N/A N/A G13032 SUP HCPCS C1894 G13032 - INTRODUCER CATHETER .038IN 10IN 30CM LARGE VALVE ASMBLY BOTH IP/OP $190.00 $141.00 $37.71 $192.85 $103.17 $103.17 $103.17 $103.17 $190.00 $190.00 $190.00 $39.60 $190.00 $141.02 $141.02 $146.45 $98.99 $39.60 $190.00 $192.85 $112.39 $190.00 $192.85 $190.00 $190.00 $142.50 $190.00 $190.00 $190.00 $95.00 $95.00 $150.48 $190.00 $152.00 $123.50 $37.71 N/A $110.20 $190.00 $190.00 $190.00 $39.60 $190.00 N/A N/A G13033 SUP HCPCS C1894 G13033 - INTRODUCER SHEATH .038IN 10FR 80CM LARGE VALVE ASMBLY BOTH IP/OP $265.00 $196.00 $52.60 $268.98 $143.90 $143.90 $143.90 $143.90 $265.00 $265.00 $265.00 $55.23 $265.00 $196.68 $196.68 $204.26 $138.07 $55.23 $265.00 $268.98 $156.75 $265.00 $268.98 $265.00 $265.00 $198.75 $265.00 $265.00 $265.00 $132.50 $132.50 $209.88 $265.00 $212.00 $172.25 $52.60 N/A $153.70 $265.00 $265.00 $265.00 $55.23 $265.00 N/A N/A G13081 SUP HCPCS C1894 G13081 - INTRODUCER CATHETER .035IN 10FR 38.5CM CHK FLO VALVE RADIOPQ BOTH IP/OP $214.50 $159.00 $42.52 $214.23 $116.33 $116.33 $116.33 $116.33 $214.23 $214.23 $214.23 $44.65 $214.23 $159.00 $159.00 $165.13 $111.61 $44.65 $214.23 $214.23 $126.72 $214.23 $214.23 $214.23 $214.23 $160.88 $214.23 $214.23 $214.23 $107.12 $107.12 $169.67 $214.23 $171.38 $139.25 $42.52 N/A $124.41 $214.23 $214.23 $214.23 $44.65 $214.23 N/A N/A G13116 SUP HCPCS C1763 G13116 - GRAFT SFT TIS 20X7CM SURGISIS BIODESIGN 4 PLY SHT PRCN ACLR BOTH IP/OP "$1,309.50" $969.00 $259.85 "$1,309.23" $589.15 $589.15 $589.15 $589.15 "$1,309.23" "$1,309.23" "$1,309.23" $272.88 "$1,309.23" "$1,309.23" "$1,309.23" "$1,309.23" "$1,309.23" $272.86 "$1,309.23" "$1,309.23" $774.41 "$1,309.23" "$1,309.23" "$1,309.23" "$1,309.23" $982.13 "$1,309.23" "$1,309.23" "$1,309.23" $654.62 $654.62 "$1,036.91" "$1,309.23" "$1,047.38" $589.15 $259.85 N/A $759.51 "$1,309.23" "$1,309.23" "$1,309.23" $272.84 "$1,309.23" N/A N/A G13166 SUP HCPCS C1894 G13166 - TRAY INTRO 7.5MM 8.5MM 9MM BLU RHINO G2 TRCH TUBE LD DIL RX BOTH IP/OP "$1,651.50" "$1,222.00" $327.76 "$1,651.40" $896.71 $896.71 $896.71 $896.71 "$1,651.40" "$1,651.40" "$1,651.40" $344.19 "$1,651.40" "$1,225.67" "$1,225.67" "$1,272.90" $860.38 $344.17 "$1,651.40" "$1,096.10" $976.80 "$1,651.40" "$1,096.10" "$1,651.40" "$1,651.40" "$1,238.63" "$1,651.40" "$1,651.40" "$1,651.40" $825.70 $825.70 "$1,307.91" "$1,651.40" "$1,321.12" "$1,073.41" $327.76 N/A $957.87 "$1,651.40" "$1,651.40" "$1,651.40" $344.15 "$1,651.40" N/A N/A G13282 SUP Custom 27203010 G13282 - SET CATHETER 9FR 78CM BLOCKER ADAPTER SPHERICAL BALLOON BOTH IP/OP $505.50 $374.00 $89.91 $505.10 $505.10 $505.10 $505.10 $505.10 $505.10 $505.10 $89.91 $505.10 $505.10 $374.89 $374.89 $389.33 $263.16 $105.27 $505.10 $202.04 $505.10 $505.10 $505.10 $505.10 $505.10 $379.13 $505.10 $505.10 $505.10 $252.55 $252.55 $400.04 $505.10 $404.08 $328.32 $505.10 N/A $293.19 $505.10 $303.06 $505.10 $505.10 $505.10 N/A N/A G13287 SUP HCPCS C1773 G13287 - SET RETRIEVAL 6.3FR 11FR 80CM 60CM LOOP CATHETER GUNTHER BOTH IP/OP $625.00 $463.00 $124.05 $649.00 $339.38 $339.38 $339.38 $339.38 $625.00 $625.00 $625.00 $130.27 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $649.00 $369.69 $625.00 $649.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A G13338 SUP HCPCS C1894 G13338 - INTRODUCER SHEATH 7FR .1IN 80CM TUOHY BORST SIDEARM RADIOPQ BOTH IP/OP $377.50 $279.00 $74.92 $390.71 $204.98 $204.98 $204.98 $204.98 $377.50 $377.50 $377.50 $78.68 $377.50 $280.18 $280.18 $290.98 $196.68 $78.68 $377.50 $390.71 $223.29 $377.50 $390.71 $377.50 $377.50 $283.13 $377.50 $377.50 $377.50 $188.75 $188.75 $298.98 $377.50 $302.00 $245.38 $74.92 N/A $218.95 $377.50 $377.50 $377.50 $78.67 $377.50 N/A N/A G13389 SUP HCPCS C1876 G13389 - STENT VASCULAR .035IN 6MM 40MM 80CM SELF EXPANDING DELIVERY BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A G13398 SUP HCPCS C1876 G13398 - STENT BILIARY .035IN 8MM 7FR 30MM 80CM SELF EXPANDING BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A G13399 SUP HCPCS C1876 G13399 - STENT BILIARY .035IN 9MM 7FR 40MM 80CM SELF EXPANDING BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A G13400 SUP HCPCS C1876 G13400 - STENT BILIARY .035IN 8MM 6CM 80CM SELF EXPANDING PRELOADED BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A G13404 SUP HCPCS C1876 G13404 - STENT VASCULAR 9MM 40MM 80CM SELF EXPANDING DELIVERY SYSTEM BOTH IP/OP $2.50 $2.00 $0.50 $2.50 $1.13 $1.13 $1.13 $1.13 $2.50 $2.50 $2.50 $0.52 $2.50 $2.50 $2.50 $2.50 $2.50 $0.52 $2.50 $2.50 $1.48 $2.50 $2.50 $2.50 $2.50 $1.88 $2.50 $2.50 $2.50 $1.25 $1.25 $1.98 $2.50 $2.00 $1.13 $0.50 N/A $1.45 $2.50 $2.50 $2.50 $0.52 $2.50 N/A N/A G13539 SUP HCPCS C1894 G13539 - INTRODUCER SHEATH .038IN 6FR .087IN 80CM GWIRE FLEXOR BOTH IP/OP $377.50 $279.00 $74.92 $390.71 $204.98 $204.98 $204.98 $204.98 $377.50 $377.50 $377.50 $78.68 $377.50 $280.18 $280.18 $290.98 $196.68 $78.68 $377.50 $390.71 $223.29 $377.50 $390.71 $377.50 $377.50 $283.13 $377.50 $377.50 $377.50 $188.75 $188.75 $298.98 $377.50 $302.00 $245.38 $74.92 N/A $218.95 $377.50 $377.50 $377.50 $78.67 $377.50 N/A N/A G13559 SUP HCPCS C1725 G13559 - CATHETER ANGIOGRAPHIC .038IN CHGA CURVE 5FR 80CM LP RADIOPQ BOTH IP/OP $87.50 $65.00 $17.37 $87.50 $47.51 $47.51 $47.51 $47.51 $87.50 $87.50 $87.50 $18.24 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $87.50 $51.76 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $17.37 N/A $50.75 $87.50 $87.50 $87.50 $18.24 $87.50 N/A N/A G13561 SUP HCPCS C1725 G13561 - CATHETER ANGIOGRAPHIC CHUANG C CURVE 5FR 80CM TORCON NB BOTH IP/OP $62.50 $46.00 $12.40 $65.00 $33.94 $33.94 $33.94 $33.94 $62.50 $62.50 $62.50 $13.03 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $65.00 $36.97 $62.50 $65.00 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $12.40 N/A $36.25 $62.50 $62.50 $62.50 $13.03 $62.50 N/A N/A G13793 SUP Custom 27203010 G13793 - CATHETER ANGIOGRAPHIC VANSCHIE 5 CURVE ANGLE 5FR 65CM BOTH IP/OP $65.00 $48.00 $11.57 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $65.00 $11.57 $65.00 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $26.00 $65.00 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $65.00 N/A $37.70 $65.00 $39.00 $65.00 $65.00 $65.00 N/A N/A G13806 SUP HCPCS C1763 G13806 - GRAFT SFT TIS 7X4CM SURGISIS BIODESIGN 4 PLY PRCN ACLR CLGN BOTH IP/OP "$1,870.50" "$1,384.00" $371.21 "$1,870.33" $841.65 $841.65 $841.65 $841.65 "$1,870.33" "$1,870.33" "$1,870.33" $389.82 "$1,870.33" "$1,870.33" "$1,870.33" "$1,870.33" "$1,870.33" $389.80 "$1,870.33" "$1,870.33" "$1,106.30" "$1,870.33" "$1,870.33" "$1,870.33" "$1,870.33" "$1,402.88" "$1,870.33" "$1,870.33" "$1,870.33" $935.17 $935.17 "$1,481.30" "$1,870.33" "$1,496.26" $841.65 $371.21 N/A "$1,084.89" "$1,870.33" "$1,870.33" "$1,870.33" $389.78 "$1,870.33" N/A N/A G13807 SUP HCPCS C1763 G13807 - GRAFT SFT TIS 10X7CM SURGISIS BIODESIGN 4 PLY PRCN ACLR CLGN BOTH IP/OP $898.00 $665.00 $178.18 $897.75 $403.99 $403.99 $403.99 $403.99 $897.75 $897.75 $897.75 $187.11 $897.75 $897.75 $897.75 $897.75 $897.75 $187.10 $897.75 $897.75 $531.02 $897.75 $897.75 $897.75 $897.75 $673.50 $897.75 $897.75 $897.75 $448.88 $448.88 $711.02 $897.75 $718.20 $403.99 $178.18 N/A $520.84 $897.75 $897.75 $897.75 $187.09 $897.75 N/A N/A G13808 SUP HCPCS C1763 G13808 - GRAFT SFT TIS 3.5X5CM SURGISIS BIODESIGN 4 PLY PRCN ACLR BOTH IP/OP $994.00 $736.00 $197.20 $993.60 $447.12 $447.12 $447.12 $447.12 $993.60 $993.60 $993.60 $207.09 $993.60 $993.60 $993.60 $993.60 $993.60 $207.08 $993.60 $993.60 $587.71 $993.60 $993.60 $993.60 $993.60 $745.50 $993.60 $993.60 $993.60 $496.80 $496.80 $786.93 $993.60 $794.88 $447.12 $197.20 N/A $576.52 $993.60 $993.60 $993.60 $207.07 $993.60 N/A N/A G13811 SUP Custom 27203010 G13811 - DEVICE TORQUE .014-.045IN 1 HAND GWIRE OLCOTT HYDPHI STERILE BOTH IP/OP $40.00 $30.00 $7.12 $41.60 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $16.64 $40.00 $40.00 $41.60 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 N/A $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A G13816 SUP HCPCS C1769 G13816 - GUIDEWIRE ENDSCP STR STANDARD .035IN 480CM PURPLE STERILE BOTH IP/OP $192.50 $142.00 $38.21 $192.50 $104.53 $104.53 $104.53 $104.53 $192.50 $192.50 $192.50 $40.12 $192.50 $142.87 $142.87 $148.38 $100.29 $40.12 $192.50 $192.50 $113.86 $192.50 $192.50 $192.50 $192.50 $144.38 $192.50 $192.50 $192.50 $96.25 $96.25 $152.46 $192.50 $154.00 $125.13 $38.21 N/A $111.65 $192.50 $192.50 $192.50 $40.12 $192.50 N/A N/A G14014 SUP HCPCS C1758 G14014 - GRAFT SFT TIS 2X3CM SURGISIS BIODESIGN FRZDR PRCN ACLR CLGN BOTH IP/OP $276.50 $205.00 $54.83 $276.25 $150.00 $150.00 $150.00 $150.00 $276.25 $276.25 $276.25 $57.58 $276.25 $205.03 $205.03 $212.93 $143.93 $57.57 $276.25 $276.25 $163.40 $276.25 $276.25 $276.25 $276.25 $207.38 $276.25 $276.25 $276.25 $138.13 $138.13 $218.79 $276.25 $221.00 $179.56 $54.83 N/A $160.37 $276.25 $276.25 $276.25 $57.57 $276.25 N/A N/A G14015 SUP HCPCS C1758 G14015 - CATHETER URET 3FR 70CM FLXTP CLS END RT BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $15.00 $15.00 $15.00 $15.00 $27.63 $27.63 $27.63 $5.76 $27.63 $20.51 $20.51 $21.30 $14.40 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $17.96 $5.48 N/A $16.24 $27.63 $16.58 $27.63 $5.76 $27.63 N/A N/A G14016 SUP HCPCS C1758 G14016 - CATHETER URET 4FR 70CM LF FLXTP CLS END FLX TP RT BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $15.00 $15.00 $15.00 $15.00 $27.63 $27.63 $27.63 $5.76 $27.63 $20.51 $20.51 $21.30 $14.40 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $17.96 $5.48 N/A $16.24 $27.63 $16.58 $27.63 $5.76 $27.63 N/A N/A G14017 SUP HCPCS C1758 G14017 - CATHETER URET 5FR 70CM LF FLXTP CLS END RT BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $15.00 $15.00 $15.00 $15.00 $27.63 $27.63 $27.63 $5.76 $27.63 $20.51 $20.51 $21.30 $14.40 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $17.96 $5.48 N/A $16.24 $27.63 $27.63 $27.63 $5.76 $27.63 N/A N/A G14018 SUP HCPCS C1758 G14018 - CATHETER URET 6FR 70CM LF FLXTP CLS END FLX TP RT BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $15.00 $15.00 $15.00 $15.00 $27.63 $27.63 $27.63 $5.76 $27.63 $20.51 $20.51 $21.30 $14.40 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $17.96 $5.48 N/A $16.24 $27.63 $16.58 $27.63 $5.76 $27.63 N/A N/A G14019 SUP HCPCS C1758 G14019 - CATHETER URET 7FR 70CM FLXTP CLS END RT BOTH IP/OP $32.00 $24.00 $6.31 $31.77 $17.25 $17.25 $17.25 $17.25 $31.77 $31.77 $31.77 $6.62 $31.77 $23.58 $23.58 $24.49 $16.55 $6.62 $31.77 $31.77 $18.79 $31.77 $31.77 $31.77 $31.77 $24.00 $31.77 $31.77 $31.77 $15.89 $15.89 $25.16 $31.77 $25.42 $20.65 $6.31 N/A $18.56 $31.77 $31.77 $31.77 $6.62 $31.77 N/A N/A G14022 SUP HCPCS C1758 G14022 - CATHETER URET 8FR 70CM LF FLXTP CLS END FLX TP RT BOTH IP/OP $32.00 $24.00 $6.31 $31.77 $17.25 $17.25 $17.25 $17.25 $31.77 $31.77 $31.77 $6.62 $31.77 $23.58 $23.58 $24.49 $16.55 $6.62 $31.77 $31.77 $18.79 $31.77 $31.77 $31.77 $31.77 $24.00 $31.77 $31.77 $31.77 $15.89 $15.89 $25.16 $31.77 $25.42 $20.65 $6.31 N/A $18.56 $31.77 $19.06 $31.77 $6.62 $31.77 N/A N/A G14023 SUP HCPCS C1758 G14023 - CATHETER URET 3FR 70CM FLXTP CLS END FLX TP LT BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $15.00 $15.00 $15.00 $15.00 $27.63 $27.63 $27.63 $5.76 $27.63 $20.51 $20.51 $21.30 $14.40 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $17.96 $5.48 N/A $16.24 $27.63 $27.63 $27.63 $5.76 $27.63 N/A N/A G14024 SUP HCPCS C1758 G14024 - CATHETER URET 4FR 70CM FLXTP CLS END FLX TP LT BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $15.00 $15.00 $15.00 $15.00 $27.63 $27.63 $27.63 $5.76 $27.63 $20.51 $20.51 $21.30 $14.40 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $17.96 $5.48 N/A $16.24 $27.63 $27.63 $27.63 $5.76 $27.63 N/A N/A G14025 SUP HCPCS C1758 G14025 - CATHETER URET 5FR 70CM LF FLXTP CLS END FLX TP LT BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $15.00 $15.00 $15.00 $15.00 $27.63 $27.63 $27.63 $5.76 $27.63 $20.51 $20.51 $21.30 $14.40 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $17.96 $5.48 N/A $16.24 $27.63 $27.63 $27.63 $5.76 $27.63 N/A N/A G14026 SUP HCPCS C1758 G14026 - CATHETER URET 6FR 70CM FLXTP CLS END LT BOTH IP/OP $32.00 $24.00 $6.31 $31.77 $17.25 $17.25 $17.25 $17.25 $31.77 $31.77 $31.77 $6.62 $31.77 $23.58 $23.58 $24.49 $16.55 $6.62 $31.77 $31.77 $18.79 $31.77 $31.77 $31.77 $31.77 $24.00 $31.77 $31.77 $31.77 $15.89 $15.89 $25.16 $31.77 $25.42 $20.65 $6.31 N/A $18.56 $31.77 $19.06 $31.77 $6.62 $31.77 N/A N/A G14027 SUP HCPCS C1758 G14027 - CATHETER URET 7FR 70CM FLXTP CLS END LT BOTH IP/OP $32.00 $24.00 $6.31 $31.77 $17.25 $17.25 $17.25 $17.25 $31.77 $31.77 $31.77 $6.62 $31.77 $23.58 $23.58 $24.49 $16.55 $6.62 $31.77 $31.77 $18.79 $31.77 $31.77 $31.77 $31.77 $24.00 $31.77 $31.77 $31.77 $15.89 $15.89 $25.16 $31.77 $25.42 $20.65 $6.31 N/A $18.56 $31.77 $19.06 $31.77 $6.62 $31.77 N/A N/A G14034 SUP HCPCS C1758 G14034 - CATHETER URET 8FR 70CM WHSTLTP RT BOTH IP/OP $3.00 $2.00 $0.55 $2.78 $1.51 $1.51 $1.51 $1.51 $2.78 $2.78 $2.78 $0.58 $2.78 $2.06 $2.06 $2.14 $1.45 $0.58 $2.78 $2.78 $1.64 $2.78 $2.78 $2.78 $2.78 $2.25 $2.78 $2.78 $2.78 $1.39 $1.39 $2.20 $2.78 $2.22 $1.81 $0.55 N/A $1.74 $2.78 $2.78 $2.78 $0.58 $2.78 N/A N/A G14035 SUP HCPCS C1758 G14035 - CATHETER URET 9FR 70CM WHSTLTP RT BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G14040 SUP HCPCS C1758 G14040 - CATHETER URET 6FR 70CM WHSTLTP LT BOTH IP/OP $27.00 $20.00 $5.34 $26.88 $14.60 $14.60 $14.60 $14.60 $26.88 $26.88 $26.88 $5.60 $26.88 $19.95 $19.95 $20.72 $14.00 $5.60 $26.88 $26.88 $15.90 $26.88 $26.88 $26.88 $26.88 $20.25 $26.88 $26.88 $26.88 $13.44 $13.44 $21.29 $26.88 $21.50 $17.47 $5.34 N/A $15.66 $26.88 $26.88 $26.88 $5.60 $26.88 N/A N/A G14041 SUP HCPCS C1758 G14041 - CATHETER URET WHSTL 7FR 70CM LT BOTH IP/OP $27.00 $20.00 $5.34 $26.88 $14.60 $14.60 $14.60 $14.60 $26.88 $26.88 $26.88 $5.60 $26.88 $19.95 $19.95 $20.72 $14.00 $5.60 $26.88 $26.88 $15.90 $26.88 $26.88 $26.88 $26.88 $20.25 $26.88 $26.88 $26.88 $13.44 $13.44 $21.29 $26.88 $21.50 $17.47 $5.34 N/A $15.66 $26.88 $16.13 $26.88 $5.60 $26.88 N/A N/A G14046 SUP HCPCS C1758 G14046 - CATHETER URET 6FR 70CM RND TIP LT BOTH IP/OP $27.00 $20.00 $5.34 $26.88 $14.60 $14.60 $14.60 $14.60 $26.88 $26.88 $26.88 $5.60 $26.88 $19.95 $19.95 $20.72 $14.00 $5.60 $26.88 $26.88 $15.90 $26.88 $26.88 $26.88 $26.88 $20.25 $26.88 $26.88 $26.88 $13.44 $13.44 $21.29 $26.88 $21.50 $17.47 $5.34 N/A $15.66 $26.88 $26.88 $26.88 $5.60 $26.88 N/A N/A G14047 SUP HCPCS C1758 G14047 - CATHETER URET 7FR 70CM RND TIP LT BOTH IP/OP $27.00 $20.00 $5.34 $26.88 $14.60 $14.60 $14.60 $14.60 $26.88 $26.88 $26.88 $5.60 $26.88 $19.95 $19.95 $20.72 $14.00 $5.60 $26.88 $26.88 $15.90 $26.88 $26.88 $26.88 $26.88 $20.25 $26.88 $26.88 $26.88 $13.44 $13.44 $21.29 $26.88 $21.50 $17.47 $5.34 N/A $15.66 $26.88 $26.88 $26.88 $5.60 $26.88 N/A N/A G14048 SUP HCPCS C1758 G14048 - CATHETER URET 8FR 70CM RND TIP LT BOTH IP/OP $3.00 $2.00 $0.55 $2.78 $1.51 $1.51 $1.51 $1.51 $2.78 $2.78 $2.78 $0.58 $2.78 $2.06 $2.06 $2.14 $1.45 $0.58 $2.78 $2.78 $1.64 $2.78 $2.78 $2.78 $2.78 $2.25 $2.78 $2.78 $2.78 $1.39 $1.39 $2.20 $2.78 $2.22 $1.81 $0.55 N/A $1.74 $2.78 $2.78 $2.78 $0.58 $2.78 N/A N/A G14049 SUP HCPCS C1758 G14049 - CATHETER URET 9FR 70CM RND TIP LT BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G14050 SUP HCPCS C1758 G14050 - CATHETER URET 10FR 70CM RND TIP LT BOTH IP/OP $27.00 $20.00 $5.34 $26.88 $14.60 $14.60 $14.60 $14.60 $26.88 $26.88 $26.88 $5.60 $26.88 $19.95 $19.95 $20.72 $14.00 $5.60 $26.88 $26.88 $15.90 $26.88 $26.88 $26.88 $26.88 $20.25 $26.88 $26.88 $26.88 $13.44 $13.44 $21.29 $26.88 $21.50 $17.47 $5.34 N/A $15.66 $26.88 $26.88 $26.88 $5.60 $26.88 N/A N/A G14053 SUP HCPCS C1758 G14053 - CATHETER URET RND 5FR 70CM STY NTCH PORT LT BOTH IP/OP $27.00 $20.00 $5.34 $26.88 $14.60 $14.60 $14.60 $14.60 $26.88 $26.88 $26.88 $5.60 $26.88 $19.95 $19.95 $20.72 $14.00 $5.60 $26.88 $26.88 $15.90 $26.88 $26.88 $26.88 $26.88 $20.25 $26.88 $26.88 $26.88 $13.44 $13.44 $21.29 $26.88 $21.50 $17.47 $5.34 N/A $15.66 $26.88 $26.88 $26.88 $5.60 $26.88 N/A N/A G14054 SUP HCPCS C1758 G14054 - CATHETER URET RND 6FR 70CM STY NTCH PORT LT BOTH IP/OP $3.00 $2.00 $0.55 $2.78 $1.51 $1.51 $1.51 $1.51 $2.78 $2.78 $2.78 $0.58 $2.78 $2.06 $2.06 $2.14 $1.45 $0.58 $2.78 $2.78 $1.64 $2.78 $2.78 $2.78 $2.78 $2.25 $2.78 $2.78 $2.78 $1.39 $1.39 $2.20 $2.78 $2.22 $1.81 $0.55 N/A $1.74 $2.78 $2.78 $2.78 $0.58 $2.78 N/A N/A G14055 SUP HCPCS C1758 G14055 - CATHETER URET 7FR 70CM RND TIP RT BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G14056 SUP HCPCS C1758 G14056 - CATHETER URET PGTL CRV 4.7FR 45CM DRETLER MTLNTH BOTH IP/OP $276.50 $205.00 $54.83 $276.25 $150.00 $150.00 $150.00 $150.00 $276.25 $276.25 $276.25 $57.58 $276.25 $205.03 $205.03 $212.93 $143.93 $57.57 $276.25 $276.25 $163.40 $276.25 $276.25 $276.25 $276.25 $207.38 $276.25 $276.25 $276.25 $138.13 $138.13 $218.79 $276.25 $221.00 $179.56 $54.83 N/A $160.37 $276.25 $276.25 $276.25 $57.57 $276.25 N/A N/A G14057 SUP HCPCS C1758 G14057 - CATHETER URET RND 8FR 70CM STY NTCH PORT RT BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $15.00 $15.00 $15.00 $15.00 $27.63 $27.63 $27.63 $5.76 $27.63 $20.51 $20.51 $21.30 $14.40 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $17.96 $5.48 N/A $16.24 $27.63 $27.63 $27.63 $5.76 $27.63 N/A N/A G14099 SUP HCPCS C2627 G14099 - SET SUPRAPUBIC 14FR 25CM NEEDLE OBTURATOR CONNECT TUBE 1 WAY BOTH IP/OP $96.00 $71.00 $18.98 $95.63 $51.93 $51.93 $51.93 $51.93 $95.63 $95.63 $95.63 $19.93 $95.63 $70.98 $70.98 $73.71 $49.82 $19.93 $95.63 $95.63 $56.57 $95.63 $95.63 $95.63 $95.63 $72.00 $95.63 $95.63 $95.63 $47.82 $47.82 $75.74 $95.63 $76.50 $62.16 $18.98 N/A $55.68 $95.63 $95.63 $95.63 $19.93 $95.63 N/A N/A G14116 SUP Custom 27203010 G14116 - CONNECTOR CATH 7-10FR F LL TO T-B ADPR URET BOTH IP/OP $10.00 $7.00 $1.76 $9.90 $9.90 $9.90 $9.90 $9.90 $9.90 $9.90 $1.76 $9.90 $9.90 $7.35 $7.35 $7.63 $5.16 $2.06 $9.90 $3.96 $9.90 $9.90 $9.90 $9.90 $9.90 $7.50 $9.90 $9.90 $9.90 $4.95 $4.95 $7.84 $9.90 $7.92 $6.44 $9.90 N/A $5.80 $9.90 $5.94 $9.90 $9.90 $9.90 N/A N/A G14120 SUP HCPCS C1729 G14120 - TUBE CONNCTNG STANDARD 14FR 50CM MALE LUER LOCK LOCK LOCK BOTH IP/OP $41.00 $30.00 $8.08 $40.70 $22.10 $22.10 $22.10 $22.10 $40.70 $40.70 $40.70 $8.48 $40.70 $30.21 $30.21 $31.37 $21.20 $8.48 $40.70 $40.70 $24.07 $40.70 $40.70 $40.70 $40.70 $30.75 $40.70 $40.70 $40.70 $20.35 $20.35 $32.23 $40.70 $32.56 $26.46 $8.08 N/A $23.78 $40.70 $40.70 $40.70 $8.48 $40.70 N/A N/A G14121 SUP HCPCS C1729 G14121 - TUBE CNCT 14FR 30CM T-B 2 F LL Y 1 DRN BG CNCT ADPR BOTH IP/OP $41.00 $30.00 $8.08 $40.70 $22.10 $22.10 $22.10 $22.10 $40.70 $40.70 $40.70 $8.48 $40.70 $30.21 $30.21 $31.37 $21.20 $8.48 $40.70 $40.70 $24.07 $40.70 $40.70 $40.70 $40.70 $30.75 $40.70 $40.70 $40.70 $20.35 $20.35 $32.23 $40.70 $32.56 $26.46 $8.08 N/A $23.78 $40.70 $40.70 $40.70 $8.48 $40.70 N/A N/A G14127 SUP HCPCS C1773 G14127 - STOPCOCK IV 3W 2 F TO 1 M LL PLS PERC BOTH IP/OP $398.50 $295.00 $79.08 $398.45 $216.36 $216.36 $216.36 $216.36 $398.45 $398.45 $398.45 $83.05 $398.45 $295.73 $295.73 $307.13 $207.59 $83.04 $398.45 $398.45 $235.68 $398.45 $398.45 $398.45 $398.45 $298.88 $398.45 $398.45 $398.45 $199.23 $199.23 $315.57 $398.45 $318.76 $258.99 $79.08 N/A $231.13 $398.45 $398.45 $398.45 $83.04 $398.45 N/A N/A G14133 SUP HCPCS C2627 G14133 - DISK RTNT 14FR PERC BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G14134 SUP HCPCS C2627 G14134 - DILATOR URTH 6FR 20CM PE FSCA BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G14135 SUP HCPCS C2627 G14135 - DILATOR URTH 7FR 20CM STRL PE FSCA BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G14136 SUP HCPCS C2627 G14136 - DILATOR URTH 7FR 20CM STRL PE FSCA BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G14137 SUP HCPCS C2627 G14137 - DILATOR URTH 9FR 20CM PE FSCA BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G14138 SUP HCPCS C2627 G14138 - DILATOR URTH 10FR 20CM PE FSCA BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G14139 SUP HCPCS C2627 G14139 - DILATOR URTH 12FR 20CM PE FSCA BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G14140 SUP HCPCS C2627 G14140 - DILATOR URTH 14FR 20CM PE FSCA BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G14141 SUP HCPCS C2627 G14141 - DILATOR URTH 16FR 20CM PE FSCA BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G14143 SUP HCPCS C1758 G14143 - DILATOR URTH 18FR 20CM STRL PE FSCA BOTH IP/OP $124.00 $92.00 $24.58 $123.83 $67.24 $67.24 $67.24 $67.24 $123.83 $123.83 $123.83 $25.81 $123.83 $91.91 $91.91 $95.45 $64.52 $25.81 $123.83 $123.83 $73.25 $123.83 $123.83 $123.83 $123.83 $93.00 $123.83 $123.83 $123.83 $61.92 $61.92 $98.07 $123.83 $99.06 $80.49 $24.58 N/A $71.92 $123.83 $123.83 $123.83 $25.81 $123.83 N/A N/A G14144 SUP HCPCS C1758 G14144 - SET CATH .025IN PGTL CRV 4FR 70CM STRL 145CM SDPRT GW PU RT BOTH IP/OP $108.50 $80.00 $21.52 $108.45 $58.89 $58.89 $58.89 $58.89 $108.45 $108.45 $108.45 $22.60 $108.45 $80.49 $80.49 $83.59 $56.50 $22.60 $108.45 $108.45 $64.15 $108.45 $108.45 $108.45 $108.45 $81.38 $108.45 $108.45 $108.45 $54.23 $54.23 $85.89 $108.45 $86.76 $70.49 $21.52 N/A $62.93 $108.45 $108.45 $108.45 $22.60 $108.45 N/A N/A G14145 SUP HCPCS C1758 G14145 - SET CATH PGTL CRV 5FR .38IN 70CM STRL 145CM SDPRT GW RT BOTH IP/OP $108.50 $80.00 $21.52 $108.45 $58.89 $58.89 $58.89 $58.89 $108.45 $108.45 $108.45 $22.60 $108.45 $80.49 $80.49 $83.59 $56.50 $22.60 $108.45 $108.45 $64.15 $108.45 $108.45 $108.45 $108.45 $81.38 $108.45 $108.45 $108.45 $54.23 $54.23 $85.89 $108.45 $86.76 $70.49 $21.52 N/A $62.93 $108.45 $108.45 $108.45 $22.60 $108.45 N/A N/A G14146 SUP HCPCS C1758 G14146 - SET CATH .038IN PGTL CRV 5FR 70CM 145CM SDPRT GW LFRIC SRFC BOTH IP/OP $108.50 $80.00 $21.52 $108.45 $58.89 $58.89 $58.89 $58.89 $108.45 $108.45 $108.45 $22.60 $108.45 $80.49 $80.49 $83.59 $56.50 $22.60 $108.45 $108.45 $64.15 $108.45 $108.45 $108.45 $108.45 $81.38 $108.45 $108.45 $108.45 $54.23 $54.23 $85.89 $108.45 $86.76 $70.49 $21.52 N/A $62.93 $108.45 $108.45 $108.45 $22.60 $108.45 N/A N/A G14147 SUP HCPCS C1758 G14147 - SET CATH PGTL CRV 7FR .045IN 70CM STRL 145CM SDPRT GW RT BOTH IP/OP $124.00 $92.00 $24.58 $123.83 $67.24 $67.24 $67.24 $67.24 $123.83 $123.83 $123.83 $25.81 $123.83 $91.91 $91.91 $95.45 $64.52 $25.81 $123.83 $123.83 $73.25 $123.83 $123.83 $123.83 $123.83 $93.00 $123.83 $123.83 $123.83 $61.92 $61.92 $98.07 $123.83 $99.06 $80.49 $24.58 N/A $71.92 $123.83 $123.83 $123.83 $25.81 $123.83 N/A N/A G14148 SUP HCPCS C1758 G14148 - SET CATH .025IN PGTL CRV 4FR 70CM 145CM SDPRT GW LFRIC SRFC BOTH IP/OP $108.50 $80.00 $21.52 $108.45 $58.89 $58.89 $58.89 $58.89 $108.45 $108.45 $108.45 $22.60 $108.45 $80.49 $80.49 $83.59 $56.50 $22.60 $108.45 $108.45 $64.15 $108.45 $108.45 $108.45 $108.45 $81.38 $108.45 $108.45 $108.45 $54.23 $54.23 $85.89 $108.45 $86.76 $70.49 $21.52 N/A $62.93 $108.45 $108.45 $108.45 $22.60 $108.45 N/A N/A G14149 SUP HCPCS C1758 G14149 - SET CATH .038IN PGTL CRV 5FR 70CM 145CM SDPRT GW LFRIC SRFC BOTH IP/OP $108.50 $80.00 $21.52 $108.45 $58.89 $58.89 $58.89 $58.89 $108.45 $108.45 $108.45 $22.60 $108.45 $80.49 $80.49 $83.59 $56.50 $22.60 $108.45 $108.45 $64.15 $108.45 $108.45 $108.45 $108.45 $81.38 $108.45 $108.45 $108.45 $54.23 $54.23 $85.89 $108.45 $86.76 $70.49 $21.52 N/A $62.93 $108.45 $108.45 $108.45 $22.60 $108.45 N/A N/A G14150 SUP HCPCS C1758 G14150 - SET CATH .038IN PGTL CRV 6FR 70CM 145CM SDPRT GW LFRIC SRFC BOTH IP/OP $108.50 $80.00 $21.52 $108.45 $58.89 $58.89 $58.89 $58.89 $108.45 $108.45 $108.45 $22.60 $108.45 $80.49 $80.49 $83.59 $56.50 $22.60 $108.45 $108.45 $64.15 $108.45 $108.45 $108.45 $108.45 $81.38 $108.45 $108.45 $108.45 $54.23 $54.23 $85.89 $108.45 $86.76 $70.49 $21.52 N/A $62.93 $108.45 $108.45 $108.45 $22.60 $108.45 N/A N/A G14151 SUP HCPCS C1758 G14151 - SET CATH .045IN PGTL CRV 7FR 70CM 145CM SDPRT GW LFRIC SRFC BOTH IP/OP $124.00 $92.00 $24.58 $123.83 $67.24 $67.24 $67.24 $67.24 $123.83 $123.83 $123.83 $25.81 $123.83 $91.91 $91.91 $95.45 $64.52 $25.81 $123.83 $123.83 $73.25 $123.83 $123.83 $123.83 $123.83 $93.00 $123.83 $123.83 $123.83 $61.92 $61.92 $98.07 $123.83 $99.06 $80.49 $24.58 N/A $71.92 $123.83 $123.83 $123.83 $25.81 $123.83 N/A N/A G14152 SUP HCPCS C1758 G14152 - SET CATH .025IN PGTL CRV 4FR 70CM STRL 145CM SDPRT GW ALONG BOTH IP/OP $108.50 $80.00 $21.52 $108.45 $58.89 $58.89 $58.89 $58.89 $108.45 $108.45 $108.45 $22.60 $108.45 $80.49 $80.49 $83.59 $56.50 $22.60 $108.45 $108.45 $64.15 $108.45 $108.45 $108.45 $108.45 $81.38 $108.45 $108.45 $108.45 $54.23 $54.23 $85.89 $108.45 $86.76 $70.49 $21.52 N/A $62.93 $108.45 $108.45 $108.45 $22.60 $108.45 N/A N/A G14153 SUP HCPCS C1758 G14153 - SET CATH .038IN PGTL CRV 6FR 70CM STRL 145CM SDPRT GW ALONG BOTH IP/OP $124.00 $92.00 $24.58 $123.83 $67.24 $67.24 $67.24 $67.24 $123.83 $123.83 $123.83 $25.81 $123.83 $91.91 $91.91 $95.45 $64.52 $25.81 $123.83 $123.83 $73.25 $123.83 $123.83 $123.83 $123.83 $93.00 $123.83 $123.83 $123.83 $61.92 $61.92 $98.07 $123.83 $99.06 $80.49 $24.58 N/A $71.92 $123.83 $123.83 $123.83 $25.81 $123.83 N/A N/A G14155 SUP HCPCS C1758 G14155 - SET CATH .045IN PGTL CRV 7FR 70CM 145CM SDPRT GW ALONG SHFT BOTH IP/OP $124.00 $92.00 $24.58 $123.83 $67.24 $67.24 $67.24 $67.24 $123.83 $123.83 $123.83 $25.81 $123.83 $91.91 $91.91 $95.45 $64.52 $25.81 $123.83 $123.83 $73.25 $123.83 $123.83 $123.83 $123.83 $93.00 $123.83 $123.83 $123.83 $61.92 $61.92 $98.07 $123.83 $99.06 $80.49 $24.58 N/A $71.92 $123.83 $123.83 $123.83 $25.81 $123.83 N/A N/A G14156 SUP HCPCS C1758 G14156 - SET CATH .038IN PGTL CRV 5FR 70CM STRL 145CM SDPRT GW ALONG BOTH IP/OP $108.50 $80.00 $21.52 $108.45 $58.89 $58.89 $58.89 $58.89 $108.45 $108.45 $108.45 $22.60 $108.45 $80.49 $80.49 $83.59 $56.50 $22.60 $108.45 $108.45 $64.15 $108.45 $108.45 $108.45 $108.45 $81.38 $108.45 $108.45 $108.45 $54.23 $54.23 $85.89 $108.45 $86.76 $70.49 $21.52 N/A $62.93 $108.45 $108.45 $108.45 $22.60 $108.45 N/A N/A G14157 SUP HCPCS C1758 G14157 - SET CATH .038IN PGTL CRV 6FR 70CM 145CM SDPRT GW ALONG SHFT BOTH IP/OP $124.00 $92.00 $24.58 $123.83 $67.24 $67.24 $67.24 $67.24 $123.83 $123.83 $123.83 $25.81 $123.83 $91.91 $91.91 $95.45 $64.52 $25.81 $123.83 $123.83 $73.25 $123.83 $123.83 $123.83 $123.83 $93.00 $123.83 $123.83 $123.83 $61.92 $61.92 $98.07 $123.83 $99.06 $80.49 $24.58 N/A $71.92 $123.83 $123.83 $123.83 $25.81 $123.83 N/A N/A G14158 SUP HCPCS C1758 G14158 - SET CATH .045IN PGTL CRV 7FR 70CM 145CM SDPRT GW ALONG SHFT BOTH IP/OP $108.50 $80.00 $21.52 $108.45 $58.89 $58.89 $58.89 $58.89 $108.45 $108.45 $108.45 $22.60 $108.45 $80.49 $80.49 $83.59 $56.50 $22.60 $108.45 $108.45 $64.15 $108.45 $108.45 $108.45 $108.45 $81.38 $108.45 $108.45 $108.45 $54.23 $54.23 $85.89 $108.45 $86.76 $70.49 $21.52 N/A $62.93 $108.45 $108.45 $108.45 $22.60 $108.45 N/A N/A G14173 SUP HCPCS C2627 G14173 - SET CATH .038IN PGTL CRV 5FR 70CM 145CM SDPRT GW ALONG SHFT BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G14174 SUP HCPCS C2627 G14174 - DILATOR URTH 24FR 20CM PE FSCA BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G14175 SUP HCPCS C2627 G14175 - DILATOR URTH 20FR 20CM STRL PE FSCA DISP BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G14177 SUP HCPCS C2627 G14177 - DILATOR URTH 22FR 20CM STRL PE FSCA DISP BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G14178 SUP Custom 27203010 G14178 - DILATOR URTH 5FR 20CM STRL PE FSCA DISP BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 N/A $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A G14185 SUP HCPCS C1769 G14185 - SHEATH ACC 12FR 13CM LF FLXR PRLL RPD RELS WKG CHNL LFRIC BOTH IP/OP $511.00 $378.00 $101.41 $510.95 $277.45 $277.45 $277.45 $277.45 $510.95 $510.95 $510.95 $106.49 $510.95 $379.23 $379.23 $393.84 $266.20 $106.49 $510.95 $510.95 $302.23 $510.95 $510.95 $510.95 $510.95 $383.25 $510.95 $510.95 $510.95 $255.48 $255.48 $404.67 $510.95 $408.76 $332.12 $101.41 N/A $296.38 $510.95 $306.57 $510.95 $106.48 $510.95 N/A N/A G14186 SUP HCPCS C2627 G14186 - STYLET NPHSTM 14FR FLXB BOTH IP/OP $63.50 $47.00 $12.55 $63.25 $34.34 $34.34 $34.34 $34.34 $63.25 $63.25 $63.25 $13.18 $63.25 $46.94 $46.94 $48.75 $32.95 $13.18 $63.25 $63.25 $37.41 $63.25 $63.25 $63.25 $63.25 $47.63 $63.25 $63.25 $63.25 $31.63 $31.63 $50.09 $63.25 $50.60 $41.11 $12.55 N/A $36.83 $63.25 $63.25 $63.25 $13.18 $63.25 N/A N/A G14187 SUP HCPCS C2627 G14187 - DILATOR URTH 8FR 37CM STRL PE FSCA DISP BOTH IP/OP $63.50 $47.00 $12.55 $63.25 $34.34 $34.34 $34.34 $34.34 $63.25 $63.25 $63.25 $13.18 $63.25 $46.94 $46.94 $48.75 $32.95 $13.18 $63.25 $63.25 $37.41 $63.25 $63.25 $63.25 $63.25 $47.63 $63.25 $63.25 $63.25 $31.63 $31.63 $50.09 $63.25 $50.60 $41.11 $12.55 N/A $36.83 $63.25 $63.25 $63.25 $13.18 $63.25 N/A N/A G14188 SUP HCPCS C2627 G14188 - DILATOR URTH 10FR 37CM STRL PE FSCA DISP BOTH IP/OP $63.50 $47.00 $12.55 $63.25 $34.34 $34.34 $34.34 $34.34 $63.25 $63.25 $63.25 $13.18 $63.25 $46.94 $46.94 $48.75 $32.95 $13.18 $63.25 $63.25 $37.41 $63.25 $63.25 $63.25 $63.25 $47.63 $63.25 $63.25 $63.25 $31.63 $31.63 $50.09 $63.25 $50.60 $41.11 $12.55 N/A $36.83 $63.25 $63.25 $63.25 $13.18 $63.25 N/A N/A G14189 SUP HCPCS C2627 G14189 - DILATOR URTH 12FR 37CM STRL PE FSCA DISP BOTH IP/OP $63.50 $47.00 $12.55 $63.25 $34.34 $34.34 $34.34 $34.34 $63.25 $63.25 $63.25 $13.18 $63.25 $46.94 $46.94 $48.75 $32.95 $13.18 $63.25 $63.25 $37.41 $63.25 $63.25 $63.25 $63.25 $47.63 $63.25 $63.25 $63.25 $31.63 $31.63 $50.09 $63.25 $50.60 $41.11 $12.55 N/A $36.83 $63.25 $63.25 $63.25 $13.18 $63.25 N/A N/A G14190 SUP HCPCS C2627 G14190 - DILATOR URTH 14FR 37CM STRL PE FSCA DISP BOTH IP/OP $63.50 $47.00 $12.55 $63.25 $34.34 $34.34 $34.34 $34.34 $63.25 $63.25 $63.25 $13.18 $63.25 $46.94 $46.94 $48.75 $32.95 $13.18 $63.25 $63.25 $37.41 $63.25 $63.25 $63.25 $63.25 $47.63 $63.25 $63.25 $63.25 $31.63 $31.63 $50.09 $63.25 $50.60 $41.11 $12.55 N/A $36.83 $63.25 $63.25 $63.25 $13.18 $63.25 N/A N/A G14191 SUP HCPCS C2627 G14191 - DILATOR URTH 16FR 37CM PE FSCA BOTH IP/OP $63.50 $47.00 $12.55 $63.25 $34.34 $34.34 $34.34 $34.34 $63.25 $63.25 $63.25 $13.18 $63.25 $46.94 $46.94 $48.75 $32.95 $13.18 $63.25 $63.25 $37.41 $63.25 $63.25 $63.25 $63.25 $47.63 $63.25 $63.25 $63.25 $31.63 $31.63 $50.09 $63.25 $50.60 $41.11 $12.55 N/A $36.83 $63.25 $63.25 $63.25 $13.18 $63.25 N/A N/A G14192 SUP HCPCS C2627 G14192 - DILATOR URTH 20FR 37CM PE FSCA BOTH IP/OP $63.50 $47.00 $12.55 $63.25 $34.34 $34.34 $34.34 $34.34 $63.25 $63.25 $63.25 $13.18 $63.25 $46.94 $46.94 $48.75 $32.95 $13.18 $63.25 $63.25 $37.41 $63.25 $63.25 $63.25 $63.25 $47.63 $63.25 $63.25 $63.25 $31.63 $31.63 $50.09 $63.25 $50.60 $41.11 $12.55 N/A $36.83 $63.25 $63.25 $63.25 $13.18 $63.25 N/A N/A G14193 SUP HCPCS C2627 G14193 - DILATOR URTH 22FR 37CM STRL DISP BOTH IP/OP $73.00 $54.00 $14.44 $72.73 $39.49 $39.49 $39.49 $39.49 $72.73 $72.73 $72.73 $15.16 $72.73 $53.98 $53.98 $56.06 $37.89 $15.16 $72.73 $72.73 $43.02 $72.73 $72.73 $72.73 $72.73 $54.75 $72.73 $72.73 $72.73 $36.37 $36.37 $57.60 $72.73 $58.18 $47.27 $14.44 N/A $42.34 $72.73 $72.73 $72.73 $15.16 $72.73 N/A N/A G14194 SUP HCPCS C2627 G14194 - DILATOR URTH 24FR 37CM STRL DISP BOTH IP/OP $75.50 $56.00 $14.94 $75.28 $40.88 $40.88 $40.88 $40.88 $75.28 $75.28 $75.28 $15.69 $75.28 $55.87 $55.87 $58.03 $39.22 $15.69 $75.28 $75.28 $44.53 $75.28 $75.28 $75.28 $75.28 $56.63 $75.28 $75.28 $75.28 $37.64 $37.64 $59.62 $75.28 $60.22 $48.93 $14.94 N/A $43.79 $75.28 $75.28 $75.28 $15.69 $75.28 N/A N/A G14195 SUP HCPCS C2627 G14195 - DILATOR URTH 8FR 37CM SDPRT PE FSCA BOTH IP/OP $65.50 $48.00 $12.99 $65.45 $35.54 $35.54 $35.54 $35.54 $65.45 $65.45 $65.45 $13.64 $65.45 $48.58 $48.58 $50.45 $34.10 $13.64 $65.45 $65.45 $38.71 $65.45 $65.45 $65.45 $65.45 $49.13 $65.45 $65.45 $65.45 $32.73 $32.73 $51.84 $65.45 $52.36 $42.54 $12.99 N/A $37.99 $65.45 $65.45 $65.45 $13.64 $65.45 N/A N/A G14196 SUP HCPCS C2627 G14196 - DILATOR URTH 10FR 37CM STRL SDPRT DISP BOTH IP/OP $65.50 $48.00 $12.99 $65.45 $35.54 $35.54 $35.54 $35.54 $65.45 $65.45 $65.45 $13.64 $65.45 $48.58 $48.58 $50.45 $34.10 $13.64 $65.45 $65.45 $38.71 $65.45 $65.45 $65.45 $65.45 $49.13 $65.45 $65.45 $65.45 $32.73 $32.73 $51.84 $65.45 $52.36 $42.54 $12.99 N/A $37.99 $65.45 $65.45 $65.45 $13.64 $65.45 N/A N/A G14197 SUP HCPCS C2627 G14197 - DILATOR URTH 12FR 37CM SDPRT PE FSCA BOTH IP/OP $65.50 $48.00 $12.99 $65.45 $35.54 $35.54 $35.54 $35.54 $65.45 $65.45 $65.45 $13.64 $65.45 $48.58 $48.58 $50.45 $34.10 $13.64 $65.45 $65.45 $38.71 $65.45 $65.45 $65.45 $65.45 $49.13 $65.45 $65.45 $65.45 $32.73 $32.73 $51.84 $65.45 $52.36 $42.54 $12.99 N/A $37.99 $65.45 $65.45 $65.45 $13.64 $65.45 N/A N/A G14198 SUP HCPCS C2627 G14198 - DILATOR URTH 14FR 37CM STRL SDPRT DISP BOTH IP/OP $65.50 $48.00 $12.99 $65.45 $35.54 $35.54 $35.54 $35.54 $65.45 $65.45 $65.45 $13.64 $65.45 $48.58 $48.58 $50.45 $34.10 $13.64 $65.45 $65.45 $38.71 $65.45 $65.45 $65.45 $65.45 $49.13 $65.45 $65.45 $65.45 $32.73 $32.73 $51.84 $65.45 $52.36 $42.54 $12.99 N/A $37.99 $65.45 $65.45 $65.45 $13.64 $65.45 N/A N/A G14199 SUP HCPCS C2627 G14199 - DILATOR URTH 16FR 37CM SDPRT PE FSCA BOTH IP/OP $65.50 $48.00 $12.99 $65.45 $35.54 $35.54 $35.54 $35.54 $65.45 $65.45 $65.45 $13.64 $65.45 $48.58 $48.58 $50.45 $34.10 $13.64 $65.45 $65.45 $38.71 $65.45 $65.45 $65.45 $65.45 $49.13 $65.45 $65.45 $65.45 $32.73 $32.73 $51.84 $65.45 $52.36 $42.54 $12.99 N/A $37.99 $65.45 $65.45 $65.45 $13.64 $65.45 N/A N/A G14200 SUP HCPCS C2627 G14200 - DILATOR URTH 18FR 37CM STRL SDPRT DISP BOTH IP/OP $65.50 $48.00 $12.99 $65.45 $35.54 $35.54 $35.54 $35.54 $65.45 $65.45 $65.45 $13.64 $65.45 $48.58 $48.58 $50.45 $34.10 $13.64 $65.45 $65.45 $38.71 $65.45 $65.45 $65.45 $65.45 $49.13 $65.45 $65.45 $65.45 $32.73 $32.73 $51.84 $65.45 $52.36 $42.54 $12.99 N/A $37.99 $65.45 $65.45 $65.45 $13.64 $65.45 N/A N/A G14201 SUP HCPCS C2627 G14201 - DILATOR URTH 20FR 37CM STRL SDPRT DISP BOTH IP/OP $65.50 $48.00 $12.99 $65.45 $35.54 $35.54 $35.54 $35.54 $65.45 $65.45 $65.45 $13.64 $65.45 $48.58 $48.58 $50.45 $34.10 $13.64 $65.45 $65.45 $38.71 $65.45 $65.45 $65.45 $65.45 $49.13 $65.45 $65.45 $65.45 $32.73 $32.73 $51.84 $65.45 $52.36 $42.54 $12.99 N/A $37.99 $65.45 $65.45 $65.45 $13.64 $65.45 N/A N/A G14202 SUP HCPCS C2627 G14202 - DILATOR URTH 22FR 37CM STRL SDPRT DISP BOTH IP/OP $65.50 $48.00 $12.99 $65.45 $35.54 $35.54 $35.54 $35.54 $65.45 $65.45 $65.45 $13.64 $65.45 $48.58 $48.58 $50.45 $34.10 $13.64 $65.45 $65.45 $38.71 $65.45 $65.45 $65.45 $65.45 $49.13 $65.45 $65.45 $65.45 $32.73 $32.73 $51.84 $65.45 $52.36 $42.54 $12.99 N/A $37.99 $65.45 $65.45 $65.45 $13.64 $65.45 N/A N/A G14211 SUP HCPCS C1773 G14211 - DILATOR URTH 24FR 37CM STRL SDPRT DISP BOTH IP/OP $398.50 $295.00 $79.08 $398.45 $216.36 $216.36 $216.36 $216.36 $398.45 $398.45 $398.45 $83.05 $398.45 $295.73 $295.73 $307.13 $207.59 $83.04 $398.45 $398.45 $235.68 $398.45 $398.45 $398.45 $398.45 $298.88 $398.45 $398.45 $398.45 $199.23 $199.23 $315.57 $398.45 $318.76 $258.99 $79.08 N/A $231.13 $398.45 $398.45 $398.45 $83.04 $398.45 N/A N/A G14214 SUP HCPCS C2627 G14214 - FORCEPS GRSP 5FR 20MM 60CM 3 PR BOTH IP/OP $511.00 $378.00 $101.41 $510.95 $277.45 $277.45 $277.45 $277.45 $510.95 $510.95 $510.95 $106.49 $510.95 $379.23 $379.23 $393.84 $266.20 $106.49 $510.95 $510.95 $302.23 $510.95 $510.95 $510.95 $510.95 $383.25 $510.95 $510.95 $510.95 $255.48 $255.48 $404.67 $510.95 $408.76 $332.12 $101.41 N/A $296.38 $510.95 $510.95 $510.95 $106.48 $510.95 N/A N/A G14220 SUP Custom 27203010 G14220 - NEEDLE ENDSCP 23GA 5FR 35CM 8MM INJEC WILLIAMS URETHRAL BOTH IP/OP $48.50 $36.00 $8.63 $48.50 $48.50 $48.50 $48.50 $48.50 $48.50 $48.50 $8.63 $48.50 $48.50 $36.00 $36.00 $37.38 $25.27 $10.11 $48.50 $18.92 $48.50 $48.50 $48.50 $48.50 $48.50 $36.38 $48.50 $48.50 $48.50 $24.25 $24.25 $38.41 $48.50 $38.80 $31.53 $48.50 N/A $28.13 $48.50 $29.10 $48.50 $48.50 $48.50 N/A N/A G14231 SUP HCPCS C1769 G14231 - TUBE DRN STD 14FR 30CM STRL LF 1 WY STPCK CNCT DISP BOTH IP/OP $34.00 $25.00 $6.71 $33.80 $18.35 $18.35 $18.35 $18.35 $33.80 $33.80 $33.80 $7.04 $33.80 $25.09 $25.09 $26.05 $17.61 $7.04 $33.80 $33.80 $19.99 $33.80 $33.80 $33.80 $33.80 $25.50 $33.80 $33.80 $33.80 $16.90 $16.90 $26.77 $33.80 $27.04 $21.97 $6.71 N/A $19.72 $33.80 $33.80 $33.80 $7.04 $33.80 N/A N/A G14254 SUP Custom 27203010 G14254 - PUNCH SRG 14FR 3MM NS FL CATH TIP REUSE CUT .118IN RND HL BOTH IP/OP $33.00 $24.00 $5.87 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $33.00 $5.87 $33.00 $33.00 $24.49 $24.49 $25.44 $17.19 $6.88 $33.00 $13.20 $33.00 $33.00 $33.00 $33.00 $33.00 $24.75 $33.00 $33.00 $33.00 $16.50 $16.50 $26.14 $33.00 $26.40 $21.45 $33.00 N/A $19.14 $33.00 $19.80 $33.00 $33.00 $33.00 N/A N/A G14255 SUP Custom 27203010 G14255 - NEEDLE PRC 22GA 20CM SKNY CHBA TIP PERC NPHSTM BOTH IP/OP $36.00 $27.00 $6.36 $35.75 $35.75 $35.75 $35.75 $35.75 $35.75 $35.75 $6.36 $35.75 $35.75 $26.53 $26.53 $27.56 $18.63 $7.45 $35.75 $14.30 $35.75 $35.75 $35.75 $35.75 $35.75 $27.00 $35.75 $35.75 $35.75 $17.88 $17.88 $28.31 $35.75 $28.60 $23.24 $35.75 N/A $20.88 $35.75 $21.45 $35.75 $35.75 $35.75 N/A N/A G14256 SUP Custom 27203010 G14256 - NEEDLE PRC STD 18GA 20CM ECHTP 2 PRT TROC DISP NPHSTM BOTH IP/OP $36.00 $27.00 $6.36 $35.75 $35.75 $35.75 $35.75 $35.75 $35.75 $35.75 $6.36 $35.75 $35.75 $26.53 $26.53 $27.56 $18.63 $7.45 $35.75 $14.30 $35.75 $35.75 $35.75 $35.75 $35.75 $27.00 $35.75 $35.75 $35.75 $17.88 $17.88 $28.31 $35.75 $28.60 $23.24 $35.75 N/A $20.88 $35.75 $21.45 $35.75 $35.75 $35.75 N/A N/A G14257 SUP Custom 27203010 G14257 - NEEDLE PRC 18GA 11CM MTPLK PERC BOTH IP/OP $75.00 $56.00 $13.29 $74.65 $74.65 $74.65 $74.65 $74.65 $74.65 $74.65 $13.29 $74.65 $74.65 $55.41 $55.41 $57.54 $38.89 $15.56 $74.65 $29.86 $74.65 $74.65 $74.65 $74.65 $74.65 $56.25 $74.65 $74.65 $74.65 $37.33 $37.33 $59.12 $74.65 $59.72 $48.52 $74.65 N/A $43.50 $74.65 $44.79 $74.65 $74.65 $74.65 N/A N/A G14259 SUP Custom 27203010 G14259 - NEEDLE PRC STD 18GA 25CM 2 PRT TROC DISP BOTH IP/OP $96.00 $71.00 $17.03 $95.70 $95.70 $95.70 $95.70 $95.70 $95.70 $95.70 $17.03 $95.70 $95.70 $71.03 $71.03 $73.77 $49.86 $19.94 $95.70 $38.28 $95.70 $95.70 $95.70 $95.70 $95.70 $72.00 $95.70 $95.70 $95.70 $47.85 $47.85 $75.79 $95.70 $76.56 $62.21 $95.70 N/A $55.68 $95.70 $57.42 $95.70 $95.70 $95.70 N/A N/A G14260 SUP HCPCS C1769 G14260 - NEEDLE BX STD 18GA 25CM TFE SHTH TROC STY RNL BOTH IP/OP $91.50 $68.00 $18.11 $91.25 $49.55 $49.55 $49.55 $49.55 $91.25 $91.25 $91.25 $19.02 $91.25 $67.73 $67.73 $70.34 $47.54 $19.02 $91.25 $91.25 $53.97 $91.25 $91.25 $91.25 $91.25 $68.63 $91.25 $91.25 $91.25 $45.63 $45.63 $72.27 $91.25 $73.00 $59.31 $18.11 N/A $53.07 $91.25 $91.25 $91.25 $19.02 $91.25 N/A N/A G14261 SUP HCPCS C1726 G14261 - GUIDEWIRE URO STD .038IN 80CM STRL LF 3MM SFTJ FX COR STRG BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $179.19 $179.19 $179.19 $179.19 $330.00 $330.00 $330.00 $68.78 $330.00 $244.93 $244.93 $254.36 $171.93 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $214.50 $65.50 N/A $191.40 $330.00 $330.00 $330.00 $68.77 $330.00 N/A N/A G14263 SUP Custom 27203010 G14263 - DILATOR URTH 18FR 37CM STRL DISP BOTH IP/OP $525.50 $389.00 $93.49 $525.20 $525.20 $525.20 $525.20 $525.20 $525.20 $525.20 $93.49 $525.20 $525.20 $389.80 $389.80 $404.82 $273.63 $109.46 $525.20 $210.08 $525.20 $525.20 $525.20 $525.20 $525.20 $394.13 $525.20 $525.20 $525.20 $262.60 $262.60 $415.96 $525.20 $420.16 $341.38 $525.20 N/A $304.79 $525.20 $315.12 $525.20 $525.20 $525.20 N/A N/A G14270 SUP HCPCS C1894 G14270 - SET NDL 18-22GA 14-22CM MTPLK COAX PERC BOTH IP/OP $129.00 $95.00 $25.54 $128.70 $69.88 $69.88 $69.88 $69.88 $128.70 $128.70 $128.70 $26.82 $128.70 $95.52 $95.52 $99.20 $67.05 $26.82 $128.70 $128.70 $76.13 $128.70 $128.70 $128.70 $128.70 $96.75 $128.70 $128.70 $128.70 $64.35 $64.35 $101.93 $128.70 $102.96 $83.66 $25.54 N/A $74.82 $128.70 $128.70 $128.70 $26.82 $128.70 N/A N/A G14275 SUP HCPCS C2627 G14275 - TUBE CNCT STD 14FR 135CM M LL DRN BG BOTH IP/OP $578.50 $428.00 $114.74 $578.13 $313.92 $313.92 $313.92 $313.92 $578.13 $578.13 $578.13 $120.50 $578.13 $429.09 $429.09 $445.62 $301.21 $120.49 $578.13 $578.13 $341.96 $578.13 $578.13 $578.13 $578.13 $433.88 $578.13 $578.13 $578.13 $289.07 $289.07 $457.88 $578.13 $462.50 $375.78 $114.74 N/A $335.53 $578.13 $578.13 $578.13 $120.48 $578.13 N/A N/A G14276 SUP Custom 27203010 G14276 - SET DIL 26-36FR 37CM STRL PE FSCA DISP BOTH IP/OP $104.00 $77.00 $18.46 $103.73 $103.73 $103.73 $103.73 $103.73 $103.73 $103.73 $18.46 $103.73 $103.73 $76.99 $76.99 $79.96 $54.04 $21.62 $103.73 $41.49 $103.73 $103.73 $103.73 $103.73 $103.73 $78.00 $103.73 $103.73 $103.73 $51.87 $51.87 $82.15 $103.73 $82.98 $67.42 $103.73 N/A $60.32 $103.73 $62.24 $103.73 $103.73 $103.73 N/A N/A G14277 SUP Custom 27203010 G14277 - DILATOR URTH 26FR 37CM PE FSCA BOTH IP/OP $90.50 $67.00 $16.06 $90.20 $90.20 $90.20 $90.20 $90.20 $90.20 $90.20 $16.06 $90.20 $90.20 $66.95 $66.95 $69.53 $46.99 $18.80 $90.20 $36.08 $90.20 $90.20 $90.20 $90.20 $90.20 $67.88 $90.20 $90.20 $90.20 $45.10 $45.10 $71.44 $90.20 $72.16 $58.63 $90.20 N/A $52.49 $90.20 $54.12 $90.20 $90.20 $90.20 N/A N/A G14278 SUP Custom 27203010 G14278 - DILATOR URTH 28FR 37CM STRL PE FSCA DISP BOTH IP/OP $104.00 $77.00 $18.46 $103.73 $103.73 $103.73 $103.73 $103.73 $103.73 $103.73 $18.46 $103.73 $103.73 $76.99 $76.99 $79.96 $54.04 $21.62 $103.73 $41.49 $103.73 $103.73 $103.73 $103.73 $103.73 $78.00 $103.73 $103.73 $103.73 $51.87 $51.87 $82.15 $103.73 $82.98 $67.42 $103.73 N/A $60.32 $103.73 $62.24 $103.73 $103.73 $103.73 N/A N/A G14279 SUP Custom 27203010 G14279 - DILATOR URTH 30FR 37CM STRL DISP BOTH IP/OP $104.00 $77.00 $18.46 $103.73 $103.73 $103.73 $103.73 $103.73 $103.73 $103.73 $18.46 $103.73 $103.73 $76.99 $76.99 $79.96 $54.04 $21.62 $103.73 $41.49 $103.73 $103.73 $103.73 $103.73 $103.73 $78.00 $103.73 $103.73 $103.73 $51.87 $51.87 $82.15 $103.73 $82.98 $67.42 $103.73 N/A $60.32 $103.73 $62.24 $103.73 $103.73 $103.73 N/A N/A G14280 SUP Custom 27203010 G14280 - DILATOR URTH 32FR 37CM PE FSCA BOTH IP/OP $104.00 $77.00 $18.46 $103.73 $103.73 $103.73 $103.73 $103.73 $103.73 $103.73 $18.46 $103.73 $103.73 $76.99 $76.99 $79.96 $54.04 $21.62 $103.73 $41.49 $103.73 $103.73 $103.73 $103.73 $103.73 $78.00 $103.73 $103.73 $103.73 $51.87 $51.87 $82.15 $103.73 $82.98 $67.42 $103.73 N/A $60.32 $103.73 $62.24 $103.73 $103.73 $103.73 N/A N/A G14281 SUP Custom 27203010 G14281 - DILATOR URTH 34FR 37CM PE FSCA BOTH IP/OP $104.00 $77.00 $18.46 $103.73 $103.73 $103.73 $103.73 $103.73 $103.73 $103.73 $18.46 $103.73 $103.73 $76.99 $76.99 $79.96 $54.04 $21.62 $103.73 $41.49 $103.73 $103.73 $103.73 $103.73 $103.73 $78.00 $103.73 $103.73 $103.73 $51.87 $51.87 $82.15 $103.73 $82.98 $67.42 $103.73 N/A $60.32 $103.73 $62.24 $103.73 $103.73 $103.73 N/A N/A G14282 SUP HCPCS C1729 G14282 - DILATOR URTH 36FR 37CM PE FSCA BOTH IP/OP $405.00 $300.00 $80.34 $404.80 $219.81 $219.81 $219.81 $219.81 $404.80 $404.80 $404.80 $84.37 $404.80 $300.44 $300.44 $312.02 $210.90 $84.36 $404.80 $404.80 $239.44 $404.80 $404.80 $404.80 $404.80 $303.75 $404.80 $404.80 $404.80 $202.40 $202.40 $320.60 $404.80 $323.84 $263.12 $80.34 N/A $234.90 $404.80 $404.80 $404.80 $84.36 $404.80 N/A N/A G14283 SUP HCPCS C1729 G14283 - SET NPHSTM STD 10FR 19.5CM LTX COPE LOOP NDL GW CATH CNN DIL BOTH IP/OP $188.50 $139.00 $37.33 $188.10 $102.14 $102.14 $102.14 $102.14 $188.10 $188.10 $188.10 $39.20 $188.10 $139.61 $139.61 $144.99 $98.00 $39.20 $188.10 $188.10 $111.26 $188.10 $188.10 $188.10 $188.10 $141.38 $188.10 $188.10 $188.10 $94.05 $94.05 $148.98 $188.10 $150.48 $122.27 $37.33 N/A $109.33 $188.10 $188.10 $188.10 $39.20 $188.10 N/A N/A G14284 SUP HCPCS C1894 G14284 - SET NPHSTM 10FR 18GA 19.5CM STRL LTX 35CM CK RADOPQ CATH CNN BOTH IP/OP $217.00 $161.00 $43.01 $216.70 $117.67 $117.67 $117.67 $117.67 $216.70 $216.70 $216.70 $45.17 $216.70 $160.83 $160.83 $167.03 $112.90 $45.16 $216.70 $216.70 $128.18 $216.70 $216.70 $216.70 $216.70 $162.75 $216.70 $216.70 $216.70 $108.35 $108.35 $171.63 $216.70 $173.36 $140.86 $43.01 N/A $125.86 $216.70 $216.70 $216.70 $45.16 $216.70 N/A N/A G14285 SUP HCPCS C1769 G14285 - SET NPHSTM 6-16FR 20CM COPE LOOP NDL GW CATH CNN DIL PERC BOTH IP/OP $34.00 $25.00 $6.71 $33.80 $18.35 $18.35 $18.35 $18.35 $33.80 $33.80 $33.80 $7.04 $33.80 $25.09 $25.09 $26.05 $17.61 $7.04 $33.80 $33.80 $19.99 $33.80 $33.80 $33.80 $33.80 $25.50 $33.80 $33.80 $33.80 $16.90 $16.90 $26.77 $33.80 $27.04 $21.97 $6.71 N/A $19.72 $33.80 $33.80 $33.80 $7.04 $33.80 N/A N/A G14287 SUP Custom 27203010 G14287 - GUIDEWIRE VASC 39CM STD STRG .038IN 80CM STRL 1CM FXCR FLX BOTH IP/OP $51.00 $38.00 $9.01 $50.60 $50.60 $50.60 $50.60 $50.60 $50.60 $50.60 $9.01 $50.60 $50.60 $37.56 $37.56 $39.00 $26.36 $10.55 $50.60 $20.24 $50.60 $50.60 $50.60 $50.60 $50.60 $38.25 $50.60 $50.60 $50.60 $25.30 $25.30 $40.08 $50.60 $40.48 $32.89 $50.60 N/A $29.58 $50.60 $30.36 $50.60 $50.60 $50.60 N/A N/A G14292 SUP HCPCS C1726 G14292 - SET DILAT 84CM 6-30FR 8FR 30CM 16CM RADIOPQ CATHETER SHEATH BOTH IP/OP $496.00 $367.00 $98.41 $500.50 $269.25 $269.25 $269.25 $269.25 $495.85 $495.85 $495.85 $103.35 $495.85 $368.02 $368.02 $382.20 $258.34 $103.34 $495.85 $500.50 $293.30 $495.85 $495.85 $495.85 $495.85 $372.00 $495.85 $495.85 $495.85 $247.93 $247.93 $392.71 $495.85 $396.68 $322.30 $98.41 N/A $287.68 $495.85 $495.85 $495.85 $103.34 $495.85 N/A N/A G14297 SUP HCPCS C1769 G14297 - ADAPTER INST 3-6FR 1 WY STPCK SDARM Y FIT M LL BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $179.19 $179.19 $179.19 $179.19 $330.00 $330.00 $330.00 $68.78 $330.00 $244.93 $244.93 $254.36 $171.93 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $214.50 $65.50 N/A $191.40 $330.00 $330.00 $330.00 $68.77 $330.00 N/A N/A G14298 SUP HCPCS C2627 G14298 - SET DIL 6-18FR 60CM PE URETER BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $22.70 $22.70 $22.70 $22.70 $41.80 $41.80 $41.80 $8.71 $41.80 $31.02 $31.02 $32.22 $21.78 $8.71 $41.80 $41.80 $24.72 $41.80 $41.80 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $27.17 $8.30 N/A $24.36 $41.80 $41.80 $41.80 $8.71 $41.80 N/A N/A G14299 SUP HCPCS C2627 G14299 - DILATOR URET 8FR 60CM STRL PE DISP BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $22.70 $22.70 $22.70 $22.70 $41.80 $41.80 $41.80 $8.71 $41.80 $31.02 $31.02 $32.22 $21.78 $8.71 $41.80 $41.80 $24.72 $41.80 $41.80 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $27.17 $8.30 N/A $24.36 $41.80 $41.80 $41.80 $8.71 $41.80 N/A N/A G14300 SUP HCPCS C2627 G14300 - DILATOR URET 9FR 60CM STRL PE DISP BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $22.70 $22.70 $22.70 $22.70 $41.80 $41.80 $41.80 $8.71 $41.80 $31.02 $31.02 $32.22 $21.78 $8.71 $41.80 $41.80 $24.72 $41.80 $41.80 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $27.17 $8.30 N/A $24.36 $41.80 $41.80 $41.80 $8.71 $41.80 N/A N/A G14301 SUP HCPCS C2627 G14301 - DILATOR URET 10FR 60CM STRL PE BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $22.70 $22.70 $22.70 $22.70 $41.80 $41.80 $41.80 $8.71 $41.80 $31.02 $31.02 $32.22 $21.78 $8.71 $41.80 $41.80 $24.72 $41.80 $41.80 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $27.17 $8.30 N/A $24.36 $41.80 $41.80 $41.80 $8.71 $41.80 N/A N/A G14302 SUP HCPCS C2627 G14302 - DILATOR URET 12FR 60CM STRL PE BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $22.70 $22.70 $22.70 $22.70 $41.80 $41.80 $41.80 $8.71 $41.80 $31.02 $31.02 $32.22 $21.78 $8.71 $41.80 $41.80 $24.72 $41.80 $41.80 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $27.17 $8.30 N/A $24.36 $41.80 $41.80 $41.80 $8.71 $41.80 N/A N/A G14303 SUP HCPCS C2627 G14303 - DILATOR URET 14FR 60CM STRL PE BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $22.70 $22.70 $22.70 $22.70 $41.80 $41.80 $41.80 $8.71 $41.80 $31.02 $31.02 $32.22 $21.78 $8.71 $41.80 $41.80 $24.72 $41.80 $41.80 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $27.17 $8.30 N/A $24.36 $41.80 $41.80 $41.80 $8.71 $41.80 N/A N/A G14304 SUP HCPCS C2627 G14304 - DILATOR URET 16FR 60CM STRL PE BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $22.70 $22.70 $22.70 $22.70 $41.80 $41.80 $41.80 $8.71 $41.80 $31.02 $31.02 $32.22 $21.78 $8.71 $41.80 $41.80 $24.72 $41.80 $41.80 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $27.17 $8.30 N/A $24.36 $41.80 $41.80 $41.80 $8.71 $41.80 N/A N/A G14305 SUP HCPCS C1726 G14305 - DILATOR URET 16FR 60CM PE FSCA BOTH IP/OP $51.50 $38.00 $10.15 $51.15 $27.77 $27.77 $27.77 $27.77 $51.15 $51.15 $51.15 $10.66 $51.15 $37.96 $37.96 $39.43 $26.65 $10.66 $51.15 $51.15 $30.26 $51.15 $51.15 $51.15 $51.15 $38.63 $51.15 $51.15 $51.15 $25.58 $25.58 $40.51 $51.15 $40.92 $33.25 $10.15 N/A $29.87 $51.15 $51.15 $51.15 $10.66 $51.15 N/A N/A G14306 SUP HCPCS C1894 G14306 - CATHETER BLNDIL 8FR 84CM STRL AMPTZ GD RNL BOTH IP/OP $87.00 $64.00 $17.25 $86.90 $47.19 $47.19 $47.19 $47.19 $86.90 $86.90 $86.90 $18.11 $86.90 $64.50 $64.50 $66.98 $45.27 $18.11 $86.90 $86.90 $51.40 $86.90 $86.90 $86.90 $86.90 $65.25 $86.90 $86.90 $86.90 $43.45 $43.45 $68.82 $86.90 $69.52 $56.49 $17.25 N/A $50.46 $86.90 $86.90 $86.90 $18.11 $86.90 N/A N/A G14307 SUP HCPCS C1769 G14307 - SET INTRO .038IN 50CM 12FR 5FR 100CM STRL 22CM GW RADOPQ BOTH IP/OP $39.00 $29.00 $7.72 $38.88 $21.11 $21.11 $21.11 $21.11 $38.88 $38.88 $38.88 $8.10 $38.88 $28.86 $28.86 $29.97 $20.26 $8.10 $38.88 $38.88 $23.00 $38.88 $38.88 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $25.27 $7.72 N/A $22.62 $38.88 $23.33 $38.88 $8.10 $38.88 N/A N/A G14309 SUP HCPCS C1769 G14309 - GUIDEWIRE ESCP STD CDE .038IN 145CM FXCR BOTH IP/OP $34.00 $25.00 $6.71 $33.80 $18.35 $18.35 $18.35 $18.35 $33.80 $33.80 $33.80 $7.04 $33.80 $25.09 $25.09 $26.05 $17.61 $7.04 $33.80 $33.80 $19.99 $33.80 $33.80 $33.80 $33.80 $25.50 $33.80 $33.80 $33.80 $16.90 $16.90 $26.77 $33.80 $27.04 $21.97 $6.71 N/A $19.72 $33.80 $33.80 $33.80 $7.04 $33.80 N/A N/A G14311 SUP HCPCS C1892 G14311 - GUIDEWIRE VASC STD STRG .038IN 145CM STRL 3CM FLX TP FXCR SS BOTH IP/OP $143.00 $106.00 $28.38 $143.00 $77.65 $77.65 $77.65 $77.65 $143.00 $143.00 $143.00 $29.80 $143.00 $106.13 $106.13 $110.22 $74.50 $29.80 $143.00 $143.00 $84.58 $143.00 $143.00 $143.00 $143.00 $107.25 $143.00 $143.00 $143.00 $71.50 $71.50 $113.26 $143.00 $114.40 $92.95 $28.38 N/A $82.94 $143.00 $143.00 $143.00 $29.80 $143.00 N/A N/A G14320 SUP HCPCS C1758 G14320 - SET INTRO STD 9FR 65CM 60CM PLWY SHTH GW URET BOTH IP/OP $352.00 $260.00 $69.86 $352.00 $191.14 $191.14 $191.14 $191.14 $352.00 $352.00 $352.00 $73.37 $352.00 $261.25 $261.25 $271.32 $183.39 $73.36 $352.00 $352.00 $208.21 $352.00 $352.00 $352.00 $352.00 $264.00 $352.00 $352.00 $352.00 $176.00 $176.00 $278.78 $352.00 $281.60 $228.80 $69.86 N/A $204.16 $352.00 $352.00 $352.00 $73.36 $352.00 N/A N/A G14323 SUP HCPCS C1769 G14323 - DILATOR URET 7FR 6MM 65CM 4CM BLN CATH BOTH IP/OP $37.50 $28.00 $7.42 $37.40 $20.31 $20.31 $20.31 $20.31 $37.40 $37.40 $37.40 $7.80 $37.40 $27.76 $27.76 $28.83 $19.49 $7.79 $37.40 $37.40 $22.12 $37.40 $37.40 $37.40 $37.40 $28.13 $37.40 $37.40 $37.40 $18.70 $18.70 $29.62 $37.40 $29.92 $24.31 $7.42 N/A $21.75 $37.40 $37.40 $37.40 $7.79 $37.40 N/A N/A G14326 SUP HCPCS C1769 G14326 - GUIDEWIRE URO .038IN 145CM 3CM FX COR STRG FLX TP HVDTY SS BOTH IP/OP $39.00 $29.00 $7.72 $38.88 $21.11 $21.11 $21.11 $21.11 $38.88 $38.88 $38.88 $8.10 $38.88 $28.86 $28.86 $29.97 $20.26 $8.10 $38.88 $38.88 $23.00 $38.88 $38.88 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $25.27 $7.72 N/A $22.62 $38.88 $38.88 $38.88 $8.10 $38.88 N/A N/A G14328 SUP Custom 27203010 G14328 - GUIDEWIRE VASC STD .038IN 100CM FXCR SS BOTH IP/OP $572.00 $423.00 $101.82 $572.00 $572.00 $572.00 $572.00 $572.00 $572.00 $572.00 $101.82 $572.00 $572.00 $424.54 $424.54 $440.90 $298.01 $119.21 $572.00 $228.80 $572.00 $572.00 $572.00 $572.00 $572.00 $429.00 $572.00 $572.00 $572.00 $286.00 $286.00 $453.02 $572.00 $457.60 $371.80 $572.00 N/A $331.76 $572.00 $343.20 $572.00 $572.00 $572.00 N/A N/A G14335 SUP HCPCS C1773 G14335 - SET NPHSTM 7FR 82CM STRL LAWSON RTRGD GW PNCT PERC DISP BOTH IP/OP $398.50 $295.00 $79.08 $398.45 $216.36 $216.36 $216.36 $216.36 $398.45 $398.45 $398.45 $83.05 $398.45 $295.73 $295.73 $307.13 $207.59 $83.04 $398.45 $398.45 $235.68 $398.45 $398.45 $398.45 $398.45 $298.88 $398.45 $398.45 $398.45 $199.23 $199.23 $315.57 $398.45 $318.76 $258.99 $79.08 N/A $231.13 $398.45 $398.45 $398.45 $83.04 $398.45 N/A N/A G14337 SUP HCPCS C2628 G14337 - FORCEPS GRSP 4.5FR 65CM 15MM 3WR COAX SHTH BOTH IP/OP $319.00 $236.00 $63.31 $319.00 $173.22 $173.22 $173.22 $173.22 $319.00 $319.00 $319.00 $66.49 $319.00 $236.76 $236.76 $245.89 $166.20 $66.48 $319.00 $319.00 $188.69 $319.00 $319.00 $319.00 $319.00 $239.25 $319.00 $319.00 $319.00 $159.50 $159.50 $252.65 $319.00 $255.20 $207.35 $63.31 N/A $185.02 $319.00 $319.00 $319.00 $66.48 $319.00 N/A N/A G14343 SUP HCPCS C1729 G14343 - CATHETER BLNOCC 6FR 75CM STRL REM ADPR RADOPQ SIL UPJ DISP BOTH IP/OP $363.00 $269.00 $72.05 $363.00 $197.11 $197.11 $197.11 $197.11 $363.00 $363.00 $363.00 $75.66 $363.00 $269.42 $269.42 $279.80 $189.12 $75.65 $363.00 $363.00 $214.71 $363.00 $363.00 $363.00 $363.00 $272.25 $363.00 $363.00 $363.00 $181.50 $181.50 $287.50 $363.00 $290.40 $235.95 $72.05 N/A $210.54 $363.00 $363.00 $363.00 $75.65 $363.00 N/A N/A G14344 SUP HCPCS C1758 G14344 - CATHETER NPHSTM 17FR 12MM 25CM 15CM KAYE TMPND BLN RADOPQ BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $179.19 $179.19 $179.19 $179.19 $330.00 $330.00 $330.00 $68.78 $330.00 $244.93 $244.93 $254.36 $171.93 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $214.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A G14363 SUP HCPCS C2617 G14363 - DILATOR SRG 7FR 6MM 65CM STRL 10CM BLN CATH RADOPQ PINVISE BOTH IP/OP $301.00 $223.00 $59.66 $300.60 $135.27 $135.27 $135.27 $135.27 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $177.80 $300.60 $300.60 $300.60 $300.60 $225.75 $300.60 $300.60 $300.60 $150.30 $150.30 $238.08 $300.60 $240.48 $135.27 $59.66 N/A $174.58 $300.60 $300.60 $300.60 $62.65 $300.60 N/A N/A G14364 SUP HCPCS C2617 G14364 - SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 8CM GRN STRL 70 BOTH IP/OP $301.00 $223.00 $59.66 $300.60 $135.27 $135.27 $135.27 $135.27 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $177.80 $300.60 $300.60 $300.60 $300.60 $225.75 $300.60 $300.60 $300.60 $150.30 $150.30 $238.08 $300.60 $240.48 $135.27 $59.66 N/A $174.58 $300.60 $300.60 $300.60 $62.65 $300.60 N/A N/A G14365 SUP HCPCS C2617 G14365 - SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 10CM GRN STRL 70 BOTH IP/OP $301.00 $223.00 $59.66 $300.60 $135.27 $135.27 $135.27 $135.27 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $177.80 $300.60 $300.60 $300.60 $300.60 $225.75 $300.60 $300.60 $300.60 $150.30 $150.30 $238.08 $300.60 $240.48 $135.27 $59.66 N/A $174.58 $300.60 $180.36 $300.60 $62.65 $300.60 N/A N/A G14366 SUP HCPCS C2617 G14366 - SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 12CM GRN STRL 70 BOTH IP/OP $301.00 $223.00 $59.66 $300.60 $135.27 $135.27 $135.27 $135.27 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $177.80 $300.60 $300.60 $300.60 $300.60 $225.75 $300.60 $300.60 $300.60 $150.30 $150.30 $238.08 $300.60 $240.48 $135.27 $59.66 N/A $174.58 $300.60 $180.36 $300.60 $62.65 $300.60 N/A N/A G14367 SUP HCPCS C2617 G14367 - SET STNT .035IN 50CM SM 2 PGTL CRV STRG 5FR 14CM GRN STRL 70 BOTH IP/OP $301.00 $223.00 $59.66 $300.60 $135.27 $135.27 $135.27 $135.27 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $177.80 $300.60 $300.60 $300.60 $300.60 $225.75 $300.60 $300.60 $300.60 $150.30 $150.30 $238.08 $300.60 $240.48 $135.27 $59.66 N/A $174.58 $300.60 $300.60 $300.60 $62.65 $300.60 N/A N/A G14405 SUP HCPCS C1892 G14405 - SET STNT .035IN 50CM SM 2 PGTL CRV 5FR 16CM GRN STRL 70CM BOTH IP/OP $143.00 $106.00 $28.38 $143.00 $77.65 $77.65 $77.65 $77.65 $143.00 $143.00 $143.00 $29.80 $143.00 $106.13 $106.13 $110.22 $74.50 $29.80 $143.00 $143.00 $84.58 $143.00 $143.00 $143.00 $143.00 $107.25 $143.00 $143.00 $143.00 $71.50 $71.50 $113.26 $143.00 $114.40 $92.95 $28.38 N/A $82.94 $143.00 $143.00 $143.00 $29.80 $143.00 N/A N/A G14408 SUP HCPCS C1758 G14408 - SET INTRO 14FR 60CM 65CM PLWY CATH 2 KNOB GW SHTH URET BOTH IP/OP $60.50 $45.00 $11.98 $60.38 $32.79 $32.79 $32.79 $32.79 $60.38 $60.38 $60.38 $12.58 $60.38 $44.81 $44.81 $46.54 $31.46 $12.58 $60.38 $60.38 $35.71 $60.38 $60.38 $60.38 $60.38 $45.38 $60.38 $60.38 $60.38 $30.19 $30.19 $47.82 $60.38 $48.30 $39.25 $11.98 N/A $35.09 $60.38 $36.23 $60.38 $12.58 $60.38 N/A N/A G14420 SUP HCPCS C2627 G14420 - TUBE CNCT LG 24FR 30CM LF M LL TO BG DRN BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $22.70 $22.70 $22.70 $22.70 $41.80 $41.80 $41.80 $8.71 $41.80 $31.02 $31.02 $32.22 $21.78 $8.71 $41.80 $41.80 $24.72 $41.80 $41.80 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $27.17 $8.30 N/A $24.36 $41.80 $41.80 $41.80 $8.71 $41.80 N/A N/A G14421 SUP HCPCS C2627 G14421 - DILATOR URET 6FR 60CM STRL LFRIC SRFC PE DISP BOTH IP/OP $166.00 $123.00 $32.89 $165.73 $89.99 $89.99 $89.99 $89.99 $165.73 $165.73 $165.73 $34.54 $165.73 $123.00 $123.00 $127.74 $86.35 $34.54 $165.73 $165.73 $98.03 $165.73 $165.73 $165.73 $165.73 $124.50 $165.73 $165.73 $165.73 $82.87 $82.87 $131.26 $165.73 $132.58 $107.72 $32.89 N/A $96.28 $165.73 $165.73 $165.73 $34.54 $165.73 N/A N/A G14422 SUP HCPCS C1758 G14422 - SET NPHSTM 5FR 75CM 15CM KAYE TMPND BLN CATH STY STNT PERC BOTH IP/OP $352.00 $260.00 $69.86 $352.00 $191.14 $191.14 $191.14 $191.14 $352.00 $352.00 $352.00 $73.37 $352.00 $261.25 $261.25 $271.32 $183.39 $73.36 $352.00 $352.00 $352.00 $352.00 $352.00 $352.00 $352.00 $264.00 $352.00 $352.00 $352.00 $176.00 $176.00 $278.78 $352.00 $281.60 $228.80 $69.86 N/A $204.16 $352.00 $211.20 $352.00 $73.36 $352.00 N/A N/A G14423 SUP HCPCS C1729 G14423 - DILATOR URET .038IN 5FR 5MM 65CM STRL 4CM INFL BLN RADOPQ BOTH IP/OP $466.50 $345.00 $92.57 $466.40 $253.26 $253.26 $253.26 $253.26 $466.40 $466.40 $466.40 $97.21 $466.40 $346.16 $346.16 $359.50 $242.99 $97.20 $466.40 $466.40 $275.88 $466.40 $466.40 $466.40 $466.40 $349.88 $466.40 $466.40 $466.40 $233.20 $233.20 $369.39 $466.40 $373.12 $303.16 $92.57 N/A $270.57 $466.40 $466.40 $466.40 $97.20 $466.40 N/A N/A G14426 SUP HCPCS C1892 G14426 - SET NPHSTM 17FR 12MM 25CM 10ML STRL LF 15CM KAYE TMPND BLN BOTH IP/OP $143.00 $106.00 $28.38 $143.00 $77.65 $77.65 $77.65 $77.65 $143.00 $143.00 $143.00 $29.80 $143.00 $106.13 $106.13 $110.22 $74.50 $29.80 $143.00 $143.00 $84.58 $143.00 $143.00 $143.00 $143.00 $107.25 $143.00 $143.00 $143.00 $71.50 $71.50 $113.26 $143.00 $114.40 $92.95 $28.38 N/A $82.94 $143.00 $143.00 $143.00 $29.80 $143.00 N/A N/A G14427 SUP HCPCS C1892 G14427 - SET INTRO STD 12FR 65CM 60CM PLWY GW 2 KNOB URET BOTH IP/OP $143.00 $106.00 $28.38 $143.00 $77.65 $77.65 $77.65 $77.65 $143.00 $143.00 $143.00 $29.80 $143.00 $106.13 $106.13 $110.22 $74.50 $29.80 $143.00 $143.00 $84.58 $143.00 $143.00 $143.00 $143.00 $107.25 $143.00 $143.00 $143.00 $71.50 $71.50 $113.26 $143.00 $114.40 $92.95 $28.38 N/A $82.94 $143.00 $143.00 $143.00 $29.80 $143.00 N/A N/A G14428 SUP HCPCS C1892 G14428 - SET INTRO STD 11FR 65CM 60CM PLWY GW 2 KNOB URET BOTH IP/OP $143.00 $106.00 $28.38 $143.00 $77.65 $77.65 $77.65 $77.65 $143.00 $143.00 $143.00 $29.80 $143.00 $106.13 $106.13 $110.22 $74.50 $29.80 $143.00 $143.00 $84.58 $143.00 $143.00 $143.00 $143.00 $107.25 $143.00 $143.00 $143.00 $71.50 $71.50 $113.26 $143.00 $114.40 $92.95 $28.38 N/A $82.94 $143.00 $143.00 $143.00 $29.80 $143.00 N/A N/A G14430 SUP HCPCS C1758 G14430 - CATHETER URETERAL 6FR 70CM OPEN END ACCEPTS .038IN GWIRE BOTH IP/OP $21.50 $16.00 $4.24 $21.38 $11.61 $11.61 $11.61 $11.61 $21.38 $21.38 $21.38 $4.46 $21.38 $15.87 $15.87 $16.48 $11.14 $4.46 $21.38 N/A $12.65 $21.38 $21.38 $21.38 $21.38 $16.13 $21.38 $21.38 $21.38 $10.69 $10.69 $16.93 $21.38 $17.10 $13.90 $4.24 N/A $12.47 $21.38 $21.38 $21.38 $4.46 $21.38 N/A N/A G14431 SUP HCPCS C1729 G14431 - CATHETER URET .025IN 4FR 70CM STRL OP-EN PVC DISP BOTH IP/OP $19.00 $14.00 $3.69 $18.59 $10.09 $10.09 $10.09 $10.09 $18.59 $18.59 $18.59 $3.87 $18.59 $13.80 $13.80 $14.33 $9.69 $3.87 $18.59 $18.59 $11.00 $18.59 $18.59 $18.59 $18.59 $14.25 $18.59 $18.59 $18.59 $9.30 $9.30 $14.72 $18.59 $14.87 $12.08 $3.69 N/A $11.02 $18.59 $18.59 $18.59 $3.87 $18.59 N/A N/A G14432 SUP HCPCS C1892 G14432 - SET NPHSTM 7-18FR 20-30CM STRL MLCT CATH STNT STY RTNT DISK BOTH IP/OP $164.50 $122.00 $32.64 $164.45 $89.30 $89.30 $89.30 $89.30 $164.45 $164.45 $164.45 $34.28 $164.45 $122.05 $122.05 $126.76 $85.68 $34.27 $164.45 $164.45 $97.27 $164.45 $164.45 $164.45 $164.45 $123.38 $164.45 $164.45 $164.45 $82.23 $82.23 $130.24 $164.45 $131.56 $106.89 $32.64 N/A $95.41 $164.45 $164.45 $164.45 $34.27 $164.45 N/A N/A G14433 SUP HCPCS C1892 G14433 - SET INTRO .038IN STD STRG 16FR 65CM 60CM PLWY 2 KNOB GW SHTH BOTH IP/OP $164.50 $122.00 $32.64 $164.45 $89.30 $89.30 $89.30 $89.30 $164.45 $164.45 $164.45 $34.28 $164.45 $122.05 $122.05 $126.76 $85.68 $34.27 $164.45 $164.45 $97.27 $164.45 $164.45 $164.45 $164.45 $123.38 $164.45 $164.45 $164.45 $82.23 $82.23 $130.24 $164.45 $131.56 $106.89 $32.64 N/A $95.41 $164.45 $164.45 $164.45 $34.27 $164.45 N/A N/A G14434 SUP HCPCS C2627 G14434 - SET INTRO STD 18FR 65CM 60CM PLWY GW SHTH 2 KNOB URET BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $22.70 $22.70 $22.70 $22.70 $41.80 $41.80 $41.80 $8.71 $41.80 $31.02 $31.02 $32.22 $21.78 $8.71 $41.80 $41.80 $24.72 $41.80 $41.80 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $27.17 $8.30 N/A $24.36 $41.80 $41.80 $41.80 $8.71 $41.80 N/A N/A G14437 SUP HCPCS C1729 G14437 - DILATOR URET 11FR 60CM SET PE BOTH IP/OP $186.00 $138.00 $36.90 $185.90 $100.94 $100.94 $100.94 $100.94 $185.90 $185.90 $185.90 $38.75 $185.90 $137.97 $137.97 $143.29 $96.85 $38.74 $185.90 $185.90 $109.96 $185.90 $185.90 $185.90 $185.90 $139.50 $185.90 $185.90 $185.90 $92.95 $92.95 $147.23 $185.90 $148.72 $120.84 $36.90 N/A $107.88 $185.90 $185.90 $185.90 $38.74 $185.90 N/A N/A G14440 SUP HCPCS C1892 G14440 - SET NPHSTM 22FR 35CM MLCT CATH STY RTNT DISK CNCT TUBE PU BOTH IP/OP $119.00 $88.00 $23.58 $118.80 $64.51 $64.51 $64.51 $64.51 $118.80 $118.80 $118.80 $24.76 $118.80 $88.17 $88.17 $91.57 $61.89 $24.76 $118.80 $118.80 $70.27 $118.80 $118.80 $118.80 $118.80 $89.25 $118.80 $118.80 $118.80 $59.40 $59.40 $94.09 $118.80 $95.04 $77.22 $23.58 N/A $69.02 $118.80 $118.80 $118.80 $24.76 $118.80 N/A N/A G14441 SUP HCPCS C1892 G14441 - SET INTRO STD 9FR 37CM 32CM PLWY 2 KNOB SHTH GW BOTH IP/OP $119.00 $88.00 $23.58 $118.80 $64.51 $64.51 $64.51 $64.51 $118.80 $118.80 $118.80 $24.76 $118.80 $88.17 $88.17 $91.57 $61.89 $24.76 $118.80 $118.80 $70.27 $118.80 $118.80 $118.80 $118.80 $89.25 $118.80 $118.80 $118.80 $59.40 $59.40 $94.09 $118.80 $95.04 $77.22 $23.58 N/A $69.02 $118.80 $118.80 $118.80 $24.76 $118.80 N/A N/A G14442 SUP HCPCS C1892 G14442 - SET INTRO STD 10FR 37CM 32CM PLWY GW 2 KNOB SHTH URET BOTH IP/OP $119.00 $88.00 $23.58 $118.80 $64.51 $64.51 $64.51 $64.51 $118.80 $118.80 $118.80 $24.76 $118.80 $88.17 $88.17 $91.57 $61.89 $24.76 $118.80 $118.80 $70.27 $118.80 $118.80 $118.80 $118.80 $89.25 $118.80 $118.80 $118.80 $59.40 $59.40 $94.09 $118.80 $95.04 $77.22 $23.58 N/A $69.02 $118.80 $118.80 $118.80 $24.76 $118.80 N/A N/A G14443 SUP HCPCS C1892 G14443 - SET INTRO STD 12FR 37CM 32CM PLWY 2 KNOB SHTH GW URETER BOTH IP/OP $119.00 $88.00 $23.58 $118.80 $64.51 $64.51 $64.51 $64.51 $118.80 $118.80 $118.80 $24.76 $118.80 $88.17 $88.17 $91.57 $61.89 $24.76 $118.80 $118.80 $70.27 $118.80 $118.80 $118.80 $118.80 $89.25 $118.80 $118.80 $118.80 $59.40 $59.40 $94.09 $118.80 $95.04 $77.22 $23.58 N/A $69.02 $118.80 $118.80 $118.80 $24.76 $118.80 N/A N/A G14444 SUP HCPCS C1892 G14444 - SET INTRO STD 14FR 37CM 32CM PLWY 2 KNOB SHTH GW BOTH IP/OP $119.00 $88.00 $23.58 $118.80 $64.51 $64.51 $64.51 $64.51 $118.80 $118.80 $118.80 $24.76 $118.80 $88.17 $88.17 $91.57 $61.89 $24.76 $118.80 $118.80 $70.27 $118.80 $118.80 $118.80 $118.80 $89.25 $118.80 $118.80 $118.80 $59.40 $59.40 $94.09 $118.80 $95.04 $77.22 $23.58 N/A $69.02 $118.80 $118.80 $118.80 $24.76 $118.80 N/A N/A G14445 SUP HCPCS C1892 G14445 - SET INTRO STD 16FR 37CM 32CM PLWY GW 2 KNOB SHTH URET BOTH IP/OP $119.00 $88.00 $23.58 $118.80 $64.51 $64.51 $64.51 $64.51 $118.80 $118.80 $118.80 $24.76 $118.80 $88.17 $88.17 $91.57 $61.89 $24.76 $118.80 $118.80 $70.27 $118.80 $118.80 $118.80 $118.80 $89.25 $118.80 $118.80 $118.80 $59.40 $59.40 $94.09 $118.80 $95.04 $77.22 $23.58 N/A $69.02 $118.80 $118.80 $118.80 $24.76 $118.80 N/A N/A G14454 SUP HCPCS C1729 G14454 - LINE INJ 7FR 30CM CNRST STD FIT BOTH IP/OP $186.00 $138.00 $36.90 $185.90 $100.94 $100.94 $100.94 $100.94 $185.90 $185.90 $185.90 $38.75 $185.90 $137.97 $137.97 $143.29 $96.85 $38.74 $185.90 $185.90 $109.96 $185.90 $185.90 $185.90 $185.90 $139.50 $185.90 $185.90 $185.90 $92.95 $92.95 $147.23 $185.90 $148.72 $120.84 $36.90 N/A $107.88 $185.90 $185.90 $185.90 $38.74 $185.90 N/A N/A G14457 SUP Custom 27203010 G14457 - CATHETER URET .038IN 8FR 70CM STRL OP-EN DISP BOTH IP/OP $11.50 $9.00 $1.96 $11.01 $11.01 $11.01 $11.01 $11.01 $11.01 $11.01 $1.96 $11.01 $11.01 $8.17 $8.17 $8.49 $5.74 $2.29 $11.01 $4.40 $11.01 $11.01 $11.01 $11.01 $11.01 $8.63 $11.01 $11.01 $11.01 $5.51 $5.51 $8.72 $11.01 $8.81 $7.16 $11.01 N/A $6.67 $11.01 $6.61 $11.01 $11.01 $11.01 N/A N/A G14461 SUP Custom 27203010 G14461 - NEEDLE PRC STD 18GA 15CM ECHTP TROC STY SHTH PTFE RNL BOTH IP/OP $36.00 $27.00 $6.36 $35.75 $35.75 $35.75 $35.75 $35.75 $35.75 $35.75 $6.36 $35.75 $35.75 $26.53 $26.53 $27.56 $18.63 $7.45 $35.75 $14.30 $35.75 $35.75 $35.75 $35.75 $35.75 $27.00 $35.75 $35.75 $35.75 $17.88 $17.88 $28.31 $35.75 $28.60 $23.24 $35.75 N/A $20.88 $35.75 $21.45 $35.75 $35.75 $35.75 N/A N/A G14463 SUP HCPCS C1758 G14463 - NEEDLE PRC 18GA 15CM STRL ECHTP 2 PRT TROC DISP NPHSTM BOTH IP/OP $405.00 $300.00 $80.34 $404.80 $219.81 $219.81 $219.81 $219.81 $404.80 $404.80 $404.80 $84.37 $404.80 $300.44 $300.44 $312.02 $210.90 $84.36 $404.80 $404.80 $239.44 $404.80 $404.80 $404.80 $404.80 $303.75 $404.80 $404.80 $404.80 $202.40 $202.40 $320.60 $404.80 $323.84 $263.12 $80.34 N/A $234.90 $404.80 $404.80 $404.80 $84.36 $404.80 N/A N/A G14485 SUP HCPCS C1726 G14485 - ADAPTER CATH F LL TO LG FIT BOTH IP/OP $511.00 $378.00 $101.41 $510.95 $277.45 $277.45 $277.45 $277.45 $510.95 $510.95 $510.95 $106.49 $510.95 $379.23 $379.23 $393.84 $266.20 $106.49 $510.95 $510.95 $302.23 $510.95 $510.95 $510.95 $510.95 $383.25 $510.95 $510.95 $510.95 $255.48 $255.48 $404.67 $510.95 $408.76 $332.12 $101.41 N/A $296.38 $510.95 $510.95 $510.95 $106.48 $510.95 N/A N/A G14500 SUP Custom 27203010 G14500 - STYLET NPHSTM 8.5FR FLXB MLCT CATH REM BOTH IP/OP $147.50 $109.00 $26.24 $147.40 $147.40 $147.40 $147.40 $147.40 $147.40 $147.40 $26.24 $147.40 $147.40 $109.40 $109.40 $113.62 $76.80 $30.72 $147.40 $58.96 $147.40 $147.40 $147.40 $147.40 $147.40 $110.63 $147.40 $147.40 $147.40 $73.70 $73.70 $116.74 $147.40 $117.92 $95.81 $147.40 N/A $85.55 $147.40 $88.44 $147.40 $147.40 $147.40 N/A N/A G14501 SUP HCPCS C1729 G14501 - APPROXIMATOR SRG WILLSCHER SET VASC BOTH IP/OP $186.00 $138.00 $36.90 $185.90 $100.94 $100.94 $100.94 $100.94 $185.90 $185.90 $185.90 $38.75 $185.90 $137.97 $137.97 $143.29 $96.85 $38.74 $185.90 $185.90 $109.96 $185.90 $185.90 $185.90 $185.90 $139.50 $185.90 $185.90 $185.90 $92.95 $92.95 $147.23 $185.90 $148.72 $120.84 $36.90 N/A $107.88 $185.90 $185.90 $185.90 $38.74 $185.90 N/A N/A G14504 SUP HCPCS C1726 G14504 - SET NPHSTM 5FR 20CM MLCT CATH LL STY RTNT DISK CNCT TUBE PU BOTH IP/OP $588.00 $435.00 $116.62 $587.60 $319.07 $319.07 $319.07 $319.07 $587.60 $587.60 $587.60 $122.47 $587.60 $436.12 $436.12 $452.92 $306.14 $122.46 $587.60 $587.60 $347.57 $587.60 $587.60 $587.60 $587.60 $441.00 $587.60 $587.60 $587.60 $293.80 $293.80 $465.38 $587.60 $470.08 $381.94 $116.62 N/A $341.04 $587.60 $587.60 $587.60 $122.46 $587.60 N/A N/A G14508 SUP HCPCS C1729 G14508 - SET DIL 6-30FR 30CM 19CM AMPTZ MOD RADOPQ SHTH RNL BOTH IP/OP $363.00 $269.00 $72.05 $363.00 $197.11 $197.11 $197.11 $197.11 $363.00 $363.00 $363.00 $75.66 $363.00 $269.42 $269.42 $279.80 $189.12 $75.65 $363.00 $363.00 $214.71 $363.00 $363.00 $363.00 $363.00 $272.25 $363.00 $363.00 $363.00 $181.50 $181.50 $287.50 $363.00 $290.40 $235.95 $72.05 N/A $210.54 $363.00 $363.00 $363.00 $75.65 $363.00 N/A N/A G14510 SUP HCPCS C1729 G14510 - SET NPHSTM PGTL CRV 6FR 7CM STRL 3 DIL 2 NDL CATH CNCT TUBE BOTH IP/OP $186.00 $138.00 $36.90 $185.90 $100.94 $100.94 $100.94 $100.94 $185.90 $185.90 $185.90 $38.75 $185.90 $137.97 $137.97 $143.29 $96.85 $38.74 $185.90 $185.90 $109.96 $185.90 $185.90 $185.90 $185.90 $139.50 $185.90 $185.90 $185.90 $92.95 $92.95 $147.23 $185.90 $148.72 $120.84 $36.90 N/A $107.88 $185.90 $185.90 $185.90 $38.74 $185.90 N/A N/A G14511 SUP HCPCS C1758 G14511 - SET NPHSTM 7FR 20CM MLCT CATH STNT LL RTNT DISK PU BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G14513 SUP HCPCS C2625 G14513 - CATHETER URET 10FR 70CM OP-EN ACPT .038IN GW BOTH IP/OP $123.00 $91.00 $24.41 $123.00 $55.35 $55.35 $55.35 $55.35 $123.00 $123.00 $123.00 $25.64 $123.00 $123.00 $123.00 $123.00 $123.00 $25.63 $123.00 $123.00 $72.75 $123.00 $123.00 $123.00 $123.00 $92.25 $123.00 $123.00 $123.00 $61.50 $61.50 $97.42 $123.00 $98.40 $55.35 $24.41 N/A $71.34 $123.00 $123.00 $123.00 $25.63 $123.00 N/A N/A G14514 SUP HCPCS C2625 G14514 - SET STNT .025IN PGTL CRV STRG 3.7FR 125CM BLU STRL 145CM BOTH IP/OP $141.50 $105.00 $28.07 $141.45 $63.65 $63.65 $63.65 $63.65 $141.45 $141.45 $141.45 $29.48 $141.45 $141.45 $141.45 $141.45 $141.45 $29.48 $141.45 $141.45 $83.67 $141.45 $141.45 $141.45 $141.45 $106.13 $141.45 $141.45 $141.45 $70.73 $70.73 $112.03 $141.45 $113.16 $63.65 $28.07 N/A $82.07 $141.45 $141.45 $141.45 $29.48 $141.45 N/A N/A G14515 SUP HCPCS C2628 G14515 - SET STNT .035IN PGTL CRV STRG 4.7FR 125CM BLU STRL 145CM BOTH IP/OP $319.00 $236.00 $63.31 $319.00 $173.22 $173.22 $173.22 $173.22 $319.00 $319.00 $319.00 $66.49 $319.00 $236.76 $236.76 $245.89 $166.20 $66.48 $319.00 $319.00 $188.69 $319.00 $319.00 $319.00 $319.00 $239.25 $319.00 $319.00 $319.00 $159.50 $159.50 $252.65 $319.00 $255.20 $207.35 $63.31 N/A $185.02 $319.00 $319.00 $319.00 $66.48 $319.00 N/A N/A G14519 SUP Custom 27203010 G14519 - NEEDLE NPHSTM 18GA 5CMX4.5MM INCS ACPT .038IN GW BOTH IP/OP $16.00 $12.00 $2.78 $15.62 $15.62 $15.62 $15.62 $15.62 $15.62 $15.62 $2.78 $15.62 $15.62 $11.59 $11.59 $12.04 $8.14 $3.26 $15.62 $6.25 $15.62 $15.62 $15.62 $15.62 $15.62 $12.00 $15.62 $15.62 $15.62 $7.81 $7.81 $12.37 $15.62 $12.50 $10.15 $15.62 N/A $9.28 $15.62 $9.37 $15.62 $15.62 $15.62 N/A N/A G14521 SUP HCPCS C1758 G14521 - SET DRN 300ML NS PCH 1 CNCT BOTH IP/OP $276.50 $205.00 $54.83 $276.25 $150.00 $150.00 $150.00 $150.00 $276.25 $276.25 $276.25 $57.58 $276.25 $205.03 $205.03 $212.93 $143.93 $57.57 $276.25 $276.25 $163.40 $276.25 $276.25 $276.25 $276.25 $207.38 $276.25 $276.25 $276.25 $138.13 $138.13 $218.79 $276.25 $221.00 $179.56 $54.83 N/A $160.37 $276.25 $276.25 $276.25 $57.57 $276.25 N/A N/A G14526 SUP HCPCS C1729 G14526 - STYLET NPHSTM 5FR FLXB 10FR MLCT CATH REM BOTH IP/OP $186.00 $138.00 $36.90 $185.90 $100.94 $100.94 $100.94 $100.94 $185.90 $185.90 $185.90 $38.75 $185.90 $137.97 $137.97 $143.29 $96.85 $38.74 $185.90 $185.90 $109.96 $185.90 $185.90 $185.90 $185.90 $139.50 $185.90 $185.90 $185.90 $92.95 $92.95 $147.23 $185.90 $148.72 $120.84 $36.90 N/A $107.88 $185.90 $185.90 $185.90 $38.74 $185.90 N/A N/A G14544 SUP HCPCS C1769 G14544 - DEVICE SPEC RTRVL 5FR 5MM 65CM 4CM RTNR 4WR OCL STON BLN BOTH IP/OP $34.00 $25.00 $6.71 $33.80 $18.35 $18.35 $18.35 $18.35 $33.80 $33.80 $33.80 $7.04 $33.80 $25.09 $25.09 $26.05 $17.61 $7.04 $33.80 $33.80 $19.99 $33.80 $33.80 $33.80 $33.80 $25.50 $33.80 $33.80 $33.80 $16.90 $16.90 $26.77 $33.80 $27.04 $21.97 $6.71 N/A $19.72 $33.80 $33.80 $33.80 $7.04 $33.80 N/A N/A G14547 SUP Custom 27203010 G14547 - GUIDEWIRE URO STD STRG .035IN 145CM STRL 3CM FLX TP FX COR BOTH IP/OP $604.00 $447.00 $107.51 $604.00 $604.00 $604.00 $604.00 $604.00 $604.00 $604.00 $107.51 $604.00 $604.00 $448.29 $448.29 $465.56 $314.68 $125.88 $604.00 $241.60 $604.00 $604.00 $604.00 $604.00 $604.00 $453.00 $604.00 $604.00 $604.00 $302.00 $302.00 $478.37 $604.00 $483.20 $392.60 $604.00 N/A $350.32 $604.00 $362.40 $604.00 $604.00 $604.00 N/A N/A G14551 SUP HCPCS C1769 G14551 - EXTRACTOR STON 5FR 6MM 65CM 4CM RTNR 4WR HLCL BLNDIL FLFRM BOTH IP/OP $39.00 $29.00 $7.72 $38.88 $21.11 $21.11 $21.11 $21.11 $38.88 $38.88 $38.88 $8.10 $38.88 $28.86 $28.86 $29.97 $20.26 $8.10 $38.88 $15.55 $23.00 $38.88 $38.88 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $25.27 $7.72 N/A $22.62 $38.88 $38.88 $38.88 $8.10 $38.88 N/A N/A G14554 SUP HCPCS C1769 G14554 - GUIDEWIRE ESCP STD .028IN 145CM LD EXTR RDRR PC FXCR DFLC BOTH IP/OP $34.00 $25.00 $6.71 $33.80 $18.35 $18.35 $18.35 $18.35 $33.80 $33.80 $33.80 $7.04 $33.80 $25.09 $25.09 $26.05 $17.61 $7.04 $33.80 $33.80 $19.99 $33.80 $33.80 $33.80 $33.80 $25.50 $33.80 $33.80 $33.80 $16.90 $16.90 $26.77 $33.80 $27.04 $21.97 $6.71 N/A $19.72 $33.80 $33.80 $33.80 $7.04 $33.80 N/A N/A G14565 SUP HCPCS C2627 G14565 - GUIDEWIRE ESCP STD STRG .038IN 145CM STRL 1CM FXCR FLX TP SS BOTH IP/OP $104.00 $77.00 $20.59 $103.73 $56.33 $56.33 $56.33 $56.33 $103.73 $103.73 $103.73 $21.62 $103.73 $76.99 $76.99 $79.96 $54.04 $21.62 $103.73 $103.73 $61.36 $103.73 $103.73 $103.73 $103.73 $78.00 $103.73 $103.73 $103.73 $51.87 $51.87 $82.15 $103.73 $82.98 $67.42 $20.59 N/A $60.32 $103.73 $103.73 $103.73 $21.62 $103.73 N/A N/A G14566 SUP HCPCS C2627 G14566 - DILATOR URTH 6FR 37CM SET PTFE FSCA BOTH IP/OP $90.50 $67.00 $17.90 $90.20 $48.98 $48.98 $48.98 $48.98 $90.20 $90.20 $90.20 $18.80 $90.20 $66.95 $66.95 $69.53 $46.99 $18.80 $90.20 $90.20 $53.35 $90.20 $90.20 $90.20 $90.20 $67.88 $90.20 $90.20 $90.20 $45.10 $45.10 $71.44 $90.20 $72.16 $58.63 $17.90 N/A $52.49 $90.20 $90.20 $90.20 $18.80 $90.20 N/A N/A G14567 SUP HCPCS C2627 G14567 - DILATOR URTH 8FR 37CM SET PTFE FSCA BOTH IP/OP $90.50 $67.00 $17.90 $90.20 $48.98 $48.98 $48.98 $48.98 $90.20 $90.20 $90.20 $18.80 $90.20 $66.95 $66.95 $69.53 $46.99 $18.80 $90.20 $90.20 $53.35 $90.20 $90.20 $90.20 $90.20 $67.88 $90.20 $90.20 $90.20 $45.10 $45.10 $71.44 $90.20 $72.16 $58.63 $17.90 N/A $52.49 $90.20 $90.20 $90.20 $18.80 $90.20 N/A N/A G14568 SUP HCPCS C2627 G14568 - DILATOR URTH 10FR 37CM SET TFE FSCA BOTH IP/OP $90.50 $67.00 $17.90 $90.20 $48.98 $48.98 $48.98 $48.98 $90.20 $90.20 $90.20 $18.80 $90.20 $66.95 $66.95 $69.53 $46.99 $18.80 $90.20 $90.20 $53.35 $90.20 $90.20 $90.20 $90.20 $67.88 $90.20 $90.20 $90.20 $45.10 $45.10 $71.44 $90.20 $72.16 $58.63 $17.90 N/A $52.49 $90.20 $90.20 $90.20 $18.80 $90.20 N/A N/A G14569 SUP HCPCS C2627 G14569 - DILATOR URTH 12FR 37CM PTFE FSCA BOTH IP/OP $104.00 $77.00 $20.59 $103.73 $56.33 $56.33 $56.33 $56.33 $103.73 $103.73 $103.73 $21.62 $103.73 $76.99 $76.99 $79.96 $54.04 $21.62 $103.73 $103.73 $61.36 $103.73 $103.73 $103.73 $103.73 $78.00 $103.73 $103.73 $103.73 $51.87 $51.87 $82.15 $103.73 $82.98 $67.42 $20.59 N/A $60.32 $103.73 $103.73 $103.73 $21.62 $103.73 N/A N/A G14570 SUP HCPCS C2627 G14570 - DILATOR URTH 14FR 37CM SET TFE FSCA BOTH IP/OP $104.00 $77.00 $20.59 $103.73 $56.33 $56.33 $56.33 $56.33 $103.73 $103.73 $103.73 $21.62 $103.73 $76.99 $76.99 $79.96 $54.04 $21.62 $103.73 $103.73 $61.36 $103.73 $103.73 $103.73 $103.73 $78.00 $103.73 $103.73 $103.73 $51.87 $51.87 $82.15 $103.73 $82.98 $67.42 $20.59 N/A $60.32 $103.73 $103.73 $103.73 $21.62 $103.73 N/A N/A G14571 SUP HCPCS C2627 G14571 - DILATOR URTH 16FR 37CM SET PTFE FSCA BOTH IP/OP $104.00 $77.00 $20.59 $103.73 $56.33 $56.33 $56.33 $56.33 $103.73 $103.73 $103.73 $21.62 $103.73 $76.99 $76.99 $79.96 $54.04 $21.62 $103.73 $103.73 $61.36 $103.73 $103.73 $103.73 $103.73 $78.00 $103.73 $103.73 $103.73 $51.87 $51.87 $82.15 $103.73 $82.98 $67.42 $20.59 N/A $60.32 $103.73 $103.73 $103.73 $21.62 $103.73 N/A N/A G14572 SUP HCPCS C2627 G14572 - DILATOR URTH 18FR 37CM SET PTFE FSCA BOTH IP/OP $721.50 $534.00 $143.11 $721.05 $391.53 $391.53 $391.53 $391.53 $721.05 $721.05 $721.05 $150.28 $721.05 $535.16 $535.16 $555.79 $375.67 $150.27 $721.05 $721.05 $426.50 $721.05 $721.05 $721.05 $721.05 $541.13 $721.05 $721.05 $721.05 $360.53 $360.53 $571.07 $721.05 $576.84 $468.68 $143.11 N/A $418.47 $721.05 $721.05 $721.05 $150.27 $721.05 N/A N/A G14574 SUP HCPCS C1769 G14574 - DILATOR URET 6-18FR 37CM SET PTFE FSCA BOTH IP/OP $638.00 $472.00 $126.63 $638.00 $346.43 $346.43 $346.43 $346.43 $638.00 $638.00 $638.00 $132.98 $638.00 $473.52 $473.52 $491.77 $332.40 $132.97 $638.00 $638.00 $377.38 $638.00 $638.00 $638.00 $638.00 $478.50 $638.00 $638.00 $638.00 $319.00 $319.00 $505.30 $638.00 $510.40 $414.70 $126.63 N/A $370.04 $638.00 $638.00 $638.00 $132.96 $638.00 N/A N/A G14575 SUP HCPCS C2627 G14575 - DILATOR URET 6-18FR 60CM SET GW LFRIC SRFC PTFE FSCA BOTH IP/OP $99.00 $73.00 $19.65 $99.00 $53.76 $53.76 $53.76 $53.76 $99.00 $99.00 $99.00 $20.63 $99.00 $73.48 $73.48 $76.31 $51.58 $20.63 $99.00 $99.00 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $64.35 $19.65 N/A $57.42 $99.00 $99.00 $99.00 $20.63 $99.00 N/A N/A G14576 SUP HCPCS C2627 G14576 - DILATOR URET 6FR 60CM SET PTFE DISP BOTH IP/OP $99.00 $73.00 $19.65 $99.00 $53.76 $53.76 $53.76 $53.76 $99.00 $99.00 $99.00 $20.63 $99.00 $73.48 $73.48 $76.31 $51.58 $20.63 $99.00 $99.00 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $64.35 $19.65 N/A $57.42 $99.00 $99.00 $99.00 $20.63 $99.00 N/A N/A G14577 SUP HCPCS C2627 G14577 - DILATOR URET 8FR 60CM SET PTFE FSCA BOTH IP/OP $99.00 $73.00 $19.65 $99.00 $53.76 $53.76 $53.76 $53.76 $99.00 $99.00 $99.00 $20.63 $99.00 $73.48 $73.48 $76.31 $51.58 $20.63 $99.00 $99.00 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $64.35 $19.65 N/A $57.42 $99.00 $99.00 $99.00 $20.63 $99.00 N/A N/A G14578 SUP HCPCS C2627 G14578 - DILATOR URET 10FR 60CM SET PTFE DISP BOTH IP/OP $99.00 $73.00 $19.65 $99.00 $53.76 $53.76 $53.76 $53.76 $99.00 $99.00 $99.00 $20.63 $99.00 $73.48 $73.48 $76.31 $51.58 $20.63 $99.00 $99.00 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $64.35 $19.65 N/A $57.42 $99.00 $99.00 $99.00 $20.63 $99.00 N/A N/A G14579 SUP HCPCS C2627 G14579 - DILATOR URET 12FR 60CM SET PTFE DISP BOTH IP/OP $114.00 $84.00 $22.60 $113.85 $61.82 $61.82 $61.82 $61.82 $113.85 $113.85 $113.85 $23.73 $113.85 $84.50 $84.50 $87.76 $59.32 $23.73 $113.85 $113.85 $67.34 $113.85 $113.85 $113.85 $113.85 $85.50 $113.85 $113.85 $113.85 $56.93 $56.93 $90.17 $113.85 $91.08 $74.00 $22.60 N/A $66.12 $113.85 $113.85 $113.85 $23.73 $113.85 N/A N/A G14580 SUP HCPCS C2627 G14580 - DILATOR URET 14FR 60CM SET PTFE FSCA BOTH IP/OP $114.00 $84.00 $22.60 $113.85 $61.82 $61.82 $61.82 $61.82 $113.85 $113.85 $113.85 $23.73 $113.85 $84.50 $84.50 $87.76 $59.32 $23.73 $113.85 $113.85 $67.34 $113.85 $113.85 $113.85 $113.85 $85.50 $113.85 $113.85 $113.85 $56.93 $56.93 $90.17 $113.85 $91.08 $74.00 $22.60 N/A $66.12 $113.85 $113.85 $113.85 $23.73 $113.85 N/A N/A G14581 SUP HCPCS C2627 G14581 - DILATOR URET 16FR 60CM SET TFE FSCA BOTH IP/OP $114.00 $84.00 $22.60 $113.85 $61.82 $61.82 $61.82 $61.82 $113.85 $113.85 $113.85 $23.73 $113.85 $84.50 $84.50 $87.76 $59.32 $23.73 $113.85 $113.85 $67.34 $113.85 $113.85 $113.85 $113.85 $85.50 $113.85 $113.85 $113.85 $56.93 $56.93 $90.17 $113.85 $91.08 $74.00 $22.60 N/A $66.12 $113.85 $113.85 $113.85 $23.73 $113.85 N/A N/A G14587 SUP HCPCS C1758 G14587 - DILATOR URET 18FR 60CM SET PTFE FSCA BOTH IP/OP $73.00 $54.00 $14.41 $72.60 $39.42 $39.42 $39.42 $39.42 $72.60 $72.60 $72.60 $15.13 $72.60 $53.88 $53.88 $55.96 $37.82 $15.13 $72.60 $72.60 $42.94 $72.60 $72.60 $72.60 $72.60 $54.75 $72.60 $72.60 $72.60 $36.30 $36.30 $57.50 $72.60 $58.08 $47.19 $14.41 N/A $42.34 $72.60 $72.60 $72.60 $15.13 $72.60 N/A N/A G14589 SUP HCPCS C1769 G14589 - CATHETER URET 20D .035IN TPR STRG 6FR 70CM 145CM GW BOTH IP/OP $52.50 $39.00 $10.34 $52.08 $28.28 $28.28 $28.28 $28.28 $52.08 $52.08 $52.08 $10.85 $52.08 $38.65 $38.65 $40.14 $27.13 $10.85 $52.08 $52.08 $30.81 $52.08 $52.08 $52.08 $52.08 $39.38 $52.08 $52.08 $52.08 $26.04 $26.04 $41.25 $52.08 $41.66 $33.85 $10.34 N/A $30.45 $52.08 $52.08 $52.08 $10.85 $52.08 N/A N/A G14590 SUP HCPCS C1769 G14590 - GUIDEWIRE VASC STRG .038IN 145CM STRL 15CM BNTSN FLX TP FX BOTH IP/OP $52.50 $39.00 $10.34 $52.08 $28.28 $28.28 $28.28 $28.28 $52.08 $52.08 $52.08 $10.85 $52.08 $38.65 $38.65 $40.14 $27.13 $10.85 $52.08 $52.08 $30.81 $52.08 $52.08 $52.08 $52.08 $39.38 $52.08 $52.08 $52.08 $26.04 $26.04 $41.25 $52.08 $41.66 $33.85 $10.34 N/A $30.45 $52.08 $52.08 $52.08 $10.85 $52.08 N/A N/A G14592 SUP HCPCS C1758 G14592 - GUIDEWIRE VASC .035IN 145CM STRL 15CM BNTSN BNTSN FLX TP BOTH IP/OP $27.50 $20.00 $5.46 $27.50 $14.93 $14.93 $14.93 $14.93 $27.50 $27.50 $27.50 $5.73 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $27.50 $16.27 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $5.46 N/A $15.95 $27.50 $16.50 $27.50 $5.73 $27.50 N/A N/A G14593 SUP HCPCS C1758 G14593 - CATHETER URET 4FR 70CM RND TIP STY LT BOTH IP/OP $27.50 $20.00 $5.46 $27.50 $14.93 $14.93 $14.93 $14.93 $27.50 $27.50 $27.50 $5.73 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $27.50 $16.27 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $5.46 N/A $15.95 $27.50 $27.50 $27.50 $5.73 $27.50 N/A N/A G14595 SUP HCPCS C1773 G14595 - CATHETER URET 5FR 70CM RND TIP STY LT BOTH IP/OP $398.50 $295.00 $79.08 $398.45 $216.36 $216.36 $216.36 $216.36 $398.45 $398.45 $398.45 $83.05 $398.45 $295.73 $295.73 $307.13 $207.59 $83.04 $398.45 $398.45 $235.68 $398.45 $398.45 $398.45 $398.45 $298.88 $398.45 $398.45 $398.45 $199.23 $199.23 $315.57 $398.45 $318.76 $258.99 $79.08 N/A $231.13 $398.45 $398.45 $398.45 $83.04 $398.45 N/A N/A G14596 SUP HCPCS C1773 G14596 - FORCEPS SPEC RTRVL 3.2FR 10MM 65CM STRL 3WR GRSP COAX SHTH BOTH IP/OP $398.50 $295.00 $79.08 $398.45 $216.36 $216.36 $216.36 $216.36 $398.45 $398.45 $398.45 $83.05 $398.45 $295.73 $295.73 $307.13 $207.59 $83.04 $398.45 $398.45 $235.68 $398.45 $398.45 $398.45 $398.45 $298.88 $398.45 $398.45 $398.45 $199.23 $199.23 $315.57 $398.45 $318.76 $258.99 $79.08 N/A $231.13 $398.45 $398.45 $398.45 $83.04 $398.45 N/A N/A G14597 SUP HCPCS C1758 G14597 - FORCEPS ESCP 14MM 3.5FR 65CM STRL GRSP BOTH IP/OP $83.50 $62.00 $16.57 $83.50 $45.34 $45.34 $45.34 $45.34 $83.50 $83.50 $83.50 $17.40 $83.50 $61.97 $61.97 $64.36 $43.50 $17.40 $83.50 $83.50 $49.39 $83.50 $83.50 $83.50 $83.50 $62.63 $83.50 $83.50 $83.50 $41.75 $41.75 $66.13 $83.50 $66.80 $54.28 $16.57 N/A $48.43 $83.50 $83.50 $83.50 $17.40 $83.50 N/A N/A G14598 SUP HCPCS C1758 G14598 - CATHETER URET 20D .028IN TPR STRG 4FR 70CM 145CM GW BOTH IP/OP $73.00 $54.00 $14.41 $72.60 $39.42 $39.42 $39.42 $39.42 $72.60 $72.60 $72.60 $15.13 $72.60 $53.88 $53.88 $55.96 $37.82 $15.13 $72.60 $72.60 $42.94 $72.60 $72.60 $72.60 $72.60 $54.75 $72.60 $72.60 $72.60 $36.30 $36.30 $57.50 $72.60 $58.08 $47.19 $14.41 N/A $42.34 $72.60 $72.60 $72.60 $15.13 $72.60 N/A N/A G14599 SUP HCPCS C1758 G14599 - CATHETER URET 20D .035IN 5FR 70CM FLXB ANG TIP TPR END GW BOTH IP/OP $83.50 $62.00 $16.57 $83.50 $45.34 $45.34 $45.34 $45.34 $83.50 $83.50 $83.50 $17.40 $83.50 $61.97 $61.97 $64.36 $43.50 $17.40 $83.50 $83.50 $49.39 $83.50 $83.50 $83.50 $83.50 $62.63 $83.50 $83.50 $83.50 $41.75 $41.75 $66.13 $83.50 $66.80 $54.28 $16.57 N/A $48.43 $83.50 $83.50 $83.50 $17.40 $83.50 N/A N/A G14600 SUP HCPCS C1758 G14600 - CATHETER URET 20D .028IN BVL STRG 4FR 70CM 145CM GW BOTH IP/OP $73.00 $54.00 $14.41 $72.60 $39.42 $39.42 $39.42 $39.42 $72.60 $72.60 $72.60 $15.13 $72.60 $53.88 $53.88 $55.96 $37.82 $15.13 $72.60 $72.60 $42.94 $72.60 $72.60 $72.60 $72.60 $54.75 $72.60 $72.60 $72.60 $36.30 $36.30 $57.50 $72.60 $58.08 $47.19 $14.41 N/A $42.34 $72.60 $72.60 $72.60 $15.13 $72.60 N/A N/A G14606 SUP HCPCS C2617 G14606 - CATHETER URET 20D .035IN 5FR 70CM 145CM ANG TIP BVL END GW BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14608 SUP HCPCS C1758 G14608 - SET STNT .025IN 50CM SM 2 PGTL CRV STRG 3.7FR 26CM GRN STRL BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $179.19 $179.19 $179.19 $179.19 $330.00 $330.00 $330.00 $68.78 $330.00 $244.93 $244.93 $254.36 $171.93 $68.78 $330.00 $330.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $214.50 $65.50 N/A $191.40 $330.00 $330.00 $330.00 $68.77 $330.00 N/A N/A G14619 SUP HCPCS C1769 G14619 - TROCAR SRG STD 18GA 11CM DISP BOTH IP/OP $52.50 $39.00 $10.34 $52.08 $28.28 $28.28 $28.28 $28.28 $52.08 $52.08 $52.08 $10.85 $52.08 $38.65 $38.65 $40.14 $27.13 $10.85 $52.08 $52.08 $30.81 $52.08 $52.08 $52.08 $52.08 $39.38 $52.08 $52.08 $52.08 $26.04 $26.04 $41.25 $52.08 $41.66 $33.85 $10.34 N/A $30.45 $52.08 $52.08 $52.08 $10.85 $52.08 N/A N/A G14631 SUP HCPCS C1769 G14631 - GUIDEWIRE ESCP .038IN 145CM STRL CNS BNTSN MOV COR SS PTFE BOTH IP/OP $71.50 $53.00 $14.17 $71.38 $38.76 $38.76 $38.76 $38.76 $71.38 $71.38 $71.38 $14.88 $71.38 $52.98 $52.98 $55.02 $37.19 $14.88 $71.38 $71.38 $42.22 $71.38 $71.38 $71.38 $71.38 $53.63 $71.38 $71.38 $71.38 $35.69 $35.69 $56.53 $71.38 $57.10 $46.40 $14.17 N/A $41.47 $71.38 $71.38 $71.38 $14.88 $71.38 N/A N/A G14639 SUP HCPCS C2617 G14639 - GUIDEWIRE VASC STRG .038IN 145CM AMPTZ FLXB FXCR BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14650 SUP HCPCS C2627 G14650 - SET NPHSTM .038IN 22GA 18GA 80CM 20CM SFTJ 2 NDL ENTRY GW BOTH IP/OP $306.50 $227.00 $60.76 $306.13 $166.23 $166.23 $166.23 $166.23 $306.13 $306.13 $306.13 $63.81 $306.13 $227.21 $227.21 $235.97 $159.49 $63.80 $306.13 $306.13 $181.08 $306.13 $306.13 $306.13 $306.13 $229.88 $306.13 $306.13 $306.13 $153.07 $153.07 $242.45 $306.13 $244.90 $198.98 $60.76 N/A $177.77 $306.13 $306.13 $306.13 $63.80 $306.13 N/A N/A G14658 SUP HCPCS C1769 G14658 - SET NPHSTM 300ML STRL 2 CNCT DRN PCH SFT ELC BELT REED VLV BOTH IP/OP $466.00 $345.00 $92.40 $465.53 $252.78 $252.78 $252.78 $252.78 $465.53 $465.53 $465.53 $97.03 $465.53 $345.52 $345.52 $358.83 $242.54 $97.02 $465.53 $465.53 $275.36 $465.53 $465.53 $465.53 $465.53 $349.50 $465.53 $465.53 $465.53 $232.77 $232.77 $368.70 $465.53 $372.42 $302.59 $92.40 N/A $270.28 $465.53 $279.32 $465.53 $97.02 $465.53 N/A N/A G14659 SUP HCPCS C1758 G14659 - SET NPHSTM 8.2FR 19.5CM LTX COPE LOOP CATH NDL GW STPCK BOTH IP/OP $33.00 $24.00 $6.53 $32.90 $17.86 $17.86 $17.86 $17.86 $32.90 $32.90 $32.90 $6.86 $32.90 $24.42 $24.42 $25.36 $17.14 $6.86 $32.90 $32.90 $19.46 $32.90 $32.90 $32.90 $32.90 $24.75 $32.90 $32.90 $32.90 $16.45 $16.45 $26.06 $32.90 $26.32 $21.39 $6.53 N/A $19.14 $32.90 $32.90 $32.90 $6.86 $32.90 N/A N/A G14663 SUP HCPCS C1758 G14663 - CATHETER URETERAL 4.8FR 8FR 70CM CONE TIP BOTH IP/OP $29.00 $21.00 $5.66 $28.54 $15.50 $15.50 $15.50 $15.50 $28.54 $28.54 $28.54 $5.95 $28.54 $21.18 $21.18 $22.00 $14.87 $5.95 $28.54 $27.63 $16.88 $28.54 $28.54 $28.54 $28.54 $21.75 $28.54 $28.54 $28.54 $14.27 $14.27 $22.60 $28.54 $22.83 $18.55 $5.66 N/A $16.82 $28.54 $28.54 $28.54 $5.95 $28.54 N/A N/A G14665 SUP HCPCS C1758 G14665 - CATHETER URET .038IN 5FR 70CM FLXTP OP-EN GW MOD BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $15.00 $15.00 $15.00 $15.00 $27.63 $27.63 $27.63 $5.76 $27.63 $20.51 $20.51 $21.30 $14.40 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $17.96 $5.48 N/A $16.24 $27.63 $27.63 $27.63 $5.76 $27.63 N/A N/A G14667 SUP HCPCS C1758 G14667 - CATHETER URETERAL CONE 7FR 12FR 70CM BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $15.00 $15.00 $15.00 $15.00 $27.63 $27.63 $27.63 $5.76 $27.63 $20.51 $20.51 $21.30 $14.40 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $17.96 $5.48 N/A $16.24 $27.63 $27.63 $27.63 $5.76 $27.63 N/A N/A G14669 SUP HCPCS C1758 G14669 - CATHETER URET 6FR 10FR 70CM CONE TIP BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $15.00 $15.00 $15.00 $15.00 $27.63 $27.63 $27.63 $5.76 $27.63 $20.51 $20.51 $21.30 $14.40 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $17.96 $5.48 N/A $16.24 $27.63 $27.63 $27.63 $5.76 $27.63 N/A N/A G14671 SUP HCPCS C1758 G14671 - CATHETER URET 8FR 14FR 70CM CONE TIP BOTH IP/OP $3.50 $3.00 $0.65 $3.29 $1.79 $1.79 $1.79 $1.79 $3.29 $3.29 $3.29 $0.69 $3.29 $2.44 $2.44 $2.54 $1.71 $0.69 $3.29 $3.29 $1.95 $3.29 $3.29 $3.29 $3.29 $2.63 $3.29 $3.29 $3.29 $1.65 $1.65 $2.61 $3.29 $2.63 $2.14 $0.65 N/A $2.03 $3.29 $3.29 $3.29 $0.69 $3.29 N/A N/A G14674 SUP HCPCS C1773 G14674 - CATHETER URET 5FR 70CM ANG TIP TPR END MOD BOTH IP/OP $313.50 $232.00 $62.21 $313.45 $170.20 $170.20 $170.20 $170.20 $313.45 $313.45 $313.45 $65.33 $313.45 $232.64 $232.64 $241.61 $163.31 $65.33 $313.45 $313.45 $185.41 $313.45 $313.45 $313.45 $313.45 $235.13 $313.45 $313.45 $313.45 $156.73 $156.73 $248.25 $313.45 $250.76 $203.74 $62.21 N/A $181.83 $313.45 $313.45 $313.45 $65.32 $313.45 N/A N/A G14676 SUP Custom 27203010 G14676 - FORCEPS GRASPING 10MM 3.2FR 115MM COAXIAL SHEATH HANDLE BOTH IP/OP $398.50 $295.00 $70.92 $398.45 $398.45 $398.45 $398.45 $398.45 $398.45 $398.45 $70.92 $398.45 $398.45 $295.73 $295.73 $307.13 $207.59 $83.04 $398.45 $159.38 $398.45 $398.45 $398.45 $398.45 $398.45 $298.88 $398.45 $398.45 $398.45 $199.23 $199.23 $315.57 $398.45 $318.76 $258.99 $398.45 N/A $231.13 $398.45 $239.07 $398.45 $398.45 $398.45 N/A N/A G14677 SUP HCPCS C1773 G14677 - RETRIEVER SRG 3FR 115CM STRL FLTWR LOOP URET BOTH IP/OP $398.50 $295.00 $79.08 $398.45 $216.36 $216.36 $216.36 $216.36 $398.45 $398.45 $398.45 $83.05 $398.45 $295.73 $295.73 $307.13 $207.59 $83.04 $398.45 $398.45 $235.68 $398.45 $398.45 $398.45 $398.45 $298.88 $398.45 $398.45 $398.45 $199.23 $199.23 $315.57 $398.45 $318.76 $258.99 $79.08 N/A $231.13 $398.45 $398.45 $398.45 $83.04 $398.45 N/A N/A G14681 SUP Custom 27203010 G14681 - SYRINGE ASP 5ML VAC BOTH IP/OP $604.00 $447.00 $107.51 $604.00 $604.00 $604.00 $604.00 $604.00 $604.00 $604.00 $107.51 $604.00 $604.00 $448.29 $448.29 $465.56 $314.68 $125.88 $604.00 $241.60 $604.00 $604.00 $604.00 $604.00 $604.00 $453.00 $604.00 $604.00 $604.00 $302.00 $302.00 $478.37 $604.00 $483.20 $392.60 $604.00 N/A $350.32 $604.00 $362.40 $604.00 $604.00 $604.00 N/A N/A G14685 SUP HCPCS C1769 G14685 - DEVICE SPEC RTRVL 5CM 5MM 5FR 4CM 65CM RTNR 3WR STON HLCL BOTH IP/OP $52.50 $39.00 $10.34 $52.08 $28.28 $28.28 $28.28 $28.28 $52.08 $52.08 $52.08 $10.85 $52.08 $38.65 $38.65 $40.14 $27.13 $10.85 $52.08 $52.08 $30.81 $52.08 $52.08 $52.08 $52.08 $39.38 $52.08 $52.08 $52.08 $26.04 $26.04 $41.25 $52.08 $41.66 $33.85 $10.34 N/A $30.45 $52.08 $52.08 $52.08 $10.85 $52.08 N/A N/A G14686 SUP HCPCS C1758 G14686 - GUIDEWIRE VASC .035IN 145CM CNS BNTSN MOV COR DSGN FLXB BOTH IP/OP $27.50 $20.00 $5.46 $27.50 $14.93 $14.93 $14.93 $14.93 $27.50 $27.50 $27.50 $5.73 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $27.50 $16.27 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $5.46 N/A $15.95 $27.50 $16.50 $27.50 $5.73 $27.50 N/A N/A G14687 SUP HCPCS C1758 G14687 - CATHETER URET 4FR 70CM RND TIP STY RT BOTH IP/OP $27.50 $20.00 $5.46 $27.50 $14.93 $14.93 $14.93 $14.93 $27.50 $27.50 $27.50 $5.73 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $27.50 $16.27 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $5.46 N/A $15.95 $27.50 $27.50 $27.50 $5.73 $27.50 N/A N/A G14688 SUP HCPCS C1894 G14688 - CATHETER URET 5FR 70CM RND TIP STY LT BOTH IP/OP $87.00 $64.00 $17.25 $86.90 $47.19 $47.19 $47.19 $47.19 $86.90 $86.90 $86.90 $18.11 $86.90 $64.50 $64.50 $66.98 $45.27 $18.11 $86.90 $86.90 $51.40 $86.90 $86.90 $86.90 $86.90 $65.25 $86.90 $86.90 $86.90 $43.45 $43.45 $68.82 $86.90 $69.52 $56.49 $17.25 N/A $50.46 $86.90 $86.90 $86.90 $18.11 $86.90 N/A N/A G14693 SUP HCPCS C1769 G14693 - STRAINER SPEC NS STON DISP BOTH IP/OP $1.50 $1.00 $0.28 $1.40 $0.76 $0.76 $0.76 $0.76 $1.40 $1.40 $1.40 $0.29 $1.40 $1.04 $1.04 $1.08 $0.73 $0.29 $1.40 $1.40 $0.83 $1.40 $1.40 $1.40 $1.40 $1.13 $1.40 $1.40 $1.40 $0.70 $0.70 $1.11 $1.40 $1.12 $0.91 $0.28 N/A $0.87 $1.40 $1.40 $1.40 $0.29 $1.40 N/A N/A G14694 SUP HCPCS C1729 G14694 - GUIDEWIRE VASC .035IN 145CM 8CM AMPTZ FLX TP XSTIF SS BOTH IP/OP $188.50 $139.00 $37.33 $188.10 $102.14 $102.14 $102.14 $102.14 $188.10 $188.10 $188.10 $39.20 $188.10 $139.61 $139.61 $144.99 $98.00 $39.20 $188.10 $188.10 $111.26 $188.10 $188.10 $188.10 $188.10 $141.38 $188.10 $188.10 $188.10 $94.05 $94.05 $148.98 $188.10 $150.48 $122.27 $37.33 N/A $109.33 $188.10 $188.10 $188.10 $39.20 $188.10 N/A N/A G14700 SUP HCPCS C2617 G14700 - CATHETER NPHSTM 8.2FR 19.5CM STRL LTX COPE LOOP CNN PERC BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $156.83 $261.38 $54.47 $261.38 N/A N/A G14705 SUP HCPCS C1729 G14705 - SET STNT .025IN SM 2 PGTL CRV STRG 3.7FR 14CM GRN STRL 70CM BOTH IP/OP $188.50 $139.00 $37.33 $188.10 $102.14 $102.14 $102.14 $102.14 $188.10 $188.10 $188.10 $39.20 $188.10 $139.61 $139.61 $144.99 $98.00 $39.20 $188.10 $188.10 $111.26 $188.10 $188.10 $188.10 $188.10 $141.38 $188.10 $188.10 $188.10 $94.05 $94.05 $148.98 $188.10 $150.48 $122.27 $37.33 N/A $109.33 $188.10 $188.10 $188.10 $39.20 $188.10 N/A N/A G14706 SUP HCPCS C1758 G14706 - SET NPHSTM 12FR 19.5CM CK CNN GW COPE TY LOOP BOTH IP/OP $33.00 $24.00 $6.53 $32.90 $17.86 $17.86 $17.86 $17.86 $32.90 $32.90 $32.90 $6.86 $32.90 $24.42 $24.42 $25.36 $17.14 $6.86 $32.90 $32.90 $19.46 $32.90 $32.90 $32.90 $32.90 $24.75 $32.90 $32.90 $32.90 $16.45 $16.45 $26.06 $32.90 $26.32 $21.39 $6.53 N/A $19.14 $32.90 $32.90 $32.90 $6.86 $32.90 N/A N/A G14714 SUP HCPCS C1729 G14714 - CATHETER URET 6FR 70CM ANG TIP TPR END BOTH IP/OP $405.00 $300.00 $80.34 $404.80 $219.81 $219.81 $219.81 $219.81 $404.80 $404.80 $404.80 $84.37 $404.80 $300.44 $300.44 $312.02 $210.90 $84.36 $404.80 $404.80 $239.44 $404.80 $404.80 $404.80 $404.80 $303.75 $404.80 $404.80 $404.80 $202.40 $202.40 $320.60 $404.80 $323.84 $263.12 $80.34 N/A $234.90 $404.80 $404.80 $404.80 $84.36 $404.80 N/A N/A G14717 SUP HCPCS C1758 G14717 - SET NPHSTM THNWL 12FR 21GA 19.5CM STRL 15CM COPE LOOP 1 WY BOTH IP/OP $29.00 $21.00 $5.68 $28.60 $15.53 $15.53 $15.53 $15.53 $28.60 $28.60 $28.60 $5.96 $28.60 $21.23 $21.23 $22.04 $14.90 $5.96 $28.60 $28.60 $16.92 $28.60 $28.60 $28.60 $28.60 $21.75 $28.60 $28.60 $28.60 $14.30 $14.30 $22.65 $28.60 $22.88 $18.59 $5.68 N/A $16.82 $28.60 $28.60 $28.60 $5.96 $28.60 N/A N/A G14731 SUP HCPCS C1769 G14731 - CATHETER URET 4.8FR 8FR 70CM CONE TIP OP-EN BOTH IP/OP $3.50 $3.00 $0.67 $3.38 $1.84 $1.84 $1.84 $1.84 $3.38 $3.38 $3.38 $0.70 $3.38 $2.51 $2.51 $2.61 $1.76 $0.70 $3.38 $3.38 $2.00 $3.38 $3.38 $3.38 $3.38 $2.63 $3.38 $3.38 $3.38 $1.69 $1.69 $2.68 $3.38 $2.70 $2.20 $0.67 N/A $2.03 $3.38 $3.38 $3.38 $0.70 $3.38 N/A N/A G14732 SUP Custom 27203010 G14732 - GUIDEWIRE URO STD STRG .038IN 145CM STRL LF 3CM FX COR FLX BOTH IP/OP $61.50 $46.00 $10.90 $61.25 $61.25 $61.25 $61.25 $61.25 $61.25 $61.25 $10.90 $61.25 $61.25 $45.46 $45.46 $47.21 $31.91 $12.77 $61.25 $24.50 $61.25 $61.25 $61.25 $61.25 $61.25 $46.13 $61.25 $61.25 $61.25 $30.63 $30.63 $48.51 $61.25 $49.00 $39.81 $61.25 N/A $35.67 $61.25 $36.75 $61.25 $61.25 $61.25 N/A N/A G14738 SUP HCPCS C1758 G14738 - ADAPTER CATH Y 3-6FR M LL SDARM T-B BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G14742 SUP HCPCS C2617 G14742 - FILIFORM URTH 7FR 10IN MLBL TIP THRD BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14744 SUP Custom 27203010 G14744 - SET STNT .035IN 70CM SM 2 PGTL CRV STRG 3.7FR 24CM GRN STRL BOTH IP/OP $367.00 $272.00 $65.30 $366.85 $366.85 $366.85 $366.85 $366.85 $366.85 $366.85 $65.30 $366.85 $366.85 $272.28 $272.28 $282.77 $191.13 $76.46 $366.85 $146.74 $366.85 $366.85 $366.85 $366.85 $366.85 $275.25 $366.85 $366.85 $366.85 $183.43 $183.43 $290.55 $366.85 $293.48 $238.45 $366.85 N/A $212.86 $366.85 $220.11 $366.85 $366.85 $366.85 N/A N/A G14748 SUP Custom 27203010 G14748 - ADAPTER CATHETER 3-6FR FOLEY SIDEARM TUOHY-BORST STERILE BOTH IP/OP $51.00 $38.00 $9.01 $50.60 $50.60 $50.60 $50.60 $50.60 $50.60 $50.60 $9.01 $50.60 $50.60 $37.56 $37.56 $39.00 $26.36 $10.55 $50.60 $20.24 $50.60 $50.60 $50.60 $50.60 $50.60 $38.25 $50.60 $50.60 $50.60 $25.30 $25.30 $40.08 $50.60 $40.48 $32.89 $50.60 N/A $29.58 $50.60 $30.36 $50.60 $50.60 $50.60 N/A N/A G14772 SUP HCPCS C1729 G14772 - DISK RTNT 12FR STAB INDWL PERC CATH TIE BOTH IP/OP $186.00 $138.00 $36.90 $185.90 $100.94 $100.94 $100.94 $100.94 $185.90 $185.90 $185.90 $38.75 $185.90 $137.97 $137.97 $143.29 $96.85 $38.74 $185.90 $185.90 $109.96 $185.90 $185.90 $185.90 $185.90 $139.50 $185.90 $185.90 $185.90 $92.95 $92.95 $147.23 $185.90 $148.72 $120.84 $36.90 N/A $107.88 $185.90 $185.90 $185.90 $38.74 $185.90 N/A N/A G14779 SUP HCPCS C2625 G14779 - SET NPHSTM 7-12FR 30CM 20CM MLCT CATH STNT LL CNCT TUBE STY BOTH IP/OP $139.50 $103.00 $27.67 $139.40 $62.73 $62.73 $62.73 $62.73 $139.40 $139.40 $139.40 $29.05 $139.40 $139.40 $139.40 $139.40 $139.40 $29.05 $139.40 $139.40 $82.46 $139.40 $139.40 $139.40 $139.40 $104.63 $139.40 $139.40 $139.40 $69.70 $69.70 $110.40 $139.40 $111.52 $62.73 $27.67 N/A $80.91 $139.40 $139.40 $139.40 $29.05 $139.40 N/A N/A G14780 SUP HCPCS C2617 G14780 - SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100CM BNDR CATH BOTH IP/OP $139.50 $103.00 $27.67 $139.40 $62.73 $62.73 $62.73 $62.73 $139.40 $139.40 $139.40 $29.05 $139.40 $139.40 $139.40 $139.40 $139.40 $29.05 $139.40 $139.40 $82.46 $139.40 $139.40 $139.40 $139.40 $104.63 $139.40 $139.40 $139.40 $69.70 $69.70 $110.40 $139.40 $111.52 $62.73 $27.67 N/A $80.91 $139.40 $139.40 $139.40 $29.05 $139.40 N/A N/A G14782 SUP HCPCS C1769 G14782 - SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100CM BNDR CATH BOTH IP/OP $405.00 $300.00 $80.34 $404.80 $219.81 $219.81 $219.81 $219.81 $404.80 $404.80 $404.80 $84.37 $404.80 $300.44 $300.44 $312.02 $210.90 $84.36 $404.80 $404.80 $239.44 $404.80 $404.80 $404.80 $404.80 $303.75 $404.80 $404.80 $404.80 $202.40 $202.40 $320.60 $404.80 $323.84 $263.12 $80.34 N/A $234.90 $404.80 $404.80 $404.80 $84.36 $404.80 N/A N/A G14787 SUP HCPCS C2617 G14787 - DILATOR URET 7FR 6MM 65CM 4CM SET BLN RADOPQ GW BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14788 SUP HCPCS C2617 G14788 - SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 16CM STRL 145CM BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G14789 SUP HCPCS C2617 G14789 - SET STNT .038IN 40CM J 2 PGTL CRV STRG 10FR 10FR 26CM STRL BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G14790 SUP HCPCS C2617 G14790 - SET STNT .038IN 40CM J 2 PGTL CRV STRG 10FR 10FR 24CM STRL BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G14791 SUP HCPCS C2628 G14791 - CATHETER BLNOCC 5.3FR 75CM STRL REM ADPR RADOPQ SIL UPJ DISP BOTH IP/OP $319.00 $236.00 $63.31 $319.00 $173.22 $173.22 $173.22 $173.22 $319.00 $319.00 $319.00 $66.49 $319.00 $236.76 $236.76 $245.89 $166.20 $66.48 $319.00 $319.00 $188.69 $319.00 $319.00 $319.00 $319.00 $239.25 $319.00 $319.00 $319.00 $159.50 $159.50 $252.65 $319.00 $255.20 $207.35 $63.31 N/A $185.02 $319.00 $319.00 $319.00 $66.48 $319.00 N/A N/A G14794 SUP HCPCS C2617 G14794 - SET STNT .038IN 40CM J 2 PGTL CRV STRG 10FR 10FR 22CM STRL BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14796 SUP HCPCS C2627 G14796 - SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 8CM STRL 145CM BOTH IP/OP $37.00 $27.00 $7.28 $36.70 $19.93 $19.93 $19.93 $19.93 $36.70 $36.70 $36.70 $7.65 $36.70 $27.24 $27.24 $28.29 $19.12 $7.65 $36.70 $36.70 $21.71 $36.70 $36.70 $36.70 $36.70 $27.75 $36.70 $36.70 $36.70 $18.35 $18.35 $29.07 $36.70 $29.36 $23.86 $7.28 N/A $21.46 $36.70 $36.70 $36.70 $7.65 $36.70 N/A N/A G14798 SUP HCPCS C1758 G14798 - DILATOR URTH 11FR 20CM PE FSCA BOTH IP/OP $29.00 $21.00 $5.68 $28.60 $15.53 $15.53 $15.53 $15.53 $28.60 $28.60 $28.60 $5.96 $28.60 $21.23 $21.23 $22.04 $14.90 $5.96 $28.60 $28.60 $16.92 $28.60 $28.60 $28.60 $28.60 $21.75 $28.60 $28.60 $28.60 $14.30 $14.30 $22.65 $28.60 $22.88 $18.59 $5.68 N/A $16.82 $28.60 $28.60 $28.60 $5.96 $28.60 N/A N/A G14799 SUP HCPCS C2617 G14799 - CATHETER URET 5FR 110CM FLXTP CLS END RT BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14803 SUP HCPCS C1758 G14803 - SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 18CM STRL 145CM BOTH IP/OP $124.00 $92.00 $24.58 $123.83 $67.24 $67.24 $67.24 $67.24 $123.83 $123.83 $123.83 $25.81 $123.83 $91.91 $91.91 $95.45 $64.52 $25.81 $123.83 $123.83 $73.25 $123.83 $123.83 $123.83 $123.83 $93.00 $123.83 $123.83 $123.83 $61.92 $61.92 $98.07 $123.83 $99.06 $80.49 $24.58 N/A $71.92 $123.83 $123.83 $123.83 $25.81 $123.83 N/A N/A G14804 SUP HCPCS C1758 G14804 - CATHETER URET .045IN PGTL CRV 8FR 70CM SDPRT GW RT BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G14808 SUP HCPCS C1758 G14808 - CATHETER URET .038IN 5FR 115CM OP-EN GW MOD BOTH IP/OP $276.50 $205.00 $54.83 $276.25 $150.00 $150.00 $150.00 $150.00 $276.25 $276.25 $276.25 $57.58 $276.25 $205.03 $205.03 $212.93 $143.93 $57.57 $276.25 $276.25 $163.40 $276.25 $276.25 $276.25 $276.25 $207.38 $276.25 $276.25 $276.25 $138.13 $138.13 $218.79 $276.25 $221.00 $179.56 $54.83 N/A $160.37 $276.25 $276.25 $276.25 $57.57 $276.25 N/A N/A G14809 SUP HCPCS C1758 G14809 - CATHETER URET STD 6FR 70CM FLXTP OP-EN FLX TP ACPT .038IN GW BOTH IP/OP $28.00 $21.00 $5.48 $27.63 $15.00 $15.00 $15.00 $15.00 $27.63 $27.63 $27.63 $5.76 $27.63 $20.51 $20.51 $21.30 $14.40 $5.76 $27.63 $27.63 $16.34 $27.63 $27.63 $27.63 $27.63 $21.00 $27.63 $27.63 $27.63 $13.82 $13.82 $21.88 $27.63 $22.10 $17.96 $5.48 N/A $16.24 $27.63 $27.63 $27.63 $5.76 $27.63 N/A N/A G14822 SUP HCPCS C2625 G14822 - CATHETER URET 3FR 70CM OP-EN ACPT .018IN GW BOTH IP/OP $139.50 $103.00 $27.67 $139.40 $62.73 $62.73 $62.73 $62.73 $139.40 $139.40 $139.40 $29.05 $139.40 $139.40 $139.40 $139.40 $139.40 $29.05 $139.40 $139.40 $82.46 $139.40 $139.40 $139.40 $139.40 $104.63 $139.40 $139.40 $139.40 $69.70 $69.70 $110.40 $139.40 $111.52 $62.73 $27.67 N/A $80.91 $139.40 $139.40 $139.40 $29.05 $139.40 N/A N/A G14823 SUP HCPCS C2625 G14823 - SET STNT .038IN 5MM PGTL CRV 7FR 70CM WHT STRL 145CM BNDR BOTH IP/OP $139.50 $103.00 $27.67 $139.40 $62.73 $62.73 $62.73 $62.73 $139.40 $139.40 $139.40 $29.05 $139.40 $139.40 $139.40 $139.40 $139.40 $29.05 $139.40 $139.40 $82.46 $139.40 $139.40 $139.40 $139.40 $104.63 $139.40 $139.40 $139.40 $69.70 $69.70 $110.40 $139.40 $111.52 $62.73 $27.67 N/A $80.91 $139.40 $139.40 $139.40 $29.05 $139.40 N/A N/A G14832 SUP HCPCS C2617 G14832 - SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 4FR 12CM STRL CP BOTH IP/OP $253.50 $188.00 $50.26 $253.25 $113.96 $113.96 $113.96 $113.96 $253.25 $253.25 $253.25 $52.78 $253.25 $253.25 $253.25 $253.25 $253.25 $52.78 $253.25 $253.25 $149.80 $253.25 $253.25 $253.25 $253.25 $190.13 $253.25 $253.25 $253.25 $126.63 $126.63 $200.57 $253.25 $202.60 $113.96 $50.26 N/A $147.03 $253.25 $253.25 $253.25 $52.78 $253.25 N/A N/A G14834 SUP HCPCS C2617 G14834 - SET STNT .038IN 5MM PGTL CRV 7FR 70CM WHT STRL 145CM BNDR BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14836 SUP HCPCS C2625 G14836 - SET STNT SM 2 PGTL CRV 3.7FR AST LGTH STRL CATH RADOPQ PSTNR BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14837 SUP HCPCS C2625 G14837 - SET STNT .038IN 3CM 40CM 70CM 6FR 22-32CM STRL 145CM KWART BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14840 SUP HCPCS C2617 G14840 - SET STNT .038IN 3CM 40CM 70CM .038IN 7FR 22-32CM STRL 145CM BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G14843 SUP HCPCS C2617 G14843 - SET STNT .018IN SM 2 PGTL CRV 4.7FR 4FR 16CM STRL CP MDRL BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G14844 SUP HCPCS C2625 G14844 - SET STNT .038IN 40CM 2 PGTL CRV STRG 12FR 12FR 26CM STRL 145 BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14854 SUP HCPCS C2617 G14854 - SET STNT .038IN 8.2FR 22-32CM STRL KWART RETRO-INJ STNT BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G14857 SUP HCPCS C1758 G14857 - SET STNT .038IN 40CM 2 PGTL CRV STRG 12FR 12FR 24CM STRL 145 BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G14859 SUP HCPCS C2627 G14859 - CATHETER URET .038IN 5FR 95CM OP-EN GW MOD BOTH IP/OP $66.50 $49.00 $13.18 $66.43 $36.07 $36.07 $36.07 $36.07 $66.43 $66.43 $66.43 $13.85 $66.43 $49.30 $49.30 $51.20 $34.61 $13.84 $66.43 $66.43 $39.29 $66.43 $66.43 $66.43 $66.43 $49.88 $66.43 $66.43 $66.43 $33.22 $33.22 $52.61 $66.43 $53.14 $43.18 $13.18 N/A $38.57 $66.43 $66.43 $66.43 $13.84 $66.43 N/A N/A G14861 SUP HCPCS C2627 G14861 - DILATOR URTH 26FR 20CM PE FSCA BOTH IP/OP $66.50 $49.00 $13.18 $66.43 $36.07 $36.07 $36.07 $36.07 $66.43 $66.43 $66.43 $13.85 $66.43 $49.30 $49.30 $51.20 $34.61 $13.84 $66.43 $66.43 $39.29 $66.43 $66.43 $66.43 $66.43 $49.88 $66.43 $66.43 $66.43 $33.22 $33.22 $52.61 $66.43 $53.14 $43.18 $13.18 N/A $38.57 $66.43 $66.43 $66.43 $13.84 $66.43 N/A N/A G14865 SUP HCPCS C2617 G14865 - DILATOR URTH 30FR 20CM PE FSCA BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G14866 SUP HCPCS C2617 G14866 - SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 16CM STRL CP MDRL BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G14867 SUP HCPCS C2617 G14867 - SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 14CM STRL CP MDRL BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G14870 SUP HCPCS C1758 G14870 - SET STNT .018IN SM 2 PGTL CRV 6FR 4FR 12CM STRL CP MDRL BOTH IP/OP $37.00 $27.00 $7.28 $36.70 $19.93 $19.93 $19.93 $19.93 $36.70 $36.70 $36.70 $7.65 $36.70 $27.24 $27.24 $28.29 $19.12 $7.65 $36.70 $36.70 $21.71 $36.70 $36.70 $36.70 $36.70 $27.75 $36.70 $36.70 $36.70 $18.35 $18.35 $29.07 $36.70 $29.36 $23.86 $7.28 N/A $21.46 $36.70 $36.70 $36.70 $7.65 $36.70 N/A N/A G14873 SUP HCPCS C1758 G14873 - CATHETER URET 3.8FR 70CM LSR BOTH IP/OP $276.50 $205.00 $54.83 $276.25 $150.00 $150.00 $150.00 $150.00 $276.25 $276.25 $276.25 $57.58 $276.25 $205.03 $205.03 $212.93 $143.93 $57.57 $276.25 $276.25 $163.40 $276.25 $276.25 $276.25 $276.25 $207.38 $276.25 $276.25 $276.25 $138.13 $138.13 $218.79 $276.25 $221.00 $179.56 $54.83 N/A $160.37 $276.25 $276.25 $276.25 $57.57 $276.25 N/A N/A G14885 SUP HCPCS C2625 G14885 - SET STNT 3CM 6FR 22CM STRL 145CM KWART RETRO-INJ RADOPQ BOTH IP/OP $301.00 $223.00 $59.66 $300.60 $135.27 $135.27 $135.27 $135.27 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $177.80 $300.60 $300.60 $300.60 $300.60 $225.75 $300.60 $300.60 $300.60 $150.30 $150.30 $238.08 $300.60 $240.48 $135.27 $59.66 N/A $174.58 $300.60 $300.60 $300.60 $62.65 $300.60 N/A N/A G14886 SUP HCPCS C2625 G14886 - CATHETER URET 5FR 70CM SPRL TIP SDPRT ACC ACPT .038IN GW BOTH IP/OP $26.50 $20.00 $5.19 $26.14 $11.76 $11.76 $11.76 $11.76 $26.14 $26.14 $26.14 $5.45 $26.14 $26.14 $26.14 $26.14 $26.14 $5.45 $26.14 $26.14 $15.46 $26.14 $26.14 $26.14 $26.14 $19.88 $26.14 $26.14 $26.14 $13.07 $13.07 $20.70 $26.14 $20.91 $11.76 $5.19 N/A $15.37 $26.14 $26.14 $26.14 $5.45 $26.14 N/A N/A G14887 SUP HCPCS C2625 G14887 - SET STNT .038IN 2 PGTL CRV 6FR 26CM STRL KWART RETRO-INJ BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14890 SUP HCPCS C1758 G14890 - SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 6FR 24CM STRL 145 BOTH IP/OP $37.00 $27.00 $7.28 $36.70 $19.93 $19.93 $19.93 $19.93 $36.70 $36.70 $36.70 $7.65 $36.70 $27.24 $27.24 $28.29 $19.12 $7.65 $36.70 $36.70 $21.71 $36.70 $36.70 $36.70 $36.70 $27.75 $36.70 $36.70 $36.70 $18.35 $18.35 $29.07 $36.70 $29.36 $23.86 $7.28 N/A $21.46 $36.70 $36.70 $36.70 $7.65 $36.70 N/A N/A G14891 SUP HCPCS C2627 G14891 - SET CATH 16FR 25CM LTX STM MLCT LOOP NDL OBT CNCT TUBE SPBC BOTH IP/OP $96.00 $71.00 $18.98 $95.63 $51.93 $51.93 $51.93 $51.93 $95.63 $95.63 $95.63 $19.93 $95.63 $70.98 $70.98 $73.71 $49.82 $19.93 $95.63 $95.63 $56.57 $95.63 $95.63 $95.63 $95.63 $72.00 $95.63 $95.63 $95.63 $47.82 $47.82 $75.74 $95.63 $76.50 $62.16 $18.98 N/A $55.68 $95.63 $95.63 $95.63 $19.93 $95.63 N/A N/A G14893 SUP HCPCS C1894 G14893 - CATHETER URET 3FR 70CM LSR ACPT .010IN GW BOTH IP/OP $451.00 $334.00 $89.51 $451.00 $244.89 $244.89 $244.89 $244.89 $451.00 $451.00 $451.00 $94.00 $451.00 $334.73 $334.73 $347.63 $234.97 $93.99 $451.00 $451.00 $266.77 $451.00 $451.00 $451.00 $451.00 $338.25 $451.00 $451.00 $451.00 $225.50 $225.50 $357.19 $451.00 $360.80 $293.15 $89.51 N/A $261.58 $451.00 $451.00 $451.00 $93.99 $451.00 N/A N/A G14897 SUP HCPCS C2617 G14897 - DILATOR URTH RING 8-26FR 50CM LTX RADOPQ PTFE TRQ GW RADOPQ BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14898 SUP HCPCS C2617 G14898 - SET STNT 50CM 70CM SM 2 PGTL CRV STRG 3.7FR 22CM STRL 145CM BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G14900 SUP Custom 27203010 G14900 - SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 4FR 14CM STRL CP BOTH IP/OP $27.00 $20.00 $4.73 $26.58 $26.58 $26.58 $26.58 $26.58 $26.58 $26.58 $4.73 $26.58 $26.58 $19.73 $19.73 $20.49 $13.85 $5.54 $26.58 $10.63 $26.58 $26.58 $26.58 $26.58 $26.58 $20.25 $26.58 $26.58 $26.58 $13.29 $13.29 $21.05 $26.58 $21.26 $17.28 $26.58 N/A $15.66 $26.58 $15.95 $26.58 $26.58 $26.58 N/A N/A G14905 SUP HCPCS C2625 G14905 - DEVICE SCR 16FR STRL RTNT DISK SIL DISP ACPT 16FR BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14906 SUP HCPCS C2617 G14906 - SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 10CM STRL RADOPQ BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G14910 SUP HCPCS C2625 G14910 - SET STNT .038IN 2 PGTL CRV 6FR 28CM STRL KWART RETRO-INJ BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14911 SUP HCPCS C2625 G14911 - SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 7FR 26CM STRL 145 BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14912 SUP HCPCS C2625 G14912 - SET STNT .038IN 40CM 70CM 2 PGTL CRV 7FR 24CM STRL 145CM BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14916 SUP HCPCS C2625 G14916 - SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 7FR 28CM STRL 145 BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14917 SUP HCPCS C1729 G14917 - SET STNT .038IN 3CM 40CM 70CM STRG 4.7FR 22-32CM STRL 145CM BOTH IP/OP $405.00 $300.00 $80.34 $404.80 $219.81 $219.81 $219.81 $219.81 $404.80 $404.80 $404.80 $84.37 $404.80 $300.44 $300.44 $312.02 $210.90 $84.36 $404.80 $404.80 $239.44 $404.80 $404.80 $404.80 $404.80 $303.75 $404.80 $404.80 $404.80 $202.40 $202.40 $320.60 $404.80 $323.84 $263.12 $80.34 N/A $234.90 $404.80 $404.80 $404.80 $84.36 $404.80 N/A N/A G14919 SUP Custom 27203010 G14919 - SET NPHSTM .038IN THNWL CRV 14FR 19.5CM STRL 30CM COPE LOOP BOTH IP/OP $186.00 $138.00 $33.04 $185.60 $185.60 $185.60 $185.60 $185.60 $185.60 $185.60 $33.04 $185.60 $185.60 $137.75 $137.75 $143.06 $96.70 $38.68 $185.60 $74.24 $185.60 $185.60 $185.60 $185.60 $185.60 $139.50 $185.60 $185.60 $185.60 $92.80 $92.80 $147.00 $185.60 $148.48 $120.64 $185.60 N/A $107.88 $185.60 $111.36 $185.60 $185.60 $185.60 N/A N/A G14920 SUP HCPCS C2627 G14920 - BRUSH CYTO 3.2FR 115CM BX SET STRG TIP OCL URET BOTH IP/OP $144.50 $107.00 $28.60 $144.10 $78.25 $78.25 $78.25 $78.25 $144.10 $144.10 $144.10 $30.03 $144.10 $106.95 $106.95 $111.07 $75.08 $30.03 $144.10 $144.10 $85.24 $144.10 $144.10 $144.10 $144.10 $108.38 $144.10 $144.10 $144.10 $72.05 $72.05 $114.13 $144.10 $115.28 $93.67 $28.60 N/A $83.81 $144.10 $144.10 $144.10 $30.03 $144.10 N/A N/A G14921 SUP HCPCS C1773 G14921 - GUIDEWIRE ESCP .035IN 145CM 3CM FLX TP STD BD SS URET BOTH IP/OP $665.00 $492.00 $131.90 $664.55 $360.85 $360.85 $360.85 $360.85 $664.55 $664.55 $664.55 $138.51 $664.55 $493.23 $493.23 $512.24 $346.23 $138.50 $664.55 $664.55 $393.08 $664.55 $664.55 $664.55 $664.55 $498.75 $664.55 $664.55 $664.55 $332.28 $332.28 $526.32 $664.55 $531.64 $431.96 $131.90 N/A $385.70 $664.55 $664.55 $664.55 $138.49 $664.55 N/A N/A G14922 SUP HCPCS C1773 G14922 - SET CATH 16FR 14FR 22CM 3CC LTX 30CM RTNR BLN NDL OBT CNCT BOTH IP/OP $665.00 $492.00 $131.90 $664.55 $360.85 $360.85 $360.85 $360.85 $664.55 $664.55 $664.55 $138.51 $664.55 $493.23 $493.23 $512.24 $346.23 $138.50 $664.55 $664.55 $393.08 $664.55 $664.55 $664.55 $664.55 $498.75 $664.55 $664.55 $664.55 $332.28 $332.28 $526.32 $664.55 $531.64 $431.96 $131.90 N/A $385.70 $664.55 $664.55 $664.55 $138.49 $664.55 N/A N/A G14925 SUP HCPCS C1758 G14925 - FORCEPS SPEC RTRVL 3.3FR 115CM STRL 1 JAW STON FLXB SHFT BOTH IP/OP $33.00 $24.00 $6.53 $32.90 $17.86 $17.86 $17.86 $17.86 $32.90 $32.90 $32.90 $6.86 $32.90 $24.42 $24.42 $25.36 $17.14 $6.86 $32.90 $32.90 $19.46 $32.90 $32.90 $32.90 $32.90 $24.75 $32.90 $32.90 $32.90 $16.45 $16.45 $26.06 $32.90 $26.32 $21.39 $6.53 N/A $19.14 $32.90 $32.90 $32.90 $6.86 $32.90 N/A N/A G14935 SUP HCPCS C1773 G14935 - CATHETER URET STD 8FR 70CM PLLK OP-EN FLX TP ACPT .038IN GW BOTH IP/OP $665.00 $492.00 $131.90 $664.55 $360.85 $360.85 $360.85 $360.85 $664.55 $664.55 $664.55 $138.51 $664.55 $493.23 $493.23 $512.24 $346.23 $138.50 $664.55 $664.55 $393.08 $664.55 $664.55 $664.55 $664.55 $498.75 $664.55 $664.55 $664.55 $332.28 $332.28 $526.32 $664.55 $531.64 $431.96 $131.90 N/A $385.70 $664.55 $664.55 $664.55 $138.49 $664.55 N/A N/A G14936 SUP HCPCS C1773 G14936 - FORCEPS SPEC RTRVL 3.3FR 65CM STRL LF ALGTR TTH FLXB SHFT BOTH IP/OP $764.50 $566.00 $151.68 $764.25 $414.99 $414.99 $414.99 $414.99 $764.25 $764.25 $764.25 $159.29 $764.25 $567.23 $567.23 $589.08 $398.17 $159.28 $764.25 $764.25 $452.05 $764.25 $764.25 $764.25 $764.25 $573.38 $764.25 $764.25 $764.25 $382.13 $382.13 $605.29 $764.25 $611.40 $496.76 $151.68 N/A $443.41 $764.25 $764.25 $764.25 $159.27 $764.25 N/A N/A G14938 SUP HCPCS C1758 G14938 - FORCEPS SPEC RTRVL 3.3FR 65CM 1 JAW RAT TTH URO BOTH IP/OP $29.00 $21.00 $5.68 $28.60 $15.53 $15.53 $15.53 $15.53 $28.60 $28.60 $28.60 $5.96 $28.60 $21.23 $21.23 $22.04 $14.90 $5.96 $28.60 $28.60 $16.92 $28.60 $28.60 $28.60 $28.60 $21.75 $28.60 $28.60 $28.60 $14.30 $14.30 $22.65 $28.60 $22.88 $18.59 $5.68 N/A $16.82 $28.60 $28.60 $28.60 $5.96 $28.60 N/A N/A G14941 SUP HCPCS C1758 G14941 - CATHETER URET .038IN 5FR 70CM PLLK OP-EN GW MOD FLX TP BOTH IP/OP $29.00 $21.00 $5.68 $28.60 $15.53 $15.53 $15.53 $15.53 $28.60 $28.60 $28.60 $5.96 $28.60 $21.23 $21.23 $22.04 $14.90 $5.96 $28.60 $28.60 $16.92 $28.60 $28.60 $28.60 $28.60 $21.75 $28.60 $28.60 $28.60 $14.30 $14.30 $22.65 $28.60 $22.88 $18.59 $5.68 N/A $16.82 $28.60 $28.60 $28.60 $5.96 $28.60 N/A N/A G14943 SUP HCPCS C2617 G14943 - CATHETER URET SPRL 6FR 70CM LG SDPRT ACPT .038IN GW BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G14951 SUP HCPCS C2617 G14951 - SET STNT .038IN 40CM 2 PGTL CRV STRG 12FR 22CM STRL 145CM BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G14952 SUP HCPCS C1758 G14952 - SET STNT .018IN SM 2 PGTL CRV CDE 7FR 4FR 12CM STRL CP MDRL BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G14955 SUP HCPCS C2625 G14955 - CATHETER URET 5FR 70CM WHSTLTP MOD BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G14975 SUP HCPCS C1769 G14975 - SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 4.7FR 24CM STRL BOTH IP/OP $70.00 $52.00 $13.89 $69.98 $38.00 $38.00 $38.00 $38.00 $69.98 $69.98 $69.98 $14.59 $69.98 $51.94 $51.94 $53.94 $36.46 $14.58 $69.98 $69.98 $41.39 $69.98 $69.98 $69.98 $69.98 $52.50 $69.98 $69.98 $69.98 $34.99 $34.99 $55.42 $69.98 $55.98 $45.49 $13.89 N/A $40.60 $69.98 $69.98 $69.98 $14.58 $69.98 N/A N/A G14980 SUP HCPCS C1758 G14980 - GUIDEWIRE URO .035IN 145CM 8CM AMPTZ STRG FLX TP SS BOTH IP/OP $109.50 $81.00 $21.73 $109.48 $59.45 $59.45 $59.45 $59.45 $109.48 $109.48 $109.48 $22.82 $109.48 $81.26 $81.26 $84.39 $57.04 $22.82 $109.48 $109.48 $64.76 $109.48 $109.48 $109.48 $109.48 $82.13 $109.48 $109.48 $109.48 $54.74 $54.74 $86.71 $109.48 $87.58 $71.16 $21.73 N/A $63.51 $109.48 $109.48 $109.48 $22.82 $109.48 N/A N/A G14991 SUP HCPCS C2617 G14991 - SET CATH .038IN PGTL CRV 7FR 90CM STRL 145CM PSTNR SDPRT GW BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G14992 SUP HCPCS C2617 G14992 - SET STNT .038IN 40CM 2 PGTL CRV STRG 10FR 28CM STRL 145CM BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G15000 SUP HCPCS C2617 G15000 - SET STNT .038IN 40CM 2 PGTL CRV STRG 10FR 20CM STRL 145CM BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G15003 SUP HCPCS C2617 G15003 - SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 8CM STRL CP MDRL BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G15010 SUP Custom 27203010 G15010 - SET NEPHROSTOMY 8FR 8.5FR 80CM 50CM RTRGRD PLACEMENT URETER BOTH IP/OP $104.00 $77.00 $18.43 $103.53 $103.53 $103.53 $103.53 $103.53 $103.53 $103.53 $18.43 $103.53 $103.53 $76.84 $76.84 $79.80 $53.94 $21.58 $103.53 $41.41 $103.53 $103.53 $103.53 $103.53 $103.53 $78.00 $103.53 $103.53 $103.53 $51.77 $51.77 $82.00 $103.53 $82.82 $67.29 $103.53 N/A $60.32 $103.53 $62.12 $103.53 $103.53 $103.53 N/A N/A G15015 SUP HCPCS C2625 G15015 - SET STNT .018IN SM 2 PGTL CRV CDE 6FR 4FR 10CM STRL CP MDRL BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G15016 SUP HCPCS C2625 G15016 - SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 8.2FR 24CM STRL BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G15020 SUP HCPCS C1758 G15020 - SET STNT .038IN 40CM 70CM 2 PGTL CRV STRG 4.7FR 26CM STRL BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G15030 SUP Custom 27203010 G15030 - CATHETER URET 3FR 115CM LSR FBR HNDL BOTH IP/OP $59.50 $44.00 $10.57 $59.40 $59.40 $59.40 $59.40 $59.40 $59.40 $59.40 $10.57 $59.40 $59.40 $44.09 $44.09 $45.79 $30.95 $12.38 $59.40 $23.76 $59.40 $59.40 $59.40 $59.40 $59.40 $44.63 $59.40 $59.40 $59.40 $29.70 $29.70 $47.04 $59.40 $47.52 $38.61 $59.40 N/A $34.51 $59.40 $35.64 $59.40 $59.40 $59.40 N/A N/A G15034 SUP HCPCS C1729 G15034 - ADAPTER CATH 14FR 15CM GOLDBERG FL DRN BG URET BOTH IP/OP $156.00 $115.00 $30.88 $155.60 $84.49 $84.49 $84.49 $84.49 $155.60 $155.60 $155.60 $32.43 $155.60 $115.49 $115.49 $119.94 $81.07 $32.43 $155.60 $155.60 $92.04 $155.60 $155.60 $155.60 $155.60 $117.00 $155.60 $155.60 $155.60 $77.80 $77.80 $123.24 $155.60 $124.48 $101.14 $30.88 N/A $90.48 $155.60 $155.60 $155.60 $32.43 $155.60 N/A N/A G15035 SUP HCPCS C1729 G15035 - SET NPHSTM PGTL CRV 8.2FR 15CM 5CM MOD CATH STNT CNCT TUBE BOTH IP/OP $156.00 $115.00 $30.88 $155.60 $84.49 $84.49 $84.49 $84.49 $155.60 $155.60 $155.60 $32.43 $155.60 $115.49 $115.49 $119.94 $81.07 $32.43 $155.60 $155.60 $92.04 $155.60 $155.60 $155.60 $155.60 $117.00 $155.60 $155.60 $155.60 $77.80 $77.80 $123.24 $155.60 $124.48 $101.14 $30.88 N/A $90.48 $155.60 $155.60 $155.60 $32.43 $155.60 N/A N/A G15037 SUP HCPCS C1758 G15037 - SET NPHSTM PGTL CRV 8.2FR 15CM 7CM MOD CATH STNT CNCT TUBE BOTH IP/OP $33.00 $24.00 $6.53 $32.90 $17.86 $17.86 $17.86 $17.86 $32.90 $32.90 $32.90 $6.86 $32.90 $24.42 $24.42 $25.36 $17.14 $6.86 $32.90 $32.90 $19.46 $32.90 $32.90 $32.90 $32.90 $24.75 $32.90 $32.90 $32.90 $16.45 $16.45 $26.06 $32.90 $26.32 $21.39 $6.53 N/A $19.14 $32.90 $32.90 $32.90 $6.86 $32.90 N/A N/A G15038 SUP HCPCS C2617 G15038 - CATHETER URET .038IN 5FR 115CM PLLK OP-EN GW MOD FLX TP BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G15040 SUP HCPCS C1758 G15040 - SET STNT .038IN 2 PGTL CRV CDE 7FR 10CM STRL RADOPQ GW SFLX BOTH IP/OP $276.50 $205.00 $54.83 $276.25 $150.00 $150.00 $150.00 $150.00 $276.25 $276.25 $276.25 $57.58 $276.25 $205.03 $205.03 $212.93 $143.93 $57.57 $276.25 $276.25 $163.40 $276.25 $276.25 $276.25 $276.25 $207.38 $276.25 $276.25 $276.25 $138.13 $138.13 $218.79 $276.25 $221.00 $179.56 $54.83 N/A $160.37 $276.25 $276.25 $276.25 $57.57 $276.25 N/A N/A G15042 SUP HCPCS C2617 G15042 - CATHETER URET STD 4FR 70CM LF FLXTP PLCK OP-EN ACPT .028IN BOTH IP/OP $7.00 $5.00 $1.32 $6.66 $3.00 $3.00 $3.00 $3.00 $6.66 $6.66 $6.66 $1.39 $6.66 $6.66 $6.66 $6.66 $6.66 $1.39 $6.66 $6.66 $3.94 $6.66 $6.66 $6.66 $6.66 $5.25 $6.66 $6.66 $6.66 $3.33 $3.33 $5.27 $6.66 $5.33 $3.00 $1.32 N/A $4.06 $6.66 $6.66 $6.66 $1.39 $6.66 N/A N/A G15045 SUP Custom 27203010 G15045 - STENT URTH 10FR 30CM STRL FRLT KLG SUT BLB SIL DISP BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 N/A $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A G15047 SUP HCPCS C2617 G15047 - SET BX 3.2FR 115CM BRSH DFLC RADOPQ URET BOTH IP/OP $67.00 $50.00 $13.22 $66.63 $29.98 $29.98 $29.98 $29.98 $66.63 $66.63 $66.63 $13.89 $66.63 $66.63 $66.63 $66.63 $66.63 $13.89 $66.63 $66.63 $39.41 $66.63 $66.63 $66.63 $66.63 $50.25 $66.63 $66.63 $66.63 $33.32 $33.32 $52.77 $66.63 $53.30 $29.98 $13.22 N/A $38.86 $66.63 $66.63 $66.63 $13.89 $66.63 N/A N/A G15049 SUP HCPCS C2617 G15049 - STENT URTH 8FR 30CM STRL FRLT KLG SIL DISP HYPOSPADIAS BOTH IP/OP $67.00 $50.00 $13.22 $66.63 $29.98 $29.98 $29.98 $29.98 $66.63 $66.63 $66.63 $13.89 $66.63 $66.63 $66.63 $66.63 $66.63 $13.89 $66.63 $66.63 $39.41 $66.63 $66.63 $66.63 $66.63 $50.25 $66.63 $66.63 $66.63 $33.32 $33.32 $52.77 $66.63 $53.30 $29.98 $13.22 N/A $38.86 $66.63 $66.63 $66.63 $13.89 $66.63 N/A N/A G15050 SUP HCPCS C2617 G15050 - STENT URTH 8FR 12CM STRL ZAONTZ DISP HYPOSPADIAS EPISPADIAS BOTH IP/OP $67.00 $50.00 $13.22 $66.63 $29.98 $29.98 $29.98 $29.98 $66.63 $66.63 $66.63 $13.89 $66.63 $66.63 $66.63 $66.63 $66.63 $13.89 $66.63 $66.63 $39.41 $66.63 $66.63 $66.63 $66.63 $50.25 $66.63 $66.63 $66.63 $33.32 $33.32 $52.77 $66.63 $53.30 $29.98 $13.22 N/A $38.86 $66.63 $66.63 $66.63 $13.89 $66.63 N/A N/A G15054 SUP Custom 27203010 G15054 - FORCEPS ENDSCP 3.3FR 115CM FLEXIBLE OVAL BIOP CUP TISSUE BOTH IP/OP $781.00 $578.00 $139.02 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $781.00 $139.02 $781.00 $781.00 $579.66 $579.66 $601.99 $406.90 $162.77 $781.00 $312.40 $781.00 $781.00 $781.00 $781.00 $781.00 $585.75 $781.00 $781.00 $781.00 $390.50 $390.50 $618.55 $781.00 $624.80 $507.65 $781.00 N/A $452.98 $781.00 $468.60 $781.00 $781.00 $781.00 N/A N/A G15056 SUP Custom 27203010 G15056 - STENT URTH 10FR 12CM STRL ZAONTZ DISP HYPOSPADIAS OR BOTH IP/OP $46.00 $34.00 $8.11 $45.55 $45.55 $45.55 $45.55 $45.55 $45.55 $45.55 $8.11 $45.55 $45.55 $33.81 $33.81 $35.11 $23.73 $9.49 $45.55 $18.22 $45.55 $45.55 $45.55 $45.55 $45.55 $34.50 $45.55 $45.55 $45.55 $22.78 $22.78 $36.08 $45.55 $36.44 $29.61 $45.55 N/A $26.68 $45.55 $27.33 $45.55 $45.55 $45.55 N/A N/A G15061 SUP HCPCS C1726 G15061 - CARRIER SUT 30D 16CM PEREYRA RAZ LGT REUSE BOTH IP/OP $385.00 $285.00 $76.41 $385.00 $209.06 $209.06 $209.06 $209.06 $385.00 $385.00 $385.00 $80.24 $385.00 $285.75 $285.75 $296.76 $200.59 $80.24 $385.00 $385.00 $227.73 $385.00 $385.00 $385.00 $385.00 $288.75 $385.00 $385.00 $385.00 $192.50 $192.50 $304.92 $385.00 $308.00 $250.25 $76.41 N/A $223.30 $385.00 $385.00 $385.00 $80.23 $385.00 N/A N/A G15062 SUP HCPCS C1726 G15062 - CATHETER URTH 7FR 30CM STRL M DISP BOTH IP/OP $443.00 $328.00 $87.87 $442.75 $240.41 $240.41 $240.41 $240.41 $442.75 $442.75 $442.75 $92.28 $442.75 $328.61 $328.61 $341.27 $230.67 $92.27 $442.75 $442.75 $261.89 $442.75 $442.75 $442.75 $442.75 $332.25 $442.75 $442.75 $442.75 $221.38 $221.38 $350.66 $442.75 $354.20 $287.79 $87.87 N/A $256.94 $442.75 $442.75 $442.75 $92.27 $442.75 N/A N/A G15067 SUP HCPCS C1769 G15067 - CATHETER BLNDIL SET F URET BOTH IP/OP $37.50 $28.00 $7.42 $37.40 $20.31 $20.31 $20.31 $20.31 $37.40 $37.40 $37.40 $7.80 $37.40 $27.76 $27.76 $28.83 $19.49 $7.79 $37.40 $37.40 $22.12 $37.40 $37.40 $37.40 $37.40 $28.13 $37.40 $37.40 $37.40 $18.70 $18.70 $29.62 $37.40 $29.92 $24.31 $7.42 N/A $21.75 $37.40 $37.40 $37.40 $7.79 $37.40 N/A N/A G15070 SUP HCPCS C2627 G15070 - GUIDEWIRE ESCP STRG STD .038IN 80CM STRL 3CM FLX TP FXCR SS BOTH IP/OP $144.50 $107.00 $28.60 $144.10 $78.25 $78.25 $78.25 $78.25 $144.10 $144.10 $144.10 $30.03 $144.10 $106.95 $106.95 $111.07 $75.08 $30.03 $144.10 $144.10 $85.24 $144.10 $144.10 $144.10 $144.10 $108.38 $144.10 $144.10 $144.10 $72.05 $72.05 $114.13 $144.10 $115.28 $93.67 $28.60 N/A $83.81 $144.10 $144.10 $144.10 $30.03 $144.10 N/A N/A G15076 SUP HCPCS C2617 G15076 - SET CATH 10FR 22CM 3ML STRL LTX 30CM RTNR BLN SS NDL OBT BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G15077 SUP HCPCS C2617 G15077 - SET DRN 8FR 6-10FR 30CM 20CM CATH DIL LOOP BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G15079 SUP HCPCS C1892 G15079 - SET STNT .018IN SM 2 PGTL CRV CDE 4.7FR 8CM STRL RADOPQ BOTH IP/OP $104.00 $77.00 $20.55 $103.53 $56.22 $56.22 $56.22 $56.22 $103.53 $103.53 $103.53 $21.58 $103.53 $76.84 $76.84 $79.80 $53.94 $21.58 $103.53 $103.53 $61.24 $103.53 $103.53 $103.53 $103.53 $78.00 $103.53 $103.53 $103.53 $51.77 $51.77 $82.00 $103.53 $82.82 $67.29 $20.55 N/A $60.32 $103.53 $103.53 $103.53 $21.58 $103.53 N/A N/A G15088 SUP HCPCS C2627 G15088 - CATHETER URO 8FR 8.5FR 88CM 30CM CK SET GW 810 STNT PLC BOTH IP/OP $42.00 $31.00 $8.30 $41.80 $22.70 $22.70 $22.70 $22.70 $41.80 $41.80 $41.80 $8.71 $41.80 $31.02 $31.02 $32.22 $21.78 $8.71 $41.80 $41.80 $24.72 $41.80 $41.80 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $27.17 $8.30 N/A $24.36 $41.80 $41.80 $41.80 $8.71 $41.80 N/A N/A G15089 SUP HCPCS C2627 G15089 - DILATOR URET 7FR 60CM SET PE BOTH IP/OP $187.00 $138.00 $37.11 $187.00 $101.54 $101.54 $101.54 $101.54 $187.00 $187.00 $187.00 $38.98 $187.00 $138.79 $138.79 $144.14 $97.43 $38.97 $187.00 $187.00 $110.61 $187.00 $187.00 $187.00 $187.00 $140.25 $187.00 $187.00 $187.00 $93.50 $93.50 $148.10 $187.00 $149.60 $121.55 $37.11 N/A $108.46 $187.00 $187.00 $187.00 $38.97 $187.00 N/A N/A G15093 SUP HCPCS C2617 G15093 - CATHETER SPBC 16FR 12CM OB PLWY ACC INTRO SET GW TROC NDL BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G15108 SUP Custom 27203010 G15108 - SET STNT .018IN 2 PGTL CRV CDE 7FR 16CM STRL RADOPQ PSTNR GW BOTH IP/OP $76.00 $56.00 $13.51 $75.90 $75.90 $75.90 $75.90 $75.90 $75.90 $75.90 $13.51 $75.90 $75.90 $56.33 $56.33 $58.50 $39.54 $15.82 $75.90 $30.36 $75.90 $75.90 $75.90 $75.90 $75.90 $57.00 $75.90 $75.90 $75.90 $37.95 $37.95 $60.11 $75.90 $60.72 $49.34 $75.90 N/A $44.08 $75.90 $45.54 $75.90 $75.90 $75.90 N/A N/A G15109 SUP Custom 27203010 G15109 - DILATOR URTH 8FR 35.5CM DIST TIP BOTH IP/OP $76.00 $56.00 $13.51 $75.90 $75.90 $75.90 $75.90 $75.90 $75.90 $75.90 $13.51 $75.90 $75.90 $56.33 $56.33 $58.50 $39.54 $15.82 $75.90 $30.36 $75.90 $75.90 $75.90 $75.90 $75.90 $57.00 $75.90 $75.90 $75.90 $37.95 $37.95 $60.11 $75.90 $60.72 $49.34 $75.90 N/A $44.08 $75.90 $45.54 $75.90 $75.90 $75.90 N/A N/A G15110 SUP Custom 27203010 G15110 - SET STENT .038IN PIGTAIL CURVE STR 6FR 125CM 145CM CATHETER BOTH IP/OP $110.00 $81.00 $19.52 $123.00 $109.68 $109.68 $109.68 $109.68 $109.68 $109.68 $19.52 $109.68 $109.68 $81.40 $81.40 $84.54 $57.14 $22.86 $109.68 $123.00 $109.68 $109.68 $109.68 $109.68 $109.68 $82.50 $109.68 $109.68 $109.68 $54.84 $54.84 $86.87 $109.68 $87.74 $71.29 $109.68 N/A $63.80 $109.68 $65.81 $109.68 $109.68 $109.68 N/A N/A G15116 SUP HCPCS C1758 G15116 - CATHETER URET 4FR 70CM WHSTLTP MOD BOTH IP/OP $33.00 $24.00 $6.53 $32.90 $17.86 $17.86 $17.86 $17.86 $32.90 $32.90 $32.90 $6.86 $32.90 $24.42 $24.42 $25.36 $17.14 $6.86 $32.90 $32.90 $19.46 $32.90 $32.90 $32.90 $32.90 $24.75 $32.90 $32.90 $32.90 $16.45 $16.45 $26.06 $32.90 $26.32 $21.39 $6.53 N/A $19.14 $32.90 $32.90 $32.90 $6.86 $32.90 N/A N/A G15120 SUP HCPCS C2617 G15120 - CATHETER URET 4FR 115CM FLXTP CLS END RT BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15121 SUP HCPCS C1758 G15121 - SET STNT .038IN 2 PGTL CRV 7FR 24CM BLK STRL 145CM RADOPQ BOTH IP/OP $83.50 $62.00 $16.57 $83.50 $45.34 $45.34 $45.34 $45.34 $83.50 $83.50 $83.50 $17.40 $83.50 $61.97 $61.97 $64.36 $43.50 $17.40 $83.50 $83.50 $49.39 $83.50 $83.50 $83.50 $83.50 $62.63 $83.50 $83.50 $83.50 $41.75 $41.75 $66.13 $83.50 $66.80 $54.28 $16.57 N/A $48.43 $83.50 $83.50 $83.50 $17.40 $83.50 N/A N/A G15123 SUP HCPCS C2617 G15123 - CATHETER URET 20D .035IN 7FR 70CM 145CM ANG TIP TPR END GW BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15124 SUP HCPCS C2617 G15124 - SET STNT .038IN 2 PGTL CRV FLFRM 7FR 22CM BLK STRL 145CM BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15125 SUP HCPCS C2617 G15125 - SET STNT .038IN 2 PGTL CRV 7FR 26CM BLK STRL 145CM RADOPQ BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15126 SUP HCPCS C2617 G15126 - SET STNT .038IN 2 PGTL CRV 7FR 28CM BLK STRL 145CM RADOPQ BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15127 SUP HCPCS C2617 G15127 - SET STNT .038IN 2 PGTL CRV STRG FLFRM 7FR 30CM BLK STRL 145 BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15128 SUP HCPCS C2617 G15128 - SET STNT .038IN 2 PGTL CRV STRG FLFRM 8.5FR 22CM BLK STRL BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15129 SUP HCPCS C2617 G15129 - SET STNT .038IN 2 PGTL CRV 8.5FR 24CM BLK STRL 145CM RADOPQ BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15130 SUP HCPCS C2617 G15130 - SET STNT .038IN 2 PGTL CRV 8.5FR 28CM BLK STRL 145CM RADOPQ BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15133 SUP Custom 27203010 G15133 - SET NPHSTM 500ML STRL 1 CNCT DRN PCH SFT ELC BELT REED VLV BOTH IP/OP $71.50 $53.00 $12.68 $71.25 $71.25 $71.25 $71.25 $71.25 $71.25 $71.25 $12.68 $71.25 $71.25 $52.88 $52.88 $54.92 $37.12 $14.85 $71.25 $28.50 $71.25 $71.25 $71.25 $71.25 $71.25 $53.63 $71.25 $71.25 $71.25 $35.63 $35.63 $56.43 $71.25 $57.00 $46.31 $71.25 N/A $41.47 $71.25 $42.75 $71.25 $71.25 $71.25 N/A N/A G15134 SUP Custom 27203010 G15134 - SET STNT .038IN 2 PGTL CRV STRG FLFRM 8.5FR 26CM BLK STRL BOTH IP/OP $71.50 $53.00 $12.68 $71.25 $71.25 $71.25 $71.25 $71.25 $71.25 $71.25 $12.68 $71.25 $71.25 $52.88 $52.88 $54.92 $37.12 $14.85 $71.25 $28.50 $71.25 $71.25 $71.25 $71.25 $71.25 $53.63 $71.25 $71.25 $71.25 $35.63 $35.63 $56.43 $71.25 $57.00 $46.31 $71.25 N/A $41.47 $71.25 $42.75 $71.25 $71.25 $71.25 N/A N/A G15136 SUP Custom 27203010 G15136 - SET NPHSTM 500ML STRL DRN PCH SFT ELC BELT REED VLV MECH BOTH IP/OP $71.50 $53.00 $12.68 $71.25 $71.25 $71.25 $71.25 $71.25 $71.25 $71.25 $12.68 $71.25 $71.25 $52.88 $52.88 $54.92 $37.12 $14.85 $71.25 $28.50 $71.25 $71.25 $71.25 $71.25 $71.25 $53.63 $71.25 $71.25 $71.25 $35.63 $35.63 $56.43 $71.25 $57.00 $46.31 $71.25 N/A $41.47 $71.25 $42.75 $71.25 $71.25 $71.25 N/A N/A G15137 SUP Custom 27203010 G15137 - SET NPHSTM 500ML NS CK 1 CNCT DRN PCH SFT ELC BELT DISP BOTH IP/OP $71.50 $53.00 $12.68 $71.25 $71.25 $71.25 $71.25 $71.25 $71.25 $71.25 $12.68 $71.25 $71.25 $52.88 $52.88 $54.92 $37.12 $14.85 $71.25 $28.50 $71.25 $71.25 $71.25 $71.25 $71.25 $53.63 $71.25 $71.25 $71.25 $35.63 $35.63 $56.43 $71.25 $57.00 $46.31 $71.25 N/A $41.47 $71.25 $42.75 $71.25 $71.25 $71.25 N/A N/A G15138 SUP HCPCS C2617 G15138 - SET NPHSTM 500ML NS 2 CNCT DRN PCH SFT ELC BELT REED VLV BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G15144 SUP HCPCS C2617 G15144 - SET STNT .018IN SM 2 PGTL CRV 7FR 14CM STRL RADOPQ PSTNR GW BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15145 SUP HCPCS C2617 G15145 - SET STNT .038IN 2 PGTL CRV FLFRM 6FR 22CM BLK STRL 145CM BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15146 SUP HCPCS C2617 G15146 - SET STNT .038IN 2 PGTL CRV FLFRM 6FR 24CM BLK STRL 145CM BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15147 SUP HCPCS C2617 G15147 - SET STNT .038IN 2 PGTL CRV FLFRM 6FR 26CM BLK STRL 145CM BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15148 SUP HCPCS C2617 G15148 - SET STNT .038IN 2 PGTL CRV 6FR 28CM BLK STRL 145CM RADOPQ BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15149 SUP HCPCS C2627 G15149 - SET STNT .038IN 2 PGTL CRV STRG FLFRM 6FR 30CM BLK STRL 145 BOTH IP/OP $138.00 $102.00 $27.37 $137.90 $74.88 $74.88 $74.88 $74.88 $137.90 $137.90 $137.90 $28.74 $137.90 $102.35 $102.35 $106.29 $71.85 $28.74 $137.90 $137.90 $81.57 $137.90 $137.90 $137.90 $137.90 $103.50 $137.90 $137.90 $137.90 $68.95 $68.95 $109.22 $137.90 $110.32 $89.64 $27.37 N/A $80.04 $137.90 $137.90 $137.90 $28.74 $137.90 N/A N/A G15150 SUP HCPCS C2617 G15150 - SET CATH LOOP 14FR 23CM BLU SFLX 1 WY STPCK NDL OBT CNCT BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G15167 SUP Custom 27203010 G15167 - DILATOR URTH 6-10FR MEATUS BOTH IP/OP $35.50 $26.00 $6.31 $35.43 $35.43 $35.43 $35.43 $35.43 $35.43 $35.43 $6.31 $35.43 $35.43 $26.30 $26.30 $27.31 $18.46 $7.38 $35.43 $14.17 $35.43 $35.43 $35.43 $35.43 $35.43 $26.63 $35.43 $35.43 $35.43 $17.72 $17.72 $28.06 $35.43 $28.34 $23.03 $35.43 N/A $20.59 $35.43 $21.26 $35.43 $35.43 $35.43 N/A N/A G15168 SUP HCPCS C2625 G15168 - CATHETER URO 8-14FR SPRT SFT LOPRFL NKNK CRV PERC BOTH IP/OP $141.50 $105.00 $28.07 $141.45 $63.65 $63.65 $63.65 $63.65 $141.45 $141.45 $141.45 $29.48 $141.45 $141.45 $141.45 $141.45 $141.45 $29.48 $141.45 $141.45 $83.67 $141.45 $141.45 $141.45 $141.45 $106.13 $141.45 $141.45 $141.45 $70.73 $70.73 $112.03 $141.45 $113.16 $63.65 $28.07 N/A $82.07 $141.45 $141.45 $141.45 $29.48 $141.45 N/A N/A G15170 SUP Custom 27203010 G15170 - SET NPHSTM PGTL CRV 8.2FR 125CM DRETLER STNT GW BOTH IP/OP $59.50 $44.00 $10.57 $59.40 $59.40 $59.40 $59.40 $59.40 $59.40 $59.40 $10.57 $59.40 $59.40 $44.09 $44.09 $45.79 $30.95 $12.38 $59.40 $23.76 $59.40 $59.40 $59.40 $59.40 $59.40 $44.63 $59.40 $59.40 $59.40 $29.70 $29.70 $47.04 $59.40 $47.52 $38.61 $59.40 N/A $34.51 $59.40 $35.64 $59.40 $59.40 $59.40 N/A N/A G15172 SUP HCPCS C1758 G15172 - CATHETER URTH 22-24FR RTNR FL TRC TEMP TRC BOTH IP/OP $32.00 $24.00 $6.28 $31.63 $17.18 $17.18 $17.18 $17.18 $31.63 $31.63 $31.63 $6.59 $31.63 $23.48 $23.48 $24.38 $16.48 $6.59 $31.63 $31.63 $18.71 $31.63 $31.63 $31.63 $31.63 $24.00 $31.63 $31.63 $31.63 $15.82 $15.82 $25.05 $31.63 $25.30 $20.56 $6.28 N/A $18.56 $31.63 $31.63 $31.63 $6.59 $31.63 N/A N/A G15193 SUP HCPCS C2617 G15193 - CATHETER URET 3FR 70CM RND TIP STY RT BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15195 SUP HCPCS C1758 G15195 - SET STNT .038IN 2 PGTL CRV STRG FLFRM 6FR 20CM BLK STRL 145 BOTH IP/OP $32.00 $24.00 $6.33 $31.90 $17.32 $17.32 $17.32 $17.32 $31.90 $31.90 $31.90 $6.65 $31.90 $23.68 $23.68 $24.59 $16.62 $6.65 $31.90 $31.90 $18.87 $31.90 $31.90 $31.90 $31.90 $24.00 $31.90 $31.90 $31.90 $15.95 $15.95 $25.26 $31.90 $25.52 $20.74 $6.33 N/A $18.56 $31.90 $31.90 $31.90 $6.65 $31.90 N/A N/A G15196 SUP HCPCS C2627 G15196 - CATHETER URET 2FR 115CM LSR ADPR BOTH IP/OP $257.00 $190.00 $50.97 $256.80 $139.44 $139.44 $139.44 $139.44 $256.80 $256.80 $256.80 $53.52 $256.80 $190.60 $190.60 $197.94 $133.79 $53.52 $256.80 $256.80 $151.90 $256.80 $256.80 $256.80 $256.80 $192.75 $256.80 $256.80 $256.80 $128.40 $128.40 $203.39 $256.80 $205.44 $166.92 $50.97 N/A $149.06 $256.80 $256.80 $256.80 $53.52 $256.80 N/A N/A G15211 SUP HCPCS C1773 G15211 - FOLLOWER URTH 10FR 35.5CM PHLPS DIL DIST TIP THRD WO SDPRT BOTH IP/OP $665.00 $492.00 $131.90 $664.55 $360.85 $360.85 $360.85 $360.85 $664.55 $664.55 $664.55 $138.51 $664.55 $493.23 $493.23 $512.24 $346.23 $138.50 $664.55 $664.55 $393.08 $664.55 $664.55 $664.55 $664.55 $498.75 $664.55 $664.55 $664.55 $332.28 $332.28 $526.32 $664.55 $531.64 $431.96 $131.90 N/A $385.70 $664.55 $664.55 $664.55 $138.49 $664.55 N/A N/A G15214 SUP HCPCS C1729 G15214 - FORCEPS SPEC RTRVL 3.3FR 115CM MS TTH FLXB SHFT BOTH IP/OP $188.50 $139.00 $37.33 $188.10 $102.14 $102.14 $102.14 $102.14 $188.10 $188.10 $188.10 $39.20 $188.10 $139.61 $139.61 $144.99 $98.00 $39.20 $188.10 $188.10 $111.26 $188.10 $188.10 $188.10 $188.10 $141.38 $188.10 $188.10 $188.10 $94.05 $94.05 $148.98 $188.10 $150.48 $122.27 $37.33 N/A $109.33 $188.10 $188.10 $188.10 $39.20 $188.10 N/A N/A G15216 SUP HCPCS C1758 G15216 - SET NPHSTM 14FR 19.5CM STRL LTX CK CATH CNN COPE LOOP NTR BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G15219 SUP Custom 27203010 G15219 - CATHETER URET .038IN 5FR 70CM OP-EN MOD BOTH IP/OP $25.50 $19.00 $4.50 $25.30 $25.30 $25.30 $25.30 $25.30 $25.30 $25.30 $4.50 $25.30 $25.30 $18.78 $18.78 $19.50 $13.18 $5.27 $25.30 $10.12 $25.30 $25.30 $25.30 $25.30 $25.30 $19.13 $25.30 $25.30 $25.30 $12.65 $12.65 $20.04 $25.30 $20.24 $16.45 $25.30 N/A $14.79 $25.30 $15.18 $25.30 $25.30 $25.30 N/A N/A G15221 SUP HCPCS C1892 G15221 - ADAPTER CATH 7-10FR T-B M LL LD TM BOTH IP/OP $137.00 $101.00 $27.12 $136.63 $74.19 $74.19 $74.19 $74.19 $136.63 $136.63 $136.63 $28.48 $136.63 $101.41 $101.41 $105.31 $71.18 $28.48 $136.63 $136.63 $80.82 $136.63 $136.63 $136.63 $136.63 $102.75 $136.63 $136.63 $136.63 $68.32 $68.32 $108.21 $136.63 $109.30 $88.81 $27.12 N/A $79.46 $136.63 $136.63 $136.63 $28.47 $136.63 N/A N/A G15223 SUP HCPCS C2625 G15223 - SET INTRO STD 20FR 37CM 32CM PLWY 2 KNOB SHTH GW BOTH IP/OP $160.50 $119.00 $31.82 $160.30 $72.14 $72.14 $72.14 $72.14 $160.30 $160.30 $160.30 $33.41 $160.30 $160.30 $160.30 $160.30 $160.30 $33.41 $160.30 $160.30 $94.82 $160.30 $160.30 $160.30 $160.30 $120.38 $160.30 $160.30 $160.30 $80.15 $80.15 $126.96 $160.30 $128.24 $72.14 $31.82 N/A $93.09 $160.30 $160.30 $160.30 $33.41 $160.30 N/A N/A G15224 SUP HCPCS C2625 G15224 - SET STNT .038IN 5MM PGTL CRV 6FR 75CM BLK STRL 100CM BNDR BOTH IP/OP $160.50 $119.00 $31.82 $160.30 $72.14 $72.14 $72.14 $72.14 $160.30 $160.30 $160.30 $33.41 $160.30 $160.30 $160.30 $160.30 $160.30 $33.41 $160.30 $160.30 $94.82 $160.30 $160.30 $160.30 $160.30 $120.38 $160.30 $160.30 $160.30 $80.15 $80.15 $126.96 $160.30 $128.24 $72.14 $31.82 N/A $93.09 $160.30 $160.30 $160.30 $33.41 $160.30 N/A N/A G15225 SUP HCPCS C1769 G15225 - SET STNT .038IN 5MM PGTL CRV 6FR 75CM BLK STRL 100CM BNDR BOTH IP/OP $39.00 $29.00 $7.72 $38.88 $21.11 $21.11 $21.11 $21.11 $38.88 $38.88 $38.88 $8.10 $38.88 $28.86 $28.86 $29.97 $20.26 $8.10 $38.88 $38.88 $23.00 $38.88 $38.88 $38.88 $38.88 $29.25 $38.88 $38.88 $38.88 $19.44 $19.44 $30.79 $38.88 $31.10 $25.27 $7.72 N/A $22.62 $38.88 $38.88 $38.88 $8.10 $38.88 N/A N/A G15227 SUP HCPCS C2625 G15227 - SET STNT 3CM 2 PGTL CRV 7FR 22CM STRL 145CM KWART RETRO-INJ BOTH IP/OP $301.00 $223.00 $59.66 $300.60 $135.27 $135.27 $135.27 $135.27 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $177.80 $300.60 $300.60 $300.60 $300.60 $225.75 $300.60 $300.60 $300.60 $150.30 $150.30 $238.08 $300.60 $240.48 $135.27 $59.66 N/A $174.58 $300.60 $300.60 $300.60 $62.65 $300.60 N/A N/A G15230 SUP HCPCS C1773 G15230 - FORCEPS SPEC RTRVL 5.2FR 65CM 1 JAW ALGTR TTH FLXB SHFT BOTH IP/OP $665.00 $492.00 $131.90 $664.55 $360.85 $360.85 $360.85 $360.85 $664.55 $664.55 $664.55 $138.51 $664.55 $493.23 $493.23 $512.24 $346.23 $138.50 $664.55 $664.55 $393.08 $664.55 $664.55 $664.55 $664.55 $498.75 $664.55 $664.55 $664.55 $332.28 $332.28 $526.32 $664.55 $531.64 $431.96 $131.90 N/A $385.70 $664.55 $664.55 $664.55 $138.49 $664.55 N/A N/A G15233 SUP HCPCS C2617 G15233 - GUIDEWIRE ESCP STD .035IN 145CM FXCR SS BOTH IP/OP $67.00 $50.00 $13.22 $66.63 $29.98 $29.98 $29.98 $29.98 $66.63 $66.63 $66.63 $13.89 $66.63 $66.63 $66.63 $66.63 $66.63 $13.89 $66.63 $66.63 $39.41 $66.63 $66.63 $66.63 $66.63 $50.25 $66.63 $66.63 $66.63 $33.32 $33.32 $52.77 $66.63 $53.30 $29.98 $13.22 N/A $38.86 $66.63 $66.63 $66.63 $13.89 $66.63 N/A N/A G15240 SUP HCPCS C1729 G15240 - TUBE CNCT 10FR 30CM M LL DRN BG BOTH IP/OP $151.00 $112.00 $29.88 $150.55 $81.75 $81.75 $81.75 $81.75 $150.55 $150.55 $150.55 $31.38 $150.55 $111.74 $111.74 $116.04 $78.44 $31.38 $150.55 $150.55 $89.05 $150.55 $150.55 $150.55 $150.55 $113.25 $150.55 $150.55 $150.55 $75.28 $75.28 $119.24 $150.55 $120.44 $97.86 $29.88 N/A $87.58 $150.55 $150.55 $150.55 $31.37 $150.55 N/A N/A G15248 SUP HCPCS C1769 G15248 - SET NPHSTM 10FR 19.5CM COPE LOOP CATH CNN GW BOTH IP/OP $51.00 $38.00 $10.12 $51.00 $27.69 $27.69 $27.69 $27.69 $51.00 $51.00 $51.00 $10.63 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $51.00 $30.17 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $10.12 N/A $29.58 $51.00 $51.00 $51.00 $10.63 $51.00 N/A N/A G15252 SUP HCPCS C1769 G15252 - GUIDEWIRE VASC STD STRG .028IN 145CM STRL 3CM FXCR FLX TP SS BOTH IP/OP $51.00 $38.00 $10.12 $51.00 $27.69 $27.69 $27.69 $27.69 $51.00 $51.00 $51.00 $10.63 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $51.00 $30.17 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $10.12 N/A $29.58 $51.00 $51.00 $51.00 $10.63 $51.00 N/A N/A G15256 SUP HCPCS C1769 G15256 - GUIDEWIRE VASC STD STRG .035IN 145CM STRL 3CM FX COR FLX TP BOTH IP/OP $51.00 $38.00 $10.12 $51.00 $27.69 $27.69 $27.69 $27.69 $51.00 $51.00 $51.00 $10.63 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $51.00 $30.17 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $10.12 N/A $29.58 $51.00 $51.00 $51.00 $10.63 $51.00 N/A N/A G15261 SUP HCPCS C2627 G15261 - CUFF CONTINENCE 10ML NS TEMP INTOP CAP SYR SIL M REUSE BOTH IP/OP $144.50 $107.00 $28.60 $144.10 $78.25 $78.25 $78.25 $78.25 $144.10 $144.10 $144.10 $30.03 $144.10 $106.95 $106.95 $111.07 $75.08 $30.03 $144.10 $144.10 $85.24 $144.10 $144.10 $144.10 $144.10 $108.38 $144.10 $144.10 $144.10 $72.05 $72.05 $114.13 $144.10 $115.28 $93.67 $28.60 N/A $83.81 $144.10 $144.10 $144.10 $30.03 $144.10 N/A N/A G15262 SUP Custom 27203010 G15262 - GUIDEWIRE URO STD STRG .038IN 145CM STRL 3CM FLX TP FXCR SS BOTH IP/OP $177.50 $131.00 $31.52 $177.10 $177.10 $177.10 $177.10 $177.10 $177.10 $177.10 $31.52 $177.10 $177.10 $131.44 $131.44 $136.51 $92.27 $36.91 $177.10 $70.84 $177.10 $177.10 $177.10 $177.10 $177.10 $133.13 $177.10 $177.10 $177.10 $88.55 $88.55 $140.26 $177.10 $141.68 $115.12 $177.10 N/A $102.95 $177.10 $106.26 $177.10 $177.10 $177.10 N/A N/A G15276 SUP Custom 27203010 G15276 - ADAPTER CATH 2 M LL BOTH IP/OP $60.50 $45.00 $10.77 $60.50 $60.50 $60.50 $60.50 $60.50 $60.50 $60.50 $10.77 $60.50 $60.50 $44.90 $44.90 $46.63 $31.52 $12.61 $60.50 $24.20 $60.50 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $39.33 $60.50 N/A $35.09 $60.50 $36.30 $60.50 $60.50 $60.50 N/A N/A G15279 SUP Custom 27203010 G15279 - NEEDLE ESCP 25GA 5FR 35CM 8MM WMS CSCP BOTH IP/OP $47.00 $35.00 $8.34 $46.83 $46.83 $46.83 $46.83 $46.83 $46.83 $46.83 $8.34 $46.83 $46.83 $34.76 $34.76 $36.10 $24.40 $9.76 $46.83 $18.73 $46.83 $46.83 $46.83 $46.83 $46.83 $35.25 $46.83 $46.83 $46.83 $23.42 $23.42 $37.09 $46.83 $37.46 $30.44 $46.83 N/A $27.26 $46.83 $28.10 $46.83 $46.83 $46.83 N/A N/A G15280 SUP HCPCS C1769 G15280 - NEEDLE ESCP 14FR 20CM HATTER ASP CSCP FLXB BOTH IP/OP $51.00 $38.00 $10.12 $51.00 $27.69 $27.69 $27.69 $27.69 $51.00 $51.00 $51.00 $10.63 $51.00 $37.85 $37.85 $39.31 $26.57 $10.63 $51.00 $51.00 $30.17 $51.00 $51.00 $51.00 $51.00 $38.25 $51.00 $51.00 $51.00 $25.50 $25.50 $40.39 $51.00 $40.80 $33.15 $10.12 N/A $29.58 $51.00 $51.00 $51.00 $10.63 $51.00 N/A N/A G15284 SUP HCPCS C1758 G15284 - GUIDEWIRE VASC STD .035IN 145CM STRL MOV COR SS SLIP-COAT BOTH IP/OP $41.00 $30.00 $8.08 $40.70 $22.10 $22.10 $22.10 $22.10 $40.70 $40.70 $40.70 $8.48 $40.70 $30.21 $30.21 $31.37 $21.20 $8.48 $40.70 $40.70 $24.07 $40.70 $40.70 $40.70 $40.70 $30.75 $40.70 $40.70 $40.70 $20.35 $20.35 $32.23 $40.70 $32.56 $26.46 $8.08 N/A $23.78 $40.70 $40.70 $40.70 $8.48 $40.70 N/A N/A G15290 SUP Custom 27203010 G15290 - CATHETER ESCP 2FR 3CM SILBER ASP BOTH IP/OP $37.50 $28.00 $6.66 $37.40 $37.40 $37.40 $37.40 $37.40 $37.40 $37.40 $6.66 $37.40 $37.40 $27.76 $27.76 $28.83 $19.49 $7.79 $37.40 $14.96 $37.40 $37.40 $37.40 $37.40 $37.40 $28.13 $37.40 $37.40 $37.40 $18.70 $18.70 $29.62 $37.40 $29.92 $24.31 $37.40 N/A $21.75 $37.40 $22.44 $37.40 $37.40 $37.40 N/A N/A G15291 SUP Custom 27203010 G15291 - NEEDLE PRC 22GA 20CM STRL SKNY ECHTP CHBA TIP PERC US IMG BOTH IP/OP $42.00 $31.00 $7.44 $41.80 $41.80 $41.80 $41.80 $41.80 $41.80 $41.80 $7.44 $41.80 $41.80 $31.02 $31.02 $32.22 $21.78 $8.71 $41.80 $16.72 $41.80 $41.80 $41.80 $41.80 $41.80 $31.50 $41.80 $41.80 $41.80 $20.90 $20.90 $33.11 $41.80 $33.44 $27.17 $41.80 N/A $24.36 $41.80 $25.08 $41.80 $41.80 $41.80 N/A N/A G15292 SUP Custom 27203010 G15292 - NEEDLE PRC TROC 18GA 20CM STRL ECHTP 2 PRT DISP US IMG BOTH IP/OP $93.50 $69.00 $16.64 $93.50 $93.50 $93.50 $93.50 $93.50 $93.50 $93.50 $16.64 $93.50 $93.50 $69.40 $69.40 $72.07 $48.71 $19.49 $93.50 $37.40 $93.50 $93.50 $93.50 $93.50 $93.50 $70.13 $93.50 $93.50 $93.50 $46.75 $46.75 $74.05 $93.50 $74.80 $60.78 $93.50 N/A $54.23 $93.50 $56.10 $93.50 $93.50 $93.50 N/A N/A G15293 SUP Custom 27203010 G15293 - NEEDLE PRC 18GA 22GA 14-22CM MTPLK ECHTP COAX PERC BOTH IP/OP $80.00 $59.00 $14.19 $79.70 $79.70 $79.70 $79.70 $79.70 $79.70 $79.70 $14.19 $79.70 $79.70 $59.15 $59.15 $61.43 $41.52 $16.61 $79.70 $31.88 $79.70 $79.70 $79.70 $79.70 $79.70 $60.00 $79.70 $79.70 $79.70 $39.85 $39.85 $63.12 $79.70 $63.76 $51.81 $79.70 N/A $46.40 $79.70 $47.82 $79.70 $79.70 $79.70 N/A N/A G15296 SUP Custom 27203010 G15296 - NEEDLE TROC STD 18GA 25CM ECHTP 2 PRT DISP BOTH IP/OP $60.50 $45.00 $10.77 $60.50 $60.50 $60.50 $60.50 $60.50 $60.50 $60.50 $10.77 $60.50 $60.50 $44.90 $44.90 $46.63 $31.52 $12.61 $60.50 $24.20 $60.50 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $39.33 $60.50 N/A $35.09 $60.50 $36.30 $60.50 $60.50 $60.50 N/A N/A G15299 SUP HCPCS C1758 G15299 - NEEDLE ESCP 23GA 3.7FR 35CM WMS CSCP BOTH IP/OP $30.00 $22.00 $5.89 $29.70 $16.13 $16.13 $16.13 $16.13 $29.70 $29.70 $29.70 $6.19 $29.70 $22.04 $22.04 $22.89 $15.47 $6.19 $29.70 $29.70 $17.57 $29.70 $29.70 $29.70 $29.70 $22.50 $29.70 $29.70 $29.70 $14.85 $14.85 $23.52 $29.70 $23.76 $19.31 $5.89 N/A $17.40 $29.70 $29.70 $29.70 $6.19 $29.70 N/A N/A G15300 SUP HCPCS C1758 G15300 - ADAPTER ESCP ANG STRL LF SCHOBORG LSR FBR CATH URET DISP BOTH IP/OP $83.50 $62.00 $16.57 $83.50 $45.34 $45.34 $45.34 $45.34 $83.50 $83.50 $83.50 $17.40 $83.50 $61.97 $61.97 $64.36 $43.50 $17.40 $83.50 $83.50 $49.39 $83.50 $83.50 $83.50 $83.50 $62.63 $83.50 $83.50 $83.50 $41.75 $41.75 $66.13 $83.50 $66.80 $54.28 $16.57 N/A $48.43 $83.50 $83.50 $83.50 $17.40 $83.50 N/A N/A G15301 SUP HCPCS C1758 G15301 - CATHETER URET 40D .035IN TPR STRG 5FR 70CM 145CM SF GW NYL BOTH IP/OP $73.00 $54.00 $14.41 $72.60 $39.42 $39.42 $39.42 $39.42 $72.60 $72.60 $72.60 $15.13 $72.60 $53.88 $53.88 $55.96 $37.82 $15.13 $72.60 $72.60 $42.94 $72.60 $72.60 $72.60 $72.60 $54.75 $72.60 $72.60 $72.60 $36.30 $36.30 $57.50 $72.60 $58.08 $47.19 $14.41 N/A $42.34 $72.60 $72.60 $72.60 $15.13 $72.60 N/A N/A G15302 SUP HCPCS C1758 G15302 - CATHETER URET 40D .035IN TPR 6FR 70CM 145CM GW BOTH IP/OP $73.00 $54.00 $14.41 $72.60 $39.42 $39.42 $39.42 $39.42 $72.60 $72.60 $72.60 $15.13 $72.60 $53.88 $53.88 $55.96 $37.82 $15.13 $72.60 $72.60 $42.94 $72.60 $72.60 $72.60 $72.60 $54.75 $72.60 $72.60 $72.60 $36.30 $36.30 $57.50 $72.60 $58.08 $47.19 $14.41 N/A $42.34 $72.60 $72.60 $72.60 $15.13 $72.60 N/A N/A G15397 SUP HCPCS C2617 G15397 - CATHETER URET 40D .035IN 5FR 70CM 145CM FLXB ANG TIP BVL END BOTH IP/OP $216.00 $160.00 $42.78 $215.55 $97.00 $97.00 $97.00 $97.00 $215.55 $215.55 $215.55 $44.93 $215.55 $215.55 $215.55 $215.55 $215.55 $44.92 $215.55 $215.55 $127.50 $215.55 $215.55 $215.55 $215.55 $162.00 $215.55 $215.55 $215.55 $107.78 $107.78 $170.72 $215.55 $172.44 $97.00 $42.78 N/A $125.28 $215.55 $215.55 $215.55 $44.92 $215.55 N/A N/A G15422 SUP HCPCS C1773 G15422 - FORCEPS SPEC RTRVL 5.2FR 65CM 2 JAW ALGTR TTH BOTH IP/OP $675.50 $500.00 $134.03 $675.28 $366.68 $366.68 $366.68 $366.68 $675.28 $675.28 $675.28 $140.75 $675.28 $501.19 $501.19 $520.51 $351.82 $140.74 $675.28 $675.28 $399.43 $675.28 $675.28 $675.28 $675.28 $506.63 $675.28 $675.28 $675.28 $337.64 $337.64 $534.82 $675.28 $540.22 $438.93 $134.03 N/A $391.79 $675.28 $675.28 $675.28 $140.73 $675.28 N/A N/A G15424 SUP HCPCS C1758 G15424 - STENT URET 2 PGTL CRV 4.7FR 8CM STRL SFLX PED DISP ACPT .035 BOTH IP/OP $32.00 $24.00 $6.28 $31.63 $17.18 $17.18 $17.18 $17.18 $31.63 $31.63 $31.63 $6.59 $31.63 $23.48 $23.48 $24.38 $16.48 $6.59 $31.63 $31.63 $18.71 $31.63 $31.63 $31.63 $31.63 $24.00 $31.63 $31.63 $31.63 $15.82 $15.82 $25.05 $31.63 $25.30 $20.56 $6.28 N/A $18.56 $31.63 $31.63 $31.63 $6.59 $31.63 N/A N/A G15425 SUP HCPCS C1758 G15425 - CATHETER URET .018IN 3FR 70CM OP-EN GW MOD BOTH IP/OP $32.00 $24.00 $6.28 $31.63 $17.18 $17.18 $17.18 $17.18 $31.63 $31.63 $31.63 $6.59 $31.63 $23.48 $23.48 $24.38 $16.48 $6.59 $31.63 $31.63 $18.71 $31.63 $31.63 $31.63 $31.63 $24.00 $31.63 $31.63 $31.63 $15.82 $15.82 $25.05 $31.63 $25.30 $20.56 $6.28 N/A $18.56 $31.63 $31.63 $31.63 $6.59 $31.63 N/A N/A G15429 SUP HCPCS C1726 G15429 - CATHETER URET .025IN 4FR 70CM OP-EN GW MOD BOTH IP/OP $45.00 $33.00 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $45.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 N/A $26.10 $45.00 $27.00 $45.00 $9.38 $45.00 N/A N/A G15434 SUP HCPCS C1726 G15434 - DEVICE SUT 10D 17CM PEREYRA LGT CR REUSE BOTH IP/OP $45.00 $33.00 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $45.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 N/A $26.10 $45.00 $45.00 $45.00 $9.38 $45.00 N/A N/A G15435 SUP HCPCS C1726 G15435 - CATHETER URDY 7FR 38CM STRL 2 LUM URETER DISP BOTH IP/OP $54.50 $40.00 $10.76 $54.23 $29.45 $29.45 $29.45 $29.45 $54.23 $54.23 $54.23 $11.30 $54.23 $40.25 $40.25 $41.80 $28.25 $11.30 $54.23 $54.23 $32.08 $54.23 $54.23 $54.23 $54.23 $40.88 $54.23 $54.23 $54.23 $27.12 $27.12 $42.95 $54.23 $43.38 $35.25 $10.76 N/A $31.61 $54.23 $32.54 $54.23 $11.30 $54.23 N/A N/A G15443 SUP HCPCS C2617 G15443 - CATHETER URDY 7.4FR 30CM 3 LUM BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15444 SUP HCPCS C2617 G15444 - SET STNT .038IN 2 PGTL CRV STRG FLFRM 8.5FR 20CM BLK STRL BOTH IP/OP $287.00 $212.00 $56.96 $287.00 $129.15 $129.15 $129.15 $129.15 $287.00 $287.00 $287.00 $59.82 $287.00 $287.00 $287.00 $287.00 $287.00 $59.81 $287.00 $287.00 $169.76 $287.00 $287.00 $287.00 $287.00 $215.25 $287.00 $287.00 $287.00 $143.50 $143.50 $227.30 $287.00 $229.60 $129.15 $56.96 N/A $166.46 $287.00 $287.00 $287.00 $59.81 $287.00 N/A N/A G15469 SUP HCPCS C1769 G15469 - SET STNT .038IN 2 PGTL CRV STRG FLFRM 7FR 20CM BLK STRL 145 BOTH IP/OP $208.00 $154.00 $41.26 $207.90 $112.89 $112.89 $112.89 $112.89 $207.90 $207.90 $207.90 $43.33 $207.90 $154.30 $154.30 $160.25 $108.32 $43.33 $207.90 $207.90 $122.97 $207.90 $207.90 $207.90 $207.90 $156.00 $207.90 $207.90 $207.90 $103.95 $103.95 $164.66 $207.90 $166.32 $135.14 $41.26 N/A $120.64 $207.90 $207.90 $207.90 $43.33 $207.90 N/A N/A G15473 SUP HCPCS C2625 G15473 - SET INTRO .035IN STRG 8-14FR 18GA 14CM STRL 10CM SP TUBE NDL BOTH IP/OP $160.50 $119.00 $31.82 $160.30 $72.14 $72.14 $72.14 $72.14 $160.30 $160.30 $160.30 $33.41 $160.30 $160.30 $160.30 $160.30 $160.30 $33.41 $160.30 $160.30 $94.82 $160.30 $160.30 $160.30 $160.30 $120.38 $160.30 $160.30 $160.30 $80.15 $80.15 $126.96 $160.30 $128.24 $72.14 $31.82 N/A $93.09 $160.30 $160.30 $160.30 $33.41 $160.30 N/A N/A G15475 SUP Custom 27203010 G15475 - SET STNT .038IN 5MM PGTL CRV 8.2FR 75CM STRL 100CM BNDR CATH BOTH IP/OP $30.00 $22.00 $5.29 $29.70 $29.70 $29.70 $29.70 $29.70 $29.70 $29.70 $5.29 $29.70 $29.70 $22.04 $22.04 $22.89 $15.47 $6.19 $29.70 $11.88 $29.70 $29.70 $29.70 $29.70 $29.70 $22.50 $29.70 $29.70 $29.70 $14.85 $14.85 $23.52 $29.70 $23.76 $19.31 $29.70 N/A $17.40 $29.70 $17.82 $29.70 $29.70 $29.70 N/A N/A G15476 SUP Custom 27203010 G15476 - ADAPTER CATH 9FR STRL CKFL SDARM STPCK F LL PEEL OPN DISP BOTH IP/OP $27.50 $20.00 $4.90 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $4.90 $27.50 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $11.00 $27.50 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $27.50 N/A $15.95 $27.50 $16.50 $27.50 $27.50 $27.50 N/A N/A G15495 SUP HCPCS C2625 G15495 - SET STNT 3CM 145CM STRL KWART RETRO-INJ INSRTR TETH RELS SLV BOTH IP/OP $301.00 $223.00 $59.66 $300.60 $135.27 $135.27 $135.27 $135.27 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $177.80 $300.60 $300.60 $300.60 $300.60 $225.75 $300.60 $300.60 $300.60 $150.30 $150.30 $238.08 $300.60 $240.48 $135.27 $59.66 N/A $174.58 $300.60 $300.60 $300.60 $62.65 $300.60 N/A N/A G15500 SUP HCPCS C1758 G15500 - ADAPTER CATH 9FR STRL CKFL SLF SL F LL DISP BOTH IP/OP $33.00 $24.00 $6.53 $32.90 $17.86 $17.86 $17.86 $17.86 $32.90 $32.90 $32.90 $6.86 $32.90 $24.42 $24.42 $25.36 $17.14 $6.86 $32.90 $32.90 $19.46 $32.90 $32.90 $32.90 $32.90 $24.75 $32.90 $32.90 $32.90 $16.45 $16.45 $26.06 $32.90 $26.32 $21.39 $6.53 N/A $19.14 $32.90 $32.90 $32.90 $6.86 $32.90 N/A N/A G15513 SUP Custom 27203010 G15513 - CATHETER URET 4FR 70CM SPRL TIP ACC LG SDPRT ACPT .028IN GW BOTH IP/OP $115.50 $85.00 $20.49 $115.13 $115.13 $115.13 $115.13 $115.13 $115.13 $115.13 $20.49 $115.13 $115.13 $85.45 $85.45 $88.74 $59.98 $23.99 $115.13 $46.05 $115.13 $115.13 $115.13 $115.13 $115.13 $86.63 $115.13 $115.13 $115.13 $57.57 $57.57 $91.18 $115.13 $92.10 $74.83 $115.13 N/A $66.99 $115.13 $69.08 $115.13 $115.13 $115.13 N/A N/A G15514 SUP HCPCS C2617 G15514 - NEEDLE PRC 18GA 25CM ECHTP TROC STY SHTH TFE RNL BOTH IP/OP $216.00 $160.00 $42.78 $215.55 $97.00 $97.00 $97.00 $97.00 $215.55 $215.55 $215.55 $44.93 $215.55 $215.55 $215.55 $215.55 $215.55 $44.92 $215.55 $215.55 $127.50 $215.55 $215.55 $215.55 $215.55 $162.00 $215.55 $215.55 $215.55 $107.78 $107.78 $170.72 $215.55 $172.44 $97.00 $42.78 N/A $125.28 $215.55 $215.55 $215.55 $44.92 $215.55 N/A N/A G15530 SUP HCPCS C1769 G15530 - STENT URET 2 PGTL CRV 7FR 20CM STRL SFLX DISP ACPT .038IN GW BOTH IP/OP $59.00 $44.00 $11.64 $58.65 $31.85 $31.85 $31.85 $31.85 $58.65 $58.65 $58.65 $12.22 $58.65 $43.53 $43.53 $45.21 $30.56 $12.22 $58.65 $58.65 $34.69 $58.65 $58.65 $58.65 $58.65 $44.25 $58.65 $58.65 $58.65 $29.33 $29.33 $46.45 $58.65 $46.92 $38.12 $11.64 N/A $34.22 $58.65 $58.65 $58.65 $12.22 $58.65 N/A N/A G15532 SUP HCPCS C2617 G15532 - GUIDEWIRE ESCP STD .028IN 145CM FXCR HDRPH BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G15540 SUP HCPCS C1726 G15540 - SET STNT .025IN 3.7FR 21-32CM STRL CATH RADOPQ MTLNTH PSTNR BOTH IP/OP $97.50 $72.00 $19.29 $97.18 $52.77 $52.77 $52.77 $52.77 $97.18 $97.18 $97.18 $20.25 $97.18 $72.13 $72.13 $74.91 $50.63 $20.25 $97.18 $97.18 $57.48 $97.18 $97.18 $97.18 $97.18 $73.13 $97.18 $97.18 $97.18 $48.59 $48.59 $76.97 $97.18 $77.74 $63.17 $19.29 N/A $56.55 $97.18 $97.18 $97.18 $20.25 $97.18 N/A N/A G15579 SUP HCPCS C1758 G15579 - CATHETER URDY 7.4FR 30CM 3 LUM BLN BOTH IP/OP $33.00 $24.00 $6.53 $32.90 $17.86 $17.86 $17.86 $17.86 $32.90 $32.90 $32.90 $6.86 $32.90 $24.42 $24.42 $25.36 $17.14 $6.86 $32.90 $32.90 $19.46 $32.90 $32.90 $32.90 $32.90 $24.75 $32.90 $32.90 $32.90 $16.45 $16.45 $26.06 $32.90 $26.32 $21.39 $6.53 N/A $19.14 $32.90 $32.90 $32.90 $6.86 $32.90 N/A N/A G15600 SUP HCPCS C1769 G15600 - CATHETER URET .028IN 4FR 115CM FLXTP OP-EN GW MOD FLX TP BOTH IP/OP $59.00 $44.00 $11.64 $58.65 $31.85 $31.85 $31.85 $31.85 $58.65 $58.65 $58.65 $12.22 $58.65 $43.53 $43.53 $45.21 $30.56 $12.22 $58.65 $58.65 $34.69 $58.65 $58.65 $58.65 $58.65 $44.25 $58.65 $58.65 $58.65 $29.33 $29.33 $46.45 $58.65 $46.92 $38.12 $11.64 N/A $34.22 $58.65 $58.65 $58.65 $12.22 $58.65 N/A N/A G15602 SUP HCPCS C1769 G15602 - GUIDEWIRE ESCP STD .035IN 145CM FXCR HDRPH BOTH IP/OP $59.00 $44.00 $11.64 $58.65 $31.85 $31.85 $31.85 $31.85 $58.65 $58.65 $58.65 $12.22 $58.65 $43.53 $43.53 $45.21 $30.56 $12.22 $58.65 $58.65 $34.69 $58.65 $58.65 $58.65 $58.65 $44.25 $58.65 $58.65 $58.65 $29.33 $29.33 $46.45 $58.65 $46.92 $38.12 $11.64 N/A $34.22 $58.65 $58.65 $58.65 $12.22 $58.65 N/A N/A G15603 SUP HCPCS C1726 G15603 - GUIDEWIRE URO BNTSN CRV STRG .035IN 145CM STRL 15CM FXCR FLX BOTH IP/OP $45.00 $33.00 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $45.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 N/A $26.10 $45.00 $45.00 $45.00 $9.38 $45.00 N/A N/A G15606 SUP HCPCS C2617 G15606 - CATHETER URDY 10FR 39CM 2 LUM BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G15607 SUP HCPCS C2617 G15607 - SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 8CM GRY STRL CATH BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G15608 SUP HCPCS C2617 G15608 - SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 10CM GRY STRL CATH BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G15610 SUP HCPCS C2617 G15610 - SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 12CM GRY STRL CATH BOTH IP/OP $216.00 $160.00 $42.78 $215.55 $97.00 $97.00 $97.00 $97.00 $215.55 $215.55 $215.55 $44.93 $215.55 $215.55 $215.55 $215.55 $215.55 $44.92 $215.55 $215.55 $127.50 $215.55 $215.55 $215.55 $215.55 $162.00 $215.55 $215.55 $215.55 $107.78 $107.78 $170.72 $215.55 $172.44 $97.00 $42.78 N/A $125.28 $215.55 $215.55 $215.55 $44.92 $215.55 N/A N/A G15621 SUP Custom 27203010 G15621 - STENT URET 2 PGTL CRV 4.7FR 10CM STRL SFLX PED DISP ACPT BOTH IP/OP $48.50 $36.00 $8.56 $48.08 $48.08 $48.08 $48.08 $48.08 $48.08 $48.08 $8.56 $48.08 $48.08 $35.68 $35.68 $37.06 $25.05 $10.02 $48.08 $19.23 $48.08 $48.08 $48.08 $48.08 $48.08 $36.38 $48.08 $48.08 $48.08 $24.04 $24.04 $38.08 $48.08 $38.46 $31.25 $48.08 N/A $28.13 $48.08 $28.85 $48.08 $48.08 $48.08 N/A N/A G15624 SUP HCPCS C2617 G15624 - NEEDLE PRC STD 18GA 11CM ECHTP 2 PRT TROC DISP BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G15632 SUP HCPCS C2627 G15632 - SET STNT .018IN SM 2 PGTL CRV CDE 3FR 7FR 6CM STRL RADOPQ GW BOTH IP/OP $258.50 $191.00 $51.22 $258.05 $140.12 $140.12 $140.12 $140.12 $258.05 $258.05 $258.05 $53.78 $258.05 $191.52 $191.52 $198.90 $134.44 $53.78 $258.05 $258.05 $152.64 $258.05 $258.05 $258.05 $258.05 $193.88 $258.05 $258.05 $258.05 $129.03 $129.03 $204.38 $258.05 $206.44 $167.73 $51.22 N/A $149.93 $258.05 $258.05 $258.05 $53.78 $258.05 N/A N/A G15636 SUP HCPCS C1758 G15636 - SET DIL 6-12FR 60CM WO GW PE HDRPH URET BOTH IP/OP $47.50 $35.00 $9.39 $47.30 $25.68 $25.68 $25.68 $25.68 $47.30 $47.30 $47.30 $9.86 $47.30 $35.11 $35.11 $36.46 $24.64 $9.86 $47.30 $47.30 $27.98 $47.30 $47.30 $47.30 $47.30 $35.63 $47.30 $47.30 $47.30 $23.65 $23.65 $37.46 $47.30 $37.84 $30.75 $9.39 N/A $27.55 $47.30 $47.30 $47.30 $9.86 $47.30 N/A N/A G15637 SUP HCPCS C1758 G15637 - CATHETER URET 5FR 70CM ECHTP OP-EN ACPT .038IN GW BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $29.54 $29.54 $29.54 $29.54 $54.40 $54.40 $54.40 $11.34 $54.40 $40.38 $40.38 $41.93 $28.34 $11.34 $54.40 $54.40 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $35.36 $10.80 N/A $31.61 $54.40 $54.40 $54.40 $11.34 $54.40 N/A N/A G15638 SUP HCPCS C1758 G15638 - CATHETER URET .038IN 6FR 70CM ECHTP OP-EN GW BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $29.54 $29.54 $29.54 $29.54 $54.40 $54.40 $54.40 $11.34 $54.40 $40.38 $40.38 $41.93 $28.34 $11.34 $54.40 $54.40 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $35.36 $10.80 N/A $31.61 $54.40 $54.40 $54.40 $11.34 $54.40 N/A N/A G15639 SUP HCPCS C1758 G15639 - CATHETER URET .038IN 7FR 70CM ECHTP OP-EN GW BOTH IP/OP $54.50 $40.00 $10.80 $54.40 $29.54 $29.54 $29.54 $29.54 $54.40 $54.40 $54.40 $11.34 $54.40 $40.38 $40.38 $41.93 $28.34 $11.34 $54.40 $54.40 $32.18 $54.40 $54.40 $54.40 $54.40 $40.88 $54.40 $54.40 $54.40 $27.20 $27.20 $43.08 $54.40 $43.52 $35.36 $10.80 N/A $31.61 $54.40 $54.40 $54.40 $11.34 $54.40 N/A N/A G15650 SUP Custom 27203010 G15650 - CATHETER URET .038IN 8FR 70CM ECHTP OP-EN GW BOTH IP/OP $30.00 $22.00 $5.29 $29.70 $29.70 $29.70 $29.70 $29.70 $29.70 $29.70 $5.29 $29.70 $29.70 $22.04 $22.04 $22.89 $15.47 $6.19 $29.70 $11.88 $29.70 $29.70 $29.70 $29.70 $29.70 $22.50 $29.70 $29.70 $29.70 $14.85 $14.85 $23.52 $29.70 $23.76 $19.31 $29.70 N/A $17.40 $29.70 $17.82 $29.70 $29.70 $29.70 N/A N/A G15670 SUP HCPCS C1758 G15670 - ADAPTER CATH UNV 9FR STRL CKFL F LL DISP BOTH IP/OP $151.00 $112.00 $29.91 $150.68 $81.82 $81.82 $81.82 $81.82 $150.68 $150.68 $150.68 $31.41 $150.68 $111.83 $111.83 $116.14 $78.50 $31.40 $150.68 $150.68 $89.13 $150.68 $150.68 $150.68 $150.68 $113.25 $150.68 $150.68 $150.68 $75.34 $75.34 $119.34 $150.68 $120.54 $97.94 $29.91 N/A $87.58 $150.68 $150.68 $150.68 $31.40 $150.68 N/A N/A G15731 SUP HCPCS C1769 G15731 - GUIDEWIRE VASC .032IN 145CM AMPTZ MOV COR STRG TPR BOTH IP/OP $70.00 $52.00 $13.89 $69.98 $38.00 $38.00 $38.00 $38.00 $69.98 $69.98 $69.98 $14.59 $69.98 $51.94 $51.94 $53.94 $36.46 $14.58 $69.98 $69.98 $41.39 $69.98 $69.98 $69.98 $69.98 $52.50 $69.98 $69.98 $69.98 $34.99 $34.99 $55.42 $69.98 $55.98 $45.49 $13.89 N/A $40.60 $69.98 $41.99 $69.98 $14.58 $69.98 N/A N/A G15732 SUP HCPCS C1769 G15732 - CATHETER URET .045IN PGTL CRV 8FR 70CM 145CM SDPRT SHFT GW BOTH IP/OP $70.00 $52.00 $13.89 $69.98 $38.00 $38.00 $38.00 $38.00 $69.98 $69.98 $69.98 $14.59 $69.98 $51.94 $51.94 $53.94 $36.46 $14.58 $69.98 $69.98 $41.39 $69.98 $69.98 $69.98 $69.98 $52.50 $69.98 $69.98 $69.98 $34.99 $34.99 $55.42 $69.98 $55.98 $45.49 $13.89 N/A $40.60 $69.98 $69.98 $69.98 $14.58 $69.98 N/A N/A G15733 SUP HCPCS C1892 G15733 - GUIDEWIRE VASC .038IN 145CM LF 3CM AMPTZ 2 FLXB STF SS BOTH IP/OP $137.00 $101.00 $27.12 $136.63 $74.19 $74.19 $74.19 $74.19 $136.63 $136.63 $136.63 $28.48 $136.63 $101.41 $101.41 $105.31 $71.18 $28.48 $136.63 $136.63 $80.82 $136.63 $136.63 $136.63 $136.63 $102.75 $136.63 $136.63 $136.63 $68.32 $68.32 $108.21 $136.63 $109.30 $88.81 $27.12 N/A $79.46 $136.63 $136.63 $136.63 $28.47 $136.63 N/A N/A G15739 SUP HCPCS C1726 G15739 - POUCH SPEC RTRVL 5X2IN YLW LAPSAC SRG REM MORCELLATION INTGR BOTH IP/OP $54.50 $40.00 $10.76 $54.23 $29.45 $29.45 $29.45 $29.45 $54.23 $54.23 $54.23 $11.30 $54.23 $40.25 $40.25 $41.80 $28.25 $11.30 $54.23 $54.23 $32.08 $54.23 $54.23 $54.23 $54.23 $40.88 $54.23 $54.23 $54.23 $27.12 $27.12 $42.95 $54.23 $43.38 $35.25 $10.76 N/A $31.61 $54.23 $54.23 $54.23 $11.30 $54.23 N/A N/A G15753 SUP HCPCS C2627 G15753 - TUBE CNCT 14FR 11CM M LL DRN BG T-B ADPR BOTH IP/OP $73.00 $54.00 $14.44 $72.73 $39.49 $39.49 $39.49 $39.49 $72.73 $72.73 $72.73 $15.16 $72.73 $53.98 $53.98 $56.06 $37.89 $15.16 $72.73 $72.73 $43.02 $72.73 $72.73 $72.73 $72.73 $54.75 $72.73 $72.73 $72.73 $36.37 $36.37 $57.60 $72.73 $58.18 $47.27 $14.44 N/A $42.34 $72.73 $72.73 $72.73 $15.16 $72.73 N/A N/A G15764 SUP HCPCS C2627 G15764 - DILATOR URTH 6FR 37CM PE FSCA BOTH IP/OP $30.00 $22.00 $5.89 $29.70 $16.13 $16.13 $16.13 $16.13 $29.70 $29.70 $29.70 $6.19 $29.70 $22.04 $22.04 $22.89 $15.47 $6.19 $29.70 $29.70 $17.57 $29.70 $29.70 $29.70 $29.70 $22.50 $29.70 $29.70 $29.70 $14.85 $14.85 $23.52 $29.70 $23.76 $19.31 $5.89 N/A $17.40 $29.70 $29.70 $29.70 $6.19 $29.70 N/A N/A G15766 SUP Custom 27203010 G15766 - CATHETER URDY 4FR 60CM PRSS BLDR BOTH IP/OP $70.50 $52.00 $12.53 $70.40 $70.40 $70.40 $70.40 $70.40 $70.40 $70.40 $12.53 $70.40 $70.40 $52.25 $52.25 $54.26 $36.68 $14.67 $70.40 $28.16 $70.40 $70.40 $70.40 $70.40 $70.40 $52.88 $70.40 $70.40 $70.40 $35.20 $35.20 $55.76 $70.40 $56.32 $45.76 $70.40 N/A $40.89 $70.40 $42.24 $70.40 $70.40 $70.40 N/A N/A G15771 SUP Custom 27203010 G15771 - CATHETER URDY 12FR 36CM STRL LTX 5CM PRSS BLN SIL RCTL DISP BOTH IP/OP $627.00 $464.00 $111.58 $626.88 $626.88 $626.88 $626.88 $626.88 $626.88 $626.88 $111.58 $626.88 $626.88 $465.27 $465.27 $483.20 $326.60 $130.65 $626.88 $250.75 $626.88 $626.88 $626.88 $626.88 $626.88 $470.25 $626.88 $626.88 $626.88 $313.44 $313.44 $496.49 $626.88 $501.50 $407.47 $626.88 N/A $363.66 $626.88 $376.13 $626.88 $626.88 $626.88 N/A N/A G15789 SUP HCPCS C1729 G15789 - INTRODUCER ESCP 25.5CM 5X8IN LAPSAC LGR ACC PORT HNDL SS AL BOTH IP/OP $466.00 $345.00 $92.40 $465.53 $252.78 $252.78 $252.78 $252.78 $465.53 $465.53 $465.53 $97.03 $465.53 $345.52 $345.52 $358.83 $242.54 $97.02 $465.53 $465.53 $275.36 $465.53 $465.53 $465.53 $465.53 $349.50 $465.53 $465.53 $465.53 $232.77 $232.77 $368.70 $465.53 $372.42 $302.59 $92.40 N/A $270.28 $465.53 $465.53 $465.53 $97.02 $465.53 N/A N/A G15792 SUP HCPCS C1758 G15792 - SET NPHSTM 12FR 30CM STRL LTX 20CM COPE LOOP NDL GW DIL CNCT BOTH IP/OP $33.00 $24.00 $6.53 $32.90 $17.86 $17.86 $17.86 $17.86 $32.90 $32.90 $32.90 $6.86 $32.90 $24.42 $24.42 $25.36 $17.14 $6.86 $32.90 $32.90 $19.46 $32.90 $32.90 $32.90 $32.90 $24.75 $32.90 $32.90 $32.90 $16.45 $16.45 $26.06 $32.90 $26.32 $21.39 $6.53 N/A $19.14 $32.90 $32.90 $32.90 $6.86 $32.90 N/A N/A G15803 SUP HCPCS C1758 G15803 - CATHETER URET .038IN 5FR 120CM FLXTP OP-EN GW MOD BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G15821 SUP HCPCS C1758 G15821 - CATHETER URET 9FR 15CM WHSTLTP MOD LT BOTH IP/OP $32.00 $24.00 $6.28 $31.63 $17.18 $17.18 $17.18 $17.18 $31.63 $31.63 $31.63 $6.59 $31.63 $23.48 $23.48 $24.38 $16.48 $6.59 $31.63 $31.63 $18.71 $31.63 $31.63 $31.63 $31.63 $24.00 $31.63 $31.63 $31.63 $15.82 $15.82 $25.05 $31.63 $25.30 $20.56 $6.28 N/A $18.56 $31.63 $31.63 $31.63 $6.59 $31.63 N/A N/A G15859 SUP HCPCS C1758 G15859 - CATHETER URET 3FR 125CM RND TIP STY LT BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G15864 SUP Custom 27203010 G15864 - CATHETER URET 4FR 90CM WHSTLTP MOD RT BOTH IP/OP $70.00 $52.00 $12.39 $69.58 $69.58 $69.58 $69.58 $69.58 $69.58 $69.58 $12.39 $69.58 $69.58 $51.64 $51.64 $53.63 $36.25 $14.50 $69.58 $27.83 $69.58 $69.58 $69.58 $69.58 $69.58 $52.50 $69.58 $69.58 $69.58 $34.79 $34.79 $55.11 $69.58 $55.66 $45.23 $69.58 N/A $40.60 $69.58 $41.75 $69.58 $69.58 $69.58 N/A N/A G15871 SUP HCPCS C1758 G15871 - NEEDLE INJ 20GA 5FR 35CM 7MM WMS CSCP BOTH IP/OP $100.50 $74.00 $19.90 $100.25 $54.44 $54.44 $54.44 $54.44 $100.25 $100.25 $100.25 $20.89 $100.25 $74.41 $74.41 $77.27 $52.23 $20.89 $100.25 $100.25 $59.30 $100.25 $100.25 $100.25 $100.25 $75.38 $100.25 $100.25 $100.25 $50.13 $50.13 $79.40 $100.25 $80.20 $65.16 $19.90 N/A $58.29 $100.25 $100.25 $100.25 $20.89 $100.25 N/A N/A G15873 SUP HCPCS C1726 G15873 - CATHETER URET PGTL CRV 8.2FR 56CM SFLX BOTH IP/OP $49.50 $37.00 $9.75 $49.10 $26.66 $26.66 $26.66 $26.66 $49.10 $49.10 $49.10 $10.23 $49.10 $36.44 $36.44 $37.85 $25.58 $10.23 $49.10 $49.10 $29.04 $49.10 $49.10 $49.10 $49.10 $37.13 $49.10 $49.10 $49.10 $24.55 $24.55 $38.89 $49.10 $39.28 $31.92 $9.75 N/A $28.71 $49.10 $49.10 $49.10 $10.23 $49.10 N/A N/A G15875 SUP HCPCS C2625 G15875 - CATHETER URDY 7.4FR 30CM 3 LUM BOTH IP/OP $259.50 $192.00 $51.47 $259.33 $116.70 $116.70 $116.70 $116.70 $259.33 $259.33 $259.33 $54.05 $259.33 $259.33 $259.33 $259.33 $259.33 $54.05 $259.33 $259.33 $153.39 $259.33 $259.33 $259.33 $259.33 $194.63 $259.33 $259.33 $259.33 $129.67 $129.67 $205.39 $259.33 $207.46 $116.70 $51.47 N/A $150.51 $259.33 $259.33 $259.33 $54.04 $259.33 N/A N/A G15876 SUP HCPCS C2625 G15876 - SET STNT .038IN 5MM PGTL CRV 8.4FR 90CM STRL 125CM BNDR CATH BOTH IP/OP $225.50 $167.00 $44.76 $225.50 $101.48 $101.48 $101.48 $101.48 $225.50 $225.50 $225.50 $47.00 $225.50 $225.50 $225.50 $225.50 $225.50 $47.00 $225.50 $225.50 $133.38 $225.50 $225.50 $225.50 $225.50 $169.13 $225.50 $225.50 $225.50 $112.75 $112.75 $178.60 $225.50 $180.40 $101.48 $44.76 N/A $130.79 $225.50 $225.50 $225.50 $46.99 $225.50 N/A N/A G15877 SUP HCPCS C2625 G15877 - SET STNT .038IN 5MM PGTL CRV 7.2FR 90CM STRL 125CM BNDR CATH BOTH IP/OP $259.50 $192.00 $51.47 $259.33 $116.70 $116.70 $116.70 $116.70 $259.33 $259.33 $259.33 $54.05 $259.33 $259.33 $259.33 $259.33 $259.33 $54.05 $259.33 $259.33 $153.39 $259.33 $259.33 $259.33 $259.33 $194.63 $259.33 $259.33 $259.33 $129.67 $129.67 $205.39 $259.33 $207.46 $116.70 $51.47 N/A $150.51 $259.33 $259.33 $259.33 $54.04 $259.33 N/A N/A G15878 SUP HCPCS C2625 G15878 - SET STNT .038IN 5MM PGTL CRV 8.4FR 90CM STRL 125CM BNDR CATH BOTH IP/OP $225.50 $167.00 $44.76 $225.50 $101.48 $101.48 $101.48 $101.48 $225.50 $225.50 $225.50 $47.00 $225.50 $225.50 $225.50 $225.50 $225.50 $47.00 $225.50 $225.50 $133.38 $225.50 $225.50 $225.50 $225.50 $169.13 $225.50 $225.50 $225.50 $112.75 $112.75 $178.60 $225.50 $180.40 $101.48 $44.76 N/A $130.79 $225.50 $225.50 $225.50 $46.99 $225.50 N/A N/A G15885 SUP HCPCS C1758 G15885 - SET STNT .038IN 5MM PGTL CRV 7.2FR 90CM STRL 125CM BNDR CATH BOTH IP/OP $36.50 $27.00 $7.20 $36.30 $19.71 $19.71 $19.71 $19.71 $36.30 $36.30 $36.30 $7.57 $36.30 $26.94 $26.94 $27.98 $18.91 $7.57 $36.30 $36.30 $21.47 $36.30 $36.30 $36.30 $36.30 $27.38 $36.30 $36.30 $36.30 $18.15 $18.15 $28.75 $36.30 $29.04 $23.60 $7.20 N/A $21.17 $36.30 $36.30 $36.30 $7.56 $36.30 N/A N/A G15889 SUP HCPCS C1758 G15889 - CATHETER URET 3FR 70CM STF STY PED BOTH IP/OP $40.00 $30.00 $7.93 $39.95 $21.69 $21.69 $21.69 $21.69 $39.95 $39.95 $39.95 $8.33 $39.95 $29.65 $29.65 $30.79 $20.81 $8.33 $39.95 $39.95 $23.63 $39.95 $39.95 $39.95 $39.95 $30.00 $39.95 $39.95 $39.95 $19.98 $19.98 $31.64 $39.95 $31.96 $25.97 $7.93 N/A $23.20 $39.95 $39.95 $39.95 $8.33 $39.95 N/A N/A G15899 SUP HCPCS C1726 G15899 - CATHETER URET .038IN 5FR 70CM FLXTP OP-EN GW MOD BOTH IP/OP $45.00 $33.00 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $45.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 N/A $26.10 $45.00 $45.00 $45.00 $9.38 $45.00 N/A N/A G15924 SUP HCPCS C2617 G15924 - POUCH DRN 300ML STRL SFT ELC BELT REED VLV MECH REUSE BOTH IP/OP $77.00 $57.00 $15.21 $76.63 $34.48 $34.48 $34.48 $34.48 $76.63 $76.63 $76.63 $15.97 $76.63 $76.63 $76.63 $76.63 $76.63 $15.97 $76.63 $76.63 $45.33 $76.63 $76.63 $76.63 $76.63 $57.75 $76.63 $76.63 $76.63 $38.32 $38.32 $60.69 $76.63 $61.30 $34.48 $15.21 N/A $44.66 $76.63 $76.63 $76.63 $15.97 $76.63 N/A N/A G15925 SUP HCPCS C1729 G15925 - STENT URTH 8FR 40CM STRL FRLT KLG CNTR BLB SIL DISP BOTH IP/OP $405.00 $300.00 $80.34 $404.80 $219.81 $219.81 $219.81 $219.81 $404.80 $404.80 $404.80 $84.37 $404.80 $300.44 $300.44 $312.02 $210.90 $84.36 $404.80 $404.80 $239.44 $404.80 $404.80 $404.80 $404.80 $303.75 $404.80 $404.80 $404.80 $202.40 $202.40 $320.60 $404.80 $323.84 $263.12 $80.34 N/A $234.90 $404.80 $404.80 $404.80 $84.36 $404.80 N/A N/A G15929 SUP HCPCS C2617 G15929 - SET NPHSTM 10FR 19.5CM LTX COPE LOOP MOD CATH GW RTNT DISK BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G15934 SUP HCPCS C1769 G15934 - SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 14CM STRL CP MDRL BOTH IP/OP $59.00 $44.00 $11.64 $58.65 $31.85 $31.85 $31.85 $31.85 $58.65 $58.65 $58.65 $12.22 $58.65 $43.53 $43.53 $45.21 $30.56 $12.22 $58.65 $58.65 $34.69 $58.65 $58.65 $58.65 $58.65 $44.25 $58.65 $58.65 $58.65 $29.33 $29.33 $46.45 $58.65 $46.92 $38.12 $11.64 N/A $34.22 $58.65 $58.65 $58.65 $12.22 $58.65 N/A N/A G15935 SUP HCPCS C1769 G15935 - GUIDEWIRE ESCP STD STRG .025IN 145CM 3CM FLX TP FXCR SS BOTH IP/OP $52.50 $39.00 $10.34 $52.08 $28.28 $28.28 $28.28 $28.28 $52.08 $52.08 $52.08 $10.85 $52.08 $38.65 $38.65 $40.14 $27.13 $10.85 $52.08 $52.08 $30.81 $52.08 $52.08 $52.08 $52.08 $39.38 $52.08 $52.08 $52.08 $26.04 $26.04 $41.25 $52.08 $41.66 $33.85 $10.34 N/A $30.45 $52.08 $52.08 $52.08 $10.85 $52.08 N/A N/A G16019 SUP HCPCS C2617 G16019 - TUBE CNCT 14FR 30CM STRL 2 DRN PCH BOTH IP/OP $253.50 $188.00 $50.30 $253.45 $114.05 $114.05 $114.05 $114.05 $253.45 $253.45 $253.45 $52.83 $253.45 $253.45 $253.45 $253.45 $253.45 $52.82 $253.45 $253.45 $149.92 $253.45 $253.45 $253.45 $253.45 $190.13 $253.45 $253.45 $253.45 $126.73 $126.73 $200.73 $253.45 $202.76 $114.05 $50.30 N/A $147.03 $253.45 $253.45 $253.45 $52.82 $253.45 N/A N/A G16020 SUP HCPCS C2617 G16020 - SET STNT .035IN SM 2 PGTL CRV 4.7FR 4FR 10CM STRL CATH BOTH IP/OP $253.50 $188.00 $50.30 $253.45 $114.05 $114.05 $114.05 $114.05 $253.45 $253.45 $253.45 $52.83 $253.45 $253.45 $253.45 $253.45 $253.45 $52.82 $253.45 $253.45 $149.92 $253.45 $253.45 $253.45 $253.45 $190.13 $253.45 $253.45 $253.45 $126.73 $126.73 $200.73 $253.45 $202.76 $114.05 $50.30 N/A $147.03 $253.45 $253.45 $253.45 $52.82 $253.45 N/A N/A G16021 SUP HCPCS C2617 G16021 - SET STNT .035IN SM 2 PGTL CRV 4.7FR 4FR 14CM STRL CATH BOTH IP/OP $253.50 $188.00 $50.30 $253.45 $114.05 $114.05 $114.05 $114.05 $253.45 $253.45 $253.45 $52.83 $253.45 $253.45 $253.45 $253.45 $253.45 $52.82 $253.45 $253.45 $149.92 $253.45 $253.45 $253.45 $253.45 $190.13 $253.45 $253.45 $253.45 $126.73 $126.73 $200.73 $253.45 $202.76 $114.05 $50.30 N/A $147.03 $253.45 $253.45 $253.45 $52.82 $253.45 N/A N/A G16035 SUP HCPCS C2617 G16035 - SET STNT .035IN SM 2 PGTL CRV 4.7FR 4FR 16CM STRL CATH BOTH IP/OP $253.50 $188.00 $50.30 $253.45 $114.05 $114.05 $114.05 $114.05 $253.45 $253.45 $253.45 $52.83 $253.45 $253.45 $253.45 $253.45 $253.45 $52.82 $253.45 $253.45 $149.92 $253.45 $253.45 $253.45 $253.45 $190.13 $253.45 $253.45 $253.45 $126.73 $126.73 $200.73 $253.45 $202.76 $114.05 $50.30 N/A $147.03 $253.45 $253.45 $253.45 $52.82 $253.45 N/A N/A G16040 SUP HCPCS C2617 G16040 - SET STNT .038IN SM 2 PGTL CRV 7FR 4FR 12CM STRL CATH RADOPQ BOTH IP/OP $253.50 $188.00 $50.30 $253.45 $114.05 $114.05 $114.05 $114.05 $253.45 $253.45 $253.45 $52.83 $253.45 $253.45 $253.45 $253.45 $253.45 $52.82 $253.45 $253.45 $149.92 $253.45 $253.45 $253.45 $253.45 $190.13 $253.45 $253.45 $253.45 $126.73 $126.73 $200.73 $253.45 $202.76 $114.05 $50.30 N/A $147.03 $253.45 $253.45 $253.45 $52.82 $253.45 N/A N/A G16112 SUP Custom 27203010 G16112 - SET STNT .038IN SM 2 PGTL CRV 6FR 4FR 14CM STRL CATH RADOPQ BOTH IP/OP $70.00 $52.00 $12.39 $69.58 $69.58 $69.58 $69.58 $69.58 $69.58 $69.58 $12.39 $69.58 $69.58 $51.64 $51.64 $53.63 $36.25 $14.50 $69.58 $27.83 $69.58 $69.58 $69.58 $69.58 $69.58 $52.50 $69.58 $69.58 $69.58 $34.79 $34.79 $55.11 $69.58 $55.66 $45.23 $69.58 N/A $40.60 $69.58 $41.75 $69.58 $69.58 $69.58 N/A N/A G16116 SUP HCPCS C1726 G16116 - NEEDLE INJ 23GA 5FR 45CM 8MM WMS CSCP BOTH IP/OP $588.00 $435.00 $116.62 $587.60 $319.07 $319.07 $319.07 $319.07 $587.60 $587.60 $587.60 $122.47 $587.60 $436.12 $436.12 $452.92 $306.14 $122.46 $587.60 $587.60 $347.57 $587.60 $587.60 $587.60 $587.60 $441.00 $587.60 $587.60 $587.60 $293.80 $293.80 $465.38 $587.60 $470.08 $381.94 $116.62 N/A $341.04 $587.60 $587.60 $587.60 $122.46 $587.60 N/A N/A G16120 SUP HCPCS C2627 G16120 - SET DIL 6-30FR 30CM 16CM AMPTZ MOD RADOPQ SHTH RNL BOTH IP/OP $215.50 $159.00 $42.68 $215.05 $116.77 $116.77 $116.77 $116.77 $215.05 $215.05 $215.05 $44.82 $215.05 $159.61 $159.61 $165.76 $112.04 $44.82 $215.05 $215.05 $127.20 $215.05 $215.05 $215.05 $215.05 $161.63 $215.05 $215.05 $215.05 $107.53 $107.53 $170.32 $215.05 $172.04 $139.78 $42.68 N/A $124.99 $215.05 $215.05 $215.05 $44.82 $215.05 N/A N/A G16121 SUP HCPCS C1769 G16121 - INTRODUCER NPHSTM 18FR 12CM OB PLWY ACC SET GW TROC NDL SPBC BOTH IP/OP $215.50 $159.00 $42.68 $215.05 $116.77 $116.77 $116.77 $116.77 $215.05 $215.05 $215.05 $44.82 $215.05 $159.61 $159.61 $165.76 $112.04 $44.82 $215.05 $215.05 $127.20 $215.05 $215.05 $215.05 $215.05 $161.63 $215.05 $215.05 $215.05 $107.53 $107.53 $170.32 $215.05 $172.04 $139.78 $42.68 N/A $124.99 $215.05 $215.05 $215.05 $44.82 $215.05 N/A N/A G16122 SUP HCPCS C1769 G16122 - SET CATH TROC 20FR 12CM OB PLWY INTRO NDL GW SPBC BOTH IP/OP $215.50 $159.00 $42.68 $215.05 $116.77 $116.77 $116.77 $116.77 $215.05 $215.05 $215.05 $44.82 $215.05 $159.61 $159.61 $165.76 $112.04 $44.82 $215.05 $215.05 $127.20 $215.05 $215.05 $215.05 $215.05 $161.63 $215.05 $215.05 $215.05 $107.53 $107.53 $170.32 $215.05 $172.04 $139.78 $42.68 N/A $124.99 $215.05 $215.05 $215.05 $44.82 $215.05 N/A N/A G16123 SUP HCPCS C1769 G16123 - INTRODUCER NPHSTM 22FR 12CM PLWY ACC SET GW TROC NDL BOTH IP/OP $215.50 $159.00 $42.68 $215.05 $116.77 $116.77 $116.77 $116.77 $215.05 $215.05 $215.05 $44.82 $215.05 $159.61 $159.61 $165.76 $112.04 $44.82 $215.05 $215.05 $127.20 $215.05 $215.05 $215.05 $215.05 $161.63 $215.05 $215.05 $215.05 $107.53 $107.53 $170.32 $215.05 $172.04 $139.78 $42.68 N/A $124.99 $215.05 $215.05 $215.05 $44.82 $215.05 N/A N/A G16187 SUP HCPCS C2625 G16187 - POUCH DRN STRL BELT PLS ADJ REUSE BOTH IP/OP $160.50 $119.00 $31.82 $160.30 $72.14 $72.14 $72.14 $72.14 $160.30 $160.30 $160.30 $33.41 $160.30 $160.30 $160.30 $160.30 $160.30 $33.41 $160.30 $160.30 $94.82 $160.30 $160.30 $160.30 $160.30 $120.38 $160.30 $160.30 $160.30 $80.15 $80.15 $126.96 $160.30 $128.24 $72.14 $31.82 N/A $93.09 $160.30 $160.30 $160.30 $33.41 $160.30 N/A N/A G16198 SUP HCPCS C2627 G16198 - CATHETER URET .038IN 5FR 120CM OP-EN GW MOD BOTH IP/OP $166.00 $123.00 $32.89 $165.73 $89.99 $89.99 $89.99 $89.99 $165.73 $165.73 $165.73 $34.54 $165.73 $123.00 $123.00 $127.74 $86.35 $34.54 $165.73 $165.73 $98.03 $165.73 $165.73 $165.73 $165.73 $124.50 $165.73 $165.73 $165.73 $82.87 $82.87 $131.26 $165.73 $132.58 $107.72 $32.89 N/A $96.28 $165.73 $165.73 $165.73 $34.54 $165.73 N/A N/A G16226 SUP HCPCS C2617 G16226 - SET CATH 10FR 22CM RTNR BLN SPBC BOTH IP/OP $318.00 $235.00 $63.07 $317.75 $142.99 $142.99 $142.99 $142.99 $317.75 $317.75 $317.75 $66.23 $317.75 $317.75 $317.75 $317.75 $317.75 $66.22 $317.75 $317.75 $187.95 $317.75 $317.75 $317.75 $317.75 $238.50 $317.75 $317.75 $317.75 $158.88 $158.88 $251.66 $317.75 $254.20 $142.99 $63.07 N/A $184.44 $317.75 $317.75 $317.75 $66.22 $317.75 N/A N/A G16227 SUP HCPCS C2617 G16227 - SET STNT 5FR 8-20CM GRN GW CATH PSTNR RNL TRNSPLNT BOTH IP/OP $318.00 $235.00 $63.07 $317.75 $142.99 $142.99 $142.99 $142.99 $317.75 $317.75 $317.75 $66.23 $317.75 $317.75 $317.75 $317.75 $317.75 $66.22 $317.75 $317.75 $187.95 $317.75 $317.75 $317.75 $317.75 $238.50 $317.75 $317.75 $317.75 $158.88 $158.88 $251.66 $317.75 $254.20 $142.99 $63.07 N/A $184.44 $317.75 $317.75 $317.75 $66.22 $317.75 N/A N/A G16228 SUP HCPCS C2617 G16228 - SET STNT .028IN 6FR 8-20CM GRN STRL 145CM GRN CATH MTLNTH BOTH IP/OP $365.50 $270.00 $72.53 $365.43 $164.44 $164.44 $164.44 $164.44 $365.43 $365.43 $365.43 $76.16 $365.43 $365.43 $365.43 $365.43 $365.43 $76.16 $365.43 $365.43 $216.15 $365.43 $365.43 $365.43 $365.43 $274.13 $365.43 $365.43 $365.43 $182.72 $182.72 $289.42 $365.43 $292.34 $164.44 $72.53 N/A $211.99 $365.43 $365.43 $365.43 $76.16 $365.43 N/A N/A G16229 SUP HCPCS C2617 G16229 - SET STNT 6FR 22-32CM GRN GW CATH PSTNR RNL TRNSPLNT BOTH IP/OP $318.00 $235.00 $63.07 $317.75 $142.99 $142.99 $142.99 $142.99 $317.75 $317.75 $317.75 $66.23 $317.75 $317.75 $317.75 $317.75 $317.75 $66.22 $317.75 $317.75 $187.95 $317.75 $317.75 $317.75 $317.75 $238.50 $317.75 $317.75 $317.75 $158.88 $158.88 $251.66 $317.75 $254.20 $142.99 $63.07 N/A $184.44 $317.75 $317.75 $317.75 $66.22 $317.75 N/A N/A G16230 SUP HCPCS C2617 G16230 - SET STNT 7FR 8-20CM GRN GW CATH PSTNR RNL TRNSPLNT BOTH IP/OP $318.00 $235.00 $63.07 $317.75 $142.99 $142.99 $142.99 $142.99 $317.75 $317.75 $317.75 $66.23 $317.75 $317.75 $317.75 $317.75 $317.75 $66.22 $317.75 $317.75 $187.95 $317.75 $317.75 $317.75 $317.75 $238.50 $317.75 $317.75 $317.75 $158.88 $158.88 $251.66 $317.75 $254.20 $142.99 $63.07 N/A $184.44 $317.75 $317.75 $317.75 $66.22 $317.75 N/A N/A G16658 SUP HCPCS C1769 G16658 - SET STNT 8.5FR 8-20CM GRN GW CATH PSTNR RNL TRNSPLNT BOTH IP/OP $466.00 $345.00 $92.40 $465.53 $252.78 $252.78 $252.78 $252.78 $465.53 $465.53 $465.53 $97.03 $465.53 $345.52 $345.52 $358.83 $242.54 $97.02 $465.53 $465.53 $275.36 $465.53 $465.53 $465.53 $465.53 $349.50 $465.53 $465.53 $465.53 $232.77 $232.77 $368.70 $465.53 $372.42 $302.59 $92.40 N/A $270.28 $465.53 $465.53 $465.53 $97.02 $465.53 N/A N/A G16672 SUP Custom 27203010 G16672 - SET NPHSTM 12FR 19.5CM LTX COPE LOOP MOD CATH GW RTNT DISK BOTH IP/OP $482.50 $357.00 $85.85 $482.33 $482.33 $482.33 $482.33 $482.33 $482.33 $482.33 $85.85 $482.33 $482.33 $357.99 $357.99 $371.78 $251.29 $100.52 $482.33 $192.93 $482.33 $482.33 $482.33 $482.33 $482.33 $361.88 $482.33 $482.33 $482.33 $241.17 $241.17 $382.01 $482.33 $385.86 $313.51 $482.33 N/A $279.85 $482.33 $289.40 $482.33 $482.33 $482.33 N/A N/A G16684 SUP Custom 27203010 G16684 - EXTRACTOR STON FLT 3FR 115CM 4WR BSKT LSR PLMD BOTH IP/OP $60.50 $45.00 $10.77 $60.50 $60.50 $60.50 $60.50 $60.50 $60.50 $60.50 $10.77 $60.50 $60.50 $44.90 $44.90 $46.63 $31.52 $12.61 $60.50 $24.20 $60.50 $60.50 $60.50 $60.50 $60.50 $45.38 $60.50 $60.50 $60.50 $30.25 $30.25 $47.92 $60.50 $48.40 $39.33 $60.50 N/A $35.09 $60.50 $36.30 $60.50 $60.50 $60.50 N/A N/A G16695 SUP Custom 27203010 G16695 - NEEDLE INJ 23GA 3.7FR 35CM 8MM WMS CSCP BOTH IP/OP $73.50 $54.00 $13.02 $73.15 $73.15 $73.15 $73.15 $73.15 $73.15 $73.15 $13.02 $73.15 $73.15 $54.29 $54.29 $56.38 $38.11 $15.25 $73.15 $29.26 $73.15 $73.15 $73.15 $73.15 $73.15 $55.13 $73.15 $73.15 $73.15 $36.58 $36.58 $57.93 $73.15 $58.52 $47.55 $73.15 N/A $42.63 $73.15 $43.89 $73.15 $73.15 $73.15 N/A N/A G16696 SUP HCPCS C2627 G16696 - CATHETER PRSS 12FR 36CM 2CM BLN SIL RCTL BOTH IP/OP $166.50 $123.00 $32.97 $166.10 $90.19 $90.19 $90.19 $90.19 $166.10 $166.10 $166.10 $34.62 $166.10 $123.28 $123.28 $128.03 $86.54 $34.62 $166.10 $166.10 $98.25 $166.10 $166.10 $166.10 $166.10 $124.88 $166.10 $166.10 $166.10 $83.05 $83.05 $131.55 $166.10 $132.88 $107.97 $32.97 N/A $96.57 $166.10 $166.10 $166.10 $34.62 $166.10 N/A N/A G16699 SUP HCPCS C2627 G16699 - SET CATH TROC 8FR 54CM STRL DRN ADPR SPBC CYSTOSTOMY BOTH IP/OP $166.50 $123.00 $32.97 $166.10 $90.19 $90.19 $90.19 $90.19 $166.10 $166.10 $166.10 $34.62 $166.10 $123.28 $123.28 $128.03 $86.54 $34.62 $166.10 $166.10 $98.25 $166.10 $166.10 $166.10 $166.10 $124.88 $166.10 $166.10 $166.10 $83.05 $83.05 $131.55 $166.10 $132.88 $107.97 $32.97 N/A $96.57 $166.10 $166.10 $166.10 $34.62 $166.10 N/A N/A G16702 SUP HCPCS C1773 G16702 - SET CATH LOPRFL STD 10FR 54CM STRL TROC STY PLS DRN ADPR BOTH IP/OP $398.00 $295.00 $78.95 $397.80 $216.01 $216.01 $216.01 $216.01 $397.80 $397.80 $397.80 $82.91 $397.80 $295.25 $295.25 $306.62 $207.25 $82.91 $397.80 $397.80 $235.30 $397.80 $397.80 $397.80 $397.80 $298.50 $397.80 $397.80 $397.80 $198.90 $198.90 $315.06 $397.80 $318.24 $258.57 $78.95 N/A $230.84 $397.80 $397.80 $397.80 $82.90 $397.80 N/A N/A G16705 SUP HCPCS C1726 G16705 - FORCEPS SPEC RTRVL 2.5FR 10MM 115CM COAX SHTH GRSP BOTH IP/OP $98.50 $73.00 $19.49 $98.20 $53.32 $53.32 $53.32 $53.32 $98.20 $98.20 $98.20 $20.47 $98.20 $72.88 $72.88 $75.69 $51.16 $20.47 $98.20 $98.20 $58.09 $98.20 $98.20 $98.20 $98.20 $73.88 $98.20 $98.20 $98.20 $49.10 $49.10 $77.77 $98.20 $78.56 $63.83 $19.49 N/A $57.13 $98.20 $98.20 $98.20 $20.46 $98.20 N/A N/A G16708 SUP HCPCS C1758 G16708 - CATHETER URDY 7FR 43CM STRL 2 LUM LOOP URETHRA DISP BOTH IP/OP $29.00 $21.00 $5.68 $28.60 $15.53 $15.53 $15.53 $15.53 $28.60 $28.60 $28.60 $5.96 $28.60 $21.23 $21.23 $22.04 $14.90 $5.96 $28.60 $28.60 $16.92 $28.60 $28.60 $28.60 $28.60 $21.75 $28.60 $28.60 $28.60 $14.30 $14.30 $22.65 $28.60 $22.88 $18.59 $5.68 N/A $16.82 $28.60 $28.60 $28.60 $5.96 $28.60 N/A N/A G16731 SUP HCPCS C2617 G16731 - CATHETER URET .038IN 6FR 10CM FLXTP OP-EN GW MOD BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G16740 SUP HCPCS C2627 G16740 - SET CATH 12FR 16GA 30CM UNIVERSA MLCT 1 WY STPCK CNCT TUBE BOTH IP/OP $166.50 $123.00 $32.97 $166.10 $90.19 $90.19 $90.19 $90.19 $166.10 $166.10 $166.10 $34.62 $166.10 $123.28 $123.28 $128.03 $86.54 $34.62 $166.10 $166.10 $98.25 $166.10 $166.10 $166.10 $166.10 $124.88 $166.10 $166.10 $166.10 $83.05 $83.05 $131.55 $166.10 $132.88 $107.97 $32.97 N/A $96.57 $166.10 $166.10 $166.10 $34.62 $166.10 N/A N/A G16758 SUP HCPCS C2617 G16758 - SET STNT .038IN CDE 3FR 4FR 8-12CM STRL CATH RADOPQ MTLNTH BOTH IP/OP $67.00 $50.00 $13.22 $66.63 $29.98 $29.98 $29.98 $29.98 $66.63 $66.63 $66.63 $13.89 $66.63 $66.63 $66.63 $66.63 $66.63 $13.89 $66.63 $66.63 $39.41 $66.63 $66.63 $66.63 $66.63 $50.25 $66.63 $66.63 $66.63 $33.32 $33.32 $52.77 $66.63 $53.30 $29.98 $13.22 N/A $38.86 $66.63 $66.63 $66.63 $13.89 $66.63 N/A N/A G16775 SUP Custom 27203010 G16775 - STENT URTH 6FR 12CM STRL ZAONTZ PS DRN DISP HYPOSPADIAS BOTH IP/OP $78.50 $58.00 $13.90 $78.10 $78.10 $78.10 $78.10 $78.10 $78.10 $78.10 $13.90 $78.10 $78.10 $57.97 $57.97 $60.20 $40.69 $16.28 $78.10 $31.24 $78.10 $78.10 $78.10 $78.10 $78.10 $58.88 $78.10 $78.10 $78.10 $39.05 $39.05 $61.86 $78.10 $62.48 $50.77 $78.10 N/A $45.53 $78.10 $46.86 $78.10 $78.10 $78.10 N/A N/A G16780 SUP HCPCS C1726 G16780 - NEEDLE ESCP 4.5MM 18GA 10CM INCISING RNL FSCA BOTH IP/OP $49.50 $37.00 $9.75 $49.10 $26.66 $26.66 $26.66 $26.66 $49.10 $49.10 $49.10 $10.23 $49.10 $36.44 $36.44 $37.85 $25.58 $10.23 $49.10 $49.10 $29.04 $49.10 $49.10 $49.10 $49.10 $37.13 $49.10 $49.10 $49.10 $24.55 $24.55 $38.89 $49.10 $39.28 $31.92 $9.75 N/A $28.71 $49.10 $49.10 $49.10 $10.23 $49.10 N/A N/A G16783 SUP HCPCS C1758 G16783 - CATHETER URDY 7FR 30CM 2 LUM BOTH IP/OP $32.00 $24.00 $6.28 $31.63 $17.18 $17.18 $17.18 $17.18 $31.63 $31.63 $31.63 $6.59 $31.63 $23.48 $23.48 $24.38 $16.48 $6.59 $31.63 $31.63 $18.71 $31.63 $31.63 $31.63 $31.63 $24.00 $31.63 $31.63 $31.63 $15.82 $15.82 $25.05 $31.63 $25.30 $20.56 $6.28 N/A $18.56 $31.63 $31.63 $31.63 $6.59 $31.63 N/A N/A G16784 SUP HCPCS C1758 G16784 - CATHETER URET 4FR 110CM RND TIP RT BOTH IP/OP $32.00 $24.00 $6.28 $31.63 $17.18 $17.18 $17.18 $17.18 $31.63 $31.63 $31.63 $6.59 $31.63 $23.48 $23.48 $24.38 $16.48 $6.59 $31.63 $31.63 $18.71 $31.63 $31.63 $31.63 $31.63 $24.00 $31.63 $31.63 $31.63 $15.82 $15.82 $25.05 $31.63 $25.30 $20.56 $6.28 N/A $18.56 $31.63 $31.63 $31.63 $6.59 $31.63 N/A N/A G16791 SUP HCPCS C2627 G16791 - CATHETER URET 3FR 70CM RND TIP STY PORT LT BOTH IP/OP $51.00 $38.00 $10.04 $50.60 $27.48 $27.48 $27.48 $27.48 $50.60 $50.60 $50.60 $10.55 $50.60 $37.56 $37.56 $39.00 $26.36 $10.55 $50.60 $50.60 $29.93 $50.60 $50.60 $50.60 $50.60 $38.25 $50.60 $50.60 $50.60 $25.30 $25.30 $40.08 $50.60 $40.48 $32.89 $10.04 N/A $29.58 $50.60 $50.60 $50.60 $10.55 $50.60 N/A N/A G16792 SUP HCPCS C1758 G16792 - CATHETER SPBC 8FR 54CM CYSTOSTOMY SFT LOPRFL BOTH IP/OP $35.50 $26.00 $7.03 $35.43 $19.24 $19.24 $19.24 $19.24 $35.43 $35.43 $35.43 $7.38 $35.43 $26.30 $26.30 $27.31 $18.46 $7.38 $35.43 $35.43 $20.96 $35.43 $35.43 $35.43 $35.43 $26.63 $35.43 $35.43 $35.43 $17.72 $17.72 $28.06 $35.43 $28.34 $23.03 $7.03 N/A $20.59 $35.43 $35.43 $35.43 $7.38 $35.43 N/A N/A G16816 SUP HCPCS C1729 G16816 - CATHETER URET .038IN 5FR 70CM FLXTP OP-EN GW MOD BOTH IP/OP $216.50 $160.00 $42.94 $216.33 $117.47 $117.47 $117.47 $117.47 $216.33 $216.33 $216.33 $45.09 $216.33 $160.56 $160.56 $166.75 $112.71 $45.09 $216.33 $216.33 $127.96 $216.33 $216.33 $216.33 $216.33 $162.38 $216.33 $216.33 $216.33 $108.17 $108.17 $171.33 $216.33 $173.06 $140.61 $42.94 N/A $125.57 $216.33 $216.33 $216.33 $45.08 $216.33 N/A N/A G16817 SUP HCPCS C2625 G16817 - SET NPHSTM 12FR 40CM COPE LOOP MOD NDL GW CNN DIL BOTH IP/OP $139.50 $103.00 $27.67 $139.40 $62.73 $62.73 $62.73 $62.73 $139.40 $139.40 $139.40 $29.05 $139.40 $139.40 $139.40 $139.40 $139.40 $29.05 $139.40 $139.40 $82.46 $139.40 $139.40 $139.40 $139.40 $104.63 $139.40 $139.40 $139.40 $69.70 $69.70 $110.40 $139.40 $111.52 $62.73 $27.67 N/A $80.91 $139.40 $139.40 $139.40 $29.05 $139.40 N/A N/A G16818 SUP HCPCS C2625 G16818 - SET STNT .038IN 5MM 6FR 75CM STRL 100CM BNDR CATH RADOPQ BOTH IP/OP $139.50 $103.00 $27.67 $139.40 $62.73 $62.73 $62.73 $62.73 $139.40 $139.40 $139.40 $29.05 $139.40 $139.40 $139.40 $139.40 $139.40 $29.05 $139.40 $139.40 $82.46 $139.40 $139.40 $139.40 $139.40 $104.63 $139.40 $139.40 $139.40 $69.70 $69.70 $110.40 $139.40 $111.52 $62.73 $27.67 N/A $80.91 $139.40 $139.40 $139.40 $29.05 $139.40 N/A N/A G16820 SUP HCPCS C2617 G16820 - SET STNT .038IN 5MM 6FR 75CM STRL 100CM BNDR CATH RADOPQ BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G16821 SUP HCPCS C2617 G16821 - SET STNT .018IN SM 2 PGTL CRV CDE 3FR 16CM STRL CP MDRL CATH BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G16876 SUP HCPCS C1769 G16876 - SET STNT .018IN SM 2 PGTL CRV CDE 3FR 20CM STRL CP MDRL CATH BOTH IP/OP $39.50 $29.00 $7.81 $39.33 $21.36 $21.36 $21.36 $21.36 $39.33 $39.33 $39.33 $8.20 $39.33 $29.19 $29.19 $30.32 $20.49 $8.20 $39.33 $39.33 $23.26 $39.33 $39.33 $39.33 $39.33 $29.63 $39.33 $39.33 $39.33 $19.67 $19.67 $31.15 $39.33 $31.46 $25.56 $7.81 N/A $22.91 $39.33 $39.33 $39.33 $8.20 $39.33 N/A N/A G16880 SUP HCPCS C2617 G16880 - GUIDEWIRE ESCP 70CM STD STRG .038IN 145CM STRL 3CM FXCR FLX BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G16881 SUP HCPCS C2617 G16881 - SET STNT .018IN SM 2 PGTL CRV CDE 3FR 22CM STRL CP MDRL CATH BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G16890 SUP HCPCS C1758 G16890 - SET STNT .018IN SM 2 PGTL CRV CDE 3FR 24CM STRL CP MDRL CATH BOTH IP/OP $182.50 $135.00 $36.21 $182.45 $99.07 $99.07 $99.07 $99.07 $182.45 $182.45 $182.45 $38.03 $182.45 $135.41 $135.41 $140.63 $95.06 $38.02 $182.45 $182.45 $107.92 $182.45 $182.45 $182.45 $182.45 $136.88 $182.45 $182.45 $182.45 $91.23 $91.23 $144.50 $182.45 $145.96 $118.59 $36.21 N/A $105.85 $182.45 $182.45 $182.45 $38.02 $182.45 N/A N/A G16893 SUP HCPCS C1726 G16893 - SET CATH 7.5FR 25CM DEWAN URDY NDL SF WRE PLWY SHTH DIL SPBC BOTH IP/OP $511.00 $378.00 $101.41 $510.95 $277.45 $277.45 $277.45 $277.45 $510.95 $510.95 $510.95 $106.49 $510.95 $379.23 $379.23 $393.84 $266.20 $106.49 $510.95 $510.95 $302.23 $510.95 $510.95 $510.95 $510.95 $383.25 $510.95 $510.95 $510.95 $255.48 $255.48 $404.67 $510.95 $408.76 $332.12 $101.41 N/A $296.38 $510.95 $510.95 $510.95 $106.48 $510.95 N/A N/A G16919 SUP HCPCS C2627 G16919 - SYSTEM IRR URTSCP BOTH IP/OP $205.50 $152.00 $40.76 $205.38 $111.52 $111.52 $111.52 $111.52 $205.38 $205.38 $205.38 $42.81 $205.38 $152.43 $152.43 $158.31 $107.00 $42.80 $205.38 $205.38 $121.48 $205.38 $205.38 $205.38 $205.38 $154.13 $205.38 $205.38 $205.38 $102.69 $102.69 $162.66 $205.38 $164.30 $133.50 $40.76 N/A $119.19 $205.38 $205.38 $205.38 $42.80 $205.38 N/A N/A G16920 SUP HCPCS C2627 G16920 - CATHETER SPBC 8FR 20CM STRL MLCT SIL DISP BOTH IP/OP $205.50 $152.00 $40.76 $205.38 $111.52 $111.52 $111.52 $111.52 $205.38 $205.38 $205.38 $42.81 $205.38 $152.43 $152.43 $158.31 $107.00 $42.80 $205.38 $205.38 $121.48 $205.38 $205.38 $205.38 $205.38 $154.13 $205.38 $205.38 $205.38 $102.69 $102.69 $162.66 $205.38 $164.30 $133.50 $40.76 N/A $119.19 $205.38 $205.38 $205.38 $42.80 $205.38 N/A N/A G16921 SUP HCPCS C2627 G16921 - CATHETER SPBC 10FR 20CM MLCT WNG SFT SIL BOTH IP/OP $205.50 $152.00 $40.76 $205.38 $111.52 $111.52 $111.52 $111.52 $205.38 $205.38 $205.38 $42.81 $205.38 $152.43 $152.43 $158.31 $107.00 $42.80 $205.38 $205.38 $121.48 $205.38 $205.38 $205.38 $205.38 $154.13 $205.38 $205.38 $205.38 $102.69 $102.69 $162.66 $205.38 $164.30 $133.50 $40.76 N/A $119.19 $205.38 $205.38 $205.38 $42.80 $205.38 N/A N/A G16922 SUP HCPCS C2627 G16922 - CATHETER SPBC 12FR 20CM STRL MLCT SIL DISP BOTH IP/OP $205.50 $152.00 $40.76 $205.38 $111.52 $111.52 $111.52 $111.52 $205.38 $205.38 $205.38 $42.81 $205.38 $152.43 $152.43 $158.31 $107.00 $42.80 $205.38 $205.38 $121.48 $205.38 $205.38 $205.38 $205.38 $154.13 $205.38 $205.38 $205.38 $102.69 $102.69 $162.66 $205.38 $164.30 $133.50 $40.76 N/A $119.19 $205.38 $205.38 $205.38 $42.80 $205.38 N/A N/A G16923 SUP HCPCS C2627 G16923 - CATHETER SPBC 14FR 25CM STRL MLCT WNG SIL DISP BOTH IP/OP $205.50 $152.00 $40.76 $205.38 $111.52 $111.52 $111.52 $111.52 $205.38 $205.38 $205.38 $42.81 $205.38 $152.43 $152.43 $158.31 $107.00 $42.80 $205.38 $205.38 $121.48 $205.38 $205.38 $205.38 $205.38 $154.13 $205.38 $205.38 $205.38 $102.69 $102.69 $162.66 $205.38 $164.30 $133.50 $40.76 N/A $119.19 $205.38 $205.38 $205.38 $42.80 $205.38 N/A N/A G16924 SUP HCPCS C2627 G16924 - CATHETER SPBC 16FR 25CM STRL MLCT WNG SIL DISP BOTH IP/OP $205.50 $152.00 $40.76 $205.38 $111.52 $111.52 $111.52 $111.52 $205.38 $205.38 $205.38 $42.81 $205.38 $152.43 $152.43 $158.31 $107.00 $42.80 $205.38 $205.38 $121.48 $205.38 $205.38 $205.38 $205.38 $154.13 $205.38 $205.38 $205.38 $102.69 $102.69 $162.66 $205.38 $164.30 $133.50 $40.76 N/A $119.19 $205.38 $205.38 $205.38 $42.80 $205.38 N/A N/A G16925 SUP HCPCS C2627 G16925 - CATHETER SPBC 18FR 25CM MLCT WNG SFT SIL BOTH IP/OP $205.50 $152.00 $40.76 $205.38 $111.52 $111.52 $111.52 $111.52 $205.38 $205.38 $205.38 $42.81 $205.38 $152.43 $152.43 $158.31 $107.00 $42.80 $205.38 $205.38 $121.48 $205.38 $205.38 $205.38 $205.38 $154.13 $205.38 $205.38 $205.38 $102.69 $102.69 $162.66 $205.38 $164.30 $133.50 $40.76 N/A $119.19 $205.38 $205.38 $205.38 $42.80 $205.38 N/A N/A G16926 SUP HCPCS C2627 G16926 - CATHETER SPBC 20FR 25CM STRL MLCT WNG SIL DISP BOTH IP/OP $205.50 $152.00 $40.76 $205.38 $111.52 $111.52 $111.52 $111.52 $205.38 $205.38 $205.38 $42.81 $205.38 $152.43 $152.43 $158.31 $107.00 $42.80 $205.38 $205.38 $121.48 $205.38 $205.38 $205.38 $205.38 $154.13 $205.38 $205.38 $205.38 $102.69 $102.69 $162.66 $205.38 $164.30 $133.50 $40.76 N/A $119.19 $205.38 $205.38 $205.38 $42.80 $205.38 N/A N/A G16927 SUP HCPCS C2627 G16927 - CATHETER SPBC 22FR 25CM STRL MLCT WNG SIL DISP BOTH IP/OP $205.50 $152.00 $40.76 $205.38 $111.52 $111.52 $111.52 $111.52 $205.38 $205.38 $205.38 $42.81 $205.38 $152.43 $152.43 $158.31 $107.00 $42.80 $205.38 $205.38 $121.48 $205.38 $205.38 $205.38 $205.38 $154.13 $205.38 $205.38 $205.38 $102.69 $102.69 $162.66 $205.38 $164.30 $133.50 $40.76 N/A $119.19 $205.38 $205.38 $205.38 $42.80 $205.38 N/A N/A G16938 SUP HCPCS C2625 G16938 - CATHETER SPBC 24FR 25CM STRL MLCT WNG SFT SIL BOTH IP/OP $160.50 $119.00 $31.82 $160.30 $72.14 $72.14 $72.14 $72.14 $160.30 $160.30 $160.30 $33.41 $160.30 $160.30 $160.30 $160.30 $160.30 $33.41 $160.30 $160.30 $94.82 $160.30 $160.30 $160.30 $160.30 $120.38 $160.30 $160.30 $160.30 $80.15 $80.15 $126.96 $160.30 $128.24 $72.14 $31.82 N/A $93.09 $160.30 $160.30 $160.30 $33.41 $160.30 N/A N/A G16939 SUP Custom 27203010 G16939 - SET STNT .038IN 5MM PGTL CRV TPR 7FR 75CM STRL 100CM BNDR BOTH IP/OP $266.50 $197.00 $47.38 $266.20 $266.20 $266.20 $266.20 $266.20 $266.20 $266.20 $47.38 $266.20 $266.20 $197.57 $197.57 $205.19 $138.69 $55.48 $266.20 $106.48 $266.20 $266.20 $266.20 $266.20 $266.20 $199.88 $266.20 $266.20 $266.20 $133.10 $133.10 $210.83 $266.20 $212.96 $173.03 $266.20 N/A $154.57 $266.20 $159.72 $266.20 $266.20 $266.20 N/A N/A G16940 SUP Custom 27203010 G16940 - SET NPHSTM 16.8CM NDL GW PERC BOTH IP/OP $306.50 $227.00 $54.49 $306.13 $306.13 $306.13 $306.13 $306.13 $306.13 $306.13 $54.49 $306.13 $306.13 $227.21 $227.21 $235.97 $159.49 $63.80 $306.13 $122.45 $306.13 $306.13 $306.13 $306.13 $306.13 $229.88 $306.13 $306.13 $306.13 $153.07 $153.07 $242.45 $306.13 $244.90 $198.98 $306.13 N/A $177.77 $306.13 $183.68 $306.13 $306.13 $306.13 N/A N/A G16987 SUP HCPCS C1726 G16987 - SET NPHSTM NDL SHTH PERC BOTH IP/OP $111.00 $82.00 $22.03 $111.00 $60.27 $60.27 $60.27 $60.27 $111.00 $111.00 $111.00 $23.14 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $111.00 $65.66 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $22.03 N/A $64.38 $111.00 $111.00 $111.00 $23.13 $111.00 N/A N/A G16989 SUP HCPCS C1758 G16989 - CATHETER URDY 7.4FR 30CM 3 LUM CDE OVL PORT BLN BOTH IP/OP $32.00 $24.00 $6.28 $31.63 $17.18 $17.18 $17.18 $17.18 $31.63 $31.63 $31.63 $6.59 $31.63 $23.48 $23.48 $24.38 $16.48 $6.59 $31.63 $31.63 $18.71 $31.63 $31.63 $31.63 $31.63 $24.00 $31.63 $31.63 $31.63 $15.82 $15.82 $25.05 $31.63 $25.30 $20.56 $6.28 N/A $18.56 $31.63 $31.63 $31.63 $6.59 $31.63 N/A N/A G16992 SUP HCPCS C2625 G16992 - CATHETER URET .038IN 5FR 70CM OP-EN GW BOTH IP/OP $236.00 $175.00 $46.79 $235.75 $106.09 $106.09 $106.09 $106.09 $235.75 $235.75 $235.75 $49.14 $235.75 $235.75 $235.75 $235.75 $235.75 $49.13 $235.75 $235.75 $139.45 $235.75 $235.75 $235.75 $235.75 $177.00 $235.75 $235.75 $235.75 $117.88 $117.88 $186.71 $235.75 $188.60 $106.09 $46.79 N/A $136.88 $235.75 $235.75 $235.75 $49.13 $235.75 N/A N/A G16993 SUP HCPCS C2625 G16993 - SET STNT .038IN 5MM PGTL CRV 4.7FR 75CM STRL 100CM BNDR CATH BOTH IP/OP $379.50 $281.00 $75.27 $379.25 $170.66 $170.66 $170.66 $170.66 $379.25 $379.25 $379.25 $79.05 $379.25 $379.25 $379.25 $379.25 $379.25 $79.04 $379.25 $379.25 $224.33 $379.25 $379.25 $379.25 $379.25 $284.63 $379.25 $379.25 $379.25 $189.63 $189.63 $300.37 $379.25 $303.40 $170.66 $75.27 N/A $220.11 $379.25 $379.25 $379.25 $79.04 $379.25 N/A N/A G16994 SUP HCPCS C2625 G16994 - SET STNT .038IN 5MM PGTL CRV 8.4FR 90CM STRL 125CM BNDR CATH BOTH IP/OP $379.50 $281.00 $75.27 $379.25 $170.66 $170.66 $170.66 $170.66 $379.25 $379.25 $379.25 $79.05 $379.25 $379.25 $379.25 $379.25 $379.25 $79.04 $379.25 $379.25 $224.33 $379.25 $379.25 $379.25 $379.25 $284.63 $379.25 $379.25 $379.25 $189.63 $189.63 $300.37 $379.25 $303.40 $170.66 $75.27 N/A $220.11 $379.25 $379.25 $379.25 $79.04 $379.25 N/A N/A G16995 SUP HCPCS C2625 G16995 - SET STENT .038IN 5MM PIGTAIL CURVE 8.2FR 75CM 100CM CATHETER BOTH IP/OP $236.00 $175.00 $46.79 $235.75 $106.09 $106.09 $106.09 $106.09 $235.75 $235.75 $235.75 $49.14 $235.75 $235.75 $235.75 $235.75 $235.75 $49.13 $235.75 $235.75 $139.45 $235.75 $235.75 $235.75 $235.75 $177.00 $235.75 $235.75 $235.75 $117.88 $117.88 $186.71 $235.75 $188.60 $106.09 $46.79 N/A $136.88 $235.75 $235.75 $235.75 $49.13 $235.75 N/A N/A G16996 SUP HCPCS C2625 G16996 - SET STNT .038IN 5MM PGTL CRV 7.2FR 90CM STRL 125CM BNDR CATH BOTH IP/OP $236.00 $175.00 $46.79 $235.75 $106.09 $106.09 $106.09 $106.09 $235.75 $235.75 $235.75 $49.14 $235.75 $235.75 $235.75 $235.75 $235.75 $49.13 $235.75 $235.75 $139.45 $235.75 $235.75 $235.75 $235.75 $177.00 $235.75 $235.75 $235.75 $117.88 $117.88 $186.71 $235.75 $188.60 $106.09 $46.79 N/A $136.88 $235.75 $235.75 $235.75 $49.13 $235.75 N/A N/A G16997 SUP HCPCS C2625 G16997 - SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100CM BNDR CATH BOTH IP/OP $236.00 $175.00 $46.79 $235.75 $106.09 $106.09 $106.09 $106.09 $235.75 $235.75 $235.75 $49.14 $235.75 $235.75 $235.75 $235.75 $235.75 $49.13 $235.75 $235.75 $139.45 $235.75 $235.75 $235.75 $235.75 $177.00 $235.75 $235.75 $235.75 $117.88 $117.88 $186.71 $235.75 $188.60 $106.09 $46.79 N/A $136.88 $235.75 $235.75 $235.75 $49.13 $235.75 N/A N/A G17013 SUP HCPCS C1758 G17013 - CATHETER URET .05IN 10FR 50CM STRL LF 2 INJ LUM TPR TIP BOTH IP/OP $79.50 $59.00 $15.72 $79.20 $43.01 $43.01 $43.01 $43.01 $79.20 $79.20 $79.20 $16.51 $79.20 $58.78 $58.78 $61.05 $41.26 $16.51 $79.20 $79.20 $46.85 $79.20 $79.20 $79.20 $79.20 $59.63 $79.20 $79.20 $79.20 $39.60 $39.60 $62.73 $79.20 $63.36 $51.48 $15.72 N/A $46.11 $79.20 $79.20 $79.20 $16.51 $79.20 N/A N/A G17018 SUP Custom 27203010 G17018 - SET STNT .038IN 5MM PGTL CRV 6FR 75CM STRL 100CM BNDR CATH BOTH IP/OP $89.50 $66.00 $15.86 $89.10 $89.10 $89.10 $89.10 $89.10 $89.10 $89.10 $15.86 $89.10 $89.10 $66.13 $66.13 $68.68 $46.42 $18.57 $89.10 $35.64 $89.10 $89.10 $89.10 $89.10 $89.10 $67.13 $89.10 $89.10 $89.10 $44.55 $44.55 $70.57 $89.10 $71.28 $57.92 $89.10 N/A $51.91 $89.10 $53.46 $89.10 $89.10 $89.10 N/A N/A G17043 SUP HCPCS C1726 G17043 - TUBE CNCT 5FR 10CM M TO F LL MOD BOTH IP/OP $74.00 $55.00 $14.61 $73.60 $39.96 $39.96 $39.96 $39.96 $73.60 $73.60 $73.60 $15.34 $73.60 $54.63 $54.63 $56.73 $38.35 $15.34 $73.60 $73.60 $43.53 $73.60 $73.60 $73.60 $73.60 $55.50 $73.60 $73.60 $73.60 $36.80 $36.80 $58.29 $73.60 $58.88 $47.84 $14.61 N/A $42.92 $73.60 $73.60 $73.60 $15.34 $73.60 N/A N/A G17051 SUP HCPCS C1758 G17051 - CATHETER URDY 7FR 38CM CLR JSPH 2 LUM NRDOP BOTH IP/OP $29.00 $21.00 $5.68 $28.60 $15.53 $15.53 $15.53 $15.53 $28.60 $28.60 $28.60 $5.96 $28.60 $21.23 $21.23 $22.04 $14.90 $5.96 $28.60 $28.60 $16.92 $28.60 $28.60 $28.60 $28.60 $21.75 $28.60 $28.60 $28.60 $14.30 $14.30 $22.65 $28.60 $22.88 $18.59 $5.68 N/A $16.82 $28.60 $28.60 $28.60 $5.96 $28.60 N/A N/A G17083 SUP HCPCS C1758 G17083 - ADAPTER CATH STD TLR LL SYR BOTH IP/OP $56.50 $42.00 $11.13 $56.10 $30.46 $30.46 $30.46 $30.46 $56.10 $56.10 $56.10 $11.69 $56.10 $41.64 $41.64 $43.24 $29.23 $11.69 $56.10 $56.10 $33.18 $56.10 $56.10 $56.10 $56.10 $42.38 $56.10 $56.10 $56.10 $28.05 $28.05 $44.43 $56.10 $44.88 $36.47 $11.13 N/A $32.77 $56.10 $56.10 $56.10 $11.69 $56.10 N/A N/A G17104 SUP Custom 27203010 G17104 - CATHETER URET .028IN 4FR 70CM FLXTP OP-EN GW MOD BOTH IP/OP $306.50 $227.00 $54.49 $306.13 $306.13 $306.13 $306.13 $306.13 $306.13 $306.13 $54.49 $306.13 $306.13 $227.21 $227.21 $235.97 $159.49 $63.80 $306.13 $122.45 $306.13 $306.13 $306.13 $306.13 $306.13 $229.88 $306.13 $306.13 $306.13 $153.07 $153.07 $242.45 $306.13 $244.90 $198.98 $306.13 N/A $177.77 $306.13 $183.68 $306.13 $306.13 $306.13 N/A N/A G17128 SUP HCPCS C1769 G17128 - SET NPHSTM 6-12FR NDL GW DIL PERC BOTH IP/OP $248.50 $184.00 $49.28 $248.30 $134.83 $134.83 $134.83 $134.83 $248.30 $248.30 $248.30 $51.75 $248.30 $184.29 $184.29 $191.39 $129.36 $51.75 $248.30 $248.30 $146.87 $248.30 $248.30 $248.30 $248.30 $186.38 $248.30 $248.30 $248.30 $124.15 $124.15 $196.65 $248.30 $198.64 $161.40 $49.28 N/A $144.13 $248.30 $248.30 $248.30 $51.75 $248.30 N/A N/A G17130 SUP HCPCS C2617 G17130 - SET STNT .038IN 2 PGTL CRV 6FR 10CM STRL CATH RADOPQ PSTNR BOTH IP/OP $312.50 $231.00 $62.00 $312.38 $140.57 $140.57 $140.57 $140.57 $312.38 $312.38 $312.38 $65.11 $312.38 $312.38 $312.38 $312.38 $312.38 $65.10 $312.38 $312.38 $184.77 $312.38 $312.38 $312.38 $312.38 $234.38 $312.38 $312.38 $312.38 $156.19 $156.19 $247.40 $312.38 $249.90 $140.57 $62.00 N/A $181.25 $312.38 $312.38 $312.38 $65.10 $312.38 N/A N/A G17131 SUP HCPCS C2617 G17131 - SET STNT 2 PGTL CRV 7-14FR 30CM 13CM RELS SLV PSTNR ULTHNE BOTH IP/OP $312.50 $231.00 $62.00 $312.38 $140.57 $140.57 $140.57 $140.57 $312.38 $312.38 $312.38 $65.11 $312.38 $312.38 $312.38 $312.38 $312.38 $65.10 $312.38 $312.38 $184.77 $312.38 $312.38 $312.38 $312.38 $234.38 $312.38 $312.38 $312.38 $156.19 $156.19 $247.40 $312.38 $249.90 $140.57 $62.00 N/A $181.25 $312.38 $312.38 $312.38 $65.10 $312.38 N/A N/A G17132 SUP HCPCS C2617 G17132 - SET STNT .038IN 2 PGTL CRV 7-14FR 13CM STRL 28CM RADOPQ BOTH IP/OP $312.50 $231.00 $62.00 $312.38 $140.57 $140.57 $140.57 $140.57 $312.38 $312.38 $312.38 $65.11 $312.38 $312.38 $312.38 $312.38 $312.38 $65.10 $312.38 $312.38 $184.77 $312.38 $312.38 $312.38 $312.38 $234.38 $312.38 $312.38 $312.38 $156.19 $156.19 $247.40 $312.38 $249.90 $140.57 $62.00 N/A $181.25 $312.38 $312.38 $312.38 $65.10 $312.38 N/A N/A G17133 SUP HCPCS C2617 G17133 - SET STNT BCNTP 7-14FR 26CM STRL 13CM RELS SLV PSTNR ULTHNE BOTH IP/OP $312.50 $231.00 $62.00 $312.38 $140.57 $140.57 $140.57 $140.57 $312.38 $312.38 $312.38 $65.11 $312.38 $312.38 $312.38 $312.38 $312.38 $65.10 $312.38 $312.38 $184.77 $312.38 $312.38 $312.38 $312.38 $234.38 $312.38 $312.38 $312.38 $156.19 $156.19 $247.40 $312.38 $249.90 $140.57 $62.00 N/A $181.25 $312.38 $312.38 $312.38 $65.10 $312.38 N/A N/A G17135 SUP HCPCS C2617 G17135 - SET STNT 2 PGTL CRV 7-14FR 24CM 13CM RELS SLV PSTNR ULTHNE BOTH IP/OP $312.50 $231.00 $62.00 $312.38 $140.57 $140.57 $140.57 $140.57 $312.38 $312.38 $312.38 $65.11 $312.38 $312.38 $312.38 $312.38 $312.38 $65.10 $312.38 $312.38 $184.77 $312.38 $312.38 $312.38 $312.38 $234.38 $312.38 $312.38 $312.38 $156.19 $156.19 $247.40 $312.38 $249.90 $140.57 $62.00 N/A $181.25 $312.38 $312.38 $312.38 $65.10 $312.38 N/A N/A G17136 SUP HCPCS C2617 G17136 - SET STNT 2 PGTL CRV 7-14FR 22CM 13CM RELS SLV PSTNR ULTHNE BOTH IP/OP $312.50 $231.00 $62.00 $312.38 $140.57 $140.57 $140.57 $140.57 $312.38 $312.38 $312.38 $65.11 $312.38 $312.38 $312.38 $312.38 $312.38 $65.10 $312.38 $312.38 $184.77 $312.38 $312.38 $312.38 $312.38 $234.38 $312.38 $312.38 $312.38 $156.19 $156.19 $247.40 $312.38 $249.90 $140.57 $62.00 N/A $181.25 $312.38 $312.38 $312.38 $65.10 $312.38 N/A N/A G17138 SUP HCPCS C2617 G17138 - SET STNT .038IN 2 PGTL CRV 7-14FR 13CM STRL 20CM RADOPQ BOTH IP/OP $312.50 $231.00 $62.00 $312.38 $140.57 $140.57 $140.57 $140.57 $312.38 $312.38 $312.38 $65.11 $312.38 $312.38 $312.38 $312.38 $312.38 $65.10 $312.38 $312.38 $184.77 $312.38 $312.38 $312.38 $312.38 $234.38 $312.38 $312.38 $312.38 $156.19 $156.19 $247.40 $312.38 $249.90 $140.57 $62.00 N/A $181.25 $312.38 $312.38 $312.38 $65.10 $312.38 N/A N/A G17139 SUP HCPCS C2617 G17139 - SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 30CM RADOPQ BOTH IP/OP $272.00 $201.00 $53.91 $271.63 $122.23 $122.23 $122.23 $122.23 $271.63 $271.63 $271.63 $56.61 $271.63 $271.63 $271.63 $271.63 $271.63 $56.61 $271.63 $271.63 $160.67 $271.63 $271.63 $271.63 $271.63 $204.00 $271.63 $271.63 $271.63 $135.82 $135.82 $215.13 $271.63 $217.30 $122.23 $53.91 N/A $157.76 $271.63 $271.63 $271.63 $56.61 $271.63 N/A N/A G17140 SUP HCPCS C2617 G17140 - STENT URET THNWL PGTL CRV 7-14FR 26CM STRL LF RTRMX+ PSTNR BOTH IP/OP $312.50 $231.00 $62.00 $312.38 $140.57 $140.57 $140.57 $140.57 $312.38 $312.38 $312.38 $65.11 $312.38 $312.38 $312.38 $312.38 $312.38 $65.10 $312.38 $312.38 $184.77 $312.38 $312.38 $312.38 $312.38 $234.38 $312.38 $312.38 $312.38 $156.19 $156.19 $247.40 $312.38 $249.90 $140.57 $62.00 N/A $181.25 $312.38 $312.38 $312.38 $65.10 $312.38 N/A N/A G17141 SUP HCPCS C2617 G17141 - SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 28CM RADOPQ BOTH IP/OP $312.50 $231.00 $62.00 $312.38 $140.57 $140.57 $140.57 $140.57 $312.38 $312.38 $312.38 $65.11 $312.38 $312.38 $312.38 $312.38 $312.38 $65.10 $312.38 $312.38 $184.77 $312.38 $312.38 $312.38 $312.38 $234.38 $312.38 $312.38 $312.38 $156.19 $156.19 $247.40 $312.38 $249.90 $140.57 $62.00 N/A $181.25 $312.38 $312.38 $312.38 $65.10 $312.38 N/A N/A G17142 SUP HCPCS C2617 G17142 - SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 24CM RADOPQ BOTH IP/OP $312.50 $231.00 $62.00 $312.38 $140.57 $140.57 $140.57 $140.57 $312.38 $312.38 $312.38 $65.11 $312.38 $312.38 $312.38 $312.38 $312.38 $65.10 $312.38 $312.38 $184.77 $312.38 $312.38 $312.38 $312.38 $234.38 $312.38 $312.38 $312.38 $156.19 $156.19 $247.40 $312.38 $249.90 $140.57 $62.00 N/A $181.25 $312.38 $312.38 $312.38 $65.10 $312.38 N/A N/A G17143 SUP HCPCS C2617 G17143 - SET STNT 2 PGTL CRV 6-9.5FR 22CM 13CM RELS SLV PSTNR ULTHNE BOTH IP/OP $312.50 $231.00 $62.00 $312.38 $140.57 $140.57 $140.57 $140.57 $312.38 $312.38 $312.38 $65.11 $312.38 $312.38 $312.38 $312.38 $312.38 $65.10 $312.38 $312.38 $184.77 $312.38 $312.38 $312.38 $312.38 $234.38 $312.38 $312.38 $312.38 $156.19 $156.19 $247.40 $312.38 $249.90 $140.57 $62.00 N/A $181.25 $312.38 $312.38 $312.38 $65.10 $312.38 N/A N/A G17144 SUP HCPCS C2617 G17144 - SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 20CM RADOPQ BOTH IP/OP $312.50 $231.00 $62.00 $312.38 $140.57 $140.57 $140.57 $140.57 $312.38 $312.38 $312.38 $65.11 $312.38 $312.38 $312.38 $312.38 $312.38 $65.10 $312.38 $312.38 $184.77 $312.38 $312.38 $312.38 $312.38 $234.38 $312.38 $312.38 $312.38 $156.19 $156.19 $247.40 $312.38 $249.90 $140.57 $62.00 N/A $181.25 $312.38 $312.38 $312.38 $65.10 $312.38 N/A N/A G17145 SUP HCPCS C1758 G17145 - SET STNT .038IN 2 PGTL CRV 6-9.5FR 13CM STRL 18CM RADOPQ BOTH IP/OP $86.00 $64.00 $17.03 $85.80 $46.59 $46.59 $46.59 $46.59 $85.80 $85.80 $85.80 $17.88 $85.80 $63.68 $63.68 $66.13 $44.70 $17.88 $85.80 $85.80 $50.75 $85.80 $85.80 $85.80 $85.80 $64.50 $85.80 $85.80 $85.80 $42.90 $42.90 $67.95 $85.80 $68.64 $55.77 $17.03 N/A $49.88 $85.80 $85.80 $85.80 $17.88 $85.80 N/A N/A G17150 SUP HCPCS C2625 G17150 - CATHETER URET .04IN 6/10FR 50CM LF FLXTP 2 LUM GW AQ BOTH IP/OP $292.50 $216.00 $57.98 $292.13 $131.46 $131.46 $131.46 $131.46 $292.13 $292.13 $292.13 $60.89 $292.13 $292.13 $292.13 $292.13 $292.13 $60.88 $292.13 $292.13 $172.79 $292.13 $292.13 $292.13 $292.13 $219.38 $292.13 $292.13 $292.13 $146.07 $146.07 $231.37 $292.13 $233.70 $131.46 $57.98 N/A $169.65 $292.13 $292.13 $292.13 $60.88 $292.13 N/A N/A G17151 SUP HCPCS C2625 G17151 - SET STNT .038IN 3CM STRG 4.7FR 22-32CM STRL 145CM KWART BOTH IP/OP $292.50 $216.00 $57.98 $292.13 $131.46 $131.46 $131.46 $131.46 $292.13 $292.13 $292.13 $60.89 $292.13 $292.13 $292.13 $292.13 $292.13 $60.88 $292.13 $292.13 $172.79 $292.13 $292.13 $292.13 $292.13 $219.38 $292.13 $292.13 $292.13 $146.07 $146.07 $231.37 $292.13 $233.70 $131.46 $57.98 N/A $169.65 $292.13 $292.13 $292.13 $60.88 $292.13 N/A N/A G17152 SUP HCPCS C2625 G17152 - SET STNT .038IN 3CM STRG 6FR 22-32CM STRL 145CM KWART BOTH IP/OP $292.50 $216.00 $57.98 $292.13 $131.46 $131.46 $131.46 $131.46 $292.13 $292.13 $292.13 $60.89 $292.13 $292.13 $292.13 $292.13 $292.13 $60.88 $292.13 $292.13 $172.79 $292.13 $292.13 $292.13 $292.13 $219.38 $292.13 $292.13 $292.13 $146.07 $146.07 $231.37 $292.13 $233.70 $131.46 $57.98 N/A $169.65 $292.13 $292.13 $292.13 $60.88 $292.13 N/A N/A G17153 SUP HCPCS C2625 G17153 - SET STNT 7FR 22-32CM KWART RETRO-INJ SFLX MTLNTH RELS SLV GW BOTH IP/OP $292.50 $216.00 $57.98 $292.13 $131.46 $131.46 $131.46 $131.46 $292.13 $292.13 $292.13 $60.89 $292.13 $292.13 $292.13 $292.13 $292.13 $60.88 $292.13 $292.13 $172.79 $292.13 $292.13 $292.13 $292.13 $219.38 $292.13 $292.13 $292.13 $146.07 $146.07 $231.37 $292.13 $233.70 $131.46 $57.98 N/A $169.65 $292.13 $292.13 $292.13 $60.88 $292.13 N/A N/A G17155 SUP HCPCS C2627 G17155 - SET STNT .038IN 3CM STRG 8.2FR 22-32CM STRL 145CM KWART BOTH IP/OP $444.50 $329.00 $88.20 $444.40 $241.31 $241.31 $241.31 $241.31 $444.40 $444.40 $444.40 $92.62 $444.40 $329.83 $329.83 $342.54 $231.53 $92.62 $444.40 $444.40 $262.86 $444.40 $444.40 $444.40 $444.40 $333.38 $444.40 $444.40 $444.40 $222.20 $222.20 $351.96 $444.40 $355.52 $288.86 $88.20 N/A $257.81 $444.40 $444.40 $444.40 $92.61 $444.40 N/A N/A G17156 SUP HCPCS C1769 G17156 - SET NPHSTM 8.5FR 25CM STRL 2 GW CNN DIL MCLC CATH ULTHNE BOTH IP/OP $444.50 $329.00 $88.20 $444.40 $241.31 $241.31 $241.31 $241.31 $444.40 $444.40 $444.40 $92.62 $444.40 $329.83 $329.83 $342.54 $231.53 $92.62 $444.40 $444.40 $262.86 $444.40 $444.40 $444.40 $444.40 $333.38 $444.40 $444.40 $444.40 $222.20 $222.20 $351.96 $444.40 $355.52 $288.86 $88.20 N/A $257.81 $444.40 $444.40 $444.40 $92.61 $444.40 N/A N/A G17157 SUP HCPCS C2627 G17157 - SET NPHSTM 10.2FR 25CM STRL MCLC 2 GW CNN DIL CNCT TUBE BOTH IP/OP $511.50 $379.00 $101.43 $511.05 $277.50 $277.50 $277.50 $277.50 $511.05 $511.05 $511.05 $106.52 $511.05 $379.30 $379.30 $393.92 $266.26 $106.51 $511.05 $511.05 $302.29 $511.05 $511.05 $511.05 $511.05 $383.63 $511.05 $511.05 $511.05 $255.53 $255.53 $404.75 $511.05 $408.84 $332.18 $101.43 N/A $296.67 $511.05 $511.05 $511.05 $106.50 $511.05 N/A N/A G17158 SUP HCPCS C2627 G17158 - SET NPHSTM 12FR 25CM 2 GW CNN DIL CNCT TUBE MC LC LCK LOOP BOTH IP/OP $511.50 $379.00 $101.43 $511.05 $277.50 $277.50 $277.50 $277.50 $511.05 $511.05 $511.05 $106.52 $511.05 $379.30 $379.30 $393.92 $266.26 $106.51 $511.05 $511.05 $302.29 $511.05 $511.05 $511.05 $511.05 $383.63 $511.05 $511.05 $511.05 $255.53 $255.53 $404.75 $511.05 $408.84 $332.18 $101.43 N/A $296.67 $511.05 $511.05 $511.05 $106.50 $511.05 N/A N/A G17160 SUP HCPCS C1758 G17160 - SET NPHSTM 14FR 25CM 2 GW CNN DIL CNCT TUBE MC LC LCK LOOP BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G17185 SUP HCPCS C2625 G17185 - DRAIN INCS .25IN 12IN STRL LF PNRS SIL DISP OPN WND BOTH IP/OP $236.00 $175.00 $46.79 $235.75 $106.09 $106.09 $106.09 $106.09 $235.75 $235.75 $235.75 $49.14 $235.75 $235.75 $235.75 $235.75 $235.75 $49.13 $235.75 $235.75 $139.45 $235.75 $235.75 $235.75 $235.75 $177.00 $235.75 $235.75 $235.75 $117.88 $117.88 $186.71 $235.75 $188.60 $106.09 $46.79 N/A $136.88 $235.75 $235.75 $235.75 $49.13 $235.75 N/A N/A G17186 SUP HCPCS C2625 G17186 - SET STNT 8.2FR 75CM BNDR SFLX OP-EN DVRSN URETER BOTH IP/OP $236.00 $175.00 $46.79 $235.75 $106.09 $106.09 $106.09 $106.09 $235.75 $235.75 $235.75 $49.14 $235.75 $235.75 $235.75 $235.75 $235.75 $49.13 $235.75 $235.75 $139.45 $235.75 $235.75 $235.75 $235.75 $177.00 $235.75 $235.75 $235.75 $117.88 $117.88 $186.71 $235.75 $188.60 $106.09 $46.79 N/A $136.88 $235.75 $235.75 $235.75 $49.13 $235.75 N/A N/A G17214 SUP HCPCS C1769 G17214 - CATHETER URTH 18FR 34CM 5ML UNIVERSA 2W FL CLS END RND TIP BOTH IP/OP $9.00 $7.00 $1.70 $8.59 $4.66 $4.66 $4.66 $4.66 $8.59 $8.59 $8.59 $1.79 $8.59 $6.38 $6.38 $6.62 $4.48 $1.79 $8.59 $8.59 $5.08 $8.59 $8.59 $8.59 $8.59 $6.75 $8.59 $8.59 $8.59 $4.30 $4.30 $6.80 $8.59 $6.87 $5.58 $1.70 N/A $5.22 $8.59 $8.59 $8.59 $1.79 $8.59 N/A N/A G17230 SUP HCPCS C1726 G17230 - SET CATH .021IN 6FR 25CM 1ML UNIVERSA 2W FL OP-EN GW SIL PED BOTH IP/OP $45.00 $33.00 $8.93 $45.00 $24.44 $24.44 $24.44 $24.44 $45.00 $45.00 $45.00 $9.38 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $45.00 $26.62 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $8.93 N/A $26.10 $45.00 $45.00 $45.00 $9.38 $45.00 N/A N/A G17237 SUP HCPCS C1758 G17237 - CATHETER URDY 7FR 38CM 2 LUM CDE BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G17239 SUP HCPCS C1729 G17239 - CATHETER URET 5FR 110CM RND TIP RT BOTH IP/OP $311.50 $231.00 $61.77 $311.20 $168.98 $168.98 $168.98 $168.98 $311.20 $311.20 $311.20 $64.86 $311.20 $230.97 $230.97 $239.87 $162.14 $64.86 $311.20 $311.20 $184.07 $311.20 $311.20 $311.20 $311.20 $233.63 $311.20 $311.20 $311.20 $155.60 $155.60 $246.47 $311.20 $248.96 $202.28 $61.77 N/A $180.67 $311.20 $311.20 $311.20 $64.85 $311.20 N/A N/A G17252 SUP HCPCS C1726 G17252 - CATHETER XTRN 1.3IN NS NADH CNDM SIL M REUSE BOTH IP/OP $51.50 $38.00 $10.15 $51.15 $27.77 $27.77 $27.77 $27.77 $51.15 $51.15 $51.15 $10.66 $51.15 $37.96 $37.96 $39.43 $26.65 $10.66 $51.15 $51.15 $30.26 $51.15 $51.15 $51.15 $51.15 $38.63 $51.15 $51.15 $51.15 $25.58 $25.58 $40.51 $51.15 $40.92 $33.25 $10.15 N/A $29.87 $51.15 $51.15 $51.15 $10.66 $51.15 N/A N/A G17262 SUP HCPCS C1758 G17262 - TUBING URDY INF ST VNT BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G17306 SUP HCPCS C2617 G17306 - ADAPTER CATH TLR LL SYR PED BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G17310 SUP HCPCS C1769 G17310 - SET STNT .025IN 3.7FR 8-30CM STRL CATH RADOPQ MTLNTH PSTNR BOTH IP/OP $396.00 $293.00 $78.60 $396.00 $215.03 $215.03 $215.03 $215.03 $396.00 $396.00 $396.00 $82.54 $396.00 $293.91 $293.91 $305.24 $206.32 $82.53 $396.00 $396.00 $234.23 $396.00 $396.00 $396.00 $396.00 $297.00 $396.00 $396.00 $396.00 $198.00 $198.00 $313.63 $396.00 $316.80 $257.40 $78.60 N/A $229.68 $396.00 $396.00 $396.00 $82.53 $396.00 N/A N/A G17318 SUP HCPCS C1726 G17318 - SET DIL 6-18FR 60CM AQ PE URET BOTH IP/OP $48.50 $36.00 $9.54 $48.08 $26.11 $26.11 $26.11 $26.11 $48.08 $48.08 $48.08 $10.02 $48.08 $35.68 $35.68 $37.06 $25.05 $10.02 $48.08 $48.08 $28.44 $48.08 $48.08 $48.08 $48.08 $36.38 $48.08 $48.08 $48.08 $24.04 $24.04 $38.08 $48.08 $38.46 $31.25 $9.54 N/A $28.13 $48.08 $48.08 $48.08 $10.02 $48.08 N/A N/A G17320 SUP HCPCS C1726 G17320 - CATHETER SUPRAPUBIC 14FR 22CM 30CM SET NEEDLE OBTURATOR BOTH IP/OP $144.50 $107.00 $28.60 $144.10 $78.25 $78.25 $78.25 $78.25 $144.10 $144.10 $144.10 $30.03 $144.10 $106.95 $106.95 $111.07 $75.08 $30.03 $144.10 $144.10 $85.24 $144.10 $144.10 $144.10 $144.10 $108.38 $144.10 $144.10 $144.10 $72.05 $72.05 $114.13 $144.10 $115.28 $93.67 $28.60 N/A $83.81 $144.10 $144.10 $144.10 $30.03 $144.10 N/A N/A G17322 SUP HCPCS C1726 G17322 - CATHETER URDY 5FR 30CM 2 LUM BOTH IP/OP $658.00 $487.00 $130.56 $657.80 $357.19 $357.19 $357.19 $357.19 $657.80 $657.80 $657.80 $137.10 $657.80 $488.22 $488.22 $507.03 $342.71 $137.09 $657.80 $657.80 $389.09 $657.80 $657.80 $657.80 $657.80 $493.50 $657.80 $657.80 $657.80 $328.90 $328.90 $520.98 $657.80 $526.24 $427.57 $130.56 N/A $381.64 $657.80 $657.80 $657.80 $137.09 $657.80 N/A N/A G17323 SUP HCPCS C1758 G17323 - SET DIL 6-30FR 30CM 16CM AMPTZ RADOPQ SHTH HDRPH RNL BOTH IP/OP $97.50 $72.00 $19.29 $97.18 $52.77 $52.77 $52.77 $52.77 $97.18 $97.18 $97.18 $20.25 $97.18 $72.13 $72.13 $74.91 $50.63 $20.25 $97.18 $97.18 $57.48 $97.18 $97.18 $97.18 $97.18 $73.13 $97.18 $97.18 $97.18 $48.59 $48.59 $76.97 $97.18 $77.74 $63.17 $19.29 N/A $56.55 $97.18 $97.18 $97.18 $20.25 $97.18 N/A N/A G17330 SUP HCPCS C1758 G17330 - CATHETER URET .05IN 6/10FR .04IN 50CM STRL LF FLXTP 2 LUM AQ BOTH IP/OP $103.50 $77.00 $20.51 $103.33 $56.11 $56.11 $56.11 $56.11 $103.33 $103.33 $103.33 $21.54 $103.33 $76.69 $76.69 $79.65 $53.83 $21.54 $103.33 $103.33 $61.12 $103.33 $103.33 $103.33 $103.33 $77.63 $103.33 $103.33 $103.33 $51.67 $51.67 $81.84 $103.33 $82.66 $67.16 $20.51 N/A $60.03 $103.33 $103.33 $103.33 $21.53 $103.33 N/A N/A G17354 SUP HCPCS C2627 G17354 - CATHETER URTH 16FR 34CM 5ML UNIVERSA 2W FL OP-EN SIL BOTH IP/OP $5.00 $4.00 $0.96 $4.85 $2.63 $2.63 $2.63 $2.63 $4.85 $4.85 $4.85 $1.01 $4.85 $3.60 $3.60 $3.74 $2.53 $1.01 $4.85 $4.85 $2.87 $4.85 $4.85 $4.85 $4.85 $3.75 $4.85 $4.85 $4.85 $2.43 $2.43 $3.84 $4.85 $3.88 $3.15 $0.96 N/A $2.90 $4.85 $4.85 $4.85 $1.01 $4.85 N/A N/A G17355 SUP HCPCS C2627 G17355 - DILATOR URET 8FR 60CM PE HDRPH BOTH IP/OP $58.50 $43.00 $11.55 $58.20 $31.60 $31.60 $31.60 $31.60 $58.20 $58.20 $58.20 $12.13 $58.20 $43.20 $43.20 $44.86 $30.32 $12.13 $58.20 $58.20 $34.43 $58.20 $58.20 $58.20 $58.20 $43.88 $58.20 $58.20 $58.20 $29.10 $29.10 $46.09 $58.20 $46.56 $37.83 $11.55 N/A $33.93 $58.20 $58.20 $58.20 $12.13 $58.20 N/A N/A G17477 SUP HCPCS C2627 G17477 - STOPCOCK CSCP SAN ANTONIO MOD FIT BOTH IP/OP $58.50 $43.00 $11.55 $58.20 $31.60 $31.60 $31.60 $31.60 $58.20 $58.20 $58.20 $12.13 $58.20 $43.20 $43.20 $44.86 $30.32 $12.13 $58.20 $58.20 $34.43 $58.20 $58.20 $58.20 $58.20 $43.88 $58.20 $58.20 $58.20 $29.10 $29.10 $46.09 $58.20 $46.56 $37.83 $11.55 N/A $33.93 $58.20 $58.20 $58.20 $12.13 $58.20 N/A N/A G17515 SUP HCPCS C2627 G17515 - CATHETER URTH 18FR 34CM 5ML UNIVERSA 2W OP-EN BLN FL SIL DOD BOTH IP/OP $16.00 $12.00 $3.16 $15.92 $8.64 $8.64 $8.64 $8.64 $15.92 $15.92 $15.92 $3.32 $15.92 $11.82 $11.82 $12.27 $8.29 $3.32 $15.92 $15.92 $9.42 $15.92 $15.92 $15.92 $15.92 $12.00 $15.92 $15.92 $15.92 $7.96 $7.96 $12.61 $15.92 $12.74 $10.35 $3.16 N/A $9.28 $15.92 $15.92 $15.92 $3.32 $15.92 N/A N/A G17520 SUP Custom 27203010 G17520 - CATHETER SPBC 8FR 54CM CYSTOSTOMY MOD TROC STY DRN ADPR PUL BOTH IP/OP $303.00 $224.00 $53.90 $302.83 $302.83 $302.83 $302.83 $302.83 $302.83 $302.83 $53.90 $302.83 $302.83 $224.76 $224.76 $233.42 $157.77 $63.11 $302.83 $121.13 $302.83 $302.83 $302.83 $302.83 $302.83 $227.25 $302.83 $302.83 $302.83 $151.42 $151.42 $239.84 $302.83 $242.26 $196.84 $302.83 N/A $175.74 $302.83 $181.70 $302.83 $302.83 $302.83 N/A N/A G17521 SUP HCPCS C1758 G17521 - EXTRACTOR STON 4.5FR 2CM 65CM STRL NCRCL TPLS UNDX HNDL WRE BOTH IP/OP $100.50 $74.00 $19.90 $100.25 $54.44 $54.44 $54.44 $54.44 $100.25 $100.25 $100.25 $20.89 $100.25 $74.41 $74.41 $77.27 $52.23 $20.89 $100.25 $100.25 $59.30 $100.25 $100.25 $100.25 $100.25 $75.38 $100.25 $100.25 $100.25 $50.13 $50.13 $79.40 $100.25 $80.20 $65.16 $19.90 N/A $58.29 $100.25 $100.25 $100.25 $20.89 $100.25 N/A N/A G17539 SUP HCPCS C1769 G17539 - CATHETER URET .038IN PGTL CRV 6FR 70CM SDPRT GW BOTH IP/OP $95.00 $70.00 $18.77 $94.58 $51.36 $51.36 $51.36 $51.36 $94.58 $94.58 $94.58 $19.71 $94.58 $70.20 $70.20 $72.90 $49.28 $19.71 $94.58 $94.58 $55.94 $94.58 $94.58 $94.58 $94.58 $71.25 $94.58 $94.58 $94.58 $47.29 $47.29 $74.91 $94.58 $75.66 $61.48 $18.77 N/A $55.10 $94.58 $94.58 $94.58 $19.71 $94.58 N/A N/A G17540 SUP HCPCS C1769 G17540 - GUIDEWIRE VASC STRG .038IN 145CM STRL 3CM RDRR PC STD BD BOTH IP/OP $95.00 $70.00 $18.77 $94.58 $51.36 $51.36 $51.36 $51.36 $94.58 $94.58 $94.58 $19.71 $94.58 $70.20 $70.20 $72.90 $49.28 $19.71 $94.58 $94.58 $55.94 $94.58 $94.58 $94.58 $94.58 $71.25 $94.58 $94.58 $94.58 $47.29 $47.29 $74.91 $94.58 $75.66 $61.48 $18.77 N/A $55.10 $94.58 $94.58 $94.58 $19.71 $94.58 N/A N/A G17541 SUP HCPCS C1769 G17541 - GUIDEWIRE VASC ANG STD .035IN 145CM 3CM RDRR PC TRQ CNTRL BOTH IP/OP $95.00 $70.00 $18.77 $94.58 $51.36 $51.36 $51.36 $51.36 $94.58 $94.58 $94.58 $19.71 $94.58 $70.20 $70.20 $72.90 $49.28 $19.71 $94.58 $94.58 $55.94 $94.58 $94.58 $94.58 $94.58 $71.25 $94.58 $94.58 $94.58 $47.29 $47.29 $74.91 $94.58 $75.66 $61.48 $18.77 N/A $55.10 $94.58 $94.58 $94.58 $19.71 $94.58 N/A N/A G17542 SUP HCPCS C1769 G17542 - GUIDEWIRE VASC ANG .038IN 145CM STRL 3CM RDRR PC STD BD NTNL BOTH IP/OP $95.00 $70.00 $18.77 $94.58 $51.36 $51.36 $51.36 $51.36 $94.58 $94.58 $94.58 $19.71 $94.58 $70.20 $70.20 $72.90 $49.28 $19.71 $94.58 $94.58 $55.94 $94.58 $94.58 $94.58 $94.58 $71.25 $94.58 $94.58 $94.58 $47.29 $47.29 $74.91 $94.58 $75.66 $61.48 $18.77 N/A $55.10 $94.58 $94.58 $94.58 $19.71 $94.58 N/A N/A G17558 SUP Custom 27203010 G17558 - CATHETER IU 5FR 40CM 55CM NOVY SET CRV CANNULATION DISP BOTH IP/OP $243.50 $180.00 $43.34 $243.48 $243.48 $243.48 $243.48 $243.48 $243.48 $243.48 $43.34 $243.48 $243.48 $180.71 $180.71 $187.67 $126.85 $50.74 $243.48 $97.39 $243.48 $243.48 $243.48 $243.48 $243.48 $182.63 $243.48 $243.48 $243.48 $121.74 $121.74 $192.84 $243.48 $194.78 $158.26 $243.48 N/A $141.23 $243.48 $146.09 $243.48 $243.48 $243.48 N/A N/A G17560 SUP HCPCS C1758 G17560 - POSITIONER STNT 6FR 50CM RADOPQ URET BOTH IP/OP $111.00 $82.00 $22.03 $111.00 $60.27 $60.27 $60.27 $60.27 $111.00 $111.00 $111.00 $23.14 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $111.00 $65.66 $111.00 $111.00 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $22.03 N/A $64.38 $111.00 $111.00 $111.00 $23.13 $111.00 N/A N/A G17571 SUP HCPCS C2625 G17571 - CATHETER URET .03IN 4FR 70CM SFLX OP-EN GW BOTH IP/OP $141.50 $105.00 $28.07 $141.45 $63.65 $63.65 $63.65 $63.65 $141.45 $141.45 $141.45 $29.48 $141.45 $141.45 $141.45 $141.45 $141.45 $29.48 $141.45 $141.45 $83.67 $141.45 $141.45 $141.45 $141.45 $106.13 $141.45 $141.45 $141.45 $70.73 $70.73 $112.03 $141.45 $113.16 $63.65 $28.07 N/A $82.07 $141.45 $141.45 $141.45 $29.48 $141.45 N/A N/A G17578 SUP HCPCS C2627 G17578 - CATHETER URET .05IN 5/10FR .04IN 50CM FLXTP 2 LUM AQ BOTH IP/OP $58.50 $43.00 $11.55 $58.20 $31.60 $31.60 $31.60 $31.60 $58.20 $58.20 $58.20 $12.13 $58.20 $43.20 $43.20 $44.86 $30.32 $12.13 $58.20 $58.20 $34.43 $58.20 $58.20 $58.20 $58.20 $43.88 $58.20 $58.20 $58.20 $29.10 $29.10 $46.09 $58.20 $46.56 $37.83 $11.55 N/A $33.93 $58.20 $58.20 $58.20 $12.13 $58.20 N/A N/A G17601 SUP HCPCS C1892 G17601 - DILATOR URET 14FR 60CM PE HDRPH BOTH IP/OP $164.50 $122.00 $32.64 $164.45 $89.30 $89.30 $89.30 $89.30 $164.45 $164.45 $164.45 $34.28 $164.45 $122.05 $122.05 $126.76 $85.68 $34.27 $164.45 $164.45 $97.27 $164.45 $164.45 $164.45 $164.45 $123.38 $164.45 $164.45 $164.45 $82.23 $82.23 $130.24 $164.45 $131.56 $106.89 $32.64 N/A $95.41 $164.45 $164.45 $164.45 $34.27 $164.45 N/A N/A G17618 SUP Custom 27203010 G17618 - INTRODUCER NPHSTM 14FR 65CM 60CM PLWY PERC BOTH IP/OP $390.50 $289.00 $69.51 $390.50 $390.50 $390.50 $390.50 $390.50 $390.50 $390.50 $69.51 $390.50 $390.50 $289.83 $289.83 $301.00 $203.45 $81.38 $390.50 $156.20 $390.50 $390.50 $390.50 $390.50 $390.50 $292.88 $390.50 $390.50 $390.50 $195.25 $195.25 $309.28 $390.50 $312.40 $253.83 $390.50 N/A $226.49 $390.50 $234.30 $390.50 $390.50 $390.50 N/A N/A G17627 SUP Custom 27203010 G17627 - NEEDLE BRCHTX 18GA 20CM ECHTP SET BOTH IP/OP $462.50 $342.00 $82.27 $462.20 $462.20 $462.20 $462.20 $462.20 $462.20 $462.20 $82.27 $462.20 $462.20 $343.04 $343.04 $356.26 $240.81 $96.33 $462.20 $184.88 $462.20 $462.20 $462.20 $462.20 $462.20 $346.88 $462.20 $462.20 $462.20 $231.10 $231.10 $366.06 $462.20 $369.76 $300.43 $462.20 N/A $268.25 $462.20 $277.32 $462.20 $462.20 $462.20 N/A N/A G17639 SUP HCPCS C2625 G17639 - DILATOR URET LNG TPR 6-12FR 60CM STRL LFRIC SRFC AQ BOTH IP/OP $141.50 $105.00 $28.07 $141.45 $63.65 $63.65 $63.65 $63.65 $141.45 $141.45 $141.45 $29.48 $141.45 $141.45 $141.45 $141.45 $141.45 $29.48 $141.45 $141.45 $83.67 $141.45 $141.45 $141.45 $141.45 $106.13 $141.45 $141.45 $141.45 $70.73 $70.73 $112.03 $141.45 $113.16 $63.65 $28.07 N/A $82.07 $141.45 $141.45 $141.45 $29.48 $141.45 N/A N/A G17648 SUP HCPCS C2617 G17648 - POSITIONER STNT 4FR 25CM BOTH IP/OP $77.00 $57.00 $15.21 $76.63 $34.48 $34.48 $34.48 $34.48 $76.63 $76.63 $76.63 $15.97 $76.63 $76.63 $76.63 $76.63 $76.63 $15.97 $76.63 $76.63 $45.33 $76.63 $76.63 $76.63 $76.63 $57.75 $76.63 $76.63 $76.63 $38.32 $38.32 $60.69 $76.63 $61.30 $34.48 $15.21 N/A $44.66 $76.63 $76.63 $76.63 $15.97 $76.63 N/A N/A G17666 SUP HCPCS C2617 G17666 - STENT URTH 8FR 24FR 30CM STRL FRLT KLG SDPRT SUT BLB DISP BOTH IP/OP $118.00 $87.00 $23.40 $117.88 $53.05 $53.05 $53.05 $53.05 $117.88 $117.88 $117.88 $24.57 $117.88 $117.88 $117.88 $117.88 $117.88 $24.57 $117.88 $117.88 $69.73 $117.88 $117.88 $117.88 $117.88 $88.50 $117.88 $117.88 $117.88 $58.94 $58.94 $93.36 $117.88 $94.30 $53.05 $23.40 N/A $68.44 $117.88 $117.88 $117.88 $24.57 $117.88 N/A N/A G17667 SUP HCPCS C2617 G17667 - SET STNT 6FR 50CM STRL KL DPR URETHRA DISP BOTH IP/OP $92.50 $68.00 $18.31 $92.25 $41.51 $41.51 $41.51 $41.51 $92.25 $92.25 $92.25 $19.23 $92.25 $92.25 $92.25 $92.25 $92.25 $19.23 $92.25 $92.25 $54.57 $92.25 $92.25 $92.25 $92.25 $69.38 $92.25 $92.25 $92.25 $46.13 $46.13 $73.06 $92.25 $73.80 $41.51 $18.31 N/A $53.65 $92.25 $92.25 $92.25 $19.22 $92.25 N/A N/A G17668 SUP HCPCS C2617 G17668 - STENT URTH 6FR 50CM KL DPR BOTH IP/OP $102.50 $76.00 $20.34 $102.50 $46.13 $46.13 $46.13 $46.13 $102.50 $102.50 $102.50 $21.36 $102.50 $102.50 $102.50 $102.50 $102.50 $21.36 $102.50 $102.50 $60.63 $102.50 $102.50 $102.50 $102.50 $76.88 $102.50 $102.50 $102.50 $51.25 $51.25 $81.18 $102.50 $82.00 $46.13 $20.34 N/A $59.45 $102.50 $102.50 $102.50 $21.36 $102.50 N/A N/A G17669 SUP HCPCS C2617 G17669 - SET STNT 8FR 50CM STRL KL DPR URETHRA DISP BOTH IP/OP $92.50 $68.00 $18.31 $92.25 $41.51 $41.51 $41.51 $41.51 $92.25 $92.25 $92.25 $19.23 $92.25 $92.25 $92.25 $92.25 $92.25 $19.23 $92.25 $92.25 $54.57 $92.25 $92.25 $92.25 $92.25 $69.38 $92.25 $92.25 $92.25 $46.13 $46.13 $73.06 $92.25 $73.80 $41.51 $18.31 N/A $53.65 $92.25 $92.25 $92.25 $19.22 $92.25 N/A N/A G17671 SUP HCPCS C2617 G17671 - STENT URTH 8FR 50CM STRL KL DPR DISP BOTH IP/OP $301.00 $223.00 $59.66 $300.60 $135.27 $135.27 $135.27 $135.27 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $300.60 $300.60 $300.60 $62.65 $300.60 $300.60 $177.80 $300.60 $300.60 $300.60 $300.60 $225.75 $300.60 $300.60 $300.60 $150.30 $150.30 $238.08 $300.60 $240.48 $135.27 $59.66 N/A $174.58 $300.60 $300.60 $300.60 $62.65 $300.60 N/A N/A G17676 SUP HCPCS C2617 G17676 - SET STNT .025IN SM 2 PGTL CRV STRG 3.7FR 6CM STRL RADOPQ BOTH IP/OP $253.50 $188.00 $50.30 $253.45 $114.05 $114.05 $114.05 $114.05 $253.45 $253.45 $253.45 $52.83 $253.45 $253.45 $253.45 $253.45 $253.45 $52.82 $253.45 $253.45 $149.92 $253.45 $253.45 $253.45 $253.45 $190.13 $253.45 $253.45 $253.45 $126.73 $126.73 $200.73 $253.45 $202.76 $114.05 $50.30 N/A $147.03 $253.45 $253.45 $253.45 $52.82 $253.45 N/A N/A G17793 SUP HCPCS C2617 G17793 - POSITIONER STNT 5FR 50CM BOTH IP/OP $289.00 $214.00 $57.32 $288.80 $129.96 $129.96 $129.96 $129.96 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $288.80 $288.80 $288.80 $60.19 $288.80 $288.80 $170.83 $288.80 $288.80 $288.80 $288.80 $216.75 $288.80 $288.80 $288.80 $144.40 $144.40 $228.73 $288.80 $231.04 $129.96 $57.32 N/A $167.62 $288.80 $288.80 $288.80 $60.19 $288.80 N/A N/A G17794 SUP HCPCS C2627 G17794 - SET STNT .018IN 2 PGTL CRV CDE 3FR 4FR 4CM STRL CP MDRL CATH BOTH IP/OP $73.00 $54.00 $14.41 $72.60 $39.42 $39.42 $39.42 $39.42 $72.60 $72.60 $72.60 $15.13 $72.60 $53.88 $53.88 $55.96 $37.82 $15.13 $72.60 $72.60 $42.94 $72.60 $72.60 $72.60 $72.60 $54.75 $72.60 $72.60 $72.60 $36.30 $36.30 $57.50 $72.60 $58.08 $47.19 $14.41 N/A $42.34 $72.60 $72.60 $72.60 $15.13 $72.60 N/A N/A G17795 SUP HCPCS C1726 G17795 - DILATOR URTH 6-12FR 30CM LNG TPR FSCA BOTH IP/OP $73.00 $54.00 $14.41 $72.60 $39.42 $39.42 $39.42 $39.42 $72.60 $72.60 $72.60 $15.13 $72.60 $53.88 $53.88 $55.96 $37.82 $15.13 $72.60 $72.60 $42.94 $72.60 $72.60 $72.60 $72.60 $54.75 $72.60 $72.60 $72.60 $36.30 $36.30 $57.50 $72.60 $58.08 $47.19 $14.41 N/A $42.34 $72.60 $72.60 $72.60 $15.13 $72.60 N/A N/A G17797 SUP HCPCS C1758 G17797 - DILATOR URTH LNG TPR 18FR 30CM AQ BOTH IP/OP $43.00 $32.00 $8.51 $42.90 $23.29 $23.29 $23.29 $23.29 $42.90 $42.90 $42.90 $8.94 $42.90 $31.84 $31.84 $33.07 $22.35 $8.94 $42.90 $42.90 $25.38 $42.90 $42.90 $42.90 $42.90 $32.25 $42.90 $42.90 $42.90 $21.45 $21.45 $33.98 $42.90 $34.32 $27.89 $8.51 N/A $24.94 $42.90 $42.90 $42.90 $8.94 $42.90 N/A N/A G17819 SUP HCPCS C1758 G17819 - DEVICE TRQ STRL OLCOTT DISP ACPT .014-.045IN GW RDRR BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G17842 SUP HCPCS C1726 G17842 - CATHETER URET .040IN 7FR 70CM SFLX OP-EN GW BOTH IP/OP $264.00 $195.00 $52.40 $264.00 $143.35 $143.35 $143.35 $143.35 $264.00 $264.00 $264.00 $55.02 $264.00 $195.94 $195.94 $203.49 $137.54 $55.02 $264.00 $264.00 $156.16 $264.00 $264.00 $264.00 $264.00 $198.00 $264.00 $264.00 $264.00 $132.00 $132.00 $209.09 $264.00 $211.20 $171.60 $52.40 N/A $153.12 $264.00 $264.00 $264.00 $55.02 $264.00 N/A N/A G17843 SUP HCPCS C1726 G17843 - CATHETER URTH 9FR 8.7MM 29CM 18CM CDE BLN BOTH IP/OP $264.00 $195.00 $52.40 $264.00 $143.35 $143.35 $143.35 $143.35 $264.00 $264.00 $264.00 $55.02 $264.00 $195.94 $195.94 $203.49 $137.54 $55.02 $264.00 $264.00 $156.16 $264.00 $264.00 $264.00 $264.00 $198.00 $264.00 $264.00 $264.00 $132.00 $132.00 $209.09 $264.00 $211.20 $171.60 $52.40 N/A $153.12 $264.00 $264.00 $264.00 $55.02 $264.00 N/A N/A G17844 SUP HCPCS C1726 G17844 - CATHETER URTH FLFRM 9FR 8.7MM 29CM 18CM BLN BOTH IP/OP $264.00 $195.00 $52.40 $264.00 $143.35 $143.35 $143.35 $143.35 $264.00 $264.00 $264.00 $55.02 $264.00 $195.94 $195.94 $203.49 $137.54 $55.02 $264.00 $264.00 $156.16 $264.00 $264.00 $264.00 $264.00 $198.00 $264.00 $264.00 $264.00 $132.00 $132.00 $209.09 $264.00 $211.20 $171.60 $52.40 N/A $153.12 $264.00 $264.00 $264.00 $55.02 $264.00 N/A N/A G17852 SUP HCPCS C2617 G17852 - CATHETER URTH 7FR 8.7MM 29CM 18CM OPN TIP BLN BOTH IP/OP $251.50 $186.00 $49.84 $251.13 $113.01 $113.01 $113.01 $113.01 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $251.13 $251.13 $251.13 $52.34 $251.13 $251.13 $148.54 $251.13 $251.13 $251.13 $251.13 $188.63 $251.13 $251.13 $251.13 $125.57 $125.57 $198.89 $251.13 $200.90 $113.01 $49.84 N/A $145.87 $251.13 $251.13 $251.13 $52.34 $251.13 N/A N/A G17866 SUP HCPCS C1769 G17866 - SET STNT .035IN 4.7FR 21-32CM STRL CATH RADOPQ MTLNTH PSTNR BOTH IP/OP $108.00 $80.00 $21.41 $107.85 $58.56 $58.56 $58.56 $58.56 $107.85 $107.85 $107.85 $22.48 $107.85 $80.05 $80.05 $83.13 $56.19 $22.48 $107.85 $107.85 $63.79 $107.85 $107.85 $107.85 $107.85 $81.00 $107.85 $107.85 $107.85 $53.93 $53.93 $85.42 $107.85 $86.28 $70.10 $21.41 N/A $62.64 $107.85 $107.85 $107.85 $22.48 $107.85 N/A N/A G17872 SUP Custom 27203010 G17872 - EXTRACTOR STONE 3FR 1.8CM 115CM TIPLESS MODIFIED BASKET BOTH IP/OP $458.50 $339.00 $81.57 $458.25 $458.25 $458.25 $458.25 $458.25 $458.25 $458.25 $81.57 $458.25 $458.25 $340.11 $340.11 $353.22 $238.75 $95.50 $458.25 $184.88 $458.25 $458.25 $458.25 $458.25 $458.25 $343.88 $458.25 $458.25 $458.25 $229.13 $229.13 $362.93 $458.25 $366.60 $297.86 $458.25 N/A $265.93 $458.25 $274.95 $458.25 $458.25 $458.25 N/A N/A G17898 SUP HCPCS C1769 G17898 - KIT PRC 11FR MNPRC ENTRY PED PERC BOTH IP/OP $109.00 $81.00 $21.58 $108.75 $59.05 $59.05 $59.05 $59.05 $108.75 $108.75 $108.75 $22.67 $108.75 $80.71 $80.71 $83.82 $56.66 $22.66 $108.75 $108.75 $64.33 $108.75 $108.75 $108.75 $108.75 $81.75 $108.75 $108.75 $108.75 $54.38 $54.38 $86.13 $108.75 $87.00 $70.69 $21.58 N/A $63.22 $108.75 $108.75 $108.75 $22.66 $108.75 N/A N/A G17913 SUP HCPCS C1758 G17913 - FILIFORM URTH 18FR 12.5IN INTGR BOTH IP/OP $27.50 $20.00 $5.46 $27.50 $14.93 $14.93 $14.93 $14.93 $27.50 $27.50 $27.50 $5.73 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $27.50 $16.27 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $5.46 N/A $15.95 $27.50 $27.50 $27.50 $5.73 $27.50 N/A N/A G17915 SUP HCPCS C1758 G17915 - CATHETER URET .038IN 7FR 15CM FLXTP OP-EN GW MOD BOTH IP/OP $33.00 $24.00 $6.53 $32.90 $17.86 $17.86 $17.86 $17.86 $32.90 $32.90 $32.90 $6.86 $32.90 $24.42 $24.42 $25.36 $17.14 $6.86 $32.90 $32.90 $19.46 $32.90 $32.90 $32.90 $32.90 $24.75 $32.90 $32.90 $32.90 $16.45 $16.45 $26.06 $32.90 $26.32 $21.39 $6.53 N/A $19.14 $32.90 $32.90 $32.90 $6.86 $32.90 N/A N/A G17940 SUP Custom 27203010 G17940 - SET DRN 200ML NS BG PED DISP BOTH IP/OP $478.50 $354.00 $85.11 $478.13 $478.13 $478.13 $478.13 $478.13 $478.13 $478.13 $85.11 $478.13 $478.13 $354.87 $354.87 $368.54 $249.11 $99.65 $478.13 $191.25 $478.13 $478.13 $478.13 $478.13 $478.13 $358.88 $478.13 $478.13 $478.13 $239.07 $239.07 $378.68 $478.13 $382.50 $310.78 $478.13 N/A $277.53 $478.13 $286.88 $478.13 $478.13 $478.13 N/A N/A G17941 SUP Custom 27203010 G17941 - EXTRACTOR STON 3.2FR 115CM 5CM NFORCE DWR 3WR BSKT HLCL OCL BOTH IP/OP $478.50 $354.00 $85.11 $478.13 $478.13 $478.13 $478.13 $478.13 $478.13 $478.13 $85.11 $478.13 $478.13 $354.87 $354.87 $368.54 $249.11 $99.65 $478.13 $191.25 $478.13 $478.13 $478.13 $478.13 $478.13 $358.88 $478.13 $478.13 $478.13 $239.07 $239.07 $378.68 $478.13 $382.50 $310.78 $478.13 N/A $277.53 $478.13 $286.88 $478.13 $478.13 $478.13 N/A N/A G17948 SUP HCPCS C1726 G17948 - EXTRACTOR SRG 3.2FR 115CM 7CM NFORCE HLCL STON SET NTNL URO BOTH IP/OP $59.50 $44.00 $11.79 $59.40 $32.25 $32.25 $32.25 $32.25 $59.40 $59.40 $59.40 $12.38 $59.40 $44.09 $44.09 $45.79 $30.95 $12.38 $59.40 $59.40 $35.14 $59.40 $59.40 $59.40 $59.40 $44.63 $59.40 $59.40 $59.40 $29.70 $29.70 $47.04 $59.40 $47.52 $38.61 $11.79 N/A $34.51 $59.40 $59.40 $59.40 $12.38 $59.40 N/A N/A G17949 SUP HCPCS C1726 G17949 - DILATOR URTH 12FR 30CM AMPTZ RNL BOTH IP/OP $59.50 $44.00 $11.79 $59.40 $32.25 $32.25 $32.25 $32.25 $59.40 $59.40 $59.40 $12.38 $59.40 $44.09 $44.09 $45.79 $30.95 $12.38 $59.40 $59.40 $35.14 $59.40 $59.40 $59.40 $59.40 $44.63 $59.40 $59.40 $59.40 $29.70 $29.70 $47.04 $59.40 $47.52 $38.61 $11.79 N/A $34.51 $59.40 $59.40 $59.40 $12.38 $59.40 N/A N/A G17950 SUP HCPCS C1726 G17950 - DILATOR URTH 14FR 30CM AMPTZ RNL BOTH IP/OP $59.50 $44.00 $11.79 $59.40 $32.25 $32.25 $32.25 $32.25 $59.40 $59.40 $59.40 $12.38 $59.40 $44.09 $44.09 $45.79 $30.95 $12.38 $59.40 $59.40 $35.14 $59.40 $59.40 $59.40 $59.40 $44.63 $59.40 $59.40 $59.40 $29.70 $29.70 $47.04 $59.40 $47.52 $38.61 $11.79 N/A $34.51 $59.40 $59.40 $59.40 $12.38 $59.40 N/A N/A G17951 SUP HCPCS C1892 G17951 - DILATOR URET 16FR 30CM AMPTZ RNL BOTH IP/OP $59.50 $44.00 $11.79 $59.40 $32.25 $32.25 $32.25 $32.25 $59.40 $59.40 $59.40 $12.38 $59.40 $44.09 $44.09 $45.79 $30.95 $12.38 $59.40 $59.40 $35.14 $59.40 $59.40 $59.40 $59.40 $44.63 $59.40 $59.40 $59.40 $29.70 $29.70 $47.04 $59.40 $47.52 $38.61 $11.79 N/A $34.51 $59.40 $59.40 $59.40 $12.38 $59.40 N/A N/A G17952 SUP HCPCS C1892 G17952 - DILATOR URTH 18FR 30CM AMPTZ RNL BOTH IP/OP $59.50 $44.00 $11.79 $59.40 $32.25 $32.25 $32.25 $32.25 $59.40 $59.40 $59.40 $12.38 $59.40 $44.09 $44.09 $45.79 $30.95 $12.38 $59.40 $59.40 $35.14 $59.40 $59.40 $59.40 $59.40 $44.63 $59.40 $59.40 $59.40 $29.70 $29.70 $47.04 $59.40 $47.52 $38.61 $11.79 N/A $34.51 $59.40 $59.40 $59.40 $12.38 $59.40 N/A N/A G17953 SUP HCPCS C1726 G17953 - DILATOR URET 20FR 30CM AMPTZ RNL BOTH IP/OP $59.50 $44.00 $11.79 $59.40 $32.25 $32.25 $32.25 $32.25 $59.40 $59.40 $59.40 $12.38 $59.40 $44.09 $44.09 $45.79 $30.95 $12.38 $59.40 $59.40 $35.14 $59.40 $59.40 $59.40 $59.40 $44.63 $59.40 $59.40 $59.40 $29.70 $29.70 $47.04 $59.40 $47.52 $38.61 $11.79 N/A $34.51 $59.40 $59.40 $59.40 $12.38 $59.40 N/A N/A G17954 SUP HCPCS C1726 G17954 - DILATOR URET 22FR 30CM AMPTZ RNL BOTH IP/OP $59.50 $44.00 $11.79 $59.40 $32.25 $32.25 $32.25 $32.25 $59.40 $59.40 $59.40 $12.38 $59.40 $44.09 $44.09 $45.79 $30.95 $12.38 $59.40 $59.40 $35.14 $59.40 $59.40 $59.40 $59.40 $44.63 $59.40 $59.40 $59.40 $29.70 $29.70 $47.04 $59.40 $47.52 $38.61 $11.79 N/A $34.51 $59.40 $59.40 $59.40 $12.38 $59.40 N/A N/A G17955 SUP HCPCS C1726 G17955 - DILATOR SRG 24FR 30CM AMPTZ NPHSTM TRACT DILATION BOTH IP/OP $59.50 $44.00 $11.79 $59.40 $32.25 $32.25 $32.25 $32.25 $59.40 $59.40 $59.40 $12.38 $59.40 $44.09 $44.09 $45.79 $30.95 $12.38 $59.40 $59.40 $35.14 $59.40 $59.40 $59.40 $59.40 $44.63 $59.40 $59.40 $59.40 $29.70 $29.70 $47.04 $59.40 $47.52 $38.61 $11.79 N/A $34.51 $59.40 $59.40 $59.40 $12.38 $59.40 N/A N/A G17956 SUP HCPCS C1726 G17956 - DILATOR URET 26FR 30CM AMPTZ RNL BOTH IP/OP $59.50 $44.00 $11.79 $59.40 $32.25 $32.25 $32.25 $32.25 $59.40 $59.40 $59.40 $12.38 $59.40 $44.09 $44.09 $45.79 $30.95 $12.38 $59.40 $59.40 $35.14 $59.40 $59.40 $59.40 $59.40 $44.63 $59.40 $59.40 $59.40 $29.70 $29.70 $47.04 $59.40 $47.52 $38.61 $11.79 N/A $34.51 $59.40 $59.40 $59.40 $12.38 $59.40 N/A N/A G17957 SUP HCPCS C1726 G17957 - DILATOR URET 28FR 30CM AMPTZ RNL BOTH IP/OP $59.50 $44.00 $11.79 $59.40 $32.25 $32.25 $32.25 $32.25 $59.40 $59.40 $59.40 $12.38 $59.40 $44.09 $44.09 $45.79 $30.95 $12.38 $59.40 $59.40 $35.14 $59.40 $59.40 $59.40 $59.40 $44.63 $59.40 $59.40 $59.40 $29.70 $29.70 $47.04 $59.40 $47.52 $38.61 $11.79 N/A $34.51 $59.40 $59.40 $59.40 $12.38 $59.40 N/A N/A G17963 SUP HCPCS C1894 G17963 - DILATOR URTH 30FR 30CM AMPTZ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $70.85 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17964 SUP HCPCS C1892 G17964 - SHEATH DIL 22FR 16CM AMPTZ OPQ RNL BOTH IP/OP $62.00 $46.00 $12.23 $61.60 $33.45 $33.45 $33.45 $33.45 $61.60 $61.60 $61.60 $12.84 $61.60 $45.72 $45.72 $47.48 $32.09 $12.84 $61.60 $61.60 $36.44 $61.60 $61.60 $61.60 $61.60 $46.50 $61.60 $61.60 $61.60 $30.80 $30.80 $48.79 $61.60 $49.28 $40.04 $12.23 N/A $35.96 $61.60 $61.60 $61.60 $12.84 $61.60 N/A N/A G17965 SUP HCPCS C1894 G17965 - SHEATH ACC 24FR 16CM AMPTZ OPQ RNL BOTH IP/OP $62.00 $46.00 $12.23 $61.60 $33.45 $33.45 $33.45 $33.45 $61.60 $61.60 $61.60 $12.84 $61.60 $45.72 $45.72 $47.48 $32.09 $12.84 $61.60 $61.60 $36.44 $61.60 $61.60 $61.60 $61.60 $46.50 $61.60 $61.60 $61.60 $30.80 $30.80 $48.79 $61.60 $49.28 $40.04 $12.23 N/A $35.96 $61.60 $61.60 $61.60 $12.84 $61.60 N/A N/A G17966 SUP HCPCS C1894 G17966 - SHEATH DIL 26FR 16CM AMPTZ OPQ RNL BOTH IP/OP $62.00 $46.00 $12.23 $61.60 $33.45 $33.45 $33.45 $33.45 $61.60 $61.60 $61.60 $12.84 $61.60 $45.72 $45.72 $47.48 $32.09 $12.84 $61.60 $61.60 $36.44 $61.60 $61.60 $61.60 $61.60 $46.50 $61.60 $61.60 $61.60 $30.80 $30.80 $48.79 $61.60 $49.28 $40.04 $12.23 N/A $35.96 $61.60 $61.60 $61.60 $12.84 $61.60 N/A N/A G17967 SUP HCPCS C1894 G17967 - SHEATH DIL 28FR 16CM AMPTZ OPQ RNL BOTH IP/OP $62.00 $46.00 $12.23 $61.60 $33.45 $33.45 $33.45 $33.45 $61.60 $61.60 $61.60 $12.84 $61.60 $45.72 $45.72 $47.48 $32.09 $12.84 $61.60 $24.64 $36.44 $61.60 $61.60 $61.60 $61.60 $46.50 $61.60 $61.60 $61.60 $30.80 $30.80 $48.79 $61.60 $49.28 $40.04 $12.23 N/A $35.96 $61.60 $61.60 $61.60 $12.84 $61.60 N/A N/A G17968 SUP HCPCS C1894 G17968 - SHEATH DIL 30FR 16CM AMPTZ OPQ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $28.34 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17969 SUP HCPCS C1894 G17969 - SHEATH DIL 24FR 20CM AMPTZ OPQ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $28.34 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17970 SUP HCPCS C1894 G17970 - SHEATH DIL 26FR 20CM AMPTZ OPQ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $70.85 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17971 SUP HCPCS C1894 G17971 - SHEATH DIL 28FR 20CM AMPTZ OPQ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $70.85 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17973 SUP HCPCS C1894 G17973 - SHEATH DIL 30FR 20CM AMPTZ OPQ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $70.85 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17975 SUP HCPCS C1894 G17975 - SHEATH DIL 30FR 19CM AMPTZ OPQ RNL BOTH IP/OP $62.00 $46.00 $12.23 $61.60 $33.45 $33.45 $33.45 $33.45 $61.60 $61.60 $61.60 $12.84 $61.60 $45.72 $45.72 $47.48 $32.09 $12.84 $61.60 $61.60 $36.44 $61.60 $61.60 $61.60 $61.60 $46.50 $61.60 $61.60 $61.60 $30.80 $30.80 $48.79 $61.60 $49.28 $40.04 $12.23 N/A $35.96 $61.60 $61.60 $61.60 $12.84 $61.60 N/A N/A G17976 SUP HCPCS C1894 G17976 - SHEATH DIL 28FR 30CM OPQ AMPTZ RNL BOTH IP/OP $62.00 $46.00 $12.23 $61.60 $33.45 $33.45 $33.45 $33.45 $61.60 $61.60 $61.60 $12.84 $61.60 $45.72 $45.72 $47.48 $32.09 $12.84 $61.60 $61.60 $36.44 $61.60 $61.60 $61.60 $61.60 $46.50 $61.60 $61.60 $61.60 $30.80 $30.80 $48.79 $61.60 $49.28 $40.04 $12.23 N/A $35.96 $61.60 $61.60 $61.60 $12.84 $61.60 N/A N/A G17980 SUP HCPCS C1894 G17980 - SHEATH DIL 30FR 30CM AMPTZ OPQ BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $70.85 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17981 SUP HCPCS C1894 G17981 - SHEATH DIL 30FR 24CM AMPTZ OPQ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $70.85 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17982 SUP HCPCS C1894 G17982 - SHEATH DIL 12FR 16CM AMPTZ OPQ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $70.85 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17983 SUP HCPCS C1894 G17983 - SHEATH DIL 14FR 16CM AMPTZ OPQ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $70.85 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17984 SUP HCPCS C1894 G17984 - SHEATH DIL 16FR 16CM AMPTZ OPQ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $70.85 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17985 SUP HCPCS C1894 G17985 - SHEATH DIL 18FR 16CM AMPTZ OPQ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $70.85 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17986 SUP HCPCS C1894 G17986 - SHEATH DIL 20FR 16CM AMPTZ OPQ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $70.85 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17997 SUP HCPCS C1894 G17997 - SHEATH DIL 30FR 25CM AMPTZ OPQ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $70.85 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17998 SUP HCPCS C1894 G17998 - SHEATH DIL 30FR 22CM AMPTZ OPQ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $70.85 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G17999 SUP HCPCS C1894 G17999 - SHEATH DIL 32FR 16CM AMPTZ OPQ RNL BOTH IP/OP $71.00 $53.00 $14.06 $70.85 $38.47 $38.47 $38.47 $38.47 $70.85 $70.85 $70.85 $14.77 $70.85 $52.58 $52.58 $54.61 $36.91 $14.77 $70.85 $70.85 $41.91 $70.85 $70.85 $70.85 $70.85 $53.25 $70.85 $70.85 $70.85 $35.43 $35.43 $56.11 $70.85 $56.68 $46.05 $14.06 N/A $41.18 $70.85 $70.85 $70.85 $14.77 $70.85 N/A N/A G18001 SUP HCPCS C1892 G18001 - SHEATH DIL 34FR 16CM AMPTZ OPQ RNL BOTH IP/OP $81.00 $60.00 $16.05 $80.85 $43.90 $43.90 $43.90 $43.90 $80.85 $80.85 $80.85 $16.85 $80.85 $60.01 $60.01 $62.32 $42.12 $16.85 $80.85 $80.85 $47.82 $80.85 $80.85 $80.85 $80.85 $60.75 $80.85 $80.85 $80.85 $40.43 $40.43 $64.03 $80.85 $64.68 $52.55 $16.05 N/A $46.98 $80.85 $80.85 $80.85 $16.85 $80.85 N/A N/A G18002 SUP HCPCS C1894 G18002 - INTRODUCER NPHSTM 24FR 16CM 30CM AMPTZ DIL RNL BOTH IP/OP $81.00 $60.00 $16.05 $80.85 $43.90 $43.90 $43.90 $43.90 $80.85 $80.85 $80.85 $16.85 $80.85 $60.01 $60.01 $62.32 $42.12 $16.85 $80.85 $80.85 $47.82 $80.85 $80.85 $80.85 $80.85 $60.75 $80.85 $80.85 $80.85 $40.43 $40.43 $64.03 $80.85 $64.68 $52.55 $16.05 N/A $46.98 $80.85 $80.85 $80.85 $16.85 $80.85 N/A N/A G18003 SUP HCPCS C1892 G18003 - INTRODUCER NPHSTM 26FR 16CM 30CM AMPTZ DIL RNL BOTH IP/OP $81.00 $60.00 $16.05 $80.85 $43.90 $43.90 $43.90 $43.90 $80.85 $80.85 $80.85 $16.85 $80.85 $60.01 $60.01 $62.32 $42.12 $16.85 $80.85 $80.85 $47.82 $80.85 $80.85 $80.85 $80.85 $60.75 $80.85 $80.85 $80.85 $40.43 $40.43 $64.03 $80.85 $64.68 $52.55 $16.05 N/A $46.98 $80.85 $80.85 $80.85 $16.85 $80.85 N/A N/A G18004 SUP HCPCS C1894 G18004 - INTRODUCER NPHSTM 28FR 16CM 30CM AMPTZ DIL RNL BOTH IP/OP $81.00 $60.00 $16.05 $80.85 $43.90 $43.90 $43.90 $43.90 $80.85 $80.85 $80.85 $16.85 $80.85 $60.01 $60.01 $62.32 $42.12 $16.85 $80.85 $80.85 $47.82 $80.85 $80.85 $80.85 $80.85 $60.75 $80.85 $80.85 $80.85 $40.43 $40.43 $64.03 $80.85 $64.68 $52.55 $16.05 N/A $46.98 $80.85 $80.85 $80.85 $16.85 $80.85 N/A N/A G18005 SUP HCPCS C1892 G18005 - INTRODUCER NPHSTM 30FR 16CM 30CM AMPTZ DIL SHTH RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18006 SUP HCPCS C1892 G18006 - INTRODUCER NPHSTM 28FR 20CM 30CM AMPTZ DIL RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18007 SUP HCPCS C1892 G18007 - INTRODUCER NPHSTM 30FR 20CM 30CM AMPTZ DIL RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18008 SUP HCPCS C1892 G18008 - INTRODUCER NPHSTM 22FR 16CM 30CM AMPTZ DIL RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18009 SUP HCPCS C1892 G18009 - INTRODUCER NPHSTM 24FR 24CM 30CM AMPTZ DIL RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18010 SUP HCPCS C1892 G18010 - INTRODUCER NPHSTM 26FR 24CM 30CM AMPTZ DIL RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18011 SUP HCPCS C1892 G18011 - INTRODUCER NPHSTM 28FR 24CM 30CM AMPTZ DIL RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18012 SUP HCPCS C1892 G18012 - INTRODUCER NPHSTM 30FR 24CM 30CM AMPTZ DIL SHTH RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18013 SUP HCPCS C1892 G18013 - INTRODUCER NPHSTM 16FR 16CM 30CM AMPTZ DIL RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18014 SUP HCPCS C1892 G18014 - INTRODUCER NPHSTM 18FR 16CM 30CM AMPTZ DIL RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18015 SUP HCPCS C1892 G18015 - INTRODUCER NPHSTM 20FR 16CM 30CM AMPTZ DIL RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18016 SUP HCPCS C1892 G18016 - INTRODUCER NPHSTM 28FR 30CM 40CM AMPTZ DIL RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18017 SUP HCPCS C1892 G18017 - INTRODUCER NPHSTM 30FR 25CM 30CM AMPTZ DIL RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18018 SUP HCPCS C1892 G18018 - INTRODUCER NPHSTM 30FR 28CM 32CM AMPTZ DIL RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18019 SUP HCPCS C1892 G18019 - INTRODUCER NPHSTM 30FR 30CM 40CM AMPTZ DIL RNL BOTH IP/OP $81.00 $60.00 $16.05 $80.85 $43.90 $43.90 $43.90 $43.90 $80.85 $80.85 $80.85 $16.85 $80.85 $60.01 $60.01 $62.32 $42.12 $16.85 $80.85 $80.85 $47.82 $80.85 $80.85 $80.85 $80.85 $60.75 $80.85 $80.85 $80.85 $40.43 $40.43 $64.03 $80.85 $64.68 $52.55 $16.05 N/A $46.98 $80.85 $80.85 $80.85 $16.85 $80.85 N/A N/A G18020 SUP HCPCS C1892 G18020 - INTRODUCER NPHSTM 32FR 16CM 30CM AMPTZ DIL RNL BOTH IP/OP $81.00 $60.00 $16.05 $80.85 $43.90 $43.90 $43.90 $43.90 $80.85 $80.85 $80.85 $16.85 $80.85 $60.01 $60.01 $62.32 $42.12 $16.85 $80.85 $80.85 $47.82 $80.85 $80.85 $80.85 $80.85 $60.75 $80.85 $80.85 $80.85 $40.43 $40.43 $64.03 $80.85 $64.68 $52.55 $16.05 N/A $46.98 $80.85 $80.85 $80.85 $16.85 $80.85 N/A N/A G18021 SUP HCPCS C1892 G18021 - INTRODUCER NPHSTM 34FR 16CM 30CM AMPTZ DIL RNL BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18063 SUP HCPCS C1892 G18063 - INTRODUCER NPHSTM 36FR 16CM 30CM AMPTZ DIL RNL BOTH IP/OP $104.00 $77.00 $20.55 $103.53 $56.22 $56.22 $56.22 $56.22 $103.53 $103.53 $103.53 $21.58 $103.53 $76.84 $76.84 $79.80 $53.94 $21.58 $103.53 $103.53 $61.24 $103.53 $103.53 $103.53 $103.53 $78.00 $103.53 $103.53 $103.53 $51.77 $51.77 $82.00 $103.53 $82.82 $67.29 $20.55 N/A $60.32 $103.53 $103.53 $103.53 $21.58 $103.53 N/A N/A G18067 SUP HCPCS C1726 G18067 - SET INTRO 8FR 10FR 70CM 30CM DSLT HFMN SHTH CATH RADOPQ BAND BOTH IP/OP $59.00 $44.00 $11.68 $58.83 $31.94 $31.94 $31.94 $31.94 $58.83 $58.83 $58.83 $12.26 $58.83 $43.66 $43.66 $45.35 $30.65 $12.26 $58.83 $58.83 $34.80 $58.83 $58.83 $58.83 $58.83 $44.25 $58.83 $58.83 $58.83 $29.42 $29.42 $46.59 $58.83 $47.06 $38.24 $11.68 N/A $34.22 $58.83 $58.83 $58.83 $12.26 $58.83 N/A N/A G18070 SUP HCPCS C2625 G18070 - CATHETER GD .038IN 5FR 100CM AMPTZ RADOPQ TFE SHTH RNL BOTH IP/OP $236.00 $175.00 $46.79 $235.75 $106.09 $106.09 $106.09 $106.09 $235.75 $235.75 $235.75 $49.14 $235.75 $235.75 $235.75 $235.75 $235.75 $49.13 $235.75 $235.75 $139.45 $235.75 $235.75 $235.75 $235.75 $177.00 $235.75 $235.75 $235.75 $117.88 $117.88 $186.71 $235.75 $188.60 $106.09 $46.79 N/A $136.88 $235.75 $235.75 $235.75 $49.13 $235.75 N/A N/A G18131 SUP HCPCS C2617 G18131 - SET STNT .038IN 5MM PGTL CRV 7FR 75CM STRL 100MM BNDR 2 CATH BOTH IP/OP $236.00 $175.00 $46.79 $235.75 $106.09 $106.09 $106.09 $106.09 $235.75 $235.75 $235.75 $49.14 $235.75 $235.75 $235.75 $235.75 $235.75 $49.13 $235.75 $235.75 $139.45 $235.75 $235.75 $235.75 $235.75 $177.00 $235.75 $235.75 $235.75 $117.88 $117.88 $186.71 $235.75 $188.60 $106.09 $46.79 N/A $136.88 $235.75 $235.75 $235.75 $49.13 $235.75 N/A N/A G18140 SUP HCPCS C2617 G18140 - SET STNT .038IN 2 PGTL CRV 6-10FR 13CM STRL 26CM RADOPQ BOTH IP/OP $155.50 $115.00 $30.84 $155.40 $69.93 $69.93 $69.93 $69.93 $155.40 $155.40 $155.40 $32.39 $155.40 $155.40 $155.40 $155.40 $155.40 $32.39 $155.40 $155.40 $91.92 $155.40 $155.40 $155.40 $155.40 $116.63 $155.40 $155.40 $155.40 $77.70 $77.70 $123.08 $155.40 $124.32 $69.93 $30.84 N/A $90.19 $155.40 $155.40 $155.40 $32.39 $155.40 N/A N/A G18142 SUP HCPCS C1769 G18142 - SET CATH .038IN PGTL CRV 6FR 70CM 145CM SDPRT SHFT GW MOD BOTH IP/OP $95.00 $70.00 $18.77 $94.58 $51.36 $51.36 $51.36 $51.36 $94.58 $94.58 $94.58 $19.71 $94.58 $70.20 $70.20 $72.90 $49.28 $19.71 $94.58 $94.58 $55.94 $94.58 $94.58 $94.58 $94.58 $71.25 $94.58 $94.58 $94.58 $47.29 $47.29 $74.91 $94.58 $75.66 $61.48 $18.77 N/A $55.10 $94.58 $94.58 $94.58 $19.71 $94.58 N/A N/A G18143 SUP HCPCS C1769 G18143 - GUIDEWIRE VASC STRG .035IN 145CM STRL 7CM RDRR PC STD BD BOTH IP/OP $95.00 $70.00 $18.77 $94.58 $51.36 $51.36 $51.36 $51.36 $94.58 $94.58 $94.58 $19.71 $94.58 $70.20 $70.20 $72.90 $49.28 $19.71 $94.58 $94.58 $55.94 $94.58 $94.58 $94.58 $94.58 $71.25 $94.58 $94.58 $94.58 $47.29 $47.29 $74.91 $94.58 $75.66 $61.48 $18.77 N/A $55.10 $94.58 $94.58 $94.58 $19.71 $94.58 N/A N/A G18144 SUP HCPCS C1769 G18144 - GUIDEWIRE VASC ANG STD .035IN 145CM STRL 7CM RDRR PC STF BD BOTH IP/OP $95.00 $70.00 $18.77 $94.58 $51.36 $51.36 $51.36 $51.36 $94.58 $94.58 $94.58 $19.71 $94.58 $70.20 $70.20 $72.90 $49.28 $19.71 $94.58 $94.58 $55.94 $94.58 $94.58 $94.58 $94.58 $71.25 $94.58 $94.58 $94.58 $47.29 $47.29 $74.91 $94.58 $75.66 $61.48 $18.77 N/A $55.10 $94.58 $94.58 $94.58 $19.71 $94.58 N/A N/A G18145 SUP HCPCS C1769 G18145 - GUIDEWIRE VASC STRG STD .038IN 145CM STRL 7CM RDRR PC STF BD BOTH IP/OP $95.00 $70.00 $18.77 $94.58 $51.36 $51.36 $51.36 $51.36 $94.58 $94.58 $94.58 $19.71 $94.58 $70.20 $70.20 $72.90 $49.28 $19.71 $94.58 $94.58 $55.94 $94.58 $94.58 $94.58 $94.58 $71.25 $94.58 $94.58 $94.58 $47.29 $47.29 $74.91 $94.58 $75.66 $61.48 $18.77 N/A $55.10 $94.58 $94.58 $94.58 $19.71 $94.58 N/A N/A G18153 SUP HCPCS C1769 G18153 - GUIDEWIRE VASC STD ANG .038IN 145CM STRL 7CM RDRR PC NTNL BOTH IP/OP $95.00 $70.00 $18.77 $94.58 $51.36 $51.36 $51.36 $51.36 $94.58 $94.58 $94.58 $19.71 $94.58 $70.20 $70.20 $72.90 $49.28 $19.71 $94.58 $94.58 $55.94 $94.58 $94.58 $94.58 $94.58 $71.25 $94.58 $94.58 $94.58 $47.29 $47.29 $74.91 $94.58 $75.66 $61.48 $18.77 N/A $55.10 $94.58 $94.58 $94.58 $19.71 $94.58 N/A N/A G18154 SUP HCPCS C1769 G18154 - GUIDEWIRE VASC STRG .035IN 145CM 8CM RDRR PC STF BD LFRIC BOTH IP/OP $95.00 $70.00 $18.77 $94.58 $51.36 $51.36 $51.36 $51.36 $94.58 $94.58 $94.58 $19.71 $94.58 $70.20 $70.20 $72.90 $49.28 $19.71 $94.58 $94.58 $55.94 $94.58 $94.58 $94.58 $94.58 $71.25 $94.58 $94.58 $94.58 $47.29 $47.29 $74.91 $94.58 $75.66 $61.48 $18.77 N/A $55.10 $94.58 $94.58 $94.58 $19.71 $94.58 N/A N/A G18155 SUP HCPCS C1769 G18155 - GUIDEWIRE VASC .035IN 145CM STRL 8CM RDRR PC STF BD ANG TIP BOTH IP/OP $95.00 $70.00 $18.77 $94.58 $51.36 $51.36 $51.36 $51.36 $94.58 $94.58 $94.58 $19.71 $94.58 $70.20 $70.20 $72.90 $49.28 $19.71 $94.58 $94.58 $55.94 $94.58 $94.58 $94.58 $94.58 $71.25 $94.58 $94.58 $94.58 $47.29 $47.29 $74.91 $94.58 $75.66 $61.48 $18.77 N/A $55.10 $94.58 $94.58 $94.58 $19.71 $94.58 N/A N/A G18156 SUP HCPCS C1769 G18156 - GUIDEWIRE VASC STRG .038IN 145CM 8CM RDRR PC 1 TO 1 TRQ BOTH IP/OP $95.00 $70.00 $18.77 $94.58 $51.36 $51.36 $51.36 $51.36 $94.58 $94.58 $94.58 $19.71 $94.58 $70.20 $70.20 $72.90 $49.28 $19.71 $94.58 $94.58 $55.94 $94.58 $94.58 $94.58 $94.58 $71.25 $94.58 $94.58 $94.58 $47.29 $47.29 $74.91 $94.58 $75.66 $61.48 $18.77 N/A $55.10 $94.58 $94.58 $94.58 $19.71 $94.58 N/A N/A G18162 SUP HCPCS C2617 G18162 - GUIDEWIRE URO STRG .038IN 145CM STRL 5CM AMPTZ FLX TP FX COR BOTH IP/OP $33.00 $24.00 $6.53 $32.90 $14.81 $14.81 $14.81 $14.81 $32.90 $32.90 $32.90 $6.86 $32.90 $32.90 $32.90 $32.90 $32.90 $6.86 $32.90 $32.90 $19.46 $32.90 $32.90 $32.90 $32.90 $24.75 $32.90 $32.90 $32.90 $16.45 $16.45 $26.06 $32.90 $26.32 $14.81 $6.53 N/A $19.14 $32.90 $32.90 $32.90 $6.86 $32.90 N/A N/A G18189 SUP HCPCS C2627 G18189 - SET STNT 4FR 12-18CM STRL SALLE CATH MTLNTH PSTNR CNCT GW BOTH IP/OP $199.00 $147.00 $39.42 $198.63 $107.86 $107.86 $107.86 $107.86 $198.63 $198.63 $198.63 $41.40 $198.63 $147.42 $147.42 $153.10 $103.49 $41.40 $198.63 $198.63 $117.49 $198.63 $198.63 $198.63 $198.63 $149.25 $198.63 $198.63 $198.63 $99.32 $99.32 $157.31 $198.63 $158.90 $129.11 $39.42 N/A $115.42 $198.63 $198.63 $198.63 $41.39 $198.63 N/A N/A G18191 SUP Custom 27203010 G18191 - SET CATH 8FR 54CM CYSTOSTOMY MOD TROC STY DRN ADPR SPBC BOTH IP/OP $462.50 $342.00 $82.27 $462.20 $462.20 $462.20 $462.20 $462.20 $462.20 $462.20 $82.27 $462.20 $462.20 $343.04 $343.04 $356.26 $240.81 $96.33 $462.20 $184.88 $462.20 $462.20 $462.20 $462.20 $462.20 $346.88 $462.20 $462.20 $462.20 $231.10 $231.10 $366.06 $462.20 $369.76 $300.43 $462.20 N/A $268.25 $462.20 $277.32 $462.20 $462.20 $462.20 N/A N/A G18193 SUP Custom 27203010 G18193 - EXTRACTOR STON HLX 3FR 1CM 115CM NCRCL FLXB SHTH NTNL MEM BOTH IP/OP $303.00 $224.00 $53.90 $302.83 $302.83 $302.83 $302.83 $302.83 $302.83 $302.83 $53.90 $302.83 $302.83 $224.76 $224.76 $233.42 $157.77 $63.11 $302.83 $121.13 $302.83 $302.83 $302.83 $302.83 $302.83 $227.25 $302.83 $302.83 $302.83 $151.42 $151.42 $239.84 $302.83 $242.26 $196.84 $302.83 N/A $175.74 $302.83 $181.70 $302.83 $302.83 $302.83 N/A N/A G18201 SUP HCPCS C1892 G18201 - CATHETER XTRN 1.53IN NS NADH CNDM SIL M DISP BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18376 SUP HCPCS C1887 G18376 - CATHETER SPRT 2.3FR 150CM CXI ANG TIP BRD KINK RST RADOPQ SS BOTH IP/OP $487.50 $361.00 $96.76 $494.81 $264.71 $264.71 $264.71 $264.71 $487.50 $487.50 $487.50 $101.61 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $494.81 $288.36 $487.50 $494.81 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A G18622 SUP HCPCS C2617 G18622 - INTRODUCER NPHSTM 30FR 22CM 30CM AMPTZ DIL RNL BOTH IP/OP $286.00 $212.00 $56.73 $285.83 $128.62 $128.62 $128.62 $128.62 $285.83 $285.83 $285.83 $59.57 $285.83 $285.83 $285.83 $285.83 $285.83 $59.57 $285.83 $285.83 $169.07 $285.83 $285.83 $285.83 $285.83 $214.50 $285.83 $285.83 $285.83 $142.92 $142.92 $226.38 $285.83 $228.66 $128.62 $56.73 N/A $165.88 $285.83 $285.83 $285.83 $59.57 $285.83 N/A N/A G18624 SUP HCPCS C2625 G18624 - SET STNT .038IN 2 PGTL CRV 7FR 20CM BLU STRL CATH RADOPQ BOTH IP/OP $271.50 $201.00 $53.81 $271.13 $122.01 $122.01 $122.01 $122.01 $271.13 $271.13 $271.13 $56.51 $271.13 $271.13 $271.13 $271.13 $271.13 $56.51 $271.13 $271.13 $160.37 $271.13 $271.13 $271.13 $271.13 $203.63 $271.13 $271.13 $271.13 $135.57 $135.57 $214.73 $271.13 $216.90 $122.01 $53.81 N/A $157.47 $271.13 $271.13 $271.13 $56.50 $271.13 N/A N/A G18629 SUP HCPCS C1769 G18629 - SET STNT .038IN 5MM PGTL CRV 4.7FR 75CM STRL 100MM BNDR 2 BOTH IP/OP $108.00 $80.00 $21.41 $107.85 $58.56 $58.56 $58.56 $58.56 $107.85 $107.85 $107.85 $22.48 $107.85 $80.05 $80.05 $83.13 $56.19 $22.48 $107.85 $107.85 $63.79 $107.85 $107.85 $107.85 $107.85 $81.00 $107.85 $107.85 $107.85 $53.93 $53.93 $85.42 $107.85 $86.28 $70.10 $21.41 N/A $62.64 $107.85 $107.85 $107.85 $22.48 $107.85 N/A N/A G18639 SUP HCPCS C2617 G18639 - GUIDEWIRE ESCP STRG .035IN 145CM STRL 3CM RDRR PC 1-1 TRQ BOTH IP/OP $286.00 $212.00 $56.73 $285.83 $128.62 $128.62 $128.62 $128.62 $285.83 $285.83 $285.83 $59.57 $285.83 $285.83 $285.83 $285.83 $285.83 $59.57 $285.83 $285.83 $169.07 $285.83 $285.83 $285.83 $285.83 $214.50 $285.83 $285.83 $285.83 $142.92 $142.92 $226.38 $285.83 $228.66 $128.62 $56.73 N/A $165.88 $285.83 $285.83 $285.83 $59.57 $285.83 N/A N/A G18671 SUP Custom 27203010 G18671 - SET STNT .038IN 2 PGTL CRV 7FR 24CM BLU STRL CATH RADOPQ BOTH IP/OP $85.00 $63.00 $15.08 $84.70 $84.70 $84.70 $84.70 $84.70 $84.70 $84.70 $15.08 $84.70 $84.70 $62.86 $62.86 $65.29 $44.13 $17.65 $84.70 $33.88 $84.70 $84.70 $84.70 $84.70 $84.70 $63.75 $84.70 $84.70 $84.70 $42.35 $42.35 $67.08 $84.70 $67.76 $55.06 $84.70 N/A $49.30 $84.70 $50.82 $84.70 $84.70 $84.70 N/A N/A G18702 SUP Custom 27203010 G18702 - NEEDLE BRCHTX 18GA 20CM ECHTP LOC BOTH IP/OP $95.00 $70.00 $16.84 $94.60 $94.60 $94.60 $94.60 $94.60 $94.60 $94.60 $16.84 $94.60 $94.60 $70.21 $70.21 $72.92 $49.29 $19.72 $94.60 $37.84 $94.60 $94.60 $94.60 $94.60 $94.60 $71.25 $94.60 $94.60 $94.60 $47.30 $47.30 $74.92 $94.60 $75.68 $61.49 $94.60 N/A $55.10 $94.60 $56.76 $94.60 $94.60 $94.60 N/A N/A G18705 SUP Custom 27203010 G18705 - NEEDLE BX 14GA 15CM STRL Q COR 1 HNDCNTL LTWT SFT TIS DISP BOTH IP/OP $95.00 $70.00 $16.84 $94.60 $94.60 $94.60 $94.60 $94.60 $94.60 $94.60 $16.84 $94.60 $94.60 $70.21 $70.21 $72.92 $49.29 $19.72 $94.60 $37.84 $94.60 $94.60 $94.60 $94.60 $94.60 $71.25 $94.60 $94.60 $94.60 $47.30 $47.30 $74.92 $94.60 $75.68 $61.49 $94.60 N/A $55.10 $94.60 $56.76 $94.60 $94.60 $94.60 N/A N/A G18707 SUP Custom 27203010 G18707 - NEEDLE BX 18GA 15CM STRL Q COR 1 HND CNTRL LTWT SFT TIS DISP BOTH IP/OP $95.00 $70.00 $16.84 $94.60 $94.60 $94.60 $94.60 $94.60 $94.60 $94.60 $16.84 $94.60 $94.60 $70.21 $70.21 $72.92 $49.29 $19.72 $94.60 $37.84 $94.60 $94.60 $94.60 $94.60 $94.60 $71.25 $94.60 $94.60 $94.60 $47.30 $47.30 $74.92 $94.60 $75.68 $61.49 $94.60 N/A $55.10 $94.60 $56.76 $94.60 $94.60 $94.60 N/A N/A G18725 SUP HCPCS C1892 G18725 - NEEDLE BX 18GA 20CM STRL Q COR 1 HND CNTRL LTWT SFT TIS DISP BOTH IP/OP $93.00 $69.00 $18.45 $92.98 $50.49 $50.49 $50.49 $50.49 $92.98 $92.98 $92.98 $19.38 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $92.98 $55.00 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $18.45 N/A $53.94 $92.98 $92.98 $92.98 $19.38 $92.98 N/A N/A G18758 SUP HCPCS C1758 G18758 - INTRODUCER NPHSTM 26FR 20CM 32CM AMPTZ DIL RNL BOTH IP/OP $40.00 $30.00 $7.93 $39.95 $21.69 $21.69 $21.69 $21.69 $39.95 $39.95 $39.95 $8.33 $39.95 $29.65 $29.65 $30.79 $20.81 $8.33 $39.95 $39.95 $23.63 $39.95 $39.95 $39.95 $39.95 $30.00 $39.95 $39.95 $39.95 $19.98 $19.98 $31.64 $39.95 $31.96 $25.97 $7.93 N/A $23.20 $39.95 $39.95 $39.95 $8.33 $39.95 N/A N/A G18777 SUP Custom 27203010 G18777 - EXTRACTOR ESCP 2.2FR 1CM 115CM NCRCL 4WR REM HNDL NTNL URET BOTH IP/OP $462.50 $342.00 $82.27 $462.20 $462.20 $462.20 $462.20 $462.20 $462.20 $462.20 $82.27 $462.20 $462.20 $343.04 $343.04 $356.26 $240.81 $96.33 $462.20 $184.88 $462.20 $462.20 $462.20 $462.20 $462.20 $346.88 $462.20 $462.20 $462.20 $231.10 $231.10 $366.06 $462.20 $369.76 $300.43 $462.20 N/A $268.25 $462.20 $277.32 $462.20 $462.20 $462.20 N/A N/A G18778 SUP Custom 27203010 G18778 - EXTRACTOR STON 2.2FR 2CM 115CM NCRCL TPLS MOD BSKT NTNL BOTH IP/OP $462.50 $342.00 $82.27 $462.20 $462.20 $462.20 $462.20 $462.20 $462.20 $462.20 $82.27 $462.20 $462.20 $343.04 $343.04 $356.26 $240.81 $96.33 $462.20 $184.88 $462.20 $462.20 $462.20 $462.20 $462.20 $346.88 $462.20 $462.20 $462.20 $231.10 $231.10 $366.06 $462.20 $369.76 $300.43 $462.20 N/A $268.25 $462.20 $277.32 $462.20 $462.20 $462.20 N/A N/A G18790 SUP HCPCS C1758 G18790 - EXTRACTOR STON 2.2FR 1CM 115CM STRL NCRCL NTNL URO DISP BOTH IP/OP $33.00 $24.00 $6.53 $32.90 $17.86 $17.86 $17.86 $17.86 $32.90 $32.90 $32.90 $6.86 $32.90 $24.42 $24.42 $25.36 $17.14 $6.86 $32.90 $32.90 $19.46 $32.90 $32.90 $32.90 $32.90 $24.75 $32.90 $32.90 $32.90 $16.45 $16.45 $26.06 $32.90 $26.32 $21.39 $6.53 N/A $19.14 $32.90 $32.90 $32.90 $6.86 $32.90 N/A N/A G18792 SUP HCPCS C1769 G18792 - CATHETER URET .038IN 5FR 110CM FLXTP OP-EN GW MOD BOTH IP/OP $108.50 $80.00 $21.51 $108.38 $58.85 $58.85 $58.85 $58.85 $108.38 $108.38 $108.38 $22.59 $108.38 $80.44 $80.44 $83.54 $56.47 $22.59 $108.38 $108.38 $64.11 $108.38 $108.38 $108.38 $108.38 $81.38 $108.38 $108.38 $108.38 $54.19 $54.19 $85.84 $108.38 $86.70 $70.45 $21.51 N/A $62.93 $108.38 $108.38 $108.38 $22.59 $108.38 N/A N/A G18803 SUP HCPCS C1892 G18803 - GUIDEWIRE URO .035IN 145CM STRL RDRR PC 2 FLX TP AQ DISP BOTH IP/OP $164.50 $122.00 $32.64 $164.45 $89.30 $89.30 $89.30 $89.30 $164.45 $164.45 $164.45 $34.28 $164.45 $122.05 $122.05 $126.76 $85.68 $34.27 $164.45 $164.45 $97.27 $164.45 $164.45 $164.45 $164.45 $123.38 $164.45 $164.45 $164.45 $82.23 $82.23 $130.24 $164.45 $131.56 $106.89 $32.64 N/A $95.41 $164.45 $164.45 $164.45 $34.27 $164.45 N/A N/A G18813 SUP Custom 27203010 G18813 - INTRODUCER NPHSTM 12FR 65CM 60CM PLWY 2 KNOB BOTH IP/OP $59.50 $44.00 $10.57 $59.40 $59.40 $59.40 $59.40 $59.40 $59.40 $59.40 $10.57 $59.40 $59.40 $44.09 $44.09 $45.79 $30.95 $12.38 $59.40 $23.76 $59.40 $59.40 $59.40 $59.40 $59.40 $44.63 $59.40 $59.40 $59.40 $29.70 $29.70 $47.04 $59.40 $47.52 $38.61 $59.40 N/A $34.51 $59.40 $35.64 $59.40 $59.40 $59.40 N/A N/A G18827 SUP HCPCS C2627 G18827 - ADAPTER CATH 6FR STRL T-B SDARM URET DISP BOTH IP/OP $102.50 $76.00 $20.34 $102.50 $55.66 $55.66 $55.66 $55.66 $102.50 $102.50 $102.50 $21.36 $102.50 $76.08 $76.08 $79.01 $53.40 $21.36 $102.50 $102.50 $60.63 $102.50 $102.50 $102.50 $102.50 $76.88 $102.50 $102.50 $102.50 $51.25 $51.25 $81.18 $102.50 $82.00 $66.63 $20.34 N/A $59.45 $102.50 $102.50 $102.50 $21.36 $102.50 N/A N/A G18845 SUP HCPCS C1758 G18845 - STENT URTH 6FR 50CM STRL 26CM KL DPR INK MRK DISP BOTH IP/OP $86.00 $64.00 $17.03 $85.80 $46.59 $46.59 $46.59 $46.59 $85.80 $85.80 $85.80 $17.88 $85.80 $63.68 $63.68 $66.13 $44.70 $17.88 $85.80 $85.80 $50.75 $85.80 $85.80 $85.80 $85.80 $64.50 $85.80 $85.80 $85.80 $42.90 $42.90 $67.95 $85.80 $68.64 $55.77 $17.03 N/A $49.88 $85.80 $85.80 $85.80 $17.88 $85.80 N/A N/A G18876 SUP HCPCS C1758 G18876 - CATHETER URET STD 6/10FR 24CM FLXTP 2 LUM ACC HDRPH BOTH IP/OP $28.00 $21.00 $5.52 $27.83 $15.11 $15.11 $15.11 $15.11 $27.83 $27.83 $27.83 $5.80 $27.83 $20.66 $20.66 $21.45 $14.50 $5.80 $27.83 $27.83 $16.46 $27.83 $27.83 $27.83 $27.83 $21.00 $27.83 $27.83 $27.83 $13.92 $13.92 $22.04 $27.83 $22.26 $18.09 $5.52 N/A $16.24 $27.83 $27.83 $27.83 $5.80 $27.83 N/A N/A G18882 SUP Custom 27203010 G18882 - GRASPER ENDSCP 3.2FR 10MM 115CM 3 PRONG DELTA WIRE STAINLESS BOTH IP/OP $473.00 $350.00 $84.16 $472.83 $472.83 $472.83 $472.83 $472.83 $472.83 $472.83 $84.16 $472.83 $472.83 $350.93 $350.93 $364.46 $246.34 $98.54 $472.83 $189.13 $472.83 $472.83 $472.83 $472.83 $472.83 $354.75 $472.83 $472.83 $472.83 $236.42 $236.42 $374.48 $472.83 $378.26 $307.34 $472.83 N/A $274.34 $472.83 $283.70 $472.83 $472.83 $472.83 N/A N/A G18883 SUP HCPCS C1758 G18883 - CATHETER URET 5FR 100CM RND TIP LT BOTH IP/OP $49.50 $37.00 $9.79 $49.35 $26.80 $26.80 $26.80 $26.80 $49.35 $49.35 $49.35 $10.29 $49.35 $36.63 $36.63 $38.04 $25.71 $10.29 $49.35 $49.35 $29.19 $49.35 $49.35 $49.35 $49.35 $37.13 $49.35 $49.35 $49.35 $24.68 $24.68 $39.09 $49.35 $39.48 $32.08 $9.79 N/A $28.71 $49.35 $49.35 $49.35 $10.28 $49.35 N/A N/A G18884 SUP HCPCS C1758 G18884 - CATHETER URET .05IN 7.1FR 40CM SFLX NTPR TIP LSR BOTH IP/OP $104.50 $77.00 $20.71 $104.35 $56.66 $56.66 $56.66 $56.66 $104.35 $104.35 $104.35 $21.75 $104.35 $77.45 $77.45 $80.43 $54.37 $21.75 $104.35 $104.35 $61.72 $104.35 $104.35 $104.35 $104.35 $78.38 $104.35 $104.35 $104.35 $52.18 $52.18 $82.65 $104.35 $83.48 $67.83 $20.71 N/A $60.61 $104.35 $104.35 $104.35 $21.75 $104.35 N/A N/A G18909 SUP HCPCS C1758 G18909 - CATHETER URET PGTL CRV 8.2FR 56CM SFLX HDRPH BOTH IP/OP $32.00 $24.00 $6.28 $31.63 $17.18 $17.18 $17.18 $17.18 $31.63 $31.63 $31.63 $6.59 $31.63 $23.48 $23.48 $24.38 $16.48 $6.59 $31.63 $31.63 $18.71 $31.63 $31.63 $31.63 $31.63 $24.00 $31.63 $31.63 $31.63 $15.82 $15.82 $25.05 $31.63 $25.30 $20.56 $6.28 N/A $18.56 $31.63 $31.63 $31.63 $6.59 $31.63 N/A N/A G18996 SUP HCPCS C1758 G18996 - CATHETER URET 3FR 100CM RND TIP STY LT BOTH IP/OP $104.50 $77.00 $20.71 $104.35 $56.66 $56.66 $56.66 $56.66 $104.35 $104.35 $104.35 $21.75 $104.35 $77.45 $77.45 $80.43 $54.37 $21.75 $104.35 $104.35 $61.72 $104.35 $104.35 $104.35 $104.35 $78.38 $104.35 $104.35 $104.35 $52.18 $52.18 $82.65 $104.35 $83.48 $67.83 $20.71 N/A $60.61 $104.35 $104.35 $104.35 $21.75 $104.35 N/A N/A G18997 SUP HCPCS C1758 G18997 - CATHETER URET PGTL CRV 10FR 56CM SFLX HDRPH BOTH IP/OP $119.50 $88.00 $23.66 $119.20 $64.73 $64.73 $64.73 $64.73 $119.20 $119.20 $119.20 $24.84 $119.20 $88.47 $88.47 $91.88 $62.10 $24.84 $119.20 $119.20 $70.51 $119.20 $119.20 $119.20 $119.20 $89.63 $119.20 $119.20 $119.20 $59.60 $59.60 $94.41 $119.20 $95.36 $77.48 $23.66 N/A $69.31 $119.20 $119.20 $119.20 $24.84 $119.20 N/A N/A G19002 SUP HCPCS C1758 G19002 - CATHETER URET PGTL CRV 7FR 56CM SFLX HDRPH BOTH IP/OP $53.50 $40.00 $10.54 $53.13 $28.85 $28.85 $28.85 $28.85 $53.13 $53.13 $53.13 $11.07 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $53.13 $31.43 $53.13 $53.13 $53.13 $53.13 $40.13 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $10.54 N/A $31.03 $53.13 $53.13 $53.13 $11.07 $53.13 N/A N/A G19030 SUP Custom 27203010 G19030 - CATHETER URET .038IN 7FR 70CM OP-EN GW MOD BOTH IP/OP $43.00 $32.00 $7.65 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $43.00 $7.65 $43.00 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $17.20 $43.00 $43.00 $43.00 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $43.00 N/A $24.94 $43.00 $25.80 $43.00 $43.00 $43.00 N/A N/A G19032 SUP Custom 27203010 G19032 - NEEDLE ESCP 18GA 20CM SKNY ECHTP CHBA TIP BOTH IP/OP $30.00 $22.00 $5.29 $29.70 $29.70 $29.70 $29.70 $29.70 $29.70 $29.70 $5.29 $29.70 $29.70 $22.04 $22.04 $22.89 $15.47 $6.19 $29.70 $11.88 $29.70 $29.70 $29.70 $29.70 $29.70 $22.50 $29.70 $29.70 $29.70 $14.85 $14.85 $23.52 $29.70 $23.76 $19.31 $29.70 N/A $17.40 $29.70 $17.82 $29.70 $29.70 $29.70 N/A N/A G19055 SUP HCPCS C1758 G19055 - ADAPTER CATH 9FR CKFL 3W STPCK SDARM SLF SL BOTH IP/OP $53.50 $40.00 $10.54 $53.13 $28.85 $28.85 $28.85 $28.85 $53.13 $53.13 $53.13 $11.07 $53.13 $39.43 $39.43 $40.95 $27.68 $11.07 $53.13 $53.13 $31.43 $53.13 $53.13 $53.13 $53.13 $40.13 $53.13 $53.13 $53.13 $26.57 $26.57 $42.08 $53.13 $42.50 $34.53 $10.54 N/A $31.03 $53.13 $53.13 $53.13 $11.07 $53.13 N/A N/A G19069 SUP HCPCS C2617 G19069 - CATHETER URET .038IN 7FR 70CM OP-EN GW MOD BOTH IP/OP $261.50 $194.00 $51.88 $261.38 $117.62 $117.62 $117.62 $117.62 $261.38 $261.38 $261.38 $54.48 $261.38 $261.38 $261.38 $261.38 $261.38 $54.47 $261.38 $261.38 $154.61 $261.38 $261.38 $261.38 $261.38 $196.13 $261.38 $261.38 $261.38 $130.69 $130.69 $207.01 $261.38 $209.10 $117.62 $51.88 N/A $151.67 $261.38 $261.38 $261.38 $54.47 $261.38 N/A N/A G19072 SUP Custom 27203010 G19072 - SET STNT 5FR 8-20CM STRL GRN CATH RADOPQ MTLNTH PSTNR BOTH IP/OP $478.50 $354.00 $85.11 $478.13 $478.13 $478.13 $478.13 $478.13 $478.13 $478.13 $85.11 $478.13 $478.13 $354.87 $354.87 $368.54 $249.11 $99.65 $478.13 $191.25 $478.13 $478.13 $478.13 $478.13 $478.13 $358.88 $478.13 $478.13 $478.13 $239.07 $239.07 $378.68 $478.13 $382.50 $310.78 $478.13 N/A $277.53 $478.13 $286.88 $478.13 $478.13 $478.13 N/A N/A G19073 SUP Custom 27203010 G19073 - EXTRACTOR STON 2.2FR 115CM 5CM NFORCE 3WR HLCL OCL NTNL BOTH IP/OP $550.00 $407.00 $97.87 $549.85 $549.85 $549.85 $549.85 $549.85 $549.85 $549.85 $97.87 $549.85 $549.85 $408.10 $408.10 $423.82 $286.47 $114.59 $549.85 $219.94 $549.85 $549.85 $549.85 $549.85 $549.85 $412.50 $549.85 $549.85 $549.85 $274.93 $274.93 $435.48 $549.85 $439.88 $357.40 $549.85 N/A $319.00 $549.85 $329.91 $549.85 $549.85 $549.85 N/A N/A G19089 SUP HCPCS C1729 G19089 - SET NPHSTM ECHTP NDL GW DIL PERC BOTH IP/OP $417.50 $309.00 $82.85 $417.45 $226.68 $226.68 $226.68 $226.68 $417.45 $417.45 $417.45 $87.01 $417.45 $309.83 $309.83 $321.77 $217.49 $87.00 $417.45 $417.45 $246.92 $417.45 $417.45 $417.45 $417.45 $313.13 $417.45 $417.45 $417.45 $208.73 $208.73 $330.62 $417.45 $333.96 $271.34 $82.85 N/A $242.15 $417.45 $417.45 $417.45 $87.00 $417.45 N/A N/A G19097 SUP HCPCS C1894 G19097 - SET NPHSTM PGTL CRV 6FR 7CM ECHTP NDL GW CATH DIL CNCT TUBE BOTH IP/OP $254.50 $188.00 $50.47 $254.28 $138.07 $138.07 $138.07 $138.07 $254.28 $254.28 $254.28 $53.00 $254.28 $188.73 $188.73 $196.00 $132.48 $52.99 $254.28 $254.28 $150.41 $254.28 $254.28 $254.28 $254.28 $190.88 $254.28 $254.28 $254.28 $127.14 $127.14 $201.39 $254.28 $203.42 $165.28 $50.47 N/A $147.61 $254.28 $254.28 $254.28 $52.99 $254.28 N/A N/A G19098 SUP HCPCS C1769 G19098 - SET NPHSTM COPE LOOP ECHTP NDL GW CATH CNN PERC BOTH IP/OP $466.00 $345.00 $92.40 $465.53 $252.78 $252.78 $252.78 $252.78 $465.53 $465.53 $465.53 $97.03 $465.53 $345.52 $345.52 $358.83 $242.54 $97.02 $465.53 $465.53 $275.36 $465.53 $465.53 $465.53 $465.53 $349.50 $465.53 $465.53 $465.53 $232.77 $232.77 $368.70 $465.53 $372.42 $302.59 $92.40 N/A $270.28 $465.53 $465.53 $465.53 $97.02 $465.53 N/A N/A G19110 SUP Custom 27203010 G19110 - SET NPHSTM 10FR 19.5CM LTX COPE LOOP ECHTP NDL STPCK CNN BOTH IP/OP $515.50 $381.00 $91.73 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $91.73 $515.33 $515.33 $382.48 $382.48 $397.22 $268.49 $107.40 $515.33 $206.13 $515.33 $515.33 $515.33 $515.33 $515.33 $386.63 $515.33 $515.33 $515.33 $257.67 $257.67 $408.14 $515.33 $412.26 $334.96 $515.33 N/A $298.99 $515.33 $309.20 $515.33 $515.33 $515.33 N/A N/A G19111 SUP Custom 27203010 G19111 - EXTRACTOR STON 3ANG 2.4FR 1CM 115CM STRL NCR DWR TPLS BSKT BOTH IP/OP $515.50 $381.00 $91.73 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $91.73 $515.33 $515.33 $382.48 $382.48 $397.22 $268.49 $107.40 $515.33 $206.13 $515.33 $515.33 $515.33 $515.33 $515.33 $386.63 $515.33 $515.33 $515.33 $257.67 $257.67 $408.14 $515.33 $412.26 $334.96 $515.33 N/A $298.99 $515.33 $309.20 $515.33 $515.33 $515.33 N/A N/A G19119 SUP HCPCS C1758 G19119 - EXTRACTOR STON 2.4FR 2CM 115CM NCR DWR TPLS MOD BSKT NTNL BOTH IP/OP $225.50 $167.00 $44.76 $225.50 $122.45 $122.45 $122.45 $122.45 $225.50 $225.50 $225.50 $47.00 $225.50 $167.37 $167.37 $173.82 $117.49 $47.00 $225.50 $225.50 $133.38 $225.50 $225.50 $225.50 $225.50 $169.13 $225.50 $225.50 $225.50 $112.75 $112.75 $178.60 $225.50 $180.40 $146.58 $44.76 N/A $130.79 $225.50 $225.50 $225.50 $46.99 $225.50 N/A N/A G19168 SUP HCPCS C1894 G19168 - SHEATH ACCES 12FR 35CM DILATION CONTIN WORKING CHANNEL BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G19169 SUP HCPCS C1894 G19169 - SET STNT ANTGRD 2 PGTL CRV 6FR 50CM GRN STRL 32CM SEIDMON BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G19172 SUP HCPCS C1894 G19172 - SHEATH ACCES 12FR DILATION CONTIN WKG CHNL FLXR BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G19173 SUP HCPCS C1894 G19173 - SHEATH ACC 12FR 55CM STRL LTX FLXR DILATION CNT WRK CHNL BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G19174 SUP HCPCS C1894 G19174 - SHEATH ACCES 9.5FR TPR DILAT CONTIN WRK CHNL LOCK BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G19175 SUP HCPCS C1894 G19175 - SHEATH ACC 12FR 20CM STRL LTX FLXR DILATION CNT WRK CHNL BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G19176 SUP HCPCS C1894 G19176 - SHEATH ACCES 9.5FR TPR DILAT CONTIN WRK CHNL LOCK BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G19177 SUP HCPCS C1894 G19177 - SHEATH ACC FNL 9.5FR 55CM STRL FLXR WKG CHNL LFRIC SRFC DIL BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G19191 SUP Custom 27203010 G19191 - NEEDLE ENDSCP 22GA 25CM SKINNY NEEDLE CHIBA ECHOTIP BOTH IP/OP $29.00 $21.00 $5.09 $28.60 $28.60 $28.60 $28.60 $28.60 $28.60 $28.60 $5.09 $28.60 $28.60 $21.23 $21.23 $22.04 $14.90 $5.96 $28.60 $11.44 $28.60 $28.60 $28.60 $28.60 $28.60 $21.75 $28.60 $28.60 $28.60 $14.30 $14.30 $22.65 $28.60 $22.88 $18.59 $28.60 N/A $16.82 $28.60 $17.16 $28.60 $28.60 $28.60 N/A N/A G21363 SUP Custom 27203010 G21363 - PROBE DPLR 20MHZ 17.4CM STRL LF SWARTZ STD CUF IMPL MCVSC BOTH IP/OP "$1,240.00" $918.00 $220.72 "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" $220.72 "$1,240.00" "$1,240.00" $920.33 $920.33 $955.79 $646.04 $258.43 "$1,240.00" $496.00 "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" "$1,240.00" $930.00 "$1,240.00" "$1,240.00" "$1,240.00" $620.00 $620.00 $982.08 "$1,240.00" $992.00 $806.00 "$1,240.00" N/A $719.20 "$1,240.00" $744.00 "$1,240.00" "$1,240.00" "$1,240.00" N/A N/A G21421 SUP HCPCS C1729 G21421 - CATHETER ENDSCP 7FR 250CM 5 SIDEPORT LATEX FREE BILIARY BOTH IP/OP $207.50 $154.00 $41.18 $207.50 $112.67 $112.67 $112.67 $112.67 $207.50 $207.50 $207.50 $43.25 $207.50 $154.01 $154.01 $159.94 $108.11 $43.25 $207.50 $207.50 $122.74 $207.50 $207.50 $207.50 $207.50 $155.63 $207.50 $207.50 $207.50 $103.75 $103.75 $164.34 $207.50 $166.00 $134.88 $41.18 N/A $120.35 $207.50 $207.50 $207.50 $43.24 $207.50 N/A N/A G21509 SUP HCPCS C2617 G21509 - STENT PANCREATIC 7FR 15CM DRAIN OBSTRUCTED POSITIONING BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $79.88 $79.88 $79.88 $79.88 $177.50 $177.50 $177.50 $37.00 $177.50 $177.50 $177.50 $177.50 $177.50 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $79.88 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A G21586 SUP HCPCS C1729 G21586 - SET DRAIN .035IN PIGTAIL CURVE 7FR 250CM 5 SIDEPORT CATHETER BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $190.05 $190.05 $190.05 $190.05 $350.00 $350.00 $350.00 $72.95 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $347.50 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A G21962 SUP HCPCS C1769 G21962 - GUIDEWIRE ENDSCP 250CM PROGRESSIVELY FLEXIBLE TIP BOTH IP/OP $415.00 $307.00 $82.37 $415.00 $225.35 $225.35 $225.35 $225.35 $415.00 $415.00 $415.00 $86.50 $415.00 $308.01 $308.01 $319.88 $216.22 $86.49 $415.00 $415.00 $245.47 $415.00 $415.00 $415.00 $415.00 $311.25 $415.00 $415.00 $415.00 $207.50 $207.50 $328.68 $415.00 $332.00 $269.75 $82.37 N/A $240.70 $415.00 $249.00 $415.00 $86.49 $415.00 N/A N/A G21978 SUP HCPCS C1769 G21978 - GUIDEWIRE ENDSCP 360CM SAVARY-GILLIARD NONSTRL REUSABLE BOTH IP/OP $480.00 $355.00 $95.27 $480.00 $260.64 $260.64 $260.64 $260.64 $480.00 $480.00 $480.00 $100.04 $480.00 $356.26 $356.26 $369.98 $250.08 $100.04 $480.00 $480.00 $283.92 $480.00 $480.00 $480.00 $480.00 $360.00 $480.00 $480.00 $480.00 $240.00 $240.00 $380.16 $480.00 $384.00 $312.00 $95.27 N/A $278.40 $480.00 $480.00 $480.00 $100.03 $480.00 N/A N/A G22102 SUP HCPCS C2617 G22102 - STENT PANCREATIC 5FR 153CM DRAIN OBSTRUCTED POSITIONING BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $79.88 $79.88 $79.88 $79.88 $177.50 $177.50 $177.50 $37.00 $177.50 $177.50 $177.50 $177.50 $177.50 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $79.88 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A G22139 SUP HCPCS C1769 G22139 - GUIDEWIRE ENDSCP 200CM FLEXIBLE TIP SAVARY-GILLIARD BOTH IP/OP $345.00 $255.00 $68.47 $345.00 $187.34 $187.34 $187.34 $187.34 $345.00 $345.00 $345.00 $71.91 $345.00 $256.06 $256.06 $265.93 $179.75 $71.90 $345.00 $345.00 $204.07 $345.00 $345.00 $345.00 $345.00 $258.75 $345.00 $345.00 $345.00 $172.50 $172.50 $273.24 $345.00 $276.00 $224.25 $68.47 N/A $200.10 $345.00 $207.00 $345.00 $71.90 $345.00 N/A N/A G22409 SUP Custom 27203010 G22409 - BRUSH CYTOLOGY 5FR 2MM 180CM GASTROSCOPE GREEN BOTH IP/OP $46.50 $34.00 $8.23 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $46.25 $8.23 $46.25 $46.25 $34.33 $34.33 $35.65 $24.10 $9.64 $46.25 $18.50 $46.25 $46.25 $46.25 $46.25 $46.25 $34.88 $46.25 $46.25 $46.25 $23.13 $23.13 $36.63 $46.25 $37.00 $30.06 $46.25 N/A $26.97 $46.25 $27.75 $46.25 $46.25 $46.25 N/A N/A G23160 SUP HCPCS C1887 G23160 - CATHETER GD STRG 2.3FR 135CM CXI MRKR BAND KINK RST RADOPQ BOTH IP/OP $487.50 $361.00 $96.76 $494.81 $264.71 $264.71 $264.71 $264.71 $487.50 $487.50 $487.50 $101.61 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $494.81 $288.36 $487.50 $494.81 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A G23239 SUP HCPCS C2617 G23239 - LASER SRG 115V 20AMP RHPSD H-30 BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23240 SUP HCPCS C2617 G23240 - SET STNT .038IN 3CM PGTL CRV 7FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $137.50 $102.00 $27.20 $137.05 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $81.07 $137.05 $137.05 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $137.05 $137.05 $28.56 $137.05 N/A N/A G23241 SUP HCPCS C2617 G23241 - STENT URET 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23242 SUP HCPCS C2617 G23242 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM BOTH IP/OP $137.50 $102.00 $27.20 $137.05 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $81.07 $137.05 $137.05 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $137.05 $137.05 $28.56 $137.05 N/A N/A G23243 SUP HCPCS C2617 G23243 - STENT URET 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23244 SUP HCPCS C2617 G23244 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23312 SUP HCPCS C2617 G23312 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM BOTH IP/OP $137.50 $102.00 $27.20 $137.05 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $81.07 $137.05 $137.05 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $137.05 $137.05 $28.56 $137.05 N/A N/A G23313 SUP HCPCS C2617 G23313 - SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23314 SUP HCPCS C2617 G23314 - SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23315 SUP HCPCS C2617 G23315 - SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23316 SUP HCPCS C2617 G23316 - SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23317 SUP HCPCS C2617 G23317 - SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23318 SUP HCPCS C2617 G23318 - SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23319 SUP HCPCS C2617 G23319 - SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23320 SUP HCPCS C2617 G23320 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23326 SUP HCPCS C2617 G23326 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23327 SUP HCPCS C2617 G23327 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23328 SUP HCPCS C2617 G23328 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23329 SUP HCPCS C2617 G23329 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23330 SUP HCPCS C2617 G23330 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23331 SUP HCPCS C2617 G23331 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23332 SUP HCPCS C2617 G23332 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23333 SUP HCPCS C2617 G23333 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM BOTH IP/OP $137.50 $102.00 $27.20 $137.05 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $81.07 $137.05 $137.05 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $137.05 $137.05 $28.56 $137.05 N/A N/A G23334 SUP HCPCS C2617 G23334 - SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23335 SUP HCPCS C2617 G23335 - SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23336 SUP HCPCS C2617 G23336 - SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23337 SUP HCPCS C2617 G23337 - SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23338 SUP HCPCS C2617 G23338 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23339 SUP HCPCS C2617 G23339 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23340 SUP HCPCS C2617 G23340 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23341 SUP HCPCS C2617 G23341 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23342 SUP HCPCS C2617 G23342 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23343 SUP HCPCS C2617 G23343 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23344 SUP HCPCS C2617 G23344 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23345 SUP HCPCS C2617 G23345 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23346 SUP HCPCS C2617 G23346 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23347 SUP HCPCS C2617 G23347 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23348 SUP HCPCS C2617 G23348 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23349 SUP HCPCS C2617 G23349 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23350 SUP HCPCS C2617 G23350 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23351 SUP HCPCS C2617 G23351 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23352 SUP HCPCS C2617 G23352 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23353 SUP HCPCS C2617 G23353 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23354 SUP HCPCS C2617 G23354 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23355 SUP HCPCS C2617 G23355 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23356 SUP HCPCS C2617 G23356 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23357 SUP HCPCS C2617 G23357 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23358 SUP HCPCS C2617 G23358 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23359 SUP HCPCS C2617 G23359 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23360 SUP HCPCS C2617 G23360 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23361 SUP HCPCS C2617 G23361 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23362 SUP HCPCS C2617 G23362 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23363 SUP HCPCS C2617 G23363 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23365 SUP HCPCS C2617 G23365 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $137.50 $102.00 $27.20 $137.05 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $81.07 $137.05 $137.05 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $137.05 $137.05 $28.56 $137.05 N/A N/A G23366 SUP HCPCS C2617 G23366 - SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23367 SUP HCPCS C2617 G23367 - SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23368 SUP HCPCS C2617 G23368 - SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23369 SUP HCPCS C2617 G23369 - SET STNT 2 PGTL CRV 5FR 26CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23370 SUP HCPCS C2617 G23370 - SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23371 SUP HCPCS C2617 G23371 - SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23372 SUP HCPCS C2617 G23372 - SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23373 SUP HCPCS C2617 G23373 - SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23374 SUP HCPCS C2617 G23374 - SET STNT 2 PGTL CRV 6FR 22CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23376 SUP HCPCS C2617 G23376 - SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23377 SUP HCPCS C2617 G23377 - SET STNT 2 PGTL CRV 6FR 26CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23378 SUP HCPCS C2617 G23378 - SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23379 SUP HCPCS C2617 G23379 - SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23380 SUP HCPCS C2617 G23380 - SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23381 SUP HCPCS C2617 G23381 - SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23382 SUP HCPCS C2617 G23382 - SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ GRAD PSTNR BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23383 SUP HCPCS C2617 G23383 - STENT URET 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23384 SUP HCPCS C2617 G23384 - STENT URET 2 PGTL CRV 7FR 26CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23385 SUP HCPCS C2617 G23385 - SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ GRAD PSTNR BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23386 SUP HCPCS C2617 G23386 - SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23387 SUP HCPCS C2617 G23387 - SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23388 SUP HCPCS C2617 G23388 - SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23389 SUP HCPCS C2617 G23389 - SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23390 SUP HCPCS C2617 G23390 - SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23391 SUP HCPCS C2617 G23391 - SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23392 SUP HCPCS C2617 G23392 - SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23395 SUP HCPCS C2617 G23395 - SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23396 SUP HCPCS C2617 G23396 - STENT URET 5FR 20CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23397 SUP HCPCS C2617 G23397 - SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23398 SUP HCPCS C2617 G23398 - SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23399 SUP HCPCS C2617 G23399 - STENT URET 5FR 26CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23400 SUP HCPCS C2617 G23400 - STENT URET 5FR 28CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23401 SUP HCPCS C2617 G23401 - SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23402 SUP HCPCS C2617 G23402 - SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23404 SUP HCPCS C2617 G23404 - SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23405 SUP HCPCS C2617 G23405 - STENT URET 6FR 22CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23406 SUP HCPCS C2617 G23406 - SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23407 SUP HCPCS C2617 G23407 - STENT URET 6FR 26CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23408 SUP HCPCS C2617 G23408 - STENT URET 6FR 28CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23411 SUP HCPCS C2617 G23411 - STENT URET 6FR 30CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23412 SUP HCPCS C2617 G23412 - SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23413 SUP HCPCS C2617 G23413 - SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23415 SUP HCPCS C2617 G23415 - SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23416 SUP HCPCS C2617 G23416 - STENT URET 7FR 24CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23417 SUP HCPCS C2617 G23417 - STENT URET 7FR 26CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23418 SUP HCPCS C2617 G23418 - STENT URET 7FR 28CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23419 SUP HCPCS C2617 G23419 - SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23420 SUP HCPCS C2617 G23420 - SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23421 SUP HCPCS C2617 G23421 - SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23422 SUP HCPCS C2617 G23422 - SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23423 SUP HCPCS C2617 G23423 - STENT URET 8FR 24CM STRL UNIVERSA FIRM PSTNR NO GW MFL TETH BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23424 SUP HCPCS C2617 G23424 - SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23425 SUP HCPCS C2617 G23425 - SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23428 SUP HCPCS C2617 G23428 - SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23429 SUP HCPCS C2617 G23429 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23430 SUP HCPCS C2617 G23430 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23431 SUP HCPCS C2617 G23431 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23432 SUP HCPCS C2617 G23432 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23433 SUP HCPCS C2617 G23433 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23434 SUP HCPCS C2617 G23434 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23435 SUP HCPCS C2617 G23435 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23436 SUP HCPCS C2617 G23436 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23437 SUP HCPCS C2617 G23437 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23438 SUP HCPCS C2617 G23438 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23439 SUP HCPCS C2617 G23439 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23440 SUP HCPCS C2617 G23440 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23441 SUP HCPCS C2617 G23441 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23442 SUP HCPCS C2617 G23442 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23443 SUP HCPCS C2617 G23443 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23444 SUP HCPCS C2617 G23444 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23445 SUP HCPCS C2617 G23445 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23446 SUP HCPCS C2617 G23446 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23447 SUP HCPCS C2617 G23447 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23448 SUP HCPCS C2617 G23448 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23449 SUP HCPCS C2617 G23449 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23450 SUP HCPCS C2617 G23450 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23451 SUP HCPCS C2617 G23451 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23452 SUP HCPCS C2617 G23452 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23453 SUP HCPCS C2617 G23453 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23454 SUP HCPCS C2617 G23454 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23455 SUP HCPCS C2617 G23455 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $137.50 $102.00 $27.20 $137.05 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $81.07 $137.05 $137.05 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $137.05 $137.05 $28.56 $137.05 N/A N/A G23456 SUP HCPCS C2617 G23456 - SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23457 SUP HCPCS C2617 G23457 - SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23458 SUP HCPCS C2617 G23458 - SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23459 SUP HCPCS C2617 G23459 - SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23460 SUP HCPCS C2617 G23460 - SET STNT 2 PGTL CRV 5FR 26CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23461 SUP HCPCS C2617 G23461 - SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23462 SUP HCPCS C2617 G23462 - SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23463 SUP HCPCS C2617 G23463 - SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23464 SUP HCPCS C2617 G23464 - SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23465 SUP HCPCS C2617 G23465 - SET STNT 2 PGTL CRV 6FR 22CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23466 SUP HCPCS C2617 G23466 - SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23467 SUP HCPCS C2617 G23467 - SET STNT 2 PGTL CRV 6FR 26CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23468 SUP HCPCS C2617 G23468 - SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23469 SUP HCPCS C2617 G23469 - SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23470 SUP HCPCS C2617 G23470 - SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23471 SUP HCPCS C2617 G23471 - SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23472 SUP HCPCS C2617 G23472 - SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23473 SUP HCPCS C2617 G23473 - SET STNT 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23474 SUP HCPCS C2617 G23474 - SET STNT 2 PGTL CRV 7FR 26CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23475 SUP HCPCS C2617 G23475 - SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23476 SUP HCPCS C2617 G23476 - SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23477 SUP HCPCS C2617 G23477 - SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23478 SUP HCPCS C2617 G23478 - SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23479 SUP HCPCS C2617 G23479 - SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23480 SUP HCPCS C2617 G23480 - SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23481 SUP HCPCS C2617 G23481 - SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23482 SUP HCPCS C2617 G23482 - SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $149.00 $110.00 $29.52 $148.75 $66.94 $66.94 $66.94 $66.94 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $148.75 $148.75 $148.75 $31.00 $148.75 $148.75 $87.99 $148.75 $148.75 $148.75 $148.75 $111.75 $148.75 $148.75 $148.75 $74.38 $74.38 $117.81 $148.75 $119.00 $66.94 $29.52 N/A $86.42 $148.75 $148.75 $148.75 $31.00 $148.75 N/A N/A G23483 SUP HCPCS C2617 G23483 - SET STNT .038IN 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23484 SUP HCPCS C2617 G23484 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23485 SUP HCPCS C2617 G23485 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23486 SUP HCPCS C2617 G23486 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23487 SUP HCPCS C2617 G23487 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23488 SUP HCPCS C2617 G23488 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23489 SUP HCPCS C2617 G23489 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23490 SUP HCPCS C2617 G23490 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23491 SUP HCPCS C2617 G23491 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23492 SUP HCPCS C2617 G23492 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23493 SUP HCPCS C2617 G23493 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23494 SUP HCPCS C2617 G23494 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23495 SUP HCPCS C2617 G23495 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23496 SUP HCPCS C2617 G23496 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23497 SUP HCPCS C2617 G23497 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23498 SUP HCPCS C2617 G23498 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23499 SUP HCPCS C2617 G23499 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23500 SUP HCPCS C2617 G23500 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23501 SUP HCPCS C2617 G23501 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23502 SUP HCPCS C2617 G23502 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23503 SUP HCPCS C2617 G23503 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23504 SUP HCPCS C2617 G23504 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23505 SUP HCPCS C2617 G23505 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23506 SUP HCPCS C2617 G23506 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23507 SUP HCPCS C2617 G23507 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23508 SUP HCPCS C2617 G23508 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23509 SUP HCPCS C2617 G23509 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23510 SUP HCPCS C2617 G23510 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23511 SUP HCPCS C2617 G23511 - SET STNT .038IN 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $137.50 $102.00 $27.20 $137.05 $61.67 $61.67 $61.67 $61.67 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $137.05 $137.05 $137.05 $28.56 $137.05 $137.05 $81.07 $137.05 $137.05 $137.05 $137.05 $103.13 $137.05 $137.05 $137.05 $68.53 $68.53 $108.54 $137.05 $109.64 $61.67 $27.20 N/A $79.75 $137.05 $137.05 $137.05 $28.56 $137.05 N/A N/A G23512 SUP HCPCS C2617 G23512 - SET STNT 2 PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA RADOPQ BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G23523 SUP Custom 27803010 G23523 - COIL EMBOLIZATION 3MM 7CM 7.4 LOOP NESTER PLATINUM SYNTH BOTH IP/OP $264.50 $196.00 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $105.68 $264.20 $264.20 $264.20 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G23552 SUP Custom 27203010 G23552 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$1,597.59" "$1,597.59" "$1,659.15" "$1,121.45" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" "$1,399.13" "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A G23553 SUP Custom 27203010 G23553 - FIBER LSR 20W 365UM RD STRL SMARTSYNC CNCT HO DISP RHPSD BOTH IP/OP "$2,367.50" "$1,752.00" $421.38 "$2,367.30" "$2,367.30" "$2,367.30" "$2,367.30" "$2,367.30" "$2,367.30" "$2,367.30" $421.38 "$2,367.30" "$2,367.30" "$1,757.01" "$1,757.01" "$1,824.71" "$1,233.36" $493.37 "$2,367.30" $946.92 "$2,367.30" "$2,367.30" "$2,367.30" "$2,367.30" "$2,367.30" "$1,775.63" "$2,367.30" "$2,367.30" "$2,367.30" "$1,183.65" "$1,183.65" "$1,874.90" "$2,367.30" "$1,893.84" "$1,538.75" "$2,367.30" N/A "$1,373.15" "$2,367.30" "$1,420.38" "$2,367.30" "$2,367.30" "$2,367.30" N/A N/A G23665 SUP Custom 27203010 G23665 - LASER SRG 230V 10AMP RHPSD H-30 HL-30B BOTH IP/OP "$2,231.50" "$1,651.00" $397.16 "$2,231.25" "$2,231.25" "$2,231.25" "$2,231.25" "$2,231.25" "$2,231.25" "$2,231.25" $397.16 "$2,231.25" "$2,231.25" "$1,656.03" "$1,656.03" "$1,719.85" "$1,162.48" $465.02 "$2,231.25" $892.50 "$2,231.25" "$2,231.25" "$2,231.25" "$2,231.25" "$2,231.25" "$1,673.63" "$2,231.25" "$2,231.25" "$2,231.25" "$1,115.63" "$1,115.63" "$1,767.15" "$2,231.25" "$1,785.00" "$1,450.31" "$2,231.25" N/A "$1,294.27" "$2,231.25" "$1,338.75" "$2,231.25" "$2,231.25" "$2,231.25" N/A N/A G23666 SUP Custom 27203010 G23666 - FIBER LSR 940UM CK HO BOTH IP/OP "$1,169.00" $865.00 $208.04 "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" $208.04 "$1,168.75" "$1,168.75" $867.45 $867.45 $900.87 $608.92 $243.58 "$1,168.75" $467.50 "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" $876.75 "$1,168.75" "$1,168.75" "$1,168.75" $584.38 $584.38 $925.65 "$1,168.75" $935.00 $759.69 "$1,168.75" N/A $678.02 "$1,168.75" $701.25 "$1,168.75" "$1,168.75" "$1,168.75" N/A N/A G23667 SUP Custom 27203010 G23667 - FIBER LSR 550UM CK HO BOTH IP/OP "$1,009.50" $747.00 $179.67 "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" $179.67 "$1,009.38" "$1,009.38" $749.16 $749.16 $778.03 $525.89 $210.37 "$1,009.38" $403.75 "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" $757.13 "$1,009.38" "$1,009.38" "$1,009.38" $504.69 $504.69 $799.43 "$1,009.38" $807.50 $656.10 "$1,009.38" N/A $585.51 "$1,009.38" $605.63 "$1,009.38" "$1,009.38" "$1,009.38" N/A N/A G23668 SUP Custom 27203010 G23668 - FIBER LSR 365UM CK HO BOTH IP/OP "$1,594.00" "$1,180.00" $283.69 "$1,593.75" "$1,593.75" "$1,593.75" "$1,593.75" "$1,593.75" "$1,593.75" "$1,593.75" $283.69 "$1,593.75" "$1,593.75" "$1,182.88" "$1,182.88" "$1,228.46" $830.34 $332.16 "$1,593.75" $637.50 "$1,593.75" "$1,593.75" "$1,593.75" "$1,593.75" "$1,593.75" "$1,195.50" "$1,593.75" "$1,593.75" "$1,593.75" $796.88 $796.88 "$1,262.25" "$1,593.75" "$1,275.00" "$1,035.94" "$1,593.75" N/A $924.52 "$1,593.75" $956.25 "$1,593.75" "$1,593.75" "$1,593.75" N/A N/A G23731 SUP Custom 27203010 G23731 - FIBER LSR 273UM CK HO BOTH IP/OP "$2,921.50" "$2,162.00" $519.98 "$2,921.25" "$2,921.25" "$2,921.25" "$2,921.25" "$2,921.25" "$2,921.25" "$2,921.25" $519.98 "$2,921.25" "$2,921.25" "$2,168.15" "$2,168.15" "$2,251.70" "$1,521.97" $608.82 "$2,921.25" "$1,168.50" "$2,921.25" "$2,921.25" "$2,921.25" "$2,921.25" "$2,921.25" "$2,191.13" "$2,921.25" "$2,921.25" "$2,921.25" "$1,460.63" "$1,460.63" "$2,313.63" "$2,921.25" "$2,337.00" "$1,898.81" "$2,921.25" N/A "$1,694.47" "$2,921.25" "$1,752.75" "$2,921.25" "$2,921.25" "$2,921.25" N/A N/A G23733 SUP Custom 27203010 G23733 - FIBER LSR 150UM CK HO BOTH IP/OP $849.50 $629.00 $151.14 $849.10 $849.10 $849.10 $849.10 $849.10 $849.10 $849.10 $151.14 $849.10 $849.10 $630.20 $630.20 $654.49 $442.38 $176.96 $849.10 $339.64 $849.10 $849.10 $849.10 $849.10 $849.10 $637.13 $849.10 $849.10 $849.10 $424.55 $424.55 $672.49 $849.10 $679.28 $551.92 $849.10 N/A $492.71 $849.10 $509.46 $849.10 $849.10 $849.10 N/A N/A G23734 SUP Custom 27203010 G23734 - FIBER LSR 200UM RD STRL SMARTSYNC CNCT HO DISP RHPSD H-30 BOTH IP/OP $953.50 $706.00 $169.68 $953.25 $953.25 $953.25 $953.25 $953.25 $953.25 $953.25 $169.68 $953.25 $953.25 $707.50 $707.50 $734.77 $496.64 $198.67 $953.25 $381.30 $953.25 $953.25 $953.25 $953.25 $953.25 $715.13 $953.25 $953.25 $953.25 $476.63 $476.63 $754.97 $953.25 $762.60 $619.61 $953.25 N/A $553.03 $953.25 $571.95 $953.25 $953.25 $953.25 N/A N/A G23735 SUP Custom 27203010 G23735 - FIBER LSR 550UM RD STRL SMARTSYNC CNCT HO DISP RHPSD H-30 BOTH IP/OP "$1,578.50" "$1,168.00" $280.97 "$1,578.50" "$1,578.50" "$1,578.50" "$1,578.50" "$1,578.50" "$1,578.50" "$1,578.50" $280.97 "$1,578.50" "$1,578.50" "$1,171.56" "$1,171.56" "$1,216.71" $822.40 $328.98 "$1,578.50" $631.40 "$1,578.50" "$1,578.50" "$1,578.50" "$1,578.50" "$1,578.50" "$1,183.88" "$1,578.50" "$1,578.50" "$1,578.50" $789.25 $789.25 "$1,250.17" "$1,578.50" "$1,262.80" "$1,026.03" "$1,578.50" N/A $915.53 "$1,578.50" $947.10 "$1,578.50" "$1,578.50" "$1,578.50" N/A N/A G24129 SUP HCPCS C1769 G24129 - SET INTRO .018IN .087IN 5.5CM GW SUBMANDIBULAR SLVA DCT BOTH IP/OP $387.50 $287.00 $76.91 $387.50 $210.41 $210.41 $210.41 $210.41 $387.50 $387.50 $387.50 $80.76 $387.50 $287.60 $287.60 $298.69 $201.89 $80.76 $387.50 $387.50 $229.21 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $251.88 $76.91 N/A $224.75 $387.50 $387.50 $387.50 $80.76 $387.50 N/A N/A G24132 SUP HCPCS C1769 G24132 - SET INTRO .018IN .074IN 5.5CM GW SUBMANDIBULAR SLVA DCT BOTH IP/OP $387.50 $287.00 $76.91 $387.50 $210.41 $210.41 $210.41 $210.41 $387.50 $387.50 $387.50 $80.76 $387.50 $287.60 $287.60 $298.69 $201.89 $80.76 $387.50 $387.50 $229.21 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $251.88 $76.91 N/A $224.75 $387.50 $232.50 $387.50 $80.76 $387.50 N/A N/A G24889 SUP HCPCS C1874 G24889 - STENT VASCULAR 6MM 6FR 60MM 125CM DRUG ELUTING OTW DELIVERY BOTH IP/OP "$3,737.50" "$2,766.00" $741.80 "$3,737.50" "$1,681.88" "$1,681.88" "$1,681.88" "$1,681.88" "$3,737.50" "$3,737.50" "$3,737.50" $778.99 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$3,737.50" "$1,842.59" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" $741.80 N/A "$2,167.75" "$3,737.50" "$3,737.50" "$3,737.50" $778.90 "$3,737.50" N/A N/A G24890 SUP HCPCS C1874 G24890 - STENT VASCULAR .035IN 6MM 6FR 80MM 125CM DRUG ELUTING SELF BOTH IP/OP "$4,487.50" "$3,321.00" $890.66 "$4,487.50" "$2,019.38" "$2,019.38" "$2,019.38" "$2,019.38" "$4,487.50" "$4,487.50" "$4,487.50" $935.31 "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" $935.24 "$4,487.50" "$4,487.50" "$2,212.34" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$3,365.63" "$4,487.50" "$4,487.50" "$4,487.50" "$2,243.75" "$2,243.75" "$3,554.10" "$4,487.50" "$3,590.00" "$2,019.38" $890.66 N/A "$2,602.75" "$4,487.50" "$4,487.50" "$4,487.50" $935.20 "$4,487.50" N/A N/A G24894 SUP HCPCS C1874 G24894 - STENT VASCULAR 7MM 6FR 60MM 125CM DRUG ELUTING OTW DELIVERY BOTH IP/OP "$3,737.50" "$2,766.00" $741.80 "$3,737.50" "$1,681.88" "$1,681.88" "$1,681.88" "$1,681.88" "$3,737.50" "$3,737.50" "$3,737.50" $778.99 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$3,737.50" "$1,842.59" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" $741.80 N/A "$2,167.75" "$3,737.50" "$3,737.50" "$3,737.50" $778.90 "$3,737.50" N/A N/A G24895 SUP HCPCS C1874 G24895 - STENT VASC .035IN 7MM 6FR 80MM 125CM ZL PTX DRG ELUT SLF XPD BOTH IP/OP "$4,487.50" "$3,321.00" $890.66 "$4,487.50" "$2,019.38" "$2,019.38" "$2,019.38" "$2,019.38" "$4,487.50" "$4,487.50" "$4,487.50" $935.31 "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" $935.24 "$4,487.50" "$4,487.50" "$2,212.34" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$3,365.63" "$4,487.50" "$4,487.50" "$4,487.50" "$2,243.75" "$2,243.75" "$3,554.10" "$4,487.50" "$3,590.00" "$2,019.38" $890.66 N/A "$2,602.75" "$4,487.50" "$4,487.50" "$4,487.50" $935.20 "$4,487.50" N/A N/A G24935 SUP HCPCS C1874 G24935 - STENT VASCULAR 6MM 6FR 100MM 125CM DRUG ELUTING OTW SELF BOTH IP/OP "$4,487.50" "$3,321.00" $890.66 "$4,487.50" "$2,019.38" "$2,019.38" "$2,019.38" "$2,019.38" "$4,487.50" "$4,487.50" "$4,487.50" $935.31 "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" $935.24 "$4,487.50" "$4,487.50" "$2,212.34" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$3,365.63" "$4,487.50" "$4,487.50" "$4,487.50" "$2,243.75" "$2,243.75" "$3,554.10" "$4,487.50" "$3,590.00" "$2,019.38" $890.66 N/A "$2,602.75" "$4,487.50" "$4,487.50" "$4,487.50" $935.20 "$4,487.50" N/A N/A G24937 SUP HCPCS C1874 G24937 - STENT VASCULAR 7MM 6FR 100MM 125CM DRUG ELUTING OTW DELIVERY BOTH IP/OP "$4,487.50" "$3,321.00" $890.66 "$4,487.50" "$2,019.38" "$2,019.38" "$2,019.38" "$2,019.38" "$4,487.50" "$4,487.50" "$4,487.50" $935.31 "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" $935.24 "$4,487.50" "$4,487.50" "$2,212.34" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$3,365.63" "$4,487.50" "$4,487.50" "$4,487.50" "$2,243.75" "$2,243.75" "$3,554.10" "$4,487.50" "$3,590.00" "$2,019.38" $890.66 N/A "$2,602.75" "$4,487.50" "$4,487.50" "$4,487.50" $935.20 "$4,487.50" N/A N/A G25292 SUP Custom 27203010 G25292 - SYSTEM LTHTRP UNV 11.6FR 5FR 38CM STRL LITHASSIST TUO 2 LUM BOTH IP/OP "$2,666.50" "$1,973.00" $474.57 "$2,666.15" "$2,666.15" "$2,666.15" "$2,666.15" "$2,666.15" "$2,666.15" "$2,666.15" $474.57 "$2,666.15" "$2,666.15" "$1,978.82" "$1,978.82" "$2,055.07" "$1,389.06" $555.65 "$2,666.15" "$1,066.46" "$2,666.15" "$2,666.15" "$2,666.15" "$2,666.15" "$2,666.15" "$1,999.88" "$2,666.15" "$2,666.15" "$2,666.15" "$1,333.08" "$1,333.08" "$2,111.59" "$2,666.15" "$2,132.92" "$1,733.00" "$2,666.15" N/A "$1,546.57" "$2,666.15" "$1,599.69" "$2,666.15" "$2,666.15" "$2,666.15" N/A N/A G25293 SUP Custom 27203010 G25293 - FIBER LSR CK HO DISP BOTH IP/OP $803.00 $594.00 $142.86 $802.58 $802.58 $802.58 $802.58 $802.58 $802.58 $802.58 $142.86 $802.58 $802.58 $595.67 $595.67 $618.63 $418.14 $167.27 $802.58 $321.03 $802.58 $802.58 $802.58 $802.58 $802.58 $602.25 $802.58 $802.58 $802.58 $401.29 $401.29 $635.64 $802.58 $642.06 $521.68 $802.58 N/A $465.74 $802.58 $481.55 $802.58 $802.58 $802.58 N/A N/A G25294 SUP Custom 27203010 G25294 - FIBER LSR 200UM CK HO DISP BOTH IP/OP $659.50 $488.00 $117.35 $659.25 $659.25 $659.25 $659.25 $659.25 $659.25 $659.25 $117.35 $659.25 $659.25 $489.30 $489.30 $508.15 $343.47 $137.39 $659.25 $263.70 $659.25 $659.25 $659.25 $659.25 $659.25 $494.63 $659.25 $659.25 $659.25 $329.63 $329.63 $522.13 $659.25 $527.40 $428.51 $659.25 N/A $382.51 $659.25 $395.55 $659.25 $659.25 $659.25 N/A N/A G25295 SUP Custom 27203010 G25295 - FIBER LSR HO HO DISP BOTH IP/OP $659.50 $488.00 $117.35 $659.25 $659.25 $659.25 $659.25 $659.25 $659.25 $659.25 $117.35 $659.25 $659.25 $489.30 $489.30 $508.15 $343.47 $137.39 $659.25 $263.70 $659.25 $659.25 $659.25 $659.25 $659.25 $494.63 $659.25 $659.25 $659.25 $329.63 $329.63 $522.13 $659.25 $527.40 $428.51 $659.25 N/A $382.51 $659.25 $395.55 $659.25 $659.25 $659.25 N/A N/A G25296 SUP Custom 27203010 G25296 - FIBER LSR 365UM RD SMARTSYNC HO DISP STD SMA CNCT BOTH IP/OP $858.00 $635.00 $152.71 $857.93 $857.93 $857.93 $857.93 $857.93 $857.93 $857.93 $152.71 $857.93 $857.93 $636.76 $636.76 $661.29 $446.98 $178.80 $857.93 $343.17 $857.93 $857.93 $857.93 $857.93 $857.93 $643.50 $857.93 $857.93 $857.93 $428.97 $428.97 $679.48 $857.93 $686.34 $557.65 $857.93 N/A $497.64 $857.93 $514.76 $857.93 $857.93 $857.93 N/A N/A G25297 SUP Custom 27203010 G25297 - FIBER LSR 550UM CK HO DISP BOTH IP/OP "$1,421.00" "$1,052.00" $252.88 "$1,420.65" "$1,420.65" "$1,420.65" "$1,420.65" "$1,420.65" "$1,420.65" "$1,420.65" $252.88 "$1,420.65" "$1,420.65" "$1,054.41" "$1,054.41" "$1,095.04" $740.16 $296.08 "$1,420.65" $568.26 "$1,420.65" "$1,420.65" "$1,420.65" "$1,420.65" "$1,420.65" "$1,065.75" "$1,420.65" "$1,420.65" "$1,420.65" $710.33 $710.33 "$1,125.15" "$1,420.65" "$1,136.52" $923.42 "$1,420.65" N/A $824.18 "$1,420.65" $852.39 "$1,420.65" "$1,420.65" "$1,420.65" N/A N/A G25298 SUP Custom 27203010 G25298 - FIBER LSR 940UM RD SMARTSYNC HO DISP STD SMA CNCT BOTH IP/OP $531.50 $393.00 $94.56 $531.25 $531.25 $531.25 $531.25 $531.25 $531.25 $531.25 $94.56 $531.25 $531.25 $394.29 $394.29 $409.49 $276.78 $110.72 $531.25 $212.50 $531.25 $531.25 $531.25 $531.25 $531.25 $398.63 $531.25 $531.25 $531.25 $265.63 $265.63 $420.75 $531.25 $425.00 $345.31 $531.25 N/A $308.27 $531.25 $318.75 $531.25 $531.25 $531.25 N/A N/A G25299 SUP Custom 27203010 G25299 - FIBER LSR 273UM CK MU HO BOTH IP/OP "$1,009.50" $747.00 $179.67 "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" $179.67 "$1,009.38" "$1,009.38" $749.16 $749.16 $778.03 $525.89 $210.37 "$1,009.38" $403.75 "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" $757.13 "$1,009.38" "$1,009.38" "$1,009.38" $504.69 $504.69 $799.43 "$1,009.38" $807.50 $656.10 "$1,009.38" N/A $585.51 "$1,009.38" $605.63 "$1,009.38" "$1,009.38" "$1,009.38" N/A N/A G25300 SUP Custom 27203010 G25300 - FIBER LSR 365UM CK MU HO BOTH IP/OP "$1,169.00" $865.00 $208.04 "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" $208.04 "$1,168.75" "$1,168.75" $867.45 $867.45 $900.87 $608.92 $243.58 "$1,168.75" $467.50 "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" $876.75 "$1,168.75" "$1,168.75" "$1,168.75" $584.38 $584.38 $925.65 "$1,168.75" $935.00 $759.69 "$1,168.75" N/A $678.02 "$1,168.75" $701.25 "$1,168.75" "$1,168.75" "$1,168.75" N/A N/A G25301 SUP Custom 27203010 G25301 - FIBER LSR 550UM CK MU HO BOTH IP/OP "$2,231.50" "$1,651.00" $397.16 "$2,231.25" "$2,231.25" "$2,231.25" "$2,231.25" "$2,231.25" "$2,231.25" "$2,231.25" $397.16 "$2,231.25" "$2,231.25" "$1,656.03" "$1,656.03" "$1,719.85" "$1,162.48" $465.02 "$2,231.25" $892.50 "$2,231.25" "$2,231.25" "$2,231.25" "$2,231.25" "$2,231.25" "$1,673.63" "$2,231.25" "$2,231.25" "$2,231.25" "$1,115.63" "$1,115.63" "$1,767.15" "$2,231.25" "$1,785.00" "$1,450.31" "$2,231.25" N/A "$1,294.27" "$2,231.25" "$1,338.75" "$2,231.25" "$2,231.25" "$2,231.25" N/A N/A G25507 SUP Custom 27203010 G25507 - NEEDLE ENDSCP 19GA 5.2FR 0-8CM 138-140CM ULTRASOUND SHEATH BOTH IP/OP $650.00 $481.00 $115.70 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $650.00 $115.70 $650.00 $650.00 $482.43 $482.43 $501.02 $338.65 $135.47 $650.00 $260.00 $650.00 $650.00 $650.00 $650.00 $650.00 $487.50 $650.00 $650.00 $650.00 $325.00 $325.00 $514.80 $650.00 $520.00 $422.50 $650.00 N/A $377.00 $650.00 $390.00 $650.00 $650.00 $650.00 N/A N/A G25668 SUP Custom 27203010 G25668 - LIGATOR ENDSCP 15MM 4 BAND LATEX SHORTSHOT SAEED HEMORRHOID BOTH IP/OP $112.50 $83.00 $20.03 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $112.50 $20.03 $112.50 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $45.00 $112.50 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $112.50 N/A $65.25 $112.50 $67.50 $112.50 $112.50 $112.50 N/A N/A G25981 SUP HCPCS C1894 G25981 - BUNDLE FO 150CM VUEOPTIC BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $95.57 $95.57 $95.57 $95.57 $176.00 $176.00 $176.00 $36.68 $176.00 $130.63 $130.63 $135.66 $91.70 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $114.40 $34.93 N/A $102.08 $176.00 $176.00 $176.00 $36.68 $176.00 N/A N/A G26124 SUP Custom 27203010 G26124 - INTRODUCER SPBC 10FR 14FR 17CM 20CM 1STP DRN CATH DIL TROC BOTH IP/OP $537.00 $397.00 $95.51 $536.58 $536.58 $536.58 $536.58 $536.58 $536.58 $536.58 $95.51 $536.58 $536.58 $398.25 $398.25 $413.60 $279.56 $111.83 $536.58 $214.63 $536.58 $536.58 $536.58 $536.58 $536.58 $402.75 $536.58 $536.58 $536.58 $268.29 $268.29 $424.97 $536.58 $429.26 $348.78 $536.58 N/A $311.46 $536.58 $321.95 $536.58 $536.58 $536.58 N/A N/A G26574 SUP HCPCS C1726 G26574 - SET SPINAL 4FR MICROCOMPRESSION BROWN TRIGEMINAL GANGLION BOTH IP/OP "$1,027.00" $760.00 $203.83 "$1,027.00" $557.66 $557.66 $557.66 $557.66 "$1,027.00" "$1,027.00" "$1,027.00" $214.05 "$1,027.00" $762.24 $762.24 $791.61 $535.07 $214.04 "$1,027.00" "$1,027.00" $607.47 "$1,027.00" "$1,027.00" "$1,027.00" "$1,027.00" $770.25 "$1,027.00" "$1,027.00" "$1,027.00" $513.50 $513.50 $813.38 "$1,027.00" $821.60 $667.55 $203.83 N/A $595.66 "$1,027.00" "$1,027.00" "$1,027.00" $214.03 "$1,027.00" N/A N/A G26642 SUP HCPCS C1894 G26642 - EXTRACTOR STON 5CM 7FR 6MM 65CM 4CM RTNR 3WR HLCL BLN BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $95.57 $95.57 $95.57 $95.57 $176.00 $176.00 $176.00 $36.68 $176.00 $130.63 $130.63 $135.66 $91.70 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $114.40 $34.93 N/A $102.08 $176.00 $176.00 $176.00 $36.68 $176.00 N/A N/A G26648 SUP HCPCS C1894 G26648 - INTRODUCER SPBC 10FR 16FR 17CM 20CM 1STP DRN CATH DIL TROC BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $95.57 $95.57 $95.57 $95.57 $176.00 $176.00 $176.00 $36.68 $176.00 $130.63 $130.63 $135.66 $91.70 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $114.40 $34.93 N/A $102.08 $176.00 $176.00 $176.00 $36.68 $176.00 N/A N/A G26655 SUP HCPCS C1894 G26655 - INTRODUCER SPBC 12FR 18FR 17CM 20CM 1STP DRN CATH DIL TROC BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $95.57 $95.57 $95.57 $95.57 $176.00 $176.00 $176.00 $36.68 $176.00 $130.63 $130.63 $135.66 $91.70 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $114.40 $34.93 N/A $102.08 $176.00 $176.00 $176.00 $36.68 $176.00 N/A N/A G26666 SUP HCPCS C1894 G26666 - INTRODUCER SPBC 16FR 20- FR 17CM 20CM PLWY 1 STP DIL TROC BOTH IP/OP $176.00 $130.00 $34.93 $176.00 $95.57 $95.57 $95.57 $95.57 $176.00 $176.00 $176.00 $36.68 $176.00 $130.63 $130.63 $135.66 $91.70 $36.68 $176.00 $176.00 $104.10 $176.00 $176.00 $176.00 $176.00 $132.00 $176.00 $176.00 $176.00 $88.00 $88.00 $139.39 $176.00 $140.80 $114.40 $34.93 N/A $102.08 $176.00 $176.00 $176.00 $36.68 $176.00 N/A N/A G26891 SUP HCPCS C1725 G26891 - CATHETER BLNDIL 4MM 80CM STRL 2CM ATB ADV 2 LUM XPD RADOPQ BOTH IP/OP $275.00 $204.00 $54.58 $277.75 $149.33 $149.33 $149.33 $149.33 $275.00 $275.00 $275.00 $57.32 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $277.75 $162.66 $275.00 $277.75 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $54.58 N/A $159.50 $275.00 $275.00 $275.00 $57.31 $275.00 N/A N/A G26908 SUP HCPCS C1726 G26908 - SET ENDSCP INSTR .035IN 3 WAY MULTPUR ADAPTER EXPLORATION BOTH IP/OP "$1,980.00" "$1,465.00" $392.98 "$1,980.00" "$1,075.14" "$1,075.14" "$1,075.14" "$1,075.14" "$1,980.00" "$1,980.00" "$1,980.00" $412.68 "$1,980.00" "$1,469.56" "$1,469.56" "$1,526.18" "$1,031.58" $412.65 "$1,980.00" "$1,980.00" "$1,171.17" "$1,980.00" "$1,980.00" "$1,980.00" "$1,980.00" "$1,485.00" "$1,980.00" "$1,980.00" "$1,980.00" $990.00 $990.00 "$1,568.16" "$1,980.00" "$1,584.00" "$1,287.00" $392.98 N/A "$1,148.40" "$1,980.00" "$1,980.00" "$1,980.00" $412.63 "$1,980.00" N/A N/A G26957 SUP HCPCS C1769 G26957 - GUIDEWIRE VASCULAR 10MM RAD .035IN 110CM REUTER TIP BOTH IP/OP $187.50 $139.00 $37.21 $215.63 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $215.63 $110.91 $187.50 $215.63 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G26973 SUP HCPCS C1725 G26973 - CATHETER ANGIOGRAPHIC ROBERTS UTERINE CATHETER CURVE 5FR 90 BOTH IP/OP $32.50 $24.00 $6.45 $32.50 $17.65 $17.65 $17.65 $17.65 $32.50 $32.50 $32.50 $6.77 $32.50 $24.12 $24.12 $25.05 $16.93 $6.77 $32.50 $32.50 $19.22 $32.50 $32.50 $32.50 $32.50 $24.38 $32.50 $32.50 $32.50 $16.25 $16.25 $25.74 $32.50 $26.00 $21.13 $6.45 N/A $18.85 $32.50 $32.50 $32.50 $6.77 $32.50 N/A N/A G26986 SUP HCPCS C1770 G26986 - COIL EMBOLIZATION .018IN 10MM 14CM 4.5 LOOP SOFT RADIOPACITY BOTH IP/OP $264.50 $196.00 $55.06 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $105.68 $264.20 $264.20 $264.20 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G26989 SUP HCPCS C1770 G26989 - COIL EMBOLIZATION .018IN 6MM 14CM 7.4 LOOP SOFT RADIOPACITY BOTH IP/OP $264.50 $196.00 $55.06 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $105.68 $264.20 $264.20 $264.20 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G26990 SUP HCPCS C1770 G26990 - COIL EMBOLIZATION .018IN 8MM 14CM 5.6 LOOP SOFT RADIOPACITY BOTH IP/OP $264.50 $196.00 $55.06 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $105.68 $264.20 $264.20 $264.20 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G26991 SUP Custom 27203010 G26991 - COIL EMBOLIZATION .035IN 10MM 14CM 4.5 LOOP SOFT NESTER BOTH IP/OP $264.50 $196.00 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $47.03 $264.20 $264.20 $196.09 $196.09 $203.65 $137.65 $55.06 $264.20 $105.68 $264.20 $264.20 $264.20 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $171.73 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G26994 SUP Custom 27803010 G26994 - COIL EMBOLIZATION .035IN 7.4 LOOP 6MM 14CM SOFT CATHETER BOTH IP/OP $264.50 $196.00 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $105.68 $264.20 $264.20 $264.20 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G26995 SUP HCPCS C1770 G26995 - COIL EMBOLIZATION .035IN 5.6 LOOPS 8MM 14CM SOFT CATHETER BOTH IP/OP $264.50 $196.00 $55.06 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $105.68 $264.20 $264.20 $264.20 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G27035 SUP HCPCS C1769 G27035 - GUIDEWIRE VASCULAR STR .035IN 260CM FLEXIBLE TIP STIFF SHAFT BOTH IP/OP $86.50 $64.00 $17.12 $89.70 $46.83 $46.83 $46.83 $46.83 $86.25 $86.25 $86.25 $17.98 $86.25 $64.01 $64.01 $66.48 $44.94 $17.98 $86.25 $89.70 $51.02 $86.25 $89.70 $86.25 $86.25 $64.88 $86.25 $86.25 $86.25 $43.13 $43.13 $68.31 $86.25 $69.00 $56.06 $17.12 N/A $50.17 $86.25 $51.75 $86.25 $17.97 $86.25 N/A N/A G27047 SUP Custom 27203010 G27047 - CATHETER JEJUNOSTOMY 16.5FR 80CM 2 LUMEN REPLACEMENT BOTH IP/OP $180.50 $134.00 $32.10 $180.35 $180.35 $180.35 $180.35 $180.35 $180.35 $180.35 $32.10 $180.35 $180.35 $133.86 $133.86 $139.01 $93.96 $37.59 $180.35 $72.14 $180.35 $180.35 $180.35 $180.35 $180.35 $135.38 $180.35 $180.35 $180.35 $90.18 $90.18 $142.84 $180.35 $144.28 $117.23 $180.35 N/A $104.69 $180.35 $108.21 $180.35 $180.35 $180.35 N/A N/A G27059 SUP HCPCS C2617 G27059 - INTRODUCER SPBC 18FR 22FR 17CM 20CM 1STP DRN CATH DIL TROC BOTH IP/OP $253.50 $188.00 $50.30 $253.45 $114.05 $114.05 $114.05 $114.05 $253.45 $253.45 $253.45 $52.83 $253.45 $253.45 $253.45 $253.45 $253.45 $52.82 $253.45 $253.45 $149.92 $253.45 $253.45 $253.45 $253.45 $190.13 $253.45 $253.45 $253.45 $126.73 $126.73 $200.73 $253.45 $202.76 $114.05 $50.30 N/A $147.03 $253.45 $253.45 $253.45 $52.82 $253.45 N/A N/A G27061 SUP HCPCS C1729 G27061 - SET STNT 2 PGTL CRV 8.2FR 40CM RADOPQ PSTNR SFLX URETER BOTH IP/OP $151.00 $112.00 $29.88 $150.55 $81.75 $81.75 $81.75 $81.75 $150.55 $150.55 $150.55 $31.38 $150.55 $111.74 $111.74 $116.04 $78.44 $31.38 $150.55 $150.55 $89.05 $150.55 $150.55 $150.55 $150.55 $113.25 $150.55 $150.55 $150.55 $75.28 $75.28 $119.24 $150.55 $120.44 $97.86 $29.88 N/A $87.58 $150.55 $150.55 $150.55 $31.37 $150.55 N/A N/A G27063 SUP HCPCS C2617 G27063 - SET NPHSTM 12FR 30CM COPE LOOP MOD NDL GW CNN DIL BOTH IP/OP $365.50 $270.00 $72.53 $365.43 $164.44 $164.44 $164.44 $164.44 $365.43 $365.43 $365.43 $76.16 $365.43 $365.43 $365.43 $365.43 $365.43 $76.16 $365.43 $365.43 $216.15 $365.43 $365.43 $365.43 $365.43 $274.13 $365.43 $365.43 $365.43 $182.72 $182.72 $289.42 $365.43 $292.34 $164.44 $72.53 N/A $211.99 $365.43 $365.43 $365.43 $76.16 $365.43 N/A N/A G27161 SUP HCPCS C2617 G27161 - STENT PANCREATIC 5FR 14CM DRAIN OBSTRUCTED POSITIONING BOTH IP/OP $177.50 $131.00 $35.23 $177.50 $79.88 $79.88 $79.88 $79.88 $177.50 $177.50 $177.50 $37.00 $177.50 $177.50 $177.50 $177.50 $177.50 $36.99 $177.50 $177.50 $104.99 $177.50 $177.50 $177.50 $177.50 $133.13 $177.50 $177.50 $177.50 $88.75 $88.75 $140.58 $177.50 $142.00 $79.88 $35.23 N/A $102.95 $177.50 $177.50 $177.50 $36.99 $177.50 N/A N/A G27234 SUP Custom 27203010 G27234 - DEVICE STNT RTRVL 4.5FR 65CM NSNARE FLXB NTNL WRE CNSTRCT BOTH IP/OP $289.50 $214.00 $51.46 $289.10 $289.10 $289.10 $289.10 $289.10 $289.10 $289.10 $51.46 $289.10 $289.10 $214.57 $214.57 $222.84 $150.62 $60.25 $289.10 $115.64 $289.10 $289.10 $289.10 $289.10 $289.10 $217.13 $289.10 $289.10 $289.10 $144.55 $144.55 $228.97 $289.10 $231.28 $187.92 $289.10 N/A $167.91 $289.10 $173.46 $289.10 $289.10 $289.10 N/A N/A G27887 SUP HCPCS C1769 G27887 - GUIDEWIRE VASC STRG .028IN 145CM FX COR SS BOTH IP/OP $65.00 $48.00 $12.87 $64.83 $35.20 $35.20 $35.20 $35.20 $64.83 $64.83 $64.83 $13.51 $64.83 $48.12 $48.12 $49.97 $33.78 $13.51 $64.83 $64.83 $38.35 $64.83 $64.83 $64.83 $64.83 $48.75 $64.83 $64.83 $64.83 $32.42 $32.42 $51.35 $64.83 $51.86 $42.14 $12.87 N/A $37.70 $64.83 $64.83 $64.83 $13.51 $64.83 N/A N/A G27935 SUP HCPCS C1894 G27935 - INTRODUCER SHTH .038IN 8FR 80CM STRL FLXR SHTL SL 1 DIL T-B BOTH IP/OP $187.50 $139.00 $37.21 $390.71 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $390.71 $110.91 $187.50 $390.71 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G28445 SUP HCPCS C1894 G28445 - INTRODUCER CATH 16FR 5.3MM 45CM PRFRMR CK-FLW ACPT .038IN GW BOTH IP/OP $317.50 $235.00 $63.02 $328.61 $172.40 $172.40 $172.40 $172.40 $317.50 $317.50 $317.50 $66.17 $317.50 $235.65 $235.65 $244.73 $165.42 $66.17 $317.50 $328.61 $187.80 $317.50 $328.61 $317.50 $317.50 $238.13 $317.50 $317.50 $317.50 $158.75 $158.75 $251.46 $317.50 $254.00 $206.38 $63.02 N/A $184.15 $317.50 $317.50 $317.50 $66.17 $317.50 N/A N/A G28999 SUP HCPCS C1894 G28999 - INTRODUCER CATHETER 20FR 25CM SET CHK-FLO BOTH IP/OP $847.50 $627.00 $168.21 $847.50 $460.19 $460.19 $460.19 $460.19 $847.50 $847.50 $847.50 $176.64 $847.50 $629.01 $629.01 $653.25 $441.55 $176.63 $847.50 $847.50 $501.30 $847.50 $847.50 $847.50 $847.50 $635.63 $847.50 $847.50 $847.50 $423.75 $423.75 $671.22 $847.50 $678.00 $550.88 $168.21 N/A $491.55 $847.50 $847.50 $847.50 $176.62 $847.50 N/A N/A G29982 SUP HCPCS C1894 G29982 - SHEATH GUID .018/.038IN ANL1 CURVE 6FR .087IN 45CM RADIOPQ BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $202.50 $110.91 $187.50 $202.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G29983 SUP HCPCS C1894 G29983 - SHEATH GUID .018/.038IN ANL2 CURVE 6FR .087IN 45CM RADIOPQ BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $202.50 $110.91 $187.50 $202.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G29985 SUP HCPCS C1894 G29985 - SHEATH GUID ANL1 CURVE 7FR .100IN 45CM UNIQUELY FABRICATED BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $202.50 $110.91 $187.50 $202.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G29986 SUP HCPCS C1894 G29986 - SHEATH GUID .018/.038IN ANL2 CURVE 7FR .1IN 45CM RADIOPQ BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $202.50 $110.91 $187.50 $202.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G29989 SUP HCPCS C1894 G29989 - SHEATH GUID .018-.038IN ANL2 CURVE 6FR .087IN 90CM RADIOPQ BOTH IP/OP $377.50 $279.00 $74.92 $392.60 $204.98 $204.98 $204.98 $204.98 $377.50 $377.50 $377.50 $78.68 $377.50 $280.18 $280.18 $290.98 $196.68 $78.68 $377.50 $392.60 $223.29 $377.50 $392.60 $377.50 $377.50 $283.13 $377.50 $377.50 $377.50 $188.75 $188.75 $298.98 $377.50 $302.00 $245.38 $74.92 N/A $218.95 $377.50 $377.50 $377.50 $78.67 $377.50 N/A N/A G30117 SUP HCPCS C1894 G30117 - INTRODUCER SHEATH .018 .038IN ANL2 CURVE 5FR .074IN 45CM BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $202.50 $110.91 $187.50 $202.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G30357 SUP HCPCS C1726 G30357 - POUCH DRN 300ML NS ELC BELT ADJ 1 CNCT 2 TUBE REED VLV MECH BOTH IP/OP $619.00 $458.00 $122.82 $618.80 $336.01 $336.01 $336.01 $336.01 $618.80 $618.80 $618.80 $128.97 $618.80 $459.27 $459.27 $476.97 $322.39 $128.96 $618.80 $618.80 $366.02 $618.80 $618.80 $618.80 $618.80 $464.25 $618.80 $618.80 $618.80 $309.40 $309.40 $490.09 $618.80 $495.04 $402.22 $122.82 N/A $359.02 $618.80 $618.80 $618.80 $128.96 $618.80 N/A N/A G30358 SUP HCPCS C1726 G30358 - EXTRACTOR SRG 12FR 38CM STRL PRC NC STON TPLS ATRM NTNL DISP BOTH IP/OP $519.50 $384.00 $103.08 $519.35 $282.01 $282.01 $282.01 $282.01 $519.35 $519.35 $519.35 $108.25 $519.35 $385.46 $385.46 $400.31 $270.58 $108.24 $519.35 $519.35 $307.20 $519.35 $519.35 $519.35 $519.35 $389.63 $519.35 $519.35 $519.35 $259.68 $259.68 $411.33 $519.35 $415.48 $337.58 $103.08 N/A $301.31 $519.35 $519.35 $519.35 $108.23 $519.35 N/A N/A G30360 SUP HCPCS C1773 G30360 - CATHETER NPHSTM 10MM 15CM CLR ULTRX TRNS TPR BLN RADOPQ STRP BOTH IP/OP $420.00 $311.00 $83.30 $419.70 $227.90 $227.90 $227.90 $227.90 $419.70 $419.70 $419.70 $87.48 $419.70 $311.50 $311.50 $323.50 $218.66 $87.47 $419.70 $419.70 $248.25 $419.70 $419.70 $419.70 $419.70 $315.00 $419.70 $419.70 $419.70 $209.85 $209.85 $332.40 $419.70 $335.76 $272.81 $83.30 N/A $243.60 $419.70 $419.70 $419.70 $87.47 $419.70 N/A N/A G30361 SUP HCPCS C1773 G30361 - FORCEPS SPEC RTRVL 15MM 3.2FR 115CM STRL CPTR 3 PR STON FB BOTH IP/OP $420.00 $311.00 $83.30 $419.70 $227.90 $227.90 $227.90 $227.90 $419.70 $419.70 $419.70 $87.48 $419.70 $311.50 $311.50 $323.50 $218.66 $87.47 $419.70 $419.70 $248.25 $419.70 $419.70 $419.70 $419.70 $315.00 $419.70 $419.70 $419.70 $209.85 $209.85 $332.40 $419.70 $335.76 $272.81 $83.30 N/A $243.60 $419.70 $419.70 $419.70 $87.47 $419.70 N/A N/A G30362 SUP HCPCS C1773 G30362 - GRASPER ESCP 2.8FR 15MM 115CM CPTR 3 PR OPN WD MICROTHROW BOTH IP/OP $420.00 $311.00 $83.30 $419.70 $227.90 $227.90 $227.90 $227.90 $419.70 $419.70 $419.70 $87.48 $419.70 $311.50 $311.50 $323.50 $218.66 $87.47 $419.70 $419.70 $248.25 $419.70 $419.70 $419.70 $419.70 $315.00 $419.70 $419.70 $419.70 $209.85 $209.85 $332.40 $419.70 $335.76 $272.81 $83.30 N/A $243.60 $419.70 $419.70 $419.70 $87.47 $419.70 N/A N/A G30364 SUP HCPCS C1726 G30364 - CATHETER NEPHROSTOMY 20 ATM 10MM 15CM INFLATE BALLOON SHEATH BOTH IP/OP $519.50 $384.00 $103.08 $519.35 $282.01 $282.01 $282.01 $282.01 $519.35 $519.35 $519.35 $108.25 $519.35 $385.46 $385.46 $400.31 $270.58 $108.24 $519.35 $519.35 $307.20 $519.35 $519.35 $519.35 $519.35 $389.63 $519.35 $519.35 $519.35 $259.68 $259.68 $411.33 $519.35 $415.48 $337.58 $103.08 N/A $301.31 $519.35 $519.35 $519.35 $108.23 $519.35 N/A N/A G30365 SUP HCPCS C1726 G30365 - SET NEPHROSTOMY 10MM 15CM CATHETER RADIOPQ BALLOON SHEATH BOTH IP/OP $619.00 $458.00 $122.82 $618.80 $336.01 $336.01 $336.01 $336.01 $618.80 $618.80 $618.80 $128.97 $618.80 $459.27 $459.27 $476.97 $322.39 $128.96 $618.80 $618.80 $366.02 $618.80 $618.80 $618.80 $618.80 $464.25 $618.80 $618.80 $618.80 $309.40 $309.40 $490.09 $618.80 $495.04 $402.22 $122.82 N/A $359.02 $618.80 $618.80 $618.80 $128.96 $618.80 N/A N/A G30375 SUP HCPCS C1773 G30375 - FORCEPS SPEC RTRVL 15MM 3.2FR 90CM STRL CPTR 3 PR STON FB BOTH IP/OP $483.00 $357.00 $95.79 $482.65 $262.08 $262.08 $262.08 $262.08 $482.65 $482.65 $482.65 $100.60 $482.65 $358.22 $358.22 $372.03 $251.46 $100.59 $482.65 $482.65 $285.49 $482.65 $482.65 $482.65 $482.65 $362.25 $482.65 $482.65 $482.65 $241.33 $241.33 $382.26 $482.65 $386.12 $313.72 $95.79 N/A $280.14 $482.65 $482.65 $482.65 $100.58 $482.65 N/A N/A G30389 SUP HCPCS C1894 G30389 - SHEATH ACCES 14FR 35CM DILATION CONTIN WORKING CHANNEL BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G30390 SUP HCPCS C1894 G30390 - FORCEPS SPEC RTRVL 15MM 2.8FR 115CM STRL CPTR 3 PR STON FB BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G30391 SUP HCPCS C1894 G30391 - SHEATH ACC 14FR 55CM STRL FLXR DILATION CNT WRK CHNL AQ URET BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G30393 SUP HCPCS C1894 G30393 - SHEATH ACC 14FR 20CM FLXR DILATION CNT WKG CHNL URET BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G30403 SUP HCPCS C2627 G30403 - SHEATH ACC 14FR 28CM FLXR DILATION CNT WKG CHNL LFRIC SM BOTH IP/OP $166.50 $123.00 $32.97 $166.10 $90.19 $90.19 $90.19 $90.19 $166.10 $166.10 $166.10 $34.62 $166.10 $123.28 $123.28 $128.03 $86.54 $34.62 $166.10 $166.10 $98.25 $166.10 $166.10 $166.10 $166.10 $124.88 $166.10 $166.10 $166.10 $83.05 $83.05 $131.55 $166.10 $132.88 $107.97 $32.97 N/A $96.57 $166.10 $166.10 $166.10 $34.62 $166.10 N/A N/A G30404 SUP HCPCS C2627 G30404 - SET CATH 8.5FR 25CM MCLC NDL OBT CNN CNCT TUBE ULTHNE SPBC BOTH IP/OP $166.50 $123.00 $32.97 $166.10 $90.19 $90.19 $90.19 $90.19 $166.10 $166.10 $166.10 $34.62 $166.10 $123.28 $123.28 $128.03 $86.54 $34.62 $166.10 $166.10 $98.25 $166.10 $166.10 $166.10 $166.10 $124.88 $166.10 $166.10 $166.10 $83.05 $83.05 $131.55 $166.10 $132.88 $107.97 $32.97 N/A $96.57 $166.10 $166.10 $166.10 $34.62 $166.10 N/A N/A G30405 SUP HCPCS C2627 G30405 - SET CATH 12FR 25CM MCLC NDL OBT CNN CNCT TUBE ULTHNE SPBC BOTH IP/OP $166.50 $123.00 $32.97 $166.10 $90.19 $90.19 $90.19 $90.19 $166.10 $166.10 $166.10 $34.62 $166.10 $123.28 $123.28 $128.03 $86.54 $34.62 $166.10 $166.10 $98.25 $166.10 $166.10 $166.10 $166.10 $124.88 $166.10 $166.10 $166.10 $83.05 $83.05 $131.55 $166.10 $132.88 $107.97 $32.97 N/A $96.57 $166.10 $166.10 $166.10 $34.62 $166.10 N/A N/A G30470 SUP HCPCS C1769 G30470 - SET CATH 14FR 25CM MCLC NDL OBT CNN CNCT TUBE LCK LOOP BOTH IP/OP $596.00 $441.00 $118.26 $595.83 $323.54 $323.54 $323.54 $323.54 $595.83 $595.83 $595.83 $124.19 $595.83 $442.23 $442.23 $459.27 $310.43 $124.18 $595.83 $595.83 $352.43 $595.83 $595.83 $595.83 $595.83 $447.00 $595.83 $595.83 $595.83 $297.92 $297.92 $471.90 $595.83 $476.66 $387.29 $118.26 N/A $345.68 $595.83 $595.83 $595.83 $124.17 $595.83 N/A N/A G30471 SUP HCPCS C1769 G30471 - GUIDEWIRE VASCULAR .038IN 150CM 3CM STIFF ANGLED TIP CORE BOTH IP/OP $119.50 $88.00 $23.65 $119.17 $64.71 $64.71 $64.71 $64.71 $119.17 $119.17 $119.17 $24.84 $119.17 $88.45 $88.45 $91.86 $62.09 $24.84 $119.17 $47.67 $70.49 $119.17 $119.17 $119.17 $119.17 $89.63 $119.17 $119.17 $119.17 $59.59 $59.59 $94.38 $119.17 $95.34 $77.46 $23.65 N/A $69.31 $119.17 $119.17 $119.17 $24.84 $119.17 N/A N/A G30472 SUP HCPCS C1769 G30472 - GUIDEWIRE VASC STRG TPR .038IN 150CM STRL 3CM HIWIRE 1-1 TRQ BOTH IP/OP $76.00 $56.00 $15.05 $75.84 $41.18 $41.18 $41.18 $41.18 $75.84 $75.84 $75.84 $15.81 $75.84 $56.29 $56.29 $58.46 $39.51 $15.81 $75.84 $75.84 $44.86 $75.84 $75.84 $75.84 $75.84 $57.00 $75.84 $75.84 $75.84 $37.92 $37.92 $60.07 $75.84 $60.67 $49.30 $15.05 N/A $44.08 $75.84 $75.84 $75.84 $15.81 $75.84 N/A N/A G30473 SUP HCPCS C1769 G30473 - GUIDEWIRE VASCULAR STANDARD STR TAPER .038IN 150CM 3CM ONE BOTH IP/OP $75.00 $56.00 $14.85 $74.80 $40.62 $40.62 $40.62 $40.62 $74.80 $74.80 $74.80 $15.59 $74.80 $55.52 $55.52 $57.66 $38.97 $15.59 $74.80 $74.80 $44.24 $74.80 $74.80 $74.80 $74.80 $56.25 $74.80 $74.80 $74.80 $37.40 $37.40 $59.24 $74.80 $59.84 $48.62 $14.85 N/A $43.50 $74.80 $74.80 $74.80 $15.59 $74.80 N/A N/A G30474 SUP HCPCS C1769 G30474 - GUIDEWIRE VASC STRG TPR .038IN 150CM STRL 3CM HIWIRE 1-1 TRQ BOTH IP/OP $119.50 $88.00 $23.65 $119.17 $64.71 $64.71 $64.71 $64.71 $119.17 $119.17 $119.17 $24.84 $119.17 $88.45 $88.45 $91.86 $62.09 $24.84 $119.17 $119.17 $70.49 $119.17 $119.17 $119.17 $119.17 $89.63 $119.17 $119.17 $119.17 $59.59 $59.59 $94.38 $119.17 $95.34 $77.46 $23.65 N/A $69.31 $119.17 $119.17 $119.17 $24.84 $119.17 N/A N/A G30475 SUP HCPCS C1769 G30475 - GUIDEWIRE VASCULAR ANGLE TAPER .035IN 150CM 3CM 1TO 1 TORQUE BOTH IP/OP $119.50 $88.00 $23.65 $119.17 $64.71 $64.71 $64.71 $64.71 $119.17 $119.17 $119.17 $24.84 $119.17 $88.45 $88.45 $91.86 $62.09 $24.84 $119.17 $119.17 $70.49 $119.17 $119.17 $119.17 $119.17 $89.63 $119.17 $119.17 $119.17 $59.59 $59.59 $94.38 $119.17 $95.34 $77.46 $23.65 N/A $69.31 $119.17 $119.17 $119.17 $24.84 $119.17 N/A N/A G30476 SUP HCPCS C1769 G30476 - GUIDEWIRE VASCULAR STANDARD STR TAPER .035IN 150CM 3CM 1TO 1 BOTH IP/OP $75.00 $56.00 $14.85 $74.80 $40.62 $40.62 $40.62 $40.62 $74.80 $74.80 $74.80 $15.59 $74.80 $55.52 $55.52 $57.66 $38.97 $15.59 $74.80 $74.80 $44.24 $74.80 $74.80 $74.80 $74.80 $56.25 $74.80 $74.80 $74.80 $37.40 $37.40 $59.24 $74.80 $59.84 $48.62 $14.85 N/A $43.50 $74.80 $74.80 $74.80 $15.59 $74.80 N/A N/A G30477 SUP HCPCS C1769 G30477 - GUIDEWIRE VASC STRG TPR .035IN 150CM 3CM HIWIRE STF BD 1 TO BOTH IP/OP $119.50 $88.00 $23.65 $119.17 $64.71 $64.71 $64.71 $64.71 $119.17 $119.17 $119.17 $24.84 $119.17 $88.45 $88.45 $91.86 $62.09 $24.84 $119.17 $119.17 $70.49 $119.17 $119.17 $119.17 $119.17 $89.63 $119.17 $119.17 $119.17 $59.59 $59.59 $94.38 $119.17 $95.34 $77.46 $23.65 N/A $69.31 $119.17 $119.17 $119.17 $24.84 $119.17 N/A N/A G30478 SUP HCPCS C1769 G30478 - GUIDEWIRE VASC TPR .025IN 150CM STRL 3MM HIWIRE STF BD STRG BOTH IP/OP $119.50 $88.00 $23.65 $119.17 $64.71 $64.71 $64.71 $64.71 $119.17 $119.17 $119.17 $24.84 $119.17 $88.45 $88.45 $91.86 $62.09 $24.84 $119.17 $119.17 $70.49 $119.17 $119.17 $119.17 $119.17 $89.63 $119.17 $119.17 $119.17 $59.59 $59.59 $94.38 $119.17 $95.34 $77.46 $23.65 N/A $69.31 $119.17 $119.17 $119.17 $24.84 $119.17 N/A N/A G30479 SUP HCPCS C1769 G30479 - GUIDEWIRE VASC TPR .025IN 150CM STRL 3MM HIWIRE STF BD ANG BOTH IP/OP $76.00 $56.00 $15.05 $75.84 $41.18 $41.18 $41.18 $41.18 $75.84 $75.84 $75.84 $15.81 $75.84 $56.29 $56.29 $58.46 $39.51 $15.81 $75.84 $75.84 $44.86 $75.84 $75.84 $75.84 $75.84 $57.00 $75.84 $75.84 $75.84 $37.92 $37.92 $60.07 $75.84 $60.67 $49.30 $15.05 N/A $44.08 $75.84 $75.84 $75.84 $15.81 $75.84 N/A N/A G30480 SUP HCPCS C1769 G30480 - GUIDEWIRE VASC ANG TPR .025IN 150CM STRL 3CM HIWIRE STD BD BOTH IP/OP $76.00 $56.00 $15.05 $75.84 $41.18 $41.18 $41.18 $41.18 $75.84 $75.84 $75.84 $15.81 $75.84 $56.29 $56.29 $58.46 $39.51 $15.81 $75.84 $75.84 $44.86 $75.84 $75.84 $75.84 $75.84 $57.00 $75.84 $75.84 $75.84 $37.92 $37.92 $60.07 $75.84 $60.67 $49.30 $15.05 N/A $44.08 $75.84 $75.84 $75.84 $15.81 $75.84 N/A N/A G30481 SUP HCPCS C1769 G30481 - GUIDEWIRE VASCULAR STANDARD ANGLE TAPER .035IN 150CM 3CM 1TO BOTH IP/OP $379.50 $281.00 $75.26 $379.18 $205.89 $205.89 $205.89 $205.89 $379.18 $379.18 $379.18 $79.03 $379.18 $281.43 $281.43 $292.27 $197.55 $79.03 $379.18 $379.18 $224.28 $379.18 $379.18 $379.18 $379.18 $284.63 $379.18 $379.18 $379.18 $189.59 $189.59 $300.31 $379.18 $303.34 $246.47 $75.26 N/A $220.11 $379.18 $379.18 $379.18 $79.02 $379.18 N/A N/A G31027 SUP Custom 27203010 G31027 - DEVICE INFLAT 30 ATM EASY TO READ ERGONOMICAL QUICK RELEASE BOTH IP/OP $150.00 $111.00 $26.70 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $26.70 $150.00 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $60.00 $150.00 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $150.00 N/A $87.00 $150.00 $90.00 $150.00 $150.00 $150.00 N/A N/A G31138 SUP HCPCS C1894 G31138 - INTRODUCER SHEATH .038IN 6FR .087IN 90CM TUOHY BORST SIDEARM BOTH IP/OP $387.50 $287.00 $76.91 $401.06 $210.41 $210.41 $210.41 $210.41 $387.50 $387.50 $387.50 $80.76 $387.50 $287.60 $287.60 $298.69 $201.89 $80.76 $387.50 $401.06 $229.21 $387.50 $401.06 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $251.88 $76.91 N/A $224.75 $387.50 $387.50 $387.50 $80.76 $387.50 N/A N/A G31215 SUP Custom 27203010 G31215 - CATHETER ANGIOGRAPHIC .035IN PIGTAIL 5FR 70CM SIZING 10 BOTH IP/OP $287.50 $213.00 $51.18 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $287.50 $51.18 $287.50 $287.50 $213.38 $213.38 $221.61 $149.79 $59.92 $287.50 $115.00 $287.50 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $186.88 $287.50 N/A $166.75 $287.50 $172.50 $287.50 $287.50 $287.50 N/A N/A G31216 SUP HCPCS C1884 G31216 - CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 100CM SIZING 10 BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A G31221 SUP HCPCS C1884 G31221 - CATHETER ANGIOGRAPHIC .035IN VCF CURVE 5FR 100CM 10 SIDEPORT BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A G31224 SUP HCPCS C1887 G31224 - CATHETER ANGIOGRAPHIC .035IN PIGTAIL CURVE 5FR 70CM 10 BOTH IP/OP $97.50 $72.00 $19.35 $97.50 $52.94 $52.94 $52.94 $52.94 $97.50 $97.50 $97.50 $20.32 $97.50 $72.36 $72.36 $75.15 $50.80 $20.32 $97.50 $97.50 $57.67 $97.50 $97.50 $97.50 $97.50 $73.13 $97.50 $97.50 $97.50 $48.75 $48.75 $77.22 $97.50 $78.00 $63.38 $19.35 N/A $56.55 $97.50 $97.50 $97.50 $20.32 $97.50 N/A N/A G31518 SUP Custom 27203010 G31518 - NEEDLE ENDSCP 22GA 5.2FR 8- CM ULTRASOUND BALL TIP ADJUST BOTH IP/OP $730.00 $540.00 $129.94 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $129.94 $730.00 $730.00 $541.81 $541.81 $562.68 $380.33 $152.14 $730.00 $292.00 $730.00 $730.00 $730.00 $730.00 $730.00 $547.50 $730.00 $730.00 $730.00 $365.00 $365.00 $578.16 $730.00 $584.00 $474.50 $730.00 N/A $423.40 $730.00 $438.00 $730.00 $730.00 $730.00 N/A N/A G31519 SUP Custom 27203010 G31519 - NEEDLE ENDSCP 25GA 5.2FR 0-8CM ULTRASOUND CNTOUR HANDLE BOTH IP/OP $730.00 $540.00 $129.94 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $129.94 $730.00 $730.00 $541.81 $541.81 $562.68 $380.33 $152.14 $730.00 $292.00 $730.00 $730.00 $730.00 $730.00 $730.00 $547.50 $730.00 $730.00 $730.00 $365.00 $365.00 $578.16 $730.00 $584.00 $474.50 $730.00 N/A $423.40 $730.00 $438.00 $730.00 $730.00 $730.00 N/A N/A G31520 SUP Custom 27203010 G31520 - NEEDLE ENDSCP 19GA 5.2-4.2FR 0-8CM ULTRASOUND CNTOUR HANDLE BOTH IP/OP $730.00 $540.00 $129.94 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $730.00 $129.94 $730.00 $730.00 $541.81 $541.81 $562.68 $380.33 $152.14 $730.00 $292.00 $730.00 $730.00 $730.00 $730.00 $730.00 $547.50 $730.00 $730.00 $730.00 $365.00 $365.00 $578.16 $730.00 $584.00 $474.50 $730.00 N/A $423.40 $730.00 $438.00 $730.00 $730.00 $730.00 N/A N/A G31550 SUP HCPCS C1894 G31550 - CATHETER PSH .035IN 5FR STRL LF FSN GW BIL DCT DISP ESCP BOTH IP/OP $180.00 $133.00 $35.73 $180.00 $97.74 $97.74 $97.74 $97.74 $180.00 $180.00 $180.00 $37.52 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $180.00 $106.47 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $35.73 N/A $104.40 $180.00 $180.00 $180.00 $37.51 $180.00 N/A N/A G31551 SUP Custom 27203010 G31551 - CATHETER ENDSCP 7FR 3.2MM 170CM DOME TIP FUSION PURPLE BOTH IP/OP $180.00 $133.00 $32.04 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $180.00 $32.04 $180.00 $180.00 $133.60 $133.60 $138.74 $93.78 $37.51 $180.00 $72.00 $180.00 $180.00 $180.00 $180.00 $180.00 $135.00 $180.00 $180.00 $180.00 $90.00 $90.00 $142.56 $180.00 $144.00 $117.00 $180.00 N/A $104.40 $180.00 $108.00 $180.00 $180.00 $180.00 N/A N/A G32011 SUP HCPCS C1876 G32011 - STENT BILIARY .035IN 6MM 6FR 30MM 80CM SELF EXPANDING BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$3,125.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A G32233 SUP HCPCS C1894 G32233 - INTRODUCER SHEATH .038IN LONG 10FR 40CM LARGE VALVE ASMBLY BOTH IP/OP $190.00 $141.00 $37.71 $192.85 $103.17 $103.17 $103.17 $103.17 $190.00 $190.00 $190.00 $39.60 $190.00 $141.02 $141.02 $146.45 $98.99 $39.60 $190.00 $192.85 $112.39 $190.00 $192.85 $190.00 $190.00 $142.50 $190.00 $190.00 $190.00 $95.00 $95.00 $150.48 $190.00 $152.00 $123.50 $37.71 N/A $110.20 $190.00 $190.00 $190.00 $39.60 $190.00 N/A N/A G32500 SUP HCPCS C1874 G32500 - GRAFT EVAS 2 BRCH 12MM 106MM STRL 28MM H&L-B 1-SHOT ZNTH BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32501 SUP HCPCS C1874 G32501 - GRAFT EVAS 2 BRCH 12MM 7.7MM 20FR 121MM 28MM ZNTH H&L-B BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32502 SUP HCPCS C1874 G32502 - GRAFT EVAS 24MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32503 SUP HCPCS C1874 G32503 - GRAFT EVAS 26MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32504 SUP HCPCS C1874 G32504 - GRAFT EVAS 28MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32505 SUP HCPCS C1874 G32505 - GRAFT EVAS 30MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32506 SUP HCPCS C1874 G32506 - GRAFT EVAS 32MM 7.7MM 20FR 76MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32507 SUP HCPCS C1874 G32507 - GRAFT EVAS 24MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32508 SUP HCPCS C1874 G32508 - GRAFT EVAS 26MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32509 SUP HCPCS C1874 G32509 - GRAFT EVAS 28MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32510 SUP HCPCS C1874 G32510 - GRAFT EVAS 30MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32511 SUP HCPCS C1874 G32511 - GRAFT EVAS 32MM 7.7MM 20FR 91MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32512 SUP HCPCS C1874 G32512 - GRAFT EVAS 24MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32513 SUP HCPCS C1874 G32513 - GRAFT EVAS 26MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32514 SUP HCPCS C1874 G32514 - GRAFT EVAS 28MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32515 SUP HCPCS C1874 G32515 - GRAFT EVAS 30MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32516 SUP HCPCS C1874 G32516 - GRAFT EVAS 32MM 7.7MM 20FR 106MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32517 SUP HCPCS C1874 G32517 - GRAFT EVAS 24MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32518 SUP HCPCS C1874 G32518 - GRAFT EVAS 26MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32519 SUP HCPCS C1874 G32519 - GRAFT EVAS 28MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32520 SUP HCPCS C1874 G32520 - GRAFT EVAS 30MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32521 SUP HCPCS C1874 G32521 - GRAFT EVAS 32MM 7.7MM 20FR 121MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32522 SUP HCPCS C1874 G32522 - GRAFT EVAS 34MM 7.7MM 20FR 84MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32523 SUP HCPCS C1874 G32523 - GRAFT EVAS 36MM 8.5MM 20FR 84MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32524 SUP HCPCS C1874 G32524 - GRAFT EVAS 34MM 7.7MM 20FR 99MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32525 SUP HCPCS C1874 G32525 - GRAFT EVAS 36MM 8.5MM 20FR 99MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32526 SUP HCPCS C1874 G32526 - GRAFT EVAS 34MM 7.7MM 20FR 114MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32527 SUP HCPCS C1874 G32527 - GRAFT EVAS 36MM 8.5MM 20FR 114MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32528 SUP HCPCS C1874 G32528 - GRAFT EVAS 34MM 7.7MM 20FR 129MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32529 SUP HCPCS C1874 G32529 - GRAFT EVAS 36MM 8.5MM 20FR 129MM ZNTH H&L-B 1-SHOT 1 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32530 SUP HCPCS C1874 G32530 - GRAFT EVAS 24MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32531 SUP HCPCS C1874 G32531 - GRAFT EVAS 26MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32532 SUP HCPCS C1874 G32532 - GRAFT EVAS 20FR 94MM 28MM ZNTH VSCR FEN PROX BFUR BD AAA BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32533 SUP HCPCS C1874 G32533 - GRAFT EVAS 30MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32534 SUP HCPCS C1874 G32534 - GRAFT EVAS 32MM 7.7MM 20FR 94MM ZNTH H&L-B 1-SHOT 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32535 SUP HCPCS C1874 G32535 - GRAFT EVAS 24MM 7.7MM 20FR 109MM ZNTH H&L-B 1-SHOT 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32536 SUP HCPCS C1874 G32536 - GRAFT EVAS 26MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32537 SUP HCPCS C1874 G32537 - GRAFT EVAS 28MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32538 SUP HCPCS C1874 G32538 - GRAFT EVAS 30MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32539 SUP HCPCS C1874 G32539 - GRAFT EVAS 32MM 109MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32540 SUP HCPCS C1874 G32540 - GRAFT EVAS 24MM 7.7MM 20FR 124MM ZNTH H&L-B 1-SHOT 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32541 SUP HCPCS C1874 G32541 - GRAFT EVAS 12FR 124MM 91MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32542 SUP HCPCS C1874 G32542 - GRAFT EVAS 2FR 124MM 28MM ZNTH FEN PROX BD AAA BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32543 SUP HCPCS C1874 G32543 - GRAFT EVAS 30MM 124MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32544 SUP HCPCS C1874 G32544 - GRAFT EVAS 32MM 124MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32545 SUP HCPCS C1874 G32545 - GRAFT EVAS 34MM 107MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32546 SUP HCPCS C1874 G32546 - GRAFT EVAS 36MM 107MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32547 SUP HCPCS C1874 G32547 - GRAFT EVAS 34MM 20FR 122MM STRL H L-B 1-SHOT ZNTH 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32548 SUP HCPCS C1874 G32548 - GRAFT EVAS 36MM 8.5MM 22FR 122MM ZNTH H&L-B 1-SHOT 2 PROX BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32549 SUP HCPCS C1874 G32549 - GRAFT EVAS 34MM 137MM STRL H&L-B 1-SHOT ZNTH 2 PROX INTNL BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32550 SUP HCPCS C1874 G32550 - GRAFT EVAS 36MM 137MM STRL ZNTH H&L-B 1-SHOT 2 PROX INTNL BOTH IP/OP "$27,500.00" "$20,350.00" "$5,458.06" "$27,500.00" "$12,375.00" "$12,375.00" "$12,375.00" "$12,375.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.69" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.30" "$27,500.00" "$27,500.00" "$13,557.50" "$27,500.00" "$27,500.00" "$27,500.00" "$27,500.00" "$20,625.00" "$27,500.00" "$27,500.00" "$27,500.00" "$13,750.00" "$13,750.00" "$21,780.00" "$27,500.00" "$22,000.00" "$12,375.00" "$5,458.06" N/A "$15,950.00" "$27,500.00" "$27,500.00" "$27,500.00" "$5,731.00" "$27,500.00" N/A N/A G32551 SUP HCPCS C1874 G32551 - GRAFT EVAS 12FR 76MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32552 SUP HCPCS C1874 G32552 - GRAFT EVAS 16FR 76MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32553 SUP HCPCS C1874 G32553 - GRAFT EVAS 20FR 76MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32554 SUP HCPCS C1874 G32554 - GRAFT EVAS 12FR 91MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32555 SUP HCPCS C1874 G32555 - GRAFT EVAS 16FR 91MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32556 SUP HCPCS C1874 G32556 - GRAFT EVAS 20FR 91MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32557 SUP HCPCS C1874 G32557 - GRAFT EVAS 16FR 106MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32558 SUP HCPCS C1874 G32558 - GRAFT EVAS 20FR 106MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32559 SUP HCPCS C1874 G32559 - GRAFT EVAS 16FR 121MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32560 SUP HCPCS C1874 G32560 - GRAFT EVAS 20FR 121MM 28MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32561 SUP HCPCS C1874 G32561 - GRAFT EVAS 12FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32562 SUP HCPCS C1874 G32562 - GRAFT EVAS 16FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32563 SUP HCPCS C1874 G32563 - GRAFT EVAS 20FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32564 SUP HCPCS C1874 G32564 - GRAFT EVAS 24FR 76MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32565 SUP HCPCS C1874 G32565 - GRAFT EVAS 12FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32566 SUP HCPCS C1874 G32566 - GRAFT EVAS 16FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32567 SUP HCPCS C1874 G32567 - GRAFT EVAS 20FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32568 SUP HCPCS C1874 G32568 - GRAFT EVAS 24FR 91MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32569 SUP HCPCS C1874 G32569 - GRAFT EVAS 12FR 106MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32570 SUP HCPCS C1874 G32570 - GRAFT EVAS 16FR 106MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32571 SUP HCPCS C1874 G32571 - GRAFT EVAS 2 BRCH 20FR 106MM 45MM ZNTH H&L-B 1-SHOT VSCR FEN BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32572 SUP HCPCS C1874 G32572 - GRAFT EVAS 24FR 106MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32573 SUP HCPCS C1874 G32573 - GRAFT EVAS 12FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32574 SUP HCPCS C1874 G32574 - GRAFT EVAS 16FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32575 SUP HCPCS C1874 G32575 - GRAFT EVAS 20FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32576 SUP HCPCS C1874 G32576 - GRAFT EVAS 24FR 121MM 45MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32577 SUP HCPCS C1874 G32577 - GRAFT EVAS 12FR 76MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32578 SUP HCPCS C1874 G32578 - GRAFT EVAS 2 BRCH 20MM 8.1MM 20FR 76MM STRL 62MM ZNTH DIST BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32579 SUP HCPCS C1874 G32579 - GRAFT EVAS 24FR 76MM 62MM ZNTH 1-SHOT 2 BRCH VSCR FENESTRATE BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32580 SUP HCPCS C1874 G32580 - GRAFT EVAS 12FR 91MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32581 SUP HCPCS C1874 G32581 - GRAFT EVAS 16FR 91MM 62MM ZNTH FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32582 SUP HCPCS C1874 G32582 - GRAFT EVAS 20FR 91MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32583 SUP HCPCS C1874 G32583 - GRAFT EVAS 24FR 91MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32584 SUP HCPCS C1874 G32584 - GRAFT EVAS 12FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32585 SUP HCPCS C1874 G32585 - GRAFT EVAS 16FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32586 SUP HCPCS C1874 G32586 - GRAFT EVAS 20FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32587 SUP HCPCS C1874 G32587 - GRAFT EVAS 24FR 106MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32588 SUP HCPCS C1874 G32588 - GRAFT EVAS 12FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32589 SUP HCPCS C1874 G32589 - GRAFT EVAS 16FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32590 SUP HCPCS C1874 G32590 - GRAFT EVAS 20FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32591 SUP HCPCS C1874 G32591 - GRAFT EVAS 24FR 121MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32592 SUP HCPCS C1874 G32592 - GRAFT EVAS 16FR 76MM 62MM ZNTH VSCR FEN DIST BFUR BD AAA BOTH IP/OP "$9,270.00" "$6,860.00" "$1,839.86" "$9,270.00" "$4,171.50" "$4,171.50" "$4,171.50" "$4,171.50" "$9,270.00" "$9,270.00" "$9,270.00" "$1,932.10" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$9,270.00" "$4,570.11" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$1,839.86" N/A "$5,376.60" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.87" "$9,270.00" N/A N/A G32701 SUP Custom 27203010 G32701 - GUIDEWIRE VASC TPR STRG .025IN 150CM 3CM HIWIRE 1 TO 1 TRQ BOTH IP/OP $103.50 $77.00 $18.35 $103.07 $103.07 $103.07 $103.07 $103.07 $103.07 $103.07 $18.35 $103.07 $103.07 $76.50 $76.50 $79.45 $53.70 $21.48 $103.07 $41.23 $103.07 $103.07 $103.07 $103.07 $103.07 $77.63 $103.07 $103.07 $103.07 $51.54 $51.54 $81.63 $103.07 $82.46 $67.00 $103.07 N/A $60.03 $103.07 $61.84 $103.07 $103.07 $103.07 N/A N/A G32702 SUP Custom 27203010 G32702 - EXTRACTOR STON 2.4FR 1CM 115CM STRL NCOMPASS NCRCL 16 4WR BOTH IP/OP $515.50 $381.00 $91.73 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $91.73 $515.33 $515.33 $382.48 $382.48 $397.22 $268.49 $107.40 $515.33 $206.13 $515.33 $515.33 $515.33 $515.33 $515.33 $386.63 $515.33 $515.33 $515.33 $257.67 $257.67 $408.14 $515.33 $412.26 $334.96 $515.33 N/A $298.99 $515.33 $309.20 $515.33 $515.33 $515.33 N/A N/A G32724 SUP Custom 27203010 G32724 - EXTRACTOR STON 7MM 2.8FR 145MM NTRAP UMRL DSGN ENTRAPMENT BOTH IP/OP $515.50 $381.00 $91.73 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $91.73 $515.33 $515.33 $382.48 $382.48 $397.22 $268.49 $107.40 $515.33 $206.13 $515.33 $515.33 $515.33 $515.33 $515.33 $386.63 $515.33 $515.33 $515.33 $257.67 $257.67 $408.14 $515.33 $412.26 $334.96 $515.33 N/A $298.99 $515.33 $309.20 $515.33 $515.33 $515.33 N/A N/A G32727 SUP Custom 27203010 G32727 - CATHETER URTH 26FR 34CM UNIVERSA 2W FL CLS END RND TIP SIL BOTH IP/OP $34.00 $25.00 $6.04 $33.94 $33.94 $33.94 $33.94 $33.94 $33.94 $33.94 $6.04 $33.94 $33.94 $25.19 $25.19 $26.16 $17.68 $7.07 $33.94 $13.58 $33.94 $33.94 $33.94 $33.94 $33.94 $25.50 $33.94 $33.94 $33.94 $16.97 $16.97 $26.88 $33.94 $27.15 $22.06 $33.94 N/A $19.72 $33.94 $20.36 $33.94 $33.94 $33.94 N/A N/A G32730 SUP Custom 27203010 G32730 - EXTRACTOR STON HLX 3FR 3.2FR 115CM STRL CPTR 4WR OCL BSKT BOTH IP/OP $473.50 $350.00 $84.24 $473.25 $473.25 $473.25 $473.25 $473.25 $473.25 $473.25 $84.24 $473.25 $473.25 $351.25 $351.25 $364.78 $246.56 $98.63 $473.25 $189.30 $473.25 $473.25 $473.25 $473.25 $473.25 $355.13 $473.25 $473.25 $473.25 $236.63 $236.63 $374.81 $473.25 $378.60 $307.61 $473.25 N/A $274.63 $473.25 $283.95 $473.25 $473.25 $473.25 N/A N/A G32733 SUP Custom 27203010 G32733 - EXTRACTOR STONE 3FR 3.2FR 115CM 3 WIRE HELICAL OCCLUSIVE BOTH IP/OP $407.50 $302.00 $72.50 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $72.50 $407.30 $407.30 $302.30 $302.30 $313.95 $212.20 $84.89 $407.30 $162.92 $407.30 $407.30 $407.30 $407.30 $407.30 $305.63 $407.30 $407.30 $407.30 $203.65 $203.65 $322.58 $407.30 $325.84 $264.75 $407.30 N/A $236.35 $407.30 $244.38 $407.30 $407.30 $407.30 N/A N/A G32734 SUP Custom 27203010 G32734 - EXTRACTOR STON 3FR 3.2FR 115CM 5CM ATLS WR 4WR FLFRM BSKT BOTH IP/OP $407.50 $302.00 $72.50 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $72.50 $407.30 $407.30 $302.30 $302.30 $313.95 $212.20 $84.89 $407.30 $162.92 $407.30 $407.30 $407.30 $407.30 $407.30 $305.63 $407.30 $407.30 $407.30 $203.65 $203.65 $322.58 $407.30 $325.84 $264.75 $407.30 N/A $236.35 $407.30 $244.38 $407.30 $407.30 $407.30 N/A N/A G32739 SUP Custom 27203010 G32739 - EXTRACTOR STON 1.1FR 1.7FR 115CM STRL ATLS WR 4WR OCL BSKT BOTH IP/OP $282.00 $209.00 $50.12 $281.55 $281.55 $281.55 $281.55 $281.55 $281.55 $281.55 $50.12 $281.55 $281.55 $208.97 $208.97 $217.02 $146.69 $58.68 $281.55 $112.62 $281.55 $281.55 $281.55 $281.55 $281.55 $211.50 $281.55 $281.55 $281.55 $140.78 $140.78 $222.99 $281.55 $225.24 $183.01 $281.55 N/A $163.56 $281.55 $168.93 $281.55 $281.55 $281.55 N/A N/A G32740 SUP Custom 27203010 G32740 - EXTRACTOR STON 4.5FR 65CM CPTR 4WR OCL BSKT SHTH SS BOTH IP/OP $282.00 $209.00 $50.12 $281.55 $281.55 $281.55 $281.55 $281.55 $281.55 $281.55 $50.12 $281.55 $281.55 $208.97 $208.97 $217.02 $146.69 $58.68 $281.55 $112.62 $281.55 $281.55 $281.55 $281.55 $281.55 $211.50 $281.55 $281.55 $281.55 $140.78 $140.78 $222.99 $281.55 $225.24 $183.01 $281.55 N/A $163.56 $281.55 $168.93 $281.55 $281.55 $281.55 N/A N/A G32742 SUP Custom 27203010 G32742 - EXTRACTOR STON 4.5FR 65CM 5CM CPTR 4WR HLCL FLFRM BSKT SHTH BOTH IP/OP $282.00 $209.00 $50.12 $281.55 $281.55 $281.55 $281.55 $281.55 $281.55 $281.55 $50.12 $281.55 $281.55 $208.97 $208.97 $217.02 $146.69 $58.68 $281.55 $112.62 $281.55 $281.55 $281.55 $281.55 $281.55 $211.50 $281.55 $281.55 $281.55 $140.78 $140.78 $222.99 $281.55 $225.24 $183.01 $281.55 N/A $163.56 $281.55 $168.93 $281.55 $281.55 $281.55 N/A N/A G32746 SUP Custom 27203010 G32746 - EXTRACTOR STON 4.5FR 65CM 5CM CPTR 5WR HLCL FLFRM BSKT SHTH BOTH IP/OP $282.00 $209.00 $50.12 $281.55 $281.55 $281.55 $281.55 $281.55 $281.55 $281.55 $50.12 $281.55 $281.55 $208.97 $208.97 $217.02 $146.69 $58.68 $281.55 $112.62 $281.55 $281.55 $281.55 $281.55 $281.55 $211.50 $281.55 $281.55 $281.55 $140.78 $140.78 $222.99 $281.55 $225.24 $183.01 $281.55 N/A $163.56 $281.55 $168.93 $281.55 $281.55 $281.55 N/A N/A G32749 SUP Custom 27203010 G32749 - EXTRACTOR STON HLX 4.5FR 65CM CPTR 4WR HLCL OCL BSKT SHTH SS BOTH IP/OP $407.50 $302.00 $72.50 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $72.50 $407.30 $407.30 $302.30 $302.30 $313.95 $212.20 $84.89 $407.30 $162.92 $407.30 $407.30 $407.30 $407.30 $407.30 $305.63 $407.30 $407.30 $407.30 $203.65 $203.65 $322.58 $407.30 $325.84 $264.75 $407.30 N/A $236.35 $407.30 $244.38 $407.30 $407.30 $407.30 N/A N/A G32750 SUP Custom 27203010 G32750 - EXTRACTOR STON HLCL 3FR 3.2FR 115CM STRL CPTR 5WR OCL SHTH BOTH IP/OP $407.50 $302.00 $72.50 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $72.50 $407.30 $407.30 $302.30 $302.30 $313.95 $212.20 $84.89 $407.30 $162.92 $407.30 $407.30 $407.30 $407.30 $407.30 $305.63 $407.30 $407.30 $407.30 $203.65 $203.65 $322.58 $407.30 $325.84 $264.75 $407.30 N/A $236.35 $407.30 $244.38 $407.30 $407.30 $407.30 N/A N/A G32756 SUP Custom 27203010 G32756 - EXTRACTOR STON 3FR 3.2FR 115CM 5CM CPTR 4WR HLCL FLFRM BSKT BOTH IP/OP $407.50 $302.00 $72.50 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $72.50 $407.30 $407.30 $302.30 $302.30 $313.95 $212.20 $84.89 $407.30 $162.92 $407.30 $407.30 $407.30 $407.30 $407.30 $305.63 $407.30 $407.30 $407.30 $203.65 $203.65 $322.58 $407.30 $325.84 $264.75 $407.30 N/A $236.35 $407.30 $244.38 $407.30 $407.30 $407.30 N/A N/A G32757 SUP Custom 27203010 G32757 - EXTRACTOR STON 2.5FR 115CM CPTR 4WR HLCL OCL URO SS BOTH IP/OP $407.50 $302.00 $72.50 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $72.50 $407.30 $407.30 $302.30 $302.30 $313.95 $212.20 $84.89 $407.30 $162.92 $407.30 $407.30 $407.30 $407.30 $407.30 $305.63 $407.30 $407.30 $407.30 $203.65 $203.65 $322.58 $407.30 $325.84 $264.75 $407.30 N/A $236.35 $407.30 $244.38 $407.30 $407.30 $407.30 N/A N/A G32773 SUP HCPCS C2625 G32773 - CATHETER URTH 26FR 34CM UNIVERSA 2W FL OP-EN OPN TIP SIL BOTH IP/OP $17.50 $13.00 $3.39 $17.08 $7.69 $7.69 $7.69 $7.69 $17.08 $17.08 $17.08 $3.56 $17.08 $17.08 $17.08 $17.08 $17.08 $3.56 $17.08 $17.08 $10.10 $17.08 $17.08 $17.08 $17.08 $13.13 $17.08 $17.08 $17.08 $8.54 $8.54 $13.53 $17.08 $13.66 $7.69 $3.39 N/A $10.15 $17.08 $17.08 $17.08 $3.56 $17.08 N/A N/A G32774 SUP HCPCS C2625 G32774 - SET NPHSTM 4FR .025IN 12-18CM 145CM SALLE SFLX GW STY SS PU BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $92.25 $92.25 $92.25 $92.25 $205.00 $205.00 $205.00 $42.73 $205.00 $205.00 $205.00 $205.00 $205.00 $42.72 $205.00 $205.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $92.25 $40.69 N/A $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A G32779 SUP Custom 27203010 G32779 - EXTRACTOR STONE 1.7FR 115CM 3 WIRE HELICAL OCCLUSIVE BASKET BOTH IP/OP $407.50 $302.00 $72.50 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $72.50 $407.30 $407.30 $302.30 $302.30 $313.95 $212.20 $84.89 $407.30 $162.92 $407.30 $407.30 $407.30 $407.30 $407.30 $305.63 $407.30 $407.30 $407.30 $203.65 $203.65 $322.58 $407.30 $325.84 $264.75 $407.30 N/A $236.35 $407.30 $244.38 $407.30 $407.30 $407.30 N/A N/A G32781 SUP Custom 27203010 G32781 - SET STNT .038IN 4.7FR 12-18CM STRL 145CM SALLE INTOP GW STY BOTH IP/OP $282.00 $209.00 $50.12 $281.55 $281.55 $281.55 $281.55 $281.55 $281.55 $281.55 $50.12 $281.55 $281.55 $208.97 $208.97 $217.02 $146.69 $58.68 $281.55 $112.62 $281.55 $281.55 $281.55 $281.55 $281.55 $211.50 $281.55 $281.55 $281.55 $140.78 $140.78 $222.99 $281.55 $225.24 $183.01 $281.55 N/A $163.56 $281.55 $168.93 $281.55 $281.55 $281.55 N/A N/A G32784 SUP Custom 27203010 G32784 - EXTRACTOR STON 4.5FR 65CM 5CM CPTR 6WR HLCL OCL BSKT SHTH SS BOTH IP/OP $407.50 $302.00 $72.50 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $72.50 $407.30 $407.30 $302.30 $302.30 $313.95 $212.20 $84.89 $407.30 $162.92 $407.30 $407.30 $407.30 $407.30 $407.30 $305.63 $407.30 $407.30 $407.30 $203.65 $203.65 $322.58 $407.30 $325.84 $264.75 $407.30 N/A $236.35 $407.30 $244.38 $407.30 $407.30 $407.30 N/A N/A G32786 SUP Custom 27203010 G32786 - EXTRACTOR STON 5CM 3.2FR 3FR 115CM CPTR 3WR HLCL FLFRM SS BOTH IP/OP $282.00 $209.00 $50.12 $281.55 $281.55 $281.55 $281.55 $281.55 $281.55 $281.55 $50.12 $281.55 $281.55 $208.97 $208.97 $217.02 $146.69 $58.68 $281.55 $112.62 $281.55 $281.55 $281.55 $281.55 $281.55 $211.50 $281.55 $281.55 $281.55 $140.78 $140.78 $222.99 $281.55 $225.24 $183.01 $281.55 N/A $163.56 $281.55 $168.93 $281.55 $281.55 $281.55 N/A N/A G32788 SUP Custom 27203010 G32788 - EXTRACTOR STON HLX 4.5FR 65CM 5CM CPTR 4WR HLCL FLFRM BSKT BOTH IP/OP $407.50 $302.00 $72.50 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $72.50 $407.30 $407.30 $302.30 $302.30 $313.95 $212.20 $84.89 $407.30 $162.92 $407.30 $407.30 $407.30 $407.30 $407.30 $305.63 $407.30 $407.30 $407.30 $203.65 $203.65 $322.58 $407.30 $325.84 $264.75 $407.30 N/A $236.35 $407.30 $244.38 $407.30 $407.30 $407.30 N/A N/A G32789 SUP Custom 27203010 G32789 - SET DILAT 8-20FR 37CM SIDEPORT LOW FRICTION SLIPPERY SURFACE BOTH IP/OP $485.00 $359.00 $86.33 $485.00 $485.00 $485.00 $485.00 $485.00 $485.00 $485.00 $86.33 $485.00 $485.00 $359.97 $359.97 $373.84 $252.69 $101.08 $485.00 $451.00 $485.00 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $315.25 $485.00 N/A $281.30 $485.00 $291.00 $485.00 $485.00 $485.00 N/A N/A G32824 SUP Custom 27203010 G32824 - EXTRACTOR STONE 3.2FR 3FR 115CM 4 WIRE SHEATH TIP OCCLUSIVE BOTH IP/OP $407.50 $302.00 $72.50 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $407.30 $72.50 $407.30 $407.30 $302.30 $302.30 $313.95 $212.20 $84.89 $407.30 $162.92 $407.30 $407.30 $407.30 $407.30 $407.30 $305.63 $407.30 $407.30 $407.30 $203.65 $203.65 $322.58 $407.30 $325.84 $264.75 $407.30 N/A $236.35 $407.30 $244.38 $407.30 $407.30 $407.30 N/A N/A G32831 SUP HCPCS C1758 G32831 - CATHETER BALDILAT .038IN 5FR 6MM 4CM TAPERED TIP PLATINUM BOTH IP/OP $434.00 $321.00 $86.11 $433.88 $235.60 $235.60 $235.60 $235.60 $433.88 $433.88 $433.88 $90.43 $433.88 $322.03 $322.03 $334.43 $226.05 $90.43 $433.88 $433.88 $256.64 $433.88 $433.88 $433.88 $433.88 $325.50 $433.88 $433.88 $433.88 $216.94 $216.94 $343.63 $433.88 $347.10 $282.02 $86.11 N/A $251.72 $433.88 $433.88 $433.88 $90.42 $433.88 N/A N/A G32833 SUP HCPCS C1758 G32833 - CATHETER BALDILAT .038IN 5FR 6MM 10CM TAPERED TIP PLATINUM BOTH IP/OP $434.00 $321.00 $86.11 $433.88 $235.60 $235.60 $235.60 $235.60 $433.88 $433.88 $433.88 $90.43 $433.88 $322.03 $322.03 $334.43 $226.05 $90.43 $433.88 $433.88 $256.64 $433.88 $433.88 $433.88 $433.88 $325.50 $433.88 $433.88 $433.88 $216.94 $216.94 $343.63 $433.88 $347.10 $282.02 $86.11 N/A $251.72 $433.88 $433.88 $433.88 $90.42 $433.88 N/A N/A G32840 SUP HCPCS C1758 G32840 - SET CATHETERIZATION .038IN 5FR 6MM 4CM BALDILAT INFLAT BOTH IP/OP $512.00 $379.00 $101.60 $511.88 $277.95 $277.95 $277.95 $277.95 $511.88 $511.88 $511.88 $106.69 $511.88 $379.92 $379.92 $394.56 $266.69 $106.68 $511.88 $511.88 $302.78 $511.88 $511.88 $511.88 $511.88 $384.00 $511.88 $511.88 $511.88 $255.94 $255.94 $405.41 $511.88 $409.50 $332.72 $101.60 N/A $296.96 $511.88 $511.88 $511.88 $106.68 $511.88 N/A N/A G32842 SUP HCPCS C1758 G32842 - SET CATHETERIZATION .038IN 5FR 6MM 10CM BALDILAT INFLAT BOTH IP/OP $512.00 $379.00 $101.60 $511.88 $277.95 $277.95 $277.95 $277.95 $511.88 $511.88 $511.88 $106.69 $511.88 $379.92 $379.92 $394.56 $266.69 $106.68 $511.88 $511.88 $302.78 $511.88 $511.88 $511.88 $511.88 $384.00 $511.88 $511.88 $511.88 $255.94 $255.94 $405.41 $511.88 $409.50 $332.72 $101.60 N/A $296.96 $511.88 $511.88 $511.88 $106.68 $511.88 N/A N/A G32852 SUP HCPCS C1894 G32852 - EXTRACTOR STON 2.5FR 2.8FR 115CM CPTR 4WR OCL BSKT SHTH SS BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G32853 SUP HCPCS C1894 G32853 - SHEATH ACC 12FR 13CM FLXR DILATION CNT WRK CHNL PRTC PED BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G32855 SUP HCPCS C2627 G32855 - SHEATH ACC 9.5FR 13CM FLXR DILATION CNT WKG CHNL PRTC PED BOTH IP/OP $224.00 $166.00 $44.45 $223.98 $121.62 $121.62 $121.62 $121.62 $223.98 $223.98 $223.98 $46.68 $223.98 $166.24 $166.24 $172.64 $116.69 $46.68 $223.98 $223.98 $132.48 $223.98 $223.98 $223.98 $223.98 $168.00 $223.98 $223.98 $223.98 $111.99 $111.99 $177.39 $223.98 $179.18 $145.59 $44.45 N/A $129.92 $223.98 $223.98 $223.98 $46.68 $223.98 N/A N/A G32862 SUP Custom 27203010 G32862 - STENT URET 8.5FR 65CM WHT STRL PATERSON-FORRESTER DISP URN BOTH IP/OP $289.50 $214.00 $51.46 $289.10 $289.10 $289.10 $289.10 $289.10 $289.10 $289.10 $51.46 $289.10 $289.10 $214.57 $214.57 $222.84 $150.62 $60.25 $289.10 $115.64 $289.10 $289.10 $289.10 $289.10 $289.10 $217.13 $289.10 $289.10 $289.10 $144.55 $144.55 $228.97 $289.10 $231.28 $187.92 $289.10 N/A $167.91 $289.10 $173.46 $289.10 $289.10 $289.10 N/A N/A G32863 SUP Custom 27203010 G32863 - EXTRACTOR STON 10FR 2CM 38CM PRC NC BSKT RPD ATRM TPLS NTNL BOTH IP/OP $515.50 $381.00 $91.73 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $91.73 $515.33 $515.33 $382.48 $382.48 $397.22 $268.49 $107.40 $515.33 $206.13 $515.33 $515.33 $515.33 $515.33 $515.33 $386.63 $515.33 $515.33 $515.33 $257.67 $257.67 $408.14 $515.33 $412.26 $334.96 $515.33 N/A $298.99 $515.33 $309.20 $515.33 $515.33 $515.33 N/A N/A G33016 SUP HCPCS C1880 G33016 - SYSTEM EMBOLIC PROTECTION 30MM 8.5FR 50MM 65CM DILAT COAXIAL BOTH IP/OP "$3,050.00" "$2,257.00" $635.65 "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" $635.65 "$3,050.00" "$1,220.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$2,287.50" "$3,050.00" "$3,050.00" "$3,050.00" "$1,525.00" "$1,525.00" "$2,415.60" "$3,050.00" "$2,440.00" "$1,372.50" "$3,050.00" N/A "$1,769.00" "$3,050.00" "$1,830.00" "$3,050.00" "$3,050.00" "$3,050.00" N/A N/A G33017 SUP HCPCS C1880 G33017 - FILTER EMBOLIZATION 30MM 8.5FR 50MM 65CM 3 WAY STOPCOCK BOTH IP/OP "$3,050.00" "$2,257.00" $635.65 "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" $635.65 "$3,050.00" "$1,220.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$3,050.00" "$2,287.50" "$3,050.00" "$3,050.00" "$3,050.00" "$1,525.00" "$1,525.00" "$2,415.60" "$3,050.00" "$2,440.00" "$1,372.50" "$3,050.00" N/A "$1,769.00" "$3,050.00" "$1,830.00" "$3,050.00" "$3,050.00" "$3,050.00" N/A N/A G34038 SUP Custom 27203010 G34038 - BRUSH CYTOLOGY 1MM 5MM 172.5CM SHAFT ULTRASOUND ECHOBRUSH BOTH IP/OP $380.00 $281.00 $67.64 $380.00 $380.00 $380.00 $380.00 $380.00 $380.00 $380.00 $67.64 $380.00 $380.00 $282.04 $282.04 $292.90 $197.98 $79.20 $380.00 $152.00 $380.00 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $247.00 $380.00 N/A $220.40 $380.00 $228.00 $380.00 $380.00 $380.00 N/A N/A G34109 SUP HCPCS C2625 G34109 - SET STENT 6FR 22CM RADIOPQ EXTRINSIC OBSTRUCTION POSITIONER BOTH IP/OP "$2,246.00" "$1,662.00" $445.73 "$2,245.75" "$1,010.59" "$1,010.59" "$1,010.59" "$1,010.59" "$2,245.75" "$2,245.75" "$2,245.75" $468.07 "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" $468.04 "$2,245.75" "$2,245.75" "$1,328.36" "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" "$1,684.50" "$2,245.75" "$2,245.75" "$2,245.75" "$1,122.88" "$1,122.88" "$1,778.63" "$2,245.75" "$1,796.60" "$1,010.59" $445.73 N/A "$1,302.68" "$2,245.75" "$2,245.75" "$2,245.75" $468.01 "$2,245.75" N/A N/A G34110 SUP HCPCS C2625 G34110 - SET STENT 6FR 24CM RADIOPQ EXTRINSIC OBSTRUCTION POSITIONER BOTH IP/OP "$2,246.00" "$1,662.00" $445.73 "$2,245.75" "$1,010.59" "$1,010.59" "$1,010.59" "$1,010.59" "$2,245.75" "$2,245.75" "$2,245.75" $468.07 "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" $468.04 "$2,245.75" "$2,245.75" "$1,328.36" "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" "$1,684.50" "$2,245.75" "$2,245.75" "$2,245.75" "$1,122.88" "$1,122.88" "$1,778.63" "$2,245.75" "$1,796.60" "$1,010.59" $445.73 N/A "$1,302.68" "$2,245.75" "$2,245.75" "$2,245.75" $468.01 "$2,245.75" N/A N/A G34111 SUP HCPCS C2625 G34111 - STENT URETERAL 6FR 26CM RESONANCE METAL ADULT BOTH IP/OP "$2,246.00" "$1,662.00" $445.73 "$2,245.75" "$1,010.59" "$1,010.59" "$1,010.59" "$1,010.59" "$2,245.75" "$2,245.75" "$2,245.75" $468.07 "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" $468.04 "$2,245.75" "$2,245.75" "$1,328.36" "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" "$1,684.50" "$2,245.75" "$2,245.75" "$2,245.75" "$1,122.88" "$1,122.88" "$1,778.63" "$2,245.75" "$1,796.60" "$1,010.59" $445.73 N/A "$1,302.68" "$2,245.75" "$2,245.75" "$2,245.75" $468.01 "$2,245.75" N/A N/A G34112 SUP HCPCS C2625 G34112 - SET STENT 6FR 28CM RADIOPQ EXTRINSIC OBSTRUCTION POSITIONER BOTH IP/OP "$2,246.00" "$1,662.00" $445.73 "$2,245.75" "$1,010.59" "$1,010.59" "$1,010.59" "$1,010.59" "$2,245.75" "$2,245.75" "$2,245.75" $468.07 "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" $468.04 "$2,245.75" "$2,245.75" "$1,328.36" "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" "$1,684.50" "$2,245.75" "$2,245.75" "$2,245.75" "$1,122.88" "$1,122.88" "$1,778.63" "$2,245.75" "$1,796.60" "$1,010.59" $445.73 N/A "$1,302.68" "$2,245.75" "$2,245.75" "$2,245.75" $468.01 "$2,245.75" N/A N/A G34176 SUP HCPCS C2625 G34176 - EXTRACTOR STON 1.5CM 2.4FR 115CM 1.5CM NCOMPASS 4/16 WRE MOD BOTH IP/OP "$2,246.00" "$1,662.00" $445.73 "$2,245.75" "$1,010.59" "$1,010.59" "$1,010.59" "$1,010.59" "$2,245.75" "$2,245.75" "$2,245.75" $468.07 "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" $468.04 "$2,245.75" "$2,245.75" "$1,328.36" "$2,245.75" "$2,245.75" "$2,245.75" "$2,245.75" "$1,684.50" "$2,245.75" "$2,245.75" "$2,245.75" "$1,122.88" "$1,122.88" "$1,778.63" "$2,245.75" "$1,796.60" "$1,010.59" $445.73 N/A "$1,302.68" "$2,245.75" "$2,245.75" "$2,245.75" $468.01 "$2,245.75" N/A N/A G34309 SUP HCPCS C1880 G34309 - FILTER EMBL 65CM 30MM 7FR 49MM STRL 71CM CELECT NAVALIGN BOTH IP/OP "$2,312.50" "$1,711.00" $481.95 "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" $481.95 "$2,312.50" $850.00 "$2,312.50" "$2,312.50" "$2,125.00" "$2,312.50" "$2,312.50" "$1,734.38" "$2,312.50" "$2,312.50" "$2,312.50" "$1,156.25" "$1,156.25" "$1,831.50" "$2,312.50" "$1,850.00" "$1,040.63" "$2,312.50" N/A "$1,341.25" "$2,312.50" "$1,387.50" "$2,312.50" "$2,312.50" "$2,312.50" N/A N/A G34311 SUP Custom 27203010 G34311 - STENT URET 6FR 30CM RSNCE PSTN MTL ADLT URETER BOTH IP/OP $45.00 $33.00 $8.01 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $45.00 $8.01 $45.00 $45.00 $33.40 $33.40 $34.69 $23.45 $9.38 $45.00 $18.00 $45.00 $45.00 $45.00 $45.00 $45.00 $33.75 $45.00 $45.00 $45.00 $22.50 $22.50 $35.64 $45.00 $36.00 $29.25 $45.00 N/A $26.10 $45.00 $27.00 $45.00 $45.00 $45.00 N/A N/A G34502 SUP HCPCS C1880 G34502 - FILTER EMBOLIZATION 65CM 30MM 7FR 49MM 79CM RADIOPQ PRELOAD BOTH IP/OP "$2,312.50" "$1,711.00" $481.95 "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" "$2,312.50" $481.95 "$2,312.50" $850.00 "$2,312.50" "$2,312.50" "$2,125.00" "$2,312.50" "$2,312.50" "$1,734.38" "$2,312.50" "$2,312.50" "$2,312.50" "$1,156.25" "$1,156.25" "$1,831.50" "$2,312.50" "$1,850.00" "$1,040.63" "$2,312.50" N/A "$1,341.25" "$2,312.50" "$1,387.50" "$2,312.50" "$2,312.50" "$2,312.50" N/A N/A G34870 SUP HCPCS C1894 G34870 - ADAPTER L/S NS VUELITE ACMI SCP BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G34871 SUP HCPCS C1894 G34871 - SHEATH ACC 10.7FR 13CM RPD RELS PRLL FLXR CNT CHNL URETER BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G34872 SUP HCPCS C1894 G34872 - SHEATH ACC 10.7FR 20CM RPD RELS PRLL FLXR CNT CHNL URETER BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G34873 SUP HCPCS C1894 G34873 - SHEATH ACC 10.7FR 28CM RPD RELS PRLL FLXR CNT CHNL URETER BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G34874 SUP HCPCS C1894 G34874 - SHEATH ACC 10.7FR 35CM RPD RELS PRLL FLXR CNT CHNL URETER BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G34875 SUP HCPCS C1894 G34875 - SHEATH ACC 10.7FR 45CM RPD RELS PRLL FLXR CNT CHNL URETER BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G34876 SUP HCPCS C1894 G34876 - SHEATH ACC 10.7FR 55CM RPD RELS PRLL FLXR CNT CHNL URETER BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G34877 SUP HCPCS C1894 G34877 - SHEATH ACC 10.7FR 13CM FLXR DILATION CNT WRK CHNL URETER BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G34878 SUP HCPCS C1894 G34878 - SHEATH ACCES SM TPR FNL 10.7FR DILAT LOCK HUB FLXB BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G34879 SUP HCPCS C1894 G34879 - SHEATH ACCES 10.7FR DILATION CONTIN WRK CHNL FLXR BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G34880 SUP HCPCS C1894 G34880 - SHEATH ACCES 10.7FR DILATION CONTIN WRK CHNL FLXR BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G34881 SUP HCPCS C1894 G34881 - SHEATH ACC 10.7FR 20CM FLXR DILATION CNT WRK CHNL URETER BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G34931 SUP Custom 27203010 G34931 - SHEATH ACC 10.7FR 55CM FLXR DILATION CNT WRK CHNL URETER BOTH IP/OP $462.50 $342.00 $82.33 $462.50 $462.50 $462.50 $462.50 $462.50 $462.50 $462.50 $82.33 $462.50 $462.50 $343.27 $343.27 $356.50 $240.96 $96.39 $462.50 $185.00 $462.50 $462.50 $462.50 $462.50 $462.50 $346.88 $462.50 $462.50 $462.50 $231.25 $231.25 $366.30 $462.50 $370.00 $300.63 $462.50 N/A $268.25 $462.50 $277.50 $462.50 $462.50 $462.50 N/A N/A G35129 SUP Custom 27203010 G35129 - LIGATOR ENDSCP MINI HEXAGON 9.5-13MM 5FR 2.8MM 6 BAND SNARE BOTH IP/OP $795.00 $588.00 $141.51 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $795.00 $141.51 $795.00 $795.00 $590.05 $590.05 $612.79 $414.20 $165.69 $795.00 $318.00 $795.00 $795.00 $795.00 $795.00 $795.00 $596.25 $795.00 $795.00 $795.00 $397.50 $397.50 $629.64 $795.00 $636.00 $516.75 $795.00 N/A $461.10 $795.00 $477.00 $795.00 $795.00 $795.00 N/A N/A G3600320 SUP Custom 27203010 G3600320 - BIT DRL 3.2MM STRL OC DISP BOTH IP/OP $676.50 $501.00 $120.42 $676.50 $676.50 $676.50 $676.50 $676.50 $676.50 $676.50 $120.42 $676.50 $676.50 $502.10 $502.10 $521.45 $352.46 $140.99 $676.50 $270.60 $676.50 $676.50 $676.50 $676.50 $676.50 $507.38 $676.50 $676.50 $676.50 $338.25 $338.25 $535.79 $676.50 $541.20 $439.73 $676.50 N/A $392.37 $676.50 $405.90 $676.50 $676.50 $676.50 N/A N/A G3600321 SUP Custom 27203010 G3600321 - BIT DRL 3.2MM STRL FLXB OC DISP BOTH IP/OP $676.50 $501.00 $120.42 $676.50 $676.50 $676.50 $676.50 $676.50 $676.50 $676.50 $120.42 $676.50 $676.50 $502.10 $502.10 $521.45 $352.46 $140.99 $676.50 $270.60 $676.50 $676.50 $676.50 $676.50 $676.50 $507.38 $676.50 $676.50 $676.50 $338.25 $338.25 $535.79 $676.50 $541.20 $439.73 $676.50 N/A $392.37 $676.50 $405.90 $676.50 $676.50 $676.50 N/A N/A G3601513 SUP HCPCS C1713 G3601513 - CONNECTOR ROD 13MM CLS SPNE LAT BOTH IP/OP "$1,018.50" $754.00 $202.15 "$1,018.50" $458.33 $458.33 $458.33 $458.33 "$1,018.50" "$1,018.50" "$1,018.50" $212.28 "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" $212.27 "$1,018.50" $407.40 $602.44 "$1,018.50" "$1,018.50" "$1,018.50" "$1,018.50" $763.88 "$1,018.50" "$1,018.50" "$1,018.50" $509.25 $509.25 $806.65 "$1,018.50" $814.80 $458.33 $202.15 N/A $590.73 "$1,018.50" "$1,018.50" "$1,018.50" $212.26 "$1,018.50" N/A N/A G36022 SUP HCPCS C1876 G36022 - STENT BILIARY .035IN 5MM 6FR 80MM 125CM SELF EXPANDING BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,283.75" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,283.75" "$1,330.88" "$2,250.00" "$2,283.75" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A G3602350 SUP HCPCS C1713 G3602350 - CONNECTOR ROD DMN AX SPNE 3.5-3.5 MM ROD BOTH IP/OP "$1,458.00" "$1,079.00" $289.38 "$1,458.00" $656.10 $656.10 $656.10 $656.10 "$1,458.00" "$1,458.00" "$1,458.00" $303.88 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" "$1,458.00" $862.41 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 $289.38 N/A $845.64 "$1,458.00" "$1,458.00" "$1,458.00" $303.85 "$1,458.00" N/A N/A G3602475 SUP HCPCS C1713 G3602475 - CONNECTOR ROD DMN AX SPNE 3.5-4.75 MM ROD BOTH IP/OP "$1,458.00" "$1,079.00" $289.38 "$1,458.00" $656.10 $656.10 $656.10 $656.10 "$1,458.00" "$1,458.00" "$1,458.00" $303.88 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" $583.20 $862.41 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 $289.38 N/A $845.64 "$1,458.00" "$1,458.00" "$1,458.00" $303.85 "$1,458.00" N/A N/A G3602513 SUP HCPCS C1713 G3602513 - CONNECTOR ROD 13MM OPN SPNE LAT BOTH IP/OP "$1,077.00" $797.00 $213.76 "$1,077.00" $484.65 $484.65 $484.65 $484.65 "$1,077.00" "$1,077.00" "$1,077.00" $224.47 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $224.46 "$1,077.00" "$1,077.00" $637.05 "$1,077.00" "$1,077.00" "$1,077.00" "$1,077.00" $807.75 "$1,077.00" "$1,077.00" "$1,077.00" $538.50 $538.50 $852.98 "$1,077.00" $861.60 $484.65 $213.76 N/A $624.66 "$1,077.00" "$1,077.00" "$1,077.00" $224.45 "$1,077.00" N/A N/A G3602525 SUP HCPCS C1713 G3602525 - CONNECTOR ROD SM MAS TO MAS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3602527 SUP HCPCS C1713 G3602527 - CONNECTOR ROD LG MAS TO MAS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3602535 SUP HCPCS C1713 G3602535 - CONNECTOR ROD SM ROD TO ROD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3602537 SUP HCPCS C1713 G3602537 - CONNECTOR ROD LG ROD TO ROD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3602550 SUP HCPCS C1713 G3602550 - CONNECTOR ROD DMN AX SPNE 3.5-5.5/6 MM ROD BOTH IP/OP "$1,458.00" "$1,079.00" $289.38 "$1,458.00" $656.10 $656.10 $656.10 $656.10 "$1,458.00" "$1,458.00" "$1,458.00" $303.88 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" $303.86 "$1,458.00" "$1,458.00" $862.41 "$1,458.00" "$1,458.00" "$1,458.00" "$1,458.00" "$1,093.50" "$1,458.00" "$1,458.00" "$1,458.00" $729.00 $729.00 "$1,154.74" "$1,458.00" "$1,166.40" $656.10 $289.38 N/A $845.64 "$1,458.00" "$1,458.00" "$1,458.00" $303.85 "$1,458.00" N/A N/A G3603008 SUP HCPCS C1713 G3603008 - SCREW BN 3MM 8MM SPNE CRV XS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603010 SUP HCPCS C1713 G3603010 - SCREW BN 3MM 10MM SPNE CRV XS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603012 SUP HCPCS C1713 G3603012 - SCREW BN 3MM 12MM SPNE CRV XS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603014 SUP HCPCS C1713 G3603014 - SCREW BN 3MM 14MM SPNE CRV XS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603016 SUP HCPCS C1713 G3603016 - SCREW BN 3MM 16MM SPNE CRV XS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603018 SUP HCPCS C1713 G3603018 - SCREW BN 3MM 18MM SPNE CRV XS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603020 SUP HCPCS C1713 G3603020 - SCREW BN 3MM 20MM SPNE CRV XS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603022 SUP HCPCS C1713 G3603022 - SCREW BN 3MM 22MM SPNE CRV XS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603024 SUP HCPCS C1713 G3603024 - SCREW BN 3MM 24MM SPNE CRV XS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603026 SUP HCPCS C1713 G3603026 - SCREW BN 3MM 26MM SPNE CRV XS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603028 SUP HCPCS C1713 G3603028 - SCREW BN XS 3MM 28MM MA SPNE CRV BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603030 SUP HCPCS C1713 G3603030 - SCREW BN 3MM 30MM SPNE CRV XS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603032 SUP HCPCS C1713 G3603032 - SCREW BN 3MM 32MM SPNE CRV XS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603034 SUP HCPCS C1713 G3603034 - SCREW BN 3MM 34MM SPNE CRV XS BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603508 SUP HCPCS C1713 G3603508 - SCREW BN 3.5MM 8MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603510 SUP HCPCS C1713 G3603510 - SCREW BN 3.5MM 10MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603536 SUP HCPCS C1713 G3603536 - SCREW BN 3.5MM 36MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603538 SUP HCPCS C1713 G3603538 - SCREW BN 3.5MM 38MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603540 SUP HCPCS C1713 G3603540 - SCREW BN 3.5MM 40MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3603542 SUP HCPCS C1713 G3603542 - SCREW BN 3.5MM 42MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3604008 SUP HCPCS C1713 G3604008 - SCREW BN 4MM 8MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3604010 SUP HCPCS C1713 G3604010 - SCREW BN 4MM 10MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3604036 SUP HCPCS C1713 G3604036 - SCREW BN 4MM 36MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3604038 SUP HCPCS C1713 G3604038 - SCREW BN 4MM 38MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3604040 SUP HCPCS C1713 G3604040 - SCREW BN 4MM 40MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3604042 SUP HCPCS C1713 G3604042 - SCREW BN 4MM 42MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3604508 SUP HCPCS C1713 G3604508 - SCREW BN 4.5MM 8MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3604510 SUP HCPCS C1713 G3604510 - SCREW BN 4.5MM 10MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3604536 SUP HCPCS C1713 G3604536 - SCREW BN 4.5MM 36MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3604538 SUP HCPCS C1713 G3604538 - SCREW BN 4.5MM 38MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3604540 SUP HCPCS C1713 G3604540 - SCREW BN 4.5MM 40MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3604542 SUP HCPCS C1713 G3604542 - SCREW BN 4.5MM 42MM MA NSTD SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3605515 SUP HCPCS C1713 G3605515 - SCREW BN 5.5MM 15MM MA TRNS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3605520 SUP HCPCS C1713 G3605520 - SCREW BN 5.5MM 20MM MA TRNS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3605525 SUP HCPCS C1713 G3605525 - SCREW BN 5.5MM 25MM MA TRNS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3605530 SUP HCPCS C1713 G3605530 - SCREW BN 5.5MM 30MM MA TRNS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3605535 SUP HCPCS C1713 G3605535 - SCREW BN 5.5MM 35MM MA TRNS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3605540 SUP HCPCS C1713 G3605540 - SCREW BN 5.5MM 40MM MA TRNS SPNE BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3606010 SUP Custom 27203010 G3606010 - BIT DRL 2.4MM STRL LF DISP BOTH IP/OP $649.50 $481.00 $115.61 $649.50 $649.50 $649.50 $649.50 $649.50 $649.50 $649.50 $115.61 $649.50 $649.50 $482.06 $482.06 $500.63 $338.39 $135.36 $649.50 $259.80 $649.50 $649.50 $649.50 $649.50 $649.50 $487.13 $649.50 $649.50 $649.50 $324.75 $324.75 $514.40 $649.50 $519.60 $422.18 $649.50 N/A $376.71 $649.50 $389.70 $649.50 $649.50 $649.50 N/A N/A G3606069 SUP HCPCS C1713 G3606069 - CONNECTOR ROD XTN SPNE 3.2/3.5 MM MA SCR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3606071 SUP HCPCS C1713 G3606071 - CONNECTOR ROD XTN SPNE 4.75 MM MA SCR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3606072 SUP HCPCS C1713 G3606072 - CONNECTOR ROD XTN SPNE 5.5/6/6.35 MA SCR BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A G3606073 SUP HCPCS C1713 G3606073 - HOOK SPNL 4.5MM LMR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A G3606073L SUP HCPCS C1713 G3606073L - HOOK SPNL OFST 4.5MM LMR LT BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A G3606073R SUP HCPCS C1713 G3606073R - HOOK SPNL OFST 4.5MM LMR RT BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A G3606074 SUP HCPCS C1713 G3606074 - HOOK SPNL 6MM LMR BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" $500.00 $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A G3606074L SUP HCPCS C1713 G3606074L - HOOK SPNL OFST 6MM LMR LT BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A G3606074R SUP HCPCS C1713 G3606074R - HOOK SPNL OFST 6MM LMR RT BOTH IP/OP "$1,250.00" $925.00 $248.09 "$1,250.00" $562.50 $562.50 $562.50 $562.50 "$1,250.00" "$1,250.00" "$1,250.00" $260.53 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $260.51 "$1,250.00" "$1,250.00" $739.38 "$1,250.00" "$1,250.00" "$1,250.00" "$1,250.00" $937.50 "$1,250.00" "$1,250.00" "$1,250.00" $625.00 $625.00 $990.00 "$1,250.00" "$1,000.00" $562.50 $248.09 N/A $725.00 "$1,250.00" "$1,250.00" "$1,250.00" $260.50 "$1,250.00" N/A N/A G360T0320 SUP Custom 27203010 G360T0320 - BIT DRL TPR 3.2MM OC BOTH IP/OP $676.50 $501.00 $120.42 $676.50 $676.50 $676.50 $676.50 $676.50 $676.50 $676.50 $120.42 $676.50 $676.50 $502.10 $502.10 $521.45 $352.46 $140.99 $676.50 $270.60 $676.50 $676.50 $676.50 $676.50 $676.50 $507.38 $676.50 $676.50 $676.50 $338.25 $338.25 $535.79 $676.50 $541.20 $439.73 $676.50 N/A $392.37 $676.50 $405.90 $676.50 $676.50 $676.50 N/A N/A G360T0321 SUP Custom 27203010 G360T0321 - BIT DRL TPR 3.2MM FLXB OC BOTH IP/OP $676.50 $501.00 $120.42 $676.50 $676.50 $676.50 $676.50 $676.50 $676.50 $676.50 $120.42 $676.50 $676.50 $502.10 $502.10 $521.45 $352.46 $140.99 $676.50 $270.60 $676.50 $676.50 $676.50 $676.50 $676.50 $507.38 $676.50 $676.50 $676.50 $338.25 $338.25 $535.79 $676.50 $541.20 $439.73 $676.50 N/A $392.37 $676.50 $405.90 $676.50 $676.50 $676.50 N/A N/A G36226 SUP HCPCS C1763 G36226 - GRAFT SOFT TISSUE 9.5X.6CM PLUG SURGISIS BIODESIGN PIG BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" "$2,237.50" "$1,323.48" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A G36229 SUP HCPCS C1876 G36229 - STENT BILIARY .035IN 12MM 6FR 40MM 80CM SELF EXPANDING BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A G36231 SUP HCPCS C1876 G36231 - STENT BILIARY .035IN 12MM 6FR 80MM 80CM SELF EXPANDING BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A G36239 SUP HCPCS C1876 G36239 - STENT BIL 12MM 40MM STRL 125CM ZL 635 FLXR SLF XPD RADOPQ BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" N/A N/A G36240 SUP HCPCS C1876 G36240 - STENT BIL .035IN 12MM 6FR 60MM STRL 125CM ZL 635 SLF XPD BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A G36245 SUP HCPCS C1876 G36245 - STENT BILIARY .035IN 14MM 6FR 60MM 125CM SELF EXPANDING BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" N/A N/A G36321 SUP Custom 27803010 G36321 - CATHETER ANGIOGRAPHIC .038IN 160D TIGHT CURVE 4FR 65CM BOTH IP/OP $122.50 $91.00 $21.81 $122.50 $122.50 $122.50 $122.50 $122.50 $122.50 $122.50 $21.81 $122.50 $122.50 $122.50 $122.50 $122.50 $122.50 $25.53 $122.50 $49.00 $122.50 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $55.13 $122.50 N/A $71.05 $122.50 $73.50 $122.50 $122.50 $122.50 N/A N/A G36333 SUP HCPCS C1894 G36333 - SET INTROD .018IN 5FR 21GA 10CM 40CM COAXIAL CATHETER GWIRE BOTH IP/OP $100.00 $74.00 $19.85 $101.50 $54.30 $54.30 $54.30 $54.30 $100.00 $100.00 $100.00 $20.84 $100.00 $74.22 $74.22 $77.08 $52.10 $20.84 $100.00 $101.50 $59.15 $100.00 $101.50 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $65.00 $19.85 N/A $58.00 $100.00 $100.00 $100.00 $20.84 $100.00 N/A N/A G36359 SUP HCPCS C1725 G36359 - CATHETER ANGIOGRAPHIC .035IN VTK CURVE 5.5FR 125CM SHEATH BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $105.89 $105.89 $105.89 $105.89 $195.00 $195.00 $195.00 $40.64 $195.00 $144.73 $144.73 $150.31 $101.60 $40.64 $195.00 $195.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $126.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A G36360 SUP HCPCS C1725 G36360 - CATHETER ANGIOGRAPHIC .035IN SIM2 CURVE 5.5FR 125CM SHEATH BOTH IP/OP $195.00 $144.00 $38.70 $195.00 $105.89 $105.89 $105.89 $105.89 $195.00 $195.00 $195.00 $40.64 $195.00 $144.73 $144.73 $150.31 $101.60 $40.64 $195.00 $195.00 $115.34 $195.00 $195.00 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $126.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A G36405 SUP HCPCS C1770 G36405 - COIL EMBOLIZATION .035IN 5MM 5CM 3.1 LOOP MREYE PLATINUM BOTH IP/OP $250.50 $185.00 $52.17 $264.07 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $52.17 $250.30 $105.63 $250.30 $250.30 $264.07 $250.30 $250.30 $187.88 $250.30 $250.30 $250.30 $125.15 $125.15 $198.24 $250.30 $200.24 $112.64 $250.30 N/A $145.29 $250.30 $150.18 $250.30 $250.30 $250.30 N/A N/A G38463 SUP HCPCS C1874 G38463 - STENT VASCULAR 6MM 40MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM BOTH IP/OP "$2,937.50" "$2,174.00" $583.02 "$2,937.50" "$1,321.88" "$1,321.88" "$1,321.88" "$1,321.88" "$2,937.50" "$2,937.50" "$2,937.50" $612.25 "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" $612.21 "$2,937.50" "$2,937.50" "$1,448.19" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,203.13" "$2,937.50" "$2,937.50" "$2,937.50" "$1,468.75" "$1,468.75" "$2,326.50" "$2,937.50" "$2,350.00" "$1,321.88" $583.02 N/A "$1,703.75" "$2,937.50" "$2,937.50" "$2,937.50" $612.18 "$2,937.50" N/A N/A G38479 SUP HCPCS C1874 G38479 - STENT VASCULAR 6MM 60MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM BOTH IP/OP "$3,737.50" "$2,766.00" $741.80 "$3,737.50" "$1,681.88" "$1,681.88" "$1,681.88" "$1,681.88" "$3,737.50" "$3,737.50" "$3,737.50" $778.99 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$3,737.50" "$1,842.59" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" $741.80 N/A "$2,167.75" "$3,737.50" "$3,737.50" "$3,737.50" $778.90 "$3,737.50" N/A N/A G38480 SUP HCPCS C1874 G38480 - STENT VASCULAR 6MM 80MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM BOTH IP/OP "$4,487.50" "$3,321.00" $890.66 "$4,487.50" "$2,019.38" "$2,019.38" "$2,019.38" "$2,019.38" "$4,487.50" "$4,487.50" "$4,487.50" $935.31 "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" $935.24 "$4,487.50" "$4,487.50" "$2,212.34" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$3,365.63" "$4,487.50" "$4,487.50" "$4,487.50" "$2,243.75" "$2,243.75" "$3,554.10" "$4,487.50" "$3,590.00" "$2,019.38" $890.66 N/A "$2,602.75" "$4,487.50" "$4,487.50" "$4,487.50" $935.20 "$4,487.50" N/A N/A G38481 SUP HCPCS C1874 G38481 - STENT VASCULAR 125CM 6FR 80MM 100MM OTW ZILVER PTX BOTH IP/OP "$4,487.50" "$3,321.00" $890.66 "$4,487.50" "$2,019.38" "$2,019.38" "$2,019.38" "$2,019.38" "$4,487.50" "$4,487.50" "$4,487.50" $935.31 "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" $935.24 "$4,487.50" "$4,487.50" "$2,212.34" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$3,365.63" "$4,487.50" "$4,487.50" "$4,487.50" "$2,243.75" "$2,243.75" "$3,554.10" "$4,487.50" "$3,590.00" "$2,019.38" $890.66 N/A "$2,602.75" "$4,487.50" "$4,487.50" "$4,487.50" $935.20 "$4,487.50" N/A N/A G38482 SUP HCPCS C1874 G38482 - STENT VASCULAR 6MM 120MM 125CM DRUG ELUTE OTW DELIVERY BOTH IP/OP "$4,987.50" "$3,691.00" $989.89 "$4,987.50" "$2,244.38" "$2,244.38" "$2,244.38" "$2,244.38" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.52" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.45" "$4,987.50" "$4,987.50" "$2,458.84" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$3,740.63" "$4,987.50" "$4,987.50" "$4,987.50" "$2,493.75" "$2,493.75" "$3,950.10" "$4,987.50" "$3,990.00" "$2,244.38" $989.89 N/A "$2,892.75" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.40" "$4,987.50" N/A N/A G38486 SUP HCPCS C1874 G38486 - STENT VASCULAR 7MM 40MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM BOTH IP/OP "$2,937.50" "$2,174.00" $583.02 "$2,937.50" "$1,321.88" "$1,321.88" "$1,321.88" "$1,321.88" "$2,937.50" "$2,937.50" "$2,937.50" $612.25 "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" $612.21 "$2,937.50" "$2,937.50" "$1,448.19" "$2,937.50" "$2,937.50" "$2,937.50" "$2,937.50" "$2,203.13" "$2,937.50" "$2,937.50" "$2,937.50" "$1,468.75" "$1,468.75" "$2,326.50" "$2,937.50" "$2,350.00" "$1,321.88" $583.02 N/A "$1,703.75" "$2,937.50" "$2,937.50" "$2,937.50" $612.18 "$2,937.50" N/A N/A G38487 SUP HCPCS C1874 G38487 - STENT VASCULAR 7MM 60MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM BOTH IP/OP "$3,737.50" "$2,766.00" $741.80 "$3,737.50" "$1,681.88" "$1,681.88" "$1,681.88" "$1,681.88" "$3,737.50" "$3,737.50" "$3,737.50" $778.99 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$3,737.50" "$1,842.59" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" $741.80 N/A "$2,167.75" "$3,737.50" "$3,737.50" "$3,737.50" $778.90 "$3,737.50" N/A N/A G38488 SUP HCPCS C1874 G38488 - STENT VASCULAR 7MM 80MM 125CM DRUG ELUTE OTW DELIVERY SYSTEM BOTH IP/OP "$4,487.50" "$3,321.00" $890.66 "$4,487.50" "$2,019.38" "$2,019.38" "$2,019.38" "$2,019.38" "$4,487.50" "$4,487.50" "$4,487.50" $935.31 "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" $935.24 "$4,487.50" "$4,487.50" "$2,212.34" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$3,365.63" "$4,487.50" "$4,487.50" "$4,487.50" "$2,243.75" "$2,243.75" "$3,554.10" "$4,487.50" "$3,590.00" "$2,019.38" $890.66 N/A "$2,602.75" "$4,487.50" "$4,487.50" "$4,487.50" $935.20 "$4,487.50" N/A N/A G38489 SUP HCPCS C1874 G38489 - STENT VASCULAR 7MM 100MM 125CM DRUG ELUTE OTW DELIVERY BOTH IP/OP "$4,487.50" "$3,321.00" $890.66 "$4,487.50" "$2,019.38" "$2,019.38" "$2,019.38" "$2,019.38" "$4,487.50" "$4,487.50" "$4,487.50" $935.31 "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" $935.24 "$4,487.50" "$4,487.50" "$2,212.34" "$4,487.50" "$4,487.50" "$4,487.50" "$4,487.50" "$3,365.63" "$4,487.50" "$4,487.50" "$4,487.50" "$2,243.75" "$2,243.75" "$3,554.10" "$4,487.50" "$3,590.00" "$2,019.38" $890.66 N/A "$2,602.75" "$4,487.50" "$4,487.50" "$4,487.50" $935.20 "$4,487.50" N/A N/A G38490 SUP HCPCS C1874 G38490 - STENT VASCULAR 7MM 120MM 125CM DRUG ELUTE OTW DELIVERY BOTH IP/OP "$4,987.50" "$3,691.00" $989.89 "$4,987.50" "$2,244.38" "$2,244.38" "$2,244.38" "$2,244.38" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.52" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.45" "$4,987.50" "$4,987.50" "$2,458.84" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$3,740.63" "$4,987.50" "$4,987.50" "$4,987.50" "$2,493.75" "$2,493.75" "$3,950.10" "$4,987.50" "$3,990.00" "$2,244.38" $989.89 N/A "$2,892.75" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.40" "$4,987.50" N/A N/A G38532 SUP HCPCS C1874 G38532 - STENT VASCULAR 8MM 120MM 125CM OTW DRUG ELUTE DELIVERY BOTH IP/OP "$4,987.50" "$3,691.00" $989.89 "$4,987.50" "$2,244.38" "$2,244.38" "$2,244.38" "$2,244.38" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.52" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.45" "$4,987.50" "$4,987.50" "$2,458.84" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$3,740.63" "$4,987.50" "$4,987.50" "$4,987.50" "$2,493.75" "$2,493.75" "$3,950.10" "$4,987.50" "$3,990.00" "$2,244.38" $989.89 N/A "$2,892.75" "$4,987.50" "$2,992.50" "$4,987.50" "$1,039.40" "$4,987.50" N/A N/A G38589 SUP Custom 27803010 G38589 - GRAFT EVAS 2 BRCH 20MM 7.7MM 20FR 109MM 45MM ZNTH FENESTRATE BOTH IP/OP "$9,270.00" "$6,860.00" "$1,650.06" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,650.06" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$1,931.97" "$9,270.00" "$3,708.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$9,270.00" "$6,952.50" "$9,270.00" "$9,270.00" "$9,270.00" "$4,635.00" "$4,635.00" "$7,341.84" "$9,270.00" "$7,416.00" "$4,171.50" "$9,270.00" N/A "$5,376.60" "$9,270.00" "$5,562.00" "$9,270.00" "$9,270.00" "$9,270.00" N/A N/A G42409 SUP Custom 27803010 G42409 - COIL EMBOLIZATION .035IN 4MM 3CM 2.4 LOOP MREYE PLATINUM BOTH IP/OP $250.50 $185.00 $44.55 $264.07 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $44.55 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $52.17 $250.30 $105.63 $250.30 $250.30 $264.07 $250.30 $250.30 $187.88 $250.30 $250.30 $250.30 $125.15 $125.15 $198.24 $250.30 $200.24 $112.64 $250.30 N/A $145.29 $250.30 $150.18 $250.30 $250.30 $250.30 N/A N/A G42410 SUP HCPCS C1770 G42410 - COIL EMBOLIZATION 5MM 3CM 1.9 LOOP STAINLESS STEEL SYNTH BOTH IP/OP $250.50 $185.00 $52.17 $264.07 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $52.17 $250.30 $105.63 $250.30 $250.30 $264.07 $250.30 $250.30 $187.88 $250.30 $250.30 $250.30 $125.15 $125.15 $198.24 $250.30 $200.24 $112.64 $250.30 N/A $145.29 $250.30 $150.18 $250.30 $250.30 $250.30 N/A N/A G42419 SUP HCPCS C1770 G42419 - COIL EMBOLIZATION .035IN 3MM 5CM 5.3 LOOP STAINLESS STEEL BOTH IP/OP $250.50 $185.00 $52.17 $264.07 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $52.17 $250.30 $105.63 $250.30 $250.30 $264.07 $250.30 $250.30 $187.88 $250.30 $250.30 $250.30 $125.15 $125.15 $198.24 $250.30 $200.24 $112.64 $250.30 N/A $145.29 $250.30 $150.18 $250.30 $250.30 $250.30 N/A N/A G42423 SUP HCPCS C1770 G42423 - COIL EMBOLIZATION .035IN 8MM 5CM 2 LOOP MREYE PLATINUM BOTH IP/OP $250.50 $185.00 $52.17 $264.07 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $52.17 $250.30 $105.63 $250.30 $250.30 $264.07 $250.30 $250.30 $187.88 $250.30 $250.30 $250.30 $125.15 $125.15 $198.24 $250.30 $200.24 $112.64 $250.30 N/A $145.29 $250.30 $150.18 $250.30 $250.30 $250.30 N/A N/A G43821 SUP HCPCS C1876 G43821 - STENT VASCULAR .035IN 6MM 6FR 40MM 125CM SELF EXPANDING BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,283.75" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,283.75" "$1,330.88" "$2,250.00" "$2,283.75" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A G43823 SUP HCPCS C1876 G43823 - STENT VASCULAR 6MM 6FR 80MM 125CM SELF EXPAND INTROD OTW BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,283.75" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,283.75" "$1,330.88" "$2,250.00" "$2,283.75" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A G43845 SUP HCPCS C1877 G43845 - STENT VASCULAR .035IN 6MM 6FR 30MM 80CM SELF EXPANDING BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A G43846 SUP HCPCS C1876 G43846 - STENT VASCULAR 6MM 40MM 80CM SELF EXPAND OTW INTROD RADIOPQ BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,283.75" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,283.75" "$1,330.88" "$2,250.00" "$2,283.75" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A G43850 SUP HCPCS C1876 G43850 - STENT VASCULAR .035IN 7MM 6FR 30MM 80CM SELF EXPANDING BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A G43851 SUP HCPCS C1876 G43851 - STENT VASCULAR 7MM 6FR 40MM 80CM SELF EXPAND FLEXIBLE SLOT BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,283.75" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,283.75" "$1,330.88" "$2,250.00" "$2,283.75" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A G43855 SUP HCPCS C1876 G43855 - STENT VASCULAR .035IN 8MM 6FR 30MM 80CM SELF EXPANDING BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,283.75" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,283.75" "$1,330.88" "$2,250.00" "$2,283.75" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A G43856 SUP HCPCS C1876 G43856 - STENT VASCULAR .035IN 8MM 6FR 40MM 80CM SELF EXPANDING BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,283.75" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,283.75" "$1,330.88" "$2,250.00" "$2,283.75" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A G43857 SUP HCPCS C1876 G43857 - STENT VASCULAR .035IN 8MM 6FR 60MM 80CM SELF EXPANDING BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,283.75" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,283.75" "$1,330.88" "$2,250.00" "$2,283.75" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A G43861 SUP HCPCS C1876 G43861 - STENT VASCULAR 9MM 6FR 40MM 80CM SELF EXPAND INTROD OTW BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,283.75" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,283.75" "$1,330.88" "$2,250.00" "$2,283.75" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A G43863 SUP HCPCS C1876 G43863 - STENT VASCULAR .035IN 9MM 6FR 80MM 80CM SELF EXPANDING BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A G43865 SUP HCPCS C1876 G43865 - STENT VASCULAR .035IN 10MM 6FR 30MM 80CM SELF EXPANDING BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,283.75" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,283.75" "$1,330.88" "$2,250.00" "$2,283.75" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A G43866 SUP HCPCS C1876 G43866 - STENT VASCULAR .035IN 10MM 6FR 40MM 80CM SELF EXPANDING BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,283.75" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,283.75" "$1,330.88" "$2,250.00" "$2,283.75" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A G43868 SUP HCPCS C1876 G43868 - STENT VASCULAR .035IN 10MM 6FR 80MM 80CM SELF EXPANDING BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A G43870 SUP HCPCS C1894 G43870 - SET INTROD .018IN 5FR 10CM 40CM MICROPUNCTURE SET BOTH IP/OP $69.00 $51.00 $13.69 $69.00 $37.47 $37.47 $37.47 $37.47 $69.00 $69.00 $69.00 $14.38 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $69.00 $40.81 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $13.69 N/A $40.02 $69.00 $69.00 $69.00 $14.38 $69.00 N/A N/A G44153 SUP HCPCS C1894 G44153 - SHEATH GUID .018-.038IN ANL0 CURVE 5FR .074IN 45CM INTROD BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $202.50 $110.91 $187.50 $202.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G44154 SUP HCPCS C1894 G44154 - SHEATH GUID .018-.038IN ANL0 CURVE 6FR .087IN 45CM INTROD BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $202.50 $110.91 $187.50 $202.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G44155 SUP HCPCS C1894 G44155 - SHEATH GUID .018/.038IN ANL0 CURVE 7FR .1IN 45CM INTROD BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $202.50 $110.91 $187.50 $202.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G44846 SUP HCPCS C1769 G44846 - GUIDEWIRE URO STRG .035IN 150CM 3CM MTN HBRD FLXB BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $48.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 N/A $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A G44848 SUP HCPCS C1769 G44848 - GUIDEWIRE URO .035IN 150CM 3CM MTN HBRD FLXB STRG TIP BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $48.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 N/A $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A G44849 SUP HCPCS C1769 G44849 - GUIDEWIRE URO .038IN 150CM 3CM MTN HBRD FLXB STRG TIP BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $48.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 N/A $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A G44855 SUP HCPCS C1769 G44855 - GUIDEWIRE URO .038IN 150CM 3CM MTN HBRD FLXB ANG TIP BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 N/A $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A G45208 SUP HCPCS C1769 G45208 - GUIDEWIRE VASCULAR CURVE .035IN 260CM 2 END FLEXIBLE TIP BOTH IP/OP "$1,432.50" "$1,060.00" $284.32 "$1,432.50" $777.85 $777.85 $777.85 $777.85 "$1,432.50" "$1,432.50" "$1,432.50" $298.57 "$1,432.50" "$1,063.20" "$1,063.20" "$1,104.17" $746.33 $298.55 "$1,432.50" "$1,432.50" $847.32 "$1,432.50" "$1,432.50" "$1,432.50" "$1,432.50" "$1,074.38" "$1,432.50" "$1,432.50" "$1,432.50" $716.25 $716.25 "$1,134.54" "$1,432.50" "$1,146.00" $931.13 $284.32 N/A $830.85 "$1,432.50" "$1,432.50" "$1,432.50" $298.53 "$1,432.50" N/A N/A G45352 SUP HCPCS C1769 G45352 - GUIDEWIRE VASC STRG .035IN 300CM 4CM LNDRQS XSTF FLX TP PTFE BOTH IP/OP "$1,169.50" $865.00 $232.03 "$1,169.05" $634.79 $634.79 $634.79 $634.79 "$1,169.05" "$1,169.05" "$1,169.05" $243.66 "$1,169.05" $867.67 $867.67 $901.10 $609.08 $243.64 "$1,169.05" "$1,169.05" $691.49 "$1,169.05" "$1,169.05" "$1,169.05" "$1,169.05" $877.13 "$1,169.05" "$1,169.05" "$1,169.05" $584.53 $584.53 $925.89 "$1,169.05" $935.24 $759.88 $232.03 N/A $678.31 "$1,169.05" "$1,169.05" "$1,169.05" $243.63 "$1,169.05" N/A N/A G46023 SUP HCPCS C1726 G46023 - GUIDEWIRE URO .035IN 150CM 3CM MTN HBRD FLXB ANG TIP BOTH IP/OP $104.00 $77.00 $20.62 $103.87 $56.40 $56.40 $56.40 $56.40 $103.87 $103.87 $103.87 $21.65 $103.87 $77.09 $77.09 $80.06 $54.12 $21.65 $103.87 $103.87 $61.44 $103.87 $103.87 $103.87 $103.87 $78.00 $103.87 $103.87 $103.87 $51.94 $51.94 $82.27 $103.87 $83.10 $67.52 $20.62 N/A $60.32 $103.87 $103.87 $103.87 $21.65 $103.87 N/A N/A G46024 SUP HCPCS C1726 G46024 - CATHETER NPHSTM 6MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR BOTH IP/OP $619.00 $458.00 $122.82 $618.80 $336.01 $336.01 $336.01 $336.01 $618.80 $618.80 $618.80 $128.97 $618.80 $459.27 $459.27 $476.97 $322.39 $128.96 $618.80 $618.80 $366.02 $618.80 $618.80 $618.80 $618.80 $464.25 $618.80 $618.80 $618.80 $309.40 $309.40 $490.09 $618.80 $495.04 $402.22 $122.82 N/A $359.02 $618.80 $618.80 $618.80 $128.96 $618.80 N/A N/A G46027 SUP Custom 27203010 G46027 - SET NPHSTM 8MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR RADOPQ BOTH IP/OP $515.50 $381.00 $91.73 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $91.73 $515.33 $515.33 $382.48 $382.48 $397.22 $268.49 $107.40 $515.33 $206.13 $515.33 $515.33 $515.33 $515.33 $515.33 $386.63 $515.33 $515.33 $515.33 $257.67 $257.67 $408.14 $515.33 $412.26 $334.96 $515.33 N/A $298.99 $515.33 $309.20 $515.33 $515.33 $515.33 N/A N/A G46028 SUP HCPCS C1894 G46028 - EXTRACTOR STON 1.7FR 1CM 115CM NCOMPASS 4/16 WRE BSKT MOD BOTH IP/OP $407.00 $301.00 $80.78 $407.00 $221.00 $221.00 $221.00 $221.00 $407.00 $407.00 $407.00 $84.83 $407.00 $302.08 $302.08 $313.72 $212.05 $84.82 $407.00 $407.00 $240.74 $407.00 $407.00 $407.00 $407.00 $305.25 $407.00 $407.00 $407.00 $203.50 $203.50 $322.34 $407.00 $325.60 $264.55 $80.78 N/A $236.06 $407.00 $407.00 $407.00 $84.82 $407.00 N/A N/A G46029 SUP HCPCS C1894 G46029 - SHEATH ACC 3FR 9.5FR 55CM FLXR 2 CNT WRK CHNL 2 LUM DILATION BOTH IP/OP $407.00 $301.00 $80.78 $407.00 $221.00 $221.00 $221.00 $221.00 $407.00 $407.00 $407.00 $84.83 $407.00 $302.08 $302.08 $313.72 $212.05 $84.82 $407.00 $407.00 $240.74 $407.00 $407.00 $407.00 $407.00 $305.25 $407.00 $407.00 $407.00 $203.50 $203.50 $322.34 $407.00 $325.60 $264.55 $80.78 N/A $236.06 $407.00 $407.00 $407.00 $84.82 $407.00 N/A N/A G46030 SUP HCPCS C2627 G46030 - SHEATH ACC 3FR 12FR 13CM FLXR 2 CNT WRK CHNL 2 LUM DILATION BOTH IP/OP $117.50 $87.00 $23.25 $117.15 $63.61 $63.61 $63.61 $63.61 $117.15 $117.15 $117.15 $24.42 $117.15 $86.95 $86.95 $90.30 $61.04 $24.42 $117.15 $117.15 $69.29 $117.15 $117.15 $117.15 $117.15 $88.13 $117.15 $117.15 $117.15 $58.58 $58.58 $92.78 $117.15 $93.72 $76.15 $23.25 N/A $68.15 $117.15 $117.15 $117.15 $24.41 $117.15 N/A N/A G46031 SUP HCPCS C2627 G46031 - SHEATH ACC 18FR 17CM CLR AMPTZ RADOPQ STRP RNL BOTH IP/OP $117.50 $87.00 $23.25 $117.15 $63.61 $63.61 $63.61 $63.61 $117.15 $117.15 $117.15 $24.42 $117.15 $86.95 $86.95 $90.30 $61.04 $24.42 $117.15 $117.15 $69.29 $117.15 $117.15 $117.15 $117.15 $88.13 $117.15 $117.15 $117.15 $58.58 $58.58 $92.78 $117.15 $93.72 $76.15 $23.25 N/A $68.15 $117.15 $117.15 $117.15 $24.41 $117.15 N/A N/A G46032 SUP HCPCS C2627 G46032 - SHEATH ACC 24FR 17CM CLR AMPTZ RADOPQ STRP RNL BOTH IP/OP $117.50 $87.00 $23.25 $117.15 $63.61 $63.61 $63.61 $63.61 $117.15 $117.15 $117.15 $24.42 $117.15 $86.95 $86.95 $90.30 $61.04 $24.42 $117.15 $117.15 $69.29 $117.15 $117.15 $117.15 $117.15 $88.13 $117.15 $117.15 $117.15 $58.58 $58.58 $92.78 $117.15 $93.72 $76.15 $23.25 N/A $68.15 $117.15 $117.15 $117.15 $24.41 $117.15 N/A N/A G46033 SUP HCPCS C1726 G46033 - SHEATH ACC 30FR 17CM CLR AMPTZ RADOPQ STRP RNL BOTH IP/OP $519.50 $384.00 $103.08 $519.35 $282.01 $282.01 $282.01 $282.01 $519.35 $519.35 $519.35 $108.25 $519.35 $385.46 $385.46 $400.31 $270.58 $108.24 $519.35 $519.35 $307.20 $519.35 $519.35 $519.35 $519.35 $389.63 $519.35 $519.35 $519.35 $259.68 $259.68 $411.33 $519.35 $415.48 $337.58 $103.08 N/A $301.31 $519.35 $519.35 $519.35 $108.23 $519.35 N/A N/A G46034 SUP HCPCS C1726 G46034 - CATHETER NPHSTM 6MM 15CM ULTRX INFL BLN SHRT TRNS TPR RADOPQ BOTH IP/OP $519.50 $384.00 $103.08 $519.35 $282.01 $282.01 $282.01 $282.01 $519.35 $519.35 $519.35 $108.25 $519.35 $385.46 $385.46 $400.31 $270.58 $108.24 $519.35 $519.35 $307.20 $519.35 $519.35 $519.35 $519.35 $389.63 $519.35 $519.35 $519.35 $259.68 $259.68 $411.33 $519.35 $415.48 $337.58 $103.08 N/A $301.31 $519.35 $519.35 $519.35 $108.23 $519.35 N/A N/A G46035 SUP HCPCS C1726 G46035 - CATHETER NPHSTM 8MM 15CM ULTRX INFL BLN SHRT TRNS TPR RADOPQ BOTH IP/OP $519.50 $384.00 $103.08 $519.35 $282.01 $282.01 $282.01 $282.01 $519.35 $519.35 $519.35 $108.25 $519.35 $385.46 $385.46 $400.31 $270.58 $108.24 $519.35 $519.35 $307.20 $519.35 $519.35 $519.35 $519.35 $389.63 $519.35 $519.35 $519.35 $259.68 $259.68 $411.33 $519.35 $415.48 $337.58 $103.08 N/A $301.31 $519.35 $519.35 $519.35 $108.23 $519.35 N/A N/A G46036 SUP HCPCS C1726 G46036 - CATHETER NPHSTM 8MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR BOTH IP/OP $619.00 $458.00 $122.82 $618.80 $336.01 $336.01 $336.01 $336.01 $618.80 $618.80 $618.80 $128.97 $618.80 $459.27 $459.27 $476.97 $322.39 $128.96 $618.80 $618.80 $366.02 $618.80 $618.80 $618.80 $618.80 $464.25 $618.80 $618.80 $618.80 $309.40 $309.40 $490.09 $618.80 $495.04 $402.22 $122.82 N/A $359.02 $618.80 $618.80 $618.80 $128.96 $618.80 N/A N/A G46037 SUP HCPCS C1726 G46037 - SET NPHSTM 6MM 15CM ULTRX INFL BLN SHRT TRNS TPR RADOPQ STRP BOTH IP/OP $619.00 $458.00 $122.82 $618.80 $336.01 $336.01 $336.01 $336.01 $618.80 $618.80 $618.80 $128.97 $618.80 $459.27 $459.27 $476.97 $322.39 $128.96 $618.80 $618.80 $366.02 $618.80 $618.80 $618.80 $618.80 $464.25 $618.80 $618.80 $618.80 $309.40 $309.40 $490.09 $618.80 $495.04 $402.22 $122.82 N/A $359.02 $618.80 $618.80 $618.80 $128.96 $618.80 N/A N/A G46038 SUP HCPCS C1726 G46038 - SET NPHSTM 6MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR RADOPQ BOTH IP/OP $619.00 $458.00 $122.82 $618.80 $336.01 $336.01 $336.01 $336.01 $618.80 $618.80 $618.80 $128.97 $618.80 $459.27 $459.27 $476.97 $322.39 $128.96 $618.80 $618.80 $366.02 $618.80 $618.80 $618.80 $618.80 $464.25 $618.80 $618.80 $618.80 $309.40 $309.40 $490.09 $618.80 $495.04 $402.22 $122.82 N/A $359.02 $618.80 $618.80 $618.80 $128.96 $618.80 N/A N/A G46041 SUP HCPCS C1726 G46041 - CATHETER NPHSTM 10MM 15CM ULTRX BOTH IP/OP $519.50 $384.00 $103.08 $519.35 $282.01 $282.01 $282.01 $282.01 $519.35 $519.35 $519.35 $108.25 $519.35 $385.46 $385.46 $400.31 $270.58 $108.24 $519.35 $519.35 $307.20 $519.35 $519.35 $519.35 $519.35 $389.63 $519.35 $519.35 $519.35 $259.68 $259.68 $411.33 $519.35 $415.48 $337.58 $103.08 N/A $301.31 $519.35 $519.35 $519.35 $108.23 $519.35 N/A N/A G46042 SUP HCPCS C1726 G46042 - CATHETER NPHSTM 6MM 15CM ULTRX BOTH IP/OP $519.50 $384.00 $103.08 $519.35 $282.01 $282.01 $282.01 $282.01 $519.35 $519.35 $519.35 $108.25 $519.35 $385.46 $385.46 $400.31 $270.58 $108.24 $519.35 $519.35 $307.20 $519.35 $519.35 $519.35 $519.35 $389.63 $519.35 $519.35 $519.35 $259.68 $259.68 $411.33 $519.35 $415.48 $337.58 $103.08 N/A $301.31 $519.35 $519.35 $519.35 $108.23 $519.35 N/A N/A G46043 SUP HCPCS C1726 G46043 - EXTRACTOR STON 2.2FR 11MM 115CM STRL NGAGE NTNL URETER BOTH IP/OP $519.50 $384.00 $103.08 $519.35 $282.01 $282.01 $282.01 $282.01 $519.35 $519.35 $519.35 $108.25 $519.35 $385.46 $385.46 $400.31 $270.58 $108.24 $519.35 $519.35 $307.20 $519.35 $519.35 $519.35 $519.35 $389.63 $519.35 $519.35 $519.35 $259.68 $259.68 $411.33 $519.35 $415.48 $337.58 $103.08 N/A $301.31 $519.35 $519.35 $519.35 $108.23 $519.35 N/A N/A G46044 SUP Custom 27203010 G46044 - SET NPHSTM 8MM 15CM CLR ULTRX INFL BLN SHRT TRNS TPR RADOPQ BOTH IP/OP $814.00 $602.00 $144.89 $814.00 $814.00 $814.00 $814.00 $814.00 $814.00 $814.00 $144.89 $814.00 $814.00 $604.15 $604.15 $627.43 $424.09 $169.65 $814.00 $325.60 $814.00 $814.00 $814.00 $814.00 $814.00 $610.50 $814.00 $814.00 $814.00 $407.00 $407.00 $644.69 $814.00 $651.20 $529.10 $814.00 N/A $472.12 $814.00 $488.40 $814.00 $814.00 $814.00 N/A N/A G46071 SUP Custom 27203010 G46071 - DEVICE BX BX KNDY REUSE BOTH IP/OP $814.00 $602.00 $144.89 $814.00 $814.00 $814.00 $814.00 $814.00 $814.00 $814.00 $144.89 $814.00 $814.00 $604.15 $604.15 $627.43 $424.09 $169.65 $814.00 $325.60 $814.00 $814.00 $814.00 $814.00 $814.00 $610.50 $814.00 $814.00 $814.00 $407.00 $407.00 $644.69 $814.00 $651.20 $529.10 $814.00 N/A $472.12 $814.00 $488.40 $814.00 $814.00 $814.00 N/A N/A G46072 SUP HCPCS C1894 G46072 - NEEDLE BX 18GA 25CM STRL HUB ECHGN TIP SMPL NTCH DISP BOTH IP/OP $20.50 $15.00 $4.04 $20.35 $11.05 $11.05 $11.05 $11.05 $20.35 $20.35 $20.35 $4.24 $20.35 $15.10 $15.10 $15.69 $10.60 $4.24 $20.35 $20.35 $12.04 $20.35 $20.35 $20.35 $20.35 $15.38 $20.35 $20.35 $20.35 $10.18 $10.18 $16.12 $20.35 $16.28 $13.23 $4.04 N/A $11.89 $20.35 $20.35 $20.35 $4.24 $20.35 N/A N/A G46073 SUP HCPCS C1894 G46073 - SHEATH ACC 3FR 9.5FR 13CM FLXR DL 2 CNT WRK CHNL 2 LUM BOTH IP/OP $407.00 $301.00 $80.78 $407.00 $221.00 $221.00 $221.00 $221.00 $407.00 $407.00 $407.00 $84.83 $407.00 $302.08 $302.08 $313.72 $212.05 $84.82 $407.00 $407.00 $240.74 $407.00 $407.00 $407.00 $407.00 $305.25 $407.00 $407.00 $407.00 $203.50 $203.50 $322.34 $407.00 $325.60 $264.55 $80.78 N/A $236.06 $407.00 $407.00 $407.00 $84.82 $407.00 N/A N/A G46074 SUP HCPCS C1894 G46074 - SHEATH ACC 3FR 9.5FR 20CM FLXR DL 2 CNT WRK CHNL 2 LUM BOTH IP/OP $407.00 $301.00 $80.78 $407.00 $221.00 $221.00 $221.00 $221.00 $407.00 $407.00 $407.00 $84.83 $407.00 $302.08 $302.08 $313.72 $212.05 $84.82 $407.00 $407.00 $240.74 $407.00 $407.00 $407.00 $407.00 $305.25 $407.00 $407.00 $407.00 $203.50 $203.50 $322.34 $407.00 $325.60 $264.55 $80.78 N/A $236.06 $407.00 $407.00 $407.00 $84.82 $407.00 N/A N/A G46075 SUP HCPCS C1894 G46075 - SHEATH ACC 3FR 9.5FR 28CM FLXR DL 2 CNT WRK CHNL 2 LUM BOTH IP/OP $407.00 $301.00 $80.78 $407.00 $221.00 $221.00 $221.00 $221.00 $407.00 $407.00 $407.00 $84.83 $407.00 $302.08 $302.08 $313.72 $212.05 $84.82 $407.00 $407.00 $240.74 $407.00 $407.00 $407.00 $407.00 $305.25 $407.00 $407.00 $407.00 $203.50 $203.50 $322.34 $407.00 $325.60 $264.55 $80.78 N/A $236.06 $407.00 $407.00 $407.00 $84.82 $407.00 N/A N/A G46076 SUP HCPCS C1894 G46076 - SHEATH ACC 3FR 9.5FR 35CM FLXR DL 2 CNT WRK CHNL 2 LUM BOTH IP/OP $407.00 $301.00 $80.78 $407.00 $221.00 $221.00 $221.00 $221.00 $407.00 $407.00 $407.00 $84.83 $407.00 $302.08 $302.08 $313.72 $212.05 $84.82 $407.00 $407.00 $240.74 $407.00 $407.00 $407.00 $407.00 $305.25 $407.00 $407.00 $407.00 $203.50 $203.50 $322.34 $407.00 $325.60 $264.55 $80.78 N/A $236.06 $407.00 $407.00 $407.00 $84.82 $407.00 N/A N/A G46077 SUP HCPCS C1894 G46077 - SHEATH ACC 3FR 9.5FR 45CM FLXR DL 2 CNT WRK CHNL 2 LUM BOTH IP/OP $407.00 $301.00 $80.78 $407.00 $221.00 $221.00 $221.00 $221.00 $407.00 $407.00 $407.00 $84.83 $407.00 $302.08 $302.08 $313.72 $212.05 $84.82 $407.00 $407.00 $240.74 $407.00 $407.00 $407.00 $407.00 $305.25 $407.00 $407.00 $407.00 $203.50 $203.50 $322.34 $407.00 $325.60 $264.55 $80.78 N/A $236.06 $407.00 $407.00 $407.00 $84.82 $407.00 N/A N/A G46078 SUP HCPCS C1894 G46078 - SHEATH ACC 3FR 12FR 20CM FLXR 2 CNT WRK CHNL 2 LUM DILATION BOTH IP/OP $407.00 $301.00 $80.78 $407.00 $221.00 $221.00 $221.00 $221.00 $407.00 $407.00 $407.00 $84.83 $407.00 $302.08 $302.08 $313.72 $212.05 $84.82 $407.00 $407.00 $240.74 $407.00 $407.00 $407.00 $407.00 $305.25 $407.00 $407.00 $407.00 $203.50 $203.50 $322.34 $407.00 $325.60 $264.55 $80.78 N/A $236.06 $407.00 $407.00 $407.00 $84.82 $407.00 N/A N/A G46079 SUP HCPCS C1894 G46079 - SHEATH ACC 3FR 12FR 28CM FLXR 2 CNT WRK CHNL 2 LUM DILATION BOTH IP/OP $407.00 $301.00 $80.78 $407.00 $221.00 $221.00 $221.00 $221.00 $407.00 $407.00 $407.00 $84.83 $407.00 $302.08 $302.08 $313.72 $212.05 $84.82 $407.00 $407.00 $240.74 $407.00 $407.00 $407.00 $407.00 $305.25 $407.00 $407.00 $407.00 $203.50 $203.50 $322.34 $407.00 $325.60 $264.55 $80.78 N/A $236.06 $407.00 $407.00 $407.00 $84.82 $407.00 N/A N/A G46080 SUP HCPCS C1894 G46080 - SHEATH ACC 3FR 12FR 35CM FLXR DL 2 CNT WRK CHNL 2 LUM BOTH IP/OP $407.00 $301.00 $80.78 $407.00 $221.00 $221.00 $221.00 $221.00 $407.00 $407.00 $407.00 $84.83 $407.00 $302.08 $302.08 $313.72 $212.05 $84.82 $407.00 $407.00 $240.74 $407.00 $407.00 $407.00 $407.00 $305.25 $407.00 $407.00 $407.00 $203.50 $203.50 $322.34 $407.00 $325.60 $264.55 $80.78 N/A $236.06 $407.00 $407.00 $407.00 $84.82 $407.00 N/A N/A G46081 SUP HCPCS C1894 G46081 - SHEATH ACC 3FR 12FR 45CM FLXR DL 2 CNT WRK CHNL 2 LUM BOTH IP/OP $407.00 $301.00 $80.78 $407.00 $221.00 $221.00 $221.00 $221.00 $407.00 $407.00 $407.00 $84.83 $407.00 $302.08 $302.08 $313.72 $212.05 $84.82 $407.00 $407.00 $240.74 $407.00 $407.00 $407.00 $407.00 $305.25 $407.00 $407.00 $407.00 $203.50 $203.50 $322.34 $407.00 $325.60 $264.55 $80.78 N/A $236.06 $407.00 $407.00 $407.00 $84.82 $407.00 N/A N/A G46137 SUP HCPCS C1769 G46137 - SHEATH ACC 3FR 12FR 55CM FLXR 2 CNT WRK CHNL 2 LUM DILATION BOTH IP/OP $669.50 $495.00 $132.86 $669.38 $363.47 $363.47 $363.47 $363.47 $669.38 $669.38 $669.38 $139.52 $669.38 $496.81 $496.81 $515.96 $348.75 $139.51 $669.38 $669.38 $395.94 $669.38 $669.38 $669.38 $669.38 $502.13 $669.38 $669.38 $669.38 $334.69 $334.69 $530.15 $669.38 $535.50 $435.10 $132.86 N/A $388.31 $669.38 $669.38 $669.38 $139.50 $669.38 N/A N/A G46138 SUP HCPCS C1769 G46138 - GUIDEWIRE ESCP ANG STRG TPR .038IN 150CM STRL 3CM BIWIRE 1-1 BOTH IP/OP $134.00 $99.00 $26.57 $133.88 $72.70 $72.70 $72.70 $72.70 $133.88 $133.88 $133.88 $27.90 $133.88 $99.37 $99.37 $103.19 $69.75 $27.90 $133.88 $53.55 $79.19 $133.88 $133.88 $133.88 $133.88 $100.50 $133.88 $133.88 $133.88 $66.94 $66.94 $106.03 $133.88 $107.10 $87.02 $26.57 N/A $77.72 $133.88 $133.88 $133.88 $27.90 $133.88 N/A N/A G46139 SUP HCPCS C1769 G46139 - GUIDEWIRE ESCP ANG .035IN 150CM STRL 3CM BIWIRE 1TO 1 TRQ BOTH IP/OP $134.00 $99.00 $26.57 $133.88 $72.70 $72.70 $72.70 $72.70 $133.88 $133.88 $133.88 $27.90 $133.88 $99.37 $99.37 $103.19 $69.75 $27.90 $133.88 $133.88 $79.19 $133.88 $133.88 $133.88 $133.88 $100.50 $133.88 $133.88 $133.88 $66.94 $66.94 $106.03 $133.88 $107.10 $87.02 $26.57 N/A $77.72 $133.88 $133.88 $133.88 $27.90 $133.88 N/A N/A G46140 SUP HCPCS C1769 G46140 - GUIDEWIRE VASC STRG ANG TPR .025IN 150CM 3CM BIWIRE 1TO 1 BOTH IP/OP $111.50 $83.00 $22.11 $111.38 $60.48 $60.48 $60.48 $60.48 $111.38 $111.38 $111.38 $23.21 $111.38 $82.67 $82.67 $85.85 $58.03 $23.21 $111.38 $111.38 $65.88 $111.38 $111.38 $111.38 $111.38 $83.63 $111.38 $111.38 $111.38 $55.69 $55.69 $88.21 $111.38 $89.10 $72.40 $22.11 N/A $64.67 $111.38 $111.38 $111.38 $23.21 $111.38 N/A N/A G46141 SUP HCPCS C1769 G46141 - GUIDEWIRE URO ANG STRG TPR .038IN 150CM STRL 3CM BIWIRE 1-1 BOTH IP/OP $111.50 $83.00 $22.11 $111.38 $60.48 $60.48 $60.48 $60.48 $111.38 $111.38 $111.38 $23.21 $111.38 $82.67 $82.67 $85.85 $58.03 $23.21 $111.38 $111.38 $65.88 $111.38 $111.38 $111.38 $111.38 $83.63 $111.38 $111.38 $111.38 $55.69 $55.69 $88.21 $111.38 $89.10 $72.40 $22.11 N/A $64.67 $111.38 $111.38 $111.38 $23.21 $111.38 N/A N/A G46142 SUP HCPCS C1769 G46142 - GUIDEWIRE VASC STD STRG .035IN 150CM 3CM BIWIRE 1TO 1 TRQ BOTH IP/OP $111.50 $83.00 $22.11 $111.38 $60.48 $60.48 $60.48 $60.48 $111.38 $111.38 $111.38 $23.21 $111.38 $82.67 $82.67 $85.85 $58.03 $23.21 $111.38 $111.38 $65.88 $111.38 $111.38 $111.38 $111.38 $83.63 $111.38 $111.38 $111.38 $55.69 $55.69 $88.21 $111.38 $89.10 $72.40 $22.11 N/A $64.67 $111.38 $111.38 $111.38 $23.21 $111.38 N/A N/A G46167 SUP HCPCS C1894 G46167 - SHEATH ACCES 9.5FR CONTIN WKG CHNL FLXB SCP BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G46168 SUP HCPCS C1894 G46168 - SHEATH ACCES 12FR CONTIN WOR CHNL TPR DILAT LOCK BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G46169 SUP HCPCS C1894 G46169 - GUIDEWIRE URO ANG STRG TPR .025IN 150CM 3CM BIWIRE STD BD BOTH IP/OP $308.00 $228.00 $61.13 $308.00 $167.24 $167.24 $167.24 $167.24 $308.00 $308.00 $308.00 $64.19 $308.00 $228.60 $228.60 $237.41 $160.47 $64.19 $308.00 $308.00 $182.18 $308.00 $308.00 $308.00 $308.00 $231.00 $308.00 $308.00 $308.00 $154.00 $154.00 $243.94 $308.00 $246.40 $200.20 $61.13 N/A $178.64 $308.00 $308.00 $308.00 $64.19 $308.00 N/A N/A G46199 SUP Custom 27203010 G46199 - RETRIEVER STNT 2.4FR 115CM NSNARE FLXB NTNL BOTH IP/OP $797.00 $590.00 $141.84 $796.88 $796.88 $796.88 $796.88 $796.88 $796.88 $796.88 $141.84 $796.88 $796.88 $591.44 $591.44 $614.24 $415.17 $166.08 $796.88 $318.75 $796.88 $796.88 $796.88 $796.88 $796.88 $597.75 $796.88 $796.88 $796.88 $398.44 $398.44 $631.13 $796.88 $637.50 $517.97 $796.88 N/A $462.26 $796.88 $478.13 $796.88 $796.88 $796.88 N/A N/A G46200 SUP Custom 27203010 G46200 - ELECTRODE ESURG .014IN 27FR CUT LOOP FIT 27FR STRZ 1 STM BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46202 SUP Custom 27203010 G46202 - KNIFE ESCP STRL COLLINGS DISP FIT 24/27FR 1 STM RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46203 SUP Custom 27203010 G46203 - ELECTRODE ESURG 3MM RLLR BRL FIT 24/26/28FR ACMI USA/ELT BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46204 SUP Custom 27203010 G46204 - ELECTRODE ESURG .014IN CUT LOOP GW FIT 24FR STRZ 2 STM RSSCP BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A G46205 SUP Custom 27203010 G46205 - ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR ACMI USA/ELT RSSCP BOTH IP/OP $308.50 $228.00 $54.85 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $54.85 $308.13 $308.13 $228.69 $228.69 $237.51 $160.54 $64.22 $308.13 $123.25 $308.13 $308.13 $308.13 $308.13 $308.13 $231.38 $308.13 $308.13 $308.13 $154.07 $154.07 $244.04 $308.13 $246.50 $200.28 $308.13 N/A $178.93 $308.13 $184.88 $308.13 $308.13 $308.13 N/A N/A G46206 SUP Custom 27203010 G46206 - EXTRACTOR STONE 1.5FR 1CM 115CM 4 WIRE TIPLESS BASKET BOTH IP/OP $515.50 $381.00 $91.73 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $91.73 $515.33 $515.33 $382.48 $382.48 $397.22 $268.49 $107.40 $515.33 $206.13 $515.33 $515.33 $515.33 $515.33 $515.33 $386.63 $515.33 $515.33 $515.33 $257.67 $257.67 $408.14 $515.33 $412.26 $334.96 $515.33 N/A $298.99 $515.33 $309.20 $515.33 $515.33 $515.33 N/A N/A G46209 SUP Custom 27203010 G46209 - KNIFE ESCP COLLINGS FIT 24/26/28 FR ACMI USA/ELT RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46210 SUP Custom 27203010 G46210 - ELECTRODE ESURG .012IN CUT LOOP GW FIT 24FR ACMI USA/ELT BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46211 SUP Custom 27203010 G46211 - ELECTRODE ESURG .015IN CUT LOOP GW FIT 24FR ACMI USA/ELT BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46212 SUP Custom 27203010 G46212 - ELECTRODE ESURG .012IN CUT LOOP GW FIT 26FR ACMI USA/ELT BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46213 SUP Custom 27203010 G46213 - ELECTRODE ESURG .015IN CUT LOOP GW FIT 26FR ACMI USA/ELT BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46214 SUP Custom 27203010 G46214 - ELECTRODE ESURG .012IN CUT LOOP GW FIT 28FR ACMI USA/ELT BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46215 SUP Custom 27203010 G46215 - ELECTRODE ESURG .015IN LOOP GW URO FIT 28FR ACMI USA/ELT BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A G46216 SUP Custom 27203010 G46216 - ELECTRODE ESURG PRFR RESCT COAG FIT 28 FR ACMI USA/ELT RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46217 SUP Custom 27203010 G46217 - ELECTRODE ESURG 3MM RLLR BALL FIT 24/26/28FR ACMI USA/ELT BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46218 SUP Custom 27203010 G46218 - ELECTRODE ESURG 5MM RLLR BALL FIT 24/26/28FR ACMI USA/ELT BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46219 SUP Custom 27203010 G46219 - ELECTRODE ESURG .012IN CUT LOOP GW FIT 24FR STRZ 1 STM RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46220 SUP Custom 27203010 G46220 - ELECTRODE MNPLR .014IN CUT LOOP GW FIT 24FR STRZ 1 STM RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46221 SUP Custom 27203010 G46221 - ELECTRODE ESURG .012IN LOOP GW URO FIT 27FR STRZ SGL STM BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A G46222 SUP Custom 27203010 G46222 - ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR STRZ 1 STM RSSCP BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A G46223 SUP Custom 27203010 G46223 - ELECTRODE ESURG PRFR RESCT COAG FIT 27 FR STRZ 1 STM RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46224 SUP Custom 27203010 G46224 - ELECTRODE MNPLR 3MM CK RLLR BALL DISP FIT 24/27FR STRZ 1 STM BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46225 SUP Custom 27203010 G46225 - ELECTRODE ESURG 5MM RLLR BALL FIT 24/27FR STRZ 1 STM RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46226 SUP Custom 27203010 G46226 - ELECTRODE ESURG 3MM RLLR BRL FIT 24/27FR STRZ 1 STM RSSCP BOTH IP/OP $308.50 $228.00 $54.85 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $54.85 $308.13 $308.13 $228.69 $228.69 $237.51 $160.54 $64.22 $308.13 $123.25 $308.13 $308.13 $308.13 $308.13 $308.13 $231.38 $308.13 $308.13 $308.13 $154.07 $154.07 $244.04 $308.13 $246.50 $200.28 $308.13 N/A $178.93 $308.13 $184.88 $308.13 $308.13 $308.13 N/A N/A G46228 SUP Custom 27203010 G46228 - KNIFE ESCP COLLINGS 24/26/28 FR RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46229 SUP Custom 27203010 G46229 - ELECTRODE ESURG 12D .012IN CUT LOOP GW FIT 24FR OL OES RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46230 SUP Custom 27203010 G46230 - ELECTRODE ESURG 30D 24FR .012IN CUT LOOP WRE OL OES RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46231 SUP Custom 27203010 G46231 - ELECTRODE ESURG 12D .012IN CUT LOOP GW FIT 26FR OL OES RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46232 SUP Custom 27203010 G46232 - ELECTRODE ESURG 30D .012IN 26FR LOOP CUT WRE FIT 26FR OL OES BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46233 SUP Custom 27203010 G46233 - ELECTRODE ESURG 12D .012IN CUT LOOP GW FIT 28FR OL OES RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46234 SUP Custom 27203010 G46234 - ELECTRODE ESURG 30D .012IN CUT LOOP GW FIT 28FR OL OES RSSCP BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A G46235 SUP Custom 27203010 G46235 - ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR OL OES RSSCP BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A G46236 SUP Custom 27203010 G46236 - ELECTRODE ESURG PRFR RESCT COAG FIT 26 FR OL OES RSSCP BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A G46237 SUP Custom 27203010 G46237 - ELECTRODE ESURG PRFR RESCT COAG FIT 28 FR OL OES RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46238 SUP Custom 27203010 G46238 - ELECTRODE ESURG 5MM RLLR BALL FIT 24/26/28FR OL OES RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46239 SUP Custom 27203010 G46239 - ELECTRODE ESURG 3MM RLLR BALL FIT 24/26/28FR OL OES RSSCP BOTH IP/OP $308.50 $228.00 $54.85 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $54.85 $308.13 $308.13 $228.69 $228.69 $237.51 $160.54 $64.22 $308.13 $123.25 $308.13 $308.13 $308.13 $308.13 $308.13 $231.38 $308.13 $308.13 $308.13 $154.07 $154.07 $244.04 $308.13 $246.50 $200.28 $308.13 N/A $178.93 $308.13 $184.88 $308.13 $308.13 $308.13 N/A N/A G46240 SUP Custom 27203010 G46240 - ELECTRODE ESURG 3MM DIMPLED TIP VPR RLLR BALL FIT 24/26/28FR BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46241 SUP Custom 27203010 G46241 - ELECTRODE ESURG .014IN CUT LOOP GW FIT 27FR STRZ 2 STM BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A G46242 SUP Custom 27203010 G46242 - ELECTRODE ESURG PRFR RESCT COAG FIT 24 FR STRZ 2 STM RSSCP BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A G46243 SUP Custom 27203010 G46243 - ELECTRODE ESURG PRFR RESCT COAG FIT 27 FR STRZ 2 STM RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46244 SUP Custom 27203010 G46244 - ELECTRODE ESURG 3MM RLLR BALL FIT 24/27FR STRZ 2 STM RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46245 SUP Custom 27203010 G46245 - ELECTRODE ESURG 5MM RLLR BALL FIT 24/27FR STRZ 2 STM RSSCP BOTH IP/OP $159.50 $118.00 $28.37 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $159.38 $28.37 $159.38 $159.38 $118.29 $118.29 $122.85 $83.04 $33.22 $159.38 $63.75 $159.38 $159.38 $159.38 $159.38 $159.38 $119.63 $159.38 $159.38 $159.38 $79.69 $79.69 $126.23 $159.38 $127.50 $103.60 $159.38 N/A $92.51 $159.38 $95.63 $159.38 $159.38 $159.38 N/A N/A G46246 SUP Custom 27203010 G46246 - ELECTRODE ESURG 3MM RLLR BALL FIT 24/27FR STRZ 2 STM RSSCP BOTH IP/OP $308.50 $228.00 $54.85 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $308.13 $54.85 $308.13 $308.13 $228.69 $228.69 $237.51 $160.54 $64.22 $308.13 $123.25 $308.13 $308.13 $308.13 $308.13 $308.13 $231.38 $308.13 $308.13 $308.13 $154.07 $154.07 $244.04 $308.13 $246.50 $200.28 $308.13 N/A $178.93 $308.13 $184.88 $308.13 $308.13 $308.13 N/A N/A G46247 SUP Custom 27203010 G46247 - ELECTRODE ESURG 3MM DIMPLED TIP VPR RLLR BALL FIT 24/27FR BOTH IP/OP $351.00 $260.00 $62.41 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $350.63 $62.41 $350.63 $350.63 $260.24 $260.24 $270.27 $182.68 $73.08 $350.63 $140.25 $350.63 $350.63 $350.63 $350.63 $350.63 $263.25 $350.63 $350.63 $350.63 $175.32 $175.32 $277.70 $350.63 $280.50 $227.91 $350.63 N/A $203.58 $350.63 $210.38 $350.63 $350.63 $350.63 N/A N/A G46612 SUP HCPCS C1763 G46612 - GRAFT SOFT TISSUE 13X8CM INSERTABLE 4 LAYER SURGISIS ES BOTH IP/OP "$2,487.50" "$1,841.00" $493.71 "$2,487.50" "$1,119.38" "$1,119.38" "$1,119.38" "$1,119.38" "$2,487.50" "$2,487.50" "$2,487.50" $518.46 "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" $518.42 "$2,487.50" "$2,487.50" "$1,471.36" "$2,487.50" "$2,487.50" "$2,487.50" "$2,487.50" "$1,865.63" "$2,487.50" "$2,487.50" "$2,487.50" "$1,243.75" "$1,243.75" "$1,970.10" "$2,487.50" "$1,990.00" "$1,119.38" $493.71 N/A "$1,442.75" "$2,487.50" "$2,487.50" "$2,487.50" $518.40 "$2,487.50" N/A N/A G47325 SUP HCPCS C1770 G47325 - COIL EMBL 10MM 14CM NST MCIOL PLTN .018IN CATH BOTH IP/OP $264.50 $196.00 $55.06 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $105.68 $264.20 $264.20 $264.20 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G47329 SUP HCPCS C1770 G47329 - COIL EMBL 6MM 14CM NST MCIOL PLTN .018IN CATH BOTH IP/OP $264.50 $196.00 $55.06 $278.73 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $111.49 $264.20 $264.20 $278.73 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G47330 SUP HCPCS C1770 G47330 - COIL EMBL 8MM 14CM NST MCIOL PLTN .018IN CATH BOTH IP/OP $264.50 $196.00 $55.06 $278.73 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $111.49 $264.20 $264.20 $278.73 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G47332 SUP Custom 27803010 G47332 - COIL EMBL 3MM 3CM NST MCIOL PRELD CRTDG PLTN SNTH FBR .018IN BOTH IP/OP $250.50 $185.00 $44.55 $264.07 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $44.55 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $52.17 $250.30 $105.63 $250.30 $250.30 $264.07 $250.30 $250.30 $187.88 $250.30 $250.30 $250.30 $125.15 $125.15 $198.24 $250.30 $200.24 $112.64 $250.30 N/A $145.29 $250.30 $150.18 $250.30 $250.30 $250.30 N/A N/A G47338 SUP HCPCS Q4107 G47338 - COIL EMBL 3MM 7CM NST MCIOL PLTN .018IN CATH BOTH IP/OP $264.50 $196.00 $55.06 $278.73 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $80.90 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $111.49 $264.20 $264.20 $278.73 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G47339 SUP Custom 27805113 G47339 - COIL EMBL 4MM 7CM NST MCIOL PLTN .018IN CATH BOTH IP/OP $264.50 $196.00 $47.03 $278.73 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $111.49 $264.20 $264.20 $278.73 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G47345 SUP HCPCS C1770 G47345 - COIL EMBL 10MM 14CM NST MCIOL PLTN .035IN CATH BOTH IP/OP $264.50 $196.00 $55.06 $278.73 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $111.49 $264.20 $264.20 $278.73 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G47354 SUP Custom 27803010 G47354 - COIL EMBL 6MM 14CM NST MCIOL PLTN .035IN CATH BOTH IP/OP $264.50 $196.00 $47.03 $278.73 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $111.49 $264.20 $264.20 $278.73 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G47355 SUP HCPCS C1770 G47355 - COIL EMBL 8MM 14CM NST MCIOL PLTN .035IN CATH BOTH IP/OP $264.50 $196.00 $55.06 $278.73 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $111.49 $264.20 $264.20 $278.73 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G47365 SUP Custom 27803010 G47365 - COIL EMBL 10MM 7CM NST MCIOL PLTN .035IN CATH BOTH IP/OP $264.50 $196.00 $47.03 $278.73 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $111.49 $264.20 $264.20 $278.73 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G47371 SUP Custom 27803010 G47371 - COIL EMBL 3MM 7IN NST PLTN ACPT .035IN CATH BOTH IP/OP $264.50 $196.00 $47.03 $278.73 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $111.49 $264.20 $264.20 $278.73 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G47372 SUP Custom 27803010 G47372 - COIL EMBL 4MM 7CM NST MCIOL PLTN .035IN CATH BOTH IP/OP $264.50 $196.00 $47.03 $278.73 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $111.49 $264.20 $264.20 $278.73 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G47419 SUP HCPCS C1770 G47419 - COIL EMBL 6-2MM TRND MCIOL PLTN .018IN CATH BOTH IP/OP $275.50 $204.00 $57.38 $290.47 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $57.38 $275.33 $116.19 $275.33 $275.33 $290.47 $275.33 $275.33 $206.63 $275.33 $275.33 $275.33 $137.67 $137.67 $218.06 $275.33 $220.26 $123.90 $275.33 N/A $159.79 $275.33 $165.20 $275.33 $275.33 $275.33 N/A N/A G47421 SUP HCPCS C1770 G47421 - COIL EMBL 8-4MM 9.5CM TRND MCL PRELD CRTDG PLTN SNTH FBR BOTH IP/OP $275.50 $204.00 $57.38 $290.47 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $57.38 $275.33 $116.19 $275.33 $275.33 $290.47 $275.33 $275.33 $206.63 $275.33 $275.33 $275.33 $137.67 $137.67 $218.06 $275.33 $220.26 $123.90 $275.33 N/A $159.79 $275.33 $165.20 $275.33 $275.33 $275.33 N/A N/A G47519 SUP HCPCS C1770 G47519 - COIL EMBL 4-3MM TRND PLTN .035IN CATH BOTH IP/OP $275.50 $204.00 $57.38 $290.47 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $57.38 $275.33 $116.19 $275.33 $275.33 $290.47 $275.33 $275.33 $206.63 $275.33 $275.33 $275.33 $137.67 $137.67 $218.06 $275.33 $220.26 $123.90 $275.33 N/A $159.79 $275.33 $165.20 $275.33 $275.33 $275.33 N/A N/A G47520 SUP HCPCS C1770 G47520 - COIL EMBL 5-3MM TRND PLTN .035IN CATH BOTH IP/OP $275.50 $204.00 $57.38 $290.47 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $57.38 $275.33 $116.19 $275.33 $275.33 $290.47 $275.33 $275.33 $206.63 $275.33 $275.33 $275.33 $137.67 $137.67 $218.06 $275.33 $220.26 $123.90 $275.33 N/A $159.79 $275.33 $165.20 $275.33 $275.33 $275.33 N/A N/A G47522 SUP HCPCS C1770 G47522 - COIL EMBL 7-3MM TRND PLTN .035IN CATH BOTH IP/OP $275.50 $204.00 $57.38 $290.47 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $275.33 $57.38 $275.33 $116.19 $275.33 $275.33 $290.47 $275.33 $275.33 $206.63 $275.33 $275.33 $275.33 $137.67 $137.67 $218.06 $275.33 $220.26 $123.90 $275.33 N/A $159.79 $275.33 $165.20 $275.33 $275.33 $275.33 N/A N/A G47654 SUP HCPCS C1763 G47654 - DILATOR URTH 26FR 37CM S-CRV SDPRT HDRPH BOTH IP/OP $985.50 $729.00 $195.50 $985.03 $443.26 $443.26 $443.26 $443.26 $985.03 $985.03 $985.03 $205.30 $985.03 $985.03 $985.03 $985.03 $985.03 $205.29 $985.03 $985.03 $582.65 $985.03 $985.03 $985.03 $985.03 $739.13 $985.03 $985.03 $985.03 $492.52 $492.52 $780.14 $985.03 $788.02 $443.26 $195.50 N/A $571.59 $985.03 $985.03 $985.03 $205.28 $985.03 N/A N/A G47655 SUP HCPCS C1763 G47655 - GRAFT SFT TIS STD SURGISIS BIODESIGN STRTH FLXB RST TO INFCT BOTH IP/OP "$1,457.50" "$1,079.00" $289.28 "$1,457.50" $655.88 $655.88 $655.88 $655.88 "$1,457.50" "$1,457.50" "$1,457.50" $303.78 "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" $303.76 "$1,457.50" "$1,457.50" $862.11 "$1,457.50" "$1,457.50" "$1,457.50" "$1,457.50" "$1,093.13" "$1,457.50" "$1,457.50" "$1,457.50" $728.75 $728.75 "$1,154.34" "$1,457.50" "$1,166.00" $655.88 $289.28 N/A $845.35 "$1,457.50" "$1,457.50" "$1,457.50" $303.74 "$1,457.50" N/A N/A G47700 SUP HCPCS C1892 G47700 - INTRODUCER SHEATH .035IN ANL1 CURVE 11.4FR 10FR 45CM HIGH BOTH IP/OP $200.00 $148.00 $39.70 $212.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $212.00 $118.30 $200.00 $212.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A G47701 SUP HCPCS C1892 G47701 - INTRODUCER SHEATH .035IN ANL1 CURVE 13.4FR 12FR 45CM HIGH BOTH IP/OP $200.00 $148.00 $39.70 $212.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $212.00 $118.30 $200.00 $212.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A G47732 SUP HCPCS C1769 G47732 - GUIDEWIRE VASCULAR .014IN 135CM SHAPEABLE TIP KINK BOTH IP/OP $167.50 $124.00 $33.15 $167.03 $90.70 $90.70 $90.70 $90.70 $167.03 $167.03 $167.03 $34.81 $167.03 $123.97 $123.97 $128.75 $87.02 $34.81 $167.03 $167.03 $98.80 $167.03 $167.03 $167.03 $167.03 $125.63 $167.03 $167.03 $167.03 $83.52 $83.52 $132.29 $167.03 $133.62 $108.57 $33.15 N/A $97.15 $167.03 $167.03 $167.03 $34.81 $167.03 N/A N/A G47733 SUP HCPCS C1769 G47733 - GUIDEWIRE VASC .014IN 190CM APRCH SHP TIP KINK RST MNVBL LNR BOTH IP/OP $204.00 $151.00 $40.49 $204.00 $110.77 $110.77 $110.77 $110.77 $204.00 $204.00 $204.00 $42.52 $204.00 $151.41 $151.41 $157.24 $106.28 $42.52 $204.00 $204.00 $120.67 $204.00 $204.00 $204.00 $204.00 $153.00 $204.00 $204.00 $204.00 $102.00 $102.00 $161.57 $204.00 $163.20 $132.60 $40.49 N/A $118.32 $204.00 $204.00 $204.00 $42.51 $204.00 N/A N/A G47734 SUP HCPCS C1769 G47734 - GUIDEWIRE VASC .014IN 300CM APRCH SHP TIP KINK RST MNVBL LNR BOTH IP/OP $204.00 $151.00 $40.49 $204.00 $110.77 $110.77 $110.77 $110.77 $204.00 $204.00 $204.00 $42.52 $204.00 $151.41 $151.41 $157.24 $106.28 $42.52 $204.00 $204.00 $120.67 $204.00 $204.00 $204.00 $204.00 $153.00 $204.00 $204.00 $204.00 $102.00 $102.00 $161.57 $204.00 $163.20 $132.60 $40.49 N/A $118.32 $204.00 $204.00 $204.00 $42.51 $204.00 N/A N/A G47804 SUP HCPCS C1729 G47804 - GRAFT SFT TIS LG SURGISIS BIODESIGN STRTH FLXB RST TO INFCT BOTH IP/OP $244.50 $181.00 $48.47 $244.20 $132.60 $132.60 $132.60 $132.60 $244.20 $244.20 $244.20 $50.90 $244.20 $181.25 $181.25 $188.23 $127.23 $50.89 $244.20 $244.20 $144.44 $244.20 $244.20 $244.20 $244.20 $183.38 $244.20 $244.20 $244.20 $122.10 $122.10 $193.41 $244.20 $195.36 $158.73 $48.47 N/A $141.81 $244.20 $244.20 $244.20 $50.89 $244.20 N/A N/A G47805 SUP HCPCS C1729 G47805 - SET CATH CRC NPHSTM SPBC BOTH IP/OP $244.50 $181.00 $48.47 $244.20 $132.60 $132.60 $132.60 $132.60 $244.20 $244.20 $244.20 $50.90 $244.20 $181.25 $181.25 $188.23 $127.23 $50.89 $244.20 $244.20 $144.44 $244.20 $244.20 $244.20 $244.20 $183.38 $244.20 $244.20 $244.20 $122.10 $122.10 $193.41 $244.20 $195.36 $158.73 $48.47 N/A $141.81 $244.20 $244.20 $244.20 $50.89 $244.20 N/A N/A G47806 SUP HCPCS C1729 G47806 - SET CATH CRC NPHSTM SPBC BOTH IP/OP $244.50 $181.00 $48.47 $244.20 $132.60 $132.60 $132.60 $132.60 $244.20 $244.20 $244.20 $50.90 $244.20 $181.25 $181.25 $188.23 $127.23 $50.89 $244.20 $244.20 $144.44 $244.20 $244.20 $244.20 $244.20 $183.38 $244.20 $244.20 $244.20 $122.10 $122.10 $193.41 $244.20 $195.36 $158.73 $48.47 N/A $141.81 $244.20 $244.20 $244.20 $50.89 $244.20 N/A N/A G47858 SUP Custom 27203010 G47858 - SET CATH CRC NPHSTM SPBC BOTH IP/OP "$1,034.00" $765.00 $184.05 "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" $184.05 "$1,034.00" "$1,034.00" $767.43 $767.43 $797.01 $538.71 $215.50 "$1,034.00" $413.60 "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" "$1,034.00" $775.50 "$1,034.00" "$1,034.00" "$1,034.00" $517.00 $517.00 $818.93 "$1,034.00" $827.20 $672.10 "$1,034.00" N/A $599.72 "$1,034.00" $620.40 "$1,034.00" "$1,034.00" "$1,034.00" N/A N/A G47859 SUP Custom 27203010 G47859 - NEEDLE BX 18GA 20CM PAT HUB ECHGN TIP SMPL NTCH PRCS PSTN BOTH IP/OP $52.00 $38.00 $9.20 $51.70 $51.70 $51.70 $51.70 $51.70 $51.70 $51.70 $9.20 $51.70 $51.70 $38.37 $38.37 $39.85 $26.94 $10.77 $51.70 $20.68 $51.70 $51.70 $51.70 $51.70 $51.70 $39.00 $51.70 $51.70 $51.70 $25.85 $25.85 $40.95 $51.70 $41.36 $33.61 $51.70 N/A $30.16 $51.70 $31.02 $51.70 $51.70 $51.70 N/A N/A G47868 SUP HCPCS C1770 G47868 - COIL EMBOLIZATION STARTER KIT VERSATILE MICROCOIL MREYE BOTH IP/OP "$8,750.00" "$6,475.00" "$1,823.60" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$1,823.60" "$8,750.00" "$3,500.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$8,750.00" "$6,562.50" "$8,750.00" "$8,750.00" "$8,750.00" "$4,375.00" "$4,375.00" "$6,930.00" "$8,750.00" "$7,000.00" "$3,937.50" "$8,750.00" N/A "$5,075.00" "$8,750.00" "$5,250.00" "$8,750.00" "$8,750.00" "$8,750.00" N/A N/A G47942 SUP HCPCS C1894 G47942 - SET INTROD .018IN 4FR 21GA 40CM 10CM SILHOUETTE BOTH IP/OP $105.00 $78.00 $20.84 $106.58 $57.02 $57.02 $57.02 $57.02 $105.00 $105.00 $105.00 $21.88 $105.00 $77.93 $77.93 $80.93 $54.71 $21.88 $105.00 $106.58 $62.11 $105.00 $106.58 $105.00 $105.00 $78.75 $105.00 $105.00 $105.00 $52.50 $52.50 $83.16 $105.00 $84.00 $68.25 $20.84 N/A $60.90 $105.00 $105.00 $105.00 $21.88 $105.00 N/A N/A G48003 SUP HCPCS C1894 G48003 - SET INTROD .018IN 4FR 40CM 10CM TRANSITIONLESS STIFFENED BOTH IP/OP $170.00 $126.00 $33.74 $172.55 $92.31 $92.31 $92.31 $92.31 $170.00 $170.00 $170.00 $35.43 $170.00 $126.17 $126.17 $131.04 $88.57 $35.43 $170.00 $172.55 $100.56 $170.00 $172.55 $170.00 $170.00 $127.50 $170.00 $170.00 $170.00 $85.00 $85.00 $134.64 $170.00 $136.00 $110.50 $33.74 N/A $98.60 $170.00 $170.00 $170.00 $35.43 $170.00 N/A N/A G48008 SUP HCPCS C1894 G48008 - SET INTROD .018IN 5FR 21GA 40CM 10CM COAXIAL CATHETER GWIRE BOTH IP/OP $172.50 $128.00 $34.24 $175.09 $93.67 $93.67 $93.67 $93.67 $172.50 $172.50 $172.50 $35.95 $172.50 $128.03 $128.03 $132.96 $89.87 $35.95 $172.50 $175.09 $102.03 $172.50 $175.09 $172.50 $172.50 $129.38 $172.50 $172.50 $172.50 $86.25 $86.25 $136.62 $172.50 $138.00 $112.13 $34.24 N/A $100.05 $172.50 $103.50 $172.50 $35.95 $172.50 N/A N/A G48031 SUP HCPCS C1876 G48031 - STENT ESOPHAGEAL 20MM 25MM 10CM 8MM PARTIALLY COVERED BOTH IP/OP "$4,705.00" "$3,482.00" $933.82 "$4,705.00" "$2,117.25" "$2,117.25" "$2,117.25" "$2,117.25" "$4,705.00" "$4,705.00" "$4,705.00" $980.64 "$4,705.00" "$4,705.00" "$4,705.00" "$4,705.00" "$4,705.00" $980.57 "$4,705.00" "$4,705.00" "$2,319.57" "$4,705.00" "$4,705.00" "$4,705.00" "$4,705.00" "$3,528.75" "$4,705.00" "$4,705.00" "$4,705.00" "$2,352.50" "$2,352.50" "$3,726.36" "$4,705.00" "$3,764.00" "$2,117.25" $933.82 N/A "$2,728.90" "$4,705.00" "$2,823.00" "$4,705.00" $980.52 "$4,705.00" N/A N/A G48186 SUP HCPCS C1894 G48186 - SHEATH GUID .018-.035IN ANL0 CURVE 4FR 1.5IN 45CM RADIOPQ BOTH IP/OP $195.00 $144.00 $38.70 $202.50 $105.89 $105.89 $105.89 $105.89 $195.00 $195.00 $195.00 $40.64 $195.00 $144.73 $144.73 $150.31 $101.60 $40.64 $195.00 $202.50 $115.34 $195.00 $202.50 $195.00 $195.00 $146.25 $195.00 $195.00 $195.00 $97.50 $97.50 $154.44 $195.00 $156.00 $126.75 $38.70 N/A $113.10 $195.00 $195.00 $195.00 $40.64 $195.00 N/A N/A G48188 SUP HCPCS C1894 G48188 - SHEATH GUID .018/.035IN ANL0 CURVE 4FR .059IN 90CM RADIOPQ BOTH IP/OP $377.50 $279.00 $74.92 $392.60 $204.98 $204.98 $204.98 $204.98 $377.50 $377.50 $377.50 $78.68 $377.50 $280.18 $280.18 $290.98 $196.68 $78.68 $377.50 $392.60 $223.29 $377.50 $392.60 $377.50 $377.50 $283.13 $377.50 $377.50 $377.50 $188.75 $188.75 $298.98 $377.50 $302.00 $245.38 $74.92 N/A $218.95 $377.50 $377.50 $377.50 $78.67 $377.50 N/A N/A G48189 SUP HCPCS C1894 G48189 - SHEATH GUID ANL0 CURVE STR 5FR .074IN 90CM CHK-FLO VALVE BOTH IP/OP $377.50 $279.00 $74.92 $392.60 $204.98 $204.98 $204.98 $204.98 $377.50 $377.50 $377.50 $78.68 $377.50 $280.18 $280.18 $290.98 $196.68 $78.68 $377.50 $392.60 $223.29 $377.50 $392.60 $377.50 $377.50 $283.13 $377.50 $377.50 $377.50 $188.75 $188.75 $298.98 $377.50 $302.00 $245.38 $74.92 N/A $218.95 $377.50 $377.50 $377.50 $78.67 $377.50 N/A N/A G48240 SUP Custom 27203010 G48240 - FORCEPS BIOP 2.4FR 115CM 1 BITE COLLECT BACKLOAD BIGOPSY BOTH IP/OP $880.00 $651.00 $156.64 $880.00 $880.00 $880.00 $880.00 $880.00 $880.00 $880.00 $156.64 $880.00 $880.00 $653.14 $653.14 $678.30 $458.48 $183.40 $880.00 $352.00 $880.00 $880.00 $880.00 $880.00 $880.00 $660.00 $880.00 $880.00 $880.00 $440.00 $440.00 $696.96 $880.00 $704.00 $572.00 $880.00 N/A $510.40 $880.00 $528.00 $880.00 $880.00 $880.00 N/A N/A G48294 SUP Custom 27203010 G48294 - EXTRACTOR STONE 1.7FR 8MM 115CM PATENTED NGAGE NITINOL BOTH IP/OP $515.50 $381.00 $91.73 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $91.73 $515.33 $515.33 $382.48 $382.48 $397.22 $268.49 $107.40 $515.33 $206.13 $515.33 $515.33 $515.33 $515.33 $515.33 $386.63 $515.33 $515.33 $515.33 $257.67 $257.67 $408.14 $515.33 $412.26 $334.96 $515.33 N/A $298.99 $515.33 $309.20 $515.33 $515.33 $515.33 N/A N/A G48295 SUP Custom 27203010 G48295 - NEEDLE BX 20GA 20CM PAT HUB ECHGN TIP SMPL NTCH PRCS PSTN BOTH IP/OP $26.00 $19.00 $4.59 $25.77 $25.77 $25.77 $25.77 $25.77 $25.77 $25.77 $4.59 $25.77 $25.77 $19.13 $19.13 $19.86 $13.43 $5.37 $25.77 $10.31 $25.77 $25.77 $25.77 $25.77 $25.77 $19.50 $25.77 $25.77 $25.77 $12.89 $12.89 $20.41 $25.77 $20.62 $16.75 $25.77 N/A $15.08 $25.77 $15.46 $25.77 $25.77 $25.77 N/A N/A G48296 SUP Custom 27203010 G48296 - SET NPHSTM 10MM 30FR 15CM CLR 17CM ULTRX RADOPQ STRP BLN BOTH IP/OP $515.50 $381.00 $91.73 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $91.73 $515.33 $515.33 $382.48 $382.48 $397.22 $268.49 $107.40 $515.33 $206.13 $515.33 $515.33 $515.33 $515.33 $515.33 $386.63 $515.33 $515.33 $515.33 $257.67 $257.67 $408.14 $515.33 $412.26 $334.96 $515.33 N/A $298.99 $515.33 $309.20 $515.33 $515.33 $515.33 N/A N/A G48297 SUP Custom 27203010 G48297 - EXTRACTOR STONE 2.2FR 8MM 115CM NGAGE NITINOL KIDNEY URETER BOTH IP/OP $515.50 $381.00 $91.73 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $515.33 $91.73 $515.33 $515.33 $382.48 $382.48 $397.22 $268.49 $107.40 $515.33 $206.13 $515.33 $515.33 $515.33 $515.33 $515.33 $386.63 $515.33 $515.33 $515.33 $257.67 $257.67 $408.14 $515.33 $412.26 $334.96 $515.33 N/A $298.99 $515.33 $309.20 $515.33 $515.33 $515.33 N/A N/A G48373 SUP HCPCS C1880 G48373 - FILTER EMBOLIZATION 30MM 8.5FR 48MM 65CM 3 WAY STOPCOCK BOTH IP/OP "$2,750.00" "$2,035.00" $573.13 "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" $573.13 "$2,750.00" "$1,100.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,750.00" "$2,062.50" "$2,750.00" "$2,750.00" "$2,750.00" "$1,375.00" "$1,375.00" "$2,178.00" "$2,750.00" "$2,200.00" "$1,237.50" "$2,750.00" N/A "$1,595.00" "$2,750.00" "$1,650.00" "$2,750.00" "$2,750.00" "$2,750.00" N/A N/A G48402 SUP HCPCS C1874 G48402 - GRAFT EVAS 2 BRCH 22MM 18FR 82MM STRL Z-TRK ZNTH FLX SLF BOTH IP/OP "$21,145.00" "$15,647.00" "$4,196.75" "$21,145.00" "$9,515.25" "$9,515.25" "$9,515.25" "$9,515.25" "$21,145.00" "$21,145.00" "$21,145.00" "$4,407.15" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$4,406.85" "$21,145.00" "$21,145.00" "$10,424.49" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$15,858.75" "$21,145.00" "$21,145.00" "$21,145.00" "$10,572.50" "$10,572.50" "$16,746.84" "$21,145.00" "$16,916.00" "$9,515.25" "$4,196.75" N/A "$12,264.10" "$21,145.00" "$21,145.00" "$21,145.00" "$4,406.62" "$21,145.00" N/A N/A G48422 SUP HCPCS C1874 G48422 - GRAFT EVAS BFUR 30MM 7.7MM 20FR 82MM ZNTH FLX Z-TRK SLF XPD BOTH IP/OP "$21,145.00" "$15,647.00" "$4,196.75" "$21,145.00" "$9,515.25" "$9,515.25" "$9,515.25" "$9,515.25" "$21,145.00" "$21,145.00" "$21,145.00" "$4,407.15" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$4,406.85" "$21,145.00" "$21,145.00" "$10,424.49" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$15,858.75" "$21,145.00" "$21,145.00" "$21,145.00" "$10,572.50" "$10,572.50" "$16,746.84" "$21,145.00" "$16,916.00" "$9,515.25" "$4,196.75" N/A "$12,264.10" "$21,145.00" "$21,145.00" "$21,145.00" "$4,406.62" "$21,145.00" N/A N/A G48424 SUP Custom 27803010 G48424 - GRAFT EVAS 2 BRCH 30MM 20FR 111MM ZNTH FLX Z-TRK SLF BOTH IP/OP "$21,145.00" "$15,647.00" "$3,763.81" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$3,763.81" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$4,406.85" "$21,145.00" "$8,458.00" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$15,858.75" "$21,145.00" "$21,145.00" "$21,145.00" "$10,572.50" "$10,572.50" "$16,746.84" "$21,145.00" "$16,916.00" "$9,515.25" "$21,145.00" N/A "$12,264.10" "$21,145.00" "$12,687.00" "$21,145.00" "$21,145.00" "$21,145.00" N/A N/A G48429 SUP HCPCS C1874 G48429 - GRAFT EVAS 2 BRCH 32MM 20FR 111MM ZNTH FLX Z-TRK SLF BOTH IP/OP "$21,145.00" "$15,647.00" "$4,196.75" "$21,145.00" "$9,515.25" "$9,515.25" "$9,515.25" "$9,515.25" "$21,145.00" "$21,145.00" "$21,145.00" "$4,407.15" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$4,406.85" "$21,145.00" "$21,145.00" "$10,424.49" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$15,858.75" "$21,145.00" "$21,145.00" "$21,145.00" "$10,572.50" "$10,572.50" "$16,746.84" "$21,145.00" "$16,916.00" "$9,515.25" "$4,196.75" N/A "$12,264.10" "$21,145.00" "$21,145.00" "$21,145.00" "$4,406.62" "$21,145.00" N/A N/A G48431 SUP HCPCS C1874 G48431 - GRAFT EVAS BFUR 32MM 20FR 140MM ZNTH FLX Z-TRK SLF XPD WVN BOTH IP/OP "$21,145.00" "$15,647.00" "$4,196.75" "$21,145.00" "$9,515.25" "$9,515.25" "$9,515.25" "$9,515.25" "$21,145.00" "$21,145.00" "$21,145.00" "$4,407.15" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$4,406.85" "$21,145.00" "$21,145.00" "$10,424.49" "$21,145.00" "$21,145.00" "$21,145.00" "$21,145.00" "$15,858.75" "$21,145.00" "$21,145.00" "$21,145.00" "$10,572.50" "$10,572.50" "$16,746.84" "$21,145.00" "$16,916.00" "$9,515.25" "$4,196.75" N/A "$12,264.10" "$21,145.00" "$21,145.00" "$21,145.00" "$4,406.62" "$21,145.00" N/A N/A G48522 SUP Custom 27203010 G48522 - EXTRACTOR STON 1.7FR 11MM 115CM NGAGE NTNL KNDY URETER BOTH IP/OP "$1,615.00" "$1,195.00" $287.47 "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" $287.47 "$1,615.00" "$1,615.00" "$1,198.65" "$1,198.65" "$1,244.84" $841.42 $336.58 "$1,615.00" $646.00 "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,615.00" "$1,211.25" "$1,615.00" "$1,615.00" "$1,615.00" $807.50 $807.50 "$1,279.08" "$1,615.00" "$1,292.00" "$1,049.75" "$1,615.00" N/A $936.70 "$1,615.00" $969.00 "$1,615.00" "$1,615.00" "$1,615.00" N/A N/A G48526 SUP Custom 27203010 G48526 - FIBER LSR 273UM GRN OPTILITE FLT TIP CNCT HO REUSE STD SMA BOTH IP/OP "$2,330.00" "$1,724.00" $414.70 "$2,329.80" "$2,329.80" "$2,329.80" "$2,329.80" "$2,329.80" "$2,329.80" "$2,329.80" $414.70 "$2,329.80" "$2,329.80" "$1,729.18" "$1,729.18" "$1,795.81" "$1,213.83" $485.56 "$2,329.80" $931.92 "$2,329.80" "$2,329.80" "$2,329.80" "$2,329.80" "$2,329.80" "$1,747.50" "$2,329.80" "$2,329.80" "$2,329.80" "$1,164.90" "$1,164.90" "$1,845.20" "$2,329.80" "$1,863.84" "$1,514.37" "$2,329.80" N/A "$1,351.40" "$2,329.80" "$1,397.88" "$2,329.80" "$2,329.80" "$2,329.80" N/A N/A G48611 SUP Custom 27203010 G48611 - FIBER LSR 273UM FLT BLK OPTILITE CNCT HO DISP STD SMA CNCT BOTH IP/OP $538.50 $398.00 $95.82 $538.33 $538.33 $538.33 $538.33 $538.33 $538.33 $538.33 $95.82 $538.33 $538.33 $399.55 $399.55 $414.94 $280.47 $112.19 $538.33 $215.33 $538.33 $538.33 $538.33 $538.33 $538.33 $403.88 $538.33 $538.33 $538.33 $269.17 $269.17 $426.36 $538.33 $430.66 $349.91 $538.33 N/A $312.33 $538.33 $323.00 $538.33 $538.33 $538.33 N/A N/A G48612 SUP Custom 27203010 G48612 - FIBER LSR 273UM GRN OPTILITE FLT TIP CNCT HO REUSE CNVGNT BOTH IP/OP "$4,735.50" "$3,504.00" $842.92 "$4,735.50" "$4,735.50" "$4,735.50" "$4,735.50" "$4,735.50" "$4,735.50" "$4,735.50" $842.92 "$4,735.50" "$4,735.50" "$3,514.69" "$3,514.69" "$3,650.12" "$2,060.15" $986.93 "$4,735.50" "$1,894.20" "$4,735.50" "$4,735.50" "$4,735.50" "$4,735.50" "$4,735.50" "$3,551.63" "$4,735.50" "$4,735.50" "$4,735.50" "$2,367.75" "$2,367.75" "$3,750.52" "$4,735.50" "$3,788.40" "$3,078.08" "$4,735.50" N/A "$2,746.59" "$4,735.50" "$2,841.30" "$4,735.50" "$4,735.50" "$4,735.50" N/A N/A G48613 SUP Custom 27203010 G48613 - FIBER LSR 940UM BLK OPTILITE FLT TIP CNCT HO DISP STD SMA BOTH IP/OP $336.50 $249.00 $59.89 $336.46 $336.46 $336.46 $336.46 $336.46 $336.46 $336.46 $59.89 $336.46 $336.46 $249.72 $249.72 $259.34 $175.30 $70.12 $336.46 $134.58 $336.46 $336.46 $336.46 $336.46 $336.46 $252.38 $336.46 $336.46 $336.46 $168.23 $168.23 $266.48 $336.46 $269.17 $218.70 $336.46 N/A $195.17 $336.46 $201.88 $336.46 $336.46 $336.46 N/A N/A G48614 SUP Custom 27203010 G48614 - FIBER LSR 365UM BLU OPTILITE FLT TIP CNCT HO REUSE CNVGNT BOTH IP/OP "$2,367.50" "$1,752.00" $421.38 "$2,367.30" "$2,367.30" "$2,367.30" "$2,367.30" "$2,367.30" "$2,367.30" "$2,367.30" $421.38 "$2,367.30" "$2,367.30" "$1,757.01" "$1,757.01" "$1,824.71" "$1,233.36" $493.37 "$2,367.30" $946.92 "$2,367.30" "$2,367.30" "$2,367.30" "$2,367.30" "$2,367.30" "$1,775.63" "$2,367.30" "$2,367.30" "$2,367.30" "$1,183.65" "$1,183.65" "$1,874.90" "$2,367.30" "$1,893.84" "$1,538.75" "$2,367.30" N/A "$1,373.15" "$2,367.30" "$1,420.38" "$2,367.30" "$2,367.30" "$2,367.30" N/A N/A G48615 SUP Custom 27203010 G48615 - FIBER LSR 273UM RD OPTILITE FLT TIP CNCT HO DISP CNVGNT LSR BOTH IP/OP $390.00 $289.00 $69.35 $389.58 $389.58 $389.58 $389.58 $389.58 $389.58 $389.58 $69.35 $389.58 $389.58 $289.15 $289.15 $300.29 $202.97 $81.19 $389.58 $155.83 $389.58 $389.58 $389.58 $389.58 $389.58 $292.50 $389.58 $389.58 $389.58 $194.79 $194.79 $308.55 $389.58 $311.66 $253.23 $389.58 N/A $226.20 $389.58 $233.75 $389.58 $389.58 $389.58 N/A N/A G48616 SUP Custom 27203010 G48616 - FIBER LSR 550UM VIOL OPTILITE FLT TIP CNCT HO REUSE CNVGNT BOTH IP/OP "$2,152.50" "$1,593.00" $383.15 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" $383.15 "$2,152.50" "$2,152.50" "$1,597.59" "$1,597.59" "$1,659.15" "$1,121.45" $448.60 "$2,152.50" $861.00 "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$2,152.50" "$1,614.38" "$2,152.50" "$2,152.50" "$2,152.50" "$1,076.25" "$1,076.25" "$1,704.78" "$2,152.50" "$1,722.00" "$1,399.13" "$2,152.50" N/A "$1,248.45" "$2,152.50" "$1,291.50" "$2,152.50" "$2,152.50" "$2,152.50" N/A N/A G48617 SUP Custom 27203010 G48617 - FIBER LSR 365UM FLT RD OPTILITE CNCT HO DISP CNVGNT LSR SYS BOTH IP/OP $744.00 $551.00 $132.39 $743.75 $743.75 $743.75 $743.75 $743.75 $743.75 $743.75 $132.39 $743.75 $743.75 $552.01 $552.01 $573.28 $387.49 $155.01 $743.75 $297.50 $743.75 $743.75 $743.75 $743.75 $743.75 $558.00 $743.75 $743.75 $743.75 $371.88 $371.88 $589.05 $743.75 $595.00 $483.44 $743.75 N/A $431.52 $743.75 $446.25 $743.75 $743.75 $743.75 N/A N/A G48618 SUP Custom 27203010 G48618 - FIBER LSR 940UM ORNG OPTILITE FLT TIP CNCT HO REUSE CNVGNT BOTH IP/OP "$1,009.50" $747.00 $179.67 "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" $179.67 "$1,009.38" "$1,009.38" $749.16 $749.16 $778.03 $525.89 $210.37 "$1,009.38" $403.75 "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" "$1,009.38" $757.13 "$1,009.38" "$1,009.38" "$1,009.38" $504.69 $504.69 $799.43 "$1,009.38" $807.50 $656.10 "$1,009.38" N/A $585.51 "$1,009.38" $605.63 "$1,009.38" "$1,009.38" "$1,009.38" N/A N/A G48619 SUP Custom 27203010 G48619 - FIBER LSR 365UM FLT BLU OPTILITE FLXB CNCT HO REUSE STD SMA BOTH IP/OP "$1,169.00" $865.00 $208.04 "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" $208.04 "$1,168.75" "$1,168.75" $867.45 $867.45 $900.87 $608.92 $243.58 "$1,168.75" $467.50 "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" "$1,168.75" $876.75 "$1,168.75" "$1,168.75" "$1,168.75" $584.38 $584.38 $925.65 "$1,168.75" $935.00 $759.69 "$1,168.75" N/A $678.02 "$1,168.75" $701.25 "$1,168.75" "$1,168.75" "$1,168.75" N/A N/A G48620 SUP Custom 27203010 G48620 - FIBER LSR 550UM RD OPTILITE FLT TIP CNCT HO REUSE STD SMA BOTH IP/OP "$2,860.00" "$2,116.00" $509.04 "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" $509.04 "$2,859.75" "$2,859.75" "$2,122.51" "$2,122.51" "$2,204.30" "$1,489.93" $596.00 "$2,859.75" "$1,143.90" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$2,859.75" "$2,145.00" "$2,859.75" "$2,859.75" "$2,859.75" "$1,429.88" "$1,429.88" "$2,264.92" "$2,859.75" "$2,287.80" "$1,858.84" "$2,859.75" N/A "$1,658.80" "$2,859.75" "$1,715.85" "$2,859.75" "$2,859.75" "$2,859.75" N/A N/A G48621 SUP Custom 27203010 G48621 - FIBER LSR 550UM FLT RD OPTILITE CNCT HO DISP CNVGNT LSR SYS BOTH IP/OP $744.00 $551.00 $132.39 $743.75 $743.75 $743.75 $743.75 $743.75 $743.75 $743.75 $132.39 $743.75 $743.75 $552.01 $552.01 $573.28 $387.49 $155.01 $743.75 $297.50 $743.75 $743.75 $743.75 $743.75 $743.75 $558.00 $743.75 $743.75 $743.75 $371.88 $371.88 $589.05 $743.75 $595.00 $483.44 $743.75 N/A $431.52 $743.75 $446.25 $743.75 $743.75 $743.75 N/A N/A G48622 SUP Custom 27203010 G48622 - FIBER LSR 940UM ORNG OPTILITE FLT TIP CNCT HO REUSE STD SMA BOTH IP/OP "$4,735.50" "$3,504.00" $842.92 "$4,735.50" "$4,735.50" "$4,735.50" "$4,735.50" "$4,735.50" "$4,735.50" "$4,735.50" $842.92 "$4,735.50" "$4,735.50" "$3,514.69" "$3,514.69" "$3,650.12" "$2,060.15" $986.93 "$4,735.50" "$1,894.20" "$4,735.50" "$4,735.50" "$4,735.50" "$4,735.50" "$4,735.50" "$3,551.63" "$4,735.50" "$4,735.50" "$4,735.50" "$2,367.75" "$2,367.75" "$3,750.52" "$4,735.50" "$3,788.40" "$3,078.08" "$4,735.50" N/A "$2,746.59" "$4,735.50" "$2,841.30" "$4,735.50" "$4,735.50" "$4,735.50" N/A N/A G48623 SUP Custom 27203010 G48623 - FIBER LSR 940UM FLT 940UM RD OPTILITE RD CNCT HO DISP CNVGNT BOTH IP/OP $892.00 $660.00 $158.73 $891.75 $891.75 $891.75 $891.75 $891.75 $891.75 $891.75 $158.73 $891.75 $891.75 $661.86 $661.86 $687.36 $464.60 $185.85 $891.75 $356.70 $891.75 $891.75 $891.75 $891.75 $891.75 $669.00 $891.75 $891.75 $891.75 $445.88 $445.88 $706.27 $891.75 $713.40 $579.64 $891.75 N/A $517.36 $891.75 $535.05 $891.75 $891.75 $891.75 N/A N/A G48624 SUP Custom 27203010 G48624 - FIBER LSR 273UM BLK OPTILITE FLT TIP CNCT HO DISP TRMDN LSR BOTH IP/OP $974.00 $721.00 $173.33 $973.75 $973.75 $973.75 $973.75 $973.75 $973.75 $973.75 $173.33 $973.75 $973.75 $722.72 $722.72 $750.57 $507.32 $202.94 $973.75 $389.50 $973.75 $973.75 $973.75 $973.75 $973.75 $730.50 $973.75 $973.75 $973.75 $486.88 $486.88 $771.21 $973.75 $779.00 $632.94 $973.75 N/A $564.92 $973.75 $584.25 $973.75 $973.75 $973.75 N/A N/A G48625 SUP Custom 27203010 G48625 - FIBER LSR 150UM BLK OPTILITE FLT TIP CNCT HO DISP STD SMA BOTH IP/OP $892.00 $660.00 $158.73 $891.75 $891.75 $891.75 $891.75 $891.75 $891.75 $891.75 $158.73 $891.75 $891.75 $661.86 $661.86 $687.36 $464.60 $185.85 $891.75 $356.70 $891.75 $891.75 $891.75 $891.75 $891.75 $669.00 $891.75 $891.75 $891.75 $445.88 $445.88 $706.27 $891.75 $713.40 $579.64 $891.75 N/A $517.36 $891.75 $535.05 $891.75 $891.75 $891.75 N/A N/A G48626 SUP Custom 27203010 G48626 - FIBER LSR 200UM BLK OPTILITE FLT TIP CNCT HO DISP STD SMA BOTH IP/OP $717.50 $531.00 $127.72 $717.50 $717.50 $717.50 $717.50 $717.50 $717.50 $717.50 $127.72 $717.50 $717.50 $532.53 $532.53 $553.05 $373.82 $149.53 $717.50 $287.00 $717.50 $717.50 $717.50 $717.50 $717.50 $538.13 $717.50 $717.50 $717.50 $358.75 $358.75 $568.26 $717.50 $574.00 $466.38 $717.50 N/A $416.15 $717.50 $430.50 $717.50 $717.50 $717.50 N/A N/A G48627 SUP Custom 27203010 G48627 - FIBER LSR FLT 365UM BLK OPTILITE CNCT EXTREMELY FLXB HO DISP BOTH IP/OP $953.50 $706.00 $169.68 $953.25 $953.25 $953.25 $953.25 $953.25 $953.25 $953.25 $169.68 $953.25 $953.25 $707.50 $707.50 $734.77 $496.64 $198.67 $953.25 $381.30 $953.25 $953.25 $953.25 $953.25 $953.25 $715.13 $953.25 $953.25 $953.25 $476.63 $476.63 $754.97 $953.25 $762.60 $619.61 $953.25 N/A $553.03 $953.25 $571.95 $953.25 $953.25 $953.25 N/A N/A G49044 SUP HCPCS C1894 G49044 - INTRODUCER SHEATH .035IN ANL1 CURVE 8.8FR 7FR 110CM GUIDE BOTH IP/OP $502.50 $372.00 $99.73 $502.50 $272.86 $272.86 $272.86 $272.86 $502.50 $502.50 $502.50 $104.73 $502.50 $372.96 $372.96 $387.33 $261.80 $104.73 $502.50 $502.50 $297.23 $502.50 $502.50 $502.50 $502.50 $376.88 $502.50 $502.50 $502.50 $251.25 $251.25 $397.98 $502.50 $402.00 $326.63 $99.73 N/A $291.45 $502.50 $502.50 $502.50 $104.72 $502.50 N/A N/A G49099 SUP HCPCS C1894 G49099 - SHEATH GUID .018/.038IN ANL0 CURVE 8FR .113IN 45CM RADIOPQ BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $202.50 $110.91 $187.50 $202.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49100 SUP HCPCS C1894 G49100 - INTRODUCER CATHETER .018/.038IN ANL1 CURVE 8FR .113IN 45CM BOTH IP/OP $187.50 $139.00 $37.21 $202.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $202.50 $110.91 $187.50 $202.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49257 SUP Custom 27203010 G49257 - NEEDLE ESCP 20GA 6FR 8- CM STRL ECHTP ULT US CONE TIP SH CLC BOTH IP/OP $697.50 $516.00 $124.16 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $697.50 $124.16 $697.50 $697.50 $517.68 $517.68 $537.63 $363.40 $145.37 $697.50 $279.00 $697.50 $697.50 $697.50 $697.50 $697.50 $523.13 $697.50 $697.50 $697.50 $348.75 $348.75 $552.42 $697.50 $558.00 $453.38 $697.50 N/A $404.55 $697.50 $418.50 $697.50 $697.50 $697.50 N/A N/A G49333 SUP HCPCS C1877 G49333 - STENT VASCULAR .018IN 10MM 5FR 80MM 125CM SELF EXPANDING BOTH IP/OP "$3,062.50" "$2,266.00" $607.83 "$3,062.50" "$1,378.13" "$1,378.13" "$1,378.13" "$1,378.13" "$3,062.50" "$3,062.50" "$3,062.50" $638.30 "$3,062.50" "$3,062.50" "$3,062.50" "$3,062.50" "$3,062.50" $638.26 "$3,062.50" "$3,062.50" "$1,509.81" "$3,062.50" "$3,062.50" "$3,062.50" "$3,062.50" "$2,296.88" "$3,062.50" "$3,062.50" "$3,062.50" "$1,531.25" "$1,531.25" "$2,425.50" "$3,062.50" "$2,450.00" "$1,378.13" $607.83 N/A "$1,776.25" "$3,062.50" "$3,062.50" "$3,062.50" $638.23 "$3,062.50" N/A N/A G49472 SUP HCPCS C1892 G49472 - SET INTROD .018IN LONG 5FR 70CM 30CM COAXIAL CATHETER PEEL BOTH IP/OP $147.50 $109.00 $29.28 $151.93 $80.09 $80.09 $80.09 $80.09 $147.50 $147.50 $147.50 $30.74 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $151.93 $87.25 $147.50 $151.93 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $29.28 N/A $85.55 $147.50 $147.50 $147.50 $30.74 $147.50 N/A N/A G49473 SUP HCPCS C1894 G49473 - SET INTROD .018IN LONG 5FR 21GA 100CM 45CM NEEDLE WIRE GUIDE BOTH IP/OP $147.50 $109.00 $29.28 $151.93 $80.09 $80.09 $80.09 $80.09 $147.50 $147.50 $147.50 $30.74 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $151.93 $87.25 $147.50 $151.93 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $29.28 N/A $85.55 $147.50 $147.50 $147.50 $30.74 $147.50 N/A N/A G49620 SUP Custom 27203010 G49620 - FIBER LSR 550UM FLT BLK OPTILITE CNCT HO DISP STD SMA CNCT BOTH IP/OP $154.50 $114.00 $27.42 $154.07 $154.07 $154.07 $154.07 $154.07 $154.07 $154.07 $27.42 $154.07 $154.07 $114.35 $114.35 $118.76 $80.27 $32.11 $154.07 $61.63 $154.07 $154.07 $154.07 $154.07 $154.07 $115.88 $154.07 $154.07 $154.07 $77.04 $77.04 $122.02 $154.07 $123.26 $100.15 $154.07 N/A $89.61 $154.07 $92.44 $154.07 $154.07 $154.07 N/A N/A G49762 SUP HCPCS C2617 G49762 - MICROSCOPE SRG NS INSP FO SAFE EFCT CMPLT BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49862 SUP HCPCS C2617 G49862 - SET STNT .038IN 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49863 SUP HCPCS C2617 G49863 - SET STNT .038IN 2 PGTL CRV 5FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49864 SUP HCPCS C2617 G49864 - SET STNT .038IN 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49865 SUP HCPCS C2617 G49865 - SET STNT .038IN 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49866 SUP HCPCS C2617 G49866 - SET STNT .038IN 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49867 SUP HCPCS C2617 G49867 - SET STNT .038IN 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49868 SUP HCPCS C2617 G49868 - SET STNT .038IN 2 PGTL CRV 5FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49869 SUP HCPCS C2617 G49869 - SET STNT .038IN 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49870 SUP HCPCS C2617 G49870 - SET STNT .038IN 2 PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49871 SUP HCPCS C2617 G49871 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49872 SUP HCPCS C2617 G49872 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49873 SUP HCPCS C2617 G49873 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49874 SUP HCPCS C2617 G49874 - SET STENT .038IN 3CM 2 PIGTAIL CURVE 6FR 26CM 145CM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49875 SUP HCPCS C2617 G49875 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49876 SUP HCPCS C2617 G49876 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49877 SUP HCPCS C2617 G49877 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49878 SUP HCPCS C2617 G49878 - SET STNT 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49879 SUP HCPCS C2617 G49879 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49880 SUP HCPCS C2617 G49880 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49881 SUP HCPCS C2617 G49881 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49882 SUP HCPCS C2617 G49882 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49883 SUP HCPCS C2617 G49883 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49884 SUP HCPCS C2617 G49884 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49885 SUP HCPCS C2617 G49885 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49886 SUP HCPCS C2617 G49886 - SET STNT 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49887 SUP HCPCS C2617 G49887 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49888 SUP HCPCS C2617 G49888 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49889 SUP HCPCS C2617 G49889 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49890 SUP HCPCS C2617 G49890 - SET STNT 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA FIRM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49891 SUP HCPCS C2617 G49891 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49892 SUP HCPCS C2617 G49892 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49893 SUP HCPCS C2617 G49893 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49894 SUP HCPCS C2617 G49894 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49895 SUP HCPCS C2625 G49895 - SET STENT 2 PIGTAIL CURVE 5FR 20CM RADIOPQ GRADUATE MARK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49896 SUP HCPCS C2625 G49896 - SET STENT 2 PIGTAIL CURVE 5FR 22CM RADIOPQ GRADUATE MARK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49897 SUP HCPCS C2625 G49897 - SET STENT 2 PIGTAIL CURVE 5FR 24CM RADIOPQ GRADUATE MARK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49898 SUP HCPCS C2625 G49898 - SET STENT 2 PIGTAIL CURVE 5FR 26CM RADIOPQ GRADUATE MARK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49899 SUP HCPCS C2625 G49899 - SET STENT 2 PIGTAIL CURVE 5FR 28CM RADIOPQ GRADUATE MARK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49900 SUP HCPCS C2617 G49900 - SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49901 SUP HCPCS C2617 G49901 - SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49902 SUP HCPCS C2617 G49902 - SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49903 SUP HCPCS C2625 G49903 - SET STENT 2 PIGTAIL CURVE 6FR 20CM RADIOPQ GRADUATE MARK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49904 SUP HCPCS C2625 G49904 - SET STENT 2 PIGTAIL CURVE 6FR 22CM RADIOPQ GRADUATE MARK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49905 SUP HCPCS C2617 G49905 - SET STENT 2 PIGTAIL CURVE 6FR 24CM RADIOPQ TIP FIRM BOTH IP/OP $281.50 $208.00 $55.82 $281.25 $152.72 $152.72 $152.72 $152.72 $281.25 $281.25 $281.25 $58.62 $281.25 $208.74 $208.74 $216.79 $146.53 $58.62 $281.25 $187.50 $166.36 $281.25 $281.25 $281.25 $281.25 $211.13 $281.25 $281.25 $281.25 $140.63 $140.63 $222.75 $281.25 $225.00 $182.81 $55.82 N/A $163.27 $281.25 $281.25 $281.25 $58.61 $281.25 N/A N/A G49906 SUP HCPCS C2625 G49906 - STENT URETERAL 6FR 26CM POSITIONER BRAID TETHER STRAIGHTENER BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49907 SUP HCPCS C2625 G49907 - STENT URETERAL 6FR 28CM POSITIONER SET BRAID TETHER RADIOPQ BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49908 SUP HCPCS C2617 G49908 - SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49909 SUP HCPCS C2617 G49909 - SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49910 SUP HCPCS C2617 G49910 - STENT URET 6FR 22-32CM UNIVERSA PSTNR SET BRD TETH RADOPQ BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49911 SUP HCPCS C2617 G49911 - SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49912 SUP HCPCS C2625 G49912 - SET STENT 2 PIGTAIL CURVE 7FR 22CM RADIOPQ GRADUATE MARK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49913 SUP HCPCS C2625 G49913 - SET STENT PIGTAIL 7FR 24CM RADIOPQ TIP STRAIGHTENER BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49914 SUP HCPCS C2625 G49914 - SET STENT PIGTAIL 7FR 26CM RADIOPQ TIP STRAIGHTENER BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49915 SUP HCPCS C2625 G49915 - SET STENT 2 PIGTAIL CURVE 7FR 28CM RADIOPQ GRADUATE MARK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49916 SUP HCPCS C2617 G49916 - SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49917 SUP HCPCS C2617 G49917 - STENT URET 2 PGTL CRV 7FR 30CM UNIVERSA FIRM GRAD MRK RADOPQ BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49918 SUP HCPCS C2617 G49918 - SET STNT PGTL 7FR 22-32CM STRL UNIVERSA RADOPQ TIP BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49919 SUP HCPCS C2617 G49919 - SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49920 SUP HCPCS C2625 G49920 - SET STENT 2 PIGTAIL CURVE 8FR 22CM RADIOPQ GRADUATE MARK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49921 SUP HCPCS C2625 G49921 - SET STENT 2 PIGTAIL CURVE 8FR 24CM RADIOPQ GRADUATE MARK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49922 SUP HCPCS C2625 G49922 - SET STENT 2 PIGTAIL CURVE 8FR 26CM RADIOPQ GRADUATE MARK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49923 SUP HCPCS C2625 G49923 - SET STENT 2 PIGTAIL CURVE 8FR 28CM RADIOPQ GRADUATE MARK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49924 SUP HCPCS C2617 G49924 - SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49925 SUP HCPCS C2617 G49925 - SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49931 SUP HCPCS C2617 G49931 - SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49932 SUP HCPCS C2617 G49932 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49933 SUP HCPCS C2617 G49933 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49934 SUP HCPCS C2617 G49934 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49935 SUP HCPCS C2617 G49935 - SET STNT .038IN 2 PGTL CRV 3CM 5FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49936 SUP HCPCS C2617 G49936 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49937 SUP HCPCS C2617 G49937 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49938 SUP HCPCS C2617 G49938 - SET STNT .038IN 3CM 2 PGTL CRV 5FR 22-32CM STRL 145CM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49939 SUP HCPCS C2617 G49939 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49940 SUP HCPCS C2617 G49940 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49941 SUP HCPCS C2617 G49941 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49942 SUP HCPCS C2617 G49942 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49943 SUP HCPCS C2617 G49943 - SET STNT .038IN 3CM PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49944 SUP HCPCS C2617 G49944 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49945 SUP HCPCS C2617 G49945 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49946 SUP HCPCS C2617 G49946 - SET STNT .038IN 3CM 2 PGTL CRV 6FR 22-32CM STRL 145CM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49947 SUP HCPCS C2617 G49947 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49948 SUP HCPCS C2617 G49948 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49949 SUP HCPCS C2617 G49949 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49950 SUP HCPCS C2617 G49950 - SET STNT 3CM 2 PGTL CRV 7FR 24CM STRL 145CM UNIVERSA SFT BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49951 SUP HCPCS C2617 G49951 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49952 SUP HCPCS C2617 G49952 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49953 SUP HCPCS C2617 G49953 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49954 SUP HCPCS C2617 G49954 - SET STNT .038IN 3CM 2 PGTL CRV 7FR 22-32CM STRL 145CM BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49955 SUP HCPCS C2617 G49955 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49956 SUP HCPCS C2617 G49956 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49957 SUP HCPCS C2617 G49957 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49958 SUP HCPCS C2617 G49958 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49959 SUP HCPCS C2617 G49959 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49960 SUP HCPCS C2617 G49960 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49961 SUP HCPCS C2617 G49961 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G49962 SUP HCPCS C2617 G49962 - SET STNT .038IN 3CM 2 PGTL CRV 8FR 22-32CM STRL 145CM BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49963 SUP HCPCS C2617 G49963 - SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49964 SUP HCPCS C2617 G49964 - SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49965 SUP HCPCS C2617 G49965 - SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49966 SUP HCPCS C2617 G49966 - SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49967 SUP HCPCS C2617 G49967 - SET STNT 2 PGTL CRV 5FR 26CM UNIVERSA SFT GRAD MRK RADOPQ BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49968 SUP HCPCS C2617 G49968 - SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49969 SUP HCPCS C2617 G49969 - SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49970 SUP HCPCS C2617 G49970 - STENT URET 2 PGTL CRV 5FR 30CM UNIVERSA SFT GRAD MRK RADOPQ BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49971 SUP HCPCS C2617 G49971 - SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ GRAD MRK BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49972 SUP HCPCS C2617 G49972 - SET STNT PGTL 6FR 20CM STRL UNIVERSA RADOPQ TIP PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49973 SUP HCPCS C2617 G49973 - SET STNT PGTL 6FR 22CM STRL UNIVERSA RADOPQ TIP PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49974 SUP HCPCS C2617 G49974 - SET STNT 2 PGTL CRV 6FR 24CM STRL UNIVERSA RADOPQ PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49975 SUP HCPCS C2617 G49975 - SET STNT 2 PGTL CRV 6FR 26CM STRL UNIVERSA RADOPQ PSTNR BRD BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49976 SUP HCPCS C2617 G49976 - SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49977 SUP HCPCS C2617 G49977 - STENT URET 2 PGTL CRV 6FR 30CM UNIVERSA SFT GRAD MRK RADOPQ BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49978 SUP HCPCS C2617 G49978 - SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49979 SUP HCPCS C2617 G49979 - SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49980 SUP HCPCS C2617 G49980 - SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49981 SUP HCPCS C2617 G49981 - SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49982 SUP HCPCS C2617 G49982 - SET STNT 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49983 SUP HCPCS C2617 G49983 - SET STNT 2 PGTL CRV 7FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49984 SUP HCPCS C2617 G49984 - SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49985 SUP HCPCS C2617 G49985 - SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49986 SUP HCPCS C2617 G49986 - SET STNT 2 PGTL CRV 7FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49987 SUP HCPCS C2617 G49987 - SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49988 SUP HCPCS C2617 G49988 - SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49989 SUP HCPCS C2617 G49989 - SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49990 SUP HCPCS C2617 G49990 - SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49991 SUP HCPCS C2617 G49991 - SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49992 SUP HCPCS C2617 G49992 - SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G49993 SUP HCPCS C2617 G49993 - SET STNT 2 PGTL CRV 8FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G50001 SUP HCPCS C1887 G50001 - CATHETER GUID .018IN 2.6FR 150CM DEPTH MARKER RADIOPQ BOTH IP/OP $487.50 $361.00 $96.76 $545.56 $264.71 $264.71 $264.71 $264.71 $487.50 $487.50 $487.50 $101.61 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $545.56 $288.36 $487.50 $545.56 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A G50003 SUP HCPCS C1887 G50003 - CATHETER GUID 2.6FR 150CM BRAID KINK RESISTANT RADIOPQ BOTH IP/OP $487.50 $361.00 $96.76 $545.56 $264.71 $264.71 $264.71 $264.71 $487.50 $487.50 $487.50 $101.61 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $545.56 $288.36 $487.50 $545.56 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A G50010 SUP Custom 27203010 G50010 - FIBER LSR 550UM NS STRP TL BOTH IP/OP $275.00 $204.00 $48.95 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $48.95 $275.00 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $110.00 $275.00 $275.00 $275.00 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $275.00 N/A $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A G50122 SUP HCPCS C1876 G50122 - STENT BILIARY 6MM 6FR 140MM 80CM SELF EXPAND FLEXIBLE INTROD BOTH IP/OP "$3,237.50" "$2,396.00" $642.56 "$3,237.50" "$1,456.88" "$1,456.88" "$1,456.88" "$1,456.88" "$3,237.50" "$3,237.50" "$3,237.50" $674.78 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $674.73 "$3,237.50" "$3,237.50" "$1,596.09" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$1,456.88" $642.56 N/A "$1,877.75" "$3,237.50" "$3,237.50" "$3,237.50" $674.70 "$3,237.50" N/A N/A G50131 SUP HCPCS C1876 G50131 - STENT BILIARY .035IN 7MM 6FR 140MM 80CM SELF EXPANDABLE BOTH IP/OP "$3,237.50" "$2,396.00" $642.56 "$3,237.50" "$1,456.88" "$1,456.88" "$1,456.88" "$1,456.88" "$3,237.50" "$3,237.50" "$3,237.50" $674.78 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $674.73 "$3,237.50" "$3,237.50" "$1,596.09" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$1,456.88" $642.56 N/A "$1,877.75" "$3,237.50" "$3,237.50" "$3,237.50" $674.70 "$3,237.50" N/A N/A G50168 SUP HCPCS C1876 G50168 - STENT BILIARY .035IN 7MM 6FR 100MM 125CM SELF EXPANDABLE BOTH IP/OP "$3,237.50" "$2,396.00" $642.56 "$3,237.50" "$1,456.88" "$1,456.88" "$1,456.88" "$1,456.88" "$3,237.50" "$3,237.50" "$3,237.50" $674.78 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $674.73 "$3,237.50" "$3,237.50" "$1,596.09" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$1,456.88" $642.56 N/A "$1,877.75" "$3,237.50" "$3,237.50" "$3,237.50" $674.70 "$3,237.50" N/A N/A G50171 SUP HCPCS C1876 G50171 - STENT BILIARY 8MM 6FR 100MM 125CM SELF EXPAND FLEXIBLE BOTH IP/OP "$3,237.50" "$2,396.00" $642.56 "$3,237.50" "$1,456.88" "$1,456.88" "$1,456.88" "$1,456.88" "$3,237.50" "$3,237.50" "$3,237.50" $674.78 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $674.73 "$3,237.50" "$3,237.50" "$1,596.09" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$1,456.88" $642.56 N/A "$1,877.75" "$3,237.50" "$3,237.50" "$3,237.50" $674.70 "$3,237.50" N/A N/A G50214 SUP Custom 27203010 G50214 - GLASSES SF NS HO LSR BOTH IP/OP $96.00 $71.00 $17.03 $95.70 $95.70 $95.70 $95.70 $95.70 $95.70 $95.70 $17.03 $95.70 $95.70 $71.03 $71.03 $73.77 $49.86 $19.94 $95.70 $38.28 $95.70 $95.70 $95.70 $95.70 $95.70 $72.00 $95.70 $95.70 $95.70 $47.85 $47.85 $75.79 $95.70 $76.56 $62.21 $95.70 N/A $55.68 $95.70 $57.42 $95.70 $95.70 $95.70 N/A N/A G50319 SUP HCPCS C1725 G50319 - CATHETER BLNDIL 2MM 170CM STRL LF 20CM ADV LOPRFL KINK RST BOTH IP/OP "$1,351.50" "$1,000.00" $268.24 "$1,351.50" $733.86 $733.86 $733.86 $733.86 "$1,351.50" "$1,351.50" "$1,351.50" $281.69 "$1,351.50" "$1,003.08" "$1,003.08" "$1,041.74" $704.13 $281.67 "$1,351.50" "$1,351.50" $799.41 "$1,351.50" "$1,351.50" "$1,351.50" "$1,351.50" "$1,013.63" "$1,351.50" "$1,351.50" "$1,351.50" $675.75 $675.75 "$1,070.39" "$1,351.50" "$1,081.20" $878.48 $268.24 N/A $783.87 "$1,351.50" "$1,351.50" "$1,351.50" $281.65 "$1,351.50" N/A N/A G50333 SUP HCPCS C1725 G50333 - CATHETER BLNDIL 3MM 170CM STRL LF 20CM ADV LOPRFL KINK RST BOTH IP/OP "$1,351.50" "$1,000.00" $268.24 "$1,351.50" $733.86 $733.86 $733.86 $733.86 "$1,351.50" "$1,351.50" "$1,351.50" $281.69 "$1,351.50" "$1,003.08" "$1,003.08" "$1,041.74" $704.13 $281.67 "$1,351.50" "$1,351.50" $799.41 "$1,351.50" "$1,351.50" "$1,351.50" "$1,351.50" "$1,013.63" "$1,351.50" "$1,351.50" "$1,351.50" $675.75 $675.75 "$1,070.39" "$1,351.50" "$1,081.20" $878.48 $268.24 N/A $783.87 "$1,351.50" "$1,351.50" "$1,351.50" $281.65 "$1,351.50" N/A N/A G50337 SUP HCPCS C1725 G50337 - CATHETER BLNDIL 4MM 170CM STRL LF 8CM ADV LOPRFL KINK RST BOTH IP/OP "$1,351.50" "$1,000.00" $268.24 "$1,351.50" $733.86 $733.86 $733.86 $733.86 "$1,351.50" "$1,351.50" "$1,351.50" $281.69 "$1,351.50" "$1,003.08" "$1,003.08" "$1,041.74" $704.13 $281.67 "$1,351.50" "$1,351.50" $799.41 "$1,351.50" "$1,351.50" "$1,351.50" "$1,351.50" "$1,013.63" "$1,351.50" "$1,351.50" "$1,351.50" $675.75 $675.75 "$1,070.39" "$1,351.50" "$1,081.20" $878.48 $268.24 N/A $783.87 "$1,351.50" "$1,351.50" "$1,351.50" $281.65 "$1,351.50" N/A N/A G50686 SUP HCPCS C1880 G50686 - SYSTEM EMBOLIC PROTECTION .038IN 12FR 40MM 11FR 75CM GWIRE BOTH IP/OP "$3,437.50" "$2,544.00" $716.41 "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" $716.41 "$3,437.50" "$1,295.00" "$3,437.50" "$3,437.50" "$3,237.50" "$3,437.50" "$3,437.50" "$2,578.13" "$3,437.50" "$3,437.50" "$3,437.50" "$1,718.75" "$1,718.75" "$2,722.50" "$3,437.50" "$2,750.00" "$1,546.88" "$3,437.50" N/A "$1,993.75" "$3,437.50" "$2,062.50" "$3,437.50" "$3,437.50" "$3,437.50" N/A N/A G50687 SUP HCPCS C1880 G50687 - SYSTEM EMBOLIC PROTECTION .038IN 12FR 40MM 11FR 45CM GWIRE BOTH IP/OP "$3,437.50" "$2,544.00" $716.41 "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" "$3,437.50" $716.41 "$3,437.50" "$1,295.00" "$3,437.50" "$3,437.50" "$3,237.50" "$3,437.50" "$3,437.50" "$2,578.13" "$3,437.50" "$3,437.50" "$3,437.50" "$1,718.75" "$1,718.75" "$2,722.50" "$3,437.50" "$2,750.00" "$1,546.88" "$3,437.50" N/A "$1,993.75" "$3,437.50" "$2,062.50" "$3,437.50" "$3,437.50" "$3,437.50" N/A N/A G50784 SUP HCPCS C1769 G50784 - GUIDEWIRE VASCULAR TAPER .014IN 135CM APPROACH STAINLESS BOTH IP/OP $417.00 $309.00 $82.74 $416.88 $226.37 $226.37 $226.37 $226.37 $416.88 $416.88 $416.88 $86.89 $416.88 $309.41 $309.41 $321.33 $217.19 $86.88 $416.88 $416.88 $246.58 $416.88 $416.88 $416.88 $416.88 $312.75 $416.88 $416.88 $416.88 $208.44 $208.44 $330.17 $416.88 $333.50 $270.97 $82.74 N/A $241.86 $416.88 $416.88 $416.88 $86.88 $416.88 N/A N/A G50785 SUP HCPCS C1769 G50785 - GUIDEWIRE VASCULAR TAPER .014IN 135CM APPROACH STAINLESS BOTH IP/OP $417.00 $309.00 $82.74 $416.88 $226.37 $226.37 $226.37 $226.37 $416.88 $416.88 $416.88 $86.89 $416.88 $309.41 $309.41 $321.33 $217.19 $86.88 $416.88 $416.88 $246.58 $416.88 $416.88 $416.88 $416.88 $312.75 $416.88 $416.88 $416.88 $208.44 $208.44 $330.17 $416.88 $333.50 $270.97 $82.74 N/A $241.86 $416.88 $416.88 $416.88 $86.88 $416.88 N/A N/A G50788 SUP HCPCS C1769 G50788 - GUIDEWIRE VASCULAR TAPER .014IN 190CM APPROACH STAINLESS BOTH IP/OP $417.00 $309.00 $82.74 $423.13 $226.37 $226.37 $226.37 $226.37 $416.88 $416.88 $416.88 $86.89 $416.88 $309.41 $309.41 $321.33 $217.19 $86.88 $416.88 $423.13 $246.58 $416.88 $423.13 $416.88 $416.88 $312.75 $416.88 $416.88 $416.88 $208.44 $208.44 $330.17 $416.88 $333.50 $270.97 $82.74 N/A $241.86 $416.88 $416.88 $416.88 $86.88 $416.88 N/A N/A G50789 SUP HCPCS C1769 G50789 - GUIDEWIRE VASCULAR TAPER .014IN 190CM APPROACH STAINLESS BOTH IP/OP $417.00 $309.00 $82.74 $423.13 $226.37 $226.37 $226.37 $226.37 $416.88 $416.88 $416.88 $86.89 $416.88 $309.41 $309.41 $321.33 $217.19 $86.88 $416.88 $423.13 $246.58 $416.88 $423.13 $416.88 $416.88 $312.75 $416.88 $416.88 $416.88 $208.44 $208.44 $330.17 $416.88 $333.50 $270.97 $82.74 N/A $241.86 $416.88 $416.88 $416.88 $86.88 $416.88 N/A N/A G50791 SUP HCPCS C1769 G50791 - GUIDEWIRE VASCULAR TAPER .014IN 300CM 12GM TIP LOAD APPROACH BOTH IP/OP $417.00 $309.00 $82.74 $423.13 $226.37 $226.37 $226.37 $226.37 $416.88 $416.88 $416.88 $86.89 $416.88 $309.41 $309.41 $321.33 $217.19 $86.88 $416.88 $423.13 $246.58 $416.88 $423.13 $416.88 $416.88 $312.75 $416.88 $416.88 $416.88 $208.44 $208.44 $330.17 $416.88 $333.50 $270.97 $82.74 N/A $241.86 $416.88 $416.88 $416.88 $86.88 $416.88 N/A N/A G50792 SUP HCPCS C1769 G50792 - GUIDEWIRE VASCULAR TAPER .014IN 300CM 18GM TIP LOAD APPROACH BOTH IP/OP $417.00 $309.00 $82.74 $423.13 $226.37 $226.37 $226.37 $226.37 $416.88 $416.88 $416.88 $86.89 $416.88 $309.41 $309.41 $321.33 $217.19 $86.88 $416.88 $423.13 $246.58 $416.88 $423.13 $416.88 $416.88 $312.75 $416.88 $416.88 $416.88 $208.44 $208.44 $330.17 $416.88 $333.50 $270.97 $82.74 N/A $241.86 $416.88 $416.88 $416.88 $86.88 $416.88 N/A N/A G50793 SUP HCPCS C1769 G50793 - GUIDEWIRE VASCULAR TAPER .014IN 300CM 25GM TIP LOAD APPROACH BOTH IP/OP $417.00 $309.00 $82.74 $423.13 $226.37 $226.37 $226.37 $226.37 $416.88 $416.88 $416.88 $86.89 $416.88 $309.41 $309.41 $321.33 $217.19 $86.88 $416.88 $423.13 $246.58 $416.88 $423.13 $416.88 $416.88 $312.75 $416.88 $416.88 $416.88 $208.44 $208.44 $330.17 $416.88 $333.50 $270.97 $82.74 N/A $241.86 $416.88 $416.88 $416.88 $86.88 $416.88 N/A N/A G50972 SUP HCPCS C1894 G50972 - NEEDLE PRC SHTH TFE BOTH IP/OP "$5,119.00" "$3,788.00" "$1,015.94" "$5,118.75" "$2,779.48" "$2,779.48" "$2,779.48" "$2,779.48" "$5,118.75" "$5,118.75" "$5,118.75" "$1,066.88" "$5,118.75" "$3,799.14" "$3,799.14" "$3,945.53" "$2,060.15" "$1,066.80" "$5,118.75" "$5,118.75" "$3,027.74" "$5,118.75" "$5,118.75" "$5,118.75" "$5,118.75" "$3,839.25" "$5,118.75" "$5,118.75" "$5,118.75" "$2,559.38" "$2,559.38" "$4,054.05" "$5,118.75" "$4,095.00" "$3,327.19" "$1,015.94" N/A "$2,969.02" "$5,118.75" "$5,118.75" "$5,118.75" "$1,066.75" "$5,118.75" N/A N/A G50973 SUP HCPCS C1894 G50973 - SHEATH ACC FLXR DFLC VSN URETER BOTH IP/OP "$1,024.00" $758.00 $203.19 "$1,023.75" $555.90 $555.90 $555.90 $555.90 "$1,023.75" "$1,023.75" "$1,023.75" $213.38 "$1,023.75" $759.83 $759.83 $789.11 $533.37 $213.36 "$1,023.75" "$1,023.75" $605.55 "$1,023.75" "$1,023.75" "$1,023.75" "$1,023.75" $768.00 "$1,023.75" "$1,023.75" "$1,023.75" $511.88 $511.88 $810.81 "$1,023.75" $819.00 $665.44 $203.19 N/A $593.92 "$1,023.75" "$1,023.75" "$1,023.75" $213.35 "$1,023.75" N/A N/A G50974 SUP HCPCS C1894 G50974 - SHEATH ACC 180D FLXR DFLC VSN URETER BOTH IP/OP "$1,024.00" $758.00 $203.19 "$1,023.75" $555.90 $555.90 $555.90 $555.90 "$1,023.75" "$1,023.75" "$1,023.75" $213.38 "$1,023.75" $759.83 $759.83 $789.11 $533.37 $213.36 "$1,023.75" "$1,023.75" $605.55 "$1,023.75" "$1,023.75" "$1,023.75" "$1,023.75" $768.00 "$1,023.75" "$1,023.75" "$1,023.75" $511.88 $511.88 $810.81 "$1,023.75" $819.00 $665.44 $203.19 N/A $593.92 "$1,023.75" "$1,023.75" "$1,023.75" $213.35 "$1,023.75" N/A N/A G51183 SUP HCPCS C1874 G51183 - STENT ESOPHAGEAL 23MM 18MM 12CM 2 LASSO LOOP CONTROL RELEASE BOTH IP/OP "$4,705.00" "$3,482.00" $933.82 "$4,705.00" "$2,117.25" "$2,117.25" "$2,117.25" "$2,117.25" "$4,705.00" "$4,705.00" "$4,705.00" $980.64 "$4,705.00" "$4,705.00" "$4,705.00" "$4,705.00" "$4,705.00" $980.57 "$4,705.00" "$4,705.00" "$2,319.57" "$4,705.00" "$4,705.00" "$4,705.00" "$4,705.00" "$3,528.75" "$4,705.00" "$4,705.00" "$4,705.00" "$2,352.50" "$2,352.50" "$3,726.36" "$4,705.00" "$3,764.00" "$2,117.25" $933.82 N/A "$2,728.90" "$4,705.00" "$4,705.00" "$4,705.00" $980.52 "$4,705.00" N/A N/A G51574 SUP HCPCS C1887 G51574 - CATHETER GUID .014IN 3-1.9FR 150CM SUPPORT CORSSCATH BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $196.84 $196.84 $196.84 $196.84 $362.50 $362.50 $362.50 $75.55 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $362.50 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $75.55 $362.50 N/A N/A G51577 SUP HCPCS C1887 G51577 - CATHETER SPRT .018IN 3.4-2.2FR 150CM CROSSCATH BOTH IP/OP $362.50 $268.00 $71.95 $362.50 $196.84 $196.84 $196.84 $196.84 $362.50 $362.50 $362.50 $75.55 $362.50 $269.05 $269.05 $279.42 $188.86 $75.55 $362.50 $362.50 $214.42 $362.50 $362.50 $362.50 $362.50 $271.88 $362.50 $362.50 $362.50 $181.25 $181.25 $287.10 $362.50 $290.00 $235.63 $71.95 N/A $210.25 $362.50 $362.50 $362.50 $75.55 $362.50 N/A N/A G51954 SUP HCPCS C1769 G51954 - GUIDEWIRE VASCULAR MICRO .018IN 190CM SHAPEABLE TIP APPROACH BOTH IP/OP $167.50 $124.00 $33.15 $167.03 $90.70 $90.70 $90.70 $90.70 $167.03 $167.03 $167.03 $34.81 $167.03 $123.97 $123.97 $128.75 $87.02 $34.81 $167.03 $167.03 $98.80 $167.03 $167.03 $167.03 $167.03 $125.63 $167.03 $167.03 $167.03 $83.52 $83.52 $132.29 $167.03 $133.62 $108.57 $33.15 N/A $97.15 $167.03 $167.03 $167.03 $34.81 $167.03 N/A N/A G52226 SUP HCPCS C1874 G52226 - STENT ESOPHAGEAL 25MM 20MM 12CM CONTROLLED RELEASE FULLY BOTH IP/OP "$4,705.00" "$3,482.00" $933.82 "$4,705.00" "$2,117.25" "$2,117.25" "$2,117.25" "$2,117.25" "$4,705.00" "$4,705.00" "$4,705.00" $980.64 "$4,705.00" "$4,705.00" "$4,705.00" "$4,705.00" "$4,705.00" $980.57 "$4,705.00" "$4,705.00" "$2,319.57" "$4,705.00" "$4,705.00" "$4,705.00" "$4,705.00" "$3,528.75" "$4,705.00" "$4,705.00" "$4,705.00" "$2,352.50" "$2,352.50" "$3,726.36" "$4,705.00" "$3,764.00" "$2,117.25" $933.82 N/A "$2,728.90" "$4,705.00" "$4,705.00" "$4,705.00" $980.52 "$4,705.00" N/A N/A G52247 SUP HCPCS C1725 G52247 - CATHETER BLNDIL 3MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL BOTH IP/OP $612.00 $453.00 $121.47 $612.00 $332.32 $332.32 $332.32 $332.32 $612.00 $612.00 $612.00 $127.56 $612.00 $454.23 $454.23 $471.73 $318.85 $127.55 $612.00 $612.00 $362.00 $612.00 $612.00 $612.00 $612.00 $459.00 $612.00 $612.00 $612.00 $306.00 $306.00 $484.70 $612.00 $489.60 $397.80 $121.47 N/A $354.96 $612.00 $612.00 $612.00 $127.54 $612.00 N/A N/A G52249 SUP HCPCS C1725 G52249 - CATHETER BLNDIL 3MM 135CM STRL LF 12CM ADV 2 LUM LOPRFL BOTH IP/OP $612.00 $453.00 $121.47 $612.00 $332.32 $332.32 $332.32 $332.32 $612.00 $612.00 $612.00 $127.56 $612.00 $454.23 $454.23 $471.73 $318.85 $127.55 $612.00 $612.00 $362.00 $612.00 $612.00 $612.00 $612.00 $459.00 $612.00 $612.00 $612.00 $306.00 $306.00 $484.70 $612.00 $489.60 $397.80 $121.47 N/A $354.96 $612.00 $612.00 $612.00 $127.54 $612.00 N/A N/A G52253 SUP HCPCS C1725 G52253 - CATHETER BLNDIL 4MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL BOTH IP/OP $612.00 $453.00 $121.47 $612.00 $332.32 $332.32 $332.32 $332.32 $612.00 $612.00 $612.00 $127.56 $612.00 $454.23 $454.23 $471.73 $318.85 $127.55 $612.00 $612.00 $362.00 $612.00 $612.00 $612.00 $612.00 $459.00 $612.00 $612.00 $612.00 $306.00 $306.00 $484.70 $612.00 $489.60 $397.80 $121.47 N/A $354.96 $612.00 $612.00 $612.00 $127.54 $612.00 N/A N/A G52260 SUP HCPCS C1725 G52260 - CATHETER BLNDIL 5MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL BOTH IP/OP $612.00 $453.00 $121.47 $612.00 $332.32 $332.32 $332.32 $332.32 $612.00 $612.00 $612.00 $127.56 $612.00 $454.23 $454.23 $471.73 $318.85 $127.55 $612.00 $612.00 $362.00 $612.00 $612.00 $612.00 $612.00 $459.00 $612.00 $612.00 $612.00 $306.00 $306.00 $484.70 $612.00 $489.60 $397.80 $121.47 N/A $354.96 $612.00 $612.00 $612.00 $127.54 $612.00 N/A N/A G52263 SUP HCPCS C1725 G52263 - CATHETER BLNDIL 5MM 135CM STRL LF 14CM ADV 2 LUM LOPRFL BOTH IP/OP $612.00 $453.00 $121.47 $612.00 $332.32 $332.32 $332.32 $332.32 $612.00 $612.00 $612.00 $127.56 $612.00 $454.23 $454.23 $471.73 $318.85 $127.55 $612.00 $612.00 $362.00 $612.00 $612.00 $612.00 $612.00 $459.00 $612.00 $612.00 $612.00 $306.00 $306.00 $484.70 $612.00 $489.60 $397.80 $121.47 N/A $354.96 $612.00 $612.00 $612.00 $127.54 $612.00 N/A N/A G52267 SUP HCPCS C1725 G52267 - CATHETER BLNDIL 6MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL BOTH IP/OP $612.00 $453.00 $121.47 $612.00 $332.32 $332.32 $332.32 $332.32 $612.00 $612.00 $612.00 $127.56 $612.00 $454.23 $454.23 $471.73 $318.85 $127.55 $612.00 $612.00 $362.00 $612.00 $612.00 $612.00 $612.00 $459.00 $612.00 $612.00 $612.00 $306.00 $306.00 $484.70 $612.00 $489.60 $397.80 $121.47 N/A $354.96 $612.00 $612.00 $612.00 $127.54 $612.00 N/A N/A G52270 SUP HCPCS C1725 G52270 - CATHETER BLNDIL 6MM 135CM STRL LF 14CM ADV 2 LUM LOPRFL BOTH IP/OP $612.00 $453.00 $121.47 $612.00 $332.32 $332.32 $332.32 $332.32 $612.00 $612.00 $612.00 $127.56 $612.00 $454.23 $454.23 $471.73 $318.85 $127.55 $612.00 $612.00 $362.00 $612.00 $612.00 $612.00 $612.00 $459.00 $612.00 $612.00 $612.00 $306.00 $306.00 $484.70 $612.00 $489.60 $397.80 $121.47 N/A $354.96 $612.00 $612.00 $612.00 $127.54 $612.00 N/A N/A G52274 SUP HCPCS C1725 G52274 - CATHETER BLNDIL 7MM 135CM STRL LF 8CM ADV 2 LUM LOPRFL BOTH IP/OP $612.00 $453.00 $121.47 $612.00 $332.32 $332.32 $332.32 $332.32 $612.00 $612.00 $612.00 $127.56 $612.00 $454.23 $454.23 $471.73 $318.85 $127.55 $612.00 $612.00 $362.00 $612.00 $612.00 $612.00 $612.00 $459.00 $612.00 $612.00 $612.00 $306.00 $306.00 $484.70 $612.00 $489.60 $397.80 $121.47 N/A $354.96 $612.00 $612.00 $612.00 $127.54 $612.00 N/A N/A G52277 SUP HCPCS C1725 G52277 - CATHETER BLNDIL 7MM 135CM STRL LF 14CM ADV 2 LUM LOPRFL BOTH IP/OP $600.00 $444.00 $119.09 $600.00 $325.80 $325.80 $325.80 $325.80 $600.00 $600.00 $600.00 $125.06 $600.00 $445.32 $445.32 $462.48 $312.60 $125.05 $600.00 $600.00 $354.90 $600.00 $600.00 $600.00 $600.00 $450.00 $600.00 $600.00 $600.00 $300.00 $300.00 $475.20 $600.00 $480.00 $390.00 $119.09 N/A $348.00 $600.00 $600.00 $600.00 $125.04 $600.00 N/A N/A G52349 SUP HCPCS C1725 G52349 - CATHETER BLNDIL 6MM 80CM STRL LF 12CM ADV 2 LUM LOPRFL BOTH IP/OP $612.00 $453.00 $121.47 $612.00 $332.32 $332.32 $332.32 $332.32 $612.00 $612.00 $612.00 $127.56 $612.00 $454.23 $454.23 $471.73 $318.85 $127.55 $612.00 $612.00 $362.00 $612.00 $612.00 $612.00 $612.00 $459.00 $612.00 $612.00 $612.00 $306.00 $306.00 $484.70 $612.00 $489.60 $397.80 $121.47 N/A $354.96 $612.00 $612.00 $612.00 $127.54 $612.00 N/A N/A G52542 SUP HCPCS C1887 G52542 - CATHETER GUID .035IN 4FR 135CM SUPPORT STR TIP LP RADIOPQ BOTH IP/OP $487.50 $361.00 $96.76 $494.81 $264.71 $264.71 $264.71 $264.71 $487.50 $487.50 $487.50 $101.61 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $494.81 $288.36 $487.50 $494.81 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A G52543 SUP HCPCS C1887 G52543 - CATHETER SPRT DAV CRV 4FR 135CM STRL CXI RADOPQ BRD LOPRFL BOTH IP/OP $487.50 $361.00 $96.76 $494.81 $264.71 $264.71 $264.71 $264.71 $487.50 $487.50 $487.50 $101.61 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $494.81 $288.36 $487.50 $494.81 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A G52544 SUP HCPCS C1887 G52544 - CATHETER GUID .035IN 4FR 150CM SUPPORT STR TIP LP RADIOPQ BOTH IP/OP $422.50 $313.00 $83.86 $494.81 $229.42 $229.42 $229.42 $229.42 $422.50 $422.50 $422.50 $88.06 $422.50 $313.58 $313.58 $325.66 $220.12 $88.05 $422.50 $494.81 $249.91 $422.50 $494.81 $422.50 $422.50 $316.88 $422.50 $422.50 $422.50 $211.25 $211.25 $334.62 $422.50 $338.00 $274.63 $83.86 N/A $245.05 $422.50 $422.50 $422.50 $88.05 $422.50 N/A N/A G52545 SUP HCPCS C1887 G52545 - CATHETER GUID .035IN 4FR 150CM SUPPORT ANGLED TIP LP RADIOPQ BOTH IP/OP $487.50 $361.00 $96.76 $494.81 $264.71 $264.71 $264.71 $264.71 $487.50 $487.50 $487.50 $101.61 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $494.81 $288.36 $487.50 $494.81 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $96.76 N/A $282.75 $487.50 $487.50 $487.50 $101.60 $487.50 N/A N/A G52599 SUP Custom 27203010 G52599 - SHEATH ACC VUE FLXR DFLC UT ESCP SYS BOTH IP/OP $64.50 $48.00 $11.42 $64.13 $64.13 $64.13 $64.13 $64.13 $64.13 $64.13 $11.42 $64.13 $64.13 $47.60 $47.60 $49.43 $33.41 $13.37 $64.13 $25.65 $64.13 $64.13 $64.13 $64.13 $64.13 $48.38 $64.13 $64.13 $64.13 $32.07 $32.07 $50.79 $64.13 $51.30 $41.68 $64.13 N/A $37.41 $64.13 $38.48 $64.13 $64.13 $64.13 N/A N/A G52603 SUP Custom 27203010 G52603 - CARTRIDGE CO2 LITHOTRIPTER PNEUMATIC KIT LMA STONEBREAKER BOTH IP/OP $36.00 $27.00 $6.34 $35.63 $35.63 $35.63 $35.63 $35.63 $35.63 $35.63 $6.34 $35.63 $35.63 $26.44 $26.44 $27.46 $18.56 $7.43 $35.63 $14.25 $35.63 $35.63 $35.63 $35.63 $35.63 $27.00 $35.63 $35.63 $35.63 $17.82 $17.82 $28.22 $35.63 $28.50 $23.16 $35.63 N/A $20.88 $35.63 $21.38 $35.63 $35.63 $35.63 N/A N/A G52605 SUP Custom 27203010 G52605 - CATHETER URTH 10FR 25CM 3ML UNIVERSA 2W OP-EN BLN FL SIL DOD BOTH IP/OP $192.50 $142.00 $34.21 $192.19 $192.19 $192.19 $192.19 $192.19 $192.19 $192.19 $34.21 $192.19 $192.19 $142.64 $142.64 $148.14 $100.13 $40.05 $192.19 $76.88 $192.19 $192.19 $192.19 $192.19 $192.19 $144.38 $192.19 $192.19 $192.19 $96.10 $96.10 $152.21 $192.19 $153.75 $124.92 $192.19 N/A $111.65 $192.19 $115.31 $192.19 $192.19 $192.19 N/A N/A G52606 SUP Custom 27203010 G52606 - PROBE LITHOTRIPTER 1.6MM 500MM PNEUMATIC KIT LMA BOTH IP/OP $461.50 $342.00 $82.10 $461.25 $461.25 $461.25 $461.25 $461.25 $461.25 $461.25 $82.10 $461.25 $461.25 $342.34 $342.34 $355.53 $240.31 $96.13 $461.25 $184.50 $461.25 $461.25 $461.25 $461.25 $461.25 $346.13 $461.25 $461.25 $461.25 $230.63 $230.63 $365.31 $461.25 $369.00 $299.81 $461.25 N/A $267.67 $461.25 $276.75 $461.25 $461.25 $461.25 N/A N/A G52607 SUP Custom 27203010 G52607 - PROBE LITHOTRIPTER 1MM 500MM PNEUMATIC KIT LMA STONEBREAKER BOTH IP/OP $461.50 $342.00 $82.10 $461.25 $461.25 $461.25 $461.25 $461.25 $461.25 $461.25 $82.10 $461.25 $461.25 $342.34 $342.34 $355.53 $240.31 $96.13 $461.25 $184.50 $461.25 $461.25 $461.25 $461.25 $461.25 $346.13 $461.25 $461.25 $461.25 $230.63 $230.63 $365.31 $461.25 $369.00 $299.81 $461.25 N/A $267.67 $461.25 $276.75 $461.25 $461.25 $461.25 N/A N/A G52608 SUP Custom 27203010 G52608 - PROBE LITHOTRIPTER 2MM 425MM PNEUMATIC KIT STONEBREAKER BOTH IP/OP $461.50 $342.00 $82.10 $461.25 $461.25 $461.25 $461.25 $461.25 $461.25 $461.25 $82.10 $461.25 $461.25 $342.34 $342.34 $355.53 $240.31 $96.13 $461.25 $184.50 $461.25 $461.25 $461.25 $461.25 $461.25 $346.13 $461.25 $461.25 $461.25 $230.63 $230.63 $365.31 $461.25 $369.00 $299.81 $461.25 N/A $267.67 $461.25 $276.75 $461.25 $461.25 $461.25 N/A N/A G52609 SUP Custom 27203010 G52609 - LITHOTRIPTER SRG LMA STONEBREAKER XHST LN STRL PRB CAP PORT BOTH IP/OP "$2,306.50" "$1,707.00" $410.51 "$2,306.25" "$2,306.25" "$2,306.25" "$2,306.25" "$2,306.25" "$2,306.25" "$2,306.25" $410.51 "$2,306.25" "$2,306.25" "$1,711.70" "$1,711.70" "$1,777.66" "$1,201.56" $480.65 "$2,306.25" $922.50 "$2,306.25" "$2,306.25" "$2,306.25" "$2,306.25" "$2,306.25" "$1,729.88" "$2,306.25" "$2,306.25" "$2,306.25" "$1,153.13" "$1,153.13" "$1,826.55" "$2,306.25" "$1,845.00" "$1,499.06" "$2,306.25" N/A "$1,337.77" "$2,306.25" "$1,383.75" "$2,306.25" "$2,306.25" "$2,306.25" N/A N/A G52731 SUP Custom 27203010 G52731 - COIL EMBOLIZATION .018IN 2MM 3CM 4.8 LOOP SOFT ENHANCED BOTH IP/OP $250.50 $185.00 $44.55 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $44.55 $250.30 $250.30 $185.77 $185.77 $192.93 $130.41 $52.17 $250.30 $100.12 $250.30 $250.30 $250.30 $250.30 $250.30 $187.88 $250.30 $250.30 $250.30 $125.15 $125.15 $198.24 $250.30 $200.24 $162.70 $250.30 N/A $145.29 $250.30 $150.18 $250.30 $250.30 $250.30 N/A N/A G52732 SUP Custom 27203010 G52732 - COIL EMBOLIZATION .018IN 3MM 3CM 3.2 LOOP SOFT ENHANCED BOTH IP/OP $250.50 $185.00 $44.55 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $44.55 $250.30 $250.30 $185.77 $185.77 $192.93 $130.41 $52.17 $250.30 $100.12 $250.30 $250.30 $250.30 $250.30 $250.30 $187.88 $250.30 $250.30 $250.30 $125.15 $125.15 $198.24 $250.30 $200.24 $162.70 $250.30 N/A $145.29 $250.30 $150.18 $250.30 $250.30 $250.30 N/A N/A G52734 SUP Custom 27203010 G52734 - COIL EMBOLIZATION .018IN 3MM 5CM 5.3 LOOP SOFT ENHANCED BOTH IP/OP $250.50 $185.00 $44.55 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $250.30 $44.55 $250.30 $250.30 $185.77 $185.77 $192.93 $130.41 $52.17 $250.30 $100.12 $250.30 $250.30 $250.30 $250.30 $250.30 $187.88 $250.30 $250.30 $250.30 $125.15 $125.15 $198.24 $250.30 $200.24 $162.70 $250.30 N/A $145.29 $250.30 $150.18 $250.30 $250.30 $250.30 N/A N/A G52736 SUP HCPCS Q4107 G52736 - COIL EMBOLIZATION .018IN 3MM 7CM 7.4 LOOP SOFT ENHANCED BOTH IP/OP $249.50 $185.00 $51.96 $249.30 $249.30 $249.30 $249.30 $249.30 $249.30 $249.30 $80.90 $249.30 $249.30 $249.30 $249.30 $249.30 $249.30 $51.96 $249.30 $105.68 $249.30 $249.30 $249.30 $249.30 $249.30 $187.13 $249.30 $249.30 $249.30 $124.65 $124.65 $197.45 $249.30 $199.44 $112.19 $249.30 N/A $144.71 $249.30 $149.58 $249.30 $249.30 $249.30 N/A N/A G52737 SUP Custom 27805113 G52737 - COIL EMBOLIZATION .018IN 4MM 7CM 5.6 LOOP SOFT ENHANCED BOTH IP/OP $264.50 $196.00 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $105.68 $264.20 $264.20 $264.20 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G52742 SUP Custom 27803010 G52742 - COIL EMBOLIZATION .035IN 4MM 7CM 5.6 LOOP SOFT ENHANCED BOTH IP/OP $264.50 $196.00 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $105.68 $264.20 $264.20 $264.20 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G52743 SUP Custom 27203010 G52743 - COIL EMBOLIZATION .035IN 6MM 7CM 3.7 LOOP SOFT ENHANCED BOTH IP/OP $264.50 $196.00 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $47.03 $264.20 $264.20 $196.09 $196.09 $203.65 $137.65 $55.06 $264.20 $105.68 $264.20 $264.20 $264.20 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $171.73 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G52744 SUP Custom 27203010 G52744 - COIL EMBOLIZATION .035IN 8MM 7CM 2.8 LOOP SOFT ENHANCED BOTH IP/OP $264.50 $196.00 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $47.03 $264.20 $264.20 $196.09 $196.09 $203.65 $137.65 $55.06 $264.20 $105.68 $264.20 $264.20 $264.20 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $171.73 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G52745 SUP Custom 27803010 G52745 - COIL EMBOLIZATION .035IN 10MM 7CM 2.2 LOOP SOFT ENHANCED BOTH IP/OP $264.50 $196.00 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $47.03 $264.20 $264.20 $264.20 $264.20 $264.20 $264.20 $55.06 $264.20 $105.68 $264.20 $264.20 $264.20 $264.20 $264.20 $198.38 $264.20 $264.20 $264.20 $132.10 $132.10 $209.25 $264.20 $211.36 $118.89 $264.20 N/A $153.41 $264.20 $158.52 $264.20 $264.20 $264.20 N/A N/A G52752 SUP Custom 27203010 G52752 - COIL EMBOLIZATION .035IN 16MM 14CM 2.8 LOOP SOFT EXTENDED BOTH IP/OP $304.00 $225.00 $54.08 $303.83 $303.83 $303.83 $303.83 $303.83 $303.83 $303.83 $54.08 $303.83 $303.83 $225.50 $225.50 $234.19 $158.30 $63.32 $303.83 $121.53 $303.83 $303.83 $303.83 $303.83 $303.83 $228.00 $303.83 $303.83 $303.83 $151.92 $151.92 $240.63 $303.83 $243.06 $197.49 $303.83 N/A $176.32 $303.83 $182.30 $303.83 $303.83 $303.83 N/A N/A G52753 SUP Custom 27803010 G52753 - COIL EMBOLIZATION .035IN 18MM 14CM 2.5 LOOP SOFT ENHANCED BOTH IP/OP $304.00 $225.00 $54.08 $303.83 $303.83 $303.83 $303.83 $303.83 $303.83 $303.83 $54.08 $303.83 $303.83 $303.83 $303.83 $303.83 $303.83 $63.32 $303.83 $121.53 $303.83 $303.83 $303.83 $303.83 $303.83 $228.00 $303.83 $303.83 $303.83 $151.92 $151.92 $240.63 $303.83 $243.06 $136.72 $303.83 N/A $176.32 $303.83 $182.30 $303.83 $303.83 $303.83 N/A N/A G52754 SUP Custom 27803010 G52754 - COIL EMBOLIZATION .035IN 20MM 14CM 2.2 LOOP SOFT ENHANCED BOTH IP/OP $304.00 $225.00 $54.08 $303.83 $303.83 $303.83 $303.83 $303.83 $303.83 $303.83 $54.08 $303.83 $303.83 $303.83 $303.83 $303.83 $303.83 $63.32 $303.83 $121.53 $303.83 $303.83 $303.83 $303.83 $303.83 $228.00 $303.83 $303.83 $303.83 $151.92 $151.92 $240.63 $303.83 $243.06 $136.72 $303.83 N/A $176.32 $303.83 $182.30 $303.83 $303.83 $303.83 N/A N/A G52756 SUP Custom 27803010 G52756 - COIL EMBOLIZATION .035IN 20MM 20CM 3.2 LOOP SOFT ENHANCED BOTH IP/OP $325.50 $241.00 $57.90 $325.28 $325.28 $325.28 $325.28 $325.28 $325.28 $325.28 $57.90 $325.28 $325.28 $325.28 $325.28 $325.28 $325.28 $67.79 $325.28 $130.11 $325.28 $325.28 $325.28 $325.28 $325.28 $244.13 $325.28 $325.28 $325.28 $162.64 $162.64 $257.62 $325.28 $260.22 $146.38 $325.28 N/A $188.79 $325.28 $195.17 $325.28 $325.28 $325.28 N/A N/A G52909 SUP HCPCS C1880 G52909 - FILTER EMBOLIZATION 30MM 7FR 48MM 65CM NAVALIGN DELIVERY BOTH IP/OP "$3,487.50" "$2,581.00" $726.83 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$1,395.00" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" "$3,487.50" N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" "$3,487.50" "$3,487.50" N/A N/A G52914 SUP HCPCS C1880 G52914 - SYSTEM EMBL PRTC 30MM 7FR 48MM 65CM CELECT NAVALIGN DLV BOTH IP/OP "$3,487.50" "$2,581.00" $726.83 "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" $726.83 "$3,487.50" "$1,395.00" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$1,569.38" "$3,487.50" N/A "$2,022.75" "$3,487.50" "$2,092.50" "$3,487.50" "$3,487.50" "$3,487.50" N/A N/A G52939 SUP HCPCS C1769 G52939 - GUIDEWIRE VASC STRG TPR .014IN 300CM APRCH SMTH NVG HDRPH SS BOTH IP/OP $499.00 $369.00 $98.99 $506.23 $270.82 $270.82 $270.82 $270.82 $498.75 $498.75 $498.75 $103.95 $498.75 $370.17 $370.17 $384.44 $259.85 $103.94 $498.75 $506.23 $295.01 $498.75 $506.23 $498.75 $498.75 $374.25 $498.75 $498.75 $498.75 $249.38 $249.38 $395.01 $498.75 $399.00 $324.19 $98.99 N/A $289.42 $498.75 $498.75 $498.75 $103.94 $498.75 N/A N/A G53024 SUP HCPCS C2628 G53024 - CATHETER BLNOCC 10FR 32MM 120CM 34ML CODA 2 LUM LOPRFL BLN BOTH IP/OP "$1,042.50" $771.00 $206.91 "$1,042.50" $566.08 $566.08 $566.08 $566.08 "$1,042.50" "$1,042.50" "$1,042.50" $217.28 "$1,042.50" $773.74 $773.74 $803.56 $543.14 $217.27 "$1,042.50" "$1,042.50" $616.64 "$1,042.50" "$1,042.50" "$1,042.50" "$1,042.50" $781.88 "$1,042.50" "$1,042.50" "$1,042.50" $521.25 $521.25 $825.66 "$1,042.50" $834.00 $677.63 $206.91 N/A $604.65 "$1,042.50" "$1,042.50" "$1,042.50" $217.26 "$1,042.50" N/A N/A G53025 SUP HCPCS C2628 G53025 - CATHETER BLNOCC 10FR 40MM 120CM 40ML CODA 2 LUM LOPRFL BLN BOTH IP/OP "$1,042.50" $771.00 $206.91 "$1,042.50" $566.08 $566.08 $566.08 $566.08 "$1,042.50" "$1,042.50" "$1,042.50" $217.28 "$1,042.50" $773.74 $773.74 $803.56 $543.14 $217.27 "$1,042.50" "$1,042.50" $616.64 "$1,042.50" "$1,042.50" "$1,042.50" "$1,042.50" $781.88 "$1,042.50" "$1,042.50" "$1,042.50" $521.25 $521.25 $825.66 "$1,042.50" $834.00 $677.63 $206.91 N/A $604.65 "$1,042.50" "$1,042.50" "$1,042.50" $217.26 "$1,042.50" N/A N/A G53030 SUP HCPCS C1758 G53030 - PROBE LTHTRP 1.6MM 605MM LMA STONEBREAKER PNEUM KT DISP BOTH IP/OP $64.00 $47.00 $12.65 $63.75 $34.62 $34.62 $34.62 $34.62 $63.75 $63.75 $63.75 $13.29 $63.75 $47.32 $47.32 $49.14 $33.21 $13.29 $63.75 $63.75 $37.71 $63.75 $63.75 $63.75 $63.75 $48.00 $63.75 $63.75 $63.75 $31.88 $31.88 $50.49 $63.75 $51.00 $41.44 $12.65 N/A $37.12 $63.75 $63.75 $63.75 $13.29 $63.75 N/A N/A G53145 SUP HCPCS C2617 G53145 - CATHETER URTH 16FR 34CM 30ML UNIVERSA 3W FL RND BLDR SIL BOTH IP/OP $20.50 $15.00 $4.02 $20.25 $9.11 $9.11 $9.11 $9.11 $20.25 $20.25 $20.25 $4.22 $20.25 $20.25 $20.25 $20.25 $20.25 $4.22 $20.25 $20.25 $11.98 $20.25 $20.25 $20.25 $20.25 $15.38 $20.25 $20.25 $20.25 $10.13 $10.13 $16.04 $20.25 $16.20 $9.11 $4.02 N/A $11.89 $20.25 $20.25 $20.25 $4.22 $20.25 N/A N/A G53146 SUP HCPCS C2617 G53146 - SET STNT .038IN 3CM PGTL CRV 5FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53178 SUP Custom 27203010 G53178 - TRAY TRCH 24-28FR LF CGL BLU RHINO G2 TRCH TUBE SHLY INTRO BOTH IP/OP "$1,142.50" $845.00 $203.37 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $203.37 "$1,142.50" "$1,142.50" $847.96 $847.96 $880.64 $595.24 $238.11 "$1,142.50" $457.00 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $856.88 "$1,142.50" "$1,142.50" "$1,142.50" $571.25 $571.25 $904.86 "$1,142.50" $914.00 $742.63 "$1,142.50" N/A $662.65 "$1,142.50" $685.50 "$1,142.50" "$1,142.50" "$1,142.50" N/A N/A G53179 SUP HCPCS C1769 G53179 - TRAY TRACHEOSTOMY 24-26-28FR 2 CANNU TUBE SHILEY CUFFED BOTH IP/OP "$1,142.50" $845.00 $226.76 "$1,142.50" $620.38 $620.38 $620.38 $620.38 "$1,142.50" "$1,142.50" "$1,142.50" $238.13 "$1,142.50" $847.96 $847.96 $880.64 $595.24 $238.11 "$1,142.50" "$1,142.50" $675.79 "$1,142.50" "$1,142.50" "$1,142.50" "$1,142.50" $856.88 "$1,142.50" "$1,142.50" "$1,142.50" $571.25 $571.25 $904.86 "$1,142.50" $914.00 $742.63 $226.76 N/A $662.65 "$1,142.50" "$1,142.50" "$1,142.50" $238.10 "$1,142.50" N/A N/A G53211 SUP HCPCS C1769 G53211 - SET STNT 2 PGTL CRV 8FR 22-32CM STRL UNIVERSA RADOPQ SFT BOTH IP/OP $68.00 $50.00 $13.41 $67.58 $36.70 $36.70 $36.70 $36.70 $67.58 $67.58 $67.58 $14.09 $67.58 $50.16 $50.16 $52.09 $35.21 $14.08 $67.58 $67.58 $39.97 $67.58 $67.58 $67.58 $67.58 $51.00 $67.58 $67.58 $67.58 $33.79 $33.79 $53.52 $67.58 $54.06 $43.93 $13.41 N/A $39.44 $67.58 $67.58 $67.58 $14.08 $67.58 N/A N/A G53235 SUP HCPCS C1758 G53235 - CATHETER URTH 26FR 34CM 30ML UNIVERSA 2W FL RND TIP CLS END BOTH IP/OP $27.00 $20.00 $5.27 $26.56 $14.42 $14.42 $14.42 $14.42 $26.56 $26.56 $26.56 $5.54 $26.56 $19.71 $19.71 $20.47 $13.84 $5.54 $26.56 $26.56 $15.71 $26.56 $26.56 $26.56 $26.56 $20.25 $26.56 $26.56 $26.56 $13.28 $13.28 $21.04 $26.56 $21.25 $17.26 $5.27 N/A $15.66 $26.56 $26.56 $26.56 $5.54 $26.56 N/A N/A G53236 SUP HCPCS C1758 G53236 - CATHETER URTH 18FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END BOTH IP/OP $32.00 $24.00 $6.33 $31.88 $17.31 $17.31 $17.31 $17.31 $31.88 $31.88 $31.88 $6.64 $31.88 $23.66 $23.66 $24.57 $16.61 $6.64 $31.88 $31.88 $18.86 $31.88 $31.88 $31.88 $31.88 $24.00 $31.88 $31.88 $31.88 $15.94 $15.94 $25.25 $31.88 $25.50 $20.72 $6.33 N/A $18.56 $31.88 $31.88 $31.88 $6.64 $31.88 N/A N/A G53237 SUP HCPCS C1758 G53237 - CATHETER URTH 20FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END BOTH IP/OP $32.00 $24.00 $6.33 $31.88 $17.31 $17.31 $17.31 $17.31 $31.88 $31.88 $31.88 $6.64 $31.88 $23.66 $23.66 $24.57 $16.61 $6.64 $31.88 $31.88 $18.86 $31.88 $31.88 $31.88 $31.88 $24.00 $31.88 $31.88 $31.88 $15.94 $15.94 $25.25 $31.88 $25.50 $20.72 $6.33 N/A $18.56 $31.88 $31.88 $31.88 $6.64 $31.88 N/A N/A G53238 SUP HCPCS C1758 G53238 - CATHETER URTH 22FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END BOTH IP/OP $32.00 $24.00 $6.33 $31.88 $17.31 $17.31 $17.31 $17.31 $31.88 $31.88 $31.88 $6.64 $31.88 $23.66 $23.66 $24.57 $16.61 $6.64 $31.88 $31.88 $18.86 $31.88 $31.88 $31.88 $31.88 $24.00 $31.88 $31.88 $31.88 $15.94 $15.94 $25.25 $31.88 $25.50 $20.72 $6.33 N/A $18.56 $31.88 $31.88 $31.88 $6.64 $31.88 N/A N/A G53240 SUP HCPCS C1758 G53240 - CATHETER URTH 24FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END BOTH IP/OP $32.00 $24.00 $6.33 $31.88 $17.31 $17.31 $17.31 $17.31 $31.88 $31.88 $31.88 $6.64 $31.88 $23.66 $23.66 $24.57 $16.61 $6.64 $31.88 $31.88 $18.86 $31.88 $31.88 $31.88 $31.88 $24.00 $31.88 $31.88 $31.88 $15.94 $15.94 $25.25 $31.88 $25.50 $20.72 $6.33 N/A $18.56 $31.88 $31.88 $31.88 $6.64 $31.88 N/A N/A G53241 SUP HCPCS C1758 G53241 - CATHETER URTH 26FR 34CM 30ML UNIVERSA 3W FL RND TIP CLS END BOTH IP/OP $32.00 $24.00 $6.33 $31.88 $17.31 $17.31 $17.31 $17.31 $31.88 $31.88 $31.88 $6.64 $31.88 $23.66 $23.66 $24.57 $16.61 $6.64 $31.88 $31.88 $18.86 $31.88 $31.88 $31.88 $31.88 $24.00 $31.88 $31.88 $31.88 $15.94 $15.94 $25.25 $31.88 $25.50 $20.72 $6.33 N/A $18.56 $31.88 $31.88 $31.88 $6.64 $31.88 N/A N/A G53242 SUP HCPCS C1758 G53242 - CATHETER URTH 16FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL BOTH IP/OP $32.00 $24.00 $6.33 $31.88 $17.31 $17.31 $17.31 $17.31 $31.88 $31.88 $31.88 $6.64 $31.88 $23.66 $23.66 $24.57 $16.61 $6.64 $31.88 $31.88 $18.86 $31.88 $31.88 $31.88 $31.88 $24.00 $31.88 $31.88 $31.88 $15.94 $15.94 $25.25 $31.88 $25.50 $20.72 $6.33 N/A $18.56 $31.88 $31.88 $31.88 $6.64 $31.88 N/A N/A G53243 SUP HCPCS C1758 G53243 - CATHETER URTH 18FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL BOTH IP/OP $32.00 $24.00 $6.33 $31.88 $17.31 $17.31 $17.31 $17.31 $31.88 $31.88 $31.88 $6.64 $31.88 $23.66 $23.66 $24.57 $16.61 $6.64 $31.88 $31.88 $18.86 $31.88 $31.88 $31.88 $31.88 $24.00 $31.88 $31.88 $31.88 $15.94 $15.94 $25.25 $31.88 $25.50 $20.72 $6.33 N/A $18.56 $31.88 $31.88 $31.88 $6.64 $31.88 N/A N/A G53244 SUP HCPCS C1758 G53244 - CATHETER URTH 20FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL BOTH IP/OP $32.00 $24.00 $6.33 $31.88 $17.31 $17.31 $17.31 $17.31 $31.88 $31.88 $31.88 $6.64 $31.88 $23.66 $23.66 $24.57 $16.61 $6.64 $31.88 $31.88 $18.86 $31.88 $31.88 $31.88 $31.88 $24.00 $31.88 $31.88 $31.88 $15.94 $15.94 $25.25 $31.88 $25.50 $20.72 $6.33 N/A $18.56 $31.88 $31.88 $31.88 $6.64 $31.88 N/A N/A G53245 SUP HCPCS C1758 G53245 - CATHETER URTH 22FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL BOTH IP/OP $32.00 $24.00 $6.33 $31.88 $17.31 $17.31 $17.31 $17.31 $31.88 $31.88 $31.88 $6.64 $31.88 $23.66 $23.66 $24.57 $16.61 $6.64 $31.88 $31.88 $18.86 $31.88 $31.88 $31.88 $31.88 $24.00 $31.88 $31.88 $31.88 $15.94 $15.94 $25.25 $31.88 $25.50 $20.72 $6.33 N/A $18.56 $31.88 $31.88 $31.88 $6.64 $31.88 N/A N/A G53246 SUP HCPCS C1758 G53246 - CATHETER URTH 24FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL BOTH IP/OP $32.00 $24.00 $6.33 $31.88 $17.31 $17.31 $17.31 $17.31 $31.88 $31.88 $31.88 $6.64 $31.88 $23.66 $23.66 $24.57 $16.61 $6.64 $31.88 $31.88 $18.86 $31.88 $31.88 $31.88 $31.88 $24.00 $31.88 $31.88 $31.88 $15.94 $15.94 $25.25 $31.88 $25.50 $20.72 $6.33 N/A $18.56 $31.88 $31.88 $31.88 $6.64 $31.88 N/A N/A G53418 SUP HCPCS C1874 G53418 - GRAFT EVAS BFUR 28MM 20FR 120MM ZNTH TX2 Z-TRK PROX PRFRM BOTH IP/OP "$30,235.00" "$22,374.00" "$6,000.89" "$30,235.00" "$13,605.75" "$13,605.75" "$13,605.75" "$13,605.75" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.73" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$14,905.86" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$6,000.89" N/A "$17,536.30" "$30,235.00" "$30,235.00" "$30,235.00" "$6,300.97" "$30,235.00" N/A N/A G53421 SUP HCPCS C1874 G53421 - GRAFT EVAS BFUR 30MM 20FR 120MM ZNTH TX2 PRFRM Z-TRK + SLF BOTH IP/OP "$30,235.00" "$22,374.00" "$6,000.89" "$30,235.00" "$13,605.75" "$13,605.75" "$13,605.75" "$13,605.75" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.73" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$30,235.00" "$14,905.86" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$6,000.89" N/A "$17,536.30" "$30,235.00" "$30,235.00" "$30,235.00" "$6,300.97" "$30,235.00" N/A N/A G53422 SUP Custom 27803010 G53422 - GRAFT EVAS BFUR 30MM 20FR 140MM ZNTH TX2 PRFRM Z-TRK + SLF BOTH IP/OP "$30,235.00" "$22,374.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$30,235.00" N/A "$17,536.30" "$30,235.00" "$18,141.00" "$30,235.00" "$30,235.00" "$30,235.00" N/A N/A G53423 SUP Custom 27803010 G53423 - GRAFT EVAS 30MM 20FR 200MM ZNTH TX2 DIST CMPNT PRFRM Z TRK + BOTH IP/OP "$30,235.00" "$22,374.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$30,235.00" N/A "$17,536.30" "$30,235.00" "$18,141.00" "$30,235.00" "$30,235.00" "$30,235.00" N/A N/A G53424 SUP Custom 27803010 G53424 - GRAFT EVAS BFUR 32MM 20FR 120MM ZNTH TX2 PRFRM Z-TRK + PROX BOTH IP/OP "$30,235.00" "$22,374.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$30,235.00" N/A "$17,536.30" "$30,235.00" "$18,141.00" "$30,235.00" "$30,235.00" "$30,235.00" N/A N/A G53426 SUP HCPCS C1874 G53426 - GRAFT EVAS 2 BRCH 32MM 20FR 200MM ZNTH TX2 PROX PRFRM Z-TRK BOTH IP/OP "$30,235.00" "$22,374.00" "$6,000.89" "$30,235.00" "$13,605.75" "$13,605.75" "$13,605.75" "$13,605.75" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.73" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$30,235.00" "$14,905.86" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$6,000.89" N/A "$17,536.30" "$30,235.00" "$30,235.00" "$30,235.00" "$6,300.97" "$30,235.00" N/A N/A G53427 SUP HCPCS C1874 G53427 - GRAFT EVAS 2 BRCH CYL 34MM 20FR 127MM STRL PRFRM Z-TRK + BOTH IP/OP "$30,235.00" "$22,374.00" "$6,000.89" "$30,235.00" "$13,605.75" "$13,605.75" "$13,605.75" "$13,605.75" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.73" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$30,235.00" "$14,905.86" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$6,000.89" N/A "$17,536.30" "$30,235.00" "$30,235.00" "$30,235.00" "$6,300.97" "$30,235.00" N/A N/A G53428 SUP Custom 27803010 G53428 - GRAFT EVAS BFUR 34MM 20FR 152MM ZNTH TX2 PRFRM Z-TRK + SLF BOTH IP/OP "$30,235.00" "$22,374.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$30,235.00" N/A "$17,536.30" "$30,235.00" "$18,141.00" "$30,235.00" "$30,235.00" "$30,235.00" N/A N/A G53429 SUP Custom 27803010 G53429 - GRAFT EVAS BFUR 34MM 20FR 202MM ZNTH TX2 PRFRM Z-TRK + PROX BOTH IP/OP "$30,235.00" "$22,374.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$30,235.00" N/A "$17,536.30" "$30,235.00" "$18,141.00" "$30,235.00" "$30,235.00" "$30,235.00" N/A N/A G53430 SUP Custom 27803010 G53430 - GRAFT EVAS BFUR 36MM 22FR 127MM ZNTH TX2 PRFRM Z-TRK + SLF BOTH IP/OP "$30,235.00" "$22,374.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$30,235.00" N/A "$17,536.30" "$30,235.00" "$18,141.00" "$30,235.00" "$30,235.00" "$30,235.00" N/A N/A G53433 SUP HCPCS C1874 G53433 - GRAFT EVAS 2 BRCH 38MM 22FR 127MM ZNTH TX2 PRFRM Z-TRK + SLF BOTH IP/OP "$30,235.00" "$22,374.00" "$6,000.89" "$30,235.00" "$13,605.75" "$13,605.75" "$13,605.75" "$13,605.75" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.73" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$30,235.00" "$14,905.86" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$6,000.89" N/A "$17,536.30" "$30,235.00" "$30,235.00" "$30,235.00" "$6,300.97" "$30,235.00" N/A N/A G53434 SUP Custom 27803010 G53434 - GRAFT EVAS BFUR 38MM 22FR 152MM ZNTH TX2 PRFRM Z-TRK + SLF BOTH IP/OP "$30,235.00" "$22,374.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$30,235.00" N/A "$17,536.30" "$30,235.00" "$18,141.00" "$30,235.00" "$30,235.00" "$30,235.00" N/A N/A G53435 SUP Custom 27803010 G53435 - GRAFT EVAS BFUR 38MM 22FR 202MM ZNTH TX2 PRFRM Z-TRK + SLF BOTH IP/OP "$30,235.00" "$22,374.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$30,235.00" N/A "$17,536.30" "$30,235.00" "$18,141.00" "$30,235.00" "$30,235.00" "$30,235.00" N/A N/A G53436 SUP Custom 27803010 G53436 - GRAFT EVAS BFUR 40MM 22FR 135MM ZNTH TX2 PRFRM Z-TRK + SLF BOTH IP/OP "$30,235.00" "$22,374.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$30,235.00" N/A "$17,536.30" "$30,235.00" "$18,141.00" "$30,235.00" "$30,235.00" "$30,235.00" N/A N/A G53440 SUP Custom 27803010 G53440 - GRAFT EVAS BFUR 42MM 22FR 162MM ZNTH TX2 PRFRM Z-TRK + SLF BOTH IP/OP "$30,235.00" "$22,374.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$30,235.00" N/A "$17,536.30" "$30,235.00" "$18,141.00" "$30,235.00" "$30,235.00" "$30,235.00" N/A N/A G53441 SUP Custom 27803010 G53441 - GRAFT EVAS BFUR 42MM 22FR 216MM ZNTH TX2 PRFRM Z-TRK + SLF BOTH IP/OP "$30,235.00" "$22,374.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$30,235.00" N/A "$17,536.30" "$30,235.00" "$18,141.00" "$30,235.00" "$30,235.00" "$30,235.00" N/A N/A G53442 SUP Custom 27803010 G53442 - GRAFT EVAS BFUR 32MM 20FR 160MM ZNTH TX2 PRFRM Z-TRK + SLF BOTH IP/OP "$30,235.00" "$22,374.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$30,235.00" N/A "$17,536.30" "$30,235.00" "$18,141.00" "$30,235.00" "$30,235.00" "$30,235.00" N/A N/A G53446 SUP Custom 27803010 G53446 - GRAFT EVAS BFUR 36MM 22FR 157MM ZNTH TX2 PRFRM Z-TRK + SLF BOTH IP/OP "$30,235.00" "$22,374.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$30,235.00" N/A "$17,536.30" "$30,235.00" "$18,141.00" "$30,235.00" "$30,235.00" "$30,235.00" N/A N/A G53449 SUP HCPCS C1874 G53449 - GRAFT EVAS CYL TPR 38-34MM 8.5MM 22FR 202MM STRL PRFRM Z-TRK BOTH IP/OP "$30,235.00" "$22,374.00" "$6,000.89" "$30,235.00" "$13,605.75" "$13,605.75" "$13,605.75" "$13,605.75" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.73" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$30,235.00" "$14,905.86" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$6,000.89" N/A "$17,536.30" "$30,235.00" "$30,235.00" "$30,235.00" "$6,300.97" "$30,235.00" N/A N/A G53450 SUP Custom 27803010 G53450 - GRAFT EVAS 40MM 22FR 158MM ZNTH TX2 PROX TPR CMPNT PRFRM BOTH IP/OP "$30,235.00" "$22,374.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$5,381.83" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$6,301.31" "$30,235.00" "$12,094.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$30,235.00" "$22,676.25" "$30,235.00" "$30,235.00" "$30,235.00" "$15,117.50" "$15,117.50" "$23,946.12" "$30,235.00" "$24,188.00" "$13,605.75" "$30,235.00" N/A "$17,536.30" "$30,235.00" "$18,141.00" "$30,235.00" "$30,235.00" "$30,235.00" N/A N/A G53454 SUP Custom 27803010 G53454 - GRAFT EVAS 28MM 20FR 80MM ZNTH TX2 TBE CMPNT PROX XTN PRFRM BOTH IP/OP "$12,996.50" "$9,617.00" "$2,313.29" "$12,996.03" "$12,996.03" "$12,996.03" "$12,996.03" "$12,996.03" "$12,996.03" "$12,996.03" "$2,313.29" "$12,996.03" "$12,996.03" "$12,996.03" "$12,996.03" "$12,996.03" "$12,996.03" "$2,708.52" "$12,996.03" "$5,198.41" "$12,996.03" "$12,996.03" "$12,996.03" "$12,996.03" "$12,996.03" "$9,747.38" "$12,996.03" "$12,996.03" "$12,996.03" "$6,498.02" "$6,498.02" "$10,292.86" "$12,996.03" "$10,396.82" "$5,848.21" "$12,996.03" N/A "$7,537.97" "$12,996.03" "$7,797.62" "$12,996.03" "$12,996.03" "$12,996.03" N/A N/A G53455 SUP Custom 27803010 G53455 - GRAFT EVAS BFUR 30MM 20FR 80MM ZNTH TX2 PRFRM Z-TRK + PROX BOTH IP/OP "$12,995.00" "$9,616.00" "$2,313.11" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,313.11" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,708.30" "$12,995.00" "$5,198.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$9,746.25" "$12,995.00" "$12,995.00" "$12,995.00" "$6,497.50" "$6,497.50" "$10,292.04" "$12,995.00" "$10,396.00" "$5,847.75" "$12,995.00" N/A "$7,537.10" "$12,995.00" "$7,797.00" "$12,995.00" "$12,995.00" "$12,995.00" N/A N/A G53456 SUP Custom 27803010 G53456 - GRAFT EVAS BFUR 32MM 20FR 80MM ZNTH TX2 PRFRM Z-TRK + SLF BOTH IP/OP "$12,995.00" "$9,616.00" "$2,313.11" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,313.11" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,708.30" "$12,995.00" "$5,198.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$9,746.25" "$12,995.00" "$12,995.00" "$12,995.00" "$6,497.50" "$6,497.50" "$10,292.04" "$12,995.00" "$10,396.00" "$5,847.75" "$12,995.00" N/A "$7,537.10" "$12,995.00" "$7,797.00" "$12,995.00" "$12,995.00" "$12,995.00" N/A N/A G53457 SUP Custom 27803010 G53457 - GRAFT EVAS 34MM 20FR 77MM ZNTH TX2 DIST XTN TBE CMPNT PRFRM BOTH IP/OP "$12,995.00" "$9,616.00" "$2,313.11" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,313.11" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,708.30" "$12,995.00" "$5,198.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$9,746.25" "$12,995.00" "$12,995.00" "$12,995.00" "$6,497.50" "$6,497.50" "$10,292.04" "$12,995.00" "$10,396.00" "$5,847.75" "$12,995.00" N/A "$7,537.10" "$12,995.00" "$7,797.00" "$12,995.00" "$12,995.00" "$12,995.00" N/A N/A G53458 SUP Custom 27803010 G53458 - GRAFT EVAS 36MM 22FR 77MM ZNTH TX2 PROX XTN Z-TRK + TAA BOTH IP/OP "$12,995.00" "$9,616.00" "$2,313.11" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,313.11" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,708.30" "$12,995.00" "$5,198.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$9,746.25" "$12,995.00" "$12,995.00" "$12,995.00" "$6,497.50" "$6,497.50" "$10,292.04" "$12,995.00" "$10,396.00" "$5,847.75" "$12,995.00" N/A "$7,537.10" "$12,995.00" "$7,797.00" "$12,995.00" "$12,995.00" "$12,995.00" N/A N/A G53459 SUP Custom 27803010 G53459 - GRAFT EVAS 38MM 22FR 77MM ZNTH TX2 PROX XTN PRFRM Z TRK + BOTH IP/OP "$12,995.00" "$9,616.00" "$2,313.11" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,313.11" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,708.30" "$12,995.00" "$5,198.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$9,746.25" "$12,995.00" "$12,995.00" "$12,995.00" "$6,497.50" "$6,497.50" "$10,292.04" "$12,995.00" "$10,396.00" "$5,847.75" "$12,995.00" N/A "$7,537.10" "$12,995.00" "$7,797.00" "$12,995.00" "$12,995.00" "$12,995.00" N/A N/A G53460 SUP Custom 27803010 G53460 - GRAFT EVAS BFUR 40MM 22FR 81MM ZNTH TX2 PRFRM Z-TRK + SLF BOTH IP/OP "$12,995.00" "$9,616.00" "$2,313.11" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,313.11" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,708.30" "$12,995.00" "$5,198.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$9,746.25" "$12,995.00" "$12,995.00" "$12,995.00" "$6,497.50" "$6,497.50" "$10,292.04" "$12,995.00" "$10,396.00" "$5,847.75" "$12,995.00" N/A "$7,537.10" "$12,995.00" "$7,797.00" "$12,995.00" "$12,995.00" "$12,995.00" N/A N/A G53461 SUP Custom 27803010 G53461 - GRAFT EVAS 42MM 22FR 81MM ZNTH TX2 PROX XTN PRFRM Z-TRK + BOTH IP/OP "$12,995.00" "$9,616.00" "$2,313.11" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,313.11" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,708.30" "$12,995.00" "$5,198.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$9,746.25" "$12,995.00" "$12,995.00" "$12,995.00" "$6,497.50" "$6,497.50" "$10,292.04" "$12,995.00" "$10,396.00" "$5,847.75" "$12,995.00" N/A "$7,537.10" "$12,995.00" "$7,797.00" "$12,995.00" "$12,995.00" "$12,995.00" N/A N/A G53463 SUP HCPCS C1874 G53463 - GRAFT EVAS 30MM 7.7MM 20FR 80MM STRL ZNTH TX2 PRFRM ESBE BOTH IP/OP "$12,995.00" "$9,616.00" "$2,579.18" "$12,995.00" "$5,847.75" "$5,847.75" "$5,847.75" "$5,847.75" "$12,995.00" "$12,995.00" "$12,995.00" "$2,708.48" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$2,708.30" "$12,995.00" "$12,995.00" "$6,406.54" "$12,995.00" "$12,995.00" "$12,995.00" "$12,995.00" "$9,746.25" "$12,995.00" "$12,995.00" "$12,995.00" "$6,497.50" "$6,497.50" "$10,292.04" "$12,995.00" "$10,396.00" "$5,847.75" "$2,579.18" N/A "$7,537.10" "$12,995.00" "$12,995.00" "$12,995.00" "$2,708.16" "$12,995.00" N/A N/A G53486 SUP Custom 27803010 G53486 - GRAFT EVAS 42MM 22FR 144MM ZNTH TX2 PRFRM Z TRK + INTRO SYS BOTH IP/OP "$16,442.50" "$12,167.00" "$2,926.77" "$16,442.50" "$16,442.50" "$16,442.50" "$16,442.50" "$16,442.50" "$16,442.50" "$16,442.50" "$2,926.77" "$16,442.50" "$16,442.50" "$16,442.50" "$16,442.50" "$16,442.50" "$16,442.50" "$3,426.80" "$16,442.50" "$6,577.00" "$16,442.50" "$16,442.50" "$16,442.50" "$16,442.50" "$16,442.50" "$12,331.88" "$16,442.50" "$16,442.50" "$16,442.50" "$8,221.25" "$8,221.25" "$13,022.46" "$16,442.50" "$13,154.00" "$7,399.13" "$16,442.50" N/A "$9,536.65" "$16,442.50" "$9,865.50" "$16,442.50" "$16,442.50" "$16,442.50" N/A N/A G53556 SUP HCPCS C1769 G53556 - CATHETER URTH 26FR 34CM 30ML UNIVERSA 3W FL OP-EN SIL BOTH IP/OP $7.00 $5.00 $1.34 $6.76 $3.67 $3.67 $3.67 $3.67 $6.76 $6.76 $6.76 $1.41 $6.76 $5.02 $5.02 $5.21 $3.52 $1.41 $6.76 $6.76 $4.00 $6.76 $6.76 $6.76 $6.76 $5.25 $6.76 $6.76 $6.76 $3.38 $3.38 $5.35 $6.76 $5.41 $4.39 $1.34 N/A $4.06 $6.76 $6.76 $6.76 $1.41 $6.76 N/A N/A G53557 SUP HCPCS C1769 G53557 - GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ FLXB STF BOTH IP/OP $68.00 $50.00 $13.41 $67.58 $36.70 $36.70 $36.70 $36.70 $67.58 $67.58 $67.58 $14.09 $67.58 $50.16 $50.16 $52.09 $35.21 $14.08 $67.58 $27.03 $39.97 $67.58 $67.58 $67.58 $67.58 $51.00 $67.58 $67.58 $67.58 $33.79 $33.79 $53.52 $67.58 $54.06 $43.93 $13.41 N/A $39.44 $67.58 $67.58 $67.58 $14.08 $67.58 N/A N/A G53558 SUP HCPCS C1769 G53558 - GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ 2 FLXB STF BOTH IP/OP $68.00 $50.00 $13.41 $67.58 $36.70 $36.70 $36.70 $36.70 $67.58 $67.58 $67.58 $14.09 $67.58 $50.16 $50.16 $52.09 $35.21 $14.08 $67.58 $67.58 $39.97 $67.58 $67.58 $67.58 $67.58 $51.00 $67.58 $67.58 $67.58 $33.79 $33.79 $53.52 $67.58 $54.06 $43.93 $13.41 N/A $39.44 $67.58 $67.58 $67.58 $14.08 $67.58 N/A N/A G53559 SUP HCPCS C1769 G53559 - GUIDEWIRE ESCP STRG .025IN 145CM STRL 5CM AMPTZ XSTF FXCR BOTH IP/OP $68.00 $50.00 $13.41 $67.58 $36.70 $36.70 $36.70 $36.70 $67.58 $67.58 $67.58 $14.09 $67.58 $50.16 $50.16 $52.09 $35.21 $14.08 $67.58 $27.03 $39.97 $67.58 $67.58 $67.58 $67.58 $51.00 $67.58 $67.58 $67.58 $33.79 $33.79 $53.52 $67.58 $54.06 $43.93 $13.41 N/A $39.44 $67.58 $67.58 $67.58 $14.08 $67.58 N/A N/A G53560 SUP HCPCS C1769 G53560 - CATHETER NPHSTM 8MM 15CM ULTRX BOTH IP/OP $68.00 $50.00 $13.41 $67.58 $36.70 $36.70 $36.70 $36.70 $67.58 $67.58 $67.58 $14.09 $67.58 $50.16 $50.16 $52.09 $35.21 $14.08 $67.58 $67.58 $39.97 $67.58 $67.58 $67.58 $67.58 $51.00 $67.58 $67.58 $67.58 $33.79 $33.79 $53.52 $67.58 $54.06 $43.93 $13.41 N/A $39.44 $67.58 $67.58 $67.58 $14.08 $67.58 N/A N/A G53561 SUP HCPCS C1769 G53561 - GUIDEWIRE ESCP .035IN STRG 145CM 5CM AMPTZ FLX TP FXCR XSTF BOTH IP/OP $88.50 $65.00 $17.49 $88.13 $47.85 $47.85 $47.85 $47.85 $88.13 $88.13 $88.13 $18.37 $88.13 $65.41 $65.41 $67.93 $45.92 $18.37 $88.13 $88.13 $52.13 $88.13 $88.13 $88.13 $88.13 $66.38 $88.13 $88.13 $88.13 $44.07 $44.07 $69.80 $88.13 $70.50 $57.28 $17.49 N/A $51.33 $88.13 $88.13 $88.13 $18.37 $88.13 N/A N/A G53562 SUP HCPCS C1769 G53562 - GUIDEWIRE ESCP STRG .035IN 260CM STRL 5CM AMPTZ XSTF FXCR BOTH IP/OP $88.50 $65.00 $17.49 $88.13 $47.85 $47.85 $47.85 $47.85 $88.13 $88.13 $88.13 $18.37 $88.13 $65.41 $65.41 $67.93 $45.92 $18.37 $88.13 $88.13 $52.13 $88.13 $88.13 $88.13 $88.13 $66.38 $88.13 $88.13 $88.13 $44.07 $44.07 $69.80 $88.13 $70.50 $57.28 $17.49 N/A $51.33 $88.13 $88.13 $88.13 $18.37 $88.13 N/A N/A G53563 SUP HCPCS C1769 G53563 - GUIDEWIRE ESCP STRG .038IN 260CM STRL 5CM AMPTZ XSTF FXCR BOTH IP/OP $68.00 $50.00 $13.41 $67.58 $36.70 $36.70 $36.70 $36.70 $67.58 $67.58 $67.58 $14.09 $67.58 $50.16 $50.16 $52.09 $35.21 $14.08 $67.58 $67.58 $39.97 $67.58 $67.58 $67.58 $67.58 $51.00 $67.58 $67.58 $67.58 $33.79 $33.79 $53.52 $67.58 $54.06 $43.93 $13.41 N/A $39.44 $67.58 $67.58 $67.58 $14.08 $67.58 N/A N/A G53564 SUP HCPCS C1769 G53564 - GUIDEWIRE VASC STRG .035IN 145CM STRL 5CM AMPTZ 2 FLX TP BOTH IP/OP $68.00 $50.00 $13.41 $67.58 $36.70 $36.70 $36.70 $36.70 $67.58 $67.58 $67.58 $14.09 $67.58 $50.16 $50.16 $52.09 $35.21 $14.08 $67.58 $67.58 $39.97 $67.58 $67.58 $67.58 $67.58 $51.00 $67.58 $67.58 $67.58 $33.79 $33.79 $53.52 $67.58 $54.06 $43.93 $13.41 N/A $39.44 $67.58 $67.58 $67.58 $14.08 $67.58 N/A N/A G53566 SUP HCPCS C1769 G53566 - GUIDEWIRE URO STRG .038IN 145CM 5CM AMPTZ 2 FLX TP FX COR BOTH IP/OP $68.00 $50.00 $13.41 $67.58 $36.70 $36.70 $36.70 $36.70 $67.58 $67.58 $67.58 $14.09 $67.58 $50.16 $50.16 $52.09 $35.21 $14.08 $67.58 $67.58 $39.97 $67.58 $67.58 $67.58 $67.58 $51.00 $67.58 $67.58 $67.58 $33.79 $33.79 $53.52 $67.58 $54.06 $43.93 $13.41 N/A $39.44 $67.58 $67.58 $67.58 $14.08 $67.58 N/A N/A G53567 SUP HCPCS C1769 G53567 - GUIDEWIRE VASC STRG .035IN 145CM 5CM AMPTZ 2 FLX TP FXCR ULT BOTH IP/OP $68.00 $50.00 $13.41 $67.58 $36.70 $36.70 $36.70 $36.70 $67.58 $67.58 $67.58 $14.09 $67.58 $50.16 $50.16 $52.09 $35.21 $14.08 $67.58 $67.58 $39.97 $67.58 $67.58 $67.58 $67.58 $51.00 $67.58 $67.58 $67.58 $33.79 $33.79 $53.52 $67.58 $54.06 $43.93 $13.41 N/A $39.44 $67.58 $67.58 $67.58 $14.08 $67.58 N/A N/A G53568 SUP HCPCS C1769 G53568 - GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ FLXB ULT STF BOTH IP/OP $68.00 $50.00 $13.41 $67.58 $36.70 $36.70 $36.70 $36.70 $67.58 $67.58 $67.58 $14.09 $67.58 $50.16 $50.16 $52.09 $35.21 $14.08 $67.58 $67.58 $39.97 $67.58 $67.58 $67.58 $67.58 $51.00 $67.58 $67.58 $67.58 $33.79 $33.79 $53.52 $67.58 $54.06 $43.93 $13.41 N/A $39.44 $67.58 $67.58 $67.58 $14.08 $67.58 N/A N/A G53569 SUP HCPCS C1769 G53569 - GUIDEWIRE VASC STRG .035IN 145CM STRL 5CM AMPTZ 2 FLXB ULT BOTH IP/OP $68.00 $50.00 $13.41 $67.58 $36.70 $36.70 $36.70 $36.70 $67.58 $67.58 $67.58 $14.09 $67.58 $50.16 $50.16 $52.09 $35.21 $14.08 $67.58 $67.58 $39.97 $67.58 $67.58 $67.58 $67.58 $51.00 $67.58 $67.58 $67.58 $33.79 $33.79 $53.52 $67.58 $54.06 $43.93 $13.41 N/A $39.44 $67.58 $67.58 $67.58 $14.08 $67.58 N/A N/A G53672 SUP HCPCS C2617 G53672 - GUIDEWIRE VASC STRG .038IN 145CM STRL 5CM AMPTZ 2 FLXB ULT BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53674 SUP HCPCS C2617 G53674 - SET STNT .038IN 3CM PGTL CRV 5FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53675 SUP HCPCS C2617 G53675 - SET STNT .038IN 3CM PGTL CRV 5FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53676 SUP HCPCS C2617 G53676 - SET STNT 3CM PGTL CRV 5FR 22CM STRL 145CM UNIVERSA RADOPQ BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53677 SUP HCPCS C2617 G53677 - SET STNT .038IN 3CM PGTL CRV 5FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53678 SUP HCPCS C2617 G53678 - SET STNT .038IN 3CM PGTL CRV 5FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53680 SUP HCPCS C2617 G53680 - SET STNT .038IN 3CM PGTL CRV 5FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53681 SUP HCPCS C2617 G53681 - SET STNT 2 PGTL CRV 5FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53682 SUP HCPCS C2617 G53682 - SET STNT 2 PGTL CRV 5FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53683 SUP HCPCS C2617 G53683 - SET STNT 2 PGTL CRV 5FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53684 SUP HCPCS C2617 G53684 - SET STNT 2 PGTL CRV 5FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53685 SUP HCPCS C2617 G53685 - SET STNT 2 PGTL CRV 5FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53686 SUP HCPCS C2617 G53686 - SET STNT 2 PGTL CRV 5FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53687 SUP HCPCS C2617 G53687 - SET STNT 2 PGTL CRV 5FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53688 SUP HCPCS C2617 G53688 - SET STNT .038IN 3CM PGTL CRV 5FR 22-32CM STRL 145CM UNIVERSA BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53689 SUP HCPCS C2617 G53689 - SET STNT 2 PGTL CRV 5FR 22-32CM STRL UNIVERSA PSTNR BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53690 SUP HCPCS C2617 G53690 - SET STNT 2 PGTL CRV 6FR 18CM UNIVERSA SFT GRAD MRK BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53691 SUP HCPCS C2617 G53691 - SET STNT PGTL CRV 6FR 20CM UNIVERSA SFT GRAD MRK BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53692 SUP HCPCS C2617 G53692 - SET STNT 2 PGTL CRV 6FR 22CM UNIVERSA SFT GRAD MRK BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53693 SUP HCPCS C2617 G53693 - SET STNT .038IN 3CM PGTL CRV 6FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53694 SUP HCPCS C2617 G53694 - SET STNT .038IN 3CM PGTL CRV 6FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53695 SUP HCPCS C2617 G53695 - SET STNT PGTL CRV 6FR 28CM UNIVERSA GW SFT GRAD MRK BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53696 SUP HCPCS C2617 G53696 - SET STNT .038IN 3CM PGTL CRV 6FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53697 SUP HCPCS C2617 G53697 - SET STNT 2 PGTL CRV 6FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53698 SUP HCPCS C2617 G53698 - SET STNT 6FR 22CM STRL LF UNIVERSA PSTNR GW BRD TETH RADOPQ BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53699 SUP HCPCS C2617 G53699 - SET STNT 2 PGTL CRV 6FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53700 SUP HCPCS C2617 G53700 - SET STNT 6FR 26CM STRL LF UNIVERSA PSTNR GW BRD TETH RADOPQ BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53701 SUP HCPCS C2617 G53701 - SET STNT 6FR 24CM STRL LF UNIVERSA PSTNR GW BRD TETH RADOPQ BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53702 SUP HCPCS C2617 G53702 - SET STNT 2 PGTL CRV 6FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53703 SUP HCPCS C2617 G53703 - SET STNT 2 PGTL CRV 6FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53704 SUP HCPCS C2617 G53704 - SET STNT .038IN 3CM PGTL CRV 6FR 22-32CM STRL 145CM UNIVERSA BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53706 SUP HCPCS C2617 G53706 - SET STNT 2 PGTL CRV 6FR 22-32CM STRL UNIVERSA RADOPQ MTLNTH BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53707 SUP HCPCS C2617 G53707 - SET STNT 3CM PGTL CRV 7FR 22-32CM STRL LF 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53708 SUP HCPCS C2617 G53708 - SET STNT .038IN 3CM PGTL CRV 7FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53709 SUP HCPCS C2617 G53709 - SET STNT .038IN 3CM PGTL CRV 7FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53710 SUP HCPCS C2617 G53710 - SET STNT .038IN 3CM PGTL CRV 7FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53711 SUP HCPCS C2617 G53711 - SET STNT .038IN 3CM PGTL CRV 7FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53712 SUP HCPCS C2617 G53712 - SET STNT .038IN 3CM PGTL CRV 7FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53713 SUP HCPCS C2617 G53713 - SET STNT .038IN 3CM PGTL CRV 7FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53714 SUP HCPCS C2617 G53714 - SET STNT .038IN 3CM PGTL CRV 7FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53715 SUP HCPCS C2617 G53715 - SET STNT 2 PGTL CRV 7FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53716 SUP HCPCS C2617 G53716 - SET STNT 2 PGTL CRV 7FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53717 SUP HCPCS C2617 G53717 - SET STNT 2 PGTL CRV 7FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53718 SUP HCPCS C2617 G53718 - SET STNT 2 PGTL CRV 7FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53719 SUP HCPCS C2617 G53719 - SET STNT 2 PGTL CRV 7FR 26CM STRL LF UNIVERSA RADOPQ SFT BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53720 SUP HCPCS C2617 G53720 - SET STNT 2 PGTL CRV 7FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53721 SUP HCPCS C2617 G53721 - SET STNT 2 PGTL CRV 7FR 30CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53722 SUP HCPCS C2617 G53722 - SET STNT .038IN 3CM PGTL CRV 8FR 22-32CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53723 SUP HCPCS C2617 G53723 - SET STNT .038IN 3CM PGTL CRV 8FR 18CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53724 SUP HCPCS C2617 G53724 - SET STNT .038IN 3CM PGTL CRV 8FR 20CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53725 SUP HCPCS C2617 G53725 - SET STNT .038IN 3CM PGTL CRV 8FR 22CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53726 SUP HCPCS C2617 G53726 - SET STNT .038IN 3CM PGTL CRV 8FR 24CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53727 SUP HCPCS C2617 G53727 - SET STNT .038IN 3CM PGTL CRV 8FR 26CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53728 SUP HCPCS C2617 G53728 - SET STNT .038IN 3CM PGTL CRV 8FR 28CM STRL 145CM UNIVERSA BOTH IP/OP $202.50 $150.00 $40.19 $202.50 $91.13 $91.13 $91.13 $91.13 $202.50 $202.50 $202.50 $42.21 $202.50 $202.50 $202.50 $202.50 $202.50 $42.20 $202.50 $202.50 $119.78 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $91.13 $40.19 N/A $117.45 $202.50 $202.50 $202.50 $42.20 $202.50 N/A N/A G53729 SUP HCPCS C2617 G53729 - SET STNT .038IN 3CM PGTL CRV 8FR 30CM STRL 145CM UNIVERSA BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53731 SUP HCPCS C2617 G53731 - SET STNT 2 PGTL CRV 8FR 18CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53732 SUP HCPCS C2617 G53732 - SET STNT 2 PGTL CRV 8FR 20CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53734 SUP HCPCS C2617 G53734 - SET STNT 2 PGTL CRV 8FR 22CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53735 SUP HCPCS C2617 G53735 - SET STNT 2 PGTL CRV 8FR 24CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53736 SUP HCPCS C2617 G53736 - SET STNT 2 PGTL CRV 8FR 26CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G53737 SUP HCPCS C2617 G53737 - SET STNT 2 PGTL CRV 8FR 28CM STRL UNIVERSA RADOPQ SFT PSTNR BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $84.38 $84.38 $84.38 $84.38 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $187.50 $187.50 $187.50 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $84.38 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G54613 SUP HCPCS C1763 G54613 - GRAFT SOFT TISSUE .4CM SET PLUG BUTTON BIODESIGN SURGISIS BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,612.50" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,612.50" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A G54614 SUP HCPCS C1763 G54614 - GRAFT ENDOVASCULAR .7CM SET PLUG BUTTON BIODESIGN SURGISIS BOTH IP/OP "$2,612.50" "$1,933.00" $518.52 "$2,825.00" "$1,175.63" "$1,175.63" "$1,175.63" "$1,175.63" "$2,612.50" "$2,612.50" "$2,612.50" $544.51 "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" $544.47 "$2,612.50" "$2,825.00" "$1,287.96" "$2,612.50" "$2,612.50" "$2,612.50" "$2,612.50" "$1,959.38" "$2,612.50" "$2,612.50" "$2,612.50" "$1,306.25" "$1,306.25" "$2,069.10" "$2,612.50" "$2,090.00" "$1,175.63" $518.52 N/A "$1,515.25" "$2,612.50" "$2,612.50" "$2,612.50" $544.45 "$2,612.50" N/A N/A G55230 SUP HCPCS C1874 G55230 - GRAFT EVAS 2 BRCH 13MM 5.4MM 14FR 39MM STRL ZNTH SPRLZ Z-TRK BOTH IP/OP "$7,712.50" "$5,707.00" "$1,530.74" "$7,712.50" "$3,470.63" "$3,470.63" "$3,470.63" "$3,470.63" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.48" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.37" "$7,712.50" "$7,712.50" "$3,802.26" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$5,784.38" "$7,712.50" "$7,712.50" "$7,712.50" "$3,856.25" "$3,856.25" "$6,108.30" "$7,712.50" "$6,170.00" "$3,470.63" "$1,530.74" N/A "$4,473.25" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.29" "$7,712.50" N/A N/A G55231 SUP HCPCS C1874 G55231 - GRAFT EVAS 2 BRCH 13MM 5.4MM 14FR 56MM STRL ZNTH SPRLZ Z-TRK BOTH IP/OP "$7,712.50" "$5,707.00" "$1,530.74" "$7,712.50" "$3,470.63" "$3,470.63" "$3,470.63" "$3,470.63" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.48" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.37" "$7,712.50" "$7,712.50" "$3,802.26" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$5,784.38" "$7,712.50" "$7,712.50" "$7,712.50" "$3,856.25" "$3,856.25" "$6,108.30" "$7,712.50" "$6,170.00" "$3,470.63" "$1,530.74" N/A "$4,473.25" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.29" "$7,712.50" N/A N/A G55236 SUP HCPCS C1874 G55236 - GRAFT EVAS 2 BRCH 16MM 14FR 39MM SPRLZ ZNTH Z-TRK SLF XPD LG BOTH IP/OP "$7,712.50" "$5,707.00" "$1,530.74" "$7,712.50" "$3,470.63" "$3,470.63" "$3,470.63" "$3,470.63" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.48" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.37" "$7,712.50" "$7,712.50" "$3,802.26" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$5,784.38" "$7,712.50" "$7,712.50" "$7,712.50" "$3,856.25" "$3,856.25" "$6,108.30" "$7,712.50" "$6,170.00" "$3,470.63" "$1,530.74" N/A "$4,473.25" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.29" "$7,712.50" N/A N/A G55237 SUP HCPCS C1874 G55237 - GRAFT EVAS BFUR 16MM 5.4MM 14FR 56MM ZNTH SPRLZ ANCLRY BOTH IP/OP "$7,712.50" "$5,707.00" "$1,530.74" "$7,712.50" "$3,470.63" "$3,470.63" "$3,470.63" "$3,470.63" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.48" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.37" "$7,712.50" "$7,712.50" "$3,802.26" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$5,784.38" "$7,712.50" "$7,712.50" "$7,712.50" "$3,856.25" "$3,856.25" "$6,108.30" "$7,712.50" "$6,170.00" "$3,470.63" "$1,530.74" N/A "$4,473.25" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.29" "$7,712.50" N/A N/A G55242 SUP HCPCS C1874 G55242 - GRAFT EVAS 2 BRCH 20MM 6MM 16FR 74MM ZNTH SPRLZ ILC LG BOTH IP/OP "$7,712.50" "$5,707.00" "$1,530.74" "$7,712.50" "$3,470.63" "$3,470.63" "$3,470.63" "$3,470.63" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.48" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.37" "$7,712.50" "$7,712.50" "$3,802.26" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$5,784.38" "$7,712.50" "$7,712.50" "$7,712.50" "$3,856.25" "$3,856.25" "$6,108.30" "$7,712.50" "$6,170.00" "$3,470.63" "$1,530.74" N/A "$4,473.25" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.29" "$7,712.50" N/A N/A G55243 SUP Custom 27803010 G55243 - GRAFT EVAS 2 BRCH 20MM 16FR 90MM SPRLZ ZNTH Z-TRK SLF XPD LG BOTH IP/OP "$7,712.50" "$5,707.00" "$1,372.83" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$1,372.83" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.37" "$7,712.50" "$3,085.00" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$5,784.38" "$7,712.50" "$7,712.50" "$7,712.50" "$3,856.25" "$3,856.25" "$6,108.30" "$7,712.50" "$6,170.00" "$3,470.63" "$7,712.50" N/A "$4,473.25" "$7,712.50" "$4,627.50" "$7,712.50" "$7,712.50" "$7,712.50" N/A N/A G55245 SUP Custom 27803010 G55245 - GRAFT EVAS 24MM 6MM 5.3MM 56MM 71CM ZNTH SPRLZ ILC LG CAPTOR BOTH IP/OP "$9,412.50" "$6,965.00" "$1,675.43" "$9,412.50" "$9,412.50" "$9,412.50" "$9,412.50" "$9,412.50" "$9,412.50" "$9,412.50" "$1,675.43" "$9,412.50" "$9,412.50" "$9,412.50" "$9,412.50" "$9,412.50" "$9,412.50" "$1,961.67" "$9,412.50" "$3,765.00" "$9,412.50" "$9,412.50" "$9,412.50" "$9,412.50" "$9,412.50" "$7,059.38" "$9,412.50" "$9,412.50" "$9,412.50" "$4,706.25" "$4,706.25" "$7,454.70" "$9,412.50" "$7,530.00" "$4,235.63" "$9,412.50" N/A "$5,459.25" "$9,412.50" "$5,647.50" "$9,412.50" "$9,412.50" "$9,412.50" N/A N/A G55246 SUP Custom 27803010 G55246 - GRAFT EVAS BFUR 24MM 16FR 74MM ZNTH SPRLZ Z-TRK SLF XPD WVN BOTH IP/OP "$7,712.50" "$5,707.00" "$1,372.83" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$1,372.83" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$1,607.37" "$7,712.50" "$3,085.00" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$7,712.50" "$5,784.38" "$7,712.50" "$7,712.50" "$7,712.50" "$3,856.25" "$3,856.25" "$6,108.30" "$7,712.50" "$6,170.00" "$3,470.63" "$7,712.50" N/A "$4,473.25" "$7,712.50" "$4,627.50" "$7,712.50" "$7,712.50" "$7,712.50" N/A N/A G55247 SUP HCPCS C1874 G55247 - GRAFT EVAS 24MM 6MM 16FR 90MM ZNTH SPRLZ ANCLRY CNTRLT/IPSL BOTH IP/OP $386.00 $286.00 $76.54 $385.63 $173.53 $173.53 $173.53 $173.53 $385.63 $385.63 $385.63 $80.37 $385.63 $385.63 $385.63 $385.63 $385.63 $80.37 $385.63 $385.63 $228.10 $385.63 $385.63 $385.63 $385.63 $289.50 $385.63 $385.63 $385.63 $192.82 $192.82 $305.42 $385.63 $308.50 $173.53 $76.54 N/A $223.88 $385.63 $385.63 $385.63 $80.37 $385.63 N/A N/A G55800 SUP HCPCS C1729 G55800 - SET DRN 14FR 6-16FR 30CM 20CM UNIVERSA ECHTP SFTJ LOOP CATH BOTH IP/OP $351.00 $260.00 $69.60 $350.68 $190.42 $190.42 $190.42 $190.42 $350.68 $350.68 $350.68 $73.09 $350.68 $260.27 $260.27 $270.30 $182.70 $73.09 $350.68 $350.68 $207.43 $350.68 $350.68 $350.68 $350.68 $263.25 $350.68 $350.68 $350.68 $175.34 $175.34 $277.74 $350.68 $280.54 $227.94 $69.60 N/A $203.58 $350.68 $350.68 $350.68 $73.08 $350.68 N/A N/A G55801 SUP HCPCS C1729 G55801 - SET DRN 6FR 5-8FR 15CM 20CM CATH DIL LOOP BOTH IP/OP $351.00 $260.00 $69.60 $350.68 $190.42 $190.42 $190.42 $190.42 $350.68 $350.68 $350.68 $73.09 $350.68 $260.27 $260.27 $270.30 $182.70 $73.09 $350.68 $350.68 $207.43 $350.68 $350.68 $350.68 $350.68 $263.25 $350.68 $350.68 $350.68 $175.34 $175.34 $277.74 $350.68 $280.54 $227.94 $69.60 N/A $203.58 $350.68 $350.68 $350.68 $73.08 $350.68 N/A N/A G55802 SUP HCPCS C1729 G55802 - SHIELD SPLSH ELLIPSE 9X12IN LTX BRR RBR BOTH IP/OP $351.00 $260.00 $69.60 $350.68 $190.42 $190.42 $190.42 $190.42 $350.68 $350.68 $350.68 $73.09 $350.68 $260.27 $260.27 $270.30 $182.70 $73.09 $350.68 $350.68 $207.43 $350.68 $350.68 $350.68 $350.68 $263.25 $350.68 $350.68 $350.68 $175.34 $175.34 $277.74 $350.68 $280.54 $227.94 $69.60 N/A $203.58 $350.68 $350.68 $350.68 $73.08 $350.68 N/A N/A G55803 SUP HCPCS C1729 G55803 - SET DRN 12FR 6-14FR 30CM 20CM UNIVERSA DIL LOOP CATH INTRO BOTH IP/OP $351.00 $260.00 $69.60 $350.68 $190.42 $190.42 $190.42 $190.42 $350.68 $350.68 $350.68 $73.09 $350.68 $260.27 $260.27 $270.30 $182.70 $73.09 $350.68 $350.68 $207.43 $350.68 $350.68 $350.68 $350.68 $263.25 $350.68 $350.68 $350.68 $175.34 $175.34 $277.74 $350.68 $280.54 $227.94 $69.60 N/A $203.58 $350.68 $350.68 $350.68 $73.08 $350.68 N/A N/A G55804 SUP HCPCS C1729 G55804 - SET DRN 10FR 6-12FR 30CM 20CM CATH DIL LOOP BOTH IP/OP $351.00 $260.00 $69.60 $350.68 $190.42 $190.42 $190.42 $190.42 $350.68 $350.68 $350.68 $73.09 $350.68 $260.27 $260.27 $270.30 $182.70 $73.09 $350.68 $350.68 $207.43 $350.68 $350.68 $350.68 $350.68 $263.25 $350.68 $350.68 $350.68 $175.34 $175.34 $277.74 $350.68 $280.54 $227.94 $69.60 N/A $203.58 $350.68 $350.68 $350.68 $73.08 $350.68 N/A N/A G55821 SUP HCPCS C2627 G55821 - SET CATH 14FR 15GA 30CM UNIVERSA MLCT 1 WY STPCK CNCT TUBE BOTH IP/OP $99.00 $73.00 $19.65 $99.00 $53.76 $53.76 $53.76 $53.76 $99.00 $99.00 $99.00 $20.63 $99.00 $73.48 $73.48 $76.31 $51.58 $20.63 $99.00 $99.00 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $64.35 $19.65 N/A $57.42 $99.00 $99.00 $99.00 $20.63 $99.00 N/A N/A G55822 SUP HCPCS C2627 G55822 - CATHETER SPBC 12FR 14FR 22CM 3CC STRL LTX 30CM RTNR SET NDL BOTH IP/OP $99.00 $73.00 $19.65 $99.00 $53.76 $53.76 $53.76 $53.76 $99.00 $99.00 $99.00 $20.63 $99.00 $73.48 $73.48 $76.31 $51.58 $20.63 $99.00 $99.00 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $64.35 $19.65 N/A $57.42 $99.00 $99.00 $99.00 $20.63 $99.00 N/A N/A G55823 SUP HCPCS C2627 G55823 - SET CATH 10FR 18GA 30CM UNIVERSA MLCT DRN SPBC BOTH IP/OP $99.00 $73.00 $19.65 $99.00 $53.76 $53.76 $53.76 $53.76 $99.00 $99.00 $99.00 $20.63 $99.00 $73.48 $73.48 $76.31 $51.58 $20.63 $99.00 $99.00 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $64.35 $19.65 N/A $57.42 $99.00 $99.00 $99.00 $20.63 $99.00 N/A N/A G55824 SUP HCPCS C2627 G55824 - SET CATH 12FR 54CM TROC STY DRN ADPR SPBC CYSTOSTOMY BOTH IP/OP $99.00 $73.00 $19.65 $99.00 $53.76 $53.76 $53.76 $53.76 $99.00 $99.00 $99.00 $20.63 $99.00 $73.48 $73.48 $76.31 $51.58 $20.63 $99.00 $99.00 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $64.35 $19.65 N/A $57.42 $99.00 $99.00 $99.00 $20.63 $99.00 N/A N/A G55825 SUP HCPCS C1729 G55825 - INSERTER SRG 1.91IN STRL DISP ACPT 3.1FR BOTH IP/OP $4.00 $3.00 $0.79 $3.96 $2.15 $2.15 $2.15 $2.15 $3.96 $3.96 $3.96 $0.83 $3.96 $2.94 $2.94 $3.05 $2.06 $0.83 $3.96 $3.96 $2.34 $3.96 $3.96 $3.96 $3.96 $3.00 $3.96 $3.96 $3.96 $1.98 $1.98 $3.14 $3.96 $3.17 $2.57 $0.79 N/A $2.32 $3.96 $3.96 $3.96 $0.83 $3.96 N/A N/A G56219 SUP HCPCS C1894 G56219 - INTRODUCER SHEATH .035IN 4FR .059IN 70CM ANL0 CURVE STR TIP BOTH IP/OP $225.00 $167.00 $44.66 $238.50 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $238.50 $133.09 $225.00 $238.50 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A G56220 SUP HCPCS C1894 G56220 - INTRODUCER SHEATH .035IN 5FR .074IN 70CM ANL0 CURVE STR TIP BOTH IP/OP $225.00 $167.00 $44.66 $238.50 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $238.50 $133.09 $225.00 $238.50 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A G56221 SUP HCPCS C1894 G56221 - INTRODUCER SHEATH .035IN 6FR .087IN 70CM ANL0 CURVE STR TIP BOTH IP/OP $225.00 $167.00 $44.66 $238.50 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $238.50 $133.09 $225.00 $238.50 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A G56222 SUP HCPCS C1894 G56222 - INTRODUCER SHEATH .035IN 7FR .1IN 70CM ANL0 CURVE STR TIP BOTH IP/OP $225.00 $167.00 $44.66 $238.50 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $238.50 $133.09 $225.00 $238.50 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A G56224 SUP HCPCS C1894 G56224 - INTRODUCER SHEATH .035IN 4FR .059IN 70CM ANL1 CURVE MULTPUR BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A G56225 SUP HCPCS C1894 G56225 - INTRODUCER SHEATH .035IN 5FR .074IN 70CM ANL1 CURVE MULTPUR BOTH IP/OP $225.00 $167.00 $44.66 $238.50 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $238.50 $133.09 $225.00 $238.50 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A G56226 SUP HCPCS C1894 G56226 - INTRODUCER SHEATH .035IN 6FR .087IN 70CM ANL1 CURVE MULTPUR BOTH IP/OP $225.00 $167.00 $44.66 $238.50 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $238.50 $133.09 $225.00 $238.50 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A G56227 SUP HCPCS C1894 G56227 - INTRODUCER SHEATH .035IN 7FR .1IN 70CM ANL1 CURVE MULTPUR BOTH IP/OP $225.00 $167.00 $44.66 $238.50 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $238.50 $133.09 $225.00 $238.50 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A G56228 SUP HCPCS C1894 G56228 - INTRODUCER SHEATH .035IN 8FR .113IN 70CM ANL1 CURVE MULTPUR BOTH IP/OP $225.00 $167.00 $44.66 $238.50 $122.18 $122.18 $122.18 $122.18 $225.00 $225.00 $225.00 $46.90 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $238.50 $133.09 $225.00 $238.50 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A G56277 SUP HCPCS C1751 G56277 - TRAY CATHETER CEN VEN STERILE BOTH IP/OP $463.00 $343.00 $91.89 $574.48 $251.41 $251.41 $251.41 $251.41 $463.00 $463.00 $463.00 $96.50 $463.00 $343.64 $343.64 $356.88 $241.22 $96.49 $463.00 $574.48 $273.86 $463.00 $574.48 $463.00 $463.00 $347.25 $463.00 $463.00 $463.00 $231.50 $231.50 $366.70 $463.00 $370.40 $300.95 $91.89 N/A $268.54 $463.00 $463.00 $463.00 $96.49 $463.00 N/A N/A G56278 SUP HCPCS C1892 G56278 - INTRODUCER SHEATH .035IN 10FR .134IN 45CM ANL0 CURVE STR TIP BOTH IP/OP $187.50 $139.00 $37.21 $212.00 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $212.00 $110.91 $187.50 $212.00 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A G56279 SUP HCPCS C1892 G56279 - INTRODUCER SHEATH .035IN 12FR .162IN 45CM ANL0 CURVE STR TIP BOTH IP/OP $200.00 $148.00 $39.70 $212.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $212.00 $118.30 $200.00 $212.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A G56334 SUP HCPCS C1729 G56334 - CATHETER DRN 16FR 15GA 30CM UNIVERSA MLCT NDL BOTH IP/OP $99.00 $73.00 $19.65 $99.00 $53.76 $53.76 $53.76 $53.76 $99.00 $99.00 $99.00 $20.63 $99.00 $73.48 $73.48 $76.31 $51.58 $20.63 $99.00 $99.00 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $64.35 $19.65 N/A $57.42 $99.00 $99.00 $99.00 $20.63 $99.00 N/A N/A G56335 SUP HCPCS C1729 G56335 - CATHETER DRN 8FR 19GA 15CM UNIVERSA MLCT NDL BOTH IP/OP $99.00 $73.00 $19.65 $99.00 $53.76 $53.76 $53.76 $53.76 $99.00 $99.00 $99.00 $20.63 $99.00 $73.48 $73.48 $76.31 $51.58 $20.63 $99.00 $99.00 $58.56 $99.00 $99.00 $99.00 $99.00 $74.25 $99.00 $99.00 $99.00 $49.50 $49.50 $78.41 $99.00 $79.20 $64.35 $19.65 N/A $57.42 $99.00 $99.00 $99.00 $20.63 $99.00 N/A N/A G56401 SUP Custom 27203010 G56401 - CATHETER DRN 10FR 18GA 15CM UNIVERSA MLCT NDL BOTH IP/OP $412.50 $305.00 $73.43 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $73.43 $412.50 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $165.00 $412.50 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $412.50 N/A $239.25 $412.50 $247.50 $412.50 $412.50 $412.50 N/A N/A G56428 SUP HCPCS C1894 G56428 - EXTRACTOR STON STD 10FR 1.5CM 38CM PERC NGAGE BSKT NTNL SS BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56429 SUP HCPCS C1894 G56429 - SHEATH ESCP 9.5FR 20CM STRL PRLL FLXR DIL HDRPH URETER DISP BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56430 SUP HCPCS C1894 G56430 - SHEATH ESCP 9.5FR 28CM STRL PRLL FLXR DIL HDRPH URETER DISP BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56431 SUP HCPCS C1894 G56431 - SHEATH ESCP 9.5FR 35CM STRL PRLL FLXR DIL HDRPH URETER DISP BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56432 SUP HCPCS C1894 G56432 - SHEATH ESCP 9.5FR 45CM STRL PRLL FLXR DIL HDRPH URETER DISP BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56433 SUP HCPCS C1894 G56433 - SHEATH ESCP 9.5FR 55CM STRL PRLL FLXR DIL HDRPH URETER DISP BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56434 SUP HCPCS C1894 G56434 - SHEATH ESCP 12FR 20CM STRL PRLL FLXR DIL HDRPH URETER DISP BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56435 SUP HCPCS C1894 G56435 - SHEATH ACC 12FR 28CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56436 SUP HCPCS C1894 G56436 - SHEATH ACC 12FR 35CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56438 SUP HCPCS C1894 G56438 - SHEATH ESCP 12FR 45CM STRL PRLL FLXR DIL HDRPH URETER DISP BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56439 SUP HCPCS C1894 G56439 - SHEATH ESCP 12FR 55CM STRL PRLL FLXR DIL HDRPH URETER DISP BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56440 SUP HCPCS C1894 G56440 - SHEATH ESCP 14FR 20CM STRL PRLL FLXR DIL HDRPH URETER DISP BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56441 SUP HCPCS C1894 G56441 - SHEATH ACC 14FR 28CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56442 SUP HCPCS C1894 G56442 - SHEATH ACC 14FR 35CM RPD RELS PRLL FLXR CNT CHNL HDRPH URET BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56443 SUP HCPCS C1894 G56443 - SHEATH ESCP 14FR 45CM STRL PRLL FLXR DIL HDRPH URETER DISP BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56445 SUP HCPCS C1894 G56445 - SHEATH ESCP 14FR 55CM STRL PRLL FLXR DIL HDRPH URETER DISP BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56446 SUP HCPCS C1894 G56446 - SHEATH ESCP 9.5FR 13CM STRL PRLL FLXR DIL HDRPH URETER DISP BOTH IP/OP $325.00 $241.00 $64.50 $325.00 $176.48 $176.48 $176.48 $176.48 $325.00 $325.00 $325.00 $67.74 $325.00 $241.22 $241.22 $250.51 $169.33 $67.73 $325.00 $325.00 $192.24 $325.00 $325.00 $325.00 $325.00 $243.75 $325.00 $325.00 $325.00 $162.50 $162.50 $257.40 $325.00 $260.00 $211.25 $64.50 N/A $188.50 $325.00 $325.00 $325.00 $67.73 $325.00 N/A N/A G56537 SUP Custom 27203010 G56537 - TRAY SURG 14FR 18GA 29CM 5CM 19 SIDEPORT CATHETER ECHOGENIC BOTH IP/OP $450.50 $333.00 $80.17 $450.38 $450.38 $450.38 $450.38 $450.38 $450.38 $450.38 $80.17 $450.38 $450.38 $334.27 $334.27 $347.15 $234.65 $93.86 $450.38 $180.15 $450.38 $450.38 $450.38 $450.38 $450.38 $337.88 $450.38 $450.38 $450.38 $225.19 $225.19 $356.70 $450.38 $360.30 $292.75 $450.38 N/A $261.29 $450.38 $270.23 $450.38 $450.38 $450.38 N/A N/A G57716 SUP Custom 27203010 G57716 - TRAY INTRO 7.5MM 8.5MM 9MM BLU RHINO G2 TRCH TUBE LD DIL RX BOTH IP/OP "$1,096.50" $811.00 $195.11 "$1,096.10" "$1,096.10" "$1,096.10" "$1,096.10" "$1,096.10" "$1,096.10" "$1,096.10" $195.11 "$1,096.10" "$1,096.10" $813.53 $813.53 $844.87 $571.07 $228.44 "$1,096.10" $438.44 "$1,096.10" "$1,096.10" "$1,096.10" "$1,096.10" "$1,096.10" $822.38 "$1,096.10" "$1,096.10" "$1,096.10" $548.05 $548.05 $868.11 "$1,096.10" $876.88 $712.47 "$1,096.10" N/A $635.97 "$1,096.10" $657.66 "$1,096.10" "$1,096.10" "$1,096.10" N/A N/A G57717 SUP Custom 27203010 G57717 - TRAY TRCH 8.5FR SHLY BLU RHINO FLXB ADLT PERC BOTH IP/OP "$1,096.50" $811.00 $195.11 "$1,096.10" "$1,096.10" "$1,096.10" "$1,096.10" "$1,096.10" "$1,096.10" "$1,096.10" $195.11 "$1,096.10" "$1,096.10" $813.53 $813.53 $844.87 $571.07 $228.44 "$1,096.10" $438.44 "$1,096.10" "$1,096.10" "$1,096.10" "$1,096.10" "$1,096.10" $822.38 "$1,096.10" "$1,096.10" "$1,096.10" $548.05 $548.05 $868.11 "$1,096.10" $876.88 $712.47 "$1,096.10" N/A $635.97 "$1,096.10" $657.66 "$1,096.10" "$1,096.10" "$1,096.10" N/A N/A GA3501 SUP HCPCS C1769 GA3501 - GUIDEWIRE VASC ANG .035IN 180CM 25CM GLDWR ADV PTFE NTNL BOTH IP/OP $400.00 $296.00 $79.39 $400.00 $217.20 $217.20 $217.20 $217.20 $400.00 $400.00 $400.00 $83.37 $400.00 $296.88 $296.88 $308.32 $208.40 $83.36 $400.00 $160.00 $236.60 $400.00 $400.00 $400.00 $400.00 $300.00 $400.00 $400.00 $400.00 $200.00 $200.00 $316.80 $400.00 $320.00 $260.00 $79.39 N/A $232.00 $400.00 $400.00 $400.00 $83.36 $400.00 N/A N/A GA3502 SUP HCPCS C1769 GA3502 - GUIDEWIRE VASCULAR ANGLED .035IN 260CM 25CM GLIDEWIRE BOTH IP/OP $450.00 $333.00 $89.31 $575.00 $244.35 $244.35 $244.35 $244.35 $450.00 $450.00 $450.00 $93.79 $450.00 $333.99 $333.99 $346.86 $234.45 $93.78 $450.00 $575.00 $266.18 $450.00 $575.00 $450.00 $450.00 $337.50 $450.00 $450.00 $450.00 $225.00 $225.00 $356.40 $450.00 $360.00 $292.50 $89.31 N/A $261.00 $450.00 $450.00 $450.00 $93.78 $450.00 N/A N/A GD-1115-100 SUP Custom 27203010 GD-1115-100 - CANNULA ASCP 10CM OSTEOPRECISION VNT BOTH IP/OP "$1,875.00" "$1,388.00" $333.75 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $333.75 "$1,875.00" "$1,875.00" "$1,391.63" "$1,391.63" "$1,445.25" $976.88 $390.77 "$1,875.00" $750.00 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" "$1,218.75" "$1,875.00" N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" "$1,875.00" "$1,875.00" N/A N/A GEM1521 SUP Custom 27203010 GEM1521 - CLIP HEMOSTATIC 30 CARTRIDGE SUPERFINE GEM BLUE TITANIUM BOTH IP/OP $29.50 $22.00 $5.19 $29.17 $29.17 $29.17 $29.17 $29.17 $29.17 $29.17 $5.19 $29.17 $29.17 $21.65 $21.65 $22.48 $15.20 $6.08 $29.17 $11.67 $29.17 $29.17 $29.17 $29.17 $29.17 $22.13 $29.17 $29.17 $29.17 $14.59 $14.59 $23.10 $29.17 $23.34 $18.96 $29.17 N/A $17.11 $29.17 $17.50 $29.17 $29.17 $29.17 N/A N/A GEM2431 SUP Custom 27203010 GEM2431 - CLIP INTNL MIC GM CRTDG TI HMST BOTH IP/OP $26.00 $19.00 $4.60 $25.83 $25.83 $25.83 $25.83 $25.83 $25.83 $25.83 $4.60 $25.83 $25.83 $19.17 $19.17 $19.91 $13.46 $5.38 $25.83 $10.33 $25.83 $25.83 $25.83 $25.83 $25.83 $19.50 $25.83 $25.83 $25.83 $12.92 $12.92 $20.46 $25.83 $20.66 $16.79 $25.83 N/A $15.08 $25.83 $15.50 $25.83 $25.83 $25.83 N/A N/A GEM2751 SUP Custom 27803010 GEM2751 - COUPLER ANSTM 1.5MM STRL GM MCVSC ANSTM DISP BOTH IP/OP $646.00 $478.00 $114.96 $645.83 $645.83 $645.83 $645.83 $645.83 $645.83 $645.83 $114.96 $645.83 $645.83 $645.83 $645.83 $645.83 $645.83 $134.60 $645.83 $323.83 $645.83 $645.83 $645.83 $645.83 $645.83 $484.50 $645.83 $645.83 $645.83 $322.92 $322.92 $511.50 $645.83 $516.66 $290.62 $645.83 N/A $374.68 $645.83 $387.50 $645.83 $645.83 $645.83 N/A N/A GEM2752 SUP Custom 27803010 GEM2752 - COUPLER ANSTM 20MHZ 2MM STRL LF GM RING PIN US DPLR SS DISP BOTH IP/OP $748.00 $554.00 $133.13 $770.83 $747.92 $747.92 $747.92 $747.92 $747.92 $747.92 $133.13 $747.92 $747.92 $747.92 $747.92 $747.92 $747.92 $155.87 $747.92 $323.83 $747.92 $747.92 $770.83 $747.92 $747.92 $561.00 $747.92 $747.92 $747.92 $373.96 $373.96 $592.35 $747.92 $598.34 $336.56 $747.92 N/A $433.84 $747.92 $448.75 $747.92 $747.92 $747.92 N/A N/A GEM2753 SUP Custom 27803010 GEM2753 - COUPLER ANSTM 20MHZ 2.5MM STRL LF GM RING PIN US DPLR SS BOTH IP/OP $748.00 $554.00 $133.13 $770.83 $747.92 $747.92 $747.92 $747.92 $747.92 $747.92 $133.13 $747.92 $747.92 $747.92 $747.92 $747.92 $747.92 $155.87 $747.92 $323.83 $747.92 $747.92 $770.83 $747.92 $747.92 $561.00 $747.92 $747.92 $747.92 $373.96 $373.96 $592.35 $747.92 $598.34 $336.56 $747.92 N/A $433.84 $747.92 $448.75 $747.92 $747.92 $747.92 N/A N/A GEM2754 SUP Custom 27803010 GEM2754 - COUPLER ANSTM 3MM STRL GM MCVSC DISP BOTH IP/OP $748.00 $554.00 $133.13 $770.83 $747.92 $747.92 $747.92 $747.92 $747.92 $747.92 $133.13 $747.92 $747.92 $747.92 $747.92 $747.92 $747.92 $155.87 $747.92 $323.83 $747.92 $747.92 $770.83 $747.92 $747.92 $561.00 $747.92 $747.92 $747.92 $373.96 $373.96 $592.35 $747.92 $598.34 $336.56 $747.92 N/A $433.84 $747.92 $448.75 $747.92 $747.92 $747.92 N/A N/A GEM2756 SUP Custom 27803010 GEM2756 - COUPLER ANSTM 4MM STRL GM MCVSC ANSTM DISP BOTH IP/OP $748.00 $554.00 $133.13 $770.83 $747.92 $747.92 $747.92 $747.92 $747.92 $747.92 $133.13 $747.92 $747.92 $747.92 $747.92 $747.92 $747.92 $155.87 $747.92 $323.83 $747.92 $747.92 $770.83 $747.92 $747.92 $561.00 $747.92 $747.92 $747.92 $373.96 $373.96 $592.35 $747.92 $598.34 $336.56 $747.92 N/A $433.84 $747.92 $448.75 $747.92 $747.92 $747.92 N/A N/A GEZ6200US7B SUP HCPCS C1757 GEZ6200US7B - CATHETER THROMBECTOMY 7FR .08IN 145CM ASPIRAT FULL-WALL BOTH IP/OP "$1,425.00" "$1,055.00" $282.83 "$1,425.00" $773.78 $773.78 $773.78 $773.78 "$1,425.00" "$1,425.00" "$1,425.00" $297.01 "$1,425.00" "$1,057.64" "$1,057.64" "$1,098.39" $742.43 $296.99 "$1,425.00" "$1,425.00" $842.89 "$1,425.00" "$1,425.00" "$1,425.00" "$1,425.00" "$1,068.75" "$1,425.00" "$1,425.00" "$1,425.00" $712.50 $712.50 "$1,128.60" "$1,425.00" "$1,140.00" $926.25 $282.83 N/A $826.50 "$1,425.00" "$1,425.00" "$1,425.00" $296.97 "$1,425.00" N/A N/A GFS-10A SUP Custom 27203010 GFS-10A - PASSER SUT STRL LF GAB/FRAT GD ORG VLV IMPL BOTH IP/OP $950.50 $703.00 $169.13 $950.18 $950.18 $950.18 $950.18 $950.18 $950.18 $950.18 $169.13 $950.18 $950.18 $705.22 $705.22 $732.40 $495.04 $198.03 $950.18 $380.07 $950.18 $950.18 $950.18 $950.18 $950.18 $712.88 $950.18 $950.18 $950.18 $475.09 $475.09 $752.54 $950.18 $760.14 $617.62 $950.18 N/A $551.29 $950.18 $570.11 $950.18 $950.18 $950.18 N/A N/A GFS-1A SUP Custom 27203010 GFS-1A - PASSER SUTURE GUIDE ORGANIZER LATEX FREE GABBAY-FRATER VALVE BOTH IP/OP $404.00 $299.00 $71.83 $403.53 $403.53 $403.53 $403.53 $403.53 $403.53 $403.53 $71.83 $403.53 $403.53 $299.50 $299.50 $311.04 $210.24 $84.10 $403.53 $161.41 $403.53 $403.53 $403.53 $403.53 $403.53 $303.00 $403.53 $403.53 $403.53 $201.77 $201.77 $319.60 $403.53 $322.82 $262.29 $403.53 N/A $234.32 $403.53 $242.12 $403.53 $403.53 $403.53 N/A N/A GIA10038L SUP Custom 27203010 GIA10038L - RELOAD STPLR 100MMX3.8MM BLU STRL LF 1.5MM DST GIA 4 ROW LNR BOTH IP/OP $268.50 $199.00 $47.72 $268.10 $268.10 $268.10 $268.10 $268.10 $268.10 $268.10 $47.72 $268.10 $268.10 $198.98 $198.98 $206.65 $139.68 $55.87 $268.10 $92.53 $268.10 $268.10 $231.33 $268.10 $268.10 $201.38 $268.10 $268.10 $268.10 $134.05 $134.05 $212.34 $268.10 $214.48 $174.27 $268.10 N/A $155.73 $268.10 $160.86 $268.10 $268.10 $268.10 N/A N/A GIA10038S SUP Custom 27203010 GIA10038S - STAPLER INTERNAL 100MMX3.8MM 1.5MM 2 STAGGER ROW STAPLE LOAD BOTH IP/OP $515.00 $381.00 $91.59 $514.53 $514.53 $514.53 $514.53 $514.53 $514.53 $514.53 $91.59 $514.53 $514.53 $381.88 $381.88 $396.60 $268.07 $107.23 $514.53 $177.58 $514.53 $514.53 $443.95 $514.53 $514.53 $386.25 $514.53 $514.53 $514.53 $257.27 $257.27 $407.51 $514.53 $411.62 $334.44 $514.53 N/A $298.70 $514.53 $308.72 $514.53 $514.53 $514.53 N/A N/A GIA10048L SUP Custom 27203010 GIA10048L - RELOAD STPLR 100MMX4.8MM GRN STRL LF 2MM DST GIA 4 ROW LNR BOTH IP/OP $268.50 $199.00 $47.72 $268.10 $268.10 $268.10 $268.10 $268.10 $268.10 $268.10 $47.72 $268.10 $268.10 $198.98 $198.98 $206.65 $139.68 $55.87 $268.10 $92.53 $268.10 $268.10 $231.33 $268.10 $268.10 $201.38 $268.10 $268.10 $268.10 $134.05 $134.05 $212.34 $268.10 $214.48 $174.27 $268.10 N/A $155.73 $268.10 $160.86 $268.10 $268.10 $268.10 N/A N/A GIA10048S SUP Custom 27203010 GIA10048S - STAPLER INTERNAL 104MMX4.8MM 2MM 2 STAGGER ROW STAPLE LOAD BOTH IP/OP $565.00 $418.00 $100.51 $564.67 $564.67 $564.67 $564.67 $564.67 $564.67 $564.67 $100.51 $564.67 $564.67 $419.10 $419.10 $435.25 $294.19 $117.68 $564.67 $225.87 $564.67 $564.67 $564.67 $564.67 $564.67 $423.75 $564.67 $564.67 $564.67 $282.34 $282.34 $447.22 $564.67 $451.74 $367.04 $564.67 N/A $327.70 $564.67 $338.80 $564.67 $564.67 $564.67 N/A N/A GIA6025L SUP Custom 27203010 GIA6025L - RELOAD STPLR 60MMX2.5MM WHT STRL LF 1MM DST GIA 4 ROW LNR BOTH IP/OP $128.50 $95.00 $22.79 $128.02 $128.02 $128.02 $128.02 $128.02 $128.02 $128.02 $22.79 $128.02 $128.02 $95.02 $95.02 $98.68 $66.70 $26.68 $128.02 $51.21 $128.02 $128.02 $128.02 $128.02 $128.02 $96.38 $128.02 $128.02 $128.02 $64.01 $64.01 $101.39 $128.02 $102.42 $83.21 $128.02 N/A $74.53 $128.02 $76.81 $128.02 $128.02 $128.02 N/A N/A GIA6038L SUP Custom 27203010 GIA6038L - RELOAD STPLR 60MMX3.8MM BLU STRL LF 1.5MM DST GIA 4 ROW LNR BOTH IP/OP $117.50 $87.00 $20.84 $117.10 $117.10 $117.10 $117.10 $117.10 $117.10 $117.10 $20.84 $117.10 $117.10 $86.91 $86.91 $90.26 $61.01 $24.40 $117.10 $40.42 $117.10 $117.10 $101.05 $117.10 $117.10 $88.13 $117.10 $117.10 $117.10 $58.55 $58.55 $92.74 $117.10 $93.68 $76.12 $117.10 N/A $68.15 $117.10 $70.26 $117.10 $117.10 $117.10 N/A N/A GIA6038S SUP Custom 27203010 GIA6038S - STAPLER INTERNAL TEARDROP 60MMX3.8MM 1.5MM 4 ROW 2 STAGGER BOTH IP/OP $223.00 $165.00 $39.66 $222.80 $222.80 $222.80 $222.80 $222.80 $222.80 $222.80 $39.66 $222.80 $222.80 $165.36 $165.36 $171.73 $116.08 $46.43 $222.80 $76.91 $222.80 $222.80 $192.28 $222.80 $222.80 $167.25 $222.80 $222.80 $222.80 $111.40 $111.40 $176.46 $222.80 $178.24 $144.82 $222.80 N/A $129.34 $222.80 $133.68 $222.80 $222.80 $222.80 N/A N/A GIA6048L SUP Custom 27203010 GIA6048L - RELOAD STPLR 60MMX4.8MM GRN STRL LF 2MM DST GIA 4 ROW LNR BOTH IP/OP $115.50 $85.00 $20.54 $115.40 $115.40 $115.40 $115.40 $115.40 $115.40 $115.40 $20.54 $115.40 $115.40 $85.65 $85.65 $88.95 $60.12 $24.05 $115.40 $39.84 $115.40 $115.40 $99.60 $115.40 $115.40 $86.63 $115.40 $115.40 $115.40 $57.70 $57.70 $91.40 $115.40 $92.32 $75.01 $115.40 N/A $66.99 $115.40 $69.24 $115.40 $115.40 $115.40 N/A N/A GIA6048S SUP Custom 27203010 GIA6048S - STAPLER INTERNAL TEARDROP 60MMX4.8MM 2MM 4 ROW 2 STAGGER BOTH IP/OP $229.00 $169.00 $40.69 $228.58 $228.58 $228.58 $228.58 $228.58 $228.58 $228.58 $40.69 $228.58 $228.58 $169.65 $169.65 $176.19 $119.09 $47.64 $228.58 $91.43 $228.58 $228.58 $228.58 $228.58 $228.58 $171.75 $228.58 $228.58 $228.58 $114.29 $114.29 $181.04 $228.58 $182.86 $148.58 $228.58 N/A $132.82 $228.58 $137.15 $228.58 $228.58 $228.58 N/A N/A GIA8038L SUP Custom 27203010 GIA8038L - RELOAD STPLR 80MMX3.8MM BLU STRL LF 1.5MM DST GIA 4 ROW LNR BOTH IP/OP $171.50 $127.00 $30.47 $171.20 $171.20 $171.20 $171.20 $171.20 $171.20 $171.20 $30.47 $171.20 $171.20 $127.06 $127.06 $131.96 $89.20 $35.68 $171.20 $59.09 $171.20 $171.20 $147.73 $171.20 $171.20 $128.63 $171.20 $171.20 $171.20 $85.60 $85.60 $135.59 $171.20 $136.96 $111.28 $171.20 N/A $99.47 $171.20 $102.72 $171.20 $171.20 $171.20 N/A N/A GIA8038S SUP Custom 27203010 GIA8038S - STAPLER INTERNAL TEARDROP 80MMX3.8MM 1.5MM 4 ROW 2 STAGGER BOTH IP/OP $328.50 $243.00 $58.44 $328.33 $328.33 $328.33 $328.33 $328.33 $328.33 $328.33 $58.44 $328.33 $328.33 $243.69 $243.69 $253.08 $171.06 $68.43 $328.33 $113.32 $328.33 $328.33 $283.30 $328.33 $328.33 $246.38 $328.33 $328.33 $328.33 $164.17 $164.17 $260.04 $328.33 $262.66 $213.41 $328.33 N/A $190.53 $328.33 $197.00 $328.33 $328.33 $328.33 N/A N/A GIA8048L SUP Custom 27203010 GIA8048L - RELOAD STPLR 80MMX4.8MM GRN STRL LF 2MM DST GIA 4 ROW LNR BOTH IP/OP $171.50 $127.00 $30.47 $171.20 $171.20 $171.20 $171.20 $171.20 $171.20 $171.20 $30.47 $171.20 $171.20 $127.06 $127.06 $131.96 $89.20 $35.68 $171.20 $59.09 $171.20 $171.20 $147.73 $171.20 $171.20 $128.63 $171.20 $171.20 $171.20 $85.60 $85.60 $135.59 $171.20 $136.96 $111.28 $171.20 N/A $99.47 $171.20 $102.72 $171.20 $171.20 $171.20 N/A N/A GIA8048S SUP Custom 27203010 GIA8048S - STAPLER INTERNAL TEARDROP 80MMX4.8MM 2MM 4 ROW 2 STAGGER BOTH IP/OP $337.00 $249.00 $59.96 $336.83 $336.83 $336.83 $336.83 $336.83 $336.83 $336.83 $59.96 $336.83 $336.83 $250.00 $250.00 $259.63 $175.49 $70.20 $336.83 $134.73 $336.83 $336.83 $336.83 $336.83 $336.83 $252.75 $336.83 $336.83 $336.83 $168.42 $168.42 $266.77 $336.83 $269.46 $218.94 $336.83 N/A $195.46 $336.83 $202.10 $336.83 $336.83 $336.83 N/A N/A GJ44 SUP HCPCS Q4107 GJ44 - GRAFT SKIN 4CMX4CMX.38-1.02MM GRAFTJACKET THK.4-.8MM REGENER BOTH IP/OP "$4,302.50" "$3,184.00" $80.90 "$4,302.50" "$4,302.50" "$4,302.50" "$4,302.50" "$4,302.50" "$4,302.50" "$4,302.50" $80.90 "$4,302.50" "$4,302.50" "$4,302.50" "$4,302.50" "$4,302.50" "$4,302.50" $896.69 "$4,302.50" "$1,721.00" "$4,302.50" "$4,302.50" "$4,302.50" "$4,302.50" "$4,302.50" "$3,226.88" "$4,302.50" "$4,302.50" "$4,302.50" "$2,151.25" "$2,151.25" "$3,407.58" "$4,302.50" "$3,442.00" "$1,936.13" "$4,302.50" N/A "$2,495.45" "$4,302.50" "$2,581.50" "$4,302.50" "$4,302.50" "$4,302.50" N/A N/A GJ48 SUP HCPCS Q4107 GJ48 - GRAFT SKIN 8CMX4CMX.38-1.02MM GRAFTJACKET THK.4-.8MM REGENER BOTH IP/OP "$7,570.50" "$5,602.00" $80.90 "$7,570.20" "$7,570.20" "$7,570.20" "$7,570.20" "$7,570.20" "$7,570.20" "$7,570.20" $80.90 "$7,570.20" "$7,570.20" "$7,570.20" "$7,570.20" "$7,570.20" "$7,570.20" "$1,577.71" "$7,570.20" "$3,028.08" "$7,570.20" "$7,570.20" "$7,570.20" "$7,570.20" "$7,570.20" "$5,677.88" "$7,570.20" "$7,570.20" "$7,570.20" "$3,785.10" "$3,785.10" "$5,995.60" "$7,570.20" "$6,056.16" "$3,406.59" "$7,570.20" N/A "$4,390.89" "$7,570.20" "$4,542.12" "$7,570.20" "$7,570.20" "$7,570.20" N/A N/A GJX SUP HCPCS Q4113 GJX - GRAFT SKN 2ML GTJKT XPRESS SFT TIS SCFLD FLW ACLR DRML MTRX BOTH IP/OP "$4,840.00" "$3,582.00" $718.00 "$4,840.00" "$4,840.00" "$4,840.00" "$4,840.00" "$4,840.00" "$4,840.00" "$4,840.00" $718.00 "$4,840.00" "$4,840.00" "$4,840.00" "$4,840.00" "$4,840.00" "$4,840.00" "$1,008.71" "$4,840.00" "$1,936.00" "$4,840.00" "$4,840.00" "$4,840.00" "$4,840.00" "$4,840.00" "$3,630.00" "$4,840.00" "$4,840.00" "$4,840.00" "$2,420.00" "$2,420.00" "$3,833.28" "$4,840.00" "$3,872.00" "$2,178.00" "$4,840.00" N/A "$2,807.20" "$4,840.00" "$2,904.00" "$4,840.00" "$4,840.00" "$4,840.00" N/A N/A GLU-50122 SUP HCPCS A6196 GLU-50122 - DRESSING WND 12X5IN STRL LF GLUCAN II B GLUCAN CLGN DISP BOTH IP/OP $171.00 $127.00 $3.48 $170.71 $170.71 $170.71 $170.71 $170.71 $170.71 $170.71 $3.48 $170.71 $170.71 $126.70 $126.70 $131.58 $88.94 $35.58 $170.71 $68.28 $170.71 $170.71 $170.71 $170.71 $170.71 $128.25 $170.71 $170.71 $170.71 $85.36 $85.36 $135.20 $170.71 $136.57 $110.96 $170.71 N/A $99.18 $170.71 $102.43 $170.71 $170.71 $170.71 N/A N/A GM1253-1720 SUP Custom 27203010 GM1253-1720 - SET 3 NEEDLES W/MARKER 1.2x5mm BOTH IP/OP $225.00 $167.00 $40.05 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $225.00 $40.05 $225.00 $225.00 $167.00 $167.00 $173.43 $117.23 $46.89 $225.00 $90.00 $225.00 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $146.25 $225.00 N/A $130.50 $225.00 $135.00 $225.00 $225.00 $225.00 N/A N/A GM1601 SUP HCPCS C1769 GM1601 - GUIDEWIRE VASCULAR 45D .016IN 180CM 2MM ANGLED FLEXIBLE TIP BOTH IP/OP $725.00 $537.00 $143.89 $725.00 $393.68 $393.68 $393.68 $393.68 $725.00 $725.00 $725.00 $151.11 $725.00 $538.10 $538.10 $558.83 $377.73 $151.10 $725.00 $725.00 $428.84 $725.00 $725.00 $725.00 $725.00 $543.75 $725.00 $725.00 $725.00 $362.50 $362.50 $574.20 $725.00 $580.00 $471.25 $143.89 N/A $420.50 $725.00 $725.00 $725.00 $151.09 $725.00 N/A N/A GMN-DSP-160 SUP HCPCS C1713 "GMN-DSP-160 - PLATE DORSAL SPANNING, SHORT" BOTH IP/OP "$2,990.00" "$2,213.00" $593.44 "$2,990.00" "$1,345.50" "$1,345.50" "$1,345.50" "$1,345.50" "$2,990.00" "$2,990.00" "$2,990.00" $623.19 "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" $623.15 "$2,990.00" "$1,196.00" "$1,474.07" "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" "$2,242.50" "$2,990.00" "$2,990.00" "$2,990.00" "$1,495.00" "$1,495.00" "$2,368.08" "$2,990.00" "$2,392.00" "$1,345.50" $593.44 N/A "$1,734.20" "$2,990.00" "$1,794.00" "$2,990.00" "$2,990.00" "$2,990.00" N/A N/A GMN-DSP-210 SUP HCPCS C1713 GMN-DSP-210 - PLATE DORSAL SPANNING BOTH IP/OP "$2,990.00" "$2,213.00" $593.44 "$2,990.00" "$1,345.50" "$1,345.50" "$1,345.50" "$1,345.50" "$2,990.00" "$2,990.00" "$2,990.00" $623.19 "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" $623.15 "$2,990.00" "$1,196.00" "$1,474.07" "$2,990.00" "$2,990.00" "$2,990.00" "$2,990.00" "$2,242.50" "$2,990.00" "$2,990.00" "$2,990.00" "$1,495.00" "$1,495.00" "$2,368.08" "$2,990.00" "$2,392.00" "$1,345.50" $593.44 N/A "$1,734.20" "$2,990.00" "$1,794.00" "$2,990.00" "$2,990.00" "$2,990.00" N/A N/A GMN-HP SUP HCPCS C1713 GMN-HP - PLATE BN GEMINUS HK VOLR BOTH IP/OP $990.00 $733.00 $196.49 $990.00 $445.50 $445.50 $445.50 $445.50 $990.00 $990.00 $990.00 $206.34 $990.00 $990.00 $990.00 $990.00 $990.00 $206.33 $990.00 $990.00 $585.59 $990.00 $990.00 $990.00 $990.00 $742.50 $990.00 $990.00 $990.00 $495.00 $495.00 $784.08 $990.00 $792.00 $445.50 $196.49 N/A $574.20 $990.00 $594.00 $990.00 $206.32 $990.00 N/A N/A GMN-HP-SCRW SUP HCPCS C1713 GMN-HP-SCRW - PLATE BN GEMINUS HK SCR VOLR BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $105.00 $175.00 $36.47 $175.00 N/A N/A GMN-LTN-3HL SUP HCPCS C1713 GMN-LTN-3HL - PLATE BN NAR NS GEMINUS 3 HL TI LT DIST VOLR RDS FOSSA BOTH IP/OP "$1,990.00" "$1,473.00" $394.97 "$1,990.00" $895.50 $895.50 $895.50 $895.50 "$1,990.00" "$1,990.00" "$1,990.00" $414.77 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" $414.74 "$1,990.00" $796.00 "$1,177.09" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,492.50" "$1,990.00" "$1,990.00" "$1,990.00" $995.00 $995.00 "$1,576.08" "$1,990.00" "$1,592.00" $895.50 $394.97 N/A "$1,154.20" "$1,990.00" "$1,194.00" "$1,990.00" $414.72 "$1,990.00" N/A N/A GMN-LTN-4HL SUP HCPCS C1713 GMN-LTN-4HL - PLATE BN NAR NS GEMINUS 4 HL TI LT DIST VOLR RDS FOSSA BOTH IP/OP "$1,990.00" "$1,473.00" $394.97 "$1,990.00" $895.50 $895.50 $895.50 $895.50 "$1,990.00" "$1,990.00" "$1,990.00" $414.77 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" $414.74 "$1,990.00" $796.00 "$1,177.09" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,492.50" "$1,990.00" "$1,990.00" "$1,990.00" $995.00 $995.00 "$1,576.08" "$1,990.00" "$1,592.00" $895.50 $394.97 N/A "$1,154.20" "$1,990.00" "$1,194.00" "$1,990.00" $414.72 "$1,990.00" N/A N/A GMN-LTS-3HL SUP HCPCS C1713 GMN-LTS-3HL - PLATE BN STD NS GEMINUS 3 HL TI RDS LT VOLR DIST BOTH IP/OP "$2,237.50" "$1,656.00" $444.09 "$2,237.50" "$1,006.88" "$1,006.88" "$1,006.88" "$1,006.88" "$2,237.50" "$2,237.50" "$2,237.50" $466.35 "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" "$2,237.50" $466.32 "$2,237.50" $796.00 "$1,323.48" "$2,237.50" "$1,990.00" "$2,237.50" "$2,237.50" "$1,678.13" "$2,237.50" "$2,237.50" "$2,237.50" "$1,118.75" "$1,118.75" "$1,772.10" "$2,237.50" "$1,790.00" "$1,006.88" $444.09 N/A "$1,297.75" "$2,237.50" "$2,237.50" "$2,237.50" $466.30 "$2,237.50" N/A N/A GMN-LTS-4HL SUP HCPCS C1713 GMN-LTS-4HL - PLATE BN STD NS GEMINUS 4 HL TI LT DIST VOLR RDS FOSSA BOTH IP/OP "$1,990.00" "$1,473.00" $394.97 "$1,990.00" $895.50 $895.50 $895.50 $895.50 "$1,990.00" "$1,990.00" "$1,990.00" $414.77 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" $414.74 "$1,990.00" $796.00 "$1,177.09" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,492.50" "$1,990.00" "$1,990.00" "$1,990.00" $995.00 $995.00 "$1,576.08" "$1,990.00" "$1,592.00" $895.50 $394.97 N/A "$1,154.20" "$1,990.00" "$1,194.00" "$1,990.00" $414.72 "$1,990.00" N/A N/A GMN-LTS-7HL SUP HCPCS C1713 GMN-LTS-7HL - PLATE BN STD NS GEMINUS 7 HL TI LT DIST VOLR RDS FOSSA BOTH IP/OP "$2,190.00" "$1,621.00" $434.66 "$2,190.00" $985.50 $985.50 $985.50 $985.50 "$2,190.00" "$2,190.00" "$2,190.00" $456.45 "$2,190.00" "$2,190.00" "$2,190.00" "$2,190.00" "$2,190.00" $456.42 "$2,190.00" $876.00 "$1,295.39" "$2,190.00" "$2,190.00" "$2,190.00" "$2,190.00" "$1,642.50" "$2,190.00" "$2,190.00" "$2,190.00" "$1,095.00" "$1,095.00" "$1,734.48" "$2,190.00" "$1,752.00" $985.50 $434.66 N/A "$1,270.20" "$2,190.00" "$1,314.00" "$2,190.00" $456.40 "$2,190.00" N/A N/A GMN-LTW-4HL SUP HCPCS C1713 GMN-LTW-4HL - PLATE BN W NS GEMINUS 4 HL TI LT DIST VOLR RDS FOSSA BOTH IP/OP "$1,990.00" "$1,473.00" $394.97 "$1,990.00" $895.50 $895.50 $895.50 $895.50 "$1,990.00" "$1,990.00" "$1,990.00" $414.77 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" $414.74 "$1,990.00" $796.00 "$1,177.09" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,492.50" "$1,990.00" "$1,990.00" "$1,990.00" $995.00 $995.00 "$1,576.08" "$1,990.00" "$1,592.00" $895.50 $394.97 N/A "$1,154.20" "$1,990.00" "$1,194.00" "$1,990.00" $414.72 "$1,990.00" N/A N/A GMN-RTN-3HL SUP HCPCS C1713 GMN-RTN-3HL - PLATE BN NAR NS GEMINUS 3 HL TI RT DIST VOLR RDS FOSSA BOTH IP/OP "$1,990.00" "$1,473.00" $394.97 "$1,990.00" $895.50 $895.50 $895.50 $895.50 "$1,990.00" "$1,990.00" "$1,990.00" $414.77 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" $414.74 "$1,990.00" "$1,990.00" "$1,177.09" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,492.50" "$1,990.00" "$1,990.00" "$1,990.00" $995.00 $995.00 "$1,576.08" "$1,990.00" "$1,592.00" $895.50 $394.97 N/A "$1,154.20" "$1,990.00" "$1,194.00" "$1,990.00" $414.72 "$1,990.00" N/A N/A GMN-RTN-4HL SUP HCPCS C1713 GMN-RTN-4HL - PLATE BN NAR NS GEMINUS 4 HL TI RT DIST VOLR RDS FOSSA BOTH IP/OP "$1,990.00" "$1,473.00" $394.97 "$1,990.00" $895.50 $895.50 $895.50 $895.50 "$1,990.00" "$1,990.00" "$1,990.00" $414.77 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" $414.74 "$1,990.00" $796.00 "$1,177.09" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,492.50" "$1,990.00" "$1,990.00" "$1,990.00" $995.00 $995.00 "$1,576.08" "$1,990.00" "$1,592.00" $895.50 $394.97 N/A "$1,154.20" "$1,990.00" "$1,194.00" "$1,990.00" $414.72 "$1,990.00" N/A N/A GMN-RTS-3HL SUP HCPCS C1713 GMN-RTS-3HL - PLATE BN STD NS GEMINUS 3 HL TI RT DIST VOLR RDS BOTH IP/OP "$1,990.00" "$1,473.00" $394.97 "$1,990.00" $895.50 $895.50 $895.50 $895.50 "$1,990.00" "$1,990.00" "$1,990.00" $414.77 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" $414.74 "$1,990.00" $796.00 "$1,177.09" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,492.50" "$1,990.00" "$1,990.00" "$1,990.00" $995.00 $995.00 "$1,576.08" "$1,990.00" "$1,592.00" $895.50 $394.97 N/A "$1,154.20" "$1,990.00" "$1,194.00" "$1,990.00" $414.72 "$1,990.00" N/A N/A GMN-RTS-4HL SUP HCPCS C1713 GMN-RTS-4HL - PLATE BN STD NS GEMINUS 4 HL TI RT DIST VOLR RDS FOSSA BOTH IP/OP "$1,990.00" "$1,473.00" $394.97 "$1,990.00" $895.50 $895.50 $895.50 $895.50 "$1,990.00" "$1,990.00" "$1,990.00" $414.77 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" $414.74 "$1,990.00" $796.00 "$1,177.09" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,492.50" "$1,990.00" "$1,990.00" "$1,990.00" $995.00 $995.00 "$1,576.08" "$1,990.00" "$1,592.00" $895.50 $394.97 N/A "$1,154.20" "$1,990.00" "$1,194.00" "$1,990.00" $414.72 "$1,990.00" N/A N/A GMN-RTS-7HL SUP HCPCS C1713 GMN-RTS-7HL - PLATE BN STD NS GEMINUS 7 HL TI RDS RT FOSSA DIST BOTH IP/OP "$2,190.00" "$1,621.00" $434.66 "$2,190.00" $985.50 $985.50 $985.50 $985.50 "$2,190.00" "$2,190.00" "$2,190.00" $456.45 "$2,190.00" "$2,190.00" "$2,190.00" "$2,190.00" "$2,190.00" $456.42 "$2,190.00" "$2,190.00" "$1,295.39" "$2,190.00" "$2,190.00" "$2,190.00" "$2,190.00" "$1,642.50" "$2,190.00" "$2,190.00" "$2,190.00" "$1,095.00" "$1,095.00" "$1,734.48" "$2,190.00" "$1,752.00" $985.50 $434.66 N/A "$1,270.20" "$2,190.00" "$2,190.00" "$2,190.00" $456.40 "$2,190.00" N/A N/A GMN-RTW-4HL SUP HCPCS C1713 GMN-RTW-4HL - PLATE BN W NS GEMINUS 4 HL TI RDS RT DIST FOSSA BOTH IP/OP "$1,990.00" "$1,473.00" $394.97 "$1,990.00" $895.50 $895.50 $895.50 $895.50 "$1,990.00" "$1,990.00" "$1,990.00" $414.77 "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" $414.74 "$1,990.00" "$1,990.00" "$1,177.09" "$1,990.00" "$1,990.00" "$1,990.00" "$1,990.00" "$1,492.50" "$1,990.00" "$1,990.00" "$1,990.00" $995.00 $995.00 "$1,576.08" "$1,990.00" "$1,592.00" $895.50 $394.97 N/A "$1,154.20" "$1,990.00" "$1,194.00" "$1,990.00" $414.72 "$1,990.00" N/A N/A GN1000 SUP Custom 27803010 GN1000 - KIT SNR 10MM 4FR 120CM 102CM AGN CATH PREFORM LOOP RADOPQ BOTH IP/OP $825.00 $611.00 $146.85 $825.00 $825.00 $825.00 $825.00 $825.00 $825.00 $825.00 $146.85 $825.00 $825.00 $825.00 $825.00 $825.00 $825.00 $171.94 $825.00 $330.00 $825.00 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $371.25 $825.00 N/A $478.50 $825.00 $495.00 $825.00 $825.00 $825.00 N/A N/A GN1500 SUP HCPCS C1773 GN1500 - KIT SNR 15MM 6FR 120CM 102CM AGN CATH PREFORM LOOP RADOPQ BOTH IP/OP $800.00 $592.00 $158.78 $800.00 $434.40 $434.40 $434.40 $434.40 $800.00 $800.00 $800.00 $166.74 $800.00 $593.76 $593.76 $616.64 $416.80 $166.73 $800.00 $800.00 $473.20 $800.00 $800.00 $800.00 $800.00 $600.00 $800.00 $800.00 $800.00 $400.00 $400.00 $633.60 $800.00 $640.00 $520.00 $158.78 N/A $464.00 $800.00 $800.00 $800.00 $166.72 $800.00 N/A N/A GN2500 SUP Custom 27803010 GN2500 - KIT SNR 25MM 6FR 120CM 102CM AGN CATH PREFORM LOOP RADOPQ BOTH IP/OP $800.00 $592.00 $142.40 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $142.40 $800.00 $800.00 $800.00 $800.00 $800.00 $800.00 $166.73 $800.00 $320.00 $800.00 $800.00 $800.00 $800.00 $800.00 $600.00 $800.00 $800.00 $800.00 $400.00 $400.00 $633.60 $800.00 $640.00 $360.00 $800.00 N/A $464.00 $800.00 $480.00 $800.00 $800.00 $800.00 N/A N/A GN500 SUP Custom 27803010 GN500 - KIT SNR 5MM 4FR 120CM 102CM AGN CATH PREFORM LOOP RADOPQ BOTH IP/OP $747.50 $553.00 $133.01 $747.25 $747.25 $747.25 $747.25 $747.25 $747.25 $747.25 $133.01 $747.25 $747.25 $747.25 $747.25 $747.25 $747.25 $155.74 $747.25 $298.90 $747.25 $747.25 $747.25 $747.25 $747.25 $560.63 $747.25 $747.25 $747.25 $373.63 $373.63 $591.82 $747.25 $597.80 $336.26 $747.25 N/A $433.55 $747.25 $448.35 $747.25 $747.25 $747.25 N/A N/A GOLD-18 SUP HCPCS L8610 GOLD-18 - WEIGHT EYELID 3 SUTURE HOLE SUTUREGROOVE GOLD 1.8GM STERILE BOTH IP/OP $800.00 $592.00 $158.78 $800.00 $360.00 $360.00 $360.00 $360.00 $800.00 $800.00 $800.00 $166.74 $800.00 $800.00 $800.00 $800.00 $800.00 $166.73 $800.00 $800.00 $473.20 $800.00 $800.00 $800.00 $800.00 $600.00 $800.00 $800.00 $800.00 $400.00 $400.00 $633.60 $800.00 $640.00 $360.00 $158.78 N/A $464.00 $800.00 $800.00 $800.00 $166.72 $800.00 N/A N/A GPSL SUP HCPCS C1781 GPSL - MESH SURG 15X10CM SOFT KNIT NONABSORBABLE GYNECARE GYNEMESH BOTH IP/OP $847.00 $627.00 $168.11 $847.00 $381.15 $381.15 $381.15 $381.15 $847.00 $847.00 $847.00 $176.54 $847.00 $847.00 $847.00 $847.00 $847.00 $176.52 $847.00 $847.00 $501.00 $847.00 $847.00 $847.00 $847.00 $635.25 $847.00 $847.00 $847.00 $423.50 $423.50 $670.82 $847.00 $677.60 $381.15 $168.11 N/A $491.26 $847.00 $847.00 $847.00 $176.51 $847.00 N/A N/A GPSXL3 SUP HCPCS C1781 GPSXL3 - MESH SURG 25X25CM SOFT KNIT NONABSORBABLE GYNECARE GYNEMESH BOTH IP/OP "$4,367.00" "$3,232.00" $866.74 "$4,367.00" "$1,965.15" "$1,965.15" "$1,965.15" "$1,965.15" "$4,367.00" "$4,367.00" "$4,367.00" $910.19 "$4,367.00" "$4,367.00" "$4,367.00" "$4,367.00" "$4,367.00" $910.13 "$4,367.00" "$4,367.00" "$2,152.93" "$4,367.00" "$4,367.00" "$4,367.00" "$4,367.00" "$3,275.25" "$4,367.00" "$4,367.00" "$4,367.00" "$2,183.50" "$2,183.50" "$3,458.66" "$4,367.00" "$3,493.60" "$1,965.15" $866.74 N/A "$2,532.86" "$4,367.00" "$4,367.00" "$4,367.00" $910.08 "$4,367.00" N/A N/A GR1807 SUP HCPCS C1769 GR1807 - GUIDEWIRE VASCULAR ANGLE .018IN 260CM 3CM GLIDEWIRE HYDPHI BOTH IP/OP $975.00 $722.00 $193.51 "$1,010.63" $529.43 $529.43 $529.43 $529.43 $975.00 $975.00 $975.00 $203.21 $975.00 $723.65 $723.65 $751.53 $507.98 $203.20 $975.00 "$1,010.63" $576.71 $975.00 "$1,010.63" $975.00 $975.00 $731.25 $975.00 $975.00 $975.00 $487.50 $487.50 $772.20 $975.00 $780.00 $633.75 $193.51 N/A $565.50 $975.00 $975.00 $975.00 $203.19 $975.00 N/A N/A GR3501 SUP HCPCS C1769 GR3501 - GUIDEWIRE VASC STRG .035IN 150CM 3CM GLDWR STF SHFT HDRPH BOTH IP/OP $72.50 $54.00 $14.39 $80.45 $39.37 $39.37 $39.37 $39.37 $72.50 $72.50 $72.50 $15.11 $72.50 $53.81 $53.81 $55.88 $37.77 $15.11 $72.50 $80.45 $42.88 $72.50 $80.45 $72.50 $72.50 $54.38 $72.50 $72.50 $72.50 $36.25 $36.25 $57.42 $72.50 $58.00 $47.13 $14.39 N/A $42.05 $72.50 $72.50 $72.50 $15.11 $72.50 N/A N/A GR3503 SUP HCPCS C1769 GR3503 - GUIDEWIRE VASCULAR STANDARD STR .035IN 180CM 3CM JACKET CORE BOTH IP/OP $99.50 $74.00 $19.70 $108.00 $53.89 $53.89 $53.89 $53.89 $99.25 $99.25 $99.25 $20.69 $99.25 $73.66 $73.66 $76.50 $51.71 $20.68 $99.25 $108.00 $58.71 $99.25 $108.00 $99.25 $99.25 $74.63 $99.25 $99.25 $99.25 $49.63 $49.63 $78.61 $99.25 $79.40 $64.51 $19.70 N/A $57.71 $99.25 $99.25 $99.25 $20.68 $99.25 N/A N/A GR3504 SUP HCPCS C1769 GR3504 - GUIDEWIRE VASCULAR STANDARD STR .035IN 260CM 3CM JACKET CORE BOTH IP/OP $111.00 $82.00 $22.03 $120.75 $60.27 $60.27 $60.27 $60.27 $111.00 $111.00 $111.00 $23.14 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $120.75 $65.66 $111.00 $120.75 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $22.03 N/A $64.38 $111.00 $66.60 $111.00 $23.13 $111.00 N/A N/A GR3506 SUP HCPCS C1769 GR3506 - GUIDEWIRE VASC STD ANG .035IN 150CM 3CM GLDWR GLD TCH JKT BOTH IP/OP $80.50 $60.00 $15.97 $80.45 $43.68 $43.68 $43.68 $43.68 $80.45 $80.45 $80.45 $16.77 $80.45 $59.71 $59.71 $62.01 $41.91 $16.77 $80.45 $80.45 $47.59 $80.45 $80.45 $80.45 $80.45 $60.38 $80.45 $80.45 $80.45 $40.23 $40.23 $63.72 $80.45 $64.36 $52.29 $15.97 N/A $46.69 $80.45 $80.45 $80.45 $16.77 $80.45 N/A N/A GR3508 SUP HCPCS C1769 GR3508 - GUIDEWIRE VASCULAR ANGLE STANDARD .035IN 180CM 3CM JACKET BOTH IP/OP $99.50 $74.00 $19.70 $108.00 $53.89 $53.89 $53.89 $53.89 $99.25 $99.25 $99.25 $20.69 $99.25 $73.66 $73.66 $76.50 $51.71 $20.68 $99.25 $108.00 $58.71 $99.25 $108.00 $99.25 $99.25 $74.63 $99.25 $99.25 $99.25 $49.63 $49.63 $78.61 $99.25 $79.40 $64.51 $19.70 N/A $57.71 $99.25 $99.25 $99.25 $20.68 $99.25 N/A N/A GR3509 SUP HCPCS C1769 GR3509 - GUIDEWIRE VASC STD ANG .035IN 260CM 3CM GLDWR GLD TCH FLXB BOTH IP/OP $111.00 $82.00 $22.03 $120.75 $60.27 $60.27 $60.27 $60.27 $111.00 $111.00 $111.00 $23.14 $111.00 $82.38 $82.38 $85.56 $57.83 $23.13 $111.00 $120.75 $65.66 $111.00 $120.75 $111.00 $111.00 $83.25 $111.00 $111.00 $111.00 $55.50 $55.50 $87.91 $111.00 $88.80 $72.15 $22.03 N/A $64.38 $111.00 $111.00 $111.00 $23.13 $111.00 N/A N/A GR3807 SUP HCPCS C1769 GR3807 - GUIDEWIRE VASCULAR ANGLED .038IN 150CM 8CM GLIDEWIRE HYDPHI BOTH IP/OP $82.00 $61.00 $17.66 $89.00 $48.33 $48.33 $48.33 $48.33 $89.00 $89.00 $89.00 $18.55 $89.00 $66.06 $66.06 $68.60 $46.37 $18.55 $89.00 $89.00 $52.64 $89.00 $89.00 $89.00 $89.00 $61.50 $89.00 $89.00 $89.00 $44.50 $44.50 $70.49 $89.00 $71.20 $57.85 $17.66 N/A $47.56 $89.00 $89.00 $89.00 $18.55 $89.00 N/A N/A GR3807 SUP HCPCS C1769 GR3807 - GUIDEWIRE VASC .97MM 150CM STRL LF 8CM RADIFOCUS GLDWR FLX BOTH IP/OP $89.00 $66.00 $17.66 $89.00 $48.33 $48.33 $48.33 $48.33 $89.00 $89.00 $89.00 $18.55 $89.00 $66.06 $66.06 $68.60 $46.37 $18.55 $89.00 $89.00 $52.64 $89.00 $89.00 $89.00 $89.00 $66.75 $89.00 $89.00 $89.00 $44.50 $44.50 $70.49 $89.00 $71.20 $57.85 $17.66 N/A $51.62 $89.00 $89.00 $89.00 $18.55 $89.00 N/A N/A GR3808 SUP HCPCS C1769 GR3808 - GUIDEWIRE VASCULAR ANGLED .038IN 180CM 3CM GLIDEWIRE HYDPHI BOTH IP/OP $99.50 $74.00 $21.44 $108.00 $58.64 $58.64 $58.64 $58.64 $108.00 $108.00 $108.00 $22.51 $108.00 $80.16 $80.16 $83.25 $56.27 $22.51 $108.00 $108.00 $63.88 $108.00 $108.00 $108.00 $108.00 $74.63 $108.00 $108.00 $108.00 $54.00 $54.00 $85.54 $108.00 $86.40 $70.20 $21.44 N/A $57.71 $108.00 $108.00 $108.00 $22.51 $108.00 N/A N/A GR3808 SUP HCPCS C1769 GR3808 - GUIDEWIRE VASC STD .038IN 180CM 3CM GLDWR FLXB ANG TIP BOTH IP/OP $108.00 $80.00 $21.44 $108.00 $58.64 $58.64 $58.64 $58.64 $108.00 $108.00 $108.00 $22.51 $108.00 $80.16 $80.16 $83.25 $56.27 $22.51 $108.00 $108.00 $63.88 $108.00 $108.00 $108.00 $108.00 $81.00 $108.00 $108.00 $108.00 $54.00 $54.00 $85.54 $108.00 $86.40 $70.20 $21.44 N/A $62.64 $108.00 $108.00 $108.00 $22.51 $108.00 N/A N/A GR3809 SUP HCPCS C1769 GR3809 - GUIDEWIRE VASCULAR ANGLED .038IN 260CM 3CM GLIDEWIRE HYDPHI BOTH IP/OP $111.00 $82.00 $23.97 $120.75 $65.57 $65.57 $65.57 $65.57 $120.75 $120.75 $120.75 $25.17 $120.75 $89.62 $89.62 $93.07 $62.91 $25.17 $120.75 $120.75 $71.42 $120.75 $120.75 $120.75 $120.75 $83.25 $120.75 $120.75 $120.75 $60.38 $60.38 $95.63 $120.75 $96.60 $78.49 $23.97 N/A $64.38 $120.75 $120.75 $120.75 $25.16 $120.75 N/A N/A GR3809 SUP HCPCS C1769 GR3809 - GUIDEWIRE VASC STD .038IN 260CM 3CM GLDWR FLXB ANG TIP BOTH IP/OP $121.00 $90.00 $23.97 $120.75 $65.57 $65.57 $65.57 $65.57 $120.75 $120.75 $120.75 $25.17 $120.75 $89.62 $89.62 $93.07 $62.91 $25.17 $120.75 $120.75 $71.42 $120.75 $120.75 $120.75 $120.75 $90.75 $120.75 $120.75 $120.75 $60.38 $60.38 $95.63 $120.75 $96.60 $78.49 $23.97 N/A $70.18 $120.75 $120.75 $120.75 $25.16 $120.75 N/A N/A GR74089-02 SUP Custom 27203010 GR74089-02 - BAG TISS CLSR 7.5CM DRAIN WL DFCT 7.5CM SILO STRL DISP SIL BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $200.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A GRAD0010-11 SUP Custom 27203010 GRAD0010-11 - PACK SRG CRD CATH BOTH IP/OP $125.50 $93.00 $22.34 $125.50 $125.50 $125.50 $125.50 $125.50 $125.50 $125.50 $22.34 $125.50 $125.50 $93.15 $93.15 $96.74 $65.39 $26.16 $125.50 $50.20 $125.50 $125.50 $125.50 $125.50 $125.50 $94.13 $125.50 $125.50 $125.50 $62.75 $62.75 $99.40 $125.50 $100.40 $81.58 $125.50 N/A $72.79 $125.50 $75.30 $125.50 $125.50 $125.50 N/A N/A GRAD0024-06 SUP Custom 27203010 GRAD0024-06 - TRAY PROCEDURE IMPLANT EP PACK BOTH IP/OP $195.50 $145.00 $34.75 $195.25 $195.25 $195.25 $195.25 $195.25 $195.25 $195.25 $34.75 $195.25 $195.25 $144.91 $144.91 $150.50 $101.73 $40.69 $195.25 $78.10 $195.25 $195.25 $195.25 $195.25 $195.25 $146.63 $195.25 $195.25 $195.25 $97.63 $97.63 $154.64 $195.25 $156.20 $126.91 $195.25 N/A $113.39 $195.25 $117.15 $195.25 $195.25 $195.25 N/A N/A GRAD0026-06 SUP HCPCS C1751 GRAD0026-06 - TRAY SRG STRL PICC CTH LB RAD BOTH IP/OP $89.00 $66.00 $17.65 $88.91 $48.28 $48.28 $48.28 $48.28 $88.91 $88.91 $88.91 $18.53 $88.91 $65.99 $65.99 $68.53 $46.32 $18.53 $88.91 $88.91 $52.59 $88.91 $88.91 $88.91 $88.91 $66.75 $88.91 $88.91 $88.91 $44.46 $44.46 $70.42 $88.91 $71.13 $57.79 $17.65 N/A $51.62 $88.91 $88.91 $88.91 $18.53 $88.91 N/A N/A GRAD0027-05 SUP Custom 27203010 GRAD0027-05 - TRAY SRG STRL VNS ACC CTH LB RAD BOTH IP/OP $118.00 $87.00 $20.96 $117.73 $117.73 $117.73 $117.73 $117.73 $117.73 $117.73 $20.96 $117.73 $117.73 $87.38 $87.38 $90.75 $61.34 $24.54 $117.73 $43.24 $117.73 $117.73 $117.73 $117.73 $117.73 $88.50 $117.73 $117.73 $117.73 $58.87 $58.87 $93.24 $117.73 $94.18 $76.52 $117.73 N/A $68.44 $117.73 $70.64 $117.73 $117.73 $117.73 N/A N/A GRAD0058-03 SUP Custom 27203010 GRAD0058-03 - TRAY NEURO ANGIO BOTH IP/OP $131.50 $97.00 $23.39 $131.43 $131.43 $131.43 $131.43 $131.43 $131.43 $131.43 $23.39 $131.43 $131.43 $97.55 $97.55 $101.31 $68.48 $27.39 $131.43 $52.57 $131.43 $131.43 $131.43 $131.43 $131.43 $98.63 $131.43 $131.43 $131.43 $65.72 $65.72 $104.09 $131.43 $105.14 $85.43 $131.43 N/A $76.27 $131.43 $78.86 $131.43 $131.43 $131.43 N/A N/A GRAD0059-03 SUP Custom 27203010 GRAD0059-03 - TRAY BX STRL LF AVID TRUCUSTOM DISP BOTH IP/OP $52.50 $39.00 $9.30 $52.27 $52.27 $52.27 $52.27 $52.27 $52.27 $52.27 $9.30 $52.27 $52.27 $38.79 $38.79 $40.29 $27.23 $10.89 $52.27 $20.91 $52.27 $52.27 $52.27 $52.27 $52.27 $39.38 $52.27 $52.27 $52.27 $26.14 $26.14 $41.40 $52.27 $41.82 $33.98 $52.27 N/A $30.45 $52.27 $31.36 $52.27 $52.27 $52.27 N/A N/A GS3503 SUP HCPCS C1769 GS3503 - GUIDEWIRE VASCULAR STR .035IN 180CM 3CM STIFF SHAFT BOTH IP/OP $117.00 $87.00 $23.17 $116.75 $63.40 $63.40 $63.40 $63.40 $116.75 $116.75 $116.75 $24.33 $116.75 $86.65 $86.65 $89.99 $60.83 $24.33 $116.75 $116.75 $69.06 $116.75 $116.75 $116.75 $116.75 $87.75 $116.75 $116.75 $116.75 $58.38 $58.38 $92.47 $116.75 $93.40 $75.89 $23.17 N/A $67.86 $116.75 $116.75 $116.75 $24.33 $116.75 N/A N/A GS3504 SUP HCPCS C1769 GS3504 - GUIDEWIRE VASCULAR STR .035IN 260CM 3CM STIFF SHAFT FLEXIBLE BOTH IP/OP $125.00 $93.00 $24.74 $135.58 $67.67 $67.67 $67.67 $67.67 $124.63 $124.63 $124.63 $25.98 $124.63 $92.50 $92.50 $96.06 $64.93 $25.97 $124.63 $135.58 $73.72 $124.63 $135.58 $124.63 $124.63 $93.75 $124.63 $124.63 $124.63 $62.32 $62.32 $98.71 $124.63 $99.70 $81.01 $24.74 N/A $72.50 $124.63 $124.63 $124.63 $25.97 $124.63 N/A N/A GS3506 SUP HCPCS C1769 GS3506 - GUIDEWIRE VASCULAR ANGLE .035IN 150CM 3CM FLEXIBLE TIP STIFF BOTH IP/OP $113.00 $84.00 $24.38 $122.85 $66.71 $66.71 $66.71 $66.71 $122.85 $122.85 $122.85 $25.61 $122.85 $91.18 $91.18 $94.69 $64.00 $25.60 $122.85 $122.85 $72.67 $122.85 $122.85 $122.85 $122.85 $84.75 $122.85 $122.85 $122.85 $61.43 $61.43 $97.30 $122.85 $98.28 $79.85 $24.38 N/A $65.54 $122.85 $122.85 $122.85 $25.60 $122.85 N/A N/A GS3506 SUP HCPCS C1769 GS3506 - GUIDEWIRE VASCULAR ANGLE .035I BOTH IP/OP $123.00 $91.00 $24.38 $122.85 $66.71 $66.71 $66.71 $66.71 $122.85 $122.85 $122.85 $25.61 $122.85 $91.18 $91.18 $94.69 $64.00 $25.60 $122.85 $122.85 $72.67 $122.85 $122.85 $122.85 $122.85 $92.25 $122.85 $122.85 $122.85 $61.43 $61.43 $97.30 $122.85 $98.28 $79.85 $24.38 N/A $71.34 $122.85 $122.85 $122.85 $25.60 $122.85 N/A N/A GS3508 SUP HCPCS C1769 GS3508 - GUIDEWIRE VASCULAR ANGLE .035IN 180CM 3CM STIFF SHAFT BOTH IP/OP $117.00 $87.00 $23.17 $127.18 $63.40 $63.40 $63.40 $63.40 $116.75 $116.75 $116.75 $24.33 $116.75 $86.65 $86.65 $89.99 $60.83 $24.33 $116.75 $127.18 $69.06 $116.75 $127.18 $116.75 $116.75 $87.75 $116.75 $116.75 $116.75 $58.38 $58.38 $92.47 $116.75 $93.40 $75.89 $23.17 N/A $67.86 $116.75 $116.75 $116.75 $24.33 $116.75 N/A N/A GS3509 SUP HCPCS C1769 GS3509 - GUIDEWIRE VASCULAR ANGLE .035IN 260CM 3CM STIFF SHAFT BOTH IP/OP $125.00 $93.00 $24.74 $135.58 $67.67 $67.67 $67.67 $67.67 $124.63 $124.63 $124.63 $25.98 $124.63 $92.50 $92.50 $96.06 $64.93 $25.97 $124.63 $135.58 $73.72 $124.63 $135.58 $124.63 $124.63 $93.75 $124.63 $124.63 $124.63 $62.32 $62.32 $98.71 $124.63 $99.70 $81.01 $24.74 N/A $72.50 $124.63 $124.63 $124.63 $25.97 $124.63 N/A N/A GS3807 SUP HCPCS C1769 GS3807 - GUIDEWIRE VASCULAR ANGLE .038IN 180CM 3CM STIFF SHAFT BOTH IP/OP $117.00 $87.00 $25.24 $127.18 $69.06 $69.06 $69.06 $69.06 $127.18 $127.18 $127.18 $26.51 $127.18 $94.39 $94.39 $98.03 $66.26 $26.51 $127.18 $127.18 $75.23 $127.18 $127.18 $127.18 $127.18 $87.75 $127.18 $127.18 $127.18 $63.59 $63.59 $100.73 $127.18 $101.74 $82.67 $25.24 N/A $67.86 $127.18 $127.18 $127.18 $26.50 $127.18 N/A N/A GS3807 SUP HCPCS C1769 GS3807 - GUIDEWIRE VASC ANG .038IN 180CM 3CM GLDWR RADOPQ STF FLXB BOTH IP/OP $127.50 $94.00 $25.24 $127.18 $69.06 $69.06 $69.06 $69.06 $127.18 $127.18 $127.18 $26.51 $127.18 $94.39 $94.39 $98.03 $66.26 $26.51 $127.18 $127.18 $75.23 $127.18 $127.18 $127.18 $127.18 $95.63 $127.18 $127.18 $127.18 $63.59 $63.59 $100.73 $127.18 $101.74 $82.67 $25.24 N/A $73.95 $127.18 $127.18 $127.18 $26.50 $127.18 N/A N/A GSLM-14 SUP HCPCS L8610 GSLM-14 - WEIGHT EYELID SLIM SUTUREGROOVE THK.75MM GOLD 1.4GM STERILE BOTH IP/OP $700.00 $518.00 $138.93 $700.00 $315.00 $315.00 $315.00 $315.00 $700.00 $700.00 $700.00 $145.90 $700.00 $700.00 $700.00 $700.00 $700.00 $145.89 $700.00 $700.00 $414.05 $700.00 $700.00 $700.00 $700.00 $525.00 $700.00 $700.00 $700.00 $350.00 $350.00 $554.40 $700.00 $560.00 $315.00 $138.93 N/A $406.00 $700.00 $700.00 $700.00 $145.88 $700.00 N/A N/A GSLM-16 SUP HCPCS L8610 GSLM-16 - WEIGHT EYLD THK.75MM STRL SUTUREGROOVE SLIM AU 1.6GM DISP BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $337.50 $337.50 $337.50 $337.50 $750.00 $750.00 $750.00 $156.32 $750.00 $750.00 $750.00 $750.00 $750.00 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $337.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A GST45B SUP Custom 27203010 GST45B - RELOAD STPLR 45MMX3.6MM BLU STRL LF 1.5MM ECHLN EPTH ECHLN BOTH IP/OP $878.00 $650.00 $156.26 $877.84 $877.84 $877.84 $877.84 $877.84 $877.84 $877.84 $156.26 $877.84 $877.84 $651.53 $651.53 $676.64 $457.35 $182.95 $877.84 $351.14 $877.84 $877.84 $877.84 $877.84 $877.84 $658.50 $877.84 $877.84 $877.84 $438.92 $438.92 $695.25 $877.84 $702.27 $570.60 $877.84 N/A $509.24 $877.84 $526.70 $877.84 $877.84 $877.84 N/A N/A GST45G SUP Custom 27203010 GST45G - RELOAD STPLR 45MMX4.1MM GRN STRL LF 2MM ECHLN EPTH ECHLN FLX BOTH IP/OP $878.00 $650.00 $156.26 $877.84 $877.84 $877.84 $877.84 $877.84 $877.84 $877.84 $156.26 $877.84 $877.84 $651.53 $651.53 $676.64 $457.35 $182.95 $877.84 $351.14 $877.84 $877.84 $877.84 $877.84 $877.84 $658.50 $877.84 $877.84 $877.84 $438.92 $438.92 $695.25 $877.84 $702.27 $570.60 $877.84 N/A $509.24 $877.84 $526.70 $877.84 $877.84 $877.84 N/A N/A GST45W SUP Custom 27203010 GST45W - RELOAD STPLR 45MMX2.6MM WHT STRL LF 1MM ECHLN EPTH ECHLN FLX BOTH IP/OP $878.00 $650.00 $156.26 $877.84 $877.84 $877.84 $877.84 $877.84 $877.84 $877.84 $156.26 $877.84 $877.84 $651.53 $651.53 $676.64 $457.35 $182.95 $877.84 $351.14 $877.84 $877.84 $877.84 $877.84 $877.84 $658.50 $877.84 $877.84 $877.84 $438.92 $438.92 $695.25 $877.84 $702.27 $570.60 $877.84 N/A $509.24 $877.84 $526.70 $877.84 $877.84 $877.84 N/A N/A GST60D SUP Custom 27203010 GST60D - RELOAD STPLR 60MMX3.8MM AU 1.8MM ECHLN EPTH REG THKTIS BOTH IP/OP $949.50 $703.00 $168.96 $949.21 $949.21 $949.21 $949.21 $949.21 $949.21 $949.21 $168.96 $949.21 $949.21 $704.50 $704.50 $731.65 $494.54 $197.83 $949.21 $379.68 $949.21 $949.21 $949.21 $949.21 $949.21 $712.13 $949.21 $949.21 $949.21 $474.61 $474.61 $751.77 $949.21 $759.37 $616.99 $949.21 N/A $550.71 $949.21 $569.53 $949.21 $949.21 $949.21 N/A N/A GST60G SUP Custom 27203010 GST60G - RELOAD STPLR 60MMX4.1MM GRN STRL LF 2MM ECHLN EPTH ECHLN FLX BOTH IP/OP $949.50 $703.00 $168.96 $949.21 $949.21 $949.21 $949.21 $949.21 $949.21 $949.21 $168.96 $949.21 $949.21 $704.50 $704.50 $731.65 $494.54 $197.83 $949.21 $379.68 $949.21 $949.21 $949.21 $949.21 $949.21 $712.13 $949.21 $949.21 $949.21 $474.61 $474.61 $751.77 $949.21 $759.37 $616.99 $949.21 N/A $550.71 $949.21 $569.53 $949.21 $949.21 $949.21 N/A N/A GST60W SUP Custom 27203010 GST60W - RELOAD STPLR 60MMX2.6MM WHT STRL LF 1MM ECHLN EPTH ECHLN FLX BOTH IP/OP $949.50 $703.00 $168.96 $949.21 $949.21 $949.21 $949.21 $949.21 $949.21 $949.21 $168.96 $949.21 $949.21 $704.50 $704.50 $731.65 $494.54 $197.83 $949.21 $379.68 $949.21 $949.21 $949.21 $949.21 $949.21 $712.13 $949.21 $949.21 $949.21 $474.61 $474.61 $751.77 $949.21 $759.37 $616.99 $949.21 N/A $550.71 $949.21 $569.53 $949.21 $949.21 $949.21 N/A N/A GTK14 SUP Custom 27203010 GTK14 - SYSTEM XTRT 14CM ALEXIS KII SPEC CNTN BG BLN BLNT TPGRD BOTH IP/OP $812.50 $601.00 $144.63 $937.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $375.00 $812.50 $812.50 $937.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A GTK17 SUP Custom 27203010 GTK17 - SYSTEM XTRT 12X100MM 6500ML ALEXIS BLN BLNT TIP CNTN BOTH IP/OP $812.50 $601.00 $144.63 $937.50 $812.50 $812.50 $812.50 $812.50 $812.50 $812.50 $144.63 $812.50 $812.50 $603.04 $603.04 $626.28 $423.31 $169.33 $812.50 $375.00 $812.50 $812.50 $937.50 $812.50 $812.50 $609.38 $812.50 $812.50 $812.50 $406.25 $406.25 $643.50 $812.50 $650.00 $528.13 $812.50 N/A $471.25 $812.50 $487.50 $812.50 $812.50 $812.50 N/A N/A H470045A SUP HCPCS C1768 H470045A - GRAFT VASCULAR STANDARD WALL TAPER 4-7MM 45CM STRETCH COATED BOTH IP/OP "$3,147.50" "$2,329.00" $624.70 "$3,147.50" "$1,416.38" "$1,416.38" "$1,416.38" "$1,416.38" "$3,147.50" "$3,147.50" "$3,147.50" $656.02 "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" $655.97 "$3,147.50" "$3,147.50" "$1,551.72" "$3,147.50" "$3,147.50" "$3,147.50" "$3,147.50" "$2,360.63" "$3,147.50" "$3,147.50" "$3,147.50" "$1,573.75" "$1,573.75" "$2,492.82" "$3,147.50" "$2,518.00" "$1,416.38" $624.70 N/A "$1,825.55" "$3,147.50" "$3,147.50" "$3,147.50" $655.94 "$3,147.50" N/A N/A H74912044166070 SUP HCPCS C1876 H74912044166070 - STENT EPRSTH 75CM 16MM 60MM WLSTNT RADOPQ CATH SLF XPD STPCK BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H74912044169070 SUP HCPCS C1876 H74912044169070 - STENT EPRSTH 75CM 16MM 90MM WLSTNT RADOPQ CATH SLF XPD STPCK BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H74912100012 SUP HCPCS C1769 H74912100012 - GUIDEWIRE VASCULAR STR FLOPPY SPRING COIL .014IN 300CM BOTH IP/OP $159.50 $118.00 $31.61 $159.25 $86.47 $86.47 $86.47 $86.47 $159.25 $159.25 $159.25 $33.19 $159.25 $118.20 $118.20 $122.75 $82.97 $33.19 $159.25 $159.25 $94.20 $159.25 $159.25 $159.25 $159.25 $119.63 $159.25 $159.25 $159.25 $79.63 $79.63 $126.13 $159.25 $127.40 $103.51 $31.61 N/A $92.51 $159.25 $159.25 $159.25 $33.19 $159.25 N/A N/A H74912118012 SUP HCPCS C1769 H74912118012 - GUIDEWIRE VASCULAR STR SPRING COIL .014IN 300CM 3CM MODERATE BOTH IP/OP $796.50 $589.00 $158.04 $796.25 $432.36 $432.36 $432.36 $432.36 $796.25 $796.25 $796.25 $165.96 $796.25 $590.98 $590.98 $613.75 $414.85 $165.95 $796.25 $796.25 $470.98 $796.25 $796.25 $796.25 $796.25 $597.38 $796.25 $796.25 $796.25 $398.13 $398.13 $630.63 $796.25 $637.00 $517.56 $158.04 N/A $461.97 $796.25 $796.25 $796.25 $165.94 $796.25 N/A N/A H74912119012 SUP HCPCS C1769 H74912119012 - GUIDEWIRE VASCULAR STR SPRING COIL .014IN 300CM EXTRA BOTH IP/OP $159.50 $118.00 $31.61 $159.25 $86.47 $86.47 $86.47 $86.47 $159.25 $159.25 $159.25 $33.19 $159.25 $118.20 $118.20 $122.75 $82.97 $33.19 $159.25 $159.25 $94.20 $159.25 $159.25 $159.25 $159.25 $119.63 $159.25 $159.25 $159.25 $79.63 $79.63 $126.13 $159.25 $127.40 $103.51 $31.61 N/A $92.51 $159.25 $159.25 $159.25 $33.19 $159.25 N/A N/A H74912154012 SUP HCPCS C1769 H74912154012 - GUIDEWIRE VASC STRG .014IN 300CM 35CM CHC PT FLPY INTMD TIP BOTH IP/OP $159.50 $118.00 $31.61 $159.25 $86.47 $86.47 $86.47 $86.47 $159.25 $159.25 $159.25 $33.19 $159.25 $118.20 $118.20 $122.75 $82.97 $33.19 $159.25 $159.25 $94.20 $159.25 $159.25 $159.25 $159.25 $119.63 $159.25 $159.25 $159.25 $79.63 $79.63 $126.13 $159.25 $127.40 $103.51 $31.61 N/A $92.51 $159.25 $159.25 $159.25 $33.19 $159.25 N/A N/A H74912154012 SUP HCPCS C1769 H74912154012 - GUIDEWIRE VASCULAR STR FLOPPY INTERMEDIATE .014IN 300CM 35CM BOTH IP/OP $159.50 $118.00 $31.61 $159.25 $86.47 $86.47 $86.47 $86.47 $159.25 $159.25 $159.25 $33.19 $159.25 $118.20 $118.20 $122.75 $82.97 $33.19 $159.25 $159.25 $94.20 $159.25 $159.25 $159.25 $159.25 $119.63 $159.25 $159.25 $159.25 $79.63 $79.63 $126.13 $159.25 $127.40 $103.51 $31.61 N/A $92.51 $159.25 $159.25 $159.25 $33.19 $159.25 N/A N/A H74912155012 SUP HCPCS C1769 H74912155012 - GUIDEWIRE VASCULAR STR .014IN 300CM EXTRA SUPPORT BOTH IP/OP $159.50 $118.00 $31.61 $159.25 $86.47 $86.47 $86.47 $86.47 $159.25 $159.25 $159.25 $33.19 $159.25 $118.20 $118.20 $122.75 $82.97 $33.19 $159.25 $159.25 $94.20 $159.25 $159.25 $159.25 $159.25 $119.63 $159.25 $159.25 $159.25 $79.63 $79.63 $126.13 $159.25 $127.40 $103.51 $31.61 N/A $92.51 $159.25 $159.25 $159.25 $33.19 $159.25 N/A N/A H74914090100 SUP HCPCS C1876 H74914090100 - STENT EPRSTH 14MM 90MM 100MM VICI VNS STNT CATH NTNL ACPT BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A H74916060100 SUP HCPCS C1876 H74916060100 - STENT EPRSTH 16MM 60MM 100MM VICI VNS STNT CATH NTNL ACPT BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A H74916090100 SUP HCPCS C1876 H74916090100 - STENT EPRSTH 16MM 90MM 100MM VICI VNS STNT CATH NTNL ACPT BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$5,250.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A H74917521 SUP HCPCS C1769 H74917521 - GUIDEWIRE VASCULAR STR SPRING COIL .014IN 300CM 5CM SUPER BOTH IP/OP $478.00 $354.00 $94.82 $477.75 $259.42 $259.42 $259.42 $259.42 $477.75 $477.75 $477.75 $99.58 $477.75 $354.59 $354.59 $368.25 $248.91 $99.57 $477.75 $477.75 $282.59 $477.75 $477.75 $477.75 $477.75 $358.50 $477.75 $477.75 $477.75 $238.88 $238.88 $378.38 $477.75 $382.20 $310.54 $94.82 N/A $277.24 $477.75 $477.75 $477.75 $99.56 $477.75 N/A N/A H749201001900 SUP HCPCS C1884 H749201001900 - SYSTEM EMBOLIC PROTECTION .014IN 110UM 3.2FR 6FR 3.5-5.5MM BOTH IP/OP "$3,001.50" "$2,221.00" $595.67 "$3,001.25" "$1,350.56" "$1,350.56" "$1,350.56" "$1,350.56" "$3,001.25" "$3,001.25" "$3,001.25" $625.54 "$3,001.25" "$3,001.25" "$3,001.25" "$3,001.25" "$3,001.25" $625.49 "$3,001.25" "$3,001.25" "$1,479.62" "$3,001.25" "$3,001.25" "$3,001.25" "$3,001.25" "$2,251.13" "$3,001.25" "$3,001.25" "$3,001.25" "$1,500.63" "$1,500.63" "$2,376.99" "$3,001.25" "$2,401.00" "$1,350.56" $595.67 N/A "$1,740.87" "$3,001.25" "$3,001.25" "$3,001.25" $625.46 "$3,001.25" N/A N/A H749201003000 SUP HCPCS C1884 H749201003000 - SYSTEM EMBOLIC PROTECTION .014IN 110UM 3.2FR 6FR 3.5-5.5MM BOTH IP/OP "$3,001.50" "$2,221.00" $595.67 "$3,001.25" "$1,350.56" "$1,350.56" "$1,350.56" "$1,350.56" "$3,001.25" "$3,001.25" "$3,001.25" $625.54 "$3,001.25" "$3,001.25" "$3,001.25" "$3,001.25" "$3,001.25" $625.49 "$3,001.25" "$3,001.25" "$1,479.62" "$3,001.25" "$3,001.25" "$3,001.25" "$3,001.25" "$2,251.13" "$3,001.25" "$3,001.25" "$3,001.25" "$1,500.63" "$1,500.63" "$2,376.99" "$3,001.25" "$2,401.00" "$1,350.56" $595.67 N/A "$1,740.87" "$3,001.25" "$3,001.25" "$3,001.25" $625.46 "$3,001.25" N/A N/A H7492062009150 SUP HCPCS C1726 H7492062009150 - CATH BALDILAT .014IN 3.2-2.3FR 1.5MM 135CM 9MM PTCA OTW TRK BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7492062009200 SUP HCPCS C1726 H7492062009200 - CATH BALDILAT .014IN 3.2-2.3FR 2MM 135CM 9MM PTCA OTW TRK BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7492062009250 SUP HCPCS C1726 H7492062009250 - CATH BALDILAT .014IN 3.2-2.4FR 2.5MM 135CM 9MM PTCA OTW TRK BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7492062009300 SUP HCPCS C1726 H7492062009300 - CATH BALDILAT .014IN 3.2-2.4FR 3MM 135CM 9MM PTCA OTW TRK BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7492062009350 SUP HCPCS C1726 H7492062009350 - CATH BALDILAT .014IN 3.5MM 135CM 9MM CORON OTW TRK TIP MAV BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7492062015150 SUP HCPCS C1726 H7492062015150 - CATH BALDILAT .014IN 3.2-2.3FR 1.5MM 135CM 15MM PTCA OTW TRK BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7492062015200 SUP HCPCS C1726 H7492062015200 - CATH BALDILAT .014IN 3.2-2.3FR 2MM 135CM 15MM PTCA OTW TRK BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7492062015250 SUP HCPCS C1726 H7492062015250 - CATH BALDILAT .014IN 3.2-2.4FR 2.5MM 135CM 15MM PTCA OTW TRK BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7492062015270 SUP HCPCS C1726 H7492062015270 - CATH BALDILAT .014IN 2.75MM 135CM 15MM CORON OTW TRK TIP MAV BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7492062015300 SUP HCPCS C1726 H7492062015300 - CATH BALDILAT .014IN 3.2-2.4FR 3MM 135CM 15MM PTCA OTW TRK BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7492062015350 SUP HCPCS C1726 H7492062015350 - CATH BALDILAT .014IN 3.2-2.7FR 3.5MM 135CM 15MM PTCA OTW TRK BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7492062020150 SUP HCPCS C1726 H7492062020150 - CATH BALDILAT .014IN 3.2-2.3FR 1.5MM 135CM 20MM PTCA OTW TRK BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7492062020200 SUP HCPCS C1726 H7492062020200 - CATH BALDILAT .014IN 3.2-2.3FR 2MM 135CM 20MM PTCA OTW TRK BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7492062020250 SUP HCPCS C1726 H7492062020250 - CATH BALDILAT .014IN 3.2-2.4FR 2.5MM 135CM 20MM PTCA OTW TRK BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7492062020300 SUP HCPCS C1726 H7492062020300 - CATH BALDILAT .014IN 3MM 135CM 20MM CORON OTW TRK TIP MAV BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H749364560 SUP HCPCS C1753 H749364560 - CATHETER ULTRASOUND .035IN 15MHZ 8FR 95CM GWIRE TRANSDUCER BOTH IP/OP "$1,925.00" "$1,425.00" $382.06 "$1,925.00" "$1,045.28" "$1,045.28" "$1,045.28" "$1,045.28" "$1,925.00" "$1,925.00" "$1,925.00" $401.22 "$1,925.00" "$1,428.74" "$1,428.74" "$1,483.79" "$1,002.93" $401.19 "$1,925.00" "$1,925.00" "$1,138.64" "$1,925.00" "$1,925.00" "$1,925.00" "$1,925.00" "$1,443.75" "$1,925.00" "$1,925.00" "$1,925.00" $962.50 $962.50 "$1,524.60" "$1,925.00" "$1,540.00" "$1,251.25" $382.06 N/A "$1,116.50" "$1,925.00" "$1,925.00" "$1,925.00" $401.17 "$1,925.00" N/A N/A H74937911415150 SUP HCPCS C1877 H74937911415150 - STENT BILIARY 4MM 15MM 150CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937911415900 SUP HCPCS C1877 H74937911415900 - STENT BILIARY 4MM 15MM 90CM PREMOUNT BALLOON EXPAND CATHETER BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937911515150 SUP HCPCS C1877 H74937911515150 - STENT BILIARY 5MM 15MM 150CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937911515900 SUP HCPCS C2617 H74937911515900 - STENT BILIARY SMALL 5MM 15MM 90CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937911614150 SUP HCPCS C1877 H74937911614150 - STENT BILIARY 6MM 14MM 150CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937911614900 SUP HCPCS C2617 H74937911614900 - STENT BILIARY SMALL 6MM 16MM 90CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937911715150 SUP HCPCS C1877 H74937911715150 - STENT BILIARY 7MM 15MM 150CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937911715900 SUP HCPCS C1877 H74937911715900 - STENT BILIARY SMALL 7MM 15MM 90CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937912419150 SUP HCPCS C1877 H74937912419150 - STENT BILIARY 4MM 19MM 150CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937912419900 SUP HCPCS C1877 H74937912419900 - STENT BILIARY 4MM 19MM 90CM PREMOUNTED BALLOON EXPANDING BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937912519150 SUP HCPCS C1877 H74937912519150 - STENT BILIARY 5MM 19MM 150CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937912519900 SUP HCPCS C2617 H74937912519900 - STENT BILIARY SMALL 5MM 19MM 90CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937912618150 SUP HCPCS C1877 H74937912618150 - STENT BILIARY 6MM 18MM 150CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937912618900 SUP HCPCS C2617 H74937912618900 - STENT BILIARY SMALL 6MM 18MM 90CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937912719150 SUP HCPCS C1877 H74937912719150 - STENT BILIARY 7MM 19MM 150CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H74937912719900 SUP HCPCS C1877 H74937912719900 - STENT BILIARY SMALL 7MM 19MM 90CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H7493791540200 SUP HCPCS C1725 H7493791540200 - CATHETER BALDILAT 4MM 90CM 2CM SV RAPEX ULSF SV ANGIOPLST BOTH IP/OP "$1,162.50" $860.00 $230.73 "$1,162.50" $631.24 $631.24 $631.24 $631.24 "$1,162.50" "$1,162.50" "$1,162.50" $242.29 "$1,162.50" $862.81 $862.81 $896.06 $605.66 $242.28 "$1,162.50" "$1,162.50" $687.62 "$1,162.50" "$1,162.50" "$1,162.50" "$1,162.50" $871.88 "$1,162.50" "$1,162.50" "$1,162.50" $581.25 $581.25 $920.70 "$1,162.50" $930.00 $755.63 $230.73 N/A $674.25 "$1,162.50" "$1,162.50" "$1,162.50" $242.27 "$1,162.50" N/A N/A H7493791550200 SUP HCPCS C1726 H7493791550200 - CATHETER BLNDIL 3.1FR 5MM 90CM 2CM ULSF SV PTA RX NONLASER BOTH IP/OP "$1,055.00" $781.00 $209.39 "$1,055.00" $572.87 $572.87 $572.87 $572.87 "$1,055.00" "$1,055.00" "$1,055.00" $219.89 "$1,055.00" $783.02 $783.02 $813.19 $549.66 $219.87 "$1,055.00" "$1,055.00" $624.03 "$1,055.00" "$1,055.00" "$1,055.00" "$1,055.00" $791.25 "$1,055.00" "$1,055.00" "$1,055.00" $527.50 $527.50 $835.56 "$1,055.00" $844.00 $685.75 $209.39 N/A $611.90 "$1,055.00" "$1,055.00" "$1,055.00" $219.86 "$1,055.00" N/A N/A H74938046102070 SUP HCPCS C1877 H74938046102070 - STENT BILIARY 30MM 10MM 25MM 75CM OTW PREMOUNT BALLOON BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046104070 SUP HCPCS C1877 H74938046104070 - STENT BILIARY 40MM 10MM 37MM 75CM OTW PREMOUNT CATHETER BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046106070 SUP HCPCS C1877 H74938046106070 - STENT BILIARY 60MM 10MM 57MM 75CM OTW PREMOUNT CATHETER BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046520750 SUP HCPCS C1877 H74938046520750 - STENT BILIARY 5MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A H74938046530750 SUP HCPCS C1877 H74938046530750 - STENT BILIARY 30MM 5MM 27MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046540750 SUP HCPCS C1877 H74938046540750 - STENT BILIARY 5MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A H74938046560750 SUP HCPCS C1877 H74938046560750 - STENT BILIARY 5MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046620750 SUP HCPCS C1877 H74938046620750 - STENT BILIARY 6MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046630750 SUP HCPCS C1877 H74938046630750 - STENT BILIARY 6MM 30MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046640750 SUP HCPCS C1877 H74938046640750 - STENT BILIARY 40MM 6MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046660750 SUP HCPCS C1877 H74938046660750 - STENT BILIARY 60MM 6MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046720750 SUP HCPCS C1877 H74938046720750 - STENT BILIARY 7MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046730750 SUP HCPCS C1877 H74938046730750 - STENT BILIARY 30MM 7MM 27MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046740750 SUP HCPCS C1877 H74938046740750 - STENT BILIARY 40MM 7MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046760750 SUP HCPCS C1877 H74938046760750 - STENT BILIARY 60MM 7MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046820750 SUP HCPCS C1877 H74938046820750 - STENT BILIARY 8MM 17MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046830750 SUP HCPCS C1877 H74938046830750 - STENT BILIARY 8MM 27MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046840750 SUP HCPCS C1877 H74938046840750 - STENT BILIARY 40MM 8MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046860750 SUP HCPCS C1877 H74938046860750 - STENT BILIARY 60MM 8MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046920750 SUP HCPCS C1877 H74938046920750 - STENT BILIARY 30MM 9MM 25MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046940750 SUP HCPCS C1877 H74938046940750 - STENT BILIARY 40MM 9MM 37MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938046960750 SUP HCPCS C1877 H74938046960750 - STENT BILIARY 60MM 9MM 57MM 75CM OTW PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047120130 SUP HCPCS C1877 H74938047120130 - STENT BILIARY 30MM 10MM 25MM 135CM OTW PREMOUNT BALLOON BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047140130 SUP HCPCS C1877 H74938047140130 - STENT BILIARY 10MM 7FR 37MM 135CM BALLOON EXPANDABLE BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $67.50 $67.50 $67.50 $67.50 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $150.00 $150.00 $150.00 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $67.50 $29.77 N/A $87.00 $150.00 $90.00 $150.00 $31.26 $150.00 N/A N/A H74938047160130 SUP HCPCS C1877 H74938047160130 - STENT BILIARY 10MM 7FR 57MM 135CM BALLOON EXPANDABLE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047520130 SUP HCPCS C1877 H74938047520130 - STENT BILIARY .035IN 5MM 17MM 75CM CATHETER BALLOON INFLAT BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047530130 SUP HCPCS C1877 H74938047530130 - STENT BILIARY 5MM 27MM 135CM OTW BALLOON EXPAND PREMOUNT BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047540130 SUP HCPCS C1877 H74938047540130 - STENT BILIARY 5MM 40MM 135CM OTW BALLOON EXPAND PREMOUNT BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047560130 SUP HCPCS C1877 H74938047560130 - STENT BILIARY 5MM 6FR 60MM 135CM BALLOON EXPANDING BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047620130 SUP HCPCS C1877 H74938047620130 - STENT BILIARY 6MM 6FR 17MM 135CM PREMOUNTED BALLOON EXPRESS BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047630130 SUP HCPCS C1877 H74938047630130 - STENT BILIARY 30MM 6MM 27MM 135CM OTW PREMOUNT BALLOON BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047640130 SUP HCPCS C1877 H74938047640130 - STENT BILIARY 40MM 6MM 37MM 135CM OTW PREMOUNT BALLOON BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047660130 SUP HCPCS C1877 H74938047660130 - STENT BILIARY 9MM 6MM 57MM 135CM PREMOUNT BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047720130 SUP HCPCS C1877 H74938047720130 - STENT BILIARY 20MM 7MM 17MM 135CM OTW BALLOON EXPAND BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047730130 SUP HCPCS C1877 H74938047730130 - STENT BILIARY 30MM 7MM 27MM 135CM OTW PREMOUNT BALLOON BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047740130 SUP HCPCS C1877 H74938047740130 - STENT BILIARY 9MM 7MM 6FR 37MM 135CM BALLOON EXPANDABLE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047760130 SUP HCPCS C1877 H74938047760130 - STENT BILIARY 9MM 7MM 6FR 57MM 135CM BALLOON EXPANDABLE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047820130 SUP HCPCS C1877 H74938047820130 - STENT BILIARY 8MM 6FR 17MM 135CM BALLOON EXPANDABLE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047830130 SUP HCPCS C1877 H74938047830130 - STENT BILIARY 30MM 8MM 27MM 135CM OTW PREMOUNT BALLOON BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047840130 SUP HCPCS C1877 H74938047840130 - STENT BILIARY 8MM 37MM 135CM BALLOON EXPAND PREMOUNT EXPRESS BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047860130 SUP HCPCS C1877 H74938047860130 - STENT BILIARY 8MM 7IN 57MM 135CM OTW PREMOUNT BALLOON BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047920130 SUP HCPCS C1877 H74938047920130 - STENT BILIARY 30MM 9MM 25MM 135CM OTW PREMOUNT BALLOON BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047940130 SUP HCPCS C1877 H74938047940130 - STENT BILIARY 9MM 7FR 37MM 135CM BALLOON EXPANDABLE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74938047960130 SUP HCPCS C1877 H74938047960130 - STENT BILIARY 11MM 9MM 7FR 57MM 135CM PREMOUNT BALLOON BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" $877.50 "$1,462.50" $304.79 "$1,462.50" N/A N/A H7493808012200 SUP HCPCS C1726 H7493808012200 - CATH BALDILAT .014IN 2MM 12MM PCTA RAPEX LP TPR TIP Q M BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493808012250 SUP HCPCS C1726 H7493808012250 - CATH BALDILAT 1.8-2.7FR 2.5MM 135CM 12MM PTCA RAPEX LP TPR BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493808012300 SUP HCPCS C1726 H7493808012300 - CATH BALDILAT 3MM 135CM 12MM PCTA RAPEX LP TPR TIP Q M BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $367.50 $612.50 $127.65 $612.50 N/A N/A H7493808012350 SUP HCPCS C1726 H7493808012350 - CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 12MM PTCA RAPEX BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493808012400 SUP HCPCS C1726 H7493808012400 - CATH BALDILAT .014IN 1.8-2.7FR 4MM 135CM 12MM PTCA RAPEX LP BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H749380801250 SUP HCPCS C1726 H749380801250 - CATH BALDILAT .014IN 2-2.7FR 5MM 135CM 12MM PTCA RAPEX LP BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493808015250 SUP HCPCS C1726 H7493808015250 - CATH BALDILAT .014IN 2.5MM 15MM PTCA RAPEX Q M BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493808015300 SUP HCPCS C1726 H7493808015300 - CATH BALDILAT 3MM 135CM 15MM CORON PCTA RAPEX LP TPR TIP Q M BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493808015350 SUP HCPCS C1726 H7493808015350 - CATH BALDILAT .014IN 3.5MM 15MM PTCA RAPEX Q M BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493808015400 SUP HCPCS C1726 H7493808015400 - CATH BALDILAT .014IN 1.8-2.7FR 4MM 135CM 15MM PTCA RAPEX LP BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493808015450 SUP HCPCS C1726 H7493808015450 - CATH BALDILAT .014IN 2-2.7FR 4.5MM 135CM 15MM PTCA RAPEX LP BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493808015500 SUP HCPCS C1726 H7493808015500 - CATH BALDILAT .014IN 2-2.7FR 5MM 135CM 15MM PTCA RAPEX LP BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493808020250 SUP HCPCS C1726 H7493808020250 - CATH BALDILAT .014IN 1.8-2.7FR 2.5MM 135CM 20MM PTCA RAPEX BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493808020300 SUP HCPCS C1726 H7493808020300 - CATH BALDILAT .014IN 1.8-2.7FR 3MM 135CM 20MM PTCA RAPEX LP BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493808020350 SUP HCPCS C1726 H7493808020350 - CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 20MM PTCA RAPEX BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493892809200 SUP HCPCS C1726 H7493892809200 - CATHETER BLNDIL 2MM 142CM 9MM MAVERICK2 MNRL TRAKTIP TPR BOTH IP/OP $269.50 $199.00 $53.49 $269.50 $146.34 $146.34 $146.34 $146.34 $269.50 $269.50 $269.50 $56.17 $269.50 $200.02 $200.02 $207.73 $140.41 $56.17 $269.50 $269.50 $159.41 $269.50 $269.50 $269.50 $269.50 $202.13 $269.50 $269.50 $269.50 $134.75 $134.75 $213.44 $269.50 $215.60 $175.18 $53.49 N/A $156.31 $269.50 $269.50 $269.50 $56.16 $269.50 N/A N/A H7493892809250 SUP HCPCS C1725 H7493892809250 - CATHETER BLNDIL 2.5MM 142CM 9MM MAVERICK2 MNRL TRAKTIP TPR BOTH IP/OP $269.50 $199.00 $53.49 $269.50 $146.34 $146.34 $146.34 $146.34 $269.50 $269.50 $269.50 $56.17 $269.50 $200.02 $200.02 $207.73 $140.41 $56.17 $269.50 $269.50 $159.41 $269.50 $269.50 $269.50 $269.50 $202.13 $269.50 $269.50 $269.50 $134.75 $134.75 $213.44 $269.50 $215.60 $175.18 $53.49 N/A $156.31 $269.50 $269.50 $269.50 $56.16 $269.50 N/A N/A H7493892809300 SUP HCPCS C1725 H7493892809300 - CATHETER BLNDIL 3MM 142CM 9MM MAVERICK2 MNRL TRAKTIP TPR BOTH IP/OP $269.50 $199.00 $53.49 $269.50 $146.34 $146.34 $146.34 $146.34 $269.50 $269.50 $269.50 $56.17 $269.50 $200.02 $200.02 $207.73 $140.41 $56.17 $269.50 $269.50 $159.41 $269.50 $269.50 $269.50 $269.50 $202.13 $269.50 $269.50 $269.50 $134.75 $134.75 $213.44 $269.50 $215.60 $175.18 $53.49 N/A $156.31 $269.50 $269.50 $269.50 $56.16 $269.50 N/A N/A H7493892809350 SUP HCPCS C1726 H7493892809350 - CATH BALDILAT .014IN 1.8-2.7FR 3.5MM 135CM 9MM PTCA RAPEX LP BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493892815150 SUP HCPCS C1726 H7493892815150 - CATH BALDILAT .014IN 1.8-2.6-2.3FR 1.5MM 135CM 15MM PTCA BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $367.50 $612.50 $127.65 $612.50 N/A N/A H7493892815200 SUP HCPCS C1726 H7493892815200 - CATHETER BLNDIL 2MM 142CM 15MM MAVERICK2 MNRL TRAKTIP TPR BOTH IP/OP $269.50 $199.00 $53.49 $269.50 $146.34 $146.34 $146.34 $146.34 $269.50 $269.50 $269.50 $56.17 $269.50 $200.02 $200.02 $207.73 $140.41 $56.17 $269.50 $269.50 $159.41 $269.50 $269.50 $269.50 $269.50 $202.13 $269.50 $269.50 $269.50 $134.75 $134.75 $213.44 $269.50 $215.60 $175.18 $53.49 N/A $156.31 $269.50 $269.50 $269.50 $56.16 $269.50 N/A N/A H7493892815250 SUP HCPCS C1726 H7493892815250 - CATH BALDILAT .014IN 1.8-2.6-2.4FR 2.5MM 135CM 15MM PTCA BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493892815300 SUP HCPCS C1726 H7493892815300 - CATH BALDILAT .014IN 1.8-2.6-2.4FR 3MM 135CM 15MM PTCA RAPEX BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493892820200 SUP HCPCS C1726 H7493892820200 - CATH BALDILAT .014IN 1.8-2.6-2.3FR 2MM 135CM 20MM PTCA RAPEX BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493892820250 SUP HCPCS C1726 H7493892820250 - CATH BALDILAT .014IN 1.8-2.6-2.4FR 2.5MM 135CM 20MM PTCA BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $612.50 $612.50 $127.65 $612.50 N/A N/A H7493892820300 SUP HCPCS C1726 H7493892820300 - CATH BALDILAT .014IN 1.8-2.6-2.4FR 3MM 135CM 20MM PTCA RAPEX BOTH IP/OP $612.50 $453.00 $121.57 $612.50 $332.59 $332.59 $332.59 $332.59 $612.50 $612.50 $612.50 $127.66 $612.50 $454.60 $454.60 $472.12 $319.11 $127.65 $612.50 $612.50 $362.29 $612.50 $612.50 $612.50 $612.50 $459.38 $612.50 $612.50 $612.50 $306.25 $306.25 $485.10 $612.50 $490.00 $398.13 $121.57 N/A $355.25 $612.50 $367.50 $612.50 $127.65 $612.50 N/A N/A H7493894812010 SUP HCPCS C1876 H7493894812010 - STENT BILIARY 10MM 21MM 135CM SELF EXPAND LATEX FREE BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894812070 SUP HCPCS C1876 H7493894812070 - STENT BILIARY 10MM 6FR 21MM 75CM SELF EXPANDING NONCOATED BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894814010 SUP HCPCS C1876 H7493894814010 - STENT BILIARY 10MM 40MM 135CM SELF EXPANDING SENTINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894814070 SUP HCPCS C1876 H7493894814070 - STENT BILIARY 10MM 6FR 41MM 75CM SELF EXPANDING SHEATH BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894816010 SUP HCPCS C1876 H7493894816010 - STENT BILIARY 10MM 59MM 135CM SELF EXPANDABLE SENTINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894818010 SUP HCPCS C1876 H7493894818010 - STENT BILIARY 10MM 79MM 135CM SELF EXPAND SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894852010 SUP HCPCS C1876 H7493894852010 - STENT BILIARY 5MM 21MM 135CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894852070 SUP HCPCS C1876 H7493894852070 - STENT BILIARY 5MM 21MM 75CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894854010 SUP HCPCS C1876 H7493894854010 - STENT BILIARY 5MM 40MM 135CM SELF EXPAND DELIVERY SYSTEM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894854070 SUP HCPCS C1876 H7493894854070 - STENT BILIARY 5MM 6FR 40MM 75CM SELF EXPANDING NONCOATED BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894856010 SUP HCPCS C1876 H7493894856010 - STENT BILIARY 5MM 60MM 135CM SELF EXPAND DELIVERY SYSTEM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894856070 SUP HCPCS C1876 H7493894856070 - STENT BILIARY 5MM 6FR 60MM 75CM SELF EXPANDING NONCOATED BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894862010 SUP HCPCS C1876 H7493894862010 - STENT BILIARY 6MM 20MM 135CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894862070 SUP HCPCS C1876 H7493894862070 - STENT BILIARY 6MM 20MM 75CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894864010 SUP HCPCS C1876 H7493894864010 - STENT BILIARY 6MM 40MM 135CM SELF EXPAND DELIVERY SYSTEM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894864070 SUP HCPCS C1876 H7493894864070 - STENT BILIARY 6MM 40MM 75CM SELF EXPAND DELIVERY SYSTEM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894866010 SUP HCPCS C1876 H7493894866010 - STENT BILIARY 6MM 59MM 135CM SELF EXPAND DELIVERY SYSTEM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894866070 SUP HCPCS C1876 H7493894866070 - STENT BILIARY 6MM 59MM 75CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894868010 SUP HCPCS C1876 H7493894868010 - STENT BILIARY 6MM 79MM 135CM SELF EXPAND DELIVERY SYSTEM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894868070 SUP HCPCS C1876 H7493894868070 - STENT BILIARY 6MM 79MM 75CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894872010 SUP HCPCS C1876 H7493894872010 - STENT BILIARY 7MM 1350MM 20MM SELF EXPANDING CATHETER BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894872070 SUP HCPCS C1876 H7493894872070 - STENT BILIARY 7MM 20MM 75CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894874010 SUP HCPCS C1876 H7493894874010 - STENT BILIARY 7MM 39MM 135CM SELF EXPAND DELIVERY SYSTEM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894874070 SUP HCPCS C1876 H7493894874070 - STENT BILIARY 7MM 39MM 75CM SELF EXPAND SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894876010 SUP HCPCS C1876 H7493894876010 - STENT BILIARY 7MM 59MM 135CM SELF EXPAND DELIVERY SYSTEM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894876070 SUP HCPCS C1876 H7493894876070 - STENT BILIARY 7MM 59MM 75CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894878010 SUP HCPCS C1876 H7493894878010 - STENT BILIARY 7MM 78MM 135CM SELF EXPAND DELIVERY SYSTEM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894878070 SUP HCPCS C1876 H7493894878070 - STENT BILIARY 7MM 78MM 75CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894882010 SUP HCPCS C1876 H7493894882010 - STENT BILIARY 8MM 21MM 135CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894882070 SUP HCPCS C1876 H7493894882070 - STENT BILIARY 8MM 21MM 75CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894884010 SUP HCPCS C1876 H7493894884010 - STENT BILIARY 8MM 42MM 135CM SELF EXPAND DELIVERY SYSTEM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894884070 SUP HCPCS C1876 H7493894884070 - STENT BILIARY 8MM 42MM 75CM SELF EXPAND DELIVERY SYSTEM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894886010 SUP HCPCS C1876 H7493894886010 - STENT BILIARY 8MM 60MM 135CM SELF EXPAND DELIVERY SYSTEM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894886070 SUP HCPCS C1876 H7493894886070 - STENT BILIARY 8MM 60MM 75CM SELF EXPAND DELIVERY SYSTEM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894888010 SUP HCPCS C1876 H7493894888010 - STENT BILIARY 6MM 81MM 135CM SELF EXPANDING DELIVERY SYSTEM BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894892010 SUP HCPCS C1876 H7493894892010 - STENT BILIARY 9MM 21MM 135CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894892070 SUP HCPCS C1876 H7493894892070 - STENT BILIARY 9MM 21MM 75CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894894010 SUP HCPCS C1876 H7493894894010 - STENT BILIARY 9MM 42MM 135CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894894070 SUP HCPCS C1876 H7493894894070 - STENT BILIARY 9MM 750MM 42MM SELF EXPANDING CATHETER BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894896010 SUP HCPCS C1876 H7493894896010 - STENT BILIARY 9MM 60MM 135CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894896070 SUP HCPCS C1876 H7493894896070 - STENT BILIARY 9MM 60MM 75CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894898010 SUP HCPCS C1876 H7493894898010 - STENT BILIARY 9MM 80MM 135CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493894898070 SUP HCPCS C1876 H7493894898070 - STENT BILIARY 9MM 80MM 75CM SELF EXPANDING SENTINOL NITINOL BOTH IP/OP "$2,437.50" "$1,804.00" $483.78 "$2,437.50" "$1,096.88" "$1,096.88" "$1,096.88" "$1,096.88" "$2,437.50" "$2,437.50" "$2,437.50" $508.04 "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" $508.00 "$2,437.50" "$2,437.50" "$1,441.78" "$2,437.50" "$2,437.50" "$2,437.50" "$2,437.50" "$1,828.13" "$2,437.50" "$2,437.50" "$2,437.50" "$1,218.75" "$1,218.75" "$1,930.50" "$2,437.50" "$1,950.00" "$1,096.88" $483.78 N/A "$1,413.75" "$2,437.50" "$2,437.50" "$2,437.50" $507.98 "$2,437.50" N/A N/A H7493897008250 SUP HCPCS C2617 H7493897008250 - STENT CORON 2.5MM 8MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8% BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A H7493897008300 SUP HCPCS C2617 H7493897008300 - STENT CORON 3MM 8MM RAPEX BLN EXPANDABLE TAXUS XPR2 MNRL BOTH IP/OP "$6,500.00" "$4,810.00" "$1,290.09" "$6,500.00" "$2,925.00" "$2,925.00" "$2,925.00" "$2,925.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.76" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.67" "$6,500.00" "$6,500.00" "$3,204.50" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$4,875.00" "$6,500.00" "$6,500.00" "$6,500.00" "$3,250.00" "$3,250.00" "$5,148.00" "$6,500.00" "$5,200.00" "$2,925.00" "$1,290.09" N/A "$3,770.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.60" "$6,500.00" N/A N/A H7493897008350 SUP HCPCS C2617 H7493897008350 - STENT CORON 3.5MM 8MM RAPEX BLN XPD TAXUS XPR2 MNRL PCLTXL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A H7493897012250 SUP HCPCS C2617 H7493897012250 - STENT CORON 2.50MM 12MM XPR TAXUS XPR2 MNRL PCLTXL ELUT RX BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A H7493897012300 SUP HCPCS C2617 H7493897012300 - STENT CORON 3MM 12MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8% BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A H7493897012350 SUP HCPCS C2617 H7493897012350 - STENT CORON 3.5MM 12MM RAPEX BLN XPD TAXUS XPR2 MNRL PCLTXL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A H7493897016250 SUP HCPCS C2617 H7493897016250 - STENT CORON 2.5MM 16MM SYS ART TAXUS XPR2 MNRL 8.8% PCLTXL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A H7493897016300 SUP HCPCS C2617 H7493897016300 - STENT CORONARY ARTERY EXPRESS 2 TAXUS 3 X 16MM 8.8% PACLITAX BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A H7493897016350 SUP HCPCS C2617 H7493897016350 - STENT CORON 3.5MM 16MM RAPEX BLN EXPANDABLE TAXUS XPR2 MNRL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$3,750.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A H7493897020250 SUP HCPCS C2617 H7493897020250 - STENT CORON 2.5MM 20MM TAXUS XPR2 MNRL 8.8% PCLTXL ELUT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A H7493897020300 SUP HCPCS C2617 H7493897020300 - STENT CORON 3MM 20MM RAPEX BLN EXPANDABLE TAXUS XPR2 MNRL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A H7493897020350 SUP HCPCS C2617 H7493897020350 - STENT CORON 3.5MM 20MM RAPEX BLN XPD XPR RX PCLTXL ELUT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A H7493897028300 SUP HCPCS C2617 H7493897028300 - STENT CORON 3MM 28MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8% BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A H7493897028350 SUP HCPCS C2617 H7493897028350 - STENT CORON 3.5MM 28MM RAPEX BLN XPD TAXUS XPR2 MNRL 8.8% BOTH IP/OP "$6,500.00" "$4,810.00" "$1,290.09" "$6,500.00" "$2,925.00" "$2,925.00" "$2,925.00" "$2,925.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.76" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.67" "$6,500.00" "$6,500.00" "$3,204.50" "$6,500.00" "$6,500.00" "$6,500.00" "$6,500.00" "$4,875.00" "$6,500.00" "$6,500.00" "$6,500.00" "$3,250.00" "$3,250.00" "$5,148.00" "$6,500.00" "$5,200.00" "$2,925.00" "$1,290.09" N/A "$3,770.00" "$6,500.00" "$6,500.00" "$6,500.00" "$1,354.60" "$6,500.00" N/A N/A H7493897032300 SUP HCPCS C2617 H7493897032300 - STENT CORON 3MM 32MM RAPEX BLN XPD TAXUS XPR2 MNRL PCLTXL BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A H7493897032350 SUP HCPCS C2617 H7493897032350 - STENT CORON 3.5MM 32MM RAPEX BLN XPD XPR RX PCLTXL ELUT BOTH IP/OP "$6,250.00" "$4,625.00" "$1,240.47" "$6,250.00" "$2,812.50" "$2,812.50" "$2,812.50" "$2,812.50" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.66" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.57" "$6,250.00" "$6,250.00" "$3,081.25" "$6,250.00" "$6,250.00" "$6,250.00" "$6,250.00" "$4,687.50" "$6,250.00" "$6,250.00" "$6,250.00" "$3,125.00" "$3,125.00" "$4,950.00" "$6,250.00" "$5,000.00" "$2,812.50" "$1,240.47" N/A "$3,625.00" "$6,250.00" "$6,250.00" "$6,250.00" "$1,302.50" "$6,250.00" N/A N/A H74939031302010 SUP HCPCS C1725 H74939031302010 - CATHETER BLNDIL 3MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031303010 SUP HCPCS C1725 H74939031303010 - CATHETER BLNDIL 3MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031304010 SUP HCPCS C1725 H74939031304010 - CATHETER BLNDIL 3MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031306010 SUP HCPCS C1725 H74939031306010 - CATHETER BLNDIL 3MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031352010 SUP HCPCS C1725 H74939031352010 - CATHETER BLNDIL 3.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031353010 SUP HCPCS C1725 H74939031353010 - CATHETER BLNDIL 3.5MM 135CM 30MM STRLG MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031354010 SUP HCPCS C1725 H74939031354010 - CATHETER BLNDIL 3.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031401080 SUP HCPCS C1725 H74939031401080 - CATHETER BLNDIL 4MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031401580 SUP HCPCS C1725 H74939031401580 - CATHETER BLNDIL 4MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031402010 SUP HCPCS C1725 H74939031402010 - CATHETER BLNDIL 4MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031402080 SUP HCPCS C1725 H74939031402080 - CATHETER BLNDIL 4MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031403010 SUP HCPCS C1725 H74939031403010 - CATHETER BLNDIL 4MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031403080 SUP HCPCS C1725 H74939031403080 - CATHETER BLNDIL 4MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031404010 SUP HCPCS C1725 H74939031404010 - CATHETER BLNDIL 4MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031404080 SUP HCPCS C1725 H74939031404080 - CATHETER BLNDIL 4MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031406010 SUP HCPCS C1725 H74939031406010 - CATHETER BLNDIL 4MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031451580 SUP HCPCS C1725 H74939031451580 - CATHETER BLNDIL 4.5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031452010 SUP HCPCS C1725 H74939031452010 - CATHETER BLNDIL 4.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031452080 SUP HCPCS C1725 H74939031452080 - CATHETER BLNDIL 4.5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031453010 SUP HCPCS C1725 H74939031453010 - CATHETER BLNDIL 4.5MM 135CM 30MM STRLG MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031453080 SUP HCPCS C1725 H74939031453080 - CATHETER BLNDIL 4.5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031454010 SUP HCPCS C1725 H74939031454010 - CATHETER BLNDIL 4.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031454080 SUP HCPCS C1725 H74939031454080 - CATHETER BLNDIL 4.5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031501080 SUP HCPCS C1725 H74939031501080 - CATHETER BLNDIL 5MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031501580 SUP HCPCS C1725 H74939031501580 - CATHETER BLNDIL 5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031502010 SUP HCPCS C1725 H74939031502010 - CATHETER BLNDIL 5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031502080 SUP HCPCS C1725 H74939031502080 - CATHETER BLNDIL 5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031503010 SUP HCPCS C1725 H74939031503010 - CATHETER BLNDIL 5MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031503080 SUP HCPCS C1725 H74939031503080 - CATHETER BLNDIL 5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031504010 SUP HCPCS C1725 H74939031504010 - CATHETER BLNDIL 5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031504080 SUP HCPCS C1725 H74939031504080 - CATHETER BLNDIL 5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031506010 SUP HCPCS C1725 H74939031506010 - CATHETER BLNDIL 5MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031551580 SUP HCPCS C1725 H74939031551580 - CATHETER BLNDIL 5.5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031552010 SUP HCPCS C1725 H74939031552010 - CATHETER BLNDIL 5.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031552080 SUP HCPCS C1725 H74939031552080 - CATHETER BLNDIL 5.5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031553010 SUP HCPCS C1725 H74939031553010 - CATHETER BLNDIL 5.5MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031553080 SUP HCPCS C1725 H74939031553080 - CATHETER BLNDIL 5.5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031554010 SUP HCPCS C1725 H74939031554010 - CATHETER BLNDIL 5.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031554080 SUP HCPCS C1725 H74939031554080 - CATHETER BLNDIL 5.5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031601080 SUP HCPCS C1725 H74939031601080 - CATHETER BLNDIL 6MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031601580 SUP HCPCS C1725 H74939031601580 - CATHETER BLNDIL 6MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031602010 SUP HCPCS C1725 H74939031602010 - CATHETER BLNDIL 6MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031602080 SUP HCPCS C1725 H74939031602080 - CATHETER BLNDIL 6MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031603010 SUP HCPCS C1725 H74939031603010 - CATHETER BLNDIL 6MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031603080 SUP HCPCS C1725 H74939031603080 - CATHETER BLNDIL 6MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031604010 SUP HCPCS C1725 H74939031604010 - CATHETER BLNDIL 6MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031604080 SUP HCPCS C1725 H74939031604080 - CATHETER BLNDIL 6MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031606010 SUP HCPCS C1725 H74939031606010 - CATHETER BLNDIL 6MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031651580 SUP HCPCS C1725 H74939031651580 - CATHETER BLNDIL 6.5MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031652010 SUP HCPCS C1725 H74939031652010 - CATHETER BLNDIL 6.5MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031652080 SUP HCPCS C1725 H74939031652080 - CATHETER BLNDIL 6.5MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031653010 SUP HCPCS C1725 H74939031653010 - CATHETER BLNDIL 6.5MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031653080 SUP HCPCS C1725 H74939031653080 - CATHETER BLNDIL 6.5MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031654010 SUP HCPCS C1725 H74939031654010 - CATHETER BLNDIL 6.5MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031654080 SUP HCPCS C1725 H74939031654080 - CATHETER BLNDIL 6.5MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031701080 SUP HCPCS C1725 H74939031701080 - CATHETER BLNDIL 7MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031701580 SUP HCPCS C1725 H74939031701580 - CATHETER BLNDIL 7MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031702010 SUP HCPCS C1725 H74939031702010 - CATHETER BLNDIL 7MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031702080 SUP HCPCS C1725 H74939031702080 - CATHETER BLNDIL 7MM 80CM 20MM STRLG MNRL RX INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031703010 SUP HCPCS C1725 H74939031703010 - CATHETER BLNDIL 7MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031703080 SUP HCPCS C1725 H74939031703080 - CATHETER BLNDIL 7MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031704010 SUP HCPCS C1725 H74939031704010 - CATHETER BLNDIL 7MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031704080 SUP HCPCS C1725 H74939031704080 - CATHETER BLNDIL 7MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031706010 SUP HCPCS C1725 H74939031706010 - CATHETER BLNDIL 7MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031801080 SUP HCPCS C1725 H74939031801080 - CATHETER BLNDIL 8MM 80CM 10MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031801580 SUP HCPCS C1725 H74939031801580 - CATHETER BLNDIL 8MM 80CM 15MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031802010 SUP HCPCS C1725 H74939031802010 - CATHETER BLNDIL 8MM 135CM 20MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031802080 SUP HCPCS C1725 H74939031802080 - CATHETER BLNDIL 8MM 80CM 20MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031803010 SUP HCPCS C1725 H74939031803010 - CATHETER BLNDIL 8MM 135CM 30MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031803080 SUP HCPCS C1725 H74939031803080 - CATHETER BLNDIL 8MM 80CM 30MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031804010 SUP HCPCS C1725 H74939031804010 - CATHETER BLNDIL 8MM 135CM 40MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031804080 SUP HCPCS C1725 H74939031804080 - CATHETER BLNDIL 8MM 80CM 40MM STRLG MNRL TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939031806010 SUP HCPCS C1725 H74939031806010 - CATHETER BLNDIL 8MM 135CM 60MM STRLG MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032102010 SUP HCPCS C1753 H74939032102010 - CATHETER BLNDIL 10MM 135CM 20MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032102080 SUP HCPCS C1753 H74939032102080 - CATHETER BLNDIL 10MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032103010 SUP HCPCS C1753 H74939032103010 - CATHETER BLNDIL 10MM 135CM 30MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032103080 SUP HCPCS C1753 H74939032103080 - CATHETER BLNDIL 10MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032104010 SUP HCPCS C1753 H74939032104010 - CATHETER BLNDIL 10MM 135CM 40MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032104080 SUP HCPCS C1753 H74939032104080 - CATHETER BLNDIL 10MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032106010 SUP HCPCS C1753 H74939032106010 - CATHETER BLNDIL 10MM 135CM 60MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032106080 SUP HCPCS C1753 H74939032106080 - CATHETER BLNDIL 10MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032108010 SUP HCPCS C1753 H74939032108010 - CATHETER BLNDIL 10MM 135CM 80MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032108080 SUP HCPCS C1753 H74939032108080 - CATHETER BLNDIL 10MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032252210 SUP HCPCS C1725 H74939032252210 - CATHETER BLNDIL 2.5MM 150CM 220MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032300610 SUP HCPCS C1725 H74939032300610 - CATHETER BLNDIL 3MM 150CM 60MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032401010 SUP HCPCS C1753 H74939032401010 - CATHETER BLNDIL 4MM 135CM 100MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032401080 SUP HCPCS C1753 H74939032401080 - CATHETER BLNDIL 4MM 80CM 100MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032402010 SUP HCPCS C1726 H74939032402010 - CATHETER BLNDIL 4MM 135CM 20MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032402040 SUP HCPCS C1753 H74939032402040 - CATHETER BLNDIL 4MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032402080 SUP HCPCS C1753 H74939032402080 - CATHETER BLNDIL 4MM 80CM 20MM STRLG OTW INFL PORT LOPRFL TPR BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032402210 SUP HCPCS C1725 H74939032402210 - CATHETER BLNDIL 4MM 150CM 220MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032403010 SUP HCPCS C1753 H74939032403010 - CATHETER BLNDIL 4MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032403080 SUP HCPCS C1753 H74939032403080 - CATHETER BLNDIL 4MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032404010 SUP HCPCS C1726 H74939032404010 - CATHETER BLNDIL 4MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032404040 SUP HCPCS C1753 H74939032404040 - CATHETER BLNDIL 4MM 40CM 40MM STRLG OTW INFL PORT LOPRFL TPR BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032404080 SUP HCPCS C1753 H74939032404080 - CATHETER BLNDIL 4MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032406010 SUP HCPCS C1753 H74939032406010 - CATHETER BLNDIL 4MM 135CM 60MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032406080 SUP HCPCS C1753 H74939032406080 - CATHETER BLNDIL 4MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032408010 SUP HCPCS C1753 H74939032408010 - CATHETER BLNDIL 4MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032408080 SUP HCPCS C1753 H74939032408080 - CATHETER BLNDIL 4MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032501010 SUP HCPCS C1753 H74939032501010 - CATHETER BLNDIL 5MM 135CM 100MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032501080 SUP HCPCS C1726 H74939032501080 - CATHETER BLNDIL 5MM 80CM 100MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032501510 SUP HCPCS C1725 H74939032501510 - CATHETER BLNDIL 5MM 150CM 150MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032502010 SUP HCPCS C1753 H74939032502010 - CATHETER BLNDIL 5MM 135CM 20MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032502040 SUP HCPCS C1753 H74939032502040 - CATHETER BLNDIL 5MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032502080 SUP HCPCS C1726 H74939032502080 - CATHETER BLNDIL 5MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032502110 SUP HCPCS C1725 H74939032502110 - CATHETER BLNDIL 5MM 150CM 200MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032502210 SUP HCPCS C1725 H74939032502210 - CATHETER BLNDIL 5MM 150CM 220MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032503010 SUP HCPCS C1753 H74939032503010 - CATHETER BLNDIL 5MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032503080 SUP HCPCS C1753 H74939032503080 - CATHETER BLNDIL 5MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032504010 SUP HCPCS C1726 H74939032504010 - CATHETER BLNDIL 5MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032504040 SUP HCPCS C1753 H74939032504040 - CATHETER BLNDIL 5MM 40CM 40MM STRLG OTW INFL PORT LOPRFL TPR BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032504080 SUP HCPCS C1726 H74939032504080 - CATHETER BLNDIL 5MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032506010 SUP HCPCS C1753 H74939032506010 - CATHETER BLNDIL 5MM 135CM 60MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032506080 SUP HCPCS C1726 H74939032506080 - CATHETER BLNDIL 5MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032508010 SUP HCPCS C1753 H74939032508010 - CATHETER BLNDIL 5MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032508080 SUP HCPCS C1726 H74939032508080 - CATHETER BLNDIL 5MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032601010 SUP HCPCS C1753 H74939032601010 - CATHETER BLNDIL 6MM 135CM 100MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032601080 SUP HCPCS C1753 H74939032601080 - CATHETER BLNDIL 6MM 80CM 100MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032601510 SUP HCPCS C1725 H74939032601510 - CATHETER BLNDIL 6MM 150CM 150MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032602010 SUP HCPCS C1726 H74939032602010 - CATHETER BLNDIL 6MM 135CM 20MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032602040 SUP HCPCS C1753 H74939032602040 - CATHETER BLNDIL 6MM 40CM 20MM STRLG OTW INFL PORT LOPRFL TPR BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032602080 SUP HCPCS C1726 H74939032602080 - CATHETER BLNDIL 6MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032602110 SUP HCPCS C1725 H74939032602110 - CATHETER BLNDIL 6MM 150CM 200MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032602210 SUP HCPCS C1725 H74939032602210 - CATHETER BLNDIL 6MM 150CM 220MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032603010 SUP HCPCS C1753 H74939032603010 - CATHETER BLNDIL 6MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032603080 SUP HCPCS C1753 H74939032603080 - CATHETER BLNDIL 6MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032604010 SUP HCPCS C1726 H74939032604010 - CATHETER BLNDIL 6MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032604040 SUP HCPCS C1753 H74939032604040 - CATHETER BLNDIL 6MM 40CM 40MM STRLG OTW INFL PORT LOPRFL TPR BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032604080 SUP HCPCS C1726 H74939032604080 - CATHETER BLNDIL 6MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032606010 SUP HCPCS C1726 H74939032606010 - CATHETER BLNDIL 6MM 135CM 60MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032606080 SUP HCPCS C1726 H74939032606080 - CATHETER BLNDIL 6MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032608010 SUP HCPCS C1726 H74939032608010 - CATHETER BLNDIL 6MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032608080 SUP HCPCS C1753 H74939032608080 - CATHETER BLNDIL 6MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032701010 SUP HCPCS C1753 H74939032701010 - CATHETER BLNDIL 7MM 135CM 100MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032701080 SUP HCPCS C1753 H74939032701080 - CATHETER BLNDIL 7MM 80CM 100MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032701210 SUP HCPCS C1725 H74939032701210 - CATHETER BLNDIL 7MM 150CM 120MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032701510 SUP HCPCS C1725 H74939032701510 - CATHETER BLNDIL 7MM 150CM 150MM STRLG OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032702010 SUP HCPCS C1726 H74939032702010 - CATHETER BLNDIL 7MM 135CM 20MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032702040 SUP HCPCS C1753 H74939032702040 - CATHETER BLNDIL 7MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032702080 SUP HCPCS C1726 H74939032702080 - CATHETER BLNDIL 7MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032702110 SUP HCPCS C1725 H74939032702110 - CATHETER BLNDIL 7MM 150CM 200MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032702210 SUP HCPCS C1725 H74939032702210 - CATHETER BLNDIL 7MM 150CM 220MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032703010 SUP HCPCS C1753 H74939032703010 - CATHETER BLNDIL 7MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032703080 SUP HCPCS C1753 H74939032703080 - CATHETER BLNDIL 7MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032704010 SUP HCPCS C1726 H74939032704010 - CATHETER BLNDIL 7MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032704040 SUP HCPCS C1753 H74939032704040 - CATHETER BLNDIL 7MM 40CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032704080 SUP HCPCS C1726 H74939032704080 - CATHETER BLNDIL 7MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032706010 SUP HCPCS C1726 H74939032706010 - CATHETER BLNDIL 7MM 135CM 60MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032706080 SUP HCPCS C1726 H74939032706080 - CATHETER BLNDIL 7MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032708010 SUP HCPCS C1753 H74939032708010 - CATHETER BLNDIL 7MM 135CM 80MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032708080 SUP HCPCS C1726 H74939032708080 - CATHETER BLNDIL 7MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032802010 SUP HCPCS C1726 H74939032802010 - CATHETER BLNDIL 8MM 135CM 20MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032802040 SUP HCPCS C1753 H74939032802040 - CATHETER BLNDIL 8MM 40CM 20MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032802080 SUP HCPCS C1726 H74939032802080 - CATHETER BLNDIL 8MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032803010 SUP HCPCS C1753 H74939032803010 - CATHETER BLNDIL 8MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032803080 SUP HCPCS C1753 H74939032803080 - CATHETER BLNDIL 8MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032804010 SUP HCPCS C1726 H74939032804010 - CATHETER BLNDIL 8MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032804040 SUP HCPCS C1753 H74939032804040 - CATHETER BLNDIL 8MM 40CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032804080 SUP HCPCS C1726 H74939032804080 - CATHETER BLNDIL 8MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032806010 SUP HCPCS C1726 H74939032806010 - CATHETER BLNDIL 8MM 135CM 40MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032806080 SUP HCPCS C1726 H74939032806080 - CATHETER BLNDIL 8MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $150.00 $111.00 $29.77 $150.00 $81.45 $81.45 $81.45 $81.45 $150.00 $150.00 $150.00 $31.26 $150.00 $111.33 $111.33 $115.62 $78.15 $31.26 $150.00 $150.00 $88.73 $150.00 $150.00 $150.00 $150.00 $112.50 $150.00 $150.00 $150.00 $75.00 $75.00 $118.80 $150.00 $120.00 $97.50 $29.77 N/A $87.00 $150.00 $150.00 $150.00 $31.26 $150.00 N/A N/A H74939032808010 SUP HCPCS C1726 H74939032808010 - CATHETER BLNDIL 8MM 135CM 80MM STRLG OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032808080 SUP HCPCS C1753 H74939032808080 - CATHETER BLNDIL 8MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032902010 SUP HCPCS C1753 H74939032902010 - CATHETER BLNDIL 9MM 135CM 20MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032902080 SUP HCPCS C1753 H74939032902080 - CATHETER BLNDIL 9MM 80CM 20MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032903010 SUP HCPCS C1753 H74939032903010 - CATHETER BLNDIL 9MM 135CM 30MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032903080 SUP HCPCS C1753 H74939032903080 - CATHETER BLNDIL 9MM 80CM 30MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939032904010 SUP HCPCS C1726 H74939032904010 - CATHETER BLNDIL 9MM 135CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032904080 SUP HCPCS C1726 H74939032904080 - CATHETER BLNDIL 9MM 80CM 40MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032906010 SUP HCPCS C1753 H74939032906010 - CATHETER BLNDIL 9MM 135CM 60MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032906080 SUP HCPCS C1753 H74939032906080 - CATHETER BLNDIL 9MM 80CM 60MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032908010 SUP HCPCS C1753 H74939032908010 - CATHETER BLNDIL 9MM 135CM 80MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939032908080 SUP HCPCS C1753 H74939032908080 - CATHETER BLNDIL 9MM 80CM 80MM STRLG OTW TPR TIP LOPRFL INFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939134152010 SUP HCPCS C1726 H74939134152010 - CATHETER BLNDIL 1.5MM 142CM 20MM CYTE ES OTW ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939134202010 SUP HCPCS C1726 H74939134202010 - CATHETER BLNDIL 2MM 142CM 20MM CYTE ES OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939134203010 SUP HCPCS C1753 H74939134203010 - CATHETER BLNDIL 2MM 143CM 30MM CYTE ES OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939134204010 SUP HCPCS C1726 H74939134204010 - CATHETER BLNDIL 2MM 144CM 40MM CYTE ES OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939134252010 SUP HCPCS C1753 H74939134252010 - CATHETER BLNDIL 2.5MM 143CM 20MM CYTE ES OTW ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939134253010 SUP HCPCS C1753 H74939134253010 - CATHETER BLNDIL 2.5MM 144CM 30MM CYTE ES OTW ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939134254010 SUP HCPCS C1726 H74939134254010 - CATHETER BLNDIL 2.5MM 145CM 40MM CYTE ES OTW ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939134302010 SUP HCPCS C1726 H74939134302010 - CATHETER BLNDIL 3MM 143CM 20MM CYTE ES OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939134303010 SUP HCPCS C1753 H74939134303010 - CATHETER BLNDIL 3MM 144CM 30MM CYTE ES OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939134304010 SUP HCPCS C1726 H74939134304010 - CATHETER BLNDIL 3MM 145CM 40MM CYTE ES OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939134352010 SUP HCPCS C1753 H74939134352010 - CATHETER BLNDIL 3.5MM 143CM 20MM CYTE ES OTW ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939134353010 SUP HCPCS C1753 H74939134353010 - CATHETER BLNDIL 3.5MM 144CM 30MM CYTE ES OTW ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939134354010 SUP HCPCS C1753 H74939134354010 - CATHETER BLNDIL 3.5MM 145CM 40MM CYTE ES OTW ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939134402010 SUP HCPCS C1726 H74939134402010 - CATHETER BLNDIL 4MM 143CM 20MM CYTE ES OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939134403010 SUP HCPCS C1753 H74939134403010 - CATHETER BLNDIL 4MM 144CM 30MM CYTE ES OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939134404010 SUP HCPCS C1726 H74939134404010 - CATHETER BLNDIL 4MM 145CM 40MM CYTE ES OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939135152010 SUP HCPCS C1753 H74939135152010 - CATHETER BLNDIL 1.5MM 143CM 20MM CYTE ES MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939135202010 SUP HCPCS C1753 H74939135202010 - CATHETER BLNDIL 2MM 143CM 20MM CYTE ES MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939135203010 SUP HCPCS C1753 H74939135203010 - CATHETER BLNDIL 2MM 144CM 30MM CYTE ES MNRL ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939135204010 SUP HCPCS C1753 H74939135204010 - CATHETER BLNDIL 2MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939135252010 SUP HCPCS C1753 H74939135252010 - CATHETER BLNDIL 2.5MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939135253010 SUP HCPCS C1753 H74939135253010 - CATHETER BLNDIL 2.5MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939135254010 SUP HCPCS C1753 H74939135254010 - CATHETER BLNDIL 2.5MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939135302010 SUP HCPCS C1753 H74939135302010 - CATHETER BLNDIL 3MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939135303010 SUP HCPCS C1753 H74939135303010 - CATHETER BLNDIL 3MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939135304010 SUP HCPCS C1753 H74939135304010 - CATHETER BLNDIL 3MM 146CM 40MM CYTE ES MNRL ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939135352010 SUP HCPCS C1753 H74939135352010 - CATHETER BLNDIL 3.5MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939135353010 SUP HCPCS C1753 H74939135353010 - CATHETER BLNDIL 3.5MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939135354010 SUP HCPCS C1753 H74939135354010 - CATHETER BLNDIL 3.5MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939135402010 SUP HCPCS C1753 H74939135402010 - CATHETER BLNDIL 4MM 144CM 20MM CYTE ES MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939135403010 SUP HCPCS C1753 H74939135403010 - CATHETER BLNDIL 4MM 145CM 30MM CYTE ES MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939135404010 SUP HCPCS C1753 H74939135404010 - CATHETER BLNDIL 4MM 145CM 40MM CYTE ES MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939147201010 SUP HCPCS C1725 H74939147201010 - CATHETER BLNDIL 2MM 150CM 100MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147201090 SUP HCPCS C1725 H74939147201090 - CATHETER BLNDIL 2MM 90CM 100MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147201210 SUP HCPCS C1725 H74939147201210 - CATHETER BLNDIL 2MM 150CM 120MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147201290 SUP HCPCS C1725 H74939147201290 - CATHETER BLNDIL 2MM 90CM 120MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147201510 SUP HCPCS C1725 H74939147201510 - CATHETER BLNDIL 2MM 150CM 150MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147201590 SUP HCPCS C1725 H74939147201590 - CATHETER BLNDIL 2MM 90CM 150MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147208010 SUP HCPCS C1725 H74939147208010 - CATHETER BLNDIL 2MM 150CM 80MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147208090 SUP HCPCS C1725 H74939147208090 - CATHETER BLNDIL 2MM 90CM 80MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147251010 SUP HCPCS C1725 H74939147251010 - CATHETER BLNDIL 2.5MM 150CM 100MM STRLG SL OTW TPR TIP BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147251090 SUP HCPCS C1725 H74939147251090 - CATHETER BLNDIL 2.5MM 90CM 100MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147251210 SUP HCPCS C1725 H74939147251210 - CATHETER BLNDIL 2.5MM 150CM 120MM STRLG SL MNRL TPR TIP BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147251290 SUP HCPCS C1725 H74939147251290 - CATHETER BLNDIL 2.5MM 90CM 120MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147251510 SUP HCPCS C1725 H74939147251510 - CATHETER BLNDIL 2.5MM 150CM 150MM STRLG SL MNRL TPR TIP BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147251590 SUP HCPCS C1725 H74939147251590 - CATHETER BLNDIL 2.5MM 90CM 150MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147258010 SUP HCPCS C1725 H74939147258010 - CATHETER BLNDIL 2.5MM 150CM 80MM STRLG SL MNRL TPR TIP BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147258090 SUP HCPCS C1725 H74939147258090 - CATHETER BLNDIL 2.5MM 90CM 80MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147301010 SUP HCPCS C1725 H74939147301010 - CATHETER BLNDIL 3MM 150CM 100MM STRLG SL MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147301090 SUP HCPCS C1725 H74939147301090 - CATHETER BLNDIL 3MM 90CM 100MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147301210 SUP HCPCS C1725 H74939147301210 - CATHETER BLNDIL 3MM 150CM 120MM STRLG SL MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147301290 SUP HCPCS C1725 H74939147301290 - CATHETER BLNDIL 3MM 90CM 120MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147301510 SUP HCPCS C1725 H74939147301510 - CATHETER BLNDIL 3MM 150CM 150MM STRLG SL MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147301590 SUP HCPCS C1725 H74939147301590 - CATHETER BLNDIL 3MM 90CM 150MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147308010 SUP HCPCS C1725 H74939147308010 - CATHETER BLNDIL 3MM 150CM 80MM STRLG SL MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147308090 SUP HCPCS C1725 H74939147308090 - CATHETER BLNDIL 3MM 90CM 80MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147351010 SUP HCPCS C1725 H74939147351010 - CATHETER BLNDIL 3.5MM 150CM 100MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147351090 SUP HCPCS C1725 H74939147351090 - CATHETER BLNDIL 3.5MM 90CM 100MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147351210 SUP HCPCS C1725 H74939147351210 - CATHETER BLNDIL 3.5MM 150CM 120MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147351290 SUP HCPCS C1725 H74939147351290 - CATHETER BLNDIL 3.5MM 90CM 120MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147351510 SUP HCPCS C1725 H74939147351510 - CATHETER BLNDIL 3.5MM 150CM 150MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147351590 SUP HCPCS C1725 H74939147351590 - CATHETER BLNDIL 3.5MM 90CM 150MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147358010 SUP HCPCS C1725 H74939147358010 - CATHETER BLNDIL 3.5MM 150CM 80MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147358090 SUP HCPCS C1725 H74939147358090 - CATHETER BLNDIL 3.5MM 90CM 80MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147401010 SUP HCPCS C1725 H74939147401010 - CATHETER BLNDIL 4MM 150CM 100MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147401090 SUP HCPCS C1725 H74939147401090 - CATHETER BLNDIL 4MM 90CM 100MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147401210 SUP HCPCS C1725 H74939147401210 - CATHETER BLNDIL 4MM 150CM 120MM STRLG SL MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147401290 SUP HCPCS C1725 H74939147401290 - CATHETER BLNDIL 4MM 90CM 120MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147401510 SUP HCPCS C1725 H74939147401510 - CATHETER BLNDIL 4MM 150CM 150MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147401590 SUP HCPCS C1725 H74939147401590 - CATHETER BLNDIL 4MM 90CM 150MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147408010 SUP HCPCS C1725 H74939147408010 - CATHETER BLNDIL 4MM 150CM 80MM STRLG SL MNRL TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939147408090 SUP HCPCS C1725 H74939147408090 - CATHETER BLNDIL 4MM 90CM 80MM STRLG SL MNRL RX INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148201010 SUP HCPCS C1726 H74939148201010 - CATHETER BLNDIL 2MM 150CM 100MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148201090 SUP HCPCS C1753 H74939148201090 - CATHETER BLNDIL 2MM 100CM 90MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148201210 SUP HCPCS C1726 H74939148201210 - CATHETER BLNDIL 2MM 150CM 120MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148201290 SUP HCPCS C1725 H74939148201290 - CATHETER BLNDIL 2MM 90CM 120MM STRLG SL OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148201510 SUP HCPCS C1726 H74939148201510 - CATHETER BLNDIL 2MM 150CM 150MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148201590 SUP HCPCS C1725 H74939148201590 - CATHETER BLNDIL 2MM 90CM 150MM STRLG SL OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148208010 SUP HCPCS C1726 H74939148208010 - CATHETER BLNDIL 2MM 150CM 80MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148208090 SUP HCPCS C1753 H74939148208090 - CATHETER BLNDIL 2MM 90CM 80MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939148251010 SUP HCPCS C1753 H74939148251010 - CATHETER BLNDIL 2.5MM 150CM 100MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939148251090 SUP HCPCS C1753 H74939148251090 - CATHETER BLNDIL 2.5MM 90CM 100MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939148251210 SUP HCPCS C1725 H74939148251210 - CATHETER BLNDIL 2.5MM 150CM 120MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148251290 SUP HCPCS C1725 H74939148251290 - CATHETER BLNDIL 2.5MM 90CM 120MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148251510 SUP HCPCS C1725 H74939148251510 - CATHETER BLNDIL 2.5MM 150CM 150MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148251590 SUP HCPCS C1725 H74939148251590 - CATHETER BLNDIL 2.5MM 90CM 150MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148258010 SUP HCPCS C1753 H74939148258010 - CATHETER BLNDIL 2.5MM 150CM 80MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939148258090 SUP HCPCS C1753 H74939148258090 - CATHETER BLNDIL 2.5MM 90CM 80MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939148301010 SUP HCPCS C1726 H74939148301010 - CATHETER BLNDIL 3MM 150CM 100MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148301090 SUP HCPCS C1753 H74939148301090 - CATHETER BLNDIL 3MM 90CM 100MM STRLG SL OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939148301210 SUP HCPCS C1726 H74939148301210 - CATHETER BLNDIL 3MM 150CM 120MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148301290 SUP HCPCS C1725 H74939148301290 - CATHETER BLNDIL 3MM 90CM 120MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148301510 SUP HCPCS C1726 H74939148301510 - CATHETER BLNDIL 3MM 150CM 150MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148301590 SUP HCPCS C1725 H74939148301590 - CATHETER BLNDIL 3MM 90CM 150MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148308010 SUP HCPCS C1726 H74939148308010 - CATHETER BLNDIL 3MM 150CM 80MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148308090 SUP HCPCS C1753 H74939148308090 - CATHETER BLNDIL 3MM 90CM 80MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939148351010 SUP HCPCS C1753 H74939148351010 - CATHETER BLNDIL 3.5MM 150CM 100MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148351090 SUP HCPCS C1753 H74939148351090 - CATHETER BLNDIL 3.5MM 90CM 100MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148351210 SUP HCPCS C1725 H74939148351210 - CATHETER BLNDIL 3.5MM 150CM 120MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148351290 SUP HCPCS C1725 H74939148351290 - CATHETER BLNDIL 3.5MM 90CM 120MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148351510 SUP HCPCS C1725 H74939148351510 - CATHETER BLNDIL 3.5MM 150CM 150MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148351590 SUP HCPCS C1725 H74939148351590 - CATHETER BLNDIL 3.5MM 90CM 150MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148358010 SUP HCPCS C1753 H74939148358010 - CATHETER BLNDIL 3.5MM 150CM 80MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939148358090 SUP HCPCS C1753 H74939148358090 - CATHETER BLNDIL 3.5MM 90CM 80MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148401010 SUP HCPCS C1753 H74939148401010 - CATHETER BLNDIL 4MM 150CM 100MM STRLG SL OTW INFL PORT BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $250.50 $417.50 $87.01 $417.50 N/A N/A H74939148401210 SUP HCPCS C1725 H74939148401210 - CATHETER BLNDIL 4MM 150CM 120MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148401290 SUP HCPCS C1725 H74939148401290 - CATHETER BLNDIL 4MM 90CM 120MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148401510 SUP HCPCS C1726 H74939148401510 - CATHETER BLNDIL 4MM 150CM 150MM STRLG SL OTW TPR TIP LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148401590 SUP HCPCS C1725 H74939148401590 - CATHETER BLNDIL 4MM 90CM 150MM STRLG SL OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939148408010 SUP HCPCS C1726 H74939148408010 - CATHETER BLNDIL 4MM 150CM 80MM STRLG SL OTW INFL PORT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939171030210 SUP HCPCS C1753 H74939171030210 - CATHETER BALDILAT LP 5.3FR 3MM 135CM 20MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171030240 SUP HCPCS C1753 H74939171030240 - CATHETER BLNDIL 3MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171030270 SUP HCPCS C1753 H74939171030270 - CATHETER BALDILAT LP 5.3FR 3MM 75CM 20MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171030310 SUP HCPCS C1753 H74939171030310 - CATHETER BALDILAT .035IN 5FR 3MM 135CM 30MM PTA LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171030340 SUP HCPCS C1753 H74939171030340 - CATHETER BLNDIL 3MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171030370 SUP HCPCS C1753 H74939171030370 - CATHETER BLNDIL 3MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171030410 SUP HCPCS C1753 H74939171030410 - CATHETER BALDILAT LP 5.3FR 3MM 135CM 40MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171030440 SUP HCPCS C1753 H74939171030440 - CATHETER BLNDIL 3MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171030470 SUP HCPCS C1753 H74939171030470 - CATHETER BALDILAT LP 5.3FR 3MM 75CM 40MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171030610 SUP HCPCS C1753 H74939171030610 - CATHETER BALDILAT LP 5.3FR 3MM 135CM 60MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171030640 SUP HCPCS C1753 H74939171030640 - CATHETER BLNDIL 3MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171030670 SUP HCPCS C1753 H74939171030670 - CATHETER BALDILAT LP 5.3FR 3MM 75CM 60MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171030810 SUP HCPCS C1753 H74939171030810 - CATHETER BLNDIL 3MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171030840 SUP HCPCS C1753 H74939171030840 - CATHETER BLNDIL 3MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171030870 SUP HCPCS C1753 H74939171030870 - CATHETER BLNDIL 3MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171031010 SUP HCPCS C1753 H74939171031010 - CATHETER BALDILAT .035IN 3MM 135CM 100MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171031040 SUP HCPCS C1753 H74939171031040 - CATHETER BLNDIL 3MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171031070 SUP HCPCS C1753 H74939171031070 - CATHETER BLNDIL 3MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171031210 SUP HCPCS C1753 H74939171031210 - CATHETER BLNDIL 3MM 135CM 120MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171031270 SUP HCPCS C1753 H74939171031270 - CATHETER BLNDIL 3MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171031510 SUP HCPCS C1753 H74939171031510 - CATHETER BALDILAT LP 5.3FR 3MM 135CM 150MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171031570 SUP HCPCS C1753 H74939171031570 - CATHETER BLNDIL 3MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171031810 SUP HCPCS C1753 H74939171031810 - CATHETER BALDILAT .035IN 5FR 3MM 135CM 180MM PTA LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171031870 SUP HCPCS C1753 H74939171031870 - CATHETER BLNDIL 3MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171032010 SUP HCPCS C1753 H74939171032010 - CATHETER BALDILAT LP 5.3FR 3MM 135CM 200MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171032070 SUP HCPCS C1753 H74939171032070 - CATHETER BLNDIL 3MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171040210 SUP HCPCS C1725 H74939171040210 - CATHETER BALDILAT .035IN 4MM 135CM 20MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171040240 SUP HCPCS C1753 H74939171040240 - CATHETER BLNDIL 4MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171040270 SUP HCPCS C1726 H74939171040270 - CATHETER BALDILAT LP 5.3FR 4MM 75CM 20MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171040310 SUP HCPCS C1753 H74939171040310 - CATHETER BALDILAT 4MM 135CM 30MM HIGH PRESSURE LP INFLAT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171040340 SUP HCPCS C1753 H74939171040340 - CATHETER BLNDIL 4MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171040370 SUP HCPCS C1753 H74939171040370 - CATHETER BLNDIL 4MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171040410 SUP HCPCS C1726 H74939171040410 - CATHETER BALDILAT LP 5.3FR 4MM 135CM 40MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171040440 SUP HCPCS C1753 H74939171040440 - CATHETER BLNDIL 4MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171040470 SUP HCPCS C1726 H74939171040470 - CATHETER BALDILAT LP 5.3FR 4MM 75CM 40MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171040610 SUP HCPCS C1753 H74939171040610 - CATHETER BALDILAT LP 5.3FR 4MM 135CM 60MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171040640 SUP HCPCS C1753 H74939171040640 - CATHETER BLNDIL 4MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171040670 SUP HCPCS C1753 H74939171040670 - CATHETER BALDILAT LP 5.3FR 4MM 75CM 60MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171040810 SUP HCPCS C1753 H74939171040810 - CATHETER BALDILAT LP 5.3FR 4MM 135CM 80MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171040840 SUP HCPCS C1753 H74939171040840 - CATHETER BLNDIL 4MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171040870 SUP HCPCS C1753 H74939171040870 - CATHETER BLNDIL 4MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171041010 SUP HCPCS C1753 H74939171041010 - CATHETER BALDILAT .035IN 4MM 135CM 100MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171041040 SUP HCPCS C1753 H74939171041040 - CATHETER BLNDIL 4MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171041070 SUP HCPCS C1753 H74939171041070 - CATHETER BLNDIL 4MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171041210 SUP HCPCS C1726 H74939171041210 - CATHETER BLNDIL 4MM 135CM 120MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171041270 SUP HCPCS C1753 H74939171041270 - CATHETER BLNDIL 4MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171041510 SUP HCPCS C1753 H74939171041510 - CATHETER BALDILAT LP 5.3FR 4MM 135CM 150MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171041570 SUP HCPCS C1753 H74939171041570 - CATHETER BLNDIL 4MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171041810 SUP HCPCS C1753 H74939171041810 - CATHETER BLNDIL 4MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171041870 SUP HCPCS C1753 H74939171041870 - CATHETER BLNDIL 4MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171042010 SUP HCPCS C1725 H74939171042010 - CATHETER BALDILAT .035IN 4MM 135CM 200MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171042070 SUP HCPCS C1753 H74939171042070 - CATHETER BLNDIL 4MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171050210 SUP HCPCS C1726 H74939171050210 - CATHETER BALDILAT .035IN 5MM 135CM 20MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171050240 SUP HCPCS C1753 H74939171050240 - CATHETER BLNDIL 5MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171050270 SUP HCPCS C1725 H74939171050270 - CATHETER BALDILAT LP 5.3FR 5MM 75CM 20MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171050310 SUP HCPCS C1753 H74939171050310 - CATHETER BALDILAT LP 5FR 5MM 135CM 30MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171050340 SUP HCPCS C1753 H74939171050340 - CATHETER BLNDIL 5MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171050370 SUP HCPCS C1753 H74939171050370 - CATHETER BLNDIL 5MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171050410 SUP HCPCS C1726 H74939171050410 - CATHETER BALDILAT 5FR 5MM 135CM 40MM HIGH PRESSURE LP INFLAT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171050440 SUP HCPCS C1726 H74939171050440 - CATHETER BLNDIL 5MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171050470 SUP HCPCS C1726 H74939171050470 - CATHETER BALDILAT .035IN 5MM 75CM 40MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171050610 SUP HCPCS C1753 H74939171050610 - CATHETER BALDILAT .035IN 5MM 135CM 60MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171050640 SUP HCPCS C1753 H74939171050640 - CATHETER BLNDIL 5MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171050670 SUP HCPCS C1753 H74939171050670 - CATHETER BALDILAT .035IN 5MM 75CM 60MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171050810 SUP HCPCS C1753 H74939171050810 - CATHETER BALDILAT LP 5.3FR 5MM 135CM 80MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171050840 SUP HCPCS C1753 H74939171050840 - CATHETER BLNDIL 5MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171050870 SUP HCPCS C1753 H74939171050870 - CATHETER BLNDIL 5MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171051010 SUP HCPCS C1725 H74939171051010 - CATHETER BALDILAT LP 5.3FR 5MM 135CM 100MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171051040 SUP HCPCS C1753 H74939171051040 - CATHETER BLNDIL 5MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171051070 SUP HCPCS C1753 H74939171051070 - CATHETER BLNDIL 5MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171051210 SUP HCPCS C1753 H74939171051210 - CATHETER BALDILAT LP 5.3FR 5MM 135CM 120MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171051240 SUP HCPCS C1753 H74939171051240 - CATHETER BLNDIL 5MM 40CM 120MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171051270 SUP HCPCS C1753 H74939171051270 - CATHETER BLNDIL 5MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171051510 SUP HCPCS C1726 H74939171051510 - CATHETER BALDILAT LP 5.3FR 5MM 135CM 150MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171051570 SUP HCPCS C1753 H74939171051570 - CATHETER BLNDIL 5MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171051810 SUP HCPCS C1753 H74939171051810 - CATHETER BLNDIL 5MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171051870 SUP HCPCS C1753 H74939171051870 - CATHETER BLNDIL 5MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171052010 SUP HCPCS C1726 H74939171052010 - CATHETER BALDILAT LP 5.3FR 5MM 135CM 200MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171052070 SUP HCPCS C1753 H74939171052070 - CATHETER BLNDIL 5MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171060210 SUP HCPCS C1726 H74939171060210 - CATHETER BALDILAT .035IN 6MM 135CM 20MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171060240 SUP HCPCS C1753 H74939171060240 - CATHETER BLNDIL 6MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171060270 SUP HCPCS C1726 H74939171060270 - CATHETER BALDILAT .035IN 6MM 75CM 20MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171060310 SUP HCPCS C1753 H74939171060310 - CATHETER BLNDIL 6MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171060340 SUP HCPCS C1753 H74939171060340 - CATHETER BLNDIL 6MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171060370 SUP HCPCS C1753 H74939171060370 - CATHETER BLNDIL 6MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171060410 SUP HCPCS C1726 H74939171060410 - CATHETER BALDILAT LP 5.3FR 6MM 135CM 40MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171060440 SUP HCPCS C1726 H74939171060440 - CATHETER BLNDIL 6MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171060470 SUP HCPCS C1726 H74939171060470 - CATHETER BALDILAT 6MM 75CM 40MM HIGH PRESSURE LP INFLAT PORT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171060610 SUP HCPCS C1753 H74939171060610 - CATHETER BALDILAT LP 5.3FR 6MM 135CM 60MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171060640 SUP HCPCS C1753 H74939171060640 - CATHETER BLNDIL 6MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171060670 SUP HCPCS C1753 H74939171060670 - CATHETER BALDILAT .035IN 6MM 75CM 60MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171060810 SUP HCPCS C1753 H74939171060810 - CATHETER BALDILAT LP 5.3FR 6MM 135CM 80MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171060840 SUP HCPCS C1753 H74939171060840 - CATHETER BLNDIL 6MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171060870 SUP HCPCS C1753 H74939171060870 - CATHETER BALDILAT .035IN 6MM 75CM 80MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171061010 SUP HCPCS C1726 H74939171061010 - CATHETER BALDILAT LP 5.3FR 6MM 135CM 100MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171061040 SUP HCPCS C1753 H74939171061040 - CATHETER BLNDIL 6MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171061070 SUP HCPCS C1726 H74939171061070 - CATHETER BALDILAT LP 5.3FR 6MM 75CM 100MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171061210 SUP HCPCS C1753 H74939171061210 - CATHETER BALDILAT LP 5.3FR 6MM 135CM 120MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171061240 SUP HCPCS C1753 H74939171061240 - CATHETER BLNDIL 6MM 40CM 120MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171061270 SUP HCPCS C1753 H74939171061270 - CATHETER BLNDIL 6MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171061510 SUP HCPCS C1726 H74939171061510 - CATHETER BALDILAT LP 5.3FR 6MM 135CM 150MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171061570 SUP HCPCS C1753 H74939171061570 - CATHETER BLNDIL 6MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171061810 SUP HCPCS C1753 H74939171061810 - CATHETER BLNDIL 6MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171061870 SUP HCPCS C1753 H74939171061870 - CATHETER BLNDIL 6MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171062010 SUP HCPCS C1726 H74939171062010 - CATHETER BALDILAT 6MM 135CM 200MM HIGH PRESSURE LP INFLAT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171062070 SUP HCPCS C1753 H74939171062070 - CATHETER BLNDIL 6MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171070210 SUP HCPCS C1753 H74939171070210 - CATHETER BALDILAT .035IN 7MM 135CM 20MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171070240 SUP HCPCS C1753 H74939171070240 - CATHETER BLNDIL 7MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171070270 SUP HCPCS C1726 H74939171070270 - CATHETER BALDILAT LP 5.3FR 7MM 75CM 20MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171070310 SUP HCPCS C1753 H74939171070310 - CATHETER BALDILAT LP 5.3FR 7MM 135CM 30MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171070340 SUP HCPCS C1753 H74939171070340 - CATHETER BLNDIL 7MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171070370 SUP HCPCS C1753 H74939171070370 - CATHETER BLNDIL 7MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171070410 SUP HCPCS C1726 H74939171070410 - CATHETER BALDILAT .035IN 7MM 135CM 40MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171070440 SUP HCPCS C1726 H74939171070440 - CATHETER BLNDIL 7MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171070470 SUP HCPCS C1726 H74939171070470 - CATHETER BALDILAT .035IN 7MM 75CM 40MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171070610 SUP HCPCS C1753 H74939171070610 - CATHETER BALDILAT LP 5.3FR 7MM 135CM 60MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171070640 SUP HCPCS C1753 H74939171070640 - CATHETER BLNDIL 7MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171070670 SUP HCPCS C1753 H74939171070670 - CATHETER BALDILAT .035IN 7MM 75CM 60MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171070810 SUP HCPCS C1753 H74939171070810 - CATHETER BALDILAT LP 5.3FR 7MM 135CM 80MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171070840 SUP HCPCS C1753 H74939171070840 - CATHETER BLNDIL 7MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171070870 SUP HCPCS C1753 H74939171070870 - CATHETER BLNDIL 7MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171071010 SUP HCPCS C1725 H74939171071010 - CATHETER BALDILAT LP 5.3FR 7MM 135CM 100MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171071040 SUP HCPCS C1753 H74939171071040 - CATHETER BLNDIL 7MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171071070 SUP HCPCS C1753 H74939171071070 - CATHETER BLNDIL 7MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171071210 SUP HCPCS C1753 H74939171071210 - CATHETER BALDILAT LP 5.3FR 7MM 135CM 120MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171071270 SUP HCPCS C1753 H74939171071270 - CATHETER BLNDIL 7MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171071510 SUP HCPCS C1753 H74939171071510 - CATHETER BALDILAT LP 5.3FR 7MM 135CM 150MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171071570 SUP HCPCS C1753 H74939171071570 - CATHETER BLNDIL 7MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171071810 SUP HCPCS C1753 H74939171071810 - CATHETER BLNDIL 7MM 135CM 180MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171071870 SUP HCPCS C1753 H74939171071870 - CATHETER BLNDIL 7MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171072010 SUP HCPCS C1753 H74939171072010 - CATHETER BALDILAT LP 5.3FR 7MM 135CM 200MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171072070 SUP HCPCS C1753 H74939171072070 - CATHETER BLNDIL 7MM 75CM 200MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171080210 SUP HCPCS C1753 H74939171080210 - CATHETER BALDILAT LP 5.3FR 8MM 135CM 20MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171080240 SUP HCPCS C1753 H74939171080240 - CATHETER BLNDIL 8MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171080270 SUP HCPCS C1725 H74939171080270 - CATHETER BALDILAT LP 5.3FR 8MM 75CM 20MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171080310 SUP HCPCS C1753 H74939171080310 - CATHETER BALDILAT LP 5.3FR 8MM 135CM 30MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171080340 SUP HCPCS C1753 H74939171080340 - CATHETER BLNDIL 8MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171080370 SUP HCPCS C1753 H74939171080370 - CATHETER BALDILAT LP 5.3FR 8MM 75CM 30MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171080410 SUP HCPCS C1726 H74939171080410 - CATHETER BALDILAT 8MM 135CM 40MM HIGH PRESSURE LP INFLAT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171080440 SUP HCPCS C1726 H74939171080440 - CATHETER BLNDIL 8MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171080470 SUP HCPCS C1726 H74939171080470 - CATHETER BALDILAT .035IN 8MM 75CM 40MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171080610 SUP HCPCS C1753 H74939171080610 - CATHETER BALDILAT LP 5.3FR 8MM 135CM 60MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171080640 SUP HCPCS C1753 H74939171080640 - CATHETER BLNDIL 8MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171080670 SUP HCPCS C1753 H74939171080670 - CATHETER BALDILAT .035IN 8MM 75CM 60MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171080810 SUP HCPCS C1753 H74939171080810 - CATHETER BALDILAT LP 5.3FR 8MM 135CM 80MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171080840 SUP HCPCS C1753 H74939171080840 - CATHETER BLNDIL 8MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171080870 SUP HCPCS C1725 H74939171080870 - CATHETER BALDILAT .035IN 8MM 75CM 80MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171081010 SUP HCPCS C1726 H74939171081010 - CATHETER BALDILAT LP 5.3FR 8MM 135CM 100MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171081040 SUP HCPCS C1753 H74939171081040 - CATHETER BLNDIL 8MM 40CM 100MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171081070 SUP HCPCS C1726 H74939171081070 - CATHETER BLNDIL 8MM 75CM 100MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171081210 SUP HCPCS C1753 H74939171081210 - CATHETER BLNDIL 8MM 135CM 120MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171081270 SUP HCPCS C1753 H74939171081270 - CATHETER BLNDIL 8MM 75CM 120MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171081510 SUP HCPCS C1753 H74939171081510 - CATHETER BLNDIL 8MM 135CM 150MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171081570 SUP HCPCS C1753 H74939171081570 - CATHETER BLNDIL 8MM 75CM 150MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171081810 SUP HCPCS C1753 H74939171081810 - CATHETER BALDILAT .035IN 5FR 8MM 135CM 180MM PTA LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171081870 SUP HCPCS C1753 H74939171081870 - CATHETER BLNDIL 8MM 75CM 180MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171082010 SUP HCPCS C1753 H74939171082010 - CATHETER BALDILAT .035IN 5FR 8MM 135CM 200MM PTA LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171082070 SUP HCPCS C1753 H74939171082070 - CATHETER BALDILAT LP 5.3FR 8MM 75CM 200MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171086070 SUP HCPCS C1725 "H74939171086070 - MUSTANG 8X 60, 75" BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $271.50 $271.50 $271.50 $271.50 $500.00 $500.00 $500.00 $104.21 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A H74939171090210 SUP HCPCS C1753 H74939171090210 - CATHETER BALDILAT 18 ATM LP TAPER 5.8FR 9MM 135CM 20MM 2 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171090240 SUP HCPCS C1753 H74939171090240 - CATHETER BLNDIL 9MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171090270 SUP HCPCS C1753 H74939171090270 - CATHETER BALDILAT LP 5.3FR 9MM 75CM 20MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171090310 SUP HCPCS C1753 H74939171090310 - CATHETER BLNDIL 9MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171090340 SUP HCPCS C1753 H74939171090340 - CATHETER BLNDIL 9MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171090370 SUP HCPCS C1753 H74939171090370 - CATHETER BLNDIL 9MM 75CM 30MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171090410 SUP HCPCS C1753 H74939171090410 - CATHETER BALDILAT LP 5.8FR 9MM 135CM 40MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171090440 SUP HCPCS C1753 H74939171090440 - CATHETER BLNDIL 9MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171090470 SUP HCPCS C1725 H74939171090470 - CATHETER BALDILAT .035IN 9MM 75CM 40MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171090610 SUP HCPCS C1753 H74939171090610 - CATHETER BLNDIL 9MM 135CM 60MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171090640 SUP HCPCS C1753 H74939171090640 - CATHETER BLNDIL 9MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171090670 SUP HCPCS C1726 H74939171090670 - CATHETER BLNDIL 9MM 75CM 60MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171090810 SUP HCPCS C1753 H74939171090810 - CATHETER BLNDIL 9MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171090840 SUP HCPCS C1753 H74939171090840 - CATHETER BLNDIL 9MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171090870 SUP HCPCS C1753 H74939171090870 - CATHETER BLNDIL 9MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT .035 BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171100210 SUP HCPCS C1753 H74939171100210 - CATHETER BALDILAT LP 5.8FR 10MM 135CM 20MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171100240 SUP HCPCS C1753 H74939171100240 - CATHETER BLNDIL 10MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171100270 SUP HCPCS C1726 H74939171100270 - CATHETER BALDILAT 10MM 75CM 20MM HIGH PRESSURE LP INFLAT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171100310 SUP HCPCS C1753 H74939171100310 - CATHETER BLNDIL 10MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171100340 SUP HCPCS C1753 H74939171100340 - CATHETER BLNDIL 10MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171100370 SUP HCPCS C1753 H74939171100370 - CATHETER BALDILAT LP 5.8FR 10MM 75CM 30MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171100410 SUP HCPCS C1753 H74939171100410 - CATHETER BALDILAT LP 5.8FR 10MM 135CM 40MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171100440 SUP HCPCS C1753 H74939171100440 - CATHETER BLNDIL 10MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171100470 SUP HCPCS C1726 H74939171100470 - CATHETER BALDILAT 10MM 75CM 40MM HIGH PRESSURE LP MUSTANG BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171100610 SUP HCPCS C1753 H74939171100610 - CATHETER BLNDIL 10MM 135CM 60MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171100640 SUP HCPCS C1753 H74939171100640 - CATHETER BLNDIL 10MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171100670 SUP HCPCS C1725 H74939171100670 - CATHETER BALDILAT 5.8FR 10MM 75CM 60MM HIGH PRESSURE LP BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171100810 SUP HCPCS C1753 H74939171100810 - CATHETER BLNDIL 10MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171100840 SUP HCPCS C1753 H74939171100840 - CATHETER BLNDIL 10MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171100870 SUP HCPCS C1753 H74939171100870 - CATHETER BALDILAT LP 5.8FR 10MM 75CM 80MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171120210 SUP HCPCS C1753 H74939171120210 - CATHETER BALDILAT LP 5.8FR 12MM 135CM 20MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171120240 SUP HCPCS C1753 H74939171120240 - CATHETER BLNDIL 12MM 40CM 20MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171120270 SUP HCPCS C1753 H74939171120270 - CATHETER BALDILAT LP 5.8FR 12MM 75CM 20MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171120310 SUP HCPCS C1753 H74939171120310 - CATHETER BLNDIL 12MM 135CM 30MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171120340 SUP HCPCS C1753 H74939171120340 - CATHETER BLNDIL 12MM 40CM 30MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171120370 SUP HCPCS C1753 H74939171120370 - CATHETER BALDILAT LP 5.8FR 12MM 75CM 30MM HIGH PRESSURE BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $258.00 $430.00 $89.61 $430.00 N/A N/A H74939171120410 SUP HCPCS C1753 H74939171120410 - CATHETER BLNDIL 12MM 135CM 40MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171120440 SUP HCPCS C1753 H74939171120440 - CATHETER BLNDIL 12MM 40CM 40MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171120470 SUP HCPCS C1726 H74939171120470 - CATHETER BALDILAT 12MM 75CM 40MM HIGH PRESSURE LP MUSTANG BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171120610 SUP HCPCS C1753 H74939171120610 - CATHETER BLNDIL 12MM 135CM 60MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171120640 SUP HCPCS C1753 H74939171120640 - CATHETER BLNDIL 12MM 40CM 60MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171120670 SUP HCPCS C1753 H74939171120670 - CATHETER BLNDIL 12MM 75CM 60MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171120810 SUP HCPCS C1753 H74939171120810 - CATHETER BLNDIL 12MM 135CM 80MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171120840 SUP HCPCS C1753 H74939171120840 - CATHETER BLNDIL 12MM 40CM 80MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939171120870 SUP HCPCS C1753 H74939171120870 - CATHETER BLNDIL 12MM 75CM 80MM MUSTANG HI-PRS NYBAX ACPT BOTH IP/OP $430.00 $318.00 $85.34 $430.00 $233.49 $233.49 $233.49 $233.49 $430.00 $430.00 $430.00 $89.62 $430.00 $319.15 $319.15 $331.44 $224.03 $89.62 $430.00 $430.00 $254.35 $430.00 $430.00 $430.00 $430.00 $322.50 $430.00 $430.00 $430.00 $215.00 $215.00 $340.56 $430.00 $344.00 $279.50 $85.34 N/A $249.40 $430.00 $430.00 $430.00 $89.61 $430.00 N/A N/A H74939185150410 SUP HCPCS C1725 H74939185150410 - CATHETER BLNDIL 1.5MM 150CM 40MM CYTE MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185201210 SUP HCPCS C1725 H74939185201210 - CATHETER BLNDIL 2MM 150CM 120MM CYTE MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185201290 SUP HCPCS C1725 H74939185201290 - CATHETER BLNDIL 2MM 90CM 120MM CYTE MNRL RX ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185201510 SUP HCPCS C1725 H74939185201510 - CATHETER BLNDIL 2MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185201590 SUP HCPCS C1725 H74939185201590 - CATHETER BLNDIL 2MM 90CM 150MM CYTE MNRL RX ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185251210 SUP HCPCS C1725 H74939185251210 - CATHETER BLNDIL 2.5MM 150CM 120MM CYTE MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185251290 SUP HCPCS C1725 H74939185251290 - CATHETER BLNDIL 2.5MM 90CM 120MM CYTE MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185251510 SUP HCPCS C1725 H74939185251510 - CATHETER BLNDIL 2.5MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185251590 SUP HCPCS C1725 H74939185251590 - CATHETER BLNDIL 2.5MM 90CM 150MM CYTE MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185301210 SUP HCPCS C1725 H74939185301210 - CATHETER BLNDIL 3MM 150CM 120MM CYTE MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185301290 SUP HCPCS C1725 H74939185301290 - CATHETER BLNDIL 3MM 90CM 120MM CYTE MNRL RX ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185301510 SUP HCPCS C1725 H74939185301510 - CATHETER BLNDIL 3MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185301590 SUP HCPCS C1725 H74939185301590 - CATHETER BLNDIL 3MM 90CM 150MM CYTE MNRL RX ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185351210 SUP HCPCS C1725 H74939185351210 - CATHETER BLNDIL 3.5MM 150CM 120MM CYTE MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185351290 SUP HCPCS C1725 H74939185351290 - CATHETER BLNDIL 3.5MM 90CM 120MM CYTE MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185351510 SUP HCPCS C1725 H74939185351510 - CATHETER BLNDIL 3.5MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185351590 SUP HCPCS C1725 H74939185351590 - CATHETER BLNDIL 3.5MM 90CM 150MM CYTE MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185401210 SUP HCPCS C1725 H74939185401210 - CATHETER BLNDIL 4MM 150CM 120MM CYTE MNRL RX ULT LOPRFL BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185401290 SUP HCPCS C1725 H74939185401290 - CATHETER BLNDIL 4MM 90CM 120MM CYTE MNRL RX ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185401510 SUP HCPCS C1725 H74939185401510 - CATHETER BLNDIL 4MM 150CM 150MM CYTE MNRL ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939185401590 SUP HCPCS C1725 H74939185401590 - CATHETER BLNDIL 4MM 90CM 150MM CYTE MNRL RX ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186150410 SUP HCPCS C1726 H74939186150410 - CATHETER BLNDIL 1.5MM 150CM 40MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186150490 SUP HCPCS C1753 H74939186150490 - CATHETER BLNDIL 1.5MM 90CM 40MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186200610 SUP HCPCS C1753 H74939186200610 - CATHETER BLNDIL 2MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186200690 SUP HCPCS C1753 H74939186200690 - CATHETER BLNDIL 2MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX BSLD BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186200810 SUP HCPCS C1753 H74939186200810 - CATHETER BLNDIL 2MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186200890 SUP HCPCS C1753 H74939186200890 - CATHETER BLNDIL 2MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX BSLD BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186201010 SUP HCPCS C1726 H74939186201010 - CATHETER BLNDIL 2MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186201090 SUP HCPCS C1753 H74939186201090 - CATHETER BLNDIL 2MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186201210 SUP HCPCS C1726 H74939186201210 - CATHETER BLNDIL 2MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186201290 SUP HCPCS C1753 H74939186201290 - CATHETER BLNDIL 2MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186201510 SUP HCPCS C1726 H74939186201510 - CATHETER BLNDIL 2MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186201590 SUP HCPCS C1753 H74939186201590 - CATHETER BLNDIL 2MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186202210 SUP HCPCS C1726 H74939186202210 - CATHETER BLNDIL 2MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186202290 SUP HCPCS C1753 H74939186202290 - CATHETER BLNDIL 2MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186250610 SUP HCPCS C1725 H74939186250610 - CATHETER BLNDIL 2.5MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186250690 SUP HCPCS C1753 H74939186250690 - CATHETER BLNDIL 2.5MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186250810 SUP HCPCS C1753 H74939186250810 - CATHETER BLNDIL 2.5MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186250890 SUP HCPCS C1753 H74939186250890 - CATHETER BLNDIL 2.5MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186251010 SUP HCPCS C1753 H74939186251010 - CATHETER BLNDIL 2.5MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186251090 SUP HCPCS C1753 H74939186251090 - CATHETER BLNDIL 2.5MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186251210 SUP HCPCS C1726 H74939186251210 - CATHETER BLNDIL 2.5MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186251290 SUP HCPCS C1753 H74939186251290 - CATHETER BLNDIL 2.5MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186251510 SUP HCPCS C1753 H74939186251510 - CATHETER BLNDIL 2.5MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186251590 SUP HCPCS C1753 H74939186251590 - CATHETER BLNDIL 2.5MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186252210 SUP HCPCS C1726 H74939186252210 - CATHETER BLNDIL 2.5MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186252290 SUP HCPCS C1753 H74939186252290 - CATHETER BLNDIL 2.5MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186300610 SUP HCPCS C1753 H74939186300610 - CATHETER BLNDIL 3MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186300690 SUP HCPCS C1753 H74939186300690 - CATHETER BLNDIL 3MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX BSLD BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186300810 SUP HCPCS C1753 H74939186300810 - CATHETER BLNDIL 3MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186300890 SUP HCPCS C1753 H74939186300890 - CATHETER BLNDIL 3MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX BSLD BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186301010 SUP HCPCS C1726 H74939186301010 - CATHETER BLNDIL 3MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186301090 SUP HCPCS C1753 H74939186301090 - CATHETER BLNDIL 3MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186301210 SUP HCPCS C1726 H74939186301210 - CATHETER BLNDIL 3MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186301290 SUP HCPCS C1753 H74939186301290 - CATHETER BLNDIL 3MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186301510 SUP HCPCS C1726 H74939186301510 - CATHETER BLNDIL 3MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186301590 SUP HCPCS C1753 H74939186301590 - CATHETER BLNDIL 3MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186302210 SUP HCPCS C1726 H74939186302210 - CATHETER BLNDIL 3MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186302290 SUP HCPCS C1753 H74939186302290 - CATHETER BLNDIL 3MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186350610 SUP HCPCS C1753 H74939186350610 - CATHETER BLNDIL 3.5MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186350690 SUP HCPCS C1753 H74939186350690 - CATHETER BLNDIL 3.5MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186350810 SUP HCPCS C1753 H74939186350810 - CATHETER BLNDIL 3.5MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186350890 SUP HCPCS C1753 H74939186350890 - CATHETER BLNDIL 3.5MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186351010 SUP HCPCS C1753 H74939186351010 - CATHETER BLNDIL 3.5MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186351090 SUP HCPCS C1753 H74939186351090 - CATHETER BLNDIL 3.5MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186351210 SUP HCPCS C1753 H74939186351210 - CATHETER BLNDIL 3.5MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186351290 SUP HCPCS C1753 H74939186351290 - CATHETER BLNDIL 3.5MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186351510 SUP HCPCS C1753 H74939186351510 - CATHETER BLNDIL 3.5MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186351590 SUP HCPCS C1753 H74939186351590 - CATHETER BLNDIL 3.5MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186352210 SUP HCPCS C1753 H74939186352210 - CATHETER BLNDIL 3.5MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186352290 SUP HCPCS C1753 H74939186352290 - CATHETER BLNDIL 3.5MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186400610 SUP HCPCS C1753 H74939186400610 - CATHETER BLNDIL 4MM 150CM 60MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186400690 SUP HCPCS C1753 H74939186400690 - CATHETER BLNDIL 4MM 90CM 60MM CYTE OTW ULT LOPRFL NYBAX BSLD BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186400810 SUP HCPCS C1753 H74939186400810 - CATHETER BLNDIL 4MM 150CM 80MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186400890 SUP HCPCS C1753 H74939186400890 - CATHETER BLNDIL 4MM 90CM 80MM CYTE OTW ULT LOPRFL NYBAX BSLD BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186401010 SUP HCPCS C1726 H74939186401010 - CATHETER BLNDIL 4MM 150CM 100MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186401090 SUP HCPCS C1753 H74939186401090 - CATHETER BLNDIL 4MM 90CM 100MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186401210 SUP HCPCS C1726 H74939186401210 - CATHETER BLNDIL 4MM 150CM 120MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186401290 SUP HCPCS C1753 H74939186401290 - CATHETER BLNDIL 4MM 90CM 120MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186401510 SUP HCPCS C1753 H74939186401510 - CATHETER BLNDIL 4MM 150CM 150MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186401590 SUP HCPCS C1753 H74939186401590 - CATHETER BLNDIL 4MM 90CM 150MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186402210 SUP HCPCS C1726 H74939186402210 - CATHETER BLNDIL 4MM 150CM 220MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939186402290 SUP HCPCS C1753 H74939186402290 - CATHETER BLNDIL 4MM 90CM 220MM CYTE OTW ULT LOPRFL NYBAX BOTH IP/OP $417.50 $309.00 $82.86 $417.50 $226.70 $226.70 $226.70 $226.70 $417.50 $417.50 $417.50 $87.02 $417.50 $309.87 $309.87 $321.81 $217.52 $87.01 $417.50 $417.50 $246.95 $417.50 $417.50 $417.50 $417.50 $313.13 $417.50 $417.50 $417.50 $208.75 $208.75 $330.66 $417.50 $334.00 $271.38 $82.86 N/A $242.15 $417.50 $417.50 $417.50 $87.01 $417.50 N/A N/A H74939200061020 SUP HCPCS C1876 H74939200061020 - STENT VASCULAR .035IN 6MM 100MM 120CM SELF EXPAND OTW GWIRE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200061070 SUP HCPCS C1876 H74939200061070 - STENT VASCULAR 6MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200061220 SUP HCPCS C1876 H74939200061220 - STENT VASCULAR 6MM 120MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200061270 SUP HCPCS C1876 H74939200061270 - STENT VASCULAR .035IN 6MM 120MM 75CM SELF EXPAND OTW GWIRE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200062020 SUP HCPCS C1876 H74939200062020 - STENT VASCULAR 6MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200062070 SUP HCPCS C1876 H74939200062070 - STENT VASCULAR 6MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200063020 SUP HCPCS C1876 H74939200063020 - STENT VASCULAR 6MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200063070 SUP HCPCS C1876 H74939200063070 - STENT VASCULAR 6MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200064020 SUP HCPCS C1876 H74939200064020 - STENT VASCULAR 6MM 40MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200064070 SUP HCPCS C1876 H74939200064070 - STENT VASCULAR .035IN 6MM 40MM 75CM SELF EXPAND OTW GWIRE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200065020 SUP HCPCS C1876 H74939200065020 - STENT VASCULAR 6MM 50MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200065070 SUP HCPCS C1876 H74939200065070 - STENT VASCULAR 6MM 50MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200066020 SUP HCPCS C1876 H74939200066020 - STENT VASCULAR .035IN 6MM 60MM 120CM SELF EXPAND OTW GWIRE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200066070 SUP HCPCS C1876 H74939200066070 - STENT VASCULAR 6MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200067020 SUP HCPCS C1876 H74939200067020 - STENT VASCULAR 6MM 70MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200067070 SUP HCPCS C1876 H74939200067070 - STENT VASCULAR 6MM 70MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200068020 SUP HCPCS C1876 H74939200068020 - STENT VASCULAR 6MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200068070 SUP HCPCS C1876 H74939200068070 - STENT VASCULAR 6MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200071020 SUP HCPCS C1876 H74939200071020 - STENT VASCULAR .035IN 7MM 100MM 120CM SELF EXPAND OTW GWIRE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200071070 SUP HCPCS C1876 H74939200071070 - STENT VASCULAR 7MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200071220 SUP HCPCS C1876 H74939200071220 - STENT VASCULAR 7MM 120MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200071270 SUP HCPCS C1876 H74939200071270 - STENT VASCULAR 7MM 120MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200072020 SUP HCPCS C1876 H74939200072020 - STENT VASCULAR 7MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200072070 SUP HCPCS C1876 H74939200072070 - STENT VASCULAR 7MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200073020 SUP HCPCS C1876 H74939200073020 - STENT VASCULAR 7MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200073070 SUP HCPCS C1876 H74939200073070 - STENT VASCULAR .035IN 7MM 30MM 75CM SELF EXPAND OTW GWIRE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200074020 SUP HCPCS C1876 H74939200074020 - STENT VASCULAR .035IN 7MM 40MM 120CM SELF EXPAND OTW GWIRE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200074070 SUP HCPCS C1876 H74939200074070 - STENT VASCULAR .035IN 7MM 40MM 75CM SELF EXPAND OTW GWIRE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200075020 SUP HCPCS C1876 H74939200075020 - STENT VASCULAR 7MM 50MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200075070 SUP HCPCS C1876 H74939200075070 - STENT VASCULAR 7MM 50MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200076020 SUP HCPCS C1876 H74939200076020 - STENT VASCULAR 7MM 60MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200076070 SUP HCPCS C1876 H74939200076070 - STENT VASCULAR 7MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200077020 SUP HCPCS C1876 H74939200077020 - STENT VASCULAR 7MM 70MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200077070 SUP HCPCS C1876 H74939200077070 - STENT VASCULAR 7MM 70MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200078020 SUP HCPCS C1876 H74939200078020 - STENT VASCULAR 7MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200078070 SUP HCPCS C1876 H74939200078070 - STENT VASCULAR 7MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIUM BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200081020 SUP HCPCS C1876 H74939200081020 - STENT VASCULAR 8MM 100MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200081070 SUP HCPCS C1876 H74939200081070 - STENT VASCULAR 8MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200081220 SUP HCPCS C1876 H74939200081220 - STENT VASCULAR .035IN 8MM 120MM 120CM SELF EXPAND OTW GWIRE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200081270 SUP HCPCS C1876 H74939200081270 - STENT VASCULAR 8MM 120MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200082020 SUP HCPCS C1876 H74939200082020 - STENT VASCULAR 8MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200082070 SUP HCPCS C1876 H74939200082070 - STENT VASCULAR 8MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIUM BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200083020 SUP HCPCS C1876 H74939200083020 - STENT VASCULAR 8MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200083070 SUP HCPCS C1876 H74939200083070 - STENT VASCULAR .035IN 8MM 30MM 75CM SELF EXPAND OTW GWIRE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200084020 SUP HCPCS C1876 H74939200084020 - STENT VASCULAR 8MM 40MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200085020 SUP HCPCS C1876 H74939200085020 - STENT VASCULAR 8MM 50MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200085070 SUP HCPCS C1876 H74939200085070 - STENT VASCULAR 8MM 50MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200086020 SUP HCPCS C1876 H74939200086020 - STENT VASCULAR 8MM 60MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200086070 SUP HCPCS C1876 H74939200086070 - STENT VASCULAR 8MM 6FR 60MM 75CM SELF EXPAND SHEATH EPIC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200087020 SUP HCPCS C1876 H74939200087020 - STENT VASCULAR 8MM 70MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200087070 SUP HCPCS C1876 H74939200087070 - STENT VASCULAR 8MM 70MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200088020 SUP HCPCS C1876 H74939200088020 - STENT VASCULAR 8MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200088070 SUP HCPCS C1876 H74939200088070 - STENT VASCULAR 8MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200091020 SUP HCPCS C1876 H74939200091020 - STENT VASCULAR .035IN 8MM 100MM 120CM SELF EXPAND OTW GWIRE BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200091070 SUP HCPCS C1876 H74939200091070 - STENT VASCULAR 9MM 100MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200092020 SUP HCPCS C1876 H74939200092020 - STENT VASCULAR 9MM 20MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200092070 SUP HCPCS C1876 H74939200092070 - STENT VASCULAR 9MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200093020 SUP HCPCS C1876 H74939200093020 - STENT VASCULAR 9MM 30MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200093070 SUP HCPCS C1876 H74939200093070 - STENT VASCULAR 9MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200094020 SUP HCPCS C1876 H74939200094020 - STENT VASCULAR 9MM 40MM 120CM SELF EXPAND EPIC METAL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200094070 SUP HCPCS C1876 H74939200094070 - STENT VASCULAR 9MM 40MM 75CM SELF EXPAND EPIC NITINOL ILIUM BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200095020 SUP HCPCS C1876 H74939200095020 - STENT VASCULAR 9MM 50MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200095070 SUP HCPCS C1876 H74939200095070 - STENT VASCULAR 9MM 50MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200096020 SUP HCPCS C1876 H74939200096020 - STENT VASCULAR 9MM 60MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200096070 SUP HCPCS C1876 H74939200096070 - STENT VASCULAR 9MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIUM BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200097020 SUP HCPCS C1876 H74939200097020 - STENT VASCULAR 9MM 70MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200097070 SUP HCPCS C1876 H74939200097070 - STENT VASCULAR 9MM 70MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200098020 SUP HCPCS C1876 H74939200098020 - STENT VASCULAR 9MM 80MM 120CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200098070 SUP HCPCS C1876 H74939200098070 - STENT VASCULAR 9MM 80MM 75CM SELF EXPAND EPIC NITINOL ILIUM BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200101020 SUP HCPCS C1876 H74939200101020 - STENT VASCULAR 9MM 100MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200101070 SUP HCPCS C1876 H74939200101070 - STENT VASCULAR 10MM 100MM 75CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200102020 SUP HCPCS C1876 H74939200102020 - STENT VASCULAR 10MM 20MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200102070 SUP HCPCS C1876 H74939200102070 - STENT VASCULAR 10MM 20MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200103020 SUP HCPCS C1876 H74939200103020 - STENT VASCULAR 10MM 30MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200103070 SUP HCPCS C1876 H74939200103070 - STENT VASCULAR 10MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200104020 SUP HCPCS C1876 H74939200104020 - STENT VASCULAR 10MM 40MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200104070 SUP HCPCS C1876 H74939200104070 - STENT VASCULAR 10MM 40MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200105020 SUP HCPCS C1876 H74939200105020 - STENT VASCULAR 10MM 50MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200105070 SUP HCPCS C1876 H74939200105070 - STENT VASCULAR 10MM 50MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200106020 SUP HCPCS C1876 H74939200106020 - STENT VASCULAR 10MM 60MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200106070 SUP HCPCS C1876 H74939200106070 - STENT VASCULAR 10MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200107020 SUP HCPCS C1876 H74939200107020 - STENT VASCULAR 10MM 70MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200107070 SUP HCPCS C1876 H74939200107070 - STENT VASCULAR 10MM 70MM 75CM SELF EXPAND EPIC NITINOL ILIUM BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200108020 SUP HCPCS C1876 H74939200108020 - STENT VASCULAR 10MM 80MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200108070 SUP HCPCS C1876 H74939200108070 - STENT VASCULAR 10MM 80MM 75CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200123020 SUP HCPCS C1876 H74939200123020 - STENT VASCULAR 12MM 30MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200123070 SUP HCPCS C1876 H74939200123070 - STENT VASCULAR 12MM 30MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200124020 SUP HCPCS C1876 H74939200124020 - STENT VASCULAR 12MM 40MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200124070 SUP HCPCS C1876 H74939200124070 - STENT VASCULAR 12MM 40MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200125020 SUP HCPCS C1876 H74939200125020 - STENT VASCULAR 12MM 50MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200125070 SUP HCPCS C1876 H74939200125070 - STENT VASCULAR 12MM 50MM 75CM SELF EXPAND EPIC NITINOL ILIUM BOTH IP/OP "$2,500.00" "$1,850.00" $496.19 "$2,500.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.06 "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.03 "$2,500.00" "$2,500.00" "$1,478.75" "$2,500.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,875.00" "$2,500.00" "$2,500.00" "$2,500.00" "$1,250.00" "$1,250.00" "$1,980.00" "$2,500.00" "$2,000.00" "$1,125.00" $496.19 N/A "$1,450.00" "$2,500.00" "$2,500.00" "$2,500.00" $521.00 "$2,500.00" N/A N/A H74939200126020 SUP HCPCS C1876 H74939200126020 - STENT VASCULAR 12MM 60MM 120CM SELF EXPAND EPIC NITINOL BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939200126070 SUP HCPCS C1876 H74939200126070 - STENT VASCULAR 12MM 60MM 75CM SELF EXPAND EPIC NITINOL ILIAC BOTH IP/OP "$1,462.50" "$1,082.00" $290.27 "$1,462.50" $658.13 $658.13 $658.13 $658.13 "$1,462.50" "$1,462.50" "$1,462.50" $304.82 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" $304.80 "$1,462.50" "$1,462.50" $865.07 "$1,462.50" "$1,462.50" "$1,462.50" "$1,462.50" "$1,096.88" "$1,462.50" "$1,462.50" "$1,462.50" $731.25 $731.25 "$1,158.30" "$1,462.50" "$1,170.00" $658.13 $290.27 N/A $848.25 "$1,462.50" "$1,462.50" "$1,462.50" $304.79 "$1,462.50" N/A N/A H74939206030210 SUP HCPCS C1753 H74939206030210 - CATHETER BLNDIL 3MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206030270 SUP HCPCS C1753 H74939206030270 - CATHETER BLNDIL 3MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206030370 SUP HCPCS C1753 H74939206030370 - CATHETER BLNDIL 3MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206030410 SUP HCPCS C1753 H74939206030410 - CATHETER BLNDIL 3MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206030470 SUP HCPCS C1753 H74939206030470 - CATHETER BLNDIL 3MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206030670 SUP HCPCS C1753 H74939206030670 - CATHETER BLNDIL 3MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206030810 SUP HCPCS C1753 H74939206030810 - CATHETER BLNDIL 3MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206031010 SUP HCPCS C1753 H74939206031010 - CATHETER BLNDIL 3MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206031210 SUP HCPCS C1753 H74939206031210 - CATHETER BLNDIL 3MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206031510 SUP HCPCS C1753 H74939206031510 - CATHETER BLNDIL 3MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206031810 SUP HCPCS C1753 H74939206031810 - CATHETER BLNDIL 3MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206032010 SUP HCPCS C1753 H74939206032010 - CATHETER BLNDIL 3MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206040210 SUP HCPCS C1753 H74939206040210 - CATHETER BLNDIL 4MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206040270 SUP HCPCS C1753 H74939206040270 - CATHETER BLNDIL 4MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206040370 SUP HCPCS C1753 H74939206040370 - CATHETER BLNDIL 4MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206040410 SUP HCPCS C1753 H74939206040410 - CATHETER BLNDIL 4MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206040470 SUP HCPCS C1753 H74939206040470 - CATHETER BLNDIL 4MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206040610 SUP HCPCS C1753 H74939206040610 - CATHETER BLNDIL 4MM 135CM 60MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206040670 SUP HCPCS C1753 H74939206040670 - CATHETER BLNDIL 4MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206040810 SUP HCPCS C1753 H74939206040810 - CATHETER BLNDIL 4MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206040870 SUP HCPCS C1753 H74939206040870 - CATHETER BLNDIL 4MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206041010 SUP HCPCS C1753 H74939206041010 - CATHETER BLNDIL 4MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206041070 SUP HCPCS C1753 H74939206041070 - CATHETER BLNDIL 4MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206041210 SUP HCPCS C1753 H74939206041210 - CATHETER BLNDIL 4MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206041510 SUP HCPCS C1753 H74939206041510 - CATHETER BLNDIL 4MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206041810 SUP HCPCS C1753 H74939206041810 - CATHETER BLNDIL 4MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206042010 SUP HCPCS C1753 H74939206042010 - CATHETER BLNDIL 4MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206050210 SUP HCPCS C1753 H74939206050210 - CATHETER BLNDIL 5MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206050270 SUP HCPCS C1753 H74939206050270 - CATHETER BLNDIL 5MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206050370 SUP HCPCS C1753 H74939206050370 - CATHETER BLNDIL 5MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206050410 SUP HCPCS C1753 H74939206050410 - CATHETER BLNDIL 5MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206050470 SUP HCPCS C1753 H74939206050470 - CATHETER BLNDIL 5MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206050610 SUP HCPCS C1753 H74939206050610 - CATHETER BLNDIL 5MM 135CM 60MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206050670 SUP HCPCS C1753 H74939206050670 - CATHETER BLNDIL 5MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206050810 SUP HCPCS C1753 H74939206050810 - CATHETER BLNDIL 5MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206050870 SUP HCPCS C1753 H74939206050870 - CATHETER BLNDIL 5MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206051010 SUP HCPCS C1753 H74939206051010 - CATHETER BLNDIL 5MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206051070 SUP HCPCS C1753 H74939206051070 - CATHETER BLNDIL 5MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206051210 SUP HCPCS C1753 H74939206051210 - CATHETER BLNDIL 5MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206051510 SUP HCPCS C1753 H74939206051510 - CATHETER BLNDIL 5MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206051810 SUP HCPCS C1753 H74939206051810 - CATHETER BLNDIL 5MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206052010 SUP HCPCS C1753 H74939206052010 - CATHETER BLNDIL 5MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206060210 SUP HCPCS C1753 H74939206060210 - CATHETER BLNDIL 6MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206060270 SUP HCPCS C1753 H74939206060270 - CATHETER BLNDIL 6MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206060370 SUP HCPCS C1753 H74939206060370 - CATHETER BLNDIL 6MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206060410 SUP HCPCS C1753 H74939206060410 - CATHETER BLNDIL 6MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206060470 SUP HCPCS C1753 H74939206060470 - CATHETER BLNDIL 6MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206060610 SUP HCPCS C1753 H74939206060610 - CATHETER BLNDIL 6MM 135CM 60MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206060670 SUP HCPCS C1753 H74939206060670 - CATHETER BLNDIL 6MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206060810 SUP HCPCS C1753 H74939206060810 - CATHETER BLNDIL 6MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206060870 SUP HCPCS C1753 H74939206060870 - CATHETER BLNDIL 6MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206061010 SUP HCPCS C1753 H74939206061010 - CATHETER BLNDIL 6MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $120.00 $200.00 $41.68 $200.00 N/A N/A H74939206061070 SUP HCPCS C1753 H74939206061070 - CATHETER BLNDIL 6MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $120.00 $200.00 $41.68 $200.00 N/A N/A H74939206061210 SUP HCPCS C1753 H74939206061210 - CATHETER BLNDIL 6MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206061510 SUP HCPCS C1753 H74939206061510 - CATHETER BLNDIL 6MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206061810 SUP HCPCS C1753 H74939206061810 - CATHETER BLNDIL 6MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206062010 SUP HCPCS C1753 H74939206062010 - CATHETER BLNDIL 6MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206070210 SUP HCPCS C1753 H74939206070210 - CATHETER BLNDIL 7MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $120.00 $200.00 $41.68 $200.00 N/A N/A H74939206070270 SUP HCPCS C1753 H74939206070270 - CATHETER BLNDIL 7MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $120.00 $200.00 $41.68 $200.00 N/A N/A H74939206070370 SUP HCPCS C1753 H74939206070370 - CATHETER BLNDIL 7MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $120.00 $200.00 $41.68 $200.00 N/A N/A H74939206070410 SUP HCPCS C1753 H74939206070410 - CATHETER BLNDIL 7MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $120.00 $200.00 $41.68 $200.00 N/A N/A H74939206070470 SUP HCPCS C1753 H74939206070470 - CATHETER BLNDIL 7MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206070610 SUP HCPCS C1753 "H74939206070610 - BALLOON CATHETER CHARGER 7.0 x60, 135cm" BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206070670 SUP HCPCS C1753 H74939206070670 - CATHETER BLNDIL 7MM 75CM 60MM CHRGR OTW 2 LUM TPR TIP LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206070810 SUP HCPCS C1753 H74939206070810 - CATHETER BLNDIL 7MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206070870 SUP HCPCS C1753 H74939206070870 - CATHETER BLNDIL 7MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $120.00 $200.00 $41.68 $200.00 N/A N/A H74939206071010 SUP HCPCS C1753 H74939206071010 - CATHETER BLNDIL 7MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206071070 SUP HCPCS C1753 H74939206071070 - CATHETER BLNDIL 7MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206071210 SUP HCPCS C1753 H74939206071210 - CATHETER BLNDIL 7MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206071510 SUP HCPCS C1753 H74939206071510 - CATHETER BLNDIL 7MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206071810 SUP HCPCS C1753 H74939206071810 - CATHETER BLNDIL 7MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206072010 SUP HCPCS C1753 H74939206072010 - CATHETER BLNDIL 7MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206080210 SUP HCPCS C1753 H74939206080210 - CATHETER BLNDIL 8MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206080270 SUP HCPCS C1753 H74939206080270 - CATHETER BLNDIL 8MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206080370 SUP HCPCS C1753 H74939206080370 - CATHETER BLNDIL 8MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206080410 SUP HCPCS C1753 H74939206080410 - CATHETER BLNDIL 8MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206080470 SUP HCPCS C1753 H74939206080470 - CATHETER BLNDIL 8MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206080670 SUP HCPCS C1753 H74939206080670 - CATHETER BLNDIL 8MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206080810 SUP HCPCS C1753 H74939206080810 - CATHETER BLNDIL 8MM 135CM 80MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206080870 SUP HCPCS C1753 H74939206080870 - CATHETER BLNDIL 8MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206081010 SUP HCPCS C1753 H74939206081010 - CATHETER BLNDIL 8MM 135CM 100MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206081070 SUP HCPCS C1753 H74939206081070 - CATHETER BLNDIL 8MM 75CM 100MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206081210 SUP HCPCS C1753 H74939206081210 - CATHETER BLNDIL 8MM 135CM 120MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206081510 SUP HCPCS C1753 H74939206081510 - CATHETER BLNDIL 8MM 135CM 150MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206081810 SUP HCPCS C1753 H74939206081810 - CATHETER BLNDIL 8MM 135CM 180MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206082010 SUP HCPCS C1753 H74939206082010 - CATHETER BLNDIL 8MM 135CM 200MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206090210 SUP HCPCS C1753 H74939206090210 - CATHETER BLNDIL 9MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206090270 SUP HCPCS C1753 H74939206090270 - CATHETER BLNDIL 9MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206090370 SUP HCPCS C1753 H74939206090370 - CATHETER BLNDIL 9MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206090410 SUP HCPCS C1753 H74939206090410 - CATHETER BLNDIL 9MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206090470 SUP HCPCS C1753 H74939206090470 - CATHETER BLNDIL 9MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206090670 SUP HCPCS C1753 H74939206090670 - CATHETER BLNDIL 9MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206090870 SUP HCPCS C1753 H74939206090870 - CATHETER BLNDIL 9MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT LOPRFL BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206100210 SUP HCPCS C1753 H74939206100210 - CATHETER BLNDIL 10MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206100270 SUP HCPCS C1753 H74939206100270 - CATHETER BLNDIL 10MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206100370 SUP HCPCS C1753 H74939206100370 - CATHETER BLNDIL 10MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206100410 SUP HCPCS C1753 H74939206100410 - CATHETER BLNDIL 10MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206100470 SUP HCPCS C1753 H74939206100470 - CATHETER BLNDIL 10MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206100670 SUP HCPCS C1753 H74939206100670 - CATHETER BLNDIL 10MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206100870 SUP HCPCS C1753 H74939206100870 - CATHETER BLNDIL 10MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206120210 SUP HCPCS C1753 H74939206120210 - CATHETER BLNDIL 12MM 135CM 20MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206120270 SUP HCPCS C1753 H74939206120270 - CATHETER BLNDIL 12MM 75CM 20MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206120370 SUP HCPCS C1753 H74939206120370 - CATHETER BLNDIL 12MM 75CM 30MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206120410 SUP HCPCS C1753 H74939206120410 - CATHETER BLNDIL 12MM 135CM 40MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206120470 SUP HCPCS C1753 H74939206120470 - CATHETER BLNDIL 12MM 75CM 40MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206120670 SUP HCPCS C1753 H74939206120670 - CATHETER BLNDIL 12MM 75CM 60MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939206120870 SUP HCPCS C1753 H74939206120870 - CATHETER BLNDIL 12MM 75CM 80MM CHRGR OTW NC 2 LUM SHFT BOTH IP/OP $200.00 $148.00 $39.70 $200.00 $108.60 $108.60 $108.60 $108.60 $200.00 $200.00 $200.00 $41.69 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $200.00 $118.30 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $39.70 N/A $116.00 $200.00 $200.00 $200.00 $41.68 $200.00 N/A N/A H74939208001601 SUP HCPCS C1769 H74939208001601 - WIRE CATHETER .017IN .018IN 165CM 300CM SHAPABLE DISTAL TIP BOTH IP/OP $206.00 $152.00 $40.85 $205.80 $111.75 $111.75 $111.75 $111.75 $205.80 $205.80 $205.80 $42.89 $205.80 $152.74 $152.74 $158.63 $107.22 $42.89 $205.80 $205.80 $121.73 $205.80 $205.80 $205.80 $205.80 $154.50 $205.80 $205.80 $205.80 $102.90 $102.90 $162.99 $205.80 $164.64 $133.77 $40.85 N/A $119.48 $205.80 $205.80 $205.80 $42.89 $205.80 N/A N/A H74939208181650 SUP HCPCS C2628 H74939208181650 - CATHETER ATHERECTOMY .017IN .018IN 165CM SHAPABLE DISTAL TIP BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$2,128.56" "$2,128.56" "$2,128.56" "$2,128.56" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$2,909.42" "$2,909.42" "$3,021.54" "$2,042.32" $816.97 "$3,920.00" "$3,920.00" "$2,318.68" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$2,548.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A H74939212014131 SUP HCPCS C1887 H74939212014131 - CATHETER SPRT 15MM SPC 3.4FR 135CM CLR PUR RUBICON 14 RADOPQ BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $798.21 $798.21 $798.21 $798.21 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,091.03" "$1,091.03" "$1,133.08" $765.87 $306.36 "$1,470.00" "$1,470.00" $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $955.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A H74939212014151 SUP HCPCS C1887 H74939212014151 - CATHETER GUID .018IN 150CM RADIOPQ ULTRA LP ROBUST BALLOON BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $798.21 $798.21 $798.21 $798.21 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,091.03" "$1,091.03" "$1,133.08" $765.87 $306.36 "$1,470.00" "$1,470.00" $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $955.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A H74939216718210 SUP HCPCS C1769 H74939216718210 - GUIDEWIRE VASCULAR STR SHORT TAPER .014IN 182CM 8CM ROBUST BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $172.95 $172.95 $172.95 $172.95 $318.50 $318.50 $318.50 $66.38 $318.50 $236.39 $236.39 $245.50 $165.94 $66.38 $318.50 $318.50 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $207.03 $63.21 N/A $184.73 $318.50 $318.50 $318.50 $66.38 $318.50 N/A N/A H74939216718220 SUP HCPCS C1769 H74939216718220 - GUIDEWIRE VASCULAR ANGLE SHORT TAPER .014IN 182CM 8CM ROBUST BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $172.95 $172.95 $172.95 $172.95 $318.50 $318.50 $318.50 $66.38 $318.50 $236.39 $236.39 $245.50 $165.94 $66.38 $318.50 $318.50 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $207.03 $63.21 N/A $184.73 $318.50 $318.50 $318.50 $66.38 $318.50 N/A N/A H74939216730010 SUP HCPCS C1769 H74939216730010 - GUIDEWIRE VASCULAR STR SHORT TAPER .014IN 300CM 8CM ROBUST BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $172.95 $172.95 $172.95 $172.95 $318.50 $318.50 $318.50 $66.38 $318.50 $236.39 $236.39 $245.50 $165.94 $66.38 $318.50 $318.50 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $207.03 $63.21 N/A $184.73 $318.50 $318.50 $318.50 $66.38 $318.50 N/A N/A H74939216730020 SUP HCPCS C1769 H74939216730020 - GUIDEWIRE VASCULAR ANGLE SHORT TAPER .014IN 300CM 8CM ROBUST BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $172.95 $172.95 $172.95 $172.95 $318.50 $318.50 $318.50 $66.38 $318.50 $236.39 $236.39 $245.50 $165.94 $66.38 $318.50 $318.50 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $207.03 $63.21 N/A $184.73 $318.50 $318.50 $318.50 $66.38 $318.50 N/A N/A H74939216918210 SUP HCPCS C1769 H74939216918210 - GUIDEWIRE VASCULAR STR LONG TAPER .014IN 182CM 11CM ROBUST BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $172.95 $172.95 $172.95 $172.95 $318.50 $318.50 $318.50 $66.38 $318.50 $236.39 $236.39 $245.50 $165.94 $66.38 $318.50 $318.50 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $207.03 $63.21 N/A $184.73 $318.50 $318.50 $318.50 $66.38 $318.50 N/A N/A H74939216918220 SUP HCPCS C1769 H74939216918220 - GUIDEWIRE VASCULAR ANGLE LONG TAPER .014IN 182CM 11CM ROBUST BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $172.95 $172.95 $172.95 $172.95 $318.50 $318.50 $318.50 $66.38 $318.50 $236.39 $236.39 $245.50 $165.94 $66.38 $318.50 $318.50 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $207.03 $63.21 N/A $184.73 $318.50 $318.50 $318.50 $66.38 $318.50 N/A N/A H74939216930010 SUP HCPCS C1769 H74939216930010 - GUIDEWIRE VASCULAR STR LONG TAPER .014IN 300CM 11CM ROBUST BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $172.95 $172.95 $172.95 $172.95 $318.50 $318.50 $318.50 $66.38 $318.50 $236.39 $236.39 $245.50 $165.94 $66.38 $318.50 $318.50 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $207.03 $63.21 N/A $184.73 $318.50 $318.50 $318.50 $66.38 $318.50 N/A N/A H74939216930020 SUP HCPCS C1769 H74939216930020 - GUIDEWIRE VASCULAR ANGLE LONG TAPER .014IN 300CM 11CM ROBUST BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $172.95 $172.95 $172.95 $172.95 $318.50 $318.50 $318.50 $66.38 $318.50 $236.39 $236.39 $245.50 $165.94 $66.38 $318.50 $318.50 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $207.03 $63.21 N/A $184.73 $318.50 $318.50 $318.50 $66.38 $318.50 N/A N/A H74939239018091 SUP HCPCS C1887 H74939239018091 - CATHETER SPRT 15MM SPC 4FR 90CM CLR PUR RUBICON 18 RADOPQ BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $798.21 $798.21 $798.21 $798.21 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,091.03" "$1,091.03" "$1,133.08" $765.87 $306.36 "$1,470.00" "$1,470.00" $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $955.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A H74939239018131 SUP HCPCS C1887 H74939239018131 - CATHETER SPRT 15MM SPC 4FR 135CM CLR PUR RUBICON 18 RADOPQ BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $798.21 $798.21 $798.21 $798.21 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,091.03" "$1,091.03" "$1,133.08" $765.87 $306.36 "$1,470.00" "$1,470.00" $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $955.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A H74939239018151 SUP HCPCS C1887 H74939239018151 - CATHETER SPRT 15MM SPC 4FR 150CM CLR PUR RUBICON 18 RADOPQ BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $798.21 $798.21 $798.21 $798.21 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,091.03" "$1,091.03" "$1,133.08" $765.87 $306.36 "$1,470.00" "$1,470.00" $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $955.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A H74939240035061 SUP HCPCS C1887 H74939240035061 - CATHETER SPRT 50MM SPC 5.1FR 65CM CLR PUR RUBICON 35 RADOPQ BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $798.21 $798.21 $798.21 $798.21 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,091.03" "$1,091.03" "$1,133.08" $765.87 $306.36 "$1,470.00" "$1,470.00" $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $955.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A H74939240035091 SUP HCPCS C1887 H74939240035091 - CATHETER SPRT 50MM SPC 5.1FR 90CM CLR PUR RUBICON 35 RADOPQ BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $798.21 $798.21 $798.21 $798.21 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,091.03" "$1,091.03" "$1,133.08" $765.87 $306.36 "$1,470.00" "$1,470.00" $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $955.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A H74939240035131 SUP HCPCS C1887 H74939240035131 - CATHETER SPRT 50MM SPC 5.1FR 135CM CLR PUR RUBICON 35 RADOPQ BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $798.21 $798.21 $798.21 $798.21 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,091.03" "$1,091.03" "$1,133.08" $765.87 $306.36 "$1,470.00" "$1,470.00" $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $955.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A H74939240035151 SUP HCPCS C1887 H74939240035151 - CATHETER SPRT 50MM SPC 5.1FR 150CM CLR PUR RUBICON 35 RADOPQ BOTH IP/OP "$1,470.00" "$1,088.00" $291.76 "$1,470.00" $798.21 $798.21 $798.21 $798.21 "$1,470.00" "$1,470.00" "$1,470.00" $306.38 "$1,470.00" "$1,091.03" "$1,091.03" "$1,133.08" $765.87 $306.36 "$1,470.00" "$1,470.00" $869.51 "$1,470.00" "$1,470.00" "$1,470.00" "$1,470.00" "$1,102.50" "$1,470.00" "$1,470.00" "$1,470.00" $735.00 $735.00 "$1,164.24" "$1,470.00" "$1,176.00" $955.50 $291.76 N/A $852.60 "$1,470.00" "$1,470.00" "$1,470.00" $306.35 "$1,470.00" N/A N/A H74939293051530 SUP HCPCS C1876 H74939293051530 - STENT VASC 5MM 150MM BLU 130CM INNOVA TRIAXIAL DLV SYS BOTH IP/OP "$1,775.00" "$1,314.00" $352.29 "$1,775.00" $798.75 $798.75 $798.75 $798.75 "$1,775.00" "$1,775.00" "$1,775.00" $369.95 "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" $369.93 "$1,775.00" "$1,775.00" "$1,049.91" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,331.25" "$1,775.00" "$1,775.00" "$1,775.00" $887.50 $887.50 "$1,405.80" "$1,775.00" "$1,420.00" $798.75 $352.29 N/A "$1,029.50" "$1,775.00" "$1,775.00" "$1,775.00" $369.91 "$1,775.00" N/A N/A H74939293058030 SUP HCPCS C1876 H74939293058030 - STENT VASC 5MM 80MM BLU 130CM INNOVA TRIAXIAL DLV SYS RADOPQ BOTH IP/OP "$1,525.00" "$1,129.00" $302.67 "$1,525.00" $686.25 $686.25 $686.25 $686.25 "$1,525.00" "$1,525.00" "$1,525.00" $317.85 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" $317.83 "$1,525.00" "$1,525.00" $902.04 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,143.75" "$1,525.00" "$1,525.00" "$1,525.00" $762.50 $762.50 "$1,207.80" "$1,525.00" "$1,220.00" $686.25 $302.67 N/A $884.50 "$1,525.00" "$1,525.00" "$1,525.00" $317.81 "$1,525.00" N/A N/A H74939293061530 SUP HCPCS C1876 H74939293061530 - STENT VASC 6MM 150MM BLU 130CM INNOVA TRIAXIAL DLV SYS BOTH IP/OP "$1,775.00" "$1,314.00" $352.29 "$1,775.00" $798.75 $798.75 $798.75 $798.75 "$1,775.00" "$1,775.00" "$1,775.00" $369.95 "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" $369.93 "$1,775.00" "$1,775.00" "$1,049.91" "$1,775.00" "$1,775.00" "$1,775.00" "$1,775.00" "$1,331.25" "$1,775.00" "$1,775.00" "$1,775.00" $887.50 $887.50 "$1,405.80" "$1,775.00" "$1,420.00" $798.75 $352.29 N/A "$1,029.50" "$1,775.00" "$1,775.00" "$1,775.00" $369.91 "$1,775.00" N/A N/A H74939293066030DUP1 SUP HCPCS C1876 H74939293066030DUP1 - STENT VASC 6MM 60MM BLU 130CM INNOVA TRIAXIAL DLV SYS RADOPQ BOTH IP/OP "$1,525.00" "$1,129.00" $302.67 "$1,525.00" $686.25 $686.25 $686.25 $686.25 "$1,525.00" "$1,525.00" "$1,525.00" $317.85 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" $317.83 "$1,525.00" "$1,525.00" $902.04 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,143.75" "$1,525.00" "$1,525.00" "$1,525.00" $762.50 $762.50 "$1,207.80" "$1,525.00" "$1,220.00" $686.25 $302.67 N/A $884.50 "$1,525.00" "$1,525.00" "$1,525.00" $317.81 "$1,525.00" N/A N/A H74939293071030 SUP HCPCS C1876 H74939293071030 - STENT VASC 7MM 100MM BLU 130CM INNOVA TRIAXIAL DLV SYS BOTH IP/OP "$1,525.00" "$1,129.00" $302.67 "$1,525.00" $686.25 $686.25 $686.25 $686.25 "$1,525.00" "$1,525.00" "$1,525.00" $317.85 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" $317.83 "$1,525.00" "$1,525.00" $902.04 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,143.75" "$1,525.00" "$1,525.00" "$1,525.00" $762.50 $762.50 "$1,207.80" "$1,525.00" "$1,220.00" $686.25 $302.67 N/A $884.50 "$1,525.00" "$1,525.00" "$1,525.00" $317.81 "$1,525.00" N/A N/A H74939293071030 SUP HCPCS C1876 H74939293071030 - STENT VASC 7MM 100MM BLU 130CM INNOVA TRIAXIAL DLV SYS BOTH IP/OP "$1,525.00" "$1,129.00" $302.67 "$1,525.00" $686.25 $686.25 $686.25 $686.25 "$1,525.00" "$1,525.00" "$1,525.00" $317.85 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" $317.83 "$1,525.00" "$1,525.00" $902.04 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,143.75" "$1,525.00" "$1,525.00" "$1,525.00" $762.50 $762.50 "$1,207.80" "$1,525.00" "$1,220.00" $686.25 $302.67 N/A $884.50 "$1,525.00" "$1,525.00" "$1,525.00" $317.81 "$1,525.00" N/A N/A H74939293076030 SUP HCPCS C1876 H74939293076030 - STENT VASC 7MM 60MM BLU 130CM INNOVA TRIAXIAL DLV SYS RADOPQ BOTH IP/OP "$1,525.00" "$1,129.00" $302.67 "$1,525.00" $686.25 $686.25 $686.25 $686.25 "$1,525.00" "$1,525.00" "$1,525.00" $317.85 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" $317.83 "$1,525.00" "$1,525.00" $902.04 "$1,525.00" "$1,525.00" "$1,525.00" "$1,525.00" "$1,143.75" "$1,525.00" "$1,525.00" "$1,525.00" $762.50 $762.50 "$1,207.80" "$1,525.00" "$1,220.00" $686.25 $302.67 N/A $884.50 "$1,525.00" "$1,525.00" "$1,525.00" $317.81 "$1,525.00" N/A N/A H74939294601210 SUP HCPCS C1874 H74939294601210 - STENT VASC 6MM 120MM 130CM ELUVIA DRG ELUTE DLV SYS BOTH IP/OP "$7,237.50" "$5,356.00" "$1,436.46" "$7,237.50" "$3,256.88" "$3,256.88" "$3,256.88" "$3,256.88" "$7,237.50" "$7,237.50" "$7,237.50" "$1,508.48" "$7,237.50" "$7,237.50" "$7,237.50" "$7,237.50" "$7,237.50" "$1,508.37" "$7,237.50" "$7,237.50" "$3,568.09" "$7,237.50" "$7,237.50" "$7,237.50" "$7,237.50" "$5,428.13" "$7,237.50" "$7,237.50" "$7,237.50" "$3,618.75" "$3,618.75" "$5,732.10" "$7,237.50" "$5,790.00" "$3,256.88" "$1,436.46" N/A "$4,197.75" "$7,237.50" "$7,237.50" "$7,237.50" "$1,508.30" "$7,237.50" N/A N/A H7493952808400 SUP HCPCS C1874 H7493952808400 - SYSTEM COR STNT 4MM 8MM 144CM PROMUS PRMR MNRL RADOPQ 1 ACC BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A H7493952812400 SUP HCPCS C1874 H7493952812400 - SYSTEM COR STNT 4MM 12MM 144CM PROMUS PRMR MNRL RADOPQ 1 ACC BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A H7493952816400 SUP HCPCS C1874 H7493952816400 - SYSTEM COR STNT 4MM 16MM 144CM PROMUS PRMR MNRL RADOPQ 1 ACC BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A H7493952820400 SUP HCPCS C1874 H7493952820400 - SYSTEM COR STNT 4MM 20MM 144CM PROMUS PRMR MNRL RADOPQ 1 ACC BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A H7493952824400 SUP HCPCS C1874 H7493952824400 - SYSTEM COR STNT 4MM 24MM 144CM PROMUS PRMR MNRL RADOPQ 1 ACC BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A H7493952828400 SUP HCPCS C1874 H7493952828400 - SYSTEM COR STNT 4MM 28MM 144CM PROMUS PRMR MNRL RADOPQ 1 ACC BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A H7493952832400 SUP HCPCS C1874 H7493952832400 - SYSTEM COR STNT 4MM 32MM 144CM PROMUS PRMR MNRL RADOPQ 1 ACC BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A H7493952838400 SUP HCPCS C1874 H7493952838400 - SYSTEM COR STNT 4MM 38MM 144CM PROMUS PRMR MNRL RADOPQ 1 ACC BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A H749CBO3200100 SUP HCPCS C1726 H749CBO3200100 - CATHETER BLNDIL 2MM 137CM 10MM F CBLN OTW INFL PORT GW PORT BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" "$1,086.00" "$1,086.00" "$1,086.00" "$1,086.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$1,484.40" "$1,484.40" "$1,541.60" "$1,042.00" $416.82 "$2,000.00" "$2,000.00" "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" "$1,300.00" $396.95 N/A "$1,160.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A H749CBO3200150 SUP HCPCS C1726 H749CBO3200150 - CATHETER BLNDIL 2MM 137CM 15MM F CBLN OTW INFL PORT GW PORT BOTH IP/OP "$1,715.00" "$1,269.00" $340.38 "$1,715.00" $931.25 $931.25 $931.25 $931.25 "$1,715.00" "$1,715.00" "$1,715.00" $357.45 "$1,715.00" "$1,272.87" "$1,272.87" "$1,321.92" $893.52 $357.42 "$1,715.00" "$1,715.00" "$1,014.42" "$1,715.00" "$1,715.00" "$1,715.00" "$1,715.00" "$1,286.25" "$1,715.00" "$1,715.00" "$1,715.00" $857.50 $857.50 "$1,358.28" "$1,715.00" "$1,372.00" "$1,114.75" $340.38 N/A $994.70 "$1,715.00" "$1,715.00" "$1,715.00" $357.41 "$1,715.00" N/A N/A H749CBO3250100 SUP HCPCS C1726 H749CBO3250100 - CATHETER BLNDIL 2.5MM 137CM 10MM F CBLN OTW INFL PORT GW BOTH IP/OP "$1,715.00" "$1,269.00" $340.38 "$1,715.00" $931.25 $931.25 $931.25 $931.25 "$1,715.00" "$1,715.00" "$1,715.00" $357.45 "$1,715.00" "$1,272.87" "$1,272.87" "$1,321.92" $893.52 $357.42 "$1,715.00" "$1,715.00" "$1,014.42" "$1,715.00" "$1,715.00" "$1,715.00" "$1,715.00" "$1,286.25" "$1,715.00" "$1,715.00" "$1,715.00" $857.50 $857.50 "$1,358.28" "$1,715.00" "$1,372.00" "$1,114.75" $340.38 N/A $994.70 "$1,715.00" "$1,715.00" "$1,715.00" $357.41 "$1,715.00" N/A N/A H749CBO3250150 SUP HCPCS C1726 H749CBO3250150 - CATHETER BLNDIL 2.5MM 137CM 15MM F CBLN OTW INFL PORT GW BOTH IP/OP "$1,715.00" "$1,269.00" $340.38 "$1,715.00" $931.25 $931.25 $931.25 $931.25 "$1,715.00" "$1,715.00" "$1,715.00" $357.45 "$1,715.00" "$1,272.87" "$1,272.87" "$1,321.92" $893.52 $357.42 "$1,715.00" "$1,715.00" "$1,014.42" "$1,715.00" "$1,715.00" "$1,715.00" "$1,715.00" "$1,286.25" "$1,715.00" "$1,715.00" "$1,715.00" $857.50 $857.50 "$1,358.28" "$1,715.00" "$1,372.00" "$1,114.75" $340.38 N/A $994.70 "$1,715.00" "$1,715.00" "$1,715.00" $357.41 "$1,715.00" N/A N/A H787107140145 SUP HCPCS C1713 H787107140145 - CATHETER ANGIO ANG KMP CRV 4FR 65CM SFVU RADOPQ SLCT HTORQ BOTH IP/OP $35.00 $26.00 $6.95 $35.00 $15.75 $15.75 $15.75 $15.75 $35.00 $35.00 $35.00 $7.29 $35.00 $35.00 $35.00 $35.00 $35.00 $7.29 $35.00 $35.00 $20.70 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $15.75 $6.95 N/A $20.30 $35.00 $21.00 $35.00 $7.29 $35.00 N/A N/A H787107322055 SUP HCPCS C1887 H787107322055 - CATHETER ANGIO OM CRV 5FR 100CM SFVU RADOPQ FLSH HTORQ SHFT BOTH IP/OP $35.00 $26.00 $6.95 $35.00 $19.01 $19.01 $19.01 $19.01 $35.00 $35.00 $35.00 $7.29 $35.00 $25.98 $25.98 $26.98 $18.24 $7.29 $35.00 $35.00 $20.70 $35.00 $35.00 $35.00 $35.00 $26.25 $35.00 $35.00 $35.00 $17.50 $17.50 $27.72 $35.00 $28.00 $22.75 $6.95 N/A $20.30 $35.00 $35.00 $35.00 $7.29 $35.00 N/A N/A H965100510 SUP HCPCS C1887 H965100510 - CATHETER GD STRG 7FR 90CM STRL GDR SFTP XF 2X2 RND BRD X BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $271.50 $271.50 $271.50 $271.50 $500.00 $500.00 $500.00 $104.21 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A H965251850 SUP Custom 27203010 H965251850 - CANNULA PRFSN ANGIOVAC DIL FNL TIP RADOPQ COIL REINF DISP BOTH IP/OP "$28,750.00" "$21,275.00" "$2,060.15" "$28,750.00" "$28,750.00" "$28,750.00" "$28,750.00" "$28,750.00" "$28,750.00" "$28,750.00" "$5,117.50" "$28,750.00" "$28,750.00" "$4,181.12" "$4,181.12" "$22,160.50" "$2,060.15" "$5,991.82" "$28,750.00" "$11,500.00" "$28,750.00" "$28,750.00" "$28,750.00" "$28,750.00" "$28,750.00" "$21,562.50" "$28,750.00" "$28,750.00" "$28,750.00" "$14,375.00" "$14,375.00" "$22,770.00" "$28,750.00" "$23,000.00" "$18,687.50" "$28,750.00" N/A "$16,675.00" "$28,750.00" "$17,250.00" "$28,750.00" "$28,750.00" "$28,750.00" N/A N/A H965251860 SUP Custom 27203010 H965251860 - CANNULA PRFSN 20D ANGIOVAC DIL FNL TIP RADOPQ COIL REINF BOTH IP/OP "$28,750.00" "$21,275.00" "$2,060.15" "$28,750.00" "$28,750.00" "$28,750.00" "$28,750.00" "$28,750.00" "$28,750.00" "$28,750.00" "$5,117.50" "$28,750.00" "$28,750.00" "$4,181.12" "$4,181.12" "$22,160.50" "$2,060.15" "$5,991.82" "$28,750.00" "$11,500.00" "$28,750.00" "$28,750.00" "$28,750.00" "$28,750.00" "$28,750.00" "$21,562.50" "$28,750.00" "$28,750.00" "$28,750.00" "$14,375.00" "$14,375.00" "$22,770.00" "$28,750.00" "$23,000.00" "$18,687.50" "$28,750.00" N/A "$16,675.00" "$28,750.00" "$17,250.00" "$28,750.00" "$28,750.00" "$28,750.00" N/A N/A H965251870 SUP Custom 27203010 H965251870 - SYSTEM PRFSN ANGIOVAC CRCT PMP HD BBL TRP BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$2,783.25" "$2,783.25" "$2,890.50" "$1,953.75" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$2,437.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A H965251880 SUP Custom 27203010 H965251880 - SYSTEM PRFSN ANGIOVAC CRCT BBL TRP BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$2,783.25" "$2,783.25" "$2,890.50" "$1,953.75" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$2,437.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A H965251900 SUP Custom 27203010 H965251900 - CANNULA PRFSN ANGIOVAC STRG DIL CRCT BBL TRP COIL REINF DISP BOTH IP/OP "$32,500.00" "$24,050.00" "$2,060.15" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$5,785.00" "$32,500.00" "$32,500.00" "$4,181.12" "$4,181.12" "$25,051.00" "$2,060.15" "$6,773.36" "$32,500.00" "$13,000.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$24,375.00" "$32,500.00" "$32,500.00" "$32,500.00" "$16,250.00" "$16,250.00" "$25,740.00" "$32,500.00" "$26,000.00" "$21,125.00" "$32,500.00" N/A "$18,850.00" "$32,500.00" "$19,500.00" "$32,500.00" "$32,500.00" "$32,500.00" N/A N/A H965251910 SUP Custom 27203010 H965251910 - CANNULA PRFSN 20D ANGIOVAC DIL CRCT PMP HD BBL TRP DISP BOTH IP/OP "$32,500.00" "$24,050.00" "$2,060.15" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$5,785.00" "$32,500.00" "$32,500.00" "$4,181.12" "$4,181.12" "$25,051.00" "$2,060.15" "$6,773.36" "$32,500.00" "$13,000.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$32,500.00" "$24,375.00" "$32,500.00" "$32,500.00" "$32,500.00" "$16,250.00" "$16,250.00" "$25,740.00" "$32,500.00" "$26,000.00" "$21,125.00" "$32,500.00" N/A "$18,850.00" "$32,500.00" "$19,500.00" "$32,500.00" "$32,500.00" "$32,500.00" N/A N/A H965251990 SUP Custom 27203010 H965251990 - SYSTEM PRFSN ANGIOVAC CRCT BOTH IP/OP "$3,750.00" "$2,775.00" $667.50 "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" $667.50 "$3,750.00" "$3,750.00" "$2,783.25" "$2,783.25" "$2,890.50" "$1,953.75" $781.54 "$3,750.00" "$1,500.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$3,750.00" "$2,812.50" "$3,750.00" "$3,750.00" "$3,750.00" "$1,875.00" "$1,875.00" "$2,970.00" "$3,750.00" "$3,000.00" "$2,437.50" "$3,750.00" N/A "$2,175.00" "$3,750.00" "$2,250.00" "$3,750.00" "$3,750.00" "$3,750.00" N/A N/A H965402100 SUP HCPCS C1877 H965402100 - STENT ENDOPRSTH 100CM 12MM 20MM 75CM UNCONSTRAIN FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965402110 SUP HCPCS C1877 H965402110 - STENT ENDOPRSTH 12MM 8FR 40MM 100CM FLEXIBLE RECONSTRAINABLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965402120 SUP HCPCS C2617 H965402120 - STENT ENDOPRSTH 100CM 12MM 8FR 60MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965402130 SUP HCPCS C2617 H965402130 - STENT ENDOPRSTH 100CM 12MM 8FR 90MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965403100 SUP HCPCS C1877 H965403100 - STENT ENDOPRSTH 100CM 14MM 20MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965403110 SUP HCPCS C1877 H965403110 - STENT ENDOPRSTH 100CM 14MM 40MM 75CM UNCONSTRAIN FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965403120 SUP HCPCS C1877 H965403120 - STENT ENDOPRSTH 100CM 14MM 9FR 60MM 75CM CATHETER BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965403130 SUP HCPCS C1877 H965403130 - STENT ENDOPRSTH 100CM 14MM 9FR 90MM 75CM CATHETER BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965403300 SUP HCPCS C1877 H965403300 - STENT ENDOPRSTH 160CM 16MM 9FR 20MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965403310 SUP HCPCS C1877 H965403310 - STENT ENDOPRSTH 100CM 16MM 9FR 40MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965403320 SUP HCPCS C1877 H965403320 - STENT ENDOPRSTH 100CM 16MM 9FR 60MM 75CM CATHETER BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965403330 SUP HCPCS C2617 H965403330 - STENT ENDOPRSTH 100CM 16MM 9FR 90MM 75CM CATHETER BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965404110 SUP HCPCS C1877 H965404110 - STENT ENDOPRSTH 100CM 18MM 10FR 40MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965404120 SUP HCPCS C1877 H965404120 - STENT ENDOPRSTH 100CM 18MM 10FR 60MM 75CM CATHETER BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965404130 SUP HCPCS C1877 H965404130 - STENT ENDOPRSTH 100CM 18MM 10FR 90MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965404300 SUP HCPCS C1877 H965404300 - STENT ENDOPRSTH 100CM 20MM 10FR 40MM 75CM CATHETER BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965404310 SUP HCPCS C1877 H965404310 - STENT ENDOPRSTH 100CM 20MM 10FR 55MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965404320 SUP HCPCS C1877 H965404320 - STENT ENDOPRSTH 100CM 20MM 10FR 80MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965404500 SUP HCPCS C1877 H965404500 - STENT ENDOPRSTH 100CM 22MM 10FR 35MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965404510 SUP HCPCS C1877 H965404510 - STENT ENDOPRSTH 100CM 22MM 10FR 45MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965404520 SUP HCPCS C1877 H965404520 - STENT ENDOPRSTH 100CM 22MM 10FR 70MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965405100 SUP HCPCS C1877 H965405100 - STENT ENDOPRSTH 100CM 24MM 11FR 35MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965405110 SUP HCPCS C1877 H965405110 - STENT ENDOPRSTH 100CM 24MM 12FR 45MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965405120 SUP HCPCS C1877 H965405120 - STENT ENDOPRSTH 100CM 24MM 11FR 70MM 75CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965412000 SUP HCPCS C1877 H965412000 - STENT ENDOPRSTH 160CM 12MM 9FR 20MM 135CM FLEXIBLE DELIVERY BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965412010 SUP HCPCS C1877 H965412010 - STENT ENDOPRSTH 160CM 12MM 8FR 40MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965412020 SUP HCPCS C1877 H965412020 - STENT ENDOPRSTH 160CM 12MM 8FR 60MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965412030 SUP HCPCS C1877 H965412030 - STENT ENDOPRSTH 160CM 12MM 8FR 90MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A H965700150021 SUP Custom 27203010 H965700150021 - STOPCOCK ANGIO 200 PSI NAMIC 3W ROT M COLR RT PORT PRTC BOTH IP/OP $2.50 $2.00 $0.41 $2.32 $2.32 $2.32 $2.32 $2.32 $2.32 $2.32 $0.41 $2.32 $2.32 $1.72 $1.72 $1.79 $1.21 $0.48 $2.32 $0.93 $2.32 $2.32 $2.32 $2.32 $2.32 $1.88 $2.32 $2.32 $2.32 $1.16 $1.16 $1.84 $2.32 $1.86 $1.51 $2.32 N/A $1.45 $2.32 $1.39 $2.32 $2.32 $2.32 N/A N/A H965700150151 SUP Custom 27203010 H965700150151 - STOPCOCK ANGIO 200 PSI NAMIC 1 WY ROT M COLR PORT PRTC BOTH IP/OP $2.50 $2.00 $0.38 $2.16 $2.16 $2.16 $2.16 $2.16 $2.16 $2.16 $0.38 $2.16 $2.16 $1.60 $1.60 $1.66 $1.13 $0.45 $2.16 $0.86 $2.16 $2.16 $2.16 $2.16 $2.16 $1.88 $2.16 $2.16 $2.16 $1.08 $1.08 $1.71 $2.16 $1.73 $1.40 $2.16 N/A $1.45 $2.16 $1.30 $2.16 $2.16 $2.16 N/A N/A H965914000211 SUP Custom 27203010 H965914000211 - ADAPTER ANGIO 200 PSI 5/16IN 28 THRD ORG Y .1IN STRL NAMIC BOTH IP/OP $16.50 $12.00 $2.86 $16.05 $16.05 $16.05 $16.05 $16.05 $16.05 $16.05 $2.86 $16.05 $16.05 $11.91 $11.91 $12.37 $8.36 $3.34 $16.05 $6.42 $16.05 $16.05 $16.05 $16.05 $16.05 $12.38 $16.05 $16.05 $16.05 $8.03 $8.03 $12.71 $16.05 $12.84 $10.43 $16.05 N/A $9.57 $16.05 $9.63 $16.05 $16.05 $16.05 N/A N/A H965SCH306011 SUP HCPCS C1769 H965SCH306011 - GUIDEWIRE VASCULAR C .035IN 300CM 10CM FLEXIBLE MEIER WIRE BOTH IP/OP $391.50 $290.00 $77.63 $391.15 $212.39 $212.39 $212.39 $212.39 $391.15 $391.15 $391.15 $81.53 $391.15 $290.31 $290.31 $301.50 $203.79 $81.52 $391.15 $391.15 $231.37 $391.15 $391.15 $391.15 $391.15 $293.63 $391.15 $391.15 $391.15 $195.58 $195.58 $309.79 $391.15 $312.92 $254.25 $77.63 N/A $227.07 $391.15 $391.15 $391.15 $81.52 $391.15 N/A N/A HARH45 SUP Custom 27203010 HARH45 - SHEARS ESURG CRV 5MM 45CM STRL HRMN A +7 ADV HMSTS 3 HNDCNTL BOTH IP/OP "$2,852.00" "$2,110.00" $507.65 "$2,851.98" "$2,851.98" "$2,851.98" "$2,851.98" "$2,851.98" "$2,851.98" "$2,851.98" $507.65 "$2,851.98" "$2,851.98" "$2,116.74" "$2,116.74" "$2,198.31" "$1,485.88" $594.38 "$2,851.98" "$1,228.54" "$2,851.98" "$2,851.98" "$2,851.98" "$2,851.98" "$2,851.98" "$2,139.00" "$2,851.98" "$2,851.98" "$2,851.98" "$1,425.99" "$1,425.99" "$2,258.77" "$2,851.98" "$2,281.58" "$1,853.79" "$2,851.98" N/A "$1,654.16" "$2,851.98" "$1,711.19" "$2,851.98" "$2,851.98" "$2,851.98" N/A N/A HCA-5125 SUP HCPCS C1713 HCA-5125 - SCREW BONE 5MM 25MM NONLOCKING POLARUS TITANIUM CANCELLOUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCA-5127 SUP HCPCS C1713 HCA-5127 - SCREW BONE 5MM 27.5MM NONLOCKING POLARUS CANCELLOUS HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCA-5130 SUP HCPCS C1713 HCA-5130 - SCREW BONE 5MM 30MM NONLOCKING POLARUS TITANIUM CANCELLOUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCA-5132 SUP HCPCS C1713 HCA-5132 - SCREW BONE 5MM 32.5MM NONLOCKING POLARUS TITANIUM CANCELLOUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCA-5135 SUP HCPCS C1713 HCA-5135 - SCREW BN 5MM 35MM NLCKG ORTH BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCA-5137 SUP HCPCS C1713 HCA-5137 - SCREW BONE 5MM 37.5MM NONLOCKING POLARUS TITANIUM CANCELLOUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCA-5140 SUP HCPCS C1713 HCA-5140 - SCREW BN 5MM 40MM CANC BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCA-5145 SUP HCPCS C1713 HCA-5145 - SCREW BONE 5MM 45MM POLARUS TITANIUM SHOULDER HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCA-5150 SUP HCPCS C1713 HCA-5150 - SCREW BONE 5MM 50MM POLARUS TITANIUM SHOULDER HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCA-5155 SUP HCPCS C1713 HCA-5155 - SCREW BN 5MM 55MM CANC BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCA5200-S SUP HCPCS C1713 HCA5200-S - SCREW BONE 5MM 20MM NONLOCKING POLARUS TITANIUM CANCELLOUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCA5250-S SUP HCPCS C1713 HCA5250-S - SCREW BONE 5MM 25MM POLARUS TITANIUM SHOULDER HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCA5275-S SUP HCPCS C1713 HCA5275-S - SCREW BONE 5MM 27.5MM NONLOCKING POLARUS CANCELLOUS HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCA5300-S SUP HCPCS C1713 HCA5300-S - SCREW BONE 5MM 30MM POLARUS TITANIUM SHOULDER HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCA5325-S SUP HCPCS C1713 HCA5325-S - SCREW BONE 5MM 32.5MM NONLOCKING POLARUS CANCELLOUS HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCA5350-S SUP HCPCS C1713 HCA5350-S - SCREW BONE 5MM 35MM POLARUS TITANIUM SHOULDER HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCA5375-S SUP HCPCS C1713 HCA5375-S - SCREW BONE 5MM 37.5MM POLARUS TITANIUM SHOULDER HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCA5400-S SUP HCPCS C1713 HCA5400-S - SCREW BONE 5MM 40MM POLARUS TITANIUM SHOULDER HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCA5425-S SUP HCPCS C1713 HCA5425-S - SCREW BONE 5MM 42.5MM NONLOCKING POLARUS CANCELLOUS HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCA5450-S SUP HCPCS C1713 HCA5450-S - SCREW BONE 5MM 45MM POLARUS TITANIUM SHOULDER HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCA5500-S SUP HCPCS C1713 HCA5500-S - SCREW BONE 5MM 50MM POLARUS TITANIUM SHOULDER HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCA5550-S SUP HCPCS C1713 HCA5550-S - SCREW BONE 5MM 55MM POLARUS TITANIUM SHOULDER HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCA-L5325-S SUP HCPCS C1713 HCA-L5325-S - SCREW BN 5.3MM 25MM STRL PLRS LCK TI CANC HUM BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCA-L5330-S SUP HCPCS C1713 HCA-L5330-S - SCREW BONE 5.3MM 30MM PLRS TI ORTH LCK STRL BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCA-L5335-S SUP HCPCS C1713 HCA-L5335-S - SCREW BONE 5.3MM 35MM TI CANC LCK STRL BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCA-L5340-S SUP HCPCS C1713 HCA-L5340-S - SCREW BONE 5.3MM 40MM PLRS TI ORTH LCK STRL BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCA-L5345-S SUP HCPCS C1713 HCA-L5345-S - SCREW BN 5.3MM 45MM STRL LCK TI CANC BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCLP-27100-TS SUP HCPCS C1713 HCLP-27100-TS - PEG FX 2.7MM 10MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A HCLP-27120-TS SUP HCPCS C1713 HCLP-27120-TS - PEG FX 2.7MM 12MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A HCLP-27140-TS SUP HCPCS C1713 HCLP-27140-TS - PEG FX 2.7MM 14MM NS GEMINUS HI CMPR LCK TI RDS DIST VOLR BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A HCLP-27160-TS SUP HCPCS C1713 HCLP-27160-TS - PEG FIX 2.7MM 16MM HIGH COMPRESSION LOCKING GEMINUS TITANIUM BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $217.50 $146.40 $247.50 $217.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A HCLP-27180-TS SUP HCPCS C1713 HCLP-27180-TS - PEG FX 2.7MM 18MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $217.50 $217.50 N/A N/A HCLP-27190-TS SUP HCPCS C1713 HCLP-27190-TS - PEG FX 2.7MM 19MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A HCLP-27200-TS SUP HCPCS C1713 HCLP-27200-TS - PEG FIX 2.7MM 20MM HIGH COMPRESSION LOCKING GEMINUS TITANIUM BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $87.00 $146.40 $247.50 $217.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A HCLP-27210-TS SUP HCPCS C1713 HCLP-27210-TS - PEG FX 2.7MM 21MM NS GEMINUS HI CMPR LCK TI RDS DIST VOLR BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $217.50 $217.50 $217.50 $217.50 N/A N/A HCLP-27220-TS SUP HCPCS C1713 HCLP-27220-TS - PEG FX 2.7MM 22MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $217.50 $217.50 N/A N/A HCLP-27230-TS SUP HCPCS C1713 HCLP-27230-TS - PEG FX 2.7MM 23MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A HCLP-27240-TS SUP HCPCS C1713 HCLP-27240-TS - PEG FX 2.7MM 24MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A HCLP-27260-TS SUP HCPCS C1713 HCLP-27260-TS - PEG FX 2.7MM 26MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A HCLP-27280-TS SUP HCPCS C1713 HCLP-27280-TS - PEG FX 2.7MM 28MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $217.50 $217.50 $45.33 $217.50 N/A N/A HCLP-27300-TS SUP HCPCS C1713 HCLP-27300-TS - PEG FX 2.7MM 30MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A HCLP-27320-TS SUP HCPCS C1713 HCLP-27320-TS - PEG FX 2.7MM 32MM NS GEMINUS HI CMPR LCK TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A HCO-3150-S SUP HCPCS C1713 HCO-3150-S - SCREW BONE 3.5MM 15MM CORTICAL BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $380.00 $380.00 N/A N/A HCO3175-S SUP HCPCS C1713 HCO3175-S - SCREW BONE 3.5MM 17.5MM INTERLOCK POLARUS TITANIUM SHOULDER BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCO3200-S SUP HCPCS C1713 HCO3200-S - SCREW BONE 3.5MM 20MM INTERLOCK POLARUS TITANIUM SHOULDER BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCO3225-S SUP HCPCS C1713 HCO3225-S - SCREW BN 3.5MM 22.5MM STRL CORT BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCO3250-S SUP HCPCS C1713 HCO3250-S - SCREW BONE 3.5MM 25MM INTERLOCK POLARUS TITANIUM SHOULDER BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCO3275-S SUP HCPCS C1713 HCO3275-S - SCREW BONE 3.5MM 27.5MM INTERLOCK POLARUS TITANIUM SHOULDER BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCO3300-S SUP HCPCS C1713 HCO3300-S - SCREW BONE 3.5MM 30MM INTERLOCK POLARUS TITANIUM SHOULDER BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCO3325-S SUP HCPCS C1713 HCO3325-S - SCREW BONE 3.5MM 32.5MM INTERLOCK POLARUS TITANIUM SHOULDER BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCO3350-S SUP HCPCS C1713 HCO3350-S - SCREW BONE 3.5MM 35MM INTERLOCK POLARUS TITANIUM SHOULDER BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $228.00 $380.00 $79.19 $380.00 N/A N/A HCO3375-S SUP HCPCS C1713 HCO3375-S - SCREW BONE 3.5MM 37.5MM POLARUS SHOULDER HUMERUS CORTICAL BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCO3400-S SUP HCPCS C1713 HCO3400-S - SCREW BONE 3.5MM 40MM POLARUS TITANIUM SHOULDER HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCO3450-S SUP HCPCS C1713 HCO3450-S - SCREW BONE 3.5MM 45MM INTERLOCK POLARUS TITANIUM SHOULDER BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCO3500-S SUP HCPCS C1713 HCO3500-S - SCREW BONE 3.5MM 50MM POLARUS TITANIUM SHOULDER HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCO3550-S SUP HCPCS C1713 HCO3550-S - SCREW BONE 3.5MM 55MM POLARUS TITANIUM SHOULDER HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HCO35WA SUP Custom 27803010 HCO35WA - WASHER ORTH 3.5MM NS PLRS TI CORT SCR BOTH IP/OP $92.50 $68.00 $16.47 $92.50 $92.50 $92.50 $92.50 $92.50 $92.50 $92.50 $16.47 $92.50 $92.50 $92.50 $92.50 $92.50 $92.50 $19.28 $92.50 $37.00 $92.50 $92.50 $92.50 $92.50 $92.50 $69.38 $92.50 $92.50 $92.50 $46.25 $46.25 $73.26 $92.50 $74.00 $41.63 $92.50 N/A $53.65 $92.50 $55.50 $92.50 $92.50 $92.50 N/A N/A HCO3600-S SUP HCPCS C1713 HCO3600-S - SCREW BONE 3.5MM 60MM POLARUS TITANIUM SHOULDER HUMERUS BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $152.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HD-1500 SUP Custom 27203010 HD-1500 - DRIVER SURG 1.5MM HEXAGONAL SOLID BOTH IP/OP $302.00 $223.00 $53.73 $301.88 $301.88 $301.88 $301.88 $301.88 $301.88 $301.88 $53.73 $301.88 $301.88 $224.06 $224.06 $232.69 $157.28 $62.92 $301.88 $120.75 $301.88 $301.88 $301.88 $301.88 $301.88 $226.50 $301.88 $301.88 $301.88 $150.94 $150.94 $239.09 $301.88 $241.50 $196.22 $301.88 N/A $175.16 $301.88 $181.13 $301.88 $301.88 $301.88 N/A N/A HD-1509 SUP Custom 27203010 HD-1509 - DRIVER CANN HEX ASMBLY 1.5MM SURG BOTH IP/OP $682.50 $505.00 $121.49 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $121.49 $682.50 $682.50 $506.55 $506.55 $526.07 $355.58 $142.24 $682.50 $273.00 $682.50 $682.50 $682.50 $682.50 $682.50 $511.88 $682.50 $682.50 $682.50 $341.25 $341.25 $540.54 $682.50 $546.00 $443.63 $682.50 N/A $395.85 $682.50 $409.50 $682.50 $682.50 $682.50 N/A N/A HD-2000 SUP Custom 27203010 HD-2000 - DRIVER SURG HEXAGON 2MM SOLID ASMBLY ACUTRAK BOTH IP/OP $682.50 $505.00 $121.49 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $121.49 $682.50 $682.50 $506.55 $506.55 $526.07 $355.58 $142.24 $682.50 $273.00 $682.50 $682.50 $682.50 $682.50 $682.50 $511.88 $682.50 $682.50 $682.50 $341.25 $341.25 $540.54 $682.50 $546.00 $443.63 $682.50 N/A $395.85 $682.50 $409.50 $682.50 $682.50 $682.50 N/A N/A HD-2011 SUP Custom 27203010 HD-2011 - DRIVER SRG 2MM HEX CNN BOTH IP/OP $682.50 $505.00 $121.49 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $121.49 $682.50 $682.50 $506.55 $506.55 $526.07 $355.58 $142.24 $682.50 $273.00 $682.50 $682.50 $682.50 $682.50 $682.50 $511.88 $682.50 $682.50 $682.50 $341.25 $341.25 $540.54 $682.50 $546.00 $443.63 $682.50 N/A $395.85 $682.50 $409.50 $682.50 $682.50 $682.50 N/A N/A HD-2500 SUP Custom 27203010 HD-2500 - DRIVER SURG HEXAGON 2.5MM SOLID ASMBLY ACUTRAK BOTH IP/OP $682.50 $505.00 $121.49 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $121.49 $682.50 $682.50 $506.55 $506.55 $526.07 $355.58 $142.24 $682.50 $273.00 $682.50 $682.50 $682.50 $682.50 $682.50 $511.88 $682.50 $682.50 $682.50 $341.25 $341.25 $540.54 $682.50 $546.00 $443.63 $682.50 N/A $395.85 $682.50 $409.50 $682.50 $682.50 $682.50 N/A N/A HD-2515 SUP Custom 27203010 HD-2515 - DRIVER SURG HEXAGON 2.5MM CANN ACUTRAK BOTH IP/OP $682.50 $505.00 $121.49 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $121.49 $682.50 $682.50 $506.55 $506.55 $526.07 $355.58 $142.24 $682.50 $273.00 $682.50 $682.50 $682.50 $682.50 $682.50 $511.88 $682.50 $682.50 $682.50 $341.25 $341.25 $540.54 $682.50 $546.00 $443.63 $682.50 N/A $395.85 $682.50 $409.50 $682.50 $682.50 $682.50 N/A N/A HD-2516 SUP Custom 27203010 HD-2516 - DRIVER SURG HEXAGON 2.5MM CANN ASMBLY ACUTRAK BOTH IP/OP $682.50 $505.00 $121.49 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $121.49 $682.50 $682.50 $506.55 $506.55 $526.07 $355.58 $142.24 $682.50 $273.00 $682.50 $682.50 $682.50 $682.50 $682.50 $511.88 $682.50 $682.50 $682.50 $341.25 $341.25 $540.54 $682.50 $546.00 $443.63 $682.50 N/A $395.85 $682.50 $409.50 $682.50 $682.50 $682.50 N/A N/A HD-3016 SUP Custom 27203010 HD-3016 - DRIVER SURG 3MM CANN ASMBLY ACUTRAK BOTH IP/OP $682.50 $505.00 $121.49 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $121.49 $682.50 $682.50 $506.55 $506.55 $526.07 $355.58 $142.24 $682.50 $273.00 $682.50 $682.50 $682.50 $682.50 $682.50 $511.88 $682.50 $682.50 $682.50 $341.25 $341.25 $540.54 $682.50 $546.00 $443.63 $682.50 N/A $395.85 $682.50 $409.50 $682.50 $682.50 $682.50 N/A N/A HD-3500 SUP Custom 27203010 HD-3500 - DRIVER SURG HEXAGON 3.5MM SOLID POLARUS BOTH IP/OP $682.50 $505.00 $121.49 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $121.49 $682.50 $682.50 $506.55 $506.55 $526.07 $355.58 $142.24 $682.50 $273.00 $682.50 $682.50 $682.50 $682.50 $682.50 $511.88 $682.50 $682.50 $682.50 $341.25 $341.25 $540.54 $682.50 $546.00 $443.63 $682.50 N/A $395.85 $682.50 $409.50 $682.50 $682.50 $682.50 N/A N/A HD-3725 SUP Custom 27203010 HD-3725 - DRIVER SURG 3MM CANN HUDSON FITTING POLARUS NONSTRL BOTH IP/OP $682.50 $505.00 $121.49 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $121.49 $682.50 $682.50 $506.55 $506.55 $526.07 $355.58 $142.24 $682.50 $273.00 $682.50 $682.50 $682.50 $682.50 $682.50 $511.88 $682.50 $682.50 $682.50 $341.25 $341.25 $540.54 $682.50 $546.00 $443.63 $682.50 N/A $395.85 $682.50 $409.50 $682.50 $682.50 $682.50 N/A N/A HDF-1500 SUP Custom 27203010 HDF-1500 - DRIVER SURG HEXAGON 1.5MM SOLID ACUTRAK MINI SCREW BOTH IP/OP $682.50 $505.00 $121.49 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $121.49 $682.50 $682.50 $506.55 $506.55 $526.07 $355.58 $142.24 $682.50 $273.00 $682.50 $682.50 $682.50 $682.50 $682.50 $511.88 $682.50 $682.50 $682.50 $341.25 $341.25 $540.54 $682.50 $546.00 $443.63 $682.50 N/A $395.85 $682.50 $409.50 $682.50 $682.50 $682.50 N/A N/A HDL-2000 SUP Custom 27203010 HDL-2000 - SCREWDRIVER SRG 2MM SLD BOTH IP/OP $682.50 $505.00 $121.49 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $121.49 $682.50 $682.50 $506.55 $506.55 $526.07 $355.58 $142.24 $682.50 $273.00 $682.50 $682.50 $682.50 $682.50 $682.50 $511.88 $682.50 $682.50 $682.50 $341.25 $341.25 $540.54 $682.50 $546.00 $443.63 $682.50 N/A $395.85 $682.50 $409.50 $682.50 $682.50 $682.50 N/A N/A HDL-2500 SUP Custom 27203010 HDL-2500 - DRIVER SURG HEXAGON 2.5MM SOLID BOTH IP/OP $682.50 $505.00 $121.49 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $121.49 $682.50 $682.50 $506.55 $506.55 $526.07 $355.58 $142.24 $682.50 $273.00 $682.50 $682.50 $682.50 $682.50 $682.50 $511.88 $682.50 $682.50 $682.50 $341.25 $341.25 $540.54 $682.50 $546.00 $443.63 $682.50 N/A $395.85 $682.50 $409.50 $682.50 $682.50 $682.50 N/A N/A HDM-1500 SUP Custom 27203010 HDM-1500 - DRIVER SURG HEXAGON 1.5MM SOLID ACUTRAK BOTH IP/OP $682.50 $505.00 $121.49 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $682.50 $121.49 $682.50 $682.50 $506.55 $506.55 $526.07 $355.58 $142.24 $682.50 $273.00 $682.50 $682.50 $682.50 $682.50 $682.50 $511.88 $682.50 $682.50 $682.50 $341.25 $341.25 $540.54 $682.50 $546.00 $443.63 $682.50 N/A $395.85 $682.50 $409.50 $682.50 $682.50 $682.50 N/A N/A HEL180620-20 SUP Custom 27803010 HEL180620-20 - COIL EMBL HLCL 6MM 20CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS BOTH IP/OP "$1,269.00" $939.00 $225.87 "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" $225.87 "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" $264.46 "$1,268.93" $507.57 "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" $951.75 "$1,268.93" "$1,268.93" "$1,268.93" $634.47 $634.47 "$1,004.99" "$1,268.93" "$1,015.14" $571.02 "$1,268.93" N/A $736.02 "$1,268.93" $761.36 "$1,268.93" "$1,268.93" "$1,268.93" N/A N/A HEL180730-20 SUP Custom 27803010 HEL180730-20 - COIL EMBL HLCL 7MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS BOTH IP/OP "$1,358.50" "$1,005.00" $241.78 "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" $241.78 "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" $283.08 "$1,358.30" $543.32 "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,018.88" "$1,358.30" "$1,358.30" "$1,358.30" $679.15 $679.15 "$1,075.77" "$1,358.30" "$1,086.64" $611.24 "$1,358.30" N/A $787.93 "$1,358.30" $814.98 "$1,358.30" "$1,358.30" "$1,358.30" N/A N/A HEL180830-20 SUP Custom 27803010 HEL180830-20 - COIL EMBL HLCL 8MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS BOTH IP/OP "$1,358.50" "$1,005.00" $241.78 "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" $241.78 "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" $283.08 "$1,358.30" $543.32 "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,018.88" "$1,358.30" "$1,358.30" "$1,358.30" $679.15 $679.15 "$1,075.77" "$1,358.30" "$1,086.64" $611.24 "$1,358.30" N/A $787.93 "$1,358.30" $814.98 "$1,358.30" "$1,358.30" "$1,358.30" N/A N/A HEL18093020 SUP Custom 27803010 HEL18093020 - COIL EMBL HLCL 9MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS BOTH IP/OP "$1,358.50" "$1,005.00" $241.78 "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" $241.78 "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" $283.08 "$1,358.30" $543.32 "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,018.88" "$1,358.30" "$1,358.30" "$1,358.30" $679.15 $679.15 "$1,075.77" "$1,358.30" "$1,086.64" $611.24 "$1,358.30" N/A $787.93 "$1,358.30" $814.98 "$1,358.30" "$1,358.30" "$1,358.30" N/A N/A HEL181030-20 SUP Custom 27803010 HEL181030-20 - COIL EMBL HLCL 10MM 30CM HELIPAQ 18 MCIOL LOOP DTCH STRCH RS BOTH IP/OP "$1,358.50" "$1,005.00" $241.78 "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" $241.78 "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" $283.08 "$1,358.30" $543.32 "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,358.30" "$1,018.88" "$1,358.30" "$1,358.30" "$1,358.30" $679.15 $679.15 "$1,075.77" "$1,358.30" "$1,086.64" $611.24 "$1,358.30" N/A $787.93 "$1,358.30" $814.98 "$1,358.30" "$1,358.30" "$1,358.30" N/A N/A HEL181230-20 SUP Custom 27803010 HEL181230-20 - COIL EMBL 12MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS BOTH IP/OP "$1,430.00" "$1,058.00" $254.50 "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" $254.50 "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" $297.98 "$1,429.78" $571.91 "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" "$1,072.50" "$1,429.78" "$1,429.78" "$1,429.78" $714.89 $714.89 "$1,132.39" "$1,429.78" "$1,143.82" $643.40 "$1,429.78" N/A $829.40 "$1,429.78" $857.87 "$1,429.78" "$1,429.78" "$1,429.78" N/A N/A HEL181430-20 SUP Custom 27803010 HEL181430-20 - COIL EMBL 14MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS BOTH IP/OP "$1,430.00" "$1,058.00" $254.50 "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" $254.50 "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" $297.98 "$1,429.78" $571.91 "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" "$1,429.78" "$1,072.50" "$1,429.78" "$1,429.78" "$1,429.78" $714.89 $714.89 "$1,132.39" "$1,429.78" "$1,143.82" $643.40 "$1,429.78" N/A $829.40 "$1,429.78" $857.87 "$1,429.78" "$1,429.78" "$1,429.78" N/A N/A HEL181630-20 SUP Custom 27803010 HEL181630-20 - COIL EMBL 16MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS BOTH IP/OP "$1,269.00" $939.00 $225.87 "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" $225.87 "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" $264.46 "$1,268.93" $507.57 "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" "$1,268.93" $951.75 "$1,268.93" "$1,268.93" "$1,268.93" $634.47 $634.47 "$1,004.99" "$1,268.93" "$1,015.14" $571.02 "$1,268.93" N/A $736.02 "$1,268.93" $761.36 "$1,268.93" "$1,268.93" "$1,268.93" N/A N/A HEL181830-20 SUP Custom 27803010 HEL181830-20 - COIL EMBL 18MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS BOTH IP/OP "$1,501.50" "$1,111.00" $267.23 "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" $267.23 "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" $312.88 "$1,501.28" $600.51 "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,126.13" "$1,501.28" "$1,501.28" "$1,501.28" $750.64 $750.64 "$1,189.01" "$1,501.28" "$1,201.02" $675.58 "$1,501.28" N/A $870.87 "$1,501.28" $900.77 "$1,501.28" "$1,501.28" "$1,501.28" N/A N/A HEL182030-20 SUP Custom 27803010 HEL182030-20 - COIL EMBL 20MM 30CM HELIPAQ 18 MCIOL HLCL LOOP DTCH STRCH RS BOTH IP/OP "$1,501.50" "$1,111.00" $267.23 "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" $267.23 "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" $312.88 "$1,501.28" $600.51 "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,501.28" "$1,126.13" "$1,501.28" "$1,501.28" "$1,501.28" $750.64 $750.64 "$1,189.01" "$1,501.28" "$1,201.02" $675.58 "$1,501.28" N/A $870.87 "$1,501.28" $900.77 "$1,501.28" "$1,501.28" "$1,501.28" N/A N/A HERO 1003 SUP Custom 27203010 HERO 1003 - KIT HEMODIALYSIS 16FR Y 10FR 12FR DELIVERY STYLET DILAT BOTH IP/OP "$1,275.00" $944.00 $226.95 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $226.95 "$1,275.00" "$1,275.00" $946.31 $946.31 $982.77 $664.28 $265.72 "$1,275.00" $510.00 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $828.75 "$1,275.00" N/A $739.50 "$1,275.00" $765.00 "$1,275.00" "$1,275.00" "$1,275.00" N/A N/A HEX2.7-12 SUP HCPCS C1713 HEX2.7-12 - SCREW BN 2.7MM 12MM SS CORT TRIMED CLVCL FX SYS BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A HEX2.7-14 SUP HCPCS C1713 HEX2.7-14 - SCREW BN 2.7MM 14MM SS CORT TRIMED CLVCL FX SYS BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-08 SUP HCPCS C1713 HEX3.2-08 - SCREW BONE 3.2MM 8MM HEXAGONAL HEAD CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-10 SUP HCPCS C1713 HEX3.2-10 - SCREW BN 3.2MM 10MM HEX CORT ANKL FX SYS BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-11 SUP HCPCS C1713 HEX3.2-11 - SCREW BONE 3.2MM 11MM HEXAGONAL HEAD CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-12 SUP HCPCS C1713 HEX3.2-12 - SCREW BN 3.2MM 12MM HEX CORT ANKL FX SYS BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-13 SUP HCPCS C1713 HEX3.2-13 - SCREW BN 3.2MM 13MM HEX CORT ANKL FX SYS BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-14 SUP HCPCS C1713 HEX3.2-14 - SCREW BN 3.2MM 14MM HEX CORT ANKL FX SYS BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-15 SUP HCPCS C1713 HEX3.2-15 - SCREW BONE 3.2MM 15MM HEXAGONAL HEAD CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-16 SUP HCPCS C1713 HEX3.2-16 - SCREW BN 3.2MM 16MM HEX CORT ANKL FX SYS BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-18 SUP HCPCS C1713 HEX3.2-18 - SCREW BN 3.2MM 18MM HEX CORT ANKL FX SYS BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-20 SUP HCPCS C1713 HEX3.2-20 - SCREW BONE 3.2MM 20MM HEXAGONAL HEAD CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-22 SUP HCPCS C1713 HEX3.2-22 - SCREW BONE 3.2MM 22MM HEXAGONAL HEAD CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-24 SUP HCPCS C1713 HEX3.2-24 - SCREW BONE 3.2MM 24MM HEXAGONAL HEAD CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-26 SUP HCPCS C1713 HEX3.2-26 - SCREW BONE 3.2MM 26MM HEXAGONAL HEAD CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-28 SUP HCPCS C1713 HEX3.2-28 - SCREW BONE 3.2MM 28MM HEXAGON CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A HEX3.2-30 SUP HCPCS C1713 HEX3.2-30 - SCREW BN 3.2MM 30MM HEX CORT BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $225.00 $225.00 N/A N/A HF0200DSSM SUP Custom 27011340 HF0200DSSM - FIBER LSR 270UM HO 1 WL STRL DISP BOTH IP/OP "$1,074.50" $795.00 $191.22 "$1,074.28" "$1,074.28" "$1,074.28" "$1,074.28" "$1,074.28" "$1,074.28" "$1,074.28" $191.22 "$1,074.28" "$1,074.28" $797.33 $797.33 $828.06 $559.70 $223.89 "$1,074.28" $429.71 "$1,074.28" "$1,074.28" "$1,074.28" "$1,074.28" "$1,074.28" $805.88 "$1,074.28" "$1,074.28" "$1,074.28" $537.14 $537.14 $850.83 "$1,074.28" $859.42 $698.28 "$1,074.28" N/A $623.21 "$1,074.28" $644.57 "$1,074.28" "$1,074.28" "$1,074.28" N/A N/A HH0710 SUP HCPCS C1781 HH0710 - MESH SRG 10X7CM GORE BIO-ASNTH REINF TISS HIATAL HRN REPR BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" "$1,275.00" "$1,275.00" $265.71 "$1,275.00" N/A N/A HLFDBX0270C SUP Custom 27203010 HLFDBX0270C - LASER SRG 270MH DISP BOTH IP/OP $711.00 $526.00 $126.50 $710.67 $710.67 $710.67 $710.67 $710.67 $710.67 $710.67 $126.50 $710.67 $710.67 $527.46 $527.46 $547.78 $370.26 $148.11 $710.67 $284.27 $710.67 $710.67 $710.67 $710.67 $710.67 $533.25 $710.67 $710.67 $710.67 $355.34 $355.34 $562.85 $710.67 $568.54 $461.94 $710.67 N/A $412.38 $710.67 $426.40 $710.67 $710.67 $710.67 N/A N/A HLFDBX0400C SUP Custom 27203010 HLFDBX0400C - LASER SRG 400MH DISP BOTH IP/OP $849.00 $628.00 $151.06 $848.67 $848.67 $848.67 $848.67 $848.67 $848.67 $848.67 $151.06 $848.67 $848.67 $629.88 $629.88 $654.15 $442.16 $176.87 $848.67 $339.47 $848.67 $848.67 $848.67 $848.67 $848.67 $636.75 $848.67 $848.67 $848.67 $424.34 $424.34 $672.15 $848.67 $678.94 $551.64 $848.67 N/A $492.42 $848.67 $509.20 $848.67 $848.67 $848.67 N/A N/A HLFDBX1000C SUP Custom 27203010 HLFDBX1000C - LASER SURGICAL 1000 MH DISPOSABLE BOTH IP/OP "$2,193.50" "$1,623.00" $390.37 "$2,193.09" "$2,193.09" "$2,193.09" "$2,193.09" "$2,193.09" "$2,193.09" "$2,193.09" $390.37 "$2,193.09" "$2,193.09" "$1,627.71" "$1,627.71" "$1,690.43" "$1,142.60" $457.06 "$2,193.09" $877.24 "$2,193.09" "$2,193.09" "$2,193.09" "$2,193.09" "$2,193.09" "$1,645.13" "$2,193.09" "$2,193.09" "$2,193.09" "$1,096.55" "$1,096.55" "$1,736.93" "$2,193.09" "$1,754.47" "$1,425.51" "$2,193.09" N/A "$1,272.23" "$2,193.09" "$1,315.85" "$2,193.09" "$2,193.09" "$2,193.09" N/A N/A HLS1007M SUP HCPCS C1894 HLS1007M - INTRODUCER SHTH 7FR 13CM 20CM SFSHTH HMSTS VLV TRAW SDPRT BOTH IP/OP $130.00 $96.00 $25.80 $130.00 $70.59 $70.59 $70.59 $70.59 $130.00 $130.00 $130.00 $27.10 $130.00 $96.49 $96.49 $100.20 $67.73 $27.09 $130.00 $130.00 $76.90 $130.00 $130.00 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $65.00 $65.00 $102.96 $130.00 $104.00 $84.50 $25.80 N/A $75.40 $130.00 $130.00 $130.00 $27.09 $130.00 N/A N/A HLS10095M SUP HCPCS C1894 HLS10095M - INTRODUCER SHEATH 9.5FR 13CM 20CM HEMOSTASIS VALVE TEAR AWAY BOTH IP/OP $146.50 $108.00 $29.03 $146.25 $79.41 $79.41 $79.41 $79.41 $146.25 $146.25 $146.25 $30.48 $146.25 $108.55 $108.55 $112.73 $76.20 $30.48 $146.25 $146.25 $86.51 $146.25 $146.25 $146.25 $146.25 $109.88 $146.25 $146.25 $146.25 $73.13 $73.13 $115.83 $146.25 $117.00 $95.06 $29.03 N/A $84.97 $146.25 $146.25 $146.25 $30.48 $146.25 N/A N/A HLS10105M SUP HCPCS C1894 HLS10105M - INTRODUCER SHEATH 10.5FR 13CM 20CM HEMOSTASIS VALVE TEAR BOTH IP/OP $130.00 $96.00 $25.80 $130.00 $70.59 $70.59 $70.59 $70.59 $130.00 $130.00 $130.00 $27.10 $130.00 $96.49 $96.49 $100.20 $67.73 $27.09 $130.00 $127.50 $76.90 $130.00 $127.50 $130.00 $130.00 $97.50 $130.00 $130.00 $130.00 $65.00 $65.00 $102.96 $130.00 $104.00 $84.50 $25.80 N/A $75.40 $130.00 $130.00 $130.00 $27.09 $130.00 N/A N/A HLS2509M SUP HCPCS C1894 HLS2509M - INTRODUCER LEAD LONG 9FR 25CM 31.5CM HEMOSTASIS VALVE TEAR BOTH IP/OP $146.00 $108.00 $28.98 $146.00 $79.28 $79.28 $79.28 $79.28 $146.00 $146.00 $146.00 $30.43 $146.00 $108.36 $108.36 $112.54 $76.07 $30.43 $146.00 $146.00 $86.36 $146.00 $146.00 $146.00 $146.00 $109.50 $146.00 $146.00 $146.00 $73.00 $73.00 $115.63 $146.00 $116.80 $94.90 $28.98 N/A $84.68 $146.00 $146.00 $146.00 $30.43 $146.00 N/A N/A HN1200 SUP HCPCS C1776 HN1200 - SLEEVE CENTERING 38.1IN 9MM 12.7IN IMHS CP SET SCR IM HIP BOTH IP/OP $831.50 $615.00 $164.98 $831.25 $374.06 $374.06 $374.06 $374.06 $831.25 $831.25 $831.25 $173.25 $831.25 $831.25 $831.25 $831.25 $831.25 $173.24 $831.25 $332.50 $491.68 $831.25 $831.25 $831.25 $831.25 $623.63 $831.25 $831.25 $831.25 $415.63 $415.63 $658.35 $831.25 $665.00 $374.06 $164.98 N/A $482.27 $831.25 $831.25 $831.25 $173.23 $831.25 N/A N/A HN1202 SUP HCPCS C1713 HN1202 - SCREW SET IMHS CENTERING SLV HIP BOTH IP/OP $534.00 $395.00 $105.94 $533.75 $240.19 $240.19 $240.19 $240.19 $533.75 $533.75 $533.75 $111.25 $533.75 $533.75 $533.75 $533.75 $533.75 $111.24 $533.75 $533.75 $315.71 $533.75 $533.75 $533.75 $533.75 $400.50 $533.75 $533.75 $533.75 $266.88 $266.88 $422.73 $533.75 $427.00 $240.19 $105.94 N/A $309.72 $533.75 $533.75 $533.75 $533.75 $533.75 N/A N/A HNR4.0-35-70-P-10S-0 SUP HCPCS C1725 HNR4.0-35-70-P-10S-0 - CATH ANGIO .035IN 4FR 70CM 10 SDPRT STR HFLO ATRM TIP DSGN BOTH IP/OP $47.00 $35.00 $9.30 $46.88 $25.46 $25.46 $25.46 $25.46 $46.88 $46.88 $46.88 $9.77 $46.88 $34.79 $34.79 $36.14 $24.42 $9.77 $46.88 $46.88 $27.73 $46.88 $46.88 $46.88 $46.88 $35.25 $46.88 $46.88 $46.88 $23.44 $23.44 $37.13 $46.88 $37.50 $30.47 $9.30 N/A $27.26 $46.88 $46.88 $46.88 $9.77 $46.88 N/A N/A HOOK-L4 SUP HCPCS C1713 HOOK-L4 - PLATE BONE 4 HOLE HOOK LEFT ELBOW BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" $750.00 "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,125.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A HOOK-R6 SUP HCPCS C1713 HOOK-R6 - PLATE BONE 6 HOLE HOOK ORTHOPEDIC BOTH IP/OP "$2,000.00" "$1,480.00" $396.95 "$2,000.00" $900.00 $900.00 $900.00 $900.00 "$2,000.00" "$2,000.00" "$2,000.00" $416.85 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" $416.82 "$2,000.00" $800.00 "$1,183.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" $900.00 $396.95 N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" $416.80 "$2,000.00" N/A N/A HP01 SUP HCPCS C1781 HP01 - PLUG SURG BIOABSORBABLE BIO-A HERN REPAIR BOTH IP/OP "$1,260.00" $932.00 $250.08 "$1,260.00" $567.00 $567.00 $567.00 $567.00 "$1,260.00" "$1,260.00" "$1,260.00" $262.62 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $262.60 "$1,260.00" "$1,260.00" $745.29 "$1,260.00" "$1,260.00" "$1,260.00" "$1,260.00" $945.00 "$1,260.00" "$1,260.00" "$1,260.00" $630.00 $630.00 $997.92 "$1,260.00" "$1,008.00" $567.00 $250.08 N/A $730.80 "$1,260.00" "$1,260.00" "$1,260.00" $262.58 "$1,260.00" N/A N/A HP-2515 SUP Custom 27203010 HP-2515 - DRIVER SURG 2.5MM 2.5MM POWER TIP CANN ACUTRAK BOTH IP/OP $387.50 $287.00 $68.98 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $68.98 $387.50 $387.50 $287.60 $287.60 $298.69 $201.89 $80.76 $387.50 $155.00 $387.50 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $251.88 $387.50 N/A $224.75 $387.50 $232.50 $387.50 $387.50 $387.50 N/A N/A HP3000 SUP Custom 27203010 HP3000 - POSITIONER SRG STRFSH EVO MULTIAPPENDAGE SIL SCT CUP LOPRFL BOTH IP/OP "$1,987.50" "$1,471.00" $353.78 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $353.78 "$1,987.50" "$1,987.50" "$1,475.12" "$1,475.12" "$1,531.97" "$1,035.49" $414.22 "$1,987.50" $795.00 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" "$1,291.88" "$1,987.50" N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" "$1,987.50" "$1,987.50" N/A N/A HP-3016 SUP Custom 27203010 HP-3016 - DRIVER SURG 3MM CANN POWER TIP ACUTRAK OPTIONAL INSTRUMENTS BOTH IP/OP $387.50 $287.00 $68.98 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $68.98 $387.50 $387.50 $287.60 $287.60 $298.69 $201.89 $80.76 $387.50 $155.00 $387.50 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $251.88 $387.50 N/A $224.75 $387.50 $232.50 $387.50 $387.50 $387.50 N/A N/A HPC-0015 SUP Custom 27203010 HPC-0015 - TIP SCREWDRIVER SMALL HEXAGON 1.5MM SHAFT STERILE DISPOSABLE BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A HPC-0025 SUP Custom 27203010 HPC-0025 - DRIVER SURG HEXAGON 2.5MM QUICK RELEASE MAYO LOCK ELBOW BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A HPC-0035 SUP Custom 27203010 HPC-0035 - DRIVER SURG HEXAGON 3.5MM QUICK RELEASE POLARUS PROXIMAL BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A HR-0001-S SUP HCPCS C1713 HR-0001-S - CAP END SCREW POLARUS TITANIUM STERILE INTRAMEDULLARY NAIL BOTH IP/OP $380.00 $281.00 $75.42 $380.00 $171.00 $171.00 $171.00 $171.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $380.00 $380.00 $380.00 $79.20 $380.00 $380.00 $224.77 $380.00 $380.00 $380.00 $380.00 $285.00 $380.00 $380.00 $380.00 $190.00 $190.00 $300.96 $380.00 $304.00 $171.00 $75.42 N/A $220.40 $380.00 $380.00 $380.00 $79.19 $380.00 N/A N/A HR-0024-S SUP HCPCS C1713 HR-0024-S - CAP END 4MM STRL PLRS SCR ASMB BOTH IP/OP $757.50 $561.00 $150.34 $757.50 $340.88 $340.88 $340.88 $340.88 $757.50 $757.50 $757.50 $157.88 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $757.50 $448.06 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $150.34 N/A $439.35 $757.50 $757.50 $757.50 $157.86 $757.50 N/A N/A HR-0028-S SUP HCPCS C1713 HR-0028-S - CAP END 8MM STRL PLRS SCR ASMB BOTH IP/OP $757.50 $561.00 $150.34 $757.50 $340.88 $340.88 $340.88 $340.88 $757.50 $757.50 $757.50 $157.88 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $757.50 $448.06 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $150.34 N/A $439.35 $757.50 $454.50 $757.50 $157.86 $757.50 N/A N/A HR-0050-S SUP HCPCS C1713 HR-0050-S - CAP END PLRS SCR ASMB INS DEV BOTH IP/OP $757.50 $561.00 $150.34 $757.50 $340.88 $340.88 $340.88 $340.88 $757.50 $757.50 $757.50 $157.88 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $757.50 $448.06 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $150.34 N/A $439.35 $757.50 $757.50 $757.50 $157.86 $757.50 N/A N/A HR-0054-S SUP HCPCS C1713 HR-0054-S - CAP END 4MM STRL PLRS SCR ASMB BOTH IP/OP $757.50 $561.00 $150.34 $757.50 $340.88 $340.88 $340.88 $340.88 $757.50 $757.50 $757.50 $157.88 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $757.50 $448.06 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $150.34 N/A $439.35 $757.50 $757.50 $757.50 $157.86 $757.50 N/A N/A HR-0058-S SUP HCPCS C1713 HR-0058-S - CAP END 8MM STRL PLRS SCR ASMB BOTH IP/OP $757.50 $561.00 $150.34 $757.50 $340.88 $340.88 $340.88 $340.88 $757.50 $757.50 $757.50 $157.88 $757.50 $757.50 $757.50 $757.50 $757.50 $157.87 $757.50 $757.50 $448.06 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $340.88 $150.34 N/A $439.35 $757.50 $757.50 $757.50 $157.86 $757.50 N/A N/A HR-0105 SUP Custom 27203010 HR-0105 - BIT DRILL 2.7MM TAP POLARUS BOTH IP/OP $75.00 $56.00 $13.35 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $13.35 $75.00 $75.00 $55.67 $55.67 $57.81 $39.08 $15.63 $75.00 $30.00 $75.00 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $48.75 $75.00 N/A $43.50 $75.00 $45.00 $75.00 $75.00 $75.00 N/A N/A HR-0820-S SUP HCPCS C1713 HR-0820-S - ROD ORTHOPEDIC 8MM 200MM INTRAMEDULLARY POLARUS PLUS BOTH IP/OP "$4,107.50" "$3,040.00" $815.24 "$4,107.50" "$1,848.38" "$1,848.38" "$1,848.38" "$1,848.38" "$4,107.50" "$4,107.50" "$4,107.50" $856.11 "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" $856.05 "$4,107.50" "$4,107.50" "$2,025.00" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$3,080.63" "$4,107.50" "$4,107.50" "$4,107.50" "$2,053.75" "$2,053.75" "$3,253.14" "$4,107.50" "$3,286.00" "$1,848.38" $815.24 N/A "$2,382.35" "$4,107.50" "$2,464.50" "$4,107.50" $856.00 "$4,107.50" N/A N/A HR-0822-S SUP HCPCS C1713 HR-0822-S - ROD ORTHOPEDIC 8MM 220MM HUMERUS INTRAMEDULLARY IMPLANT BOTH IP/OP "$4,107.50" "$3,040.00" $815.24 "$4,107.50" "$1,848.38" "$1,848.38" "$1,848.38" "$1,848.38" "$4,107.50" "$4,107.50" "$4,107.50" $856.11 "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" $856.05 "$4,107.50" "$4,107.50" "$2,025.00" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$3,080.63" "$4,107.50" "$4,107.50" "$4,107.50" "$2,053.75" "$2,053.75" "$3,253.14" "$4,107.50" "$3,286.00" "$1,848.38" $815.24 N/A "$2,382.35" "$4,107.50" "$4,107.50" "$4,107.50" $856.00 "$4,107.50" N/A N/A HR-0824-S SUP HCPCS C1713 HR-0824-S - ROD ORTHOPEDIC 8MM 240MM INTRAMEDULLARY IMPLANT POLARUS PLUS BOTH IP/OP "$4,107.50" "$3,040.00" $815.24 "$4,107.50" "$1,848.38" "$1,848.38" "$1,848.38" "$1,848.38" "$4,107.50" "$4,107.50" "$4,107.50" $856.11 "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" $856.05 "$4,107.50" "$4,107.50" "$2,025.00" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$3,080.63" "$4,107.50" "$4,107.50" "$4,107.50" "$2,053.75" "$2,053.75" "$3,253.14" "$4,107.50" "$3,286.00" "$1,848.38" $815.24 N/A "$2,382.35" "$4,107.50" "$4,107.50" "$4,107.50" $856.00 "$4,107.50" N/A N/A HR-0826-S SUP HCPCS C1713 HR-0826-S - ROD ORTHOPEDIC 8MM 260MM HUMERUS INTRAMEDULLARY IMPLANT BOTH IP/OP "$4,107.50" "$3,040.00" $815.24 "$4,107.50" "$1,848.38" "$1,848.38" "$1,848.38" "$1,848.38" "$4,107.50" "$4,107.50" "$4,107.50" $856.11 "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" $856.05 "$4,107.50" "$4,107.50" "$2,025.00" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$3,080.63" "$4,107.50" "$4,107.50" "$4,107.50" "$2,053.75" "$2,053.75" "$3,253.14" "$4,107.50" "$3,286.00" "$1,848.38" $815.24 N/A "$2,382.35" "$4,107.50" "$4,107.50" "$4,107.50" $856.00 "$4,107.50" N/A N/A HR-0828-S SUP HCPCS C1713 HR-0828-S - ROD ORTHOPEDIC 8MM 280MM HUMERUS INTRAMEDULLARY IMPLANT BOTH IP/OP "$4,107.50" "$3,040.00" $815.24 "$4,107.50" "$1,848.38" "$1,848.38" "$1,848.38" "$1,848.38" "$4,107.50" "$4,107.50" "$4,107.50" $856.11 "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" $856.05 "$4,107.50" "$4,107.50" "$2,025.00" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$3,080.63" "$4,107.50" "$4,107.50" "$4,107.50" "$2,053.75" "$2,053.75" "$3,253.14" "$4,107.50" "$3,286.00" "$1,848.38" $815.24 N/A "$2,382.35" "$4,107.50" "$4,107.50" "$4,107.50" $856.00 "$4,107.50" N/A N/A HR-3106 SUP Custom 27203010 HR-3106 - DRILL SRG WITNESS HL CLRNC BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A HR-3107 SUP Custom 27203010 HR-3107 - TAP SRG 3.5 MM SCR BOTH IP/OP $930.00 $688.00 $165.54 $930.00 $930.00 $930.00 $930.00 $930.00 $930.00 $930.00 $165.54 $930.00 $930.00 $690.25 $690.25 $716.84 $484.53 $193.82 $930.00 $372.00 $930.00 $930.00 $930.00 $930.00 $930.00 $697.50 $930.00 $930.00 $930.00 $465.00 $465.00 $736.56 $930.00 $744.00 $604.50 $930.00 N/A $539.40 $930.00 $558.00 $930.00 $930.00 $930.00 N/A N/A HR-4D1055-S SUP HCPCS C1713 HR-4D1055-S - ROD XTRNFX 2-4D 5.5MM 150MM STRL 10MM ANT POST BOTH IP/OP "$3,817.50" "$2,825.00" $757.68 "$3,817.50" "$1,717.88" "$1,717.88" "$1,717.88" "$1,717.88" "$3,817.50" "$3,817.50" "$3,817.50" $795.66 "$3,817.50" "$3,817.50" "$3,817.50" "$3,817.50" "$3,817.50" $795.61 "$3,817.50" "$1,527.00" "$1,882.03" "$3,817.50" "$3,817.50" "$3,817.50" "$3,817.50" "$2,863.13" "$3,817.50" "$3,817.50" "$3,817.50" "$1,908.75" "$1,908.75" "$3,023.46" "$3,817.50" "$3,054.00" "$1,717.88" $757.68 N/A "$2,214.15" "$3,817.50" "$3,817.50" "$3,817.50" $795.57 "$3,817.50" N/A N/A HRA-1055-S SUP HCPCS C1713 HRA-1055-S - ROD XTRNFX 2-4D STD 5.5MM 150MM STRL 10MM BOTH IP/OP "$5,422.50" "$4,013.00" "$1,076.23" "$5,422.50" "$2,440.13" "$2,440.13" "$2,440.13" "$2,440.13" "$5,422.50" "$5,422.50" "$5,422.50" "$1,130.18" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$1,130.11" "$5,422.50" "$2,169.00" "$2,673.29" "$5,422.50" "$5,422.50" "$5,422.50" "$5,422.50" "$4,066.88" "$5,422.50" "$5,422.50" "$5,422.50" "$2,711.25" "$2,711.25" "$4,294.62" "$5,422.50" "$4,338.00" "$2,440.13" "$1,076.23" N/A "$3,145.05" "$5,422.50" "$5,422.50" "$5,422.50" "$1,130.05" "$5,422.50" N/A N/A HR-D105 SUP Custom 27203010 HR-D105 - DRILL SURG LONG 2.8MM 35MM TAP POLARUS STERILE BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A HRH-0820-S SUP HCPCS C1713 HRH-0820-S - ROD XTRNFX 8MM 200MM STRL PLRS + SPCL BOTH IP/OP "$4,107.50" "$3,040.00" $815.24 "$4,107.50" "$1,848.38" "$1,848.38" "$1,848.38" "$1,848.38" "$4,107.50" "$4,107.50" "$4,107.50" $856.11 "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" $856.05 "$4,107.50" "$1,643.00" "$2,025.00" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$3,080.63" "$4,107.50" "$4,107.50" "$4,107.50" "$2,053.75" "$2,053.75" "$3,253.14" "$4,107.50" "$3,286.00" "$1,848.38" $815.24 N/A "$2,382.35" "$4,107.50" "$4,107.50" "$4,107.50" $856.00 "$4,107.50" N/A N/A HRH-0822-S SUP HCPCS C1713 HRH-0822-S - ROD XTRNFX 8MM 220MM PLRS + HUM PROX BOTH IP/OP "$4,107.50" "$3,040.00" $815.24 "$4,107.50" "$1,848.38" "$1,848.38" "$1,848.38" "$1,848.38" "$4,107.50" "$4,107.50" "$4,107.50" $856.11 "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" $856.05 "$4,107.50" "$1,643.00" "$2,025.00" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$3,080.63" "$4,107.50" "$4,107.50" "$4,107.50" "$2,053.75" "$2,053.75" "$3,253.14" "$4,107.50" "$3,286.00" "$1,848.38" $815.24 N/A "$2,382.35" "$4,107.50" "$4,107.50" "$4,107.50" $856.00 "$4,107.50" N/A N/A HRH-0824-S SUP HCPCS C1713 HRH-0824-S - ROD XTRNFX 8MM 240MM PLRS + SPCL BOTH IP/OP "$4,107.50" "$3,040.00" $815.24 "$4,107.50" "$1,848.38" "$1,848.38" "$1,848.38" "$1,848.38" "$4,107.50" "$4,107.50" "$4,107.50" $856.11 "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" $856.05 "$4,107.50" "$4,107.50" "$2,025.00" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$3,080.63" "$4,107.50" "$4,107.50" "$4,107.50" "$2,053.75" "$2,053.75" "$3,253.14" "$4,107.50" "$3,286.00" "$1,848.38" $815.24 N/A "$2,382.35" "$4,107.50" "$2,464.50" "$4,107.50" $856.00 "$4,107.50" N/A N/A HRH-0826-S SUP HCPCS C1713 HRH-0826-S - ROD XTRNFX 8MM 260MM STRL PLRS + SPCL BOTH IP/OP "$4,107.50" "$3,040.00" $815.24 "$4,107.50" "$1,848.38" "$1,848.38" "$1,848.38" "$1,848.38" "$4,107.50" "$4,107.50" "$4,107.50" $856.11 "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" $856.05 "$4,107.50" "$1,643.00" "$2,025.00" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$3,080.63" "$4,107.50" "$4,107.50" "$4,107.50" "$2,053.75" "$2,053.75" "$3,253.14" "$4,107.50" "$3,286.00" "$1,848.38" $815.24 N/A "$2,382.35" "$4,107.50" "$4,107.50" "$4,107.50" $856.00 "$4,107.50" N/A N/A HRH-0828-S SUP HCPCS C1713 HRH-0828-S - ROD XTRNFX 8MM 280MM NS PLRS + SPCL BOTH IP/OP "$4,107.50" "$3,040.00" $815.24 "$4,107.50" "$1,848.38" "$1,848.38" "$1,848.38" "$1,848.38" "$4,107.50" "$4,107.50" "$4,107.50" $856.11 "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" $856.05 "$4,107.50" "$1,643.00" "$2,025.00" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$3,080.63" "$4,107.50" "$4,107.50" "$4,107.50" "$2,053.75" "$2,053.75" "$3,253.14" "$4,107.50" "$3,286.00" "$1,848.38" $815.24 N/A "$2,382.35" "$4,107.50" "$2,464.50" "$4,107.50" $856.00 "$4,107.50" N/A N/A HR-L1115-S SUP HCPCS C1713 HR-L1115-S - ROD ORTHOPEDIC 11MM 150MM LOCK POLARUS HUMERUS STERILE BOTH IP/OP "$4,107.50" "$3,040.00" $815.24 "$4,107.50" "$1,848.38" "$1,848.38" "$1,848.38" "$1,848.38" "$4,107.50" "$4,107.50" "$4,107.50" $856.11 "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" $856.05 "$4,107.50" "$1,643.00" "$2,025.00" "$4,107.50" "$4,107.50" "$4,107.50" "$4,107.50" "$3,080.63" "$4,107.50" "$4,107.50" "$4,107.50" "$2,053.75" "$2,053.75" "$3,253.14" "$4,107.50" "$3,286.00" "$1,848.38" $815.24 N/A "$2,382.35" "$4,107.50" "$2,464.50" "$4,107.50" $856.00 "$4,107.50" N/A N/A HRSD105 SUP Custom 27203010 HRSD105 - DRILL SURG SHORT 2.8MM TAP POLARUS STERILE BOTH IP/OP $95.00 $70.00 $16.91 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $16.91 $95.00 $95.00 $70.51 $70.51 $73.23 $49.50 $19.80 $95.00 $38.00 $95.00 $95.00 $95.00 $95.00 $95.00 $71.25 $95.00 $95.00 $95.00 $47.50 $47.50 $75.24 $95.00 $76.00 $61.75 $95.00 N/A $55.10 $95.00 $57.00 $95.00 $95.00 $95.00 N/A N/A HR-WC50-S SUP Custom 27203010 HR-WC50-S - WASHER XTRNFX 5MM STRL CIRC CLEATED FIB BOTH IP/OP $132.50 $98.00 $23.59 $132.50 $132.50 $132.50 $132.50 $132.50 $132.50 $132.50 $23.59 $132.50 $132.50 $98.34 $98.34 $102.13 $69.03 $27.61 $132.50 $53.00 $132.50 $132.50 $132.50 $132.50 $132.50 $99.38 $132.50 $132.50 $132.50 $66.25 $66.25 $104.94 $132.50 $106.00 $86.13 $132.50 N/A $76.85 $132.50 $79.50 $132.50 $132.50 $132.50 N/A N/A HS007 SUP Custom 27011340 HS007 - SUPPORT ORTHOPEDIC HALO SUPER STRUCTURE TLSO 14 BOTH IP/OP "$1,861.00" "$1,377.00" $331.18 "$1,860.55" "$1,860.55" "$1,860.55" "$1,860.55" "$1,860.55" "$1,860.55" "$1,860.55" $331.18 "$1,860.55" "$1,860.55" "$1,380.90" "$1,380.90" "$1,434.11" $969.35 $387.76 "$1,860.55" $744.22 "$1,860.55" "$1,860.55" "$1,860.55" "$1,860.55" "$1,860.55" "$1,395.75" "$1,860.55" "$1,860.55" "$1,860.55" $930.28 $930.28 "$1,473.56" "$1,860.55" "$1,488.44" "$1,209.36" "$1,860.55" N/A "$1,079.38" "$1,860.55" "$1,116.33" "$1,860.55" "$1,860.55" "$1,860.55" N/A N/A HSK-3038 SUP Custom 27203010 HSK-3038 - SYSTEM PROX SL 3.8MM HRTSTR III DLV DEV LDR AOR CTR BOTH IP/OP "$1,347.50" $997.00 $239.78 "$1,347.10" "$1,347.10" "$1,347.10" "$1,347.10" "$1,347.10" "$1,347.10" "$1,347.10" $239.78 "$1,347.10" "$1,347.10" $999.82 $999.82 "$1,038.34" $701.84 $280.75 "$1,347.10" $538.84 "$1,347.10" "$1,347.10" "$1,347.10" "$1,347.10" "$1,347.10" "$1,010.63" "$1,347.10" "$1,347.10" "$1,347.10" $673.55 $673.55 "$1,066.90" "$1,347.10" "$1,077.68" $875.62 "$1,347.10" N/A $781.55 "$1,347.10" $808.26 "$1,347.10" "$1,347.10" "$1,347.10" N/A N/A HT036 SUP Custom 27011340 HT036 - HALTER TRC LG HLCRWN VST XTRNFXTR ADLT HDNK BOTH IP/OP "$1,492.50" "$1,104.00" $265.67 "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" $265.67 "$1,492.50" "$1,492.50" "$1,107.73" "$1,107.73" "$1,150.42" $777.59 $311.05 "$1,492.50" $597.00 "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,119.38" "$1,492.50" "$1,492.50" "$1,492.50" $746.25 $746.25 "$1,182.06" "$1,492.50" "$1,194.00" $970.13 "$1,492.50" N/A $865.65 "$1,492.50" $895.50 "$1,492.50" "$1,492.50" "$1,492.50" N/A N/A HT036HI SUP Custom 27011340 HT036HI - SET TRACTION LARGE PIN HALO CROWN SKULL BOTH IP/OP "$1,492.50" "$1,104.00" $265.67 "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" $265.67 "$1,492.50" "$1,492.50" "$1,107.73" "$1,107.73" "$1,150.42" $777.59 $311.05 "$1,492.50" $597.00 "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,492.50" "$1,119.38" "$1,492.50" "$1,492.50" "$1,492.50" $746.25 $746.25 "$1,182.06" "$1,492.50" "$1,194.00" $970.13 "$1,492.50" N/A $865.65 "$1,492.50" $895.50 "$1,492.50" "$1,492.50" "$1,492.50" N/A N/A HT064050A SUP HCPCS C1768 HT064050A - GRAFT VASCULAR THIN WALL 6MM 50CM 40CM REMOVABLE RING BOTH IP/OP "$4,527.50" "$3,350.00" $898.60 "$4,527.50" "$2,037.38" "$2,037.38" "$2,037.38" "$2,037.38" "$4,527.50" "$4,527.50" "$4,527.50" $943.64 "$4,527.50" "$4,527.50" "$4,527.50" "$4,527.50" "$4,527.50" $943.58 "$4,527.50" "$4,527.50" "$2,232.06" "$4,527.50" "$4,527.50" "$4,527.50" "$4,527.50" "$3,395.63" "$4,527.50" "$4,527.50" "$4,527.50" "$2,263.75" "$2,263.75" "$3,585.78" "$4,527.50" "$3,622.00" "$2,037.38" $898.60 N/A "$2,625.95" "$4,527.50" "$4,527.50" "$4,527.50" $943.53 "$4,527.50" N/A N/A HT067090A SUP HCPCS C1768 HT067090A - GRAFT VASCULAR THIN WALL 6MM 90CM 70CM REMOVABLE RING BOTH IP/OP "$7,437.50" "$5,504.00" "$1,476.16" "$7,437.50" "$3,346.88" "$3,346.88" "$3,346.88" "$3,346.88" "$7,437.50" "$7,437.50" "$7,437.50" "$1,550.16" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$1,550.06" "$7,437.50" "$7,437.50" "$3,666.69" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$5,578.13" "$7,437.50" "$7,437.50" "$7,437.50" "$3,718.75" "$3,718.75" "$5,890.50" "$7,437.50" "$5,950.00" "$3,346.88" "$1,476.16" N/A "$4,313.75" "$7,437.50" "$7,437.50" "$7,437.50" "$1,549.98" "$7,437.50" N/A N/A HT084050A SUP HCPCS C1768 HT084050A - GRAFT VASCULAR THIN WALL 8MM 50CM 40CM REMOVABLE RING BOTH IP/OP "$4,527.50" "$3,350.00" $898.60 "$4,527.50" "$2,037.38" "$2,037.38" "$2,037.38" "$2,037.38" "$4,527.50" "$4,527.50" "$4,527.50" $943.64 "$4,527.50" "$4,527.50" "$4,527.50" "$4,527.50" "$4,527.50" $943.58 "$4,527.50" "$4,527.50" "$2,232.06" "$4,527.50" "$4,527.50" "$4,527.50" "$4,527.50" "$3,395.63" "$4,527.50" "$4,527.50" "$4,527.50" "$2,263.75" "$2,263.75" "$3,585.78" "$4,527.50" "$3,622.00" "$2,037.38" $898.60 N/A "$2,625.95" "$4,527.50" "$4,527.50" "$4,527.50" $943.53 "$4,527.50" N/A N/A HT087080A SUP HCPCS C1768 HT087080A - GRAFT VASC THNWL 8MM 80CM 70CM GORE REM RING STRCH HEP BOTH IP/OP "$7,170.00" "$5,306.00" "$1,423.07" "$7,170.00" "$3,226.50" "$3,226.50" "$3,226.50" "$3,226.50" "$7,170.00" "$7,170.00" "$7,170.00" "$1,494.41" "$7,170.00" "$7,170.00" "$7,170.00" "$7,170.00" "$7,170.00" "$1,494.31" "$7,170.00" "$7,170.00" "$3,534.81" "$7,170.00" "$7,170.00" "$7,170.00" "$7,170.00" "$5,377.50" "$7,170.00" "$7,170.00" "$7,170.00" "$3,585.00" "$3,585.00" "$5,678.64" "$7,170.00" "$5,736.00" "$3,226.50" "$1,423.07" N/A "$4,158.60" "$7,170.00" "$7,170.00" "$7,170.00" "$1,494.23" "$7,170.00" N/A N/A HT087090A SUP HCPCS C1768 HT087090A - GRAFT VASCULAR THINWALL 8MM 90CM 70CM REMOVABLE RING STRETCH BOTH IP/OP "$7,437.50" "$5,504.00" "$1,476.16" "$7,437.50" "$3,346.88" "$3,346.88" "$3,346.88" "$3,346.88" "$7,437.50" "$7,437.50" "$7,437.50" "$1,550.16" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$1,550.06" "$7,437.50" "$7,437.50" "$3,666.69" "$7,437.50" "$7,437.50" "$7,437.50" "$7,437.50" "$5,578.13" "$7,437.50" "$7,437.50" "$7,437.50" "$3,718.75" "$3,718.75" "$5,890.50" "$7,437.50" "$5,950.00" "$3,346.88" "$1,476.16" N/A "$4,313.75" "$7,437.50" "$7,437.50" "$7,437.50" "$1,549.98" "$7,437.50" N/A N/A HT-0915 SUP Custom 27203010 HT-0915 - DRIVER SRG 1.5MM HEX BOTH IP/OP $470.00 $348.00 $83.66 $470.00 $470.00 $470.00 $470.00 $470.00 $470.00 $470.00 $83.66 $470.00 $470.00 $348.83 $348.83 $362.28 $244.87 $97.95 $470.00 $188.00 $470.00 $470.00 $470.00 $470.00 $470.00 $352.50 $470.00 $470.00 $470.00 $235.00 $235.00 $372.24 $470.00 $376.00 $305.50 $470.00 N/A $272.60 $470.00 $282.00 $470.00 $470.00 $470.00 N/A N/A HT-1120 SUP Custom 27203010 HT-1120 - DRIVER SRG 2MM HEX BOTH IP/OP $470.00 $348.00 $83.66 $470.00 $470.00 $470.00 $470.00 $470.00 $470.00 $470.00 $83.66 $470.00 $470.00 $348.83 $348.83 $362.28 $244.87 $97.95 $470.00 $188.00 $470.00 $470.00 $470.00 $470.00 $470.00 $352.50 $470.00 $470.00 $470.00 $235.00 $235.00 $372.24 $470.00 $376.00 $305.50 $470.00 N/A $272.60 $470.00 $282.00 $470.00 $470.00 $470.00 N/A N/A HT-1725 SUP Custom 27203010 HT-1725 - DRIVER SRG 2.5MM HEX BOTH IP/OP $470.00 $348.00 $83.66 $470.00 $470.00 $470.00 $470.00 $470.00 $470.00 $470.00 $83.66 $470.00 $470.00 $348.83 $348.83 $362.28 $244.87 $97.95 $470.00 $188.00 $470.00 $470.00 $470.00 $470.00 $470.00 $352.50 $470.00 $470.00 $470.00 $235.00 $235.00 $372.24 $470.00 $376.00 $305.50 $470.00 N/A $272.60 $470.00 $282.00 $470.00 $470.00 $470.00 N/A N/A HT-2502 SUP Custom 27203010 HT-2502 - TIP SCRDRVR 6IN 2.5MM QRLSE SLD BOTH IP/OP $277.50 $205.00 $49.40 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $49.40 $277.50 $277.50 $205.96 $205.96 $213.90 $144.58 $57.83 $277.50 $111.00 $277.50 $277.50 $277.50 $277.50 $277.50 $208.13 $277.50 $277.50 $277.50 $138.75 $138.75 $219.78 $277.50 $222.00 $180.38 $277.50 N/A $160.95 $277.50 $166.50 $277.50 $277.50 $277.50 N/A N/A HT-3010 SUP HCPCS C1713 HT-3010 - SCREW BN ACUTRAC DRVR CNN TIP BOTH IP/OP $470.00 $348.00 $93.28 $470.00 $211.50 $211.50 $211.50 $211.50 $470.00 $470.00 $470.00 $97.96 $470.00 $470.00 $470.00 $470.00 $470.00 $97.95 $470.00 $470.00 $278.01 $470.00 $470.00 $470.00 $470.00 $352.50 $470.00 $470.00 $470.00 $235.00 $235.00 $372.24 $470.00 $376.00 $211.50 $93.28 N/A $272.60 $470.00 $282.00 $470.00 $97.95 $470.00 N/A N/A HT-3012 SUP Custom 27203010 HT-3012 - TIP SCRDRVR 3MM QRLSE SLD HEX BOTH IP/OP $277.50 $205.00 $49.40 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $49.40 $277.50 $277.50 $205.96 $205.96 $213.90 $144.58 $57.83 $277.50 $111.00 $277.50 $277.50 $277.50 $277.50 $277.50 $208.13 $277.50 $277.50 $277.50 $138.75 $138.75 $219.78 $277.50 $222.00 $180.38 $277.50 N/A $160.95 $277.50 $166.50 $277.50 $277.50 $277.50 N/A N/A HT-4000 SUP Custom 27203010 HT-4000 - DRIVER SRG 4MM CNN BOTH IP/OP $487.50 $361.00 $86.78 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $487.50 $86.78 $487.50 $487.50 $361.82 $361.82 $375.77 $253.99 $101.60 $487.50 $195.00 $487.50 $487.50 $487.50 $487.50 $487.50 $365.63 $487.50 $487.50 $487.50 $243.75 $243.75 $386.10 $487.50 $390.00 $316.88 $487.50 N/A $282.75 $487.50 $292.50 $487.50 $487.50 $487.50 N/A N/A HT-4001 SUP Custom 27203010 HT-4001 - TIP SCRDRVR 4MM SLD HEX BOTH IP/OP $277.50 $205.00 $49.40 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $49.40 $277.50 $277.50 $205.96 $205.96 $213.90 $144.58 $57.83 $277.50 $111.00 $277.50 $277.50 $277.50 $277.50 $277.50 $208.13 $277.50 $277.50 $277.50 $138.75 $138.75 $219.78 $277.50 $222.00 $180.38 $277.50 N/A $160.95 $277.50 $166.50 $277.50 $277.50 $277.50 N/A N/A HW-0034 SUP HCPCS C1713 HW-0034 - SCREW BN .25IN 8-32IN DRL HNDL SET BOTH IP/OP $2.50 $2.00 $0.50 $2.50 $1.13 $1.13 $1.13 $1.13 $2.50 $2.50 $2.50 $0.52 $2.50 $2.50 $2.50 $2.50 $2.50 $0.52 $2.50 $2.50 $1.48 $2.50 $2.50 $2.50 $2.50 $1.88 $2.50 $2.50 $2.50 $1.25 $1.25 $1.98 $2.50 $2.00 $1.13 $0.50 N/A $1.45 $2.50 $1.50 $2.50 $0.52 $2.50 N/A N/A I20-13/C70F SUP Custom 27803010 I20-13/C70F - GRAFT STNT STRG 20-13MM 17FR 70MM AFX ACTIVESEAL STRATA SLF BOTH IP/OP "$8,237.50" "$6,096.00" "$1,466.28" "$8,237.50" "$8,237.50" "$8,237.50" "$8,237.50" "$8,237.50" "$8,237.50" "$8,237.50" "$1,466.28" "$8,237.50" "$8,237.50" "$8,237.50" "$8,237.50" "$8,237.50" "$8,237.50" "$1,716.79" "$8,237.50" "$3,295.00" "$8,237.50" "$8,237.50" "$8,237.50" "$8,237.50" "$8,237.50" "$6,178.13" "$8,237.50" "$8,237.50" "$8,237.50" "$4,118.75" "$4,118.75" "$6,524.10" "$8,237.50" "$6,590.00" "$3,706.88" "$8,237.50" N/A "$4,777.75" "$8,237.50" "$4,942.50" "$8,237.50" "$8,237.50" "$8,237.50" N/A N/A I20-13/C88F SUP Custom 27803010 I20-13/C88F - GRAFT STNT STRG 20-13MM 17FR 88MM AFX ACTIVESEAL STRATA SLF BOTH IP/OP "$8,187.50" "$6,059.00" "$1,457.38" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$1,457.38" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$1,706.37" "$8,187.50" "$3,275.00" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$6,140.63" "$8,187.50" "$8,187.50" "$8,187.50" "$4,093.75" "$4,093.75" "$6,484.50" "$8,187.50" "$6,550.00" "$3,684.38" "$8,187.50" N/A "$4,748.75" "$8,187.50" "$4,912.50" "$8,187.50" "$8,187.50" "$8,187.50" N/A N/A I20-13/C88F SA SUP Custom 27803010 I20-13/C88F SA - GRAFT STNT 20-13MM 88MM STRL LF AFX STRATA ILC LMB AAA BOTH IP/OP "$8,187.50" "$6,059.00" "$1,457.38" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$1,457.38" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$1,706.37" "$8,187.50" "$3,275.00" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$8,187.50" "$6,140.63" "$8,187.50" "$8,187.50" "$8,187.50" "$4,093.75" "$4,093.75" "$6,484.50" "$8,187.50" "$6,550.00" "$3,684.38" "$8,187.50" N/A "$4,748.75" "$8,187.50" "$4,912.50" "$8,187.50" "$8,187.50" "$8,187.50" N/A N/A I20-20/C55F SUP Custom 27803010 I20-20/C55F - GRAFT STNT STRG 20MM 17FR 55MM AFX ACTIVESEAL STRATA SLF BOTH IP/OP "$6,700.00" "$4,958.00" "$1,192.60" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$1,192.60" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$1,396.35" "$6,700.00" "$2,680.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$6,700.00" "$5,025.00" "$6,700.00" "$6,700.00" "$6,700.00" "$3,350.00" "$3,350.00" "$5,306.40" "$6,700.00" "$5,360.00" "$3,015.00" "$6,700.00" N/A "$3,886.00" "$6,700.00" "$4,020.00" "$6,700.00" "$6,700.00" "$6,700.00" N/A N/A IAB05830-LWS SUP HCPCS C1714 IAB05830-LWS - CATHETER IAB .025IN 8FR 15CM 64.3CM FLEXIBLE GWIRE STOPCOCK BOTH IP/OP "$3,452.00" "$2,554.00" $719.37 "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$2,561.85" "$2,561.85" "$2,660.57" "$1,798.34" $719.37 "$3,451.70" "$1,380.68" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$2,589.00" "$3,451.70" "$3,451.70" "$3,451.70" "$1,725.85" "$1,725.85" "$2,733.75" "$3,451.70" "$2,761.36" "$2,243.61" "$3,451.70" N/A "$2,002.16" "$3,451.70" "$2,071.02" "$3,451.70" "$3,451.70" "$3,451.70" N/A N/A IAB-05840-LWS SUP HCPCS C1714 IAB-05840-LWS - CATHETER IABP 8FR LATEX FREE FIBEROPTIX 40ML BOTH IP/OP "$3,452.00" "$2,554.00" $719.37 "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$2,561.85" "$2,561.85" "$2,660.57" "$1,798.34" $719.37 "$3,451.70" "$1,380.68" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$3,451.70" "$2,589.00" "$3,451.70" "$3,451.70" "$3,451.70" "$1,725.85" "$1,725.85" "$2,733.75" "$3,451.70" "$2,761.36" "$2,243.61" "$3,451.70" N/A "$2,002.16" "$3,451.70" "$2,071.02" "$3,451.70" "$3,451.70" "$3,451.70" N/A N/A IAS12-150 SUP Custom 27203010 iAS12-150 - PORT HND ACC 12MM 150MM AIRSEAL OBT OPTC TIP ATO VNT INTC BOTH IP/OP $37.00 $27.00 $6.53 $36.69 $36.69 $36.69 $36.69 $36.69 $36.69 $36.69 $6.53 $36.69 $36.69 $27.23 $27.23 $28.28 $19.12 $7.65 $36.69 $14.68 $36.69 $36.69 $36.69 $36.69 $36.69 $27.75 $36.69 $36.69 $36.69 $18.35 $18.35 $29.06 $36.69 $29.35 $23.85 $36.69 N/A $21.46 $36.69 $22.01 $36.69 $36.69 $36.69 N/A N/A IAS5-120LP SUP Custom 27203010 IAS5-120LP - PORT ACC 5MM 120MM AIRSEAL 2 WL CNN LOPRFL OBT BLDLS OPTC BOTH IP/OP $292.00 $216.00 $51.92 $291.67 $291.67 $291.67 $291.67 $291.67 $291.67 $291.67 $51.92 $291.67 $291.67 $216.48 $216.48 $224.82 $151.96 $60.79 $291.67 $116.67 $291.67 $291.67 $291.67 $291.67 $291.67 $219.00 $291.67 $291.67 $291.67 $145.84 $145.84 $231.00 $291.67 $233.34 $189.59 $291.67 N/A $169.36 $291.67 $175.00 $291.67 $291.67 $291.67 N/A N/A IAS8-120LP SUP Custom 27203010 IAS8-120LP - OBTURATOR ESCP LOPRFL 8MM 120MM AIRSEAL ACC PORT BLDLS OPTC BOTH IP/OP $300.00 $222.00 $53.40 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $53.40 $300.00 $300.00 $222.66 $222.66 $231.24 $156.30 $62.52 $300.00 $120.00 $300.00 $300.00 $300.00 $300.00 $300.00 $225.00 $300.00 $300.00 $300.00 $150.00 $150.00 $237.60 $300.00 $240.00 $195.00 $300.00 N/A $174.00 $300.00 $180.00 $300.00 $300.00 $300.00 N/A N/A IBI-85641 SUP Custom 27203010 IBI-85641 - CABLE CATH 8FT STRL LF REUSE BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A IBI-85931 SUP Custom 27203010 IBI-85931 - CABLE CATH 150CM INQ 24 PIN CNCT DX BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A IBI-87008 SUP HCPCS C1731 IBI-87008 - CATHETER EP 4MM SPC 7FR 20MM 110CM INQ AFOCUS II 20 ELTRD MP BOTH IP/OP "$3,800.00" "$2,812.00" $754.21 "$3,800.00" "$2,063.40" "$2,063.40" "$2,063.40" "$2,063.40" "$3,800.00" "$3,800.00" "$3,800.00" $792.02 "$3,800.00" "$2,820.36" "$2,820.36" "$2,929.04" "$1,979.80" $791.96 "$3,800.00" "$3,800.00" "$2,247.70" "$3,800.00" "$3,800.00" "$3,800.00" "$3,800.00" "$2,850.00" "$3,800.00" "$3,800.00" "$3,800.00" "$1,900.00" "$1,900.00" "$3,009.60" "$3,800.00" "$3,040.00" "$2,470.00" $754.21 N/A "$2,204.00" "$3,800.00" "$3,800.00" "$3,800.00" $791.92 "$3,800.00" N/A N/A ICV1102 SUP HCPCS C1785 ICV1102 - PACEMAKER CRD REPLY 2 CHMBR BOTH IP/OP "$10,500.00" "$7,770.00" "$2,083.99" "$10,500.00" "$4,725.00" "$4,725.00" "$4,725.00" "$4,725.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.46" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.32" "$10,500.00" "$10,500.00" "$5,176.50" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$7,875.00" "$10,500.00" "$10,500.00" "$10,500.00" "$5,250.00" "$5,250.00" "$8,316.00" "$10,500.00" "$8,400.00" "$4,725.00" "$2,083.99" N/A "$6,090.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.20" "$10,500.00" N/A N/A ICV1102 SYSTEM SUP HCPCS C1785 ICV1102 System - Reply DR V2 System BOTH IP/OP "$12,500.00" "$9,250.00" "$2,480.94" "$12,500.00" "$5,625.00" "$5,625.00" "$5,625.00" "$5,625.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,605.31" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,605.14" "$12,500.00" "$12,500.00" "$6,162.50" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$9,375.00" "$12,500.00" "$12,500.00" "$12,500.00" "$6,250.00" "$6,250.00" "$9,900.00" "$12,500.00" "$10,000.00" "$5,625.00" "$2,480.94" N/A "$7,250.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,605.00" "$12,500.00" N/A N/A ICV1116 SUP HCPCS C1786 ICV1116 - PACEMAKER CRD ESPRT DR BOTH IP/OP "$9,125.00" "$6,753.00" "$1,811.08" "$9,125.00" "$4,106.25" "$4,106.25" "$4,106.25" "$4,106.25" "$9,125.00" "$9,125.00" "$9,125.00" "$1,901.88" "$9,125.00" "$9,125.00" "$9,125.00" "$9,125.00" "$9,125.00" "$1,901.75" "$9,125.00" "$9,125.00" "$4,498.63" "$9,125.00" "$9,125.00" "$9,125.00" "$9,125.00" "$6,843.75" "$9,125.00" "$9,125.00" "$9,125.00" "$4,562.50" "$4,562.50" "$7,227.00" "$9,125.00" "$7,300.00" "$4,106.25" "$1,811.08" N/A "$5,292.50" "$9,125.00" "$9,125.00" "$9,125.00" "$1,901.65" "$9,125.00" N/A N/A ICV1116 SYSTEM SUP HCPCS C1785 ICV1116 System - Esprit DR System BOTH IP/OP "$11,610.00" "$8,591.00" "$2,304.29" "$11,610.00" "$5,224.50" "$5,224.50" "$5,224.50" "$5,224.50" "$11,610.00" "$11,610.00" "$11,610.00" "$2,419.81" "$11,610.00" "$11,610.00" "$11,610.00" "$11,610.00" "$11,610.00" "$2,419.65" "$11,610.00" "$11,610.00" "$5,723.73" "$11,610.00" "$11,610.00" "$11,610.00" "$11,610.00" "$8,707.50" "$11,610.00" "$11,610.00" "$11,610.00" "$5,805.00" "$5,805.00" "$9,195.12" "$11,610.00" "$9,288.00" "$5,224.50" "$2,304.29" N/A "$6,733.80" "$11,610.00" "$11,610.00" "$11,610.00" "$2,419.52" "$11,610.00" N/A N/A ICV1122 SUP HCPCS C1786 ICV1122 - PACEMAKER CRD REPLY 1 CHMBR BOTH IP/OP "$8,250.00" "$6,105.00" "$1,637.42" "$8,250.00" "$3,712.50" "$3,712.50" "$3,712.50" "$3,712.50" "$8,250.00" "$8,250.00" "$8,250.00" "$1,719.51" "$8,250.00" "$8,250.00" "$8,250.00" "$8,250.00" "$8,250.00" "$1,719.39" "$8,250.00" "$8,250.00" "$4,067.25" "$8,250.00" "$8,250.00" "$8,250.00" "$8,250.00" "$6,187.50" "$8,250.00" "$8,250.00" "$8,250.00" "$4,125.00" "$4,125.00" "$6,534.00" "$8,250.00" "$6,600.00" "$3,712.50" "$1,637.42" N/A "$4,785.00" "$8,250.00" "$8,250.00" "$8,250.00" "$1,719.30" "$8,250.00" N/A N/A ICV1122 SYSTEM SUP HCPCS C1786 ICV1122 System - Reply SR V2 System BOTH IP/OP "$9,500.00" "$7,030.00" "$1,885.51" "$9,500.00" "$4,275.00" "$4,275.00" "$4,275.00" "$4,275.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,980.04" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.90" "$9,500.00" "$9,500.00" "$4,683.50" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$7,125.00" "$9,500.00" "$9,500.00" "$9,500.00" "$4,750.00" "$4,750.00" "$7,524.00" "$9,500.00" "$7,600.00" "$4,275.00" "$1,885.51" N/A "$5,510.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.80" "$9,500.00" N/A N/A ICV1127 SUP HCPCS C1786 ICV1127 - PACEMAKER CRD ESPRT SR BOTH IP/OP "$6,962.50" "$5,152.00" "$1,381.88" "$6,962.50" "$3,133.13" "$3,133.13" "$3,133.13" "$3,133.13" "$6,962.50" "$6,962.50" "$6,962.50" "$1,451.16" "$6,962.50" "$6,962.50" "$6,962.50" "$6,962.50" "$6,962.50" "$1,451.06" "$6,962.50" "$6,962.50" "$3,432.51" "$6,962.50" "$6,962.50" "$6,962.50" "$6,962.50" "$5,221.88" "$6,962.50" "$6,962.50" "$6,962.50" "$3,481.25" "$3,481.25" "$5,514.30" "$6,962.50" "$5,570.00" "$3,133.13" "$1,381.88" N/A "$4,038.25" "$6,962.50" "$6,962.50" "$6,962.50" "$1,450.99" "$6,962.50" N/A N/A ICV1127 SYSTEM SUP HCPCS C1786 ICV1127 System - Esprit SR System BOTH IP/OP "$8,205.00" "$6,072.00" "$1,628.49" "$8,205.00" "$3,692.25" "$3,692.25" "$3,692.25" "$3,692.25" "$8,205.00" "$8,205.00" "$8,205.00" "$1,710.13" "$8,205.00" "$8,205.00" "$8,205.00" "$8,205.00" "$8,205.00" "$1,710.01" "$8,205.00" "$8,205.00" "$4,045.07" "$8,205.00" "$8,205.00" "$8,205.00" "$8,205.00" "$6,153.75" "$8,205.00" "$8,205.00" "$8,205.00" "$4,102.50" "$4,102.50" "$6,498.36" "$8,205.00" "$6,564.00" "$3,692.25" "$1,628.49" N/A "$4,758.90" "$8,205.00" "$8,205.00" "$8,205.00" "$1,709.92" "$8,205.00" N/A N/A ICV1179 SUP HCPCS C1882 ICV1179 - DEFIBRILLATOR CRD PARADYM CRT ICD BOTH IP/OP "$44,412.50" "$32,865.00" "$7,712.84" "$44,412.50" "$19,985.63" "$19,985.63" "$19,985.63" "$19,985.63" "$44,412.50" "$44,412.50" "$44,412.50" "$9,256.68" "$44,412.50" "$44,412.50" "$44,412.50" "$44,412.50" "$44,412.50" "$9,256.05" "$44,412.50" "$44,412.50" "$21,895.36" "$44,412.50" "$44,412.50" "$44,412.50" "$44,412.50" "$33,309.38" "$44,412.50" "$44,412.50" "$44,412.50" "$22,206.25" "$22,206.25" "$35,174.70" "$44,412.50" "$35,530.00" "$19,985.63" "$7,712.84" N/A "$25,759.25" "$44,412.50" "$44,412.50" "$44,412.50" "$8,098.48" "$44,412.50" N/A N/A ICV1179 SYSTEM SUP HCPCS C1882 ICV1179 System - Paradym CRT-D 8750 System BOTH IP/OP "$58,187.50" "$43,059.00" "$7,712.84" "$58,187.50" "$26,184.38" "$26,184.38" "$26,184.38" "$26,184.38" "$58,187.50" "$58,187.50" "$58,187.50" "$9,417.94" "$58,187.50" "$58,187.50" "$58,187.50" "$58,187.50" "$58,187.50" "$12,126.92" "$58,187.50" "$58,187.50" "$28,686.44" "$58,187.50" "$58,187.50" "$58,187.50" "$58,187.50" "$43,640.63" "$58,187.50" "$58,187.50" "$58,187.50" "$29,093.75" "$29,093.75" "$46,084.50" "$58,187.50" "$46,550.00" "$26,184.38" "$7,712.84" N/A "$33,748.75" "$58,187.50" "$58,187.50" "$58,187.50" "$8,098.48" "$58,187.50" N/A N/A ICV1199 SUP HCPCS C1722 ICV1199 - DEFIBRILLATOR CRD PARADYM VR ICD BOTH IP/OP "$36,575.00" "$27,066.00" "$7,259.22" "$36,575.00" "$16,458.75" "$16,458.75" "$16,458.75" "$16,458.75" "$36,575.00" "$36,575.00" "$36,575.00" "$7,623.14" "$36,575.00" "$36,575.00" "$36,575.00" "$36,575.00" "$36,575.00" "$7,622.63" "$36,575.00" "$36,575.00" "$18,031.48" "$36,575.00" "$36,575.00" "$36,575.00" "$36,575.00" "$27,431.25" "$36,575.00" "$36,575.00" "$36,575.00" "$18,287.50" "$18,287.50" "$28,967.40" "$36,575.00" "$29,260.00" "$16,458.75" "$7,259.22" N/A "$21,213.50" "$36,575.00" "$36,575.00" "$36,575.00" "$7,622.23" "$36,575.00" N/A N/A ICV1200 SUP HCPCS C1721 ICV1200 - DEFIBRILLATOR CRD PARADYM DR ICD BOTH IP/OP "$42,512.50" "$31,459.00" "$8,860.07" "$42,512.50" "$42,512.50" "$42,512.50" "$42,512.50" "$42,512.50" "$42,512.50" "$42,512.50" "$42,512.50" "$42,512.50" "$42,512.50" "$42,512.50" "$42,512.50" "$42,512.50" "$42,512.50" "$8,860.07" "$42,512.50" "$17,005.00" "$42,512.50" "$42,512.50" "$42,512.50" "$42,512.50" "$42,512.50" "$31,884.38" "$42,512.50" "$42,512.50" "$42,512.50" "$21,256.25" "$21,256.25" "$33,669.90" "$42,512.50" "$34,010.00" "$19,130.63" "$42,512.50" N/A "$24,657.25" "$42,512.50" "$25,507.50" "$42,512.50" "$42,512.50" "$42,512.50" N/A N/A ICV1258 SUP HCPCS C1785 ICV1258 - Reply DR BOTH IP/OP "$9,125.00" "$6,753.00" "$1,811.08" "$9,125.00" "$4,106.25" "$4,106.25" "$4,106.25" "$4,106.25" "$9,125.00" "$9,125.00" "$9,125.00" "$1,901.88" "$9,125.00" "$9,125.00" "$9,125.00" "$9,125.00" "$9,125.00" "$1,901.75" "$9,125.00" "$9,125.00" "$4,498.63" "$9,125.00" "$9,125.00" "$9,125.00" "$9,125.00" "$6,843.75" "$9,125.00" "$9,125.00" "$9,125.00" "$4,562.50" "$4,562.50" "$7,227.00" "$9,125.00" "$7,300.00" "$4,106.25" "$1,811.08" N/A "$5,292.50" "$9,125.00" "$9,125.00" "$9,125.00" "$1,901.65" "$9,125.00" N/A N/A ICV1258 SYSTEM SUP HCPCS C1785 ICV1258 SYSTEM - Reply DR System BOTH IP/OP "$11,610.00" "$8,591.00" "$2,304.29" "$11,610.00" "$5,224.50" "$5,224.50" "$5,224.50" "$5,224.50" "$11,610.00" "$11,610.00" "$11,610.00" "$2,419.81" "$11,610.00" "$11,610.00" "$11,610.00" "$11,610.00" "$11,610.00" "$2,419.65" "$11,610.00" "$11,610.00" "$5,723.73" "$11,610.00" "$11,610.00" "$11,610.00" "$11,610.00" "$8,707.50" "$11,610.00" "$11,610.00" "$11,610.00" "$5,805.00" "$5,805.00" "$9,195.12" "$11,610.00" "$9,288.00" "$5,224.50" "$2,304.29" N/A "$6,733.80" "$11,610.00" "$11,610.00" "$11,610.00" "$2,419.52" "$11,610.00" N/A N/A ID-1-5 SUP Custom 27203010 ID-1-5 - SET TBG AQUILEX FL CNTRL INFL BOTH IP/OP $58.00 $43.00 $10.28 $57.75 $57.75 $57.75 $57.75 $57.75 $57.75 $57.75 $10.28 $57.75 $57.75 $42.86 $42.86 $44.51 $30.09 $12.04 $57.75 $23.10 $57.75 $57.75 $57.75 $57.75 $57.75 $43.50 $57.75 $57.75 $57.75 $28.88 $28.88 $45.74 $57.75 $46.20 $37.54 $57.75 N/A $33.64 $57.75 $34.65 $57.75 $57.75 $57.75 N/A N/A ID3305 SUP Custom 27803010 ID3305 - GRAFT SOFT TISSUE 3X3IN PATCH RESORB SUTURABLE DURAGEN BOTH IP/OP "$2,069.00" "$1,531.00" $368.24 "$2,068.76" "$2,068.76" "$2,068.76" "$2,068.76" "$2,068.76" "$2,068.76" "$2,068.76" $368.24 "$2,068.76" "$2,068.76" "$2,068.76" "$2,068.76" "$2,068.76" "$2,068.76" $431.15 "$2,068.76" $827.50 "$2,068.76" "$2,068.76" "$2,068.76" "$2,068.76" "$2,068.76" "$1,551.75" "$2,068.76" "$2,068.76" "$2,068.76" "$1,034.38" "$1,034.38" "$1,638.46" "$2,068.76" "$1,655.01" $930.94 "$2,068.76" N/A "$1,200.02" "$2,068.76" "$1,241.26" "$2,068.76" "$2,068.76" "$2,068.76" N/A N/A IJ27U SUP HCPCS C1898 IJ27U - LEAD PACING 58CM ACTIVE FIX ISOLINE BOTH IP/OP "$10,000.00" "$7,400.00" "$2,084.11" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$4,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$10,000.00" N/A "$5,800.00" "$10,000.00" "$6,000.00" "$10,000.00" "$10,000.00" "$10,000.00" N/A N/A IM3ST SUP Custom 27803010 IM3ST - KIT PRESSURE MONITR 3 LUMEN BOLT OXYGEN PROBE TEMPERATURE BOTH IP/OP "$3,115.00" "$2,305.00" $554.47 "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" $554.47 "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" $649.20 "$3,115.00" "$1,246.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$3,115.00" "$2,336.25" "$3,115.00" "$3,115.00" "$3,115.00" "$1,557.50" "$1,557.50" "$2,467.08" "$3,115.00" "$2,492.00" "$1,401.75" "$3,115.00" N/A "$1,806.70" "$3,115.00" "$1,869.00" "$3,115.00" "$3,115.00" "$3,115.00" N/A N/A IN2130 SUP HCPCS C1726 IN2130 - DEVICE INFL 30 ATM 14IN CLR LF MNRCH XTN TBG PLYCRB BOTH IP/OP $142.50 $105.00 $28.28 $142.50 $77.38 $77.38 $77.38 $77.38 $142.50 $142.50 $142.50 $29.70 $142.50 $105.76 $105.76 $109.84 $74.24 $29.70 $142.50 $142.50 $84.29 $142.50 $142.50 $142.50 $142.50 $106.88 $142.50 $142.50 $142.50 $71.25 $71.25 $112.86 $142.50 $114.00 $92.63 $28.28 N/A $82.65 $142.50 $142.50 $142.50 $29.70 $142.50 N/A N/A IN2130 SUP HCPCS C1726 IN2130 - DEVICE INFLAT 30 ATM 14IN EXTN TUBING LATEX FREE MONARCH BOTH IP/OP $142.50 $105.00 $28.28 $142.50 $77.38 $77.38 $77.38 $77.38 $142.50 $142.50 $142.50 $29.70 $142.50 $105.76 $105.76 $109.84 $74.24 $29.70 $142.50 $142.50 $84.29 $142.50 $142.50 $142.50 $142.50 $106.88 $142.50 $142.50 $142.50 $71.25 $71.25 $112.86 $142.50 $114.00 $92.63 $28.28 N/A $82.65 $142.50 $142.50 $142.50 $29.70 $142.50 N/A N/A INS5010 SUP HCPCS C1729 INS5010 - CATHETER DRN 1.5MM .7MM 80CM STRL LF HRMTC TUO CLS TIP LL BOTH IP/OP $636.00 $471.00 $126.22 $635.93 $345.31 $345.31 $345.31 $345.31 $635.93 $635.93 $635.93 $132.54 $635.93 $471.99 $471.99 $490.17 $331.32 $132.53 $635.93 $635.93 $376.15 $635.93 $635.93 $635.93 $635.93 $477.00 $635.93 $635.93 $635.93 $317.97 $317.97 $503.66 $635.93 $508.74 $413.35 $126.22 N/A $368.88 $635.93 $635.93 $635.93 $132.53 $635.93 N/A N/A INS8401 SUP Custom 27803010 INS8401 - SYSTEM DRN 35CM 700ML BLU STRL LF BE2 MNTR TRNDCR ATCH VNTRC BOTH IP/OP $742.00 $549.00 $132.00 $763.85 $741.60 $741.60 $741.60 $741.60 $741.60 $741.60 $132.00 $741.60 $741.60 $741.60 $741.60 $741.60 $741.60 $154.56 $741.60 $305.54 $741.60 $741.60 $763.85 $741.60 $741.60 $556.50 $741.60 $741.60 $741.60 $370.80 $370.80 $587.35 $741.60 $593.28 $333.72 $741.60 N/A $430.36 $741.60 $444.96 $741.60 $741.60 $741.60 N/A N/A INS8420 SUP Custom 27803010 INS8420 - KIT XTRN DRN 1.9MM VNTRC BOTH IP/OP $361.50 $268.00 $64.30 $361.25 $361.25 $361.25 $361.25 $361.25 $361.25 $361.25 $64.30 $361.25 $361.25 $361.25 $361.25 $361.25 $361.25 $75.29 $361.25 $144.50 $361.25 $361.25 $361.25 $361.25 $361.25 $271.13 $361.25 $361.25 $361.25 $180.63 $180.63 $286.11 $361.25 $289.00 $162.56 $361.25 N/A $209.67 $361.25 $216.75 $361.25 $361.25 $361.25 N/A N/A INS8700 SUP Custom 27011340 INS8700 - BAG XTRN DRN 700ML EDS 3 CSF CLT BOTH IP/OP $824.50 $610.00 $65.95 $824.38 $824.38 $824.38 $824.38 $824.38 $824.38 $824.38 $146.74 $824.38 $824.38 $611.85 $611.85 $635.43 $429.50 $171.81 $824.38 $65.95 $824.38 $824.38 $164.88 $824.38 $824.38 $618.38 $824.38 $824.38 $824.38 $412.19 $412.19 $652.91 $824.38 $659.50 $535.85 $824.38 N/A $478.21 $824.38 $494.63 $824.38 $824.38 $824.38 N/A N/A INT-105-19 SUP HCPCS C1894 INT-105-19 - INTRODUCER SHTH 16FR 15CM PTFE BOTH IP/OP $52.50 $39.00 $10.42 $52.50 $28.51 $28.51 $28.51 $28.51 $52.50 $52.50 $52.50 $10.94 $52.50 $38.97 $38.97 $40.47 $27.35 $10.94 $52.50 $52.50 $31.05 $52.50 $52.50 $52.50 $52.50 $39.38 $52.50 $52.50 $52.50 $26.25 $26.25 $41.58 $52.50 $42.00 $34.13 $10.42 N/A $30.45 $52.50 $52.50 $52.50 $10.94 $52.50 N/A N/A INT-105-45 SUP HCPCS C1894 INT-105-45 - INTRODUCER TEAR AWAY 120F X 30CM BOTH IP/OP $125.00 $93.00 $24.81 $125.00 $67.88 $67.88 $67.88 $67.88 $125.00 $125.00 $125.00 $26.05 $125.00 $92.78 $92.78 $96.35 $65.13 $26.05 $125.00 $125.00 $73.94 $125.00 $125.00 $125.00 $125.00 $93.75 $125.00 $125.00 $125.00 $62.50 $62.50 $99.00 $125.00 $100.00 $81.25 $24.81 N/A $72.50 $125.00 $125.00 $125.00 $26.05 $125.00 N/A N/A INT22512UX SUP HCPCS C1876 INT22512UX - SYSTEM COR STNT 2.25MM 12MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT22522UX SUP HCPCS C1874 INT22522UX - SYSTEM COR STNT 2.25MM 22MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT22526UX SUP HCPCS C1874 INT22526UX - SYSTEM COR STNT 2.25MM 26MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,625.00" "$1,203.00" $322.52 "$1,625.00" $731.25 $731.25 $731.25 $731.25 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 $322.52 N/A $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A INT25008UX SUP HCPCS C1877 INT25008UX - SYSTEM COR STNT 2.5MM 8MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT25012UX SUP HCPCS C1874 INT25012UX - SYSTEM COR STNT 2.5MM 12MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT25014UX SUP HCPCS C1874 INT25014UX - SYSTEM COR STNT 2.5MM 14MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT25022UX SUP HCPCS C1874 INT25022UX - SYSTEM COR STNT 2.5MM 22MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,625.00" "$1,203.00" $322.52 "$1,625.00" $731.25 $731.25 $731.25 $731.25 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 $322.52 N/A $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A INT25026UX SUP HCPCS C1874 INT25026UX - SYSTEM COR STNT 2.5MM 26MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT27508UX SUP HCPCS C1874 INT27508UX - SYSTEM COR STNT 2.75MM 8MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT27512UX SUP HCPCS C1874 INT27512UX - SYSTEM COR STNT 2.75MM 12MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT27514UX SUP HCPCS C1874 INT27514UX - SYSTEM COR STNT 2.75MM 14MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT27518UX SUP HCPCS C1874 INT27518UX - SYSTEM COR STNT 2.75MM 18MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,625.00" "$1,203.00" $322.52 "$1,625.00" $731.25 $731.25 $731.25 $731.25 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 $322.52 N/A $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A INT30009UX SUP HCPCS C1876 INT30009UX - SYSTEM COR STNT 3MM 9MM INTGR MICROTRAC RX 1 STRN INTGR TIP BOTH IP/OP "$1,625.00" "$1,203.00" $322.52 "$1,625.00" $731.25 $731.25 $731.25 $731.25 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 $322.52 N/A $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A INT30012UX SUP HCPCS C1874 INT30012UX - SYSTEM COR STNT 3MM 12MM INTGR MICROTRAC RX 1 STRN INTGR TIP BOTH IP/OP "$1,625.00" "$1,203.00" $322.52 "$1,625.00" $731.25 $731.25 $731.25 $731.25 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 $322.52 N/A $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A INT30018UX SUP HCPCS C1874 INT30018UX - SYSTEM COR STNT 3MM 18MM INTGR MICROTRAC RX 1 STRN INTGR TIP BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT30022UX SUP HCPCS C1874 INT30022UX - SYSTEM COR STNT 3MM 22MM INTGR MICROTRAC RX 1 STRN INTGR TIP BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT30026UX SUP HCPCS C1874 INT30026UX - SYSTEM COR STNT 3MM 26MM INTGR MICROTRAC RX 1 STRN INTGR TIP BOTH IP/OP "$1,625.00" "$1,203.00" $322.52 "$1,625.00" $731.25 $731.25 $731.25 $731.25 "$1,625.00" "$1,625.00" "$1,625.00" $338.69 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" $338.67 "$1,625.00" "$1,625.00" $961.19 "$1,625.00" "$1,625.00" "$1,625.00" "$1,625.00" "$1,218.75" "$1,625.00" "$1,625.00" "$1,625.00" $812.50 $812.50 "$1,287.00" "$1,625.00" "$1,300.00" $731.25 $322.52 N/A $942.50 "$1,625.00" "$1,625.00" "$1,625.00" $338.65 "$1,625.00" N/A N/A INT35026UX SUP HCPCS C1874 INT35026UX - SYSTEM COR STNT 3.5MM 26MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT35030UX SUP HCPCS C1874 INT35030UX - SYSTEM COR STNT 3.5MM 30MM INTGR MICROTRAC RX 1 STRN INTGR BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT40009UX SUP HCPCS C1874 INT40009UX - SYSTEM COR STNT 4MM 9MM INTGR MICROTRAC RX 1 STRN INTGR TIP BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT40012UX SUP HCPCS C1876 INT40012UX - SYSTEM COR STNT 4MM 12MM INTGR MICROTRAC RX 1 STRN INTGR TIP BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT40015UX SUP HCPCS C1874 INT40015UX - SYSTEM COR STNT 4MM 15MM INTGR MICROTRAC RX 1 STRN INTGR TIP BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT40018UX SUP HCPCS C1874 INT40018UX - SYSTEM COR STNT 4MM 18MM INTGR MICROTRAC RX 1 STRN INTGR TIP BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT40022UX SUP HCPCS C1874 INT40022UX - SYSTEM COR STNT 4MM 22MM INTGR MICROTRAC RX 1 STRN INTGR TIP BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT40026UX SUP HCPCS C1874 INT40026UX - SYSTEM COR STNT 4MM 26MM INTGR MICROTRAC RX 1 STRN INTGR TIP BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A INT40030UX SUP HCPCS C1874 INT40030UX - SYSTEM COR STNT 4MM 30MM INTGR MICROTRAC RX 1 STRN INTGR TIP BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $787.50 $787.50 $787.50 $787.50 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" $787.50 $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A IPC-5000E SUP Custom 27203010 IPC-5000E - CATHETER PRESSURE 3.5MM 5MM 82CM 2CM SENSOR TIP EXTERNAL BOTH IP/OP $57.00 $42.00 $10.12 $56.88 $56.88 $56.88 $56.88 $56.88 $56.88 $56.88 $10.12 $56.88 $56.88 $42.22 $42.22 $43.84 $29.63 $11.85 $56.88 $28.00 $56.88 $56.88 $56.88 $56.88 $56.88 $42.75 $56.88 $56.88 $56.88 $28.44 $28.44 $45.05 $56.88 $45.50 $36.97 $56.88 N/A $33.06 $56.88 $34.13 $56.88 $56.88 $56.88 N/A N/A IR-500 SUP Custom 27203010 IR-500 - SET IRRIGATION 300- MMHG 2 SPIKE 213CM FLUID WARM HEAT BOTH IP/OP $97.00 $72.00 $17.18 $96.53 $96.53 $96.53 $96.53 $96.53 $96.53 $96.53 $17.18 $96.53 $96.53 $71.64 $71.64 $74.41 $50.29 $20.12 $96.53 $38.61 $96.53 $96.53 $96.53 $96.53 $96.53 $72.75 $96.53 $96.53 $96.53 $48.27 $48.27 $76.45 $96.53 $77.22 $62.74 $96.53 N/A $56.26 $96.53 $57.92 $96.53 $96.53 $96.53 N/A N/A IRC115 SUP Custom 27203010 IRC115 - SYSTEM IRRIGATION INTEGRATED POWER CONSOLE LEGEND EHS BOTH IP/OP "$4,710.00" "$3,485.00" $838.38 "$4,710.00" "$4,710.00" "$4,710.00" "$4,710.00" "$4,710.00" "$4,710.00" "$4,710.00" $838.38 "$4,710.00" "$4,710.00" "$3,495.76" "$3,495.76" "$3,630.47" "$2,060.15" $981.62 "$4,710.00" "$1,884.00" "$4,710.00" "$4,710.00" "$4,710.00" "$4,710.00" "$4,710.00" "$3,532.50" "$4,710.00" "$4,710.00" "$4,710.00" "$2,355.00" "$2,355.00" "$3,730.32" "$4,710.00" "$3,768.00" "$3,061.50" "$4,710.00" N/A "$2,731.80" "$4,710.00" "$2,826.00" "$4,710.00" "$4,710.00" "$4,710.00" N/A N/A IRC230 SUP Custom 27203010 IRC230 - TOOL DISSECTING IRRIGATION CONSOLE MIDAS REX LEGEND EHS BOTH IP/OP "$4,710.00" "$3,485.00" $838.38 "$4,710.00" "$4,710.00" "$4,710.00" "$4,710.00" "$4,710.00" "$4,710.00" "$4,710.00" $838.38 "$4,710.00" "$4,710.00" "$3,495.76" "$3,495.76" "$3,630.47" "$2,060.15" $981.62 "$4,710.00" "$1,884.00" "$4,710.00" "$4,710.00" "$4,710.00" "$4,710.00" "$4,710.00" "$3,532.50" "$4,710.00" "$4,710.00" "$4,710.00" "$2,355.00" "$2,355.00" "$3,730.32" "$4,710.00" "$3,768.00" "$3,061.50" "$4,710.00" N/A "$2,731.80" "$4,710.00" "$2,826.00" "$4,710.00" "$4,710.00" "$4,710.00" N/A N/A IRC400 SUP Custom 27203010 IRC400 - CABLE SIGNAL IRRIGATION SYSTEM MIDAS REX LEGEND EHS BOTH IP/OP $254.00 $188.00 $45.21 $254.00 $254.00 $254.00 $254.00 $254.00 $254.00 $254.00 $45.21 $254.00 $254.00 $188.52 $188.52 $195.78 $132.33 $52.94 $254.00 $101.60 $254.00 $254.00 $254.00 $254.00 $254.00 $190.50 $254.00 $254.00 $254.00 $127.00 $127.00 $201.17 $254.00 $203.20 $165.10 $254.00 N/A $147.32 $254.00 $152.40 $254.00 $254.00 $254.00 N/A N/A IRC500 SUP Custom 27203010 IRC500 - POLE INTRAVENOUS IRRIGATION SYSTEM MIDAS REX LEGEND EHS BOTH IP/OP $218.00 $161.00 $38.80 $218.00 $218.00 $218.00 $218.00 $218.00 $218.00 $218.00 $38.80 $218.00 $218.00 $161.80 $161.80 $168.03 $113.58 $45.43 $218.00 $87.20 $218.00 $218.00 $218.00 $218.00 $218.00 $163.50 $218.00 $218.00 $218.00 $109.00 $109.00 $172.66 $218.00 $174.40 $141.70 $218.00 N/A $126.44 $218.00 $130.80 $218.00 $218.00 $218.00 N/A N/A IRD200 SUP Custom 27203010 IRD200 - TUBING IRRIGATION REMOTE CONTROL MIDAS REX LEGEND EHS BOTH IP/OP $162.00 $120.00 $28.84 $162.00 $162.00 $162.00 $162.00 $162.00 $162.00 $162.00 $28.84 $162.00 $162.00 $120.24 $120.24 $124.87 $84.40 $33.76 $162.00 $64.80 $162.00 $162.00 $162.00 $162.00 $162.00 $121.50 $162.00 $162.00 $162.00 $81.00 $81.00 $128.30 $162.00 $129.60 $105.30 $162.00 N/A $93.96 $162.00 $97.20 $162.00 $162.00 $162.00 N/A N/A IRD250 SUP Custom 27203010 IRD250 - TUBING IRRIGATION MIDAS REX LEGEND EHS DISPOSABLE BOTH IP/OP $200.00 $148.00 $35.60 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $35.60 $200.00 $200.00 $148.44 $148.44 $154.16 $104.20 $41.68 $200.00 $80.00 $200.00 $200.00 $200.00 $200.00 $200.00 $150.00 $200.00 $200.00 $200.00 $100.00 $100.00 $158.40 $200.00 $160.00 $130.00 $200.00 N/A $116.00 $200.00 $120.00 $200.00 $200.00 $200.00 N/A N/A IRD300 SUP Custom 27203010 IRD300 - TUBING IRRIGATION MIDAS REX LEGEND EHS DISPOSABLE BOTH IP/OP $196.50 $145.00 $34.96 $196.40 $196.40 $196.40 $196.40 $196.40 $196.40 $196.40 $34.96 $196.40 $196.40 $145.77 $145.77 $151.39 $102.32 $40.93 $196.40 $78.56 $196.40 $196.40 $196.40 $196.40 $196.40 $147.38 $196.40 $196.40 $196.40 $98.20 $98.20 $155.55 $196.40 $157.12 $127.66 $196.40 N/A $113.97 $196.40 $117.84 $196.40 $196.40 $196.40 N/A N/A IRD350 SUP Custom 27203010 IRD350 - TUBING IRRIGATION BURR TRANSNASAL BOTH IP/OP $322.00 $238.00 $57.32 $322.00 $322.00 $322.00 $322.00 $322.00 $322.00 $322.00 $57.32 $322.00 $322.00 $238.99 $238.99 $248.20 $167.76 $67.11 $322.00 $128.80 $322.00 $322.00 $322.00 $322.00 $322.00 $241.50 $322.00 $322.00 $322.00 $161.00 $161.00 $255.02 $322.00 $257.60 $209.30 $322.00 N/A $186.76 $322.00 $193.20 $322.00 $322.00 $322.00 N/A N/A IST2 SUP Custom 27203010 "IST2 - INDIGO SYSTEM, ASPIRATION TUBING" BOTH IP/OP $912.50 $675.00 $162.43 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $912.50 $162.43 $912.50 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $365.00 $912.50 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $912.50 N/A $529.25 $912.50 $547.50 $912.50 $912.50 $912.50 N/A N/A J219H SUP Custom 27203010 J219H - SUTURE ABSORBABLE 3-0 SH-1 27IN BRAID COATED VICRYL UNDYED BOTH IP/OP $163.00 $121.00 $28.97 $167.48 $162.75 $162.75 $162.75 $162.75 $162.75 $162.75 $28.97 $162.75 $162.75 $120.79 $120.79 $125.45 $84.79 $33.92 $162.75 $66.99 $162.75 $162.75 $167.48 $162.75 $162.75 $122.25 $162.75 $162.75 $162.75 $81.38 $81.38 $128.90 $162.75 $130.20 $105.79 $162.75 N/A $94.54 $162.75 $97.65 $162.75 $162.75 $162.75 N/A N/A J408G SUP Custom 27203010 J408G - SUTURE VCL 8-0 5-130-4 9IN BRAID COAT VIOL ABS BOTH IP/OP $49.00 $36.00 $8.71 $48.93 $48.93 $48.93 $48.93 $48.93 $48.93 $48.93 $8.71 $48.93 $48.93 $36.32 $36.32 $37.72 $25.49 $10.20 $48.93 $19.57 $48.93 $48.93 $48.93 $48.93 $48.93 $36.75 $48.93 $48.93 $48.93 $24.47 $24.47 $38.75 $48.93 $39.14 $31.80 $48.93 N/A $28.42 $48.93 $29.36 $48.93 $48.93 $48.93 N/A N/A J494H SUP Custom 27203010 J494H - SUTURE ABSORBABLE 4-0 P-3 18IN BRAID COATED VICRYL MULTIPASS BOTH IP/OP $411.50 $305.00 $73.23 $423.38 $411.38 $411.38 $411.38 $411.38 $411.38 $411.38 $73.23 $411.38 $411.38 $305.33 $305.33 $317.09 $214.33 $85.74 $411.38 $169.35 $411.38 $411.38 $423.38 $411.38 $411.38 $308.63 $411.38 $411.38 $411.38 $205.69 $205.69 $325.81 $411.38 $329.10 $267.40 $411.38 N/A $238.67 $411.38 $246.83 $411.38 $411.38 $411.38 N/A N/A J546G SUP Custom 27203010 J546G - SUTURE ABS 7-0 TG140-8 18IN VIOL VC MCRPT 2 ARM BRD COAT BOTH IP/OP $36.00 $27.00 $6.33 $36.59 $35.56 $35.56 $35.56 $35.56 $35.56 $35.56 $6.33 $35.56 $35.56 $26.39 $26.39 $27.41 $18.53 $7.41 $35.56 $14.64 $35.56 $35.56 $36.59 $35.56 $35.56 $27.00 $35.56 $35.56 $35.56 $17.78 $17.78 $28.16 $35.56 $28.45 $23.11 $35.56 N/A $20.88 $35.56 $21.34 $35.56 $35.56 $35.56 N/A N/A J548G SUP Custom 27203010 J548G - SUTURE ABSORBABLE 8-0 TG140-8 12IN 2 ARM BRAID COATED VICRYL BOTH IP/OP $36.50 $27.00 $6.42 $37.10 $36.05 $36.05 $36.05 $36.05 $36.05 $36.05 $6.42 $36.05 $36.05 $26.76 $26.76 $27.79 $18.78 $7.51 $36.05 $14.84 $36.05 $36.05 $37.10 $36.05 $36.05 $27.38 $36.05 $36.05 $36.05 $18.03 $18.03 $28.55 $36.05 $28.84 $23.43 $36.05 N/A $21.17 $36.05 $21.63 $36.05 $36.05 $36.05 N/A N/A J555G SUP Custom 27203010 J555G - SUTURE ABS 6-0 S-29 18IN VIOL VC SBRLC 2 ARM BRD COAT BOTH IP/OP $37.50 $28.00 $6.62 $38.28 $37.20 $37.20 $37.20 $37.20 $37.20 $37.20 $6.62 $37.20 $37.20 $27.61 $27.61 $28.67 $19.38 $7.75 $37.20 $15.31 $37.20 $37.20 $38.28 $37.20 $37.20 $28.13 $37.20 $37.20 $37.20 $18.60 $18.60 $29.46 $37.20 $29.76 $24.18 $37.20 N/A $21.75 $37.20 $22.32 $37.20 $37.20 $37.20 N/A N/A J570G SUP Custom 27203010 J570G - SUTURE ABSORBABLE 6-0 S-14 18IN 2 ARM BRAID COATED VICRYL BOTH IP/OP $37.50 $28.00 $6.64 $38.38 $37.29 $37.29 $37.29 $37.29 $37.29 $37.29 $6.64 $37.29 $37.29 $27.68 $27.68 $28.74 $19.43 $7.77 $37.29 $15.35 $37.29 $37.29 $38.38 $37.29 $37.29 $28.13 $37.29 $37.29 $37.29 $18.65 $18.65 $29.53 $37.29 $29.83 $24.24 $37.29 N/A $21.75 $37.29 $22.37 $37.29 $37.29 $37.29 N/A N/A J6054-0610 SUP HCPCS C1776 J6054-0610 - SYSTEM THR 6-10 SECURE-FIT PLUS BOTH IP/OP "$7,204.00" "$5,331.00" "$1,429.81" "$7,204.00" "$3,241.80" "$3,241.80" "$3,241.80" "$3,241.80" "$7,204.00" "$7,204.00" "$7,204.00" "$1,501.49" "$7,204.00" "$7,204.00" "$7,204.00" "$7,204.00" "$7,204.00" "$1,501.39" "$7,204.00" "$2,881.60" "$3,551.57" "$7,204.00" "$7,204.00" "$7,204.00" "$7,204.00" "$5,403.00" "$7,204.00" "$7,204.00" "$7,204.00" "$3,602.00" "$3,602.00" "$5,705.57" "$7,204.00" "$5,763.20" "$3,241.80" "$1,429.81" N/A "$4,178.32" "$7,204.00" "$7,204.00" "$7,204.00" "$1,501.31" "$7,204.00" N/A N/A J6054-0711 SUP HCPCS C1776 J6054-0711 - STEM FEMORAL 7 11MM 130MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,865.00" "$5,080.00" "$1,362.53" "$6,865.00" "$3,089.25" "$3,089.25" "$3,089.25" "$3,089.25" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.84" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.74" "$6,865.00" "$6,865.00" "$3,384.45" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$5,148.75" "$6,865.00" "$6,865.00" "$6,865.00" "$3,432.50" "$3,432.50" "$5,437.08" "$6,865.00" "$5,492.00" "$3,089.25" "$1,362.53" N/A "$3,981.70" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.67" "$6,865.00" N/A N/A J6054-0713 SUP HCPCS C1776 J6054-0713 - STEM FEMORAL 7 13MM 130MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,865.00" "$5,080.00" "$1,362.53" "$6,865.00" "$3,089.25" "$3,089.25" "$3,089.25" "$3,089.25" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.84" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.74" "$6,865.00" "$6,865.00" "$3,384.45" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$5,148.75" "$6,865.00" "$6,865.00" "$6,865.00" "$3,432.50" "$3,432.50" "$5,437.08" "$6,865.00" "$5,492.00" "$3,089.25" "$1,362.53" N/A "$3,981.70" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.67" "$6,865.00" N/A N/A J6054-0812 SUP HCPCS C1776 J6054-0812 - STEM FEMORAL 8 12MM 130MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,865.00" "$5,080.00" "$1,362.53" "$6,865.00" "$3,089.25" "$3,089.25" "$3,089.25" "$3,089.25" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.84" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.74" "$6,865.00" "$6,865.00" "$3,384.45" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$5,148.75" "$6,865.00" "$6,865.00" "$6,865.00" "$3,432.50" "$3,432.50" "$5,437.08" "$6,865.00" "$5,492.00" "$3,089.25" "$1,362.53" N/A "$3,981.70" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.67" "$6,865.00" N/A N/A J6054-0814 SUP HCPCS C1776 J6054-0814 - STEM FEMORAL 8 14MM 130MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,865.00" "$5,080.00" "$1,362.53" "$6,865.00" "$3,089.25" "$3,089.25" "$3,089.25" "$3,089.25" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.84" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.74" "$6,865.00" "$2,746.00" "$3,384.45" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$5,148.75" "$6,865.00" "$6,865.00" "$6,865.00" "$3,432.50" "$3,432.50" "$5,437.08" "$6,865.00" "$5,492.00" "$3,089.25" "$1,362.53" N/A "$3,981.70" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.67" "$6,865.00" N/A N/A J6054-0913 SUP HCPCS C1776 J6054-0913 - STEM FEMORAL 9 13MM 130MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,865.00" "$5,080.00" "$1,362.53" "$6,865.00" "$3,089.25" "$3,089.25" "$3,089.25" "$3,089.25" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.84" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.74" "$6,865.00" "$2,746.00" "$3,384.45" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$5,148.75" "$6,865.00" "$6,865.00" "$6,865.00" "$3,432.50" "$3,432.50" "$5,437.08" "$6,865.00" "$5,492.00" "$3,089.25" "$1,362.53" N/A "$3,981.70" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.67" "$6,865.00" N/A N/A J6054-0915 SUP HCPCS C1776 J6054-0915 - STEM FEMORAL 9 15MM 130MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,865.00" "$5,080.00" "$1,362.53" "$6,865.00" "$3,089.25" "$3,089.25" "$3,089.25" "$3,089.25" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.74" "$6,865.00" "$2,746.00" "$3,384.45" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$5,148.75" "$6,865.00" "$6,865.00" "$6,865.00" "$3,432.50" "$3,432.50" "$5,437.08" "$6,865.00" "$5,492.00" "$3,089.25" "$1,362.53" N/A "$3,981.70" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.67" "$6,865.00" N/A N/A J6054-1014 SUP HCPCS C1776 J6054-1014 - STEM FEMORAL 10 14MM 130MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,865.00" "$5,080.00" "$1,362.53" "$6,865.00" "$3,089.25" "$3,089.25" "$3,089.25" "$3,089.25" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.74" "$6,865.00" "$2,746.00" "$3,384.45" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$5,148.75" "$6,865.00" "$6,865.00" "$6,865.00" "$3,432.50" "$3,432.50" "$5,437.08" "$6,865.00" "$5,492.00" "$3,089.25" "$1,362.53" N/A "$3,981.70" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.67" "$6,865.00" N/A N/A J6054-1016 SUP HCPCS C1776 J6054-1016 - STEM FEMORAL 10 16MM 130MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,865.00" "$5,080.00" "$1,362.53" "$6,865.00" "$3,089.25" "$3,089.25" "$3,089.25" "$3,089.25" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.74" "$6,865.00" "$2,746.00" "$3,384.45" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$5,148.75" "$6,865.00" "$6,865.00" "$6,865.00" "$3,432.50" "$3,432.50" "$5,437.08" "$6,865.00" "$5,492.00" "$3,089.25" "$1,362.53" N/A "$3,981.70" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.67" "$6,865.00" N/A N/A J6054-1115 SUP HCPCS C1776 J6054-1115 - STEM FEMORAL 11 15MM 170MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,865.00" "$5,080.00" "$1,362.53" "$6,865.00" "$3,089.25" "$3,089.25" "$3,089.25" "$3,089.25" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.84" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.74" "$6,865.00" "$2,746.00" "$3,384.45" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$5,148.75" "$6,865.00" "$6,865.00" "$6,865.00" "$3,432.50" "$3,432.50" "$5,437.08" "$6,865.00" "$5,492.00" "$3,089.25" "$1,362.53" N/A "$3,981.70" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.67" "$6,865.00" N/A N/A J6054-1117 SUP HCPCS C1776 J6054-1117 - STEM FEMORAL 11 17MM 170MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,865.00" "$5,080.00" "$1,362.53" "$6,865.00" "$3,089.25" "$3,089.25" "$3,089.25" "$3,089.25" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.84" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.74" "$6,865.00" "$2,746.00" "$3,384.45" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$5,148.75" "$6,865.00" "$6,865.00" "$6,865.00" "$3,432.50" "$3,432.50" "$5,437.08" "$6,865.00" "$5,492.00" "$3,089.25" "$1,362.53" N/A "$3,981.70" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.67" "$6,865.00" N/A N/A J6054-1216 SUP HCPCS C1776 J6054-1216 - STEM FEMORAL 12 16MM 170MM PRIM SECFIT PLUS HYDRXAPT HIP BOTH IP/OP "$6,865.00" "$5,080.00" "$1,362.53" "$6,865.00" "$3,089.25" "$3,089.25" "$3,089.25" "$3,089.25" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.74" "$6,865.00" "$2,746.00" "$3,384.45" "$6,865.00" "$6,865.00" "$6,865.00" "$6,865.00" "$5,148.75" "$6,865.00" "$6,865.00" "$6,865.00" "$3,432.50" "$3,432.50" "$5,437.08" "$6,865.00" "$5,492.00" "$3,089.25" "$1,362.53" N/A "$3,981.70" "$6,865.00" "$6,865.00" "$6,865.00" "$1,430.67" "$6,865.00" N/A N/A J634H SUP Custom 27203010 J634H - SUTURE ABS VIOL 18IN VCL 3-0 TIE BRAID COAT BOTH IP/OP $5.50 $4.00 $0.94 $5.29 $5.29 $5.29 $5.29 $5.29 $5.29 $5.29 $0.94 $5.29 $5.29 $3.93 $3.93 $4.08 $2.76 $1.10 $5.29 $2.12 $5.29 $5.29 $5.29 $5.29 $5.29 $4.13 $5.29 $5.29 $5.29 $2.65 $2.65 $4.19 $5.29 $4.23 $3.44 $5.29 N/A $3.19 $5.29 $3.17 $5.29 $5.29 $5.29 N/A N/A J671G SUP Custom 27203010 J671G - SUTURE ABSORBABLE 5-0 S-14 18IN 2 ARM BRAID COATED VICRYL BOTH IP/OP $31.50 $23.00 $5.59 $31.41 $31.41 $31.41 $31.41 $31.41 $31.41 $31.41 $5.59 $31.41 $31.41 $23.31 $23.31 $24.21 $16.36 $6.55 $31.41 $12.56 $31.41 $31.41 $31.41 $31.41 $31.41 $23.63 $31.41 $31.41 $31.41 $15.71 $15.71 $24.88 $31.41 $25.13 $20.42 $31.41 N/A $18.27 $31.41 $18.85 $31.41 $31.41 $31.41 N/A N/A J726D SUP Custom 27203010 J726D - SUTURE VCL 2-0 CT2 8-18IN CR BRAID COAT VIOL ABS BOTH IP/OP $47.50 $35.00 $8.40 $47.20 $47.20 $47.20 $47.20 $47.20 $47.20 $47.20 $8.40 $47.20 $47.20 $35.03 $35.03 $36.38 $24.59 $9.84 $47.20 $18.88 $47.20 $47.20 $47.20 $47.20 $47.20 $35.63 $47.20 $47.20 $47.20 $23.60 $23.60 $37.38 $47.20 $37.76 $30.68 $47.20 N/A $27.55 $47.20 $28.32 $47.20 $47.20 $47.20 N/A N/A J727D SUP Custom 27203010 J727D - SUTURE ABSORBABLE 0 CT-2 8-18IN TAPER POINT BRAID 8 STRAND BOTH IP/OP $30.00 $22.00 $5.32 $30.76 $29.89 $29.89 $29.89 $29.89 $29.89 $29.89 $5.32 $29.89 $29.89 $22.18 $22.18 $23.04 $15.57 $6.23 $29.89 $12.30 $29.89 $29.89 $30.76 $29.89 $29.89 $22.50 $29.89 $29.89 $29.89 $14.95 $14.95 $23.67 $29.89 $23.91 $19.43 $29.89 N/A $17.40 $29.89 $17.93 $29.89 $29.89 $29.89 N/A N/A J739D SUP Custom 27203010 J739D - SUTURE ABSORBABLE 2-0 CT-1 18IN CONTROL RELEASE BRAIDED 8 BOTH IP/OP $30.00 $22.00 $5.32 $30.73 $29.86 $29.86 $29.86 $29.86 $29.86 $29.86 $5.32 $29.86 $29.86 $22.16 $22.16 $23.02 $15.56 $6.22 $29.86 $12.29 $29.86 $29.86 $30.73 $29.86 $29.86 $22.50 $29.86 $29.86 $29.86 $14.93 $14.93 $23.65 $29.86 $23.89 $19.41 $29.86 N/A $17.40 $29.86 $17.92 $29.86 $29.86 $29.86 N/A N/A J740D SUP Custom 27203010 J740D - SUTURE ABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND BOTH IP/OP $30.00 $22.00 $5.33 $30.83 $29.96 $29.96 $29.96 $29.96 $29.96 $29.96 $5.33 $29.96 $29.96 $22.24 $22.24 $23.09 $15.61 $6.24 $29.96 $12.33 $29.96 $29.96 $30.83 $29.96 $29.96 $22.50 $29.96 $29.96 $29.96 $14.98 $14.98 $23.73 $29.96 $23.97 $19.47 $29.96 N/A $17.40 $29.96 $17.98 $29.96 $29.96 $29.96 N/A N/A J741D SUP Custom 27203010 J741D - SUTURE ABSORBABLE 1 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND BOTH IP/OP $361.50 $268.00 $64.30 $361.24 $361.24 $361.24 $361.24 $361.24 $361.24 $361.24 $64.30 $361.24 $361.24 $268.11 $268.11 $278.44 $188.21 $75.29 $361.24 $144.50 $361.24 $361.24 $361.24 $361.24 $361.24 $271.13 $361.24 $361.24 $361.24 $180.62 $180.62 $286.10 $361.24 $288.99 $234.81 $361.24 N/A $209.67 $361.24 $216.74 $361.24 $361.24 $361.24 N/A N/A J754T CR SUP Custom 27203010 J754T CR - NEEDLE 0 VICRYL 18 OS-6 BOTH IP/OP $465.50 $344.00 $82.81 $465.23 $465.23 $465.23 $465.23 $465.23 $465.23 $465.23 $82.81 $465.23 $465.23 $345.29 $345.29 $358.60 $242.38 $96.96 $465.23 $186.09 $465.23 $465.23 $465.23 $465.23 $465.23 $349.13 $465.23 $465.23 $465.23 $232.62 $232.62 $368.46 $465.23 $372.18 $302.40 $465.23 N/A $269.99 $465.23 $279.14 $465.23 $465.23 $465.23 N/A N/A J761D SUP Custom 27203010 J761D - SUTURE ABSORBABLE 3-0 CP-2 18IN CONTROL RELEASE BRAID 8 BOTH IP/OP $37.50 $28.00 $6.64 $38.39 $37.30 $37.30 $37.30 $37.30 $37.30 $37.30 $6.64 $37.30 $37.30 $27.68 $27.68 $28.75 $19.43 $7.77 $37.30 $15.36 $37.30 $37.30 $38.39 $37.30 $37.30 $28.13 $37.30 $37.30 $37.30 $18.65 $18.65 $29.54 $37.30 $29.84 $24.25 $37.30 N/A $21.75 $37.30 $22.38 $37.30 $37.30 $37.30 N/A N/A J762D SUP Custom 27203010 J762D - SUTURE ABSORBABLE 2-0 CP-2 18IN CONTROL RELEASE BRAID 8 BOTH IP/OP $36.50 $27.00 $6.48 $37.49 $36.43 $36.43 $36.43 $36.43 $36.43 $36.43 $6.48 $36.43 $36.43 $27.04 $27.04 $28.08 $18.98 $7.59 $36.43 $15.00 $36.43 $36.43 $37.49 $36.43 $36.43 $27.38 $36.43 $36.43 $36.43 $18.22 $18.22 $28.85 $36.43 $29.14 $23.68 $36.43 N/A $21.17 $36.43 $21.86 $36.43 $36.43 $36.43 N/A N/A J764D SUP Custom 27203010 J764D - SUTURE ABSORBABLE 0 CTX 18IN CONTROL RELEASE BRAID 8 STRAND BOTH IP/OP $30.00 $22.00 $5.31 $30.69 $29.82 $29.82 $29.82 $29.82 $29.82 $29.82 $5.31 $29.82 $29.82 $22.13 $22.13 $22.99 $15.54 $6.21 $29.82 $12.28 $29.82 $29.82 $30.69 $29.82 $29.82 $22.50 $29.82 $29.82 $29.82 $14.91 $14.91 $23.62 $29.82 $23.86 $19.38 $29.82 N/A $17.40 $29.82 $17.89 $29.82 $29.82 $29.82 N/A N/A J765D SUP Custom 27203010 J765D - SUTURE ABSORBABLE 1 CTX 18IN CONTROL RELEASE BRAID 8 STRAND BOTH IP/OP $30.00 $22.00 $5.31 $30.69 $29.82 $29.82 $29.82 $29.82 $29.82 $29.82 $5.31 $29.82 $29.82 $22.13 $22.13 $22.99 $15.54 $6.21 $29.82 $12.28 $29.82 $29.82 $30.69 $29.82 $29.82 $22.50 $29.82 $29.82 $29.82 $14.91 $14.91 $23.62 $29.82 $23.86 $19.38 $29.82 N/A $17.40 $29.82 $17.89 $29.82 $29.82 $29.82 N/A N/A J774D SUP Custom 27203010 J774D - SUTURE ABS 3-0 SH 18IN VIOL VCL CR BRD 8 STRN COAT BOTH IP/OP $29.50 $22.00 $5.24 $30.30 $29.45 $29.45 $29.45 $29.45 $29.45 $29.45 $5.24 $29.45 $29.45 $21.86 $21.86 $22.70 $15.34 $6.14 $29.45 $12.12 $29.45 $29.45 $30.30 $29.45 $29.45 $22.13 $29.45 $29.45 $29.45 $14.73 $14.73 $23.32 $29.45 $23.56 $19.14 $29.45 N/A $17.11 $29.45 $17.67 $29.45 $29.45 $29.45 N/A N/A J775D SUP Custom 27203010 J775D - SUTURE ABS 2-0 SH 18IN VIOL VCL CR BRD 8 STRN COAT BOTH IP/OP $29.00 $21.00 $5.13 $29.66 $28.82 $28.82 $28.82 $28.82 $28.82 $28.82 $5.13 $28.82 $28.82 $21.39 $21.39 $22.21 $15.02 $6.01 $28.82 $11.86 $28.82 $28.82 $29.66 $28.82 $28.82 $21.75 $28.82 $28.82 $28.82 $14.41 $14.41 $22.83 $28.82 $23.06 $18.73 $28.82 N/A $16.82 $28.82 $17.29 $28.82 $28.82 $28.82 N/A N/A J790D SUP Custom 27203010 J790D - SUTURE ABSORBABLE 3-0 X-1 18IN CONTROL RELEASE BRAID 8 BOTH IP/OP $44.00 $33.00 $7.78 $44.95 $43.68 $43.68 $43.68 $43.68 $43.68 $43.68 $7.78 $43.68 $43.68 $32.42 $32.42 $33.67 $22.76 $9.10 $43.68 $17.98 $43.68 $43.68 $44.95 $43.68 $43.68 $33.00 $43.68 $43.68 $43.68 $21.84 $21.84 $34.59 $43.68 $34.94 $28.39 $43.68 N/A $25.52 $43.68 $26.21 $43.68 $43.68 $43.68 N/A N/A J840D SUP Custom 27203010 J840D - SUTURE ABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND BOTH IP/OP $30.50 $23.00 $5.34 $30.90 $30.02 $30.02 $30.02 $30.02 $30.02 $30.02 $5.34 $30.02 $30.02 $22.28 $22.28 $23.14 $15.64 $6.26 $30.02 $12.36 $30.02 $30.02 $30.90 $30.02 $30.02 $22.88 $30.02 $30.02 $30.02 $15.01 $15.01 $23.78 $30.02 $24.02 $19.51 $30.02 N/A $17.69 $30.02 $18.01 $30.02 $30.02 $30.02 N/A N/A J841D SUP Custom 27203010 J841D - SUTURE ABSORBABLE 1 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND BOTH IP/OP $30.00 $22.00 $5.30 $30.66 $29.80 $29.80 $29.80 $29.80 $29.80 $29.80 $5.30 $29.80 $29.80 $22.12 $22.12 $22.97 $15.53 $6.21 $29.80 $12.26 $29.80 $29.80 $30.66 $29.80 $29.80 $22.50 $29.80 $29.80 $29.80 $14.90 $14.90 $23.60 $29.80 $23.84 $19.37 $29.80 N/A $17.40 $29.80 $17.88 $29.80 $29.80 $29.80 N/A N/A J841D CR SUP Custom 27203010 J841D CR - NEEDLE 1VICRYL 18 CT1 BOTH IP/OP $355.50 $263.00 $63.23 $355.23 $355.23 $355.23 $355.23 $355.23 $355.23 $355.23 $63.23 $355.23 $355.23 $263.65 $263.65 $273.81 $185.07 $74.03 $355.23 $142.09 $355.23 $355.23 $355.23 $355.23 $355.23 $266.63 $355.23 $355.23 $355.23 $177.62 $177.62 $281.34 $355.23 $284.18 $230.90 $355.23 N/A $206.19 $355.23 $213.14 $355.23 $355.23 $355.23 N/A N/A J864D SUP Custom 27203010 J864D - SUTURE ABS 3-0 SH 18IN UD VCL CR BRD 8 STRN COAT BOTH IP/OP $361.50 $268.00 $64.27 $371.58 $361.08 $361.08 $361.08 $361.08 $361.08 $361.08 $64.27 $361.08 $361.08 $267.99 $267.99 $278.32 $188.12 $75.25 $361.08 $148.63 $361.08 $361.08 $371.58 $361.08 $361.08 $271.13 $361.08 $361.08 $361.08 $180.54 $180.54 $285.98 $361.08 $288.86 $234.70 $361.08 N/A $209.67 $361.08 $216.65 $361.08 $361.08 $361.08 N/A N/A JA-DLVT35L SUP Custom 27203010 JA-DLVT35L - TUBE ENDOTRAC 35FR 2 LUMEN LEFT SIDE VIVASIGHT-DL BOTH IP/OP $442.50 $327.00 $78.77 $442.50 $442.50 $442.50 $442.50 $442.50 $442.50 $442.50 $78.77 $442.50 $442.50 $328.42 $328.42 $341.08 $230.54 $92.22 $442.50 $177.00 $442.50 $442.50 $442.50 $442.50 $442.50 $331.88 $442.50 $442.50 $442.50 $221.25 $221.25 $350.46 $442.50 $354.00 $287.63 $442.50 N/A $256.65 $442.50 $265.50 $442.50 $442.50 $442.50 N/A N/A JA-DLVT37L SUP Custom 27203010 JA-DLVT37L - TUBE ENDOTRAC 60MA MINI 37FR 11.5MM 4.2MM 330MM 2 LUMEN 2 BOTH IP/OP $442.50 $327.00 $78.77 $442.50 $442.50 $442.50 $442.50 $442.50 $442.50 $442.50 $78.77 $442.50 $442.50 $328.42 $328.42 $341.08 $230.54 $92.22 $442.50 $177.00 $442.50 $442.50 $442.50 $442.50 $442.50 $331.88 $442.50 $442.50 $442.50 $221.25 $221.25 $350.46 $442.50 $354.00 $287.63 $442.50 N/A $256.65 $442.50 $265.50 $442.50 $442.50 $442.50 N/A N/A JA-DLVT39L SUP Custom 27203010 JA-DLVT39L - TUBE ENDOTRAC 39FR 2 LUMEN LEFT SIDE VIVASIGHT-DL BOTH IP/OP $442.50 $327.00 $78.77 $442.50 $442.50 $442.50 $442.50 $442.50 $442.50 $442.50 $78.77 $442.50 $442.50 $328.42 $328.42 $341.08 $230.54 $92.22 $442.50 $177.00 $442.50 $442.50 $442.50 $442.50 $442.50 $331.88 $442.50 $442.50 $442.50 $221.25 $221.25 $350.46 $442.50 $354.00 $287.63 $442.50 N/A $256.65 $442.50 $265.50 $442.50 $442.50 $442.50 N/A N/A JA-DLVT41L SUP Custom 27203010 JA-DLVT41L - TUBE ENDOTRAC 41FR 2 LUMEN LEFT SIDE VIVASIGHT-DL BOTH IP/OP $442.50 $327.00 $78.77 $442.50 $442.50 $442.50 $442.50 $442.50 $442.50 $442.50 $78.77 $442.50 $442.50 $328.42 $328.42 $341.08 $230.54 $92.22 $442.50 $177.00 $442.50 $442.50 $442.50 $442.50 $442.50 $331.88 $442.50 $442.50 $442.50 $221.25 $221.25 $350.46 $442.50 $354.00 $287.63 $442.50 N/A $256.65 $442.50 $265.50 $442.50 $442.50 $442.50 N/A N/A JA-TVT70100 SUP Custom 27203010 JA-TVT70100 - TUBE ENDOTRAC 60MA MINI 10FR 7MM 312MM 1 LUMEN 2 LED 5 PIN BOTH IP/OP $302.50 $224.00 $53.85 $302.50 $302.50 $302.50 $302.50 $302.50 $302.50 $302.50 $53.85 $302.50 $302.50 $224.52 $224.52 $233.17 $157.60 $63.04 $302.50 $121.00 $302.50 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $196.63 $302.50 N/A $175.45 $302.50 $181.50 $302.50 $302.50 $302.50 N/A N/A JA-TVT75105 SUP Custom 27203010 JA-TVT75105 - TUBE ENDOTRACHEAL VIVASIGHT SL SINGLE LUMEN 7.5MM BOTH IP/OP $302.50 $224.00 $53.85 $302.50 $302.50 $302.50 $302.50 $302.50 $302.50 $302.50 $53.85 $302.50 $302.50 $224.52 $224.52 $233.17 $157.60 $63.04 $302.50 $121.00 $302.50 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $196.63 $302.50 N/A $175.45 $302.50 $181.50 $302.50 $302.50 $302.50 N/A N/A JA-TVT80110 SUP Custom 27203010 JA-TVT80110 - TUBE ENDOTRACHEAL VIVASIGHT SL SINGLE LUMEN 8.0MM BOTH IP/OP $302.50 $224.00 $53.85 $302.50 $302.50 $302.50 $302.50 $302.50 $302.50 $302.50 $53.85 $302.50 $302.50 $224.52 $224.52 $233.17 $157.60 $63.04 $302.50 $121.00 $302.50 $302.50 $302.50 $302.50 $302.50 $226.88 $302.50 $302.50 $302.50 $151.25 $151.25 $239.58 $302.50 $242.00 $196.63 $302.50 N/A $175.45 $302.50 $181.50 $302.50 $302.50 $302.50 N/A N/A JB840 SUP Custom 27203010 JB840 - SUTURE ABS 0 CTB-1 18IN UD VCL ETHGRD CR BRD 8 STRN COAT BOTH IP/OP $38.00 $28.00 $6.68 $38.62 $37.53 $37.53 $37.53 $37.53 $37.53 $37.53 $6.68 $37.53 $37.53 $27.85 $27.85 $28.93 $19.55 $7.82 $37.53 $15.45 $37.53 $37.53 $38.62 $37.53 $37.53 $28.50 $37.53 $37.53 $37.53 $18.77 $18.77 $29.72 $37.53 $30.02 $24.39 $37.53 N/A $22.04 $37.53 $22.52 $37.53 $37.53 $37.53 N/A N/A JEM 330 SUP HCPCS A7521 JEM 330 - CATHETER AIRWAY EXCHANGE SMOOTH ROUNDED TIP LATEX FREE JEM BOTH IP/OP $24.00 $18.00 $4.95 $33.69 $23.75 $23.75 $23.75 $23.75 $23.75 $23.75 $33.69 $23.75 $23.75 $23.75 $23.75 $23.75 $23.75 $4.95 $23.75 $9.50 $23.75 $23.75 $23.75 $23.75 $23.75 $18.00 $23.75 $23.75 $23.75 $11.88 $11.88 $18.81 $23.75 $19.00 $10.69 $23.75 N/A $13.92 $23.75 $14.25 $23.75 $23.75 $23.75 N/A N/A JEM 365 SUP HCPCS A7520 JEM 365 - CATHETER AIRWAY EXCHANGE SMOOTH ROUNDED TIP LATEX FREE JEM BOTH IP/OP $26.50 $20.00 $5.45 $33.95 $26.15 $26.15 $26.15 $26.15 $26.15 $26.15 $33.95 $26.15 $26.15 $26.15 $26.15 $26.15 $26.15 $5.45 $26.15 $10.46 $26.15 $26.15 $26.15 $26.15 $26.15 $19.88 $26.15 $26.15 $26.15 $13.08 $13.08 $20.71 $26.15 $20.92 $11.77 $26.15 N/A $15.37 $26.15 $15.69 $26.15 $26.15 $26.15 N/A N/A JEM 400 SUP Custom 27203010 JEM 400 - CATHETER AIRWAY EXCHANGE SMOOTH ROUNDED TIP LATEX FREE JEM BOTH IP/OP $27.50 $20.00 $4.90 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $27.50 $4.90 $27.50 $27.50 $20.41 $20.41 $21.20 $14.33 $5.73 $27.50 $11.00 $27.50 $27.50 $27.50 $27.50 $27.50 $20.63 $27.50 $27.50 $27.50 $13.75 $13.75 $21.78 $27.50 $22.00 $17.88 $27.50 N/A $15.95 $27.50 $16.50 $27.50 $27.50 $27.50 N/A N/A JEM370 SUP Custom 27203010 JEM370 - CATHETER ARWYEX SMPL RPD TCHQ PE DISP 7MM BOTH IP/OP $23.00 $17.00 $4.01 $22.55 $22.55 $22.55 $22.55 $22.55 $22.55 $22.55 $4.01 $22.55 $22.55 $16.74 $16.74 $17.38 $11.75 $4.70 $22.55 $9.02 $22.55 $22.55 $22.55 $22.55 $22.55 $17.25 $22.55 $22.55 $22.55 $11.28 $11.28 $17.86 $22.55 $18.04 $14.66 $22.55 N/A $13.34 $22.55 $13.53 $22.55 $22.55 $22.55 N/A N/A JJ1952 SUP Custom 27203010 JJ1952 - HEMOSTAT ABSORBABLE 8X4IN ORIGINAL FLEXIBLE SHEER WEAVE BOTH IP/OP $148.00 $110.00 $26.33 $563.87 $147.91 $147.91 $147.91 $147.91 $147.91 $147.91 $26.33 $147.91 $147.91 $109.78 $109.78 $114.01 $77.06 $30.83 $147.91 $252.62 $147.91 $147.91 $563.87 $147.91 $147.91 $111.00 $147.91 $147.91 $147.91 $73.96 $73.96 $117.14 $147.91 $118.33 $96.14 $147.91 N/A $85.84 $147.91 $88.75 $147.91 $147.91 $147.91 N/A N/A J-NCS-504070 SUP HCPCS C1887 J-NCS-504070 - CATH IU NOVY 5FR 40CM SET CVD CANNULATION 55CM DISP BOTH IP/OP $246.50 $182.00 $48.87 $246.25 $133.71 $133.71 $133.71 $133.71 $246.25 $246.25 $246.25 $51.32 $246.25 $182.77 $182.77 $189.81 $128.30 $51.32 $246.25 $246.25 $145.66 $246.25 $246.25 $246.25 $246.25 $184.88 $246.25 $246.25 $246.25 $123.13 $123.13 $195.03 $246.25 $197.00 $160.06 $48.87 N/A $142.97 $246.25 $246.25 $246.25 $51.32 $246.25 N/A N/A JP-2230 SUP Custom 27203010 JP-2230 - DRAIN INCS 19FR JP SIL RND HBLS CHNL STRL LATEX BOTH IP/OP $41.00 $30.00 $7.23 $40.63 $40.63 $40.63 $40.63 $40.63 $40.63 $40.63 $7.23 $40.63 $40.63 $30.16 $30.16 $31.32 $21.17 $8.47 $40.63 $8.70 $40.63 $40.63 $21.75 $40.63 $40.63 $30.75 $40.63 $40.63 $40.63 $20.32 $20.32 $32.18 $40.63 $32.50 $26.41 $40.63 N/A $23.78 $40.63 $24.38 $40.63 $40.63 $40.63 N/A N/A JP-HUF071 SUP Custom 27203010 JP-HUF071 - DRAIN INCISION FLAT 10FR 20CMX7MM FULL DUCT TROCAR LATEX BOTH IP/OP $55.50 $41.00 $9.81 $55.14 $55.14 $55.14 $55.14 $55.14 $55.14 $55.14 $9.81 $55.14 $55.14 $40.92 $40.92 $42.50 $28.73 $11.49 $55.14 $22.06 $55.14 $55.14 $55.14 $55.14 $55.14 $41.63 $55.14 $55.14 $55.14 $27.57 $27.57 $43.67 $55.14 $44.11 $35.84 $55.14 N/A $32.19 $55.14 $33.08 $55.14 $55.14 $55.14 N/A N/A JW31U SUP HCPCS C1898 JW31U - LEAD PCNG OTW LT VNTRC SIN BOTH IP/OP "$4,750.00" "$3,515.00" $989.95 "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" $989.95 "$4,750.00" "$1,900.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$4,750.00" "$3,562.50" "$4,750.00" "$4,750.00" "$4,750.00" "$2,375.00" "$2,375.00" "$3,762.00" "$4,750.00" "$3,800.00" "$2,137.50" "$4,750.00" N/A "$2,755.00" "$4,750.00" "$2,850.00" "$4,750.00" "$4,750.00" "$4,750.00" N/A N/A K10-02949D SUP Custom 27203010 K10-02949D - KIT MANIFOLD BOTH IP/OP $58.00 $43.00 $10.28 $57.75 $57.75 $57.75 $57.75 $57.75 $57.75 $57.75 $10.28 $57.75 $57.75 $42.86 $42.86 $44.51 $30.09 $12.04 $57.75 $23.10 $57.75 $57.75 $57.75 $57.75 $57.75 $43.50 $57.75 $57.75 $57.75 $28.88 $28.88 $45.74 $57.75 $46.20 $37.54 $57.75 N/A $33.64 $57.75 $34.65 $57.75 $57.75 $57.75 N/A N/A K173 SUP HCPCS C1785 K173 - PACEMAKER CARDIAC 7.5MM MODIFIED ELLIPSE 44.5X47MM 2 CHAMBER BOTH IP/OP "$10,000.00" "$7,400.00" "$1,984.75" "$10,000.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.25" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.11" "$10,000.00" "$10,000.00" "$4,930.00" "$10,000.00" "$10,000.00" "$10,000.00" "$10,000.00" "$7,500.00" "$10,000.00" "$10,000.00" "$10,000.00" "$5,000.00" "$5,000.00" "$7,920.00" "$10,000.00" "$8,000.00" "$4,500.00" "$1,984.75" N/A "$5,800.00" "$10,000.00" "$10,000.00" "$10,000.00" "$2,084.00" "$10,000.00" N/A N/A K20-2154 SUP Custom 27203010 K20-2154 - BLADE OPTH 7MM CRNL SS TRPHN HNDL STRL DISP BOTH IP/OP $92.50 $68.00 $16.47 $92.50 $92.50 $92.50 $92.50 $92.50 $92.50 $92.50 $16.47 $92.50 $92.50 $68.65 $68.65 $71.30 $48.19 $19.28 $92.50 $37.00 $92.50 $92.50 $92.50 $92.50 $92.50 $69.38 $92.50 $92.50 $92.50 $46.25 $46.25 $73.26 $92.50 $74.00 $60.13 $92.50 N/A $53.65 $92.50 $55.50 $92.50 $92.50 $92.50 N/A N/A K581H SUP Custom 27203010 K581H - SUTURE NONABSORBABLE 4-0 BB 24IN 2 ARM BRAID PERMA-HAND BOTH IP/OP $392.00 $290.00 $69.70 $402.98 $391.58 $391.58 $391.58 $391.58 $391.58 $391.58 $69.70 $391.58 $391.58 $290.63 $290.63 $301.83 $204.01 $81.61 $391.58 $161.19 $391.58 $391.58 $402.98 $391.58 $391.58 $294.00 $391.58 $391.58 $391.58 $195.79 $195.79 $310.13 $391.58 $313.26 $254.53 $391.58 N/A $227.36 $391.58 $234.95 $391.58 $391.58 $391.58 N/A N/A K8-6180 SUP Custom 27203010 K8-6180 - SPHERE EYE 18MM CLR SLD PLS BOTH IP/OP $63.00 $47.00 $11.17 $62.78 $62.78 $62.78 $62.78 $62.78 $62.78 $62.78 $11.17 $62.78 $62.78 $46.60 $46.60 $48.39 $32.71 $13.08 $62.78 $25.11 $62.78 $62.78 $62.78 $62.78 $62.78 $47.25 $62.78 $62.78 $62.78 $31.39 $31.39 $49.72 $62.78 $50.22 $40.81 $62.78 N/A $36.54 $62.78 $37.67 $62.78 $62.78 $62.78 N/A N/A K8-6200 SUP HCPCS L8610 K8-6200 - SPHERE EYE 20MM SOLID CLEAR PLST BOTH IP/OP $63.00 $47.00 $12.46 $62.78 $28.25 $28.25 $28.25 $28.25 $62.78 $62.78 $62.78 $13.08 $62.78 $62.78 $62.78 $62.78 $62.78 $13.08 $62.78 $62.78 $37.13 $62.78 $62.78 $62.78 $62.78 $47.25 $62.78 $62.78 $62.78 $31.39 $31.39 $49.72 $62.78 $50.22 $28.25 $12.46 N/A $36.54 $62.78 $62.78 $62.78 $13.08 $62.78 N/A N/A K8-6220 SUP HCPCS L8610 K8-6220 - SPHERE EYE 22MM SOLID CLEAR PLST BOTH IP/OP $63.00 $47.00 $12.46 $62.78 $28.25 $28.25 $28.25 $28.25 $62.78 $62.78 $62.78 $13.08 $62.78 $62.78 $62.78 $62.78 $62.78 $13.08 $62.78 $62.78 $37.13 $62.78 $62.78 $62.78 $62.78 $47.25 $62.78 $62.78 $62.78 $31.39 $31.39 $49.72 $62.78 $50.22 $28.25 $12.46 N/A $36.54 $62.78 $62.78 $62.78 $13.08 $62.78 N/A N/A K8-6330 SUP Custom 27203010 K8-6330 - CONFORMER OPTH LG UNV CLR PLS BOTH IP/OP $63.00 $47.00 $11.17 $62.78 $62.78 $62.78 $62.78 $62.78 $62.78 $62.78 $11.17 $62.78 $62.78 $46.60 $46.60 $48.39 $32.71 $13.08 $62.78 $25.11 $62.78 $62.78 $62.78 $62.78 $62.78 $47.25 $62.78 $62.78 $62.78 $31.39 $31.39 $49.72 $62.78 $50.22 $40.81 $62.78 N/A $36.54 $62.78 $37.67 $62.78 $62.78 $62.78 N/A N/A KC9529 SUP Custom 27203010 KC9529 - SLEEVES KNEE MEDIUM LENGTH BOTH IP/OP $74.00 $55.00 $13.10 $73.60 $73.60 $73.60 $73.60 $73.60 $73.60 $73.60 $13.10 $73.60 $73.60 $54.63 $54.63 $56.73 $38.35 $15.34 $73.60 $29.44 $73.60 $73.60 $73.60 $73.60 $73.60 $55.50 $73.60 $73.60 $73.60 $36.80 $36.80 $58.29 $73.60 $58.88 $47.84 $73.60 N/A $42.92 $73.60 $44.16 $73.60 $73.60 $73.60 N/A N/A KC-RUMI-30 SUP Custom 27203010 KC-RUMI-30 - MANIPULATOR ENDSCP 3CM EASY LOAD DESIGN LOCK HANDLE SAFELY BOTH IP/OP $223.50 $165.00 $39.74 $263.89 $223.26 $223.26 $223.26 $223.26 $223.26 $223.26 $39.74 $223.26 $223.26 $165.70 $165.70 $172.09 $116.32 $46.53 $223.26 $105.56 $223.26 $223.26 $263.89 $223.26 $223.26 $167.63 $223.26 $223.26 $223.26 $111.63 $111.63 $176.82 $223.26 $178.61 $145.12 $223.26 N/A $129.63 $223.26 $133.96 $223.26 $223.26 $223.26 N/A N/A KC-RUMI-35 SUP HCPCS C1713 KC-RUMI-35 - MANIPULATOR ESCP 3.5CM STRL LF KOH-EFCT RUMI II K CP EZ LD BOTH IP/OP $223.50 $165.00 $44.31 $263.89 $100.47 $100.47 $100.47 $100.47 $223.26 $223.26 $223.26 $46.53 $223.26 $223.26 $223.26 $223.26 $223.26 $46.53 $223.26 $263.89 $132.06 $223.26 $263.89 $223.26 $223.26 $167.63 $223.26 $223.26 $223.26 $111.63 $111.63 $176.82 $223.26 $178.61 $100.47 $44.31 N/A $129.63 $223.26 $133.96 $223.26 $223.26 $223.26 N/A N/A KC-RUMI-40 SUP Custom 27203010 KC-RUMI-40 - DEVICE UTERINE 4CM LATEX FREE RUMI II KOH-EFFICIENT CERVIX BOTH IP/OP $223.50 $165.00 $39.74 $263.89 $223.26 $223.26 $223.26 $223.26 $223.26 $223.26 $39.74 $223.26 $223.26 $165.70 $165.70 $172.09 $116.32 $46.53 $223.26 $105.56 $223.26 $223.26 $263.89 $223.26 $223.26 $167.63 $223.26 $223.26 $223.26 $111.63 $111.63 $176.82 $223.26 $178.61 $145.12 $223.26 N/A $129.63 $223.26 $133.96 $223.26 $223.26 $223.26 N/A N/A KLIPPEN SUP HCPCS C1879 KLIPPEN - MARKER BOTH IP/OP $87.50 $65.00 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $18.24 $87.50 $35.00 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $39.38 $87.50 N/A $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A KLTSD424 SUP Custom 27203010 KLTSD424 - AIRWAY ESOPHAGEAL 4 18MM 10MM 5-6FT GASTRIC ACCES LATEX FREE BOTH IP/OP $91.00 $67.00 $16.14 $90.67 $90.67 $90.67 $90.67 $90.67 $90.67 $90.67 $16.14 $90.67 $90.67 $67.30 $67.30 $69.89 $47.24 $18.90 $90.67 $36.27 $90.67 $90.67 $90.67 $90.67 $90.67 $68.25 $90.67 $90.67 $90.67 $45.34 $45.34 $71.81 $90.67 $72.54 $58.94 $90.67 N/A $52.78 $90.67 $54.40 $90.67 $90.67 $90.67 N/A N/A KLTSD425 SUP Custom 27203010 KLTSD425 - AIRWAY ESOPHAGEAL 5 18MM 10MM 6+ FT GASTRIC ACCES LATEX FREE BOTH IP/OP $85.50 $63.00 $15.21 $85.44 $85.44 $85.44 $85.44 $85.44 $85.44 $85.44 $15.21 $85.44 $85.44 $63.41 $63.41 $65.86 $44.51 $17.81 $85.44 $34.18 $85.44 $85.44 $85.44 $85.44 $85.44 $64.13 $85.44 $85.44 $85.44 $42.72 $42.72 $67.67 $85.44 $68.35 $55.54 $85.44 N/A $49.59 $85.44 $51.26 $85.44 $85.44 $85.44 N/A N/A KM172-14-54 SUP Custom 27203010 KM172-14-54 - WIRE .054IN 4IN KWIRE SS SMTH TROCAR PNT 1 END ORTH NONSTRL BOTH IP/OP $6.00 $4.00 $1.01 $5.70 $5.70 $5.70 $5.70 $5.70 $5.70 $5.70 $1.01 $5.70 $5.70 $4.23 $4.23 $4.39 $2.97 $1.19 $5.70 $2.28 $5.70 $5.70 $5.70 $5.70 $5.70 $4.50 $5.70 $5.70 $5.70 $2.85 $2.85 $4.51 $5.70 $4.56 $3.71 $5.70 N/A $3.48 $5.70 $3.42 $5.70 $5.70 $5.70 N/A N/A KT1835C SUP HCPCS C1753 KT1835C - KIT CATH ER-REBOA BOTH IP/OP $467.50 $346.00 $92.79 $562.50 $253.85 $253.85 $253.85 $253.85 $467.50 $467.50 $467.50 $97.44 $467.50 $346.98 $346.98 $360.35 $243.57 $97.43 $467.50 $562.50 $276.53 $467.50 $512.50 $467.50 $467.50 $350.63 $467.50 $467.50 $467.50 $233.75 $233.75 $370.26 $467.50 $374.00 $303.88 $92.79 N/A $271.15 $467.50 $467.50 $467.50 $97.43 $467.50 N/A N/A KW-062 SUP HCPCS C1769 KW-062 - WIRE FIX .062IN KWIRE SS BOTH IP/OP $181.50 $134.00 $35.97 $181.25 $98.42 $98.42 $98.42 $98.42 $181.25 $181.25 $181.25 $37.78 $181.25 $134.52 $134.52 $139.71 $94.43 $37.77 $181.25 $181.25 $107.21 $181.25 $181.25 $181.25 $181.25 $136.13 $181.25 $181.25 $181.25 $90.63 $90.63 $143.55 $181.25 $145.00 $117.81 $35.97 N/A $105.27 $181.25 $181.25 $181.25 $37.77 $181.25 N/A N/A KW062SS SUP HCPCS C1769 KW062SS - WIRE FIX 1.6MM KWIRE SS BOTH IP/OP $62.50 $46.00 $12.40 $62.50 $33.94 $33.94 $33.94 $33.94 $62.50 $62.50 $62.50 $13.03 $62.50 $46.39 $46.39 $48.18 $32.56 $13.03 $62.50 $62.50 $36.97 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $40.63 $12.40 N/A $36.25 $62.50 $62.50 $62.50 $13.03 $62.50 N/A N/A KWIR-STD-09152 SUP Custom 27203010 KWIR-STD-09152 - WIRE FX STD .9MM 152MM KRSH TIP SS BOTH IP/OP $60.00 $44.00 $10.68 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $10.68 $60.00 $60.00 $44.53 $44.53 $46.25 $31.26 $12.50 $60.00 $24.00 $60.00 $60.00 $60.00 $60.00 $60.00 $45.00 $60.00 $60.00 $60.00 $30.00 $30.00 $47.52 $60.00 $48.00 $39.00 $60.00 N/A $34.80 $60.00 $36.00 $60.00 $60.00 $60.00 N/A N/A KWIR-STD-15127 SUP HCPCS C1713 KWIR-STD-15127 - WIRE FX 1.5MM 127MM KRSH STD TIP SS BOTH IP/OP $70.00 $52.00 $13.89 $70.00 $31.50 $31.50 $31.50 $31.50 $70.00 $70.00 $70.00 $14.59 $70.00 $70.00 $70.00 $70.00 $70.00 $14.59 $70.00 $24.00 $41.41 $70.00 $60.00 $70.00 $70.00 $52.50 $70.00 $70.00 $70.00 $35.00 $35.00 $55.44 $70.00 $56.00 $31.50 $13.89 N/A $40.60 $70.00 $70.00 $70.00 $14.59 $70.00 N/A N/A L3030 SUP HCPCS C1713 L3030 - PIN SKL STRL MYFLD WNG GRV PLS ADLT CRNM DISP BOTH IP/OP $900.00 $666.00 $178.63 $900.00 $405.00 $405.00 $405.00 $405.00 $900.00 $900.00 $900.00 $187.58 $900.00 $900.00 $900.00 $900.00 $900.00 $187.57 $900.00 $900.00 $532.35 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $405.00 $178.63 N/A $522.00 $900.00 $900.00 $900.00 $900.00 $900.00 N/A N/A LA6AL75 SUP HCPCS C1887 LA6AL75 - CATHETER GD AL.75 CRV 6FR 100CM STRL LF LNCHR LG LUM RADOPQ BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 N/A $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A LA7EBU30 SUP HCPCS C1887 LA7EBU30 - CATHETER GD EBU3 CRV 7FR 100CM STRL LF LNCHR LG LUM RADOPQ BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 N/A $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A LA7JR40 SUP HCPCS C1887 LA7JR40 - CATHETER GD STD JR4 CRV 7FR 100CM STRL LF LNCHR LG LUM BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 N/A $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A LAG3.2-24 SUP HCPCS C1713 LAG3.2-24 - SCREW BN 3.2MM 24MM LG CORT BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A LAG3.2-26 SUP HCPCS C1713 LAG3.2-26 - SCREW BN 3.2MM 26MM LG CORT BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A LAG-4300 SUP HCPCS C1713 LAG-4300 - SCREW BONE 30MM LAG MALLEOLUS NONSTRL BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $460.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $276.00 $460.00 $95.86 $460.00 N/A N/A LAG-4350 SUP HCPCS C1713 LAG-4350 - SCREW BONE 35MM LAG MALLEOLUS NONSTRL BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $460.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LAG-4400 SUP HCPCS C1713 LAG-4400 - SCREW BONE 40MM LAG MALLEOLUS NONSTRL BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LAG-4450 SUP HCPCS C1713 LAG-4450 - SCREW BONE 45MM LAG MALLEOLUS NONSTRL BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LAG-4500 SUP HCPCS C1713 LAG-4500 - SCREW BONE 4MM 50MM LAG TITANIUM MALLEOLUS NONSTRL BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LAG-5036 SUP HCPCS C1713 LAG-5036 - SCREW BONE 36MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $460.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LAG-5038 SUP HCPCS C1713 LAG-5038 - SCREW BONE 38MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LAG-5040 SUP HCPCS C1713 LAG-5040 - SCREW BONE 40MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LAG-5042 SUP HCPCS C1713 LAG-5042 - SCREW BONE 42MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LAG-5044 SUP HCPCS C1713 LAG-5044 - SCREW BONE 44MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $460.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LAG-5046 SUP HCPCS C1713 LAG-5046 - SCREW BONE 46MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $460.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LAG-5048 SUP HCPCS C1713 LAG-5048 - SCREW BONE 48MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $460.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LAG-5050 SUP HCPCS C1713 LAG-5050 - SCREW BONE 50MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $460.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LAG-5052 SUP HCPCS C1713 LAG-5052 - SCREW BONE 52MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LAG-5054 SUP HCPCS C1713 LAG-5054 - SCREW BONE 54MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $276.00 $460.00 $95.86 $460.00 N/A N/A LAG-5056 SUP HCPCS C1713 LAG-5056 - SCREW BONE 56MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $276.00 $460.00 $95.86 $460.00 N/A N/A LAG-5058 SUP HCPCS C1713 LAG-5058 - SCREW BONE 58MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $460.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $276.00 $460.00 $95.86 $460.00 N/A N/A LAG-5060 SUP HCPCS C1713 LAG-5060 - SCREW BONE 60MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $460.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $276.00 $460.00 $95.86 $460.00 N/A N/A LAG-5062 SUP HCPCS C1713 LAG-5062 - SCREW BONE 62MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $460.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LAG-5064 SUP HCPCS C1713 LAG-5064 - SCREW BONE 64MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $276.00 $460.00 $95.86 $460.00 N/A N/A LAG-5066 SUP HCPCS C1713 LAG-5066 - SCREW BONE 66MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $276.00 $460.00 $95.86 $460.00 N/A N/A LAG-5068 SUP HCPCS C1713 LAG-5068 - SCREW BONE 68MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $460.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $276.00 $460.00 $95.86 $460.00 N/A N/A LAG-5070 SUP HCPCS C1713 LAG-5070 - SCREW BONE 70MM SYNDESMOSIS LAG UPPER/LOWER EXTREMITY BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $276.00 $460.00 $95.86 $460.00 N/A N/A LAG-5072 SUP HCPCS C1713 LAG-5072 - SCREW BONE 72MM UPR/LWR XTRMT SYNDESMOSIS LAG BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $276.00 $460.00 $95.86 $460.00 N/A N/A LAG-5074 SUP HCPCS C1713 LAG-5074 - SCREW BONE 74MM UPR/LWR XTRMT SYNDESMOSIS LAG BOTH IP/OP $460.00 $340.00 $91.30 $460.00 $207.00 $207.00 $207.00 $207.00 $460.00 $460.00 $460.00 $95.88 $460.00 $460.00 $460.00 $460.00 $460.00 $95.87 $460.00 $184.00 $272.09 $460.00 $460.00 $460.00 $460.00 $345.00 $460.00 $460.00 $460.00 $230.00 $230.00 $364.32 $460.00 $368.00 $207.00 $91.30 N/A $266.80 $460.00 $460.00 $460.00 $95.86 $460.00 N/A N/A LC3006 SUP Custom 27203010 LC3006 - KIT SRG STRL LF SPY PAQ DISP BOTH IP/OP "$1,374.50" "$1,017.00" $244.62 "$1,374.25" "$1,374.25" "$1,374.25" "$1,374.25" "$1,374.25" "$1,374.25" "$1,374.25" $244.62 "$1,374.25" "$1,374.25" "$1,019.97" "$1,019.97" "$1,059.27" $715.98 $286.41 "$1,374.25" $549.70 "$1,374.25" "$1,374.25" "$1,374.25" "$1,374.25" "$1,374.25" "$1,030.88" "$1,374.25" "$1,374.25" "$1,374.25" $687.13 $687.13 "$1,088.41" "$1,374.25" "$1,099.40" $893.26 "$1,374.25" N/A $797.21 "$1,374.25" $824.55 "$1,374.25" "$1,374.25" "$1,374.25" N/A N/A LCBS2.7-10 SUP HCPCS C1713 LCBS2.7-10 - SCREW BN 2.7MM 10MM LCK SS CORT TRIMED CLVCL FX SYS BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A LCBS2.7-16 SUP HCPCS C1713 LCBS2.7-16 - SCREW BN 2.7MM 16MM LCK SS CORT TRIMED CLVCL FX SYS BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $262.50 $262.50 $54.71 $262.50 N/A N/A LCBS3.2-08 SUP HCPCS C1713 LCBS3.2-08 - SCREW BONE 3.2MM 8MM FRARM ELB CORT LOCK BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A LCBS3.2-12 SUP HCPCS C1713 LCBS3.2-12 - SCREW BONE 3.2MM 12MM LOCK FOREARM ELBOW CORTICAL BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $262.50 $262.50 $54.71 $262.50 N/A N/A LCBS3.2-14 SUP HCPCS C1713 LCBS3.2-14 - SCREW BONE 3.2MM 14MM LOCK OLECRANON HOOK PLATE FOREARM BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $262.50 $262.50 $54.71 $262.50 N/A N/A LCBS3.2-16 SUP HCPCS C1713 LCBS3.2-16 - SCREW BONE 3.2MM 16MM LOCK FOREARM ELBOW CORTICAL BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $262.50 $262.50 $54.71 $262.50 N/A N/A LCBS3.2-18 SUP HCPCS C1713 LCBS3.2-18 - SCREW BONE 3.2MM 18MM LOCK FOREARM ELBOW CORTICAL BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $262.50 $262.50 $54.71 $262.50 N/A N/A LCBS3.2-22 SUP HCPCS C1713 LCBS3.2-22 - SCREW BONE 3.2MM 22MM LOCK FOREARM ELBOW CORTICAL BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $262.50 $262.50 $54.71 $262.50 N/A N/A LCBS32-24 SUP HCPCS C1713 LCBS32-24 - SCREW BONE 3.2MM 24MM LOCK FOREARM ELBOW CORTICAL BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $250.00 $250.00 $52.10 $250.00 N/A N/A LF1737 SUP Custom 27203010 LF1737 - SEALER/DIVIDER LAPSCP 350D 5MM 37CM LGSR MD 1 STP SL MLFNC BOTH IP/OP "$1,318.50" $976.00 $234.67 "$1,318.35" "$1,318.35" "$1,318.35" "$1,318.35" "$1,318.35" "$1,318.35" "$1,318.35" $234.67 "$1,318.35" "$1,318.35" $978.48 $978.48 "$1,016.18" $686.86 $274.76 "$1,318.35" $527.34 "$1,318.35" "$1,318.35" "$1,318.35" "$1,318.35" "$1,318.35" $988.88 "$1,318.35" "$1,318.35" "$1,318.35" $659.18 $659.18 "$1,044.13" "$1,318.35" "$1,054.68" $856.93 "$1,318.35" N/A $764.73 "$1,318.35" $791.01 "$1,318.35" "$1,318.35" "$1,318.35" N/A N/A LF1837 SUP Custom 27203010 LF1837 - SEALER/DIVIDER BIPOL 180D STR 5MM 37CM ENERGY PLATFORM HAND BOTH IP/OP "$1,071.50" $793.00 $190.68 "$1,071.25" "$1,071.25" "$1,071.25" "$1,071.25" "$1,071.25" "$1,071.25" "$1,071.25" $190.68 "$1,071.25" "$1,071.25" $795.08 $795.08 $825.72 $558.12 $223.26 "$1,071.25" $592.52 "$1,071.25" "$1,071.25" "$1,071.25" "$1,071.25" "$1,071.25" $803.63 "$1,071.25" "$1,071.25" "$1,071.25" $535.63 $535.63 $848.43 "$1,071.25" $857.00 $696.31 "$1,071.25" N/A $621.47 "$1,071.25" $642.75 "$1,071.25" "$1,071.25" "$1,071.25" N/A N/A LF1923 SUP Custom 27203010 LF1923 - SEALER/DIVIDER LAPSCP 350D 18.5MM 23CM 20.3MM LGSR MD CRV BOTH IP/OP "$7,070.50" "$5,232.00" $471.35 "$7,070.25" "$7,070.25" "$7,070.25" "$7,070.25" "$7,070.25" "$7,070.25" "$7,070.25" "$1,258.50" "$7,070.25" "$7,070.25" "$4,181.12" "$4,181.12" "$5,449.75" "$2,060.15" "$1,473.52" "$7,070.25" $471.35 "$7,070.25" "$7,070.25" "$1,178.38" "$7,070.25" "$7,070.25" "$5,302.88" "$7,070.25" "$7,070.25" "$7,070.25" "$3,535.13" "$3,535.13" "$5,599.64" "$7,070.25" "$5,656.20" "$4,595.66" "$7,070.25" N/A "$4,100.89" "$7,070.25" "$4,242.15" "$7,070.25" "$7,070.25" "$7,070.25" N/A N/A LF2019 SUP Custom 27203010 LF2019 - DISSECTOR SRG 40D 20.6MM 19.8MM 4MM 21CM 21.6X2MM LGSR EXACT BOTH IP/OP "$1,743.50" "$1,290.00" $310.34 "$1,743.50" "$1,743.50" "$1,743.50" "$1,743.50" "$1,743.50" "$1,743.50" "$1,743.50" $310.34 "$1,743.50" "$1,743.50" "$1,294.03" "$1,294.03" "$1,343.89" $908.36 $363.36 "$1,743.50" $697.40 "$1,743.50" "$1,743.50" "$1,743.50" "$1,743.50" "$1,743.50" "$1,307.63" "$1,743.50" "$1,743.50" "$1,743.50" $871.75 $871.75 "$1,380.85" "$1,743.50" "$1,394.80" "$1,133.28" "$1,743.50" N/A "$1,011.23" "$1,743.50" "$1,046.10" "$1,743.50" "$1,743.50" "$1,743.50" N/A N/A LF4318 SUP Custom 27203010 LF4318 - SEALER/DIVIDER BP 180D 34MM LG 13.5MM 7.1IN STRL LF 36MM BOTH IP/OP "$8,796.00" "$6,509.00" "$1,565.61" "$8,795.55" "$8,795.55" "$8,795.55" "$8,795.55" "$8,795.55" "$8,795.55" "$8,795.55" "$1,565.61" "$8,795.55" "$8,795.55" "$4,181.12" "$4,181.12" "$6,779.61" "$2,060.15" "$1,833.09" "$8,795.55" "$3,518.22" "$8,795.55" "$8,795.55" "$8,795.55" "$8,795.55" "$8,795.55" "$6,597.00" "$8,795.55" "$8,795.55" "$8,795.55" "$4,397.78" "$4,397.78" "$6,966.08" "$8,795.55" "$7,036.44" "$5,717.11" "$8,795.55" N/A "$5,101.68" "$8,795.55" "$5,277.33" "$8,795.55" "$8,795.55" "$8,795.55" N/A N/A LF4418 SUP Custom 27203010 LF4418 - SEALER/DIVIDER BP 14D 180D 34MM 13.5MM 18CM STRL LF 36MM BOTH IP/OP "$1,466.00" "$1,085.00" $260.94 "$1,465.93" "$1,465.93" "$1,465.93" "$1,465.93" "$1,465.93" "$1,465.93" "$1,465.93" $260.94 "$1,465.93" "$1,465.93" "$1,088.01" "$1,088.01" "$1,129.94" $763.75 $305.52 "$1,465.93" $586.37 "$1,465.93" "$1,465.93" "$1,465.93" "$1,465.93" "$1,465.93" "$1,099.50" "$1,465.93" "$1,465.93" "$1,465.93" $732.97 $732.97 "$1,161.02" "$1,465.93" "$1,172.74" $952.85 "$1,465.93" N/A $850.28 "$1,465.93" $879.56 "$1,465.93" "$1,465.93" "$1,465.93" N/A N/A LFC002 SUP Custom 27203010 LFC002 - TIP APL LIQUIBAND ADH TISS FLW CNTRL BOTH IP/OP $93.00 $69.00 $16.55 $92.98 $92.98 $92.98 $92.98 $92.98 $92.98 $92.98 $16.55 $92.98 $92.98 $69.01 $69.01 $71.67 $48.44 $19.38 $92.98 $37.19 $92.98 $92.98 $92.98 $92.98 $92.98 $69.75 $92.98 $92.98 $92.98 $46.49 $46.49 $73.64 $92.98 $74.38 $60.44 $92.98 N/A $53.94 $92.98 $55.79 $92.98 $92.98 $92.98 N/A N/A LHEX3.2-12 SUP HCPCS C1713 LHEX3.2-12 - SCREW BN 3.2MM 12MM LCK SS CORT TRIMED CLVCL FX SYS BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A LL0006 SUP Custom 27011340 LL0006 - TUBING UROLOGY SET BOTH IP/OP $314.50 $233.00 $55.92 $314.15 $314.15 $314.15 $314.15 $314.15 $314.15 $314.15 $55.92 $314.15 $314.15 $233.16 $233.16 $242.15 $163.67 $65.47 $314.15 $125.66 $314.15 $314.15 $314.15 $314.15 $314.15 $235.88 $314.15 $314.15 $314.15 $157.08 $157.08 $248.81 $314.15 $251.32 $204.20 $314.15 N/A $182.41 $314.15 $188.49 $314.15 $314.15 $314.15 N/A N/A LN205 SUP Custom 27203010 LN205 - RESERVOIR CARDIOTOMY 3L UNFILTERED BOTH IP/OP $77.00 $57.00 $13.71 $77.00 $77.00 $77.00 $77.00 $77.00 $77.00 $77.00 $13.71 $77.00 $77.00 $57.15 $57.15 $59.35 $40.12 $16.05 $77.00 $30.80 $77.00 $77.00 $77.00 $77.00 $77.00 $57.75 $77.00 $77.00 $77.00 $38.50 $38.50 $60.98 $77.00 $61.60 $50.05 $77.00 N/A $44.66 $77.00 $46.20 $77.00 $77.00 $77.00 N/A N/A LPG1510 SUP HCPCS C1781 LPG1510 - MESH SURG 15X10CM SELF FIXATE FLAT SHEET LATEX FREE PROGRIP BOTH IP/OP $886.50 $656.00 $175.93 $886.40 $398.88 $398.88 $398.88 $398.88 $886.40 $886.40 $886.40 $184.75 $886.40 $886.40 $886.40 $886.40 $886.40 $184.74 $886.40 $886.40 $524.31 $886.40 $886.40 $886.40 $886.40 $664.88 $886.40 $886.40 $886.40 $443.20 $443.20 $702.03 $886.40 $709.12 $398.88 $175.93 N/A $514.17 $886.40 $886.40 $886.40 $184.73 $886.40 N/A N/A LPP11 SUP Custom 27803010 LPP11 - EXPANDER TISSUE P5CM 11X9CM TEXTURED LP PLUS LATERAL EXTN BOTH IP/OP "$2,625.00" "$1,943.00" $467.25 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $467.25 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" "$2,625.00" N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" "$2,625.00" "$2,625.00" N/A N/A LPP12 SUP HCPCS C1789 LPP12 - EXPANDER TISSUE P5.2CM 9.8X12CM TEXTURED LOW POLE PLUS BOTH IP/OP "$3,025.00" "$2,239.00" $600.39 "$3,025.00" "$1,361.25" "$1,361.25" "$1,361.25" "$1,361.25" "$3,025.00" "$3,025.00" "$3,025.00" $630.49 "$3,025.00" "$3,025.00" "$3,025.00" "$3,025.00" "$3,025.00" $630.44 "$3,025.00" "$3,025.00" "$1,491.33" "$3,025.00" "$3,025.00" "$3,025.00" "$3,025.00" "$2,268.75" "$3,025.00" "$3,025.00" "$3,025.00" "$1,512.50" "$1,512.50" "$2,395.80" "$3,025.00" "$2,420.00" "$1,361.25" $600.39 N/A "$1,754.50" "$3,025.00" "$3,025.00" "$3,025.00" $630.41 "$3,025.00" N/A N/A LPP13 SUP HCPCS C1789 LPP13 - EXPANDER TISSUE P5.5CM 13X10.6CM TEXTURED LP PLUS LATERAL BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A LPP14 SUP HCPCS C1789 LPP14 - EXPANDER TISSUE P6CM 14X11.2CM TEXTURED LP PLUS LATERAL EXTN BOTH IP/OP "$3,025.00" "$2,239.00" $600.39 "$3,025.00" "$1,361.25" "$1,361.25" "$1,361.25" "$1,361.25" "$3,025.00" "$3,025.00" "$3,025.00" $630.49 "$3,025.00" "$3,025.00" "$3,025.00" "$3,025.00" "$3,025.00" $630.44 "$3,025.00" "$3,025.00" "$1,491.33" "$3,025.00" "$3,025.00" "$3,025.00" "$3,025.00" "$2,268.75" "$3,025.00" "$3,025.00" "$3,025.00" "$1,512.50" "$1,512.50" "$2,395.80" "$3,025.00" "$2,420.00" "$1,361.25" $600.39 N/A "$1,754.50" "$3,025.00" "$3,025.00" "$3,025.00" $630.41 "$3,025.00" N/A N/A LPP15 SUP HCPCS C1789 LPP15 - EXPANDER TISS P6.4-7.9CM MID HT 15X11.5CM 500-600CC BOTH IP/OP "$3,025.00" "$2,239.00" $600.39 "$3,025.00" "$1,361.25" "$1,361.25" "$1,361.25" "$1,361.25" "$3,025.00" "$3,025.00" "$3,025.00" $630.49 "$3,025.00" "$3,025.00" "$3,025.00" "$3,025.00" "$3,025.00" $630.44 "$3,025.00" "$3,025.00" "$1,491.33" "$3,025.00" "$3,025.00" "$3,025.00" "$3,025.00" "$2,268.75" "$3,025.00" "$3,025.00" "$3,025.00" "$1,512.50" "$1,512.50" "$2,395.80" "$3,025.00" "$2,420.00" "$1,361.25" $600.39 N/A "$1,754.50" "$3,025.00" "$3,025.00" "$3,025.00" $630.41 "$3,025.00" N/A N/A LPP16 SUP HCPCS C1789 LPP16 - EXPANDER TISS P6.6-8.2CM MID HT 16X12CM 580-690CC DERMASPAN BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$2,625.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A LQB001 SUP Custom 27203010 LQB001 - ADHESIVE SKIN CLOSURE DOME LIQUIBAND TISSUE BOTH IP/OP $127.50 $94.00 $22.65 $127.22 $127.22 $127.22 $127.22 $127.22 $127.22 $127.22 $22.65 $127.22 $127.22 $94.42 $94.42 $98.06 $66.28 $26.51 $127.22 $50.89 $127.22 $127.22 $127.22 $127.22 $127.22 $95.63 $127.22 $127.22 $127.22 $63.61 $63.61 $100.76 $127.22 $101.78 $82.69 $127.22 N/A $73.95 $127.22 $76.33 $127.22 $127.22 $127.22 N/A N/A LS1500 SUP Custom 27203010 LS1500 - SEALER/DIVIDER LAPSCP 179D 12MM 5MM 37CM STRL 18X2.6MM LGSR BOTH IP/OP "$1,216.00" $900.00 $216.39 "$1,215.66" "$1,215.66" "$1,215.66" "$1,215.66" "$1,215.66" "$1,215.66" "$1,215.66" $216.39 "$1,215.66" "$1,215.66" $902.26 $902.26 $937.03 $633.36 $253.36 "$1,215.66" $486.26 "$1,215.66" "$1,215.66" "$1,215.66" "$1,215.66" "$1,215.66" $912.00 "$1,215.66" "$1,215.66" "$1,215.66" $607.83 $607.83 $962.80 "$1,215.66" $972.53 $790.18 "$1,215.66" N/A $705.28 "$1,215.66" $729.40 "$1,215.66" "$1,215.66" "$1,215.66" N/A N/A LT200 SUP HCPCS C1760 LT200 - CLIP INTERNAL MEDIUM LIGATE OPEN LATEX FREE LIGACLIP EXTRA BOTH IP/OP $31.00 $23.00 $6.07 $30.60 $13.77 $13.77 $13.77 $13.77 $30.60 $30.60 $30.60 $6.38 $30.60 $30.60 $30.60 $30.60 $30.60 $6.38 $30.60 $30.60 $18.10 $30.60 $30.60 $30.60 $30.60 $23.25 $30.60 $30.60 $30.60 $15.30 $15.30 $24.24 $30.60 $24.48 $13.77 $6.07 N/A $17.98 $30.60 $30.60 $30.60 $6.38 $30.60 N/A N/A LT400 SUP HCPCS C1760 LT400 - CLIP INTERNAL LARGE LIGATE OPEN LATEX FREE LIGACLIP EXTRA BOTH IP/OP $56.50 $42.00 $11.13 $56.10 $25.25 $25.25 $25.25 $25.25 $56.10 $56.10 $56.10 $11.69 $56.10 $56.10 $56.10 $56.10 $56.10 $11.69 $56.10 $56.10 $33.18 $56.10 $56.10 $56.10 $56.10 $42.38 $56.10 $56.10 $56.10 $28.05 $28.05 $44.43 $56.10 $44.88 $25.25 $11.13 N/A $32.77 $56.10 $56.10 $56.10 $11.69 $56.10 N/A N/A LUB07030 SUP HCPCS C2625 LUB07030 - STENT BIL 7MM 6FR 30MM 80CM .035IN CATH GWIRE E-LMNX BOTH IP/OP "$3,883.50" "$2,874.00" $770.72 "$3,883.20" "$1,747.44" "$1,747.44" "$1,747.44" "$1,747.44" "$3,883.20" "$3,883.20" "$3,883.20" $809.36 "$3,883.20" "$3,883.20" "$3,883.20" "$3,883.20" "$3,883.20" $809.30 "$3,883.20" "$3,883.20" "$1,914.42" "$3,883.20" "$3,883.20" "$3,883.20" "$3,883.20" "$2,912.63" "$3,883.20" "$3,883.20" "$3,883.20" "$1,941.60" "$1,941.60" "$3,075.49" "$3,883.20" "$3,106.56" "$1,747.44" $770.72 N/A "$2,252.43" "$3,883.20" "$3,883.20" "$3,883.20" $809.26 "$3,883.20" N/A N/A LUB07040 SUP HCPCS C2625 LUB07040 - STENT BIL .035IN 7MM 6FR 40MM 80CM LMNX SLF XPD DLV SYS NTNL BOTH IP/OP "$3,883.50" "$2,874.00" $770.72 "$3,883.19" "$1,747.44" "$1,747.44" "$1,747.44" "$1,747.44" "$3,883.19" "$3,883.19" "$3,883.19" $809.35 "$3,883.19" "$3,883.19" "$3,883.19" "$3,883.19" "$3,883.19" $809.30 "$3,883.19" "$3,883.19" "$1,914.41" "$3,883.19" "$3,883.19" "$3,883.19" "$3,883.19" "$2,912.63" "$3,883.19" "$3,883.19" "$3,883.19" "$1,941.60" "$1,941.60" "$3,075.49" "$3,883.19" "$3,106.55" "$1,747.44" $770.72 N/A "$2,252.43" "$3,883.19" "$3,883.19" "$3,883.19" $809.26 "$3,883.19" N/A N/A LUB08030 SUP HCPCS C2625 LUB08030 - STENT BIL .035IN 8MM 6FR 30MM 80CM LMNX SLF XPD DLV SYS NTNL BOTH IP/OP "$3,883.50" "$2,874.00" $770.72 "$3,883.19" "$1,747.44" "$1,747.44" "$1,747.44" "$1,747.44" "$3,883.19" "$3,883.19" "$3,883.19" $809.35 "$3,883.19" "$3,883.19" "$3,883.19" "$3,883.19" "$3,883.19" $809.30 "$3,883.19" "$3,883.19" "$1,914.41" "$3,883.19" "$3,883.19" "$3,883.19" "$3,883.19" "$2,912.63" "$3,883.19" "$3,883.19" "$3,883.19" "$1,941.60" "$1,941.60" "$3,075.49" "$3,883.19" "$3,106.55" "$1,747.44" $770.72 N/A "$2,252.43" "$3,883.19" "$3,883.19" "$3,883.19" $809.26 "$3,883.19" N/A N/A LUB08060 SUP HCPCS C2625 LUB08060 - STENT BIL .035IN 8MM 6FR 60MM 80CM LMNX SLF XPD DLV SYS NTNL BOTH IP/OP "$3,883.50" "$2,874.00" $770.72 "$3,883.19" "$1,747.44" "$1,747.44" "$1,747.44" "$1,747.44" "$3,883.19" "$3,883.19" "$3,883.19" $809.35 "$3,883.19" "$3,883.19" "$3,883.19" "$3,883.19" "$3,883.19" $809.30 "$3,883.19" "$3,883.19" "$1,914.41" "$3,883.19" "$3,883.19" "$3,883.19" "$3,883.19" "$2,912.63" "$3,883.19" "$3,883.19" "$3,883.19" "$1,941.60" "$1,941.60" "$3,075.49" "$3,883.19" "$3,106.55" "$1,747.44" $770.72 N/A "$2,252.43" "$3,883.19" "$3,883.19" "$3,883.19" $809.26 "$3,883.19" N/A N/A LUB10040 SUP HCPCS C2625 LUB10040 - STENT VASC .035IN 10MM 6FR 40MM 80CM E-LMNX SAFE PERFORMAXX BOTH IP/OP "$2,250.00" "$1,665.00" $446.57 "$2,250.00" "$1,012.50" "$1,012.50" "$1,012.50" "$1,012.50" "$2,250.00" "$2,250.00" "$2,250.00" $468.96 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" "$2,250.00" "$1,330.88" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" $446.57 N/A "$1,305.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.90 "$2,250.00" N/A N/A LUB12080 SUP HCPCS C2625 LUB12080 - STENT BIL 12MM 6FR 80MM 80CM .035IN SLF XPD DLV SYS LMNX BOTH IP/OP "$4,687.00" "$3,468.00" $930.17 "$4,686.61" "$2,108.97" "$2,108.97" "$2,108.97" "$2,108.97" "$4,686.61" "$4,686.61" "$4,686.61" $976.81 "$4,686.61" "$4,686.61" "$4,686.61" "$4,686.61" "$4,686.61" $976.74 "$4,686.61" "$4,686.61" "$2,310.50" "$4,686.61" "$4,686.61" "$4,686.61" "$4,686.61" "$3,515.25" "$4,686.61" "$4,686.61" "$4,686.61" "$2,343.31" "$2,343.31" "$3,711.80" "$4,686.61" "$3,749.29" "$2,108.97" $930.17 N/A "$2,718.46" "$4,686.61" "$4,686.61" "$4,686.61" $976.69 "$4,686.61" N/A N/A LX10BD.100 SUP HCPCS V2632 LX10BD.100 - LENS IOL 5 D +10 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.105 SUP HCPCS V2632 LX10BD.105 - LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.110 SUP HCPCS V2632 LX10BD.110 - LENS IOL 5 D +11 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.115 SUP HCPCS V2632 LX10BD.115 - LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.120 SUP HCPCS V2632 LX10BD.120 - LENS IOL 5 D +12 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.125 SUP HCPCS V2632 LX10BD.125 - LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.130 SUP HCPCS V2632 LX10BD.130 - LENS IOL 5 D +13 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.135 SUP HCPCS V2632 LX10BD.135 - LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.140 SUP HCPCS V2632 LX10BD.140 - LENS IOL 5 D +14 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.145 SUP HCPCS V2632 LX10BD.145 - LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.150 SUP HCPCS V2632 LX10BD.150 - LENS IOL 5 D +15 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.155 SUP HCPCS V2632 LX10BD.155 - LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.160 SUP HCPCS V2632 LX10BD.160 - LENS IOL 5 D +16 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.165 SUP HCPCS V2632 LX10BD.165 - LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.170 SUP HCPCS V2632 LX10BD.170 - LENS IOL 5 D +17 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.175 SUP HCPCS V2632 LX10BD.175 - LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.180 SUP HCPCS V2632 LX10BD.180 - LENS IOL 5 D +18 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.185 SUP HCPCS V2632 LX10BD.185 - LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.190 SUP HCPCS V2632 LX10BD.190 - LENS IOL 5 D +19 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.195 SUP HCPCS V2632 LX10BD.195 - LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.200 SUP HCPCS V2632 LX10BD.200 - LENS IOL 5 D +20 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.205 SUP HCPCS V2632 LX10BD.205 - LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.210 SUP HCPCS V2632 LX10BD.210 - LENS IOL 5 D +21 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.215 SUP HCPCS V2632 LX10BD.215 - LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.220 SUP HCPCS V2632 LX10BD.220 - LENS IOL 5 D +22 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.225 SUP HCPCS V2632 LX10BD.225 - LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.230 SUP HCPCS V2632 LX10BD.230 - LENS IOL 5 D +23 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.235 SUP HCPCS V2632 LX10BD.235 - LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.240 SUP HCPCS V2632 LX10BD.240 - LENS IOL 5 D +24 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.245 SUP HCPCS V2632 LX10BD.245 - LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.250 SUP HCPCS V2632 LX10BD.250 - LENS IOL 5 D +25 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.255 SUP HCPCS V2632 LX10BD.255 - LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.260 SUP HCPCS V2632 LX10BD.260 - LENS IOL 5 D +26 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.265 SUP HCPCS V2632 LX10BD.265 - LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.270 SUP HCPCS V2632 LX10BD.270 - LENS IOL 5 D +27 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.275 SUP HCPCS V2632 LX10BD.275 - LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.280 SUP HCPCS V2632 LX10BD.280 - LENS IOL 5 D +28 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.285 SUP HCPCS V2632 LX10BD.285 - LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.290 SUP HCPCS V2632 LX10BD.290 - LENS IOL 5 D +29 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.295 SUP HCPCS V2632 LX10BD.295 - LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX10BD.300 SUP HCPCS V2632 LX10BD.300 - LENS IOL 5 D +30 DIOP MOD C BCNVX 5.25MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.100 SUP HCPCS V2632 LX90BD.100 - LENS IOL 5 D +10 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.105 SUP HCPCS V2632 LX90BD.105 - LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.110 SUP HCPCS V2632 LX90BD.110 - LENS IOL 5 D +11 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.115 SUP HCPCS V2632 LX90BD.115 - LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.120 SUP HCPCS V2632 LX90BD.120 - LENS IOL 5 D +12 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.125 SUP HCPCS V2632 LX90BD.125 - LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.130 SUP HCPCS V2632 LX90BD.130 - LENS IOL 5 D +13 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.135 SUP HCPCS V2632 LX90BD.135 - LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.140 SUP HCPCS V2632 LX90BD.140 - LENS IOL 5 D +14 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.145 SUP HCPCS V2632 LX90BD.145 - LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.150 SUP HCPCS V2632 LX90BD.150 - LENS IOL 5 D +15 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.155 SUP HCPCS V2632 LX90BD.155 - LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.160 SUP HCPCS V2632 LX90BD.160 - LENS IOL 5 D +16 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.165 SUP HCPCS V2632 LX90BD.165 - LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.170 SUP HCPCS V2632 LX90BD.170 - LENS IOL 5 D +17 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.175 SUP HCPCS V2632 LX90BD.175 - LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.180 SUP HCPCS V2632 LX90BD.180 - LENS IOL 5 D +18 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.185 SUP HCPCS V2632 LX90BD.185 - LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.190 SUP HCPCS V2632 LX90BD.190 - LENS IOL 5 D +19 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.195 SUP HCPCS V2632 LX90BD.195 - LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.200 SUP HCPCS V2632 LX90BD.200 - LENS IOL 5 D +20 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.205 SUP HCPCS V2632 LX90BD.205 - LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.210 SUP HCPCS V2632 LX90BD.210 - LENS IOL 5 D +21 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.215 SUP HCPCS V2632 LX90BD.215 - LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.220 SUP HCPCS V2632 LX90BD.220 - LENS IOL 5 D +22 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.225 SUP HCPCS V2632 LX90BD.225 - LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.230 SUP HCPCS V2632 LX90BD.230 - LENS IOL 5 D +23 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.235 SUP HCPCS V2632 LX90BD.235 - LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.240 SUP HCPCS V2632 LX90BD.240 - LENS IOL 5 D +24 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.245 SUP HCPCS V2632 LX90BD.245 - LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.250 SUP HCPCS V2632 LX90BD.250 - LENS IOL 5 D +25 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.255 SUP HCPCS V2632 LX90BD.255 - LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.260 SUP HCPCS V2632 LX90BD.260 - LENS IOL 5 D +26 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.265 SUP HCPCS V2632 LX90BD.265 - LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.270 SUP HCPCS V2632 LX90BD.270 - LENS IOL 5 D +27 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.275 SUP HCPCS V2632 LX90BD.275 - LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.280 SUP HCPCS V2632 LX90BD.280 - LENS IOL 5 D +28 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.285 SUP HCPCS V2632 LX90BD.285 - LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.290 SUP HCPCS V2632 LX90BD.290 - LENS IOL 5 D +29 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.295 SUP HCPCS V2632 LX90BD.295 - LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LX90BD.300 SUP HCPCS V2632 LX90BD.300 - LENS IOL 5 D +30 DIOP MOD C BCNVX 5.75MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A LXA19 SUP Custom 27803010 LXA19 - VALVE AORTIC 1.7SQ CM SMALL LP 18.6MM 15.4MM 11MM 21MM BOTH IP/OP "$12,500.00" "$9,250.00" "$2,225.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,225.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,605.14" "$12,500.00" "$5,000.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$9,375.00" "$12,500.00" "$12,500.00" "$12,500.00" "$6,250.00" "$6,250.00" "$9,900.00" "$12,500.00" "$10,000.00" "$5,625.00" "$12,500.00" N/A "$7,250.00" "$12,500.00" "$7,500.00" "$12,500.00" "$12,500.00" "$12,500.00" N/A N/A LXA21 SUP Custom 27803010 LXA21 - VALVE AORTIC 2.1SQ CM SMALL LP 20.7MM 17.3MM 13MM 23MM BOTH IP/OP "$12,500.00" "$9,250.00" "$2,225.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,225.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,605.14" "$12,500.00" "$5,000.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$9,375.00" "$12,500.00" "$12,500.00" "$12,500.00" "$6,250.00" "$6,250.00" "$9,900.00" "$12,500.00" "$10,000.00" "$5,625.00" "$12,500.00" N/A "$7,250.00" "$12,500.00" "$7,500.00" "$12,500.00" "$12,500.00" "$12,500.00" N/A N/A M001102200 SUP HCPCS C1726 M001102200 - CATHETER BLNDIL 9FR 15MM 100CM 3CM LV ANGPLSTY BOTH IP/OP $998.00 $739.00 $198.08 $998.00 $541.91 $541.91 $541.91 $541.91 $998.00 $998.00 $998.00 $208.01 $998.00 $740.72 $740.72 $769.26 $519.96 $207.99 $998.00 $998.00 $590.32 $998.00 $998.00 $998.00 $998.00 $748.50 $998.00 $998.00 $998.00 $499.00 $499.00 $790.42 $998.00 $798.40 $648.70 $198.08 N/A $578.84 $998.00 $998.00 $998.00 $207.98 $998.00 N/A N/A M001102240 SUP HCPCS C1726 M001102240 - CATHETER BLNDIL 9FR 20MM 100CM 3CM BLU MAX 20 OTW NC HI-PRS BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $373.31 $373.31 $373.31 $373.31 $687.50 $687.50 $687.50 $143.29 $687.50 $510.26 $510.26 $529.93 $358.19 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $446.88 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A M0011031020 SUP HCPCS C1751 M0011031020 - CATHETER INFS .014-.016IN 3-2.7FR .021-.022IN 150CM 12CM BOTH IP/OP "$1,225.00" $907.00 $243.13 "$1,225.00" $665.18 $665.18 $665.18 $665.18 "$1,225.00" "$1,225.00" "$1,225.00" $255.32 "$1,225.00" $909.20 $909.20 $944.23 $638.23 $255.30 "$1,225.00" "$1,225.00" $724.59 "$1,225.00" "$1,225.00" "$1,225.00" "$1,225.00" $918.75 "$1,225.00" "$1,225.00" "$1,225.00" $612.50 $612.50 $970.20 "$1,225.00" $980.00 $796.25 $243.13 N/A $710.50 "$1,225.00" "$1,225.00" "$1,225.00" $255.29 "$1,225.00" N/A N/A M001125000 SUP HCPCS C1753 M001125000 - CATHETER BLNDIL 4MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125010 SUP HCPCS C1753 M001125010 - CATHETER BLNDIL 4MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125020 SUP HCPCS C1753 M001125020 - CATHETER BLNDIL 4MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125030 SUP HCPCS C1753 M001125030 - CATHETER BLNDIL 4MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125040 SUP HCPCS C1753 M001125040 - CATHETER BLNDIL 4MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125050 SUP HCPCS C1753 M001125050 - CATHETER BLNDIL 4MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125060 SUP HCPCS C1753 M001125060 - CATHETER BLNDIL 4MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125070 SUP HCPCS C1753 M001125070 - CATHETER BLNDIL 4MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125080 SUP HCPCS C1753 M001125080 - CATHETER BLNDIL 4MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125090 SUP HCPCS C1753 M001125090 - CATHETER BLNDIL 4MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125100 SUP HCPCS C1753 M001125100 - CATHETER BLNDIL 4MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125110 SUP HCPCS C1753 M001125110 - CATHETER BLNDIL 4MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $825.00 $611.00 $163.74 $825.00 $447.98 $447.98 $447.98 $447.98 $825.00 $825.00 $825.00 $171.95 $825.00 $612.32 $612.32 $635.91 $429.83 $171.94 $825.00 $825.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $536.25 $163.74 N/A $478.50 $825.00 $825.00 $825.00 $171.93 $825.00 N/A N/A M001125120 SUP HCPCS C1753 M001125120 - CATHETER BLNDIL 5MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125130 SUP HCPCS C1753 M001125130 - CATHETER BLNDIL 5MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125140 SUP HCPCS C1753 M001125140 - CATHETER BLNDIL 5MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125150 SUP HCPCS C1753 M001125150 - CATHETER BLNDIL 5MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125160 SUP HCPCS C1753 M001125160 - CATHETER BLNDIL 5MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125170 SUP HCPCS C1753 M001125170 - CATHETER BLNDIL 5MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125180 SUP HCPCS C1753 M001125180 - CATHETER BLNDIL 5MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125190 SUP HCPCS C1753 M001125190 - CATHETER BLNDIL 5MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125200 SUP HCPCS C1753 M001125200 - CATHETER BLNDIL 5MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125210 SUP HCPCS C1753 M001125210 - CATHETER BLNDIL 5MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125220 SUP HCPCS C1753 M001125220 - CATHETER BLNDIL 5MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125230 SUP HCPCS C1753 M001125230 - CATHETER BLNDIL 5MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125240 SUP HCPCS C1753 M001125240 - CATHETER BLNDIL 6MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125250 SUP HCPCS C1753 M001125250 - CATHETER BLNDIL 6MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125260 SUP HCPCS C1753 M001125260 - CATHETER BLNDIL 6MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125270 SUP HCPCS C1753 M001125270 - CATHETER BLNDIL 6MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125280 SUP HCPCS C1753 M001125280 - CATHETER BLNDIL 6MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125290 SUP HCPCS C1753 M001125290 - CATHETER BLNDIL 6MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125300 SUP HCPCS C1753 M001125300 - CATHETER BLNDIL 6MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125310 SUP HCPCS C1753 M001125310 - CATHETER BLNDIL 6MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125320 SUP HCPCS C1753 M001125320 - CATHETER BLNDIL 6MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $277.83 $463.05 $96.50 $463.05 N/A N/A M001125330 SUP HCPCS C1753 M001125330 - CATHETER BLNDIL 6MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125340 SUP HCPCS C1753 M001125340 - CATHETER BLNDIL 6MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125350 SUP HCPCS C1753 M001125350 - CATHETER BLNDIL 6MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125360 SUP HCPCS C1753 M001125360 - CATHETER BLNDIL 7MM 40CM 20MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125370 SUP HCPCS C1753 M001125370 - CATHETER BLNDIL 7MM 75CM 20MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125380 SUP HCPCS C1753 M001125380 - CATHETER BLNDIL 7MM 120CM 20MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125390 SUP HCPCS C1753 M001125390 - CATHETER BLNDIL 7MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125400 SUP HCPCS C1753 M001125400 - CATHETER BLNDIL 7MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125410 SUP HCPCS C1753 M001125410 - CATHETER BLNDIL 7MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125420 SUP HCPCS C1753 M001125420 - CATHETER BLNDIL 7MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125430 SUP HCPCS C1753 M001125430 - CATHETER BLNDIL 7MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125440 SUP HCPCS C1753 M001125440 - CATHETER BLNDIL 7MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125450 SUP HCPCS C1753 M001125450 - CATHETER BLNDIL 7MM 40CM 100MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125460 SUP HCPCS C1753 M001125460 - CATHETER BLNDIL 7MM 75CM 100MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125470 SUP HCPCS C1753 M001125470 - CATHETER BLNDIL 7MM 120CM 100MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $825.00 $611.00 $163.74 $825.00 $447.98 $447.98 $447.98 $447.98 $825.00 $825.00 $825.00 $171.95 $825.00 $612.32 $612.32 $635.91 $429.83 $171.94 $825.00 $825.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $536.25 $163.74 N/A $478.50 $825.00 $825.00 $825.00 $171.93 $825.00 N/A N/A M001125480 SUP HCPCS C1753 M001125480 - CATHETER BLNDIL 8MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125490 SUP HCPCS C1726 M001125490 - CATHETER BLNDIL 8MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125500 SUP HCPCS C1753 M001125500 - CATHETER BLNDIL 8MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125510 SUP HCPCS C1753 M001125510 - CATHETER BLNDIL 8MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125520 SUP HCPCS C1753 M001125520 - CATHETER BLNDIL 8MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125530 SUP HCPCS C1753 M001125530 - CATHETER BLNDIL 8MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125540 SUP HCPCS C1753 M001125540 - CATHETER BLNDIL 8MM 40CM 80MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125550 SUP HCPCS C1753 M001125550 - CATHETER BLNDIL 8MM 75CM 80MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125560 SUP HCPCS C1753 M001125560 - CATHETER BLNDIL 8MM 120CM 80MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125580 SUP HCPCS C1753 M001125580 - CATHETER BLNDIL 9MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125590 SUP HCPCS C1753 M001125590 - CATHETER BLNDIL 9MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125600 SUP HCPCS C1753 M001125600 - CATHETER BLNDIL 9MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125610 SUP HCPCS C1753 M001125610 - CATHETER BLNDIL 9MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125620 SUP HCPCS C1753 M001125620 - CATHETER BLNDIL 9MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $277.83 $463.05 $96.50 $463.05 N/A N/A M001125630 SUP HCPCS C1753 M001125630 - CATHETER BLNDIL 9MM 40CM 80MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125640 SUP HCPCS C1753 M001125640 - CATHETER BLNDIL 9MM 75CM 80MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125650 SUP HCPCS C1753 M001125650 - CATHETER BLNDIL 9MM 120CM 80MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125660 SUP HCPCS C1753 M001125660 - CATHETER BLNDIL 10MM 40CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125670 SUP HCPCS C1753 M001125670 - CATHETER BLNDIL 10MM 75CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125680 SUP HCPCS C1753 M001125680 - CATHETER BLNDIL 10MM 120CM 30MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $277.83 $463.05 $96.50 $463.05 N/A N/A M001125690 SUP HCPCS C1753 M001125690 - CATHETER BLNDIL 10MM 40CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125700 SUP HCPCS C1726 M001125700 - CATHETER BLNDIL 10MM 75CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125710 SUP HCPCS C1753 M001125710 - CATHETER BLNDIL 10MM 120CM 40MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $277.83 $463.05 $96.50 $463.05 N/A N/A M001125720 SUP HCPCS C1753 M001125720 - CATHETER BLNDIL 10MM 40CM 80MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125730 SUP HCPCS C1753 M001125730 - CATHETER BLNDIL 10MM 75CM 80MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M001125740 SUP HCPCS C1753 M001125740 - CATHETER BLNDIL 10MM 120CM 80MM BLU MAX 20 OTW HI-PRS PERI BOTH IP/OP $463.50 $343.00 $91.90 $463.05 $251.44 $251.44 $251.44 $251.44 $463.05 $463.05 $463.05 $96.51 $463.05 $343.68 $343.68 $356.92 $241.25 $96.50 $463.05 $463.05 $273.89 $463.05 $463.05 $463.05 $463.05 $347.63 $463.05 $463.05 $463.05 $231.53 $231.53 $366.74 $463.05 $370.44 $300.98 $91.90 N/A $268.83 $463.05 $463.05 $463.05 $96.50 $463.05 N/A N/A M0011341080 SUP HCPCS C1751 M0011341080 - CATHETER INFUS .014-.016IN 3-2.5FR .022-.021IN 150CM 20CM BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $780.56 $780.56 $780.56 $780.56 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,066.91" "$1,066.91" "$1,108.03" $748.94 $299.59 "$1,437.50" "$1,437.50" $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $934.38 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A M001145080 SUP HCPCS C1753 M001145080 - CATHETER BLNDIL 12MM 75CM 20MM XXL QD-FOLD SCRCH RST HI BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145090 SUP HCPCS C1753 M001145090 - CATHETER BLNDIL 12MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145100 SUP HCPCS C1726 M001145100 - CATHETER BLNDIL 12MM 75CM 40MM XXL SCRCH RST HI STRTH SHFT BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145110 SUP HCPCS C1726 M001145110 - CATHETER BLNDIL 12MM 120CM 40MM XXL QD-FOLD SCRCH RST HI BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145120 SUP HCPCS C1753 M001145120 - CATHETER BLNDIL 14MM 75CM 20MM XXL QD-FOLD SCRCH RST HI BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145130 SUP HCPCS C1753 M001145130 - CATHETER BLNDIL 14MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145140 SUP HCPCS C1753 M001145140 - CATHETER BLNDIL 14MM 75CM 40MM XXL SCRCH RST HI STRTH SHFT BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145150 SUP HCPCS C1726 M001145150 - CATHETER BLNDIL 14MM 120CM 40MM XXL QD-FOLD SCRCH RST HI BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145300 SUP HCPCS C1753 M001145300 - CATHETER BLNDIL 12MM 75CM 60MM XXL QD-FOLD SCRCH RST HI BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145320 SUP HCPCS C1753 M001145320 - CATHETER BLNDIL 14MM 75CM 60MM XXL QD-FOLD SCRCH RST HI BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145500 SUP HCPCS C1753 M001145500 - CATHETER BLNDIL 16MM 75CM 20MM XXL QD-FOLD SCRCH RST HI BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145510 SUP HCPCS C1753 M001145510 - CATHETER BLNDIL 16MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145520 SUP HCPCS C1753 M001145520 - CATHETER BLNDIL 16MM 75CM 40MM XXL QD-FOLD SCRCH RST HI BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145530 SUP HCPCS C1726 M001145530 - CATHETER BLNDIL 16MM 120CM 40MM XXL SCRCH RST HI STRTH SHFT BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145540 SUP HCPCS C1753 M001145540 - CATHETER BLNDIL 16MM 75CM 60MM XXL QD-FOLD SCRCH RST HI BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145550 SUP HCPCS C1753 M001145550 - CATHETER BLNDIL 18MM 75CM 20MM XXL QD-FOLD SCRCH RST HI BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145560 SUP HCPCS C1753 M001145560 - CATHETER BLNDIL 18MM 120CM 20MM XXL SCRCH RST HI STRTH SHFT BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145570 SUP HCPCS C1753 M001145570 - CATHETER BLNDIL 18MM 75CM 40MM XXL QD-FOLD SCRCH RST HI BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145580 SUP HCPCS C1726 M001145580 - CATHETER BLNDIL 18MM 120CM 40MM XXL SCRCH RST HI STRTH SHFT BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001145590 SUP HCPCS C1753 M001145590 - CATHETER BLNDIL 18MM 75CM 60MM XXL QD-FOLD SCRCH RST HI BOTH IP/OP $505.00 $374.00 $100.23 $505.00 $274.22 $274.22 $274.22 $274.22 $505.00 $505.00 $505.00 $105.25 $505.00 $374.81 $374.81 $389.25 $263.11 $105.25 $505.00 $505.00 $298.71 $505.00 $505.00 $505.00 $505.00 $378.75 $505.00 $505.00 $505.00 $252.50 $252.50 $399.96 $505.00 $404.00 $328.25 $100.23 N/A $292.90 $505.00 $505.00 $505.00 $105.24 $505.00 N/A N/A M001151050 SUP Custom 27203010 M001151050 - DEVICE INFLAT 12FR 3IN PRESSURE GAUGE LATEX FREE ENCORE 26 BOTH IP/OP $69.50 $51.00 $12.35 $69.40 $69.40 $69.40 $69.40 $69.40 $69.40 $69.40 $12.35 $69.40 $69.40 $51.51 $51.51 $53.49 $36.16 $14.46 $69.40 $27.76 $69.40 $69.40 $69.40 $69.40 $69.40 $52.13 $69.40 $69.40 $69.40 $34.70 $34.70 $54.96 $69.40 $55.52 $45.11 $69.40 N/A $40.31 $69.40 $41.64 $69.40 $69.40 $69.40 N/A N/A M001151062 SUP Custom 27203010 M001151062 - DEVICE INFLAT 12FR PRESSURE GAUGE ENCORE 26 20ML BOTH IP/OP $15.00 $11.00 $2.61 $14.69 $14.69 $14.69 $14.69 $14.69 $14.69 $14.69 $2.61 $14.69 $14.69 $10.90 $10.90 $11.32 $7.65 $3.06 $14.69 $5.88 $14.69 $14.69 $14.69 $14.69 $14.69 $11.25 $14.69 $14.69 $14.69 $7.35 $7.35 $11.63 $14.69 $11.75 $9.55 $14.69 N/A $8.70 $14.69 $8.81 $14.69 $14.69 $14.69 N/A N/A M001163980 SUP HCPCS C1753 M001163980 - CATHETER BLNDIL 3MM 120CM 15MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164000 SUP HCPCS C1753 M001164000 - CATHETER BLNDIL 3MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164010 SUP HCPCS C1753 M001164010 - CATHETER BLNDIL 3MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164020 SUP HCPCS C1753 M001164020 - CATHETER BLNDIL 3MM 120CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164030 SUP HCPCS C1753 M001164030 - CATHETER BLNDIL 3MM 150CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164040 SUP HCPCS C1753 M001164040 - CATHETER BLNDIL 3MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164050 SUP HCPCS C1753 M001164050 - CATHETER BLNDIL 3MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164060 SUP HCPCS C1753 M001164060 - CATHETER BLNDIL 3MM 120CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164070 SUP HCPCS C1753 M001164070 - CATHETER BLNDIL 3MM 150CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164080 SUP HCPCS C1753 M001164080 - CATHETER BLNDIL 3MM 40CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164090 SUP HCPCS C1753 M001164090 - CATHETER BLNDIL 3MM 75CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164100 SUP HCPCS C1753 M001164100 - CATHETER BLNDIL 3MM 120CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164110 SUP HCPCS C1753 M001164110 - CATHETER BLNDIL 3MM 150CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164120 SUP HCPCS C1753 M001164120 - CATHETER BLNDIL 4MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164130 SUP HCPCS C1753 M001164130 - CATHETER BLNDIL 4MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164140 SUP HCPCS C1753 M001164140 - CATHETER BLNDIL 4MM 120CM 15MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164150 SUP HCPCS C1753 M001164150 - CATHETER BLNDIL 4MM 150CM 15MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164160 SUP HCPCS C1753 M001164160 - CATHETER BLNDIL 4MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164170 SUP HCPCS C1726 M001164170 - CATHETER BLNDIL 4MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164180 SUP HCPCS C1726 M001164180 - CATHETER BLNDIL 4MM 120CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164190 SUP HCPCS C1753 M001164190 - CATHETER BLNDIL 4MM 150CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164200 SUP HCPCS C1753 M001164200 - CATHETER BLNDIL 4MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164210 SUP HCPCS C1753 M001164210 - CATHETER BLNDIL 4MM 120CM 30MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164220 SUP HCPCS C1753 M001164220 - CATHETER BLNDIL 4MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164230 SUP HCPCS C1726 M001164230 - CATHETER BLNDIL 4MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164240 SUP HCPCS C1726 M001164240 - CATHETER BLNDIL 4MM 120CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164250 SUP HCPCS C1753 M001164250 - CATHETER BLNDIL 4MM 150CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164280 SUP HCPCS C1753 M001164280 - CATHETER BLNDIL 4MM 40CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164290 SUP HCPCS C1726 M001164290 - CATHETER BLNDIL 4MM 75CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164300 SUP HCPCS C1726 M001164300 - CATH BALDILAT 5FR 4MM 120CM 10CM PERI PTA OTW TPR SHFT LP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164310 SUP HCPCS C1753 M001164310 - CATHETER BLNDIL 4MM 150CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164320 SUP HCPCS C1753 M001164320 - CATHETER BLNDIL 5MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164330 SUP HCPCS C1753 M001164330 - CATHETER BLNDIL 5MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164340 SUP HCPCS C1753 M001164340 - CATHETER BLNDIL 5MM 120CM 15MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164350 SUP HCPCS C1753 M001164350 - CATHETER BLNDIL 5MM 150CM 15MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164360 SUP HCPCS C1753 M001164360 - CATHETER BLNDIL 5MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164370 SUP HCPCS C1753 M001164370 - CATHETER BLNDIL 5MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164380 SUP HCPCS C1753 M001164380 - CATHETER BLNDIL 5MM 120CM 50MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164390 SUP HCPCS C1753 M001164390 - CATHETER BLNDIL 5MM 150CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164400 SUP HCPCS C1753 M001164400 - CATHETER BLNDIL 5MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164410 SUP HCPCS C1753 M001164410 - CATHETER BLNDIL 5MM 120CM 30MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164420 SUP HCPCS C1753 M001164420 - CATHETER BLNDIL 5MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164430 SUP HCPCS C1753 M001164430 - CATHETER BLNDIL 5MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164440 SUP HCPCS C1753 M001164440 - CATHETER BLNDIL 5MM 120CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164450 SUP HCPCS C1753 M001164450 - CATHETER BLNDIL 5MM 150CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164480 SUP HCPCS C1753 M001164480 - CATHETER BLNDIL 5MM 40CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164490 SUP HCPCS C1726 M001164490 - CATHETER BLNDIL 5MM 75CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164500 SUP HCPCS C1726 M001164500 - CATH BALDILAT 5FR 5MM 120CM 10CM PERI PTA OTW TPR SHFT LP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164510 SUP HCPCS C1753 M001164510 - CATHETER BLNDIL 5MM 150CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164520 SUP HCPCS C1753 M001164520 - CATHETER BLNDIL 6MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164530 SUP HCPCS C1753 M001164530 - CATHETER BLNDIL 6MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164540 SUP HCPCS C1753 M001164540 - CATHETER BLNDIL 6MM 120CM 15MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164550 SUP HCPCS C1753 M001164550 - CATHETER BLNDIL 6MM 150CM 15MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164560 SUP HCPCS C1753 M001164560 - CATHETER BLNDIL 6MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164570 SUP HCPCS C1753 M001164570 - CATHETER BLNDIL 6MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164580 SUP HCPCS C1753 M001164580 - CATHETER BLNDIL 6MM 120CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164590 SUP HCPCS C1753 M001164590 - CATHETER BLNDIL 6MM 150CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164600 SUP HCPCS C1753 M001164600 - CATHETER BLNDIL 6MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164610 SUP HCPCS C1753 M001164610 - CATHETER BLNDIL 6MM 120CM 30MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164620 SUP HCPCS C1753 M001164620 - CATHETER BLNDIL TPR 6MM 40CM 40MM U-T D OTW NC HDRPH PERI BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164630 SUP HCPCS C1753 M001164630 - CATHETER BLNDIL 6MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164640 SUP HCPCS C1753 M001164640 - CATHETER BLNDIL 6MM 120CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164650 SUP HCPCS C1753 M001164650 - CATHETER BLNDIL 6MM 150CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164680 SUP HCPCS C1753 M001164680 - CATHETER BLNDIL 6MM 40CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164690 SUP HCPCS C1726 M001164690 - CATHETER BLNDIL TPR 6MM 75CM 100MM U-T D OTW NC HDRPH PERI BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164700 SUP HCPCS C1726 M001164700 - CATHETER BLNDIL 6MM 120CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164710 SUP HCPCS C1753 M001164710 - CATHETER BLNDIL 6MM 150CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164720 SUP HCPCS C1753 M001164720 - CATHETER BLNDIL 7MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $510.00 $377.00 $101.21 $509.93 $276.89 $276.89 $276.89 $276.89 $509.93 $509.93 $509.93 $106.28 $509.93 $378.47 $378.47 $393.05 $265.67 $106.28 $509.93 $509.93 $301.62 $509.93 $509.93 $509.93 $509.93 $382.50 $509.93 $509.93 $509.93 $254.97 $254.97 $403.86 $509.93 $407.94 $331.45 $101.21 N/A $295.80 $509.93 $509.93 $509.93 $106.27 $509.93 N/A N/A M001164730 SUP HCPCS C1753 M001164730 - CATHETER BLNDIL 7MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164740 SUP HCPCS C1753 M001164740 - CATHETER BLNDIL 7MM 120CM 15MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164750 SUP HCPCS C1753 M001164750 - CATHETER BLNDIL 7MM 150CM 15MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164760 SUP HCPCS C1753 M001164760 - CATHETER BLNDIL 7MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164770 SUP HCPCS C1753 M001164770 - CATHETER BLNDIL 7MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164780 SUP HCPCS C1753 M001164780 - CATHETER BLNDIL 7MM 120CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164790 SUP HCPCS C1753 M001164790 - CATHETER BLNDIL 7MM 150CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164800 SUP HCPCS C1753 M001164800 - CATHETER BLNDIL 7MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164810 SUP HCPCS C1753 M001164810 - CATHETER BLNDIL 7MM 120CM 30MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164820 SUP HCPCS C1753 M001164820 - CATHETER BLNDIL TPR 7MM 40CM 40MM U-T D OTW NC HDRPH PERI BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164830 SUP HCPCS C1753 M001164830 - CATHETER BLNDIL 7MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164840 SUP HCPCS C1753 M001164840 - CATHETER BLNDIL 7MM 120CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164850 SUP HCPCS C1753 M001164850 - CATHETER BLNDIL 7MM 150CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164880 SUP HCPCS C1753 M001164880 - CATHETER BLNDIL 7MM 40CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164890 SUP HCPCS C1753 M001164890 - CATHETER BLNDIL TPR 7MM 75CM 100MM U-T D OTW NC HDRPH PERI BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164900 SUP HCPCS C1753 M001164900 - CATHETER BLNDIL 7MM 120CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164910 SUP HCPCS C1753 M001164910 - CATHETER BLNDIL 7MM 150CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164920 SUP HCPCS C1753 M001164920 - CATHETER BLNDIL 8MM 40CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164930 SUP HCPCS C1753 M001164930 - CATHETER BLNDIL 8MM 75CM 15MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164940 SUP HCPCS C1753 M001164940 - CATHETER BLNDIL 8MM 120CM 15MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164950 SUP HCPCS C1753 M001164950 - CATHETER BLNDIL 8MM 150CM 15MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164960 SUP HCPCS C1753 M001164960 - CATHETER BLNDIL 8MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164970 SUP HCPCS C1753 M001164970 - CATHETER BLNDIL 8MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164980 SUP HCPCS C1753 M001164980 - CATHETER BLNDIL 8MM 120CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001164990 SUP HCPCS C1753 M001164990 - CATHETER BLNDIL 8MM 150CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165000 SUP HCPCS C1753 M001165000 - CATHETER BLNDIL 8MM 40CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165010 SUP HCPCS C1726 M001165010 - CATHETER BLNDIL 8MM 75CM 30MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165020 SUP HCPCS C1753 M001165020 - CATHETER BLNDIL 8MM 120CM 30MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165030 SUP HCPCS C1753 M001165030 - CATHETER BLNDIL 8MM 150CM 30MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165040 SUP HCPCS C1753 M001165040 - CATHETER BLNDIL TPR 8MM 40CM 40MM U-T D OTW NC HDRPH PERI BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165050 SUP HCPCS C1753 M001165050 - CATHETER BLNDIL 8MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165060 SUP HCPCS C1753 M001165060 - CATHETER BLNDIL 8MM 120CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165070 SUP HCPCS C1753 M001165070 - CATHETER BLNDIL 8MM 150CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165080 SUP HCPCS C1753 M001165080 - CATHETER BLNDIL 8MM 40CM 80MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165090 SUP HCPCS C1753 M001165090 - CATHETER BLNDIL 8MM 75CM 80MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165100 SUP HCPCS C1753 M001165100 - CATHETER BLNDIL 8MM 120CM 80MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165110 SUP HCPCS C1753 M001165110 - CATHETER BLNDIL 8MM 150CM 80MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165120 SUP HCPCS C1753 M001165120 - CATHETER BLNDIL 9MM 40CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165130 SUP HCPCS C1753 M001165130 - CATHETER BLNDIL 9MM 75CM 20MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165140 SUP HCPCS C1753 M001165140 - CATHETER BLNDIL 9MM 120CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165150 SUP HCPCS C1753 M001165150 - CATHETER BLNDIL 9MM 150CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165160 SUP HCPCS C1753 M001165160 - CATHETER BLNDIL 9MM 40CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165170 SUP HCPCS C1753 M001165170 - CATHETER BLNDIL 9MM 75CM 40MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165180 SUP HCPCS C1753 M001165180 - CATHETER BLNDIL 9MM 120CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165190 SUP HCPCS C1753 M001165190 - CATHETER BLNDIL 9MM 150CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165200 SUP HCPCS C1753 M001165200 - CATHETER BLNDIL 10MM 40CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165210 SUP HCPCS C1753 M001165210 - CATHETER BLNDIL 10MM 75CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165220 SUP HCPCS C1753 M001165220 - CATHETER BLNDIL 10MM 120CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165230 SUP HCPCS C1753 M001165230 - CATHETER BLNDIL 10MM 150CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165240 SUP HCPCS C1753 M001165240 - CATHETER BLNDIL TPR 10MM 40CM 40MM U-T D OTW NC HDRPH PERI BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165250 SUP HCPCS C1753 M001165250 - CATHETER BLNDIL 10MM 75CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165260 SUP HCPCS C1753 M001165260 - CATHETER BLNDIL 10MM 120CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165270 SUP HCPCS C1753 M001165270 - CATHETER BLNDIL 10MM 150CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165290 SUP HCPCS C1726 M001165290 - CATHETER BLNDIL 12MM 75CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165300 SUP HCPCS C1753 M001165300 - CATHETER BLNDIL 12MM 120CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165330 SUP HCPCS C1753 M001165330 - CATHETER BLNDIL 12MM 75CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165340 SUP HCPCS C1753 M001165340 - CATHETER BLNDIL 12MM 120CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165550 SUP HCPCS C1753 M001165550 - CATHETER BLNDIL 4MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165560 SUP HCPCS C1753 M001165560 - CATHETER BLNDIL 4MM 120CM 60MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165590 SUP HCPCS C1753 M001165590 - CATHETER BLNDIL 5MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165600 SUP HCPCS C1753 M001165600 - CATHETER BLNDIL 5MM 120CM 60MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165630 SUP HCPCS C1753 M001165630 - CATHETER BLNDIL 6MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165640 SUP HCPCS C1753 M001165640 - CATHETER BLNDIL 6MM 120CM 60MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165670 SUP HCPCS C1753 M001165670 - CATHETER BLNDIL 7MM 75CM 60MM U-T D OTW 2 LUM TPR TIP HI-PRS BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001165680 SUP HCPCS C1753 M001165680 - CATHETER BLNDIL 7MM 120CM 60MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169410 SUP HCPCS C1753 M001169410 - CATHETER BLNDIL 3MM 135CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169420 SUP HCPCS C1753 M001169420 - CATHETER BLNDIL 3MM 135CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169430 SUP HCPCS C1753 M001169430 - CATHETER BLNDIL 3MM 135CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169440 SUP HCPCS C1753 M001169440 - CATHETER BLNDIL 4MM 135CM 15MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169450 SUP HCPCS C1753 M001169450 - CATHETER BLNDIL 4MM 135CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169460 SUP HCPCS C1753 M001169460 - CATHETER BLNDIL 4MM 135CM 30MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169470 SUP HCPCS C1753 M001169470 - CATHETER BLNDIL 4MM 135CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169480 SUP HCPCS C1753 M001169480 - CATHETER BLNDIL 4MM 135CM 60MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169490 SUP HCPCS C1753 M001169490 - CATHETER BLNDIL 4MM 135CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169510 SUP HCPCS C1753 M001169510 - CATHETER BLNDIL 5MM 135CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169520 SUP HCPCS C1753 M001169520 - CATHETER BLNDIL 5MM 135CM 30MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169530 SUP HCPCS C1753 M001169530 - CATHETER BLNDIL 5MM 135CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $249.15 $415.25 $86.54 $415.25 N/A N/A M001169540 SUP HCPCS C1753 M001169540 - CATHETER BLNDIL 5MM 135CM 60MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169550 SUP HCPCS C1753 M001169550 - CATHETER BLNDIL 5MM 135CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169570 SUP HCPCS C1753 M001169570 - CATHETER BLNDIL 6MM 135CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169580 SUP HCPCS C1753 M001169580 - CATHETER BLNDIL 6MM 135CM 30MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169590 SUP HCPCS C1753 M001169590 - CATHETER BLNDIL 6MM 135CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $249.15 $415.25 $86.54 $415.25 N/A N/A M001169600 SUP HCPCS C1753 M001169600 - CATHETER BLNDIL 6MM 135CM 60MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169610 SUP HCPCS C1753 M001169610 - CATHETER BLNDIL 6MM 135CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169620 SUP HCPCS C1753 M001169620 - CATHETER BLNDIL 7MM 135CM 15MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169630 SUP HCPCS C1753 M001169630 - CATHETER BLNDIL 7MM 135CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169640 SUP HCPCS C1753 M001169640 - CATHETER BLNDIL 7MM 135CM 30MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169650 SUP HCPCS C1753 M001169650 - CATHETER BLNDIL 7MM 135CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169660 SUP HCPCS C1753 M001169660 - CATHETER BLNDIL 7MM 135CM 60MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169670 SUP HCPCS C1753 M001169670 - CATHETER BLNDIL 7MM 135CM 100MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169690 SUP HCPCS C1753 M001169690 - CATHETER BLNDIL 8MM 135CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169700 SUP HCPCS C1753 M001169700 - CATHETER BLNDIL 8MM 135CM 30MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169710 SUP HCPCS C1753 M001169710 - CATHETER BLNDIL 8MM 135CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169720 SUP HCPCS C1753 M001169720 - CATHETER BLNDIL 8MM 135CM 60MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169730 SUP HCPCS C1753 M001169730 - CATHETER BLNDIL 8MM 135CM 80MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169740 SUP HCPCS C1753 M001169740 - CATHETER BLNDIL 9MM 135CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169750 SUP HCPCS C1753 M001169750 - CATHETER BLNDIL 9MM 135CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169760 SUP HCPCS C1753 M001169760 - CATHETER BLNDIL 10MM 135CM 20MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001169770 SUP HCPCS C1753 M001169770 - CATHETER BLNDIL 10MM 135CM 40MM U-T D OTW 2 LUM TPR TIP BOTH IP/OP $415.50 $307.00 $82.42 $415.25 $225.48 $225.48 $225.48 $225.48 $415.25 $415.25 $415.25 $86.55 $415.25 $308.20 $308.20 $320.07 $216.35 $86.54 $415.25 $415.25 $245.62 $415.25 $415.25 $415.25 $415.25 $311.63 $415.25 $415.25 $415.25 $207.63 $207.63 $328.88 $415.25 $332.20 $269.91 $82.42 N/A $240.99 $415.25 $415.25 $415.25 $86.54 $415.25 N/A N/A M001171020 SUP Custom 27203010 M001171020 - CATHETER BALLOON OCCLUSION STANDARD 7FR 110.5MM 65CM 2 LUMEN BOTH IP/OP $471.50 $349.00 $83.92 $471.45 $471.45 $471.45 $471.45 $471.45 $471.45 $471.45 $83.92 $471.45 $471.45 $349.91 $349.91 $363.39 $245.63 $98.26 $471.45 $188.58 $471.45 $471.45 $471.45 $471.45 $471.45 $353.63 $471.45 $471.45 $471.45 $235.73 $235.73 $373.39 $471.45 $377.16 $306.44 $471.45 N/A $273.47 $471.45 $282.87 $471.45 $471.45 $471.45 N/A N/A M001171030 SUP HCPCS C2628 M001171030 - CATHETER BALLOON OCCLUSION STANDARD 7FR 110.5MM 100CM 2 BOTH IP/OP $471.50 $349.00 $93.57 $471.45 $256.00 $256.00 $256.00 $256.00 $471.45 $471.45 $471.45 $98.26 $471.45 $349.91 $349.91 $363.39 $245.63 $98.26 $471.45 $471.45 $278.86 $471.45 $471.45 $471.45 $471.45 $353.63 $471.45 $471.45 $471.45 $235.73 $235.73 $373.39 $471.45 $377.16 $306.44 $93.57 N/A $273.47 $471.45 $471.45 $471.45 $98.25 $471.45 N/A N/A M001171050 SUP HCPCS C1726 M001171050 - CATHETER BALLOON OCCLUSION 14FR 20MM 65CM 2 LUMEN RADIOPQ BOTH IP/OP $606.00 $448.00 $120.21 $605.65 $328.87 $328.87 $328.87 $328.87 $605.65 $605.65 $605.65 $126.23 $605.65 $449.51 $449.51 $466.84 $315.54 $126.22 $605.65 $605.65 $358.24 $605.65 $605.65 $605.65 $605.65 $454.50 $605.65 $605.65 $605.65 $302.83 $302.83 $479.67 $605.65 $484.52 $393.67 $120.21 N/A $351.48 $605.65 $605.65 $605.65 $126.22 $605.65 N/A N/A M001171060 SUP HCPCS C1726 M001171060 - CATHETER BALLOON OCCLUSION 14FR 20MM 100CM 2 LUMEN GWIRE BOTH IP/OP $606.00 $448.00 $120.21 $605.65 $328.87 $328.87 $328.87 $328.87 $605.65 $605.65 $605.65 $126.23 $605.65 $449.51 $449.51 $466.84 $315.54 $126.22 $605.65 $605.65 $358.24 $605.65 $605.65 $605.65 $605.65 $454.50 $605.65 $605.65 $605.65 $302.83 $302.83 $479.67 $605.65 $484.52 $393.67 $120.21 N/A $351.48 $605.65 $605.65 $605.65 $126.22 $605.65 N/A N/A M001171070 SUP HCPCS C1726 M001171070 - CATHETER BALLOON OCCLUSION 7FR 27MM 65CM 2 LUMEN RADIOPQ BOTH IP/OP $606.00 $448.00 $120.21 $605.65 $328.87 $328.87 $328.87 $328.87 $605.65 $605.65 $605.65 $126.23 $605.65 $449.51 $449.51 $466.84 $315.54 $126.22 $605.65 $605.65 $358.24 $605.65 $605.65 $605.65 $605.65 $454.50 $605.65 $605.65 $605.65 $302.83 $302.83 $479.67 $605.65 $484.52 $393.67 $120.21 N/A $351.48 $605.65 $605.65 $605.65 $126.22 $605.65 N/A N/A M001171080 SUP HCPCS C1726 M001171080 - CATHETER BALLOON OCCLUSION 7FR 27MM 100CM 2 LUMEN RADIOPQ BOTH IP/OP $576.00 $426.00 $114.31 $575.93 $312.73 $312.73 $312.73 $312.73 $575.93 $575.93 $575.93 $120.04 $575.93 $427.46 $427.46 $443.93 $300.06 $120.03 $575.93 $575.93 $340.66 $575.93 $575.93 $575.93 $575.93 $432.00 $575.93 $575.93 $575.93 $287.97 $287.97 $456.14 $575.93 $460.74 $374.35 $114.31 N/A $334.08 $575.93 $575.93 $575.93 $120.02 $575.93 N/A N/A M001171090 SUP HCPCS C1726 M001171090 - CATHETER BALLOON OCCLUSION 7FR 33MM 65CM 2 LUMEN RADIOPQ BOTH IP/OP $606.00 $448.00 $120.21 $605.65 $328.87 $328.87 $328.87 $328.87 $605.65 $605.65 $605.65 $126.23 $605.65 $449.51 $449.51 $466.84 $315.54 $126.22 $605.65 $605.65 $358.24 $605.65 $605.65 $605.65 $605.65 $454.50 $605.65 $605.65 $605.65 $302.83 $302.83 $479.67 $605.65 $484.52 $393.67 $120.21 N/A $351.48 $605.65 $605.65 $605.65 $126.22 $605.65 N/A N/A M001171100 SUP HCPCS C1726 M001171100 - CATHETER BALLOON OCCLUSION 16FR 33MM 100CM 2 LUMEN RADIOPQ BOTH IP/OP $606.00 $448.00 $120.21 $605.65 $328.87 $328.87 $328.87 $328.87 $605.65 $605.65 $605.65 $126.23 $605.65 $449.51 $449.51 $466.84 $315.54 $126.22 $605.65 $605.65 $358.24 $605.65 $605.65 $605.65 $605.65 $454.50 $605.65 $605.65 $605.65 $302.83 $302.83 $479.67 $605.65 $484.52 $393.67 $120.21 N/A $351.48 $605.65 $605.65 $605.65 $126.22 $605.65 N/A N/A M001171110 SUP HCPCS C1726 M001171110 - CATHETER BALLOON OCCLUSION 7FR 40MM 65CM 2 LUMEN RADIOPQ BOTH IP/OP $606.00 $448.00 $120.21 $605.65 $328.87 $328.87 $328.87 $328.87 $605.65 $605.65 $605.65 $126.23 $605.65 $449.51 $449.51 $466.84 $315.54 $126.22 $605.65 $605.65 $358.24 $605.65 $605.65 $605.65 $605.65 $454.50 $605.65 $605.65 $605.65 $302.83 $302.83 $479.67 $605.65 $484.52 $393.67 $120.21 N/A $351.48 $605.65 $605.65 $605.65 $126.22 $605.65 N/A N/A M001171120 SUP HCPCS C1726 M001171120 - CATHETER BALLOON OCCLUSION 7FR 40MM 100CM 2 LUMEN RADIOPQ BOTH IP/OP $606.00 $448.00 $120.21 $605.65 $328.87 $328.87 $328.87 $328.87 $605.65 $605.65 $605.65 $126.23 $605.65 $449.51 $449.51 $466.84 $315.54 $126.22 $605.65 $605.65 $358.24 $605.65 $605.65 $605.65 $605.65 $454.50 $605.65 $605.65 $605.65 $302.83 $302.83 $479.67 $605.65 $484.52 $393.67 $120.21 N/A $351.48 $605.65 $605.65 $605.65 $126.22 $605.65 N/A N/A M001173010 SUP HCPCS C2628 M001173010 - CATHETER BALLOON OCCLUSION 6FR 11.5MM 80CM 2 LUMEN RADIOPQ BOTH IP/OP $471.50 $349.00 $93.57 $471.45 $256.00 $256.00 $256.00 $256.00 $471.45 $471.45 $471.45 $98.26 $471.45 $349.91 $349.91 $363.39 $245.63 $98.26 $471.45 $471.45 $278.86 $471.45 $471.45 $471.45 $471.45 $353.63 $471.45 $471.45 $471.45 $235.73 $235.73 $373.39 $471.45 $377.16 $306.44 $93.57 N/A $273.47 $471.45 $471.45 $471.45 $98.25 $471.45 N/A N/A M001175000 SUP Custom 27203010 M001175000 - CATHETER BLNOCC .035IN 5FR 8.5MM 65CM EQLZR 2 LUM BOTH IP/OP $551.50 $408.00 $98.10 $551.13 $551.13 $551.13 $551.13 $551.13 $551.13 $551.13 $98.10 $551.13 $551.13 $409.05 $409.05 $424.81 $287.14 $114.86 $551.13 $220.45 $551.13 $551.13 $551.13 $551.13 $551.13 $413.63 $551.13 $551.13 $551.13 $275.57 $275.57 $436.49 $551.13 $440.90 $358.23 $551.13 N/A $319.87 $551.13 $330.68 $551.13 $551.13 $551.13 N/A N/A M001181250 SUP HCPCS C1887 M001181250 - MICROCATHETER INFS STRG 3-2.4FR 105CM RNGD STC 18 RADOPQ BOTH IP/OP "$1,008.00" $746.00 $200.06 "$1,008.00" $547.34 $547.34 $547.34 $547.34 "$1,008.00" "$1,008.00" "$1,008.00" $210.09 "$1,008.00" $748.14 $748.14 $776.97 $525.17 $210.08 "$1,008.00" "$1,008.00" $596.23 "$1,008.00" "$1,008.00" "$1,008.00" "$1,008.00" $756.00 "$1,008.00" "$1,008.00" "$1,008.00" $504.00 $504.00 $798.34 "$1,008.00" $806.40 $655.20 $200.06 N/A $584.64 "$1,008.00" "$1,008.00" "$1,008.00" $210.07 "$1,008.00" N/A N/A M001181260 SUP HCPCS C1887 M001181260 - MICROCATHETER INFS STRG 3-2.4FR 105CM RNGD STC 18 RADOPQ BOTH IP/OP "$1,008.00" $746.00 $200.06 "$1,008.00" $547.34 $547.34 $547.34 $547.34 "$1,008.00" "$1,008.00" "$1,008.00" $210.09 "$1,008.00" $748.14 $748.14 $776.97 $525.17 $210.08 "$1,008.00" "$1,008.00" $596.23 "$1,008.00" "$1,008.00" "$1,008.00" "$1,008.00" $756.00 "$1,008.00" "$1,008.00" "$1,008.00" $504.00 $504.00 $798.34 "$1,008.00" $806.40 $655.20 $200.06 N/A $584.64 "$1,008.00" "$1,008.00" "$1,008.00" $210.07 "$1,008.00" N/A N/A M001181270 SUP HCPCS C1887 M001181270 - MICROCATHETER INFS 90D 3-2.4FR 105CM RNGD STC 18 RADOPQ BOTH IP/OP "$1,055.50" $781.00 $209.44 "$1,055.25" $573.00 $573.00 $573.00 $573.00 "$1,055.25" "$1,055.25" "$1,055.25" $219.94 "$1,055.25" $783.21 $783.21 $813.39 $549.79 $219.93 "$1,055.25" "$1,055.25" $624.18 "$1,055.25" "$1,055.25" "$1,055.25" "$1,055.25" $791.63 "$1,055.25" "$1,055.25" "$1,055.25" $527.63 $527.63 $835.76 "$1,055.25" $844.20 $685.91 $209.44 N/A $612.19 "$1,055.25" "$1,055.25" "$1,055.25" $219.91 "$1,055.25" N/A N/A M001181280 SUP HCPCS C1887 M001181280 - MICROCATHETER INFS 90D 3-2.4FR 105CM RNGD STC 18 RADOPQ BOTH IP/OP "$1,055.50" $781.00 $209.44 "$1,055.25" $573.00 $573.00 $573.00 $573.00 "$1,055.25" "$1,055.25" "$1,055.25" $219.94 "$1,055.25" $783.21 $783.21 $813.39 $549.79 $219.93 "$1,055.25" "$1,055.25" $624.18 "$1,055.25" "$1,055.25" "$1,055.25" "$1,055.25" $791.63 "$1,055.25" "$1,055.25" "$1,055.25" $527.63 $527.63 $835.76 "$1,055.25" $844.20 $685.91 $209.44 N/A $612.19 "$1,055.25" "$1,055.25" "$1,055.25" $219.91 "$1,055.25" N/A N/A M001181310 SUP HCPCS C1887 M001181310 - MICROCATHETER INFS STRG 3-2.4FR 130CM RNGD STC 18 RADOPQ BOTH IP/OP "$1,008.00" $746.00 $200.06 "$1,008.00" $547.34 $547.34 $547.34 $547.34 "$1,008.00" "$1,008.00" "$1,008.00" $210.09 "$1,008.00" $748.14 $748.14 $776.97 $525.17 $210.08 "$1,008.00" "$1,008.00" $596.23 "$1,008.00" "$1,008.00" "$1,008.00" "$1,008.00" $756.00 "$1,008.00" "$1,008.00" "$1,008.00" $504.00 $504.00 $798.34 "$1,008.00" $806.40 $655.20 $200.06 N/A $584.64 "$1,008.00" "$1,008.00" "$1,008.00" $210.07 "$1,008.00" N/A N/A M001181320 SUP HCPCS C1887 M001181320 - MICROCATHETER INFS STRG 3-2.4FR 130CM RNGD STC 18 RADOPQ BOTH IP/OP "$1,008.00" $746.00 $200.06 "$1,008.00" $547.34 $547.34 $547.34 $547.34 "$1,008.00" "$1,008.00" "$1,008.00" $210.09 "$1,008.00" $748.14 $748.14 $776.97 $525.17 $210.08 "$1,008.00" "$1,008.00" $596.23 "$1,008.00" "$1,008.00" "$1,008.00" "$1,008.00" $756.00 "$1,008.00" "$1,008.00" "$1,008.00" $504.00 $504.00 $798.34 "$1,008.00" $806.40 $655.20 $200.06 N/A $584.64 "$1,008.00" "$1,008.00" "$1,008.00" $210.07 "$1,008.00" N/A N/A M001181330 SUP HCPCS C1887 M001181330 - MICROCATHETER INFS 90D 3-2.4FR 130CM RNGD STC 18 RADOPQ BOTH IP/OP "$1,055.50" $781.00 $209.44 "$1,055.25" $573.00 $573.00 $573.00 $573.00 "$1,055.25" "$1,055.25" "$1,055.25" $219.94 "$1,055.25" $783.21 $783.21 $813.39 $549.79 $219.93 "$1,055.25" "$1,055.25" $624.18 "$1,055.25" "$1,055.25" "$1,055.25" "$1,055.25" $791.63 "$1,055.25" "$1,055.25" "$1,055.25" $527.63 $527.63 $835.76 "$1,055.25" $844.20 $685.91 $209.44 N/A $612.19 "$1,055.25" "$1,055.25" "$1,055.25" $219.91 "$1,055.25" N/A N/A M001181340 SUP HCPCS C1887 M001181340 - MICROCATHETER INFS 90D 3-2.4FR 130CM RNGD STC 18 RADOPQ BOTH IP/OP "$1,055.50" $781.00 $209.44 "$1,055.25" $573.00 $573.00 $573.00 $573.00 "$1,055.25" "$1,055.25" "$1,055.25" $219.94 "$1,055.25" $783.21 $783.21 $813.39 $549.79 $219.93 "$1,055.25" "$1,055.25" $624.18 "$1,055.25" "$1,055.25" "$1,055.25" "$1,055.25" $791.63 "$1,055.25" "$1,055.25" "$1,055.25" $527.63 $527.63 $835.76 "$1,055.25" $844.20 $685.91 $209.44 N/A $612.19 "$1,055.25" "$1,055.25" "$1,055.25" $219.91 "$1,055.25" N/A N/A M001181370 SUP HCPCS C1887 M001181370 - MICROCATHETER INFS STRG 3-2.4FR 150CM RNGD STC 18 RADOPQ BOTH IP/OP "$1,008.00" $746.00 $200.06 "$1,008.00" $547.34 $547.34 $547.34 $547.34 "$1,008.00" "$1,008.00" "$1,008.00" $210.09 "$1,008.00" $748.14 $748.14 $776.97 $525.17 $210.08 "$1,008.00" "$1,008.00" $596.23 "$1,008.00" "$1,008.00" "$1,008.00" "$1,008.00" $756.00 "$1,008.00" "$1,008.00" "$1,008.00" $504.00 $504.00 $798.34 "$1,008.00" $806.40 $655.20 $200.06 N/A $584.64 "$1,008.00" "$1,008.00" "$1,008.00" $210.07 "$1,008.00" N/A N/A M001181380 SUP HCPCS C1887 M001181380 - MICROCATHETER INFS STRG 3-2.4FR 150CM RNGD STC 18 RADOPQ BOTH IP/OP "$1,008.00" $746.00 $200.06 "$1,008.00" $547.34 $547.34 $547.34 $547.34 "$1,008.00" "$1,008.00" "$1,008.00" $210.09 "$1,008.00" $748.14 $748.14 $776.97 $525.17 $210.08 "$1,008.00" "$1,008.00" $596.23 "$1,008.00" "$1,008.00" "$1,008.00" "$1,008.00" $756.00 "$1,008.00" "$1,008.00" "$1,008.00" $504.00 $504.00 $798.34 "$1,008.00" $806.40 $655.20 $200.06 N/A $584.64 "$1,008.00" "$1,008.00" "$1,008.00" $210.07 "$1,008.00" N/A N/A M001181390 SUP HCPCS C1887 M001181390 - MICROCATHETER INFS 90D 3-2.4FR 150CM RNGD STC 18 RADOPQ BOTH IP/OP "$1,055.50" $781.00 $209.44 "$1,055.25" $573.00 $573.00 $573.00 $573.00 "$1,055.25" "$1,055.25" "$1,055.25" $219.94 "$1,055.25" $783.21 $783.21 $813.39 $549.79 $219.93 "$1,055.25" "$1,055.25" $624.18 "$1,055.25" "$1,055.25" "$1,055.25" "$1,055.25" $791.63 "$1,055.25" "$1,055.25" "$1,055.25" $527.63 $527.63 $835.76 "$1,055.25" $844.20 $685.91 $209.44 N/A $612.19 "$1,055.25" "$1,055.25" "$1,055.25" $219.91 "$1,055.25" N/A N/A M001181400 SUP HCPCS C1887 M001181400 - MICROCATHETER INFS 90D 3-2.4FR 150CM RNGD STC 18 RADOPQ BOTH IP/OP "$1,055.50" $781.00 $209.44 "$1,055.25" $573.00 $573.00 $573.00 $573.00 "$1,055.25" "$1,055.25" "$1,055.25" $219.94 "$1,055.25" $783.21 $783.21 $813.39 $549.79 $219.93 "$1,055.25" "$1,055.25" $624.18 "$1,055.25" "$1,055.25" "$1,055.25" "$1,055.25" $791.63 "$1,055.25" "$1,055.25" "$1,055.25" $527.63 $527.63 $835.76 "$1,055.25" $844.20 $685.91 $209.44 N/A $612.19 "$1,055.25" "$1,055.25" "$1,055.25" $219.91 "$1,055.25" N/A N/A M001182590 SUP HCPCS C1887 M001182590 - MICROCATHETER INFS 3-2.5FR 150CM RNGD RADOPQ BRD DIST TIP BOTH IP/OP "$1,960.00" "$1,450.00" $388.99 "$1,959.90" "$1,064.23" "$1,064.23" "$1,064.23" "$1,064.23" "$1,959.90" "$1,959.90" "$1,959.90" $408.49 "$1,959.90" "$1,454.64" "$1,454.64" "$1,510.69" "$1,021.11" $408.46 "$1,959.90" "$1,959.90" "$1,159.28" "$1,959.90" "$1,959.90" "$1,959.90" "$1,959.90" "$1,470.00" "$1,959.90" "$1,959.90" "$1,959.90" $979.95 $979.95 "$1,552.24" "$1,959.90" "$1,567.92" "$1,273.94" $388.99 N/A "$1,136.80" "$1,959.90" "$1,959.90" "$1,959.90" $408.44 "$1,959.90" N/A N/A M001182830 SUP HCPCS C1751 M001182830 - CATHETER INFUS MICRO 3-2.8FR .027IN 80CM 20CM KIT RADIOPQ BOTH IP/OP $900.00 $666.00 $178.55 $899.60 $488.48 $488.48 $488.48 $488.48 $899.60 $899.60 $899.60 $187.50 $899.60 $667.68 $667.68 $693.41 $468.69 $187.49 $899.60 $899.60 $532.11 $899.60 $899.60 $899.60 $899.60 $675.00 $899.60 $899.60 $899.60 $449.80 $449.80 $712.48 $899.60 $719.68 $584.74 $178.55 N/A $522.00 $899.60 $899.60 $899.60 $187.48 $899.60 N/A N/A M001182840 SUP HCPCS C1751 M001182840 - CATHETER INFUS STR 20.8-30FR .027IN 105CM 10CM RENEGADE BOTH IP/OP $900.00 $666.00 $178.55 $899.60 $488.48 $488.48 $488.48 $488.48 $899.60 $899.60 $899.60 $187.50 $899.60 $667.68 $667.68 $693.41 $468.69 $187.49 $899.60 $899.60 $532.11 $899.60 $899.60 $899.60 $899.60 $675.00 $899.60 $899.60 $899.60 $449.80 $449.80 $712.48 $899.60 $719.68 $584.74 $178.55 N/A $522.00 $899.60 $899.60 $899.60 $187.48 $899.60 N/A N/A M001182850 SUP HCPCS C1751 M001182850 - CATHETER INFUS MICRO 3-2.8FR .027IN 105CM 20CM KIT RADIOPQ BOTH IP/OP $900.00 $666.00 $178.55 $899.60 $488.48 $488.48 $488.48 $488.48 $899.60 $899.60 $899.60 $187.50 $899.60 $667.68 $667.68 $693.41 $468.69 $187.49 $899.60 $899.60 $532.11 $899.60 $899.60 $899.60 $899.60 $675.00 $899.60 $899.60 $899.60 $449.80 $449.80 $712.48 $899.60 $719.68 $584.74 $178.55 N/A $522.00 $899.60 $899.60 $899.60 $187.48 $899.60 N/A N/A M001182860 SUP HCPCS C1751 M001182860 - CATHETER INFUS MICRO 3-2.8FR .027IN 115CM 10CM KIT RADIOPQ BOTH IP/OP $900.00 $666.00 $178.55 $899.60 $488.48 $488.48 $488.48 $488.48 $899.60 $899.60 $899.60 $187.50 $899.60 $667.68 $667.68 $693.41 $468.69 $187.49 $899.60 $899.60 $532.11 $899.60 $899.60 $899.60 $899.60 $675.00 $899.60 $899.60 $899.60 $449.80 $449.80 $712.48 $899.60 $719.68 $584.74 $178.55 N/A $522.00 $899.60 $899.60 $899.60 $187.48 $899.60 N/A N/A M001182870 SUP HCPCS C1751 M001182870 - CATHETER INFUS MICRO 3-2.8FR .027IN 115CM 20CM KIT RADIOPQ BOTH IP/OP $900.00 $666.00 $178.55 $899.60 $488.48 $488.48 $488.48 $488.48 $899.60 $899.60 $899.60 $187.50 $899.60 $667.68 $667.68 $693.41 $468.69 $187.49 $899.60 $899.60 $532.11 $899.60 $899.60 $899.60 $899.60 $675.00 $899.60 $899.60 $899.60 $449.80 $449.80 $712.48 $899.60 $719.68 $584.74 $178.55 N/A $522.00 $899.60 $899.60 $899.60 $187.48 $899.60 N/A N/A M001182880 SUP HCPCS C1751 M001182880 - CATHETER INFUS MICRO 3-2.8FR .027IN 135CM 10CM KIT RADIOPQ BOTH IP/OP $900.00 $666.00 $178.55 $899.60 $488.48 $488.48 $488.48 $488.48 $899.60 $899.60 $899.60 $187.50 $899.60 $667.68 $667.68 $693.41 $468.69 $187.49 $899.60 $899.60 $532.11 $899.60 $899.60 $899.60 $899.60 $675.00 $899.60 $899.60 $899.60 $449.80 $449.80 $712.48 $899.60 $719.68 $584.74 $178.55 N/A $522.00 $899.60 $899.60 $899.60 $187.48 $899.60 N/A N/A M001182890 SUP HCPCS C1751 M001182890 - CATHETER INFUS MICRO 3-2.8FR .027IN 135CM 20CM KIT RADIOPQ BOTH IP/OP $900.00 $666.00 $178.55 $899.60 $488.48 $488.48 $488.48 $488.48 $899.60 $899.60 $899.60 $187.50 $899.60 $667.68 $667.68 $693.41 $468.69 $187.49 $899.60 $899.60 $532.11 $899.60 $899.60 $899.60 $899.60 $675.00 $899.60 $899.60 $899.60 $449.80 $449.80 $712.48 $899.60 $719.68 $584.74 $178.55 N/A $522.00 $899.60 $899.60 $899.60 $187.48 $899.60 N/A N/A M001182900 SUP HCPCS C1751 M001182900 - CATHETER INFUS MICRO 3-2.8FR .027IN 150CM 10CM KIT RADIOPQ BOTH IP/OP $900.00 $666.00 $178.55 $899.60 $488.48 $488.48 $488.48 $488.48 $899.60 $899.60 $899.60 $187.50 $899.60 $667.68 $667.68 $693.41 $468.69 $187.49 $899.60 $899.60 $532.11 $899.60 $899.60 $899.60 $899.60 $675.00 $899.60 $899.60 $899.60 $449.80 $449.80 $712.48 $899.60 $719.68 $584.74 $178.55 N/A $522.00 $899.60 $899.60 $899.60 $187.48 $899.60 N/A N/A M001182910 SUP HCPCS C1751 M001182910 - CATHETER INFUS MICRO 3-2.8FR .027IN 150CM 20CM KIT RADIOPQ BOTH IP/OP $900.00 $666.00 $178.55 $899.60 $488.48 $488.48 $488.48 $488.48 $899.60 $899.60 $899.60 $187.50 $899.60 $667.68 $667.68 $693.41 $468.69 $187.49 $899.60 $899.60 $532.11 $899.60 $899.60 $899.60 $899.60 $675.00 $899.60 $899.60 $899.60 $449.80 $449.80 $712.48 $899.60 $719.68 $584.74 $178.55 N/A $522.00 $899.60 $899.60 $899.60 $187.48 $899.60 N/A N/A M001182920 SUP HCPCS C1887 M001182920 - CATHETER INFUS .018IN 3-2.8FR .027IN 105CM 10CM KIT BOTH IP/OP "$1,194.00" $884.00 $236.89 "$1,193.53" $648.09 $648.09 $648.09 $648.09 "$1,193.53" "$1,193.53" "$1,193.53" $248.76 "$1,193.53" $885.84 $885.84 $919.97 $621.83 $248.74 "$1,193.53" "$1,193.53" $705.97 "$1,193.53" "$1,193.53" "$1,193.53" "$1,193.53" $895.50 "$1,193.53" "$1,193.53" "$1,193.53" $596.77 $596.77 $945.28 "$1,193.53" $954.82 $775.79 $236.89 N/A $692.52 "$1,193.53" "$1,193.53" "$1,193.53" $248.73 "$1,193.53" N/A N/A M001182930 SUP HCPCS C1887 M001182930 - CATHETER INFUS MICRO 3-2.8FR .027IN 105CM 20MM KIT RADIOPQ BOTH IP/OP "$1,194.00" $884.00 $236.89 "$1,193.53" $648.09 $648.09 $648.09 $648.09 "$1,193.53" "$1,193.53" "$1,193.53" $248.76 "$1,193.53" $885.84 $885.84 $919.97 $621.83 $248.74 "$1,193.53" "$1,193.53" $705.97 "$1,193.53" "$1,193.53" "$1,193.53" "$1,193.53" $895.50 "$1,193.53" "$1,193.53" "$1,193.53" $596.77 $596.77 $945.28 "$1,193.53" $954.82 $775.79 $236.89 N/A $692.52 "$1,193.53" "$1,193.53" "$1,193.53" $248.73 "$1,193.53" N/A N/A M001182940 SUP HCPCS C1887 M001182940 - CATHETER INFUS MICRO 3-2.8FR .027IN 115CM 10CM KIT RADIOPQ BOTH IP/OP "$1,194.00" $884.00 $236.89 "$1,193.53" $648.09 $648.09 $648.09 $648.09 "$1,193.53" "$1,193.53" "$1,193.53" $248.76 "$1,193.53" $885.84 $885.84 $919.97 $621.83 $248.74 "$1,193.53" "$1,193.53" $705.97 "$1,193.53" "$1,193.53" "$1,193.53" "$1,193.53" $895.50 "$1,193.53" "$1,193.53" "$1,193.53" $596.77 $596.77 $945.28 "$1,193.53" $954.82 $775.79 $236.89 N/A $692.52 "$1,193.53" "$1,193.53" "$1,193.53" $248.73 "$1,193.53" N/A N/A M001182950 SUP HCPCS C1887 M001182950 - CATHETER INFUS MICRO 3-2.8FR .027IN 115CM 20CM KIT RADIOPQ BOTH IP/OP "$1,194.00" $884.00 $236.89 "$1,193.53" $648.09 $648.09 $648.09 $648.09 "$1,193.53" "$1,193.53" "$1,193.53" $248.76 "$1,193.53" $885.84 $885.84 $919.97 $621.83 $248.74 "$1,193.53" "$1,193.53" $705.97 "$1,193.53" "$1,193.53" "$1,193.53" "$1,193.53" $895.50 "$1,193.53" "$1,193.53" "$1,193.53" $596.77 $596.77 $945.28 "$1,193.53" $954.82 $775.79 $236.89 N/A $692.52 "$1,193.53" "$1,193.53" "$1,193.53" $248.73 "$1,193.53" N/A N/A M001182960 SUP HCPCS C1887 M001182960 - CATHETER INFUS MICRO 3-2.8FR .027IN 135CM 10CM KIT RADIOPQ BOTH IP/OP "$1,194.00" $884.00 $236.89 "$1,193.53" $648.09 $648.09 $648.09 $648.09 "$1,193.53" "$1,193.53" "$1,193.53" $248.76 "$1,193.53" $885.84 $885.84 $919.97 $621.83 $248.74 "$1,193.53" "$1,193.53" $705.97 "$1,193.53" "$1,193.53" "$1,193.53" "$1,193.53" $895.50 "$1,193.53" "$1,193.53" "$1,193.53" $596.77 $596.77 $945.28 "$1,193.53" $954.82 $775.79 $236.89 N/A $692.52 "$1,193.53" "$1,193.53" "$1,193.53" $248.73 "$1,193.53" N/A N/A M001182970 SUP HCPCS C1887 M001182970 - CATHETER INFUS MICRO 3-2.8FR .027IN 135CM 20CM KIT RADIOPQ BOTH IP/OP "$1,194.00" $884.00 $236.89 "$1,193.53" $648.09 $648.09 $648.09 $648.09 "$1,193.53" "$1,193.53" "$1,193.53" $248.76 "$1,193.53" $885.84 $885.84 $919.97 $621.83 $248.74 "$1,193.53" "$1,193.53" $705.97 "$1,193.53" "$1,193.53" "$1,193.53" "$1,193.53" $895.50 "$1,193.53" "$1,193.53" "$1,193.53" $596.77 $596.77 $945.28 "$1,193.53" $954.82 $775.79 $236.89 N/A $692.52 "$1,193.53" "$1,193.53" "$1,193.53" $248.73 "$1,193.53" N/A N/A M001184500 SUP HCPCS C1887 M001184500 - GUIDEWIRE VASCULAR .016IN 105CM 10CM PRELOAD HI-FLO RENEGADE BOTH IP/OP "$1,540.00" "$1,140.00" $305.65 "$1,540.00" $836.22 $836.22 $836.22 $836.22 "$1,540.00" "$1,540.00" "$1,540.00" $320.97 "$1,540.00" "$1,142.99" "$1,142.99" "$1,187.03" $802.34 $320.95 "$1,540.00" "$1,540.00" $910.91 "$1,540.00" "$1,540.00" "$1,540.00" "$1,540.00" "$1,155.00" "$1,540.00" "$1,540.00" "$1,540.00" $770.00 $770.00 "$1,219.68" "$1,540.00" "$1,232.00" "$1,001.00" $305.65 N/A $893.20 "$1,540.00" "$1,540.00" "$1,540.00" $320.94 "$1,540.00" N/A N/A M001184510 SUP HCPCS C1887 M001184510 - GUIDEWIRE VASCULAR .016IN 105CM 20CM PRELOAD HI-FLO RENEGADE BOTH IP/OP "$1,540.00" "$1,140.00" $305.65 "$1,540.00" $836.22 $836.22 $836.22 $836.22 "$1,540.00" "$1,540.00" "$1,540.00" $320.97 "$1,540.00" "$1,142.99" "$1,142.99" "$1,187.03" $802.34 $320.95 "$1,540.00" "$1,540.00" $910.91 "$1,540.00" "$1,540.00" "$1,540.00" "$1,540.00" "$1,155.00" "$1,540.00" "$1,540.00" "$1,540.00" $770.00 $770.00 "$1,219.68" "$1,540.00" "$1,232.00" "$1,001.00" $305.65 N/A $893.20 "$1,540.00" "$1,540.00" "$1,540.00" $320.94 "$1,540.00" N/A N/A M001184520 SUP HCPCS C1887 M001184520 - GUIDEWIRE VASCULAR .016IN 115CM 10CM PRELOAD HI-FLO RENEGADE BOTH IP/OP "$1,540.00" "$1,140.00" $305.65 "$1,540.00" $836.22 $836.22 $836.22 $836.22 "$1,540.00" "$1,540.00" "$1,540.00" $320.97 "$1,540.00" "$1,142.99" "$1,142.99" "$1,187.03" $802.34 $320.95 "$1,540.00" "$1,540.00" $910.91 "$1,540.00" "$1,540.00" "$1,540.00" "$1,540.00" "$1,155.00" "$1,540.00" "$1,540.00" "$1,540.00" $770.00 $770.00 "$1,219.68" "$1,540.00" "$1,232.00" "$1,001.00" $305.65 N/A $893.20 "$1,540.00" "$1,540.00" "$1,540.00" $320.94 "$1,540.00" N/A N/A M001184530 SUP HCPCS C1887 M001184530 - GUIDEWIRE VASCULAR .016IN 115CM 20CM PRELOAD HI-FLO RENEGADE BOTH IP/OP "$1,540.00" "$1,140.00" $305.65 "$1,540.00" $836.22 $836.22 $836.22 $836.22 "$1,540.00" "$1,540.00" "$1,540.00" $320.97 "$1,540.00" "$1,142.99" "$1,142.99" "$1,187.03" $802.34 $320.95 "$1,540.00" "$1,540.00" $910.91 "$1,540.00" "$1,540.00" "$1,540.00" "$1,540.00" "$1,155.00" "$1,540.00" "$1,540.00" "$1,540.00" $770.00 $770.00 "$1,219.68" "$1,540.00" "$1,232.00" "$1,001.00" $305.65 N/A $893.20 "$1,540.00" "$1,540.00" "$1,540.00" $320.94 "$1,540.00" N/A N/A M001184540 SUP HCPCS C1887 M001184540 - CATHETER GUID 10CM MICRO 2.8-3FR 180CM 135CM KIT STEERABLE BOTH IP/OP "$1,540.00" "$1,140.00" $305.65 "$1,540.00" $836.22 $836.22 $836.22 $836.22 "$1,540.00" "$1,540.00" "$1,540.00" $320.97 "$1,540.00" "$1,142.99" "$1,142.99" "$1,187.03" $802.34 $320.95 "$1,540.00" "$1,540.00" $910.91 "$1,540.00" "$1,540.00" "$1,540.00" "$1,540.00" "$1,155.00" "$1,540.00" "$1,540.00" "$1,540.00" $770.00 $770.00 "$1,219.68" "$1,540.00" "$1,232.00" "$1,001.00" $305.65 N/A $893.20 "$1,540.00" "$1,540.00" "$1,540.00" $320.94 "$1,540.00" N/A N/A M001184550 SUP HCPCS C1887 M001184550 - MICROCATHETER INFS .016IN 3-2.8FR 180CM RNGD HFL FATHOM BOTH IP/OP "$1,540.00" "$1,140.00" $305.65 "$1,540.00" $836.22 $836.22 $836.22 $836.22 "$1,540.00" "$1,540.00" "$1,540.00" $320.97 "$1,540.00" "$1,142.99" "$1,142.99" "$1,187.03" $802.34 $320.95 "$1,540.00" "$1,540.00" $910.91 "$1,540.00" "$1,540.00" "$1,540.00" "$1,540.00" "$1,155.00" "$1,540.00" "$1,540.00" "$1,540.00" $770.00 $770.00 "$1,219.68" "$1,540.00" "$1,232.00" "$1,001.00" $305.65 N/A $893.20 "$1,540.00" "$1,540.00" "$1,540.00" $320.94 "$1,540.00" N/A N/A M001184560 SUP HCPCS C1887 M001184560 - MICROCATHETER INFS .016IN 3-2.8FR 180CM RNGD HFL FATHOM BOTH IP/OP "$1,540.00" "$1,140.00" $305.65 "$1,540.00" $836.22 $836.22 $836.22 $836.22 "$1,540.00" "$1,540.00" "$1,540.00" $320.97 "$1,540.00" "$1,142.99" "$1,142.99" "$1,187.03" $802.34 $320.95 "$1,540.00" "$1,540.00" $910.91 "$1,540.00" "$1,540.00" "$1,540.00" "$1,540.00" "$1,155.00" "$1,540.00" "$1,540.00" "$1,540.00" $770.00 $770.00 "$1,219.68" "$1,540.00" "$1,232.00" "$1,001.00" $305.65 N/A $893.20 "$1,540.00" "$1,540.00" "$1,540.00" $320.94 "$1,540.00" N/A N/A M001184570 SUP HCPCS C1887 M001184570 - MICROCATHETER INFS .016IN 3-2.8FR 180CM RNGD HFL FATHOM BOTH IP/OP "$1,540.00" "$1,140.00" $305.65 "$1,540.00" $836.22 $836.22 $836.22 $836.22 "$1,540.00" "$1,540.00" "$1,540.00" $320.97 "$1,540.00" "$1,142.99" "$1,142.99" "$1,187.03" $802.34 $320.95 "$1,540.00" "$1,540.00" $910.91 "$1,540.00" "$1,540.00" "$1,540.00" "$1,540.00" "$1,155.00" "$1,540.00" "$1,540.00" "$1,540.00" $770.00 $770.00 "$1,219.68" "$1,540.00" "$1,232.00" "$1,001.00" $305.65 N/A $893.20 "$1,540.00" "$1,540.00" "$1,540.00" $320.94 "$1,540.00" N/A N/A M001196000 SUP HCPCS C1887 M001196000 - CATHETER GD HS CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196040 SUP HCPCS C1887 M001196040 - CATHETER GD RE S 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196080 SUP HCPCS C1887 M001196080 - CATHETER GD RE SS CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196120 SUP HCPCS C1887 M001196120 - CATHETER GD RE1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196160 SUP HCPCS C1887 M001196160 - CATHETER GD C1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196200 SUP HCPCS C1887 M001196200 - CATHETER GD C2 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196230 SUP HCPCS C1887 M001196230 - CATHETER GD MP CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $128.70 $214.50 $44.70 $214.50 N/A N/A M001196260 SUP HCPCS C1887 M001196260 - CATHETER GD MP CRV 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196300 SUP HCPCS C1887 M001196300 - CATHETER GD MP2 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $128.70 $214.50 $44.70 $214.50 N/A N/A M001196330 SUP HCPCS C1887 M001196330 - CATHETER GD MP2 CRV 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $128.70 $214.50 $44.70 $214.50 N/A N/A M001196380 SUP HCPCS C1887 M001196380 - CATHETER GD 40D 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 RND BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196450 SUP HCPCS C1887 M001196450 - CATHETER GD ST CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196480 SUP HCPCS C1887 M001196480 - CATHETER GD ST CRV 6FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196530 SUP HCPCS C1887 M001196530 - CATHETER GD XVR 1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196560 SUP HCPCS C1887 M001196560 - CATHETER GD XVR 2 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $128.70 $214.50 $44.70 $214.50 N/A N/A M001196620 SUP HCPCS C1887 M001196620 - CATHETER GD LIMA CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196660 SUP HCPCS C1887 M001196660 - CATHETER GD RDC CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196700 SUP HCPCS C1887 M001196700 - CATHETER GD BATES 1 CRV 6FR 55CM STRL LF MACH1 LG LUM SH BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196800 SUP HCPCS C1887 M001196800 - CATHETER GD BATES 2 CRV 6FR 55CM STRL LF MACH1 LG LUM SH BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001196960 SUP HCPCS C1887 M001196960 - CATHETER GD RDC1 CRV 6FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197000 SUP HCPCS C1887 M001197000 - CATHETER GD HS CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197040 SUP HCPCS C1887 M001197040 - CATHETER GD RE S 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197080 SUP HCPCS C1887 M001197080 - CATHETER GD RE SS CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197120 SUP HCPCS C1887 M001197120 - CATHETER GD RE L CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197160 SUP HCPCS C1887 M001197160 - CATHETER GD C1 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197200 SUP HCPCS C1887 M001197200 - CATHETER GD C2 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197230 SUP HCPCS C1887 M001197230 - CATHETER GD MP CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197260 SUP HCPCS C1887 M001197260 - CATHETER GD MP CRV 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197300 SUP HCPCS C1887 M001197300 - CATHETER GD MP2 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197330 SUP HCPCS C1887 M001197330 - CATHETER GD MP2 CRV 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197380 SUP HCPCS C1887 M001197380 - CATHETER GD 40D 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 RND BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197450 SUP HCPCS C1887 M001197450 - CATHETER GD ST CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197480 SUP HCPCS C1887 M001197480 - CATHETER GD ST CRV 7FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197530 SUP HCPCS C1887 M001197530 - CATHETER GD XVR 1 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197560 SUP HCPCS C1887 M001197560 - CATHETER GD XVR 2 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197620 SUP HCPCS C1887 M001197620 - CATHETER GD LIMA CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197660 SUP HCPCS C1887 M001197660 - CATHETER GD RDC CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197700 SUP HCPCS C1887 M001197700 - CATHETER GD BATES 1 CRV 7FR 55CM STRL LF MACH1 LG LUM SH BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197800 SUP HCPCS C1887 M001197800 - CATHETER GD BATES 2 CRV 7FR 55CM STRL LF MACH1 LG LUM SH BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001197960 SUP HCPCS C1887 M001197960 - CATHETER GD RDC1 CRV 7FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198000 SUP HCPCS C1887 M001198000 - CATHETER GD HS CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198040 SUP HCPCS C1887 M001198040 - CATHETER GD RE S 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198080 SUP HCPCS C1887 M001198080 - CATHETER GD RE SS CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198120 SUP HCPCS C1887 M001198120 - CATHETER GD RE L CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198160 SUP HCPCS C1887 M001198160 - CATHETER GD C1 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198200 SUP HCPCS C1887 M001198200 - CATHETER GD C2 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198230 SUP HCPCS C1887 M001198230 - CATHETER GD MP CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198260 SUP HCPCS C1887 M001198260 - CATHETER GD MP CRV 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198300 SUP HCPCS C1887 M001198300 - CATHETER GD MP2 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198330 SUP HCPCS C1887 M001198330 - CATHETER GD MP2 CRV 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198380 SUP HCPCS C1887 M001198380 - CATHETER GD 40D 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 RND BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198450 SUP HCPCS C1887 M001198450 - CATHETER GD ST CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198480 SUP HCPCS C1887 M001198480 - CATHETER GD ST CRV 8FR 90CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198530 SUP HCPCS C1887 M001198530 - CATHETER GD XVR 1 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198560 SUP HCPCS C1887 M001198560 - CATHETER GD XVR 2 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198620 SUP HCPCS C1887 M001198620 - CATHETER GD LIMA CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198660 SUP HCPCS C1887 M001198660 - CATHETER GD RDC CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2X2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198700 SUP HCPCS C1887 M001198700 - CATHETER GD BATES 1 CRV 8FR 55CM STRL LF MACH1 LG LUM SH BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198800 SUP HCPCS C1887 M001198800 - CATHETER GD BATES 2 CRV 8FR 55CM STRL LF MACH1 LG LUM SH BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001198960 SUP HCPCS C1887 M001198960 - CATHETER GD RDC1 CRV 8FR 55CM STRL LF MACH1 LG LUM RADOPQ 2 BOTH IP/OP $214.50 $159.00 $42.57 $214.50 $116.47 $116.47 $116.47 $116.47 $214.50 $214.50 $214.50 $44.71 $214.50 $159.20 $159.20 $165.34 $111.75 $44.70 $214.50 $214.50 $126.88 $214.50 $214.50 $214.50 $214.50 $160.88 $214.50 $214.50 $214.50 $107.25 $107.25 $169.88 $214.50 $171.60 $139.43 $42.57 N/A $124.41 $214.50 $214.50 $214.50 $44.70 $214.50 N/A N/A M001206130 SUP HCPCS C1892 M001206130 - INTRODUCER SHTH 11FR 30CM BNA PL PLWY COAX LCK TPR PE BOTH IP/OP $135.00 $100.00 $26.79 $135.00 $73.31 $73.31 $73.31 $73.31 $135.00 $135.00 $135.00 $28.14 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $135.00 $79.85 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $26.79 N/A $78.30 $135.00 $135.00 $135.00 $28.13 $135.00 N/A N/A M001207020 SUP HCPCS C1894 M001207020 - SYSTEM INTROD .018IN .038IN J FLOPPY 6FR 4FR 60CM 145CM 2 BOTH IP/OP $63.50 $47.00 $12.53 $63.13 $34.28 $34.28 $34.28 $34.28 $63.13 $63.13 $63.13 $13.16 $63.13 $46.86 $46.86 $48.66 $32.89 $13.16 $63.13 $63.13 $37.34 $63.13 $63.13 $63.13 $63.13 $47.63 $63.13 $63.13 $63.13 $31.57 $31.57 $50.00 $63.13 $50.50 $41.03 $12.53 N/A $36.83 $63.13 $63.13 $63.13 $13.16 $63.13 N/A N/A M001207030 SUP HCPCS C1894 M001207030 - SYSTEM INTROD .018IN .038IN FLOPPY STR 6FR 4FR 60CM 145CM 2 BOTH IP/OP $189.50 $140.00 $37.59 $189.38 $102.83 $102.83 $102.83 $102.83 $189.38 $189.38 $189.38 $39.47 $189.38 $140.56 $140.56 $145.97 $98.67 $39.47 $189.38 $189.38 $112.02 $189.38 $189.38 $189.38 $189.38 $142.13 $189.38 $189.38 $189.38 $94.69 $94.69 $149.99 $189.38 $151.50 $123.10 $37.59 N/A $109.91 $189.38 $189.38 $189.38 $39.47 $189.38 N/A N/A M001207040 SUP HCPCS C1892 M001207040 - SYSTEM INTROD .038IN FLOPPY 6FR 4FR 60CM 20CM DILAT RADIOPQ BOTH IP/OP $152.00 $112.00 $30.14 $151.88 $82.47 $82.47 $82.47 $82.47 $151.88 $151.88 $151.88 $31.66 $151.88 $112.73 $112.73 $117.07 $79.13 $31.65 $151.88 $151.88 $89.84 $151.88 $151.88 $151.88 $151.88 $114.00 $151.88 $151.88 $151.88 $75.94 $75.94 $120.29 $151.88 $121.50 $98.72 $30.14 N/A $88.16 $151.88 $151.88 $151.88 $31.65 $151.88 N/A N/A M001207050 SUP HCPCS C1894 M001207050 - SYSTEM INTROD 6FR ACCUSTICK II STERILE DISPOSABLE BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 N/A $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A M001207111 SUP HCPCS C1729 M001207111 - INTRODUCER SHEATH .018IN FLOPPY 60CM 6CM RADIOPQ GWIRE BOTH IP/OP $452.00 $334.00 $89.69 $451.88 $245.37 $245.37 $245.37 $245.37 $451.88 $451.88 $451.88 $94.18 $451.88 $335.39 $335.39 $348.31 $235.43 $94.18 $451.88 $451.88 $267.29 $451.88 $451.88 $451.88 $451.88 $339.00 $451.88 $451.88 $451.88 $225.94 $225.94 $357.89 $451.88 $361.50 $293.72 $89.69 N/A $262.16 $451.88 $451.88 $451.88 $94.17 $451.88 N/A N/A M001208500 SUP Custom 27203010 M001208500 - SET GASTROSTOMY 18GA BEVELED NEEDLE AFFIXATION DEVICE BROWN BOTH IP/OP $131.50 $97.00 $23.36 $131.25 $131.25 $131.25 $131.25 $131.25 $131.25 $131.25 $23.36 $131.25 $131.25 $97.41 $97.41 $101.17 $68.38 $27.35 $131.25 $52.50 $131.25 $131.25 $131.25 $131.25 $131.25 $98.63 $131.25 $131.25 $131.25 $65.63 $65.63 $103.95 $131.25 $105.00 $85.31 $131.25 N/A $76.27 $131.25 $78.75 $131.25 $131.25 $131.25 N/A N/A M001221000 SUP HCPCS C1729 M001221000 - CATHETER DRAIN 8FR 30CM LOCK STIFFEN CANNU AMPLATZ ANCHOR BOTH IP/OP $189.50 $140.00 $37.59 $189.38 $102.83 $102.83 $102.83 $102.83 $189.38 $189.38 $189.38 $39.47 $189.38 $140.56 $140.56 $145.97 $98.67 $39.47 $189.38 $189.38 $112.02 $189.38 $189.38 $189.38 $189.38 $142.13 $189.38 $189.38 $189.38 $94.69 $94.69 $149.99 $189.38 $151.50 $123.10 $37.59 N/A $109.91 $189.38 $189.38 $189.38 $39.47 $189.38 N/A N/A M001221010 SUP HCPCS C1729 M001221010 - CATHETER DRAIN 10FR 30CM LOCK STIFFEN CANNU AMPLATZ ANCHOR BOTH IP/OP $189.50 $140.00 $37.59 $189.38 $102.83 $102.83 $102.83 $102.83 $189.38 $189.38 $189.38 $39.47 $189.38 $140.56 $140.56 $145.97 $98.67 $39.47 $189.38 $189.38 $112.02 $189.38 $189.38 $189.38 $189.38 $142.13 $189.38 $189.38 $189.38 $94.69 $94.69 $149.99 $189.38 $151.50 $123.10 $37.59 N/A $109.91 $189.38 $189.38 $189.38 $39.47 $189.38 N/A N/A M001221020 SUP HCPCS C2617 M001221020 - CATHETER DRAIN 12FR 30CM LOCK STIFFEN CANNU LATEX FREE BOTH IP/OP $189.50 $140.00 $37.59 $189.38 $85.22 $85.22 $85.22 $85.22 $189.38 $189.38 $189.38 $39.47 $189.38 $189.38 $189.38 $189.38 $189.38 $39.47 $189.38 $189.38 $112.02 $189.38 $189.38 $189.38 $189.38 $142.13 $189.38 $189.38 $189.38 $94.69 $94.69 $149.99 $189.38 $151.50 $85.22 $37.59 N/A $109.91 $189.38 $189.38 $189.38 $39.47 $189.38 N/A N/A M001221360 SUP HCPCS C2617 M001221360 - STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 2.66MM BOTH IP/OP $246.00 $182.00 $48.75 $245.63 $110.53 $110.53 $110.53 $110.53 $245.63 $245.63 $245.63 $51.20 $245.63 $245.63 $245.63 $245.63 $245.63 $51.19 $245.63 $245.63 $145.29 $245.63 $245.63 $245.63 $245.63 $184.50 $245.63 $245.63 $245.63 $122.82 $122.82 $194.54 $245.63 $196.50 $110.53 $48.75 N/A $142.68 $245.63 $245.63 $245.63 $51.19 $245.63 N/A N/A M001221370 SUP HCPCS C2617 M001221370 - STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 2.66MM BOTH IP/OP $246.00 $182.00 $48.75 $245.63 $110.53 $110.53 $110.53 $110.53 $245.63 $245.63 $245.63 $51.20 $245.63 $245.63 $245.63 $245.63 $245.63 $51.19 $245.63 $245.63 $145.29 $245.63 $245.63 $245.63 $245.63 $184.50 $245.63 $245.63 $245.63 $122.82 $122.82 $194.54 $245.63 $196.50 $110.53 $48.75 N/A $142.68 $245.63 $245.63 $245.63 $51.19 $245.63 N/A N/A M001221380 SUP HCPCS C2617 M001221380 - STENT NEPHROURETERAL 2.66MM 26CM STIFFENING CANNU INTERNAL BOTH IP/OP $246.00 $182.00 $48.75 $245.63 $110.53 $110.53 $110.53 $110.53 $245.63 $245.63 $245.63 $51.20 $245.63 $245.63 $245.63 $245.63 $245.63 $51.19 $245.63 $245.63 $145.29 $245.63 $245.63 $245.63 $245.63 $184.50 $245.63 $245.63 $245.63 $122.82 $122.82 $194.54 $245.63 $196.50 $110.53 $48.75 N/A $142.68 $245.63 $245.63 $245.63 $51.19 $245.63 N/A N/A M001221390 SUP HCPCS C2617 M001221390 - STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 2.66MM BOTH IP/OP $246.00 $182.00 $48.75 $245.63 $110.53 $110.53 $110.53 $110.53 $245.63 $245.63 $245.63 $51.20 $245.63 $245.63 $245.63 $245.63 $245.63 $51.19 $245.63 $245.63 $145.29 $245.63 $245.63 $245.63 $245.63 $184.50 $245.63 $245.63 $245.63 $122.82 $122.82 $194.54 $245.63 $196.50 $110.53 $48.75 N/A $142.68 $245.63 $245.63 $245.63 $51.19 $245.63 N/A N/A M001221400 SUP HCPCS C2617 M001221400 - STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM BOTH IP/OP $246.00 $182.00 $48.75 $245.63 $110.53 $110.53 $110.53 $110.53 $245.63 $245.63 $245.63 $51.20 $245.63 $245.63 $245.63 $245.63 $245.63 $51.19 $245.63 $245.63 $145.29 $245.63 $245.63 $245.63 $245.63 $184.50 $245.63 $245.63 $245.63 $122.82 $122.82 $194.54 $245.63 $196.50 $110.53 $48.75 N/A $142.68 $245.63 $245.63 $245.63 $51.19 $245.63 N/A N/A M001221410 SUP HCPCS C2617 M001221410 - STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM BOTH IP/OP $246.00 $182.00 $48.75 $245.63 $110.53 $110.53 $110.53 $110.53 $245.63 $245.63 $245.63 $51.20 $245.63 $245.63 $245.63 $245.63 $245.63 $51.19 $245.63 $245.63 $145.29 $245.63 $245.63 $245.63 $245.63 $184.50 $245.63 $245.63 $245.63 $122.82 $122.82 $194.54 $245.63 $196.50 $110.53 $48.75 N/A $142.68 $245.63 $245.63 $245.63 $51.19 $245.63 N/A N/A M001221420 SUP HCPCS C2617 M001221420 - STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM BOTH IP/OP $246.00 $182.00 $48.75 $245.63 $110.53 $110.53 $110.53 $110.53 $245.63 $245.63 $245.63 $51.20 $245.63 $245.63 $245.63 $245.63 $245.63 $51.19 $245.63 $245.63 $145.29 $245.63 $245.63 $245.63 $245.63 $184.50 $245.63 $245.63 $245.63 $122.82 $122.82 $194.54 $245.63 $196.50 $110.53 $48.75 N/A $142.68 $245.63 $245.63 $245.63 $51.19 $245.63 N/A N/A M001221430 SUP HCPCS C2617 M001221430 - STENT URETERAL LARGE REGULAR PROXIMAL PIGTAIL CURVE 3.33MM BOTH IP/OP $246.00 $182.00 $48.75 $245.63 $110.53 $110.53 $110.53 $110.53 $245.63 $245.63 $245.63 $51.20 $245.63 $245.63 $245.63 $245.63 $245.63 $51.19 $245.63 $245.63 $145.29 $245.63 $245.63 $245.63 $245.63 $184.50 $245.63 $245.63 $245.63 $122.82 $122.82 $194.54 $245.63 $196.50 $110.53 $48.75 N/A $142.68 $245.63 $245.63 $245.63 $51.19 $245.63 N/A N/A M001225140 SUP HCPCS C1729 M001225140 - SET NEPHROSTOMY PIGTAIL CURVE 8FR FIRM DUROMETER LOCK VTC BOTH IP/OP $176.50 $131.00 $34.98 $176.25 $95.70 $95.70 $95.70 $95.70 $176.25 $176.25 $176.25 $36.73 $176.25 $130.81 $130.81 $135.85 $91.83 $36.73 $176.25 $176.25 $104.25 $176.25 $176.25 $176.25 $176.25 $132.38 $176.25 $176.25 $176.25 $88.13 $88.13 $139.59 $176.25 $141.00 $114.56 $34.98 N/A $102.37 $176.25 $176.25 $176.25 $36.73 $176.25 N/A N/A M001225510 SUP HCPCS C2617 M001225510 - STENT URET .038IN LG REG PGTL CRV 8FR 24CM DRMTR RADOPQ DRN BOTH IP/OP $313.50 $232.00 $62.22 $313.50 $141.08 $141.08 $141.08 $141.08 $313.50 $313.50 $313.50 $65.34 $313.50 $313.50 $313.50 $313.50 $313.50 $65.34 $313.50 $313.50 $185.44 $313.50 $313.50 $313.50 $313.50 $235.13 $313.50 $313.50 $313.50 $156.75 $156.75 $248.29 $313.50 $250.80 $141.08 $62.22 N/A $181.83 $313.50 $313.50 $313.50 $65.33 $313.50 N/A N/A M001262160 SUP Custom 27203010 M001262160 - NEEDLE ELECTROSURGICAL STANDARD UMBRELLA 5CM 15CM ARRAY TIP BOTH IP/OP "$5,362.50" "$3,968.00" $954.53 "$5,362.50" "$5,362.50" "$5,362.50" "$5,362.50" "$5,362.50" "$5,362.50" "$5,362.50" $954.53 "$5,362.50" "$5,362.50" "$3,980.05" "$3,980.05" "$4,133.42" "$2,060.15" "$1,117.60" "$5,362.50" "$2,145.00" "$5,362.50" "$5,362.50" "$5,362.50" "$5,362.50" "$5,362.50" "$4,021.88" "$5,362.50" "$5,362.50" "$5,362.50" "$2,681.25" "$2,681.25" "$4,247.10" "$5,362.50" "$4,290.00" "$3,485.63" "$5,362.50" N/A "$3,110.25" "$5,362.50" "$3,217.50" "$5,362.50" "$5,362.50" "$5,362.50" N/A N/A M001271460 SUP HCPCS C1729 M001271460 - CATHETER DRAIN LOOP 8FR 25CM QUICKSTICK FLEXIMA HYDPHI BOTH IP/OP $170.50 $126.00 $33.78 $170.18 $92.41 $92.41 $92.41 $92.41 $170.18 $170.18 $170.18 $35.47 $170.18 $126.31 $126.31 $131.17 $88.66 $35.47 $170.18 $170.18 $100.66 $170.18 $170.18 $170.18 $170.18 $127.88 $170.18 $170.18 $170.18 $85.09 $85.09 $134.78 $170.18 $136.14 $110.62 $33.78 N/A $98.89 $170.18 $170.18 $170.18 $35.47 $170.18 N/A N/A M001271470 SUP HCPCS C1729 M001271470 - CATHETER DRAIN LOOP 10FR 25CM QUICKSTICK FLEXIMA HYDPHI BOTH IP/OP $170.50 $126.00 $33.78 $170.18 $92.41 $92.41 $92.41 $92.41 $170.18 $170.18 $170.18 $35.47 $170.18 $126.31 $126.31 $131.17 $88.66 $35.47 $170.18 $170.18 $100.66 $170.18 $170.18 $170.18 $170.18 $127.88 $170.18 $170.18 $170.18 $85.09 $85.09 $134.78 $170.18 $136.14 $110.62 $33.78 N/A $98.89 $170.18 $170.18 $170.18 $35.47 $170.18 N/A N/A M001271540 SUP HCPCS C1729 M001271540 - CATHETER DRAIN PIGTAIL CURVE 8FR 35CM FLEXIBLE STIFF CANNU BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271550 SUP HCPCS C1729 M001271550 - CATHETER DRAIN 10FR 35CM METAL AND FLEXIBLE STIFFENING CANNU BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271560 SUP HCPCS C1729 M001271560 - CATHETER DRAIN PIGTAIL CURVE 8FR 35CM FLEXIBLE STIFF CANNU BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271570 SUP HCPCS C1729 M001271570 - CATHETER DRAIN PIGTAIL CURVE 10FR 35CM FLEXIBLE STIFF CANNU BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271580 SUP HCPCS C1729 M001271580 - CATHETER DRAIN PIGTAIL CURVE 12FR 35CM FLEXIBLE STIFF CANNU BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271590 SUP HCPCS C1729 M001271590 - CATHETER DRAIN PIGTAIL CURVE 14FR 35CM FLEXIBLE STIFF CANNU BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271600 SUP HCPCS C1729 M001271600 - CATHETER DRAIN PIGTAIL CURVE 10FR 35CM FLEXIBLE STIFF CANNU BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271610 SUP HCPCS C1729 M001271610 - CATHETER DRN PGTL CRV 12FR 35CM FLXB STF CNN LCK DRMTR SFT BOTH IP/OP $235.50 $174.00 $46.69 $235.25 $127.74 $127.74 $127.74 $127.74 $235.25 $235.25 $235.25 $49.03 $235.25 $174.60 $174.60 $181.33 $122.57 $49.03 $235.25 $235.25 $139.15 $235.25 $235.25 $235.25 $235.25 $176.63 $235.25 $235.25 $235.25 $117.63 $117.63 $186.32 $235.25 $188.20 $152.91 $46.69 N/A $136.59 $235.25 $235.25 $235.25 $49.03 $235.25 N/A N/A M001271620 SUP HCPCS C1729 M001271620 - CATHETER DRAIN PIGTAIL CURVE 14FR 35CM FLEXIBLE STIFF CANNU BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271630 SUP HCPCS C1729 M001271630 - KIT DRAIN 8FR 35CM FIRM DUROMETER LARGE HOLE FLEXIMA BOTH IP/OP $344.00 $255.00 $68.28 $344.00 $186.79 $186.79 $186.79 $186.79 $344.00 $344.00 $344.00 $71.70 $344.00 $255.32 $255.32 $265.16 $179.22 $71.69 $344.00 $344.00 $203.48 $344.00 $344.00 $344.00 $344.00 $258.00 $344.00 $344.00 $344.00 $172.00 $172.00 $272.45 $344.00 $275.20 $223.60 $68.28 N/A $199.52 $344.00 $344.00 $344.00 $71.69 $344.00 N/A N/A M001271640 SUP HCPCS C1729 M001271640 - KIT DRAIN 10FR 35CM FIRM DUROMETER LARGE HOLE FLEXIMA BOTH IP/OP $344.00 $255.00 $68.28 $344.00 $186.79 $186.79 $186.79 $186.79 $344.00 $344.00 $344.00 $71.70 $344.00 $255.32 $255.32 $265.16 $179.22 $71.69 $344.00 $344.00 $203.48 $344.00 $344.00 $344.00 $344.00 $258.00 $344.00 $344.00 $344.00 $172.00 $172.00 $272.45 $344.00 $275.20 $223.60 $68.28 N/A $199.52 $344.00 $344.00 $344.00 $71.69 $344.00 N/A N/A M001271650 SUP HCPCS C1729 M001271650 - CATHETER DRAIN REGULAR PIGTAIL CURVE 8FR 35CM KIT LOCK BOTH IP/OP $344.00 $255.00 $68.28 $344.00 $186.79 $186.79 $186.79 $186.79 $344.00 $344.00 $344.00 $71.70 $344.00 $255.32 $255.32 $265.16 $179.22 $71.69 $344.00 $344.00 $203.48 $344.00 $344.00 $344.00 $344.00 $258.00 $344.00 $344.00 $344.00 $172.00 $172.00 $272.45 $344.00 $275.20 $223.60 $68.28 N/A $199.52 $344.00 $344.00 $344.00 $71.69 $344.00 N/A N/A M001271660 SUP HCPCS C1729 M001271660 - KIT DRAIN REGULAR 10FR 35CM DUROMETER LARGE HOLE FLEXIMA BOTH IP/OP $344.00 $255.00 $68.28 $344.00 $186.79 $186.79 $186.79 $186.79 $344.00 $344.00 $344.00 $71.70 $344.00 $255.32 $255.32 $265.16 $179.22 $71.69 $344.00 $344.00 $203.48 $344.00 $344.00 $344.00 $344.00 $258.00 $344.00 $344.00 $344.00 $172.00 $172.00 $272.45 $344.00 $275.20 $223.60 $68.28 N/A $199.52 $344.00 $344.00 $344.00 $71.69 $344.00 N/A N/A M001271770 SUP HCPCS C1729 M001271770 - CATHETER NEPHROSTOMY PIGTAIL CURVE 8FR 25CM LOCK DUROMETER BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271780 SUP HCPCS C1729 M001271780 - CATHETER NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK DUROMETER BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271790 SUP HCPCS C1729 M001271790 - CATHETER NEPHROSTOMY REGULAR PIGTAIL CURVE 8FR 25CM LOCK BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271800 SUP HCPCS C1729 M001271800 - CATHETER NEPHROSTOMY REGULAR PIGTAIL CURVE 10FR 25CM LOCK BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271810 SUP HCPCS C1729 M001271810 - CATHETER NEPHROSTOMY PIGTAIL CURVE 12FR 25CM LOCK DUROMETER BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271820 SUP Custom 27203010 M001271820 - CATHETER NEPHROSTOMY PIGTAIL CURVE 14FR 25CM LOCK DUROMETER BOTH IP/OP $190.50 $141.00 $33.87 $190.30 $190.30 $190.30 $190.30 $190.30 $190.30 $190.30 $33.87 $190.30 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $76.12 $190.30 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $190.30 N/A $110.49 $190.30 $114.18 $190.30 $190.30 $190.30 N/A N/A M001271830 SUP HCPCS C1726 M001271830 - CATHETER NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK DUROMETER BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271840 SUP HCPCS C1729 M001271840 - CATHETER DRAIN 12FR 25CM RADIOPQ SOFT DUROMETER TEMP TIP BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271850 SUP HCPCS C1729 M001271850 - CATHETER NPHSTM PGTL CRV 14FR 25CM LCK SFT DRMTR FLXM PU BOTH IP/OP $190.50 $141.00 $37.77 $190.30 $103.33 $103.33 $103.33 $103.33 $190.30 $190.30 $190.30 $39.66 $190.30 $141.24 $141.24 $146.68 $99.15 $39.66 $190.30 $190.30 $112.56 $190.30 $190.30 $190.30 $190.30 $142.88 $190.30 $190.30 $190.30 $95.15 $95.15 $150.72 $190.30 $152.24 $123.70 $37.77 N/A $110.49 $190.30 $190.30 $190.30 $39.66 $190.30 N/A N/A M001271860 SUP Custom 27203010 M001271860 - SET NEPHROSTOMY PIGTAIL CURVE 8FR 25CM LOCK REGULAR BOTH IP/OP $344.00 $255.00 $61.23 $344.00 $344.00 $344.00 $344.00 $344.00 $344.00 $344.00 $61.23 $344.00 $344.00 $255.32 $255.32 $265.16 $179.22 $71.69 $344.00 $137.60 $344.00 $344.00 $344.00 $344.00 $344.00 $258.00 $344.00 $344.00 $344.00 $172.00 $172.00 $272.45 $344.00 $275.20 $223.60 $344.00 N/A $199.52 $344.00 $206.40 $344.00 $344.00 $344.00 N/A N/A M001271870 SUP Custom 27203010 M001271870 - KIT NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK REGULAR BOTH IP/OP $344.00 $255.00 $61.23 $344.00 $344.00 $344.00 $344.00 $344.00 $344.00 $344.00 $61.23 $344.00 $344.00 $255.32 $255.32 $265.16 $179.22 $71.69 $344.00 $137.60 $344.00 $344.00 $344.00 $344.00 $344.00 $258.00 $344.00 $344.00 $344.00 $172.00 $172.00 $272.45 $344.00 $275.20 $223.60 $344.00 N/A $199.52 $344.00 $206.40 $344.00 $344.00 $344.00 N/A N/A M001271880 SUP Custom 27203010 M001271880 - KIT NEPHROSTOMY PIGTAIL CURVE 12FR 25CM LOCK REGULAR BOTH IP/OP $344.00 $255.00 $61.23 $344.00 $344.00 $344.00 $344.00 $344.00 $344.00 $344.00 $61.23 $344.00 $344.00 $255.32 $255.32 $265.16 $179.22 $71.69 $344.00 $137.60 $344.00 $344.00 $344.00 $344.00 $344.00 $258.00 $344.00 $344.00 $344.00 $172.00 $172.00 $272.45 $344.00 $275.20 $223.60 $344.00 N/A $199.52 $344.00 $206.40 $344.00 $344.00 $344.00 N/A N/A M001271900 SUP Custom 27203010 M001271900 - KIT NEPHROSTOMY J PIGTAIL CURVE 18FR 21GA 25CM DUROMETER BOTH IP/OP $344.00 $255.00 $61.23 $344.00 $344.00 $344.00 $344.00 $344.00 $344.00 $344.00 $61.23 $344.00 $344.00 $255.32 $255.32 $265.16 $179.22 $71.69 $344.00 $137.60 $344.00 $344.00 $344.00 $344.00 $344.00 $258.00 $344.00 $344.00 $344.00 $172.00 $172.00 $272.45 $344.00 $275.20 $223.60 $344.00 N/A $199.52 $344.00 $206.40 $344.00 $344.00 $344.00 N/A N/A M001272600 SUP HCPCS C1729 M001272600 - CATHETER DRAIN REGULAR 8FR 35CM RADIOPQ FLEXIMA BILIARY BOTH IP/OP $201.00 $149.00 $39.82 $200.63 $108.94 $108.94 $108.94 $108.94 $200.63 $200.63 $200.63 $41.82 $200.63 $148.91 $148.91 $154.65 $104.53 $41.81 $200.63 $200.63 $118.67 $200.63 $200.63 $200.63 $200.63 $150.75 $200.63 $200.63 $200.63 $100.32 $100.32 $158.90 $200.63 $160.50 $130.41 $39.82 N/A $116.58 $200.63 $200.63 $200.63 $41.81 $200.63 N/A N/A M001272610 SUP HCPCS C1729 M001272610 - CATHETER DRAIN 10FR 35CM RADIOPQ MARKER REGULAR DUROMETER BOTH IP/OP $201.00 $149.00 $39.82 $200.63 $108.94 $108.94 $108.94 $108.94 $200.63 $200.63 $200.63 $41.82 $200.63 $148.91 $148.91 $154.65 $104.53 $41.81 $200.63 $200.63 $118.67 $200.63 $200.63 $200.63 $200.63 $150.75 $200.63 $200.63 $200.63 $100.32 $100.32 $158.90 $200.63 $160.50 $130.41 $39.82 N/A $116.58 $200.63 $200.63 $200.63 $41.81 $200.63 N/A N/A M001272620 SUP HCPCS C1729 M001272620 - CATHETER DRAIN 12FR 35CM RADIOPQ MARKER REGULAR DUROMETER BOTH IP/OP $201.00 $149.00 $39.82 $200.63 $108.94 $108.94 $108.94 $108.94 $200.63 $200.63 $200.63 $41.82 $200.63 $148.91 $148.91 $154.65 $104.53 $41.81 $200.63 $200.63 $118.67 $200.63 $200.63 $200.63 $200.63 $150.75 $200.63 $200.63 $200.63 $100.32 $100.32 $158.90 $200.63 $160.50 $130.41 $39.82 N/A $116.58 $200.63 $200.63 $200.63 $41.81 $200.63 N/A N/A M001272630 SUP HCPCS C1729 M001272630 - CATHETER DRAIN 14FR 35CM RADIOPQ REGULAR DUROMETER LATEX BOTH IP/OP $201.00 $149.00 $39.82 $200.63 $108.94 $108.94 $108.94 $108.94 $200.63 $200.63 $200.63 $41.82 $200.63 $148.91 $148.91 $154.65 $104.53 $41.81 $200.63 $200.63 $118.67 $200.63 $200.63 $200.63 $200.63 $150.75 $200.63 $200.63 $200.63 $100.32 $100.32 $158.90 $200.63 $160.50 $130.41 $39.82 N/A $116.58 $200.63 $200.63 $200.63 $41.81 $200.63 N/A N/A M001272640 SUP HCPCS C1729 M001272640 - CATHETER DRAIN 8FR 35CM RADIOPQ FIRM DUROMETER FLEXIBLE BOTH IP/OP $201.00 $149.00 $39.82 $200.63 $108.94 $108.94 $108.94 $108.94 $200.63 $200.63 $200.63 $41.82 $200.63 $148.91 $148.91 $154.65 $104.53 $41.81 $200.63 $200.63 $118.67 $200.63 $200.63 $200.63 $200.63 $150.75 $200.63 $200.63 $200.63 $100.32 $100.32 $158.90 $200.63 $160.50 $130.41 $39.82 N/A $116.58 $200.63 $200.63 $200.63 $41.81 $200.63 N/A N/A M001272650 SUP HCPCS C1729 M001272650 - CATHETER DRAIN 10FR 35CM RADIOPQ REGULAR DUROMETER LATEX BOTH IP/OP $201.00 $149.00 $39.82 $200.63 $108.94 $108.94 $108.94 $108.94 $200.63 $200.63 $200.63 $41.82 $200.63 $148.91 $148.91 $154.65 $104.53 $41.81 $200.63 $200.63 $118.67 $200.63 $200.63 $200.63 $200.63 $150.75 $200.63 $200.63 $200.63 $100.32 $100.32 $158.90 $200.63 $160.50 $130.41 $39.82 N/A $116.58 $200.63 $200.63 $200.63 $41.81 $200.63 N/A N/A M001272660 SUP HCPCS C1729 M001272660 - CATHETER DRAIN 10FR 35CM RADIOPQ SOFT DUROMETER LATEX FREE BOTH IP/OP $201.00 $149.00 $39.82 $200.63 $108.94 $108.94 $108.94 $108.94 $200.63 $200.63 $200.63 $41.82 $200.63 $148.91 $148.91 $154.65 $104.53 $41.81 $200.63 $200.63 $118.67 $200.63 $200.63 $200.63 $200.63 $150.75 $200.63 $200.63 $200.63 $100.32 $100.32 $158.90 $200.63 $160.50 $130.41 $39.82 N/A $116.58 $200.63 $200.63 $200.63 $41.81 $200.63 N/A N/A M001272670 SUP HCPCS C1729 M001272670 - CATHETER DRAIN 12FR 35CM RADIOPQ SOFT DUROMETER LATEX FREE BOTH IP/OP $201.00 $149.00 $39.82 $200.63 $108.94 $108.94 $108.94 $108.94 $200.63 $200.63 $200.63 $41.82 $200.63 $148.91 $148.91 $154.65 $104.53 $41.81 $200.63 $200.63 $118.67 $200.63 $200.63 $200.63 $200.63 $150.75 $200.63 $200.63 $200.63 $100.32 $100.32 $158.90 $200.63 $160.50 $130.41 $39.82 N/A $116.58 $200.63 $200.63 $200.63 $41.81 $200.63 N/A N/A M001273130 SUP HCPCS C1729 M001273130 - CATHETER DRAIN 14FR 30CM 2 LUMEN REGULAR DUROMETER BOTH IP/OP $364.50 $270.00 $72.29 $364.25 $197.79 $197.79 $197.79 $197.79 $364.25 $364.25 $364.25 $75.92 $364.25 $270.35 $270.35 $280.76 $189.77 $75.91 $364.25 $364.25 $215.45 $364.25 $364.25 $364.25 $364.25 $273.38 $364.25 $364.25 $364.25 $182.13 $182.13 $288.49 $364.25 $291.40 $236.76 $72.29 N/A $211.41 $364.25 $364.25 $364.25 $75.91 $364.25 N/A N/A M001274000 SUP HCPCS C2617 M001274000 - STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 20CM BOTH IP/OP $266.50 $197.00 $52.84 $266.25 $119.81 $119.81 $119.81 $119.81 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $157.49 $266.25 $266.25 $266.25 $266.25 $199.88 $266.25 $266.25 $266.25 $133.13 $133.13 $210.87 $266.25 $213.00 $119.81 $52.84 N/A $154.57 $266.25 $266.25 $266.25 $55.49 $266.25 N/A N/A M001274010 SUP HCPCS C2617 M001274010 - STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 22CM BOTH IP/OP $266.50 $197.00 $52.84 $266.25 $119.81 $119.81 $119.81 $119.81 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $157.49 $266.25 $266.25 $266.25 $266.25 $199.88 $266.25 $266.25 $266.25 $133.13 $133.13 $210.87 $266.25 $213.00 $119.81 $52.84 N/A $154.57 $266.25 $266.25 $266.25 $55.49 $266.25 N/A N/A M001274020 SUP HCPCS C2617 M001274020 - STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 24CM BOTH IP/OP $266.50 $197.00 $52.84 $266.25 $119.81 $119.81 $119.81 $119.81 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $157.49 $266.25 $266.25 $266.25 $266.25 $199.88 $266.25 $266.25 $266.25 $133.13 $133.13 $210.87 $266.25 $213.00 $119.81 $52.84 N/A $154.57 $266.25 $266.25 $266.25 $55.49 $266.25 N/A N/A M001274030 SUP HCPCS C2617 M001274030 - STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 26CM BOTH IP/OP $266.50 $197.00 $52.84 $266.25 $119.81 $119.81 $119.81 $119.81 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $157.49 $266.25 $266.25 $266.25 $266.25 $199.88 $266.25 $266.25 $266.25 $133.13 $133.13 $210.87 $266.25 $213.00 $119.81 $52.84 N/A $154.57 $266.25 $266.25 $266.25 $55.49 $266.25 N/A N/A M001274040 SUP HCPCS C2617 M001274040 - STENT URETERAL LARGE REGULAR PIGTAIL CURVE 2.66MM 28CM BOTH IP/OP $266.50 $197.00 $52.84 $266.25 $119.81 $119.81 $119.81 $119.81 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $157.49 $266.25 $266.25 $266.25 $266.25 $199.88 $266.25 $266.25 $266.25 $133.13 $133.13 $210.87 $266.25 $213.00 $119.81 $52.84 N/A $154.57 $266.25 $266.25 $266.25 $55.49 $266.25 N/A N/A M001274050 SUP HCPCS C2617 M001274050 - STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 20CM BOTH IP/OP $266.50 $197.00 $52.84 $266.25 $119.81 $119.81 $119.81 $119.81 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $157.49 $266.25 $266.25 $266.25 $266.25 $199.88 $266.25 $266.25 $266.25 $133.13 $133.13 $210.87 $266.25 $213.00 $119.81 $52.84 N/A $154.57 $266.25 $266.25 $266.25 $55.49 $266.25 N/A N/A M001274060 SUP HCPCS C2617 M001274060 - STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 22CM BOTH IP/OP $266.50 $197.00 $52.84 $266.25 $119.81 $119.81 $119.81 $119.81 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $157.49 $266.25 $266.25 $266.25 $266.25 $199.88 $266.25 $266.25 $266.25 $133.13 $133.13 $210.87 $266.25 $213.00 $119.81 $52.84 N/A $154.57 $266.25 $266.25 $266.25 $55.49 $266.25 N/A N/A M001274070 SUP HCPCS C2617 M001274070 - STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 24CM BOTH IP/OP $266.50 $197.00 $52.84 $266.25 $119.81 $119.81 $119.81 $119.81 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $157.49 $266.25 $266.25 $266.25 $266.25 $199.88 $266.25 $266.25 $266.25 $133.13 $133.13 $210.87 $266.25 $213.00 $119.81 $52.84 N/A $154.57 $266.25 $266.25 $266.25 $55.49 $266.25 N/A N/A M001274080 SUP HCPCS C2617 M001274080 - STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 26CM BOTH IP/OP $266.50 $197.00 $52.84 $266.25 $119.81 $119.81 $119.81 $119.81 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $157.49 $266.25 $266.25 $266.25 $266.25 $199.88 $266.25 $266.25 $266.25 $133.13 $133.13 $210.87 $266.25 $213.00 $119.81 $52.84 N/A $154.57 $266.25 $266.25 $266.25 $55.49 $266.25 N/A N/A M001274090 SUP HCPCS C2617 M001274090 - STENT URETERAL LARGE REGULAR PIGTAIL CURVE 3.33MM 28CM BOTH IP/OP $266.50 $197.00 $52.84 $266.25 $119.81 $119.81 $119.81 $119.81 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $266.25 $266.25 $266.25 $55.49 $266.25 $266.25 $157.49 $266.25 $266.25 $266.25 $266.25 $199.88 $266.25 $266.25 $266.25 $133.13 $133.13 $210.87 $266.25 $213.00 $119.81 $52.84 N/A $154.57 $266.25 $266.25 $266.25 $55.49 $266.25 N/A N/A M001274110 SUP HCPCS C2617 M001274110 - KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 22CM DRAIN BOTH IP/OP $424.00 $314.00 $84.10 $423.75 $190.69 $190.69 $190.69 $190.69 $423.75 $423.75 $423.75 $88.32 $423.75 $423.75 $423.75 $423.75 $423.75 $88.31 $423.75 $423.75 $250.65 $423.75 $423.75 $423.75 $423.75 $318.00 $423.75 $423.75 $423.75 $211.88 $211.88 $335.61 $423.75 $339.00 $190.69 $84.10 N/A $245.92 $423.75 $423.75 $423.75 $88.31 $423.75 N/A N/A M001274120 SUP HCPCS C2617 M001274120 - KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 24CM DRAIN BOTH IP/OP $424.00 $314.00 $84.10 $423.75 $190.69 $190.69 $190.69 $190.69 $423.75 $423.75 $423.75 $88.32 $423.75 $423.75 $423.75 $423.75 $423.75 $88.31 $423.75 $423.75 $250.65 $423.75 $423.75 $423.75 $423.75 $318.00 $423.75 $423.75 $423.75 $211.88 $211.88 $335.61 $423.75 $339.00 $190.69 $84.10 N/A $245.92 $423.75 $423.75 $423.75 $88.31 $423.75 N/A N/A M001274130 SUP HCPCS C2617 M001274130 - KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 26CM DRAIN BOTH IP/OP $424.00 $314.00 $84.10 $423.75 $190.69 $190.69 $190.69 $190.69 $423.75 $423.75 $423.75 $88.32 $423.75 $423.75 $423.75 $423.75 $423.75 $88.31 $423.75 $423.75 $250.65 $423.75 $423.75 $423.75 $423.75 $318.00 $423.75 $423.75 $423.75 $211.88 $211.88 $335.61 $423.75 $339.00 $190.69 $84.10 N/A $245.92 $423.75 $423.75 $423.75 $88.31 $423.75 N/A N/A M001274140 SUP HCPCS C2617 M001274140 - KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 6FR 28CM DRAIN BOTH IP/OP $424.00 $314.00 $84.10 $423.75 $190.69 $190.69 $190.69 $190.69 $423.75 $423.75 $423.75 $88.32 $423.75 $423.75 $423.75 $423.75 $423.75 $88.31 $423.75 $423.75 $250.65 $423.75 $423.75 $423.75 $423.75 $318.00 $423.75 $423.75 $423.75 $211.88 $211.88 $335.61 $423.75 $339.00 $190.69 $84.10 N/A $245.92 $423.75 $423.75 $423.75 $88.31 $423.75 N/A N/A M001274150 SUP HCPCS C2617 M001274150 - KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 20CM DRAIN BOTH IP/OP $424.00 $314.00 $84.10 $423.75 $190.69 $190.69 $190.69 $190.69 $423.75 $423.75 $423.75 $88.32 $423.75 $423.75 $423.75 $423.75 $423.75 $88.31 $423.75 $423.75 $250.65 $423.75 $423.75 $423.75 $423.75 $318.00 $423.75 $423.75 $423.75 $211.88 $211.88 $335.61 $423.75 $339.00 $190.69 $84.10 N/A $245.92 $423.75 $423.75 $423.75 $88.31 $423.75 N/A N/A M001274160 SUP HCPCS C2617 M001274160 - KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 22CM DRAIN BOTH IP/OP $424.00 $314.00 $84.10 $423.75 $190.69 $190.69 $190.69 $190.69 $423.75 $423.75 $423.75 $88.32 $423.75 $423.75 $423.75 $423.75 $423.75 $88.31 $423.75 $423.75 $250.65 $423.75 $423.75 $423.75 $423.75 $318.00 $423.75 $423.75 $423.75 $211.88 $211.88 $335.61 $423.75 $339.00 $190.69 $84.10 N/A $245.92 $423.75 $423.75 $423.75 $88.31 $423.75 N/A N/A M001274170 SUP HCPCS C2617 M001274170 - KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 24CM DRAIN BOTH IP/OP $424.00 $314.00 $84.10 $423.75 $190.69 $190.69 $190.69 $190.69 $423.75 $423.75 $423.75 $88.32 $423.75 $423.75 $423.75 $423.75 $423.75 $88.31 $423.75 $423.75 $250.65 $423.75 $423.75 $423.75 $423.75 $318.00 $423.75 $423.75 $423.75 $211.88 $211.88 $335.61 $423.75 $339.00 $190.69 $84.10 N/A $245.92 $423.75 $423.75 $423.75 $88.31 $423.75 N/A N/A M001274180 SUP HCPCS C2617 M001274180 - KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 26CM DRAIN BOTH IP/OP $424.00 $314.00 $84.10 $423.75 $190.69 $190.69 $190.69 $190.69 $423.75 $423.75 $423.75 $88.32 $423.75 $423.75 $423.75 $423.75 $423.75 $88.31 $423.75 $423.75 $250.65 $423.75 $423.75 $423.75 $423.75 $318.00 $423.75 $423.75 $423.75 $211.88 $211.88 $335.61 $423.75 $339.00 $190.69 $84.10 N/A $245.92 $423.75 $423.75 $423.75 $88.31 $423.75 N/A N/A M001274190 SUP HCPCS C2617 M001274190 - KIT STENT .038IN LARGE REGULAR PIGTAIL CURVE 8FR 28CM DRAIN BOTH IP/OP $424.00 $314.00 $84.10 $423.75 $190.69 $190.69 $190.69 $190.69 $423.75 $423.75 $423.75 $88.32 $423.75 $423.75 $423.75 $423.75 $423.75 $88.31 $423.75 $423.75 $250.65 $423.75 $423.75 $423.75 $423.75 $318.00 $423.75 $423.75 $423.75 $211.88 $211.88 $335.61 $423.75 $339.00 $190.69 $84.10 N/A $245.92 $423.75 $423.75 $423.75 $88.31 $423.75 N/A N/A M001281560 SUP HCPCS C1729 M001281560 - CATHETER DRAIN 8FR 35CM 1 LUMEN REGULAR DUROMETER FLEXIBLE BOTH IP/OP $198.00 $147.00 $39.22 $197.63 $107.31 $107.31 $107.31 $107.31 $197.63 $197.63 $197.63 $41.19 $197.63 $146.68 $146.68 $152.33 $102.97 $41.19 $197.63 $197.63 $116.90 $197.63 $197.63 $197.63 $197.63 $148.50 $197.63 $197.63 $197.63 $98.82 $98.82 $156.52 $197.63 $158.10 $128.46 $39.22 N/A $114.84 $197.63 $197.63 $197.63 $41.19 $197.63 N/A N/A M001281570 SUP HCPCS C1729 M001281570 - CATHETER DRAIN 10FR 35CM REGULAR DUROMETER DISSOLVABLE TIP BOTH IP/OP $198.00 $147.00 $39.22 $197.63 $107.31 $107.31 $107.31 $107.31 $197.63 $197.63 $197.63 $41.19 $197.63 $146.68 $146.68 $152.33 $102.97 $41.19 $197.63 $197.63 $116.90 $197.63 $197.63 $197.63 $197.63 $148.50 $197.63 $197.63 $197.63 $98.82 $98.82 $156.52 $197.63 $158.10 $128.46 $39.22 N/A $114.84 $197.63 $197.63 $197.63 $41.19 $197.63 N/A N/A M001281580 SUP HCPCS C1729 M001281580 - CATHETER DRAIN REGULAR 12FR 35CM TEMP TIP FLEXIMA HYDPHI BOTH IP/OP $198.00 $147.00 $39.22 $197.63 $107.31 $107.31 $107.31 $107.31 $197.63 $197.63 $197.63 $41.19 $197.63 $146.68 $146.68 $152.33 $102.97 $41.19 $197.63 $197.63 $116.90 $197.63 $197.63 $197.63 $197.63 $148.50 $197.63 $197.63 $197.63 $98.82 $98.82 $156.52 $197.63 $158.10 $128.46 $39.22 N/A $114.84 $197.63 $197.63 $197.63 $41.19 $197.63 N/A N/A M001281590 SUP HCPCS C1729 M001281590 - CATHETER DRAIN 14FR 35CM REGULAR DUROMETER DISSOLVABLE TIP BOTH IP/OP $198.00 $147.00 $39.22 $197.63 $107.31 $107.31 $107.31 $107.31 $197.63 $197.63 $197.63 $41.19 $197.63 $146.68 $146.68 $152.33 $102.97 $41.19 $197.63 $197.63 $116.90 $197.63 $197.63 $197.63 $197.63 $148.50 $197.63 $197.63 $197.63 $98.82 $98.82 $156.52 $197.63 $158.10 $128.46 $39.22 N/A $114.84 $197.63 $197.63 $197.63 $41.19 $197.63 N/A N/A M001281660 SUP Custom 27203010 M001281660 - KIT NEPHROSTOMY .018IN PIGTAIL CURVE FLOPPY 10FR 21GA 25CM BOTH IP/OP $364.50 $270.00 $64.82 $364.13 $364.13 $364.13 $364.13 $364.13 $364.13 $364.13 $64.82 $364.13 $364.13 $270.26 $270.26 $280.67 $189.71 $75.89 $364.13 $145.65 $364.13 $364.13 $364.13 $364.13 $364.13 $273.38 $364.13 $364.13 $364.13 $182.07 $182.07 $288.39 $364.13 $291.30 $236.68 $364.13 N/A $211.41 $364.13 $218.48 $364.13 $364.13 $364.13 N/A N/A M001281790 SUP HCPCS C1726 M001281790 - CATHETER NEPHROSTOMY PIGTAIL CURVE 8FR 25CM LOCK REGULAR BOTH IP/OP $198.00 $147.00 $39.22 $197.63 $107.31 $107.31 $107.31 $107.31 $197.63 $197.63 $197.63 $41.19 $197.63 $146.68 $146.68 $152.33 $102.97 $41.19 $197.63 $197.63 $116.90 $197.63 $197.63 $197.63 $197.63 $148.50 $197.63 $197.63 $197.63 $98.82 $98.82 $156.52 $197.63 $158.10 $128.46 $39.22 N/A $114.84 $197.63 $197.63 $197.63 $41.19 $197.63 N/A N/A M001281800 SUP HCPCS C1729 M001281800 - CATHETER NEPHROSTOMY PIGTAIL CURVE 10FR 25CM LOCK SOFT BOTH IP/OP $198.00 $147.00 $39.22 $197.63 $107.31 $107.31 $107.31 $107.31 $197.63 $197.63 $197.63 $41.19 $197.63 $146.68 $146.68 $152.33 $102.97 $41.19 $197.63 $197.63 $116.90 $197.63 $197.63 $197.63 $197.63 $148.50 $197.63 $197.63 $197.63 $98.82 $98.82 $156.52 $197.63 $158.10 $128.46 $39.22 N/A $114.84 $197.63 $197.63 $197.63 $41.19 $197.63 N/A N/A M001281810 SUP Custom 27203010 M001281810 - CATHETER NEPHROSTOMY 12FR 25CM REGULAR DUROMETER DRAIN HOLE BOTH IP/OP $198.00 $147.00 $35.18 $197.63 $197.63 $197.63 $197.63 $197.63 $197.63 $197.63 $35.18 $197.63 $197.63 $146.68 $146.68 $152.33 $102.97 $41.19 $197.63 $79.05 $197.63 $197.63 $197.63 $197.63 $197.63 $148.50 $197.63 $197.63 $197.63 $98.82 $98.82 $156.52 $197.63 $158.10 $128.46 $197.63 N/A $114.84 $197.63 $118.58 $197.63 $197.63 $197.63 N/A N/A M001281820 SUP Custom 27203010 M001281820 - CATHETER NEPHROSTOMY PIGTAIL CURVE 14FR 25CM LOCK REGULAR BOTH IP/OP $198.00 $147.00 $35.18 $197.63 $197.63 $197.63 $197.63 $197.63 $197.63 $197.63 $35.18 $197.63 $197.63 $146.68 $146.68 $152.33 $102.97 $41.19 $197.63 $79.05 $197.63 $197.63 $197.63 $197.63 $197.63 $148.50 $197.63 $197.63 $197.63 $98.82 $98.82 $156.52 $197.63 $158.10 $128.46 $197.63 N/A $114.84 $197.63 $118.58 $197.63 $197.63 $197.63 N/A N/A M001282600 SUP HCPCS C1729 M001282600 - CATHETER DRAIN 8FR 35CM RADIOPQ TEMPTIP HYDPHI BILIARY BOTH IP/OP $201.00 $149.00 $39.82 $200.63 $108.94 $108.94 $108.94 $108.94 $200.63 $200.63 $200.63 $41.82 $200.63 $148.91 $148.91 $154.65 $104.53 $41.81 $200.63 $200.63 $118.67 $200.63 $200.63 $200.63 $200.63 $150.75 $200.63 $200.63 $200.63 $100.32 $100.32 $158.90 $200.63 $160.50 $130.41 $39.82 N/A $116.58 $200.63 $200.63 $200.63 $41.81 $200.63 N/A N/A M001282610 SUP HCPCS C1729 M001282610 - CATHETER DRAIN 10FR 35CM RADIOPQ TEMPTIP HYDPHI BILIARY BOTH IP/OP $201.00 $149.00 $39.82 $200.63 $108.94 $108.94 $108.94 $108.94 $200.63 $200.63 $200.63 $41.82 $200.63 $148.91 $148.91 $154.65 $104.53 $41.81 $200.63 $200.63 $118.67 $200.63 $200.63 $200.63 $200.63 $150.75 $200.63 $200.63 $200.63 $100.32 $100.32 $158.90 $200.63 $160.50 $130.41 $39.82 N/A $116.58 $200.63 $200.63 $200.63 $41.81 $200.63 N/A N/A M001291650 SUP HCPCS C1729 M001291650 - KIT DRAIN REGULAR 8FR 35CM DUROMETER FLEXIMA POLYURETHANE BOTH IP/OP $403.00 $298.00 $79.96 $402.85 $218.75 $218.75 $218.75 $218.75 $402.85 $402.85 $402.85 $83.96 $402.85 $299.00 $299.00 $310.52 $209.88 $83.96 $402.85 $402.85 $238.29 $402.85 $402.85 $402.85 $402.85 $302.25 $402.85 $402.85 $402.85 $201.43 $201.43 $319.06 $402.85 $322.28 $261.85 $79.96 N/A $233.74 $402.85 $402.85 $402.85 $83.95 $402.85 N/A N/A M0013120021 SUP Custom 27803010 M0013120021 - COIL EMBOLIZATION .018IN HELIX STR 2MM PLATINUM FIBER BOTH IP/OP $136.50 $101.00 $24.30 $136.50 $136.50 $136.50 $136.50 $136.50 $136.50 $136.50 $24.30 $136.50 $136.50 $136.50 $136.50 $136.50 $136.50 $28.45 $136.50 $54.60 $136.50 $136.50 $136.50 $136.50 $136.50 $102.38 $136.50 $136.50 $136.50 $68.25 $68.25 $108.11 $136.50 $109.20 $61.43 $136.50 N/A $79.17 $136.50 $81.90 $136.50 $136.50 $136.50 N/A N/A M0013120051 SUP Custom 27803010 M0013120051 - COIL EMBOLIZATION STR 2MM 50MM 5MM 18 COIL PLATINUM FIBER BOTH IP/OP $136.50 $101.00 $24.30 $136.50 $136.50 $136.50 $136.50 $136.50 $136.50 $136.50 $24.30 $136.50 $136.50 $136.50 $136.50 $136.50 $136.50 $28.45 $136.50 $54.60 $136.50 $136.50 $136.50 $136.50 $136.50 $102.38 $136.50 $136.50 $136.50 $68.25 $68.25 $108.11 $136.50 $109.20 $61.43 $136.50 N/A $79.17 $136.50 $81.90 $136.50 $136.50 $136.50 N/A N/A M0013120211 SUP Custom 27803010 M0013120211 - COIL EMBL .018IN 2MM 5MM 10MM 18 COIL PSH INTRO DCRN PLTN BOTH IP/OP $199.00 $147.00 $35.39 $198.83 $198.83 $198.83 $198.83 $198.83 $198.83 $198.83 $35.39 $198.83 $198.83 $198.83 $198.83 $198.83 $198.83 $41.44 $198.83 $79.53 $198.83 $198.83 $198.83 $198.83 $198.83 $149.25 $198.83 $198.83 $198.83 $99.42 $99.42 $157.47 $198.83 $159.06 $89.47 $198.83 N/A $115.42 $198.83 $119.30 $198.83 $198.83 $198.83 N/A N/A M0013120211 SUP Custom 27803010 M0013120211 - COIL EMBOLIZATION 2MM 5MM 10MM 8-18 COIL FIBERED PLATINUM BOTH IP/OP $199.00 $147.00 $35.39 $198.83 $198.83 $198.83 $198.83 $198.83 $198.83 $198.83 $35.39 $198.83 $198.83 $198.83 $198.83 $198.83 $198.83 $41.44 $198.83 $79.53 $198.83 $198.83 $198.83 $198.83 $198.83 $149.25 $198.83 $198.83 $198.83 $99.42 $99.42 $157.47 $198.83 $159.06 $89.47 $198.83 N/A $115.42 $198.83 $119.30 $198.83 $198.83 $198.83 N/A N/A M0013120221 SUP Custom 27803010 M0013120221 - COIL EMBL HLCL 4MM 4MM 20MM CMPLX 18 COIL FBR PLTN BOTH IP/OP $199.00 $147.00 $115.42 $994.15 $994.15 $994.15 $994.15 $994.15 $994.15 $994.15 $176.96 $994.15 $994.15 $994.15 $994.15 $994.15 $994.15 $207.19 $994.15 $397.66 $994.15 $994.15 $994.15 $994.15 $994.15 $149.25 $994.15 $994.15 $994.15 $497.08 $497.08 $787.37 $994.15 $795.32 $447.37 $994.15 N/A $115.42 $994.15 $596.49 $994.15 $994.15 $994.15 N/A N/A M0013120221 SUP Custom 27803010 M0013120221 - COIL EMBOLIZATION .018IN HELIX 4MM 4MM COMPLEX PLATINUM BOTH IP/OP $994.50 $736.00 $176.96 $994.15 $994.15 $994.15 $994.15 $994.15 $994.15 $994.15 $176.96 $994.15 $994.15 $994.15 $994.15 $994.15 $994.15 $207.19 $994.15 $397.66 $994.15 $994.15 $994.15 $994.15 $994.15 $745.88 $994.15 $994.15 $994.15 $497.08 $497.08 $787.37 $994.15 $795.32 $447.37 $994.15 N/A $576.81 $994.15 $596.49 $994.15 $994.15 $994.15 N/A N/A M0013120331 SUP Custom 27803010 M0013120331 - COIL EMBOLIZATION .018IN HELIX 6MM 6MM COMPLEX PLATINUM BOTH IP/OP $199.00 $147.00 $35.39 $198.83 $198.83 $198.83 $198.83 $198.83 $198.83 $198.83 $35.39 $198.83 $198.83 $198.83 $198.83 $198.83 $198.83 $41.44 $198.83 $79.53 $198.83 $198.83 $198.83 $198.83 $198.83 $149.25 $198.83 $198.83 $198.83 $99.42 $99.42 $157.47 $198.83 $159.06 $89.47 $198.83 N/A $115.42 $198.83 $119.30 $198.83 $198.83 $198.83 N/A N/A M0013120431 SUP Custom 27803010 M0013120431 - COIL EMBL .018IN MULTILOOP 18 4MM 7MM 30IN 18 COIL PSH INTRO BOTH IP/OP $205.50 $152.00 $119.19 "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" $182.46 "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" $213.63 "$1,025.05" $410.02 "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" $154.13 "$1,025.05" "$1,025.05" "$1,025.05" $512.53 $512.53 $811.84 "$1,025.05" $820.04 $461.27 "$1,025.05" N/A $119.19 "$1,025.05" $615.03 "$1,025.05" "$1,025.05" "$1,025.05" N/A N/A M0013120431 SUP Custom 27803010 M0013120431 - COIL EMBOLIZATION .018IN HELIX 4MM 30MM COMPLEX PLATINUM BOTH IP/OP "$1,025.50" $759.00 $182.46 "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" $182.46 "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" $213.63 "$1,025.05" $410.02 "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" "$1,025.05" $769.13 "$1,025.05" "$1,025.05" "$1,025.05" $512.53 $512.53 $811.84 "$1,025.05" $820.04 $461.27 "$1,025.05" N/A $594.79 "$1,025.05" $615.03 "$1,025.05" "$1,025.05" "$1,025.05" N/A N/A M0013120441 SUP Custom 27803010 M0013120441 - COIL EMBOLIZATION .018IN HELIX 7MM 10MM COMPLEX PLATINUM BOTH IP/OP $205.50 $152.00 $36.49 $205.01 $205.01 $205.01 $205.01 $205.01 $205.01 $205.01 $36.49 $205.01 $205.01 $205.01 $205.01 $205.01 $205.01 $42.73 $205.01 $82.00 $205.01 $205.01 $205.01 $205.01 $205.01 $154.13 $205.01 $205.01 $205.01 $102.51 $102.51 $162.37 $205.01 $164.01 $92.25 $205.01 N/A $119.19 $205.01 $123.01 $205.01 $205.01 $205.01 N/A N/A M0013120551 SUP Custom 27803010 M0013120551 - COIL EMBL .018IN HLCL 8MM 12MM CMPLX 18 COIL PSH INTRO PLTN BOTH IP/OP $205.50 $152.00 $36.49 $205.01 $205.01 $205.01 $205.01 $205.01 $205.01 $205.01 $36.49 $205.01 $205.01 $205.01 $205.01 $205.01 $205.01 $42.73 $205.01 $82.00 $205.01 $205.01 $205.01 $205.01 $205.01 $154.13 $205.01 $205.01 $205.01 $102.51 $102.51 $162.37 $205.01 $164.01 $92.25 $205.01 N/A $119.19 $205.01 $123.01 $205.01 $205.01 $205.01 N/A N/A M0013120551 SUP Custom 27803010 M0013120551 - COIL EMBOLIZATION .018IN HELICAL 8MM 12MM FIBERED COMPLEX BOTH IP/OP "$1,025.50" $759.00 $36.49 $769.13 $205.01 $205.01 $205.01 $205.01 $205.01 $205.01 $36.49 $205.01 $205.01 $205.01 $205.01 $205.01 $205.01 $42.73 $205.01 $82.00 $205.01 $205.01 $205.01 $205.01 $205.01 $769.13 $205.01 $205.01 $205.01 $102.51 $102.51 $162.37 $205.01 $164.01 $92.25 $205.01 N/A $594.79 $205.01 $123.01 $205.01 $205.01 $205.01 N/A N/A M0013120661 SUP Custom 27803010 M0013120661 - COIL EMBOLIZATION .018IN HELICAL COMPLEX 10MM 14MM 60MM BOTH IP/OP $205.50 $152.00 $36.49 $205.01 $205.01 $205.01 $205.01 $205.01 $205.01 $205.01 $36.49 $205.01 $205.01 $205.01 $205.01 $205.01 $205.01 $42.73 $205.01 $82.00 $205.01 $205.01 $205.01 $205.01 $205.01 $154.13 $205.01 $205.01 $205.01 $102.51 $102.51 $162.37 $205.01 $164.01 $92.25 $205.01 N/A $119.19 $205.01 $123.01 $205.01 $205.01 $205.01 N/A N/A M0013120771 SUP Custom 27803010 M0013120771 - COIL EMBOLIZATION .018IN HELIX 11MM 17MM COMPLEX PLATINUM BOTH IP/OP $205.50 $152.00 $36.49 $205.01 $205.01 $205.01 $205.01 $205.01 $205.01 $205.01 $36.49 $205.01 $205.01 $205.01 $205.01 $205.01 $205.01 $42.73 $205.01 $82.00 $205.01 $205.01 $205.01 $205.01 $205.01 $154.13 $205.01 $205.01 $205.01 $102.51 $102.51 $162.37 $205.01 $164.01 $92.25 $205.01 N/A $119.19 $205.01 $123.01 $205.01 $205.01 $205.01 N/A N/A M001314001 SUP HCPCS C1725 M001314001 - CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 5FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314011 SUP HCPCS C1725 M001314011 - CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 5FR 100CM BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314021 SUP HCPCS C1725 M001314021 - CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 5FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314031 SUP HCPCS C1725 M001314031 - CATHETER ANGIOGRAPHIC STR 5FR 100CM BRAID TORQUE SELECTIVE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314041 SUP HCPCS C1725 M001314041 - CATHETER ANGIOGRAPHIC BERN CURVE FLUTE TAPER 5FR 100CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314051 SUP HCPCS C1725 M001314051 - CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 100CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314061 SUP HCPCS C1725 M001314061 - CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 100CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314071 SUP HCPCS C1725 M001314071 - CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 40CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314081 SUP HCPCS C1887 M001314081 - CATHETER ANGIO BERN CRV 5FR 40CM IMGR2 BRD TRQ SLCT CRBRL BOTH IP/OP $25.50 $19.00 $14.79 $127.40 $69.18 $69.18 $69.18 $69.18 $127.40 $127.40 $127.40 $26.55 $127.40 $94.56 $94.56 $98.20 $66.38 $26.55 $127.40 $127.40 $75.36 $127.40 $127.40 $127.40 $127.40 $19.13 $127.40 $127.40 $127.40 $63.70 $63.70 $100.90 $127.40 $101.92 $82.81 $25.29 N/A $14.79 $127.40 $127.40 $127.40 $26.55 $127.40 N/A N/A M001314081 SUP HCPCS C1887 M001314081 - CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 40CM BRAID TORQUE BOTH IP/OP $127.50 $94.00 $25.29 $127.40 $69.18 $69.18 $69.18 $69.18 $127.40 $127.40 $127.40 $26.55 $127.40 $94.56 $94.56 $98.20 $66.38 $26.55 $127.40 $127.40 $75.36 $127.40 $127.40 $127.40 $127.40 $95.63 $127.40 $127.40 $127.40 $63.70 $63.70 $100.90 $127.40 $101.92 $82.81 $25.29 N/A $73.95 $127.40 $127.40 $127.40 $26.55 $127.40 N/A N/A M001314091 SUP HCPCS C1887 M001314091 - CATHETER ANGIO BERN CRV 5FR 65CM STRL LF IMGR2 RADOPQ BRD BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314101 SUP HCPCS C1725 M001314101 - CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314111 SUP HCPCS C1725 M001314111 - CATHETER ANGIOGRAPHIC WEIN CURVE FLUTE TAPER 5FR 100CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314121 SUP HCPCS C1725 M001314121 - CATHETER ANGIOGRAPHIC WEIN CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314131 SUP HCPCS C1725 M001314131 - CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 5FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314141 SUP HCPCS C1725 M001314141 - CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 5FR 100CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314151 SUP HCPCS C1725 M001314151 - CATHETER ANGIO HDHNTR 1 CRV 5FR 100CM IMGR2 BRD TRQ SLCT BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314161 SUP HCPCS C1725 M001314161 - CATHETER ANGIOGRAPHIC HEADHUNTER 3 CURVE 5FR 100CM TAPER TIP BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314171 SUP HCPCS C1725 M001314171 - CATHETER ANGIOGRAPHIC HEADHUNTER 3 CURVE 5FR 100CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314181 SUP HCPCS C1725 M001314181 - CATHETER ANGIOGRAPHIC HEADHUNTER 1 HEADHUNTER CURVE 5FR 100 BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314191 SUP HCPCS C1725 M001314191 - CATHETER ANGIOGRAPHIC HEADHUNTER 1 HEADHUNTER CURVE 5FR 100 BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314201 SUP HCPCS C1725 M001314201 - CATHETER ANGIOGRAPHIC HEADHUNTER 3 HEADHUNTER CURVE 5FR 100 BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314211 SUP HCPCS C1725 M001314211 - CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314221 SUP HCPCS C1725 M001314221 - CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314231 SUP HCPCS C1725 M001314231 - CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314241 SUP HCPCS C1725 M001314241 - CATHETER ANGIOGRAPHIC BENTSON 2 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314251 SUP HCPCS C1725 M001314251 - CATHETER ANGIOGRAPHIC BENTSON 2 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314261 SUP HCPCS C1725 M001314261 - CATHETER ANGIOGRAPHIC BENTSON 3 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314271 SUP HCPCS C1725 M001314271 - CATHETER ANGIOGRAPHIC BENTSON 3 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314281 SUP HCPCS C1725 M001314281 - CATHETER ANGIOGRAPHIC MANN CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314291 SUP HCPCS C1725 M001314291 - CATHETER ANGIOGRAPHIC MANN CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314301 SUP HCPCS C1725 M001314301 - CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314311 SUP HCPCS C1725 M001314311 - CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314321 SUP HCPCS C1725 M001314321 - CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314331 SUP HCPCS C1725 M001314331 - CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314341 SUP HCPCS C1725 M001314341 - CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314351 SUP HCPCS C1725 M001314351 - CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314361 SUP HCPCS C1725 M001314361 - CATHETER ANGIOGRAPHIC SIMMONS 3 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314371 SUP HCPCS C1725 M001314371 - CATHETER ANGIOGRAPHIC SIMMONS 3 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314381 SUP HCPCS C1725 M001314381 - CATHETER ANGIOGRAPHIC SIMMONS 4 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314391 SUP HCPCS C1725 M001314391 - CATHETER ANGIOGRAPHIC NEWTON 1 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314401 SUP HCPCS C1725 M001314401 - CATHETER ANGIOGRAPHIC NEWTON 1 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314411 SUP HCPCS C1725 M001314411 - CATHETER ANGIOGRAPHIC NEWTON 2 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314421 SUP HCPCS C1725 M001314421 - CATHETER ANGIOGRAPHIC NEWTON 2 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314431 SUP HCPCS C1725 M001314431 - CATHETER ANGIOGRAPHIC NEWTON 3 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314441 SUP HCPCS C1725 M001314441 - CATHETER ANGIOGRAPHIC NEWTON 3 CURVE 5FR 100CM TAPER TIP BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314451 SUP HCPCS C1725 M001314451 - CATHETER ANGIOGRAPHIC NEWTON 4 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314461 SUP HCPCS C1725 M001314461 - CATHETER ANGIOGRAPHIC NEWTON 4 CURVE 5FR 100CM TAPER TIP BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314471 SUP HCPCS C1725 M001314471 - CATHETER ANGIOGRAPHIC NEWTON 5 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314481 SUP HCPCS C1725 M001314481 - CATHETER ANGIOGRAPHIC NEWTON 5 CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314491 SUP HCPCS C1725 M001314491 - CATHETER ANGIOGRAPHIC CK CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314501 SUP HCPCS C1725 M001314501 - CATHETER ANGIOGRAPHIC MULTPUR GEN CURVE 5FR 100CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314511 SUP HCPCS C1725 M001314511 - CATHETER ANGIOGRAPHIC MULTPUR GEN CURVE 5FR 100CM BRAID BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314521 SUP HCPCS C1725 M001314521 - CATHETER ANGIOGRAPHIC CHUANG B CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314531 SUP HCPCS C1725 M001314531 - CATHETER ANGIOGRAPHIC CHUANG B CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314541 SUP HCPCS C1725 M001314541 - CATHETER ANGIOGRAPHIC CHUANG C CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314551 SUP HCPCS C1725 M001314551 - CATHETER ANGIOGRAPHIC CHUANG C CURVE 5FR 65CM TAPER TIP BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314561 SUP HCPCS C1725 M001314561 - CATHETER ANGIOGRAPHIC CHUANG 2.5 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314571 SUP HCPCS C1725 M001314571 - CATHETER ANGIOGRAPHIC CHUANG 2.5 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314581 SUP HCPCS C1725 M001314581 - CATHETER ANGIOGRAPHIC CONTRALATERAL 2 CURVE 5FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314591 SUP HCPCS C1726 M001314591 - CATHETER ANGIOGRAPHIC CONTRALATERAL 2 CURVE 5FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314601 SUP HCPCS C1725 M001314601 - CATHETER ANGIOGRAPHIC DUCK CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314611 SUP HCPCS C1725 M001314611 - CATHETER ANGIOGRAPHIC DUCK CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314621 SUP HCPCS C1725 M001314621 - CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314631 SUP HCPCS C1725 M001314631 - CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314641 SUP HCPCS C1725 M001314641 - CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314651 SUP HCPCS C1725 M001314651 - CATHETER ANGIOGRAPHIC COBRA 1 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314661 SUP HCPCS C1725 M001314661 - CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314671 SUP HCPCS C1725 M001314671 - CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314681 SUP HCPCS C1725 M001314681 - CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314691 SUP HCPCS C1725 M001314691 - CATHETER ANGIOGRAPHIC COBRA 2 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314701 SUP HCPCS C1725 M001314701 - CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314711 SUP HCPCS C1725 M001314711 - CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314721 SUP HCPCS C1725 M001314721 - CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314731 SUP HCPCS C1725 M001314731 - CATHETER ANGIOGRAPHIC COBRA 3 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314741 SUP HCPCS C1725 M001314741 - CATHETER ANGIOGRAPHIC VAN ANDEL 2 CURVE 5FR 65CM BRAID BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314751 SUP HCPCS C1725 M001314751 - CATHETER ANGIOGRAPHIC TRAIN CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314761 SUP HCPCS C1725 M001314761 - CATHETER ANGIOGRAPHIC MIKELSON CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314771 SUP HCPCS C1725 M001314771 - CATHETER ANGIOGRAPHIC MIKELSON CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314781 SUP HCPCS C1725 M001314781 - CATHETER ANGIOGRAPHIC HK 1 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314791 SUP HCPCS C1725 M001314791 - CATHETER ANGIOGRAPHIC HK 1 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314801 SUP HCPCS C1725 M001314801 - CATHETER ANGIOGRAPHIC SHEPHERD HOOK .8 CURVE 5FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314811 SUP HCPCS C1725 M001314811 - CATHETER ANGIOGRAPHIC SHEPHERD HOOK .8 CURVE 5FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314821 SUP HCPCS C1725 M001314821 - CATHETER ANGIOGRAPHIC SHEPHERD HOOK 1 CURVE 5FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314831 SUP HCPCS C1725 M001314831 - CATHETER ANGIOGRAPHIC SHEPHERD HOOK 1 CURVE 5FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314841 SUP HCPCS C1725 M001314841 - CATHETER ANGIOGRAPHIC ROSCH 1 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314851 SUP HCPCS C1725 M001314851 - CATHETER ANGIOGRAPHIC ROSCH 1 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314861 SUP HCPCS C1725 M001314861 - CATHETER ANGIOGRAPHIC ROSCH 2 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314871 SUP HCPCS C1725 M001314871 - CATHETER ANGIOGRAPHIC ROSCH 2 CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314881 SUP HCPCS C1725 M001314881 - CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314891 SUP HCPCS C1725 M001314891 - CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001314901 SUP HCPCS C1725 M001314901 - CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001314911 SUP HCPCS C1725 M001314911 - CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE 5FR 65CM BRAID BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001315001 SUP HCPCS C1725 M001315001 - CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 4FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315011 SUP HCPCS C1725 M001315011 - CATHETER ANGIOGRAPHIC .035IN TENNIS RACQUET CURVE 4FR 90CM BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315021 SUP HCPCS C1725 M001315021 - CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 4FR 100CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315031 SUP HCPCS C1725 M001315031 - CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315041 SUP HCPCS C1725 M001315041 - CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 90CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315051 SUP HCPCS C1725 M001315051 - CATHETER ANGIOGRAPHIC .035IN TENNIS RACQUET CURVE 5FR 100CM BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315061 SUP HCPCS C1725 M001315061 - CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315071 SUP HCPCS C1725 M001315071 - CATHETER ANGIOGRAPHIC .038IN TENNIS RACQUET CURVE 5FR 90CM BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315081 SUP HCPCS C1725 M001315081 - CATHETER ANGIOGRAPHIC TENNIS RACQUET CURVE 5FR 100CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315091 SUP HCPCS C1725 M001315091 - CATHETER ANGIOGRAPHIC PIGTAIL CURVE 4FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315101 SUP HCPCS C1725 M001315101 - CATHETER ANGIOGRAPHIC STR FLUSH CURVE 4FR 65CM HIGH FLOW BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315111 SUP HCPCS C1725 M001315111 - CATHETER ANGIOGRAPHIC .035IN 4FR 90CM PIGTAIL IMAGER II BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315121 SUP HCPCS C1725 M001315121 - CATHETER ANGIOGRAPHIC STR 4FR 90CM BRAID TORQUE SELECTIVE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315131 SUP HCPCS C1726 M001315131 - CATHETER ANGIO PGTL CRV 5FR 65CM STRL LF IMGR2 RADOPQ BRD BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315131 SUP HCPCS C1726 M001315131 - CATHETER ANGIOGRAPHIC PIGTAIL FLUSH CURVE 5FR 65CM HIGH FLOW BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315141 SUP HCPCS C1725 M001315141 - CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 90CM TAPER TIP FLUTE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315151 SUP HCPCS C1725 M001315151 - CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 100CM TAPER TIP BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315161 SUP HCPCS C1725 M001315161 - CATHETER ANGIOGRAPHIC STR FLUSH CURVE 5FR 65CM HIGH FLOW BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315171 SUP HCPCS C1725 M001315171 - CATHETER ANGIOGRAPHIC STR FLUSH CURVE 5FR 90CM HIGH FLOW BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315181 SUP HCPCS C1725 M001315181 - CATHETER ANGIOGRAPHIC STR 5FR 100CM BRAID TORQUE SELECTIVE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315191 SUP HCPCS C1725 M001315191 - CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315201 SUP HCPCS C1725 M001315201 - CATHETER ANGIOGRAPHIC STR 5FR 65CM BRAID TORQUE SELECTIVE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315211 SUP HCPCS C1725 M001315211 - CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 90CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315221 SUP HCPCS C1725 M001315221 - CATHETER ANGIOGRAPHIC STR 5FR 90CM TAPER TIP FLUTE HUB BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315231 SUP HCPCS C1725 M001315231 - CATHETER ANGIOGRAPHIC PIGTAIL CURVE 5FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315241 SUP HCPCS C1725 M001315241 - CATHETER ANGIOGRAPHIC STR 5FR 100CM BRAID TORQUE SELECTIVE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315251 SUP HCPCS C1725 M001315251 - CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 4FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315261 SUP HCPCS C1725 M001315261 - CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 4FR 90CM IMAGER II BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315271 SUP HCPCS C1725 M001315271 - CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 4FR 100CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315281 SUP HCPCS C1726 M001315281 - CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315291 SUP HCPCS C1725 M001315291 - CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 90CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315301 SUP HCPCS C1725 M001315301 - CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 100CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315311 SUP HCPCS C1725 M001315311 - CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 65CM TAPER TIP BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315321 SUP HCPCS C1725 M001315321 - CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 90CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001315331 SUP HCPCS C1725 M001315331 - CATHETER ANGIOGRAPHIC CONTRALATERAL CURVE 5FR 100CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316021 SUP HCPCS C1725 M001316021 - CATHETER ANGIOGRAPHIC MULTPUR SHORT TIP CURVE 4FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316031 SUP HCPCS C1725 M001316031 - CATHETER ANGIOGRAPHIC SHORT TIP CURVE 4FR 100CM TAPER TIP BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316041 SUP HCPCS C1725 M001316041 - CATHETER ANGIOGRAPHIC BARNH CURVE 4FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316061 SUP HCPCS C1725 M001316061 - CATHETER ANGIOGRAPHIC .035IN BERN CURVE 4FR 100CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316071 SUP HCPCS C1725 M001316071 - CATHETER ANGIOGRAPHIC BERNSTEIN CURVE 4FR 40CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316091 SUP HCPCS C1725 M001316091 - CATHETER ANGIOGRAPHIC BERENSTEIN CURVE 4FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316121 SUP HCPCS C1725 M001316121 - CATHETER ANGIOGRAPHIC WEINBERG CEREBRAL CURVE 4FR 100CM BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316131 SUP HCPCS C1725 M001316131 - CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 4FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316151 SUP HCPCS C1725 M001316151 - CATHETER ANGIOGRAPHIC HEADHUNTER 1 CURVE 4FR 100CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316171 SUP HCPCS C1725 M001316171 - CATHETER ANGIOGRAPHIC HEADHUNTER 3 CURVE 4FR 100CM BRAID BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316191 SUP HCPCS C1725 M001316191 - CATHETER ANGIOGRAPHIC HEADHUNTER 1 HEADHUNTER CURVE 4FR 100 BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316201 SUP HCPCS C1725 M001316201 - CATHETER ANGIOGRAPHIC HEADHUNTER 3 HEADHUNTER CURVE 4FR 100 BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316211 SUP HCPCS C1725 M001316211 - CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 4FR 65CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316231 SUP HCPCS C1725 M001316231 - CATHETER ANGIOGRAPHIC BENTSON 1 CURVE 4FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316251 SUP HCPCS C1725 M001316251 - CATHETER ANGIOGRAPHIC BENTSON 2 CURVE 4FR 100CM TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316271 SUP HCPCS C1725 M001316271 - CATHETER ANGIOGRAPHIC BENTSON 3 CURVE 4FR 100CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316291 SUP HCPCS C1725 M001316291 - CATHETER ANGIOGRAPHIC MANI CURVE 4FR 100CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316311 SUP HCPCS C1725 M001316311 - CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 4FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316331 SUP HCPCS C1725 M001316331 - CATHETER ANGIOGRAPHIC SIMMONS 1 CURVE 4FR 100CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316351 SUP HCPCS C1725 M001316351 - CATHETER ANGIOGRAPHIC SIMMONS 2 CURVE 4FR 100CM TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316371 SUP HCPCS C1725 M001316371 - CATHETER ANGIOGRAPHIC SIM3 CURVE 4FR 100CM BRAID IMAGER II BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316381 SUP HCPCS C1725 M001316381 - CATHETER ANGIOGRAPHIC SIMMONS 4 CURVE 4FR 100CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316401 SUP HCPCS C1725 M001316401 - CATHETER ANGIOGRAPHIC NEWTON 1 CURVE 4FR 100CM TORQUE SELECT BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316421 SUP HCPCS C1725 M001316421 - CATHETER ANGIOGRAPHIC NEWTON 2 CURVE 4FR 100CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316441 SUP HCPCS C1725 M001316441 - CATHETER ANGIOGRAPHIC NEWTON 3 CURVE 4FR 100CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316461 SUP HCPCS C1725 M001316461 - CATHETER ANGIOGRAPHIC NEWTON 4 CURVE 4FR 100CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316481 SUP HCPCS C1725 M001316481 - CATHETER ANGIOGRAPHIC NEWTON 5 CURVE 4FR 100CM BRAID IMAGER BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316491 SUP HCPCS C1725 M001316491 - CATHETER ANGIOGRAPHIC CK CURVE 4FR 100CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316511 SUP HCPCS C1725 M001316511 - CATHETER ANGIOGRAPHIC GEN CURVE 4FR 100CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316531 SUP HCPCS C1725 M001316531 - CATHETER ANGIOGRAPHIC CHUANG B CURVE 4FR 65CM TORQUE SELECT BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316551 SUP HCPCS C1725 M001316551 - CATHETER ANGIOGRAPHIC CHUANG C CURVE 4FR 65CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316571 SUP HCPCS C1725 M001316571 - CATHETER ANGIOGRAPHIC CHUANG 2 CURVE 4FR 65CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316581 SUP HCPCS C1725 M001316581 - CATHETER ANGIOGRAPHIC CONTRALATERAL 2 CURVE 4FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316611 SUP HCPCS C1725 M001316611 - CATHETER ANGIOGRAPHIC DUCK CURVE 4FR 65CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316631 SUP HCPCS C1725 M001316631 - CATHETER ANGIOGRAPHIC COBRA 1 CURVE 4FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316651 SUP HCPCS C1725 M001316651 - CATHETER ANGIOGRAPHIC COBRA 1 CURVE 4FR 65CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316671 SUP HCPCS C1725 M001316671 - CATHETER ANGIOGRAPHIC COBRA 2 CURVE 4FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316691 SUP HCPCS C1725 M001316691 - CATHETER ANGIOGRAPHIC COBRA 2 CURVE 4FR 65CM TAPER TIP FLUTE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316711 SUP HCPCS C1725 M001316711 - CATHETER ANGIOGRAPHIC COBRA 3 CURVE 4FR 65CM BRAID TORQUE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316731 SUP HCPCS C1725 M001316731 - CATHETER ANGIOGRAPHIC COBRA 3 CURVE 4FR 65CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316741 SUP HCPCS C1725 M001316741 - CATHETER ANGIOGRAPHIC VAN CURVE 4FR 65CM BRAID TORQUE BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001316751 SUP HCPCS C1725 M001316751 - CATHETER ANGIOGRAPHIC TRAIN CURVE FLUTE TAPER 4FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316771 SUP HCPCS C1725 M001316771 - CATHETER ANGIOGRAPHIC MIKELSON CURVE FLUTE TAPER 4FR 65CM BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316791 SUP HCPCS C1725 M001316791 - CATHETER ANGIOGRAPHIC HK 1 CURVE FLUTE TAPER 4FR 65CM BRAID BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316811 SUP HCPCS C1725 M001316811 - CATHETER ANGIOGRAPHIC SHK .8 CURVE FLUTE TAPER 4FR 65CM BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316831 SUP HCPCS C1725 M001316831 - CATHETER ANGIOGRAPHIC SHEPHERD HOOK 1 CURVE 4FR 65CM TAPER BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316851 SUP HCPCS C1725 M001316851 - CATHETER ANGIOGRAPHIC RIGHT CORON 1 CURVE 4FR 65CM TAPER TIP BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316871 SUP HCPCS C1725 M001316871 - CATHETER ANGIOGRAPHIC RIGHT CORON SHEPHERDS CROOK 2 CURVE BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316891 SUP HCPCS C1725 M001316891 - CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE FLUTE TAPER 4FR 65 BOTH IP/OP $25.50 $19.00 $5.06 $25.48 $13.84 $13.84 $13.84 $13.84 $25.48 $25.48 $25.48 $5.31 $25.48 $18.91 $18.91 $19.64 $13.28 $5.31 $25.48 $25.48 $15.07 $25.48 $25.48 $25.48 $25.48 $19.13 $25.48 $25.48 $25.48 $12.74 $12.74 $20.18 $25.48 $20.38 $16.56 $5.06 N/A $14.79 $25.48 $25.48 $25.48 $5.31 $25.48 N/A N/A M001316911 SUP HCPCS C1725 M001316911 - CATHETER ANGIOGRAPHIC RENAL DOUBLE CURVE FLUTE TAPER 4FR 65 BOTH IP/OP $30.00 $22.00 $5.95 $30.00 $16.29 $16.29 $16.29 $16.29 $30.00 $30.00 $30.00 $6.25 $30.00 $22.27 $22.27 $23.12 $15.63 $6.25 $30.00 $30.00 $17.75 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $19.50 $5.95 N/A $17.40 $30.00 $30.00 $30.00 $6.25 $30.00 N/A N/A M001321751 SUP HCPCS C1887 M001321751 - CATHETER ANGIO .038IN C2 4FR 65CM GLDCATH TIP HDRPH BOTH IP/OP $139.50 $103.00 $27.69 $139.50 $75.75 $75.75 $75.75 $75.75 $139.50 $139.50 $139.50 $29.08 $139.50 $103.54 $103.54 $107.53 $72.68 $29.07 $139.50 $139.50 $82.51 $139.50 $139.50 $139.50 $139.50 $104.63 $139.50 $139.50 $139.50 $69.75 $69.75 $110.48 $139.50 $111.60 $90.68 $27.69 N/A $80.91 $139.50 $139.50 $139.50 $29.07 $139.50 N/A N/A M001361480 SUP HCPCS C1895 M001361480 - COIL EMBOLIZATION .018IN STANDARD LENGTH 2D 2MM 4CM BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" "$1,275.00" "$1,275.00" $265.71 "$1,275.00" N/A N/A M001361490 SUP HCPCS C1895 M001361490 - COIL EMBOLIZATION .018IN STANDARD LENGTH 2D 2MM 6CM BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" "$1,275.00" "$1,275.00" $265.71 "$1,275.00" N/A N/A M001361500 SUP Custom 27803010 M001361500 - COIL EMBOLIZATION 2D HELIX 3MM 6CM 18 COIL OCCLUSION SYSTEM BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361510 SUP Custom 27803010 M001361510 - COIL EMBOLIZATION 2D HELIX 3MM 12CM 18 COIL OCCLUSION SYSTEM BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361520 SUP Custom 27803010 M001361520 - COIL EMBOLIZATION 2D HELIX 4MM 8CM 18 COIL OCCLUSION SYSTEM BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361530 SUP Custom 27803010 M001361530 - COIL EMBOLIZATION 2D HELIX 4MM 15CM 8 COIL OCCLUSION SYSTEM BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361540 SUP Custom 27803010 M001361540 - COIL EMBOLIZATION 2D HELIX 5MM 8CM 18 COIL OCCLUSION SYSTEM BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361550 SUP Custom 27803010 M001361550 - COIL EMBOLIZATION 2D HELIX 5MM 15CM 8 COIL OCCLUSION SYSTEM BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361560 SUP Custom 27803010 M001361560 - COIL EMBOLIZATION 2D HELIX 6MM 10CM 18 COIL OCCLUSION SYSTEM BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361570 SUP Custom 27803010 M001361570 - COIL EMBOLIZATION 2D HELIX 6MM 20CM 18 COIL OCCLUSION SYSTEM BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361580 SUP Custom 27803010 M001361580 - COIL EMBOLIZATION 2D HELIX 8MM 20CM OCCLUSION SYSTEM BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361590 SUP Custom 27803010 M001361590 - COIL EMBOLIZATION 2D HELIX 10MM 20CM DETACHABLE OCCLUSION BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361600 SUP Custom 27803010 M001361600 - COIL EMBOLIZATION .018IN 2D HELIX BUCK 10MM 30CM OCCLUSION BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361610 SUP Custom 27803010 M001361610 - COIL EMBOLIZATION 2D HELIX 12MM 20CM OCCLUSION INTERLOCK BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361620 SUP Custom 27803010 M001361620 - COIL EMBOLIZATION .018IN 2D HELIX TAPER 12MM 30CM 18 COIL BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361630 SUP Custom 27803010 M001361630 - COIL EMBOLIZATION .018IN 2D HELIX TAPER 14MM 20CM 18 COIL BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361640 SUP Custom 27803010 M001361640 - COIL EMBOLIZATION .018IN 2D HELIX 14MM 30CM INTERLOCK IDC BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361740 SUP Custom 27803010 M001361740 - COIL EMBOLIZATION DIAMOND 2/3MM 2.3CM 18 COIL RETRACTABLE BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361750 SUP Custom 27803010 M001361750 - COIL EMBOLIZATION DIAMOND 2/4MM 4.1CM 18 COIL RETRACTABLE BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361760 SUP Custom 27803010 M001361760 - COIL EMBOLIZATION DIAMOND 2/5MM 5.8CM 18 COIL RETRACTABLE BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361770 SUP Custom 27803010 M001361770 - COIL EMBOLIZATION DIAMOND 2/6MM 8CM OCCLUSION SYSTEM BOTH IP/OP "$1,022.50" $757.00 $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $182.00 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $213.10 "$1,022.48" $408.99 "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" "$1,022.48" $766.88 "$1,022.48" "$1,022.48" "$1,022.48" $511.24 $511.24 $809.80 "$1,022.48" $817.98 $460.12 "$1,022.48" N/A $593.05 "$1,022.48" $613.49 "$1,022.48" "$1,022.48" "$1,022.48" N/A N/A M001361920 SUP HCPCS C1895 M001361920 - COIL EMBOLIZATION 2D LONG LENGTH 10MM 50CM 18 COIL BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" "$1,275.00" "$1,275.00" $265.71 "$1,275.00" N/A N/A M001361930 SUP HCPCS C1895 M001361930 - COIL EMBOLIZATION .018IN 2D LONG 14CM 50CM 18 COIL BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" "$1,275.00" "$1,275.00" $265.71 "$1,275.00" N/A N/A M001361940 SUP HCPCS C1895 M001361940 - COIL EMBOLIZATION .018IN LONG LENGTH 2D HELIX 18CM 50CM BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" "$1,275.00" "$1,275.00" $265.71 "$1,275.00" N/A N/A M001361950 SUP HCPCS C1895 M001361950 - COIL EMBOLIZATION .018IN LONG LENGTH 2D HELIX 20MM 50CM BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" "$1,275.00" "$1,275.00" $265.71 "$1,275.00" N/A N/A M001361960 SUP HCPCS C1895 M001361960 - COIL EMBOLIZATION .018IN LONG LENGTH 2D HELIX 20MM 50CM BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" "$1,275.00" "$1,275.00" $265.71 "$1,275.00" N/A N/A M001363500 SUP Custom 27803010 M001363500 - COIL EMBOLIZATION .035IN 2D 3MM 4CM OCCLUSION INTERLOCK IDC BOTH IP/OP "$1,177.50" $871.00 $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $245.33 "$1,177.13" $470.85 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $883.13 "$1,177.13" "$1,177.13" "$1,177.13" $588.57 $588.57 $932.29 "$1,177.13" $941.70 $529.71 "$1,177.13" N/A $682.95 "$1,177.13" $706.28 "$1,177.13" "$1,177.13" "$1,177.13" N/A N/A M001363520 SUP Custom 27803010 M001363520 - COIL EMBOLIZATION .035IN 2D HELICAL 4MM 10CM 35 COIL BOTH IP/OP "$1,177.50" $871.00 $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $245.33 "$1,177.13" $470.85 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $883.13 "$1,177.13" "$1,177.13" "$1,177.13" $588.57 $588.57 $932.29 "$1,177.13" $941.70 $529.71 "$1,177.13" N/A $682.95 "$1,177.13" $706.28 "$1,177.13" "$1,177.13" "$1,177.13" N/A N/A M001363530 SUP Custom 27803010 M001363530 - COIL EMBOLIZATION .035 2D HELIX 4MM 20CM DETACHABLE BOTH IP/OP "$1,755.00" "$1,299.00" $312.39 "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" $312.39 "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" $365.76 "$1,755.00" $702.00 "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,316.25" "$1,755.00" "$1,755.00" "$1,755.00" $877.50 $877.50 "$1,389.96" "$1,755.00" "$1,404.00" $789.75 "$1,755.00" N/A "$1,017.90" "$1,755.00" "$1,053.00" "$1,755.00" "$1,755.00" "$1,755.00" N/A N/A M001363540 SUP Custom 27803010 M001363540 - COIL EMBOLIZATION .035IN 2D 6MM 10CM OCCLUSION DETACHABLE BOTH IP/OP "$1,177.50" $871.00 $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $245.33 "$1,177.13" $470.85 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $883.13 "$1,177.13" "$1,177.13" "$1,177.13" $588.57 $588.57 $932.29 "$1,177.13" $941.70 $529.71 "$1,177.13" N/A $682.95 "$1,177.13" $706.28 "$1,177.13" "$1,177.13" "$1,177.13" N/A N/A M001363550 SUP Custom 27803010 M001363550 - COIL EMBOLIZATION .035IN 2D 6MM 20CM OCCLUSION SYSTEM BOTH IP/OP "$1,761.50" "$1,304.00" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $367.10 "$1,761.40" $704.56 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,321.13" "$1,761.40" "$1,761.40" "$1,761.40" $880.70 $880.70 "$1,395.03" "$1,761.40" "$1,409.12" $792.63 "$1,761.40" N/A "$1,021.67" "$1,761.40" "$1,056.84" "$1,761.40" "$1,761.40" "$1,761.40" N/A N/A M001363560 SUP Custom 27803010 M001363560 - COIL EMBOLIZATION .035IN 2D HELIX 6MM 40CM DETACHABLE BOTH IP/OP "$2,340.00" "$1,732.00" $416.52 "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" $416.52 "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" $487.68 "$2,340.00" $936.00 "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$1,755.00" "$2,340.00" "$2,340.00" "$2,340.00" "$1,170.00" "$1,170.00" "$1,853.28" "$2,340.00" "$1,872.00" "$1,053.00" "$2,340.00" N/A "$1,357.20" "$2,340.00" "$1,404.00" "$2,340.00" "$2,340.00" "$2,340.00" N/A N/A M001363570 SUP HCPCS C1895 M001363570 - COIL EMBOLIZATION .018IN 2D HELIX 8MM 10CM OCCLUSION SYSTEM BOTH IP/OP "$1,177.50" $871.00 $233.63 "$1,177.13" $529.71 $529.71 $529.71 $529.71 "$1,177.13" "$1,177.13" "$1,177.13" $245.34 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $245.33 "$1,177.13" "$1,177.13" $696.27 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $883.13 "$1,177.13" "$1,177.13" "$1,177.13" $588.57 $588.57 $932.29 "$1,177.13" $941.70 $529.71 $233.63 N/A $682.95 "$1,177.13" "$1,177.13" "$1,177.13" $245.31 "$1,177.13" N/A N/A M001363580 SUP Custom 27803010 M001363580 - COIL EMBOLIZATION .035IN 2D 8MM 20CM OCCLUSION SYSTEM BOTH IP/OP "$1,761.50" "$1,304.00" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $367.10 "$1,761.40" $704.56 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,321.13" "$1,761.40" "$1,761.40" "$1,761.40" $880.70 $880.70 "$1,395.03" "$1,761.40" "$1,409.12" $792.63 "$1,761.40" N/A "$1,021.67" "$1,761.40" "$1,056.84" "$1,761.40" "$1,761.40" "$1,761.40" N/A N/A M001363590 SUP Custom 27803010 M001363590 - COIL EMBOLIZATION .035IN 2D 8MM 40CM OCCLUSION SYSTEM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A M001363600 SUP Custom 27803010 M001363600 - COIL EMBOLIZATION .035IN 2D 10MM 20CM OCCLUSION INTERLOCK BOTH IP/OP "$1,761.50" "$1,304.00" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $367.10 "$1,761.40" $704.56 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,321.13" "$1,761.40" "$1,761.40" "$1,761.40" $880.70 $880.70 "$1,395.03" "$1,761.40" "$1,409.12" $792.63 "$1,761.40" N/A "$1,021.67" "$1,761.40" "$1,056.84" "$1,761.40" "$1,761.40" "$1,761.40" N/A N/A M001363610 SUP Custom 27803010 M001363610 - COIL EMBOLIZATION .035IN 2D 10MM 40CM OCCLUSION SYSTEM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A M001363620 SUP Custom 27803010 M001363620 - COIL EMBOLIZATION .035IN 2D 12MM 20CM OCCLUSION SYSTEM BOTH IP/OP "$1,761.50" "$1,304.00" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $367.10 "$1,761.40" $704.56 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,321.13" "$1,761.40" "$1,761.40" "$1,761.40" $880.70 $880.70 "$1,395.03" "$1,761.40" "$1,409.12" $792.63 "$1,761.40" N/A "$1,021.67" "$1,761.40" "$1,056.84" "$1,761.40" "$1,761.40" "$1,761.40" N/A N/A M001363630 SUP Custom 27803010 M001363630 - COIL EMBOLIZATION .035IN 2D 12MM 40CM FIBER OCCLUSION SYSTEM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A M001363640 SUP Custom 27803010 M001363640 - COIL EMBOLIZATION .035IN 2D 15MM 20CM OCCLUSION SYSTEM BOTH IP/OP "$1,761.50" "$1,304.00" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $367.10 "$1,761.40" $704.56 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,321.13" "$1,761.40" "$1,761.40" "$1,761.40" $880.70 $880.70 "$1,395.03" "$1,761.40" "$1,409.12" $792.63 "$1,761.40" N/A "$1,021.67" "$1,761.40" "$1,056.84" "$1,761.40" "$1,761.40" "$1,761.40" N/A N/A M001363650 SUP Custom 27803010 M001363650 - COIL EMBOLIZATION .035IN 2D 15MM 40CM OCCLUSION SYSTEM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A M001363660 SUP HCPCS C1895 M001363660 - COIL EMBOLIZATION .018IN 2D 18MM 20CM OCCLUSION SYSTEM BOTH IP/OP "$1,761.50" "$1,304.00" $349.59 "$1,761.40" $792.63 $792.63 $792.63 $792.63 "$1,761.40" "$1,761.40" "$1,761.40" $367.12 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $367.10 "$1,761.40" "$1,761.40" "$1,041.87" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,321.13" "$1,761.40" "$1,761.40" "$1,761.40" $880.70 $880.70 "$1,395.03" "$1,761.40" "$1,409.12" $792.63 $349.59 N/A "$1,021.67" "$1,761.40" "$1,761.40" "$1,761.40" $367.08 "$1,761.40" N/A N/A M001363670 SUP Custom 27803010 M001363670 - COIL EMBOLIZATION .035IN 2D 18MM 40CM OCCLUSION SYSTEM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A M001363700 SUP Custom 27803010 M001363700 - COIL EMBOLIZATION .035IN CUBE 4MM 6CM OCCLUSION SYSTEM BOTH IP/OP "$1,177.50" $871.00 $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $245.33 "$1,177.13" $470.85 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $883.13 "$1,177.13" "$1,177.13" "$1,177.13" $588.57 $588.57 $932.29 "$1,177.13" $941.70 $529.71 "$1,177.13" N/A $682.95 "$1,177.13" $706.28 "$1,177.13" "$1,177.13" "$1,177.13" N/A N/A M001363710 SUP Custom 27803010 M001363710 - COIL EMBOLIZATION .035IN CUBE 4MM 17CM OCCLUSION SYSTEM BOTH IP/OP "$1,755.00" "$1,299.00" $312.39 "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" $312.39 "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" $365.76 "$1,755.00" $702.00 "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,316.25" "$1,755.00" "$1,755.00" "$1,755.00" $877.50 $877.50 "$1,389.96" "$1,755.00" "$1,404.00" $789.75 "$1,755.00" N/A "$1,017.90" "$1,755.00" "$1,053.00" "$1,755.00" "$1,755.00" "$1,755.00" N/A N/A M001363720 SUP Custom 27803010 M001363720 - COIL EMBOLIZATION .035IN CUBE 6MM 10CM OCCLUSION SYSTEM BOTH IP/OP "$1,177.50" $871.00 $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $245.33 "$1,177.13" $470.85 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $883.13 "$1,177.13" "$1,177.13" "$1,177.13" $588.57 $588.57 $932.29 "$1,177.13" $941.70 $529.71 "$1,177.13" N/A $682.95 "$1,177.13" $706.28 "$1,177.13" "$1,177.13" "$1,177.13" N/A N/A M001363730 SUP Custom 27803010 M001363730 - COIL EMBOLIZATION .035IN CUBE 6MM 20CM OCCLUSION SYSTEM BOTH IP/OP "$1,761.50" "$1,304.00" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $367.10 "$1,761.40" $704.56 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,321.13" "$1,761.40" "$1,761.40" "$1,761.40" $880.70 $880.70 "$1,395.03" "$1,761.40" "$1,409.12" $792.63 "$1,761.40" N/A "$1,021.67" "$1,761.40" "$1,056.84" "$1,761.40" "$1,761.40" "$1,761.40" N/A N/A M001363760 SUP Custom 27803010 M001363760 - COIL EMBOLIZATION .035IN CUBE 8MM 20CM OCCLUSION SYSTEM BOTH IP/OP "$1,761.50" "$1,304.00" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $367.10 "$1,761.40" $704.56 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,321.13" "$1,761.40" "$1,761.40" "$1,761.40" $880.70 $880.70 "$1,395.03" "$1,761.40" "$1,409.12" $792.63 "$1,761.40" N/A "$1,021.67" "$1,761.40" "$1,056.84" "$1,761.40" "$1,761.40" "$1,761.40" N/A N/A M001363770 SUP Custom 27803010 M001363770 - COIL EMBOLIZATION .035IN CUBE 8MM 40CM OCCLUSION SYSTEM BOTH IP/OP "$2,340.00" "$1,732.00" $416.52 "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" $416.52 "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" $487.68 "$2,340.00" $936.00 "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$1,755.00" "$2,340.00" "$2,340.00" "$2,340.00" "$1,170.00" "$1,170.00" "$1,853.28" "$2,340.00" "$1,872.00" "$1,053.00" "$2,340.00" N/A "$1,357.20" "$2,340.00" "$1,404.00" "$2,340.00" "$2,340.00" "$2,340.00" N/A N/A M001363790 SUP Custom 27803010 M001363790 - COIL EMBOLIZATION .035IN CUBE 10MM 25CM OCCLUSION SYSTEM BOTH IP/OP "$1,761.50" "$1,304.00" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $367.10 "$1,761.40" $704.56 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,321.13" "$1,761.40" "$1,761.40" "$1,761.40" $880.70 $880.70 "$1,395.03" "$1,761.40" "$1,409.12" $792.63 "$1,761.40" N/A "$1,021.67" "$1,761.40" "$1,056.84" "$1,761.40" "$1,761.40" "$1,761.40" N/A N/A M001363800 SUP Custom 27803010 M001363800 - COIL EMBOLIZATION .035IN CUBE 10MM 40CM OCCLUSION SYSTEM BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A M001363810 SUP Custom 27803010 M001363810 - COIL EMBOLIZATION .035IN CUBE 15MM 25CM OCCLUSION SYSTEM BOTH IP/OP "$1,761.50" "$1,304.00" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $313.53 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" $367.10 "$1,761.40" $704.56 "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,761.40" "$1,321.13" "$1,761.40" "$1,761.40" "$1,761.40" $880.70 $880.70 "$1,395.03" "$1,761.40" "$1,409.12" $792.63 "$1,761.40" N/A "$1,021.67" "$1,761.40" "$1,056.84" "$1,761.40" "$1,761.40" "$1,761.40" N/A N/A M001363820 SUP Custom 27803010 M001363820 - COIL EMBOLIZATION .035IN CUBE 15MM 40CM FIBER OCCLUSION BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A M001363830 SUP Custom 27803010 M001363830 - COIL EMBOLIZATION .035IN CUBE 20MM 40CM FIBER OCCLUSION BOTH IP/OP "$2,250.00" "$1,665.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $400.50 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" $468.92 "$2,250.00" $900.00 "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$1,687.50" "$2,250.00" "$2,250.00" "$2,250.00" "$1,125.00" "$1,125.00" "$1,782.00" "$2,250.00" "$1,800.00" "$1,012.50" "$2,250.00" N/A "$1,305.00" "$2,250.00" "$1,350.00" "$2,250.00" "$2,250.00" "$2,250.00" N/A N/A M001363910 SUP Custom 27803010 M001363910 - COIL EMBOLIZATION .035IN DIAMOND 4MM 4.5CM OCCLUSION SYSTEM BOTH IP/OP "$1,177.50" $871.00 $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $245.33 "$1,177.13" $470.85 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $883.13 "$1,177.13" "$1,177.13" "$1,177.13" $588.57 $588.57 $932.29 "$1,177.13" $941.70 $529.71 "$1,177.13" N/A $682.95 "$1,177.13" $706.28 "$1,177.13" "$1,177.13" "$1,177.13" N/A N/A M001363920 SUP Custom 27803010 M001363920 - COIL EMBOLIZATION .035IN DIAMOND 6MM 9CM OCCLUSION INTERLOCK BOTH IP/OP "$1,177.50" $871.00 $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $245.33 "$1,177.13" $470.85 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $883.13 "$1,177.13" "$1,177.13" "$1,177.13" $588.57 $588.57 $932.29 "$1,177.13" $941.70 $529.71 "$1,177.13" N/A $682.95 "$1,177.13" $706.28 "$1,177.13" "$1,177.13" "$1,177.13" N/A N/A M001363930 SUP Custom 27803010 M001363930 - COIL EMBOLIZATION .035IN DIAMOND 8MM 14CM OCCLUSION BOTH IP/OP "$1,177.50" $871.00 $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $209.53 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $245.33 "$1,177.13" $470.85 "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" "$1,177.13" $883.13 "$1,177.13" "$1,177.13" "$1,177.13" $588.57 $588.57 $932.29 "$1,177.13" $941.70 $529.71 "$1,177.13" N/A $682.95 "$1,177.13" $706.28 "$1,177.13" "$1,177.13" "$1,177.13" N/A N/A M001363940 SUP Custom 27803010 M001363940 - COIL EMBOLIZATION .035IN DIAMOND 10MM 21.5CM OCCLUSION BOTH IP/OP "$1,755.00" "$1,299.00" $312.39 "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" $312.39 "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" $365.76 "$1,755.00" $702.00 "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,316.25" "$1,755.00" "$1,755.00" "$1,755.00" $877.50 $877.50 "$1,389.96" "$1,755.00" "$1,404.00" $789.75 "$1,755.00" N/A "$1,017.90" "$1,755.00" "$1,053.00" "$1,755.00" "$1,755.00" "$1,755.00" N/A N/A M001363950 SUP Custom 27803010 M001363950 - COIL EMBOLIZATION .035IN DIAMOND 12MM 30CM OCCLUSION SYSTEM BOTH IP/OP "$1,755.00" "$1,299.00" $312.39 "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" $312.39 "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" $365.76 "$1,755.00" $702.00 "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,755.00" "$1,316.25" "$1,755.00" "$1,755.00" "$1,755.00" $877.50 $877.50 "$1,389.96" "$1,755.00" "$1,404.00" $789.75 "$1,755.00" N/A "$1,017.90" "$1,755.00" "$1,053.00" "$1,755.00" "$1,755.00" "$1,755.00" N/A N/A M001391260 SUP HCPCS C1769 M001391260 - GUIDEWIRE VASCULAR STR .014IN 185CM JOURNEY NITINOL HYDPHI BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $172.95 $172.95 $172.95 $172.95 $318.50 $318.50 $318.50 $66.38 $318.50 $236.39 $236.39 $245.50 $165.94 $66.38 $318.50 $318.50 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $207.03 $63.21 N/A $184.73 $318.50 $318.50 $318.50 $66.38 $318.50 N/A N/A M001391270 SUP HCPCS C1769 M001391270 - GUIDEWIRE VASCULAR .014IN 185CM 7CM NAVIGATE RADIOPQ ANGLE BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $172.95 $172.95 $172.95 $172.95 $318.50 $318.50 $318.50 $66.38 $318.50 $236.39 $236.39 $245.50 $165.94 $66.38 $318.50 $318.50 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $207.03 $63.21 N/A $184.73 $318.50 $318.50 $318.50 $66.38 $318.50 N/A N/A M001391280 SUP HCPCS C1769 M001391280 - GUIDEWIRE VASCULAR .014IN 300CM 2CM FLEXIBLE CONVENTION STR BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $172.95 $172.95 $172.95 $172.95 $318.50 $318.50 $318.50 $66.38 $318.50 $236.39 $236.39 $245.50 $165.94 $66.38 $318.50 $318.50 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $207.03 $63.21 N/A $184.73 $318.50 $318.50 $318.50 $66.38 $318.50 N/A N/A M001391290 SUP HCPCS C1769 M001391290 - GUIDEWIRE VASCULAR .014IN 300CM 7CM NAVIGATE RADIOPQ ANGLE BOTH IP/OP $318.50 $236.00 $63.21 $318.50 $172.95 $172.95 $172.95 $172.95 $318.50 $318.50 $318.50 $66.38 $318.50 $236.39 $236.39 $245.50 $165.94 $66.38 $318.50 $318.50 $188.39 $318.50 $318.50 $318.50 $318.50 $238.88 $318.50 $318.50 $318.50 $159.25 $159.25 $252.25 $318.50 $254.80 $207.03 $63.21 N/A $184.73 $318.50 $318.50 $318.50 $66.38 $318.50 N/A N/A M0014012160 SUP Custom 27803010 M0014012160 - PUSHER SURG .016FR .018IN 177CM EMBOLIZATION COIL BOTH IP/OP $420.00 $311.00 $74.72 $419.80 $419.80 $419.80 $419.80 $419.80 $419.80 $419.80 $74.72 $419.80 $419.80 $419.80 $419.80 $419.80 $419.80 $87.49 $419.80 $167.92 $419.80 $419.80 $419.80 $419.80 $419.80 $315.00 $419.80 $419.80 $419.80 $209.90 $209.90 $332.48 $419.80 $335.84 $188.91 $419.80 N/A $243.60 $419.80 $251.88 $419.80 $419.80 $419.80 N/A N/A M001442001 SUP Custom 27203010 M001442001 - DEVICE FLOW CONTROL 1050 PSI 1 WAY HIGH PRESSURE FLOSWITCH BOTH IP/OP $11.50 $9.00 $2.03 $11.43 $11.43 $11.43 $11.43 $11.43 $11.43 $11.43 $2.03 $11.43 $11.43 $8.48 $8.48 $8.81 $5.96 $2.38 $11.43 $4.57 $11.43 $11.43 $11.43 $11.43 $11.43 $8.63 $11.43 $11.43 $11.43 $5.72 $5.72 $9.05 $11.43 $9.14 $7.43 $11.43 N/A $6.67 $11.43 $6.86 $11.43 $11.43 $11.43 N/A N/A M001442011 SUP Custom 27203010 M001442011 - DEVICE FLOW CONTROL 1050 PSI 1 WAY HIGH PRESSURE FLOW BOTH IP/OP $10.50 $8.00 $1.87 $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $1.87 $10.50 $10.50 $7.79 $7.79 $8.09 $5.47 $2.19 $10.50 $4.20 $10.50 $10.50 $10.50 $10.50 $10.50 $7.88 $10.50 $10.50 $10.50 $5.25 $5.25 $8.32 $10.50 $8.40 $6.83 $10.50 N/A $6.09 $10.50 $6.30 $10.50 $10.50 $10.50 N/A N/A M001442011 SUP Custom 27203010 M001442011 - DEVICE FLW CNTRL 1050 PSI FLOWSWITCH 1 WY HI-PRS BOTH IP/OP $10.50 $8.00 $1.87 $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $10.50 $1.87 $10.50 $10.50 $7.79 $7.79 $8.09 $5.47 $2.19 $10.50 $4.20 $10.50 $10.50 $10.50 $10.50 $10.50 $7.88 $10.50 $10.50 $10.50 $5.25 $5.25 $8.32 $10.50 $8.40 $6.83 $10.50 N/A $6.09 $10.50 $6.30 $10.50 $10.50 $10.50 N/A N/A M001461541 SUP HCPCS C1769 M001461541 - GUIDEWIRE VASC .035IN 260CM 3CM GLDWR ANG TIP FLXB COR STD BOTH IP/OP $712.50 $527.00 $141.41 $712.50 $386.89 $386.89 $386.89 $386.89 $712.50 $712.50 $712.50 $148.50 $712.50 $528.82 $528.82 $549.20 $371.21 $148.49 $712.50 $712.50 $421.44 $712.50 $712.50 $712.50 $712.50 $534.38 $712.50 $712.50 $712.50 $356.25 $356.25 $564.30 $712.50 $570.00 $463.13 $141.41 N/A $413.25 $712.50 $712.50 $712.50 $148.49 $712.50 N/A N/A M001461940 SUP HCPCS C1769 M001461940 - GUIDEWIRE VASCULAR .035IN 145CM 9CM INFUS KATZEN BOTH IP/OP $473.50 $350.00 $93.93 $473.28 $256.99 $256.99 $256.99 $256.99 $473.28 $473.28 $473.28 $98.64 $473.28 $351.27 $351.27 $364.80 $246.58 $98.64 $473.28 $473.28 $279.95 $473.28 $473.28 $473.28 $473.28 $355.13 $473.28 $473.28 $473.28 $236.64 $236.64 $374.84 $473.28 $378.62 $307.63 $93.93 N/A $274.63 $473.28 $473.28 $473.28 $98.63 $473.28 N/A N/A M001461960 SUP HCPCS C1769 M001461960 - GUIDEWIRE VASCULAR .035IN 145CM 12CM INFUS KATZEN BOTH IP/OP $473.50 $350.00 $93.93 $473.28 $256.99 $256.99 $256.99 $256.99 $473.28 $473.28 $473.28 $98.64 $473.28 $351.27 $351.27 $364.80 $246.58 $98.64 $473.28 $189.31 $279.95 $473.28 $473.28 $473.28 $473.28 $355.13 $473.28 $473.28 $473.28 $236.64 $236.64 $374.84 $473.28 $378.62 $307.63 $93.93 N/A $274.63 $473.28 $473.28 $473.28 $98.63 $473.28 N/A N/A M001465001 SUP HCPCS C1769 M001465001 - GUIDEWIRE VASCULAR 6CM J .035IN 145CM 3MM FLEXIBLE TIP BOTH IP/OP $76.00 $56.00 $15.07 $75.95 $41.24 $41.24 $41.24 $41.24 $75.95 $75.95 $75.95 $15.83 $75.95 $56.37 $56.37 $58.54 $39.57 $15.83 $75.95 $75.95 $44.92 $75.95 $75.95 $75.95 $75.95 $57.00 $75.95 $75.95 $75.95 $37.98 $37.98 $60.15 $75.95 $60.76 $49.37 $15.07 N/A $44.08 $75.95 $75.95 $75.95 $15.83 $75.95 N/A N/A M001465011 SUP HCPCS C1769 M001465011 - GUIDEWIRE VASCULAR SHORT LARGE J FLAT SPRING COIL .035IN 180 BOTH IP/OP $104.00 $77.00 $20.60 $103.81 $56.37 $56.37 $56.37 $56.37 $103.81 $103.81 $103.81 $21.64 $103.81 $77.05 $77.05 $80.02 $54.09 $21.64 $103.81 $103.81 $61.40 $103.81 $103.81 $103.81 $103.81 $78.00 $103.81 $103.81 $103.81 $51.91 $51.91 $82.22 $103.81 $83.05 $67.48 $20.60 N/A $60.32 $103.81 $103.81 $103.81 $21.63 $103.81 N/A N/A M001465021 SUP HCPCS C1769 M001465021 - GUIDEWIRE VASCULAR J .035IN 260CM 3MM FLEXIBLE TIP AMPLATZ BOTH IP/OP $108.50 $80.00 $21.53 $108.46 $58.89 $58.89 $58.89 $58.89 $108.46 $108.46 $108.46 $22.61 $108.46 $80.50 $80.50 $83.60 $56.51 $22.60 $108.46 $108.46 $64.15 $108.46 $108.46 $108.46 $108.46 $81.38 $108.46 $108.46 $108.46 $54.23 $54.23 $85.90 $108.46 $86.77 $70.50 $21.53 N/A $62.93 $108.46 $108.46 $108.46 $22.60 $108.46 N/A N/A M001465031 SUP HCPCS C1769 M001465031 - GUIDEWIRE VASCULAR J .035IN 145CM 3MM FLEXIBLE TIP AMPLATZ BOTH IP/OP $76.00 $56.00 $15.07 $75.95 $41.24 $41.24 $41.24 $41.24 $75.95 $75.95 $75.95 $15.83 $75.95 $56.37 $56.37 $58.54 $39.57 $15.83 $75.95 $75.95 $44.92 $75.95 $75.95 $75.95 $75.95 $57.00 $75.95 $75.95 $75.95 $37.98 $37.98 $60.15 $75.95 $60.76 $49.37 $15.07 N/A $44.08 $75.95 $75.95 $75.95 $15.83 $75.95 N/A N/A M001465041 SUP HCPCS C1769 M001465041 - GUIDEWIRE VASCULAR 6CM LARGE J .035IN 180CM 3MM FLEXIBLE TIP BOTH IP/OP $104.00 $77.00 $20.60 $103.81 $56.37 $56.37 $56.37 $56.37 $103.81 $103.81 $103.81 $21.64 $103.81 $77.05 $77.05 $80.02 $54.09 $21.64 $103.81 $103.81 $61.40 $103.81 $103.81 $103.81 $103.81 $78.00 $103.81 $103.81 $103.81 $51.91 $51.91 $82.22 $103.81 $83.05 $67.48 $20.60 N/A $60.32 $103.81 $103.81 $103.81 $21.63 $103.81 N/A N/A M001465091 SUP HCPCS C1769 M001465091 - GUIDEWIRE VASCULAR SHORT STR .035IN 260CM FLEXIBLE TIP BOTH IP/OP $111.00 $82.00 $21.99 $110.79 $60.16 $60.16 $60.16 $60.16 $110.79 $110.79 $110.79 $23.09 $110.79 $82.23 $82.23 $85.40 $57.72 $23.09 $110.79 $110.79 $65.53 $110.79 $110.79 $110.79 $110.79 $83.25 $110.79 $110.79 $110.79 $55.40 $55.40 $87.75 $110.79 $88.63 $72.01 $21.99 N/A $64.38 $110.79 $110.79 $110.79 $23.09 $110.79 N/A N/A M001465101 SUP HCPCS C1769 M001465101 - GUIDEWIRE VASCULAR .038IN 260CM 1CM FLEXIBLE TIP AMPLATZ BOTH IP/OP $111.00 $82.00 $21.99 $110.79 $60.16 $60.16 $60.16 $60.16 $110.79 $110.79 $110.79 $23.09 $110.79 $82.23 $82.23 $85.40 $57.72 $23.09 $110.79 $110.79 $65.53 $110.79 $110.79 $110.79 $110.79 $83.25 $110.79 $110.79 $110.79 $55.40 $55.40 $87.75 $110.79 $88.63 $72.01 $21.99 N/A $64.38 $110.79 $110.79 $110.79 $23.09 $110.79 N/A N/A M001465171 SUP HCPCS C1769 M001465171 - GUIDEWIRE VASCULAR TAPER .038IN 145CM 6CM STR TIP AMPLATZ BOTH IP/OP $67.00 $50.00 $13.21 $66.57 $36.15 $36.15 $36.15 $36.15 $66.57 $66.57 $66.57 $13.87 $66.57 $49.41 $49.41 $51.31 $34.68 $13.87 $66.57 $66.57 $39.38 $66.57 $66.57 $66.57 $66.57 $50.25 $66.57 $66.57 $66.57 $33.29 $33.29 $52.72 $66.57 $53.26 $43.27 $13.21 N/A $38.86 $66.57 $66.57 $66.57 $13.87 $66.57 N/A N/A M001465181 SUP HCPCS C1769 M001465181 - GUIDEWIRE VASCULAR SHORT J .038IN 145CM 4CM FLEXIBLE TIP BOTH IP/OP $70.00 $52.00 $13.81 $69.58 $37.78 $37.78 $37.78 $37.78 $69.58 $69.58 $69.58 $14.50 $69.58 $51.64 $51.64 $53.63 $36.25 $14.50 $69.58 $69.58 $41.16 $69.58 $69.58 $69.58 $69.58 $52.50 $69.58 $69.58 $69.58 $34.79 $34.79 $55.11 $69.58 $55.66 $45.23 $13.81 N/A $40.60 $69.58 $69.58 $69.58 $14.50 $69.58 N/A N/A M001465191 SUP HCPCS C1769 M001465191 - GUIDEWIRE VASCULAR STR .038IN 180CM 6CM FLEXIBLE TIP AMPLATZ BOTH IP/OP $101.50 $75.00 $20.14 $101.48 $55.10 $55.10 $55.10 $55.10 $101.48 $101.48 $101.48 $21.15 $101.48 $75.32 $75.32 $78.22 $52.87 $21.15 $101.48 $101.48 $60.03 $101.48 $101.48 $101.48 $101.48 $76.13 $101.48 $101.48 $101.48 $50.74 $50.74 $80.37 $101.48 $81.18 $65.96 $20.14 N/A $58.87 $101.48 $101.48 $101.48 $21.15 $101.48 N/A N/A M001465201 SUP HCPCS C1769 M001465201 - GUIDEWIRE VASCULAR STR .038IN 260CM 6CM FLEXIBLE TIP AMPLATZ BOTH IP/OP $106.50 $79.00 $21.07 $106.14 $57.63 $57.63 $57.63 $57.63 $106.14 $106.14 $106.14 $22.12 $106.14 $78.78 $78.78 $81.81 $55.30 $22.12 $106.14 $106.14 $62.78 $106.14 $106.14 $106.14 $106.14 $79.88 $106.14 $106.14 $106.14 $53.07 $53.07 $84.06 $106.14 $84.91 $68.99 $21.07 N/A $61.77 $106.14 $106.14 $106.14 $22.12 $106.14 N/A N/A M001465231 SUP HCPCS C1769 M001465231 - GUIDEWIRE URO STRG TPR .035IN 145CM 7CM AMP SPST BOTH IP/OP $65.00 $48.00 $12.90 $65.00 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $65.00 $38.45 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A M001465231 SUP HCPCS C1769 M001465231 - GUIDEWIRE VASCULAR STR .035IN 145CM 7CM FLEXIBLE TIP AMPLATZ BOTH IP/OP $66.50 $49.00 $12.90 $65.00 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $65.00 $38.45 $65.00 $65.00 $65.00 $65.00 $49.88 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 N/A $38.57 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A M001465241 SUP HCPCS C1769 M001465241 - GUIDEWIRE VASCULAR STR .035IN 145CM 3.5CM SUPER STIFF SHAFT BOTH IP/OP $66.50 $49.00 $13.13 $66.15 $35.92 $35.92 $35.92 $35.92 $66.15 $66.15 $66.15 $13.79 $66.15 $49.10 $49.10 $50.99 $34.46 $13.79 $66.15 $66.15 $39.13 $66.15 $66.15 $66.15 $66.15 $49.88 $66.15 $66.15 $66.15 $33.08 $33.08 $52.39 $66.15 $52.92 $43.00 $13.13 N/A $38.57 $66.15 $66.15 $66.15 $13.79 $66.15 N/A N/A M001465251 SUP HCPCS C1769 M001465251 - GUIDEWIRE URO STRG .035IN 180CM 7CM AMP SPST BOTH IP/OP $101.50 $75.00 $20.14 $101.48 $55.10 $55.10 $55.10 $55.10 $101.48 $101.48 $101.48 $21.15 $101.48 $75.32 $75.32 $78.22 $52.87 $21.15 $101.48 $101.48 $60.03 $101.48 $101.48 $101.48 $101.48 $76.13 $101.48 $101.48 $101.48 $50.74 $50.74 $80.37 $101.48 $81.18 $65.96 $20.14 N/A $58.87 $101.48 $101.48 $101.48 $21.15 $101.48 N/A N/A M001465251 SUP HCPCS C1769 M001465251 - GUIDEWIRE VASCULAR TAPER .035IN 180CM 7CM STR TIP AMPLATZ BOTH IP/OP $101.50 $75.00 $20.14 $101.48 $55.10 $55.10 $55.10 $55.10 $101.48 $101.48 $101.48 $21.15 $101.48 $75.32 $75.32 $78.22 $52.87 $21.15 $101.48 $101.48 $60.03 $101.48 $101.48 $101.48 $101.48 $76.13 $101.48 $101.48 $101.48 $50.74 $50.74 $80.37 $101.48 $81.18 $65.96 $20.14 N/A $58.87 $101.48 $101.48 $101.48 $21.15 $101.48 N/A N/A M001465261 SUP HCPCS C1769 M001465261 - GUIDEWIRE URO STRG .035IN 260CM 7CM AMP SPST BOTH IP/OP $106.50 $79.00 $21.07 $106.14 $57.63 $57.63 $57.63 $57.63 $106.14 $106.14 $106.14 $22.12 $106.14 $78.78 $78.78 $81.81 $55.30 $22.12 $106.14 $106.14 $62.78 $106.14 $106.14 $106.14 $106.14 $79.88 $106.14 $106.14 $106.14 $53.07 $53.07 $84.06 $106.14 $84.91 $68.99 $21.07 N/A $61.77 $106.14 $106.14 $106.14 $22.12 $106.14 N/A N/A M001465261 SUP HCPCS C1769 M001465261 - GUIDEWIRE VASCULAR STR .035IN 260CM 7CM FLEXIBLE TIP AMPLATZ BOTH IP/OP $106.50 $79.00 $21.07 $106.14 $57.63 $57.63 $57.63 $57.63 $106.14 $106.14 $106.14 $22.12 $106.14 $78.78 $78.78 $81.81 $55.30 $22.12 $106.14 $106.14 $62.78 $106.14 $106.14 $106.14 $106.14 $79.88 $106.14 $106.14 $106.14 $53.07 $53.07 $84.06 $106.14 $84.91 $68.99 $21.07 N/A $61.77 $106.14 $106.14 $106.14 $22.12 $106.14 N/A N/A M001465501 SUP Custom 27203010 M001465501 - VISE TORQUE ACCEPTS .025-.038 IN GWIRE BOTH IP/OP $156.00 $115.00 $27.76 $155.95 $155.95 $155.95 $155.95 $155.95 $155.95 $155.95 $27.76 $155.95 $155.95 $115.75 $115.75 $120.21 $81.25 $32.50 $155.95 $62.38 $155.95 $155.95 $155.95 $155.95 $155.95 $117.00 $155.95 $155.95 $155.95 $77.98 $77.98 $123.51 $155.95 $124.76 $101.37 $155.95 N/A $90.48 $155.95 $93.57 $155.95 $155.95 $155.95 N/A N/A M001465631 SUP HCPCS C1769 M001465631 - GUIDEWIRE URO STRG .035IN 75CM 7CM AMP SPST BOTH IP/OP $65.00 $48.00 $12.90 $65.00 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $65.00 $38.45 $65.00 $65.00 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A M001465631 SUP HCPCS C1769 M001465631 - GUIDEWIRE VASCULAR .035IN 75CM 7CM DISTAL STR TIP ATRAUMATIC BOTH IP/OP $66.50 $49.00 $12.90 $65.00 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $65.00 $38.45 $65.00 $65.00 $65.00 $65.00 $49.88 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 N/A $38.57 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A M001465641 SUP HCPCS C1769 M001465641 - GUIDEWIRE VASCULAR STR .038IN 75CM 6CM FLOPPY TIP AMPLATZ BOTH IP/OP $66.50 $49.00 $13.13 $66.15 $35.92 $35.92 $35.92 $35.92 $66.15 $66.15 $66.15 $13.79 $66.15 $49.10 $49.10 $50.99 $34.46 $13.79 $66.15 $66.15 $39.13 $66.15 $66.15 $66.15 $66.15 $49.88 $66.15 $66.15 $66.15 $33.08 $33.08 $52.39 $66.15 $52.92 $43.00 $13.13 N/A $38.57 $66.15 $66.15 $66.15 $13.79 $66.15 N/A N/A M001465911 SUP HCPCS C1769 M001465911 - GUIDEWIRE VASCULAR SHAPEABLE CURVE .035IN 180CM 5CM STR TIP BOTH IP/OP $127.00 $94.00 $25.12 $126.58 $68.73 $68.73 $68.73 $68.73 $126.58 $126.58 $126.58 $26.38 $126.58 $93.95 $93.95 $97.57 $65.95 $26.38 $126.58 $126.58 $74.87 $126.58 $126.58 $126.58 $126.58 $95.25 $126.58 $126.58 $126.58 $63.29 $63.29 $100.25 $126.58 $101.26 $82.28 $25.12 N/A $73.66 $126.58 $126.58 $126.58 $26.38 $126.58 N/A N/A M001465921 SUP HCPCS C1769 M001465921 - GUIDEWIRE VASCULAR SHAPEABLE CURVE .035IN 260CM 5CM STR TIP BOTH IP/OP $127.00 $94.00 $25.12 $126.58 $68.73 $68.73 $68.73 $68.73 $126.58 $126.58 $126.58 $26.38 $126.58 $93.95 $93.95 $97.57 $65.95 $26.38 $126.58 $126.58 $74.87 $126.58 $126.58 $126.58 $126.58 $95.25 $126.58 $126.58 $126.58 $63.29 $63.29 $100.25 $126.58 $101.26 $82.28 $25.12 N/A $73.66 $126.58 $126.58 $126.58 $26.38 $126.58 N/A N/A M001466000 SUP HCPCS C1769 M001466000 - GUIDEWIRE VASCULAR LONG .018IN 145CM 10CM RADIOPQ PLATINUM BOTH IP/OP $194.50 $144.00 $38.57 $194.35 $105.53 $105.53 $105.53 $105.53 $194.35 $194.35 $194.35 $40.51 $194.35 $144.25 $144.25 $149.80 $101.26 $40.50 $194.35 $194.35 $114.96 $194.35 $194.35 $194.35 $194.35 $145.88 $194.35 $194.35 $194.35 $97.18 $97.18 $153.93 $194.35 $155.48 $126.33 $38.57 N/A $112.81 $194.35 $194.35 $194.35 $40.50 $194.35 N/A N/A M001466010 SUP HCPCS C1769 M001466010 - GUIDEWIRE VASCULAR LONG .018IN 180CM 10CM RADIOPQ PLATINUM BOTH IP/OP $194.50 $144.00 $38.57 $194.35 $105.53 $105.53 $105.53 $105.53 $194.35 $194.35 $194.35 $40.51 $194.35 $144.25 $144.25 $149.80 $101.26 $40.50 $194.35 $194.35 $114.96 $194.35 $194.35 $194.35 $194.35 $145.88 $194.35 $194.35 $194.35 $97.18 $97.18 $153.93 $194.35 $155.48 $126.33 $38.57 N/A $112.81 $194.35 $194.35 $194.35 $40.50 $194.35 N/A N/A M001466020 SUP HCPCS C1769 M001466020 - GUIDEWIRE VASCULAR LONG .018IN 260CM 8CM RADIOPQ PLATINUM BOTH IP/OP $203.50 $151.00 $40.36 $203.35 $110.42 $110.42 $110.42 $110.42 $203.35 $203.35 $203.35 $42.38 $203.35 $150.93 $150.93 $156.74 $105.95 $42.38 $203.35 $203.35 $120.28 $203.35 $203.35 $203.35 $203.35 $152.63 $203.35 $203.35 $203.35 $101.68 $101.68 $161.05 $203.35 $162.68 $132.18 $40.36 N/A $118.03 $203.35 $203.35 $203.35 $42.38 $203.35 N/A N/A M001466040 SUP HCPCS C1769 M001466040 - GUIDEWIRE VASCULAR SHORT .018IN 180CM 3CM RADIOPQ PLATINUM BOTH IP/OP $194.50 $144.00 $38.57 $194.35 $105.53 $105.53 $105.53 $105.53 $194.35 $194.35 $194.35 $40.51 $194.35 $144.25 $144.25 $149.80 $101.26 $40.50 $194.35 $194.35 $114.96 $194.35 $194.35 $194.35 $194.35 $145.88 $194.35 $194.35 $194.35 $97.18 $97.18 $153.93 $194.35 $155.48 $126.33 $38.57 N/A $112.81 $194.35 $194.35 $194.35 $40.50 $194.35 N/A N/A M001466050 SUP HCPCS C1769 M001466050 - GUIDEWIRE VASC .018IN 260CM 3CM PLTN + SHRT TPR TIP RADOPQ BOTH IP/OP $203.50 $151.00 $40.36 $203.35 $110.42 $110.42 $110.42 $110.42 $203.35 $203.35 $203.35 $42.38 $203.35 $150.93 $150.93 $156.74 $105.95 $42.38 $203.35 $203.35 $120.28 $203.35 $203.35 $203.35 $203.35 $152.63 $203.35 $203.35 $203.35 $101.68 $101.68 $161.05 $203.35 $162.68 $132.18 $40.36 N/A $118.03 $203.35 $203.35 $203.35 $42.38 $203.35 N/A N/A M001466100 SUP HCPCS C1769 M001466100 - GUIDEWIRE VASCULAR SHORT .025IN 180CM 3CM RADIOPQ PLATINUM BOTH IP/OP $194.50 $144.00 $38.57 $194.35 $105.53 $105.53 $105.53 $105.53 $194.35 $194.35 $194.35 $40.51 $194.35 $144.25 $144.25 $149.80 $101.26 $40.50 $194.35 $194.35 $114.96 $194.35 $194.35 $194.35 $194.35 $145.88 $194.35 $194.35 $194.35 $97.18 $97.18 $153.93 $194.35 $155.48 $126.33 $38.57 N/A $112.81 $194.35 $194.35 $194.35 $40.50 $194.35 N/A N/A M001466110 SUP HCPCS C1769 M001466110 - GUIDEWIRE VASCULAR SHORT .025IN 260CM 3CM RADIOPQ PLATINUM BOTH IP/OP $202.50 $150.00 $40.16 $202.33 $109.87 $109.87 $109.87 $109.87 $202.33 $202.33 $202.33 $42.17 $202.33 $150.17 $150.17 $155.96 $105.41 $42.17 $202.33 $202.33 $119.68 $202.33 $202.33 $202.33 $202.33 $151.88 $202.33 $202.33 $202.33 $101.17 $101.17 $160.25 $202.33 $161.86 $131.51 $40.16 N/A $117.45 $202.33 $202.33 $202.33 $42.17 $202.33 N/A N/A M001467120 SUP HCPCS C1769 M001467120 - GUIDEWIRE VASCULAR .014IN 300CM 7CM SHORT TAPER STR TIP BOTH IP/OP $203.50 $151.00 $40.36 $203.35 $110.42 $110.42 $110.42 $110.42 $203.35 $203.35 $203.35 $42.38 $203.35 $150.93 $150.93 $156.74 $105.95 $42.38 $203.35 $203.35 $120.28 $203.35 $203.35 $203.35 $203.35 $152.63 $203.35 $203.35 $203.35 $101.68 $101.68 $161.05 $203.35 $162.68 $132.18 $40.36 N/A $118.03 $203.35 $203.35 $203.35 $42.38 $203.35 N/A N/A M001467300 SUP HCPCS C1769 M001467300 - GUIDEWIRE VASCULAR STR .018IN 60CM 3CM RADIOPQ PLATINUM PLUS BOTH IP/OP $203.50 $151.00 $40.36 $203.35 $110.42 $110.42 $110.42 $110.42 $203.35 $203.35 $203.35 $42.38 $203.35 $150.93 $150.93 $156.74 $105.95 $42.38 $203.35 $203.35 $120.28 $203.35 $203.35 $203.35 $203.35 $152.63 $203.35 $203.35 $203.35 $101.68 $101.68 $161.05 $203.35 $162.68 $132.18 $40.36 N/A $118.03 $203.35 $203.35 $203.35 $42.38 $203.35 N/A N/A M001467310 SUP HCPCS C1769 M001467310 - GUIDEWIRE VASCULAR STR .018IN 180CM 3CM RADIOPQ PLATINUM BOTH IP/OP $203.50 $151.00 $40.36 $203.35 $110.42 $110.42 $110.42 $110.42 $203.35 $203.35 $203.35 $42.38 $203.35 $150.93 $150.93 $156.74 $105.95 $42.38 $203.35 $203.35 $120.28 $203.35 $203.35 $203.35 $203.35 $152.63 $203.35 $203.35 $203.35 $101.68 $101.68 $161.05 $203.35 $162.68 $132.18 $40.36 N/A $118.03 $203.35 $203.35 $203.35 $42.38 $203.35 N/A N/A M001467320 SUP HCPCS C1769 M001467320 - GUIDEWIRE VASCULAR STR .018IN 260CM 3CM RADIOPQ PLATINUM BOTH IP/OP $203.50 $151.00 $40.36 $203.35 $110.42 $110.42 $110.42 $110.42 $203.35 $203.35 $203.35 $42.38 $203.35 $150.93 $150.93 $156.74 $105.95 $42.38 $203.35 $203.35 $120.28 $203.35 $203.35 $203.35 $203.35 $152.63 $203.35 $203.35 $203.35 $101.68 $101.68 $161.05 $203.35 $162.68 $132.18 $40.36 N/A $118.03 $203.35 $203.35 $203.35 $42.38 $203.35 N/A N/A M001467400 SUP HCPCS C1769 M001467400 - GUIDEWIRE VASCULAR .014IN 180CM 3CM RADIOPQ PLATINUM PLUS BOTH IP/OP $203.50 $151.00 $40.36 $203.35 $110.42 $110.42 $110.42 $110.42 $203.35 $203.35 $203.35 $42.38 $203.35 $150.93 $150.93 $156.74 $105.95 $42.38 $203.35 $203.35 $120.28 $203.35 $203.35 $203.35 $203.35 $152.63 $203.35 $203.35 $203.35 $101.68 $101.68 $161.05 $203.35 $162.68 $132.18 $40.36 N/A $118.03 $203.35 $203.35 $203.35 $42.38 $203.35 N/A N/A M001468010 SUP HCPCS C1769 M001468010 - GUIDEWIRE VASCULAR STR .014IN 190CM 2CM STEERABLE TRANSEND BOTH IP/OP $546.00 $404.00 $108.37 $546.00 $296.48 $296.48 $296.48 $296.48 $546.00 $546.00 $546.00 $113.80 $546.00 $405.24 $405.24 $420.86 $284.47 $113.79 $546.00 $546.00 $322.96 $546.00 $546.00 $546.00 $546.00 $409.50 $546.00 $546.00 $546.00 $273.00 $273.00 $432.43 $546.00 $436.80 $354.90 $108.37 N/A $316.68 $546.00 $546.00 $546.00 $113.79 $546.00 N/A N/A M001468050 SUP HCPCS C1769 M001468050 - GUIDEWIRE VASC .014IN 182CM 2CM TRNSD EX RADOPQ HDRPH PLTN BOTH IP/OP $587.50 $435.00 $116.60 "$1,116.25" $319.01 $319.01 $319.01 $319.01 $587.50 $587.50 $587.50 $122.45 $587.50 $436.04 $436.04 $452.85 $306.09 $122.44 $587.50 "$1,116.25" $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $381.88 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A M001468070 SUP HCPCS C1769 M001468070 - GUIDEWIRE VASC .014IN 205CM 2CM TRNSD EX SHP FLPY BOTH IP/OP "$1,116.50" $826.00 $221.55 "$1,116.25" $606.12 $606.12 $606.12 $606.12 "$1,116.25" "$1,116.25" "$1,116.25" $232.65 "$1,116.25" $828.48 $828.48 $860.41 $581.57 $232.64 "$1,116.25" "$1,116.25" $660.26 "$1,116.25" "$1,116.25" "$1,116.25" "$1,116.25" $837.38 "$1,116.25" "$1,116.25" "$1,116.25" $558.13 $558.13 $884.07 "$1,116.25" $893.00 $725.56 $221.55 N/A $647.57 "$1,116.25" "$1,116.25" "$1,116.25" $232.63 "$1,116.25" N/A N/A M001468100 SUP HCPCS C1769 M001468100 - GUIDEWIRE VASCULAR STR .014IN 135CM 2CM STEERABLE TRANSEND BOTH IP/OP $546.00 $404.00 $108.37 $546.00 $296.48 $296.48 $296.48 $296.48 $546.00 $546.00 $546.00 $113.80 $546.00 $405.24 $405.24 $420.86 $284.47 $113.79 $546.00 $546.00 $322.96 $546.00 $546.00 $546.00 $546.00 $409.50 $546.00 $546.00 $546.00 $273.00 $273.00 $432.43 $546.00 $436.80 $354.90 $108.37 N/A $316.68 $546.00 $546.00 $546.00 $113.79 $546.00 N/A N/A M001468110 SUP HCPCS C1769 M001468110 - GUIDEWIRE VASCULAR STR .014IN 165CM 2CM STEERABLE TRANSEND BOTH IP/OP $546.00 $404.00 $108.37 $546.00 $296.48 $296.48 $296.48 $296.48 $546.00 $546.00 $546.00 $113.80 $546.00 $405.24 $405.24 $420.86 $284.47 $113.79 $546.00 $546.00 $322.96 $546.00 $546.00 $546.00 $546.00 $409.50 $546.00 $546.00 $546.00 $273.00 $273.00 $432.43 $546.00 $436.80 $354.90 $108.37 N/A $316.68 $546.00 $546.00 $546.00 $113.79 $546.00 N/A N/A M001468120 SUP HCPCS C1769 M001468120 - GUIDEWIRE VASCULAR STR .018IN 135CM 2CM STEERABLE TRANSEND BOTH IP/OP $546.00 $404.00 $108.37 $546.00 $296.48 $296.48 $296.48 $296.48 $546.00 $546.00 $546.00 $113.80 $546.00 $405.24 $405.24 $420.86 $284.47 $113.79 $546.00 $546.00 $322.96 $546.00 $546.00 $546.00 $546.00 $409.50 $546.00 $546.00 $546.00 $273.00 $273.00 $432.43 $546.00 $436.80 $354.90 $108.37 N/A $316.68 $546.00 $546.00 $546.00 $113.79 $546.00 N/A N/A M001468130 SUP HCPCS C1769 M001468130 - GUIDEWIRE VASCULAR STR .018IN 165CM 2CM STEERABLE TRANSEND BOTH IP/OP $546.00 $404.00 $108.37 $546.00 $296.48 $296.48 $296.48 $296.48 $546.00 $546.00 $546.00 $113.80 $546.00 $405.24 $405.24 $420.86 $284.47 $113.79 $546.00 $546.00 $322.96 $546.00 $546.00 $546.00 $546.00 $409.50 $546.00 $546.00 $546.00 $273.00 $273.00 $432.43 $546.00 $436.80 $354.90 $108.37 N/A $316.68 $546.00 $546.00 $546.00 $113.79 $546.00 N/A N/A M001468480 SUP HCPCS C1769 M001468480 - GUIDEWIRE VASCULAR STR .018IN 110CM 8CM RADIOPQ V-18 BOTH IP/OP $211.00 $156.00 $41.88 $211.00 $114.57 $114.57 $114.57 $114.57 $211.00 $211.00 $211.00 $43.98 $211.00 $156.60 $156.60 $162.64 $109.93 $43.97 $211.00 $211.00 $124.81 $211.00 $211.00 $211.00 $211.00 $158.25 $211.00 $211.00 $211.00 $105.50 $105.50 $167.11 $211.00 $168.80 $137.15 $41.88 N/A $122.38 $211.00 $211.00 $211.00 $43.97 $211.00 N/A N/A M001468500 SUP HCPCS C1769 M001468500 - GUIDEWIRE VASCULAR STR .018IN 150CM 8CM RADIOPQ V-18 BOTH IP/OP $179.00 $132.00 $35.52 $178.95 $97.17 $97.17 $97.17 $97.17 $178.95 $178.95 $178.95 $37.30 $178.95 $132.82 $132.82 $137.93 $93.23 $37.30 $178.95 $178.95 $105.85 $178.95 $178.95 $178.95 $178.95 $134.25 $178.95 $178.95 $178.95 $89.48 $89.48 $141.73 $178.95 $143.16 $116.32 $35.52 N/A $103.82 $178.95 $178.95 $178.95 $37.29 $178.95 N/A N/A M001468520 SUP HCPCS C1769 M001468520 - GUIDEWIRE VASCULAR TAPER .018IN 200CM 8CM RADIOPQ STR TIP BOTH IP/OP $189.00 $140.00 $37.42 $188.53 $102.37 $102.37 $102.37 $102.37 $188.53 $188.53 $188.53 $39.29 $188.53 $139.93 $139.93 $145.32 $98.22 $39.29 $188.53 $188.53 $111.52 $188.53 $188.53 $188.53 $188.53 $141.75 $188.53 $188.53 $188.53 $94.27 $94.27 $149.32 $188.53 $150.82 $122.54 $37.42 N/A $109.62 $188.53 $188.53 $188.53 $39.29 $188.53 N/A N/A M001468540 SUP HCPCS C1769 M001468540 - GUIDEWIRE VASCULAR TAPER .018IN 300CM 8CM RADIOPQ STR TIP BOTH IP/OP $197.50 $146.00 $39.15 $197.25 $107.11 $107.11 $107.11 $107.11 $197.25 $197.25 $197.25 $41.11 $197.25 $146.40 $146.40 $152.04 $102.77 $41.11 $197.25 $197.25 $116.67 $197.25 $197.25 $197.25 $197.25 $148.13 $197.25 $197.25 $197.25 $98.63 $98.63 $156.22 $197.25 $157.80 $128.21 $39.15 N/A $114.55 $197.25 $197.25 $197.25 $41.11 $197.25 N/A N/A M001468560 SUP HCPCS C1769 M001468560 - GUIDEWIRE VASCULAR STR .018IN 150CM 12CM RADIOPQ V-18 BOTH IP/OP $213.50 $158.00 $42.30 $213.15 $115.74 $115.74 $115.74 $115.74 $213.15 $213.15 $213.15 $44.43 $213.15 $158.20 $158.20 $164.30 $111.05 $44.42 $213.15 $213.15 $126.08 $213.15 $213.15 $213.15 $213.15 $160.13 $213.15 $213.15 $213.15 $106.58 $106.58 $168.81 $213.15 $170.52 $138.55 $42.30 N/A $123.83 $213.15 $213.15 $213.15 $44.42 $213.15 N/A N/A M001468580 SUP HCPCS C1769 M001468580 - GUIDEWIRE VASCULAR STR .018IN 200CM 12CM RADIOPQ V-18 BOTH IP/OP $213.50 $158.00 $42.30 $213.15 $115.74 $115.74 $115.74 $115.74 $213.15 $213.15 $213.15 $44.43 $213.15 $158.20 $158.20 $164.30 $111.05 $44.42 $213.15 $213.15 $126.08 $213.15 $213.15 $213.15 $213.15 $160.13 $213.15 $213.15 $213.15 $106.58 $106.58 $168.81 $213.15 $170.52 $138.55 $42.30 N/A $123.83 $213.15 $213.15 $213.15 $44.42 $213.15 N/A N/A M001468600 SUP HCPCS C1769 M001468600 - GUIDEWIRE VASCULAR STR .018IN 300CM 12CM RADIOPQ V-18 BOTH IP/OP $213.50 $158.00 $42.30 $213.15 $115.74 $115.74 $115.74 $115.74 $213.15 $213.15 $213.15 $44.43 $213.15 $158.20 $158.20 $164.30 $111.05 $44.42 $213.15 $213.15 $126.08 $213.15 $213.15 $213.15 $213.15 $160.13 $213.15 $213.15 $213.15 $106.58 $106.58 $168.81 $213.15 $170.52 $138.55 $42.30 N/A $123.83 $213.15 $213.15 $213.15 $44.42 $213.15 N/A N/A M001491001 SUP HCPCS C1769 M001491001 - GUIDEWIRE VASCULAR STANDARD TAPER .025IN 150CM 3CM FIX CORE BOTH IP/OP $15.50 $11.00 $3.03 $15.28 $8.30 $8.30 $8.30 $8.30 $15.28 $15.28 $15.28 $3.18 $15.28 $11.34 $11.34 $11.78 $7.96 $3.18 $15.28 $15.28 $9.04 $15.28 $15.28 $15.28 $15.28 $11.63 $15.28 $15.28 $15.28 $7.64 $7.64 $12.10 $15.28 $12.22 $9.93 $3.03 N/A $8.99 $15.28 $15.28 $15.28 $3.18 $15.28 N/A N/A M001491011 SUP HCPCS C1769 M001491011 - GUIDEWIRE VASCULAR .035IN 150CM 4CM FIX CORE STR TIP STARTER BOTH IP/OP $15.50 $11.00 $3.03 $15.28 $8.30 $8.30 $8.30 $8.30 $15.28 $15.28 $15.28 $3.18 $15.28 $11.34 $11.34 $11.78 $7.96 $3.18 $15.28 $15.28 $9.04 $15.28 $15.28 $15.28 $15.28 $11.63 $15.28 $15.28 $15.28 $7.64 $7.64 $12.10 $15.28 $12.22 $9.93 $3.03 N/A $8.99 $15.28 $15.28 $15.28 $3.18 $15.28 N/A N/A M001491021 SUP HCPCS C1769 M001491021 - GUIDEWIRE VASCULAR STANDARD STR SPRING COIL .038IN 150CM 3CM BOTH IP/OP $15.50 $11.00 $3.03 $15.28 $8.30 $8.30 $8.30 $8.30 $15.28 $15.28 $15.28 $3.18 $15.28 $11.34 $11.34 $11.78 $7.96 $3.18 $15.28 $15.28 $9.04 $15.28 $15.28 $15.28 $15.28 $11.63 $15.28 $15.28 $15.28 $7.64 $7.64 $12.10 $15.28 $12.22 $9.93 $3.03 N/A $8.99 $15.28 $15.28 $15.28 $3.18 $15.28 N/A N/A M001491031 SUP HCPCS C1769 M001491031 - GUIDEWIRE VASCULAR STR .035IN 260CM 3CM FIX CORE FLEXIBLE BOTH IP/OP $35.00 $26.00 $6.93 $34.94 $18.97 $18.97 $18.97 $18.97 $34.94 $34.94 $34.94 $7.28 $34.94 $25.93 $25.93 $26.93 $18.20 $7.28 $34.94 $34.94 $20.67 $34.94 $34.94 $34.94 $34.94 $26.25 $34.94 $34.94 $34.94 $17.47 $17.47 $27.67 $34.94 $27.95 $22.71 $6.93 N/A $20.30 $34.94 $34.94 $34.94 $7.28 $34.94 N/A N/A M001491451 SUP HCPCS C1769 M001491451 - GUIDEWIRE VASCULAR STR SPRING COIL .035IN 150CM 15CM STARTER BOTH IP/OP $25.00 $19.00 $4.90 $24.71 $13.42 $13.42 $13.42 $13.42 $24.71 $24.71 $24.71 $5.15 $24.71 $18.34 $18.34 $19.05 $12.87 $5.15 $24.71 $24.71 $14.62 $24.71 $24.71 $24.71 $24.71 $18.75 $24.71 $24.71 $24.71 $12.36 $12.36 $19.57 $24.71 $19.77 $16.06 $4.90 N/A $14.50 $24.71 $24.71 $24.71 $5.15 $24.71 N/A N/A M001491471 SUP HCPCS C1769 M001491471 - GUIDEWIRE VASCULAR STANDARD TAPER .035IN 180CM 15CM STR TIP BOTH IP/OP $195.50 $145.00 $38.80 $195.50 $106.16 $106.16 $106.16 $106.16 $195.50 $195.50 $195.50 $40.75 $195.50 $145.10 $145.10 $150.69 $101.86 $40.74 $195.50 $195.50 $115.64 $195.50 $195.50 $195.50 $195.50 $146.63 $195.50 $195.50 $195.50 $97.75 $97.75 $154.84 $195.50 $156.40 $127.08 $38.80 N/A $113.39 $195.50 $195.50 $195.50 $40.74 $195.50 N/A N/A M001491481 SUP HCPCS C1769 M001491481 - GUIDEWIRE VASCULAR STANDARD TAPER .035IN 260CM 15CM STR TIP BOTH IP/OP $251.50 $186.00 $49.89 $251.38 $136.50 $136.50 $136.50 $136.50 $251.38 $251.38 $251.38 $52.39 $251.38 $186.57 $186.57 $193.76 $130.97 $52.39 $251.38 $251.38 $148.69 $251.38 $251.38 $251.38 $251.38 $188.63 $251.38 $251.38 $251.38 $125.69 $125.69 $199.09 $251.38 $201.10 $163.40 $49.89 N/A $145.87 $251.38 $251.38 $251.38 $52.39 $251.38 N/A N/A M001491561 SUP HCPCS C1769 M001491561 - GUIDEWIRE VASCULAR 1.5MM STANDARD ROSEN CURVE TAPER .035IN BOTH IP/OP $130.00 $96.00 $25.78 $129.88 $70.52 $70.52 $70.52 $70.52 $129.88 $129.88 $129.88 $27.07 $129.88 $96.40 $96.40 $100.11 $67.67 $27.07 $129.88 $129.88 $76.82 $129.88 $129.88 $129.88 $129.88 $97.50 $129.88 $129.88 $129.88 $64.94 $64.94 $102.86 $129.88 $103.90 $84.42 $25.78 N/A $75.40 $129.88 $129.88 $129.88 $27.07 $129.88 N/A N/A M001491571 SUP HCPCS C1769 M001491571 - GUIDEWIRE VASCULAR 1.5MM STANDARD ROSEN CURVE TAPER .035IN BOTH IP/OP $209.00 $155.00 $41.47 $208.95 $113.46 $113.46 $113.46 $113.46 $208.95 $208.95 $208.95 $43.55 $208.95 $155.08 $155.08 $161.06 $108.86 $43.55 $208.95 $208.95 $123.59 $208.95 $208.95 $208.95 $208.95 $156.75 $208.95 $208.95 $208.95 $104.48 $104.48 $165.49 $208.95 $167.16 $135.82 $41.47 N/A $121.22 $208.95 $208.95 $208.95 $43.55 $208.95 N/A N/A M001491601 SUP HCPCS C1769 M001491601 - GUIDEWIRE VASCULAR STANDARD STR .035IN 150CM 3CM FIX CORE BOTH IP/OP $19.00 $14.00 $3.70 $18.62 $10.11 $10.11 $10.11 $10.11 $18.62 $18.62 $18.62 $3.88 $18.62 $13.82 $13.82 $14.35 $9.70 $3.88 $18.62 $18.62 $11.01 $18.62 $18.62 $18.62 $18.62 $14.25 $18.62 $18.62 $18.62 $9.31 $9.31 $14.75 $18.62 $14.90 $12.10 $3.70 N/A $11.02 $18.62 $18.62 $18.62 $3.88 $18.62 N/A N/A M001491611 SUP HCPCS C1769 M001491611 - GUIDEWIRE VASCULAR STANDARD STR .035IN 260CM 3CM FIX CORE BOTH IP/OP $37.50 $28.00 $7.39 $37.24 $20.22 $20.22 $20.22 $20.22 $37.24 $37.24 $37.24 $7.76 $37.24 $27.64 $27.64 $28.70 $19.40 $7.76 $37.24 $37.24 $22.03 $37.24 $37.24 $37.24 $37.24 $28.13 $37.24 $37.24 $37.24 $18.62 $18.62 $29.49 $37.24 $29.79 $24.21 $7.39 N/A $21.75 $37.24 $37.24 $37.24 $7.76 $37.24 N/A N/A M001491771 SUP HCPCS C1769 M001491771 - GUIDEWIRE VASCULAR BENTSON STANDARD .035IN 180CM 15CM SPRING BOTH IP/OP $216.00 $160.00 $42.87 $216.00 $117.29 $117.29 $117.29 $117.29 $216.00 $216.00 $216.00 $45.02 $216.00 $160.32 $160.32 $166.49 $112.54 $45.02 $216.00 $216.00 $127.76 $216.00 $216.00 $216.00 $216.00 $162.00 $216.00 $216.00 $216.00 $108.00 $108.00 $171.07 $216.00 $172.80 $140.40 $42.87 N/A $125.28 $216.00 $216.00 $216.00 $45.01 $216.00 N/A N/A M001491851 SUP HCPCS C1769 M001491851 - GUIDEWIRE VASCULAR J ROSEN CURVE SPRING COIL .035IN 180CM BOTH IP/OP $181.00 $134.00 $35.85 $180.63 $98.08 $98.08 $98.08 $98.08 $180.63 $180.63 $180.63 $37.65 $180.63 $134.06 $134.06 $139.23 $94.11 $37.65 $180.63 $180.63 $106.84 $180.63 $180.63 $180.63 $180.63 $135.75 $180.63 $180.63 $180.63 $90.32 $90.32 $143.06 $180.63 $144.50 $117.41 $35.85 N/A $104.98 $180.63 $180.63 $180.63 $37.64 $180.63 N/A N/A M001492031 SUP HCPCS C1769 M001492031 - GUIDEWIRE VASCULAR 3CM STR .025IN 125CM 10MM FIX CORE BOTH IP/OP $19.50 $14.00 $3.87 $19.50 $10.59 $10.59 $10.59 $10.59 $19.50 $19.50 $19.50 $4.06 $19.50 $14.47 $14.47 $15.03 $10.16 $4.06 $19.50 $19.50 $11.53 $19.50 $19.50 $19.50 $19.50 $14.63 $19.50 $19.50 $19.50 $9.75 $9.75 $15.44 $19.50 $15.60 $12.68 $3.87 N/A $11.31 $19.50 $19.50 $19.50 $4.06 $19.50 N/A N/A M001492061 SUP HCPCS C1769 M001492061 - GUIDEWIRE VASCULAR 3CM STR .028IN 150CM 10MM FIX CORE BOTH IP/OP $19.50 $14.00 $3.87 $19.50 $10.59 $10.59 $10.59 $10.59 $19.50 $19.50 $19.50 $4.06 $19.50 $14.47 $14.47 $15.03 $10.16 $4.06 $19.50 $19.50 $11.53 $19.50 $19.50 $19.50 $19.50 $14.63 $19.50 $19.50 $19.50 $9.75 $9.75 $15.44 $19.50 $15.60 $12.68 $3.87 N/A $11.31 $19.50 $19.50 $19.50 $4.06 $19.50 N/A N/A M001492081 SUP HCPCS C1769 M001492081 - GUIDEWIRE VASCULAR 3CM STR .032IN 150CM 10MM FIX CORE BOTH IP/OP $29.00 $21.00 $5.71 $28.75 $15.61 $15.61 $15.61 $15.61 $28.75 $28.75 $28.75 $5.99 $28.75 $21.34 $21.34 $22.16 $14.98 $5.99 $28.75 $28.75 $17.01 $28.75 $28.75 $28.75 $28.75 $21.75 $28.75 $28.75 $28.75 $14.38 $14.38 $22.77 $28.75 $23.00 $18.69 $5.71 N/A $16.82 $28.75 $28.75 $28.75 $5.99 $28.75 N/A N/A M001492111 SUP HCPCS C1769 M001492111 - GUIDEWIRE VASCULAR 3CM STR .035IN 125CM 10MM FIX CORE BOTH IP/OP $19.50 $14.00 $3.87 $19.50 $10.59 $10.59 $10.59 $10.59 $19.50 $19.50 $19.50 $4.06 $19.50 $14.47 $14.47 $15.03 $10.16 $4.06 $19.50 $19.50 $11.53 $19.50 $19.50 $19.50 $19.50 $14.63 $19.50 $19.50 $19.50 $9.75 $9.75 $15.44 $19.50 $15.60 $12.68 $3.87 N/A $11.31 $19.50 $19.50 $19.50 $4.06 $19.50 N/A N/A M001492121 SUP HCPCS C1769 M001492121 - GUIDEWIRE VASCULAR STR .035IN 180CM 3CM FIX CORE STARTER BOTH IP/OP $38.50 $28.00 $7.63 $38.45 $20.88 $20.88 $20.88 $20.88 $38.45 $38.45 $38.45 $8.01 $38.45 $28.54 $28.54 $29.64 $20.03 $8.01 $38.45 $38.45 $22.74 $38.45 $38.45 $38.45 $38.45 $28.88 $38.45 $38.45 $38.45 $19.23 $19.23 $30.45 $38.45 $30.76 $24.99 $7.63 N/A $22.33 $38.45 $38.45 $38.45 $8.01 $38.45 N/A N/A M001492311 SUP HCPCS C1769 M001492311 - GUIDEWIRE VASCULAR STR .035IN 80CM 3MM FIX CORE STARTER PTFE BOTH IP/OP $15.50 $11.00 $3.03 $15.28 $8.30 $8.30 $8.30 $8.30 $15.28 $15.28 $15.28 $3.18 $15.28 $11.34 $11.34 $11.78 $7.96 $3.18 $15.28 $15.28 $9.04 $15.28 $15.28 $15.28 $15.28 $11.63 $15.28 $15.28 $15.28 $7.64 $7.64 $12.10 $15.28 $12.22 $9.93 $3.03 N/A $8.99 $15.28 $15.28 $15.28 $3.18 $15.28 N/A N/A M001492751 SUP HCPCS C1769 M001492751 - GUIDEWIRE VASCULAR .018IN 130CM 3CM SHORT TAPER STR TIP BOTH IP/OP $196.00 $145.00 $38.90 $196.00 $106.43 $106.43 $106.43 $106.43 $196.00 $196.00 $196.00 $40.85 $196.00 $145.47 $145.47 $151.08 $102.12 $40.85 $196.00 $196.00 $115.93 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $127.40 $38.90 N/A $113.68 $196.00 $196.00 $196.00 $40.85 $196.00 N/A N/A M001492761 SUP HCPCS C1769 M001492761 - GUIDEWIRE VASCULAR J SHORT TAPER .018IN 130CM 3CM THRUWAY BOTH IP/OP $196.00 $145.00 $38.90 $196.00 $106.43 $106.43 $106.43 $106.43 $196.00 $196.00 $196.00 $40.85 $196.00 $145.47 $145.47 $151.08 $102.12 $40.85 $196.00 $196.00 $115.93 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $127.40 $38.90 N/A $113.68 $196.00 $196.00 $196.00 $40.85 $196.00 N/A N/A M001492771 SUP HCPCS C1769 M001492771 - GUIDEWIRE VASCULAR STR LONG TAPER .018IN 130CM 3CM SHAPEABLE BOTH IP/OP $196.00 $145.00 $38.90 $196.00 $106.43 $106.43 $106.43 $106.43 $196.00 $196.00 $196.00 $40.85 $196.00 $145.47 $145.47 $151.08 $102.12 $40.85 $196.00 $196.00 $115.93 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $127.40 $38.90 N/A $113.68 $196.00 $196.00 $196.00 $40.85 $196.00 N/A N/A M001492781 SUP HCPCS C1769 M001492781 - GUIDEWIRE VASCULAR J LONG TAPER .018IN 130CM 3CM THRUWAY BOTH IP/OP $210.50 $156.00 $41.70 $210.10 $114.08 $114.08 $114.08 $114.08 $210.10 $210.10 $210.10 $43.79 $210.10 $155.94 $155.94 $161.95 $109.46 $43.79 $210.10 $210.10 $124.27 $210.10 $210.10 $210.10 $210.10 $157.88 $210.10 $210.10 $210.10 $105.05 $105.05 $166.40 $210.10 $168.08 $136.57 $41.70 N/A $122.09 $210.10 $210.10 $210.10 $43.78 $210.10 N/A N/A M001492791 SUP HCPCS C1769 M001492791 - GUIDEWIRE VASCULAR STR SHORT TAPER .018IN 190CM 3CM BOTH IP/OP $196.00 $145.00 $38.90 $196.00 $106.43 $106.43 $106.43 $106.43 $196.00 $196.00 $196.00 $40.85 $196.00 $145.47 $145.47 $151.08 $102.12 $40.85 $196.00 $196.00 $115.93 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $127.40 $38.90 N/A $113.68 $196.00 $196.00 $196.00 $40.85 $196.00 N/A N/A M001492801 SUP HCPCS C1769 M001492801 - GUIDEWIRE VASCULAR .018IN 190CM 3CM SHORT TAPER J TIP DISTAL BOTH IP/OP $196.00 $145.00 $38.90 $196.00 $106.43 $106.43 $106.43 $106.43 $196.00 $196.00 $196.00 $40.85 $196.00 $145.47 $145.47 $151.08 $102.12 $40.85 $196.00 $196.00 $115.93 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $127.40 $38.90 N/A $113.68 $196.00 $196.00 $196.00 $40.85 $196.00 N/A N/A M001492811 SUP HCPCS C1769 M001492811 - GUIDEWIRE VASCULAR STR LONG TAPER .018IN 190CM 3CM SHAPEABLE BOTH IP/OP $196.00 $145.00 $38.90 $196.00 $106.43 $106.43 $106.43 $106.43 $196.00 $196.00 $196.00 $40.85 $196.00 $145.47 $145.47 $151.08 $102.12 $40.85 $196.00 $196.00 $115.93 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $127.40 $38.90 N/A $113.68 $196.00 $196.00 $196.00 $40.85 $196.00 N/A N/A M001492821 SUP HCPCS C1769 M001492821 - GUIDEWIRE VASCULAR J LONG TAPER .018IN 190CM 3CM THRUWAY BOTH IP/OP $196.00 $145.00 $38.90 $196.00 $106.43 $106.43 $106.43 $106.43 $196.00 $196.00 $196.00 $40.85 $196.00 $145.47 $145.47 $151.08 $102.12 $40.85 $196.00 $196.00 $115.93 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $127.40 $38.90 N/A $113.68 $196.00 $196.00 $196.00 $40.85 $196.00 N/A N/A M001492831 SUP HCPCS C1769 M001492831 - GUIDEWIRE VASCULAR STR SHORT TAPER .018IN 300CM 3CM BOTH IP/OP $196.00 $145.00 $38.90 $196.00 $106.43 $106.43 $106.43 $106.43 $196.00 $196.00 $196.00 $40.85 $196.00 $145.47 $145.47 $151.08 $102.12 $40.85 $196.00 $196.00 $115.93 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $127.40 $38.90 N/A $113.68 $196.00 $196.00 $196.00 $40.85 $196.00 N/A N/A M001492841 SUP HCPCS C1769 M001492841 - GUIDEWIRE VASCULAR J SHORT TAPER .018IN 300CM 3CM THRUWAY BOTH IP/OP $196.00 $145.00 $38.90 $196.00 $106.43 $106.43 $106.43 $106.43 $196.00 $196.00 $196.00 $40.85 $196.00 $145.47 $145.47 $151.08 $102.12 $40.85 $196.00 $196.00 $115.93 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $127.40 $38.90 N/A $113.68 $196.00 $196.00 $196.00 $40.85 $196.00 N/A N/A M001492851 SUP HCPCS C1769 M001492851 - GUIDEWIRE VASCULAR STR LONG TAPER .018IN 300CM 3CM SHAPEABLE BOTH IP/OP $196.00 $145.00 $38.90 $196.00 $106.43 $106.43 $106.43 $106.43 $196.00 $196.00 $196.00 $40.85 $196.00 $145.47 $145.47 $151.08 $102.12 $40.85 $196.00 $196.00 $115.93 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $127.40 $38.90 N/A $113.68 $196.00 $196.00 $196.00 $40.85 $196.00 N/A N/A M001492861 SUP HCPCS C1769 M001492861 - GUIDEWIRE VASCULAR J LONG TAPER .018IN 300CM 3CM THRUWAY BOTH IP/OP $196.00 $145.00 $38.90 $196.00 $106.43 $106.43 $106.43 $106.43 $196.00 $196.00 $196.00 $40.85 $196.00 $145.47 $145.47 $151.08 $102.12 $40.85 $196.00 $196.00 $115.93 $196.00 $196.00 $196.00 $196.00 $147.00 $196.00 $196.00 $196.00 $98.00 $98.00 $155.23 $196.00 $156.80 $127.40 $38.90 N/A $113.68 $196.00 $196.00 $196.00 $40.85 $196.00 N/A N/A M001503000 SUP HCPCS C1884 M001503000 - FILTER VASCULAR 12FR INTROD GREENFIELD TITANIUM VENA CAVA BOTH IP/OP "$2,497.50" "$1,848.00" $495.64 "$2,497.25" "$1,123.76" "$1,123.76" "$1,123.76" "$1,123.76" "$2,497.25" "$2,497.25" "$2,497.25" $520.49 "$2,497.25" "$2,497.25" "$2,497.25" "$2,497.25" "$2,497.25" $520.45 "$2,497.25" "$2,497.25" "$1,477.12" "$2,497.25" "$2,497.25" "$2,497.25" "$2,497.25" "$1,873.13" "$2,497.25" "$2,497.25" "$2,497.25" "$1,248.63" "$1,248.63" "$1,977.82" "$2,497.25" "$1,997.80" "$1,123.76" $495.64 N/A "$1,448.55" "$2,497.25" "$2,497.25" "$2,497.25" $520.43 "$2,497.25" N/A N/A M001503010 SUP HCPCS C1884 M001503010 - FILTER VASCULAR 15FR INTROD GREENFIELD TITANIUM VENA CAVA BOTH IP/OP "$2,497.50" "$1,848.00" $495.64 "$2,497.25" "$1,123.76" "$1,123.76" "$1,123.76" "$1,123.76" "$2,497.25" "$2,497.25" "$2,497.25" $520.49 "$2,497.25" "$2,497.25" "$2,497.25" "$2,497.25" "$2,497.25" $520.45 "$2,497.25" "$2,497.25" "$1,477.12" "$2,497.25" "$2,497.25" "$2,497.25" "$2,497.25" "$1,873.13" "$2,497.25" "$2,497.25" "$2,497.25" "$1,248.63" "$1,248.63" "$1,977.82" "$2,497.25" "$1,997.80" "$1,123.76" $495.64 N/A "$1,448.55" "$2,497.25" "$2,497.25" "$2,497.25" $520.43 "$2,497.25" N/A N/A M001503350 SUP Custom 27803010 M001503350 - DILATOR VASC 12FR INTRO 6-14FR GRNFLD RADOPQ TI VC BOTH IP/OP $162.50 $120.00 $28.93 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $28.93 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $65.00 $162.50 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $162.50 N/A $94.25 $162.50 $97.50 $162.50 $162.50 $162.50 N/A N/A M001503500 SUP HCPCS C1884 M001503500 - FILTER VASCULAR 12FR 47MM 38MM KIT GREENFIELD TITANIUM VENA BOTH IP/OP $332.50 $246.00 $65.99 $332.50 $149.63 $149.63 $149.63 $149.63 $332.50 $332.50 $332.50 $69.30 $332.50 $332.50 $332.50 $332.50 $332.50 $69.30 $332.50 $332.50 $196.67 $332.50 $332.50 $332.50 $332.50 $249.38 $332.50 $332.50 $332.50 $166.25 $166.25 $263.34 $332.50 $266.00 $149.63 $65.99 N/A $192.85 $332.50 $332.50 $332.50 $69.29 $332.50 N/A N/A M001504000 SUP Custom 27803010 M001504000 - FILTER VASCULAR .035IN 12FR 46MM 32MM OTW REINFORCE SHEATH BOTH IP/OP "$2,364.00" "$1,749.00" $420.71 "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" $420.71 "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" $492.59 "$2,363.53" $945.41 "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" "$1,773.00" "$2,363.53" "$2,363.53" "$2,363.53" "$1,181.77" "$1,181.77" "$1,871.92" "$2,363.53" "$1,890.82" "$1,063.59" "$2,363.53" N/A "$1,371.12" "$2,363.53" "$1,418.12" "$2,363.53" "$2,363.53" "$2,363.53" N/A N/A M001505010 SUP Custom 27803010 M001505010 - FILTER VASCULAR 12FR OTW CAPSULE GREENFIELD FEMORAL SYSTEM BOTH IP/OP "$2,364.00" "$1,749.00" $420.71 "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" $420.71 "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" $492.59 "$2,363.53" $945.41 "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" "$2,363.53" "$1,773.00" "$2,363.53" "$2,363.53" "$2,363.53" "$1,181.77" "$1,181.77" "$1,871.92" "$2,363.53" "$1,890.82" "$1,063.59" "$2,363.53" N/A "$1,371.12" "$2,363.53" "$1,418.12" "$2,363.53" "$2,363.53" "$2,363.53" N/A N/A M001509000 SUP HCPCS C1769 M001509000 - GUIDEWIRE VASCULAR STR .016IN 140CM 25CM STEERABLE FATHOM BOTH IP/OP $744.50 $551.00 $147.73 $744.33 $404.17 $404.17 $404.17 $404.17 $744.33 $744.33 $744.33 $155.14 $744.33 $552.44 $552.44 $573.73 $387.80 $155.13 $744.33 $744.33 $440.27 $744.33 $744.33 $744.33 $744.33 $558.38 $744.33 $744.33 $744.33 $372.17 $372.17 $589.51 $744.33 $595.46 $483.81 $147.73 N/A $431.81 $744.33 $744.33 $744.33 $155.12 $744.33 N/A N/A M001509010 SUP HCPCS C1769 M001509010 - GUIDEWIRE VASCULAR STR .016IN 140CM 35CM STEERABLE FATHOM BOTH IP/OP $744.50 $551.00 $147.73 $744.33 $404.17 $404.17 $404.17 $404.17 $744.33 $744.33 $744.33 $155.14 $744.33 $552.44 $552.44 $573.73 $387.80 $155.13 $744.33 $744.33 $440.27 $744.33 $744.33 $744.33 $744.33 $558.38 $744.33 $744.33 $744.33 $372.17 $372.17 $589.51 $744.33 $595.46 $483.81 $147.73 N/A $431.81 $744.33 $744.33 $744.33 $155.12 $744.33 N/A N/A M001509100 SUP HCPCS C1769 M001509100 - GUIDEWIRE VASCULAR .016IN 180CM 25CM STEERABLE STR TIP BOTH IP/OP $744.50 $551.00 $147.73 $744.33 $404.17 $404.17 $404.17 $404.17 $744.33 $744.33 $744.33 $155.14 $744.33 $552.44 $552.44 $573.73 $387.80 $155.13 $744.33 $744.33 $440.27 $744.33 $744.33 $744.33 $744.33 $558.38 $744.33 $744.33 $744.33 $372.17 $372.17 $589.51 $744.33 $595.46 $483.81 $147.73 N/A $431.81 $744.33 $744.33 $744.33 $155.12 $744.33 N/A N/A M001509110 SUP HCPCS C1769 M001509110 - GUIDEWIRE VASCULAR .016IN 180CM 35CM STEERABLE STR TIP BOTH IP/OP $744.50 $551.00 $147.73 $744.33 $404.17 $404.17 $404.17 $404.17 $744.33 $744.33 $744.33 $155.14 $744.33 $552.44 $552.44 $573.73 $387.80 $155.13 $744.33 $744.33 $440.27 $744.33 $744.33 $744.33 $744.33 $558.38 $744.33 $744.33 $744.33 $372.17 $372.17 $589.51 $744.33 $595.46 $483.81 $147.73 N/A $431.81 $744.33 $744.33 $744.33 $155.12 $744.33 N/A N/A M0015501010 SUP HCPCS C1887 M0015501010 - CATHETER INFUS .014IN MICRO TAPER 14 FLEX 3-2.8FR .024IN 105 BOTH IP/OP "$1,157.50" $857.00 $229.66 "$1,157.13" $628.32 $628.32 $628.32 $628.32 "$1,157.13" "$1,157.13" "$1,157.13" $241.17 "$1,157.13" $858.82 $858.82 $891.92 $602.86 $241.16 "$1,157.13" "$1,157.13" $684.44 "$1,157.13" "$1,157.13" "$1,157.13" "$1,157.13" $868.13 "$1,157.13" "$1,157.13" "$1,157.13" $578.57 $578.57 $916.45 "$1,157.13" $925.70 $752.13 $229.66 N/A $671.35 "$1,157.13" "$1,157.13" "$1,157.13" $241.15 "$1,157.13" N/A N/A M0015501030 SUP HCPCS C1887 M0015501030 - CATHETER INFUS .038IN MICRO TAPER-14 FLEX 3-2.8FR .024IN 125 BOTH IP/OP "$1,157.50" $857.00 $229.66 "$1,157.13" $628.32 $628.32 $628.32 $628.32 "$1,157.13" "$1,157.13" "$1,157.13" $241.17 "$1,157.13" $858.82 $858.82 $891.92 $602.86 $241.16 "$1,157.13" "$1,157.13" $684.44 "$1,157.13" "$1,157.13" "$1,157.13" "$1,157.13" $868.13 "$1,157.13" "$1,157.13" "$1,157.13" $578.57 $578.57 $916.45 "$1,157.13" $925.70 $752.13 $229.66 N/A $671.35 "$1,157.13" "$1,157.13" "$1,157.13" $241.15 "$1,157.13" N/A N/A M0015501040 SUP HCPCS C1887 M0015501040 - CATHETER INFUS .014IN MICRO TAPER-14 FLEX 3-2.8FR .024IN 135 BOTH IP/OP "$1,157.50" $857.00 $229.66 "$1,157.13" $628.32 $628.32 $628.32 $628.32 "$1,157.13" "$1,157.13" "$1,157.13" $241.17 "$1,157.13" $858.82 $858.82 $891.92 $602.86 $241.16 "$1,157.13" "$1,157.13" $684.44 "$1,157.13" "$1,157.13" "$1,157.13" "$1,157.13" $868.13 "$1,157.13" "$1,157.13" "$1,157.13" $578.57 $578.57 $916.45 "$1,157.13" $925.70 $752.13 $229.66 N/A $671.35 "$1,157.13" "$1,157.13" "$1,157.13" $241.15 "$1,157.13" N/A N/A M0015502030 SUP HCPCS C1887 M0015502030 - CATHETER INFUS .016IN MICRO TAPER 14 FLEX 3-2.8FR .024IN 125 BOTH IP/OP "$1,157.50" $857.00 $229.66 "$1,157.13" $628.32 $628.32 $628.32 $628.32 "$1,157.13" "$1,157.13" "$1,157.13" $241.17 "$1,157.13" $858.82 $858.82 $891.92 $602.86 $241.16 "$1,157.13" "$1,157.13" $684.44 "$1,157.13" "$1,157.13" "$1,157.13" "$1,157.13" $868.13 "$1,157.13" "$1,157.13" "$1,157.13" $578.57 $578.57 $916.45 "$1,157.13" $925.70 $752.13 $229.66 N/A $671.35 "$1,157.13" "$1,157.13" "$1,157.13" $241.15 "$1,157.13" N/A N/A M0015502040 SUP HCPCS C1887 M0015502040 - CATHETER INFUS .038IN MICRO TAPER 14 FLEX 3-2.8FR .024IN 135 BOTH IP/OP "$1,157.50" $857.00 $229.66 "$1,157.13" $628.32 $628.32 $628.32 $628.32 "$1,157.13" "$1,157.13" "$1,157.13" $241.17 "$1,157.13" $858.82 $858.82 $891.92 $602.86 $241.16 "$1,157.13" "$1,157.13" $684.44 "$1,157.13" "$1,157.13" "$1,157.13" "$1,157.13" $868.13 "$1,157.13" "$1,157.13" "$1,157.13" $578.57 $578.57 $916.45 "$1,157.13" $925.70 $752.13 $229.66 N/A $671.35 "$1,157.13" "$1,157.13" "$1,157.13" $241.15 "$1,157.13" N/A N/A M001705020 SUP HCPCS C1874 M001705020 - STENT ENDOPRSTH 116CM 10MM 10FR 20MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705030 SUP HCPCS C2628 M001705030 - STENT ENDOPRSTH 116CM 10MM 10FR 30MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$2,128.56" "$2,128.56" "$2,128.56" "$2,128.56" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$2,909.42" "$2,909.42" "$3,021.54" "$2,042.32" $816.97 "$3,920.00" "$3,920.00" "$2,318.68" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$2,548.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705050 SUP HCPCS C1874 M001705050 - STENT ENDOPRSTH 116CM 10MM 10FR 50MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705070 SUP HCPCS C1874 M001705070 - STENT ENDOPRSTH 116CM 10MM 10FR 70MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705230 SUP HCPCS C2628 M001705230 - STENT ENDOPRSTH 116CM 12MM 11FR 30MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$2,128.56" "$2,128.56" "$2,128.56" "$2,128.56" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$2,909.42" "$2,909.42" "$3,021.54" "$2,042.32" $816.97 "$3,920.00" "$3,920.00" "$2,318.68" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$2,548.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705250 SUP HCPCS C2628 M001705250 - STENT ENDOPRSTH 116CM 12MM 11FR 50MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$2,128.56" "$2,128.56" "$2,128.56" "$2,128.56" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$2,909.42" "$2,909.42" "$3,021.54" "$2,042.32" $816.97 "$3,920.00" "$3,920.00" "$2,318.68" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$2,548.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705270 SUP HCPCS C1874 M001705270 - STENT ENDOPRSTH 116CM 12MM 11FR 70MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705450 SUP HCPCS C1874 M001705450 - STENT ENDOPRSTH 116CM 14MM 12FR 50MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705470 SUP HCPCS C1874 M001705470 - STENT ENDOPRSTH 116CM 14MM 12FR 70MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705620 SUP HCPCS C1874 M001705620 - STENT ENDOPRSTH 116CM 6MM 20MM 90CM DELIVERY SYSTEM BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705630 SUP HCPCS C1874 M001705630 - STENT ENDOPRSTH 116CM 6MM 9FR 30MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705650 SUP HCPCS C2617 M001705650 - STENT ENDOPRSTH 116CM 6MM 9FR 50MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705670 SUP HCPCS C1874 M001705670 - STENT ENDOPRSTH 116CM 6MM 9FR 70MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705720 SUP HCPCS C1874 M001705720 - STENT ENDOPRSTH 116CM 7MM 9FR 20MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705730 SUP HCPCS C1874 M001705730 - STENT ENDOPRSTH 116CM 7MM 9FR 30MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705750 SUP HCPCS C1874 M001705750 - STENT ENDOPRSTH 116CM 7MM 9FR 50MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705770 SUP HCPCS C1874 M001705770 - STENT ENDOPRSTH 116CM 7MM 9FR 90MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705820 SUP HCPCS C1874 M001705820 - STENT ENDOPRSTH 116CM 8MM 9FR 20MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705830 SUP HCPCS C1874 M001705830 - STENT ENDOPRSTH 116CM 8MM 9FR 30MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705850 SUP HCPCS C1874 M001705850 - STENT ENDOPRSTH 116CM 8MM 9FR 50MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705870 SUP HCPCS C1874 M001705870 - STENT ENDOPRSTH 116CM 8MM 9FR 70MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705920 SUP HCPCS C1874 M001705920 - STENT ENDOPRSTH 116CM 9MM 10FR 20MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705930 SUP HCPCS C1874 M001705930 - STENT ENDOPRSTH 116CM 9MM 10FR 30MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705950 SUP HCPCS C1874 M001705950 - STENT ENDOPRSTH 116CM 9MM 10FR 50MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001705970 SUP HCPCS C1874 M001705970 - STENT ENDOPRSTH 116CM 9MM 10FR 70MM 90CM COVER COATED BOTH IP/OP "$3,920.00" "$2,901.00" $778.02 "$3,920.00" "$1,764.00" "$1,764.00" "$1,764.00" "$1,764.00" "$3,920.00" "$3,920.00" "$3,920.00" $817.03 "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" $816.97 "$3,920.00" "$3,920.00" "$1,932.56" "$3,920.00" "$3,920.00" "$3,920.00" "$3,920.00" "$2,940.00" "$3,920.00" "$3,920.00" "$3,920.00" "$1,960.00" "$1,960.00" "$3,104.64" "$3,920.00" "$3,136.00" "$1,764.00" $778.02 N/A "$2,273.60" "$3,920.00" "$3,920.00" "$3,920.00" $816.93 "$3,920.00" N/A N/A M001711000 SUP HCPCS C1877 M001711000 - STENT ENDOPRSTH 100CM 5MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711010 SUP HCPCS C1877 M001711010 - STENT ENDOPRSTH 5MM 6FR 20MM 135CM FLEXIBLE RECONSTRAINABLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711020 SUP HCPCS C1877 M001711020 - STENT ENDOPRSTH 100CM 5MM 40MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711030 SUP HCPCS C1877 M001711030 - STENT ENDOPRSTH 160CM 5MM 40MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711040 SUP HCPCS C1877 M001711040 - STENT ENDOPRSTH 100CM 5MM 55MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711050 SUP HCPCS C1877 M001711050 - STENT ENDOPRSTH 160CM 5MM 55MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711060 SUP HCPCS C1877 M001711060 - STENT ENDOPRSTH 100CM 5MM 80MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711070 SUP HCPCS C1877 M001711070 - STENT ENDOPRSTH 160CM 5MM 80MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711080 SUP HCPCS C1877 M001711080 - STENT ENDOPRSTH 100CM 6MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711090 SUP HCPCS C1877 M001711090 - STENT ENDOPRSTH 5MM 6FR 20MM 160CM FLEXIBLE RECONSTRAINABLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711100 SUP HCPCS C1877 M001711100 - STENT ENDOPRSTH 100CM 6MM 45MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711110 SUP HCPCS C1877 M001711110 - STENT ENDOPRSTH 160CM 6MM 45MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711120 SUP HCPCS C1877 M001711120 - STENT ENDOPRSTH 100CM 6MM 60MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711130 SUP HCPCS C1877 M001711130 - STENT ENDOPRSTH 160CM 6MM 60MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711140 SUP HCPCS C1877 M001711140 - STENT ENDOPRSTH 100CM 6MM 90MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711150 SUP HCPCS C1877 M001711150 - STENT ENDOPRSTH 160CM 6MM 90MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711160 SUP HCPCS C1877 M001711160 - STENT ENDOPRSTH 100CM 7MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711170 SUP HCPCS C1877 M001711170 - STENT ENDOPRSTH 7MM 6FR 20MM 160CM FLEXIBLE RECONSTRAINABLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711180 SUP HCPCS C1877 M001711180 - STENT ENDOPRSTH 100CM 7MM 40MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711190 SUP HCPCS C1877 M001711190 - STENT ENDOPRSTH 160CM 7MM 40MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711200 SUP HCPCS C1877 M001711200 - STENT ENDOPRSTH STENT 100CM 7MM 6FR 60MM 75CM SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711210 SUP HCPCS C1877 M001711210 - STENT ENDOPRSTH 160CM 7MM 60MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711220 SUP HCPCS C1877 M001711220 - STENT ENDOPRSTH 100CM 7MM 90MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711230 SUP HCPCS C1877 M001711230 - STENT ENDOPRSTH 160CM 7MM 90MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711240 SUP HCPCS C1877 M001711240 - STENT ENDOPRSTH 8MM 6FR 20MM 100CM FLEXIBLE RECONSTRAINABLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711250 SUP HCPCS C1877 M001711250 - STENT ENDOPRSTH 160CM 8MM 20MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711260 SUP HCPCS C2617 M001711260 - STENT ENDOPRSTH 8MM 6FR 40MM 100CM FLEXIBLE RECONSTRAINABLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711270 SUP HCPCS C1877 M001711270 - STENT TRACHEOBRONCHIAL 8MM 6FR 40MM 135CM ENDOPRSTH UNISTEP BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711280 SUP HCPCS C2617 M001711280 - STENT ENDOPRSTH 8MM 6FR 60MM 100CM FLEXIBLE RECONSTRAINABLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711290 SUP HCPCS C2617 M001711290 - STENT ENDOPRSTH 160CM 8MM 60MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711300 SUP HCPCS C2617 M001711300 - STENT ENDOPRSTH 100CM 8MM 80MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711310 SUP HCPCS C2617 M001711310 - STENT ENDOPRSTH 160CM 8MM 80MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711320 SUP HCPCS C1877 M001711320 - STENT ENDOPRSTH 10MM 6FR 20MM 100CM FLEXIBLE RECONSTRAINABLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711330 SUP HCPCS C1877 M001711330 - STENT ENDOPRSTH 160CM 10MM 20MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711340 SUP HCPCS C1877 M001711340 - STENT ENDOPRSTH 10MM 7FR 42MM 75CM ENDOPRSTH UNCOVERED BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711350 SUP HCPCS C1877 M001711350 - STENT ENDOPRSTH 160CM 10MM 42MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711360 SUP HCPCS C1877 M001711360 - STENT ENDOPRSTH 10MM 68MM 100CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711370 SUP HCPCS C1877 M001711370 - STENT ENDOPRSTH 160CM 10MM 68MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711380 SUP HCPCS C2617 M001711380 - STENT ENDOPRSTH 100CM 10MM 94MM 75CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001711390 SUP HCPCS C1877 M001711390 - STENT ENDOPRSTH 160CM 10MM 94MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712000 SUP HCPCS C1877 M001712000 - STENT ENDOPRSTH 100CM 6MM 24MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712010 SUP HCPCS C1877 M001712010 - STENT ENDOPRSTH 160CM 6MM 24MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712020 SUP HCPCS C1877 M001712020 - STENT ENDOPRSTH 100CM 6MM 6FR 36MM 75CM SYSTEM NONCOVERED BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712030 SUP HCPCS C1877 M001712030 - STENT ENDOPRSTH 160CM 6MM 36MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712040 SUP HCPCS C1877 M001712040 - STENT ENDOPRSTH 100CM 6MM 46MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712050 SUP HCPCS C1877 M001712050 - STENT ENDOPRSTH 160CM 6MM 46MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712060 SUP HCPCS C1877 M001712060 - STENT ENDOPRSTH 100CM 6MM 59MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712070 SUP HCPCS C1877 M001712070 - STENT ENDOPRSTH 160CM 6MM 59MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712080 SUP HCPCS C1877 M001712080 - STENT ENDOPRSTH 100CM 7MM 23MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712090 SUP HCPCS C1877 M001712090 - STENT ENDOPRSTH 160CM 7MM 6FR 23MM 135CM SYSTEM NONCOVERED BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712100 SUP HCPCS C1877 M001712100 - STENT ENDOPRSTH 100CM 7MM 34MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712110 SUP HCPCS C1877 M001712110 - STENT ENDOPRSTH 160CM 7MM 34MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712120 SUP HCPCS C1877 M001712120 - STENT ENDOPRSTH 100CM 7MM 6FR 55MM 75CM SYSTEM NONCOVERED BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712130 SUP HCPCS C1877 M001712130 - STENT ENDOPRSTH 160CM 7MM 55MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712140 SUP HCPCS C1877 M001712140 - STENT ENDOPRSTH 100CM 7MM 67MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712150 SUP HCPCS C1877 M001712150 - STENT ENDOPRSTH 160CM 7MM 67MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712160 SUP HCPCS C1877 M001712160 - STENT ENDOPRSTH 100CM 8MM 20MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712170 SUP HCPCS C1877 M001712170 - STENT ENDOPRSTH 160CM 8MM 20MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712180 SUP HCPCS C1877 M001712180 - STENT ENDOPRSTH 100CM 8MM 38MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712190 SUP HCPCS C1877 M001712190 - STENT ENDOPRSTH 160CM 8MM 38MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712200 SUP HCPCS C1877 M001712200 - STENT ENDOPRSTH 100CM 8MM 47MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712210 SUP HCPCS C1877 M001712210 - STENT ENDOPRSTH 160CM 8MM 47MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712220 SUP HCPCS C1877 M001712220 - STENT ENDOPRSTH 100CM 8MM 6FR 66MM 75CM SYSTEM NONCOVERED BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712230 SUP HCPCS C1877 M001712230 - STENT ENDOPRSTH 160CM 8MM 66MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712240 SUP HCPCS C1877 M001712240 - STENT ENDOPRSTH 100CM 9MM 6FR 18MM 75CM SYSTEM NONCOVERED BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712250 SUP HCPCS C1877 M001712250 - STENT ENDOPRSTH 160CM 9MM 6FR 18MM 135CM SYSTEM NONCOVERED BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712260 SUP HCPCS C1877 M001712260 - STENT ENDOPRSTH 100CM 9MM 35MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712270 SUP HCPCS C1877 M001712270 - STENT ENDOPRSTH 9MM 35MM 160CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712280 SUP HCPCS C1877 M001712280 - STENT ENDOPRSTH 100CM 9MM 52MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712290 SUP HCPCS C1877 M001712290 - STENT ENDOPRSTH 9MM 52MM 160CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712300 SUP HCPCS C1877 M001712300 - STENT ENDOPRSTH 100CM 9MM 61MM 75CM DELIVERY SYSTEM FLEXIBLE BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712310 SUP HCPCS C1877 M001712310 - STENT ENDOPRSTH 160CM 9MM 61MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712320 SUP HCPCS C1877 M001712320 - STENT ENDOPRSTH 100CM 10MM 20MM 75CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712330 SUP HCPCS C1877 M001712330 - STENT ENDOPRSTH 160CM 10MM 20MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712340 SUP HCPCS C1877 M001712340 - STENT ENDOPRSTH 100CM 10MM 39MM 75CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712350 SUP HCPCS C1877 M001712350 - STENT ENDOPRSTH 160CM 10MM 39MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712360 SUP HCPCS C2617 M001712360 - STENT ENDOPRSTH 10MM 6FR 49MM 75CM UNCOVERED UNISTEP PLUS BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712370 SUP HCPCS C1877 M001712370 - STENT ENDOPRSTH 160CM 10MM 49MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712380 SUP HCPCS C2617 M001712380 - STENT ENDOPRSTH 100CM 10MM 69MM 75CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001712390 SUP HCPCS C1877 M001712390 - STENT ENDOPRSTH 160CM 10MM 69MM 135CM DELIVERY SYSTEM BOTH IP/OP "$2,200.00" "$1,628.00" $436.65 "$2,200.00" $990.00 $990.00 $990.00 $990.00 "$2,200.00" "$2,200.00" "$2,200.00" $458.54 "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.50 "$2,200.00" "$2,200.00" "$1,301.30" "$2,200.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,650.00" "$2,200.00" "$2,200.00" "$2,200.00" "$1,100.00" "$1,100.00" "$1,742.40" "$2,200.00" "$1,760.00" $990.00 $436.65 N/A "$1,276.00" "$2,200.00" "$2,200.00" "$2,200.00" $458.48 "$2,200.00" N/A N/A M001719000 SUP HCPCS C1876 M001719000 - STENT ENDOPRSTH 6MM 22MM CLOSE CELL DESIGN HIGH DELIVERABLE BOTH IP/OP "$4,500.00" "$3,330.00" $893.14 "$4,500.00" "$2,025.00" "$2,025.00" "$2,025.00" "$2,025.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.91 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 "$4,500.00" "$4,500.00" "$2,218.50" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,025.00" $893.14 N/A "$2,610.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.80 "$4,500.00" N/A N/A M001719010 SUP HCPCS C1876 M001719010 - STENT ENDOPRSTH 8MM 21MM CLOSE CELL DESIGN HIGH DELIVERABLE BOTH IP/OP "$4,500.00" "$3,330.00" $893.14 "$4,500.00" "$2,025.00" "$2,025.00" "$2,025.00" "$2,025.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.91 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 "$4,500.00" "$4,500.00" "$2,218.50" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,025.00" $893.14 N/A "$2,610.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.80 "$4,500.00" N/A N/A M001719020 SUP HCPCS C1876 M001719020 - STENT ENDOPRSTH 8MM 29MM CLOSE CELL DESIGN HIGH DELIVERABLE BOTH IP/OP "$4,500.00" "$3,330.00" $893.14 "$4,500.00" "$2,025.00" "$2,025.00" "$2,025.00" "$2,025.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.91 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 "$4,500.00" "$4,500.00" "$2,218.50" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,025.00" $893.14 N/A "$2,610.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.80 "$4,500.00" N/A N/A M001719030 SUP HCPCS C1876 M001719030 - STENT ENDOPRSTH 8MM 22MM CLOSE CELL DESIGN HIGH DELIVERABLE BOTH IP/OP "$4,500.00" "$3,330.00" $893.14 "$4,500.00" "$2,025.00" "$2,025.00" "$2,025.00" "$2,025.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.91 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 "$4,500.00" "$4,500.00" "$2,218.50" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,025.00" $893.14 N/A "$2,610.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.80 "$4,500.00" N/A N/A M001719040 SUP HCPCS C1876 M001719040 - STENT ENDOPRSTH 10MM 24MM CLOSE CELL DESIGN HIGH DELIVERABLE BOTH IP/OP "$4,500.00" "$3,330.00" $893.14 "$4,500.00" "$2,025.00" "$2,025.00" "$2,025.00" "$2,025.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.91 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 "$4,500.00" "$4,500.00" "$2,218.50" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,025.00" $893.14 N/A "$2,610.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.80 "$4,500.00" N/A N/A M001719050 SUP HCPCS C1876 M001719050 - STENT ENDOPRSTH 10MM 31MM CLOSE CELL DESIGN HIGH DELIVERABLE BOTH IP/OP "$4,500.00" "$3,330.00" $893.14 "$4,500.00" "$2,025.00" "$2,025.00" "$2,025.00" "$2,025.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.91 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 "$4,500.00" "$4,500.00" "$2,218.50" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,025.00" $893.14 N/A "$2,610.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.80 "$4,500.00" N/A N/A M001719060 SUP HCPCS C1876 M001719060 - STENT ENDOPRSTH 10MM 37MM CLOSE CELL DESIGN HIGH DELIVERABLE BOTH IP/OP "$4,500.00" "$3,330.00" $893.14 "$4,500.00" "$2,025.00" "$2,025.00" "$2,025.00" "$2,025.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.91 "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.85 "$4,500.00" "$4,500.00" "$2,218.50" "$4,500.00" "$4,500.00" "$4,500.00" "$4,500.00" "$3,375.00" "$4,500.00" "$4,500.00" "$4,500.00" "$2,250.00" "$2,250.00" "$3,564.00" "$4,500.00" "$3,600.00" "$2,025.00" $893.14 N/A "$2,610.00" "$4,500.00" "$4,500.00" "$4,500.00" $937.80 "$4,500.00" N/A N/A M0017600121 SUP HCPCS C1884 M0017600121 - PARTICLES EMBOLIZATION 45-150UM 2 VIAL CNTOUR-PVA PVA BOTH IP/OP $367.50 $272.00 $72.84 $367.01 $165.15 $165.15 $165.15 $165.15 $367.01 $367.01 $367.01 $76.49 $367.01 $367.01 $367.01 $367.01 $367.01 $76.49 $367.01 $367.01 $217.09 $367.01 $367.01 $367.01 $367.01 $275.63 $367.01 $367.01 $367.01 $183.51 $183.51 $290.67 $367.01 $293.61 $165.15 $72.84 N/A $213.15 $367.01 $367.01 $367.01 $76.48 $367.01 N/A N/A M0017600151 SUP HCPCS C1884 M0017600151 - PARTICLES EMBOLIZATION 45-150UM 5 VIAL CNTOUR PVA BOTH IP/OP $359.00 $266.00 $71.16 $358.51 $161.33 $161.33 $161.33 $161.33 $358.51 $358.51 $358.51 $74.72 $358.51 $358.51 $358.51 $358.51 $358.51 $74.72 $358.51 $358.51 $212.06 $358.51 $358.51 $358.51 $358.51 $269.25 $358.51 $358.51 $358.51 $179.26 $179.26 $283.94 $358.51 $286.81 $161.33 $71.16 N/A $208.22 $358.51 $358.51 $358.51 $74.71 $358.51 N/A N/A M0017600221 SUP HCPCS C1884 M0017600221 - PARTICLES EMBL 150-250UM CNTR VL PVA BOTH IP/OP $367.50 $272.00 $72.84 $367.01 $165.15 $165.15 $165.15 $165.15 $367.01 $367.01 $367.01 $76.49 $367.01 $367.01 $367.01 $367.01 $367.01 $76.49 $367.01 $367.01 $217.09 $367.01 $367.01 $367.01 $367.01 $275.63 $367.01 $367.01 $367.01 $183.51 $183.51 $290.67 $367.01 $293.61 $165.15 $72.84 N/A $213.15 $367.01 $367.01 $367.01 $76.48 $367.01 N/A N/A M0017600221 SUP HCPCS C1884 M0017600221 - PARTICLES EMBOLIZATION 150-250UM 2 VIAL CNTOUR PVA BOTH IP/OP $367.50 $272.00 $72.84 $367.01 $165.15 $165.15 $165.15 $165.15 $367.01 $367.01 $367.01 $76.49 $367.01 $367.01 $367.01 $367.01 $367.01 $76.49 $367.01 $367.01 $217.09 $367.01 $367.01 $367.01 $367.01 $275.63 $367.01 $367.01 $367.01 $183.51 $183.51 $290.67 $367.01 $293.61 $165.15 $72.84 N/A $213.15 $367.01 $367.01 $367.01 $76.48 $367.01 N/A N/A M0017600251 SUP HCPCS C1884 M0017600251 - PARTICLES EMBOLIZATION 150-250UM 5 VIAL CNTOUR PVA BOTH IP/OP $359.00 $266.00 $71.16 $358.51 $161.33 $161.33 $161.33 $161.33 $358.51 $358.51 $358.51 $74.72 $358.51 $358.51 $358.51 $358.51 $358.51 $74.72 $358.51 $358.51 $212.06 $358.51 $358.51 $358.51 $358.51 $269.25 $358.51 $358.51 $358.51 $179.26 $179.26 $283.94 $358.51 $286.81 $161.33 $71.16 N/A $208.22 $358.51 $358.51 $358.51 $74.71 $358.51 N/A N/A M0017600321 SUP HCPCS C1884 M0017600321 - PARTICLES EMBOLIZATION 250-355UM 2 VIAL CNTOUR PVA BOTH IP/OP $367.50 $272.00 $72.84 $367.01 $165.15 $165.15 $165.15 $165.15 $367.01 $367.01 $367.01 $76.49 $367.01 $367.01 $367.01 $367.01 $367.01 $76.49 $367.01 $367.01 $217.09 $367.01 $367.01 $367.01 $367.01 $275.63 $367.01 $367.01 $367.01 $183.51 $183.51 $290.67 $367.01 $293.61 $165.15 $72.84 N/A $213.15 $367.01 $367.01 $367.01 $76.48 $367.01 N/A N/A M0017600351 SUP HCPCS C1884 M0017600351 - PARTICLES EMBOLIZATION 250-355UM 5 VIAL CNTOUR PVA BOTH IP/OP $359.00 $266.00 $71.16 $358.51 $161.33 $161.33 $161.33 $161.33 $358.51 $358.51 $358.51 $74.72 $358.51 $358.51 $358.51 $358.51 $358.51 $74.72 $358.51 $358.51 $212.06 $358.51 $358.51 $358.51 $358.51 $269.25 $358.51 $358.51 $358.51 $179.26 $179.26 $283.94 $358.51 $286.81 $161.33 $71.16 N/A $208.22 $358.51 $358.51 $358.51 $74.71 $358.51 N/A N/A M0017600351 SUP HCPCS C1884 M0017600351 - PARTICLES EMBL 250-355UM CNTR 5 VL PVA BOTH IP/OP $359.00 $266.00 $71.16 $358.51 $161.33 $161.33 $161.33 $161.33 $358.51 $358.51 $358.51 $74.72 $358.51 $358.51 $358.51 $358.51 $358.51 $74.72 $358.51 $358.51 $212.06 $358.51 $358.51 $358.51 $358.51 $269.25 $358.51 $358.51 $358.51 $179.26 $179.26 $283.94 $358.51 $286.81 $161.33 $71.16 N/A $208.22 $358.51 $358.51 $358.51 $74.71 $358.51 N/A N/A M0017600421 SUP HCPCS C1884 M0017600421 - PARTICLES EMBOLIZATION 355-500UM 2 VIAL CNTOUR PVA BOTH IP/OP $367.50 $272.00 $72.84 $367.01 $165.15 $165.15 $165.15 $165.15 $367.01 $367.01 $367.01 $76.49 $367.01 $367.01 $367.01 $367.01 $367.01 $76.49 $367.01 $367.01 $217.09 $367.01 $367.01 $367.01 $367.01 $275.63 $367.01 $367.01 $367.01 $183.51 $183.51 $290.67 $367.01 $293.61 $165.15 $72.84 N/A $213.15 $367.01 $367.01 $367.01 $76.48 $367.01 N/A N/A M0017600651 SUP HCPCS C1884 M0017600651 - PARTICLES EMBOLIZATION 500-710UM 5 VIAL CNTOUR PVA BOTH IP/OP $359.00 $266.00 $71.16 $358.51 $161.33 $161.33 $161.33 $161.33 $358.51 $358.51 $358.51 $74.72 $358.51 $358.51 $358.51 $358.51 $358.51 $74.72 $358.51 $358.51 $212.06 $358.51 $358.51 $358.51 $358.51 $269.25 $358.51 $358.51 $358.51 $179.26 $179.26 $283.94 $358.51 $286.81 $161.33 $71.16 N/A $208.22 $358.51 $358.51 $358.51 $74.71 $358.51 N/A N/A M0017600821 SUP HCPCS C1884 M0017600821 - PARTICLES EMBOLIZATION 710-1000UM 2 VIAL CNTOUR PVA BOTH IP/OP $367.50 $272.00 $72.84 $367.01 $165.15 $165.15 $165.15 $165.15 $367.01 $367.01 $367.01 $76.49 $367.01 $367.01 $367.01 $367.01 $367.01 $76.49 $367.01 $367.01 $217.09 $367.01 $367.01 $367.01 $367.01 $275.63 $367.01 $367.01 $367.01 $183.51 $183.51 $290.67 $367.01 $293.61 $165.15 $72.84 N/A $213.15 $367.01 $367.01 $367.01 $76.48 $367.01 N/A N/A M0017600821 SUP Custom 27203010 PARTICLES EMBL 710-1000UM 2 VL CNTOUR-PVA BOTH IP/OP $499.00 $369.00 $72.84 $374.25 $165.15 $165.15 $165.15 $165.15 $367.01 $367.01 $367.01 $76.49 $367.01 $367.01 $367.01 $367.01 $367.01 $76.49 $367.01 $367.01 $217.09 $367.01 $367.01 $367.01 $367.01 $374.25 $367.01 $367.01 $367.01 $183.51 $183.51 $290.67 $367.01 $293.61 $165.15 $72.84 N/A $289.42 $367.01 $367.01 $367.01 $76.48 $367.01 N/A N/A M0017600851 SUP HCPCS C1884 M0017600851 - PARTICLES EMBOLIZATION 710-1000UM 5 VIAL CNTOUR PVA BOTH IP/OP $359.00 $266.00 $71.16 $358.51 $161.33 $161.33 $161.33 $161.33 $358.51 $358.51 $358.51 $74.72 $358.51 $358.51 $358.51 $358.51 $358.51 $74.72 $358.51 $358.51 $212.06 $358.51 $358.51 $358.51 $358.51 $269.25 $358.51 $358.51 $358.51 $179.26 $179.26 $283.94 $358.51 $286.81 $161.33 $71.16 N/A $208.22 $358.51 $358.51 $358.51 $74.71 $358.51 N/A N/A M0017601151 SUP HCPCS C1884 M0017601151 - PARTICLES EMBOLIZATION 1000-1180UM 5 VIAL CNTOUR PVA BOTH IP/OP $359.00 $266.00 $71.16 $358.51 $161.33 $161.33 $161.33 $161.33 $358.51 $358.51 $358.51 $74.72 $358.51 $358.51 $358.51 $358.51 $358.51 $74.72 $358.51 $358.51 $212.06 $358.51 $358.51 $358.51 $358.51 $269.25 $358.51 $358.51 $358.51 $179.26 $179.26 $283.94 $358.51 $286.81 $161.33 $71.16 N/A $208.22 $358.51 $358.51 $358.51 $74.71 $358.51 N/A N/A M001BATR111000 SUP HCPCS C1753 M001BATR111000 - MODULE CATH POLARCATH PWR SYS PERI CRYOPLASTY BOTH IP/OP "$1,416.00" "$1,048.00" $281.03 "$1,415.95" $768.86 $768.86 $768.86 $768.86 "$1,415.95" "$1,415.95" "$1,415.95" $295.12 "$1,415.95" "$1,050.92" "$1,050.92" "$1,091.41" $737.71 $295.10 "$1,415.95" "$1,415.95" $837.53 "$1,415.95" "$1,415.95" "$1,415.95" "$1,415.95" "$1,062.00" "$1,415.95" "$1,415.95" "$1,415.95" $707.98 $707.98 "$1,121.43" "$1,415.95" "$1,132.76" $920.37 $281.03 N/A $821.28 "$1,415.95" "$1,415.95" "$1,415.95" $295.08 "$1,415.95" N/A N/A M001NC20000001 SUP Custom 27203010 M001NC20000001 - CARTRIDGE CATH POLARCATH N2O PERI BOTH IP/OP "$1,354.50" "$1,002.00" $241.08 "$1,354.38" "$1,354.38" "$1,354.38" "$1,354.38" "$1,354.38" "$1,354.38" "$1,354.38" $241.08 "$1,354.38" "$1,354.38" "$1,005.22" "$1,005.22" "$1,043.96" $705.63 $282.27 "$1,354.38" $541.75 "$1,354.38" "$1,354.38" "$1,354.38" "$1,354.38" "$1,354.38" "$1,015.88" "$1,354.38" "$1,354.38" "$1,354.38" $677.19 $677.19 "$1,072.67" "$1,354.38" "$1,083.50" $880.35 "$1,354.38" N/A $785.61 "$1,354.38" $812.63 "$1,354.38" "$1,354.38" "$1,354.38" N/A N/A M001P4100080010 SUP HCPCS C1753 M001P4100080010 - CATHETER BLNDIL 4MM 80CM 100MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,982.50" "$1,467.00" $393.44 "$1,982.33" "$1,076.41" "$1,076.41" "$1,076.41" "$1,076.41" "$1,982.33" "$1,982.33" "$1,982.33" $413.17 "$1,982.33" "$1,471.29" "$1,471.29" "$1,527.98" "$1,032.79" $413.14 "$1,982.33" "$1,982.33" "$1,172.55" "$1,982.33" "$1,982.33" "$1,982.33" "$1,982.33" "$1,486.88" "$1,982.33" "$1,982.33" "$1,982.33" $991.17 $991.17 "$1,570.01" "$1,982.33" "$1,585.86" "$1,288.51" $393.44 N/A "$1,149.85" "$1,982.33" "$1,982.33" "$1,982.33" $413.12 "$1,982.33" N/A N/A M001P4100120010 SUP HCPCS C1753 M001P4100120010 - CATHETER BLNDIL 4MM 120CM 100MM POLARCATH PERI ACPT .035IN BOTH IP/OP "$1,982.50" "$1,467.00" $393.44 "$1,982.33" "$1,076.41" "$1,076.41" "$1,076.41" "$1,076.41" "$1,982.33" "$1,982.33" "$1,982.33" $413.17 "$1,982.33" "$1,471.29" "$1,471.29" "$1,527.98" "$1,032.79" $413.14 "$1,982.33" "$1,982.33" "$1,172.55" "$1,982.33" "$1,982.33" "$1,982.33" "$1,982.33" "$1,486.88" "$1,982.33" "$1,982.33" "$1,982.33" $991.17 $991.17 "$1,570.01" "$1,982.33" "$1,585.86" "$1,288.51" $393.44 N/A "$1,149.85" "$1,982.33" "$1,982.33" "$1,982.33" $413.12 "$1,982.33" N/A N/A M001P420080010 SUP HCPCS C1753 M001P420080010 - CATHETER BLNDIL 4MM 80CM 20MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P420120010 SUP HCPCS C1753 M001P420120010 - CATHETER BLNDIL 4MM 120CM 20MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P440080010 SUP HCPCS C1753 M001P440080010 - CATHETER BLNDIL 4MM 80CM 40MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P440120010 SUP HCPCS C1753 M001P440120010 - CATHETER BLNDIL 4MM 120CM 40MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P460080010 SUP HCPCS C1753 M001P460080010 - CATHETER BLNDIL 4MM 80CM 60MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P460120010 SUP HCPCS C1726 M001P460120010 - CATHETER BLNDIL 4MM 120CM 60MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P480080010 SUP HCPCS C1753 M001P480080010 - CATHETER BLNDIL 4MM 80CM 80MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,982.50" "$1,467.00" $393.44 "$1,982.33" "$1,076.41" "$1,076.41" "$1,076.41" "$1,076.41" "$1,982.33" "$1,982.33" "$1,982.33" $413.17 "$1,982.33" "$1,471.29" "$1,471.29" "$1,527.98" "$1,032.79" $413.14 "$1,982.33" "$1,982.33" "$1,172.55" "$1,982.33" "$1,982.33" "$1,982.33" "$1,982.33" "$1,486.88" "$1,982.33" "$1,982.33" "$1,982.33" $991.17 $991.17 "$1,570.01" "$1,982.33" "$1,585.86" "$1,288.51" $393.44 N/A "$1,149.85" "$1,982.33" "$1,982.33" "$1,982.33" $413.12 "$1,982.33" N/A N/A M001P480120010 SUP HCPCS C1726 M001P480120010 - CATHETER BLNDIL 4MM 120CM 80MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,982.50" "$1,467.00" $393.44 "$1,982.33" "$1,076.41" "$1,076.41" "$1,076.41" "$1,076.41" "$1,982.33" "$1,982.33" "$1,982.33" $413.17 "$1,982.33" "$1,471.29" "$1,471.29" "$1,527.98" "$1,032.79" $413.14 "$1,982.33" "$1,982.33" "$1,172.55" "$1,982.33" "$1,982.33" "$1,982.33" "$1,982.33" "$1,486.88" "$1,982.33" "$1,982.33" "$1,982.33" $991.17 $991.17 "$1,570.01" "$1,982.33" "$1,585.86" "$1,288.51" $393.44 N/A "$1,149.85" "$1,982.33" "$1,982.33" "$1,982.33" $413.12 "$1,982.33" N/A N/A M001P5100080010 SUP HCPCS C1753 M001P5100080010 - CATHETER BLNDIL 5MM 80CM 100MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,982.50" "$1,467.00" $393.44 "$1,982.33" "$1,076.41" "$1,076.41" "$1,076.41" "$1,076.41" "$1,982.33" "$1,982.33" "$1,982.33" $413.17 "$1,982.33" "$1,471.29" "$1,471.29" "$1,527.98" "$1,032.79" $413.14 "$1,982.33" "$1,982.33" "$1,172.55" "$1,982.33" "$1,982.33" "$1,982.33" "$1,982.33" "$1,486.88" "$1,982.33" "$1,982.33" "$1,982.33" $991.17 $991.17 "$1,570.01" "$1,982.33" "$1,585.86" "$1,288.51" $393.44 N/A "$1,149.85" "$1,982.33" "$1,189.40" "$1,982.33" $413.12 "$1,982.33" N/A N/A M001P5100120010 SUP HCPCS C1753 M001P5100120010 - CATHETER BLNDIL 5MM 120CM 100MM POLARCATH PERI ACPT .035IN BOTH IP/OP "$1,982.50" "$1,467.00" $393.44 "$1,982.33" "$1,076.41" "$1,076.41" "$1,076.41" "$1,076.41" "$1,982.33" "$1,982.33" "$1,982.33" $413.17 "$1,982.33" "$1,471.29" "$1,471.29" "$1,527.98" "$1,032.79" $413.14 "$1,982.33" "$1,982.33" "$1,172.55" "$1,982.33" "$1,982.33" "$1,982.33" "$1,982.33" "$1,486.88" "$1,982.33" "$1,982.33" "$1,982.33" $991.17 $991.17 "$1,570.01" "$1,982.33" "$1,585.86" "$1,288.51" $393.44 N/A "$1,149.85" "$1,982.33" "$1,982.33" "$1,982.33" $413.12 "$1,982.33" N/A N/A M001P5120120010 SUP HCPCS C1725 M001P5120120010 - CATHETER BLNDIL 5MM 120CM 120MM POLARCATH PERI ACPT .035IN BOTH IP/OP "$2,229.00" "$1,649.00" $442.32 "$2,228.58" "$1,210.12" "$1,210.12" "$1,210.12" "$1,210.12" "$2,228.58" "$2,228.58" "$2,228.58" $464.49 "$2,228.58" "$1,654.05" "$1,654.05" "$1,717.79" "$1,161.09" $464.46 "$2,228.58" "$2,228.58" "$1,318.21" "$2,228.58" "$2,228.58" "$2,228.58" "$2,228.58" "$1,671.75" "$2,228.58" "$2,228.58" "$2,228.58" "$1,114.29" "$1,114.29" "$1,765.04" "$2,228.58" "$1,782.86" "$1,448.58" $442.32 N/A "$1,292.82" "$2,228.58" "$2,228.58" "$2,228.58" $464.44 "$2,228.58" N/A N/A M001P5150120010 SUP HCPCS C1725 M001P5150120010 - CATHETER BLNDIL 5MM 150CM 120MM POLARCATH PERI ACPT .035IN BOTH IP/OP "$2,487.50" "$1,841.00" $493.63 "$2,487.13" "$1,350.51" "$1,350.51" "$1,350.51" "$1,350.51" "$2,487.13" "$2,487.13" "$2,487.13" $518.38 "$2,487.13" "$1,845.95" "$1,845.95" "$1,917.08" "$1,295.79" $518.35 "$2,487.13" "$2,487.13" "$1,471.14" "$2,487.13" "$2,487.13" "$2,487.13" "$2,487.13" "$1,865.63" "$2,487.13" "$2,487.13" "$2,487.13" "$1,243.57" "$1,243.57" "$1,969.81" "$2,487.13" "$1,989.70" "$1,616.63" $493.63 N/A "$1,442.75" "$2,487.13" "$2,487.13" "$2,487.13" $518.32 "$2,487.13" N/A N/A M001P520080010 SUP HCPCS C1753 M001P520080010 - CATHETER BLNDIL 5MM 80CM 20MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P520120010 SUP HCPCS C1753 M001P520120010 - CATHETER BLNDIL 5MM 120CM 20MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P540080010 SUP HCPCS C1753 M001P540080010 - CATHETER BLNDIL 5MM 80CM 40MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P540120010 SUP HCPCS C1726 M001P540120010 - CATHETER BLNDIL 5MM 120CM 40MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P560080010 SUP HCPCS C1753 M001P560080010 - CATHETER BLNDIL 5MM 80CM 60MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P560120010 SUP HCPCS C1726 M001P560120010 - CATHETER BLNDIL 5MM 120CM 60MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P580080010 SUP HCPCS C1753 M001P580080010 - CATHETER BLNDIL 5MM 80CM 80MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,982.50" "$1,467.00" $393.44 "$1,982.33" "$1,076.41" "$1,076.41" "$1,076.41" "$1,076.41" "$1,982.33" "$1,982.33" "$1,982.33" $413.17 "$1,982.33" "$1,471.29" "$1,471.29" "$1,527.98" "$1,032.79" $413.14 "$1,982.33" "$1,982.33" "$1,172.55" "$1,982.33" "$1,982.33" "$1,982.33" "$1,982.33" "$1,486.88" "$1,982.33" "$1,982.33" "$1,982.33" $991.17 $991.17 "$1,570.01" "$1,982.33" "$1,585.86" "$1,288.51" $393.44 N/A "$1,149.85" "$1,982.33" "$1,982.33" "$1,982.33" $413.12 "$1,982.33" N/A N/A M001P580120010 SUP HCPCS C1726 M001P580120010 - CATHETER BLNDIL 5MM 120CM 80MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$1,982.50" "$1,467.00" $393.44 "$1,982.33" "$1,076.41" "$1,076.41" "$1,076.41" "$1,076.41" "$1,982.33" "$1,982.33" "$1,982.33" $413.17 "$1,982.33" "$1,471.29" "$1,471.29" "$1,527.98" "$1,032.79" $413.14 "$1,982.33" "$1,982.33" "$1,172.55" "$1,982.33" "$1,982.33" "$1,982.33" "$1,982.33" "$1,486.88" "$1,982.33" "$1,982.33" "$1,982.33" $991.17 $991.17 "$1,570.01" "$1,982.33" "$1,585.86" "$1,288.51" $393.44 N/A "$1,149.85" "$1,982.33" "$1,982.33" "$1,982.33" $413.12 "$1,982.33" N/A N/A M001P6100080010 SUP HCPCS C1753 M001P6100080010 - CATHETER BLNDIL 6MM 80CM 100MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,982.50" "$1,467.00" $393.44 "$1,982.33" "$1,076.41" "$1,076.41" "$1,076.41" "$1,076.41" "$1,982.33" "$1,982.33" "$1,982.33" $413.17 "$1,982.33" "$1,471.29" "$1,471.29" "$1,527.98" "$1,032.79" $413.14 "$1,982.33" "$1,982.33" "$1,172.55" "$1,982.33" "$1,982.33" "$1,982.33" "$1,982.33" "$1,486.88" "$1,982.33" "$1,982.33" "$1,982.33" $991.17 $991.17 "$1,570.01" "$1,982.33" "$1,585.86" "$1,288.51" $393.44 N/A "$1,149.85" "$1,982.33" "$1,982.33" "$1,982.33" $413.12 "$1,982.33" N/A N/A M001P6100120010 SUP HCPCS C1753 M001P6100120010 - CATHETER BLNDIL 6MM 120CM 100MM POLARCATH PERI ACPT .035IN BOTH IP/OP "$1,982.50" "$1,467.00" $393.44 "$1,982.33" "$1,076.41" "$1,076.41" "$1,076.41" "$1,076.41" "$1,982.33" "$1,982.33" "$1,982.33" $413.17 "$1,982.33" "$1,471.29" "$1,471.29" "$1,527.98" "$1,032.79" $413.14 "$1,982.33" "$1,982.33" "$1,172.55" "$1,982.33" "$1,982.33" "$1,982.33" "$1,982.33" "$1,486.88" "$1,982.33" "$1,982.33" "$1,982.33" $991.17 $991.17 "$1,570.01" "$1,982.33" "$1,585.86" "$1,288.51" $393.44 N/A "$1,149.85" "$1,982.33" "$1,982.33" "$1,982.33" $413.12 "$1,982.33" N/A N/A M001P6120120010 SUP HCPCS C1725 M001P6120120010 - CATHETER BLNDIL 6MM 120CM 120MM POLARCATH PERI ACPT .035IN BOTH IP/OP "$2,229.00" "$1,649.00" $442.32 "$2,228.58" "$1,210.12" "$1,210.12" "$1,210.12" "$1,210.12" "$2,228.58" "$2,228.58" "$2,228.58" $464.49 "$2,228.58" "$1,654.05" "$1,654.05" "$1,717.79" "$1,161.09" $464.46 "$2,228.58" "$2,228.58" "$1,318.21" "$2,228.58" "$2,228.58" "$2,228.58" "$2,228.58" "$1,671.75" "$2,228.58" "$2,228.58" "$2,228.58" "$1,114.29" "$1,114.29" "$1,765.04" "$2,228.58" "$1,782.86" "$1,448.58" $442.32 N/A "$1,292.82" "$2,228.58" "$2,228.58" "$2,228.58" $464.44 "$2,228.58" N/A N/A M001P6150120010 SUP HCPCS C1725 M001P6150120010 - CATHETER BLNDIL 6MM 120CM 150MM POLARCATH PERI ACPT .035IN BOTH IP/OP "$2,487.50" "$1,841.00" $493.63 "$2,487.13" "$1,350.51" "$1,350.51" "$1,350.51" "$1,350.51" "$2,487.13" "$2,487.13" "$2,487.13" $518.38 "$2,487.13" "$1,845.95" "$1,845.95" "$1,917.08" "$1,295.79" $518.35 "$2,487.13" "$2,487.13" "$1,471.14" "$2,487.13" "$2,487.13" "$2,487.13" "$2,487.13" "$1,865.63" "$2,487.13" "$2,487.13" "$2,487.13" "$1,243.57" "$1,243.57" "$1,969.81" "$2,487.13" "$1,989.70" "$1,616.63" $493.63 N/A "$1,442.75" "$2,487.13" "$2,487.13" "$2,487.13" $518.32 "$2,487.13" N/A N/A M001P620080010 SUP HCPCS C1753 M001P620080010 - CATHETER BLNDIL 6MM 80CM 20MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,019.48" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P620120010 SUP HCPCS C1753 M001P620120010 - CATHETER BLNDIL 6MM 120CM 20MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,019.48" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P640080010 SUP HCPCS C1726 M001P640080010 - CATHETER BLNDIL 6MM 80CM 40MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P640120010 SUP HCPCS C1726 M001P640120010 - CATHETER BLNDIL 6MM 120CM 40MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P660080010 SUP HCPCS C1753 M001P660080010 - CATHETER BLNDIL 6MM 80CM 60MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,019.48" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P660120010 SUP HCPCS C1726 M001P660120010 - CATHETER BLNDIL 6MM 120CM 60MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P680080010 SUP HCPCS C1753 M001P680080010 - CATHETER BLNDIL 6MM 80CM 80MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,982.50" "$1,467.00" $393.44 "$1,982.33" "$1,076.41" "$1,076.41" "$1,076.41" "$1,076.41" "$1,982.33" "$1,982.33" "$1,982.33" $413.17 "$1,982.33" "$1,471.29" "$1,471.29" "$1,527.98" "$1,032.79" $413.14 "$1,982.33" "$1,982.33" "$1,172.55" "$1,982.33" "$1,982.33" "$1,982.33" "$1,982.33" "$1,486.88" "$1,982.33" "$1,982.33" "$1,982.33" $991.17 $991.17 "$1,570.01" "$1,982.33" "$1,585.86" "$1,288.51" $393.44 N/A "$1,149.85" "$1,982.33" "$1,982.33" "$1,982.33" $413.12 "$1,982.33" N/A N/A M001P680120010 SUP HCPCS C1753 M001P680120010 - CATHETER BLNDIL 6MM 120CM 80MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$1,982.50" "$1,467.00" $393.44 "$1,982.33" "$1,076.41" "$1,076.41" "$1,076.41" "$1,076.41" "$1,982.33" "$1,982.33" "$1,982.33" $413.17 "$1,982.33" "$1,471.29" "$1,471.29" "$1,527.98" "$1,032.79" $413.14 "$1,982.33" "$1,982.33" "$1,172.55" "$1,982.33" "$1,982.33" "$1,982.33" "$1,982.33" "$1,486.88" "$1,982.33" "$1,982.33" "$1,982.33" $991.17 $991.17 "$1,570.01" "$1,982.33" "$1,585.86" "$1,288.51" $393.44 N/A "$1,149.85" "$1,982.33" "$1,982.33" "$1,982.33" $413.12 "$1,982.33" N/A N/A M001P720080010 SUP HCPCS C1753 M001P720080010 - CATHETER BLNDIL 7MM 80CM 20MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P720120010 SUP HCPCS C1726 M001P720120010 - CATHETER BLNDIL 7MM 120CM 20MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P740080010 SUP HCPCS C1753 M001P740080010 - CATHETER BLNDIL 7MM 80CM 40MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,019.48" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P740120010 SUP HCPCS C1726 M001P740120010 - CATHETER BLNDIL 7MM 120CM 40MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P760080010 SUP HCPCS C2618 M001P760080010 - CATHETER BLNDIL 7MM 80CM 60MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $354.12 "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" $679.65 "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" "$1,699.13" N/A $985.71 "$1,699.13" "$1,019.48" "$1,699.13" "$1,699.13" "$1,699.13" N/A N/A M001P760120010 SUP HCPCS C1753 M001P760120010 - CATHETER BLNDIL 7MM 120CM 60MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P780080010 SUP HCPCS C1753 M001P780080010 - CATHETER BLNDIL 7MM 80CM 80MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,982.50" "$1,467.00" $393.44 "$1,982.33" "$1,076.41" "$1,076.41" "$1,076.41" "$1,076.41" "$1,982.33" "$1,982.33" "$1,982.33" $413.17 "$1,982.33" "$1,471.29" "$1,471.29" "$1,527.98" "$1,032.79" $413.14 "$1,982.33" "$1,982.33" "$1,172.55" "$1,982.33" "$1,982.33" "$1,982.33" "$1,982.33" "$1,486.88" "$1,982.33" "$1,982.33" "$1,982.33" $991.17 $991.17 "$1,570.01" "$1,982.33" "$1,585.86" "$1,288.51" $393.44 N/A "$1,149.85" "$1,982.33" "$1,982.33" "$1,982.33" $413.12 "$1,982.33" N/A N/A M001P780120010 SUP HCPCS C1726 M001P780120010 - CATHETER BLNDIL 7MM 120CM 80MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,982.50" "$1,467.00" $393.44 "$1,982.33" "$1,076.41" "$1,076.41" "$1,076.41" "$1,076.41" "$1,982.33" "$1,982.33" "$1,982.33" $413.17 "$1,982.33" "$1,471.29" "$1,471.29" "$1,527.98" "$1,032.79" $413.14 "$1,982.33" "$1,982.33" "$1,172.55" "$1,982.33" "$1,982.33" "$1,982.33" "$1,982.33" "$1,486.88" "$1,982.33" "$1,982.33" "$1,982.33" $991.17 $991.17 "$1,570.01" "$1,982.33" "$1,585.86" "$1,288.51" $393.44 N/A "$1,149.85" "$1,982.33" "$1,982.33" "$1,982.33" $413.12 "$1,982.33" N/A N/A M001P820080010 SUP HCPCS C1725 M001P820080010 - CATHETER BLNDIL 8MM 80CM 20MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P840080010 SUP HCPCS C1725 M001P840080010 - CATHETER BLNDIL 8MM 80CM 40MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001P840120010 SUP HCPCS C1726 M001P840120010 - CATHETER BLNDIL 8MM 120CM 40MM POLARCATH PERI ACPT .035IN GW BOTH IP/OP "$1,699.50" "$1,258.00" $337.23 "$1,699.13" $922.63 $922.63 $922.63 $922.63 "$1,699.13" "$1,699.13" "$1,699.13" $354.14 "$1,699.13" "$1,261.09" "$1,261.09" "$1,309.69" $885.25 $354.12 "$1,699.13" "$1,699.13" "$1,005.04" "$1,699.13" "$1,699.13" "$1,699.13" "$1,699.13" "$1,274.63" "$1,699.13" "$1,699.13" "$1,699.13" $849.57 $849.57 "$1,345.71" "$1,699.13" "$1,359.30" "$1,104.43" $337.23 N/A $985.71 "$1,699.13" "$1,699.13" "$1,699.13" $354.10 "$1,699.13" N/A N/A M001PCB50201350 SUP HCPCS C1726 M001PCB50201350 - CATHETER BLNDIL 5MM 135CM 20MM PR CTBLN OTW TPR TIP INFL BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A M001PCB5020500 SUP HCPCS C1753 M001PCB5020500 - CATHETER BALDILAT 5MM 50CM 2CM OTW PERIPHERAL CUTTING BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A M001PCB5020900 SUP HCPCS C1726 M001PCB5020900 - CATHETER BALDILAT 5MM 90CM 20MM OTW PLAQUE MODIFICATION BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A M001PCB60201350 SUP HCPCS C1726 M001PCB60201350 - CATHETER BLNDIL 5MM 135CM 20MM PR CTBLN OTW TPR TIP INFL BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A M001PCB6020500 SUP HCPCS C1753 M001PCB6020500 - CATHETER BLNDIL 6MM 50CM 20MM PR CTBLN OTW TPR TIP INFL PORT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A M001PCB6020900 SUP HCPCS C1726 M001PCB6020900 - CATHETER BLNDIL 6MM 90CM 20MM PR CTBLN OTW INFL PORT TPR TIP BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A M001PCB70201350 SUP HCPCS C1753 M001PCB70201350 - CATHETER BLNDIL 7MM 135CM 20MM PR CTBLN OTW TPR TIP INFL BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 N/A "$1,015.00" "$1,750.00" "$1,050.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A M001PCB7020500 SUP HCPCS C1753 M001PCB7020500 - CATHETER BLNDIL 7MM 50CM 20MM PR CTBLN OTW TPR TIP INFL PORT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A M001PCB7020900 SUP HCPCS C1753 M001PCB7020900 - CATHETER BLNDIL 7MM 90CM 20MM PR CTBLN OTW TPR TIP INFL PORT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A M001PCB80201350 SUP HCPCS C1753 M001PCB80201350 - CATHETER BALDILAT 8MM 135CM 2CM OTW PLAQUE MODIFICATION BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A M001PCB8020500 SUP HCPCS C1753 M001PCB8020500 - CATHETER BLNDIL 8MM 50CM 20MM PR CTBLN OTW INFL PORT TPR TIP BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A M001PCB8020900 SUP HCPCS C1753 M001PCB8020900 - CATHETER BLNDIL 8MM 90CM 20MM PR CTBLN OTW TPR TIP INFL PORT BOTH IP/OP "$1,750.00" "$1,295.00" $347.33 "$1,750.00" $950.25 $950.25 $950.25 $950.25 "$1,750.00" "$1,750.00" "$1,750.00" $364.74 "$1,750.00" "$1,298.85" "$1,298.85" "$1,348.90" $911.75 $364.72 "$1,750.00" "$1,750.00" "$1,035.13" "$1,750.00" "$1,750.00" "$1,750.00" "$1,750.00" "$1,312.50" "$1,750.00" "$1,750.00" "$1,750.00" $875.00 $875.00 "$1,386.00" "$1,750.00" "$1,400.00" "$1,137.50" $347.33 N/A "$1,015.00" "$1,750.00" "$1,750.00" "$1,750.00" $364.70 "$1,750.00" N/A N/A M001PCIU400000 SUP HCPCS C2618 M001PCIU400000 - UNIT CATH POLARCATH PERI CRYOPLASTY BOTH IP/OP "$2,561.00" "$1,895.00" $533.74 "$2,561.00" "$2,561.00" "$2,561.00" "$2,561.00" "$2,561.00" "$2,561.00" "$2,561.00" "$2,561.00" "$2,561.00" "$2,561.00" "$1,900.77" "$1,900.77" "$1,974.02" "$1,334.28" $533.74 "$2,561.00" "$1,024.40" "$2,561.00" "$2,561.00" "$2,561.00" "$2,561.00" "$2,561.00" "$1,920.75" "$2,561.00" "$2,561.00" "$2,561.00" "$1,280.50" "$1,280.50" "$2,028.31" "$2,561.00" "$2,048.80" "$1,664.65" "$2,561.00" N/A "$1,485.38" "$2,561.00" "$1,536.60" "$2,561.00" "$2,561.00" "$2,561.00" N/A N/A M001T20100135010 SUP HCPCS C1725 M001T20100135010 - CATHETER BLNDIL 2MM 135CM 100MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,536.50" "$1,877.00" $503.41 "$2,536.38" "$1,377.25" "$1,377.25" "$1,377.25" "$1,377.25" "$2,536.38" "$2,536.38" "$2,536.38" $528.65 "$2,536.38" "$1,882.50" "$1,882.50" "$1,955.04" "$1,321.45" $528.61 "$2,536.38" "$2,536.38" "$1,500.27" "$2,536.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,902.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,268.19" "$1,268.19" "$2,008.81" "$2,536.38" "$2,029.10" "$1,648.65" $503.41 N/A "$1,471.17" "$2,536.38" "$2,536.38" "$2,536.38" $528.58 "$2,536.38" N/A N/A M001T20100150010 SUP HCPCS C1725 M001T20100150010 - CATHETER BLNDIL 2MM 150CM 100MM POLARCATH COAX RADOPQ PERI BOTH IP/OP "$2,536.50" "$1,877.00" $503.41 "$2,536.38" "$1,377.25" "$1,377.25" "$1,377.25" "$1,377.25" "$2,536.38" "$2,536.38" "$2,536.38" $528.65 "$2,536.38" "$1,882.50" "$1,882.50" "$1,955.04" "$1,321.45" $528.61 "$2,536.38" "$2,536.38" "$1,500.27" "$2,536.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,902.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,268.19" "$1,268.19" "$2,008.81" "$2,536.38" "$2,029.10" "$1,648.65" $503.41 N/A "$1,471.17" "$2,536.38" "$2,536.38" "$2,536.38" $528.58 "$2,536.38" N/A N/A M001T20120150010 SUP HCPCS C1725 M001T20120150010 - CATHETER BLNDIL 2MM 150CM 120MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,795.00" "$2,068.00" $554.73 "$2,794.95" "$1,517.66" "$1,517.66" "$1,517.66" "$1,517.66" "$2,794.95" "$2,794.95" "$2,794.95" $582.54 "$2,794.95" "$2,074.41" "$2,074.41" "$2,154.35" "$1,456.17" $582.50 "$2,794.95" "$2,794.95" "$1,653.21" "$2,794.95" "$2,794.95" "$2,794.95" "$2,794.95" "$2,096.25" "$2,794.95" "$2,794.95" "$2,794.95" "$1,397.48" "$1,397.48" "$2,213.60" "$2,794.95" "$2,235.96" "$1,816.72" $554.73 N/A "$1,621.10" "$2,794.95" "$2,794.95" "$2,794.95" $582.47 "$2,794.95" N/A N/A M001T20150150010 SUP HCPCS C1725 M001T20150150010 - CATHETER BLNDIL 2MM 150CM 150MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$3,041.50" "$2,251.00" $603.60 "$3,041.20" "$1,651.37" "$1,651.37" "$1,651.37" "$1,651.37" "$3,041.20" "$3,041.20" "$3,041.20" $633.86 "$3,041.20" "$2,257.18" "$2,257.18" "$2,344.16" "$1,584.47" $633.82 "$3,041.20" "$3,041.20" "$1,798.87" "$3,041.20" "$3,041.20" "$3,041.20" "$3,041.20" "$2,281.13" "$3,041.20" "$3,041.20" "$3,041.20" "$1,520.60" "$1,520.60" "$2,408.63" "$3,041.20" "$2,432.96" "$1,976.78" $603.60 N/A "$1,764.07" "$3,041.20" "$3,041.20" "$3,041.20" $633.79 "$3,041.20" N/A N/A M001T2020135010 SUP HCPCS C1725 M001T2020135010 - CATHETER BLNDIL 2MM 135CM 20MM POLARCATH COAX RADOPQ PERI BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T2020150010 SUP HCPCS C1725 M001T2020150010 - CATHETER BLNDIL 2MM 150CM 20MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T2040135010 SUP HCPCS C1725 M001T2040135010 - CATHETER BLNDIL 2MM 135CM 40MM POLARCATH COAX RADOPQ PERI BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T2040150010 SUP HCPCS C1725 M001T2040150010 - CATHETER BLNDIL 2MM 150CM 40MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T2060135010 SUP HCPCS C1725 M001T2060135010 - CATHETER BLNDIL 2MM 135CM 60MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T2060150010 SUP HCPCS C1725 M001T2060150010 - CATHETER BLNDIL 2MM 150CM 60MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T25100135010 SUP HCPCS C1725 M001T25100135010 - CATHETER BLNDIL 2.5MM 135CM 100MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,536.50" "$1,877.00" $503.41 "$2,536.38" "$1,377.25" "$1,377.25" "$1,377.25" "$1,377.25" "$2,536.38" "$2,536.38" "$2,536.38" $528.65 "$2,536.38" "$1,882.50" "$1,882.50" "$1,955.04" "$1,321.45" $528.61 "$2,536.38" "$2,536.38" "$1,500.27" "$2,536.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,902.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,268.19" "$1,268.19" "$2,008.81" "$2,536.38" "$2,029.10" "$1,648.65" $503.41 N/A "$1,471.17" "$2,536.38" "$2,536.38" "$2,536.38" $528.58 "$2,536.38" N/A N/A M001T25100150010 SUP HCPCS C1725 M001T25100150010 - CATHETER BLNDIL 2.5MM 150CM 100MM POLARCATH COAX RADOPQ PERI BOTH IP/OP "$2,536.50" "$1,877.00" $503.41 "$2,536.38" "$1,377.25" "$1,377.25" "$1,377.25" "$1,377.25" "$2,536.38" "$2,536.38" "$2,536.38" $528.65 "$2,536.38" "$1,882.50" "$1,882.50" "$1,955.04" "$1,321.45" $528.61 "$2,536.38" "$2,536.38" "$1,500.27" "$2,536.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,902.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,268.19" "$1,268.19" "$2,008.81" "$2,536.38" "$2,029.10" "$1,648.65" $503.41 N/A "$1,471.17" "$2,536.38" "$2,536.38" "$2,536.38" $528.58 "$2,536.38" N/A N/A M001T25120150010 SUP HCPCS C1725 M001T25120150010 - CATHETER BLNDIL 2.5MM 150CM 120MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,795.00" "$2,068.00" $554.73 "$2,794.95" "$1,517.66" "$1,517.66" "$1,517.66" "$1,517.66" "$2,794.95" "$2,794.95" "$2,794.95" $582.54 "$2,794.95" "$2,074.41" "$2,074.41" "$2,154.35" "$1,456.17" $582.50 "$2,794.95" "$2,794.95" "$1,653.21" "$2,794.95" "$2,794.95" "$2,794.95" "$2,794.95" "$2,096.25" "$2,794.95" "$2,794.95" "$2,794.95" "$1,397.48" "$1,397.48" "$2,213.60" "$2,794.95" "$2,235.96" "$1,816.72" $554.73 N/A "$1,621.10" "$2,794.95" "$2,794.95" "$2,794.95" $582.47 "$2,794.95" N/A N/A M001T25150150010 SUP HCPCS C1725 M001T25150150010 - CATHETER BLNDIL 2.5MM 150CM 150MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$3,041.50" "$2,251.00" $603.60 "$3,041.20" "$1,651.37" "$1,651.37" "$1,651.37" "$1,651.37" "$3,041.20" "$3,041.20" "$3,041.20" $633.86 "$3,041.20" "$2,257.18" "$2,257.18" "$2,344.16" "$1,584.47" $633.82 "$3,041.20" "$3,041.20" "$1,798.87" "$3,041.20" "$3,041.20" "$3,041.20" "$3,041.20" "$2,281.13" "$3,041.20" "$3,041.20" "$3,041.20" "$1,520.60" "$1,520.60" "$2,408.63" "$3,041.20" "$2,432.96" "$1,976.78" $603.60 N/A "$1,764.07" "$3,041.20" "$3,041.20" "$3,041.20" $633.79 "$3,041.20" N/A N/A M001T2520135010 SUP HCPCS C1725 M001T2520135010 - CATHETER BLNDIL 2.5MM 135CM 20MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T2520150010 SUP HCPCS C1725 M001T2520150010 - CATHETER BLNDIL 2.5MM 150CM 20MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T2540135010 SUP HCPCS C1725 M001T2540135010 - CATHETER BLNDIL 2.5MM 135CM 40MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T2540150010 SUP HCPCS C1725 M001T2540150010 - CATHETER BLNDIL 2.5MM 150CM 40MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T2560135010 SUP HCPCS C1725 M001T2560135010 - CATHETER BLNDIL 2.5MM 135CM 60MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T2560150010 SUP HCPCS C1725 M001T2560150010 - CATHETER BLNDIL 2.5MM 150CM 60MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T30100135010 SUP HCPCS C1725 M001T30100135010 - CATHETER BLNDIL 3MM 135CM 100MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,536.50" "$1,877.00" $503.41 "$2,536.38" "$1,377.25" "$1,377.25" "$1,377.25" "$1,377.25" "$2,536.38" "$2,536.38" "$2,536.38" $528.65 "$2,536.38" "$1,882.50" "$1,882.50" "$1,955.04" "$1,321.45" $528.61 "$2,536.38" "$2,536.38" "$1,500.27" "$2,536.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,902.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,268.19" "$1,268.19" "$2,008.81" "$2,536.38" "$2,029.10" "$1,648.65" $503.41 N/A "$1,471.17" "$2,536.38" "$2,536.38" "$2,536.38" $528.58 "$2,536.38" N/A N/A M001T30100150010 SUP HCPCS C1725 M001T30100150010 - CATHETER BLNDIL 3MM 150CM 100MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,536.50" "$1,877.00" $503.41 "$2,536.38" "$1,377.25" "$1,377.25" "$1,377.25" "$1,377.25" "$2,536.38" "$2,536.38" "$2,536.38" $528.65 "$2,536.38" "$1,882.50" "$1,882.50" "$1,955.04" "$1,321.45" $528.61 "$2,536.38" "$2,536.38" "$1,500.27" "$2,536.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,902.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,268.19" "$1,268.19" "$2,008.81" "$2,536.38" "$2,029.10" "$1,648.65" $503.41 N/A "$1,471.17" "$2,536.38" "$2,536.38" "$2,536.38" $528.58 "$2,536.38" N/A N/A M001T30120150010 SUP HCPCS C1725 M001T30120150010 - CATHETER BLNDIL 3MM 150CM 120MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,795.00" "$2,068.00" $554.73 "$2,794.95" "$1,517.66" "$1,517.66" "$1,517.66" "$1,517.66" "$2,794.95" "$2,794.95" "$2,794.95" $582.54 "$2,794.95" "$2,074.41" "$2,074.41" "$2,154.35" "$1,456.17" $582.50 "$2,794.95" "$2,794.95" "$1,653.21" "$2,794.95" "$2,794.95" "$2,794.95" "$2,794.95" "$2,096.25" "$2,794.95" "$2,794.95" "$2,794.95" "$1,397.48" "$1,397.48" "$2,213.60" "$2,794.95" "$2,235.96" "$1,816.72" $554.73 N/A "$1,621.10" "$2,794.95" "$2,794.95" "$2,794.95" $582.47 "$2,794.95" N/A N/A M001T30150150010 SUP HCPCS C1725 M001T30150150010 - CATHETER BLNDIL 3MM 150CM 150MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$3,041.50" "$2,251.00" $603.60 "$3,041.20" "$1,651.37" "$1,651.37" "$1,651.37" "$1,651.37" "$3,041.20" "$3,041.20" "$3,041.20" $633.86 "$3,041.20" "$2,257.18" "$2,257.18" "$2,344.16" "$1,584.47" $633.82 "$3,041.20" "$3,041.20" "$1,798.87" "$3,041.20" "$3,041.20" "$3,041.20" "$3,041.20" "$2,281.13" "$3,041.20" "$3,041.20" "$3,041.20" "$1,520.60" "$1,520.60" "$2,408.63" "$3,041.20" "$2,432.96" "$1,976.78" $603.60 N/A "$1,764.07" "$3,041.20" "$3,041.20" "$3,041.20" $633.79 "$3,041.20" N/A N/A M001T3020135010 SUP HCPCS C1725 M001T3020135010 - CATHETER BLNDIL 3MM 135CM 20MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T3020150010 SUP HCPCS C1725 M001T3020150010 - CATHETER BLNDIL 3MM 150CM 20MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T3040135010 SUP HCPCS C1725 M001T3040135010 - CATHETER BLNDIL 3MM 135CM 40MM POLARCATH COAX RADOPQ PERI BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T3040150010 SUP HCPCS C1725 M001T3040150010 - CATHETER BLNDIL 3MM 150CM 40MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T3060135010 SUP HCPCS C1725 M001T3060135010 - CATHETER BLNDIL 3MM 135CM 60MM POLARCATH COAX RADOPQ MRKNG BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T3060150010 SUP HCPCS C1725 M001T3060150010 - CATHETER BLNDIL 3MM 150CM 60MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T35100135010 SUP HCPCS C1725 M001T35100135010 - CATHETER BLNDIL 3.5MM 135CM 100MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,536.50" "$1,877.00" $503.41 "$2,536.38" "$1,377.25" "$1,377.25" "$1,377.25" "$1,377.25" "$2,536.38" "$2,536.38" "$2,536.38" $528.65 "$2,536.38" "$1,882.50" "$1,882.50" "$1,955.04" "$1,321.45" $528.61 "$2,536.38" "$2,536.38" "$1,500.27" "$2,536.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,902.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,268.19" "$1,268.19" "$2,008.81" "$2,536.38" "$2,029.10" "$1,648.65" $503.41 N/A "$1,471.17" "$2,536.38" "$2,536.38" "$2,536.38" $528.58 "$2,536.38" N/A N/A M001T35100150010 SUP HCPCS C1725 M001T35100150010 - CATHETER BLNDIL 3.5MM 150CM 100MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,536.50" "$1,877.00" $503.41 "$2,536.38" "$1,377.25" "$1,377.25" "$1,377.25" "$1,377.25" "$2,536.38" "$2,536.38" "$2,536.38" $528.65 "$2,536.38" "$1,882.50" "$1,882.50" "$1,955.04" "$1,321.45" $528.61 "$2,536.38" "$2,536.38" "$1,500.27" "$2,536.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,902.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,268.19" "$1,268.19" "$2,008.81" "$2,536.38" "$2,029.10" "$1,648.65" $503.41 N/A "$1,471.17" "$2,536.38" "$2,536.38" "$2,536.38" $528.58 "$2,536.38" N/A N/A M001T35120150010 SUP HCPCS C1725 M001T35120150010 - CATHETER BLNDIL 3.5MM 150CM 120MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,795.00" "$2,068.00" $554.73 "$2,794.95" "$1,517.66" "$1,517.66" "$1,517.66" "$1,517.66" "$2,794.95" "$2,794.95" "$2,794.95" $582.54 "$2,794.95" "$2,074.41" "$2,074.41" "$2,154.35" "$1,456.17" $582.50 "$2,794.95" "$2,794.95" "$1,653.21" "$2,794.95" "$2,794.95" "$2,794.95" "$2,794.95" "$2,096.25" "$2,794.95" "$2,794.95" "$2,794.95" "$1,397.48" "$1,397.48" "$2,213.60" "$2,794.95" "$2,235.96" "$1,816.72" $554.73 N/A "$1,621.10" "$2,794.95" "$2,794.95" "$2,794.95" $582.47 "$2,794.95" N/A N/A M001T35150150010 SUP HCPCS C1725 M001T35150150010 - CATHETER BLNDIL 3.5MM 150CM 150MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$3,041.50" "$2,251.00" $603.60 "$3,041.20" "$1,651.37" "$1,651.37" "$1,651.37" "$1,651.37" "$3,041.20" "$3,041.20" "$3,041.20" $633.86 "$3,041.20" "$2,257.18" "$2,257.18" "$2,344.16" "$1,584.47" $633.82 "$3,041.20" "$3,041.20" "$1,798.87" "$3,041.20" "$3,041.20" "$3,041.20" "$3,041.20" "$2,281.13" "$3,041.20" "$3,041.20" "$3,041.20" "$1,520.60" "$1,520.60" "$2,408.63" "$3,041.20" "$2,432.96" "$1,976.78" $603.60 N/A "$1,764.07" "$3,041.20" "$3,041.20" "$3,041.20" $633.79 "$3,041.20" N/A N/A M001T3520135010 SUP HCPCS C1725 M001T3520135010 - CATHETER BLNDIL 3.5MM 135CM 20MM POLARCATH COAX RADOPQ PERI BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T3520150010 SUP HCPCS C1725 M001T3520150010 - CATHETER BLNDIL 3.5MM 150CM 20MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T3540135010 SUP HCPCS C1725 M001T3540135010 - CATHETER BLNDIL 3.5MM 135CM 40MM POLARCATH COAX RADOPQ MRKNG BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T3540150010 SUP HCPCS C1725 M001T3540150010 - CATHETER BLNDIL 3.5MM 150CM 40MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T3560135010 SUP HCPCS C1725 M001T3560135010 - CATHETER BLNDIL 3.5MM 135CM 60MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T3560150010 SUP HCPCS C1725 M001T3560150010 - CATHETER BLNDIL 3.5MM 150CM 60MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T40100135010 SUP HCPCS C1725 M001T40100135010 - CATHETER BLNDIL 4MM 135CM 100MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,536.50" "$1,877.00" $503.41 "$2,536.38" "$1,377.25" "$1,377.25" "$1,377.25" "$1,377.25" "$2,536.38" "$2,536.38" "$2,536.38" $528.65 "$2,536.38" "$1,882.50" "$1,882.50" "$1,955.04" "$1,321.45" $528.61 "$2,536.38" "$2,536.38" "$1,500.27" "$2,536.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,902.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,268.19" "$1,268.19" "$2,008.81" "$2,536.38" "$2,029.10" "$1,648.65" $503.41 N/A "$1,471.17" "$2,536.38" "$2,536.38" "$2,536.38" $528.58 "$2,536.38" N/A N/A M001T40100150010 SUP HCPCS C1725 M001T40100150010 - CATHETER BLNDIL 4MM 150CM 100MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,536.50" "$1,877.00" $503.41 "$2,536.38" "$1,377.25" "$1,377.25" "$1,377.25" "$1,377.25" "$2,536.38" "$2,536.38" "$2,536.38" $528.65 "$2,536.38" "$1,882.50" "$1,882.50" "$1,955.04" "$1,321.45" $528.61 "$2,536.38" "$2,536.38" "$1,500.27" "$2,536.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,902.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,268.19" "$1,268.19" "$2,008.81" "$2,536.38" "$2,029.10" "$1,648.65" $503.41 N/A "$1,471.17" "$2,536.38" "$2,536.38" "$2,536.38" $528.58 "$2,536.38" N/A N/A M001T40120150010 SUP HCPCS C1725 M001T40120150010 - CATHETER BLNDIL 4MM 150CM 120MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,795.00" "$2,068.00" $554.73 "$2,794.95" "$1,517.66" "$1,517.66" "$1,517.66" "$1,517.66" "$2,794.95" "$2,794.95" "$2,794.95" $582.54 "$2,794.95" "$2,074.41" "$2,074.41" "$2,154.35" "$1,456.17" $582.50 "$2,794.95" "$2,794.95" "$1,653.21" "$2,794.95" "$2,794.95" "$2,794.95" "$2,794.95" "$2,096.25" "$2,794.95" "$2,794.95" "$2,794.95" "$1,397.48" "$1,397.48" "$2,213.60" "$2,794.95" "$2,235.96" "$1,816.72" $554.73 N/A "$1,621.10" "$2,794.95" "$2,794.95" "$2,794.95" $582.47 "$2,794.95" N/A N/A M001T40150150010 SUP HCPCS C1725 M001T40150150010 - CATHETER BLNDIL 4MM 150CM 150MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$3,041.50" "$2,251.00" $603.60 "$3,041.20" "$1,651.37" "$1,651.37" "$1,651.37" "$1,651.37" "$3,041.20" "$3,041.20" "$3,041.20" $633.86 "$3,041.20" "$2,257.18" "$2,257.18" "$2,344.16" "$1,584.47" $633.82 "$3,041.20" "$3,041.20" "$1,798.87" "$3,041.20" "$3,041.20" "$3,041.20" "$3,041.20" "$2,281.13" "$3,041.20" "$3,041.20" "$3,041.20" "$1,520.60" "$1,520.60" "$2,408.63" "$3,041.20" "$2,432.96" "$1,976.78" $603.60 N/A "$1,764.07" "$3,041.20" "$3,041.20" "$3,041.20" $633.79 "$3,041.20" N/A N/A M001T4020135010 SUP HCPCS C1725 M001T4020135010 - CATHETER BLNDIL 5FR 4MM 135CM 20MM POLARCATH SHTH PERI ACPT BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T4020150010 SUP HCPCS C1725 M001T4020150010 - CATHETER BLNDIL 4MM 150CM 20MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T4040135010 SUP HCPCS C1725 M001T4040135010 - CATHETER BLNDIL 4MM 135CM 40MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T4040150010 SUP HCPCS C1725 M001T4040150010 - CATHETER BLNDIL 4MM 150CM 40MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T4060135010 SUP HCPCS C1725 M001T4060135010 - CATHETER BLNDIL 4MM 135CM 60MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T4060150010 SUP HCPCS C1725 M001T4060150010 - CATHETER BLNDIL 4MM 150CM 60MM POLARCATH COAX RADOPQ PERI BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T50100135010 SUP HCPCS C1725 M001T50100135010 - CATHETER BLNDIL 5MM 135CM 100MM POLARCATH COAX RADOPQ PERI BOTH IP/OP "$2,536.50" "$1,877.00" $503.41 "$2,536.38" "$1,377.25" "$1,377.25" "$1,377.25" "$1,377.25" "$2,536.38" "$2,536.38" "$2,536.38" $528.65 "$2,536.38" "$1,882.50" "$1,882.50" "$1,955.04" "$1,321.45" $528.61 "$2,536.38" "$2,536.38" "$1,500.27" "$2,536.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,902.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,268.19" "$1,268.19" "$2,008.81" "$2,536.38" "$2,029.10" "$1,648.65" $503.41 N/A "$1,471.17" "$2,536.38" "$2,536.38" "$2,536.38" $528.58 "$2,536.38" N/A N/A M001T50120135010 SUP HCPCS C1725 M001T50120135010 - CATHETER BLNDIL 5MM 135CM 120MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$2,795.00" "$2,068.00" $554.73 "$2,794.95" "$1,517.66" "$1,517.66" "$1,517.66" "$1,517.66" "$2,794.95" "$2,794.95" "$2,794.95" $582.54 "$2,794.95" "$2,074.41" "$2,074.41" "$2,154.35" "$1,456.17" $582.50 "$2,794.95" "$2,794.95" "$1,653.21" "$2,794.95" "$2,794.95" "$2,794.95" "$2,794.95" "$2,096.25" "$2,794.95" "$2,794.95" "$2,794.95" "$1,397.48" "$1,397.48" "$2,213.60" "$2,794.95" "$2,235.96" "$1,816.72" $554.73 N/A "$1,621.10" "$2,794.95" "$2,794.95" "$2,794.95" $582.47 "$2,794.95" N/A N/A M001T50150135010 SUP HCPCS C1725 M001T50150135010 - CATHETER BLNDIL 5MM 135CM 150MM POLARCATH COAX RADOPQ PERI BOTH IP/OP "$3,041.50" "$2,251.00" $603.60 "$3,041.20" "$1,651.37" "$1,651.37" "$1,651.37" "$1,651.37" "$3,041.20" "$3,041.20" "$3,041.20" $633.86 "$3,041.20" "$2,257.18" "$2,257.18" "$2,344.16" "$1,584.47" $633.82 "$3,041.20" "$3,041.20" "$1,798.87" "$3,041.20" "$3,041.20" "$3,041.20" "$3,041.20" "$2,281.13" "$3,041.20" "$3,041.20" "$3,041.20" "$1,520.60" "$1,520.60" "$2,408.63" "$3,041.20" "$2,432.96" "$1,976.78" $603.60 N/A "$1,764.07" "$3,041.20" "$3,041.20" "$3,041.20" $633.79 "$3,041.20" N/A N/A M001T5020135010 SUP HCPCS C1725 M001T5020135010 - CATHETER BLNDIL 5MM 135CM 20MM POLARCATH COAX RADOPQ PERI BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T5040135010 SUP HCPCS C1725 M001T5040135010 - CATHETER BLNDIL 5MM 135CM 40MM POLARCATH COAX RADOPQ PERI BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T5060135010 SUP HCPCS C1725 M001T5060135010 - CATHETER BLNDIL 5MM 135CM 60MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T60100135010 SUP HCPCS C1725 M001T60100135010 - CATHETER BLNDIL 6MM 135CM 100MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,536.50" "$1,877.00" $503.41 "$2,536.38" "$1,377.25" "$1,377.25" "$1,377.25" "$1,377.25" "$2,536.38" "$2,536.38" "$2,536.38" $528.65 "$2,536.38" "$1,882.50" "$1,882.50" "$1,955.04" "$1,321.45" $528.61 "$2,536.38" "$2,536.38" "$1,500.27" "$2,536.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,902.38" "$2,536.38" "$2,536.38" "$2,536.38" "$1,268.19" "$1,268.19" "$2,008.81" "$2,536.38" "$2,029.10" "$1,648.65" $503.41 N/A "$1,471.17" "$2,536.38" "$2,536.38" "$2,536.38" $528.58 "$2,536.38" N/A N/A M001T60120135010 SUP HCPCS C1725 M001T60120135010 - CATHETER BLNDIL 6MM 135CM 120MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$2,795.00" "$2,068.00" $554.73 "$2,794.95" "$1,517.66" "$1,517.66" "$1,517.66" "$1,517.66" "$2,794.95" "$2,794.95" "$2,794.95" $582.54 "$2,794.95" "$2,074.41" "$2,074.41" "$2,154.35" "$1,456.17" $582.50 "$2,794.95" "$2,794.95" "$1,653.21" "$2,794.95" "$2,794.95" "$2,794.95" "$2,794.95" "$2,096.25" "$2,794.95" "$2,794.95" "$2,794.95" "$1,397.48" "$1,397.48" "$2,213.60" "$2,794.95" "$2,235.96" "$1,816.72" $554.73 N/A "$1,621.10" "$2,794.95" "$2,794.95" "$2,794.95" $582.47 "$2,794.95" N/A N/A M001T60150135010 SUP HCPCS C1725 M001T60150135010 - CATHETER BLNDIL 6MM 135CM 150MM POLARCATH PERI ACPT .014IN BOTH IP/OP "$3,041.50" "$2,251.00" $603.60 "$3,041.20" "$1,651.37" "$1,651.37" "$1,651.37" "$1,651.37" "$3,041.20" "$3,041.20" "$3,041.20" $633.86 "$3,041.20" "$2,257.18" "$2,257.18" "$2,344.16" "$1,584.47" $633.82 "$3,041.20" "$3,041.20" "$1,798.87" "$3,041.20" "$3,041.20" "$3,041.20" "$3,041.20" "$2,281.13" "$3,041.20" "$3,041.20" "$3,041.20" "$1,520.60" "$1,520.60" "$2,408.63" "$3,041.20" "$2,432.96" "$1,976.78" $603.60 N/A "$1,764.07" "$3,041.20" "$3,041.20" "$3,041.20" $633.79 "$3,041.20" N/A N/A M001T6020135010 SUP HCPCS C1725 M001T6020135010 - CATHETER BLNDIL 6MM 135CM 20MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T6040135010 SUP HCPCS C1725 M001T6040135010 - CATHETER BLNDIL 6MM 135CM 40MM POLARCATH RADOPQ PERI ACPT BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M001T6060135010 SUP HCPCS C1725 M001T6060135010 - CATHETER BLNDIL 6MM 135CM 60MM POLARCATH PERI ACPT .014IN GW BOTH IP/OP "$2,265.50" "$1,676.00" $449.65 "$2,265.50" "$1,230.17" "$1,230.17" "$1,230.17" "$1,230.17" "$2,265.50" "$2,265.50" "$2,265.50" $472.19 "$2,265.50" "$1,681.45" "$1,681.45" "$1,746.25" "$1,180.33" $472.16 "$2,265.50" "$2,265.50" "$1,340.04" "$2,265.50" "$2,265.50" "$2,265.50" "$2,265.50" "$1,699.13" "$2,265.50" "$2,265.50" "$2,265.50" "$1,132.75" "$1,132.75" "$1,794.28" "$2,265.50" "$1,812.40" "$1,472.58" $449.65 N/A "$1,313.99" "$2,265.50" "$2,265.50" "$2,265.50" $472.13 "$2,265.50" N/A N/A M002002231680 SUP HCPCS C1768 M002002231680 - GRAFT CARDIO 16X8MM 40CM WOVEN BIFURCATED NONSEALED COOLEY BOTH IP/OP "$1,337.50" $990.00 $265.46 "$1,337.50" $601.88 $601.88 $601.88 $601.88 "$1,337.50" "$1,337.50" "$1,337.50" $278.77 "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" $278.75 "$1,337.50" "$1,337.50" $791.13 "$1,337.50" "$1,337.50" "$1,337.50" "$1,337.50" "$1,003.13" "$1,337.50" "$1,337.50" "$1,337.50" $668.75 $668.75 "$1,059.30" "$1,337.50" "$1,070.00" $601.88 $265.46 N/A $775.75 "$1,337.50" "$1,337.50" "$1,337.50" $278.74 "$1,337.50" N/A N/A M002020195300 SUP HCPCS C1768 M002020195300 - PATCH CV 7.6X2.5CM ULMX KNIT PLSTR 2 VLR BOTH IP/OP $279.00 $206.00 $55.36 $278.93 $125.52 $125.52 $125.52 $125.52 $278.93 $278.93 $278.93 $58.14 $278.93 $278.93 $278.93 $278.93 $278.93 $58.13 $278.93 $278.93 $164.99 $278.93 $278.93 $278.93 $278.93 $209.25 $278.93 $278.93 $278.93 $139.47 $139.47 $220.91 $278.93 $223.14 $125.52 $55.36 N/A $161.82 $278.93 $278.93 $278.93 $58.13 $278.93 N/A N/A M00202019530P0 SUP HCPCS C1768 M00202019530P0 - PATCH CV THK.36MM ULTHN TPR 3X1IN HMSH PL FNS KNIT PRETRIM BOTH IP/OP $322.00 $238.00 $63.85 $321.70 $144.77 $144.77 $144.77 $144.77 $321.70 $321.70 $321.70 $67.05 $321.70 $321.70 $321.70 $321.70 $321.70 $67.05 $321.70 $321.70 $190.29 $321.70 $321.70 $321.70 $321.70 $241.50 $321.70 $321.70 $321.70 $160.85 $160.85 $254.79 $321.70 $257.36 $144.77 $63.85 N/A $186.76 $321.70 $193.02 $321.70 $67.04 $321.70 N/A N/A M002020851470 SUP HCPCS C1768 M002020851470 - GRAFT CV 2 BRCH THN 14MM 7MM 40CM STRL HMSH G2 VLR MCVL SFT BOTH IP/OP "$1,772.50" "$1,312.00" $351.79 "$1,772.45" $797.60 $797.60 $797.60 $797.60 "$1,772.45" "$1,772.45" "$1,772.45" $369.42 "$1,772.45" "$1,772.45" "$1,772.45" "$1,772.45" "$1,772.45" $369.40 "$1,772.45" "$1,772.45" "$1,048.40" "$1,772.45" "$1,772.45" "$1,772.45" "$1,772.45" "$1,329.38" "$1,772.45" "$1,772.45" "$1,772.45" $886.23 $886.23 "$1,403.78" "$1,772.45" "$1,417.96" $797.60 $351.79 N/A "$1,028.05" "$1,772.45" "$1,772.45" "$1,772.45" $369.38 "$1,772.45" N/A N/A M002020851890 SUP HCPCS C1768 M002020851890 - GRAFT CV 2 BRCH 18MM 9MM 40CM STRL HMSH GMCVL 2 VLR CLGN BOTH IP/OP "$1,772.50" "$1,312.00" $351.79 "$1,772.45" $797.60 $797.60 $797.60 $797.60 "$1,772.45" "$1,772.45" "$1,772.45" $369.42 "$1,772.45" "$1,772.45" "$1,772.45" "$1,772.45" "$1,772.45" $369.40 "$1,772.45" "$1,772.45" "$1,048.40" "$1,772.45" "$1,772.45" "$1,772.45" "$1,772.45" "$1,329.38" "$1,772.45" "$1,772.45" "$1,772.45" $886.23 $886.23 "$1,403.78" "$1,772.45" "$1,417.96" $797.60 $351.79 N/A "$1,028.05" "$1,772.45" "$1,772.45" "$1,772.45" $369.38 "$1,772.45" N/A N/A M002020852010 SUP HCPCS C1768 M002020852010 - GRAFT VASC 2 BRCH 20MM 10MM 40CM STRL HMSH GPLSTR 2 VLR WVN BOTH IP/OP "$1,772.50" "$1,312.00" $351.79 "$1,772.45" $797.60 $797.60 $797.60 $797.60 "$1,772.45" "$1,772.45" "$1,772.45" $369.42 "$1,772.45" "$1,772.45" "$1,772.45" "$1,772.45" "$1,772.45" $369.40 "$1,772.45" "$1,772.45" "$1,048.40" "$1,772.45" "$1,772.45" "$1,772.45" "$1,772.45" "$1,329.38" "$1,772.45" "$1,772.45" "$1,772.45" $886.23 $886.23 "$1,403.78" "$1,772.45" "$1,417.96" $797.60 $351.79 N/A "$1,028.05" "$1,772.45" "$1,772.45" "$1,772.45" $369.38 "$1,772.45" N/A N/A M002020952080 SUP HCPCS C1768 M002020952080 - GRAFT CV 8MM 60CM STRL HMSH GMCVL 2 VLR STRG TUBE KNTD SFT BOTH IP/OP "$1,308.00" $968.00 $259.61 "$1,308.00" $588.60 $588.60 $588.60 $588.60 "$1,308.00" "$1,308.00" "$1,308.00" $272.62 "$1,308.00" "$1,308.00" "$1,308.00" "$1,308.00" "$1,308.00" $272.60 "$1,308.00" "$1,308.00" $773.68 "$1,308.00" "$1,308.00" "$1,308.00" "$1,308.00" $981.00 "$1,308.00" "$1,308.00" "$1,308.00" $654.00 $654.00 "$1,035.94" "$1,308.00" "$1,046.40" $588.60 $259.61 N/A $758.64 "$1,308.00" "$1,308.00" "$1,308.00" $272.59 "$1,308.00" N/A N/A M002020952160 SUP HCPCS C1768 M002020952160 - GRAFT VASC 16MM 30CM STRL HMSH GMCVL PLSTR 2 VLR STRG TUBE BOTH IP/OP "$1,240.00" $918.00 $246.09 "$1,239.88" $557.95 $557.95 $557.95 $557.95 "$1,239.88" "$1,239.88" "$1,239.88" $258.42 "$1,239.88" "$1,239.88" "$1,239.88" "$1,239.88" "$1,239.88" $258.40 "$1,239.88" "$1,239.88" $733.39 "$1,239.88" "$1,239.88" "$1,239.88" "$1,239.88" $930.00 "$1,239.88" "$1,239.88" "$1,239.88" $619.94 $619.94 $981.98 "$1,239.88" $991.90 $557.95 $246.09 N/A $719.20 "$1,239.88" "$1,239.88" "$1,239.88" $258.39 "$1,239.88" N/A N/A M00202175416P0 SUP HCPCS C1768 M00202175416P0 - GRAFT CV STRG TUBE 16MM 30CM STRL HMSH PL WVN SMTH NDL PSG BOTH IP/OP "$1,385.00" "$1,025.00" $274.83 "$1,384.73" $623.13 $623.13 $623.13 $623.13 "$1,384.73" "$1,384.73" "$1,384.73" $288.61 "$1,384.73" "$1,384.73" "$1,384.73" "$1,384.73" "$1,384.73" $288.59 "$1,384.73" "$1,384.73" $819.07 "$1,384.73" "$1,384.73" "$1,384.73" "$1,384.73" "$1,038.75" "$1,384.73" "$1,384.73" "$1,384.73" $692.37 $692.37 "$1,096.71" "$1,384.73" "$1,107.78" $623.13 $274.83 N/A $803.30 "$1,384.73" "$1,384.73" "$1,384.73" $288.58 "$1,384.73" N/A N/A M002021754180 SUP HCPCS C1768 M002021754180 - GRAFT VASCULAR 18MM 30CM WOVEN STR HEMASHIELD MICROVEL BOTH IP/OP "$1,235.50" $914.00 $245.22 "$1,235.50" $555.98 $555.98 $555.98 $555.98 "$1,235.50" "$1,235.50" "$1,235.50" $257.51 "$1,235.50" "$1,235.50" "$1,235.50" "$1,235.50" "$1,235.50" $257.49 "$1,235.50" "$1,235.50" $730.80 "$1,235.50" "$1,235.50" "$1,235.50" "$1,235.50" $926.63 "$1,235.50" "$1,235.50" "$1,235.50" $617.75 $617.75 $978.52 "$1,235.50" $988.40 $555.98 $245.22 N/A $716.59 "$1,235.50" "$1,235.50" "$1,235.50" $257.48 "$1,235.50" N/A N/A M00202175420P0 SUP HCPCS C1768 M00202175420P0 - GRAFT CV STRG 20MM 30CM STRL HMSH PL WVN SMTH NDL PSG SUT BOTH IP/OP "$1,385.00" "$1,025.00" $274.83 "$1,384.73" $623.13 $623.13 $623.13 $623.13 "$1,384.73" "$1,384.73" "$1,384.73" $288.61 "$1,384.73" "$1,384.73" "$1,384.73" "$1,384.73" "$1,384.73" $288.59 "$1,384.73" "$1,384.73" $819.07 "$1,384.73" "$1,384.73" "$1,384.73" "$1,384.73" "$1,038.75" "$1,384.73" "$1,384.73" "$1,384.73" $692.37 $692.37 "$1,096.71" "$1,384.73" "$1,107.78" $623.13 $274.83 N/A $803.30 "$1,384.73" "$1,384.73" "$1,384.73" $288.58 "$1,384.73" N/A N/A M00202175422P0 SUP HCPCS C1768 M00202175422P0 - GRAFT CV STRG 22MM 30CM STRL HMSH PL WVN SMTH NDL PSG SUT BOTH IP/OP "$1,385.00" "$1,025.00" $274.83 "$1,384.73" $623.13 $623.13 $623.13 $623.13 "$1,384.73" "$1,384.73" "$1,384.73" $288.61 "$1,384.73" "$1,384.73" "$1,384.73" "$1,384.73" "$1,384.73" $288.59 "$1,384.73" "$1,384.73" $819.07 "$1,384.73" "$1,384.73" "$1,384.73" "$1,384.73" "$1,038.75" "$1,384.73" "$1,384.73" "$1,384.73" $692.37 $692.37 "$1,096.71" "$1,384.73" "$1,107.78" $623.13 $274.83 N/A $803.30 "$1,384.73" "$1,384.73" "$1,384.73" $288.58 "$1,384.73" N/A N/A M00202175428P0 SUP HCPCS C1768 M00202175428P0 - GRAFT CV STRG TUBE 28MM 30CM HMSH PL WVN SMTH NDL PSG SUT BOTH IP/OP "$1,440.50" "$1,066.00" $285.83 "$1,440.13" $648.06 $648.06 $648.06 $648.06 "$1,440.13" "$1,440.13" "$1,440.13" $300.16 "$1,440.13" "$1,440.13" "$1,440.13" "$1,440.13" "$1,440.13" $300.14 "$1,440.13" "$1,440.13" $851.84 "$1,440.13" "$1,440.13" "$1,440.13" "$1,440.13" "$1,080.38" "$1,440.13" "$1,440.13" "$1,440.13" $720.07 $720.07 "$1,140.58" "$1,440.13" "$1,152.10" $648.06 $285.83 N/A $835.49 "$1,440.13" "$1,440.13" "$1,440.13" $300.12 "$1,440.13" N/A N/A M00202175430P0 SUP HCPCS C1768 M00202175430P0 - GRAFT CV STRG TUBE 30MM 30CM HMSH PL WVN SMTH NDL PSG SUT BOTH IP/OP "$1,440.50" "$1,066.00" $285.83 "$1,440.13" $648.06 $648.06 $648.06 $648.06 "$1,440.13" "$1,440.13" "$1,440.13" $300.16 "$1,440.13" "$1,440.13" "$1,440.13" "$1,440.13" "$1,440.13" $300.14 "$1,440.13" "$1,440.13" $851.84 "$1,440.13" "$1,440.13" "$1,440.13" "$1,440.13" "$1,080.38" "$1,440.13" "$1,440.13" "$1,440.13" $720.07 $720.07 "$1,140.58" "$1,440.13" "$1,152.10" $648.06 $285.83 N/A $835.49 "$1,440.13" "$1,440.13" "$1,440.13" $300.12 "$1,440.13" N/A N/A M00202175434P0 SUP HCPCS C1768 M00202175434P0 - GRAFT CV STRG TUBE 34MM 30CM HMSH PL WVN SMTH NDL PSG SUT BOTH IP/OP "$1,440.50" "$1,066.00" $285.83 "$1,440.13" $648.06 $648.06 $648.06 $648.06 "$1,440.13" "$1,440.13" "$1,440.13" $300.16 "$1,440.13" "$1,440.13" "$1,440.13" "$1,440.13" "$1,440.13" $300.14 "$1,440.13" "$1,440.13" $851.84 "$1,440.13" "$1,440.13" "$1,440.13" "$1,440.13" "$1,080.38" "$1,440.13" "$1,440.13" "$1,440.13" $720.07 $720.07 "$1,140.58" "$1,440.13" "$1,152.10" $648.06 $285.83 N/A $835.49 "$1,440.13" "$1,440.13" "$1,440.13" $300.12 "$1,440.13" N/A N/A M002363200201 SUP HCPCS C1768 M002363200201 - SIZER GFT SM 5-24MM LF MPK PLS DISP BOTH IP/OP $26.00 $19.00 $5.16 $26.00 $11.70 $11.70 $11.70 $11.70 $26.00 $26.00 $26.00 $5.42 $26.00 $26.00 $26.00 $26.00 $26.00 $5.42 $26.00 $26.00 $15.38 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $11.70 $5.16 N/A $15.08 $26.00 $26.00 $26.00 $5.42 $26.00 N/A N/A M002363200211 SUP HCPCS C1768 M002363200211 - SIZER GFT LG 24-38MM LF MPK PLS DISP BOTH IP/OP $26.00 $19.00 $5.16 $26.00 $11.70 $11.70 $11.70 $11.70 $26.00 $26.00 $26.00 $5.42 $26.00 $26.00 $26.00 $26.00 $26.00 $5.42 $26.00 $26.00 $15.38 $26.00 $26.00 $26.00 $26.00 $19.50 $26.00 $26.00 $26.00 $13.00 $13.00 $20.59 $26.00 $20.80 $11.70 $5.16 N/A $15.08 $26.00 $26.00 $26.00 $5.42 $26.00 N/A N/A M0031351020 SUP HCPCS C1757 M0031351020 - CATHETER INFS MIC 155CM 15CM FRCKR10 BOTH IP/OP "$2,303.00" "$1,704.00" $457.09 "$2,303.00" "$1,250.53" "$1,250.53" "$1,250.53" "$1,250.53" "$2,303.00" "$2,303.00" "$2,303.00" $480.00 "$2,303.00" "$1,709.29" "$1,709.29" "$1,775.15" "$1,199.86" $479.97 "$2,303.00" "$2,303.00" "$1,362.22" "$2,303.00" "$2,303.00" "$2,303.00" "$2,303.00" "$1,727.25" "$2,303.00" "$2,303.00" "$2,303.00" "$1,151.50" "$1,151.50" "$1,823.98" "$2,303.00" "$1,842.40" "$1,496.95" $457.09 N/A "$1,335.74" "$2,303.00" "$2,303.00" "$2,303.00" $479.95 "$2,303.00" N/A N/A M0031441890 SUP HCPCS C1751 M0031441890 - MICROCATHETER CRBRVASC .014-.016IN STRG 2.6-2FR .019IN 150CM BOTH IP/OP "$2,138.50" "$1,582.00" $424.44 "$2,138.50" "$1,161.21" "$1,161.21" "$1,161.21" "$1,161.21" "$2,138.50" "$2,138.50" "$2,138.50" $445.72 "$2,138.50" "$1,587.19" "$1,587.19" "$1,648.36" "$1,114.16" $445.69 "$2,138.50" "$2,138.50" "$1,264.92" "$2,138.50" "$2,138.50" "$2,138.50" "$2,138.50" "$1,603.88" "$2,138.50" "$2,138.50" "$2,138.50" "$1,069.25" "$1,069.25" "$1,693.69" "$2,138.50" "$1,710.80" "$1,390.03" $424.44 N/A "$1,240.33" "$2,138.50" "$2,138.50" "$2,138.50" $445.66 "$2,138.50" N/A N/A M0031681890 SUP HCPCS C1751 M0031681890 - CATHETER INFS .038IN 2.4-1.7FR .014IN 150CM 6CM EXCLS SL-10 BOTH IP/OP "$2,162.00" "$1,600.00" $429.10 "$2,162.00" "$1,173.97" "$1,173.97" "$1,173.97" "$1,173.97" "$2,162.00" "$2,162.00" "$2,162.00" $450.61 "$2,162.00" "$1,604.64" "$1,604.64" "$1,666.47" "$1,126.40" $450.58 "$2,162.00" "$2,162.00" "$1,278.82" "$2,162.00" "$2,162.00" "$2,162.00" "$2,162.00" "$1,621.50" "$2,162.00" "$2,162.00" "$2,162.00" "$1,081.00" "$1,081.00" "$1,712.30" "$2,162.00" "$1,729.60" "$1,405.30" $429.10 N/A "$1,253.96" "$2,162.00" "$2,162.00" "$2,162.00" $450.56 "$2,162.00" N/A N/A M0031681900 SUP HCPCS C1751 M0031681900 - MICROCATHETER CRBRVASC 45D .014IN PSHP 2.4-1.7FR .0165IN 150 BOTH IP/OP "$2,326.50" "$1,722.00" $461.75 "$2,326.50" "$1,263.29" "$1,263.29" "$1,263.29" "$1,263.29" "$2,326.50" "$2,326.50" "$2,326.50" $484.90 "$2,326.50" "$1,726.73" "$1,726.73" "$1,793.27" "$1,212.11" $484.87 "$2,326.50" "$2,326.50" "$1,376.12" "$2,326.50" "$2,326.50" "$2,326.50" "$2,326.50" "$1,744.88" "$2,326.50" "$2,326.50" "$2,326.50" "$1,163.25" "$1,163.25" "$1,842.59" "$2,326.50" "$1,861.20" "$1,512.23" $461.75 N/A "$1,349.37" "$2,326.50" "$2,326.50" "$2,326.50" $484.84 "$2,326.50" N/A N/A M003182880US0 SUP HCPCS C1887 M003182880US0 - MICROCATHETER INFS 135CM RNGD HFL RADOPQ DIST TIP VORTEC + BOTH IP/OP "$1,774.50" "$1,313.00" $352.14 "$1,774.25" $963.42 $963.42 $963.42 $963.42 "$1,774.25" "$1,774.25" "$1,774.25" $369.80 "$1,774.25" "$1,316.85" "$1,316.85" "$1,367.59" $924.38 $369.77 "$1,774.25" "$1,774.25" "$1,049.47" "$1,774.25" "$1,774.25" "$1,774.25" "$1,774.25" "$1,330.88" "$1,774.25" "$1,774.25" "$1,774.25" $887.13 $887.13 "$1,405.21" "$1,774.25" "$1,419.40" "$1,153.26" $352.14 N/A "$1,029.21" "$1,774.25" "$1,774.25" "$1,774.25" $369.75 "$1,774.25" N/A N/A M003182900US0 SUP HCPCS C1751 M003182900US0 - CATHETER INFS 150CM 10CM RNGD HF KT MCTH RADOPQ BRAID HDRPH BOTH IP/OP "$1,774.50" "$1,313.00" $352.14 "$1,774.25" $963.42 $963.42 $963.42 $963.42 "$1,774.25" "$1,774.25" "$1,774.25" $369.80 "$1,774.25" "$1,316.85" "$1,316.85" "$1,367.59" $924.38 $369.77 "$1,774.25" "$1,774.25" "$1,049.47" "$1,774.25" "$1,774.25" "$1,774.25" "$1,774.25" "$1,330.88" "$1,774.25" "$1,774.25" "$1,774.25" $887.13 $887.13 "$1,405.21" "$1,774.25" "$1,419.40" "$1,153.26" $352.14 N/A "$1,029.21" "$1,774.25" "$1,774.25" "$1,774.25" $369.75 "$1,774.25" N/A N/A M0032072209150 SUP HCPCS C1726 M0032072209150 - CATHETER BLNDIL 1.5MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT BOTH IP/OP "$2,644.00" "$1,957.00" $524.72 "$2,643.75" "$1,435.56" "$1,435.56" "$1,435.56" "$1,435.56" "$2,643.75" "$2,643.75" "$2,643.75" $551.02 "$2,643.75" "$1,962.19" "$1,962.19" "$2,037.80" "$1,377.39" $550.99 "$2,643.75" "$2,643.75" "$1,563.78" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$1,983.00" "$2,643.75" "$2,643.75" "$2,643.75" "$1,321.88" "$1,321.88" "$2,093.85" "$2,643.75" "$2,115.00" "$1,718.44" $524.72 N/A "$1,533.52" "$2,643.75" "$2,643.75" "$2,643.75" $550.96 "$2,643.75" N/A N/A M0032072209200 SUP HCPCS C1726 M0032072209200 - CATHETER BLNDIL 2MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT BOTH IP/OP "$2,644.00" "$1,957.00" $524.72 "$2,643.75" "$1,435.56" "$1,435.56" "$1,435.56" "$1,435.56" "$2,643.75" "$2,643.75" "$2,643.75" $551.02 "$2,643.75" "$1,962.19" "$1,962.19" "$2,037.80" "$1,377.39" $550.99 "$2,643.75" "$2,643.75" "$1,563.78" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$1,983.00" "$2,643.75" "$2,643.75" "$2,643.75" "$1,321.88" "$1,321.88" "$2,093.85" "$2,643.75" "$2,115.00" "$1,718.44" $524.72 N/A "$1,533.52" "$2,643.75" "$2,643.75" "$2,643.75" $550.96 "$2,643.75" N/A N/A M0032072209250 SUP HCPCS C1726 M0032072209250 - CATHETER BLNDIL 2.5MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT BOTH IP/OP "$2,644.00" "$1,957.00" $524.72 "$2,643.75" "$1,435.56" "$1,435.56" "$1,435.56" "$1,435.56" "$2,643.75" "$2,643.75" "$2,643.75" $551.02 "$2,643.75" "$1,962.19" "$1,962.19" "$2,037.80" "$1,377.39" $550.99 "$2,643.75" "$2,643.75" "$1,563.78" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$1,983.00" "$2,643.75" "$2,643.75" "$2,643.75" "$1,321.88" "$1,321.88" "$2,093.85" "$2,643.75" "$2,115.00" "$1,718.44" $524.72 N/A "$1,533.52" "$2,643.75" "$2,643.75" "$2,643.75" $550.96 "$2,643.75" N/A N/A M0032072209300 SUP HCPCS C1726 M0032072209300 - CATHETER BLNDIL 3MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT BOTH IP/OP "$2,644.00" "$1,957.00" $524.72 "$2,643.75" "$1,435.56" "$1,435.56" "$1,435.56" "$1,435.56" "$2,643.75" "$2,643.75" "$2,643.75" $551.02 "$2,643.75" "$1,962.19" "$1,962.19" "$2,037.80" "$1,377.39" $550.99 "$2,643.75" "$2,643.75" "$1,563.78" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$1,983.00" "$2,643.75" "$2,643.75" "$2,643.75" "$1,321.88" "$1,321.88" "$2,093.85" "$2,643.75" "$2,115.00" "$1,718.44" $524.72 N/A "$1,533.52" "$2,643.75" "$2,643.75" "$2,643.75" $550.96 "$2,643.75" N/A N/A M0032072209350 SUP HCPCS C1726 M0032072209350 - CATHETER BLNDIL 3.5MM 135CM LF 9MM GTWY OTW 2 LUM HDRPH ACPT BOTH IP/OP "$2,644.00" "$1,957.00" $524.72 "$2,643.75" "$1,435.56" "$1,435.56" "$1,435.56" "$1,435.56" "$2,643.75" "$2,643.75" "$2,643.75" $551.02 "$2,643.75" "$1,962.19" "$1,962.19" "$2,037.80" "$1,377.39" $550.99 "$2,643.75" "$2,643.75" "$1,563.78" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$1,983.00" "$2,643.75" "$2,643.75" "$2,643.75" "$1,321.88" "$1,321.88" "$2,093.85" "$2,643.75" "$2,115.00" "$1,718.44" $524.72 N/A "$1,533.52" "$2,643.75" "$2,643.75" "$2,643.75" $550.96 "$2,643.75" N/A N/A M0032072215250 SUP HCPCS C1726 M0032072215250 - CATHETER BLNDIL 2.5MM 135CM LF 15MM GTWY OTW 2 LUM HDRPH BOTH IP/OP "$2,644.00" "$1,957.00" $524.72 "$2,643.75" "$1,435.56" "$1,435.56" "$1,435.56" "$1,435.56" "$2,643.75" "$2,643.75" "$2,643.75" $551.02 "$2,643.75" "$1,962.19" "$1,962.19" "$2,037.80" "$1,377.39" $550.99 "$2,643.75" "$2,643.75" "$1,563.78" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$1,983.00" "$2,643.75" "$2,643.75" "$2,643.75" "$1,321.88" "$1,321.88" "$2,093.85" "$2,643.75" "$2,115.00" "$1,718.44" $524.72 N/A "$1,533.52" "$2,643.75" "$2,643.75" "$2,643.75" $550.96 "$2,643.75" N/A N/A M0032072215300 SUP HCPCS C1726 M0032072215300 - CATHETER BLNDIL 3MM 135CM LF 15MM GTWY OTW 2 LUM HDRPH ACPT BOTH IP/OP "$2,644.00" "$1,957.00" $524.72 "$2,643.75" "$1,435.56" "$1,435.56" "$1,435.56" "$1,435.56" "$2,643.75" "$2,643.75" "$2,643.75" $551.02 "$2,643.75" "$1,962.19" "$1,962.19" "$2,037.80" "$1,377.39" $550.99 "$2,643.75" "$2,643.75" "$1,563.78" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$1,983.00" "$2,643.75" "$2,643.75" "$2,643.75" "$1,321.88" "$1,321.88" "$2,093.85" "$2,643.75" "$2,115.00" "$1,718.44" $524.72 N/A "$1,533.52" "$2,643.75" "$2,643.75" "$2,643.75" $550.96 "$2,643.75" N/A N/A M0032072215350 SUP HCPCS C1726 M0032072215350 - CATHETER BLNDIL 3.5MM 135CM LF 15MM GTWY OTW 2 LUM HDRPH BOTH IP/OP "$2,644.00" "$1,957.00" $524.72 "$2,643.75" "$1,435.56" "$1,435.56" "$1,435.56" "$1,435.56" "$2,643.75" "$2,643.75" "$2,643.75" $551.02 "$2,643.75" "$1,962.19" "$1,962.19" "$2,037.80" "$1,377.39" $550.99 "$2,643.75" "$2,643.75" "$1,563.78" "$2,643.75" "$2,643.75" "$2,643.75" "$2,643.75" "$1,983.00" "$2,643.75" "$2,643.75" "$2,643.75" "$1,321.88" "$1,321.88" "$2,093.85" "$2,643.75" "$2,115.00" "$1,718.44" $524.72 N/A "$1,533.52" "$2,643.75" "$2,643.75" "$2,643.75" $550.96 "$2,643.75" N/A N/A M00326110 SUP HCPCS C1769 M00326110 - GUIDEWIRE VASCULAR .014IN 200CM 35CM SOFT TIP ATRAUMATIC BOTH IP/OP "$1,386.50" "$1,026.00" $275.19 "$1,386.50" $752.87 $752.87 $752.87 $752.87 "$1,386.50" "$1,386.50" "$1,386.50" $288.98 "$1,386.50" "$1,029.06" "$1,029.06" "$1,068.71" $722.37 $288.96 "$1,386.50" "$1,386.50" $820.11 "$1,386.50" "$1,386.50" "$1,386.50" "$1,386.50" "$1,039.88" "$1,386.50" "$1,386.50" "$1,386.50" $693.25 $693.25 "$1,098.11" "$1,386.50" "$1,109.20" $901.23 $275.19 N/A $804.17 "$1,386.50" "$1,386.50" "$1,386.50" $288.95 "$1,386.50" N/A N/A M00326410 SUP HCPCS C1769 M00326410 - GUIDEWIRE VASC .014IN 200CM 35CM SYNCHRO2 STD ATRM RBN TIP BOTH IP/OP "$1,316.00" $974.00 $261.19 "$1,316.00" $714.59 $714.59 $714.59 $714.59 "$1,316.00" "$1,316.00" "$1,316.00" $274.29 "$1,316.00" $976.74 $976.74 "$1,014.37" $685.64 $274.27 "$1,316.00" "$1,316.00" $778.41 "$1,316.00" "$1,316.00" "$1,316.00" "$1,316.00" $987.00 "$1,316.00" "$1,316.00" "$1,316.00" $658.00 $658.00 "$1,042.27" "$1,316.00" "$1,052.80" $855.40 $261.19 N/A $763.28 "$1,316.00" "$1,316.00" "$1,316.00" $274.25 "$1,316.00" N/A N/A M00326420 SUP HCPCS C1769 M00326420 - GUIDEWIRE VASCULAR STANDARD .014IN 200CM 35CM PRESHAPED BOTH IP/OP "$1,386.50" "$1,026.00" $275.19 "$1,386.50" $752.87 $752.87 $752.87 $752.87 "$1,386.50" "$1,386.50" "$1,386.50" $288.98 "$1,386.50" "$1,029.06" "$1,029.06" "$1,068.71" $722.37 $288.96 "$1,386.50" "$1,386.50" $820.11 "$1,386.50" "$1,386.50" "$1,386.50" "$1,386.50" "$1,039.88" "$1,386.50" "$1,386.50" "$1,386.50" $693.25 $693.25 "$1,098.11" "$1,386.50" "$1,109.20" $901.23 $275.19 N/A $804.17 "$1,386.50" "$1,386.50" "$1,386.50" $288.95 "$1,386.50" N/A N/A M00326520 SUP HCPCS C1769 M00326520 - GUIDEWIRE VASC .014IN 300CM 35CM SYNCHRO2 STD ATRM RBN TIP BOTH IP/OP "$1,715.50" "$1,269.00" $340.48 "$1,715.50" $931.52 $931.52 $931.52 $931.52 "$1,715.50" "$1,715.50" "$1,715.50" $357.55 "$1,715.50" "$1,273.24" "$1,273.24" "$1,322.31" $893.78 $357.53 "$1,715.50" "$1,715.50" "$1,014.72" "$1,715.50" "$1,715.50" "$1,715.50" "$1,715.50" "$1,286.63" "$1,715.50" "$1,715.50" "$1,715.50" $857.75 $857.75 "$1,358.68" "$1,715.50" "$1,372.40" "$1,115.08" $340.48 N/A $994.99 "$1,715.50" "$1,715.50" "$1,715.50" $357.51 "$1,715.50" N/A N/A M003468140 SUP HCPCS C1769 M003468140 - GUIDEWIRE VASC .014IN 300CM STRL LF 2CM TRNSD X SPRT ICE BOTH IP/OP "$1,351.50" "$1,000.00" $268.19 "$1,351.25" $733.73 $733.73 $733.73 $733.73 "$1,351.25" "$1,351.25" "$1,351.25" $281.63 "$1,351.25" "$1,002.90" "$1,002.90" "$1,041.54" $704.00 $281.62 "$1,351.25" "$1,351.25" $799.26 "$1,351.25" "$1,351.25" "$1,351.25" "$1,351.25" "$1,013.63" "$1,351.25" "$1,351.25" "$1,351.25" $675.63 $675.63 "$1,070.19" "$1,351.25" "$1,081.00" $878.31 $268.19 N/A $783.87 "$1,351.25" "$1,351.25" "$1,351.25" $281.60 "$1,351.25" N/A N/A M0035503010 SUP HCPCS C1887 M0035503010 - CATHETER INFUS .038IN MICRO 3FR .024IN 105CM 12CM KIT GWIRE BOTH IP/OP "$1,157.50" $857.00 $229.66 "$1,157.13" $628.32 $628.32 $628.32 $628.32 "$1,157.13" "$1,157.13" "$1,157.13" $241.17 "$1,157.13" $858.82 $858.82 $891.92 $602.86 $241.16 "$1,157.13" "$1,157.13" $684.44 "$1,157.13" "$1,157.13" "$1,157.13" "$1,157.13" $868.13 "$1,157.13" "$1,157.13" "$1,157.13" $578.57 $578.57 $916.45 "$1,157.13" $925.70 $752.13 $229.66 N/A $671.35 "$1,157.13" "$1,157.13" "$1,157.13" $241.15 "$1,157.13" N/A N/A M0035503040 SUP HCPCS C1887 M0035503040 - CATHETER INFUS .018IN MICRO 3-2.8FR .024-.018IN 135CM 12CM BOTH IP/OP "$1,157.50" $857.00 $229.66 "$1,157.13" $628.32 $628.32 $628.32 $628.32 "$1,157.13" "$1,157.13" "$1,157.13" $241.17 "$1,157.13" $858.82 $858.82 $891.92 $602.86 $241.16 "$1,157.13" "$1,157.13" $684.44 "$1,157.13" "$1,157.13" "$1,157.13" "$1,157.13" $868.13 "$1,157.13" "$1,157.13" "$1,157.13" $578.57 $578.57 $916.45 "$1,157.13" $925.70 $752.13 $229.66 N/A $671.35 "$1,157.13" "$1,157.13" "$1,157.13" $241.15 "$1,157.13" N/A N/A M003N3EZ25200 SUP HCPCS C2617 M003N3EZ25200 - STENT INTRCRAN 2.5MM 20MM NRFRM EZ 3 BOTH IP/OP "$15,745.00" "$11,651.00" "$3,124.99" "$15,745.00" "$7,085.25" "$7,085.25" "$7,085.25" "$7,085.25" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.65" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.43" "$15,745.00" "$15,745.00" "$7,762.29" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$11,808.75" "$15,745.00" "$15,745.00" "$15,745.00" "$7,872.50" "$7,872.50" "$12,470.04" "$15,745.00" "$12,596.00" "$7,085.25" "$3,124.99" N/A "$9,132.10" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.26" "$15,745.00" N/A N/A M003N3EZ30200 SUP HCPCS C2617 M003N3EZ30200 - STENT INTRCRAN 3MM 20MM NRFRM EZ NRFRM3 BOTH IP/OP "$15,745.00" "$11,651.00" "$3,124.99" "$15,745.00" "$7,085.25" "$7,085.25" "$7,085.25" "$7,085.25" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.65" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.43" "$15,745.00" "$15,745.00" "$7,762.29" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$11,808.75" "$15,745.00" "$15,745.00" "$15,745.00" "$7,872.50" "$7,872.50" "$12,470.04" "$15,745.00" "$12,596.00" "$7,085.25" "$3,124.99" N/A "$9,132.10" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.26" "$15,745.00" N/A N/A M003N3EZ35200 SUP HCPCS C2617 M003N3EZ35200 - STENT INTRCRAN 3.5MM 20MM NRFRM EZ NRFRM3 BOTH IP/OP "$15,745.00" "$11,651.00" "$3,124.99" "$15,745.00" "$7,085.25" "$7,085.25" "$7,085.25" "$7,085.25" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.65" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.43" "$15,745.00" "$15,745.00" "$7,762.29" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$11,808.75" "$15,745.00" "$15,745.00" "$15,745.00" "$7,872.50" "$7,872.50" "$12,470.04" "$15,745.00" "$12,596.00" "$7,085.25" "$3,124.99" N/A "$9,132.10" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.26" "$15,745.00" N/A N/A M003N3EZ40200 SUP HCPCS C2617 M003N3EZ40200 - STENT INTRCRAN 4MM 20MM NRFRM EZ 3 BOTH IP/OP "$15,745.00" "$11,651.00" "$3,124.99" "$15,745.00" "$7,085.25" "$7,085.25" "$7,085.25" "$7,085.25" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.65" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.43" "$15,745.00" "$15,745.00" "$7,762.29" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$11,808.75" "$15,745.00" "$15,745.00" "$15,745.00" "$7,872.50" "$7,872.50" "$12,470.04" "$15,745.00" "$12,596.00" "$7,085.25" "$3,124.99" N/A "$9,132.10" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.26" "$15,745.00" N/A N/A M003N3EZ45200 SUP HCPCS C2617 M003N3EZ45200 - STENT INTRCRAN 4.5MM 20MM NRFRM EZ PRELD SLF XPD RADOPQ NTNL BOTH IP/OP "$15,745.00" "$11,651.00" "$3,124.99" "$15,745.00" "$7,085.25" "$7,085.25" "$7,085.25" "$7,085.25" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.65" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.43" "$15,745.00" "$15,745.00" "$7,762.29" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$11,808.75" "$15,745.00" "$15,745.00" "$15,745.00" "$7,872.50" "$7,872.50" "$12,470.04" "$15,745.00" "$12,596.00" "$7,085.25" "$3,124.99" N/A "$9,132.10" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.26" "$15,745.00" N/A N/A M003N3EZ45300 SUP Custom 27803010 M003N3EZ45300 - STENT INTRCRAN 4.5MM 30MM NRFRM EZ PRELD SLF XPD RADOPQ NTNL BOTH IP/OP "$15,745.00" "$11,651.00" "$2,802.61" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$2,802.61" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$3,281.43" "$15,745.00" "$6,298.00" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$15,745.00" "$11,808.75" "$15,745.00" "$15,745.00" "$15,745.00" "$7,872.50" "$7,872.50" "$12,470.04" "$15,745.00" "$12,596.00" "$7,085.25" "$15,745.00" N/A "$9,132.10" "$15,745.00" "$9,447.00" "$15,745.00" "$15,745.00" "$15,745.00" N/A N/A M003SNF3STA0 SUP Custom 27203010 M003SNF3STA0 - STENT INTRCRAN 2FR NRFRM3 STAB CATH BOTH IP/OP "$2,875.00" "$2,128.00" $511.75 "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" $511.75 "$2,875.00" "$2,875.00" "$2,133.83" "$2,133.83" "$2,216.05" "$1,497.88" $599.18 "$2,875.00" "$1,150.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,875.00" "$2,156.25" "$2,875.00" "$2,875.00" "$2,875.00" "$1,437.50" "$1,437.50" "$2,277.00" "$2,875.00" "$2,300.00" "$1,868.75" "$2,875.00" N/A "$1,667.50" "$2,875.00" "$1,725.00" "$2,875.00" "$2,875.00" "$2,875.00" N/A N/A M003UZAS30150 SUP Custom 27803010 M003UZAS30150 - STENT 3.0MM 15MM 3.5MM NEUROFORM ATLAS BOTH IP/OP "$18,125.00" "$13,413.00" "$3,226.25" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,226.25" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,777.45" "$18,125.00" "$7,250.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$13,593.75" "$18,125.00" "$18,125.00" "$18,125.00" "$9,062.50" "$9,062.50" "$14,355.00" "$18,125.00" "$14,500.00" "$8,156.25" "$18,125.00" N/A "$10,512.50" "$18,125.00" "$10,875.00" "$18,125.00" "$18,125.00" "$18,125.00" N/A N/A M003UZAS30210 SUP Custom 27803010 M003UZAS30210 - STENT 3.0MM 21MM 3.5MM NEUROFORM ATLAS BOTH IP/OP "$18,125.00" "$13,413.00" "$3,226.25" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,226.25" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,777.45" "$18,125.00" "$7,250.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$13,593.75" "$18,125.00" "$18,125.00" "$18,125.00" "$9,062.50" "$9,062.50" "$14,355.00" "$18,125.00" "$14,500.00" "$8,156.25" "$18,125.00" N/A "$10,512.50" "$18,125.00" "$10,875.00" "$18,125.00" "$18,125.00" "$18,125.00" N/A N/A M003UZAS30240 SUP Custom 27803010 M003UZAS30240 - STENT 3.0MM 24MM 3.5MM NEUROFORM ATLAS BOTH IP/OP "$18,125.00" "$13,413.00" "$3,226.25" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,226.25" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,777.45" "$18,125.00" "$7,250.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$13,593.75" "$18,125.00" "$18,125.00" "$18,125.00" "$9,062.50" "$9,062.50" "$14,355.00" "$18,125.00" "$14,500.00" "$8,156.25" "$18,125.00" N/A "$10,512.50" "$18,125.00" "$10,875.00" "$18,125.00" "$18,125.00" "$18,125.00" N/A N/A M003UZAS40210 SUP Custom 27803010 M003UZAS40210 - STENT 4.0MM 21MM 4.5MM NEUROFORM ATLAS BOTH IP/OP "$18,125.00" "$13,413.00" "$3,226.25" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,226.25" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,777.45" "$18,125.00" "$7,250.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$13,593.75" "$18,125.00" "$18,125.00" "$18,125.00" "$9,062.50" "$9,062.50" "$14,355.00" "$18,125.00" "$14,500.00" "$8,156.25" "$18,125.00" N/A "$10,512.50" "$18,125.00" "$10,875.00" "$18,125.00" "$18,125.00" "$18,125.00" N/A N/A M003UZAS40240 SUP Custom 27803010 M003UZAS40240 - STENT 4.0MM 24MM 4.5MM NEUROFORM ATLAS BOTH IP/OP "$18,125.00" "$13,413.00" "$3,226.25" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,226.25" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,777.45" "$18,125.00" "$7,250.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$13,593.75" "$18,125.00" "$18,125.00" "$18,125.00" "$9,062.50" "$9,062.50" "$14,355.00" "$18,125.00" "$14,500.00" "$8,156.25" "$18,125.00" N/A "$10,512.50" "$18,125.00" "$10,875.00" "$18,125.00" "$18,125.00" "$18,125.00" N/A N/A M003UZAS45210 SUP Custom 27803010 M003UZAS45210 - STENT 4.5MM 21MM 5.0MM NEUROFORM ATLAS BOTH IP/OP "$18,125.00" "$13,413.00" "$3,226.25" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,226.25" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,777.45" "$18,125.00" "$7,250.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$13,593.75" "$18,125.00" "$18,125.00" "$18,125.00" "$9,062.50" "$9,062.50" "$14,355.00" "$18,125.00" "$14,500.00" "$8,156.25" "$18,125.00" N/A "$10,512.50" "$18,125.00" "$10,875.00" "$18,125.00" "$18,125.00" "$18,125.00" N/A N/A M003UZAS45300 SUP Custom 27803010 M003UZAS45300 - STENT 4.5MM 30MM 5.0MM NEUROFORM ATLAS BOTH IP/OP "$18,125.00" "$13,413.00" "$3,226.25" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,226.25" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$3,777.45" "$18,125.00" "$7,250.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$18,125.00" "$13,593.75" "$18,125.00" "$18,125.00" "$18,125.00" "$9,062.50" "$9,062.50" "$14,355.00" "$18,125.00" "$14,500.00" "$8,156.25" "$18,125.00" N/A "$10,512.50" "$18,125.00" "$10,875.00" "$18,125.00" "$18,125.00" "$18,125.00" N/A N/A M003WS0250090 SUP HCPCS C2617 M003WS0250090 - STENT INTRCRAN 2.5MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD BOTH IP/OP "$15,980.00" "$11,825.00" "$3,171.63" "$15,980.00" "$7,191.00" "$7,191.00" "$7,191.00" "$7,191.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.63" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.41" "$15,980.00" "$15,980.00" "$7,878.14" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$11,985.00" "$15,980.00" "$15,980.00" "$15,980.00" "$7,990.00" "$7,990.00" "$12,656.16" "$15,980.00" "$12,784.00" "$7,191.00" "$3,171.63" N/A "$9,268.40" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.23" "$15,980.00" N/A N/A M003WS0250150 SUP HCPCS C2617 M003WS0250150 - STENT INTRACRANIAL .014IN 2.5MM 15MM OTW FLEXIBLE TRACKABLE BOTH IP/OP "$15,980.00" "$11,825.00" "$3,171.63" "$15,980.00" "$7,191.00" "$7,191.00" "$7,191.00" "$7,191.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.63" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.41" "$15,980.00" "$15,980.00" "$7,878.14" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$11,985.00" "$15,980.00" "$15,980.00" "$15,980.00" "$7,990.00" "$7,990.00" "$12,656.16" "$15,980.00" "$12,784.00" "$7,191.00" "$3,171.63" N/A "$9,268.40" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.23" "$15,980.00" N/A N/A M003WS0300090 SUP HCPCS C2617 M003WS0300090 - STENT INTRCRAN 3MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD OTW BOTH IP/OP "$15,980.00" "$11,825.00" "$3,171.63" "$15,980.00" "$7,191.00" "$7,191.00" "$7,191.00" "$7,191.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.63" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.41" "$15,980.00" "$15,980.00" "$7,878.14" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$11,985.00" "$15,980.00" "$15,980.00" "$15,980.00" "$7,990.00" "$7,990.00" "$12,656.16" "$15,980.00" "$12,784.00" "$7,191.00" "$3,171.63" N/A "$9,268.40" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.23" "$15,980.00" N/A N/A M003WS0300150 SUP Custom 27803010 M003WS0300150 - STENT INTRCRAN 3MM 3.5FR 15MM STRL WINGSPAN GTWY SLF XPD OTW BOTH IP/OP "$15,980.00" "$11,825.00" "$2,844.44" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$2,844.44" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.41" "$15,980.00" "$6,392.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$11,985.00" "$15,980.00" "$15,980.00" "$15,980.00" "$7,990.00" "$7,990.00" "$12,656.16" "$15,980.00" "$12,784.00" "$7,191.00" "$15,980.00" N/A "$9,268.40" "$15,980.00" "$9,588.00" "$15,980.00" "$15,980.00" "$15,980.00" N/A N/A M003WS0350090 SUP HCPCS C2617 M003WS0350090 - STENT INTRCRAN 3.5MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD BOTH IP/OP "$15,980.00" "$11,825.00" "$3,171.63" "$15,980.00" "$7,191.00" "$7,191.00" "$7,191.00" "$7,191.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.63" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.41" "$15,980.00" "$15,980.00" "$7,878.14" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$11,985.00" "$15,980.00" "$15,980.00" "$15,980.00" "$7,990.00" "$7,990.00" "$12,656.16" "$15,980.00" "$12,784.00" "$7,191.00" "$3,171.63" N/A "$9,268.40" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.23" "$15,980.00" N/A N/A M003WS0350150 SUP Custom 27803010 M003WS0350150 - STENT INTRCRAN 3.5MM 3.5FR 15MM STRL WINGSPAN GTWY SLF XPD BOTH IP/OP "$15,980.00" "$11,825.00" "$2,844.44" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$2,844.44" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.41" "$15,980.00" "$6,392.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$11,985.00" "$15,980.00" "$15,980.00" "$15,980.00" "$7,990.00" "$7,990.00" "$12,656.16" "$15,980.00" "$12,784.00" "$7,191.00" "$15,980.00" N/A "$9,268.40" "$15,980.00" "$9,588.00" "$15,980.00" "$15,980.00" "$15,980.00" N/A N/A M003WS0400090 SUP HCPCS C2617 M003WS0400090 - STENT INTRCRAN 4MM 3.5FR 9MM STRL WINGSPAN GTWY SLF XPD OTW BOTH IP/OP "$15,980.00" "$11,825.00" "$3,171.63" "$15,980.00" "$7,191.00" "$7,191.00" "$7,191.00" "$7,191.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.63" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.41" "$15,980.00" "$15,980.00" "$7,878.14" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$11,985.00" "$15,980.00" "$15,980.00" "$15,980.00" "$7,990.00" "$7,990.00" "$12,656.16" "$15,980.00" "$12,784.00" "$7,191.00" "$3,171.63" N/A "$9,268.40" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.23" "$15,980.00" N/A N/A M003WS0400150 SUP Custom 27803010 M003WS0400150 - STENT INTRCRAN 4MM 3.5FR 15MM STRL WINGSPAN GTWY SLF XPD OTW BOTH IP/OP "$15,980.00" "$11,825.00" "$2,844.44" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$2,844.44" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.41" "$15,980.00" "$6,392.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$11,985.00" "$15,980.00" "$15,980.00" "$15,980.00" "$7,990.00" "$7,990.00" "$12,656.16" "$15,980.00" "$12,784.00" "$7,191.00" "$15,980.00" N/A "$9,268.40" "$15,980.00" "$9,588.00" "$15,980.00" "$15,980.00" "$15,980.00" N/A N/A M00510860 SUP Custom 27203010 M00510860 - BASKET SPEC RTRVL 1.5CM 3.2MM STRL 3CM TRPZD RX LTHTRP DIST BOTH IP/OP $645.50 $478.00 $114.84 $645.18 $645.18 $645.18 $645.18 $645.18 $645.18 $645.18 $114.84 $645.18 $645.18 $478.85 $478.85 $497.30 $336.14 $134.46 $645.18 $258.07 $645.18 $645.18 $645.18 $645.18 $645.18 $484.13 $645.18 $645.18 $645.18 $322.59 $322.59 $510.98 $645.18 $516.14 $419.37 $645.18 N/A $374.39 $645.18 $387.11 $645.18 $645.18 $645.18 N/A N/A M00510870 SUP Custom 27203010 M00510870 - BASKET SPEC RTRVL 2MM 3.2MM STRL 4CM TRPZD RX LTHTRP DIST BOTH IP/OP $645.50 $478.00 $114.84 $645.18 $645.18 $645.18 $645.18 $645.18 $645.18 $645.18 $114.84 $645.18 $645.18 $478.85 $478.85 $497.30 $336.14 $134.46 $645.18 $258.07 $645.18 $645.18 $645.18 $645.18 $645.18 $484.13 $645.18 $645.18 $645.18 $322.59 $322.59 $510.98 $645.18 $516.14 $419.37 $645.18 N/A $374.39 $645.18 $387.11 $645.18 $645.18 $645.18 N/A N/A M00510880 SUP Custom 27203010 M00510880 - BASKET SPEC RTRVL 2.5CM 3.2MM STRL 5CM TRPZD RX LTHTRP DIST BOTH IP/OP $645.50 $478.00 $114.84 $645.18 $645.18 $645.18 $645.18 $645.18 $645.18 $645.18 $114.84 $645.18 $645.18 $478.85 $478.85 $497.30 $336.14 $134.46 $645.18 $258.07 $645.18 $645.18 $645.18 $645.18 $645.18 $484.13 $645.18 $645.18 $645.18 $322.59 $322.59 $510.98 $645.18 $516.14 $419.37 $645.18 N/A $374.39 $645.18 $387.11 $645.18 $645.18 $645.18 N/A N/A M00510890 SUP Custom 27203010 M00510890 - BASKET SPEC RTRVL 3CM 3.2MM STRL 3CM TRPZD RX LTHTRP DIST BOTH IP/OP $645.50 $478.00 $114.84 $645.18 $645.18 $645.18 $645.18 $645.18 $645.18 $645.18 $114.84 $645.18 $645.18 $478.85 $478.85 $497.30 $336.14 $134.46 $645.18 $258.07 $645.18 $645.18 $645.18 $645.18 $645.18 $484.13 $645.18 $645.18 $645.18 $322.59 $322.59 $510.98 $645.18 $516.14 $419.37 $645.18 N/A $374.39 $645.18 $387.11 $645.18 $645.18 $645.18 N/A N/A M00513210 SUP Custom 27203010 M00513210 - BASKET SPECIMEN RETRIEVAL 16MM 1MM 120CM AIRWAY ZERO TIP BOTH IP/OP $622.50 $461.00 $110.79 $622.40 $622.40 $622.40 $622.40 $622.40 $622.40 $622.40 $110.79 $622.40 $622.40 $461.95 $461.95 $479.75 $324.27 $129.72 $622.40 $248.96 $622.40 $622.40 $622.40 $622.40 $622.40 $466.88 $622.40 $622.40 $622.40 $311.20 $311.20 $492.94 $622.40 $497.92 $404.56 $622.40 N/A $361.05 $622.40 $373.44 $622.40 $622.40 $622.40 N/A N/A M00513740 SUP HCPCS C1874 M00513740 - STENT ESOPHAGEAL 18-23MM 12CM 9CM COVER DISTAL RELEASE NEXT BOTH IP/OP "$4,137.50" "$3,062.00" $821.19 "$4,137.50" "$1,861.88" "$1,861.88" "$1,861.88" "$1,861.88" "$4,137.50" "$4,137.50" "$4,137.50" $862.36 "$4,137.50" "$4,137.50" "$4,137.50" "$4,137.50" "$4,137.50" $862.30 "$4,137.50" "$4,137.50" "$2,039.79" "$4,137.50" "$4,137.50" "$4,137.50" "$4,137.50" "$3,103.13" "$4,137.50" "$4,137.50" "$4,137.50" "$2,068.75" "$2,068.75" "$3,276.90" "$4,137.50" "$3,310.00" "$1,861.88" $821.19 N/A "$2,399.75" "$4,137.50" "$4,137.50" "$4,137.50" $862.26 "$4,137.50" N/A N/A M00516720 SUP HCPCS C1874 M00516720 - STENT ESOPHAGEAL FLARE LP 18MM 18.5FR 15CM 120CM SELF EXPAND BOTH IP/OP "$5,500.00" "$4,070.00" "$1,091.61" "$5,892.90" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.34" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.26" "$5,500.00" "$5,892.90" "$2,711.50" "$5,500.00" "$5,892.90" "$5,500.00" "$5,500.00" "$4,125.00" "$5,500.00" "$5,500.00" "$5,500.00" "$2,750.00" "$2,750.00" "$4,356.00" "$5,500.00" "$4,400.00" "$2,475.00" "$1,091.61" N/A "$3,190.00" "$5,500.00" "$5,500.00" "$5,500.00" "$1,146.20" "$5,500.00" N/A N/A M00516900 SUP HCPCS C1874 M00516900 - STENT ESOPHAGEAL LP 18MM 18.5FR 10CM 7CM PRTL COVER COAXIAL BOTH IP/OP "$5,237.50" "$3,876.00" "$1,039.51" "$5,772.58" "$2,356.88" "$2,356.88" "$2,356.88" "$2,356.88" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.63" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.55" "$5,237.50" "$5,772.58" "$2,582.09" "$5,237.50" "$5,772.58" "$5,237.50" "$5,237.50" "$3,928.13" "$5,237.50" "$5,237.50" "$5,237.50" "$2,618.75" "$2,618.75" "$4,148.10" "$5,237.50" "$4,190.00" "$2,356.88" "$1,039.51" N/A "$3,037.75" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.50" "$5,237.50" N/A N/A M00516910 SUP HCPCS C1874 M00516910 - STENT ESOPHAGEAL LP 18MM 18.5FR 12CM 9CM PRTL COVER COAXIAL BOTH IP/OP "$5,237.50" "$3,876.00" "$1,039.51" "$5,772.58" "$2,356.88" "$2,356.88" "$2,356.88" "$2,356.88" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.63" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.55" "$5,237.50" "$5,772.58" "$2,582.09" "$5,237.50" "$5,772.58" "$5,237.50" "$5,237.50" "$3,928.13" "$5,237.50" "$5,237.50" "$5,237.50" "$2,618.75" "$2,618.75" "$4,148.10" "$5,237.50" "$4,190.00" "$2,356.88" "$1,039.51" N/A "$3,037.75" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.50" "$5,237.50" N/A N/A M00516920 SUP HCPCS C1874 M00516920 - STENT ESOPHAGEAL LP 23MM 18MM 153MM 12CM PRTL COVER COAXIAL BOTH IP/OP "$5,237.50" "$3,876.00" "$1,039.51" "$5,772.58" "$2,356.88" "$2,356.88" "$2,356.88" "$2,356.88" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.63" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.55" "$5,237.50" "$5,772.58" "$2,582.09" "$5,237.50" "$5,772.58" "$5,237.50" "$5,237.50" "$3,928.13" "$5,237.50" "$5,237.50" "$5,237.50" "$2,618.75" "$2,618.75" "$4,148.10" "$5,237.50" "$4,190.00" "$2,356.88" "$1,039.51" N/A "$3,037.75" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.50" "$5,237.50" N/A N/A M00516930 SUP HCPCS C1874 M00516930 - STENT ESOPHAGEAL LP 23MM 18.5MM 10CM 7CM BRAID DELIVERY BOTH IP/OP "$5,237.50" "$3,876.00" "$1,039.51" "$5,772.58" "$2,356.88" "$2,356.88" "$2,356.88" "$2,356.88" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.63" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.55" "$5,237.50" "$5,772.58" "$2,582.09" "$5,237.50" "$5,772.58" "$5,237.50" "$5,237.50" "$3,928.13" "$5,237.50" "$5,237.50" "$5,237.50" "$2,618.75" "$2,618.75" "$4,148.10" "$5,237.50" "$4,190.00" "$2,356.88" "$1,039.51" N/A "$3,037.75" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.50" "$5,237.50" N/A N/A M00516950 SUP HCPCS C1874 M00516950 - STENT ESOPHAGEAL LP 23MM 18.5FR 15CM 12CM BRAID DELIVERY BOTH IP/OP "$5,237.50" "$3,876.00" "$1,039.51" "$5,772.58" "$2,356.88" "$2,356.88" "$2,356.88" "$2,356.88" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.63" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.55" "$5,237.50" "$5,772.58" "$2,582.09" "$5,237.50" "$5,772.58" "$5,237.50" "$5,237.50" "$3,928.13" "$5,237.50" "$5,237.50" "$5,237.50" "$2,618.75" "$2,618.75" "$4,148.10" "$5,237.50" "$4,190.00" "$2,356.88" "$1,039.51" N/A "$3,037.75" "$5,237.50" "$5,237.50" "$5,237.50" "$1,091.50" "$5,237.50" N/A N/A M00522611 SUP Custom 27803010 M00522611 - CLIP INTERNAL 11MM 235CM 2.8MM SECURE LOCK RADIOPQ USER BOTH IP/OP $392.50 $290.00 $69.83 $392.29 $392.29 $392.29 $392.29 $392.29 $392.29 $392.29 $69.83 $392.29 $392.29 $392.29 $392.29 $392.29 $392.29 $81.76 $392.29 $156.92 $392.29 $392.29 $392.29 $392.29 $392.29 $294.38 $392.29 $392.29 $392.29 $196.15 $196.15 $310.69 $392.29 $313.83 $176.53 $392.29 N/A $227.65 $392.29 $235.37 $392.29 $392.29 $392.29 N/A N/A M00522612 SUP Custom 27803010 M00522612 - CLIP INTERNAL 11MM OPEN 235CM 2.8MM HEMOSTASIS RESOLUTION BOTH IP/OP $381.00 $282.00 $67.77 $380.74 $380.74 $380.74 $380.74 $380.74 $380.74 $380.74 $67.77 $380.74 $380.74 $380.74 $380.74 $380.74 $380.74 $79.35 $380.74 $152.30 $380.74 $380.74 $380.74 $380.74 $380.74 $285.75 $380.74 $380.74 $380.74 $190.37 $190.37 $301.55 $380.74 $304.59 $171.33 $380.74 N/A $220.98 $380.74 $228.44 $380.74 $380.74 $380.74 N/A N/A M00530850 SUP HCPCS C1769 M00530850 - CANNULA ERCP STANDARD 5FR 210CM GWIRE CNTOUR BILIARY STERILE BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $61.09 $61.09 $61.09 $61.09 $112.50 $112.50 $112.50 $23.45 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A M00530860 SUP HCPCS C1769 M00530860 - CANNULA ERCP TAPER 5FR 210CM CNTOUR BILIARY DISPOSABLE BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $61.09 $61.09 $61.09 $61.09 $112.50 $112.50 $112.50 $23.45 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A M00530960 SUP HCPCS C1769 M00530960 - CANNULA ERCP STANDARD 5FR 210CM FLUORO TIP BILIARY BOTH IP/OP $82.00 $61.00 $16.26 $81.93 $44.49 $44.49 $44.49 $44.49 $81.93 $81.93 $81.93 $17.08 $81.93 $60.81 $60.81 $63.15 $42.69 $17.08 $81.93 $81.93 $48.46 $81.93 $81.93 $81.93 $81.93 $61.50 $81.93 $81.93 $81.93 $40.97 $40.97 $64.89 $81.93 $65.54 $53.25 $16.26 N/A $47.56 $81.93 $81.93 $81.93 $17.07 $81.93 N/A N/A M00530970 SUP HCPCS C1769 M00530970 - CANNULA ERCP .035IN 5FR 210CM TAPERED TIP GWIRE FLUORO TIP BOTH IP/OP $82.00 $61.00 $16.26 $81.93 $44.49 $44.49 $44.49 $44.49 $81.93 $81.93 $81.93 $17.08 $81.93 $60.81 $60.81 $63.15 $42.69 $17.08 $81.93 $81.93 $48.46 $81.93 $81.93 $81.93 $81.93 $61.50 $81.93 $81.93 $81.93 $40.97 $40.97 $64.89 $81.93 $65.54 $53.25 $16.26 N/A $47.56 $81.93 $81.93 $81.93 $17.07 $81.93 N/A N/A M00530980 SUP HCPCS C1769 M00530980 - CANNULA ERCP ULTRA TAPER 5FR 210CM FLUORO TIP BILIARY BOTH IP/OP $82.00 $61.00 $16.26 $81.93 $44.49 $44.49 $44.49 $44.49 $81.93 $81.93 $81.93 $17.08 $81.93 $60.81 $60.81 $63.15 $42.69 $17.08 $81.93 $81.93 $48.46 $81.93 $81.93 $81.93 $81.93 $61.50 $81.93 $81.93 $81.93 $40.97 $40.97 $64.89 $81.93 $65.54 $53.25 $16.26 N/A $47.56 $81.93 $81.93 $81.93 $17.07 $81.93 N/A N/A M00532240 SUP HCPCS C2617 M00532240 - STENT BILIARY 2 PIGTAIL CURVE 10FR 3CM RAPEX TEMPORARY BOTH IP/OP $134.00 $99.00 $26.51 $133.55 $60.10 $60.10 $60.10 $60.10 $133.55 $133.55 $133.55 $27.84 $133.55 $133.55 $133.55 $133.55 $133.55 $27.83 $133.55 $133.55 $78.99 $133.55 $133.55 $133.55 $133.55 $100.50 $133.55 $133.55 $133.55 $66.78 $66.78 $105.77 $133.55 $106.84 $60.10 $26.51 N/A $77.72 $133.55 $133.55 $133.55 $27.83 $133.55 N/A N/A M00532260 SUP HCPCS C2617 M00532260 - STENT BILIARY 2 PIGTAIL CURVE 3.3MM 5CM TEMPORARY RAPEX BOTH IP/OP $134.00 $99.00 $26.51 $133.55 $60.10 $60.10 $60.10 $60.10 $133.55 $133.55 $133.55 $27.84 $133.55 $133.55 $133.55 $133.55 $133.55 $27.83 $133.55 $133.55 $78.99 $133.55 $133.55 $133.55 $133.55 $100.50 $133.55 $133.55 $133.55 $66.78 $66.78 $105.77 $133.55 $106.84 $60.10 $26.51 N/A $77.72 $133.55 $133.55 $133.55 $27.83 $133.55 N/A N/A M00532270 SUP HCPCS C2617 M00532270 - STENT BILIARY 2 PIGTAIL CURVE 10FR 7CM RAPEX TEMPORARY BOTH IP/OP $134.00 $99.00 $26.51 $133.55 $60.10 $60.10 $60.10 $60.10 $133.55 $133.55 $133.55 $27.84 $133.55 $133.55 $133.55 $133.55 $133.55 $27.83 $133.55 $133.55 $78.99 $133.55 $133.55 $133.55 $133.55 $100.50 $133.55 $133.55 $133.55 $66.78 $66.78 $105.77 $133.55 $106.84 $60.10 $26.51 N/A $77.72 $133.55 $133.55 $133.55 $27.83 $133.55 N/A N/A M00533580 SUP HCPCS C2617 M00533580 - STENT BILIARY 10FR 202.5CM DELIVERY SYSTEM RAPEX ADVANIX BOTH IP/OP $199.00 $147.00 $39.48 $198.93 $89.52 $89.52 $89.52 $89.52 $198.93 $198.93 $198.93 $41.46 $198.93 $198.93 $198.93 $198.93 $198.93 $41.46 $198.93 $198.93 $117.67 $198.93 $198.93 $198.93 $198.93 $149.25 $198.93 $198.93 $198.93 $99.47 $99.47 $157.55 $198.93 $159.14 $89.52 $39.48 N/A $115.42 $198.93 $198.93 $198.93 $41.46 $198.93 N/A N/A M00534200 SUP HCPCS C2617 M00534200 - STENT BILIARY DUODENAL BEND 7FR 5CM RAPEX PRELOAD DELIVERY BOTH IP/OP $325.00 $241.00 $64.47 $324.83 $146.17 $146.17 $146.17 $146.17 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $192.14 $324.83 $324.83 $324.83 $324.83 $243.75 $324.83 $324.83 $324.83 $162.42 $162.42 $257.27 $324.83 $259.86 $146.17 $64.47 N/A $188.50 $324.83 $324.83 $324.83 $67.69 $324.83 N/A N/A M00534210 SUP HCPCS C2617 M00534210 - STENT BILIARY DUODENAL BEND 7FR 7CM PRELOAD TEMPORARY RAPEX BOTH IP/OP $325.00 $241.00 $64.47 $324.83 $146.17 $146.17 $146.17 $146.17 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $192.14 $324.83 $324.83 $324.83 $324.83 $243.75 $324.83 $324.83 $324.83 $162.42 $162.42 $257.27 $324.83 $259.86 $146.17 $64.47 N/A $188.50 $324.83 $324.83 $324.83 $67.69 $324.83 N/A N/A M00534220 SUP HCPCS C2617 M00534220 - STENT BILIARY DUODENAL BEND 7FR 9CM RAPEX PRELOAD ADVANIX BOTH IP/OP $325.00 $241.00 $64.47 $324.83 $146.17 $146.17 $146.17 $146.17 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $192.14 $324.83 $324.83 $324.83 $324.83 $243.75 $324.83 $324.83 $324.83 $162.42 $162.42 $257.27 $324.83 $259.86 $146.17 $64.47 N/A $188.50 $324.83 $324.83 $324.83 $67.69 $324.83 N/A N/A M00534230 SUP HCPCS C2617 M00534230 - STENT BILIARY DUODENAL BEND 7FR 12CM RAPEX PRELOAD ADVANIX BOTH IP/OP $325.00 $241.00 $64.47 $324.83 $146.17 $146.17 $146.17 $146.17 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $192.14 $324.83 $324.83 $324.83 $324.83 $243.75 $324.83 $324.83 $324.83 $162.42 $162.42 $257.27 $324.83 $259.86 $146.17 $64.47 N/A $188.50 $324.83 $324.83 $324.83 $67.69 $324.83 N/A N/A M00534260 SUP HCPCS C2617 M00534260 - STENT BILIARY DUODENAL BEND 2.83MM 5CM PRELOAD RAPEX BOTH IP/OP $325.00 $241.00 $64.47 $324.83 $146.17 $146.17 $146.17 $146.17 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $192.14 $324.83 $324.83 $324.83 $324.83 $243.75 $324.83 $324.83 $324.83 $162.42 $162.42 $257.27 $324.83 $259.86 $146.17 $64.47 N/A $188.50 $324.83 $324.83 $324.83 $67.69 $324.83 N/A N/A M00534270 SUP HCPCS C2617 M00534270 - STENT BILIARY DUODENAL BEND 2.83MM 7CM PRELOAD RAPEX BOTH IP/OP $325.00 $241.00 $64.47 $324.83 $146.17 $146.17 $146.17 $146.17 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $192.14 $324.83 $324.83 $324.83 $324.83 $243.75 $324.83 $324.83 $324.83 $162.42 $162.42 $257.27 $324.83 $259.86 $146.17 $64.47 N/A $188.50 $324.83 $324.83 $324.83 $67.69 $324.83 N/A N/A M00534320 SUP HCPCS C2617 M00534320 - STENT BILIARY DUODENAL BEND 10FR 5CM PRELOAD RAPEX DELIVERY BOTH IP/OP $325.00 $241.00 $64.47 $324.83 $146.17 $146.17 $146.17 $146.17 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $192.14 $324.83 $324.83 $324.83 $324.83 $243.75 $324.83 $324.83 $324.83 $162.42 $162.42 $257.27 $324.83 $259.86 $146.17 $64.47 N/A $188.50 $324.83 $324.83 $324.83 $67.69 $324.83 N/A N/A M00534330 SUP HCPCS C2617 M00534330 - STENT BILIARY DUODENAL BEND 10FR 7CM PRELOAD RADIOPQ MARKER BOTH IP/OP $325.00 $241.00 $64.47 $324.83 $146.17 $146.17 $146.17 $146.17 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $192.14 $324.83 $324.83 $324.83 $324.83 $243.75 $324.83 $324.83 $324.83 $162.42 $162.42 $257.27 $324.83 $259.86 $146.17 $64.47 N/A $188.50 $324.83 $324.83 $324.83 $67.69 $324.83 N/A N/A M00534340 SUP HCPCS C2617 M00534340 - STENT BILIARY DUODENAL BEND 10FR 9CM PRELOAD RADIOPQ MARKER BOTH IP/OP $325.00 $241.00 $64.47 $324.83 $146.17 $146.17 $146.17 $146.17 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $192.14 $324.83 $324.83 $324.83 $324.83 $243.75 $324.83 $324.83 $324.83 $162.42 $162.42 $257.27 $324.83 $259.86 $146.17 $64.47 N/A $188.50 $324.83 $324.83 $324.83 $67.69 $324.83 N/A N/A M00534350 SUP HCPCS C2617 M00534350 - STENT BILIARY DUODENAL BEND 10FR 12CM PRELOAD TEMPORARY BOTH IP/OP $325.00 $241.00 $64.47 $324.83 $146.17 $146.17 $146.17 $146.17 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $324.83 $324.83 $324.83 $67.70 $324.83 $324.83 $192.14 $324.83 $324.83 $324.83 $324.83 $243.75 $324.83 $324.83 $324.83 $162.42 $162.42 $257.27 $324.83 $259.86 $146.17 $64.47 N/A $188.50 $324.83 $324.83 $324.83 $67.69 $324.83 N/A N/A M00534360 SUP HCPCS C1726 M00534360 - STENT BILIARY DUODENAL BEND 10FR 15CM PRELOAD TEMPORARY BOTH IP/OP $325.00 $241.00 $64.47 $324.83 $176.38 $176.38 $176.38 $176.38 $324.83 $324.83 $324.83 $67.70 $324.83 $241.09 $241.09 $250.38 $169.24 $67.70 $324.83 $324.83 $192.14 $324.83 $324.83 $324.83 $324.83 $243.75 $324.83 $324.83 $324.83 $162.42 $162.42 $257.27 $324.83 $259.86 $211.14 $64.47 N/A $188.50 $324.83 $324.83 $324.83 $67.69 $324.83 N/A N/A M00545170 SUP HCPCS C1769 M00545170 - SPHINCTEROTOME ESCP 4.4FR 20MM STRL 5MM ATME RX CANNULATE BOTH IP/OP $518.50 $384.00 $102.85 $518.20 $281.38 $281.38 $281.38 $281.38 $518.20 $518.20 $518.20 $108.01 $518.20 $384.61 $384.61 $399.43 $269.98 $108.00 $518.20 $518.20 $306.52 $518.20 $518.20 $518.20 $518.20 $388.88 $518.20 $518.20 $518.20 $259.10 $259.10 $410.41 $518.20 $414.56 $336.83 $102.85 N/A $300.73 $518.20 $518.20 $518.20 $107.99 $518.20 N/A N/A M00545190 SUP HCPCS C1769 M00545190 - SPHINCTEROTOME ESCP 3.9FR 20MM STRL 5MM ATME RX CANNULATE BOTH IP/OP $518.50 $384.00 $102.85 $518.20 $281.38 $281.38 $281.38 $281.38 $518.20 $518.20 $518.20 $108.01 $518.20 $384.61 $384.61 $399.43 $269.98 $108.00 $518.20 $518.20 $306.52 $518.20 $518.20 $518.20 $518.20 $388.88 $518.20 $518.20 $518.20 $259.10 $259.10 $410.41 $518.20 $414.56 $336.83 $102.85 N/A $300.73 $518.20 $518.20 $518.20 $107.99 $518.20 N/A N/A M00545261 SUP Custom 27203010 M00545261 - SYSTEM CHLGM RX LCK DEV BX CAP DISP OLMPS FUJIFILM G5 SER BOTH IP/OP $23.00 $17.00 $4.02 $22.58 $22.58 $22.58 $22.58 $22.58 $22.58 $22.58 $4.02 $22.58 $22.58 $16.76 $16.76 $17.40 $11.76 $4.71 $22.58 $9.03 $22.58 $22.58 $22.58 $22.58 $22.58 $17.25 $22.58 $22.58 $22.58 $11.29 $11.29 $17.88 $22.58 $18.06 $14.68 $22.58 N/A $13.34 $22.58 $13.55 $22.58 $22.58 $22.58 N/A N/A M00545550 SUP HCPCS C2617 M00545550 - STENT BIL DDNL BND 7FR 5CM RX DLV SYS DISP ACPT .035IN GW BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545560 SUP HCPCS C2617 M00545560 - STENT BIL DDNL BND 7FR 7CM RX DLV SYS DISP ACPT .035IN GW BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545570 SUP HCPCS C2617 M00545570 - STENT BIL DDNL BND 7FR 10CM RX DLV SYS DISP ACPT .035IN GW BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545580 SUP HCPCS C2617 M00545580 - STENT BIL DDNL BND 7FR 12CM RX DLV SYS DISP ACPT .035IN GW BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545610 SUP HCPCS C2617 M00545610 - STENT BIL DDNL BND 10FR 7CM RX DLV SYS DISP ACPT .035IN GW BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545620 SUP HCPCS C2617 M00545620 - STENT BIL DDNL BND 10FR 10CM RX DLV SYS DISP ACPT .035IN GW BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545630 SUP HCPCS C2617 M00545630 - STENT BIL DDNL BND 10FR 12CM RX DLV SYS DISP ACPT .035IN GW BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545650 SUP HCPCS C2617 M00545650 - STENT BIL DDNL BND 8.5FR 5CM RX DLV SYS DISP ACPT .035IN GW BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545660 SUP HCPCS C2617 M00545660 - STENT BIL DDNL BND 8.5FR 7CM RX DLV SYS DISP ACPT .035IN GW BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545670 SUP HCPCS C2617 M00545670 - STENT BIL DDNL BND 8.5FR 10CM RX DLV SYS DISP ACPT .035IN GW BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545680 SUP HCPCS C2617 M00545680 - STENT BIL DDNL BND 8.5FR 12CM RX DLV SYS DISP ACPT .035IN GW BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545700 SUP HCPCS C2617 M00545700 - STENT BIL DDNL BND 11.5FR 5CM RX DLV SYS DISP ACPT .035IN GW BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545710 SUP HCPCS C2617 M00545710 - STENT BIL DDNL BND 11.5FR 7CM RX DLV SYS DISP ACPT .035IN GW BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545720 SUP HCPCS C2617 M00545720 - STENT BIL DDNL BND 11.5FR 10CM RX DLV SYS DISP ACPT .035IN BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545730 SUP HCPCS C2617 M00545730 - STENT BIL DDNL BND 11.5FR 12CM RX DLV SYS DISP ACPT .035IN BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545740 SUP HCPCS C1876 M00545740 - STENT BIL DDNL BND 11.5FR 15CM RX DLV SYS DISP ACPT .035IN BOTH IP/OP $254.50 $188.00 $50.46 $254.25 $114.41 $114.41 $114.41 $114.41 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $254.25 $254.25 $254.25 $52.99 $254.25 $254.25 $150.39 $254.25 $254.25 $254.25 $254.25 $190.88 $254.25 $254.25 $254.25 $127.13 $127.13 $201.37 $254.25 $203.40 $114.41 $50.46 N/A $147.61 $254.25 $254.25 $254.25 $52.99 $254.25 N/A N/A M00545900 SUP HCPCS C1726 M00545900 - CATHETER BLNDIL 12 ATM 4MM 180CM 4CM HRCN RX LOPRFL RADOPQ BOTH IP/OP $596.00 $441.00 $118.20 $595.55 $323.38 $323.38 $323.38 $323.38 $595.55 $595.55 $595.55 $124.13 $595.55 $442.02 $442.02 $459.05 $310.28 $124.12 $595.55 $595.55 $352.27 $595.55 $595.55 $595.55 $595.55 $447.00 $595.55 $595.55 $595.55 $297.78 $297.78 $471.68 $595.55 $476.44 $387.11 $118.20 N/A $345.68 $595.55 $595.55 $595.55 $124.11 $595.55 N/A N/A M00545920 SUP HCPCS C1726 M00545920 - CATHETER BLNDIL 11 ATM 6MM 180CM 4CM HRCN RX LOPRFL RADOPQ BOTH IP/OP $596.00 $441.00 $118.20 $595.55 $323.38 $323.38 $323.38 $323.38 $595.55 $595.55 $595.55 $124.13 $595.55 $442.02 $442.02 $459.05 $310.28 $124.12 $595.55 $595.55 $352.27 $595.55 $595.55 $595.55 $595.55 $447.00 $595.55 $595.55 $595.55 $297.78 $297.78 $471.68 $595.55 $476.44 $387.11 $118.20 N/A $345.68 $595.55 $595.55 $595.55 $124.11 $595.55 N/A N/A M00545960 SUP HCPCS C1726 M00545960 - CATHETER BLNDIL 8 ATM 10MM 180CM 4CM HRCN RX LOPRFL RADOPQ BOTH IP/OP $596.00 $441.00 $118.20 $595.55 $323.38 $323.38 $323.38 $323.38 $595.55 $595.55 $595.55 $124.13 $595.55 $442.02 $442.02 $459.05 $310.28 $124.12 $595.55 $595.55 $352.27 $595.55 $595.55 $595.55 $595.55 $447.00 $595.55 $595.55 $595.55 $297.78 $297.78 $471.68 $595.55 $476.44 $387.11 $118.20 N/A $345.68 $595.55 $595.55 $595.55 $124.11 $595.55 N/A N/A M00546900 SUP HCPCS C1726 M00546900 - CATHETER SPEC RTRVL .035IN 6-7FR 9-12MM 200CM STRL LTX XTRT BOTH IP/OP $395.50 $293.00 $78.41 $395.06 $214.52 $214.52 $214.52 $214.52 $395.06 $395.06 $395.06 $82.34 $395.06 $293.21 $293.21 $304.51 $205.83 $82.33 $395.06 $395.06 $233.68 $395.06 $395.06 $395.06 $395.06 $296.63 $395.06 $395.06 $395.06 $197.53 $197.53 $312.89 $395.06 $316.05 $256.79 $78.41 N/A $229.39 $395.06 $395.06 $395.06 $82.33 $395.06 N/A N/A M00546910 SUP HCPCS C1726 M00546910 - CATHETER SPEC RTRVL .035IN 7-6FR 12-15MM 200CM STRL LTX XTRT BOTH IP/OP $395.50 $293.00 $78.41 $395.06 $214.52 $214.52 $214.52 $214.52 $395.06 $395.06 $395.06 $82.34 $395.06 $293.21 $293.21 $304.51 $205.83 $82.33 $395.06 $395.06 $233.68 $395.06 $395.06 $395.06 $395.06 $296.63 $395.06 $395.06 $395.06 $197.53 $197.53 $312.89 $395.06 $316.05 $256.79 $78.41 N/A $229.39 $395.06 $395.06 $395.06 $82.33 $395.06 N/A N/A M00546920 SUP HCPCS C1769 M00546920 - CATHETER SPEC RTRVL .035IN 7-6FR 15-18MM 200CM STRL LTX XTRT BOTH IP/OP $395.50 $293.00 $78.41 $395.06 $214.52 $214.52 $214.52 $214.52 $395.06 $395.06 $395.06 $82.34 $395.06 $293.21 $293.21 $304.51 $205.83 $82.33 $395.06 $395.06 $233.68 $395.06 $395.06 $395.06 $395.06 $296.63 $395.06 $395.06 $395.06 $197.53 $197.53 $312.89 $395.06 $316.05 $256.79 $78.41 N/A $229.39 $395.06 $395.06 $395.06 $82.33 $395.06 N/A N/A M00547000 SUP Custom 27203010 M00547000 - CATHETER BALDILAT 7-6FR 9-12MM 200CM 3 LUMEN SPECIMEN BOTH IP/OP $275.00 $204.00 $48.95 $356.55 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $48.95 $275.00 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $142.62 $275.00 $275.00 $356.55 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $275.00 N/A $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A M00547010 SUP Custom 27203010 M00547010 - CATHETER BALDILAT 7-6FR 12-15MM 200CM 3 LUMEN SPECIMEN BOTH IP/OP $275.00 $204.00 $48.95 $356.55 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $48.95 $275.00 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $142.62 $275.00 $275.00 $356.55 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $275.00 N/A $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A M00547020 SUP Custom 27203010 M00547020 - CATHETER BALDILAT 7-6FR 15-18MM 200CM 3 LUMEN SPECIMEN BOTH IP/OP $275.00 $204.00 $48.95 $356.55 $275.00 $275.00 $275.00 $275.00 $275.00 $275.00 $48.95 $275.00 $275.00 $204.11 $204.11 $211.97 $143.28 $57.31 $275.00 $142.62 $275.00 $275.00 $356.55 $275.00 $275.00 $206.25 $275.00 $275.00 $275.00 $137.50 $137.50 $217.80 $275.00 $220.00 $178.75 $275.00 N/A $159.50 $275.00 $165.00 $275.00 $275.00 $275.00 N/A N/A M00551591 SUP HCPCS C1769 M00551591 - GUIDEWIRE ENDSCP .018IN 450CM EXCHANGE SHAPEABLE STIFF SHAFT BOTH IP/OP $318.00 $235.00 $63.08 $317.83 $172.58 $172.58 $172.58 $172.58 $317.83 $317.83 $317.83 $66.24 $317.83 $235.89 $235.89 $244.98 $165.59 $66.24 $317.83 $317.83 $188.00 $317.83 $317.83 $317.83 $317.83 $238.50 $317.83 $317.83 $317.83 $158.92 $158.92 $251.72 $317.83 $254.26 $206.59 $63.08 N/A $184.44 $317.83 $317.83 $317.83 $66.24 $317.83 N/A N/A M00553650 SUP HCPCS C1874 M00553650 - STENT PNCR 15MM 24MM 10MM 146MM 138MM 10.8FR CAUT BOTH IP/OP "$11,000.00" "$8,140.00" "$2,183.23" "$11,000.00" "$4,950.00" "$4,950.00" "$4,950.00" "$4,950.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.68" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.52" "$11,000.00" "$11,000.00" "$5,423.00" "$11,000.00" "$11,000.00" "$11,000.00" "$11,000.00" "$8,250.00" "$11,000.00" "$11,000.00" "$11,000.00" "$5,500.00" "$5,500.00" "$8,712.00" "$11,000.00" "$8,800.00" "$4,950.00" "$2,183.23" N/A "$6,380.00" "$11,000.00" "$11,000.00" "$11,000.00" "$2,292.40" "$11,000.00" N/A N/A M00553750 SUP HCPCS C1874 M00553750 - STENT BIL 10MM 10.8FR 146CM 10MM 21MM LUM SDL AXS BOTH IP/OP "$9,500.00" "$7,030.00" "$1,885.51" "$9,500.00" "$4,275.00" "$4,275.00" "$4,275.00" "$4,275.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,980.04" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.90" "$9,500.00" "$9,500.00" "$4,683.50" "$9,500.00" "$9,500.00" "$9,500.00" "$9,500.00" "$7,125.00" "$9,500.00" "$9,500.00" "$9,500.00" "$4,750.00" "$4,750.00" "$7,524.00" "$9,500.00" "$7,600.00" "$4,275.00" "$1,885.51" N/A "$5,510.00" "$9,500.00" "$9,500.00" "$9,500.00" "$1,979.80" "$9,500.00" N/A N/A M00555580 SUP Custom 27203010 M00555580 - NEEDLE BX 19GA 1.14MM STRL LF ACQUIRE US DISP BOTH IP/OP "$1,300.00" $962.00 $231.40 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $231.40 "$1,300.00" "$1,300.00" $964.86 $964.86 "$1,002.04" $677.30 $270.93 "$1,300.00" $520.00 "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" "$1,300.00" $975.00 "$1,300.00" "$1,300.00" "$1,300.00" $650.00 $650.00 "$1,029.60" "$1,300.00" "$1,040.00" $845.00 "$1,300.00" N/A $754.00 "$1,300.00" $780.00 "$1,300.00" "$1,300.00" "$1,300.00" N/A N/A M00556021 SUP HCPCS C1769 M00556021 - GUIDEWIRE ENDSCP STR .035IN 260CM HIGH PERFORMANCE RAPEX BOTH IP/OP $424.00 $314.00 $84.10 $423.74 $230.09 $230.09 $230.09 $230.09 $423.74 $423.74 $423.74 $88.32 $423.74 $314.50 $314.50 $326.62 $220.77 $88.31 $423.74 $423.74 $250.64 $423.74 $423.74 $423.74 $423.74 $318.00 $423.74 $423.74 $423.74 $211.87 $211.87 $335.60 $423.74 $338.99 $275.43 $84.10 N/A $245.92 $423.74 $423.74 $423.74 $88.31 $423.74 N/A N/A M00556041 SUP HCPCS C1769 M00556041 - GUIDEWIRE ENDSCP STR .035IN 450CM HIGH PERFORMANCE RAPEX BOTH IP/OP $424.00 $314.00 $84.10 $423.74 $230.09 $230.09 $230.09 $230.09 $423.74 $423.74 $423.74 $88.32 $423.74 $314.50 $314.50 $326.62 $220.77 $88.31 $423.74 $423.74 $250.64 $423.74 $423.74 $423.74 $423.74 $318.00 $423.74 $423.74 $423.74 $211.87 $211.87 $335.60 $423.74 $338.99 $275.43 $84.10 N/A $245.92 $423.74 $423.74 $423.74 $88.31 $423.74 N/A N/A M00556621 SUP HCPCS C1769 M00556621 - GUIDEWIRE ENDSCP STANDARD STR TRIM .038IN 260CM HIGH BOTH IP/OP $240.50 $178.00 $47.70 $240.35 $130.51 $130.51 $130.51 $130.51 $240.35 $240.35 $240.35 $50.09 $240.35 $178.39 $178.39 $185.26 $125.22 $50.09 $240.35 $240.35 $142.17 $240.35 $240.35 $240.35 $240.35 $180.38 $240.35 $240.35 $240.35 $120.18 $120.18 $190.36 $240.35 $192.28 $156.23 $47.70 N/A $139.49 $240.35 $240.35 $240.35 $50.09 $240.35 N/A N/A M00558330 SUP HCPCS C1726 M00558330 - CATHETER BLNDIL 2.8MM 6-7-8MM 180CM STRL LF 8CM CRE FX WRE BOTH IP/OP $460.50 $341.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $345.38 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 $562.50 $267.09 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A M00558330 SUP Custom 27203090 CRE DILATION BALLOON CRE 6-8MM 8CM F/G BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 $562.50 $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A M00558340 SUP Custom 27203091 CRE DILATION BALLOON 8-10MM 8CM F/G BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 $562.50 $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A M00558360 SUP Custom 27203094 CRE DILATION BALLOON 15-18MM 8CM F/G BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 $562.50 $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A M00558370 SUP HCPCS C1726 M00558370 - CATHETER BALDILAT 6FR 15-18MM 180CM 8CM FIX WIRE HIGH BOTH IP/OP $460.50 $341.00 $91.31 $460.05 $249.81 $249.81 $249.81 $249.81 $460.05 $460.05 $460.05 $95.89 $460.05 $341.45 $341.45 $354.61 $239.69 $95.88 $460.05 $460.05 $272.12 $460.05 $460.05 $460.05 $460.05 $345.38 $460.05 $460.05 $460.05 $230.03 $230.03 $364.36 $460.05 $368.04 $299.03 $91.31 N/A $267.09 $460.05 $460.05 $460.05 $95.87 $460.05 N/A N/A M00558380 SUP HCPCS C1726 M00558380 - CATHETER BALDILAT 6FR 18-20MM 180CM 8CM FIX WIRE HIGH BOTH IP/OP $460.50 $341.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $345.38 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 $562.50 $267.09 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A M00558380 SUP Custom 27203095 CRE DILATION BALLOON 18-20MM 8CM F/G BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 $562.50 $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A M00558410 SUP HCPCS C1726 M00558410 - DILATOR ENDSCP 7.5FR 10-12MM 180CM 5.5CM CRE PEBAX ESOPHAGUS BOTH IP/OP $530.50 $393.00 $105.26 $530.33 $287.97 $287.97 $287.97 $287.97 $530.33 $530.33 $530.33 $110.53 $530.33 $393.61 $393.61 $408.78 $276.30 $110.53 $530.33 $530.33 $313.69 $530.33 $530.33 $530.33 $530.33 $397.88 $530.33 $530.33 $530.33 $265.17 $265.17 $420.02 $530.33 $424.26 $344.71 $105.26 N/A $307.69 $530.33 $530.33 $530.33 $110.52 $530.33 N/A N/A M00558420 SUP HCPCS C1726 M00558420 - DILATOR ENDSCP 7.5FR 12-15MM 180CM 5.5CM CRE PEBAX ESOPHAGUS BOTH IP/OP $530.50 $393.00 $105.26 $530.33 $287.97 $287.97 $287.97 $287.97 $530.33 $530.33 $530.33 $110.53 $530.33 $393.61 $393.61 $408.78 $276.30 $110.53 $530.33 $530.33 $313.69 $530.33 $530.33 $530.33 $530.33 $397.88 $530.33 $530.33 $530.33 $265.17 $265.17 $420.02 $530.33 $424.26 $344.71 $105.26 N/A $307.69 $530.33 $530.33 $530.33 $110.52 $530.33 N/A N/A M00558450 SUP HCPCS C1769 M00558450 - DILATOR ENDSCP 7.5FR 6-8MM 240CM 5.5CM INFLATE CRE PEBAX BOTH IP/OP $530.50 $393.00 $105.26 $530.33 $287.97 $287.97 $287.97 $287.97 $530.33 $530.33 $530.33 $110.53 $530.33 $393.61 $393.61 $408.78 $276.30 $110.53 $530.33 $530.33 $313.69 $530.33 $530.33 $530.33 $530.33 $397.88 $530.33 $530.33 $530.33 $265.17 $265.17 $420.02 $530.33 $424.26 $344.71 $105.26 N/A $307.69 $530.33 $530.33 $530.33 $110.52 $530.33 N/A N/A M00558480 SUP HCPCS C1769 M00558480 - DILATOR ENDSCP 7.5FR 12-15MM 240CM 5.5CM INFLATE CRE PEBAX BOTH IP/OP $530.50 $393.00 $105.26 $530.33 $287.97 $287.97 $287.97 $287.97 $530.33 $530.33 $530.33 $110.53 $530.33 $393.61 $393.61 $408.78 $276.30 $110.53 $530.33 $530.33 $313.69 $530.33 $530.33 $530.33 $530.33 $397.88 $530.33 $530.33 $530.33 $265.17 $265.17 $420.02 $530.33 $424.26 $344.71 $105.26 N/A $307.69 $530.33 $530.33 $530.33 $110.52 $530.33 N/A N/A M00558500 SUP HCPCS C1726 M00558500 - CATHETER BALDILAT 7.5FR 18-20MM 240CM 5.5CM WIRE GUIDE CRE BOTH IP/OP $530.50 $393.00 $105.26 $530.33 $287.97 $287.97 $287.97 $287.97 $530.33 $530.33 $530.33 $110.53 $530.33 $393.61 $393.61 $408.78 $276.30 $110.53 $530.33 $530.33 $313.69 $530.33 $530.33 $530.33 $530.33 $397.88 $530.33 $530.33 $530.33 $265.17 $265.17 $420.02 $530.33 $424.26 $344.71 $105.26 N/A $307.69 $530.33 $530.33 $530.33 $110.52 $530.33 N/A N/A M00558660 SUP HCPCS C1726 M00558660 - DILATOR ESCP 7.5FR 6-8MM 240CM STRL LF 5.5CM CRE INFL BLN BOTH IP/OP $530.50 $393.00 $105.26 $530.33 $287.97 $287.97 $287.97 $287.97 $530.33 $530.33 $530.33 $110.53 $530.33 $393.61 $393.61 $408.78 $276.30 $110.53 $530.33 $212.13 $313.69 $530.33 $530.33 $530.33 $530.33 $397.88 $530.33 $530.33 $530.33 $265.17 $265.17 $420.02 $530.33 $424.26 $344.71 $105.26 N/A $307.69 $530.33 $530.33 $530.33 $110.52 $530.33 N/A N/A M00558670 SUP HCPCS C1726 M00558670 - DILATOR ESCP 7.5FR 8-10MM 240CM STRL LF 5.5CM CRE INFL BLN BOTH IP/OP $530.50 $393.00 $105.26 $530.33 $287.97 $287.97 $287.97 $287.97 $530.33 $530.33 $530.33 $110.53 $530.33 $393.61 $393.61 $408.78 $276.30 $110.53 $530.33 $212.13 $313.69 $530.33 $530.33 $530.33 $530.33 $397.88 $530.33 $530.33 $530.33 $265.17 $265.17 $420.02 $530.33 $424.26 $344.71 $105.26 N/A $307.69 $530.33 $530.33 $530.33 $110.52 $530.33 N/A N/A M00558680 SUP HCPCS C1726 M00558680 - DILATOR ESCP 7.5FR 10-12MM 240CM STRL LF 5.5CM CRE INFL BLN BOTH IP/OP $530.50 $393.00 $105.26 $530.33 $287.97 $287.97 $287.97 $287.97 $530.33 $530.33 $530.33 $110.53 $530.33 $393.61 $393.61 $408.78 $276.30 $110.53 $530.33 $212.13 $313.69 $530.33 $530.33 $530.33 $530.33 $397.88 $530.33 $530.33 $530.33 $265.17 $265.17 $420.02 $530.33 $424.26 $344.71 $105.26 N/A $307.69 $530.33 $530.33 $530.33 $110.52 $530.33 N/A N/A M00558690 SUP HCPCS C1726 M00558690 - DILATOR ESCP 7.5FR 12-13.5-15MM 240CM STRL LF 5.5CM CRE INFL BOTH IP/OP $530.50 $393.00 $105.26 $530.33 $287.97 $287.97 $287.97 $287.97 $530.33 $530.33 $530.33 $110.53 $530.33 $393.61 $393.61 $408.78 $276.30 $110.53 $530.33 $212.13 $313.69 $530.33 $530.33 $530.33 $530.33 $397.88 $530.33 $530.33 $530.33 $265.17 $265.17 $420.02 $530.33 $424.26 $344.71 $105.26 N/A $307.69 $530.33 $530.33 $530.33 $110.52 $530.33 N/A N/A M00558700 SUP HCPCS C1726 M00558700 - DILATOR ESCP 7.5FR 15-16.5-18MM 240CM STRL LF 5.5CM CRE INFL BOTH IP/OP $530.50 $393.00 $105.26 $530.33 $287.97 $287.97 $287.97 $287.97 $530.33 $530.33 $530.33 $110.53 $530.33 $393.61 $393.61 $408.78 $276.30 $110.53 $530.33 $212.13 $313.69 $530.33 $530.33 $530.33 $530.33 $397.88 $530.33 $530.33 $530.33 $265.17 $265.17 $420.02 $530.33 $424.26 $344.71 $105.26 N/A $307.69 $530.33 $530.33 $530.33 $110.52 $530.33 N/A N/A M00558710 SUP HCPCS C1726 M00558710 - DILATOR ESCP 7.5FR 18-20MM 240CM STRL LF 5.5CM CRE INFL BOTH IP/OP $530.50 $393.00 $105.26 $530.33 $287.97 $287.97 $287.97 $287.97 $530.33 $530.33 $530.33 $110.53 $530.33 $393.61 $393.61 $408.78 $276.30 $110.53 $530.33 $212.13 $313.69 $530.33 $530.33 $530.33 $530.33 $397.88 $530.33 $530.33 $530.33 $265.17 $265.17 $420.02 $530.33 $424.26 $344.71 $105.26 N/A $307.69 $530.33 $530.33 $530.33 $110.52 $530.33 N/A N/A M00560071 SUP HCPCS C1726 M00560071 - CATHETER ELHMST 7FR 300CM STRL GLDPRB BP RND DIST TIP FIRM BOTH IP/OP $303.50 $225.00 $60.21 $303.35 $164.72 $164.72 $164.72 $164.72 $303.35 $303.35 $303.35 $63.23 $303.35 $225.15 $225.15 $233.82 $158.05 $63.22 $303.35 $303.35 $179.43 $303.35 $303.35 $303.35 $303.35 $227.63 $303.35 $303.35 $303.35 $151.68 $151.68 $240.25 $303.35 $242.68 $197.18 $60.21 N/A $176.03 $303.35 $303.35 $303.35 $63.22 $303.35 N/A N/A M00560150 SUP Custom 27203010 M00560150 - CATHETER ELHMST 7FR 25GA .24MM 210CM INJ GLDPRB BP RND DIST BOTH IP/OP $558.00 $413.00 $99.28 $557.75 $557.75 $557.75 $557.75 $557.75 $557.75 $557.75 $99.28 $557.75 $557.75 $413.96 $413.96 $429.91 $290.59 $116.24 $557.75 $223.10 $557.75 $557.75 $557.75 $557.75 $557.75 $418.50 $557.75 $557.75 $557.75 $278.88 $278.88 $441.74 $557.75 $446.20 $362.54 $557.75 N/A $323.64 $557.75 $334.65 $557.75 $557.75 $557.75 N/A N/A M00560160 SUP HCPCS C1726 M00560160 - CATHETER ELECTROHEMOSTASIS 10FR 210CM BIPOL STANDARD PLUG BOTH IP/OP $558.00 $413.00 $110.70 $557.75 $302.86 $302.86 $302.86 $302.86 $557.75 $557.75 $557.75 $116.25 $557.75 $413.96 $413.96 $429.91 $290.59 $116.24 $557.75 $557.75 $329.91 $557.75 $557.75 $557.75 $557.75 $418.50 $557.75 $557.75 $557.75 $278.88 $278.88 $441.74 $557.75 $446.20 $362.54 $110.70 N/A $323.64 $557.75 $557.75 $557.75 $116.24 $557.75 N/A N/A M00561311 SUP Custom 27203010 M00561311 - SNARE ENDSCP JUMBO LARGE OVAL MEDIUM STIFF DISPOSABLE BOTH IP/OP $34.00 $25.00 $6.00 $33.68 $33.68 $33.68 $33.68 $33.68 $33.68 $33.68 $6.00 $33.68 $33.68 $25.00 $25.00 $25.96 $17.55 $7.02 $33.68 $13.47 $33.68 $33.68 $33.68 $33.68 $33.68 $25.50 $33.68 $33.68 $33.68 $16.84 $16.84 $26.67 $33.68 $26.94 $21.89 $33.68 N/A $19.72 $33.68 $20.21 $33.68 $33.68 $33.68 N/A N/A M00561831 SUP Custom 27203010 M00561831 - SNARE ENDSCP MINI STANDARD OVAL 2.4MM 195CMX20MM POLYPECTOMY BOTH IP/OP $46.50 $34.00 $8.27 $46.48 $46.48 $46.48 $46.48 $46.48 $46.48 $46.48 $8.27 $46.48 $46.48 $34.50 $34.50 $35.83 $24.22 $9.69 $46.48 $18.59 $46.48 $46.48 $46.48 $46.48 $46.48 $34.88 $46.48 $46.48 $46.48 $23.24 $23.24 $36.81 $46.48 $37.18 $30.21 $46.48 N/A $26.97 $46.48 $27.89 $46.48 $46.48 $46.48 N/A N/A M00562321 SUP Custom 27203010 M00562321 - SNARE ESCP MED OVL 2.4MM 240CM 27MM CPTVTR STF DISP PLYP BOTH IP/OP $34.00 $25.00 $6.00 $33.68 $33.68 $33.68 $33.68 $33.68 $33.68 $33.68 $6.00 $33.68 $33.68 $25.00 $25.00 $25.96 $17.55 $7.02 $33.68 $13.47 $33.68 $33.68 $33.68 $33.68 $33.68 $25.50 $33.68 $33.68 $33.68 $16.84 $16.84 $26.67 $33.68 $26.94 $21.89 $33.68 N/A $19.72 $33.68 $20.21 $33.68 $33.68 $33.68 N/A N/A M00562391 SUP Custom 27203010 M00562391 - SNARE ENDSCP THIN JUMBO OVAL 2.4MM 240CM 30MM FLEXIBLE WIRE BOTH IP/OP $34.00 $25.00 $6.00 $33.68 $33.68 $33.68 $33.68 $33.68 $33.68 $33.68 $6.00 $33.68 $33.68 $25.00 $25.00 $25.96 $17.55 $7.02 $33.68 $13.47 $33.68 $33.68 $33.68 $33.68 $33.68 $25.50 $33.68 $33.68 $33.68 $16.84 $16.84 $26.67 $33.68 $26.94 $21.89 $33.68 N/A $19.72 $33.68 $20.21 $33.68 $33.68 $33.68 N/A N/A M00562401 SUP Custom 27203010 M00562401 - SNARE ENDSCP MEDIUM OVAL 2.4MM 240CM 27MM LOOP FLEXIBLE BOTH IP/OP $33.00 $24.00 $5.85 $32.88 $32.88 $32.88 $32.88 $32.88 $32.88 $32.88 $5.85 $32.88 $32.88 $24.40 $24.40 $25.34 $17.13 $6.85 $32.88 $13.15 $32.88 $32.88 $32.88 $32.88 $32.88 $24.75 $32.88 $32.88 $32.88 $16.44 $16.44 $26.04 $32.88 $26.30 $21.37 $32.88 N/A $19.14 $32.88 $19.73 $32.88 $32.88 $32.88 N/A N/A M00562402 SUP Custom 27203010 M00562402 - SNARE ENDSCP STANDARD OVAL 2.4MM 240CMX27MM FLEXIBLE BOTH IP/OP $21.50 $16.00 $3.77 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $21.19 $3.77 $21.19 $21.19 $15.73 $15.73 $16.33 $11.04 $4.42 $21.19 $8.48 $21.19 $21.19 $21.19 $21.19 $21.19 $16.13 $21.19 $21.19 $21.19 $10.60 $10.60 $16.78 $21.19 $16.95 $13.77 $21.19 N/A $12.47 $21.19 $12.71 $21.19 $21.19 $21.19 N/A N/A M00562671 SUP Custom 27203010 M00562671 - INTRODUCER SHTH 9.5FR HMSTS VLV SDPRT BOTH IP/OP $61.50 $46.00 $10.93 $61.41 $61.41 $61.41 $61.41 $61.41 $61.41 $61.41 $10.93 $61.41 $61.41 $45.58 $45.58 $47.33 $31.99 $12.80 $61.41 $24.56 $61.41 $61.41 $61.41 $61.41 $61.41 $46.13 $61.41 $61.41 $61.41 $30.71 $30.71 $48.64 $61.41 $49.13 $39.92 $61.41 N/A $35.67 $61.41 $36.85 $61.41 $61.41 $61.41 N/A N/A M00565020 SUP HCPCS C1876 M00565020 - STENT DUODENAL 22-27MM 10FR 9CM 230CM DELIVERY SYSTEM BOTH IP/OP "$5,737.50" "$4,246.00" "$1,138.75" "$6,159.53" "$2,581.88" "$2,581.88" "$2,581.88" "$2,581.88" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.84" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$6,159.53" "$2,828.59" "$5,737.50" "$6,159.53" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$1,138.75" N/A "$3,327.75" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.70" "$5,737.50" N/A N/A M00565040 SUP HCPCS C1874 M00565040 - STENT COLONIC 25-30MM 10FR 60CM 230CM DELIVERY SYSTEM BOTH IP/OP "$5,737.50" "$4,246.00" "$1,138.75" "$6,159.53" "$2,581.88" "$2,581.88" "$2,581.88" "$2,581.88" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.84" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$6,159.53" "$2,828.59" "$5,737.50" "$6,159.53" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$1,138.75" N/A "$3,327.75" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.70" "$5,737.50" N/A N/A M00565050 SUP HCPCS C1874 M00565050 - STENT COLONIC 25-30MM 10FR 90CM 230CM DELIVERY SYSTEM BOTH IP/OP "$5,737.50" "$4,246.00" "$1,138.75" "$6,159.53" "$2,581.88" "$2,581.88" "$2,581.88" "$2,581.88" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.84" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$6,159.53" "$2,828.59" "$5,737.50" "$6,159.53" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$1,138.75" N/A "$3,327.75" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.70" "$5,737.50" N/A N/A M00565060 SUP HCPCS C1874 M00565060 - STENT COLONIC 25-30MM 10FR 120CM 230CM DELIVERY SYSTEM BOTH IP/OP "$5,737.50" "$4,246.00" "$1,138.75" "$6,159.53" "$2,581.88" "$2,581.88" "$2,581.88" "$2,581.88" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.84" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.76" "$5,737.50" "$6,159.53" "$2,828.59" "$5,737.50" "$6,159.53" "$5,737.50" "$5,737.50" "$4,303.13" "$5,737.50" "$5,737.50" "$5,737.50" "$2,868.75" "$2,868.75" "$4,544.10" "$5,737.50" "$4,590.00" "$2,581.88" "$1,138.75" N/A "$3,327.75" "$5,737.50" "$5,737.50" "$5,737.50" "$1,195.70" "$5,737.50" N/A N/A M00566461 SUP Custom 27203010 M00566461 - KIT PG 20FR 5ML STRL LF EVV PUL METH AMP TROC CNN RND XTRN BOTH IP/OP $219.50 $162.00 $39.01 $219.16 $219.16 $219.16 $219.16 $219.16 $219.16 $219.16 $39.01 $219.16 $219.16 $162.66 $162.66 $168.93 $114.18 $45.68 $219.16 $87.66 $219.16 $219.16 $219.16 $219.16 $219.16 $164.63 $219.16 $219.16 $219.16 $109.58 $109.58 $173.57 $219.16 $175.33 $142.45 $219.16 N/A $127.31 $219.16 $131.50 $219.16 $219.16 $219.16 N/A N/A M00566471 SUP HCPCS C1769 M00566471 - KIT PG 11 20FR 22GA 1.5IN STRL LF EVV SFGLD CHLRPRP PUSH BOTH IP/OP $219.50 $162.00 $43.50 $219.16 $119.00 $119.00 $119.00 $119.00 $219.16 $219.16 $219.16 $45.68 $219.16 $162.66 $162.66 $168.93 $114.18 $45.68 $219.16 $219.16 $129.63 $219.16 $219.16 $219.16 $219.16 $164.63 $219.16 $219.16 $219.16 $109.58 $109.58 $173.57 $219.16 $175.33 $142.45 $43.50 N/A $127.31 $219.16 $219.16 $219.16 $45.67 $219.16 N/A N/A M00566481 SUP Custom 27203010 M00566481 - KIT PG 24FR 5ML STRL LF EVV PUL METH AMP TROC CNN RND XTRN BOTH IP/OP $219.50 $162.00 $39.01 $219.16 $219.16 $219.16 $219.16 $219.16 $219.16 $219.16 $39.01 $219.16 $219.16 $162.66 $162.66 $168.93 $114.18 $45.68 $219.16 $87.66 $219.16 $219.16 $219.16 $219.16 $219.16 $164.63 $219.16 $219.16 $219.16 $109.58 $109.58 $173.57 $219.16 $175.33 $142.45 $219.16 N/A $127.31 $219.16 $131.50 $219.16 $219.16 $219.16 N/A N/A M0056820 SUP Custom 27203010 M0056820 - KIT PG 20FR SIL PUL METH FENST DRP STD CLMP EVV 5ML BOTH IP/OP $437.50 $324.00 $77.88 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $437.50 $77.88 $437.50 $437.50 $324.71 $324.71 $337.23 $227.94 $91.18 $437.50 $175.00 $437.50 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $284.38 $437.50 N/A $253.75 $437.50 $262.50 $437.50 $437.50 $437.50 N/A N/A M00568201 SUP Custom 27203010 M00568201 - KIT PEG STANDARD UNIVERSAL 20FR PULL METHOD FENESTRATE DRAPE BOTH IP/OP $148.00 $110.00 $26.30 $147.75 $147.75 $147.75 $147.75 $147.75 $147.75 $147.75 $26.30 $147.75 $147.75 $109.66 $109.66 $113.89 $76.98 $30.79 $147.75 $59.10 $147.75 $147.75 $147.75 $147.75 $147.75 $111.00 $147.75 $147.75 $147.75 $73.88 $73.88 $117.02 $147.75 $118.20 $96.04 $147.75 N/A $85.84 $147.75 $88.65 $147.75 $147.75 $147.75 N/A N/A M00568241 SUP Custom 27203010 M00568241 - KIT PEG STANDARD 24FR PULL METHOD FENESTRATE DRAPE CLMP BOTH IP/OP $148.00 $110.00 $26.30 $147.75 $147.75 $147.75 $147.75 $147.75 $147.75 $147.75 $26.30 $147.75 $147.75 $109.66 $109.66 $113.89 $76.98 $30.79 $147.75 $59.10 $147.75 $147.75 $147.75 $147.75 $147.75 $111.00 $147.75 $147.75 $147.75 $73.88 $73.88 $117.02 $147.75 $118.20 $96.04 $147.75 N/A $85.84 $147.75 $88.65 $147.75 $147.75 $147.75 N/A N/A M00570360 SUP HCPCS C1874 M00570360 - STENT BIL .035IN 10MM 8.5FR 40MM 194CM WALLFLEX RMLM FLLY BOTH IP/OP "$6,000.00" "$4,440.00" "$1,190.85" "$6,198.75" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.55" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.47" "$6,000.00" "$6,198.75" "$2,958.00" "$6,000.00" "$6,198.75" "$6,000.00" "$6,000.00" "$4,500.00" "$6,000.00" "$6,000.00" "$6,000.00" "$3,000.00" "$3,000.00" "$4,752.00" "$6,000.00" "$4,800.00" "$2,700.00" "$1,190.85" N/A "$3,480.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.40" "$6,000.00" N/A N/A M00570370 SUP HCPCS C1874 M00570370 - STENT BIL .035IN 10MM 8.5FR 60MM 194CM WALLFLEX RMLM FLLY BOTH IP/OP "$6,000.00" "$4,440.00" "$1,190.85" "$6,198.75" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.55" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.47" "$6,000.00" "$6,198.75" "$2,958.00" "$6,000.00" "$6,198.75" "$6,000.00" "$6,000.00" "$4,500.00" "$6,000.00" "$6,000.00" "$6,000.00" "$3,000.00" "$3,000.00" "$4,752.00" "$6,000.00" "$4,800.00" "$2,700.00" "$1,190.85" N/A "$3,480.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.40" "$6,000.00" N/A N/A M00570380 SUP HCPCS C1874 M00570380 - STENT BIL .035IN 10MM 8.5FR 80MM 194CM WALLFLEX RMLM FLLY BOTH IP/OP "$6,000.00" "$4,440.00" "$1,190.85" "$6,198.75" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.55" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.47" "$6,000.00" "$6,198.75" "$2,958.00" "$6,000.00" "$6,198.75" "$6,000.00" "$6,000.00" "$4,500.00" "$6,000.00" "$6,000.00" "$6,000.00" "$3,000.00" "$3,000.00" "$4,752.00" "$6,000.00" "$4,800.00" "$2,700.00" "$1,190.85" N/A "$3,480.00" "$6,000.00" "$6,000.00" "$6,000.00" "$1,250.40" "$6,000.00" N/A N/A M00570520 SUP HCPCS C1874 M00570520 - STENT BILIARY 10MM 8.5FR 40MM RAPEX WALLFLEX PERMALUME BOTH IP/OP "$6,298.00" "$4,661.00" "$1,249.98" "$6,297.90" "$2,834.06" "$2,834.06" "$2,834.06" "$2,834.06" "$6,297.90" "$6,297.90" "$6,297.90" "$1,312.64" "$6,297.90" "$6,297.90" "$6,297.90" "$6,297.90" "$6,297.90" "$1,312.55" "$6,297.90" "$6,297.90" "$6,297.90" "$6,297.90" "$6,297.90" "$6,297.90" "$6,297.90" "$4,723.50" "$6,297.90" "$6,297.90" "$6,297.90" "$3,148.95" "$3,148.95" "$4,987.94" "$6,297.90" "$5,038.32" "$2,834.06" "$1,249.98" N/A "$3,652.84" "$6,297.90" "$6,297.90" "$6,297.90" "$1,312.48" "$6,297.90" N/A N/A M00570530 SUP HCPCS C1769 M00570530 - STENT BILIARY 10MM 8.5FR 60MM RAPEX SELF EXPAND WALLFLEX BOTH IP/OP "$6,298.00" "$4,661.00" "$1,249.98" "$6,297.90" "$3,419.76" "$3,419.76" "$3,419.76" "$3,419.76" "$6,297.90" "$6,297.90" "$6,297.90" "$1,312.64" "$6,297.90" "$4,181.12" "$4,181.12" "$4,854.42" "$2,060.15" "$1,312.55" "$6,297.90" "$6,297.90" "$3,094.73" "$6,297.90" "$6,297.90" "$6,297.90" "$6,297.90" "$4,723.50" "$6,297.90" "$6,297.90" "$6,297.90" "$3,148.95" "$3,148.95" "$4,987.94" "$6,297.90" "$5,038.32" "$4,093.64" "$1,249.98" N/A "$3,652.84" "$6,297.90" "$6,297.90" "$6,297.90" "$1,312.48" "$6,297.90" N/A N/A M00570540 SUP HCPCS C1874 M00570540 - STENT BILIARY 10MM 8.5FR 80MM RAPEX SELF EXPAND WALLFLEX BOTH IP/OP "$6,298.00" "$4,661.00" "$1,249.98" "$6,297.90" "$2,834.06" "$2,834.06" "$2,834.06" "$2,834.06" "$6,297.90" "$6,297.90" "$6,297.90" "$1,312.64" "$6,297.90" "$6,297.90" "$6,297.90" "$6,297.90" "$6,297.90" "$1,312.55" "$6,297.90" "$6,297.90" "$6,297.90" "$6,297.90" "$6,297.90" "$6,297.90" "$6,297.90" "$4,723.50" "$6,297.90" "$6,297.90" "$6,297.90" "$3,148.95" "$3,148.95" "$4,987.94" "$6,297.90" "$5,038.32" "$2,834.06" "$1,249.98" N/A "$3,652.84" "$6,297.90" "$6,297.90" "$6,297.90" "$1,312.48" "$6,297.90" N/A N/A M00570640 SUP HCPCS C1769 M00570640 - STENT BIL 10MM 8FR 60MM 194CM WLSTNT UNCOVER INTGR RTRVL BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,133.58" "$2,239.88" "$2,239.88" "$2,239.88" "$2,239.88" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$3,061.58" "$3,061.58" "$3,179.55" "$2,060.15" $859.70 "$4,125.00" "$4,133.58" "$2,439.94" "$4,125.00" "$4,133.58" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$2,681.25" $818.71 N/A "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A M00570650 SUP HCPCS C1769 M00570650 - STENT BILIARY 10MM 8FR 80MM RAPEX DELIVERY SYSTEM WALLFLEX BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,133.58" "$2,239.88" "$2,239.88" "$2,239.88" "$2,239.88" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$3,061.58" "$3,061.58" "$3,179.55" "$2,060.15" $859.70 "$4,125.00" "$4,133.58" "$2,439.94" "$4,125.00" "$4,133.58" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$2,681.25" $818.71 N/A "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A M00570660 SUP HCPCS C1769 M00570660 - STENT BILIARY .035IN 10MM 8.5FR 100MM UNCOVERED RAPEX GWIRE BOTH IP/OP "$4,125.00" "$3,053.00" $818.71 "$4,133.58" "$2,239.88" "$2,239.88" "$2,239.88" "$2,239.88" "$4,125.00" "$4,125.00" "$4,125.00" $859.75 "$4,125.00" "$3,061.58" "$3,061.58" "$3,179.55" "$2,060.15" $859.70 "$4,125.00" "$4,133.58" "$2,439.94" "$4,125.00" "$4,133.58" "$4,125.00" "$4,125.00" "$3,093.75" "$4,125.00" "$4,125.00" "$4,125.00" "$2,062.50" "$2,062.50" "$3,267.00" "$4,125.00" "$3,300.00" "$2,681.25" $818.71 N/A "$2,392.50" "$4,125.00" "$4,125.00" "$4,125.00" $859.65 "$4,125.00" N/A N/A M00570720 SUP HCPCS C1874 M00570720 - STENT BILIARY .035IN 10MM 8.5FR 40MM 3.2MM RAPEX PARTIALLY BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$6,123.15" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$6,123.15" "$5,750.00" "$5,750.00" "$6,123.15" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A M00570730 SUP HCPCS C1874 M00570730 - STENT BIL .035IN 10MM 8.5FR 60MM 3.2MM WALLFLEX FLRSCP MRKR BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$6,123.15" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$6,123.15" "$2,834.75" "$5,750.00" "$6,123.15" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A M00573080 SUP HCPCS C1769 M00573080 - SPHINCTEROTOME ENDSCP .035IN 3.9FR 20MM 260CM CHOLANGIOGRAM BOTH IP/OP $750.00 $555.00 $148.86 $750.00 $407.25 $407.25 $407.25 $407.25 $750.00 $750.00 $750.00 $156.32 $750.00 $556.65 $556.65 $578.10 $390.75 $156.31 $750.00 $750.00 $443.63 $750.00 $750.00 $750.00 $750.00 $562.50 $750.00 $750.00 $750.00 $375.00 $375.00 $594.00 $750.00 $600.00 $487.50 $148.86 N/A $435.00 $750.00 $750.00 $750.00 $156.30 $750.00 N/A N/A M00582120 SUP Custom 27203010 M00582120 - TUBE GSTRM STD RT ANG 14FR EVV BLN REPL BLSTR BOTH IP/OP $78.00 $58.00 $13.84 $77.78 $77.78 $77.78 $77.78 $77.78 $77.78 $77.78 $13.84 $77.78 $77.78 $57.73 $57.73 $59.95 $40.52 $16.21 $77.78 $31.11 $77.78 $77.78 $77.78 $77.78 $77.78 $58.50 $77.78 $77.78 $77.78 $38.89 $38.89 $61.60 $77.78 $62.22 $50.56 $77.78 N/A $45.24 $77.78 $46.67 $77.78 $77.78 $77.78 N/A N/A M00582130 SUP Custom 27203010 M00582130 - TUBE GSTRM STD RT ANG 16FR EVV BLN REPL BLSTR BOTH IP/OP $78.00 $58.00 $13.84 $77.78 $77.78 $77.78 $77.78 $77.78 $77.78 $77.78 $13.84 $77.78 $77.78 $57.73 $57.73 $59.95 $40.52 $16.21 $77.78 $31.11 $77.78 $77.78 $77.78 $77.78 $77.78 $58.50 $77.78 $77.78 $77.78 $38.89 $38.89 $61.60 $77.78 $62.22 $50.56 $77.78 N/A $45.24 $77.78 $46.67 $77.78 $77.78 $77.78 N/A N/A M00582160 SUP Custom 27203010 M00582160 - TUBE GSTRM STD RT ANG 24FR EVV BLN REPL BLSTR BOTH IP/OP $78.00 $58.00 $13.84 $77.78 $77.78 $77.78 $77.78 $77.78 $77.78 $77.78 $13.84 $77.78 $77.78 $57.73 $57.73 $59.95 $40.52 $16.21 $77.78 $31.11 $77.78 $77.78 $77.78 $77.78 $77.78 $58.50 $77.78 $77.78 $77.78 $38.89 $38.89 $61.60 $77.78 $62.22 $50.56 $77.78 N/A $45.24 $77.78 $46.67 $77.78 $77.78 $77.78 N/A N/A M00583040 SUP HCPCS C1769 M00583040 - SPHINCTEROTOME ENDSCP .035IN 4.4FR 20MM 260CM CANN PRELOAD BOTH IP/OP "$1,002.50" $742.00 $198.92 "$1,002.23" $544.21 $544.21 $544.21 $544.21 "$1,002.23" "$1,002.23" "$1,002.23" $208.89 "$1,002.23" $743.86 $743.86 $772.52 $522.16 $208.88 "$1,002.23" "$1,002.23" $592.82 "$1,002.23" "$1,002.23" "$1,002.23" "$1,002.23" $751.88 "$1,002.23" "$1,002.23" "$1,002.23" $501.12 $501.12 $793.77 "$1,002.23" $801.78 $651.45 $198.92 N/A $581.45 "$1,002.23" "$1,002.23" "$1,002.23" $208.86 "$1,002.23" N/A N/A M00583060 SUP HCPCS C1769 M00583060 - SPHINCTEROTOME ENDSCP .035IN 4.4FR 20MM 450CM CANN PRELOAD BOTH IP/OP "$1,002.50" $742.00 $198.92 "$1,002.23" $544.21 $544.21 $544.21 $544.21 "$1,002.23" "$1,002.23" "$1,002.23" $208.89 "$1,002.23" $743.86 $743.86 $772.52 $522.16 $208.88 "$1,002.23" "$1,002.23" $592.82 "$1,002.23" "$1,002.23" "$1,002.23" "$1,002.23" $751.88 "$1,002.23" "$1,002.23" "$1,002.23" $501.12 $501.12 $793.77 "$1,002.23" $801.78 $651.45 $198.92 N/A $581.45 "$1,002.23" "$1,002.23" "$1,002.23" $208.86 "$1,002.23" N/A N/A M00584040 SUP HCPCS C1769 M00584040 - SPHINCTEROTOME ENDSCP .035IN STR 4.4FR 260CM 20MM CANN BOTH IP/OP "$1,002.50" $742.00 $198.92 "$1,002.23" $544.21 $544.21 $544.21 $544.21 "$1,002.23" "$1,002.23" "$1,002.23" $208.89 "$1,002.23" $743.86 $743.86 $772.52 $522.16 $208.88 "$1,002.23" "$1,002.23" $592.82 "$1,002.23" "$1,002.23" "$1,002.23" "$1,002.23" $751.88 "$1,002.23" "$1,002.23" "$1,002.23" $501.12 $501.12 $793.77 "$1,002.23" $801.78 $651.45 $198.92 N/A $581.45 "$1,002.23" "$1,002.23" "$1,002.23" $208.86 "$1,002.23" N/A N/A M0061453500 SUP HCPCS C2617 M0061453500 - STENT URETERAL PIGTAIL CURVE LP TAPER 4.8FR 22CM ATTACH BOTH IP/OP $524.50 $388.00 $104.06 $524.30 $235.94 $235.94 $235.94 $235.94 $524.30 $524.30 $524.30 $109.28 $524.30 $524.30 $524.30 $524.30 $524.30 $109.27 $524.30 $524.30 $310.12 $524.30 $524.30 $524.30 $524.30 $393.38 $524.30 $524.30 $524.30 $262.15 $262.15 $415.25 $524.30 $419.44 $235.94 $104.06 N/A $304.21 $524.30 $524.30 $524.30 $109.26 $524.30 N/A N/A M0061453510 SUP HCPCS C2617 M0061453510 - STENT URETERAL PIGTAIL CURVE LP TAPER 4.8FR 24CM ATTACH BOTH IP/OP $524.50 $388.00 $104.06 $524.30 $235.94 $235.94 $235.94 $235.94 $524.30 $524.30 $524.30 $109.28 $524.30 $524.30 $524.30 $524.30 $524.30 $109.27 $524.30 $524.30 $310.12 $524.30 $524.30 $524.30 $524.30 $393.38 $524.30 $524.30 $524.30 $262.15 $262.15 $415.25 $524.30 $419.44 $235.94 $104.06 N/A $304.21 $524.30 $524.30 $524.30 $109.26 $524.30 N/A N/A M0061453520 SUP HCPCS C2617 M0061453520 - STENT URETERAL PIGTAIL CURVE LP 4.8FR 26CM TAPER TIP BLADDER BOTH IP/OP $524.50 $388.00 $104.06 $524.30 $235.94 $235.94 $235.94 $235.94 $524.30 $524.30 $524.30 $109.28 $524.30 $524.30 $524.30 $524.30 $524.30 $109.27 $524.30 $524.30 $310.12 $524.30 $524.30 $524.30 $524.30 $393.38 $524.30 $524.30 $524.30 $262.15 $262.15 $415.25 $524.30 $419.44 $235.94 $104.06 N/A $304.21 $524.30 $524.30 $524.30 $109.26 $524.30 N/A N/A M0061453530 SUP HCPCS C2617 M0061453530 - STENT URETERAL PIGTAIL CURVE LP TAPER 4.8FR 28CM ATTACH BOTH IP/OP $524.50 $388.00 $104.06 $524.30 $235.94 $235.94 $235.94 $235.94 $524.30 $524.30 $524.30 $109.28 $524.30 $524.30 $524.30 $524.30 $524.30 $109.27 $524.30 $524.30 $310.12 $524.30 $524.30 $524.30 $524.30 $393.38 $524.30 $524.30 $524.30 $262.15 $262.15 $415.25 $524.30 $419.44 $235.94 $104.06 N/A $304.21 $524.30 $524.30 $524.30 $109.26 $524.30 N/A N/A M0061453610 SUP HCPCS C2617 M0061453610 - STENT URETERAL PIGTAIL CURVE LP TAPER 6FR 24CM ATTACH SUTURE BOTH IP/OP $524.50 $388.00 $104.06 $524.30 $235.94 $235.94 $235.94 $235.94 $524.30 $524.30 $524.30 $109.28 $524.30 $524.30 $524.30 $524.30 $524.30 $109.27 $524.30 $524.30 $310.12 $524.30 $524.30 $524.30 $524.30 $393.38 $524.30 $524.30 $524.30 $262.15 $262.15 $415.25 $524.30 $419.44 $235.94 $104.06 N/A $304.21 $524.30 $524.30 $524.30 $109.26 $524.30 N/A N/A M0061752500 SUP HCPCS C2617 M0061752500 - STENT URETERAL TAPER 4.8FR 20CM BLADDER MARK HIGH COIL BOTH IP/OP $581.50 $430.00 $115.40 $581.43 $261.64 $261.64 $261.64 $261.64 $581.43 $581.43 $581.43 $121.18 $581.43 $581.43 $581.43 $581.43 $581.43 $121.18 $581.43 $581.43 $343.92 $581.43 $581.43 $581.43 $581.43 $436.13 $581.43 $581.43 $581.43 $290.72 $290.72 $460.49 $581.43 $465.14 $261.64 $115.40 N/A $337.27 $581.43 $581.43 $581.43 $121.17 $581.43 N/A N/A M0061901340 SUP HCPCS C2617 M0061901340 - STENT URETERAL 6FR 28CM 2 DUROMETER POLARIS HYDROPLUS BOTH IP/OP $356.50 $264.00 $70.74 $356.40 $160.38 $160.38 $160.38 $160.38 $356.40 $356.40 $356.40 $74.28 $356.40 $356.40 $356.40 $356.40 $356.40 $74.28 $356.40 $356.40 $210.81 $356.40 $356.40 $356.40 $356.40 $267.38 $356.40 $356.40 $356.40 $178.20 $178.20 $282.27 $356.40 $285.12 $160.38 $70.74 N/A $206.77 $356.40 $356.40 $356.40 $74.27 $356.40 N/A N/A M0061901440 SUP HCPCS C2617 M0061901440 - STENT URETERAL 7FR 28CM 2 DUROMETER POLARIS HYDROPLUS BOTH IP/OP $306.50 $227.00 $60.78 $306.25 $137.81 $137.81 $137.81 $137.81 $306.25 $306.25 $306.25 $63.83 $306.25 $306.25 $306.25 $306.25 $306.25 $63.83 $306.25 $306.25 $181.15 $306.25 $306.25 $306.25 $306.25 $229.88 $306.25 $306.25 $306.25 $153.13 $153.13 $242.55 $306.25 $245.00 $137.81 $60.78 N/A $177.77 $306.25 $306.25 $306.25 $63.82 $306.25 N/A N/A M0061901520 SUP HCPCS C2617 M0061901520 - STENT URETERAL 8FR 24CM 2 DUROMETER POLARIS PERCUFLEX BOTH IP/OP $306.50 $227.00 $60.78 $306.25 $137.81 $137.81 $137.81 $137.81 $306.25 $306.25 $306.25 $63.83 $306.25 $306.25 $306.25 $306.25 $306.25 $63.83 $306.25 $306.25 $181.15 $306.25 $306.25 $306.25 $306.25 $229.88 $306.25 $306.25 $306.25 $153.13 $153.13 $242.55 $306.25 $245.00 $137.81 $60.78 N/A $177.77 $306.25 $306.25 $306.25 $63.82 $306.25 N/A N/A M0061901530 SUP HCPCS C2617 M0061901530 - STENT URETERAL 8FR 26CM 2 DUROMETER POLARIS HYDROPLUS BOTH IP/OP $356.50 $264.00 $70.74 $356.40 $160.38 $160.38 $160.38 $160.38 $356.40 $356.40 $356.40 $74.28 $356.40 $356.40 $356.40 $356.40 $356.40 $74.28 $356.40 $356.40 $210.81 $356.40 $356.40 $356.40 $356.40 $267.38 $356.40 $356.40 $356.40 $178.20 $178.20 $282.27 $356.40 $285.12 $160.38 $70.74 N/A $206.77 $356.40 $356.40 $356.40 $74.27 $356.40 N/A N/A M0061901540 SUP HCPCS C2617 M0061901540 - STENT URETERAL 8FR 28CM 2 DUROMETER POLARIS HYDROPLUS BOTH IP/OP $360.00 $266.00 $71.45 $359.98 $161.99 $161.99 $161.99 $161.99 $359.98 $359.98 $359.98 $75.03 $359.98 $359.98 $359.98 $359.98 $359.98 $75.02 $359.98 $359.98 $212.93 $359.98 $359.98 $359.98 $359.98 $270.00 $359.98 $359.98 $359.98 $179.99 $179.99 $285.10 $359.98 $287.98 $161.99 $71.45 N/A $208.80 $359.98 $359.98 $359.98 $75.02 $359.98 N/A N/A M0061921300 SUP HCPCS C2617 M0061921300 - STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 20CM 2 BOTH IP/OP $658.50 $487.00 $130.70 $658.50 $296.33 $296.33 $296.33 $296.33 $658.50 $658.50 $658.50 $137.25 $658.50 $658.50 $658.50 $658.50 $658.50 $137.24 $658.50 $658.50 $389.50 $658.50 $658.50 $658.50 $658.50 $493.88 $658.50 $658.50 $658.50 $329.25 $329.25 $521.53 $658.50 $526.80 $296.33 $130.70 N/A $381.93 $658.50 $658.50 $658.50 $137.23 $658.50 N/A N/A M0061921310 SUP HCPCS C1768 M0061921310 - STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 22CM 2 BOTH IP/OP $658.50 $487.00 $130.70 $658.50 $296.33 $296.33 $296.33 $296.33 $658.50 $658.50 $658.50 $137.25 $658.50 $658.50 $658.50 $658.50 $658.50 $137.24 $658.50 $658.50 $389.50 $658.50 $658.50 $658.50 $658.50 $493.88 $658.50 $658.50 $658.50 $329.25 $329.25 $521.53 $658.50 $526.80 $296.33 $130.70 N/A $381.93 $658.50 $658.50 $658.50 $137.23 $658.50 N/A N/A M0061921320 SUP HCPCS C1768 M0061921320 - STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 24CM 2 BOTH IP/OP $658.50 $487.00 $130.70 $658.50 $296.33 $296.33 $296.33 $296.33 $658.50 $658.50 $658.50 $137.25 $658.50 $658.50 $658.50 $658.50 $658.50 $137.24 $658.50 $658.50 $389.50 $658.50 $658.50 $658.50 $658.50 $493.88 $658.50 $658.50 $658.50 $329.25 $329.25 $521.53 $658.50 $526.80 $296.33 $130.70 N/A $381.93 $658.50 $658.50 $658.50 $137.23 $658.50 N/A N/A M0061921330 SUP HCPCS C1768 M0061921330 - STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 26CM 2 BOTH IP/OP $658.50 $487.00 $130.70 $658.50 $296.33 $296.33 $296.33 $296.33 $658.50 $658.50 $658.50 $137.25 $658.50 $658.50 $658.50 $658.50 $658.50 $137.24 $658.50 $658.50 $389.50 $658.50 $658.50 $658.50 $658.50 $493.88 $658.50 $658.50 $658.50 $329.25 $329.25 $521.53 $658.50 $526.80 $296.33 $130.70 N/A $381.93 $658.50 $658.50 $658.50 $137.23 $658.50 N/A N/A M0061921340 SUP HCPCS C2617 M0061921340 - STENT URETERAL 2 PIGTAIL CURVE LP TAPER 6FR 2.1FR 28CM 2 BOTH IP/OP $658.50 $487.00 $130.70 $658.50 $296.33 $296.33 $296.33 $296.33 $658.50 $658.50 $658.50 $137.25 $658.50 $658.50 $658.50 $658.50 $658.50 $137.24 $658.50 $658.50 $389.50 $658.50 $658.50 $658.50 $658.50 $493.88 $658.50 $658.50 $658.50 $329.25 $329.25 $521.53 $658.50 $526.80 $296.33 $130.70 N/A $381.93 $658.50 $658.50 $658.50 $137.23 $658.50 N/A N/A M0061921410 SUP HCPCS C2617 M0061921410 - STENT URETERAL 2 PIGTAIL CURVE LP TAPER 7FR 2.1FR 22CM 2 BOTH IP/OP $658.50 $487.00 $130.70 $658.50 $296.33 $296.33 $296.33 $296.33 $658.50 $658.50 $658.50 $137.25 $658.50 $658.50 $658.50 $658.50 $658.50 $137.24 $658.50 $658.50 $389.50 $658.50 $658.50 $658.50 $658.50 $493.88 $658.50 $658.50 $658.50 $329.25 $329.25 $521.53 $658.50 $526.80 $296.33 $130.70 N/A $381.93 $658.50 $658.50 $658.50 $137.23 $658.50 N/A N/A M0061921420 SUP HCPCS C2617 M0061921420 - STENT URETERAL 2 PIGTAIL CURVE TAPER 7FR 2.1FR 24CM 2 BOTH IP/OP $658.50 $487.00 $130.70 $658.50 $296.33 $296.33 $296.33 $296.33 $658.50 $658.50 $658.50 $137.25 $658.50 $658.50 $658.50 $658.50 $658.50 $137.24 $658.50 $658.50 $389.50 $658.50 $658.50 $658.50 $658.50 $493.88 $658.50 $658.50 $658.50 $329.25 $329.25 $521.53 $658.50 $526.80 $296.33 $130.70 N/A $381.93 $658.50 $658.50 $658.50 $137.23 $658.50 N/A N/A M0061921430 SUP HCPCS C2617 M0061921430 - STENT URETERAL 2 PIGTAIL CURVE LP TAPER 7FR 2.1FR 26CM 2 BOTH IP/OP $658.50 $487.00 $130.70 $658.50 $296.33 $296.33 $296.33 $296.33 $658.50 $658.50 $658.50 $137.25 $658.50 $658.50 $658.50 $658.50 $658.50 $137.24 $658.50 $658.50 $389.50 $658.50 $658.50 $658.50 $658.50 $493.88 $658.50 $658.50 $658.50 $329.25 $329.25 $521.53 $658.50 $526.80 $296.33 $130.70 N/A $381.93 $658.50 $658.50 $658.50 $137.23 $658.50 N/A N/A M0061921440 SUP HCPCS C2617 M0061921440 - STENT URETERAL 2 PIGTAIL CURVE LP TAPER 7FR 2.1FR 28CM 2 BOTH IP/OP $658.50 $487.00 $130.70 $658.50 $296.33 $296.33 $296.33 $296.33 $658.50 $658.50 $658.50 $137.25 $658.50 $658.50 $658.50 $658.50 $658.50 $137.24 $658.50 $658.50 $389.50 $658.50 $658.50 $658.50 $658.50 $493.88 $658.50 $658.50 $658.50 $329.25 $329.25 $521.53 $658.50 $526.80 $296.33 $130.70 N/A $381.93 $658.50 $658.50 $658.50 $137.23 $658.50 N/A N/A M0061921510 SUP HCPCS C2617 M0061921510 - STENT URETERAL 2 PIGTAIL CURVE LP TAPER 8FR 2.1FR 22CM 2 BOTH IP/OP $658.50 $487.00 $130.70 $658.50 $296.33 $296.33 $296.33 $296.33 $658.50 $658.50 $658.50 $137.25 $658.50 $658.50 $658.50 $658.50 $658.50 $137.24 $658.50 $658.50 $389.50 $658.50 $658.50 $658.50 $658.50 $493.88 $658.50 $658.50 $658.50 $329.25 $329.25 $521.53 $658.50 $526.80 $296.33 $130.70 N/A $381.93 $658.50 $658.50 $658.50 $137.23 $658.50 N/A N/A M0061921520 SUP HCPCS C2617 M0061921520 - STENT URETERAL 2 PIGTAIL CURVE LP TAPER 8FR 2.1FR 24CM 2 BOTH IP/OP $658.50 $487.00 $130.70 $658.50 $296.33 $296.33 $296.33 $296.33 $658.50 $658.50 $658.50 $137.25 $658.50 $658.50 $658.50 $658.50 $658.50 $137.24 $658.50 $658.50 $389.50 $658.50 $658.50 $658.50 $658.50 $493.88 $658.50 $658.50 $658.50 $329.25 $329.25 $521.53 $658.50 $526.80 $296.33 $130.70 N/A $381.93 $658.50 $658.50 $658.50 $137.23 $658.50 N/A N/A M0061921530 SUP HCPCS C2617 M0061921530 - STENT URETERAL 2 PIGTAIL CURVE TAPER 8FR 2.1FR 26CM 2 BOTH IP/OP $658.50 $487.00 $130.70 $658.50 $296.33 $296.33 $296.33 $296.33 $658.50 $658.50 $658.50 $137.25 $658.50 $658.50 $658.50 $658.50 $658.50 $137.24 $658.50 $658.50 $389.50 $658.50 $658.50 $658.50 $658.50 $493.88 $658.50 $658.50 $658.50 $329.25 $329.25 $521.53 $658.50 $526.80 $296.33 $130.70 N/A $381.93 $658.50 $658.50 $658.50 $137.23 $658.50 N/A N/A M0062101170 SUP HCPCS C1726 M0062101170 - CATHETER BLNDIL 17CM 30FR 55CM LF 12CM NPHRMX AMPTZ LOPRFL BOTH IP/OP "$1,077.50" $797.00 $213.79 "$1,077.18" $584.91 $584.91 $584.91 $584.91 "$1,077.18" "$1,077.18" "$1,077.18" $224.51 "$1,077.18" $799.48 $799.48 $830.29 $561.21 $224.50 "$1,077.18" $430.87 $637.15 "$1,077.18" "$1,077.18" "$1,077.18" "$1,077.18" $808.13 "$1,077.18" "$1,077.18" "$1,077.18" $538.59 $538.59 $853.13 "$1,077.18" $861.74 $700.17 $213.79 N/A $624.95 "$1,077.18" "$1,077.18" "$1,077.18" $224.48 "$1,077.18" N/A N/A M0062251020 SUP HCPCS C1758 M0062251020 - CATHETER BLNDIL 6MM 75CM LF 4CM URMT U QD-FOLD HI-PRS KINK BOTH IP/OP "$1,132.00" $838.00 $224.61 "$1,131.68" $614.50 $614.50 $614.50 $614.50 "$1,131.68" "$1,131.68" "$1,131.68" $235.87 "$1,131.68" $839.93 $839.93 $872.30 $589.61 $235.85 "$1,131.68" "$1,131.68" $669.39 "$1,131.68" "$1,131.68" "$1,131.68" "$1,131.68" $849.00 "$1,131.68" "$1,131.68" "$1,131.68" $565.84 $565.84 $896.29 "$1,131.68" $905.34 $735.59 $224.61 N/A $656.56 "$1,131.68" "$1,131.68" "$1,131.68" $235.84 "$1,131.68" N/A N/A M0062251170 SUP HCPCS C1758 M0062251170 - CATHETER BALDILAT SHORT TAPER 5.8FR 18FR 75CM 10CM KINK BOTH IP/OP "$1,132.00" $838.00 $224.61 "$1,131.68" $614.50 $614.50 $614.50 $614.50 "$1,131.68" "$1,131.68" "$1,131.68" $235.87 "$1,131.68" $839.93 $839.93 $872.30 $589.61 $235.85 "$1,131.68" "$1,131.68" $669.39 "$1,131.68" "$1,131.68" "$1,131.68" "$1,131.68" $849.00 "$1,131.68" "$1,131.68" "$1,131.68" $565.84 $565.84 $896.29 "$1,131.68" $905.34 $735.59 $224.61 N/A $656.56 "$1,131.68" "$1,131.68" "$1,131.68" $235.84 "$1,131.68" N/A N/A M0062502080 SUP HCPCS C1894 M0062502080 - SHEATH ACC 13-15FR 36CM LF NVGTR RADOPQ 2 TPR DIL TIP UNQ BOTH IP/OP $517.00 $383.00 $102.52 $516.53 $280.48 $280.48 $280.48 $280.48 $516.53 $516.53 $516.53 $107.66 $516.53 $383.37 $383.37 $398.14 $269.11 $107.65 $516.53 $516.53 $305.53 $516.53 $516.53 $516.53 $516.53 $387.75 $516.53 $516.53 $516.53 $258.27 $258.27 $409.09 $516.53 $413.22 $335.74 $102.52 N/A $299.86 $516.53 $516.53 $516.53 $107.64 $516.53 N/A N/A M0062502091 SUP HCPCS C1894 M0062502091 - SHEATH ACCES 2 TAPER 15FR 13FR 36CM KINK RESISTANT RADIOPQ BOTH IP/OP $94.50 $70.00 $18.69 $94.17 $51.13 $51.13 $51.13 $51.13 $94.17 $94.17 $94.17 $19.63 $94.17 $69.89 $69.89 $72.59 $49.06 $19.63 $94.17 $94.17 $55.70 $94.17 $94.17 $94.17 $94.17 $70.88 $94.17 $94.17 $94.17 $47.09 $47.09 $74.58 $94.17 $75.34 $61.21 $18.69 N/A $54.81 $94.17 $94.17 $94.17 $19.63 $94.17 N/A N/A M0062601200 SUP HCPCS C1769 M0062601200 - DILATOR SURG 8-10FR 70CM 30CM KINK RESISTANT STYLET SHEATH BOTH IP/OP $236.50 $175.00 $46.88 $236.20 $128.26 $128.26 $128.26 $128.26 $236.20 $236.20 $236.20 $49.23 $236.20 $175.31 $175.31 $182.06 $123.06 $49.23 $236.20 $236.20 $139.71 $236.20 $236.20 $236.20 $236.20 $177.38 $236.20 $236.20 $236.20 $118.10 $118.10 $187.07 $236.20 $188.96 $153.53 $46.88 N/A $137.17 $236.20 $236.20 $236.20 $49.22 $236.20 N/A N/A M0062602500 SUP Custom 27203010 M0062602500 - DILATOR SURG SHEATH SET AMPLATZ RENAL STERILE BOTH IP/OP "$1,132.00" $838.00 $201.44 "$1,131.68" "$1,131.68" "$1,131.68" "$1,131.68" "$1,131.68" "$1,131.68" "$1,131.68" $201.44 "$1,131.68" "$1,131.68" $839.93 $839.93 $872.30 $589.61 $235.85 "$1,131.68" $452.67 "$1,131.68" "$1,131.68" "$1,131.68" "$1,131.68" "$1,131.68" $849.00 "$1,131.68" "$1,131.68" "$1,131.68" $565.84 $565.84 $896.29 "$1,131.68" $905.34 $735.59 "$1,131.68" N/A $656.56 "$1,131.68" $679.01 "$1,131.68" "$1,131.68" "$1,131.68" N/A N/A M0063201020 SUP Custom 27203010 M0063201020 - BASKET SPEC RTRVL 20MM 7FR 70CM SGR 4WR 0 TIP OVR GW BOTH IP/OP $529.00 $391.00 $94.12 $528.75 $528.75 $528.75 $528.75 $528.75 $528.75 $528.75 $94.12 $528.75 $528.75 $392.44 $392.44 $407.56 $275.48 $110.20 $528.75 $211.50 $528.75 $528.75 $528.75 $528.75 $528.75 $396.75 $528.75 $528.75 $528.75 $264.38 $264.38 $418.77 $528.75 $423.00 $343.69 $528.75 N/A $306.82 $528.75 $317.25 $528.75 $528.75 $528.75 N/A N/A M0063201040 SUP Custom 27203010 M0063201040 - BASKET SPEC RTRVL 3FR 16MM 90CM S-D 4WR STON LSR BOTH IP/OP $649.00 $480.00 $115.52 $649.00 $649.00 $649.00 $649.00 $649.00 $649.00 $649.00 $115.52 $649.00 $649.00 $481.69 $481.69 $500.25 $338.13 $135.26 $649.00 $259.60 $649.00 $649.00 $649.00 $649.00 $649.00 $486.75 $649.00 $649.00 $649.00 $324.50 $324.50 $514.01 $649.00 $519.20 $421.85 $649.00 N/A $376.42 $649.00 $389.40 $649.00 $649.00 $649.00 N/A N/A M0063301060 SUP Custom 27203010 M0063301060 - BASKET STON RTRVL HLCL 11MM 3FR 120CM STRL GMN 3 PR WRE SCR BOTH IP/OP $854.00 $632.00 $152.00 $853.95 $853.95 $853.95 $853.95 $853.95 $853.95 $853.95 $152.00 $853.95 $853.95 $633.80 $633.80 $658.22 $444.91 $177.97 $853.95 $341.58 $853.95 $853.95 $853.95 $853.95 $853.95 $640.50 $853.95 $853.95 $853.95 $426.98 $426.98 $676.33 $853.95 $683.16 $555.07 $853.95 N/A $495.32 $853.95 $512.37 $853.95 $853.95 $853.95 N/A N/A M0063311060 SUP Custom 27203010 M0063311060 - BASKET SPEC RTRVL 120CM 3FR 11MM STON 3WR HLCL 0 TIP PR GMN BOTH IP/OP $473.00 $350.00 $84.19 $473.00 $473.00 $473.00 $473.00 $473.00 $473.00 $473.00 $84.19 $473.00 $473.00 $351.06 $351.06 $364.59 $246.43 $98.58 $473.00 $189.20 $473.00 $473.00 $473.00 $473.00 $473.00 $354.75 $473.00 $473.00 $473.00 $236.50 $236.50 $374.62 $473.00 $378.40 $307.45 $473.00 N/A $274.34 $473.00 $283.80 $473.00 $473.00 $473.00 N/A N/A M0063401220 SUP Custom 27203010 M0063401220 - BASKET STON RTRVL HLCL 10MM 1.9FR 120CM STRL BGLY 3WR DISP BOTH IP/OP $854.00 $632.00 $152.00 $853.95 $853.95 $853.95 $853.95 $853.95 $853.95 $853.95 $152.00 $853.95 $853.95 $633.80 $633.80 $658.22 $444.91 $177.97 $853.95 $341.58 $853.95 $853.95 $853.95 $853.95 $853.95 $640.50 $853.95 $853.95 $853.95 $426.98 $426.98 $676.33 $853.95 $683.16 $555.07 $853.95 N/A $495.32 $853.95 $512.37 $853.95 $853.95 $853.95 N/A N/A M0063601000 SUP HCPCS C1726 M0063601000 - CATHETER SPEC RTRVL 3FR 120CM 60CM OVL LOOP BOTH IP/OP $455.50 $337.00 $90.41 $455.50 $247.34 $247.34 $247.34 $247.34 $455.50 $455.50 $455.50 $94.94 $455.50 $338.07 $338.07 $351.10 $237.32 $94.93 $455.50 $455.50 $269.43 $455.50 $455.50 $455.50 $455.50 $341.63 $455.50 $455.50 $455.50 $227.75 $227.75 $360.76 $455.50 $364.40 $296.08 $90.41 N/A $264.19 $455.50 $455.50 $455.50 $94.93 $455.50 N/A N/A M0063801100 SUP Custom 27203010 M0063801100 - BASKET STON RTRVL 20MM 3FR 120CM STRL LF SGR HEMI PERMAFORM BOTH IP/OP $854.00 $632.00 $152.00 $853.95 $853.95 $853.95 $853.95 $853.95 $853.95 $853.95 $152.00 $853.95 $853.95 $633.80 $633.80 $658.22 $444.91 $177.97 $853.95 $341.58 $853.95 $853.95 $853.95 $853.95 $853.95 $640.50 $853.95 $853.95 $853.95 $426.98 $426.98 $676.33 $853.95 $683.16 $555.07 $853.95 N/A $495.32 $853.95 $512.37 $853.95 $853.95 $853.95 N/A N/A M0063901010 SUP Custom 27203010 M0063901010 - BASKET STON RTRVL 12MM 2.4FR 120CM STRL LF 0TP 4WR FLT DIST BOTH IP/OP $922.00 $682.00 $164.10 $921.93 $921.93 $921.93 $921.93 $921.93 $921.93 $921.93 $164.10 $921.93 $921.93 $684.26 $684.26 $710.62 $480.33 $192.14 $921.93 $368.77 $921.93 $921.93 $921.93 $921.93 $921.93 $691.50 $921.93 $921.93 $921.93 $460.97 $460.97 $730.17 $921.93 $737.54 $599.25 $921.93 N/A $534.76 $921.93 $553.16 $921.93 $921.93 $921.93 N/A N/A M0063901020 SUP Custom 27203010 M0063901020 - BASKET STON RTRVL 16MM 3FR 90CM STRL LF 0TP 4WR FLT DIST BOTH IP/OP $922.00 $682.00 $164.10 $921.93 $921.93 $921.93 $921.93 $921.93 $921.93 $921.93 $164.10 $921.93 $921.93 $684.26 $684.26 $710.62 $480.33 $192.14 $921.93 $368.77 $921.93 $921.93 $921.93 $921.93 $921.93 $691.50 $921.93 $921.93 $921.93 $460.97 $460.97 $730.17 $921.93 $737.54 $599.25 $921.93 N/A $534.76 $921.93 $553.16 $921.93 $921.93 $921.93 N/A N/A M0063901050 SUP Custom 27203010 M0063901050 - BASKET STON RTRVL 12MM 1.9FR 120CM STRL LF 0TP 4WR FLT DIST BOTH IP/OP $939.50 $695.00 $167.23 $939.48 $939.48 $939.48 $939.48 $939.48 $939.48 $939.48 $167.23 $939.48 $939.48 $697.28 $697.28 $724.15 $489.47 $195.80 $939.48 $375.79 $939.48 $939.48 $939.48 $939.48 $939.48 $704.63 $939.48 $939.48 $939.48 $469.74 $469.74 $744.07 $939.48 $751.58 $610.66 $939.48 N/A $544.91 $939.48 $563.69 $939.48 $939.48 $939.48 N/A N/A M0063902000 SUP Custom 27203010 M0063902000 - BASKET STON RTRVL 1.9FR 90CM STRL LF ESCAPE SGR STD 4WR NTNL BOTH IP/OP "$1,159.00" $858.00 $206.22 "$1,158.53" "$1,158.53" "$1,158.53" "$1,158.53" "$1,158.53" "$1,158.53" "$1,158.53" $206.22 "$1,158.53" "$1,158.53" $859.86 $859.86 $892.99 $603.59 $241.45 "$1,158.53" $463.41 "$1,158.53" "$1,158.53" "$1,158.53" "$1,158.53" "$1,158.53" $869.25 "$1,158.53" "$1,158.53" "$1,158.53" $579.27 $579.27 $917.56 "$1,158.53" $926.82 $753.04 "$1,158.53" N/A $672.22 "$1,158.53" $695.12 "$1,158.53" "$1,158.53" "$1,158.53" N/A N/A M0063902010 SUP Custom 27203010 M0063902010 - BASKET STON RTRVL 1.9FR 120CM STRL LF ESCAPE SGR STD 4WR BOTH IP/OP "$1,159.00" $858.00 $206.22 "$1,158.53" "$1,158.53" "$1,158.53" "$1,158.53" "$1,158.53" "$1,158.53" "$1,158.53" $206.22 "$1,158.53" "$1,158.53" $859.86 $859.86 $892.99 $603.59 $241.45 "$1,158.53" $463.41 "$1,158.53" "$1,158.53" "$1,158.53" "$1,158.53" "$1,158.53" $869.25 "$1,158.53" "$1,158.53" "$1,158.53" $579.27 $579.27 $917.56 "$1,158.53" $926.82 $753.04 "$1,158.53" N/A $672.22 "$1,158.53" $695.12 "$1,158.53" "$1,158.53" "$1,158.53" N/A N/A M0063903100 SUP Custom 27203010 M0063903100 - COIL SPECIMEN RETRIEVAL 7MM 3FR 115CM LATEX FREE STONE CONE BOTH IP/OP "$1,112.50" $823.00 $197.96 "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" $197.96 "$1,112.15" "$1,112.15" $825.44 $825.44 $857.25 $579.43 $231.78 "$1,112.15" $444.86 "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" $834.38 "$1,112.15" "$1,112.15" "$1,112.15" $556.08 $556.08 $880.82 "$1,112.15" $889.72 $722.90 "$1,112.15" N/A $645.25 "$1,112.15" $667.29 "$1,112.15" "$1,112.15" "$1,112.15" N/A N/A M0063903200 SUP Custom 27803010 M0063903200 - COIL SPECIMEN RETRIEVAL 3FR 10MM 115CM SHEAQTH QUICK RELEASE BOTH IP/OP "$1,112.50" $823.00 $197.96 "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" $197.96 "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" $231.78 "$1,112.15" $444.86 "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" "$1,112.15" $834.38 "$1,112.15" "$1,112.15" "$1,112.15" $556.08 $556.08 $880.82 "$1,112.15" $889.72 $500.47 "$1,112.15" N/A $645.25 "$1,112.15" $667.29 "$1,112.15" "$1,112.15" "$1,112.15" N/A N/A M0064002011 SUP HCPCS C1758 M0064002011 - CATHETER URETERAL 5FR 70CM 1 LUMEN OPEN END INJEC HUB LATEX BOTH IP/OP $921.50 $682.00 $182.88 $921.45 $500.35 $500.35 $500.35 $500.35 $921.45 $921.45 $921.45 $192.05 $921.45 $683.90 $683.90 $710.25 $480.08 $192.04 $921.45 $921.45 $545.04 $921.45 $921.45 $921.45 $921.45 $691.13 $921.45 $921.45 $921.45 $460.73 $460.73 $729.79 $921.45 $737.16 $598.94 $182.88 N/A $534.47 $921.45 $921.45 $921.45 $192.03 $921.45 N/A N/A M0064201000 SUP Custom 27203010 M0064201000 - CATHETER SUPRAPUBIC 14FR 15CM KIT BALLOON PUNCTURE FADER TIP BOTH IP/OP $198.00 $147.00 $35.24 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $198.00 $35.24 $198.00 $198.00 $146.96 $146.96 $152.62 $103.16 $41.27 $198.00 $79.20 $198.00 $198.00 $198.00 $198.00 $198.00 $148.50 $198.00 $198.00 $198.00 $99.00 $99.00 $156.82 $198.00 $158.40 $128.70 $198.00 N/A $114.84 $198.00 $118.80 $198.00 $198.00 $198.00 N/A N/A M006580211 SUP Custom 27203010 M006580211 - UNIT ELECTROSURGICAL PROCEDURE SET GENESYS HTA BOTH IP/OP "$4,209.50" "$3,115.00" $749.22 "$4,209.12" "$4,209.12" "$4,209.12" "$4,209.12" "$4,209.12" "$4,209.12" "$4,209.12" $749.22 "$4,209.12" "$4,209.12" "$3,124.01" "$3,124.01" "$3,244.39" "$2,060.15" $877.23 "$4,209.12" "$1,683.65" "$4,209.12" "$4,209.12" "$4,209.12" "$4,209.12" "$4,209.12" "$3,157.13" "$4,209.12" "$4,209.12" "$4,209.12" "$2,104.56" "$2,104.56" "$3,333.62" "$4,209.12" "$3,367.30" "$2,735.93" "$4,209.12" N/A "$2,441.51" "$4,209.12" "$2,525.47" "$4,209.12" "$4,209.12" "$4,209.12" N/A N/A M0066301001 SUP HCPCS C1769 M0066301001 - GUIDEWIRE ENDSCP STANDARD .035IN 150CM 3CM STR TIP GLIDEWIRE BOTH IP/OP $138.00 $102.00 $27.37 $137.89 $74.87 $74.87 $74.87 $74.87 $137.89 $137.89 $137.89 $28.74 $137.89 $102.34 $102.34 $106.29 $71.84 $28.74 $137.89 $137.89 $81.56 $137.89 $137.89 $137.89 $137.89 $103.50 $137.89 $137.89 $137.89 $68.95 $68.95 $109.21 $137.89 $110.31 $89.63 $27.37 N/A $80.04 $137.89 $137.89 $137.89 $28.74 $137.89 N/A N/A M0066301011 SUP HCPCS C1769 M0066301011 - GUIDEWIRE URO STD .038IN 150CM STRL 3CM GLDWR SFT FLXB STRG BOTH IP/OP $138.00 $102.00 $27.37 $137.89 $74.87 $74.87 $74.87 $74.87 $137.89 $137.89 $137.89 $28.74 $137.89 $102.34 $102.34 $106.29 $71.84 $28.74 $137.89 $137.89 $81.56 $137.89 $137.89 $137.89 $137.89 $103.50 $137.89 $137.89 $137.89 $68.95 $68.95 $109.21 $137.89 $110.31 $89.63 $27.37 N/A $80.04 $137.89 $137.89 $137.89 $28.74 $137.89 N/A N/A M0066301101 SUP HCPCS C1769 M0066301101 - GUIDEWIRE ENDSCP ANGLE .035IN 150CM 3CM FLEXIBLE TIP STIFF BOTH IP/OP $201.50 $149.00 $39.93 $201.16 $109.23 $109.23 $109.23 $109.23 $201.16 $201.16 $201.16 $41.93 $201.16 $149.30 $149.30 $155.05 $104.80 $41.92 $201.16 $201.16 $118.99 $201.16 $201.16 $201.16 $201.16 $151.13 $201.16 $201.16 $201.16 $100.58 $100.58 $159.32 $201.16 $160.93 $130.75 $39.93 N/A $116.87 $201.16 $120.70 $201.16 $41.92 $201.16 N/A N/A M0066301121 SUP HCPCS C1769 M0066301121 - GUIDEWIRE ENDSCP ANGLE .038IN 150CM 3CM FLEXIBLE TIP STIFF BOTH IP/OP $201.50 $149.00 $39.93 $201.16 $109.23 $109.23 $109.23 $109.23 $201.16 $201.16 $201.16 $41.93 $201.16 $149.30 $149.30 $155.05 $104.80 $41.92 $201.16 $201.16 $118.99 $201.16 $201.16 $201.16 $201.16 $151.13 $201.16 $201.16 $201.16 $100.58 $100.58 $159.32 $201.16 $160.93 $130.75 $39.93 N/A $116.87 $201.16 $201.16 $201.16 $41.92 $201.16 N/A N/A M0066401041 SUP HCPCS C1769 M0066401041 - GUIDEWIRE URO STRG .035IN 145CM LF 7CM AMP SPST BNTSN FLX TP BOTH IP/OP $120.50 $89.00 $23.90 $120.44 $65.40 $65.40 $65.40 $65.40 $120.44 $120.44 $120.44 $25.10 $120.44 $89.39 $89.39 $92.84 $62.75 $25.10 $120.44 $120.44 $71.24 $120.44 $120.44 $120.44 $120.44 $90.38 $120.44 $120.44 $120.44 $60.22 $60.22 $95.39 $120.44 $96.35 $78.29 $23.90 N/A $69.89 $120.44 $120.44 $120.44 $25.10 $120.44 N/A N/A M0066703051 SUP HCPCS C1769 M0066703051 - GUIDEWIRE ENDSCP STR FLOPPY .035IN 150CM 3CM HIGH BOTH IP/OP $969.00 $717.00 $192.27 $968.75 $526.03 $526.03 $526.03 $526.03 $968.75 $968.75 $968.75 $201.91 $968.75 $719.01 $719.01 $746.71 $504.72 $201.90 $968.75 $968.75 $573.02 $968.75 $968.75 $968.75 $968.75 $726.75 $968.75 $968.75 $968.75 $484.38 $484.38 $767.25 $968.75 $775.00 $629.69 $192.27 N/A $562.02 $968.75 $968.75 $968.75 $201.89 $968.75 N/A N/A M0066703061 SUP HCPCS C1769 M0066703061 - GUIDEWIRE ENDSCP ANGLE FLOPPY .035IN 150CM 3CM HIGH BOTH IP/OP $194.00 $144.00 $38.45 $193.75 $105.21 $105.21 $105.21 $105.21 $193.75 $193.75 $193.75 $40.38 $193.75 $143.80 $143.80 $149.34 $100.94 $40.38 $193.75 $193.75 $114.60 $193.75 $193.75 $193.75 $193.75 $145.50 $193.75 $193.75 $193.75 $96.88 $96.88 $153.45 $193.75 $155.00 $125.94 $38.45 N/A $112.52 $193.75 $193.75 $193.75 $40.38 $193.75 N/A N/A M0066703091 SUP HCPCS C1769 M0066703091 - GUIDEWIRE ENDSCP STR .038IN 150CM 3CM RADIOPQ FLEXIBLE TIP BOTH IP/OP $194.00 $144.00 $38.45 $193.75 $105.21 $105.21 $105.21 $105.21 $193.75 $193.75 $193.75 $40.38 $193.75 $143.80 $143.80 $149.34 $100.94 $40.38 $193.75 $193.75 $114.60 $193.75 $193.75 $193.75 $193.75 $145.50 $193.75 $193.75 $193.75 $96.88 $96.88 $153.45 $193.75 $155.00 $125.94 $38.45 N/A $112.52 $193.75 $193.75 $193.75 $40.38 $193.75 N/A N/A M0066703101 SUP HCPCS C1769 M0066703101 - GUIDEWIRE ENDSCP ANGLE .038IN 150CM 3CM 2 FLEXIBLE TIP BOTH IP/OP $969.00 $717.00 $192.27 $968.75 $526.03 $526.03 $526.03 $526.03 $968.75 $968.75 $968.75 $201.91 $968.75 $719.01 $719.01 $746.71 $504.72 $201.90 $968.75 $968.75 $573.02 $968.75 $968.75 $968.75 $968.75 $726.75 $968.75 $968.75 $968.75 $484.38 $484.38 $767.25 $968.75 $775.00 $629.69 $192.27 N/A $562.02 $968.75 $968.75 $968.75 $201.89 $968.75 N/A N/A M0067201001 SUP Custom 27203010 M0067201001 - SYSTEM PUMP IRRIGATION 1 HAND ACTION 1 WAY VALVE VACUUM BOTH IP/OP $213.00 $158.00 $37.87 $212.74 $212.74 $212.74 $212.74 $212.74 $212.74 $212.74 $37.87 $212.74 $212.74 $157.90 $157.90 $163.98 $110.84 $44.34 $212.74 $85.10 $212.74 $212.74 $212.74 $212.74 $212.74 $159.75 $212.74 $212.74 $212.74 $106.37 $106.37 $168.49 $212.74 $170.19 $138.28 $212.74 N/A $123.54 $212.74 $127.64 $212.74 $212.74 $212.74 N/A N/A M0067301251 SUP Custom 27203010 M0067301251 - EVACUATOR UROLOGY UROVAC BLADDER BOTH IP/OP $108.00 $80.00 $19.22 $107.98 $107.98 $107.98 $107.98 $107.98 $107.98 $107.98 $19.22 $107.98 $107.98 $80.14 $80.14 $83.23 $56.26 $22.50 $107.98 $43.19 $107.98 $107.98 $107.98 $107.98 $107.98 $81.00 $107.98 $107.98 $107.98 $53.99 $53.99 $85.52 $107.98 $86.38 $70.19 $107.98 N/A $62.64 $107.98 $64.79 $107.98 $107.98 $107.98 N/A N/A M0068318170 SUP HCPCS C1781 M0068318170 - MESH TRANSVAGINAL UPHOLD CAPIO BOTH IP/OP "$7,046.50" "$5,214.00" "$1,398.50" "$7,046.25" "$3,170.81" "$3,170.81" "$3,170.81" "$3,170.81" "$7,046.25" "$7,046.25" "$7,046.25" "$1,468.61" "$7,046.25" "$7,046.25" "$7,046.25" "$7,046.25" "$7,046.25" "$1,468.52" "$7,046.25" "$7,046.25" "$3,473.80" "$7,046.25" "$7,046.25" "$7,046.25" "$7,046.25" "$5,284.88" "$7,046.25" "$7,046.25" "$7,046.25" "$3,523.13" "$3,523.13" "$5,580.63" "$7,046.25" "$5,637.00" "$3,170.81" "$1,398.50" N/A "$4,086.97" "$7,046.25" "$7,046.25" "$7,046.25" "$1,468.44" "$7,046.25" N/A N/A M0068318200 SUP HCPCS C1763 M0068318200 - MESH SRG THK200UM 2.8SQ MM Y 35.4CM BLU NTR STRP UPSYLON BOTH IP/OP "$2,775.00" "$2,054.00" $550.77 "$2,775.00" "$1,248.75" "$1,248.75" "$1,248.75" "$1,248.75" "$2,775.00" "$2,775.00" "$2,775.00" $578.38 "$2,775.00" "$2,775.00" "$2,775.00" "$2,775.00" "$2,775.00" $578.34 "$2,775.00" "$2,775.00" "$1,368.08" "$2,775.00" "$2,775.00" "$2,775.00" "$2,775.00" "$2,081.25" "$2,775.00" "$2,775.00" "$2,775.00" "$1,387.50" "$1,387.50" "$2,197.80" "$2,775.00" "$2,220.00" "$1,248.75" $550.77 N/A "$1,609.50" "$2,775.00" "$2,775.00" "$2,775.00" $578.31 "$2,775.00" N/A N/A M0068318250 SUP HCPCS C2631 M0068318250 - DEVICE SUTURING FUNNEL 3MM 1.2MM 6.3MM 3 FINGER GRIP CAPTURE BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" "$1,275.00" "$1,275.00" $265.71 "$1,275.00" N/A N/A M0068502110 SUP HCPCS C1771 M0068502110 - SLING TRANSVAGINAL 2.7MM CURVE SYSTEM DELIVERY DEVICE MESH BOTH IP/OP "$3,940.00" "$2,916.00" $781.99 "$3,940.00" "$1,773.00" "$1,773.00" "$1,773.00" "$1,773.00" "$3,940.00" "$3,940.00" "$3,940.00" $821.19 "$3,940.00" "$3,940.00" "$3,940.00" "$3,940.00" "$3,940.00" $821.14 "$3,940.00" "$3,940.00" "$1,942.42" "$3,940.00" "$3,940.00" "$3,940.00" "$3,940.00" "$2,955.00" "$3,940.00" "$3,940.00" "$3,940.00" "$1,970.00" "$1,970.00" "$3,120.48" "$3,940.00" "$3,152.00" "$1,773.00" $781.99 N/A "$2,285.20" "$3,940.00" "$3,940.00" "$3,940.00" $821.10 "$3,940.00" N/A N/A M0068503000 SUP HCPCS C1771 M0068503000 - SLING PUBOVAGINAL SLING SYSTEM LYNX FMALE SUPRAPUBIC BOTH IP/OP "$3,753.50" "$2,778.00" $744.89 "$3,753.08" "$1,688.89" "$1,688.89" "$1,688.89" "$1,688.89" "$3,753.08" "$3,753.08" "$3,753.08" $782.24 "$3,753.08" "$3,753.08" "$3,753.08" "$3,753.08" "$3,753.08" $782.18 "$3,753.08" "$3,753.08" "$1,850.27" "$3,753.08" "$3,753.08" "$3,753.08" "$3,753.08" "$2,815.13" "$3,753.08" "$3,753.08" "$3,753.08" "$1,876.54" "$1,876.54" "$2,972.44" "$3,753.08" "$3,002.46" "$1,688.89" $744.89 N/A "$2,177.03" "$3,753.08" "$3,753.08" "$3,753.08" $782.14 "$3,753.08" N/A N/A M0068505000 SUP HCPCS C1771 M0068505000 - SLING PUBOVAGINAL HALO SLING SYSTEM NEEDLE OBTRYX FMALE BOTH IP/OP "$3,187.50" "$2,359.00" $632.64 "$3,187.50" "$1,434.38" "$1,434.38" "$1,434.38" "$1,434.38" "$3,187.50" "$3,187.50" "$3,187.50" $664.35 "$3,187.50" "$3,187.50" "$3,187.50" "$3,187.50" "$3,187.50" $664.31 "$3,187.50" "$3,187.50" "$1,571.44" "$3,187.50" "$3,187.50" "$3,187.50" "$3,187.50" "$2,390.63" "$3,187.50" "$3,187.50" "$3,187.50" "$1,593.75" "$1,593.75" "$2,524.50" "$3,187.50" "$2,550.00" "$1,434.38" $632.64 N/A "$1,848.75" "$3,187.50" "$3,187.50" "$3,187.50" $664.28 "$3,187.50" N/A N/A M0068505110 SUP HCPCS C1771 M0068505110 - SLING PUBOVAGINAL HALO NEEDLE OBTRYX II MIDURETHRAL BOTH IP/OP "$3,500.00" "$2,590.00" $694.66 "$3,500.00" "$1,575.00" "$1,575.00" "$1,575.00" "$1,575.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.49 "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.44 "$3,500.00" "$3,500.00" "$1,725.50" "$3,500.00" "$3,500.00" "$3,500.00" "$3,500.00" "$2,625.00" "$3,500.00" "$3,500.00" "$3,500.00" "$1,750.00" "$1,750.00" "$2,772.00" "$3,500.00" "$2,800.00" "$1,575.00" $694.66 N/A "$2,030.00" "$3,500.00" "$3,500.00" "$3,500.00" $729.40 "$3,500.00" N/A N/A M0068507000 SUP HCPCS C1771 M0068507000 - SYSTEM URTH SPRT 9CM SOLYX ADV 1 INCS SLNG 1 DLV DEV 1 MESH BOTH IP/OP "$4,893.50" "$3,621.00" $971.22 "$4,893.40" "$2,202.03" "$2,202.03" "$2,202.03" "$2,202.03" "$4,893.40" "$4,893.40" "$4,893.40" "$1,019.91" "$4,893.40" "$4,893.40" "$4,893.40" "$4,893.40" "$4,893.40" "$1,019.84" "$4,893.40" "$4,893.40" "$2,412.45" "$4,893.40" "$4,893.40" "$4,893.40" "$4,893.40" "$3,670.13" "$4,893.40" "$4,893.40" "$4,893.40" "$2,446.70" "$2,446.70" "$3,875.57" "$4,893.40" "$3,914.72" "$2,202.03" $971.22 N/A "$2,838.23" "$4,893.40" "$4,893.40" "$4,893.40" "$1,019.78" "$4,893.40" N/A N/A M120101 SUP HCPCS C1751 M120101 - KIT CATH 5ML/SEC FULL 20GA 10CM POWERGLIDE MDLN PWR INJ IV BOTH IP/OP $215.00 $159.00 $42.67 $215.00 $116.75 $116.75 $116.75 $116.75 $215.00 $215.00 $215.00 $44.81 $215.00 $159.57 $159.57 $165.72 $112.02 $44.81 $215.00 $215.00 $127.17 $215.00 $215.00 $215.00 $215.00 $161.25 $215.00 $215.00 $215.00 $107.50 $107.50 $170.28 $215.00 $172.00 $139.75 $42.67 N/A $124.70 $215.00 $215.00 $215.00 $44.81 $215.00 N/A N/A M365SC550040 SUP HCPCS C1787 M365SC550040 - KIT STIMULATOR PRECISION SPECTRA SPINE CORD CASE REMOTE CONT BOTH IP/OP "$2,000.00" "$1,480.00" $416.82 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,484.40" "$1,484.40" "$1,541.60" "$1,042.00" $416.82 "$2,000.00" $800.00 "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,500.00" "$2,000.00" "$2,000.00" "$2,000.00" "$1,000.00" "$1,000.00" "$1,584.00" "$2,000.00" "$1,600.00" "$1,300.00" "$2,000.00" N/A "$1,160.00" "$2,000.00" "$1,200.00" "$2,000.00" "$2,000.00" "$2,000.00" N/A N/A M3717A SUP Custom 27203010 M3717A - PAD DFBR HRTSTRT MLFNC XTRN PLUG CONCTR PED LATEX FREE DISP BOTH IP/OP $60.50 $45.00 $10.71 $60.16 $60.16 $60.16 $60.16 $60.16 $60.16 $60.16 $10.71 $60.16 $60.16 $44.65 $44.65 $46.37 $31.34 $12.54 $60.16 $24.06 $60.16 $60.16 $60.16 $60.16 $60.16 $45.38 $60.16 $60.16 $60.16 $30.08 $30.08 $47.65 $60.16 $48.13 $39.10 $60.16 N/A $35.09 $60.16 $36.10 $60.16 $60.16 $60.16 N/A N/A M6275033/10.S SUP HCPCS A6209 M6275033/10.S - DRESSING FOAM THK1CM SMALL 10X7.5CM COMFORTABLE VERSATILE BOTH IP/OP $23.50 $17.00 $4.66 $23.48 $12.75 $12.75 $12.75 $12.75 $23.48 $23.48 $23.48 $4.89 $23.48 $17.43 $17.43 $18.10 $12.23 $4.89 $23.48 $23.48 $13.89 $23.48 $23.48 $23.48 $23.48 $17.63 $23.48 $23.48 $23.48 $11.74 $11.74 $18.60 $23.48 $18.78 $15.26 $4.66 N/A $13.63 $23.48 $23.48 $23.48 $4.89 $23.48 N/A N/A M6275034/10.S SUP HCPCS A6209 M6275034/10.S - DRESSING THK1CM WHITE FOAM LARGE 15X10CM VER HIGHER TENSILE BOTH IP/OP $30.50 $23.00 $5.96 $30.02 $16.30 $16.30 $16.30 $16.30 $30.02 $30.02 $30.02 $6.26 $30.02 $22.28 $22.28 $23.14 $15.64 $6.26 $30.02 $30.02 $17.76 $30.02 $30.02 $30.02 $30.02 $22.88 $30.02 $30.02 $30.02 $15.01 $15.01 $23.78 $30.02 $24.02 $19.51 $5.96 N/A $17.69 $30.02 $30.02 $30.02 $6.26 $30.02 N/A N/A M6275053/10.S SUP HCPCS A6209 M6275053/10.S - DRESSING FOAM THK3.3CM LARGE 18X12.5CM OPEN PORE HYDROPHOBIC BOTH IP/OP $135.50 $100.00 $26.85 $135.29 $73.46 $73.46 $73.46 $73.46 $135.29 $135.29 $135.29 $28.20 $135.29 $100.41 $100.41 $104.28 $70.49 $28.20 $135.29 $135.29 $80.02 $135.29 $135.29 $135.29 $135.29 $101.63 $135.29 $135.29 $135.29 $67.65 $67.65 $107.15 $135.29 $108.23 $87.94 $26.85 N/A $78.59 $135.29 $135.29 $135.29 $28.19 $135.29 N/A N/A M6275096/10.S SUP HCPCS A6209 M6275096/10.S - DRESSING FOAM MEDIUM 18X12.5CM OPEN PORE HYDROPHOBIC BOTH IP/OP $155.50 $115.00 $30.78 $155.06 $84.20 $84.20 $84.20 $84.20 $155.06 $155.06 $155.06 $32.32 $155.06 $115.09 $115.09 $119.52 $80.79 $32.32 $155.06 $155.06 $91.72 $155.06 $155.06 $155.06 $155.06 $116.63 $155.06 $155.06 $155.06 $77.53 $77.53 $122.81 $155.06 $124.05 $100.79 $30.78 N/A $90.19 $155.06 $155.06 $155.06 $32.31 $155.06 N/A N/A M6275098/10.S SUP HCPCS A6209 M6275098/10.S - DRESSING FOAM SMALL 10X7.5CM 1 DRAPES PAD CONCTR VAC BOTH IP/OP $124.00 $92.00 $24.57 $123.77 $67.21 $67.21 $67.21 $67.21 $123.77 $123.77 $123.77 $25.80 $123.77 $91.86 $91.86 $95.40 $64.48 $25.80 $123.77 $123.77 $73.21 $123.77 $123.77 $123.77 $123.77 $93.00 $123.77 $123.77 $123.77 $61.89 $61.89 $98.03 $123.77 $99.02 $80.45 $24.57 N/A $71.92 $123.77 $123.77 $123.77 $25.79 $123.77 N/A N/A M6275099/10.S SUP HCPCS A6209 M6275099/10.S - DRESSING FOAM LARGE 26X15CM 2 DRAPE SENSATRAC PAD CONCTR VAC BOTH IP/OP $17.50 $13.00 $3.45 $17.36 $9.43 $9.43 $9.43 $9.43 $17.36 $17.36 $17.36 $3.62 $17.36 $12.88 $12.88 $13.38 $9.04 $3.62 $17.36 $17.36 $10.27 $17.36 $17.36 $17.36 $17.36 $13.13 $17.36 $17.36 $17.36 $8.68 $8.68 $13.75 $17.36 $13.89 $11.28 $3.45 N/A $10.15 $17.36 $17.36 $17.36 $3.62 $17.36 N/A N/A M653G SUP Custom 27203010 M653G - SUTURE NABSB 5 CCS 18IN SLVR STL MFL 4 STRN SS BOTH IP/OP $42.50 $31.00 $7.50 $167.81 $42.16 $42.16 $42.16 $42.16 $42.16 $42.16 $7.50 $42.16 $42.16 $31.29 $31.29 $32.50 $21.97 $8.79 $42.16 $67.12 $42.16 $42.16 $167.81 $42.16 $42.16 $31.88 $42.16 $42.16 $42.16 $21.08 $21.08 $33.39 $42.16 $33.73 $27.40 $42.16 N/A $24.65 $42.16 $25.30 $42.16 $42.16 $42.16 N/A N/A M7001 SUP Custom 27803010 M7001 - CATHETER DRN SYS ASPT PLR BOTH IP/OP $987.50 $731.00 $175.78 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $175.78 $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $205.81 $987.50 $395.00 $987.50 $987.50 $987.50 $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $444.38 $987.50 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A M732LPBC3560DX1 SUP HCPCS C1725 M732LPBC3560DX1 - CATHETER BLNDIL .064IN 3.5MM 110CM LF 60MM LITHOPLASTY OTW BOTH IP/OP "$6,875.00" "$5,088.00" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" N/A "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A M732LPBC4060DX1 SUP HCPCS C1725 M732LPBC4060DX1 - CATHETER BLNDIL .064IN 4MM 110CM LF 60MM LITHOPLASTY OTW BLN BOTH IP/OP "$6,875.00" "$5,088.00" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" N/A "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A M732LPBC4560DX1 SUP HCPCS C1725 M732LPBC4560DX1 - CATHETER BLNDIL .064IN 4.5MM 110CM LF 60MM LITHOPLASTY OTW BOTH IP/OP "$6,875.00" "$5,088.00" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" N/A "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A M732LPBC5060DX1 SUP HCPCS C1725 M732LPBC5060DX1 - CATHETER BLNDIL .064IN 5MM 110CM LF 60MM LITHOPLASTY OTW BLN BOTH IP/OP "$6,875.00" "$5,088.00" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" N/A "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A M732LPBC5560DX1 SUP HCPCS C1725 M732LPBC5560DX1 - CATHETER BLNDIL .064IN 5.5MM 110CM LF 60MM LITHOPLASTY OTW BOTH IP/OP "$6,875.00" "$5,088.00" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" N/A "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A M732LPBC6060DX1 SUP HCPCS C1725 M732LPBC6060DX1 - CATHETER BLNDIL .064IN 6MM 110CM LF 60MM LITHOPLASTY OTW BLN BOTH IP/OP "$6,875.00" "$5,088.00" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" N/A "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A M732LPBC6560DX1 SUP HCPCS C1725 M732LPBC6560DX1 - CATHETER BLNDIL .064IN 6.5MM 110CM LF 60MM LITHOPLASTY OTW BOTH IP/OP "$6,875.00" "$5,088.00" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" N/A "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A M732LPBC7060DX1 SUP HCPCS C1725 M732LPBC7060DX1 - CATHETER BLNDIL .064IN 7MM 110CM LF 60MM LITHOPLASTY OTW BLN BOTH IP/OP "$6,875.00" "$5,088.00" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" N/A "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A M8275026/5 SUP Custom 27203010 M8275026/5 - DRESSING ABTHERA SNSA TRC FOAM OPN ABD NEG PRSS BOTH IP/OP "$1,196.00" $885.00 $212.89 "$1,196.00" "$1,196.00" "$1,196.00" "$1,196.00" "$1,196.00" "$1,196.00" "$1,196.00" $212.89 "$1,196.00" "$1,196.00" $887.67 $887.67 $921.88 $623.12 $249.26 "$1,196.00" $478.40 "$1,196.00" "$1,196.00" "$1,196.00" "$1,196.00" "$1,196.00" $897.00 "$1,196.00" "$1,196.00" "$1,196.00" $598.00 $598.00 $947.23 "$1,196.00" $956.80 $777.40 "$1,196.00" N/A $693.68 "$1,196.00" $717.60 "$1,196.00" "$1,196.00" "$1,196.00" N/A N/A M8275041/5.S SUP HCPCS A6209 M8275041/5.S - KIT DRESSING THK1.75CM MEDIUM 7.5X11.5CM DRAPE PAD CONCTR BOTH IP/OP $94.00 $70.00 $18.57 $93.58 $50.81 $50.81 $50.81 $50.81 $93.58 $93.58 $93.58 $19.50 $93.58 $69.46 $69.46 $72.13 $48.76 $19.50 $93.58 $93.58 $55.35 $93.58 $93.58 $93.58 $93.58 $70.50 $93.58 $93.58 $93.58 $46.79 $46.79 $74.12 $93.58 $74.86 $60.83 $18.57 N/A $54.52 $93.58 $93.58 $93.58 $19.50 $93.58 N/A N/A M8275051/10 SUP HCPCS A6209 M8275051/10 - KIT DRESSING THK3.3CM SMALL STANDARD 10X7.5CM 1 ADHESIVE BOTH IP/OP $81.00 $60.00 $16.01 $80.69 $43.81 $43.81 $43.81 $43.81 $80.69 $80.69 $80.69 $16.82 $80.69 $59.89 $59.89 $62.20 $42.04 $16.82 $80.69 $80.69 $47.73 $80.69 $80.69 $80.69 $80.69 $60.75 $80.69 $80.69 $80.69 $40.35 $40.35 $63.91 $80.69 $64.55 $52.45 $16.01 N/A $46.98 $80.69 $80.69 $80.69 $16.82 $80.69 N/A N/A M8275052/10.S SUP HCPCS A6209 M8275052/10.S - KIT DRESSING THK3.3CM MEDIUM STANDARD 18X12.5CM 2 ADHESIVE BOTH IP/OP $100.00 $74.00 $19.79 $99.71 $54.14 $54.14 $54.14 $54.14 $99.71 $99.71 $99.71 $20.78 $99.71 $74.00 $74.00 $76.86 $51.95 $20.78 $99.71 $99.71 $58.98 $99.71 $99.71 $99.71 $99.71 $75.00 $99.71 $99.71 $99.71 $49.86 $49.86 $78.97 $99.71 $79.77 $64.81 $19.79 N/A $58.00 $99.71 $99.71 $99.71 $20.78 $99.71 N/A N/A M8275053/10.S SUP HCPCS A6209 M8275053/10.S - KIT DRESSING THK3.3CM LARGE STANDARD 26X15CM 2 ADHESIVE BOTH IP/OP $123.00 $91.00 $24.37 $122.79 $66.67 $66.67 $66.67 $66.67 $122.79 $122.79 $122.79 $25.59 $122.79 $91.13 $91.13 $94.65 $63.97 $25.59 $122.79 $122.79 $72.63 $122.79 $122.79 $122.79 $122.79 $92.25 $122.79 $122.79 $122.79 $61.40 $61.40 $97.25 $122.79 $98.23 $79.81 $24.37 N/A $71.34 $122.79 $122.79 $122.79 $25.59 $122.79 N/A N/A M8275057 SUP Custom 27203010 CANISTER WND DRAIN PAD TBG CLMP CONNCTR SENSATRAC STRL LF BOTH IP/OP $48.50 $36.00 $8.55 $48.03 $48.03 $48.03 $48.03 $48.03 $48.03 $48.03 $8.55 $48.03 $48.03 $35.65 $35.65 $37.02 $25.02 $10.01 $48.03 $19.21 $48.03 $48.03 $48.03 $48.03 $48.03 $36.38 $48.03 $48.03 $48.03 $24.02 $24.02 $38.04 $48.03 $38.42 $31.22 $48.03 N/A $28.13 $48.03 $28.82 $48.03 $48.03 $48.03 N/A N/A M8275057/10.S SUP Custom 27203010 M8275057/10.S - PAD WOUND DRAIN TUBE CLMP CONCTR SENSATRAC VAC STERILE BOTH IP/OP $43.00 $32.00 $7.58 $42.59 $42.59 $42.59 $42.59 $42.59 $42.59 $42.59 $7.58 $42.59 $42.59 $31.61 $31.61 $32.83 $22.19 $8.88 $42.59 $17.04 $42.59 $42.59 $42.59 $42.59 $42.59 $32.25 $42.59 $42.59 $42.59 $21.30 $21.30 $33.73 $42.59 $34.07 $27.68 $42.59 N/A $24.94 $42.59 $25.55 $42.59 $42.59 $42.59 N/A N/A M8275063/10.S SUP Custom 27203010 M8275063/10.S - CANISTER WOUND DRAIN C500ML GEL TUBE CLMP CONCTR CHARCOAL BOTH IP/OP $83.00 $61.00 $14.72 $82.68 $82.68 $82.68 $82.68 $82.68 $82.68 $82.68 $14.72 $82.68 $82.68 $61.37 $61.37 $63.73 $43.08 $17.23 $82.68 $33.07 $82.68 $82.68 $82.68 $82.68 $82.68 $62.25 $82.68 $82.68 $82.68 $41.34 $41.34 $65.48 $82.68 $66.14 $53.74 $82.68 N/A $48.14 $82.68 $49.61 $82.68 $82.68 $82.68 N/A N/A M8275065/5 SUP HCPCS A6209 M8275065/5 - KIT DRESSING THK1.5CM XL STANDARD 60X30CM 5 DRAPE 1 PAD BOTH IP/OP $254.00 $188.00 $50.37 $253.80 $137.81 $137.81 $137.81 $137.81 $253.80 $253.80 $253.80 $52.90 $253.80 $188.37 $188.37 $195.63 $132.23 $52.89 $253.80 $253.80 $150.12 $253.80 $253.80 $253.80 $253.80 $190.50 $253.80 $253.80 $253.80 $126.90 $126.90 $201.01 $253.80 $203.04 $164.97 $50.37 N/A $147.32 $253.80 $253.80 $253.80 $52.89 $253.80 N/A N/A M8275096/10 SUP HCPCS A6209 M8275096/10 - KIT DRESSING THK3.2CM MEDIUM 18X12.5CM 2 ADHESIVE DRAPE 1 BOTH IP/OP $141.00 $104.00 $27.93 $140.73 $76.42 $76.42 $76.42 $76.42 $140.73 $140.73 $140.73 $29.33 $140.73 $104.45 $104.45 $108.47 $73.32 $29.33 $140.73 $140.73 $83.24 $140.73 $140.73 $140.73 $140.73 $105.75 $140.73 $140.73 $140.73 $70.37 $70.37 $111.46 $140.73 $112.58 $91.47 $27.93 N/A $81.78 $140.73 $140.73 $140.73 $29.33 $140.73 N/A N/A M8275096/5.S SUP Custom 27203010 M8275096/5.S - DRSG THK3.3CM MED 18X12.5CM SENSATRAC PAD DRP FLXB CNTOUR BOTH IP/OP $173.00 $128.00 $30.75 $172.74 $172.74 $172.74 $172.74 $172.74 $172.74 $172.74 $30.75 $172.74 $172.74 $128.21 $128.21 $133.15 $90.00 $36.00 $172.74 $69.10 $172.74 $172.74 $172.74 $172.74 $172.74 $129.75 $172.74 $172.74 $172.74 $86.37 $86.37 $136.81 $172.74 $138.19 $112.28 $172.74 N/A $100.34 $172.74 $103.64 $172.74 $172.74 $172.74 N/A N/A M8275098/10 SUP HCPCS A6209 M8275098/10 - DRESSING FOAM THK3.3CM SMALL 10X7.5CM SENSATRAC PAD DRAPE BOTH IP/OP $112.50 $83.00 $22.29 $112.33 $61.00 $61.00 $61.00 $61.00 $112.33 $112.33 $112.33 $23.41 $112.33 $83.37 $83.37 $86.58 $58.52 $23.41 $112.33 $112.33 $66.44 $112.33 $112.33 $112.33 $112.33 $84.38 $112.33 $112.33 $112.33 $56.17 $56.17 $88.97 $112.33 $89.86 $73.01 $22.29 N/A $65.25 $112.33 $112.33 $112.33 $23.41 $112.33 N/A N/A M8275099/10 SUP HCPCS A6209 M8275099/10 - DRESSING FOAM THK3.3CM LARGE 26X15CM ADHESIVE DRAPE BOTH IP/OP $170.50 $126.00 $33.82 $170.41 $92.53 $92.53 $92.53 $92.53 $170.41 $170.41 $170.41 $35.52 $170.41 $126.48 $126.48 $131.35 $88.78 $35.52 $170.41 $170.41 $100.80 $170.41 $170.41 $170.41 $170.41 $127.88 $170.41 $170.41 $170.41 $85.21 $85.21 $134.96 $170.41 $136.33 $110.77 $33.82 N/A $98.89 $170.41 $170.41 $170.41 $35.51 $170.41 N/A N/A M8275099/5.S SUP Custom 27203010 M8275099/5.S - DRSG THK3.3CM LG 26X15CM DRP SENSATRAC PAD PU VAC GFM SLVR BOTH IP/OP $206.50 $153.00 $36.68 $206.04 $206.04 $206.04 $206.04 $206.04 $206.04 $206.04 $36.68 $206.04 $206.04 $152.92 $152.92 $158.82 $107.35 $42.94 $206.04 $82.42 $206.04 $206.04 $206.04 $206.04 $206.04 $154.88 $206.04 $206.04 $206.04 $103.02 $103.02 $163.18 $206.04 $164.83 $133.93 $206.04 N/A $119.77 $206.04 $123.62 $206.04 $206.04 $206.04 N/A N/A MA30AC SUP HCPCS V2632 MA30AC - LENS IOL 5 D +1 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.100 SUP HCPCS V2632 MA30AC.100 - LENS IOL 5 D +10 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.105 SUP HCPCS V2632 MA30AC.105 - LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.110 SUP HCPCS V2632 MA30AC.110 - LENS IOL 5 D +11 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.115 SUP HCPCS V2632 MA30AC.115 - LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.120 SUP HCPCS V2632 MA30AC.120 - LENS IOL 5 D +12 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.125 SUP HCPCS V2632 MA30AC.125 - LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.130 SUP HCPCS V2632 MA30AC.130 - LENS IOL 5 D +13 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.135 SUP HCPCS V2632 MA30AC.135 - LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.140 SUP HCPCS V2632 MA30AC.140 - LENS IOL 5 D +14 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.145 SUP HCPCS V2632 MA30AC.145 - LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.150 SUP HCPCS V2632 MA30AC.150 - LENS IOL 5 D +15 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.155 SUP HCPCS V2632 MA30AC.155 - LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.160 SUP HCPCS V2632 MA30AC.160 - LENS IOL 5 D +16 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.165 SUP HCPCS V2632 MA30AC.165 - LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.170 SUP HCPCS V2632 MA30AC.170 - LENS IOL 5 D +17 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.175 SUP HCPCS V2632 MA30AC.175 - LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.180 SUP HCPCS V2632 MA30AC.180 - LENS IOL 5 D +18 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.185 SUP HCPCS V2632 MA30AC.185 - LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.190 SUP HCPCS V2632 MA30AC.190 - LENS IOL 5 D +19 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.195 SUP HCPCS V2632 MA30AC.195 - LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.200 SUP HCPCS V2632 MA30AC.200 - LENS IOL 5 D +20 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.205 SUP HCPCS V2632 MA30AC.205 - LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.210 SUP HCPCS V2632 MA30AC.210 - LENS IOL 5 D +21 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.215 SUP HCPCS V2632 MA30AC.215 - LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.220 SUP HCPCS V2632 MA30AC.220 - LENS IOL 5 D +22 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.225 SUP HCPCS V2632 MA30AC.225 - LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.230 SUP HCPCS V2632 MA30AC.230 - LENS IOL 5 D +23 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.235 SUP HCPCS V2632 MA30AC.235 - LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.240 SUP HCPCS V2632 MA30AC.240 - LENS IOL 5 D +24 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.245 SUP HCPCS V2632 MA30AC.245 - LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.250 SUP HCPCS V2632 MA30AC.250 - LENS IOL 5 D +25 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.255 SUP HCPCS V2632 MA30AC.255 - LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.260 SUP HCPCS V2632 MA30AC.260 - LENS IOL 5 D +26 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.265 SUP HCPCS V2632 MA30AC.265 - LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.270 SUP HCPCS V2632 MA30AC.270 - LENS IOL 5 D +27 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.275 SUP HCPCS V2632 MA30AC.275 - LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.280 SUP HCPCS V2632 MA30AC.280 - LENS IOL 5 D +28 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.285 SUP HCPCS V2632 MA30AC.285 - LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.290 SUP HCPCS V2632 MA30AC.290 - LENS IOL 5 D +29 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.295 SUP HCPCS V2632 MA30AC.295 - LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA30AC.300 SUP HCPCS V2632 MA30AC.300 - LENS IOL 5 D +30 DIOP MOD C BCNVX 5.5MM 12.5MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM SUP HCPCS V2632 MA50BM - LENS IOL 10 D +19.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.060 SUP HCPCS V2632 MA50BM.060 - LENS IOL 10 D +6 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.065 SUP HCPCS V2632 MA50BM.065 - LENS IOL 10 D +6.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.070 SUP HCPCS V2632 MA50BM.070 - LENS IOL 10 D +7 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.075 SUP HCPCS V2632 MA50BM.075 - LENS IOL 10 D +7.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.080 SUP HCPCS V2632 MA50BM.080 - LENS IOL 10 D +8 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.085 SUP HCPCS V2632 MA50BM.085 - LENS IOL 10 D +8.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.090 SUP HCPCS V2632 MA50BM.090 - LENS IOL 10 D +9 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.095 SUP HCPCS V2632 MA50BM.095 - LENS IOL 10 D +9.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.100 SUP HCPCS V2632 MA50BM.100 - LENS IOL 10 D +10 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.105 SUP HCPCS V2632 MA50BM.105 - LENS IOL 10 D +10.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.110 SUP HCPCS V2632 MA50BM.110 - LENS IOL 10 D +11 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.115 SUP HCPCS V2632 MA50BM.115 - LENS IOL 10 D +11.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.120 SUP HCPCS V2632 MA50BM.120 - LENS IOL 10 D +12 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.125 SUP HCPCS V2632 MA50BM.125 - LENS IOL 10 D +12.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.130 SUP HCPCS V2632 MA50BM.130 - LENS IOL 10 D +13 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.135 SUP HCPCS V2632 MA50BM.135 - LENS IOL 10 D +13.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.140 SUP HCPCS V2632 MA50BM.140 - LENS IOL 10 D +14 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.145 SUP HCPCS V2632 MA50BM.145 - LENS IOL 10 D +14.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.150 SUP HCPCS V2632 MA50BM.150 - LENS IOL 10 D +15 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.155 SUP HCPCS V2632 MA50BM.155 - LENS IOL 10 D +15.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.160 SUP HCPCS V2632 MA50BM.160 - LENS IOL 10 D +16 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.165 SUP HCPCS V2632 MA50BM.165 - LENS IOL 10 D +16.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.170 SUP HCPCS V2632 MA50BM.170 - LENS IOL 10 D +17 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.175 SUP HCPCS V2632 MA50BM.175 - LENS IOL 10 D +17.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.180 SUP HCPCS V2632 MA50BM.180 - LENS IOL 10 D +18 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.185 SUP HCPCS V2632 MA50BM.185 - LENS IOL 10 D +18.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.190 SUP HCPCS V2632 MA50BM.190 - LENS IOL 10 D +19 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.195 SUP HCPCS V2632 MA50BM.195 - LENS IOL 10 D +19.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.200 SUP HCPCS V2632 MA50BM.200 - LENS IOL 10 D +20 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.205 SUP HCPCS V2632 MA50BM.205 - LENS IOL 10 D +20.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.210 SUP HCPCS V2632 MA50BM.210 - LENS IOL 10 D +21 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.215 SUP HCPCS V2632 MA50BM.215 - LENS IOL 10 D +21.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.220 SUP HCPCS V2632 MA50BM.220 - LENS IOL 10 D +22 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.225 SUP HCPCS V2632 MA50BM.225 - LENS IOL 10 D +22.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.230 SUP HCPCS V2632 MA50BM.230 - LENS IOL 10 D +23 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.235 SUP HCPCS V2632 MA50BM.235 - LENS IOL 10 D +23.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.240 SUP HCPCS V2632 MA50BM.240 - LENS IOL 10 D +24 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.245 SUP HCPCS V2632 MA50BM.245 - LENS IOL 10 D +24.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.250 SUP HCPCS V2632 MA50BM.250 - LENS IOL 10 D +25 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.255 SUP HCPCS V2632 MA50BM.255 - LENS IOL 10 D +25.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.260 SUP HCPCS V2632 MA50BM.260 - LENS IOL 10 D +26 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.265 SUP HCPCS V2632 MA50BM.265 - LENS IOL 10 D +26.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.270 SUP HCPCS V2632 MA50BM.270 - LENS IOL 10 D +27 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.275 SUP HCPCS V2632 MA50BM.275 - LENS IOL 10 D +27.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.280 SUP HCPCS V2632 MA50BM.280 - LENS IOL 10 D +28 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.285 SUP HCPCS V2632 MA50BM.285 - LENS IOL 10 D +28.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.290 SUP HCPCS V2632 MA50BM.290 - LENS IOL 10 D +29 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.295 SUP HCPCS V2632 MA50BM.295 - LENS IOL 10 D +29.5 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA50BM.300 SUP HCPCS V2632 MA50BM.300 - LENS IOL 10 D +30 DIOP MOD C BCNVX 6.5MM 13MM BLU STRL ACRSF BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA60AC.060 SUP HCPCS V2630 MA60AC.060 - LENS IOL 10 D +6 DIOPTER BICNVX 6MM 13MM MULTIPIECE FOLDABLE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.065 SUP HCPCS V2632 MA60AC.065 - LENS IOL 10 D +6.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA60AC.070 SUP HCPCS V2632 MA60AC.070 - LENS IOL 10 D +7 DIOPTER BICNVX 6MM 13MM MULTIPIECE FOLDABLE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.075 SUP HCPCS V2632 MA60AC.075 - LENS IOL 10 D +7.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA60AC.080 SUP HCPCS V2632 MA60AC.080 - LENS IOL 10 D +8 DIOPTER BICNVX 6MM 13MM MULTIPIECE FOLDABLE BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA60AC.085 SUP HCPCS V2632 MA60AC.085 - LENS IOL 10 D +8.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.090 SUP HCPCS V2632 MA60AC.090 - LENS IOL 10 D +9 DIOPTER BICNVX 6MM 13MM MULTIPIECE FOLDABLE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.095 SUP HCPCS V2632 MA60AC.095 - LENS IOL 10 D +9.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.100 SUP HCPCS V2632 MA60AC.100 - LENS IOL 10 D +10 DIOPTER BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA60AC.105 SUP HCPCS V2632 MA60AC.105 - LENS IOL +10.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.110 SUP HCPCS V2632 MA60AC.110 - LENS IOL 10 D +11 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.115 SUP HCPCS V2632 MA60AC.115 - LENS IOL +11.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.120 SUP HCPCS V2632 MA60AC.120 - LENS IOL 10 D +12 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA60AC.125 SUP HCPCS V2632 MA60AC.125 - LENS IOL +12.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.130 SUP HCPCS V2632 MA60AC.130 - LENS IOL 10 D +13 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.135 SUP HCPCS V2632 MA60AC.135 - LENS IOL +13.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.140 SUP HCPCS V2630 MA60AC.140 - LENS IOL 10 D +14 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.145 SUP HCPCS V2632 MA60AC.145 - LENS IOL +14.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.150 SUP HCPCS V2630 MA60AC.150 - LENS IOL 10 D +15 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.155 SUP HCPCS V2630 MA60AC.155 - LENS IOL +15.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.160 SUP HCPCS V2632 MA60AC.160 - LENS IOL 10 D +16 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.165 SUP HCPCS V2632 MA60AC.165 - LENS IOL +16.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.170 SUP HCPCS V2632 MA60AC.170 - LENS IOL 10 D +17 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.175 SUP HCPCS V2632 MA60AC.175 - LENS IOL +17.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.180 SUP HCPCS V2630 MA60AC.180 - LENS IOL 10 D +18 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.185 SUP HCPCS V2630 MA60AC.185 - LENS IOL +18.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.190 SUP HCPCS V2630 MA60AC.190 - LENS IOL 10 D +19 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.195 SUP HCPCS V2630 MA60AC.195 - LENS IOL +19.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.200 SUP HCPCS V2630 MA60AC.200 - LENS IOL 10 D +20 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.205 SUP HCPCS V2630 MA60AC.205 - LENS IOL +20.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.210 SUP HCPCS V2630 MA60AC.210 - LENS IOL 10 D +21 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.215 SUP HCPCS V2630 MA60AC.215 - LENS IOL +21.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.220 SUP HCPCS V2630 MA60AC.220 - LENS IOL 10 D +22 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.225 SUP HCPCS V2630 MA60AC.225 - LENS IOL +22.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.230 SUP HCPCS V2632 MA60AC.230 - LENS IOL 10 D +23 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.235 SUP HCPCS V2632 MA60AC.235 - LENS IOL +23.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.240 SUP HCPCS V2630 MA60AC.240 - LENS IOL 10 D +24 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.245 SUP HCPCS V2632 MA60AC.245 - LENS IOL 10 D +24.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.250 SUP HCPCS V2632 MA60AC.250 - LENS IOL 10 D +25 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.255 SUP HCPCS V2632 MA60AC.255 - LENS IOL 10 D +25.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA60AC.260 SUP HCPCS V2632 MA60AC.260 - LENS IOL 10 D +26 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA60AC.265 SUP HCPCS V2632 MA60AC.265 - LENS IOL 10 D +26.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.270 SUP HCPCS V2632 MA60AC.270 - LENS IOL 10 D +27 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA60AC.275 SUP HCPCS V2632 MA60AC.275 - LENS IOL +27.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.280 SUP HCPCS V2632 MA60AC.280 - LENS IOL +28 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA60AC.285 SUP HCPCS V2632 MA60AC.285 - LENS IOL +28.5 DIOPTER 10 D BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA60AC.290 SUP HCPCS V2632 MA60AC.290 - LENS IOL 10 D +29 DIOPTER BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.295 SUP HCPCS V2632 MA60AC.295 - LENS IOL 10 D +29.5 DIOPTER BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60AC.300 SUP HCPCS V2632 MA60AC.300 - LENS IOL 10 D +30 DIOPTER BICNVX 6MM 13MM MULTIPIECE BOTH IP/OP $372.50 $276.00 $73.93 $372.50 $167.63 $167.63 $167.63 $167.63 $372.50 $372.50 $372.50 $77.64 $372.50 $372.50 $372.50 $372.50 $372.50 $77.63 $372.50 $372.50 $220.33 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $167.63 $73.93 N/A $216.05 $372.50 $372.50 $372.50 $77.63 $372.50 N/A N/A MA60MA.000 SUP HCPCS V2632 MA60MA.000 - LENS IOL 5 D +0 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA60MA.010 SUP HCPCS V2632 MA60MA.010 - LENS IOL 5 D +1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA60MA.030 SUP HCPCS V2632 MA60MA.030 - LENS IOL 5 D +3 DIOPTER MENISCUS 6MM 13MM MULTIPIECE BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA60MAN010 SUP HCPCS V2632 MA60MAN010 - LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA60MAN020 SUP HCPCS V2632 MA60MAN020 - LENS IOL 5 D -2 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA60MAN030 SUP HCPCS V2632 MA60MAN030 - LENS IOL 5 D -3 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A MA60MAN040 SUP HCPCS V2632 MA60MAN040 - LENS IOL 5 D -4 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $89.84 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MA60MAN050 SUP HCPCS V2632 MA60MAN050 - LENS IOL 5 D -5 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF XPD BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A MAJ-209 SUP Custom 27203010 MAJ-209 - VALVE SUCTION FLEXIBLE ATTCH VISERA STERILE DISPOSABLE BOTH IP/OP $30.00 $22.00 $5.30 $29.75 $29.75 $29.75 $29.75 $29.75 $29.75 $29.75 $5.30 $29.75 $29.75 $22.08 $22.08 $22.93 $15.50 $6.20 $29.75 $11.90 $29.75 $29.75 $29.75 $29.75 $29.75 $22.50 $29.75 $29.75 $29.75 $14.88 $14.88 $23.56 $29.75 $23.80 $19.34 $29.75 N/A $17.40 $29.75 $17.85 $29.75 $29.75 $29.75 N/A N/A MAJ-210 SUP Custom 27203010 VALVE BIOP BSCP NOMENCLATURE DISP BOTH IP/OP $167.00 $124.00 $29.70 $166.85 $166.85 $166.85 $166.85 $166.85 $166.85 $166.85 $29.70 $166.85 $166.85 $123.84 $123.84 $128.61 $86.93 $34.77 $166.85 $66.74 $166.85 $166.85 $166.85 $166.85 $166.85 $125.25 $166.85 $166.85 $166.85 $83.43 $83.43 $132.15 $166.85 $133.48 $108.45 $166.85 N/A $96.86 $166.85 $100.11 $166.85 $166.85 $166.85 N/A N/A MAL-0002 SUP Custom 27803010 MAL-0002 - EXPANDER OPHTHALMIC 7MM SAVES CONSIDERABLE TIME DISPOSABLE BOTH IP/OP "$1,937.50" "$1,434.00" $344.88 "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" $344.88 "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" $403.80 "$1,937.50" $775.00 "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,937.50" "$1,453.13" "$1,937.50" "$1,937.50" "$1,937.50" $968.75 $968.75 "$1,534.50" "$1,937.50" "$1,550.00" $871.88 "$1,937.50" N/A "$1,123.75" "$1,937.50" "$1,162.50" "$1,937.50" "$1,937.50" "$1,937.50" N/A N/A MAP111 SUP HCPCS C1725 MAP111 - VALVE HEMOSTASIS 9FR MAP INSERTION TOOL ACCES-9 METAL BOTH IP/OP $33.50 $25.00 $6.60 $33.25 $18.05 $18.05 $18.05 $18.05 $33.25 $33.25 $33.25 $6.93 $33.25 $24.68 $24.68 $25.63 $17.32 $6.93 $33.25 $33.25 $19.67 $33.25 $33.25 $33.25 $33.25 $25.13 $33.25 $33.25 $33.25 $16.63 $16.63 $26.33 $33.25 $26.60 $21.61 $6.60 N/A $19.43 $33.25 $33.25 $33.25 $6.93 $33.25 N/A N/A MAP500 SUP HCPCS C1769 MAP500 - DEVICE TORQUE LATEX FREE PIN VISE SALMON PTFE HYDPHI ACCEPTS BOTH IP/OP $0.50 $0.00 $0.09 $0.44 $0.24 $0.24 $0.24 $0.24 $0.44 $0.44 $0.44 $0.09 $0.44 $0.33 $0.33 $0.34 $0.23 $0.09 $0.44 $0.44 $0.26 $0.44 $0.44 $0.44 $0.44 $0.38 $0.44 $0.44 $0.44 $0.22 $0.22 $0.35 $0.44 $0.35 $0.29 $0.09 N/A $0.29 $0.44 $0.44 $0.44 $0.09 $0.44 N/A N/A MAXIICRTDMMAM SUP HCPCS C1882 MAXIICRTDMMAM - DEFIBRILLATOR CARDIAC DEVICE RESYNCHRONIZATION THERAPY BOTH IP/OP "$60,500.00" "$44,770.00" "$7,712.84" "$60,500.00" "$27,225.00" "$27,225.00" "$27,225.00" "$27,225.00" "$60,500.00" "$60,500.00" "$60,500.00" "$9,417.94" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$12,608.87" "$60,500.00" "$60,500.00" "$29,826.50" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$45,375.00" "$60,500.00" "$60,500.00" "$60,500.00" "$30,250.00" "$30,250.00" "$47,916.00" "$60,500.00" "$48,400.00" "$27,225.00" "$7,712.84" N/A "$35,090.00" "$60,500.00" "$60,500.00" "$60,500.00" "$8,098.48" "$60,500.00" N/A N/A MAXIIDRMMEM SUP HCPCS C1882 MAXIIDRMMEM - DEFIBRILLATOR CARDIAC SYSTEM MAXIMO II VR ICD BOTH IP/OP "$49,812.50" "$36,861.00" "$7,712.84" "$49,812.50" "$22,415.63" "$22,415.63" "$22,415.63" "$22,415.63" "$49,812.50" "$49,812.50" "$49,812.50" "$9,417.94" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$10,381.47" "$49,812.50" "$49,812.50" "$24,557.56" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$37,359.38" "$49,812.50" "$49,812.50" "$49,812.50" "$24,906.25" "$24,906.25" "$39,451.50" "$49,812.50" "$39,850.00" "$22,415.63" "$7,712.84" N/A "$28,891.25" "$49,812.50" "$49,812.50" "$49,812.50" "$8,098.48" "$49,812.50" N/A N/A MAXIIVREMEM SUP HCPCS C1882 MAXIIVREMEM - DEFIBRILLATOR CARDIAC SYSTEM MAXIMO II VR ICD BOTH IP/OP "$43,750.00" "$32,375.00" "$7,712.84" "$43,750.00" "$19,687.50" "$19,687.50" "$19,687.50" "$19,687.50" "$43,750.00" "$43,750.00" "$43,750.00" "$9,118.59" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$9,117.98" "$43,750.00" "$43,750.00" "$21,568.75" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$32,812.50" "$43,750.00" "$43,750.00" "$43,750.00" "$21,875.00" "$21,875.00" "$34,650.00" "$43,750.00" "$35,000.00" "$19,687.50" "$7,712.84" N/A "$25,375.00" "$43,750.00" "$43,750.00" "$43,750.00" "$8,098.48" "$43,750.00" N/A N/A MAXX-1915 SUP HCPCS C1874 MAXX-1915 - STENT ESPH 19MM 24FR 150MM 90CM ENDOMAXX OTW FLLY COVERED BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$7,000.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$7,000.00" "$2,834.75" "$5,750.00" "$7,000.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A MAXX-197 SUP HCPCS C1874 MAXX-197 - STENT ESPH 19MM 24MM 70MM ENDOMAXX FLLY COVERED BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$7,000.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$7,000.00" "$2,834.75" "$5,750.00" "$7,000.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A MAXX-2310 SUP HCPCS C1874 MAXX-2310 - STENT ESOPHAGEAL 23MM 24FR 90CM 100CM FULLY COVERED OTW LP BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$7,000.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$7,000.00" "$2,834.75" "$5,750.00" "$7,000.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A MAXX-237 SUP HCPCS C1874 MAXX-237 - STENT ESPH 28MM 23MM 24FR 70MM 90CM ENDOMAXX OTW FLLY CVR BOTH IP/OP "$5,750.00" "$4,255.00" "$1,141.23" "$7,000.00" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.44" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.36" "$5,750.00" "$7,000.00" "$2,834.75" "$5,750.00" "$7,000.00" "$5,750.00" "$5,750.00" "$4,312.50" "$5,750.00" "$5,750.00" "$5,750.00" "$2,875.00" "$2,875.00" "$4,554.00" "$5,750.00" "$4,600.00" "$2,587.50" "$1,141.23" N/A "$3,335.00" "$5,750.00" "$5,750.00" "$5,750.00" "$1,198.30" "$5,750.00" N/A N/A MB3555 SUP HCPCS C1713 MB3555 - DISC INTVRTB 15MM 15X5MM STRL MOBI-C FLT SPHRCL PLT MBL INS BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$8,250.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A MB3556 SUP HCPCS C1713 MB3556 - DISC INTVRTB 15MM 15X6MM STRL MOBI-C FLT SPHRCL PLT MBL INS BOTH IP/OP "$13,750.00" "$10,175.00" "$2,729.03" "$13,750.00" "$6,187.50" "$6,187.50" "$6,187.50" "$6,187.50" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.84" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.65" "$13,750.00" "$5,500.00" "$6,778.75" "$13,750.00" "$13,750.00" "$13,750.00" "$13,750.00" "$10,312.50" "$13,750.00" "$13,750.00" "$13,750.00" "$6,875.00" "$6,875.00" "$10,890.00" "$13,750.00" "$11,000.00" "$6,187.50" "$2,729.03" N/A "$7,975.00" "$13,750.00" "$13,750.00" "$13,750.00" "$2,865.50" "$13,750.00" N/A N/A MB3575 SUP HCPCS C1713 MB3575 - DISC INTVRTB 15MM 17X5MM STRL MOBI-C FLT SPHRCL PLT MBL INS BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A MB3595 SUP HCPCS C1713 MB3595 - DISC INTVRTB 15MM 19X5MM STRL MOBI-C FLT SPHRCL PLT MBL INS BOTH IP/OP "$11,250.00" "$8,325.00" "$2,232.84" "$11,250.00" "$5,062.50" "$5,062.50" "$5,062.50" "$5,062.50" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.78" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$2,344.62" "$11,250.00" "$4,500.00" "$5,546.25" "$11,250.00" "$11,250.00" "$11,250.00" "$11,250.00" "$8,437.50" "$11,250.00" "$11,250.00" "$11,250.00" "$5,625.00" "$5,625.00" "$8,910.00" "$11,250.00" "$9,000.00" "$5,062.50" "$2,232.84" N/A "$6,525.00" "$11,250.00" "$6,750.00" "$11,250.00" "$2,344.50" "$11,250.00" N/A N/A MB46G SUP Custom 27203010 MB46G - SUTURE NONABSORBABLE 5 V-40 30IN 4 STRAND BRAID ETHIBOND BOTH IP/OP $45.50 $34.00 $8.07 $46.67 $45.35 $45.35 $45.35 $45.35 $45.35 $45.35 $8.07 $45.35 $45.35 $33.66 $33.66 $34.96 $23.63 $9.45 $45.35 $18.67 $45.35 $45.35 $46.67 $45.35 $45.35 $34.13 $45.35 $45.35 $45.35 $22.68 $22.68 $35.92 $45.35 $36.28 $29.48 $45.35 N/A $26.39 $45.35 $27.21 $45.35 $45.35 $45.35 N/A N/A MC011502 SUP HCPCS C1751 MC011502 - SET CATHETER 15.5FR 20CM 3 LUMEN BASIC GWIRE DILAT SCALPEL BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A MC011503 SUP HCPCS C1751 MC011503 - SET CATH 15.5FR 24CM 3 LUM BSC GW DIL HMDIAL BOTH IP/OP $287.50 $213.00 $57.06 $287.50 $129.38 $129.38 $129.38 $129.38 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $287.50 $287.50 $287.50 $59.92 $287.50 $287.50 $170.06 $287.50 $287.50 $287.50 $287.50 $215.63 $287.50 $287.50 $287.50 $143.75 $143.75 $227.70 $287.50 $230.00 $129.38 $57.06 N/A $166.75 $287.50 $287.50 $287.50 $59.92 $287.50 N/A N/A MC011505 SUP HCPCS C1750 MC011505 - SET CATH 15.5FR 32CM 3 LUM BSC GW DIL SCPL HMDIAL BOTH IP/OP $475.00 $352.00 $275.50 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" "$1,437.50" $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $356.25 "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $275.50 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A MC011505 SUP HCPCS C1750 MC011505 - SET CATH 15.5FR 32CM 3 LUM BSC GW DIL SCPL HMDIAL BOTH IP/OP "$1,437.50" "$1,064.00" $285.31 "$1,437.50" $646.88 $646.88 $646.88 $646.88 "$1,437.50" "$1,437.50" "$1,437.50" $299.61 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" $299.59 "$1,437.50" "$1,437.50" $850.28 "$1,437.50" "$1,437.50" "$1,437.50" "$1,437.50" "$1,078.13" "$1,437.50" "$1,437.50" "$1,437.50" $718.75 $718.75 "$1,138.50" "$1,437.50" "$1,150.00" $646.88 $285.31 N/A $833.75 "$1,437.50" "$1,437.50" "$1,437.50" $299.58 "$1,437.50" N/A N/A MC061402 SUP HCPCS C1752 MC061402 - SET CATH 14FR 15CM SLX 2 LUM BSC INTRO NDL GW DIL BOTH IP/OP $212.50 $157.00 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $212.50 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $212.50 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A MC061404 SUP HCPCS C1752 MC061404 - SET CATH 14FR 24CM SLX 2 LUM BSC INTRO NDL GW DIL BOTH IP/OP $212.50 $157.00 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $85.00 $212.50 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $212.50 N/A $123.25 $212.50 $127.50 $212.50 $212.50 $212.50 N/A N/A MC061405 SUP HCPCS C1751 MC061405 - SET CATH 14FR 30CM SLX 2 LUM BSC STY INTRO NDL DIL BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A MC172150SX SUP HCPCS C1725 MC172150SX - CATHETER BLNOCC MIC STRG 2.4-1.7FR .017IN 150CM HEADWAY SMTH BOTH IP/OP "$1,912.00" "$1,415.00" $379.39 "$2,193.38" "$1,037.97" "$1,037.97" "$1,037.97" "$1,037.97" "$1,911.55" "$1,911.55" "$1,911.55" $398.41 "$1,911.55" "$1,418.75" "$1,418.75" "$1,473.42" $995.92 $398.39 "$1,911.55" "$2,193.38" "$1,130.68" "$1,911.55" "$2,193.38" "$1,911.55" "$1,911.55" "$1,434.00" "$1,911.55" "$1,911.55" "$1,911.55" $955.78 $955.78 "$1,513.95" "$1,911.55" "$1,529.24" "$1,242.51" $379.39 N/A "$1,108.96" "$1,911.55" "$1,911.55" "$1,911.55" $398.37 "$1,911.55" N/A N/A MC272150S SUP HCPCS C1887 MC272150S - MICROCATHETER CRBRVASC 2.6-3.1FR .027 150CM STRL LF HEADWAY BOTH IP/OP "$1,906.00" "$1,410.00" $378.29 "$1,906.00" "$1,034.96" "$1,034.96" "$1,034.96" "$1,034.96" "$1,906.00" "$1,906.00" "$1,906.00" $397.26 "$1,906.00" "$1,414.63" "$1,414.63" "$1,469.14" $993.03 $397.23 "$1,906.00" "$1,906.00" "$1,127.40" "$1,906.00" "$1,906.00" "$1,906.00" "$1,906.00" "$1,429.50" "$1,906.00" "$1,906.00" "$1,906.00" $953.00 $953.00 "$1,509.55" "$1,906.00" "$1,524.80" "$1,238.90" $378.29 N/A "$1,105.48" "$1,906.00" "$1,906.00" "$1,906.00" $397.21 "$1,906.00" N/A N/A MC40BD.100 SUP HCPCS V2632 MC40BD.100 - LENS IOL 5 D +10 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.105 SUP HCPCS V2632 MC40BD.105 - LENS IOL 5 D +10.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.110 SUP HCPCS V2632 MC40BD.110 - LENS IOL 5 D +11 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.115 SUP HCPCS V2632 MC40BD.115 - LENS IOL 5 D +11.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.120 SUP HCPCS V2632 MC40BD.120 - LENS IOL 5 D +12 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.125 SUP HCPCS V2632 MC40BD.125 - LENS IOL 5 D +12.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.130 SUP HCPCS V2632 MC40BD.130 - LENS IOL 5 D +13 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.135 SUP HCPCS V2632 MC40BD.135 - LENS IOL 5 D +13.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.140 SUP HCPCS V2632 MC40BD.140 - LENS IOL 5 D +14 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.145 SUP HCPCS V2632 MC40BD.145 - LENS IOL 5 D +14.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.150 SUP HCPCS V2632 MC40BD.150 - LENS IOL 5 D +15 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.155 SUP HCPCS V2632 MC40BD.155 - LENS IOL 5 D +15.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.160 SUP HCPCS V2632 MC40BD.160 - LENS IOL 5 D +16 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.165 SUP HCPCS V2632 MC40BD.165 - LENS IOL 5 D +16.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.170 SUP HCPCS V2632 MC40BD.170 - LENS IOL 5 D +17 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.175 SUP HCPCS V2632 MC40BD.175 - LENS IOL 5 D +17.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.180 SUP HCPCS V2632 MC40BD.180 - LENS IOL 5 D +18 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.185 SUP HCPCS V2632 MC40BD.185 - LENS IOL 5 D +18.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.190 SUP HCPCS V2632 MC40BD.190 - LENS IOL 5 D +19 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.195 SUP HCPCS V2632 MC40BD.195 - LENS IOL 5 D +19.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.200 SUP HCPCS V2632 MC40BD.200 - LENS IOL 5 D +20 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.205 SUP HCPCS V2632 MC40BD.205 - LENS IOL 5 D +20.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.210 SUP HCPCS V2632 MC40BD.210 - LENS IOL 5 D +21 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.215 SUP HCPCS V2632 MC40BD.215 - LENS IOL 5 D +21.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.220 SUP HCPCS V2632 MC40BD.220 - LENS IOL 5 D +22 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.225 SUP HCPCS V2632 MC40BD.225 - LENS IOL 5 D +22.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.230 SUP HCPCS V2632 MC40BD.230 - LENS IOL 5 D +23 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.235 SUP HCPCS V2632 MC40BD.235 - LENS IOL 5 D +23.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.240 SUP HCPCS V2632 MC40BD.240 - LENS IOL 5 D +24 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.245 SUP HCPCS V2632 MC40BD.245 - LENS IOL 5 D +24.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.250 SUP HCPCS V2632 MC40BD.250 - LENS IOL 5 D +25 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.255 SUP HCPCS V2632 MC40BD.255 - LENS IOL 5 D +25.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.260 SUP HCPCS V2632 MC40BD.260 - LENS IOL 5 D +26 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.265 SUP HCPCS V2632 MC40BD.265 - LENS IOL 5 D +26.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.270 SUP HCPCS V2632 MC40BD.270 - LENS IOL 5 D +27 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.275 SUP HCPCS V2632 MC40BD.275 - LENS IOL 5 D +27.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.280 SUP HCPCS V2632 MC40BD.280 - LENS IOL 5 D +28 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.285 SUP HCPCS V2632 MC40BD.285 - LENS IOL 5 D +28.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.290 SUP HCPCS V2632 MC40BD.290 - LENS IOL 5 D +29 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.295 SUP HCPCS V2632 MC40BD.295 - LENS IOL 5 D +29.5 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC40BD.300 SUP HCPCS V2632 MC40BD.300 - LENS IOL 5 D +30 DIOP BCNVX 5MM 12.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD SUP HCPCS V2632 MC50BD - LENS IOL 5 D +17 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.100 SUP HCPCS V2632 MC50BD.100 - LENS IOL 5 D +10 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.110 SUP HCPCS V2632 MC50BD.110 - LENS IOL 5 D +11 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.120 SUP HCPCS V2632 MC50BD.120 - LENS IOL 5 D +12 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.130 SUP HCPCS V2632 MC50BD.130 - LENS IOL 5 D +13 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.140 SUP HCPCS V2632 MC50BD.140 - LENS IOL 5 D +14 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.150 SUP HCPCS V2632 MC50BD.150 - LENS IOL 5 D +15 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.160 SUP HCPCS V2632 MC50BD.160 - LENS IOL 5 D +16 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.170 SUP HCPCS V2632 MC50BD.170 - LENS IOL 5 D +17 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.180 SUP HCPCS V2632 MC50BD.180 - LENS IOL 5 D +18 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.190 SUP HCPCS V2632 MC50BD.190 - LENS IOL 5 D +19 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.200 SUP HCPCS V2632 MC50BD.200 - LENS IOL 5 D +20 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.210 SUP HCPCS V2632 MC50BD.210 - LENS IOL 5 D +21 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.220 SUP HCPCS V2632 MC50BD.220 - LENS IOL 5 D +22 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.230 SUP HCPCS V2632 MC50BD.230 - LENS IOL 5 D +23 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.240 SUP HCPCS V2632 MC50BD.240 - LENS IOL 5 D +24 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.250 SUP HCPCS V2632 MC50BD.250 - LENS IOL 5 D +25 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.260 SUP HCPCS V2632 MC50BD.260 - LENS IOL 5 D +26 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.270 SUP HCPCS V2632 MC50BD.270 - LENS IOL 5 D +27 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $89.84 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.280 SUP HCPCS V2632 MC50BD.280 - LENS IOL 5 D +28 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.285 SUP HCPCS V2632 MC50BD.285 - LENS IOL 5 D +28.5 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.290 SUP HCPCS V2632 MC50BD.290 - LENS IOL 5 D +29 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC50BD.295 SUP HCPCS V2632 MC50BD.295 - LENS IOL 5 D +29.5 DIOP MOD C BCNVX 6.5MM 13.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD SUP HCPCS V2632 MC60BD - LENS IOL 5D BCNVX 6MM 13.5MM STRL SLANT 1 PC UV ABS PMMA PC BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.100 SUP HCPCS V2632 MC60BD.100 - LENS IOL 5 D +10 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.105 SUP HCPCS V2632 MC60BD.105 - LENS IOL 5 D +10.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.110 SUP HCPCS V2632 MC60BD.110 - LENS IOL 5 D +11 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.115 SUP HCPCS V2632 MC60BD.115 - LENS IOL 5 D +11.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.120 SUP HCPCS V2632 MC60BD.120 - LENS IOL 5 D +12 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.125 SUP HCPCS V2632 MC60BD.125 - LENS IOL 5 D +12.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.130 SUP HCPCS V2632 MC60BD.130 - LENS IOL 5 D +13 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.135 SUP HCPCS V2632 MC60BD.135 - LENS IOL 5 D +13.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.140 SUP HCPCS V2632 MC60BD.140 - LENS IOL 5 D +14 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.145 SUP HCPCS V2632 MC60BD.145 - LENS IOL 5 D +14.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.150 SUP HCPCS V2632 MC60BD.150 - LENS IOL 5 D +15 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.155 SUP HCPCS V2632 MC60BD.155 - LENS IOL 5 D +15.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.160 SUP HCPCS V2632 MC60BD.160 - LENS IOL 5 D +16 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.165 SUP HCPCS V2632 MC60BD.165 - LENS IOL 5 D +16.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.170 SUP HCPCS V2632 MC60BD.170 - LENS IOL 5 D +17 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.175 SUP HCPCS V2632 MC60BD.175 - LENS IOL 5 D +17.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.180 SUP HCPCS V2632 MC60BD.180 - LENS IOL 5 D +18 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.185 SUP HCPCS V2632 MC60BD.185 - LENS IOL 5 D +18.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.190 SUP HCPCS V2632 MC60BD.190 - LENS IOL 5 D +19 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.195 SUP HCPCS V2632 MC60BD.195 - LENS IOL 5 D +19.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.200 SUP HCPCS V2632 MC60BD.200 - LENS IOL 5 D +20 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.205 SUP HCPCS V2632 MC60BD.205 - LENS IOL 5 D +20.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.210 SUP HCPCS V2632 MC60BD.210 - LENS IOL 5 D +21 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.215 SUP HCPCS V2632 MC60BD.215 - LENS IOL 5 D +21.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.220 SUP HCPCS V2632 MC60BD.220 - LENS IOL 5 D +22 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.225 SUP HCPCS V2632 MC60BD.225 - LENS IOL 5 D +22.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.230 SUP HCPCS V2632 MC60BD.230 - LENS IOL 5 D +23 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.235 SUP HCPCS V2632 MC60BD.235 - LENS IOL 5 D +23.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.240 SUP HCPCS V2632 MC60BD.240 - LENS IOL 5 D +24 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.245 SUP HCPCS V2632 MC60BD.245 - LENS IOL 5 D +24.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.250 SUP HCPCS V2632 MC60BD.250 - LENS IOL 5 D +25 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.255 SUP HCPCS V2632 MC60BD.255 - LENS IOL 5 D +25.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.260 SUP HCPCS V2632 MC60BD.260 - LENS IOL 5 D +26 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.265 SUP HCPCS V2632 MC60BD.265 - LENS IOL 5 D +26.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.270 SUP HCPCS V2632 MC60BD.270 - LENS IOL 5 D +27 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.275 SUP HCPCS V2632 MC60BD.275 - LENS IOL 5 D +27.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.280 SUP HCPCS V2632 MC60BD.280 - LENS IOL 5 D +28 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.285 SUP HCPCS V2632 MC60BD.285 - LENS IOL 5 D +28.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.290 SUP HCPCS V2632 MC60BD.290 - LENS IOL 5 D +29 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.295 SUP HCPCS V2632 MC60BD.295 - LENS IOL 5 D +29.5 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MC60BD.300 SUP HCPCS V2632 MC60BD.300 - LENS IOL 5 D +30 DIOP BCNVX 6MM 13.5MM STRL SLANT 1 PC UV BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MCPE28131YB SUP HCPCS C1725 MCPE28131YB - CATHETER INTERVENTIONAL MICRO 2.8FR .027IN 130CM MARKER BAND BOTH IP/OP "$1,350.00" $999.00 $267.94 "$1,400.00" $733.05 $733.05 $733.05 $733.05 "$1,350.00" "$1,350.00" "$1,350.00" $281.37 "$1,350.00" "$1,001.97" "$1,001.97" "$1,040.58" $703.35 $281.35 "$1,350.00" "$1,400.00" $798.53 "$1,350.00" "$1,400.00" "$1,350.00" "$1,350.00" "$1,012.50" "$1,350.00" "$1,350.00" "$1,350.00" $675.00 $675.00 "$1,069.20" "$1,350.00" "$1,080.00" $877.50 $267.94 N/A $783.00 "$1,350.00" "$1,350.00" "$1,350.00" $281.34 "$1,350.00" N/A N/A MCR-0007 SUP Custom 27203010 MCR-0007 - RETRACTOR SRG STRL MST CPSL RTRCTR BOTH IP/OP $283.50 $210.00 $50.43 $283.33 $283.33 $283.33 $283.33 $283.33 $283.33 $283.33 $50.43 $283.33 $283.33 $210.29 $210.29 $218.39 $147.61 $59.05 $283.33 $113.33 $283.33 $283.33 $283.33 $283.33 $283.33 $212.63 $283.33 $283.33 $283.33 $141.67 $141.67 $224.40 $283.33 $226.66 $184.16 $283.33 N/A $164.43 $283.33 $170.00 $283.33 $283.33 $283.33 N/A N/A MD800F SUP HCPCS C1880 MD800F - FILTER CARDIO MRDN VC FEM DLV KIT BOTH IP/OP "$4,151.00" "$3,072.00" $865.11 "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" $865.11 "$4,151.00" "$1,660.40" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$3,113.25" "$4,151.00" "$4,151.00" "$4,151.00" "$2,075.50" "$2,075.50" "$3,287.59" "$4,151.00" "$3,320.80" "$1,867.95" "$4,151.00" N/A "$2,407.58" "$4,151.00" "$2,490.60" "$4,151.00" "$4,151.00" "$4,151.00" N/A N/A MD800J SUP HCPCS C1880 MD800J - FILTER CARDIO MRDN VC JUG DLV KIT BOTH IP/OP "$4,151.00" "$3,072.00" $865.11 "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" $865.11 "$4,151.00" "$1,660.40" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$4,151.00" "$3,113.25" "$4,151.00" "$4,151.00" "$4,151.00" "$2,075.50" "$2,075.50" "$3,287.59" "$4,151.00" "$3,320.80" "$1,867.95" "$4,151.00" N/A "$2,407.58" "$4,151.00" "$2,490.60" "$4,151.00" "$4,151.00" "$4,151.00" N/A N/A MDRT4101 SUP HCPCS Q4105 MDRT4101 - GRAFT SKIN 10X4IN MESHED DERMAL REGENERATION TEMPLATE BOVINE BOTH IP/OP "$17,769.00" "$13,149.00" $46.26 "$17,768.95" "$17,768.95" "$17,768.95" "$17,768.95" "$17,768.95" "$17,768.95" "$17,768.95" $46.26 "$17,768.95" "$17,768.95" "$17,768.95" "$17,768.95" "$17,768.95" "$17,768.95" "$3,703.24" "$17,768.95" "$7,107.58" "$17,768.95" "$17,768.95" "$17,768.95" "$17,768.95" "$17,768.95" "$13,326.75" "$17,768.95" "$17,768.95" "$17,768.95" "$8,884.48" "$8,884.48" "$14,073.01" "$17,768.95" "$14,215.16" "$7,996.03" "$17,768.95" N/A "$10,306.02" "$17,768.95" "$10,661.37" "$17,768.95" "$17,768.95" "$17,768.95" N/A N/A MDRT8101 SUP HCPCS Q4105 MDRT8101 - GRAFT SKIN 25X20CM MESH DERMAL REGENERATION TEMPLATE BOTH IP/OP "$28,138.00" "$20,822.00" $46.26 "$28,137.80" "$28,137.80" "$28,137.80" "$28,137.80" "$28,137.80" "$28,137.80" "$28,137.80" $46.26 "$28,137.80" "$28,137.80" "$28,137.80" "$28,137.80" "$28,137.80" "$28,137.80" "$5,864.23" "$28,137.80" "$11,255.12" "$28,137.80" "$28,137.80" "$28,137.80" "$28,137.80" "$28,137.80" "$21,103.50" "$28,137.80" "$28,137.80" "$28,137.80" "$14,068.90" "$14,068.90" "$22,285.14" "$28,137.80" "$22,510.24" "$12,662.01" "$28,137.80" N/A "$16,320.04" "$28,137.80" "$16,882.68" "$28,137.80" "$28,137.80" "$28,137.80" N/A N/A MG-02770-002 SUP Custom 27203010 MG-02770-002 - TUBE ENDBR 7FR 75CM STRL LF EZ-BLOCKER 1EZ-ML PRT 1 O2 ADPR BOTH IP/OP $347.50 $257.00 $61.86 $347.50 $347.50 $347.50 $347.50 $347.50 $347.50 $347.50 $61.86 $347.50 $347.50 $257.91 $257.91 $267.85 $181.05 $72.42 $347.50 $139.00 $347.50 $347.50 $347.50 $347.50 $347.50 $260.63 $347.50 $347.50 $347.50 $173.75 $173.75 $275.22 $347.50 $278.00 $225.88 $347.50 N/A $201.55 $347.50 $208.50 $347.50 $347.50 $347.50 N/A N/A MH443 SUP Custom 27011340 MH443 - VALVE SCT RED BTN EVIS 140 VID IMG SYS STRL DISP BOTH IP/OP $184.00 $136.00 $32.71 $183.78 $183.78 $183.78 $183.78 $183.78 $183.78 $183.78 $32.71 $183.78 $183.78 $136.40 $136.40 $141.66 $95.75 $38.30 $183.78 $73.51 $183.78 $183.78 $183.78 $183.78 $183.78 $138.00 $183.78 $183.78 $183.78 $91.89 $91.89 $145.55 $183.78 $147.02 $119.46 $183.78 N/A $106.72 $183.78 $110.27 $183.78 $183.78 $183.78 N/A N/A MIS-7F11 SUP HCPCS C1894 MIS-7F11 - SET INTROD .018IN MICRO STR 7FR 21GA 11CM 2.75IN 1 END GWIRE BOTH IP/OP $152.50 $113.00 $30.27 $152.50 $82.81 $82.81 $82.81 $82.81 $152.50 $152.50 $152.50 $31.78 $152.50 $113.19 $113.19 $117.55 $79.45 $31.78 $152.50 $152.50 $90.20 $152.50 $152.50 $152.50 $152.50 $114.38 $152.50 $152.50 $152.50 $76.25 $76.25 $120.78 $152.50 $122.00 $99.13 $30.27 N/A $88.45 $152.50 $152.50 $152.50 $31.78 $152.50 N/A N/A MM0500 SUP HCPCS Q4118 MM0500 - DRESSING BIO STRL MICROMATRIX MICRONIZE PRTCL PRCN XCLR MTRX BOTH IP/OP "$3,024.00" "$2,238.00" $3.07 "$3,023.75" "$3,023.75" "$3,023.75" "$3,023.75" "$3,023.75" "$3,023.75" "$3,023.75" $3.07 "$3,023.75" "$3,023.75" "$3,023.75" "$3,023.75" "$3,023.75" "$3,023.75" $630.18 "$3,023.75" "$1,209.50" "$3,023.75" "$3,023.75" "$3,023.75" "$3,023.75" "$3,023.75" "$2,268.00" "$3,023.75" "$3,023.75" "$3,023.75" "$1,511.88" "$1,511.88" "$2,394.81" "$3,023.75" "$2,419.00" "$1,360.69" "$3,023.75" N/A "$1,753.92" "$3,023.75" "$1,814.25" "$3,023.75" "$3,023.75" "$3,023.75" N/A N/A MM1000 SUP HCPCS Q4118 MM1000 - DRESSING BIO STRL MICROMATRIX MICRONIZE PRTCL PRCN XCLR MTRX BOTH IP/OP "$5,535.00" "$4,096.00" $3.07 "$5,535.00" "$5,535.00" "$5,535.00" "$5,535.00" "$5,535.00" "$5,535.00" "$5,535.00" $3.07 "$5,535.00" "$5,535.00" "$5,535.00" "$5,535.00" "$5,535.00" "$5,535.00" "$1,153.55" "$5,535.00" "$2,214.00" "$5,535.00" "$5,535.00" "$5,535.00" "$5,535.00" "$5,535.00" "$4,151.25" "$5,535.00" "$5,535.00" "$5,535.00" "$2,767.50" "$2,767.50" "$4,383.72" "$5,535.00" "$4,428.00" "$2,490.75" "$5,535.00" N/A "$3,210.30" "$5,535.00" "$3,321.00" "$5,535.00" "$5,535.00" "$5,535.00" N/A N/A MMSLED-42 SUP HCPCS C1713 MMSLED-42 - WIRE FIX 42MM SLED MEDIAL MALLEOLAR BOTH IP/OP "$1,887.50" "$1,397.00" $374.62 "$1,887.50" $849.38 $849.38 $849.38 $849.38 "$1,887.50" "$1,887.50" "$1,887.50" $393.40 "$1,887.50" "$1,887.50" "$1,887.50" "$1,887.50" "$1,887.50" $393.38 "$1,887.50" $755.00 "$1,116.46" "$1,887.50" "$1,887.50" "$1,887.50" "$1,887.50" "$1,415.63" "$1,887.50" "$1,887.50" "$1,887.50" $943.75 $943.75 "$1,494.90" "$1,887.50" "$1,510.00" $849.38 $374.62 N/A "$1,094.75" "$1,887.50" "$1,887.50" "$1,887.50" $393.36 "$1,887.50" N/A N/A MMSLEDW SUP HCPCS C1713 MMSLEDW - WASHER ORTHOPEDIC SLED MEDIAL MALLEOLAR BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $185.63 $185.63 $185.63 $185.63 $412.50 $412.50 $412.50 $85.98 $412.50 $412.50 $412.50 $412.50 $412.50 $85.97 $412.50 $165.00 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $185.63 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A MN60AC.060 SUP HCPCS V2632 MN60AC.060 - LENS IOL 10 D +6 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.065 SUP HCPCS V2632 MN60AC.065 - LENS IOL 10 D +6.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.075 SUP HCPCS V2632 MN60AC.075 - LENS IOL 10 D +7.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.085 SUP HCPCS V2632 MN60AC.085 - LENS IOL 10 D +8.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.095 SUP HCPCS V2632 MN60AC.095 - LENS IOL 10 D +9.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.100 SUP HCPCS V2632 MN60AC.100 - LENS IOL 10 D +10 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.105 SUP HCPCS V2632 MN60AC.105 - LENS IOL 10 D +10.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.110 SUP HCPCS V2632 MN60AC.110 - LENS IOL 10 D +11 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.115 SUP HCPCS V2632 MN60AC.115 - LENS IOL 10 D +11.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.120 SUP HCPCS V2632 MN60AC.120 - LENS IOL 10 D +12 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.125 SUP HCPCS V2632 MN60AC.125 - LENS IOL 10 D +12.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.130 SUP HCPCS V2632 MN60AC.130 - LENS IOL 10 D +13 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.135 SUP HCPCS V2632 MN60AC.135 - LENS IOL 10 D +13.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.140 SUP HCPCS V2632 MN60AC.140 - LENS IOL 10 D +14 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.145 SUP HCPCS V2632 MN60AC.145 - LENS IOL 10 D +14.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.150 SUP HCPCS V2632 MN60AC.150 - LENS IOL 10 D +15 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.155 SUP HCPCS V2632 MN60AC.155 - LENS IOL 10 D +15.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.160 SUP HCPCS V2632 MN60AC.160 - LENS IOL 10 D +16 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.165 SUP HCPCS V2632 MN60AC.165 - LENS IOL 10 D +16.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.170 SUP HCPCS V2632 MN60AC.170 - LENS IOL 10 D +17 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.175 SUP HCPCS V2632 MN60AC.175 - LENS IOL 10 D +17.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.180 SUP HCPCS V2632 MN60AC.180 - LENS IOL 10 D +18 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.185 SUP HCPCS V2632 MN60AC.185 - LENS IOL 10 D +18.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.190 SUP HCPCS V2632 MN60AC.190 - LENS IOL 10 D +19 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.195 SUP HCPCS V2632 MN60AC.195 - LENS IOL 10 D +19.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.200 SUP HCPCS V2632 MN60AC.200 - LENS IOL 10 D +20 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.205 SUP HCPCS V2632 MN60AC.205 - LENS IOL 10 D +20.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.210 SUP HCPCS V2632 MN60AC.210 - LENS IOL 10 D +21 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.215 SUP HCPCS V2632 MN60AC.215 - LENS IOL 10 D +21.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.220 SUP HCPCS V2632 MN60AC.220 - LENS IOL 10 D +22 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.225 SUP HCPCS V2632 MN60AC.225 - LENS IOL 10 D +22.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.230 SUP HCPCS V2632 MN60AC.230 - LENS IOL 10 D +23 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.235 SUP HCPCS V2632 MN60AC.235 - LENS IOL 10 D +23.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.240 SUP HCPCS V2632 MN60AC.240 - LENS IOL 10 D +24 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.245 SUP HCPCS V2632 MN60AC.245 - LENS IOL 10 D +24.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.250 SUP HCPCS V2632 MN60AC.250 - LENS IOL 10 D +25 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.255 SUP HCPCS V2632 MN60AC.255 - LENS IOL 10 D +25.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.260 SUP HCPCS V2632 MN60AC.260 - LENS IOL 10 D +26 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.265 SUP HCPCS V2632 MN60AC.265 - LENS IOL 10 D +26.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.270 SUP HCPCS V2632 MN60AC.270 - LENS IOL 10 D +27 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.275 SUP HCPCS V2632 MN60AC.275 - LENS IOL 10 D +27.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.280 SUP HCPCS V2632 MN60AC.280 - LENS IOL 10 D +28 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.285 SUP HCPCS V2632 MN60AC.285 - LENS IOL 10 D +28.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.290 SUP HCPCS V2632 MN60AC.290 - LENS IOL 10 D +29 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.295 SUP HCPCS V2632 MN60AC.295 - LENS IOL 10 D +29.5 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60AC.300 SUP HCPCS V2632 MN60AC.300 - LENS IOL 10 D +30 DIOP MOD C BCNVX 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60MA.000 SUP HCPCS V2632 MN60MA.000 - LENS IOL 5 D +0 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60MA.010 SUP HCPCS V2632 MN60MA.010 - LENS IOL 5 D +1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60MA.030 SUP HCPCS V2632 MN60MA.030 - LENS IOL 5 D +30 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60MA.040 SUP HCPCS V2632 MN60MA.040 - LENS IOL 5 D +4 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60MA.050 SUP HCPCS V2632 MN60MA.050 - LENS IOL 5 D +5 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60MAN010 SUP HCPCS V2632 MN60MAN010 - LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60MAN020 SUP HCPCS V2632 MN60MAN020 - LENS IOL 5 D -2 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60MAN030 SUP HCPCS V2632 MN60MAN030 - LENS IOL 5 D -3 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60MAN040 SUP HCPCS V2632 MN60MAN040 - LENS IOL 5 D -4 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MN60MAN050 SUP HCPCS V2632 MN60MAN050 - LENS IOL 5 D -5 DIOP MOD C MNSCS 6MM 13MM BLU STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A MPQ-2.5 SUP HCPCS L8603 MPQ-2.5 - AGENT BULKING INJECTABLE NONPYROGENIC SOFT TEXTURE PREFILL BOTH IP/OP "$1,237.50" $916.00 $257.91 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $284.68 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A MR17035101 SUP HCPCS C1751 MR17035101 - SET CATHETER 5FR 60CM 1 LUMEN PICC BASIC GWIRE INTROD NEEDLE BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A MR17035201 SUP HCPCS C1751 MR17035201 - SET CATHETER 5FR 55CM PICC 2 LUMEN BASIC GWIRE INTROD NEEDLE BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A MRDP50ASN SUP HCPCS C1750 MRDP50ASN - 5F MINI ATTACHABLE CATHETER BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A MRDP66AMN SUP HCPCS C1788 MRDP66AMN - 6.6f DIGNITY PORT BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A MRN-420 SUP HCPCS L8606 MRN-420 - NEEDLE ESCP 3.8FR MACROPLASTIQUE URTH BOTH IP/OP $75.00 $56.00 $14.89 $75.00 $33.75 $33.75 $33.75 $33.75 $75.00 $75.00 $75.00 $15.63 $75.00 $75.00 $75.00 $75.00 $75.00 $15.63 $75.00 $75.00 $44.36 $75.00 $75.00 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $33.75 $14.89 N/A $43.50 $75.00 $75.00 $75.00 $15.63 $75.00 N/A N/A MRPP80AFS SUP HCPCS C1751 MRPP80AFS - CATHETER CENTRAL VENOUS PRO-FUSE TRINIFLEX OD8 FR ATTACHABLE BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $225.00 $225.00 $225.00 $225.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $500.00 $500.00 $500.00 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $225.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A MS DC5020 SUP Custom 27203010 MS DC5020 - BIT DRILL 5IN 2MM QRLSE STRL BOTH IP/OP $66.50 $49.00 $11.80 $66.30 $66.30 $66.30 $66.30 $66.30 $66.30 $66.30 $11.80 $66.30 $66.30 $49.21 $49.21 $51.10 $34.54 $13.82 $66.30 $26.52 $66.30 $66.30 $66.30 $66.30 $66.30 $49.88 $66.30 $66.30 $66.30 $33.15 $33.15 $52.51 $66.30 $53.04 $43.10 $66.30 N/A $38.57 $66.30 $39.78 $66.30 $66.30 $66.30 N/A N/A MS03 SUP Custom 27203010 MS03 - STOCKINETTE CAST 25YDX3IN WATER REPELLENT 3M SYNTH BOTH IP/OP $24.00 $18.00 $4.27 $25.20 $24.00 $24.00 $24.00 $24.00 $24.00 $24.00 $4.27 $24.00 $24.00 $17.81 $17.81 $18.50 $12.50 $5.00 $24.00 $10.08 $24.00 $24.00 $25.20 $24.00 $24.00 $18.00 $24.00 $24.00 $24.00 $12.00 $12.00 $19.01 $24.00 $19.20 $15.60 $24.00 N/A $13.92 $24.00 $14.40 $24.00 $24.00 $24.00 N/A N/A MS-1106ST SUP HCPCS C1769 MS-1106ST - WIRE FIX .045IN KWIRE BOTH IP/OP $17.50 $13.00 $3.47 $17.50 $9.50 $9.50 $9.50 $9.50 $17.50 $17.50 $17.50 $3.65 $17.50 $12.99 $12.99 $13.49 $9.12 $3.65 $17.50 $17.50 $10.35 $17.50 $17.50 $17.50 $17.50 $13.13 $17.50 $17.50 $17.50 $8.75 $8.75 $13.86 $17.50 $14.00 $11.38 $3.47 N/A $10.15 $17.50 $17.50 $17.50 $3.65 $17.50 N/A N/A MS-2213 SUP Custom 27203010 MS-2213 - TIP SCRDRVR CRCIFRM BOTH IP/OP $470.00 $348.00 $83.66 $470.00 $470.00 $470.00 $470.00 $470.00 $470.00 $470.00 $83.66 $470.00 $470.00 $348.83 $348.83 $362.28 $244.87 $97.95 $470.00 $188.00 $470.00 $470.00 $470.00 $470.00 $470.00 $352.50 $470.00 $470.00 $470.00 $235.00 $235.00 $372.24 $470.00 $376.00 $305.50 $470.00 N/A $272.60 $470.00 $282.00 $470.00 $470.00 $470.00 N/A N/A MSC9023Z SUP HCPCS A6196 MSC9023Z - DRESSING GRMCDL 3.125X2.375IN LF ARGLS ANMC FLM TRNS IONIC BOTH IP/OP $27.00 $20.00 $3.48 $26.69 $26.69 $26.69 $26.69 $26.69 $26.69 $26.69 $3.48 $26.69 $26.69 $19.81 $19.81 $20.57 $13.91 $5.56 $26.69 $9.05 $26.69 $26.69 $22.63 $26.69 $26.69 $20.25 $26.69 $26.69 $26.69 $13.35 $13.35 $21.14 $26.69 $21.35 $17.35 $26.69 N/A $15.66 $26.69 $16.01 $26.69 $26.69 $26.69 N/A N/A MSC97310 SUP Custom 27203010 MSC97310 - DRESSING FOAM 10X3.5IN GENTLE POSTOPERATIVE STRIP BOTH IP/OP $59.00 $44.00 $10.43 $58.60 $58.60 $58.60 $58.60 $58.60 $58.60 $58.60 $10.43 $58.60 $58.60 $43.49 $43.49 $45.17 $30.53 $12.21 $58.60 $22.94 $58.60 $58.60 $57.35 $58.60 $58.60 $44.25 $58.60 $58.60 $58.60 $29.30 $29.30 $46.41 $58.60 $46.88 $38.09 $58.60 N/A $34.22 $58.60 $35.16 $58.60 $58.60 $58.60 N/A N/A MSC9736 SUP Custom 27203010 MSC9736 - DRESSING FOAM 6X3.5IN 7 DAY ADHESIVE ANTIMICROBIAL FLEXIBLE BOTH IP/OP $45.50 $34.00 $8.10 $45.48 $45.48 $45.48 $45.48 $45.48 $45.48 $45.48 $8.10 $45.48 $45.48 $33.76 $33.76 $35.06 $23.70 $9.48 $45.48 $18.19 $45.48 $45.48 $45.48 $45.48 $45.48 $34.13 $45.48 $45.48 $45.48 $22.74 $22.74 $36.02 $45.48 $36.38 $29.56 $45.48 N/A $26.39 $45.48 $27.29 $45.48 $45.48 $45.48 N/A N/A MS-CT21 SUP Custom 27203010 MS-CT21 - TAP 2.1MM SURG BOTH IP/OP $277.50 $205.00 $49.40 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $49.40 $277.50 $277.50 $205.96 $205.96 $213.90 $144.58 $57.83 $277.50 $111.00 $277.50 $277.50 $277.50 $277.50 $277.50 $208.13 $277.50 $277.50 $277.50 $138.75 $138.75 $219.78 $277.50 $222.00 $180.38 $277.50 N/A $160.95 $277.50 $166.50 $277.50 $277.50 $277.50 N/A N/A MS-CT27 SUP Custom 27203010 MS-CT27 - TAP 2.7MM SURG BOTH IP/OP $277.50 $205.00 $49.40 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $49.40 $277.50 $277.50 $205.96 $205.96 $213.90 $144.58 $57.83 $277.50 $111.00 $277.50 $277.50 $277.50 $277.50 $277.50 $208.13 $277.50 $277.50 $277.50 $138.75 $138.75 $219.78 $277.50 $222.00 $180.38 $277.50 N/A $160.95 $277.50 $166.50 $277.50 $277.50 $277.50 N/A N/A MS-CTL21 SUP Custom 27100030 MS-CTL21 - TAP SURG LONG 2.1MM ELBOW BOTH IP/OP $205.00 $152.00 $36.49 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $36.49 $205.00 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $82.00 $205.00 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $205.00 N/A $118.90 $205.00 $123.00 $205.00 $205.00 $205.00 N/A N/A MS-CTL27 SUP Custom 27100030 MS-CTL27 - TAP SURG LONG 2.7MM ELBOW BOTH IP/OP $277.50 $205.00 $49.40 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $49.40 $277.50 $277.50 $205.96 $205.96 $213.90 $144.58 $57.83 $277.50 $111.00 $277.50 $277.50 $277.50 $277.50 $277.50 $208.13 $277.50 $277.50 $277.50 $138.75 $138.75 $219.78 $277.50 $222.00 $180.38 $277.50 N/A $160.95 $277.50 $166.50 $277.50 $277.50 $277.50 N/A N/A MS-D761 SUP Custom 27203010 MS-D761 - BIT DRL 6.1MM BOTH IP/OP $215.00 $159.00 $38.27 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $215.00 $38.27 $215.00 $215.00 $159.57 $159.57 $165.72 $112.02 $44.81 $215.00 $86.00 $215.00 $215.00 $215.00 $215.00 $215.00 $161.25 $215.00 $215.00 $215.00 $107.50 $107.50 $170.28 $215.00 $172.00 $139.75 $215.00 N/A $124.70 $215.00 $129.00 $215.00 $215.00 $215.00 N/A N/A MS-DC15 SUP Custom 27203010 MS-DC15 - BIT DRL 1.5MM BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A MSDC-20 SUP Custom 27203010 MSDC-20 - BIT DRILL LONG 2MM 5IN QUICK RELEASE STERILE BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 N/A $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A MS-DC28 SUP Custom 27203010 MS-DC28 - DRILL SRG 2.8MM 5IN QRLSE BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A MSDC-35 SUP Custom 27203010 MSDC-35 - BIT DRILL 5IN 3.5MM ACTRK2 ORTH QRLSE STRL BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $100.20 $100.20 $104.06 $70.34 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $87.75 $135.00 N/A $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A MS-DC35 SUP Custom 27203010 MS-DC35 - DRILL SRG 3.5MM 5IN QRLSE BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A MS-DC5020 SUP Custom 27203010 MS-DC5020 - DRILL SRG 2MM 5IN QRLSE BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A MS-DCL15 SUP Custom 27203010 MS-DCL15 - DRILL SURG 1.5MM QUICK RELEASE SURGIBIT STERILE BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A MS-DCL20 SUP Custom 27203010 MS-DCL20 - DRILL SURG 2MM QUICK RELEASE SURGIBIT STERILE BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A MS-DCL28 SUP Custom 27203010 MS-DCL28 - BIT DRILL LONG 2.8MM 2-8MM QUICK RELEASE STERILE BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A MS-DCR20 SUP Custom 27203010 MS-DCR20 - DRILL SURG 2MM QUICK RELEASE RAD DISTAL BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A MS-DCSB32 SUP Custom 27203010 MS-DCSB32 - DRILL SURG 3.2MM SURGIBIT NONSTRL BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A MS-DG23 SUP Custom 27203010 MS-DG23 - GUIDE 2MM DRILL DEPTH GA SURG BOTH IP/OP $842.50 $623.00 $149.97 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $842.50 $149.97 $842.50 $842.50 $625.30 $625.30 $649.40 $438.94 $175.59 $842.50 $337.00 $842.50 $842.50 $842.50 $842.50 $842.50 $631.88 $842.50 $842.50 $842.50 $421.25 $421.25 $667.26 $842.50 $674.00 $547.63 $842.50 N/A $488.65 $842.50 $505.50 $842.50 $842.50 $842.50 N/A N/A MS-DG28 SUP Custom 27203010 MS-DG28 - GUIDE DRILL 2.8MM ASMBLY NONSTRL BOTH IP/OP $890.00 $659.00 $158.42 $890.00 $890.00 $890.00 $890.00 $890.00 $890.00 $890.00 $158.42 $890.00 $890.00 $660.56 $660.56 $686.01 $463.69 $185.49 $890.00 $356.00 $890.00 $890.00 $890.00 $890.00 $890.00 $667.50 $890.00 $890.00 $890.00 $445.00 $445.00 $704.88 $890.00 $712.00 $578.50 $890.00 N/A $516.20 $890.00 $534.00 $890.00 $890.00 $890.00 N/A N/A MS-DG40 SUP Custom 27203010 MS-DG40 - GUIDE DRILL 4MM ASMBLY NONSTRL BOTH IP/OP $925.00 $685.00 $164.65 $925.00 $925.00 $925.00 $925.00 $925.00 $925.00 $925.00 $164.65 $925.00 $925.00 $686.54 $686.54 $712.99 $481.93 $192.78 $925.00 $370.00 $925.00 $925.00 $925.00 $925.00 $925.00 $693.75 $925.00 $925.00 $925.00 $462.50 $462.50 $732.60 $925.00 $740.00 $601.25 $925.00 N/A $536.50 $925.00 $555.00 $925.00 $925.00 $925.00 N/A N/A MS-DG46 SUP Custom 27203010 MS-DG46 - GUIDE DRILL 4.6MM ASMBLY NONSTRL BOTH IP/OP "$1,185.00" $877.00 $210.93 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $210.93 "$1,185.00" "$1,185.00" $879.51 $879.51 $913.40 $617.39 $246.97 "$1,185.00" $474.00 "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" "$1,185.00" $888.75 "$1,185.00" "$1,185.00" "$1,185.00" $592.50 $592.50 $938.52 "$1,185.00" $948.00 $770.25 "$1,185.00" N/A $687.30 "$1,185.00" $711.00 "$1,185.00" "$1,185.00" "$1,185.00" N/A N/A MS-DS2835 SUP Custom 27203010 MS-DS2835 - SLEEVE DRILL 2.8/3.5MM LAG SCR BOTH IP/OP $277.50 $205.00 $49.40 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $277.50 $49.40 $277.50 $277.50 $205.96 $205.96 $213.90 $144.58 $57.83 $277.50 $111.00 $277.50 $277.50 $277.50 $277.50 $277.50 $208.13 $277.50 $277.50 $277.50 $138.75 $138.75 $219.78 $277.50 $222.00 $180.38 $277.50 N/A $160.95 $277.50 $166.50 $277.50 $277.50 $277.50 N/A N/A MS-LDC20 SUP Custom 27203010 MS-LDC20 - DRILL SRG LNG 2MM QRLSE BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A MS-LDC28 SUP Custom 27203010 MS-LDC28 - DRILL SRG LNG 2.8MM QRLSE BOTH IP/OP $147.50 $109.00 $26.26 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $147.50 $26.26 $147.50 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $59.00 $147.50 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $147.50 N/A $85.55 $147.50 $88.50 $147.50 $147.50 $147.50 N/A N/A MS-LTT27 SUP Custom 27203010 MS-LTT27 - DRILL SRG LNG 2.7MM TPR BOTH IP/OP $565.00 $418.00 $100.57 $565.00 $565.00 $565.00 $565.00 $565.00 $565.00 $565.00 $100.57 $565.00 $565.00 $419.34 $419.34 $435.50 $294.37 $117.75 $565.00 $226.00 $565.00 $565.00 $565.00 $565.00 $565.00 $423.75 $565.00 $565.00 $565.00 $282.50 $282.50 $447.48 $565.00 $452.00 $367.25 $565.00 N/A $327.70 $565.00 $339.00 $565.00 $565.00 $565.00 N/A N/A MS-LTT35 SUP HCPCS C1713 MS-LTT35 - TAP SURG LONG 3.5MM UPPER EXTREMITY BONE PLATE SYSTEM BOTH IP/OP $565.00 $418.00 $112.14 $565.00 $254.25 $254.25 $254.25 $254.25 $565.00 $565.00 $565.00 $117.76 $565.00 $565.00 $565.00 $565.00 $565.00 $117.75 $565.00 $565.00 $334.20 $565.00 $565.00 $565.00 $565.00 $423.75 $565.00 $565.00 $565.00 $282.50 $282.50 $447.48 $565.00 $452.00 $254.25 $112.14 N/A $327.70 $565.00 $339.00 $565.00 $117.75 $565.00 N/A N/A MS-PH28 SUP Custom 27203010 MS-PH28 - BIT DRL 2.8MM BOTH IP/OP $205.00 $152.00 $36.49 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $36.49 $205.00 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $82.00 $205.00 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $205.00 N/A $118.90 $205.00 $123.00 $205.00 $205.00 $205.00 N/A N/A MS-PH40 SUP Custom 27203010 MS-PH40 - BIT DRL 4MM CANC BOTH IP/OP $205.00 $152.00 $36.49 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $36.49 $205.00 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $82.00 $205.00 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $205.00 N/A $118.90 $205.00 $123.00 $205.00 $205.00 $205.00 N/A N/A MS-PH46 SUP Custom 27203010 MS-PH46 - DRILL SURG 4.6MM CANCELLOUS STERILE CANCELLOUS SCREWS BOTH IP/OP $205.00 $152.00 $36.49 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $36.49 $205.00 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $82.00 $205.00 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $205.00 N/A $118.90 $205.00 $123.00 $205.00 $205.00 $205.00 N/A N/A MS-PHBCD SUP Custom 27203010 MS-PHBCD - DRILL SURG SCREW CLEARANCE BOTH IP/OP $205.00 $152.00 $36.49 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $36.49 $205.00 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $82.00 $205.00 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $205.00 N/A $118.90 $205.00 $123.00 $205.00 $205.00 $205.00 N/A N/A MS-PIN20 SUP Custom 27203010 MS-PIN20 - PIN FIX 2MM STNM QCK CPLR BOTH IP/OP $202.50 $150.00 $36.05 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $36.05 $202.50 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $81.00 $202.50 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $202.50 N/A $117.45 $202.50 $121.50 $202.50 $202.50 $202.50 N/A N/A MS-PIN28 SUP Custom 27203010 MS-PIN28 - PIN DRILL 2.8MM LNG HUM ELB QRLSE DRILL GUIDE CLMP NONSTRL BOTH IP/OP $202.50 $150.00 $36.05 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $202.50 $36.05 $202.50 $202.50 $150.30 $150.30 $156.09 $105.50 $42.20 $202.50 $81.00 $202.50 $202.50 $202.50 $202.50 $202.50 $151.88 $202.50 $202.50 $202.50 $101.25 $101.25 $160.38 $202.50 $162.00 $131.63 $202.50 N/A $117.45 $202.50 $121.50 $202.50 $202.50 $202.50 N/A N/A MSS4022 SUP Custom 27203010 MSS4022 - DRESSING HYALOMATRIX 5X5CM BILAYER FLXB SEMIPERM BOTH IP/OP $687.00 $508.00 $122.27 $686.93 $686.93 $686.93 $686.93 $686.93 $686.93 $686.93 $122.27 $686.93 $686.93 $509.84 $509.84 $529.49 $357.89 $143.16 $686.93 $271.93 $686.93 $686.93 $679.82 $686.93 $686.93 $515.25 $686.93 $686.93 $686.93 $343.47 $343.47 $544.05 $686.93 $549.54 $446.50 $686.93 N/A $398.46 $686.93 $412.16 $686.93 $686.93 $686.93 N/A N/A MS-T35S SUP HCPCS C1713 MS-T35S - SCREW BONE 3.5MM SHRT CORT SLFTAP BOTH IP/OP $330.00 $244.00 $65.50 $330.00 $148.50 $148.50 $148.50 $148.50 $330.00 $330.00 $330.00 $68.78 $330.00 $330.00 $330.00 $330.00 $330.00 $68.78 $330.00 $132.00 $195.20 $330.00 $330.00 $330.00 $330.00 $247.50 $330.00 $330.00 $330.00 $165.00 $165.00 $261.36 $330.00 $264.00 $148.50 $65.50 N/A $191.40 $330.00 $198.00 $330.00 $68.77 $330.00 N/A N/A MT-1000 SUP Custom 27203010 MT-1000 - MINNIE TIE BOTH IP/OP $380.00 $281.00 $67.60 $379.79 $379.79 $379.79 $379.79 $379.79 $379.79 $379.79 $67.60 $379.79 $379.79 $281.88 $281.88 $292.74 $197.87 $79.15 $379.79 $151.92 $379.79 $379.79 $379.79 $379.79 $379.79 $285.00 $379.79 $379.79 $379.79 $189.90 $189.90 $300.79 $379.79 $303.83 $246.86 $379.79 N/A $220.40 $379.79 $227.87 $379.79 $379.79 $379.79 N/A N/A MTA3U0 SUP HCPCS V2630 MTA3U0 - LENS IOL +21 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.050 SUP HCPCS V2630 MTA3U0.050 - LENS IOL +5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.060 SUP HCPCS V2630 MTA3U0.060 - LENS IOL +6 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.070 SUP HCPCS V2630 MTA3U0.070 - LENS IOL +7 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.080 SUP HCPCS V2630 MTA3U0.080 - LENS IOL +8 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.090 SUP HCPCS V2630 MTA3U0.090 - LENS IOL +9 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.100 SUP HCPCS V2630 MTA3U0.100 - LENS IOL +10 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.105 SUP HCPCS V2630 MTA3U0.105 - LENS IOL +10.5 DIOPTER .5 MM CONVEXOPLANO 5.5MM 12.5MM 1 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.110 SUP HCPCS V2630 MTA3U0.110 - LENS IOL +11 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.115 SUP HCPCS V2630 MTA3U0.115 - LENS IOL +11.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.120 SUP HCPCS V2630 MTA3U0.120 - LENS IOL +12 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.125 SUP HCPCS V2630 MTA3U0.125 - LENS IOL +12.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.130 SUP HCPCS V2630 MTA3U0.130 - LENS IOL +13 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.135 SUP HCPCS V2630 MTA3U0.135 - LENS IOL +13.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.145 SUP HCPCS V2630 MTA3U0.145 - LENS IOL +14.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.150 SUP HCPCS V2630 MTA3U0.150 - LENS IOL +15 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.155 SUP HCPCS V2630 MTA3U0.155 - LENS IOL +15.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.160 SUP HCPCS V2630 MTA3U0.160 - LENS IOL +16 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.165 SUP HCPCS V2630 MTA3U0.165 - LENS IOL +16.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.170 SUP HCPCS V2630 MTA3U0.170 - LENS IOL +17 DIOPTER .5 MM CONVEXOPLANO 5.5MM 12.5MM 1 PIECE BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.180 SUP HCPCS V2630 MTA3U0.180 - LENS IOL +18 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.185 SUP HCPCS V2630 MTA3U0.185 - LENS IOL +18.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.190 SUP HCPCS V2632 MTA3U0.190 - LENS IOL +19 DIOPTER .5 MM CONVEXOPLANO 5.5MM 12.5MM 1 PIECE BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.200 SUP HCPCS V2632 MTA3U0.200 - LENS IOL +20 DIOPTER .5 MM CONVEXOPLANO 5.5MM 12.5MM 1 PIECE BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.205 SUP HCPCS V2630 MTA3U0.205 - LENS IOL +20.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.210 SUP HCPCS V2630 MTA3U0.210 - LENS IOL +21 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.215 SUP HCPCS V2630 MTA3U0.215 - LENS IOL +21.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.220 SUP HCPCS V2630 MTA3U0.220 - LENS IOL +22 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.230 SUP HCPCS V2630 MTA3U0.230 - LENS IOL +23 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.235 SUP HCPCS V2630 MTA3U0.235 - LENS IOL +23.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.240 SUP HCPCS V2630 MTA3U0.240 - LENS IOL +24 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.245 SUP HCPCS V2630 MTA3U0.245 - LENS IOL +24.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.250 SUP HCPCS V2630 MTA3U0.250 - LENS IOL +25 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.255 SUP HCPCS V2630 MTA3U0.255 - LENS IOL +25.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.260 SUP HCPCS V2630 MTA3U0.260 - LENS IOL +26 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.265 SUP HCPCS V2630 MTA3U0.265 - LENS IOL +26.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.270 SUP HCPCS V2630 MTA3U0.270 - LENS IOL +27 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.275 SUP HCPCS V2630 MTA3U0.275 - LENS IOL +27.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.280 SUP HCPCS V2630 MTA3U0.280 - LENS IOL +28 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.285 SUP HCPCS V2630 MTA3U0.285 - LENS IOL +28.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.290 SUP HCPCS V2630 MTA3U0.290 - LENS IOL +29 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.295 SUP HCPCS V2630 MTA3U0.295 - LENS IOL +29.5 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA3U0.300 SUP HCPCS V2630 MTA3U0.300 - LENS IOL +30 DIOP CNVXPLN 5.5MM 12.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0 SUP HCPCS V2630 MTA4U0 - LENS IOL +6.5 DIOP CNVXPLN 5.5MM 13MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.050 SUP HCPCS V2630 MTA4U0.050 - LENS IOL +5 DIOPTER CONVEXOPLANO 5.5MM 13MM 1 PIECE UV BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.055 SUP HCPCS V2630 MTA4U0.055 - LENS IOL +5.5 DIOPTER CONVEXOPLANO 5.5MM 13MM 1 PIECE UV BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.060 SUP HCPCS V2630 MTA4U0.060 - LENS IOL +6 DIOPTER CONVEXOPLANO 5.5MM 13MM 1 PIECE UV BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.065 SUP HCPCS V2630 MTA4U0.065 - LENS IOL +6.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.070 SUP HCPCS V2630 MTA4U0.070 - LENS IOL +7 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.075 SUP HCPCS V2630 MTA4U0.075 - LENS IOL +7.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.080 SUP HCPCS V2630 MTA4U0.080 - LENS IOL +8 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.085 SUP HCPCS V2630 MTA4U0.085 - LENS IOL +8.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.090 SUP HCPCS V2630 MTA4U0.090 - LENS IOL +9 DIOPTER .5 MM CONVEXOPLANO 5.5MM 13MM 1 PIECE UV BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.095 SUP HCPCS V2630 MTA4U0.095 - LENS IOL +9.5 DIOPTER CONVEXOPLANO 5.5MM 13MM 1 PIECE UV BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.100 SUP HCPCS V2630 MTA4U0.100 - LENS IOL +10 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.105 SUP HCPCS V2630 MTA4U0.105 - LENS IOL +10.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.110 SUP HCPCS V2630 MTA4U0.110 - LENS IOL +11 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.115 SUP HCPCS V2630 MTA4U0.115 - LENS IOL +11.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.120 SUP HCPCS V2630 MTA4U0.120 - LENS IOL +12 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.125 SUP HCPCS V2630 MTA4U0.125 - LENS IOL +12.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.130 SUP HCPCS V2630 MTA4U0.130 - LENS IOL +13 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.135 SUP HCPCS V2630 MTA4U0.135 - LENS IOL +13.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.140 SUP HCPCS V2630 MTA4U0.140 - LENS IOL +14 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.145 SUP HCPCS V2630 MTA4U0.145 - LENS IOL +14.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.155 SUP HCPCS V2630 MTA4U0.155 - LENS IOL +15.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.160 SUP HCPCS V2630 MTA4U0.160 - LENS IOL +16 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.165 SUP HCPCS V2632 MTA4U0.165 - LENS IOL +16.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.170 SUP HCPCS V2632 MTA4U0.170 - LENS IOL +17 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.175 SUP HCPCS V2630 MTA4U0.175 - LENS IOL +17.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.180 SUP HCPCS V2630 MTA4U0.180 - LENS IOL +18 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.185 SUP HCPCS V2630 MTA4U0.185 - LENS IOL +18.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.190 SUP HCPCS V2630 MTA4U0.190 - LENS IOL +19 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.195 SUP HCPCS V2632 MTA4U0.195 - LENS IOL +19.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.200 SUP HCPCS V2630 MTA4U0.200 - LENS IOL +20 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.205 SUP HCPCS V2632 MTA4U0.205 - LENS IOL +20.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.210 SUP HCPCS V2630 MTA4U0.210 - LENS IOL +21 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.215 SUP HCPCS V2630 MTA4U0.215 - LENS IOL +21.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.220 SUP HCPCS V2630 MTA4U0.220 - LENS IOL +22 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.225 SUP HCPCS V2630 MTA4U0.225 - LENS IOL +22.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.230 SUP HCPCS V2630 MTA4U0.230 - LENS IOL +23 DIOPTER .5 MM CONVEXOPLANO 5.5MM 13MM 1 PIECE BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.235 SUP HCPCS V2630 MTA4U0.235 - LENS IOL +23.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.240 SUP HCPCS V2630 MTA4U0.240 - LENS IOL +24 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.245 SUP HCPCS V2630 MTA4U0.245 - LENS IOL +24.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.250 SUP HCPCS V2630 MTA4U0.250 - LENS IOL +25 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.255 SUP HCPCS V2630 MTA4U0.255 - LENS IOL +25.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.260 SUP HCPCS V2630 MTA4U0.260 - LENS IOL +26 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.265 SUP HCPCS V2630 MTA4U0.265 - LENS IOL +26.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.270 SUP HCPCS V2630 MTA4U0.270 - LENS IOL +27 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.275 SUP HCPCS V2630 MTA4U0.275 - LENS IOL +27.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.280 SUP HCPCS V2630 MTA4U0.280 - LENS IOL +28 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.285 SUP HCPCS V2630 MTA4U0.285 - LENS IOL +28.5 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.290 SUP HCPCS V2630 MTA4U0.290 - LENS IOL +29 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA4U0.300 SUP HCPCS V2630 MTA4U0.300 - LENS IOL +30 DIOP CNVXPLN 5.5MM 13MM CLR STRL KLMN MULTIFLEX BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0 SUP HCPCS V2630 MTA5U0 - LENS IOL +13.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.050 SUP HCPCS V2630 MTA5U0.050 - LENS IOL +5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.060 SUP HCPCS V2630 MTA5U0.060 - LENS IOL +6 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.070 SUP HCPCS V2630 MTA5U0.070 - LENS IOL +7 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.080 SUP HCPCS V2630 MTA5U0.080 - LENS IOL +8 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.085 SUP HCPCS V2630 MTA5U0.085 - LENS IOL +8.5 DIOP CNVXPLN 13.5MM 5.5MM ANTER CHAM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.095 SUP HCPCS V2630 MTA5U0.095 - LENS IOL +9.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.100 SUP HCPCS V2630 MTA5U0.100 - LENS IOL +10 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.105 SUP HCPCS V2630 MTA5U0.105 - LENS IOL +10.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.115 SUP HCPCS V2630 MTA5U0.115 - LENS IOL +11.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.125 SUP HCPCS V2630 MTA5U0.125 - LENS IOL +12.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.135 SUP HCPCS V2630 MTA5U0.135 - LENS IOL +13.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.140 SUP HCPCS V2630 MTA5U0.140 - LENS IOL +14 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.145 SUP HCPCS V2630 MTA5U0.145 - LENS IOL +14.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.150 SUP HCPCS V2630 MTA5U0.150 - LENS IOL +15 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.155 SUP HCPCS V2630 MTA5U0.155 - LENS IOL +15.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.160 SUP HCPCS V2630 MTA5U0.160 - LENS IOL +16 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $127.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.165 SUP HCPCS V2632 MTA5U0.165 - LENS IOL +16.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $89.84 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.170 SUP HCPCS V2630 MTA5U0.170 - LENS IOL +17 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT .5 MM 5.5 BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.175 SUP HCPCS V2630 MTA5U0.175 - LENS IOL +17.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.180 SUP HCPCS V2630 MTA5U0.180 - LENS IOL +18 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.185 SUP HCPCS V2630 MTA5U0.185 - LENS IOL +18.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.190 SUP HCPCS V2630 MTA5U0.190 - LENS IOL +19 DIOPTER CONVEXOPLANO 115.3 A-CONSTANT 5.5MM BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.195 SUP HCPCS V2630 MTA5U0.195 - LENS IOL +19.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.200 SUP HCPCS V2630 MTA5U0.200 - LENS IOL +20 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.210 SUP HCPCS V2630 MTA5U0.210 - LENS IOL +21 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.215 SUP HCPCS V2630 MTA5U0.215 - LENS IOL +21.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.220 SUP HCPCS V2630 MTA5U0.220 - LENS IOL +22 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.225 SUP HCPCS V2630 MTA5U0.225 - LENS IOL +22.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.230 SUP HCPCS V2630 MTA5U0.230 - LENS IOL +23 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.235 SUP HCPCS V2630 MTA5U0.235 - LENS IOL +23.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.240 SUP HCPCS V2630 MTA5U0.240 - LENS IOL +24 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.250 SUP HCPCS V2630 MTA5U0.250 - LENS IOL +25 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.260 SUP HCPCS V2630 MTA5U0.260 - LENS IOL +26 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.270 SUP HCPCS V2630 MTA5U0.270 - LENS IOL +27 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.280 SUP HCPCS V2630 MTA5U0.280 - LENS IOL +28 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.285 SUP HCPCS V2630 MTA5U0.285 - LENS IOL +28.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.290 SUP HCPCS V2630 MTA5U0.290 - LENS IOL +29 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.295 SUP HCPCS V2630 MTA5U0.295 - LENS IOL +29.5 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTA5U0.300 SUP HCPCS V2630 MTA5U0.300 - LENS IOL +30 DIOP CNVXPLN 5.5MM 13.5MM CLR STRL KLMN BOTH IP/OP $212.50 $157.00 $42.18 $212.50 $95.63 $95.63 $95.63 $95.63 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $212.50 $212.50 $212.50 $44.29 $212.50 $212.50 $125.69 $212.50 $212.50 $212.50 $212.50 $159.38 $212.50 $212.50 $212.50 $106.25 $106.25 $168.30 $212.50 $170.00 $95.63 $42.18 N/A $123.25 $212.50 $212.50 $212.50 $44.29 $212.50 N/A N/A MTLS-30060-TS SUP HCPCS C1713 MTLS-30060-TS - SCREW BN 3MM 6MM NS MULTITHREAD LCK TI DRSL SPAN PLT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A MTLS-30080-TS SUP HCPCS C1713 MTLS-30080-TS - SCREW BN 3MM 8MM NS MULTITHREAD LCK TI DRSL SPAN PLT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A MTLS-30100-TS SUP HCPCS C1713 MTLS-30100-TS - SCREW BN 3MM 10MM NS MULTITHREAD LCK TI DRSL SPAN PLT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A MTLS-30120-TS SUP HCPCS C1713 MTLS-30120-TS - SCREW BN 3MM 12MM NS MULTITHREAD LCK TI DRSL SPAN PLT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A MTLS-30140-TS SUP HCPCS C1713 MTLS-30140-TS - SCREW BN 3MM 14MM NS MULTITHREAD LCK TI DRSL SPAN PLT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A MTLS-30160-TS SUP HCPCS C1713 MTLS-30160-TS - SCREW BN 3MM 16MM NS MULTITHREAD LCK TI DRSL SPAN PLT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A MTLS-30180-TS SUP HCPCS C1713 MTLS-30180-TS - SCREW BN 3MM 18MM NS MULTITHREAD LCK TI DRSL SPAN PLT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A MTNL-30060-TS SUP HCPCS C1713 MTNL-30060-TS - SCREW BN 3MM 6MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $250.00 $250.00 N/A N/A MTNL-30080-TS SUP HCPCS C1713 MTNL-30080-TS - SCREW BN 3MM 8MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A MTNL-30100-TS SUP HCPCS C1713 MTNL-30100-TS - SCREW BN 3MM 10MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A MTNL-30120-TS SUP HCPCS C1713 MTNL-30120-TS - SCREW BN 3MM 12MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A MTNL-30140-TS SUP HCPCS C1713 MTNL-30140-TS - SCREW BN 3MM 14MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A MTNL-30160-TS SUP HCPCS C1713 MTNL-30160-TS - SCREW BN 3MM 16MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A MTNL-30180-TS SUP HCPCS C1713 MTNL-30180-TS - SCREW BN 3MM 18MM NS LF CMPR MULTITHREAD TI DRSL SPAN PLT BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $250.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A MTP-F010 SUP Custom 27203010 MTP-F010 - REAMER SURG 10MM CONCAVE METATARSOPHALANGEAL BOTH IP/OP "$1,120.00" $829.00 $199.36 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $199.36 "$1,120.00" "$1,120.00" $831.26 $831.26 $863.30 $583.52 $233.42 "$1,120.00" $448.00 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $840.00 "$1,120.00" "$1,120.00" "$1,120.00" $560.00 $560.00 $887.04 "$1,120.00" $896.00 $728.00 "$1,120.00" N/A $649.60 "$1,120.00" $672.00 "$1,120.00" "$1,120.00" "$1,120.00" N/A N/A MTP-F012 SUP Custom 27203010 MTP-F012 - REAMER SURG 12MM CONCAVE METATARSOPHALANGEAL BOTH IP/OP "$1,120.00" $829.00 $199.36 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $199.36 "$1,120.00" "$1,120.00" $831.26 $831.26 $863.30 $583.52 $233.42 "$1,120.00" $448.00 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $840.00 "$1,120.00" "$1,120.00" "$1,120.00" $560.00 $560.00 $887.04 "$1,120.00" $896.00 $728.00 "$1,120.00" N/A $649.60 "$1,120.00" $672.00 "$1,120.00" "$1,120.00" "$1,120.00" N/A N/A MTP-F014 SUP Custom 27203010 MTP-F014 - REAMER SRG 14MM CNCV BOTH IP/OP "$1,120.00" $829.00 $199.36 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $199.36 "$1,120.00" "$1,120.00" $831.26 $831.26 $863.30 $583.52 $233.42 "$1,120.00" $448.00 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $840.00 "$1,120.00" "$1,120.00" "$1,120.00" $560.00 $560.00 $887.04 "$1,120.00" $896.00 $728.00 "$1,120.00" N/A $649.60 "$1,120.00" $672.00 "$1,120.00" "$1,120.00" "$1,120.00" N/A N/A MTP-F016 SUP Custom 27203010 MTP-F016 - REAMER SURG 16MM CNCV MTP BOTH IP/OP "$1,120.00" $829.00 $199.36 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $199.36 "$1,120.00" "$1,120.00" $831.26 $831.26 $863.30 $583.52 $233.42 "$1,120.00" $448.00 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $840.00 "$1,120.00" "$1,120.00" "$1,120.00" $560.00 $560.00 $887.04 "$1,120.00" $896.00 $728.00 "$1,120.00" N/A $649.60 "$1,120.00" $672.00 "$1,120.00" "$1,120.00" "$1,120.00" N/A N/A MTP-F020 SUP Custom 27203010 MTP-F020 - REAMER SRG 20MM CNCV BOTH IP/OP "$1,120.00" $829.00 $199.36 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $199.36 "$1,120.00" "$1,120.00" $831.26 $831.26 $863.30 $583.52 $233.42 "$1,120.00" $448.00 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $840.00 "$1,120.00" "$1,120.00" "$1,120.00" $560.00 $560.00 $887.04 "$1,120.00" $896.00 $728.00 "$1,120.00" N/A $649.60 "$1,120.00" $672.00 "$1,120.00" "$1,120.00" "$1,120.00" N/A N/A MTP-F024 SUP Custom 27203010 MTP-F024 - REAMER SURG 24MM CONCAVE METATARSOPHALANGEAL BOTH IP/OP "$1,120.00" $829.00 $199.36 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $199.36 "$1,120.00" "$1,120.00" $831.26 $831.26 $863.30 $583.52 $233.42 "$1,120.00" $448.00 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $840.00 "$1,120.00" "$1,120.00" "$1,120.00" $560.00 $560.00 $887.04 "$1,120.00" $896.00 $728.00 "$1,120.00" N/A $649.60 "$1,120.00" $672.00 "$1,120.00" "$1,120.00" "$1,120.00" N/A N/A MTP-M010 SUP Custom 27203010 MTP-M010 - REAMER SURG 10MM CONVEX METATARSOPHALANGEAL BOTH IP/OP "$1,120.00" $829.00 $199.36 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $199.36 "$1,120.00" "$1,120.00" $831.26 $831.26 $863.30 $583.52 $233.42 "$1,120.00" $448.00 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $840.00 "$1,120.00" "$1,120.00" "$1,120.00" $560.00 $560.00 $887.04 "$1,120.00" $896.00 $728.00 "$1,120.00" N/A $649.60 "$1,120.00" $672.00 "$1,120.00" "$1,120.00" "$1,120.00" N/A N/A MTP-M012 SUP Custom 27203010 MTP-M012 - REAMER SURG 12MM CONVEX METATARSOPHALANGEAL BOTH IP/OP "$1,120.00" $829.00 $199.36 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $199.36 "$1,120.00" "$1,120.00" $831.26 $831.26 $863.30 $583.52 $233.42 "$1,120.00" $448.00 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $840.00 "$1,120.00" "$1,120.00" "$1,120.00" $560.00 $560.00 $887.04 "$1,120.00" $896.00 $728.00 "$1,120.00" N/A $649.60 "$1,120.00" $672.00 "$1,120.00" "$1,120.00" "$1,120.00" N/A N/A MTP-M014 SUP Custom 27203010 MTP-M014 - REAMER SURG CONVEX 14MM METATARSOPHALANGEAL MODULAR HAND BOTH IP/OP "$1,120.00" $829.00 $199.36 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $199.36 "$1,120.00" "$1,120.00" $831.26 $831.26 $863.30 $583.52 $233.42 "$1,120.00" $448.00 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $840.00 "$1,120.00" "$1,120.00" "$1,120.00" $560.00 $560.00 $887.04 "$1,120.00" $896.00 $728.00 "$1,120.00" N/A $649.60 "$1,120.00" $672.00 "$1,120.00" "$1,120.00" "$1,120.00" N/A N/A MTP-M016 SUP Custom 27203010 MTP-M016 - REAMER SURG 16MM CNVX MTP BOTH IP/OP "$1,120.00" $829.00 $199.36 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $199.36 "$1,120.00" "$1,120.00" $831.26 $831.26 $863.30 $583.52 $233.42 "$1,120.00" $448.00 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $840.00 "$1,120.00" "$1,120.00" "$1,120.00" $560.00 $560.00 $887.04 "$1,120.00" $896.00 $728.00 "$1,120.00" N/A $649.60 "$1,120.00" $672.00 "$1,120.00" "$1,120.00" "$1,120.00" N/A N/A MTP-M020 SUP Custom 27203010 MTP-M020 - REAMER SURG LARGE 20MM CONVEX METATARSOPHALANGEAL FRFT MIDFT BOTH IP/OP "$1,120.00" $829.00 $199.36 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $199.36 "$1,120.00" "$1,120.00" $831.26 $831.26 $863.30 $583.52 $233.42 "$1,120.00" $448.00 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $840.00 "$1,120.00" "$1,120.00" "$1,120.00" $560.00 $560.00 $887.04 "$1,120.00" $896.00 $728.00 "$1,120.00" N/A $649.60 "$1,120.00" $672.00 "$1,120.00" "$1,120.00" "$1,120.00" N/A N/A MTP-M024 SUP Custom 27203010 MTP-M024 - REAMER SURG 24MM CONVEX METATARSOPHALANGEAL BOTH IP/OP "$1,120.00" $829.00 $199.36 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $199.36 "$1,120.00" "$1,120.00" $831.26 $831.26 $863.30 $583.52 $233.42 "$1,120.00" $448.00 "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" "$1,120.00" $840.00 "$1,120.00" "$1,120.00" "$1,120.00" $560.00 $560.00 $887.04 "$1,120.00" $896.00 $728.00 "$1,120.00" N/A $649.60 "$1,120.00" $672.00 "$1,120.00" "$1,120.00" "$1,120.00" N/A N/A MVP-7Q SUP Custom 27803010 MVP-7Q - PLUG OCL MIC 7MM STRL LF MVP MECH VASC DISP V03 BOTH IP/OP "$3,737.50" "$2,766.00" $665.28 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $665.28 "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" $778.94 "$3,737.50" "$1,495.00" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$3,737.50" "$2,803.13" "$3,737.50" "$3,737.50" "$3,737.50" "$1,868.75" "$1,868.75" "$2,960.10" "$3,737.50" "$2,990.00" "$1,681.88" "$3,737.50" N/A "$2,167.75" "$3,737.50" "$2,242.50" "$3,737.50" "$3,737.50" "$3,737.50" N/A N/A MWCE-35-5/3-TORNADO SUP Custom 27803010 MWCE-35-5/3-TORNADO - COIL EMBOLIZATION .035IN 5-3MM TORNADO PLATINUM BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $121.50 $270.00 N/A $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A MWM2021 SUP HCPCS Q4104 MWM2021 - DRESSING BIO 2X2IN STRL LF INTGR BL MX MESH BVN CLGN GAG BOTH IP/OP "$6,325.50" "$4,681.00" "$1,255.44" "$6,325.45" "$2,846.45" "$2,846.45" "$2,846.45" "$2,846.45" "$6,325.45" "$6,325.45" "$6,325.45" "$1,318.38" "$6,325.45" "$6,325.45" "$6,325.45" "$6,325.45" "$6,325.45" "$1,318.29" "$6,325.45" "$6,325.45" "$3,118.45" "$6,325.45" "$6,325.45" "$6,325.45" "$6,325.45" "$4,744.13" "$6,325.45" "$6,325.45" "$6,325.45" "$3,162.73" "$3,162.73" "$5,009.76" "$6,325.45" "$5,060.36" "$2,846.45" "$1,255.44" N/A "$3,668.79" "$6,325.45" "$6,325.45" "$6,325.45" "$1,318.22" "$6,325.45" N/A N/A MWM4051 SUP HCPCS C9363 MWM4051 - DRESSING BIOLOGICAL 5X4IN MESHED ADHERENT BILAYER MATRIX BOTH IP/OP "$11,031.00" "$8,163.00" $50.75 "$11,030.65" "$11,030.65" "$11,030.65" "$11,030.65" "$11,030.65" "$11,030.65" "$11,030.65" $50.75 "$11,030.65" "$11,030.65" "$11,030.65" "$11,030.65" "$11,030.65" "$11,030.65" "$2,298.91" "$11,030.65" "$4,412.26" "$11,030.65" "$11,030.65" "$11,030.65" "$11,030.65" "$11,030.65" "$8,273.25" "$11,030.65" "$11,030.65" "$11,030.65" "$5,515.33" "$5,515.33" "$8,736.27" "$11,030.65" "$8,824.52" "$4,963.79" "$11,030.65" N/A "$6,397.98" "$11,030.65" "$6,618.39" "$11,030.65" "$11,030.65" "$11,030.65" N/A N/A MWM8101 SUP HCPCS Q4104 MWM8101 - DRESSING BIOLOGICAL 10X8IN BILAYER MATRIX MESH LATEX FREE BOTH IP/OP "$28,138.00" "$20,822.00" "$5,584.65" "$28,137.80" "$12,662.01" "$12,662.01" "$12,662.01" "$12,662.01" "$28,137.80" "$28,137.80" "$28,137.80" "$5,864.62" "$28,137.80" "$28,137.80" "$28,137.80" "$28,137.80" "$28,137.80" "$5,864.23" "$28,137.80" "$28,137.80" "$13,871.94" "$28,137.80" "$28,137.80" "$28,137.80" "$28,137.80" "$21,103.50" "$28,137.80" "$28,137.80" "$28,137.80" "$14,068.90" "$14,068.90" "$22,285.14" "$28,137.80" "$22,510.24" "$12,662.01" "$5,584.65" N/A "$16,320.04" "$28,137.80" "$28,137.80" "$28,137.80" "$5,863.92" "$28,137.80" N/A N/A MX0100 SUP HCPCS C1782 MX0100 - TISSUE MORCELLATOR BOTH IP/OP "$3,567.50" "$2,640.00" $743.46 "$3,567.27" "$3,567.27" "$3,567.27" "$3,567.27" "$3,567.27" "$3,567.27" "$3,567.27" "$3,567.27" "$3,567.27" "$3,567.27" "$2,647.63" "$2,647.63" "$2,749.65" "$1,858.55" $743.46 "$3,567.27" "$1,426.91" "$3,567.27" "$3,567.27" "$3,567.27" "$3,567.27" "$3,567.27" "$2,675.63" "$3,567.27" "$3,567.27" "$3,567.27" "$1,783.64" "$1,783.64" "$2,825.28" "$3,567.27" "$2,853.82" "$2,318.73" "$3,567.27" N/A "$2,069.15" "$3,567.27" "$2,140.36" "$3,567.27" "$3,567.27" "$3,567.27" N/A N/A MX563 SUP Custom 27203010 MX563 - SUTURE NONABSORBABLE 2-0 SH 30IN 2 ARM 4 STRAND BRAID BOTH IP/OP $40.00 $30.00 $7.09 $154.00 $39.82 $39.82 $39.82 $39.82 $39.82 $39.82 $7.09 $39.82 $39.82 $29.55 $29.55 $30.69 $20.75 $8.30 $39.82 $61.60 $39.82 $39.82 $154.00 $39.82 $39.82 $30.00 $39.82 $39.82 $39.82 $19.91 $19.91 $31.54 $39.82 $31.86 $25.88 $39.82 N/A $23.20 $39.82 $23.89 $39.82 $39.82 $39.82 N/A N/A MX6740 SUP HCPCS C1760 MX6740 - DEVICE CLOSURE .035IN 6-7FR LOCKING SYRINGE INTROD DILAT BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A MZ30BD SUP HCPCS V2632 MZ30BD - LENS IOL 5 D +10 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.100 SUP HCPCS V2632 MZ30BD.100 - LENS IOL 5 D +10 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.110 SUP HCPCS V2632 MZ30BD.110 - LENS IOL 5 D +11 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.120 SUP HCPCS V2632 MZ30BD.120 - LENS IOL 5 D +12 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.130 SUP HCPCS V2632 MZ30BD.130 - LENS IOL 5 D +13 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.140 SUP HCPCS V2632 MZ30BD.140 - LENS IOL 5 D +14 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.150 SUP HCPCS V2632 MZ30BD.150 - LENS IOL 5 D +15 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.160 SUP HCPCS V2632 MZ30BD.160 - LENS IOL 5 D +16 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.170 SUP HCPCS V2632 MZ30BD.170 - LENS IOL 5 D +17 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.180 SUP HCPCS V2632 MZ30BD.180 - LENS IOL 5 D +18 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.190 SUP HCPCS V2632 MZ30BD.190 - LENS IOL 5 D +19 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.200 SUP HCPCS V2632 MZ30BD.200 - LENS IOL 5 D +20 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.210 SUP HCPCS V2632 MZ30BD.210 - LENS IOL 5 D +21 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.220 SUP HCPCS V2632 MZ30BD.220 - LENS IOL 5 D +22 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.225 SUP HCPCS V2632 MZ30BD.225 - LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.235 SUP HCPCS V2632 MZ30BD.235 - LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.245 SUP HCPCS V2632 MZ30BD.245 - LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.255 SUP HCPCS V2632 MZ30BD.255 - LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.265 SUP HCPCS V2632 MZ30BD.265 - LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.275 SUP HCPCS V2632 MZ30BD.275 - LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.285 SUP HCPCS V2632 MZ30BD.285 - LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ30BD.295 SUP HCPCS V2632 MZ30BD.295 - LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5.5MM 12MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.100 SUP HCPCS V2632 MZ40BD.100 - LENS IOL 5 D +10 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.105 SUP HCPCS V2632 MZ40BD.105 - LENS IOL 5 D +10.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.110 SUP HCPCS V2632 MZ40BD.110 - LENS IOL 5 D +11 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.115 SUP HCPCS V2632 MZ40BD.115 - LENS IOL 5 D +11.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.120 SUP HCPCS V2632 MZ40BD.120 - LENS IOL 5 D +12 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.125 SUP HCPCS V2632 MZ40BD.125 - LENS IOL 5 D +12.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.130 SUP HCPCS V2632 MZ40BD.130 - LENS IOL 5 D +13 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.135 SUP HCPCS V2632 MZ40BD.135 - LENS IOL 5 D +13.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.140 SUP HCPCS V2632 MZ40BD.140 - LENS IOL 5 D +14 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.145 SUP HCPCS V2632 MZ40BD.145 - LENS IOL 5 D +14.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.150 SUP HCPCS V2632 MZ40BD.150 - LENS IOL 5 D +15 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.155 SUP HCPCS V2632 MZ40BD.155 - LENS IOL 5 D +15.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.160 SUP HCPCS V2632 MZ40BD.160 - LENS IOL 5 D +16 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.165 SUP HCPCS V2632 MZ40BD.165 - LENS IOL 5 D +16.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.170 SUP HCPCS V2632 MZ40BD.170 - LENS IOL 5 D +17 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.175 SUP HCPCS V2632 MZ40BD.175 - LENS IOL 5 D +17.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.180 SUP HCPCS V2632 MZ40BD.180 - LENS IOL 5 D +18 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.185 SUP HCPCS V2632 MZ40BD.185 - LENS IOL 5 D +18.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.190 SUP HCPCS V2632 MZ40BD.190 - LENS IOL 5 D +19 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.195 SUP HCPCS V2632 MZ40BD.195 - LENS IOL 5 D +19.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.200 SUP HCPCS V2632 MZ40BD.200 - LENS IOL 5 D +20 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.205 SUP HCPCS V2632 MZ40BD.205 - LENS IOL 5 D +20.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.210 SUP HCPCS V2632 MZ40BD.210 - LENS IOL 5 D +21 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.215 SUP HCPCS V2632 MZ40BD.215 - LENS IOL 5 D +21.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.220 SUP HCPCS V2632 MZ40BD.220 - LENS IOL 5 D +22 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.225 SUP HCPCS V2632 MZ40BD.225 - LENS IOL 5 D +22.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.230 SUP HCPCS V2632 MZ40BD.230 - LENS IOL 5 D +23 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.235 SUP HCPCS V2632 MZ40BD.235 - LENS IOL 5 D +23.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.240 SUP HCPCS V2632 MZ40BD.240 - LENS IOL 5 D +24 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.245 SUP HCPCS V2632 MZ40BD.245 - LENS IOL 5 D +24.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.250 SUP HCPCS V2632 MZ40BD.250 - LENS IOL 5 D +25 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.255 SUP HCPCS V2632 MZ40BD.255 - LENS IOL 5 D +25.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.260 SUP HCPCS V2632 MZ40BD.260 - LENS IOL 5 D +26 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.265 SUP HCPCS V2632 MZ40BD.265 - LENS IOL 5 D +26.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.270 SUP HCPCS V2632 MZ40BD.270 - LENS IOL 5 D +27 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.275 SUP HCPCS V2632 MZ40BD.275 - LENS IOL 5 D +27.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.280 SUP HCPCS V2632 MZ40BD.280 - LENS IOL 5 D +28 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.285 SUP HCPCS V2632 MZ40BD.285 - LENS IOL 5 D +28.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.290 SUP HCPCS V2632 MZ40BD.290 - LENS IOL 5 D +29 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.295 SUP HCPCS V2632 MZ40BD.295 - LENS IOL 5 D +29.5 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ40BD.300 SUP HCPCS V2632 MZ40BD.300 - LENS IOL 5 D +30 DIOP MOD C BCNVX 5MM 11.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD SUP HCPCS V2632 MZ60BD - LENS IOL 5 D +25.5 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.040 SUP HCPCS V2632 MZ60BD.040 - LENS IOL 5 D +4 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1 BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.050 SUP HCPCS V2632 MZ60BD.050 - LENS IOL 5 D +5 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1 BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.060 SUP HCPCS V2632 MZ60BD.060 - LENS IOL 5 D +6 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1 BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.070 SUP HCPCS V2632 MZ60BD.070 - LENS IOL 5 D +7 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1 BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.080 SUP HCPCS V2632 MZ60BD.080 - LENS IOL 5 D +8 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1 BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.090 SUP HCPCS V2632 MZ60BD.090 - LENS IOL 5 D +9 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT 1 BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.100 SUP HCPCS V2632 MZ60BD.100 - LENS IOL 5 D +10 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.110 SUP HCPCS V2632 MZ60BD.110 - LENS IOL 5 D +11 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.120 SUP HCPCS V2632 MZ60BD.120 - LENS IOL 5 D +12 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.130 SUP HCPCS V2632 MZ60BD.130 - LENS IOL 5 D +13 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.140 SUP HCPCS V2632 MZ60BD.140 - LENS IOL 5 D +14 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.150 SUP HCPCS V2632 MZ60BD.150 - LENS IOL 5 D +15 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $97.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.160 SUP HCPCS V2632 MZ60BD.160 - LENS IOL 5 D +16 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.170 SUP HCPCS V2632 MZ60BD.170 - LENS IOL 5 D +17 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.180 SUP HCPCS V2632 MZ60BD.180 - LENS IOL 5 D +18 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.190 SUP HCPCS V2632 MZ60BD.190 - LENS IOL 5 D +19 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.200 SUP HCPCS V2632 MZ60BD.200 - LENS IOL 5 D +20 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.210 SUP HCPCS V2632 MZ60BD.210 - LENS IOL 5 D +21 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.220 SUP HCPCS V2632 MZ60BD.220 - LENS IOL 5 D +22 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.230 SUP HCPCS V2632 MZ60BD.230 - LENS IOL 5 D +23 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.240 SUP HCPCS V2632 MZ60BD.240 - LENS IOL 5 D +24 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.245 SUP HCPCS V2632 MZ60BD.245 - LENS IOL 5 D +24.5 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.250 SUP HCPCS V2632 MZ60BD.250 - LENS IOL 5 D +25 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.260 SUP HCPCS V2632 MZ60BD.260 - LENS IOL 5 D +26 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.270 SUP HCPCS V2632 MZ60BD.270 - LENS IOL 5 D +27 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.280 SUP HCPCS V2632 MZ60BD.280 - LENS IOL 5 D +28 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.290 SUP HCPCS V2632 MZ60BD.290 - LENS IOL 5 D +29 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.300 SUP HCPCS V2632 MZ60BD.300 - LENS IOL 5 D +30 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.320 SUP HCPCS V2632 MZ60BD.320 - LENS IOL 5 D +32 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60BD.340 SUP HCPCS V2632 MZ60BD.340 - LENS IOL 5 D +34 DIOP MOD C BCNVX 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60MD SUP HCPCS V2632 MZ60MD - LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60MD.000 SUP HCPCS V2632 MZ60MD.000 - LENS IOL 5 D +0 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60MD.010 SUP HCPCS V2632 MZ60MD.010 - LENS IOL 5 D +1 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60MD.020 SUP HCPCS V2632 MZ60MD.020 - LENS IOL 5 D +2 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60MD.030 SUP HCPCS V2632 MZ60MD.030 - LENS IOL 5 D +3 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60MDN010 SUP HCPCS V2632 MZ60MDN010 - LENS IOL 5 D -1 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60MDN020 SUP HCPCS V2632 MZ60MDN020 - LENS IOL 5 D -2 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60MDN030 SUP HCPCS V2632 MZ60MDN030 - LENS IOL 5 D -3 DIOP MOD C MNSCS 6MM 12.5MM CLR STRL SLANT BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60PDN040 SUP HCPCS V2632 MZ60PDN040 - LENS IOL 5 D -4 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60PDN050 SUP HCPCS V2632 MZ60PDN050 - LENS IOL 5 D -5 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60PDN060 SUP HCPCS V2632 MZ60PDN060 - LENS IOL 5 D -6 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60PDN070 SUP HCPCS V2632 MZ60PDN070 - LENS IOL 5 D -7 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60PDN080 SUP HCPCS V2632 MZ60PDN080 - LENS IOL 5 D -8 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60PDN090 SUP HCPCS V2632 MZ60PDN090 - LENS IOL 5 D -9 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A MZ60PDN100 SUP HCPCS V2632 MZ60PDN100 - LENS IOL 5 D -10 DIOP MOD C PLANO CNCV 6MM 12.5MM CLR STRL BOTH IP/OP $162.50 $120.00 $32.25 $162.50 $73.13 $73.13 $73.13 $73.13 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $162.50 $162.50 $162.50 $33.87 $162.50 $162.50 $96.12 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $73.13 $32.25 N/A $94.25 $162.50 $162.50 $162.50 $33.87 $162.50 N/A N/A N103A SUP Custom 27203010 N103A - NEEDLE DSCT MIC STRG 3CM LF CO HEAT RST TIP UL SHRP TUNG BOTH IP/OP $90.50 $67.00 $16.04 $90.13 $90.13 $90.13 $90.13 $90.13 $90.13 $90.13 $16.04 $90.13 $90.13 $66.89 $66.89 $69.47 $46.96 $18.78 $90.13 $36.05 $90.13 $90.13 $90.13 $90.13 $90.13 $67.88 $90.13 $90.13 $90.13 $45.07 $45.07 $71.38 $90.13 $72.10 $58.58 $90.13 N/A $52.49 $90.13 $54.08 $90.13 $90.13 $90.13 N/A N/A N118 SUP HCPCS C1882 N118 - DEFIBRILLATOR CARDIAC THK.39IN 2.43X3.13IN IS-1/DF-1 CONCTR BOTH IP/OP "$45,500.00" "$33,670.00" "$26,390.00" "$34,125.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$34,125.00" N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$26,390.00" N/A N/A N/A N/A N/A N/A N/A N143001 SUP HCPCS C1769 N143001 - GUIDEWIRE VASC 15D .014IN 300CM 5CM NTRX INTMD TIP KINK RST BOTH IP/OP $282.00 $209.00 $55.90 $281.67 $152.95 $152.95 $152.95 $152.95 $281.67 $281.67 $281.67 $58.71 $281.67 $209.06 $209.06 $217.11 $146.75 $58.70 $281.67 $281.67 $166.61 $281.67 $281.67 $281.67 $281.67 $211.50 $281.67 $281.67 $281.67 $140.84 $140.84 $223.08 $281.67 $225.34 $183.09 $55.90 N/A $163.56 $281.67 $281.67 $281.67 $58.70 $281.67 N/A N/A N181805 SUP HCPCS C1769 N181805 - GUIDEWIRE VASC 15D .018IN 180CM 5CM NTRX INTMD TIP KINK RST BOTH IP/OP $217.00 $161.00 $43.00 $216.67 $117.65 $117.65 $117.65 $117.65 $216.67 $216.67 $216.67 $45.16 $216.67 $160.81 $160.81 $167.01 $112.89 $45.16 $216.67 $216.67 $128.16 $216.67 $216.67 $216.67 $216.67 $162.75 $216.67 $216.67 $216.67 $108.34 $108.34 $171.60 $216.67 $173.34 $140.84 $43.00 N/A $125.86 $216.67 $216.67 $216.67 $45.15 $216.67 N/A N/A N7695 SUP HCPCS A7520 N7695 - TUBE ET SYR CK BOTH IP/OP $11.50 $9.00 $2.32 $33.95 $11.13 $11.13 $11.13 $11.13 $11.13 $11.13 $33.95 $11.13 $11.13 $11.13 $11.13 $11.13 $11.13 $2.32 $11.13 $4.45 $11.13 $11.13 $11.13 $11.13 $11.13 $8.63 $11.13 $11.13 $11.13 $5.57 $5.57 $8.81 $11.13 $8.90 $5.01 $11.13 N/A $6.67 $11.13 $6.68 $11.13 $11.13 $11.13 N/A N/A NA-U200H-8022 SUP Custom 27203010 NA-U200H-8022 - NEEDLE ASP 2.2MM 22GA 1400MM 80MM WO SH BOTH IP/OP $919.00 $680.00 $163.54 $918.75 $918.75 $918.75 $918.75 $918.75 $918.75 $918.75 $163.54 $918.75 $918.75 $681.90 $681.90 $708.17 $478.67 $191.48 $918.75 $367.50 $918.75 $918.75 $918.75 $918.75 $918.75 $689.25 $918.75 $918.75 $918.75 $459.38 $459.38 $727.65 $918.75 $735.00 $597.19 $918.75 N/A $533.02 $918.75 $551.25 $918.75 $918.75 $918.75 N/A N/A NA-U200H-8022S SUP Custom 27203010 NA-U200H-8022S - NEEDLE ASP 2.2MM 22GA 1400MM 80MM WSH BOTH IP/OP $919.00 $680.00 $163.54 $918.75 $918.75 $918.75 $918.75 $918.75 $918.75 $918.75 $163.54 $918.75 $918.75 $681.90 $681.90 $708.17 $478.67 $191.48 $918.75 $367.50 $918.75 $918.75 $918.75 $918.75 $918.75 $689.25 $918.75 $918.75 $918.75 $459.38 $459.38 $727.65 $918.75 $735.00 $597.19 $918.75 N/A $533.02 $918.75 $551.25 $918.75 $918.75 $918.75 N/A N/A NAV2076 SUP Custom 27203010 NAV2076 - BIT DRL 2.9MM STRL VRTX DISP BOTH IP/OP "$1,950.00" "$1,443.00" $347.10 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" $347.10 "$1,950.00" "$1,950.00" "$1,447.29" "$1,447.29" "$1,503.06" "$1,015.95" $406.40 "$1,950.00" $780.00 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,462.50" "$1,950.00" "$1,950.00" "$1,950.00" $975.00 $975.00 "$1,544.40" "$1,950.00" "$1,560.00" "$1,267.50" "$1,950.00" N/A "$1,131.00" "$1,950.00" "$1,170.00" "$1,950.00" "$1,950.00" "$1,950.00" N/A N/A NAVG3606010 SUP Custom 27203010 NAVG3606010 - BIT DRL STRL LF NAVIGATED INFNT DISP OC UPR THOR SYS BOTH IP/OP "$1,950.00" "$1,443.00" $347.10 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" $347.10 "$1,950.00" "$1,950.00" "$1,447.29" "$1,447.29" "$1,503.06" "$1,015.95" $406.40 "$1,950.00" $780.00 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,462.50" "$1,950.00" "$1,950.00" "$1,950.00" $975.00 $975.00 "$1,544.40" "$1,950.00" "$1,560.00" "$1,267.50" "$1,950.00" N/A "$1,131.00" "$1,950.00" "$1,170.00" "$1,950.00" "$1,950.00" "$1,950.00" N/A N/A NAVNS3606010 SUP Custom 27203010 NAVNS3606010 - DRILL SRG 2.4MM NS BOTH IP/OP "$1,950.00" "$1,443.00" $347.10 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" $347.10 "$1,950.00" "$1,950.00" "$1,447.29" "$1,447.29" "$1,503.06" "$1,015.95" $406.40 "$1,950.00" $780.00 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,462.50" "$1,950.00" "$1,950.00" "$1,950.00" $975.00 $975.00 "$1,544.40" "$1,950.00" "$1,560.00" "$1,267.50" "$1,950.00" N/A "$1,131.00" "$1,950.00" "$1,170.00" "$1,950.00" "$1,950.00" "$1,950.00" N/A N/A NB5STFLP SUP Custom 27203010 NB5STFLP - TROCAR LAPSCOP STANDARD LP 5MM FIX SMOOTH ENTRY DIRECTIONAL BOTH IP/OP $51.00 $38.00 $9.03 $50.75 $50.75 $50.75 $50.75 $50.75 $50.75 $50.75 $9.03 $50.75 $50.75 $37.67 $37.67 $39.12 $26.44 $10.58 $50.75 $20.30 $50.75 $50.75 $50.75 $50.75 $50.75 $38.25 $50.75 $50.75 $50.75 $25.38 $25.38 $40.19 $50.75 $40.60 $32.99 $50.75 N/A $29.58 $50.75 $30.45 $50.75 $50.75 $50.75 N/A N/A NL8505061 SUP Custom 27203010 NL8505061 - SHUNT CARDIO 5MM 3.5MM SUNDT CRTD INTNL LOOP CONICAL SPRG BOTH IP/OP "$1,035.00" $766.00 $184.23 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $184.23 "$1,035.00" "$1,035.00" $768.18 $768.18 $797.78 $539.24 $215.71 "$1,035.00" $414.00 "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" "$1,035.00" $776.25 "$1,035.00" "$1,035.00" "$1,035.00" $517.50 $517.50 $819.72 "$1,035.00" $828.00 $672.75 "$1,035.00" N/A $600.30 "$1,035.00" $621.00 "$1,035.00" "$1,035.00" "$1,035.00" N/A N/A NL850-5063 SUP Custom 27803010 NL850-5063 - SHUNT CAROTID STR 3.5-4.5MM 10CM 1CM TEMPORARY INTERNAL SOFT BOTH IP/OP "$1,120.50" $829.00 $199.38 "$1,120.13" "$1,120.13" "$1,120.13" "$1,120.13" "$1,120.13" "$1,120.13" "$1,120.13" $199.38 "$1,120.13" "$1,120.13" "$1,120.13" "$1,120.13" "$1,120.13" "$1,120.13" $233.45 "$1,120.13" $448.05 "$1,120.13" "$1,120.13" "$1,120.13" "$1,120.13" "$1,120.13" $840.38 "$1,120.13" "$1,120.13" "$1,120.13" $560.07 $560.07 $887.14 "$1,120.13" $896.10 $504.06 "$1,120.13" N/A $649.89 "$1,120.13" $672.08 "$1,120.13" "$1,120.13" "$1,120.13" N/A N/A NL8505065 SUP Custom 27803010 NL8505065 - SHUNT CARDIO 3X4MM 10CM INTERNAL LOOP SOFT CONICAL SPRING BOTH IP/OP $868.00 $642.00 $154.46 $867.78 $867.78 $867.78 $867.78 $867.78 $867.78 $867.78 $154.46 $867.78 $867.78 $867.78 $867.78 $867.78 $867.78 $180.85 $867.78 $347.11 $867.78 $867.78 $867.78 $867.78 $867.78 $651.00 $867.78 $867.78 $867.78 $433.89 $433.89 $687.28 $867.78 $694.22 $390.50 $867.78 N/A $503.44 $867.78 $520.67 $867.78 $867.78 $867.78 N/A N/A NL850-5067 SUP Custom 27803010 NL850-5067 - SHUNT CAROTID STR 4-5MM 10CM TEMPORARY INTERNAL SOFT CONICAL BOTH IP/OP $868.00 $642.00 $154.46 $867.78 $867.78 $867.78 $867.78 $867.78 $867.78 $867.78 $154.46 $867.78 $867.78 $867.78 $867.78 $867.78 $867.78 $180.85 $867.78 $347.11 $867.78 $867.78 $867.78 $867.78 $867.78 $651.00 $867.78 $867.78 $867.78 $433.89 $433.89 $687.28 $867.78 $694.22 $390.50 $867.78 N/A $503.44 $867.78 $520.67 $867.78 $867.78 $867.78 N/A N/A NL8505070 SUP Custom 27803010 NL8505070 - SHUNT CAROTID 3-4MM 30CM TEMPORARY EXTERNAL LOOP SOFT BOTH IP/OP $966.00 $715.00 $171.88 $965.63 $965.63 $965.63 $965.63 $965.63 $965.63 $965.63 $171.88 $965.63 $965.63 $965.63 $965.63 $965.63 $965.63 $201.25 $965.63 $386.25 $965.63 $965.63 $965.63 $965.63 $965.63 $724.50 $965.63 $965.63 $965.63 $482.82 $482.82 $764.78 $965.63 $772.50 $434.53 $965.63 N/A $560.28 $965.63 $579.38 $965.63 $965.63 $965.63 N/A N/A NL8505071 SUP Custom 27803010 NL8505071 - SHUNT CAROTID 3.5-5MM 30CM TEMPORARY EXTERNAL LOOP SOFT BOTH IP/OP "$1,221.50" $904.00 $217.34 "$1,221.03" "$1,221.03" "$1,221.03" "$1,221.03" "$1,221.03" "$1,221.03" "$1,221.03" $217.34 "$1,221.03" "$1,221.03" "$1,221.03" "$1,221.03" "$1,221.03" "$1,221.03" $254.48 "$1,221.03" $488.41 "$1,221.03" "$1,221.03" "$1,221.03" "$1,221.03" "$1,221.03" $916.13 "$1,221.03" "$1,221.03" "$1,221.03" $610.52 $610.52 $967.06 "$1,221.03" $976.82 $549.46 "$1,221.03" N/A $708.47 "$1,221.03" $732.62 "$1,221.03" "$1,221.03" "$1,221.03" N/A N/A NL850-5072 SUP Custom 27803010 NL850-5072 - SHUNT CAROTID 4-5MM 5.5-6.3MM 2.2-3.1MM 30CM TEMPORARY BOTH IP/OP $1.00 $1.00 $0.18 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.18 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $1.00 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $1.00 N/A $0.58 $1.00 $0.60 $1.00 $1.00 $1.00 N/A N/A NL850-5076 SUP Custom 27803010 NL850-5076 - SHUNT NEUROSURGICAL 3-4MM 30CM NONREINFORCED EXTERNAL LOOP BOTH IP/OP $1.00 $1.00 $0.18 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.18 $1.00 $1.00 $1.00 $1.00 $1.00 $1.00 $0.21 $1.00 $0.40 $1.00 $1.00 $1.00 $1.00 $1.00 $0.75 $1.00 $1.00 $1.00 $0.50 $0.50 $0.79 $1.00 $0.80 $0.45 $1.00 N/A $0.58 $1.00 $0.60 $1.00 $1.00 $1.00 N/A N/A NL8505078 SUP Custom 27803010 NL8505078 - SHUNT CARDIO 4MM 5MM 30CM EXTERNAL LOOP NONREINFORCED CENTER BOTH IP/OP "$1,508.00" "$1,116.00" $268.37 "$1,507.68" "$1,507.68" "$1,507.68" "$1,507.68" "$1,507.68" "$1,507.68" "$1,507.68" $268.37 "$1,507.68" "$1,507.68" "$1,507.68" "$1,507.68" "$1,507.68" "$1,507.68" $314.22 "$1,507.68" $603.07 "$1,507.68" "$1,507.68" "$1,507.68" "$1,507.68" "$1,507.68" "$1,131.00" "$1,507.68" "$1,507.68" "$1,507.68" $753.84 $753.84 "$1,194.08" "$1,507.68" "$1,206.14" $678.46 "$1,507.68" N/A $874.64 "$1,507.68" $904.61 "$1,507.68" "$1,507.68" "$1,507.68" N/A N/A NL865 SUP Custom 27203010 NL865 - BLADE WIRE SAW 12IN ROUND SPIRAL LOOPED END LATEX FREE GIGLI BOTH IP/OP $121.50 $90.00 $21.63 $121.50 $121.50 $121.50 $121.50 $121.50 $121.50 $121.50 $21.63 $121.50 $121.50 $90.18 $90.18 $93.65 $63.30 $25.32 $121.50 $48.60 $121.50 $121.50 $121.50 $121.50 $121.50 $91.13 $121.50 $121.50 $121.50 $60.75 $60.75 $96.23 $121.50 $97.20 $78.98 $121.50 N/A $70.47 $121.50 $72.90 $121.50 $121.50 $121.50 N/A N/A NN-8004 SUP Custom 27011340 NN-8004 - HANDPIECE ELECTROSURGICAL 13GA 13CM MYRIAD BOTH IP/OP "$7,402.50" "$5,478.00" "$1,317.65" "$8,235.00" "$7,402.50" "$7,402.50" "$7,402.50" "$7,402.50" "$7,402.50" "$7,402.50" "$1,317.65" "$7,402.50" "$7,402.50" "$4,181.12" "$4,181.12" "$5,705.85" "$2,060.15" "$1,542.76" "$7,402.50" "$3,458.67" "$7,402.50" "$7,402.50" "$8,235.00" "$7,402.50" "$7,402.50" "$5,551.88" "$7,402.50" "$7,402.50" "$7,402.50" "$3,701.25" "$3,701.25" "$5,862.78" "$7,402.50" "$5,922.00" "$4,811.63" "$7,402.50" N/A "$4,293.45" "$7,402.50" "$4,441.50" "$7,402.50" "$7,402.50" "$7,402.50" N/A N/A NN-8011 SUP HCPCS C1894 NN-8011 - SHEATH ENDSCP 13.5MM 50MM GROUNDBREAK ACCES TECHNOLOGY BOTH IP/OP "$4,975.00" "$3,682.00" $987.41 "$6,060.00" "$2,701.43" "$2,701.43" "$2,701.43" "$2,701.43" "$4,975.00" "$4,975.00" "$4,975.00" "$1,036.91" "$4,975.00" "$3,692.45" "$3,692.45" "$3,834.73" "$2,060.15" "$1,036.84" "$4,975.00" "$6,060.00" "$2,942.71" "$4,975.00" "$5,535.00" "$4,975.00" "$4,975.00" "$3,731.25" "$4,975.00" "$4,975.00" "$4,975.00" "$2,487.50" "$2,487.50" "$3,940.20" "$4,975.00" "$3,980.00" "$3,233.75" $987.41 N/A "$2,885.50" "$4,975.00" "$4,975.00" "$4,975.00" "$1,036.79" "$4,975.00" N/A N/A NN-8012 SUP HCPCS C1894 NN-8012 - SHEATH ENDSCP 13.5MM 60MM GROUNDBREAK ACCES TECHNOLOGY BOTH IP/OP "$2,562.50" "$1,896.00" $508.59 "$3,030.00" "$1,391.44" "$1,391.44" "$1,391.44" "$1,391.44" "$2,562.50" "$2,562.50" "$2,562.50" $534.09 "$2,562.50" "$1,901.89" "$1,901.89" "$1,975.18" "$1,335.06" $534.05 "$2,562.50" "$3,030.00" "$1,515.72" "$2,562.50" "$2,767.50" "$2,562.50" "$2,562.50" "$1,921.88" "$2,562.50" "$2,562.50" "$2,562.50" "$1,281.25" "$1,281.25" "$2,029.50" "$2,562.50" "$2,050.00" "$1,665.63" $508.59 N/A "$1,486.25" "$2,562.50" "$2,562.50" "$2,562.50" $534.03 "$2,562.50" N/A N/A NN-8013 SUP HCPCS C1894 NN-8013 - SHEATH ENDSCP 13.5MM 75MM GROUNDBREAK ACCES TECHNOLOGY BOTH IP/OP "$5,125.00" "$3,793.00" "$1,017.18" "$6,060.00" "$2,782.88" "$2,782.88" "$2,782.88" "$2,782.88" "$5,125.00" "$5,125.00" "$5,125.00" "$1,068.18" "$5,125.00" "$3,803.78" "$3,803.78" "$3,950.35" "$2,060.15" "$1,068.11" "$5,125.00" "$6,060.00" "$3,031.44" "$5,125.00" "$5,125.00" "$5,125.00" "$5,125.00" "$3,843.75" "$5,125.00" "$5,125.00" "$5,125.00" "$2,562.50" "$2,562.50" "$4,059.00" "$5,125.00" "$4,100.00" "$3,331.25" "$1,017.18" N/A "$2,972.50" "$5,125.00" "$5,125.00" "$5,125.00" "$1,068.05" "$5,125.00" N/A N/A NN-8016 SUP Custom 27203010 NN-8016 - VALVE MRCLTR .5MM STRL LF NICO MYRIAD INFS MTR LN DISP BOTH IP/OP $175.00 $130.00 $31.15 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $175.00 $31.15 $175.00 $175.00 $129.89 $129.89 $134.89 $91.18 $36.47 $175.00 $113.40 $175.00 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $113.75 $175.00 N/A $101.50 $175.00 $105.00 $175.00 $175.00 $175.00 N/A N/A NN-8030 SUP Custom 27203010 NN-8030 - SHEATH ESCP 13.5MM 95MM STRL BRAINPATH ATRM TIP LCK FRST BOTH IP/OP "$2,562.50" "$1,896.00" $456.13 "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" $456.13 "$2,562.50" "$2,562.50" "$1,901.89" "$1,901.89" "$1,975.18" "$1,335.06" $534.05 "$2,562.50" "$1,212.00" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$1,921.88" "$2,562.50" "$2,562.50" "$2,562.50" "$1,281.25" "$1,281.25" "$2,029.50" "$2,562.50" "$2,050.00" "$1,665.63" "$2,562.50" N/A "$1,486.25" "$2,562.50" "$1,537.50" "$2,562.50" "$2,562.50" "$2,562.50" N/A N/A NON21459 SUP Custom 27203010 NON21459 - PAD ABD 30X10IN STRL LF ABS NWVN SFT HDRPHB BCK BOTH IP/OP $122.00 $90.00 $21.70 $121.92 $121.92 $121.92 $121.92 $121.92 $121.92 $121.92 $21.70 $121.92 $121.92 $90.49 $90.49 $93.98 $63.52 $25.41 $121.92 $48.77 $121.92 $121.92 $121.92 $121.92 $121.92 $91.50 $121.92 $121.92 $121.92 $60.96 $60.96 $96.56 $121.92 $97.54 $79.25 $121.92 N/A $70.76 $121.92 $73.15 $121.92 $121.92 $121.92 N/A N/A NON28226 SUP HCPCS C1713 NON28226 - CAP BOUF REG LG 24IN FLG LF PR MULTIPLY ELC CLSR LTWT LINT BOTH IP/OP $0.50 $0.00 $0.04 $0.38 $0.10 $0.10 $0.10 $0.10 $0.22 $0.22 $0.22 $0.05 $0.22 $0.22 $0.22 $0.22 $0.22 $0.05 $0.22 $0.12 $0.13 $0.22 $0.30 $0.22 $0.22 $0.38 $0.22 $0.22 $0.22 $0.11 $0.11 $0.17 $0.22 $0.18 $0.10 $0.04 N/A $0.29 $0.22 $0.13 $0.22 $0.22 $0.22 N/A N/A NON28234P SUP HCPCS C1713 NON28234P - CAP BOUF REG LG 24IN LF PR MULTIPLY ELC CLSR LTWT LINT FR PP BOTH IP/OP $435.00 $322.00 $86.31 $434.85 $195.68 $195.68 $195.68 $195.68 $434.85 $434.85 $434.85 $90.63 $434.85 $434.85 $434.85 $434.85 $434.85 $90.63 $434.85 $333.98 $257.21 $434.85 $333.98 $434.85 $434.85 $326.25 $434.85 $434.85 $434.85 $217.43 $217.43 $344.40 $434.85 $347.88 $195.68 $86.31 N/A $252.30 $434.85 $260.91 $434.85 $90.62 $434.85 N/A N/A NPAS-100 SUP HCPCS C1894 NPAS-100 - GWIRE VASC .018IN 7FR 22GA 20CM 15CM INTROD NDL NEFF SS PERC BOTH IP/OP $171.00 $127.00 $33.91 $170.84 $92.77 $92.77 $92.77 $92.77 $170.84 $170.84 $170.84 $35.61 $170.84 $126.80 $126.80 $131.68 $89.01 $35.60 $170.84 $170.84 $101.05 $170.84 $170.84 $170.84 $170.84 $128.25 $170.84 $170.84 $170.84 $85.42 $85.42 $135.31 $170.84 $136.67 $111.05 $33.91 N/A $99.18 $170.84 $170.84 $170.84 $35.60 $170.84 N/A N/A NSLG2S25 SUP Custom 27203010 NSLG2S25 - DEVICE SL STRG 25CM ENSEAL G2 I-BLDE END TO END EES GNTR ROT BOTH IP/OP "$1,329.00" $983.00 $236.48 "$1,328.53" "$1,328.53" "$1,328.53" "$1,328.53" "$1,328.53" "$1,328.53" "$1,328.53" $236.48 "$1,328.53" "$1,328.53" $986.03 $986.03 "$1,024.03" $692.16 $276.88 "$1,328.53" $753.75 "$1,328.53" "$1,328.53" "$1,328.53" "$1,328.53" "$1,328.53" $996.75 "$1,328.53" "$1,328.53" "$1,328.53" $664.27 $664.27 "$1,052.20" "$1,328.53" "$1,062.82" $863.54 "$1,328.53" N/A $770.82 "$1,328.53" $797.12 "$1,328.53" "$1,328.53" "$1,328.53" N/A N/A NSLG2S35 SUP Custom 27203010 NSLG2S35 - SEALER TISS 360D STRG 5MM 35CM ENSEAL G2 STRNG I-BLDE TCH BOTH IP/OP "$1,637.00" "$1,211.00" $291.31 "$1,636.58" "$1,636.58" "$1,636.58" "$1,636.58" "$1,636.58" "$1,636.58" "$1,636.58" $291.31 "$1,636.58" "$1,636.58" "$1,214.67" "$1,214.67" "$1,261.48" $852.66 $341.08 "$1,636.58" $745.99 "$1,636.58" "$1,636.58" "$1,636.58" "$1,636.58" "$1,636.58" "$1,227.75" "$1,636.58" "$1,636.58" "$1,636.58" $818.29 $818.29 "$1,296.17" "$1,636.58" "$1,309.26" "$1,063.78" "$1,636.58" N/A $949.46 "$1,636.58" $981.95 "$1,636.58" "$1,636.58" "$1,636.58" N/A N/A NSLX120L SUP Custom 27203010 NSLX120L - SEALER BP 13MM 20CM ENSEAL X1 CRV LG JAW BOTH IP/OP "$2,181.00" "$1,614.00" $388.19 "$2,180.86" "$2,180.86" "$2,180.86" "$2,180.86" "$2,180.86" "$2,180.86" "$2,180.86" $388.19 "$2,180.86" "$2,180.86" "$1,618.63" "$1,618.63" "$1,681.01" "$1,136.23" $454.52 "$2,180.86" $976.50 "$2,180.86" "$2,180.86" "$2,180.86" "$2,180.86" "$2,180.86" "$1,635.75" "$2,180.86" "$2,180.86" "$2,180.86" "$1,090.43" "$1,090.43" "$1,727.24" "$2,180.86" "$1,744.69" "$1,417.56" "$2,180.86" N/A "$1,264.98" "$2,180.86" "$1,308.52" "$2,180.86" "$2,180.86" "$2,180.86" N/A N/A N-VVDC-01-ABRM SUP Custom 27803010 N-VVDC-01-ABRM - CATHETER XTRN DRN 3MM 33CM EVM VNTRC BOTH IP/OP $144.00 $107.00 $25.63 $144.00 $144.00 $144.00 $144.00 $144.00 $144.00 $144.00 $25.63 $144.00 $144.00 $144.00 $144.00 $144.00 $144.00 $30.01 $144.00 $57.60 $144.00 $144.00 $144.00 $144.00 $144.00 $108.00 $144.00 $144.00 $144.00 $72.00 $72.00 $114.05 $144.00 $115.20 $64.80 $144.00 N/A $83.52 $144.00 $86.40 $144.00 $144.00 $144.00 N/A N/A OHOOKR-8 SUP HCPCS C1713 OHOOKR-8 - PLATE BN RT OFST OLCRN HK PLT CORT BOTH IP/OP "$2,212.50" "$1,637.00" $439.13 "$2,212.50" $995.63 $995.63 $995.63 $995.63 "$2,212.50" "$2,212.50" "$2,212.50" $461.14 "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" $461.11 "$2,212.50" $885.00 "$1,308.69" "$2,212.50" "$2,212.50" "$2,212.50" "$2,212.50" "$1,659.38" "$2,212.50" "$2,212.50" "$2,212.50" "$1,106.25" "$1,106.25" "$1,752.30" "$2,212.50" "$1,770.00" $995.63 $439.13 N/A "$1,283.25" "$2,212.50" "$2,212.50" "$2,212.50" $461.09 "$2,212.50" N/A N/A OM-10000Z SUP Custom 27203010 OM-10000Z - STABILIZER SURGICAL ACROBAT I SUCTION POD MALLEABLE FOOT BOTH IP/OP "$3,525.50" "$2,609.00" $627.52 "$3,525.40" "$3,525.40" "$3,525.40" "$3,525.40" "$3,525.40" "$3,525.40" "$3,525.40" $627.52 "$3,525.40" "$3,525.40" "$2,616.55" "$2,616.55" "$2,717.38" "$1,836.73" $734.73 "$3,525.40" "$1,410.16" "$3,525.40" "$3,525.40" "$3,525.40" "$3,525.40" "$3,525.40" "$2,644.13" "$3,525.40" "$3,525.40" "$3,525.40" "$1,762.70" "$1,762.70" "$2,792.12" "$3,525.40" "$2,820.32" "$2,291.51" "$3,525.40" N/A "$2,044.79" "$3,525.40" "$2,115.24" "$3,525.40" "$3,525.40" "$3,525.40" N/A N/A OMST12BT SUP Custom 27203010 OMST12BT - TROCAR LAPSCOP 5-10MM 12MM BLUNT TIP BUILT IN CONVERTER BOTH IP/OP "$1,089.50" $806.00 $193.88 "$1,089.22" "$1,089.22" "$1,089.22" "$1,089.22" "$1,089.22" "$1,089.22" "$1,089.22" $193.88 "$1,089.22" "$1,089.22" $808.42 $808.42 $839.57 $567.48 $227.01 "$1,089.22" $206.10 "$1,089.22" "$1,089.22" $515.26 "$1,089.22" "$1,089.22" $817.13 "$1,089.22" "$1,089.22" "$1,089.22" $544.61 $544.61 $862.66 "$1,089.22" $871.38 $707.99 "$1,089.22" N/A $631.91 "$1,089.22" $653.53 "$1,089.22" "$1,089.22" "$1,089.22" N/A N/A OMS-T12BT SUP Custom 27203010 OMS-T12BT - TROCAR LAPSCOP 12MM SPCMKR BLNT TIP BLN STRL DISP PRPERITN BOTH IP/OP $318.50 $236.00 $56.61 $318.05 $318.05 $318.05 $318.05 $318.05 $318.05 $318.05 $56.61 $318.05 $318.05 $236.06 $236.06 $245.15 $165.70 $66.29 $318.05 $127.22 $318.05 $318.05 $318.05 $318.05 $318.05 $238.88 $318.05 $318.05 $318.05 $159.03 $159.03 $251.90 $318.05 $254.44 $206.73 $318.05 N/A $184.73 $318.05 $190.83 $318.05 $318.05 $318.05 N/A N/A OMST12T SUP Custom 27203010 OMST12T - BALLON TIP TROCAR BOTH IP/OP "$1,646.00" "$1,218.00" $292.97 "$1,645.90" "$1,645.90" "$1,645.90" "$1,645.90" "$1,645.90" "$1,645.90" "$1,645.90" $292.97 "$1,645.90" "$1,645.90" "$1,221.59" "$1,221.59" "$1,268.66" $857.51 $343.02 "$1,645.90" $658.36 "$1,645.90" "$1,645.90" "$1,645.90" "$1,645.90" "$1,645.90" "$1,234.50" "$1,645.90" "$1,645.90" "$1,645.90" $822.95 $822.95 "$1,303.55" "$1,645.90" "$1,316.72" "$1,069.84" "$1,645.90" N/A $954.68 "$1,645.90" $987.54 "$1,645.90" "$1,645.90" "$1,645.90" N/A N/A ONB12LGF SUP Custom 27203010 ONB12LGF - TROCAR LAPSCP LNG 12MM 150MM STRL LF VRSPRT V2 FX CNN BLDLS BOTH IP/OP $451.00 $334.00 $80.23 $450.75 $450.75 $450.75 $450.75 $450.75 $450.75 $450.75 $80.23 $450.75 $450.75 $334.55 $334.55 $347.44 $234.84 $93.94 $450.75 $180.30 $450.75 $450.75 $450.75 $450.75 $450.75 $338.25 $450.75 $450.75 $450.75 $225.38 $225.38 $356.99 $450.75 $360.60 $292.99 $450.75 N/A $261.58 $450.75 $270.45 $450.75 $450.75 $450.75 N/A N/A ONXACE-19 SUP Custom 27803010 ONXACE-19 - VALVE AOR 19MM ONX BOTH IP/OP "$14,875.00" "$11,008.00" "$2,647.75" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$2,647.75" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$3,100.11" "$14,875.00" "$5,950.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$11,156.25" "$14,875.00" "$14,875.00" "$14,875.00" "$7,437.50" "$7,437.50" "$11,781.00" "$14,875.00" "$11,900.00" "$6,693.75" "$14,875.00" N/A "$8,627.50" "$14,875.00" "$8,925.00" "$14,875.00" "$14,875.00" "$14,875.00" N/A N/A ONXACE-21 SUP Custom 27803010 ONXACE-21 - VALVE AOR 21MM ONX BOTH IP/OP "$14,875.00" "$11,008.00" "$2,647.75" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$2,647.75" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$3,100.11" "$14,875.00" "$5,950.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$11,156.25" "$14,875.00" "$14,875.00" "$14,875.00" "$7,437.50" "$7,437.50" "$11,781.00" "$14,875.00" "$11,900.00" "$6,693.75" "$14,875.00" N/A "$8,627.50" "$14,875.00" "$8,925.00" "$14,875.00" "$14,875.00" "$14,875.00" N/A N/A ONXACE-23 SUP Custom 27803010 ONXACE-23 - VALVE AOR 23MM ONX BOTH IP/OP "$14,875.00" "$11,008.00" "$2,647.75" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$2,647.75" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$3,100.11" "$14,875.00" "$5,950.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$11,156.25" "$14,875.00" "$14,875.00" "$14,875.00" "$7,437.50" "$7,437.50" "$11,781.00" "$14,875.00" "$11,900.00" "$6,693.75" "$14,875.00" N/A "$8,627.50" "$14,875.00" "$8,925.00" "$14,875.00" "$14,875.00" "$14,875.00" N/A N/A ONXACE-25 SUP Custom 27803010 ONXACE-25 - VALVE AOR 23.4MM 25MM 17.4MM ONX CNFRM-X SW RING PROS BOTH IP/OP "$14,875.00" "$11,008.00" "$2,647.75" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$2,647.75" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$3,100.11" "$14,875.00" "$5,950.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$11,156.25" "$14,875.00" "$14,875.00" "$14,875.00" "$7,437.50" "$7,437.50" "$11,781.00" "$14,875.00" "$11,900.00" "$6,693.75" "$14,875.00" N/A "$8,627.50" "$14,875.00" "$8,925.00" "$14,875.00" "$14,875.00" "$14,875.00" N/A N/A ONXACE-25/33 SUP Custom 27803010 ONXACE-25/33 - ON-X AORTIC VALVE SIZE 25/33 BOTH IP/OP "$14,875.00" "$11,008.00" "$2,647.75" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$2,647.75" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$3,100.11" "$14,875.00" "$5,950.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$11,156.25" "$14,875.00" "$14,875.00" "$14,875.00" "$7,437.50" "$7,437.50" "$11,781.00" "$14,875.00" "$11,900.00" "$6,693.75" "$14,875.00" N/A "$8,627.50" "$14,875.00" "$8,925.00" "$14,875.00" "$14,875.00" "$14,875.00" N/A N/A ONXACE-27/29 SUP Custom 27803010 ONXACE-27/29 - VALVE AOR 23.4MM 27/29MM 17.4MM ONX CNFRM-X SW RING PROS BOTH IP/OP "$14,875.00" "$11,008.00" "$2,647.75" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$2,647.75" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$3,100.11" "$14,875.00" "$5,950.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$14,875.00" "$11,156.25" "$14,875.00" "$14,875.00" "$14,875.00" "$7,437.50" "$7,437.50" "$11,781.00" "$14,875.00" "$11,900.00" "$6,693.75" "$14,875.00" N/A "$8,627.50" "$14,875.00" "$8,925.00" "$14,875.00" "$14,875.00" "$14,875.00" N/A N/A OS-401 SUP Custom 27804086 OS-401 - FILLER BN VOID 4CC BOTH IP/OP $375.00 $278.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $150.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $375.00 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A OSN-50 SUP HCPCS C1713 OSN-50 - WIRE FX 50MM SLED NTRL OLCRN BOTH IP/OP "$2,150.00" "$1,591.00" $426.72 "$2,150.00" $967.50 $967.50 $967.50 $967.50 "$2,150.00" "$2,150.00" "$2,150.00" $448.11 "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" $448.08 "$2,150.00" $860.00 "$1,271.73" "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" "$1,612.50" "$2,150.00" "$2,150.00" "$2,150.00" "$1,075.00" "$1,075.00" "$1,702.80" "$2,150.00" "$1,720.00" $967.50 $426.72 N/A "$1,247.00" "$2,150.00" "$2,150.00" "$2,150.00" $448.06 "$2,150.00" N/A N/A OSN-70 SUP HCPCS C1713 OSN-70 - WIRE FIX 70MM SLED NEUTRAL OLECRANON BOTH IP/OP "$2,412.50" "$1,785.00" $478.82 "$2,412.50" "$1,085.63" "$1,085.63" "$1,085.63" "$1,085.63" "$2,412.50" "$2,412.50" "$2,412.50" $502.83 "$2,412.50" "$2,412.50" "$2,412.50" "$2,412.50" "$2,412.50" $502.79 "$2,412.50" "$2,412.50" "$1,426.99" "$2,412.50" "$2,412.50" "$2,412.50" "$2,412.50" "$1,809.38" "$2,412.50" "$2,412.50" "$2,412.50" "$1,206.25" "$1,206.25" "$1,910.70" "$2,412.50" "$1,930.00" "$1,085.63" $478.82 N/A "$1,399.25" "$2,412.50" "$2,412.50" "$2,412.50" $502.77 "$2,412.50" N/A N/A OSW SUP HCPCS C1713 OSW - WASHER ORTHOPEDIC LP FIX OLECRANON STERILE BOTH IP/OP $687.50 $509.00 $136.45 $687.50 $309.38 $309.38 $309.38 $309.38 $687.50 $687.50 $687.50 $143.29 $687.50 $687.50 $687.50 $687.50 $687.50 $143.28 $687.50 $687.50 $406.66 $687.50 $687.50 $687.50 $687.50 $515.63 $687.50 $687.50 $687.50 $343.75 $343.75 $544.50 $687.50 $550.00 $309.38 $136.45 N/A $398.75 $687.50 $687.50 $687.50 $143.28 $687.50 N/A N/A P100510 SUP HCPCS C1781 P100510 - GRAFT SFT TIS THK1MM 10X5CM STRL PERMACOL PRCN DRML CLGN BOTH IP/OP $49.00 $36.00 $9.73 $49.00 $22.05 $22.05 $22.05 $22.05 $49.00 $49.00 $49.00 $10.21 $49.00 $49.00 $49.00 $49.00 $49.00 $10.21 $49.00 $49.00 $28.98 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $22.05 $9.73 N/A $28.42 $49.00 $49.00 $49.00 $10.21 $49.00 N/A N/A P101010 SUP HCPCS C9364 P101010 - GRAFT SFT TIS THK1MM 10X10CM STRL PERMACOL PRCN DRML CLGN BOTH IP/OP $49.00 $36.00 $10.21 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $17.30 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $22.05 $49.00 N/A $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A P101015 SUP HCPCS C9364 P101015 - GRAFT SFT TIS THK1MM 15X10CM STRL PERMACOL PRCN DRML CLGN BOTH IP/OP "$7,500.00" "$5,550.00" $17.30 "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" $17.30 "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$1,563.08" "$7,500.00" "$3,000.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$7,500.00" "$5,625.00" "$7,500.00" "$7,500.00" "$7,500.00" "$3,750.00" "$3,750.00" "$5,940.00" "$7,500.00" "$6,000.00" "$3,375.00" "$7,500.00" N/A "$4,350.00" "$7,500.00" "$4,500.00" "$7,500.00" "$7,500.00" "$7,500.00" N/A N/A P101828 SUP HCPCS C9364 P101828 - GRAFT SFT TIS THK1MM 28X18CM STRL PERMACOL PRCN DRML CLGN BOTH IP/OP "$27,720.00" "$20,513.00" $17.30 "$27,720.00" "$27,720.00" "$27,720.00" "$27,720.00" "$27,720.00" "$27,720.00" "$27,720.00" $17.30 "$27,720.00" "$27,720.00" "$27,720.00" "$27,720.00" "$27,720.00" "$27,720.00" "$5,777.15" "$27,720.00" "$11,088.00" "$27,720.00" "$27,720.00" "$27,720.00" "$27,720.00" "$27,720.00" "$20,790.00" "$27,720.00" "$27,720.00" "$27,720.00" "$13,860.00" "$13,860.00" "$21,954.24" "$27,720.00" "$22,176.00" "$12,474.00" "$27,720.00" N/A "$16,077.60" "$27,720.00" "$16,632.00" "$27,720.00" "$27,720.00" "$27,720.00" N/A N/A P151015 SUP HCPCS C9364 P151015 - GRAFT SFT TIS THK1.5MM 15X10CM STRL PERMACOL PRCN DRML CLGN BOTH IP/OP $49.00 $36.00 $10.21 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $17.30 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $22.05 $49.00 N/A $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A P151020 SUP HCPCS C9364 P151020 - GRAFT SFT TIS THK1.5MM 10X20CM STRL PERMACOL PRCN DRML CLGN BOTH IP/OP $73.50 $54.00 $15.32 $73.50 $73.50 $73.50 $73.50 $73.50 $73.50 $73.50 $17.30 $73.50 $73.50 $73.50 $73.50 $73.50 $73.50 $15.32 $73.50 $29.40 $73.50 $73.50 $73.50 $73.50 $73.50 $55.13 $73.50 $73.50 $73.50 $36.75 $36.75 $58.21 $73.50 $58.80 $33.08 $73.50 N/A $42.63 $73.50 $44.10 $73.50 $73.50 $73.50 N/A N/A P151520 SUP HCPCS C9364 P151520 - GRAFT SFT TIS THK1.5MM 20X15CM STRL PERMACOL PRCN DRML CLGN BOTH IP/OP $49.00 $36.00 $10.21 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $17.30 $49.00 $49.00 $49.00 $49.00 $49.00 $49.00 $10.21 $49.00 $19.60 $49.00 $49.00 $49.00 $49.00 $49.00 $36.75 $49.00 $49.00 $49.00 $24.50 $24.50 $38.81 $49.00 $39.20 $22.05 $49.00 N/A $28.42 $49.00 $29.40 $49.00 $49.00 $49.00 N/A N/A P152030 SUP HCPCS C9364 P152030 - GRAFT SFT TIS THK1.5MM 30X20CM STRL PERMACOL PRCN DRML CLGN BOTH IP/OP $54.00 $40.00 $11.23 $53.90 $53.90 $53.90 $53.90 $53.90 $53.90 $53.90 $17.30 $53.90 $53.90 $53.90 $53.90 $53.90 $53.90 $11.23 $53.90 $21.56 $53.90 $53.90 $53.90 $53.90 $53.90 $40.50 $53.90 $53.90 $53.90 $26.95 $26.95 $42.69 $53.90 $43.12 $24.26 $53.90 N/A $31.32 $53.90 $32.34 $53.90 $53.90 $53.90 N/A N/A P152040 SUP HCPCS C9364 P152040 - GRAFT SFT TIS THK1.5MM 40X20CM STRL PERMACOL PRCN DRML CLGN BOTH IP/OP "$43,120.00" "$31,909.00" $17.30 "$43,120.00" "$43,120.00" "$43,120.00" "$43,120.00" "$43,120.00" "$43,120.00" "$43,120.00" $17.30 "$43,120.00" "$43,120.00" "$43,120.00" "$43,120.00" "$43,120.00" "$43,120.00" "$8,986.68" "$43,120.00" "$17,248.00" "$43,120.00" "$43,120.00" "$43,120.00" "$43,120.00" "$43,120.00" "$32,340.00" "$43,120.00" "$43,120.00" "$43,120.00" "$21,560.00" "$21,560.00" "$34,151.04" "$43,120.00" "$34,496.00" "$19,404.00" "$43,120.00" N/A "$25,009.60" "$43,120.00" "$25,872.00" "$43,120.00" "$43,120.00" "$43,120.00" N/A N/A P224PC8T SUP HCPCS C1725 P224PC8T - CATHETER CENTRAL VENOUS BOTH IP/OP $125.00 $93.00 $24.79 $124.88 $67.81 $67.81 $67.81 $67.81 $124.88 $124.88 $124.88 $26.03 $124.88 $92.69 $92.69 $96.26 $65.06 $26.03 $124.88 $124.88 $73.87 $124.88 $124.88 $124.88 $124.88 $93.75 $124.88 $124.88 $124.88 $62.44 $62.44 $98.90 $124.88 $99.90 $81.17 $24.79 N/A $72.50 $124.88 $124.88 $124.88 $26.02 $124.88 N/A N/A PALS-25100-CC SUP HCPCS C1713 PALS-25100-CC - SCREW BN 2.5MM 10MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A PALS-25120-CC SUP HCPCS C1713 PALS-25120-CC - SCREW BN 2.5MM 12MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A PALS-25140-CC SUP HCPCS C1713 PALS-25140-CC - SCREW BN 2.5MM 14MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A PALS-25160-CC SUP HCPCS C1713 PALS-25160-CC - SCREW BN 2.5MM 16MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A PALS-25180-CC SUP HCPCS C1713 PALS-25180-CC - SCREW BN 2.5MM 18MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $140.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A PALS-25200-CC SUP HCPCS C1713 PALS-25200-CC - SCREW BN 2.5MM 20MM GEMINUS CNN LCK PA COCR DIST VOLR RDS BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $140.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A PALS-25220-CC SUP HCPCS C1713 PALS-25220-CC - SCREW BN 2.5MM 22MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $140.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A PALS-25240-CC SUP HCPCS C1713 PALS-25240-CC - SCREW BN 2.5MM 24MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $140.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A PALS-25260-CC SUP HCPCS C1713 PALS-25260-CC - SCREW BN 2.5MM 26MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $140.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A PALS-25280-CC SUP HCPCS C1713 PALS-25280-CC - SCREW BN 2.5MM 28MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $140.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A PALS-25300-CC SUP HCPCS C1713 PALS-25300-CC - SCREW BN 2.5MM 30MM NS GEMINUS PA LCK CNN COCR DIST VOLR RDS BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $140.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $210.00 $350.00 $72.94 $350.00 N/A N/A PANL-35080-TS SUP HCPCS C1713 PANL-35080-TS - SCREW BN 3.5MM 8MM NLCKG TI CORT BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A PANL-35090-TS SUP HCPCS C1713 PANL-35090-TS - SCREW BN 3.5MM 9MM NLCKG TI CORT BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A PANL-35100-TS SUP HCPCS C1713 PANL-35100-TS - SCREW BN 3.5MM 10MM BLU NS GEMINUS PA TI CORT VOLR DIST RDS BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $87.00 $146.40 $247.50 $217.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A PANL-35110-TS SUP HCPCS C1713 PANL-35110-TS - SCREW BN 3.5MM 11MM BLU NS GEMINUS PA TI CORT VOLR DIST RDS BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $87.00 $146.40 $247.50 $217.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $148.50 $247.50 $51.58 $247.50 N/A N/A PANL-35120-TS SUP HCPCS C1713 PANL-35120-TS - SCREW BN 3.5MM 12MM NS GEMINUS PA NLCKG TI CORT DIST VOLR BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $217.50 $217.50 $45.33 $217.50 N/A N/A PANL-35130-TS SUP HCPCS C1713 PANL-35130-TS - SCREW BN 3.5MM 13MM NS GEMINUS PA NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A PANL-35140-TS SUP HCPCS C1713 PANL-35140-TS - SCREW BN 3.5MM 14MM NS GEMINUS PA NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $217.50 $217.50 $45.33 $217.50 N/A N/A PANL-35150-TS SUP HCPCS C1713 PANL-35150-TS - SCREW BN 3.5MM 15MM NS GEMINUS PA NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A PANL-35160-TS SUP HCPCS C1713 PANL-35160-TS - SCREW BN 3.5MM 16MM NS GEMINUS PA NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A PANL-35170-TS SUP HCPCS C1713 PANL-35170-TS - SCREW BN 3.5MM 17MM NS GEMINUS PA NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A PANL-35180-TS SUP HCPCS C1713 PANL-35180-TS - SCREW BN 3.5MM 18MM NS GEMINUS PA NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A PAPS2 SUP Custom 27203010 PAPS2 - CANISTER SUCTION MAX NONSTRL BOTH IP/OP $900.00 $666.00 $160.20 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $160.20 $900.00 $900.00 $667.98 $667.98 $693.72 $468.90 $187.57 $900.00 $360.00 $900.00 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $585.00 $900.00 N/A $522.00 $900.00 $540.00 $900.00 $900.00 $900.00 N/A N/A PC02520OS SUP HCPCS C1781 PC02520OS - MESH SURG PARIETEX 10X8IN VNTRL HERN OPN SKRT RECT PLSTR BOTH IP/OP "$3,925.00" "$2,905.00" $779.01 "$3,925.00" "$1,766.25" "$1,766.25" "$1,766.25" "$1,766.25" "$3,925.00" "$3,925.00" "$3,925.00" $818.07 "$3,925.00" "$3,925.00" "$3,925.00" "$3,925.00" "$3,925.00" $818.01 "$3,925.00" "$3,925.00" "$1,935.03" "$3,925.00" "$3,925.00" "$3,925.00" "$3,925.00" "$2,943.75" "$3,925.00" "$3,925.00" "$3,925.00" "$1,962.50" "$1,962.50" "$3,108.60" "$3,925.00" "$3,140.00" "$1,766.25" $779.01 N/A "$2,276.50" "$3,925.00" "$3,925.00" "$3,925.00" $817.97 "$3,925.00" N/A N/A PC101 SUP HCPCS C1729 PC101 - KIT PRICRDCTS PGTL 6FR .035IN 60CM 7 SPRL DRN HL CATH DIST BOTH IP/OP $237.50 $176.00 $47.11 $237.38 $128.90 $128.90 $128.90 $128.90 $237.38 $237.38 $237.38 $49.48 $237.38 $176.18 $176.18 $182.97 $123.67 $49.47 $237.38 $237.38 $140.41 $237.38 $237.38 $237.38 $237.38 $178.13 $237.38 $237.38 $237.38 $118.69 $118.69 $188.00 $237.38 $189.90 $154.30 $47.11 N/A $137.75 $237.38 $237.38 $237.38 $49.47 $237.38 N/A N/A PC-1016SN SUP HCPCS C1768 PC-1016SN - PATCH CV 16X10CM SP PRGRD APX PRC BVN PRICRD BOTH IP/OP "$2,027.50" "$1,500.00" $402.41 "$2,027.50" $912.38 $912.38 $912.38 $912.38 "$2,027.50" "$2,027.50" "$2,027.50" $422.58 "$2,027.50" "$2,027.50" "$2,027.50" "$2,027.50" "$2,027.50" $422.55 "$2,027.50" "$2,027.50" "$1,199.27" "$2,027.50" "$2,027.50" "$2,027.50" "$2,027.50" "$1,520.63" "$2,027.50" "$2,027.50" "$2,027.50" "$1,013.75" "$1,013.75" "$1,605.78" "$2,027.50" "$1,622.00" $912.38 $402.41 N/A "$1,175.95" "$2,027.50" "$2,027.50" "$2,027.50" $422.53 "$2,027.50" N/A N/A PC111 SUP Custom 27803010 PC111 - ADAPTER DRILL FN2 DISS TO MALE SCHRADER MIDAS REX LEGEND BOTH IP/OP $406.00 $300.00 $72.25 $405.90 $405.90 $405.90 $405.90 $405.90 $405.90 $405.90 $72.25 $405.90 $405.90 $405.90 $405.90 $405.90 $405.90 $84.59 $405.90 $162.36 $405.90 $405.90 $405.90 $405.90 $405.90 $304.50 $405.90 $405.90 $405.90 $202.95 $202.95 $321.47 $405.90 $324.72 $182.66 $405.90 N/A $235.48 $405.90 $243.54 $405.90 $405.90 $405.90 N/A N/A PCA-15 SUP HCPCS C1713 "PCA-15 - LOCKING PLATE, CURVED A, 15-HOLE" BOTH IP/OP "$3,237.50" "$2,396.00" $642.56 "$3,237.50" "$1,456.88" "$1,456.88" "$1,456.88" "$1,456.88" "$3,237.50" "$3,237.50" "$3,237.50" $674.78 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $674.73 "$3,237.50" "$1,295.00" "$1,596.09" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$1,456.88" $642.56 N/A "$1,877.75" "$3,237.50" "$1,942.50" "$3,237.50" $674.70 "$3,237.50" N/A N/A PCB10 SUP HCPCS C1713 PCB10 - PLATE BN CRV B NS 10 HL LCK BOTH IP/OP "$2,587.50" "$1,915.00" $513.55 "$2,587.50" "$1,164.38" "$1,164.38" "$1,164.38" "$1,164.38" "$2,587.50" "$2,587.50" "$2,587.50" $539.30 "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" $539.26 "$2,587.50" "$1,035.00" "$1,275.64" "$2,587.50" "$2,587.50" "$2,587.50" "$2,587.50" "$1,940.63" "$2,587.50" "$2,587.50" "$2,587.50" "$1,293.75" "$1,293.75" "$2,049.30" "$2,587.50" "$2,070.00" "$1,164.38" $513.55 N/A "$1,500.75" "$2,587.50" "$2,587.50" "$2,587.50" $539.24 "$2,587.50" N/A N/A PCB15 SUP HCPCS C1713 PCB15 - PLATE BN CRV B NS 15 HL LCK BOTH IP/OP "$3,375.00" "$2,498.00" $669.85 "$3,375.00" "$1,518.75" "$1,518.75" "$1,518.75" "$1,518.75" "$3,375.00" "$3,375.00" "$3,375.00" $703.43 "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" $703.39 "$3,375.00" "$1,350.00" "$1,663.88" "$3,375.00" "$3,375.00" "$3,375.00" "$3,375.00" "$2,531.25" "$3,375.00" "$3,375.00" "$3,375.00" "$1,687.50" "$1,687.50" "$2,673.00" "$3,375.00" "$2,700.00" "$1,518.75" $669.85 N/A "$1,957.50" "$3,375.00" "$2,025.00" "$3,375.00" $703.35 "$3,375.00" N/A N/A PCDT1 SUP HCPCS C1781 PCDT1 - MESH SRG OVL 13X10IN STRL PRC FLXB TISS SEP LTWT MFL PRLN BOTH IP/OP "$6,122.50" "$4,531.00" "$1,215.11" "$6,122.25" "$2,755.01" "$2,755.01" "$2,755.01" "$2,755.01" "$6,122.25" "$6,122.25" "$6,122.25" "$1,276.03" "$6,122.25" "$6,122.25" "$6,122.25" "$6,122.25" "$6,122.25" "$1,275.94" "$6,122.25" "$6,122.25" "$3,018.27" "$6,122.25" "$6,122.25" "$6,122.25" "$6,122.25" "$4,591.88" "$6,122.25" "$6,122.25" "$6,122.25" "$3,061.13" "$3,061.13" "$4,848.82" "$6,122.25" "$4,897.80" "$2,755.01" "$1,215.11" N/A "$3,551.05" "$6,122.25" "$6,122.25" "$6,122.25" "$1,275.88" "$6,122.25" N/A N/A PCO12 SUP HCPCS C1781 PCO12 - MESH SRG RND 4.8IN PARIETEX COMP 3D WV RND PLSTR VNTRL HRN BOTH IP/OP "$1,322.50" $979.00 $262.39 "$1,322.03" $594.91 $594.91 $594.91 $594.91 "$1,322.03" "$1,322.03" "$1,322.03" $275.54 "$1,322.03" "$1,322.03" "$1,322.03" "$1,322.03" "$1,322.03" $275.53 "$1,322.03" "$1,322.03" $781.98 "$1,322.03" "$1,322.03" "$1,322.03" "$1,322.03" $991.88 "$1,322.03" "$1,322.03" "$1,322.03" $661.02 $661.02 "$1,047.05" "$1,322.03" "$1,057.62" $594.91 $262.39 N/A $767.05 "$1,322.03" "$1,322.03" "$1,322.03" $275.51 "$1,322.03" N/A N/A PCO12X SUP HCPCS C1781 PCO12X - MESH SURG ROUND 12CM 2X4.8IN 2 SIDE OPTIMIZE COMPOSITE LARGE BOTH IP/OP $951.50 $704.00 $188.77 $951.10 $428.00 $428.00 $428.00 $428.00 $951.10 $951.10 $951.10 $198.23 $951.10 $951.10 $951.10 $951.10 $951.10 $198.22 $951.10 $951.10 $562.58 $951.10 $951.10 $951.10 $951.10 $713.63 $951.10 $951.10 $951.10 $475.55 $475.55 $753.27 $951.10 $760.88 $428.00 $188.77 N/A $551.87 $951.10 $951.10 $951.10 $198.21 $951.10 N/A N/A PCO1510OS SUP HCPCS C1781 PCO1510OS - MESH SRG RECT 6X4IN PARIETEX RSRB COMP PLSTR VNTRL HRN BOTH IP/OP "$1,705.00" "$1,262.00" $338.33 "$1,704.65" $767.09 $767.09 $767.09 $767.09 "$1,704.65" "$1,704.65" "$1,704.65" $355.29 "$1,704.65" "$1,704.65" "$1,704.65" "$1,704.65" "$1,704.65" $355.27 "$1,704.65" "$1,704.65" "$1,008.30" "$1,704.65" "$1,704.65" "$1,704.65" "$1,704.65" "$1,278.75" "$1,704.65" "$1,704.65" "$1,704.65" $852.33 $852.33 "$1,350.08" "$1,704.65" "$1,363.72" $767.09 $338.33 N/A $988.90 "$1,704.65" "$1,704.65" "$1,704.65" $355.25 "$1,704.65" N/A N/A PCO15X SUP HCPCS C1781 PCO15X - MESH SURG ROUND 15CM OPTIMIZE COMPOSITE PROPRIETARY TEXTILE BOTH IP/OP "$1,245.00" $921.00 $247.08 "$1,244.88" $560.20 $560.20 $560.20 $560.20 "$1,244.88" "$1,244.88" "$1,244.88" $259.46 "$1,244.88" "$1,244.88" "$1,244.88" "$1,244.88" "$1,244.88" $259.45 "$1,244.88" "$1,244.88" $736.35 "$1,244.88" "$1,244.88" "$1,244.88" "$1,244.88" $933.75 "$1,244.88" "$1,244.88" "$1,244.88" $622.44 $622.44 $985.94 "$1,244.88" $995.90 $560.20 $247.08 N/A $722.10 "$1,244.88" "$1,244.88" "$1,244.88" $259.43 "$1,244.88" N/A N/A PCO2015X SUP HCPCS C1781 PCO2015X - MESH SURG RECTANGLE OVAL 20X15CM OPTIMIZE COMPOSITE 2 SIDE BOTH IP/OP "$1,526.00" "$1,129.00" $302.82 "$1,525.73" $686.58 $686.58 $686.58 $686.58 "$1,525.73" "$1,525.73" "$1,525.73" $318.00 "$1,525.73" "$1,525.73" "$1,525.73" "$1,525.73" "$1,525.73" $317.98 "$1,525.73" "$1,525.73" $902.47 "$1,525.73" "$1,525.73" "$1,525.73" "$1,525.73" "$1,144.50" "$1,525.73" "$1,525.73" "$1,525.73" $762.87 $762.87 "$1,208.38" "$1,525.73" "$1,220.58" $686.58 $302.82 N/A $885.08 "$1,525.73" "$1,525.73" "$1,525.73" $317.96 "$1,525.73" N/A N/A PCO20X SUP HCPCS C1781 PCO20X - MESH SURG ROUND 20CM 8IN COMPOSITE OPTIMIZE PROPRIETARY BOTH IP/OP "$1,831.00" "$1,355.00" $363.35 "$1,830.70" $823.82 $823.82 $823.82 $823.82 "$1,830.70" "$1,830.70" "$1,830.70" $381.56 "$1,830.70" "$1,830.70" "$1,830.70" "$1,830.70" "$1,830.70" $381.54 "$1,830.70" "$1,830.70" "$1,082.86" "$1,830.70" "$1,830.70" "$1,830.70" "$1,830.70" "$1,373.25" "$1,830.70" "$1,830.70" "$1,830.70" $915.35 $915.35 "$1,449.91" "$1,830.70" "$1,464.56" $823.82 $363.35 N/A "$1,061.98" "$1,830.70" "$1,830.70" "$1,830.70" $381.52 "$1,830.70" N/A N/A PCO2520OS SUP HCPCS C1781 PCO2520OS - MESH SRG RECT RND 10X8IN STRL LF PARIETEX OPN SKRT OPTIMIZE BOTH IP/OP "$4,387.50" "$3,247.00" $870.79 "$4,387.38" "$1,974.32" "$1,974.32" "$1,974.32" "$1,974.32" "$4,387.38" "$4,387.38" "$4,387.38" $914.44 "$4,387.38" "$4,387.38" "$4,387.38" "$4,387.38" "$4,387.38" $914.38 "$4,387.38" "$4,387.38" "$2,162.98" "$4,387.38" "$4,387.38" "$4,387.38" "$4,387.38" "$3,290.63" "$4,387.38" "$4,387.38" "$4,387.38" "$2,193.69" "$2,193.69" "$3,474.80" "$4,387.38" "$3,509.90" "$1,974.32" $870.79 N/A "$2,544.75" "$4,387.38" "$4,387.38" "$4,387.38" $914.33 "$4,387.38" N/A N/A PCO2520X SUP HCPCS C1781 PCO2520X - MESH SURG RECTANGLE OVAL 25X20CM 2 SIDE OPTIMIZE COMPOSITE BOTH IP/OP "$2,319.00" "$1,716.00" $460.25 "$2,318.93" "$1,043.52" "$1,043.52" "$1,043.52" "$1,043.52" "$2,318.93" "$2,318.93" "$2,318.93" $483.32 "$2,318.93" "$2,318.93" "$2,318.93" "$2,318.93" "$2,318.93" $483.29 "$2,318.93" "$2,318.93" "$1,371.65" "$2,318.93" "$2,318.93" "$2,318.93" "$2,318.93" "$1,739.25" "$2,318.93" "$2,318.93" "$2,318.93" "$1,159.47" "$1,159.47" "$1,836.59" "$2,318.93" "$1,855.14" "$1,043.52" $460.25 N/A "$1,345.02" "$2,318.93" "$2,318.93" "$2,318.93" $483.27 "$2,318.93" N/A N/A PCO3020 SUP HCPCS C1781 PCO3020 - MESH SRG RECT 12X8IN PARIETEX RSRB COMP SKRT RECT PLSTR BOTH IP/OP "$4,471.50" "$3,309.00" $887.42 "$4,471.20" "$2,012.04" "$2,012.04" "$2,012.04" "$2,012.04" "$4,471.20" "$4,471.20" "$4,471.20" $931.91 "$4,471.20" "$4,471.20" "$4,471.20" "$4,471.20" "$4,471.20" $931.85 "$4,471.20" "$4,471.20" "$2,204.30" "$4,471.20" "$4,471.20" "$4,471.20" "$4,471.20" "$3,353.63" "$4,471.20" "$4,471.20" "$4,471.20" "$2,235.60" "$2,235.60" "$3,541.19" "$4,471.20" "$3,576.96" "$2,012.04" $887.42 N/A "$2,593.47" "$4,471.20" "$4,471.20" "$4,471.20" $931.80 "$4,471.20" N/A N/A PCO3020X SUP HCPCS C1781 PCO3020X - MESH SURG RECTANGLE OVAL 30X20CM OPTIMIZE COMPOSITE TEXTILE BOTH IP/OP "$3,170.50" "$2,346.00" $629.23 "$3,170.33" "$1,426.65" "$1,426.65" "$1,426.65" "$1,426.65" "$3,170.33" "$3,170.33" "$3,170.33" $660.78 "$3,170.33" "$3,170.33" "$3,170.33" "$3,170.33" "$3,170.33" $660.73 "$3,170.33" "$3,170.33" "$1,562.97" "$3,170.33" "$3,170.33" "$3,170.33" "$3,170.33" "$2,377.88" "$3,170.33" "$3,170.33" "$3,170.33" "$1,585.17" "$1,585.17" "$2,510.90" "$3,170.33" "$2,536.26" "$1,426.65" $629.23 N/A "$1,838.89" "$3,170.33" "$3,170.33" "$3,170.33" $660.70 "$3,170.33" N/A N/A PCO3728 SUP HCPCS C1781 PCO3728 - MESH SRG RECT 14.5X11IN LF PARIETEX 3D WV RSRB COMP PLSTR BOTH IP/OP "$5,310.00" "$3,929.00" "$1,053.81" "$5,309.55" "$2,389.30" "$2,389.30" "$2,389.30" "$2,389.30" "$5,309.55" "$5,309.55" "$5,309.55" "$1,106.64" "$5,309.55" "$5,309.55" "$5,309.55" "$5,309.55" "$5,309.55" "$1,106.57" "$5,309.55" "$5,309.55" "$2,617.61" "$5,309.55" "$5,309.55" "$5,309.55" "$5,309.55" "$3,982.50" "$5,309.55" "$5,309.55" "$5,309.55" "$2,654.78" "$2,654.78" "$4,205.16" "$5,309.55" "$4,247.64" "$2,389.30" "$1,053.81" N/A "$3,079.80" "$5,309.55" "$5,309.55" "$5,309.55" "$1,106.51" "$5,309.55" N/A N/A PCO8OSX SUP HCPCS C1781 PCO8OSX - PARIETEX DUAL MESH POLYESTER SKIRTED 8 CM ROUND BOTH IP/OP "$1,147.50" $849.00 $227.72 "$1,147.35" $516.31 $516.31 $516.31 $516.31 "$1,147.35" "$1,147.35" "$1,147.35" $239.14 "$1,147.35" "$1,147.35" "$1,147.35" "$1,147.35" "$1,147.35" $239.12 "$1,147.35" "$1,147.35" $678.66 "$1,147.35" "$1,147.35" "$1,147.35" "$1,147.35" $860.63 "$1,147.35" "$1,147.35" "$1,147.35" $573.68 $573.68 $908.70 "$1,147.35" $917.88 $516.31 $227.72 N/A $665.55 "$1,147.35" "$1,147.35" "$1,147.35" $239.11 "$1,147.35" N/A N/A PCO9 SUP HCPCS C1781 PCO9 - MESH SRG RND 3.6IN STRL PARIETEX RND RSRB 3D WV PLSTR VNTRL BOTH IP/OP $959.00 $710.00 $190.24 $958.53 $431.34 $431.34 $431.34 $431.34 $958.53 $958.53 $958.53 $199.78 $958.53 $958.53 $958.53 $958.53 $958.53 $199.77 $958.53 $958.53 $566.97 $958.53 $958.53 $958.53 $958.53 $719.25 $958.53 $958.53 $958.53 $479.27 $479.27 $759.16 $958.53 $766.82 $431.34 $190.24 N/A $556.22 $958.53 $958.53 $958.53 $199.76 $958.53 N/A N/A PCO9X SUP HCPCS C1781 PCO9X - MESH SURG ROUND 9CM OPTIMIZE COMPOSITE PROPRIETARY TEXTILE BOTH IP/OP $231.50 $171.00 $45.88 $231.17 $104.03 $104.03 $104.03 $104.03 $231.17 $231.17 $231.17 $48.18 $231.17 $231.17 $231.17 $231.17 $231.17 $48.18 $231.17 $231.17 $136.74 $231.17 $231.17 $231.17 $231.17 $173.63 $231.17 $231.17 $231.17 $115.59 $115.59 $183.09 $231.17 $184.94 $104.03 $45.88 N/A $134.27 $231.17 $231.17 $231.17 $48.18 $231.17 N/A N/A PCP050120130 SUP HCPCS C1725 PCP050120130 - CATHETER BLNDIL 5MM 130CM 120MM PCFC + OTW LOPRFL COAX BOTH IP/OP $562.50 $416.00 $111.64 $562.50 $305.44 $305.44 $305.44 $305.44 $562.50 $562.50 $562.50 $117.24 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $562.50 $332.72 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $111.64 N/A $326.25 $562.50 $337.50 $562.50 $117.23 $562.50 N/A N/A PD0606 SUP Custom 27803010 PD0606 - Patch Biological L6 CM X W6 CM W Porcine Dermis Soft Tissue BOTH IP/OP "$1,566.00" "$1,159.00" $278.75 "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" $278.75 "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" $326.37 "$1,566.00" $626.40 "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" "$1,566.00" "$1,174.50" "$1,566.00" "$1,566.00" "$1,566.00" $783.00 $783.00 "$1,240.27" "$1,566.00" "$1,252.80" $704.70 "$1,566.00" N/A $908.28 "$1,566.00" $939.60 "$1,566.00" "$1,566.00" "$1,566.00" N/A N/A PD0808 SUP Custom 27803010 PD0808 - Patch Biological L8 CM X W8 CM W Porcine Dermis Soft Tissue BOTH IP/OP "$2,784.00" "$2,060.00" $495.55 "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" $495.55 "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" $580.22 "$2,784.00" "$1,113.60" "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" "$2,784.00" "$2,088.00" "$2,784.00" "$2,784.00" "$2,784.00" "$1,392.00" "$1,392.00" "$2,204.93" "$2,784.00" "$2,227.20" "$1,252.80" "$2,784.00" N/A "$1,614.72" "$2,784.00" "$1,670.40" "$2,784.00" "$2,784.00" "$2,784.00" N/A N/A PD0822 SUP Custom 27803010 PD0822 - Patch Biological L22 CM X W8 CM W Porcine Dermis Soft Tissue BOTH IP/OP "$7,656.00" "$5,665.00" "$1,362.77" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$1,362.77" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$1,595.59" "$7,656.00" "$3,062.40" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$7,656.00" "$5,742.00" "$7,656.00" "$7,656.00" "$7,656.00" "$3,828.00" "$3,828.00" "$6,063.55" "$7,656.00" "$6,124.80" "$3,445.20" "$7,656.00" N/A "$4,440.48" "$7,656.00" "$4,593.60" "$7,656.00" "$7,656.00" "$7,656.00" N/A N/A PD1010 SUP Custom 27803010 PD1010 - Patch Biological L10 CM X W10 CM W Porcine Dermis Soft Tissu BOTH IP/OP "$4,350.00" "$3,219.00" $774.30 "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" $774.30 "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" $906.59 "$4,350.00" "$1,740.00" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$4,350.00" "$3,262.50" "$4,350.00" "$4,350.00" "$4,350.00" "$2,175.00" "$2,175.00" "$3,445.20" "$4,350.00" "$3,480.00" "$1,957.50" "$4,350.00" N/A "$2,523.00" "$4,350.00" "$2,610.00" "$4,350.00" "$4,350.00" "$4,350.00" N/A N/A PD1016 SUP Custom 27803010 PD1016 - Patch Biological L10 CM X W16 CM W Porcine Dermis Soft Tissu BOTH IP/OP "$6,960.00" "$5,150.00" "$1,238.88" "$6,960.00" "$6,960.00" "$6,960.00" "$6,960.00" "$6,960.00" "$6,960.00" "$6,960.00" "$1,238.88" "$6,960.00" "$6,960.00" "$6,960.00" "$6,960.00" "$6,960.00" "$6,960.00" "$1,450.54" "$6,960.00" "$2,784.00" "$6,960.00" "$6,960.00" "$6,960.00" "$6,960.00" "$6,960.00" "$5,220.00" "$6,960.00" "$6,960.00" "$6,960.00" "$3,480.00" "$3,480.00" "$5,512.32" "$6,960.00" "$5,568.00" "$3,132.00" "$6,960.00" N/A "$4,036.80" "$6,960.00" "$4,176.00" "$6,960.00" "$6,960.00" "$6,960.00" N/A N/A PD1025 SUP Custom 27803010 PD1025 - Patch Biological L10 CM X W25 CM W Porcine Dermis Soft Tissu BOTH IP/OP "$10,875.00" "$8,048.00" "$1,935.75" "$10,875.00" "$10,875.00" "$10,875.00" "$10,875.00" "$10,875.00" "$10,875.00" "$10,875.00" "$1,935.75" "$10,875.00" "$10,875.00" "$10,875.00" "$10,875.00" "$10,875.00" "$10,875.00" "$2,266.47" "$10,875.00" "$4,350.00" "$10,875.00" "$10,875.00" "$10,875.00" "$10,875.00" "$10,875.00" "$8,156.25" "$10,875.00" "$10,875.00" "$10,875.00" "$5,437.50" "$5,437.50" "$8,613.00" "$10,875.00" "$8,700.00" "$4,893.75" "$10,875.00" N/A "$6,307.50" "$10,875.00" "$6,525.00" "$10,875.00" "$10,875.00" "$10,875.00" N/A N/A PD1620 SUP Custom 27803010 PD1620 - Patch Biological L16 CM X W20 CM W Porcine Dermis Soft Tissu BOTH IP/OP "$13,920.00" "$10,301.00" "$2,477.76" "$13,920.00" "$13,920.00" "$13,920.00" "$13,920.00" "$13,920.00" "$13,920.00" "$13,920.00" "$2,477.76" "$13,920.00" "$13,920.00" "$13,920.00" "$13,920.00" "$13,920.00" "$13,920.00" "$2,901.08" "$13,920.00" "$5,568.00" "$13,920.00" "$13,920.00" "$13,920.00" "$13,920.00" "$13,920.00" "$10,440.00" "$13,920.00" "$13,920.00" "$13,920.00" "$6,960.00" "$6,960.00" "$11,024.64" "$13,920.00" "$11,136.00" "$6,264.00" "$13,920.00" N/A "$8,073.60" "$13,920.00" "$8,352.00" "$13,920.00" "$13,920.00" "$13,920.00" N/A N/A PD2020 SUP Custom 27803010 PD2020 - Patch Biological L20 CM X W20 CM W Porcine Dermis Soft Tissu BOTH IP/OP "$17,400.00" "$12,876.00" "$3,097.20" "$17,400.00" "$17,400.00" "$17,400.00" "$17,400.00" "$17,400.00" "$17,400.00" "$17,400.00" "$3,097.20" "$17,400.00" "$17,400.00" "$17,400.00" "$17,400.00" "$17,400.00" "$17,400.00" "$3,626.35" "$17,400.00" "$6,960.00" "$17,400.00" "$17,400.00" "$17,400.00" "$17,400.00" "$17,400.00" "$13,050.00" "$17,400.00" "$17,400.00" "$17,400.00" "$8,700.00" "$8,700.00" "$13,780.80" "$17,400.00" "$13,920.00" "$7,830.00" "$17,400.00" N/A "$10,092.00" "$17,400.00" "$10,440.00" "$17,400.00" "$17,400.00" "$17,400.00" N/A N/A PD2025 SUP Custom 27803010 PD2025 - Patch Biological L25 CM X W20 CM W Porcine Dermis Soft Tissu BOTH IP/OP "$21,750.00" "$16,095.00" "$3,871.50" "$21,750.00" "$21,750.00" "$21,750.00" "$21,750.00" "$21,750.00" "$21,750.00" "$21,750.00" "$3,871.50" "$21,750.00" "$21,750.00" "$21,750.00" "$21,750.00" "$21,750.00" "$21,750.00" "$4,532.94" "$21,750.00" "$8,700.00" "$21,750.00" "$21,750.00" "$21,750.00" "$21,750.00" "$21,750.00" "$16,312.50" "$21,750.00" "$21,750.00" "$21,750.00" "$10,875.00" "$10,875.00" "$17,226.00" "$21,750.00" "$17,400.00" "$9,787.50" "$21,750.00" N/A "$12,615.00" "$21,750.00" "$13,050.00" "$21,750.00" "$21,750.00" "$21,750.00" N/A N/A PD2035 SUP Custom 27803010 PD2035 - Patch Biological L35 CM X W20 CM W Porcine Dermis Soft Tissu BOTH IP/OP "$30,450.00" "$22,533.00" "$5,420.10" "$30,450.00" "$30,450.00" "$30,450.00" "$30,450.00" "$30,450.00" "$30,450.00" "$30,450.00" "$5,420.10" "$30,450.00" "$30,450.00" "$30,450.00" "$30,450.00" "$30,450.00" "$30,450.00" "$6,346.11" "$30,450.00" "$12,180.00" "$30,450.00" "$30,450.00" "$30,450.00" "$30,450.00" "$30,450.00" "$22,837.50" "$30,450.00" "$30,450.00" "$30,450.00" "$15,225.00" "$15,225.00" "$24,116.40" "$30,450.00" "$24,360.00" "$13,702.50" "$30,450.00" N/A "$17,661.00" "$30,450.00" "$18,270.00" "$30,450.00" "$30,450.00" "$30,450.00" N/A N/A PD3030 SUP Custom 27803010 PD3030 - Patch Biological L30 CM X W30 CM W Porcine Dermis Soft Tissu BOTH IP/OP "$39,150.00" "$28,971.00" "$6,968.70" "$39,150.00" "$39,150.00" "$39,150.00" "$39,150.00" "$39,150.00" "$39,150.00" "$39,150.00" "$6,968.70" "$39,150.00" "$39,150.00" "$39,150.00" "$39,150.00" "$39,150.00" "$39,150.00" "$8,159.29" "$39,150.00" "$15,660.00" "$39,150.00" "$39,150.00" "$39,150.00" "$39,150.00" "$39,150.00" "$29,362.50" "$39,150.00" "$39,150.00" "$39,150.00" "$19,575.00" "$19,575.00" "$31,006.80" "$39,150.00" "$31,320.00" "$17,617.50" "$39,150.00" N/A "$22,707.00" "$39,150.00" "$23,490.00" "$39,150.00" "$39,150.00" "$39,150.00" N/A N/A PD-31-200 SUP HCPCS C1713 PD-31-200 - CAGE SPNL B STRL DTRAX TI CRV BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$1,750.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$2,625.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A PD-31-201 SUP HCPCS C1713 PD-31-201 - Cavux Cervical Cage B 5mm BOTH IP/OP "$4,375.00" "$3,238.00" $868.33 "$4,375.00" "$1,968.75" "$1,968.75" "$1,968.75" "$1,968.75" "$4,375.00" "$4,375.00" "$4,375.00" $911.86 "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" $911.80 "$4,375.00" "$1,750.00" "$2,156.88" "$4,375.00" "$4,375.00" "$4,375.00" "$4,375.00" "$3,281.25" "$4,375.00" "$4,375.00" "$4,375.00" "$2,187.50" "$2,187.50" "$3,465.00" "$4,375.00" "$3,500.00" "$1,968.75" $868.33 N/A "$2,537.50" "$4,375.00" "$4,375.00" "$4,375.00" $911.75 "$4,375.00" N/A N/A PD-32-301 SUP HCPCS C1713 PD-32-301 - DTRAX BONE SCREW BOTH IP/OP "$1,000.00" $740.00 $198.48 "$1,000.00" $450.00 $450.00 $450.00 $450.00 "$1,000.00" "$1,000.00" "$1,000.00" $208.43 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $208.41 "$1,000.00" "$1,000.00" $591.50 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" $750.00 "$1,000.00" "$1,000.00" "$1,000.00" $500.00 $500.00 $792.00 "$1,000.00" $800.00 $450.00 $198.48 N/A $580.00 "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" "$1,000.00" N/A N/A PD3535 SUP Custom 27803010 PD3535 - Patch Biological L35 CM X W35 CM W Porcine Dermis Soft Tissu BOTH IP/OP "$52,925.00" "$39,165.00" "$9,420.65" "$52,925.00" "$52,925.00" "$52,925.00" "$52,925.00" "$52,925.00" "$52,925.00" "$52,925.00" "$9,420.65" "$52,925.00" "$52,925.00" "$52,925.00" "$52,925.00" "$52,925.00" "$52,925.00" "$11,030.15" "$52,925.00" "$21,170.00" "$52,925.00" "$52,925.00" "$52,925.00" "$52,925.00" "$52,925.00" "$39,693.75" "$52,925.00" "$52,925.00" "$52,925.00" "$26,462.50" "$26,462.50" "$41,916.60" "$52,925.00" "$42,340.00" "$23,816.25" "$52,925.00" N/A "$30,696.50" "$52,925.00" "$31,755.00" "$52,925.00" "$52,925.00" "$52,925.00" N/A N/A PDG-AIM-015 SUP HCPCS C1713 PDG-AIM-015 - GUIDE SURG 1.5MM AIMING GEMINUS VOLAR DISTAL RAD BOTH IP/OP $75.00 $56.00 $14.89 $75.00 $33.75 $33.75 $33.75 $33.75 $75.00 $75.00 $75.00 $15.63 $75.00 $75.00 $75.00 $75.00 $75.00 $15.63 $75.00 $27.00 $44.36 $75.00 $67.50 $75.00 $75.00 $56.25 $75.00 $75.00 $75.00 $37.50 $37.50 $59.40 $75.00 $60.00 $33.75 $14.89 N/A $43.50 $75.00 $75.00 $75.00 $15.63 $75.00 N/A N/A PED-450-25 SUP HCPCS C1884 PED-450-25 - DEVICE EMBL 4.5MM 25MM STRL LF PIPELINE FLX 48 STRN BRD MESH BOTH IP/OP "$34,947.50" "$25,861.00" "$6,936.21" "$34,947.50" "$15,726.38" "$15,726.38" "$15,726.38" "$15,726.38" "$34,947.50" "$34,947.50" "$34,947.50" "$7,283.93" "$34,947.50" "$34,947.50" "$34,947.50" "$34,947.50" "$34,947.50" "$7,283.44" "$34,947.50" "$34,947.50" "$17,229.12" "$34,947.50" "$34,947.50" "$34,947.50" "$34,947.50" "$26,210.63" "$34,947.50" "$34,947.50" "$34,947.50" "$17,473.75" "$17,473.75" "$27,678.42" "$34,947.50" "$27,958.00" "$15,726.38" "$6,936.21" N/A "$20,269.55" "$34,947.50" "$34,947.50" "$34,947.50" "$7,283.06" "$34,947.50" N/A N/A PED-475-12 SUP Custom 27803010 PED-475-12 - DEVICE EMBL 4.75MM 12MM STRL LF PIPELINE FLX 48 STRN BRD BOTH IP/OP "$32,602.50" "$24,126.00" "$5,803.25" "$32,602.50" "$32,602.50" "$32,602.50" "$32,602.50" "$32,602.50" "$32,602.50" "$32,602.50" "$5,803.25" "$32,602.50" "$32,602.50" "$32,602.50" "$32,602.50" "$32,602.50" "$32,602.50" "$6,794.72" "$32,602.50" "$13,041.00" "$32,602.50" "$32,602.50" "$32,602.50" "$32,602.50" "$32,602.50" "$24,451.88" "$32,602.50" "$32,602.50" "$32,602.50" "$16,301.25" "$16,301.25" "$25,821.18" "$32,602.50" "$26,082.00" "$14,671.13" "$32,602.50" N/A "$18,909.45" "$32,602.50" "$19,561.50" "$32,602.50" "$32,602.50" "$32,602.50" N/A N/A PED-500-35 SUP Custom 27803010 PED-500-35 - DEVICE EMBL 5MM 35MM STRL LF PIPELINE FLX 48 STRN BRD MESH BOTH IP/OP "$34,947.50" "$25,861.00" "$6,220.66" "$34,947.50" "$34,947.50" "$34,947.50" "$34,947.50" "$34,947.50" "$34,947.50" "$34,947.50" "$6,220.66" "$34,947.50" "$34,947.50" "$34,947.50" "$34,947.50" "$34,947.50" "$34,947.50" "$7,283.44" "$34,947.50" "$13,979.00" "$34,947.50" "$34,947.50" "$34,947.50" "$34,947.50" "$34,947.50" "$26,210.63" "$34,947.50" "$34,947.50" "$34,947.50" "$17,473.75" "$17,473.75" "$27,678.42" "$34,947.50" "$27,958.00" "$15,726.38" "$34,947.50" N/A "$20,269.55" "$34,947.50" "$20,968.50" "$34,947.50" "$34,947.50" "$34,947.50" N/A N/A PF-20 SUP HCPCS C1729 PF-20 - CATHETER DRN 20FR STRL ACT CLRNC TCH PLEURAFLOW CHST TUBE BOTH IP/OP $969.00 $717.00 $192.27 $968.75 $526.03 $526.03 $526.03 $526.03 $968.75 $968.75 $968.75 $201.91 $968.75 $719.01 $719.01 $746.71 $504.72 $201.90 $968.75 $968.75 $573.02 $968.75 $968.75 $968.75 $968.75 $726.75 $968.75 $968.75 $968.75 $484.38 $484.38 $767.25 $968.75 $775.00 $629.69 $192.27 N/A $562.02 $968.75 $968.75 $968.75 $201.89 $968.75 N/A N/A PF-24 SUP HCPCS C1729 PF-24 - CATHETER DRN 24FR STRL PLEURAFLOW ACT CLRNC TCH CHST TUBE BOTH IP/OP $912.50 $675.00 $181.11 $912.50 $495.49 $495.49 $495.49 $495.49 $912.50 $912.50 $912.50 $190.19 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $912.50 $539.74 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $181.11 N/A $529.25 $912.50 $912.50 $912.50 $190.17 $912.50 N/A N/A PF-28 SUP HCPCS C1729 PF-28 - CATHETER DRN 28FR STRL ACT CLRNC TCH PLEURAFLOW CHST TUBE BOTH IP/OP $912.50 $675.00 $181.11 $912.50 $495.49 $495.49 $495.49 $495.49 $912.50 $912.50 $912.50 $190.19 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $912.50 $539.74 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $181.11 N/A $529.25 $912.50 $912.50 $912.50 $190.17 $912.50 N/A N/A PF-32 SUP HCPCS C1729 PF-32 - CATHETER DRN 32FR PLEURAFLOW ACT CLRNC TCH BOTH IP/OP $912.50 $675.00 $181.11 $912.50 $495.49 $495.49 $495.49 $495.49 $912.50 $912.50 $912.50 $190.19 $912.50 $677.26 $677.26 $703.36 $475.41 $190.18 $912.50 $912.50 $539.74 $912.50 $912.50 $912.50 $912.50 $684.38 $912.50 $912.50 $912.50 $456.25 $456.25 $722.70 $912.50 $730.00 $593.13 $181.11 N/A $529.25 $912.50 $912.50 $912.50 $190.17 $912.50 N/A N/A PFF0025 SUP HCPCS C1713 PFF0025 - SCREW BONE 25MM FIX FACET LATEX FREE ANCHOR FS SPN BOTH IP/OP "$5,940.00" "$4,396.00" "$1,178.94" "$5,940.00" "$2,673.00" "$2,673.00" "$2,673.00" "$2,673.00" "$5,940.00" "$5,940.00" "$5,940.00" "$1,238.04" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$1,237.96" "$5,940.00" "$2,376.00" "$2,928.42" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$4,455.00" "$5,940.00" "$5,940.00" "$5,940.00" "$2,970.00" "$2,970.00" "$4,704.48" "$5,940.00" "$4,752.00" "$2,673.00" "$1,178.94" N/A "$3,445.20" "$5,940.00" "$3,564.00" "$5,940.00" "$1,237.90" "$5,940.00" N/A N/A PFF0030 SUP HCPCS C1713 PFF0030 - SCREW BONE 30MM FIX FACET ANCHOR FS SPN BOTH IP/OP "$5,940.00" "$4,396.00" "$1,178.94" "$5,940.00" "$2,673.00" "$2,673.00" "$2,673.00" "$2,673.00" "$5,940.00" "$5,940.00" "$5,940.00" "$1,238.04" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$1,237.96" "$5,940.00" "$2,376.00" "$2,928.42" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$4,455.00" "$5,940.00" "$5,940.00" "$5,940.00" "$2,970.00" "$2,970.00" "$4,704.48" "$5,940.00" "$4,752.00" "$2,673.00" "$1,178.94" N/A "$3,445.20" "$5,940.00" "$5,940.00" "$5,940.00" "$1,237.90" "$5,940.00" N/A N/A PFF0035 SUP HCPCS C1713 PFF0035 - SCREW BONE 35MM FIX FACET ANCHOR FS SPN BOTH IP/OP "$5,940.00" "$4,396.00" "$1,178.94" "$5,940.00" "$2,673.00" "$2,673.00" "$2,673.00" "$2,673.00" "$5,940.00" "$5,940.00" "$5,940.00" "$1,238.04" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$1,237.96" "$5,940.00" "$5,940.00" "$2,928.42" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$4,455.00" "$5,940.00" "$5,940.00" "$5,940.00" "$2,970.00" "$2,970.00" "$4,704.48" "$5,940.00" "$4,752.00" "$2,673.00" "$1,178.94" N/A "$3,445.20" "$5,940.00" "$5,940.00" "$5,940.00" "$1,237.90" "$5,940.00" N/A N/A PFF0040 SUP HCPCS C1713 PFF0040 - SCREW BONE 40MM FIX FACET ANCHOR FS SPN BOTH IP/OP "$5,940.00" "$4,396.00" "$1,178.94" "$5,940.00" "$2,673.00" "$2,673.00" "$2,673.00" "$2,673.00" "$5,940.00" "$5,940.00" "$5,940.00" "$1,238.04" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$1,237.96" "$5,940.00" "$2,376.00" "$2,928.42" "$5,940.00" "$5,940.00" "$5,940.00" "$5,940.00" "$4,455.00" "$5,940.00" "$5,940.00" "$5,940.00" "$2,970.00" "$2,970.00" "$4,704.48" "$5,940.00" "$4,752.00" "$2,673.00" "$1,178.94" N/A "$3,445.20" "$5,940.00" "$3,564.00" "$5,940.00" "$1,237.90" "$5,940.00" N/A N/A PGEN00506 SUP Custom 27203010 PGEN00506 - TIP APPLICATOR 6IN SPRAY EXTENDED ERGONOMIC APPLICATOR BOTH IP/OP "$1,390.00" "$1,029.00" $247.42 "$1,390.00" "$1,390.00" "$1,390.00" "$1,390.00" "$1,390.00" "$1,390.00" "$1,390.00" $247.42 "$1,390.00" "$1,390.00" "$1,031.66" "$1,031.66" "$1,071.41" $724.19 $289.69 "$1,390.00" $556.00 "$1,390.00" "$1,390.00" "$1,390.00" "$1,390.00" "$1,390.00" "$1,042.50" "$1,390.00" "$1,390.00" "$1,390.00" $695.00 $695.00 "$1,100.88" "$1,390.00" "$1,112.00" $903.50 "$1,390.00" N/A $806.20 "$1,390.00" $834.00 "$1,390.00" "$1,390.00" "$1,390.00" N/A N/A PGPS002 SUP Custom 27203010 PGPS002 - KIT TISS CLSR 4ML STRL LF PROGEL SLNT ADH AIR LEK PLR BOTH IP/OP "$2,454.00" "$1,816.00" $436.77 "$2,453.75" "$2,453.75" "$2,453.75" "$2,453.75" "$2,453.75" "$2,453.75" "$2,453.75" $436.77 "$2,453.75" "$2,453.75" "$1,821.17" "$1,821.17" "$1,891.35" "$1,278.40" $511.39 "$2,453.75" $981.50 "$2,453.75" "$2,453.75" "$2,453.75" "$2,453.75" "$2,453.75" "$1,840.50" "$2,453.75" "$2,453.75" "$2,453.75" "$1,226.88" "$1,226.88" "$1,943.37" "$2,453.75" "$1,963.00" "$1,594.94" "$2,453.75" N/A "$1,423.32" "$2,453.75" "$1,472.25" "$2,453.75" "$2,453.75" "$2,453.75" N/A N/A PH-450-70-DT+PH-K-A1 SUP Custom 27803010 PH-450-70-DT+PH-K-A1 - KIT CRNTMY PHASOR 4.5MM BOTH IP/OP $792.00 $586.00 $140.98 $815.75 $792.00 $792.00 $792.00 $792.00 $792.00 $792.00 $140.98 $792.00 $792.00 $792.00 $792.00 $792.00 $792.00 $165.06 $792.00 $396.00 $792.00 $792.00 $815.75 $792.00 $792.00 $594.00 $792.00 $792.00 $792.00 $396.00 $396.00 $627.26 $792.00 $633.60 $356.40 $792.00 N/A $459.36 $792.00 $475.20 $792.00 $792.00 $792.00 N/A N/A PHSE6 SUP HCPCS C1781 PHSE6 - MESH SURG 4IN 3 15/16IN .75IN 4 15/16INX2 5/32INX.5IN SOFT BOTH IP/OP "$1,704.50" "$1,261.00" $338.21 "$1,704.02" $766.81 $766.81 $766.81 $766.81 "$1,704.02" "$1,704.02" "$1,704.02" $355.16 "$1,704.02" "$1,704.02" "$1,704.02" "$1,704.02" "$1,704.02" $355.14 "$1,704.02" "$1,704.02" "$1,007.93" "$1,704.02" "$1,704.02" "$1,704.02" "$1,704.02" "$1,278.38" "$1,704.02" "$1,704.02" "$1,704.02" $852.01 $852.01 "$1,349.58" "$1,704.02" "$1,363.22" $766.81 $338.21 N/A $988.61 "$1,704.02" "$1,704.02" "$1,704.02" $355.12 "$1,704.02" N/A N/A PHSM SUP HCPCS C1781 PHSM - MESH SURG 3IN 3D MEDIUM 2 15/16IN .75IN 3 15/16INX1.75INX.5 BOTH IP/OP $882.50 $653.00 $175.15 $882.48 $397.12 $397.12 $397.12 $397.12 $882.48 $882.48 $882.48 $183.93 $882.48 $882.48 $882.48 $882.48 $882.48 $183.92 $882.48 $882.48 $521.99 $882.48 $882.48 $882.48 $882.48 $661.88 $882.48 $882.48 $882.48 $441.24 $441.24 $698.92 $882.48 $705.98 $397.12 $175.15 N/A $511.85 $882.48 $882.48 $882.48 $183.91 $882.48 N/A N/A PHSM6 SUP HCPCS C1781 PHSM6 - MESH SURG 3IN MEDIUM 2 15/16IN .75IN 3 15/16INX1.75INX.5IN BOTH IP/OP "$1,704.50" "$1,261.00" $338.21 "$1,704.02" $766.81 $766.81 $766.81 $766.81 "$1,704.02" "$1,704.02" "$1,704.02" $355.16 "$1,704.02" "$1,704.02" "$1,704.02" "$1,704.02" "$1,704.02" $355.14 "$1,704.02" "$1,704.02" "$1,007.93" "$1,704.02" "$1,704.02" "$1,704.02" "$1,704.02" "$1,278.38" "$1,704.02" "$1,704.02" "$1,704.02" $852.01 $852.01 "$1,349.58" "$1,704.02" "$1,363.22" $766.81 $338.21 N/A $988.61 "$1,704.02" "$1,704.02" "$1,704.02" $355.12 "$1,704.02" N/A N/A PHY1015V SUP HCPCS C1781 PHY1015V - MESH SURG 15X10CM FLEXIBLE COMPOSITE TISSUE SEPARATE LP BOTH IP/OP "$1,857.00" "$1,374.00" $368.55 "$1,856.93" $835.62 $835.62 $835.62 $835.62 "$1,856.93" "$1,856.93" "$1,856.93" $387.03 "$1,856.93" "$1,856.93" "$1,856.93" "$1,856.93" "$1,856.93" $387.00 "$1,856.93" "$1,856.93" "$1,098.37" "$1,856.93" "$1,856.93" "$1,856.93" "$1,856.93" "$1,392.75" "$1,856.93" "$1,856.93" "$1,856.93" $928.47 $928.47 "$1,470.69" "$1,856.93" "$1,485.54" $835.62 $368.55 N/A "$1,077.06" "$1,856.93" "$1,856.93" "$1,856.93" $386.98 "$1,856.93" N/A N/A PHY1520V SUP HCPCS C1781 PHY1520V - MESH SURG 20X15CM FLEXIBLE COMPOSITE TISSUE SEPARATE LP OVAL BOTH IP/OP "$3,373.00" "$2,496.00" $669.36 "$3,372.53" "$1,517.64" "$1,517.64" "$1,517.64" "$1,517.64" "$3,372.53" "$3,372.53" "$3,372.53" $702.92 "$3,372.53" "$3,372.53" "$3,372.53" "$3,372.53" "$3,372.53" $702.87 "$3,372.53" "$3,372.53" "$1,662.66" "$3,372.53" "$3,372.53" "$3,372.53" "$3,372.53" "$2,529.75" "$3,372.53" "$3,372.53" "$3,372.53" "$1,686.27" "$1,686.27" "$2,671.04" "$3,372.53" "$2,698.02" "$1,517.64" $669.36 N/A "$1,956.34" "$3,372.53" "$3,372.53" "$3,372.53" $702.84 "$3,372.53" N/A N/A PHY2025V SUP HCPCS C1781 PHY2025V - MESH SURG 25X20CM FLEXIBLE COMPOSITE TISSUE SEPARATE LP BOTH IP/OP "$5,462.00" "$4,042.00" "$1,083.99" "$5,461.58" "$2,457.71" "$2,457.71" "$2,457.71" "$2,457.71" "$5,461.58" "$5,461.58" "$5,461.58" "$1,138.33" "$5,461.58" "$5,461.58" "$5,461.58" "$5,461.58" "$5,461.58" "$1,138.25" "$5,461.58" "$5,461.58" "$2,692.56" "$5,461.58" "$5,461.58" "$5,461.58" "$5,461.58" "$4,096.50" "$5,461.58" "$5,461.58" "$5,461.58" "$2,730.79" "$2,730.79" "$4,325.57" "$5,461.58" "$4,369.26" "$2,457.71" "$1,083.99" N/A "$3,167.96" "$5,461.58" "$5,461.58" "$5,461.58" "$1,138.19" "$5,461.58" N/A N/A PHY2030R SUP HCPCS C1781 PHY2030R - MESH SURG 30X20CM FLEXIBLE COMPOSITE TISSUE SEPARATE BOTH IP/OP "$5,891.50" "$4,360.00" "$1,169.23" "$5,891.08" "$2,650.99" "$2,650.99" "$2,650.99" "$2,650.99" "$5,891.08" "$5,891.08" "$5,891.08" "$1,227.85" "$5,891.08" "$5,891.08" "$5,891.08" "$5,891.08" "$5,891.08" "$1,227.77" "$5,891.08" "$5,891.08" "$2,904.30" "$5,891.08" "$5,891.08" "$5,891.08" "$5,891.08" "$4,418.63" "$5,891.08" "$5,891.08" "$5,891.08" "$2,945.54" "$2,945.54" "$4,665.74" "$5,891.08" "$4,712.86" "$2,650.99" "$1,169.23" N/A "$3,417.07" "$5,891.08" "$5,891.08" "$5,891.08" "$1,227.70" "$5,891.08" N/A N/A PIKA SUP Custom 27203010 PIKA - KIT CATHETER INSERTION .038IN 18GA 11 SCALPEL INSERTION BOTH IP/OP $158.00 $117.00 $28.06 $157.63 $157.63 $157.63 $157.63 $157.63 $157.63 $157.63 $28.06 $157.63 $157.63 $116.99 $116.99 $121.50 $82.13 $32.85 $157.63 $63.05 $157.63 $157.63 $157.63 $157.63 $157.63 $118.50 $157.63 $157.63 $157.63 $78.82 $78.82 $124.84 $157.63 $126.10 $102.46 $157.63 N/A $91.64 $157.63 $94.58 $157.63 $157.63 $157.63 N/A N/A PIKV SUP Custom 27203010 PIKV - KIT CATH INS .038IN 18GA 11 SCPL INS NDL SYR GW DIL VN PERC BOTH IP/OP $160.00 $118.00 $28.48 $159.99 $159.99 $159.99 $159.99 $159.99 $159.99 $159.99 $28.48 $159.99 $159.99 $118.74 $118.74 $123.32 $83.35 $33.34 $159.99 $64.00 $159.99 $159.99 $159.99 $159.99 $159.99 $120.00 $159.99 $159.99 $159.99 $80.00 $80.00 $126.71 $159.99 $127.99 $103.99 $159.99 N/A $92.80 $159.99 $95.99 $159.99 $159.99 $159.99 N/A N/A PK-16 SUP HCPCS V2790 PK-16 - GRAFT SFT TIS THK50-100UM 16MM AMNIOGRAFT PROKERA AMNIO BOTH IP/OP "$2,372.50" "$1,756.00" $470.88 "$2,372.50" "$1,067.63" "$1,067.63" "$1,067.63" "$1,067.63" "$2,372.50" "$2,372.50" "$2,372.50" $494.49 "$2,372.50" "$2,372.50" "$2,372.50" "$2,372.50" "$2,372.50" $494.46 "$2,372.50" "$2,372.50" "$1,403.33" "$2,372.50" "$2,372.50" "$2,372.50" "$2,372.50" "$1,779.38" "$2,372.50" "$2,372.50" "$2,372.50" "$1,186.25" "$1,186.25" "$1,879.02" "$2,372.50" "$1,898.00" "$1,067.63" $470.88 N/A "$1,376.05" "$2,372.50" "$2,372.50" "$2,372.50" $494.43 "$2,372.50" N/A N/A PL-2080 SUP HCPCS C1713 PL-2080 - SCREW BN CNTRSNK CO CA BOTH IP/OP $352.50 $261.00 $69.96 $352.50 $158.63 $158.63 $158.63 $158.63 $352.50 $352.50 $352.50 $73.47 $352.50 $352.50 $352.50 $352.50 $352.50 $73.46 $352.50 $141.00 $208.50 $352.50 $352.50 $352.50 $352.50 $264.38 $352.50 $352.50 $352.50 $176.25 $176.25 $279.18 $352.50 $282.00 $158.63 $69.96 N/A $204.45 $352.50 $352.50 $352.50 $73.46 $352.50 N/A N/A PLA230300 SUP HCPCS C1768 PLA230300 - GRAFT EVAS 23MM 19-21MM 3.3CM AORTA BOTH IP/OP "$8,932.50" "$6,610.00" "$1,772.88" "$9,110.00" "$4,019.63" "$4,019.63" "$4,019.63" "$4,019.63" "$8,932.50" "$8,932.50" "$8,932.50" "$1,861.76" "$8,932.50" "$8,932.50" "$8,932.50" "$8,932.50" "$8,932.50" "$1,861.63" "$8,932.50" "$9,110.00" "$4,403.72" "$8,932.50" "$9,110.00" "$8,932.50" "$8,932.50" "$6,699.38" "$8,932.50" "$8,932.50" "$8,932.50" "$4,466.25" "$4,466.25" "$7,074.54" "$8,932.50" "$7,146.00" "$4,019.63" "$1,772.88" N/A "$5,180.85" "$8,932.50" "$8,932.50" "$8,932.50" "$1,861.53" "$8,932.50" N/A N/A PLA320400 SUP HCPCS C1874 PLA320400 - GRAFT EVAS 32MM 27-29MM 4.5CM XCLDR STNT XTD ABRSN RST BOTH IP/OP "$8,932.50" "$6,610.00" "$1,772.88" "$9,110.00" "$4,019.63" "$4,019.63" "$4,019.63" "$4,019.63" "$8,932.50" "$8,932.50" "$8,932.50" "$1,861.76" "$8,932.50" "$8,932.50" "$8,932.50" "$8,932.50" "$8,932.50" "$1,861.63" "$8,932.50" "$9,110.00" "$4,403.72" "$8,932.50" "$9,110.00" "$8,932.50" "$8,932.50" "$6,699.38" "$8,932.50" "$8,932.50" "$8,932.50" "$4,466.25" "$4,466.25" "$7,074.54" "$8,932.50" "$7,146.00" "$4,019.63" "$1,772.88" N/A "$5,180.85" "$8,932.50" "$8,932.50" "$8,932.50" "$1,861.53" "$8,932.50" N/A N/A PL-BG07 SUP Custom 27203010 PL-BG07 - BIT DRILL 7MM BNGFT HRVT BOTH IP/OP $852.50 $631.00 $151.75 $852.50 $852.50 $852.50 $852.50 $852.50 $852.50 $852.50 $151.75 $852.50 $852.50 $632.73 $632.73 $657.11 $444.15 $177.67 $852.50 $341.00 $852.50 $852.50 $852.50 $852.50 $852.50 $639.38 $852.50 $852.50 $852.50 $426.25 $426.25 $675.18 $852.50 $682.00 $554.13 $852.50 N/A $494.45 $852.50 $511.50 $852.50 $852.50 $852.50 N/A N/A PL-BSWDL SUP HCPCS C1713 PL-BSWDL - PLATE BN NS WDG LT 1ST MTP BOTH IP/OP "$1,592.50" "$1,178.00" $316.07 "$1,592.50" $716.63 $716.63 $716.63 $716.63 "$1,592.50" "$1,592.50" "$1,592.50" $331.92 "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" $331.89 "$1,592.50" "$1,592.50" $941.96 "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,194.38" "$1,592.50" "$1,592.50" "$1,592.50" $796.25 $796.25 "$1,261.26" "$1,592.50" "$1,274.00" $716.63 $316.07 N/A $923.65 "$1,592.50" $955.50 "$1,592.50" $331.88 "$1,592.50" N/A N/A PL-BSWDR SUP HCPCS C1713 PL-BSWDR - PLATE BN NS WDG TI RT MTRSL OSTM BOTH IP/OP "$1,592.50" "$1,178.00" $316.07 "$1,592.50" $716.63 $716.63 $716.63 $716.63 "$1,592.50" "$1,592.50" "$1,592.50" $331.92 "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" $331.89 "$1,592.50" "$1,592.50" $941.96 "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,194.38" "$1,592.50" "$1,592.50" "$1,592.50" $796.25 $796.25 "$1,261.26" "$1,592.50" "$1,274.00" $716.63 $316.07 N/A $923.65 "$1,592.50" $955.50 "$1,592.50" $331.88 "$1,592.50" N/A N/A PLC141400 SUP HCPCS C1874 PLC141400 - GRAFT EVAS 14.5MM 12-13.5MM 14CM GORE XCLDR CNTRLT LG AAA BOTH IP/OP "$12,695.00" "$9,394.00" "$2,519.64" "$12,950.00" "$5,712.75" "$5,712.75" "$5,712.75" "$5,712.75" "$12,695.00" "$12,695.00" "$12,695.00" "$2,645.96" "$12,695.00" "$12,695.00" "$12,695.00" "$12,695.00" "$12,695.00" "$2,645.78" "$12,695.00" "$12,950.00" "$6,258.64" "$12,695.00" "$12,950.00" "$12,695.00" "$12,695.00" "$9,521.25" "$12,695.00" "$12,695.00" "$12,695.00" "$6,347.50" "$6,347.50" "$10,054.44" "$12,695.00" "$10,156.00" "$5,712.75" "$2,519.64" N/A "$7,363.10" "$12,695.00" "$12,695.00" "$12,695.00" "$2,645.64" "$12,695.00" N/A N/A PLC161000 SUP HCPCS C1876 PLC161000 - GRAFT EVAS 16MM 13.5-14.5MM 9.5CM XCLDR STNT ABRSN RST BOTH IP/OP "$12,695.00" "$9,394.00" "$2,519.64" "$12,950.00" "$5,712.75" "$5,712.75" "$5,712.75" "$5,712.75" "$12,695.00" "$12,695.00" "$12,695.00" "$2,645.96" "$12,695.00" "$12,695.00" "$12,695.00" "$12,695.00" "$12,695.00" "$2,645.78" "$12,695.00" "$12,950.00" "$6,258.64" "$12,695.00" "$12,950.00" "$12,695.00" "$12,695.00" "$9,521.25" "$12,695.00" "$12,695.00" "$12,695.00" "$6,347.50" "$6,347.50" "$10,054.44" "$12,695.00" "$10,156.00" "$5,712.75" "$2,519.64" N/A "$7,363.10" "$12,695.00" "$12,695.00" "$12,695.00" "$2,645.64" "$12,695.00" N/A N/A PL-CL6SL SUP HCPCS C1713 PL-CL6SL - PLATE BONE SMALL 6 HOLE LOCKING TITANIUM LEFT CLAVICLE BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $795.00 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A PL-CL6SR SUP HCPCS C1713 PL-CL6SR - PLATE BONE SMALL 5MM 6 HOLE LOCKING ACUMED TITANIUM RIGHT BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $795.00 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A PL-CL8JR SUP HCPCS C1713 PL-CL8JR - PLATE BONE 8 HOLE J LOCKING SYSTEM TITANIUM RIGHT CLAVICLE BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $795.00 "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A PL-CL8LL SUP HCPCS C1713 PL-CL8LL - PLATE BONE LARGE 8 HOLE LOCKING TITANIUM CLAVICLE STERILE BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$1,987.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A PL-CL8LR SUP HCPCS C1713 PL-CL8LR - PLATE BONE LARGE 8 HOLE LOCKING ACUMED TITANIUM RIGHT BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$1,987.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A PL-DL26 SUP HCPCS C1713 PL-DL26 - PLATE BN 26MM LT DRSL RADL BOTH IP/OP "$1,115.00" $825.00 $221.30 "$1,115.00" $501.75 $501.75 $501.75 $501.75 "$1,115.00" "$1,115.00" "$1,115.00" $232.39 "$1,115.00" "$1,115.00" "$1,115.00" "$1,115.00" "$1,115.00" $232.38 "$1,115.00" "$1,115.00" $659.52 "$1,115.00" "$1,115.00" "$1,115.00" "$1,115.00" $836.25 "$1,115.00" "$1,115.00" "$1,115.00" $557.50 $557.50 $883.08 "$1,115.00" $892.00 $501.75 $221.30 N/A $646.70 "$1,115.00" $669.00 "$1,115.00" $232.37 "$1,115.00" N/A N/A PL-DMTPL SUP HCPCS C1713 PL-DMTPL - PLATE BONE FUSION TITANIUM LEFT DORSAL METATARSOPHALANGEAL BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" $765.00 "$1,275.00" $265.71 "$1,275.00" N/A N/A PL-DMTPR SUP HCPCS C1713 PL-DMTPR - PLATE BONE TITANIUM RIGHT DORSAL FIRST METATARSOPHALANGEAL BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" "$1,275.00" "$1,275.00" $265.71 "$1,275.00" N/A N/A PL-DR26 SUP HCPCS C1713 PL-DR26 - PLATE BN 26MM NS TI RT DIST DRSL RADL BOTH IP/OP "$1,115.00" $825.00 $221.30 "$1,115.00" $501.75 $501.75 $501.75 $501.75 "$1,115.00" "$1,115.00" "$1,115.00" $232.39 "$1,115.00" "$1,115.00" "$1,115.00" "$1,115.00" "$1,115.00" $232.38 "$1,115.00" "$1,115.00" $659.52 "$1,115.00" "$1,115.00" "$1,115.00" "$1,115.00" $836.25 "$1,115.00" "$1,115.00" "$1,115.00" $557.50 $557.50 $883.08 "$1,115.00" $892.00 $501.75 $221.30 N/A $646.70 "$1,115.00" $669.00 "$1,115.00" $232.37 "$1,115.00" N/A N/A PL-DR30L SUP HCPCS C1713 PL-DR30L - PLATE BN NAR ACLC RDS LT DIST VOLR BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" $819.00 "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$1,228.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A PL-DR30R SUP HCPCS C1713 PL-DR30R - PLATE BN NAR ACLC RDS RT DIST VOLR BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" $819.00 "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$1,228.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A PL-DR50L SUP HCPCS C1713 PL-DR50L - PLATE BN STD ACLC RDS LT DIST VOLR BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" $819.00 "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$1,228.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A PL-DR50R SUP HCPCS C1713 PL-DR50R - PLATE BN STD ACLC RDS RT DIST VOLR BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" "$2,047.50" "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$1,228.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A PL-DR60L SUP HCPCS C1713 PL-DR60L - PLATE BONE LONG 60MM 6 HOLE ACU-LOC TITANIUM LEFT DISTAL BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" "$2,047.50" "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$1,228.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A PL-DR60R SUP HCPCS C1713 PL-DR60R - PLATE BN LNG ACLC RDS RT DIST VOLR BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" $819.00 "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$2,047.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A PL-DR65L SUP HCPCS C1713 PL-DR65L - PLATE BONE XL STANDARD 65MM ACU-LOC TITANIUM WRIST RIGHT RAD BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" $819.00 "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$2,047.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A PL-DR65R SUP HCPCS C1713 PL-DR65R - PLATE BONE XLONG ACU-LOC TITANIUM RIGHT DISTAL RADIAL WRIST BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" $819.00 "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$1,228.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A PL-DR70L SUP HCPCS C1713 PL-DR70L - PLATE BONE WIDE 70MM ACU-LOC TITANIUM LEFT DISTAL RADIAL BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" "$2,047.50" "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$2,047.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A PL-DR70R SUP HCPCS C1713 PL-DR70R - PLATE BN W ACLC RDS RT DIST VOLR BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" $819.00 "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$2,047.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A PLDS15 SUP Custom 27203010 PLDS15 - STAPLER INTNL ANG RT 15MM STRL LF LDS LNR CUT LKOUT PRELD TI BOTH IP/OP "$1,016.00" $752.00 $180.77 "$1,015.55" "$1,015.55" "$1,015.55" "$1,015.55" "$1,015.55" "$1,015.55" "$1,015.55" $180.77 "$1,015.55" "$1,015.55" $753.74 $753.74 $782.79 $529.10 $211.65 "$1,015.55" $406.22 "$1,015.55" "$1,015.55" "$1,015.55" "$1,015.55" "$1,015.55" $762.00 "$1,015.55" "$1,015.55" "$1,015.55" $507.78 $507.78 $804.32 "$1,015.55" $812.44 $660.11 "$1,015.55" N/A $589.28 "$1,015.55" $609.33 "$1,015.55" "$1,015.55" "$1,015.55" N/A N/A PL-ELCLL SUP HCPCS C1713 PL-ELCLL - PLATE BONE EXTENDED LOCKING TITANIUM LEFT CORONOID ELBOW BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$2,252.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-ELCLR SUP HCPCS C1713 PL-ELCLR - PLATE BN NS XTD LCK TI ELB RT CORONOID BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" $901.00 "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$1,351.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-ELCOL SUP HCPCS C1713 PL-ELCOL - PLATE BN SM NS TI ELB LT CORONOID BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$1,351.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-ELCOR SUP HCPCS C1713 PL-ELCOR - PLATE BN NS TI ELB RT CORONOID BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" $901.00 "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$1,351.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-ELLXL SUP HCPCS C1713 PL-ELLXL - PLATE BONE XLONG TITANIUM ELBOW EPICONDYLAR LEFT LATERAL BOTH IP/OP "$1,847.50" "$1,367.00" $366.65 "$1,847.35" $831.31 $831.31 $831.31 $831.31 "$1,847.35" "$1,847.35" "$1,847.35" $385.03 "$1,847.35" "$1,847.35" "$1,847.35" "$1,847.35" "$1,847.35" $385.01 "$1,847.35" "$1,847.35" "$1,092.71" "$1,847.35" "$1,847.35" "$1,847.35" "$1,847.35" "$1,385.63" "$1,847.35" "$1,847.35" "$1,847.35" $923.68 $923.68 "$1,463.10" "$1,847.35" "$1,477.88" $831.31 $366.65 N/A "$1,071.55" "$1,847.35" "$1,108.41" "$1,847.35" $384.99 "$1,847.35" N/A N/A PL-ELPO SUP HCPCS C1713 PL-ELPO - PLATE BN POST ELB BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$1,351.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-ELRD SUP HCPCS C1713 PL-ELRD - PLATE BONE 7 HOLE TITANIUM RADIAL HEAD NONSTRL BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$2,125.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A PL-ELT1027 SUP Custom 27100030 PL-ELT1027 - TAP SURG 2.7MM QUICK RELEASE ELBOW 2MM SCREW BOTH IP/OP $565.00 $418.00 $100.57 $565.00 $565.00 $565.00 $565.00 $565.00 $565.00 $565.00 $100.57 $565.00 $565.00 $419.34 $419.34 $435.50 $294.37 $117.75 $565.00 $226.00 $565.00 $565.00 $565.00 $565.00 $565.00 $423.75 $565.00 $565.00 $565.00 $282.50 $282.50 $447.48 $565.00 $452.00 $367.25 $565.00 N/A $327.70 $565.00 $339.00 $565.00 $565.00 $565.00 N/A N/A PL-ELT1035 SUP HCPCS C1713 PL-ELT1035 - TAP SURG 3.5MM QUICK RELEASE 2MM SCREW MAYO LOCK ELBOW PLATE BOTH IP/OP $565.00 $418.00 $112.14 $565.00 $254.25 $254.25 $254.25 $254.25 $565.00 $565.00 $565.00 $117.76 $565.00 $565.00 $565.00 $565.00 $565.00 $117.75 $565.00 $565.00 $334.20 $565.00 $565.00 $565.00 $565.00 $423.75 $565.00 $565.00 $565.00 $282.50 $282.50 $447.48 $565.00 $452.00 $254.25 $112.14 N/A $327.70 $565.00 $565.00 $565.00 $117.75 $565.00 N/A N/A PL-FIB11 SUP HCPCS C1713 PL-FIB11 - PLATE BONE 11 HOLE TITANIUM LATERAL MALLEOLUS FIBULA NONSTRL BOTH IP/OP "$1,017.50" $753.00 $201.95 "$1,017.50" $457.88 $457.88 $457.88 $457.88 "$1,017.50" "$1,017.50" "$1,017.50" $212.07 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $212.06 "$1,017.50" $407.00 $601.85 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $763.13 "$1,017.50" "$1,017.50" "$1,017.50" $508.75 $508.75 $805.86 "$1,017.50" $814.00 $457.88 $201.95 N/A $590.15 "$1,017.50" $610.50 "$1,017.50" $212.05 "$1,017.50" N/A N/A PL-FIB5 SUP HCPCS C1713 PL-FIB5 - PLATE BONE 5 HOLE TITANIUM DISTAL MALLEOLUS FIBULA NONSTRL BOTH IP/OP "$1,017.50" $753.00 $201.95 "$1,017.50" $457.88 $457.88 $457.88 $457.88 "$1,017.50" "$1,017.50" "$1,017.50" $212.07 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $212.06 "$1,017.50" "$1,017.50" $601.85 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $763.13 "$1,017.50" "$1,017.50" "$1,017.50" $508.75 $508.75 $805.86 "$1,017.50" $814.00 $457.88 $201.95 N/A $590.15 "$1,017.50" $610.50 "$1,017.50" $212.05 "$1,017.50" N/A N/A PL-FIB7 SUP HCPCS C1713 PL-FIB7 - PLATE BONE 7 HOLE TITANIUM DISTAL MALLEOLUS FIBULA NONSTRL BOTH IP/OP "$1,017.50" $753.00 $201.95 "$1,017.50" $457.88 $457.88 $457.88 $457.88 "$1,017.50" "$1,017.50" "$1,017.50" $212.07 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $212.06 "$1,017.50" "$1,017.50" $601.85 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $763.13 "$1,017.50" "$1,017.50" "$1,017.50" $508.75 $508.75 $805.86 "$1,017.50" $814.00 $457.88 $201.95 N/A $590.15 "$1,017.50" $610.50 "$1,017.50" $212.05 "$1,017.50" N/A N/A PL-FIB9 SUP HCPCS C1713 PL-FIB9 - PLATE BONE 9 HOLE TITANIUM DISTAL MALLEOLUS FIBULA NONSTRL BOTH IP/OP "$1,017.50" $753.00 $201.95 "$1,017.50" $457.88 $457.88 $457.88 $457.88 "$1,017.50" "$1,017.50" "$1,017.50" $212.07 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $212.06 "$1,017.50" "$1,017.50" $601.85 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $763.13 "$1,017.50" "$1,017.50" "$1,017.50" $508.75 $508.75 $805.86 "$1,017.50" $814.00 $457.88 $201.95 N/A $590.15 "$1,017.50" $610.50 "$1,017.50" $212.05 "$1,017.50" N/A N/A PL-GLD3 SUP HCPCS C1713 PL-GLD3 - PLATE BONE STR 3 HOLE GLIDE TITANIUM MALLEOLUS NONSTRL BOTH IP/OP "$1,017.50" $753.00 $201.95 "$1,017.50" $457.88 $457.88 $457.88 $457.88 "$1,017.50" "$1,017.50" "$1,017.50" $212.07 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $212.06 "$1,017.50" "$1,017.50" $601.85 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $763.13 "$1,017.50" "$1,017.50" "$1,017.50" $508.75 $508.75 $805.86 "$1,017.50" $814.00 $457.88 $201.95 N/A $590.15 "$1,017.50" $610.50 "$1,017.50" $212.05 "$1,017.50" N/A N/A PL-GLD5 SUP HCPCS C1713 PL-GLD5 - PLATE BONE STR 5 HOLE GLIDE TITANIUM MALLEOLUS NONSTRL BOTH IP/OP "$1,017.50" $753.00 $201.95 "$1,017.50" $457.88 $457.88 $457.88 $457.88 "$1,017.50" "$1,017.50" "$1,017.50" $212.07 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $212.06 "$1,017.50" "$1,017.50" $601.85 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $763.13 "$1,017.50" "$1,017.50" "$1,017.50" $508.75 $508.75 $805.86 "$1,017.50" $814.00 $457.88 $201.95 N/A $590.15 "$1,017.50" $610.50 "$1,017.50" $212.05 "$1,017.50" N/A N/A PL-GLD7 SUP HCPCS C1713 PL-GLD7 - PLATE BONE STR 7 HOLE GLIDE TITANIUM MALLEOLUS NONSTRL BOTH IP/OP "$1,017.50" $753.00 $201.95 "$1,017.50" $457.88 $457.88 $457.88 $457.88 "$1,017.50" "$1,017.50" "$1,017.50" $212.07 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $212.06 "$1,017.50" $407.00 $601.85 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $763.13 "$1,017.50" "$1,017.50" "$1,017.50" $508.75 $508.75 $805.86 "$1,017.50" $814.00 $457.88 $201.95 N/A $590.15 "$1,017.50" "$1,017.50" "$1,017.50" $212.05 "$1,017.50" N/A N/A PL-LE011 SUP HCPCS C1713 PL-LE011 - PLATE 11 HOLE LCK BONE OLCRN ELB BOTH IP/OP "$2,125.00" "$1,573.00" $421.76 "$2,125.00" $956.25 $956.25 $956.25 $956.25 "$2,125.00" "$2,125.00" "$2,125.00" $442.90 "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" $442.87 "$2,125.00" $850.00 "$1,256.94" "$2,125.00" "$2,125.00" "$2,125.00" "$2,125.00" "$1,593.75" "$2,125.00" "$2,125.00" "$2,125.00" "$1,062.50" "$1,062.50" "$1,683.00" "$2,125.00" "$1,700.00" $956.25 $421.76 N/A "$1,232.50" "$2,125.00" "$1,275.00" "$2,125.00" $442.85 "$2,125.00" N/A N/A PL-LE013 SUP HCPCS C1713 PL-LE013 - PLATE TI 13 HOLE LCK SYS BONE OLCRN ELB STRL BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A PL-LE09 SUP HCPCS C1713 PL-LE09 - PLATE STD TI 9 HOLE LCK BONE OLCRN NONSTRL BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$1,237.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A PL-LEL10L SUP HCPCS C1713 PL-LEL10L - PLATE BN 100MM NS 10 HL LCK TI ELB L/L BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" $901.00 "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" N/A N/A PL-LEL10R SUP HCPCS C1713 PL-LEL10R - PLATE BN 100MM NS 10 HL LCK TI ELB RL BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" $901.00 "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$2,252.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LEL14 SUP HCPCS C1713 PL-LEL14 - PLATE BONE 14 HOLE SYSTEM RIGHT LATERAL ELBOW STERILE BOTH IP/OP "$1,875.00" "$1,388.00" $372.14 "$1,875.00" $843.75 $843.75 $843.75 $843.75 "$1,875.00" "$1,875.00" "$1,875.00" $390.80 "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" $390.77 "$1,875.00" "$1,875.00" "$1,109.06" "$1,875.00" "$1,875.00" "$1,875.00" "$1,875.00" "$1,406.25" "$1,875.00" "$1,875.00" "$1,875.00" $937.50 $937.50 "$1,485.00" "$1,875.00" "$1,500.00" $843.75 $372.14 N/A "$1,087.50" "$1,875.00" "$1,875.00" "$1,875.00" $390.75 "$1,875.00" N/A N/A PL-LEL14L SUP HCPCS C1713 PL-LEL14L - PLATE BONE 142MM 14 HOLE LOCK TITANIUM ELBOW LEFT LATERAL BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" $901.00 "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$2,252.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LEL14R SUP HCPCS C1713 PL-LEL14R - PLATE BONE XLONG 14 HOLE TITANIUM EPICONDYLAR RIGHT LATERAL BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$2,252.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LEL20L SUP HCPCS C1713 PL-LEL20L - PLATE BONE 206MM 20 HOLE LOCK TITANIUM ELBOW LEFT LATERAL BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" $901.00 "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$1,351.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LEL20R SUP HCPCS C1713 PL-LEL20R - PLATE BONE 206MM 20 HOLE LOCK TITANIUM ELBOW RIGHT LATERAL BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" $901.00 "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$1,351.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LEL6L SUP HCPCS C1713 PL-LEL6L - PLATE BONE 58MM 6 HOLE LOCK TITANIUM ELBOW LEFT LATERAL BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$1,351.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LEL6R SUP HCPCS C1713 PL-LEL6R - PLATE BONE 58MM 6 HOLE LOCK TITANIUM ELBOW RIGHT LATERAL BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$2,252.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LEM12 SUP HCPCS C1713 PL-LEM12 - PLATE BONE 130MM 12 HOLE LOCK TITANIUM ELBOW MEDIAL NONSTRL BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$2,252.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LEM16 SUP HCPCS C1713 PL-LEM16 - PLATE BN 16 HL LCK BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$1,351.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LEM7 SUP HCPCS C1713 PL-LEM7 - PLATE BONE 84MM 7 HOLE LOCK TITANIUM ELBOW MEDIAL NONSTRL BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$1,351.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LEM8 SUP HCPCS C1713 PL-LEM8 - PLATE BONE 88MM 8 HOLE LOCK TITANIUM ELBOW MEDIAL NONSTRL BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$1,351.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LEM9L SUP HCPCS C1713 PL-LEM9L - PLATE BONE LONG 96MM 9 HOLE LOCK TITANIUM ELBOW MEDIAL BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$2,252.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LEM9S SUP HCPCS C1713 PL-LEM9S - PLATE BONE SHORT 95MM 9 HOLE LOCK TITANIUM ELBOW MEDIAL BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" N/A N/A PL-LEO11 SUP HCPCS C1713 PL-LEO11 - PLATE BN NS 11 HL LCK PRECONTOUR TI ELB OLCRN BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$1,351.50" "$2,252.50" "$2,252.50" "$2,252.50" N/A N/A PL-LEO13 SUP HCPCS C1713 PL-LEO13 - PLATE BONE XLONG 13 HOLE LOCKING SYSTEM TITANIUM OLECRANON BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$1,351.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LEO13E SUP HCPCS C1713 PL-LEO13E - PLATE BN 13 HL XTD ELB BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" $901.00 "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$2,252.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LEO17L SUP HCPCS C1713 PL-LEO17L - PLATE BN NS 17 HL LCK PRECONTOUR TI ELB LT OLCRN BOTH IP/OP "$2,562.50" "$1,896.00" $508.59 "$2,562.50" "$1,153.13" "$1,153.13" "$1,153.13" "$1,153.13" "$2,562.50" "$2,562.50" "$2,562.50" $534.09 "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" $534.05 "$2,562.50" "$1,025.00" "$1,263.31" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$1,921.88" "$2,562.50" "$2,562.50" "$2,562.50" "$1,281.25" "$1,281.25" "$2,029.50" "$2,562.50" "$2,050.00" "$1,153.13" $508.59 N/A "$1,486.25" "$2,562.50" "$1,537.50" "$2,562.50" $534.03 "$2,562.50" N/A N/A PL-LEO17R SUP HCPCS C1713 PL-LEO17R - PLATE BN NS 17 HL LCK PRECONTOUR TI OLCRN RT BOTH IP/OP "$2,562.50" "$1,896.00" $508.59 "$2,562.50" "$1,153.13" "$1,153.13" "$1,153.13" "$1,153.13" "$2,562.50" "$2,562.50" "$2,562.50" $534.09 "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" $534.05 "$2,562.50" "$1,025.00" "$1,263.31" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$1,921.88" "$2,562.50" "$2,562.50" "$2,562.50" "$1,281.25" "$1,281.25" "$2,029.50" "$2,562.50" "$2,050.00" "$1,153.13" $508.59 N/A "$1,486.25" "$2,562.50" "$2,562.50" "$2,562.50" $534.03 "$2,562.50" N/A N/A PL-LEO9 SUP HCPCS C1713 PL-LEO9 - PLATE BONE STANDARD 9 HOLE LOCKING TITANIUM OLECRANON BOTH IP/OP "$2,252.50" "$1,667.00" $447.06 "$2,252.50" "$1,013.63" "$1,013.63" "$1,013.63" "$1,013.63" "$2,252.50" "$2,252.50" "$2,252.50" $469.48 "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" $469.45 "$2,252.50" "$2,252.50" "$1,332.35" "$2,252.50" "$2,252.50" "$2,252.50" "$2,252.50" "$1,689.38" "$2,252.50" "$2,252.50" "$2,252.50" "$1,126.25" "$1,126.25" "$1,783.98" "$2,252.50" "$1,802.00" "$1,013.63" $447.06 N/A "$1,306.45" "$2,252.50" "$2,252.50" "$2,252.50" $469.42 "$2,252.50" N/A N/A PL-LL8LR SUP HCPCS C1713 PL-LL8LR - PLATE BONE LONG 8 HOLE RIGHT CLAVICLE BOTH IP/OP "$1,862.50" "$1,378.00" $369.66 "$1,862.50" $838.13 $838.13 $838.13 $838.13 "$1,862.50" "$1,862.50" "$1,862.50" $388.19 "$1,862.50" "$1,862.50" "$1,862.50" "$1,862.50" "$1,862.50" $388.17 "$1,862.50" "$1,862.50" "$1,101.67" "$1,862.50" "$1,862.50" "$1,862.50" "$1,862.50" "$1,396.88" "$1,862.50" "$1,862.50" "$1,862.50" $931.25 $931.25 "$1,475.10" "$1,862.50" "$1,490.00" $838.13 $369.66 N/A "$1,080.25" "$1,862.50" "$1,117.50" "$1,862.50" $388.15 "$1,862.50" N/A N/A PL-MCPL SUP HCPCS C1713 PL-MCPL - PLATE BN RND NS FSN TI 1ST MCP LT BOTH IP/OP "$1,017.50" $753.00 $201.95 "$1,017.50" $457.88 $457.88 $457.88 $457.88 "$1,017.50" "$1,017.50" "$1,017.50" $212.07 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $212.06 "$1,017.50" $407.00 $601.85 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $763.13 "$1,017.50" "$1,017.50" "$1,017.50" $508.75 $508.75 $805.86 "$1,017.50" $814.00 $457.88 $201.95 N/A $590.15 "$1,017.50" "$1,017.50" "$1,017.50" $212.05 "$1,017.50" N/A N/A PL-MCPR SUP HCPCS C1713 PL-MCPR - PLATE TI BONE RIGHT MCP BOTH IP/OP "$1,017.50" $753.00 $201.95 "$1,017.50" $457.88 $457.88 $457.88 $457.88 "$1,017.50" "$1,017.50" "$1,017.50" $212.07 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $212.06 "$1,017.50" $407.00 $601.85 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $763.13 "$1,017.50" "$1,017.50" "$1,017.50" $508.75 $508.75 $805.86 "$1,017.50" $814.00 $457.88 $201.95 N/A $590.15 "$1,017.50" $610.50 "$1,017.50" $212.05 "$1,017.50" N/A N/A PL-MPJL SUP HCPCS C1713 PL-MPJL - PLATE BN NS 4 HL FSN TI 1ST MTP LT BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" $510.00 $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" $765.00 "$1,275.00" $265.71 "$1,275.00" N/A N/A PL-MPJR SUP HCPCS C1713 PL-MPJR - PLATE BONE SHORT 4 HOLE FUSION TITANIUM FT RIGHT ANKLE FIRST BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" "$1,275.00" "$1,275.00" $265.71 "$1,275.00" N/A N/A PL-MTPL SUP HCPCS C1713 PL-MTPL - PLATE BONE 5 HOLE FUSION COMPRESSION TITANIUM LEFT FIRST BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" $765.00 "$1,275.00" $265.71 "$1,275.00" N/A N/A PL-MTPLR SUP HCPCS C1713 PL-MTPLR - PLATE BN NS 6 HL REV FSN TI 1ST MTP LT BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" $765.00 "$1,275.00" $265.71 "$1,275.00" N/A N/A PL-MTPR SUP HCPCS C1713 PL-MTPR - PLATE BN NS 4 HL FSN TI 1ST MTP RT BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" $765.00 "$1,275.00" $265.71 "$1,275.00" N/A N/A PL-MTPRR SUP HCPCS C1713 PL-MTPRR - PLATE BONE PRECONTOUR 6 HOLE REVISION FUSION TITANIUM FT BOTH IP/OP "$1,275.00" $944.00 $253.06 "$1,275.00" $573.75 $573.75 $573.75 $573.75 "$1,275.00" "$1,275.00" "$1,275.00" $265.74 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $265.72 "$1,275.00" "$1,275.00" $754.16 "$1,275.00" "$1,275.00" "$1,275.00" "$1,275.00" $956.25 "$1,275.00" "$1,275.00" "$1,275.00" $637.50 $637.50 "$1,009.80" "$1,275.00" "$1,020.00" $573.75 $253.06 N/A $739.50 "$1,275.00" $765.00 "$1,275.00" $265.71 "$1,275.00" N/A N/A PLP10342 SUP HCPCS C1713 PLP10342 - PLATE BN 1.3MM NS ANCHORAGE 6 HL LOPRFL PIN FX HL VRSN V1 TI BOTH IP/OP "$2,761.00" "$2,043.00" $547.94 "$2,760.75" "$1,242.34" "$1,242.34" "$1,242.34" "$1,242.34" "$2,760.75" "$2,760.75" "$2,760.75" $575.41 "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" $575.37 "$2,760.75" "$2,760.75" "$1,361.05" "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" "$2,070.75" "$2,760.75" "$2,760.75" "$2,760.75" "$1,380.38" "$1,380.38" "$2,186.51" "$2,760.75" "$2,208.60" "$1,242.34" $547.94 N/A "$1,601.38" "$2,760.75" "$1,656.45" "$2,760.75" $575.34 "$2,760.75" N/A N/A PLP10462 SUP HCPCS C1713 PLP10462 - PLATE BN LNG 1.3MM NS ANCHORAGE 8 HL LOPRFL PIN FX HL VRSN V BOTH IP/OP "$2,761.00" "$2,043.00" $547.94 "$2,760.75" "$1,242.34" "$1,242.34" "$1,242.34" "$1,242.34" "$2,760.75" "$2,760.75" "$2,760.75" $575.41 "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" $575.37 "$2,760.75" "$2,760.75" "$1,361.05" "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" "$2,070.75" "$2,760.75" "$2,760.75" "$2,760.75" "$1,380.38" "$1,380.38" "$2,186.51" "$2,760.75" "$2,208.60" "$1,242.34" $547.94 N/A "$1,601.38" "$2,760.75" "$1,656.45" "$2,760.75" $575.34 "$2,760.75" N/A N/A PLP20342 SUP HCPCS C1713 PLP20342 - PLATE BN 0MM STP 1.5MM NS ANCHORAGE LOPRFL PIN FX THRD HL TI BOTH IP/OP "$2,761.00" "$2,043.00" $547.94 "$2,760.75" "$1,242.34" "$1,242.34" "$1,242.34" "$1,242.34" "$2,760.75" "$2,760.75" "$2,760.75" $575.41 "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" $575.37 "$2,760.75" "$1,104.30" "$1,361.05" "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" "$2,070.75" "$2,760.75" "$2,760.75" "$2,760.75" "$1,380.38" "$1,380.38" "$2,186.51" "$2,760.75" "$2,208.60" "$1,242.34" $547.94 N/A "$1,601.38" "$2,760.75" "$1,656.45" "$2,760.75" $575.34 "$2,760.75" N/A N/A PLP30201 SUP HCPCS C1713 PLP30201 - PLATE BN LG 1.5MM NS ANCHORAGE LOPRFL PIN FX THRD HL TI LT 3 BOTH IP/OP "$2,761.00" "$2,043.00" $547.94 "$2,760.75" "$1,242.34" "$1,242.34" "$1,242.34" "$1,242.34" "$2,760.75" "$2,760.75" "$2,760.75" $575.41 "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" $575.37 "$2,760.75" "$1,104.30" "$1,361.05" "$2,760.75" "$2,760.75" "$2,760.75" "$2,760.75" "$2,070.75" "$2,760.75" "$2,760.75" "$2,760.75" "$1,380.38" "$1,380.38" "$2,186.51" "$2,760.75" "$2,208.60" "$1,242.34" $547.94 N/A "$1,601.38" "$2,760.75" "$2,760.75" "$2,760.75" $575.34 "$2,760.75" N/A N/A PLP40160 SUP HCPCS C1713 PLP40160 - PLATE BN STRG 16MMX1.5MM NS ANCHORAGE 2 HL LOPRFL UTL SMTR BOTH IP/OP "$2,301.00" "$1,703.00" $456.62 "$2,300.63" "$1,035.28" "$1,035.28" "$1,035.28" "$1,035.28" "$2,300.63" "$2,300.63" "$2,300.63" $479.51 "$2,300.63" "$2,300.63" "$2,300.63" "$2,300.63" "$2,300.63" $479.48 "$2,300.63" "$2,300.63" "$1,360.82" "$2,300.63" "$2,300.63" "$2,300.63" "$2,300.63" "$1,725.75" "$2,300.63" "$2,300.63" "$2,300.63" "$1,150.32" "$1,150.32" "$1,822.10" "$2,300.63" "$1,840.50" "$1,035.28" $456.62 N/A "$1,334.58" "$2,300.63" "$2,300.63" "$2,300.63" $479.45 "$2,300.63" N/A N/A PLP40220 SUP HCPCS C1713 PLP40220 - PLATE BN STRG 22MMX1.5MM NS ANCHORAGE 3 HL LOPRFL UTL SMTR BOTH IP/OP "$2,301.00" "$1,703.00" $456.62 "$2,300.63" "$1,035.28" "$1,035.28" "$1,035.28" "$1,035.28" "$2,300.63" "$2,300.63" "$2,300.63" $479.51 "$2,300.63" "$2,300.63" "$2,300.63" "$2,300.63" "$2,300.63" $479.48 "$2,300.63" $920.25 "$1,360.82" "$2,300.63" "$2,300.63" "$2,300.63" "$2,300.63" "$1,725.75" "$2,300.63" "$2,300.63" "$2,300.63" "$1,150.32" "$1,150.32" "$1,822.10" "$2,300.63" "$1,840.50" "$1,035.28" $456.62 N/A "$1,334.58" "$2,300.63" "$2,300.63" "$2,300.63" $479.45 "$2,300.63" N/A N/A PL-PHGL SUP HCPCS C1713 PL-PHGL - PLATE BONE LARGE POLARUS TITANIUM HUMERUS LEFT PROXIMAL BOTH IP/OP "$3,747.50" "$2,773.00" $743.79 "$3,747.50" "$1,686.38" "$1,686.38" "$1,686.38" "$1,686.38" "$3,747.50" "$3,747.50" "$3,747.50" $781.07 "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" $781.02 "$3,747.50" "$3,747.50" "$1,847.52" "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" "$2,810.63" "$3,747.50" "$3,747.50" "$3,747.50" "$1,873.75" "$1,873.75" "$2,968.02" "$3,747.50" "$2,998.00" "$1,686.38" $743.79 N/A "$2,173.55" "$3,747.50" "$2,248.50" "$3,747.50" $780.98 "$3,747.50" N/A N/A PL-PHGR SUP HCPCS C1713 PL-PHGR - PLATE BN LG HUM RT BOTH IP/OP "$3,747.50" "$2,773.00" $743.79 "$3,747.50" "$1,686.38" "$1,686.38" "$1,686.38" "$1,686.38" "$3,747.50" "$3,747.50" "$3,747.50" $781.07 "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" $781.02 "$3,747.50" "$3,747.50" "$1,847.52" "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" "$2,810.63" "$3,747.50" "$3,747.50" "$3,747.50" "$1,873.75" "$1,873.75" "$2,968.02" "$3,747.50" "$2,998.00" "$1,686.38" $743.79 N/A "$2,173.55" "$3,747.50" "$3,747.50" "$3,747.50" $780.98 "$3,747.50" N/A N/A PL-PHSL SUP HCPCS C1713 PL-PHSL - PLATE BN SM HUM LT PROX BOTH IP/OP "$3,747.50" "$2,773.00" $743.79 "$3,747.50" "$1,686.38" "$1,686.38" "$1,686.38" "$1,686.38" "$3,747.50" "$3,747.50" "$3,747.50" $781.07 "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" $781.02 "$3,747.50" "$1,499.00" "$1,847.52" "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" "$2,810.63" "$3,747.50" "$3,747.50" "$3,747.50" "$1,873.75" "$1,873.75" "$2,968.02" "$3,747.50" "$2,998.00" "$1,686.38" $743.79 N/A "$2,173.55" "$3,747.50" "$2,248.50" "$3,747.50" $780.98 "$3,747.50" N/A N/A PL-PHSR SUP HCPCS C1713 PL-PHSR - PLATE BONE SMALL POLARUS TITANIUM RIGHT PROXIMAL HUMERUS BOTH IP/OP "$3,747.50" "$2,773.00" $743.79 "$3,747.50" "$1,686.38" "$1,686.38" "$1,686.38" "$1,686.38" "$3,747.50" "$3,747.50" "$3,747.50" $781.07 "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" $781.02 "$3,747.50" "$3,747.50" "$1,847.52" "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" "$2,810.63" "$3,747.50" "$3,747.50" "$3,747.50" "$1,873.75" "$1,873.75" "$2,968.02" "$3,747.50" "$2,998.00" "$1,686.38" $743.79 N/A "$2,173.55" "$3,747.50" "$3,747.50" "$3,747.50" $780.98 "$3,747.50" N/A N/A PL-PHXGL SUP HCPCS C1713 PL-PHXGL - PLATE BONE XLONG POLARUS TITANIUM LEFT PROXIMAL HUMERUS BOTH IP/OP "$3,747.50" "$2,773.00" $743.79 "$3,747.50" "$1,686.38" "$1,686.38" "$1,686.38" "$1,686.38" "$3,747.50" "$3,747.50" "$3,747.50" $781.07 "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" $781.02 "$3,747.50" "$3,747.50" "$1,847.52" "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" "$2,810.63" "$3,747.50" "$3,747.50" "$3,747.50" "$1,873.75" "$1,873.75" "$2,968.02" "$3,747.50" "$2,998.00" "$1,686.38" $743.79 N/A "$2,173.55" "$3,747.50" "$2,248.50" "$3,747.50" $780.98 "$3,747.50" N/A N/A PL-PHXGR SUP HCPCS C1713 PL-PHXGR - PLATE BONE XLONG POLARUS TITANIUM RIGHT PROXIMAL HUMERUS BOTH IP/OP "$3,747.50" "$2,773.00" $743.79 "$3,747.50" "$1,686.38" "$1,686.38" "$1,686.38" "$1,686.38" "$3,747.50" "$3,747.50" "$3,747.50" $781.07 "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" $781.02 "$3,747.50" "$1,499.00" "$1,847.52" "$3,747.50" "$3,747.50" "$3,747.50" "$3,747.50" "$2,810.63" "$3,747.50" "$3,747.50" "$3,747.50" "$1,873.75" "$1,873.75" "$2,968.02" "$3,747.50" "$2,998.00" "$1,686.38" $743.79 N/A "$2,173.55" "$3,747.50" "$2,248.50" "$3,747.50" $780.98 "$3,747.50" N/A N/A PL-PTACK SUP Custom 27803010 PL-PTACK - TACK ORTHOPEDIC FIX PIN PLATE BOTH IP/OP $90.00 $67.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $16.02 $90.00 $90.00 $90.00 $90.00 $90.00 $90.00 $18.76 $90.00 $36.00 $90.00 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $40.50 $90.00 N/A $52.20 $90.00 $54.00 $90.00 $90.00 $90.00 N/A N/A PLS-1009 SUP HCPCS C1892 PLS-1009 - INTROD SHTH 9FR .118IN 13CM RBST VLV SPLT SDPRT BOTH IP/OP $192.50 $142.00 $38.21 $192.50 $104.53 $104.53 $104.53 $104.53 $192.50 $192.50 $192.50 $40.12 $192.50 $142.87 $142.87 $148.38 $100.29 $40.12 $192.50 $192.50 $113.86 $192.50 $192.50 $192.50 $192.50 $144.38 $192.50 $192.50 $192.50 $96.25 $96.25 $152.46 $192.50 $154.00 $125.13 $38.21 N/A $111.65 $192.50 $192.50 $192.50 $40.12 $192.50 N/A N/A PL-SA06L SUP HCPCS C1713 PL-SA06L - PLATE BN NS 6 HL TI SCAPULAR LT ACROMION BOTH IP/OP "$3,592.50" "$2,658.00" $713.02 "$3,592.50" "$1,616.63" "$1,616.63" "$1,616.63" "$1,616.63" "$3,592.50" "$3,592.50" "$3,592.50" $748.77 "$3,592.50" "$3,592.50" "$3,592.50" "$3,592.50" "$3,592.50" $748.72 "$3,592.50" "$1,437.00" "$1,771.10" "$3,592.50" "$3,592.50" "$3,592.50" "$3,592.50" "$2,694.38" "$3,592.50" "$3,592.50" "$3,592.50" "$1,796.25" "$1,796.25" "$2,845.26" "$3,592.50" "$2,874.00" "$1,616.63" $713.02 N/A "$2,083.65" "$3,592.50" "$2,155.50" "$3,592.50" $748.68 "$3,592.50" N/A N/A PL-SA06R SUP HCPCS C1713 PL-SA06R - PLATE BONE 6 HOLE ACROMION RIGHT NONSTRL BOTH IP/OP "$3,592.50" "$2,658.00" $713.02 "$3,592.50" "$1,616.63" "$1,616.63" "$1,616.63" "$1,616.63" "$3,592.50" "$3,592.50" "$3,592.50" $748.77 "$3,592.50" "$3,592.50" "$3,592.50" "$3,592.50" "$3,592.50" $748.72 "$3,592.50" "$1,437.00" "$1,771.10" "$3,592.50" "$3,592.50" "$3,592.50" "$3,592.50" "$2,694.38" "$3,592.50" "$3,592.50" "$3,592.50" "$1,796.25" "$1,796.25" "$2,845.26" "$3,592.50" "$2,874.00" "$1,616.63" $713.02 N/A "$2,083.65" "$3,592.50" "$3,592.50" "$3,592.50" $748.68 "$3,592.50" N/A N/A PLS-AIM-0910 SUP Custom 27203010 "PLS-AIM-0910 - GUIDE PLS AIMING, .9MM x 10?" BOTH IP/OP $110.00 $81.00 $19.58 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $19.58 $110.00 $110.00 $81.64 $81.64 $84.79 $57.31 $22.93 $110.00 $44.00 $110.00 $110.00 $110.00 $110.00 $110.00 $82.50 $110.00 $110.00 $110.00 $55.00 $55.00 $87.12 $110.00 $88.00 $71.50 $110.00 N/A $63.80 $110.00 $66.00 $110.00 $110.00 $110.00 N/A N/A PL-SG04L SUP HCPCS C1713 PL-SG04L - PLATE BONE 4 HOLE LEFT GLENOID SCAPULA STERILE BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$2,690.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A PL-SG04R SUP HCPCS C1713 PL-SG04R - PLATE BONE 4 HOLE RIGHT GLENOID SCAPULA NONSTRL BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$1,614.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A PLSL3012 SUP HCPCS C1713 PLSL3012 - SCREW BN T8 3MM 12MM BLU NS ANCHORAGE TX HD LCK TI FT/ANKL BOTH IP/OP $393.00 $291.00 $77.93 $392.63 $176.68 $176.68 $176.68 $176.68 $392.63 $392.63 $392.63 $81.83 $392.63 $392.63 $392.63 $392.63 $392.63 $81.83 $392.63 $157.05 $232.24 $392.63 $392.63 $392.63 $392.63 $294.75 $392.63 $392.63 $392.63 $196.32 $196.32 $310.96 $392.63 $314.10 $176.68 $77.93 N/A $227.94 $392.63 $235.58 $392.63 $81.82 $392.63 N/A N/A PLSL3016 SUP HCPCS C1713 PLSL3016 - SCREW BN T8 3MM 16MM BLU NS ANCHORAGE TX HD LCK TI FT/ANKL BOTH IP/OP $393.00 $291.00 $77.93 $392.63 $176.68 $176.68 $176.68 $176.68 $392.63 $392.63 $392.63 $81.83 $392.63 $392.63 $392.63 $392.63 $392.63 $81.83 $392.63 $157.05 $232.24 $392.63 $392.63 $392.63 $392.63 $294.75 $392.63 $392.63 $392.63 $196.32 $196.32 $310.96 $392.63 $314.10 $176.68 $77.93 N/A $227.94 $392.63 $235.58 $392.63 $81.82 $392.63 N/A N/A PLSL3516 SUP HCPCS C1713 PLSL3516 - SCREW BN T8 3.5MM 16MM YLW NS ANCHORAGE TX HD LCK TI FT/ANKL BOTH IP/OP $393.00 $291.00 $77.93 $392.63 $176.68 $176.68 $176.68 $176.68 $392.63 $392.63 $392.63 $81.83 $392.63 $392.63 $392.63 $392.63 $392.63 $81.83 $392.63 $157.05 $232.24 $392.63 $392.63 $392.63 $392.63 $294.75 $392.63 $392.63 $392.63 $196.32 $196.32 $310.96 $392.63 $314.10 $176.68 $77.93 N/A $227.94 $392.63 $235.58 $392.63 $81.82 $392.63 N/A N/A PLSL3518 SUP HCPCS C1713 PLSL3518 - SCREW BN T8 3.5MM 18MM YLW NS ANCHORAGE TX HD LCK TI FT/ANKL BOTH IP/OP $393.00 $291.00 $77.93 $392.63 $176.68 $176.68 $176.68 $176.68 $392.63 $392.63 $392.63 $81.83 $392.63 $392.63 $392.63 $392.63 $392.63 $81.83 $392.63 $157.05 $232.24 $392.63 $392.63 $392.63 $392.63 $294.75 $392.63 $392.63 $392.63 $196.32 $196.32 $310.96 $392.63 $314.10 $176.68 $77.93 N/A $227.94 $392.63 $235.58 $392.63 $81.82 $392.63 N/A N/A PLSL3530 SUP HCPCS C1713 PLSL3530 - SCREW BN T8 3.5MM 30MM YLW NS ANCHORAGE TX HD LCK TI FT/ANKL BOTH IP/OP $385.00 $285.00 $76.36 $384.75 $173.14 $173.14 $173.14 $173.14 $384.75 $384.75 $384.75 $80.19 $384.75 $384.75 $384.75 $384.75 $384.75 $80.19 $384.75 $384.75 $227.58 $384.75 $384.75 $384.75 $384.75 $288.75 $384.75 $384.75 $384.75 $192.38 $192.38 $304.72 $384.75 $307.80 $173.14 $76.36 N/A $223.30 $384.75 $230.85 $384.75 $80.18 $384.75 N/A N/A PL-SLB10L SUP HCPCS C1713 PL-SLB10L - PLATE BN 10 HL LT SCAPULA LAT BOTH IP/OP "$4,570.00" "$3,382.00" $907.03 "$4,570.00" "$2,056.50" "$2,056.50" "$2,056.50" "$2,056.50" "$4,570.00" "$4,570.00" "$4,570.00" $952.50 "$4,570.00" "$4,570.00" "$4,570.00" "$4,570.00" "$4,570.00" $952.44 "$4,570.00" "$4,570.00" "$2,253.01" "$4,570.00" "$4,570.00" "$4,570.00" "$4,570.00" "$3,427.50" "$4,570.00" "$4,570.00" "$4,570.00" "$2,285.00" "$2,285.00" "$3,619.44" "$4,570.00" "$3,656.00" "$2,056.50" $907.03 N/A "$2,650.60" "$4,570.00" "$2,742.00" "$4,570.00" $952.39 "$4,570.00" N/A N/A PL-SLB10R SUP HCPCS C1713 PL-SLB10R - PLATE BONE 10 HOLE BORDER LOCKING RIGHT LATERAL SCAPULAR BOTH IP/OP "$4,570.00" "$3,382.00" $907.03 "$4,570.00" "$2,056.50" "$2,056.50" "$2,056.50" "$2,056.50" "$4,570.00" "$4,570.00" "$4,570.00" $952.50 "$4,570.00" "$4,570.00" "$4,570.00" "$4,570.00" "$4,570.00" $952.44 "$4,570.00" "$4,570.00" "$2,253.01" "$4,570.00" "$4,570.00" "$4,570.00" "$4,570.00" "$3,427.50" "$4,570.00" "$4,570.00" "$4,570.00" "$2,285.00" "$2,285.00" "$3,619.44" "$4,570.00" "$3,656.00" "$2,056.50" $907.03 N/A "$2,650.60" "$4,570.00" "$4,570.00" "$4,570.00" $952.39 "$4,570.00" N/A N/A PL-SMB09L SUP HCPCS C1713 PL-SMB09L - PLATE BN 9 HL MED LT SCAPULA BOTH IP/OP "$4,235.00" "$3,134.00" $840.54 "$4,235.00" "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" "$4,235.00" "$4,235.00" "$4,235.00" $882.68 "$4,235.00" "$4,235.00" "$4,235.00" "$4,235.00" "$4,235.00" $882.62 "$4,235.00" "$1,694.00" "$2,087.86" "$4,235.00" "$4,235.00" "$4,235.00" "$4,235.00" "$3,176.25" "$4,235.00" "$4,235.00" "$4,235.00" "$2,117.50" "$2,117.50" "$3,354.12" "$4,235.00" "$3,388.00" "$1,905.75" $840.54 N/A "$2,456.30" "$4,235.00" "$2,541.00" "$4,235.00" $882.57 "$4,235.00" N/A N/A PL-SMB09R SUP HCPCS C1713 PL-SMB09R - PLATE BONE 9 HOLE BORDER RIGHT MEDIAL SCAPULA NONSTRL BOTH IP/OP "$4,235.00" "$3,134.00" $840.54 "$4,235.00" "$1,905.75" "$1,905.75" "$1,905.75" "$1,905.75" "$4,235.00" "$4,235.00" "$4,235.00" $882.68 "$4,235.00" "$4,235.00" "$4,235.00" "$4,235.00" "$4,235.00" $882.62 "$4,235.00" "$1,694.00" "$2,087.86" "$4,235.00" "$4,235.00" "$4,235.00" "$4,235.00" "$3,176.25" "$4,235.00" "$4,235.00" "$4,235.00" "$2,117.50" "$2,117.50" "$3,354.12" "$4,235.00" "$3,388.00" "$1,905.75" $840.54 N/A "$2,456.30" "$4,235.00" "$2,541.00" "$4,235.00" $882.57 "$4,235.00" N/A N/A PL-SMB13L SUP HCPCS C1713 PL-SMB13L - PLATE BONE 13 HOLE BORDER LEFT MEDIAL SCAPULA NONSTRL BOTH IP/OP "$4,570.00" "$3,382.00" $907.03 "$4,570.00" "$2,056.50" "$2,056.50" "$2,056.50" "$2,056.50" "$4,570.00" "$4,570.00" "$4,570.00" $952.50 "$4,570.00" "$4,570.00" "$4,570.00" "$4,570.00" "$4,570.00" $952.44 "$4,570.00" "$1,828.00" "$2,253.01" "$4,570.00" "$4,570.00" "$4,570.00" "$4,570.00" "$3,427.50" "$4,570.00" "$4,570.00" "$4,570.00" "$2,285.00" "$2,285.00" "$3,619.44" "$4,570.00" "$3,656.00" "$2,056.50" $907.03 N/A "$2,650.60" "$4,570.00" "$2,742.00" "$4,570.00" $952.39 "$4,570.00" N/A N/A PL-SMB13R SUP HCPCS C1713 PL-SMB13R - PLATE BONE 13 HOLE BORDER RIGHT MEDIAL SCAPULA NONSTRL BOTH IP/OP "$4,570.00" "$3,382.00" $907.03 "$4,570.00" "$2,056.50" "$2,056.50" "$2,056.50" "$2,056.50" "$4,570.00" "$4,570.00" "$4,570.00" $952.50 "$4,570.00" "$4,570.00" "$4,570.00" "$4,570.00" "$4,570.00" $952.44 "$4,570.00" "$1,828.00" "$2,253.01" "$4,570.00" "$4,570.00" "$4,570.00" "$4,570.00" "$3,427.50" "$4,570.00" "$4,570.00" "$4,570.00" "$2,285.00" "$2,285.00" "$3,619.44" "$4,570.00" "$3,656.00" "$2,056.50" $907.03 N/A "$2,650.60" "$4,570.00" "$4,570.00" "$4,570.00" $952.39 "$4,570.00" N/A N/A PL-SR27 SUP Custom 27203010 PL-SR27 - REAMER SRG MN FSN PLT SLV WRST BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $200.39 $200.39 $208.12 $140.67 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $175.50 $270.00 N/A $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A PL-SR29 SUP HCPCS C1776 PL-SR29 - HEAD RMR MN WRST FSN PLT BOTH IP/OP $552.50 $409.00 $109.66 $552.50 $248.63 $248.63 $248.63 $248.63 $552.50 $552.50 $552.50 $115.15 $552.50 $552.50 $552.50 $552.50 $552.50 $115.15 $552.50 $221.00 $326.80 $552.50 $552.50 $552.50 $552.50 $414.38 $552.50 $552.50 $552.50 $276.25 $276.25 $437.58 $552.50 $442.00 $248.63 $109.66 N/A $320.45 $552.50 $552.50 $552.50 $115.14 $552.50 N/A N/A PL-SR30 SUP Custom 27203010 PL-SR30 - REAMER SRG MN ASMB BOTH IP/OP "$1,690.00" "$1,251.00" $300.82 "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" $300.82 "$1,690.00" "$1,690.00" "$1,254.32" "$1,254.32" "$1,302.65" $880.49 $352.21 "$1,690.00" $676.00 "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" "$1,690.00" "$1,267.50" "$1,690.00" "$1,690.00" "$1,690.00" $845.00 $845.00 "$1,338.48" "$1,690.00" "$1,352.00" "$1,098.50" "$1,690.00" N/A $980.20 "$1,690.00" "$1,014.00" "$1,690.00" "$1,690.00" "$1,690.00" N/A N/A PL-SR38 SUP HCPCS C1776 PL-SR38 - HEAD RMR NS HBCP SHFT HND WRST BOTH IP/OP $587.50 $435.00 $116.60 $587.50 $264.38 $264.38 $264.38 $264.38 $587.50 $587.50 $587.50 $122.45 $587.50 $587.50 $587.50 $587.50 $587.50 $122.44 $587.50 $235.00 $347.51 $587.50 $587.50 $587.50 $587.50 $440.63 $587.50 $587.50 $587.50 $293.75 $293.75 $465.30 $587.50 $470.00 $264.38 $116.60 N/A $340.75 $587.50 $587.50 $587.50 $122.44 $587.50 N/A N/A PL-SR39 SUP HCPCS C1776 PL-SR39 - HEAD REAMER REPLACEMENT HUB CAP WRIST FUSION PLATE BOTH IP/OP $630.00 $466.00 $125.04 $630.00 $283.50 $283.50 $283.50 $283.50 $630.00 $630.00 $630.00 $131.31 $630.00 $630.00 $630.00 $630.00 $630.00 $131.30 $630.00 $252.00 $372.65 $630.00 $630.00 $630.00 $630.00 $472.50 $630.00 $630.00 $630.00 $315.00 $315.00 $498.96 $630.00 $504.00 $283.50 $125.04 N/A $365.40 $630.00 $630.00 $630.00 $131.29 $630.00 N/A N/A PL-SR41 SUP Custom 27203010 PL-SR41 - WRENCH SRG RMR HD HUB CAP BOTH IP/OP $270.00 $200.00 $48.06 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $270.00 $48.06 $270.00 $270.00 $200.39 $200.39 $208.12 $140.67 $56.27 $270.00 $108.00 $270.00 $270.00 $270.00 $270.00 $270.00 $202.50 $270.00 $270.00 $270.00 $135.00 $135.00 $213.84 $270.00 $216.00 $175.50 $270.00 N/A $156.60 $270.00 $162.00 $270.00 $270.00 $270.00 N/A N/A PLSS3016 SUP HCPCS C1713 PLSS3016 - SCREW BN STD T8 3MM 16MM BLU NS ANCHORAGE TX HD TI FT/ANKL BOTH IP/OP $271.50 $201.00 $53.81 $271.13 $122.01 $122.01 $122.01 $122.01 $271.13 $271.13 $271.13 $56.51 $271.13 $271.13 $271.13 $271.13 $271.13 $56.51 $271.13 $271.13 $160.37 $271.13 $271.13 $271.13 $271.13 $203.63 $271.13 $271.13 $271.13 $135.57 $135.57 $214.73 $271.13 $216.90 $122.01 $53.81 N/A $157.47 $271.13 $271.13 $271.13 $56.50 $271.13 N/A N/A PLSS3018 SUP HCPCS C1713 PLSS3018 - SCREW BN STD T8 3MM 18MM BLU NS ANCHORAGE TX HD TI FT/ANKL BOTH IP/OP $271.50 $201.00 $53.81 $271.13 $122.01 $122.01 $122.01 $122.01 $271.13 $271.13 $271.13 $56.51 $271.13 $271.13 $271.13 $271.13 $271.13 $56.51 $271.13 $108.45 $160.37 $271.13 $271.13 $271.13 $271.13 $203.63 $271.13 $271.13 $271.13 $135.57 $135.57 $214.73 $271.13 $216.90 $122.01 $53.81 N/A $157.47 $271.13 $271.13 $271.13 $56.50 $271.13 N/A N/A PLSS3020 SUP HCPCS C1713 PLSS3020 - SCREW BN STD T8 3MM 20MM BLU NS ANCHORAGE TX HD TI FT/ANKL BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $265.50 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $159.30 $265.50 $55.33 $265.50 N/A N/A PLSS3022 SUP HCPCS C1713 PLSS3022 - SCREW BN STD T8 3MM 22MM BLU NS ANCHORAGE TX HD TI FT/ANKL BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $265.50 $265.50 $55.33 $265.50 N/A N/A PLSS3024 SUP HCPCS C1713 PLSS3024 - SCREW BN STD T8 3MM 24MM BLU NS ANCHORAGE TX HD TI FT/ANKL BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $159.30 $265.50 $55.33 $265.50 N/A N/A PLSS3026 SUP HCPCS C1713 PLSS3026 - SCREW BN STD T8 3MM 26MM BLU NS ANCHORAGE TX HD TI FT/ANKL BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $265.50 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $159.30 $265.50 $55.33 $265.50 N/A N/A PLSS3028 SUP HCPCS C1713 PLSS3028 - SCREW BN STD T8 3MM 28MM BLU NS ANCHORAGE TX HD TI FT/ANKL BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $265.50 $265.50 $55.33 $265.50 N/A N/A PLSS3514 SUP HCPCS C1713 PLSS3514 - SCREW BN STD T8 3.5MM 14MM YLW NS ANCHORAGE TX HD TI FT/ANKL BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $159.30 $265.50 $55.33 $265.50 N/A N/A PLSS3516 SUP HCPCS C1713 PLSS3516 - SCREW BN STD T8 3.5MM 16MM YLW NS ANCHORAGE TX HD TI FT/ANKL BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $159.30 $265.50 $55.33 $265.50 N/A N/A PLSS3520 SUP HCPCS C1713 PLSS3520 - SCREW BN STD T8 3.5MM 20MM YLW NS ANCHORAGE TX HD TI FT/ANKL BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $265.50 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $159.30 $265.50 $55.33 $265.50 N/A N/A PLSS3522 SUP HCPCS C1713 PLSS3522 - SCREW BN STD T8 3.5MM 22MM YLW NS ANCHORAGE TX HD TI FT/ANKL BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $159.30 $265.50 $55.33 $265.50 N/A N/A PLSS3526 SUP HCPCS C1713 PLSS3526 - SCREW BN STD T8 3.5MM 26MM YLW NS ANCHORAGE TX HD TI FT/ANKL BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $159.30 $265.50 $55.33 $265.50 N/A N/A PLSS3532 SUP HCPCS C1713 PLSS3532 - SCREW BN STD T8 3.5MM 32MM YLW NS ANCHORAGE TX HD TI FT/ANKL BOTH IP/OP $265.50 $196.00 $52.70 $265.50 $119.48 $119.48 $119.48 $119.48 $265.50 $265.50 $265.50 $55.34 $265.50 $265.50 $265.50 $265.50 $265.50 $55.33 $265.50 $106.20 $157.04 $265.50 $265.50 $265.50 $265.50 $199.13 $265.50 $265.50 $265.50 $132.75 $132.75 $210.28 $265.50 $212.40 $119.48 $52.70 N/A $153.99 $265.50 $159.30 $265.50 $55.33 $265.50 N/A N/A PLT-1030 SUP HCPCS C1713 PLT-1030 - PLATE MAXFACL 7X7 HOLE MESH BIODEG 1.5 MM SCR BONE CPS TI BOTH IP/OP "$2,833.50" "$2,097.00" $562.31 "$2,833.13" "$1,274.91" "$1,274.91" "$1,274.91" "$1,274.91" "$2,833.13" "$2,833.13" "$2,833.13" $590.50 "$2,833.13" "$2,833.13" "$2,833.13" "$2,833.13" "$2,833.13" $590.46 "$2,833.13" "$2,833.13" "$1,396.73" "$2,833.13" "$2,833.13" "$2,833.13" "$2,833.13" "$2,125.13" "$2,833.13" "$2,833.13" "$2,833.13" "$1,416.57" "$1,416.57" "$2,243.84" "$2,833.13" "$2,266.50" "$1,274.91" $562.31 N/A "$1,643.43" "$2,833.13" "$2,833.13" "$2,833.13" "$2,833.13" "$2,833.13" N/A N/A PL-TACK2 SUP HCPCS C1713 PL-TACK2 - PLATE BN 3.75IN TEMP BOTH IP/OP $90.00 $67.00 $17.86 $90.00 $40.50 $40.50 $40.50 $40.50 $90.00 $90.00 $90.00 $18.76 $90.00 $90.00 $90.00 $90.00 $90.00 $18.76 $90.00 $90.00 $53.24 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $40.50 $17.86 N/A $52.20 $90.00 $90.00 $90.00 $90.00 $90.00 N/A N/A PL-TIBAM SUP HCPCS C1713 PL-TIBAM - PLATE BONE 9 HOLE TITANIUM ANTERIOR MALLEOLUS NONSTRL BOTH IP/OP "$1,017.50" $753.00 $201.95 "$1,017.50" $457.88 $457.88 $457.88 $457.88 "$1,017.50" "$1,017.50" "$1,017.50" $212.07 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $212.06 "$1,017.50" $407.00 $601.85 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $763.13 "$1,017.50" "$1,017.50" "$1,017.50" $508.75 $508.75 $805.86 "$1,017.50" $814.00 $457.88 $201.95 N/A $590.15 "$1,017.50" $610.50 "$1,017.50" $212.05 "$1,017.50" N/A N/A PL-TIBMM SUP HCPCS C1713 PL-TIBMM - PLATE BONE 9 HOLE TITANIUM MEDIAL MALLEOLUS NONSTRL BOTH IP/OP "$1,017.50" $753.00 $201.95 "$1,017.50" $457.88 $457.88 $457.88 $457.88 "$1,017.50" "$1,017.50" "$1,017.50" $212.07 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $212.06 "$1,017.50" $407.00 $601.85 "$1,017.50" "$1,017.50" "$1,017.50" "$1,017.50" $763.13 "$1,017.50" "$1,017.50" "$1,017.50" $508.75 $508.75 $805.86 "$1,017.50" $814.00 $457.88 $201.95 N/A $590.15 "$1,017.50" $610.50 "$1,017.50" $212.05 "$1,017.50" N/A N/A PL-TMT14 SUP HCPCS C1713 PL-TMT14 - PLATE BONE 4 HOLE CONGRUENT TITANIUM FIRST METATARSAL FRFT BOTH IP/OP "$1,222.50" $905.00 $242.64 "$1,222.50" $550.13 $550.13 $550.13 $550.13 "$1,222.50" "$1,222.50" "$1,222.50" $254.80 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $254.78 "$1,222.50" "$1,222.50" $723.11 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $916.88 "$1,222.50" "$1,222.50" "$1,222.50" $611.25 $611.25 $968.22 "$1,222.50" $978.00 $550.13 $242.64 N/A $709.05 "$1,222.50" $733.50 "$1,222.50" $254.77 "$1,222.50" N/A N/A PL-TMT24 SUP HCPCS C1713 PL-TMT24 - PLATE BONE CONGRUENT MIDFT NONSTRL BOTH IP/OP "$1,222.50" $905.00 $242.64 "$1,222.50" $550.13 $550.13 $550.13 $550.13 "$1,222.50" "$1,222.50" "$1,222.50" $254.80 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $254.78 "$1,222.50" $489.00 $723.11 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $916.88 "$1,222.50" "$1,222.50" "$1,222.50" $611.25 $611.25 $968.22 "$1,222.50" $978.00 $550.13 $242.64 N/A $709.05 "$1,222.50" $733.50 "$1,222.50" $254.77 "$1,222.50" N/A N/A PL-TMT5 SUP HCPCS C1713 PL-TMT5 - PLATE BONE 5 HOLE TITANIUM FIRST TARSOMETATARSAL NONSTRL BOTH IP/OP "$1,222.50" $905.00 $242.64 "$1,222.50" $550.13 $550.13 $550.13 $550.13 "$1,222.50" "$1,222.50" "$1,222.50" $254.80 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $254.78 "$1,222.50" $489.00 $723.11 "$1,222.50" "$1,222.50" "$1,222.50" "$1,222.50" $916.88 "$1,222.50" "$1,222.50" "$1,222.50" $611.25 $611.25 $968.22 "$1,222.50" $978.00 $550.13 $242.64 N/A $709.05 "$1,222.50" "$1,222.50" "$1,222.50" $254.77 "$1,222.50" N/A N/A PL-UL06 SUP HCPCS C1713 PL-UL06 - PLATE BN SHRT STRL 6 HL TI ULNA OSTM BOTH IP/OP "$1,790.00" "$1,325.00" $355.27 "$1,790.00" $805.50 $805.50 $805.50 $805.50 "$1,790.00" "$1,790.00" "$1,790.00" $373.08 "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" $373.06 "$1,790.00" $716.00 "$1,058.79" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,342.50" "$1,790.00" "$1,790.00" "$1,790.00" $895.00 $895.00 "$1,417.68" "$1,790.00" "$1,432.00" $805.50 $355.27 N/A "$1,038.20" "$1,790.00" "$1,074.00" "$1,790.00" $373.04 "$1,790.00" N/A N/A PL-UL06-S SUP HCPCS C1713 PL-UL06-S - PLATE BONE SHORT 6 HOLE TITANIUM ULNA STERILE OSTMY BOTH IP/OP "$1,790.00" "$1,325.00" $355.27 "$1,790.00" $805.50 $805.50 $805.50 $805.50 "$1,790.00" "$1,790.00" "$1,790.00" $373.08 "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" $373.06 "$1,790.00" $716.00 "$1,058.79" "$1,790.00" "$1,790.00" "$1,790.00" "$1,790.00" "$1,342.50" "$1,790.00" "$1,790.00" "$1,790.00" $895.00 $895.00 "$1,417.68" "$1,790.00" "$1,432.00" $805.50 $355.27 N/A "$1,038.20" "$1,790.00" "$1,790.00" "$1,790.00" $373.04 "$1,790.00" N/A N/A PL-VO47 SUP HCPCS C1713 PL-VO47 - PLATE 47MM TI BONE VOLR RADL NONSTRL BOTH IP/OP "$1,020.00" $755.00 $202.44 "$1,020.00" $459.00 $459.00 $459.00 $459.00 "$1,020.00" "$1,020.00" "$1,020.00" $212.59 "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" $212.58 "$1,020.00" "$1,020.00" $603.33 "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" $765.00 "$1,020.00" "$1,020.00" "$1,020.00" $510.00 $510.00 $807.84 "$1,020.00" $816.00 $459.00 $202.44 N/A $591.60 "$1,020.00" $612.00 "$1,020.00" $212.57 "$1,020.00" N/A N/A PL-VO60 SUP HCPCS C1713 PL-VO60 - PLATE 60MM TI BONE VOLR RADL NONSTRL BOTH IP/OP "$1,020.00" $755.00 $202.44 "$1,020.00" $459.00 $459.00 $459.00 $459.00 "$1,020.00" "$1,020.00" "$1,020.00" $212.59 "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" $212.58 "$1,020.00" "$1,020.00" $603.33 "$1,020.00" "$1,020.00" "$1,020.00" "$1,020.00" $765.00 "$1,020.00" "$1,020.00" "$1,020.00" $510.00 $510.00 $807.84 "$1,020.00" $816.00 $459.00 $202.44 N/A $591.60 "$1,020.00" $612.00 "$1,020.00" $212.57 "$1,020.00" N/A N/A PL-WF33 SUP HCPCS C1713 PL-WF33 - PLATE BN MN NS HBCP 3 CRNR FSN TI WRST BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" "$2,047.50" "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$1,228.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A PL-WF40 SUP HCPCS C1713 PL-WF40 - PLATE BN NS HBCP TI WRST BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" "$2,047.50" "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$1,228.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A PL-WF44 SUP HCPCS C1713 PL-WF44 - PLATE BONE MINI 4 CORNER FUSION HUB CAP TITANIUM WRIST BOTH IP/OP "$2,047.50" "$1,515.00" $406.38 "$2,047.50" $921.38 $921.38 $921.38 $921.38 "$2,047.50" "$2,047.50" "$2,047.50" $426.75 "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" $426.72 "$2,047.50" $819.00 "$1,211.10" "$2,047.50" "$2,047.50" "$2,047.50" "$2,047.50" "$1,535.63" "$2,047.50" "$2,047.50" "$2,047.50" "$1,023.75" "$1,023.75" "$1,621.62" "$2,047.50" "$1,638.00" $921.38 $406.38 N/A "$1,187.55" "$2,047.50" "$1,228.50" "$2,047.50" $426.70 "$2,047.50" N/A N/A PL-WF50 SUP HCPCS C1713 PL-WF50 - POST SCREW 50MM PLATE HUB CAP TITANIUM WRIST NONSTRL BOTH IP/OP $82.50 $61.00 $16.37 $82.50 $37.13 $37.13 $37.13 $37.13 $82.50 $82.50 $82.50 $17.20 $82.50 $82.50 $82.50 $82.50 $82.50 $17.19 $82.50 $33.00 $48.80 $82.50 $82.50 $82.50 $82.50 $61.88 $82.50 $82.50 $82.50 $41.25 $41.25 $65.34 $82.50 $66.00 $37.13 $16.37 N/A $47.85 $82.50 $49.50 $82.50 $17.19 $82.50 N/A N/A PL-WF60 SUP HCPCS C1713 PL-WF60 - COVER SCREW 60MM HUB CAP TITANIUM WRIST NONSTRL BOTH IP/OP $237.50 $176.00 $47.14 $237.50 $106.88 $106.88 $106.88 $106.88 $237.50 $237.50 $237.50 $49.50 $237.50 $237.50 $237.50 $237.50 $237.50 $49.50 $237.50 $95.00 $140.48 $237.50 $237.50 $237.50 $237.50 $178.13 $237.50 $237.50 $237.50 $118.75 $118.75 $188.10 $237.50 $190.00 $106.88 $47.14 N/A $137.75 $237.50 $142.50 $237.50 $49.50 $237.50 N/A N/A PM010-A SUP Custom 27200555 PM010-A - KIT DRUG DELIVERY 3.5IN 2.5IN CATHETER ANTIMICROBIAL NEEDLE BOTH IP/OP $89.00 $66.00 $15.84 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $89.00 $15.84 $89.00 $89.00 $66.06 $66.06 $68.60 $46.37 $18.55 $89.00 $35.60 $89.00 $89.00 $89.00 $89.00 $89.00 $66.75 $89.00 $89.00 $89.00 $44.50 $44.50 $70.49 $89.00 $71.20 $57.85 $89.00 N/A $51.62 $89.00 $53.40 $89.00 $89.00 $89.00 N/A N/A PM020 SUP Custom 27200555 PM020 - CATHETER DRG DLV 5IN STRL ONQ SKR DEHP BOTH IP/OP $116.00 $86.00 $20.65 $116.00 $116.00 $116.00 $116.00 $116.00 $116.00 $116.00 $20.65 $116.00 $116.00 $86.10 $86.10 $89.41 $60.44 $24.18 $116.00 $46.40 $116.00 $116.00 $116.00 $116.00 $116.00 $87.00 $116.00 $116.00 $116.00 $58.00 $58.00 $91.87 $116.00 $92.80 $75.40 $116.00 N/A $67.28 $116.00 $69.60 $116.00 $116.00 $116.00 N/A N/A PM020-A SUP Custom 27200555 PM020-A - SYSTEM DRG DLV T 5IN 6IN ONQ PNBSTR SLSKR TPL XPD CATH NDL BOTH IP/OP $116.00 $86.00 $20.65 $116.00 $116.00 $116.00 $116.00 $116.00 $116.00 $116.00 $20.65 $116.00 $116.00 $86.10 $86.10 $89.41 $60.44 $24.18 $116.00 $46.40 $116.00 $116.00 $116.00 $116.00 $116.00 $87.00 $116.00 $116.00 $116.00 $58.00 $58.00 $91.87 $116.00 $92.80 $75.40 $116.00 N/A $67.28 $116.00 $69.60 $116.00 $116.00 $116.00 N/A N/A PM040-A SUP Custom 27200555 PM040-A - SYSTEM DRUG DELIVERY 10IN 8IN EXPANSION KIT T PEEL NEEDLE BOTH IP/OP $375.00 $278.00 $66.75 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $375.00 $66.75 $375.00 $375.00 $278.33 $278.33 $289.05 $195.38 $78.15 $375.00 $150.00 $375.00 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $243.75 $375.00 N/A $217.50 $375.00 $225.00 $375.00 $375.00 $375.00 N/A N/A PM1110 SUP HCPCS C1786 PM1110 - PACEMAKER CRD THK6MM 52X42MM 9.5ML ACT 1 CHMBR IS-1 CNCT PLS BOTH IP/OP "$7,425.00" "$5,495.00" "$1,473.68" "$7,425.00" "$3,341.25" "$3,341.25" "$3,341.25" "$3,341.25" "$7,425.00" "$7,425.00" "$7,425.00" "$1,547.56" "$7,425.00" "$7,425.00" "$7,425.00" "$7,425.00" "$7,425.00" "$1,547.45" "$7,425.00" "$7,425.00" "$3,660.53" "$7,425.00" "$7,425.00" "$7,425.00" "$7,425.00" "$5,568.75" "$7,425.00" "$7,425.00" "$7,425.00" "$3,712.50" "$3,712.50" "$5,880.60" "$7,425.00" "$5,940.00" "$3,341.25" "$1,473.68" N/A "$4,306.50" "$7,425.00" "$7,425.00" "$7,425.00" "$1,547.37" "$7,425.00" N/A N/A PM1210 SUP HCPCS C1785 PM1210 - PACEMAKER CRD THK6MM 52X52MM 12.8ML ACT 1 CHMBR IS-1 CNCT RF BOTH IP/OP "$8,775.00" "$6,494.00" "$1,741.62" "$8,775.00" "$3,948.75" "$3,948.75" "$3,948.75" "$3,948.75" "$8,775.00" "$8,775.00" "$8,775.00" "$1,828.93" "$8,775.00" "$8,775.00" "$8,775.00" "$8,775.00" "$8,775.00" "$1,828.81" "$8,775.00" "$8,775.00" "$4,326.08" "$8,775.00" "$8,775.00" "$8,775.00" "$8,775.00" "$6,581.25" "$8,775.00" "$8,775.00" "$8,775.00" "$4,387.50" "$4,387.50" "$6,949.80" "$8,775.00" "$7,020.00" "$3,948.75" "$1,741.62" N/A "$5,089.50" "$8,775.00" "$8,775.00" "$8,775.00" "$1,828.71" "$8,775.00" N/A N/A PM2110 SUP HCPCS C1785 PM2110 - PACEMAKER CRD THK6MM 52X46MM 10.5CC ACT 2 CHMBR IS-1 CNCT BOTH IP/OP "$8,550.00" "$6,327.00" "$1,696.96" "$8,550.00" "$3,847.50" "$3,847.50" "$3,847.50" "$3,847.50" "$8,550.00" "$8,550.00" "$8,550.00" "$1,782.03" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.91" "$8,550.00" "$8,550.00" "$4,215.15" "$8,550.00" "$8,550.00" "$8,550.00" "$8,550.00" "$6,412.50" "$8,550.00" "$8,550.00" "$8,550.00" "$4,275.00" "$4,275.00" "$6,771.60" "$8,550.00" "$6,840.00" "$3,847.50" "$1,696.96" N/A "$4,959.00" "$8,550.00" "$8,550.00" "$8,550.00" "$1,781.82" "$8,550.00" N/A N/A PM2210 SUP HCPCS C1785 PM2210 - PACEMAKER CARDIAC THK6MM 52X52MM 2 CHAMBER INDUCTIVE BOTH IP/OP "$10,575.00" "$7,826.00" "$2,098.87" "$10,575.00" "$4,758.75" "$4,758.75" "$4,758.75" "$4,758.75" "$10,575.00" "$10,575.00" "$10,575.00" "$2,204.09" "$10,575.00" "$10,575.00" "$10,575.00" "$10,575.00" "$10,575.00" "$2,203.95" "$10,575.00" "$10,575.00" "$5,213.48" "$10,575.00" "$10,575.00" "$10,575.00" "$10,575.00" "$7,931.25" "$10,575.00" "$10,575.00" "$10,575.00" "$5,287.50" "$5,287.50" "$8,375.40" "$10,575.00" "$8,460.00" "$4,758.75" "$2,098.87" N/A "$6,133.50" "$10,575.00" "$10,575.00" "$10,575.00" "$2,203.83" "$10,575.00" N/A N/A PM3210 SUP HCPCS C2621 PM3210 - PACEMAKER CRD THK6MM 58X52MM 13.7ML ANTHEM RF 2 CHMBR IS-1 BOTH IP/OP "$14,750.00" "$10,915.00" "$2,927.51" "$14,750.00" "$6,637.50" "$6,637.50" "$6,637.50" "$6,637.50" "$14,750.00" "$14,750.00" "$14,750.00" "$3,074.27" "$14,750.00" "$14,750.00" "$14,750.00" "$14,750.00" "$14,750.00" "$3,074.06" "$14,750.00" "$14,750.00" "$7,271.75" "$14,750.00" "$14,750.00" "$14,750.00" "$14,750.00" "$11,062.50" "$14,750.00" "$14,750.00" "$14,750.00" "$7,375.00" "$7,375.00" "$11,682.00" "$14,750.00" "$11,800.00" "$6,637.50" "$2,927.51" N/A "$8,555.00" "$14,750.00" "$14,750.00" "$14,750.00" "$3,073.90" "$14,750.00" N/A N/A PMG-18SP-60-COPE SUP HCPCS C1769 PMG-18SP-60-COPE - GWIRE VASC .018IN 60CM 7CM ANG SFT CP MDRL SS STRL DISP BOTH IP/OP $82.50 $61.00 $16.35 $82.39 $44.74 $44.74 $44.74 $44.74 $82.39 $82.39 $82.39 $17.17 $82.39 $61.15 $61.15 $63.51 $42.93 $17.17 $82.39 $82.39 $48.73 $82.39 $82.39 $82.39 $82.39 $61.88 $82.39 $82.39 $82.39 $41.20 $41.20 $65.25 $82.39 $65.91 $53.55 $16.35 N/A $47.85 $82.39 $82.39 $82.39 $17.17 $82.39 N/A N/A PMH SUP HCPCS C1781 PMH - MESH SURG FLAT 6X6IN KNIT NONABSORBABLE NONREACTIVE PROLENE BOTH IP/OP $165.00 $122.00 $32.72 $164.86 $74.19 $74.19 $74.19 $74.19 $164.86 $164.86 $164.86 $34.36 $164.86 $164.86 $164.86 $164.86 $164.86 $34.36 $164.86 $164.86 $97.51 $164.86 $164.86 $164.86 $164.86 $123.75 $164.86 $164.86 $164.86 $82.43 $82.43 $130.57 $164.86 $131.89 $74.19 $32.72 N/A $95.70 $164.86 $164.86 $164.86 $34.36 $164.86 N/A N/A PMII SUP HCPCS C1781 PMII - MESH SURG FLAT 6X3IN KNIT NONABSORBABLE NONREACTIVE LATEX BOTH IP/OP $149.00 $110.00 $29.57 $149.00 $67.05 $67.05 $67.05 $67.05 $149.00 $149.00 $149.00 $31.06 $149.00 $149.00 $149.00 $149.00 $149.00 $31.05 $149.00 $149.00 $88.13 $149.00 $149.00 $149.00 $149.00 $111.75 $149.00 $149.00 $149.00 $74.50 $74.50 $118.01 $149.00 $119.20 $67.05 $29.57 N/A $86.42 $149.00 $149.00 $149.00 $31.05 $149.00 N/A N/A PML SUP HCPCS C1781 PML - MESH SURG FLAT 12X12IN KNIT MONOFILAMENT SOFT PROLENE BOTH IP/OP $374.50 $277.00 $74.28 $374.24 $168.41 $168.41 $168.41 $168.41 $374.24 $374.24 $374.24 $78.00 $374.24 $374.24 $374.24 $374.24 $374.24 $78.00 $374.24 $374.24 $221.36 $374.24 $374.24 $374.24 $374.24 $280.88 $374.24 $374.24 $374.24 $187.12 $187.12 $296.40 $374.24 $299.39 $168.41 $74.28 N/A $217.21 $374.24 $374.24 $374.24 $77.99 $374.24 N/A N/A PMXS SUP HCPCS C1781 PMXS - MESH SURG FLAT 4X1IN KNIT NONABSORBABLE NONREACTIVE PROLENE BOTH IP/OP $117.50 $87.00 $23.29 $117.33 $52.80 $52.80 $52.80 $52.80 $117.33 $117.33 $117.33 $24.45 $117.33 $117.33 $117.33 $117.33 $117.33 $24.45 $117.33 $117.33 $69.40 $117.33 $117.33 $117.33 $117.33 $88.13 $117.33 $117.33 $117.33 $58.67 $58.67 $92.93 $117.33 $93.86 $52.80 $23.29 N/A $68.15 $117.33 $117.33 $117.33 $24.45 $117.33 N/A N/A PN-152836002 SUP Custom 27203010 PN-152836002 - CONNECTOR EKG ASMBLY ATRIUM VENTRICLE BOTH IP/OP $45.50 $34.00 $8.02 $45.05 $45.05 $45.05 $45.05 $45.05 $45.05 $45.05 $8.02 $45.05 $45.05 $33.44 $33.44 $34.72 $23.47 $9.39 $45.05 $18.02 $45.05 $45.05 $45.05 $45.05 $45.05 $34.13 $45.05 $45.05 $45.05 $22.53 $22.53 $35.68 $45.05 $36.04 $29.28 $45.05 N/A $26.39 $45.05 $27.03 $45.05 $45.05 $45.05 N/A N/A PND6F0701058 SUP HCPCS C1887 PND6F0701058 - CATHETER DELIVERY SYSTEM .035IN .038IN STR 6FR .07IN 105CM 8 BOTH IP/OP "$1,587.50" "$1,175.00" $315.08 "$1,587.50" $862.01 $862.01 $862.01 $862.01 "$1,587.50" "$1,587.50" "$1,587.50" $330.87 "$1,587.50" "$1,178.24" "$1,178.24" "$1,223.65" $827.09 $330.85 "$1,587.50" "$1,587.50" $939.01 "$1,587.50" "$1,587.50" "$1,587.50" "$1,587.50" "$1,190.63" "$1,587.50" "$1,587.50" "$1,587.50" $793.75 $793.75 "$1,257.30" "$1,587.50" "$1,270.00" "$1,031.88" $315.08 N/A $920.75 "$1,587.50" "$1,587.50" "$1,587.50" $330.84 "$1,587.50" N/A N/A PND6F070956 SUP HCPCS C1757 PND6F070956 - CATHETER DELIVERY SYSTEM STR 6FR .07IN 95CM 6CM LUMEN BOTH IP/OP "$1,587.50" "$1,175.00" $315.08 "$1,587.50" $862.01 $862.01 $862.01 $862.01 "$1,587.50" "$1,587.50" "$1,587.50" $330.87 "$1,587.50" "$1,178.24" "$1,178.24" "$1,223.65" $827.09 $330.85 "$1,587.50" "$1,587.50" $939.01 "$1,587.50" "$1,587.50" "$1,587.50" "$1,587.50" "$1,190.63" "$1,587.50" "$1,587.50" "$1,587.50" $793.75 $793.75 "$1,257.30" "$1,587.50" "$1,270.00" "$1,031.88" $315.08 N/A $920.75 "$1,587.50" "$1,587.50" "$1,587.50" $330.84 "$1,587.50" N/A N/A PND6F1056 SUP HCPCS C1757 PND6F1056 - CATHETER DELIVERY SYSTEM .035IN .038IN 6FR .053IN 105CM 6CM BOTH IP/OP "$1,587.50" "$1,175.00" $315.08 "$1,587.50" $862.01 $862.01 $862.01 $862.01 "$1,587.50" "$1,587.50" "$1,587.50" $330.87 "$1,587.50" "$1,178.24" "$1,178.24" "$1,223.65" $827.09 $330.85 "$1,587.50" "$1,587.50" $939.01 "$1,587.50" "$1,587.50" "$1,587.50" "$1,587.50" "$1,190.63" "$1,587.50" "$1,587.50" "$1,587.50" $793.75 $793.75 "$1,257.30" "$1,587.50" "$1,270.00" "$1,031.88" $315.08 N/A $920.75 "$1,587.50" "$1,587.50" "$1,587.50" $330.84 "$1,587.50" N/A N/A PND6F1156 SUP HCPCS C1757 PND6F1156 - CATHETER DELIVERY SYSTEM .035IN .038IN STR 6FR .053IN 115CM BOTH IP/OP "$1,587.50" "$1,175.00" $315.08 "$1,587.50" $862.01 $862.01 $862.01 $862.01 "$1,587.50" "$1,587.50" "$1,587.50" $330.87 "$1,587.50" "$1,178.24" "$1,178.24" "$1,223.65" $827.09 $330.85 "$1,587.50" "$1,587.50" $939.01 "$1,587.50" "$1,587.50" "$1,587.50" "$1,587.50" "$1,190.63" "$1,587.50" "$1,587.50" "$1,587.50" $793.75 $793.75 "$1,257.30" "$1,587.50" "$1,270.00" "$1,031.88" $315.08 N/A $920.75 "$1,587.50" "$1,587.50" "$1,587.50" $330.84 "$1,587.50" N/A N/A PNG130 SUP HCPCS C9352 PNG130 - GUIDE NRV 1.5MM 3CM STRL LF NRGN FLXB ABS TUBE BCMPT CLGN BOTH IP/OP "$3,820.50" "$2,827.00" $758.22 "$3,820.25" "$1,719.11" "$1,719.11" "$1,719.11" "$1,719.11" "$3,820.25" "$3,820.25" "$3,820.25" $796.24 "$3,820.25" "$3,820.25" "$3,820.25" "$3,820.25" "$3,820.25" $796.18 "$3,820.25" "$3,820.25" "$1,883.38" "$3,820.25" "$3,820.25" "$3,820.25" "$3,820.25" "$2,865.38" "$3,820.25" "$3,820.25" "$3,820.25" "$1,910.13" "$1,910.13" "$3,025.64" "$3,820.25" "$3,056.20" "$1,719.11" $758.22 N/A "$2,215.89" "$3,820.25" "$3,820.25" "$3,820.25" $796.14 "$3,820.25" N/A N/A PNG220 SUP HCPCS C9352 PNG220 - GUIDE NERVE 2MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE BOTH IP/OP "$3,126.00" "$2,313.00" $620.37 "$3,125.68" "$1,406.56" "$1,406.56" "$1,406.56" "$1,406.56" "$3,125.68" "$3,125.68" "$3,125.68" $651.47 "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" $651.43 "$3,125.68" "$3,125.68" "$1,540.96" "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" "$2,344.50" "$3,125.68" "$3,125.68" "$3,125.68" "$1,562.84" "$1,562.84" "$2,475.54" "$3,125.68" "$2,500.54" "$1,406.56" $620.37 N/A "$1,813.08" "$3,125.68" "$3,125.68" "$3,125.68" $651.39 "$3,125.68" N/A N/A PNG230 SUP HCPCS C9352 PNG230 - GUIDE NERVE 2MM 3CM SEMIPERMEABLE NEURAGEN COLLAGEN MATRIX BOTH IP/OP "$4,202.50" "$3,110.00" $834.05 "$4,202.28" "$1,891.03" "$1,891.03" "$1,891.03" "$1,891.03" "$4,202.28" "$4,202.28" "$4,202.28" $875.86 "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" $875.80 "$4,202.28" "$4,202.28" "$2,071.72" "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" "$3,151.88" "$4,202.28" "$4,202.28" "$4,202.28" "$2,101.14" "$2,101.14" "$3,328.21" "$4,202.28" "$3,361.82" "$1,891.03" $834.05 N/A "$2,437.45" "$4,202.28" "$4,202.28" "$4,202.28" $875.76 "$4,202.28" N/A N/A PNG320 SUP HCPCS C9352 PNG320 - GUIDE NERVE 3MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE BOTH IP/OP "$3,126.00" "$2,313.00" $620.37 "$3,125.68" "$1,406.56" "$1,406.56" "$1,406.56" "$1,406.56" "$3,125.68" "$3,125.68" "$3,125.68" $651.47 "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" $651.43 "$3,125.68" "$3,125.68" "$1,540.96" "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" "$2,344.50" "$3,125.68" "$3,125.68" "$3,125.68" "$1,562.84" "$1,562.84" "$2,475.54" "$3,125.68" "$2,500.54" "$1,406.56" $620.37 N/A "$1,813.08" "$3,125.68" "$3,125.68" "$3,125.68" $651.39 "$3,125.68" N/A N/A PNG330 SUP HCPCS C9352 PNG330 - GUIDE NERVE 3MM 3CM FLEXIBLE ABSORBABLE TUBE BIOCOMPATIBLE BOTH IP/OP "$4,202.50" "$3,110.00" $834.05 "$4,202.28" "$1,891.03" "$1,891.03" "$1,891.03" "$1,891.03" "$4,202.28" "$4,202.28" "$4,202.28" $875.86 "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" $875.80 "$4,202.28" "$4,202.28" "$2,071.72" "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" "$3,151.88" "$4,202.28" "$4,202.28" "$4,202.28" "$2,101.14" "$2,101.14" "$3,328.21" "$4,202.28" "$3,361.82" "$1,891.03" $834.05 N/A "$2,437.45" "$4,202.28" "$4,202.28" "$4,202.28" $875.76 "$4,202.28" N/A N/A PNG420 SUP HCPCS C9352 PNG420 - GUIDE NERVE 4MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE BOTH IP/OP "$3,126.00" "$2,313.00" $620.37 "$3,125.68" "$1,406.56" "$1,406.56" "$1,406.56" "$1,406.56" "$3,125.68" "$3,125.68" "$3,125.68" $651.47 "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" $651.43 "$3,125.68" "$3,125.68" "$1,540.96" "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" "$2,344.50" "$3,125.68" "$3,125.68" "$3,125.68" "$1,562.84" "$1,562.84" "$2,475.54" "$3,125.68" "$2,500.54" "$1,406.56" $620.37 N/A "$1,813.08" "$3,125.68" "$3,125.68" "$3,125.68" $651.39 "$3,125.68" N/A N/A PNG430 SUP HCPCS C9352 PNG430 - GUIDE NERVE 4MM 3CM FLEXIBLE ABSORBABLE TUBE BIOCOMPATIBLE BOTH IP/OP "$4,202.50" "$3,110.00" $834.05 "$4,202.28" "$1,891.03" "$1,891.03" "$1,891.03" "$1,891.03" "$4,202.28" "$4,202.28" "$4,202.28" $875.86 "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" $875.80 "$4,202.28" "$4,202.28" "$2,071.72" "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" "$3,151.88" "$4,202.28" "$4,202.28" "$4,202.28" "$2,101.14" "$2,101.14" "$3,328.21" "$4,202.28" "$3,361.82" "$1,891.03" $834.05 N/A "$2,437.45" "$4,202.28" "$4,202.28" "$4,202.28" $875.76 "$4,202.28" N/A N/A PNG520 SUP HCPCS C9352 PNG520 - GUIDE NERVE 5MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE BOTH IP/OP "$3,126.00" "$2,313.00" $620.37 "$3,125.68" "$1,406.56" "$1,406.56" "$1,406.56" "$1,406.56" "$3,125.68" "$3,125.68" "$3,125.68" $651.47 "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" $651.43 "$3,125.68" "$3,125.68" "$1,540.96" "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" "$2,344.50" "$3,125.68" "$3,125.68" "$3,125.68" "$1,562.84" "$1,562.84" "$2,475.54" "$3,125.68" "$2,500.54" "$1,406.56" $620.37 N/A "$1,813.08" "$3,125.68" "$3,125.68" "$3,125.68" $651.39 "$3,125.68" N/A N/A PNG530 SUP HCPCS C9352 PNG530 - GUIDE NERVE 5MM 3CM FLEXIBLE ABSORBABLE TUBE NEURAGEN BOTH IP/OP "$4,202.50" "$3,110.00" $834.05 "$4,202.28" "$1,891.03" "$1,891.03" "$1,891.03" "$1,891.03" "$4,202.28" "$4,202.28" "$4,202.28" $875.86 "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" $875.80 "$4,202.28" "$4,202.28" "$2,071.72" "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" "$3,151.88" "$4,202.28" "$4,202.28" "$4,202.28" "$2,101.14" "$2,101.14" "$3,328.21" "$4,202.28" "$3,361.82" "$1,891.03" $834.05 N/A "$2,437.45" "$4,202.28" "$4,202.28" "$4,202.28" $875.76 "$4,202.28" N/A N/A PNG620 SUP HCPCS C9352 PNG620 - GUIDE NERVE 6MM 2CM NEURAGEN PERIPHERAL BOTH IP/OP "$3,126.00" "$2,313.00" $620.37 "$3,125.68" "$1,406.56" "$1,406.56" "$1,406.56" "$1,406.56" "$3,125.68" "$3,125.68" "$3,125.68" $651.47 "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" $651.43 "$3,125.68" "$3,125.68" "$1,540.96" "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" "$2,344.50" "$3,125.68" "$3,125.68" "$3,125.68" "$1,562.84" "$1,562.84" "$2,475.54" "$3,125.68" "$2,500.54" "$1,406.56" $620.37 N/A "$1,813.08" "$3,125.68" "$3,125.68" "$3,125.68" $651.39 "$3,125.68" N/A N/A PNG630 SUP HCPCS C9352 PNG630 - GUIDE NERVE 6MM 3CM FLEXIBLE ABSORBABLE TUBE BIOCOMPATIBLE BOTH IP/OP "$4,202.50" "$3,110.00" $834.05 "$4,202.28" "$1,891.03" "$1,891.03" "$1,891.03" "$1,891.03" "$4,202.28" "$4,202.28" "$4,202.28" $875.86 "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" $875.80 "$4,202.28" "$4,202.28" "$2,071.72" "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" "$3,151.88" "$4,202.28" "$4,202.28" "$4,202.28" "$2,101.14" "$2,101.14" "$3,328.21" "$4,202.28" "$3,361.82" "$1,891.03" $834.05 N/A "$2,437.45" "$4,202.28" "$4,202.28" "$4,202.28" $875.76 "$4,202.28" N/A N/A PNG720 SUP HCPCS C9352 PNG720 - GUIDE NERVE 7MM 2CM RESORB BIOCOMPATIBLE SEMIPERMEABLE TUBE BOTH IP/OP "$3,126.00" "$2,313.00" $620.37 "$3,125.68" "$1,406.56" "$1,406.56" "$1,406.56" "$1,406.56" "$3,125.68" "$3,125.68" "$3,125.68" $651.47 "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" $651.43 "$3,125.68" "$3,125.68" "$1,540.96" "$3,125.68" "$3,125.68" "$3,125.68" "$3,125.68" "$2,344.50" "$3,125.68" "$3,125.68" "$3,125.68" "$1,562.84" "$1,562.84" "$2,475.54" "$3,125.68" "$2,500.54" "$1,406.56" $620.37 N/A "$1,813.08" "$3,125.68" "$3,125.68" "$3,125.68" $651.39 "$3,125.68" N/A N/A PNG730 SUP HCPCS C9352 PNG730 - GUIDE NERVE 7MM 3CM EXCELLENT HANDLING SEMIPERMEABLE SIMPLE BOTH IP/OP "$4,202.50" "$3,110.00" $834.05 "$4,202.28" "$1,891.03" "$1,891.03" "$1,891.03" "$1,891.03" "$4,202.28" "$4,202.28" "$4,202.28" $875.86 "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" $875.80 "$4,202.28" "$4,202.28" "$2,071.72" "$4,202.28" "$4,202.28" "$4,202.28" "$4,202.28" "$3,151.88" "$4,202.28" "$4,202.28" "$4,202.28" "$2,101.14" "$2,101.14" "$3,328.21" "$4,202.28" "$3,361.82" "$1,891.03" $834.05 N/A "$2,437.45" "$4,202.28" "$4,202.28" "$4,202.28" $875.76 "$4,202.28" N/A N/A PNML6F088904M SUP HCPCS C1892 PNML6F088904M - SHEATH INTRO LNG MP CRV 6FR 8FR .088IN 90CM 4CM NEURON MXSS BOTH IP/OP "$1,137.50" $842.00 $225.77 "$1,137.50" $617.66 $617.66 $617.66 $617.66 "$1,137.50" "$1,137.50" "$1,137.50" $237.08 "$1,137.50" $844.25 $844.25 $876.79 $592.64 $237.07 "$1,137.50" "$1,137.50" $672.83 "$1,137.50" "$1,137.50" "$1,137.50" "$1,137.50" $853.13 "$1,137.50" "$1,137.50" "$1,137.50" $568.75 $568.75 $900.90 "$1,137.50" $910.00 $739.38 $225.77 N/A $659.75 "$1,137.50" "$1,137.50" "$1,137.50" $237.06 "$1,137.50" N/A N/A PNP8X3 SUP HCPCS C1781 PNP8X3 - PLUG SRG RND 8CM STRL PARIETEX KYHL PTCH RSRB MICROGRIP BOTH IP/OP $261.50 $194.00 $51.90 $261.48 $117.67 $117.67 $117.67 $117.67 $261.48 $261.48 $261.48 $54.50 $261.48 $261.48 $261.48 $261.48 $261.48 $54.50 $261.48 $261.48 $154.67 $261.48 $261.48 $261.48 $261.48 $196.13 $261.48 $261.48 $261.48 $130.74 $130.74 $207.09 $261.48 $209.18 $117.67 $51.90 N/A $151.67 $261.48 $261.48 $261.48 $54.49 $261.48 N/A N/A PNS5F120BER SUP HCPCS C1757 PNS5F120BER - CATH THRMB 120CM 5FR .4IN NEURON SLCT .035IN .038IN BER BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $169.69 $169.69 $169.69 $169.69 $312.50 $312.50 $312.50 $65.13 $312.50 $231.94 $231.94 $240.88 $162.81 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $203.13 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A PP196 SUP Custom 27203010 PP196 - NEEDLE BIOP 19GA 6CM 2 1/3IN COAXIAL INTROD ECHOTIP BOTH IP/OP $32.50 $24.00 $5.76 $32.38 $32.38 $32.38 $32.38 $32.38 $32.38 $32.38 $5.76 $32.38 $32.38 $24.03 $24.03 $24.96 $16.87 $6.75 $32.38 $12.95 $32.38 $32.38 $32.38 $32.38 $32.38 $24.38 $32.38 $32.38 $32.38 $16.19 $16.19 $25.64 $32.38 $25.90 $21.05 $32.38 N/A $18.85 $32.38 $19.43 $32.38 $32.38 $32.38 N/A N/A PP196 SUP Custom 27203010 NEEDLE BIOP 19GA 6CM ECHTP COAX THNWL PP INTROD BOTH IP/OP $37.50 $28.00 $5.76 $32.38 $32.38 $32.38 $32.38 $32.38 $32.38 $32.38 $5.76 $32.38 $32.38 $24.03 $24.03 $24.96 $16.87 $6.75 $32.38 $12.95 $32.38 $32.38 $32.38 $32.38 $32.38 $28.13 $32.38 $32.38 $32.38 $16.19 $16.19 $25.64 $32.38 $25.90 $21.05 $32.38 N/A $21.75 $32.38 $19.43 $32.38 $32.38 $32.38 N/A N/A PP9031 SUP Custom 27203010 PP9031 - KIT ESCP STRL LF PNPT PAQ DISP BOTH IP/OP "$1,487.50" "$1,101.00" $264.78 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $264.78 "$1,487.50" "$1,487.50" "$1,104.02" "$1,104.02" "$1,146.57" $774.99 $310.01 "$1,487.50" $595.00 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $966.88 "$1,487.50" N/A $862.75 "$1,487.50" $892.50 "$1,487.50" "$1,487.50" "$1,487.50" N/A N/A PRE1001US.S SUP HCPCS A6212 PRE1001US.S - UNIT THERAPEUTIC INCISION MANAGEMENT SYSTEM PEEL PLACE KIT BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $671.96 $671.96 $671.96 $671.96 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" $918.47 $918.47 $953.87 $644.74 $257.91 "$1,237.50" "$1,237.50" $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $804.38 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" $257.90 "$1,237.50" N/A N/A PRE1101US SUP Custom 27011340 PRE1101US - SYSTEM NEG PRSS 13CM PREVENA PEEL AND PLC PTCH BOTH IP/OP "$1,237.50" $916.00 $220.28 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $220.28 "$1,237.50" "$1,237.50" $918.47 $918.47 $953.87 $644.74 $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $804.38 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A PRE2001US SUP Custom 27203010 PRE2001US - KIT DRESSING 125 THERAPY UNIT CARRYING CASE CANISTER BOTH IP/OP "$1,487.50" "$1,101.00" $264.78 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $264.78 "$1,487.50" "$1,487.50" "$1,104.02" "$1,104.02" "$1,146.57" $774.99 $310.01 "$1,487.50" $595.00 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $966.88 "$1,487.50" N/A $862.75 "$1,487.50" $892.50 "$1,487.50" "$1,487.50" "$1,487.50" N/A N/A PRE4001US SUP Custom 27203010 PRE4001US - SYSTEM NEG PRSS -125 MMHG 150ML PREVENA + VIS ADBL ALRM REPL BOTH IP/OP "$1,487.50" "$1,101.00" $264.78 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $264.78 "$1,487.50" "$1,487.50" "$1,104.02" "$1,104.02" "$1,146.57" $774.99 $310.01 "$1,487.50" $595.00 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $966.88 "$1,487.50" N/A $862.75 "$1,487.50" $892.50 "$1,487.50" "$1,487.50" "$1,487.50" N/A N/A PRE4001US SUP HCPCS C1713 PRE4001US - SYSTEM NEG PRSS - 125 MMHG 150ML PREVENA + VIS ADBL ALRM REP BOTH IP/OP "$1,625.00" "$1,203.00" $264.78 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $264.78 "$1,487.50" "$1,487.50" "$1,104.02" "$1,104.02" "$1,146.57" $774.99 $310.01 "$1,487.50" $595.00 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,218.75" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $966.88 "$1,487.50" N/A $942.50 "$1,487.50" $892.50 "$1,487.50" "$1,487.50" "$1,487.50" N/A N/A PRE-4-20 SUP HCPCS C1757 PRE-4-20 - DEVICE THRMB 4MM 20MM 30MM PRST CLS RING HLCL SLT 2 TY CELL BOTH IP/OP "$10,562.50" "$7,816.00" "$2,060.15" "$10,562.50" "$5,735.44" "$5,735.44" "$5,735.44" "$5,735.44" "$10,562.50" "$10,562.50" "$10,562.50" "$2,201.49" "$10,562.50" "$4,181.12" "$4,181.12" "$8,141.58" "$2,060.15" "$2,201.34" "$10,562.50" "$10,562.50" "$3,094.73" "$10,562.50" "$10,562.50" "$10,562.50" "$10,562.50" "$7,921.88" "$10,562.50" "$10,562.50" "$10,562.50" "$5,281.25" "$5,281.25" "$8,365.50" "$10,562.50" "$8,450.00" "$6,865.63" "$2,096.39" N/A "$6,126.25" "$10,562.50" "$10,562.50" "$10,562.50" "$2,201.23" "$10,562.50" N/A N/A PRE-6-30 SUP HCPCS C1757 PRE-6-30 - DEVICE THRMB 6MM 30MM 48MM PRST CLS RING HLCL SLT 2 TY CELL BOTH IP/OP "$10,562.50" "$7,816.00" "$2,060.15" "$10,562.50" "$5,735.44" "$5,735.44" "$5,735.44" "$5,735.44" "$10,562.50" "$10,562.50" "$10,562.50" "$2,201.49" "$10,562.50" "$4,181.12" "$4,181.12" "$8,141.58" "$2,060.15" "$2,201.34" "$10,562.50" "$10,562.50" "$3,094.73" "$10,562.50" "$10,562.50" "$10,562.50" "$10,562.50" "$7,921.88" "$10,562.50" "$10,562.50" "$10,562.50" "$5,281.25" "$5,281.25" "$8,365.50" "$10,562.50" "$8,450.00" "$6,865.63" "$2,096.39" N/A "$6,126.25" "$10,562.50" "$10,562.50" "$10,562.50" "$2,201.23" "$10,562.50" N/A N/A PRES-5-40 SUP HCPCS C1757 PRES-5-40 - DEVICE THRMB 5MM 40MM 52MM PRST CLS RING HLCL SLT 2 TY CELL BOTH IP/OP "$10,562.50" "$7,816.00" "$2,060.15" "$10,562.50" "$5,735.44" "$5,735.44" "$5,735.44" "$5,735.44" "$10,562.50" "$10,562.50" "$10,562.50" "$2,201.49" "$10,562.50" "$4,181.12" "$4,181.12" "$8,141.58" "$2,060.15" "$2,201.34" "$10,562.50" "$10,562.50" "$3,094.73" "$10,562.50" "$10,562.50" "$10,562.50" "$10,562.50" "$7,921.88" "$10,562.50" "$10,562.50" "$10,562.50" "$5,281.25" "$5,281.25" "$8,365.50" "$10,562.50" "$8,450.00" "$6,865.63" "$2,096.39" N/A "$6,126.25" "$10,562.50" "$10,562.50" "$10,562.50" "$2,201.23" "$10,562.50" N/A N/A PROTECTACRTDMMAM SUP HCPCS C1721 PROTECTACRTDMMAM - PROTECTA CRT-D ADVANCED SYSTEM BOTH IP/OP "$60,500.00" "$44,770.00" "$12,608.87" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$12,608.87" "$60,500.00" "$24,200.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$45,375.00" "$60,500.00" "$60,500.00" "$60,500.00" "$30,250.00" "$30,250.00" "$47,916.00" "$60,500.00" "$48,400.00" "$27,225.00" "$60,500.00" N/A "$35,090.00" "$60,500.00" "$36,300.00" "$60,500.00" "$60,500.00" "$60,500.00" N/A N/A PROTECTADRMMEM SUP HCPCS C1721 PROTECTADRMMEM - PROTECTA DR SYSTEM (INCLUDING DF4 HEADER) BOTH IP/OP "$49,812.50" "$36,861.00" "$10,381.47" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$10,381.47" "$49,812.50" "$19,925.00" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$37,359.38" "$49,812.50" "$49,812.50" "$49,812.50" "$24,906.25" "$24,906.25" "$39,451.50" "$49,812.50" "$39,850.00" "$22,415.63" "$49,812.50" N/A "$28,891.25" "$49,812.50" "$29,887.50" "$49,812.50" "$49,812.50" "$49,812.50" N/A N/A PROTECTAVREMEM SUP HCPCS C1721 PROTECTAVREMEM - PROTECTA VR SYSTEM (INCLUDING DF4 HEADER) BOTH IP/OP "$43,750.00" "$32,375.00" "$9,117.98" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$9,117.98" "$43,750.00" "$17,500.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$32,812.50" "$43,750.00" "$43,750.00" "$43,750.00" "$21,875.00" "$21,875.00" "$34,650.00" "$43,750.00" "$35,000.00" "$19,687.50" "$43,750.00" N/A "$25,375.00" "$43,750.00" "$26,250.00" "$43,750.00" "$43,750.00" "$43,750.00" N/A N/A PRT-FSP-DU SUP HCPCS C1713 PRT-FSP-DU - PLATE BN PRTN FRAG ULNA DISTAL BOTH IP/OP "$2,190.00" "$1,621.00" $434.66 "$2,190.00" $985.50 $985.50 $985.50 $985.50 "$2,190.00" "$2,190.00" "$2,190.00" $456.45 "$2,190.00" "$2,190.00" "$2,190.00" "$2,190.00" "$2,190.00" $456.42 "$2,190.00" "$2,190.00" "$1,295.39" "$2,190.00" "$2,190.00" "$2,190.00" "$2,190.00" "$1,642.50" "$2,190.00" "$2,190.00" "$2,190.00" "$1,095.00" "$1,095.00" "$1,734.48" "$2,190.00" "$1,752.00" $985.50 $434.66 N/A "$1,270.20" "$2,190.00" "$1,314.00" "$2,190.00" $456.40 "$2,190.00" N/A N/A PRT-FSP-LR SUP HCPCS C1713 PRT-FSP-LR - PLATE BN PRTN FRAG ULNA DIST DOUBLE HOCKEY STICK BOTH IP/OP "$1,970.00" "$1,458.00" $391.00 "$1,970.00" $886.50 $886.50 $886.50 $886.50 "$1,970.00" "$1,970.00" "$1,970.00" $410.60 "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" $410.57 "$1,970.00" $788.00 "$1,165.26" "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" "$1,477.50" "$1,970.00" "$1,970.00" "$1,970.00" $985.00 $985.00 "$1,560.24" "$1,970.00" "$1,576.00" $886.50 $391.00 N/A "$1,142.60" "$1,970.00" "$1,182.00" "$1,970.00" "$1,970.00" "$1,970.00" N/A N/A PRT-FSP-YS SUP HCPCS C1713 PRT-FSP-YS - PLATE BN PRTN FRAG ULNA DIST Y BOTH IP/OP "$1,970.00" "$1,458.00" $391.00 "$1,970.00" $886.50 $886.50 $886.50 $886.50 "$1,970.00" "$1,970.00" "$1,970.00" $410.60 "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" $410.57 "$1,970.00" $788.00 "$1,165.26" "$1,970.00" "$1,970.00" "$1,970.00" "$1,970.00" "$1,477.50" "$1,970.00" "$1,970.00" "$1,970.00" $985.00 $985.00 "$1,560.24" "$1,970.00" "$1,576.00" $886.50 $391.00 N/A "$1,142.60" "$1,970.00" "$1,182.00" "$1,970.00" $410.55 "$1,970.00" N/A N/A PS11055 SUP Custom 27803010 PS11055 - GRAFT SFT TIS 5X5CM GRFX PRM ALGRF PLCNT MEMBR BOTH IP/OP "$6,875.00" "$5,088.00" "$1,223.75" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$1,223.75" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.83" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$3,093.75" "$6,875.00" N/A "$3,987.50" "$6,875.00" "$4,125.00" "$6,875.00" "$6,875.00" "$6,875.00" N/A N/A PS12055 SUP HCPCS Q4133 PS12055 - GRAFT SFT TIS 5X5CM GRFX COR PLCNT MEMBR ALGRF BOTH IP/OP "$6,900.00" "$5,106.00" "$1,369.48" "$6,900.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$6,900.00" "$6,900.00" "$6,900.00" "$1,438.13" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$1,438.04" "$6,900.00" "$6,900.00" "$3,401.70" "$6,900.00" "$6,900.00" "$6,900.00" "$6,900.00" "$5,175.00" "$6,900.00" "$6,900.00" "$6,900.00" "$3,450.00" "$3,450.00" "$5,464.80" "$6,900.00" "$5,520.00" "$3,105.00" "$1,369.48" N/A "$4,002.00" "$6,900.00" "$6,900.00" "$6,900.00" "$1,437.96" "$6,900.00" N/A N/A PS60005 SUP Custom 27803010 PS60005 - GRAFT SFT TIS 4X2CM STRAVIX ALGRF PLCNT TISS BOTH IP/OP "$4,512.50" "$3,339.00" $803.23 "$4,512.50" "$4,512.50" "$4,512.50" "$4,512.50" "$4,512.50" "$4,512.50" "$4,512.50" $803.23 "$4,512.50" "$4,512.50" "$4,512.50" "$4,512.50" "$4,512.50" "$4,512.50" $940.45 "$4,512.50" "$1,805.00" "$4,512.50" "$4,512.50" "$4,512.50" "$4,512.50" "$4,512.50" "$3,384.38" "$4,512.50" "$4,512.50" "$4,512.50" "$2,256.25" "$2,256.25" "$3,573.90" "$4,512.50" "$3,610.00" "$2,030.63" "$4,512.50" N/A "$2,617.25" "$4,512.50" "$2,707.50" "$4,512.50" "$4,512.50" "$4,512.50" N/A N/A PS60008 SUP Custom 27803010 PS60008 - GRAFT SFT TIS 6X3CM STRAVIX ALGRF PLCNT TISS BOTH IP/OP "$7,956.50" "$5,888.00" "$1,416.21" "$7,956.25" "$7,956.25" "$7,956.25" "$7,956.25" "$7,956.25" "$7,956.25" "$7,956.25" "$1,416.21" "$7,956.25" "$7,956.25" "$7,956.25" "$7,956.25" "$7,956.25" "$7,956.25" "$1,658.17" "$7,956.25" "$3,182.50" "$7,956.25" "$7,956.25" "$7,956.25" "$7,956.25" "$7,956.25" "$5,967.38" "$7,956.25" "$7,956.25" "$7,956.25" "$3,978.13" "$3,978.13" "$6,301.35" "$7,956.25" "$6,365.00" "$3,580.31" "$7,956.25" N/A "$4,614.77" "$7,956.25" "$4,773.75" "$7,956.25" "$7,956.25" "$7,956.25" N/A N/A PSC026 SUP HCPCS C1757 PSC026 - CATHETER THROMBECTOMY 3.9-2.8FR .026IN 154CM 150CM BOTH IP/OP "$3,725.00" "$2,757.00" $739.32 "$3,725.00" "$2,022.68" "$2,022.68" "$2,022.68" "$2,022.68" "$3,725.00" "$3,725.00" "$3,725.00" $776.38 "$3,725.00" "$2,764.70" "$2,764.70" "$2,871.23" "$1,940.73" $776.33 "$3,725.00" "$3,725.00" "$2,203.34" "$3,725.00" "$3,725.00" "$3,725.00" "$3,725.00" "$2,793.75" "$3,725.00" "$3,725.00" "$3,725.00" "$1,862.50" "$1,862.50" "$2,950.20" "$3,725.00" "$2,980.00" "$2,421.25" $739.32 N/A "$2,160.50" "$3,725.00" "$3,725.00" "$3,725.00" $776.29 "$3,725.00" N/A N/A PSC041 SUP HCPCS C1757 PSC041 - CATHETER THROMBECTOMY 4.1FR .041IN 141CM REPERFUSION BOTH IP/OP "$3,725.00" "$2,757.00" $739.32 "$3,725.00" "$2,022.68" "$2,022.68" "$2,022.68" "$2,022.68" "$3,725.00" "$3,725.00" "$3,725.00" $776.38 "$3,725.00" "$2,764.70" "$2,764.70" "$2,871.23" "$1,940.73" $776.33 "$3,725.00" "$3,725.00" "$2,203.34" "$3,725.00" "$3,725.00" "$3,725.00" "$3,725.00" "$2,793.75" "$3,725.00" "$3,725.00" "$3,725.00" "$1,862.50" "$1,862.50" "$2,950.20" "$3,725.00" "$2,980.00" "$2,421.25" $739.32 N/A "$2,160.50" "$3,725.00" "$3,725.00" "$3,725.00" $776.29 "$3,725.00" N/A N/A PSC054 SUP HCPCS C1757 PSC054 - CATHETER THROMBECTOMY 6-5FR .054IN 132CM 136CM REPERFUSION BOTH IP/OP "$3,725.00" "$2,757.00" $739.32 "$3,725.00" "$2,022.68" "$2,022.68" "$2,022.68" "$2,022.68" "$3,725.00" "$3,725.00" "$3,725.00" $776.38 "$3,725.00" "$2,764.70" "$2,764.70" "$2,871.23" "$1,940.73" $776.33 "$3,725.00" "$3,725.00" "$2,203.34" "$3,725.00" "$3,725.00" "$3,725.00" "$3,725.00" "$2,793.75" "$3,725.00" "$3,725.00" "$3,725.00" "$1,862.50" "$1,862.50" "$2,950.20" "$3,725.00" "$2,980.00" "$2,421.25" $739.32 N/A "$2,160.50" "$3,725.00" "$3,725.00" "$3,725.00" $776.29 "$3,725.00" N/A N/A PSD 6002-UN SUP Custom 27203010 PSD 6002-UN - REINFORCEMENT STPL LN STRL LF PRSTRP DR 2 FRNG GEL TUBE LNR BOTH IP/OP $369.00 $273.00 $65.64 $368.75 $368.75 $368.75 $368.75 $368.75 $368.75 $368.75 $65.64 $368.75 $368.75 $273.69 $273.69 $284.23 $192.12 $76.85 $368.75 $147.50 $368.75 $368.75 $368.75 $368.75 $368.75 $276.75 $368.75 $368.75 $368.75 $184.38 $184.38 $292.05 $368.75 $295.00 $239.69 $368.75 N/A $214.02 $368.75 $221.25 $368.75 $368.75 $368.75 N/A N/A PSD 6006-UV SUP Custom 27203010 PSD 6006-UV - STAPLER INTNL STRL LF PRSTRP DR 6 FRNG GEL TUBE LNR VRTS BOTH IP/OP $68.00 $50.00 $12.10 $67.99 $67.99 $67.99 $67.99 $67.99 $67.99 $67.99 $12.10 $67.99 $67.99 $50.46 $50.46 $52.41 $35.42 $14.17 $67.99 N/A $67.99 $67.99 $67.99 $67.99 $67.99 $51.00 $67.99 $67.99 $67.99 $34.00 $34.00 $53.85 $67.99 $54.39 $44.19 $67.99 N/A $39.44 $67.99 $40.79 $67.99 $67.99 $67.99 N/A N/A PSD 8006-UN SUP Custom 27203010 PSD 8006-UN - STAPLER INTNL ENDSCP LNR CTR 6 FRNG PRSTRP DR BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $259.77 $259.77 $269.78 $182.35 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $227.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A PSE45A SUP Custom 27203010 PSE45A - STAPLER INTERNAL 45MM 340MM LINEAR CUTTER ARTICULATION BOTH IP/OP "$8,485.00" "$6,279.00" "$1,510.27" "$8,484.68" "$8,484.68" "$8,484.68" "$8,484.68" "$8,484.68" "$8,484.68" "$8,484.68" "$1,510.27" "$8,484.68" "$8,484.68" "$4,181.12" "$4,181.12" "$6,539.99" "$2,060.15" "$1,768.30" "$8,484.68" "$3,393.87" "$8,484.68" "$8,484.68" "$8,484.68" "$8,484.68" "$8,484.68" "$6,363.75" "$8,484.68" "$8,484.68" "$8,484.68" "$4,242.34" "$4,242.34" "$6,719.87" "$8,484.68" "$6,787.74" "$5,515.04" "$8,484.68" N/A "$4,921.30" "$8,484.68" "$5,090.81" "$8,484.68" "$8,484.68" "$8,484.68" N/A N/A PSEE45A SUP Custom 27203010 PSEE45A - STAPLER INTNL STD 340MM 45MM ECHLN FLX PWR + LNR CTR ESCP BOTH IP/OP "$1,661.50" "$1,230.00" $295.68 "$1,661.12" "$1,661.12" "$1,661.12" "$1,661.12" "$1,661.12" "$1,661.12" "$1,661.12" $295.68 "$1,661.12" "$1,661.12" "$1,232.88" "$1,232.88" "$1,280.39" $865.44 $346.20 "$1,661.12" $664.45 "$1,661.12" "$1,661.12" "$1,661.12" "$1,661.12" "$1,661.12" "$1,246.13" "$1,661.12" "$1,661.12" "$1,661.12" $830.56 $830.56 "$1,315.61" "$1,661.12" "$1,328.90" "$1,079.73" "$1,661.12" N/A $963.67 "$1,661.12" $996.67 "$1,661.12" "$1,661.12" "$1,661.12" N/A N/A PSEE60A SUP Custom 27203010 PSEE60A - STAPLER INTERNAL BENT 60MM 440MM RIDGE ASYMMETRICAL LEG LINE BOTH IP/OP "$3,376.00" "$2,498.00" $600.86 "$3,375.63" "$3,375.63" "$3,375.63" "$3,375.63" "$3,375.63" "$3,375.63" "$3,375.63" $600.86 "$3,375.63" "$3,375.63" "$2,505.39" "$2,505.39" "$2,601.94" "$1,758.70" $703.52 "$3,375.63" $797.34 "$3,375.63" "$3,375.63" "$1,993.34" "$3,375.63" "$3,375.63" "$2,532.00" "$3,375.63" "$3,375.63" "$3,375.63" "$1,687.82" "$1,687.82" "$2,673.50" "$3,375.63" "$2,700.50" "$2,194.16" "$3,375.63" N/A "$1,958.08" "$3,375.63" "$2,025.38" "$3,375.63" "$3,375.63" "$3,375.63" N/A N/A PSMT1620 SUP HCPCS C1763 PSMT1620 - GRAFT SFT TIS THK 20X16CM STRL GENTRIX SRG MTRX PRCN XCLR BOTH IP/OP "$19,680.00" "$14,563.00" "$3,905.99" "$19,680.00" "$8,856.00" "$8,856.00" "$8,856.00" "$8,856.00" "$19,680.00" "$19,680.00" "$19,680.00" "$4,101.80" "$19,680.00" "$19,680.00" "$19,680.00" "$19,680.00" "$19,680.00" "$4,101.53" "$19,680.00" "$19,680.00" "$9,702.24" "$19,680.00" "$19,680.00" "$19,680.00" "$19,680.00" "$14,760.00" "$19,680.00" "$19,680.00" "$19,680.00" "$9,840.00" "$9,840.00" "$15,586.56" "$19,680.00" "$15,744.00" "$8,856.00" "$3,905.99" N/A "$11,414.40" "$19,680.00" "$19,680.00" "$19,680.00" "$4,101.31" "$19,680.00" N/A N/A PSMT2025 SUP HCPCS C1763 PSMT2025 - GRAFT SFT TIS THK 25X20CM STRL GENTRIX SRG MTRX PRCN XCLR BOTH IP/OP "$30,750.00" "$22,755.00" "$6,103.11" "$30,750.00" "$13,837.50" "$13,837.50" "$13,837.50" "$13,837.50" "$30,750.00" "$30,750.00" "$30,750.00" "$6,409.07" "$30,750.00" "$30,750.00" "$30,750.00" "$30,750.00" "$30,750.00" "$6,408.64" "$30,750.00" "$30,750.00" "$15,159.75" "$30,750.00" "$30,750.00" "$30,750.00" "$30,750.00" "$23,062.50" "$30,750.00" "$30,750.00" "$30,750.00" "$15,375.00" "$15,375.00" "$24,354.00" "$30,750.00" "$24,600.00" "$13,837.50" "$6,103.11" N/A "$17,835.00" "$30,750.00" "$30,750.00" "$30,750.00" "$6,408.30" "$30,750.00" N/A N/A PSS026 SUP HCPCS C1757 PSS026 - SEPARATOR THROMBECTOMY .022IN 200CM 155CM COMPATIBLE BOTH IP/OP "$5,725.00" "$4,237.00" "$1,136.27" "$5,725.00" "$3,108.68" "$3,108.68" "$3,108.68" "$3,108.68" "$5,725.00" "$5,725.00" "$5,725.00" "$1,193.23" "$5,725.00" "$4,181.12" "$4,181.12" "$4,412.83" "$2,060.15" "$1,193.15" "$5,725.00" "$5,725.00" "$3,094.73" "$5,725.00" "$5,725.00" "$5,725.00" "$5,725.00" "$4,293.75" "$5,725.00" "$5,725.00" "$5,725.00" "$2,862.50" "$2,862.50" "$4,534.20" "$5,725.00" "$4,580.00" "$3,721.25" "$1,136.27" N/A "$3,320.50" "$5,725.00" "$5,725.00" "$5,725.00" "$1,193.09" "$5,725.00" N/A N/A PSS041 SUP HCPCS C1757 PSS041 - SEPARATOR THROMBECTOMY .035IN 200CM 142CM COMPATIBLE BOTH IP/OP "$5,725.00" "$4,237.00" "$1,136.27" "$5,725.00" "$3,108.68" "$3,108.68" "$3,108.68" "$3,108.68" "$5,725.00" "$5,725.00" "$5,725.00" "$1,193.23" "$5,725.00" "$4,181.12" "$4,181.12" "$4,412.83" "$2,060.15" "$1,193.15" "$5,725.00" "$5,725.00" "$3,094.73" "$5,725.00" "$5,725.00" "$5,725.00" "$5,725.00" "$4,293.75" "$5,725.00" "$5,725.00" "$5,725.00" "$2,862.50" "$2,862.50" "$4,534.20" "$5,725.00" "$4,580.00" "$3,721.25" "$1,136.27" N/A "$3,320.50" "$5,725.00" "$5,725.00" "$5,725.00" "$1,193.09" "$5,725.00" N/A N/A PSS054 SUP HCPCS C1757 PSS054 - SEPARATOR THROMBECTOMY .045IN 175CM 135CM COMPATIBLE BOTH IP/OP "$5,725.00" "$4,237.00" "$1,136.27" "$5,725.00" "$3,108.68" "$3,108.68" "$3,108.68" "$3,108.68" "$5,725.00" "$5,725.00" "$5,725.00" "$1,193.23" "$5,725.00" "$4,181.12" "$4,181.12" "$4,412.83" "$2,060.15" "$1,193.15" "$5,725.00" "$5,725.00" "$3,094.73" "$5,725.00" "$5,725.00" "$5,725.00" "$5,725.00" "$4,293.75" "$5,725.00" "$5,725.00" "$5,725.00" "$2,862.50" "$2,862.50" "$4,534.20" "$5,725.00" "$4,580.00" "$3,721.25" "$1,136.27" N/A "$3,320.50" "$5,725.00" "$5,725.00" "$5,725.00" "$1,193.09" "$5,725.00" N/A N/A PSS-6F-4MT SUP HCPCS C1894 PSS-6F-4MT - INTRODUCER SHEATH SHORT 6FR 4CM NO WIRE PRELUDE GREEN BOTH IP/OP $42.50 $31.00 $9.43 $47.50 $25.79 $25.79 $25.79 $25.79 $47.50 $47.50 $47.50 $9.90 $47.50 $35.25 $35.25 $36.61 $24.75 $9.90 $47.50 $47.50 $28.10 $47.50 $47.50 $47.50 $47.50 $31.88 $47.50 $47.50 $47.50 $23.75 $23.75 $37.62 $47.50 $38.00 $30.88 $9.43 N/A $24.65 $47.50 $47.50 $47.50 $9.90 $47.50 N/A N/A PSS-6F-4MT SUP HCPCS C1894 PSS-6F-4MT - INTRODUCER SHTH SHRT 6FR 4CM GRN STRL PRELUDE NWR BOTH IP/OP $47.50 $35.00 $9.43 $47.50 $25.79 $25.79 $25.79 $25.79 $47.50 $47.50 $47.50 $9.90 $47.50 $35.25 $35.25 $36.61 $24.75 $9.90 $47.50 $47.50 $28.10 $47.50 $47.50 $47.50 $47.50 $35.63 $47.50 $47.50 $47.50 $23.75 $23.75 $37.62 $47.50 $38.00 $30.88 $9.43 N/A $27.55 $47.50 $47.50 $47.50 $9.90 $47.50 N/A N/A PSS-7F-4MT SUP HCPCS C1894 PSS-7F-4MT - INTRODUCER SHEATH SHORT 7FR 21GA 4CM ORANGE HUB TUBING BOTH IP/OP $42.50 $31.00 $8.44 $47.50 $23.08 $23.08 $23.08 $23.08 $42.50 $42.50 $42.50 $8.86 $42.50 $31.54 $31.54 $32.76 $22.14 $8.86 $42.50 $47.50 $25.14 $42.50 $47.50 $42.50 $42.50 $31.88 $42.50 $42.50 $42.50 $21.25 $21.25 $33.66 $42.50 $34.00 $27.63 $8.44 N/A $24.65 $42.50 $42.50 $42.50 $8.86 $42.50 N/A N/A PST2 SUP Custom 27203010 PST2 - TUBING ASPIRAT MAX TRACKING TECHNOLOGY PENUMBRA SYSTEM BOTH IP/OP $900.00 $666.00 $160.20 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $160.20 $900.00 $900.00 $667.98 $667.98 $693.72 $468.90 $187.57 $900.00 $360.00 $900.00 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $585.00 $900.00 N/A $522.00 $900.00 $540.00 $900.00 $900.00 $900.00 N/A N/A PT-45509 SUP HCPCS C1757 PT-45509 - KIT THROMBOLYTIC 9MM 5FR 6FR 65CM 2IN SHEATH CATHETER BOTH IP/OP "$1,664.50" "$1,232.00" $330.28 "$1,664.10" $903.61 $903.61 $903.61 $903.61 "$1,664.10" "$1,664.10" "$1,664.10" $346.84 "$1,664.10" "$1,235.10" "$1,235.10" "$1,282.69" $867.00 $346.82 "$1,664.10" "$1,664.10" $984.32 "$1,664.10" "$1,664.10" "$1,664.10" "$1,664.10" "$1,248.38" "$1,664.10" "$1,664.10" "$1,664.10" $832.05 $832.05 "$1,317.97" "$1,664.10" "$1,331.28" "$1,081.67" $330.28 N/A $965.41 "$1,664.10" "$1,664.10" "$1,664.10" $346.80 "$1,664.10" N/A N/A PTA5-35-135-7-14.0 SUP HCPCS C1725 PTA5-35-135-7-14.0 - CATH BALDILAT .035IN 5FR 7MM 135CM 14CM 2 LUM PTA LP GWIRE BOTH IP/OP $512.50 $379.00 $101.72 $512.50 $278.29 $278.29 $278.29 $278.29 $512.50 $512.50 $512.50 $106.82 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $512.50 $303.14 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $101.72 N/A $297.25 $512.50 $512.50 $512.50 $106.81 $512.50 N/A N/A PTB124275 SUP HCPCS C1874 PTB124275 - STENT ENDOPRSTH 12MM 4CM 2CM INTROD SELF EXPANDING VIATORR BOTH IP/OP "$10,500.00" "$7,770.00" "$2,083.99" "$10,500.00" "$4,725.00" "$4,725.00" "$4,725.00" "$4,725.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.46" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.32" "$10,500.00" "$10,500.00" "$5,176.50" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$7,875.00" "$10,500.00" "$10,500.00" "$10,500.00" "$5,250.00" "$5,250.00" "$8,316.00" "$10,500.00" "$8,400.00" "$4,725.00" "$2,083.99" N/A "$6,090.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.20" "$10,500.00" N/A N/A PTB126275 SUP HCPCS C1874 PTB126275 - STENT ENDOPRSTH 12MM 6CM 2CM INTROD SELF EXPANDING VIATORR BOTH IP/OP "$10,500.00" "$7,770.00" "$2,083.99" "$10,500.00" "$4,725.00" "$4,725.00" "$4,725.00" "$4,725.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.46" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.32" "$10,500.00" "$10,500.00" "$5,176.50" "$10,500.00" "$10,500.00" "$10,500.00" "$10,500.00" "$7,875.00" "$10,500.00" "$10,500.00" "$10,500.00" "$5,250.00" "$5,250.00" "$8,316.00" "$10,500.00" "$8,400.00" "$4,725.00" "$2,083.99" N/A "$6,090.00" "$10,500.00" "$10,500.00" "$10,500.00" "$2,188.20" "$10,500.00" N/A N/A PTB128275 SUP HCPCS C1874 PTB128275 - STENT ENDOPRSTH 12MM 8CM 2CM INTROD SELF EXPANDING VIATORR BOTH IP/OP "$9,750.00" "$7,215.00" "$1,935.13" "$9,750.00" "$4,387.50" "$4,387.50" "$4,387.50" "$4,387.50" "$9,750.00" "$9,750.00" "$9,750.00" "$2,032.14" "$9,750.00" "$9,750.00" "$9,750.00" "$9,750.00" "$9,750.00" "$2,032.01" "$9,750.00" "$9,750.00" "$4,806.75" "$9,750.00" "$9,750.00" "$9,750.00" "$9,750.00" "$7,312.50" "$9,750.00" "$9,750.00" "$9,750.00" "$4,875.00" "$4,875.00" "$7,722.00" "$9,750.00" "$7,800.00" "$4,387.50" "$1,935.13" N/A "$5,655.00" "$9,750.00" "$9,750.00" "$9,750.00" "$2,031.90" "$9,750.00" N/A N/A PTB8106275 SUP HCPCS C1874 PTB8106275 - STENT EPRSTH 10MM 6CM STRL 2CM GORE VTR SLF XPD RADOPQ 2 LUM BOTH IP/OP "$12,855.00" "$9,513.00" "$2,551.40" "$12,855.00" "$5,784.75" "$5,784.75" "$5,784.75" "$5,784.75" "$12,855.00" "$12,855.00" "$12,855.00" "$2,679.30" "$12,855.00" "$12,855.00" "$12,855.00" "$12,855.00" "$12,855.00" "$2,679.12" "$12,855.00" "$12,855.00" "$6,337.52" "$12,855.00" "$12,855.00" "$12,855.00" "$12,855.00" "$9,641.25" "$12,855.00" "$12,855.00" "$12,855.00" "$6,427.50" "$6,427.50" "$10,181.16" "$12,855.00" "$10,284.00" "$5,784.75" "$2,551.40" N/A "$7,455.90" "$12,855.00" "$12,855.00" "$12,855.00" "$2,678.98" "$12,855.00" N/A N/A PTB8108275 SUP HCPCS C1874 PTB8108275 - STENT EPRSTH 10MM 8CM STRL 2CM GORE VTR SLF XPD RADOPQ 2 LUM BOTH IP/OP "$12,855.00" "$9,513.00" "$2,551.40" "$12,855.00" "$5,784.75" "$5,784.75" "$5,784.75" "$5,784.75" "$12,855.00" "$12,855.00" "$12,855.00" "$2,679.30" "$12,855.00" "$12,855.00" "$12,855.00" "$12,855.00" "$12,855.00" "$2,679.12" "$12,855.00" "$12,855.00" "$6,337.52" "$12,855.00" "$12,855.00" "$12,855.00" "$12,855.00" "$9,641.25" "$12,855.00" "$12,855.00" "$12,855.00" "$6,427.50" "$6,427.50" "$10,181.16" "$12,855.00" "$10,284.00" "$5,784.75" "$2,551.40" N/A "$7,455.90" "$12,855.00" "$12,855.00" "$12,855.00" "$2,678.98" "$12,855.00" N/A N/A PV014300 SUP HCPCS C1769 PV014300 - GUIDEWIRE ANGIOGRAPHIC 300CM JETSTREAM JETWIRE BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,696.88" "$1,696.88" "$1,696.88" "$1,696.88" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$2,319.38" "$2,319.38" "$2,408.75" "$1,628.13" $651.28 "$3,125.00" "$3,125.00" "$1,848.44" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$2,031.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A PV2014L016N SUP HCPCS C1751 PV2014L016N - CATHETER ART LN 4FR 16CM PICCO GW NTNL BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A PV2014L022N SUP HCPCS C1751 PV2014L022N - CATHETER ART LN 4FR 22CM PICCO GW ADLT FEM ART BRACHIA BOTH IP/OP $62.50 $46.00 $12.40 $62.50 $28.13 $28.13 $28.13 $28.13 $62.50 $62.50 $62.50 $13.03 $62.50 $62.50 $62.50 $62.50 $62.50 $13.03 $62.50 $62.50 $36.97 $62.50 $62.50 $62.50 $62.50 $46.88 $62.50 $62.50 $62.50 $31.25 $31.25 $49.50 $62.50 $50.00 $28.13 $12.40 N/A $36.25 $62.50 $62.50 $62.50 $13.03 $62.50 N/A N/A PV2015L20N SUP HCPCS C1751 PV2015L20N - CATHETER ARTERIAL LINE STANDARD 5FR .028IN 7.78IN NITINOL BOTH IP/OP "$3,125.00" "$2,313.00" $620.23 "$3,125.00" "$1,406.25" "$1,406.25" "$1,406.25" "$1,406.25" "$3,125.00" "$3,125.00" "$3,125.00" $651.33 "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" $651.28 "$3,125.00" "$3,125.00" "$1,540.63" "$3,125.00" "$3,125.00" "$3,125.00" "$3,125.00" "$2,343.75" "$3,125.00" "$3,125.00" "$3,125.00" "$1,562.50" "$1,562.50" "$2,475.00" "$3,125.00" "$2,500.00" "$1,406.25" $620.23 N/A "$1,812.50" "$3,125.00" "$3,125.00" "$3,125.00" $651.25 "$3,125.00" N/A N/A PV3116F SUP HCPCS C1714 PV3116F - CATHETER ATHRCM JETSTREAM NAVITUS ROT BOTH IP/OP "$8,500.00" "$6,290.00" "$1,771.49" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$4,181.12" "$4,181.12" "$6,551.80" "$2,060.15" "$1,771.49" "$8,500.00" "$3,400.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$6,375.00" "$8,500.00" "$8,500.00" "$8,500.00" "$4,250.00" "$4,250.00" "$6,732.00" "$8,500.00" "$6,800.00" "$5,525.00" "$8,500.00" N/A "$4,930.00" "$8,500.00" "$5,100.00" "$8,500.00" "$8,500.00" "$8,500.00" N/A N/A PV3118F SUP HCPCS C1714 PV3118F - CATHETER ATHRCM .014IN 7FR 2.4/3.4MM 120CM JETSTREAM NAVITUS BOTH IP/OP "$8,500.00" "$6,290.00" "$1,771.49" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$4,181.12" "$4,181.12" "$6,551.80" "$2,060.15" "$1,771.49" "$8,500.00" "$3,400.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$6,375.00" "$8,500.00" "$8,500.00" "$8,500.00" "$4,250.00" "$4,250.00" "$6,732.00" "$8,500.00" "$6,800.00" "$5,525.00" "$8,500.00" N/A "$4,930.00" "$8,500.00" "$5,100.00" "$8,500.00" "$8,500.00" "$8,500.00" N/A N/A PV31300 SUP HCPCS C1714 PV31300 - CATHETER ATHRCM JETSTREAM NAVITUS ROT BOTH IP/OP "$8,500.00" "$6,290.00" "$1,771.49" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$4,181.12" "$4,181.12" "$6,551.80" "$2,060.15" "$1,771.49" "$8,500.00" "$3,400.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$6,375.00" "$8,500.00" "$8,500.00" "$8,500.00" "$4,250.00" "$4,250.00" "$6,732.00" "$8,500.00" "$6,800.00" "$5,525.00" "$8,500.00" N/A "$4,930.00" "$8,500.00" "$5,100.00" "$8,500.00" "$8,500.00" "$8,500.00" N/A N/A PV-3-4-3D SUP Custom 27803010 PV-3-4-3D - COIL EMBL 3D 3MM 4CM CONCERTO BOTH IP/OP "$1,562.50" "$1,156.00" $278.13 "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" $278.13 "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" $325.64 "$1,562.50" $625.00 "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" "$1,562.50" "$1,171.88" "$1,562.50" "$1,562.50" "$1,562.50" $781.25 $781.25 "$1,237.50" "$1,562.50" "$1,250.00" $703.13 "$1,562.50" N/A $906.25 "$1,562.50" $937.50 "$1,562.50" "$1,562.50" "$1,562.50" N/A N/A PV4046 SUP HCPCS C1751 PV4046 - KIT ARTERIAL LINE INJECTATE TEMPERATURE SENSOR HOUSING BOTH IP/OP $825.00 $611.00 $163.74 $825.00 $371.25 $371.25 $371.25 $371.25 $825.00 $825.00 $825.00 $171.95 $825.00 $825.00 $825.00 $825.00 $825.00 $171.94 $825.00 $825.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $371.25 $163.74 N/A $478.50 $825.00 $825.00 $825.00 $171.93 $825.00 N/A N/A PV41340 SUP HCPCS C1714 PV41340 - CATHETER ATHRCM .014IN 7FR 2.4/3.4MM 120CM LF JETSTREAM BOTH IP/OP "$8,500.00" "$6,290.00" "$1,771.49" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$4,181.12" "$4,181.12" "$6,551.80" "$2,060.15" "$1,771.49" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$6,375.00" "$8,500.00" "$8,500.00" "$8,500.00" "$4,250.00" "$4,250.00" "$6,732.00" "$8,500.00" "$6,800.00" "$5,525.00" "$8,500.00" N/A "$4,930.00" "$8,500.00" "$5,100.00" "$8,500.00" "$8,500.00" "$8,500.00" N/A N/A PVE35A SUP Custom 27203010 PVE35A - STAPLER INTERNAL 320MM 35MM POWER ADVANCE PLACEMENT TIP BOTH IP/OP $990.50 $733.00 $176.28 "$1,661.12" $990.33 $990.33 $990.33 $990.33 $990.33 $990.33 $176.28 $990.33 $990.33 $735.02 $735.02 $763.35 $515.96 $206.40 $990.33 $664.45 $990.33 $990.33 "$1,661.12" $990.33 $990.33 $742.88 $990.33 $990.33 $990.33 $495.17 $495.17 $784.34 $990.33 $792.26 $643.71 $990.33 N/A $574.49 $990.33 $594.20 $990.33 $990.33 $990.33 N/A N/A PVPS SUP HCPCS C1781 PVPS - MESH SURG 4.3X4.3CM SELF EXPAND PRTL ABSORBABLE FLEXIBLE BOTH IP/OP "$1,463.00" "$1,083.00" $290.35 "$1,462.90" $658.31 $658.31 $658.31 $658.31 "$1,462.90" "$1,462.90" "$1,462.90" $304.90 "$1,462.90" "$1,462.90" "$1,462.90" "$1,462.90" "$1,462.90" $304.88 "$1,462.90" "$1,462.90" $865.31 "$1,462.90" "$1,462.90" "$1,462.90" "$1,462.90" "$1,097.25" "$1,462.90" "$1,462.90" "$1,462.90" $731.45 $731.45 "$1,158.62" "$1,462.90" "$1,170.32" $658.31 $290.35 N/A $848.54 "$1,462.90" "$1,462.90" "$1,462.90" $304.87 "$1,462.90" N/A N/A PXC121000 SUP HCPCS C1768 PXC121000 - GRAFT EVAS LOPRFL 12MM 10CM XCLDR STNT XTD DLV SYS SL CUF BOTH IP/OP "$11,275.00" "$8,344.00" "$2,237.81" "$11,275.00" "$5,073.75" "$5,073.75" "$5,073.75" "$5,073.75" "$11,275.00" "$11,275.00" "$11,275.00" "$2,349.99" "$11,275.00" "$11,275.00" "$11,275.00" "$11,275.00" "$11,275.00" "$2,349.83" "$11,275.00" "$11,275.00" "$5,558.58" "$11,275.00" "$11,275.00" "$11,275.00" "$11,275.00" "$8,456.25" "$11,275.00" "$11,275.00" "$11,275.00" "$5,637.50" "$5,637.50" "$8,929.80" "$11,275.00" "$9,020.00" "$5,073.75" "$2,237.81" N/A "$6,539.50" "$11,275.00" "$11,275.00" "$11,275.00" "$2,349.71" "$11,275.00" N/A N/A PXSLIM045 SUP HCPCS C1757 PXSLIM045 - CATHETER DELIVERY SYSTEM 45D MICRO 2.95FR .025IN 150CM 2 TIP BOTH IP/OP "$2,210.00" "$1,635.00" $438.63 "$2,210.00" "$1,200.03" "$1,200.03" "$1,200.03" "$1,200.03" "$2,210.00" "$2,210.00" "$2,210.00" $460.62 "$2,210.00" "$1,640.26" "$1,640.26" "$1,703.47" "$1,151.41" $460.59 "$2,210.00" "$2,210.00" "$1,307.22" "$2,210.00" "$2,210.00" "$2,210.00" "$2,210.00" "$1,657.50" "$2,210.00" "$2,210.00" "$2,210.00" "$1,105.00" "$1,105.00" "$1,750.32" "$2,210.00" "$1,768.00" "$1,436.50" $438.63 N/A "$1,281.80" "$2,210.00" "$2,210.00" "$2,210.00" $460.56 "$2,210.00" N/A N/A PXSLIM090 SUP HCPCS C1757 PXSLIM090 - CATHETER DLV SYS 90D 0-.025IN MIC 2.6-2.95FR 150CM PX SLIM 2 BOTH IP/OP "$2,210.00" "$1,635.00" $438.63 "$2,210.00" "$1,200.03" "$1,200.03" "$1,200.03" "$1,200.03" "$2,210.00" "$2,210.00" "$2,210.00" $460.62 "$2,210.00" "$1,640.26" "$1,640.26" "$1,703.47" "$1,151.41" $460.59 "$2,210.00" "$2,210.00" "$1,307.22" "$2,210.00" "$2,210.00" "$2,210.00" "$2,210.00" "$1,657.50" "$2,210.00" "$2,210.00" "$2,210.00" "$1,105.00" "$1,105.00" "$1,750.32" "$2,210.00" "$1,768.00" "$1,436.50" $438.63 N/A "$1,281.80" "$2,210.00" "$2,210.00" "$2,210.00" $460.56 "$2,210.00" N/A N/A PXSLIM130 SUP HCPCS C1757 PXSLIM130 - CATHETER DELIVERY SYSTEM 130D 0-.025IN MICRO 2.6-2.95FR 150 BOTH IP/OP "$2,210.00" "$1,635.00" $438.63 "$2,210.00" "$1,200.03" "$1,200.03" "$1,200.03" "$1,200.03" "$2,210.00" "$2,210.00" "$2,210.00" $460.62 "$2,210.00" "$1,640.26" "$1,640.26" "$1,703.47" "$1,151.41" $460.59 "$2,210.00" "$2,210.00" "$1,307.22" "$2,210.00" "$2,210.00" "$2,210.00" "$2,210.00" "$1,657.50" "$2,210.00" "$2,210.00" "$2,210.00" "$1,105.00" "$1,105.00" "$1,750.32" "$2,210.00" "$1,768.00" "$1,436.50" $438.63 N/A "$1,281.80" "$2,210.00" "$2,210.00" "$2,210.00" $460.56 "$2,210.00" N/A N/A PXSLIMSTR SUP HCPCS C1757 PXSLIMSTR - CATHETER DLV SYS 0-.02IN MIC STRG 2.6-2.95FR .025IN 150CM PX BOTH IP/OP "$2,210.00" "$1,635.00" $438.63 "$2,210.00" "$1,200.03" "$1,200.03" "$1,200.03" "$1,200.03" "$2,210.00" "$2,210.00" "$2,210.00" $460.62 "$2,210.00" "$1,640.26" "$1,640.26" "$1,703.47" "$1,151.41" $460.59 "$2,210.00" "$2,210.00" "$1,307.22" "$2,210.00" "$2,210.00" "$2,210.00" "$2,210.00" "$1,657.50" "$2,210.00" "$2,210.00" "$2,210.00" "$1,105.00" "$1,105.00" "$1,750.32" "$2,210.00" "$1,768.00" "$1,436.50" $438.63 N/A "$1,281.80" "$2,210.00" "$2,210.00" "$2,210.00" $460.56 "$2,210.00" N/A N/A PXX52 SUP Custom 27203010 PXX52 - SUTURE NONABSORBABLE THK1/16IN 2-0 V-5 30IN .25X1/8IN 2 ARM BOTH IP/OP $195.50 $145.00 $34.76 $200.94 $195.26 $195.26 $195.26 $195.26 $195.26 $195.26 $34.76 $195.26 $195.26 $144.92 $144.92 $150.51 $101.73 $40.69 $195.26 $80.38 $195.26 $195.26 $200.94 $195.26 $195.26 $146.63 $195.26 $195.26 $195.26 $97.63 $97.63 $154.65 $195.26 $156.21 $126.92 $195.26 N/A $113.39 $195.26 $117.16 $195.26 $195.26 $195.26 N/A N/A PXX77 SUP Custom 27203010 PXX77 - SUTURE NONABSORBABLE THK1/16IN 2-0 V-7 30IN .25X1/8IN 2 ARM BOTH IP/OP $211.50 $157.00 $37.63 $211.39 $211.39 $211.39 $211.39 $211.39 $211.39 $211.39 $37.63 $211.39 $211.39 $156.89 $156.89 $162.94 $110.13 $44.06 $211.39 $84.56 $211.39 $211.39 $211.39 $211.39 $211.39 $158.63 $211.39 $211.39 $211.39 $105.70 $105.70 $167.42 $211.39 $169.11 $137.40 $211.39 N/A $122.67 $211.39 $126.83 $211.39 $211.39 $211.39 N/A N/A Q50-65P SUP Custom 27204833 Q50-65P - CATHETER OCL 10-50MM 65CM Q50 + BLN STNT GFT DLV FLX TP BOTH IP/OP "$1,212.50" $897.00 $215.83 "$1,212.50" "$1,212.50" "$1,212.50" "$1,212.50" "$1,212.50" "$1,212.50" "$1,212.50" $215.83 "$1,212.50" "$1,212.50" $899.92 $899.92 $934.60 $631.71 $252.70 "$1,212.50" $485.00 "$1,212.50" "$1,212.50" "$1,212.50" "$1,212.50" "$1,212.50" $909.38 "$1,212.50" "$1,212.50" "$1,212.50" $606.25 $606.25 $960.30 "$1,212.50" $970.00 $788.13 "$1,212.50" N/A $703.25 "$1,212.50" $727.50 "$1,212.50" "$1,212.50" "$1,212.50" N/A N/A QC-12-30-HELIX SUP HCPCS C2628 QC-12-30-HELIX - COIL EMBL .3683MM HLX 12MM .0145IN 30CM AXIUM DTCH PLTN BOTH IP/OP "$1,802.50" "$1,334.00" $357.75 "$1,802.50" $978.76 $978.76 $978.76 $978.76 "$1,802.50" "$1,802.50" "$1,802.50" $375.69 "$1,802.50" "$1,337.82" "$1,337.82" "$1,389.37" $939.10 $375.66 "$1,802.50" "$1,802.50" "$1,066.18" "$1,802.50" "$1,802.50" "$1,802.50" "$1,802.50" "$1,351.88" "$1,802.50" "$1,802.50" "$1,802.50" $901.25 $901.25 "$1,427.58" "$1,802.50" "$1,442.00" "$1,171.63" $357.75 N/A "$1,045.45" "$1,802.50" "$1,802.50" "$1,802.50" $375.64 "$1,802.50" N/A N/A QC-12-40-3D SUP Custom 27803010 QC-12-40-3D - COIL EMBL .3683MM 3D 12MM .0145IN 40CM AXIUM DTCH PLTN BOTH IP/OP "$2,432.50" "$1,800.00" $432.99 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" $432.99 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" $506.96 "$2,432.50" $973.00 "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$2,432.50" "$1,824.38" "$2,432.50" "$2,432.50" "$2,432.50" "$1,216.25" "$1,216.25" "$1,926.54" "$2,432.50" "$1,946.00" "$1,094.63" "$2,432.50" N/A "$1,410.85" "$2,432.50" "$1,459.50" "$2,432.50" "$2,432.50" "$2,432.50" N/A N/A QS70406 SUP Custom 27203010 QS70406 - ADHESIVE SKIN DERMA FLEX QS BOTH IP/OP $41.00 $30.00 $7.23 $40.63 $40.63 $40.63 $40.63 $40.63 $40.63 $40.63 $7.23 $40.63 $40.63 $30.16 $30.16 $31.32 $21.17 $8.47 $40.63 $16.25 $40.63 $40.63 $40.63 $40.63 $40.63 $30.75 $40.63 $40.63 $40.63 $20.32 $20.32 $32.18 $40.63 $32.50 $26.41 $40.63 N/A $23.78 $40.63 $24.38 $40.63 $40.63 $40.63 N/A N/A R020 SUP HCPCS C1768 R020 - GRAFT SFT TIS CRYOARTERY FEM POPLT ART BOTH IP/OP "$16,250.00" "$12,025.00" "$3,225.22" "$16,250.00" "$7,312.50" "$7,312.50" "$7,312.50" "$7,312.50" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.91" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.68" "$16,250.00" "$16,250.00" "$8,011.25" "$16,250.00" "$16,250.00" "$16,250.00" "$16,250.00" "$12,187.50" "$16,250.00" "$16,250.00" "$16,250.00" "$8,125.00" "$8,125.00" "$12,870.00" "$16,250.00" "$13,000.00" "$7,312.50" "$3,225.22" N/A "$9,425.00" "$16,250.00" "$16,250.00" "$16,250.00" "$3,386.50" "$16,250.00" N/A N/A R1212 SUP HCPCS A6208 R1212 - DRESSING WND 12X12IN PROCELLERA BOTH IP/OP $562.50 $416.00 $117.23 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A R1212 SUP Custom 27203010 DRESSING WOUND PROCELLERA ANTIMICROBIAL 12X12 BOTH IP/OP $900.00 $666.00 $117.23 $675.00 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $675.00 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $522.00 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A R390.003 SUP Custom 27203010 R390.003 - DEVICE EXFIX ROD ATTCH LG EXFIX 4-6 MM SCHNZ SCR NONSTRL BOTH IP/OP $632.50 $468.00 $112.59 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $632.50 $112.59 $632.50 $632.50 $469.44 $469.44 $487.53 $329.53 $131.82 $632.50 $253.00 $632.50 $632.50 $632.50 $632.50 $632.50 $474.38 $632.50 $632.50 $632.50 $316.25 $316.25 $500.94 $632.50 $506.00 $411.13 $632.50 N/A $366.85 $632.50 $379.50 $632.50 $632.50 $632.50 N/A N/A R390.010 SUP Custom 27203010 R390.010 - CLAMP EXFIX LG 6 PSTN PIN NONSTRL BOTH IP/OP $705.00 $522.00 $125.49 $705.00 $705.00 $705.00 $705.00 $705.00 $705.00 $705.00 $125.49 $705.00 $705.00 $523.25 $523.25 $543.41 $367.31 $146.93 $705.00 $282.00 $705.00 $705.00 $705.00 $705.00 $705.00 $528.75 $705.00 $705.00 $705.00 $352.50 $352.50 $558.36 $705.00 $564.00 $458.25 $705.00 N/A $408.90 $705.00 $423.00 $705.00 $705.00 $705.00 N/A N/A R390.051 SUP Custom 27203010 R390.051 - CLAMP EXFIX 4MM DISTAL RADL ADJ NONSTRL BOTH IP/OP "$1,127.50" $834.00 $200.70 "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" $200.70 "$1,127.50" "$1,127.50" $836.83 $836.83 $869.08 $587.43 $234.98 "$1,127.50" $451.00 "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" "$1,127.50" $845.63 "$1,127.50" "$1,127.50" "$1,127.50" $563.75 $563.75 $892.98 "$1,127.50" $902.00 $732.88 "$1,127.50" N/A $653.95 "$1,127.50" $676.50 "$1,127.50" "$1,127.50" "$1,127.50" N/A N/A R394.85 SUP Custom 27203010 R394.85 - ROD EXFIX 300MM 11MM CARFBR SLFDRILL MR CONDITIONAL SET BOTH IP/OP $355.00 $263.00 $63.19 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $355.00 $63.19 $355.00 $355.00 $263.48 $263.48 $273.63 $184.96 $73.99 $355.00 $142.00 $355.00 $355.00 $355.00 $355.00 $355.00 $266.25 $355.00 $355.00 $355.00 $177.50 $177.50 $281.16 $355.00 $284.00 $230.75 $355.00 N/A $205.90 $355.00 $213.00 $355.00 $355.00 $355.00 N/A N/A R395.786 SUP Custom 27203010 R395.786 - ROD EXFIX 240MM 8MM DISTAL RADL CARFBR NONSTRL BOTH IP/OP $232.50 $172.00 $41.39 $232.50 $232.50 $232.50 $232.50 $232.50 $232.50 $232.50 $41.39 $232.50 $232.50 $172.56 $172.56 $179.21 $121.13 $48.46 $232.50 $93.00 $232.50 $232.50 $232.50 $232.50 $232.50 $174.38 $232.50 $232.50 $232.50 $116.25 $116.25 $184.14 $232.50 $186.00 $151.13 $232.50 N/A $134.85 $232.50 $139.50 $232.50 $232.50 $232.50 N/A N/A R6515-01 SUP Custom 25803010 R6515-01 - SOLUTION IRR 2L LTX PHYSIOLYTE PIC 5% MNTL BOTH IP/OP $31.00 $23.00 $5.45 $30.61 $30.61 $30.61 $30.61 $30.61 $30.61 $30.61 $5.45 $30.61 $30.61 $22.72 $22.72 $23.59 $15.95 $6.38 $30.61 $12.24 $30.61 $30.61 $30.61 $30.61 $30.61 $23.25 $30.61 $30.61 $30.61 $15.31 $15.31 $24.24 $30.61 $24.49 $19.90 $30.61 N/A $17.98 $30.61 $18.37 $30.61 $30.61 $30.61 N/A N/A RA-04020 SUP HCPCS C1751 RA-04020 - KIT ARTERIAL LINE .018IN 20GA 22GA 1.75IN CATHETER RADIOPQ BOTH IP/OP $37.00 $27.00 $7.25 $39.45 $19.84 $19.84 $19.84 $19.84 $36.53 $36.53 $36.53 $7.61 $36.53 $27.11 $27.11 $28.16 $19.03 $7.61 $36.53 $39.45 $21.61 $36.53 $39.45 $36.53 $36.53 $27.75 $36.53 $36.53 $36.53 $18.27 $18.27 $28.93 $36.53 $29.22 $23.74 $7.25 N/A $21.46 $36.53 $36.53 $36.53 $7.61 $36.53 N/A N/A RAN-811-OT SUP Custom 27203010 RAN-811-OT - NEEDLE IO 8GA 11CM DLV OPN TIP BOTH IP/OP $500.00 $370.00 $89.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $500.00 $89.00 $500.00 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $216.00 $500.00 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $500.00 N/A $290.00 $500.00 $300.00 $500.00 $500.00 $500.00 N/A N/A RBY2C0725 SUP Custom 27803010 RBY2C0725 - COIL EMBL STD .02IN 7MM 25CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$2,475.00" "$1,832.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" N/A "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A RBY2C0825 SUP Custom 27803010 RBY2C0825 - COIL EMBL STD .02IN 8MM 25CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$2,475.00" "$1,832.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" N/A "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A RBY2C0840 SUP Custom 27803010 RBY2C0840 - COIL EMBL STD .02IN 8MM 40CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$3,225.00" "$2,387.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" N/A "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A RBY4C0201 SUP Custom 27803010 RBY4C0201 - COIL EMBL .02IN 2MM 1CM PENUMBRA COIL 400 RUBY CMPLX LG BOTH IP/OP "$1,975.00" "$1,462.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" N/A "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A RBYLP0102 SUP Custom 27803010 RBYLP0102 - COIL EMBL 1MM 2CM STRL LF RUBY LP BOTH IP/OP "$1,975.00" "$1,462.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" N/A "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A RBYLP0204 SUP Custom 27803010 RBYLP0204 - COIL EMBL 2MM 4CM STRL LF RUBY LP BOTH IP/OP "$1,975.00" "$1,462.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" N/A "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A RBYLP0210 SUP Custom 27803010 RBYLP0210 - COIL EMBL 2MM 10CM STRL LF RUBY LP BOTH IP/OP "$2,475.00" "$1,832.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" N/A "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A RBYLP0310 SUP Custom 27803010 RBYLP0310 - COIL EMBL 3MM 10CM STRL LF RUBY LP BOTH IP/OP "$2,475.00" "$1,832.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" N/A "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A RBYLP0315 SUP Custom 27803010 RBYLP0315 - COIL EMBL 3MM 15CM STRL LF RUBY LP BOTH IP/OP "$2,475.00" "$1,832.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" N/A "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A RBYLP0406 SUP Custom 27803010 RBYLP0406 - COIL EMBL 4MM 6CM STRL LF RUBY LP BOTH IP/OP "$1,975.00" "$1,462.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $351.55 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" $411.61 "$1,975.00" $790.00 "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,975.00" "$1,481.25" "$1,975.00" "$1,975.00" "$1,975.00" $987.50 $987.50 "$1,564.20" "$1,975.00" "$1,580.00" $888.75 "$1,975.00" N/A "$1,145.50" "$1,975.00" "$1,185.00" "$1,975.00" "$1,975.00" "$1,975.00" N/A N/A RBYPCLP15 SUP Custom 27803010 RBYPCLP15 - COIL EMBL 15CM STRL LF PK COIL LP BOTH IP/OP "$2,475.00" "$1,832.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" N/A "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A RBYPCLP30 SUP Custom 27803010 RBYPCLP30 - COIL EMBL 30CM STRL LF PK COIL LP BOTH IP/OP "$3,225.00" "$2,387.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" N/A "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A RBYPOD8 SUP Custom 27803010 RBYPOD8 - COIL EMBL 8MM 60CM RUBY POD CMPLX OCCULUSION DEV BOTH IP/OP "$4,475.00" "$3,312.00" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $796.55 "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" $932.64 "$4,475.00" "$1,790.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$4,475.00" "$3,356.25" "$4,475.00" "$4,475.00" "$4,475.00" "$2,237.50" "$2,237.50" "$3,544.20" "$4,475.00" "$3,580.00" "$2,013.75" "$4,475.00" N/A "$2,595.50" "$4,475.00" "$2,685.00" "$4,475.00" "$4,475.00" "$4,475.00" N/A N/A RBYPODJ5 SUP Custom 27803010 RBYPODJ5 - COIL EMBL J 5CM POD PK SFT BOTH IP/OP "$2,475.00" "$1,832.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $440.55 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" $515.82 "$2,475.00" $990.00 "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$2,475.00" "$1,856.25" "$2,475.00" "$2,475.00" "$2,475.00" "$1,237.50" "$1,237.50" "$1,960.20" "$2,475.00" "$1,980.00" "$1,113.75" "$2,475.00" N/A "$1,435.50" "$2,475.00" "$1,485.00" "$2,475.00" "$2,475.00" "$2,475.00" N/A N/A RBYPODJ60 SUP Custom 27803010 RBYPODJ60 - COIL EMBL J-SFT 60CM STRL LF POD PK BOTH IP/OP "$3,225.00" "$2,387.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $574.05 "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" $672.13 "$3,225.00" "$1,290.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$3,225.00" "$2,418.75" "$3,225.00" "$3,225.00" "$3,225.00" "$1,612.50" "$1,612.50" "$2,554.20" "$3,225.00" "$2,580.00" "$1,451.25" "$3,225.00" N/A "$1,870.50" "$3,225.00" "$1,935.00" "$3,225.00" "$3,225.00" "$3,225.00" N/A N/A RC41-12027 SUP Custom 27203010 RC41-12027 - CIRCUIT BREATHING 40IN ANESTHESIA HEATED WIRE LATEX NEONATE BOTH IP/OP $67.00 $50.00 $11.87 $66.67 $66.67 $66.67 $66.67 $66.67 $66.67 $66.67 $11.87 $66.67 $66.67 $49.48 $49.48 $51.39 $34.74 $13.89 $66.67 $26.67 $66.67 $66.67 $66.67 $66.67 $66.67 $50.25 $66.67 $66.67 $66.67 $33.34 $33.34 $52.80 $66.67 $53.34 $43.34 $66.67 N/A $38.86 $66.67 $40.00 $66.67 $66.67 $66.67 N/A N/A RCP3 SUP HCPCS C1713 RCP3 - PLATE BN NS RADL CLMN PIN PLT 3 HL PIN CLMN RADL BOTH IP/OP "$1,550.00" "$1,147.00" $307.64 "$1,550.00" $697.50 $697.50 $697.50 $697.50 "$1,550.00" "$1,550.00" "$1,550.00" $323.06 "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" $323.04 "$1,550.00" $620.00 $916.83 "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" "$1,162.50" "$1,550.00" "$1,550.00" "$1,550.00" $775.00 $775.00 "$1,227.60" "$1,550.00" "$1,240.00" $697.50 $307.64 N/A $899.00 "$1,550.00" "$1,550.00" "$1,550.00" $323.02 "$1,550.00" N/A N/A RCP5 SUP HCPCS C1713 RCP5 - PLATE BN NS RADL CLMN PIN PLT 5 HL PIN CLMN RADL BOTH IP/OP "$1,550.00" "$1,147.00" $307.64 "$1,550.00" $697.50 $697.50 $697.50 $697.50 "$1,550.00" "$1,550.00" "$1,550.00" $323.06 "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" $323.04 "$1,550.00" "$1,550.00" $916.83 "$1,550.00" "$1,550.00" "$1,550.00" "$1,550.00" "$1,162.50" "$1,550.00" "$1,550.00" "$1,550.00" $775.00 $775.00 "$1,227.60" "$1,550.00" "$1,240.00" $697.50 $307.64 N/A $899.00 "$1,550.00" "$1,550.00" "$1,550.00" $323.02 "$1,550.00" N/A N/A RG*ES1818SP SUP HCPCS C1769 RG*ES1818SP - GUIDEWIRE VASCULAR STR .018IN 180CM 25CM SHAPEABLE SHAFT BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $215.84 $215.84 $215.84 $215.84 $397.50 $397.50 $397.50 $82.85 $397.50 $295.02 $295.02 $306.39 $207.10 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $258.38 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A RG*GA1818SP SUP HCPCS C1769 RG*GA1818SP - GUIDEWIRE VASCULAR 45D .018IN 180CM 25CM GLIDEWIRE GT HYDPHI BOTH IP/OP $43.00 $32.00 $8.53 $46.50 $23.35 $23.35 $23.35 $23.35 $43.00 $43.00 $43.00 $8.96 $43.00 $31.91 $31.91 $33.14 $22.40 $8.96 $43.00 $46.50 $25.43 $43.00 $46.50 $43.00 $43.00 $32.25 $43.00 $43.00 $43.00 $21.50 $21.50 $34.06 $43.00 $34.40 $27.95 $8.53 N/A $24.94 $43.00 $43.00 $43.00 $8.96 $43.00 N/A N/A RH1 SUP Custom 27203010 RH1 - HANDLE INST RUBY DTCH COIL BOTH IP/OP $595.00 $440.00 $105.91 $595.00 $595.00 $595.00 $595.00 $595.00 $595.00 $595.00 $105.91 $595.00 $595.00 $441.61 $441.61 $458.63 $310.00 $124.00 $595.00 $238.00 $595.00 $595.00 $595.00 $595.00 $595.00 $446.25 $595.00 $595.00 $595.00 $297.50 $297.50 $471.24 $595.00 $476.00 $386.75 $595.00 N/A $345.10 $595.00 $357.00 $595.00 $595.00 $595.00 N/A N/A RL-3019-S SUP HCPCS C1713 RL-3019-S - ROD ORTHOPEDIC 3MM 190MM RAD INTRAMEDULLARY IMPLANT LEFT BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$1,614.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A RL-3021-S SUP HCPCS C1713 RL-3021-S - ROD ORTHOPEDIC 3MM 210MM RAD INTRAMEDULLARY IMPLANT LEFT BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$1,614.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A RL-3023-S SUP HCPCS C1713 RL-3023-S - ROD ORTHOPEDIC 3MM 230MM RAD INTRAMEDULLARY IMPLANT TITANIUM BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$1,076.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" N/A N/A RL-3619-S SUP HCPCS C1713 RL-3619-S - ROD INTRAMEDULLARY 3.6MM 190MM FOREARM LEFT RAD STERILE BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$1,614.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A RL-3621-S SUP HCPCS C1713 RL-3621-S - ROD INTRAMEDULLARY 3.6MM 210MM RAD LEFT STERILE BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$2,690.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A RL-3623-S SUP HCPCS C1713 RL-3623-S - ROD ORTHOPEDIC 3.6MM 230MM RAD INTRAMEDULLARY IMPLANT LEFT BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$2,690.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A RLPH1 SUP Custom 27203010 RLPH1 - HANDLE INST STRL LF DTCH DISP LP COIL SYS BOTH IP/OP $595.00 $440.00 $105.91 $595.00 $595.00 $595.00 $595.00 $595.00 $595.00 $595.00 $105.91 $595.00 $595.00 $441.61 $441.61 $458.63 $310.00 $124.00 $595.00 $238.00 $595.00 $595.00 $595.00 $595.00 $595.00 $446.25 $595.00 $595.00 $595.00 $297.50 $297.50 $471.24 $595.00 $476.00 $386.75 $595.00 N/A $345.10 $595.00 $357.00 $595.00 $595.00 $595.00 N/A N/A RMT3130 SUP Custom 27203010 RMT3130 - REAMER SURG 3.1MM 300MM T HANDLE ROD SYSTEM WRIST HAND BOTH IP/OP $497.50 $368.00 $88.56 $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $88.56 $497.50 $497.50 $369.24 $369.24 $383.47 $259.20 $103.68 $497.50 $199.00 $497.50 $497.50 $497.50 $497.50 $497.50 $373.13 $497.50 $497.50 $497.50 $248.75 $248.75 $394.02 $497.50 $398.00 $323.38 $497.50 N/A $288.55 $497.50 $298.50 $497.50 $497.50 $497.50 N/A N/A RMT-3137 SUP Custom 27203010 RMT-3137 - REAMER SRG 3.7MM THDL DISP FRARM ROD SYS BOTH IP/OP $497.50 $368.00 $88.56 $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $88.56 $497.50 $497.50 $369.24 $369.24 $383.47 $259.20 $103.68 $497.50 $199.00 $497.50 $497.50 $497.50 $497.50 $497.50 $373.13 $497.50 $497.50 $497.50 $248.75 $248.75 $394.02 $497.50 $398.00 $323.38 $497.50 N/A $288.55 $497.50 $298.50 $497.50 $497.50 $497.50 N/A N/A RMT3730 SUP Custom 27203010 RMT3730 - REAMER SURG 3.7MM T HANDLE WRIST HAND DISPOSABLE BOTH IP/OP $497.50 $368.00 $88.56 $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $88.56 $497.50 $497.50 $369.24 $369.24 $383.47 $259.20 $103.68 $497.50 $199.00 $497.50 $497.50 $497.50 $497.50 $497.50 $373.13 $497.50 $497.50 $497.50 $248.75 $248.75 $394.02 $497.50 $398.00 $323.38 $497.50 N/A $288.55 $497.50 $298.50 $497.50 $497.50 $497.50 N/A N/A RMT7340 SUP Custom 27203010 RMT7340 - REAMER SURG 7.3MM 400MM T HANDLE BOTH IP/OP $497.50 $368.00 $88.56 $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $88.56 $497.50 $497.50 $369.24 $369.24 $383.47 $259.20 $103.68 $497.50 $199.00 $497.50 $497.50 $497.50 $497.50 $497.50 $373.13 $497.50 $497.50 $497.50 $248.75 $248.75 $394.02 $497.50 $398.00 $323.38 $497.50 N/A $288.55 $497.50 $298.50 $497.50 $497.50 $497.50 N/A N/A RMT8340 SUP Custom 27203010 RMT8340 - REAMER SURG 8.3MM 400MM T HANDLE BOTH IP/OP $497.50 $368.00 $88.56 $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $497.50 $88.56 $497.50 $497.50 $369.24 $369.24 $383.47 $259.20 $103.68 $497.50 $199.00 $497.50 $497.50 $497.50 $497.50 $497.50 $373.13 $497.50 $497.50 $497.50 $248.75 $248.75 $394.02 $497.50 $398.00 $323.38 $497.50 N/A $288.55 $497.50 $298.50 $497.50 $497.50 $497.50 N/A N/A RR-3019-S SUP HCPCS C1713 RR-3019-S - ROD ORTHOPEDIC 3MM 190MM RAD INTRAMEDULLARY IMPLANT RIGHT BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$1,614.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A RR-3021-S SUP HCPCS C1713 RR-3021-S - ROD ORTHOPEDIC 3MM 210MM RAD INTRAMEDULLARY IMPLANT RIGHT BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$1,614.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A RR-3023-S SUP HCPCS C1713 RR-3023-S - ROD ORTHOPEDIC 3MM 230MM RAD INTRAMEDULLARY IMPLANT RIGHT BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$1,076.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$1,614.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A RR-3619-S SUP HCPCS C1713 RR-3619-S - ROD INTRAMEDULLARY 3.6MM 190MM RAD RIGHT STERILE BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$1,076.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$2,690.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A RR-3621-S SUP HCPCS C1713 RR-3621-S - ROD INTRAMEDULLARY 3.6MM 210MM RAD RIGHT STERILE BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$1,076.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$1,614.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A RR-3623-S SUP HCPCS C1713 RR-3623-S - ROD ORTHOPEDIC 3.6MM 230MM RAD INTRAMEDULLARY IMPLANT RIGHT BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$2,690.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A RRT08030040L SUP HCPCS C1768 RRT08030040L - GRAFT VASCULAR THIN WALL RING STANDARD 8MM 40CM 30CM BOTH IP/OP "$1,830.00" "$1,354.00" $363.21 "$1,830.00" $823.50 $823.50 $823.50 $823.50 "$1,830.00" "$1,830.00" "$1,830.00" $381.42 "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" $381.39 "$1,830.00" "$1,830.00" "$1,082.45" "$1,830.00" "$1,830.00" "$1,830.00" "$1,830.00" "$1,372.50" "$1,830.00" "$1,830.00" "$1,830.00" $915.00 $915.00 "$1,449.36" "$1,830.00" "$1,464.00" $823.50 $363.21 N/A "$1,061.40" "$1,830.00" "$1,830.00" "$1,830.00" $381.37 "$1,830.00" N/A N/A RRT08070070L SUP HCPCS C1768 RRT08070070L - GRAFT VASCULAR THIN WALL RING 8MM 70CM 70CM GORE-TEX BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A RRT10030030L SUP HCPCS C1768 RRT10030030L - GRAFT VASCULAR THIN WALL 10MM 30CM 30CM REMOVABLE RING LINE BOTH IP/OP "$2,302.50" "$1,704.00" $456.99 "$2,302.50" "$1,036.13" "$1,036.13" "$1,036.13" "$1,036.13" "$2,302.50" "$2,302.50" "$2,302.50" $479.90 "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" $479.87 "$2,302.50" "$2,302.50" "$1,361.93" "$2,302.50" "$2,302.50" "$2,302.50" "$2,302.50" "$1,726.88" "$2,302.50" "$2,302.50" "$2,302.50" "$1,151.25" "$1,151.25" "$1,823.58" "$2,302.50" "$1,842.00" "$1,036.13" $456.99 N/A "$1,335.45" "$2,302.50" "$2,302.50" "$2,302.50" $479.84 "$2,302.50" N/A N/A RRT10070070L SUP HCPCS C1768 RRT10070070L - GRAFT VASCULAR THIN WALL 10MM 70CM 70CM REMOVABLE RING LINE BOTH IP/OP "$3,002.50" "$2,222.00" $595.92 "$3,002.50" "$1,351.13" "$1,351.13" "$1,351.13" "$1,351.13" "$3,002.50" "$3,002.50" "$3,002.50" $625.80 "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" $625.75 "$3,002.50" "$3,002.50" "$1,480.23" "$3,002.50" "$3,002.50" "$3,002.50" "$3,002.50" "$2,251.88" "$3,002.50" "$3,002.50" "$3,002.50" "$1,501.25" "$1,501.25" "$2,377.98" "$3,002.50" "$2,402.00" "$1,351.13" $595.92 N/A "$1,741.45" "$3,002.50" "$3,002.50" "$3,002.50" $625.72 "$3,002.50" N/A N/A RS22 SUP Custom 27203010 RS22 - SUTURE NONABSORBABLE 5MM CTX 12IN 2 ARM MERSILENE WHITE BOTH IP/OP $80.50 $60.00 $14.24 $82.35 $80.02 $80.02 $80.02 $80.02 $80.02 $80.02 $14.24 $80.02 $80.02 $59.39 $59.39 $61.68 $41.69 $16.68 $80.02 $32.94 $80.02 $80.02 $82.35 $80.02 $80.02 $60.38 $80.02 $80.02 $80.02 $40.01 $40.01 $63.38 $80.02 $64.02 $52.01 $80.02 N/A $46.69 $80.02 $48.01 $80.02 $80.02 $80.02 N/A N/A RSB501 SUP HCPCS C1894 RSB501 - INTRODUCER SHTH 5FR 6CM 2.5CM PNCL RADOPQ DIL NO MN GW BOTH IP/OP $47.00 $35.00 $9.30 $62.88 $25.46 $25.46 $25.46 $25.46 $46.88 $46.88 $46.88 $9.77 $46.88 $34.79 $34.79 $36.14 $24.42 $9.77 $46.88 $25.15 $27.73 $46.88 $62.88 $46.88 $46.88 $35.25 $46.88 $46.88 $46.88 $23.44 $23.44 $37.13 $46.88 $37.50 $30.47 $9.30 N/A $27.26 $46.88 $46.88 $46.88 $9.77 $46.88 N/A N/A RSB502 SUP HCPCS C1894 RSB502 - INTRODUCER SHTH 5FR 10CM 2.5CM PNCL RADOPQ DIL NO MN GW BOTH IP/OP $53.50 $40.00 $10.62 $68.50 $29.05 $29.05 $29.05 $29.05 $53.50 $53.50 $53.50 $11.15 $53.50 $39.71 $39.71 $41.24 $27.87 $11.15 $53.50 $68.50 $31.65 $53.50 $68.50 $53.50 $53.50 $40.13 $53.50 $53.50 $53.50 $26.75 $26.75 $42.37 $53.50 $42.80 $34.78 $10.62 N/A $31.03 $53.50 $53.50 $53.50 $11.15 $53.50 N/A N/A RSB503 SUP HCPCS C1894 RSB503 - INTRODUCER SHTH 5FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST BOTH IP/OP $65.00 $48.00 $12.90 $87.15 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $87.15 $38.45 $65.00 $87.15 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A RSB602 SUP HCPCS C1894 RSB602 - INTRODUCER SHTH 6FR 10CM 2.5CM PN RO2 DIL RADOPQ KINK RST BOTH IP/OP $53.50 $40.00 $10.62 $68.50 $29.05 $29.05 $29.05 $29.05 $53.50 $53.50 $53.50 $11.15 $53.50 $39.71 $39.71 $41.24 $27.87 $11.15 $53.50 $68.50 $31.65 $53.50 $68.50 $53.50 $53.50 $40.13 $53.50 $53.50 $53.50 $26.75 $26.75 $42.37 $53.50 $42.80 $34.78 $10.62 N/A $31.03 $53.50 $53.50 $53.50 $11.15 $53.50 N/A N/A RSB603 SUP HCPCS C1894 RSB603 - INTRODUCER SHTH 6FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST BOTH IP/OP $65.00 $48.00 $12.90 $87.15 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $87.15 $38.45 $65.00 $87.15 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A RSB702 SUP HCPCS C1894 RSB702 - INTRODUCER SHTH 7FR 2.5CM 10CM DILAT RADIOPQ MRKR BOTH IP/OP $53.50 $40.00 $10.62 $68.50 $29.05 $29.05 $29.05 $29.05 $53.50 $53.50 $53.50 $11.15 $53.50 $39.71 $39.71 $41.24 $27.87 $11.15 $53.50 $68.50 $31.65 $53.50 $68.50 $53.50 $53.50 $40.13 $53.50 $53.50 $53.50 $26.75 $26.75 $42.37 $53.50 $42.80 $34.78 $10.62 N/A $31.03 $53.50 $53.50 $53.50 $11.15 $53.50 N/A N/A RSB703 SUP HCPCS C1894 RSB703 - INTRODUCER SHTH 7FR 2.5CM 25CM DILAT RADIOPQ MRKR BOTH IP/OP $65.00 $48.00 $12.90 $87.15 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $87.15 $38.45 $65.00 $87.15 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A RSB802 SUP HCPCS C1894 RSB802 - INTRODUCER SHTH 8FR 2.5CM 10CM GWIRE DILAT RADIOPQ BOTH IP/OP $53.50 $40.00 $10.62 $68.50 $29.05 $29.05 $29.05 $29.05 $53.50 $53.50 $53.50 $11.15 $53.50 $39.71 $39.71 $41.24 $27.87 $11.15 $53.50 $68.50 $31.65 $53.50 $68.50 $53.50 $53.50 $40.13 $53.50 $53.50 $53.50 $26.75 $26.75 $42.37 $53.50 $42.80 $34.78 $10.62 N/A $31.03 $53.50 $53.50 $53.50 $11.15 $53.50 N/A N/A RSB803 SUP HCPCS C1894 RSB803 - INTRODUCER SHTH 8FR 2.5CM 25CM DILAT RADIOPQ MRKR BOTH IP/OP $65.00 $48.00 $12.90 $87.15 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $87.15 $38.45 $65.00 $87.15 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A RSB902 SUP HCPCS C1894 RSB902 - INTRODUCER SHTH 9FR 10CM 2.5CM PN RO2 DIL RADOPQ KINK RST BOTH IP/OP $53.50 $40.00 $10.62 $68.50 $29.05 $29.05 $29.05 $29.05 $53.50 $53.50 $53.50 $11.15 $53.50 $39.71 $39.71 $41.24 $27.87 $11.15 $53.50 $68.50 $31.65 $53.50 $68.50 $53.50 $53.50 $40.13 $53.50 $53.50 $53.50 $26.75 $26.75 $42.37 $53.50 $42.80 $34.78 $10.62 N/A $31.03 $53.50 $53.50 $53.50 $11.15 $53.50 N/A N/A RSB903 SUP HCPCS C1894 RSB903 - INTRODUCER SHTH 9FR 25CM 2.5CM PN RO2 DIL RADOPQ KINK RST BOTH IP/OP $65.00 $48.00 $12.90 $87.15 $35.30 $35.30 $35.30 $35.30 $65.00 $65.00 $65.00 $13.55 $65.00 $48.24 $48.24 $50.10 $33.87 $13.55 $65.00 $87.15 $38.45 $65.00 $87.15 $65.00 $65.00 $48.75 $65.00 $65.00 $65.00 $32.50 $32.50 $51.48 $65.00 $52.00 $42.25 $12.90 N/A $37.70 $65.00 $65.00 $65.00 $13.55 $65.00 N/A N/A RSR01 SUP HCPCS C1887 RSR01 - SHEATH GUID STR CURVE 6FR 45CM 5CM 3 RADIOPQ CROSSCUT VALVE BOTH IP/OP $207.00 $153.00 $41.02 $261.25 $112.24 $112.24 $112.24 $112.24 $206.70 $206.70 $206.70 $43.08 $206.70 $153.41 $153.41 $159.32 $107.69 $43.08 $206.70 $261.25 $122.26 $206.70 $261.25 $206.70 $206.70 $155.25 $206.70 $206.70 $206.70 $103.35 $103.35 $163.71 $206.70 $165.36 $134.36 $41.02 N/A $120.06 $206.70 $206.70 $206.70 $43.08 $206.70 N/A N/A RSR02 SUP HCPCS C1887 RSR02 - SHEATH GD HS CRV 6FR 45CM 5CM PN DSTN XCUT VLV RADOPQ SS NYL BOTH IP/OP $205.00 $152.00 $40.69 $261.25 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $261.25 $121.26 $205.00 $261.25 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 N/A $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A RSR04 SUP HCPCS C1894 RSR04 - SHEATH GD STRG 7FR .122IN .101IN 45CM 5CM PNCL DESTINATION BOTH IP/OP $52.50 $39.00 $10.37 $52.25 $28.37 $28.37 $28.37 $28.37 $52.25 $52.25 $52.25 $10.89 $52.25 $38.78 $38.78 $40.27 $27.22 $10.89 $52.25 $52.25 $30.91 $52.25 $52.25 $52.25 $52.25 $39.38 $52.25 $52.25 $52.25 $26.13 $26.13 $41.38 $52.25 $41.80 $33.96 $10.37 N/A $30.45 $52.25 $52.25 $52.25 $10.89 $52.25 N/A N/A RSR14 SUP HCPCS C1894 RSR14 - SHEATH GD LIMA CRV 6FR 45CM 5CM PN DSTN XCUT VLV RADOPQ SS BOTH IP/OP $205.00 $152.00 $40.69 $261.25 $111.32 $111.32 $111.32 $111.32 $205.00 $205.00 $205.00 $42.73 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $261.25 $121.26 $205.00 $261.25 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $40.69 N/A $118.90 $205.00 $205.00 $205.00 $42.72 $205.00 N/A N/A RSS001 SUP HCPCS C1894 RSS001 - INTRODUCER SHEATH .035IN 10FR 10CM 2.5CM GWIRE DILAT KINK BOTH IP/OP $22.00 $16.00 $4.34 $27.18 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $27.18 $12.94 $21.88 $27.18 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A RSS005 SUP HCPCS C1894 RSS005 - INTRODUCER SHEATH 10FR 25CM 2.5CM DILAT KINK RESISTANT BOTH IP/OP $50.00 $37.00 $11.79 $59.38 $32.24 $32.24 $32.24 $32.24 $59.38 $59.38 $59.38 $12.38 $59.38 $44.07 $44.07 $45.77 $30.94 $12.38 $59.38 $59.38 $35.12 $59.38 $59.38 $59.38 $59.38 $37.50 $59.38 $59.38 $59.38 $29.69 $29.69 $47.03 $59.38 $47.50 $38.60 $11.79 N/A $29.00 $59.38 $59.38 $59.38 $12.37 $59.38 N/A N/A RSS005 SUP HCPCS C1894 RSS005 - INTRODUCER SHTH 10FR 25CM 2.5CM PNCL DIL KINK RST HDRPH PTFE BOTH IP/OP $59.50 $44.00 $11.79 $59.38 $32.24 $32.24 $32.24 $32.24 $59.38 $59.38 $59.38 $12.38 $59.38 $44.07 $44.07 $45.77 $30.94 $12.38 $59.38 $59.38 $35.12 $59.38 $59.38 $59.38 $59.38 $44.63 $59.38 $59.38 $59.38 $29.69 $29.69 $47.03 $59.38 $47.50 $38.60 $11.79 N/A $34.51 $59.38 $59.38 $59.38 $12.37 $59.38 N/A N/A RSS402 SUP HCPCS C1894 RSS402 - SHEATH INTRO 4FR 10CM 2.5CM PNCL DIL KINK RST SS HDRPH PTFE BOTH IP/OP $21.50 $16.00 $4.22 $21.25 $11.54 $11.54 $11.54 $11.54 $21.25 $21.25 $21.25 $4.43 $21.25 $15.77 $15.77 $16.38 $11.07 $4.43 $21.25 $21.25 $12.57 $21.25 $21.25 $21.25 $21.25 $16.13 $21.25 $21.25 $21.25 $10.63 $10.63 $16.83 $21.25 $17.00 $13.81 $4.22 N/A $12.47 $21.25 $21.25 $21.25 $4.43 $21.25 N/A N/A RSS501 SUP HCPCS C1894 RSS501 - SHEATH INTROD 45CM 5FR 10CM 2.5CM SMOOTH TRANSITION CROSS BOTH IP/OP $22.00 $16.00 $4.34 $27.18 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $10.87 $12.94 $21.88 $27.18 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A RSS503 SUP HCPCS C1894 RSS503 - SHEATH INTRO 5FR 10CM 2.5CM PNCL DIL KINK RST PERI ACPT .038 BOTH IP/OP $22.00 $16.00 $5.39 $27.18 $14.76 $14.76 $14.76 $14.76 $27.18 $27.18 $27.18 $5.66 $27.18 $20.17 $20.17 $20.95 $14.16 $5.66 $27.18 $27.18 $16.08 $27.18 $27.18 $27.18 $27.18 $16.50 $27.18 $27.18 $27.18 $13.59 $13.59 $21.53 $27.18 $21.74 $17.67 $5.39 N/A $12.76 $27.18 $27.18 $27.18 $5.66 $27.18 N/A N/A RSS503 SUP HCPCS C1894 RSS503 - SHEATH INTRO 5FR 10CM 2.5CM PNCL SNPON DIL LCK KINK RST SMTH BOTH IP/OP $27.50 $20.00 $5.39 $27.18 $14.76 $14.76 $14.76 $14.76 $27.18 $27.18 $27.18 $5.66 $27.18 $20.17 $20.17 $20.95 $14.16 $5.66 $27.18 $27.18 $16.08 $27.18 $27.18 $27.18 $27.18 $20.63 $27.18 $27.18 $27.18 $13.59 $13.59 $21.53 $27.18 $21.74 $17.67 $5.39 N/A $15.95 $27.18 $27.18 $27.18 $5.66 $27.18 N/A N/A RSS505 SUP HCPCS C1894 RSS505 - SHEATH INTRO 5FR 25CM 2.5CM PNCL DIL KINK RST SS HDRPH PTFE BOTH IP/OP $50.00 $37.00 $11.79 $59.38 $32.24 $32.24 $32.24 $32.24 $59.38 $59.38 $59.38 $12.38 $59.38 $44.07 $44.07 $45.77 $30.94 $12.38 $59.38 $59.38 $35.12 $59.38 $59.38 $59.38 $59.38 $37.50 $59.38 $59.38 $59.38 $29.69 $29.69 $47.03 $59.38 $47.50 $38.60 $11.79 N/A $29.00 $59.38 $59.38 $59.38 $12.37 $59.38 N/A N/A RSS505 SUP HCPCS C1894 RSS505 - SHEATH INTRO 5FR 25CM 2.5CM PNCL SNPON DIL LCK KINK RST SMTH BOTH IP/OP $59.50 $44.00 $11.79 $59.38 $32.24 $32.24 $32.24 $32.24 $59.38 $59.38 $59.38 $12.38 $59.38 $44.07 $44.07 $45.77 $30.94 $12.38 $59.38 $59.38 $35.12 $59.38 $59.38 $59.38 $59.38 $44.63 $59.38 $59.38 $59.38 $29.69 $29.69 $47.03 $59.38 $47.50 $38.60 $11.79 N/A $34.51 $59.38 $59.38 $59.38 $12.37 $59.38 N/A N/A RSS601 SUP HCPCS C1894 RSS601 - INTRODUCER SHEATH .035IN 6FR 10CM 2.5CM MINI GWIRE DILAT BOTH IP/OP $22.00 $16.00 $4.34 $27.18 $11.88 $11.88 $11.88 $11.88 $21.88 $21.88 $21.88 $4.56 $21.88 $16.24 $16.24 $16.87 $11.40 $4.56 $21.88 $27.18 $12.94 $21.88 $27.18 $21.88 $21.88 $16.50 $21.88 $21.88 $21.88 $10.94 $10.94 $17.33 $21.88 $17.50 $14.22 $4.34 N/A $12.76 $21.88 $21.88 $21.88 $4.56 $21.88 N/A N/A RSS603 SUP HCPCS C1894 RSS603 - SHEATH INTRO 6FR 10CM 2.5CM PNCL SNPON DIL LCK KINK RST PERI BOTH IP/OP $27.50 $20.00 $5.39 $27.18 $14.76 $14.76 $14.76 $14.76 $27.18 $27.18 $27.18 $5.66 $27.18 $20.17 $20.17 $20.95 $14.16 $5.66 $27.18 $27.18 $16.08 $27.18 $27.18 $27.18 $27.18 $20.63 $27.18 $27.18 $27.18 $13.59 $13.59 $21.53 $27.18 $21.74 $17.67 $5.39 N/A $15.95 $27.18 $27.18 $27.18 $5.66 $27.18 N/A N/A RSS603 SUP HCPCS C1894 RSS603 - SHEATH INTRO 6FR 10CM 2.5CM PNCL DIL KINK RST PERI ACPT .038 BOTH IP/OP $219.00 $162.00 $5.39 $164.25 $14.76 $14.76 $14.76 $14.76 $27.18 $27.18 $27.18 $5.66 $27.18 $20.17 $20.17 $20.95 $14.16 $5.66 $27.18 $27.18 $16.08 $27.18 $27.18 $27.18 $27.18 $164.25 $27.18 $27.18 $27.18 $13.59 $13.59 $21.53 $27.18 $21.74 $17.67 $5.39 N/A $127.02 $27.18 $27.18 $27.18 $5.66 $27.18 N/A N/A RSS605 SUP HCPCS C1894 RSS605 - INTRODUCER SHEATH .035IN 6FR 25CM 2.5CM GWIRE DILAT KINK BOTH IP/OP $50.00 $37.00 $11.79 $59.38 $32.24 $32.24 $32.24 $32.24 $59.38 $59.38 $59.38 $12.38 $59.38 $44.07 $44.07 $45.77 $30.94 $12.38 $59.38 $59.38 $35.12 $59.38 $59.38 $59.38 $59.38 $37.50 $59.38 $59.38 $59.38 $29.69 $29.69 $47.03 $59.38 $47.50 $38.60 $11.79 N/A $29.00 $59.38 $59.38 $59.38 $12.37 $59.38 N/A N/A RSS605 SUP HCPCS C1894 RSS605 - SHEATH INTRO 6FR 25CM 2.5CM PNCL SNPON DIL LCK KINK RST SMTH BOTH IP/OP $59.50 $44.00 $11.79 $59.38 $32.24 $32.24 $32.24 $32.24 $59.38 $59.38 $59.38 $12.38 $59.38 $44.07 $44.07 $45.77 $30.94 $12.38 $59.38 $59.38 $35.12 $59.38 $59.38 $59.38 $59.38 $44.63 $59.38 $59.38 $59.38 $29.69 $29.69 $47.03 $59.38 $47.50 $38.60 $11.79 N/A $34.51 $59.38 $59.38 $59.38 $12.37 $59.38 N/A N/A RSS606 SUP HCPCS C1894 RSS606 - INTRODUCER SHEATH 6FR 25CM 2.5CM DILAT KINK RESISTANT BOTH IP/OP $43.00 $32.00 $8.51 $42.88 $23.28 $23.28 $23.28 $23.28 $42.88 $42.88 $42.88 $8.94 $42.88 $31.83 $31.83 $33.05 $22.34 $8.94 $42.88 $42.88 $25.36 $42.88 $42.88 $42.88 $42.88 $32.25 $42.88 $42.88 $42.88 $21.44 $21.44 $33.96 $42.88 $34.30 $27.87 $8.51 N/A $24.94 $42.88 $42.88 $42.88 $8.94 $42.88 N/A N/A RSS703 SUP HCPCS C1894 RSS703 - SHEATH INTRO 7FR 10CM 2.5CM PNCL SNPON DIL LCK KINK RST SMTH BOTH IP/OP $27.50 $20.00 $5.39 $27.18 $14.76 $14.76 $14.76 $14.76 $27.18 $27.18 $27.18 $5.66 $27.18 $20.17 $20.17 $20.95 $14.16 $5.66 $27.18 $27.18 $16.08 $27.18 $27.18 $27.18 $27.18 $20.63 $27.18 $27.18 $27.18 $13.59 $13.59 $21.53 $27.18 $21.74 $17.67 $5.39 N/A $15.95 $27.18 $27.18 $27.18 $5.66 $27.18 N/A N/A RSS705 SUP HCPCS C1894 RSS705 - SHEATH INTRO 7FR 25CM 2.5CM PNCL SNPON DIL LCK KINK RST SMTH BOTH IP/OP $59.50 $44.00 $11.79 $59.38 $32.24 $32.24 $32.24 $32.24 $59.38 $59.38 $59.38 $12.38 $59.38 $44.07 $44.07 $45.77 $30.94 $12.38 $59.38 $59.38 $35.12 $59.38 $59.38 $59.38 $59.38 $44.63 $59.38 $59.38 $59.38 $29.69 $29.69 $47.03 $59.38 $47.50 $38.60 $11.79 N/A $34.51 $59.38 $59.38 $59.38 $12.37 $59.38 N/A N/A RSS705 SUP HCPCS C1894 RSS705 - SHEATH INTRO 7FR 25CM 2.5CM PNCL DIL KINK RST SS HDRPH PTFE BOTH IP/OP $499.00 $369.00 $11.79 $374.25 $32.24 $32.24 $32.24 $32.24 $59.38 $59.38 $59.38 $12.38 $59.38 $44.07 $44.07 $45.77 $30.94 $12.38 $59.38 $59.38 $35.12 $59.38 $59.38 $59.38 $59.38 $374.25 $59.38 $59.38 $59.38 $29.69 $29.69 $47.03 $59.38 $47.50 $38.60 $11.79 N/A $289.42 $59.38 $59.38 $59.38 $12.37 $59.38 N/A N/A RSS706 SUP HCPCS C1894 RSS706 - INTRODUCER SHEATH 7FR 25CM 2.5CM DILAT KINK RESISTANT SMOOTH BOTH IP/OP $43.00 $32.00 $8.51 $42.88 $23.28 $23.28 $23.28 $23.28 $42.88 $42.88 $42.88 $8.94 $42.88 $31.83 $31.83 $33.05 $22.34 $8.94 $42.88 $42.88 $25.36 $42.88 $42.88 $42.88 $42.88 $32.25 $42.88 $42.88 $42.88 $21.44 $21.44 $33.96 $42.88 $34.30 $27.87 $8.51 N/A $24.94 $42.88 $42.88 $42.88 $8.94 $42.88 N/A N/A RSS803 SUP HCPCS C1894 RSS803 - INTRODUCER SHEATH .035IN 8FR 10CM 2.5CM DILAT KINK RESISTANT BOTH IP/OP $22.00 $16.00 $5.39 $27.18 $14.76 $14.76 $14.76 $14.76 $27.18 $27.18 $27.18 $5.66 $27.18 $20.17 $20.17 $20.95 $14.16 $5.66 $27.18 $27.18 $16.08 $27.18 $27.18 $27.18 $27.18 $16.50 $27.18 $27.18 $27.18 $13.59 $13.59 $21.53 $27.18 $21.74 $17.67 $5.39 N/A $12.76 $27.18 $27.18 $27.18 $5.66 $27.18 N/A N/A RSS803 SUP HCPCS C1894 RSS803 - SHEATH INTRO 8FR 10CM 2.5CM PNCL SNPON DIL LCK KINK RST SMTH BOTH IP/OP $27.50 $20.00 $5.39 $27.18 $14.76 $14.76 $14.76 $14.76 $27.18 $27.18 $27.18 $5.66 $27.18 $20.17 $20.17 $20.95 $14.16 $5.66 $27.18 $27.18 $16.08 $27.18 $27.18 $27.18 $27.18 $20.63 $27.18 $27.18 $27.18 $13.59 $13.59 $21.53 $27.18 $21.74 $17.67 $5.39 N/A $15.95 $27.18 $27.18 $27.18 $5.66 $27.18 N/A N/A RSS805 SUP HCPCS C1894 RSS805 - INTRODUCER SHTH 8FR 25CM 2.5CM PNCL DIL MN GW KINK RST PERI BOTH IP/OP $50.00 $37.00 $11.79 $59.38 $32.24 $32.24 $32.24 $32.24 $59.38 $59.38 $59.38 $12.38 $59.38 $44.07 $44.07 $45.77 $30.94 $12.38 $59.38 $59.38 $35.12 $59.38 $59.38 $59.38 $59.38 $37.50 $59.38 $59.38 $59.38 $29.69 $29.69 $47.03 $59.38 $47.50 $38.60 $11.79 N/A $29.00 $59.38 $59.38 $59.38 $12.37 $59.38 N/A N/A RSS805 SUP HCPCS C1894 RSS805 - INTRODUCER SHTH 8FR 25CM 2.5CM PNCL DIL MN GW KINK RST PERI BOTH IP/OP $59.50 $44.00 $11.79 $59.38 $32.24 $32.24 $32.24 $32.24 $59.38 $59.38 $59.38 $12.38 $59.38 $44.07 $44.07 $45.77 $30.94 $12.38 $59.38 $59.38 $35.12 $59.38 $59.38 $59.38 $59.38 $44.63 $59.38 $59.38 $59.38 $29.69 $29.69 $47.03 $59.38 $47.50 $38.60 $11.79 N/A $34.51 $59.38 $59.38 $59.38 $12.37 $59.38 N/A N/A RSS903 SUP HCPCS C1894 RSS903 - SHEATH INTROD .038IN 9FR 10CM 2.5CM GWIRE DILAT KINK BOTH IP/OP $22.00 $16.00 $5.39 $27.18 $14.76 $14.76 $14.76 $14.76 $27.18 $27.18 $27.18 $5.66 $27.18 $20.17 $20.17 $20.95 $14.16 $5.66 $27.18 $27.18 $16.08 $27.18 $27.18 $27.18 $27.18 $16.50 $27.18 $27.18 $27.18 $13.59 $13.59 $21.53 $27.18 $21.74 $17.67 $5.39 N/A $12.76 $27.18 $27.18 $27.18 $5.66 $27.18 N/A N/A RSS903 SUP HCPCS C1894 RSS903 - SHEATH INTRO 9FR 10CM 2.5CM PNCL SNPON DIL LCK KINK RST SMTH BOTH IP/OP $27.50 $20.00 $5.39 $27.18 $14.76 $14.76 $14.76 $14.76 $27.18 $27.18 $27.18 $5.66 $27.18 $20.17 $20.17 $20.95 $14.16 $5.66 $27.18 $27.18 $16.08 $27.18 $27.18 $27.18 $27.18 $20.63 $27.18 $27.18 $27.18 $13.59 $13.59 $21.53 $27.18 $21.74 $17.67 $5.39 N/A $15.95 $27.18 $27.18 $27.18 $5.66 $27.18 N/A N/A RSZ-3004 SUP Custom 27203010 RSZ-3004 - SIZER IMPL P4.5CM HI PRFL RND 11.1CM 300ML STRL MEMORYGEL BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A RSZ-3504 SUP Custom 27203010 RSZ-3504 - SIZER IMPL P4.8CM HI PRFL RND 11.7CM 350ML STRL MEMORYGEL BOTH IP/OP $737.50 $546.00 $131.28 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $737.50 $131.28 $737.50 $737.50 $547.37 $547.37 $568.47 $384.24 $153.70 $737.50 $295.00 $737.50 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $479.38 $737.50 N/A $427.75 $737.50 $442.50 $737.50 $737.50 $737.50 N/A N/A RSZ-8004 SUP Custom 27803010 RSZ-8004 - SIZER IMPL P6CM HI PRFL RND 15.5CM 800ML STRL MEMORYGEL GEL BOTH IP/OP "$2,325.00" "$1,721.00" $413.85 "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" $413.85 "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" $484.56 "$2,325.00" $930.00 "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$2,325.00" "$1,743.75" "$2,325.00" "$2,325.00" "$2,325.00" "$1,162.50" "$1,162.50" "$1,841.40" "$2,325.00" "$1,860.00" "$1,046.25" "$2,325.00" N/A "$1,348.50" "$2,325.00" "$1,395.00" "$2,325.00" "$2,325.00" "$2,325.00" N/A N/A RU510418 SUP HCPCS C1758 RU510418 - CATHETER URETHERAL SZ 18 BOTH IP/OP $8.00 $6.00 $1.49 $7.51 $4.08 $4.08 $4.08 $4.08 $7.51 $7.51 $7.51 $1.57 $7.51 $5.57 $5.57 $5.79 $3.91 $1.57 $7.51 $7.51 $4.44 $7.51 $7.51 $7.51 $7.51 $6.00 $7.51 $7.51 $7.51 $3.76 $3.76 $5.95 $7.51 $6.01 $4.88 $1.49 N/A $4.64 $7.51 $7.51 $7.51 $1.57 $7.51 N/A N/A RU510420 SUP HCPCS C1729 RU510420 - CATHETER ROBINSON URETHERAL SZ 20 BOTH IP/OP $8.00 $6.00 $1.55 $7.81 $4.24 $4.24 $4.24 $4.24 $7.81 $7.81 $7.81 $1.63 $7.81 $5.80 $5.80 $6.02 $4.07 $1.63 $7.81 $7.81 $4.62 $7.81 $7.81 $7.81 $7.81 $6.00 $7.81 $7.81 $7.81 $3.91 $3.91 $6.19 $7.81 $6.25 $5.08 $1.55 N/A $4.64 $7.81 $7.81 $7.81 $1.63 $7.81 N/A N/A RV80510 SUP HCPCS C1725 RV80510 - CATHETER BLNDIL 5MM 80CM 10CM RIVAL CK 2 LUM TPR TIP LOPRFL BOTH IP/OP $575.00 $426.00 $114.12 $575.00 $312.23 $312.23 $312.23 $312.23 $575.00 $575.00 $575.00 $119.84 $575.00 $426.77 $426.77 $443.21 $299.58 $119.84 $575.00 $575.00 $340.11 $575.00 $575.00 $575.00 $575.00 $431.25 $575.00 $575.00 $575.00 $287.50 $287.50 $455.40 $575.00 $460.00 $373.75 $114.12 N/A $333.50 $575.00 $575.00 $575.00 $119.83 $575.00 N/A N/A RW-04018 SUP HCPCS C1769 RW-04018 - GUIDEWIRE VASCULAR .018IN 5 3/8IN SPRING TUBE POSITIVE BOTH IP/OP $16.50 $12.00 $3.27 $17.20 $8.96 $8.96 $8.96 $8.96 $16.50 $16.50 $16.50 $3.44 $16.50 $12.25 $12.25 $12.72 $8.60 $3.44 $16.50 $17.20 $9.76 $16.50 $16.50 $16.50 $16.50 $12.38 $16.50 $16.50 $16.50 $8.25 $8.25 $13.07 $16.50 $13.20 $10.73 $3.27 N/A $9.57 $16.50 $16.50 $16.50 $3.44 $16.50 N/A N/A S-0793-HA42 SUP Custom 27803010 S-0793-HA42 - CUP ACETAB 42MM 22MM CEMENTED ODC ALL POLY HIP BOTH IP/OP $822.00 $608.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $171.31 $822.00 $328.80 $822.00 $822.00 $822.00 $822.00 $822.00 $616.50 $822.00 $822.00 $822.00 $411.00 $411.00 $651.02 $822.00 $657.60 $369.90 $822.00 N/A $476.76 $822.00 $493.20 $822.00 $822.00 $822.00 N/A N/A S-0793-HA46 SUP Custom 27803010 S-0793-HA46 - CUP ACETAB 46MM 22MM CEMENTED ODC ALL POLY HIP BOTH IP/OP $822.00 $608.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $171.31 $822.00 $328.80 $822.00 $822.00 $822.00 $822.00 $822.00 $616.50 $822.00 $822.00 $822.00 $411.00 $411.00 $651.02 $822.00 $657.60 $369.90 $822.00 N/A $476.76 $822.00 $493.20 $822.00 $822.00 $822.00 N/A N/A S-0793-HA50 SUP Custom 27803010 S-0793-HA50 - CUP ACETAB 50MM 22MM CEMENTED ODC ALL POLY HIP BOTH IP/OP $822.00 $608.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $171.31 $822.00 $328.80 $822.00 $822.00 $822.00 $822.00 $822.00 $616.50 $822.00 $822.00 $822.00 $411.00 $411.00 $651.02 $822.00 $657.60 $369.90 $822.00 N/A $476.76 $822.00 $493.20 $822.00 $822.00 $822.00 N/A N/A S-0793-HA54 SUP Custom 27803010 S-0793-HA54 - CUP ACETAB 54MM 22MM CEMENTED ODC ALL POLY HIP BOTH IP/OP $822.00 $608.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $171.31 $822.00 $328.80 $822.00 $822.00 $822.00 $822.00 $822.00 $616.50 $822.00 $822.00 $822.00 $411.00 $411.00 $651.02 $822.00 $657.60 $369.90 $822.00 N/A $476.76 $822.00 $493.20 $822.00 $822.00 $822.00 N/A N/A S-0793-HA58 SUP Custom 27803010 S-0793-HA58 - CUP ACETAB 58MM 22MM CEMENTED ODC ALL POLY HIP BOTH IP/OP $822.00 $608.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $171.31 $822.00 $328.80 $822.00 $822.00 $822.00 $822.00 $822.00 $616.50 $822.00 $822.00 $822.00 $411.00 $411.00 $651.02 $822.00 $657.60 $369.90 $822.00 N/A $476.76 $822.00 $493.20 $822.00 $822.00 $822.00 N/A N/A S100000 SUP Custom 27203010 S100000 - NEEDLE INSFL 14GA 100MM STP TROC BLDLS RADL EXPANDABLE SLV BOTH IP/OP $40.00 $30.00 $7.08 $39.78 $39.78 $39.78 $39.78 $39.78 $39.78 $39.78 $7.08 $39.78 $39.78 $29.52 $29.52 $30.66 $20.73 $8.29 $39.78 $9.17 $39.78 $39.78 $22.93 $39.78 $39.78 $30.00 $39.78 $39.78 $39.78 $19.89 $19.89 $31.51 $39.78 $31.82 $25.86 $39.78 N/A $23.20 $39.78 $23.87 $39.78 $39.78 $39.78 N/A N/A S-101 SUP HCPCS C1763 S-101 - GRAFT SOFT TISSUE SQUARE 48X3IN DRESSING NONPERFORATE BOTH IP/OP $321.00 $238.00 $63.71 $321.00 $144.45 $144.45 $144.45 $144.45 $321.00 $321.00 $321.00 $66.90 $321.00 $321.00 $321.00 $321.00 $321.00 $66.90 $321.00 $321.00 $189.87 $321.00 $321.00 $321.00 $321.00 $240.75 $321.00 $321.00 $321.00 $160.50 $160.50 $254.23 $321.00 $256.80 $144.45 $63.71 N/A $186.18 $321.00 $321.00 $321.00 $66.90 $321.00 N/A N/A S1020GH SUP HCPCS C1884 S1020GH - SPHERE EMBL 120-900UM 2ML 20ML PUR STRL EMBSPH PREFL SAL SYR BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A S1020GH SUP HCPCS C1884 S1020GH - PARTICLES EMBL 900-1200UM MCSPH 1ML PUR EMBSPH PREFL SYR BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A S-104 SUP HCPCS C1763 S-104 - DRESSING WND .25SQ FT PRCN BOTH IP/OP $176.00 $130.00 $34.89 $175.78 $79.10 $79.10 $79.10 $79.10 $175.78 $175.78 $175.78 $36.64 $175.78 $175.78 $175.78 $175.78 $175.78 $36.63 $175.78 $175.78 $103.97 $175.78 $175.78 $175.78 $175.78 $132.00 $175.78 $175.78 $175.78 $87.89 $87.89 $139.22 $175.78 $140.62 $79.10 $34.89 N/A $102.08 $175.78 $175.78 $175.78 $36.63 $175.78 N/A N/A S1-1500U SUP Custom 27803010 S1-1500U - STENT LCRML DCT .64MM 40MM STRL MN MNK DIL PLG INSRTR SIL BOTH IP/OP $146.00 $108.00 $25.96 $145.83 $145.83 $145.83 $145.83 $145.83 $145.83 $145.83 $25.96 $145.83 $145.83 $145.83 $145.83 $145.83 $145.83 $30.39 $145.83 $58.33 $145.83 $145.83 $145.83 $145.83 $145.83 $109.50 $145.83 $145.83 $145.83 $72.92 $72.92 $115.50 $145.83 $116.66 $65.62 $145.83 N/A $84.68 $145.83 $87.50 $145.83 $145.83 $145.83 N/A N/A S-1399-HH22 SUP Custom 27803010 S-1399-HH22 - HEAD FEMORAL 22MM MORSE TAPER INTERLOK HIP ION BOTH IP/OP "$1,147.00" $849.00 $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $239.05 "$1,147.00" $458.80 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $860.25 "$1,147.00" "$1,147.00" "$1,147.00" $573.50 $573.50 $908.42 "$1,147.00" $917.60 $516.15 "$1,147.00" N/A $665.26 "$1,147.00" $688.20 "$1,147.00" "$1,147.00" "$1,147.00" N/A N/A S-1399-HH31 SUP Custom 27803010 S-1399-HH31 - HEAD FEMORAL 31MM MORSE TAPER INTERLOK HIP ION BOTH IP/OP "$1,147.00" $849.00 $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $239.05 "$1,147.00" $458.80 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $860.25 "$1,147.00" "$1,147.00" "$1,147.00" $573.50 $573.50 $908.42 "$1,147.00" $917.60 $516.15 "$1,147.00" N/A $665.26 "$1,147.00" $688.20 "$1,147.00" "$1,147.00" "$1,147.00" N/A N/A S-1399-HH32 SUP Custom 27803010 S-1399-HH32 - HEAD FEMORAL 32MM MORSE TAPER INTERLOK HIP ION BOTH IP/OP "$1,147.00" $849.00 $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $239.05 "$1,147.00" $458.80 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $860.25 "$1,147.00" "$1,147.00" "$1,147.00" $573.50 $573.50 $908.42 "$1,147.00" $917.60 $516.15 "$1,147.00" N/A $665.26 "$1,147.00" $688.20 "$1,147.00" "$1,147.00" "$1,147.00" N/A N/A S-1399-HH34 SUP Custom 27803010 S-1399-HH34 - HEAD FEMORAL 34MM MORSE TAPER INTERLOK HIP ION BOTH IP/OP "$1,147.00" $849.00 $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $239.05 "$1,147.00" $458.80 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $860.25 "$1,147.00" "$1,147.00" "$1,147.00" $573.50 $573.50 $908.42 "$1,147.00" $917.60 $516.15 "$1,147.00" N/A $665.26 "$1,147.00" $688.20 "$1,147.00" "$1,147.00" "$1,147.00" N/A N/A S-1399-HH62 SUP Custom 27803010 S-1399-HH62 - HEAD FEMORAL 62MM MORSE TAPER INTERLOK HIP ION BOTH IP/OP "$1,147.00" $849.00 $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $239.05 "$1,147.00" $458.80 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $860.25 "$1,147.00" "$1,147.00" "$1,147.00" $573.50 $573.50 $908.42 "$1,147.00" $917.60 $516.15 "$1,147.00" N/A $665.26 "$1,147.00" $688.20 "$1,147.00" "$1,147.00" "$1,147.00" N/A N/A S-1399-HH64 SUP Custom 27803010 S-1399-HH64 - HEAD FEMORAL 64MM MORSE TAPER INTERLOK HIP ION BOTH IP/OP "$1,147.00" $849.00 $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $239.05 "$1,147.00" $458.80 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $860.25 "$1,147.00" "$1,147.00" "$1,147.00" $573.50 $573.50 $908.42 "$1,147.00" $917.60 $516.15 "$1,147.00" N/A $665.26 "$1,147.00" $688.20 "$1,147.00" "$1,147.00" "$1,147.00" N/A N/A S-1399-HH82 SUP Custom 27803010 S-1399-HH82 - HEAD FEMORAL 82MM MORSE TAPER INTERLOK HIP ION BOTH IP/OP "$1,147.00" $849.00 $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $239.05 "$1,147.00" $458.80 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $860.25 "$1,147.00" "$1,147.00" "$1,147.00" $573.50 $573.50 $908.42 "$1,147.00" $917.60 $516.15 "$1,147.00" N/A $665.26 "$1,147.00" $688.20 "$1,147.00" "$1,147.00" "$1,147.00" N/A N/A S-1399-HH83 SUP Custom 27803010 S-1399-HH83 - HEAD FEMORAL 83MM MORSE TAPER INTERLOK HIP ION BOTH IP/OP "$1,147.00" $849.00 $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $239.05 "$1,147.00" $458.80 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $860.25 "$1,147.00" "$1,147.00" "$1,147.00" $573.50 $573.50 $908.42 "$1,147.00" $917.60 $516.15 "$1,147.00" N/A $665.26 "$1,147.00" $688.20 "$1,147.00" "$1,147.00" "$1,147.00" N/A N/A S-1399-HH84 SUP Custom 27803010 S-1399-HH84 - HEAD FEMORAL 84MM MORSE TAPER INTERLOK HIP ION BOTH IP/OP "$1,147.00" $849.00 $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $239.05 "$1,147.00" $458.80 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $860.25 "$1,147.00" "$1,147.00" "$1,147.00" $573.50 $573.50 $908.42 "$1,147.00" $917.60 $516.15 "$1,147.00" N/A $665.26 "$1,147.00" $688.20 "$1,147.00" "$1,147.00" "$1,147.00" N/A N/A S-1400-HH22 SUP Custom 27803010 S-1400-HH22 - HEAD FEMORAL +2.5MM C TAPER 22MM LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A S-1400-HH31 SUP Custom 27803010 S-1400-HH31 - HEAD FEM -2.5MM OFST CTPR 32MM STRL LFIT INTMD NK COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A S-1400-HH32 SUP Custom 27803010 S-1400-HH32 - HEAD FEMORAL +2.5MM 32MM C TAPER NECK PRIM LFIT TRIDENT COCR BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A S-1400-HH34 SUP Custom 27803010 S-1400-HH34 - HEAD FEM +7.5MM OFST CTPR 32MM STRL LFIT INTMD NK COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A S-1400-HH62 SUP Custom 27803010 S-1400-HH62 - HEAD FEMORAL +2.5MM 26MM C TAPER INTERLOK LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A S-1400-HH64 SUP Custom 27803010 S-1400-HH64 - HEAD FEMORAL +7.5MM 26MM C TAPER INTERLOK LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A S-1400-HH82 SUP Custom 27803010 S-1400-HH82 - HEAD FEMORAL +2.5MM OFFST C TAPER 28MM LFIT TRIDENT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A S-1400-HH84 SUP Custom 27803010 S-1400-HH84 - HEAD FEMORAL C TAPER INTERLOCK LFIT COCR HIP BOTH IP/OP $862.50 $638.00 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $153.53 $862.50 $862.50 $862.50 $862.50 $862.50 $862.50 $179.75 $862.50 $345.00 $862.50 $862.50 $862.50 $862.50 $862.50 $646.88 $862.50 $862.50 $862.50 $431.25 $431.25 $683.10 $862.50 $690.00 $388.13 $862.50 N/A $500.25 $862.50 $517.50 $862.50 $862.50 $862.50 N/A N/A S-1539-HA46 SUP Custom 27803010 S-1539-HA46 - CUP ACETAB 46MM 26MM ODC ALL POLY HIP BOTH IP/OP $822.00 $608.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $171.31 $822.00 $328.80 $822.00 $822.00 $822.00 $822.00 $822.00 $616.50 $822.00 $822.00 $822.00 $411.00 $411.00 $651.02 $822.00 $657.60 $369.90 $822.00 N/A $476.76 $822.00 $493.20 $822.00 $822.00 $822.00 N/A N/A S-1539-HA50 SUP Custom 27803010 S-1539-HA50 - CUP ACETAB 50MM 26MM ODC ALL POLY HIP BOTH IP/OP $822.00 $608.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $171.31 $822.00 $328.80 $822.00 $822.00 $822.00 $822.00 $822.00 $616.50 $822.00 $822.00 $822.00 $411.00 $411.00 $651.02 $822.00 $657.60 $369.90 $822.00 N/A $476.76 $822.00 $493.20 $822.00 $822.00 $822.00 N/A N/A S-1539-HA54 SUP Custom 27803010 S-1539-HA54 - CUP ACETAB 54MM 26MM ODC ALL POLY HIP BOTH IP/OP $822.00 $608.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $171.31 $822.00 $328.80 $822.00 $822.00 $822.00 $822.00 $822.00 $616.50 $822.00 $822.00 $822.00 $411.00 $411.00 $651.02 $822.00 $657.60 $369.90 $822.00 N/A $476.76 $822.00 $493.20 $822.00 $822.00 $822.00 N/A N/A S-1539-HA58 SUP Custom 27803010 S-1539-HA58 - CUP ACETAB 58MM 26MM ODC ALL POLY HIP BOTH IP/OP $822.00 $608.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $146.32 $822.00 $822.00 $822.00 $822.00 $822.00 $822.00 $171.31 $822.00 $328.80 $822.00 $822.00 $822.00 $822.00 $822.00 $616.50 $822.00 $822.00 $822.00 $411.00 $411.00 $651.02 $822.00 $657.60 $369.90 $822.00 N/A $476.76 $822.00 $493.20 $822.00 $822.00 $822.00 N/A N/A S-1645-HF01 SUP HCPCS C1776 S-1645-HF01 - STEM FEMORAL 1 MODIFY HYDRXAPT HIP BOTH IP/OP "$5,300.00" "$3,922.00" "$1,051.92" "$5,300.00" "$2,385.00" "$2,385.00" "$2,385.00" "$2,385.00" "$5,300.00" "$5,300.00" "$5,300.00" "$1,104.65" "$5,300.00" "$5,300.00" "$5,300.00" "$5,300.00" "$5,300.00" "$1,104.58" "$5,300.00" "$2,120.00" "$2,612.90" "$5,300.00" "$5,300.00" "$5,300.00" "$5,300.00" "$3,975.00" "$5,300.00" "$5,300.00" "$5,300.00" "$2,650.00" "$2,650.00" "$4,197.60" "$5,300.00" "$4,240.00" "$2,385.00" "$1,051.92" N/A "$3,074.00" "$5,300.00" "$5,300.00" "$5,300.00" "$1,104.52" "$5,300.00" N/A N/A S17-45 SUP Custom 27803010 S17-45 - GRAFT ENDOVASCULAR SHEATH ABDOMINAL AORTIC ANEURYSM BOTH IP/OP "$1,247.50" $923.00 $222.06 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $222.06 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $259.99 "$1,247.50" $499.00 "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" "$1,247.50" $935.63 "$1,247.50" "$1,247.50" "$1,247.50" $623.75 $623.75 $988.02 "$1,247.50" $998.00 $561.38 "$1,247.50" N/A $723.55 "$1,247.50" $748.50 "$1,247.50" "$1,247.50" "$1,247.50" N/A N/A S20SFRN8 SUP Custom 27803010 S20SFRN8 - CLIP INTERNAL SHORT FLEXIBLE REGULAR NEEDLE U-CLIP BOTH IP/OP "$6,210.00" "$4,595.00" "$1,105.38" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$1,105.38" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$1,294.23" "$6,210.00" "$2,484.00" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$6,210.00" "$4,657.50" "$6,210.00" "$6,210.00" "$6,210.00" "$3,105.00" "$3,105.00" "$4,918.32" "$6,210.00" "$4,968.00" "$2,794.50" "$6,210.00" N/A "$3,601.80" "$6,210.00" "$3,726.00" "$6,210.00" "$6,210.00" "$6,210.00" N/A N/A S-2301-2646 SUP Custom 27803010 S-2301-2646 - INSERT ACETAB 10D 46-48MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2301-2648 SUP Custom 27803010 S-2301-2648 - INSERT ACETAB 10D 48MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-2650 SUP Custom 27803010 S-2301-2650 - INSERT ACETAB 10D 50-52MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2301-2652 SUP Custom 27803010 S-2301-2652 - INSERT ACETAB 10D 52MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2301-2654 SUP Custom 27803010 S-2301-2654 - INSERT ACETAB 10D 54-56MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2301-2656 SUP Custom 27803010 S-2301-2656 - INSERT ACETAB 10D 56MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2301-2658 SUP Custom 27803010 S-2301-2658 - INSERT ACETAB 10D 58-60MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2301-2662 SUP Custom 27803010 S-2301-2662 - INSERT ACETAB 10D 61-72MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2301-2846 SUP Custom 27803010 S-2301-2846 - INSERT ACETAB 10D 46-48MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-2848 SUP Custom 27803010 S-2301-2848 - INSERT ACETAB 10D 48MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-2850 SUP Custom 27803010 S-2301-2850 - INSERT ACETAB 10D 50MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-2852 SUP Custom 27803010 S-2301-2852 - INSERT ACETAB 10D 52MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-2854 SUP Custom 27803010 S-2301-2854 - INSERT ACETAB 10D 54MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-2856 SUP Custom 27803010 S-2301-2856 - INSERT ACETAB 10D 56MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-2858 SUP Custom 27803010 S-2301-2858 - LINER ACETAB 10D 58MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-2862 SUP Custom 27803010 S-2301-2862 - INSERT ACETAB 10D 61-72MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-2866 SUP Custom 27803010 S-2301-2866 - INSERT ACETAB 10D 66-68MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-2870 SUP Custom 27803010 S-2301-2870 - INSERT ACETAB 10D 70-72MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-2874 SUP Custom 27803010 S-2301-2874 - INSERT ACETAB 10D 74MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-3250 SUP Custom 27803010 S-2301-3250 - INSERT ACETAB 10D 50-52MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-3252 SUP Custom 27803010 S-2301-3252 - INSERT ACETAB 10D 52MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-3254 SUP Custom 27803010 S-2301-3254 - INSERT ACETAB 10D 54-56MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-3256 SUP Custom 27803010 S-2301-3256 - INSERT ACETAB 10D 56MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-3258 SUP Custom 27803010 S-2301-3258 - INSERT ACETAB 10D 58-60MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-3262 SUP Custom 27803010 S-2301-3262 - INSERT ACETAB 10D 61-72MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-3266 SUP Custom 27803010 S-2301-3266 - INSERT ACETAB 10D 66-68MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-3270 SUP Custom 27803010 S-2301-3270 - INSERT ACETAB 10D 70-72MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301-3274 SUP Custom 27803010 S-2301-3274 - INSERT ACETAB 10D 74MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2301C-2846 SUP Custom 27803010 S-2301C-2846 - INSERT ACETAB 10D 46MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-2848 SUP Custom 27803010 S-2301C-2848 - INSERT ACETAB 10D 48MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-2850 SUP Custom 27803010 S-2301C-2850 - INSERT ACETAB 10D 50MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-2852 SUP Custom 27803010 S-2301C-2852 - INSERT ACETAB 10D 52MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-2854 SUP Custom 27803010 S-2301C-2854 - INSERT ACETAB 10D 54MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-2856 SUP Custom 27803010 S-2301C-2856 - INSERT ACETAB 10D 56MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-2858 SUP Custom 27803010 S-2301C-2858 - INSERT ACETAB 10D 58-60MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-2862 SUP Custom 27803010 S-2301C-2862 - INSERT ACETAB 10D 62MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-2866 SUP Custom 27803010 S-2301C-2866 - INSERT ACETAB 10D 66MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-2870 SUP Custom 27803010 S-2301C-2870 - INSERT ACETAB 10D 70MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-2874 SUP Custom 27803010 S-2301C-2874 - INSERT ACETAB 10D 74MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-3250 SUP Custom 27803010 S-2301C-3250 - INSERT ACETAB 10D 50MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-3252 SUP Custom 27803010 S-2301C-3252 - INSERT ACETAB 10D 52MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-3254 SUP Custom 27803010 S-2301C-3254 - INSERT ACETAB 10D 54MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-3256 SUP Custom 27803010 S-2301C-3256 - INSERT ACETAB 10D 56MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-3258 SUP Custom 27803010 S-2301C-3258 - INSERT ACETAB 10D 58-60MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-3262 SUP Custom 27803010 S-2301C-3262 - INSERT ACETAB 10D 62MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-3266 SUP Custom 27803010 S-2301C-3266 - INSERT ACETAB 10D 66MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-3270 SUP Custom 27803010 S-2301C-3270 - INSERT ACETAB 10D 70MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2301C-3274 SUP Custom 27803010 S-2301C-3274 - INSERT ACETAB 74MM 32MM 10D HIP ECNTRC OMFT BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302-2646 SUP Custom 27803010 S-2302-2646 - INSERT ACETAB 20D 46-48MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2302-2648 SUP Custom 27803010 S-2302-2648 - INSERT ACETAB 20D 48MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2302-2650 SUP Custom 27803010 S-2302-2650 - INSERT ACETAB 20D 50-52MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2302-2652 SUP Custom 27803010 S-2302-2652 - INSERT ACETAB 20D 52MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2302-2654 SUP Custom 27803010 S-2302-2654 - INSERT ACETAB 20D 54-56MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2302-2656 SUP Custom 27803010 S-2302-2656 - INSERT ACETAB 20D 56MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2302-2658 SUP Custom 27803010 S-2302-2658 - INSERT ACETAB 20D 58-60MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2302-2662 SUP Custom 27803010 S-2302-2662 - INSERT ACETAB 20D 61-72MM 26MM ECCENTRIC HIP BOTH IP/OP "$2,299.50" "$1,702.00" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $409.29 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" $479.22 "$2,299.38" $919.75 "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$2,299.38" "$1,724.63" "$2,299.38" "$2,299.38" "$2,299.38" "$1,149.69" "$1,149.69" "$1,821.11" "$2,299.38" "$1,839.50" "$1,034.72" "$2,299.38" N/A "$1,333.71" "$2,299.38" "$1,379.63" "$2,299.38" "$2,299.38" "$2,299.38" N/A N/A S-2302-2846 SUP Custom 27803010 S-2302-2846 - INSERT ACETAB 20D 46-48MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-2848 SUP Custom 27803010 S-2302-2848 - INSERT ACETAB 20D 48MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-2850 SUP Custom 27803010 S-2302-2850 - INSERT ACETAB 20D 50-52MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-2852 SUP Custom 27803010 S-2302-2852 - INSERT ACETAB 20D 52MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-2854 SUP Custom 27803010 S-2302-2854 - INSERT ACETAB 20D 54-56MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-2856 SUP Custom 27803010 S-2302-2856 - INSERT ACETAB 20D 56MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-2858 SUP Custom 27803010 S-2302-2858 - INSERT ACETAB 20D 58-60MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-2862 SUP Custom 27803010 S-2302-2862 - INSERT ACETAB 20D 61-72MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-2866 SUP Custom 27803010 S-2302-2866 - INSERT ACETAB 20D 66-68MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-2870 SUP Custom 27803010 S-2302-2870 - INSERT ACETAB 20D 70-72MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-2874 SUP Custom 27803010 S-2302-2874 - INSERT ACETAB 20D 74MM 28MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-3250 SUP Custom 27803010 S-2302-3250 - INSERT ACETAB 20D 50-52MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-3252 SUP Custom 27803010 S-2302-3252 - INSERT ACETAB 20D 52MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-3254 SUP Custom 27803010 S-2302-3254 - INSERT ACETAB 20D 54-56MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-3256 SUP Custom 27803010 S-2302-3256 - INSERT ACETAB 20D 56MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-3258 SUP Custom 27803010 S-2302-3258 - INSERT ACETAB 20D 58-60MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-3262 SUP Custom 27803010 S-2302-3262 - INSERT ACETAB 20D 61-72MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-3266 SUP Custom 27803010 S-2302-3266 - INSERT ACETAB 20D 66-68MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-3270 SUP Custom 27803010 S-2302-3270 - INSERT ACETAB 20D 70-72MM 32MM ECCENTRIC HIP BOTH IP/OP "$2,125.50" "$1,573.00" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $378.34 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" $442.98 "$2,125.50" $850.20 "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$2,125.50" "$1,594.13" "$2,125.50" "$2,125.50" "$2,125.50" "$1,062.75" "$1,062.75" "$1,683.40" "$2,125.50" "$1,700.40" $956.48 "$2,125.50" N/A "$1,232.79" "$2,125.50" "$1,275.30" "$2,125.50" "$2,125.50" "$2,125.50" N/A N/A S-2302-3274 SUP Custom 27803010 S-2302-3274 - INSERT ACETAB 74MM 32MM ECCENTRIC HIP BOTH IP/OP "$1,422.00" "$1,052.00" $253.09 "$1,421.88" "$1,421.88" "$1,421.88" "$1,421.88" "$1,421.88" "$1,421.88" "$1,421.88" $253.09 "$1,421.88" "$1,421.88" "$1,421.88" "$1,421.88" "$1,421.88" "$1,421.88" $296.34 "$1,421.88" $568.75 "$1,421.88" "$1,421.88" "$1,421.88" "$1,421.88" "$1,421.88" "$1,066.50" "$1,421.88" "$1,421.88" "$1,421.88" $710.94 $710.94 "$1,126.13" "$1,421.88" "$1,137.50" $639.85 "$1,421.88" N/A $824.76 "$1,421.88" $853.13 "$1,421.88" "$1,421.88" "$1,421.88" N/A N/A S-2302C-2846 SUP Custom 27803010 S-2302C-2846 - INSERT ACETAB 20D 46MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-2848 SUP Custom 27803010 S-2302C-2848 - INSERT ACETAB 20D 48MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-2850 SUP Custom 27803010 S-2302C-2850 - INSERT ACETAB 20D 50MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-2852 SUP Custom 27803010 S-2302C-2852 - INSERT ACETAB 20D 52MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-2854 SUP Custom 27803010 S-2302C-2854 - INSERT ACETAB 20D 54MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-2856 SUP Custom 27803010 S-2302C-2856 - INSERT ACETAB 20D 56MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-2858 SUP Custom 27803010 S-2302C-2858 - INSERT ACETAB 20D 58MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-2862 SUP Custom 27803010 S-2302C-2862 - INSERT ACETAB 20D 62MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-2866 SUP Custom 27803010 S-2302C-2866 - INSERT ACETAB 20D 66MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-2870 SUP Custom 27803010 S-2302C-2870 - INSERT ACETAB 20D 70MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-2874 SUP Custom 27803010 S-2302C-2874 - INSERT ACETAB 20D 74MM 28MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-3250 SUP Custom 27803010 S-2302C-3250 - INSERT ACETAB 20D 50MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-3252 SUP Custom 27803010 S-2302C-3252 - INSERT ACETAB 20D 52MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-3254 SUP Custom 27803010 S-2302C-3254 - INSERT ACETAB 20D 54MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-3256 SUP Custom 27803010 S-2302C-3256 - INSERT ACETAB 20D 56MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-3258 SUP Custom 27803010 S-2302C-3258 - INSERT ACETAB 20D 58MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-3262 SUP Custom 27803010 S-2302C-3262 - INSERT ACETAB 20D 62MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-3266 SUP Custom 27803010 S-2302C-3266 - INSERT ACETAB 20D 66MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-3270 SUP Custom 27803010 S-2302C-3270 - INSERT ACETAB 20D 70MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2302C-3274 SUP Custom 27803010 S-2302C-3274 - INSERT ACETAB 20D 74MM 32MM ECCENTRIC XFIRE HIP BOTH IP/OP "$3,105.00" "$2,298.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $552.69 "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" $647.12 "$3,105.00" "$1,242.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$3,105.00" "$2,328.75" "$3,105.00" "$3,105.00" "$3,105.00" "$1,552.50" "$1,552.50" "$2,459.16" "$3,105.00" "$2,484.00" "$1,397.25" "$3,105.00" N/A "$1,800.90" "$3,105.00" "$1,863.00" "$3,105.00" "$3,105.00" "$3,105.00" N/A N/A S-2337-HF04 SUP HCPCS C1776 S-2337-HF04 - STEM FEMORAL 4 100MM COLLAR ARC PRESS FIT SECFIT HA TITANIUM BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A S-2337-HF05 SUP HCPCS C1776 S-2337-HF05 - STEM FEMORAL 5 110MM COLLAR ARC PRESS FIT SECFIT HA TITANIUM BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A S-2337-HF06 SUP HCPCS C1776 S-2337-HF06 - STEM FEMORAL 6 COLLARED SECFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A S-2337-HF07 SUP HCPCS C1776 S-2337-HF07 - STEM FEMORAL 7 COLLARED SECFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A S-2337-HF08 SUP HCPCS C1776 S-2337-HF08 - STEM FEMORAL 8 COLLARED SECFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A S-2337-HF09 SUP HCPCS C1776 S-2337-HF09 - STEM FEMORAL COLLARED ARC DEPOSITED SECFIT HYDRXAPT BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A S-2337-HF10 SUP HCPCS C1776 S-2337-HF10 - STEM FEMORAL 10 COLLARED SECFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A S-2337-HF11 SUP HCPCS C1776 S-2337-HF11 - STEM FEMORAL 11 COLLARED SECFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A S-2337-HF12 SUP HCPCS C1776 S-2337-HF12 - STEM FEMORAL 12 COLLAR ARC DEPOSITED SECFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A S-2337-HF13 SUP HCPCS C1776 S-2337-HF13 - STEM FEMORAL 13 COLLARED ARC DEPOSITED SECFIT HYDRXAPT HIP BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$5,180.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$3,108.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A S-2337-HF14 SUP HCPCS C1776 S-2337-HF14 - STEM FEMORAL 14 180MM COLLAR ARC PRESS FIT SECFIT HA BOTH IP/OP "$5,180.00" "$3,833.00" "$1,028.10" "$5,180.00" "$2,331.00" "$2,331.00" "$2,331.00" "$2,331.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.64" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.57" "$5,180.00" "$2,072.00" "$2,553.74" "$5,180.00" "$5,180.00" "$5,180.00" "$5,180.00" "$3,885.00" "$5,180.00" "$5,180.00" "$5,180.00" "$2,590.00" "$2,590.00" "$4,102.56" "$5,180.00" "$4,144.00" "$2,331.00" "$1,028.10" N/A "$3,004.40" "$5,180.00" "$5,180.00" "$5,180.00" "$1,079.51" "$5,180.00" N/A N/A S-2651-0711 SUP HCPCS C1776 S-2651-0711 - NECK FEMORAL 7 -5MM STR 11MM 155MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$11,937.50" "$8,834.00" "$2,369.30" "$11,937.50" "$5,371.88" "$5,371.88" "$5,371.88" "$5,371.88" "$11,937.50" "$11,937.50" "$11,937.50" "$2,488.07" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.91" "$11,937.50" "$11,937.50" "$5,885.19" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$8,953.13" "$11,937.50" "$11,937.50" "$11,937.50" "$5,968.75" "$5,968.75" "$9,454.50" "$11,937.50" "$9,550.00" "$5,371.88" "$2,369.30" N/A "$6,923.75" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.78" "$11,937.50" N/A N/A S-2651-0713 SUP HCPCS C1776 S-2651-0713 - NECK FEMORAL 7 -5MM STR 13MM 155MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$11,937.50" "$8,834.00" "$2,369.30" "$11,937.50" "$5,371.88" "$5,371.88" "$5,371.88" "$5,371.88" "$11,937.50" "$11,937.50" "$11,937.50" "$2,488.07" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.91" "$11,937.50" "$11,937.50" "$5,885.19" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$8,953.13" "$11,937.50" "$11,937.50" "$11,937.50" "$5,968.75" "$5,968.75" "$9,454.50" "$11,937.50" "$9,550.00" "$5,371.88" "$2,369.30" N/A "$6,923.75" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.78" "$11,937.50" N/A N/A S-2651-0812 SUP HCPCS C1776 S-2651-0812 - NECK FEMORAL 8 -5MM STR 12MM 155MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$11,937.50" "$8,834.00" "$2,369.30" "$11,937.50" "$5,371.88" "$5,371.88" "$5,371.88" "$5,371.88" "$11,937.50" "$11,937.50" "$11,937.50" "$2,488.07" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.91" "$11,937.50" "$4,775.00" "$5,885.19" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$8,953.13" "$11,937.50" "$11,937.50" "$11,937.50" "$5,968.75" "$5,968.75" "$9,454.50" "$11,937.50" "$9,550.00" "$5,371.88" "$2,369.30" N/A "$6,923.75" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.78" "$11,937.50" N/A N/A S-2651-0814 SUP HCPCS C1776 S-2651-0814 - NECK FEMORAL 8 -5MM STR 14MM 155MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$11,937.50" "$8,834.00" "$2,369.30" "$11,937.50" "$5,371.88" "$5,371.88" "$5,371.88" "$5,371.88" "$11,937.50" "$11,937.50" "$11,937.50" "$2,488.07" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.91" "$11,937.50" "$4,775.00" "$5,885.19" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$8,953.13" "$11,937.50" "$11,937.50" "$11,937.50" "$5,968.75" "$5,968.75" "$9,454.50" "$11,937.50" "$9,550.00" "$5,371.88" "$2,369.30" N/A "$6,923.75" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.78" "$11,937.50" N/A N/A S-2651-0913 SUP HCPCS C1776 S-2651-0913 - NECK FEMORAL 9 -5MM STR 13MM 155MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$11,937.50" "$8,834.00" "$2,369.30" "$11,937.50" "$5,371.88" "$5,371.88" "$5,371.88" "$5,371.88" "$11,937.50" "$11,937.50" "$11,937.50" "$2,488.07" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.91" "$11,937.50" "$4,775.00" "$5,885.19" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$8,953.13" "$11,937.50" "$11,937.50" "$11,937.50" "$5,968.75" "$5,968.75" "$9,454.50" "$11,937.50" "$9,550.00" "$5,371.88" "$2,369.30" N/A "$6,923.75" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.78" "$11,937.50" N/A N/A S-2651-0915 SUP HCPCS C1776 S-2651-0915 - STEM FEMORAL 9 -5MM STR 15MM 155MM REDUCE NECK RSTOR HA BOTH IP/OP "$11,937.50" "$8,834.00" "$2,369.30" "$11,937.50" "$5,371.88" "$5,371.88" "$5,371.88" "$5,371.88" "$11,937.50" "$11,937.50" "$11,937.50" "$2,488.07" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.91" "$11,937.50" "$11,937.50" "$5,885.19" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$8,953.13" "$11,937.50" "$11,937.50" "$11,937.50" "$5,968.75" "$5,968.75" "$9,454.50" "$11,937.50" "$9,550.00" "$5,371.88" "$2,369.30" N/A "$6,923.75" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.78" "$11,937.50" N/A N/A S-2651-1014 SUP HCPCS C1776 S-2651-1014 - NECK FEMORAL 10 -5MM STR 14MM 155MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$11,937.50" "$8,834.00" "$2,369.30" "$11,937.50" "$5,371.88" "$5,371.88" "$5,371.88" "$5,371.88" "$11,937.50" "$11,937.50" "$11,937.50" "$2,488.07" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.91" "$11,937.50" "$4,775.00" "$5,885.19" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$8,953.13" "$11,937.50" "$11,937.50" "$11,937.50" "$5,968.75" "$5,968.75" "$9,454.50" "$11,937.50" "$9,550.00" "$5,371.88" "$2,369.30" N/A "$6,923.75" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.78" "$11,937.50" N/A N/A S-2651-1016 SUP HCPCS C1776 S-2651-1016 - NECK FEMORAL 10 -5MM STR 16MM 155MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$11,937.50" "$8,834.00" "$2,369.30" "$11,937.50" "$5,371.88" "$5,371.88" "$5,371.88" "$5,371.88" "$11,937.50" "$11,937.50" "$11,937.50" "$2,488.07" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.91" "$11,937.50" "$4,775.00" "$5,885.19" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$8,953.13" "$11,937.50" "$11,937.50" "$11,937.50" "$5,968.75" "$5,968.75" "$9,454.50" "$11,937.50" "$9,550.00" "$5,371.88" "$2,369.30" N/A "$6,923.75" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.78" "$11,937.50" N/A N/A S-2651-1115 SUP HCPCS C1776 S-2651-1115 - NECK FEMORAL 11 -5MM STR 15MM 155MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$11,937.50" "$8,834.00" "$2,369.30" "$11,937.50" "$5,371.88" "$5,371.88" "$5,371.88" "$5,371.88" "$11,937.50" "$11,937.50" "$11,937.50" "$2,488.07" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.91" "$11,937.50" "$4,775.00" "$5,885.19" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$8,953.13" "$11,937.50" "$11,937.50" "$11,937.50" "$5,968.75" "$5,968.75" "$9,454.50" "$11,937.50" "$9,550.00" "$5,371.88" "$2,369.30" N/A "$6,923.75" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.78" "$11,937.50" N/A N/A S-2651-1117 SUP HCPCS C1776 S-2651-1117 - NECK FEMORAL 11 -5MM STR 17MM 155MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$11,937.50" "$8,834.00" "$2,369.30" "$11,937.50" "$5,371.88" "$5,371.88" "$5,371.88" "$5,371.88" "$11,937.50" "$11,937.50" "$11,937.50" "$2,488.07" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.91" "$11,937.50" "$11,937.50" "$5,885.19" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$8,953.13" "$11,937.50" "$11,937.50" "$11,937.50" "$5,968.75" "$5,968.75" "$9,454.50" "$11,937.50" "$9,550.00" "$5,371.88" "$2,369.30" N/A "$6,923.75" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.78" "$11,937.50" N/A N/A S-2651-1216 SUP HCPCS C1776 S-2651-1216 - NECK FEMORAL 12 -5MM STR 16MM 155MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$11,937.50" "$8,834.00" "$2,369.30" "$11,937.50" "$5,371.88" "$5,371.88" "$5,371.88" "$5,371.88" "$11,937.50" "$11,937.50" "$11,937.50" "$2,488.07" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.91" "$11,937.50" "$11,937.50" "$5,885.19" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$8,953.13" "$11,937.50" "$11,937.50" "$11,937.50" "$5,968.75" "$5,968.75" "$9,454.50" "$11,937.50" "$9,550.00" "$5,371.88" "$2,369.30" N/A "$6,923.75" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.78" "$11,937.50" N/A N/A S-2651-1218 SUP HCPCS C1776 S-2651-1218 - NECK FEMORAL 12 -5MM STR 18MM 155MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$11,937.50" "$8,834.00" "$2,369.30" "$11,937.50" "$5,371.88" "$5,371.88" "$5,371.88" "$5,371.88" "$11,937.50" "$11,937.50" "$11,937.50" "$2,488.07" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.91" "$11,937.50" "$11,937.50" "$5,885.19" "$11,937.50" "$11,937.50" "$11,937.50" "$11,937.50" "$8,953.13" "$11,937.50" "$11,937.50" "$11,937.50" "$5,968.75" "$5,968.75" "$9,454.50" "$11,937.50" "$9,550.00" "$5,371.88" "$2,369.30" N/A "$6,923.75" "$11,937.50" "$11,937.50" "$11,937.50" "$2,487.78" "$11,937.50" N/A N/A S-2652-0812 SUP HCPCS C1776 S-2652-0812 - NECK FEMORAL 8 -5MM STR 12MM 205MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$5,058.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2652-0814 SUP HCPCS C1776 S-2652-0814 - NECK FEMORAL 8 -5MM STR 14MM 205MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$5,058.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2652-0913 SUP HCPCS C1776 S-2652-0913 - NECK FEMORAL 9 -5MM STR 13MM 205MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$5,058.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2652-0915 SUP HCPCS C1776 S-2652-0915 - NECK FEMORAL 9 -5MM STR 15MM 205MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$12,645.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2652-1014 SUP HCPCS C1776 S-2652-1014 - NECK FEMORAL 10 -5MM STR 14MM 205MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$5,058.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2652-1016 SUP HCPCS C1776 S-2652-1016 - NECK FEMORAL 10 -5MM STR 16MM 205MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$5,058.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2652-1115 SUP HCPCS C1776 S-2652-1115 - NECK FEMORAL 11 -5MM STR 15MM 205MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$12,645.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2652-1117 SUP HCPCS C1776 S-2652-1117 - STEM FEMORAL 11 -5MM STR 17MM 205MM REDUCE NECK RSTOR HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$5,058.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2652-1216 SUP HCPCS C1776 S-2652-1216 - NECK FEMORAL 12 -5MM STR 16MM 205MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$5,058.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2652-1218 SUP HCPCS C1776 S-2652-1218 - STEM FEMORAL 12 -5MM STR 18MM 205MM REDUCE NECK RSTOR HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$12,645.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2652-1317 SUP HCPCS C1776 S-2652-1317 - NECK FEMORAL 17 -5MM STR 13MM 205MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$12,645.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2652-1319 SUP HCPCS C1776 S-2652-1319 - NECK FEMORAL 13 -5MM STR 19MM 205MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$12,645.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$7,587.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2652-1418 SUP HCPCS C1776 S-2652-1418 - NECK FEMORAL 14 -5MM STR 18MM 205MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$5,058.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2652-1420 SUP HCPCS C1776 S-2652-1420 - NECK FEMORAL 14 -5MM STR 20MM 205MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$5,058.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2652-1422 SUP HCPCS C1776 S-2652-1422 - NECK FEMORAL 14 -5MM STR 22MM 205MM REDUCE RSTOR TITANIUM HA BOTH IP/OP "$12,645.00" "$9,357.00" "$2,509.72" "$12,645.00" "$5,690.25" "$5,690.25" "$5,690.25" "$5,690.25" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.53" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.36" "$12,645.00" "$5,058.00" "$6,233.99" "$12,645.00" "$12,645.00" "$12,645.00" "$12,645.00" "$9,483.75" "$12,645.00" "$12,645.00" "$12,645.00" "$6,322.50" "$6,322.50" "$10,014.84" "$12,645.00" "$10,116.00" "$5,690.25" "$2,509.72" N/A "$7,334.10" "$12,645.00" "$12,645.00" "$12,645.00" "$2,635.22" "$12,645.00" N/A N/A S-2653-0812-L SUP HCPCS C1776 S-2653-0812-L - STEM FEMORAL -5MM 12-8MM 255MM STR DISTAL SLOT RED NECK BOTH IP/OP "$13,223.00" "$9,785.00" "$2,624.36" "$13,222.63" "$5,950.18" "$5,950.18" "$5,950.18" "$5,950.18" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.93" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.74" "$13,222.63" "$13,222.63" "$6,518.76" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$9,917.25" "$13,222.63" "$13,222.63" "$13,222.63" "$6,611.32" "$6,611.32" "$10,472.32" "$13,222.63" "$10,578.10" "$5,950.18" "$2,624.36" N/A "$7,669.34" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.60" "$13,222.63" N/A N/A S-2653-0812-R SUP HCPCS C1776 S-2653-0812-R - STEM FEMORAL -5MM 12-8MM 255MM STR DISTAL SLOT RED NECK BOTH IP/OP "$13,223.00" "$9,785.00" "$2,624.36" "$13,222.63" "$5,950.18" "$5,950.18" "$5,950.18" "$5,950.18" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.93" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.74" "$13,222.63" "$13,222.63" "$6,518.76" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$9,917.25" "$13,222.63" "$13,222.63" "$13,222.63" "$6,611.32" "$6,611.32" "$10,472.32" "$13,222.63" "$10,578.10" "$5,950.18" "$2,624.36" N/A "$7,669.34" "$13,222.63" "$7,933.58" "$13,222.63" "$2,755.60" "$13,222.63" N/A N/A S-2653-0913-L SUP HCPCS C1776 S-2653-0913-L - STEM FEMORAL -5MM 13-9MM 255MM STR DISTAL SLOT RED NECK BOTH IP/OP "$13,223.00" "$9,785.00" "$2,624.36" "$13,222.63" "$5,950.18" "$5,950.18" "$5,950.18" "$5,950.18" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.93" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.74" "$13,222.63" "$13,222.63" "$6,518.76" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$9,917.25" "$13,222.63" "$13,222.63" "$13,222.63" "$6,611.32" "$6,611.32" "$10,472.32" "$13,222.63" "$10,578.10" "$5,950.18" "$2,624.36" N/A "$7,669.34" "$13,222.63" "$7,933.58" "$13,222.63" "$2,755.60" "$13,222.63" N/A N/A S-2653-0913-R SUP HCPCS C1776 S-2653-0913-R - STEM FEMORAL -5MM 13-9MM 255MM STR DISTAL SLOT RED NECK BOTH IP/OP "$13,223.00" "$9,785.00" "$2,624.36" "$13,222.63" "$5,950.18" "$5,950.18" "$5,950.18" "$5,950.18" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.93" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.74" "$13,222.63" "$13,222.63" "$6,518.76" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$9,917.25" "$13,222.63" "$13,222.63" "$13,222.63" "$6,611.32" "$6,611.32" "$10,472.32" "$13,222.63" "$10,578.10" "$5,950.18" "$2,624.36" N/A "$7,669.34" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.60" "$13,222.63" N/A N/A S-2653-1014-L SUP HCPCS C1776 S-2653-1014-L - STEM FEMORAL -5MM 14-10MM 255MM STR DISTAL SLOT RED NECK BOTH IP/OP "$13,223.00" "$9,785.00" "$2,624.36" "$13,222.63" "$5,950.18" "$5,950.18" "$5,950.18" "$5,950.18" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.93" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.74" "$13,222.63" "$13,222.63" "$6,518.76" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$9,917.25" "$13,222.63" "$13,222.63" "$13,222.63" "$6,611.32" "$6,611.32" "$10,472.32" "$13,222.63" "$10,578.10" "$5,950.18" "$2,624.36" N/A "$7,669.34" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.60" "$13,222.63" N/A N/A S-2653-1014-R SUP HCPCS C1776 S-2653-1014-R - STEM FEMORAL -5MM 14-10MM 255MM STR DISTAL SLOT RED NECK BOTH IP/OP "$13,223.00" "$9,785.00" "$2,624.36" "$13,222.63" "$5,950.18" "$5,950.18" "$5,950.18" "$5,950.18" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.93" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.74" "$13,222.63" "$13,222.63" "$6,518.76" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$9,917.25" "$13,222.63" "$13,222.63" "$13,222.63" "$6,611.32" "$6,611.32" "$10,472.32" "$13,222.63" "$10,578.10" "$5,950.18" "$2,624.36" N/A "$7,669.34" "$13,222.63" "$7,933.58" "$13,222.63" "$2,755.60" "$13,222.63" N/A N/A S-2653-1115-L SUP HCPCS C1776 S-2653-1115-L - STEM FEMORAL -5MM 15-11MM 255MM STR DISTAL SLOT RED NECK BOTH IP/OP "$13,223.00" "$9,785.00" "$2,624.36" "$13,222.63" "$5,950.18" "$5,950.18" "$5,950.18" "$5,950.18" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.93" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.74" "$13,222.63" "$13,222.63" "$6,518.76" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$9,917.25" "$13,222.63" "$13,222.63" "$13,222.63" "$6,611.32" "$6,611.32" "$10,472.32" "$13,222.63" "$10,578.10" "$5,950.18" "$2,624.36" N/A "$7,669.34" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.60" "$13,222.63" N/A N/A S-2653-1115-R SUP HCPCS C1776 S-2653-1115-R - STEM FEMORAL -5MM 15-11MM 255MM STR DISTAL SLOT RED NECK BOTH IP/OP "$13,223.00" "$9,785.00" "$2,624.36" "$13,222.63" "$5,950.18" "$5,950.18" "$5,950.18" "$5,950.18" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.93" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.74" "$13,222.63" "$5,289.05" "$6,518.76" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$9,917.25" "$13,222.63" "$13,222.63" "$13,222.63" "$6,611.32" "$6,611.32" "$10,472.32" "$13,222.63" "$10,578.10" "$5,950.18" "$2,624.36" N/A "$7,669.34" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.60" "$13,222.63" N/A N/A S-2653-1216-L SUP HCPCS C1776 S-2653-1216-L - STEM FEMORAL -5MM 16-12MM 255MM STR DISTAL SLOT RED NECK BOTH IP/OP "$13,223.00" "$9,785.00" "$2,624.36" "$13,222.63" "$5,950.18" "$5,950.18" "$5,950.18" "$5,950.18" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.93" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.74" "$13,222.63" "$13,222.63" "$6,518.76" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$9,917.25" "$13,222.63" "$13,222.63" "$13,222.63" "$6,611.32" "$6,611.32" "$10,472.32" "$13,222.63" "$10,578.10" "$5,950.18" "$2,624.36" N/A "$7,669.34" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.60" "$13,222.63" N/A N/A S-2653-1216-R SUP HCPCS C1776 S-2653-1216-R - STEM FEMORAL -5MM 16-12MM 255MM STR DISTAL SLOT RED NECK BOTH IP/OP "$13,223.00" "$9,785.00" "$2,624.36" "$13,222.63" "$5,950.18" "$5,950.18" "$5,950.18" "$5,950.18" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.93" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.74" "$13,222.63" "$5,289.05" "$6,518.76" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$9,917.25" "$13,222.63" "$13,222.63" "$13,222.63" "$6,611.32" "$6,611.32" "$10,472.32" "$13,222.63" "$10,578.10" "$5,950.18" "$2,624.36" N/A "$7,669.34" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.60" "$13,222.63" N/A N/A S-2653-1317-L SUP HCPCS C1776 S-2653-1317-L - STEM FEMORAL -5MM 17-13MM 255MM STR DISTAL SLOT RED NECK BOTH IP/OP "$13,223.00" "$9,785.00" "$2,624.36" "$13,222.63" "$5,950.18" "$5,950.18" "$5,950.18" "$5,950.18" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.93" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.74" "$13,222.63" "$5,289.05" "$6,518.76" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$9,917.25" "$13,222.63" "$13,222.63" "$13,222.63" "$6,611.32" "$6,611.32" "$10,472.32" "$13,222.63" "$10,578.10" "$5,950.18" "$2,624.36" N/A "$7,669.34" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.60" "$13,222.63" N/A N/A S-2653-1317-R SUP HCPCS C1776 S-2653-1317-R - STEM FEMORAL -5MM 17-13MM 255MM STR DISTAL SLOT RED NECK BOTH IP/OP "$13,223.00" "$9,785.00" "$2,624.36" "$13,222.63" "$5,950.18" "$5,950.18" "$5,950.18" "$5,950.18" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.93" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.74" "$13,222.63" "$5,289.05" "$6,518.76" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$9,917.25" "$13,222.63" "$13,222.63" "$13,222.63" "$6,611.32" "$6,611.32" "$10,472.32" "$13,222.63" "$10,578.10" "$5,950.18" "$2,624.36" N/A "$7,669.34" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.60" "$13,222.63" N/A N/A S-2653-1418-L SUP HCPCS C1776 S-2653-1418-L - STEM FEMORAL -5MM 18-14MM 255MM STR DISTAL SLOT RED NECK BOTH IP/OP "$13,223.00" "$9,785.00" "$2,624.36" "$13,222.63" "$5,950.18" "$5,950.18" "$5,950.18" "$5,950.18" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.93" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.74" "$13,222.63" "$5,289.05" "$6,518.76" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$9,917.25" "$13,222.63" "$13,222.63" "$13,222.63" "$6,611.32" "$6,611.32" "$10,472.32" "$13,222.63" "$10,578.10" "$5,950.18" "$2,624.36" N/A "$7,669.34" "$13,222.63" "$7,933.58" "$13,222.63" "$2,755.60" "$13,222.63" N/A N/A S-2653-1418-R SUP HCPCS C1776 S-2653-1418-R - STEM FEMORAL -5MM 18-14MM 255MM STR DISTAL SLOT RED NECK BOTH IP/OP "$13,223.00" "$9,785.00" "$2,624.36" "$13,222.63" "$5,950.18" "$5,950.18" "$5,950.18" "$5,950.18" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.93" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$2,755.74" "$13,222.63" "$5,289.05" "$6,518.76" "$13,222.63" "$13,222.63" "$13,222.63" "$13,222.63" "$9,917.25" "$13,222.63" "$13,222.63" "$13,222.63" "$6,611.32" "$6,611.32" "$10,472.32" "$13,222.63" "$10,578.10" "$5,950.18" "$2,624.36" N/A "$7,669.34" "$13,222.63" "$7,933.58" "$13,222.63" "$2,755.60" "$13,222.63" N/A N/A S-2722-2210 SUP Custom 27803010 S-2722-2210 - HEAD FEMORAL MORSE TAPER LFIT COCR HIP BOTH IP/OP "$1,147.00" $849.00 $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $204.17 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $239.05 "$1,147.00" $458.80 "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" "$1,147.00" $860.25 "$1,147.00" "$1,147.00" "$1,147.00" $573.50 $573.50 $908.42 "$1,147.00" $917.60 $516.15 "$1,147.00" N/A $665.26 "$1,147.00" $688.20 "$1,147.00" "$1,147.00" "$1,147.00" N/A N/A S3417 SUP Custom 27203010 LABEL SLD RL RBN CLEAN PEN KT SEYMOUR BOTH IP/OP "$1,058.50" $783.00 $188.41 "$1,058.50" "$1,058.50" "$1,058.50" "$1,058.50" "$1,058.50" "$1,058.50" "$1,058.50" $188.41 "$1,058.50" "$1,058.50" $785.62 $785.62 $815.89 $551.48 $220.60 "$1,058.50" $423.40 "$1,058.50" "$1,058.50" "$1,058.50" "$1,058.50" "$1,058.50" $793.88 "$1,058.50" "$1,058.50" "$1,058.50" $529.25 $529.25 $838.33 "$1,058.50" $846.80 $688.03 "$1,058.50" N/A $613.93 "$1,058.50" $635.10 "$1,058.50" "$1,058.50" "$1,058.50" N/A N/A S4050 SUP Custom 27203010 S4050 - STRIP RTNL 125X5X1MM STRL SIL 9229 BOTH IP/OP $210.00 $155.00 $37.38 $210.00 $210.00 $210.00 $210.00 $210.00 $210.00 $210.00 $37.38 $210.00 $210.00 $155.86 $155.86 $161.87 $109.41 $43.77 $210.00 $84.00 $210.00 $210.00 $210.00 $210.00 $210.00 $157.50 $210.00 $210.00 $210.00 $105.00 $105.00 $166.32 $210.00 $168.00 $136.50 $210.00 N/A $121.80 $210.00 $126.00 $210.00 $210.00 $210.00 N/A N/A S420GH SUP HCPCS C1884 S420GH - PARTICLES EMBOLIZATION 300-500UM MICROSPHERE .038IN PREFILL BOTH IP/OP $607.50 $450.00 $120.57 $607.50 $273.38 $273.38 $273.38 $273.38 $607.50 $607.50 $607.50 $126.62 $607.50 $607.50 $607.50 $607.50 $607.50 $126.61 $607.50 $607.50 $359.34 $607.50 $607.50 $607.50 $607.50 $455.63 $607.50 $607.50 $607.50 $303.75 $303.75 $481.14 $607.50 $486.00 $273.38 $120.57 N/A $352.35 $607.50 $607.50 $607.50 $126.60 $607.50 N/A N/A S4IVL2540 SUP HCPCS C1725 S4IVL2540 - CATHETER BLNDIL 10 ATM 6 ATM .014IN 2.5-.052MM 135CM STRL LF BOTH IP/OP "$6,875.00" "$5,088.00" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" N/A "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A S4IVL3040 SUP HCPCS C1725 S4IVL3040 - CATHETER BLNDIL 10 ATM 6 ATM .014IN 3-.052MM 40MM STRL LF BOTH IP/OP "$6,875.00" "$5,088.00" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" N/A "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A S4IVL3540 SUP HCPCS C1725 S4IVL3540 - CATHETER BLNDIL 10 ATM 6 ATM .014IN 3.5-.052MM 135CM STRL LF BOTH IP/OP "$6,875.00" "$5,088.00" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" N/A "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A S4IVL4040 SUP HCPCS C1725 S4IVL4040 - CATHETER BLNDIL 10 ATM 6 ATM .014IN 4-.052MM 40MM STRL LF BOTH IP/OP "$6,875.00" "$5,088.00" "$1,364.52" "$6,875.00" "$3,733.13" "$3,733.13" "$3,733.13" "$3,733.13" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.92" "$6,875.00" "$4,181.12" "$4,181.12" "$5,299.25" "$2,060.15" "$1,432.83" "$6,875.00" "$6,875.00" "$3,094.73" "$6,875.00" "$6,875.00" "$6,875.00" "$6,875.00" "$5,156.25" "$6,875.00" "$6,875.00" "$6,875.00" "$3,437.50" "$3,437.50" "$5,445.00" "$6,875.00" "$5,500.00" "$4,468.75" "$1,364.52" N/A "$3,987.50" "$6,875.00" "$6,875.00" "$6,875.00" "$1,432.75" "$6,875.00" N/A N/A S-50-060-120-P6 SUP HCPCS C1876 S-50-060-120-P6 - STENT VASC 5MM 6FR 60MM 120CM PERI SUPERA BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A S-50-080-120-P6 SUP HCPCS C1876 S-50-080-120-P6 - STENT VASC 5MM 6FR 80MM 120CM PERI SUPERA BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A S-50-100-120-P6 SUP HCPCS C1876 S-50-100-120-P6 - STENT VASC 5MM 6FR 100MM 120CM PERI SUPERA BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A S-50-120-120-P6 SUP HCPCS C1876 S-50-120-120-P6 - STENT VASC 5MM 6FR 120MM 120CM PERI SUPERA BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A S-55-060-120-P6 SUP HCPCS C1876 S-55-060-120-P6 - STENT VASC 5.5MM 6FR 60MM 120CM OTW SLF EXPANDABLE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A S-55-080-120-P6 SUP HCPCS C1876 S-55-080-120-P6 - STENT BIL 5.5MM 6FR 80MM 120CM MIMETIC DSGN FLXB BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A S-55-120-120-P6 SUP HCPCS C1876 S-55-120-120-P6 - STENT BIL 5.5MM 6FR 120MM 120CM MIMETIC DSGN FLXB BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A S-55-150-120-P6 SUP HCPCS C1876 S-55-150-120-P6 - STENT VASCULAR 5.5MM 6FR 150MM 120CM OTW SELF EXPANDABLE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A S-60-120-120-P6 SUP HCPCS C1876 S-60-120-120-P6 - STENT VASC 6MM 6FR 120MM 120CM PERI SUPERA BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A S620GH/C SUP HCPCS C1884 S620GH/C - PARTICLES EMBL 500-700UM RND 2ML 20ML RD STRL EMBSPH SAL SYR BOTH IP/OP $515.00 $381.00 $102.21 $515.00 $231.75 $231.75 $231.75 $231.75 $515.00 $515.00 $515.00 $107.34 $515.00 $515.00 $515.00 $515.00 $515.00 $107.33 $515.00 $515.00 $304.62 $515.00 $515.00 $515.00 $515.00 $386.25 $515.00 $515.00 $515.00 $257.50 $257.50 $407.88 $515.00 $412.00 $231.75 $102.21 N/A $298.70 $515.00 $515.00 $515.00 $107.33 $515.00 N/A N/A S-65-080-120-P6 SUP HCPCS C1876 S-65-080-120-P6 - STENT VASCULAR 6.5MM 6FR 80MM 120CM OTW SELF EXPANDABLE BOTH IP/OP "$2,062.50" "$1,526.00" $409.35 "$2,062.50" $928.13 $928.13 $928.13 $928.13 "$2,062.50" "$2,062.50" "$2,062.50" $429.88 "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" $429.85 "$2,062.50" "$2,062.50" "$1,219.97" "$2,062.50" "$2,062.50" "$2,062.50" "$2,062.50" "$1,546.88" "$2,062.50" "$2,062.50" "$2,062.50" "$1,031.25" "$1,031.25" "$1,633.50" "$2,062.50" "$1,650.00" $928.13 $409.35 N/A "$1,196.25" "$2,062.50" "$2,062.50" "$2,062.50" $429.83 "$2,062.50" N/A N/A S820GH SUP HCPCS C1884 S820GH - PARTICLES EMBL 700-900UM MCSPH 2ML GRN EMBSPH PREFL SYR BOTH IP/OP $515.00 $381.00 $102.21 $607.50 $231.75 $231.75 $231.75 $231.75 $515.00 $515.00 $515.00 $107.34 $515.00 $515.00 $515.00 $515.00 $515.00 $107.33 $515.00 $607.50 $304.62 $515.00 $607.50 $515.00 $515.00 $386.25 $515.00 $515.00 $515.00 $257.50 $257.50 $407.88 $515.00 $412.00 $231.75 $102.21 N/A $298.70 $515.00 $515.00 $515.00 $107.33 $515.00 N/A N/A SA30AT.100 SUP HCPCS V2632 SA30AT.100 - LENS IOL 0 D +10 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.105 SUP HCPCS V2632 SA30AT.105 - LENS IOL 0 D +10.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.110 SUP HCPCS V2632 SA30AT.110 - LENS IOL 0 D +11 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.115 SUP HCPCS V2632 SA30AT.115 - LENS IOL 0 D +11.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.120 SUP HCPCS V2632 SA30AT.120 - LENS IOL 0 D +12 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.125 SUP HCPCS V2632 SA30AT.125 - LENS IOL 0 D +12.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.130 SUP HCPCS V2632 SA30AT.130 - LENS IOL 0 D +13 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.135 SUP HCPCS V2632 SA30AT.135 - LENS IOL 0 D +13.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.140 SUP HCPCS V2632 SA30AT.140 - LENS IOL 0 D +14 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.145 SUP HCPCS V2632 SA30AT.145 - LENS IOL 0 D +14.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.150 SUP HCPCS V2632 SA30AT.150 - LENS IOL 0 D +15 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.155 SUP HCPCS V2632 SA30AT.155 - LENS IOL 0 D +15.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.160 SUP HCPCS V2632 SA30AT.160 - LENS IOL 0 D +16 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.165 SUP HCPCS V2632 SA30AT.165 - LENS IOL 0 D +16.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.170 SUP HCPCS V2632 SA30AT.170 - LENS IOL 0 D +17 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.175 SUP HCPCS V2632 SA30AT.175 - LENS IOL 0 D +17.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.180 SUP HCPCS V2632 SA30AT.180 - LENS IOL 0 D +18 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.185 SUP HCPCS V2632 SA30AT.185 - LENS IOL 0 D +18.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.190 SUP HCPCS V2632 SA30AT.190 - LENS IOL 0 D +19 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.195 SUP HCPCS V2632 SA30AT.195 - LENS IOL 0 D +19.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.200 SUP HCPCS V2632 SA30AT.200 - LENS IOL 0 D +20 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.205 SUP HCPCS V2632 SA30AT.205 - LENS IOL 0 D +20.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.210 SUP HCPCS V2632 SA30AT.210 - LENS IOL 0 D +21 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.215 SUP HCPCS V2632 SA30AT.215 - LENS IOL 0 D +21.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.220 SUP HCPCS V2632 SA30AT.220 - LENS IOL 0 D +22 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.225 SUP HCPCS V2632 SA30AT.225 - LENS IOL 0 D +22.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.230 SUP HCPCS V2632 SA30AT.230 - LENS IOL 0 D +23 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.235 SUP HCPCS V2632 SA30AT.235 - LENS IOL 0 D +23.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.240 SUP HCPCS V2632 SA30AT.240 - LENS IOL 0 D +24 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.245 SUP HCPCS V2632 SA30AT.245 - LENS IOL 0 D +24.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.250 SUP HCPCS V2632 SA30AT.250 - LENS IOL 0 D +25 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.255 SUP HCPCS V2632 SA30AT.255 - LENS IOL 0 D +25.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.260 SUP HCPCS V2632 SA30AT.260 - LENS IOL 0 D +26 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.265 SUP HCPCS V2632 SA30AT.265 - LENS IOL 0 D +26.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.270 SUP HCPCS V2632 SA30AT.270 - LENS IOL 0 D +27 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.275 SUP HCPCS V2632 SA30AT.275 - LENS IOL 0 D +27.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.280 SUP HCPCS V2632 SA30AT.280 - LENS IOL 0 D +28 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.285 SUP HCPCS V2632 SA30AT.285 - LENS IOL 0 D +28.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.290 SUP HCPCS V2632 SA30AT.290 - LENS IOL 0 D +29 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.295 SUP HCPCS V2632 SA30AT.295 - LENS IOL 0 D +29.5 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA30AT.300 SUP HCPCS V2632 SA30AT.300 - LENS IOL 0 D +30 DIOP BCNVX 5.5MM 13MM STRL ACRSF 1 PC FLD BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA60AT.290 SUP HCPCS V2632 SA60AT.290 - LENS IOL 0 D +29 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $225.00 $375.00 $78.15 $375.00 N/A N/A SA60AT.310 SUP HCPCS V2632 SA60AT.310 - LENS IOL 0 D +31 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $201.00 $335.00 $69.81 $335.00 N/A N/A SA60AT.350 SUP HCPCS V2632 SA60AT.350 - LENS IOL 0 D +35 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA60AT.360 SUP HCPCS V2632 SA60AT.360 - LENS IOL 0 D +36 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA60AT.370 SUP HCPCS V2632 SA60AT.370 - LENS IOL 0 D +37 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA60AT.380 SUP HCPCS V2632 SA60AT.380 - LENS IOL 0 D +38 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA60AT.390 SUP HCPCS V2632 SA60AT.390 - LENS IOL 0 D +39 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA60AT.400 SUP HCPCS V2632 SA60AT.400 - LENS IOL 0 D +40 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $375.00 $278.00 $74.43 $375.00 $168.75 $168.75 $168.75 $168.75 $375.00 $375.00 $375.00 $78.16 $375.00 $375.00 $375.00 $375.00 $375.00 $78.15 $375.00 $375.00 $221.81 $375.00 $375.00 $375.00 $375.00 $281.25 $375.00 $375.00 $375.00 $187.50 $187.50 $297.00 $375.00 $300.00 $168.75 $74.43 N/A $217.50 $375.00 $375.00 $375.00 $78.15 $375.00 N/A N/A SA60WF SUP HCPCS V2632 SA60WF - LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A SA60WF.060 SUP HCPCS V2632 SA60WF.060 - LENS IOL 0 D +6 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.065 SUP HCPCS V2632 SA60WF.065 - LENS IOL 0 D +6.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.070 SUP HCPCS V2632 SA60WF.070 - LENS IOL 0 D +7 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.075 SUP HCPCS V2632 SA60WF.075 - LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.080 SUP HCPCS V2632 SA60WF.080 - LENS IOL 0 D +8 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.085 SUP HCPCS V2632 SA60WF.085 - LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.090 SUP HCPCS V2632 SA60WF.090 - LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.095 SUP HCPCS V2632 SA60WF.095 - LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.100 SUP HCPCS V2632 SA60WF.100 - LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.105 SUP HCPCS V2632 SA60WF.105 - LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.110 SUP HCPCS V2632 SA60WF.110 - LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.115 SUP HCPCS V2632 SA60WF.115 - LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.120 SUP HCPCS V2632 SA60WF.120 - LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.125 SUP HCPCS V2632 SA60WF.125 - LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.130 SUP HCPCS V2632 SA60WF.130 - LENS IOL 0 D +13 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.135 SUP HCPCS V2632 SA60WF.135 - LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.140 SUP HCPCS V2632 SA60WF.140 - LENS IOL 0 D +14 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.145 SUP HCPCS V2632 SA60WF.145 - LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.150 SUP HCPCS V2632 SA60WF.150 - LENS IOL 0 D +15 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.155 SUP HCPCS V2632 SA60WF.155 - LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.160 SUP HCPCS V2632 SA60WF.160 - LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.165 SUP HCPCS V2632 SA60WF.165 - LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.170 SUP HCPCS V2632 SA60WF.170 - LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM CLR STRL LF ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.175 SUP HCPCS V2632 SA60WF.175 - LENS IOL 0 D +17.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.180 SUP HCPCS V2632 SA60WF.180 - LENS IOL 0 D +18 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.185 SUP HCPCS V2632 SA60WF.185 - LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.190 SUP HCPCS V2632 SA60WF.190 - LENS IOL 0 D +19 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.195 SUP HCPCS V2632 SA60WF.195 - LENS IOL 0 D +19.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.200 SUP HCPCS V2632 SA60WF.200 - LENS IOL 0 D +20 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM 1 BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.205 SUP HCPCS V2632 SA60WF.205 - LENS IOL 0 D +20.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.210 SUP HCPCS V2632 SA60WF.210 - LENS IOL 0 D +21 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.215 SUP HCPCS V2632 SA60WF.215 - LENS IOL 0 D +21.5 DIOPTER BICNVX 118.4 A-CONSTANT 6MM 13MM BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.220 SUP HCPCS V2632 SA60WF.220 - LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.225 SUP HCPCS V2632 SA60WF.225 - LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.230 SUP HCPCS V2632 SA60WF.230 - LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.235 SUP HCPCS V2632 SA60WF.235 - LENS IOL 0 D +23.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.240 SUP HCPCS V2632 SA60WF.240 - LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.245 SUP HCPCS V2632 SA60WF.245 - LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.250 SUP HCPCS V2632 SA60WF.250 - LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.255 SUP HCPCS V2632 SA60WF.255 - LENS IOL 0 D +25.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.260 SUP HCPCS V2632 SA60WF.260 - LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.265 SUP HCPCS V2632 SA60WF.265 - LENS IOL 0 D +26.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.270 SUP HCPCS V2632 SA60WF.270 - LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.275 SUP HCPCS V2632 SA60WF.275 - LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM CLR ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.280 SUP HCPCS V2632 SA60WF.280 - LENS IOL 0 D +28 DIOP ASYM BCNVX 6MM 13MM ACRSF STABLEFORCE BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.285 SUP HCPCS V2632 SA60WF.285 - LENS IOL 0 D +28.5 DIOP BCNVX 118.4 A-CNST 6MM 13MM ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.290 SUP HCPCS V2632 SA60WF.290 - LENS IOL 0 D +29 DIOP ASYM BCNVX 6MM 13MM ACRSF STABLEFORCE BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.295 SUP HCPCS V2632 SA60WF.295 - LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM CLR STRL ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SA60WF.300 SUP HCPCS V2632 SA60WF.300 - LENS IOL 0 D +30 DIOP BCNVX 118.4 A-CNST 6MM 13MM ACRSF BOTH IP/OP $335.00 $248.00 $66.49 $335.00 $150.75 $150.75 $150.75 $150.75 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $335.00 $335.00 $335.00 $69.82 $335.00 $335.00 $198.15 $335.00 $335.00 $335.00 $335.00 $251.25 $335.00 $335.00 $335.00 $167.50 $167.50 $265.32 $335.00 $268.00 $150.75 $66.49 N/A $194.30 $335.00 $335.00 $335.00 $69.81 $335.00 N/A N/A SAX02D SUP HCPCS C1768 SAX02D - GRAFT VASCULAR STANDARD WALL 8MM 8MM 70CM 40CM STRETCH BOTH IP/OP "$6,235.00" "$4,614.00" "$1,237.49" "$6,235.00" "$2,805.75" "$2,805.75" "$2,805.75" "$2,805.75" "$6,235.00" "$6,235.00" "$6,235.00" "$1,299.53" "$6,235.00" "$6,235.00" "$6,235.00" "$6,235.00" "$6,235.00" "$1,299.44" "$6,235.00" "$6,235.00" "$3,073.86" "$6,235.00" "$6,235.00" "$6,235.00" "$6,235.00" "$4,676.25" "$6,235.00" "$6,235.00" "$6,235.00" "$3,117.50" "$3,117.50" "$4,938.12" "$6,235.00" "$4,988.00" "$2,805.75" "$1,237.49" N/A "$3,616.30" "$6,235.00" "$6,235.00" "$6,235.00" "$1,299.37" "$6,235.00" N/A N/A SB4000SA SUP Custom 27203010 SB4000SA - BLADE SHVR STRG STD 4MM TY A BOTH IP/OP "$1,364.00" "$1,009.00" $242.74 "$1,363.73" "$1,363.73" "$1,363.73" "$1,363.73" "$1,363.73" "$1,363.73" "$1,363.73" $242.74 "$1,363.73" "$1,363.73" "$1,012.16" "$1,012.16" "$1,051.16" $710.50 $284.22 "$1,363.73" $545.49 "$1,363.73" "$1,363.73" "$1,363.73" "$1,363.73" "$1,363.73" "$1,023.00" "$1,363.73" "$1,363.73" "$1,363.73" $681.87 $681.87 "$1,080.07" "$1,363.73" "$1,090.98" $886.42 "$1,363.73" N/A $791.12 "$1,363.73" $818.24 "$1,363.73" "$1,363.73" "$1,363.73" N/A N/A SB4060RC SUP Custom 27203010 SB4060RC - SHAVER BLADE 4MM 60 DEG ROTATABLE SERRATED DS BOTH IP/OP $476.00 $352.00 $84.69 $475.76 $475.76 $475.76 $475.76 $475.76 $475.76 $475.76 $84.69 $475.76 $475.76 $353.11 $353.11 $366.72 $247.87 $99.15 $475.76 $190.30 $475.76 $475.76 $475.76 $475.76 $475.76 $357.00 $475.76 $475.76 $475.76 $237.88 $237.88 $376.80 $475.76 $380.61 $309.24 $475.76 N/A $276.08 $475.76 $285.46 $475.76 $475.76 $475.76 N/A N/A SB6EBU30 SUP HCPCS C1887 SB6EBU30 - CATHETER GD EBU3 CRV 6FR 100CM STRL SHR NX BAL SFTP DIST SLV BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 N/A $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A SB6HS1SH SUP HCPCS C1887 "SA6MP1 - CATHETER GUIDING SHERPA NX, 6FRX 100CM MP1" BOTH IP/OP $112.50 $83.00 $22.33 $112.50 $61.09 $61.09 $61.09 $61.09 $112.50 $112.50 $112.50 $23.45 $112.50 $83.50 $83.50 $86.72 $58.61 $23.45 $112.50 $112.50 $66.54 $112.50 $112.50 $112.50 $112.50 $84.38 $112.50 $112.50 $112.50 $56.25 $56.25 $89.10 $112.50 $90.00 $73.13 $22.33 N/A $65.25 $112.50 $112.50 $112.50 $23.45 $112.50 N/A N/A SB6JL30 SUP HCPCS C1887 SB6JL30 - CATHETER GD STD JL3 CRV 6FR 100CM STRL SHR NX BAL SFTP DIST BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 N/A $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A SB7JL30 SUP HCPCS C1887 SB7JL30 - CATHETER GD STD JL3 CRV 7FR 100CM STRL SHR NX BAL SFTP DIST BOTH IP/OP $120.00 $89.00 $23.82 $120.00 $65.16 $65.16 $65.16 $65.16 $120.00 $120.00 $120.00 $25.01 $120.00 $89.06 $89.06 $92.50 $62.52 $25.01 $120.00 $120.00 $70.98 $120.00 $120.00 $120.00 $120.00 $90.00 $120.00 $120.00 $120.00 $60.00 $60.00 $95.04 $120.00 $96.00 $78.00 $23.82 N/A $69.60 $120.00 $120.00 $120.00 $25.01 $120.00 N/A N/A SBFS045 SUP Custom 27203010 SBFS045 - KIT TRMA FX 1.1MM .045IN SBFS BOTH IP/OP "$1,015.00" $751.00 $180.67 "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" $180.67 "$1,015.00" "$1,015.00" $753.33 $753.33 $782.36 $528.82 $211.54 "$1,015.00" $406.00 "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" $761.25 "$1,015.00" "$1,015.00" "$1,015.00" $507.50 $507.50 $803.88 "$1,015.00" $812.00 $659.75 "$1,015.00" N/A $588.70 "$1,015.00" $609.00 "$1,015.00" "$1,015.00" "$1,015.00" N/A N/A SBFS062 SUP Custom 27203010 SBFS062 - KIT IM NL .062IN SLT AWL LK DV BNDRG TL CAP SM BN FX SYS BOTH IP/OP "$1,015.00" $751.00 $180.67 "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" $180.67 "$1,015.00" "$1,015.00" $753.33 $753.33 $782.36 $528.82 $211.54 "$1,015.00" $406.00 "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" "$1,015.00" $761.25 "$1,015.00" "$1,015.00" "$1,015.00" $507.50 $507.50 $803.88 "$1,015.00" $812.00 $659.75 "$1,015.00" N/A $588.70 "$1,015.00" $609.00 "$1,015.00" "$1,015.00" "$1,015.00" N/A N/A SBM-4963 SUP HCPCS C1765 "SBM-4963 - BLANKET SECTION MED (MUST ORDER MIN 4 BX, MED OR SM)" BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SBT1602D SUP HCPCS C1768 SBT1602D - GRAFT VASCULAR STANDARD WALL THIN WALL 2 BRANCH 16MM 8MM 50 BOTH IP/OP "$2,852.50" "$2,111.00" $566.15 "$2,852.50" "$1,283.63" "$1,283.63" "$1,283.63" "$1,283.63" "$2,852.50" "$2,852.50" "$2,852.50" $594.53 "$2,852.50" "$2,852.50" "$2,852.50" "$2,852.50" "$2,852.50" $594.49 "$2,852.50" "$2,852.50" "$1,406.28" "$2,852.50" "$2,852.50" "$2,852.50" "$2,852.50" "$2,139.38" "$2,852.50" "$2,852.50" "$2,852.50" "$1,426.25" "$1,426.25" "$2,259.18" "$2,852.50" "$2,282.00" "$1,283.63" $566.15 N/A "$1,654.45" "$2,852.50" "$2,852.50" "$2,852.50" $594.46 "$2,852.50" N/A N/A SBT1802D SUP HCPCS C1768 SBT1802D - GRAFT VASC STD WL THNWL 2 BRCH 18MM 9MM 50CM STRL STRCH GRTX BOTH IP/OP "$2,852.50" "$2,111.00" $566.15 "$2,852.50" "$1,283.63" "$1,283.63" "$1,283.63" "$1,283.63" "$2,852.50" "$2,852.50" "$2,852.50" $594.53 "$2,852.50" "$2,852.50" "$2,852.50" "$2,852.50" "$2,852.50" $594.49 "$2,852.50" "$2,852.50" "$1,406.28" "$2,852.50" "$2,852.50" "$2,852.50" "$2,852.50" "$2,139.38" "$2,852.50" "$2,852.50" "$2,852.50" "$1,426.25" "$1,426.25" "$2,259.18" "$2,852.50" "$2,282.00" "$1,283.63" $566.15 N/A "$1,654.45" "$2,852.50" "$2,852.50" "$2,852.50" $594.46 "$2,852.50" N/A N/A SBT2002D SUP HCPCS C1768 SBT2002D - GRAFT VASCULAR STANDARD WALL THIN WALL 2 BRANCH 20MM 10MM 50 BOTH IP/OP "$2,852.50" "$2,111.00" $566.15 "$2,852.50" "$1,283.63" "$1,283.63" "$1,283.63" "$1,283.63" "$2,852.50" "$2,852.50" "$2,852.50" $594.53 "$2,852.50" "$2,852.50" "$2,852.50" "$2,852.50" "$2,852.50" $594.49 "$2,852.50" "$2,852.50" "$1,406.28" "$2,852.50" "$2,852.50" "$2,852.50" "$2,852.50" "$2,139.38" "$2,852.50" "$2,852.50" "$2,852.50" "$1,426.25" "$1,426.25" "$2,259.18" "$2,852.50" "$2,282.00" "$1,283.63" $566.15 N/A "$1,654.45" "$2,852.50" "$2,852.50" "$2,852.50" $594.46 "$2,852.50" N/A N/A SC-4385-50 SUP Custom 27203010 SC-4385-50 - KIT STM 50CM STY CAP BOTH IP/OP $412.50 $305.00 $73.43 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $412.50 $73.43 $412.50 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $165.00 $412.50 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $412.50 N/A $239.25 $412.50 $247.50 $412.50 $412.50 $412.50 N/A N/A SCD13 SUP Custom 27011340 SCD13 - DISSECTOR LAPSCOP US HNDPC 13CM SONICISION DISP BOTH IP/OP "$4,777.50" "$3,535.00" $850.40 "$4,777.50" "$4,777.50" "$4,777.50" "$4,777.50" "$4,777.50" "$4,777.50" "$4,777.50" $850.40 "$4,777.50" "$4,777.50" "$3,545.86" "$3,545.86" "$3,682.50" "$2,060.15" $995.68 "$4,777.50" "$1,911.00" "$4,777.50" "$4,777.50" "$4,777.50" "$4,777.50" "$4,777.50" "$3,583.13" "$4,777.50" "$4,777.50" "$4,777.50" "$2,388.75" "$2,388.75" "$3,783.78" "$4,777.50" "$3,822.00" "$3,105.38" "$4,777.50" N/A "$2,770.95" "$4,777.50" "$2,866.50" "$4,777.50" "$4,777.50" "$4,777.50" N/A N/A SCD26 SUP Custom 27011340 SCD26 - DISSECTOR ENDSCP STR JAW HND SWCH CRDLS US 26CM 5 BOTH IP/OP "$4,777.50" "$3,535.00" $850.40 "$4,777.50" "$4,777.50" "$4,777.50" "$4,777.50" "$4,777.50" "$4,777.50" "$4,777.50" $850.40 "$4,777.50" "$4,777.50" "$3,545.86" "$3,545.86" "$3,682.50" "$2,060.15" $995.68 "$4,777.50" "$1,911.00" "$4,777.50" "$4,777.50" "$4,777.50" "$4,777.50" "$4,777.50" "$3,583.13" "$4,777.50" "$4,777.50" "$4,777.50" "$2,388.75" "$2,388.75" "$3,783.78" "$4,777.50" "$3,822.00" "$3,105.38" "$4,777.50" N/A "$2,770.95" "$4,777.50" "$2,866.50" "$4,777.50" "$4,777.50" "$4,777.50" N/A N/A SCREWTEST SUP HCPCS C1713 SCREWTEST - SCREW SUPPLY TEST NEW ITEM BOTH IP/OP $50.00 $37.00 $9.92 $50.00 $22.50 $22.50 $22.50 $22.50 $50.00 $50.00 $50.00 $10.42 $50.00 $50.00 $50.00 $50.00 $50.00 $10.42 $50.00 $20.00 $29.58 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $22.50 $9.92 N/A $29.00 $50.00 $30.00 $50.00 $10.42 $50.00 N/A N/A SD242.003 SUP HCPCS C1713 SD242.003 - PLATE BN STRG 170MM NS LCP SS WRST 2.4MM SCR BOTH IP/OP "$7,192.50" "$5,322.00" "$1,427.53" "$7,192.50" "$3,236.63" "$3,236.63" "$3,236.63" "$3,236.63" "$7,192.50" "$7,192.50" "$7,192.50" "$1,499.10" "$7,192.50" "$7,192.50" "$7,192.50" "$7,192.50" "$7,192.50" "$1,499.00" "$7,192.50" "$7,192.50" "$3,545.90" "$7,192.50" "$7,192.50" "$7,192.50" "$7,192.50" "$5,394.38" "$7,192.50" "$7,192.50" "$7,192.50" "$3,596.25" "$3,596.25" "$5,696.46" "$7,192.50" "$5,754.00" "$3,236.63" "$1,427.53" N/A "$4,171.65" "$7,192.50" "$7,192.50" "$7,192.50" "$1,498.92" "$7,192.50" N/A N/A SE5423WV SUP Custom 27203010 SE5423WV - PACK 23 GA POSTERIOR WIDE-FIELD ELITE BOTH IP/OP $887.50 $657.00 $157.98 "$1,457.63" $887.50 $887.50 $887.50 $887.50 $887.50 $887.50 $157.98 $887.50 $887.50 $658.70 $658.70 $684.09 $462.39 $184.96 $887.50 $583.05 $887.50 $887.50 "$1,457.63" $887.50 $887.50 $665.63 $887.50 $887.50 $887.50 $443.75 $443.75 $702.90 $887.50 $710.00 $576.88 $887.50 N/A $514.75 $887.50 $532.50 $887.50 $887.50 $887.50 N/A N/A SE5425WVB SUP Custom 27203010 SE5425WVB - PACK VITRTM 25GA STRL LF STELLARIS ELT 2 BLDE CTR W FLD POST BOTH IP/OP $987.50 $731.00 $175.78 "$1,603.55" $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $175.78 $987.50 $987.50 $732.92 $732.92 $761.17 $514.49 $205.81 $987.50 $641.42 $987.50 $987.50 "$1,603.55" $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $641.88 $987.50 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A SE5427MVB SUP Custom 27203010 SE5427MVB - PACK 27 GA. BI-BLADE VITREOUS CUTTER POSTERIOR MID-FIELD STE BOTH IP/OP $987.50 $731.00 $175.78 "$1,603.55" $987.50 $987.50 $987.50 $987.50 $987.50 $987.50 $175.78 $987.50 $987.50 $732.92 $732.92 $761.17 $514.49 $205.81 $987.50 $641.42 $987.50 $987.50 "$1,603.55" $987.50 $987.50 $740.63 $987.50 $987.50 $987.50 $493.75 $493.75 $782.10 $987.50 $790.00 $641.88 $987.50 N/A $572.75 $987.50 $592.50 $987.50 $987.50 $987.50 N/A N/A SECOC 28/28 SUP Custom 27803010 SECOC 28/28 - OUTER SMALL FRAGMENT CLAMP BOTH IP/OP $537.50 $398.00 $95.68 $537.50 $537.50 $537.50 $537.50 $537.50 $537.50 $537.50 $95.68 $537.50 $537.50 $537.50 $537.50 $537.50 $537.50 $112.02 $537.50 $215.00 $537.50 $537.50 $537.50 $537.50 $537.50 $403.13 $537.50 $537.50 $537.50 $268.75 $268.75 $425.70 $537.50 $430.00 $241.88 $537.50 N/A $311.75 $537.50 $322.50 $537.50 $537.50 $537.50 N/A N/A SECURADRMMEM SUP HCPCS C1721 SECURADRMMEM - SECURA DR SYSTEM (INCLUDING DF4 HEADER) BOTH IP/OP "$49,812.50" "$36,861.00" "$10,381.47" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$10,381.47" "$49,812.50" "$19,925.00" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$49,812.50" "$37,359.38" "$49,812.50" "$49,812.50" "$49,812.50" "$24,906.25" "$24,906.25" "$39,451.50" "$49,812.50" "$39,850.00" "$22,415.63" "$49,812.50" N/A "$28,891.25" "$49,812.50" "$29,887.50" "$49,812.50" "$49,812.50" "$49,812.50" N/A N/A SECURAVREMEM SUP HCPCS C1721 SECURAVREMEM - SECURA VR SYSTEM (INCLUDING DF4 HEADER) BOTH IP/OP "$43,750.00" "$32,375.00" "$9,117.98" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$9,117.98" "$43,750.00" "$17,500.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$43,750.00" "$32,812.50" "$43,750.00" "$43,750.00" "$43,750.00" "$21,875.00" "$21,875.00" "$34,650.00" "$43,750.00" "$35,000.00" "$19,687.50" "$43,750.00" N/A "$25,375.00" "$43,750.00" "$26,250.00" "$43,750.00" "$43,750.00" "$43,750.00" N/A N/A SECX-10-7-30-135 SUP HCPCS C1876 SECX-10-7-30-135 - STENT VASC TPR 10/7MM 6FR 30MM 135CM PRTG GPS EXPRT RX SLF BOTH IP/OP "$5,127.50" "$3,794.00" "$1,017.68" "$5,127.50" "$2,307.38" "$2,307.38" "$2,307.38" "$2,307.38" "$5,127.50" "$5,127.50" "$5,127.50" "$1,068.70" "$5,127.50" "$5,127.50" "$5,127.50" "$5,127.50" "$5,127.50" "$1,068.63" "$5,127.50" "$5,127.50" "$2,527.86" "$5,127.50" "$5,127.50" "$5,127.50" "$5,127.50" "$3,845.63" "$5,127.50" "$5,127.50" "$5,127.50" "$2,563.75" "$2,563.75" "$4,060.98" "$5,127.50" "$4,102.00" "$2,307.38" "$1,017.68" N/A "$2,973.95" "$5,127.50" "$5,127.50" "$5,127.50" "$1,068.57" "$5,127.50" N/A N/A SECX-10-7-40-135 SUP HCPCS C1876 SECX-10-7-40-135 - STENT VASC TPR 10/7MM 6FR 40MM 135CM PRTG GPS EXPRT RX SLF BOTH IP/OP "$5,127.50" "$3,794.00" "$1,017.68" "$5,127.50" "$2,307.38" "$2,307.38" "$2,307.38" "$2,307.38" "$5,127.50" "$5,127.50" "$5,127.50" "$1,068.70" "$5,127.50" "$5,127.50" "$5,127.50" "$5,127.50" "$5,127.50" "$1,068.63" "$5,127.50" "$5,127.50" "$2,527.86" "$5,127.50" "$5,127.50" "$5,127.50" "$5,127.50" "$3,845.63" "$5,127.50" "$5,127.50" "$5,127.50" "$2,563.75" "$2,563.75" "$4,060.98" "$5,127.50" "$4,102.00" "$2,307.38" "$1,017.68" N/A "$2,973.95" "$5,127.50" "$5,127.50" "$5,127.50" "$1,068.57" "$5,127.50" N/A N/A SECX-8-6-40-135 SUP HCPCS C1876 SECX-8-6-40-135 - STENT VASC .014IN TPR 8/6MM 6FR 40MM 135CM PRTG GPS EXPRT RX BOTH IP/OP "$5,127.50" "$3,794.00" "$1,017.68" "$5,127.50" "$2,307.38" "$2,307.38" "$2,307.38" "$2,307.38" "$5,127.50" "$5,127.50" "$5,127.50" "$1,068.70" "$5,127.50" "$5,127.50" "$5,127.50" "$5,127.50" "$5,127.50" "$1,068.63" "$5,127.50" "$5,127.50" "$2,527.86" "$5,127.50" "$5,127.50" "$5,127.50" "$5,127.50" "$3,845.63" "$5,127.50" "$5,127.50" "$5,127.50" "$2,563.75" "$2,563.75" "$4,060.98" "$5,127.50" "$4,102.00" "$2,307.38" "$1,017.68" N/A "$2,973.95" "$5,127.50" "$5,127.50" "$5,127.50" "$1,068.57" "$5,127.50" N/A N/A SEDR01 SUP HCPCS C1786 SEDR01 - PACEMAKER CARDIAC 2.8V 1.2AH 7.5MM 47.9X44.7MM IMPLTABLE 2 BOTH IP/OP "$8,500.00" "$6,290.00" "$1,687.04" "$8,500.00" "$3,825.00" "$3,825.00" "$3,825.00" "$3,825.00" "$8,500.00" "$8,500.00" "$8,500.00" "$1,771.61" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$1,771.49" "$8,500.00" "$8,500.00" "$4,190.50" "$8,500.00" "$8,500.00" "$8,500.00" "$8,500.00" "$6,375.00" "$8,500.00" "$8,500.00" "$8,500.00" "$4,250.00" "$4,250.00" "$6,732.00" "$8,500.00" "$6,800.00" "$3,825.00" "$1,687.04" N/A "$4,930.00" "$8,500.00" "$5,100.00" "$8,500.00" "$1,771.40" "$8,500.00" N/A N/A SEG1411 SUP HCPCS C1769 SEG1411 - GUIDEWIRE VASCULAR .014IN 190CM 8CM ANGLED SEGWAY HYDPHI BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $169.69 $169.69 $169.69 $169.69 $312.50 $312.50 $312.50 $65.13 $312.50 $231.94 $231.94 $240.88 $162.81 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $203.13 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A SEG1412 SUP HCPCS C1769 SEG1412 - GUIDEWIRE VASCULAR STR .014IN SEGWAY HYDPHI BOTH IP/OP $312.50 $231.00 $62.02 $312.50 $169.69 $169.69 $169.69 $169.69 $312.50 $312.50 $312.50 $65.13 $312.50 $231.94 $231.94 $240.88 $162.81 $65.13 $312.50 $312.50 $184.84 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $203.13 $62.02 N/A $181.25 $312.50 $312.50 $312.50 $65.13 $312.50 N/A N/A SENSH1428W SUP HCPCS C1894 SENSH1428W - SHEATH INTROD .035IN 14FR 28CM GWIRE FLEXIBILITY REINFORCED BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $271.50 $271.50 $271.50 $271.50 $500.00 $500.00 $500.00 $104.21 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A SENSH1628W SUP HCPCS C1894 SENSH1628W - SHEATH INTRO .035IN 16FR 28CM SENTRANT RADOPQ REINF COIL DIL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $271.50 $271.50 $271.50 $271.50 $500.00 $500.00 $500.00 $104.21 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A SENSH1828W SUP HCPCS C1894 SENSH1828W - SHEATH INTRO .035IN 18FR 28CM SENTRANT RADOPQ REINF COIL DIL BOTH IP/OP $500.00 $370.00 $99.24 $500.00 $271.50 $271.50 $271.50 $271.50 $500.00 $500.00 $500.00 $104.21 $500.00 $371.10 $371.10 $385.40 $260.50 $104.21 $500.00 $500.00 $295.75 $500.00 $500.00 $500.00 $500.00 $375.00 $500.00 $500.00 $500.00 $250.00 $250.00 $396.00 $500.00 $400.00 $325.00 $99.24 N/A $290.00 $500.00 $500.00 $500.00 $104.20 $500.00 N/A N/A SENSH2028W SUP HCPCS C1894 SENSH2028W - SHEATH INTROD .035IN 20FR 28CM RADIOPQ MARKER BAND BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $339.38 $339.38 $339.38 $339.38 $625.00 $625.00 $625.00 $130.27 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A SENSH2228W SUP HCPCS C1894 SENSH2228W - SHEATH INTRO 22FR 28CM SENTRANT HDRPH AAA BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $339.38 $339.38 $339.38 $339.38 $625.00 $625.00 $625.00 $130.27 $625.00 $463.88 $463.88 $481.75 $325.63 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $406.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A SENSIADRK2 SUP HCPCS C2619 SENSIADRK2 - PACEMAKER CARDIAC THK7.5MM 47.9X47MM IMPLTABLE 2 CHAMBER BOTH IP/OP "$12,500.00" "$9,250.00" "$2,605.14" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$2,605.14" "$12,500.00" "$5,000.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$12,500.00" "$9,375.00" "$12,500.00" "$12,500.00" "$12,500.00" "$6,250.00" "$6,250.00" "$9,900.00" "$12,500.00" "$10,000.00" "$5,625.00" "$12,500.00" N/A "$7,250.00" "$12,500.00" "$7,500.00" "$12,500.00" "$12,500.00" "$12,500.00" N/A N/A SENSIASRK2 SUP HCPCS C2620 SENSIASRK2 - PACEMAKER CARDIAC THK7.5MM 42.9X40.2MM IMPLTABLE 1 CHAMBER BOTH IP/OP "$5,992.50" "$4,434.00" "$1,248.90" "$5,992.50" "$5,992.50" "$5,992.50" "$5,992.50" "$5,992.50" "$5,992.50" "$5,992.50" "$5,992.50" "$5,992.50" "$5,992.50" "$5,992.50" "$5,992.50" "$5,992.50" "$5,992.50" "$1,248.90" "$5,992.50" "$2,397.00" "$5,992.50" "$5,992.50" "$5,992.50" "$5,992.50" "$5,992.50" "$4,494.38" "$5,992.50" "$5,992.50" "$5,992.50" "$2,996.25" "$2,996.25" "$4,746.06" "$5,992.50" "$4,794.00" "$2,696.63" "$5,992.50" N/A "$3,475.65" "$5,992.50" "$3,595.50" "$5,992.50" "$5,992.50" "$5,992.50" N/A N/A SESR01 SUP HCPCS C1786 SESR01 - PACEMAKER CARDIAC 2.8V .97AH 7.5MM 42.9MMX40.2MM 1 CHAMBER BOTH IP/OP "$5,000.00" "$3,700.00" $992.38 "$5,000.00" "$2,250.00" "$2,250.00" "$2,250.00" "$2,250.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.13" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.06" "$5,000.00" "$5,000.00" "$2,465.00" "$5,000.00" "$5,000.00" "$5,000.00" "$5,000.00" "$3,750.00" "$5,000.00" "$5,000.00" "$5,000.00" "$2,500.00" "$2,500.00" "$3,960.00" "$5,000.00" "$4,000.00" "$2,250.00" $992.38 N/A "$2,900.00" "$5,000.00" "$5,000.00" "$5,000.00" "$1,042.00" "$5,000.00" N/A N/A SF-2500-6101 SUP HCPCS C1713 SF-2500-6101 - PIN HALF 500MM NONSTRL DISPOSABLE BOTH IP/OP "$5,250.00" "$3,885.00" "$1,041.99" "$5,250.00" "$2,362.50" "$2,362.50" "$2,362.50" "$2,362.50" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.23" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.16" "$5,250.00" "$2,100.00" "$2,588.25" "$5,250.00" "$5,250.00" "$5,250.00" "$5,250.00" "$3,937.50" "$5,250.00" "$5,250.00" "$5,250.00" "$2,625.00" "$2,625.00" "$4,158.00" "$5,250.00" "$4,200.00" "$2,362.50" "$1,041.99" N/A "$3,045.00" "$5,250.00" "$5,250.00" "$5,250.00" "$1,094.10" "$5,250.00" N/A N/A SFR-4-15 SUP Custom 27203010 SFR-4-15 - DEVICE THROMBECTOMY SOLITARE FR 4X15 BOTH IP/OP "$15,250.00" "$11,285.00" "$2,060.15" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$2,714.50" "$15,250.00" "$15,250.00" "$4,181.12" "$4,181.12" "$11,754.70" "$2,060.15" "$3,178.27" "$15,250.00" "$6,100.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$11,437.50" "$15,250.00" "$15,250.00" "$15,250.00" "$7,625.00" "$7,625.00" "$12,078.00" "$15,250.00" "$12,200.00" "$9,912.50" "$15,250.00" N/A "$8,845.00" "$15,250.00" "$9,150.00" "$15,250.00" "$15,250.00" "$15,250.00" N/A N/A SFR-4-20 SUP Custom 27203010 SFR-4-20 - DEVICE THRMB 31MM 4MM SOLITAIRE FR REVSC BOTH IP/OP "$15,250.00" "$11,285.00" "$2,060.15" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$2,714.50" "$15,250.00" "$15,250.00" "$4,181.12" "$4,181.12" "$11,754.70" "$2,060.15" "$3,178.27" "$15,250.00" "$6,100.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$11,437.50" "$15,250.00" "$15,250.00" "$15,250.00" "$7,625.00" "$7,625.00" "$12,078.00" "$15,250.00" "$12,200.00" "$9,912.50" "$15,250.00" N/A "$8,845.00" "$15,250.00" "$9,150.00" "$15,250.00" "$15,250.00" "$15,250.00" N/A N/A SFR-6-20 SUP Custom 27203010 SFR-6-20 - DEVICE THRMB 31MM 6MM SOLITAIRE FR REVSC BOTH IP/OP "$15,250.00" "$11,285.00" "$2,060.15" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$2,714.50" "$15,250.00" "$15,250.00" "$4,181.12" "$4,181.12" "$11,754.70" "$2,060.15" "$3,178.27" "$15,250.00" "$6,100.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$11,437.50" "$15,250.00" "$15,250.00" "$15,250.00" "$7,625.00" "$7,625.00" "$12,078.00" "$15,250.00" "$12,200.00" "$9,912.50" "$15,250.00" N/A "$8,845.00" "$15,250.00" "$9,150.00" "$15,250.00" "$15,250.00" "$15,250.00" N/A N/A SFR-6-30 SUP Custom 27203010 SFR-6-30 - DEVICE THRMB 42MM 6MM SOLITAIRE FR REVSC BOTH IP/OP "$15,250.00" "$11,285.00" "$2,060.15" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$2,714.50" "$15,250.00" "$15,250.00" "$4,181.12" "$4,181.12" "$11,754.70" "$2,060.15" "$3,178.27" "$15,250.00" "$6,100.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$15,250.00" "$11,437.50" "$15,250.00" "$15,250.00" "$15,250.00" "$7,625.00" "$7,625.00" "$12,078.00" "$15,250.00" "$12,200.00" "$9,912.50" "$15,250.00" N/A "$8,845.00" "$15,250.00" "$9,150.00" "$15,250.00" "$15,250.00" "$15,250.00" N/A N/A SGL-1 SUP Custom 27203010 SGL-1 - SUTURE CR SURGITIE 0 21IN LGT LOOP DLV SYS ABS BOTH IP/OP $592.50 $438.00 $105.41 $592.20 $592.20 $592.20 $592.20 $592.20 $592.20 $592.20 $105.41 $592.20 $592.20 $439.53 $439.53 $456.47 $308.54 $123.42 $592.20 $149.40 $592.20 $592.20 $373.50 $592.20 $592.20 $444.38 $592.20 $592.20 $592.20 $296.10 $296.10 $469.02 $592.20 $473.76 $384.93 $592.20 N/A $343.65 $592.20 $355.32 $592.20 $592.20 $592.20 N/A N/A S-H00703 SUP HCPCS C1776 S-H00703 - STEM FEMORAL LONG HEAD NECK OMNIFIT HIP BOTH IP/OP "$3,866.00" "$2,861.00" $767.30 "$3,866.00" "$1,739.70" "$1,739.70" "$1,739.70" "$1,739.70" "$3,866.00" "$3,866.00" "$3,866.00" $805.77 "$3,866.00" "$3,866.00" "$3,866.00" "$3,866.00" "$3,866.00" $805.72 "$3,866.00" "$3,866.00" "$1,905.94" "$3,866.00" "$3,866.00" "$3,866.00" "$3,866.00" "$2,899.50" "$3,866.00" "$3,866.00" "$3,866.00" "$1,933.00" "$1,933.00" "$3,061.87" "$3,866.00" "$3,092.80" "$1,739.70" $767.30 N/A "$2,242.28" "$3,866.00" "$2,319.60" "$3,866.00" $805.67 "$3,866.00" N/A N/A SH-0713-S SUP HCPCS C1776 SH-0713-S - STEM HUMERAL SHORT 7MM 130MM MODULAR POLARUS SHOULDER BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$1,622.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-0813-S SUP HCPCS C1776 SH-0813-S - STEM HUMERAL SHORT 8MM 130MM MODULAR POLARUS SHOULDER BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$4,055.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-0818-S SUP HCPCS C1776 SH-0818-S - STEM HUMERAL LONG 8MM 180MM MODULAR POLARUS SHOULDER STERILE BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$4,055.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-0820 SUP HCPCS C1776 SH-0820 - STEM HUMERAL LONG 8MM 200MM POLARUS SHOULDER STERILE BOTH IP/OP "$4,987.50" "$3,691.00" $989.89 "$4,987.50" "$2,244.38" "$2,244.38" "$2,244.38" "$2,244.38" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.52" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.45" "$4,987.50" "$4,987.50" "$2,458.84" "$4,987.50" "$4,987.50" "$4,987.50" "$4,987.50" "$3,740.63" "$4,987.50" "$4,987.50" "$4,987.50" "$2,493.75" "$2,493.75" "$3,950.10" "$4,987.50" "$3,990.00" "$2,244.38" $989.89 N/A "$2,892.75" "$4,987.50" "$4,987.50" "$4,987.50" "$1,039.40" "$4,987.50" N/A N/A SH-0820-S SUP HCPCS C1776 SH-0820-S - STEM HUMERAL LONG 8MM 200MM MODULAR POLARUS SHOULDER STERILE BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$1,622.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-0822-S SUP HCPCS C1776 SH-0822-S - STEM HUMERAL LONG 8MM 220MM MODULAR POLARUS SHOULDER STERILE BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$1,622.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-0824-S SUP HCPCS C1776 SH-0824-S - STEM HUMERAL LONG 8MM 240MM MODULAR POLARUS SHOULDER STERILE BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$1,622.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-0826-S SUP HCPCS C1776 SH-0826-S - STEM HUM 8MM 260MM STRL MDLR SHLDR BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$1,622.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-0828-S SUP HCPCS C1776 SH-0828-S - STEM HUMERAL LONG 8MM 280MM MODULAR POLARUS SHOULDER STERILE BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$4,055.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-0913-S SUP HCPCS C1776 SH-0913-S - STEM HUMERAL SHORT 9MM 130MM MODULAR POLARUS TITANIUM BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$4,055.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-1013-S SUP HCPCS C1776 SH-1013-S - STEM HUMERAL SHORT 10MM 130MM MODULAR POLARUS TITANIUM BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$4,055.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-1018-S SUP HCPCS C1776 SH-1018-S - STEM HUMERAL LONG 10MM 180MM MODULAR POLARUS SHOULDER BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$4,055.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-1020-S SUP HCPCS C1776 SH-1020-S - STEM HUMERAL LONG 10MM 200MM MODULAR POLARUS SHOULDER BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$1,622.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-1022-S SUP HCPCS C1776 SH-1022-S - STEM HUMERAL LONG 10MM 220MM MODULAR POLARUS SHOULDER BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$4,055.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-1024-S SUP HCPCS C1776 SH-1024-S - STEM HUMERAL LONG 10MM 240MM MODULAR POLARUS SHOULDER BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$4,055.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-1026-S SUP HCPCS C1776 SH-1026-S - STEM HUMERAL LONG 10MM 260MM MODULAR POLARUS SHOULDER BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$4,055.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-1028-S SUP HCPCS C1776 SH-1028-S - STEM HUMERAL LONG 10MM 280MM MODULAR POLARUS SHOULDER BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$4,055.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-1213-S SUP HCPCS C1776 SH-1213-S - STEM HUMERAL SHORT 12MM 130MM MODULAR POLARUS SHOULDER BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$1,622.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-1313-S SUP HCPCS C1776 SH-1313-S - STEM HUMERAL SHORT 13MM 130MM MODULAR POLARUS SHOULDER BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$1,622.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-1340L-S SUP HCPCS C1776 SH-1340L-S - HEAD HUMERAL 13MM BODY MODULAR POLARUS SHOULDER LEFT STERILE BOTH IP/OP "$5,910.00" "$4,373.00" "$1,172.99" "$5,910.00" "$2,659.50" "$2,659.50" "$2,659.50" "$2,659.50" "$5,910.00" "$5,910.00" "$5,910.00" "$1,231.79" "$5,910.00" "$5,910.00" "$5,910.00" "$5,910.00" "$5,910.00" "$1,231.71" "$5,910.00" "$5,910.00" "$2,913.63" "$5,910.00" "$5,910.00" "$5,910.00" "$5,910.00" "$4,432.50" "$5,910.00" "$5,910.00" "$5,910.00" "$2,955.00" "$2,955.00" "$4,680.72" "$5,910.00" "$4,728.00" "$2,659.50" "$1,172.99" N/A "$3,427.80" "$5,910.00" "$5,910.00" "$5,910.00" "$1,231.64" "$5,910.00" N/A N/A SH-1340R-S SUP HCPCS C1776 SH-1340R-S - BODY HUMERAL TAPER 13MM 40MM MODULAR LOCK SCREW POLARUS BOTH IP/OP "$5,910.00" "$4,373.00" "$1,172.99" "$5,910.00" "$2,659.50" "$2,659.50" "$2,659.50" "$2,659.50" "$5,910.00" "$5,910.00" "$5,910.00" "$1,231.79" "$5,910.00" "$5,910.00" "$5,910.00" "$5,910.00" "$5,910.00" "$1,231.71" "$5,910.00" "$5,910.00" "$2,913.63" "$5,910.00" "$5,910.00" "$5,910.00" "$5,910.00" "$4,432.50" "$5,910.00" "$5,910.00" "$5,910.00" "$2,955.00" "$2,955.00" "$4,680.72" "$5,910.00" "$4,728.00" "$2,659.50" "$1,172.99" N/A "$3,427.80" "$5,910.00" "$5,910.00" "$5,910.00" "$1,231.64" "$5,910.00" N/A N/A SH-1413-S SUP HCPCS C1776 SH-1413-S - STEM HUMERAL SHORT 14MM 130MM MODULAR POLARUS SHOULDER BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$4,055.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-1513-S SUP HCPCS C1776 SH-1513-S - STEM HUMERAL SHORT 15MM 130MM MODULAR POLARUS SHOULDER BOTH IP/OP "$4,055.00" "$3,001.00" $804.82 "$4,055.00" "$1,824.75" "$1,824.75" "$1,824.75" "$1,824.75" "$4,055.00" "$4,055.00" "$4,055.00" $845.16 "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" $845.11 "$4,055.00" "$1,622.00" "$1,999.12" "$4,055.00" "$4,055.00" "$4,055.00" "$4,055.00" "$3,041.25" "$4,055.00" "$4,055.00" "$4,055.00" "$2,027.50" "$2,027.50" "$3,211.56" "$4,055.00" "$3,244.00" "$1,824.75" $804.82 N/A "$2,351.90" "$4,055.00" "$4,055.00" "$4,055.00" $845.06 "$4,055.00" N/A N/A SH-1540L-S SUP HCPCS C1776 SH-1540L-S - BODY HUMERAL TAPER 15MM 40MM MODULAR LOCK SCREW POLARUS BOTH IP/OP "$5,910.00" "$4,373.00" "$1,172.99" "$5,910.00" "$2,659.50" "$2,659.50" "$2,659.50" "$2,659.50" "$5,910.00" "$5,910.00" "$5,910.00" "$1,231.79" "$5,910.00" "$5,910.00" "$5,910.00" "$5,910.00" "$5,910.00" "$1,231.71" "$5,910.00" "$2,364.00" "$2,913.63" "$5,910.00" "$5,910.00" "$5,910.00" "$5,910.00" "$4,432.50" "$5,910.00" "$5,910.00" "$5,910.00" "$2,955.00" "$2,955.00" "$4,680.72" "$5,910.00" "$4,728.00" "$2,659.50" "$1,172.99" N/A "$3,427.80" "$5,910.00" "$5,910.00" "$5,910.00" "$1,231.64" "$5,910.00" N/A N/A SH-1540R-S SUP HCPCS C1776 SH-1540R-S - BODY HUMERAL TAPER 15MM 40MM MODULAR LOCK SCREW POLARUS BOTH IP/OP "$5,910.00" "$4,373.00" "$1,172.99" "$5,910.00" "$2,659.50" "$2,659.50" "$2,659.50" "$2,659.50" "$5,910.00" "$5,910.00" "$5,910.00" "$1,231.79" "$5,910.00" "$5,910.00" "$5,910.00" "$5,910.00" "$5,910.00" "$1,231.71" "$5,910.00" "$2,364.00" "$2,913.63" "$5,910.00" "$5,910.00" "$5,910.00" "$5,910.00" "$4,432.50" "$5,910.00" "$5,910.00" "$5,910.00" "$2,955.00" "$2,955.00" "$4,680.72" "$5,910.00" "$4,728.00" "$2,659.50" "$1,172.99" N/A "$3,427.80" "$5,910.00" "$5,910.00" "$5,910.00" "$1,231.64" "$5,910.00" N/A N/A SH-3916-S SUP HCPCS C1776 SH-3916-S - HEAD HUMERAL 16MM 39MM MODULAR SHOULDER STERILE BOTH IP/OP "$3,462.50" "$2,562.00" $687.22 "$3,462.50" "$1,558.13" "$1,558.13" "$1,558.13" "$1,558.13" "$3,462.50" "$3,462.50" "$3,462.50" $721.67 "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" $721.62 "$3,462.50" "$1,385.00" "$1,707.01" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$2,596.88" "$3,462.50" "$3,462.50" "$3,462.50" "$1,731.25" "$1,731.25" "$2,742.30" "$3,462.50" "$2,770.00" "$1,558.13" $687.22 N/A "$2,008.25" "$3,462.50" "$3,462.50" "$3,462.50" $721.59 "$3,462.50" N/A N/A SH-3920-S SUP HCPCS C1776 SH-3920-S - HEAD HUMERAL 39MM 20MM MODULAR POLARUS SHOULDER STERILE BOTH IP/OP "$3,462.50" "$2,562.00" $687.22 "$3,462.50" "$1,558.13" "$1,558.13" "$1,558.13" "$1,558.13" "$3,462.50" "$3,462.50" "$3,462.50" $721.67 "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" $721.62 "$3,462.50" "$3,462.50" "$1,707.01" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$2,596.88" "$3,462.50" "$3,462.50" "$3,462.50" "$1,731.25" "$1,731.25" "$2,742.30" "$3,462.50" "$2,770.00" "$1,558.13" $687.22 N/A "$2,008.25" "$3,462.50" "$3,462.50" "$3,462.50" $721.59 "$3,462.50" N/A N/A SH-4317-S SUP HCPCS C1776 SH-4317-S - HEAD HUMERAL 43MM 17MM MODULAR POLARUS SHOULDER STERILE BOTH IP/OP "$3,462.50" "$2,562.00" $687.22 "$3,462.50" "$1,558.13" "$1,558.13" "$1,558.13" "$1,558.13" "$3,462.50" "$3,462.50" "$3,462.50" $721.67 "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" $721.62 "$3,462.50" "$3,462.50" "$1,707.01" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$2,596.88" "$3,462.50" "$3,462.50" "$3,462.50" "$1,731.25" "$1,731.25" "$2,742.30" "$3,462.50" "$2,770.00" "$1,558.13" $687.22 N/A "$2,008.25" "$3,462.50" "$3,462.50" "$3,462.50" $721.59 "$3,462.50" N/A N/A SH-4321-S SUP HCPCS C1776 SH-4321-S - HEAD HUMERAL 43MM 21MM MODULAR POLARUS SHOULDER STERILE BOTH IP/OP "$3,462.50" "$2,562.00" $687.22 "$3,462.50" "$1,558.13" "$1,558.13" "$1,558.13" "$1,558.13" "$3,462.50" "$3,462.50" "$3,462.50" $721.67 "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" $721.62 "$3,462.50" "$1,385.00" "$1,707.01" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$2,596.88" "$3,462.50" "$3,462.50" "$3,462.50" "$1,731.25" "$1,731.25" "$2,742.30" "$3,462.50" "$2,770.00" "$1,558.13" $687.22 N/A "$2,008.25" "$3,462.50" "$3,462.50" "$3,462.50" $721.59 "$3,462.50" N/A N/A SH-4718-S SUP HCPCS C1776 SH-4718-S - HEAD HUMERAL 47MM 18MM MODULAR POLARUS TITANIUM SHOULDER BOTH IP/OP "$3,462.50" "$2,562.00" $687.22 "$3,462.50" "$1,558.13" "$1,558.13" "$1,558.13" "$1,558.13" "$3,462.50" "$3,462.50" "$3,462.50" $721.67 "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" $721.62 "$3,462.50" "$1,385.00" "$1,707.01" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$2,596.88" "$3,462.50" "$3,462.50" "$3,462.50" "$1,731.25" "$1,731.25" "$2,742.30" "$3,462.50" "$2,770.00" "$1,558.13" $687.22 N/A "$2,008.25" "$3,462.50" "$3,462.50" "$3,462.50" $721.59 "$3,462.50" N/A N/A SH-4722-S SUP HCPCS C1776 SH-4722-S - HEAD HUM 47MM 22MM STRL MDLR SHLDR BOTH IP/OP "$3,462.50" "$2,562.00" $687.22 "$3,462.50" "$1,558.13" "$1,558.13" "$1,558.13" "$1,558.13" "$3,462.50" "$3,462.50" "$3,462.50" $721.67 "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" $721.62 "$3,462.50" "$1,385.00" "$1,707.01" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$2,596.88" "$3,462.50" "$3,462.50" "$3,462.50" "$1,731.25" "$1,731.25" "$2,742.30" "$3,462.50" "$2,770.00" "$1,558.13" $687.22 N/A "$2,008.25" "$3,462.50" "$2,077.50" "$3,462.50" $721.59 "$3,462.50" N/A N/A SH-5119-S SUP HCPCS C1776 SH-5119-S - HEAD HUMERAL 51MM 19MM MODULAR POLARUS SHOULDER STERILE BOTH IP/OP "$3,462.50" "$2,562.00" $687.22 "$3,462.50" "$1,558.13" "$1,558.13" "$1,558.13" "$1,558.13" "$3,462.50" "$3,462.50" "$3,462.50" $721.67 "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" $721.62 "$3,462.50" "$3,462.50" "$1,707.01" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$2,596.88" "$3,462.50" "$3,462.50" "$3,462.50" "$1,731.25" "$1,731.25" "$2,742.30" "$3,462.50" "$2,770.00" "$1,558.13" $687.22 N/A "$2,008.25" "$3,462.50" "$2,077.50" "$3,462.50" $721.59 "$3,462.50" N/A N/A SH-5123-S SUP HCPCS C1776 SH-5123-S - HEAD HUMERAL 51MM 23MM MODULAR POLARUS SHOULDER STERILE BOTH IP/OP "$3,462.50" "$2,562.00" $687.22 "$3,462.50" "$1,558.13" "$1,558.13" "$1,558.13" "$1,558.13" "$3,462.50" "$3,462.50" "$3,462.50" $721.67 "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" $721.62 "$3,462.50" "$1,385.00" "$1,707.01" "$3,462.50" "$3,462.50" "$3,462.50" "$3,462.50" "$2,596.88" "$3,462.50" "$3,462.50" "$3,462.50" "$1,731.25" "$1,731.25" "$2,742.30" "$3,462.50" "$2,770.00" "$1,558.13" $687.22 N/A "$2,008.25" "$3,462.50" "$2,077.50" "$3,462.50" $721.59 "$3,462.50" N/A N/A SH-R1307 SUP Custom 27203010 SH-R1307 - REAMER SURG 13MM 7MM SHLDR BOTH IP/OP $735.00 $544.00 $130.83 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $130.83 $735.00 $735.00 $545.52 $545.52 $566.54 $382.94 $153.18 $735.00 $294.00 $735.00 $735.00 $735.00 $735.00 $735.00 $551.25 $735.00 $735.00 $735.00 $367.50 $367.50 $582.12 $735.00 $588.00 $477.75 $735.00 N/A $426.30 $735.00 $441.00 $735.00 $735.00 $735.00 N/A N/A SH-R1308 SUP Custom 27203010 SH-R1308 - REAMER SURG 13MM 8MM SHLDR BOTH IP/OP $735.00 $544.00 $130.83 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $130.83 $735.00 $735.00 $545.52 $545.52 $566.54 $382.94 $153.18 $735.00 $294.00 $735.00 $735.00 $735.00 $735.00 $735.00 $551.25 $735.00 $735.00 $735.00 $367.50 $367.50 $582.12 $735.00 $588.00 $477.75 $735.00 N/A $426.30 $735.00 $441.00 $735.00 $735.00 $735.00 N/A N/A SH-R1309 SUP Custom 27203010 SH-R1309 - REAMER SURG 13MM 9MM SHLDR BOTH IP/OP $735.00 $544.00 $130.83 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $130.83 $735.00 $735.00 $545.52 $545.52 $566.54 $382.94 $153.18 $735.00 $294.00 $735.00 $735.00 $735.00 $735.00 $735.00 $551.25 $735.00 $735.00 $735.00 $367.50 $367.50 $582.12 $735.00 $588.00 $477.75 $735.00 N/A $426.30 $735.00 $441.00 $735.00 $735.00 $735.00 N/A N/A SH-R1310 SUP Custom 27203010 SH-R1310 - REAMER SURG 13MM 10MM SHLDR BOTH IP/OP $735.00 $544.00 $130.83 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $130.83 $735.00 $735.00 $545.52 $545.52 $566.54 $382.94 $153.18 $735.00 $294.00 $735.00 $735.00 $735.00 $735.00 $735.00 $551.25 $735.00 $735.00 $735.00 $367.50 $367.50 $582.12 $735.00 $588.00 $477.75 $735.00 N/A $426.30 $735.00 $441.00 $735.00 $735.00 $735.00 N/A N/A SH-R1311 SUP Custom 27203010 SH-R1311 - REAMER SURG 13MM 11MM SHLDR BOTH IP/OP $735.00 $544.00 $130.83 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $130.83 $735.00 $735.00 $545.52 $545.52 $566.54 $382.94 $153.18 $735.00 $294.00 $735.00 $735.00 $735.00 $735.00 $735.00 $551.25 $735.00 $735.00 $735.00 $367.50 $367.50 $582.12 $735.00 $588.00 $477.75 $735.00 N/A $426.30 $735.00 $441.00 $735.00 $735.00 $735.00 N/A N/A SH-R1312 SUP Custom 27203010 SH-R1312 - REAMER SURG 13MM 12MM SHLDR BOTH IP/OP $735.00 $544.00 $130.83 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $130.83 $735.00 $735.00 $545.52 $545.52 $566.54 $382.94 $153.18 $735.00 $294.00 $735.00 $735.00 $735.00 $735.00 $735.00 $551.25 $735.00 $735.00 $735.00 $367.50 $367.50 $582.12 $735.00 $588.00 $477.75 $735.00 N/A $426.30 $735.00 $441.00 $735.00 $735.00 $735.00 N/A N/A SH-R1313 SUP Custom 27203010 SH-R1313 - REAMER SURG 13MM 13MM SHLDR BOTH IP/OP $735.00 $544.00 $130.83 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $130.83 $735.00 $735.00 $545.52 $545.52 $566.54 $382.94 $153.18 $735.00 $294.00 $735.00 $735.00 $735.00 $735.00 $735.00 $551.25 $735.00 $735.00 $735.00 $367.50 $367.50 $582.12 $735.00 $588.00 $477.75 $735.00 N/A $426.30 $735.00 $441.00 $735.00 $735.00 $735.00 N/A N/A SH-R1514 SUP Custom 27203010 SH-R1514 - REAMER SURG 15MM 14MM SHLDR BOTH IP/OP $735.00 $544.00 $130.83 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $130.83 $735.00 $735.00 $545.52 $545.52 $566.54 $382.94 $153.18 $735.00 $294.00 $735.00 $735.00 $735.00 $735.00 $735.00 $551.25 $735.00 $735.00 $735.00 $367.50 $367.50 $582.12 $735.00 $588.00 $477.75 $735.00 N/A $426.30 $735.00 $441.00 $735.00 $735.00 $735.00 N/A N/A SH-R1515 SUP Custom 27203010 SH-R1515 - REAMER SURG 15MM 15MM SHLDR BOTH IP/OP $735.00 $544.00 $130.83 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $130.83 $735.00 $735.00 $545.52 $545.52 $566.54 $382.94 $153.18 $735.00 $294.00 $735.00 $735.00 $735.00 $735.00 $735.00 $551.25 $735.00 $735.00 $735.00 $367.50 $367.50 $582.12 $735.00 $588.00 $477.75 $735.00 N/A $426.30 $735.00 $441.00 $735.00 $735.00 $735.00 N/A N/A SH-R1716 SUP Custom 27203010 SH-R1716 - REAMER SURG 17MM 16MM SHLDR BOTH IP/OP $735.00 $544.00 $130.83 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $130.83 $735.00 $735.00 $545.52 $545.52 $566.54 $382.94 $153.18 $735.00 $294.00 $735.00 $735.00 $735.00 $735.00 $735.00 $551.25 $735.00 $735.00 $735.00 $367.50 $367.50 $582.12 $735.00 $588.00 $477.75 $735.00 N/A $426.30 $735.00 $441.00 $735.00 $735.00 $735.00 N/A N/A SH-R1717 SUP Custom 27203010 SH-R1717 - REAMER SURG 17MM 17MM SHLDR BOTH IP/OP $735.00 $544.00 $130.83 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $735.00 $130.83 $735.00 $735.00 $545.52 $545.52 $566.54 $382.94 $153.18 $735.00 $294.00 $735.00 $735.00 $735.00 $735.00 $735.00 $551.25 $735.00 $735.00 $735.00 $367.50 $367.50 $582.12 $735.00 $588.00 $477.75 $735.00 N/A $426.30 $735.00 $441.00 $735.00 $735.00 $735.00 N/A N/A SIG30AMT SUP Custom 27203010 SIG30AMT - RELOAD STPLR 30MM PUR STRL LF ARTC MED THKTIS DISP SIGNIA BOTH IP/OP $384.50 $285.00 $68.37 $384.08 $384.08 $384.08 $384.08 $384.08 $384.08 $384.08 $68.37 $384.08 $384.08 $285.06 $285.06 $296.05 $200.11 $80.05 $384.08 $121.96 $384.08 $384.08 $304.90 $384.08 $384.08 $288.38 $384.08 $384.08 $384.08 $192.04 $192.04 $304.19 $384.08 $307.26 $249.65 $384.08 N/A $223.01 $384.08 $230.45 $384.08 $384.08 $384.08 N/A N/A SIG30AVM SUP Custom 27203010 SIG30AVM - RELOAD STPLR 30MM TN STRL LF ARTC MED VASC TISS DISP SIGNIA BOTH IP/OP $371.00 $275.00 $65.98 $370.68 $370.68 $370.68 $370.68 $370.68 $370.68 $370.68 $65.98 $370.68 $370.68 $275.12 $275.12 $285.72 $193.12 $77.25 $370.68 $117.69 $370.68 $370.68 $294.23 $370.68 $370.68 $278.25 $370.68 $370.68 $370.68 $185.34 $185.34 $293.58 $370.68 $296.54 $240.94 $370.68 N/A $215.18 $370.68 $222.41 $370.68 $370.68 $370.68 N/A N/A SIG60CTAMT SUP Custom 27203010 SIG60CTAMT - RELOAD STPLR 60MM PUR STRL LF ARTC CRV TIP INTRO MED THKTIS BOTH IP/OP "$4,322.00" "$3,198.00" $769.28 "$4,321.80" "$4,321.80" "$4,321.80" "$4,321.80" "$4,321.80" "$4,321.80" "$4,321.80" $769.28 "$4,321.80" "$4,321.80" "$3,207.64" "$3,207.64" "$3,331.24" "$2,060.15" $900.71 "$4,321.80" "$1,728.72" "$4,321.80" "$4,321.80" "$4,321.80" "$4,321.80" "$4,321.80" "$3,241.50" "$4,321.80" "$4,321.80" "$4,321.80" "$2,160.90" "$2,160.90" "$3,422.87" "$4,321.80" "$3,457.44" "$2,809.17" "$4,321.80" N/A "$2,506.76" "$4,321.80" "$2,593.08" "$4,321.80" "$4,321.80" "$4,321.80" N/A N/A SILSPT12 SUP Custom 27203010 SILSPT12 - PORT ENDSCP 5MM 12MM FLEXIBLE CANNU OBTURATOR LATEX FREE BOTH IP/OP "$1,205.50" $892.00 $214.55 "$1,205.31" "$1,205.31" "$1,205.31" "$1,205.31" "$1,205.31" "$1,205.31" "$1,205.31" $214.55 "$1,205.31" "$1,205.31" $894.58 $894.58 $929.05 $627.97 $251.20 "$1,205.31" $482.12 "$1,205.31" "$1,205.31" "$1,205.31" "$1,205.31" "$1,205.31" $904.13 "$1,205.31" "$1,205.31" "$1,205.31" $602.66 $602.66 $954.61 "$1,205.31" $964.25 $783.45 "$1,205.31" N/A $699.19 "$1,205.31" $723.19 "$1,205.31" "$1,205.31" "$1,205.31" N/A N/A SK200 SUP Custom 27803010 SK200 - KIT SNR 90D MIC 2.3-3FR 2MM 175CM 150CM AGN CATH LOOP COIL BOTH IP/OP "$1,400.00" "$1,036.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $291.78 "$1,400.00" $560.00 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,050.00" "$1,400.00" "$1,400.00" "$1,400.00" $700.00 $700.00 "$1,108.80" "$1,400.00" "$1,120.00" $630.00 "$1,400.00" N/A $812.00 "$1,400.00" $840.00 "$1,400.00" "$1,400.00" "$1,400.00" N/A N/A SK400 SUP Custom 27803010 SK400 - KIT SNR MIC 4MM 2.3-3FR 175CM 150CM AGN BOTH IP/OP "$1,400.00" "$1,036.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $249.20 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" $291.78 "$1,400.00" $560.00 "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,400.00" "$1,050.00" "$1,400.00" "$1,400.00" "$1,400.00" $700.00 $700.00 "$1,108.80" "$1,400.00" "$1,120.00" $630.00 "$1,400.00" N/A $812.00 "$1,400.00" $840.00 "$1,400.00" "$1,400.00" "$1,400.00" N/A N/A SMC-5060 SUP Custom 27203010 SMC-5060 - ROD EXFIX 60MM SHAFT CARFBR STERILE SMALL BONE BOTH IP/OP $205.00 $152.00 $36.49 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $205.00 $36.49 $205.00 $205.00 $152.15 $152.15 $158.01 $106.81 $42.72 $205.00 $82.00 $205.00 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $133.25 $205.00 N/A $118.90 $205.00 $123.00 $205.00 $205.00 $205.00 N/A N/A SMC-5090 SUP HCPCS C1713 SMC-5090 - ROD EXFIX 90MM SHAFT CARFBR STERILE SMALL BONE BOTH IP/OP $205.00 $152.00 $40.69 $205.00 $92.25 $92.25 $92.25 $92.25 $205.00 $205.00 $205.00 $42.73 $205.00 $205.00 $205.00 $205.00 $205.00 $42.72 $205.00 $82.00 $121.26 $205.00 $205.00 $205.00 $205.00 $153.75 $205.00 $205.00 $205.00 $102.50 $102.50 $162.36 $205.00 $164.00 $92.25 $40.69 N/A $118.90 $205.00 $123.00 $205.00 $42.72 $205.00 N/A N/A SMS002 SUP Custom 27203010 SMS002 - SYSTEM FEC MGMT 60CC NS LF BARD DIGNISHIELD CATH SYR CLT BG BOTH IP/OP $372.50 $276.00 $66.31 $372.50 $372.50 $372.50 $372.50 $372.50 $372.50 $372.50 $66.31 $372.50 $372.50 $276.47 $276.47 $287.12 $194.07 $77.63 $372.50 $149.00 $372.50 $372.50 $372.50 $372.50 $372.50 $279.38 $372.50 $372.50 $372.50 $186.25 $186.25 $295.02 $372.50 $298.00 $242.13 $372.50 N/A $216.05 $372.50 $223.50 $372.50 $372.50 $372.50 N/A N/A SMT-5060 SUP Custom 27203010 SMT-5060 - ROD EXFIX 60MM SHAFT THREADED STABLELOC STAINLESS STEEL BOTH IP/OP $387.50 $287.00 $68.98 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $68.98 $387.50 $387.50 $287.60 $287.60 $298.69 $201.89 $80.76 $387.50 $155.00 $387.50 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $251.88 $387.50 N/A $224.75 $387.50 $232.50 $387.50 $387.50 $387.50 N/A N/A SMT-5090 SUP Custom 27203010 SMT-5090 - ROD EXFIX 90MM SHAFT STABLELOC STAINLESS STEEL STERILE SMALL BOTH IP/OP $387.50 $287.00 $68.98 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $387.50 $68.98 $387.50 $387.50 $287.60 $287.60 $298.69 $201.89 $80.76 $387.50 $155.00 $387.50 $387.50 $387.50 $387.50 $387.50 $290.63 $387.50 $387.50 $387.50 $193.75 $193.75 $306.90 $387.50 $310.00 $251.88 $387.50 N/A $224.75 $387.50 $232.50 $387.50 $387.50 $387.50 N/A N/A SN60AT SUP HCPCS V2632 SN60AT - LENS IOL 0D MOD L BCNVX 6MM 13MM STRL ACRSF N STABLEFORCE 1 BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.060 SUP HCPCS V2632 SN60AT.060 - LENS IOL 0 D +6 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.070 SUP HCPCS V2632 SN60AT.070 - LENS IOL 0 D +7 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.075 SUP HCPCS V2632 SN60AT.075 - LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.080 SUP HCPCS V2632 SN60AT.080 - LENS IOL 0 D +8 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.085 SUP HCPCS V2632 SN60AT.085 - LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.090 SUP HCPCS V2632 SN60AT.090 - LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.095 SUP HCPCS V2632 SN60AT.095 - LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.100 SUP HCPCS V2632 SN60AT.100 - LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.105 SUP HCPCS V2632 SN60AT.105 - LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.110 SUP HCPCS V2632 SN60AT.110 - LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.115 SUP HCPCS V2632 SN60AT.115 - LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.120 SUP HCPCS V2632 SN60AT.120 - LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.125 SUP HCPCS V2632 SN60AT.125 - LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.130 SUP HCPCS V2632 SN60AT.130 - LENS IOL 0 D +13 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.135 SUP HCPCS V2632 SN60AT.135 - LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.140 SUP HCPCS V2632 SN60AT.140 - LENS IOL 0 D +14 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.145 SUP HCPCS V2632 SN60AT.145 - LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.150 SUP HCPCS V2632 SN60AT.150 - LENS IOL 0 D +15 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.155 SUP HCPCS V2632 SN60AT.155 - LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.160 SUP HCPCS V2632 SN60AT.160 - LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.165 SUP HCPCS V2632 SN60AT.165 - LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.170 SUP HCPCS V2632 SN60AT.170 - LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.175 SUP HCPCS V2632 SN60AT.175 - LENS IOL 0 D +17.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.180 SUP HCPCS V2632 SN60AT.180 - LENS IOL 0 D +18 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.185 SUP HCPCS V2632 SN60AT.185 - LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.190 SUP HCPCS V2632 SN60AT.190 - LENS IOL 0 D +19 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.195 SUP HCPCS V2632 SN60AT.195 - LENS IOL 0 D +19.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.200 SUP HCPCS V2632 SN60AT.200 - LENS IOL 0 D +20 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.205 SUP HCPCS V2632 SN60AT.205 - LENS IOL 0 D +20.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.210 SUP HCPCS V2632 SN60AT.210 - LENS IOL 0 D +21 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.215 SUP HCPCS V2632 SN60AT.215 - LENS IOL 0 D +21.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.220 SUP HCPCS V2632 SN60AT.220 - LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.225 SUP HCPCS V2632 SN60AT.225 - LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.230 SUP HCPCS V2632 SN60AT.230 - LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.235 SUP HCPCS V2632 SN60AT.235 - LENS IOL 0 D +23.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.240 SUP HCPCS V2632 SN60AT.240 - LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.245 SUP HCPCS V2632 SN60AT.245 - LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.250 SUP HCPCS V2632 SN60AT.250 - LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.255 SUP HCPCS V2632 SN60AT.255 - LENS IOL 0 D +25.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.260 SUP HCPCS V2632 SN60AT.260 - LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.265 SUP HCPCS V2632 SN60AT.265 - LENS IOL 0 D +26.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.270 SUP HCPCS V2632 SN60AT.270 - LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.275 SUP HCPCS V2632 SN60AT.275 - LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.280 SUP HCPCS V2632 SN60AT.280 - LENS IOL 0 D +28 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.285 SUP HCPCS V2632 SN60AT.285 - LENS IOL 0 D +28.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.295 SUP HCPCS V2632 SN60AT.295 - LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.300 SUP HCPCS V2632 SN60AT.300 - LENS IOL 0 D +30 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.310 SUP HCPCS V2632 SN60AT.310 - LENS IOL 0 D +31 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.320 SUP HCPCS V2632 SN60AT.320 - LENS IOL 0 D +32 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.330 SUP HCPCS V2632 SN60AT.330 - LENS IOL 0 D +33 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.340 SUP HCPCS V2632 SN60AT.340 - LENS IOL 0 D +34 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $283.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.350 SUP HCPCS V2632 SN60AT.350 - LENS IOL 0 D +35 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.360 SUP HCPCS V2632 SN60AT.360 - LENS IOL 0 D +36 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.370 SUP HCPCS V2632 SN60AT.370 - LENS IOL 0 D +37 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.380 SUP HCPCS V2632 SN60AT.380 - LENS IOL 0 D +38 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.390 SUP HCPCS V2632 SN60AT.390 - LENS IOL 0 D +39 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60AT.400 SUP HCPCS V2632 SN60AT.400 - LENS IOL 0 D +40 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF N BOTH IP/OP $472.50 $350.00 $93.78 $472.50 $212.63 $212.63 $212.63 $212.63 $472.50 $472.50 $472.50 $98.48 $472.50 $472.50 $472.50 $472.50 $472.50 $98.47 $472.50 $472.50 $279.48 $472.50 $472.50 $472.50 $472.50 $354.38 $472.50 $472.50 $472.50 $236.25 $236.25 $374.22 $472.50 $378.00 $212.63 $93.78 N/A $274.05 $472.50 $472.50 $472.50 $98.47 $472.50 N/A N/A SN60WF SUP HCPCS V2632 SN60WF - LENS IOL 0D MOD L BCNVX 6MM 13MM STRL ACRSF IQ 1 PC FLD ANT BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.065 SUP HCPCS V2632 SN60WF.065 - LENS IOL 0 D +6.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.075 SUP HCPCS V2632 SN60WF.075 - LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.085 SUP HCPCS V2632 SN60WF.085 - LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.090 SUP HCPCS V2632 SN60WF.090 - LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.095 SUP HCPCS V2632 SN60WF.095 - LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.100 SUP HCPCS V2632 SN60WF.100 - LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.105 SUP HCPCS V2632 SN60WF.105 - LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.110 SUP HCPCS V2632 SN60WF.110 - LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.115 SUP HCPCS V2632 SN60WF.115 - LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.120 SUP HCPCS V2632 SN60WF.120 - LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.125 SUP HCPCS V2632 SN60WF.125 - LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.135 SUP HCPCS V2632 SN60WF.135 - LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.145 SUP HCPCS V2632 SN60WF.145 - LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.155 SUP HCPCS V2632 SN60WF.155 - LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.160 SUP HCPCS V2632 SN60WF.160 - LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.165 SUP HCPCS V2632 SN60WF.165 - LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.170 SUP HCPCS V2632 SN60WF.170 - LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.185 SUP HCPCS V2632 SN60WF.185 - LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.215 SUP HCPCS V2632 SN60WF.215 - LENS IOL 0 D +21.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.220 SUP HCPCS V2632 SN60WF.220 - LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.225 SUP HCPCS V2632 SN60WF.225 - LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.230 SUP HCPCS V2632 SN60WF.230 - LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.240 SUP HCPCS V2632 SN60WF.240 - LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.245 SUP HCPCS V2632 SN60WF.245 - LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.250 SUP HCPCS V2632 SN60WF.250 - LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.260 SUP HCPCS V2632 SN60WF.260 - LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.270 SUP HCPCS V2632 SN60WF.270 - LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.275 SUP HCPCS V2632 SN60WF.275 - LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.280 SUP HCPCS V2632 SN60WF.280 - LENS IOL 0 D +28 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.290 SUP HCPCS V2632 SN60WF.290 - LENS IOL 0 D +29 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.295 SUP HCPCS V2632 SN60WF.295 - LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A SN60WF.300 SUP HCPCS V2632 SN60WF.300 - LENS IOL 0 D +30 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $285.00 $475.00 $98.99 $475.00 N/A N/A SN60WS SUP HCPCS V2632 SN60WS - LENS IOL 0D BCNVX 6MM 13MM STRL ACRSF IQ NTR STABLEFORCE BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.060 SUP HCPCS V2632 SN60WS.060 - LENS IOL 0 D +6 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" $721.50 "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.065 SUP HCPCS V2632 SN60WS.065 - LENS IOL 0 D +6.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" $721.50 "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.070 SUP HCPCS V2632 SN60WS.070 - LENS IOL 0 D +7 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" $721.50 "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.075 SUP HCPCS V2632 SN60WS.075 - LENS IOL 0 D +7.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.080 SUP HCPCS V2632 SN60WS.080 - LENS IOL 0 D +8 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.085 SUP HCPCS V2632 SN60WS.085 - LENS IOL 0 D +8.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.090 SUP HCPCS V2632 SN60WS.090 - LENS IOL 0 D +9 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.095 SUP HCPCS V2632 SN60WS.095 - LENS IOL 0 D +9.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" $721.50 "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.100 SUP HCPCS V2632 SN60WS.100 - LENS IOL 0 D +10 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" $721.50 "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.105 SUP HCPCS V2632 SN60WS.105 - LENS IOL 0 D +10.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" $721.50 "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.110 SUP HCPCS V2632 SN60WS.110 - LENS IOL 0 D +11 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" $721.50 "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.115 SUP HCPCS V2632 SN60WS.115 - LENS IOL 0 D +11.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" $721.50 "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.120 SUP HCPCS V2632 SN60WS.120 - LENS IOL 0 D +12 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.125 SUP HCPCS V2632 SN60WS.125 - LENS IOL 0 D +12.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.130 SUP HCPCS V2632 SN60WS.130 - LENS IOL 0 D +13 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.135 SUP HCPCS V2632 SN60WS.135 - LENS IOL 0 D +13.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.140 SUP HCPCS V2632 SN60WS.140 - LENS IOL 0 D +14 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.145 SUP HCPCS V2632 SN60WS.145 - LENS IOL 0 D +14.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.150 SUP HCPCS V2632 SN60WS.150 - LENS IOL 0 D +15 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.155 SUP HCPCS V2632 SN60WS.155 - LENS IOL 0 D +15.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.160 SUP HCPCS V2632 SN60WS.160 - LENS IOL 0 D +16 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.165 SUP HCPCS V2632 SN60WS.165 - LENS IOL 0 D +16.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.170 SUP HCPCS V2632 SN60WS.170 - LENS IOL 0 D +17 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.175 SUP HCPCS V2632 SN60WS.175 - LENS IOL 0 D +17.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.180 SUP HCPCS V2632 SN60WS.180 - LENS IOL 0 D +18 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.185 SUP HCPCS V2632 SN60WS.185 - LENS IOL 0 D +18.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.190 SUP HCPCS V2632 SN60WS.190 - LENS IOL 0 D +19 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.195 SUP HCPCS V2632 SN60WS.195 - LENS IOL 0 D +19.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.200 SUP HCPCS V2632 SN60WS.200 - LENS IOL 0 D +20 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.205 SUP HCPCS V2632 SN60WS.205 - LENS IOL 0 D +20.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.210 SUP HCPCS V2632 SN60WS.210 - LENS IOL 0 D +21 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.215 SUP HCPCS V2632 SN60WS.215 - LENS IOL 0 D +21.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.220 SUP HCPCS V2632 SN60WS.220 - LENS IOL 0 D +22 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.225 SUP HCPCS V2632 SN60WS.225 - LENS IOL 0 D +22.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.230 SUP HCPCS V2632 SN60WS.230 - LENS IOL 0 D +23 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.235 SUP HCPCS V2632 SN60WS.235 - LENS IOL 0 D +23.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.240 SUP HCPCS V2632 SN60WS.240 - LENS IOL 0 D +24 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.245 SUP HCPCS V2632 SN60WS.245 - LENS IOL 0 D +24.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.250 SUP HCPCS V2632 SN60WS.250 - LENS IOL 0 D +25 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.255 SUP HCPCS V2632 SN60WS.255 - LENS IOL 0 D +25.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.260 SUP HCPCS V2632 SN60WS.260 - LENS IOL 0 D +26 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.265 SUP HCPCS V2632 SN60WS.265 - LENS IOL 0 D +26.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.270 SUP HCPCS V2632 SN60WS.270 - LENS IOL 0 D +27 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.275 SUP HCPCS V2632 SN60WS.275 - LENS IOL 0 D +27.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" $721.50 "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.280 SUP HCPCS V2632 SN60WS.280 - LENS IOL 0 D +28 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" $721.50 "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.285 SUP HCPCS V2632 SN60WS.285 - LENS IOL 0 D +28.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.290 SUP HCPCS V2632 SN60WS.290 - LENS IOL 0 D +29 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.295 SUP HCPCS V2632 SN60WS.295 - LENS IOL 0 D +29.5 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN60WS.300 SUP HCPCS V2632 SN60WS.300 - LENS IOL 0 D +30 DIOP BCNVX 6MM 13MM STRL ACRSF IQ NTR BOTH IP/OP "$1,202.50" $890.00 $238.67 "$1,202.50" $541.13 $541.13 $541.13 $541.13 "$1,202.50" "$1,202.50" "$1,202.50" $250.63 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $250.61 "$1,202.50" "$1,202.50" $711.28 "$1,202.50" "$1,202.50" "$1,202.50" "$1,202.50" $901.88 "$1,202.50" "$1,202.50" "$1,202.50" $601.25 $601.25 $952.38 "$1,202.50" $962.00 $541.13 $238.67 N/A $697.45 "$1,202.50" "$1,202.50" "$1,202.50" $250.60 "$1,202.50" N/A N/A SN6AT3.150 SUP HCPCS V2787 SN6AT3.150 - DRILL SRG 2.1MM 110MM CNN TI BOTH IP/OP $995.00 $736.00 $207.37 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $207.37 $995.00 $398.00 $995.00 $995.00 $995.00 $995.00 $995.00 $746.25 $995.00 $995.00 $995.00 $497.50 $497.50 $788.04 $995.00 $796.00 $447.75 $995.00 N/A $577.10 $995.00 $597.00 $995.00 $995.00 $995.00 N/A N/A SN6AT3.210 SUP HCPCS V2787 SN6AT3.210 - LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI BOTH IP/OP "$1,237.50" $916.00 $257.91 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A SN6AT3.215 SUP HCPCS V2787 SN6AT3.215 - LENS IOL 0 D +21.5 DIOP +1.5 CYL BCNVX 6MM 13MM STRL ACRSF BOTH IP/OP $995.00 $736.00 $207.37 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $995.00 $207.37 $995.00 $398.00 $995.00 $995.00 $995.00 $995.00 $995.00 $746.25 $995.00 $995.00 $995.00 $497.50 $497.50 $788.04 $995.00 $796.00 $447.75 $995.00 N/A $577.10 $995.00 $597.00 $995.00 $995.00 $995.00 N/A N/A SN6AT5.145 SUP HCPCS V2632 SN6AT5.145 - LENS IOL 0 D +14.5 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" "$1,487.50" $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A SN6AT5.150 SUP HCPCS V2632 SN6AT5.150 - LENS IOL 0 D +15 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP "$1,487.50" "$1,101.00" $295.23 "$1,487.50" $669.38 $669.38 $669.38 $669.38 "$1,487.50" "$1,487.50" "$1,487.50" $310.03 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" $310.01 "$1,487.50" "$1,487.50" $879.86 "$1,487.50" "$1,487.50" "$1,487.50" "$1,487.50" "$1,115.63" "$1,487.50" "$1,487.50" "$1,487.50" $743.75 $743.75 "$1,178.10" "$1,487.50" "$1,190.00" $669.38 $295.23 N/A $862.75 "$1,487.50" "$1,487.50" "$1,487.50" $310.00 "$1,487.50" N/A N/A SN6AT5.165 SUP HCPCS V2787 SN6AT5.165 - LENS IOL 0 D +16.5 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP "$1,237.50" $916.00 $257.91 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A SN6AT5.185 SUP HCPCS V2787 SN6AT5.185 - LENS IOL 0 D +18.5 DIOP +3 CYL BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP "$1,237.50" $916.00 $257.91 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A SN6AT5.220 SUP HCPCS V2787 SN6AT5.220 - LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI BOTH IP/OP "$1,237.50" $916.00 $257.91 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A SN6AT5.225 SUP HCPCS V2787 SN6AT5.225 - LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI BOTH IP/OP "$1,237.50" $916.00 $257.91 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A SN6AT6.175 SUP HCPCS V2787 SN6AT6.175 - LENS IOL 0 D +17.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF BOTH IP/OP "$1,237.50" $916.00 $257.91 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A SN6AT6.195 SUP HCPCS V2632 SN6AT6.195 - LENS IOL 0 D +19.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" "$1,237.50" $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" $257.90 "$1,237.50" N/A N/A SN6AT6.205 SUP HCPCS V2632 SN6AT6.205 - LENS IOL 0 D +20.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" "$1,237.50" $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" $257.90 "$1,237.50" N/A N/A SN6AT6.215 SUP HCPCS V2787 SN6AT6.215 - LENS IOL 0 D +21.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF BOTH IP/OP "$1,237.50" $916.00 $257.91 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A SN6AT6.245 SUP HCPCS V2632 SN6AT6.245 - LENS IOL 0 D +24.5 DIOP +3.75 CYL BCNVX 6MM 13MM STRL ACRSF BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" "$1,237.50" $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" $257.90 "$1,237.50" N/A N/A SN6AT6.250 SUP HCPCS V2632 SN6AT6.250 - LENS IOL +25 DIOPTER +3.75 CYLINDER 0 D BICNVX 6MM 13MM 1 BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" "$1,237.50" $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" $257.90 "$1,237.50" N/A N/A SN6AT7.115 SUP HCPCS V2632 SN6AT7.115 - LENS IOL 0 D +11.5 DIOP +4.5 CYL BCNVX 6MM 13MM STRL ACRSF BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" "$1,237.50" $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" $257.90 "$1,237.50" N/A N/A SN6AT7.205 SUP HCPCS V2632 SN6AT7.205 - LENS IOL 0 D +20.5 DIOP +4.5 CYL BCNVX 6MM 13MM STRL ACRSF BOTH IP/OP "$1,237.50" $916.00 $245.61 "$1,237.50" $556.88 $556.88 $556.88 $556.88 "$1,237.50" "$1,237.50" "$1,237.50" $257.93 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" "$1,237.50" $731.98 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 $245.61 N/A $717.75 "$1,237.50" "$1,237.50" "$1,237.50" $257.90 "$1,237.50" N/A N/A SN6AT7U230 SUP HCPCS V2787 SN6AT7U230 - LENS IOL 0 D +23 DIOP +4.5 CYL BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP "$1,237.50" $916.00 $257.91 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A SN6AT8.160 SUP HCPCS V2787 SN6AT8.160 - LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE NATURAL ACRYLI BOTH IP/OP "$1,237.50" $916.00 $257.91 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A SN6AT8U150 SUP HCPCS V2787 SN6AT8U150 - LENS INTRAOCULAR ACRYSOF IQ TORIC STABLEFORCE ACRYLIC 0 D +1 BOTH IP/OP "$1,237.50" $916.00 $257.91 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A SN6AT9.165 SUP HCPCS V2787 SN6AT9.165 - LENS IOL 0 D +16.5 DIOP +6 CYL BICNVX 13MM 6MM BOTH IP/OP "$1,237.50" $916.00 $257.91 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A SN6AT9.170 SUP HCPCS V2787 SN6AT9.170 - LENS IOL 0 D +17 DIOP +6 CYL BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP "$1,237.50" $916.00 $257.91 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $257.91 "$1,237.50" $495.00 "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" "$1,237.50" $928.13 "$1,237.50" "$1,237.50" "$1,237.50" $618.75 $618.75 $980.10 "$1,237.50" $990.00 $556.88 "$1,237.50" N/A $717.75 "$1,237.50" $742.50 "$1,237.50" "$1,237.50" "$1,237.50" N/A N/A SN6AT9U210 SUP HCPCS V2632 SN6AT9U210 - LENS IOL 0 D +21 DIOP +6 CYL BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $995.00 $736.00 $197.48 $995.00 $447.75 $447.75 $447.75 $447.75 $995.00 $995.00 $995.00 $207.38 $995.00 $995.00 $995.00 $995.00 $995.00 $207.37 $995.00 $995.00 $588.54 $995.00 $995.00 $995.00 $995.00 $746.25 $995.00 $995.00 $995.00 $497.50 $497.50 $788.04 $995.00 $796.00 $447.75 $197.48 N/A $577.10 $995.00 $995.00 $995.00 $207.36 $995.00 N/A N/A SN6CWS SUP HCPCS V2632 SN6CWS - LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $238.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.060 SUP HCPCS V2632 SN6CWS.060 - LENS IOL 0 D +6 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.065 SUP HCPCS V2632 SN6CWS.065 - LENS IOL 0 D +6.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.070 SUP HCPCS V2632 SN6CWS.070 - LENS IOL 0 D +7 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.075 SUP HCPCS V2632 SN6CWS.075 - LENS IOL 0 D +7.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.080 SUP HCPCS V2632 SN6CWS.080 - LENS IOL 0 D +8 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.085 SUP HCPCS V2632 SN6CWS.085 - LENS IOL 0 D +8.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.090 SUP HCPCS V2632 SN6CWS.090 - LENS IOL 0 D +9 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.095 SUP HCPCS V2632 SN6CWS.095 - LENS IOL 0 D +9.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $238.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.100 SUP HCPCS V2632 SN6CWS.100 - LENS IOL 0 D +10 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $238.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.105 SUP HCPCS V2632 SN6CWS.105 - LENS IOL 0 D +10.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $238.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.110 SUP HCPCS V2632 SN6CWS.110 - LENS IOL 0 D +11 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $238.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.115 SUP HCPCS V2632 SN6CWS.115 - LENS IOL 0 D +11.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.120 SUP HCPCS V2632 SN6CWS.120 - LENS IOL 0 D +12 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.125 SUP HCPCS V2632 SN6CWS.125 - LENS IOL 0 D +12.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.130 SUP HCPCS V2632 SN6CWS.130 - LENS IOL 0 D +13 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.135 SUP HCPCS V2632 SN6CWS.135 - LENS IOL 0 D +13.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.140 SUP HCPCS V2632 SN6CWS.140 - LENS IOL 0 D +14 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.145 SUP HCPCS V2632 SN6CWS.145 - LENS IOL 0 D +14.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.150 SUP HCPCS V2632 SN6CWS.150 - LENS IOL 0 D +15 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $238.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.155 SUP HCPCS V2632 SN6CWS.155 - LENS IOL 0 D +15.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.160 SUP HCPCS V2632 SN6CWS.160 - LENS IOL 0 D +16 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.165 SUP HCPCS V2632 SN6CWS.165 - LENS IOL 0 D +16.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $238.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.170 SUP HCPCS V2632 SN6CWS.170 - LENS IOL 0 D +17 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $238.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.175 SUP HCPCS V2632 SN6CWS.175 - LENS IOL 0 D +17.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $238.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.180 SUP HCPCS V2632 SN6CWS.180 - LENS IOL 0 D +18 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.185 SUP HCPCS V2632 SN6CWS.185 - LENS IOL 0 D +18.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.190 SUP HCPCS V2632 SN6CWS.190 - LENS IOL 0 D +19 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.195 SUP HCPCS V2632 SN6CWS.195 - LENS IOL 0 D +19.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.200 SUP HCPCS V2632 SN6CWS.200 - LENS IOL 0 D +20 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.205 SUP HCPCS V2632 SN6CWS.205 - LENS IOL 0 D +20.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.210 SUP HCPCS V2632 SN6CWS.210 - LENS IOL 0 D +21 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.215 SUP HCPCS V2632 SN6CWS.215 - LENS IOL 0 D +21.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.220 SUP HCPCS V2632 SN6CWS.220 - LENS IOL 0 D +22 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.225 SUP HCPCS V2632 SN6CWS.225 - LENS IOL 0 D +22.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.230 SUP HCPCS V2632 SN6CWS.230 - LENS IOL 0 D +23 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $238.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.235 SUP HCPCS V2632 SN6CWS.235 - LENS IOL 0 D +23.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.240 SUP HCPCS V2632 SN6CWS.240 - LENS IOL 0 D +24 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.245 SUP HCPCS V2632 SN6CWS.245 - LENS IOL 0 D +24.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.250 SUP HCPCS V2632 SN6CWS.250 - LENS IOL 0 D +25 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.255 SUP HCPCS V2632 SN6CWS.255 - LENS IOL 0 D +25.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.260 SUP HCPCS V2632 SN6CWS.260 - LENS IOL 0 D +26 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.265 SUP HCPCS V2632 SN6CWS.265 - LENS IOL 0 D +26.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $238.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.270 SUP HCPCS V2632 SN6CWS.270 - LENS IOL 0 D +27 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.275 SUP HCPCS V2632 SN6CWS.275 - LENS IOL 0 D +27.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $238.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.280 SUP HCPCS V2632 SN6CWS.280 - LENS IOL 0 D +28 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $397.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.295 SUP HCPCS V2632 SN6CWS.295 - LENS IOL 0 D +29.5 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $238.50 $397.50 $82.84 $397.50 N/A N/A SN6CWS.300 SUP HCPCS V2632 SN6CWS.300 - LENS IOL 0 D +30 DIOP MOD L BCNVX 6MM 13MM STRL ACRSF IQ BOTH IP/OP $397.50 $294.00 $78.89 $397.50 $178.88 $178.88 $178.88 $178.88 $397.50 $397.50 $397.50 $82.85 $397.50 $397.50 $397.50 $397.50 $397.50 $82.84 $397.50 $397.50 $235.12 $397.50 $397.50 $397.50 $397.50 $298.13 $397.50 $397.50 $397.50 $198.75 $198.75 $314.82 $397.50 $318.00 $178.88 $78.89 N/A $230.55 $397.50 $238.50 $397.50 $82.84 $397.50 N/A N/A SNEVAVPGMA SUP Custom 27203010 SNEVAVPGMA - PACK CAH VP SHUNT CUSTOM BOTH IP/OP $310.50 $230.00 $55.27 $329.10 $310.48 $310.48 $310.48 $310.48 $310.48 $310.48 $55.27 $310.48 $310.48 $230.44 $230.44 $239.32 $161.76 $64.71 $310.48 $138.22 $310.48 $310.48 $329.10 $310.48 $310.48 $232.88 $310.48 $310.48 $310.48 $155.24 $155.24 $245.90 $310.48 $248.38 $201.81 $310.48 N/A $180.09 $310.48 $186.29 $310.48 $310.48 $310.48 N/A N/A SOFT33 SUP Custom 27203010 SOFT33 - INSERT CLMP 33MM SOFTJAW SET ATRAUMATIC OCCLUSION HIGH FLOW BOTH IP/OP $32.50 $24.00 $5.79 $35.15 $32.50 $32.50 $32.50 $32.50 $32.50 $32.50 $5.79 $32.50 $32.50 $24.12 $24.12 $25.05 $16.93 $6.77 $32.50 $16.87 $32.50 $32.50 $35.15 $32.50 $32.50 $24.38 $32.50 $32.50 $32.50 $16.25 $16.25 $25.74 $32.50 $26.00 $21.13 $32.50 N/A $18.85 $32.50 $19.50 $32.50 $32.50 $32.50 N/A N/A SOFT61 SUP Custom 27203010 SOFT61 - INSERT CLMP 61MM SOFTJAW SET ATRAUMATIC OCCLUSION HIGH FLOW BOTH IP/OP $37.50 $28.00 $6.68 $40.55 $37.50 $37.50 $37.50 $37.50 $37.50 $37.50 $6.68 $37.50 $37.50 $27.83 $27.83 $28.91 $19.54 $7.82 $37.50 $19.46 $37.50 $37.50 $40.55 $37.50 $37.50 $28.13 $37.50 $37.50 $37.50 $18.75 $18.75 $29.70 $37.50 $30.00 $24.38 $37.50 N/A $21.75 $37.50 $22.50 $37.50 $37.50 $37.50 N/A N/A SOFT86 SUP Custom 27203010 SOFT86 - INSERT CLP 86MM STRL LF FGRTY-HYDRGRP SFJW SET ATRM OCL HFLO BOTH IP/OP $40.00 $30.00 $7.12 $43.25 $40.00 $40.00 $40.00 $40.00 $40.00 $40.00 $7.12 $40.00 $40.00 $29.69 $29.69 $30.83 $20.84 $8.34 $40.00 $20.76 $40.00 $40.00 $43.25 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $26.00 $40.00 N/A $23.20 $40.00 $24.00 $40.00 $40.00 $40.00 N/A N/A SOPVAHPGMA SUP Custom 27203010 SOPVAHPGMA - PACK CAH CARPAL TUNNEL CUSTOM BOTH IP/OP $81.50 $60.00 $14.49 $81.43 $81.43 $81.43 $81.43 $81.43 $81.43 $81.43 $14.49 $81.43 $81.43 $60.44 $60.44 $62.77 $42.43 $16.97 $81.43 $32.57 $81.43 $81.43 $81.43 $81.43 $81.43 $61.13 $81.43 $81.43 $81.43 $40.72 $40.72 $64.49 $81.43 $65.14 $52.93 $81.43 N/A $47.27 $81.43 $48.86 $81.43 $81.43 $81.43 N/A N/A SP-1863 SUP HCPCS C1713 SP-1863 - COVER BURR HOLE 18.5MM SLOT TEFLON PI BOTH IP/OP $835.00 $618.00 $165.73 $835.00 $375.75 $375.75 $375.75 $375.75 $835.00 $835.00 $835.00 $174.03 $835.00 $835.00 $835.00 $835.00 $835.00 $174.02 $835.00 $334.00 $493.90 $835.00 $835.00 $835.00 $835.00 $626.25 $835.00 $835.00 $835.00 $417.50 $417.50 $661.32 $835.00 $668.00 $375.75 $165.73 N/A $484.30 $835.00 $501.00 $835.00 $174.01 $835.00 N/A N/A SP-1864 SUP HCPCS C1713 SP-1864 - PLATE BONE 26MM 2X4 HOLE MATRIX ORAL CRANIOMAXILLOFACIAL BOTH IP/OP $870.00 $644.00 $172.67 $870.00 $391.50 $391.50 $391.50 $391.50 $870.00 $870.00 $870.00 $181.33 $870.00 $870.00 $870.00 $870.00 $870.00 $181.32 $870.00 $870.00 $514.61 $870.00 $870.00 $870.00 $870.00 $652.50 $870.00 $870.00 $870.00 $435.00 $435.00 $689.04 $870.00 $696.00 $391.50 $172.67 N/A $504.60 $870.00 $522.00 $870.00 $181.31 $870.00 N/A N/A SP-1865 SUP HCPCS C1713 SP-1865 - MESH CRNL .2MM NS LORENZ TRAUMAONE MDFC ORBT FLR 1.5MM SCR BOTH IP/OP "$3,670.00" "$2,716.00" $728.40 "$3,670.00" "$1,651.50" "$1,651.50" "$1,651.50" "$1,651.50" "$3,670.00" "$3,670.00" "$3,670.00" $764.92 "$3,670.00" "$3,670.00" "$3,670.00" "$3,670.00" "$3,670.00" $764.87 "$3,670.00" "$1,468.00" "$1,809.31" "$3,670.00" "$3,670.00" "$3,670.00" "$3,670.00" "$2,752.50" "$3,670.00" "$3,670.00" "$3,670.00" "$1,835.00" "$1,835.00" "$2,906.64" "$3,670.00" "$2,936.00" "$1,651.50" $728.40 N/A "$2,128.60" "$3,670.00" "$3,670.00" "$3,670.00" $764.83 "$3,670.00" N/A N/A SP-1889 SUP Custom 27203010 SP-1889 - BLADE SURG 7X2MM REDX BOTH IP/OP $757.50 $561.00 $134.84 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $757.50 $134.84 $757.50 $757.50 $562.22 $562.22 $583.88 $394.66 $157.87 $757.50 $303.00 $757.50 $757.50 $757.50 $757.50 $757.50 $568.13 $757.50 $757.50 $757.50 $378.75 $378.75 $599.94 $757.50 $606.00 $492.38 $757.50 N/A $439.35 $757.50 $454.50 $757.50 $757.50 $757.50 N/A N/A SP-1942 SUP HCPCS C1713 SP-1942 - PLATE SHUNT MEDIUM 18.5MM SPECIALTY X-DRIVE THINFLAP BOTH IP/OP $847.50 $627.00 $168.21 $847.50 $381.38 $381.38 $381.38 $381.38 $847.50 $847.50 $847.50 $176.64 $847.50 $847.50 $847.50 $847.50 $847.50 $176.63 $847.50 $339.00 $501.30 $847.50 $847.50 $847.50 $847.50 $635.63 $847.50 $847.50 $847.50 $423.75 $423.75 $671.22 $847.50 $678.00 $381.38 $168.21 N/A $491.55 $847.50 $508.50 $847.50 $176.62 $847.50 N/A N/A SP-2032 SUP HCPCS C1713 SP-2032 - SCREW BONE 2.5MM 6MM SLFDRILL REDX BLADE BYRD LORENZ BOTH IP/OP "$1,032.50" $764.00 $204.93 "$1,032.50" $464.63 $464.63 $464.63 $464.63 "$1,032.50" "$1,032.50" "$1,032.50" $215.20 "$1,032.50" "$1,032.50" "$1,032.50" "$1,032.50" "$1,032.50" $215.18 "$1,032.50" $413.00 $610.72 "$1,032.50" "$1,032.50" "$1,032.50" "$1,032.50" $774.38 "$1,032.50" "$1,032.50" "$1,032.50" $516.25 $516.25 $817.74 "$1,032.50" $826.00 $464.63 $204.93 N/A $598.85 "$1,032.50" $619.50 "$1,032.50" $215.17 "$1,032.50" N/A N/A SP-2256 SUP HCPCS C1713 SP-2256 - PLATE BONE 1MM SPECIALTY TRAUMAONE MANDIB BOTH IP/OP "$1,847.50" "$1,367.00" $366.68 "$1,847.50" $831.38 $831.38 $831.38 $831.38 "$1,847.50" "$1,847.50" "$1,847.50" $385.07 "$1,847.50" "$1,847.50" "$1,847.50" "$1,847.50" "$1,847.50" $385.04 "$1,847.50" "$1,847.50" "$1,092.80" "$1,847.50" "$1,847.50" "$1,847.50" "$1,847.50" "$1,385.63" "$1,847.50" "$1,847.50" "$1,847.50" $923.75 $923.75 "$1,463.22" "$1,847.50" "$1,478.00" $831.38 $366.68 N/A "$1,071.55" "$1,847.50" "$1,108.50" "$1,847.50" $385.02 "$1,847.50" N/A N/A SP-2258 SUP Custom 27203010 SP-2258 - TAP SURG 2.3MM BOTH IP/OP "$1,592.50" "$1,178.00" $283.47 "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" $283.47 "$1,592.50" "$1,592.50" "$1,181.95" "$1,181.95" "$1,227.50" $829.69 $331.89 "$1,592.50" $637.00 "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,592.50" "$1,194.38" "$1,592.50" "$1,592.50" "$1,592.50" $796.25 $796.25 "$1,261.26" "$1,592.50" "$1,274.00" "$1,035.13" "$1,592.50" N/A $923.65 "$1,592.50" $955.50 "$1,592.50" "$1,592.50" "$1,592.50" N/A N/A SP-2276 SUP HCPCS C1713 SP-2276 - PLATE BONE THK2.6MM SMALL SPECIALTY SYSTEM LORENZ BOTH IP/OP "$9,147.50" "$6,769.00" "$1,815.55" "$9,147.50" "$4,116.38" "$4,116.38" "$4,116.38" "$4,116.38" "$9,147.50" "$9,147.50" "$9,147.50" "$1,906.57" "$9,147.50" "$9,147.50" "$9,147.50" "$9,147.50" "$9,147.50" "$1,906.44" "$9,147.50" "$3,659.00" "$4,509.72" "$9,147.50" "$9,147.50" "$9,147.50" "$9,147.50" "$6,860.63" "$9,147.50" "$9,147.50" "$9,147.50" "$4,573.75" "$4,573.75" "$7,244.82" "$9,147.50" "$7,318.00" "$4,116.38" "$1,815.55" N/A "$5,305.55" "$9,147.50" "$5,488.50" "$9,147.50" "$1,906.34" "$9,147.50" N/A N/A SP-2277 SUP HCPCS C1713 SP-2277 - PLATE BONE THK2.6MM MEDIUM SPECIALTY SYSTEM LORENZ BOTH IP/OP "$9,945.00" "$7,359.00" "$1,973.83" "$9,945.00" "$4,475.25" "$4,475.25" "$4,475.25" "$4,475.25" "$9,945.00" "$9,945.00" "$9,945.00" "$2,072.79" "$9,945.00" "$9,945.00" "$9,945.00" "$9,945.00" "$9,945.00" "$2,072.65" "$9,945.00" "$3,978.00" "$4,902.89" "$9,945.00" "$9,945.00" "$9,945.00" "$9,945.00" "$7,458.75" "$9,945.00" "$9,945.00" "$9,945.00" "$4,972.50" "$4,972.50" "$7,876.44" "$9,945.00" "$7,956.00" "$4,475.25" "$1,973.83" N/A "$5,768.10" "$9,945.00" "$9,945.00" "$9,945.00" "$2,072.54" "$9,945.00" N/A N/A SP-2284 SUP HCPCS C1713 SP-2284 - PLATE BONE 1MM 4 HOLE STR LORENZ TRAUMAONE TITANIUM MANDIB BOTH IP/OP "$1,582.50" "$1,171.00" $314.09 "$1,582.50" $712.13 $712.13 $712.13 $712.13 "$1,582.50" "$1,582.50" "$1,582.50" $329.83 "$1,582.50" "$1,582.50" "$1,582.50" "$1,582.50" "$1,582.50" $329.81 "$1,582.50" $633.00 $936.05 "$1,582.50" "$1,582.50" "$1,582.50" "$1,582.50" "$1,186.88" "$1,582.50" "$1,582.50" "$1,582.50" $791.25 $791.25 "$1,253.34" "$1,582.50" "$1,266.00" $712.13 $314.09 N/A $917.85 "$1,582.50" "$1,582.50" "$1,582.50" $329.79 "$1,582.50" N/A N/A SP-2292 SUP HCPCS C1713 SP-2292 - PLATE BONE 2MM SPECIALTY TRAUMAONE MANDIB BOTH IP/OP "$2,492.50" "$1,844.00" $494.70 "$2,492.50" "$1,121.63" "$1,121.63" "$1,121.63" "$1,121.63" "$2,492.50" "$2,492.50" "$2,492.50" $519.50 "$2,492.50" "$2,492.50" "$2,492.50" "$2,492.50" "$2,492.50" $519.46 "$2,492.50" $997.00 "$1,474.31" "$2,492.50" "$2,492.50" "$2,492.50" "$2,492.50" "$1,869.38" "$2,492.50" "$2,492.50" "$2,492.50" "$1,246.25" "$1,246.25" "$1,974.06" "$2,492.50" "$1,994.00" "$1,121.63" $494.70 N/A "$1,445.65" "$2,492.50" "$1,495.50" "$2,492.50" $519.44 "$2,492.50" N/A N/A SP-2371 SUP HCPCS C1713 SP-2371 - PLATE BONE SPECIALTY LORENZ MIDFAC BOTH IP/OP $910.00 $673.00 $180.61 $910.00 $409.50 $409.50 $409.50 $409.50 $910.00 $910.00 $910.00 $189.67 $910.00 $910.00 $910.00 $910.00 $910.00 $189.65 $910.00 $364.00 $538.27 $910.00 $910.00 $910.00 $910.00 $682.50 $910.00 $910.00 $910.00 $455.00 $455.00 $720.72 $910.00 $728.00 $409.50 $180.61 N/A $527.80 $910.00 $546.00 $910.00 $189.64 $910.00 N/A N/A SP-2375 SUP HCPCS C1713 SP-2375 - PLATE BONE 1MM LORENZ MANDIB BOTH IP/OP "$1,677.50" "$1,241.00" $332.94 "$1,677.50" $754.88 $754.88 $754.88 $754.88 "$1,677.50" "$1,677.50" "$1,677.50" $349.63 "$1,677.50" "$1,677.50" "$1,677.50" "$1,677.50" "$1,677.50" $349.61 "$1,677.50" $671.00 $992.24 "$1,677.50" "$1,677.50" "$1,677.50" "$1,677.50" "$1,258.13" "$1,677.50" "$1,677.50" "$1,677.50" $838.75 $838.75 "$1,328.58" "$1,677.50" "$1,342.00" $754.88 $332.94 N/A $972.95 "$1,677.50" "$1,006.50" "$1,677.50" $349.59 "$1,677.50" N/A N/A SP-2376 SUP HCPCS C1713 SP-2376 - PLATE BONE 1MM LORENZ MANDIB BOTH IP/OP "$1,677.50" "$1,241.00" $332.94 "$1,677.50" $754.88 $754.88 $754.88 $754.88 "$1,677.50" "$1,677.50" "$1,677.50" $349.63 "$1,677.50" "$1,677.50" "$1,677.50" "$1,677.50" "$1,677.50" $349.61 "$1,677.50" "$1,677.50" $992.24 "$1,677.50" "$1,677.50" "$1,677.50" "$1,677.50" "$1,258.13" "$1,677.50" "$1,677.50" "$1,677.50" $838.75 $838.75 "$1,328.58" "$1,677.50" "$1,342.00" $754.88 $332.94 N/A $972.95 "$1,677.50" "$1,006.50" "$1,677.50" $349.59 "$1,677.50" N/A N/A SP-2377 SUP HCPCS C1713 SP-2377 - PLATE BONE 2MM LORENZ TRAUMAONE MIDFAC BOTH IP/OP "$2,450.00" "$1,813.00" $486.26 "$2,450.00" "$1,102.50" "$1,102.50" "$1,102.50" "$1,102.50" "$2,450.00" "$2,450.00" "$2,450.00" $510.64 "$2,450.00" "$2,450.00" "$2,450.00" "$2,450.00" "$2,450.00" $510.61 "$2,450.00" $980.00 "$1,449.18" "$2,450.00" "$2,450.00" "$2,450.00" "$2,450.00" "$1,837.50" "$2,450.00" "$2,450.00" "$2,450.00" "$1,225.00" "$1,225.00" "$1,940.40" "$2,450.00" "$1,960.00" "$1,102.50" $486.26 N/A "$1,421.00" "$2,450.00" "$1,470.00" "$2,450.00" $510.58 "$2,450.00" N/A N/A SP-2465 SUP HCPCS C1713 SP-2465 - PLATE BONE THK1.6MM LONG Y GRADE II TRAUMAONE LORENZ GOLD BOTH IP/OP "$2,017.50" "$1,493.00" $400.42 "$2,017.50" $907.88 $907.88 $907.88 $907.88 "$2,017.50" "$2,017.50" "$2,017.50" $420.50 "$2,017.50" "$2,017.50" "$2,017.50" "$2,017.50" "$2,017.50" $420.47 "$2,017.50" $807.00 "$1,193.35" "$2,017.50" "$2,017.50" "$2,017.50" "$2,017.50" "$1,513.13" "$2,017.50" "$2,017.50" "$2,017.50" "$1,008.75" "$1,008.75" "$1,597.86" "$2,017.50" "$1,614.00" $907.88 $400.42 N/A "$1,170.15" "$2,017.50" "$2,017.50" "$2,017.50" $420.45 "$2,017.50" N/A N/A SP-2467 SUP HCPCS C1713 SP-2467 - PLATE BONE THK2.6MM SMALL STR ANGLED LORENZ MAGENTA MANDIB BOTH IP/OP "$4,520.00" "$3,345.00" $897.11 "$4,520.00" "$2,034.00" "$2,034.00" "$2,034.00" "$2,034.00" "$4,520.00" "$4,520.00" "$4,520.00" $942.08 "$4,520.00" "$4,520.00" "$4,520.00" "$4,520.00" "$4,520.00" $942.02 "$4,520.00" "$1,808.00" "$2,228.36" "$4,520.00" "$4,520.00" "$4,520.00" "$4,520.00" "$3,390.00" "$4,520.00" "$4,520.00" "$4,520.00" "$2,260.00" "$2,260.00" "$3,579.84" "$4,520.00" "$3,616.00" "$2,034.00" $897.11 N/A "$2,621.60" "$4,520.00" "$2,712.00" "$4,520.00" $941.97 "$4,520.00" N/A N/A SP-2468 SUP HCPCS C1713 SP-2468 - PLATE BONE THK2.6MM 7 HOLE TRAUMAONE LORENZ MAGENTA MANDIB BOTH IP/OP "$4,075.00" "$3,016.00" $808.79 "$4,075.00" "$1,833.75" "$1,833.75" "$1,833.75" "$1,833.75" "$4,075.00" "$4,075.00" "$4,075.00" $849.33 "$4,075.00" "$4,075.00" "$4,075.00" "$4,075.00" "$4,075.00" $849.27 "$4,075.00" "$4,075.00" "$2,008.98" "$4,075.00" "$4,075.00" "$4,075.00" "$4,075.00" "$3,056.25" "$4,075.00" "$4,075.00" "$4,075.00" "$2,037.50" "$2,037.50" "$3,227.40" "$4,075.00" "$3,260.00" "$1,833.75" $808.79 N/A "$2,363.50" "$4,075.00" "$2,445.00" "$4,075.00" $849.23 "$4,075.00" N/A N/A SP-2469 SUP HCPCS C1713 SP-2469 - PLATE BONE THK2.6MM 16 HOLE STR TRAUMAONE LORENZ MAGENTA BOTH IP/OP "$6,870.00" "$5,084.00" "$1,363.52" "$6,870.00" "$3,091.50" "$3,091.50" "$3,091.50" "$3,091.50" "$6,870.00" "$6,870.00" "$6,870.00" "$1,431.88" "$6,870.00" "$6,870.00" "$6,870.00" "$6,870.00" "$6,870.00" "$1,431.78" "$6,870.00" "$6,870.00" "$3,386.91" "$6,870.00" "$6,870.00" "$6,870.00" "$6,870.00" "$5,152.50" "$6,870.00" "$6,870.00" "$6,870.00" "$3,435.00" "$3,435.00" "$5,441.04" "$6,870.00" "$5,496.00" "$3,091.50" "$1,363.52" N/A "$3,984.60" "$6,870.00" "$4,122.00" "$6,870.00" "$1,431.71" "$6,870.00" N/A N/A SP-2470 SUP HCPCS C1713 SP-2470 - PLATE BONE THK2.6MM SMALL 7 HOLE CVD LORENZ MAGENTA MANDIB BOTH IP/OP "$4,075.00" "$3,016.00" $808.79 "$4,075.00" "$1,833.75" "$1,833.75" "$1,833.75" "$1,833.75" "$4,075.00" "$4,075.00" "$4,075.00" $849.33 "$4,075.00" "$4,075.00" "$4,075.00" "$4,075.00" "$4,075.00" $849.27 "$4,075.00" "$4,075.00" "$2,008.98" "$4,075.00" "$4,075.00" "$4,075.00" "$4,075.00" "$3,056.25" "$4,075.00" "$4,075.00" "$4,075.00" "$2,037.50" "$2,037.50" "$3,227.40" "$4,075.00" "$3,260.00" "$1,833.75" $808.79 N/A "$2,363.50" "$4,075.00" "$2,445.00" "$4,075.00" $849.23 "$4,075.00" N/A N/A SP-2472 SUP HCPCS C1713 SP-2472 - PLATE BONE L CRNMXF LEFT 8X10 HOLE XRIGID 1.5/1MM BOTH IP/OP $737.50 $546.00 $146.38 $737.50 $331.88 $331.88 $331.88 $331.88 $737.50 $737.50 $737.50 $153.71 $737.50 $737.50 $737.50 $737.50 $737.50 $153.70 $737.50 $295.00 $436.23 $737.50 $737.50 $737.50 $737.50 $553.13 $737.50 $737.50 $737.50 $368.75 $368.75 $584.10 $737.50 $590.00 $331.88 $146.38 N/A $427.75 $737.50 $442.50 $737.50 $153.70 $737.50 N/A N/A SP-2473 SUP HCPCS C1713 SP-2473 - PLATE BN L 8X10 HL XRIGID CRNMXF RT 1.5/1MM SCR BOTH IP/OP "$1,242.50" $919.00 $246.61 "$1,242.50" $559.13 $559.13 $559.13 $559.13 "$1,242.50" "$1,242.50" "$1,242.50" $258.97 "$1,242.50" "$1,242.50" "$1,242.50" "$1,242.50" "$1,242.50" $258.95 "$1,242.50" $497.00 $734.94 "$1,242.50" "$1,242.50" "$1,242.50" "$1,242.50" $931.88 "$1,242.50" "$1,242.50" "$1,242.50" $621.25 $621.25 $984.06 "$1,242.50" $994.00 $559.13 $246.61 N/A $720.65 "$1,242.50" $745.50 "$1,242.50" $258.94 "$1,242.50" N/A N/A SP-2526 SUP HCPCS C1713 SP-2526 - PLATE BONE CURVE CRNMXF 5 HOLE 1MM SCR BOTH IP/OP "$2,892.50" "$2,140.00" $574.09 "$2,892.50" "$1,301.63" "$1,301.63" "$1,301.63" "$1,301.63" "$2,892.50" "$2,892.50" "$2,892.50" $602.87 "$2,892.50" "$2,892.50" "$2,892.50" "$2,892.50" "$2,892.50" $602.83 "$2,892.50" "$1,157.00" "$1,426.00" "$2,892.50" "$2,892.50" "$2,892.50" "$2,892.50" "$2,169.38" "$2,892.50" "$2,892.50" "$2,892.50" "$1,446.25" "$1,446.25" "$2,290.86" "$2,892.50" "$2,314.00" "$1,301.63" $574.09 N/A "$1,677.65" "$2,892.50" "$1,735.50" "$2,892.50" $602.80 "$2,892.50" N/A N/A SP-2566 SUP HCPCS C1713 SP-2566 - PLATE BONE STR 2MM 6 HOLE TRAUMAONE BLUE TITANIUM MANDIB BOTH IP/OP "$2,290.00" "$1,695.00" $454.51 "$2,290.00" "$1,030.50" "$1,030.50" "$1,030.50" "$1,030.50" "$2,290.00" "$2,290.00" "$2,290.00" $477.29 "$2,290.00" "$2,290.00" "$2,290.00" "$2,290.00" "$2,290.00" $477.26 "$2,290.00" "$2,290.00" "$1,354.54" "$2,290.00" "$2,290.00" "$2,290.00" "$2,290.00" "$1,717.50" "$2,290.00" "$2,290.00" "$2,290.00" "$1,145.00" "$1,145.00" "$1,813.68" "$2,290.00" "$1,832.00" "$1,030.50" $454.51 N/A "$1,328.20" "$2,290.00" "$1,374.00" "$2,290.00" $477.24 "$2,290.00" N/A N/A SP-2575 SUP HCPCS C1713 SP-2575 - PLATE BONE 100D MEDIUM 3X3 HOLE L RIGID TRAUMAONE LORENZ BOTH IP/OP $877.50 $649.00 $174.16 $877.50 $394.88 $394.88 $394.88 $394.88 $877.50 $877.50 $877.50 $182.89 $877.50 $877.50 $877.50 $877.50 $877.50 $182.88 $877.50 $351.00 $519.04 $877.50 $877.50 $877.50 $877.50 $658.13 $877.50 $877.50 $877.50 $438.75 $438.75 $694.98 $877.50 $702.00 $394.88 $174.16 N/A $508.95 $877.50 $526.50 $877.50 $182.87 $877.50 N/A N/A SP-2576 SUP HCPCS C1713 SP-2576 - PLATE BONE 100D MEDIUM 3X3 HOLE L RIGID TRAUMAONE LORENZ BOTH IP/OP $877.50 $649.00 $174.16 $877.50 $394.88 $394.88 $394.88 $394.88 $877.50 $877.50 $877.50 $182.89 $877.50 $877.50 $877.50 $877.50 $877.50 $182.88 $877.50 $351.00 $519.04 $877.50 $877.50 $877.50 $877.50 $658.13 $877.50 $877.50 $877.50 $438.75 $438.75 $694.98 $877.50 $702.00 $394.88 $174.16 N/A $508.95 $877.50 $877.50 $877.50 $182.87 $877.50 N/A N/A SP-2585 SUP HCPCS C1713 SP-2585 - PLATE .6MM MANDIB 4 HOLE STR 2/2.3MM SCR BONE BOTH IP/OP "$1,817.50" "$1,345.00" $360.73 "$1,817.50" $817.88 $817.88 $817.88 $817.88 "$1,817.50" "$1,817.50" "$1,817.50" $378.81 "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" $378.79 "$1,817.50" "$1,817.50" "$1,075.05" "$1,817.50" "$1,817.50" "$1,817.50" "$1,817.50" "$1,363.13" "$1,817.50" "$1,817.50" "$1,817.50" $908.75 $908.75 "$1,439.46" "$1,817.50" "$1,454.00" $817.88 $360.73 N/A "$1,054.15" "$1,817.50" "$1,090.50" "$1,817.50" $378.77 "$1,817.50" N/A N/A SP-2630 SUP HCPCS C1713 SP-2630 - PLATE BONE THK1.6MM STR 2X7 HOLE MATRIX GRADE II TRAUMAONE BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$1,050.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A SP-2631 SUP HCPCS C1713 SP-2631 - PLATE BONE THK1.6MM 7X2MM CVD MATRIX GOLD MANDIB 2/2.3MM BOTH IP/OP "$2,625.00" "$1,943.00" $521.00 "$2,625.00" "$1,181.25" "$1,181.25" "$1,181.25" "$1,181.25" "$2,625.00" "$2,625.00" "$2,625.00" $547.12 "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" $547.08 "$2,625.00" "$2,625.00" "$1,294.13" "$2,625.00" "$2,625.00" "$2,625.00" "$2,625.00" "$1,968.75" "$2,625.00" "$2,625.00" "$2,625.00" "$1,312.50" "$1,312.50" "$2,079.00" "$2,625.00" "$2,100.00" "$1,181.25" $521.00 N/A "$1,522.50" "$2,625.00" "$1,575.00" "$2,625.00" $547.05 "$2,625.00" N/A N/A SP-2665 SUP HCPCS C1713 SP-2665 - PLATE BONE THK1.6MM 7 HOLE 2Y GRADE II TRAUMAONE LORENZ BOTH IP/OP "$1,515.00" "$1,121.00" $300.69 "$1,515.00" $681.75 $681.75 $681.75 $681.75 "$1,515.00" "$1,515.00" "$1,515.00" $315.76 "$1,515.00" "$1,515.00" "$1,515.00" "$1,515.00" "$1,515.00" $315.74 "$1,515.00" "$1,515.00" $896.12 "$1,515.00" "$1,515.00" "$1,515.00" "$1,515.00" "$1,136.25" "$1,515.00" "$1,515.00" "$1,515.00" $757.50 $757.50 "$1,199.88" "$1,515.00" "$1,212.00" $681.75 $300.69 N/A $878.70 "$1,515.00" $909.00 "$1,515.00" $315.73 "$1,515.00" N/A N/A SP-2703 SUP HCPCS C1713 SP-2703 - PLATE STR 1.6MM 6 HOLE GAP BONE BOTH IP/OP "$2,450.00" "$1,813.00" $486.26 "$2,450.00" "$1,102.50" "$1,102.50" "$1,102.50" "$1,102.50" "$2,450.00" "$2,450.00" "$2,450.00" $510.64 "$2,450.00" "$2,450.00" "$2,450.00" "$2,450.00" "$2,450.00" $510.61 "$2,450.00" "$2,450.00" "$1,449.18" "$2,450.00" "$2,450.00" "$2,450.00" "$2,450.00" "$1,837.50" "$2,450.00" "$2,450.00" "$2,450.00" "$1,225.00" "$1,225.00" "$1,940.40" "$2,450.00" "$1,960.00" "$1,102.50" $486.26 N/A "$1,421.00" "$2,450.00" "$1,470.00" "$2,450.00" $510.58 "$2,450.00" N/A N/A SP-2834 SUP HCPCS C1713 SP-2834 - SCREW BONE L8 MM OD2.4 MM RIB SELF DRILL LOCK BOTH IP/OP $625.00 $463.00 $124.05 $625.00 $281.25 $281.25 $281.25 $281.25 $625.00 $625.00 $625.00 $130.27 $625.00 $625.00 $625.00 $625.00 $625.00 $130.26 $625.00 $625.00 $369.69 $625.00 $625.00 $625.00 $625.00 $468.75 $625.00 $625.00 $625.00 $312.50 $312.50 $495.00 $625.00 $500.00 $281.25 $124.05 N/A $362.50 $625.00 $625.00 $625.00 $130.25 $625.00 N/A N/A SP-2889 SUP HCPCS C1713 SP-2889 - PLATE BN STRG STERNALOCK BLU 24 HL STRNM PRM CLSR SYS BOTH IP/OP "$3,760.00" "$2,782.00" $746.27 "$3,760.00" "$1,692.00" "$1,692.00" "$1,692.00" "$1,692.00" "$3,760.00" "$3,760.00" "$3,760.00" $783.68 "$3,760.00" "$3,760.00" "$3,760.00" "$3,760.00" "$3,760.00" $783.63 "$3,760.00" "$3,760.00" "$1,853.68" "$3,760.00" "$3,760.00" "$3,760.00" "$3,760.00" "$2,820.00" "$3,760.00" "$3,760.00" "$3,760.00" "$1,880.00" "$1,880.00" "$2,977.92" "$3,760.00" "$3,008.00" "$1,692.00" $746.27 N/A "$2,180.80" "$3,760.00" "$3,760.00" "$3,760.00" $783.58 "$3,760.00" N/A N/A SP-2890 SUP HCPCS C1713 SP-2890 - PLATE BN HEX STERNALOCK BLU 6 HL STRNM PRM CLSR SYS BOTH IP/OP "$2,210.00" "$1,635.00" $438.63 "$2,210.00" $994.50 $994.50 $994.50 $994.50 "$2,210.00" "$2,210.00" "$2,210.00" $460.62 "$2,210.00" "$2,210.00" "$2,210.00" "$2,210.00" "$2,210.00" $460.59 "$2,210.00" "$2,210.00" "$1,307.22" "$2,210.00" "$2,210.00" "$2,210.00" "$2,210.00" "$1,657.50" "$2,210.00" "$2,210.00" "$2,210.00" "$1,105.00" "$1,105.00" "$1,750.32" "$2,210.00" "$1,768.00" $994.50 $438.63 N/A "$1,281.80" "$2,210.00" "$2,210.00" "$2,210.00" "$2,210.00" "$2,210.00" N/A N/A SP-2891 SUP HCPCS C1713 SP-2891 - PLATE BN JL STRG STERNALOCK BLU 8 HL STRNM PRM CLSR SYS BOTH IP/OP "$1,945.00" "$1,439.00" $386.03 "$1,945.00" $875.25 $875.25 $875.25 $875.25 "$1,945.00" "$1,945.00" "$1,945.00" $405.39 "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" $405.36 "$1,945.00" "$1,945.00" "$1,150.47" "$1,945.00" "$1,945.00" "$1,945.00" "$1,945.00" "$1,458.75" "$1,945.00" "$1,945.00" "$1,945.00" $972.50 $972.50 "$1,540.44" "$1,945.00" "$1,556.00" $875.25 $386.03 N/A "$1,128.10" "$1,945.00" "$1,945.00" "$1,945.00" $405.34 "$1,945.00" N/A N/A SP-2899 SUP HCPCS C1713 SP-2899 - PLATE BN STRG STERNALOCK BLU 6 HL STRNM PRM CLSR SYS BOTH IP/OP "$1,962.50" "$1,452.00" $389.51 "$1,962.50" $883.13 $883.13 $883.13 $883.13 "$1,962.50" "$1,962.50" "$1,962.50" $409.03 "$1,962.50" "$1,962.50" "$1,962.50" "$1,962.50" "$1,962.50" $409.01 "$1,962.50" "$1,962.50" "$1,160.82" "$1,962.50" "$1,962.50" "$1,962.50" "$1,962.50" "$1,471.88" "$1,962.50" "$1,962.50" "$1,962.50" $981.25 $981.25 "$1,554.30" "$1,962.50" "$1,570.00" $883.13 $389.51 N/A "$1,138.25" "$1,962.50" "$1,962.50" "$1,962.50" $408.99 "$1,962.50" N/A N/A SP-2913 SUP HCPCS C1713 SP-2913 - PLATE BN 70D L STERNALOCK BLU 8 HL STRNM PRM CLSR SYS BOTH IP/OP "$1,692.50" "$1,252.00" $335.92 "$1,692.50" $761.63 $761.63 $761.63 $761.63 "$1,692.50" "$1,692.50" "$1,692.50" $352.76 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" $352.74 "$1,692.50" $677.00 "$1,001.11" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,269.38" "$1,692.50" "$1,692.50" "$1,692.50" $846.25 $846.25 "$1,340.46" "$1,692.50" "$1,354.00" $761.63 $335.92 N/A $981.65 "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" "$1,692.50" N/A N/A SP-2914 SUP HCPCS C1713 SP-2914 - PLATE BN Y STERNALOCK BLU 12 HL STRNM PRM CLSR SYS BOTH IP/OP "$3,332.50" "$2,466.00" $661.42 "$3,332.50" "$1,499.63" "$1,499.63" "$1,499.63" "$1,499.63" "$3,332.50" "$3,332.50" "$3,332.50" $694.58 "$3,332.50" "$3,332.50" "$3,332.50" "$3,332.50" "$3,332.50" $694.53 "$3,332.50" "$3,332.50" "$1,642.92" "$3,332.50" "$3,332.50" "$3,332.50" "$3,332.50" "$2,499.38" "$3,332.50" "$3,332.50" "$3,332.50" "$1,666.25" "$1,666.25" "$2,639.34" "$3,332.50" "$2,666.00" "$1,499.63" $661.42 N/A "$1,932.85" "$3,332.50" "$3,332.50" "$3,332.50" $694.49 "$3,332.50" N/A N/A SP-2927 SUP HCPCS C1713 SP-2927 - PLATE BN STRG 1.6MM STERNALOCK BLU 16 HL STRNM PRM CLSR SYS BOTH IP/OP "$2,870.00" "$2,124.00" $569.62 "$2,870.00" "$1,291.50" "$1,291.50" "$1,291.50" "$1,291.50" "$2,870.00" "$2,870.00" "$2,870.00" $598.18 "$2,870.00" "$2,870.00" "$2,870.00" "$2,870.00" "$2,870.00" $598.14 "$2,870.00" "$2,870.00" "$1,414.91" "$2,870.00" "$2,870.00" "$2,870.00" "$2,870.00" "$2,152.50" "$2,870.00" "$2,870.00" "$2,870.00" "$1,435.00" "$1,435.00" "$2,273.04" "$2,870.00" "$2,296.00" "$1,291.50" $569.62 N/A "$1,664.60" "$2,870.00" "$2,870.00" "$2,870.00" $598.11 "$2,870.00" N/A N/A SP-2984 SUP HCPCS C1713 SP-2984 - PLATE BN 100D X STERNALOCK BLU 8 HL STRNM BOTH IP/OP "$2,445.00" "$1,809.00" $485.27 "$2,445.00" "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" "$2,445.00" "$2,445.00" "$2,445.00" $509.60 "$2,445.00" "$2,445.00" "$2,445.00" "$2,445.00" "$2,445.00" $509.56 "$2,445.00" $978.00 "$1,446.22" "$2,445.00" "$2,445.00" "$2,445.00" "$2,445.00" "$1,833.75" "$2,445.00" "$2,445.00" "$2,445.00" "$1,222.50" "$1,222.50" "$1,936.44" "$2,445.00" "$1,956.00" "$1,100.25" $485.27 N/A "$1,418.10" "$2,445.00" "$2,445.00" "$2,445.00" $509.54 "$2,445.00" N/A N/A SP-2985 SUP HCPCS C1713 SP-2985 - PLATE BN 100D Y STERNALOCK BLU 6 HL STRNM BOTH IP/OP "$2,445.00" "$1,809.00" $485.27 "$2,445.00" "$1,100.25" "$1,100.25" "$1,100.25" "$1,100.25" "$2,445.00" "$2,445.00" "$2,445.00" $509.60 "$2,445.00" "$2,445.00" "$2,445.00" "$2,445.00" "$2,445.00" $509.56 "$2,445.00" "$2,445.00" "$1,446.22" "$2,445.00" "$2,445.00" "$2,445.00" "$2,445.00" "$1,833.75" "$2,445.00" "$2,445.00" "$2,445.00" "$1,222.50" "$1,222.50" "$1,936.44" "$2,445.00" "$1,956.00" "$1,100.25" $485.27 N/A "$1,418.10" "$2,445.00" "$2,445.00" "$2,445.00" $509.54 "$2,445.00" N/A N/A SP-3001 SUP HCPCS C1713 SP-3001 - PLATE BN 13MM STERNALOCK BLU STRNM JL G BOTH IP/OP "$2,070.00" "$1,532.00" $410.84 "$2,070.00" $931.50 $931.50 $931.50 $931.50 "$2,070.00" "$2,070.00" "$2,070.00" $431.44 "$2,070.00" "$2,070.00" "$2,070.00" "$2,070.00" "$2,070.00" $431.41 "$2,070.00" "$2,070.00" "$1,224.41" "$2,070.00" "$2,070.00" "$2,070.00" "$2,070.00" "$1,552.50" "$2,070.00" "$2,070.00" "$2,070.00" "$1,035.00" "$1,035.00" "$1,639.44" "$2,070.00" "$1,656.00" $931.50 $410.84 N/A "$1,200.60" "$2,070.00" "$2,070.00" "$2,070.00" $431.39 "$2,070.00" N/A N/A SP-3022 SUP HCPCS C1713 SP-3022 - PLATE BN LG .6MM 4 HL CNTR MESH STRNL 1.5MM SCR EZ BOTH IP/OP "$1,677.50" "$1,241.00" $332.94 "$1,677.50" $754.88 $754.88 $754.88 $754.88 "$1,677.50" "$1,677.50" "$1,677.50" $349.63 "$1,677.50" "$1,677.50" "$1,677.50" "$1,677.50" "$1,677.50" $349.61 "$1,677.50" "$1,677.50" $992.24 "$1,677.50" "$1,677.50" "$1,677.50" "$1,677.50" "$1,258.13" "$1,677.50" "$1,677.50" "$1,677.50" $838.75 $838.75 "$1,328.58" "$1,677.50" "$1,342.00" $754.88 $332.94 N/A $972.95 "$1,677.50" "$1,677.50" "$1,677.50" $349.59 "$1,677.50" N/A N/A SP-3060 SUP HCPCS C1713 SP-3060 - SCREW BN 2MM 9MM OMNIMAX MXLMNDB SD XD BOTH IP/OP "$2,172.50" "$1,608.00" $431.19 "$2,172.50" $977.63 $977.63 $977.63 $977.63 "$2,172.50" "$2,172.50" "$2,172.50" $452.80 "$2,172.50" "$2,172.50" "$2,172.50" "$2,172.50" "$2,172.50" $452.77 "$2,172.50" $869.00 "$1,285.03" "$2,172.50" "$2,172.50" "$2,172.50" "$2,172.50" "$1,629.38" "$2,172.50" "$2,172.50" "$2,172.50" "$1,086.25" "$1,086.25" "$1,720.62" "$2,172.50" "$1,738.00" $977.63 $431.19 N/A "$1,260.05" "$2,172.50" "$2,172.50" "$2,172.50" "$2,172.50" "$2,172.50" N/A N/A SP-3142 SUP HCPCS C1713 SP-3142 - PLATE BN 60D JL STERNALOCK BLU STRNM BOTH IP/OP "$2,977.50" "$2,203.00" $590.96 "$2,977.50" "$1,339.88" "$1,339.88" "$1,339.88" "$1,339.88" "$2,977.50" "$2,977.50" "$2,977.50" $620.59 "$2,977.50" "$2,977.50" "$2,977.50" "$2,977.50" "$2,977.50" $620.54 "$2,977.50" "$2,977.50" "$1,467.91" "$2,977.50" "$2,977.50" "$2,977.50" "$2,977.50" "$2,233.13" "$2,977.50" "$2,977.50" "$2,977.50" "$1,488.75" "$1,488.75" "$2,358.18" "$2,977.50" "$2,382.00" "$1,339.88" $590.96 N/A "$1,726.95" "$2,977.50" "$2,977.50" "$2,977.50" "$2,977.50" "$2,977.50" N/A N/A SP-3192 SUP HCPCS C1713 SP-3192 - PLATE BN W STERNALOCK BLU 8 HL STRNL BOTH IP/OP "$3,537.50" "$2,618.00" $702.11 "$3,537.50" "$1,591.88" "$1,591.88" "$1,591.88" "$1,591.88" "$3,537.50" "$3,537.50" "$3,537.50" $737.30 "$3,537.50" "$3,537.50" "$3,537.50" "$3,537.50" "$3,537.50" $737.25 "$3,537.50" "$1,415.00" "$1,743.99" "$3,537.50" "$3,537.50" "$3,537.50" "$3,537.50" "$2,653.13" "$3,537.50" "$3,537.50" "$3,537.50" "$1,768.75" "$1,768.75" "$2,801.70" "$3,537.50" "$2,830.00" "$1,591.88" $702.11 N/A "$2,051.75" "$3,537.50" "$3,537.50" "$3,537.50" $737.22 "$3,537.50" N/A N/A SP-3215 SUP HCPCS C1713 SP-3215 - PLATE BN XW 80MM MESH CRNM CHIARI BOTH IP/OP "$2,977.50" "$2,203.00" $590.96 "$2,977.50" "$1,339.88" "$1,339.88" "$1,339.88" "$1,339.88" "$2,977.50" "$2,977.50" "$2,977.50" $620.59 "$2,977.50" "$2,977.50" "$2,977.50" "$2,977.50" "$2,977.50" $620.54 "$2,977.50" "$1,191.00" "$1,467.91" "$2,977.50" "$2,977.50" "$2,977.50" "$2,977.50" "$2,233.13" "$2,977.50" "$2,977.50" "$2,977.50" "$1,488.75" "$1,488.75" "$2,358.18" "$2,977.50" "$2,382.00" "$1,339.88" $590.96 N/A "$1,726.95" "$2,977.50" "$2,977.50" "$2,977.50" $620.51 "$2,977.50" N/A N/A SPD2-US-060-320 SUP HCPCS C1773 SPD2-US-060-320 - SYSTEM EMBL PRTC 3.2-4.2FR 6MM 320CM 190CM SPIDERFX CPTR WRE BOTH IP/OP "$3,487.50" "$2,581.00" $692.18 "$3,487.50" "$1,893.71" "$1,893.71" "$1,893.71" "$1,893.71" "$3,487.50" "$3,487.50" "$3,487.50" $726.88 "$3,487.50" "$2,588.42" "$2,588.42" "$2,688.17" "$1,816.99" $726.83 "$3,487.50" "$3,487.50" "$2,062.86" "$3,487.50" "$3,487.50" "$3,487.50" "$3,487.50" "$2,615.63" "$3,487.50" "$3,487.50" "$3,487.50" "$1,743.75" "$1,743.75" "$2,762.10" "$3,487.50" "$2,790.00" "$2,266.88" $692.18 N/A "$2,022.75" "$3,487.50" "$3,487.50" "$3,487.50" $726.80 "$3,487.50" N/A N/A SPH100200-20 SUP Custom 27803010 SPH100200-20 - COIL EMBL 2MM 2.5CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,497.50" "$1,848.00" $444.49 "$2,497.15" "$2,497.15" "$2,497.15" "$2,497.15" "$2,497.15" "$2,497.15" "$2,497.15" $444.49 "$2,497.15" "$2,497.15" "$2,497.15" "$2,497.15" "$2,497.15" "$2,497.15" $520.43 "$2,497.15" $998.86 "$2,497.15" "$2,497.15" "$2,497.15" "$2,497.15" "$2,497.15" "$1,873.13" "$2,497.15" "$2,497.15" "$2,497.15" "$1,248.58" "$1,248.58" "$1,977.74" "$2,497.15" "$1,997.72" "$1,123.72" "$2,497.15" N/A "$1,448.55" "$2,497.15" "$1,498.29" "$2,497.15" "$2,497.15" "$2,497.15" N/A N/A SPH100250-20 SUP Custom 27803010 SPH100250-20 - COIL EMBL 2.5MM 3.3CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,530.50" "$1,873.00" $450.42 "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" $450.42 "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" $527.37 "$2,530.45" "$1,012.18" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$1,897.88" "$2,530.45" "$2,530.45" "$2,530.45" "$1,265.23" "$1,265.23" "$2,004.12" "$2,530.45" "$2,024.36" "$1,138.70" "$2,530.45" N/A "$1,467.69" "$2,530.45" "$1,518.27" "$2,530.45" "$2,530.45" "$2,530.45" N/A N/A SPH100300-20 SUP Custom 27803010 SPH100300-20 - COIL EMBL 3MM 5.4CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,530.50" "$1,873.00" $450.42 "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" $450.42 "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" $527.37 "$2,530.45" "$1,012.18" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$1,897.88" "$2,530.45" "$2,530.45" "$2,530.45" "$1,265.23" "$1,265.23" "$2,004.12" "$2,530.45" "$2,024.36" "$1,138.70" "$2,530.45" N/A "$1,467.69" "$2,530.45" "$1,518.27" "$2,530.45" "$2,530.45" "$2,530.45" N/A N/A SPH100350-20 SUP Custom 27803010 SPH100350-20 - COIL EMBL 3.5MM 6.6CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,530.50" "$1,873.00" $450.42 "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" $450.42 "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" $527.37 "$2,530.45" "$1,012.18" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$2,530.45" "$1,897.88" "$2,530.45" "$2,530.45" "$2,530.45" "$1,265.23" "$1,265.23" "$2,004.12" "$2,530.45" "$2,024.36" "$1,138.70" "$2,530.45" N/A "$1,467.69" "$2,530.45" "$1,518.27" "$2,530.45" "$2,530.45" "$2,530.45" N/A N/A SPH100500-20 SUP Custom 27803010 SPH100500-20 - COIL EMBL 5MM 9.7CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,564.00" "$1,897.00" $456.34 "$2,563.73" "$2,563.73" "$2,563.73" "$2,563.73" "$2,563.73" "$2,563.73" "$2,563.73" $456.34 "$2,563.73" "$2,563.73" "$2,563.73" "$2,563.73" "$2,563.73" "$2,563.73" $534.31 "$2,563.73" "$1,025.49" "$2,563.73" "$2,563.73" "$2,563.73" "$2,563.73" "$2,563.73" "$1,923.00" "$2,563.73" "$2,563.73" "$2,563.73" "$1,281.87" "$1,281.87" "$2,030.47" "$2,563.73" "$2,050.98" "$1,153.68" "$2,563.73" N/A "$1,487.12" "$2,563.73" "$1,538.24" "$2,563.73" "$2,563.73" "$2,563.73" N/A N/A SPH100600-20 SUP Custom 27803010 SPH100600-20 - COIL EMBL 6MM 11.9CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,597.50" "$1,922.00" $462.27 "$2,597.03" "$2,597.03" "$2,597.03" "$2,597.03" "$2,597.03" "$2,597.03" "$2,597.03" $462.27 "$2,597.03" "$2,597.03" "$2,597.03" "$2,597.03" "$2,597.03" "$2,597.03" $541.25 "$2,597.03" "$1,038.81" "$2,597.03" "$2,597.03" "$2,597.03" "$2,597.03" "$2,597.03" "$1,948.13" "$2,597.03" "$2,597.03" "$2,597.03" "$1,298.52" "$1,298.52" "$2,056.85" "$2,597.03" "$2,077.62" "$1,168.66" "$2,597.03" N/A "$1,506.55" "$2,597.03" "$1,558.22" "$2,597.03" "$2,597.03" "$2,597.03" N/A N/A SPH100620-20 SUP Custom 27803010 SPH100620-20 - COIL EMBL 6MM 20CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT BOTH IP/OP "$2,730.50" "$2,021.00" $485.98 "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" $485.98 "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" $569.00 "$2,730.20" "$1,092.08" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,047.88" "$2,730.20" "$2,730.20" "$2,730.20" "$1,365.10" "$1,365.10" "$2,162.32" "$2,730.20" "$2,184.16" "$1,228.59" "$2,730.20" N/A "$1,583.69" "$2,730.20" "$1,638.12" "$2,730.20" "$2,730.20" "$2,730.20" N/A N/A SPH100700-20 SUP Custom 27803010 SPH100700-20 - COIL EMBL 7MM 13.9CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,630.50" "$1,947.00" $468.20 "$2,630.33" "$2,630.33" "$2,630.33" "$2,630.33" "$2,630.33" "$2,630.33" "$2,630.33" $468.20 "$2,630.33" "$2,630.33" "$2,630.33" "$2,630.33" "$2,630.33" "$2,630.33" $548.19 "$2,630.33" "$1,052.13" "$2,630.33" "$2,630.33" "$2,630.33" "$2,630.33" "$2,630.33" "$1,972.88" "$2,630.33" "$2,630.33" "$2,630.33" "$1,315.17" "$1,315.17" "$2,083.22" "$2,630.33" "$2,104.26" "$1,183.65" "$2,630.33" N/A "$1,525.69" "$2,630.33" "$1,578.20" "$2,630.33" "$2,630.33" "$2,630.33" N/A N/A SPH100720-20 SUP Custom 27803010 SPH100720-20 - COIL EMBL 7MM 20CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT BOTH IP/OP "$2,730.50" "$2,021.00" $485.98 "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" $485.98 "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" $569.00 "$2,730.20" "$1,092.08" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,047.88" "$2,730.20" "$2,730.20" "$2,730.20" "$1,365.10" "$1,365.10" "$2,162.32" "$2,730.20" "$2,184.16" "$1,228.59" "$2,730.20" N/A "$1,583.69" "$2,730.20" "$1,638.12" "$2,730.20" "$2,730.20" "$2,730.20" N/A N/A SPH100800-20 SUP Custom 27803010 SPH100800-20 - COIL EMBL 8MM 16.1CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,664.00" "$1,971.00" $474.13 "$2,663.63" "$2,663.63" "$2,663.63" "$2,663.63" "$2,663.63" "$2,663.63" "$2,663.63" $474.13 "$2,663.63" "$2,663.63" "$2,663.63" "$2,663.63" "$2,663.63" "$2,663.63" $555.13 "$2,663.63" "$1,065.45" "$2,663.63" "$2,663.63" "$2,663.63" "$2,663.63" "$2,663.63" "$1,998.00" "$2,663.63" "$2,663.63" "$2,663.63" "$1,331.82" "$1,331.82" "$2,109.59" "$2,663.63" "$2,130.90" "$1,198.63" "$2,663.63" N/A "$1,545.12" "$2,663.63" "$1,598.18" "$2,663.63" "$2,663.63" "$2,663.63" N/A N/A SPH100825-20 SUP Custom 27803010 SPH100825-20 - COIL EMBL 8MM 25CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT BOTH IP/OP "$2,797.00" "$2,070.00" $497.83 "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" $497.83 "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" $582.88 "$2,796.80" "$1,118.72" "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" "$2,097.75" "$2,796.80" "$2,796.80" "$2,796.80" "$1,398.40" "$1,398.40" "$2,215.07" "$2,796.80" "$2,237.44" "$1,258.56" "$2,796.80" N/A "$1,622.26" "$2,796.80" "$1,678.08" "$2,796.80" "$2,796.80" "$2,796.80" N/A N/A SPH100900-20 SUP Custom 27803010 SPH100900-20 - COIL EMBL 9MM 18.4CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,697.00" "$1,996.00" $480.05 "$2,696.93" "$2,696.93" "$2,696.93" "$2,696.93" "$2,696.93" "$2,696.93" "$2,696.93" $480.05 "$2,696.93" "$2,696.93" "$2,696.93" "$2,696.93" "$2,696.93" "$2,696.93" $562.07 "$2,696.93" "$1,078.77" "$2,696.93" "$2,696.93" "$2,696.93" "$2,696.93" "$2,696.93" "$2,022.75" "$2,696.93" "$2,696.93" "$2,696.93" "$1,348.47" "$1,348.47" "$2,135.97" "$2,696.93" "$2,157.54" "$1,213.62" "$2,696.93" N/A "$1,564.26" "$2,696.93" "$1,618.16" "$2,696.93" "$2,696.93" "$2,696.93" N/A N/A SPH100925-20 SUP Custom 27803010 SPH100925-20 - COIL EMBL 9MM 25CM MICRUSPHERE 10 MCIOL SPHRCL LOOP DTCH SFT BOTH IP/OP "$2,797.00" "$2,070.00" $497.83 "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" $497.83 "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" $582.88 "$2,796.80" "$1,118.72" "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" "$2,796.80" "$2,097.75" "$2,796.80" "$2,796.80" "$2,796.80" "$1,398.40" "$1,398.40" "$2,215.07" "$2,796.80" "$2,237.44" "$1,258.56" "$2,796.80" N/A "$1,622.26" "$2,796.80" "$1,678.08" "$2,796.80" "$2,796.80" "$2,796.80" N/A N/A SPH101000-20 SUP Custom 27803010 SPH101000-20 - COIL EMBL SPHR 10MM 20.3CM MICRUSPHERE 10 MCIOL SPHRCL LOOP BOTH IP/OP "$2,730.50" "$2,021.00" $485.98 "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" $485.98 "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" $569.00 "$2,730.20" "$1,092.08" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,730.20" "$2,047.88" "$2,730.20" "$2,730.20" "$2,730.20" "$1,365.10" "$1,365.10" "$2,162.32" "$2,730.20" "$2,184.16" "$1,228.59" "$2,730.20" N/A "$1,583.69" "$2,730.20" "$1,638.12" "$2,730.20" "$2,730.20" "$2,730.20" N/A N/A SPH10103020 SUP Custom 27803010 SPH10103020 - COIL EMBL SPHR 10MM 30CM MICRUSPHERE 10 MCIOL SPHRCL LOOP BOTH IP/OP "$2,830.50" "$2,095.00" $503.76 "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" $503.76 "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" $589.82 "$2,830.10" "$1,132.04" "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" "$2,830.10" "$2,122.88" "$2,830.10" "$2,830.10" "$2,830.10" "$1,415.05" "$1,415.05" "$2,241.44" "$2,830.10" "$2,264.08" "$1,273.55" "$2,830.10" N/A "$1,641.69" "$2,830.10" "$1,698.06" "$2,830.10" "$2,830.10" "$2,830.10" N/A N/A SPH181100-20 SUP Custom 27803010 SPH181100-20 - COIL EMBL 11MM 18.9CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,726.00" "$2,017.00" $485.19 "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" $485.19 "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" $568.09 "$2,725.80" "$1,090.32" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,044.50" "$2,725.80" "$2,725.80" "$2,725.80" "$1,362.90" "$1,362.90" "$2,158.83" "$2,725.80" "$2,180.64" "$1,226.61" "$2,725.80" N/A "$1,581.08" "$2,725.80" "$1,635.48" "$2,725.80" "$2,725.80" "$2,725.80" N/A N/A SPH181200-20 SUP Custom 27803010 SPH181200-20 - COIL EMBL 12MM 20.7CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,726.00" "$2,017.00" $485.19 "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" $485.19 "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" $568.09 "$2,725.80" "$1,090.32" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,044.50" "$2,725.80" "$2,725.80" "$2,725.80" "$1,362.90" "$1,362.90" "$2,158.83" "$2,725.80" "$2,180.64" "$1,226.61" "$2,725.80" N/A "$1,581.08" "$2,725.80" "$1,635.48" "$2,725.80" "$2,725.80" "$2,725.80" N/A N/A SPH181300-20 SUP Custom 27803010 SPH181300-20 - COIL EMBL 13MM 22.6CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,726.00" "$2,017.00" $485.19 "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" $485.19 "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" $568.09 "$2,725.80" "$1,090.32" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,725.80" "$2,044.50" "$2,725.80" "$2,725.80" "$2,725.80" "$1,362.90" "$1,362.90" "$2,158.83" "$2,725.80" "$2,180.64" "$1,226.61" "$2,725.80" N/A "$1,581.08" "$2,725.80" "$1,635.48" "$2,725.80" "$2,725.80" "$2,725.80" N/A N/A SPH181400-20 SUP Custom 27803010 SPH181400-20 - COIL EMBL 14MM 24.3CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,762.00" "$2,044.00" $491.58 "$2,761.68" "$2,761.68" "$2,761.68" "$2,761.68" "$2,761.68" "$2,761.68" "$2,761.68" $491.58 "$2,761.68" "$2,761.68" "$2,761.68" "$2,761.68" "$2,761.68" "$2,761.68" $575.56 "$2,761.68" "$1,104.67" "$2,761.68" "$2,761.68" "$2,761.68" "$2,761.68" "$2,761.68" "$2,071.50" "$2,761.68" "$2,761.68" "$2,761.68" "$1,380.84" "$1,380.84" "$2,187.25" "$2,761.68" "$2,209.34" "$1,242.76" "$2,761.68" N/A "$1,601.96" "$2,761.68" "$1,657.01" "$2,761.68" "$2,761.68" "$2,761.68" N/A N/A SPH181500-20 SUP Custom 27803010 SPH181500-20 - COIL EMBL 15MM 26CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,798.00" "$2,071.00" $497.96 "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" $497.96 "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" $583.04 "$2,797.53" "$1,119.01" "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" "$2,098.50" "$2,797.53" "$2,797.53" "$2,797.53" "$1,398.77" "$1,398.77" "$2,215.64" "$2,797.53" "$2,238.02" "$1,258.89" "$2,797.53" N/A "$1,622.84" "$2,797.53" "$1,678.52" "$2,797.53" "$2,797.53" "$2,797.53" N/A N/A SPH181600-20 SUP Custom 27803010 SPH181600-20 - COIL EMBL 16MM 27.9CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,798.00" "$2,071.00" $497.96 "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" $497.96 "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" $583.04 "$2,797.53" "$1,119.01" "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" "$2,797.53" "$2,098.50" "$2,797.53" "$2,797.53" "$2,797.53" "$1,398.77" "$1,398.77" "$2,215.64" "$2,797.53" "$2,238.02" "$1,258.89" "$2,797.53" N/A "$1,622.84" "$2,797.53" "$1,678.52" "$2,797.53" "$2,797.53" "$2,797.53" N/A N/A SPH181700-20 SUP Custom 27803010 SPH181700-20 - COIL EMBL 17MM 30CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,833.50" "$2,097.00" $504.35 "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" $504.35 "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" $590.51 "$2,833.40" "$1,133.36" "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" "$2,125.13" "$2,833.40" "$2,833.40" "$2,833.40" "$1,416.70" "$1,416.70" "$2,244.05" "$2,833.40" "$2,266.72" "$1,275.03" "$2,833.40" N/A "$1,643.43" "$2,833.40" "$1,700.04" "$2,833.40" "$2,833.40" "$2,833.40" N/A N/A SPH181800-20 SUP Custom 27803010 SPH181800-20 - COIL EMBL 18MM 30CM MICRUSPHERE 18 MCIOL SPHRCL LOOP DTCH BOTH IP/OP "$2,833.50" "$2,097.00" $504.35 "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" $504.35 "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" $590.51 "$2,833.40" "$1,133.36" "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" "$2,833.40" "$2,125.13" "$2,833.40" "$2,833.40" "$2,833.40" "$1,416.70" "$1,416.70" "$2,244.05" "$2,833.40" "$2,266.72" "$1,275.03" "$2,833.40" N/A "$1,643.43" "$2,833.40" "$1,700.04" "$2,833.40" "$2,833.40" "$2,833.40" N/A N/A SPL15010X SUP HCPCS C1726 SPL15010X - CATHETER BLNDIL 21CM .02IN 1.5MM 142CM LF 10MM SPNTR LGND BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $223.99 $223.99 $223.99 $223.99 $412.50 $412.50 $412.50 $85.98 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A SPL20006X SUP HCPCS C1726 SPL20006X - CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 6MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL20010X SUP HCPCS C1726 SPL20010X - CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 10MM SPNTR LGND BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $223.99 $223.99 $223.99 $223.99 $412.50 $412.50 $412.50 $85.98 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A SPL20025X SUP HCPCS C1726 SPL20025X - CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 25MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL20030X SUP HCPCS C1726 SPL20030X - CATHETER BLNDIL 21CM .022IN 2MM 142CM LF 30MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL22506X SUP HCPCS C1726 SPL22506X - CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 6MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL22510X SUP HCPCS C1726 SPL22510X - CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 10MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL22512X SUP HCPCS C1726 SPL22512X - CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 12MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL22515X SUP HCPCS C1726 SPL22515X - CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 15MM SPNTR LGND BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $223.99 $223.99 $223.99 $223.99 $412.50 $412.50 $412.50 $85.98 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A SPL22520X SUP HCPCS C1726 SPL22520X - CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 20MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL22525X SUP HCPCS C1726 SPL22525X - CATHETER BLNDIL 21CM .022IN 2.25MM 142CM LF 25MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL250010X SUP HCPCS C1726 SPL250010X - CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 10MM SPNTR LGND BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $223.99 $223.99 $223.99 $223.99 $412.50 $412.50 $412.50 $85.98 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A SPL25006X SUP HCPCS C1726 SPL25006X - CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 6MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL25025X SUP HCPCS C1726 SPL25025X - CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 25MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL25030X SUP HCPCS C1726 SPL25030X - CATHETER BLNDIL 21CM .022IN 2.5MM 142CM LF 30MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL27506X SUP HCPCS C1726 SPL27506X - CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 6MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL27512X SUP HCPCS C1726 SPL27512X - CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 12MM SPNTR LGND BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $223.99 $223.99 $223.99 $223.99 $412.50 $412.50 $412.50 $85.98 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A SPL27515X SUP HCPCS C1726 SPL27515X - CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 15MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL27520X SUP HCPCS C1726 SPL27520X - CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 20MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL27525X SUP HCPCS C1726 SPL27525X - CATHETER BLNDIL 21CM .023IN 2.75MM 142CM LF 25MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL30006X SUP HCPCS C1726 SPL30006X - CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 6MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL30010X SUP HCPCS C1726 SPL30010X - CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 10MM SPNTR LGND BOTH IP/OP $412.50 $305.00 $81.87 $412.50 $223.99 $223.99 $223.99 $223.99 $412.50 $412.50 $412.50 $85.98 $412.50 $306.16 $306.16 $317.96 $214.91 $85.97 $412.50 $412.50 $243.99 $412.50 $412.50 $412.50 $412.50 $309.38 $412.50 $412.50 $412.50 $206.25 $206.25 $326.70 $412.50 $330.00 $268.13 $81.87 N/A $239.25 $412.50 $412.50 $412.50 $85.97 $412.50 N/A N/A SPL30025X SUP HCPCS C1726 SPL30025X - CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 25MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL30030X SUP HCPCS C1726 SPL30030X - CATHETER BLNDIL 21CM .023IN 3MM 142CM LF 30MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL32512X SUP HCPCS C1726 SPL32512X - CATHETER BLNDIL 21CM .023IN 3.25MM 142CM LF 12MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPL40025X SUP HCPCS C1726 SPL40025X - CATHETER BLNDIL 21CM .024IN 4MM 142CM LF 25MM SPNTR LGND BOTH IP/OP $425.00 $315.00 $84.35 $425.00 $230.78 $230.78 $230.78 $230.78 $425.00 $425.00 $425.00 $88.58 $425.00 $315.44 $315.44 $327.59 $221.43 $88.57 $425.00 $425.00 $251.39 $425.00 $425.00 $425.00 $425.00 $318.75 $425.00 $425.00 $425.00 $212.50 $212.50 $336.60 $425.00 $340.00 $276.25 $84.35 N/A $246.50 $425.00 $425.00 $425.00 $88.57 $425.00 N/A N/A SPLS-20100-TS SUP HCPCS C1713 SPLS-20100-TS - PEG FX 2MM 10MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A SPLS-20120-TS SUP HCPCS C1713 SPLS-20120-TS - PEG FX 2MM 12MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $217.50 $217.50 N/A N/A SPLS-20140-TS SUP HCPCS C1713 SPLS-20140-TS - PEG FX 2MM 14MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A SPLS-20160-TS SUP HCPCS C1713 SPLS-20160-TS - PEG FX 2MM 16MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A SPLS-20170-TS SUP HCPCS C1713 SPLS-20170-TS - PEG FX 2MM 17MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $217.50 $217.50 N/A N/A SPLS-20180-TS SUP HCPCS C1713 SPLS-20180-TS - PEG FX 2MM 18MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A SPLS-20190-TS SUP HCPCS C1713 SPLS-20190-TS - PEG FX 2MM 19MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A SPLS-20200-TS SUP HCPCS C1713 SPLS-20200-TS - PEG FX 2MM 20MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $217.50 $217.50 $45.33 $217.50 N/A N/A SPLS-20210-TS SUP HCPCS C1713 SPLS-20210-TS - PEG FX 2MM 21MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A SPLS-20220-TS SUP HCPCS C1713 SPLS-20220-TS - PEG FX 2MM 22MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $217.50 $217.50 $45.33 $217.50 N/A N/A SPLS-20230-TS SUP HCPCS C1713 SPLS-20230-TS - PEG FX 2MM 23MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $217.50 $217.50 $45.33 $217.50 N/A N/A SPLS-20240-TS SUP HCPCS C1713 SPLS-20240-TS - PEG FX 2MM 24MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A SPLS-20260-TS SUP HCPCS C1713 SPLS-20260-TS - PEG FX 2MM 26MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A SPLS-20280-TS SUP HCPCS C1713 SPLS-20280-TS - PEG FX 2MM 28MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $217.50 $217.50 N/A N/A SPLS-20300-TS SUP HCPCS C1713 SPLS-20300-TS - PEG FX 2MM 30MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A SPLS-20320-TS SUP HCPCS C1713 SPLS-20320-TS - PEG FX 2MM 32MM NS GEMINUS SMTH LCK SCR CADDY TI FOSSA RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A SPS0121K SUP HCPCS C1713 SPS0121K - SPACER HUM 99MMX16MM 41MM 7MM INTSPC SM SHLDR PMMA BOTH IP/OP "$9,975.00" "$7,382.00" "$1,979.79" "$9,975.00" "$4,488.75" "$4,488.75" "$4,488.75" "$4,488.75" "$9,975.00" "$9,975.00" "$9,975.00" "$2,079.04" "$9,975.00" "$9,975.00" "$9,975.00" "$9,975.00" "$9,975.00" "$2,078.90" "$9,975.00" "$3,990.00" "$4,917.68" "$9,975.00" "$9,975.00" "$9,975.00" "$9,975.00" "$7,481.25" "$9,975.00" "$9,975.00" "$9,975.00" "$4,987.50" "$4,987.50" "$7,900.20" "$9,975.00" "$7,980.00" "$4,488.75" "$1,979.79" N/A "$5,785.50" "$9,975.00" "$5,985.00" "$9,975.00" "$2,078.79" "$9,975.00" N/A N/A SR-0620-CS SUP HCPCS C1876 SR-0620-CS - STENT VASC STRG 6MM 20MM 57CM ENROUTE UBER FLX DLV SYS ANG BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" N/A "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A SR-0630-CS SUP HCPCS C1876 SR-0630-CS - STENT VASC 6MM .065IN 30MM 57CM ENROUTE UBER FLX DLV SYS ANG BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" N/A "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A SR-0640-CS SUP HCPCS C1876 SR-0640-CS - STENT VASC 6MM 40MM 57CM ENROUTE UBER FLX DLV SYS ANG TIP BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" N/A "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A SR-0730-CS SUP HCPCS C1876 SR-0730-CS - STENT VASC 7MM .065IN 30MM 57CM ENROUTE UBER FLX DLV SYS ANG BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" N/A "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A SR-0740-CS SUP HCPCS C1876 SR-0740-CS - STENT VASC 7MM .065IN 40MM 57CM ENROUTE UBER FLX DLV SYS ANG BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" N/A "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A SR-0830-CS SUP HCPCS C1876 SR-0830-CS - STENT VASC 8MM .065IN 30MM 57CM ENROUTE UBER FLX DLV SYS ANG BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" N/A "$3,915.00" "$6,750.00" "$4,050.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A SR-0840-CS SUP HCPCS C1876 SR-0840-CS - STENT VASC 8MM .065IN 40MM 57CM ENROUTE UBER FLX DLV SYS ANG BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" N/A "$3,915.00" "$6,750.00" "$4,050.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A SR-0930-CS SUP HCPCS C1876 SR-0930-CS - STENT VASC 9MM 30MM 57CM ENROUTE UBER FLX DLV SYS ANG TIP BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" N/A "$3,915.00" "$6,750.00" "$4,050.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A SR-0940-CS SUP HCPCS C1876 SR-0940-CS - STENT VASC 9MM .078IN 40MM 57CM ENROUTE UBER FLX DLV SYS ANG BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" N/A "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A SR-1030-CS SUP HCPCS C1876 SR-1030-CS - STENT VASC SHRT STRG 10MM 6FR 30MM 57CM ENROUTE UBER FLX BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" N/A "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A SR-1040-CS SUP HCPCS C1876 SR-1040-CS - STENT VASC 10MM .078IN 40MM 57CM ENROUTE UBER FLX DLV SYS BOTH IP/OP "$6,750.00" "$4,995.00" "$1,339.71" "$6,750.00" "$3,037.50" "$3,037.50" "$3,037.50" "$3,037.50" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.87" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.77" "$6,750.00" "$6,750.00" "$3,327.75" "$6,750.00" "$6,750.00" "$6,750.00" "$6,750.00" "$5,062.50" "$6,750.00" "$6,750.00" "$6,750.00" "$3,375.00" "$3,375.00" "$5,346.00" "$6,750.00" "$5,400.00" "$3,037.50" "$1,339.71" N/A "$3,915.00" "$6,750.00" "$6,750.00" "$6,750.00" "$1,406.70" "$6,750.00" N/A N/A SRC140306-20 SUP Custom 27803010 SRC140306-20 - COIL EMBL 3MM 6CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$2,786.00" "$2,062.00" $495.88 "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" $495.88 "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" $580.60 "$2,785.85" "$1,114.34" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,089.50" "$2,785.85" "$2,785.85" "$2,785.85" "$1,392.93" "$1,392.93" "$2,206.39" "$2,785.85" "$2,228.68" "$1,253.63" "$2,785.85" N/A "$1,615.88" "$2,785.85" "$1,671.51" "$2,785.85" "$2,785.85" "$2,785.85" N/A N/A SRC140406-20 SUP Custom 27803010 SRC140406-20 - COIL EMBL 4MM 6CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$2,786.00" "$2,062.00" $495.88 "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" $495.88 "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" $580.60 "$2,785.85" "$1,114.34" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,089.50" "$2,785.85" "$2,785.85" "$2,785.85" "$1,392.93" "$1,392.93" "$2,206.39" "$2,785.85" "$2,228.68" "$1,253.63" "$2,785.85" N/A "$1,615.88" "$2,785.85" "$1,671.51" "$2,785.85" "$2,785.85" "$2,785.85" N/A N/A SRC140408-20 SUP Custom 27803010 SRC140408-20 - COIL EMBL 4MM 8CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$2,829.50" "$2,094.00" $503.63 "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" $503.63 "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" $589.67 "$2,829.38" "$1,131.75" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,122.13" "$2,829.38" "$2,829.38" "$2,829.38" "$1,414.69" "$1,414.69" "$2,240.87" "$2,829.38" "$2,263.50" "$1,273.22" "$2,829.38" N/A "$1,641.11" "$2,829.38" "$1,697.63" "$2,829.38" "$2,829.38" "$2,829.38" N/A N/A SRC140445-20 SUP Custom 27803010 SRC140445-20 - COIL EMBL 4MM 4.5CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$2,786.00" "$2,062.00" $495.88 "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" $495.88 "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" $580.60 "$2,785.85" "$1,114.34" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,785.85" "$2,089.50" "$2,785.85" "$2,785.85" "$2,785.85" "$1,392.93" "$1,392.93" "$2,206.39" "$2,785.85" "$2,228.68" "$1,253.63" "$2,785.85" N/A "$1,615.88" "$2,785.85" "$1,671.51" "$2,785.85" "$2,785.85" "$2,785.85" N/A N/A SRC140507-20 SUP Custom 27803010 SRC140507-20 - COIL EMBL 5MM 7CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$2,829.50" "$2,094.00" $503.63 "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" $503.63 "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" $589.67 "$2,829.38" "$1,131.75" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,122.13" "$2,829.38" "$2,829.38" "$2,829.38" "$1,414.69" "$1,414.69" "$2,240.87" "$2,829.38" "$2,263.50" "$1,273.22" "$2,829.38" N/A "$1,641.11" "$2,829.38" "$1,697.63" "$2,829.38" "$2,829.38" "$2,829.38" N/A N/A SRC140512-20 SUP Custom 27803010 SRC140512-20 - COIL EMBL 5MM 12CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$2,829.50" "$2,094.00" $503.63 "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" $503.63 "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" $589.67 "$2,829.38" "$1,131.75" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,122.13" "$2,829.38" "$2,829.38" "$2,829.38" "$1,414.69" "$1,414.69" "$2,240.87" "$2,829.38" "$2,263.50" "$1,273.22" "$2,829.38" N/A "$1,641.11" "$2,829.38" "$1,697.63" "$2,829.38" "$2,829.38" "$2,829.38" N/A N/A SRC140609-20 SUP Custom 27803010 SRC140609-20 - COIL EMBL 6MM 9CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$2,829.50" "$2,094.00" $503.63 "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" $503.63 "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" $589.67 "$2,829.38" "$1,131.75" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,122.13" "$2,829.38" "$2,829.38" "$2,829.38" "$1,414.69" "$1,414.69" "$2,240.87" "$2,829.38" "$2,263.50" "$1,273.22" "$2,829.38" N/A "$1,641.11" "$2,829.38" "$1,697.63" "$2,829.38" "$2,829.38" "$2,829.38" N/A N/A SRC140615-20 SUP Custom 27803010 SRC140615-20 - COIL EMBL 6MM 15CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$2,873.00" "$2,126.00" $511.38 "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" $511.38 "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" $598.74 "$2,872.90" "$1,149.16" "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" "$2,154.75" "$2,872.90" "$2,872.90" "$2,872.90" "$1,436.45" "$1,436.45" "$2,275.34" "$2,872.90" "$2,298.32" "$1,292.81" "$2,872.90" N/A "$1,666.34" "$2,872.90" "$1,723.74" "$2,872.90" "$2,872.90" "$2,872.90" N/A N/A SRC140711-20 SUP Custom 27803010 SRC140711-20 - COIL EMBL 7MM 11CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$2,829.50" "$2,094.00" $503.63 "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" $503.63 "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" $589.67 "$2,829.38" "$1,131.75" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,829.38" "$2,122.13" "$2,829.38" "$2,829.38" "$2,829.38" "$1,414.69" "$1,414.69" "$2,240.87" "$2,829.38" "$2,263.50" "$1,273.22" "$2,829.38" N/A "$1,641.11" "$2,829.38" "$1,697.63" "$2,829.38" "$2,829.38" "$2,829.38" N/A N/A SRC140717-20 SUP Custom 27803010 SRC140717-20 - COIL EMBL 7MM 17CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$2,960.00" "$2,190.00" $526.87 "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" $526.87 "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" $616.89 "$2,959.95" "$1,183.98" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,220.00" "$2,959.95" "$2,959.95" "$2,959.95" "$1,479.98" "$1,479.98" "$2,344.28" "$2,959.95" "$2,367.96" "$1,331.98" "$2,959.95" N/A "$1,716.80" "$2,959.95" "$1,775.97" "$2,959.95" "$2,959.95" "$2,959.95" N/A N/A SRC140812-20 SUP Custom 27803010 SRC140812-20 - COIL EMBL 8MM 12CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$2,873.00" "$2,126.00" $511.38 "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" $511.38 "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" $598.74 "$2,872.90" "$1,149.16" "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" "$2,872.90" "$2,154.75" "$2,872.90" "$2,872.90" "$2,872.90" "$1,436.45" "$1,436.45" "$2,275.34" "$2,872.90" "$2,298.32" "$1,292.81" "$2,872.90" N/A "$1,666.34" "$2,872.90" "$1,723.74" "$2,872.90" "$2,872.90" "$2,872.90" N/A N/A SRC140820-20 SUP Custom 27803010 SRC140820-20 - COIL EMBL 8MM 20CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$3,003.50" "$2,223.00" $534.62 "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" $534.62 "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" $625.96 "$3,003.48" "$1,201.39" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$2,252.63" "$3,003.48" "$3,003.48" "$3,003.48" "$1,501.74" "$1,501.74" "$2,378.76" "$3,003.48" "$2,402.78" "$1,351.57" "$3,003.48" N/A "$1,742.03" "$3,003.48" "$1,802.09" "$3,003.48" "$3,003.48" "$3,003.48" N/A N/A SRC140914-20 SUP Custom 27803010 SRC140914-20 - COIL EMBL 9MM 14CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$2,960.00" "$2,190.00" $526.87 "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" $526.87 "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" $616.89 "$2,959.95" "$1,183.98" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,220.00" "$2,959.95" "$2,959.95" "$2,959.95" "$1,479.98" "$1,479.98" "$2,344.28" "$2,959.95" "$2,367.96" "$1,331.98" "$2,959.95" N/A "$1,716.80" "$2,959.95" "$1,775.97" "$2,959.95" "$2,959.95" "$2,959.95" N/A N/A SRC140922-20 SUP Custom 27803010 SRC140922-20 - COIL EMBL 9MM 22CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$3,003.50" "$2,223.00" $534.62 "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" $534.62 "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" $625.96 "$3,003.48" "$1,201.39" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$2,252.63" "$3,003.48" "$3,003.48" "$3,003.48" "$1,501.74" "$1,501.74" "$2,378.76" "$3,003.48" "$2,402.78" "$1,351.57" "$3,003.48" N/A "$1,742.03" "$3,003.48" "$1,802.09" "$3,003.48" "$3,003.48" "$3,003.48" N/A N/A SRC141016-20 SUP Custom 27803010 SRC141016-20 - COIL EMBL 10MM 16CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$2,960.00" "$2,190.00" $526.87 "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" $526.87 "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" $616.89 "$2,959.95" "$1,183.98" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,959.95" "$2,220.00" "$2,959.95" "$2,959.95" "$2,959.95" "$1,479.98" "$1,479.98" "$2,344.28" "$2,959.95" "$2,367.96" "$1,331.98" "$2,959.95" N/A "$1,716.80" "$2,959.95" "$1,775.97" "$2,959.95" "$2,959.95" "$2,959.95" N/A N/A SRC141025-20 SUP Custom 27803010 SRC141025-20 - COIL EMBL 10MM 25CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$3,047.50" "$2,255.00" $542.37 "$3,047.03" "$3,047.03" "$3,047.03" "$3,047.03" "$3,047.03" "$3,047.03" "$3,047.03" $542.37 "$3,047.03" "$3,047.03" "$3,047.03" "$3,047.03" "$3,047.03" "$3,047.03" $635.03 "$3,047.03" "$1,218.81" "$3,047.03" "$3,047.03" "$3,047.03" "$3,047.03" "$3,047.03" "$2,285.63" "$3,047.03" "$3,047.03" "$3,047.03" "$1,523.52" "$1,523.52" "$2,413.25" "$3,047.03" "$2,437.62" "$1,371.16" "$3,047.03" N/A "$1,767.55" "$3,047.03" "$1,828.22" "$3,047.03" "$3,047.03" "$3,047.03" N/A N/A SRC141118-20 SUP Custom 27803010 SRC141118-20 - COIL EMBL 11MM 18CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$3,003.50" "$2,223.00" $534.62 "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" $534.62 "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" $625.96 "$3,003.48" "$1,201.39" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$2,252.63" "$3,003.48" "$3,003.48" "$3,003.48" "$1,501.74" "$1,501.74" "$2,378.76" "$3,003.48" "$2,402.78" "$1,351.57" "$3,003.48" N/A "$1,742.03" "$3,003.48" "$1,802.09" "$3,003.48" "$3,003.48" "$3,003.48" N/A N/A SRC141127-20 SUP Custom 27803010 SRC141127-20 - COIL EMBL 11MM 27CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$3,091.00" "$2,287.00" $550.12 "$3,090.55" "$3,090.55" "$3,090.55" "$3,090.55" "$3,090.55" "$3,090.55" "$3,090.55" $550.12 "$3,090.55" "$3,090.55" "$3,090.55" "$3,090.55" "$3,090.55" "$3,090.55" $644.10 "$3,090.55" "$1,236.22" "$3,090.55" "$3,090.55" "$3,090.55" "$3,090.55" "$3,090.55" "$2,318.25" "$3,090.55" "$3,090.55" "$3,090.55" "$1,545.28" "$1,545.28" "$2,447.72" "$3,090.55" "$2,472.44" "$1,390.75" "$3,090.55" N/A "$1,792.78" "$3,090.55" "$1,854.33" "$3,090.55" "$3,090.55" "$3,090.55" N/A N/A SRC141219-20 SUP Custom 27803010 SRC141219-20 - COIL EMBL 12MM 19CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$3,003.50" "$2,223.00" $534.62 "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" $534.62 "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" $625.96 "$3,003.48" "$1,201.39" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$3,003.48" "$2,252.63" "$3,003.48" "$3,003.48" "$3,003.48" "$1,501.74" "$1,501.74" "$2,378.76" "$3,003.48" "$2,402.78" "$1,351.57" "$3,003.48" N/A "$1,742.03" "$3,003.48" "$1,802.09" "$3,003.48" "$3,003.48" "$3,003.48" N/A N/A SRC141230-20 SUP Custom 27803010 SRC141230-20 - COIL EMBL 12MM 30CM CSMR 14 MCIOL 2 HLCL MLT INFNT LOOP DTCH BOTH IP/OP "$3,134.50" "$2,320.00" $557.87 "$3,134.08" "$3,134.08" "$3,134.08" "$3,134.08" "$3,134.08" "$3,134.08" "$3,134.08" $557.87 "$3,134.08" "$3,134.08" "$3,134.08" "$3,134.08" "$3,134.08" "$3,134.08" $653.18 "$3,134.08" "$1,253.63" "$3,134.08" "$3,134.08" "$3,134.08" "$3,134.08" "$3,134.08" "$2,350.88" "$3,134.08" "$3,134.08" "$3,134.08" "$1,567.04" "$1,567.04" "$2,482.19" "$3,134.08" "$2,507.26" "$1,410.34" "$3,134.08" N/A "$1,818.01" "$3,134.08" "$1,880.45" "$3,134.08" "$3,134.08" "$3,134.08" N/A N/A SRE-CV-320S SUP Custom 27803010 SRE-CV-320S - EXPANDER TISSUE WALL CHART CURVILINEAR EXTREMITY SOFTSPAN BOTH IP/OP "$1,825.00" "$1,351.00" $324.85 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $324.85 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 "$1,825.00" N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" "$1,825.00" "$1,825.00" N/A N/A SRE-CV-720S SUP Custom 27803010 SRE-CV-720S - EXPANDER TISSUE CURVILINEAR 26.2X9CM WALL CHART EXTREMITY BOTH IP/OP "$1,825.00" "$1,351.00" $324.85 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $324.85 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" $380.35 "$1,825.00" $730.00 "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,825.00" "$1,368.75" "$1,825.00" "$1,825.00" "$1,825.00" $912.50 $912.50 "$1,445.40" "$1,825.00" "$1,460.00" $821.25 "$1,825.00" N/A "$1,058.50" "$1,825.00" "$1,095.00" "$1,825.00" "$1,825.00" "$1,825.00" N/A N/A SRS-003-FSP SUP HCPCS C1713 SRS-003-FSP - CEMENT BONE PUTTY NORIAN SRS FAST SET 3ML STERILE BOTH IP/OP "$2,019.00" "$1,494.00" $400.64 "$2,018.60" $908.37 $908.37 $908.37 $908.37 "$2,018.60" "$2,018.60" "$2,018.60" $420.73 "$2,018.60" "$2,018.60" "$2,018.60" "$2,018.60" "$2,018.60" $420.70 "$2,018.60" $807.44 "$1,194.00" "$2,018.60" "$2,018.60" "$2,018.60" "$2,018.60" "$1,514.25" "$2,018.60" "$2,018.60" "$2,018.60" "$1,009.30" "$1,009.30" "$1,598.73" "$2,018.60" "$1,614.88" $908.37 $400.64 N/A "$1,171.02" "$2,018.60" "$2,018.60" "$2,018.60" $420.68 "$2,018.60" N/A N/A SRS-005-FSP SUP HCPCS C1713 SRS-005-FSP - CEMENT BONE PUTTY NORIAN SRS FAST SET 5ML STERILE BOTH IP/OP "$3,315.50" "$2,453.00" $657.95 "$3,315.05" "$1,491.77" "$1,491.77" "$1,491.77" "$1,491.77" "$3,315.05" "$3,315.05" "$3,315.05" $690.94 "$3,315.05" "$3,315.05" "$3,315.05" "$3,315.05" "$3,315.05" $690.89 "$3,315.05" "$1,326.02" "$1,634.32" "$3,315.05" "$3,315.05" "$3,315.05" "$3,315.05" "$2,486.63" "$3,315.05" "$3,315.05" "$3,315.05" "$1,657.53" "$1,657.53" "$2,625.52" "$3,315.05" "$2,652.04" "$1,491.77" $657.95 N/A "$1,922.99" "$3,315.05" "$3,315.05" "$3,315.05" $690.86 "$3,315.05" N/A N/A SRS-010-FSP SUP HCPCS C1713 SRS-010-FSP - CEMENT BONE PUTTY NORIAN SRS FAST SET 10ML STERILE BOTH IP/OP "$6,518.50" "$4,824.00" "$1,293.70" "$6,518.20" "$2,933.19" "$2,933.19" "$2,933.19" "$2,933.19" "$6,518.20" "$6,518.20" "$6,518.20" "$1,358.56" "$6,518.20" "$6,518.20" "$6,518.20" "$6,518.20" "$6,518.20" "$1,358.46" "$6,518.20" "$2,607.28" "$3,213.47" "$6,518.20" "$6,518.20" "$6,518.20" "$6,518.20" "$4,888.88" "$6,518.20" "$6,518.20" "$6,518.20" "$3,259.10" "$3,259.10" "$5,162.41" "$6,518.20" "$5,214.56" "$2,933.19" "$1,293.70" N/A "$3,780.73" "$6,518.20" "$6,518.20" "$6,518.20" "$1,358.39" "$6,518.20" N/A N/A SRS-015-FSP SUP HCPCS C1713 SRS-015-FSP - CEMENT BONE PUTTY NORIAN SRS FAST SET 15ML STERILE BOTH IP/OP "$9,567.50" "$7,080.00" "$1,898.85" "$9,567.20" "$4,305.24" "$4,305.24" "$4,305.24" "$4,305.24" "$9,567.20" "$9,567.20" "$9,567.20" "$1,994.04" "$9,567.20" "$9,567.20" "$9,567.20" "$9,567.20" "$9,567.20" "$1,993.91" "$9,567.20" "$3,826.88" "$4,716.63" "$9,567.20" "$9,567.20" "$9,567.20" "$9,567.20" "$7,175.63" "$9,567.20" "$9,567.20" "$9,567.20" "$4,783.60" "$4,783.60" "$7,577.22" "$9,567.20" "$7,653.76" "$4,305.24" "$1,898.85" N/A "$5,549.15" "$9,567.20" "$5,740.32" "$9,567.20" "$1,993.80" "$9,567.20" N/A N/A SSSA-EW-09 SUP Custom 27203010 SSSA-EW-09 - ADAPTER INTRO LNG 9FR SFSHTH SL XTD WNG VASC ATN BOTH IP/OP $110.00 $81.00 $19.58 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $19.58 $110.00 $110.00 $81.64 $81.64 $84.79 $57.31 $22.93 $110.00 $44.00 $110.00 $110.00 $110.00 $110.00 $110.00 $82.50 $110.00 $110.00 $110.00 $55.00 $55.00 $87.12 $110.00 $88.00 $71.50 $110.00 N/A $63.80 $110.00 $66.00 $110.00 $110.00 $110.00 N/A N/A ST5678 SUP HCPCS C1713 ST5678 - SET SCREW BOTH IP/OP $250.00 $185.00 $49.62 $250.00 $112.50 $112.50 $112.50 $112.50 $250.00 $250.00 $250.00 $52.11 $250.00 $250.00 $250.00 $250.00 $250.00 $52.10 $250.00 $100.00 $147.88 $250.00 $250.00 $250.00 $250.00 $187.50 $250.00 $250.00 $250.00 $125.00 $125.00 $198.00 $250.00 $200.00 $112.50 $49.62 N/A $145.00 $250.00 $150.00 $250.00 $52.10 $250.00 N/A N/A STRAP25 SUP HCPCS C1781 STRAP25 - DEVICE FX 5MM SECURESTRAP 25 ABS STRAP MESH DISP HRN REPR BOTH IP/OP "$1,528.00" "$1,131.00" $303.26 "$1,527.95" $687.58 $687.58 $687.58 $687.58 "$1,527.95" "$1,527.95" "$1,527.95" $318.46 "$1,527.95" "$1,527.95" "$1,527.95" "$1,527.95" "$1,527.95" $318.44 "$1,527.95" "$1,527.95" $903.78 "$1,527.95" "$1,527.95" "$1,527.95" "$1,527.95" "$1,146.00" "$1,527.95" "$1,527.95" "$1,527.95" $763.98 $763.98 "$1,210.14" "$1,527.95" "$1,222.36" $687.58 $303.26 N/A $886.24 "$1,527.95" "$1,527.95" "$1,527.95" $318.42 "$1,527.95" N/A N/A SXP77 SUP Custom 27203010 SXP77 - SUTURE NONABSORBABLE THK1.5MM 2-0 V-7 30IN 7X3MM 2 ARM BRAID BOTH IP/OP $197.50 $146.00 $35.12 $203.07 $197.33 $197.33 $197.33 $197.33 $197.33 $197.33 $35.12 $197.33 $197.33 $146.46 $146.46 $152.10 $102.81 $41.13 $197.33 $81.23 $197.33 $197.33 $203.07 $197.33 $197.33 $148.13 $197.33 $197.33 $197.33 $98.67 $98.67 $156.29 $197.33 $157.86 $128.26 $197.33 N/A $114.55 $197.33 $118.40 $197.33 $197.33 $197.33 N/A N/A SYN-0020 SUP Custom 27803010 SYN-0020 - STERILE TRACKING SPHERE SYN-0020 BOTH IP/OP $30.00 $22.00 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $30.00 N/A $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A SYN-0533 SUP Custom 27803010 SYN-0533 - STERILE TRACKING SPHERE SYN-0533 BOTH IP/OP $30.00 $22.00 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $5.34 $30.00 $30.00 $30.00 $30.00 $30.00 $30.00 $6.25 $30.00 $12.00 $30.00 $30.00 $30.00 $30.00 $30.00 $22.50 $30.00 $30.00 $30.00 $15.00 $15.00 $23.76 $30.00 $24.00 $13.50 $30.00 N/A $17.40 $30.00 $18.00 $30.00 $30.00 $30.00 N/A N/A SYNCRACRTPMEAM SUP HCPCS C2621 SYNCRACRTPMEAM - SYNCRA CRT-P ADVANCED SYSTEM BOTH IP/OP "$20,177.50" "$14,931.00" "$4,004.73" "$20,177.50" "$9,079.88" "$9,079.88" "$9,079.88" "$9,079.88" "$20,177.50" "$20,177.50" "$20,177.50" "$4,205.50" "$20,177.50" "$20,177.50" "$20,177.50" "$20,177.50" "$20,177.50" "$4,205.21" "$20,177.50" "$20,177.50" "$9,947.51" "$20,177.50" "$20,177.50" "$20,177.50" "$20,177.50" "$15,133.13" "$20,177.50" "$20,177.50" "$20,177.50" "$10,088.75" "$10,088.75" "$15,980.58" "$20,177.50" "$16,142.00" "$9,079.88" "$4,004.73" N/A "$11,702.95" "$20,177.50" "$20,177.50" "$20,177.50" "$4,204.99" "$20,177.50" N/A N/A T1002 SUP Custom 27203010 T1002 - RETRACTOR SRG 10IN 30MM POST GLND NK TTH SHLDR OSTM BOTH IP/OP $653.50 $484.00 $116.26 $653.13 $653.13 $653.13 $653.13 $653.13 $653.13 $653.13 $116.26 $653.13 $653.13 $484.75 $484.75 $503.43 $340.28 $136.12 $653.13 $261.25 $653.13 $653.13 $653.13 $653.13 $653.13 $490.13 $653.13 $653.13 $653.13 $326.57 $326.57 $517.28 $653.13 $522.50 $424.53 $653.13 N/A $379.03 $653.13 $391.88 $653.13 $653.13 $653.13 N/A N/A T12BA20D SUP Custom 27203010 T12BA20D - TOOL DISSECTING 2MM BALL DIAMOND LEGEND BOTH IP/OP $412.50 $305.00 $73.38 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $73.38 $412.25 $412.25 $305.97 $305.97 $317.76 $214.78 $85.92 $412.25 $164.90 $412.25 $412.25 $412.25 $412.25 $412.25 $309.38 $412.25 $412.25 $412.25 $206.13 $206.13 $326.50 $412.25 $329.80 $267.96 $412.25 N/A $239.25 $412.25 $247.35 $412.25 $412.25 $412.25 N/A N/A T12BA30D SUP Custom 27203010 T12BA30D - TOOL DISSECTING 3MM BALL DIAMOND LEGEND BOTH IP/OP $412.50 $305.00 $73.38 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $412.25 $73.38 $412.25 $412.25 $305.97 $305.97 $317.76 $214.78 $85.92 $412.25 $164.90 $412.25 $412.25 $412.25 $412.25 $412.25 $309.38 $412.25 $412.25 $412.25 $206.13 $206.13 $326.50 $412.25 $329.80 $267.96 $412.25 N/A $239.25 $412.25 $247.35 $412.25 $412.25 $412.25 N/A N/A T12MH15 SUP Custom 27203010 T12MH15 - TOOL DISSECTING 1.5MM 12CM TELESCOPING MATCH HEAD MIDAS REX BOTH IP/OP $321.00 $238.00 $57.12 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $57.12 $320.88 $320.88 $238.16 $238.16 $247.33 $167.18 $66.87 $320.88 $128.35 $320.88 $320.88 $320.88 $320.88 $320.88 $240.75 $320.88 $320.88 $320.88 $160.44 $160.44 $254.14 $320.88 $256.70 $208.57 $320.88 N/A $186.18 $320.88 $192.53 $320.88 $320.88 $320.88 N/A N/A T12MH20 SUP Custom 27203010 T12MH20 - TOOL DISSECTING 2MM 12CM DIAMOND LEGEND STERILE T12 BOTH IP/OP $321.00 $238.00 $57.12 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $57.12 $320.88 $320.88 $238.16 $238.16 $247.33 $167.18 $66.87 $320.88 $128.35 $320.88 $320.88 $320.88 $320.88 $320.88 $240.75 $320.88 $320.88 $320.88 $160.44 $160.44 $254.14 $320.88 $256.70 $208.57 $320.88 N/A $186.18 $320.88 $192.53 $320.88 $320.88 $320.88 N/A N/A T12MH20D SUP Custom 27203010 T12MH20D - TOOL DISSECTING 2MM 12CM DIAMOND LEGEND STERILE BOTH IP/OP $348.50 $258.00 $62.03 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $62.03 $348.50 $348.50 $258.66 $258.66 $268.62 $181.57 $72.63 $348.50 $139.40 $348.50 $348.50 $348.50 $348.50 $348.50 $261.38 $348.50 $348.50 $348.50 $174.25 $174.25 $276.01 $348.50 $278.80 $226.53 $348.50 N/A $202.13 $348.50 $209.10 $348.50 $348.50 $348.50 N/A N/A T12MH25 SUP Custom 27203010 T12MH25 - TOOL DISSECTING 2.5MM 12CM MATCH HEAD LEGEND STERILE BOTH IP/OP $321.00 $238.00 $57.12 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $320.88 $57.12 $320.88 $320.88 $238.16 $238.16 $247.33 $167.18 $66.87 $320.88 $128.35 $320.88 $320.88 $320.88 $320.88 $320.88 $240.75 $320.88 $320.88 $320.88 $160.44 $160.44 $254.14 $320.88 $256.70 $208.57 $320.88 N/A $186.18 $320.88 $192.53 $320.88 $320.88 $320.88 N/A N/A T12MH25D SUP Custom 27203010 T12MH25D - TOOL DISSECTING 2.5MM 12CM DIAMOND LEGEND STERILE BOTH IP/OP $348.50 $258.00 $62.03 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $62.03 $348.50 $348.50 $258.66 $258.66 $268.62 $181.57 $72.63 $348.50 $139.40 $348.50 $348.50 $348.50 $348.50 $348.50 $261.38 $348.50 $348.50 $348.50 $174.25 $174.25 $276.01 $348.50 $278.80 $226.53 $348.50 N/A $202.13 $348.50 $209.10 $348.50 $348.50 $348.50 N/A N/A T12MH30D SUP Custom 27203010 T12MH30D - TOOL DISSECTING 3MM 12CM DIAMOND LEGEND STERILE BOTH IP/OP $348.50 $258.00 $62.03 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $62.03 $348.50 $348.50 $258.66 $258.66 $268.62 $181.57 $72.63 $348.50 $139.40 $348.50 $348.50 $348.50 $348.50 $348.50 $261.38 $348.50 $348.50 $348.50 $174.25 $174.25 $276.01 $348.50 $278.80 $226.53 $348.50 N/A $202.13 $348.50 $209.10 $348.50 $348.50 $348.50 N/A N/A T12MH35D SUP Custom 27203010 T12MH35D - TOOL DISSECTING 3.5MM 12CM DIAMOND LEGEND STERILE BOTH IP/OP $348.50 $258.00 $62.03 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $62.03 $348.50 $348.50 $258.66 $258.66 $268.62 $181.57 $72.63 $348.50 $139.40 $348.50 $348.50 $348.50 $348.50 $348.50 $261.38 $348.50 $348.50 $348.50 $174.25 $174.25 $276.01 $348.50 $278.80 $226.53 $348.50 N/A $202.13 $348.50 $209.10 $348.50 $348.50 $348.50 N/A N/A T12MH45D SUP Custom 27203010 T12MH45D - TOOL DISSECTING 4.5MM 12CM DIAMOND LEGEND STERILE BOTH IP/OP $348.50 $258.00 $62.03 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $348.50 $62.03 $348.50 $348.50 $258.66 $258.66 $268.62 $181.57 $72.63 $348.50 $139.40 $348.50 $348.50 $348.50 $348.50 $348.50 $261.38 $348.50 $348.50 $348.50 $174.25 $174.25 $276.01 $348.50 $278.80 $226.53 $348.50 N/A $202.13 $348.50 $209.10 $348.50 $348.50 $348.50 N/A N/A T1415A SUP Custom 27203010 T1415A - NEEDLE BIOP STANDARD 14GA 15CM COAXIAL HANDLE TEMNO BOTH IP/OP $162.50 $120.00 $28.89 $245.86 $162.30 $162.30 $162.30 $162.30 $162.30 $162.30 $28.89 $162.30 $162.30 $120.46 $120.46 $125.10 $84.56 $33.83 $162.30 $98.34 $162.30 $162.30 $245.86 $162.30 $162.30 $121.88 $162.30 $162.30 $162.30 $81.15 $81.15 $128.54 $162.30 $129.84 $105.50 $162.30 N/A $94.25 $162.30 $97.38 $162.30 $162.30 $162.30 N/A N/A T14BA20 SUP Custom 27203010 T14BA20 - TOOL DISSECTING 2MM 14CM TELESCOPING BALL FLUTED MIDAS REX BOTH IP/OP $331.50 $245.00 $59.01 $331.50 $331.50 $331.50 $331.50 $331.50 $331.50 $331.50 $59.01 $331.50 $331.50 $246.04 $246.04 $255.52 $172.71 $69.09 $331.50 $132.60 $331.50 $331.50 $331.50 $331.50 $331.50 $248.63 $331.50 $331.50 $331.50 $165.75 $165.75 $262.55 $331.50 $265.20 $215.48 $331.50 N/A $192.27 $331.50 $198.90 $331.50 $331.50 $331.50 N/A N/A T14BA30 SUP Custom 27203010 T14BA30 - TOOL DISSECTING 3MM 14CM TELESCOPING BALL FLUTED MIDAS REX BOTH IP/OP $331.50 $245.00 $59.01 $331.50 $331.50 $331.50 $331.50 $331.50 $331.50 $331.50 $59.01 $331.50 $331.50 $246.04 $246.04 $255.52 $172.71 $69.09 $331.50 $132.60 $331.50 $331.50 $331.50 $331.50 $331.50 $248.63 $331.50 $331.50 $331.50 $165.75 $165.75 $262.55 $331.50 $265.20 $215.48 $331.50 N/A $192.27 $331.50 $198.90 $331.50 $331.50 $331.50 N/A N/A T14BA40 SUP Custom 27203010 T14BA40 - TOOL DISSECTING 4MM 14CM TELESCOPING BALL FLUTED MIDAS REX BOTH IP/OP $331.50 $245.00 $59.01 $331.50 $331.50 $331.50 $331.50 $331.50 $331.50 $331.50 $59.01 $331.50 $331.50 $246.04 $246.04 $255.52 $172.71 $69.09 $331.50 $132.60 $331.50 $331.50 $331.50 $331.50 $331.50 $248.63 $331.50 $331.50 $331.50 $165.75 $165.75 $262.55 $331.50 $265.20 $215.48 $331.50 N/A $192.27 $331.50 $198.90 $331.50 $331.50 $331.50 N/A N/A T14MH25 SUP Custom 27203010 T14MH25 - TOOL DISSECTING 2.5MM 14CM MATCH HEAD LEGEND STERILE T14 BOTH IP/OP $357.00 $264.00 $63.55 $357.00 $357.00 $357.00 $357.00 $357.00 $357.00 $357.00 $63.55 $357.00 $357.00 $264.97 $264.97 $275.18 $186.00 $74.40 $357.00 $142.80 $357.00 $357.00 $357.00 $357.00 $357.00 $267.75 $357.00 $357.00 $357.00 $178.50 $178.50 $282.74 $357.00 $285.60 $232.05 $357.00 N/A $207.06 $357.00 $214.20 $357.00 $357.00 $357.00 N/A N/A T14MH30D SUP Custom 27203010 T14MH30D - TOOL DISSECTING 3MM 14CM TELESCOPING MATCH HEAD DIAMOND BOTH IP/OP $391.00 $289.00 $69.60 $391.00 $391.00 $391.00 $391.00 $391.00 $391.00 $391.00 $69.60 $391.00 $391.00 $290.20 $290.20 $301.38 $203.71 $81.49 $391.00 $156.40 $391.00 $391.00 $391.00 $391.00 $391.00 $293.25 $391.00 $391.00 $391.00 $195.50 $195.50 $309.67 $391.00 $312.80 $254.15 $391.00 N/A $226.78 $391.00 $234.60 $391.00 $391.00 $391.00 N/A N/A T15MH25 SUP Custom 27203010 T15MH25 - TOOL DISSECTING 2.5MM 15CM MATCH HEAD LEGEND STERILE T15 BOTH IP/OP $334.00 $247.00 $59.39 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $59.39 $333.63 $333.63 $247.62 $247.62 $257.16 $173.82 $69.53 $333.63 $133.45 $333.63 $333.63 $333.63 $333.63 $333.63 $250.50 $333.63 $333.63 $333.63 $166.82 $166.82 $264.23 $333.63 $266.90 $216.86 $333.63 N/A $193.72 $333.63 $200.18 $333.63 $333.63 $333.63 N/A N/A T15MH30D SUP Custom 27203010 T15MH30D - TOOL DISSECTING 3MM 15CM DIAMOND MIDAS REX LEGEND STERILE BOTH IP/OP $368.00 $272.00 $65.44 $367.63 $367.63 $367.63 $367.63 $367.63 $367.63 $367.63 $65.44 $367.63 $367.63 $272.85 $272.85 $283.37 $191.54 $76.62 $367.63 $147.05 $367.63 $367.63 $367.63 $367.63 $367.63 $276.00 $367.63 $367.63 $367.63 $183.82 $183.82 $291.16 $367.63 $294.10 $238.96 $367.63 N/A $213.44 $367.63 $220.58 $367.63 $367.63 $367.63 N/A N/A T16X12 SUP HCPCS C1894 T16X12 - TUNNELER SURG 16GA 12IN SHEATH EFFECTIVE PAIN RELIEF FLUID BOTH IP/OP $69.00 $51.00 $13.69 $69.00 $37.47 $37.47 $37.47 $37.47 $69.00 $69.00 $69.00 $14.38 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $69.00 $40.81 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $13.69 N/A $40.02 $69.00 $69.00 $69.00 $14.38 $69.00 N/A N/A T17MH30D SUP Custom 27203010 T17MH30D - TOOL DISSECTING 3MM 17CM TELESCOPING MATCH HEAD DIAMOND BOTH IP/OP $365.50 $270.00 $65.06 $365.50 $365.50 $365.50 $365.50 $365.50 $365.50 $365.50 $65.06 $365.50 $365.50 $271.27 $271.27 $281.73 $190.43 $76.17 $365.50 $146.20 $365.50 $365.50 $365.50 $365.50 $365.50 $274.13 $365.50 $365.50 $365.50 $182.75 $182.75 $289.48 $365.50 $292.40 $237.58 $365.50 N/A $211.99 $365.50 $219.30 $365.50 $365.50 $365.50 N/A N/A T17X8 SUP HCPCS C1894 T17X8 - TUNNELER SRG 17GA 8IN STRL LF ONQ SHTH DISP BOTH IP/OP $69.00 $51.00 $13.69 $69.00 $37.47 $37.47 $37.47 $37.47 $69.00 $69.00 $69.00 $14.38 $69.00 $51.21 $51.21 $53.19 $35.95 $14.38 $69.00 $69.00 $40.81 $69.00 $69.00 $69.00 $69.00 $51.75 $69.00 $69.00 $69.00 $34.50 $34.50 $54.65 $69.00 $55.20 $44.85 $13.69 N/A $40.02 $69.00 $69.00 $69.00 $14.38 $69.00 N/A N/A T18MH25 SUP Custom 27203010 T18MH25 - TOOL DISSECTING 2.5MM 18CM TELESCOPING MATCH HEAD MIDAS REX BOTH IP/OP $334.00 $247.00 $59.39 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $333.63 $59.39 $333.63 $333.63 $247.62 $247.62 $257.16 $173.82 $69.53 $333.63 $133.45 $333.63 $333.63 $333.63 $333.63 $333.63 $250.50 $333.63 $333.63 $333.63 $166.82 $166.82 $264.23 $333.63 $266.90 $216.86 $333.63 N/A $193.72 $333.63 $200.18 $333.63 $333.63 $333.63 N/A N/A T18MH30D SUP Custom 27203010 T18MH30D - TOOL DISSECTING 3MM 18CM TELESCOPING MATCH HEAD MIDAS REX BOTH IP/OP $368.00 $272.00 $65.44 $367.63 $367.63 $367.63 $367.63 $367.63 $367.63 $367.63 $65.44 $367.63 $367.63 $272.85 $272.85 $283.37 $191.54 $76.62 $367.63 $147.05 $367.63 $367.63 $367.63 $367.63 $367.63 $276.00 $367.63 $367.63 $367.63 $183.82 $183.82 $291.16 $367.63 $294.10 $238.96 $367.63 N/A $213.44 $367.63 $220.58 $367.63 $367.63 $367.63 N/A N/A T43101 SUP Custom 27804086 T43101 - GRAFT BN .5ML GRFTN PTTY JR DBM BOTH IP/OP $312.50 $231.00 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $55.63 $312.50 $312.50 $312.50 $312.50 $312.50 $312.50 $65.13 $312.50 $125.00 $312.50 $312.50 $312.50 $312.50 $312.50 $234.38 $312.50 $312.50 $312.50 $156.25 $156.25 $247.50 $312.50 $250.00 $140.63 $312.50 N/A $181.25 $312.50 $187.50 $312.50 $312.50 $312.50 N/A N/A T43102 SUP Custom 27804086 T43102 - GRAFT BONE PUTTY JAR GRAFTON DEMINERALIZED BONE MATRIX 1ML BOTH IP/OP $350.00 $259.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $62.30 $350.00 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $140.00 $350.00 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $350.00 N/A $203.00 $350.00 $210.00 $350.00 $350.00 $350.00 N/A N/A T43103 SUP Custom 27804086 T43103 - GRAFT BN 2.5ML GRFTN PTTY JR DBM BOTH IP/OP "$1,190.00" $881.00 $211.82 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $211.82 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $248.01 "$1,190.00" $476.00 "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" "$1,190.00" $892.50 "$1,190.00" "$1,190.00" "$1,190.00" $595.00 $595.00 $942.48 "$1,190.00" $952.00 $535.50 "$1,190.00" N/A $690.20 "$1,190.00" $714.00 "$1,190.00" "$1,190.00" "$1,190.00" N/A N/A T43105 SUP Custom 27804086 T43105 - GRAFT BONE PUTTY JAR GRAFTON DEMINERALIZED BONE MATRIX 5ML BOTH IP/OP "$2,162.50" "$1,600.00" $384.93 "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" $384.93 "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" $450.69 "$2,162.50" $865.00 "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$2,162.50" "$1,621.88" "$2,162.50" "$2,162.50" "$2,162.50" "$1,081.25" "$1,081.25" "$1,712.70" "$2,162.50" "$1,730.00" $973.13 "$2,162.50" N/A "$1,254.25" "$2,162.50" "$1,297.50" "$2,162.50" "$2,162.50" "$2,162.50" N/A N/A T45001 SUP HCPCS C1713 T45001 - GRAFT BN 1CC GRFTN + PST DBM BOTH IP/OP $350.00 $259.00 $69.47 $350.00 $157.50 $157.50 $157.50 $157.50 $350.00 $350.00 $350.00 $72.95 $350.00 $350.00 $350.00 $350.00 $350.00 $72.94 $350.00 $350.00 $207.03 $350.00 $350.00 $350.00 $350.00 $262.50 $350.00 $350.00 $350.00 $175.00 $175.00 $277.20 $350.00 $280.00 $157.50 $69.47 N/A $203.00 $350.00 $350.00 $350.00 $72.94 $350.00 N/A N/A T9MH15 SUP Custom 27203010 T9MH15 - TOOL DISSECTING 1.5MM 9CM TELESCOPING MATCH HEAD MIDAS REX BOTH IP/OP $319.00 $236.00 $56.74 $318.75 $318.75 $318.75 $318.75 $318.75 $318.75 $318.75 $56.74 $318.75 $318.75 $236.58 $236.58 $245.69 $166.07 $66.43 $318.75 $127.50 $318.75 $318.75 $318.75 $318.75 $318.75 $239.25 $318.75 $318.75 $318.75 $159.38 $159.38 $252.45 $318.75 $255.00 $207.19 $318.75 N/A $185.02 $318.75 $191.25 $318.75 $318.75 $318.75 N/A N/A T9MH20 SUP Custom 27203010 T9MH20 - TOOL DISSECTING 2MM 9CM TELESCOPING MATCH HEAD MIDAS REX BOTH IP/OP $319.00 $236.00 $56.74 $318.75 $318.75 $318.75 $318.75 $318.75 $318.75 $318.75 $56.74 $318.75 $318.75 $236.58 $236.58 $245.69 $166.07 $66.43 $318.75 $127.50 $318.75 $318.75 $318.75 $318.75 $318.75 $239.25 $318.75 $318.75 $318.75 $159.38 $159.38 $252.45 $318.75 $255.00 $207.19 $318.75 N/A $185.02 $318.75 $191.25 $318.75 $318.75 $318.75 N/A N/A T9MH25 SUP Custom 27203010 T9MH25 - TOOL DISSECTING 2.5MM 9CM TELESCOPING MATCH HEAD MIDAS REX BOTH IP/OP $319.00 $236.00 $56.74 $318.75 $318.75 $318.75 $318.75 $318.75 $318.75 $318.75 $56.74 $318.75 $318.75 $236.58 $236.58 $245.69 $166.07 $66.43 $318.75 $127.50 $318.75 $318.75 $318.75 $318.75 $318.75 $239.25 $318.75 $318.75 $318.75 $159.38 $159.38 $252.45 $318.75 $255.00 $207.19 $318.75 N/A $185.02 $318.75 $191.25 $318.75 $318.75 $318.75 N/A N/A T9MH25D SUP Custom 27203010 T9MH25D - TOOL DISSECTING 2.5MM 9CM TELESCOPING MATCH HEAD DIAMOND BOTH IP/OP $361.50 $268.00 $64.30 $361.25 $361.25 $361.25 $361.25 $361.25 $361.25 $361.25 $64.30 $361.25 $361.25 $268.12 $268.12 $278.45 $188.21 $75.29 $361.25 $144.50 $361.25 $361.25 $361.25 $361.25 $361.25 $271.13 $361.25 $361.25 $361.25 $180.63 $180.63 $286.11 $361.25 $289.00 $234.81 $361.25 N/A $209.67 $361.25 $216.75 $361.25 $361.25 $361.25 N/A N/A T9MH30D SUP Custom 27203010 T9MH30D - TOOL DISSECTING 3MM 9CM TELESCOPING MATCH HEAD DIAMOND MIDAS BOTH IP/OP $361.50 $268.00 $64.30 $361.25 $361.25 $361.25 $361.25 $361.25 $361.25 $361.25 $64.30 $361.25 $361.25 $268.12 $268.12 $278.45 $188.21 $75.29 $361.25 $144.50 $361.25 $361.25 $361.25 $361.25 $361.25 $271.13 $361.25 $361.25 $361.25 $180.63 $180.63 $286.11 $361.25 $289.00 $234.81 $361.25 N/A $209.67 $361.25 $216.75 $361.25 $361.25 $361.25 N/A N/A T9MH35D SUP Custom 27203010 T9MH35D - TOOL DISSECTING 3.5MM 9CM TELESCOPING MATCH HEAD DIAMOND BOTH IP/OP $361.50 $268.00 $64.30 $361.25 $361.25 $361.25 $361.25 $361.25 $361.25 $361.25 $64.30 $361.25 $361.25 $268.12 $268.12 $278.45 $188.21 $75.29 $361.25 $144.50 $361.25 $361.25 $361.25 $361.25 $361.25 $271.13 $361.25 $361.25 $361.25 $180.63 $180.63 $286.11 $361.25 $289.00 $234.81 $361.25 N/A $209.67 $361.25 $216.75 $361.25 $361.25 $361.25 N/A N/A T9MH45D SUP Custom 27203010 T9MH45D - TOOL DISSECTING 4.5MM 9CM TELESCOPING MATCH HEAD DIAMOND BOTH IP/OP $361.50 $268.00 $64.30 $361.25 $361.25 $361.25 $361.25 $361.25 $361.25 $361.25 $64.30 $361.25 $361.25 $268.12 $268.12 $278.45 $188.21 $75.29 $361.25 $144.50 $361.25 $361.25 $361.25 $361.25 $361.25 $271.13 $361.25 $361.25 $361.25 $180.63 $180.63 $286.11 $361.25 $289.00 $234.81 $361.25 N/A $209.67 $361.25 $216.75 $361.25 $361.25 $361.25 N/A N/A TA3035L SUP Custom 27203010 TA3035L - RELOAD STPLR 30MMX3.5MM BLU STRL LF 1.5MM DST TA 2 ROW LNR BOTH IP/OP $90.00 $67.00 $15.98 $89.75 $89.75 $89.75 $89.75 $89.75 $89.75 $89.75 $15.98 $89.75 $89.75 $66.61 $66.61 $69.18 $46.76 $18.70 $89.75 $30.98 $89.75 $89.75 $77.45 $89.75 $89.75 $67.50 $89.75 $89.75 $89.75 $44.88 $44.88 $71.08 $89.75 $71.80 $58.34 $89.75 N/A $52.20 $89.75 $53.85 $89.75 $89.75 $89.75 N/A N/A TA3035S SUP Custom 27203010 TA3035S - STAPLER INTERNAL 30MMX3.5MM 1.5MM 2 ROW 2 ACTION HANDLE BOTH IP/OP $205.00 $152.00 $36.48 $204.93 $204.93 $204.93 $204.93 $204.93 $204.93 $204.93 $36.48 $204.93 $204.93 $152.10 $152.10 $157.96 $106.77 $42.71 $204.93 $70.72 $204.93 $204.93 $176.80 $204.93 $204.93 $153.75 $204.93 $204.93 $204.93 $102.47 $102.47 $162.30 $204.93 $163.94 $133.20 $204.93 N/A $118.90 $204.93 $122.96 $204.93 $204.93 $204.93 N/A N/A TA3048S SUP Custom 27203010 TA3048S - STAPLER INTERNAL 30MMX4.8MM 2MM 2 ROW 2 ACTION HANDLE LINEAR BOTH IP/OP $217.00 $161.00 $38.61 $216.93 $216.93 $216.93 $216.93 $216.93 $216.93 $216.93 $38.61 $216.93 $216.93 $161.01 $161.01 $167.21 $113.02 $45.21 $216.93 $86.77 $216.93 $216.93 $216.93 $216.93 $216.93 $162.75 $216.93 $216.93 $216.93 $108.47 $108.47 $171.81 $216.93 $173.54 $141.00 $216.93 N/A $125.86 $216.93 $130.16 $216.93 $216.93 $216.93 N/A N/A TA30V3L SUP Custom 27203010 TA30V3L - RELOAD STPLR 30MMX2.5MM WHT STRL LF 1MM DST TA 3 ROW LNR CTR BOTH IP/OP $103.00 $76.00 $18.29 $102.77 $102.77 $102.77 $102.77 $102.77 $102.77 $102.77 $18.29 $102.77 $102.77 $76.28 $76.28 $79.22 $53.54 $21.42 $102.77 $41.11 $102.77 $102.77 $102.77 $102.77 $102.77 $77.25 $102.77 $102.77 $102.77 $51.39 $51.39 $81.39 $102.77 $82.22 $66.80 $102.77 N/A $59.74 $102.77 $61.66 $102.77 $102.77 $102.77 N/A N/A TA30V3S SUP Custom 27203010 TA30V3S - STAPLER INTERNAL 30MM 3 ROW 2 ACTION HANDLE LINEAR CUTTER BOTH IP/OP $249.50 $185.00 $44.39 $249.36 $249.36 $249.36 $249.36 $249.36 $249.36 $249.36 $44.39 $249.36 $249.36 $185.07 $185.07 $192.21 $129.92 $51.97 $249.36 $99.74 $249.36 $249.36 $249.36 $249.36 $249.36 $187.13 $249.36 $249.36 $249.36 $124.68 $124.68 $197.49 $249.36 $199.49 $162.08 $249.36 N/A $144.71 $249.36 $149.62 $249.36 $249.36 $249.36 N/A N/A TA6035L SUP Custom 27203010 TA6035L - RELOAD STPLR 60MMX3.5MM BLU STRL LF 1.5MM DST TA 2 ROW LNR BOTH IP/OP $101.00 $75.00 $17.97 $100.93 $100.93 $100.93 $100.93 $100.93 $100.93 $100.93 $17.97 $100.93 $100.93 $74.91 $74.91 $77.80 $52.58 $21.03 $100.93 $34.83 $100.93 $100.93 $87.08 $100.93 $100.93 $75.75 $100.93 $100.93 $100.93 $50.47 $50.47 $79.94 $100.93 $80.74 $65.60 $100.93 N/A $58.58 $100.93 $60.56 $100.93 $100.93 $100.93 N/A N/A TA6035S SUP Custom 27203010 TA6035S - STAPLER INTERNAL 60X3.5MM STAPLE 2 ACTION HANDLE LINEAR BOTH IP/OP $212.00 $157.00 $37.73 $211.95 $211.95 $211.95 $211.95 $211.95 $211.95 $211.95 $37.73 $211.95 $211.95 $157.31 $157.31 $163.37 $110.43 $44.17 $211.95 $73.15 $211.95 $211.95 $182.88 $211.95 $211.95 $159.00 $211.95 $211.95 $211.95 $105.98 $105.98 $167.86 $211.95 $169.56 $137.77 $211.95 N/A $122.96 $211.95 $127.17 $211.95 $211.95 $211.95 N/A N/A TA6048S SUP Custom 27203010 TA6048S - STAPLER INTERNAL 60X4.8MM STAPLE 2 ACTION HANDLE LINEAR BOTH IP/OP $217.50 $161.00 $38.70 $217.44 $217.44 $217.44 $217.44 $217.44 $217.44 $217.44 $38.70 $217.44 $217.44 $161.38 $161.38 $167.60 $113.29 $45.32 $217.44 $86.98 $217.44 $217.44 $217.44 $217.44 $217.44 $163.13 $217.44 $217.44 $217.44 $108.72 $108.72 $172.21 $217.44 $173.95 $141.34 $217.44 N/A $126.15 $217.44 $130.46 $217.44 $217.44 $217.44 N/A N/A TA9035L SUP Custom 27203010 TA9035L - RELOAD STPLR 90MMX3.5MM BLU STRL LF 1.5MM DST TA 2 ROW LNR BOTH IP/OP $107.00 $79.00 $18.97 $106.55 $106.55 $106.55 $106.55 $106.55 $106.55 $106.55 $18.97 $106.55 $106.55 $79.08 $79.08 $82.13 $55.51 $22.21 $106.55 $36.78 $106.55 $106.55 $91.95 $106.55 $106.55 $80.25 $106.55 $106.55 $106.55 $53.28 $53.28 $84.39 $106.55 $85.24 $69.26 $106.55 N/A $62.06 $106.55 $63.93 $106.55 $106.55 $106.55 N/A N/A TA9035S SUP Custom 27203010 TA9035S - STAPLER INTERNAL 90X3.5MM STAPLE 2 ACTION HANDLE LINEAR BOTH IP/OP $224.00 $166.00 $39.83 $223.78 $223.78 $223.78 $223.78 $223.78 $223.78 $223.78 $39.83 $223.78 $223.78 $166.09 $166.09 $172.49 $116.59 $46.64 $223.78 $89.51 $223.78 $223.78 $223.78 $223.78 $223.78 $168.00 $223.78 $223.78 $223.78 $111.89 $111.89 $177.23 $223.78 $179.02 $145.46 $223.78 N/A $129.92 $223.78 $134.27 $223.78 $223.78 $223.78 N/A N/A TA9048L SUP Custom 27203010 TA9048L - RELOAD STPLR 90MMX4.8MM GRN STRL LF 2MM DST TA 2 ROW LNR CTR BOTH IP/OP $109.50 $81.00 $19.46 $109.32 $109.32 $109.32 $109.32 $109.32 $109.32 $109.32 $19.46 $109.32 $109.32 $81.14 $81.14 $84.26 $56.96 $22.78 $109.32 $43.73 $109.32 $109.32 $109.32 $109.32 $109.32 $82.13 $109.32 $109.32 $109.32 $54.66 $54.66 $86.58 $109.32 $87.46 $71.06 $109.32 N/A $63.51 $109.32 $65.59 $109.32 $109.32 $109.32 N/A N/A TA9048S SUP Custom 27203010 TA9048S - STAPLER INTERNAL 90X4.8MM STAPLE 2 ACTION HANDLE LINEAR BOTH IP/OP $264.00 $195.00 $46.99 $263.98 $263.98 $263.98 $263.98 $263.98 $263.98 $263.98 $46.99 $263.98 $263.98 $195.93 $195.93 $203.48 $137.53 $55.02 $263.98 $105.59 $263.98 $263.98 $263.98 $263.98 $263.98 $198.00 $263.98 $263.98 $263.98 $131.99 $131.99 $209.07 $263.98 $211.18 $171.59 $263.98 N/A $153.12 $263.98 $158.39 $263.98 $263.98 $263.98 N/A N/A TB-1550K-S SUP HCPCS C1713 TB-1550K-S - PIN FIX 50MM TENSION BAND SYSTEM STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $510.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $106.28 $510.00 N/A N/A TB-1570K-S SUP HCPCS C1713 TB-1570K-S - PIN FIX 70MM TENSION BAND KIT STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $510.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $106.28 $510.00 N/A N/A TB-1590K-S SUP HCPCS C1713 TB-1590K-S - PIN FIX 90MM TENSION BAND SYSTEM STAINLESS STEEL ORTHOPEDIC BOTH IP/OP $510.00 $377.00 $101.22 $510.00 $229.50 $229.50 $229.50 $229.50 $510.00 $510.00 $510.00 $106.30 $510.00 $510.00 $510.00 $510.00 $510.00 $106.29 $510.00 $510.00 $301.67 $510.00 $510.00 $510.00 $510.00 $382.50 $510.00 $510.00 $510.00 $255.00 $255.00 $403.92 $510.00 $408.00 $229.50 $101.22 N/A $295.80 $510.00 $510.00 $510.00 $106.28 $510.00 N/A N/A TC003 SUP HCPCS C1729 TC003 - CATHETER INTRAUTERINE BALLOON ABLATION THERMACHOICE UTERUS BOTH IP/OP "$2,472.50" "$1,830.00" $490.73 "$2,472.50" "$1,342.57" "$1,342.57" "$1,342.57" "$1,342.57" "$2,472.50" "$2,472.50" "$2,472.50" $515.33 "$2,472.50" "$1,835.09" "$1,835.09" "$1,905.80" "$1,288.17" $515.30 "$2,472.50" "$2,472.50" "$1,462.48" "$2,472.50" "$2,472.50" "$2,472.50" "$2,472.50" "$1,854.38" "$2,472.50" "$2,472.50" "$2,472.50" "$1,236.25" "$1,236.25" "$1,958.22" "$2,472.50" "$1,978.00" "$1,607.13" $490.73 N/A "$1,434.05" "$2,472.50" "$2,472.50" "$2,472.50" $515.27 "$2,472.50" N/A N/A TDF010U SUP HCPCS C1721 TDF010U - Paradym 9550 RF DR BOTH IP/OP "$38,750.00" "$28,675.00" "$8,075.93" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$8,075.93" "$38,750.00" "$15,500.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$38,750.00" "$29,062.50" "$38,750.00" "$38,750.00" "$38,750.00" "$19,375.00" "$19,375.00" "$30,690.00" "$38,750.00" "$31,000.00" "$17,437.50" "$38,750.00" N/A "$22,475.00" "$38,750.00" "$23,250.00" "$38,750.00" "$38,750.00" "$38,750.00" N/A N/A TDF011U SUP HCPCS C1722 TDF011U - Paradym 9250 RF VR BOTH IP/OP "$33,750.00" "$24,975.00" "$6,698.53" "$33,750.00" "$15,187.50" "$15,187.50" "$15,187.50" "$15,187.50" "$33,750.00" "$33,750.00" "$33,750.00" "$7,034.34" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$7,033.87" "$33,750.00" "$33,750.00" "$16,638.75" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$25,312.50" "$33,750.00" "$33,750.00" "$33,750.00" "$16,875.00" "$16,875.00" "$26,730.00" "$33,750.00" "$27,000.00" "$15,187.50" "$6,698.53" N/A "$19,575.00" "$33,750.00" "$33,750.00" "$33,750.00" "$7,033.50" "$33,750.00" N/A N/A TDF012U SUP HCPCS C1882 TDF012U - Paradym RF CRT 9750 BOTH IP/OP "$45,500.00" "$33,670.00" "$7,712.84" "$45,500.00" "$20,475.00" "$20,475.00" "$20,475.00" "$20,475.00" "$45,500.00" "$45,500.00" "$45,500.00" "$9,417.94" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$9,482.70" "$45,500.00" "$45,500.00" "$22,431.50" "$45,500.00" "$45,500.00" "$45,500.00" "$45,500.00" "$34,125.00" "$45,500.00" "$45,500.00" "$45,500.00" "$22,750.00" "$22,750.00" "$36,036.00" "$45,500.00" "$36,400.00" "$20,475.00" "$7,712.84" N/A "$26,390.00" "$45,500.00" "$45,500.00" "$45,500.00" "$8,098.48" "$45,500.00" N/A N/A TDF012U SYSTEM SUP HCPCS C1882 TDF012U SYSTEM - Paradym RF CRT 9750 System BOTH IP/OP "$60,500.00" "$44,770.00" "$7,712.84" "$60,500.00" "$27,225.00" "$27,225.00" "$27,225.00" "$27,225.00" "$60,500.00" "$60,500.00" "$60,500.00" "$9,417.94" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$12,608.87" "$60,500.00" "$60,500.00" "$29,826.50" "$60,500.00" "$60,500.00" "$60,500.00" "$60,500.00" "$45,375.00" "$60,500.00" "$60,500.00" "$60,500.00" "$30,250.00" "$30,250.00" "$47,916.00" "$60,500.00" "$48,400.00" "$27,225.00" "$7,712.84" N/A "$35,090.00" "$60,500.00" "$60,500.00" "$60,500.00" "$8,098.48" "$60,500.00" N/A N/A TE-1000 SUP Custom 27203010 TE-1000 - TOOL INSERTION EMBEDDING CURVED PLASTIC HANDLE TITANIUM TIP BOTH IP/OP $332.50 $246.00 $59.19 $332.50 $332.50 $332.50 $332.50 $332.50 $332.50 $332.50 $59.19 $332.50 $332.50 $246.78 $246.78 $256.29 $173.23 $69.30 $332.50 $133.00 $332.50 $332.50 $332.50 $332.50 $332.50 $249.38 $332.50 $332.50 $332.50 $166.25 $166.25 $263.34 $332.50 $266.00 $216.13 $332.50 N/A $192.85 $332.50 $199.50 $332.50 $332.50 $332.50 N/A N/A TECR1510 SUP HCPCS C1781 TECR1510 - MESH SRG RECT 6X4IN PARIETEX 2D FLT SHT RGD PLSTR HRN BOTH IP/OP $180.00 $133.00 $35.66 $179.68 $80.86 $80.86 $80.86 $80.86 $179.68 $179.68 $179.68 $37.45 $179.68 $179.68 $179.68 $179.68 $179.68 $37.45 $179.68 $179.68 $106.28 $179.68 $179.68 $179.68 $179.68 $135.00 $179.68 $179.68 $179.68 $89.84 $89.84 $142.31 $179.68 $143.74 $80.86 $35.66 N/A $104.40 $179.68 $179.68 $179.68 $37.45 $179.68 N/A N/A TECT1510AL SUP HCPCS C1781 TECT1510AL - MESH SRG 6X4IN PARIETEX FLXB ANTM PLSTR LT HRN BOTH IP/OP $295.00 $218.00 $58.52 $294.83 $132.67 $132.67 $132.67 $132.67 $294.83 $294.83 $294.83 $61.45 $294.83 $294.83 $294.83 $294.83 $294.83 $61.45 $294.83 $294.83 $174.39 $294.83 $294.83 $294.83 $294.83 $221.25 $294.83 $294.83 $294.83 $147.42 $147.42 $233.51 $294.83 $235.86 $132.67 $58.52 N/A $171.10 $294.83 $294.83 $294.83 $61.44 $294.83 N/A N/A TECT1510AR SUP HCPCS C1781 TECT1510AR - MESH SRG 6X4IN PARIETEX 3D FLXB LTWT ANTM MACROPOROUS PLSTR BOTH IP/OP $295.00 $218.00 $58.52 $294.83 $132.67 $132.67 $132.67 $132.67 $294.83 $294.83 $294.83 $61.45 $294.83 $294.83 $294.83 $294.83 $294.83 $61.45 $294.83 $294.83 $174.39 $294.83 $294.83 $294.83 $294.83 $221.25 $294.83 $294.83 $294.83 $147.42 $147.42 $233.51 $294.83 $235.86 $132.67 $58.52 N/A $171.10 $294.83 $294.83 $294.83 $61.44 $294.83 N/A N/A TEM1208GL SUP HCPCS C1781 TEM1208GL - MESH SURG 4.7X3IN LEFT FLAP SELF FIXATING ANATOMIC BOTH IP/OP $613.50 $454.00 $202.39 "$1,019.75" $458.89 $458.89 $458.89 $458.89 "$1,019.75" "$1,019.75" "$1,019.75" $212.54 "$1,019.75" "$1,019.75" "$1,019.75" "$1,019.75" "$1,019.75" $212.53 "$1,019.75" "$1,019.75" $603.18 "$1,019.75" "$1,019.75" "$1,019.75" "$1,019.75" $460.13 "$1,019.75" "$1,019.75" "$1,019.75" $509.88 $509.88 $807.64 "$1,019.75" $815.80 $458.89 $202.39 N/A $355.83 "$1,019.75" "$1,019.75" "$1,019.75" $212.52 "$1,019.75" N/A N/A TEM1208GL SUP HCPCS C1781 TEM1208GL - MESH SRG 4.7X3IN LF PARIETEX PROGRIP LT FLP SLF FIXATING BOTH IP/OP "$1,020.00" $755.00 $202.39 "$1,019.75" $458.89 $458.89 $458.89 $458.89 "$1,019.75" "$1,019.75" "$1,019.75" $212.54 "$1,019.75" "$1,019.75" "$1,019.75" "$1,019.75" "$1,019.75" $212.53 "$1,019.75" "$1,019.75" $603.18 "$1,019.75" "$1,019.75" "$1,019.75" "$1,019.75" $765.00 "$1,019.75" "$1,019.75" "$1,019.75" $509.88 $509.88 $807.64 "$1,019.75" $815.80 $458.89 $202.39 N/A $591.60 "$1,019.75" "$1,019.75" "$1,019.75" $212.52 "$1,019.75" N/A N/A TEM1208GR SUP HCPCS C1781 TEM1208GR - MESH SURG 4.7X3IN RIGHT FLAP SELF FIXATING ANATOMIC BOTH IP/OP $613.50 $454.00 $202.39 "$1,019.75" $458.89 $458.89 $458.89 $458.89 "$1,019.75" "$1,019.75" "$1,019.75" $212.54 "$1,019.75" "$1,019.75" "$1,019.75" "$1,019.75" "$1,019.75" $212.53 "$1,019.75" "$1,019.75" $603.18 "$1,019.75" "$1,019.75" "$1,019.75" "$1,019.75" $460.13 "$1,019.75" "$1,019.75" "$1,019.75" $509.88 $509.88 $807.64 "$1,019.75" $815.80 $458.89 $202.39 N/A $355.83 "$1,019.75" "$1,019.75" "$1,019.75" $212.52 "$1,019.75" N/A N/A TEM1208GR SUP HCPCS C1781 TEM1208GR - MESH SRG 4.7X3IN LF PARIETEX PROGRIP RT FLP SLF FIXATING BOTH IP/OP "$1,020.00" $755.00 $202.39 "$1,019.75" $458.89 $458.89 $458.89 $458.89 "$1,019.75" "$1,019.75" "$1,019.75" $212.54 "$1,019.75" "$1,019.75" "$1,019.75" "$1,019.75" "$1,019.75" $212.53 "$1,019.75" "$1,019.75" $603.18 "$1,019.75" "$1,019.75" "$1,019.75" "$1,019.75" $765.00 "$1,019.75" "$1,019.75" "$1,019.75" $509.88 $509.88 $807.64 "$1,019.75" $815.80 $458.89 $202.39 N/A $591.60 "$1,019.75" "$1,019.75" "$1,019.75" $212.52 "$1,019.75" N/A N/A TET1309 SUP HCPCS C1781 TET1309 - MESH SRG RECT 5.2X3.6IN LF PARIETEX 3D HCMB WV KNIT FLT SHT BOTH IP/OP $206.50 $153.00 $40.99 $206.50 $92.93 $92.93 $92.93 $92.93 $206.50 $206.50 $206.50 $43.04 $206.50 $206.50 $206.50 $206.50 $206.50 $43.04 $206.50 $206.50 $122.14 $206.50 $206.50 $206.50 $206.50 $154.88 $206.50 $206.50 $206.50 $103.25 $103.25 $163.55 $206.50 $165.20 $92.93 $40.99 N/A $119.77 $206.50 $206.50 $206.50 $43.03 $206.50 N/A N/A TF-19A SUP Custom 27803010 TF-19A - VALVE AORTIC 12MM CNTOUR 19MM 24MM 15MM STENT TISSUE LEAFLET BOTH IP/OP "$15,000.00" "$11,100.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$15,000.00" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$15,000.00" "$15,000.00" N/A N/A TF-21A SUP Custom 27803010 TF-21A - VALVE AORTIC 13MM CNTOUR 26MM 21MM 16MM DURABLE PROTRUSION BOTH IP/OP "$15,000.00" "$11,100.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$15,000.00" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$15,000.00" "$15,000.00" N/A N/A TF-23A SUP Custom 27803010 TF-23A - VALVE AOR 13MM 23MM 38IN 17MM TRIFECTA LINX AC BPRTH STNT BOTH IP/OP "$15,000.00" "$11,100.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$15,000.00" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$15,000.00" "$15,000.00" N/A N/A TF-25A SUP Custom 27803010 TF-25A - VALVE AORTIC 25MM 18MM BIOPROSTHESIS STENTED CUFF HOLDER BOTH IP/OP "$15,000.00" "$11,100.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$15,000.00" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$15,000.00" "$15,000.00" N/A N/A TF-27A SUP Custom 27803010 TF-27A - VALVE AOR 27MM 27MM 33MM 19MM TRIFECTA LINX FTG RST STNT BOTH IP/OP "$15,000.00" "$11,100.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$15,000.00" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$15,000.00" "$15,000.00" N/A N/A TF-29A SUP Custom 27803010 TF-29A - VALVE AORTIC 29MM 20MM BIOPROSTHESIS STENTED CUFF HOLDER BOTH IP/OP "$15,000.00" "$11,100.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$2,670.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$3,126.17" "$15,000.00" "$6,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$15,000.00" "$11,250.00" "$15,000.00" "$15,000.00" "$15,000.00" "$7,500.00" "$7,500.00" "$11,880.00" "$15,000.00" "$12,000.00" "$6,750.00" "$15,000.00" N/A "$8,700.00" "$15,000.00" "$9,000.00" "$15,000.00" "$15,000.00" "$15,000.00" N/A N/A TG221 SUP HCPCS C9356 TG221 - PROTECTOR TNDN 2X2IN STRL TENOGLIDE ABS CLGN MTRX TNDN BOTH IP/OP "$5,884.50" "$4,355.00" $77.38 "$5,884.33" "$5,884.33" "$5,884.33" "$5,884.33" "$5,884.33" "$5,884.33" "$5,884.33" $77.38 "$5,884.33" "$5,884.33" "$5,884.33" "$5,884.33" "$5,884.33" "$5,884.33" "$1,226.36" "$5,884.33" "$2,353.73" "$5,884.33" "$5,884.33" "$5,884.33" "$5,884.33" "$5,884.33" "$4,413.38" "$5,884.33" "$5,884.33" "$5,884.33" "$2,942.17" "$2,942.17" "$4,660.39" "$5,884.33" "$4,707.46" "$2,647.95" "$5,884.33" N/A "$3,413.01" "$5,884.33" "$3,530.60" "$5,884.33" "$5,884.33" "$5,884.33" N/A N/A TG451 SUP HCPCS C9356 TG451 - PROTECTOR TNDN 5X4IN TENOGLIDE ABS SHT BCMPT INTFC BVN TY I BOTH IP/OP "$8,946.50" "$6,620.00" $77.38 "$8,946.40" "$8,946.40" "$8,946.40" "$8,946.40" "$8,946.40" "$8,946.40" "$8,946.40" $77.38 "$8,946.40" "$8,946.40" "$8,946.40" "$8,946.40" "$8,946.40" "$8,946.40" "$1,864.53" "$8,946.40" "$3,578.56" "$8,946.40" "$8,946.40" "$8,946.40" "$8,946.40" "$8,946.40" "$6,709.88" "$8,946.40" "$8,946.40" "$8,946.40" "$4,473.20" "$4,473.20" "$7,085.55" "$8,946.40" "$7,157.12" "$4,025.88" "$8,946.40" N/A "$5,188.97" "$8,946.40" "$5,367.84" "$8,946.40" "$8,946.40" "$8,946.40" N/A N/A TH90G01 SUP HCPCS C1787 TH90G01 - KIT STM NS LF PRX HNDST GU REUSE BOTH IP/OP "$2,975.00" "$2,202.00" $620.02 "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,208.05" "$2,208.05" "$2,293.13" "$1,549.98" $620.02 "$2,975.00" "$1,950.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,975.00" "$2,231.25" "$2,975.00" "$2,975.00" "$2,975.00" "$1,487.50" "$1,487.50" "$2,356.20" "$2,975.00" "$2,380.00" "$1,933.75" "$2,975.00" N/A "$1,725.50" "$2,975.00" "$1,785.00" "$2,975.00" "$2,975.00" "$2,975.00" N/A N/A THD155024/2 SUP HCPCS C1751 THD155024/2 - CATHETER CV STD 14.5FR 19CM HMGLD PRMCTH STAR BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $437.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A THD155028/3 SUP HCPCS C1751 THD155028/3 - CATHETER CV STD 14.5FR 23CM HMGLD PRMCTH STAR BOTH IP/OP $437.50 $324.00 $86.83 $437.50 $196.88 $196.88 $196.88 $196.88 $437.50 $437.50 $437.50 $91.19 $437.50 $437.50 $437.50 $437.50 $437.50 $91.18 $437.50 $437.50 $258.78 $437.50 $437.50 $437.50 $437.50 $328.13 $437.50 $437.50 $437.50 $218.75 $218.75 $346.50 $437.50 $350.00 $196.88 $86.83 N/A $253.75 $437.50 $437.50 $437.50 $91.18 $437.50 N/A N/A THD155032 SUP HCPCS C1750 THD155032 - SET CATHETER 15.5FR 32CM 2 LUMEN TITAN HD HEMODIALYSIS BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A THD155036 SUP HCPCS C1750 THD155036 - SET CATH 90D STRG 15.5FR 36CM TTN HD INTRO NDL GW DIL SCPL BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A THD155040 SUP HCPCS C1750 THD155040 - SET CATH 90D STRG 15.5FR 40CM TTN HD INTRO NDL GW DIL SCPL BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A THD155055 SUP HCPCS C1750 THD155055 - SET CATHETER 15.5FR 55CM 2 LUMEN TITAN HD LONG TERM BOTH IP/OP $475.00 $352.00 $94.28 $475.00 $213.75 $213.75 $213.75 $213.75 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $475.00 $475.00 $475.00 $99.00 $475.00 $475.00 $280.96 $475.00 $475.00 $475.00 $475.00 $356.25 $475.00 $475.00 $475.00 $237.50 $237.50 $376.20 $475.00 $380.00 $213.75 $94.28 N/A $275.50 $475.00 $475.00 $475.00 $98.99 $475.00 N/A N/A TKFV-2 SUP Custom 27203010 TKFV-2 - CLAMP SURG MIC 2 DISP 15GM GRN .2-1MM VN BOTH IP/OP "$1,787.50" "$1,323.00" $71.50 "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" "$1,787.50" $318.18 "$1,787.50" "$1,787.50" "$1,326.68" "$1,326.68" "$1,377.81" $931.29 $372.53 "$1,787.50" $71.50 "$1,787.50" "$1,787.50" $178.75 "$1,787.50" "$1,787.50" "$1,340.63" "$1,787.50" "$1,787.50" "$1,787.50" $893.75 $893.75 "$1,415.70" "$1,787.50" "$1,430.00" "$1,161.88" "$1,787.50" N/A "$1,036.75" "$1,787.50" "$1,072.50" "$1,787.50" "$1,787.50" "$1,787.50" N/A N/A TKMV-1 SUP Custom 27203010 TKMV-1 - CLAMP SURG 30GM/SQ MM MEDIUM HEMISPHERE BIOVER POLYCARBONATE BOTH IP/OP $87.50 $65.00 $15.58 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $87.50 $15.58 $87.50 $87.50 $64.94 $64.94 $67.45 $45.59 $18.24 $87.50 $35.00 $87.50 $87.50 $87.50 $87.50 $87.50 $65.63 $87.50 $87.50 $87.50 $43.75 $43.75 $69.30 $87.50 $70.00 $56.88 $87.50 N/A $50.75 $87.50 $52.50 $87.50 $87.50 $87.50 N/A N/A TKMV-2 SUP Custom 27203010 TKMV-2 - CLAMP SRG 30GM/SQ MM MED HMSPHR BIOVER 2 PLYCRB VN BOTH IP/OP $162.50 $120.00 $28.93 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $162.50 $28.93 $162.50 $162.50 $120.61 $120.61 $125.26 $84.66 $33.87 $162.50 $65.00 $162.50 $162.50 $162.50 $162.50 $162.50 $121.88 $162.50 $162.50 $162.50 $81.25 $81.25 $128.70 $162.50 $130.00 $105.63 $162.50 N/A $94.25 $162.50 $97.50 $162.50 $162.50 $162.50 N/A N/A TKS100 SUP Custom 27203010 TKS100 - TUBING SCT STRL NEURO BOTH IP/OP $24.00 $18.00 $4.23 $28.90 $23.76 $23.76 $23.76 $23.76 $23.76 $23.76 $4.23 $23.76 $23.76 $17.63 $17.63 $18.31 $12.38 $4.95 $23.76 $11.56 $23.76 $23.76 $28.90 $23.76 $23.76 $18.00 $23.76 $23.76 $23.76 $11.88 $11.88 $18.82 $23.76 $19.01 $15.44 $23.76 N/A $13.92 $23.76 $14.26 $23.76 $23.76 $23.76 N/A N/A TN30MCD SUP Custom 27203010 TN30MCD - BURR SURG 3MM MATCH FLUTED DIAMOND COARSE TRANSNASAL STERILE BOTH IP/OP $904.50 $669.00 $161.00 $904.50 $904.50 $904.50 $904.50 $904.50 $904.50 $904.50 $161.00 $904.50 $904.50 $671.32 $671.32 $697.19 $471.24 $188.51 $904.50 $361.80 $904.50 $904.50 $904.50 $904.50 $904.50 $678.38 $904.50 $904.50 $904.50 $452.25 $452.25 $716.36 $904.50 $723.60 $587.93 $904.50 N/A $524.61 $904.50 $542.70 $904.50 $904.50 $904.50 N/A N/A TN30MFL SUP Custom 27203010 TN30MFL - BURR SURG 3MM MATCH FLUTED TRANSNASAL STERILE BOTH IP/OP $904.50 $669.00 $161.00 $904.50 $904.50 $904.50 $904.50 $904.50 $904.50 $904.50 $161.00 $904.50 $904.50 $671.32 $671.32 $697.19 $471.24 $188.51 $904.50 $361.80 $904.50 $904.50 $904.50 $904.50 $904.50 $678.38 $904.50 $904.50 $904.50 $452.25 $452.25 $716.36 $904.50 $723.60 $587.93 $904.50 N/A $524.61 $904.50 $542.70 $904.50 $904.50 $904.50 N/A N/A TO-FTRT SUP Custom 27203010 TO-FTRT - RETRACTOR SURG FUNNEL SHOEHORN 4MM 2.5MM TENDON SHEATH TOBY BOTH IP/OP $908.50 $672.00 $161.69 $908.38 $908.38 $908.38 $908.38 $908.38 $908.38 $908.38 $161.69 $908.38 $908.38 $674.20 $674.20 $700.18 $473.27 $189.32 $908.38 $363.35 $908.38 $908.38 $908.38 $908.38 $908.38 $681.38 $908.38 $908.38 $908.38 $454.19 $454.19 $719.44 $908.38 $726.70 $590.45 $908.38 N/A $526.93 $908.38 $545.03 $908.38 $908.38 $908.38 N/A N/A TP-14 SUP HCPCS C1713 TP-14 - PEG FIX 2.5MM 14MM PTHRD BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $105.00 $175.00 $36.47 $175.00 N/A N/A TP-16 SUP HCPCS C1713 TP-16 - PEG 2.5MM 16MM LNG THRD BOTH IP/OP $175.00 $130.00 $34.73 $175.00 $78.75 $78.75 $78.75 $78.75 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $175.00 $175.00 $175.00 $36.47 $175.00 $175.00 $103.51 $175.00 $175.00 $175.00 $175.00 $131.25 $175.00 $175.00 $175.00 $87.50 $87.50 $138.60 $175.00 $140.00 $78.75 $34.73 N/A $101.50 $175.00 $175.00 $175.00 $36.47 $175.00 N/A N/A TP341-M01 SUP Custom 27203010 TP341-M01 - 2.0-2.5mm BROKEN SCREW HEAD BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A TP342-M01 SUP Custom 27203010 TP342-M01 - TIP XTRT 2.5-4 MM BRKN SCR BOTH IP/OP $562.50 $416.00 $100.13 $625.00 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $250.00 $562.50 $562.50 $625.00 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A TP343-M01 SUP Custom 27203010 TP343-M01 - 3.5-5.0mm BROKEN SCREW HEAD BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A TP344-M01 SUP Custom 27203010 TP344-M01 - 4.5-6.0mm BROKEN SCREW HEAD BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A TP345-M01 SUP Custom 27203010 TP345-M01 - 5.5-7.0mm BROKEN SCREW HEAD BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A TP346-M01 SUP Custom 27203010 TP346-M01 - 7.0-8.0mm BROKEN SCREW HEAD BOTH IP/OP $562.50 $416.00 $100.13 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $562.50 $100.13 $562.50 $562.50 $417.49 $417.49 $433.58 $293.06 $117.23 $562.50 $225.00 $562.50 $562.50 $562.50 $562.50 $562.50 $421.88 $562.50 $562.50 $562.50 $281.25 $281.25 $445.50 $562.50 $450.00 $365.63 $562.50 N/A $326.25 $562.50 $337.50 $562.50 $562.50 $562.50 N/A N/A TP347-M01 SUP Custom 27203010 TP347-M01 - 2.0-2.5mm STRIPPED SCREW HEAD BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A TP348-M01 SUP Custom 27203010 TP348-M01 - 2.5-3.5mm STRIPPED SCREW HEAD BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A TP349-M01 SUP Custom 27203010 TP349-M01 - 3.5-4.5mm STRIPPED SCREW HEAD BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A TP350-M01 SUP Custom 27203010 TP350-M01 - 4.5-5.5mm STRIPPED SCREW HEAD BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A TP351-M01 SUP Custom 27203010 TP351-M01 - 5.0-6.5mm STRIPPED SCREW HEAD BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A TP352-M01 SUP Custom 27203010 TP352-M01 - 6.0-7.0mm STRIPPED SCREW HEAD BOTH IP/OP $512.50 $379.00 $91.23 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $512.50 $91.23 $512.50 $512.50 $380.38 $380.38 $395.04 $267.01 $106.81 $512.50 $205.00 $512.50 $512.50 $512.50 $512.50 $512.50 $384.38 $512.50 $512.50 $512.50 $256.25 $256.25 $405.90 $512.50 $410.00 $333.13 $512.50 N/A $297.25 $512.50 $307.50 $512.50 $512.50 $512.50 N/A N/A TPEG-14 SUP HCPCS C1713 TPEG-14 - PEG FIX 14MM THREAD LOCK TORX WRIST VOLAR BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A TPEG-16 SUP HCPCS C1713 TPEG-16 - PEG FIX 16MM THREAD LOCK TORX WRIST VOLAR BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A TPEG-18 SUP HCPCS C1713 TPEG-18 - PEG FIX 18MM THREAD LOCK TORX WRIST VOLAR BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A TPEG-20 SUP HCPCS C1713 TPEG-20 - PEG FIX 20MM THREAD LOCK TORX WRIST VOLAR BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A TPEG-22 SUP HCPCS C1713 TPEG-22 - PEG FIX 22MM THREAD LOCK TORX WRIST VOLAR BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A TPEG-24 SUP HCPCS C1713 TPEG-24 - PEG FIX 24MM THREAD LOCK TORX WRIST VOLAR BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A TPEG-28 SUP HCPCS C1713 TPEG-28 - PEG FIX 28MM THREAD LOCK TORX WRIST VOLAR BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A TPLS-23100-TS SUP HCPCS C1713 TPLS-23100-TS - PEG FX 2.3MM 10MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPLS-23120-TS SUP HCPCS C1713 TPLS-23120-TS - PEG FX 2.3MM 12MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPLS-23140-TS SUP HCPCS C1713 TPLS-23140-TS - PEG FX 2.3MM 14MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPLS-23160-TS SUP HCPCS C1713 TPLS-23160-TS - PEG FX 2.3MM 16MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPLS-23170-TS SUP HCPCS C1713 TPLS-23170-TS - PEG FX 2.3MM 17MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPLS-23180-TS SUP HCPCS C1713 TPLS-23180-TS - PEG FIX 2.3MM 18MM THREADED LOCKING GEMINUS TITANIUM DISTAL BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $87.00 $146.40 $247.50 $217.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $148.50 $247.50 $51.58 $247.50 N/A N/A TPLS-23190-TS SUP HCPCS C1713 TPLS-23190-TS - PEG FX 2.3MM 19MM NS THRDLK TI GEMINUS VOLR PLT SYS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPLS-23200-TS SUP HCPCS C1713 TPLS-23200-TS - PEG FX 2.3MM 20MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPLS-23210-TS SUP HCPCS C1713 TPLS-23210-TS - PEG FX 2.3MM 21MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPLS-23220-TS SUP HCPCS C1713 TPLS-23220-TS - PEG FX 2.3MM 22MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPLS-23230-TS SUP HCPCS C1713 TPLS-23230-TS - PEG FX 2.3MM 23MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPLS-23240-TS SUP HCPCS C1713 TPLS-23240-TS - PEG FX 2.3MM 24MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPLS-23260-TS SUP HCPCS C1713 TPLS-23260-TS - PEG FX 2.3MM 26MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPLS-23280-TS SUP HCPCS C1713 TPLS-23280-TS - PEG FX 2.3MM 28MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPLS-23300-TS SUP HCPCS C1713 TPLS-23300-TS - PEG FX 2.3MM 30MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPLS-23320-TS SUP HCPCS C1713 TPLS-23320-TS - PEG FX 2.3MM 32MM NS GEMINUS THRD LCK TI DIST VOLR RDS FOSSA BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPM002U SUP HCPCS C1786 TPM002U - Reply SR BOTH IP/OP "$6,962.50" "$5,152.00" "$1,381.88" "$6,962.50" "$3,133.13" "$3,133.13" "$3,133.13" "$3,133.13" "$6,962.50" "$6,962.50" "$6,962.50" "$1,451.16" "$6,962.50" "$6,962.50" "$6,962.50" "$6,962.50" "$6,962.50" "$1,451.06" "$6,962.50" "$6,962.50" "$3,432.51" "$6,962.50" "$6,962.50" "$6,962.50" "$6,962.50" "$5,221.88" "$6,962.50" "$6,962.50" "$6,962.50" "$3,481.25" "$3,481.25" "$5,514.30" "$6,962.50" "$5,570.00" "$3,133.13" "$1,381.88" N/A "$4,038.25" "$6,962.50" "$6,962.50" "$6,962.50" "$1,450.99" "$6,962.50" N/A N/A TPM002U SYSTEM SUP HCPCS C1786 TPM002U System - Reply SR System BOTH IP/OP "$8,205.00" "$6,072.00" "$1,628.49" "$8,205.00" "$3,692.25" "$3,692.25" "$3,692.25" "$3,692.25" "$8,205.00" "$8,205.00" "$8,205.00" "$1,710.13" "$8,205.00" "$8,205.00" "$8,205.00" "$8,205.00" "$8,205.00" "$1,710.01" "$8,205.00" "$8,205.00" "$4,045.07" "$8,205.00" "$8,205.00" "$8,205.00" "$8,205.00" "$6,153.75" "$8,205.00" "$8,205.00" "$8,205.00" "$4,102.50" "$4,102.50" "$6,498.36" "$8,205.00" "$6,564.00" "$3,692.25" "$1,628.49" N/A "$4,758.90" "$8,205.00" "$8,205.00" "$8,205.00" "$1,709.92" "$8,205.00" N/A N/A TPNL-27100-TS SUP HCPCS C1713 TPNL-27100-TS - PEG FX 2.7MM 10MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $217.50 $217.50 N/A N/A TPNL-27120-TS SUP HCPCS C1713 TPNL-27120-TS - PEG FX 2.7MM 12MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $217.50 $217.50 N/A N/A TPNL-27140-TS SUP HCPCS C1713 TPNL-27140-TS - PEG FX 2.7MM 14MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPNL-27160-TS SUP HCPCS C1713 TPNL-27160-TS - PEG FX 2.7MM 16MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPNL-27180-TS SUP HCPCS C1713 TPNL-27180-TS - PEG FX 2.7MM 18MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPNL-27200-TS SUP HCPCS C1713 TPNL-27200-TS - PEG FIX 2.7MM 20MM THREADED NONLOCKING GEMINUS TITANIUM BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $87.00 $146.40 $247.50 $217.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $148.50 $247.50 $51.58 $247.50 N/A N/A TPNL-27220-TS SUP HCPCS C1713 TPNL-27220-TS - PEG FIX 2.7MM 22MM THREADED NONLOCKING GEMINUS TITANIUM BOTH IP/OP $247.50 $183.00 $49.12 $247.50 $111.38 $111.38 $111.38 $111.38 $247.50 $247.50 $247.50 $51.59 $247.50 $247.50 $247.50 $247.50 $247.50 $51.58 $247.50 $87.00 $146.40 $247.50 $217.50 $247.50 $247.50 $185.63 $247.50 $247.50 $247.50 $123.75 $123.75 $196.02 $247.50 $198.00 $111.38 $49.12 N/A $143.55 $247.50 $247.50 $247.50 $51.58 $247.50 N/A N/A TPNL-27240-TS SUP HCPCS C1713 TPNL-27240-TS - PEG FX 2.7MM 24MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPNL-27260-TS SUP HCPCS C1713 TPNL-27260-TS - PEG FX 2.7MM 26MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPNL-27280-TS SUP HCPCS C1713 TPNL-27280-TS - PEG FX 2.7MM 28MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPNL-27300-TS SUP HCPCS C1713 TPNL-27300-TS - PEG FX 2.7MM 30MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TPNL-27320-TS SUP HCPCS C1713 TPNL-27320-TS - PEG FX 2.7MM 32MM NS GEMINUS THRD NLCKG TI DIST VOLR RDS BOTH IP/OP $217.50 $161.00 $43.17 $217.50 $97.88 $97.88 $97.88 $97.88 $217.50 $217.50 $217.50 $45.33 $217.50 $217.50 $217.50 $217.50 $217.50 $45.33 $217.50 $87.00 $128.65 $217.50 $217.50 $217.50 $217.50 $163.13 $217.50 $217.50 $217.50 $108.75 $108.75 $172.26 $217.50 $174.00 $97.88 $43.17 N/A $126.15 $217.50 $130.50 $217.50 $45.33 $217.50 N/A N/A TRB24-REG SUP Custom 27203010 TRB24-REG - BAND COMPRESSION REGULAR 24CM 2 BALLOON AIR INJEC PORT BOTH IP/OP $82.50 $61.00 $14.69 $105.00 $82.50 $82.50 $82.50 $82.50 $82.50 $82.50 $14.69 $82.50 $82.50 $61.23 $61.23 $63.59 $42.98 $17.19 $82.50 $42.00 $82.50 $82.50 $105.00 $82.50 $82.50 $61.88 $82.50 $82.50 $82.50 $41.25 $41.25 $65.34 $82.50 $66.00 $53.63 $82.50 N/A $47.85 $82.50 $49.50 $82.50 $82.50 $82.50 N/A N/A TRB29-LRG SUP Custom 27203010 TRB29-LRG - DEVICE CMPR LG 29CM TR BAND 2 BLN TRNS ADJ STRAP AIR TRTN BOTH IP/OP $82.50 $61.00 $14.69 $105.00 $82.50 $82.50 $82.50 $82.50 $82.50 $82.50 $14.69 $82.50 $82.50 $61.23 $61.23 $63.59 $42.98 $17.19 $82.50 $42.00 $82.50 $82.50 $105.00 $82.50 $82.50 $61.88 $82.50 $82.50 $82.50 $41.25 $41.25 $65.34 $82.50 $66.00 $53.63 $82.50 N/A $47.85 $82.50 $49.50 $82.50 $82.50 $82.50 N/A N/A TR-H200L-S SUP HCPCS C1776 TR-H200L-S - HEAD RADL 20MM LEFT ELB BOTH IP/OP "$6,015.00" "$4,451.00" "$1,193.83" "$6,015.00" "$2,706.75" "$2,706.75" "$2,706.75" "$2,706.75" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.68" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.59" "$6,015.00" "$2,406.00" "$2,965.40" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$4,511.25" "$6,015.00" "$6,015.00" "$6,015.00" "$3,007.50" "$3,007.50" "$4,763.88" "$6,015.00" "$4,812.00" "$2,706.75" "$1,193.83" N/A "$3,488.70" "$6,015.00" "$3,609.00" "$6,015.00" "$1,253.53" "$6,015.00" N/A N/A TR-H200R-S SUP HCPCS C1776 TR-H200R-S - HEAD RADL 4D 20MM RT ELB BOTH IP/OP "$6,015.00" "$4,451.00" "$1,193.83" "$6,015.00" "$2,706.75" "$2,706.75" "$2,706.75" "$2,706.75" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.68" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.59" "$6,015.00" "$2,406.00" "$2,965.40" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$4,511.25" "$6,015.00" "$6,015.00" "$6,015.00" "$3,007.50" "$3,007.50" "$4,763.88" "$6,015.00" "$4,812.00" "$2,706.75" "$1,193.83" N/A "$3,488.70" "$6,015.00" "$3,609.00" "$6,015.00" "$1,253.53" "$6,015.00" N/A N/A TR-H220L-S SUP HCPCS C1776 TR-H220L-S - HEAD RADL ANG 22MM STRL ACUMED ARH ANTM ELB LT BOTH IP/OP "$6,015.00" "$4,451.00" "$1,193.83" "$6,015.00" "$2,706.75" "$2,706.75" "$2,706.75" "$2,706.75" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.68" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.59" "$6,015.00" "$2,406.00" "$2,965.40" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$4,511.25" "$6,015.00" "$6,015.00" "$6,015.00" "$3,007.50" "$3,007.50" "$4,763.88" "$6,015.00" "$4,812.00" "$2,706.75" "$1,193.83" N/A "$3,488.70" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.53" "$6,015.00" N/A N/A TR-H220R-S SUP HCPCS C1776 TR-H220R-S - HEAD RADL 22MM RT BOTH IP/OP "$6,015.00" "$4,451.00" "$1,193.83" "$6,015.00" "$2,706.75" "$2,706.75" "$2,706.75" "$2,706.75" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.68" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.59" "$6,015.00" "$2,406.00" "$2,965.40" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$4,511.25" "$6,015.00" "$6,015.00" "$6,015.00" "$3,007.50" "$3,007.50" "$4,763.88" "$6,015.00" "$4,812.00" "$2,706.75" "$1,193.83" N/A "$3,488.70" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.53" "$6,015.00" N/A N/A TR-H240R-S SUP HCPCS C1776 TR-H240R-S - HEAD RADL ANG 24MM STRL ACUMED ARH ANTM ELB RT BOTH IP/OP "$6,015.00" "$4,451.00" "$1,193.83" "$6,015.00" "$2,706.75" "$2,706.75" "$2,706.75" "$2,706.75" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.68" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.59" "$6,015.00" "$6,015.00" "$2,965.40" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$4,511.25" "$6,015.00" "$6,015.00" "$6,015.00" "$3,007.50" "$3,007.50" "$4,763.88" "$6,015.00" "$4,812.00" "$2,706.75" "$1,193.83" N/A "$3,488.70" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.53" "$6,015.00" N/A N/A TR-H260L-S SUP HCPCS C1776 TR-H260L-S - HEAD RADL ANG 26MM STRL ACUMED ARH ANTM ELB LT BOTH IP/OP "$6,015.00" "$4,451.00" "$1,193.83" "$6,015.00" "$2,706.75" "$2,706.75" "$2,706.75" "$2,706.75" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.68" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.59" "$6,015.00" "$6,015.00" "$2,965.40" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$4,511.25" "$6,015.00" "$6,015.00" "$6,015.00" "$3,007.50" "$3,007.50" "$4,763.88" "$6,015.00" "$4,812.00" "$2,706.75" "$1,193.83" N/A "$3,488.70" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.53" "$6,015.00" N/A N/A TR-H260R-S SUP HCPCS C1776 TR-H260R-S - HEAD RADL 26MM 4D RIGHT ANTM STRL BOTH IP/OP "$6,015.00" "$4,451.00" "$1,193.83" "$6,015.00" "$2,706.75" "$2,706.75" "$2,706.75" "$2,706.75" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.68" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.59" "$6,015.00" "$2,406.00" "$2,965.40" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$4,511.25" "$6,015.00" "$6,015.00" "$6,015.00" "$3,007.50" "$3,007.50" "$4,763.88" "$6,015.00" "$4,812.00" "$2,706.75" "$1,193.83" N/A "$3,488.70" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.53" "$6,015.00" N/A N/A TR-H280L-S SUP HCPCS C1776 TR-H280L-S - HEAD RADIAL ANGLE 28MM 10MM ANATOMIC COCR ELBOW LEFT STERILE BOTH IP/OP "$6,015.00" "$4,451.00" "$1,193.83" "$6,015.00" "$2,706.75" "$2,706.75" "$2,706.75" "$2,706.75" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.68" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.59" "$6,015.00" "$2,406.00" "$2,965.40" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$4,511.25" "$6,015.00" "$6,015.00" "$6,015.00" "$3,007.50" "$3,007.50" "$4,763.88" "$6,015.00" "$4,812.00" "$2,706.75" "$1,193.83" N/A "$3,488.70" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.53" "$6,015.00" N/A N/A TR-H280R-S SUP HCPCS C1776 TR-H280R-S - HEAD RADL 28MM STRL RT BOTH IP/OP "$6,015.00" "$4,451.00" "$1,193.83" "$6,015.00" "$2,706.75" "$2,706.75" "$2,706.75" "$2,706.75" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.68" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$1,253.59" "$6,015.00" "$2,406.00" "$2,965.40" "$6,015.00" "$6,015.00" "$6,015.00" "$6,015.00" "$4,511.25" "$6,015.00" "$6,015.00" "$6,015.00" "$3,007.50" "$3,007.50" "$4,763.88" "$6,015.00" "$4,812.00" "$2,706.75" "$1,193.83" N/A "$3,488.70" "$6,015.00" "$3,609.00" "$6,015.00" "$1,253.53" "$6,015.00" N/A N/A TR-S0600-S SUP HCPCS C1776 TR-S0600-S - STEM RADL 0MM 6MM STRL BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$3,610.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$2,166.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0602-S SUP HCPCS C1776 TR-S0602-S - STEM RADL 2MM 6MM STRL BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$1,444.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$2,166.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0604-S SUP HCPCS C1776 TR-S0604-S - STEM RADL 4MM 6MM STRL BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$1,444.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$2,166.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0606-S SUP Custom 27203010 TR-S0606-S - STEM RADIAL 6MM 6MM ELBOW BOTH IP/OP "$3,610.00" "$2,671.00" $642.58 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $642.58 "$3,610.00" "$3,610.00" "$2,679.34" "$2,679.34" "$2,782.59" "$1,880.81" $752.36 "$3,610.00" "$1,444.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$2,346.50" "$3,610.00" N/A "$2,093.80" "$3,610.00" "$2,166.00" "$3,610.00" "$3,610.00" "$3,610.00" N/A N/A TR-S0608-S SUP HCPCS C1776 TR-S0608-S - STEM RADL 6MM 8MM STRL BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$3,610.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$2,166.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0700-S SUP HCPCS C1776 TR-S0700-S - STEM RADL 0MM 7MM ELB BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$1,444.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$2,166.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0702-S SUP HCPCS C1776 TR-S0702-S - STEM RADL 2MM 7MM STRL BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$1,444.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$2,166.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0704-S SUP HCPCS C1776 TR-S0704-S - STEM RADIAL FLUTE TAPER STANDARD 4MM 25MM 7MM ANATOMIC BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$1,444.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$3,610.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0706-S SUP HCPCS C1776 TR-S0706-S - STEM RADIAL 7MM 6MM ELBOW STERILE BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$1,444.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$2,166.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0708-S SUP HCPCS C1776 TR-S0708-S - STEM RADIAL FLUTE TAPER 7MM 25MM 8MM ANATOMIC TOT THREAD BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$3,610.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$3,610.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0800-S SUP HCPCS C1776 TR-S0800-S - STEM RADIAL FLUTE TAPER 25MM 8MM ANATOMIC TOT THREAD HOLE BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$3,610.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$3,610.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0802-S SUP HCPCS C1776 TR-S0802-S - STEM RADIAL FLUTE TAPER 2MM 25MM 8MM ANATOMIC TOT THREAD BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$1,444.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$3,610.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0804-S SUP HCPCS C1776 TR-S0804-S - STEM RADIAL FLUTE TAPER 4MM 25MM 8MM THREAD HOLE GRIT BLAST BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$1,444.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$3,610.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0806-S SUP HCPCS C1776 TR-S0806-S - STEM RADIAL 8MM 6MM HEAD TITANIUM ELBOW STERILE BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$1,444.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$2,166.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0808-S SUP HCPCS C1776 TR-S0808-S - STEM RADIAL FLUTE TAPER 8MM 25MM 8MM ANATOMIC TOT THREAD BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$3,610.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$3,610.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0900-S SUP HCPCS C1776 TR-S0900-S - STEM RADL 0MM 9MM STRL BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$1,444.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$2,166.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0902-S SUP HCPCS C1776 TR-S0902-S - STEM RADIAL FLUTE TAPER 2MM 25MM 9MM ANATOMIC TOT THREAD BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$3,610.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$3,610.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0904-S SUP HCPCS C1776 TR-S0904-S - STEM RADIAL FLUTE TAPER 4MM 25MM 9MM ANATOMIC TOT THREAD BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$3,610.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$3,610.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0906-S SUP HCPCS C1776 TR-S0906-S - STEM RADIAL FLUTE TAPER 6MM 25MM 9MM ANATOMIC TOT THREAD BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$3,610.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$2,166.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S0908-S SUP HCPCS C1776 TR-S0908-S - STEM RADIAL FLUTE TAPER 8MM 25MM 9MM ANATOMIC TOT THREAD BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$3,610.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$3,610.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S1000-S SUP HCPCS C1776 TR-S1000-S - STEM RADL 0MM 10MM STRL BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$1,444.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$3,610.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S1002-S SUP HCPCS C1776 TR-S1002-S - STEM RADL 2MM 10MM STRL ELB BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$1,444.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$3,610.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S1004-S SUP HCPCS C1776 TR-S1004-S - STEM RADL 4MM 10MM STRL BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$1,444.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$2,166.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TR-S1006-S SUP Custom 27203010 TR-S1006-S - STEM RADIAL 10MM 6MM ELBOW BOTH IP/OP "$3,610.00" "$2,671.00" $642.58 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $642.58 "$3,610.00" "$3,610.00" "$2,679.34" "$2,679.34" "$2,782.59" "$1,880.81" $752.36 "$3,610.00" "$1,444.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$2,346.50" "$3,610.00" N/A "$2,093.80" "$3,610.00" "$2,166.00" "$3,610.00" "$3,610.00" "$3,610.00" N/A N/A TR-S1008-S SUP HCPCS C1776 TR-S1008-S - STEM RADIAL FLUTE TAPER 8MM 25MM 10MM ANATOMIC TOT THREAD BOTH IP/OP "$3,610.00" "$2,671.00" $716.49 "$3,610.00" "$1,624.50" "$1,624.50" "$1,624.50" "$1,624.50" "$3,610.00" "$3,610.00" "$3,610.00" $752.41 "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" $752.36 "$3,610.00" "$3,610.00" "$1,779.73" "$3,610.00" "$3,610.00" "$3,610.00" "$3,610.00" "$2,707.50" "$3,610.00" "$3,610.00" "$3,610.00" "$1,805.00" "$1,805.00" "$2,859.12" "$3,610.00" "$2,888.00" "$1,624.50" $716.49 N/A "$2,093.80" "$3,610.00" "$3,610.00" "$3,610.00" $752.32 "$3,610.00" N/A N/A TRX2.3-10 SUP HCPCS C1713 TRX2.3-10 - SCREW BONE 2.3MM 10MM ANKLE CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A TRX2.3-12 SUP HCPCS C1713 TRX2.3-12 - SCREW BONE 2.3MM 12MM ANKLE CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A TRX2.3-14 SUP HCPCS C1713 TRX2.3-14 - SCREW BONE 2.3MM 14MM ANKLE CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A TRX2.3-16 SUP HCPCS C1713 TRX2.3-16 - SCREW BONE 2.3MM 16MM ANKLE CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A TRX2.3-18 SUP HCPCS C1713 TRX2.3-18 - SCREW BONE 2.3MM 18MM ANKLE CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A TRX2.3-20 SUP HCPCS C1713 TRX2.3-20 - SCREW BONE 2.3MM 20MM CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $46.89 $225.00 N/A N/A TRX2.3-22 SUP HCPCS C1713 TRX2.3-22 - SCREW BONE 2.3MM 22MM ANKLE CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A TRX2.3-24 SUP HCPCS C1713 TRX2.3-24 - SCREW BONE 2.3MM 24MM ANKLE CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A TRX2.3-26 SUP HCPCS C1713 TRX2.3-26 - SCREW BONE 2.3MM 26MM ANKLE CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $135.00 $225.00 $225.00 $225.00 N/A N/A TRX2.3-28 SUP HCPCS C1713 TRX2.3-28 - SCREW BONE 2.3MM 28MM CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $225.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A TRX2.3-30 SUP HCPCS C1713 TRX2.3-30 - SCREW BONE 2.3MM 30MM CORTICAL BOTH IP/OP $225.00 $167.00 $44.66 $225.00 $101.25 $101.25 $101.25 $101.25 $225.00 $225.00 $225.00 $46.90 $225.00 $225.00 $225.00 $225.00 $225.00 $46.89 $225.00 $90.00 $133.09 $225.00 $225.00 $225.00 $225.00 $168.75 $225.00 $225.00 $225.00 $112.50 $112.50 $178.20 $225.00 $180.00 $101.25 $44.66 N/A $130.50 $225.00 $225.00 $225.00 $46.89 $225.00 N/A N/A TS101DC SUP Custom 27203010 TS101DC - SET TBG DIEGO ELT DECLOG BOTH IP/OP $118.00 $87.00 $20.94 $117.64 $117.64 $117.64 $117.64 $117.64 $117.64 $117.64 $20.94 $117.64 $117.64 $87.31 $87.31 $90.68 $61.29 $24.52 $117.64 $47.06 $117.64 $117.64 $117.64 $117.64 $117.64 $88.50 $117.64 $117.64 $117.64 $58.82 $58.82 $93.17 $117.64 $94.11 $76.47 $117.64 N/A $68.44 $117.64 $70.58 $117.64 $117.64 $117.64 N/A N/A TT12 SUP Custom 27203010 TT12 - ATTACHMENT TOOL 12CM TELESCOPING TUBE MIDAS REX LEGEND BOTH IP/OP "$1,486.50" "$1,100.00" $264.55 "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" $264.55 "$1,486.25" "$1,486.25" "$1,103.09" "$1,103.09" "$1,145.60" $774.34 $309.75 "$1,486.25" $594.50 "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,114.88" "$1,486.25" "$1,486.25" "$1,486.25" $743.13 $743.13 "$1,177.11" "$1,486.25" "$1,189.00" $966.06 "$1,486.25" N/A $862.17 "$1,486.25" $891.75 "$1,486.25" "$1,486.25" "$1,486.25" N/A N/A TT12A SUP Custom 27203010 TT12A - ATTACHMENT TOOL 12CM ANGLED TELESCOPING TUBE MIDAS REX BOTH IP/OP "$1,486.50" "$1,100.00" $264.55 "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" $264.55 "$1,486.25" "$1,486.25" "$1,103.09" "$1,103.09" "$1,145.60" $774.34 $309.75 "$1,486.25" $594.50 "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,114.88" "$1,486.25" "$1,486.25" "$1,486.25" $743.13 $743.13 "$1,177.11" "$1,486.25" "$1,189.00" $966.06 "$1,486.25" N/A $862.17 "$1,486.25" $891.75 "$1,486.25" "$1,486.25" "$1,486.25" N/A N/A TT12C SUP Custom 27203010 TT12C - ATTACHMENT TOOL CURVE 12CM HIGH SPEED CVD DRILL LEGEND MIDAS BOTH IP/OP "$1,486.50" "$1,100.00" $264.55 "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" $264.55 "$1,486.25" "$1,486.25" "$1,103.09" "$1,103.09" "$1,145.60" $774.34 $309.75 "$1,486.25" $594.50 "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,114.88" "$1,486.25" "$1,486.25" "$1,486.25" $743.13 $743.13 "$1,177.11" "$1,486.25" "$1,189.00" $966.06 "$1,486.25" N/A $862.17 "$1,486.25" $891.75 "$1,486.25" "$1,486.25" "$1,486.25" N/A N/A TT12F SUP Custom 27203010 TT12F - ATTACHMENT TOOL FINE 12CM TUBE TELESCOPE LATEX FREE LEGEND BOTH IP/OP "$1,486.50" "$1,100.00" $264.55 "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" $264.55 "$1,486.25" "$1,486.25" "$1,103.09" "$1,103.09" "$1,145.60" $774.34 $309.75 "$1,486.25" $594.50 "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,486.25" "$1,114.88" "$1,486.25" "$1,486.25" "$1,486.25" $743.13 $743.13 "$1,177.11" "$1,486.25" "$1,189.00" $966.06 "$1,486.25" N/A $862.17 "$1,486.25" $891.75 "$1,486.25" "$1,486.25" "$1,486.25" N/A N/A TT14A SUP Custom 27203010 TT14A - ATTACHMENT TOOL 14CM ANGLED TELESCOPING TUBE MIDAS REX BOTH IP/OP "$1,591.00" "$1,177.00" $283.16 "$1,590.80" "$1,590.80" "$1,590.80" "$1,590.80" "$1,590.80" "$1,590.80" "$1,590.80" $283.16 "$1,590.80" "$1,590.80" "$1,180.69" "$1,180.69" "$1,226.19" $828.81 $331.54 "$1,590.80" $636.32 "$1,590.80" "$1,590.80" "$1,590.80" "$1,590.80" "$1,590.80" "$1,193.25" "$1,590.80" "$1,590.80" "$1,590.80" $795.40 $795.40 "$1,259.91" "$1,590.80" "$1,272.64" "$1,034.02" "$1,590.80" N/A $922.78 "$1,590.80" $954.48 "$1,590.80" "$1,590.80" "$1,590.80" N/A N/A TT15 SUP Custom 27203010 TT15 - ATTACHMENT TOOL 15CM TELESCOPING TUBE MIDAS REX LEGEND BOTH IP/OP "$1,521.50" "$1,126.00" $270.76 "$1,521.10" "$1,521.10" "$1,521.10" "$1,521.10" "$1,521.10" "$1,521.10" "$1,521.10" $270.76 "$1,521.10" "$1,521.10" "$1,128.96" "$1,128.96" "$1,172.46" $792.49 $317.01 "$1,521.10" $608.44 "$1,521.10" "$1,521.10" "$1,521.10" "$1,521.10" "$1,521.10" "$1,141.13" "$1,521.10" "$1,521.10" "$1,521.10" $760.55 $760.55 "$1,204.71" "$1,521.10" "$1,216.88" $988.72 "$1,521.10" N/A $882.47 "$1,521.10" $912.66 "$1,521.10" "$1,521.10" "$1,521.10" N/A N/A TT15H SUP Custom 27203010 TT15H - ATTACHMENT TOOL 15CM HOODED TELESCOPING TUBE MIDAS REX BOTH IP/OP "$2,144.50" "$1,587.00" $381.69 "$2,144.30" "$2,144.30" "$2,144.30" "$2,144.30" "$2,144.30" "$2,144.30" "$2,144.30" $381.69 "$2,144.30" "$2,144.30" "$1,591.50" "$1,591.50" "$1,652.83" "$1,117.18" $446.90 "$2,144.30" $857.72 "$2,144.30" "$2,144.30" "$2,144.30" "$2,144.30" "$2,144.30" "$1,608.38" "$2,144.30" "$2,144.30" "$2,144.30" "$1,072.15" "$1,072.15" "$1,698.29" "$2,144.30" "$1,715.44" "$1,393.80" "$2,144.30" N/A "$1,243.81" "$2,144.30" "$1,286.58" "$2,144.30" "$2,144.30" "$2,144.30" N/A N/A TT17 SUP Custom 27203010 TT17 - ATTACHMENT TOOL 15CM TELESCOPING TUBE MIDAS REX LEGEND BOTH IP/OP "$1,597.00" "$1,182.00" $284.26 "$1,596.95" "$1,596.95" "$1,596.95" "$1,596.95" "$1,596.95" "$1,596.95" "$1,596.95" $284.26 "$1,596.95" "$1,596.95" "$1,185.26" "$1,185.26" "$1,230.93" $832.01 $332.82 "$1,596.95" $638.78 "$1,596.95" "$1,596.95" "$1,596.95" "$1,596.95" "$1,596.95" "$1,197.75" "$1,596.95" "$1,596.95" "$1,596.95" $798.48 $798.48 "$1,264.78" "$1,596.95" "$1,277.56" "$1,038.02" "$1,596.95" N/A $926.26 "$1,596.95" $958.17 "$1,596.95" "$1,596.95" "$1,596.95" N/A N/A TT18H SUP Custom 27203010 TT18H - ATTACHMENT TOOL 18CM HOODED TELESCOPING TUBE MIDAS REX BOTH IP/OP "$2,208.00" "$1,634.00" $393.00 "$2,207.85" "$2,207.85" "$2,207.85" "$2,207.85" "$2,207.85" "$2,207.85" "$2,207.85" $393.00 "$2,207.85" "$2,207.85" "$1,638.67" "$1,638.67" "$1,701.81" "$1,150.29" $460.14 "$2,207.85" $883.14 "$2,207.85" "$2,207.85" "$2,207.85" "$2,207.85" "$2,207.85" "$1,656.00" "$2,207.85" "$2,207.85" "$2,207.85" "$1,103.93" "$1,103.93" "$1,748.62" "$2,207.85" "$1,766.28" "$1,435.10" "$2,207.85" N/A "$1,280.64" "$2,207.85" "$1,324.71" "$2,207.85" "$2,207.85" "$2,207.85" N/A N/A TT9 SUP Custom 27203010 TT9 - ATTACHMENT TOOL 9CM TELESCOPING TUBE MIDAS REX LEGEND BOTH IP/OP "$1,250.50" $925.00 $222.59 "$1,250.50" "$1,250.50" "$1,250.50" "$1,250.50" "$1,250.50" "$1,250.50" "$1,250.50" $222.59 "$1,250.50" "$1,250.50" $928.12 $928.12 $963.89 $651.51 $260.62 "$1,250.50" $500.20 "$1,250.50" "$1,250.50" "$1,250.50" "$1,250.50" "$1,250.50" $937.88 "$1,250.50" "$1,250.50" "$1,250.50" $625.25 $625.25 $990.40 "$1,250.50" "$1,000.40" $812.83 "$1,250.50" N/A $725.29 "$1,250.50" $750.30 "$1,250.50" "$1,250.50" "$1,250.50" N/A N/A TT9C SUP Custom 27203010 TT9C - ATTACHMENT TOOL 9CM CVD TELESCOPING TUBE MIDAS REX LEGEND BOTH IP/OP "$1,330.50" $985.00 $236.82 "$1,330.45" "$1,330.45" "$1,330.45" "$1,330.45" "$1,330.45" "$1,330.45" "$1,330.45" $236.82 "$1,330.45" "$1,330.45" $987.46 $987.46 "$1,025.51" $693.16 $277.28 "$1,330.45" $532.18 "$1,330.45" "$1,330.45" "$1,330.45" "$1,330.45" "$1,330.45" $997.88 "$1,330.45" "$1,330.45" "$1,330.45" $665.23 $665.23 "$1,053.72" "$1,330.45" "$1,064.36" $864.79 "$1,330.45" N/A $771.69 "$1,330.45" $798.27 "$1,330.45" "$1,330.45" "$1,330.45" N/A N/A TVI-07 SUP HCPCS C1894 TVI-07 - TOOL INSERTION 7FR TRANSVALVULAR BOTH IP/OP $9.00 $7.00 $1.79 $45.00 $4.89 $4.89 $4.89 $4.89 $9.00 $9.00 $9.00 $1.88 $9.00 $6.68 $6.68 $6.94 $4.69 $1.88 $9.00 $45.00 $5.32 $9.00 $9.00 $9.00 $9.00 $6.75 $9.00 $9.00 $9.00 $4.50 $4.50 $7.13 $9.00 $7.20 $5.85 $1.79 N/A $5.22 $9.00 $9.00 $9.00 $1.88 $9.00 N/A N/A TVTRL SUP HCPCS C1771 TVTRL - SLING GYNECOLOGICAL GYNECARE TVT SECUR STRESS URINARY BOTH IP/OP "$2,262.00" "$1,674.00" $448.95 "$2,262.00" "$1,017.90" "$1,017.90" "$1,017.90" "$1,017.90" "$2,262.00" "$2,262.00" "$2,262.00" $471.46 "$2,262.00" "$2,262.00" "$2,262.00" "$2,262.00" "$2,262.00" $471.43 "$2,262.00" "$2,262.00" "$1,337.97" "$2,262.00" "$2,262.00" "$2,262.00" "$2,262.00" "$1,696.50" "$2,262.00" "$2,262.00" "$2,262.00" "$1,131.00" "$1,131.00" "$1,791.50" "$2,262.00" "$1,809.60" "$1,017.90" $448.95 N/A "$1,311.96" "$2,262.00" "$2,262.00" "$2,262.00" $471.40 "$2,262.00" N/A N/A TW173016 SUP Custom 27203010 TW173016 - ENDO STITCH 10 MM SUTURING DEVICE BOTH IP/OP $836.50 $619.00 $148.83 $836.10 $836.10 $836.10 $836.10 $836.10 $836.10 $836.10 $148.83 $836.10 $836.10 $620.55 $620.55 $644.47 $435.61 $174.25 $836.10 $334.44 $836.10 $836.10 $836.10 $836.10 $836.10 $627.38 $836.10 $836.10 $836.10 $418.05 $418.05 $662.19 $836.10 $668.88 $543.47 $836.10 N/A $485.17 $836.10 $501.66 $836.10 $836.10 $836.10 N/A N/A U202H SUP Custom 27203010 U202H - SUTURE ABSORBABLE 5-0 RB-1 27IN MONOFILAMENT CHROMIC BOTH IP/OP $295.00 $218.00 $52.44 $303.15 $294.60 $294.60 $294.60 $294.60 $294.60 $294.60 $52.44 $294.60 $294.60 $218.65 $218.65 $227.08 $153.49 $61.40 $294.60 $121.26 $294.60 $294.60 $303.15 $294.60 $294.60 $221.25 $294.60 $294.60 $294.60 $147.30 $147.30 $233.32 $294.60 $235.68 $191.49 $294.60 N/A $171.10 $294.60 $176.76 $294.60 $294.60 $294.60 N/A N/A UA1329-S SUP Custom 27203010 UA1329-S - GUIDE NEEDLE DUAL READY TO USE INDIVIDUALLY STERILE BOTH IP/OP $900.00 $666.00 $160.20 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $900.00 $160.20 $900.00 $900.00 $667.98 $667.98 $693.72 $468.90 $187.57 $900.00 $360.00 $900.00 $900.00 $900.00 $900.00 $900.00 $675.00 $900.00 $900.00 $900.00 $450.00 $450.00 $712.80 $900.00 $720.00 $585.00 $900.00 N/A $522.00 $900.00 $540.00 $900.00 $900.00 $900.00 N/A N/A UH1-36-22 SUP Custom 27803010 UH1-36-22 - HEAD BIPOL 36MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-38-22 SUP Custom 27803010 UH1-38-22 - HEAD BIPOL 38MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-40-22 SUP Custom 27803010 UH1-40-22 - HEAD BIPOL UNIVERSAL 40MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-41-22 SUP Custom 27803010 UH1-41-22 - HEAD BIPOL UNIVERSAL 41MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-41-26 SUP Custom 27803010 UH1-41-26 - HEAD BIPOL UNIVERSAL 41MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-42-22 SUP Custom 27803010 UH1-42-22 - HEAD BP UNV 42MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-42-26 SUP Custom 27803010 UH1-42-26 - HEAD BIPOL UNIVERSAL 42MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-42-28 SUP Custom 27803010 UH1-42-28 - HEAD BIPOL UNIVERSAL 42MM 28MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-43-22 SUP Custom 27803010 UH1-43-22 - HEAD BIPOL UNIVERSAL 43MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-43-26 SUP Custom 27803010 UH1-43-26 - HEAD BIPOL UNIVERSAL 43MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-44-22 SUP Custom 27803010 UH1-44-22 - HEAD BIPOL UNIVERSAL 44MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-44-26 SUP Custom 27803010 UH1-44-26 - HEAD BIPOL UNIVERSAL 44MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-44-28 SUP Custom 27803010 UH1-44-28 - HEAD BIPOL UNIVERSAL 44MM 28MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-45-22 SUP Custom 27803010 UH1-45-22 - HEAD BIPOL UNIVERSAL 45MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-45-26 SUP Custom 27803010 UH1-45-26 - HEAD BIPOL UNIVERSAL 45MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-45-28 SUP Custom 27803010 UH1-45-28 - HEAD BP 45MM 28MM UHR HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-46-22 SUP Custom 27803010 UH1-46-22 - HEAD BIPOL UNIVERSAL 46MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-46-26 SUP Custom 27803010 UH1-46-26 - HEAD BIPOL UNIVERSAL 46MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-46-28 SUP Custom 27803010 UH1-46-28 - HEAD BIPOL UNIVERSAL 46MM 28MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-47-22 SUP Custom 27803010 UH1-47-22 - HEAD BIPOL UNIVERSAL 47MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-47-26 SUP Custom 27803010 UH1-47-26 - HEAD BIPOL UNIVERSAL 47MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-47-28 SUP Custom 27803010 UH1-47-28 - HEAD BP UNV 47MM 28MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-48-22 SUP Custom 27803010 UH1-48-22 - HEAD BIPOL UNIVERSAL 48MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-48-26 SUP Custom 27803010 UH1-48-26 - HEAD BIPOL UNIVERSAL 48MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-48-28 SUP Custom 27803010 UH1-48-28 - HEAD BP 48MM 28MM UHR HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-48-32 SUP Custom 27803010 UH1-48-32 - HEAD BIPOL UNIVERSAL 48MM 32MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-49-22 SUP Custom 27803010 UH1-49-22 - HEAD BIPOL UNIVERSAL 49MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-49-26 SUP Custom 27803010 UH1-49-26 - HEAD BIPOL UNIVERSAL 49MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-49-28 SUP Custom 27803010 UH1-49-28 - HEAD BIPOL UNIVERSAL 49MM 28MM UHR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-49-32 SUP Custom 27803010 UH1-49-32 - HEAD BIPOL UNIVERSAL 49MM 32MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-50-22 SUP Custom 27803010 UH1-50-22 - HEAD BIPOL UNIVERSAL 50MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-50-26 SUP Custom 27803010 UH1-50-26 - HEAD BIPOL UNIVERSAL 50MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-50-28 SUP Custom 27803010 UH1-50-28 - HEAD BIPOL UNIVERSAL 50MM 28MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-50-32 SUP Custom 27803010 UH1-50-32 - HEAD BIPOL UNIVERSAL 50MM 32MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-51-22 SUP Custom 27803010 UH1-51-22 - HEAD BIPOL UNIVERSAL 51MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-51-26 SUP Custom 27803010 UH1-51-26 - HEAD BIPOL UNIVERSAL 51MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-51-28 SUP Custom 27803010 UH1-51-28 - HEAD BIPOL UNIVERSAL 51MM 28MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-51-32 SUP Custom 27803010 UH1-51-32 - HEAD BIPOL UNIVERSAL 51MM 32MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-52-22 SUP Custom 27803010 UH1-52-22 - HEAD BIPOL UNIVERSAL 52MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-52-26 SUP Custom 27803010 UH1-52-26 - HEAD BIPOL UNIVERSAL 52MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-52-28 SUP Custom 27803010 UH1-52-28 - HEAD BP 52MM 28MM UHR HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-52-32 SUP Custom 27803010 UH1-52-32 - HEAD BIPOL UNIVERSAL 52MM 32MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-53-22 SUP Custom 27803010 UH1-53-22 - HEAD BIPOL UNIVERSAL 53MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-53-26 SUP Custom 27803010 UH1-53-26 - HEAD BIPOL UNIVERSAL 53MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-53-28 SUP Custom 27803010 UH1-53-28 - HEAD BP 53MM 28MM UHR HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-53-32 SUP Custom 27803010 UH1-53-32 - HEAD BIPOL UNIVERSAL 53MM 32MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-54-22 SUP Custom 27803010 UH1-54-22 - HEAD BIPOL UNIVERSAL 54MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-54-26 SUP Custom 27803010 UH1-54-26 - HEAD BIPOL UNIVERSAL 54MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-54-28 SUP Custom 27803010 UH1-54-28 - HEAD BIPOL UNIVERSAL 54MM 28MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-54-32 SUP Custom 27803010 UH1-54-32 - HEAD BIPOL UNIVERSAL 54MM 32MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-55-22 SUP Custom 27803010 UH1-55-22 - HEAD BIPOL UNIVERSAL 55MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-55-26 SUP Custom 27803010 UH1-55-26 - HEAD BIPOL UNIVERSAL 55MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-55-28 SUP Custom 27803010 UH1-55-28 - HEAD BP 55MM 28MM UHR HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-55-32 SUP Custom 27803010 UH1-55-32 - HEAD BIPOL UNIVERSAL 55MM 32MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-56-22 SUP Custom 27803010 UH1-56-22 - HEAD BIPOL UNIVERSAL 56MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-56-26 SUP Custom 27803010 UH1-56-26 - HEAD BIPOL UNIVERSAL 56MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-56-28 SUP Custom 27803010 UH1-56-28 - HEAD BIPOL UNIVERSAL 56MM 28MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-56-32 SUP Custom 27803010 UH1-56-32 - HEAD BIPOL UNIVERSAL 56MM 32MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-58-22 SUP Custom 27803010 UH1-58-22 - HEAD BIPOL UNIVERSAL 58MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-58-26 SUP Custom 27803010 UH1-58-26 - HEAD BIPOL UNIVERSAL 58MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-58-28 SUP Custom 27803010 UH1-58-28 - HEAD BIPOL UNIVERSAL 58MM 28MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-58-32 SUP Custom 27803010 UH1-58-32 - HEAD BIPOL UNIVERSAL 58MM 32MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-61-22 SUP Custom 27803010 UH1-61-22 - HEAD BIPOL UNIVERSAL 61MM 22MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-61-26 SUP Custom 27803010 UH1-61-26 - HEAD BIPOL UNIVERSAL 61MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-61-28 SUP Custom 27803010 UH1-61-28 - HEAD BIPOL UNIVERSAL 61MM 28MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-61-32 SUP Custom 27803010 UH1-61-32 - HEAD BIPOL UNIVERSAL 61MM 32MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-64-26 SUP Custom 27803010 UH1-64-26 - HEAD BIPOL UNIVERSAL 64MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-64-28 SUP Custom 27803010 UH1-64-28 - HEAD BIPOL UNIVERSAL 64MM 28MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-64-32 SUP Custom 27803010 UH1-64-32 - HEAD BIPOL UNIVERSAL 64MM 32MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-68-26 SUP Custom 27803010 UH1-68-26 - HEAD BIPOL UNIVERSAL 68MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-68-28 SUP Custom 27803010 UH1-68-28 - HEAD BIPOL UNIVERSAL 68MM 28MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-68-32 SUP Custom 27803010 UH1-68-32 - HEAD BIPOL UNIVERSAL 68MM 32MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-72-26 SUP Custom 27803010 UH1-72-26 - HEAD BIPOL UNIVERSAL 72MM 26MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-72-28 SUP Custom 27803010 UH1-72-28 - HEAD BIPOL UNIVERSAL 72MM 28MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UH1-72-32 SUP Custom 27803010 UH1-72-32 - HEAD BIPOL UNIVERSAL 72MM 32MM UHR COCR UHMWPE HIP BOTH IP/OP "$1,150.00" $851.00 $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $204.70 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $239.67 "$1,150.00" $460.00 "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" "$1,150.00" $862.50 "$1,150.00" "$1,150.00" "$1,150.00" $575.00 $575.00 $910.80 "$1,150.00" $920.00 $517.50 "$1,150.00" N/A $667.00 "$1,150.00" $690.00 "$1,150.00" "$1,150.00" "$1,150.00" N/A N/A UL-3021-S SUP HCPCS C1713 UL-3021-S - ROD INTRAMEDULLARY 3MM 210MM HAND WRIST ULNA STERILE BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$2,690.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A UL-3023-S SUP HCPCS C1713 UL-3023-S - ROD ORTHOPEDIC 3MM 230MM ULNA INTRAMEDULLARY IMPLANT ULNA BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$1,614.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A UL-3025-S SUP HCPCS C1713 UL-3025-S - ROD ORTHOPEDIC 3MM 250MM ULNA INTRAMEDULLARY IMPLANT ULNAR BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$2,690.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A UL-3027-S SUP HCPCS C1713 UL-3027-S - ROD INTRAMEDULLARY 3MM 270MM ULNA STERILE BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$1,076.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$1,614.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A UL-3621-S SUP HCPCS C1713 UL-3621-S - ROD INTRAMEDULLARY 3.6MM 210MM ULNA STERILE BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$1,076.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$1,614.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A UL-3623-S SUP HCPCS C1713 UL-3623-S - ROD ORTHOPEDIC 3MM 230MM ULNA INTRAMEDULLARY IMPLANT ULNA BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$1,076.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$2,690.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A UL-3625-S SUP HCPCS C1713 UL-3625-S - ROD ORTHOPEDIC 3.6MM 250MM ULNA INTRAMEDULLARY IMPLANT ULNAR BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$2,690.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A UL-3627-S SUP HCPCS C1713 UL-3627-S - ROD ORTHOPEDIC 3.6MM 270MM ULNA INTRAMEDULLARY IMPLANT ULNAR BOTH IP/OP "$2,690.00" "$1,991.00" $533.90 "$2,690.00" "$1,210.50" "$1,210.50" "$1,210.50" "$1,210.50" "$2,690.00" "$2,690.00" "$2,690.00" $560.66 "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" $560.63 "$2,690.00" "$2,690.00" "$1,326.17" "$2,690.00" "$2,690.00" "$2,690.00" "$2,690.00" "$2,017.50" "$2,690.00" "$2,690.00" "$2,690.00" "$1,345.00" "$1,345.00" "$2,130.48" "$2,690.00" "$2,152.00" "$1,210.50" $533.90 N/A "$1,560.20" "$2,690.00" "$1,614.00" "$2,690.00" $560.60 "$2,690.00" N/A N/A ULTRA O-RNG RPL SUP Custom 27803010 ULTRA O-RNG RPL - O RING OPTH BLK ULFL REPL SIL BOTH IP/OP $135.00 $100.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $24.03 $135.00 $135.00 $135.00 $135.00 $135.00 $135.00 $28.14 $135.00 $54.00 $135.00 $135.00 $135.00 $135.00 $135.00 $101.25 $135.00 $135.00 $135.00 $67.50 $67.50 $106.92 $135.00 $108.00 $60.75 $135.00 N/A $78.30 $135.00 $81.00 $135.00 $135.00 $135.00 N/A N/A UM-04018 SUP Custom 27203010 UM-04018 - KIT ARTERIAL LINE 18GA 20GA 16CM 1.5IN INDWELL CATHETER BOTH IP/OP $75.50 $56.00 $13.44 $75.50 $75.50 $75.50 $75.50 $75.50 $75.50 $75.50 $13.44 $75.50 $75.50 $56.04 $56.04 $58.20 $39.34 $15.74 $75.50 $30.20 $75.50 $75.50 $75.50 $75.50 $75.50 $56.63 $75.50 $75.50 $75.50 $37.75 $37.75 $59.80 $75.50 $60.40 $49.08 $75.50 N/A $43.79 $75.50 $45.30 $75.50 $75.50 $75.50 N/A N/A UOCP SUP HCPCS C1713 UOCP - PLATE BN SHTNG ULNA BOTH IP/OP "$2,150.00" "$1,591.00" $426.72 "$2,150.00" $967.50 $967.50 $967.50 $967.50 "$2,150.00" "$2,150.00" "$2,150.00" $448.11 "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" $448.08 "$2,150.00" $860.00 "$1,271.73" "$2,150.00" "$2,150.00" "$2,150.00" "$2,150.00" "$1,612.50" "$2,150.00" "$2,150.00" "$2,150.00" "$1,075.00" "$1,075.00" "$1,702.80" "$2,150.00" "$1,720.00" $967.50 $426.72 N/A "$1,247.00" "$2,150.00" "$1,290.00" "$2,150.00" $448.06 "$2,150.00" N/A N/A UPA3030 SUP HCPCS C1781 UPA3030 - MESH SURG ULTRAPRO ADV 30X30CM PRTL ABS LTWT BOTH IP/OP $619.50 $458.00 $122.92 $619.33 $278.70 $278.70 $278.70 $278.70 $619.33 $619.33 $619.33 $129.08 $619.33 $619.33 $619.33 $619.33 $619.33 $129.08 $619.33 $619.33 $366.33 $619.33 $619.33 $619.33 $619.33 $464.63 $619.33 $619.33 $619.33 $309.67 $309.67 $490.51 $619.33 $495.46 $278.70 $122.92 N/A $359.31 $619.33 $619.33 $619.33 $129.07 $619.33 N/A N/A UPA31015 SUP HCPCS C1781 UPA31015 - MESH SRG RECT 15X10CM BLU STRP ULTRAPRO ADV PRT ABS LTWT HI BOTH IP/OP $311.00 $230.00 $61.66 $310.66 $139.80 $139.80 $139.80 $139.80 $310.66 $310.66 $310.66 $64.75 $310.66 $310.66 $310.66 $310.66 $310.66 $64.74 $310.66 $310.66 $183.76 $310.66 $310.66 $310.66 $310.66 $233.25 $310.66 $310.66 $310.66 $155.33 $155.33 $246.04 $310.66 $248.53 $139.80 $61.66 N/A $180.38 $310.66 $310.66 $310.66 $64.74 $310.66 N/A N/A UPEG-14 SUP HCPCS C1713 UPEG-14 - PEG FIX 14MM UNTHREADED VOLAR BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A UPEG-16 SUP HCPCS C1713 UPEG-16 - PEG FIX 14MM UNTHREADED VOLAR BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $262.50 $262.50 $54.71 $262.50 N/A N/A UPEG-18 SUP HCPCS C1713 UPEG-18 - PEG FIX 18MM UNTHREADED VOLAR BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A UPEG-20 SUP HCPCS C1713 UPEG-20 - SCREW BONE 20MM PEG UNTHREADED TRX BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $157.50 $262.50 $54.71 $262.50 N/A N/A UPEG-22 SUP HCPCS C1713 UPEG-22 - PEG FIX 22MM UNTHREADED VOLAR BOTH IP/OP $262.50 $194.00 $52.10 $262.50 $118.13 $118.13 $118.13 $118.13 $262.50 $262.50 $262.50 $54.71 $262.50 $262.50 $262.50 $262.50 $262.50 $54.71 $262.50 $105.00 $155.27 $262.50 $262.50 $262.50 $262.50 $196.88 $262.50 $262.50 $262.50 $131.25 $131.25 $207.90 $262.50 $210.00 $118.13 $52.10 N/A $152.25 $262.50 $262.50 $262.50 $54.71 $262.50 N/A N/A UPLUG403 SUP HCPCS C1781 UPLUG403 - MESH SURG 14X7CM ONLAY PLUG ULTRAPRO 40MM BOTH IP/OP $674.50 $499.00 $133.84 $674.33 $303.45 $303.45 $303.45 $303.45 $674.33 $674.33 $674.33 $140.55 $674.33 $674.33 $674.33 $674.33 $674.33 $140.54 $674.33 $674.33 $398.87 $674.33 $674.33 $674.33 $674.33 $505.88 $674.33 $674.33 $674.33 $337.17 $337.17 $534.07 $674.33 $539.46 $303.45 $133.84 N/A $391.21 $674.33 $674.33 $674.33 $140.53 $674.33 N/A N/A UPLUG553 SUP HCPCS C1781 UPLUG553 - MESH SURG 14X7CM ONLAY PLUG ULTRAPRO 55MM BOTH IP/OP $674.50 $499.00 $133.84 $674.33 $303.45 $303.45 $303.45 $303.45 $674.33 $674.33 $674.33 $140.55 $674.33 $674.33 $674.33 $674.33 $674.33 $140.54 $674.33 $674.33 $398.87 $674.33 $674.33 $674.33 $674.33 $505.88 $674.33 $674.33 $674.33 $337.17 $337.17 $534.07 $674.33 $539.46 $303.45 $133.84 N/A $391.21 $674.33 $674.33 $674.33 $140.53 $674.33 N/A N/A URO170716Q SUP HCPCS C1729 URO170716Q - TRAY CATH 16FR LTX 1 LYR FL STRG TIP DRN BG PVP SIL ADLT BOTH IP/OP $34.00 $25.00 $6.68 $33.65 $18.27 $18.27 $18.27 $18.27 $33.65 $33.65 $33.65 $7.01 $33.65 $24.98 $24.98 $25.94 $17.53 $7.01 $33.65 $33.65 $19.90 $33.65 $33.65 $33.65 $33.65 $25.50 $33.65 $33.65 $33.65 $16.83 $16.83 $26.65 $33.65 $26.92 $21.87 $6.68 N/A $19.72 $33.65 $33.65 $33.65 $7.01 $33.65 N/A N/A URO170816Q SUP Custom 27203010 URO170816Q - TRAY CATHETERIZATION 16FR URINE METER FOLEY STATLOCK LATEX BOTH IP/OP $36.00 $27.00 $6.40 $39.73 $35.98 $35.98 $35.98 $35.98 $35.98 $35.98 $6.40 $35.98 $35.98 $26.70 $26.70 $27.73 $18.75 $7.50 $35.98 $15.89 $35.98 $35.98 $39.73 $35.98 $35.98 $27.00 $35.98 $35.98 $35.98 $17.99 $17.99 $28.50 $35.98 $28.78 $23.39 $35.98 N/A $20.88 $35.98 $21.59 $35.98 $35.98 $35.98 N/A N/A URO170816TQ SUP Custom 27203010 URO170816TQ - TRAY CATHETERIZATION 16FR 2 CONCTR TEMPERATURE SENSE BOTH IP/OP $63.00 $47.00 $11.20 $69.50 $62.90 $62.90 $62.90 $62.90 $62.90 $62.90 $11.20 $62.90 $62.90 $46.68 $46.68 $48.48 $32.77 $13.11 $62.90 $27.80 $62.90 $62.90 $69.50 $62.90 $62.90 $47.25 $62.90 $62.90 $62.90 $31.45 $31.45 $49.82 $62.90 $50.32 $40.89 $62.90 N/A $36.54 $62.90 $37.74 $62.90 $62.90 $62.90 N/A N/A URO170816TQ SUP Custom 27203010 URO170816TQ - TRAY CATH 16FR LF TEMP SENSE 1 LYR FL CLS SYS SIL ADLT BOTH IP/OP $63.00 $47.00 $11.20 $69.50 $62.90 $62.90 $62.90 $62.90 $62.90 $62.90 $11.20 $62.90 $62.90 $46.68 $46.68 $48.48 $32.77 $13.11 $62.90 $27.80 $62.90 $62.90 $69.50 $62.90 $62.90 $47.25 $62.90 $62.90 $62.90 $31.45 $31.45 $49.82 $62.90 $50.32 $40.89 $62.90 N/A $36.54 $62.90 $37.74 $62.90 $62.90 $62.90 N/A N/A URO175716 SUP HCPCS C1729 URO175716 - TRAY CATH 16FR LTX 1 LYR FL STRG TIP DRN BG PVP SIL ADLT BOTH IP/OP $34.00 $25.00 $6.68 $37.15 $18.27 $18.27 $18.27 $18.27 $33.65 $33.65 $33.65 $7.01 $33.65 $24.98 $24.98 $25.94 $17.53 $7.01 $33.65 $37.15 $19.90 $33.65 $37.15 $33.65 $33.65 $25.50 $33.65 $33.65 $33.65 $16.83 $16.83 $26.65 $33.65 $26.92 $21.87 $6.68 N/A $19.72 $33.65 $33.65 $33.65 $7.01 $33.65 N/A N/A USA-FDX SUP Custom 27203010 USA-FDX - ASPIRATOR SCT 72IN LF FLD DMD TUBE DISP BOTH IP/OP "$1,350.00" $999.00 $240.30 "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" $240.30 "$1,350.00" "$1,350.00" "$1,001.97" "$1,001.97" "$1,040.58" $703.35 $281.35 "$1,350.00" $540.00 "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,350.00" "$1,012.50" "$1,350.00" "$1,350.00" "$1,350.00" $675.00 $675.00 "$1,069.20" "$1,350.00" "$1,080.00" $877.50 "$1,350.00" N/A $783.00 "$1,350.00" $810.00 "$1,350.00" "$1,350.00" "$1,350.00" N/A N/A V060 SUP HCPCS C1768 V060 - GRAFT SFT TIS 7-9MM 18CM CRYOVEIN FRZN FEM VN SPRFC BOTH IP/OP "$14,800.00" "$10,952.00" "$2,937.43" "$14,800.00" "$6,660.00" "$6,660.00" "$6,660.00" "$6,660.00" "$14,800.00" "$14,800.00" "$14,800.00" "$3,084.69" "$14,800.00" "$14,800.00" "$14,800.00" "$14,800.00" "$14,800.00" "$3,084.48" "$14,800.00" "$14,800.00" "$7,296.40" "$14,800.00" "$14,800.00" "$14,800.00" "$14,800.00" "$11,100.00" "$14,800.00" "$14,800.00" "$14,800.00" "$7,400.00" "$7,400.00" "$11,721.60" "$14,800.00" "$11,840.00" "$6,660.00" "$2,937.43" N/A "$8,584.00" "$14,800.00" "$14,800.00" "$14,800.00" "$3,084.32" "$14,800.00" N/A N/A V-193C SUP HCPCS C1722 V-193C - DEFIBRILLATOR CARDIAC THK14MM 1 CHAMBER DEFT TECHNOLOGY BOTH IP/OP "$33,750.00" "$24,975.00" "$6,698.53" "$33,750.00" "$15,187.50" "$15,187.50" "$15,187.50" "$15,187.50" "$33,750.00" "$33,750.00" "$33,750.00" "$7,034.34" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$7,033.87" "$33,750.00" "$33,750.00" "$16,638.75" "$33,750.00" "$33,750.00" "$33,750.00" "$33,750.00" "$25,312.50" "$33,750.00" "$33,750.00" "$33,750.00" "$16,875.00" "$16,875.00" "$26,730.00" "$33,750.00" "$27,000.00" "$15,187.50" "$6,698.53" N/A "$19,575.00" "$33,750.00" "$33,750.00" "$33,750.00" "$7,033.50" "$33,750.00" N/A N/A V402G SUP Custom 27203010 V402G - SUTURE ABS 9-0 BV100-3 5IN VIOL VCL MFL COAT BOTH IP/OP $46.50 $34.00 $8.27 $47.80 $46.45 $46.45 $46.45 $46.45 $46.45 $46.45 $8.27 $46.45 $46.45 $34.48 $34.48 $35.80 $24.20 $9.68 $46.45 $19.12 $46.45 $46.45 $47.80 $46.45 $46.45 $34.88 $46.45 $46.45 $46.45 $23.23 $23.23 $36.79 $46.45 $37.16 $30.19 $46.45 N/A $26.97 $46.45 $27.87 $46.45 $46.45 $46.45 N/A N/A V4908(SUB) SUP Custom 27203010 V4908(SUB) - SET PERITONEAL DIALYSIS BOTH IP/OP $202.00 $149.00 $35.94 $201.93 $201.93 $201.93 $201.93 $201.93 $201.93 $201.93 $35.94 $201.93 $201.93 $149.87 $149.87 $155.65 $105.21 $42.08 $201.93 $80.77 $201.93 $201.93 $201.93 $201.93 $201.93 $151.50 $201.93 $201.93 $201.93 $100.97 $100.97 $159.93 $201.93 $161.54 $131.25 $201.93 N/A $117.16 $201.93 $121.16 $201.93 $201.93 $201.93 N/A N/A VAMF2626C100TU SUP Custom 27803010 VAMF2626C100TU - GRAFT STNT 26MM 100MM VALIANT PROX MAIN SECT FREEFLO CLS WEB BOTH IP/OP "$42,487.50" "$31,441.00" "$7,562.78" "$42,487.50" "$42,487.50" "$42,487.50" "$42,487.50" "$42,487.50" "$42,487.50" "$42,487.50" "$7,562.78" "$42,487.50" "$42,487.50" "$42,487.50" "$42,487.50" "$42,487.50" "$42,487.50" "$8,854.86" "$42,487.50" "$16,995.00" "$42,487.50" "$42,487.50" "$42,487.50" "$42,487.50" "$42,487.50" "$31,865.63" "$42,487.50" "$42,487.50" "$42,487.50" "$21,243.75" "$21,243.75" "$33,650.10" "$42,487.50" "$33,990.00" "$19,119.38" "$42,487.50" N/A "$24,642.75" "$42,487.50" "$25,492.50" "$42,487.50" "$42,487.50" "$42,487.50" N/A N/A VAMF2824C150TU SUP Custom 27803010 VAMF2824C150TU - GRAFT STNT STRG TPR SINUSOIDAL 25FR 24MM 112MM 100MM VALIANT BOTH IP/OP "$46,237.50" "$34,216.00" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$9,636.40" "$46,237.50" "$18,495.00" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$34,678.13" "$46,237.50" "$46,237.50" "$46,237.50" "$23,118.75" "$23,118.75" "$36,620.10" "$46,237.50" "$36,990.00" "$20,806.88" "$46,237.50" N/A "$26,817.75" "$46,237.50" "$27,742.50" "$46,237.50" "$46,237.50" "$46,237.50" N/A N/A VAMF3026C150TU SUP Custom 27803010 VAMF3026C150TU - GRAFT STNT TPR 30MM 26MM 150MM VALIANT CAPTIVIA THRX BOTH IP/OP "$46,237.50" "$34,216.00" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$9,636.40" "$46,237.50" "$18,495.00" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$34,678.13" "$46,237.50" "$46,237.50" "$46,237.50" "$23,118.75" "$23,118.75" "$36,620.10" "$46,237.50" "$36,990.00" "$20,806.88" "$46,237.50" N/A "$26,817.75" "$46,237.50" "$27,742.50" "$46,237.50" "$46,237.50" "$46,237.50" N/A N/A VAMF3228C150TU SUP Custom 27803010 VAMF3228C150TU - GRAFT STNT TPR 28MM 150MM VALIANT CAPTIVIA DLV SYS BOTH IP/OP "$46,237.50" "$34,216.00" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$9,636.40" "$46,237.50" "$18,495.00" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$34,678.13" "$46,237.50" "$46,237.50" "$46,237.50" "$23,118.75" "$23,118.75" "$36,620.10" "$46,237.50" "$36,990.00" "$20,806.88" "$46,237.50" N/A "$26,817.75" "$46,237.50" "$27,742.50" "$46,237.50" "$46,237.50" "$46,237.50" N/A N/A VAMF3430C150TU SUP Custom 27803010 VAMF3430C150TU - GRAFT STNT TPR 34MM 30MM 150MM VALIANT CAPTIVIA EVAS BOTH IP/OP "$46,237.50" "$34,216.00" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$9,636.40" "$46,237.50" "$18,495.00" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$34,678.13" "$46,237.50" "$46,237.50" "$46,237.50" "$23,118.75" "$23,118.75" "$36,620.10" "$46,237.50" "$36,990.00" "$20,806.88" "$46,237.50" N/A "$26,817.75" "$46,237.50" "$27,742.50" "$46,237.50" "$46,237.50" "$46,237.50" N/A N/A VAMF3434C150TU SUP Custom 27803010 VAMF3434C150TU - GRAFT STNT STRG 34MM 150MM VALIANT PROX MAIN SECT CLS WEB BOTH IP/OP "$46,237.50" "$34,216.00" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$9,636.40" "$46,237.50" "$18,495.00" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$34,678.13" "$46,237.50" "$46,237.50" "$46,237.50" "$23,118.75" "$23,118.75" "$36,620.10" "$46,237.50" "$36,990.00" "$20,806.88" "$46,237.50" N/A "$26,817.75" "$46,237.50" "$27,742.50" "$46,237.50" "$46,237.50" "$46,237.50" N/A N/A VAMF3434C200TU SUP Custom 27803010 VAMF3434C200TU - GRAFT STNT STRG SINUSOIDAL 34MM 24FR 200MM 212MM VALIANT SYS BOTH IP/OP "$48,737.50" "$36,066.00" "$8,675.28" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$8,675.28" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$10,157.43" "$48,737.50" "$19,495.00" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$36,553.13" "$48,737.50" "$48,737.50" "$48,737.50" "$24,368.75" "$24,368.75" "$38,600.10" "$48,737.50" "$38,990.00" "$21,931.88" "$48,737.50" N/A "$28,267.75" "$48,737.50" "$29,242.50" "$48,737.50" "$48,737.50" "$48,737.50" N/A N/A VAMF3632C150TU SUP Custom 27803010 VAMF3632C150TU - GRAFT STNT STRG TPR 32MM 36MM 150MM STRL LF VALIANT CAPTIVIA BOTH IP/OP "$46,237.50" "$34,216.00" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$9,636.40" "$46,237.50" "$18,495.00" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$34,678.13" "$46,237.50" "$46,237.50" "$46,237.50" "$23,118.75" "$23,118.75" "$36,620.10" "$46,237.50" "$36,990.00" "$20,806.88" "$46,237.50" N/A "$26,817.75" "$46,237.50" "$27,742.50" "$46,237.50" "$46,237.50" "$46,237.50" N/A N/A VAMF3636C150TU SUP Custom 27803010 VAMF3636C150TU - GRAFT STNT SINUSOIDAL STRG 36MM 24FR 167MM 150MM VALIANT BOTH IP/OP "$46,237.50" "$34,216.00" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$9,636.40" "$46,237.50" "$18,495.00" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$34,678.13" "$46,237.50" "$46,237.50" "$46,237.50" "$23,118.75" "$23,118.75" "$36,620.10" "$46,237.50" "$36,990.00" "$20,806.88" "$46,237.50" N/A "$26,817.75" "$46,237.50" "$27,742.50" "$46,237.50" "$46,237.50" "$46,237.50" N/A N/A VAMF3636C200TU SUP Custom 27803010 VAMF3636C200TU - GRAFT STNT STRG 36MM 200MM 207MM VALIANT PROX FREEFLO EVAS BOTH IP/OP "$48,737.50" "$36,066.00" "$8,675.28" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$8,675.28" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$10,157.43" "$48,737.50" "$19,495.00" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$36,553.13" "$48,737.50" "$48,737.50" "$48,737.50" "$24,368.75" "$24,368.75" "$38,600.10" "$48,737.50" "$38,990.00" "$21,931.88" "$48,737.50" N/A "$28,267.75" "$48,737.50" "$29,242.50" "$48,737.50" "$48,737.50" "$48,737.50" N/A N/A VAMF3838C200TU SUP HCPCS C2625 VAMF3838C200TU - GRAFT STNT SINUSOIDAL STRG 38MM 24FR 207MM 200MM VALIANT BOTH IP/OP "$48,737.50" "$36,066.00" "$7,712.84" "$48,737.50" "$21,931.88" "$21,931.88" "$21,931.88" "$21,931.88" "$48,737.50" "$48,737.50" "$48,737.50" "$9,417.94" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$10,157.43" "$48,737.50" "$48,737.50" "$24,027.59" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$36,553.13" "$48,737.50" "$48,737.50" "$48,737.50" "$24,368.75" "$24,368.75" "$38,600.10" "$48,737.50" "$38,990.00" "$21,931.88" "$7,712.84" N/A "$28,267.75" "$48,737.50" "$48,737.50" "$48,737.50" "$8,098.48" "$48,737.50" N/A N/A VAMF4242C150TU SUP Custom 27803010 VAMF4242C150TU - GRAFT STNT SINUSOIDAL STRG 42MM 25FR 157MM 150MM VALIANT BOTH IP/OP "$46,237.50" "$34,216.00" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$8,230.28" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$9,636.40" "$46,237.50" "$18,495.00" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$46,237.50" "$34,678.13" "$46,237.50" "$46,237.50" "$46,237.50" "$23,118.75" "$23,118.75" "$36,620.10" "$46,237.50" "$36,990.00" "$20,806.88" "$46,237.50" N/A "$26,817.75" "$46,237.50" "$27,742.50" "$46,237.50" "$46,237.50" "$46,237.50" N/A N/A VAMF4242C200TU SUP HCPCS C1768 VAMF4242C200TU - GRAFT STNT SINUSOIDAL STRG 42MM 25FR 207MM 200MM VALIANT BOTH IP/OP "$48,737.50" "$36,066.00" "$7,712.84" "$48,737.50" "$21,931.88" "$21,931.88" "$21,931.88" "$21,931.88" "$48,737.50" "$48,737.50" "$48,737.50" "$9,417.94" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$10,157.43" "$48,737.50" "$48,737.50" "$24,027.59" "$48,737.50" "$48,737.50" "$48,737.50" "$48,737.50" "$36,553.13" "$48,737.50" "$48,737.50" "$48,737.50" "$24,368.75" "$24,368.75" "$38,600.10" "$48,737.50" "$38,990.00" "$21,931.88" "$7,712.84" N/A "$28,267.75" "$48,737.50" "$48,737.50" "$48,737.50" "$8,098.48" "$48,737.50" N/A N/A VBH060502 SUP HCPCS C1874 VBH060502 - STENT ENDOPRSTH 6MM 7FR 5CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$7,097.50" "$5,252.00" "$1,408.68" "$7,097.50" "$3,193.88" "$3,193.88" "$3,193.88" "$3,193.88" "$7,097.50" "$7,097.50" "$7,097.50" "$1,479.30" "$7,097.50" "$7,097.50" "$7,097.50" "$7,097.50" "$7,097.50" "$1,479.20" "$7,097.50" "$7,097.50" "$3,499.07" "$7,097.50" "$7,097.50" "$7,097.50" "$7,097.50" "$5,323.13" "$7,097.50" "$7,097.50" "$7,097.50" "$3,548.75" "$3,548.75" "$5,621.22" "$7,097.50" "$5,678.00" "$3,193.88" "$1,408.68" N/A "$4,116.55" "$7,097.50" "$7,097.50" "$7,097.50" "$1,479.12" "$7,097.50" N/A N/A VBH061002 SUP HCPCS C1874 VBH061002 - STENT ENDOPRSTH STENT 6MM 7FR 10CM 120CM DELIVERY SYSTEM BOTH IP/OP "$8,122.50" "$6,011.00" "$1,612.11" "$8,122.50" "$3,655.13" "$3,655.13" "$3,655.13" "$3,655.13" "$8,122.50" "$8,122.50" "$8,122.50" "$1,692.93" "$8,122.50" "$8,122.50" "$8,122.50" "$8,122.50" "$8,122.50" "$1,692.82" "$8,122.50" "$8,122.50" "$4,004.39" "$8,122.50" "$8,122.50" "$8,122.50" "$8,122.50" "$6,091.88" "$8,122.50" "$8,122.50" "$8,122.50" "$4,061.25" "$4,061.25" "$6,433.02" "$8,122.50" "$6,498.00" "$3,655.13" "$1,612.11" N/A "$4,711.05" "$8,122.50" "$8,122.50" "$8,122.50" "$1,692.73" "$8,122.50" N/A N/A VBH080502 SUP HCPCS C1874 VBH080502 - STENT ENDOPRSTH 8MM 8FR 5CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$6,737.50" "$4,986.00" "$1,337.23" "$6,737.50" "$3,031.88" "$3,031.88" "$3,031.88" "$3,031.88" "$6,737.50" "$6,737.50" "$6,737.50" "$1,404.26" "$6,737.50" "$6,737.50" "$6,737.50" "$6,737.50" "$6,737.50" "$1,404.17" "$6,737.50" "$6,737.50" "$3,321.59" "$6,737.50" "$6,737.50" "$6,737.50" "$6,737.50" "$5,053.13" "$6,737.50" "$6,737.50" "$6,737.50" "$3,368.75" "$3,368.75" "$5,336.10" "$6,737.50" "$5,390.00" "$3,031.88" "$1,337.23" N/A "$3,907.75" "$6,737.50" "$6,737.50" "$6,737.50" "$1,404.10" "$6,737.50" N/A N/A VBH081002 SUP HCPCS C1874 VBH081002 - STENT ENDOPRSTH 8MM 8FR 10CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$7,737.50" "$5,726.00" "$1,535.70" "$7,737.50" "$3,481.88" "$3,481.88" "$3,481.88" "$3,481.88" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.69" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.58" "$7,737.50" "$7,737.50" "$3,814.59" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$5,803.13" "$7,737.50" "$7,737.50" "$7,737.50" "$3,868.75" "$3,868.75" "$6,128.10" "$7,737.50" "$6,190.00" "$3,481.88" "$1,535.70" N/A "$4,487.75" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.50" "$7,737.50" N/A N/A VBH081502 SUP HCPCS C1874 VBH081502 - STENT ENDOPRSTH 8MM 8FR 15CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$8,900.00" "$6,586.00" "$1,766.43" "$8,900.00" "$4,005.00" "$4,005.00" "$4,005.00" "$4,005.00" "$8,900.00" "$8,900.00" "$8,900.00" "$1,854.98" "$8,900.00" "$8,900.00" "$8,900.00" "$8,900.00" "$8,900.00" "$1,854.86" "$8,900.00" "$8,900.00" "$4,387.70" "$8,900.00" "$8,900.00" "$8,900.00" "$8,900.00" "$6,675.00" "$8,900.00" "$8,900.00" "$8,900.00" "$4,450.00" "$4,450.00" "$7,048.80" "$8,900.00" "$7,120.00" "$4,005.00" "$1,766.43" N/A "$5,162.00" "$8,900.00" "$8,900.00" "$8,900.00" "$1,854.76" "$8,900.00" N/A N/A VBH090502 SUP HCPCS C1874 VBH090502 - STENT ENDOPRSTH 9MM 9FR 5CM 120CM DELIVERY SYSTEM TIP TO HUB BOTH IP/OP "$7,487.50" "$5,541.00" "$1,486.08" "$7,487.50" "$3,369.38" "$3,369.38" "$3,369.38" "$3,369.38" "$7,487.50" "$7,487.50" "$7,487.50" "$1,560.58" "$7,487.50" "$7,487.50" "$7,487.50" "$7,487.50" "$7,487.50" "$1,560.48" "$7,487.50" "$7,487.50" "$3,691.34" "$7,487.50" "$7,487.50" "$7,487.50" "$7,487.50" "$5,615.63" "$7,487.50" "$7,487.50" "$7,487.50" "$3,743.75" "$3,743.75" "$5,930.10" "$7,487.50" "$5,990.00" "$3,369.38" "$1,486.08" N/A "$4,342.75" "$7,487.50" "$7,487.50" "$7,487.50" "$1,560.40" "$7,487.50" N/A N/A VBH091002 SUP HCPCS C1874 VBH091002 - STENT ENDOPRSTH 9MM 9FR 10CM 120CM DELIVERY SYSTEM TIP TO BOTH IP/OP "$8,237.50" "$6,096.00" "$1,634.94" "$8,237.50" "$3,706.88" "$3,706.88" "$3,706.88" "$3,706.88" "$8,237.50" "$8,237.50" "$8,237.50" "$1,716.90" "$8,237.50" "$8,237.50" "$8,237.50" "$8,237.50" "$8,237.50" "$1,716.79" "$8,237.50" "$8,237.50" "$4,061.09" "$8,237.50" "$8,237.50" "$8,237.50" "$8,237.50" "$6,178.13" "$8,237.50" "$8,237.50" "$8,237.50" "$4,118.75" "$4,118.75" "$6,524.10" "$8,237.50" "$6,590.00" "$3,706.88" "$1,634.94" N/A "$4,777.75" "$8,237.50" "$8,237.50" "$8,237.50" "$1,716.70" "$8,237.50" N/A N/A VBH100502 SUP HCPCS C1874 VBH100502 - STENT EPRSTH 10MM 11FR 5CM 120CM VBHN DLV SYS TIP TO HUB DPL BOTH IP/OP "$6,737.50" "$4,986.00" "$1,337.23" "$6,737.50" "$3,031.88" "$3,031.88" "$3,031.88" "$3,031.88" "$6,737.50" "$6,737.50" "$6,737.50" "$1,404.26" "$6,737.50" "$6,737.50" "$6,737.50" "$6,737.50" "$6,737.50" "$1,404.17" "$6,737.50" "$6,737.50" "$3,321.59" "$6,737.50" "$6,737.50" "$6,737.50" "$6,737.50" "$5,053.13" "$6,737.50" "$6,737.50" "$6,737.50" "$3,368.75" "$3,368.75" "$5,336.10" "$6,737.50" "$5,390.00" "$3,031.88" "$1,337.23" N/A "$3,907.75" "$6,737.50" "$4,042.50" "$6,737.50" "$1,404.10" "$6,737.50" N/A N/A VBH101002 SUP HCPCS C1874 VBH101002 - STENT ENDOPRSTH 10MM 11FR 10CM 120CM DELIVERY SYSTEM TIP TO BOTH IP/OP "$7,737.50" "$5,726.00" "$1,535.70" "$7,737.50" "$3,481.88" "$3,481.88" "$3,481.88" "$3,481.88" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.69" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.58" "$7,737.50" "$7,737.50" "$3,814.59" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$5,803.13" "$7,737.50" "$7,737.50" "$7,737.50" "$3,868.75" "$3,868.75" "$6,128.10" "$7,737.50" "$6,190.00" "$3,481.88" "$1,535.70" N/A "$4,487.75" "$7,737.50" "$4,642.50" "$7,737.50" "$1,612.50" "$7,737.50" N/A N/A VBH101002A SUP HCPCS C1874 VBH101002A - STENT EPRSTH 10MM 11FR 10CM 120CM VBHN DLV SYS TIP TO HUB BOTH IP/OP "$9,807.50" "$7,258.00" "$1,946.54" "$9,807.50" "$4,413.38" "$4,413.38" "$4,413.38" "$4,413.38" "$9,807.50" "$9,807.50" "$9,807.50" "$2,044.13" "$9,807.50" "$9,807.50" "$9,807.50" "$9,807.50" "$9,807.50" "$2,043.99" "$9,807.50" "$9,807.50" "$4,835.10" "$9,807.50" "$9,807.50" "$9,807.50" "$9,807.50" "$7,355.63" "$9,807.50" "$9,807.50" "$9,807.50" "$4,903.75" "$4,903.75" "$7,767.54" "$9,807.50" "$7,846.00" "$4,413.38" "$1,946.54" N/A "$5,688.35" "$9,807.50" "$9,807.50" "$9,807.50" "$2,043.88" "$9,807.50" N/A N/A VBHR061002A SUP HCPCS C1874 VBHR061002A - STENT EPRSTH 6MM 10CM STRL 120CM VBHN FLXB SLF XPD RADOPQ BOTH IP/OP "$9,807.50" "$7,258.00" "$1,946.54" "$10,002.50" "$4,413.38" "$4,413.38" "$4,413.38" "$4,413.38" "$9,807.50" "$9,807.50" "$9,807.50" "$2,044.13" "$9,807.50" "$9,807.50" "$9,807.50" "$9,807.50" "$9,807.50" "$2,043.99" "$9,807.50" "$10,002.50" "$4,835.10" "$9,807.50" "$10,002.50" "$9,807.50" "$9,807.50" "$7,355.63" "$9,807.50" "$9,807.50" "$9,807.50" "$4,903.75" "$4,903.75" "$7,767.54" "$9,807.50" "$7,846.00" "$4,413.38" "$1,946.54" N/A "$5,688.35" "$9,807.50" "$9,807.50" "$9,807.50" "$2,043.88" "$9,807.50" N/A N/A VBHR080502A SUP HCPCS C1874 "VBHR080502A - VIABAHN ENDOPROSTHESIS , 8X5" BOTH IP/OP "$8,940.00" "$6,616.00" "$1,774.37" "$9,120.00" "$4,023.00" "$4,023.00" "$4,023.00" "$4,023.00" "$8,940.00" "$8,940.00" "$8,940.00" "$1,863.32" "$8,940.00" "$8,940.00" "$8,940.00" "$8,940.00" "$8,940.00" "$1,863.19" "$8,940.00" "$9,120.00" "$4,407.42" "$8,940.00" "$9,120.00" "$8,940.00" "$8,940.00" "$6,705.00" "$8,940.00" "$8,940.00" "$8,940.00" "$4,470.00" "$4,470.00" "$7,080.48" "$8,940.00" "$7,152.00" "$4,023.00" "$1,774.37" N/A "$5,185.20" "$8,940.00" "$8,940.00" "$8,940.00" "$1,863.10" "$8,940.00" N/A N/A VBJ050502 SUP HCPCS C1874 VBJ050502 - STENT ENDOPRSTH 5MM 6FR 5CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$7,737.50" "$5,726.00" "$1,535.70" "$7,737.50" "$3,481.88" "$3,481.88" "$3,481.88" "$3,481.88" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.69" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.58" "$7,737.50" "$7,737.50" "$3,814.59" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$5,803.13" "$7,737.50" "$7,737.50" "$7,737.50" "$3,868.75" "$3,868.75" "$6,128.10" "$7,737.50" "$6,190.00" "$3,481.88" "$1,535.70" N/A "$4,487.75" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.50" "$7,737.50" N/A N/A VBJ051002 SUP HCPCS C1874 VBJ051002 - STENT ENDOPRSTH 5MM 6FR 10CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$8,487.50" "$6,281.00" "$1,684.56" "$8,487.50" "$3,819.38" "$3,819.38" "$3,819.38" "$3,819.38" "$8,487.50" "$8,487.50" "$8,487.50" "$1,769.01" "$8,487.50" "$8,487.50" "$8,487.50" "$8,487.50" "$8,487.50" "$1,768.89" "$8,487.50" "$8,487.50" "$4,184.34" "$8,487.50" "$8,487.50" "$8,487.50" "$8,487.50" "$6,365.63" "$8,487.50" "$8,487.50" "$8,487.50" "$4,243.75" "$4,243.75" "$6,722.10" "$8,487.50" "$6,790.00" "$3,819.38" "$1,684.56" N/A "$4,922.75" "$8,487.50" "$8,487.50" "$8,487.50" "$1,768.80" "$8,487.50" N/A N/A VBJ051502 SUP HCPCS C1874 VBJ051502 - STENT ENDOPRSTH 5MM 6FR 15CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$9,737.50" "$7,206.00" "$1,932.65" "$9,737.50" "$4,381.88" "$4,381.88" "$4,381.88" "$4,381.88" "$9,737.50" "$9,737.50" "$9,737.50" "$2,029.54" "$9,737.50" "$9,737.50" "$9,737.50" "$9,737.50" "$9,737.50" "$2,029.40" "$9,737.50" "$9,737.50" "$4,800.59" "$9,737.50" "$9,737.50" "$9,737.50" "$9,737.50" "$7,303.13" "$9,737.50" "$9,737.50" "$9,737.50" "$4,868.75" "$4,868.75" "$7,712.10" "$9,737.50" "$7,790.00" "$4,381.88" "$1,932.65" N/A "$5,647.75" "$9,737.50" "$9,737.50" "$9,737.50" "$2,029.30" "$9,737.50" N/A N/A VBJ052502 SUP HCPCS C1874 VBJ052502 - STENT ENDOPRSTH 5MM 6FR 25CM 120CM BIOACTIVE SURFACE BOTH IP/OP "$15,987.50" "$11,831.00" "$3,173.12" "$15,987.50" "$7,194.38" "$7,194.38" "$7,194.38" "$7,194.38" "$15,987.50" "$15,987.50" "$15,987.50" "$3,332.19" "$15,987.50" "$15,987.50" "$15,987.50" "$15,987.50" "$15,987.50" "$3,331.97" "$15,987.50" "$15,987.50" "$7,881.84" "$15,987.50" "$15,987.50" "$15,987.50" "$15,987.50" "$11,990.63" "$15,987.50" "$15,987.50" "$15,987.50" "$7,993.75" "$7,993.75" "$12,662.10" "$15,987.50" "$12,790.00" "$7,194.38" "$3,173.12" N/A "$9,272.75" "$15,987.50" "$15,987.50" "$15,987.50" "$3,331.80" "$15,987.50" N/A N/A VBJ060502 SUP HCPCS C1874 VBJ060502 - STENT ENDOPRSTH 6MM 6FR 5CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$7,737.50" "$5,726.00" "$1,535.70" "$7,737.50" "$3,481.88" "$3,481.88" "$3,481.88" "$3,481.88" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.69" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.58" "$7,737.50" "$7,737.50" "$3,814.59" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$5,803.13" "$7,737.50" "$7,737.50" "$7,737.50" "$3,868.75" "$3,868.75" "$6,128.10" "$7,737.50" "$6,190.00" "$3,481.88" "$1,535.70" N/A "$4,487.75" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.50" "$7,737.50" N/A N/A VBJ061002 SUP HCPCS C1874 VBJ061002 - STENT EPRSTH 6MM 6FR 10CM 120CM VBHN DLV SYS HEP SPRFC FEM BOTH IP/OP "$8,487.50" "$6,281.00" "$1,684.56" "$8,487.50" "$3,819.38" "$3,819.38" "$3,819.38" "$3,819.38" "$8,487.50" "$8,487.50" "$8,487.50" "$1,769.01" "$8,487.50" "$8,487.50" "$8,487.50" "$8,487.50" "$8,487.50" "$1,768.89" "$8,487.50" "$8,487.50" "$4,184.34" "$8,487.50" "$8,487.50" "$8,487.50" "$8,487.50" "$6,365.63" "$8,487.50" "$8,487.50" "$8,487.50" "$4,243.75" "$4,243.75" "$6,722.10" "$8,487.50" "$6,790.00" "$3,819.38" "$1,684.56" N/A "$4,922.75" "$8,487.50" "$8,487.50" "$8,487.50" "$1,768.80" "$8,487.50" N/A N/A VBJ061502 SUP HCPCS C1874 VBJ061502 - STENT ENDOPRSTH 6MM 6FR 15CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$9,737.50" "$7,206.00" "$1,932.65" "$9,737.50" "$4,381.88" "$4,381.88" "$4,381.88" "$4,381.88" "$9,737.50" "$9,737.50" "$9,737.50" "$2,029.54" "$9,737.50" "$9,737.50" "$9,737.50" "$9,737.50" "$9,737.50" "$2,029.40" "$9,737.50" "$9,737.50" "$4,800.59" "$9,737.50" "$9,737.50" "$9,737.50" "$9,737.50" "$7,303.13" "$9,737.50" "$9,737.50" "$9,737.50" "$4,868.75" "$4,868.75" "$7,712.10" "$9,737.50" "$7,790.00" "$4,381.88" "$1,932.65" N/A "$5,647.75" "$9,737.50" "$9,737.50" "$9,737.50" "$2,029.30" "$9,737.50" N/A N/A VBJ062502 SUP HCPCS C1874 VBJ062502 - STENT ENDOPRSTH 6MM 6FR 25CM 120CM BIOACTIVE SURFACE BOTH IP/OP "$15,987.50" "$11,831.00" "$3,173.12" "$15,987.50" "$7,194.38" "$7,194.38" "$7,194.38" "$7,194.38" "$15,987.50" "$15,987.50" "$15,987.50" "$3,332.19" "$15,987.50" "$15,987.50" "$15,987.50" "$15,987.50" "$15,987.50" "$3,331.97" "$15,987.50" "$15,987.50" "$7,881.84" "$15,987.50" "$15,987.50" "$15,987.50" "$15,987.50" "$11,990.63" "$15,987.50" "$15,987.50" "$15,987.50" "$7,993.75" "$7,993.75" "$12,662.10" "$15,987.50" "$12,790.00" "$7,194.38" "$3,173.12" N/A "$9,272.75" "$15,987.50" "$15,987.50" "$15,987.50" "$3,331.80" "$15,987.50" N/A N/A VBJ070502 SUP HCPCS C1874 VBJ070502 - STENT ENDOPRSTH 7MM 7FR 5CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$7,737.50" "$5,726.00" "$1,535.70" "$7,737.50" "$3,481.88" "$3,481.88" "$3,481.88" "$3,481.88" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.69" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.58" "$7,737.50" "$7,737.50" "$3,814.59" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$5,803.13" "$7,737.50" "$7,737.50" "$7,737.50" "$3,868.75" "$3,868.75" "$6,128.10" "$7,737.50" "$6,190.00" "$3,481.88" "$1,535.70" N/A "$4,487.75" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.50" "$7,737.50" N/A N/A VBJ071002 SUP HCPCS C1874 VBJ071002 - STENT ENDOPRSTH 7MM 7FR 10CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$8,487.50" "$6,281.00" "$1,684.56" "$8,487.50" "$3,819.38" "$3,819.38" "$3,819.38" "$3,819.38" "$8,487.50" "$8,487.50" "$8,487.50" "$1,769.01" "$8,487.50" "$8,487.50" "$8,487.50" "$8,487.50" "$8,487.50" "$1,768.89" "$8,487.50" "$8,487.50" "$4,184.34" "$8,487.50" "$8,487.50" "$8,487.50" "$8,487.50" "$6,365.63" "$8,487.50" "$8,487.50" "$8,487.50" "$4,243.75" "$4,243.75" "$6,722.10" "$8,487.50" "$6,790.00" "$3,819.38" "$1,684.56" N/A "$4,922.75" "$8,487.50" "$8,487.50" "$8,487.50" "$1,768.80" "$8,487.50" N/A N/A VBJ071502 SUP HCPCS C1874 VBJ071502 - STENT ENDOPRSTH 7MM 7FR 15CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$9,737.50" "$7,206.00" "$1,932.65" "$9,737.50" "$4,381.88" "$4,381.88" "$4,381.88" "$4,381.88" "$9,737.50" "$9,737.50" "$9,737.50" "$2,029.54" "$9,737.50" "$9,737.50" "$9,737.50" "$9,737.50" "$9,737.50" "$2,029.40" "$9,737.50" "$9,737.50" "$4,800.59" "$9,737.50" "$9,737.50" "$9,737.50" "$9,737.50" "$7,303.13" "$9,737.50" "$9,737.50" "$9,737.50" "$4,868.75" "$4,868.75" "$7,712.10" "$9,737.50" "$7,790.00" "$4,381.88" "$1,932.65" N/A "$5,647.75" "$9,737.50" "$9,737.50" "$9,737.50" "$2,029.30" "$9,737.50" N/A N/A VBJ072502 SUP HCPCS C1874 VBJ072502 - STENT ENDOPRSTH 7MM 7FR 25CM 120CM BIOACTIVE SURFACE BOTH IP/OP "$15,987.50" "$11,831.00" "$3,173.12" "$15,987.50" "$7,194.38" "$7,194.38" "$7,194.38" "$7,194.38" "$15,987.50" "$15,987.50" "$15,987.50" "$3,332.19" "$15,987.50" "$15,987.50" "$15,987.50" "$15,987.50" "$15,987.50" "$3,331.97" "$15,987.50" "$15,987.50" "$7,881.84" "$15,987.50" "$15,987.50" "$15,987.50" "$15,987.50" "$11,990.63" "$15,987.50" "$15,987.50" "$15,987.50" "$7,993.75" "$7,993.75" "$12,662.10" "$15,987.50" "$12,790.00" "$7,194.38" "$3,173.12" N/A "$9,272.75" "$15,987.50" "$15,987.50" "$15,987.50" "$3,331.80" "$15,987.50" N/A N/A VBJ080202 SUP HCPCS C1874 VBJ080202 - STENT ENDOPRSTH 8MM 7FR 2.5CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$7,355.00" "$5,443.00" "$1,459.78" "$7,355.00" "$3,309.75" "$3,309.75" "$3,309.75" "$3,309.75" "$7,355.00" "$7,355.00" "$7,355.00" "$1,532.97" "$7,355.00" "$7,355.00" "$7,355.00" "$7,355.00" "$7,355.00" "$1,532.86" "$7,355.00" "$7,355.00" "$3,626.02" "$7,355.00" "$7,355.00" "$7,355.00" "$7,355.00" "$5,516.25" "$7,355.00" "$7,355.00" "$7,355.00" "$3,677.50" "$3,677.50" "$5,825.16" "$7,355.00" "$5,884.00" "$3,309.75" "$1,459.78" N/A "$4,265.90" "$7,355.00" "$7,355.00" "$7,355.00" "$1,532.78" "$7,355.00" N/A N/A VBJ080502 SUP HCPCS C1874 VBJ080502 - STENT ENDOPRSTH 8MM 7FR 5CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$7,737.50" "$5,726.00" "$1,535.70" "$7,737.50" "$3,481.88" "$3,481.88" "$3,481.88" "$3,481.88" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.69" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.58" "$7,737.50" "$7,737.50" "$3,814.59" "$7,737.50" "$7,737.50" "$7,737.50" "$7,737.50" "$5,803.13" "$7,737.50" "$7,737.50" "$7,737.50" "$3,868.75" "$3,868.75" "$6,128.10" "$7,737.50" "$6,190.00" "$3,481.88" "$1,535.70" N/A "$4,487.75" "$7,737.50" "$7,737.50" "$7,737.50" "$1,612.50" "$7,737.50" N/A N/A VBJ081002 SUP HCPCS C1874 VBJ081002 - STENT ENDOPRSTH 8MM 7FR 10CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$8,950.00" "$6,623.00" "$1,776.35" "$8,950.00" "$4,027.50" "$4,027.50" "$4,027.50" "$4,027.50" "$8,950.00" "$8,950.00" "$8,950.00" "$1,865.40" "$8,950.00" "$8,950.00" "$8,950.00" "$8,950.00" "$8,950.00" "$1,865.28" "$8,950.00" "$8,950.00" "$4,412.35" "$8,950.00" "$8,950.00" "$8,950.00" "$8,950.00" "$6,712.50" "$8,950.00" "$8,950.00" "$8,950.00" "$4,475.00" "$4,475.00" "$7,088.40" "$8,950.00" "$7,160.00" "$4,027.50" "$1,776.35" N/A "$5,191.00" "$8,950.00" "$8,950.00" "$8,950.00" "$1,865.18" "$8,950.00" N/A N/A VBJ081502 SUP HCPCS C1874 VBJ081502 - STENT ENDOPRSTH 8MM 7FR 15CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$9,660.00" "$7,148.00" "$1,917.27" "$9,660.00" "$4,347.00" "$4,347.00" "$4,347.00" "$4,347.00" "$9,660.00" "$9,660.00" "$9,660.00" "$2,013.39" "$9,660.00" "$9,660.00" "$9,660.00" "$9,660.00" "$9,660.00" "$2,013.25" "$9,660.00" "$9,660.00" "$4,762.38" "$9,660.00" "$9,660.00" "$9,660.00" "$9,660.00" "$7,245.00" "$9,660.00" "$9,660.00" "$9,660.00" "$4,830.00" "$4,830.00" "$7,650.72" "$9,660.00" "$7,728.00" "$4,347.00" "$1,917.27" N/A "$5,602.80" "$9,660.00" "$9,660.00" "$9,660.00" "$2,013.14" "$9,660.00" N/A N/A VBJR050502A SUP HCPCS C1874 VBJR050502A - STENT EPRSTH 5MM 5CM STRL 120CM VBHN FLXB SLF XPD RADOPQ HEP BOTH IP/OP "$9,207.50" "$6,814.00" "$1,827.46" "$9,392.50" "$4,143.38" "$4,143.38" "$4,143.38" "$4,143.38" "$9,207.50" "$9,207.50" "$9,207.50" "$1,919.07" "$9,207.50" "$9,207.50" "$9,207.50" "$9,207.50" "$9,207.50" "$1,918.94" "$9,207.50" "$9,392.50" "$4,539.30" "$9,207.50" "$9,392.50" "$9,207.50" "$9,207.50" "$6,905.63" "$9,207.50" "$9,207.50" "$9,207.50" "$4,603.75" "$4,603.75" "$7,292.34" "$9,207.50" "$7,366.00" "$4,143.38" "$1,827.46" N/A "$5,340.35" "$9,207.50" "$9,207.50" "$9,207.50" "$1,918.84" "$9,207.50" N/A N/A VBJR051002A SUP HCPCS C1874 VBJR051002A - STENT ENDOPRSTH 5MM 10CM 120CM FLEXIBLE SELF EXPAND RADIOPQ BOTH IP/OP "$10,072.50" "$7,454.00" "$1,999.14" "$10,275.00" "$4,532.63" "$4,532.63" "$4,532.63" "$4,532.63" "$10,072.50" "$10,072.50" "$10,072.50" "$2,099.36" "$10,072.50" "$10,072.50" "$10,072.50" "$10,072.50" "$10,072.50" "$2,099.22" "$10,072.50" "$10,275.00" "$4,965.74" "$10,072.50" "$10,275.00" "$10,072.50" "$10,072.50" "$7,554.38" "$10,072.50" "$10,072.50" "$10,072.50" "$5,036.25" "$5,036.25" "$7,977.42" "$10,072.50" "$8,058.00" "$4,532.63" "$1,999.14" N/A "$5,842.05" "$10,072.50" "$10,072.50" "$10,072.50" "$2,099.11" "$10,072.50" N/A N/A VBJR060502A SUP HCPCS C1874 VBJR060502A - STENT EPRSTH 6MM 6FR 5CM 120CM VBHN DLV SYS HEP SPRFC FEM BOTH IP/OP "$9,207.50" "$6,814.00" "$1,827.46" "$9,392.50" "$4,143.38" "$4,143.38" "$4,143.38" "$4,143.38" "$9,207.50" "$9,207.50" "$9,207.50" "$1,919.07" "$9,207.50" "$9,207.50" "$9,207.50" "$9,207.50" "$9,207.50" "$1,918.94" "$9,207.50" "$9,392.50" "$4,539.30" "$9,207.50" "$9,392.50" "$9,207.50" "$9,207.50" "$6,905.63" "$9,207.50" "$9,207.50" "$9,207.50" "$4,603.75" "$4,603.75" "$7,292.34" "$9,207.50" "$7,366.00" "$4,143.38" "$1,827.46" N/A "$5,340.35" "$9,207.50" "$9,207.50" "$9,207.50" "$1,918.84" "$9,207.50" N/A N/A VBJR061002A SUP HCPCS C1874 VBJR061002A - STENT EPRSTH 6MM 6FR 10CM 120CM VBHN DLV SYS HEP SPRFC BOTH IP/OP "$10,072.50" "$7,454.00" "$1,999.14" "$10,275.00" "$4,532.63" "$4,532.63" "$4,532.63" "$4,532.63" "$10,072.50" "$10,072.50" "$10,072.50" "$2,099.36" "$10,072.50" "$10,072.50" "$10,072.50" "$10,072.50" "$10,072.50" "$2,099.22" "$10,072.50" "$10,275.00" "$4,965.74" "$10,072.50" "$10,275.00" "$10,072.50" "$10,072.50" "$7,554.38" "$10,072.50" "$10,072.50" "$10,072.50" "$5,036.25" "$5,036.25" "$7,977.42" "$10,072.50" "$8,058.00" "$4,532.63" "$1,999.14" N/A "$5,842.05" "$10,072.50" "$10,072.50" "$10,072.50" "$2,099.11" "$10,072.50" N/A N/A VBJR061502A SUP HCPCS C1874 "VBJR061502A - VIABAHN ENDOPROSTHESIS, 6MMX 15CM" BOTH IP/OP "$11,225.00" "$8,307.00" "$2,227.88" "$11,450.00" "$5,051.25" "$5,051.25" "$5,051.25" "$5,051.25" "$11,225.00" "$11,225.00" "$11,225.00" "$2,339.57" "$11,225.00" "$11,225.00" "$11,225.00" "$11,225.00" "$11,225.00" "$2,339.41" "$11,225.00" "$11,450.00" "$5,533.93" "$11,225.00" "$11,450.00" "$11,225.00" "$11,225.00" "$8,418.75" "$11,225.00" "$11,225.00" "$11,225.00" "$5,612.50" "$5,612.50" "$8,890.20" "$11,225.00" "$8,980.00" "$5,051.25" "$2,227.88" N/A "$6,510.50" "$11,225.00" "$11,225.00" "$11,225.00" "$2,339.29" "$11,225.00" N/A N/A VBJR062502A SUP HCPCS C1874 VBJR062502A - STENT ENDOPRSTH 6MM 25CM 120CM FLEXIBLE SELF EXPAND RADIOPQ BOTH IP/OP "$18,450.00" "$13,653.00" "$3,661.86" "$18,820.00" "$8,302.50" "$8,302.50" "$8,302.50" "$8,302.50" "$18,450.00" "$18,450.00" "$18,450.00" "$3,845.44" "$18,450.00" "$18,450.00" "$18,450.00" "$18,450.00" "$18,450.00" "$3,845.18" "$18,450.00" "$18,820.00" "$9,095.85" "$18,450.00" "$18,820.00" "$18,450.00" "$18,450.00" "$13,837.50" "$18,450.00" "$18,450.00" "$18,450.00" "$9,225.00" "$9,225.00" "$14,612.40" "$18,450.00" "$14,760.00" "$8,302.50" "$3,661.86" N/A "$10,701.00" "$18,450.00" "$18,450.00" "$18,450.00" "$3,844.98" "$18,450.00" N/A N/A VBJR070202A SUP HCPCS C1874 VBJR070202A - STENT EPRSTH 7MM 2.5CM STRL 120CM VBHN FLXB SLF XPD RADOPQ BOTH IP/OP "$9,207.50" "$6,814.00" "$1,827.46" "$9,392.50" "$4,143.38" "$4,143.38" "$4,143.38" "$4,143.38" "$9,207.50" "$9,207.50" "$9,207.50" "$1,919.07" "$9,207.50" "$9,207.50" "$9,207.50" "$9,207.50" "$9,207.50" "$1,918.94" "$9,207.50" "$9,392.50" "$4,539.30" "$9,207.50" "$9,392.50" "$9,207.50" "$9,207.50" "$6,905.63" "$9,207.50" "$9,207.50" "$9,207.50" "$4,603.75" "$4,603.75" "$7,292.34" "$9,207.50" "$7,366.00" "$4,143.38" "$1,827.46" N/A "$5,340.35" "$9,207.50" "$9,207.50" "$9,207.50" "$1,918.84" "$9,207.50" N/A N/A VBJR070502A SUP HCPCS C1874 "VBJR070502A - LOW-PROFILE, VIABAHN 7MMX 5CM" BOTH IP/OP "$9,207.50" "$6,814.00" "$1,827.46" "$9,392.50" "$4,143.38" "$4,143.38" "$4,143.38" "$4,143.38" "$9,207.50" "$9,207.50" "$9,207.50" "$1,919.07" "$9,207.50" "$9,207.50" "$9,207.50" "$9,207.50" "$9,207.50" "$1,918.94" "$9,207.50" "$9,392.50" "$4,539.30" "$9,207.50" "$9,392.50" "$9,207.50" "$9,207.50" "$6,905.63" "$9,207.50" "$9,207.50" "$9,207.50" "$4,603.75" "$4,603.75" "$7,292.34" "$9,207.50" "$7,366.00" "$4,143.38" "$1,827.46" N/A "$5,340.35" "$9,207.50" "$9,207.50" "$9,207.50" "$1,918.84" "$9,207.50" N/A N/A VBJR071002A SUP HCPCS C1874 VBJR071002A - STENT ENDOPRSTH SPRFC FEM ART ILIUM 10CM 7MM 7FR BOTH IP/OP "$10,072.50" "$7,454.00" "$1,999.14" "$10,275.00" "$4,532.63" "$4,532.63" "$4,532.63" "$4,532.63" "$10,072.50" "$10,072.50" "$10,072.50" "$2,099.36" "$10,072.50" "$10,072.50" "$10,072.50" "$10,072.50" "$10,072.50" "$2,099.22" "$10,072.50" "$10,275.00" "$4,965.74" "$10,072.50" "$10,275.00" "$10,072.50" "$10,072.50" "$7,554.38" "$10,072.50" "$10,072.50" "$10,072.50" "$5,036.25" "$5,036.25" "$7,977.42" "$10,072.50" "$8,058.00" "$4,532.63" "$1,999.14" N/A "$5,842.05" "$10,072.50" "$10,072.50" "$10,072.50" "$2,099.11" "$10,072.50" N/A N/A VBJR071502A SUP HCPCS C1874 VBJR071502A - STENT ENDOPRSTH 7MM 7FR 15CM 120CM DELIVERY SYSTEM VIABAHN BOTH IP/OP "$11,225.00" "$8,307.00" "$2,227.88" "$11,450.00" "$5,051.25" "$5,051.25" "$5,051.25" "$5,051.25" "$11,225.00" "$11,225.00" "$11,225.00" "$2,339.57" "$11,225.00" "$11,225.00" "$11,225.00" "$11,225.00" "$11,225.00" "$2,339.41" "$11,225.00" "$11,450.00" "$5,533.93" "$11,225.00" "$11,450.00" "$11,225.00" "$11,225.00" "$8,418.75" "$11,225.00" "$11,225.00" "$11,225.00" "$5,612.50" "$5,612.50" "$8,890.20" "$11,225.00" "$8,980.00" "$5,051.25" "$2,227.88" N/A "$6,510.50" "$11,225.00" "$11,225.00" "$11,225.00" "$2,339.29" "$11,225.00" N/A N/A VBJR072502A SUP HCPCS C1874 VBJR072502A - STENT ENDOPRSTH 7MM 25CM 120CM FLEXIBLE SELF EXPAND RADIOPQ BOTH IP/OP "$18,450.00" "$13,653.00" "$3,661.86" "$18,820.00" "$8,302.50" "$8,302.50" "$8,302.50" "$8,302.50" "$18,450.00" "$18,450.00" "$18,450.00" "$3,845.44" "$18,450.00" "$18,450.00" "$18,450.00" "$18,450.00" "$18,450.00" "$3,845.18" "$18,450.00" "$18,820.00" "$9,095.85" "$18,450.00" "$18,820.00" "$18,450.00" "$18,450.00" "$13,837.50" "$18,450.00" "$18,450.00" "$18,450.00" "$9,225.00" "$9,225.00" "$14,612.40" "$18,450.00" "$14,760.00" "$8,302.50" "$3,661.86" N/A "$10,701.00" "$18,450.00" "$18,450.00" "$18,450.00" "$3,844.98" "$18,450.00" N/A N/A VBJR080202A SUP HCPCS C1874 VBJR080202A - STENT EPRSTH 8MM 2.5CM STRL 120CM VBHN FLXB SLF XPD RADOPQ BOTH IP/OP "$9,207.50" "$6,814.00" "$1,827.46" "$9,392.50" "$4,143.38" "$4,143.38" "$4,143.38" "$4,143.38" "$9,207.50" "$9,207.50" "$9,207.50" "$1,919.07" "$9,207.50" "$9,207.50" "$9,207.50" "$9,207.50" "$9,207.50" "$1,918.94" "$9,207.50" "$9,392.50" "$4,539.30" "$9,207.50" "$9,392.50" "$9,207.50" "$9,207.50" "$6,905.63" "$9,207.50" "$9,207.50" "$9,207.50" "$4,603.75" "$4,603.75" "$7,292.34" "$9,207.50" "$7,366.00" "$4,143.38" "$1,827.46" N/A "$5,340.35" "$9,207.50" "$9,207.50" "$9,207.50" "$1,918.84" "$9,207.50" N/A N/A VBJR080502A SUP HCPCS C1874 "VBJR080502A - VIABAHN ENDOPROSTHESIS, 8MMX 5CM" BOTH IP/OP "$9,207.50" "$6,814.00" "$1,827.46" "$9,392.50" "$4,143.38" "$4,143.38" "$4,143.38" "$4,143.38" "$9,207.50" "$9,207.50" "$9,207.50" "$1,919.07" "$9,207.50" "$9,207.50" "$9,207.50" "$9,207.50" "$9,207.50" "$1,918.94" "$9,207.50" "$9,392.50" "$4,539.30" "$9,207.50" "$9,392.50" "$9,207.50" "$9,207.50" "$6,905.63" "$9,207.50" "$9,207.50" "$9,207.50" "$4,603.75" "$4,603.75" "$7,292.34" "$9,207.50" "$7,366.00" "$4,143.38" "$1,827.46" N/A "$5,340.35" "$9,207.50" "$9,207.50" "$9,207.50" "$1,918.84" "$9,207.50" N/A N/A VBP32 SUP HCPCS C1713 VBP32 - PIN FIX 32MM BUTTRESS TITANIUM VOLAR BOTH IP/OP $937.50 $694.00 $186.07 $937.50 $421.88 $421.88 $421.88 $421.88 $937.50 $937.50 $937.50 $195.40 $937.50 $937.50 $937.50 $937.50 $937.50 $195.39 $937.50 $375.00 $554.53 $937.50 $937.50 $937.50 $937.50 $703.13 $937.50 $937.50 $937.50 $468.75 $468.75 $742.50 $937.50 $750.00 $421.88 $186.07 N/A $543.75 $937.50 $562.50 $937.50 $195.38 $937.50 N/A N/A VCP740D SUP Custom 27203010 VCP740D - SUTURE ABSORBABLE 0 CT-1 18IN CONTROL RELEASE BRAID 8 STRAND BOTH IP/OP $33.00 $24.00 $5.84 $32.80 $32.80 $32.80 $32.80 $32.80 $32.80 $32.80 $5.84 $32.80 $32.80 $24.34 $24.34 $25.28 $17.09 $6.84 $32.80 $13.12 $32.80 $32.80 $32.80 $32.80 $32.80 $24.75 $32.80 $32.80 $32.80 $16.40 $16.40 $25.98 $32.80 $26.24 $21.32 $32.80 N/A $19.14 $32.80 $19.68 $32.80 $32.80 $32.80 N/A N/A VE220GS SUP HCPCS C1884 VE220GS - PARTICLES EMBL 100-300UM 2ML YLW LC BEAD VL BOTH IP/OP "$4,237.50" "$3,136.00" $841.04 "$4,237.50" "$1,906.88" "$1,906.88" "$1,906.88" "$1,906.88" "$4,237.50" "$4,237.50" "$4,237.50" "$4,237.50" "$4,237.50" "$4,237.50" "$4,237.50" "$4,237.50" "$4,237.50" $883.14 "$4,237.50" "$4,237.50" "$2,089.09" "$4,237.50" "$4,237.50" "$4,237.50" "$4,237.50" "$3,178.13" "$4,237.50" "$4,237.50" "$4,237.50" "$2,118.75" "$2,118.75" "$3,356.10" "$4,237.50" "$3,390.00" "$1,906.88" $841.04 N/A "$2,457.75" "$4,237.50" "$4,237.50" "$4,237.50" $883.10 "$4,237.50" N/A N/A VE420GS SUP HCPCS C1884 VE420GS - PARTICLES EMBL 300-500UM 2ML BLU LC BEAD LBL BOTH IP/OP "$4,037.50" "$2,988.00" $801.34 "$4,037.50" "$1,816.88" "$1,816.88" "$1,816.88" "$1,816.88" "$4,037.50" "$4,037.50" "$4,037.50" $841.52 "$4,037.50" "$4,037.50" "$4,037.50" "$4,037.50" "$4,037.50" $841.46 "$4,037.50" "$4,037.50" "$1,990.49" "$4,037.50" "$4,037.50" "$4,037.50" "$4,037.50" "$3,028.13" "$4,037.50" "$4,037.50" "$4,037.50" "$2,018.75" "$2,018.75" "$3,197.70" "$4,037.50" "$3,230.00" "$1,816.88" $801.34 N/A "$2,341.75" "$4,037.50" "$4,037.50" "$4,037.50" $841.42 "$4,037.50" N/A N/A VEDR01 SUP HCPCS C1785 VEDR01 - PACEMAKER CARDIAC 2.8V 1.3AH 7.5MM 47.9X7.5X44.7MM IMPLTABLE BOTH IP/OP "$6,002.50" "$4,442.00" "$1,191.35" "$6,002.50" "$2,701.13" "$2,701.13" "$2,701.13" "$2,701.13" "$6,002.50" "$6,002.50" "$6,002.50" "$1,251.07" "$6,002.50" "$6,002.50" "$6,002.50" "$6,002.50" "$6,002.50" "$1,250.99" "$6,002.50" "$6,002.50" "$2,959.23" "$6,002.50" "$6,002.50" "$6,002.50" "$6,002.50" "$4,501.88" "$6,002.50" "$6,002.50" "$6,002.50" "$3,001.25" "$3,001.25" "$4,753.98" "$6,002.50" "$4,802.00" "$2,701.13" "$1,191.35" N/A "$3,481.45" "$6,002.50" "$6,002.50" "$6,002.50" "$1,250.92" "$6,002.50" N/A N/A VERSADRK2 SUP HCPCS C1785 VERSADRK2 - PACEMAKER CARDIAC THK7.5MM 47.9X44.7MM IMPLTABLE 2 CHAMBER BOTH IP/OP "$7,987.50" "$5,911.00" "$1,585.32" "$7,987.50" "$3,594.38" "$3,594.38" "$3,594.38" "$3,594.38" "$7,987.50" "$7,987.50" "$7,987.50" "$1,664.79" "$7,987.50" "$7,987.50" "$7,987.50" "$7,987.50" "$7,987.50" "$1,664.68" "$7,987.50" "$7,987.50" "$3,937.84" "$7,987.50" "$7,987.50" "$7,987.50" "$7,987.50" "$5,990.63" "$7,987.50" "$7,987.50" "$7,987.50" "$3,993.75" "$3,993.75" "$6,326.10" "$7,987.50" "$6,390.00" "$3,594.38" "$1,585.32" N/A "$4,632.75" "$7,987.50" "$7,987.50" "$7,987.50" "$1,664.60" "$7,987.50" N/A N/A VG-0108N SUP HCPCS C1768 VG-0108N - PATCH VASC 8X.8CM STRL VSGRD BVN PRICRD PERI BOTH IP/OP $525.50 $389.00 $104.25 $525.28 $236.38 $236.38 $236.38 $236.38 $525.28 $525.28 $525.28 $109.48 $525.28 $525.28 $525.28 $525.28 $525.28 $109.47 $525.28 $525.28 $310.70 $525.28 $525.28 $525.28 $525.28 $394.13 $525.28 $525.28 $525.28 $262.64 $262.64 $416.02 $525.28 $420.22 $236.38 $104.25 N/A $304.79 $525.28 $525.28 $525.28 $109.47 $525.28 N/A N/A VG-0209N SUP HCPCS C1768 VG-0209N - PATCH CARDIO TAPER 9X2CM FLEXIBLE VASCU-GUARD BOVINE BOTH IP/OP $532.50 $394.00 $105.69 $532.50 $239.63 $239.63 $239.63 $239.63 $532.50 $532.50 $532.50 $110.99 $532.50 $532.50 $532.50 $532.50 $532.50 $110.98 $532.50 $532.50 $314.97 $532.50 $532.50 $532.50 $532.50 $399.38 $532.50 $532.50 $532.50 $266.25 $266.25 $421.74 $532.50 $426.00 $239.63 $105.69 N/A $308.85 $532.50 $532.50 $532.50 $110.97 $532.50 N/A N/A VG1CPAR10P SUP HCPCS C1762 VG1CPAR10P - GRAFT BONE 12X14.5X10MM ANTERIOR CERV FUSION PARALLEL SOLID BOTH IP/OP "$2,995.00" "$2,216.00" $594.43 "$2,995.00" "$1,347.75" "$1,347.75" "$1,347.75" "$1,347.75" "$2,995.00" "$2,995.00" "$2,995.00" $624.23 "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" $624.19 "$2,995.00" "$2,495.63" "$1,476.54" "$2,995.00" "$2,495.63" "$2,995.00" "$2,995.00" "$2,246.25" "$2,995.00" "$2,995.00" "$2,995.00" "$1,497.50" "$1,497.50" "$2,372.04" "$2,995.00" "$2,396.00" "$1,347.75" $594.43 N/A "$1,737.10" "$2,995.00" "$2,995.00" "$2,995.00" $624.16 "$2,995.00" N/A N/A VG1CPAR5P SUP HCPCS C1762 VG1CPAR5P - GRAFT BONE VG1 CERV BOTH IP/OP "$2,995.00" "$2,216.00" $594.43 "$2,995.00" "$1,347.75" "$1,347.75" "$1,347.75" "$1,347.75" "$2,995.00" "$2,995.00" "$2,995.00" $624.23 "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" $624.19 "$2,995.00" "$2,495.63" "$1,476.54" "$2,995.00" "$2,495.63" "$2,995.00" "$2,995.00" "$2,246.25" "$2,995.00" "$2,995.00" "$2,995.00" "$1,497.50" "$1,497.50" "$2,372.04" "$2,995.00" "$2,396.00" "$1,347.75" $594.43 N/A "$1,737.10" "$2,995.00" "$2,995.00" "$2,995.00" $624.16 "$2,995.00" N/A N/A VG1CPAR6P SUP HCPCS C1762 VG1CPAR6P - GRAFT BONE 12X14.5X6MM ANTERIOR CERV FUSION PARALLEL SOLID BOTH IP/OP "$2,995.00" "$2,216.00" $594.43 "$2,995.00" "$1,347.75" "$1,347.75" "$1,347.75" "$1,347.75" "$2,995.00" "$2,995.00" "$2,995.00" $624.23 "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" $624.19 "$2,995.00" "$2,495.63" "$1,476.54" "$2,995.00" "$2,495.63" "$2,995.00" "$2,995.00" "$2,246.25" "$2,995.00" "$2,995.00" "$2,995.00" "$1,497.50" "$1,497.50" "$2,372.04" "$2,995.00" "$2,396.00" "$1,347.75" $594.43 N/A "$1,737.10" "$2,995.00" "$2,995.00" "$2,995.00" $624.16 "$2,995.00" N/A N/A VG1CPAR7P SUP HCPCS C1762 VG1CPAR7P - GRAFT BONE 12X14.5X7MM ANTERIOR CERV FUSION PARALLEL SOLID BOTH IP/OP "$2,995.00" "$2,216.00" $594.43 "$2,995.00" "$1,347.75" "$1,347.75" "$1,347.75" "$1,347.75" "$2,995.00" "$2,995.00" "$2,995.00" $624.23 "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" $624.19 "$2,995.00" "$2,495.63" "$1,476.54" "$2,995.00" "$2,495.63" "$2,995.00" "$2,995.00" "$2,246.25" "$2,995.00" "$2,995.00" "$2,995.00" "$1,497.50" "$1,497.50" "$2,372.04" "$2,995.00" "$2,396.00" "$1,347.75" $594.43 N/A "$1,737.10" "$2,995.00" "$2,995.00" "$2,995.00" $624.16 "$2,995.00" N/A N/A VG1CPAR8P SUP HCPCS C1762 VG1CPAR8P - GRAFT BONE 12X14.5X8MM ANTERIOR CERV FUSION PARALLEL BOTH IP/OP "$2,995.00" "$2,216.00" $594.43 "$2,995.00" "$1,347.75" "$1,347.75" "$1,347.75" "$1,347.75" "$2,995.00" "$2,995.00" "$2,995.00" $624.23 "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" $624.19 "$2,995.00" "$2,495.63" "$1,476.54" "$2,995.00" "$2,495.63" "$2,995.00" "$2,995.00" "$2,246.25" "$2,995.00" "$2,995.00" "$2,995.00" "$1,497.50" "$1,497.50" "$2,372.04" "$2,995.00" "$2,396.00" "$1,347.75" $594.43 N/A "$1,737.10" "$2,995.00" "$2,995.00" "$2,995.00" $624.16 "$2,995.00" N/A N/A VG1CPAR9P SUP HCPCS C1762 VG1CPAR9P - GRAFT BONE 12X14.5X9MM ANTERIOR CERV FUSION PARALLEL SOLID BOTH IP/OP "$2,995.00" "$2,216.00" $594.43 "$2,995.00" "$1,347.75" "$1,347.75" "$1,347.75" "$1,347.75" "$2,995.00" "$2,995.00" "$2,995.00" $624.23 "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" $624.19 "$2,995.00" "$2,495.63" "$1,476.54" "$2,995.00" "$2,495.63" "$2,995.00" "$2,995.00" "$2,246.25" "$2,995.00" "$2,995.00" "$2,995.00" "$1,497.50" "$1,497.50" "$2,372.04" "$2,995.00" "$2,396.00" "$1,347.75" $594.43 N/A "$1,737.10" "$2,995.00" "$2,995.00" "$2,995.00" $624.16 "$2,995.00" N/A N/A VG1C-T46P SUP HCPCS C1762 VG1C-T46P - GRAFT BONE 7D 6MM 4MM 1 PIECE LORDOSIS SOLID CENTRL VOID BOTH IP/OP "$3,327.50" "$2,462.00" $660.43 "$3,327.50" "$1,497.38" "$1,497.38" "$1,497.38" "$1,497.38" "$3,327.50" "$3,327.50" "$3,327.50" $693.53 "$3,327.50" "$3,327.50" "$3,327.50" "$3,327.50" "$3,327.50" $693.49 "$3,327.50" "$2,495.63" "$1,640.46" "$3,327.50" "$2,495.63" "$3,327.50" "$3,327.50" "$2,495.63" "$3,327.50" "$3,327.50" "$3,327.50" "$1,663.75" "$1,663.75" "$2,635.38" "$3,327.50" "$2,662.00" "$1,497.38" $660.43 N/A "$1,929.95" "$3,327.50" "$3,327.50" "$3,327.50" $693.45 "$3,327.50" N/A N/A VG1C-T57P SUP HCPCS C1762 VG1C-T57P - GRAFT BONE 7D 7MM 5MM 1 PIECE LORDOSIS SOLID CENTRL VOID BOTH IP/OP "$2,995.00" "$2,216.00" $594.43 "$2,995.00" "$1,347.75" "$1,347.75" "$1,347.75" "$1,347.75" "$2,995.00" "$2,995.00" "$2,995.00" $624.23 "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" $624.19 "$2,995.00" "$2,495.63" "$1,476.54" "$2,995.00" "$2,495.63" "$2,995.00" "$2,995.00" "$2,246.25" "$2,995.00" "$2,995.00" "$2,995.00" "$1,497.50" "$1,497.50" "$2,372.04" "$2,995.00" "$2,396.00" "$1,347.75" $594.43 N/A "$1,737.10" "$2,995.00" "$2,995.00" "$2,995.00" $624.16 "$2,995.00" N/A N/A VG1C-T68P SUP HCPCS C1762 VG1C-T68P - GRAFT BONE 7D 12X14.5X8MM 6MM ANTERIOR CERV FUSION PRESERVON BOTH IP/OP "$3,327.50" "$2,462.00" $660.43 "$3,327.50" "$1,497.38" "$1,497.38" "$1,497.38" "$1,497.38" "$3,327.50" "$3,327.50" "$3,327.50" $693.53 "$3,327.50" "$3,327.50" "$3,327.50" "$3,327.50" "$3,327.50" $693.49 "$3,327.50" "$2,495.63" "$1,640.46" "$3,327.50" "$2,495.63" "$3,327.50" "$3,327.50" "$2,495.63" "$3,327.50" "$3,327.50" "$3,327.50" "$1,663.75" "$1,663.75" "$2,635.38" "$3,327.50" "$2,662.00" "$1,497.38" $660.43 N/A "$1,929.95" "$3,327.50" "$3,327.50" "$3,327.50" $693.45 "$3,327.50" N/A N/A VG1C-T79P SUP HCPCS C1762 VG1C-T79P - GRAFT BONE 7D 12X14.5X9MM 7MM ANTERIOR CERV FUSION PRESERVON BOTH IP/OP "$3,247.50" "$2,403.00" $644.55 "$3,247.50" "$1,461.38" "$1,461.38" "$1,461.38" "$1,461.38" "$3,247.50" "$3,247.50" "$3,247.50" $676.86 "$3,247.50" "$3,247.50" "$3,247.50" "$3,247.50" "$3,247.50" $676.81 "$3,247.50" "$2,495.63" "$1,601.02" "$3,247.50" "$2,495.63" "$3,247.50" "$3,247.50" "$2,435.63" "$3,247.50" "$3,247.50" "$3,247.50" "$1,623.75" "$1,623.75" "$2,572.02" "$3,247.50" "$2,598.00" "$1,461.38" $644.55 N/A "$1,883.55" "$3,247.50" "$3,247.50" "$3,247.50" $676.78 "$3,247.50" N/A N/A VG1C-T810P SUP HCPCS C1762 VG1C-T810P - GRAFT BONE 7D 12X14.5X10MM 8MM ANTERIOR CERV FUSION BOTH IP/OP "$2,995.00" "$2,216.00" $594.43 "$2,995.00" "$1,347.75" "$1,347.75" "$1,347.75" "$1,347.75" "$2,995.00" "$2,995.00" "$2,995.00" $624.23 "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" "$2,995.00" $624.19 "$2,995.00" "$2,495.63" "$1,476.54" "$2,995.00" "$2,495.63" "$2,995.00" "$2,995.00" "$2,246.25" "$2,995.00" "$2,995.00" "$2,995.00" "$1,497.50" "$1,497.50" "$2,372.04" "$2,995.00" "$2,396.00" "$1,347.75" $594.43 N/A "$1,737.10" "$2,995.00" "$2,995.00" "$2,995.00" $624.16 "$2,995.00" N/A N/A VG2C-T57P SUP Custom 27803010 VG2C-T57P - LifeNet Health 5.75 X 7.22mm Cervical Lordotic BOTH IP/OP "$3,247.50" "$2,403.00" $578.06 "$3,247.50" "$3,247.50" "$3,247.50" "$3,247.50" "$3,247.50" "$3,247.50" "$3,247.50" $578.06 "$3,247.50" "$3,247.50" "$3,247.50" "$3,247.50" "$3,247.50" "$3,247.50" $676.81 "$3,247.50" "$1,052.25" "$3,247.50" "$3,247.50" "$2,630.63" "$3,247.50" "$3,247.50" "$2,435.63" "$3,247.50" "$3,247.50" "$3,247.50" "$1,623.75" "$1,623.75" "$2,572.02" "$3,247.50" "$2,598.00" "$1,461.38" "$3,247.50" N/A "$1,883.55" "$3,247.50" "$1,948.50" "$3,247.50" "$3,247.50" "$3,247.50" N/A N/A VH - 2004 SUP Custom 27203010 VH - 2004 - SYSTEM VSL HRVT SHRT BLNT CONE 30ML VSVW TROC ESCP CNN SL BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A VH-4000 SUP Custom 27203010 VH-4000 - KIT VSL HRVT VSVW HEMOPRO 2 ESCP BOTH IP/OP "$3,219.50" "$2,382.00" $573.05 "$3,219.38" "$3,219.38" "$3,219.38" "$3,219.38" "$3,219.38" "$3,219.38" "$3,219.38" $573.05 "$3,219.38" "$3,219.38" "$2,389.42" "$2,389.42" "$2,481.50" "$1,677.30" $670.95 "$3,219.38" "$1,287.75" "$3,219.38" "$3,219.38" "$3,219.38" "$3,219.38" "$3,219.38" "$2,414.63" "$3,219.38" "$3,219.38" "$3,219.38" "$1,609.69" "$1,609.69" "$2,549.75" "$3,219.38" "$2,575.50" "$2,092.60" "$3,219.38" N/A "$1,867.31" "$3,219.38" "$1,931.63" "$3,219.38" "$3,219.38" "$3,219.38" N/A N/A VKML SUP HCPCS C1781 VKML - MESH SURG FLAT 12X12IN KNIT VICRYL POLYGLACTIN 910 WOVEN BOTH IP/OP "$1,899.50" "$1,406.00" $376.95 "$1,899.22" $854.65 $854.65 $854.65 $854.65 "$1,899.22" "$1,899.22" "$1,899.22" $395.84 "$1,899.22" "$1,899.22" "$1,899.22" "$1,899.22" "$1,899.22" $395.82 "$1,899.22" "$1,899.22" "$1,123.39" "$1,899.22" "$1,899.22" "$1,899.22" "$1,899.22" "$1,424.63" "$1,899.22" "$1,899.22" "$1,899.22" $949.61 $949.61 "$1,504.18" "$1,899.22" "$1,519.38" $854.65 $376.95 N/A "$1,101.71" "$1,899.22" "$1,899.22" "$1,899.22" $395.80 "$1,899.22" N/A N/A VKMM SUP HCPCS C1781 VKMM - MESH SRG 6X6IN VCL KNIT WVN BOTH IP/OP $892.00 $660.00 $177.04 $891.99 $401.40 $401.40 $401.40 $401.40 $891.99 $891.99 $891.99 $185.91 $891.99 $891.99 $891.99 $891.99 $891.99 $185.90 $891.99 $891.99 $527.61 $891.99 $891.99 $891.99 $891.99 $669.00 $891.99 $891.99 $891.99 $446.00 $446.00 $706.46 $891.99 $713.59 $401.40 $177.04 N/A $517.36 $891.99 $891.99 $891.99 $185.89 $891.99 N/A N/A VLBPL-11-7 SUP HCPCS C1713 VLBPL-11-7 - PLATE BONE 11 HOLE 7 PEG LOCKING VOLAR BEARING PLATE BOTH IP/OP "$5,187.50" "$3,839.00" "$1,029.59" "$5,187.50" "$2,334.38" "$2,334.38" "$2,334.38" "$2,334.38" "$5,187.50" "$5,187.50" "$5,187.50" "$1,081.20" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$1,081.13" "$5,187.50" "$2,075.00" "$2,557.44" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$3,890.63" "$5,187.50" "$5,187.50" "$5,187.50" "$2,593.75" "$2,593.75" "$4,108.50" "$5,187.50" "$4,150.00" "$2,334.38" "$1,029.59" N/A "$3,008.75" "$5,187.50" "$5,187.50" "$5,187.50" "$1,081.08" "$5,187.50" N/A N/A VLBPL-3-7 SUP HCPCS C1713 VLBPL-3-7 - PLATE BONE 3 HOLE 7 PEG LOCKING VOLAR BEARING PLATE TITANIUM BOTH IP/OP "$2,700.00" "$1,998.00" $535.88 "$2,700.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$2,700.00" "$2,700.00" "$2,700.00" $562.75 "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" $562.71 "$2,700.00" "$2,700.00" "$1,331.10" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,025.00" "$2,700.00" "$2,700.00" "$2,700.00" "$1,350.00" "$1,350.00" "$2,138.40" "$2,700.00" "$2,160.00" "$1,215.00" $535.88 N/A "$1,566.00" "$2,700.00" "$2,700.00" "$2,700.00" $562.68 "$2,700.00" N/A N/A VLBPL-5-5 SUP HCPCS C1713 VLBPL-5-5 - PLATE BONE 5 HOLE 5 PEG LOCKING VOLAR BEARING PLATE TITANIUM BOTH IP/OP "$2,962.50" "$2,192.00" $587.98 "$2,962.50" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$2,962.50" "$2,962.50" "$2,962.50" $617.46 "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" $617.42 "$2,962.50" "$1,185.00" "$1,460.51" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,221.88" "$2,962.50" "$2,962.50" "$2,962.50" "$1,481.25" "$1,481.25" "$2,346.30" "$2,962.50" "$2,370.00" "$1,333.13" $587.98 N/A "$1,718.25" "$2,962.50" "$1,777.50" "$2,962.50" $617.39 "$2,962.50" N/A N/A VLBPL-5-7 SUP HCPCS C1713 VLBPL-5-7 - PLATE BONE 5 HOLE EDGE FREE CNTOUR VOLAR BEARING PLATE LEFT BOTH IP/OP "$2,962.50" "$2,192.00" $587.98 "$2,962.50" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$2,962.50" "$2,962.50" "$2,962.50" $617.46 "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" $617.42 "$2,962.50" "$2,962.50" "$1,460.51" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,221.88" "$2,962.50" "$2,962.50" "$2,962.50" "$1,481.25" "$1,481.25" "$2,346.30" "$2,962.50" "$2,370.00" "$1,333.13" $587.98 N/A "$1,718.25" "$2,962.50" "$2,962.50" "$2,962.50" $617.39 "$2,962.50" N/A N/A VLBPL-7-7 SUP HCPCS C1713 VLBPL-7-7 - PLATE BONE 7 HOLE EDGE FREE CNTOUR VOLAR BEARING PLATE LEFT BOTH IP/OP "$3,237.50" "$2,396.00" $642.56 "$3,237.50" "$1,456.88" "$1,456.88" "$1,456.88" "$1,456.88" "$3,237.50" "$3,237.50" "$3,237.50" $674.78 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $674.73 "$3,237.50" "$1,295.00" "$1,596.09" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$1,456.88" $642.56 N/A "$1,877.75" "$3,237.50" "$3,237.50" "$3,237.50" $674.70 "$3,237.50" N/A N/A VLBPL-9-7 SUP HCPCS C1713 VLBPL-9-7 - PLATE BN VOLR BRNG PLT 9 HL 7 PG LCK TI LT WRST BOTH IP/OP "$4,225.00" "$3,127.00" $838.56 "$4,225.00" "$1,901.25" "$1,901.25" "$1,901.25" "$1,901.25" "$4,225.00" "$4,225.00" "$4,225.00" $880.60 "$4,225.00" "$4,225.00" "$4,225.00" "$4,225.00" "$4,225.00" $880.54 "$4,225.00" "$1,690.00" "$2,082.93" "$4,225.00" "$4,225.00" "$4,225.00" "$4,225.00" "$3,168.75" "$4,225.00" "$4,225.00" "$4,225.00" "$2,112.50" "$2,112.50" "$3,346.20" "$4,225.00" "$3,380.00" "$1,901.25" $838.56 N/A "$2,450.50" "$4,225.00" "$2,535.00" "$4,225.00" "$4,225.00" "$4,225.00" N/A N/A VLBPR-11-7 SUP HCPCS C1713 VLBPR-11-7 - PLATE BONE VOLAR BEARING PLATE TITANIUM RIGHT WRIST 11 HOLE BOTH IP/OP "$5,187.50" "$3,839.00" "$1,029.59" "$5,187.50" "$2,334.38" "$2,334.38" "$2,334.38" "$2,334.38" "$5,187.50" "$5,187.50" "$5,187.50" "$1,081.20" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$1,081.13" "$5,187.50" "$5,187.50" "$2,557.44" "$5,187.50" "$5,187.50" "$5,187.50" "$5,187.50" "$3,890.63" "$5,187.50" "$5,187.50" "$5,187.50" "$2,593.75" "$2,593.75" "$4,108.50" "$5,187.50" "$4,150.00" "$2,334.38" "$1,029.59" N/A "$3,008.75" "$5,187.50" "$3,112.50" "$5,187.50" "$1,081.08" "$5,187.50" N/A N/A VLBPR-3-7 SUP HCPCS C1713 VLBPR-3-7 - PLATE BONE 3 HOLE 7 PEG LOCKING VOLAR BEARING PLATE TITANIUM BOTH IP/OP "$2,700.00" "$1,998.00" $535.88 "$2,700.00" "$1,215.00" "$1,215.00" "$1,215.00" "$1,215.00" "$2,700.00" "$2,700.00" "$2,700.00" $562.75 "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" $562.71 "$2,700.00" "$2,700.00" "$1,331.10" "$2,700.00" "$2,700.00" "$2,700.00" "$2,700.00" "$2,025.00" "$2,700.00" "$2,700.00" "$2,700.00" "$1,350.00" "$1,350.00" "$2,138.40" "$2,700.00" "$2,160.00" "$1,215.00" $535.88 N/A "$1,566.00" "$2,700.00" "$2,700.00" "$2,700.00" $562.68 "$2,700.00" N/A N/A VLBPR-5-5 SUP HCPCS C1713 VLBPR-5-5 - PLATE TI 5 HOLE 5 PG LCK VOLR BRNG PLT BONE RIGHT BOTH IP/OP "$2,962.50" "$2,192.00" $587.98 "$2,962.50" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$2,962.50" "$2,962.50" "$2,962.50" $617.46 "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" $617.42 "$2,962.50" "$1,185.00" "$1,460.51" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,221.88" "$2,962.50" "$2,962.50" "$2,962.50" "$1,481.25" "$1,481.25" "$2,346.30" "$2,962.50" "$2,370.00" "$1,333.13" $587.98 N/A "$1,718.25" "$2,962.50" "$1,777.50" "$2,962.50" $617.39 "$2,962.50" N/A N/A VLBPR-5-7 SUP HCPCS C1713 VLBPR-5-7 - PLATE BONE STANDARD 5 HOLE PEG VOLAR BEARING PLATE RIGHT BOTH IP/OP "$2,962.50" "$2,192.00" $587.98 "$2,962.50" "$1,333.13" "$1,333.13" "$1,333.13" "$1,333.13" "$2,962.50" "$2,962.50" "$2,962.50" $617.46 "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" $617.42 "$2,962.50" "$2,962.50" "$1,460.51" "$2,962.50" "$2,962.50" "$2,962.50" "$2,962.50" "$2,221.88" "$2,962.50" "$2,962.50" "$2,962.50" "$1,481.25" "$1,481.25" "$2,346.30" "$2,962.50" "$2,370.00" "$1,333.13" $587.98 N/A "$1,718.25" "$2,962.50" "$2,962.50" "$2,962.50" $617.39 "$2,962.50" N/A N/A VLBPR-7-7 SUP HCPCS C1713 VLBPR-7-7 - PLATE BONE STANDARD 7 HOLE PEG VOLAR BEARING PLATE RIGHT BOTH IP/OP "$3,237.50" "$2,396.00" $642.56 "$3,237.50" "$1,456.88" "$1,456.88" "$1,456.88" "$1,456.88" "$3,237.50" "$3,237.50" "$3,237.50" $674.78 "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" $674.73 "$3,237.50" "$3,237.50" "$1,596.09" "$3,237.50" "$3,237.50" "$3,237.50" "$3,237.50" "$2,428.13" "$3,237.50" "$3,237.50" "$3,237.50" "$1,618.75" "$1,618.75" "$2,564.10" "$3,237.50" "$2,590.00" "$1,456.88" $642.56 N/A "$1,877.75" "$3,237.50" "$3,237.50" "$3,237.50" $674.70 "$3,237.50" N/A N/A VLBPR-9-7 SUP HCPCS C1713 VLBPR-9-7 - PLATE BONE 9 HOLE 7 PEG LOCKING VOLAR BEARING PLATE TITANIUM BOTH IP/OP "$4,225.00" "$3,127.00" $838.56 "$4,225.00" "$1,901.25" "$1,901.25" "$1,901.25" "$1,901.25" "$4,225.00" "$4,225.00" "$4,225.00" $880.60 "$4,225.00" "$4,225.00" "$4,225.00" "$4,225.00" "$4,225.00" $880.54 "$4,225.00" "$4,225.00" "$2,082.93" "$4,225.00" "$4,225.00" "$4,225.00" "$4,225.00" "$3,168.75" "$4,225.00" "$4,225.00" "$4,225.00" "$2,112.50" "$2,112.50" "$3,346.20" "$4,225.00" "$3,380.00" "$1,901.25" $838.56 N/A "$2,450.50" "$4,225.00" "$4,225.00" "$4,225.00" $880.49 "$4,225.00" N/A N/A VLOCA306L SUP Custom 27203010 VLOCA306L - DEVICE CLOSURE 3-0 4IN ABSORBABLE RELOAD ENDO STITCH V-LOC BOTH IP/OP $543.50 $402.00 $315.23 $407.63 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $407.63 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A $315.23 N/A N/A N/A N/A N/A N/A N/A VLOCL0315 SUP Custom 27203010 VLOCL0315 - DEVICE CLSR 2-0 GS-21 .5 CRC 12IN GRN 37MM V-LOC 180 TPR PNT BOTH IP/OP $66.00 $49.00 $11.70 $65.75 $65.75 $65.75 $65.75 $65.75 $65.75 $65.75 $11.70 $65.75 $65.75 $48.80 $48.80 $50.68 $34.26 $13.70 $65.75 $26.30 $65.75 $65.75 $65.75 $65.75 $65.75 $49.50 $65.75 $65.75 $65.75 $32.88 $32.88 $52.07 $65.75 $52.60 $42.74 $65.75 N/A $38.28 $65.75 $39.45 $65.75 $65.75 $65.75 N/A N/A VLOCL0316 SUP Custom 27203010 VLOCL0316 - DEVICE CLOSURE 0 GS-21 .5 CIR 12IN 37MM TAPER POINT BOTH IP/OP $8.00 $6.00 $1.40 $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $1.40 $7.89 $7.89 $5.86 $5.86 $6.08 $4.11 $1.64 $7.89 $3.16 $7.89 $7.89 $7.89 $7.89 $7.89 $6.00 $7.89 $7.89 $7.89 $3.95 $3.95 $6.25 $7.89 $6.31 $5.13 $7.89 N/A $4.64 $7.89 $4.73 $7.89 $7.89 $7.89 N/A N/A VLOCL0325 SUP Custom 27203010 VLOCL0325 - DEVICE CLOSURE 2-0 GS-21 .5 CIR 18IN 37MM TAPER POINT BOTH IP/OP $73.00 $54.00 $12.91 $72.53 $72.53 $72.53 $72.53 $72.53 $72.53 $72.53 $12.91 $72.53 $72.53 $53.83 $53.83 $55.91 $37.79 $15.12 $72.53 $29.01 $72.53 $72.53 $72.53 $72.53 $72.53 $54.75 $72.53 $72.53 $72.53 $36.27 $36.27 $57.44 $72.53 $58.02 $47.14 $72.53 N/A $42.34 $72.53 $43.52 $72.53 $72.53 $72.53 N/A N/A VLOCL0346 SUP Custom 27203010 VLOCL0346 - DEVICE CLSR 0 GS-21 9IN GRN V-LOC 180 ABS TPR PNT BOTH IP/OP $76.00 $56.00 $13.51 $75.89 $75.89 $75.89 $75.89 $75.89 $75.89 $75.89 $13.51 $75.89 $75.89 $56.33 $56.33 $58.50 $39.54 $15.82 $75.89 $30.36 $75.89 $75.89 $75.89 $75.89 $75.89 $57.00 $75.89 $75.89 $75.89 $37.95 $37.95 $60.10 $75.89 $60.71 $49.33 $75.89 N/A $44.08 $75.89 $45.53 $75.89 $75.89 $75.89 N/A N/A VLOCL0604 SUP Custom 27203010 VLOCL0604 - DEVICE CLSR 3-0 V-20 6IN GRN V-LOC 180 SURGALLOY ABS TPR PNT BOTH IP/OP $63.00 $47.00 $11.15 $62.63 $62.63 $62.63 $62.63 $62.63 $62.63 $62.63 $11.15 $62.63 $62.63 $46.48 $46.48 $48.28 $32.63 $13.05 $62.63 $25.05 $62.63 $62.63 $62.63 $62.63 $62.63 $47.25 $62.63 $62.63 $62.63 $31.32 $31.32 $49.60 $62.63 $50.10 $40.71 $62.63 N/A $36.54 $62.63 $37.58 $62.63 $62.63 $62.63 N/A N/A VLOCL0614 SUP Custom 27203010 VLOCL0614 - DEVICE CLOSURE 3-0 V-20 .5 CIR 12IN 26MM TAPER POINT BOTH IP/OP $789.00 $584.00 $140.44 $789.00 $789.00 $789.00 $789.00 $789.00 $789.00 $789.00 $140.44 $789.00 $789.00 $585.60 $585.60 $608.16 $411.07 $164.44 $789.00 $315.60 $789.00 $789.00 $789.00 $789.00 $789.00 $591.75 $789.00 $789.00 $789.00 $394.50 $394.50 $624.89 $789.00 $631.20 $512.85 $789.00 N/A $457.62 $789.00 $473.40 $789.00 $789.00 $789.00 N/A N/A VLOCL0615 SUP Custom 27203010 VLOCL0615 - DEVICE CLSR 2-0 V-20 12IN GRN V-LOC 180 TPR PNT ABS 2 ANG BOTH IP/OP $66.00 $49.00 $11.70 $65.75 $65.75 $65.75 $65.75 $65.75 $65.75 $65.75 $11.70 $65.75 $65.75 $48.80 $48.80 $50.68 $34.26 $13.70 $65.75 $26.30 $65.75 $65.75 $65.75 $65.75 $65.75 $49.50 $65.75 $65.75 $65.75 $32.88 $32.88 $52.07 $65.75 $52.60 $42.74 $65.75 N/A $38.28 $65.75 $39.45 $65.75 $65.75 $65.75 N/A N/A VLOCL0615 SUP Custom 27203010 VLOCL0615 - DEVICE CLSR 2-0 V-20 12IN GRN V-LOC 180 ABS TPR PNT BOTH IP/OP $66.00 $49.00 $11.70 $65.75 $65.75 $65.75 $65.75 $65.75 $65.75 $65.75 $11.70 $65.75 $65.75 $48.80 $48.80 $50.68 $34.26 $13.70 $65.75 $26.30 $65.75 $65.75 $65.75 $65.75 $65.75 $49.50 $65.75 $65.75 $65.75 $32.88 $32.88 $52.07 $65.75 $52.60 $42.74 $65.75 N/A $38.28 $65.75 $39.45 $65.75 $65.75 $65.75 N/A N/A VLOCM0315 SUP Custom 27203010 VLOCM0315 - DEVICE CLOSURE 2-0 GS-21 .5 CIR 12IN 37MM TAPER POINT BOTH IP/OP $8.00 $6.00 $1.40 $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $7.89 $1.40 $7.89 $7.89 $5.86 $5.86 $6.08 $4.11 $1.64 $7.89 $3.16 $7.89 $7.89 $7.89 $7.89 $7.89 $6.00 $7.89 $7.89 $7.89 $3.95 $3.95 $6.25 $7.89 $6.31 $5.13 $7.89 N/A $4.64 $7.89 $4.73 $7.89 $7.89 $7.89 N/A N/A VLOCM0345 SUP HCPCS C1760 VLOCM0345 - DEVICE CLOSURE 2-0 GS-21 .5 CIR 9IN 37MM TAPER POINT BOTH IP/OP $74.00 $55.00 $14.62 $73.68 $33.16 $33.16 $33.16 $33.16 $73.68 $73.68 $73.68 $15.36 $73.68 $73.68 $73.68 $73.68 $73.68 $15.36 $73.68 $73.68 $43.58 $73.68 $73.68 $73.68 $73.68 $55.50 $73.68 $73.68 $73.68 $36.84 $36.84 $58.35 $73.68 $58.94 $33.16 $14.62 N/A $42.92 $73.68 $73.68 $73.68 $15.35 $73.68 N/A N/A VLOCM0604 SUP Custom 27203010 VLOCM0604 - DEVICE CLSR 3-0 V-20 6IN VIOL V-LOC 90 SURGALLOY ABS TPR PNT BOTH IP/OP $63.00 $47.00 $11.15 $62.63 $62.63 $62.63 $62.63 $62.63 $62.63 $62.63 $11.15 $62.63 $62.63 $46.48 $46.48 $48.28 $32.63 $13.05 $62.63 $25.05 $62.63 $62.63 $62.63 $62.63 $62.63 $47.25 $62.63 $62.63 $62.63 $31.32 $31.32 $49.60 $62.63 $50.10 $40.71 $62.63 N/A $36.54 $62.63 $37.58 $62.63 $62.63 $62.63 N/A N/A VLOCM0804 SUP Custom 27203010 VLOCM0804 - DEVICE CLSR 3-0 CV-23 6IN VIOL V-LOC 90 ABS BOTH IP/OP $753.50 $558.00 $25.12 $753.48 $753.48 $753.48 $753.48 $753.48 $753.48 $753.48 $134.12 $753.48 $753.48 $559.23 $559.23 $580.78 $392.56 $157.03 $753.48 $25.12 $753.48 $753.48 $753.48 $753.48 $753.48 $565.13 $753.48 $753.48 $753.48 $376.74 $376.74 $596.76 $753.48 $602.78 $489.76 $753.48 N/A $437.03 $753.48 $452.09 $753.48 $753.48 $753.48 N/A N/A VLOCM1904 SUP Custom 27203010 VLOCM1904 - DEVICE CLSR 3-0 CV-23 6IN UD 17MM V-LOC 90 SURGALLOY ABS BOTH IP/OP $63.00 $47.00 $11.15 $62.63 $62.63 $62.63 $62.63 $62.63 $62.63 $62.63 $11.15 $62.63 $62.63 $46.48 $46.48 $48.28 $32.63 $13.05 $62.63 $25.05 $62.63 $62.63 $62.63 $62.63 $62.63 $47.25 $62.63 $62.63 $62.63 $31.32 $31.32 $49.60 $62.63 $50.10 $40.71 $62.63 N/A $36.54 $62.63 $37.58 $62.63 $62.63 $62.63 N/A N/A VLOCM1944 SUP Custom 27203010 VLOCM1944 - DEVICE CLSR 3-0 CV-23 .5 CRC 9IN UD 17MM V-LOC 90 SURGALLOY BOTH IP/OP $63.00 $47.00 $11.15 $62.63 $62.63 $62.63 $62.63 $62.63 $62.63 $62.63 $11.15 $62.63 $62.63 $46.48 $46.48 $48.28 $32.63 $13.05 $62.63 $25.05 $62.63 $62.63 $62.63 $62.63 $62.63 $47.25 $62.63 $62.63 $62.63 $31.32 $31.32 $49.60 $62.63 $50.10 $40.71 $62.63 N/A $36.54 $62.63 $37.58 $62.63 $62.63 $62.63 N/A N/A VLS03AF SUP Custom 27011340 VLS03AF - LINER TRACTION SHORT AIRFLO SYNTH HEAD BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 N/A $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A VLS05AF SUP Custom 27011340 VLS05AF - HALTER TRACTION TALL LINER LIGHTWEIGHT VACUUM FORMED BREMER BOTH IP/OP $255.00 $189.00 $45.39 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $255.00 $45.39 $255.00 $255.00 $189.26 $189.26 $196.55 $132.86 $53.14 $255.00 $102.00 $255.00 $255.00 $255.00 $255.00 $255.00 $191.25 $255.00 $255.00 $255.00 $127.50 $127.50 $201.96 $255.00 $204.00 $165.75 $255.00 N/A $147.90 $255.00 $153.00 $255.00 $255.00 $255.00 N/A N/A VN1004040 SUP HCPCS C1874 VN1004040 - STENT ENDOPRSTH 10MM 4CM 40CM EXPANDABLE PULL LINE SOLID BOTH IP/OP "$7,695.00" "$5,694.00" "$1,527.27" "$7,925.00" "$3,462.75" "$3,462.75" "$3,462.75" "$3,462.75" "$7,695.00" "$7,695.00" "$7,695.00" "$1,603.83" "$7,695.00" "$7,695.00" "$7,695.00" "$7,695.00" "$7,695.00" "$1,603.72" "$7,695.00" "$7,925.00" "$3,793.64" "$7,695.00" "$7,925.00" "$7,695.00" "$7,695.00" "$5,771.25" "$7,695.00" "$7,695.00" "$7,695.00" "$3,847.50" "$3,847.50" "$6,094.44" "$7,695.00" "$6,156.00" "$3,462.75" "$1,527.27" N/A "$4,463.10" "$7,695.00" "$7,695.00" "$7,695.00" "$1,603.64" "$7,695.00" N/A N/A VN1006040 SUP HCPCS C1874 VN1006040 - STENT ENDOPRSTH 10MM 6CM 40CM EXPANDABLE PULL LINE SOLID BOTH IP/OP "$7,695.00" "$5,694.00" "$1,527.27" "$7,925.00" "$3,462.75" "$3,462.75" "$3,462.75" "$3,462.75" "$7,695.00" "$7,695.00" "$7,695.00" "$1,603.83" "$7,695.00" "$7,695.00" "$7,695.00" "$7,695.00" "$7,695.00" "$1,603.72" "$7,695.00" "$7,925.00" "$3,793.64" "$7,695.00" "$7,925.00" "$7,695.00" "$7,695.00" "$5,771.25" "$7,695.00" "$7,695.00" "$7,695.00" "$3,847.50" "$3,847.50" "$6,094.44" "$7,695.00" "$6,156.00" "$3,462.75" "$1,527.27" N/A "$4,463.10" "$7,695.00" "$7,695.00" "$7,695.00" "$1,603.64" "$7,695.00" N/A N/A VN1008040 SUP HCPCS C1874 VN1008040 - STENT ENDOPRSTH 10MM 8CM 40CM EXPANDABLE PULL LINE HOLE BOTH IP/OP "$7,695.00" "$5,694.00" "$1,527.27" "$7,925.00" "$3,462.75" "$3,462.75" "$3,462.75" "$3,462.75" "$7,695.00" "$7,695.00" "$7,695.00" "$1,603.83" "$7,695.00" "$7,695.00" "$7,695.00" "$7,695.00" "$7,695.00" "$1,603.72" "$7,695.00" "$7,925.00" "$3,793.64" "$7,695.00" "$7,925.00" "$7,695.00" "$7,695.00" "$5,771.25" "$7,695.00" "$7,695.00" "$7,695.00" "$3,847.50" "$3,847.50" "$6,094.44" "$7,695.00" "$6,156.00" "$3,462.75" "$1,527.27" N/A "$4,463.10" "$7,695.00" "$7,695.00" "$7,695.00" "$1,603.64" "$7,695.00" N/A N/A VN1010040 SUP HCPCS C1874 VN1010040 - STENT ENDOPRSTH 10MM 10CM 40CM EXPANDABLE PULL LINE HOLE BOTH IP/OP "$7,695.00" "$5,694.00" "$1,527.27" "$7,925.00" "$3,462.75" "$3,462.75" "$3,462.75" "$3,462.75" "$7,695.00" "$7,695.00" "$7,695.00" "$1,603.83" "$7,695.00" "$7,695.00" "$7,695.00" "$7,695.00" "$7,695.00" "$1,603.72" "$7,695.00" "$7,925.00" "$3,793.64" "$7,695.00" "$7,925.00" "$7,695.00" "$7,695.00" "$5,771.25" "$7,695.00" "$7,695.00" "$7,695.00" "$3,847.50" "$3,847.50" "$6,094.44" "$7,695.00" "$6,156.00" "$3,462.75" "$1,527.27" N/A "$4,463.10" "$7,695.00" "$7,695.00" "$7,695.00" "$1,603.64" "$7,695.00" N/A N/A VP40101-070 SUP Custom 27011340 VP40101-070 - IMMOBILIZER ORTH UNV 24IN QCK WRP REINF POST STAY ELC HKLP BOTH IP/OP $37.50 $28.00 $6.67 $37.45 $37.45 $37.45 $37.45 $37.45 $37.45 $37.45 $6.67 $37.45 $37.45 $27.80 $27.80 $28.87 $19.51 $7.80 $37.45 $15.43 $37.45 $37.45 $37.45 $37.45 $37.45 $28.13 $37.45 $37.45 $37.45 $18.73 $18.73 $29.66 $37.45 $29.96 $24.34 $37.45 N/A $21.75 $37.45 $22.47 $37.45 $37.45 $37.45 N/A N/A VPPL-5-7 SUP HCPCS C1713 VPPL-5-7 - PLATE BN NS VOLR FA PLT 5 HL 7 PG WRST LT VOLR BOTH IP/OP "$1,950.00" "$1,443.00" $387.03 "$1,950.00" $877.50 $877.50 $877.50 $877.50 "$1,950.00" "$1,950.00" "$1,950.00" $406.43 "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" $406.40 "$1,950.00" $780.00 "$1,153.43" "$1,950.00" "$1,950.00" "$1,950.00" "$1,950.00" "$1,462.50" "$1,950.00" "$1,950.00" "$1,950.00" $975.00 $975.00 "$1,544.40" "$1,950.00" "$1,560.00" $877.50 $387.03 N/A "$1,131.00" "$1,950.00" "$1,950.00" "$1,950.00" $406.38 "$1,950.00" N/A N/A VR702 SUP Custom 27203010 VR702 - REGULATOR PERFUSION PUMP KIT EXTN BOTH IP/OP "$1,500.00" "$1,110.00" $267.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" $267.00 "$1,500.00" "$1,500.00" "$1,113.30" "$1,113.30" "$1,156.20" $781.50 $312.62 "$1,500.00" $600.00 "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,500.00" "$1,125.00" "$1,500.00" "$1,500.00" "$1,500.00" $750.00 $750.00 "$1,188.00" "$1,500.00" "$1,200.00" $975.00 "$1,500.00" N/A $870.00 "$1,500.00" $900.00 "$1,500.00" "$1,500.00" "$1,500.00" N/A N/A VS101000 SUP Custom 27203010 VS101000 - SLEEVE LAPSCOP 12MM 100MM RADIAL EXPAND BLADELESS TROCAR BOTH IP/OP $112.50 $83.00 $19.99 $112.30 $112.30 $112.30 $112.30 $112.30 $112.30 $112.30 $19.99 $112.30 $112.30 $83.35 $83.35 $86.56 $58.51 $23.40 $112.30 $39.20 $112.30 $112.30 $98.00 $112.30 $112.30 $84.38 $112.30 $112.30 $112.30 $56.15 $56.15 $88.94 $112.30 $89.84 $73.00 $112.30 N/A $65.25 $112.30 $67.38 $112.30 $112.30 $112.30 N/A N/A VS101005 SUP Custom 27203010 VS101005 - CANNULA ESCP 5MM BLU STRL LF VRSTP BLDLS TROC DIL RADL XPD BOTH IP/OP $107.00 $79.00 $18.97 $106.55 $106.55 $106.55 $106.55 $106.55 $106.55 $106.55 $18.97 $106.55 $106.55 $79.08 $79.08 $82.13 $55.51 $22.21 $106.55 $42.62 $106.55 $106.55 $106.55 $106.55 $106.55 $80.25 $106.55 $106.55 $106.55 $53.28 $53.28 $84.39 $106.55 $85.24 $69.26 $106.55 N/A $62.06 $106.55 $63.93 $106.55 $106.55 $106.55 N/A N/A VS150000 SUP Custom 27203010 VS150000 - NEEDLE INSFL LNG 14GA 150MM VRSTP BLDLS TROC EXPANDABLE SLV BOTH IP/OP $40.00 $30.00 $7.11 $39.95 $39.95 $39.95 $39.95 $39.95 $39.95 $39.95 $7.11 $39.95 $39.95 $29.65 $29.65 $30.79 $20.81 $8.33 $39.95 $15.98 $39.95 $39.95 $39.95 $39.95 $39.95 $30.00 $39.95 $39.95 $39.95 $19.98 $19.98 $31.64 $39.95 $31.96 $25.97 $39.95 N/A $23.20 $39.95 $23.97 $39.95 $39.95 $39.95 N/A N/A VTP2201 SUP HCPCS C9356 VTP2201 - PROTECTOR TENDON VERAWRAP HYALURONIC ACID ALGINATE 2X2 TENDO BOTH IP/OP "$4,900.00" "$3,626.00" $77.38 "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" $77.38 "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" "$1,021.21" "$4,900.00" "$1,960.00" "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" "$4,900.00" "$3,675.00" "$4,900.00" "$4,900.00" "$4,900.00" "$2,450.00" "$2,450.00" "$3,880.80" "$4,900.00" "$3,920.00" "$2,205.00" "$4,900.00" N/A "$2,842.00" "$4,900.00" "$2,940.00" "$4,900.00" "$4,900.00" "$4,900.00" N/A N/A VU-CTE-520 SUP HCPCS C1789 VU-CTE-520 - EXPANDER TISSUE P4.5-7CM 23.8X7.5CM TEXTURED COUNTER PROFILE BOTH IP/OP "$1,987.50" "$1,471.00" $394.47 "$1,987.50" $894.38 $894.38 $894.38 $894.38 "$1,987.50" "$1,987.50" "$1,987.50" $414.24 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" "$1,987.50" "$1,175.61" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 $394.47 N/A "$1,152.75" "$1,987.50" "$1,987.50" "$1,987.50" $414.20 "$1,987.50" N/A N/A VU-CTE-720 SUP Custom 27803010 VU-CTE-720 - EXPANDER TISS P4.7-7.5CM CURVILINEAR 26.2X9CM 720-1080CC BOTH IP/OP "$1,987.50" "$1,471.00" $353.78 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $353.78 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" $414.22 "$1,987.50" $795.00 "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,987.50" "$1,490.63" "$1,987.50" "$1,987.50" "$1,987.50" $993.75 $993.75 "$1,574.10" "$1,987.50" "$1,590.00" $894.38 "$1,987.50" N/A "$1,152.75" "$1,987.50" "$1,192.50" "$1,987.50" "$1,987.50" "$1,987.50" N/A N/A VXH13300 SUP HCPCS C1874 VXH13300 - STENT CORON 3MM 13MM 137CM .014IN RAPEX RPTRL DLV SYS BX VLC BOTH IP/OP $2.50 $2.00 $0.50 $2.50 $1.13 $1.13 $1.13 $1.13 $2.50 $2.50 $2.50 $0.52 $2.50 $2.50 $2.50 $2.50 $2.50 $0.52 $2.50 $2.50 $1.48 $2.50 $2.50 $2.50 $2.50 $1.88 $2.50 $2.50 $2.50 $1.25 $1.25 $1.98 $2.50 $2.00 $1.13 $0.50 N/A $1.45 $2.50 $2.50 $2.50 $0.52 $2.50 N/A N/A W04200 SUP HCPCS C1887 W04200 - CATHETER VASC 4FR WAVELINQ BOTH IP/OP "$17,500.00" "$12,950.00" "$2,060.15" "$17,500.00" "$9,502.50" "$9,502.50" "$9,502.50" "$9,502.50" "$17,500.00" "$17,500.00" "$17,500.00" "$3,647.44" "$17,500.00" "$4,181.12" "$4,181.12" "$13,489.00" "$2,060.15" "$3,647.19" "$17,500.00" "$17,500.00" "$3,094.73" "$17,500.00" "$17,500.00" "$17,500.00" "$17,500.00" "$13,125.00" "$17,500.00" "$17,500.00" "$17,500.00" "$8,750.00" "$8,750.00" "$13,860.00" "$17,500.00" "$14,000.00" "$11,375.00" "$3,473.31" N/A "$10,150.00" "$17,500.00" "$17,500.00" "$17,500.00" "$3,647.00" "$17,500.00" N/A N/A W4200 SUP HCPCS C1760 W4200 - CLIP LG INTNL HRZN TI ENDSCP LIGAT STRL DISP LATEX FREE ORNG BOTH IP/OP $16.00 $12.00 $3.09 $15.59 $7.02 $7.02 $7.02 $7.02 $15.59 $15.59 $15.59 $3.25 $15.59 $15.59 $15.59 $15.59 $15.59 $3.25 $15.59 $15.59 $9.22 $15.59 $15.59 $15.59 $15.59 $12.00 $15.59 $15.59 $15.59 $7.80 $7.80 $12.35 $15.59 $12.47 $7.02 $3.09 N/A $9.28 $15.59 $15.59 $15.59 $3.25 $15.59 N/A N/A WA22706S SUP Custom 27203010 WA22706S - ELECTRODE ELECTROSURGICAL OLYMPUS PLASMA LOOP 30 D MEDIUM DI BOTH IP/OP "$1,158.00" $857.00 $206.05 "$1,157.59" "$1,157.59" "$1,157.59" "$1,157.59" "$1,157.59" "$1,157.59" "$1,157.59" $206.05 "$1,157.59" "$1,157.59" $859.16 $859.16 $892.27 $603.10 $241.25 "$1,157.59" $463.04 "$1,157.59" "$1,157.59" "$1,157.59" "$1,157.59" "$1,157.59" $868.50 "$1,157.59" "$1,157.59" "$1,157.59" $578.80 $578.80 $916.81 "$1,157.59" $926.07 $752.43 "$1,157.59" N/A $671.64 "$1,157.59" $694.55 "$1,157.59" "$1,157.59" "$1,157.59" N/A N/A WA22760S SUP Custom 27203010 WA22760S - ELECTRODE ELECTROSURGICAL OLYMPUS PLASMA BUTTON MEDIUM DISPO BOTH IP/OP "$1,210.00" $895.00 $215.33 "$1,209.74" "$1,209.74" "$1,209.74" "$1,209.74" "$1,209.74" "$1,209.74" "$1,209.74" $215.33 "$1,209.74" "$1,209.74" $897.87 $897.87 $932.47 $630.27 $252.12 "$1,209.74" $483.90 "$1,209.74" "$1,209.74" "$1,209.74" "$1,209.74" "$1,209.74" $907.50 "$1,209.74" "$1,209.74" "$1,209.74" $604.87 $604.87 $958.11 "$1,209.74" $967.79 $786.33 "$1,209.74" N/A $701.80 "$1,209.74" $725.84 "$1,209.74" "$1,209.74" "$1,209.74" N/A N/A WBTN-2750-T SUP HCPCS C1713 WBTN-2750-T - WASHER ORTH 5MM 27MM NS GEMINUS TI DIST VOLR RDS FOSSA BOTH IP/OP $100.00 $74.00 $19.85 $100.00 $45.00 $45.00 $45.00 $45.00 $100.00 $100.00 $100.00 $20.84 $100.00 $100.00 $100.00 $100.00 $100.00 $20.84 $100.00 $100.00 $59.15 $100.00 $100.00 $100.00 $100.00 $75.00 $100.00 $100.00 $100.00 $50.00 $50.00 $79.20 $100.00 $80.00 $45.00 $19.85 N/A $58.00 $100.00 $100.00 $100.00 $20.84 $100.00 N/A N/A WHV-4 SUP HCPCS C1713 WHV-4 - VOLAR HOOK PLATE BOTH IP/OP "$1,812.50" "$1,341.00" $359.74 "$1,812.50" $815.63 $815.63 $815.63 $815.63 "$1,812.50" "$1,812.50" "$1,812.50" $377.77 "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" $377.74 "$1,812.50" $725.00 "$1,072.09" "$1,812.50" "$1,812.50" "$1,812.50" "$1,812.50" "$1,359.38" "$1,812.50" "$1,812.50" "$1,812.50" $906.25 $906.25 "$1,435.50" "$1,812.50" "$1,450.00" $815.63 $359.74 N/A "$1,051.25" "$1,812.50" "$1,812.50" "$1,812.50" $377.73 "$1,812.50" N/A N/A WHV-6 SUP HCPCS C1713 WHV-6 - VOLAR HOOK PLATE BOTH IP/OP "$2,075.00" "$1,536.00" $411.84 "$2,075.00" $933.75 $933.75 $933.75 $933.75 "$2,075.00" "$2,075.00" "$2,075.00" $432.48 "$2,075.00" "$2,075.00" "$2,075.00" "$2,075.00" "$2,075.00" $432.45 "$2,075.00" $830.00 "$1,227.36" "$2,075.00" "$2,075.00" "$2,075.00" "$2,075.00" "$1,556.25" "$2,075.00" "$2,075.00" "$2,075.00" "$1,037.50" "$1,037.50" "$1,643.40" "$2,075.00" "$1,660.00" $933.75 $411.84 N/A "$1,203.50" "$2,075.00" "$2,075.00" "$2,075.00" $432.43 "$2,075.00" N/A N/A WIRE-0.7/080 SUP HCPCS C1713 WIRE-0.7/080 - WIRE FX .7MM 80MM KRSH SS BOTH IP/OP $50.00 $37.00 $9.92 $50.00 $22.50 $22.50 $22.50 $22.50 $50.00 $50.00 $50.00 $10.42 $50.00 $50.00 $50.00 $50.00 $50.00 $10.42 $50.00 $20.00 $29.58 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $22.50 $9.92 N/A $29.00 $50.00 $50.00 $50.00 $10.42 $50.00 N/A N/A WIRE-0.8/120 SUP HCPCS C1713 WIRE-0.8/120 - WIRE FX .8MM 120MM KRSH SS BOTH IP/OP $50.00 $37.00 $9.92 $50.00 $22.50 $22.50 $22.50 $22.50 $50.00 $50.00 $50.00 $10.42 $50.00 $50.00 $50.00 $50.00 $50.00 $10.42 $50.00 $20.00 $29.58 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $22.50 $9.92 N/A $29.00 $50.00 $50.00 $50.00 $10.42 $50.00 N/A N/A WIRE-0.9 SUP HCPCS C1713 WIRE-0.9 - WIRE FIX .9MM KWIRE STAINLESS STEEL BOTH IP/OP $37.50 $28.00 $7.44 $37.50 $16.88 $16.88 $16.88 $16.88 $37.50 $37.50 $37.50 $7.82 $37.50 $37.50 $37.50 $37.50 $37.50 $7.82 $37.50 $37.50 $22.18 $37.50 $37.50 $37.50 $37.50 $28.13 $37.50 $37.50 $37.50 $18.75 $18.75 $29.70 $37.50 $30.00 $16.88 $7.44 N/A $21.75 $37.50 $37.50 $37.50 $7.82 $37.50 N/A N/A WIRE-0.9/100 SUP HCPCS C1713 WIRE-0.9/100 - WIRE FX .9MM 100MM NS KRSH BOTH IP/OP $50.00 $37.00 $9.92 $50.00 $22.50 $22.50 $22.50 $22.50 $50.00 $50.00 $50.00 $10.42 $50.00 $50.00 $50.00 $50.00 $50.00 $10.42 $50.00 $50.00 $29.58 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $22.50 $9.92 N/A $29.00 $50.00 $30.00 $50.00 $10.42 $50.00 N/A N/A WIRE-1.1 SUP HCPCS C1713 WIRE-1.1 - WIRE FX 1.1MM NS KRSH BOTH IP/OP $40.00 $30.00 $7.94 $40.00 $18.00 $18.00 $18.00 $18.00 $40.00 $40.00 $40.00 $8.34 $40.00 $40.00 $40.00 $40.00 $40.00 $8.34 $40.00 $40.00 $23.66 $40.00 $40.00 $40.00 $40.00 $30.00 $40.00 $40.00 $40.00 $20.00 $20.00 $31.68 $40.00 $32.00 $18.00 $7.94 N/A $23.20 $40.00 $40.00 $40.00 $8.34 $40.00 N/A N/A WIRE-1.6/100 SUP HCPCS C1713 WIRE-1.6/100 - WIRE FX 1.6MM 100MM NS KRSH BOTH IP/OP $50.00 $37.00 $9.92 $50.00 $22.50 $22.50 $22.50 $22.50 $50.00 $50.00 $50.00 $10.42 $50.00 $50.00 $50.00 $50.00 $50.00 $10.42 $50.00 $20.00 $29.58 $50.00 $50.00 $50.00 $50.00 $37.50 $50.00 $50.00 $50.00 $25.00 $25.00 $39.60 $50.00 $40.00 $22.50 $9.92 N/A $29.00 $50.00 $50.00 $50.00 $10.42 $50.00 N/A N/A WN-1104ST SUP HCPCS C1769 WN-1104ST - GUIDEWIRE ORTH .045IN 4IN SS BOTH IP/OP $90.00 $67.00 $17.86 $90.00 $48.87 $48.87 $48.87 $48.87 $90.00 $90.00 $90.00 $18.76 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $90.00 $53.24 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $17.86 N/A $52.20 $90.00 $90.00 $90.00 $18.76 $90.00 N/A N/A WN-2020 SUP HCPCS C1769 WN-2020 - GUIDEWIRE ORTHOPEDIC STANDARD 2MM 20IN TROCAR POLARUS BOTH IP/OP $187.50 $139.00 $37.21 $187.50 $101.81 $101.81 $101.81 $101.81 $187.50 $187.50 $187.50 $39.08 $187.50 $139.16 $139.16 $144.53 $97.69 $39.08 $187.50 $187.50 $110.91 $187.50 $187.50 $187.50 $187.50 $140.63 $187.50 $187.50 $187.50 $93.75 $93.75 $148.50 $187.50 $150.00 $121.88 $37.21 N/A $108.75 $187.50 $187.50 $187.50 $39.08 $187.50 N/A N/A WN-2020ST SUP HCPCS C1769 WN-2020ST - GUIDEWIRE ORTH 2MM 20IN TROC TIP NTNL BOTH IP/OP $230.00 $170.00 $45.65 $230.00 $124.89 $124.89 $124.89 $124.89 $230.00 $230.00 $230.00 $47.94 $230.00 $170.71 $170.71 $177.28 $119.83 $47.93 $230.00 $230.00 $136.05 $230.00 $230.00 $230.00 $230.00 $172.50 $230.00 $230.00 $230.00 $115.00 $115.00 $182.16 $230.00 $184.00 $149.50 $45.65 N/A $133.40 $230.00 $230.00 $230.00 $47.93 $230.00 N/A N/A WS0450090 SUP HCPCS C1876 WS0450090 - STENT INTRCRAN 4.5MM 9MM WINGSPAN BOTH IP/OP "$15,980.00" "$11,825.00" "$3,171.63" "$15,980.00" "$7,191.00" "$7,191.00" "$7,191.00" "$7,191.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.63" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.41" "$15,980.00" "$15,980.00" "$7,878.14" "$15,980.00" "$15,980.00" "$15,980.00" "$15,980.00" "$11,985.00" "$15,980.00" "$15,980.00" "$15,980.00" "$7,990.00" "$7,990.00" "$12,656.16" "$15,980.00" "$12,784.00" "$7,191.00" "$3,171.63" N/A "$9,268.40" "$15,980.00" "$15,980.00" "$15,980.00" "$3,330.23" "$15,980.00" N/A N/A WS-1504STT SUP HCPCS C1769 WS-1504STT - GUIDEWIRE ORTHOPEDIC .054IN 4IN THREAD ACUTRAK 2 STAINLESS BOTH IP/OP $122.50 $91.00 $24.31 $122.50 $66.52 $66.52 $66.52 $66.52 $122.50 $122.50 $122.50 $25.53 $122.50 $90.92 $90.92 $94.42 $63.82 $25.53 $122.50 $122.50 $72.46 $122.50 $122.50 $122.50 $122.50 $91.88 $122.50 $122.50 $122.50 $61.25 $61.25 $97.02 $122.50 $98.00 $79.63 $24.31 N/A $71.05 $122.50 $122.50 $122.50 $25.53 $122.50 N/A N/A WS1505-DT SUP HCPCS C1769 WS1505-DT - WIRE FIX .062IN FUSION KWIRE BOTH IP/OP $17.50 $13.00 $3.47 $17.50 $9.50 $9.50 $9.50 $9.50 $17.50 $17.50 $17.50 $3.65 $17.50 $12.99 $12.99 $13.49 $9.12 $3.65 $17.50 $17.50 $10.35 $17.50 $17.50 $17.50 $17.50 $13.13 $17.50 $17.50 $17.50 $8.75 $8.75 $13.86 $17.50 $14.00 $11.38 $3.47 N/A $10.15 $17.50 $17.50 $17.50 $3.65 $17.50 N/A N/A WS-1606 SUP HCPCS C1771 WS-1606 - GUIDEWIRE ORTHOPEDIC .062IN 6IN STAINLESS STEEL BOTH IP/OP $17.50 $13.00 $3.47 $17.50 $7.88 $7.88 $7.88 $7.88 $17.50 $17.50 $17.50 $3.65 $17.50 $17.50 $17.50 $17.50 $17.50 $3.65 $17.50 $17.50 $10.35 $17.50 $17.50 $17.50 $17.50 $13.13 $17.50 $17.50 $17.50 $8.75 $8.75 $13.86 $17.50 $14.00 $7.88 $3.47 N/A $10.15 $17.50 $17.50 $17.50 $3.65 $17.50 N/A N/A WS-2020 SUP HCPCS C1769 WS-2020 - GUIDEWIRE ORTHOPEDIC .078IN 20IN POLARUS STAINLESS STEEL BOTH IP/OP $147.50 $109.00 $29.28 $147.50 $80.09 $80.09 $80.09 $80.09 $147.50 $147.50 $147.50 $30.74 $147.50 $109.47 $109.47 $113.69 $76.85 $30.74 $147.50 $147.50 $87.25 $147.50 $147.50 $147.50 $147.50 $110.63 $147.50 $147.50 $147.50 $73.75 $73.75 $116.82 $147.50 $118.00 $95.88 $29.28 N/A $85.55 $147.50 $147.50 $147.50 $30.74 $147.50 N/A N/A WS-2409STT SUP HCPCS C1769 WS-2409STT - GUIDEWIRE ORTHOPEDIC .094IN 9IN 1 TROCAR TIP THREADED BOTH IP/OP $90.00 $67.00 $17.86 $90.00 $48.87 $48.87 $48.87 $48.87 $90.00 $90.00 $90.00 $18.76 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $90.00 $53.24 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $17.86 N/A $52.20 $90.00 $90.00 $90.00 $18.76 $90.00 N/A N/A WSM0710 SUP HCPCS Q4166 WSM0710 - MATRIX TISS 10X7CM CYTAL 2 LYR PRCN BLDR WND BOTH IP/OP "$2,562.50" "$1,896.00" $18.42 "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" $18.42 "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" $534.05 "$2,562.50" "$1,025.00" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$2,562.50" "$1,921.88" "$2,562.50" "$2,562.50" "$2,562.50" "$1,281.25" "$1,281.25" "$2,029.50" "$2,562.50" "$2,050.00" "$1,153.13" "$2,562.50" N/A "$1,486.25" "$2,562.50" "$1,537.50" "$2,562.50" "$2,562.50" "$2,562.50" N/A N/A WSM1015 SUP HCPCS Q4166 WSM1015 - DRESSING BIO 15X10CM STRL CYTAL 2 LYR PRCN XCLR MTRX BOTH IP/OP "$4,612.50" "$3,413.00" $18.42 "$4,612.50" "$4,612.50" "$4,612.50" "$4,612.50" "$4,612.50" "$4,612.50" "$4,612.50" $18.42 "$4,612.50" "$4,612.50" "$4,612.50" "$4,612.50" "$4,612.50" "$4,612.50" $961.30 "$4,612.50" "$1,845.00" "$4,612.50" "$4,612.50" "$4,612.50" "$4,612.50" "$4,612.50" "$3,459.38" "$4,612.50" "$4,612.50" "$4,612.50" "$2,306.25" "$2,306.25" "$3,653.10" "$4,612.50" "$3,690.00" "$2,075.63" "$4,612.50" N/A "$2,675.25" "$4,612.50" "$2,767.50" "$4,612.50" "$4,612.50" "$4,612.50" N/A N/A WSR0710 SUP HCPCS Q4166 WSR0710 - MATRIX TISS 10X7CM CYTAL 3 LYR PRCN BLDR BOTH IP/OP "$4,664.00" "$3,451.00" $18.42 "$4,663.75" "$4,663.75" "$4,663.75" "$4,663.75" "$4,663.75" "$4,663.75" "$4,663.75" $18.42 "$4,663.75" "$4,663.75" "$4,663.75" "$4,663.75" "$4,663.75" "$4,663.75" $971.98 "$4,663.75" "$1,865.50" "$4,663.75" "$4,663.75" "$4,663.75" "$4,663.75" "$4,663.75" "$3,498.00" "$4,663.75" "$4,663.75" "$4,663.75" "$2,331.88" "$2,331.88" "$3,693.69" "$4,663.75" "$3,731.00" "$2,098.69" "$4,663.75" N/A "$2,705.12" "$4,663.75" "$2,798.25" "$4,663.75" "$4,663.75" "$4,663.75" N/A N/A WSR1015 SUP HCPCS Q4166 WSR1015 - MATRIX TISS 15X10CM CYTAL 3 LYR PRCN BLDR WND BOTH IP/OP "$7,995.00" "$5,916.00" $18.42 "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" $18.42 "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$1,666.25" "$7,995.00" "$3,198.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$7,995.00" "$5,996.25" "$7,995.00" "$7,995.00" "$7,995.00" "$3,997.50" "$3,997.50" "$6,332.04" "$7,995.00" "$6,396.00" "$3,597.75" "$7,995.00" N/A "$4,637.10" "$7,995.00" "$4,797.00" "$7,995.00" "$7,995.00" "$7,995.00" N/A N/A WSX0710 SUP HCPCS Q4166 WSX0710 - GRAFT SKN 10X7CM CYTAL FENESTRATE MTRX 6 LYR BOTH IP/OP "$6,211.50" "$4,597.00" $18.42 "$6,211.50" "$6,211.50" "$6,211.50" "$6,211.50" "$6,211.50" "$6,211.50" "$6,211.50" $18.42 "$6,211.50" "$6,211.50" "$6,211.50" "$6,211.50" "$6,211.50" "$6,211.50" "$1,294.54" "$6,211.50" "$2,484.60" "$6,211.50" "$6,211.50" "$6,211.50" "$6,211.50" "$6,211.50" "$4,658.63" "$6,211.50" "$6,211.50" "$6,211.50" "$3,105.75" "$3,105.75" "$4,919.51" "$6,211.50" "$4,969.20" "$2,795.18" "$6,211.50" N/A "$3,602.67" "$6,211.50" "$3,726.90" "$6,211.50" "$6,211.50" "$6,211.50" N/A N/A WSX1015 SUP HCPCS Q4166 WSX1015 - GRAFT SKN 15X10CM CYTAL FENESTRATE MTRX 6 LYR BOTH IP/OP "$10,660.00" "$7,888.00" $18.42 "$10,660.00" "$10,660.00" "$10,660.00" "$10,660.00" "$10,660.00" "$10,660.00" "$10,660.00" $18.42 "$10,660.00" "$10,660.00" "$10,660.00" "$10,660.00" "$10,660.00" "$10,660.00" "$2,221.66" "$10,660.00" "$4,264.00" "$10,660.00" "$10,660.00" "$10,660.00" "$10,660.00" "$10,660.00" "$7,995.00" "$10,660.00" "$10,660.00" "$10,660.00" "$5,330.00" "$5,330.00" "$8,442.72" "$10,660.00" "$8,528.00" "$4,797.00" "$10,660.00" N/A "$6,182.80" "$10,660.00" "$6,396.00" "$10,660.00" "$10,660.00" "$10,660.00" N/A N/A WT-0906STT SUP HCPCS C1769 WT-0906STT - GUIDEWIRE ORTHOPEDIC .035IN 5.75IN 1 TROCAR TIP THREADED BOTH IP/OP $90.00 $67.00 $17.86 $90.00 $48.87 $48.87 $48.87 $48.87 $90.00 $90.00 $90.00 $18.76 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $90.00 $53.24 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $17.86 N/A $52.20 $90.00 $90.00 $90.00 $18.76 $90.00 N/A N/A WT-1606STT SUP HCPCS C1769 WT-1606STT - GUIDEWIRE ORTHOPEDIC .062IN 6IN TROCAR THREAD TITANIUM ELBOW BOTH IP/OP $90.00 $67.00 $17.86 $90.00 $48.87 $48.87 $48.87 $48.87 $90.00 $90.00 $90.00 $18.76 $90.00 $66.80 $66.80 $69.37 $46.89 $18.76 $90.00 $90.00 $53.24 $90.00 $90.00 $90.00 $90.00 $67.50 $90.00 $90.00 $90.00 $45.00 $45.00 $71.28 $90.00 $72.00 $58.50 $17.86 N/A $52.20 $90.00 $90.00 $90.00 $18.76 $90.00 N/A N/A X0411407 SUP HCPCS C1713 X0411407 - CONNECTOR ROD 4.75MM 10MM CD HORIZON CROSSLINK GDLH LIBERTY BOTH IP/OP "$4,822.50" "$3,569.00" $957.15 "$4,822.50" "$2,170.13" "$2,170.13" "$2,170.13" "$2,170.13" "$4,822.50" "$4,822.50" "$4,822.50" "$1,005.13" "$4,822.50" "$4,822.50" "$4,822.50" "$4,822.50" "$4,822.50" "$1,005.06" "$4,822.50" "$1,929.00" "$2,377.49" "$4,822.50" "$4,822.50" "$4,822.50" "$4,822.50" "$3,616.88" "$4,822.50" "$4,822.50" "$4,822.50" "$2,411.25" "$2,411.25" "$3,819.42" "$4,822.50" "$3,858.00" "$2,170.13" $957.15 N/A "$2,797.05" "$4,822.50" "$4,822.50" "$4,822.50" "$1,005.01" "$4,822.50" N/A N/A X42200 SUP HCPCS C9359 X42200 - GRAFT BN 10X2.5CM GRFTN DBM PLIF BOTH IP/OP "$4,926.50" "$3,646.00" $977.74 "$4,926.25" "$2,216.81" "$2,216.81" "$2,216.81" "$2,216.81" "$4,926.25" "$4,926.25" "$4,926.25" "$1,026.75" "$4,926.25" "$4,926.25" "$4,926.25" "$4,926.25" "$4,926.25" "$1,026.68" "$4,926.25" "$4,926.25" "$2,428.64" "$4,926.25" "$4,926.25" "$4,926.25" "$4,926.25" "$3,694.88" "$4,926.25" "$4,926.25" "$4,926.25" "$2,463.13" "$2,463.13" "$3,901.59" "$4,926.25" "$3,941.00" "$2,216.81" $977.74 N/A "$2,857.37" "$4,926.25" "$4,926.25" "$4,926.25" "$1,026.63" "$4,926.25" N/A N/A X42210 SUP HCPCS C9359 X42210 - GRAFT BN 5X2.5CM GRFTN PLIF DBM BOTH IP/OP "$3,054.00" "$2,260.00" $606.09 "$3,053.75" "$1,374.19" "$1,374.19" "$1,374.19" "$1,374.19" "$3,053.75" "$3,053.75" "$3,053.75" $636.48 "$3,053.75" "$3,053.75" "$3,053.75" "$3,053.75" "$3,053.75" $636.44 "$3,053.75" "$3,053.75" "$1,505.50" "$3,053.75" "$3,053.75" "$3,053.75" "$3,053.75" "$2,290.50" "$3,053.75" "$3,053.75" "$3,053.75" "$1,526.88" "$1,526.88" "$2,418.57" "$3,053.75" "$2,443.00" "$1,374.19" $606.09 N/A "$1,771.32" "$3,053.75" "$3,053.75" "$3,053.75" $636.40 "$3,053.75" N/A N/A X44135 SUP HCPCS C9359 X44135 - GRAFT BN LG DFCT 15ML GRFTN OTHBLND JR DBM BOTH IP/OP "$3,080.00" "$2,279.00" $611.30 "$3,080.00" "$1,386.00" "$1,386.00" "$1,386.00" "$1,386.00" "$3,080.00" "$3,080.00" "$3,080.00" $641.95 "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" $641.91 "$3,080.00" "$3,080.00" "$1,518.44" "$3,080.00" "$3,080.00" "$3,080.00" "$3,080.00" "$2,310.00" "$3,080.00" "$3,080.00" "$3,080.00" "$1,540.00" "$1,540.00" "$2,439.36" "$3,080.00" "$2,464.00" "$1,386.00" $611.30 N/A "$1,786.40" "$3,080.00" "$3,080.00" "$3,080.00" $641.87 "$3,080.00" N/A N/A X44145 SUP HCPCS C9359 X44145 - GRAFT BN SM DFCT 5ML GRFTN OTHBLND JR DBM BOTH IP/OP "$2,340.00" "$1,732.00" $464.43 "$2,340.00" "$1,053.00" "$1,053.00" "$1,053.00" "$1,053.00" "$2,340.00" "$2,340.00" "$2,340.00" $487.71 "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" $487.68 "$2,340.00" "$2,340.00" "$1,384.11" "$2,340.00" "$2,340.00" "$2,340.00" "$2,340.00" "$1,755.00" "$2,340.00" "$2,340.00" "$2,340.00" "$1,170.00" "$1,170.00" "$1,853.28" "$2,340.00" "$1,872.00" "$1,053.00" $464.43 N/A "$1,357.20" "$2,340.00" "$2,340.00" "$2,340.00" $487.66 "$2,340.00" N/A N/A X523H SUP Custom 27203010 X523H - SUTURE NABSB 2-0 SH 36IN GRN EBND 2 ARM BRD BOTH IP/OP $387.50 $287.00 $68.93 $398.48 $387.23 $387.23 $387.23 $387.23 $387.23 $387.23 $68.93 $387.23 $387.23 $287.40 $287.40 $298.48 $201.75 $80.70 $387.23 $159.39 $387.23 $387.23 $398.48 $387.23 $387.23 $290.63 $387.23 $387.23 $387.23 $193.62 $193.62 $306.69 $387.23 $309.78 $251.70 $387.23 N/A $224.75 $387.23 $232.34 $387.23 $387.23 $387.23 N/A N/A X559H SUP Custom 27203010 X559H - SUTURE NONABSORBABLE 2-0 SH-2 36IN 2 ARM BRAID ETHIBOND BOTH IP/OP $416.50 $308.00 $74.07 $428.18 $416.10 $416.10 $416.10 $416.10 $416.10 $416.10 $74.07 $416.10 $416.10 $308.83 $308.83 $320.73 $216.79 $86.72 $416.10 $171.27 $416.10 $416.10 $428.18 $416.10 $416.10 $312.38 $416.10 $416.10 $416.10 $208.05 $208.05 $329.55 $416.10 $332.88 $270.47 $416.10 N/A $241.57 $416.10 $249.66 $416.10 $416.10 $416.10 N/A N/A X833H SUP Custom 27203010 X833H - SUTURE NABSB 2-0 SH 30IN GRN EBND BRD BOTH IP/OP $5.50 $4.00 $0.95 $5.31 $5.31 $5.31 $5.31 $5.31 $5.31 $5.31 $0.95 $5.31 $5.31 $3.94 $3.94 $4.09 $2.77 $1.11 $5.31 $2.12 $5.31 $5.31 $5.31 $5.31 $5.31 $4.13 $5.31 $5.31 $5.31 $2.66 $2.66 $4.21 $5.31 $4.25 $3.45 $5.31 N/A $3.19 $5.31 $3.19 $5.31 $5.31 $5.31 N/A N/A XA3816KT SUP HCPCS C1751 XA3816KT - KIT CATHETER 8.5FR 16CM 3 LUMEN EXPAND CHLORAPREP SAFETY BOTH IP/OP $825.00 $611.00 $163.74 $825.00 $371.25 $371.25 $371.25 $371.25 $825.00 $825.00 $825.00 $171.95 $825.00 $825.00 $825.00 $825.00 $825.00 $171.94 $825.00 $825.00 $487.99 $825.00 $825.00 $825.00 $825.00 $618.75 $825.00 $825.00 $825.00 $412.50 $412.50 $653.40 $825.00 $660.00 $371.25 $163.74 N/A $478.50 $825.00 $825.00 $825.00 $171.93 $825.00 N/A N/A XA3820KT SUP HCPCS C1751 XA3820KT - CATHETER CV 20CM PEDIASAT 3 LUM OXM CNT SCVO2 MNTR PED BOTH IP/OP "$1,125.00" $833.00 $223.28 "$1,125.00" $506.25 $506.25 $506.25 $506.25 "$1,125.00" "$1,125.00" "$1,125.00" $234.48 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $234.46 "$1,125.00" "$1,125.00" $665.44 "$1,125.00" "$1,125.00" "$1,125.00" "$1,125.00" $843.75 "$1,125.00" "$1,125.00" "$1,125.00" $562.50 $562.50 $891.00 "$1,125.00" $900.00 $506.25 $223.28 N/A $652.50 "$1,125.00" "$1,125.00" "$1,125.00" $234.45 "$1,125.00" N/A N/A XBR001002 SUP HCPCS C1713 XBR001002 - WIRE FX OLV 1.2MM 65MM KRSH SMTH TROC TIP BOTH IP/OP $210.00 $155.00 $41.67 $209.95 $94.48 $94.48 $94.48 $94.48 $209.95 $209.95 $209.95 $43.76 $209.95 $209.95 $209.95 $209.95 $209.95 $43.76 $209.95 $83.98 $124.19 $209.95 $209.95 $209.95 $209.95 $157.50 $209.95 $209.95 $209.95 $104.98 $104.98 $166.28 $209.95 $167.96 $94.48 $41.67 N/A $121.80 $209.95 $209.95 $209.95 $43.75 $209.95 N/A N/A XC200 SUP Custom 27803010 XC200 - CLIP SUT STRL LF LPR TY VCL 1 PC ABS POLY BOTH IP/OP $352.00 $260.00 $62.66 $352.00 $352.00 $352.00 $352.00 $352.00 $352.00 $352.00 $62.66 $352.00 $352.00 $352.00 $352.00 $352.00 $352.00 $73.36 $352.00 $140.80 $352.00 $352.00 $352.00 $352.00 $352.00 $264.00 $352.00 $352.00 $352.00 $176.00 $176.00 $278.78 $352.00 $281.60 $158.40 $352.00 N/A $204.16 $352.00 $211.20 $352.00 $352.00 $352.00 N/A N/A XF0012002 SUP Custom 27203010 XF0012002 - BIT DRL 2MM AO BOTH IP/OP $491.00 $363.00 $87.37 $490.85 $490.85 $490.85 $490.85 $490.85 $490.85 $490.85 $87.37 $490.85 $490.85 $364.31 $364.31 $378.35 $255.73 $102.30 $490.85 $196.34 $490.85 $490.85 $490.85 $490.85 $490.85 $368.25 $490.85 $490.85 $490.85 $245.43 $245.43 $388.75 $490.85 $392.68 $319.05 $490.85 N/A $284.78 $490.85 $294.51 $490.85 $490.85 $490.85 N/A N/A XFO082001 SUP Custom 27203010 XFO082001 - BIT DRL 2MM 3MM SCR BOTH IP/OP $287.50 $213.00 $51.14 $287.30 $287.30 $287.30 $287.30 $287.30 $287.30 $287.30 $51.14 $287.30 $287.30 $213.23 $213.23 $221.45 $149.68 $59.88 $287.30 $114.92 $287.30 $287.30 $287.30 $287.30 $287.30 $215.63 $287.30 $287.30 $287.30 $143.65 $143.65 $227.54 $287.30 $229.84 $186.75 $287.30 N/A $166.75 $287.30 $172.38 $287.30 $287.30 $287.30 N/A N/A XFO082501 SUP Custom 27203010 XFO082501 - BIT DRL 2.5MM 3.5MM SCR BOTH IP/OP $287.50 $213.00 $51.14 $287.30 $287.30 $287.30 $287.30 $287.30 $287.30 $287.30 $51.14 $287.30 $287.30 $213.23 $213.23 $221.45 $149.68 $59.88 $287.30 $114.92 $287.30 $287.30 $287.30 $287.30 $287.30 $215.63 $287.30 $287.30 $287.30 $143.65 $143.65 $227.54 $287.30 $229.84 $186.75 $287.30 N/A $166.75 $287.30 $172.38 $287.30 $287.30 $287.30 N/A N/A XL-105914 SUP HCPCS C1776 XL-105914 - LINER ACETAB 24 36MM HIGH WALL RINGLOC ARCOMXL HIP BOTH IP/OP "$6,575.00" "$4,866.00" "$1,304.97" "$6,575.00" "$2,958.75" "$2,958.75" "$2,958.75" "$2,958.75" "$6,575.00" "$6,575.00" "$6,575.00" "$1,370.39" "$6,575.00" "$6,575.00" "$6,575.00" "$6,575.00" "$6,575.00" "$1,370.30" "$6,575.00" "$2,630.00" "$3,241.48" "$6,575.00" "$6,575.00" "$6,575.00" "$6,575.00" "$4,931.25" "$6,575.00" "$6,575.00" "$6,575.00" "$3,287.50" "$3,287.50" "$5,207.40" "$6,575.00" "$5,260.00" "$2,958.75" "$1,304.97" N/A "$3,813.50" "$6,575.00" "$6,575.00" "$6,575.00" "$1,370.23" "$6,575.00" N/A N/A XM106.0204S SUP HCPCS C1763 XM106.0204S - GRAFT SOFT TISSUE THICK 4X2CM NONCROSS LINKED EXTRACELLULAR BOTH IP/OP $485.00 $359.00 $96.26 $485.00 $218.25 $218.25 $218.25 $218.25 $485.00 $485.00 $485.00 $101.09 $485.00 $485.00 $485.00 $485.00 $485.00 $101.08 $485.00 $485.00 $286.88 $485.00 $485.00 $485.00 $485.00 $363.75 $485.00 $485.00 $485.00 $242.50 $242.50 $384.12 $485.00 $388.00 $218.25 $96.26 N/A $281.30 $485.00 $485.00 $485.00 $101.07 $485.00 N/A N/A XM106.0407S SUP HCPCS C1763 XM106.0407S - GRAFT SOFT TISSUE THICK 7X4CM NONCROSS LINKED EXTRACELLULAR BOTH IP/OP "$1,732.50" "$1,282.00" $343.86 "$1,732.50" $779.63 $779.63 $779.63 $779.63 "$1,732.50" "$1,732.50" "$1,732.50" $361.10 "$1,732.50" "$1,732.50" "$1,732.50" "$1,732.50" "$1,732.50" $361.07 "$1,732.50" "$1,732.50" "$1,024.77" "$1,732.50" "$1,732.50" "$1,732.50" "$1,732.50" "$1,299.38" "$1,732.50" "$1,732.50" "$1,732.50" $866.25 $866.25 "$1,372.14" "$1,732.50" "$1,386.00" $779.63 $343.86 N/A "$1,004.85" "$1,732.50" "$1,732.50" "$1,732.50" $361.05 "$1,732.50" N/A N/A XM106.0416S SUP HCPCS C1763 XM106.0416S - GRAFT SOFT TISSUE THICK 16X4CM NONCROSS LINKED EXTRACELLULAR BOTH IP/OP "$4,790.00" "$3,545.00" $950.70 "$4,790.00" "$2,155.50" "$2,155.50" "$2,155.50" "$2,155.50" "$4,790.00" "$4,790.00" "$4,790.00" $998.36 "$4,790.00" "$4,790.00" "$4,790.00" "$4,790.00" "$4,790.00" $998.29 "$4,790.00" "$4,790.00" "$2,361.47" "$4,790.00" "$4,790.00" "$4,790.00" "$4,790.00" "$3,592.50" "$4,790.00" "$4,790.00" "$4,790.00" "$2,395.00" "$2,395.00" "$3,793.68" "$4,790.00" "$3,832.00" "$2,155.50" $950.70 N/A "$2,778.20" "$4,790.00" "$4,790.00" "$4,790.00" $998.24 "$4,790.00" N/A N/A XM106.0516S SUP HCPCS C1763 XM106.0516S - GRAFT SOFT TISSUE THICK 16X5CM NONCROSS LINKED EXTRACELLULAR BOTH IP/OP "$5,985.00" "$4,429.00" "$1,187.87" "$5,985.00" "$2,693.25" "$2,693.25" "$2,693.25" "$2,693.25" "$5,985.00" "$5,985.00" "$5,985.00" "$1,247.42" "$5,985.00" "$5,985.00" "$5,985.00" "$5,985.00" "$5,985.00" "$1,247.34" "$5,985.00" "$5,985.00" "$2,950.61" "$5,985.00" "$5,985.00" "$5,985.00" "$5,985.00" "$4,488.75" "$5,985.00" "$5,985.00" "$5,985.00" "$2,992.50" "$2,992.50" "$4,740.12" "$5,985.00" "$4,788.00" "$2,693.25" "$1,187.87" N/A "$3,471.30" "$5,985.00" "$5,985.00" "$5,985.00" "$1,247.27" "$5,985.00" N/A N/A XM106.0612S SUP HCPCS C1763 XM106.0612S - GRAFT SOFT TISSUE THICK 12X6CM NONCROSS LINKED EXTRACELLULAR BOTH IP/OP "$4,455.50" "$3,297.00" $884.27 "$4,455.30" "$2,004.89" "$2,004.89" "$2,004.89" "$2,004.89" "$4,455.30" "$4,455.30" "$4,455.30" $928.60 "$4,455.30" "$4,455.30" "$4,455.30" "$4,455.30" "$4,455.30" $928.53 "$4,455.30" "$4,455.30" "$2,196.46" "$4,455.30" "$4,455.30" "$4,455.30" "$4,455.30" "$3,341.63" "$4,455.30" "$4,455.30" "$4,455.30" "$2,227.65" "$2,227.65" "$3,528.60" "$4,455.30" "$3,564.24" "$2,004.89" $884.27 N/A "$2,584.19" "$4,455.30" "$4,455.30" "$4,455.30" $928.48 "$4,455.30" N/A N/A XM106.0616S SUP HCPCS C1763 XM106.0616S - GRAFT SOFT TISSUE THICK 16X6CM NONCROSS LINKED EXTRACELLULAR BOTH IP/OP "$5,940.00" "$4,396.00" "$1,178.89" "$5,939.73" "$2,672.88" "$2,672.88" "$2,672.88" "$2,672.88" "$5,939.73" "$5,939.73" "$5,939.73" "$1,237.99" "$5,939.73" "$5,939.73" "$5,939.73" "$5,939.73" "$5,939.73" "$1,237.91" "$5,939.73" "$5,939.73" "$2,928.29" "$5,939.73" "$5,939.73" "$5,939.73" "$5,939.73" "$4,455.00" "$5,939.73" "$5,939.73" "$5,939.73" "$2,969.87" "$2,969.87" "$4,704.27" "$5,939.73" "$4,751.78" "$2,672.88" "$1,178.89" N/A "$3,445.20" "$5,939.73" "$5,939.73" "$5,939.73" "$1,237.84" "$5,939.73" N/A N/A XM106.0620S SUP HCPCS C1763 XM106.0620S - GRAFT SOFT TISSUE THICK 20X6CM NONCROSS LINKED EXTRACELLULAR BOTH IP/OP "$8,977.50" "$6,643.00" "$1,781.81" "$8,977.50" "$4,039.88" "$4,039.88" "$4,039.88" "$4,039.88" "$8,977.50" "$8,977.50" "$8,977.50" "$1,871.14" "$8,977.50" "$8,977.50" "$8,977.50" "$8,977.50" "$8,977.50" "$1,871.01" "$8,977.50" "$8,977.50" "$4,425.91" "$8,977.50" "$8,977.50" "$8,977.50" "$8,977.50" "$6,733.13" "$8,977.50" "$8,977.50" "$8,977.50" "$4,488.75" "$4,488.75" "$7,110.18" "$8,977.50" "$7,182.00" "$4,039.88" "$1,781.81" N/A "$5,206.95" "$8,977.50" "$8,977.50" "$8,977.50" "$1,870.91" "$8,977.50" N/A N/A XM106.0812S SUP HCPCS C1763 XM106.0812S - GRAFT SOFT TISSUE THICK 12X8CM NONCROSS LINKED EXTRACELLULAR BOTH IP/OP "$5,940.00" "$4,396.00" "$1,178.89" "$5,939.73" "$2,672.88" "$2,672.88" "$2,672.88" "$2,672.88" "$5,939.73" "$5,939.73" "$5,939.73" "$1,237.99" "$5,939.73" "$5,939.73" "$5,939.73" "$5,939.73" "$5,939.73" "$1,237.91" "$5,939.73" "$5,939.73" "$2,928.29" "$5,939.73" "$5,939.73" "$5,939.73" "$5,939.73" "$4,455.00" "$5,939.73" "$5,939.73" "$5,939.73" "$2,969.87" "$2,969.87" "$4,704.27" "$5,939.73" "$4,751.78" "$2,672.88" "$1,178.89" N/A "$3,445.20" "$5,939.73" "$5,939.73" "$5,939.73" "$1,237.84" "$5,939.73" N/A N/A XM106.0816S SUP HCPCS C1763 XM106.0816S - GRAFT SOFT TISSUE THICK 16X8CM NONCROSS LINKED EXTRACELULAR BOTH IP/OP "$7,920.50" "$5,861.00" "$1,571.98" "$7,920.30" "$3,564.14" "$3,564.14" "$3,564.14" "$3,564.14" "$7,920.30" "$7,920.30" "$7,920.30" "$1,650.79" "$7,920.30" "$7,920.30" "$7,920.30" "$7,920.30" "$7,920.30" "$1,650.68" "$7,920.30" "$7,920.30" "$3,904.71" "$7,920.30" "$7,920.30" "$7,920.30" "$7,920.30" "$5,940.38" "$7,920.30" "$7,920.30" "$7,920.30" "$3,960.15" "$3,960.15" "$6,272.88" "$7,920.30" "$6,336.24" "$3,564.14" "$1,571.98" N/A "$4,593.89" "$7,920.30" "$7,920.30" "$7,920.30" "$1,650.59" "$7,920.30" N/A N/A XM106.0820S SUP HCPCS C1763 XM106.0820S - GRAFT SOFT TISSUE THICK 20X8CM NONCROSS LINKED EXTRACELLULAR BOTH IP/OP "$9,899.00" "$7,325.00" "$1,964.68" "$9,898.88" "$4,454.50" "$4,454.50" "$4,454.50" "$4,454.50" "$9,898.88" "$9,898.88" "$9,898.88" "$2,063.17" "$9,898.88" "$9,898.88" "$9,898.88" "$9,898.88" "$9,898.88" "$2,063.04" "$9,898.88" "$9,898.88" "$4,880.15" "$9,898.88" "$9,898.88" "$9,898.88" "$9,898.88" "$7,424.25" "$9,898.88" "$9,898.88" "$9,898.88" "$4,949.44" "$4,949.44" "$7,839.91" "$9,898.88" "$7,919.10" "$4,454.50" "$1,964.68" N/A "$5,741.42" "$9,898.88" "$9,898.88" "$9,898.88" "$2,062.93" "$9,898.88" N/A N/A XM106.1016S SUP HCPCS C1763 XM106.1016S - GRAFT SOFT TISSUE THICK 16X10CM EXTRACELLULAR MATRIX BOTH IP/OP "$9,899.00" "$7,325.00" "$1,964.68" "$9,898.88" "$4,454.50" "$4,454.50" "$4,454.50" "$4,454.50" "$9,898.88" "$9,898.88" "$9,898.88" "$2,063.17" "$9,898.88" "$9,898.88" "$9,898.88" "$9,898.88" "$9,898.88" "$2,063.04" "$9,898.88" "$9,898.88" "$4,880.15" "$9,898.88" "$9,898.88" "$9,898.88" "$9,898.88" "$7,424.25" "$9,898.88" "$9,898.88" "$9,898.88" "$4,949.44" "$4,949.44" "$7,839.91" "$9,898.88" "$7,919.10" "$4,454.50" "$1,964.68" N/A "$5,741.42" "$9,898.88" "$9,898.88" "$9,898.88" "$2,062.93" "$9,898.88" N/A N/A XM106.1020S SUP HCPCS C1762 XM106.1020S - GRAFT SOFT TISSUE 20X16CM COLLAGEN MATRIX CRANIUM NONSTRL BOTH IP/OP "$12,374.00" "$9,157.00" "$2,455.85" "$12,373.60" "$5,568.12" "$5,568.12" "$5,568.12" "$5,568.12" "$12,373.60" "$12,373.60" "$12,373.60" "$2,578.97" "$12,373.60" "$12,373.60" "$12,373.60" "$12,373.60" "$12,373.60" "$2,578.79" "$12,373.60" "$12,373.60" "$6,100.18" "$12,373.60" "$12,373.60" "$12,373.60" "$12,373.60" "$9,280.50" "$12,373.60" "$12,373.60" "$12,373.60" "$6,186.80" "$6,186.80" "$9,799.89" "$12,373.60" "$9,898.88" "$5,568.12" "$2,455.85" N/A "$7,176.92" "$12,373.60" "$12,373.60" "$12,373.60" "$2,578.66" "$12,373.60" N/A N/A XM106.1220S SUP HCPCS C1763 XM106.1220S - GRAFT SOFT TISSUE THICK 20X12CM NONCROSS LINKED BOTH IP/OP "$14,848.50" "$10,988.00" "$2,947.02" "$14,848.33" "$6,681.75" "$6,681.75" "$6,681.75" "$6,681.75" "$14,848.33" "$14,848.33" "$14,848.33" "$3,094.76" "$14,848.33" "$14,848.33" "$14,848.33" "$14,848.33" "$14,848.33" "$3,094.56" "$14,848.33" "$14,848.33" "$7,320.23" "$14,848.33" "$14,848.33" "$14,848.33" "$14,848.33" "$11,136.38" "$14,848.33" "$14,848.33" "$14,848.33" "$7,424.17" "$7,424.17" "$11,759.88" "$14,848.33" "$11,878.66" "$6,681.75" "$2,947.02" N/A "$8,612.13" "$14,848.33" "$14,848.33" "$14,848.33" "$3,094.39" "$14,848.33" N/A N/A XM106.1620S SUP HCPCS C1762 XM106.1620S - GRAFT SOFT TISSUE 20X16CM COLLAGEN MATRIX CRANIUM NONSTRL BOTH IP/OP "$19,796.00" "$14,649.00" "$3,928.97" "$19,795.80" "$8,908.11" "$8,908.11" "$8,908.11" "$8,908.11" "$19,795.80" "$19,795.80" "$19,795.80" "$4,125.94" "$19,795.80" "$19,795.80" "$19,795.80" "$19,795.80" "$19,795.80" "$4,125.66" "$19,795.80" "$19,795.80" "$9,759.33" "$19,795.80" "$19,795.80" "$19,795.80" "$19,795.80" "$14,847.00" "$19,795.80" "$19,795.80" "$19,795.80" "$9,897.90" "$9,897.90" "$15,678.27" "$19,795.80" "$15,836.64" "$8,908.11" "$3,928.97" N/A "$11,481.68" "$19,795.80" "$19,795.80" "$19,795.80" "$4,125.44" "$19,795.80" N/A N/A XM106.1625S SUP HCPCS C1763 XM106.1625S - GRAFT SOFT TISSUE THICK 25X16CM HYDRATED EXTRACELLULAR BOTH IP/OP "$23,202.00" "$17,169.00" "$4,604.96" "$23,201.73" "$10,440.78" "$10,440.78" "$10,440.78" "$10,440.78" "$23,201.73" "$23,201.73" "$23,201.73" "$4,835.82" "$23,201.73" "$23,201.73" "$23,201.73" "$23,201.73" "$23,201.73" "$4,835.50" "$23,201.73" "$23,201.73" "$11,438.45" "$23,201.73" "$23,201.73" "$23,201.73" "$23,201.73" "$17,401.50" "$23,201.73" "$23,201.73" "$23,201.73" "$11,600.87" "$11,600.87" "$18,375.77" "$23,201.73" "$18,561.38" "$10,440.78" "$4,604.96" N/A "$13,457.16" "$23,201.73" "$23,201.73" "$23,201.73" "$4,835.24" "$23,201.73" N/A N/A XM106.2020S SUP HCPCS C1763 XM106.2020S - GRAFT SOFT TISSUE THICK 20X20CM EXTRACELLULAR MATRIX BOTH IP/OP "$24,745.50" "$18,312.00" "$4,911.31" "$24,745.23" "$11,135.35" "$11,135.35" "$11,135.35" "$11,135.35" "$24,745.23" "$24,745.23" "$24,745.23" "$5,157.52" "$24,745.23" "$24,745.23" "$24,745.23" "$24,745.23" "$24,745.23" "$5,157.18" "$24,745.23" "$24,745.23" "$12,199.40" "$24,745.23" "$24,745.23" "$24,745.23" "$24,745.23" "$18,559.13" "$24,745.23" "$24,745.23" "$24,745.23" "$12,372.62" "$12,372.62" "$19,598.22" "$24,745.23" "$19,796.18" "$11,135.35" "$4,911.31" N/A "$14,352.39" "$24,745.23" "$24,745.23" "$24,745.23" "$5,156.91" "$24,745.23" N/A N/A XM106.2025S SUP HCPCS C1763 XM106.2025S - GRAFT SOFT TISSUE THICK 25X20CM MATRIX XCM BIOLOGIC PIG BOTH IP/OP "$30,933.00" "$22,890.00" "$6,139.43" "$30,933.00" "$13,919.85" "$13,919.85" "$13,919.85" "$13,919.85" "$30,933.00" "$30,933.00" "$30,933.00" "$6,447.21" "$30,933.00" "$30,933.00" "$30,933.00" "$30,933.00" "$30,933.00" "$6,446.78" "$30,933.00" "$30,933.00" "$15,249.97" "$30,933.00" "$30,933.00" "$30,933.00" "$30,933.00" "$23,199.75" "$30,933.00" "$30,933.00" "$30,933.00" "$15,466.50" "$15,466.50" "$24,498.94" "$30,933.00" "$24,746.40" "$13,919.85" "$6,139.43" N/A "$17,941.14" "$30,933.00" "$30,933.00" "$30,933.00" "$6,446.44" "$30,933.00" N/A N/A XM106.2030S SUP HCPCS C1763 XM106.2030S - GRAFT SOFT TISSUE THICK 30X20CM HYDRATED EXTRACELLULAR BOTH IP/OP "$37,117.00" "$27,467.00" "$7,366.77" "$37,116.85" "$16,702.58" "$16,702.58" "$16,702.58" "$16,702.58" "$37,116.85" "$37,116.85" "$37,116.85" "$7,736.08" "$37,116.85" "$37,116.85" "$37,116.85" "$37,116.85" "$37,116.85" "$7,735.56" "$37,116.85" "$37,116.85" "$18,298.61" "$37,116.85" "$37,116.85" "$37,116.85" "$37,116.85" "$27,837.75" "$37,116.85" "$37,116.85" "$37,116.85" "$18,558.43" "$18,558.43" "$29,396.55" "$37,116.85" "$29,693.48" "$16,702.58" "$7,366.77" N/A "$21,527.86" "$37,116.85" "$37,116.85" "$37,116.85" "$7,735.15" "$37,116.85" N/A N/A XP-5000Z SUP Custom 27203010 XP-5000Z - STABILIZER SRG YLW ACRB-I VAC PSTNR BOTH IP/OP "$2,126.00" "$1,573.00" $378.42 "$2,125.95" "$2,125.95" "$2,125.95" "$2,125.95" "$2,125.95" "$2,125.95" "$2,125.95" $378.42 "$2,125.95" "$2,125.95" "$1,577.88" "$1,577.88" "$1,638.68" "$1,107.62" $443.07 "$2,125.95" $850.38 "$2,125.95" "$2,125.95" "$2,125.95" "$2,125.95" "$2,125.95" "$1,594.50" "$2,125.95" "$2,125.95" "$2,125.95" "$1,062.98" "$1,062.98" "$1,683.75" "$2,125.95" "$1,700.76" "$1,381.87" "$2,125.95" N/A "$1,233.08" "$2,125.95" "$1,275.57" "$2,125.95" "$2,125.95" "$2,125.95" N/A N/A XT-7542 SUP HCPCS C1725 XT-7542 - CATHETER BLNDIL .035IN 5FR 4MM 75CM 2CM OPTPLST XT 2 LUM BOTH IP/OP $497.50 $368.00 $98.74 $497.50 $270.14 $270.14 $270.14 $270.14 $497.50 $497.50 $497.50 $103.69 $497.50 $369.24 $369.24 $383.47 $259.20 $103.68 $497.50 $497.50 $294.27 $497.50 $497.50 $497.50 $497.50 $373.13 $497.50 $497.50 $497.50 $248.75 $248.75 $394.02 $497.50 $398.00 $323.38 $98.74 N/A $288.55 $497.50 $497.50 $497.50 $103.68 $497.50 N/A N/A Z117H SUP Custom 27203010 Z117H - SUTURE ABSORBABLE 6-0 BV-1 30IN 2 ARM MONOFILAMENT PDS II BOTH IP/OP $40.00 $30.00 $7.06 $39.65 $39.65 $39.65 $39.65 $39.65 $39.65 $39.65 $7.06 $39.65 $39.65 $29.43 $29.43 $30.56 $20.66 $8.26 $39.65 $15.86 $39.65 $39.65 $39.65 $39.65 $39.65 $30.00 $39.65 $39.65 $39.65 $19.83 $19.83 $31.40 $39.65 $31.72 $25.77 $39.65 N/A $23.20 $39.65 $23.79 $39.65 $39.65 $39.65 N/A N/A Z126H SUP Custom 27203010 Z126H - SUTURE ABSORBABLE 5-0 C-1 30IN 2 ARM MONOFILAMENT PDS II BOTH IP/OP $46.50 $34.00 $8.24 $47.67 $46.32 $46.32 $46.32 $46.32 $46.32 $46.32 $8.24 $46.32 $46.32 $34.38 $34.38 $35.70 $24.13 $9.65 $46.32 $19.07 $46.32 $46.32 $47.67 $46.32 $46.32 $34.88 $46.32 $46.32 $46.32 $23.16 $23.16 $36.69 $46.32 $37.06 $30.11 $46.32 N/A $26.97 $46.32 $27.79 $46.32 $46.32 $46.32 N/A N/A Z135H SUP Custom 27203010 Z135H - SUTURE ABSORBABLE 7-0 BV-1 30IN 2 ARM MONOFILAMENT PDS II BOTH IP/OP $40.50 $30.00 $7.13 $40.04 $40.04 $40.04 $40.04 $40.04 $40.04 $40.04 $7.13 $40.04 $40.04 $29.72 $29.72 $30.86 $20.86 $8.34 $40.04 $16.02 $40.04 $40.04 $40.04 $40.04 $40.04 $30.38 $40.04 $40.04 $40.04 $20.02 $20.02 $31.71 $40.04 $32.03 $26.03 $40.04 N/A $23.49 $40.04 $24.02 $40.04 $40.04 $40.04 N/A N/A Z137H SUP Custom 27203010 Z137H - SUTURE ABSORBABLE 4-0 V-5 36IN 2 ARM MONOFILAMENT PDS II BOTH IP/OP $25.50 $19.00 $4.48 $34.00 $25.17 $25.17 $25.17 $25.17 $25.17 $25.17 $4.48 $25.17 $25.17 $18.68 $18.68 $19.40 $13.11 $5.25 $25.17 $34.00 $25.17 $25.17 $25.17 $25.17 $25.17 $19.13 $25.17 $25.17 $25.17 $12.59 $12.59 $19.93 $25.17 $20.14 $16.36 $25.17 N/A $14.79 $25.17 $15.10 $25.17 $25.17 $25.17 N/A N/A Z60353 SUP HCPCS L8614 Z60353 - IMPLANT COCHLEAR FREEDOM CNTOUR ADVANCE NUCLEUS CI24RE BOTH IP/OP "$39,847.50" "$29,487.00" "$8,304.66" "$39,847.50" "$39,847.50" "$39,847.50" "$39,847.50" "$39,847.50" "$39,847.50" "$39,847.50" "$12,551.80" "$39,847.50" "$39,847.50" "$39,847.50" "$39,847.50" "$39,847.50" "$39,847.50" "$8,304.66" "$39,847.50" "$15,939.00" "$39,847.50" "$39,847.50" "$39,847.50" "$39,847.50" "$39,847.50" "$29,885.63" "$39,847.50" "$39,847.50" "$39,847.50" "$19,923.75" "$19,923.75" "$31,559.22" "$39,847.50" "$31,878.00" "$17,931.38" "$39,847.50" N/A "$23,111.55" "$39,847.50" "$23,908.50" "$39,847.50" "$39,847.50" "$39,847.50" N/A N/A ZBM12060 SUP HCPCS C2625 ZBM12060 - STENT BILIARY .035IN 12MM 6FR 60MM 80CM CATHETER GWIRE BOTH IP/OP "$3,883.50" "$2,874.00" $770.72 "$3,883.20" "$1,747.44" "$1,747.44" "$1,747.44" "$1,747.44" "$3,883.20" "$3,883.20" "$3,883.20" $809.36 "$3,883.20" "$3,883.20" "$3,883.20" "$3,883.20" "$3,883.20" $809.30 "$3,883.20" "$3,883.20" "$1,914.42" "$3,883.20" "$3,883.20" "$3,883.20" "$3,883.20" "$2,912.63" "$3,883.20" "$3,883.20" "$3,883.20" "$1,941.60" "$1,941.60" "$3,075.49" "$3,883.20" "$3,106.56" "$1,747.44" $770.72 N/A "$2,252.43" "$3,883.20" "$3,883.20" "$3,883.20" $809.26 "$3,883.20" N/A N/A